COLLEGE OF OSTEOPATHIC PHYSICIANS
AND SURGEONS LOS ANGELES, CALIFORNIA
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FOR REFERENCE
NOT TO BE TAKEN FROM THIS ROOM
DIETOTHERAPY
DIETOTHERAPY
J
BY
WILLIAM EDWARD FITCH, M.D.
MAJOR MED. RES. CORPS, U. S. A.
FORMERLY LECTURER ON SURGERY. FORDHAM UNIVERSITY SCHOOL OF MEDI-
CINE; ASSISTANT ATTENDING GYNECOLOGIST PRESBYTERIAN DISPEN-
SARY; ATTENDING PHYSICIAN TO THE VANDERBILT CLINIC,
COLLEGE PHYS. <k SURGS., NEW YORK CITY
AND
FORTY CONTRIBUTORS
VOLUME II
PUBLISHED WITH THE PERMISSION OF THE
SURGEON GENERAL OF THE ARMY
D. APPLETON AND COMPANY
NEW YORK LONDON
1918
JJO'O
COPYKIGHT, 1918, BY
D. APPLETON AND COMPANY
Printed in the United States of America
CONTRIBUTORS TO VOLUME II
A. L. BENEDICT, A.M., M.D., F.A.C.P.
Capt. Med. Res. Corps, U. S. A.; Consulting Gastro-Enterologist, Buffalo
Hospital, Buffalo, N. Y.
WILLIAM E. FITCH, M.D.
Major Med. Res. Corps, U.S.A.; Editor Pediatrics, New York City
H. S. GRINDLEY, B.S., Sc.D.
Professor of Animal Nutrition, College of Agriculture, University of
Illinois, Urbana, 111.
WINFIELD S. HALL, B.S., M.S., M.D., Ph.D.
Professor of Physiology, Northwestern University Medical School; Lec-
turer on Dietetics, Mercy and Wesley Hospitals, Chicago
H. LYONS HUNT, M.D., L.R.C.P. (Edin.)
Capt. Med. Res. Corps, U.S.A.; Prof, of Medicine
University Medical School, New York City
GEORGE N. KREIDER, A.M., M.D., F.A.C.S.
Captain Med. Res. Corps, U. S. Army
H. EDWIN LEWIS, M.D.
New York City
A. BRUCE MACALLUM, A.B., M.D.
Lecturer Biological Chemistry; Sen. Fel. in Medical Research, University
of Toronto, Toronto, Ont.
E. E. SMITH, Ph.D., M.D.
Formerly Professor of Physiology and Biological Chemistry, Fordham
University School of Medicine, New York City
CONTENTS
VOLUME II
CHAPTER I
FOOD PRESERVATION
H. S. GRINDLEY, B.S., Sc.D.
PAGE
Food Preservation 1
Drying 2
Smoking ' 2
Salting 3
Refrigeration 3
Canning 6
Treatment with Chemical Agents 7
CHAPTER II
PRESERVATION OF FOODS BY DEHYDRATION
H. EDWIN LEWIS, M.D.
Value of Dehydration 9
Application of Dehydration to Special Foods 12
Desiccation of Milk 12
Dehydration of Casein 17
Dried Eggs 17
Preservation of Meat by Dehydration 18
Dried Fish 20
Dried Fruits 20
Dehydrated Vegetables 32
Success of Dehydration 46
Economic Advantages 46
CHAPTER III
SCIENTIFIC COOKERY
H. S. GRINDLBT, B.S., Sc.D.
History of Cooking 49
Principles of Scientific Cooking 51
Varieties of Cookery 54
Meat 55
Fish 66
Vegetable Foods 67
Food Concentration 70
CHAPTER IV
HYGIENE OF EATING
Role of the Senses in the Pleasure of Eating 75
Effect of the Manner of Eating on Digestion 78
Drinking of Water with MefuS 88
vii
viii CONTENTS
PAGE
Personal Idiosyncrasies 89
Order and Frequency of Meals 90
Sleep and Digestion 93
Occupation and Digestion 94
Variety and Diet 94
Relation of Medication to Meals 96
CHAPTER V
VARIOUS FACTORS BEARING ON DIET, DIGESTION AND ASSIMI-
LATION
A. L. BENEDICT, A.M., M.D., F.A.C.P.
Transmutability and Reservation ct Foods 99
Waste and Digestibility of Foodstuffs 103
Substitutes for Food 108
Starvation and Inanition 109
Fasting. . ... 112
Perversion of Appetite 119
CHAPTER VI
OVERFEEDING AND UNDERFEEDING
Superalimentation 127
Overfeeding 128
Overeating 129
Effects of Overeating . . 135
Metabolism of Overfeeding 138
Convalescents 141
Underfeeding 145
Malificent Sequences of Underfeeding 148
Metabolism of Underfeeding 153
Pathology of Metabolism of Starvation 158
Conclusions . . 163
Nature of Protein . . 167
Metabolism of Protein 169
Effect of Protein Diet on Health and Endurance 169
Standard for Protein Requirement in Dietary 180
High Versus Low Protein Diet 185
Protein Structure and Properties 198
Chemical Formation of Protein Fractions 198
Physical Properties of Proteins 201
Theories of Protein Metabolism 203
CHAPTER VIII
THE SIGNIFICANCE OF LIPOIDS AND VITAMINES IN ANIMAL
METABOLISM
A. BRUCE MACALLUM, A.B., M.D.
Lipoids 219
Nitrogenous Importance of Lipoids 219
Lipoids in Metabolism 220
Bio-electric Potentiality of Lipoids 221
CONTENTS ix
PAGE
Vitamines 221
Nature of Vitamines 221
Physiological and Pharmacological Properties of Vitamines 222
Destructive Action of Heat on Vitamines 222
Role of Vitamines in Metabolism 224
Vitamines in Foodstuffs 226
Phosphorous Content of Foods as Index to Percentage of Vitamines 233
CHAPTER IX
THE CALORIC METHOD OF FEEDING
WINFIELD S. HALL, B.S., M.S., PH.D., M.D.
Food as a Source of Heat and Growth 243
Calculation of Fuel Values of Food 257
Factors Governing the Amount of Food Required 265
Regulations of Body Temperature 274
CHAPTER X
GENERAL NUTRITION AND MINERAL METABOLISM
General Consideration 285
Metabolism 286
Anabolism and Catabolism 286
Metabolism Experiments 288
Facts Which Affect Metabolism 295
CHAPTER XI
SCIENTIFIC FEEDING OF NITROGEN FOODS
Nitrogen in Diet 321
Protein Metabolism 327
Urea 327
Ammonia 329
Creatinin 329
Uric Acid 329
Purin Bodies 329
Fat Free Diet 338
Carbohydrate Free Diet 338
Cellulose Free Diet 339
Importance of Function of Mineral Elements 341
Mineral Metabolism 341
Electrolytic Properties of Salts 343
Salt Free Diet 345
Low and High Calcium Diets 349
CHAPTER XII
DIET IN HEALTH
WINFIELD S. HALL, B.S., M.S., PH.D., M.D.
General Principles 361
Amount of Food Required 362
Composition of Meals 366
Various Influences of Diet . ... 368
x CONTENTS
PAGE
Diet Studies of Various Classes of People 374
Use of Alcohol in the Diet 385
Diet in Tropical Countries 386
General Considerations 386
Foodstuffs 389
Alcohol and Beverages 401
CHAPTER XIII
DIET IN CRITICAL PHYSIOLOGICAL PERIODS
Diet in Childhood 409
Early Childhood 410
Diet for School Children 414
Diet During Puberty 418
Diet in Sedentary Occupations 421
Diet During Menstruation 425
Diet During Pregnancy 425
Diet During the Puerperium 428
Diet During Lactation 429
Diet During the Menopause 432
Diet During Old Age 433
CHAPTER XIV
HYGIENE OF THE INTESTINES
WILLIAM P. CUNNINGHAM, A.M., M.D.
General Considerations 455
Chronic Intestinal Stasis 458
Diseases Due to Chronic Intestinal Stasis 460
Considerations of Diet in Chronic Intestinal Stasis 464
Hygiene of the Intestinal Canal 469
CHAPTER XV
PHYSIOLOGICAL REQUIREMENTS OF INFANT FEEDING IN HEALTH
WILLIAM C. HOLLOPETER, A.M., M.D., LL.D.
Breast Feeding 471
Diet During Lactation 481
Unsuccessful Nursing 484
Lack of Uniformity in Breast Milk 487
Deficiency in Breast Milk 487
Artificial Feeding 489
Cow's Milk 489
Condensed Milk 499
Butter Milk 500
Peptonized Milk 501
Sterilized Milk 502
Pasteurized Milk 503
Proprietary Foods 504
Rules Governing Home Modification 506
Clinical Application of Artificial Feeding 509
Intervals 511
Percentages 511
Fats 511
Sugars 512
Proteins 514
Summary of Rules 515
CONTENTS xi
CHAPTER XVI
SPECIAL DIETS
H. LYONS HUNT, M.D., L.R.C.S. AND P. (Edinburgh), L.F.P. AND S. (Glasgow)
PAGE
Vegetable Diet 520
Meat Diet ,532
Fruit Diet 540
Tufnell and Bellingham Diets 547
Weir Mitchell Diet 549
Training Diet 552
Reducing Diet 559
Diet for Professional Singers and Lecturers 560
The Dry Cure 581
The Yolk Cure 563
Milk Cures .554
General Considerations 577
Recipes for the Preparation of Various Beverages and Foods 578
CHAPTER XVIII
ARMY AND NAVY RATIONS
GEORGE N. KREIDER, A.M., M.D., F.A.C.S.
United States Army Rations 663
Rations for Boys' Military Camps 684
Rations of Foreign Armies 697
Diet in Prison Camps 718
Conclusions Regarding the Composition and Food Value of the Military Ration . . . 722
Navy Rations 724
CHAPTER XIX
FOOD ECONOMICS IN WAR
Food Situation in Germany 740
Food Situation in Great Britain 747
Use of Certain Foodstuffs in War 759
Alcohol in War Economics 766
Food Situation in the United States 768
INDEX . . 775
VOLUME II
FIGURE PAGE
1. The Vegetables at the Right, when Dried, Will Have Only the Bulk of the
Small Pile at the Left .* 38
2. The Bucket and Milk Bottles Contain the Water Extracted from this Box
of Vegetables 38
3. This Barrel of Dehydrated Vegetables Represents Thirty Barrels of Green
Vegetables 39
4. Diagram of the Benedict "Universal" or "Unit" Apparatus for Measuring
Absorption of Oxygen and Output of Carbon Dioxid 247
5. Calorimeter 289
6. Case X. Inflammatory, Superimposed upon Evolutionary Stasis 456
7. E. B., Female, 30, Single 457
8. J. S. Chronic Intestinal Stasis, with Very Broad Band Angulating Duo-
deno-Jejunal Junction 458
9. C. 0. Chronic Intestinal Stasis, with Marked Duodeno-Jejunal Kink,
Causing Distention of Duodenum 459
10. Case V 462
11. (A) Band in which Stump of Tube and Ovary is Caught 465
12. Component Parts of a Day's Ration of the United States Soldier, which
Represents a Food or Fuel Value of 4,199 Calories 682
13. Comparative Fuel Value of the Food Rations of the Soldiers of the Lead-
ing Armies of the World 700
DIETOTHERAPY
VOLUME II
NUTRITION AND DIET IN HEALTH
CHAPTER I
FOOD PRESERVATION
H. S. GRINDLEY, B.S., Sc.D.
Methods of Food Preservation: Drying; Smoking; Salting; Freezing;
Refrigeration; Sterilization; Exclusion of Air Canning; Treatment
with Antiseptic Agents.
METHODS OF FOOD PRESERVATION
The different methods of food preservation have of late years received
much attention, for it is very largely due to the different processes of
preserving food that it is possible to maintain large armies and navies in
action and to permit of the aggregation of men in communities away
from all immediate sources of food supply. It was originally thought that
mere contact with the air was the prime cause of the decomposition of
food, but experiments have proven that the great number of germs con-
tained in even comparatively pure atmospheres are the real agents of
putrefaction, rather than the air itself. The basis of all food preserva-
tion depends upon the principle of preventing microorganisms present in
the atmosphere from coming into contact with food to contaminate it.
Since germs of putrefaction require a certain amount of moisture and
heat for their growth, such foods as contain little water, and that are not
kept too warm, are not so likely to undergo decomposition ; on the other
hand, foods containing much water undergo fermentation very rapidly.
1
2 POOD PRESERVATION
Yeo(l) has suggested the following classification of the methods for
preserving food products :
(a) Drying (e) Refrigeration
(&) Smoking (/) Sterilization
(c) Salting (#) Exclusion of air canning
(d} Freezing (h) Treatment with antiseptic
chemical agents
Drying. Drying is the primitive method of preserving food. Of
course, in this process a large proportion of water is extracted. Pemmi-
can (see page 19) is a form of meat preserved by this method. At pres-
ent this form of preserving food is limited mainly to fruits and vegetables,
although, in some sections of the great West where excessively dry and
clear atmospheres are found, meat may be hung in the open anywhere
and be preserved by this method. Biltong, or dried beef, sometimes called
"jerked beef," is kept by cutting it into thin slices and drying it in the
sun for several days. Familiar instances of preservation of fruits by this
method are found in raisins, figs, dates, prunes, dried apples and peaches,
used also for some vegetables such as lima beans, okra, corn, etc. Desic-
cated meats and vegetables, used largely for making soups, have the ad-
vantage of being easily transported and at the same time of producing
nutritious food. (See Volume II, Chapter II, Dehydration.)
Smoking. Smoking is the preservation of meat or fish by means of
volatilized creosote and other substances developed from wood smoke,
which have an antiseptic action. This process of preserving meat is prin-
cipally applied to beef, tongue, ham and bacon. The meat, on being
slaughtered, is first put down in salt for several days ; it is then taken up
and hung in a chamber or confined "smokehouse," and a saturated wood
fire is started. This fire is usually made of green wood and scraps of
leather thrown on the top to add to the smoke.
The creosote rising from the wood during combustion closes the pores
of the meat to some extent, thereby excluding air-containing bacteria.
Juniper berries and fragrant woods are sometimes put into the fire to give
additional flavor. In North Carolina and Virginia, the famous "Smith-
field hams" and bacons are cured by being smoked as above for a time and
then taken down and the fleshy part of the meat rubbed over with sugar,
pepper and other condiments. Then saltpeter, which acts as an antiseptic,
is rubbed well into the flesh, and the meat is laid on a bench for a few
days and afterwards hung and smoked again. Later it is washed and
dried, and again exposed to the fumes of the "smokehouse." The outer
METHODS OF FOOD PRESERVATION 3
surface of meat, such as ham or bacon, preserved by smoking, becomes con-
siderably drier and tougher than the interior, but the latter is not made
especially tough by the smoking if it was originally tender. Well-smoked
bacon sliced thin and thoroughly cooked is a very digestible form of fatty
food. The digestibility of hams is also enhanced by the smoking process.
In some instances the process of smoking is applied largely to the preser-
vation of fish, and their digestibility and flavor are not impaired by
smoking.
Salting The salting of food as an, agency of preservation is a
method that has been practiced for many centuries. In this way, meat
and fish are easily preserved. Salted meat usually becomes pale from the
action of the salt upon the hemoglobin contained in the blood vessels of
the muscle fiber. The addition of a little salpeter prevents the meat from
becoming pale by preserving the original reddish color of salted meat.
Freezing. Freezing is a method of preserving food which necessitates
immediate cooking after thawing, to prevent decomposition. Excepting
milk and cream, foods are not easily eaten in an actual frozen state, ex-
cept by the northern Eskimos, who prefer their meat in that form. Meat
and fish may be kept for considerable periods of time frozen in blocks of
ice without losing much in flavor, but vegetables are not as good when
cooked after being frozen. Meat which has been frozen is much better
cooked by roasting than boiling, unless it has been imperfectly thawed,
in which case the central portion may remain frozen after the external
layers have begun to cook, and when very large cuts are cooked by roast-
ing, the inside, on being cut into, may be found almost raw. Frozen meat
loses about 10 per cent of its nutritive value in cooking.
Refrigeration The preservation of meat by refrigeration or cold
storage has in the past few years practically revolutionized the meat trade.
This method of preserving meat has enabled cargoes to be brought from
distant countries through equatorial regions not much the worse for the
voyage. Slaughtering and refrigeration go on all the year round at the
great slaughtering houses in this country, and the tables of both rich and
poor in the large cities are constantly supplied with beef, mutton, lamb
and chicken. From the earliest time the subjection of meat to extreme cold
has been practiced in order to enhance jts keeping qualities. Bacterial
growth is inhibited to a greater or less extent by refrigeration, which con-
sists (a) in actually freezing the meat, in which condition it may be kept
without decomposition almost indefinitely until finally thawed for use, or
(6) by keeping the meat at or near the temperature of freezing without
4 FOOD PRESERVATION
actually congealing it, as is done by the use of the ordinary methods of re-
frigeration. The second method, while much less efficacious than the first,
serves to prevent much decomposition for a considerable time, and is pre-
ferred for beef, mutton and pork. Lower temperatures are employed with
poultry and game. There are many processes of refrigeration in use: the
direct expansion, indirect expansion by circulation of cooled air, etc.
THE EFFECT OF PROLONGED COLD STORAGE. Dr. Carl von Baer
reported to the Royal Society of London the discovery in Arctic Siberia
of the body of a frozen mammoth, the meat of which was still preserved.
As this animal had been extinct since the days of prehistoric man, it af-
forded an illustration of the marvelous preservative power of intense cold.
In 1861 the entire bodies of three Swiss guides, who forty years before
had been buried by an avalanche over the Glacier de Boissons, were found
in a state of excellent preservation. With these examples of the influence
of cold, it is little wonder that meat may be preserved for a few months
on ice and yet be quite fit to eat.
These two instances, however, are hardly in harmony with the follow-
ing experiences. Wiley (2) records his experience of examining a quar-
ter of beef which had been kept frozen in a warehouse for more than eleven
years. This meat was found to be wholly inedible. It had an unpleas-
ant and a decidedly mummy-like odor, was light in fiber and color, having
evidently lost a large part of its weight and was of a character wholly
unsuitable for consumption. On one occasion, the author had an oppor-
tunity of inspecting a large quarter of beef which was furnished by a
western packing house to the United States Army for food, and they
claimed that it had been in cold storage for more than twelve months, and
that it left the storage in a wholesome condition, having been inspected
and passed by a representative of the Government. It was taken from the
refrigerating cars still cold and delivered to the commissary department
and was found to be putrid, with foul odors emanating from it. It was
soft and of such a character as to be wholly unfit and unsuitable for con-
sumption.
These facts appear to show that in the first instance eleven years is
too long a time to keep meat frozen; in fact, it is scarcely worth while,
from a practical point of view, to discuss so long a limit. In the other
instance, the facts point out that a shorter period of time was conducive
of no better results. Only the necessary time for the preparation and
transportation of the meat is to be considered, and the sanitary laws of
the nation, state and municipality should undoubtedly regulate the time
of cold storage and see that all packages of meat exposed for sale are
METHODS OF FOOD PRESERVATION 5
plainly tagged as to the date of the slaughter, in order that the consumer
may know what he is really purchasing.
A great variety of food materials are now kept for indefinite periods
of time in cold storage that is to say, they are stored in chambers cooled
by air which passes over pipes conveying cold brine, carbonic anhydrid
or ammonia gas. The circulation of such air, by keeping the substance at
a temperature below that necessary for the development of putrefactive
germs, is a sufficient protection against the processes of putrefaction. Ex-
perience has shown that the best temperature for the preservation of ma-
terials by cold storage is as follows:
REQUISITE COLD STORAGE TEMPERATURES FOR THE PRESERVA-
TION OF CERTAIN ANIMAL FOODS
Brined meat 35 to 40 F. Lard 34 to 35 F.
Fresh beef 37 to 39 F. Fish 25 to 28 F.
Mutton 32 to 36 F. Oysters 38 to 42 F.
Pork 30 to 33 F. Poultry (frozen) 5 to 10 F.
Veal 32 to 36 F. Poultry (cold storage) 28 to 30 F.
Ham 30 to 35 F. Fresh fruit 33 to 40 F.
Vegetables 33 to 40 F.
After all that has been said in favor of cold storage of meats, the fact
remains that meat which has been in cold storage for any length of time
is not as wholesome and tasty as absolutely fresh meat. It is the opinion
of the author that much of the intestinal disturbance results from the end
products of protein digestion, which are to some extent due to the inges-
tion of cold storage meats. The germs of putrefaction attack meat very
soon after the animal heat leaves the carcass, and no matter how it is pre-
served or what methods are resorted to for its preservation, putrefaction
to a greater or less degree goes on until the meat is cooked.
It is practically impossible to secure on the New York markets an ab-
solutely fresh fowl, either duck, chicken or turkey ; they have all been in
cold storage for a greater or lesser period of time, and no matter what
price is exacted for these fowls, when cooked, the flesh next to the bone
will have an unsavory odor and a far from inviting or palatable taste.
Even the <f kosher" killed fowls, after a journey of several hundreds of
miles without proper air, food and water, are sick, and such fowls are
unfit for slaughter unless turned into an open lot and fed wholesome
food for a few days. This of course is not done. The only people who
enjoy absolutely fresh fowls and meat are people living in rural districts
who can always secure fresh foods. Cold storage eggs are advertised and
6 FOOD PRESERVATION
sold as "eggs fresh from the farm," whereas they may have been in cold
storage anywhere from a few months to a few years, and instead of having
that fresh egg flavor, they will offer to the olfactory nerves an odor some-
what similar to that of a rancid oil.
Sterilization. Sterilization, by the application of heat in sterilizing
containers, renders meat or other foods germ free. Practically all thor-
oughly cooked food is, for the time being, "sterilized," and it is a well-
known fact that overdone meat keeps longer than underdone meat, since
the outer layers are firmly coagulated and dried by the heat of boiling or
roasting which forms an almost impervious envelope, hermetically sealing
it from the air. The products of decomposition in meat include albu-
minoses, leukomain, ptomain, hydrogen, carbon dioxid and marsh gas.
Exclusion of Air. This is the preservation of food by a process of
canning, the principles of which include the destruction of the organism
which produces putrefactive changes, and afterwards, the hermetical seal-
ing of the container to prevent the access of more bacteria. If the destruc-
tion of the microorganisms is not complete, the bacteria will still produce
changes in the meat or vegetables, and the gases accumulate in the tin. If
the pressure is great enough, the tin becomes "blown," the ends bulge, and
the contents are unfit for food. The process of canning meat or vegetables
is conducted somewhat as follows: The container is first of all boiled to
kill any germs. The product to be canned should then be thoroughly
sterilized by heat, and immediately placed in the container and hermet-
ically sealed. Some unscrupulous manufacturers use antiseptics instead
of heat, much to the detriment of the public health. H. W. Wiley (3),
who made an exhaustive studv of canned foods, says :
/ /
All manner of food is canned, and that at prices which place it within the
reach of the humblest pockets. Preserved food has been a great democratic fac-
tor, and has nearly obliterated one of the old lines of demarcation between the
poor and the wealthy. Vegetables out of season are no longer a luxury of the
rich. In the American grocery pineapples from Singapore, salmon from British
Columbia, fruit from California, peas from France, okra from Louisiana, sweet
corn from New York, string beans from Scotland, mutton from Australia, sar-
dines from Italy, stand side by side on the shelves.
Of the dangers of poisoning from canned goods, Wiley says:
Vegetables are usually canned in the fresh state, and if they are in any degree
spoiled at the time the fact is usually conspicuously evident to the taste, so that
the canner cannot afford to use them. Bacterial action seldom occurs in the can
without bursting it or rendering it unsalable. Ptomains may, however, develop
where the canned food is allowed to stand for some time after opening, though
METHODS OF FOOD PRESERVATION 7
even then this is unlikely in the case of preserved vegetables. It may be said,
therefore, that the principal risks to health which may arise from the use of
canned goods are those due to the use of preservatives, or to the presence of the
heavy metals, copper, tin, lead and zinc. In this country there is no restriction
whatever in regard to the character of the tin employed, and as a result of this,
the tin of some of the cans has been found to contain as high as 12 per cent
of lead. The analyses of numerous samples of solder employed show that it con-
tains fully 50 per cent of lead. In addition to this there is no care taken to pre-
vent the solder from coming into contact with the contents of the can. It is a
rare thing to carefully examine the contents of a can without finding pellets of
solder somewhere therein.
Treatment with Antiseptic Chemical Agents. The use of various anti-
septic and preservative fluids is designed to prevent activity of germs and
fermentation. Sugar, like salt, in strong solution possesses decided anti-
septic powers, and hence the employment of strong fluids for the preser-
vation of fruits, and of sugar itself in making candied fruits. Other
harmless preservative materials which are added are oils, chiefly service-
able for keeping fish, and vinegar and spirits of wine for pickling such
products as chillies, tarragon and shallot. Vinegar is used to preserve
oysters, lobsters and other sea food, as well as cucumbers, cauliflower and
other vegetables. Fish are immersed in mixtures of cider vinegar flavored
with cloves, nutmeg, parsley, bay-leaf, onions, etc. After being "soused"
once or twice, the food is heated in the fluid to 140 F. Flavoring sub-
stances are added, and the whole is put into air-tight jars. The fumes of
burning sulphur are sometimes used as a preservative of foods, especially
fruits. Acetic acid, weak carbolic acid solutions and bisulphite of calcium
are injected into the blood vessels of meat for the same purpose. Chlorid
of aluminium, borax, salicylic acid and other materials have been exten-
sively used for the preservation of milk.
Another method of preserving meat consists of injecting the animal,
the moment it is killed, with a solution of borax, which is so uniformly
distributed through the circulation to all the fibers of the meat, that only
a very small quantity of the antiseptic need be employed. The preserva-
tion of meat by the antiseptic action of these substances, if used in excess,
is apt to endanger the normal digestive functions, and besides render the
meat less nutritious. The use of many of these chemical agents has been
forbidden by federal enactment, and their use in all forms of animal food
is everywhere condemned.
8 FOOD PRESERVATION
REFERENCES
1. YEO, BURNEY. Physiological Chemistry.
2. WILEY, HARVEY W. Foods and Their Adulteration.
3. . U. S. Dept. Agric., Bull. 13.
CHAPTER II
PRESERVATION OF FOODS BY DEHYDRATION
H. EDWIN LEWIS, M.D.
Dehydration : Value ; Methods.
Dehydration of Animal Foods: Milk, Casein; Eggs; Meat; Fish.
Dehydration of Fruits: Prunes; Apricots; Peaches; Plums; Apples; Un-
usual Fruits Persimmons, Copra, etc.
Dehydration of Vegetables: Potatoes; Corn; Beans Soy Bean, Lima
Bean; Cabbage, Parsnips, Turnips, etc.; Use in Allied Armies.
Value of Process of Dehydration It will be quite in place, before going
into details regarding the question of dehydration, to discuss briefly the
whole subject from a broad outlook. First, stress should be laid on the
fact that dehydration is the surest means known of preserving foodstuffs,
especially those of the vegetable kingdom, for an indefinite length of time
without injury to the products thus treated. Dehydration, indeed, is a
most effective mode of really preserving vegetables and fruits, and to a
lesser extent animal foods; the cellular membrane of vegetable matter is
in no respect injured by the process of evaporation when properly car-
ried out.
The vitamine element, now known to be so essential to the conservation
of good health, is preserved in vegetables which are subjected to Amer-
ican evaporating methods. Moreover, the palatability and flavor of vege-
tables dehydrated in this manner are not impaired ; in consequence, vege-
tables and fruits dried by this process retain to a really remarkable extent
their normal flavor and fresh taste when prepared for the table. Fur-
thermore, since their cellular tissue is uninjured, they resume their natu-
ral appearance soon after they have been soaked in water.
Proper dehydration is perhaps the most wonderful means of preserving
food, particularly vegetable food, yot devised. This process does not harm
the nutritive properties of the food. It represents the utmost food eoon-
9
10 PRESERVATION OF FOODS BY DEHYDRATION
omy, and the translation of its principles into practice is peculiarly ap-
plicable to the present juncture, when war makes it incumbent upon all
to avoid waste and to save the food supply by every known means.
Few persons have any idea of the fearful, almost criminal, waste of
vegetables and fruits in this country. We are certainly a careless and im-
provident people. This is no doubt due largely to our living in a country
of almost unlimited resources, where prosperity has always reigned and
where stint or lack of food has been unknown.
The United States Department of Agriculture has stated that in the
neighborhood of 50 per cent of the vegetables and fruits grown here never
reach the consumer's table, and according to R. G. Skerrett(l), it is
equally certain that the greater part of the product thus sacrificed does
not leave the farm or orchard. This unfortunate happening is due to
various causes lack of transportation, the state of the market, but mainly
because only the very best fruits and vegetables will pass final muster or
will be in a condition which will ensure their sale at a profitable figure.
All these difficulties might be overcome and could be overcome if facili-
ties for proper dehydration were available.
It has been pointed out that scientifically dehydrated vegetables and
fruits can be conserved for a practically unlimited period of time. It
may also be stated that these same food products can be sold to the con-
sumer at a price considerably below that of fresh products, which can only
be obtained at certain periods of the year, and even below the price of
canned foods of this nature. For instance, one pound of kidney beans
dried artificially costs ten cents, a pint can of these same beans costs fif-
teen cents. One pound of the dried beans will go as far as four cans, in
addition to providing a good deal more nutriment.
A weighty reason why Germany has been able to hold out so long in
spite of the blockade may be attributed to a large extent to the fact that
she had adopted, long before the war, a widespread system of preserving
by dehydrating processes vegetables and fruits that otherwise would have
been lost. Immediately before the war, there were more than four hun-
dred dehydrating establishments in Germany, and since hostilities com-
menced, many more have been built. At the present time all the German
cities of any size contain evaporating plants, by which means the surplus
stock of farm products has been saved to tide the population over the
lean days.
The public must be taught to realize the necessity for economy in food
and should also be taught the value of dehydration as a factor in achieving
this object. There is always a certain amount of prejudice against novel
VALUE OF PROCESS OF DEHYDRATION 11
ideas. Canning, at one time, was regarded with hostility, and cold storage
was and is still looked upon with a good deal of distrust. Cold storage
when not abused is a highly satisfactory method of preserving food, and
canning possesses conspicuous merits. Perhaps the American people have
contracted the "canning habit," or rather the habit of eating canned foods,
with too great facility because canned food provided such an easy method
of satisfying the food wants of the body. At any rate, a good deal of
the prejudice which existed against canned foods has vanished. Now
there is need for an educational propaganda to enlighten the public as to
the nutritive and economic value of dehydrated foodstuffs.
DEHYDRATION OF VEGETABLES. Dehydration as applied to vege-
tables is as yet in its swaddling clothes and has only just cut, metaphor-
ically speaking, its first teeth. True it is, that the dried fruit industry,
which, by the way, is almost as old as the immemorial hills, is established
on a firm basis, but the dehydration of the common or garden vegetables,
as potatoes, cabbage, spinach, onions and so forth, has not found favor
in the eyes of the people at large. The reason for this is that the man in
the street does not understand the situation and is either indifferent to
dehydrated foods or is mildly and ignorantly prejudiced against them. If
he could be taught the significance of modern dehydrating methods and
be shown that dehydrated foods nre superior to canned or cold storage
foods in fact, almost identical with the products in a fresh state and
that only by the dehydration of vegetables can conditions be handled suc-
cessfully, he would assuredly alter his attitude toward this question.
Here are some further reasons why dehydrated vegetables fill a place
which cannot be filled by vegetables subjected to any other preservative
process.
First, some dehydrated vegetables, when scientifically prepared, retain
their original flavor more fully than when canned in the usual fashion.
Two of the most important of the canned American vegetables, corn and
string beans, are outstanding examples of the truth of this statement. If
beans and corn, which have been dehydrated under exactly correct condi-
tions, are soaked and cooked, they retain their natural flavor, which, on
the other hand, is much impaired by the ordinary canning process.
As H. J. Burgess ( 2") has pointed out, some factor in the dehydrating
process possibly oxidation has something to do with it develops flavors
which no other process will develop. All vegetables are not improved in
flavor by means of dehydration ; generally speaking, however, the flavor
of no vegetable is impaired by this process as it is by canning. A lack of
understanding on the part of the public as to the merits of dehydration
12 PRESENTATION OF FOODS BY DEHYDRATION
is largely responsible for the relatively slow progress of the industry. In
order to render the public more cognizant of the economic and other
obvious advantages of dehydration, especially of the dehydration of vege-
tables, it will be necessary to induce housewives to take an intelligent
interest in the matter. This result will only be brought about by the
prosecution of a publicity campaign showing the advantages of dehydra-
tion and popularizing food products treated by this process.
We have dwelt upon and endeavored to drive home as forcibly as pos-
sible the potentialities of a universal system of dehydrating vegetables,
because vegetables best lend themselves to the method. We feel convinced
that if this means of preserving them is generally adopted, a great ad-
vance will have been made in economizing and conserving the food supply
as well as in providing a reserve of nutritive foodstuff in case of need.
The details of the dehydration of vegetables will be exhaustively dealt
with at the end of this chapter.
The dehydration of fruits is a long established industry, as is also
the drying of meat; desiccation of milk has been carried on during a
period of several years. These subjects, therefore, will only be discussed
under their several heads.
APPLICATION OF DEHYDRATION TO SPECIAL FOODS
DESICCATION OF MILK
With regard to the desiccation of milk, it may be said that the prac-
tical process of converting cow's milk into dry milk powder is a compara-
tively recent discovery. Attempts were made in the middle of the last
century to condense milk to a stage of dryness; these resulted in failure.
According to Levi Wells (3), a consular report from Sweden, dated No-
vember 20, 1901, refers to a process reported to the Academy of Agricul-
ture, a meeting of which was held in Stockholm in that month. The
New York Produce Review and American Creamery, January 1, 1902,
comments on a similar process used in America, and claims that it was
discovered prior to the Swedish process.
Historical Development of the Process. Dr. Eric Pritchard(4) states
that in the year 1903 Mr. S. Amundsen succeeded in employing on a
commercial scale a method of desiccation invented a few years previously
by Dr. G. Ekenberg. Dr. Pritchard is the greatest authority on dried
milk in Great Britain, and one of the first in the world. In the course
of the following account of desiccated milk, his work just referred to
will be largely drawn upon for facts and views. The establishment of
APPLICATION OF DEHYDRATION TO FOODS 13
Mr. Amundsen's factory in Christiania was almost the necessary conse-
quence of the fact that in this part of Sweden the butter industry, entail-
ing a large and unavoidable loss of by-products and residuals, was of con-
siderable importance. The outcome of this condition was the invention
of the Ekenberg process. At first this process was by no means an un-
qualified success, chiefly because the method could be used only for the
desiccation of milk from which the butter fat had been extracted. How-
ever, in the course of time the Ekenberg system was so greatly improved
that manufacturers were able to produce desiccated milk on a commercial
scale without the preliminary removal of the cream.
Present Methods. So many improvements have since been made that
at the present moment there are, according to Pritchard, three distinct
methods of manufacture, each good in its way and each possessing special
advantages. Levi Wells, on the other hand, says that there are two dis-
tinct methods of drying milk from which several systems have been
evolved.
EKENBERG PROCESS. As described by Pritchard, the Ekenberg
process consists in the partial condensation of milk at a low temperature
under reduced pressure, and its subsequent desiccation within the interior
of cylinders heated to a comparatively low temperature. The milk solidi-
fies into a crystalline mass on the surface of the cylinders, which are kept
in constant rotation. This mass is subsequently broken up and pulver-
ized. The method is largely employed in France and in other parts of
Europe.
JUST-HATMAKER PROCESS. In Great Britain the method usually em-
ployed is that known as the Just-Hatmaker process. In this method the
previously concentrated milk is spread on the outer surface of rotating
cylinders, which are heated to 160 C. by steam. The thin film of milk
dries very rapidly on the highly polished surfaces, and when dry is
scraped off by sharp knife blades and subsequently pulverized as in the
Ekenberg process.
BEVENOT DE NEVEU PROCESS. A third process, generally known as
the Bevenot de !Neveu method, consists in concentrating the milk in vacuo
and at a low temperature, and then forcing it under high pressure, 250
atmospheres, through minute perforations in a metal disk into the drying
chamber. The nebula of homogenized milk is then surrounded by an en-
velope of dry hot air and swept across the chamber. Owing to the fine
state of division of the particles in which the condensed milk is pre-
sented, and to its intimate contact with dry air, the milk is almost in-
stantaneously desiccated, and falls as an extremely fine powder to the
14 PRESERVATION OF FOODS BY DEHYDRATION
floor of the chamber. The moisture thus evaporated is carried off as a
cloud of steam, while the snow-like desiccated milk is rapidly swept up
from the floor and packed in tins or other receptacles.
The rapidity with which the concentrated milk is evaporated in the
drying chamber is the distinguishing feature of this method. So swift
is the evaporation that the water is removed from the coagulable ingredi-
ents, such as the whey products, before they have time to become coagu-
lated by the heat. In fact, the coagulable substances which have been so
desiccated can be reconstituted by adding water.
By the Bevenot de Neveu process milk and whey can be reduced to
a very dry powder containing no more than 1 per cent of water, appar-
ently without alteration of their physical properties; that is to say, none
of the enzymes or vitamines appear to be destroyed. The milk, when re-
constituted with water, can be coagulated by rennet or heat, precipitated
with acids, and soured by lactic acid ferments, just as is the case with
milk fresh from the cow. Moreover, when allowed to stand, the cream
will slowly rise as it does in fresh milk which has been homogenized.
As Pritchard says, these results are in his opinion very valuable, for they
refute the chief argument usually brought against desiccated milks that
they are so profoundly altered by the heat to which they have been sub-
jected in the course of manufacture that they no longer possess those sub-
tle and vital properties which are supposed to be essential to good nutri-
tion.
If the results of the Bevenot de Neveu method of desiccating milk
are as Pritchard thinks they are, and he is a close and trained observer,
and if none of the enzymes or vitamines are destroyed, the process is
an excellent one. The odor, however, of the Bevenot de Neveu milk
is slightly tallowy, due to the oxidation of the fat, a result which seems
to follow from the fine state of division in which the fat particles are pre-
sented to the oxygen of the air. While this oxidation in no way impairs
the nutritive value of the milk, it detracts, of course, from its popularity.
This is unfortunate, as in all other respects it is superior, in Pritchard's
opinion, to other varieties of desiccated milk.
STAUF PROCESS. Robert Stauf, of Posen, Germany, devised a process
for producing dry powders from blood, milk, etc., by atomizing these
liquids into supplementary regulated currents of heated air. The amount
of air and heat supplied was sufficient to completely absorb and vaporize
the moisture of the liquid. The resulting dry powder was separated from
the moisture-laden air by means of a screen. The screen retained the
powder and the air passed off through the screen. The Stauf process was
APPLICATION OF DEHYDRATION TO FOODS 15
the first spray-drying process to be commercially used in the United
States.
Comparison of Kinds of Desiccated Milk. The appearances of the
cylinder-dried and air-dried milks are distinctive. The color of Just-
Hatmaker milk is biscuit yellow, that of Bevenot de Neveu milk of a
peculiarly snow-like white. When allowed to stand, the fat rises in the
former as a yellow oil, in the latter as a rich cream. The odor of the
cylinder-dried milk is agreeable and distinctly biscuity.
Fatless Milk. Levi Wells is of the opinion that drying milk from
which the fat has been removed seems to be a success. Milk is changed
by the drying process from a quickly perishable, bulky substance, incon-
venient to transport, into a product requiring little space. Its keeping
properties are practically unlimited, and, furthermore, it is a safe food,
free or almost free from hurtful germs.
According to Wells, probably over 90 per cent of the milk powder pro-
duced at the present time is made of skim milk. From one hundred
pounds of whole milk of average quality, 3.5 pounds of butter fat and
nine pounds of dry skim milk can be secured. Dry skim milk powder
has the appearance of ordinary flour made from grain. This grade of
dried milk possesses in a condensed form all the valuable properties of
fresh, sweet, skim milk. It can be used in this form by bakers and con-
fectioners, or, if desired, it can be converted into its original liquid state
by adding the amount of water that has been extracted from it. Wells
is not so enthusiastic concerning desiccated whole milk. He undoubtedly
refers to America when he states that most of the milk desiccated is skim
milk, as Pritchard, although he writes solely on infant feeding, points
out that in Great Britain dried milks, whether prepared by the cylinder
or the air process, are usually sold in throe qualities: "full fat" milk,
from which no cream has been extracted before drying; "half cream,"
from which part of the fat has been removed ; and as desiccated milk, from
which all the cream has been separated.
Reconstruction of Desiccated Milk for Infants. If it is desired to repro-
duce undiluted cow's milk, it can be accomplished by prescribing so many
ounces of the reconstituted dried milk made up in the proportion of one
dram of the powder to one ounce of water, and modified for infant con-
sumption. If dried milk is to be modified to correspond to breast milk
in all its constituent parts, including its content of whey products, these
latter must be added independently.
The Bevenot de Neveu process of desiccation produces a whey powder
which when reconstituted with water almost exactly reproduces the orig-
16 PRESERVATION OF FOODS BY DEHYDRATION
inal whey from which it was prepared. By an appropriate combination
of dried milk, whey powder, sugar and cream, a humanized milk can be
prepared which has a percentage composition the same as human milk,
namely caseinogen, 0.5 per cent; whey proteins, 1 per cent; sugar, 6.5
per cent, and fat, 3.5 per cent. The formula is as follows :
Full Cream Dried Milk 3 teaspoonfuls
Dried Whey Powder 2^ tablespoonf uls
Sugar 2 teaspoonfuls
Thick Cream 1 oz.
Water to 1 pt.
This is a very valuable substitute for breast milk.
Strong, healthy infants, who have been accustomed to take ordinary
cow's milk, or who have been gradually accustomed to larger quantities
of caseinogen by a graduated course of feeding, thrive well on a mixture
of the following formula: proteins, 2.5 per cent; sugar, 6.5 per cent; fat,
3.5 per cent. This is prepared by combining:
Full Cream Dried Milk 2 oz.
Sugar 1/2 oz.
Thick Cream l!/2 oz.
Water to make the pint
For the feeding of poor infants and for the sake of economy, Pritchard
uses desiccated separated milk, which he modifies by adding supplemen-
tary fat and by sweetening with a small quantity of sugar. He employs
as a fat an emulsion of linseed oil. The formula for preparing 20 ounces
of separated dried milk and an emulsion of linseed oil is as follows:
Separated Dried Milk l 1 /^ oz.
Emulsion of Linseed Oil (50 per cent fat) . . l 1 /^ oz.
Sugar ; 1/2 oz.
Water to make pint
Advantages of Desiccated Milk Pritchard believes with Professor
Porcher that desiccated milk is ff la vache dans le placard." If you have
dried milk, you are as well off as if you kept a cow in the larder ready
to be milked at any moment. Dairy milk deteriorates and is liable to
infection almost from the moment it is milked up to the moment of con-
sumption. Desiccated milk represents milk which has only deteriorated
between the time of milking and desiccation. This time may be short.
The range of usefulness of desiccated milk is obviously a wide one. It
APPLICATION OF DEHYDRATION TO FOODS 17
possesses many advantages. Its keeping properties are to all intents and
purposes unlimited ; it is easily transported ; it is convenient to handle
and is ready for immediate use under any circumstances and at all times ;
it is sterile ; and its cost is somewhat less than the dairy milks. When the
desiccation is properly done, the nutritive properties of the milk are pre-
served. Skim milk is more easily and successfully desiccated than milk
from which the fat has not been removed, yet whole milk can be desic-
cated with success, although its keeping properties are not equal to those
of dried skim milk. For the various reasons already given, desiccated
milk is especially well adapted for use in armies, hotels, restaurants,
boarding houses and hospitals. As the public gains a better conception
of its value, its use is certain to be greatly increased.
The average composition of whole milk powder is as follows: solids,
96.3; ash, 5.6; fat, 26.8; protein, 32.0; lactose, 31.9. Analysis of skim
milk powder shows solids, 91.7; ash, 6.9; fat, 1.7; protein, 33.8; lactose,
49.3.
DEHYDRATION OF CASEIN
According to Cautley(5), dried casein is a very nutritious food, on
a par with the cheese made from skim milk. It is enormously valuable
in that it can be added to other foods, thus enhancing their protein value.
Casein is purin free, does not clot and is easily digested and absorbed.
It is indicated in all affections in which additional protein is needed, and
is useful as a means of giving phosphorus in organic combinations. It
is especially valuable in the treatment of acid dyspepsia, for the protein
fixes the acid.
DRIED EGGS
Special investigations of the freezing and drying of eggs and of the
two general methods in use for preserving eggs when removed from their
shells have been made by Pennington(6), and by Stiles and Bates(7).
There is no doubt that the drying of eggs is an economically desirable
procedure provided that the eggs are fresh and wholesome and that they
are handled with care.
Pennington has pointed out that the handling of eggs from which the
shells have been removed is analogous in many respects to the handling
of milk, and should be characterized by the most scrupulous cleanliness
from beginning to end. Bacteriological investigation will best demon-
strate the sources of contamination, which can be eliminated almost wholly
by the adoption and enforcement of strict sanitary measures, such as clean-
liness of surroundings and of the workers, frequent cleansing and drying
18 PRESERVATION OF FOODS BY DEHYDRATION"
of the fingers, use of appliances and containers which have been thoroughly
sterilized, and prompt drying of the egg after the shell has been removed.
According to Stiles and Bates, the drying of eggs expels over nine-
tenths of the water originally present. One pound of the dry product rep-
resents the solids of from 36 to 40 average-sized eggs.
Stiles and Bates describe four general methods of drying eggs in com-
mercial use. Of these methods the following, known as the "instantaneous
method," is perhaps the most satisfactory. The liquid eggs are sprayed
into a heated chamber at a temperature of about 160 F., where they are
immediately reduced to a fine powder which usually contains from 3 to
5 per cent of moisture. This powder is carried by currents of air through
cotton bags or other filtering devices, and finally falls into bins, ready to
be packed in suitable containers. Other processes of drying eggs are
known as the "Belt" method, the "Disk" method and the "Tray" or
"Board" method. Egg substance thoroughly dried, preferably by the in-
stantaneous process, will keep in a satisfactory condition in almost any
climate, for an unlimited period of time and retain all the nutritive value
of the fresh egg.
Stiles and Bates, as the result of many experiments to determine the
bacterial content of frozen and dried fresh eggs, came to the following
conclusions: Under normal conditions, strictly fresh dried eggs contain
few if any bacteria, and no appreciable numbers of B. coli in 1 c.c. quan-
tities. Consequently, it may be stated that if the eggs are fresh, if all the
necessary sanitary conditions are fulfilled when preparing them for dry-
ing, and if the instantaneous method is employed, the eggs thus treated
will preserve their nutritive properties for an indefinite length of time
and will constitute an important reserve supply of food.
THE PRESERVATION OF MEAT BY DEHYDRATION
Ancient and Modern Methods of Drying Meats The drying of meat is
a very ancient custom. Almost as soon as our prehistoric ancestors were
enabled by means of hunting to gratify their natural instinct for animal
food, they preserved some of the meat or fish thus obtained by drying it
in the sun and then storing it. Even before flesh food was known to
them, they were accustomed to dry insects in the sun, and many of the
primitive peoples still existing follow similar customs.
In the dry climates of South America or of South Africa, and on our
Western plains, meat is cut into thin strips and hung out of doors to be
exposed to the direct action of the sun's rays. In a short time the moisture
APPLICATION OF DEHYDRATION TO FOODS 19
has disappeared and the hard, dry pieces will keep indefinitely, or, at
any rate, as long as they are kept dry. The meat retains a fair degree of
palatability and practically all of its nutritive properties. In the West
this is known as "jerked beef," and in South Africa as "biltong." "Pem-
niican," a food largely used by explorers, is a mixture of dried lean, meat,
fat, and sometimes dried fruits, such as currants and raisins.
TELLIER METHOD. Drying is not so well adapted to meats as to vege-
tables and fruits. Dried meats lose, to a considerable extent, their natural
flavor. Perhaps the best method of preserving meat by dehydration is
that devised by the celebrated French refrigeration engineer, Charles Tel-
lier, who has described the process in his book, "La Conservation de la
Viande." A. F. Burger (8) gives an account of the method. By this
process the meat is dehydrated in vacuo, without the employment of heat
or the use of any agents which might alter its properties, as is the case
when meat is preserved by pickling or by drying with heat. Meat dehy-
drated in vacuo loses most of its water and retains its natural properties.
Its culinary properties are not prejudicially affected nor is its nutritive
value impaired, since no essential alteration of the tissue or of the juices
occurs.
The degree of vacuum to be applied in removing the water should be
as near absolute as possible; in any event the pressure remaining in the
evaporating chamber should not be above 4 or 5 millimeters of mercury
and the vacuum should be kept up for 12 to 24 hours. The method em-
ployed by Tellier was as follows : An apparatus is constructed, consisting
of two strong cylindrical containers, each surrounded by a water jacket
for the purpose of maintaining a desired temperature. These two recep-
tacles are connected by a pipe passing out at the top. The larger of the
two vessels is filled with the meat to be dried, placed upon trays. The
other vessel is filled with coke or other inert spongy, porous material which
is kept wet by a solution of caustic potash.
After the air has been drawn out of the system by means of an ordi-
nary air pump, carbonic acid gas is turned in and later removed by the
pump. This procedure takes out the last traces of air. The residue of
carbonic acid gas is then absorbed by the caustic potash solution which
impregnates the coke, the result being a very perfect vacuum. The process
is said to be inexpensive and to require but little hand labor. Three ad-
vantages of the method are stated, (a) The meat preserved in this man-
ner keeps even when exposed to the air. For all practical purposes it is
sterile, since the organisms contained therein are either killed by the de-
hydration or are so weakened thereby that they cannot vegetate or multiply
20 PRESERVATION OF FOODS BY DEHYDRATION
on account of the lack of moisture. (6) Having been cut into suitable
pieces before preparation, it may be easily handled in small shops, (c)
Meat thus treated can be much more easily transported than fresh meat.
POWDERED MEATS. Powdered meats are prepared by complete des-
iccation, and products of this nature are found upon the market in a finely
ground form. Meat powders are made from fresh meats in their natural
state and also from artificially digested meats.'
ITALIAN METHOD FOE POWDERING MEAT. Some four years ago an
Italian inventor perfected a process for preparing beef meal. Meat treated
by this process is said to retain the characteristic taste and aroma of ordi-
nary beef. By this process the beef is dried at a low temperature; that
part of the vapors which contain the aroma substances is collected, con-
densed and added to the dried beef after the latter has been properly
ground. Beef prepared by this method is said to have unlimited keeping
properties. It can be used in exactly the same way as ordinary beef for
soups or in combination with vegetables.
DISADVANTAGES OF MEAT IN POWDERED FORM. Dehydration of meat
or its reduction to powder, however, impairs its flavor and renders it less
palatable. In consequence, meat treated by these processes is not likely
to become widely popular. Circumstances may occur in which dehydrated
or powdered meat may be extremely useful, indeed, almost essential, but
in everyday life dehydrated or powdered meat will not have a vogue. The
dehydration of vegetables, on the other hand, will probably revolutionize
the food situation. It is mainly this form of dehydration, therefore, that
will be discussed most exhaustively and upon which emphasis will be
chiefly laid in our consideration of the subject.
DRIED FISH
A good deal of fish is sun-dried, but at present there are no artificial
modes of dehydrating fish. An immense quantity of fish is cured ard
incidentally dried, but this is not dehydration. There is a dried fish
powder made in Greenock from white fish, mainly protein; dehydration,
however, is not usually applied to fish.
DRIED FRUITS
The drying of fruits is an extremely ancient procedure. It was the
custom in primitive days and by primitive peoples for fruits to be pre-
served by extracting the, moisture or a large proportion of the water con-
tent, through exposure to the action of the sun. It appears likely that
APPLICATION OF DE1IYDKATION TO FOODS 21
fruits were first dried in warm countries, but the custom lias long pre-
vailed among the inhabitants of temperate and northern latitudes. In
this country the drying of fruits has been practiced since the first coming
of white men. Dried apples and berries were factors of much impor-
tance in the winter bills-of-fare of the early colonial settlers as they had
been in the winter supplies of the Indians. The methods of drying, how-
ever, were crude, and in consequence, the dried product was poor and by
no means uniform in quality.
Sun-drying Sun-drying of certain fruits, when carefully done under
favorable conditions, is productive of excellent results. For example,
raisins and figs are dried better in the sun than by artificial methods. The
weather, of course, plays an important role. It must be borne in mind,
however, that fruit is often subjected to contamination in the open air.
It is a matter of common knowledge that disease-bearing micro-
organisms of various kinds, as well as minute organisms which cause de-
cay in the fruit, may be carried in the blowing dust. Moreover, insects
attracted by the fruit may deposit their eggs on it. Such possibilities
can be guarded against, to a large extent, by selecting clean and well-
protected out-of-door drying places, by avoiding careless and unnecessary
exposure of the fruit, by washing or sterilizing in fact, by taking every
needful precaution.
Artificial Drying. During recent years the methods of artificial dry-
ing and the machinery employed for the purpose have been so greatly im-
proved that this mode of preserving fruit has largely supplanted the time-
hallowed ways, in the case of apples, apricots and peaches, at any rate,
and indeed for most of the fruits grown in the northern parts of America
and in Europe. The greater cost of artificial methods is more than offset
by the saving of time and labor. The superiority of the artificially dried
product in cleanliness and uniformity of the fruit is so obvious as to re-
quire no emphasis.
These improvements, furthering the great development of the dried-
fruit industry in the United States in recent years, have resulted largely
from the investigations and the efforts of the TJ. S. Department of Agri-
culture and of the agricultural experimental stations. Consequently, the
large fruit-drying establishments, numerous in the fruit-growing sections
of this country, which are distinguished by high standards of cleanliness,
are reaping the reward of their foresight. The subject matter of this
essay on dried fruits is partly gathered from a bulletin in the Year Book
of the Department of Agriculture (9) and Farmers' Bulletin(lO) of the
same department.
22 PRESERVATION OF FOODS BY DEHYDRATION
The preparation of dried fruits for the market involves a great deal
more ingenuity and thought than is usually imagined. It is not a simple
matter, for although methods vary in different districts and for different
kinds of fruits, they are one and all founded on a scientific basis, and as
Langworthy aptly remarks, "The producer who understands the scientific
reasons for all these processes has the advantage of being able to apply
them more accurately and economically, and thus to get a better and more
uniform product even when crops and weather conditions are poor" (9).
As a rule, nowadays, fruits are dried without the addition of any for-
eign substance. With regard to the terms used to describe the preparation
of fruit products under discussion, the appellations, drying, evaporating,
desiccating and dehydration are all more or less applicable. We have em-
ployed the term dehydration at the head of the chapter, and although there
may be fine and nice distinctions qualifying the exact significance of this
term, after all, it is removal of water which constitutes the principle of the
process. Dehydration accurately means drawing off moisture. However, in
the case of fruits, "dried fruit" is the broadest and most appropriate term.
The various methods used have the same object, the drying of fruits in
such a way that they shall retain as much of the natural flavor and nutri-
tive food properties as possible, and at the same time have an attractive
appearance, be free from contamination of any description, and, above all,
possess good keeping qualities.
On the whole, the modern methods of rapid drying produce fruit
better in flavor, color and texture than fruit dried at home in the old-
fashioned way. Some think that a better flavor is obtained by sun drying,
but that rapid, artificial drying imparts a better color. The weight of evi-
dence, however, for the majority of the fruits, the most notable exceptions
being raisins and figs, is in favor of rapid artificial drying.
The consumption of dried fruit in this country is very large and is
increasing; the exports also are very important, showing, from all points
of view, that the industry of fruit drying is in a remarkably healthy con-
dition. California easily leads in the production of dried fruits. More
than 80 per cent of the total amount comes from that state. The present
output of dried fruits in this country is in excess of 500,000,000 pounds
annually.
Dried Prunes Up to quite recent times apples were the chief fruit
dried in this country. Recently, however, while the quantity of apples
so treated increases slowly, the drying of raisins, prunes and peaches pro-
gresses by leaps and bounds. As long ago as 1909, statistics showed that
about 12,000,000 pounds of dried apricots, 44,000,000 pounds of dried
APPLICATION OF DEHYDRATION TO FOODS 23
peaches and 115,000,000 pounds of prunes were consumed in Amer-
ica alone. More and more of these fruits are being dried each year.
Primes, peaches, apricots and cherries, belonging to the same botanical
family, are subjected to much the same kind of process, so that a descrip-
tion of the methods used for drying prunes will exemplify the manner
in which similar fruits are dried.
PREPARATION OF FRUIT FOR DEHYDRATION. It is needless to ex-
plain that prunes are dried plums. Everyone, however, does not know
that American California and Oregon plums, in particular, are fast taking
the lead as the main sources of prune products. In order to have the fin-
ished product in the very best condition, the greatest care must be taken
not only in the carrying out of the process itself, but in the prior prepara-
tion of the fruit. In the first place, the gathering should be done most
carefully, the fruit should be picked by hand or shaken gently upon sheets
spread under the trees, the object, of course, being not to bruise them. If
the plums be not perfectly ripe, they should be exposed to the rays of the
sun for a day or two, so that their natural sugar content may be increased
and their water content diminished. The fruit is then graded according
to size to render the drying more uniform. Cleaning the fruit is the next
step, followed by treatment of the skin in such a way that the water will
be all the more quickly evaporated from the interior. Dipping the fruit
in boiling water is sometimes thought to sufficiently answer the purpose ;
but more frequently this simple method is supplemented by pricking the
skins with a special apparatus, by dipping the fruit into lye, or by placing
the sorted prunes into perforated metal baskets which are dipped into a
hot 0.75 per cent solution of potash. The fruit is only kept in this solution
a very short time, just dipped in and out, and immediately transferred
to cold water. This is necessary to prevent the prunes from acquiring an
alkaline taste. The alkaline bath removes the thin coating of wax, the
so-called bloom, which would interfere with the passage of the water
through the skin when the drying process is in progress. California prune
dryers use a soda in preference to a potash solution. Having expedited
the evaporation of water from the interior, and having washed the alkali
free, the fruit is ready for drying.
When the climate is suitable, and the weather permits, prunes arc
sometimes dried in the open air, or in ordinary drying sheds, but most
frequently artificial means are resorted to, to hasten the process.
As said before, the question of the best and most rational method of
preparing dried fruit cannot be answered offhand or in general terms.
Local conditions largely determine this matter; the amount and the kind
24 PRESERVATION OF FOODS BY DEHYDRATION
of raw materials available are the most important factors involved. Sun-
drying in California usually requires from one to two weeks, and artifi-
cial drying a considerably shorter period of time the ordinary American
method requiring from twenty-four to forty-eight hours, according to the
character of the fruit.
METHODS OF DEHYDRATION. At the present time there are three
principal systems used by those engaged in the fruit-evaporating industry :
first, the old method of drying in a hot chamber under ordinary atmos-
pheric conditions ; second, the vacuum system, by which the fruit is dried
under diminished atmospheric pressure; and third, the dehydrating sys-
tem, in which the fruit is dried by warm air which has been previously
cooled at a low temperature so as to deprive it of the moisture which it
might contain. The advantages claimed for this latter system are that the
fruit can be dried at a much lower temperature than is possible otherwise,
because the air being quite dry, can take up large quantities of moisture
without requiring to be heated. It is also more rapid than the other proc-
esses. As stated in the remarks on the dehydration of vegetables, this
method does not injure the cellular structure and consequently vegetables
and fruits treated by this method retain to a remarkable degree their con-
tour and full flavor when prepared for the table.
Dried prunes are "sweated" for two or three weeks and then regraded
according to the number required to make a pound. After grading they
are finished or "glossed" by heating in steam or immersing in salted boil-
ing water, fruit juice or glycerin, by which means the exterior is sterilized
and a shiny surface is imparted.
Dried Peaches and Apricots Peaches and apricots are usually pitted
before drying. After using the same care in gathering these fruits as in
the case of plums, in order to avoid bruising, they are then promptly
prepared for drying. When peaches are peeled before drying, they are
usually dipped in hot lye to loosen the skin, but apricots are almost in-
variably dried with their skins on. When the fruit has been pitted and
cut, it is laid in trays. When sulphuring is practiced, a method which
will be described briefly when the evaporation of apples is discussed, it
takes place at this point. The drying proper then follows.
OLD-FASHIONED METHOD OF DRYING FRUIT. The following house-
hold method of drying peaches and plums, which was prevalent in the old
days, is still practiced in the Southeastern States. The fruit is peeled,
pitted, mashed, spread out in a thin layer, and dried in an oven or in the
sun until the mass is tough and resembles leather in appearance. The
name given to it is peach or plum leather, and it is said to keep indefi-
APPLICATION OF DEHYDRATION TO FOODS 25
nitely, even if only packed in bags. Stone fruits are sometimes preserved
by housekeepers. The fruit is pitted, sprinkled with sugar, placed in an
oven moderately heated, kept there until the oven is hot and afterwards
dried slowly in the sun or in a cool oven.
Dried Apples Apples have been artificially dried in this country, at
least, on a large scale for a longer period than any other fruit. A large
quantity of apples is still dried in primitive fashion. In country districts
in which apple cultivation is not carried on extensively, there is frequently
to be seen during the autumn, apples sliced or quartered for drying in
the sun, placed on a flat rock, on the roof of a low shed or on any easily
available flat surface. While, perhaps, the greater part of this sun-dried
fruit is intended for home consumption, a good deal of it is sent to the
market and some is exported.
According to H. P. Gould, the average weight of ripe winter apples
of mixed varieties is about fifty pounds to the bushel. In evaporating
them some forty pounds of water per bushel, or approximately five gallons,
passes off in the form of vapor. The object of the process is to draw off,
as rapidly as possible by artificial means, sufficient moisture to prevent
deterioration through decay or other natural means, and at the same time
to maintain a desirable texture and flavor.
More apples are artificially dried than any other fruits, because they
are grown more largely in temperate climates. In many of the lands
in which apples flourish, the changeableness of the weather renders sun
drying out of the question, hence evaporators are numerous. Some are
situated in villages near railroad stations or in a central and easily
reached locality. Many are erected in or about the orchards them-
selves. The largest evaporators, generally placed in towns or villages,
are operated by men who make a business of evaporating; consequently
these plants are of larger capacity and are better constructed in every
respect than those in the orchards.
It would be superfluous to enter here into a detailed description of the
various kinds of evaporators in use. The brief description given a few
pages back of the three chief systems for dehydrating fruits will suffice.
Dried apples are produced on a large scale, in three principal forms :
whole apples, consisting of the smaller fruits which have been peeled and
the core removed; split apples, made from larger fruit which have been
peeled, the seeds removed, and the fruit split lengthwise in six or eight
sections, and "ring apples," made from large fruit, which after peeling
and removing of the core, are cut across the core hole into thin flat
disks.
26 PRESERVATION OF FOODS BY DEHYDKATION
It must always be borne in mind that the success of the process of
drying apples depends mainly on the kind of fruit used. Of course, the
primary economy of evaporating fruits is in utilizing the surplus fruit and
poorer grades of fruits, which would otherwise be wasted. Consequently,
it is this sort of fruit which is usually dried. Nowadays, however, there
is an increasing demand for dehydrated apples of the best quality.
An important point which is often overlooked in the selection of apples
for drying, is the fact that the varieties of apples differ considerably in
the amount of substance they lose in peeling and coring, and in the weight
of dried fruit they will give. Water constitutes the greater part of the
weight of an apple. Some kinds of apples contain more water than others,
and the water content of the same variety of apples will vary, in some
degree, according to the season and weather.
Complicated machines which peel, core and sometimes even slice the
apple at one operation are in general use. After these operations are com-
pleted, the apples are as a rule dipped for a few minutes in a weak solu-
tion of salt and water to prevent the discoloration brought about in several
varieties of apples by the action of the oxygen in the air. The fumes of
burning sulphur are employed not only to achieve the same object, but
to prevent further discoloration after the apple has been sliced, and to
render the color lighter. The method is also supposed to be necessary to
kill moths, insects, fungi or hurtful microorganisms. Bleaching by sul-
phur should be employed immediately after the surface of the apple has
been exposed to the air by paring. On being removed from the dehydrator
the fruit should be allowed to stand for the "sweating" to take place, a
process which generally lasts for several days and which should be carried
out in the open air. or in well-ventilated rooms.
The proper storage of the dried fruit is important because if brought
into a damp atmosphere the spongy cells will absorb additional moisture
which may accumulate to such an extent as to again make the fruit a
favorable medium for the growth of bacteria.
Raisins. The amount of raisins produced in this country is enormous.
The methods of curing the grapes depend partly upon the purpose for
which the dried products are intended. The smaller varieties of grapes
are used for making raisins for cooking purposes, and only the best quality
of the larger varieties can be dehydrated to make good table or layer
raisins. Bunches of the latter are first carefully picked over, and the
dried or unripe fruit discarded. The bunches are then placed on trays
in the sun. The smaller sultana, the currant varieties and the less attrac-
tive bunches of grapes of the larger varieties are dipped in weak lye before
APPLICATION OF DEHYDRATION TO FOODS 27
they are dried in order to soften the skins slightly and loosen the stems
which are removed before the raisins are packed.
Other Dried Fruits. In days gone by, strawberries, raspberries, black-
berries, blueberries, barberries, currants and most small native fruits were
frequently dried at home. This practice has greatly fallen into disuse
since dehydration and preserving have come into vogue, but still exists in
a few regions, notably in the mountains of Tennessee, where dietary
studies made by the Department of Agriculture showed that these dried
berries were used as staple foods.
Dates are cured in this country, the date palm having been introduced
and found to ripen well in Arizona and neighboring regions, but as yet
the industry is in its infancy.
While the fig tree can be grown in any mild climate, the varieties suit-
able for drying can be produced only under special conditions. However,
most of the difficulties in this direction have been overcome. In Cali-
fornia, the Smyrna fig has become naturalized, and the dry fig industry in
that state is assuming goodly proportions.
Bananas The banana is not dried in this country, but as it is
regarded from nearly all standpoints as the most nutritive of fruits, it will
be pertinent to deal somewhat briefly with the drying of bananas. Ja-
maica has been, so to speak, the mother of the dried banana industry, and
it is on this island that the majority of the really important factories for
drying bananas are now to be found. There are several factories for the
same purpose in the Philippines. The drying of bananas is done by hot
air. The larger pieces of dried banana are generally known as "banana
figs."
DRIED BANANA PRODUCTS. The dried food products made from
bananas are "banana figs," cooking bananas, banana chips and banana
flour and meal. All the factories in Jamaica dry or evaporate the bananas
whole without the addition of sugar, and yet they are as sweet and pal-
atable as pressed figs. Cooking bananas are so thoroughly dried as to be
quite hard. Their color is almost white. When broken into pieces, they
are known as banana chips and are exported to be ground into meal or
flour. All banana foods are wholesome and nutritious, and, owing to the
large yield of the fruit and its high carbohydrate content of sugar and
starch, bananas have long been recognized as a very cheap food, although
their value from the nutritive and economic standpoints is not yet fully
appreciated. "Banana figs" are delicious, and cut into small pieces may
be used like raisins to impart an additional flavor to cakes and puddings.
The chips after having been well pounded or ground in a coffee or other
28 PBESEBVATION OF FOODS BY DEHYDRATION
hand mill, may be boiled and then used as an excellent breakfast food or
for making puddings. Gruel, porridge or other preparations made from
banana meal or flour, which is rich in easily soluble carbohydrates, are
recommended for infants, invalids and dyspeptics. It is said that the
negro women of Jamaica use banana meal gruel as a substitute for milk
for their infant children. An inexpensive and nutritious bread can be
made from banana flour, or the flour may be admixed with other ingredi-
ents to make a wholesome and cheap bread.
Unusual Dried Fruits The better qualities of the meat in the interior
of the cocoanut seed, commonly known as copra, is desiccated. It is used
mainly for flavoring and garnishing purposes in the countries into which
it is exported. There are several other dried fruits, some of which are
grown and dried here, but most of which are imported. Among these the
following may be mentioned: olives from the eastern Mediterranean re-
gion, where they are eaten as a staple food; dried cactus fruit, in the
southwestern part of this country, in Mexico and in lands abutting on the
Mediterranean ; and dried chestnut, much used in European cookery and
now fairly prevalent in America. In China may be found the lichi nut
or Chinese raisin. The jujube is common in China and Japan, but is lit-
tle known here except in the form of jujube paste. There is also the carob
bean or St. John's bread, the dried pods of a European locust bean.
Of Chinese and Japanese fruits available for drying, the persimmon
is the most suitable. In some districts of China strains of persimmon are
found which are being grown for drying purposes only. A dried persim-
mon in appearance and flavor resembles a dried fig with the exception
that it is devoid of small seeds, and is covered with a heavy layer of fine
grape sugar. The cultivation of persimmons for drying purposes is a
growing industry in China, where thousands of acres are devoted to this
purpose. Hundreds of varieties exist, and the trade in China of dried per-
simmons compares in importance with our trade in dried peaches.
Comparison of Food Value of Fresh and Dried Fruits The food value of
dried fruits is naturally their most important characteristic, although a
pleasing flavor is an extremely desirable adjunct,, as is also their acid con-
tent, which is believed to aid digestion. The flavor, the aroma and the
appearance act as stimulants to appetite and, according to present-day
views, influence the secretion of the gastric juices.
The flavor of dried fruits is seldom if ever the same as that of fresh
fruits, but as mentioned before, fruits dehydrated by the most recent
American process retain to a very considerable degree their fresh taste
and flavor.
APPLICATION OF DEHYDRATION TO FOODS
29
A pound of fresh fruit will yield on an average about six ounces dried.
The food value then of one pound of dried fruit is greater than that of
the same weight of fresh, since it has been concentrated by evaporating
the original water content.
It goes without saying that the nutritive value of dried fruits, as of
other foods, in the first instance, depends upon the proportion of food in-
gredients therein contained, and in a general way the food value is in
inverse ratio to the water content. Analysis has demonstrated that dried
fruits which contain from 15 to 30 per cent water and by the most mod-
ern methods of dehydration a good deal less water remains are relatively
so much the more nutritious than fresh fruits, of which the water contents
average anywhere from 75 to 95 per cent.
The following table will show the average composition of dried fruits
and fruit products :
FRUITS
Refuse,
per cent
Water,
per cent
Pro-
tein,
per cent
After
extract,
per cent
EDIBLE PORTION
Nitro-
gen free
extract,
per cent
Crude
fiber,
per cent
Ash,
per cent
Fuel
value
per
pound
Apples.
26.1
29.4
29.2
9.7
19.0
15.4
18.8
16.5
22.3
14.6
8.1
17.3
17.2
1.6
4.7
5.3
3.1
.5
2.1
4.3
2.8
2.1
2.6
7.3
5.7
2.4
_ , . *-
2.2
1.0
2.3
.5
1.5
2.8
.3
5.4
3.3
1.8
1.1
1.7
62.0
62.5
55.5
83.4
78.1
74.6
68.0
66.0
71.2
73.6
80.2
67.0
71.2
6.1
2.1
.7
3.5
6.2
6.9
2.1
2.5
6.4
3.0
2.0
2.4
5.3
2.6
.9
1.3
2.4
2.4
2.3
3.4
2.6
2.5
4.5
1,350
1,290
1,240
1,610
1,525
1,615
1,475
1,635
1,400
1,605
1,705
1,480
M95
Apricots
Bananas
Banana flour ....
Citrons
I );i1('S
10.0
Figs. .
Pears
Prunes
15.0
10.0
Raisins
Raspberries
St John's bread. .
Zante currants. . .
The fuel value per pound of fresh apples is only 290 calories ; of apri-
cots, 270; of bananas, 460; of raspberries, 255, and so on.
While the main change that takes place during the dehydration of
fruit is the loss of water, other changes likewise occur, varying with the
kinds of fruits and the methods employed. In dried fruits, the fact must
be taken into consideration that in contradistinction to fresh fruits, the
refuse is reduced to a minimum. Moreover, of the small acid content
found in fresh fruits, as apples, pears, plums, berries, etc., the greater part
remains in the dried fruits. It has been stated previously that the food
30 PRESERVATION OF FOODS BY DEHYDRATION
value of such fruits is higher the lower the water content. Consequently,
raisins, dates and figs having on the whole a less water content than dried
apples, peaches and prunes, contain more nutritive material. The food
value of fruits, as of vegetables, depends chiefly on the carbohydrates they
contain in the form of sugar. Protein is so little in evidence in fruits as
to be practically a negligible quantity. Fats, too, need not be taken into
account. The mineral constituents of fruits occur in all varieties and are
important in that they are necessary for the formation of the fluids and
tissues of the body.
As sources of nutrition, and more especially of energy, dried fruits
compare rather with cereals and dry vegetable foods than with fresh fruits.
In many respects they even compare favorably with the former, although
it should not be forgotten that they yield less protein than cereals and
legumes and only extremely small quantities of fat. However, dehydrated
fruits, some more than others, retain a certain amount of the properties
of fresh fruits. For instance, many fruits have a laxative action indeed
they are often eaten for this very purpose, and the effect appears to be
equally as potent with dried as with fresh fruits. The manner of de-
hydrating by the most advanced American methods seems to be not only
effective in conserving fruits, but, to a large extent, in preserving their
original properties.
Economic Advantages of Dried Fruit. The economy of dehydrating
fruit can be conclusively proven without the least difficulty. It is obvious
that dehydrated fruit is economical because it has a higher food value than
fresh fruit, and because of the ease by which it can be transported, on ac-
count of its keeping properties and its small bulk, thus preventing the sac-
rifice of surplus supply or fruit of inferior quality. But from the point
of view of cost, dehydrated fruits are economical. Even now these fruits
may be termed reasonable in price compared with many other ordinary
articles of diet. This has been demonstrated by a large number of studies
made in connection with the nutrition investigations of the Office of Ex-
periment of the IT. S. Department of Agriculture. From these studies,
and from information derived from other sources, these conclusions may
be with fairness drawn. Since all the fruit products contain little pro-
tein, they are more expensive by far than the cereals and dried legumes
and most animal foods. On the other hand, as sources of energy, derived
almost wholly from their sugars and other carbohydrate contents, de-
hydrated fruits are a great deal cheaper than meats, compare favorably
with dairy products, but are more expensive than cereals and starchy
vegetables, as dried beans or potatoes.
APPLICATION OF DEHYDRATION TO FOODS
31
So far as a comparison of one dehydrated fruit with another is con-
cerned, that is as regards its food value, the cheaper compare favorably
with the more expensive kinds.
The following table will show the comparative cost of total nutrients
and energy in some fresh and dried fruits and other food materials at cer-
tain average prices in 1907. Since that time prices have advanced con-
siderably, but the comparison will still hold good, except, perhaps, that the
price of meat will be relatively higher at the present time than that of
dried fruit.
COMPARATIVE COST OF TOTAL NUTRIENTS AND FUEL VALUE
OF SOME FRESH AND DRIED FRUITS
KIND OF FOOD
MATERIAL
Price
per
Pound
Cost of
1 pound
Protein
Cost of
1,000
Calories
Energy
Total
Weight
of Food
material
AMOUNTS FOR TEN CENTS
Protein
Fat
Carbo-
hydrate
Energy
Fresh fruits:
Apples
('cuts
1.5
3.0
4.0
12.0
10.0
15.0
10.0
10.0
25.0
3.5
2.0
5.0
6.0
5.0
Dollars
5.00
3.33
4.00
7.50
5.26
3.50
5.56
4.35
1.31
1.06
.59
.54
.22
Cents
7.3
8.1
11.9
8.9
6.9
10.2
8.4
6.9
22.5
10.5
11.8
4.2
3.2
3.1
Lbs.
6.67
3.33
2.50
.83
1.00
.67
1.00
1.00
.40
2.86
5.00
2.00
1.67
2.00
Lbs.
.02
.03
.03
.01
.02
.03
.02
.02
.07
.09
.17
.18
'.45
Lbs.
.02
.03
.02
.03
.03
.07
.11
.02
.03
.03
Lbs.
.72
.64
.36
.55
.71
.50
.62
.69
.14
.26
1.06
1.67
1.19
Calories
1,467
1,232
837
1,121
1,450
988
1,190
1,445
444
925
850
2,430
3,106
3,210
Plums
Grapes
Dried fruits:
Apples
Dates
Figs. .
Prunes
Raisins
Porterhouse steak
Whole milk
8kim milk
White bread
Sugar. . . .
Dried beans
From a broad outlook, it appears plainly evident that dried fruits are
the cheapest of the fruit products and the most economical. Neither fresh
nor dried fruits can be rightly regarded as a luxury, since they add con-
siderably to the food value of a diot, and vary the monotony of the daily
fare. Dried fruits in sealed cartons or packages are much safer because
they are less easily soiled than when sold in open boxes. There is little
doubt that the fruit products dehydrated by the most up-to-date American
processes are cleaner by far and better in every respect than those sub-
jected to the old-fashioned methods and are superior to the imported
varieties.
32 PRESERVATION OF FOODS BY DEHYDRATION
DEHYDRATED VEGETABLES
Dehydration is absolutely the correct term to apply to the process used
for preserving vegetables by withdrawing the moisture which has been de-
veloped and it may almost be said perfected in this country.
Importance of Dehydrated Vegetables as Food In the introduction to
this chapter, stress was laid with intent upon the supreme importance of
dehydrating vegetable foodstuffs in such a manner that when prepared for
feeding purposes they resemble in all their salient and essential features
these same vegetables in their original form. It was pointed out that
vegetables thus treated furnished an economical advance of immeasurable
value, since vegetables far more than fruits provide all the forms of nutri-
tive material necessary to maintain the human organism at a high stand-
ard of health. Some vegetables from their protein content are fairly sat-
isfactory substitutes for meat ; others are valuable as foods because of their
carbohydrate and fat content. In order to make up a well-balanced dietary
and to avoid constipation, that bane of this age, the consumption of a cer-
tain amount of vegetables is always indicated.
It is difficult, even frequently impossible, except at prohibitive prices,
to procure really fresh vegetables at all times of the year. It is true that
one can always buy canned vegetables, but canned goods have their draw-
backs. Dehydrated vegetables, when properly prepared, retain their orig-
inal flavor in a far higher degree than the ordinary canned vegetables and
cereals ; a few vegetables are improved in flavor by dehydration. The pre-
dominating advantages of this process lie not only in the facility and cer-
tainty with which vegetables and cereals can be preserved for a great
length of time without any clearly perceptible loss of taste, flavor or nutri-
tive properties, but in the ease with which they can be transported owing
to their small bulk.
Methods of Dehydrating Vegetables. It may be stated emphatically
that no single device for the preservation of foodstuff excels that of de-
hydration. Apart from the element of cost, the use of an extreme degree
of heat to drive out moisture has the objection that in some cases it so
alters the product that it is no longer an agreeable article of diet. Heat
also removes desirable volatile ingredients. It may be pointed out that
flavors, which play a very important part in rendering a food palatable
and acceptable, are, as Mendel shows, not always thermostabile.
The most destructive criticism that can be brought against the use
of heat, particularly at high temperatures, as a mode of drying food-
stuffs is that high temperatures for a prolonged period are liable to
APPLICATION OF DEHYDRATION TO FOODS 33
seriously injure the vitamiue element. The presence or absence of this
element, in fact, when a diet is restricted to one or two food materials,
makes all the difference between health and disease. Therefore it would
seem to be the bounden duty of those engaged in the dehydrated food
industry to take every precaution not to destroy or injure these "accessory
diet factors" known as vitamines. It is stated by those who have had
experience with the American process of dehydration that because the
heat employed is not intense, and because the time during which the
food material is subjected to the process is not long, that the vitam-
ino substances are in no wise prejudicially affected. The main dehy-
drating characteristics of the system are the comparatively low tempera-
ture which insures the retention of all the valuable properties of the food
treated and the thorough circulation of the air currents which permeate
vegetables or fruits in such a way that most -effective dehydration is the
result.
Enough has been said as to the system of dehydration best calculated
to fulfill the purpose desired, and the only excuse for being somewhat
prolix about the matter is that the success of a dehydrating method
depends entirely upon its mode of working. If the finished product, to
use a rather clumsy expression, is not as nutritive, palatable and attractive
in appearance when prepared for the table as the vegetable in its original
form, or nearly so, then its other obvious advantages small bulk and
keeping properties cannot compensate for this lack.
Dehydrated Potatoes. The potato is, of all the vegetables, the most
important. Of the starchy group the common potato easily occupies the
first place, both in regard to nutritive value and to the wide range of its
cultivation. In this country the sweet potato comes next in popularity,
usefulness and consumption. In 1909(11) it was shown that in the
average of 376 American dietary studies, potatoes were found to furnish
12.5 per cent, or about one-eighth, of the total food material, and 8.3 per
cent, or about one-twelfth, of the carbohydrates. All other vegetables
together furnished only 7.8 per cent of the total food and 3.7 of the carbo-
hydrates. The structure, composition and nutritive properties of the
potato have been exhaustively dealt with in Volume I, Chapter XIII,
therefore it will be superfluous to discuss this phase of the question
further. Attention will now be concentrated upon a consideration of
dehydrated potatoes, their virtues and drawbacks.
METHODS OF DEHYDRATION. It may be well imagined tliat efforts
have been made to preserve, in a compact form, a food substance of so
great value in the diet as is the potato. This object has been brought
34 PKESEKVATION OF FOODS BY DEHYDRATION
about by drying, which reduces their bulk and prevents decay. The
word drying is used here intentionally, because dehydration is a recent
method, and potatoes have been dried in various ways for a great num-
ber of years. The method known as "chunno" is one of the oldest and
has been employed in Peru for a very long time. This procedure consists
of pressing part of the juice out of the potatoes, which are then dried in
the air until they are reduced to about one-fourth of their original weight.
Methods of a similar kind have been and are practiced in Europe and
America, and while these differ considerably, one of the main objects
to be attained always remains the same, namely, the inhibiting of the
growth of germs.
As has been pointed out previously, decay is mainly caused by bac-
teria, which can only grow where moisture and warmth exist, so that, if
moisture be removed, growth is inhibited, and the keeping qualities of
the potato are prolonged indefinitely.
COMPOSITION OF DEHYDRATED PRODUCT. The composition of pota-
toes which have undergone one of these processes is here given, together
with the composition of raw and cooked potatoes, for purposes of
comparison :
COMPOSITION AND FUEL VALUE OF THE POTATO UNDER
VARIOUS METHODS OF PREPARATION
KIND OF FOOD
Refuse
Per cent
Water
Per cent
Pro-
tein
Per cent
Fat
Per cent
Sugar,
starch,
etc.
Per cent
Crude
fiber
Per cent
Ash
Per cent
Fuel
value
per
pound
Calories
Potato as pur-
chased
20.0
62.6
78.3
75.5
75.1
2.2
7.1
35.3
1.8
2.2
2.5
2.6
6.8
8.5
9.2
.1
.1
.1
3.0
29.8
.4
1.3
13.8
18.0
20.3
17.5
46.7
80.9
52.6
.9
.4
.6
.5
.8
1.0
1.0
1.5
4.5
3.1
1.1
310
375
440
505
2,675
1,680
1,215
Potato, edible por-
tion
Potato, boiled .
Potato, mashed
and seasoned . .
Potatoes, fried in
fat, "potato
chips"
Potato, evap-
orated
White bread. . . .
Naturally, if extreme heat is used in the process, some of the starch
content may be changed into dextrin and other minor changes in the
chemical composition may take place. However, there is no reason to
APPLICATION OF DEHYDRATION TO FOODS 35
suppose that the nutritive value of the potato is decreased by these changes.
Lang-worthy, in the bulletin referred to above, states that various
kinds of desiccated potatoes have been studied at the California Agri-
cultural Experiment Station. Their water content ranged from 4.8 to
7.!) per cent and their total carbohydrates from 77.9 to 80.6 per cent.
Their general composition somewhat resembled that of good white flour.
They contained slightly less water, slightly more carbohydrates and
noticeably more mineral matters. Dehydrated potatoes should be soaked
in water before use, in the same way as other dehydrated vegetables. By
this means they will regain some or most of their original properties.
POTATO FLOUR. With regard to the value of potato flour, which, as
just pointed out, resembles good white flour: it has been frequently em-
ployed in the manufacture of what have been termed "economy breads."
The potato is very largely grown in Germany, and in that country the
value of the addition of potato meal to wheat flour for the purpose of
making bread of a cheaper sort was recognized in 1914 as an economical
war measure. In Germany and Austria the bakers were compelled by
law to use at least 30 per cent potato meal in making their bread.
It has been found, as the result, of experiments made by the Bureau of
Chemistry of the U. S. Department of Agriculture, that the most satis-
factory loaves, combining economy and appearance, were those made
with 30 per cent potato meal, or even less. The bread has a rather coarse
texture and dark appearance, but is said to possess a distinctive and
pleasant flavor. It should be said that the Bureau of Chemistry em-
ployed the imported "potato flake" in some of its experiments and in
others meal made by slicing, milling and drying potatoes on a small
scale in its laboratories.
Sweet Potato The sweet potato, from a nutritive point of view, that
is, from an analysis of its component parts, is similar to the ordinary
kind. It contains rather less water and rather more carbohydrates, and
supplies somewhat more tissue-building material, pound for pound. The
carbohydrates found in sweet potatoes contain more sugar than in the
white varieties, but the proportion of sugar and starch varies with the
climate. In hot countries there is more and in temperate climates less
sugar.
Dried sweet potatoes were at one time a home product. In days long
passed, strings of them might be seen hanging from the kitchen rafters
in the company of apples and other dried fruits and vegetables. Modern
drying methods and storage warehouses have almost sounded the death-
knell of this custom. When sweet potatoes are first gathered, they
36 PRESERVATION OF FOODS BY DEHYDRATION
are allowed to "sweat" for some time before they are stored. When
grown on a large scale they are sometimes "kiln-dried," that is, sub-
jected to a temperature of 90 F. or thereabouts for a week or so. They
are then dried more slowly and at a lower temperature in the usual way.
Special devices for dehydrating sweet potatoes, in the. same way as white
potatoes and other vegetables, are now largely used. While the greater
part of the sweet potato crop is used for human food, stock are fed with
some of the coarser kinds; some also are used for the preparation of
sweet potato flour.
Starch-yielding Tubers. The tubers are sliced, dried and ground.
They are also used for the manufacture of starch. There are several
tropical starch-bearing roots, as the cassava, yam, yautia and taro. The
cassava is very nutritious, and its meal makes an excellent bread which
is palatable and wholesome. Analysis of this vegetable shows water
content 10.5 per cent, protein 9.1, fat 0.3 per cent, total carbohydrates
79, and a fuel value of 1,650 calories per pound. Yams, often con-
founded with sweet potatoes, belong to a group of climbing plants. The
flours and starches prepared from these differ from wheat flour in that
they contain no true gluten.
Beets.; Of the succulent roots, tubers and bulbs, beets are, on the
whole, the most important. These possess considerable value as -food ;
directly they are used as vegetable food, also as the source of the sugar
supply; indirectly they contribute on a very wide scale to the food of
the inhabitants of all the world by furnishing provender for farm animals.
BEET-SUGAR INDUSTRY. No industry in America is more likely to
be revolutionized by the improvements effected in the methods of dehy-
dration than the beet-sugar industry. In 1916 the area used for beet
cultivation amounted to 680,000 acres, the beets totalled 6,671,000 short
tons, and the production of sugar was in the neighborhood of 900,000
tons. In this country undoubtedly sufficient beets can be grown, and
consequently enough sugar can be produced therefrom to make us inde-
pendent of outside supplies. Many difficulties arising in the manufacture
of beet sugar may be wholly or partially solved by dehydration. Where
sugar beets are not grown near a factory, the transportation is, generally
speaking, too costly to render their cultivation profitable. In the next
place, the time for harvesting is short, and in order to preserve the
surplus supply, that is, the stock which the sugar factory temporarily
cannot deal with, it is frequently deposited in silos. An inevitable loss
occurs, owing to fermentation or even to decay of the beets. Also, under
existing circumstances, a beet-sugar factory is compelled to remain idle
APPLICATION" OF DEHYDRATION TO FOODS 37
during some nine months of the year, simply because beets can be sup-
plied to it only for a hundred days or so yearly.
ADVANTAGES OF DEHYDRATION OF BEETS. The economic gain due
to methods of dehydration would be very great, and the cost of sugar
reduced a great deal, if these factories could work from the beginning
to the end of the year. The advocates of dehydration claim that the
adoption of this process in the case of sugar beets would bring about an
ideal state of affairs. Certainly it would be possible to convey the beets
long distances at a little cost on account of their small bulk, and it
would also be possible to keep them without risk of deterioration until
sitch time as it was most convenient to use them. The new scheme pro-
vides for the establishment of dehydrating plants at points near refineries,
anywhere near railroads in a zone of four hundred miles therefrom.
The beets received from the farmers of the neighborhood at the
dehydrating plants could be cut into small slices, cassettes, and at once
dehydrated in this form, which is suitable for refining later. One short
ton of beets is reduced in weight to 500 pounds by the process. Accord-
ing to R. G. Skerrett, referred to previously, the percentage loss of
cossettes, measured by dry substance polarization, was only 1.66 after
730 days, and curiously enough there was a decrease of nearly 50 per
cent of the original moisture. Furthermore, on account of the relatively
low temperature employed, enzymic action was not impeded by dehydra-
tion, and sugar production continued for a time. Hence, dehydration
of the cossettes by the most recent process actually promotes this con-
version of normal sugar of the beets and reduces the cost of running the
refinery and of transportation. If this novel process of dehydration
exercises such an effect upon beets, there is no need to expatiate on its
self-evident value.
Carrots, Parsnips, Salsify, Turnips. Of the other so-called succulent
root crops used as food, carrots, parsnips, salsify, turnips and onions
are the most common. Carrots are dehydrated 011 a large scale and
resemble fresh carrots in composition.
Dehydrated Foods Used in the Army In feeding the soldiers of the
Allied Forces it was naturally a stupendous task to keep them supplied
with wholesome and nourishing food. Well-balanced rations are essen-
tial to the maintenance of good health, and especially to men engaged
in the arduous and devitalizing duties of trench warfare. In order to
have a well-balanced diet a sufficient quantity of vegetables is needed;
but in view of the difficulties of transportation across the Atlantic, the
tonnage of this enormous amount of vegetable foodstuff had to be kept
38 PRESERVATION OF FOODS BY DEHYDRATION
FIG. 1. THE VEGETABLES AT THE RIGHT, WHEN DRIED, WILL HAVE ONLY THE BULK OF
THE SMALL PILE AT THE LEFT. (Courtesy of the Scientific American.)
FIG. 2. THE BUCKET AND MILK BOTTLES CONTAIN THE WATER EXTRACTED FROM THIS
Box OF VEGETABLES. (Courtesy of the Scientific American.)
APPLICATION OF DEHYDRATION TO FOODS
39
as low as possible, while at the same time furnishing the field kitchens
with adequate stores. It was entirely beyond the scope of human en-
deavor, in fact, for the warring governments to ship whole cargoes of
fresh vegetables in cold storage and later to transfer and convey them
many hundreds of miles to the firing lines. For a long time canned
vegetables were in great demand, indeed vegetable food was shipped
FIG. 3. THIS BARREL OF DEHYDRATED VEGETABLES REPRESENTS THIRTY BARRELS OF
GREEN VEGETABLES. It is sufficient to make soup for 6,000 men. (Courtesy of the
Scientific American. )
mainly in this form. The French were the first to recognize the possi-
bilities of dehydrated vegetables as an economical measure, and from
this country and Canada have imported tremendous quantities of vege-
tables treated by this process. Celery, cabbage and carrots are largely
grown in Monroe and Wayne counties, New York, where there are a
large number of evaporators. Accordingly this part of New York State
was drawn upon for supplies of these dehydrated vegetables. At the
40 PRESERVATION OF FOODS BY DEHYDRATION
time of writing the French Government contracts with a produce com-
pany of Belleville, Ontario, to furnish its War Department with all the
dehydrated vegetables it can supply. The vegetables desired are celery,
cabbage, carrots, onions, potatoes and turnips. These crops when dehy-
drated are mixed after a certain formula and placed in fifteen-pound
cans, which are sealed and shipped to the French Army, where they are
used for making stews for the soldiers.
Celery Celery for dehydrating purposes may be in almost any con-
dition, as long as it is free from disease. Any variety may be used, but
the unblanched green winter kind is preferred, as it retains its flavor
and color best. The celery is packed in the rough or is conveyed loose
to the evaporator, where it is weighed and stacked ready for further
preparation and treatment. After the roots and dead leaves have been
removed, the celery is placed in the washing vat, thoroughly cleansed,
and is then carried to the cutting machine, whence the shredded celery
drops into a box through which runs a continuous belt elevator. In th;s
manner the shredded material is taken to the second floor, where it is
caught in large baskets and conveyed to the drying bins.
METHOD OF DEHYDRATION. The kiln method is employed here
which is fully described in Farmers' Bulletin No. 291. Before placing
the shredded celery in the drying bin, the kilns are heated to a tempera-
ture of 160 to 180 F. After the process has been completed the celery
is shoveled from the bin and placed in bags for shipment.
Cabbage, Onions, etc. The processes involved in the dehydration of
cabbage are similar to those used for celery, except that the cabbage is
not cleaned before shredding. The method used in drying onions is
very like the method just described. The preparation of the product
before shredding, however, is different. The tops and remains of roots
are removed by hand and the onion is peeled by machinery. It is
shredded before being elevated to the drying bins. The relative weights
of green vegetables and those which have undergone the. kiln evaporator
process are as follows :
1 ton of green celery .... 150 pounds when dried
1 ton of green cabbage ... 150 to 175 pounds when dried
1 ton of green carrots .... 200 pounds when dried
1 bushel of onions 5 pounds when dried
Under the contract with the French Government the finished product
is allowed to contain, at the maximum, 15 per cent of moisture. This
requires a drying period of from twelve to fourteen hours, according to
APPLICATION OF DEHYDRATION TO FOODS 41
the degree of heat produced by the kilns. The cost of treating the vege-
tables by the above process is as follows:
Green celery .$10 per ton
Cabbage $8 per ton
Carrots $10 per ton
Onions 10 cents per bushel
ADVANTAGES OF THE KILN METHOD FOR THESE VEGETABLES.
The kiln process has been in vogue the longest and is at the present time
most used in this country. The use of circulating heated air at a com-
paratively low temperature for dehydrating vegetables is theoretically
scientific and practically is superior to methods which rely upon heat
alone, or mainly, as a means of dehydration. Turnips, parsnips and all
other vegetables can be dehydrated, and the description of the procedure
followed in one case will apply to all. Fresh carrots contain : refuse, 20.0
per cent; water, 88.2 per cent; protein, 1.1 per cent; fat, A per cent;
sugar, starch, etc., 8.2 per cent; crude fiber, 1.1 per cent and ash, 1.0 per
cent. The fuel value per pound is 210 calories. Carrots dried by the
kiln process contain: water, 3.5 per cent; protein, 7.7 per cent; fat, .6 per
cent; sugar, starch, etc., crude fiber, 83.3 per cent; and ash, 4.9 per cent.
Fuel value per pound, 1,790 calories.
Beans It is often said, and indeed the view is widely circulated,
that dried legumes are the rational and the best substitutes for meat.
This is true to a large extent, as the dried legume is very rich in protein
and in energy-giving constituents. However, drawbacks exist in certain
legumes, principally in beans, which somewhat detract from their food
value. In the first place, in preparing beans for the table by the usual
methods, they become less concentrated, whereas the cooking of meat
renders it more concentrated. In the one case water has been added;
in the other water has been removed by the roasting or broiling. Dried
beans are also liable to cause flatulence, due to the slow rate at which
they are digested and, perhaps, to their sulphur content. Still, it can-
not be denied that dried beans and lentils are wholesome, valuable and
nutritious foods which may be prepared in many ways as the staple diet,
and which are, all in all, the most satisfactory substitutes for meat.
COMPOSITION OF FRESH AND DRIED BEANS. The following table,
taken from Farmers' Bulletin 121 315 of the U. S. Department of
Agriculture, shows the composition of fresh and dried legumes, compared
with that of some other foods:
42 PRESERVATION OF FOODS BY DEHYDRATION
COMPOSITION AND FUEL VALUE OF FRESH AND DRIED
LEGUMES
MATERIAL
Water
Protein
Fat
Carbo-
hydrate
Ash
Fuel
value
per
pound
Fresh legumes:
String beans
Per cent
89.2
Per cent
2.3
Per cent
.3
Per cent
74
Per cent
.8
Calories
195
" peas. .
81.8
3.4
.4
13.7
.7
335
Shelled kidney beans ....
" lima beans
58.9
68.5
9.4
7.1
.6
.7
29.1
22.0
2.0
1.7
740
570
u peas
74.6
7.0
.5
16.9
1.0
465
u cowpeas
65.9
9.4
.6
22.7
1.4
620
Canned string beans
" lima beans. .
93.7
79.5
1.1
4.0
.1
.3
3.8
14.6
1.3
1 6
95
360
" kidney beans. . . .
" peas
72.7
85.3
7.0
3.6
.2
.2
18.5
9.8
1.6
1.1
480
255
Dried legumes :
Lima beans
10.4
18.1
1.5
65.9
4.1
1,625
Naw beans
12.6
22.5
1.8
59.6
3.5
1,605
Lentils
8.4
25.7
1.0
59.2
5.7
1,620
Peas
9.5
24.6
1.0
62.0
2.9
1,655
Cowpeas
13.0
21.4
1.4
60.8
3.4
1,590
Soy beans
10.8
34.0
16.8
33.7
4.7
1,970
Chick peas
14.8
12.4
6.7
63.3
2.8
1,690
As the great majority of these legumes are lacking in fat, it is a
rational and natural proceeding to add salt pork to the baked beans and
bacon to cowpeas.
It may be estimated that a pint of these dried legumes and a half
pound of pork have a protein content exceeding a pound and a half of
uncooked meat of average composition. Moreover, since this combina-
tion is rich in starch as well as in fat and protein, it may serve as a
substitute for potato and meat.
LIMA BEANS. Lima beans possess great fuel value. They are, how-
ever, not sufficiently appreciated as a table food because it is not generally
known that they can be used in a dried state in practically the same
manner as are the common beans. In reality they are richer and more
delicate in flavor than the common beans.
SOY BEAN. In far Eastern countries, where the supply of animals
suitable for food is small and where a large proportion of the inhabitants
are interdicted by religion and caste from killing or eating animals,
recourse has been had to the vegetable kingdom to make up this lack of
animal food. Legumes are the vegetables used, the soy bean in particu-
APPLICATION OF DEHYDRATION TO FOODS 43
lar. Although somewhat of a digression, it will not be out of place to
state in this connection that the soy bean is more important than rice
as food for the inhabitants of Asia. The idea is popular that the people
of India and China subsist almost wholly upon rice, whereas the truth
is that, while enormous quantities of rice are consumed in these coun-
tries, the soy bean supplies the protein element essential to the conser-
vation of health.
The soy bean is employed by these peoples in a variety of ways.
The nitrogenous material and a considerable amount of the fat of the
beans are separated and made into a number of special articles of diet,
as bean cheese or bean curd, and soy, a thick brown sauce used by millions
of people as a flavoring material and condiment. By this means the
necessary nitrogenous element and flavor are added to the otherwise taste-
less rice, vegetables and other foods which form their diet.
SOY BEAN FLOUR. A soy bean flour has been made which is said by
Friedenwald and Ruhrah(12) to be most useful. It has the following
composition :
Constituent Per Cent
Protein 44.64
Fat 19.43
Mineral matter 4.20
Moisture 5.26
Crude fiber 2.35
Cane sugar 9.34
Non-nitrogenous extract 14.78
Starch none
Reducing sugars none
Polarization normal weight due to optically active 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 remov-
ing the coarse fibrous hulls which contain little protein. The composition
of this flour may be compared with round of beef, medium, which con-
tains: protein, 10.0 per cent; fat, 12.8 per cent; and moisture, 60.7 per
cent. Each ounce of this soy gruel flour yields about 13 grams of pro-
tein and 120 calories. It can be used as a gruel, in broths and in
making biscuits.
COOKING OF BEANS. As W. S. Hall(13) has pointed out, dried
legumes require very thorough cooking, considerably more than other
foods. This prolonged cooking is necessary because the nutrients, en-
44 PRESERVATION OF FOODS BY DEHYDRATION
closed within the walls of the plant cells, are inaccessible to the digestive
juices until the cell walls have been broken down by cooking and masti-
cation. The grinding of dried legumes into meal greatly facilitates the
cooking and the mastication, and in consequence the digestibility. Owing
also to the fact that dried legumes, such as navy beans and dried peas,
are somewhat difficult of digestion, unless made into purees, they are less
well adapted for general use in the dietaries of people of sedentary occu-
pation than for those who are engaged in active out-of-door pursuits.
FOOD VALUE OF BEANS. The high nutritive value of dried beans,
cowpeas and other legumes, due to their protein content, renders this
class of food very useful as meat substitutes. Comparing the nutritive
value of dried legumes and meat, it is found that two-thirds of a pint of
dried beans, cowpeas or lentils is equal to one pound of beef of average
composition.
Corn In earlier times corn was dried or evaporated for domestic
use by most housewives in rural districts, and at the present time sweet,
corn in the milky stage of its development is frequently preserved by
means of dehydration. Sweet corn is a satisfactory vegetable to dehy-
drate. It retains its flavor and sugar content to a remarkable degree.
RELATION OF SPOILED CORN TO PELLAGRA. One of the chief theories
as to the causation of pellagra is that it is due to the eating of spoiled
corn, the staple diet of the inhabitants of those countries or districts in
which the disease is most prevalent. In Italy, this belief, inspired and
fostered by the views of Lombroso, has been responsible for prophylactic
measures directed mainly against the use of damaged corn as an article
of food. Dehydrating or desiccating plants have been established for
the artificial drying of corn there to prevent waste. These desiccators
are of two types, fixed and portable. At present there are a large num-
ber of public plants for dehydrating corn throughout Italy.
Use of Vegetable Flours. In a previous part of this chapter reference
has been made to "economy loaves." These are made partially or wholly
from a flour less expensive in these days and more easily obtainable
than wheat flour. The advantages of dried bananas among the fruit
products and dehydrated potatoes among the vegetable products were
discussed. Other flours made from fruits and vegetables from dried
chestnuts, the soy bean, the white bean and several other varieties of
bean, cottonseed, cassava and peas offer promise of furnishing the
public with a cheap and nutritious bread. The soy bean and cottonseed
flours when mixed with wheat flours in proper proportions, about 25 per
cent, furnish a bread with about twice the amount of protein that ordinary
45
wheat bread contains. Stress should be laid upon the fact that wheat
flour is not essential for the production of a good, nutritious and whole-
some bread. A bread made of some other cereal, of corn, for example, will
in almost all respects equal bread made from wheat flour. The addition
of a vegetable or fruit to wheat flour, as the dried potato, bean, banana
or chestnut, will not detract from the food value and will be more eco-
nomical and quite as satisfactory as a bread made from wheat flour,
cornmeal or rye flour alone.
Yeast. A food material which comes under the head of vegetable
products and which when dehydrated is now somewhat largely used as
food for man and beast, is yeast. The main object in drying yeast is
to utilize to the fullest extent its excellent food properties and to make
it available for transportation over long distances. Up to the present
time the constructors of yeast dehydrators have relied chiefly upon the
experience gained in the construction of potato driers. The working
principle of all the yeast driers on the market is practically the same.
The moist yeast passes over steam-heated cylinders, where it is freed
from most of its water in the fraction of a minute. Scientific researches
have shown that dehydrated yeast is one of the richest of concentrated
foods, and attention may be called to the fact that the food value of such
yeast cannot be estimated in the same way as the food value of other
foods, such as potatoes, wheat or corn. It is considerably higher on account
of special dietetic properties. Yeast has a very high vitamine content.
Dry yeast has given good results when fed to domestic animals. It is
stated that when milch cows are fed upon it the yield of butter is increased.
According to J. C. Smith (14), it has been demonstrated that a
great many inexpensive and nutritive dishes can be prepared from de-
bittered, dried yeast, and physiological experiments have shown that this
food yeast is wholesome and very easily digested. Experiments have
shown that one pound of dried yeast is equal in food value to 3.3 pounds
of average fat beef, and furthermore its advocates state that it is not
only valuable as an article of food, but is indicated as a means of invig-
orating devitalized individuals.
SUMMARY
The domestic dehydration of vegetables and fruits is becoming a
quite common practice. The best and most efficient form of a home
dehydrator is that which withdraws the water by the agency of dry
steam, and not by hot air.
46 PRESERVATION OF FOODS BY DEHYDRATION
Success of Dehydration. Practically all vegetables and fruits can be
successfully dehydrated commercially by employing heated air at a com-
paratively low temperature for a rather short period of time. In this
process the air currents should thoroughly penetrate the vegetables and
fruits subjected to the treatment. To a lesser extent the above remarks
apply to the dehydration of animal foods. Meat does not lend itself
particularly well to this mode of preservation, but the desiccation of
milk with retention of its solubility, nutritive properties and vitamine
elements intact, if not an accomplished fact, is in a fair way of becoming
so ere long. As Mendel has said, "If the best dried milk of the future
shall be shown to retain even the more subtle physiological properties,
such as its antiscorbutic potency, it will represent good achievement."
A dried milk does not deteriorate and is sterile, most important factors
in the conservation of the public health.
With the possible exception of milk, the dehydration of animal foods
has not been as successful as in the case of vegetables and fruits. The
dehydration of fruit is quite satisfactory, so also is the dehydration of
vegetables. The flavor and taste of certain fruits are more apt to be
altered or attenuated than that of vegetables.
Economic Advantages. From the economic aspect, dehydration of food-
stuffs seems destined to revolutionize the entire food situation. The
immense waste of vegetables and fruits which is now universal should be
prevented in the future. The farmer or producer of food products will
be independent of the local markets. His produce will be dehydrated
on the most approved system at a nearby plant. Such produce, on
account of its keeping properties, comparative lightness and small bulk,
can be delivered at a low cost in this country or abroad. Vegetables
weighing a pound can be transported thousands of miles and made into
soup or stew sufficient for fifty or sixty hearty adults.
The value of dehydration methods of preserving food to exploring
parties, to workmen engaged in operations in out-of-the-way parts of the
world and so on, is so patent as to require neither emphasis nor elabo-
ration. Enough has been said on the subject of dehydration to show that
when carried out in a strictly scientific manner, it is a long step in the
direction of the ideal system of economizing the food supply of a nation.
In this chapter a certain amount of repetition may be observed.
This has been done intentionally in order to emphasize the need for
economy of food products and to draw attention to dehydration as an
important factor in the achievement of this object.
The war has had some redeeming features, some advantages to
SUMMARY 47
counterbalance, in a slight degree, the dreadful loss of human life and
the reversion to barbarism which have blackened its course. It has
aroused the race from the slough of self-indulgence and apathy with
which many years of peace and prosperity had imbued its members,
and has taught them with the whip of adversity that self-restraint and
endurance were still to be regarded as high among the cardinal virtues.
Perhaps no calamity brought about by the war has served better to teach
this lesson than the lack of food. Shortage of the food supply quickly
brings home to all sorts and conditions of men and women the truth
that food is after all one of the essentials of life and that without a suffi-
cient provision of food, life is hardly worth living. Consequently, one
of the effects of the war has been to quicken man's brain to devise means
for producing more food, to economize that which has been produced,
to search out and cultivate foods which can be more easily and cheaply
produced, and to be satisfied with simpler and more wholesome food
products. The fear of famine has spurred him on in this endeavor.
Therefore it may be said with truth that the war will be responsible for
at least a partial, if not the complete, solution of the food problem, and
that the development of such measures as dehydration of foodstuffs is
an indirect consequence of the war.
REFERENCES
1. SKERRETT, R. G. Scient. Am., March 10, 1917.
2. BURGESS, H. J. Pure Products, Aug., 1914.
3. WELLS, LEVI. Yearbook of the Dept. of Agric., 1912.
4. PRITOHARD, ERIC. The Infant, Nutrition and Management.
5. CAUTLEY. Sutherland's System of Diet and Dietetics.
6. PENNINGTON. IT. S. Dept. of Agric., Bur. of Chem., Circular 98.
7. STILES and BATES. U. S. Dept. of Agric., Bur. of Chem., Circu-
lar 104.
8. BURGER, A. F. Pine Products, Oct., 1913.
9. LANGWORTHY, C. F. Yearbook of the Dept. of Agric., 1912.
10. GOULD, H. P. U. S. Dept. of Agriculture, Farmers' Bull. 293.
11. LANGWORTHY, C. F. U. S. Dept. of Agriculture, Farmers' Bull.
295.
12. FRIEDENWALD and RUHRAH. Diet in Health and Disease.
13. HALL, W. S. Nutrition and Dietetics.
14. SMITH, J. C. Pure Products, Aug., 1913.
CHAPTER III
SCIENTIFIC COOKERY
H. S. GKINDLEY, B.S., Sc.D.
We may live without poetry, music and books, but civilized man cannot live
without cooks. (Owen Meredith.)
History of Cooking.
Principles of Scientific Cooking: Changes Produced by Cooking; Evil
Effects of Poor Cookery.
Varieties of Cookery: Meat Boiling, Stewing, Frying, Baking, Roasting,
Broiling, Braising, Steaming; Losses in Cooking Meat; Cooking of
Fish ; Cooking of Vegetable Foods.
Food Concentration: Desiccation; Concentrated Proteins; Dried Vegeta-
bles; Desiccated Milk; Desiccated Eggs; Meat.
HISTORY OF COOKING
Cooking as an art has been developed from the crude methods used by
primitive peoples from almost the beginning of time. The early Egyp-
tians, it is said, had professional bakers. We read of their roasting and
boiling the flesh of oxen. The Greeks attributed the discovery of bread-
making to the god Pan, but bread was in use among the Chaldeans and
Egyptians before the Greek gods had their inception. Ching-Nong, 1998
B.C., is reputed to have been the first who taught men the science of mak-
ing bread from wheat. So we see that bread is a very ancient food, its
origin being lost in the mists of antiquity. In the days of the patriarch
Abraham, his wife, Sarah, made cakes which were thought to be a fit offer-
ing for angels. Prior to the bondage of the Israelites in Egypt, baking
had become a highly perfected art. The Egyptians used many varieties
of flour and made cAkes of various kinds and shapes. According to sacred
history, one of the most important servants in the service of Pharaoh, dur-
ing Joseph's regime, was a professional baker.
49
50 SCIENTIFIC COOKERY
There appears to have been considerable difference as to the manner
in which good eating was appreciated by the early Greeks. After the
Homeric age of simplicity, in which roast and boiled meats seem to have
sufficed the kingly table, a diversity of preparation was attained in cook-
ing, and a certain epicureanism was displayed in the quality, seasoning
and method of dressing food. The Greeks boiled and roasted the flesh of
sheep, pigs, lambs and goats. They cooked poultry, small birds, game and
sausage. Fish was the principal article of food \vith all classes of Greeks,
but with the wealthier classes much skill and delicacy were attained in
the stuffing and cooking of fish. The Romans (1) were not far behind
their Greek brothers in the culinary art ; by degrees, however, a taste for
better eating crept in ; and after the Asiatic conquest, luxury in eating
w r as introduced by Lucullus. There is plenty of evidence that primitive
peoples of all races, savage, semi-savage and civilized, barbecued their
meats over heaps of live coals, or roasted over the coals pieces of flesh
cut or torn from big game. Small animals were sometimes roasted whole
over the coals and sometimes they were incased in mud and then baked in
hot ashes.
Prehistoric man may have lived wholly on raw food, berries, fruits,
shellfish, etc. (see Chapter I, Volume I, The Evolution of Man's Diet),
but this diet is not suited for most races of man today, although the north-
ern Eskimo still prefers to eat his meat raw and frozen. While it is pos-
sible for man to live upon raw food for a considerable length of time, it
is apparently designed by nature that a large portion of his food should
be cooked, for there are no savage races who do not practice the art of
cooking, in however elementary a fashion, and progress in the scale of
development and civilization is uniformly accompanied by advance in the
art of cooking.
Of ancient British cookery very little is known ; no doubt it was crude.
We find but little mentioned of the art of cooking in the Saxon Chronicles.
The Danes and Germans appear to have been great drinkers and to have
paid little attention to the preparation of foods. The Normans were more
particular in these matters ; some offices among them were held by right
of the kitchen. We do know, however, that the mortar was extensively
used by the Anglo-Saxons and that oil and lard were used instead of butter.
The French were the first to introduce art into the process of prepar-
ing foods, but it was not until the introduction of Italian taste by the prin-
cesses of the House of Medici that cooking became an art. The ancient
use of oil was modified through the discovery made by the French of
dressing meat in its own gravy, and at the present day it is universally
PRINCIPLES OF SCIENTIFIC COOKING 51
admitted that the French cook is a true gastronomic artist, and it is for
his perfection in this art that all the hotels of any importance in this
country employ a Frenchman to till the post of chef de cuisine. The esti-
mation in which his services are appreciated may be understood by the
large salary attached to this office in fashionable hotels and club houses.
A visit to the kitchen of one of these establishments shows what a highly
important post he fills. Such a person should know not only how things
are to be done, but he should have the organizing ability to arrange and
direct the work of the numerous assistants.
During the past decade the art cf cooking as a branch of woman's edu-
cation has been given considerable attention in this country. Domestic
science classes, in connection with universities and other institutions of
learning for young women, have been established in New York, Boston,
Philadelphia and other places.
PRINCIPLES OF SCIENTIFIC COOKING
It is an error to suppose that cooking increases the digestibility of all
food ; this is not the case with animal foods, as cooking diminishes rather
than increases their digestibility. Proper cooking increases the digesti-
bility of vegetable foods by breaking down their cellulose coverings,
thereby allowing rupture of the starch grains, which aids the free admix-
ture of the digestive juices and hastens the chemical process of diges-
tion (1).
Generally speaking, all foods except fruits having organized structure
require cooking. It is well known that the majority of fruits, and some
vegetables, are eaten raw by preference, without interfering with the appe-
tite ; but food from the animal kingdom, as a rule, requires thorough cook-
ing. Raw animal food has been eaten by man, but it becomes wearisome :
an exclusive animal diet soon excites disgust. Milk, eggs, oysters and
clams are an exception.
While the physician need not be a cook, he should understand the gen-
eral methods of preparing foods, and should know the ingredients of com-
pound dishes just as thoroughly as he knows the meaning of Galenical
terms and the ingredients of tinctures, compound powders, pills, etc. If
he is ignorant of the composition and proper preparation of foods, he can-
not intelligently supervise the diet of his patients. He should study
dietetics exactly as he studies the pharmacopoeia or a work dealing with
pharmacognosy or materia medica, not that he need master the art either
of cooking or pharmacy, but that he may have an intelligent, general com-
prehension of both subjects.
52 SCIENTIFIC COOKEKY
The essential part of all cooking processes is the scientific application
of heat, and it is important to have a clear understanding of the effects
of heat upon the various chemical constituents of food. For instance, heat
coagulates the protein of foods ; still it would be erroneous to suppose that
a boiling temperature is necessary to bring about this change, since pro-
teins, both animal and vegetable, are coagulated if their temperature is
raised to 170 F. Ignorance of this fact is a fertile source of error in
cooking. When the temperature of a piece of meat is raised much above
this point, the protein is hardened and shrunken, and the digestibility of
the meat is proportionally lessened.
The vegetable foods are more readily affected by heat than animal
foods, and of the carbohydrate foods, starch is most affected. Dry heat
applied to raw starch converts a portion of it into soluble form, and ulti-
mately into dextrin. This is accomplished, to a slight extent, in the outer
crust of bread and in the preparation of toast. Moist heat applied to
starchy foods causes the starch molecules to swell, bursting the cellulose
coverings, when the foods are said to be gelatinized. This occurs below
the boiling point of water, as shown by the following table giving the
gelatinization points of different kinds of starch :
GELATINIZATION POINTS OF VARIOUS STARCHES
Oats 185 F.
Barley 176 F.
Rye 176 F.
Wheat 176 F.
Rice 176 F.
Maize ....r 167 F.
Potato 149 F.
From the above table it is observed that the gelatinization of starches
can be effected at comparatively low temperatures. In the chapter on
Sugars, Spices and Condiments (Volume I, Chapter XVII), the effect of
heat on sugar has been described, and therefore it need only be mentioned
here that the partial conversion of sugar into caramel is one of the means
by which flavor is developed in the meals by cooking.
Fats are less affected by heat than proteins and carbohydrates. When
subjected to high temperatures, however, a portion at least of the fat may
possibly undergo a partial decomposition with the liberation of free fatty
acid (2). This explains why hot fat is much more apt to prove irritating
to the stomach than cold fat, for it is quite probable that the fatty acid
may reunite with glycerin to form neutral fat on cooling. Fat which has
PRINCIPLES OF SCIENTIFIC COOKING 53
been heated and allowed to cool is often found to have become granular
in appearance. This change is no doubt brought about by driving off
water, and it tends to render the fat more brittle, and consequently easier
to digest. This change is apparent to anyone who has watched the "drip-
ping" or "rendering" of lard, or the process of drying bacon.
The great difference between the French, English or American cook-
ing consists in the fact that the French cook their meat much longer.
They are therefore enabled to make a variety of dishes by altering or
annihilating the original taste of the meat and making it a vehicle for
foreign flavors. The variety, daintiness and. grace of form which dishes
thus acquire are very admirable. The French cook throws nothing away.
Instead of going to the butcher for meat for stock, as the American cook
does, he uses the trimmings for stock and the skimmings of his boiled
meats in many combinations where the American uses butter or lard; like
every skilled workman, lie produces great results from small means.
Changes Produced by Cooking Efforts are being made to teach cook-
ing in the public schools, and in this respect much good work is being
accomplished. For any shortcomings in cooking, however, the taste of the
American is in some measure accountable. The results of cooking food
are as follows:
(a) Cooking develops certain savory flavors in food more particu-
larly in meat which are agreeable to the palate, and thereby enables man
to secure a variety in taste which is often important as a stimulus to the
appetite.
(6) Cooking alters the consistency of food generally, making it softer.
Eggs are the exception; they become harder when boiled. Cooking also
renders meat more coagulated and solid, more tender and friable, and
easier to masticate. This allows of more free mixing of the various di-
gestive fluids with the food.
(c) Cooking produces chemical changes in food which favor the action
of the digestive enzymes. This is particularly true of some forms of
starch and many varieties of meats.
(d} Cooking not only sterilizes the food but destroys many varieties
of parasites and germs which may be contained in the food and which may
be highly poisonous. It has been found that no animal parasite in meat
is capable of withstanding a temperature of 70 C. All ordinary proc-
esses of cooking will render meat free from this source of infection.
(e) The ingestion of very hot food is sometimes advised to favor the
digestive processes, although the importance of this consideration is apt
to be exaggerated.
54 SCIENTIFIC COOKERY
(/) Cooking improves the appearance of many foods, and often pro-
duces a delightful aroma which makes the morsel more appetizing.
Evil Effects of Poor Cookery Good, wholesome and proper food mate-
rials are often rendered valueless from poor cookery. The unwholesome-
ness of food is quite as often due to bad cookery as to improper selection
of material. When scientifically performed, cooking changes each of the
food nutrients, with the exception of fats, in much the same manner as do
the digestive juices, and at the same time it breaks up the food by dissolv-
ing the soluble portions so that it is more readily acted upon by the chem-
ical processes of digestion. The evil effects of bad cookery and the improper
selection of foods are too numerous to mention. No doubt their ill effects
are as far reaching as the use of strong drink ; indeed, one of the evils of
unwholesome food is its decided tendency to create a craving for drink.
For bad cookery is the forerunner of indigestion, which condition causes
thirst, and thirst is apt to produce and to perpetuate drunkenness. One
who has suffered from a fit of indigestion and recalls the accompanying
headache and the lowness of spirits, going from dejection and ill-humor
to extreme melancholy with all the mental faculties dazed and the normal
feelings more or less blunted, will hardly wonder that such a condition
may become chronic, which is often the case from the continued ingestion
of improperly prepared foods. It is not surprising, then, that the victim
of such circumstances is easily led to resort to stimulants to drown depres-
sion and enliven spirits.
VARIETIES OF COOKERY
The processes of cooking in common use are as follows :
(a) Boiling (e) Roasting
(6) Stewing (/) Broiling
(c) Frying (</) Braising
(d} Baking (h) Steaming
There can be no question that there is decided advantage in varying
the different methods of cooking, as well as flavoring the food, from time
to time. Monotony of diet and the continued sameness of flavors are not
stimulating to the digestive organs or appealing to the appetite ; and when
conditions are such that a variety of food cannot be obtained, variety in
their preparation can be made to replace its advantages to a great extent.
Even an epicurean appreciates the effect on appetite of an occasional
change of cooks, or, if he be a home person, of an occasional meal, dinner
or luncheon in a friend's home or at a hotel or restaurant. It is not the
VARIETIES OF COOKERY 55
intention of the author of this work to discuss all the details of the prepa-
ration of foods for the sick, since every trained nurse should be well
grounded in the art of domestic science and in invalid cookery which
should form the basis of her education. We cannot hope to do more than
explain the theory of the chief methods of cooking and suggest occasion-
ally the influence of scientific cookery upon digestion. Meats which have
been twice cooked are undesirable for invalids, as they are apt to be drier
and less nutritious and more difficult to digest than when fresh. For this
reason, when "hash," for example, is twice cooked, the meat fiber is too
greatly hardened. Such preparations, by the addition of too much grease
and by recooking, are not proper dishes for delicate stomachs; for a simi-
lar reason canned meats, when warmed over, are not as easily digested
as fresh meats, because they have been already cooked once. Made-up
dishes combining different foods which require different periods for their
cooking are undesirable. Soup, for instance, needs less boiling than the
vegetables added to it, which should in all cases be partially cooked alone
beforehand so that they will not be underdone. The necessary heat for
the different varieties of cooking is obtained from many sources : from
wood, coal, gas, oil, steam, electricity, and of late from the "fireless
cooker." Each one of the different methods possesses advantages for par-
ticular foods.
With these preliminary considerations, we may proceed to the study
of the effects of cooking upon animal and vegetable foods, respectively.
COOKING OF MEAT
Boiling The primitive method of boiling water originally consisted
in heating the water in a hollow dug-out in the ground by plunging in red-
hot stones taken out of the fire. Later, as pottery-making and metal-
working became an art, cooking utensils were employed. The use of the
term "boiling" (212 F.) in connection with the cooking of meat is rather
unfortunate, for the operation thus designed, if properly carried out,
should involve hardly any boiling. The temperature should be just suffi-
cient to change the coloring matter of the blood, soften the fiber and dis-
solve the connective tissue, which can be successfully accomplished by
water far below its normal boiling point. Boiling meat in its strict sense
over-coagulates the proteins, dissolves the mineral matter, and lowers the
caloric value of the food. This is best shown in a hard-boiled egg, in com-
parison with one cooked bolow the boiling point. Tn the former the albu-
min is rendered hard and indigestible, and in the latter the albumin is
soft and creamy and is even more easily digested than when raw. While
56 SCIENTIFIC COOKERY
the effect of over-boiling meats is not so apparent as in the case of eggs,
the end results are precisely the same. In the cooking of meat, however,
some boiling as a preliminary process of the operation is necessary, since
the juices of meat are rich in albumin; it is necessary to cover the meat
with boiling, unsal'ted water and boil it rapidly for five minutes to coagu-
late the albumin on the surface and inclose the meat in a waterproof cas-
ing. This will prevent the escape of the meat juices from the interior of
the cut. The next step is to place the pot over a moderate fire where
the temperature will be maintained at 180 to 200 F., twenty minutes
being allowed for each pound of meat. If the heat is not carried to this
point, the interior of the joint or piece of meat is not perfectly cooked, its
albumin is not sufficiently coagulated, and the cut will have a raw appear-
ance. If, on the other hand, the actual boiling point is long continued, the
albumin will be firmly coagulated and the meat will be tough and stringy.
This error in boiling meat is often perpetrated by incompetent cooks.
It is a scientific fact, unappreciated by many persons, that when water
has once reached the boiling point, its temperature cannot be further ele-
vated ; consequently, however hot the fire, or however prolonged the cook-
ing, the temperature of the food suspended in the boiling water cannot be
increased above that of the boiling water itself ; and the fact remains that
the temperature of the interior of large masses of food such as a cut of
meat or large potatoes is by no means as great as that of the surrounding
water. For this reason, it is a mistake to pile on more fuel when water
has once reached the boiling point, as it will have no further effect than
that of accelerating the rate of ebullition, without actually raising the
temperature of the water or any food immersed in it.
The concentration of broth or bouillon is dependent mainly upon the
method used in boiling the meat from which it is made. If the meat is
subjected to continuous boiling for an hour or more, the connective tissue
is gradually transformed into gelatin which in part becomes dissolved
in the water. A little of the fat, melted by the heat of the water and
not being able to mix with the latter, floats as scum on the surface. In
addition, a small quantity of the meat juice exudes into the surrounding
liquid, which at this stage is known as broth or bouillon. In order to
make a very concentrated and nutritious broth, the meat is cut in fine
pieces, put into cold water and left for a time. It is then placed on the
stove and slowly warmed, although it must not be allowed to reach the
boiling point. If the temperature does not pass beyond 160 F., the meat
juices will be dissolved in the water. As the water is not hot enough to
coagulate the albumin of the meat, an increasing quantity of the con-
VAKIETIES OF COOKERY 57
stituents of the muscle fibers passes out to become dissolved in the broth.
Such preparation gives to the broth the natural flavor of the meat. The
ordinary meat extracts are manufactured by allowing finely minced meat
to stand in cold water for a time, after which the water is evaporated
from the ingredients. If the purpose of cooking is to leave as great a
quantity as possible of the nutritive elements in the meat itself, a some-
what different process is employed. The meat is quickly plunged into
boiling water and left there for five minutes. By this method the sur-
face of the meat is coagulated sufficiently to form an effective barrier
to the passage of the nutritive juices from within. When the cooking is
completed, the meat holds practically all of its original nutriment and
is consequently most palatable. On the other hand, the broth contains
a minimum quantity of the meat juices in solution and therefore pos-
sesses only slight food value.
The fact that the coagulation point of a given variety of albumin
varies considerably must not be overlooked. Some albumins are coagu-
lated below 00 F. while others require a heat of 165 F. ; and since many
varieties of albumin occur in different kinds of animal food, it will be
found that they are not all equally well cooked at the same temperature.
Parkes is the authority for the statement that ammonium sulphite is lib-
erated by continued boiling and an acid resembling acetic acid is also
produced. Meat when plunged into boiling water has its external layers
immediately solidified. Some of the water which they contain is squeezed
out into the adjacent fluid and an actual loss of weight in meat occurs,
ranging sometimes as high as 30 per cent. Williams is authority for the
statement that, when salt is added to water in boiling fish or meat, it pro-
duces a threefold action: (a) It directly acts on superficial albumin with
a coagulating effect; (ft) it slightly raises the boiling point of water; (c)
by increasing the density of the water, the exosmosis of the juices is less
active, and hence the flavor is better retained. When salt meat is to be
cooked, if steeped too long in boiling water, its nutritive properties are
impaired, and the muscular fiber becomes hard and the meat loses its
inviting taste and becomes tough. In the preparation of such a cut, it
would be well first to boil the meat less completely, and finish the cooking
by some other method, either frying, roasting or broiling.
Stewing. Stewing, or preparation en casserole, is in many respects
an ideal method of cooking meat. It differs from boiling in that the juices
of the meat are dissolved in the heated water, whereas in boiling, the
juices are prevented from passing out into the water by the coagulation of
the albumin on the outer surface of the cut. If properly performed, stew-
58 SCIENTIFIC COOKERY
ing coagulates without over-hardening the proteins, while owing to the
fact that the juice is eaten together with the meat, none of the flavoring
ingredients are lost. The proper temperature for stewing ranges between
135 F. to 180 F. The prolonged action of heat and moisture converts
most of the connective tissue into gelatin, so that the fibers readily fall
apart and the meat becomes very tender. Here again, the secret of success
is in avoiding too high temperature. It is sufficient to place the pan on
the side of the fire and allow it to simmer only, instead of to boil. The
thermometer will show that the temperature of simmering and boiling
water is practically the same, 212 F., the only difference being that in
the former case the heat is reaching the water more rapidly and more of
it is wasted. The proper temperature for scientific stewing is 180 F.
In thick stews, the juices dissolved in the water are eaten together
with the cooked food; but, when it is desired to make beef tea or other
kinds of soup, an aqueous solution only is used. It is obvious to the reader
that the more the food is subdivided the greater will be the surface exposed
to the solvent action of the water, and hence the reason of mincing meat
thoroughly when it is to be used for the preparation of beef tea. If such
minced meat has been soaked for a long time in cold water, a part of its
albuminous substances and some of the extractive materials will already be
in solution. But the meat which is left will be tasteless, odorless and un-
palatable ; in fact, animals fed upon such meat soon deteriorate in strength.
The perfection of a meat stew largely depends upon the thorough co-
agulation of the outside juices and the slow process by which it is fin-
ished, while, as before stated, the temperature should never exceed 180 F.
Such flavorings as bay-leaf, onion and celery, pepper and salt, may be
added, but the saucepan should be closely covered so as to retain all the
flavors. Stewing is a very economical method of cooking; there is no
waste; all escaped juices are held in the solution; all the nourishment
is secured, and jf the dish is well cooked and not too greasy, the meat is
tender and readily digested. The difference between stewing and other
processes of cooking is graphically explained by Williams, who says : "In-
stead of the meat itself surrounding and enveloping the juices, as it should
when boiled, roasted, grilled or fried, we demand in a stew that the meat
juices shall surround or envelop the meat."
Frying Frying is a process of cooking by immersion in hot fat at
a temperature of from 350 to 380 F., and not by radiation, as in the
case of broiling or roasting. Since this method of cooking is often grossly
misunderstood, it requires some special description ; as explained by Wil-
liams, "fat does not necessarily boil, for the food, as well as the fatty
VARIETIES OF COOKERY 59
material itself, may contain a large percentage of water which, by being
suddenly vaporized, produces the familiar spluttering which accompanies
the process of frying."
Fats, when heated to 400 to 500 F.or above, decompose, yielding fatty
acids and other products, some of which are volatile. But fats and oils used
in cooking do not require a heat of above 400 F., which will cause a very
disagreeable odor with much smoke, leaving a non-volatile carbon residue.
If a temperature not exceeding 380 F. is maintained, the fat does
not smoke or decompose. It is chiefly on account of overheating that fried
foods are often unsightly and indigestible. It is difficult to regulate the
temperature without the aid of a thermometer ; but the following test may
serve to indicate that the proper temperature is nearly reached a crumb
of bread dropped into a pan of hot fat will turn brown in ten seconds if
the temperature has reached 340 F.
Butter is not a suitable medium for frying, because it rapidly decom-
poses at too low a temperature. Olive oil or cottonseed oil is far prefer-
able. A mixture of oil and suet is very good; but the best, medium for
frying purposes is a mixture of lard and suet. The frying pan should be
sufficiently deep to permit the complete submersion of the article to be
cooked. The temperature of the fat will at once cause the formation on
the surface of the article being cooked of a complete covering through
which neither grease can enter nor the juice escape. Without this im-
permeable covering, the outside of the fried food will be greasy and the
inside flavored with the frying materials, while if proper precautions are
observed, the fried article will be as free from fat as if it had been cooked
in water. With a suitable pan, and the fat at the proper temperature,
everything is ready for "frying," and the article should be plunged into
the fat and left for two or three minutes. The spluttering which follo\vs
is due to the sudden conversion of the moisture on the surface of the food
into steam; when this has ceased, the cooking is complete and the food
should be instantly removed and allowed to drain on paper, to remove all
traces of fat. It will be observed that the process is entirely different
from the so-called frying usually practiced in well-regulated homes, in
which a little fat is employed merely to prevent the food from adhering
to the frying pan an abbreviated form of roasting really being per-
formed. Frying, after all, is less perfectly understood by the ordinary
cook than almost any other process of cooking meat, and, as usually car-
ried out, results in abominably prepared and unwholesome food. The
pans are not deep enough and the food and fat are scorched and rendered
unpalatable and quite indigestible.
60 SCIENTIFIC COOKERY
Baking. Baking is a process of cooking meat in the dry heat of an
oven. The oven of the stove generally receives its heat from the fire-box,
although in large establishments it is heated by steam under pressure.
No matter how great the surrounding heat, a thermometer placed in the
center of the cut or joint will scarcely register 200 F., the meat being
really cooked in its own juice at a gentle heat.
This method of cooking meat in a confined space prevents the vola-
tile products from escaping, as in roasting, and in consequence, the meat
has a somewhat stronger and less delicate flavor than when roasted ; it is
also richer, and therefore more liable to disagree with persons of dyspeptic
tendencies. This process of cooking causes the cut or joint to become satu-
rated with empyreumatic oils unless its surface is protected by a pie
crust, as in the case of "pot pie" or "chicken pie" but even that does not
add to its digestibility.
Certain mechanical and chemical changes take place during the process
of baking; considerable moisture is driven off, therefore baked foods are
drier when cooked than before cooking; heat and moisture present in the
foods cause a rupture of the cell walls. In this way the proteins are coag-
ulated, and possibly other changes in the texture and consistency of the
foods are produced. The chemical changes brought about are as follows :
Proteins are coagulated, fats are more or less broken down into simpler
bodies, and carbohydrates on the surface especially are to a greater or
lesser extent caramelized.
Baking with dry heat food confined in a closed oven may be termed
a slow process of cooking, and it is interesting to learn that the advantages
of slow cooking are not altogether unknown to some savage tribes. In
this respect the civilized cook may learn something from their crude
methods. Mr. F. T. Bullen(3) describes as follows the process of baking
meat as practiced by the Kanakas of the Friendly Islands, and we doubt
if any better illustration of the advantages of slow cooking can be found :
A hole is scooped in the earth, in which a wood fire is made and kept burn-
ing until a fair-sized heap of glowing charcoal remains. Pebbles are then thrown
in until the live coals are covered. Whatever is to be cooked is enveloped
in leaves, placed upon the pebbles, and more leaves heaped upon it. The earth
is then thrown back into the cavity and well stamped down. A long time is, of
course, needed for the viands to get cooked through, but so subtle is the mode, that
overdoing anything is almost an impossibility. A couple of days may pass from
the time of "putting down" the joint, yet when it is dug up it will be smoking
hot, retaining all its juices tender as jelly but, withal, as full of flavor as it is
possible for .cooked meat to be. No matter how large the joint is or how tough
the meat, this gentle suasion will render it succulent and tasty; and no form of
civilized cookery can in the least compare with it.
VARIETIES OF COOKERY 61
The baking of bread is considered with the cooking of vegetables, in
Volume I, Chapter XIII, page 365.
Roasting Roasting is a process of cooking meat, in which heat is
conveyed by direct radiation, in a closed oven instead of through the
medium of water (4). The terms broiling, grilling and roasting denote
the same operation. The first two are used to designate the process when
applied to steaks or smaller pieces of meat; the term "roasting" is used
when a "large joint" or "rib roast" is cooked. In the process of roasting
there is considerable loss, especially if the joint be a fat one, but the flavor
is incomparably finer than if baked or boiled. Roasting of large joints of
meat and of fowls is perhaps best done by hanging the article to be roasted
on a spit which slowly revolves in front of and in close proximity to a
clear and quick burning coal fire. In large restaurants this is the process
generally followed.
For the proper roasting of a joint, much care is necessary to avoid
excessive heat except for a period of five minutes (175 F.), in which
the coagulated albumin will completely seal up and cover over the exter-
nal surface of the meat ; for the same reason as in boiling, the temperature
should then be slightly lowered. The process of cooking meat in this
manner is somewhat analogous to that of stewing; in fact, the interior por-
tions of the meat are "stewed in its own juices" instead of water.
The outer coating prevents the evaporation of the juices of the meat
which, together with the extractive materials, add flavor to the roast.
Roasted meat has a decided advantage in flavor as well as nutritive value
over meat which has been boiled for a long time, although the latter may
be more tender and more easily digested.
The high temperature suddenly applied in roasting meat produces a
firmer coagulation on the external surface of the joint than occurs in boil-
ing by which process more of the natural juices are retained. "If the
principles of scientific roasting are carefully observed," says Williams(5),
"the meat should be cooked by the action of radiant heat projected towards
it from all sides while it is immersed in an atmosphere nearly saturated
with its own vapor."
The proper roasting of meat or fowl cannot be accomplished without
the effusion of more or less of the meat juices and the melting of a small
portion of the superficial fat and of gelatin. These substances in solution
form the "meat gravy," which is ciuite savory and very nutritious, and
which a good cook advantageously uses for "basting" the roast to prevent
drying, and to distribute the heat more uniformly over the surface. The
process of roasting, if correctly performed, not only prevents the escape of
62 SCIENTIFIC COOKERY
the natural meat flavors, but develops in it substances which are them-
selves of a sapid savory nature. These savory substances result from
changes produced by the action of the heat on the extractives on the sur-
face of the meat somewhat analogous to the alteration which sugar under-
goes in its conversion into caramel. The action of high temperature on
these substances produces a dark brown, sticky substance on the surface
of the fowl, roast or joint which is familiar to everyone. This is sometimes
called osmozone and is one of the most tasty and sapid substances known.
Meat which by accident has become "over-roasted" or burned, will
present scorched or charred surfaces, due largely to the carbonizing of the
fat. Before the fat has become completely burned, certain volatile fatty
acids are liberated which emit a very disagreeable odor; besides, other
products are developed which are of no nutritive value, but which may be
positively irritating to the alimentary canal.
For the proper roasting of beef, mutton and game, according to Yeo,
a temperature of 135 F. is sufficient, and the meat is "rare" and "under-
done," retaining a good deal of its reddish color; but veal and poultry
should be roasted at a higher temperature from 150 to 160 F. These
temperatures are slightly lower than often recommended, and are intended
as the degrees to be maintained after the meat is placed in position and
has had the first five minutes of excessive heat previously mentioned. It
is interesting and at the same time important to remember that the smaller
the cut to be roasted the hotter should be the fire. An intensely hot fire
coagulates the exterior and prevents the drying up of the meat juices.
This method would not, however, be applicable to large cuts, because meats
are poor conductors of heat, and a large piece of meat exposed to this
intense heat would become burned and changed to charcoal on the exterior
long before the heat could penetrate to the interior. Hence the rule : the
smaller the cut to be roasted, the higher the temperature to which it should
be exposed.
Game or meat which is "high" or slightly tainted, if cooked by boiling
or stewing becomes extremely repulsive and the odors from it exceedingly
offensive. It disintegrates more rapidly and the elements of decomposi-
tion pass into and flavor the whole mass. Such meat may be made more
or less palatable, and sometimes wholesome, by roasting, when the external
layers which have commenced to decompose are thoroughly browned and
thereby disinfected, though repulsive putrefactive odors will be noticed.
As pointed out in the chapter on Animal Foods, "high game" is in a putre-
factive stage a condition produced by certain microorganisms or bacteria
which are constantly floating in the atmosphere, in search for a convenient
VARIETIES OF COOKERY 63
place of living and breeding, and which find the juices of flesh ideal for
their purposes. The period of time required for a piece of meat, game or
fowl to hang, in order to obtain the proper game flavor, depends some-
what upon the season of the year, the temperature and the climatic condi-
tions; and the boundary line between the "gamy flavor" and the stage of
putrefaction is very narrow and easily passed without recognition.
The game flavor is due to the metabolic activity of the micro-
organisms which have settled upon the meat, and which, by a process al-
lied to that of fermentation, produce changes in the albumin and other
constituents, giving rise to certain aromatic bodies. These microorganisms
of putrefaction produce an enzyme which, in coming in contact with the
albuminous portions of the flesh, may so act as to produce poisonous sub-
stances known as ptomains and leukomains. Game that is "high," or
meats which are tainted, though apparently well cooked, are liable to pro-
duce ptomain poisoning. The heat employed in the process of cooking
destroys the bacteria in the meat, and it may be safely eaten while it is
hot ; but the heat may not have been sufficient to destroy the enzyme of
such bacteria which goes on destroying albumin, with the production
of ptomains or leukomains even after cooking. It may thus happen that
a portion of tainted meat is sometimes partaken of quite freely and with
impunity immediately after it is cooked, but a few hours later, ptomains
having then been produced by the enzymes, it becomes very poisonous.
Some epicures prefer to have a leg of mutton or a piece of game hung
until the process of decomposition is noticeable and the tainted odors pres-
ent, but meat to be cooked by boiling must under all conditions be abso-
lutely fresh.
Broiling. Broiling or grilling is a means of quick cooking, requiring
much less time than roasting or boiling, because intense heat is applied to
comparatively small pieces of meat. The object in broiling is to raise the
temperature of the interior of the meat quickly to 180 F., so that the
moisture contained in it will not have time to evaporate. For successful
broiling, therefore, it is necessary to have the meat as close as possible to
the glowing coals to increase the radiation and to limit the retarding
effects of air currents. It is for this reason that steaks and chops cooked
in restaurants or hotels are often better than those cooked in the home,
where one cannot have the specially designed grills or revolving spits
which bring the meat in close contact with the radiant surface of the glow-
ing fire.
In broiling steak, the meat shov.ld first be placed over a clenr. hot fire
until one side is seared; then it should be turned and the other side seared
64 SCIENTIFIC COOKERY
in like manner. The steak should now be placed at a greater distance from
the fire and the cooking thus continued at a lower temperature, five minutes
being allowed for a steak one inch Ihick, if liked rare, and eight minutes
if preferred well done. A steak one and a half inches thick requires from
eight to 'ten minutes, and a steak two inches thick twenty minutes. Sea-
soning may be added after the steak has been cooked. A favorite season-
ing for steak is maitre d'liotel butter (14 cup of butter, 1 teaspoonful of
salt, MJ saltspoon of pepper, 1 tablespoonful of chopped parsley and 1
tablespoonful of lemon juice). A properly broiled steak or chop is thick-
ened in the center, but if badly grilled it is thin and dry. It should not
be overlooked that the evaporation in broiling depends upon the extent
of the surface of the meat, and for this reason thinly cut steaks or chops
become comparatively dry and shriveled in the center.
Roasting and broiling are the most universal methods of cooking meat.
The savage or hunter requires no utensils for cooking his game, but for
boiling it is necessary to have vessels in which to place the food. The
Polynesian cooks his meat by roasting it on a hot stone, and sprinkles it
with sea water to obtain the salt. The primitive hunter incases his meat
or fowl, skin and all, in damp clay and bakes it by surrounding it with
hot coals. The Australian savage, the lowest type of man, does all his
cooking by roasting.
Braising Braising is a process of cooking intermediate between boil-
ing and baking. First the meat is partially browned and cooked in a
moist heat in a vessel with a close fitting lid. Some of the so-called "roast-
ing pans" or "braising pots" are suitable for this purpose. The meat
should be placed in a pot or pan and partially covered with hot "stock"
or water composed of a solution of animal and vegetable juices called
"braise." Seasoning such as bay-leaf, onion, celery seed, etc., should be
added and the pan closely covered. Cooking should be done in a hot oven
in which the meat is exposed to a strong but not boiling temperature, 15
minutes being allowed for each pound of meat. Sherry or some spices
may be added, such as cloves or mace; salt and pepper should be added
when the meat is about half done. The cover of the vessel should be re-
moved half an hour before serving and the stock reduced so that it can
be served as a sauce. The amount of sauce allowed to remain should be
barely sufficient to cover the meat, and in this way the surrounding broth
is kept highly concentrated. Braising is an economical process of cook-
ing; the constituents lost by the meat from evaporation and solution are
absorbed almost entirely by the gravy. This process of cooking is espe-
cially valuable in cooking tough meat or any kind of meat which is too
VARIETIES OF COOKERY
65
fresh or young. It is best adapted to the so-called inferior pieces, as a leg
of mutton, the upper and under round, and the fleshy part of the shoulder.
Steaming Steaming as a process of cooking meat is but little used
and is mainly applied to cooking cereals, puddings, etc. Steamed foods,
as a rule, are more highly flavored than those boiled, for the reason that
in steaming, the soluble constituents are not so easily lost as in boiling.
The process of steaming can be carried out in a "modern steam cooker"
or in a perforated kettle which fits closely over another kettle containing
boiling water. If the steam is under pressure, the temperature may be
much higher than that of boiling water, and hence the method may be
used for sterilizing canned foods. In large establishments such as hotels,
restaurants and clubs, the method is also used for the baking of meats.
Ordinary home steaming is an excellent method of cooking vegetables,
hams, fruit cakes, puddings and other dishes that require the prolonged
application of moist heat.
LOSSES IN COOKING MEAT
It has been determined by Johnston that, no matter how carefully or
by what process meat is cooked, there is always a certain amount of loss
of the soluble constituents, for instance:
4 Ibs. of beef loss in weight
4 " mutton" " "
IN BOILING
lib.
14 oz.
IN BAKING
1 Ib. 3 oz.
1 Ib. 4 oz.
IN ROASTING
1 Ib. 5 oz.
1 Ib. 6 oz.
The greater part of this loss is water, shown by the following analysis
given by Konig:
COMPARATIVE COMPOSITION OF MEATS BEFORE AND AFTER
COOKING
Water,
Per cent
Nitroge-
nous
Matter,
Per cent
Fat,
Per cent
Extrac-
tive
Matter,
Per cent
Salts,
Per cent
Beef:
Before cooking (raw) . .
Same after boiling
Same after broiling (as
beefsteak)
70.88
56.82
55.39
25.51
34.13
34.23
4.52
7.50
8.21
.86
.40
.72
1.23
1.15
1.45
Veal Cutlets:
Before roasting (raw) . .
Same after roasting. . . .
71.55
57.59
20.24
29.00
6.38
11.95
.68
.03
1.15
1.43
66
SCIENTIFIC COOKERY
The actual loss of the soluble matter is more clearly stated in Bulletin
No. 21, United States Department of Agriculture. The estimate below
is calculated on the basis of dry substances:
COMPARATIVE COMPOSITION OF WATER-FREE SUBSTANCE OF
MEATS BEFORE AND AFTER COOKING
Nitrogen,
Per cent
Protein,
Per cent
Fat,
Per cent
Extractive
Matter,
Per cent
Salts,
Per cent
Beef:
Before cooking
12.37
77.31
15.47
2.98
4.24
After boiling
12.65
79.06
17.38
.90
2.66
After roasting
12.27
76.73
18.41
1.59
3.27
Veal Cutlets:
After cooking.
11.39
71.17
22.45
2.32
4.06
After roasting
10.93
68.36
28.18
.09
3.37
A careful study of these figures proves that the loss is almost entirely
confined to the extractive matter and salts of the meat.
COOKING OF FISH
Fish may be cooked by boiling, grilling, baking, frying or stewing.
Of these several processes boiling is decidedly the most advantageous for
persons with feeble digestions, and next in order is broiling. The flavor-
ing ingredients of fish are more readily dissolved by water than those of
meat, and since fish has less flavor, in the first instance, any loss in this
direction is to be carefully guarded against. For this reason, boiling, un-
less most carefully supervised, is not a suitable method of cooking fish.
Even when carefully performed, the loss exceeds 5 per cent of solid mat-
ter, and on this account, cooking by means of steaming is preferable just
as in the case of some vegetables. When fish is boiled without the addition
of salt to the w r ater, it becomes soft and disintegrates, but if boiled in sea
water or ordinary water to which salt has been added, the fish maintains
its shape and flavor. The quantity of salt regulates the osmosis of the
juices of the fish into the water.
As a rule, fish is cooked in much less time than meat. If fried fish
is to be eaten by persons of dyspeptic tendencies, it should be cooked
whole and the skin carefully removed subsequently. But fried fish is
never as easily digested as boiled fish. The essential principle of frying
fish consists in the sudden exposure of the object to be cooked to a very
high temperature, which, as we have seen in the section on frying, has
the effect of producing an instantaneous coagulation of the albuminoid
VARIETIES OF COOKERY 67
matter on the surface, together with a slight degree of charring, thus
preventing the escape of juices and other soluhle substances, while the
surrounding temperature is so high that the fish is practically cooked
through its whole thickness almost instantaneously.
In order to attain the proper temperature for frying fish, olive or good
cottonseed oil is the best medium. A deep pan is necessary, and a tem-
perature of from 350 to 390 F. When this temperature has been
reached, the fish should be suddenly plunged into the pan and left for
2 or 3 minutes. Considerable spluttering will immediately ensue, and
when it ceases, the cooking will be complete.
COOKING OF VEGETABLE FOODS
The objects to be achieved in cooking of vegetable foods are somewhat
the same as in cooking animal foods, namely, to render them more diges-
tible, to give variety, to modify their flavor and in some cases to preserve
them. While it is possible but not practicable to eat animal foods without
cooking, yet it is impossible to eat certain vegetable foods in a raw state,
as man is almost incapable of digesting the cellulose framework of vege-
table foods; hence, cooking in order to soften this cellulose framework,
and to bring about a gelatinization of its starch, are the ends to be desired
in cooking vegetables. Cellulose, as we found when studying vegetable
foods, is a very hard, indigestible substance in its raw state, or until it
has been partly converted into sugar by the action of acids, aided by heat.
It is probable that this change does not ordinarily take place in cooking
or in digestion. In ripening fruits such change is due to enzyme action.
In its unripe state, a pear or other fruit is very hard and "woody," due
to the presence of this cellular framework. In the process of ripening,
the acids of the fruit, aided by the heat of the sun, bring about a soften-
ing of this framework with partial or more or less complete solution of
the cellulose fibers, producing, when ripened, a sweet, soft fruit.
In the cooking of vegetables the cellulose envelopes are burst asunder
in consequence of the heat, so that when ingested, the digestive ferments of
the alimentary canal have more ready access to the starchy or albuminous
contents. In bread and other glutinous foods, the albumin is coagulated,
and in the case of bread, it sets in a permanent vesicular mass which the
digestive secretions readily permeate and attack. In the cooking of green
vegetables, the fibers are softened, the albumin coagulated, the gummy,
saccharine, saline and oily matters are, to a more or less extent, partially
removed by the water. It should be unnecessary to state here that all
vegetables need thorough washing before cooking. Roots and tubers,
68
SCIENTIFIC COOKEKY
especially, should be well cleaned before paring. As a general rule, all
vegetables to be boiled or stewed should be cooked rapidly with just enough
water to prevent burning and with the lid off the saucepan; the rising
scum should be frequently removed. Rain water is especially adapted for
cooking on account of its softness and freedom from salts of lime and
magnesia. These salts are present in hard water, and when vegetables or
meat are boiled in it, a certain amount of salts is deposited, thereby in-
creasing the scum. When these salts are deposited upon the meat or vege-
tables, they hinder the penetration of heat into the interior, and so their
presence may prevent the abstraction of soluble materials when it is de-
sired to make broth or soup.
GAIN OF WATER ON COOKING VEGETABLES
Per cent of
Water in
Raw State
Per cent of
Water after
Cooking
Increase
Parsnips ...
82.0
97.2
15.2
Artichokes
80.0
91.6
11.6
Cabbage
89.0
97.5
8.5
Spinach
90.0
98.0
8.0
Cauliflower. .
90.8
96.4
5.6
Sea-kale
93.3
97.9
4.6
Vegetable marrow
94.8
99.1
4.3
Some coarse, raw vegetables principally the roots and tubers, such as
turnips, carrots, beets and potatoes while they make good food in the
raw state for animals, are unpalatable and indigestible for man, and re-
quire softening and alteration by prolonged boiling in water or some other
form of cooking. The action of heat through boiling macerates the cellu-
lar fibers or walls of the cells, softens their contents and renders the vege-
tables more easily masticated, while the effect of the heat, together with
the accompanying moisture, causes swelling and rupturing of the starch
grains, in which condition the vegetable matter is more easily and
promptly acted upon by the starch digesting enzymes contained in the
saliva and pancreatic juice. Many vegetables are better steamed than
boiled, as, for instance, potatoes, rice, young peas, corn, squash, cucum-
bers, pumpkins and spinach. The effect of cooking upon green vegetables,
in some instances, is to decrease their already poor stock of nutrients.
They gain water and lose part of their carbohydrate and protein content,
much of their mineral matter and nearly all of their non-albuminoid
nitrogenous constituents. For example, in cooking cabbage by boiling,
VARIETIES OF COOKERY 69
more than 30 per cent of its total solids is lost, as well as a large amount
of the total mineral matter, and one-third of the carbohydrate, all of the
non-protein nitrogen, and 5 per cent of the protein. Some of the com-
moner vegetables gain a large percentage of water in cooking, as shown
in the table 011 the opposite page (6) :
We append below a table (7) showing the amount of carbohydrates
contained in some of the commoner vegetables before and after cooking :
Cabbage, turnip (young)
RAW
Per cent
3.09
AFTER BOILING
AND STRAINING
Per cent
2.43
Cauliflower
2.10
1.40
Spinach
2.97
.85
Winter cabbage
6.75
3.20
Asparagus
1.6
Savovs. .
2.7
The deficiency of fat in vegetables is often made up by the addition
of butter or oil in the course of preparation for the table. Vegetables
prepared in this way may be made an important vehicle for conveying fat
into the body. The amount of fat which some vegetables can readily take
up without being overloaded is shown in the following table :
100 parts of potato pure"e can take up 50 parts of fat
100 " boiled potato " " 40-50 " " "
100 " " baked " " " " 40-50
100 " red cabbage " " 40 "
100 " savoy cabbage 32
100 " cabbage lettuce 24
100 " potato souffle" " 20 " " "
100 " " fried potatoes 15
Vegetables are not, on the whole, readily digested. It has been shown
that five and one-third ounces of cabbage require three hours. The same
amount of cauliflower requires only two and one-half hours. Certain vege-
tables are difficult to deal with in the intestine owing to their bulk and
the amount of cellulose which they contain. If they are slightly stale,
their presence in the intestines causes fermentation with the generation
of gases due to the action of the organisms on the cellulose. The action
of heat on the protein contained in vegetables has an effect similar to that
which it exerts on the same constituent of animal food; the coagulation of
protein produces a shrinkage rather than a swelling of the food, and for
this reason, if the cellulose framework encloses protein only, it does not
rupture. One can readily understand, therefore, that if a vegetable food
contained only protein, its digestibility would not be increased by cooking,
but rather decreased. As a matter of fact, however, there are few vege-
70 SCIENTIFIC COOKERY
table foods which do not contain much starch together with the protein,
and hence it is that the general rule holds good, that cooking increases
the digestibility of all vegetable foods.
FOOD CONCENTRATION
Food concentration is based upon the fact that the large percentage of
free water contained in some foods can be removed by evaporation. This
process reduces the weight and at the same time the bulk of the food. Fur-
ther condensation may be accomplished by pressure with hydraulic ma-
chinery applying several tons of force to the square inch.
Desiccation. Desiccation involves the removing of more water from
foods than can be removed by evaporation alone. Such food products are
commonly refered to as "condensed." Desiccation may be carried to the
point where the food is entirely dry, in which case the substance "desic-
cated" may be torn into shreds or pulverized. Condensed and powdered
fcods are usually added to other foods in order to thicken them or add to
their nutritive properties. Desiccated meat is the most concentrated form
of protein, sugar is the most concentrated form of carbohydrate, and olive
oil is the most concentrated form of fat.
Concentrated Proteins. Concentrated proteins are prepared from milk,
meat, eggs and vegetables. Meat is concentrated by drying, and in this
form is practically indigestible. This indigestibility can, however, be
overcome by predigestion or powdering. This class of foods includes beef
meal, somatose and other such products (see page 20). Of the concen-
trated vegetable proteins may be mentioned aleurona and legumin.
Dried Vegetables Dried vegetables keep much better than dried
meats. Coffee, tea and cocoa are good examples of dried vegetable sub-
stances. They may be extracted and then concentrated by evaporation.
Potatoes are concentrated by a drying process to less than one-third of
their weight, and in this shape may be preserved for future use; so may
carrots, cauliflower and the like. They are prepared by being exposed to
the direct rays of the sun, and are serviceable only for relieving monotony
of the diet when fresh vegetables cannot be obtained. (See Volume IT,
Chapter II.)
Desiccated Vegetables. Desiccated vegetables have been used to some
extent in the United States Tavy, but it has been found that they possess
fewer antiscorbutic properties than fresh vegetables. Bread is frequently
dried and eaten in the form of "hard-tack" when it is impossible, as during
long voyages, to obtain fresh bread. Hard-tack may be preserved for a
long time, but it becomes tasteless and is useful only in emergencies.
FOOD CONCENTRATION 71
Captain Woodruff (8), of the Medical Corps of the United States Army,
writes on this subject as follows :
The Germans have been the first to take advantage of drying and compressing
processes in the manufacture of a dried, compressed bread. The great difficulty
in the use of bread for field use consists in the inability to supply it so that it will
keep a long time and be digestible. Hard-tack is ruinous to many soldiers, as al-
ready pointed out. If baker's -bread is compressed, it sinks into a heavy dough.
Only strong stomachs can digest it, and it is far worse than the soggy, hot break-
fast bread with which we cultivate dyspepsia. If the bread is merely dried, it is
too bulky for transportation. By a new process, which probably consists in dry-
ing the bread and at the same time compressing it by improved machinery, the
Germans have secured a variety of field bread which is spoken of in very high
terms. Small bits of it thrown into soup swell up like a dried sponge when thrown
into hot water. The soldiers are said to be very fond of it, and as far as known
it is entirely successful.
Desiccated Milk This is now prepared by drying in vacuo fresh
cow's milk. It is offered as a sterilized food for the artificial feeding of
infants (see Volume II, Chapter II).
Desiccated Eggs. These are also offered as a substitute for fresh eggs,
but the product is very inferior to fresh-laid hens' eggs. The albumin of
egg dries in thin scales which may be indefinitely preserved, but the yolk
is not so well taken care of.
Dried Meat. The preservation of meat and fish by drying is probably
the oldest of the primitive methods of preserving meat. This method of
drying meat is practiced extensively among savage tribes in most parts
of the world, but especially where purity of atmosphere combined with
intense heat and dryness of climate will cause the water to evaporate from
the meat so rapidly that germs do not have time to decompose it. Meat
to be preserved in this manner must necessarily be lean, as the fat does
not part with its water with sufficient rapidity. Dried meat loses consid-
erably in weight, becomes hard and tough, and in many instances taste-
less. Such meat is usually very indigestible, and requires prolonged cook-
ing and liberal seasoning. Dried meats may be predigested, evaporated
and made into a paste for broths or used to reenfofce various food prepa-
rations for invalids. Meat extracts have been described in Vol. I, p. 287.
Concentration, according to Colonel Woodruff (8), means only the
extraction of the indigestible portions of the food and part of the water.
Thus the garrison ration gives to each man about five pounds of food, of
which only four pounds are eaten, and it is impossible to condense this
amount so that it will be much less than three pounds. All foods that are
compressed and dried still contain from 5 to 12 per cent of water. The
72
SCIENTIFIC COOKERY
German soldier's war ration is equivalent to about two pounds of water-
free food in the above sense. This is not enough for American soldiers
during hard work, yet it is possible in an emergency to give the soldier
fairly good nourishment with these improved foods, and not allow the
weight to be over two pounds, as seen in the following table, in which the
analyses are only approximate:
COMPOSITION OF EMERGENCY RATION OF THE GERMAN SOLDIER
ARTICLES
GRAMS
Protein
Fats
Carbo-
hydrates
Salts
Calories
Weights
3 cubes dried compressed
bread, J^ pound each. . .
3 packages compressed soup,
6 ounces each
35
100
4
150
250
200
2
28
1,233
2,625
Hlb.
1H "
u
H
3 tablets compressed tea or
coffee ready for use, pos-
sibly a tablet of dried
fruit
Total
135
154
450
30
3,858
*2 Ibs.
* Gross Weight.
The composition of the bread is assumed to be the same as ordinary
flour, and the tablets of soup can be manufactured of the given composi-
tion. As usually made, the tablets do not contain so much fat, which is
here purposely increased in order to give the necessary energy. Even w r ith
this increase they would not contain as much as the first specimens of
Erbswurst.
For purposes of detached service the United States soldier has been
supplied as follows:
COMPOSITION OF COMPONENTS OF THE RATION OF THE UNITED
STATES SOLDIER
GRAMS
COMPONENTS OF RATION
Protein
Fats
Carbo-
hydrates
Salts
Calories
Weights
1 pound hard-tack
50
5
340
2^
1,644
1 Ib.
% pound bacon
27
236
8K
2,310
% "
Coffee, sugar and salt
19
V* "
Total
77
241
340
30
3954
2 Ibs
BIBLIOGKAPHY 73
REFERENCES
1. SYKES. Principles and Practice of Brewing.
2. GRIXDLEY. Studies of the Effect of Different Methods of Cooking
upon the Thoroughness and Ease of Digestion of Meat, U. S.
Dept. Agric., Exper. Sta., Bull. 193, 1907, Washington, D. C.
3. BULLEN, F. T. The Cruise of the Cachalot, p. 273, pub. by Smith,
Elder and Co., London.
4. SPEAGUE and GRIXDLEY. A Precise Method of Roasting, Bull. No.
4-19, Univ. of Illinois, May 15, 1907.
5. WILLIAMS. Chemistry of Cookery, p. 158.
C. WILLIAMS, M. Chemistry of Cookery, J. Chem. Soc., p. 158.
7. KRAUS. Ztschr. f. diatet. u. physik. Therap.
8. WOODRUFF. J. Am. Cavalry Assn.
BIBLIOGRAPHY
GRINDLEY, H. B. Meat Losses in Cooking, U. S. Dept. Agric., Bull. 141.
. Chief Loss During Cooking of Meats, U. S. Dept. Agric.,
Far. Bull. No. 162.
SNYDER. Studies in Bread Making, U. S. Dept. Agric., Bull. 67, 101
and 126.
CHAPTEK IV
THE HYGIENE OF EATING
The Creator in compelling man to eat that he may live, invites him through
appetite and rewards him with pleasure.
The Hole of the Senses in the Pleasure of Eating.
Effect of the Manner of Eating on Digestion: Euphagia; Food and Emo-
tion; Bradyphagia : Tachyphagia; Evils of Ovennastication.
The Drinking of Water with Meals.
. Personal Idiosyncrasies.
Order and Frequency of Meals : For Healthy Individuals and in Diseased
Conditions; For Persons Engaged in Heavy Manual Labor, Skilled
Labor, Professional Vocations, Commercial Life; For Those Who
Lead Lives of Leisure; For Night Workers.
Regularity of Meals.
Sleep and Digestion.
Occupation and Digestion.
Variety in Diet.
Relation of Medication to Meals.
THE ROLE OF THE SENSES IN THE PLEASURE OF EATING
The above quotation is a sublime aphorism of the great deipnosophist
who regaled his readers with a vast abundance of gastronomic lore, em-
phasizing the correlative influences of the five senses on the pleasure of
eating.
"True it is that nearly all animated beings are endowed with special
senses, but man, alone, is granted the faculty of cultivating them to a
very high degree for bodily nourishment and mental enrichment as well
as for other purposes. Forced by hunger to eat for his sustenance, he
labored diligently in seeking the necessary aliments which, originally, he
had found through the aid of certain lower creatures whose movements
he had cunningly espied. The first sense he naturally exercised was that
of sight; the second, touch, when with his hand he seized an edible sub-
stance and carried it toward a third sense organ which gave him its odor,
then greedily thrust it into his mouth to awaken the f/usfafirc sense: the
clattering of his teeth pleasantly rousing the auditive sense. Thus were
75
76 THE HYGIEXE OF EATING
the five senses gratified whilst hunger was satisfied; appetite, that is to
say, the desire to eat tasty food, became agreeable, being the outcome of
that primitive experience."
The high cultivation of the senses in man gives him supremacy over
other animated beings in his struggle for existence. In the animal king-
dom, as well as among uncivilized peoples, the securing of food for suste-
nance forms the principal occupation during life. The necessity of ob-
taining food has remained the same with civilized man, but the manner
of partaking it has been changed, partially to his disadvantage. New in-
terests have arisen and the act of eating has been in a measure relegated
to the background. In this age of frenzied finance, in busy metropol-
itan centers, persons scarcely take time to eat ; they swallow hastily any
kind of food, without special selection, which is often very poorly prepared.
The natural consequence is that under these conditions diseases of the
alimentary system are more frequent than in the early days.
Individuals whose sense organs are abnormal, whose perceptions are
naturally dull or accidentally obtunded, or whose mental faculties are un-
tutored, have little if any real pleasure in eating. "Hunger and thirst they
feel, and beast like, brutally appease, but they have no true appreciation
of, or appetite for, dainty food or for its use in moderation ; whilst those
of cultured mind and sound body, in the enjoyment of delicacies, bring
into play all of their senses to enhance the pleasure of eating." This is
aptly summed up in the aphorism:
The beasts feed, man eats, but only men of genius know how to eat.
"The gustative sense, one of the most precious endowments of the Cre-
ator to the creature, is granted to nearly all animated beings, but man
alone is able to cultivate this sense to its highest possibilities. Probably
prehistoric man, from watching an animal in the act of ingesting food,
tried it, but found it malodorous, nauseous, unsavory, so he rejected it.
Finding another kind of food in which he perceived a fragrance and sapid-
ity, after bruising it in his mouth, he swallowed because of the pleasing
buccal sensation it produced. Gustation, therefore, may be defined as the
perception and distinction of savory and unsavory qualities of ingesta.
"Taste, like many other words pertaining to the alimentation of man's
body, is largely used figuratively, as in the expressions "good or bad taste"
or simply taste or its want, "de gustibus non est disputandum" being ap-
plied to both the original term and its figurative uso. For instance, an
aliment may be gustful to one individual and disgustful to another.
"The seat of gustation is at the base and sides of the tongue, the base
THE ROLE OF THE SENSES 77
being the region of the circurnvallate papillae, and the side the region of
the fungifonn papillae. The exquisitely delicate filiform papillae, dis-
seminated upon nearly the whole upper surface of the tongue, are purely
tactile, while the gustatory papillae are furnished with taste bulbs. Be-
sides ramifications of twigs from the glossopharyngeal nerve and lingual
branch of the trigeminal, the circumvallate papillae contain minute gusta-
tive bulbs (discovered by JSchwalbe and Loven in 1807). These gustative
bulbs exist also in the fungiform papillae. Thus the chain of specializing
bodies in the sense end-organs is complete, from the retinal rods and cones,
the tactile corpuscles and pacinian bodies, the olfactory cells in the upper
yellow region of the nasal mucous membrane, to the organs of Corti in the
internal ear."
Tasty aliments are often designated as "palatable," although the pal-
ate is passive in gustation, its office being purely mechanical and serving
as a hard, fixed surface against which the tongue bruises the food to ex-
press and diffuse sapid particles for quick solution by the saliva, without
which there would be no gustation of solids. The other parts of the buccal
cavity possess no more than tactile properties.
It has been stated by competent physiologists that there are but two
veritable savors recognizable through the gustative bulbs, namely: the
sweet and the bitter ; while others equally competent have- identified three
additional savors: the saline, the alkaline and the acid. However, sweet,
bitter, salt and sour are almost universally accepted. But all reject the
idea of acrid savors, which really result from mechanical action of acid
substances upon the tactile papillae, and ignore the so-called aromatic savor
which belongs to olfaction. Nevertheless the concurrence of the tactile and
olfactory senses is essential to perfect gustation and to the full enjoyment
of delicious aliments.
Taste, then, with its closely associated olfactory and tactile senses, is
regarded, ^astronomically, as the special and general pleasure evoked by
the perception and specialization of the crispness, of the succulence, sapid-
ity, and perfume of aliments ; and figuratively as a judgment of the beau-
tiful, the sublime and the picturesque.
The proper hygiene of eating is too often unjustly decried as sybarit-
ism by the thoughtless ; but students of rational deipnosophism admit that
the wise cultivation of the divine gift of the five senses is not only essen-
tial to the real enjoyment of edibles but is a blessing without which man
would be but little above the boast. The pleasure of eating should be the
reward for the labor of gathering, preparing, serving and consuming tlio
food.
78 THE HYGIENE OF EATING
In observing the proper hygiene of eating, it behooves one to insist
that wholesome aliments be rendered appetizing and pleasing to the
senses ; only ascetics denounce a gourmet by saying, "It is bestial to make
eating an absorbing object of thought. A man should eat to satisfy hun-
ger ; but if he allows his mind to run on his food, he will become a glut-
ton and beast at the cost of his soul." Such a charge, while not really
applicable to the gourmet, could only have been made by one known to
live on the commonest of foods and one whose gustative sensibility has
long since been obtunded and who does not care for good fellowship. It
is only too well known that the veritable gourmet always has a good cook,
and is never gluttonish. He is a daintier eater, only giving sufficient
thought to his daily food to insure its excellence of quality, and regarding
a moderate and reasonable gratification of appetite and gustative sense
as pertaining to human intellect, and the mere satisfaction of hunger as of
beastly instinct. The gastrolater is one who makes eating "an absorbing
object of thought" and \vho in brutish style devours large quantities of
food, regardless of quality. He does not become gluttonous, for he was
born a glutton.
"Good alimentary hygiene, like good German grammar" (1), involves
a clear knowledge, first of rules, then of exceptions, and finally of excep-
tions to exceptions. An ideally healthful, well-regulated life involves
painstaking regularity in eating, drinking, sleeping, exercise and modera-
tion, as well as avoidance of risks. But it is occasionally necessary to
resort to irregular and excessive demands even to the point of danger, in
order to develop moral, mental, muscular or digestive strength, and the
"exception to the exception" is that one must be careful not to make irreg-
ularity itself a routine, nor to make the physical test a strain nearing the
danger point, nor to disregard carelessly the experience of other observers,
or even his own, in running risks.
Eating or partaking of food is the only means by which life is sus-
tained. Without it the human organism cannot thrive, cannot gain in
weight, cannot grow. Total abstinence from food causes the body to lose
steadily in weight, and results in death.
EFFECT OF THE MANNER OF EATING ON DIGESTION
Euphagia Euphagia, or the art of eating properly, like all natural
processes, if performed under the proper hygienic conditions, affords the
body the jrreatest pleasure and satisfaction. In order to receive the greatest
pleasure from the partaking of food, the organism must be prepared by
EFFECT OF THE MANNER OF EATING 79
previous work, followed by a short period of rest. In Holy Writ, we find a
quotation : "In the sweat of thy brow shalt thou eat bread," which empha-
sizes the importance of work preceding the partaking of food. A German
proverb, "Arbeit niaclit das Leben siiss" (Work sweetens life), emphasizes
not only the pleasure derived from eating, but from all other functions
of life. Even if it is admitted that work is essential to the pleasure
and satisfaction of eating, still it must not be in excess or lead to exhaus-
tion, as in this condition the appetite usually lags and digestion becomes
sluggish.
Food and Emotions Meals should be served only after a short period
of rest, allowing plenty of time for the repast. During mealtime the emo-
tions should not be disturbed, either by anger or grief. The whole and
undivided attention should be given to the meal (2). Pleasant company,
light conversation, jokes and stories add to the enjoyment of food. It is
well understood that the brain exerts a powerful influence on the process
of digestion. Great grief or anger deters appetite and may seriously
hinder the process of digestion.
Pavlov (8) has established, beyond question, the great physiological im-
portance of the mental state on digestion, having successfully demonstrated
that the sight of delicacies exerts a stimulating influence upon the secre-
tion of gastric juice even before the viands are eaten. Food to be enjoyed
must not only be properly prepared and palatable but must be served in
an attractive manner. There can be no question that a well-laid table,
snow-white linen, polished silver, crystalline drinking vessels, beautiful
floral decorations, and the good taste displayed in all the appurtenances
of a well-ordered dinner, delight the visual impression with each course
throughout the repast and heighten the pleasure of eating.
Physiologists and dietitians guided by the work done by Pavlov and
Cannon on digestion and nutrition are realizing more and more the po-
tency of the psychic factors concerned in the process of digestion, and he
who comprehends only the chemical and mechanical aspects of these all-
important questions sees as "through a glass darkly" and needs to sweep
the- cobwebs from his brain.
When a hungry diner approaches an attractively laid table with an
appeti/ing meal thereon, both his eyes and olfactories set in motion the
preliminaries to the digestion of the food in sight. As the food is received
by the waiting gustatory tract, it is comminuted and insalivated just
sufficiently to promote easy deglutition and allow the savory taste and
aroma arising therefrom to be thoroughly appreciated. During mastica-
tion numerous messages are dispatched to the stomach, the pancreas, the
80 THE HYGIENE OF EATING
duodenum and the other organs concerned in the process of digestion, in-
forming them in code message readily understood how much and what
kind of aliment is being dispatched to them to digest. When such mes-
sages are of cheerful import, these organs at once take to their tasks with
alacrity, performing them with such ease and expedition that the diner
need not know that he even possesses a stomach.
But, on the other hand, should the same meal be approached with
severe gastronomic contemplation and with arduous and lengthy mastica-
tion, the message may be "flashed" to the waiting accessory organs, "Your
master has lost coniidence in you ; the mouth and teeth will take over
most of your former duties, and hereafter you will be under constant men-
tal surveillance." It can readily be perceived that under such a mental
state digestion is performed in a tedious, faulty, complaining and unsat-
isfactory manner, and we may well say that "the last state of that man is
worse than the first."
The effect of the emotions on digestion has, until recently, received
scant attention at the hands of physiologists; in consequence, our knowl-
edge of the emotional states on the process of digestion has been meager.
Cannon (2) has placed before the profession the result of his four years'
study of this subject in the Harvard Physiological Laboratories, and his
published researches have thrown light on a hitherto dark subject. We
are well acquainted with many surface manifestations under strong emo-
tion. The contraction of the blood vessels with resulting pallor, the pour-
ing out of "cold sweat," the stopping of the flow of saliva so that the
"tongue cleaves to the roof of the mouth," the dilation of the pupils, the
"rising" of the hairs, the rapid beating of the heart, the hurried respira-
tion and the trembling and twitching of the muscles, especially those about
the lips; these bodily changes are well-recognized accompaniments of pain
and great emotional disturbances, such as fear, horror and deep disgust.
These manifestations of the emotions commonly noted are mainly super-
ficial and readily observable. The internal organs of the body do not re-
veal so obviously the disturbances of action which attend states of intense
feeling. The organs most affected to an important degree by the feelings
are those concerned with digestion.
Cannon, in his recent investigations, has shown that not only are "the
first stages of the digestive process normally started by the pleasurable
taste and smell and sight of food, tut also that pain and great emotional
excitement can seriously interfere with the starting of the process or its
continuation after it has been started." The conditions favorable to
proper digestion are wholly abolished when unpleasant feelings such as
EFFECT OF THE MA.X.NEK OF EATLN'G 81
vexation, shame, worry and anxiety, or great emotions such as anger and
fear, are allowed to prevail. It has long been known that the salivary
secretion is seriously affected by fear or "stage fright" ; and the "ordeal of
rice," employed in India to detect criminals, was a practical utilization
of the knowledge that excitement is capable of inhibiting the flow of
saliva (3).
Other digestive glands than the salivary and gastric are influenced in
emotional excitement. Oechsler(4) reports a study of psychic disturb-
ances showing that emotional excitement suppresses secretion of the gas-
tric juice, the secretion of the pancreatic juice and definite hindrance of
the flow of bile. The secretion from the various organs concerned in the
process of digestion and the chemical changes produced by them are of
little value unless the chyme is normally propelled along the alimentary
canal, and just as the secretory activities of the stomach are unfavorably
influenced by the strong emotions, so also are the inovements of almost
the entire alimentary canal practically arrested under great excitement.
Cannon, by means of the roentgen rays, the most fruitful of all the tech-
nics applied in this field of study, was able to observe the movements of
the alimentary canal in animals, and in some of his experiments the waves
of contraction were perfectly evident, while in others there was not the
slightest sign of activity. The peristaltic waves in the stomach, and the
peristalsis in the small intestine, and reversed peristalsis in the large in-
testine all ceased when the observed animal was in a state of emotional
excitement.
Other sensory stimuli bring about similar inhibitions of gastric peri-
stalsis which can actually be observed in certain animals (rabbits) without
any operative interference whatever, by mere inspection of the epigastrium
as described by Auer(5). The stoppage of intestinal peristalsis, after
similar inhibitory influences are brought to bear, has been described for
the human subject by various observers who used the roentgen ray method.
If further evidence were needed to give emphasis to the profound de-
pendence of the activity of the stomach, as regards both its secretory and
motor functions, on the "condition" of the nervous system, additional
proofs could easily be adduced. Quite recently a large number of facts
have been gathered in the pharmacologic institute at Utrecht directly ap-
plicable to the question at issue. They involve a careful record of the rate
of discharge of bismuth meals from the stomachs of laboratory animals in
various stages of psychic calmness or perturbation, but under otherwise
comparable conditions. Without attempting to group the emotional states
into well-defined categories, we may describe the subjects us ranging from
82 THE HYGIENE OF EATING
individuals tame, unperturbed, readily amenable to handling and freely
submissive to observation, on the one hand, to wild, frightened or re-
fractory subjects on the other. Corresponding with these emotional states
the discharge of the meal from the stomach ranged in time from one and
a half hours in the former group to three or even more hours in the case
of the most unamenable subjects. Such figures are more expressive than
a dozen sermons on the importance of a proper state of the nervous sys-
tem in the normal performance of some of the functions of alimentation.
The conclusion is that the activity of the stomach in man is affected
similarly to that in the lower animals ; so, likewise, the gastric and intes-
tinal peristaltic waves are stopped in man as they are stopped in lower
animals by worry, anxiety and other conditions of mental discord. Thus
we see that the emotional life of an individual exerts a marked influence
upon all gastro-intestinal activity. Fully 50 per cent of the action of gas-
tric secretions is psychic and at least partially dependent upon hedonistic
approach. The intrinsic relationship between man's emotional state and
the operation of his primitive instincts is axiomatic. In the field of nutri-
tion, the proper selection of nutritional elements is a matter of protoplas-
mic activity of the original cell.
An individual in normal health, taking a reasonable amount of exer-
cise, does best to follow his natural appetites with regard to quantity and
quality of food, though an intelligent appreciation of physiologic demands
and the nature of the aliment is always of considerable value. Sanitarium
life is particularly demoralizing to persons who think too much of their
digestive physiology. Society matrons and debutantes who have nothing
to occupy their minds except dress and eating, become morbid from think-
ing too much of what they shall wear and particularly of what they shall
eat. Some physicians, too, become health cranks from constant applica-
tion of their professional ideas to themselves and their families. Health
cranks of all kinds are usually the product of imperfect, unqualified infor-
mation carried to an extreme in one direction.
Bradyphagia. One of the most prominent advocates of this class, in
recent times, is Mr. Horace Fletcher(G), an apostle of deliberate mastica-
tion bradypJiagia. He has so largely devoted his energies to this topic
that slow eating has come to be called "fletcherism."
Mr. Fletcher, when about to pass the middle milestone in life's jour-
ney, found himself obese, dyspeptic and discouraged ; at this point he dis-
covered that by slow and deliberate mastication his health seemed to im-
prove. He then began to elaborate this supposedly new principle, claiming
that he literally chewed himself back into normal health and averring that
EFFECT OF THE MANNER OF EATING 83
by extreme mastication and iiisalivation of food, hunger was satisfied with
a much smaller amount than ordinarily craved, while at the same time his
physical and mental well-being were enhanced. Mr. Gladstone, an Eng-
lishman, anticipated Mr. Fletcher as the first advocate of prolonged masti-
cation and attributed much of his success in public life to the fact that he
had always made it a rule in eating to give every tooth a chance at the
chewing.
Bradyphagia means eating too slowly a condition in which mastica-
tion is performed at an abnormally slow rate, often leading to injury of
the body economy. Mastication normally is an entirely voluntary act,
while the performance of swallowing is a complicated reflex movement
which is usually initiated voluntarily, but is, for the most part, completed
involuntarily. Under normal conditions the presence on the tongue of
masticated food seems essential to the completion of this act, and we
might add that a pleasant taste coupled with a favorable attitude still
further facilitates the act of swallowing and the passage of food through
the esophagus into the stomach.
Prolonged mastication may be, and often is, overdone by many people
to their detriment. In many cases every morsel is masticated and remas-
ticated, carrying out the Gladstone dictum of 32 bites for each morsel,
and before being swallowed is again chewed and everything carefully
tested with the tongue to see that it is thoroughly comminuted. The
fletcherite has an abnormal fear and suspicion that something dreadful
will happen unless he masticates his food as laid down by Fletcher in his
"A B of nutrition," which as a theory has grown, budded and blossomed
so popularly that eating has become a difficult task. The enjoyment and
pleasure of eating are transformed into a doleful process and a much
smaller quantity of food is ingested. It not infrequently happens that
the bolus of food remains in the pharynx or esophagus and refuses to
budge. It is not an organic affection that causes this dysphagia. but
merely excitement and fear of eating. In such individuals, of course, in
time a chronic inanition develops owing to bradyphagia and the added
temporary dysphagia, in consequence of which the patient gradually be-
comes weaker and sometimes even dies.
We admit the necessity for the moderate chewing of meats and urge
the most thorough mastication of carbohydrate foods. In diseased condi-
tions with impaired chemical functions of the stomach, or where a neo-
plasm constricts the pylorus, fine mastication and thorough insalivation
of foods are not only highly beneficial, but necessary. Fletcherism is also
permissible in those easy-going, lackadaisical individuals whose tastes aro
84 THE HYGIENE OF EATIXu
gently epicurean and who possess the desires of a Lucullus minus the
means. Let those benighted harmless souls chew and champ to their
heart's content, for they, poor beings, need some fad, and this one can
harm no one unless it be themselves. But to busy men who are shoulder-
ing the cares of government, commerce and science, and whose strenuous
impetuosity moves them to act quickly, whose every act is intense and
every movement a flash to such individuals, fletcherism is a thorn in the
flesh.
Einhorn(T) reports a case of bradyphagia a lawyer 32 years of age,
who consulted him for digestive disturbances and gave a history of having
lost considerable flesh and of being unable for the previous three years to
attend to business. He complained of an inability to swallow food and of
intense pains in the upper abdominal region particularly after meals.
This patient had lost more than 40 pounds, of which only a small portion
was lost during the previous six months. He was a strict follower of the
ideas of Fletcher; he ate very slowly, taking as long as half an hour to
consume a glass of milk. He was emaciated, and an examination of the
thoracic organs gave negative results. The lower border of the stomach
reaching two inches below the navel, the epigastrium was slightly sensi-
tive to pressure. Examination of the stomach contents after a test break-
fast showed the presence of free hydrochloric acid with an acidity of 78.
Dr. Einhorn's diagnosis was neurasthenia with hyperchlorhydria, and
upon his advice the patient was given a more liberal diet and advised to
eat more rapidly. In three weeks he gained eleven pounds and continued
to gain in weight and entirely recovered. The difficulty of this patient in
eating and swallowing is explained by the psychic excitement subsequent
to the sitophobia and bradyphagia.
Tachyphagia Tachyphagia, or hasty eating, is a common evil. The
food is only half masticated or possibly not at all, and enters the stomach
without being properly comminuted and insalivated. Such practice will
surely lay the foundation for many disorders of the stomach and be a fruit-
ful cause of intestinal auto-intoxication. Food which is not properly com-
minuted will be the means of irritating the gastric mucous membrane and
will not be sufficiently acted upon by the gastric juice which affects only
the external surface. More particularly does this refer to the digestion of
albuminoids. Carbohydrate foods when eaten too rapidly enter the stom-
ach with only slight alteration, due to the rapidity of mastication and
swallowing, wherein the ptyalin of the saliva is not present in sufficient
quantities to produce any effect on the preliminary digestion of starches.
The chyme, as a result of imperfect mastication and imperfect admixture
EFFECT OF THE MANNER OF EATING 85
with the gastric juices, passes out through the duodenum practically un-
changed and is liable by its coarseness to produce an irritation of this
organ.
Tachyphagia has other drawbacks besides the mechanical effect just
mentioned, as it includes the taking of larger quantities of food in too
short a time and the ingestiou of foods too hot or too cold. In observing
the proper hygiene of eating, provision is made that not too much food
passes into the stomach at once, for mastication requires time; besides / in
dining congenially, some time is spent in conversation and in serving of
the different courses. Food that is too hot or too cold has its temperature
somewhat equalized by the slow passage through the mouth and esophagus.
These important factors are not observed in eating too rapidly. It is
therefore plain to the careful student of euphagia that in too rapid eating
an unsuitable quantity of food at unsuitable temperatures is consumed;
both conditions being a fruitful cause of digestive disturbances. Tachy-
phagia, or too rapid eating, is a frequent fault, causing many digestive
qualms, and initiating many chronic disorders of the alimentary canal.
This we admit. But we do not admit the necessity for slow, deliberate
and systematic mastication as a sine qua non for health in every indi-
vidual, irrespective of temperament, occupation or station in life; nor do
we believe it conducive to the best physiological work of the digestive
organs that a hard and fast rule be enjoined whereby a certain stated
period of time must be devoted to mastication regardless of the nature of
the food or the pleasure of the masticator.
Evils of Overmastication. Insalivation exerts but little physiological
effect upon the protein constituents of food. According to the teachings
of physiologists, we know quite well that either the pepsin and hydro-
chloric acid in the stomach or the trypsin beyond will take care of the
digestion of meats provided they are decently comminuted and stay in
the mouth only long enough to originate those psychic impulses which
Pavlov(S) has so well shown us regulate the subsequent flow of the di-
gestive juices. Every observer who has watched carnivorous animals feed,
knows that they habitually bolt their food, and zoological history records
no account of any psychic forms of dyspepsia in these animals. The prin-
cipal function of salivary digestion is the preliminary transformation of
starch into maltose by the action of ptyalin, and this process, though in-
augurated in the mouth, continues until the whole of the stomach content
has become acid. The time of salivary digestion, though quite brief, to
be effectual should be energetic. Primarily, it is a preliminary act and
no more should be expected of it than this. The pancreatic and other
86 THE HYGIENE OF EATISTG
juices beyond the pyloric eud of the stomach will take care of the diges-
tion of carbohydrates, and the psychic centers will forward the message
regularly and rapidly as received by the gustatory senses.
After all, we might say, and say correctly, the rapidity of chpwing is
temperamental. We all know that some people can perform a given task,
and perform it well, in half the time required by slow-moving individuals
who do everything along the lines of least resistance ; and as some people
act quickly, speak quickly and think quickly, they also chew quickly but
well. Men of aifairs in the business world, those engaged in professional
activities, soldiers, statesmen, and what not ardent and strenuous spirits
are happiest when in the busy turmoil of competitive struggle; with
them, the act of mastication is naturally performed briskly but none the
less adequately. While on the other hand, the easy-going meanderer, who
always seeks the lines of least resistance, goes through life in a leisurely,
lackadaisical way, "far from the maddening world's ignoble strife." To
these semivaletudinarians, whose gastronomic functions are constantly
under severe mental scrutiny, fletcherism holds out promises for their di-
gestive and intestinal qualms.
Time is too precious, and life too short, to spend an unnecessary part
of both in useless, if not harmful, mastication. Fletcher records in his
writings that "one-fifth of an ounce of a young onion required 722 chews
before it disappeared through involuntary swallowing," and Dr. Kellogg
records the history of a patient who devoted never less than one and one-
half hours in partaking and masticating his one scanty daily meal. It is
preposterously asinine to suggest that busy, active men those upon whose
shoulders rest the burdens and perplexing cares of government, commerce
and science, whose bright intellects are eagerly conquering the earth, the
sea and the air, should be subjected to a too prolonged and wearisome mas-
tication which is a snare and a delusion a foolish fad an anachronism
in our twentieth century civilization.
A retired business man cadaverous looking and dyspeptic consulted
Niles(9), informing him that up to his retirement from active business,
five years previous, he had never experienced a digestive discomfort dur-
ing his strenuous years of laborious business activity. He hurriedly ate
his breakfast so as to reach his office betimes. He snatched his lunch at
a near-by restaurant, and his evening meal or dinner was frequently rushed
through in order to keep some important business or social engagement.
The subject of prolonged and tedious mastication had never entered his
mind, t nor did he realize that he was "digging his grave with his teeth,"
until he was so informed by an over-zealous acquaintance, made some time
EFFECT OF THE MAKNEK OF EATING 87
after his retirement from business. With this idea implanted in his idle
mind, and with little else to do, he began to devote himself assiduously
to tietcherizing his food as a safeguard to his future health. Niles reports
that as a result of too much thought given to his digestive organs, there
resulted a morbid introspection which gradually transformed a robust,
alert business man into a puny, whining individual full of pains and ob-
sessions, whose every waking thought was short-circuited on his stomach.
Napoleon (10) at 35 years had developed and rounded out into a full-
ness that indicated abounding health and vigor, and at the same time his
mental faculties had reached their acme. His power for work had appar-
ently never been equaled by any other man. He on one occasion said
there was no limit to his endurance. Even his enemies declared that his
capacity for strenuous work equaled that of four men. His digestive
powers were perfect. He preferred plain dishes well cooked, his meats
browned, and he rarely spent more than from seven to twelve minutes at
a meal. When he became emperor and reached the pinnacle of his suc-
cess, like many other successful men, he began to pay too much attention
to eating, to the consideration of bodily comfort, and less attention to exer-
cise. The result was he became obese, and at forty his physical powers
began to decline and his grasp on the world slackened.
In Volume I, Chapter V, in the section on the Chemistry and Physi-
ology of Digestion, we discussed the mechanical and chemical changes
occurring in the stomach and intestines during digestion. It will be seen
on referring to this section that each division of the alimentary tract has
its rightful duties in the life-scheme of nutrition, and the magnification
of any one of these duties is liable to prove an opening wedge for various
digestive ills, which, like jealousy, furnish the food upon which they feed
and thrive.
We are of the opinion that Americans eat too much butcher's meat and
comminute it to an unnecessary fineness which, according to our theory,
is not only unessential, but contrary to nature. All carnivorous animals
bolt their meat, and we have no recorded observation of these creatures
suffering from any form of digestive disturbances. In the first place,
meats can only be digested in an acid medium. The gastric juices of tho
stomach are markedly acid, and it is necessary for meat to remain in the
stomach from three to four hours or longer in order to be digested.
Our belief is that meat which is too thoroughly masticated and macer-
ated will be forced into the duodenum before the acid gastric juices of
the stomach have had time to prepare it for digestion. It is well known
from experience, that eating sausage or hamburger steak produces trouble
88 THE HYGIENE OF EATING
during the process of digestion, which is explained in this way. The meat
from which sausage and hamburger steak are made is reduced to a very
fine puip with a machine, and when it enters the stomach, it does not re-
main sufficiently long to be acted upon by the gastric juices. By the peri-
staltic contractions pointed out above, it is forced into the duodenum too
early, and as a result of not being properly acted upon by the acid gastric
juices and reaching an alkaline medium in the duodenum, too soon, pro-
tein digestion is hindered. Consequently, the end products of protein
digestion are present, throwing extra work on both the kidneys and liver,
which are not able to take care of it. Finally these same end products of
protein digestion are reabsorbed -into the circulation, producing a long
chain of ill results, prominent among which is intestinal intoxication.
Major W. B. Allen, Medical Corps United States Army, conducted a
very interesting series of experiments which he related to the writer as fol-
lows: A few years ago a company of men under his direct supervision,
partaking of the regular United States Army ration, were instructed to
bolt their meats, Major Allen taking careful record of the condition of the
health of the company before beginning his investigation. He very care-
fully watched this company during a period of twelve months, having
them bolt their meat during this period of time. As a result he found
that this company of men had fewer sick calls than any other company
in the regiment. They were more free from bowel disorders, constipation,
headache and digestive disturbances than any other company of men in
the battalion, which he attributed to the fact that they did not chew their
meats to an unnecessary fineness. This observation is peculiarly interest-
ing and of value in emphasizing the foolish fallacy of Fletcher's fad.
It is a mistaken idea that the proper hygiene of eating means "giving
up all the things that taste good." It may be true that in many cases sac-
rifices are made in reforming one's diet, but these sacrifices should not
decrease the enjoyment of food. It is a well-known physiological fact
that it is extremely unhygienic to eat foods that are not relished. Foods
must have a pleasing taste and flavor and must be enjoyed in order to be
most readily assimilated. Experiments already quoted by Pavlov show
that the taste and enjoyment of food stimulate the flow of the various di-
gestive juices.
THE DRINKING OF WATER WITH MEALS
A moderate amount of drinking water during meals is not objection-
able. One or two glassfuls may be taken with impunity, provided it is
not taken when food is in the mouth and used for washing it down. A
WATER INGESTION 89
moderate amount of liquid, from 250 to 500 c.c., may be taken without
harm at each meal by persons in good health, and if there be a tendency
to accumulation of mucus or lack of sufficient secretion, digestion may
occur more rapidly when liquid is used. Physiologists estimate that the
stomach contents one hour after a meal should approximately consist of 50
per cent water that can be. removed by filtration.
Hawk (11) has shown that, when water drinking accompanies the tak-
ing of food, the passage of water is delayed somewhat. His experiments
also show that the equivalents of from one-half to three-quarters of the
amount of water ingested during a meal, if this amount is large, may be
voided in the urine within 45 to 90 minutes thereafter. That the food ele-
ments were not thereby washed through the stomach into the intestine was
shown by Cohnheim(12). Along the smaller curvature there is formed
a trough connecting the antrum pylori with the cardiac opening, and
through this water flows past the bolus of food lying in the stomach with-
out washing any of the exterior away. Even when digestion is at its
height, and when gastric juice is being secreted in large quantities, almost
neutral water is often found leaving the stomach. Cohnheim also states
that there is no dilution of the stomach contents by liquid food, and the
accurate regulation of the pyloric sphincter is not disturbed whether water
is taken with the meal or not.
From this brief review of the facts regarding the drinking of water
with meals, we may say :
a. The ingestion of moderate amounts of water with meals not only
does not inhibit the normal flow of digestive juices, but acts as an excitant
to their flow.
1). The digestive juices are not rendered less efficient by dilution, but
on the contrary, the greater the dilution, the more complete is the enzyme
action within limits.
c. Even if the food were washed into the intestine more rapidly than
usual, contrary to Cohnheim's belief, the greater efficiency and the greater
amount of the digestive juices would outbalance this.
PERSONAL IDIOSYNCRASIES
In advising proper, well-balanced dietaries, personal idiosyncrasies
must be taken into account, and the old adage, "what is one man's meat
is another man's poison," must be respected. Again individuals have a
mistaken idea of their personal idiosyncrasies; many people asseverate
that nuts do not agree with them, when the trouble really is in the want
of proper mastication.
90 THE HYGIENE OF EATING
In the succeeding chapters directions will be given to help the physi-
cian in prescribing a well-balanced dietary, both in health and disease, but
it will be difficult to formulate any rule which will completely insure such
a choice. Even the wisest physiologist cannot depend altogether on his
knowledge of food values.
Sound sleep depends somewhat upon previous fatigue. So good appe-
tite, even the zest for some particular food, follows incipient starvation.
Thus while the anabolic processes are normally nearly always the same,
so as to supply material for oxidation and repair of waste as needed, occa-
sional periods of moderate shortage do no harm but rather stimulate or-
ganic vigor and economy.
ORDER AND FREQUENCY OF MEALS
The ingestion of food and drink should be intermittent, since they are
intended to provide reserve force for the body. The supply and consump-
tion of nutrients should balance, well-nigh approximately weekly or daily,
except where it is advisable to remove an excess or supply a deficiency.
It is even deemed advisable to have the separate meals correspond as
nearly as possible to the demands for supplying food for succeeding
periods.
Individuals in normal health should have three meals daily, and so
should patients suffering from most chronic affections, when a sufficient
amount of food can be taken at three meals for proper nutrition. In dis-
eased conditions, however, it will be seen, as outlined in Volume III,
Chapter I, that five or six meals are more desirable and much more readily
digested, and, in rare cases of ulcer of the stomach, or pernicious anemia
with persistent vomiting, food in minute quantities must be given as often
as every fifteen or twenty minutes.
Persons engaged in heavy manual labor, as on a farm or in a lumber
camp or in railway construction, require a Hearty breakfast, a solid mid-
day dinner served hot and a light supper or evening meal. Individuals
engaged in this class of labor require(13) :
1. Protein: 90 to 110 grams, 50 per cent to be from animal food; or
110 to 130 grams if only one-third of the protein comes from animal food.
2. Fat : 60 to 80 grams if the food contains 500 to 550 grams carbo-
hydrates ; or 80 to 100 grams if the food contains only 450 to 500 grams
carbohydrates.
3. The heat content of the food should be 2,900 to 3,300 calories. No
fixed form should be prescribed for the food taken, because persons differ
so much from one another in their capacity to assimilate certain foods, in
OKDEli AND FREQUENCY OF MEALS 91
their physical condition, etc. The lower figures given in the foregoing
should be considered as the minimum, while the higher values are suffi-
cient for the energy expenditures of strong and healthy persons engaged
in moderately active muscular work.
For this class of workers the breakfast and dinner should be the largest
meals. The supper or evening meal, on the other hand, should be light
and easily digested, consisting of bread and milk, or other cereal food
with milk, eggs and fruit, so that the stimulation of metabolic products
would not interfere with sleep, and thus no great demand for innervation
might be made on the nervous centers. In outlining the dietary for this
class, special attention should be given to this evening meal for the reason
that a full bladder and especially one filled with urine rich in waste prod-
ucts and of high acidity, will interfere with sleep, and should be care-
fully considered.
Individuals engaged in skilled labor not involving great physical or
mental fatigue and lasting only eight hours do not demand the hearty,
warm noon dinner required by the individual engaged in heavy manual
labor, although both breakfast and luncheon should be richer in carbo-
hydrates and fats than those of the professional and business man.
Whether the evening meal is called supper or dinner, it should be essen-
tially a dinner, served hot and relatively more hearty than that of the
strictly manual laborer.
Individuals engaged in professional vocations, rising later in the morn-
ing and going to bed later in the evening, should partake of a light break-
fast consisting largely of fruits and cereals and not over 500 to 700 calo-
ries. They should partake of a slightly heartier luncheon and have their
principal meal at the close of the day's work, allowing four or five hours
for its digestion before retiring.
Individuals in the busy marts of commercial life, whose work is quite
equally divided between the morning and afternoon,, and whose social life
is relatively simple, should, if possible, take the leisure for a warm noon
meal, with a sumptuous dinner in the early evening. They require a
dietary that will yield from 2,800 to 3,000 calories daily.
For persons who lead a life of leisure, keeping late hours at night, tho
most convenient arrangement is a light breakfast of fruit, cereals, possibly
an egg with coffee; a light luncheon about midday; and a dinner at five
p. m., with a light supper, not too unwholesome and with very little stimu-
lating beverage, containing either xant.hin or alcohol, at eloven or twelve
in tho evening.
Nif/lit irorkers usually go to bed as soon as possible aflor finishiiiir
92
their allotted task. Manual laborers working at night require the same
arrangement of meals, at opposite hours, as day laborers. Business or
professional night workers usually begin and close their work at relatively
earlier hours in the evening and morning than corresponding day workers
in the morning and afternoon, respectively; consequently, they have more
time before luncheon, after completing their sleep, than day workers have
before breakfast, and they can very well use the ordinary luncheon and
dinner and take a light supper towards the close of the night's work.
Heretofore it has been taught that a full stomach is a protection
against prolonged physical and mental fatigue, exposure to cold, dampness
and infection. This is true in the sense that the increased demand for
nutriment should be met by hearty meals, even at unusual hours ; but it
is a dangerous fallacy, if construed as an indication for overeating or for
eating at too short intervals. Coffee, tea and chocolate have their greatest
value and alcoholic beverages their greatest danger in meeting such emer-
gencies. In Volume I, Chapter XVI, we have already taken occasion to
point out the danger, in particular, of drinking spirituous liquors before
going out into the cold.
REGULARITY OP MEALS
It is an indisputable fact that regularity in partaking of meals is ad-
vantageous, but it is not necessary to make oneself a slave to the clock by
insisting on minute punctuality for mealtime. It is not wise to eat
heartily simply because it is mealtime, in the absence of appetite ; neither
is it advisable for a person in normal health to skip a meal unless there
is some derangement of the digestive organs. Variety in diet is an impor-
tant factor in stimulating the appetite and digestive secretions. Variety,
however, does not necessitate the use of imported or expensive foodstuffs.
A reasonable degree of uniformity in diet in the organic nutrients or even
in the groups of foodstuffs, fats, proteins, carbohydrates, etc., should be
followed, but the different varieties of bread and crackers, meats, fruits,
etc., should be freely used with different methods of cooking and flavoring.
The benefit ascribed to the change of climate and scene is often due to a
change of food and cooking. Frequently perfectly wholesome and even ex-
pensive and well-cooked foods fail to fulfill their function, simply for want
of ingenuity on the part of the cook to afford variety and pleasing flavor.
It is regrettable that an absurd custom has been inaugurated in Amer-
ica of omitting breakfast, or of taking only coffee and a roll. This habit
was introduced by Americans who had traveled in France, where this
absurd custom exists,
SLEEP AND DIGESTION 93
SLEEP AND DIGESTION
The young in/ant should spend the greater part of his time in sleep,
awakening only to take nourishment and remaining awake but a short
period of time necessary for exercise. During the second and third years,
the child requires about fourteen hours' sleep, gradually reduced to twelve
by the eighth or tenth year and to ten hours at the close of adolescence.
For detailed information pertaining to diet and sleep at different ages and
physiological periods, the reader is referred to Volume II, Chapter NI.
During active adult life the amount of sleep depends to some extent
upon heredity and bodily vigor, but largely on the severity of mental and
physical activity; it is greatest in youth and least in old age. The
overworked medical student requires more sleep than most other profes-
sional students, or than the average college student. For severe mental
and manual labor, ten hours' sleep are usually required. Light physical
labor, routine clerical work and easy professional occupations require only
seven or eight hours' sleep.
Sleep favors digestion and allows time for its chemical process to be
completed before the next meal, so that appetite is awakened. There-
fore, from a physiological point of view, the proper time for the largest
meal for farmers and mechanics is in the early part of the day, because a
hearty supper ingested the evening before is out of the stomach by mid-
night and the digestive organs have had eight hours' rest before 8 a. m.,
when the logical time for a hearty meal occurs. Farmers and those en-
gaged in manual labor, mechanics and others, are accustomed to have a
very heavy, substantial breakfast.
Tt is a fact well known that eating a heavy meal brings about a decree
of hebetude by diverting the blood from the brain to the stomach, and
therefore, one should not retire until two or three hours after eating a
hearty dinner. If an individual retires four or five hours after dinner,
he will be able to get along very well with six or seven hours' sleep, but
if he goes to bed immediately after a hearty meal, he usually requires from
eight to ten hours' sleep.
The metabolic processes of the body are least active during quiet, deep
sleep. During sleep the body rests, which is often quite as necessary for
healthy digestion as sleep itself; indeed, the great tax upon the digestive
organs for metabolizing the full meal is little appreciated, judging from
the strenuous physical and mental stunts performed by some people imme-
diately after eating. We all realize that sound sleep often dissipates in-
digestion. For the performance of the proper physiological function?! of
94 THE HYGIENE OF EATING
the digestive organs much blood is required, which is not usually com-
patible with full functional activity either of the brain or the muscles.
Physicians have found that, for this reason, a brief rest after each meal
contributes largely to its digestion. Pavlov and other physiologists
have proven beyond doubt, by producing artificial fistulas in the various
organs of animals, that an enormous amount of blood is directed from the
periphery of the body to the digestive organs, and that the respective di-
gestive juices are secreted in greater abundance and with greater rapid-
ity during the normal digestive process. From habit, the system becomes
accustomed to fairly active physical exertion and even to engrossing men-
tal activity after a moderate meal. Yet for one's well-being it is advis-
able to eat two or three hours before any exceptional strenuous physical
exertion or difficult mental application is undertaken and to rest or even
take a nap after a hearty meal, and not to eat too heartily just before
retiring.
OCCUPATION AND DIGESTION
We had occasion in the early part of this chapter to refer to work as
stimulating appetite and digestion. It is known that agreeable occupa-
tion stimulates ambition, creates the healthy habit of thinking and study,
and leads to optimism which in turn promotes good digestion. We all
know that the worst dyspeptics are the disgruntled and pessimistic indi-
viduals who have nothing to do but to eternally bore their friends by out-
lining their ills. Many of this class do not work because some relative's
will left them in affluence. Some of these affluent individuals spend their
time with sports, while others, devoid of all sporting proclivities, readily
develop dyspepsia, hypochondria and melancholia. The former would be
far healthier and happier if a part of their time were occupied in some
useful vocation ; others follow no vocation because the compensation is in-
adequate or their services are not sought, or they fail to find the kind of
work for which they are best adapted. It is apparent to the thinking
physician that psychical and dietetic treatment for this class of patients
is far preferable to the customary wholesale administration of dyspeptic
and nervine remedies which not only do no good, but, beyond doubt, are
harmful by their chemical action in the system.
VARIETY IN DIET
Monotony in diet does not augment appetite nor facilitate digestion.
This is emphasized by Barr in his published results on the monotonous
VARIETY IN DIET 95
feeding of prisoners. He says the continued serving of one kind of food
in one way causes loss of appetite, vomiting, flatulence, diarrhea or ob-
stinate constipation. The great Shakespere said: "Let good digestion
wait on appetite and health on both."
It is a mistaken idea to bring up children without teaching and train-
ing them to eat all kinds of foods. It is likewise a mistake to say that a
boy or girl at puberty, or an individual in adult life or even old age, is
too old to acquire a liking or appetite for a particular kind of food that
he has never tasted, or even a food that he became disgusted with years
before, perhaps because of partaking too freely of it.
We have already had occasion to point out the reasons for variety in
diet. We wish to emphasize them again : First, to make it possible for
individuals to live in any part of the world ; second, to enable them to
nave a greater variety of food which permits of a better balanced ration;
third, to inculcate the habit of eating different foods in youth ; fourth, to
enable them to enjoy meals while traveling and sight-seeing; fifth, to en-
hance their chance to recover from illness by being able to partake of a
greater variety of nourishment. Older persons should be persuaded to
cultivate an appetite for all kinds of wholesome food and not be content
with one method of preparation. They should familiarize themselves with
different methods of cookery, as the greater the variety, the better the ap-
petite, and the more monotonous the fare, the poorer the appetite.
An elaborate dinner usually consists of a double meal, the soups and
entrees coming first, the "good things" last. The first dessert is repre-
sented by compotes, sherbet, etc. Such meals are usually too elaborate
and often represent an entire day's ration. "Good things" are on the
whole richer in caloric value than the plainer or substantial foods. An
ice cream soda or sundae (sondhi) contains from 200 to 400 calories; a
half pound of candy, about 000 calories ; a half pint of unshelled peanuts
or almonds, 000 calories. Either of the latter also furnishes about 20
grams of protein, a third of a day's ration. The intelligent laity and even
physicians fail to realize that allowance should be made for such indul-
gence in the ration for the regular meals.
There is probably much truth in the belief that normal appetite forms
a reasonable index of the dietetic needs for metabolism. If individuals
free from digestive disturbances maintain a practically constant weight
and a slight surplus of energy in a form of panniculus adiposus, without
being too stout or too thin, it is not unreasonable to believe that their
dietetic habits are not far removed from the metabolic needs of their
bodies.
96 THE HYGIENE OF EATING
In this chapter we have endeavored to point out the necessity for the
use of proper quality and quantity of food needs, and the absolute neces-
sity of supplementing these by other accessory adjuncts to good digestion,
in order to secure the best results.
We pointed out in the preceding chapter, Analyses and Cooking of
Foods, the reason for proper attention to the culinary art as well as the
reason for the selection of proper variety, quality and quantity of food-
stuffs. The illustrative tables on analyses of foods in Volume I, Chapter
XIX, are very extensive and complete, giving the protein, fat, carbo-
hydrate, ash, fiber and water content of every known article of food.
These tables also show the caloric value per poiind and per portion, so
arranged that the physician or dietitian can, with ease and rapidity, pre-
scribe a variety of diet either in health or for certain diseased conditions,
and can at a glance know the caloric content of the ration.
In the ensuing chapters of this work, the scientific application of
trophotherapy to the general principles of nutrition both in health and
in diseased conditions will be gone into very exhaustively. The reasons
for subjecting patients suffering from various diseases to a strict dietetic
therapy will be taken up, and the science of sitology, particularly as to
the therapeutic value of foods in disease, explained. The apparent same-
ness of diet in many affections is not real, as will be seen in the large
number of foods allowed containing protein, carbohydrates and fat. The
percentage of each element allowed in every case is not stated, because it
must vary with the patient and can be safely left for the physician to pre-
scribe after he has familiarized himself with food values and has studied
the case.
RELATION OF MEDICATION TO MEALS
Before closing this chapter, the author deems it advisable to refer to
the relation of medication to meals. The directions and rules incorpo-
rated herewith for prescribing certain medicines before meals, certain
other medicines immediately after meals, and others one or two hours
after meals, are based almost entirely on the writings of Dr. A. L.
Benedict (1).
Ordinarily, acids should be given before meals, especially when given
to promote secretion of hydrochloric acid. It is well to bear in mind that
half an hour should be allowed for their passage into the intestines before
the meal is begun. If alkalies are used to reduce gastric acidity, they
should be given one hour or more after the ingestion of the meal, and in
some instances they should be repeated in divided doses. Alkalies when
RELATION OF MEDICATION TO MEALS 97
given for this purpose should be prescribed in the form of carbonates.
Some clinicians make a common error of regarding neutral salts of alka-
line metals as alkalies. When there is a deficiency of hydrochloric acidity,
hydrochloric acid should seldom be given less than an hour after meals, in
order to permit the stomach to do what it can in this direction and some-
times acids are needed in several divided doses given at intervals of half
an hour. It should be borne in mind that acids must not be given after
the stomach has emptied itself. The practice of prescribing hydrochloric
acid before meals to reduce hypochlorhydria is useless.
Simple bitters and other remedies used to spur on a flagging appetite
or to stimulate gastric secretion should be given shortly before meals.
Drugs which exert local irritant action, unless for some special reason,
should be given during or after a meal in order to secure dilution and
thorough admixture with the stomach contents. Drugs intended to exert
a local action on the stomach, as bismuth, emulsions of bismuth, etc.,
should be given three or four hours after a meal and the interval between
meals should be lengthened as much as possible to allow sufficient time for
their action. Drugs which exert a nauseating action should be given on a
full stomach immediately after a meal, provided the physician desires to
prevent their nauseating effect ; otherwise they should be given on an
empty stomach. Remedies intended to exert their action mainly on the
intestinal tract should be given about three hours after a meal, and in cap-
sule form if they are decomposed by the gastric juice. Ordinarily, gela-
tin capsules do not dissolve within an hour, but salol or keratin coatings
may be employed for pancreatin, etc. Many substances, such as salol,
salacetol, iodipin, etc., are not acted upon in any degree in the stomach
and hence may be given immediately after a meal.
Saline cathartics and purgative mineral waters usually act more ener-
getically if taken half an hour or so before breakfast or before other meals,
and may fail if given at night when the patient is about to retire. Other
cathartics intended to act from a single dose are best given just before
retiring. Laxatives when used regularly are usually given in small dos-
age, preferably with meals, whether before or after being a matter of in-
difference, unless their administration before meals should hinder appe-
tite. Under such circumstances they should be given after meals.
Corrosive medicines of all kinds, including the mineral acids and
salts, should be well diluted and drunk through a tube, or the tongue
should be used as a trough and tho mouth should be immediately rinsed
in either case, preferably with a dilute alkaline solution of soda or borax.
Quinine and other bitter drugs may be given with chocolate to dis-
98 THE HYGIENE OF EATING
guise the taste. Jain, apple sauce, etc., may be used to disguise the taste
of some medicines.
The iodids and salicylates may be given in milk. The iron salts should
be preferably administered in sirups, never in mucilages, both to disguise
the taste and prevent corrosion. Castor oil may be given in whiskey, milk
or fruit juices or after salt has been placed on the tongue.
Since the digestion of fats and oils takes place only after saponifica-
tiou, cod liver oil should not be given until one and a half hours after
meals.
The food and digestive juices contain various substances more or less
incompatible with certain medicines; for example, starch with iodin,
hydrochloric acid with calomel, hydrochloric acid, proteins and mucin
with silver salts ; tannin with alkaloids, iron and various other substances,
and gummy substances with iron. To what degree these incompatibilities
are of consequence, or how far they can be avoided, must be considered in
each case, and for further information pertaining to these incompatibili-
ties, the reader is referred to the various text-books on Materia Medica
and Therapeutics.
. REFERENCES
1. BENEDICT, A. L. Golden Rules of Dietetics.
2. CANNON. Bodily Changes in Pain, Hunger, Fear and Rage, pub.
by D. Appleton & Co., 1915.
3. XEA, HENRY CHARLES. Superstition and Force, Philadelphia.
4. OECHSLER. Internat. Beitr. z. Path. u. Therap. d. Ernahrungs-
stb'rungen, 1914, vol. v, p. 1.
5. AUER. J. Am. Med. Assn.
6. FLETCHER, HORACE. The A B C of Nutrition, New York.
7. EINIIORN. New York Med. J., Jan. 7, 1905.
. N. Y. Med. J., Jan. 7, 1905.
8. PAVLOV, IVAN PETROVICH. The Work of the Digestive Glands,
translation by Thompson, 1902.
9. NILES, GEO. M. J. Am. Med. Assn., March 29, 1913.
10. Editorial, New York Med. J., June, 1915.
11. HAWK. J. Am. Chem. Soc., 1911, vol. xxxiii, 1909.
12. COHNHEIM. Miinch. med. Wochnschr., 1907, 54, 2581.
13. GIGON (of Basel). Monthly Review of the U. S. Labor Statistics,
vol. i, No. 2.
CHAPTEE V
VARIOUS FACTORS BEARING ON DIET, DIGESTION AND
ASSIMILATION
IN COLLABORATION WITH
A. L. BENEDICT, A.M., M.D., F.A.C.P.
The universe is naught but by life, and all that lives is nourished.
Transmutability and Reservation of Foods.
Waste and Digestibility of Foodstuffs.
Substitutes for Food.
Starvation and Inanition : Starvation ; Inanition.
Fasting: Fasting in Religion; No-Breakfast Plan; Fasting as a Cure;
Long-continued Undernutrition; Fasting Experiments; Effect of Fast-
ing on Metabolism.
Perversion of Appetite: Parorexia, Anorexia, Bulimia, Polyphagia,
Akoria, Polydipsia, Rumination, Merycism, Vomiting, Hiccough,
Aerophagia, Seasickness.
TRANSMUTABILITY AND RESERVATION OF FOODS
From a careful study of the elements of foods, it is evident that one
kind of food cannot be transmuted into a totally different kind. While
we know that one saline may, to a slight degree, replace another in osmotic
phenomena, and that even hydrochloric acid may be replaced by other
strong acids in gastric digestion, yet sodium cannot entirely take
the place of potassium, nor is it possible, because of its greater toxicity,
for potassium to supplant sodium to any great degree. The calcium salts,
being insoluble, are peculiarly adapted to the growth and development of
the skeleton, and while magnesium salts are more or less associated with
the calcium salts, they cannot be substituted for each other to any great
extent. It is unnecessary to repeat similar citations for the various inor-
ganic constituents of the body. This and the following paragraph are
based largely on Chapter VI of Benedict's "Golden Rules of Dietetics"
(Mosby Co.).
99
100 FACTORS IN DIET, DIGESTION AND ASSIMILATION
\Ykeii the various essential foodstuffs are administered in sufficient
amount to furnish the requisite calories, and in a condition available for
absorption and assimilation, it does not matter particularly in just what
natural combinations they are employed. It is possible, though not always
advisable, to replace water by substituting quantities of the various bev-
erages and semisolid or solid foods containing it. During a twenty-four-
hour period about 200 c.c. of water is evolved in the system from the
oxidation of hydrogen in organic combination, especially from the carbo-
hydrates, but also, to some extent, from fats and proteins. Therefore we
may safely assert that no one natural foodstuff or group of foodstuffs is
indispensable, or even particularly requisite for good nutrition, with per-
haps the exception of milk in the case of infants. It is admitted that one
may live on a strict vegetable diet for a protracted, if not for an indefinite,
period, yet the entire absence of animal proteins is not conducive to a
perfect state of health. Practically there is no essential difference between
animal and vegetable protein, yet there seems to be a something in ani-
mal protein that is not supplied by vegetable protein. Physiologists have
been able to note that different individuals seem to reach their optimum
on different proportions of animal and vegetable protein, and even on
different proportionate uses of different groups of flesh, as that of quad-
rupeds, fish and fowl, or of different species of meat, as beef, mutton,
pork, etc.
Theoretically, it is possible, and even practical, to replace the hydro-
carbons with proteins and carbohydrates, without serious detriment to
the human organism, as obviously no one particular kind of fat, as
olein,- palmitin or stearin, is indispensable; besides, these different va-
rieties appear to serve a similar purpose, with the exception of stearin,
which requires relatively more to replace the others progressively. So
to a considerable extent the precise chemical nature of the deposited fat of
an animal depends largely upon its diet, which may even be modified by
artificial limitation. For instance, the fat of a hog, fed on corn and meal,
will be white, firm and quite different from that of a hog fattened on
slops and swill, so it is not improbable that the diet is relatively of great
importance, and it is not at all unlikely that the yellow color of human
fat is due, in part, to the large consumption of flesh and butter and a
variety of natural pigments occurring in foodstuffs. The difference in
the caloric value of the various varieties of fats and of carbohydrates is
slight, scarcely sufficient to warrant the exact studies of calorimetry,
owing to the preponderance of many sources of error.
We learned when studying the proximate principles of foods in Vol-
TRANSMUTABILITY AND RESERVATION OF FOODS 101
nine I, Chapter 111, that all assimilable carbohydrates are ultimately
broken down into simple hexoses, and more often into dextrose. Dur-
ing the first year of life the child uses lactose almost entirely, though
it can digest a small amount of starches during early infancy (1). Later
in life the individual appetites for starches and sugars respectively are
markedly different; therefore, it is extremely difficult to state just how
far these are physiologically interchangeable, and especially to calcu-
late the exact available energy of any one sugar in the process of
nutrition. Practical experience coupled with animal experimentation
emphasizes the fact that the various sugars do not furnish desirable sub-
stitutes for starch. The reasons for the non-transmutability of sugars and
starches are (a) that the former when ingested in large quantities produce
irritation of the mucous membrane, (&) cause fermentation, (c) and by
overtaxing the glycogenic function of the liver allow a leakage of sugar
into the circulation, (d) Besides there may possibly be other abstruse
reasons.
Experience confirms the fact that individuals who partake freely of
cereals, potatoes, breadstuffs, etc., crave little sugar and vice versa, while
the individual appetite for carbohydrates generally is inverse to that for
hydrocarbons and proteins respectively and together, and that appetite for
all food varies with the individual and with the season. The craving
for sugar is not always due to a luxurious habit, though it may dej>end
upon a relative, but still not an abnormal, weakness of digestive ferments,
or even upon abnormalities of the intestinal canal. The consumption of
sugar has increased considerably during the past two or three decades,
commensurate with the growth of the cane and sugar beet industries
(see Volume I, Chapter XVII, Sugar, Spices and Condiments), also
with the increasing magnitude of the culinary and confectioner's art.
Benedict says, "An individual in normal health may ingest with impunity
100 grams a day of carbohydrates in the form of sugar, while certain
persons may take double this quantity without harm."
Hydrocarbons are theoretically replaceable by other organic foods
and even absolute fat-free diets may be allowed without harm, but the
same statement cannot be made for carbohydrates. It is a known physio-
logical impossibility for the system to digest and absorb more than a
given definite maximum of fats, and 80 grams of carbohydrate are re-
quired to prevent catabolic disturbances. We know that a too liberal
allowance of meats induces an inevitable increase of nitrogenous waste
products from the vicarious use of proteins.
Proteins, unlike carbohydrates mid hydrocarbons, nro employed, not
102 FACTORS IN DIET, DIGESTION AND ASSIMILATION
only to furnish heat and energy, but to replace wear and tear of the
tissues. They are positively non-replaceable, beyond a certain percent-
age, by either carbohydrates or fats, or even non-protein nitrogenous
substances, such as gelatin and purins, free or combined. However, it
should be borne in mind that beyond the minimum of 60 to 100 grams a
day (the precise standard being an unsettled question), proteins should
be replaced by carbohydrates and hydrocarbons, provided, of course, there
is no metabolic disturbance such as diabetes and obesity. We know that
within the system both the protein and carbohydrates may be trans-
muted into fat and so deposited. Physiology definitely proves that
dextrose and glycogen may be formed from fat or protein, and possibly
from both. There is a popular idea that much energy may be accumu-
lated by the excessive ingestion of foods, which is partially true, but
the importance of this notion lies in the fact that it leads to over-
eating.
Deposited fat is the only evidence that a reserve energy of any im-
portance is accumulated. The human body may put on 100 pounds of
fat, or over 400,000 calories in potential energy, or the requisite amount
to sustain the body for 200 days. Such a demand rarely happens in
civilized life, and if so the body certainly would lack the power to utilize
it, even with concomitant waste of protein tissue. There is no recorded
case where the body reserve energy has lasted more than about forty days
without a supply of organic nutriment from without.
Carbohydrates may be stored in the body as dextrose in solution, and
as glycogen in muscular tissue and gland cells, particularly in the liver,
to the extent of 300 grams per day, just barely enough to supply a half
day's caloric demands for the regulative functions.
In studying Protein and Nutrition (see Volume II, Chapter VII),
the researches of Chittenden, Fischer and others give proof that a small
amount of protein in excess of the daily requirement for needed calories
may be stored. Voit and other investigators, experimenting with dogs,
conclude that the proportionate storage is between 5 and 8.5 per cent.
Von Noorden(2) estimates that the human being can store about 10 per
cent of the excess protein. So we may safely conclude that the energy
eliminated from metabolized protein will aggregate about 90 per cent,
and the stored protein will be in the neighborhood of 10 per cent of the
amount ingested. In addition, it must be remembered that a small
moiety of reserve protein occurs in the circulatory and lymphatic systems,
while the remainder is stored in hypertrophic or in newly formed cells.
So much protein is required to supply the wear and tear of normal mus-
WASTE AND DIGESTIBILITY OE FOODSTUFFS 103
cular tissues that only a very small amount can be stored as a reserve
available in starvation or relative inanition.
From the foregoing we may arrive at the following conclusions :
(a) It is useless to increase the protein ration to create a reserve
of force and tissue material, since such a course overtaxes
the organs of excretion and increases the chances of auto-
intoxication.
(fr) It is not, at present, an accepted fact that only the protein
minimum just enough to balance the nitrogen equilibrium
is the ideal ration. The proper nutrients for a normal
body amount to at least three meals a day of a standard
dietary. (Volume II, Chapter VII.)
(c) The storage of hydrocarbons in persons of small stature
should not exceed the caloric requirements for a forty-day
fast about 12 pounds for a man weighing 140 pounds ; a
man of full stature should not carry more than 34 pounds
of fat.
(d) It is comparatively easy by superalimentation to increase
body weight from one-half to one pound per day by depos-
iting fat. Benedict believes that in the entire absence of
food, even on exposure to cold or at strenuous muscular
exertion, the body cannot utilize more than one-half pound
of fat daily, and, while greater loss may occur in sickness,
the physiological reduction of weight on a low diet will
equal the rate at which fat can be deposited.
WASTE AND DIGESTIBILITY OF FOODSTUFFS
Benedict, who has studied this subject from every viewpoint, holds
that the waste of foodstuffs occurs both economically and physiologically.
First, the loss in transportation to the retail market; second, the loss in
preparing and serving, besides the financial loss in using, often through
ignorance, expensive nutrients of a lower protein or caloric value than
cheaper foods. Again in the trimming and paring of foods, the cook
often wastes large quantities and finally at the table the waste is consid-
erable, when the serving is larger than is eaten, and must be borne in
mind in all cases when computing nutrients from a caloric viewpoint.
In the average well-to-do American family, the percentage of waste
104 FACTORS IX DIET, DIGESTION AND ASSIMILATION
of digestible and assimilable foods in the kitchen and at the dining
table ranges from 10 to 50 per cent. Gross waste is often due to igno-
rance on the part of the cook and other servants. On the other hand, the
removal of fat, skin, seed pods, husks, cores and other indigestible por-
tions of food material cannot be considered as waste, but both economically
and physiologically the theoretic high food-value of fat meats must be
discounted, because of the ultimate rejection of fat.
Physiologically, food waste can be accounted for, first, by the ex-
cessive ingestion of one or more kinds of organic nutriments, and, second,
by the swallowing of foods which have been imperfectly comminuted.
Vegetable foods swallowed whole, such as beans, peas, corn, huckleberries,
etc., largely escape digestion, because their skins or husks, composed
largely of cellulose matter, are not broken up. Likewise starchy vegetables,
meats, eggs, etc., swallowed without proper mastication are wasted to .a
large degree. When milk is gulped down like water, it forms large curds,
much of which is passed away unchanged. Alimentary saprophytosis
is a possible aid in the digestion of certain food materials especially
vegetable foods containing cellulose material. The efficiency of the vari-
ous enzymes and hormones exerts an obvious influence on the amount of
alimentary waste; even when mastication is well performed and intestinal
saprophytosis is within normal limits, there is considerable loss of food
material. Atkinson calculates the utilization of some of the staple foods
as follows :
THE UTILIZATION OF SOME OF THE STAPLE FOODSTUFFS
Meat and fish, .nearly 100% of protein, 79-92% of fat
Eggs 100% 96%
Milk 88-100% 93-98% doubtful of carbohydrate
Butter '. 98% u "
Oleomargarine.. 96% " "
Wheat bread. . . 81-100% " " (too little fat to estimate) 99% carbohydrate
Corn meal 89% " .'. . 97%
Rice 84% 99%
Peas 86% 96 o^
Potatoes...' 74% 92%
Beets 72% 82% "
The experiments of Leo Breisacher call attention to the loss of albu-
min, as ranging from 2.9 por cent to 4.9 per cent on a milk and choose
diet, and 0.5 per cent, 7 to 7.1 per cent on milk alone. For loss on othor
diets consult the following tables from Breisacher, referred to bv Benedict:
WASTE AND DIGESTIBILITY OF FOODSTUFFS 105
PERCENTAGE OF UNABSORBED ALBUMIN (BREISACHER)
Corn meal 15.5% Peas and bread 12.2% Wheat bread . . . . 19.9%
Rice 20.4% Rye bread 22.2% Wheat bread 18.7%
Peas, cooked soft, . .17.5% Black bread 32. % Potatoes 32.2%
Peas, cooked 27.8% Lentils 40. % Potatoes, lentils and
bread 53.5%
PERCENTAGE OF UNABSORBED FAT (BREISACHER)
Olive oil (liquid at ordinary temperatures) . . . .2.3%
Butter (melting point 31 C) 1.28-6%
Lard 34 C 2.5%
Tallow 49 C 7.4%
Stearin 60 C 86-91% unabsorbed
The excretion of fat in the stools varies with the conditions under
which it is ingested. During fasting there is a daily loss in the stools
of somewhat more than one gram of fat. When the quantity ingested
is from 25 to 40 grams, the loss varies from 10 to 15 per cent, i.e., about
4 grams. When the quantity ingested is increased to 100 grams, the
gross loss remains practically the same. The reduction in percentage
may reach a point as low as 1.25 per cent. The explanation of this
discrepancy is found in the fact that when very little fat is eaten, it
consists chiefly of beef, mutton or other meat fat, and of vegetable fat
which is embedded in the cellulose. The loss of fat when small quanti-
ties are taken averages about the same as the loss during fasting, about
1 gram daily. When the daily quantity of fat exceeds 150 grams, the
loss increases in proportion and may reach 20 per cent. This high rate
of loss is most apt to occur when oils having a direct laxative action are
administered. With a coarse vegetable diet, the loss of all nutrients
increases progressively. This effect is partly due to the laxative action
of the so-called coarse vegetables.
From these data it appears that the finer the subdivision of the food
ingested, the larger will be the proportion of nutrients assimilated.
For example, in the case of bread made from decorticated whole wheat
meal, about 00 per cent of its protein and 02 per cent of its carbohydrates
aro utilized, while fine white bread made from bolted flour yields 81 per
cent of its protein and nearly 100 per cent of its carbohydrates. Pota-
toes offer another interesting example: As ordinarily cooked and masti-
cated, this vegetable yields about 70 per cent of its protein and 92 per
cent of its carbohydrates to nearly 100 per cent. The class of coarse
vegetables, including turnips, carrots, beets and cabbage after thorough
cooking yield protein in the proportion of from 60 to 80 per cent, and
106 FACTORS IN DIET, DIGESTION AND ASSIMILATION
from 80 to 85 per cent of carbohydrates. On the other hand, if these
vegetables are not thoroughly cooked and well masticated, and if in
addition they are habitually used and in generous quantities, their excre-
tion may ultimately exceed their utilization.
It has been estimated by Rubner that on an ordinary mixed diet the
nutrient waste amounts to about 8 per cent of the total calories, and we
may safely conclude, therefore, that from 200 to 300 calories of the
standard ration may be considered as a physiological waste by failure
of digestion. This waste is taken into consideration when estimating the
required calories which are stated in terms of ingested food. Therefore
this variation is not of importance, and the physiological waste of nutrients
need not be given any consideration. Variations in food waste may
possibly explain the fact that, say, two persons of the same weight and
following the same vocation may require different amounts of food to
maintain normal weight and health. The fecal excretion from a normal
person averages from 100 grams per day moist weight upward, and on
analysis will be found to contain 20 per cent of fat and 7 per cent of
albumin, estimated by multiplying the nitrogen by 6.25. In wasting
diseases, it is considered practical to try to determine the amount of waste
of nutrients in the alimentary canal, but the difficulty and expense usu-
ally prevent such determinations. Still something may be accomplished
by ordinary chemical tests and by macroscopic and microscopic exami-
nation within the abilities of the clinician.
Contrary to popular belief, it is quite difficult to give an intelligent
opinion concerning a general comparison of foodstuffs as regards their
digestibility. A few inorganic ingredients of the diet such as water
and salines require no digestion. Benedict, who has studied this sub-
ject very carefully and exhaustively, holds that we have no precise en-
lightenment concerning the relative digestibility of hemoglobin, nucleins,
lecithin, organic combinations of iodin as in the thyroid. Carbohydrates
and proteins undergo many changes before final absorption. For instance,
cooked starch is partially digested, both mechanically and chemically ;
dextrin, as in bread crust, is still further digested; the double hexoees,
as cane sugar, maltose a stage of digestion beyond colorless dextrin
and lactose require inversion into single hexoses, and of the latter dex-
trose is the ultimate one ready for oxidation, while levulose and galactose
must be changed into dextrose. The hydrocarbons split into glycerol and
fatty acids ; the former, uniting with water, forms glycerin, and the latter
joins with alkaline bases and forms soaps, yet it does not appear that
either glycerin or soaps can in any particular be considered as nutrients.
WASTE AND DIGESTIBILITY OF FOODSTUFFS 107
There is still considerable uncertainty as to the digestion of fats. At-
water estimates that 95 per cent of fat of all animals is absorbed, and
only 1)0 per cent of the fat of vegetables. Rubner declares that only 80
per cent of the fat from beef and mutton is absorbed. Butter is fairly
well absorbed, while bacon fat is not so well absorbed, because it is
enclosed in cells, and from 7.5 to 17.4 per cent escapes absorption. It
is safe to assert that the lower the melting point of fat the greater will
be the percentage of absorption. It has been found that about S 1 /^
ounces can be absorbed without any loss being detected on examination
of the fecal excreta.
It is held that the coagulation of protein is a preliminary step in the
process of digestion. Benedict holds that there may be some good
grounds for the old theory that this stage in protein digestion acts as a
safeguard against excessive protein nourishment, though of course he
realizes that it is not a safeguard against the after-effects of the end
products of protein digestion. Rennet coagulates the caseinogen of milk.
The gastric, pancreatic and intestinal juices also coagulate caseinogen,
although the pathologic instances when the former fails to coagulate milk
are nearly always confined to adults, and this peculiar factor of safety is
not quite well understood. There is yet some question whether there
exists a separate rennet ferment or ferments, or if coagulation is really
brought about by pepsin, trypsin, and the intestinal activation for tryptic
digestion. A certain amount of coagulation takes place in the process
of cooking of proteins which may be considered a step in digestion; but
the principal aim in cooking is to kill parasites, including various bac-
teria, and at the same time to render the food more tasty and more readily
masticated and comminuted. While artificial coagulation of milk by
rennet may be considered a digestive process, yet it does not appear to
aid its further digestion in the alimentary canal, and the curd if dried
and reduced to a fine powder Is more difficult of digestion than raw cow's
milk. Tho digestion'of proteins, artificially, has not yet been successfully
accomplished. The so-called predigested protein occurs mainly as albu-
mose, and if the process is carried further it reaches the peptone stage,
making a disagreeable bitter product, actually toxic. When reduced to
the amino-acid stage there is a question whether the nutritive value is lost,
but this has recently been Stoutly denied.
Vegetable foods containing a relatively high percentage of cellulose
are indigestible, not that cellulose itself is a nutrient, but that a mesh-
work of cellulose incloses the starchy granules and .other nutrients which
escape digestion, and in this way causes considerable waste of food ma-
108 FACTORS IN DIET, DIGESTION AND ASSIMILATION
terial. It must not be overlooked, however, that cellulose, especially that
occurring in fine, threadlike meshes, is stimulating to peristaltic action.
Cartilaginous or tendinous fibrous tissue is likewise indigestible, and
when muscular tissue is not cut, chopped or comminuted sufficiently,
there will be considerable waste of nutriment. Many of the older physi-
ologists worked out elaborate tables to show the length of time required
for the stomach to perform its functions. W. Oilman Thompsoii(3)
compiled a table showing the time of the average sojourn in the stomach
of various food products. Modern research emphasizes the physiological
fact that this is not a test of digestion itself, because gastric digestion is
not complete, for the reason that the process of digestion is only begun
in the stomach. In other words, the function of the stomach is only to
make ready the foodstuffs for the various processes of digestion.
It is quite difficult to arrive at an accurate estimation of the digesti-
bility of fruits. If they are not well masticated or otherwise comminuted
there is considerable waste. When thoroughly masticated, the water and
inorganic salts are ready for absorption, and the metabolism of sugars
is a simple matter. Most fruits contain too little fat to be considered
and there is some doubt as to the actual degree of assimilation of the
protein. Bananas contain a liberal quantity of raw starch, which places
them in a class by themselves, so that they cannot be digested to any
appreciable extent until they have reached the duodenum and beyond.
SUBSTITUTES FOR FOOD
Substitutes for food are often necessary, especially under conditions
in which, from poverty or exposure, sufficient quantities of food cannot be
obtained. Under such conditions, the craving of hunger may be dimin-
ished and actual tissue-waste may be retarded by the substitution of cer-
tain mild stimulants and beverages. Tea, coffee and tobacco all possess
moderate actions in this respect, and alcohol under such conditions is both
a stimulant and a food. Natives in various barbarous or semicivilized
countries while performing long feats of marching, being often unable to
obtain sufficient food with regularity, make use of a variety of different
substances as substitutes for food, among which may be mentioned betel-
nut, cola-nut, Siberian fungus, the coca leaf and pepperwort, which are
chewed from time to time, and hashish and opium, which are both eaten
and smoked. Various forms of alcoholic fermented drinks are made use
of. "Various concentrated foods of high nutritive value with small bulk
may be used in the place of fresh foods. Attempts have been made from
STARVATION AND INANITION 109
time to time by the heads of the principal armies of the world to supply
a ration with concentrated elements for the use of troops on prolonged
marches, hut after a few days' subsistence on such a ration it has been
found that the men lose weight and deteriorate in strength.
STARVATION AND INANITION
Starvation Starvation is a condition brought about by insufficient
food for the maintenance of the body. It is of rare occurrence in civilized
communities. In such extreme cases, life may be maintained up to a
limit of about 40 days if there is no deprivation of water and no exposure
t<> cold. During prolonged deprivation of food the tissues become ex-
hausted in inverse order to their functional importance. So says Bene-
dict in his valuable little work, "Golden Rules of Dietetics." The gly-
cogen stored as a reserve is utilized within a few days, though sugar may
subsequently be formed from protein. The hydrocarbons are exhausted
at a rate varying according to circumstances and individual peculiari-
ties, only about 1 per cent remaining. Wherever there is interference
with the oxidation of fat as in certain pathological conditions, the patient
dies virtually from lack of the ability to perform the various metabolic
processes, while a relative excess of fat remains. The skeleton cartilages
and dense fibers remain nearly in a normal condition ; likewise the heart
and brain during starvation arc almost entirely unimpaired, while the
muscles and various glands are atrophied according to the ability of the
body to spare their function. If water as well as food is withheld, death
will occur in from five to eight days.
The period of time during which different individuals can subsist
without food depends upon :
(a} External conditions of temperature and moisture.
(6) The amount of work being performed.
(c) The physiological conditions of the body.
(a] The length of time that an individual can endure starvation is
influenced by various factors. As has already been stated, exposures to
cold reduce vitality and lessen resistance, so that under these conditions
the period of endurance is shortened. A moist atmosphere by prevent-
ing surface evaporation helps to prolong the possible period of starvation.
And finally the maintenance of a uniform temperature of the surround-
ing air also prolongs the period during which a man can abstain from food.
(!>} Individuals who move along the lines of the least resistance, shun-
ning every form of exercise, can live much longer without fond than those
110 FACTORS IN DIET, DIGESTION AND ASSIMILATION
undergoing strenuous exercise. In time of famine, self-forgetfulness by
diverting the mind from the sufferings of the body tends to prolong life.
(c) The full-fed, well-nourished endure longer intervals of abstinence
from food than weakened invalids. The distressed mental condition
attending delirium may be increased by lack of sufficient nourishment.
Sex seems to exert no influence upon the effects of starvation, which are
most keenly felt at the extremes of age, by young children and aged
persons.
The author, while serving in the United States Marine Hospital
Service, attended four sailors who had been shipwrecked and picked up
at sea and brought ashore. These men, after recovery, related that when
the small amount of water and food which they fortunately had, gave
out, they cast lots among themselves (five in number) to determine which
one of the party should die in order that the remaining four might par-
take of his flesh and blood for subsistence. They were the most wretched
and despicable human beings imaginable.
A pathetic account of the miseries of starvation is reported in the
journal of Lieutenant De Long(4). W. Oilman Thompson, in his work
on "Practical Dietetics," quoting from De Long, says : "After leaving their
sinking vessel, the members of the Arctic expedition were exposed, at first
in open boats and later in their long sledge journey, to the most exhaust-
ing work and to intense suffering from cold and wet. They frequently
dragged their sleds in severe storms for ten or twelve miles a day, while
subsisting solely upon half a pound of stewed deer meat, with a little tea
three times a day. This food being exhausted, they were obliged to con-
sume the meat of their last remaining dog, which they ate fried. They
subsisted upon this food exclusively for four days longer, having an allow-
ance of but half a pound a day, and finally their last journey of twenty-
five miles was performed with no other nourishment than a few ounces of
alcohol and an infusion made from some old tea leaves. During this time
their intense suffering from hunger was partially alleviated by chewing
scraps of deer skin, which, from its bulk in the stomach, seemed to afford
slight relief." De Long quotes from the physician in his Arctic expe-
dition: "Alcohol proves of great advantage; it keeps off the craving for
food, prevents gnawing at the stomach, and has kept up the strength of
the men on an allowance of three ounces per day.
"The alcohol being exhausted, they lived for another day upon a tea-
spoonful of olive oil, with n breakfast composed of an infusion made from
the Arctic willow (containing really no nourishment) and 'two old boots.'
After this the men, becoming weaker and weaker, were unable to proceed
STARVATION AND INANITION 111
farther on their journey, being driven back by intense cold and the dif-
ficulty of crossing the partly frozen rivers. Their feebleness gradually
overcame them, until one by one they died of inanition. Four men sur-
vived for sixteen days upon absolutely no food whatever, and possibly their
sufferings were even further prolonged, but the journal of their gallant
and heroic commander ceased at this point, for he, too, died."
Inanition Inanition is the inability of the tissues to assimilate food.
The term should be restricted to those cases of acute starvation observed
in early life. It is characterized by loss of weight due to a disordered
metabolism. This condition is characterized by fever, and the malady
is not infrequently mistaken for some other disease. It follows the
ingestion of improper food or abstinence from food, where infants are
abandoned, or other cases that are grossly neglected and starved. Gross
errors in feeding are a contributing cause where food is given which is
absolutely imsuited to the needs of the child.
Individuals who are well supplied with a reserve of food stored in
their tissues can resist starvation by calling upon this reserve to maintain
the energy of the body in the absence of food ; and, having a larger supply
than thin or emaciated persons, they can withstand starvation for a much
longer period, although they may complain more bitterly of the pangs of
hunger than individuals previously accustomed to a scant diet.
Experiments were conducted by Chossat to determine the rapidity of
the loss of body weight, etc., and it was found that starving animals,
while losing 40 per cent of their body weight, lost in fat 90 per cent.
"Anselmier fed starved dogs upon their own blood and succeeded in pro-
longing their lives for three or four days beyond the usual limit, until 60
instead of 40 per cent of their body weight had been lost." During the
winter of 1776 and 1777 an accident occurred in a colliery in South Wales
which resulted in the imprisonment of four men and a boy for ten days
without food. When they were rescued they were alive, though very
feeble, and were able to walk when released. Fortunately, a supply of
water was available and the atmosphere in which they were confined was
moist. A second accident occurred in this colliery and a number of men
were confined in a mine for six days without food, and while their suf-
ferings were extreme, nearly all were able to walk on being rescued. From
this we may assume that the lack of food may be endured with far less
torture if water is applied internally and externally. When water is with-
held in such a condition, the body loses weight very rapidly, the tissues
become dry, thirst excessive, the secretions suppressed, and suffering is
very greatly intensified.
112 FACTOES IN DIET, DIGESTION AND ASSIMILATION
FASTING
Fasting is one of the most ancient religious rites of winch there is any
record. More than two thousand years ago the fasting cure was advocated
by the school of the natural philosopher, Asclepiades(o), who also applied
the "water cure." It is recorded that Plutarch said, "Instead of using
medicines, rather fast a day."
Fasting in Religion. It was practiced, as stated above, in connection
with religious ceremonies and so came to be considered an inseparable part
of almost all such observances. Thus we read in a queer old book, entitled
"Of Good Workes, and First of Fasting" (6), that the Church of Eng-
land speaks of fasting and of its treatment by the Council of Calderon
as follows:
The Fathers assembled there . . . decreed in that Council that every person, as
well in his private as public fast, should continue all day without meat and drink,
till the evening prayer. And whosoever did eat and drink before the evening
prayer was ended should be accounted and reputed not to consider the purity of
his fast. The canon teacheth so evidently how fasting was used in the primitive
Church, as by words that cannot be more plainly expressed.
From the above quotation we find that fasting was considered to be a
highly important part of the religious ceremony, and of spiritual salva-
tion. We find this same idea expressed throughout the Holy Writ in
passages too numerous to mention (7). The excellent work, "Vitality,
Fasting and Nutrition," by Carrington (Rebman Co.), has been freely
consulted and quoted in the preparation of this section.
We hardly need to be reminded that the Holy Nazarene himself fasted
for forty days. Many people accept Christ's forty-day fast as sufficiently
explained by his supposedly Divine Power. It was, in short, a miracle
which would be impossible under ordinary circumstances for any other
man. Dr. Tanner aroused the whole scientific world a few years ago
by fasting forty and again forty-two days, on two separate occasions, and
while charges of "fraud" were circulated at the time and believed in by
many, yet no one who took possession of the facts of the case gave any
credence whatever to these stories. Great as was the prejudice in profes-
sional circles, and bitter as was the feeling at the time, no direct charge
of fraud could be made, for no atoms of proof of such were forthcoming.
The general view of fasting is probably well summed up by the Reverend
Puller(8) when, in discussing the previously mentioned cases of fasting
during Lent in Jerusalem, he remarks:
FASTI .Mi 113
Such fasting is certainly, for the mass of English people, impossible now. It
seems to me that this great difference in the power of fasting, which is quite in-
disputable, must be taken into account, when we are considering how to apply the
Apostolic rule to modern circumstances.
Victims of forced fasting and starvation become so ravenous that all
sense of taste gives place to intense hunger. .Muscular action is no longer
possible. There is vertigo and faintness on raising the head, the voice
is lost, and gradually the nervous system succumbs to languor and general
prostration. Chambers records an occurrence where three men and two
boys were starved for twenty-two days in an open boat. They had ten
days' ration to start with, and subsequently nothing but old boots and
jellyfish, and they fought violently with one another over these.
Robert de Moleme, the founder of the Cistercian brotherhood, was overcome
with grief on learning of the death of a female friend, and like General Boulangcr,
resolved to follow her to the Land of Shades. Being averse to direct suicide, he
retired to the mountain lodge of a relative friend, and abstained from food in the
hope that one of his frequent fainting fits would fade into the sleep that knows
no waking. But finding himself alive at the end of the seventieth day, he recon-
sidered his resolution and began to suspect a miraculous interposition of Provi-
dence. By resuming his meals, in half ounce installments, he contrived to recover
from the condition of frightful emaciation, and in the supervision of an ever-in-
creasing number of scattered monasteries, led an active life for the next fourteen
years (9).
No-Breakfast Plan. The American apostle of "fasting as cure for dis-
ease" was the late Dr. Dewey(lO), who recommended fasting as a relief
for certain disorders. That short fasts are beneficial to many people there
can be no question. Such fasts have been practiced from time immemorial.
Dewey was the first to urge the "no-breakfast" plan of restricting the
intake of food, on the supposition that the majority of people consumed
a great deal more food than was required.
This apostle says(ll) : "There is no necessity, after a night of undis-
turbed restful sleep, to partake of food ; sleep is not a hunger-causing
process." He deprecates the American breakfast, holding that when "we
arise in the morning with our brains recharged by sleep, we should at
once go to our place of business." He also says it is "a foolish expendi-
ture of energy to take any kind of physical exercise in the early morning."
holding to the view that when one has worked long enough he will be-
come fatigued, ami when this point is reached, he should have a period of
rest preceding the partaking of food.
114 EACTOKS IN DIET, DIGESTION AND ASSIMILATION
We cannot waste space in replying to his assertions. We agree, how-
ever, that moderate fasts are beneficial, but should not be instituted except
under the personal observation of the family physician. Dewey's no-
breakfast plan is not an ideal institution for general application. It
might be suited to the Eskimo, who consumes enormous quantities of meat
and oil at one sitting, or for the city dweller, who keeps late hours and
partakes of midnight suppers, who is a spender and not a producer, but
for the business man, a light repast to break the fast is necessary.
The Frenchman, as a rule, with the exception of his roll and cup of
chocolate in the morning, partakes of but little food until midday. The
Englishman consumes a rather hearty breakfast at an early morning hour,
which the average American and Canadian consider meager. The two
latter want meat, cereals, fruits and coffee. It is not disputed but that
many people would be in better health if they had no breakfast at all,
but, generally speaking, most Americans eat too much at all three
meals.
An ideal breakfast for those following sedentary occupations is a fruit,
a cereal, an egg or a piece of breakfast strip, a roll and a small cup of
coffee. As said before, we are opposed to the no-breakfast plan, believing
that the body has need for material to produce heat and energy, and ab-
stinence from food until the middle of the day tends to draw too heavily
upon the reserve store of protein and glycogen, and possibly to a limited
extent upon the store of fat. The no-breakfast plan would not satisfy the
wants and needs of the majority of live active individuals who lead strenu-
ous lives, and again the no-breakfast eater is usually a complaining,
scrawny, puny individual as compared with the hearty breakfast eater.
Fasting as a Cure It is claimed by devotees of fasting as a cure that
the principle on which the hunger cure acts is one with which all physiol-
ogists are acquainted. During a fasting condition, nature makes an effort
to rid the body of effete material. This the author experienced in a ten-
day fast a few years ago. He was suffering from intestinal stasis with
putrefaction of the alimentary contents. The end products of protein
digestion were greatly disturbing the metabolic processes of the body, re-
sulting in both mental and physical hebetude. At the suggestion of a
medical confrere, the author went on a ten-day fast with no aliment ex-
cept strained vegetable soup made without meat or fats. The craving
for food was very strong for the first two or three days, but after this,
going without the ternary food elements caused very little, if any, incon-
venience or annoyance, except for the elimination of most offensive ex-
creta, which was aided by the self-administration of Russian mineral oil.
FASTING 115
When he returned to his former dietary habits, which were slowly and
carefully resumed, there was noticeable improvement in his condition.
Temporary denutrition exercises a favorable influence in certain dis-
orders, more particularly of the alimentary tract, such as intestinal auto-
intoxication, intestinal stasis with putrefaction, intestinal toxemia, etc.
It gives nature a chance to clean house. The organism, on a starvation
dietary, soon begins to lessen the outgo of energy. The movements of the
organs of respiration slow down, the temperature drops slightly below
normal, the secretion of bile and uric acid is lessened, and later it is
claimed that there is retrenchment of the assimilative functions, reacting
on the intestinal organs, the colon contracting, while the "small intestine
retains all but the most irritating ingesta."
Beyond question, by temporarily depriving the body of the supply of
food it has been continually ingesting in excess of actual needs, we give
the organs of elimination a chance to clean the polluted sewers, and to un-
load the superfluous impurities by the various eliminative organs, which
exerts a beneficial effect to the whole organism.
Long-continued Undernutrition. Man, after all, is more or less a
creature of habit, and really the whole question of the amount of food daily
ingested is essentially one of habit. As Chittenden(12) has aptly said:
The so-called cravings of appetite are purely the result of habit. A habit, once
acquired and persistently followed, soon has us in its grasp, and then any devia-
tion therefrom disturbs our physiological equilibrium. The system makes com-
plaint and we experience a craving, it may be, for that to which the body has
become accustomed, even though this something be, in the long run, distinctly in-
jurious to the welfare of the body. There has thus come about a sentiment that
the cravings of the appetite for food are to be fully satisfied, and this is merely
obedience to Nature's laws. The idea, however, is fundamentally wrong. Anyone
with a little persistence can change his or her habits of life, change the whole
order of cravings, thus demonstrating that the latter are purely artificial, and that
they have no necessary connection with the welfare or needs of the body. In other
words, dietetic requirements are to be founded, not upon so-called instinct and
craving, but upon reason and intelligence.
After all, undernutrition can only be followed by disastrous results
if long continued. Many are the human derelicts stranded on the rocks
of semistarvation, "especially of protein starvation, the result .of having
been compelled to subsist, as many poor but respectable people have been,
for a prolonged period upon 'bread and tea' because of the deficiency of
protein in these foods. Deficiency of protein leads to wasting and degen-
eration of all muscular and nervous tissues; and, even when it is barely
116 FACTORS IN DIET, DIGESTION AND ASSIMILATION
sufficient, the individual does not always ultimately recover, but is prone
to remain neurotic and subject to many ailments."
Fasting Experiments Fasting, of late years, has been attempted either
by love of notoriety or desire for pecuniary gain by persons exhibiting
themselves for gratification of public curiosity. They are generally frauds
and are fed by some one in collusion with them. In a number of cases,
the subjects have been carefully studied by medical experts, and there is
no question that in some instances, at least, the fasts have been conducted
with honesty. Thompson (3) reports two authenticated fasts where
Tanner and Succi were the subjects. A period of starvation was prolonged
for 40 days and over. In both instances fluids were allowed, and in one
of the men intense epigastric pain and food craving was ameliorated by
medication.
"Succi, an Italian subject, in 1890, undertook an absolute fast of 40
days, during which time he lost 421/2 pounds and drank an average of
2 5 y ounces of water daily. The water he consumed was in the form of
plain water, mineral water and ice. He lost flesh very rapidly during the
fast, but on the last day he had strength sufficient to walk around the room.
When he resumed eating he first took cocoa and subsequently bouillon
and other light liquid diet, gradually returning to solid food. His mental
faculties were unimpaired throughout. He occasionally took small doses
of a few drops of an elixir supposed to contain opium."
Luigi Cornaro, a Venetian gentleman, published a treatise on a "Tem-
perate Life," advocating a very abstemious diet. He says :
I do not know whether some desperate degrees of abstinence would not have
the same effect upon other men, as they had upon Atticus who, weary of his life as
well as his physicians, by long and cruel pains of a dropsical gout, and despairing
of any cure, resolved by degrees to starve himself to death, and went so far, that
the physicians found he had ended his disease instead of his life!
His case is often referred to as an illustration of the smallest quan-
tity of food which will support life. In his early days he was a reckless,
intemperate youth, and spent his time "in riotous living." Later he re-
formed and by careful dieting prolonged his life to 103 years. During
the last 48 years of his existence, he subsisted largely on an allowance of
twelve oynces of vegetable food and 14 ounces of wine. Occasionally, he
partook of eggs, but rarely took any other form of animal food. While
there may be much wisdom in his doctrines as published, unfortunately
no one who has attempted to put his teachings into practice has been
similarly rewarded with a long life. The majority of mankind would,
FASTING 117
for the pleasures of the palate, prefer to live fewer years in lieu of the
pleasure of being less abstemious.
Periods of voluntary fasting of varying duration are practiced by
devotees of religious sects. This practice was formerly indulged in to
a greater extent by ascetics than at the present time. Such practices, un-
less they be definitely limited and supervised, may be carried to an ex-
cessive or even injurious degree. When a man by fasting reduces him-
self to the extent that his intellectual faculties are obtunded, he may be
sure that he is doing himself injury. It would be far better for such
individuals, for purposes of mental discipline or religious motives, to
eliminate temporarily from the diet accustomed luxuries, or give up such
articles in the daily ration as butter, sugar, salt, wine, tobacco, etc. This,
in fact, is a custom practiced by many persons during the season of Lent.
Contrary to the opinion once held by the laity, fasting cannot be regarded
as favoring either clearness of intellect, muscular strength or endurance.
Gerland emphasizes the folly of such practices, "the ethnologist can trace
the physical and mental decay of whole nations to a long course of insuf-
ficient food."
Dr. William Stark, a young English physician, lived for forty-four
days on bread and water, for a month on bread, water and sugar, and for
three weeks on bread, water and olive oil. At the end of his experiments
he was in a very enfeebled state of health ; he developed symptoms resem-
bling scurvy, and ultimately died, apparently a victim of his own scien-
tific enthusiasm (13).
Effect of Fasting- on Metabolism. A knowledge of the metabolic changes
occurring during a fast is of great importance both physiologically and
pathologically. Many important physiologic discoveries were made pos-
sible by experiments on fasting animals and men, while pathology has
benefited by examinations of diseased persons who were starving or nearly
starving.
The effects of fasting on metabolism have been studied at length by
Benedict (14). He carried out an experiment on a man during a seven
days' fast. He found the loss was estimated to be: protein 69.5, fat 139.6,
glycogen 23 grams per day, yielding 1,597 calories. The loss of protein
equaled 347 grams of flesh ; the actual loss of energy measured by the
calorimeter was 1,696 calories per day or 100 grams more. The heat of
combustion can be calculated from the known heat value of the sub-
stances, 1 gram of body protein yielding 5.65 calories, and 1 gram of
fat 9.. 5 4 calories, and the total when fully oxidized would aggregate about
1,734, so that during a fast the organism lives on its own flesh and fat.
118 FACTORS IN DIET, DIGESTION AND ASSIMILATION
The changes in the metabolism produced by sickness cannot be accu-
rately determined without a knowledge of the changes due to simple inani-
tion. The knowledge of the pathology of the metabolism of fasting is
sensibly incomplete, though many additions have been made to it during
the past few years.
During the first few days of a fast, a man lives upon body glycogen,
then upon his own protein and fat. In consequence, his respiratory quo-
tient falls, which indicates the combustion of carbohydrates to approach
the values indicating the consumption of protein or fat. The more abun-
dantly a man is fed preceding his fast, the greater will be his reserve sup-
ply of glycogen when the fast begins, and as a result, the more slowly
will his respiratory quotient diminish. This explains the difference, dur-
ing the first few days of fasting, between the well-fed men observed by
Breithaupt and the underfed observed by Cetti (15).
FASTING METABOLIC EXPERIMENTS
CETTI
BREITHAUPT
Days
Per Kg. per Minute
Per Kg. per Minute
of
Fast
2
CO,
Respiratory
2
CO,
Respiratory
Quotient
Quotient
1
4.86
3.51
0.72
3.96
3.48
0.78
2
4.59
3.13
0.68
4.32
3.19
0.74
3
4.48
3.07
0.68
4.26
3.12
0.73
4
4.78
3.10
0.65
4.38
3.19
0.73
5
4.68
3.10
0.66
4.37
2.75
0.63
6
4.67
3.13
0.67
4.35
2.26
0.86
7
5.06
3.39
0.67
3.76
2.60
0.69
8
4.89
3.33
0.68
4.07
2.94
0.72
9
4.62
3.10
0.67
10
4.67
3.16
0.68
Von Noorden, in commenting on the results tabulated in the above
table, says:
The fact that the respiratory quotient at times fell below the theoretical mini-
mum is explained by the conclusion that during repose and abstinence from all
voluntary movements, small quantities of glycogen arising from the decomposition
of protein collect in the liver and muscles.
If this is so, muscular work, which decreases the decomposition of
glycogen, must also increase the respiratory quotient.
It is of great practical importance to know whether the physiological
PERYKRSIOXS OK Ari'KTITK 119
laws of prolonged fasting hold good in chronic malnutrition. An indi-
vidual in a condition of undernutrition through insufficient feeding might,
under favorable circumstances, indulge in extravagant metabolism, as he
does in acute fasting. "Again, he might establish a sort of automatic and
purposive regulation, diminishing the amount of his metabolism when
placed on a continuously inadequate diet." This brings up the interesting
question, ''What amount of food is necessary to maintain patients who
are markedly emaciated from prolonged fasting."
A case much quoted, recorded by Klemperer, emphasized the food re-
quired to maintain nitrogen equilibrium. "A tailoress, aged 22, had been
improperly nourished, and her weight fell from 50 to 36 kilograms; for
eleven days she remained in nitrogen equilibrium at 18 calories per kilo-
gram." Klemperer concluded that, as she was in nitrogen equilibrium,
his patient was also in heat equilibrium, so that her diet of maintenance
would be at the rate of 18 calories per kilogram of body weight per day.
Von Noorden points out the error of Klemperer's conclusion, with the sug-
gestion that after protracted malnutrition, the organism can retain nitro-
gen to build up the cells demanding protoplasm, even when on a scanty
nitrogen diet. Von Noorden says:
"When a poorly nourished individual after a protracted fast is allowed food, in
an increased amount, sufficient to overcome the decrease in bodily heat, an effort
is at once made to retain nitrogen and repair the loss of cellular material that has
occurred. This retention of nitrogen goes on until the body has readjusted itself
to the new conditions of nutrition. Then the loss of nitrogen begins anew, unless
the calories required have been adequately supplied.
Von Noorden conducted many experiments to determine the requisite
calories per kilogram per day, in order to maintain a permanent increase
of weight, and found it did not occur until an intake of 30 to 32 calories
was reached.
PERVERSIONS OF APPETITE
Parorexia. Parorexia(16), or perversion of appetite, is manifested
for special or peculiar kinds of fat. There are three types:
(a) Malacia, a desire for highly spiced foods, such as mustard, vine-
gar or green fruits, etc.
(7>) Pica, an inexorable desire for substances which are not foods,
such as earth, chalk, pencils, ashes, sand and insects, etc.
(V) Allotriophagia, an insatiable craving f<n- disgusting and harmful
substances, such as fecal matter, pins, etc.
120 FACTOKS IN DIET, DIGESTION AND ASSIMILATION
Malacia is often observed in cases of disturbances of the stomach and
neurasthenia, while the other types are found chiefly in idiots, lunatics
or in severe hysteria.
Anorexia. Anorexia is loss of appetite, practically amounting to dis-
gust for food, and is a precursor of acute gastric or intestinal disorders.
In prolonged fevers such as typhoid, and some types of malarial infection,
it may become necessary to force the appetite. In some instances the
patient will feel a loathing for foods, or there may be absolute nausea ; at
other times the patient may have a feeling that he simply cannot eat, but
the thought or sight of food is not repulsive; again, the patient may have
a slight desire for food, but from prejudice or otherwise, which may
amount to a delusion, he feels that food would add to his distress.
There is great diversity of differences in the appetite of individuals
and even in the same individual at different times. Repression of de-
sires for food, excessive self-control and habitual abstemiousness, prac-
tically amounting to obsessions, obtund the enjoyment of food. Whether
due to actual lack of food, poverty, preoccupation or what not, the tonicity
of the organs of digestion as well as of the musculature is seriously inter-
fered with by prolonged insufficiency of diet. Nervous anorexia is a
diminution of appetite, with absence of the hunger sense, so that even
antipathy to food may be present. This condition is present in most of
the organic as well as in the functional disorders of the stomach, but the
nervous type appears as a primary affection, and has been attributed to a
depressed condition of the hunger center, or to hyperesthesia of the mu-
cous membrane of the stomach.
Bulimia. Bulimia, or hyperorexia, is the habit of moderate over-
eating by comparatively healthy individuals, and may be due in some
instances to an erroneous conception of the actual amount of food neces-
sary to maintain life. There seems to exist a popular impression that
the standard of strength may be heightened or a reserve of vital force
established by superalirnentatiou.
Certain diseased conditions, as intestinal parasites (not that the worms
consume any notable quantity of nutrients), states in which the food
passes rapidly from the stomach, certain forms of epilepsy and general
paresis, sudden transition from the lap of luxury to poverty, may cause
bulimia of a severe type. At times bulimia may be purely a matter of
indulgence of the grosser appetites. For example, Benedict (14) reports
the case of a young woman, otherwise dainty and refined, who would de-
liberately excuse herself from the table, induce vomiting by running Lor
finger down her throat, empty her stomach and return to the table to eat
PERVERSIONS OF AITKTITE 121
another hearty meal. This method, was frequently practiced by the Komans
during their Lucullan banquets.
Polyphagia Polyphagia is the demand for large quantities of food
before satiation occurs. The cases do not feel satisfied until the food is
digested. It often occurs as a primary condition in neurotics, or secon-
dary to disease of the gall bladder, spleen, diabetes or brain tumor.
Kemp(l(J) records a case that consumed 100 pounds of meat in 24
hours.
Akoria. Akoria is the absence of satiety. Individuals with akoria
never feel that they are fully fed. In fact, they never know when to stop
eating. Sometimes this condition is combined with polyphagia, and is
most often met with in neurasthenics and hysterics.
Polydipsia. Polydipsia, or excessive thirst, is symptomatic of diabetes
mellitus and insipidus. It may be due to diarrhea, which it tends to main-
tain ; to the ingestion of large quantities of salt and sugar, requiring dilu-
tioii ; to strenuous exercise, causing loss of water by excessive perspiration;
and if occurring very suddenly, it may indicate hemorrhage. Under some
circumstances, it is due to habit, especially that of excessive tippling,
more especially if the beverages contain xanthin. The drinking of water
and milk in excessive quantities is a bad habit from a health point of
view and is often indulged in through misconceptions of the hygienic
value of liquid nutriment. This misconceived habit sometimes produces
gastric dilatation in athletes, who endeavor to encourage strength and
vitality by gulping large quantities of milk. Unfortunately health
cranks, and many physicians as well, freely urge the drinking of exces-
sive quantities of water, overestimating its value as an eliminant. The
excretion of large amounts of water, free or nearly so from mineral salts,
interferes more or less with osmotic processes generally by withdrawing
the salts from the blood and tissues, and putting extra work on the circu-
latory glandular and renal organs. If pure water is used, its irritant ef-
fect on the gastric mucosa must be considered. There are persons, how-
ever, especially the indolent and overworked, middle-aged and elderly
women, who drink quantities of concentrated tea. This habit tends to
develop a distaste for water. In such conditions, as will be seen, all the
processes of the elimination and secretion are interfered with.
Rumination. Rumination applies more particularly to animals that
chew the cud, whose stomachs are divided into four compartments. The
first or largest division of typical ruminants is designated as the paunch :
the second, the reticulum ; the third, the osmasum psalterium or rnanyplies,
and the fourth the abomasum or rennet has:. The ruminants swallow
122 FACTOKS IN DIET, DIGESTION AND ASSIMILATION
herbaceous food imchewed and it is passed into the paunch, whence later
it is regurgitated in masses and thoroughly masticated and mixed with
saliva while the animal rests, after which it is again swallowed.
Merycism Merycism is a peculiar condition, rare, but sometimes
found in neurotics who have the power of regurgitating food from the
stomach. In some instances it has been claimed that they are able to
bring up any particular article of food swallowed. Benedict, in discuss-
ing this point, describes the habit as a pleasant one, which seems as a
rule to do no harm, except as any neurotic indulgence, but doubts the
possibility of selective regurgitation. The regurgitated morsel is said to
often retain its original flavor, without sourness or bitterness, w T hich would
indicate a deficiency of acid secretion and peptonization or possibly some
abnormality, on account of which the foodstuff is retained in the esophagus.
The regurgitation of small quantities of the gastric contents occurs
either as water-brash or otherwise with or without cardialgia heartburn.
This condition indicates a relative disproportion of function between en-
dogastric tension and the normal tonicity of the cardiac sphincter. The
most frequent cause of this condition is the use of too much liquid with a
meal, or too hasty swallowing, so that too much air is introduced, or to
fermentation of the stomach contents. Tonicity of the cardiac sphincter
is largely a characteristic of the individual. For this reason, some per-
sons cannot follow a vocation which requires stooping over soon after
mealtime without regurgitating food from the stomach.
Vomiting. Vomiting occurs as a symptom of so many diseases and
functional derangements that we will not attempt to consider the whole
subject collectively, but will refer the readers to various text-books on the
practice of medicine. Vomiting, so far as it is related to dietetics, may
be caused by (a) excess of food, (&) food and drinks improperly combined,
such as crabs and milk, beer and champagne, etc., (c) fermenting or
poisonous food, (d) irritating and indigestible food, including that which
is improperly cooked, (e) food that is eaten in too great haste and with-
out proper mastication.
Vomiting is mainly a conservative process of evacuating excessive and
irritating gastric contents. Individuals that do not vomit readily are
more disposed than others to serious alimentary disturbances. Vomiting
is always an indication of gastric disturbance or of biliary diseases. In-
testinal obstruction, peritonitis, pelvic disease, etc., need not be considered
here. Food which is wholesome and nourishing may cause nausea through
association or environment. Thompson (3) records an example of this
in the following story : A party of early California settlers while cross-
PERVERSIONS OF APPETITE 123
ing the continent were lost during a severe winter in the Sierras. When
nearly dead of starvation some friendly Indians took compassion and fed
them upon a delicious finely ground meal, which for some days was their
staple article of diet, and on which they rapidly gained strength. Being
at first unable to understand the Indians, the emigrants could not learn
of what the meal was composed. When at length they found out that it
was made from pounded dried grasshoppers they became so nauseated that
they could not touch the food again.
Such vomiting may properly be termed a pure psychosis due to disgust.
From a dietetic standpoint, this form is important, since the nutrition
of many delicate patients depends largely upon whether food is prepared
in a sanitary and hygienic manner and daintily served amid pleasant sur-
roundings. (Volume II, Chapter IV, Hygiene of Eating.)
Hiccough. Hiccough is an abrupt and involuntary spasmodic con-
traction of the diaphragm with coincident contraction of the epiglottis.
The ordinary cause for this phenomenon is engendered in the stomach
by the too rapid introduction of alimentary substances, by alcoholic drinks,
carbonic acid, as well as by certain foods. It must be borne in mind, how-
ever, that it can also be caused by a deranged state of the nervous centers.
If of brief duration, it is usually a gastric or esophageal reflex, more often
the latter. Swallowing too rapidly, swallowing food that is too dry, or
in boluses too large, will cause spasmodic esophageal peristalsis. Pro-
longed singultus is a psychosis due to various reflex stimuli, as from
biliary calculi, pelvic disease, etc.
Aerophagia. Aerophagia is to be distinguished from the eructation
of gas due to the literal swallowing of air with food and drink. It must
also be distinguished from gas produced by effervescence or fermentation,
or from the action of gastric juices upon intestinal carbonates with the
pylorus relaxed. Genuine aerophagia is an exaggerated condition of
hiccough with the drawing of large quantities of air into the esophagus.
It is more often a neurotic manifestation of hysteria, and while it may be
associated with gas in the stomach it more often is excited by the causes
of hiccough.
During an acute aerophagic attack, patients may suffer from dyspnea,
tachycardia and cyanosis. These distressing symptoms, according to
Aaron(17), are instantly relieved by introducing the stomach tube, which
allows the air to escape. The distention of the stomach with air pushes
the apex of the heart upward and to the left. Tliis pressure on the ven-
tricles rotates the heart on its axis and distorts the great vessels at its;
base. The distended stomach or esophagus may disturb the heart in a
124 FACTOKS IN DIET, DIGESTION AXD ASSIMILATION
reflex manner because the common innervation of these organs is through
the vagi. Stimulation of the vagi causes a slowing of the heart. These
factors often produce cardiac arrhythmias, which become apparent to the
patients by periods of different pulse-rate and irregularities, causing them
considerable worry and anxiety.
It is of the utmost importance that an accurate diagnosis be made,
because the affection is easily remedied. The roentgen fluoroscope will
always show the rise and fall of the thyroid cartilage. This is helpful
when one is not sure of his diagnosis.
The examination of the stomach contents in all aerophagics shows the
presence of bile. A positive reaction for bile, with eructations, is a pathog-
nomonic sign. The eructation of the air acts as a siphon and frequently
draws the bile from the duodenum backward into the stomach. The find-
ing of bile in the gastric contents is decisive.
In the treatment of aerophagy, Aaron is in the habit of impressing his
patient with the way he is distending his stomach with air. This can
easily be done by telling him to belch and, while this is going on, asking
him to keep his mouth open. While the mouth is open he cannot swallow
air and the eructations quickly cease. At this stage it is wise to explain
to the patient that he has been swallowing! air instead of emptying the
stomach of gas. In order to keep the mouth open a cork may be placed be-
tween the teeth and held there. In this way the air is prevented from
entering the esophagus. Then again, in order to keep the thyroid carti-
lage from rising, one may tie a ribbon moderately tight around the neck.
This not only is a direct restraint but also serves as a reminder to the
patient. After all, aerophagia is more amenable to moral suasion than to
dietetic treatment.
Seasickness. Seasickness to some extent is produced or initiated by
dietetic errors prior to or after sailing. It seems to be a disturbance of
equilibrium partly visual but mainly due to actual motion of the vessel,
and includes in its symptomatology and pathogeny a condition of shock
and gastric irritability, sometimes one and sometimes the other being the
predominant cause. A voyager from the tonic of the bracing sea air may
inadvertently overeat and thereby overtax his digestive organs and cause
vomiting. Some voyagers at sea can leave the table, vomit the first two
or three courses of a dinner, return and finish the meal with astonishing
equanimity. With such individuals nausea is not a persistent or annoy-
ing symptom. Others are always nauseated, but fail to evacuate the
stomach contents, and consequently grow weak from lack of food. Still
others, after severe experience with emesis, strongly crave and can actually
REFEKEtfCES 125
retain and digest, in defiance of all dietetic laws, substances which they
could scarcely eat at home. Old cheese, dill pickles, canned oysters and
similar incongruities of diet are indulged in without a qualm.
There is a class of individuals of both sexes, though the greater num-
ber are women, who become so ill at sea that they reach a serious condition
of prostration, with whom the mere idea of food or even the suggestion
from reading an elaborate menu, will produce nausea. Certain cases
are almost entirely free from vomiting, even from nausea in the ordinary
secondary sense, and from any definitely localized pain, but consist in a
state of general medical shock with intense discomfort.
1. FITCH, W. E. Pediatrics, Oct., 1912.
2. VON NOORDEN. Physiology of Metabolism, pub. by Keener, Chicago.
3. THOMPSON, W. OILMAN. Practical Dietetics, pub. by D. Appleton
& Co., New York.
4. DE LONG, GEORGE W. The Voyage of the Jeannette, Journals of
George W. De Long, 1883.
5. OSWALD, FELIX L. Asclepiades, Household Remedies, 215.
G. Of Good Workes, and First of Fasting, pub. in 16th century.
7. The Bible. Neh. ix, 1 ; Esther iv, 3 ; Judges xx, 26 ; I Sam. vii,
6; II Sam. xii, 16; Dan. x, 2, 3; Jonah iii, 7; Isa. Iviii, 3-6;
Matt, iv, 2; Matt, vi, 16-18; Matt xvii, 21; Mark ix, 29;
Acts x, 30 ; Acts xiii, 3 ; Acts xiv, 23 ; Acts xxvii, 9 ; I Cor. vii,
5, etc.
8. PULLER, REV. FREDERICK W. Concerning the Fast before Com-
munion, page 36.
9. DE MOLEME, ROBERT. Fasting, Hydrotherapy and Exercise, page
59.
10. DEWEY, E. H. The True Science of Living, page 95.
11. . Ibid., page 161.
12. CHITTENDEN, R. H. Century Magazine, Oct., 1905, p. 860.
13. STARK, WILLIAM. See works by this author, pub. London, 1788.
14. BENEDICT, A. L. Golden Rules of Dietetics, pub. by Mosby Co.
15. VON NOORDEN. Metabolism and Practical Medicine.
1 6. KEMP, ROBERT COLEMAN. Diseases of the Stomach, Intestines and
Pancreas, pub. by W. B. Saunders Co.
17. AARON, CHARLES D. J. Am. Mod. Ass., 1014, Ixii, 2021.
126 FACTORS IN DIET, DIGESTION AND ASSIMILATION
BIBLIOGRAPHY
CHAMBERS. Manual of Diet in Health and Disease.
CHITTENDEN. The Nutrition of Man.
FLINT. Physiology of Man, New York.
GOULEY, J. Dining and Its Amenities, pub. by Rebnian Co., 1907.
NIVEN, JAMES. Feeding in Relation to the Health of the Young, 1904.
THOMPSON, W. GILMAN. Diet in Relation to Age and Activity.
See Life of William Stokes in Masters of Medicine.
CHAPTER VI
OVERFEEDING AND UNDERFEEDING
In these days of overflowing American plenty, super alimentation, with its phy-
siological penalties and economic waste, is possibly more prevalent than under-
feeding, because of the sybaritic indulgence in the pleasures of the table in the
absence of the physical stress of more primitive social conditions. And when appe-
tite becomes pathologically exaggerated, the physician of today knows no remedy;
when it fails in disease, he dispenses the "bitter herb" of tradition and hopes for
the best.
Superalimentation : Overfeeding, Acute Overfeeding, Chronic Overfeeding;
Overeating Chronic Overeating, Gourmet, Gourmand, Glutton;
Effects of Overeating Biliousness, Intestinal Toxemia, Effects on
Mental Powers; Habitual Overeating Alimentary Toxemia, Effect
on Internal Secretions, Effects on Children, Aged, Early Life, Idiosyn-
crasy; Metabolism of Overfeeding Excess of Proteins and Carbohy-
drates, Convalescents.
Underfeeding: Chronic or Habitual Underfeeding; Maleficent Sequences of
Underfeeding Mental and Physical Deterioration, Diminished Re-
sistance to Cold and Exposure, Disease, Effect on Digestive Organs,
Underfeeding a Cause of Drinking and Crime; Protein Metabolism;
Pathology of Metabolism of Starvation Consumption of Energy in
Chronic Malnutrition, Protein Metabolism in Acute Starvation, Se-
cretion of Bile the Blood, the Urine; Conclusions.
SUPERALIMENTATION
Of the terms, overfeeding and overeating, the latter is the more apt
to apply to an adult, as children are fed, while men and women, who
have come into the full possession of their mental faculties and reasoning
powers, may, of their own volition, eat too much. Overfeeding from the
medical standpoint will be discussed later.
It is no easy matter to determine exactly what the word overeating
implies. So many circumstances must be taken into consideration. But
speaking broadly, it may be stated with little fear of contradiction that
127
128 OVERFEEDING AND UNDERFEEDING
the tendency of civilized people, especially of those who are prosperous,
is to eat more than is good for their health, mentally or physically. Of
course, primitive people, when they have the opportunity, almost invaria-
bly surfeit themselves, but their powers of digestion and assimilation are
usually equal to the occasion. Again, poor people, when temporary pros-
perity admits of the indulgence of their appetite for food, are inclined to
gorge themselves.
Overfeeding However, acute overfeeding, as it may be termed, does
not call for an extended consideration. It is true that, in the old days,
it has been recorded more than once that individuals succumbed to the
consumption of very large quantities of food. For instance, King Henry
II of England is said to have died as the result of eating gluttonously of
lampreys, fish of which he was immoderately fond. But he, together
with other historical examples of the ill effects of overeating, were chronic
indulgers in the pleasures of the table, and merely hastened their end by
eating an unduly large meal of indigestible food material. A death of
this description is generally due to interference by a distended stomach
with the action of an enfeebled heart.
It may be reiterated that people rarely die of surfeit in these days,
but that chronic overfeeding, or the habitual ingestion of an excessive
amount of nutriment, is common. In addition, the question of over-
eating must now be regarded in an altogether different sense from that
in which it was formerly regarded. No longer does superalimentation
mean the same as the word in the old sense signified. Our physiological
standards of overeating have greatly changed. Former accepted standards
have been cast aside, and an entirely revised and very much lowered
physiological standard has been set up, by which it would appear that the
population of the whole civilized world is addicted to ingesting more food
than is in keeping with the strict tenets of good health, and is conse-
quently laying up for itself divers kinds of pains and penalties affecting
body and mind.
While it is evident that the food faddist is actively preaching his
gospel of extreme moderation in eating, throughout the length and breadth
of every cultured land, and that, like all faddists, he is something of a
fanatic, yet the truth remains that there is method in his madness, and
that his deductions are based on a sound and scientific substratum of fact.
There is no smoke without fire, and whenever an abuse exists on a wide
scale prophets will arise to point the way we should go. Food faddists
are prevalent and multiply for the very good reason that abuse of food, so
far as quantity and properties are concerned, is widespread. There is
SUPKRAL1. \1KXTATIOX 121)
no doubt that among the prosperous members of a modern community,
eating to excess is a frequent vice or fault, particularly among those
\vlio have been endowed with a large share of this world's goods. It will
he tiresome to further enlarge on this phase of the subject, and without
any more elaboration we will conclude that superalimentation is widely
prevalent. .More notice is now taken of the matter, because the popula-
tion of the world has enormously increased, and therefore the food ques-
tion is all important; and also because a new physiological standard has
heen erected by scientific men who have delved into the matter, the out-
come of whose findings is, on the whole, recognized as correct by the scien-
tific medical profession.
Uut before going into the question from the more scientific standpoint,
it may be as well to discuss superalimentation from the general, rather
than scientific, aspect.
Overeating Overeating is very liable to become a habit, and with
indulgence the habit becomes a vice. A moderate excess of food is prob-
ably not only harmless but even good for the health. For those who
work hard in the open air, of course, a considerable amount of nourishing
food is required ; for sedentary workers, a great deal less aliment is indi-
cated, but, as a rule, it is wise to allow a certain amount of leeway, with
regard to the quantity of food ingested. It is an extremely difficult mat-
ter to lay down hard and fast rules about the amount of food material an
individual should ingest. The personal equation must always be con-
sidered. Regarding the matter from the wide outlook of the mass of the
population, it can be said, with as much dogmatism as it is right to place
on any statement, that the average fairly healthy person living in the ordi-
nary civili/ed community, will take no harm and probably may benefit
from ingesting more food than the amount that is laid down by scientific
experts, as furnishing Sufficient nourishment energy for the smooth and
etlicient working of the human machine. It may occur, and will occur,
that an unexpected and severe strain may be put on this machine, and in
order to cope successfully with or resist this extra pressure without injury
to its delicate mechanism, some reserve force is needed. A mental strain
or physical strain may call for the existence of such a reserve, although
naturally the chief reason will be that one is compelled to go without food
for a protracted period. In this event, a reserve of food within the body
\vill greatly assist in maintaining the vital forces and is indeed necessary
to offset, to some extent, the drain caused by lack of food. It is obvious
that, such a reserve can only be insured by eating more food than the body
actually requires to meet its necessities. It is by following this principle,
130 OVERFEEDING AND UNDERFEEDING
by instinct, probably, that primitive men and animals embraced the oppor-
tunity whenever it presented itself, of gorging themselves with food.
Following a similar line of reasoning, the consumption of an especially
large meal on Sunday by workmen can be explained and condoned from
the physiological standpoint. By eating very heartily on at least one clay
of the week the workman is putting by a reserve supply from which to
partially draw the energy needed throughout the week.
A surplus of this kind can hardly be termed an excess, and it is with
acute and chronic overeating that we are concerned.
It has already been stated that although persons have been known to
die of a surfeit, the occurrence in modern times, at any rate, is extremely
infrequent. The harmful effects of too great a consumption of food at
one time are local rather than general. The digestive organs, chiefly,
suffer. Vomiting may result and may relieve the overtaxed stomach, or
if the food reaches the intestine it will probably decompose before it is all
absorbed, and diarrhea in this instance will act as a safety valve.
If the process of assimilation does not keep pace with that of absorp-
tion, some of the surplus products of digestion will pass out of the system
by wav of the blood stream, that is, with the assistance of the kidnevs.
V V V
This mode of rescue is one that is not often employed, although, that it is
on occasions, is demonstrated by the fact that a great excess of protein in
the food may give rise to transient albuminuria. On the other hand, if
the consumption of carbohydrates has been extravagantly large, sugar may
for a time appear in the urine.
Chronic overeating is a different matter and its ill effects are brought
about in a more insidious manner. As a result of excessive eating or
gluttony, the stomach and bowels become enlarged, the liver engorged and
a predisposition is established to degenerative changes of the heart and
arteries. The general results of habitual overeating seem largely to depend
upon the food material which forms the greater part of the nutriment
ingested. For example, if carbohydrate or fat is the food of choice, then
the surplus is stored up in the form of fat, and the outcome is obesity.
Protein material can hardly be stored in this fashion, for as Hutchison
has pointed out, so great is the tendency of "nitrogenous equilibrium" to
assert itself that the body can only "lay on" protein for very short periods,
unless the process of growth is still going on. The same authority is of
the opinion that what usually appears to happen is that the surplus protein
is split up into two portions, one of which contains most of the carbon and
is probably converted into fat and stored in that form, while the nitrogen-
containing part is broken down, but not, perhaps, very rapidly and com-
STJPERAL] M K XTATION 131
pletely, so that the products which represent the intermediate steps in its
destruction circulate for some time in the blood before being excreted in
the form of urea. Some of these products may be factors in the produc-
tion of such conditions as granular degeneration of the kidneys, high
arterial tension, gout and rheumatism. Many observers think that they
are partly responsible for diseases of this character, but the more conserva-
tive and the majority of those who have made a special study of the sub-
ject prefer to reserve their decision and to await more definite proof
before laying down the law on these points. In this connection, it is well
to bear in mind that an excess of protein sparers in the blood may produce
very similar results to an excess of protein itself by shielding the latter
from complete and rapid oxidation.
It may be taken as proved that gourmandizing or gluttony, whether
done only on occasions or pursued as a habit, is by no means beneficial to
the physical or mental attributes of the human organism. Chronic gour-
mandizing is more injurious to health by far than the occasional stuffing
one's self with food, as it is doubtful whether an occasional excess, unless
carried to the extreme, is harmful.
On the mental faculties eating to excess has a remarkably pernicious
effect, but before dealing with some of the ills of the body and mind, in-
duced, fostered and aggravated by overloading the stomach and intestine
and overtaxing the digestive powers by greedy eating, gluttony from the
historical standpoint will be briefly discussed. There have been some
notorious gluttons, and there have been and are races of people who appear
to have an abnormal capacity for eating, and there are civilized individuals
at the present time who exhibit wonderful powers of consuming portentous
quantities of food.
There is a French proverb : "Ceux qui s'indigerent ou qui s'erviverent
ne savent ni boire ni manger" (Those who eat to surfeit or tipple to satu-
ration know not how to eat or drink). Such as these are gluttons in con-
tradistinction to epicures or gourmets. The epicure is an artist in the
choice of food and generally indulges somewhat sparingly in carefully
selected food and rare viands, while the glutton is a gross consumer of
coarse food and strong, crude drinks. The gourmet is a dainty eater,
while the glutton is a boorish consumer of immense quantities of heavy
food. 1 The word gluttony, which expresses precisely the act of eating to
excess, is derived from the Latin glutire, to glut, to swallow greedily, to
gorge, to devour. As the French are the acknowledged arbiters of artistic,
refined eating, they possess in their language several terms to denominate
i Anonymous author in "Dining and Its Amenities," published by Rehman f'o.
132 OVERFEEDING AND UNDERFEEDING
and distinguish between the various kinds of eaters. Some French writers
make nice distinctions between the appellations gourmand and glutton.
The gourmand, they say, loves good cheer, but eats with judgment. The
glutton devours noisily and greedily all food upon which he can lay his
hands. The older editions of the Academy's dictionary make no such dis-
tinctions, and look upon the gourmand as synonymous with the glutton,
and many French writers accept this definition. In the most correct
French of the present time, the word gourmet is used in place of gourmand,
meaning a careful eater, but a connoisseur of the art of dining. In the
English language gluttony is practically identical with gourm and i zing,
greediness, edacity, gulosity and voracity. Gluttony, however, is the word
most frequently in use to define the possession of an insatiable appetite
for food. The boa constrictor may be regarded as the supreme type of
the colossal glutton. Though perhaps not wholly in place in a work on
diet, it may be remarked that gluttony is often employed metaphorically
when reference is made to men who give themselves up to excessive mental
effort. Thus a hard-working business or professional man is called a
glutton for work ; the elder Pliny was termed by a contemporary a literary
glutton on account of his custom of mentally devouring every kind of ac-
cessible writing., The individual who indiscriminately devours writings
of any kind, being able to assimilate only a small part of them, is as much
of a literary glutton as the voracious devourer of any sort of food is a
glutton in the ordinary sense of the word.
The glutton living in a civilized country differs from his primitive
brethren and his somewhat more distant relatives, the carnivora and
omnivora, in that their appetite is instinctive and natural, while his is
abnormal and not infrequently morbid. There are men who are large
eaters without being gluttons. The human glutton is in a class by him-
self and is marked by certain unpleasant but significant characteristics.
He is essentially a gross eater to whom quantity is of more importance
than quality and who persistently and with intent gorges himself to reple-
tion. Of course, there are gluttons who should be named rather gour-
mands, for, after all, there is a shade of difference between the terms;
gourmands, while immense and voracious eaters, are nevertheless careful
in choice of food and drink. Of all the gluttons whose names appear in
history, that of the greedy Heliogabalus comes to mind as the archetype of
gluttony. Alexander the Great, who was glutton in everything, died at an
early age from the effects of a protracted debauch, and the Emperor Sep-
timus Severns succumbed to acute indigestion brought on by overeating
and vinous excess.
SUPERALIMENTATION 133
The glutton is limned to the life by the inimitable art of Shakespeare
in the person of Sir John Falstaff ; in many of the immortal bard's plays
vivid and lifelike verbal pictures of the glutton are presented. In the time
of Shakespeare, be it remembered, gross eating and heavy drinking were
customary, and in polite society the glutton was not looked at askance.
To be a good trencher man was esteemed a virtue rather than a vice. To
hark further back than the time of Shakespeare to that of another of the
greatest poets of the world, Homer, we find that to eat gluttonously and
to drink unstintedly was regarded as an almost necessary attribute of a
good fighting man. As it was heroic to kill one's enemies, so it was the
part of the militant hero to consume unlimited quantities of food and
drink. As an historical, possibly legendary, example of capacity for food,
it is related in the verses of the poet Berchoux, who told in charming
rhymes of the pleasures of the table and of the doughty deeds of his gas-
tronomic heroes, that during one morning Albinus consumed five hundred
figs, one hundred peaches, ten melons, twenty pounds of muscat grapes,
one hundred fig pickers and four hundred and eight oysters. Truly there
were gastronomic giants in those days.
The Tartars have always been conspicuous as great meat eaters and
heavy drinkers, and, if their powers in this direction have not been belied,
Genghis Khan, Tamerlane and others of the earlier Tartar warriors well
upheld the traditions of their race as carnivorous gluttons. Of European
people the Norsemen and the Saxons ate and drank inordinately, while
the Normans were more fastidious in their choice of food.
Louis XT\ 7 of France was a voracious eater. It is told by chroniclers
of his time that he frequently ate at one sitting four plates of different
soups, a whole pheasant, a partridge, a copious serving of salad, some
roast mutton, two good sized slices of ham, a fair share of pastry, and for
dessert preserved fruits, nuts, etc. A very favorite dish of his was hard
boiled eggs. 1
Charles V was as big a glutton as he was an epicure. At a dinner of
i Of old the palate ran riot. The Romans were both epicures and gluttons. The
oysters of Britain were conveyed by relays of runners to the Roman villas. One epicure
cast a slave into his fishpond to improve the flavor of his lampreys. The most absurd
dishes were contrived, up to a pie of nightingales' tongues. Their tastes were not
ours. Fowls were boiled in aniseed water, and served with a sauce containing aniseed,
mint, mustard seeds and asafetida. Nor were the middle ages far different. Charles
TV, of Germany, was a notorious gourmand. Besides ordinary meats he had roasted
horse, cats in jelly, lizard soup, fried frogs, etc., till his chef, when asked for a new
dish, could only suggest a compote of watches in allusion to that monarch's passion
for such timekeepers.
109
134 OVERFEEDING AND UNDERFEEDING
the Knights of the Golden Fleece, Roger Ascham saw him make his way
through sod beef, roast mutton and baked hare, after which he fed full
well on a capon. Nor did he forget to drink with it all. "He had his
head in the glass five times as long as any of them, and drank no less at
once than a quart of Rhine wine." It is further narrated that he became
a victim of gout.
In more modern times the Due d'Escars died within twelve hours after
eating too freely of the famous dish of truffles a la puree d'ortolans, de-
vised by Louis XVIII.
Overeating generally is more prevalent in modern times and among
civilized communities than in the days of yore, for the reason that there
are more persons who can afford to indulge their propensities in this direc-
tion. Per contra, there are fewer people who eat and drink to an im-
moderate extent. While the ancient vice of gluttony has been handed
down from generation to generation, there are few, if any, instances of
unbridled voracity which can be compared with those told in the annals
of great gastronomic feats. Still the race of gluttons is by no means
extinct, and it will be pertinent to cite a case or two of gluttony carried
to extreme limits, by modern emulators of the gourmandizing exploits of
men of ancient times and of the middle ages. Savarin in his fourth
"Meditation," section "Grands Appetits," states that a General Bisson
drank eight bottles of wine with his copious breakfast, and that Prosper
Sibuet, when eighteen years of age, on a wager, devoured a whole turkey
after having eaten a bountiful dinner.
Sergeant M. A. Hunter, Quartermasters' Corps, U. S. A., related to
the author that he witnessed an exhibition of abnormal capacity for ingest-
ing food when he was stationed at Fort Apache just before the outbreak
of the Spanish-American War. A detachment of raw recruits were sent to
Fort Apache, and among these were several Poles and Russians, who were
enormous meat eaters. The Sergeant says that the quantity of meat these
men could consume quickly attracted the attention of the Mess Sergeant
of the company, and a gourmandizing trial of strength was arranged be-
tween the champions of each race. After a lengthy encounter the Rus-
sian gained the victory, having swallowed 23l/> pounds of roast rare beef.
Reference was made in a former part of this chapter to the eating
powers displayed by certain races, and in the opening chapter of the first
volume, dealing with the evolution of man's diet, some examples were
given of these powers. Of races which inhabit the world at the present
time, the Eskimo stands supreme as a devourer of meat. Cook stated that
they eat but one meal a day and then gorge themselves with tough meat
SUPEKALIMENTATION 135
so that they develop big jaws and enormously distended abdomens. Hayes,
on an exploring expedition, had an opportunity to study the habits of these
people, and says that it is not uncommon for an Eskimo to eat from 12 to
15 pounds of food, about one-third of which is fat and the rest muscle
meat. Captain Hall, when on his Arctic expedition, declares that he saw
a native Eskimo eat 20 pounds of raw meat and consume a quart of train
oil within 24 hours.
Many primitive people of the present day both in tropical and cold
climates eat immensely, but as said before, while eating too much has
increased generally in civilized countries, cases of inordinate eating are
more rare. Gluttony in civilized people is regarded not only as a sin
against the laws of health, but as a repulsive means of gratifying the
sensual appetites, fraught with the most grave consequences. It is
frowned upon and stigmatized in polite society, and he who sins in this
respect is looked upon with contempt.
Effects of Overeating. The effects of overeating on the mind and
body are more or less obvious. Overeating causes congestion of the liver,
and a condition known as "biliousness," in which the stomach and intes-
tines are engorged. Constipation ensues, the tongue becomes heavily
coated, the bodily secretions are altered in composition, and the urine
especially becomes overloaded with salts. It is evident that we are not
nourished by the food we eat, but by the amount we can properly use and
assimilate. Probably, an excess beyond this amount is beneficial because
it supplies a reserve upon which the body can depend for nourishment in
time of need. However, it is absolutely patent that chronic overeating
so clogs the machinery of the body that the organs of elimination and
excretion are unable to work as they should, intestinal stasis follows, the
surplus food material putrefies before it is absorbed in the intestine, the
urinary tract becomes infected, the circulation becomes involved in the
toxic invasion, and the whole system is poisoned.
This condition of intestinal toxemia brings in its train many mental
and physical disabilities. The nervous and muscular systems become
saturated with the end products of protein digestion, producing a state
of lassitude, headache, fatigue, drowsiness and even mental stupor.
The effect of chronic overeating on the mental powers is very evi-
dent. Indeed, it may be laid down as an axiom that a person who habit-
ually overeats is incapable of good or sustained mental work. The cross,
irritable dyspeptic is too greatly occupied in worrying about his own ills
to be able to employ his mental faculties in other and more useful chan-
nels. The brain worker or business man, who eats largely, especially in
136 OVERFEEDING AND UNDERFEEDING
the middle of the day, cannot use his mental powers properly. His mind
loses its acuity and as for flights of imagination, if he is a literary man,
these are impossible. Overeating is an insurmountable obstacle in the
way of mental endeavor. The handicap placed upon the entire system as
the result of overeating is too great to be overcome, and the mind refuses
to respond to the stimulus of thought.
HABITUAL OVEREATING. The effects of overeating on the body have
been discussed already, and little remains to be added. It is known that
habitual eating to excess will in course of time bring about alimentary
toxemia, and it is more than surmised that this poisoning of the system
by the waste food products is mainly and sometimes wholly responsible
for many serious diseases, the maladies, for instance, so frequent in these
days, known as chronic. However, until our knowledge on these points
is more exact and definite, it would be unwise to speak very dogmatically,
that is to say, it would be unwise to say with decision that such and such
a disease, gout or rheumatism, for instance, is caused chiefly by overeat-
ing or errors of diet. This we do know and can state emphatically, that
in the treatment of conditions of this nature, diet plays a very important,
if not the most important, role.
There is another point in connection with habitual overeating which
should not be overlooked, and that is its effect on the internal secretions
concerned in the digestive process. We do not know enough of the mode
of action of the secretory glands to state exactly and in detail what their
province is, but we have learned that they have very much to do with the
working of the human organism and that when they secrete deficiently
ill. health follows. Overeating no doubt unduly taxes the internal secre-
tions, and this persistent strain results in their failure or partial failure
to perform their normal functions. It is satisfactory to be able to state
that knowledge about the internal secretions is increasing and that the
time is approaching when the mystery that envelops them will be cleared
away.
Children are often habitually overfed and the old frequently suffer
from the effects of chronic overeating. There is little doubt that many
of the ailments with which babies and young children are afflicted pro-
ceed from overfeeding. With most mothers the criterion of an infant's
health is the amount of adipose deposit it carries. The fatter it is the
prouder its parents are of it. The truth is that, as a rule, the fat baby
is not the healthy baby.
The healthy baby can digest and assimilate easily and continuously
an amount of food sufficient to produce normal growth. An excess of food
SUPERALIMENTATION 137
will not cause a corresponding excess in the rate of growth. A deficiency
or excess of .food continued for a length of time may check growth. The
rickety child is frequently extremely fat, and it is certain that harm will
result from giving the infant too much to eat.
With regard to overeating in the case of the aged, it goes without say-
ing that the habit is to be deprecated. When middle age comes digestion
often begins to lose its former vigor, and metabolism shows signs of flag-
ging. With the gradual onset of old age digestive and metabolic activity
further wanes. Consequently with the advance of age chronic overeating
should be guarded against and simple foods should be taken sparingly.
At the age of sixty an individual must reduce his intake, and at seventy
his power has further diminished and the nutriment must correspond
thereto, if he desires still another term of comfortable life.
Sir Henry Thompson(l) says: "I desire to point out that the system
of 'supporting' aged persons, as it is termed, with increased quantities of
food and stimulant, is an error of cardinal importance, and without
doubt tends to shorten or embitter life." Overfeeding of young children
and overeating in the case of aged persons are grave dietetic errors.
In early life, as Campbell has pointed out, most people can cope with
a dietary which departs widely from the ideal; they are able to consume
with comparative impunity not only far more food than is required, but
also all sorts of foods which in later years cannot be tolerated. "Com-
parative impunity" is said with intention because chronic dietetic delin-
quencies, even in early life, cannot but be harmful in the long run,
although an occasional lapse from a severely correct diet may in the case
of the habitually abstemious, be actually beneficial, and this even after
middle life.
The point which should be emphasized with regard to overeating is
that chronic eating to excess is extremely injurious to health, while an
occasional indulgence in this direction may do good rather than harm.
Another point upon which stress should be laid, is that Idiosyncrasy and
custom count for a good deal in the capacity of the organism to cope with
different kinds and quantities of food. The personal equation is always
an important factor. Individuals vary greatly in their digestive and
metabolic capacities. For example, some children are made ill by even
a slight excess of food, while their grandparents, perhaps, can consume
a large excess with comparative impunity. Adults in the prime of life
differ widely in their digestive and metabolic capacities. One man can
ingest without apparent injury an amount of food which another man
leading exactly the same kind of life cannot tolerate. But often the pos-
138 OVERFEEDING AND UNDERFEEDING
session of great digestive and metabolic capacities is of doubtful . value,
as these are apt to be abused and the "individual with what is termed a
weak stomach frequently outlasts the person of strong, vigorous frame
and sanguine temperament, largely owing to the fact that he has to be
careful. The creaking gate frequently hangs the longest. Also the ques-
tion of heredity plays a far greater part than many people imagine.
Longevity is to a considerable extent a matter of inheritance.
There is another interesting point in connection with overeating that
is deserving of passing mention. The capacity to cope with an excess of
food differs in different races irrespective of climate or conditions of life.
Custom exerts some influence. Thus the Jews seem to be conspicuous in
this respect. They lead, as a rule, a sedentary life, and yet can habit-
ually eat an excess of rich food without apparent injury to health, pos-
sibly for the reason that because far longer than any other race, on account
of their prosperity, they have been able to obtain plenty of food, and have
thus become racially adapted to it.
The question of overfeeding in contradistinction to overeating will
now be considered.
Metabolism of Overfeeding Overfeeding, speaking from the standpoint
of the medical man, signifies that the object to be attempted is the build-
ing up of fresh tissue in a person previously badly nourished or who has
lost tissue as the result of disease. Von Noorden's definition of the term
"overfeeding" is the administration of food in such a quantity as to pro-
vide more energy than the needs of the body require. According to the
same authority, it is a matter of indifference whether the excess takes the
form of albumin or of some oxidizable substance free from nitrogen.
EXCESS OF PROTEINS AND CARBOHYDRATES. If fat is ingested in
excessive amounts the greater part of the energy thus created passes into
tissue substance. Carbohydrates consumed to an excessive extent do not
afford nutriment to the tissues in the same way. Zuntz(2) has estimated
that considerably less energy is generated for digestive purposes by carbo-
hydrate consumption and that with coarse kinds of bread the energy loss
is much less. In addition, it has been shown by Rubner and Zuntz that
carbohydrate is not changed into fat with absolutely no loss of heat.
When nitrogenous substances compose the excess the results are dif-
ferent from those of fat on carbohydrate excess. Several investigators
seem to have demonstrated that in these circumstances the processes of
oxidation are augmented. Rubner (3) fed animals with a rich meat diet
and obtained values appearing to show that a daily transformation of
energy exceeding those in accord with the food necessary for main-
SDPKKALI M ENTATION 139
tenaiicc by 30 or 40 per cent or more was necessary. However, wlicn
man is considered, no large amounts need to be taken into account.
From the fact that he is omnivorous, it is known that only a compara-
tively small proportion of the food ingested can be replaced from pro-
tein. Rubner was able to distinguish two effects as the result of feeding
on protein substances :
1. The primary effect of a meal rich in protein is an increase in the
oxidation processes, which passes off in about eight to ten hours.
2. In certain circumstances, however, the continued use of a diet
rich in protein leads to a long continued increase in the consumption of
energy r which lasts as long as the excess of protein remains high. This
increase in the waste of energy rises more quickly in accordance with the
addition of protein.
From the standpoint of the most recent investigations, von ]SToorden(4)
thinks that, in estimating the elements of the food by which an. excess
of calories is produced beyond the needs which form the basis of a diet
to increase body weight, protein is the least suitable since along with a
low caloric value the necessary oxidation processes must be considerably
increased for its combustion. Consequently, very little of the surplus
calories, which result from the excess of protein, are left at the disposal
of the system. Ho well (5) point& out that if protein is eaten in excess
of the real assimilation needs of the tissues, all the excess, as far as we
can see, might just as well be substituted by carbohydrate or by carbo-
hydrate and fat. The excess nitrogen thus eaten appears to be so much
useless ballast which the body very promptly gets rid of.
Better results are obtained from carbohydrates, although in their case
at least one-fourth of the store of energy contained in an excess of them
is lost on the way from the stomach to its final storage as fat in the fat
depots. Von Noordeii is of the opinion that the conditions are most favor-
able in the case of fat, as very little expenditure of energy is required
on the part of the digestive organs, and the fat is stored as such without
any loss of energy. Rosenfeld(G) thinks that there is reason to* believe
that in animals like ourselves the carbohydrates are more easily and more
quickly destroyed in the body than the fats, and that, therefore, the latter
may be more readily deposited in the tissues, although an excess of car-
bohydrate beyond the actual needs of the body will also be preserved in
the form of fat or glycogen. The modern point of view is that body fat
is formed in the first instance from food fat and food carbohydrates. It
is customary to teach and put into practice the theory that carbohydrates
or fat and carbohydrates are best adapted for feeding purposes and,
140 OVERFEEDING AND UNDERFEEDING
despite the opinions of von Noorden, full use is seldom made of fat.
However, that authority claims that, when certain pathological conditions
of the stomach and intestines can be excluded, large and even enormous
quantities of fat are well tolerated, with results that cannot be exceeded
by an abundant exhibition of carbohydrates. This remark may be inter-
polated here that while emphasis has been laid upon the importance of
overfeeding, that is, of providing what Meltzer has termed a "factor of
safety," a certain margin beyond a bare sufficiency which will be a re-
serve against unusual demands, the question may be asked what consti-
tutes the assimilation need of the tissues ? This must be known with more
or less accuracy before the amount of the reserve required can be stated.
If a man is accustomed to eat 100 grams of protein daily, and science
demonstrates that he can maintain a nitrogen equilibrium on 30 grams,
does a reasonable factor of safety require the use of the additional 70
grams, or would a less total per day, perhaps, meet every requirement?
This is a point which should be elucidated by experiment and observation.
Von Noorden is of the opinion that the increase in the exchange of
calories following the fattening of the body tissue depends on the follow-
ing two factors.
1. The increase in the amount of protoplasm disintegrated, forms the
most characteristic feature. When large quantities of fat are put on, the
body accumulates material which adds to its weight but hardly con-
tributes at all to the energy exchange. As a result, the balance of energy
based upon the body weight falls, as a rule, in individuals who are being
overfed. An addition of flesh, that is, an increase in protoplasm, aug-
ments the transformation of energy as shown by experiments made by
Pfluger and Rubner. Zuntz(7) demonstrated that by systematic muscular
exertion, continued for a considerable period, many of those experimented
upon became thinner but gained a good deal of nitrogenous material.
When the period of exertion was over the exchange of calories was higher,
the casual factor being an increase in the protoplasm.
2. The increase in the actual size of the body, independent of the
formation of protoplasm, necessitates an increase in the consumption of
energy, which means that individuals of heavy weight require a greater
expenditure of energy in order to move and raise their limbs and so on.
It is not infrequently impossible to set up definite quantitative relation-
ships between the addition of protoplasm and the increase in the trans-
formation of energy.
In the present state of our knowledge, it will not be wise to go further
than the following statements : (a) Every increase in the amount of pro-
Sri'ERALLMKXTATlOX 141
toplasm increases the energy exchange, (b) An increase in weight, due
to increased intake of fat, also increases the energy exchange, (c) With
the ingestion of further quantities of protein, the energy exchange often
rises independently of the increase in protoplasm, probably as the result
of a peculiar irritative action of the food proteins on the active cells, the
exact nature of which is unknown. Kraus(8) points out with regard
to the conditions which obtain in convalescents that it has long been
known that convalescents, like those who have been subjected for a long
period of time to insufficient food, can be made to increase in weight more
readily than well-nourished persons. It has been observed that an addi-
tion of protein can occur in wasted and enfeebled patients on a diet which
in normally nourished individuals would be insufficient to permit a nitroge-
nous equilibrium to be attained. It was further observed that especially
during convalescence from severe diseases considerable amounts of protein
derived from the food were daily retained in the organism, and employed
in rebuilding the damaged tissues.
CONVALESCENTS
Svenson(9) studied the conditions of convalescents during recovery
from typhoid fever and pneumonia, the only ones as yet studied. In the
first days after the fever had disappeared, the values for oxygen utilized
and the carbonic acid given off were found very low. After a few days,
however, the exchange of energy rose, and in the following first to second
weeks reached values which exceeded the normal by about 30 to 50 per
cent. If, despite the much more active processes of combustion, the
convalescent increases in weight and puts on a good deal of flesh, this is
due to the fact that the taking up of nutriment is still more decidedly
raised than the energy exchange. According to Svenson, a food intake
equal to 00 or 70 calories per day and per kilogram is not unusual in
the convalescent. During the period of the marked putting on of pro-
tein and fat, the respiratory quotient rises considerably. This is exactly
the reverse of what is met with in starvation when the respiratory quo-
tient sinks abnormally. Von Noorden is inclined to doubt Svenson's
figures and thinks that fresh experiments in this direction are called for.
An important point is that flesh formation occurs in every case in
which the body has suffered from a loss consequent to starvation, under-
feeding, or disease, and again returns to a more satisfactory state of
nutrition. It should also be noted that the recuperative powers of the
organism with regard to nitrogen retention come into evidence when the
need for calories is not thoroughly satisfied. In this event, the tissues
142
OVERFEEDING AND UNDERFEEDING
have the preference when overfeeding is practiced. It is evident that
the conditions for flesh accumulation are most favorable when an excess
of food is combined with the efforts at regeneration on the part of the
organism. Excess of food can be used to the best advantage only when
the vital forces of the subject are recuperating. As said before, the sole
exact experiments which have been made hitherto on this aspect of metab-
olism have been made on convalescents from typhoid fever and pneu-
monia.
The following figures, taken from von Norden, when compared with
those obtained by feeding healthy individuals, show how markedly the
activity of the accumulation of nitrogen is increased in convalescents :
TABLE EMPHASIZING THE INCREASED NITROGEN IN CONVA-
LESCENTS, DUE TO OVERFEEDING
Days of
Conva-
lescence
Nitrogen
in Food,
Gms.
Calories
in Food
Calories
per Kg.
Daily accu-
mulation of
Nitrogen,
Gms.
Weight,
Kg.
Observers
15-27
18.69
3,188
55
56.5-69.4
28-36
20.54
3,238
54
+6.54
59.4-61.4
Benedict and Sura-
nyi (typhoid)
37-47
18.63
3,324
55
+7.69
61.4-64.3
3-13
21.3
3,216
about 56
+7.56
about 56
Ibid, (typhoid)
14-17
21.92
4,327
73
+7.33
57.5-58.5
18-25
17.04
4,215
71
+5.00
58.5-59.8
26-34
28.29
4,589
74
+9.82
59.8-63.7
35-42
27.17
3,598
56
+5.56
63.7-65.2
43-62
27.24
2,912
44
+4.86
65.2-68.1
3-13
18.20
2,775
50
+3.62
55.0-56.0
von Noorden, 1893,
unpublished ob-
servation (ty-
phoid)
14-23
18.20
2,775
48
+4.05
56.0-59.4
24-33
18.20
2,775
46
+5.87
59.4-61.0
4-10
19.10
2,180
42
+3.82
52.0-52.8
11-18
19.10
2.380
45
+4.93
52.8-54.1
19-23
20.20
2,600
48
+3.14
54.1-56.0
von Noorden, 1893,
unpublished ob-
servation (after
severe sepsis)
It may then be stated that the results of experiments carried out per-
mit the conclusions that the nitrogen gain is absolutely, as well as rela-
tively to the simultaneous putting on of fat, greatest in those convalescing
from severe acute diseases. It is less, but still considerable, in patients
SUPERALIMEOTATION
143
who were in a condition of inanition before the feeding was commenced,
and whose body weight had fallen greatly below the average. Of course
it follows that the smallest nitrogen gain is seen in individuals who were
well nourished before the experiment began.
The following table, taken from von Noorden, refers to the manner
in which the accumulation obtained through feeding is divided between
nitrogenous material and fat:
OP THE CALORIES IN EXCESS
T7I J
THERE WERE USED IN THE BODY
Observers
iood
Nitro-
gen
Excess
of Cal.
For Storage
as Protein
For Storage
as Fat
Grams
Absolute
Per cent
Absolute
Per cent
Grams
Grams
Grams
Grams
Krug
15.4
1,537
115
7.46
1,422
92.54
Healthy and well
nourished
Kaufmann and
21.5
1,906
111
5.80
1,795
94.2
Healthy ;moderate
Mohr
18.4
2,775
170
6.10
2,605
93.9
state of nutrition
Kaufmann and
17.8
1,683
133
8.00
1,550
92.0
As before
Mohr
17.0
2,830
204
7.20
2,626
92.8
30.8
367
20
5.40
347
94.6
30.9
355
86
24.20
269
75.8
Liithje
41.7
1,505
197
13.10
1,308
86.9
Healthy
42.6
1,472
228
15.50
1,244
84.5
61.0
2,524
482
19.10
2,042
80.9
Benedict and
18.7
790
227
28.70
563
71.3
Convalescent from
Suranyi ....
20.5
733
268
36.60
465
63.4
typhoid
18.6
738
263
35.60
475
64.4
24.3
830
206
24.80
624
75.2
21.9
1,723
255
14.80
1,468
85.2
17.6
1,594
174
10.90
1,420
89.1
Benedict anc
28.3
1,868
342
18.30
1,526
81.7
Convalescent from
Suranyi ....
27.2
893
193
21.80
700
78.2
typhoid
27.2
258
169
65.50
89
34.5
18.2
489
126
25.90
363
74.1
von Noorden. .
18.2
387
210
54.30
177
45.7
Convalescent from
18.2
316
204
64.50
112
35.5
typhoid
16.8
342
70
20.50
270
79.5
17.2
468
49
10.50
419
89.5
von Noorden. .
17.3
662
80
12.10
580
87.9
Stomach affection
19.9
720
136
19.00
584
81.0
badly nourished
18.0
558
143
25.60
415
74.4
18.1
707
118
16.70
589
83.3
19.1
1,795
57
3.20
1,738
9.68
Hirschfield . . .
23.0
2,273
54
2.40
2,219
97.6
Badly nourished
19.2
2,197
115
5.20
2,082
94.8
144 OVERFEEDING AND UNDERFEEDING
The argument has been brought against these overfeeding cures that
the increase of weight obtained soon disappears. Probably, this depends
to some extent on the manner in which the treatment is conducted. The
originator of this therapeutic method was Weir Mitchell, who always
prescribed isolation, complete bodily rest, and aliment mainly of a car-
bohydrate character. However, it is not essential to follow Mitchell's
trophotherapy to the letter, and in many instances, exercise in the open
air, massage and so on are indicated. The main object is to admin-
ister a large amount of highly nutritious food in a relatively small
volume and whether absolute rest is to be a part of the treatment, or
exercise, must be left to the discretion of the physician. Personally we
shall advocate exercise in conjunction with the dietetic regime. How long
the gain in weight in consequence of overfeeding can be maintained must
be taught by therapeutical experience rather than by exact experiments.
It has been pointed out that in the overfeeding treatment of wasted,
ill-nourished persons, during the first weeks the body weight rises at a
great rate, and this rise cannot be wholly explained by the accumulation
of flesh and fat. The explanation probably is the large amount of water
taken up by the blood and tissues. It is the accumulation of water in this
manner that accounts for the rapid increase of weight during the first
weeks. When diuresis increases the gain in weight slackens or stops,
although flesh and fat are still being put on at much the same rate.
The numerous investigations which have been carried on within recent
years with regard to the effects of overfeeding have, from the experi-
mental standpoint, been somewhat confusing. While all the investigators
appear to concur in the view that overfeeding is generally indicated in
cases of malnutrition resulting from lack of food or from certain patho-
logical conditions, the explanations as to what form of feeding should be
followed or why, that is, from the strictly scientific point of view, are
not altogether satisfactory. It must be borne in mind that up to the
present time exact experiments on this aspect of metabolism have been
made almost exclusively on convalescents from typhoid fever and pneu-
monia, and even these have been subjected to criticism. The explana-
tions, other than those gained from exact experiments and from clinical
experience, are after all no more than scientific surmises, although, of
course, they are founded upon physiological and pathological facts and
reenforced by profound knowledge as in the case of von Noorden.
Moreover, the point raised by Howell is well taken: that, when a
reserve supply of food provided by overfeeding is spoken of, it will be
necessary to find out as nearly as may be what constitutes the assimilation
CTKDERFEEDING 145
need of the tissues. From the point of view, (lien, of experiments with
regard to the metabolism of overfeeding, the question whether a genuine
putting-oii of flesh may be obtained from this method still remains
unsolved.
From all the experiments made in this direction, the most important
point which has been made clear is the great selective power which the
body possesses in regard to foodstuffs given in excess. It must be empha-
sized that it is only by practical experience and not by experiments,
except those which are generally conducted on animals, that we can learn
if body weight can be increased when this is necessary, if it is to the
benefit of the patient to use overfeeding and if so by what form of food
this end may be best accomplished.
When we turn to the clinical evidence on this point, the results are
more encouraging. Overfeeding in tuberculosis has been referred to in
Volume III, Chapter V, and the treatment is likewise employed in cer-
tain forms of anemia and chlorosis, neurasthenia, hysteria, visceroptosis,
malnutrition generally and especially in convalescence from various
diseases, those of a febrile and infective nature in particular.
Weir Mitchell's mode of treatment and diet have been described in
Volume II, Chapter XVI, and it only remains to say that, while the rest,
treatment and judicious stuffing with food are suitable for and have bene-
fited many, yet whether this kind of treatment should be followed or
whether a combination of overfeeding and exercise should be used must
be left to the discretion of the physician. We are distinctly inclined to
advocate, as a rule, exercise and overfeeding. Much the same may be
said with regard to the kind of food. Although carbohydrate food is
recommended by perhaps the majority, fat and carbohydrate by many,
and fat by von Noorden and others, there may be cases in which an excess
of protein food in the shape of meat may be of the greatest benefit. -No
one dietetic procedure should be slavishly followed, but the physician
should use his own judgment. On the whole, overfeeding by carbohy-
drates or fat and carbohydrates seems to have had the best results.
UNDERFEEDING
Underfeeding is by no means uncommon in civilized communities
and in urban and in industrial centers in particular. The cause is gen-
erally poverty, as in all modern countries there is always a large propor-
tion of the inhabitants who, while not actually starving, exist in a
constant condition of semi-starvation. These people not only lack suffi-
146 OVERFEEDING AND UNDERFEEDING
cient food to satisfy their appetites, but they do not ingest enough
nutriment to keep their bodies in good health. Also, and this is an
important point, their diet is ill balanced and usually composed of
innutritions food products. If the money they spend on food were
expended judiciously, that is, scientifically, they would not be underfed.
But in the first place it must be remembered that the poor are compelled
to buy in the dearest market ; they obtain the least value for the money
they spend, and they are ignorant how to lay out to the best advantage
the little they possess. This is especially the case with the city poor of
the English speaking race. Probably no indigent people in the world
buy food at such high rates and in such a foolish way as those who live
in the big industrial cities of Great Britain. In the cities of America,
too, a large proportion of the inhabitants exist on an ill-balanced diet.
Perhaps here it is not so much a question of poverty as carelessness and
laziness. The woman of the household prefers to buy her food ready
cooked in delicatessen stores than to cook it at home. The consequence is
that very large numbers drag out a bare existence continually, on the
borderland of starvation. The Latin races, as a rule, live on cheap food
which is, at the same time, nutritious. The Italian, for instance, subsists
and does hard manual labor on food like macaroni; the majority of the
inhabitants of Japan work hard and are muscular and vigorous on a diet
consisting mainly of rice, and the list of these peoples who live, thrive
and work hard on an inexpensive and nutritious diet, might be greatly
amplified. However, the object aimed at is to demonstrate that
underfeeding is widely prevalent in civilized lands rather than to explain
the causes. It may be remarked, too, that children and women are the
ones who suffer the most. The 'man has to have the greater and best part
of the food supply, because he is the wage earner, and if he were not fed,
however inadequate and ill chosen his food might be, he would not be
able to work at all.
Accordingly, it may be taken for granted that, in civilized countries
the world over, a goodly portion of the inhabitants are underfed; that
this state of malnutrition is of various degrees of severity ; that it is most
prevalent in industrial countries, and that women and children suffer
the most.
Underfeeding may also occur when the diet is normal, but the amount
of work done is excessive.
Chronic or Habitual Underfeeding. Chronic or habitual underfeeding
is more injurious to the health than eating to excess. Attention has
already been drawn to the fact that underfeeding is quite as much due to
UNDERFEEDING 147
the lack or deficiency in amount of one important constituent, as to
lack of quantity. It is natural for a hungry person who has little to
spend to prefer a bulky food possessing hardly any nutritive properties to
a more concentrated and highly nutritious product. An individual also
is largely governed by custom and taste. If she, for the woman is usually
the buyer, likes tea and bread and butter and a bony herring, a form of
diet to which she and her children have become addicted by long custom,
these are articles in which she will invest her few cents. Therefore, it
is the absolute truth that malnutrition is caused quite as often by an ill-
balanced diet as by lack of quantity.
It is almost unbelievable how long a person can live without food,
provided that water is obtainable. Professional fasters have frequently
existed for 40 days and even longer with no sustenance except some water,
and lunatics have been known to refuse food for four or five weeks at
a stretch, all of which seems to show that starvation may be borne with
a considerable degree of impunity. In this connection, although not
exactly bearing on the subject under discussion, it is interesting to know
that the sensations of starving persons are not particularly unpleasant.
In the popular mind prolonged starvation is associated with great pain
and distress, in spite of the denials of those who have undertaken starva-
tion voluntarily. Such persons, almost without exception, have stated
that, after the first three or four days of starvation, the sensation of
hunger is no longer felt, or, at any rate, is not excessively painful or
uncomfortable. It has been demonstrated by experiment, that it is only
when the weight of the body has fallen to one-half or one-third of its
original weight that death from inanition ensues. When dealing with
cases of acute disease, when nourishment cannot be administered by the
mouth, it is well to remember these facts. According to Hutchison(lO),
physicians not infrequently may be inclined to flatter themselves that they
have kept a patient alive by rectal feeding, when as a matter of fact the
patient has been subsisting on the reserve supply which has been stored
up for an emergency of this character. He has, indeed, been living on
himself or from his own tissues. One need not be unduly alarmed if a
well-nourished patient is unable to take any food at all for a few days.
The "factor of safety," his reserve supply, discussed on the previous
pages on overfeeding, will in a large number of cases be able to tide him
over the time of stress without any special injury to his health. An ill-
balanced diet is one of the main causes of chronic malnutrition. Nitrogen
being the element of which the body is mainly built up, it would seem
that a lack of protein in the food would be more injurious than a
148 OVERFEEDING AND -UNDERFEEDING
cient supply of carbohydrate or fat. The question of the protein intake
has been considered in Volume II, Chapter V.
Suffice it then to say, with regard to too small a supply of protein in
a diet otherwise sufficient, that, according to Rechenberg(ll) and von
Noorden, it is certain that in cases where the diet is full a moderate
diminution in the protein acts less harmfully than a free supply of pro-
tein with a caloric deficit in the dietary. In the latter case, the body
goes on losing fat continuously and finally also protein ; in the former the
loss in protein does not go beyond a certain limit. The protein in
requirements may be reduced to a comparatively marked extent without
harm ; the caloric value of the diet, on the other hand, cannot be lowered,
or only very slightly. Von Noorden goes on to say that it is by no means
permissible to explain any lowering of nutrition or of muscular strength,
such as may occur in certain classes or among people living under
unfavorable social conditions, as exclusively brought about by the small-
ness of the protein intake. Many, perhaps most, observers, do not agree
with von Noorden as to this point, and Hutchison expresses the most
widely held views when he says that an insufficient supply of protein
leads to imperfect tissue repair, more especially, perhaps, of the muscles
and blood ; that it causes the body to become unduly watery, whence the
pallor and puffiness of the underfed ; and that the combined effect of these
results is to produce a lowering of the power of resistance to unfavorable
influences, including disease. A daily ration of which the protein content
is greatly below the standard of Chittenden (many are of the opinion that
Ohittenden's standard is too low), is much more injurious than a short-
coming in respect to carbohydrates and fat.
Maleficent Sequences of Underfeeding. As the question of underfeed-
ing with its maleficent sequence of untoward effects on body and mind,
appears to hinge largely on the quantity of protein in the diet, and, as
this is the phase of the subject which has given rise to the most strenuous
arguments, protein in its relation to malnutrition, physiologically and
pathologically considered, will be amply dealt with later.
However, before going into the question of underfeeding from the
more scientific point of view, and before attempting to sift the wheat
from the chaff in the dicta of those who have experimented and made
observations on the metabolism of underfeeding, it may be interesting
and perhaps instructive to discuss these features from a wider aspect.
The effects of insufficient and injudicious feeding are manifest on all
hands. The mind, the body and, if the term is allowable, the spirit, are
injuriously influenced by innutritions and insufficient food. The person
UNDERFEEDING 149
who is ill- fed deteriorates in all respecls. I'nderfeeding is not the sole
cause, but it is an extremely powerful contributory cause.
With regard to both mental and physical deterioration brought about
by an insufficient and ill-balanced food supply, perhaps the most complete
and convincing evidence was afforded by reports concerning prison expe-
rience in this direction published in 1898 in England. An especial sting
was given to these reports, because they were partially confirmed at the
time by the gruesome and powerful "Ballad of Reading Gaol/' written
by that unfortunate genius, Oscar Wilde. The Parliamentary Committee,
two of whom were in the prison service, who were appointed to report on
the alleged insufficient feeding of prisoners and who were certainly not
biased against the existing system, after a searching inquiry stated that
the diet was inadequate for the labor on which the prisoners were
employed, that the breakfast and supper meals of male convicts were
insufficient, while the element of fat in the dietary was deficient and
more variety of food was desirable. It will not be contended that ihe low
diet was alone responsible for the breakdown of the health of many pris-
oners. Other influences conducing to a lowering of physical and perhaps
mental resistance must be taken into account, such as the probable physical
and mental degeneracy of a large proportion of the inmates, their monot-
onous and generally unhealthful mode of life, and so on, but it may
certainly be asserted that a diet deficient in quantity and lacking certain
essential nutritive elements was an important factor in rendering the
inmates especially prone to disease. Phthisis in those predisposed to the
disease and according to the most recent views there are few of us who
are not thus predisposed is notorious for attacking those whose vital
resistance is weakened ; and the records of prisons in which the inmates are
habitually underfed fully bear out this universally accepted theory. The
tubercle bacillus appears to find a specially favorable soil in ill-nourished
individuals and the association between an insufficient diet and such
diseases as phthisis and scrofula is so well established that the reiteration
of the facts becomes almost tiresome. Perhaps this is why diabetics, who
live in state of more or less chronic starvation, are so liable to tuberculosis.
Some few years ago the Rt. Hon. Charles Booth and Mr. Rowntree
inquired into and made a report upon the condition of the laboring popu-
lation of England and found that very considerable numbers of unskilled
laborers were poverty stricken and chronically underfed, not perhaps to
such an extent as to cause immediate physical suffering from lack of food,
but yet enough to diminish working power and to lead ultimately to
impairment of health. The power of resistance to infection and to
110
150 OVERFEEDING AND UNDERFEEDING
mental and physical deterioration is sadly impaired in these men and
even more in their families, for it cannot be too strongly insisted upon
that when a man earns woefully small wages, it is the wife and children
who suffer the most, and therefore, in the long run, it is the race and
nation who must bear the brunt of underfeeding.
Large sections of the community in all countries are still habitually
underfed. America, Canada and Australia compare very favorably with
Euopean countries in this respect. The reports from the former lands
with regard to the condition of their working population are not as precise
or as voluminous as those from Great Britain, and consequently it is to
Great Britain that we turn for accurate and full information respecting
social, economic and public health conditions.
Observations on the diet of laborers in Edinburgh showed that it con-
tained an average of 107.7 grams, and an energy value of 3,228 calories,
as opposed to the 3,500 believed to be necessary for a man doing a moder-
ate amount of muscular work. Mr. Rowntree's inquiries into the diet
of a corresponding class in York yielded somewhat similar results, the
protein average being no less than 29 per cent below what is or used to
be regarded as standard requirements. The Edinburgh investigators
(quoted by Hutchison) held the view that in order to improve the dietary
of the laboring classes, the following principles should be instilled into
them: (a) That a diet of tea and bread or of tea, bread and butter is
faulty; (6) that the faults of the tea and bread diet can be corrected by
the free use of meat, eggs, or other animal food, but that this mode cf
correction is expensive; (c) that the faults can also be corrected by the
free use of oatmeal with milk, or of peas and beans, without extra cost.
It has been mentioned once or twice before that the worst effects of
underfeeding fall on women and children, and it is the children who are
the least able to bear deprivation of food, not only from the personal point
of view, but also, and this is the most essential feature, from the national
outlook. Hippocrates was well aware that the lack of food affected the
young most injuriously, as one of his aphorisms runs after this fashion,
"Old men bear want of food best ; then those that are adults ; youths bear
it least, most especially children, and of them the most lively are the least
capable of enduring it." The young need plenty of nourishing food in
order that they may grow up healthy and vigorous, for if a considerable
proportion do not have a diet sufficient and well balanced, they, if they
survive, will come to maturity stunted in physique. If not actually
unhealthy, they will lack vitality and will be rendered peculiarly suscept-
ible to infection, probably deficient in mental attributes and when not
UNDERFEEDING 151
already steeped in crime, at least generally lacking that moral -sense
which serves as a bulwark against crime. Such as these fill our prisons
and asylums ; they are a menace to the community, and their very exist-
ence approaches a national disaster ; they propagate their like and endan-
ger the well-being of a nation. Underfeeding is a prominent factor in
their production and development; the remote results from the health
aspect can only be touched upon. There is no need to elaborate on the
fact already strongly emphasized that underfeeding lays the system open
to the inroads of disease.
Investigations of a searching and impartial character have taken
place into the condition of elementary school children in various parts of
the world, including those attending schools in parts of the Southern
States of this country, and deplorable evidences of physical deterioration
have been revealed. They provide conclusive proof of the blighting
influence of parsimony in nutrition while growth is going on, to say
nothing of diseases and defects, mental and physical. Unfortunately, this
does not only signify a temporary setback, but a lasting damage, for the
manner in which a child is fed at the growth period determines all sub-
sequent development. Dwarfing, permanent dwarfing of one kind or
another, is the consequence of insufficient feeding in early life.
Reference may be made to the effects of insufficient feeding in
diminishing resistance to cold and exposure. Sir John Franklin, in
describing his and his companions' journey ings in the Arctic regions, said
that during the whole of their march they found that no quantity of cloth-
ing could keep them warm while they fasted, but on those occasions on
which they were enabled to go to bed with full stomachs, they passed the
night in a warm and comfortable manner, which signified that the
demand for heat in the body was so great that it could no longer be met
by diminishing loss, but that the deficit had to be made up by an increase
of heat production, that is, by a greater consumption of food.
The influence that inadequate and unsuitable food exerts on the
capacity of the system for withstanding the effects of cold was well
exemplified by certain episodes of the American Civil War, an account
of which has been given by Flint (12).
Chronic underfeeding will sap the vital forces; the powers of resist-
ance of the body will be so undermined that infection will be easily con-
tracted and underfed people will be a danger to their fellowmen inasmuch
as they will provide a fertile agency for the spread of infection.
Its effects in producing liability to disease were illustrated in a strik-
ing way by the outbreaks of relapsing fever and typhus which followed
152 OVERFEEDING AND UNDERFEEDING
the potato famine in Ireland in the early part of the nineteenth century.
Similar results have been observed to follow in the wake of famine
everywhere, notably in India and in China where fever and plague
invariably dog the footsteps of famine. It has also been pointed out by
Hutchison that exposure to infection is specially apt to be dangerous on
an empty stomach, as, for example, before breakfast, a fact which it is
particularly important for members of the medical profession to bear in
mind.
Enough has been said as to the relationship of underfeeding to
disease. The two are most intimately related, and it is an obvious fact*
that the furnishing of cheap and good food is as much of an economic
as it is a hygienic measure.
There is one other phase of the subject in connection with individual
and public health that is worthy of brief comment the bad effect of
chronic underfeeding on the digestive oryans. In all cases of chronic
underfeeding an impairment of organs concerned with the digestive pro-
cess is observed. The truth of this statement may be partly verified in
the case of dyspeptics. The less they eat the less they are able to digest
and the more their nutrition fails. Frequently the most effective mode
of curing their stomach troubles is to insist that they eat more. Unfortu-
nately, so far as the poor are concerned, this remedy is impossible. But
it is an interesting question whether the effect of town life, combined
with poverty or merely ignorance or carelessness in impairing digestive
power, may not be to a certain extent responsible for the habitual under-
feeding so often found in the industrial section of urban districts. In
other words, they may be instances of both cause and effect. A vicious
circle has been established, and the town worker even when comparatively
well-to-do may in many cases be incapable of digesting enough food to
keep him in an ideal state of physical efficiency. This fact was forcibly
emphasized in the early part of 1917 when the author was mustering
officers for several National Guard regiments, passing on their fitness
to enter the Federal service. It was observed that one-third of the young
men coming from the industrial centers showed evidences of under-
feeding. They were 33 per cent undersized, underfed and underweight.
Diverging somewhat from the subject in hand, may not underfeeding
also be a potent cause of drinking? The underfed man, even if he be
poor, feels the want of some stimulating or perhaps narcotic action and
he seeks and finds this spur or Lethe in alcohol. There is a definite
relationship between underfeeding and the consumption of alcohol.
Undoubtedly there is a close connection between underfeeding and
UNDERFEEDING 153
crime. The underfed individual, especially if he or she has been under-
fed from childhood up, is a potential criminal. Again it may be said
that there is no intention to aver that lack of food is the sole cause of
crime, but, on the other hand, it is an always present spur to crime.
Poverty and underfeeding are debasing influences, morally, physically
and mentally, and in the words of Dr. King Chambers (13), "deficient
diet, like all morbid conditions, both corporeal and mental, is a vitiating
and degenerating influence. Famine is naturally the mother of crimes
and vices, not only of such sort as will satiate the gnawing desire for food,
but of general violence and lawlessness, ill temper, avarice, lust and
cruelty."
Underfeeding if not the mother of crime is at least a very near rela-
tion, and if a nation is to be happy and prosperous it is a paramount
necessity that its members shall be well fed. Ignorance has much to
do with underfeeding, and in order to inculcate into the minds of the
mass of the people some elementary truths concerning food values, a
campaign of education should be inaugurated on these lines in every
civilixed country. This has been done in the large industrial centers of
Great Britain and in some of the European countries. The Mothers'
Welfare Associations, which have sprung up throughout the urban com-
munities of Great "Britain, due to the initiative of Dr. Eric Pritchard of
London, teach mothers how to feed and bring up their babies and also
how to feed and bring up their families, including their husbands. With
regard to food values, absolutely exact and definite knowledge is still
lacking, but quite enough is known to enable us to lay down rules as
to the most nutritious and suitable foods for all sorts and conditions of
men living in all sorts of conditions and in any climate.
Metabolism of Underfeeding Some of the recent views dealing with
the metabolism of underfeeding will now be presented.
PROTEIN METABOLISM. Minimum Protein Necessary to Maintain
Nitrogen Equilibrium. Views as to protein metabolism are conflicting,
especially with regard to the question of how much protein is necessary
to maintain health, or, in other words, to maintain nitrogen equilibrium.
The opinions of von Noorden and Rechenberg on this much vexed point
have been stated, and the following (taken from von Noorden) is a table
in which certain experiments in. this direction are noted:
154
OVERFEEDING AND UNDERFEEDING
Remarks
I s 1
s s? ^ s
.s s .ss
03 <U S
-S3 "
bC g s g^ bO
^ r 3 a ,
p-plH t-9 r>
<x>
s
B
Q
I
Tj
1
s
CO
b|
i respective intakes were as follows:
lemperer, Peschel and Glaessner (b)
irscllfield, Chittenden (b), Siven
littenden (a), Caspari and Glaessner (a), Lapicque (a)
xpicque (b)
bu, Voit and Constantinidi
'iiiiuuin, Rumpf, and Schumm, Rreisacher
cs'o -g 2?
3 g a x S?
Q%i3.i' Q
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T-l CO
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oooo-* oqSoppTH
TJH iO OS 00 CO odoiOt^COt^
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AUTHORS
SS : ~~^3
1 1 '^
^J 3 I 1
e S^Q oo o
s ll i ^-^s!
I 1 - 1 ^ 111
J^S O3 D, 03 f< 'S*O
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W O rt W PH OWPQ
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Chittenden (a)
(ft)
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TODERFEE DING 155
Ymi Xoonlen hedges somewhat with regard to the intake of protein
necessary to maintain health and the nitrogen equilibrium by giving, as
his opinion, that in spite of the teaching of Chittenden and others their
doctrines will not attract too many admirers, nor will these doctrines
bring them many adherents, for the majority of men even with the allur-
ing prospect of a prolongation of life or rejuvenation prefer to enjoy the
comforts of this mundane sojourn.
The workman will still take a larger quantity of meat than the
sedentary man. More protein is always taken during severe muscular
work, and there must be a good reason for this. The Vienna scientist
then proceeds to dissect the explanation brought forward by Voit and
finishes by saying that while it is certainly true that, in passing to a diet
poor in protein, the body loses nitrogen at the outset, nevertheless the
total loss is small, and the functional capabilities may not be at all
diminished. If the musculature is kept in good condition by continual
exercise, even if the diet is lowered to less than two-thirds of Voit's
standard, muscular strength and power of carrying out work may be
actually increased. Von Noorden may be, therefore, taken as an advo-
cate of a low protein intake.
E. T. Spriggs(14), the British authority, who has given the question
of diet the most thorough experimental study, sums up the relation of
protein to activity by saying that the bulk of the caloric value required
for muscular work should be supplied by carbohydrate or fat, but that it
is an advantage also to increase the protein in food, and that a diet con-
taining a fair amount of protein is likely to be favorable to an energetic
existence.
Another English authority, Sir James Crichton Browne(15), has
pointed out that even if it should be fully established by experiments
more extended and varied than those of Chittenden, that nitrogen
equilibrium can be maintained on a much smaller amount of protein than
has hitherto been supposed, there would still be a question as to whether
it would be wise and prudent to adopt the minimum amount as the rule
of life. With a low protein supply the organism may have to adapt itself
to its situation under conditions of strain. It has a large power of
adapting itself to circumstances, but that power may be overtaxed. Let
it be granted that the average amount of protein food now habitually
ingested does considerably exceed the quantity required to maintain at
an exact point metabolic equilibrium, it does not follow that it should be
lowered to the point at which, according to laboratory observations,
metabolic equilibrium stands steady. Metabolic equilibrium is never
156 OVERFEEDING AND UNDERFEEDING
steady or at a fixed point. It varies in different individuals and in the
same individuals from hour to hour, and it is always safe to allow a
margin, and a broad margin.
This writer contends that not only is protein starvation manifested
in diminished resistance to bacterial invasion, but in a general lowering
of bodily tone, and in debility which may be traced to diminished metab-
olism, owing to the withdrawal of the stimulus to it which alimentary
principles of the protein class supply. Benedict (16), too, traverses
Chittenden's results and concludes that permanent reductions of protein
intake are decidedly disadvantageous, and not without possible danger.
The relationship of a small protein intake, then, to underfeeding has
been by no means made clear. Some assert and seem to have proved
their assertion by careful experiments that a low protein intake has little
to do with underfeeding. At least they state that a man can thrive and
perform really hard labor on a diet the protein constituent of which
would have been regarded only a few years ago as ridiculously inadequate.
Others hold that, while most people were and are accustomed to ingest
too much protein, the standard laid down by Chittenden and those who
hold his views is too low. Still others, like Sir J. Crichton Browne,
claim that a very considerable protein intake is necessary for the conser-
vation of good health, and especially in the case of laborers and those who
take a good deal of heavy exercise.
The author is among those who are not extremists and is of the
opinion that a fair amount of protein should be taken by persons who per-
form manual labor and carry on their work in the open air. Therefore,
a small protein intake is a factor of some moment so far as underfeeding
is concerned. Underfeeding in the ordinary circumstances of life occurs,
as a rule, from an insufficiency of nitrogen-free substances, generally
associated with a diminution of protein.
In all cases in which underfeeding is persisted in for long periods,
it is associated with a smaller or greater loss of protein. Hirschfield (17),
Kumagawa(lS), R. O. Neumann(19).
Neumann supplies the best example commencing with an insufficient
diet. He very gradually raised the protein and energy intake until he
arrived at nitrogen equilibrium. For thirty-five days or longer he kept
on the insufficient diet.
The following table, taken from von Noorden, showed the conditions
that existed:
UNDERFEEDING
157
TABLE SHOWING EFFECT OF INSUFFICIENT DIET WITH GRADUAL
INCREASE IN ALIMENT UNTIL NITROGEN EQUILIBRIUM WAS
ESTABLISHED
SERIES
Dura-
tion in
Days
INTAKE
Cal.
per
Kg.
NITROGEN BALANCE
Differ-
ence in
Weight
Weight
at
Outset,
Kilo.
N
Pro-
tein
Gal
Daily
Of the Whole
Series
1
2
3
4
5
10
12
8
5
15
S.02
9.07
11.24
12.70
12.23
51
57
70
79
76
1,535
1,599
1,909
1,037
2,659
23
24
29
30
40
-2.81
-3.11
-2.11
-2.76
+0.22
-28.1
-37.3
-16.9 -96.1
-13.8
+ 3.3
+0.0
-0.9
-0.1
-0.5
+ 1.3
-1.5
67.0
67.0
66.1
66.0
65.5
66.8
Aver-
age
50
10.56
1,987
30
-92.8 (!)
-0.2 (!)
66.1
The striking' fact to be gathered from Neumann's experiments is that
in the fifty days, with an average intake of 10.5(5 grains nitrogen and
1/JS7 calories, he lost !).'5 grams nitrogen, and at the same time showed
a loss of only 2 kilograms in body weight.
The next table shows a series of experiments exhibiting the different
amounts of protein requisite for the organism, as well as for the energy
intake. G. Kenvall(20), the results of whose experiments are here given,
had a different end in view from Neumann, but used the same methods
to carry out his experiments. His experiment was also of long duration :
TABLE SHOWING EFFECT OF INSUFFICIENT DIET GRADUALLY IN-
CREASED UNTIL BROUGHT UP TO BODY REQUIREMENTS 1
INTAKE
NlTROGENBALANCE
SERIES
Dura-
tion in
Days
Differ-
ence in
Weight,
Kg.
Weight
Kg.
N
Cal.
Cal.
per Kg.
Daily
Of the
Whole
Series
1
8
12.1
2,062
29
-5.34
-42.7
-1.5
71.1
2
7
13.7
2,617
37
-2.66
-18.6
-2.0
69.6
3
4
6
5
16.1
22.7
2,843
3,783
42
56
-2.74
0.14
-16.4
0.7
-0.4
-0.0
67.6
67.2
5
3
21.2
3,577
53
-2.47
-14.8
-0.0
67.2
67.2
Average
32
16.5
2,889
46.2
-2.9
-91.8
-3.9
68.2
i Taken from von Xoordim.
158 OVERFEEDING AND UNDERFEEDING
Neumann and Renvall each lost about 92 to 93 grams nitrogen in
five to seven weeks, the former on a diet which would be considered barely
sufficient under most circumstances, the latter upon one which would cer-
tainly be regarded as rich, and yet the former maintained his weight
almost unaltered. According to von Noorden, he must have stored water,
because in his opinion he could not have stored before the beginning of
the experiment quantities of intracellular protein to account for so slight
a loss of weight. Renvall lost flesh, some water and probably fat.
In the table on the opposite page (taken from von Noorden) are in-
cluded other series of experiments.
All the experiments noted in the above table were carried out on the
investigators themselves, who were working under practically identical
conditions. The difference in the amount of nitrogen and in the protein
and energy intake necessary to maintain equilibrium is remarkable and
goes to show how greatly such variable results are due to the individual
organism.
Chemical Decomposition of Protein Tissue. It used to be the almost
invariable custom to regard every sign of protein breaking down in
disease as dangerous, and protein decomposition in the tissues as the
origin of all grave symptoms. As a matter of fact, protein breaking down
in disease is still looked upon as menacing. Von Noorden, however,
thinks that in many cases this is a false conception. He is also of the
opinion that the significance which is often attached to the products of
the chemical decomposition of tissue protein is erroneous. There is no
space to deal with the German authority's arguments against these long
held beliefs, and it will be sufficient to say that in his opinion the strongest
evidence against the doctrine that protein losses constitute a grave menace
in disease is that in the most perfect health tissue protein breaks down.
Pathology of Metabolism of Starvation. It is very evident that a knowl-
edge of the metabolism during fasting is of the first importance from the
outlook of physiology and pathology. Experiments upon fasting animals
and men have brought out many momentous facts, while pathology has
to do with diseased persons who are starving or nearly so. There are
two kinds of fasting: acute starvation and chronic starvation or mal-
nutrition. The former type has been most extensively studied, but the
pathology of its metabolism is still incomplete.
To deal with the pathology of metabolism of starvation or chronic
malnutrition exhaustively would take more space than can be given to it
in this work. Nor, perhaps, would much be gained by so doing, since
opinions on some of the more important points have not crystallized, and
UNDERFEEDING
159
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OVERFEEDING AXD UNDERFEEDING
experiments on chronic malnutrition have been inadequate for many
obvious reasons. The object of this treatise will be to discuss some of
the more salient points in regard to the subject.
As to the consumption of energy on the complete withdrawal of food
during the first days, according to most authorities, the general metab-
olism suffers no diminution. The sum of the investigations gathered
from experiments on fasting men give general values of 22 to 25 calories
per kilogram per day as the mean minimum conversion of energy while
fasting during complete bodily rest. The expenditure of energy during
starvation diminished in the same proportion as the weight of the body.
The fasting man lives upon protein and fat, except during the first few
days, while his muscles and liver still contain glycogen. The respiratory
quotient at times fell below the theoretical minimum 0.7.
Pembrey and Spriggs(21) record that in rats, during fasting, the
respiratory exchange quickly reaches a minimum, and remains almost
constant during the prolongation of the fast.
CONSUMPTION OF ENERGY IN CHRONIC MALNUTRITION. With regard
to consumption of energy in chronic malnutrition, experiments are few
and inconclusive. It seems that certain individuals are able to exist
with a particularly low consumption of energy. Von Noorden believes
that even in chronic malnutrition, the minimum amount of energy
required by persons who are bedridden or who are indoors and do little
bodily work does not fall below 30 to 32 calories per day per kilogram.
The following are Rubner's figures for a dog whose consumption of
energy was investigated for three years :
TABLE SHOWING DIMINISHING CONVERSION OF CALORIES PER
KILOGRAM ACCOMPANYING PROGRESSIVE LOSS OF FLESH
Variations in
Weight,
Kilogram
Mean Weight,
Kilogram
Average Conver-
sion of Calories
Average Conver-
sion of Calories
per Kilogram
8.01-6.84
6.94
432.1
62.3
6.66-6.33
6.45
371.8
57.6
6.27-5.80
6.09
332.0
54.7
PROTEIN METABOLISM IN ACUTE STARVATION. The protein metab-
olism of man during acute starvation has often been investigated.
Fasting persons habitually drink water in small quantities. After the
first day, or perhaps after the first two days, the standard loss of nitrogen
TINT).K R FEEDING 161
inav be taken as 10 to 1*5 grams for the next week or ten days. The loss
of nitrogen according to Pransintz(22) is relatively greater in the thin
than in the fat. The nitrogen excretion of fasting women is from 20
to 30 per cent less than that of fasting men. The protein decomposition
is relatively large at first, and usually sinks somewhat sharply as the
starvation proceeds.
Figures show how the organism spares its protein when it is ill fed.
Chronic malnutrition is not characterized by a small nitrogen excretion,
but the output of nitrogen depends essentially upon the preceding diet.
In chronic malnutrition but little urinary nitrogen is usually found.
Von Noorden is not an advocate of protein feeding and claims that pro-
tein cannot prevent the loss of power in underfed people and he concludes
that in heat-value starvation a protein-rich diet does not protect the tissue
protein from being consumed. According to von Noorden our present
knowledge of the decomposition of protein in chronic underfeeding is as
follows :
1. After prolonged malnutrition the decomposition of protein is grad-
ually lessened ; more of the tissue protein is lost in the earlier than in the
later stages. Analogous are cases where the demand for heat is met fully
while only the protein intake fails to reach the required level. Loss of
the body protein does not necessarily follow in such cases. Nitrogen
equilibrium can be maintained upon a protein decomposition far smaller*
than that which usually obtains, as, for instance, on a daily excretion of
from 6 to 10 grams of nitrogen in the urine and feces. But generally it
is only weak persons who illustrate this possibility, and the question
may properly be asked whether a larger protein intake would not bring
them more nearly to their optimum of nutrition and strength.
2. Long continued underfeeding, apart, perhaps, from minute and
hitherto unproven degrees of caloric deficiency, invariably leads to loss
of body fat as well as to loss of tissue protein, whether the supply of
food protein is large or small. Only the absolute extent of nitrogen
excreted varies with the latter factor; the establishment of a nitrogen
balance is independent of its duration. A diet of low heat value but rich
in protein can diminish, or even for a time postpone, the loss of nitrogen,
but in the long run the result for human beings will be the same as if
all the components of the diet were diminished. If the heat value of the
food be continuously inadequate, an increase of protein will perhaps put
a stop to the loss of nitrogen from the body for the time being, but, in
man, a moment comes when further increase of the food protein in the
diet becomes impracticable. In these circumstances the tissue protein
162 OVERFEEDING AND UNDERFEEDING
can only be maintained by adding nitrogen-free constituents to the diet
in order to satisfy the demand for heat
3. At present no exact quantitative measurements of the relations
between the caloric deficit and the loss of body protein in chronic under-
feeding are extant. The loss is unexpectedly small in some cases, in
others surprisingly large.
4. Whenever a poorly nourished individual receives an increased
amount of food, so that the deficiency of heat is decreased, an effort is
made to retain nitrogen and repair the loss of cellular material that has
occurred. This retention of nitrogen goes on until the body has
readjusted itself to its new conditions of nutrition. Then the loss of
nitrogen begins anew unless the calories required have been adequately
supplied. The influence of starvation or chronic malnutrition upon the
digestive organs is that their activity is lowered although not uniformly.
Malnutrition leading to extreme loss of body weight does not invariably
stop the production of hydrochloric acid.
SECRETION OF BILE. There is less secretion of bile during fasting
than when the diet is full, but it is never entirely absent. The quantity
of bile secreted is diminished but it is usually more concentrated. The
glycogen in the liver is consumed rapidly, at first, but more slowly as the
fasting continues. F. Muller(23) found that during starvation the
feces contained hardly any soluble protein, but a relatively large propor-
tion of nuclein. The excretion of fat amounted to 1.21, 0.57, and 1.14
grams a day. About half consisted of neutral fats and cholesterin, the
other half being composed of free fatty acids and soaps. The absorbing
power of the intestine, according to many German authorities, does not
diminish in consequence of prolonged malnutrition. This is an important
point with regard to dietetic treatment in connection with the evacuation
of feces. A certain amount of putrefaction is said, to go on in the
intestine during the withdrawal of food despite the fact that no protein
reaches the intestine.
THE BLOOD. In chronic malnutrition the percentage of water in the
blood is maintained approximately at the normal level.
During starvation the leukocytes are diminished in number.
THE URINE. During starvation the average amount of urine remains
sub-normal. In cases of chronic underfeeding the conditions vary greatly
so that no fixed rules can be laid down.
During acute starvation protein is often found in the urine, though
mostly in minute quantities. Clinical experience shows that a moderate
degree of chronic underfeeding does not commonly lead to the appearance
UNDERFEEDING 163
of more albumin in the urine than may be present normally. The case is
altogether different when marked and protracted malnutrition is met
with. In such instances, alburninuria, transient or lasting, is the rule,
^lild glycosuria has been observed in a few fasting experiments and
chronic underfeeding but is probably not directly responsible for any
form of diabetes.
Conclusions. The above brief review of the metabolism and patholog-
ical metabolism of starvation and chronic underfeeding is necessarily
incomplete and does not profess, as stated in the introductory remarks,
to do more than give a few of the more important facts. From the
experimental aspect of underfeeding, no very definite conclusions can be
drawn, that is, conclusions of practical value. Among those who have
studied the matter in laboratories somewhat wide difference of opinion
exists with regard to important points. Animal experimentation is
fallacious, or at any rate not to be entirely depended upon in drawing
conclusions applicable to man. Experiments on those in a condition of
chronic underfeeding are few and far between except in cases of disease,
in which conditions are not analogous. Fasting experiments are valuable,
but a person fasting is not in the same condition as one who is chronically
underfed and consequently experiments as to metabolism on fasting per-
sons are not wholly reliable.
It is true that the application of the experimental method has yielded
and will yield, as science progresses, some insight into the general prin-
ciples which govern the nutrition of the body.
Upon food depends not only life itself, but the power to work and
to resist disease. An ill-fed people are a backward people, and an
unhealthy and a degenerate people. From the vegetable world innumer-
able examples can be gathered to illustrate the great effect of food
variations upon growth and development. In a good soil a plant will
evolve in a marvelous manner. On the other hand, a bad soil will yield
a poor growth. The most striking example of the effect of food upon
development in the animal world is afforded by the queen bee, which
grows from a larva in all respects similarly to the working bee, but owes
her superior growth to the fact that, different from the rank and file of
the Itee tribe, she is assiduously fed on a rich diet.
There are two or three points which the author desires to emphasize
with regard to underfeeding. The first is that chronic underfeeding is
prevalent even in this country and that it is more due to ignorance than
to poverty. The poor do not know anything about food values and, more
often than not, buy foods which constitute not only a comparatively
164 OVERFEEDING AND UNDERFEEDING
innutritions but an ill-balanced diet. Education is needed in this
direction.
Another point is that scientific experiments cannot wholly determine
food values. In the experience of mankind with regard to diet, there
are spread out before us the results of the experiments of ages, and we
must be quite as greatly influenced by such experiments as by laboratory
investigations. The experiments of ages have demonstrated that man
can live a healthy life under dietetic conditions of great variety. It is
not wise to be bound by the teachings of one system or another. By
studying in an open-minded manner the teachings of experience together
with the results of scientific experiments, we shall be able to formulate
dietaries suitable for conditions of health and disease. It is with these
principles that the problem of underfeeding should be met.
REFERENCES
1. THOMPSON,, SIR HENRY. Food and Feeding, p. 64.
2. ZUNTZ. Sind Kalorisch Aquivalente Mengen von Kohlenhydraten
und Fetten fiir Mast und Gutfettung Gleichwertig ? Therap.
d. Gengenw., 1901.
3. RUBNER. Gesetze des Energieverbranches, 1902.
4. VON NOORDEN. Pathology of Metabolism.
5. HOWEKL. Handbook of Physiology, 1915.
6. ROSENFELD. Ergebiiisse der Physiologic, 1902, vol. i, part i.
7. ZITNTX, SCHUMBITRG, U. Phys. des Marsches, 1901.
8. KRAUS. von Noorden's Pathology of Metabolism, Fever and
Infection.
9. SVENSON. StofTwechselversuche an Rekonvaleszenten, Zeitsch. f.
klin. Medi., 1901.
10. HUTCHISON. Food and Dietetics.
11. RECHENBERG. Ernahrung der Handwiber, 1890.
12. FLINT. Physiology of Man, New York, 1867, p. 35.
13. CHAMBERS, KING. Manual of Diet in Health and Diseases, 1876,
2nd ed., p. 223.
14. SPRIGGS, E. T. Sutherland's System of Diet and Dietetics.
15. BROWNE, SIR JAMES CRICHTON. Parsimony in Nutrition.
10. BENEDICT. Am. J. PhysioL, 1906, p. 409.
17. HIRSCITFIELD, F. Zur Ernahrungslehre d. Mensch., Arch. f. path,
anat. u. Physiol., 114, 301, 1889.
REFERENCES 165
18. KUMAGAWA. Ernahr. mit genuscht. u. rein vegetabilis Rost.
Arch. f. path. anat. u. Physiol., 116, 370, 1889.
19. NEUMANN. Taglich Eiweissbedarf des Menchen, Arch. f. Heil-
kunde, 45, 1, 1903.
20. RENVALL, G. Und Nig-Umsatz beim erwachsenen Mensch., Skan-
dovischer Archiv. fal Physiol., 16, 94, 1904, p. 101.
21. PEMBREY AND SPRIGGS. Metabolism in Fasting and Feeding, Jour.
Physiol., vol. 31, p. 343, 1904.
22. PRANSINTZ . Zur Eiweissersetzung des hungernden Menschen,
Miinch. med. Wchnschr., 1891, p. 319.
23. MUI/LER, F. Untersuchnngen an zwei hungernden Menschen, Arch.
f. path. anat. u. Physiol., 131, suppl., 1893.
ill
CHAPTER VII
PROTEIN AND NUTRITION
The discovery of a new dish does more for the happiness of humankind than
the discovery of a new star.
Nature of Protein; The Protein Poison.
Metabolism cf Protein: Deaniinization of Proteins in Amino-Acids; Catab-
olism of Proteins.
Effect of Protein Diet on Health and Endurance: High Protein Diet;
Low Protein Diet; Chittcnden's Investigations, Fisher's Investiga-
tions, Haelt/'s Investigations among Japanese, Other Foreign Nations
Non-Meat Eaters.
Standard of Protein Requirement in Dietary.
High versus Low Protein Diet: Protein Diet and the Xitrogen Equilibrium;
Reduction of Protein Diet Necessary; Effect of Increased Nitrogen
Diet on the Kidneys; Effect of Protein Diet on Strength and Endur-
ance; Effect of Low Protein Diet on Animals; Protein Diet and
Occupation: The Amino-Acid in Animal and Vegetable Proteins;
Minimum Protein Requirement to Maintain Nitrogen Equilibrium;
Safety Standard in Diet: Caution as to Protein Deficiency, Overfeed-
ing, Underfeeding, Ill-Effects of Absorption of End-Products of Pro-
tein Digestion.
Protein Structure and Properties: Chemical Formation of the Protein
Fractions; Quantitative Differences of Proteins, Qualitative Varia-
tions in the Amino-Acids of Proteins; Physical Properties of Proteins;
Relative Absorption of Proteins; Differences in Suitability for Tissue
( '(instruction.
Theories of Protein Metabolism.
Nature of Protein During the past few years a revolution has taken
place in our conception of protein metabolism, and we should all be
proud of the fact that our own country has furnished its full quota of
newly discovered facts upon which our present knowledge is based.
While studying the physiology of digestion (see Volume I, Chapter
VII), we learned that, among the building material employed for the
construction of the living organism, the proteins hold a place apart, and
we also learned that protein is absorbed only after being largely or com-
pletely broken down in amino-acids, which are then rebuilt into the
protein organism.
167
168 PROTEIN AND NUTRITION
The conception of the structure of a protein molecule is of special
importance not only in the study of protein metabolism, for which we
are to use it here, but also in enabling us to grasp the almost unthinkable
varieties in which protein exists, without there being, in many instances,
any outward chemical reaction or physical property by which one protein
can be distinguished from another. It is interesting to note, however,
that differences -in structure which are too slight to be recognizable by
any ordinary chemical tests may become very apparent upon minute
biological examination when we proceed to observe the behavior of an
animal into whose blood some of the protein is directly injected. It is a
well-known fact that symptoms of varying severity develop, from the
almost instantaneous death produced by snake venom to the slowly
developing anaphylactic reactions which follow the injections into the
blood of many proteins that are chemically indistinguishable from those
of the blood itself.
The Protein Poison (Protein Absorption). Vaughan and Wheeler in
1903 found that the cellular substance of the colon bacillus (1) contains
a highly active poison and that a closely related or similar poison could
be obtained from other pathogenic and non-pathogenic bacteria and from
vegetable and animal proteins. It is not found in gelatin. The symp-
toms induced by this poison in guinea pigs are, first, peripheral irrita-
tion, such as an urticarial rash ; second stage, partial paralysis, with
rapid and shallow breathing, and, third or' convulsive stage, that which
begins as isolated clonic movements and finally becomes general, involv-
ing all the muscles of the body; with fatal doses there is a progressive
fall of temperature. Kemp (2) points out that small doses administered
subcutaneously in animals produce fever and that various types of fever
may be stimulated by varying the size of the dose and the intervals of
administration. When proteins are acted on by the digestive juices, the
product becomes poisonous at the peptone stage, and if it were so
absorbed into the circulation, it would be highly injurious, but with nor-
mal digestion . the peptone is broken up into harmless amino-acids. If
proteins, however, enter the blood without being properly changed by
the action of the digestive juices, then they must be digested in the
blood and tissues (parenteral digestion"), and during the process the
protein poison is set free and exerts its deleterious effects on the body.
It is suspected by some that protein has an influence in the production
of the summer diarrheas of infancy, and studies of the protein poison
and protein sensitization have demonstrated how the protein element of
bacteria influences the nature and progress of the infectious diseases.
METABOLISM OF PROTEIN 169
Special idiosyncrasies to certain foods may be explained on the above-
mentioned grounds, as, for example, urticaria, presenting the aspect of
anaphylaxis from absorption of protein. In certain conditions, at least,
protein absorption with parenteral digestion is a iause of protein
poisoning.
METABOLISM OF PROTEIN
Deaminization of Proteins in Amino-Acids. According to E. E. Smith,
who has given the subject most careful study, the simple amino-acids(3)
formed in the intestinal tract from protein breakdown, so far as we know,
are absorbed as such and carried through the blood stream to the various
tissues of the body, where they meet their fate. They are not absorbed
with the same readiness, but there is apparently a decided selective action,
both as to the particular amino-acids absorbed and as to the quantity.
When they reach the tissues there is a recombination not to form the
protein originally ingested, but rather to form the proteins of the par-
ticular tissues. Protein resynthesis, not in absorption, but by the indi-
vidual tissues to which the amino-acids are brought by the blood stream,
must be regarded as sufficiently established to be accepted as a working
hypothesis. In this way a certain portion of the absorbed amino-acids
is utilized. A certain other, and usually a relatively large, portion, not
needed for protein resynthesis, undergoes a different change. Instead
of entering into constructive metabolic processes, it undergoes catabolic
transformations.
Catabolism of Proteins. When proteins are introduced directly into
the blood, parenterally, as we say, they act as a foreign substance and
may be eliminated more or less unchanged by the kidneys, giving rise
to albuminuria; may pass into the bile, thereby reaching the intestinal
tract, where they are digested; may pass directly into the alimentary
tract through the intestinal walls; or finally may be split by enzymes
elaborated by body cells.
Sensitization to a given protein is developed as the result of the
introduction of the protein into the blood and is specific to each protein.
When it has once been developed, the subsequent introduction of the
particular protein into the system is followed by the phenomenon of
nnaphylaxis.
EFFECT OF PROTEIN DIET ON HEALTH AND ENDURANCE
High Protein Diet. In overfeeding of a particular protein, a condi-
tion may be produced that is entirely similar to the protein sensitization
170 PROTEIN AND NUTRITION
that follows the introduction of protein parenterally. Perhaps this has
been most clearly observed in the forced feeding of eggs, especially to
the young, though it 13 not uncommonly seen with a particular form of
fish feeding, notably shellfish. Frequently, too, this has been observed
with meats, and least commonly with vegetable proteins, presumably
because of the less concentrated form of the latter and their slower
transformation into soluble protein in digestion, though in individual
instances particular vegetable proteins have produced the condition to a
marked degree. Probably few physicians have failed to recognize at
least some of the more marked cases of this kind, and probably few have
often failed to overlook most of the less marked cases.
Following an instance or period of overfeeding, there appears a con-
dition of intolerance to the protein in question, which is manifest when
the particular protein is again ingested by certain rapidly developing
symptoms, perhaps the most constant of which is an urticaria, apt to be
generalized in extent with intense itching, frequently dyspnea, sometimes
muscular incoordination and often symptoms of gastro-intestinal irrita-
tion. It is probable that angioneurotic edema is in some instances, at
least, a manifestation of protein sensitization. It is a question for con-
sideration to what extent active protein is the absorbed material and to
what extent the protein is absorbed as proteose. Where the urine
shows the elimination of unchanged protein, we may well believe that
the offending material is native protein; and where the urine is found
to contain the foreign protein as proteose, we must at least give serious
consideration to the possibility of the protein having been absorbed as
proteose, though even there it must be recognized that the native protein
may have been transformed into protein after absorption, since it is the
tendency of the tissues to bring about this change.
We may well question whether urticaria following food ingestion is
always to be regarded as an anaphylactic manifestation or whether it is
not at times produced by a different type of gastro-intestinal toxemia.
When, for example, we regard the toxemia following the ingestion of
strawberries, we have a condition well explained from most points of
view by the theory of protein sensitization ; but we have to face the fact
that strawberries are not rich in protein and that, therefore, the sensi-
tization, if present, has been produced without rich protein ingestion.
Evidently some further knowledge is required before the pathology of
susceptibility to strawberries can be unequivocally regarded as coming
within this category.
Recently, the theory of protein sensitization has attracted attention
EFFECT OF PROTEIN DIET 171
and in some instances is charged with the faults that have heretofore
been explained by chronic intestinal toxemia of bacterial origin. It is
a matter for the future to decide to what extent toxic manifestations are
to be referred to the absorption of proteins, to products of bacterial
synthesis of the digestive products of food proteins. At the present time
the evidence already at hand as to the part played by bacterial decompo-
sition is not to be ignored (4).
Low Protein Diet CHITTENDEN'S INVESTIGATIONS. Prof. Chitten-
den, of Yale University, in November, 1902, began an experiment upon
himself which he has recorded. At this time he was forty-seven years
of age and weighed 143 pounds(5). He says that, accustomed to eating
daily an amount of food approximately equal to the prevailing dietary
standards, he recognized that his habits of living should not be too suddenly
changed, so a gradual reduction was brought about in the amount of pro-
tein or albuminous foods he was accustomed to ingest. Within the course
of a month or two this gradual decrease in proteins reached complete abo-
lition of breakfast, except for a small cup of coffee. A light lunch was
partaken of at the noon hour, followed by a heavier dinner in the early
evening. Occasionally, however, the heartier meal was partaken of at
the noon hour, as his appetite suggested. It should be added that the
total intake of food was gradually diminished, as well as the protein
constituents. There was not, however, a change to a vegetable diet, but
a simple introduction of physiological economy. The goal to which his
attention was directed was the exclusion of meat in some measure, the
appetite not calling for this form of food in the same degree as formerly.
At the beginning, he confesses that this change to a smaller amount
of food daily was attended with some discomfort, but gradually passed
away, and his interest in the subject was increased by the discovery that
he was unquestionably in improved physical condition. A rheumatic
trouble in the knee joint, which had persisted for a year and a half, and
which only partially responded to treatment, entirely disappeared. Minor
troubles, such as sick headaches and bilious attacks, no longer annoyed
him periodically, as in the past. He experienced greater appreciation
of such food as was eaten and possessed a keener appetite. A more acute
taste appeared to be developed and a more thorough liking for simple
foods. According to his report, by June, 1903, his body weight had
fallen to about 128 pounds.
In speaking further of his experience, he says that during this sum-
mer the same simple diet was adhered to: a small cup of coffee for
breakfast, a fairly substantial dinner at midday, and a light supper at
172 PROTEIN AND NUTRITION
night. The next two months he spent at a fishing resort in northern
Maine. Part of the time he dispensed with a guide and rowed his own
boat, frequently six to ten miles in the forenoon (against head winds),
without breakfast, and with much greater freedom from fatigue and
muscular soreness than previously on a fuller protein dietary. On his
return home he weighed 127 pounds. From July 1st he remained con-
stantly at this point, at which it would seem that the body had found
and maintained its equilibrium. In order to determine his nitrogen
equilibrium, he collected each day's output of urine for a period of eight
and a half months. The urine was analyzed every day and the contained
amounts of nitrogen, uric acid and phosphoric acid recorded.
The daily average was as follows: from October 13, 1903, to March
12, 1904, the average volume of urine excreted was 468 grams; the
nitrogen content was 5. GO grams; uric acid, 0.392 gram, and phosphoric
acid, 0.904 gram. It will be observed that the volume of urine excreted
was small, though fairly constant for the whole period. The explana-
tion offered is that on a low intake of protein there is less thirst and
less desire to drink. When nitrogenous waste is reduced to a minimum
there is no need on the part of the body for any large amount of fluid to
flush out the kidneys, while with heavier eating partaking of highly
nitrogenous foods an abundance of water is necessary to prevent the
kidneys from becoming clogged, thereby explaining the frequent bene-
ficial results of the copious drinking of mineral waters, spring waters,
etc., frequently called for after or with heavy eating. It is obvious,
therefore, that a small volume of urine each day means so much less
wear and tear of the delicate mechanism of the kidneys. The low nitro-
gen output of only 5.69 grams, equal to 35.56 grams of decomposed
protein, is very remarkable. Prof. Chittenden affirms that there could
be little doubt that his body was in nitrogen equilibrium and that his
body weight was constant during the whole period. Chittenden, in sum-
ming up his observations, says (6) :
Health, strength, mental and physical vigor, have been maintained unimpaired,
and there is a growing conviction that in many ways there is a distinct improve-
ment in both the physical and mental condition. Greater freedom from fatigue,
greater aptitude for work, greater freedom from minor ailments, have gradually
become associated to the writer's mind with this lowered protein metabolism and
general condition of physiological economy.
Chittenden was fully alive to the necessity of caution in the accept-
ance of his feelings as a measure of physical or mental condition, but he
was keenly watchful for any sign or symptom during the course of his
EFFECT OF PKOTE1N DIET
173
experiments, and is still strongly of the opinion that there is much good
to be gained in the adoption of dietetic habits that accord more closely
with the true physiological needs of the body. Thus he asks:
If a man of 154 pounds body weight can maintain a condition of equilibrium
with continuance of health, strength and vigor (to say nothing of possible im-
provement ) with a daily consumption of, say, 60 grams of protein food, and suffi-
cient non-nitrogenous food to yield 2,800 calories, why should he load up his
system each day with twice this amount of protein food, with enough fats and
carbohydrates to yield 3,500 calories plus?
The result of Chittenden's researches demonstrates that the protein
intake must be a little in excess of protein catabolism, as all of the pro-
tein is not available and as this is a variable amount, depending on the
proportion of animal and vegetable foods to their different degrees of
digestibility and availability. (Miittenden formulates the following table,
showing the amount of food necessary to yield 60 grams of protein :
CHITTENDEN'S TABLE
VARIETY OF FOODS
Protein Content
Fuel Value
in Calories
l /i Ib. fresh lean beef (loin) 60 grams
9 hens' eggs 60 "
-4- Ib. sweetbread 60 "
3 4 11). fresh liver 60
-\ Ib. lean smoked bacon 60 "
% Ib. halibut steak 60
Yt Ib. salt codfish (boneless) 60
2 I Ibs. oysters, solid 60 "
1 ) II). American pale cheese 60 "
4 Ibs. (2 quarts) of whole milk 60 "
5 ^r, Ib. uncooked oatmeal 60 "
IK Ibs. shredded wheat 60
1 Ib. uncooked macaroni 60 "
1 .\ Ibs. white wheat bread 60 "
1 % Ibs. crackers 60
1% Ibs. flaked rice 60
: - ! Ih. dried beans 60 "
\H \bs. baked beans 60
*4 Ib. dried peas 60
I }i Ibs. potato chips 60 "
* 3 "Ib. almonds 60
-?- Ib. pine-nuts, pignolias 60 "
\% Ibs. peanuts 60 "
10 Ibs. bananas (edible portion) 60 "
10 Ibs. grapes 60
II Ibs. lettuce 60
15 Ibs. prunes 60 "
33 Ibs. apples , 60
308
720
660
432
1,820
423
245
506
1,027
1,300
1,550
2,125
1,665
1,520
2,381
2,807
963
1,125
827
5,728
2,020
1,138
3,584
4,600
4,500
990
5,550
9,570
174 PROTEIN AND NUTRITION
Value of Meats as a Source of Nitroyen. Chittenden, in discussing
"the value of meat as food," after declaring that protein food is the
supply of nitrogen needed for the body, asks the question, "What advan-
tages do meats possess as a source of this nitrogen ?" His answer was :
"Meats represent a concentrated form of protein, their nitrogen is readily
available, they are easily digestible, they have an agreeable flavor, they
add variety to the diet, they contain extractives which have an exhila-
rating and stimulating effect, they satisfy the 'pangs of hunger more
completely and for a longer period than do the vegetable proteins.
"There can be no question but that meats occupy a somewhat peculiar
place in the category of dietetic articles. A close study, of the dietetic
customs of civilized people indicates that two distinct objects are ever
kept clearly in view, viz. : the satisfying of the grosser needs of the body,
the needs of general nutrition, and the satisfying of the needs of the
higher functions of the central nervous system. Meats plainly share
with foods derived from the vegetable kingdom the ability to minister
to the former wants of the body, but in addition they have certain stimu-
lating properties which distinguish them from the grosser vegetable foods.
They might also in this respect be classed, perhaps, with such articles as
tea, coffee, etc., in their power of ministering to the wants of the brain
and nervous system. Sir William Roberts has well said that the strug-
gle for existence, or rather for a higher and better existence, among
civilized men, is almost exclusively a brain struggle; and that these
brain foods, as they have been not inappropriately termed, must be
regarded as a very important part of the equipment for that struggle,
for if we compare, with our limited information, the general charac-
teristics of the high-fed and the low-fed classes and races, we would no
doubt perceive a broad distinction between them. In regard to bodily
strength and longevity, the difference is inconsiderable, but in regard to
mental qualities, the distinction is most marked. The high-fed classes
and races display, on the whole, a richer vitality, more momentum and
individuality of character and a greater brain power than their low-fed
brethren, and they constitute a soil or breeding ground out of which
eminent men arise."
FISHER'S INVESTIGATIONS. Prof. Irving Fisher, a co-worker of
Chittenden's at Yale University, lias conducted some interesting experi-
ments emphasizing the effect of diet on endurance (Y). In arranging
the tests, a large variety of food and dishes commonly prepared in that
locality was supplied, and the subjects were particularly enjoined to
masticate 'thoroughly and even to keep liquid foods in the mouth until
EFFECT OF PROTEIN DIET
175
well insalivated and to swallow only in response to almost compulsory
inclination. The subjects for this experiment were nine in number and
the experiment lasted four and a half months. The diet supplied at the
beginning contained 28 grams of protein and had a fuel value of 2,830
calories. "The subjects were informed as to the protein content of the
various articles of food and were requested to eat those foods poor in
protein so long as the appetite evinced no disinclination to them. The
exercises carried out as tests of physical endurance were as follows" :
1. Rising on the toes as many times as possible.
2. Deep knee bending as many times as possible.
3. liaising the legs from the floor to a vertical position as many times
as possible while lying flat upon the back.
The following table will graphically present the mathematical result
of these experiments:
FISHER'S TEST DIET AND ENDURANCE
CALORIES
PROTEIN
Strength
Endur-
Weight
Total
Per cent
Gr.
Per cent
Per cent
ance
Kilos
At the beginning. .
2,830
100
98
100
100
100
68.2
After 1 l /2 months .
2,670
94
82
80
104
133
67.3
After 4 }/2 months .
2,220
78
51
52
93
189
65.5
Fisher's experimental findings are somewhat opposed to those of
Chittenden. Chittenden's experiments evidenced an increase in strength ;
in the Fisher experiments it was endurance of the men which attracted
attention and with proof that endurance was increased, while their
strength varied very little either way.
Fisher carried out some comparative endurance tests between sixteen
meat eaters (students from Yale University) and thirty-two vegetarians
connected with the Battle Creek Sanitarium. The latter had been vege-
tarians from four to twenty years. They not only abstained from meat,
but also from coffee, tea and condiments, and they were also teetotalers
and non-smokers. The endurance tests were as follows:
1. Squatting on the heels and rising thence to upright position as
many times as possible.
2. Holding out the arms fully extended for as long a time as possible.
Tlio results are shown in the following table:
176 PROTEIN AND NUTRITION
FISHER'S COMPARATIVE ENDURANCE TESTS
Meat Eaters
Vegetarians
Percentage of
Difference
Knee bendings
383
846
121%
Holding arms out (minutes) .
10
49
390%
According to the result tabulated above, the standard of meat eaters
is shown as 100, while the endurance of the vegetarians is from 121 to
390, and we may therefore draw the conclusion that strength and endur-
ance have nothing to do with the consumption of generous quantities
of protein, as was formerly a matter of faith. Furthermore, it is an
admitted fact that great endurance is possible on simple food of low
protein value, in support of which we may cite the example of the
Japanese and Arabs.
BAELTZ'S INVESTIGATIONS AMONG THE JAPANESE. Professor Baeltz, 1
a keen observer and one of the best authorities on the Japanese country
and people, says 2 that the people of the lower classes in Japan who
subsist almost entirely on carbohydrate foods are altogether of more
powerful build than those of the upper classes who eat meat. It is well
known to students of dietetics that the Japanese for some thousand years
past have been experimenting with vegetable and cereal foods, and at
the present time the diet upon which the bulk of the Japanese people
subsist is sufficient for the maintenance of an effective nitrogen equi-
librium, as well as to keep them in a state of efficient nutrition. Pro-
fessor Baeltz had two jinrikisha men in his employ, both powerful young
fellows, aged twenty-two and twenty-five respectively, who had followed
their calling for years. They were provided with an accurate amount
of measured food, the chemical composition of which was ascertained by
recognized men. These men received definite instructions: Every day
for three weeks their duty was to drag a jinrikisha with Professor
Baeltz, who weighed 170 pounds, a distance of twenty-five miles, run-
ning all the time. This would seem to be an arduous task, but not more
so than these men would willingly and readily undertake. It would be
considered quite an undertaking to walk a distance of twenty-five miles
every day for three weeks with an August sun at its best, but for these
1 Baeltz was, for some years, body-physician to the late Mikado.
2 Quoted by Dr. Albu in "Die Vegetarische Diitt." Tt should be observed that
Dr. Albu writes against vegetarianism, but concedes that one may subsist on vegetarian
diet, which is proved among other things by Baeltz's observations.
EFFECT OF PROTK1X DIET 177
men to run this distance every day, and to drag a jinrikisha with a
passenger weighing 170 pounds, is rather more than one would usually
expect.
During this experiment the men kept to their usual diet, which con-
sisted of fats amounting to less than the proposed standard enunciated
by Voit(8), while the contained protein fluctuated from between 60 to
80 per cent of his postulate. Carbohydrates were provided in exceed-
ingly large quantities in the form of rice, potatoes, barley, chestnuts,
lily roots and other foodstuffs peculiar to the country. The men were
weighed. One had gained half a pound and the other was the same as
at the beginning. Professor Baeltz now told the men that they would
be allowed a liberal allowance of meat, which quite delighted them, as
meat to them was a luxury. The carbohydrate ration was cut down and
a proportionate quantity of meat not quite as much protein as the Voit
standard, but a considerable amount was allowed. The men ate with
avidity, but after three days on the meat diet they importuned Professor
Baeltz to discontinue the meat and to give it to them only upon con-
clusion of their probation, because they felt fatigued and could not run
so well as they did previous to taking meat. Baeltz then allowed them
to return to their original carbohydrate dietary, with the same result as
before the one retained his weight, with perhaps a difference of 100
grams, and the other gained about half a pound.
Baeltz records an even greater feat of endurance on a smaller diet.
Baeltz was driving from Tokio to Nikko, a distance of about sixty-eight
and a half miles. It was midsummer and fearfully hot, and it took
Baeltz from six o'clock in the evening until eight o'clock the following
morning fourteen hours to make the distance. He says that, just as
he was driving out of Tokio, he saw a Japanese sitting in a jinrikisha
;md asked him where he was going. Nikko was likewise his destination
and he was being pulled along by a man. He arrived in Nikko just half
an hour after Baeltz. Baeltz records that his driver had changed horses
six times, and this Japanese jinrikisha man had dragged his compatriot,
an adult weighing 119 pounds, a distance of sixty-eight and a half miles
at a running pace in about fourteen and a half hours, and on a vegetable
diet only.
It is well known that the Japanese are physically a small people, yet
they are capable of remarkable feats of strength and endurance, and as
recent events have shown, they are full of courage and daring, A
v,riter(9) in the British Medical Journal says: "The Japanese them-
selves attribute their high average of physical strength to a plain and
178 PROTEIN AND NUTRITION
frugal diet, and to a system of gymnastics, jiu-jitsu, which includes a
knowledge of anatomy, and of the internal and external use of water.
In 1889 a commission was appointed to consider whether by a meat
diet or by other means the stature of the Japanese race could be raised ;
but the conclusion arrived at was that, seeing that their feats of strength
and powers of endurance were superior to races mucli taller than them-
selves, the lowness of their stature did not matter. Concerning the diet,
they are frugal to a degree, partaking of rice at every meal. Japanese
troops have often made record marches on diet consisting solely of a
little rice. Vegetables and fruits are grown in abundance in Japan,
and their value as a regular part of the dietary is realized with far more
advantage than it is in this country. Indeed, a laborer is content to
work a whole day on a dinner of tomatoes and cucumbers. Milk is
scarce, because it does not pay to raise cows to produce milk alone, and
the meat is not eaten."
OTHEK FOREIGN NATIONS NON-MEA1 EATERS. According to Sin-
clair, 1 the Hindu pattamars, carriers of dispatches, who eat only rice,
run every day, passing from one town to another, twenty leagues at
least, and continue thus for weeks. Russian agriculturists, who live on
vegetables, black bread, milk and garlic, work sixteen to eighteen hours
per day, and their strength is said often to exceed that of the American
sailors (10). The Norwegian peasants scarcely know of animal ali-
mentation ; they cover, however, whilst accompanying the carriages of
tourists, from three to four leagues, running without stopping. Modern
Egyptian workmen and boatmen, who from time immemorial have fed
almost exclusively on melons, onions, broad beans, lentils, dates and
maize, have remarkable muscular strength (11). The miners of South
America, very sober workmen, who do not eat meat, carry on their shoul-
ders weights of 200 pounds, with which they mount twelve times a day,
on an average, vertical ladders 60 to 80 meters high(12). According
to H. Ranke, the woodcutters of Upper Bavaria feed almost exclusively
on flour (1,100 to 1,200 grams per day) cooked with hogs' lard (90
grams X without eggs or cheese; on Sundays only they have a little pork.
They do, however, an enormous amount of work (13). The Turkish
soldier is extraordinarily abstemious; he drinks only water or lemonade,
feeds on pillauf of rice and figs and scarcely touches meat. We know
that his vigor is remarkable and his courage indomitable.
We might learn a great deal from the Arabs with respect to those
i We extract the majority of the following facts from the interesting work of
Mrs. A. Kingsford (Theses <le Paris, 1880).
EFFECT OK I'ROTKIX DIET 179
diseases which result from excessive meat eating. The French and
Italians have long ago experienced the greatest difficulty in their attempts
to subdue this brave and energetic people. They are of slender build, but
(heir powers of endurance are remarkable. According to Auzimour(14) :
"They are slim and wiry people; their limbs are lithe and strong; their
profile is more curved than straight. They live in tents which are far
from sanitary. The frugality of the Arabs is just as far famed as that
of the camel. Men often go on long journeys into the desert with only
a bag of meal, some figs, a skin of water and some dates. With the meal
the Arab makes his cakes, which, with his dates, are his provision for
the day. They are hardy and resist disease." Dr. Auzimour says, "Ab-
dominal wounds, with perforation of the intestines, heal without the
use of antiseptics when the injured parts have been replaced. Wounds
healing under such circumstances and without consequent blood poison-
ing are a source of wonder to surgeons acquainted only with Euro-
peans. Diseases of nutrition are almost unknown among them; ulcers
and cancer of the stomach are very seldom met with, and if one comes
across a case of summer diarrhea, it is generally because the sufferer has
been eating too many melons. Appendicitis is very rare among the
Arabs, and is entirely unknown among the vegetarian nomads." The
experience of Dr. Auzimour is that Arabs who live in towns and who
eat as Europeans do are no more resistant to these diseases than the
Europeans. W T e are convinced that common stomach troubles and intes-
tinal disorders quite often arise from fermentation caused by putrefying
animal protein, as these complaints disappear like dew under the morn-
ing sun on a low protein diet.
Professor Maurel, of Toulouse, who served for thirty years as army
surgeon in the French colonies, while in the tropics made experiments
in nutrition in consequence of which he has come to the conclusion
that most of the so-called tropical diseases are caused through overeating,
and particularly through excessive meat eating. In his work 011 nutri-
tion (15) he arrives at the following conclusions:
1. "That the majority of digestive disorders (dyspepsia, diarrhea,
dysentery) which are so common in the tropics are partly to be ascribed
to hypernutrition."
2. "That overindulgence in animal foods is largely the cause of the
liver disorders met with in the tropics."
3. "That, finally, the increased richness of blood, which is due to the
absorption of too large a quantity of food, particularly protein food
180 PROTEIN AXD NUTRITION
which he has termed hyperuutrition constitutes a contributory cause of
the fevers so prevalent in our colonies."
STANDARD FOR PROTEIN REQUIREMENT IN DIETARY
In attempting to formulate the standard for the requisite amount of
protein in the dietary, we find no such definite and satisfactory basis for
judgment as in the case of the total energy or fuel value of foods. Indi-
cations are lacking that any kind of work necessarily increases the
expenditure of fuel, or that the body can store up protein to anything
like the extent that it stores up fuel in the form of fat; the feeding of
protein above what is required for maintenance and body equilibrium
increases only slightly the store of protein in the human economy. When
one authority suggests an amount of protein but little above the mini-
mum required for equilibrium, and another advocates a much higher
amount, there is implied a difference of view regarding protein such as
no longer exists with respect to the energy metabolism. The difference,
it is true, is hardly so great as might appear from a casual examination
of the proposed standards (16). According to the standard of Voit,
Plavfair and Gautier, protein contributes about 16 per cent of the fuel
value of food; Atwater's experience suggests about 15 per cent; while
Langworthy puts it at 12 per cent and Chittenden as low as 8 1 /) per cent.
Peschel undertook a personal experiment to determine the amount
of protein necessary for his own body; he weighed 169 pounds. He
was guided by Rubner's work in nutrition which he considered of espe-
cial value, and accepted his data as a working basis: 100 grains of fat,
240 grams of starch, 249 grams of sugar, 770 grams of fresh muscle
flesh free from fat, and that the nutrients could be substituted for one
another for this purpose. Rubner teaches that "growth is a function of
a cell ; it can be rendered latent by insufficient protein, but protein can-
not raise the rapidity of growth above the level set by nature." Pesehel
holds that a certain amount of protein is necessary to repair the waste
of nitrogenous tissue which is continually going on, as well as to make
up for the loss of portions of the epidermis, hair, nails, epithelial cells,
etc. His investigations were undertaken at the suggestion and under
the direction of von Noorden to determine the exact amount of protein
necessary for his body metabolism. He ingested a ration consisting of
bread, rice, potatoes, butter, sugar, tea, etc., but no meat. The analysis
of his ration showed that he was partaking of 40 grams of protein in a
diet which yielded 8,640 calories. On the fifth day he reached his
STANDARD FOR PROTEIN REQUIREMENT IN DIETARY 181
nitrogenous equilibrium, that is to say, he was ingesting sufficient pro-
tein for the needs of the body, and the organism was sufficiently supplied
with carbohydrates and fats. He soon reduced the protein to 32 grams
per day, the caloric value of his ration then being 3,600 calories, but
the organism continued to lose nitrogen on a protein intake of only 32
grams. He therefore concluded that \ r oit's standard for protein was far
above the amount actually needed, provided the organism is well sup-
plied with fats and carbohydrates:
THE NITROGEN REQUIRED FOR MAINTENANCE
INVESTIGATOR
Body
Weight,
Kilos
Calories
per
Kilo
Protein
per Kilo,
Grams
Nitrogen
in Food,
Grams
Protein
in Food,
Grams
Chittenden's physiolog-1
ical minimum j
70
| Varies j
[with work}
.50
5.50
34
Voit's Standard
70
40
1.70
19.10
119
Maurel's Standard
70
1.50
16.83
105
Peschsel . .
77
46
.50
6.30
40
Students who have carried out experimental researches to determine
the amount of nitrogenous food necessary for body metabolism are
agreed that individuals can live for some time with no nitrogenous food,
and that they can live for a time with no food at all; but such experi-
ments are of no especial physiological value, other than furnishing evi-
dence to determine, from the metabolism of nitrogen, on a nitrogen-free
diet or during starvation, the amount of protein needed daily to prevent
the disintegration of the body tissues. The observations of Chittenden,
Voit, Maurel, Peschel and others, with which Tibbies, who has given this
subject much attention, is in complete accord, clearly demonstrate that it
is possible to maintain life, keep the body in nitrogen equilibrium and
to do a certain amount of work on a diet having the standard caloric
value, but containing a very much smaller amount of protein than is
usually given in standard dietaries.
Jones closely followed an investigation in the case of Rchmehl. This
man walked 500 miles in six days, or an average of 83i^ miles per day,
and subsisted on a ration consisting of beefsteak, eggs, beef tea, cham-
pagne and aorated waters. Tibbies says, "The severe and strenuous
exertion caused an increased excretion of nitrogen, phosphoric acid and
sulphuric acid. On the first day of the walk, the urea output amounted
to 63 grams, on the last day to 30 grams, so that the excretion gradually
diminished during the 500-mile walk. The fact should not be lost sight
112
182 PROTEIN AND NUTRITION
of that the diet influences the amount of urea excreted. A man of ordi-
nary stature, in the state of equilibrium and partaking of an ordinary
mixed diet, excretes daily from 5 to 40 grams, or an average of 33 grams
of urea. When the diet is poor in protein, it may drop to from 15 to
20 grams, but when it is rich in protein, the output may rise to 90 or
100 grams per day."
Atwater and Sherman record an investigation carried out upon
Miller, who succeeded in riding 2,007 miles in six days without showing
signs of physical or mental fatigue at the end of the journey. Miller
was twenty-four years old and the fuel value of his ration was 50 per
cent above that of the standard dietaries, showing from 169 to 211 grams
of protein daily. Estimates were made of the food consumed. The
urine and feces were analyzed and showed that the protein metabolized
in his body was more than that contained in his food.
\Veston, the American pedestrian, was used for an experiment to
determine his nitrogenous equilibrium. He consumed more protein per
day than Miller. This investigation was studied by Flint (17) and
Pavy(18), who arrived at different conclusions as to the results in this
case. Flint avers that severe muscular exertion increases the excretion
of nitrogen.
The tables on p. 183, compiled by Flint, show the nitrogen income
and outgo before, during and after the walk.
In the study of this subject, the tabulated experiments of Atwater (19)
and his associates are enlightening. 1 These experiments were all carried
on with the subject in the respiratory calorimeter. The table reports
the amount of food ingested, i.e., the sum total of food available for tissue
building and for the production of energy. In addition, the table shows
the available energy of the food digested, i.e., the difference between the
total heat of combustion and the heat of combustion of the unoxidized
matter in feces and urine, and also the loss or gain of protein or fat
to the body.
Other data shown are the average daily amount of available protein
and energy derived from the food, the amount required by the body, the
amount required by the body when at rest, and again when engaged in
vigorous muscular work.
The dietary standards previously suggested by careful investigators
have served their purpose, but they must of necessity undergo various
changes as the subject becomes more accurately and scientifically studied.
i See Table, page 184.
S TAX 1 )AltI) FOR PROTEIN REQUIREMENT IN DIETARY 183
FLINT'S OBSERVATIONS ON THE EFFECTS OF THE FIVE-DAY PEDES-
TRIAN FEAT PERFORMED BY WESTON
BEFORE THE WALK
Wright
Temper-
Nitrogen
Nitrogen
Excess or
of Body,
ature,
Pulse
Miles
in
in
Deficiency
Nude,
Deg.
Walked
Ingesta,
Egesta,
in Nitrogen
Lbs.
Fahr.
Grains
Grains
Egesta,
Grains
First Day
120.5
99.7
75
15
361.22
323.26
- 37.96
Second Day.. . .
121.25
98.4
73
5
288.35
301.18
+ 12.83
Third Day.
120
98.0
71
5
272.27
330.36
+ 5809
Fourth Day.. . .
118.5
99.1
78
15
335.01
300.57
- 34.44
Fifth Day
119.2
99.5
93
1
440.43
320.06
- 120.37
DURING THE WALK
Weight
Temper-
Nitrogen
Nitrogen
Excess or
of Body,
ature,
Miles
in
in
Deficiency
Nude,
Deg.
Pulse
Walked
Ingesta,
Egesta,
in Nitrogen
Lbs.
Fahr.
Grains
Grains
Egesta,
Grains
First Dav
116.5
95.3
98
80
151.55
357.10
+205.55
Second Dav. . . .
116.25
94.8
93
48
265.92
370.64
+ 104.72
Third Day
115
96.6
109
92
228.61
397.58
+ 168.97
Fourth Day.. . .
114
96.6
68
57
144.70
348.53
+203.83
Fifth Day ....
115.75
97.9
80
40.5
383.04
332.77
- 50.27
AFTER THE WALK
Weight
Temper-
Nitrogen
Nitrogen
Excess or
of Body,
ature,
Miles
in
in
Deficiency
Nude,
Deg.
Pulse
Walked
Ingesta,
Egesta,
in Nitrogen
Lbs.
Fahr.
Grains
Grains
Egesta,
Grains
First Day
118
98.6
76
2
385.65
295.70
- 89.95
Second Day. . . .
120.25
98.4
73
2
499.10
358.81
-140.29
Third Day
120.25
99.3
70
2
394.83
409.87
+ 15.04
Fourth Day. . . .
123.5
98.8
78
2
641.71
382.89
-258.82
Fifth Day . . .
120.75
97.5
76.5
3
283.35
418.49
+ 135.14
184 PROTEIN AND NUTRITION
INFLUENCE OF WORK ON THE FOOD REQUIRED (ATWATER)
CHARACTER AND DURATION
OF THE EXPERIMENT
Nitrogen
(Grams)
Carbon
(Grams)
Energy
(Calor.)
Protein
(Nx6.25)
(Grams)
Fat
(Grams)
(a) Rest Experiments
E. 0. : Eleven experiments, aver-
age of 37 days:
In digested food
17.7
231.5
2,459
111
In material oxidized
18.5
218.6
2,297
116
Gain (+) or loss ( ) to
the body
-.8
+12.9
-5
+20
O. F. T. : One experiment, aver-
age of 5 days :
In digested food
14.4
216.5
2,442
90
In material oxidized.. .
13.7
219.9
2,505
86
Gain or loss to the body .
+.7
-3.4
+4
-7
A. W. S.: Three experiments,
average of 9 days:
In digested food. .
14.7
214.3
2,344
92
In material oxidized. . . .
13.7
229.1
2.293
86
Gain or loss to the body .
+1.0
-14.8
+6
-24
J. F. S.: Three experiments,
average of 9 days:
In digested food. .
15.4
228.7
2,381
96
In material oxidized
15.7
207.8
2,117
98
. Gain or loss to the body .
-.3
+20.9
-2
+29
Total: Eighteen experiments,
average of 60 days' rest:
In digested food
16.6
227.3
2,428
104
In material oxidized.. .
16.9
218.7
2,285
106
Gain or loss to the body .
-.3
+8.6
-2
+13
(b) Work Experiments
E. O. : Two experiments, average
of 8 days :
In food digested
17.6
326.2
2,462
110
In material oxidized
17.3
358.9
3,865
108
Gain or loss to the body .
+.3
-32.7
+2
-43
A. W. S. : One experiment, aver-
age of 3 days
In food digested
14.8
223.6
2.505
92
In material oxidized
14.1
371.5
4,225
88
Gain or loss to the bodv .
+.7
-147.9
4-4
-196
HIGH VERSUS LOW PROTEIN DIET
185
INFLUENCE OF WORK ON THE FOOD REQUIRED (ATWATER)
Continued
CHARACTER AND DURATION
OP THE EXPERIMENT
Nitrogen
(Grams)
Carbon
(Grams)
Energy
(Calor.)
Protein
(Nx6.25)
(Grams)
Fat
(Grams)
J. F. S. : Four experiments, aver-
age of 12 days:
In food digested
15.0
306.4
3,251
94
In material oxidized
16.0
330.4
3,547
100
Gain or loss to the body .
-1.0
-24.0
-6
-27
Total: Seven experiments, 23
working days' average:
In food digested
15.9
302.5
3,227
99
In material oxidized
16.2
345.7
3,759
101
Gain or loss to the body .
-.3
-43.2
-2
-55
HIGH VERSUS LOW PROTEIN DIET
We will now present, from Sherman's (16) summary of the subject,
some of the arguments which have been advanced in favor of a high pro-
tein and of a low protein diet.
"Liebig believed that fats and carbohydrates were burned in the body
primarily to supply it with warmth, and that protein alone served as the
source of muscular work and other forms of tissue activity. He there-
fore classed the non-nitrogenons as "respiratory" and the nitrogenous as
"plastic" foodstuffs, and treated the proteins as playing a "nobler" part
in nutrition than can be accredited to either fat or carbohydrate.
Although it was soon demonstrated that carbohydrates and fats as well
as protein serve the body in the production of muscular energy, yet the
influence of Liebig's teaching, and of the great attention given to pro-
tein in Voit's classical researches on nutrition, together with the fact
that protein is the most prominent constituent of protoplasm, has resulted
in a strong tendency to associate high protein feeding with increased
stamina and muscular power.
The reasoning of those who appreciate the results of the more recent
experimental work, and yet believe the general attitude of Liebig and
Voit to have been largely sustained by experience, is well expressed by
von Noorden, who wrote(20) : "The dietary habits of peoples are the
results of biological laws, and it would seem that the action of these
laws, extending through the thousands of years of existence of the species,
186 PKOTEIN AND NUTRITION
would have resulted in the establishment of suitable habits regarding the
amounts of protein consumed. The data gathered by Voit may be taken
as showing that this normal habit involves the consumption of about
105 grams of digestible protein per day, a smaller protein consumption
being- usually associated with weak individuals or inactive peoples.
While men can maintain equilibrium on less, still it can rightly be said
that a liberal protein consumption makes for a full development of the
man. A single individual may for years, or even decades, offend against
this biological law unpunished. When, however, the small consumption
of protein continues for generations, there results a weak race." Von
Noorden, however, is careful to add: "On the other hand, the impor-
tance of protein must not be overestimated. A diet is not necessarily
good because the amount of protein is right; "it must have the proper
proportions of the non-nitrogenous nutrients as well, since the protein
is not to be depended upon for the necessary fuel value. Better some-
what less protein with a liberal amount of total food, than more protein
with insufficient fuel value; the latter brings a rapid loss of strength,
the former can be endured very well, at least for a long time, and very
likely throughout the life of the individual."
Hutchison (21) advances similar views in regard to the advantage of
a liberal protein diet and definitely pointed out that generous protein
feeding resulted in more vigorous health and increased resistance.
Chittenden, in 1905(22), arrived at precisely the opposite conclu-
sion : "The products of protein metabolism are a constant menace to
the well-being of the body, and any excess of protein over what the
body actually needs is likely to be directly injurious, and at best puts
an unnecessary and useless strain upon the liver and kidneys." Chit-
tenden has satisfied himself, by his numerous and long-continued experi-
ments, that both physical and mental stamina are promoted by decreasing
the amount of protein in the food. Greater freedom from fatigue,
greater aptitude for work, greater freedom from minor ailments, have
gradually become associated in the writer's mind with this lowered pro-
tein metabolism and general condition of physiological economy. "The
ordinary professional man who leads an active and even strenuous life,
with its burden of care and responsibility, need not clog his system and
inhibit his power for work by the ingestion of any such quantities of
protein food as the ordinary dietetic standards call for."
Although Hutchison (23) does not refute his early teaching in regard
to the views of a high protein diet, he acknowledges the importance of
Chittenden's work and states that such a diet cannot be advocated as
HIGH VEKSUS LOW PHOTEIN DIET 187
being entirely satisfactory. In his more recent work he declares (24) that
in a diet yielding 8,000 calories, the normal quantity of protein should
be about 75 grams. This is somewhat in excess of the results of Chit-
tenden's experiments, but is in accord with the relation of protein to
calories in mothers' milk. This proportion Hutchison considers nature's
teaching concerning the normal balance of nitrogenous and non-nitrog-
enous food for man.
Folin(25) holds that the argument for a high protein diet, based on
the fact that large amounts of protein are commonly eaten by those who
can afford it, can be equally well applied to the dietetic use of alcoholic
beverages and is no more convincing in one case than in the other;
while, on the other hand, study of protein metabolism has given rather
strong evidence that the body has no need of such amounts as are com-
monly eaten, for when protein is fed the nitrogen which it contains is
usually eliminated more quickly than the carbon, and further study indi-
cates that a considerable part of the nitrogen absorbed from the ali-
mentary tract never reaches the tissues at all, but is converted into urea
on its first passage through the liver.
Protein Diet and the Nitrogen Equilibrium. The loss of body nitrogen
which occurs in the early periods of restricted protein feeding, and which
was not determined nor specifically discussed by Chittenden, is treated
by Folin as follows :
"All the living protoplasm in the animal organism is suspended in a
fluid very rich in protein, and on account of the habitual use of more
nitrogenous food than the tissues can use as protein, the organism is
ordinarily in possession of approximately the maximum amount of reserve
protein in solution that it can advantageously retain. When the supply
of food protein is stopped, the excess of reserve protein inside the
organism is still siifficient to cause a rather large destruction of protein
during the first day or two of protein starvation, and after that the pro-
tein catabolism is very small, provided sufficient non-nitrogenous food is
available. But even then, and for many days thereafter, the protoplasm
of the tissues has still an abundant supply of dissolved protein, and the
normal activity of such tissues as the muscles is not at all impaired or
diminished."
When 30 or 40 grams of nitrogen have been lost by an average-sized
man during a week or more of abstinence from nitrogenous food (but
with an abundance of carbohydrate and fat), the living muscle tissues
are still well supplied with all the protein that they can use. That this
is so is indicated, on the one hand, by the unchanged creatinin elimina-
188
tiou, and on the other by the fact that one experiences no feeling of
unusual fatigue or of inability to do one's customary work. Because
the organism at the end of such an experiment still has an abundance
of available protein in the nutritive fluids, it is at once seemingly waste-
ful with nitrogen when a return is made to nitrogenous food. This is
why only gradually, and only under prolonged pressure of an excessive
supply of food, protein again acquires its original maximum store of
this reserve material.
If the interpretation just given for the phenomenon of nitrogen
equilibrium is correct, it constitutes at the same time a definite reason
why the so-called standard diets are unnecessarily rich in protein. Nitro-
gen enough to provide liberally for the endogenous metabolism and for
the maintenance of a sufficient supply of the reserve protein is shown
to be necessary; but it ought neither to be necessary nor advantageous
for the organism to split off and remove large quantities of nitrogen
which it can neither use nor store up as reserve material. In the case
of carnivorous animals, the uncertainty of the food supply has evidently
led to the development of a capacity to store a certain amount of pro-
tein in the form of increased muscle substance, but in man this capacity
seems not to exist. The slowness with which the normal human organism
stores nitrogen after having lost only very moderate amounts does not
mean that the human organism can replace lost muscle tissue only slowly
and with difficulty. When the organism really has suffered a loss of
such tissue, as, for example, during typhoid fever, we know that during
convalescence there is an astonishingly rapid recovery of weight and a
correspondingly extensive retention of nitrogen.
In the light of the- theory developed from Folin's teaching concern-
ing the double nature of protein metabolism and the explanation of the
phenomenon of nitrogen equilibrium, the following objection can perhaps
be made to the use of large quantities of protein : the excess of nitrogen
furnished with the food is normally quickly converted into urea and
eliminated, and is therefore normally harmless. The continuous ex-
cessive use of protein may lead, however, to an accumulation of a larger
amount of reserve protein than the organism can with advantage retain
in its fluid media. It is entirely possible that the continuous main-
tenance of such an unnecessarily large supply of unorganized reserve
material may sooner or later weaken one or another or all of the living
tissues. At any rate, it seems scarcely conceivable that the human organ-
ism, having all the time access to food, can gain in efficiency on account
of such an excess of stored protein. The carrying of excessive quantities
HIGH VERSUS LOW PROTEIN DIET 189
of fat is considered as an impediment; the carrying of excessive quanti-
ties of unorganized protein may be none the less so because more common
and less strikingly apparent (26).
Halliburton (27), in discussing the work of Chittenden and of Folin,
concedes that "the prevalence of dyspeptic troubles and uric acid disorders
(among the English-speaking peoples) should make us hesitate before
we conclude that our diet has reached the stage of perfection, and should
rather lead us to admit that the majority of well-to-do people eat too
much protein" ; but, he adds, "Any change in the practice of years and
of generations should be accomplished gradually, not suddenly. It is
well known that the liver is the largest organ we possess, and one of its
functions is to convert nitrogenous metabolites, which may be harmful,
into urea, which is harmless and easily disposed of, and one may gain
comfort from the reflection that the organ is adequate in health to deal
with large quantities of material. If all of us were immediately to
reduce our diet to the Chittenden level, we might be living perilously
near the margin; any unusual strain, such as privation or a severe ill-
ness, would then find us without any reserve of nutrient energy, and
we should probably suffer more severely in consequence."
Benedict (28), after many years' experience in feeding, favors the
use of liberal quantities of protein, and says, "While men may for some
months reduce the proportion of protein in their diet very markedly
and apparently suffer no deleterious consequences, yet, nevertheless, a
permanent reduction of the protein beyond that found to be the normal
amount for man is not without possible danger. The fact that a subject
can so adjust an artificial diet as to obtain nitrogenous equilibrium with
an excretion of nitrogen amounting to about two or three grams per day
is no logical argument for the permanent reduction of the nitrogen in
food for the period of a lifetime. Dietary studies, all over the world,
show that in those communities where productive power, enterprise and
civilization are at their highest, man has instinctively and independently
selected liberal rather than small quantities of protein."
A similar position is taken by Meltzer(29), who compares the appe-
tite for a liberal surplus of protein with the liberal way in which the
body is provided with organs and tissues for nearly all of its functions,
and concludes that, "valuable as the facts which Chittenden and his
co-laborer found may be, they do not make obvious their theory that
the minimum supply is the optimum the ideal." The bodily health
and vigor which people with one kidney still enjoy does not make the
possession of only one kidney an ideal condition.
190 PKOTE1N AND NUTRITION
"The finding that the accepted standard of protein diet can be reduced
to one-half can be compared with the finding that the inspired oxygen
can be reduced to one-half without affecting the health and comfort of
the individual, but no one deduces from the latter fact that the breathing
of air so rarefied would be the ideal. The storing away of protein, like
the storing away of glycogen and fat, for use in expected and unexpected
exceptional conditions is exactly like the superabundance of tissues in
an organ of an animal, or like an extra beam in the support of a building
or a bridge a factor of safety. We therefore believe that with regard
to the function of supply of tissues and energy by means of protein food
nature meant it should be governed by the same principle of affluence
which governs the entire construction of the animal for the safety of its
life and the perpetuation of its species."
After considering the arguments of Benedict and of Meltzer, it is
noteworthy that in his later book Chittenden(30) says: "It is certainly
just as plausible to assume that increase in the consumption of protein
food follows in the footsteps of commercial and other forms of pros-
perity, as to argue that prosperity or mental and physical development
are the result of an increased intake of protein food. Protein foods are
usually costly and the ability of a community to indulge freely in this
form of dietetic luxury depends in large measure upon its commercial
prosperity." Moreover, Chittenden contends that his allowance of 00
grams of protein per day for a man of average size is a perfectly trust-
worthy figure, with a reasonable margin of safety; that dietetic require-
ments, and standard dietaries, are not to be founded upon the so-called
cravings of appetite, but upon reason and intelligence reenforced by
definite knowledge of the real necessities of the bodily machinery.
"We must ever be mindful of the fact, so many times expressed, that
protein does not undergo complete oxidation in the body to simple gaseous
products like the non-nitrogenous food, but that there is left behind a
residue not so easily disposed of, and that there are many suggestions
of improvement in bodily health, of greater efficiency in working power
and of greater freedom from disease, in a system of dietetics which aims
to meet the physiological needs of the body without undue waste of
energy and unnecessary drain upon the functions of digestion, absorp-
tion, excretion and metabolism in general."
Reduction of Protein Dietary Necessary. The well-to-do families and
those living in luxury should especially avoid the excessive and exclusive
ingestion of foods from the animal kingdom. There are tables in some
families from which vegetables are almost entirely excluded, because it
HIGH VERSUS LOW PROTEIN DIET 191
is said they are not sufficiently nourishing or because they do not make
a big enough show, or because they do not satisfy palates accustomed to
animal foods; sometimes because their preparation requires more pains-
taking care and time than the housewife or cook, often from indolence,
cares to give them. Again, some individuals seem to think that an
excess of nitrogenous alimentation will make up for any deficiency, in-
tentional or otherwise, of vegetable foods. This is a very dangerous error.
On such a dietary children are slow in development, nervous, caco-
chymic and eczematous. In later life they will be subjects of rheumatism,
gout, calculi and nervous disorders. There is no question in our mind
but that the degeneracy noted in many well-to-do families is due wholly,
or in part, to a dietary composed too exclusively of foods from the ani-
mal kingdom. For this reason, which we cannot too strongly emphasize,
we ought not to further encourage this tendency by replacing beef and
mutton, roast or boiled, by pork, butcher's meat, hash, game, preserved
fish, spiced stews, salt or smoked meats, by meat of animals too young
and by fermented cheeses with the necessary accompaniment of bitters,
stimulants, spices, wines, liqueurs, coffee, tea, etc. Such a dietary,
beyond question, augments every sort of disorder of health, leads to race
degeneracy and decimates families.
It is beyond question that the dietary habit of well-to-do people,
especially Americans, and the dietary standards which have been gen-
erally accepted in the past, tend to be decidedly liberal with respect to
protein. The custom of physicians and dietitians has been to prescribe
protein in quantities which may be believed to be beneficial, but it is
known to a certainty that it is not necessary in the amounts usually
allowed.
Effect of Increased Nitrogen Diet on Kidneys. Careful observers have
proved that half the standard allowance of protein has amply met the
demands of the body for nitrogen, but it has also been shown that any-
thing more than the amount necessary for the formation and repair and
wear and tear of muscular tissues is rapidly disintegrated and the urea
moiety thrown out of the body; and it is further claimed that the addi-
tional amount which is usually consumed is harmful to the organism
by throwing extra work upon the kidneys to excrete it. It is also claimed
that this extra work thrown on the organs of elimination in turn is the
cause of gout, migraine and kindred ailments.
It is a physiological fact that nitrogen may be speedily eliminated,
and it has been demonstrated that the amount of nitrogen metabolized
is in proportion to the amount consumed. We have already shown that
192 PEOTEIX AXD NUTRITION
the amount of urea excreted with an ordinary mixed ration varies from
33 to 37 grams daily; but when an extra amount of protein is ingested
the excretion of urea may rise to 50, 60 or even 100 grams per day.
On a non-protein diet for several days' duration the excretion of urea
may sink to 9 grams. On a diet poor in protein it may drop to 15 or
20 grams.
The function of the kidneys is that of elimination, so that the excre-
tion of urea in moderate quantities is not injurious. It may be granted
that if the function of the kidneys is defective, there will be a retention
of urea or other nitrogenous waste products in the body and the organism
will suffer accordingly. Yet, on the other hand, there are certain sec-
tions of the earth where the inhabitants live for months upon flesh, fish
and fowl, and they do not appear to suffer more than Americans or Euro-
peans who live on a mixed diet. It is known that carnivorous animals
subsist entirely on flesh, and there is no evidence that they suffer from
disease of the kidneys, from the overwork of their organs. Moreover,
it has been satisfactorily demonstrated that when the amount of protein
in their food sinks below the normal level, they soon begin to suffer from
digestive disturbances.
Effect of Protein Diet on Strength and Endurance EFFECT OF LOW
PROTETX DIET ox ANIMALS. Munk of Berlin (31) made a series of
observations to determine the effects of a low protein diet on dogs ; he
observed that a ration poor in protein caused disturbances of the organ-
ism, seriously interfering with assimilation ; the absorption of fat was
the most disturbed, that of protein next, and that of carbohydrates the
least molested of all. The animals did not recover their nitrogenous and
nutritional equilibrium until their protein ration was increased. When
they were allowed skim milk, beans or other nitrogenous food, a distinct
improvement in their condition was noticeable. It is well known to the
farmer that bacon from pigs fattened on a low protein diet is poor in
quality. It is also well known that the milk of cows fed on a ration
deficient in protein is poor in fat ; the cows become thin, their coats harsh,
and they present an ill-fed and ill-kept appearance.
Observations of the effects of the different food elements on man are
confirmed by these experiments upon lower animals. Although it is
known that individuals can live and continue to keep up both health
and work for months on a diet poor in protein, nevertheless this course
cannot be continued for an indefinite period. After a time vitality is
lowered, resistance to disease is weakened, the activity of the body is
lessened and the powers of endurance are stunted. Both careful obser-
HKiH VKKSrs LOW 1'KOTKIX DIET 193
vation and experience point to the disadvantages of a low protein
diet.
The expenditure of energy is required by muscular work, and to tbis
end more fuel must be consumed. It has been demonstrated that for the
production of energy, protein, fat and carbohydrate can be interchange d
in a definite proportion. It has also been demonstrated that the increased
excretion of nitrogen during and after muscular work is not in propor-
tion to the amount of work. On the contrary, the energy expended in
doing work is derived in great part from non-nitrogenous foods.
It is evident, therefore, to the careful student of dietetics that when
extra work is to be performed a more liberal allowance of fat and carbo-
hydrate must be added to the ration. But this point is not settled beyond
dispute, since it has been the custom for ages past to increase the total
food protein in proportion to the extra work to be done. However, from
the viewpoint of endurance it is generally accepted as a fact that men
who partake liberally of animal foods are more powerful and have
greater staying qualities than those who consume little meat (32). The
carnivora are more powerful and energetic than the herbivora. The
lion or tiger is more vicious than the deer or elk. "Horses fed on beans
or oats have more spirit and endurance than those fed on hay or grass."
It is an indisputable fact, nevertheless, that feats of endurance can be
performed on a purely vegetarian diet; but this may not necessarily be
deficient in protein, so, after all, it makes no difference whether the pro-
tein is taken from the animal or vegetable kingdom.
The difference between an animal fed on a highly nitrogenous diet
and one supplied with little nitrogen is the difference between a steam
engine at half pressure and one which is producing its full horse power.
It is the difference between a tiger pacing its cage and a cow lying upon
the grass; both are healthy, but the type or degree of health is very
different in the two animals. "A hunted deer," says Ilaughton, "will
outrun a leopard in a fair and open chase, because the work supplied to
its muscles by the vegetable food is capable of being given out continu-
ously for a long period of time, but in a sudden rush at a near distance,
the leopard will, without doubt, overtake the deer, because its flesh food
stores up in the body a reserve or force capable of being given out
instantaneously in the form of exceedingly rapid muscular action."
PKOTEIN DIET AND OCCUPATION. Before concluding this subject,
we desire to call attention to the disadvantages of a purely vegetable
diet, which affects the outdoor laborer much less than the one engaged
in sedentary vocations. The laborer or lumberjack actually requires a
194 PROTEIN AND NUTRITION
large amount of carbohydrate food to enable him to perform his muscular
work, and in partaking of large quantities of vegetable foods for this
purpose he is pretty sure to get as much protein as his body requires.
The free action of the skin, too, from his strenuous exertions carries
off from the body the excess of water which his diet contains, while his
active work in the open air induces an appetite for large meals. With
the sedentary worker the case is different. He requires much less carbo-
hydrate food than the laborer taking strenuous exercise in the open air,
while his body demands considerable protein. In endeavoring to obtain
from purely vegetable sources a sufficiency of nitrogenous food, he would
inevitably overburden his diet with an excess of non-nitrogenous foods,
which his comparatively feeble digestion would be unable to metabolize,
while his skin would not act, as in the case of the laborer, to rid the
body of the surplus water which such a diet would contain. For these
reasons, a man of sedentary occupations is much less likely to be a suc-
cessful example of vegetarianism than one who leads an active life.
THE AMINO-ACIDS IN ANIMAL AND VEGETABLE PROTEINS. In study-
ing the physiology of absorption (Volume I, Chapter VI) we learned
that all proteins, whether from the vegetable or animal kingdom, consist
of amino-acids(33). The amino-acids of animal proteins are identical
with those of vegetable proteins, and therefore it would appear a priori
that there can be little difference in their value upon the organism. It
is a remarkable fact that the most valuable vegetable proteins are defi-
cient in flavoring agents, while these bodies in meat, fowl and fish add
to their palatability.
Minimum Protein Requirement to Maintain Nitrogen Equilibrium The
evidence advanced by some observers that the amount of protein pre-
scribed in standard diet is injurious to the organism is not conclusive,
but there is ample evidence of the bad effects of a long-continued diet
of low protein value. Cohnheim holds that Chittenden's experiments
do not prove that men eat too much protein, believing that they can live
for a time upon a smaller amount of protein than usual. He believes
that most men cannot continue to live upon an allowance of from 50 to
60 grams of protein and keep in good health. With Caspari and Loewi
he holds that a healthy, full-grown man requires at least 80 grams of
protein daily, and this is a considerable reduction from the standard
diet. We can safely take Chittenden's experiments as the protein mini-
mum, of the so-called standard dietaries which show that the customary
or average protein consumption of the most successful nations represents
the necessary amount or optimum protein consumption, but Folin holds
HIGH VERSUS LOW PROTEIN DIET 195
to the view that the protein optimum lies somewhere between these two
points.
The minimum ration of protein to secure nitrogenous equilibrium
was fixed by Voit at 118 grams in twenty-four hours, while Miller
asserts that the minimum nitrogenous ration has been fixed too high,
and that 60 grams of protein should be considered the minimum. This
coincides with the teaching of Chittenden, who agrees that 60 grams of
protein are insufficient; and again Rubner believes the daily necessary
potential would be maintained by 35 grams of protein for an adult in
whom growth was complete. Klemperer was able to maintain nitrogenous
equilibrium on 33 grams of protein by giving at the same time a liberal
allowance of fats and carbohydrates.
Siven, in his interesting work (34), and Peschel, in his inaugural
address (35), prove that nitrogenous equilibrium may be secured with
an alimentation containing only 40 grams of protein, and that, under
these conditions, the organism does not draw in the slightest manner
upon its own protein, provided the quantity of calories lacking is made
up by a liberal allowance of fats and carbohydrates.
Hutchison (36), although acknowledging that Chittenden's results
show what men can exist upon, holds that their general application would
be attended with risk. In solving the problem of protein requirements,
Hutchison makes an interesting comparison between the diet of an adult
and that of a nursing infant. The daily supply of milk taken by an
infant six months of age contains about 14 grams of protein, furnishing
578 calories; the average energy value of the food of an adult, on the
other hand, equals 3,000 calories, i.e., the standard of protein, in the
same proportion, would be about 75 grams, the infant's growth being
offset by the daily expenditure of energy in the routine life of an adult.
Halliburton's results coincide with the results of Chittenden's experi-
ments with metabolism and he points out the danger of living too near
the protein minimum.
Safety Standard in Diet. It may be definitely concluded that the
body must have the minimum of protein, an increased proportion being
of value because of its action as a stimulant to metabolism and as an
accessible source of energy ; that the ingestion of protein in larger amounts
than Chittenden's standard is advisable, since it increases resistance to
disease, probably due to the manufacture of antibodies resulting from
the stimulation of the body to this end. The fact that those who are
forced by their lack of means to live on a low protein diet are more sus-
ceptible to disease has long been accepted. A definite quantity to be
196 PROTEIN AND NUTRITION
known as the protein optimum cannot be fixed, for it is doubtless influ-
enced in the case of every individual by the personal equation. The
pivot on which the protein problem rests is the question of the desirabil-
ity of storing proteins and of maintaining them on a high level or on a
low level. For certain individuals a high level is better, for others a low
level, on the condition that the alimentary organs are able to digest and
assimilate proteins, and the kidneys are able to transform the nitrogenous
waste into urea for ultimate excretion. The young thrive on protein
food ; during the period of middle age, however, the metabolic processes
are less active, and then protein ingested in amounts greater than the
physiological requirements tends to a condition of obesity, and the urea
is not eliminated with as much facility because of decreased hepatic
efficiency and lessened activity of the renal excretory power. With these
conditions present, the amount of protein in the dietary must be held
down, so that the optimum at this epoch falls below that of youth and
early adult life.
CAUTION AS TO PROTEIN DEFICIENCY. Before leaving this subject
we desire to urge a word of caution against a deficiency of food in the
diet protein, being the most costly, is the principle most likely to be
short in the diet. Of late, considerable discussion as emphasized by
experiences recorded in this chapter has arisen as to the exact amount
of protein required daily by the adult after the period of growth is
complete. For generations past it has been considered that protein
starvation is the cause of much ill health and misery. In our own
country, among the poorer classes in the South, particularly in the
mountain districts and among the poorer children working in factories,
it is not uncommon for individuals to live upon a diet in which "tea,
bread and butter" figure prominently, with an occasional bloater or
other appetizer. While such a diet may yield sufficient heat to supply
the demands of the body according to scientific requirements, it does
not give the consumer strength and endurance. The general principles
laid down in this chapter should guide us in directing a diet for people
of this type, and especially where the cost of meat, fish, fowl, eggs or
milk is prohibitive, to suggest and direct the freer use of beans, peas,
lentils and mits which would supply the necessary protein to make up a
well-balanced ration without an excessive expenditure of money.
UNBEREATTNG. Undereating is often coupled with indigestion in
such a way that it is impossible to say which is the cause and which
the effect. Within wide limits the digestive glands accommodate them-
selves to the tax levied upon them, providing adequate amounts of their
HIGH VERSUS LOW PROTEIN DIET 197
juices for large or small meals. Low diet, therefore, may weaken the
adaptability of the organs it is designed to spare (Howell).
Benedict, of the Carnegie Nutrition Laboratory, has severely criti-
cized those writers who go to extreme lengths in their championship of
reduced feeding. He has shown that when the food supply is very small
the absorption is often less complete than with a more liberal diet,
indicating that the digestive system is not in such good working order
as it might be with more to do. Chittenden, the foremost advocate of
careful restriction, agrees with his critic to this extent at least that
he believes that an occasional big dinner is a valuable means of testing
the canal to see whether it has retained the reserve power which it
should have. We must admit, in spite of the scientific investigations
laid down for the bodily requirements of persons in adult life, that these
standards are subject to a personal equation which will upset the calcu-
lation, and therefore the scientific figures can only be considered as
general averages.
OVERFEEDING. Overfeeding, especially in youth and early adult
life, may be disposed of by quick digestion and speedy assimilation,
great metabolic activity and greater physical exercise, whereby the ex-
cess of food consumed is rapidly used up and eliminated; but when the
middle mile post in life's journey is reached, the body is less active
and the same interest is not taken in cricket, football, golf and other
outdoor games as in early life. Consequently, less food is metabolized
and the "undesirable balance" remains as a "sin against Nature." It
is quite true that a certain portion of this surplus may be stored up in
the body as protein, glycogen and fat and may thereby lead to obesity.
On the other hand, there are persons who "love to eat large meals,"
who lead an inactive life, follow sedentary occupations and live in warm
rooms "lapped in luxury," who never put on flesh. Luxurious habits,
especially overindulgence in meat, give rise to various stomach, kidney
and arthritical complaints. Even though it may be taken into account
that gourmands are the most frequent sufferers from the above disorders,
this does not settle the matter, for he who "eats well" often "drinks
well," and which of the two is the culprit, the protein or the alcohol?
In the majority of instances it might be safe to assume that these boon
companions share the responsibility between them. But this "unde-
sirable balance" is the causative factor in a variety of ills, such as bilious
attacks, migraine, headache, lethargy, diseases of the liver, kidneys,
blood vessels, and favors the production of rheumatism and gravel and
kindred affections, not to mention the various auto-intoxications and
113
198 PROTEIN AND NUTRITION
putrefactive stasis of the alimentary canal. The decomposition of the
end-products of protein digestion takes place in the colon ; hence, in this
region, products of decomposition develop, such as indol, phenol, skatol,
volatile fatty acids, aromatic acid, ammonia, carbonic acid, methane,
sulphuretted hydrogen and methyl mercaptan.
The Greek and Spartan athletes of old were wholly or mainly
abstainers from flesh foods, and won in all strenuous combats, until they
began to eat flesh to make themselves "fierce," after which they began
to lose in their conquests in the stadium. The diet of the country
laboring classes, for half a century past, was almost wholly innocent of
flesh meats and strong drinks, and it must be borne in mind that it is
to this sober and temperate ancestry that the working powers of this
present generation are owed. The use of flesh in the daily ration of
food dates from hardly more than one quarter of a century among the
peasantry of the most rural districts, and already they are beginning to
degenerate.
ILL-EFFECTS OF ABSORPTION OF END-PRODUCTS OF PROTEIN DIGES-
TION. Does muscular strength decline on a rich protein (meat) diet ?
Physicians are well aware of the weakening effect of a meat diet such
as, in the past, has been prescribed for diabetics. If the lower protein
estimate of Chittenden and others, say of 60 grams, be sufficient, is it
not a question, then, of serious moment to tax severely the organs of
digestion and assimilation with from 120 to 200 grams of protein ?
The end-products of protein digestion which cannot be entirely con-
sumed in the body leave behind a large proportion of incombustible
waste material which the liver and kidneys are called upon to excrete,
putting extra exertion on these organs. If this large amount of protein
is unnecessary, it is not a very far step to the assumption that it must
be injurious, because a considerable amount of energy must be devoted
to catabolism in the cells and to the excretion of its waste products by
the kidney, energy which might otherwise be utilized and assist in
metabolism of the muscles.
PROTEIN STRUCTURE AND PROPERTIES
Chemical Formation of Protein Fractions. It is an established fact that
proteins are the actual vehicles of life and upon their properties the very
possibilities of life depend. The huge molecules of the proteins have
been teased and torn out to borrow a term of histology and as a
result the conception of an unwieldy group of atoms has been replaced
PROTEIN STRUCTURE AND PROPERTIES 199
by that of an orderly structure composed of comparatively simple build-
ing stones, forming a neatly constructed block of masonry rather than
an amorphous mass of concrete. These building stones are now famil-
iarly known as protein fractions. Some of them have long been known
as rare ingredients of the excreta such, for instance, as tyrosin, leucin
and cystin but whence they came and how they were formed in the
body has been until recently unknown. Widely as the protein fractions
differed in their structure, they have this in common: they are amino-
or di-amino-acids, and share the properties of acids and bases. They
are, furthermore, capable of combining with each other to form compli-
cated chains or networks which constitute the protein molecules, and
since they admit of combination into many different groupings there
is a possibility of almost infinite varieties of protein structure.
QUANTITATIVE DIFFERENCES OF PROTEINS. A great deal of our
newer information concerning the proteins we owe to Osborne and
Mendel (37). They have experimented with pure proteins and they
have shown definitely that certain amino-acids are indispensable in food.
With certain proteins lacking certain of the amino-acids maintenance,
but not growth, occurs. With other proteins deficient in certain other
amino-acids, not even equilibrium can be maintained. For instance,
they have shown that the protein of corn (zein) is an inefficient protein,
and that when zein serves as the sole source of nitrogen in the diet,
nutritive failure results. It is a perfectly digestible protein, but lacks
tryptophan and. lysin. Likewise, gelatin does not contain tryptophan,
an amino-acid, which is essential for the maintenance of the body nutri-
tion. The addition of both of these latter to zein completes it. Add
tryptophan alone, and equilibrium is maintained. Add both, and growth
follows. Glutelin of corn is a complete protein, but it does not occur
in sufficient quantity to balance the deficient zein, therefore corn is not
a complete protein. Other proteins which are relatively poor, though
not entirely lacking in certain amino-acids necessary for growth, are
gliadin of wheat and hordein of barley. To this class also belong the
protein of hemp seed, edestin, which is comparatively poor in lysin.
Wheat gliadin will serve to maintain equilibrium, but will not permit
of growth. Add lysin to gliadin, however, and growth results. Gliadin
is evidently a better source of nitrogen than zein. Lysin is present in
many foods; for instance, 9.6 per cent in lactalbumin, 7.59 per cent in
ox muscle, 4.81 per cent in the yolk of eggs, 4.98 per cent in peas, 4.58
per cent in beans, 7.61 per cent in casein. The addition of any of these
to a corn or wheat dietary adds to its efficiency and tends to insure
200 PROTEIN AND NUTRITION
growth. These facts apply to adult animals, but, to be sure, they also
apply more trenchantly to young animals.
The energy value of gelatin is inferior to protein for growth and
repair. It is, however, a true protein, though not complete, and, there-
fore, gelatin alone cannot maintain protein equilibrium in nutrition.
The "incompleteness" of food value is doubtless due to the absence of
certain amino-acid radicals, conspicuously tryptophan, in the gelatin
molecule. Gelatin alone would not supply the necessary protein content
of a well-regulated dietary. If one were to rely largely on gelatin as
a food it would be necessary to add other proteins, such as those of milk,
rich in particular amino-acids which gelatin lacks.
QUALITATIVE VARIATIONS IN THE AMINO-ACIDS OF PROTEINS.
In the table, Volume I, Chapter III, are clearly shown the variations to
be found in several of the typical proteins. The most marked differences
in amino-acids from a quantitative point of view are very definite. Again,
considered from the qualitative standpoint, variations in nutritive value
are very important. The mention of a few of the most striking variations
may serve to make this point more clear. Albumin and casein contain
no glycocoll ; gliadin derived from wheat is also glycocoll-free and contains
only a negligible trace of lysin ; zein derived from corn contains neither
lysin nor tryptophan; and gelatin has no tryptophan, tyrosin or cystin.
Munk and Voit, in their well-known work, were the first to emphasize the
bearing of the qualitative variations in protein from the viewpoint of
nutritive value, especially as regards gelatin, which they proved could not
sustain nitrogen equilibrium. Escher showed that the addition of tyrosin
to gelatin increased its value to the point of establishing nitrogenous
equilibrium. This work constitutes the introduction to a series of experi-
ments which have done much to solve many puzzling problems associated
with the metabolism of nutrition. It is not the purpose of this work to
enter into the details of all these experiments, but a glance will be given
to the more important.
Kaufman demonstrated that gelatin with the addition of the missing
amino-acids, tyrosin and tryptophan, is capable of maintaining nitrogen
equilibrium for short periods in man and dogs. Willcock and Hop-
kins (38) report most interesting experiments with zein, which, as has
been said, is deficient in lysin and tryptophan. Light from new angles
is thrown on the problem under consideration and the results accord
perfectly with the most recent theories. According to these investigators :
We are no longer bound to Liebig's view, or to any modification of it which
implies that the whole of the protein consumed is utilized as intact protein; nor
PROTEIN STRUCTURE AND PROPERTIES 201
are we even compelled to assume that the whole of what is broken down in the
gut is resynthesized before utilization. Protein products may function in other
ways than in the repair of tissues or in supplying energy. It is highly probable
that the organism uses them, in part, for more specific and more immediate needs.
The discovery of substances absolutely essential to life, highly specific, and elabo-
rated in special organs, suggests that some part, at least, of the protein products
set free in the gut may be used directly by these organs as precursors of such
specific substances. In adrenalin, for instance, we have an aromatic substance
absolutely essential for the maintenance of life, and it is probable that the supra-
renal gland requires a constant supply of some one of the aromatic groups of the
protein molecule to serve as an indispensable basis for the elaboration of adrenalin.
If this be so, it is certain that the gland itself could not, in starving animals,
supply sufficient of such a precursor to outlast the observed survival periods.
Since adrenalin must be produced at all costs, the required precursor must, in
starvation, be obtained by tissue breakdown outside the gland. We may be sure,
however, that adrenalin is far from being the only substance elaborated to which
such considerations apply. Similarly, in an animal upon a diet sufficient to supply
energy, but lacking in some essential group, the minimal waste in the general
tissues of the body will be determined by the special need of the organs for the
missing group. On this basis we have a hypothesis to account for the special
protein-sparing properties of gelatin. It shares with protein certain molecular
groupings needed to satisfy specific needs, and is thus superior to fats and carbo-
hydrates as a protein sparer; it lacks, on the other hand, certain necessary group-
ings, fails therefore to supply all such needs, and thus cannot replace protein.
Physical Properties of Proteins. In the process of metabolism, the
role of the proteins is fast becoming the role of the aminq-acids. The
body metabolism makes use of amino-acids, but the human economy
must be fed proteins from which the amino-acids are derived, and they
depend in amount not only upon the chemical composition of the pro-
tein, but upon its physical character and also upon other substances
combined or mixed with the alimentation. It has long been thought
that the proportion of ingested protein that is digested and absorbed
from bread varies according to the amount of the outer cortex (bran)
of the grain present in the flour, less being absorbed from bread made
from the coarser meals and flours; that the percentage of cellulose in
other foods also has a bearing on the absorption of protein.
It has been shown by Hart and McCollum(39) that the inadequacy
of corn as an exclusive food is due partly to the character of its proteins,
partly to the deficient mineral content. When these deficiencies are sup-
plied, normal growth is possible on a dietary composed largely of corn.
In order to understand clearly the role of proteins in growth from
the standpoint of the sources of our food, it is necessary to appreciate,
first, that the utilization of proteins depends on the characteristics of
202 PROTEIN AND NUTRITION
the proteins themselves or of the foods containing them, which make
them resistant, and not to the digestive enzymes and hormones, which
influence the rate of their passage through the alimentary canal ; second,
their digestion and assimilation: to what extent they can supply the
essential amino-acids in the proportion in which the body requires them
for the wear and tear and tissue building; and third, the physiological
effect of individual amino-acids, especially, perhaps, those furnished by
the proteins in question in excess of the body needs (40).
RELATIVE ABSORPTION OF PROTEINS. The experiments of Mendel
and Fine (41), recently confirmed by the findings of Howe and
Hawk (42), show that when fed in a more or less isolated form, the
proteins of cereals are as completely digested and absorbed as the pro-
teins of animal food 91-97 per cent; but for the proteins fed in the
natural food these values do not hold. Only 80-85 per cent of the nitro-
gen of wheat bread is absorbed, TO per cent of rye, 58 per cent of pum-
pernickel, 40.76 per cent barley and 61-82 per cent of corn nitrogen.
These percentage values, showing the amount of protein absorbed from
whole grain cereals, were determined by methods less accurate than those
now in use, but they serve to show the comparable absorption of proteins
from different cereals, and show undoubtedly lower protein utilization
in grains than in isolated grain proteins.
DIFFERENCES IN SUITABILITY FOR TISSUE CONSTRUCTION.
"With equal digestion and absorption, proteins may still differ greatly
in their suitability for tissue construction and otherwise in their physio-
logical effect." According to Howe and Hawk:
The proteins of meat and of the commercial wheat preparation, gliadin, are
about equally well digested and absorbed, but when fed for a period of five days
in equal quantity and in similar rations, gliadin gave a negative nitrogen balance
of 1.3 grams, while meat gave a positive balance of 11.3 grams.
Osborne and Mendel have shown that a large number of proteins
contain all the amino-acids necessary for growth : ovo-albumin, ovo-
vitellin glutenin, maize glutelin, edestin, casein, lactalbumin. Hart and
McCollum(43) and their co-workers have found several natural mixtures
of proteins occurring in wheat, corn, oats and milk which furnish the
amino-acids requisite for tissue construction. McCollum, in comparing
the protein mixtures of the grains previously enumerated, with one
another and with the protein mixture of milk to determine their avail-
ability for growth, found the available nitrogen of cereals to be 23-24
per cent, 45 per cent casein nitrogen and 63 per cent of milk nitrogen
THEORIES OF PROTEIN METABOLISM 203
fed as milk. It is evident, therefore, that the amino-acids resulting
from the digestion and assimilation of milk proteins not only contain all
the units necessary for tissue building, but contain them more nearly
in the proportion in which they can be used than is the case with the
other foods considered. Wheeler says:
If there is a shortage of one ammo-acid essential to the building of body pro-
tein, the amount of that acid present determines not only the amount of tissue
construction, the rate of growth, but determines also the proportion of the food
protein that can be used for growth. It has been found that the body metabolism
can store very little reserve amino-acid practically all of the amino-acid that
cannot be built into protein is promptly deaminized and the nitrogen excreted.
The investigations of Osborne and Mendel (44) have thrown light
on the nutritive value of individual amino-acids: the aromatic amino-
acids are essential to maintenance; cystin, lysin, probably arginin, and
histidin are essential for growth. Again Wheeler says:
An understanding of the role exerted by the individual amino-acids in metab-
olism suggests wonderful possibilities, for in the future it will be possible for
the physician or dietitian to feed a frail, undersized child on just the right com-
bination of milk, eggs and cereals to furnish the amino-acids he needs, in the right
proportion, with no large excess of any one to overtax the excretory system or to
overstimulate metabolism; a worn-out neurasthenic can be given just the right
amino-acids to replace worn-out tissue and enough glycocoll to stimulate metabolism.
Enough has been drawn from the writings of Osborne, Mendel,
Howe, Hawk and others to make us feel the importance of knowing the
protein composition of foods and how to mix them in order to obtain
a sufficient quantity of complete protein. It is evident to the careful
student of dietetics that there is but one general way in which to for-
mulate the diet question, bearing in mind the fact that "a man who
maintains his weight may be in excellent nutritive condition, but a child
who does the same thing may be failing to grow" (45).
THEORIES OF PROTEIN METABOLISM
After weighing all the discussions pro and con as to the necessity
for protein in the dietary, we come to the conclusion that a reasonable
surplus of protein from suitable food materials can hardly be injurious,
and may be advantageous. Whether such a surplus should be especially
recommended or not is largely a question of economics. Where little
money can be spent for food there is danger that too little food may be
eaten, and it should be remembered in suggesting dietaries that protein
204 PROTEIN AND NUTRITION
can be secured from beans, peas, etc., at about two-fifths the cost of
obtaining it from porterhouse and sirloin cuts of steak. In considering
this subject, we must not be misled by the popular statement that "pro-
tein builds tissue" into supposing that a liberal amount of protein can
keep the body strong in spite of a deficiency in the total food. This
impression is somewhat general, but is certainly incorrect.
From investigations of Chittenden, Fisher, Peschel, Hindhede and
others, coupled with our own personal experience, we find that physical
strength and bodily health can be maintained on a low protein diet, but
it is difficult for students following the teaching of the scientists of the
old school to rid themselves of the idea that there must be "something"
of especial value in meat. It would seem to be rather difficult to express
the exact truth of what this "something" is. We know that this "some-
thing" has nothing to do with health, with working ability, with strength
and endurance; it is energy.
According to Hutchison (46), it is undoubtedly possible to maintain
a healthy life upon the protein contained in a moderate quantity of
vegetable food, and the accumulated experience of vegetarian races fully
bears this out:
This, however, does not dispose of the question. There is such a thing as
degrees of health. While one freely admits that health and a large measure of
muscular strength may be maintained upon a minimum daily supply of protein,
yet I think that a dispassionate survey of mankind will show that races which
adopt such a diet are lacking in what, for want of a better word, one can only
describe as energy. Now, energy is not to be confused with muscular strength.
A grass-fed cart horse is strong; a corn-fed hunter is energetic. Energy is a
property of the nervous system; strength, of the muscles. Muscles give us the
power to do work; the nervous system gives us the initiative to start it. Muscles
do their work upon carbohydrates, which are the characteristic nutritive con-
stituent of vegetable foods; the brain appears to require nitrogen, which can only
be obtained in a concentrated form from animal sources. If protein food, there-
fore, be regarded as a nervous food, a diet rich in it will make for intellectual
capacity and bodily energy, and it is not without reason that the more energetic
races of the world have been meat eaters.
It should be stated that Hutchison's theorizing concerning protein
versus nervous energy and brain work is, at present, simply his personal
opinion, not formed on exact observations. Mental work exercises no
direct influence on metabolism. The molecular changes which are char-
acteristic and lie at the foundation of all mental processes are neither
oxidation nor decomposition processes, or, if they are, they are too slight
in degree to be calculated by our present methods.
THKORIKS OF PROTK1X .M KTA HOLISM 205
In order to maintain the blood and muscles in a good physical con-
dition, an abundant supply of protein seems to be necessary, and by
promoting oxidation, it increases vigor and diminishes the tendency to
an undue accumulation of fat. The nervous system also requires a
plentiful supply of protein, if those mysterious influences which emanate
from the brain and spinal marrow are to be maintained with sufficient
potency to enable the tissues to ward off the inroads of disease. It is
claimed that persons who habitually live on a protein minimum con-
valesce very slowly after an acute illness, for the reason that, when their
tissues are broken down, they have no ready surplus of building mate.-
rial out of which to repair them. An increase in protein intake pro-
duces a rise in protein metabolism. This occurs to such an extent that
the organism is generally able to maintain itself in nitrogenous equi-
librium on the most diverse amounts of protein. This coincides with
the observation of von Noorden and others, that the body is unable to
store any excessive amount of protein.
These two observations are only two different ways of stating the same
fact. At first sight, the fact that the organism is able to break down as
much protein as is conveyed to it, appears not to agree with the law that
the degree of protein metabolism varies with tissue requirements and not
with the amount which is presented to the cells. The law is absolutely
true so far as the consumption of oxygen- and nitrogen -free substances
is concerned. The extraordinary variations in protein consumption,
which may, with a rise in the intake, reach to ten or fifteen times the
normal, have occasioned much uncertainty, so long as the degree of the
metabolism is regarded purely from the standpoint of protein metabolism.
"We all know the feeling of well-being which follows a meal containing
meat. Physiologists tell us that this condition of well-being is due to the
protein in the meat and not to its extractives, as it has been demonstrated
that the addition of extractives of meat to foods, such as bread, will not
produce this feeling of contentment and well-being. On the other hand,
oatmeal, which is rich in protein, is capable of bringing about, to a cer-
tain extent, this degree of well-being. A full meal of nitrogenous food
is an actual stimulant to the tissues of the body.
It has to be remarked concerning animal food that, while in the raw
state, it may be readily digestible with little or no previous mastication,
since massive pieces of it are readily attacked by the digestive juices,
this is much less true of animal food the proteins of which have been
coagulated and rendered less permeable by cooking. Yet the most indi-
gestible form of egg white is the raw liquid albumen ; it resists digestion
206 PROTEIN AND NUTRITION
so much that even a dog can utilize only 50 per cent of the nitrogen, the
balance being excreted in the feces. Large lumps of hard-boiled egg or
overdone meat may obstinately resist gastric digestion indeed, the rela-
tive digestibility of animal foods depends more upon physical consistence
than chemical composition ; beef is generally more indigestible than mutton,
and pork or veal than either, not so much by virtue of chemical compo-
sition as of physical consistence.
Americans are said to be the greatest meat eaters in the world. The
average American feels that he must have meat at least twice a day, and
. not a few of them are dissatisfied if they do not have some form of meat
at every meal. That this excessive meat consumption is injurious to a
great many people, and especially to those living sedentary lives, is attested
by the clinicians who are called upon to treat disturbances in nutrition
and metabolism. That a heavy meat diet is not necessary is amply
demonstrated by the experience of the Japanese soldiers in the war between
Russia and Japan (47), and is being demonstrated at the present time in
the European war, where the soldiers have been forced to accept a diet
that is almost wholly vegetarian. The testimony of those who are familiar
with conditions seems to indicate that the soldiers are much better off on
the vegetable diet than they were when they obtained a liberal supply of
animal food. May we not learn a lesson from the experiences of the
European soldiers which were brought about by force of necessity?
We believe it good advice to direct a liberal allowance of meat up to
middle life, or, to be more exact, to the thirtieth year, when it is no longer
necessary to have an alimentation for building more tissues or to promote
growth, but only to maintain an equilibrium of weight and strength.
From thirty to the thirty-fifth year a man should begin to restrict his
meats ; after thirty-five he should partake of meats less freely, more espe-
cially the red meats ; after forty-five he should eat meats sparingly ; after
fifty he should only eat very small portions of meat once a day. We are
satisfied that the American people would be better off by far if they had
50 per cent of the protein eliminated from the daily alimentation.
Man at maturity the thirtieth year from habits formed in early
life, habitually eats too much. The wholesome appetite of healthy child-
hood is strongly established and the pleasure of eating has become a
habit as fixed and inviolable as the "laws of the Medes and Persians."
Therefore, most men and women are inclined to eat too much and too
rich food that, although palatable, is indigestible. It is at this time
that indiscretions of diet are most frequently the cause of disorders of
digestion and assimilation. It is without question that we would be
THEORIES OF PROTEIN METABOLISM 207
satisfied with less aliment and more particularly much less protein than
we have been accustomed to ingest.
At this time of life the habit of only eating what is needed should
be acquired and the earlier habits of life should be broken. The average
man should limit himself to small portions and should make it a rule
not to have the second helping of any kind of food at a meal. This
general rule is, of course, subject to modification, for individuals en-
gaged in strenuous occupations require a somewhat more liberal dietary
allowance containing the ternary food elements. General practitioners
in agricultural districts frequently observe that farmers, during the
summer, when their occupation is most strenuous, eat very heartily.
Their work in the open enables them to consume and digest large amounts
of food. Unfortunately, during the winter months, when their work is
comparatively light, they continue the same habit and spend too much
time at the table and consume an inordinate amount of food as com-
pared with their activities. Such indiscretions at first cause slight gas-
tric disturbances, but later on chronic digestive disorders will result.
We have a suspicion that a vast number of ailments and disorders
of the stomach, nerves, liver and kidneys, not to mention gout, are to
be attributed simply to the overfeeding on meats. In the past, when
these dyspeptic and nerve-weary patients presented themselves, complain-
ing of drowsiness, debility, general disgust with life, etc. all due to the
ingestion of too much protein how often has the physician exhorted
them to eat plentifully ! Worse advice could not have been given. Chit-
tenderi, formerly a believer in a high protein diet, and particularly in
meat, has lately seen the error of the older views, and now believes in
and teaches a low protein diet. Accordingly, body weight, health,
strength, mental and physical vigor and endurance can be maintained
with at least one-half of the protein food ordinarily consumed; a kind
of physical economy which, if once entered into intelligently, entails no
hardships, but brings with it an actual betterment of the physical
strength, increased endurance, greater freedom from fatigue, and a con-
dition of well-being that is full of suggestion for the betterment of
health.
Whether the fatigue poisons come from the excessive exogenous
catabolism of proteins in general, or whether they are derived directly
in a measure from flesh foods, need not be considered here; the main
point is that by lowering the rate of protein catabolism, which neces-
sarily compels a reduction in the amount of flesh foods, there is a
diminished quantity of nitrogen waste floating about in the body. Fur-
208 PROTEIN AX I) NUTRITION
ther, we need not criticize too closely the method by which the reduction
of food is accomplished : whether it be by encouraging prolonged mas-
tication, with a view to better tasting and fuller enjoyment of the food,
to the point of involuntary swallowing; or whether it be by advising
our patients to follow natural impulses, mastication, taste and appetite
reenforced by the use of reason with a full appreciation of the principle
that the welfare of the body is best subserved by a quantity of food com-
mensurate with true physiological needs.
According to writers on dietetics, one principle in sitology which
has not received adequate recognition may be summed up as follows:
"The dietary standard varies not only with the condition of activity,
but also with the nutritive plane at which the body is to be maintained."
One may ask the question then, "What level of nutrition is most advan-
tageous ?" The answer is not easy, and it must be sought in metabolism
experiments and dietary studies; and it must also be sought in broader
observations regarding bodily and mental efficiency, general health,
strength and welfare.
According to the earlier views, the protein is built up from peptone
through synthesis in the wall of the intestine, since no other tissue in the
body has the power of causing peptone to disappear. Conheim teaches
that the peptone molecules vanish not because they are built up, but
because they are broken down. The site of this synthesis, according to
his opinion, is still uncertain, though he holds to the belief that the
intestinal wall is where protein synthesis begins. If a complete syn-
thesis of protein does take place in this intestinal wall, it must be a
neutral protein, that is, one that is found in the blood. We can hardly
conceive of the intestine synthesizing and delivering, in obedience to
reflex demands of the various organs of the body, just the particular
variety of protein (amino-acids) that is needed.
Lewis once taught that protein was built up from the fragments of
the food-protein molecule, not in the wall of the intestine, but in the
various organs of the body. If his theory is correct, then the blood
would carry molecular complexes of the lower orders from the intestine
to the organs sufficient for their local necessities, where these complexes
would be built up into the protein of the organs in situ, without having
to pass through the preliminary stage of conversion into neutral protein.
Von Noorden does not agree with this supposition, and holds that the t
organism is certainly able to convert even specific varieties of the pro-
tein of the organs into other kinds, and therefore would be able to build
up organ-protein out of neutral protein.
THEORIES OF PROTEIN METABOLISM 209
Beyond question, if the organism is able to interchange the proteins
of the tissues, which are distinctly, though slightly, differentiated, one
can well believe that it has the power to build lip specific kinds of pro-
tein out of the neutral protein of the blood. Through this physio-
metabolic process, the intestine would then hand on just half -manufac-
tured stuff made up out of the raw materials it received, but the organs
would perfect the work and produce the finished article.
We have seen, from the study of protein metabolism, that Jiydrolytic
cleavage precedes every metabolic transformation of protein inside the
body. This decomposition goes on in much the same way as it does in
the protein of the nourishment in the intestine. In the metamorphosis
of protein, decomposition would only be excluded supposing that it con-
sisted exclusively in the annexing of new groups in a growth of the
molecule. "The 'living molecule' of protein in protoplasm, as the bearer
of life, the agent and instigator of all body chemical changes, has to
enter into a temporary alliance with the lifeless combustible substances,
the dispensers of energy, in order to initiate and carry through their
oxidation, thus transferring to itself as living force their potential
energy. Thus its composition must vary at different moments according
to whether it has just annexed such combustible substances in order to
oxidize them, or has just given them off again after the combination."
If the accepted theory be that protein is not absorbed in the form
of peptone or proteoses, the query arises, "In what form is it absorbed ?"
If it is admitted that protein invades the blood stream in the form of
a molecule larger than the ammo-acids, proteose or peptone molecule, it
is .self-evident, according to Underbill of Yale(48), that
The intestine must be regarded as capable of synthesizing amino-acids into
protein. On the other hand, if amino-acids are regularly present in the systemic
circulation, the place of protein regeneration must be relegated to the cellular
elements of the different tissues.
Further :
The belief now generally accepted, as regards the protein requirements of the
organism, is that it is not so much the actual quantity as the quality of the pro-
tein supplied in the food which is of importance. If the material supplied be
uniform, it necessitates a fresh breakdown by each tissue, perhaps by each indi-
vidual cell. Although the tissues all probably possess the power of breaking down
protein material by means of their intracellular proteolytic enzymes, still the extra
work involved seems to negative the immediate resynthesis hypothesis, especially
when the hypothesis of the circulating digestion product postulates the presence
of the individual food material in the blood.
210 PROTEIN AND NUTRITION
The extensive researches of Foliu, Denis, Van Slyke(49) and Myer,
and later Abderhalden, have definitely proved the entrance into
the blood stream of the amino-acids, which once for all definitely estab-
lishes their function i.e., of being absorbed by the tissues without
undergoing any immediate chemical change. While this absorption is
rapid, it is never complete, the blood always containing a small quantity
of amino-acids. It would appear from this that there is an equilibrium
between the amino-acids of the blood and of the tissues. The way in
which the amino-acids are taken up by the tissues and held by them is
still an unsettled point.
These same investigators, in later researches, sought to determine
the ultimate fate of the amino-acids after absorption by the tissues, and
selected the changes occurring in the liver, where, after absorption, the
amino-acids rapidly disappear. Underbill offers several explanations
and suggests the following possibilities: (a) The amino-acids may be
excreted through the bile; (&) they may be transferred to other tissues,
though this is highly improbable, since none of the other large organs
show any great avidity for amino-acids; (c) the absorbed amino-acids
are synthesized into body protein in the liver, and (d) the amino-acids
are deaminized with formation of urea or ammonia.
The amino-acids disappear more rapidly and completely from the
liver than from other organs, such as the kidney, spleen, pancreas and
intestine. A most satisfactory summary of this whole subject has been
made by Van Slyke and Myer (49), which we give below in their own
words :
The amino-acids, with perhaps some peptids from the intestine, enter the circu-
lation from which they are immediately absorbed by the tissues. The power to
take them up from the blood stream is common to all tissues, but is limited. The
muscles of the dog, for example, reach the saturation point when they contain
about 75 mgm. of amino-acid nitrogen per 100 grams. The liver, however, con-
tinually desaturates itself by metabolizing the amino-acids it has absorbed, and
consequently maintains indefinitely its power to continue removing them from the
circulation so long as they do not enter it faster than the liver can metabolize
them. When the entrance is unnaturally rapid, as in our injection experiments,
or when the liver is sufficiently degenerated, as observed clinically in some patho-
logical conditions, the kidneys assist in removing the amino-acids by excreting
them unchanged. Death may result when the above agencies for preventing undue
accumulation of protein digestion products are overtaxed. In regard to the syn-
thesis of tissue proteins, it appears reasonable to believe that, since each tissue
has its own store of amino-acids, which it can replenish from the blood, it uses
these to synthesize its own proteins.
THEORIES OF PllOTEIN METABOLISM 211
From the research experiments of Van Slyke and Myer it may be
assumed, says Underbill, that
(a) The amino-acids serve as a reserve energy supply, like glycogen, or as a
reserve tissue-building material. In either case, the supply would fail unless con-
stantly supplied from the absorption from the intestinal wall. (6) The amino-
acids are intermediary products in both the anabolism and the catabolism of the
tissue proteins. In this case they could originate not only from absorbed food
products, but also from autolized tissue protein; starvation would not result in a
disappearance of the amino-acid supply of the tissues, and might even increase it.
In order to determine the correctness of either of these assumptions,
Van Slyke and Myer carefully analyzed the tissues of animals in vari-
ous stages of nutrition and concluded that the presence of free amino-
acids in the tissues hastened rather than retarded starvation.
In further summarizing, the investigators express themselves as
follows :
The amino-acids appear, therefore, to be intermediate steps, not only in the
synthesis, but in the breaking down of body proteins. Otherwise, in order to
explain their maintenance in the tissues during starvation, one would be forced,
contrary to the conclusions of all experimental work on the subject, to assume that
they are inert substances lying unchanged for long periods, even when most
urgently needed to build tissue or to supply energy. The maintenance of the
amino-acid supply by synthesis, from ammonia and the products of fats or car-
bohydrates, seems excluded. The supply of raw material in the form of fat and
carbohydrate nearly disappears during starvation, and the ammonia could origi-
nate only from broken-down protein, as the normal store of ammonia nitrogen is
only a fraction of that of free ammonia acids. These considerations, and the self-
evident wasting of starved tissues, point strongly to autolysis as the main source of
the free amino-acids of the fasting body.
The failure to increase the free amino-acid content of the tissues by high protein
feeding indicates, furthermore, that when nitrogen is retained in the organism, it
is not to an appreciable extent, as stored digestion products, but rather as body
protein.
From the foregoing it is no longer questioned that the amino-acids
are normally absorbed directly into the blood stream from the intestinal
epithelium and distributed to the tissues, and that each tissue rebuilds
itself from the mixture of amino-acids thus conveyed to it. Any excess
is changed into urea and carbonaceous residues by a process of deamina-
tion. Protein material catabolized in the tissues undoubtedly undergoes
a series of hydrolytic cleavages, resulting in the formation of amino-
acids, and the latter meet the same fate as those produced direct from
food protein.
212 PKOTEIN AND NUTKITION
Vegetable Protein. There is a prevalent belief that vegetable protein
is far more difficult of complete digestion than are albuminous substances
of animal origin, such as fish, flesh, fowl, milk and eggs. The popular
belief of the small percentage of vegetable protein utilized, which is not
without foundation, has furnished a strong argument against the vege-
table propaganda. Numerous research workers have determined experi-
mentally that the protein content of some vegetables, particularly the
coarser cereals and most of the common legumes, is very poorly absorbed.
Atwater and Bryant (50), experimenting along these lines, gathered
the following data :
CHARACTER OF THE DIET AND PROTEIN CONTENT UTILIZED
Character of Dietary Percentage of Protein
Utilized
Animal Food 97 per cent
Cereals 85
Legumes- dried 78
Vegetables .83
Fruits 85
Vegetable Food 84
Total Foods 92
There are several factors which might help to explain why the nutri-
ents of certain vegetable foods are more difficult of utilization than the
same elements from animal foods: (a) The low nitrogen content of
most vegetable foods requires their ingestion in relatively large amounts ;
(6) this increased bulk of vegetable food with its high cellular content
tends to hasten its passage through the intestinal tract, and thereby, to
a certain extent, reduce the chances for complete digestion and utiliza-
tion. In comparison with animal foods the vegetable foods may present
an unfavorable texture, especially in the older plants, in which the cell
walls may be quite tough and even supplemented with lignin.
There is abundant evidence that cellulose is not digested to any con-
siderable extent by the higher animals. Again, the vegetable membranes
are not always readily permeated by the digestive juices. Therefore it
is readily understood that plant cells should be thoroughly and effectively
comminuted and insalivated as a preliminary step to complete digestion
and assimilation.
We must not conclude from the foregoing that vegetable proteins
possess any inherent resistance to complete digestion and utilization by
the human organism. Mendel and Fine (51) have shown that the two
characteristic proteins of wheat, gliadin and glutenin, are as completely
absorbed and utilized as the nitrogenous components of fresh beef. The
THEORIES OF PROTEIN METABOLISM 213
same probably holds true for the protein content of barley, and to a
lesser degree for the proteins of corn. It is regrettable, however, that
no such reports are at hand for the isolated proteins of the legumes,
beans, lentils and peas.
The newer knowledge of the physiology of the amino-acids empha-
sizes the fact that each food product ought to be tested on its own merits
before any final pronouncement as to its availability and utilization is
made. Therefore it will be seen that a protein may be readily digestible,
and its digestion products easily absorbed into the blood stream; and
yet such a protein may be of inferior biologic value because of its failure
to yield all the amino-acids necessary for the nutritive functions of tissue-
growth jind repair. The test, to be conclusive, must be furnished by a
physiologic experiment rather than a mere chemical analysis.
\.\\A-K OF WHITE POTATO. Hindhede( 52) of Copenhagen was the
first to call attention to the physiologic value of the nitrogenous content of
the white potato. Its richness in starch has been long recognized and
has led to the inclusion of the potato in the group of carbohydrate foods.
Hindhede's research experiments were conducted on men, and were of
sufficiently long duration weeks, rather than days to give unusual sig-
nificance to the data collected. He was able, with white potatoes and
oleomargarin as the sole ingredients of the ration, to maintain a satis-
factory nitrogen balance.
The researches of Hindhede have recently been corroborated by Rose
and Cooper (53) at the department of nutrition of Columbia University.
The ration for their research experiments consisted of white potatoes
and clarified butter. Sufficient quantity was allowed to furnish the
requisite fuel value and the potatoes furnished all but 0.1 per cent of
the total nitrogen. The nitrogen balance was maintained for seven days
on a total nitrogen intake of 0.096 grams per kilogram. This report is
in harmony with other experiments in which the nitrogen equilibrium
has been maintained on potato nitrogen when the net available energy
supply was from 0.04 to 0.08 grams per kilogram of body weight, and
effectively demonstrates that the potato is a source of energy of high
nutritive efficiency in spite of the fact that only 63 per cent of the potato
nitrogen is reported to be in the form of protein.
The unusual prominence of the potato as a food both in Europe and
America is due to its palatable carbohydrate content. The researches of
careful investigators now emphasize its base yielding inorganic compo-
nents, and point out its useful function in maintaining the acid base
equilibrium of the body (54). The climax is now reached by a most
114
214 PROTEIN AND NUTRITION
favorable report on the high biologic value of the nitrogenous components
of a food that, heretofore, has rarely been regarded as having any sig-
nificance whatever as a source of nitrogen.
REFERENCES
1. VAUGHAN and WHEELER. Ed., J. Am. Med. Assn., Nov. 15, 1913.
2. KEMP, ROBERT COLEMAN. Diseases of the Stomach, Intestines
and Pancreas, 3d ed.
3. SMITH, E. E. Unpublished MSS. on Protein Poison ; see also The
Physiology of the Amino-acids, by Frank P. Underbill, of Yale.
4. KENDALL, I. A. In vol. i, chapter vii; see also I. A. Kendall's
Bacteriology, General, Pathological, Intestinal, pub. by Lea
and Febiger.
5. CHITTENDEN. Physiological Economy of Nutrition, New York,
1905.
6. . Ibid.
7. FISHER, PROF. IRVING. The Effect of Diet on Endurance, New
Haven, 1907.
8. VOIT. (Standard Table) Miinchen med. Wchnschr., vol. ix, 1807.
9. TREE. Brit. Med. J., 1904, p. 622.
10. BREMNER and HOWLAND.
11. LANE and GATHER WOOD.
12. HEAD, F., PLAYFAIR, L., and DARWIN.
13. RANKE, H. Ztschr. f. Biolog., Bd. xiii, p. 130.
14. AUZIMOUR. Resistance des Arabes, Montpellier, 1905.
15. MAUREL. Traite de 1'alimentation et de la nutrition, vol. i, p. 3,
Paris, 1905.
16. SHERMAN. Chemistry of Food and Nutrition.
17. FLINT. J. Anat. & Physiol., vol. xii, p. 91.
18. PAVY. Lancet, 1876.
19. ATWATER. U. S. Dept. of Agric., Bull. 18, and U. S. Dept. of
Agric.. Exper. Sta., Bull. 109, pp. 29, 30.
20. VON NOORDEN. Translated from the 1st ed. of von Noorden's
Pathologie der Stoffwechsel.
21. HUTCHISON. Food and Dietetics, 1st ed.
REFERENCES 215
22. CIHTTENDEN. Physiological Economy in Nutrition, pp. 51, 127.
23. HUTCHISON. Ibid., 2d ed.
24. . Chem. News, pp. 94, 104.
25. FOLIN. Am. J. Physiol., 1905, pp. 13, 117.
26. . Ibid., pp. 13, 131-132-136-137.
27. HALLIBURTON. Ann. Rep. on Progress of Chem., ii, pp. 215-218.
28. BENEDICT. Am. J. Physiol., pp. 16, 409.
29. MELTZEE. Science, pp. 25-481.
30. CHITTENDEN. The Nutrition of Man, pp. 160, 164, 227, 269.
31. MUNK (of Berlin). Virchow's Archiv., cxxxii, 96-102.
32. HINDIIEDE (of Denmark). Protein and Nutrition, London, 1913.
.'!'). r.NDERiiiLL. The Physiology of the Amino- Acids.
34. Si VEX. (In his standard work.) Skand. Arch. f. Phys., Bd. xi.
35. PESCHEL. Dissertation, Berlin, 1890.
36. HUTCHISON, ROBERT. Food and the Principles of Dietetics, Lon-
don, 1905.
37. OSBORNE and MENDEL. J. Biol. Chem., 1914; Med. Rec., 1914;
J. Am. Med. Assn., 1914.
38. WILLCOCK and HOPKINS. J. Physiol., vol. xxxv, p. 88, 1916.
39. HART and McCoLLUM. The Influence on Growth of Rations Re-
stricted to the Corn or Wheat Grain, J. Biol. Chem., 1914, 19,
373-397.
40. WHEELER. Proteins in Growth, Scientific Monthly.
41. MENDEL and FINE. Utilization of the Proteins of Wheat, J. Biol.
Chem., 1912, 10, 303; Utilization of the Proteins of Barley,
ibid., p. 345.
42. HOWE and HAWK. Utilization of Individual Proteins as Influ-
enced by Repeated Fasting, Eighth Int. Cong, of Applied
Chem., 19, 145.
43. HART and McCoLLUM. Influence on Growth of Rations Restricted
to the Corn or Wheat Grain, J. Biol. Chem., 1914, 19, 373-397.
44. OSBORNE and MENDEL. Comparative Nutritive Value of Certain
Proteins in Growth, J. Biol. Chem., 1915, 20, 351.
45. . Carnegie Inst. Pub., 1911, p. 156.
46. HUTCHISON. Foods and Dietetics, p. 174, London, 1911.
47. LEWIS, H. EDWIN. Editorial, Am. Med.
48. UNDERIIILL. The Physiology of the Amino-Acids.
49. VAN SLYKE and MYER. J. Biol. Chem., 1912, pp. 197 and 231.
50. ATWATER and BRYANT. Rep. Storrs Agric. Exper. Station, 1899,
p. 86.
216 PROTEIN AND NUTRITION
51. MENDEL, L. B., and FIXE, M. S. Studies in Nutrition (a) The
Utilization of the Protein of Wheat, J. Biolog. Chem., 1911,
vol. x, p. 303; (6) The Utilization of the Proteins of Barley,
ibid., p. 339; (c) The Utilization of the Protein of Corn, ibid.,
p. 345; (d) The Utilization of the Proteins of Legumes,
ibid., p. 433; (e) The Utilization of the Proteins of Cotton-
seed, ibid., 1912, vols. i, ii and vi.
52. HINDHEDE, M. Untersuchungen iiber die Verdaulichkeit der Kar-
toffeln, Ztschr. f. phys. u. diatet Therap., 1912, 16.
53. ROSE, MARY S., and COOPER, LENA F. The Biological Efficiency
of Potato Nitrogen, J. Biol. Chem., 1917, 30, 201.
54. BLATHERWICK, N. R. The Specific Role of Foods in Relation to
the Composition of the Urine, Arch. Int. Med., Sept., 1914,
p. 409.
BIBLIOGRAPHY
ARMSTRONG. The Simple Carbohydrate and the Glucosides.
ATWATEB. Methods and Results of Investigations on the Chemistry and
Economy of Food.
and BENEDICT. Comparison of Fats and Carbohydrates as
Protectors of Body Material, U. S. Dept. of Agric., Office of Exper.
Stations, Bull. 136, pp. 176-187.
BENEDICT. The Influence of Inanition on Metabolism, Carnegie Institu-
tion of Washington, Publication No. 77.
CATHCART. The Physiology of Protein Metabolism, 1912.
CHITTENDEN. Physiological Economy in Nutrition; The Nutrition of
Man.
. The Nutrition of Man.
FOLIN. Am. J. Physiol., 1905, 13, p. 45.
. Intermediary Protein Metabolism, J. Am. Med. Assn.,
1914, 63, p. 823.
GLIKIN. Chemie der Fette, Lipoide, und Wachsarten.
HAMMARSTEN. Text-book of Physiological Chemistry, 1914.
HARPER and PETER. Protein Content of the Wheat Kernel, Kentucky
Agric. Exper. Sta., Bull. 113, 1905.
KAJIURA. The Proteins of Rice, Biochem. J., 1912, vol. vi, pp. 171-181.
LIEBIG. Complete Works on Chemistry, 1856.
BIBLIOGRAPHY 217
LTSK. Elements of the Science of Nutrition.
. Elements <f the Science of Nutrition.
MENDEL. Theorieii des Eiweissstort'wechsels nebst einigen praktischen
Konsequenzen derselben. Ergebn. d. Physiol., 1911, 11, p. 418.
- and FINK. The Utilization of the Proteins of Corn, J. Biol.
Chem., 1911, vol. x, pp. 345-352.
. The Utilization of the Proteins of Wheat, ibid.,
pp. 303-325.
OSBORNE. The Vegetable Proteins.
- and MENDEL. Nutritive Properties of Proteins of the Maize
Kernel, J. Biol. Chem., 1914, vol. xviii, pp. 1-16.
. Amounts and Properties of the Proteins of the Maize Ker-
nel, J. Am. Chem. Soc., 1897, vol. xix, pp. 525-532.
. The Nutritive Value of the Proteins of Maize, Science, Jan.
31, 1913, vol. xxxvii, pp. 185-191.
- and MENDEL. Feeding Experiments with Isolated Food Sub-
stances.
PLIMMER. The Chemical Constitution of the Proteins.
SIVEN. On Protein Requirement, Skandin. Arch. f. Physiol., 10, 91 ;
11, 308.
VON NOORDEN. Metabolism and Practical Medicine, vol. i, pp. 283, 383.
CHAPTER VIII
THE SIGNIFICANCE OF LIPOIDS AND VITAMINES IN
ANIMAL METABOLISM
IN COLLABORATION WITH
A. BRUCE MACALLUM, A.B., M.D.
Lipoids: Nitrogenous Importance of Lipoids; Lipoids ia Metabolism;
Bio-electric Potentiality of Lipoids.
Vitamines: Nature of Vitamines; Isolation of Vitamines; Physiological
and Pharmacological Properties of Vitamines; Destructive Action of
Heat on Vitamines; Antineuritic Vitamines; Vitamines in a Well-
balanced Dietary; Role of Vitamines in Metabolism; Vitamine Con-
tent of Foods; Foodstuffs Containing Vitamines and Their Anti-
neuritic and Antiscorbutic Qualities; Relation of Phosphorus Content
to Vitamine Content of Foodstuffs; Vitamines and Pellagra.
LIPOIDS
Nitrogenous Importance of Lipoids Proteins and lipoids form the prin-
cipal component parts of all living cells. Living protoplasm is a mixture
of substances and solutions, of a non-homogeneous nature, slightly miscible
with each other. Consequently there is a substratum of colloidal ma-
terial, together with simpler substances of a water soluble nature with an
affinity for the colloidal material. It is the oxidation of these substances in
aqueous solutions, rather than the colloidal material itself, which liberates
the energy manifested in the organism, but the colloidal material makes
the conditions and supplies the enzymes which control the energy-yielding
oxidations and other metabolic processes. The colloidal materials are pro-
duced by polymerization from substances fats, amino-acids and salts in
solution supplied to the cells, but the lipoids are a sine qua non to enable
most of these substances to enter the cells. Besides, the lipoids are of such
importance in the process of nutrition, and together with protein exert
such a prominent role in all life's processes, that we deem them of suf-
ficient consequence to call attention to their essential activities in the sev-
219
220 SIGNIFICANCE OF LIPOIDS AND VITAM1NES
eral phases in metabolism. They are absolutely indispensable to man and
a constant supply is essential to the organism.
The lipoids(l) are a group of organic nitrogenous substances com-
prising the phosphatids, cerebrosids and cholesterin. The phosphatids
contain phosphorus, an organic base, and a fatty acid radicle in their
molecule. The members of this series are lecithin, cephalin and cuorin.
They are widely distributed in both animal and vegetable cells, but are
especially abundant in the yolk of eggs, fish roe, brain tissue, yeast, blood
and bile. They are also found to a lesser extent in cereal grains, legumes
and beet root. The cerebrosids are isolated almost entirely from brain and
nerve tissue. These do not contain phosphorus and yield galactose upon
hydrolysis with dilute mineral acids. Cholesterin is an unsaturated sec-
ondary alcohol, is universally present in animal and vegetable tissue,
and is most abundant in bile, yolk of eggs, nerve tissue and wool fat, and
found abundantly in wheat, barley, beans, peas, lentils, cariots, peanuts
and beets.
Lipoids in Metabolism. The importance of the lipoids in mammalian
nutrition is illustrated by the fact that the growth of the brain is directly
proportionate to the lecithin content of the mother's milk. A number of
investigators have asserted that the lipoids are essential for the main-
tenance of life and growth, but when lipoids in a comparatively pure
state are added to lipoid free diets, no beneficial results follow. In these
cases where the lipoids were extracted from the food before feeding it to
animals, the vitarnine fraction was removed along with the lipoids and for
this reason the purified lipoids gave no relief to the symptoms resulting
from the use of the lipoid free diet. Cholesterol is also an essential factor
in metabolism, as Landers' (2) experiments prove that it cannot be syn-
thetized by the mammalian animal tissue and it is promptly incorporated
from the diet and tenaciously retained by the body when animals are on
a lipoid free diet. He demonstrated anew that pure cholesterol added to
a lipoid free ration resulted neither in increment of growth of the young
nor maintenance of life. Fowls on the other hand can synthetize lipoids
or tjieir mother substances from a lipoid free diet(3). The lipoid group
in the normal diet, apart from its function as a source of absorbed vita-
mines, is of importance in replacing the lipoid deficiency following the
lipoid catabolism.
Lipoids are easily permeable by substances soluble in fat, but it is with
the greatest difficulty that they are permeated by solutions of salt, sugar
and similar substances. The ammo-acids are lipoid solvents (4) and their
method of entering the cells is through the lipoid spaces in the outer layer
VITAMINES 221
of the plasma membrane of the cells. Meyer is the authority for the state-
ment that these peculiar lipoids which intersect and surround the living
protoplasm with walls of froth, so to speak, are of decisive importance in
the life and functions of the cells. It is claimed that their presence pre-
vents a fusion of the innumerable particles of the cell, and at the same
time they protect it against a too rapid ingress and egress of water, as well
as against invasion by salts and other substances dissolved in the blood
and organic fluids. Besides this, they possess another function of acting
as a sort of sieve for all the substances soluble in fat, and for those which
dissolve in them more readily than water.
Bio-electric Potentiality of Lipoids. According to Loeb and Beutner(5)
the lipoids confer on the cells the property of bio-electrical potentiality.
Lillie(G) has shown that the cells owe the property of irritability, or the
power of responding to the various stimuli, to the lipoids. Therefore,
the great importance of the lipoids in the organic processes of the dells
becomes apparent to the student of tropho-dynamics. Moreover, it is in
accord with Schauman's phosphorus-deficiency theory of beriberi, pel-
lagra and other deficiency diseases.
VITAMINES
Nature of Vitamines. Vitamines is a term first applied by Funk(7)
to certain substances of undetermined structure which occurred in the
outer parts pericarp of cereals, and we are especially indebted to him
for pioneer work in lliis particular field. Cooper (8) holds that vita-
mines are neither proteins, fats nor lipoids, and there is no evidence that
they are carbohydrates; so they cannot yet be classed with either protein,
carbohydrate, fats or salts, though the teaching at the present time seems
to suggest that they may enter into the molecule of certain lipoids. This
belief is emphasized by Carl Voegtlin(O), who has done considerable ex-
perimental research on the subject. Some investigators are inclined to the
opinion that there are different vitamines which are active in preventing
disease one for beriberi, one for scurvy, one for pellagra, etc. Vita-
mines are present in foodstuffs in such exceedingly small amounts that
they cannot, it seems, have any caloric value, and yet they are positively
essential to health, growth and development.
Isolation of Vitamines. We are indebted to Funk (10) for first devis-
ing a method of obtaining the antineuritic vitamine in a more or less pure
form of very powerful physiological activity. He was able to isolate a crys-
talline substance, a few milligrams of which administered to a polyneuritic
pigeon (experimental beriberi) led to a complete recovery of the paralytic
222 SIGNIFICANCE OF LIPOIDS AND VITAMINES
symptoms in a very few hours. According to Funk, this crystalline sub-
stance seems to have a melting point of 233 C., and, on analysis, contains
carbon, nitrogen, hydrogen and oxygen. It is regrettable, though, owing
to defective methods, that the yield in this active substance is very poor,
only a very minute quantity being obtained from hundreds of pounds of
natural foods, rich in these accessory bodies.
At the present time the antiscorbutic vitamine has not been isolated,
and about all that is known to-day is that it is fairly stable in acid media
which probably accounts for the popularity of lemon juice as an antiscor-
butic. For the same reason milk, having an amphoteric reaction, on being
heated for a considerable time to a temperature exceeding 212 F., loses
its antiscorbutic properties, and when forming the exclusive diet for chil-
dren may give rise to the appearance of infantile scurvy.
Physiological and Pharmacological Properties of Vitamines The physio-
logical and pharmacological properties of the vitamines have not been
studied extensively. The principal points which have been established are
that they do not possess toxic properties, and that even in remarkably in-
finitesmal amounts, they relieve the symptoms of deficiency disease in
both man and animals.
Funk (11), Braddon and Cooper (12) have recently pointed out the
interesting relation between carbohydrates and the antineuritic substances.
They found that in order to prevent the occurrence of polyneuritis (ex-
perimental beriberi) in pigeons, it was necessary to administer to the bird
an infinitesmal quantity of antineuritic substance for each gram of car-
bohydrate in the diet of the pigeon. It was further found that when the
carbohydrate component of the pigeon's diet was increased, the vitamine
content also had to be increased accordingly. These discoveries emphasize
the earlier observations, that a diet rich in cabohydrate is more apt to give
rise to the appearance of the symptoms of beriberi than a diet poor in car-
bohydrate.
The table on page 226, from Voegtlin(13), graphically illustrates the
relative vitamine content of foods, showing in the order arranged the foods
that are richest in both the antineuritic and antiscorbutic vitamines. It is
not intended that this table be taken as absolutely accurate, but, at the
present time it is as accurate as the present state of our knowledge will
permit, and may be of value in helping to elucidate the question of the
proper selection of foods to constitute a satisfactory dietary for the de-
ficiency diseases.
Destructive Action of Heat on Vitamines. From the conclusions of
research workers in this particular field of biology, we may assume that
VITAMINES 223
the antineuritic vitaniine is present in foods in a combined form, which is
much more resistant than the free curative substance. This is of momen-
tous importance as, in the process of cooking, the food is subjected to a
temperature of 212 F., but beyond this degree up to 266 F. for any con-
siderable length of time, the vitamines are completely destroyed. Vita-
mines are fairly susceptible to temperatures above 100 C. (212 F.).
Various experiments (14), conducted on both man and animals, show
that the prolonged heating of foods to a temperature of 120 C. (270 F.)
for one to three hours will destroy most of the physiological activity of the*
vitamines originally present in the foods. Funk has recently experimented
with canned beef, and found that when fed to a dog to the exclusion of all
other aliment, the animal died in two weeks' time.
Antineuritic Vitamines. Funk, who has done more work on this sub-
ject than any other investigator, succeeded in obtaining a small quantity of
antineuritic vitamine from dried ox-brain; later Voegtlin and Towles
succeeded in demonstrating its presence in crude extracts from the spinal
cord. It would appear probable, therefore, that the antineuritic substance
forms an essential part of the nerve cell and fiber, and that its presence in
nerve tissue in sufficient amount is essential for proper function of the
spinal cord. Degeneration of the nerve tissues will take place whenever
the vitamine content of the nerve tissues is depleted through a dietary
deficient in vitamine. Voegtlin (15) has emphasized the fact that lipoids
and antineuritic vitamine are proportionately distributed throughout the
body, possibly due to the lipoid solubility of the antineuritic vitamine.
The animal body seems to have a peculiar tenacity for holding on to its
vitamine supply, for the latter author quoted says:
If we change the diet of man from one sufficient in vitamine to one deficient in
vitamine, we find as a rule, it takes several weeks or even months before obvious
and well-defined symptoms of deficiency diseases appear. One might ask why the
body does not react more rapidly to a deficient diet. Apparently the initial vita-
mine content of the body, which in absolute terms probably amounts to only a few
grams in a person weighing 100 pounds, is not easily used up or eliminated together
with their excretions. The catabolism of vitamine, if there is such a thing, must
be extremely slow. If vitamines do occur in the colloidal state, and a number of
facts seem to prove this assumption, it is very likely that certain other body colloids
may fix vitamines in the tissue fluids by means of absorption.
Traube(16) has attempted to show that certain alkaloids with very
powerful and prolonged physiological action occur in the form of colloids.
The fact that these substances are colloidal may be one of the reasons for their
powerful physiological activity, especially as the recent teachings of bio-chemistry
224 SIGNIFICANCE OF LIPOIDS AND VITAMINES
seem to support the view that life itself is largely dependent on the colloidal state
of living matter.
Vitamines in the Well-balanced Dietary. Ever since Stepp(lY) dem-
onstrated that the growth-promoting element in the diet could be removed
by extraction with alcohol, the lipoids, which constituted the bulk of the
extract, were supposed to be the factors which enabled the animal body
to attain adult size and weight. The subsequent researches of Funk on
the etiology of beriberi revolutionized some of the current conceptions
of nutrition and indicated a new avenue of approach towards the solu-
tion of animal growth. The plan, which proved so successful in the
antineuritic investigation, was applied to the elucidation of the growth
problem (18). The experimental evidence accumulated since then is now
sufficient to substantiate the vitamine theory in regard to this important
phase of animal physiology.
Stepp also has advanced the opinion that vitamines and lipoids are
the two essential factors in nutrition during the growth period(19).
The physiological activity of these growth-inducing fractions from yeast
and pancreas depreciates with each successive step in the preparation
of the active fraction, as in the case of antineuritic vitamine; and con-
siderably larger quantities are necessary to enable the animal to attain
its customary growth increment than are required to effect a cure in
the case of polyneuritic pigeons. These growth "vitamines" or "acces-
sories" do not in themselves directly stimulate the growth of the animal
cell. Their action in this respect consists in each and every specific
vitamine being present in a diet otherwise adequate, and playing their
part in maintaining the metabolic equilibrium. In this way the main-
tenance of the normal physico-chemical conditions is established, since
the nucleus and protoplasm of the animal cell possesses the inherent
capacity to grow and reproduce when adequately nourished. It is yet to be
proved that there is any factor in the diet which alone can bring about
growth of any animal cell for lengthy periods, in the strict sense of the
term "specific growth substance."
Careful experimental research has emphasized the fact that each indi-
vidual needs a different amount of food, which will vary according to his
structure and surroundings; he will need certain types of protein, carbo-
hydrates, fat and salts, in addition to water, and finally he must have
other substances, generically called vitamines, if he is to show physical
growth.
Role of Vitamines in Metabolism. The study of dietetics from the
point of view of the vitamines has only just begun, and the exact role they
VITAMINES 225
play in metabolism lias not yet been elucidated, but it has been clearly
demonstrated that certain deficiency diseases are due to the lack of certain
accessory foods. Pellagra, beriberi, scurvy and other deficiency diseases
are to be controlled or prevented through the administration of the proper
foods containing the adequate vitamiries(20). A number of foods and
dietary rules for use in order to prevent these deficiency diseases have
been outlined in these pages (21). In any institution where bread is the
staple article of diet, it should be made from whole-wheat flour. Rice
used in any quantity should be of the brown undermilled variety. Beans,
peas or other legumes known to prevent beriberi, should be served at least
once a week. Canned beans or peas should not be used. Some fresh vegeta-
ble or fruit should be issued at least twice a week, and barley, a known pre-
ventive of beriberi, should be used in all soups. Corn meal should be of
water-ground variety, i. e., made from the whole grain. White potatoes
and fresh meat should be served at least once a week, preferably once daily,
as they prevent scurvy and beriberi. The undue use of canned goods
must be carefully avoided (22).
Fortunately, in this country, the majority of the inhabitants live on a
fairly well mixed dietary, and thereby escape outbreaks of beriberi and
scurvy. According to the opinion of Dr. Carl Voegtlin(23), of the United
States Public Health Service, who has conducted extensive research along
this line of experimentation, it seems fairly well established that the sub-
stances preventing beriberi are present in the natural foods largely in a
combined form, which is soluble in 90 per cent alcohol or water, and when
present in sufficient quantity in the alimentation will prevent the occur-
rence of beriberi.
This mother substance can be split off by acid hydrolysis or autolysis, by means
of enzymes yielding after fractionation a substance with very powerful curative
property, which if given patients suffering from beriberi, will relieve the distress-
ing symptoms in a very few days.
At the present time very little is known of the chemical nature of the
mother substance of this beriberi vitamine. It is interesting to note that
the latest researches seem to point to the fact that foods rich in lipoids are
also rich in vitamines, and the observations of Sullivan and Voegtlin(24)
call attention to the fact that "the solubility of the mother substance
of the nntineuritic substance in alcohol, might lead to the belief that vita-
mines enter into the molecule of certain lipoids." They also hold that the
antineuritic vitamine is probably not in combination with carbohydrates,
since the starchy part of all cereal foods seems to be very poor in this sub-
226 SIGNIFICANCE OF LIPOIDS AND VITAMINES
stance. Some competent observers hold to the view that certain parts of
the protein molecule, more especially the nucleic acids, may possibly hold
in combination the active "accessory substances," but this is still an un-
settled question. The fact that foods rich in nucleated cells are also rich
in antineuritic substance, might, perhaps, be accepted as evidence of the
truth of this assumption.
Vitamine Content of Foods. Vitamines are contained in varying pro-
portions in all food products, some food constituents being rich in them
and others very poor. Again, in other foods, the vitamine is abstracted
or destroyed in the various processes of preparation and cooking. An
ordinary mixed diet contains enough vitamine to sustain nutrition. Un-
less the food contains sufficient vitamine principles, no matter how large
quantities are consumed, there will be malnutrition. This is the case
among the poor, who consume large quantities of food which is neither
proportionately balanced nor sufficiently varied to furnish the requisite
vitamine content. For this reason diseases of malnutrition are common.
The animal body is unable to produce the known vitamines from vita-
mine-free food. All the higher animals, including man, according to
Voegtlin(25), get their vitamine supply directly or indirectly from the
vegetable kingdom. Plant life synthetizes the vitamine, and man obtains
the required vitamine supply by partaking either of animal or vegetable
food. The cow stores up vitamine in her body from grasses, grains and
fodder, which she consumes. A portion of it is excreted in her milk, sup-
RELATIVE VITAMINE CONTENT OF FOODS
ANTINEURITIC PROPERTIES
ANTISCORBUTIC PROPERTIES
Relatively Rich
Relatively Poor
Relatively Rich
Relatively Poor
Brewer's yeast
Sterilized milk
Fresh vegetables
Dried vegetables
Egg yolk
Sterilized meat
Fresh fruits
Dried fruits
Ox heart
Cabbage
Raw milk
Sterilized milk
Milk
Turnips
Raw meat
Canned meat
Beef and other fresh
Carrots and other veg-
Cereals sprouting
Dried cereals
meat
etables of this type
Pork fat
Fish
Highly milled cereals
Starch
Beans
Starch
Molasses
Peas
Pork
Corn Sirup
Oats
Molasses
Barley
Corn Syrup
Wheat
Corn and other cereals
V1TAMIKES 227
plying the calf with necessary vitamine, and at the same time furnishing
a valuable source of vitamine for man. The hen derives vitamine from
the cereals she eats, and transfers a part of it to the eggs she lays. The
vegetable kingdom, therefore, furnishes the vitamine supply so essential
to animal life, and the plant laboratory builds up vitamine from simple
inorganic compounds.
A careful study of the table on page 226 shows that a mixed diet can be
outlined which will include sufficient animal foods, such as fresh milk,
eggs, meat and a variety of fresh vegetables containing sufficient anti-
neuritic and antiscorbutic substances to make a satisfactory well-balanced
mixed dietary. Ordinarily the dietary habits of the major portions of the
population of this country are such that sufficient fresh animal and
vegetable foods are consumed to overcome any deficiency of vitamines in
the diet.
Prior to 1878 wheat and corn were ground on the old-fashioned buhr
millstones ("water-ground") to the desired degree of fineness. The result-
ing wheat flour or cornmeal, from which the coarser particles of bran .were
partially sifted out, was then used for making bread. Such bread con-
tained 1.75 per cent cereal salts, all that was in the grain when it left the
harvest field, while the new patent roller-process flour of to-day contains
0.44 per cent mineral matter. During the past five or six decades the mill-
ing industry has completely revolutionized the grinding of grains. By
means of the patent roller-process it has been made possible to separate
the various parts of the grain, the germ and the bran, from the endosperm,
or starchy part, which could then be ground to the desired fineness, and
which, on account of its whiteness, appealed to the public as an assum-
ably purer product. It is admitted that the "highly milled" wheat flour
and corn meal obtained by the patent roller-process are superior, so far
as looks and keeping qualities are Concerned, to the old-fashioned water-
ground products ; but at the same time, unfortunately, this modern method
of milling deprives the finished products of some of the most valuable
food constituents of the grains. The Bureau of Chemistry of the Depart-
ment of Agriculture and the Hygienic Laboratory have made a large num-
ber 1 of analyses of highly milled wheat flour and corn meal, which clearly
show that the highly milled wheat fkmr and corn meal contain less protein,
less fat and less cereal salts than the old-fashioned water-ground product. 1
The highly milled products from wheat, corn and rice are deficient in
the essential accessory food substances, vitamines, which, as previously
Sec Corn, Corn Products and Grinding, Volume I, Chapter XIII, pages 392-396.
228 SIGNIFICANCE OF LIPOIDS AND VITAMINES
pointed out, are contained in the intact kernel in the outer pericarp, or
aleurone layer, and probably also in the germ or embryo. As pointed out,
the modern roller process eliminates, to a great extent, the bran and gerrn,
and as a result the highly milled product, as might be expected, is de-
ficient in vitamines, which assumption has been amply proven by recent
investigations conducted by Funk and his coworkers, and later by Myer
and Voegtlin of the Public Health Service(26).
Foods Containing Vitamines and Their Antineuritic and Antiscorbutic
Qualities. Laboratory experimentation (27) has proved that butter-fat
promotes the normal growth of young rats, while, under the same dietary
conditions, lard and some other fats fail to do this(28). Therefore, the
question has arisen, "What is the special constituent of the butter fat
which aids normal growth and development?" Osborne and Mendel(29)
question the presence of nitrogen and phosphorus in the butter-fat used
in their feeding experiments, McCollum and Davis (30) question the ab-
sence of nitrogen and phosphorus from this fat, and Otto Folin agrees
with the latter, stating that there was extracted a trace of nitrogen equal
to 0.2 mg. from 10 grams of butter-fat. Funk and Macallum(31) suc-
ceeded in obtaining nitrogen from centrifuged butter-fat, in small amount,
equal to 31 mg. nitrogen (16.8 14.0 mg.) from 12 kilograms of butter-
fat. Gies, of New York, reports that from 21.3 grams of butter-fat he was
able to isolate phosphorus in infinitesmal amount. From the researches
of Funk, Osborne, Mendel, Davis, Macallum and their followers, butter-
fat undoubtedly contains a growth promoting substance which may be an
accessory food substance or vitamine. It is a well-known fact that butter
contains about 15 per cent of buttermilk (see analysis, "Volume I, Chapter
XII, page 336), which is rich in both phosphorus and nitrogen. This
growth-promoting substance in butter-fat belongs, in all probability, to
the same class of so-called "accessory dietary constituents." We do not
know at the present time whether or not this substance is identical with
some vitamines, but the presumption is that this is the case. Later re-
searches demonstrate, however, that butter-fat possesses no antineuritic
vitamine, and that its action is in part antiscorbutic, in addition to a sec-
ond factor as yet indefinable (32).
Rice has long been regarded as an etiological factor in the causation of
beriberi, and modern research and clinical experimentation has at last sat-
isfactorily settled the question affirmatively. As previously stated (Vol-
ume I, Chapter XIII, page 391), the rice grain contains an outer cover-
ing or chaff, beneath which is a husk or pericarp surrounding the subperi-
carpial or aleurone layer, which in turn encloses the main central part of
VITAMIXES 229
the grain or endosperm, consisting chiefly of starchy matter. The vita-
mines are present in the snbpericarpial or aleurone layer. The vitamine
is a nitrogenous substance, but lacking in phosphorus. It is soluble in
water, alcohol and dilute acids. It is undoubtedly destroyed by heat above
212 F. Machine polished rice consists solely of starchy endosperm,
the pericarp, subpericarpial or aleurone layer being completely removed in
the polishing processes. This rice is the ordinary commercial white rice,
and is devoid of vitamine, and birds fed on such rice will rapidly develop
polyneuritis, which will prove fatal. Human beings subsisting on a die-
tary composed largely of polished rice will develop beriberi, unless the
other adjuvants of the diet supply the requisite amount of vitamine. Rice
from which the husk or chaff is removed by steaming or treatment with
hot water (parboiled rice), subsequently rubbed in a mortar by hand and
afterwards prepared for human consumption, will not produce beriberi,
for the reason that during the crude method of milling, a large percentage
of the subpericarpial or aleurone layer, which contains the vitamine sub-
stance so essential to the dietary, is left adherent to the grain.
According to Wilcox(33) :
In animals in whom polyneuritis or beriberi has been caused by feeding on pol-
ished rice, the symptoms quickly clear up if the native unhusked rice i. e., the rice
from which the husk has not been removed by previous treatment with steam or
hot water is substituted for the polished rice. Instead of this, the addition to the
polished rice of an extract of the rice polishingB will have the same beneficial effect,
the katjang idjoe bean also contains anti-beriberi vitamine and its addition in
amount of ?,- Ib. a day to a polished rice diet will prevent beriberi in natives.
F. Gowland Hopkins (34), in his recent researches to determine the
important part played by vitamines in metabolism, has confirmed the con-
clusions of Funk(35), Fraser, Stanton, Eykman and Cooper of definitely
establishing the important fact that beriberi is essentially a deficiency dis-
ease. Modern clinical research on metabolism has conclusively proved
that a diet of pure protein, fat and carbohydrate, with a due allowance of
proper admixtures of salts and water, is not sufficient to maintain health,
though the quantity allowed may be theoretically correct. A growing
animal fed on the above ternary food principles with proper mineraliza-
tion will cease to grow and will develop some deficiency disease, such as
beriberi, scurvy, etc. Some other addition to the dietary is vitally in
sary, if the animal is to maintain health and thrive. Many natural f< .<><]<
contain these essential substances which need only l>e present in the most
minute amount, in order to make the diet amply sufficient for growth and
health. Yea*!, for instance, is a substance which is perhaps richest in
115
230 SIGNIFICANCE OF LIPOIDS AND VITAMINES
vitamine. The yolk of eyys, brain, liver, kidneys, sweetbread, oatmeal,
haricot, beans, peas, etc., are all fairly rich in this vitamine substance,
while milk and fresh meat contain vitamines in smaller amounts. The
subpericarpial or aleurone layer of rice is richer in organic phosphorus
than the endosperm, and, as a result, it has been found that rice poor in
phosphorus is more likely to cause beriberi (polyneuritis of fowls) than
whole rice.
A dietary deficient in these accessory substances gives rise to beriberi,
which is a disease of the peripheral nervous system, prevalent in eastern
countries, Japan and the Philippines, where the inhabitants subsist almost
entirely upon a diet composed largely of highly milled "polished rice."
It is believed that even in our own country an alimentation composed
almost entirely of foods from highly milled wheat- "patent roller-process
flour," would produce beriberi in ninety days; in fact, Little(36) reports
an outbreak of beriberi among the fishermen of Newfoundland, who sub-
sisted mainly upon alimentation composed largely of highly-milled pat-
ent roller-process flour. It is known that beriberi does not develop in
persons living on foods made from whole-wheat flour or from whole rice.
In other words, as previously pointed out (Volume I, Chapter XIII, page
377), the outer portions of both the wheat and rice grain, namely, the
subpericarpial or aleurone layers, contain the "accessory substances" or
vitamines which are so essential to the dietary for the prevention of
disease of the peripheral nervous system (beriberi and pellagra). Like-
wise research by competent observers in cases of scurvy has established
the fact that beriberi is not due to a deficiency of the ternary elements
of the dietary proteins, fats and carbohydrates, but to certain accessory
food substances highly essential to life lacking in the alimentation.
Consequently beriberi, pellagra and scurvy are referred to as deficiency
diseases. (See chapter on Deficiency Diseases, Volume III, Chapter
XVII.
The consensus of opinion of research workers in deficiency diseases,
Fraser and Stanton(37), Strong and Crowell(38), in the Philippines,
Van Leent(SO), Vorderman(40), Takaki(41), Fletcher(42), Highet
(43), Heiser(44), Theze(45), Chamberlain (46), Vedder(47) and others,
since the appearance of Funk's work on the vitamines, is that beriberi is
a disease caused by dietary deficiency resulting from faulty metabolism,
due to the lack of the vital accessory food substances to which Funk gave
the name "vitamines."
Working along this line of research, Williams (48) and Seidell have
found that a similar isomerism existing in these substances also exists in
VITAMINES 231
the vitamine of yeast, and is primarily responsible for the instability of
these compounds, which has so far prevented their isolation. Adenin is
the purin base in yeast, which has this property of isomerism. With re-
gard to the antinenritic vitamine, Vedder has proposed the hypothesis that
this chemical substance acts as a building stone of the complex structure
of the nervous tissue, without which it cannot be repaired.
All of the foregoing investigators have succeeded in obtaining from
rice polishings a chemical substance which in doses of a few milligrams,
was capable of curing fowls suffering with polyneuritis induced by a diet
of overmilled rice.
When a deficiency of vitamine exists, the nervous tissue becomes first exhausted,
and then degenerated until finally the symptoms of polyneuritis appear in fowls
or dry beriberi in man. This theory is based on experimental observations in man.
Thus Vedder and Clark (49) found that the mitochondria in the nerves
of fowls showed definite changes after seven days on a diet of polished
rice, and long before the fowls showed any clinical symptoms of poly-
neuritis, and these changes were progressive the longer the deficiency lasted
until evident degeneration could be demonstrated. Chromatolysis and
changes in the tigroid substance of the cells of the cord, similar to that
observed in pigeons which have been exhausted by long flights, may also
be demonstrated in birds which have developed polyneuritis.
The antineuritic vitamine is the only one of the accessory food substances con-
cerning which there is sufficient evidence to even theorize concerning its action in
the body, and more work will be needed before any adequate conception of the
physiological action of the vitamines will be known. The study of beriberi, scurvy,
and other deficiencies has given a working basis that there are a number of differ-
ent accessory food substances or vitamines and that each deficiency disease is caused
by the absence of its particular vitamine.
Vedder, from his own experiments and those of other investigators,
considers that we must assume that there is a whole group of these vita-
mines, but that further investigations will be necessary to determine the
relation of these various substances to each other.
To a limited extent, in the mountainous sections, water-ground wheat
flour and corn meal are still produced on the old-fashioned buhr millstones.
This water-ground flour and meal contains practically all of the vitamines
and all of the mineral salts of the whole grain, while the highly milled
products are decidedly deficient both in the cereal salts and in these highly
essential accessory substances.
Three or four decades ago all grain, especially in the South, was
232 SIGNIFICANCE OF LIPO1DS AND V1TAMINES
ground at the neighborhood mill on the old-fashioned buhr millstones,
and the power was furnished by the nearby stream. By this method of
milling, now almost entirely replaced by the steam or electric patent
roller-process, only the coarser particles of the bran and outer skin or
husk were removed.
Two years ago the author * spent a vacation of two months in his
native state, North Carolina, and took occasion to investigate the incidence
of pellagra in counties far removed from railway accommodations, particu-
larly in western North Carolina, eastern Tennessee and Kentucky. The
inhabitants of these sections are too far removed from railway facilities
to purchase roller-process meal, and must send their corn to the nearby
neighborhood mill, where it is ground in small quantities at a time, suf-
ficient for immediate needs, and the whole meal is eaten, furnishing the
necessary vitamine substance. The families living in the lowland section,
convenient to railroads, buy their supply of patent roller-process meal at
the village store. This is devoid of the accessory vitamine substance, and
unless the dietary is augmented by fruits, vegetables, milk or fresh meat
supplying the accessory substance, deficiency disease will soon follow.
Wood (50), writing on pellagra, has observed that in an eastern county
of North Carolina, remote from railroad facilities, broad areas with thou-
sands of inhabitants are free from pellagra. The inhabitants of this
locality consume as a food large quantities of corn meal, but it is a whole
meal water-ground product.
Many experiments have been conducted 2 (51) to determine the correct
physiological estimation of the vitamine content of foods, and from the
available data collected it is safe to assume that a perfect analogy exists
between the well-known relation of polished rice to its nutritive value and
the high milling of wheat and corn to the nutritive value of wheat flour
and cornmeal. It is an accepted fact, proved by numerous investigations,
that if the alimentation of a people is principally composed of highly pol-
ished rice, and otherwise deficient in vitamines, beriberi will develop, but
on the other hand, if undermilled rice is substituted for the highly milled
product the disease is not so likely to develop.
The extreme importance of a method for determining the vitamine
content of foods, and of isolating these all important accessory substances
is quite apparent.
According to Funk, the vitamine theory is so new that "little progress
has been made thus far in the isolation of the vitamine principle in suffi-
i Dr. Fitch, 2 At the Hygienic Laboratory, Washington, D. C.
VITAMINES 233
cient quantities to be of value therapeutically, because most of the vita-,
mine was lost, destroyed or rendered inert in the processes of isolation."
Recent investigations carried out in the Hygienic Laboratory (52) on the
vitamine content of brewer's yeast, gives hope of better results. In the
past, the great difficulty had been to isolate the vitamine in sufficiently
concentrated amounts to make it of practical use therapeutically. This
problem has at last been solved by the use of Professor John TJri Lloyd's
prepared hydrous aluminum silicate (53) ; which has a very high selective
absorptive power. It was found that 0.05 gram of this solid vitamine
product would keep in health a 300-gram pigeon fed exclusively on pol-
ished rice or would cure in a very few hours pigeons that had already
manifested symptoms of polyneuritis on a polished rice diet. Control
pigeons fed on polished rice and untreated with vitamine soon died with
polyneuritis. According to research workers in the Hygienic Laboratory,
it would seem that a proportionate dose of vitamine for a man weighing
122 pounds would not exceed 10 grams, which could easily be taken in
capsule or other form for therapeutic or preventive purposes. It is now
to be hoped that the isolation of vitamines from other food products rich
in them will soon be accomplished.
Relation of Vitamines to the Phosphorus Content of Foods. Unfortu-
nately, a method for the direct isolation of vitamines from natural foods
has not been devised, as in the case of yeast. However, the phosphorus
content of natural foods seems to furnish a fairly accurate index of the
relative percentage of vitamines present. Voegtlin, Myers and Sulli-
van (54) have been able to determine that while phosphorus does not form
a component part of the vitamine molecule, yet it seems, according to
their views, that the distribution of phosphorus and vitamines within the
grain runs practically parallel.
Tibbies (5 5) in summing up the arguments of Schauman in favor of
the phosphorus deficiency theory as a factor in the causation of deficiency
diseases records the following: (a) that foods which cause beriberi, ship
beriberi, scurvy and infantile scurvy are deficient in organic phosphorus,
and (b) that the diseases are cured by foods rich in organic phosphorus
compounds. It is probable that different groups of organic phosphorus
compounds serve different purposes in the organism, and that their ab-
sence leads to different diseases. Deficiency of one organic group may
cause beriberi in adults, and deficiency of another group may cause rickets*
and infantile scurvy. Children fed with boiled or condensed milk some-
times develop scurvy-rickets. When milk is boiled it is to some extent
denatured; the organic compounds of phosphorus are more or less de-
234 SIGNIFICANCE OF LIPOIDS AND VITAMINES
stroyed. Bunge says lecithin is destroyed at 70 C. (140 F.). Rac-
zowski found 25 per cent was destroyed at 60 C., 28 per cent at 95 C.,
and 30 per cent at 110 C. Rickets is common in children of the poor in
England, less common in the highlands of Scotland and in Ireland. Many
English children are fed on skim milk containing only 0.03 per cent of
phosphorus pentoxid (P 2 O 5 ), white bread containing 0.2 per cent phos-
phorus pentoxid and margarin. A Scotch highland child gets oatmeal
containing 0.9 per cent phosphorus pentoxid and new milk containing 1
per cent phosphorus pentoxid, and German children get rye bread con-
taining 1 per cent phosphorus pentoxid.
Edie and Simpson (56) found that these diseases are not cured by the
addition to the food of carbohydrates, inorganic phosphates, egg albumin
and synthetic organic phosphorus compounds, such as glycerophosphates,
albumin, metaphosphates, etc., nor did these substances prevent polyneu-
ritis in birds. But polyneuritis in birds is prevented and cured by the
addition to the diet of substances rich in organic phosphorus, such as rice
bran, wheat bran, yeast, katjang idjoe beans, testicular extract, pancreas,
etc., in such proportion as to raise the daily income of phosphorus in the
food to the normal amount. The daily normal requirement for a man is
2 grams, for a dog 0.5 gram. It was found by Fraser and Stanton(57)
that the beriberi causing power of rice is associated with the removal of
the phosphorus-containing substances by polishing the grain. They have
definitely proved that no rice connected with the outbreak of beriberi con-
tained more than 0.26 per cent of phosphorus pentoxid, that rice which
contained 0.37 per cent of phosphorus pentoxid did not cause beriberi, and
the consumption of rice containing 0.4 per cent of phosphorus pentoxid is
perfectly safe.
More recent evidence is afforded by a Siamese Government Report on
beriberi by Highet, which furnishes conclusive evidence that the use of rice
containing less than 0.4 per cent of phosphorus pentoxid is likely to cause
beriberi. If not milled so as to reduce the phosphorus pentoxid below this
standard, Siamese rice is a safe food. Acting on this finding, the Sia-
mese Government pushed the use of under-milled rice in all government
institutions and the gendarmerie, and has practically done away with beri-
beri among these people, and an attempt is now being made to enforce its
use in the army and navy.
Fraser and Stanton(58), basing their opinion on a large number of ob-
servations and analyses, conclude that rice with a phosphorus pentoxid
(P 2 O B ) content below 0.4 per cent is deficient in vitamines. Myers and
Voegtlin adopted this method to correlate the vitamine content of wheat
V1TAMLXKS
235
and corn products, and came to the same conclusion, that the identical rela-
tion exists between the phosphorus pentoxid content of these cereals as
exists in the case of rice. To arrive at this conclusion, they conducted a
series of experiments on fowls, the classical animal for determining- the
vitamine content of foods. It is well known that fowls will live in perfect
health for many months on an exclusive diet of wheat or corn.
"Whole corn meal, or the so-called "water-ground" corn meal, furnishes
:t well-balanced dietary for fowls, hut, on the other hand, it is a matter
of recorded fact that fowls fed on highly milled products from wheat, corn
or rice will die within a month or six weeks from polyneuritis. The fol-
lowing tahle from Public Health reports graphically illustrates the findings
of Voegtlin and his coworkers:
TABLE SHOWING THE EFFECT OF WHOLE GRAIN AND HIGHLY
MILLED CEREALS ON FOWLS
VARIETY OF CEREALS, WHOLE
AND HIGHLY MILLED
Per cent of
P 2 8
dry food
Number of days required for ap-
pearance of polyneuritis in fowls
fed exclusively on this food
Wheat bread made from highly
milled flour
0.114
20-32 days
Whole wheat.
1.120
No symptoms developed
Corn grits (highly milled)
0.169
23-50 days
Corn grits (highly milled)
0.210
30 days
Corn meal (highly milled)
0.30
35 days
Corn meal (old fashioned rock
ground)
0.659
Remained well
Corn meal (rock ground)
0.772
Remained well
Corn germ
2.816
Remained well
Corn, whole
0.760
Remained well
Myers and Voegtlin conclude from their experiments the following
provision standard, phosphorus pentoxid content for wheat, flour, corn
meal and grits: for corn products, the minimum phosphorus pentoxid
content should not fall helow 0.50 per cent and for wheat flour not below
1 per cent, as a safe index for arriving at the relative amounts of vita-
mines present. These investigators consider the determination of the
phosphorus pentoxid index of considerable value in all cereal products with
the exception of the so-called "self-raising flours." These latter products
contain baking powders, composed largely of phosphates. Of recent years
certain factors have arisen which exert a tendency to limit the vitamine
content of the dietary of certain classes of our rural population. Changes
in the economic conditions of food production and the methods of cooking
236 SIGNIFICANCE OF LIPOIDS AND VITAMINES
seem to reduce the vitamine content of the diet of a large number of per-
sons almost to the danger point. One factor involved in the reduction of
the vitamine content of bread, especially cornbread, is the almost universal
use of baking soda as a leavening in bread making. It has been clinically
demonstrated on animals that bread made from highly milled corn meal,
to which milk and soda is added for leavening, lessens the high initial
content of the antineuritic substance during the process of baking as a re-
sult of the destructive action of the alkali contained in the soda.
We pointed out in the section on Bread Making (\ f olume I, Chapter
XIII, page 386) that, where bicarbonate of soda and milk are used for
leavening during the process of cooking, the sodium bicarbonate was con-
verted into a strong alkali, which is not a food product. Prior to the in-
troduction of the patent roller-process of grinding grains, cornbread made
from the water-ground meal was mixed with salt and water and it yielded
a wholesome bread ; but simultaneously with the introduction of highly
milled corn meal, it was found that when this product was mixed with salt
and water, it did not yield bread of the same lightness as the old-fashioned
water-ground meal. It then became necessary to resort to artificial leav-
ening, and sodium bicarbonate became a popular household remedy.
Bread, made by means of bicarbonate of soda and salt, under present con-
ditions, has a distinctly alkaline taste and reaction. The usual method
of preparing bread from bolted corn meal is to mix it with water and add
a small quantity of shortening and bicarbonate of soda for leavening. The
resulting mushy mixture is baked in an oven, the high temperature of
which liberates carbon dioxid from the sodium bicarbonate, and the latter
is transformed into sodium carbonate, a strong alkali. Voegtlin and Sul-
livan (59) recently demonstrated that the action of this alkali is destruc-
tive to vitamines(60). It was then definitely proved that the "accessory
substances" lose their physiological activity when exposed to alkalies, and
more especially under the influence of the high temperature of a baking
oven. Cornbread, prepared from the old-fashioned water-ground meal,
sweet milk and soda, when forming the exclusive diet of chickens, soon
leads to the development of symptoms of polyneuritis, but on the other
hand, bread prepared from the old-fashioned w 7 ater-ground corn meal, but-
termilk and salt (NaCl) does not give rise to any polyneuritic symptoms,
and the fowls seem to maintain perfect health. In contrast to the de-
structive action of alkalies on vitamines brought about by the use of bicar-
bonate of soda in bread-baking, it is necessary to emphasize the fact that
the old-fashioned way of combining baking soda with sour buttermilk in
the preparation of bread is a perfectly harmless procedure, provided that
VITAMINES
237
sufficient sour milk is added to neutralize the alkalinity of the baking soda.
The following table worked out by Voegtlin emphasizes the destructive
action of baking soda on the vitamine content of eornbread. He fed a
coop of chickens on cornbread having the following composition :
600 gin. of corn meal
800 c.c. sweet milk
10 gin. of baking soda
with the following result :
Laboratory Num-
bers of Animals
Number of days be-
fore appearance of
polyneuritis after
feeding was begun
Laboratory numbers
of animals
Number of days be-
fore appearance of
polyneuritis after
feeding was begun
31
13
37
19
32
14
38
21
33
27
39
18
34
13
40
16
35
22
36
14
Average
17
Vitamines and Pellagra The appearance of pellagra, a disease of the
peripheral nervous system, has recently stimulated much research in the
Southern States as to its causation and treatment. Voegtlin believes that
the dietary of pellagrins is deficient in vitamines. It is known that pel-
lagrins subsist on a dietary that is not rich in vitamines. The recent
investigations made by Goldberger and other officers of the Public Health
Service seem to bear out this assertion. The foodstuffs forming their
principal alimentation consist of highly milled cereals, principally corn,
and fat pork, in addition to carrots and turnips and similar vegetables.
It is also believed that baking soda, which is used as a leavening for
making cornbread, tends to further lower the vitamine content.
From the available data at hand, one may conclude that the prevalence
of pellagra in the South is due to several factors : (a) the highly milled
wheat and corn products which are undoubtedly deficient in vitamines;
(&) the preparation of bread from both highly milled flour and corn meal
by using baking soda for leavening, without buttermilk or tartaric acid,
which permits the deleterious effect of the strong alkali to destroy the
vitamine content of the food ; (c) changes in the economic conditions of
the population, and in food production and supply all of which seer" to
exert an unfavorable influence on the dietary of the poorer people. The
increased cost of living places beyond their reach the more expensive foods
238 SIGNIFICANCE OF LIPO1DS AND VITAMINES
meat, eggs, milk, etc. having a fairly high vitamine content, which
are not so liberally used as heretofore, and a reduction in the amount of
these important foods, therefore, reduces the vitamine content of the
ration. During the past ten years, the cost of food has increased out of
proportion to the increase in wages, and pellagra has likewise increased
during this decade.
The reduction of the vitamine content of the diet of pellagrins is due
() to the reduction, for economic reasons, of certain aliments in the
dietary, of vitamine rich foods, such as fresh milk, eggs and meats; (t)
the introduction of highly milled cereals, and (c) to the use of baking
soda as a leavening, which exerts a destructive action on the vitamine
content of bread.
The fact that the above-mentioned influences, which have undoubtedly
reduced the vitamine content of the diet, made themselves felt a relatively
short time before the rapid increase in pellagra in the South, furnishes con-
siderable evidence in favor of the vitamine-deficiency theory of pellagra.
REFERENCES
1. McCoLLUM and DAVIS. The Necessity for Certain Lipoids in Diet
During Growth, J. Biol. Chem., pp. 15-167.
2. LANDERS. Biochem. J., 1913, p. 78.
3. McCoLLUM. J. Biol. Chem., 1912, 11, vol. xii.
4. VOEGTLIN and SULLIVAN. Science, 1913, pp. 672, 964.
5. LOEB and BEUTNER. Ibid., pp. 672-673.
6. LILLIE. lUd., p. 967.
7. FUNK, CASIMIR. Die Vitamine, Wiesbaden, 1914.
8. COOPER. J. Hyg., 1912, vol. xii, p. 436.
9. VOEGTLIN, CARL (Prof, of Phar. IT. S. P. H. S.). Proc. Am. Soc.
Biol. Chem., 1915.
10. FUNK, CASIMIR. Die Vitamine, 1914.
11. . Ztschr. f. Physiol. Chem., 1914, vol. Ixxxix, p. 378.
12. BRAPDON and COOPER. J. Hyg., 1914, vol. xiv, p. 351.
13. VOEGTLIN, CARL. IT. S. Pub. Health Service, J. Washington Acad.
of Sci., Oct., 1916, vol. vi, No. 16.
14. SULLIVAN and VOEGTLIN. U. S. Pub. Health Service, Proc. Amer.
Soc. Biol. Chem., 1915.
15. VOEGTLTN, CARL. J. Washington Acad. of Sci., Oct., 1012, vol. vi.
No, 16.
REFERENCES 239
10. THAI/BE. Biochem. Ztschr., 1909.
17. STKI-I-, W. Biochem. Ztschr., 22-452.
18. FI;.\K, ( 1 ., and MACALLI .M, A. BUI:CE. Ztschr. f. Physiol. Chem.,
v<il. xcii, p. 13.
19. STKIM-, \V. Deutsch. med. Wchschr., 1914, 40-892.
20. FrxK. Die llolle der Vitamine beim Kohlenhydrat-Stoffwechsel,
Ztschr. f. Physiol. Chem., 1914, vol. Ixxxix, p. 378.
21. FrxK, C. Yitamines in Digestion, Proc. Phys. Soc., Dec. 13, 1913.
22. FrxK and MACAU. KM. Studies on Growth, J. Biol. Chem., 1915,
vol. xxiii, p. 413, etc.
23. VOEGTLIX, CARL. Proc. Amer. Soc. Biol. Chem., 1915.
24. . Ibid.
25. VOEGTLIX, CARL. J. Washington Acad. of Sciences, vol. vi, No. 16.
20. FrxK. Pub. Health Reports, April 14, 1910.
27. OSBORXE and \VAKK.MAX. J. Biol. Chem., May, 1915, vol. xxi,
No. 1.
28. McCoLi.i-M, E. V., and DAVIS, M. J. Biol. Cbem., 1913, vol. xv,
p. 107.
OSBORXE and MENDEL. Ibid., 1913-1914, vol. xv, p. 311; vol. xvi,
p. 423.
McCoLLUM and DAVIS. Proc. Soc. Exper. Biol. & Med., 1914, vol.
xi, p. 101.
OSBORXE and MENDEL. J. Biol. Chem., 1914, vol. xvii, p. 401.
MoCoLLUM and DAVIS. Ibid., 1914, vol. xix, p. 245.
29. OSBORXE, T. B., and MEXDEL, L. B. Feeding Experiments with
Isolated Food Substances, Carnegie Inst. of Wash. Pub., 1911,
No. 150, pt. ii, p. 80. A^W fttxu Ztschr. f. Physiol. Chem., 1912,
vol. Ixxx, pp. 315-310; see J. Biol. Chem., 1909, 1910, vols.
vi to viii.
30. MrCoLLi-M, E. V., and DAVIS. Jour. Biol. Chem., 1913, vol. xv.
31. FrxK, C., and MACALLUM, A. B. Ztschr. f. physiol. Chem., 1914,
vol. xcii, p. 13.
32. FrxK, C., and MACALLUM, A. B. J. Biol. Chem., vol. xxiii, p. 410;
vol. xxvii, p. 51.
33. WILCOX, WILLIAM HEXRY (London, Lieut. Col. R.A.M.C.). In
an article on beriberi with special reference to prophylaxis and
treatment, Lancet, March 11, 1910.
34. HOPKIXS, F. GOWLAXD. Feeding Experiments illustrating the im-
portance of accessory factors in Normal Dietary, J. Physiol.,
1912, pp. 425-400, Biochem. J., 1913, p. 97.
240 SIGNIFICANCE OF LIPOIDS AND VIT AMINES
35. FUNK, CASIMIK. The Role of the Vitamiues in the Digestion and
Application of Food, Proc. Physiol. Soc., Dec. 13, 1913.
3G. LITTLE. J. Am. Med. Assn., 1912, vol. Iviii, p. 2029.
37. FKASER and STANTON. Studies from the Inst. for Medical Re-
search, Federated Malay States, 1909, No. 10.
38. STRONG and CROWELL. The Etiology of Beriberi, Philippine Jour.
Sc., 1912, vol. vii, p. 271.
39. VAN LEENT. Arch, de med. nav., Oct., 1867, p. 241 ; Communica-
tion sur le beriberi, Cong. Internat. d. sc. med. Amst., 1880,
vol. vi, p. 170, etc.
40. VORDEEMAN. Onderzoek naar het verband tusschen den aard der
rijstvoeding in de gevangenissen op Java en Madoera en het
voorkomen van beriberi onder de geinterneerden, Bavaria, 1897.
41. TAKAKI. Three lectures on the Preservation of Health Among the
Personnel of the Japanese Navy and Army, Lancet, London,
1906, vol. i, pp. 1369, 1451, 1520, etc.
42. FLETCHER. Rice and Beriberi, J. Trop. Med. & Hyg., 1909, vol.
xii, p. 127; Lancet, London, 1907, vol. i, p. 1776, etc.
43. HIGHET. Beriberi in Siam, Philippine J. Sc., 1910, vol. v, p. 73.
44. HEISER, V. G. Practical Experiments with Beriberi and Unpol-
ished Rice, Phil. Jour. Sc., 1911, vol. vi, p. 1237; Practical
Experiments with Beriberi and Unpolished Rice, Phil. J. Am.
Med. Assn., April 29, 1911, p. 1238.
45. THEZE. Note sur le beriberi a poulo-condore, Ann. d'hyg. et de
med. colon., 1910, vol. xiii, p. 16.
46. CHAMBERLAIN. The Eradication of Beriberi from the Phil. Scouts
by Means of a Simple Change in Their Dietary, Philippine J.
Sc., 1911, vol. vi, p. 133.
47. VEDDER, E. B. Beriberi, pub. by William Wood & Co., New York,
1913.
48. TEDDER and WILLIAMS. Concerning the beriberi preventing sub-
stances or vitamine content in rice polishings, Phil. J. Sc., 1913,
vol. iii, p. 175.
49. V ODDER and CLARK. Polyneuritis Gallinarum, a Fifth Contribu-
tion to the Etiology of Beriberi, Philippine J. Sc., 1912, vol.
vii, p. 423.
50. WOOD. Pellagra, J. Am. Med. Assn., 1917.
51. Public Health Reports, 1916.
52. Bulletin Hygienic Laboratory, Washington, D. C., Feb. 18, 1916.
53. LLOYD, JOHN. Editorial, New York Med. J., March 18, 1916.
BIBLIOGRAPHY 241
54. VOEGTLIN, MYERS and SULLIVAN. Hyg. Lab. Pub. Health Rep.,
April 14, 1916.
55. TIBBLES, WILLIAM. Food in Health and Disease.
56. EDIE and SIMPSON. Brit. Med. J., 1911, vol. i, p. 1422.
57. FRASER and STANTON. Studies from Inst. Med. Research, Fed-
erated Malay States, 1909, No. 10; 1911, No. 12; Lancet, 1909,
vol. i, p. 451; 1911, vol. ii, p. 1159.
58. FRASEK and STANTON. Lancet, 1915, vol. i, p. 1021; J. Trop.
Med. & Hyg., 1911, p. 333.
59. VOEGTLIN and SULLIVAN. Proc. Amer. Soc. Biol. Chem., 1916,
vol. xvi, p. 24.
60. VEDDER and WILLIAMS. Philippine J. Sci., 1914, vol. viii, p. 175.
BIBLIOGRAPHY
DAVIS. The Influence of Diet on Growth, Biochem. J., 1913, p. 167.
FUNK, CASIMIR. The Probable Role of Vitamines in the Digestion and
Application of Food, Proc., Physiol. Soc., Dec. 13, 1913; Die
Vitamine, Ihre Bedeutung fiir die Physiologic und Pathologie
mit besonderer Beriicksichtigung der Avitaminosen, 1914.
GRIJNS. Gen. Tydsch. voor Nederl. Indie, 1901, vol. xli.
HILL and FLACK. Brit. Med. J., Sept. 16, 1911, vol. i, p. 1311; vol. ii.
HOPKINS. Feeding Experiments Illustrating the Importance of Acces-
sory Factors in Normal Dietary, J. Physiol., 1912, pp. 425-460.
and NEVILLE. The Influence of Diet on Growth, Biochem. J.,
1913, p. 97.
OSBORNE, THOMAS G., and MENDEL, LAFAYETTE B. Science, 1913, p.
189.
. Feeding Experiments with Isolated Foodstuffs, Carnegie
Inst. of Washington, Pub. 156, Parts 1 and 2, 1911.
ROSENIIEIM. Proc. Physiol. Soc., 1908, vol. liv; J. Physiol., 1908, vol.
ii, p. 317.
SIMPSON and WEBSTER. Philippine J. Med., 1912, p. 42,
TIBBLES. Foods; Their Origin, Composition and Manufacture, p. 481.
For a general statement with literature, see Funk, "Ergebnisse der Physi-
ologic," 1913, vol. xiii, p. 125.
CHAPTER IX
THE CALORIC METHOD OF FEEDING
WrxFiKLD S. HALL, Piil)., M.I).
Every bill of fare should be based upon calorimetric experimentation; the
'practical trophodynamic consideration of the foodstuffs; due cognizance of the ail-
ment of the patient, and no bill of fare should ever be a theoretical prescription
culled from lists,
Food as a Source of Heat and Growth : Introductory ; Unit and Method of
Measurement; Heat by Combustion of Various Substances and Foods;
Standard and Sample Dietaries; Caloric Values of Ingested Foods;
Constructive and Fuel Foods ; Caloric Requirement of Man ; Calorific
Value of Excretory Products; Physiological Food Value.
Calculation of Fuel Values of Food: Chemical Analyses of Foods; Method of
Reckoning the Protein, Fat and Carbohydrate Rations for Diets of
Definite Energy Values.
Factors Governing the Amount of Food Required: Amount of Heat Lost by
Body; Weight of Body; Age; Sex; Kind of Work; Choice of Food;
Intensity of Muscular Activity.
Regulation of Body Temperature: Physical Heat Regulation; Chemical Heat
Regulation; The Surface Areas of the Skin in Heat Regulation; Regu-
lation of Heat Loss; Production of Heat during Rest; Resume.
FOOD AS A SOURCE OF HEAT AND GROWTH
Introductory. Probably no single contribution to trophodynamics has
been more fruitful in its consequence than the calories idea. It was no
small achievement to put the body's need for physiological fuel upon a
definite basis and to give a concrete significance to the trophodynamic
factor in nutrition. Possibly in the remote past, Nature's scheme for
feeding man did not contemplate the accurate measuring of his food,
other than to provide him with healthy, normal instincts. At the present
age, however, food requirements have become a matter of accurate estima-
tion rather than animal intuition. Tinder-nutrition can be demonstrated
by direct dieting investigations, the increased demands for food fuel for
243
244 THE CALORIC METHOD OF FEEDING
the working man, as well as the relative abundance of the ration for the
infant at different stages of growth, need no longer remain veiled in the
mystery of uncertainty.
The past two decades have witnessed the developments of scientific
methods, rendered possible by really accurate investigations relative to the
trophodynamics of foods. "They show," declares Prof. Armsby, "that
the transformations of chemical energy into heat and work in the animal
body take place according to the same general laws and with the same
equivalencies as in our artificial motors and in lifeless matter generally.
The great law of the conservation of energy rules in the animal mech-
anism, whether in man, carnivora or herbivora, just as in the engine. The
body neither manufactures nor destroys energy. All that it gives out it
gets from its food, and all that is supplied in its food is sooner or later
recovered in some form. We are fully justified, therefore, in speaking
of the food as body fuel, and in our studies of its utilization we may be
confident that any food energy which does not reappear in the form of
heat or work has not been lost, but has been stored up in the body as the
chemical energy of meat, fat, etc., which may later serve to supply food-
energy to the human body."
Atwater(l), Langworthy(2) and their coworkers have collected data
and published a resume of almost all the known metabolism-experiments
of value in determining the trophology, trophodynamics and tropho-
therapy of foodstuffs. The results of their studies in metabolism exceed
by far those of any other observers in any other country. The scope and
importance of their experimental work, as stated by Atwater, the leading
American authority on this science, is as follows :
The science of nutrition must be studied from the standpoints of the metabolism
of matter and energy, if its fundamental laws are to be thoroughly learned. The
ideal experiment for the determination of metabolic balance would include, (a) a
respiration experiment, (6) a dietary study, and (c) a digestion experiment in
which the thermal values of food and excreta are determined. It would also in-
clude a measurement, with a calorimeter or by other suitable means, of the heat
produced in the organism. If work is also performed, it must also be measured.
No experiment has yet been made which reaches this ideal. More often special
problems connected with metabolism have been the subject of investigation, such
as the following: The functions of the nutrients of food; the formation of fat
from protein and from carbohydrates; the digestibility of foods of various kinds;
the isodynamic values of nutrients; the fuel value (potential energy) of food; the
influence on metabolism of various diseases, of alcohol, drugs, condimento, and the
like, and of various forms of treatment, medical or otherwise, as for instance, hot
water baths ; the influence of prolonged hunger or thirst on metabolism ; and the
quantities of nutrients consumed 'and appropriate for people of different classes,
occupations, and conditions, and for animals of different kinds or animals fed for
different economic purposes.
The quality and quantity of diet exert a far-reaching influence upon
the development of the race, an influence which is readily observed in the
physical well-being associated with an adequate supply of suitable food.
The problems of dietetics are of great intricacy, for no definite food or
combinations of foods, can be regarded as suitable for different people, or
for the same individual under different circumstances. The application
of experimental research in trophotherapy, as in other branches of science,
has yielded some insight into the general principles which govern the
nutrition of man.
One may well ask the question, then: "Why do physicians take so
much care in measuring the exact dosage of drugs which are administered
only occasionally, and give such little attention to measuring their food
prescriptions which are to be followed daily ?" A physician who instructs
his patients to take "a little" strychnia or a "big dose" of calomel, etc.,
would be regarded as criminally negligent, yet, in prescribing diet, this
is just the kind of advice that physicians usually give. It is rather para-
doxical that a question which so intimately engages the attention of man-
kind, like food and drink, has been given so little attention by the medical
profession. The study of the therapeutic indications of food is a question
which will demand the attention of the physician of the future. He will
find specific medication theoretically speaking in the so-called "spe-
cific values" of the articles of nutrition or aliments. It is no longer a
question that certain diseases can be successfully treated by the adminis-
tration of properly selected and prepared articles of diet which have a
distinctively active or medicinal influence over certain pathologic condi-
tions. In many instances a clear understanding of the proper kind and
proper dosage of food is more important to the physician than any knowl-
edge of the use of drugs. The appreciation of the physiological demands
of the organism necessitates the recognition of both quantitative and quali-
tative needs. If we would be able to give our patients the proper advice,
we must carefully study foodstuffs, their composition, their preparation,
their digestibility and their trophotherapeutic effects, which is the science
that deals with the treatment of disease with food. TropTiodynamics
deals with the science of the powers and effects of foods Trophology is
the science of the nature and properties of materials that are used as
food. Since our knowledge of the pathogenesis of a large number of dis-
eases is imperfect, we are not in a position at the present time to lay down
definite rules for the treatment and cure of disorders that are due to a
116
246 THE CALORIC METHOD OF FEEDING
constitutional or nutritional nature, except in a very limited number of
cases.
Unity and Method of Measurement. The unit of measure to determine
the fuel value of foods is the calorie. 1 It may be defined as that amount
of heat required to raise the temperature of one kilogram of water to 1
degree Centigrade. To determine the fuel value of any food, that is, to
calculate the amount of energy liberated by the burning of a given quan-
tity of combustible material, we use the instrument called the calorimeter.
Various forms of calorimeter have been devised, one of the best being the
bomb calorimeter devised by Berthelot. This instrument and the method
of its use have been fully described by Atwater and Snell(3). "In out-
line, it consists of a heavy steel bomb with a platinum or gold-plated
copper lining and a cover held tightly in place by means of a strong screw
collar. A weighed amount of sample is placed in a capsule within the
bomb, which is then charged with oxygen to a pressure of at least 20 atmos-
pheres (300 pounds or more to the square inch), closed, and immersed in
a weighed amount of water. The water is constantly stirred and its tem-
perature taken at intervals of one minute by means of a differential ther-
mometer capable of being read to one thousandth of a degree. After the
rate at which the temperature of the water rises or falls has been deter-
mined, the sample is ignited by means of an electric fuse, and, on account
of the large amount of oxygen present, undergoes rapid and complete
combustion. The heat liberated is communicated to the water in which
the bomb is immersed and the resulting rise in temperature is accurately
determined. The thermometer readings are also continued through an
"after period," in order that the "radiation correction" may be calculated
and the observed rise of temperature corrected accordingly. This cor-
rected rise, multiplied by the total heat capacity of the apparatus, and
the water in which it is immersed, shows the total heat liberated in the
bomb. From this must be deducted the heat arising from accessory com-
bustions (the oxidation of the iron wire used as a fuse, etc.) to obtain the
number of calories arising from the combustion of the sample."
Through the aid of the calorimeter we are able to determine not only
the heat given off by the combustion of any oxidizable material such as
carbon, fat, starch, albumin, alcohol, sugar, etc., but also the amount
radiated or conducted away from any body, for example, the living
animal. Since the body gets its energy from the oxidation of the same
i When the term "calorie" is used in this work it is intended to refer to the
greater calorie, i.e., the amount of heat necessary to raise the temperature of one
kilogram of water one degree Centigrade. This is practically the same as the amount
of heat required to warm four pounds of water one degree Fahrenheit.
FOOD AS A SOURCE OF JIKAT AXI) GROWTH
247
kind of compounds which exist in foods, that is, essentially from carbo-
hydrates, fats, proteins, and their cleavage products, if we know the kinds
and amounts of foodstuffs eaten and the extent to which they are oxidized
in the body, we can estimate in calories the amounts of energy liberated.
./
Fie. I. l)iA(;i;.\.\i OK TIII; UKXKDICT "UNIVERSAL" OK "UNIT" APPARATUS FOR
MKASTKINC AUSORPTIOX or OXYUKN AND OUTPUT OK CAKIJOX DIOXID.
Heat of Combustion of Various Substances and Foods The average
results of calorimetric combustion show for :
Carbohydrates 4.1 calories per gram
Fats !>.45 "
Protein 5.65 "
The heat of combustion of various substances as well as the relation
between their elementary composition will be made clearer by the study
of the table on page 248 from Sherman (4), which includes the number of
typical compounds found in food or formed in the body:
248
THE CALORIC METHOD OF FEEDING
FIEAT OF COMBUSTION AND APPROXIMATE ELEMENTARY
COMPOSITION OF TYPICAL COMPOUNDS
Heat of
Combustion,
Calorics
per gram
Carbon,
per cent
Hydro-
gen,
per cent
Oxygen,
per cent
Nitro-
gen,
per cent
Sulphur,
per cent
Phos-
phorus,
per cent
Glucose. . .
Sucrose. . .
Starch. . . .
Glycogen. .
Body fat. .
Butter fat .
Edestin. . .
Legumin. . .
Gliadin
Casein ....
Albumin . . .
Gelatin ,
Creatin. . . .
Urea. .
3.75
3.96
4.22
9.60
9.30
5.64
5.62
5.74
5.85
5.80
5.30
4.58
2.53
40.0
42.1
44.4
76.5
75.0
51.4
51.7
52.7
53.1
52.5
50.0
42.5
20.0
6.7
6.4
6.2
12.0
11.7
7.0
7.0
6.9
7.0
7.0
6.6
6.2
6.7
53.3
51.5
49.4
11.5
13.3
22.1
22.9
21.7
22.5
23.0
24.8
14.1
26.7
18.6
18.0
17.7
15.8
16.0
18.0
37.2
46.6
0.9
0.4
1.0
0.8
1.5
0.6
0.8
The following table from Hall (5) graphically expresses the calories
represented in different foods and other substances involved in the proc-
esses of nutrition :
TABLE SHOWING CALORIES PER GRAM OF DRY SUBSTANCE
1 Gram dry substance
Heat of combustion
in calories
Starch or glycogen 4.182
Cane sugar 4. 176
Dextrose 3.940
Lactose 4.162
Carbohydrates, average; absorbed and available 4.0
Fat (one form) 9.686
Fat (another form) 9.423
Butter 7.264
Fats, average; 9.4; absorbed and available 9.0
Egg, white 4.896
Egg, yolk 6.460
Egg average, white and yolk 5.678
Lean beef 5.656
Casein 5.849
Vegetable proteins 5.500
Proteins, average 5.650
Protein, unavailable energy (unabsorbed or unoxidized) 1 .650
Proteins, available energy for use in body 4.0
Carbon, per gram 8.080
Hydrogen, per gram 34.662
FOOD AS A SOURCE OF HEAT AND GROWTH 249
Standard and Sample Dietaries We have just studied "heat of com-
bustion and approximate elementary composition of typical compounds,"
together with the "calories represented in different foods involved in the
process of nutrition," and, before entering upon a consideration of the
theoretical requirements of individuals, some standard dietaries and a
few examples of diets consumed by people of different classes such as rep-
resented in the table l below should guide us in arranging a diet for groups
of people in various circumstances and following varied occupations :
STANDARD DIETARIES
Standard dietaries and others
Protein,
Grams
Fat,
Grams
Carbo-
hydrates,
Grams
Energy,
Grams
Standard Diet: Ranke's
100
100
240
2,310
Moleschott's
130
84
404
2,970
Pettenkof er and Voit's
137
117
352
3,113
Cornet's
120
60
500
3,007
Playfair's
119
51
530
3,025
Parke's
127
99
397
3,172
The diet of Harvard University boat crew ....
Harvard Freshman boat crew
162
153
175
223
449
468
4,130
4,620
Yale University boat crew
145
170
375
3,705
Harvard University boat crew (2d
observation)
160
170
448
4,075
Harvard Freshmen boat crew (2d
observation)
135
152
416
3,675
Yale University boat crew (2d ob-
servation)
171
171
434
4,070
Captain of Harvard crew
135
181
487
4,315
Average of above diets
135
177
440
4,085
Football team : Connecticut
181
292
557
5,470
Football team: California
270
416
710
7,885
Professional athlete
244
151
502
4,460
Athletes at Helsingfors
| 217
259
431
5,070
Brickmakers in Connecticut
{ 182
222
204
265
392
758
4,254
6,484
Mechanics in United States
154
227
626
5,275
Lumbermen in Maine
206
387
963
8,140
United States Army ration
164
98
600
4.061
United States Navy ration
143
184
520
5,000
English Royal Engineers in active
work
144
83
631
3,950
English soldiers on special duty. . .
European soldiers in Batavia
j 190
1 145
136
58
150
79
510
450
497
3,426
3,503
3,000
Mechanics in Germany
139
113
677
4,395
Farm laborers in Austria
159
62
977
5,235
Factory operatives in Russia
Mechanics in Sweden
132
189
80
110
584
714
3,680
4,725
From Bull. 45, U. S. Dept. Agric., and various other sources.
250 THE CALORIC METHOD OF FEEDING
Caloric Values of Ingested Foods. In the process of digestion and
absorption, the combustion of fats and carbohydrates yields products
identical with those in the calorimeter, and gives out an equivalent
amount of heat. This does not hold true with protein, however, which
in the bomb turns to carbon dioxid, water and nitrogen, but in the body
yields no free nitrogen, for here urea and other organic nitrogen com-
pounds are excreted as end products of protein digestion (see Volume I,
Chapter VII, Physiology and Absorption). From this data it will be seen
that these organic nitrogenous end products which are combustible result
from a more incomplete oxidation of protein in the organism than that
occurring in the bomb. The estimation of the loss of potential energy
is based on the theory that the total quantity of nitrogen excreted from
the body as urea would amount to about 0.9 calories per gram of protein.
However, this problem is not as simple as would seem at first sight, for,
owing to the excretion of other matter (creatinin, uric acid, and the like)
of higher combustion, the real loss from end products is increased to the
average of about 1.3 calories per gram of protein disintegrated in the
organism. Therefore, it is correctly estimated that when the body burns
material which it has previously absorbed it obtains:
From carbohydrates 4.1 calories per gram
From fats 9.35 " " "
From protein (5.651.30). 4.35 " " "
An allowance must be made, however, when calculating the fuel value
of food to allow for the fact that a part of each of the materials is lost
in digestion, so that the approximate values of a mixed diet are:
Carbohydrates ... 2 per cent lost, 98 per cent absorbed
Fats 5 per cent lost, 95 per cent absorbed
Protein 8 per cent lost, 92 per cent absorbed
When allowance is made for the above losses, biological chemists have
approximated the physiological fuel value of food constituents consumed
to be as follows :
Carbohydrates . . (4.1 X 98 per cent) yield 4. calories per gram
Fats (9.45 X 95 percent) yield 9. calories per gram
Protein (4.35 X 92 per cent) yield 4. calories per gram
.FOOD AS A SOUKCK OF 1IKAT AXI) GROWTH 251
Rubner's calculation shows the energy values of foodstuffs to be as
follows:
Carbohydrates yield 4.1 calories per gram
Fats " 9.3 "
Protein " 4.1
Rulnier's estimate was derived from experiments with dogs fed on
meat, starch, sugar, etc., and made no calculation for the loss in diges-
tion as has been found by other competent observers to occur with men
living 011 an ordinary well-balanced ration.
Food ingested represents potential chemical energy which is the source
of all bodily energy. In order to arrive at a correct determination of the
potential energy in food consumed, it is necessary to know how much food
is consumed and the potential energy of the various foodstuffs. By refer-
ring to page 258 will be found a table which graphically expresses the
caloric value of different foods involved in the process of nutrition. The
reader is also requested to consult The Analysis and Fuel Value of Foods,
Volume I, Chapter XIX, which contains a list of all known American
foods and graphically presents the analysis of foods, showing the percent-
age of protein, fat, carbohydrate and mineral salts with the caloric value
per pound and per portion.
Constructive and Fuel Foods. We have previously pointed out in this
chapter, the methods for calculating the fuel value or potential energy of
foods. It has been determined by means of calorimetric experiments that
the amount of heat given off from a known weight- of food substance is
fairly constant and is called the heat value, or heat of combustion, which
is expressed in calories. The consideration of a large number of estima-
tions of the heat value produced in the calorimeter and of the digestibility
of foods led Ilubner ( 6 ) to fix their value approximately, as graphically
pointed out in table on this page. These figures are accepted by the ma-
jority of observers as being approximately correct, and so have passed into
common use. The experiments of Ilubner, Atwater and other investiga-
tors seem to show that the various foods may replace each other in exact
ratio to energy derived from, them which we have already discussed
(Volume II, Chapter V, Various Factors Bearing on Diet, Digestion
and Assimilation). Thus 100 grains of fat are isodynamic with 2 25
of syntonin, 243 grams of dried muscle, 232 grams of starch, 234 grams
of cane sugar and 250 grams of dextrose. In other words, 227 grams of
carbohydrates or protein are equal in isodynamic value with 100 grams
of fat, because they yield 030 calories on combustion in the body.
252 THE CALORIC METHOD OF FEEDING
As shown in a previous chapter (Volume II, Chapter VII), a certain
amount of protein is necessary to sustain life. It is not sufficient to say
that a food to be able to maintain life and strength can furnish a given
number of calories, since any number of calories can be obtained from
fat, but fat will not maintain life nor promote growth of cells. Alimenta-
tion must be estimated in terms of protein required and of calories
required. A large proportion of the latter can be obtained from variable
amounts of fats and carbohydrates, but such an alimentation would not
build the body, though it would furnish the necessary fuel for body
activities.
Let us emphasize at this point the two clearly differentiated needs of
the body: (a) for constructive material, and (&) material for fuel. The
constructive foods are : proteins, salts and water. The fuel foods are :
sugar, starch and fat. Note that the fuels are composed of carbon, hydro-
gen and oxygen. They are, chemically, the carbonaceous foods, which
oxidize to CO 2 and H 2 O. The value of these fuel foods to the body is
based wholly upon their fuel value, which is measured by the number of
calories of heat which they liberate on oxidation.
On the other hand, the value of the constructive foods cannot at all
be measured by the number of calories which they represent. Salts, for
example, are of inestimable value for body building, yet they have no
caloric value no fuel value. Water and the salts are just as truly foods
as are the starches, sugars and fats ; but they are constructive foods of no
fuel value. Similarly, the proteins bring C, H, N, S, P and Fe, to the
body in combinations readily digested, absorbed and assimilated into
living active tissues. These elements and combinations are absolutely
essential to growth and repair. Their constructive value their food
value is very great. The fuel value of proteins (5.65 calories per gram)
is partly available eventually for fuel purposes when taken in minimal
quantities, and immediately available to the extent of 4 calories per gram
when taken in excess of the requirements for construction. This avail-
able fuel value is its fuel value, not its food value. Fuel values are meas-
ured in calories and may be estimated in cents per calorie. Constructive
food values can no more be estimated in money units than can the value
of a living, functioning nerve or muscle cell be estimated in dollars and
cents.
Caloric Requirement of Man The caloric requirement of an individual
depends somewhat upon his weight and the amount of energy expended.
As a result of much research and investigation, in order to establish a
working standard, the weight fixed upon by various investigators has been
FOOD AS A SOU11CE OF HEAT AND GROWTH 253
approximately 150 pounds. The caloric requirement for a man of this
weight leading a sedentary life can be determined by the following four
methods, as determined by Sherman (4) :
(a) By observing the amount of food ingested by many men in dif-
ferent countries and under varying conditions.
(6) By determining the approximate amount of oxygen consumed.
(c) By determining the equilibrium or balance of intake and output.
(d) By direct calculation of the heat given off by the body.
These various methods give approximately the same findings : a man
at rest requires 2,000 calories, and one leading a sedentary life requires
2,300 calories.
The protein requirement for a man at work cannot be determined so
accurately. It has been attempted by various observers with the following
results :
Voit in Germany fixed upon 118 grams of protein as the standard.
Playfair in England fixed upon 119 grams of protein as the
standard.
Gautier in France fixed 107 grams as the standard.
Atwater in this country fixed 100 grams of protein as the standard
for a man of sedentary habits.
Atwater also fixed 125 grams for a man at moderate work, 150
grams for a man at hard work, 90 grams for one completely
at rest.
Chittenden decided upon 60 grams as the standard. His objection to
the high protein ration, given by other workers in this field of research,
is based, he says, upon evidence of self-indulgence and not upon the needs
of an individual or upon the most profitable use of food. We give below
the results of his experiments. For a man of average weight (154
pounds), it is necessary to provide for the requisite quantity of food, 00
grams of protein and a total caloric value of 2,800 calories. The follow-
ing is a sample dietary suggested by Chittenden (7), showing the protein
in grams and the caloric value of each article :
THE CHITTENDEN LOW PROTEIN DIETARY
Breakfaai: Protein, grams Calories
1 shredded wheat biscuit (30 gm.) 3.15 106
1 teacup of cream (120 gm.) 3.12 206
1 German water roll (57 gm.) 5.07 165
2 one-inch cubes of butter (38 gm.) 0.38 284
M cup of coffee (100 gm.) with 0.26
^ cup of cream (30 gm.) 0.78 51
1 lump of sugar (10 gm.) 38
12.76 850
254 THE CALORIC METHOD OF FEEDl.Xd
THE CHITTENDEN LOW PROTEIN DIETARY Continued
Lunch: Protein, grams Calories
1 teacup home-made chicken soup (144 gm.) 5.25 60
1 Parker House roll (38 gm.) 3.38 110
2 one-inch cubes of butter (39 gm.) 0.38 284
1 slice lean bacon (10 gm.) 2.14 65
1 small baked potato (2 oz.-60 gm.) 1.53 55
1 rice croquette (90 gm.) 3.42 150
2 ounces maple sirup (60 gm.) 166
1 cup tea with 1 slice lemon
1 lump sugar (10 gm.) 38
16.10 928
Dinner:
1 teacup cream of corn soup (130 gm.) 3.25 72
1 Parker House roll (38 gm.) 3.38 110
1 one-inch cube of butter (19 gm.) 0.19 142
1 small lamb chop broiled, lean meat (30 gm.).. . . 8.51 92
1 teacup of mashed potato (167 gm.) 3.34 175
Apple-celery lettuce salad with mayonnaise dress-
ing (50 gm.) 0.62 75
1 Boston cracker split, 2 in. in diameter (12 gm.). 1.32 47
^-inch cube American cheese (12 gm.) 3.35 50
% teacup of bread pudding (85 gm.) 5.25 150
1 demi-tasse coffee
1 lump sugar (10 gm.) 38
29.21 951
Total grams of protein 58.07
Total calories 2729
The total amount of protein in grams and the total calories in this
dietary, as stated above, may be taken as approximately correct. It will
be seen that he has reduced the protein to as low a point as is compatible
with good health, mental and physical strength, but has allowed sufficient
carbonaceous food to produce the requisite calories for normal energy.
We have stated heretofore, and will reiterate again, that more protein is
ordinarily consumed than is needed and often more than is good for one.
Calorific Value of Excretory Products. All non-nitrogenous foodstuffs
which have undergone complete digestion and assimilation yield in our
bodies the same amount of heat as in the calorimeter, the final products
being the same. The nitrogenous foodstuffs are not so completely metab-
olized ; the oxidation of proteins in the body is not complete. We
learned, when studying the Physiology of Digestion, that the protein
molecule is made up of some twenty or more ammo-acids. We also found
that the protein molecule is split into a nitrogen-moiety and a carbon-
moiety (8). The carbon-moiety is as completely oxidized in the body as
in the calorimeter experiments. The nitrogen-moiety is not reduced in
the animal body to ammonia and water the ultimate products of nitro-
genous decomposition but it is excreted as an organic compound, which
FOOD AS A SOURCE OF HEAT AND GROWTH 255
iii man is chiefly urea, and a smaller proportion of quaternary substances
(usually referred to as "meat bases") which have a calorie value but no
food value. In order to arrive at the definite calorific value of the excre-
tory products, they must be subtracted from the fuel value of nitrogenous
foodstuffs as ascertained by calorimetric experimentation. The balance
represents only the actual energy yielded to the body and is known as the
"physiological heat" value. It may be noted in passing that the unavail-
able energy of the proteins is that represented by the urea, urates, nitrates,
sulphates and other more or less complex substances excreted in the urine
which are subject to further combustion, so that the animal body is able
to extract from proteins only about four calories, while the calorimeter
experiments in complete combustion is able to extract 5.65 calories.
It may be safely stated as a general working rule, that each gram of
protein consumed results in the excretion of about one-third of a gram
of urea.
The factors of Rubner, as previously mentioned, are generally agreed
upon as being approximately correct, but, in order to ascertain the physio-
logical available energy, the food should be burnt in a bomb calorimeter
already described, and the figure obtained will be the gross heat value.
From this, as we have previously mentioned, must be subtracted the heat
yielded by the urine and feces by combustion, and the net will show the
physiological availability of the energy. In his physiological researches,
Rubner (0) made many such experiments, and the following is summed
up from his results, to which Tibbles(O) refers:
RUBNER'S TABLE SHOWING LOSSES AND AVAILABLE ENERGY
FOOD
HEAT LOST, PER CENT
Availability
of Energy,
Per cent
In Urine
In Feces
Total
Mixed diet : Poor in fat ....
Rich in fat ....
Meat diet
4.70
3.87
16.30
5.13
2.40
2.20
2.00
6.00
5.73
6.90
5.07
15.50
24.30
5.60
10.70
9.60
23.20
10.20
17.90
26.50
7.60
89.3
90.4
76.4
89.4
82.1
73.5
92.4
Cow's milk
Graham bread
Rve bread. .
Potatoes
Physiological Food Value The value of a fuel food to the body is
finally measured by the number of calories which it can yield when
oxidized in the tissues the physiological food value. But this value
depends upon digestibility and absorbability. It was formerly considered
256 THE CALORIC METHOD OF FEEDING
that the measure of digestibility of any foodstuff depended upon the
length of time it remained in the stomach and freedom from discomfort
during the process of digestion. In normal individuals the process of
digestion is unaccompanied by any feelings save that of satisfaction and
well being. It is only under abnormal conditions that the presence of
food in the stomach or alimentary canal gives rise to any other sensation.
Beaumont (10), in a long series of experiments on Alexis .St. Martin, who
suffered from a gastric fistula, was able to determine exactly the length
of time the food remained in the stomach. For many years his experi-
ments w r ere accepted as authoritative, but the science of nutrition has
shown many errors in his reasoning and conclusions.
Physiologists in recent years have conducted experiments with the
object of ascertaining the period of time various foods remain in the
stomach (11). Penzoldt, in working out this question, made observations
on the gastric digestion in healthy men. 1 He allowed his subjects to have
a stated amount of certain foodstuffs, the exact amount and consistence of
which he took careful note. He allowed this to remain in the stomach
for a definite time and removed the contents with a stomach tube, and he
found that the time it remained in the stomach had a marked influence
upon it. Physiologists have definitely determined the fact that fluids pass
out of the stomach more rapidly than solids. For instance, six to eight
ounces of water or beverages pass out of the stomach during the course
of 30 minutes. It was found that hot drinks did not pass out of the
stomach any quicker than cold ones. Solid food substances in solution
or suspension were somewhat delayed in leaving the stomach, thus it took
two hours for eight ounces of milk to pass through the stomach. It is
a well-known fact that the length of time food remains in the stomach is
not a definite criterion of the ease or difficulty of its digestion. On the
other hand, it would be an error to consider as "indigestible" those foods
which remain in the stomach a longer time than others or to suggest that
they should be avoided by healthy people.
According to Tibbies (8) :
The test of time occupied by its passage through the stomach refers only to
the "apparent digestibility," while the test of "actual digestibility" is the amount
absorbed. It has been truly said that "We live not upon what we eat, but upon
what we digest." The term "digestibility," therefore, refers to the entire process
of digestion, and not merely to that which occurs in the stomach. In this sense
a "digestible food' is one of which the largest possible percentage is absorbed,
and an "indigestible food" is one of which a considerable portion passes out of
the system in the feces without being disintegrated and absorbed,
i See Volume III, Chapter I, for Penzoldt's observations.
CALCULATION OF FUEL VALUES OE FOOD
257
CALCULATION OF FUEL VALUES OF FOOD
Chemical Analyses of Foods To calculate the fuel values of food it is
necessary to have before one tables showing the chemical analysis of the
food in question. Taking from the tables the component parts of the
aliment to be used, and multiplying by the factors representing the num-
ber of calories per gram of carbohydrates, fats or proteins as the case
may be, one can quickly determine the calories per 100 gram or the
calories per pound in any given article of food. For assistance on this
point the reader is referred to an abbreviated table given on the following
page, containing the estimate of protein, fats, carbohydrates and caloric
value for portions ordinarily served. For a more extensive table, see
Volume I, Chapter XIX, where an accurate analysis of protein, fats,
carbohydrates, mineral matter and caloric value per pound and per por-
tion is given for the different American foods. A study of these tables
will afford a basis for calculating the requisite number of calories con-
tained in different foods for a well-balanced ration.
From the following table compiled from the more extensive work by
Locke(12) it will be easy to estimate the percentage of ternary food ele-
ments contained in the common foodstuffs, together with the caloric value
given for individual portions ordinarily served :
COMPARATIVE EQUIVALENTS IN METRIC, AVOIRDUPOIS AND
APOTHECARIES' WEIGHTS AND MEASURES'
METRIC
WEIGHTS
WEIGHTS
MEASURES
AND
MEASURES
Apothecaries'
Avoirdupois
Fluid
Fluid
Grains
oz. gr.
Ib. oz. gm.
gm. or c.c.
oz. minims
ounces and
fractions
15432.4
32 72.4
2 3 119.9
1000
33 390.06
33.814
7000.0
14 280.0
1
453.592
15 162.1
15.338
1543.2
3 103.2
.. 3 230.7
100
3 183.1
3.382
480.0
1
. . 1 42.5
31.1035
1 24.8
1.052
456.392
1 18.89
29.5737
1
1
437.5
1
28.350
. . 460.1308
0.959
15.4324
1
16.23
0.0338
1
0.06479
1.0517
0.0022
0.9508
0.06161
1
0.0021
From the United States Pharmacopeia.
258 THE CALORIC METHOD OF FEEDING
VALUES OF THE ORDINARY FOODS PREPARED TO SERVE
FOODSTUFFS
Quantity
Weight
(Cms.)
Protein
(Gms.)
Fats
(Gms.)
Car-
bohy-
drates
Total
Calories
Beef juice
4 ounces
120
5.88
0.72
31
Corned beef hash.. . .
2 heap, tblspoon.
100
6.00
1.90
9.40
81
Roast beef
1 slice
100
22.30
28.60
357
Steak, tenderloin beef.. .
Sweetbreads
1 "
2
100
80
23.50
32.00
20.40
0.45
286
135
Creamed chicken on toast
Roast chicken
Lamb chop with bone . .
Roast lamb
2 heap, tblspoon.
1 slice
1 chop
1 slice
125
100
100
75
16.26
32.10
21.70
14.78
12.62
4.40
29.90
9.53
21.76
2.10
273
181
367
150
Boiled mutton, lean ....
Mutton chop, lean
Mutton, roast leg
1
1 chop
1 slice
75
100
75
23.18
22.60
18.75
3.38
4.50
16.95
126
135
234
Ham, smoked, boiled, as
purchased
1 "
33
7.29
6.80
93
Ham, smoked, fried. . .
1
35
7.77
11.62
140
Sausage, uncooked
1 sausage
35
4.55
15.47
0.39
164
Roast turkey
1 slice
100
27.80
18.40
285
Veal cutlet
1 cutlet
80
22.82
1.14
104
Veal roast.
1 slice
75
21 33
1.00
97
Bluefish
Average helping
100
25.90
4.50
148
Codfish
100
21.68
0.27
1.58
98
Halibut
u u
100
20.35
4.04
121
Mackerel
a u
70
11.73
4.48
2.62
104
Salmon
u u
100
19.65
10.21
5.36
198
Sardines, canned. .
1 fish
10
2.30
1.97
28
Trout, brook
Average helping
50
10.57
1.17
.62
57
Clams, long
6 clams
150
12.90
1.5
3.00
79
Clams, round. . .
6 "
100
650
0.4
420
47
Crabs, hard shelled, as
purchased
1 crab
245
19.36
221
1.47
106
Lobster
105
17.22
1.89
.42
90
Oysters
6 oysters
85
5.27
1.02
3.15
44
Oyster stew
4 ounces
124
6.07
11.06
10.53
171
Scalloped ovsters
6 large ovsters
138
8.06
18.58
11.98
255
Scallops, fried.. . .
3 heap tblspoon
110
2820
1 75
602
158
Bean soup, home-made .
Chicken soup, home-
made
1 teacup
1 "
120
120
3.84
1260
1.68
096
11.28
288
78
72
Chicken gumbo soup,
canned
1
120
456
1.08
5.64
52
Clam chowder, home-
made
1 "
120
2.16
.96
8.04
51
Consomme\ canned.
1 "
120
3 00
048
14
Asparagus, cream soup.
Celery cream soup
1
1 "
125
125
3.44
3.00
8.62
8.94
' 4.87
5.01
114
116
Corn cream soup
1 "
125
3.75
8.70
10.66
140
Pea cream soup. . .
1 (i
125
629
846
1407
162
Tomato cream soup ....
Mock turtle, canned. . . .
Oxtail soup, canned
1
1 ( (
I ((
125
120
120
2.99
6.24
4.80
9.40
1.08
1.56
6.36
3.36
5.16
126
50
55
CALCULATION OF FUEL VALUES OF FOOD 259
VALUES OF THE ORDINARY FOODS PREPARED TO SERVE Continued
FOODSTUFFS
Quantity
Weight
(Gms.)
Protein
(Gms.)
Fats
(Gms.)
Car-
bohy-
drates
Total
Calories
Vegetable soup, canned .
Butter
1 teacup
1 ball
120
15
3.48
0.15
12.75
0.6
17
119
Average cream
1 tblspoon.
20
0.74
5.14
0.71
54
Thick cream.. ....
1 "
20
0.31
11 22
46
108
American cheese, pale . .
Camembert cheese. . .
1 cubic inch
1 heap, tblspoon.
20
20
5.70
4.20
7.18
4.34
0.06
91
58
Fromage de brie
1 cubic inch
20
3.18
4.20
028
53
Full cream cheese
1 U U
20
5.18
6.74
048
86
Neufchatel cheese
1 <(
20
3.74
5.48
.30
68
Roquefort cheese
1 <(
20
4.52
5.90
0.36
75
Swiss cheese
1 slice
20
5.52
6.98
0.26
89
Kumiss
1 wineglass
130
3.64
2.73
7.02
69
Buttermilk
1 glass
218
6.54
1.09
10.46
80
Whole milk
1 "
220
7.26
8.80
11.00
157
Whey
1 "
203
2.03
0.61
10.15
56
Hen's eggs, boiled. . .
1 eee
50
6.60
6.00
83
Omelette egg.. . . .
}/2 omelette
75
9.80
14.01
1.55
177
Ingredients : 3 tblspoon .
milk, 3 eggs, 1 heap,
teaspoon butter. . . .
Asparagus, canned
125
1.88
0.13
3.50
23
Baked beans, home-made
Butter beans
3 heap, tblspoon.
4
150
180
10.83
63.78
12.76
0.24
32.84
11.60
298
65
Lima beans
2 " "
80
6.40
0.54
23.60
128
String beans
2 "
60
0.48
0.66
1.14
13
Beets
2 u
70
1.61
0.07
5.18
29
Cabbage
3 " "
100
0.60
0.10
0.40
5
Carrots
3 " "
100
0.53
0.17
3.39
18
Cauliflower
2
120
1.08
0.12
0.48
8
Celery, uncooked.
3 small stalks
55
0.50
0.05
1.43
8
Corn, canned. .
2 heap, tblspoon.
100
2.80
1.20
19.00
101
Corn, green
1 ear
100
3.07
1.10
18.78
100
Cucumber, uncooked . . .
Mushrooms, broiled ....
Onions
8 thin slices
2 large, on toast
1
50
57
100
0.40
3.52
1.20
0.10
8.94
1.80
1.55
12.85
4.90
9
150
42
Peas, green
3 heap, tblspoon.
92
6.16
3.13
13.43
110
Potatoes, sweet, boiled . .
Baked potatoes
Average size
Medium "
100
130
3.00
3.77
2.10
0.20
42.1
32.07
204
149
Boiled potatoes
U
150
3.75
0.15
31.35
145
Mashed and creamed
potatoes
2 heap, tblspoon.
100
2.60
3.00
17.80
112
Squash
2
100
1.36
0.82
13.60
69
Spinach
2
100
2.10
4.10
2.60
57
Tomatoes, canned
2 " "
70
0.84
0.14
2.80
16
Tomatoes, uncooked.. . .
Turnips
Medium size
2 heap, tblspoon.
200
140
2.40
0.45
0.40
0.08
8.00
0.91
46
6
Apple
Average size
150
0.45
0.45
16.22
72
Banana
194
1.55
0.78
27.74
127
Blackberries
3 heap, tblspoon.
100
1.30
1.00
10.90
59
Cantaloupe
^ melon
465
1.40
21.39
93
260 THE CALORIC METHOD OF FEEDING
VALUES OF THE ORDINARY FOODS PREPARED TO SERVE Continued
FOODSTUFFS
Quantity
Weight
(Gms.)
Protein
(Gms.)
Fats
(Gms.)
Car-
bohy-
drates
Total
Calories
Cherries ....
About }/;j pound
100
0.90
0.80
15.90
76
Currants
4 heap, tblspoon.
100
1.50
12.80
59
Grapefruit
J/2 large
300
2.37
0.60
30.27
139
Grapes
1 bunch
150
1.50
1.80
21.60
112
Gooseberries
4 heap, tblspoon.
90
0.90
11.79
52
Huckleberries
4.
100
0.60
0.60
16.60
76
Lemon
Average size
130
.91
.65
7.67
41
Orange
u
250
1.50
0.25
21.25
96
Peach
u u
128
0.64
0.13
9.86
44
Pear..
u u
156
0.78
0.62
19.81
90
Pineapple, edible portion
Plum
2 slices
Average size
100
35
0.40
0.32
0.30
9.70
6.69
44
29
Raspberries
3 heap, tblspoon.
82
0.82
10.33
46
Strawberries
4
100
1.00
0.60
7.40
40
Watermelon. .
Large slice
300
.60
0.30
8.10
39
Apricots, dried
10 large
80
3.76
0.80
50.00
228
Dates
10 "
83
1.58
2.08
58.60
266
Figs. .
10 "
117
8.38
0.58
59.28
633
Prunes
10 very large
200
3.60
124.40
525
Raisins
10 "
25
0.57
0.75
17.13
80
Apple, baked
1 large
120
0.61
0.58
29.30
128
Apple, sauce
3 heap, tblspoon.
125
0.25
1.00
46.50
201
Cranberries, stewed
Currant jelly
2
1 U U
100
35
0.27
0.36
0.41
36.00
27.16
153
113
Marmalade, orange
Rhubarb, stewed
1
2
30
90
0.18
0.40
0.03
0.47
25.35
32.40
105
139
Rye bread
1 slice
39
3.51
.23
20.74
102
Graham bread .
1 "
37
3.29
0.67
1928
99
Biscuits, home-made. . . .
Biscuits, soda
1 biscuit
1
35
38
3.05
3.53
0.91
5.21
19.36
19.99
100
145
Rolls, French
1 roll
39
3.32
0.98
21.72
112
Whole wheat
1 slice
42
4.07
0.38
20.87
106
Zwieback.. . .
1
15
1.47
1.49
11.03
65
Boston cracker (split) . .
Graham cracker
1 cracker
1
10
8
1.10
0.80
0.85
0.75
7.11
5.9
42
34
Oyster cracker
10 crackers
11
1.24
1.16
7.76
48
Pretzels
1 pretzel
6
0.58
0.23
4.37
22
Educators, soda cracker .
Uneeda biscuits
1 cracker
1 "
3
6
0.97
0.59
6.55
1.39
4.38
10
25
Chicken sandwiches ....
Egg sandwich.. . .
1 sandwich
1 "
70
100
8.61
9.60
3.78
12.70
22.47
34.50
163
299
Ham sandwich
1 "
70
7.28
10.07
26.55
233
Cream toast
2 slices
136
9.03
14.60
37.15
325
Ingredients: 2 slices
toast; 5 tblspoon.
cream sauce.
Grapenuts
5 heap, tblspoon.
65
7.78
0.40
51.51
247
Cornmeal mush
4
115
3.85
4.11
9.52
93
Ingredients: 2 table-
spoons white corn
meal; 2 cups milk.
CALCULATION OF FUEL VALUES OF FOOD 261
VALUES OF THE ORDINARY FOODS PREPARED TO SERVE Continued
FOODSTUFFS
Quantity
Weight
(Cms.)
Protein
(Cms.)
Fats
(Gms.)
Car-
bohy-
drates
Total
Calories
Hominy, boiled
2 heap, tblspoon.
100
2.20
0.20
17.80
84
Indian meal mush
3 " "
115
2.10
1.18
18.50
96
Macaroni boiled
2
100
3.00
1.50
1580
91
Macaroni, baked with
cheese;
2
140
19.06
20.46
43.44
447
Oatmeal, boiled...
2 " "
100
2.80
0.50
11 50
63
Puffed rice
5 " "
14
0.87
0.08
12.00
54
Rice, boiled. .
i
100
2.80
0.10
24.40
112
Shredded wheat biscuit .
Spaghetti, baked with
tomato
1 biscuit
3 heap, tblspoon.
29
145
3.05
4.52
0.41
2.81
22.59
25.76
109
150
Apple pie
Y pie
126
3.91
12.35
53.93
352
Custard pie
H "
133
5.59
8.38
34.71
243
Lemon pie
K "
110
3.96
11.11
41.14
288
Mince pie
1 A "
113
6.55
13.90
43.05
333
Squash pie
K "
133
5.85
11.17
28.86
246
Bread pudding
2 heap, tblspoon.
105
5.52
4.79
38.48
225
Ingredients: 1 cup
bread crumbs; 1 cup
milk; 1 egg; ?& cup
sugar; % cup raisins
Baked custard. .
2
134
7.31
7.42
20.50
183
Ingredients : 2 cups
milk; 2 eggs; %
sugar.
Soft custard
4 tblspoon.
60
4.39
6.84
12.12
131
Ingredients: Yolk 1 egg;
1/2 cup milk; 1 heap,
tblspoon. sugar.
Snow pudding
2 heap, tblspoon.
80
4.52
0.03
11.73
67
Ingredients: % cup
water; 1 heap, tea-
spoon gelatin; 2 h.
tblspoon. sugar; 1
teaspoonlemon juice
lemon rind; white 1
egg-
Tapioca pudding. . .
3 " "
110
5.85
6.12
22.25
172
Ingredients: 2 cups
milk; 1 egg, 3 table-
spoons tapioca; 2
tablespoons sugar.
Tapioca and apples.. . . .
Ingredients: 9 small
apples; 1 cup sugar
% cup tapioca; 2
cups water.
2 "
100
0.21
0.22
28.58
120
117
262 THE CALORIC METHOD OF FEEDING
VALUES OF THE ORDINARY FOODS PREPARED TO SERVE Continued
FOODSTUFFS
Quantity
Weight
(Gms.)
Protein
(Gms.)
Fats
(Gms.)
Car-
bohy-
drates
Total
Calories
Blancmange
2 heap, tblspoon.
90
4.76
4.91
16.83
134
Ingredients: 1 heap,
tblspoon. corn-
starch; 1 heap,
tblspoon. sugar; 1
egg; 1 cup milk; 1
tblspoon. sherry
Doughnuts .
1 doughnut
37
2.48
7.77
19.65
163
Egg souffle*
}/2 souffle"
50
5.22
4.09
38.09
216
Ingredients: 2 eggs; l /%
cup sugar; 1 table-
spoon lemon juice
Ice cream
2 heap, tblspoon.
100
5.21
10.16
17.73
189
Ingredients: 3 cups
milk; 1 cup cream; 3
eggs; % cup sugar;
vanilla
Ladyfingers
1
20
1.76
1.00
14.12
74
Macaroons
1
10
0.65
1.52
6.52
44
Orange ice
2 heap, tblspoon.
100
0.94
0.23
74.68
312
Ingredients: 2% cups
orange juice; Mcup
lemon juice; \Yi
cups sugar; 1 cup
water; rind 2
oranges
Prune souffle^
2
85
3.31
0.65
18.95
97
Ingredients: % cup
stewed prunes (edi-
ble portion), white
1 egg.
French dressing
1 dessert spoon
11
8.00
74
Ingredients : 4 tblspoon .
olive oil; 1 tblspoon.
vinegar; ^teaspoon
salt; pepper.
Mayonnaise dressing
Ingredients: 2 eggs; 2
cups olive oil; 1
tblspoon. vinegar,
or 1 tblspoon. lemon
juice; salt, pepper,
mustard.
Honey
1 tblspoon.
1 "
21
30
0.2
.12
19.92
0.05
24.36
187
101
Cube sugar
1 cube
7
7.00
29
Domino sugar
1 domino
6
6.00
25
Granulated sugar
1 heap teaspoon
10
10.00
41
Powdered sugar
j
12
12.00
49
Maple sugar. .
1 cake
100
82.80
339
Almonds
10 large
15
3.15
8.23
2.60
100
( 'ALCTLATIOX OF FUEL VALUES OF FOOD 263
VALUES OF THE ORDINARY FOODS PREPARED TO SERVE Continued
FOODSTUFFS
Quantity
Weight
(Gms.)
Protein
(Gms.)
Fats
(Gms.)
Car-
bohy-
drates
Total
Calories
Brazil nuts
10 large
60
10.20
40.08
4.20
432
Chestnuts, roasted, as
purchased
20 nuts
50
2.60
2.25
17.70
104
Cocoanut
1 slice
34
1.94
17.20
9.49
207
Filberts
10 nuts
10
1.56
6.53
1.30
72
Peanuts, as purchased . .
Pecans..
15
10 large
30
30
5.85
3.30
8.73
21.36
5.55
3.99
128
229
Walnuts
10 "
42
7.73
27.05
5.46
306
Cocoa
1 cup
227
9.08
15.53
23.85
279
Ingredients: 1 heap, tea-
spoon cocoa; 1 heap,
teaspoon sugar; %
cup milk; 1 tblspoon.
cream.
Coffee or tea. ...
1 "
246
2.80
7.64
17.83
156
Ingredients % cup
milk; 1 tblspoon.
cream ; 2 cubes
sugar; coffee or tea.
Eeecnoe.
1 glass
270
13.00
12.85
29.50
294
Ingredients: 1 egg; 1
heap, tblspoon.
sugar; % cup milk;
1 tblspoon. sherry.
In discussing the energy obtained from different foods, it is important
to distinguish between heat produced when substances are burned in the
calorimeter and the heat that is available when used in the body, since
it never happens that the combustible portion of a ration is entirely con-
sumed in the body. The total food is never all digested, therefore it
cannot all be absorbed and assimilated. Furthermore, the absorbed and
assimilated proteins are never fully burned and there is usually an escape
of unconsumed gases from the alimentary canal. As actual work is per-
formed in the process of digestion, the term "net energy" has been intro-
duced and applied to the amount of energy which is available after that
used up in the digestion and preparation of the food for use in the body
has been subtracted.
In calculating the fuel value represented by a particular menu, one
deals with several carbohydrates in various proportions ; similarly with
fats and proteins derived from both animal and vegetable foods. Instead
of computing the different foodstuffs separately, it will be found more
convenient to use the average value given in the table on page 248 and
264 THE CALORIC METHOD OF FEEDING
multiplying the total amounts of carbohydrate in the menu by this factor.
The same may conveniently be done with the fats and proteins. The
fuel value which any food represents is easily determined by using the
factors in this table: Ascertain first the percentage of protein, fat and
carbohydrate which the menu contains and multiply these several amounts
by the factors given in this table; for example, oatmeal contains 7.6 per
cent of water, 15.5 per cent of protein, 7.1 per cent of fat, 68.2 per cent
of carbohydrates and 2 per cent of salts. One hundred grams of oatmeal
represent energy, viz. :
From protein 15.1 X 4.0 = 60.40
From fat 7.1 X 9.4 = 63.90
From carbohydrates . . . 68.2 X 4.0 = 272.80
^ Total 397.10
The total fuel value of one pound of dry oatmeal is obtained by multi-
plying this quantity by 4.5. The heat energy or fuel value of almost
every known food is given in the table on page 702 (Analysis and Fuel
Value of Foods, Volume I, Chapter XIX). These figures are suf-
ficiently accurate for determining the caloric value of dietaries for insti-
tutional purposes or in private practice.
Method of Reckoning the Protein, Fat and Carbohydrate Rations for Diets
of Definite Energy Values. Voit's dietary standard for a man at mod-
erately hard work is calculated for 16 per cent of the energy to be fur-
nished by protein, 18 per cent by fat, and 66 per cent by carbohydrate.
Where the total fuel value of the ration represents 3,000 calories,
according to Coleman, the calculation is made as follows :
16 per cent of 3,000 = . Q = 120 grams prctein
540
18 per cent of 3,000 = Q , = 57 grams fat
55 per cent of 3,000 = /Q = 495 grams carbohydrate
By the employment of Coleman's method the rations may be quite
accurately determined for diets of any given energy value.
With the above facts before us it is easy to determine the caloric value
contained in any food, provided the percentages of protein, fat and carbo-
hydrate are known. These percentages multiplied by the figures given in
FACTORS GOVERNING FOOD REQUIRED 265
the table previously referred to aiid their results added will give the
number of calories in 100 grams of food. It* will not be such an arduous
task to calculate the caloric value of a meal if one will remember the
fuel values of the ordinary portions, viz.: roast beef, 357 calories; bread,
100 calories; butter, 150 calories; rice croquettes, 128 calories; a medium
baked potato, 150 calories; tapioca pudding, 120 calories; sugar and
cream with coffee, 100 calories which will total 1,105 calories for the
meal, or about one-third of the day's requirements.
FACTORS GOVERNING THE AMOUNT OF FOOD REQUIRED
The amount of food required to keep any person in a normal state of
health and bodily equilibrium differs according to various circumstances^
such, for instance, as the condition of rest or work, the kind of work, the
training, the age, sex, size and weight of the body, restlessness or placidity,
and even the individual peculiarities of the person. As an illustration,
we will consider the body as an engine and the food consumed as the fuel
for the engine. It has been proved as far as possible that the laws of
conservation of matter and energy are followed by the human organism
as they are in the engine; the body loses matter and energy, but they
undergo transformation and are not destroyed in the body. Reasoning on
this analogy, it may be assumed that whatever material is used in the
body and however much energy is exhibited or heat evolved by it, both
matter and energy have been derived from the food consumed in the
process of digestion and assimilation and stored in the tissues.
Amount of Heat Lost by Body It is known that the heat of the body
is generated by the oxidation of food or tissue substances, and also that the
food required is proportional to the extent of the surface of the body.
For instance, a small animal gives off, weight for weight, more heat
than a large one. A large animal has a smaller cutaneous surface in pro-
portion to size and weight than a small one, and a small animal a rela-
tively larger surface area than a large one. For these reasons, it will
be seen at a glance that a thin, angular, lean, lanky person loses more
heat, according to weight, than a larger and more rotund person, a thin,
premature infant more than a plump and well-developed child. After
a consideration of many experiments on animals and human beings,
Camerer came to the conclusion that an. infant expendc 100 calories, a
child of 4 years expends 91.3 calories, a child of 12 years expends 57.7
calories and a man of 30 years expends 42.4 calories per kilogram of
body weight. Consequently, the amount of heat lost by the body is an
266 THE CALORIC METHOD OF FEEDIXG
important factor in the regulation of food, and to a great extent this is f
governed by the area of the body surface.
Weight of Body. The amount of food required by the body, other
things being equal, must be proportional to the weight of the body. The
bodily heat is produced by the oxidation of food consumed or stored in
the tissues. In a condition of rest, the tissues of the body are not called
on for the production of heat and energy, but still there must be a mini-
mum of food consumed to supply the energy utilized by, and the heat
radiated from, the body. In a state of rest, a man of 154 pounds weight
gives off 15 cubic feet of carbon dioxid in a period of 24 hours. The
production of 1 cubic foot of carbon dioxid by combustion is accompanied
by a liberation of heat equivalent to 160 foot-tons of energy, therefore
15 X 160 = 2,400 foot-tons of energy which are necessary to the main-
tenance of the body temperature and the performance of bodily functions
during the state of rest. Therefore 1 calorie is equal to 1.54 foot-tons
of energy, and 2,400 foot-tons is equal to about 3,696 calories for a person
weighing 154 pounds.
Age. According to Huebner(13), the younger the animal organism,
the more rapid is the rate of growth. For instance, a child's body grows
seven times more rapidly from one to three months than from six to
nine months of age. It is correctly asserted that a child commonly loses
a little weight for a few days after birth; but the average increase of
weight up to three months is 3.6 pounds; from the third to the sixth
month, 3.6 pounds; from the sixth to the ninth month, 3.4 pounds; and
from the ninth to the twelfth month, 3 pounds. So the amount of food
required by a normal child is in proportion to its rate of growth. Further
consideration of food in childhood will be found in Volume II, Chap-
ter XL
Sex In anthropometric tables (14) that have been carefully com-
piled, the following data appear: (a) The most rapid growth occurs dur-
ing the first five years after birth. In the first year the weight is trebled,
in the second year it is nearly doubled. During this period the rate of
growth is nearly identical in both sexes, only that boys are a little taller
and heavier than girls. (6) During the next period, from five to ten
years, the growth of boys is more rapid than that of girls, the weight of
the former being from 2 to 3 pounds more, on the average, (c) During
the third period, from ten to fifteen years, conditions are changed, the
growth of girls taking the lead. From the age of twelve and a half to
fourteen and a half years girls are taller than boys, and from the age of
twelve and a half to fifteen and a half years their weight exceeds that
FACTOKS GOVEK.MNG FOOD HEQUIKED 267
of boys of the same age by 3 or 4 pounds, (d) During the period from
fifteen to twenty years, boys again come to the fore, and grow more
rapidly than girls; the weight of boys increases yearly at the rate of
6.0 pounds, while that of girls is 2.75 pounds, (e) At the age of twenty-
three years, boys have attained the limit of growth in height, but in
breadth and weight they continue to increase. Girls, on the other hand,
at about twenty years of age have attained their full height and weight,
the latter remaining practically stationary until the age of twenty-five
or even thirty years. (/) In general, adults begin to increase in weight
after thirty-five years of age at the annual rate of three-quarters of a
pound, a change most often unwelcome and not of advantage. The rela-
tive weights of men and women of the same age vary with the height, up
to the height of 67 inches, men as a rule weighing more than women;
but when over 67 inches in height, women are generally heavier than
men of the same height and age, and especially after middle life the
weight of women may greatly increase.
The generally accepted statement that the quantity of food ingested
should be regulated by the size and weight of the body, offers no excep-
tion as regards the food of individuals of different sexes; the normal
height and weight of a woman being less than those of a man, a smaller
quantity of food than that required by a man should meet the needs of
the average woman. An important point to note is that this smaller
metabolism of food should be looked at from the standpoint of the per-
sonal equation relating to the sex of the individual, rather than the nor-
mally lower average size and weight of a woman. The following table
illustrates this fact by showing the difference in the quantity of food
taken daily by an active man and woman of identical age and height
who were able to maintain their nutritive and nitrogenous equilibrium
upon the amounts here designated:
Protein Fat Carbohydrate Cal.
Man 100 gm. 70 gm. 400 gm. 2,700
Woman 60 gm. 67 gm. 340 gm. 2,263
Atwater established the principle that the daily ration for a healthy
woman should be 0.8 of that of a man. As a general rule, it is usually
held that a woman requires about the same amount of protein and energy,
weight for weight, as a man under similar circumstances. The amount
of energy required to execute a definite amount of work is the same,
whether it is performed by a woman or is done by a man ; consequently,
the supply of food should be the same. Tibbies says: "On the other hand,
268
it frequently happens that the expenditure of energy on the part of a
woman to produce a definite amount of work is greater than that ex-
pended by a man doing the same identical work."
FOOD REQUIREMENTS AS INFLUENCED BY THE INTERNAL, SECRETIONS
OF WOMAN. It is claimed that the internal secretion of the ovaries facili-
tates the oxidation of carbohydrates and the organized phosphorus of the
food. There are other circumstances in the life of a woman which influ-
ence the demand for food. We know that their sex is subject to a wave
of metabolic activity which is at its highest just before each menstrual
period. During this metabolic disturbance the organism calls for an
increase in the nitrogen metabolism, and a decrease in the carbon metab-
olism. There also appears at this time the formation of new blood cells,
with an increasing amount of nerve force and general vigor. During the
menstrual epoch there is a small loss of weight due to the increased excre-
tion of carbonic acid and water, although the protein metabolism is
diminished. There is an increase in weight during pregnancy, notwith-
standing the increased combustion of non-nitrogenous elements; there is
usually an increase in the size of the organs of lactation and parturition
and a deposition of fat in the adipose tissue. These metabolic changes
call for an increased amount of food to the daily ration, which practically
means that the woman should consume about double the ordinary amount
of protein, and have a greatly increased amount of the fuel foods.
Kind of Work. The quantity of food necessary for an adult must be
regulated rather by the amount of work performed than by the size,
weight or other characteristics of the body. These requirements of the
body are analogous to those of a machine, and well they may be, as the
body itself is a living machine. It is a truism that the greater the expen-
diture of energy by a machine in the performance of work, the more fuel
it will demand for the generation of that energy.
The human machinery performs work of two types, internal and
external work. The internal work consists of that done by the organs
of digestion, respiration and circulation, by the neuro-muscular system
which maintains the body temperature, and muscle tone; and by the
glandular system in keeping up the supply of the secretions and excre-
tions. The external work includes the activities of the voluntary mus-
cular system and the process of heat radiation from the body. According
to Atwater's experiments, a man at rest in the respiratory calorimeter
liberated during two hours 150 calories; while working a stationary
bicycle for two hours, 500 calories ; and while working the same machine
against resistance for a period of two hours, 1,000 calories. It follows,
.FACTORS GOYKKXiNG FOOD KEQUJKEI) 269
therefore, that the supply of food must keep pace with the. amount of
work to be done, or else the body tissues themselves will be used up as
fuel for the generation of the energy expended.
Choice of Food. The necessity for increasing the allowance of food
in proportion to the amount of work the body is expected to do has always
been recognized. Many research workers have made observation upon
the food consumed by individuals who were allowed a free choice of food,
and found that, with diets having the fuel values in "Standard Die-
taries," nutrition of such individuals was fairly normal and the nitrogen
balance in the state of equilibrium. They concluded, therefore, that the
menus given fairly well represented the aliment required by these persons.
A close study of the table 1 on page 270 shows that when Americans and
Europeans are free to choose their own food, they seldom select that which
will yield less than 100 grams of protein per day.
When the choice of food rests with the individual, it is often found
upon observation that a male rarely consumes less than 90 grams of protein
per day. For economic and other reasons, there are many thousands who
necessarily consume a much smaller quantity, because meat, fish, fowl,
milk, eggs and cheese are dearer than bread, potatoes, rice, oatmeal, etc.
Maurel(15), who has devoted much attention to the subject, claims that,
"to maintain the body in nitrogen equilibrium when no muscular work is
being performed, an adult in full health and vigor weighing 154 pounds
requires for maintenance 105 grams of protein in a ration yielding about
2,600 calories of energy; a woman weighing 132 pounds requires 90
grams of protein in a ration yielding about 2,200 calories of energy."
Our experience leads us to assert that these figures are probably very
near the mark.
Kubner, in studying the specific dynamic action of foodstuffs, came
to the conclusion that each type of food seemed to exert a more or less
specific action upon the energy yielded ; "so that, when the foodstuffs were
fed separately, somewhat different energy values were required for the
maintenance of body equilibrium." He observed a man who metabolized
in fasting 2,042 calories; and when fed, 2,450 calories; in the form of
sugar alone he metabolized 2,087 calories ; when fed 2,450 calories in the
form of meat alone, he metabolized 2,566 calories. This experiment
clearly shows that the eating of protein increased the metabolism far
more than could be done by eating the same number of calories in the
form of carbohydrate and fat. Rnbner believes that this specific dynamic
notion of protein involves the liberation of energy which has not come to
i Bulletin No. 52, p. 24, U. S. Dept. of Agric., and other sources.
270
THE CALO1UC METHOD OF FEEDING
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FACTORS GOVKKXIXt; FOOD REQUIRED 271
the surface of the tissues and which does not directly contribute to the
support of their activities, although it aids in the maintenance of the
body temperature. This apparent loss of a part of the fuel value of protein
of an ordinary mixed diet is not a very important factor in the total body
metabolism, since this specific dynamic action and the work of digestion
and assimilation together make the total daily metabolism of energy only
about one-tenth higher on a maintenance ration than when no food is
eaten (Sherman).
Intensity of Muscular Activity. In practice, it will often be difficult
to estimate the mechanical equivalent of muscular work performed and
still it is often necessary to make use of such indefinite terms as "active,"
"severe," etc., to describe the intensity of the exertion, and thus indicate
in a general way the amount of work performed.
Atwater and Benedict (16), after a great deal of research and experi-
mentation, epitomized the results of many work experiments w r ith vigor-
ous young men in the respiratory calorimeter, and have derived the follow-
ing estimates of the average rates of metabolism, under different condi-
tions of activity :
Man sleeping 65 calories per hour
Man sitting at rest 100 " " "
Man at light muscular exercise 170 " "
Man at active muscular exercise 290 " "
Man at very severe muscular exercise. . 600
From these estimates the requisite rations may be calculated as fol-
lows :
8 hours of sleep at 65 calories equal 520 calories
2 hours' light exercise at 170 calories equal .... 340 "
8 hoiirs* active exercise at 200 calories equal. . 2,320 "
6 hours' sitting at rest at 100 calories equal. . . 600 "
Total food requirement for the day 3,780 calories
If the working day be spent in severe muscular exertions, the day's
ration would be estimated at 5,060 calories. The requisite amount of
calories for one in sedentary occupation, such as sitting at a desk, would
require only 2,260 calories.
Tigerstedt(17) gives the following estimates of food requirements for
272 THE CALORIC METHOD OF FEEDING
different occupations, indicating the intensity of work performed and the
caloric needs:
2,001-2,400 calories suffice for a shoemaker
2,401-2,700 " " for a weaver
2,701-3,200 " " for a carpenter or mason
3,201-4,100 " " for a farm laborer
4,101-5,000 " " for an excavator
Over 5,000 " " for a lumberman
Graham Lusk(18) gives the following estimate of food in calories for
the requisite occupations of women:
1,800 calories suffice for a seamstress using a needle
1,900-2,100 calories suffice for a seamstress using a machine
1,900-2,100 " " for bookbinders
2,300-2,900 " " for household servants
2,600-3,400 " " for washerwomen
Food requirements for occupations of men :
2,400-2,500 calories suffice for a tailor
2,700-2,800 " " for a bookbinder
3,100-3,200 " " for metal workers
3,200-3,300 " " for a painter
4,300-4,700 " " for stonemasons
5,000-5,400 " " for wood-sawyers
The estimated amount of food in calories for wood-sawyers emphasizes
the fact that "wood-sawing is a strenuous occupation." This proverbial
occupation has a scientific verification in the above statement and explains
the disinclination of the hungry to engage in this useful occupation as
well as the unpopularity of charitable wood yards.
On page 273 we give a table, taken from Lusk(19), of food values with
cost per 1,000 calories for various fundamental foodstuffs and the per-
centage of protein contained in 1,000 calories.
The foods in the following table were purchased on the New York mar-
kets at the prices named. If the expense of cooking and serving and other
overhead charges be included, the cost somewhat increases. Thus, at
Childs' and other similar restaurants in New York, a portion of pork and
beans served with three slices of bread and a pat of butter costs 20 cents,
representing a well-balanced ration of 1,000 calories. The same could be
FACTORS GOVERNING FOOD REQUIRED
FOOD VALUES WITH COST PER 1,000 CALORIES
273
FOODS
Cost in cents per
1,000 calories
Per cent of
calories in protein
Glucose
1%
Corn meal
2
8
Wheat flour
VA
12
Oatmeal
2 4 /B
13
Cane sugar
3U
Dried beans
4
19
Salt pork (fat)
4^2
1
Rice
5
7
Wheat bread
5U
12
Oleomargarine
1 1 A
Potatoes
IVi
8
Butter
10
Milk
10
17
Smoked ham
10M
34
Cheese
n%
25
Loin pork
1214
18
Leg of mutton
16M
30
Sirloin beef
24
37
Turkey ...
40*4
37
served in the home at a cost of about 10 cents, and most people, after
ingesting such a repast would feel comfortably satisfied. Of course, it is
understood that this menu would not satisfy everybody, especially not
those in the upper classes who demand the luxuries of the world without
rendering to the world an equivalent therefor.
Before leaving the subject of the relation of muscular activity to
metabolism, it may be well to point out that the expenditure of energy
in the muscular system does not depend simply upon the muscular move-
ments performed, but to a considerable extent upon the degree of tension
or tone maintained in the muscle while in a condition of rest. It is
obvious to the surgeon that every living muscle is always in a state of
tension from the fact that it gapes when its muscular sheath is cut. It is
equally true that the degree of tension varies greatly under different con-
ditions. Atwater and Benedict observed the differences between the
metabolism of sleeping hours and that of the hours spent sitting up with-
out muscular movements which are due largely to the more complete
relaxation of the muscles during sleep. From this we find that there
is in the resting muscles continual expenditure of energy which takes the
form of muscular tension or tone, but ultimately appears as heat, so that
the heat production or energy metabolism of the body in a condition of
rest depends largely upon the degree of tension which normally exists
in the muscle.
274 THE CALORIC METHOD OF FEEDING
REGULATION OF BODY TEMPERATURE
The regulation of body temperature has been most ably discussed
by Lusk(19), who avers that the maintenance of body heat beyond that of
its usual environment requires a, continual output of energy. This outgo
of heat is controlled by mechanisms which permit of (a) variations in
the reduction of temperature due to the quantity of blood Drought to the
surface of the skin radiation, conduction and sweating which is termed
physical regulation; and (&) by variations in heat production brought
about by an increase in the rate of oxidation in the body in response to
the stimulus of external cold, which is termed chemical regulation. The
increase in heat production following the ingestion of food (already con-
sidered in the previous pages of this work) may take the place of "chem-
ical regulation" and thereby aid in the protection of loss of body tempera-
ture. The presence of a cushion of adipose tissue under the skin, together
with suitable clothing for the external surface of the body also helps to keep
down the loss of heat to the minimum of "physical regulation."
A sudden change downward in the external temperature increases
the heat formation, augments the excretion of carbon dixoid, and the
consumption of oxygen in warm blooded animals. A sudden change
upward in the atmospheric temperature increases metabolism in warm-
blooded animals, and this change is greater if the animal be placed in
hot or cold water than if it be merely subjected to the influence of hot
or cold air.
Von Noorden(20) explains the significance of an increase in heat
production in cold weather, as due to extra precautions food, clothing,
etc. to offset the increased heat losses incidental to the external tempera-
ture. Senator was the first to offer an explanation of this phenomenon.
He held that the increased excretion of carbon dioxid was due to active
muscular movements. No one at present questions but that there is an
increase of about 100 per cent in carbon dioxid excretion after a cold
bath, which is due, no doubt, to active muscular movements. It may be
questioned that there may be a slight rise in carbon dioxid excretion
without any visible movement or alteration in the tension of the muscles.
The question of an involuntary heat regulation has been definitely
settled by Voit's animal experiments and also confirmed by Rubner's
studies. The latter studied the metabolism of a man who was kept in the
same cold room with different amounts of clothing, and he observed that
when the subject was clothed sufficiently to be comfortable the "chemical
regulation" was eliminated. Rubner emphasized the fact that suppres-
REGULATION OF BODY TEMPERATURE 275
sion of shivering and the inhibition of muscular activity when subjected
to external cold is an unnatural condition for a person subjected to great
cold, and one that never occurs normally.
Physical Heat Regulation.- An increase in heat dissipation by means
of conduction, radiation and evaporation comes into play as Nature's
means of avoiding overheating; a diminution, on the other hand, pre-
vents lowering of the body temperature. The amount of heat present
in the body falls under the influence of cold, and it does not rise, even
when the individual is placed in a warm bed, until active movements
again furnish the necessary amount of heat to raise the temperature
to normal. (Johansson.)
Chemical Heat Regulation Chemical heat regulation, like physical
heat regulation, reaches a limit below which it cannot go. According to
von Noorden, "The chemical energy set free in vital processes which is
inseparably associated with the development of heat, cannot go below a
certain limit. Only that form of heat production previously referred to
as being associated with increased functional capacity of working organs
can be excluded."
The extra heat required during cold weather is, in all probability,
derived in most part through the activity of the muscles. It is a matter
of every-day occurrence, in cold climates during winter weather, to see
a man, a wagon-driver, for instance, stop and strenuously exercise his
arms if he did Jiot do this, he would sit on the driver's box and shiver
a peculiar form of voluntary muscular activity whose function seems to
be to increase heat production through increasing the internal work of the
body. After all, it will be seen that the regulation of body temperature,
even nnder exposure to cold, is brought about by the activity and tension
of the muscles, the relation of which to metabolism and food requirement
has just been considered.
Voit, in a discussion on the 'Tieat balance" in warm and cold climates
during both winter and summer, says that involuntary chemical heat
regulation in the cold, which he admits exists within certain limits, is
insufficient in the frozen, zone. Here the inhabitants in addition to being
clothed in furs, are driven to strenuous exercise in order to maintain body
temperature. Only in so far as the movements increased are the food
requirements augmented in the Arctic regions. The same law holds good
in tropical countries the food is lessened and the inhabitants move along
the lines of least resistance. The enormous amount of food which the
Eskimo can ingest with impunity has already been referred to, and
emphasizes the point of the greater functional capacity of the alimentary
276 THE CALORIC METHOD OF FEEDING
canal in the natives of cold countries, as compared with the abstemious-
ness of the Arab and his ability to greater endurance of hunger and'
thirst. Our digestive system and nervous mechanism which controls it
are affected both by heat and cold, and as a result most people consume
more food in winter than in summer, although the body requirements
remain practically the same all the time.
The Surface Areas of the Skin in Heat Regulation. The greatest loss of
heat is from the body surface. Fully 90 per cent and upward of the
whole amount takes place by radiation, conduction and evaporation from
the skin. The actual figures are given in. a tabulation on the next page.
The reason the skin is able to act as one of the most important organs for
regulating body temperature are: (a) that it offers a large surface for
radiation, (&) it contains a large amount of blood, and (c) the quantity
of the circulating fluid is greater under the circumstances which demand
a loss of heat and vice versa. The effects of a hot atmosphere on the skin
surface, through the nerve fibers, causes a relaxation of the muscular
fibers of the blood vessels ; and, as a result, the skin becomes full-blooded,
hot and sweating leading to much loss of heat.
On the other hand, with a low temperature, the blood vessels shrink,
the skin becomes pale and cold and dry ; thus by means of a self-regulating
apparatus, the skin is the most important organ for the regulation of body
temperature.
It is a recognized fact that size, height and weight are important
factors in heat regulation. Actual experiments upon animals, says
Howell, "show that small animals produce more heat in proportion to their
weight than larger animals of the same species, owing to the relatively
larger surface, and, therefore, greater loss of heat." This point was first
emphasized by Riibner and, according to his law, the metabolism is pro-
portional to the surface area of the body, or, in other words, for the same
amount of surface area there will be the same production of heat. On
the following page will be found a table giving the surface area in square
meters of people of different heights and weights, showing the requisite
calories during a 24-hour period, to which we will refer later.
Regulation of Heat loss The regulation of heat loss is the most
important problem which the physiologists of to-day have to elucidate (21).
Experiments plainly show that heat regulation is very complex ; the body,
as we have just emphasized, possesses a means of controlling heat loss as
well as the production of heat, and under normal conditions both func-
tions are in active use.
REGULATION OF BODY TEMPERATURE
277
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278 THE CALORIC METHOD OF FEEDIXG
As we have already seen, heat loss from our bodies is accounted for as
follows :
(a) From expirations from the lungs.
(6) By evaporation of sweat from the skin.
(c) By conduction and radiation from the skin.
(d) Through the excreta, urine, feces, saliva.
The approximate percentages of heat lost in this manner, according
to Vierodt, are as follows:
(a) From expirations from lungs 3.5 per cent or 84 cal.
(6) Vaporization of water from lungs 7.2 " 182 "
(c) By evaporation from the skin 14.5 " " " 364 "
(d) By conduction and radiation from skin 73.0 " " "1,792 "
(e) By urine and feces 1.8 " 48
Total daily loss 2,470 cal.
Howell, in commenting on this observation, says the relative import-
ance of these factors will, of course, vary with conditions; for instance,
a high external temperature will aid in the diminishing loss from radia-
tion, while increasing that from evaporation, owing to the greater pro-
duction of sweat.
Many examples may be given of the power which the body possesses
of resisting the effects of a high temperature, in virtue of evaporation
from the skin. Blagden and others supported a temperature varying
between 92-100 C. (198-212 T.) in dry air for several minutes;
and in a subsequent experiment the former remained eight minutes in a
temperature of 126.5 C. (260 F.). According to Carpenter:
The workmen of Sir F. Chantrey were accustomed to enter a furnace, ' in
which his molds were dried, while the floor was red hot, and a thermometer in
the air stood at 177.8 C. (350 F.), and Chabert, the fire-king, was in the habit
of entering an oven, the temperature of which was from 205-315 C. (400-
600 F.) (Carpenter.)
But such heats are not tolerable when the air is moist as well as hot,
though this condition prevents evaporation from the body. C. James
states that, in the vapor baths of Nero, he was almost suffocated in a tem-
perature of 44.5 C. (112 F.), while in the caves of Testaccio, in which
the air is dry, he was but little incommoded by a temperature of 80 C.
(176 F.). In the former, evaporation from the skin was impossible;
in the latter it was abundant, and the layer of vapor which would rise
from all the surface of the body would, by its slowly conducting power,
REGULATION OF BODY TEMPEKATUHE 279
defend it for a time from the full action of the external heat. (Kirk's
"Handbook of Physiology.")
Under ordinary conditions we are able by suitable clothing to increase
or diminish the amount of heat lost by the skin. The ways by which the
skin may be rendered more efficient as a cooling apparatus, too, by ex-
posure, by baths, and by other means which man instinctively adopts for
lowering his temperature when necessary, are too well known to require
more than passing mention.
Production of Heat During Rest The production of heat during rest
varies in different individuals according to height, weight, to the super-
ficial area of their bodies, and to their condition of health.
In the following table is reproduced the metabolism of adult males
per minute worked out according to Zunt's method. The subjects of
these experiments were in absolute muscular rest during the observation.
The age, height and weight are recorded, the respiratory quotient ascer-
tained, and the total calories for the twenty-four hours estimated and the
calories per hour per kilogram of body weight. The minimum resting
metabolism is estimated by measurement of the gaseous interchange during
sleep or during fasting, at least twelve hours after the ingestion of food.
Von Noorden(20) in his research on this point "replaces the quantity
of carbon dioxid excreted by the heat factor which can be deduced from
the ratio existing between the quantity of carbon dioxid eliminated and
the amount of heat formed during twenty-four hours." Atwater's calori-
metric experiments are especially valuable, both on account of the care
with which they were carried out and by reason of their repeated
repetition.
The table on the following page shows height, weight and the area
of body surface in square meters, the calories per hour per kilogram of
body weight and total calories for the twenty-four hour period. Even
these numbers derived from resting metabolism, possibly do not represent
the minimal metabolism during rest, since deep sleep does not usually
extend over more than from six to eight hours.
Resume. From previous discussion of this subject, it will be observed
that although individuals of excessive weight have a greater metabolism
than those of slighter build, yet the metabolism, according to von Noorden,
does not increase in direct proportion to weight, but less rapidly. There-
fore, when considering the unit of weight to metabolism, it is well to recol-
lect it is usually smaller in the case of heavy than of light individuals.
It will be seen, from carefully studying the table, that absolute metabolism
does not run parallel with body weight, but more nearly proportionally
280
THE CALORIC METHOD OF FEEDING
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REGULATION OF BODY TEMPERATURE 281
with the surface area of the body. Bergman was convinced of this fact
several decades ago, and Rubner and von Noorden have confirmed it by
numerous experiments.
Again we reiterate that a tall thin man has a greater area of body
surface for a given weight than a short stout man. "Besides, normal men
may vary as much as 10 per cent from the average in relation of surface
area to body weight. The spare thin man, besides having a greater surface
area, also differs from the stout short man in that he has a greater per-
centage of actual protoplasm." Now, since the metabolism of the body
depends upon its weight of protoplasm (active tissue) rather than total
corporeal weight, we have here, according to Sherman (4), an important
reason for assuming that the food requirement will be greater in the tall
than in the short individual of the same weight. Von Noorden tested this
question by observing two individuals of the same weight but different
build for a period of one day. His results were as follows :
Thin man Weight, 71.0 kilo., 2,392 cal., 33.6 cal. per kilo.
Stout man Weight, 73.6 kilo., 2,136 cal., 29.0 cal. per kilo.
Finally, for the majority of individuals, it will be safe in calculating
a dietary to proceed as if the form, height, weight and body surface area
were constant without falling into serious error.
REFERENCES
1. ATWATER. Methods and Results of Investigations on the Chemistry
and Economy of Food, Office of Exper. Sta., U. S. Dept. Agric.,
1895, Bull. No. 21; Neue Versuche ueber Stoff- und Kraft-
wechsel, Ergebn. d. Physiol., vol. iii, 1904.
2. LAXGWORTHY. Digest of Metabolism, U. S. Dept. of Agric., 1898,
Exper. Bull. No. 45.
3. AT WATER and SXELL. J. Amer. Chem. Soc., July, 1903.
4. SHERMAN. Chemistry of Food and Nutrition.
5. HALL, WINFIELD S. Nutrition and Dietetics, New York, 1913.
f>. RI-BXER. Ztsch. f. Biol., 1885, vol. xxi, pp. 2:>0-:>r>7.
7. CHITTENDEX. The Nutrition of Man.
8. TIBBLES, WILLIAM. Food in Health and Disease.
9. RUBNER. Ztsch. f. Biol., vol. xlii.
10. BEAUMONT. Physiology of Digestion, pp. 9-115, Plattsburgh, 1833,
Amer. J. Physiol. 1, p. 374, 1898.
282 THE CALORIC METHOD OF FEEDING
11. CANNON, W. 13. The Mechanical Factors of Digestion, New York,
1911.
12. LOCKE, E. A. Food Values, pub. by D. Appleton & Co., 1915.
13. HUEBNER. Deutsch. nied. Wochenschr.
14. TIBBLES. Loc cit., p. 86.
15. MAUREL. Rev. Soc. scient d'hyg. aliment., 1906.
16. AT WATER and BENEDICT. Exper. Sta., U. S. Dept. Agric., Bull.
Nos. 44, 63, 69, 109, 136.
IT. TIGERSTEDT. Text-book of Physiology.
18. LUSK, GRAHAM. Med. Rec., April 25th, 1914.
19. . The Elements of the Science of Nutrition.
20. VON NOORDEN. Metabolism and Practical Medicine.
21. HOWELL, W. H. Text-book of Physiology.
BIBLIOGRAPHY
ABDERHALDEN. Handbuch der biochemischen Arbeitsmethoden, 1910,
Bd. III.
ARMSBY. Principles of Animal Nutrition, Chaps. 7 to 10.
ATWATER. Methods and Results of Investigation on the Chemistry and
Economy of Food, Office of Exper. Sta., U. S. Dept. of Agric.,
1895, Bull. No. 21.
. Ibid.
. Neue Yersuche ueber Stoff- und Kraftwechsel, Ergeb. d.
Physiol. 3, 1904.
and LANGWORTHY. A Digest of Metabolism Experiments, U. S.
Dept. of Agric., 1898, Bull. No. 45, Office of Exper. Sta.
- and BENEDICT. A Respiration Calorimeter with Appliances for
the Direct Determination of Oxygen, Carnegie Institution of
Washington, 1905, Pub. No. 126.
BENEDICT and CARPENTER. The Metabolism and Energy Transforma-
tions of Healthy Men During Rest. Ibid.
FISHER. A New Method for Indicating Food Values, A. J. Physiol., vol.
xv, 417.
LUSK. Elements of the Science of Nutrition, 2d ed., 1909, pp. 17-45.
MENDEL and SWARTZ. The Physiological Utilization of Some Complex
Carbohydrates, A. J. Med. Sci., March, 1910.
MURLIN. The Nutritive Value of Gelatin, Am. J. Physiol., xix, 285-313 ;
xx, 234-258, 1907-1908.
BIBLIOGRAPHY 283
NAGEL. Handbuch der Physiologic des Menschen, 1909, pp. 331-375.
OPPENHEIMER. Handbuch der Biochemie, II, 1-92.
REITZ and MITCHELL. On the Metabolism Experiment as a Statistical
Problem, J. Biol. Chem., 8, 297-326, 190.
RUBNER. Der Energiewert der Kost des Menschen, Ztsch. f. Biol. (n. f.),
24, 201-308 (901).
. Die Gesetze des Energieverbrauches bei der Ernahrung
(1902).
TALLQVIST. Zur Frage des Einflusses von Fett and Kohlenhydrat auf
den Eiweissumsatz.
TIGEBSTEDT. Text-book of Physiology, 1906, Chapter 4.
VOIT. Arch. f. Hyg., 41, 1902, 177-189.
- and ZISTERER. Bedingt die verschiedene Zusammensetzung
der Eiweisskorper auch einen Unterschied in ihrem Nahrwert ?
Ztschr. f. Biol. (N. F.)
VON !N"ooRDEx. Metabolism and Practical Medicine, vol. i, pp. 185-207.
WATSON and HUNTER. Observations on Diet. The Influence of Diet on
Growth and Nutrition, J. Physiol., vol. xxxiv, pp. 111-132,
1906.
CHAPTEE X
GENERAL NUTRITION AND MINERAL METABOLISM
General Considerations.
Metabolism: Anabolism and Catabolism.
Metabolism Experiments: Balance of Income and Outgo; Respiratory
Quotient.
Factors Which Affect Metabolism: Consumption of Food; Fasting; Effect
of Nitrogenous Diet on Metabolism; Carbohydrates as Protein
Sparers; Fat Versus Carbohydrates as Protein Sparers; Gelatin as a
Protein Sparer; Alcohol as a Protein Sparer; Metabolism of Water;
Metabolism of Mineral Substances; Acid-Forming and Base-Forming
Elements.
GENERAL CONSIDERATIONS
In the study of metabolism, we become acquainted with the exchanges
of material by which vital phenomena are produced, and the conversion of
chemical force into "living energy." The various metabolic processes
are not the same in all organs and tissues. For instance, the functions of
the liver and of the pancreas are distinctly different. Valuable data have
been obtained by physiologists who have painstakingly studied the meta-
bolic changes in isolated parts of the body. By the maintenance of arti-
ficial circulation through "surviving" organs, completely severed from
their normal relations, the life, of the cells may be continued for many
hours. Chemical examination of such tissues has thrown light on their
metabolic processes ; under such conditions changes in the composition of
the nutrients in the circulating medium point to the nutrient demands,
the waste, or the specific elaborations of the cells. Furthermore, by the
exclusion of individual organs, their normal activity may be inferred from
the absence of certain functions. The metabolic work of the spleen,
kidneys and thyroid has been studied by observations on individuals who
have in whole or in part, been deprived of these organs through surgical
intervention. Moreover, the changes in metabolism which go hand-iu-
hand with diverse pathological conditions of the body have also con-
tributed to our understanding of the subject.
285
286
It is readily understood that many difficulties beset the path of the
investigator who studies the metabolism of individual organs, although
the problems involved are of the greatest importance in physiology. Pro-
fessor Lafayette B. Mendel, in discussing this question, says :
The income (food and oxygen) and the outgo (excretions, urine and feces)
have been determined with accuracy, under the most varied conditions, while the
understanding of the intermediate processes is still largely a matter of "gaps and
guesses." The body is constantly undergoing losses, which must be made good
sooner or later. New material must be contributed to replace the wear and tear
of the body. Certain losses may only be temporary, as in the secretion of milk,
the production of eggs, the ejection of semen, and the menstrual flow, all of which,
however, are relatively of little importance. The lungs give off carbon dioxid and
water, the kidneys water, inorganic salts and nitrogenous compounds. The skin
eliminates water and inorganic salts and traces of nitrogenous compounds, and
with the feces there is excreted a residue of the digestive secretions, waste from
the alimentary canal and indigestible particles of food.
METABOLISM
In the study of the intricate processes of digestion, assimilation and
absorption, we traced the food through the digestive tract, and we come
now to a consideration of those processes which are fundamentally im-
portant ones the fate of the foodstuffs in metabolism, all others being
only means leading toward the end. During digestion, assimilation, res-
piration and excretion, the food ingested undergoes many and various
changes, breaking down into simpler compounds or undergoing transmu-
tation into more complex substances. This change(l) of matter into
potential and dynamic energy is termed metabolism. The body converts
potential into kinetic energy by metabolism in the body. The potential
energy of the aliment, through the processes of digestion, is transformed
into the actual energy of heat and mechanical labor. There is no dif-
ference in these changes between man and other vertebrates, though there
may be slight variations in details ; the end products are the same. It is
admitted that there may be slight differences in the nervous and intel-
lectual processes, though at present this is "seen through a glass darkly."
Anabolism and Catabolism For the sake of clearness, these chemical
changes are classified as follows :
First, there are certain chemical processes in the animal economy
where simpler substances are converted into more complex ones, which is
constructive metabolism, i.e., the process of the assimilation of nutritive
material from the alimentary canal and its conversion into the living
substance. This process is called anaboli-sm. An example of this upbuild-
METABOLISM 287
ing metabolic change is found in the first change which the fats undergo
after saponih'cation. This change has already been explained (in Vol-
ume I, Chapter VII, The Physiology of Absorption, to which the reader
is referred). In this anabolic change the fatty acids combine with
glycerin to form molecules of neutral fat. The latter molecule contains
three parts of fatty acid to one of glycerin, and is therefore much more
complex than the molecules from which it is built up.
Second, the complex food materials or tissue constituents are oxidized
and broken down into simpler materials, and finally excreted. Preceding
this oxidative change, the energy of the complex material is given up in
the form of heat, motion, etc. The body is never stable ; while growth and
nutrition progress, destruction or demolition constantly go on. This
retrograde metabolism is called catabolism, and most of the chemical
changes taking place in the animal body belong to this group.
It is readily seen that analysis and synthesis play their part coinci-
dently or successively in the various phases of the activity of the living
substance ; and when the effects of destructive or catabolic change are
no longer offset by appropriate anabolic processes, the functions may be-
come impaired or may cease altogether. It will be seen, therefore, ttiat
the continuity of life depends upon perfect metabolism. Indeed, it is
well said that "metabolism, in its entirety, is made up of a series of
processes both catabolic and anabolic. In vegetable life the synthetic
changes predominate, and highly complex compounds are built up, one
might say, directly from the elements" (2). In animal life, on the other
hand, catabolism prevails to a large extent, so that in these late years
physiologists are accustomed to point out quantitative rather than quali-
tative differences between animal and vegetable life. Foodstuffs, for
instance, are ingested in the form of complex molecules of carbohydrate,
fat and protein, and during the varied processes of digestion, absorption
and assimilation undergo more or less complete combustion. Oxygen
unites with carbon to form carbon dioxid and with hydrogen to form
water; the nitrogen of the highly complex protein substances reappears
in combination with carbon, hydrogen and oxygen, as urea, uric acid,
hippuric acid, etc., and the sulphur and phosphorus of organic compounds
are eliminated after oxidation to sulphuric acid. It is through these
catabolic processes that the potential energy of the foodstuffs is ultimately
transformed to maintain body temperature, nitrogen equilibrium, and
furnish the necessary energy for the wear and tear of the body. In the
cleavage of complex compounds to simpler ones, a portion of the potential
energy of the ingested food, perhaps stored up temporarily in the form
288
of glycogea or tissue fat, becomes kinetic. In some cases the combustion
proceeds to the same end-products which rise by oxidation outside of the
body, or, again, the compounds which are discharged by the elimination
of the products of catabolic changes may be completely oxidized or even
undergo subsequent synthesis, as is true of such .substances as urea and
hippuric acid.
METABOLISM EXPERIMENTS
Balance of Income and Outgo. A balance sheet of the anabolic income
and the catabolic outgo will graphically show the exact amount
of matter and energy used daily in the body. According to Tib-
bles(l), the income consists of (a) matter: food, drink and oxygen of
the air; (6) energy: the potential energy of food and drink. The outgo
consists of (a) matter: in the urine, feces, perspiration and breath: (6)
energy: the potential energy of urine, feces, products of perspiration and
respiration. A scientific balance sheet of this process would graph-
ically "show the amount of C, N, H, O, P, S, Cl, K, Na, Mg, and Fe in
the income and outgo, and it would also show the compounds in the ex-
creta, including proteins, fats, carbohydrates, water and carbon dioxid."
Many observers have worked over this problem. Two of the most
explicit results are the following, given below. The first of Ranke(3),
the second by Pettenkofer and Voit(4), as shown in the following tabu-
lation from Tibbies (1) :
EXCHANGE OF MATERIAL WITH STANDARD DIETS
INCOME
EXPENDITURE
Food
Amount
in
Gms.
Nitro-
gen
(Gms.)
Carbon
(Gms.)
Excretions
Nitro-
gen
(Gms.)
Carbon
(Gms.)
Water
(Gms.)
Protein
100
100
250
15.5
53.0
79.0
93.0
Urine
14.4
1.1
6.16
10.84
208.00
Fat
Feces
Carbohydrate
Total .
Respiration
(C0 2 )
Total
15.5
225.0
15.5
225.00
Protein
137]
117
352 J
2016
19.5
315.5
Urine
17.4
2.1
12.70
14.50
248.60
1279
83
828
Fat
Feces
Carbohydrate
Water
Respiration....
Total
Total
19.5
315.5
19.5
275.80
2190
METABOLISM EXPERIMENTS
289
The researches and results of these men, now classical, have never
been assailed ; but they are not so complete as the researches conducted by
Atwater (5) and his coworkers. Few investigators have carried out their
experiments with the completeness of those conducted by Atwater from
1897 to 1907. Atwater and his colleagues selected for their observations
Fio. 5. CALORIMETER. Devised by Atwater and Rosa, Bull. G3, U. S. Dept. Agric..
1899. Recent improvements on same by Atwater and Benedict "A Respiration
Calorimeter" Carnegie Institution of Washington, 1905, used in Howell's Physi-
ology, 6th Edition, Saunders, 1915.
a man in normal health, with good digestion. A well-balanced palatable
dietary was provided; it was well cooked, accurately sampled, and care-
fully analyzed. The quantities of nitrogen and carbon were sufficient to
maintain equilibrium during work or rest. Pour days before the experi-
ment was begun a preliminary digestion experiment was made to determine
the requisite food for equilibrium maintenance.
290
NUTRITION AND MINERAL METABOLISM
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292 NUTRITION AND MINERAL METABOLISM
During these preliminary digestion experiments the man was ordered
to work and rest just as he was to do while in the respiratory calorimeter,
shown in the accompanying illustration (6).
The results of some of these calorimetric investigations are given in
the following tables, a study of which will show that the body has con-
siderable power of adjusting the expenditure of nitrogen to the income.
The catabolized protein cannot be calculated as an exact measure of per-
manent demands of the body, nor as a measure of the usual requirements
of a man at work ; but experiments of this type show that the body re-
quires a specific quantity of energy-producing foodstuffs for sustenance,
and an additional amount to supply the demands for bodily wear and
tear.
According to Atwater, the results of a rest experiment during a period
of 45 days were as follows: Net income, 2,255 calories; net expenditure,
2,255 calories. During a period of light work lasting for 65 days, the
net income amounted to 2,690 calories, the net expenditure to 2,628 calo-
ries. During the 45 days of rest the elimination of energy was estimated
to be: By the skin and lungs, 1,669; in the evaporation of water from
the lungs, 550; in the urine and feces, 31; total, 2,250 calories. During
a period of 20 days of work the heat eliminated by means of radiation
and conduction from the skin and air in the lungs amount to 2,777 ; in
the evaporation of water from the lungs, 1,126 ; in the urine and feces,
19; by muscular work, 234; total, 3,656 calories.
The Respiratory Quotient. It has always been held that the energy
expended by the body is measured by the quantity of carbon dioxid ex-
creted. Parkes determined that during rest a man of 150 pounds ex-
creted daily 15 cubic feet of carbon dioxid ; that 1 cubic foot of gas re-
sulting from combustion meant the expenditure of 160 foot-tons of energy,
and 15 cubic feet 2,400 foot-tons of energy, the equivalent of about 1,560
calories. He estimated the amount of carbon dioxid excreted hourly dur-
ing a period of rest to be 0.62 cubic feet ; during a period of hard work,
1.66 ; and during laborious work, 2.75 cubic feet. Atwater and Benedict
proved that carbon dioxid excretion varies with the condition. The aver-
age daily amount during rest and fasting was 676 grams ; during rest
with food, 812 grams; during work with carbohydrate diet, 1,820 grams;
during work with fat diet, 1,665 grams; and during work with mixed
diet, 1,475 grams. Parkes estimated the daily expenditure of energy dur-
ing rest to be 1,600 calories; during moderate work, 2,600; and during
hard work, 3,200 calories.
The significance of the respiratory quotient in metabolism has been
METABOLISM EXPERIMENTS
293
studied extensively by Zuntz(7) of Germany and Atwater(5) in this
country. The respiratory quotient is the most delicate test of the car-
bonaceous metabolism of the organism ; it is the ratio of the carbon dioxid
exhaled to the oxygen consumed. Correct values for the gaseous inter-
change and for the respiratory quotient can be obtained only when delicate
technical precautions are observed with the Atwater-Rosa calorimeter,
or by Zuntz's method. Atwater at the beginning of each experiment
directs (for a period of from three to ten minutes, varying with practice
and with the capability of control on the part of the individual examined)
that the ventilation is to be slightly increased, and as a result of the greater
activity of the respiratory musculature, the consumption of oxygen is
raised somewhat above the amount consumed during rest. Von Noorden
says, "As a result of the forced respiration, too much carbonic acid is with-
drawn from the blood, and so the respiratory quotient is found to be too
high. Subsequent to the period of forced respiration, there follows for
some minutes one of quieter respiration, during which there is a com-
pensatory diminution in the carbon dioxid output, below the amount that
is formed, with the result that the respiratory quotient is too low. Only
after these two periods are passed does the gaseous exchange become
regular and the normal values for 2 , CO 2 , and the respiratory quotient
can be determined."
The respiratory quotient is affected by numerous other, frequently
accidental, influences, apart from the purely mechanical ones associated
with respiration, and so conclusions can be drawn only when the results
obtained by numerous experiments are found to agree.
The tabulation below from the experiments of Atwater and Benedict 1
shows :
EFFECTS OF FOOD AND WORK ON RESPIRATION
CONDITIONS
Heat
measured
(Calories)
CO 2
exhaled
(Liters)
Oxygen
consumed
(Liters)
Respiratory
quotient
Rest: Fasting. . .
2,197
342.2
473.6
.727
" Ordinary mixed diet . .
Moderate work:
Fat diet
2,287
3,570
404.5
613.9
469.4
737.5
.862
.832
Carbohydrate diet
Hard work:
Fat diet
3,699
5,128
655.1
856.6
757.1
1,058.9
.865
.809
Carbohydrate diet
5,142
929.2
1,025.9
.906
i Bull. 109, U. S. Dept. Agric.
119
294 NUTRITION AND MINERAL METABOLISM
The respiratory quotient is calculated as follows: Divide the amount
of carbon dioxid exhaled by the amount of oxygen consumed; one liter
of carbon dioxid weighs 1.9642 grams, and one liter of oxygen 1.4286
grams, and the corresponding factors are 1 -+- 1.9642 = 0.5091, and
1 -r- 1.4286 = 0.7. The amount of carbon dioxid exhaled by a man in
one experiment lasting several days was 3,248.3 grams and oxygen con-
sumed 2,755.3 grams.
The values of the respiratory quotient, i.e., the proportion of the O 2
intake to the O 2 output in the form of CO 2
Gram O 9 in CO c.c. (XX
Gram O 2 c.c. O 2
on a fat and carbohydrate dietary can easily be calculated from the ele-
mentary composition of these food principles.
According to von Noorden(S) :
In the case of these two foodstuffs, decomposition products of different ele-
mentary composition, which would require to be taken into consideration, do not,
as a rule, appear either in the urine or in the feces in appreciable quantities. It
is quite different in the case of protein, where the amounts of C, H, 0, and S ap-
pearing in the urine and feces must be deducted in order to ascertain the quan-
tity of oxygen required for the formation of H and CO 2 . As its amount varies
in different experiments, and as the nature of the calculations differs not only for
different proteins, but also as carried out by different authors, so the statements
vary as to the amount of oxygen requisite for the combustion of the protein, and
also as to the amount of CO expired. For these reasons the respiratory quotient,
as well as the physiological and physical heat values, vary in the case of a protein
dietary.
The amount of the respiratory quotient for the most common sub-
stances, according to von Noorden, is as follows:
Starch, etc 1 .00
Fat ' 0.707
Protein 0.809
Alcohol 0.667
"The calculated theoretical limiting values of the respiratory quotient,
in the case of the exclusive combustion of the carbohydrates, or of fats,
are usually not attained within the organism, since protein is invariably
oxidized along with these bodies. If we take for the fasting state (the
individual being in fair average condition) the proportion on the part of
the protein in the total energy exchange of the organism as 15 per cent
FACTORS WHICH AFFECT METABOLISM 295
of the latter, then the limiting values of the respiratory quotient, with a
distribution of the energy exchange, are as follows:
With 15 per cent (energy value) protein, 85 per cent (energy value)
carbohydrate = 0.971 respiratory quotient.
^With 15 per cent (energy value) protein, 85 per cent (energy value)
fat = . 722 respiratory quotient.
"Under normal nutritive conditions these values neither rise above this
level nor fall below it, provided that the oxidation of the foodstuffs to
their end-products is complete, and that no intermediate products appear."
If the experimental technic be correct, and the analysis accurate, the
height of the respiratory quotient gives us an idea as to the nature of the
matter which has undergone metabolism in the organism. The course of
the respiratory quotient has thus given definite information as to the
rapidity with which carbohydrate and other food materials introduced
into the body have undergone metabolism (9). The respiratory quotient
is always increased after a hearty meal. All foodstuffs rich in carbon
augment the outgo of carbon dioxid.
According to William Tibbies (1), "A strictly carbohydrate diet is
possible only for short periods during which the respiratory quotient rises
to unity or nearly so." A dietary consisting largely of fat lowers the
respiratory quotient, but increases the expenditure of carbon dioxid,
while, on the other hand, alcohol and the ethereal oils diminish the outgo
of carbon dioxid. Again the respiratory quotient falls in the formation
of sugar from protein, for which considerable oxygen intake is necessary
without corresponding quantities of carbon dioxid being expired, if the
glucose formed is either stored as glycogen or excreted in the urine. "Rest
causes a fall in the respiratory quotient to about 0.7 or 0. 8, but muscular
activity causes an increase in the intake of oxygen and the output of
carbon dioxid, especially the latter, and the respiratory quotient rises to
0.8 to 0.9."
FACTORS WHICH AFFECT METABOLISM
According to Sherman (10) :
The calorimetric method of studying total metabolism permits of experiments
being carried out very quickly, and is therefore especially useful for the direct
investigation of conditions which affect metabolism at once, e.g., muscular work,
work of digestion, etc. Moreover, the apparatus can be made portable and thus
be carried by the subject like a knapsack in experiments on marching, moimtnin
climbing, or bicycling. The observations cannot be made continuous, but the
probable results for the 24 hours' metabolism can be estimated by the data ob-
tained during frequent short periods at different times of the day and night.
296
NUTRITION AND MINERAL METABOLISM
Assuming that the total nitrogen and carbon of the absorbed food existed in
the form of protein, fat and carbohydrates, and that the amount of carbohydrates
in the body is constant from day to day, it is only necessary to determine the car-
bon dioxid of the expired air and the carbon and nitrogen of the waste products
in order to calculate the amounts of material oxidized and of energy liberated in
the body. Experiments of this sort have played a most important part in the de-
velopment of our knowledge of nutrition. The calculations are usually based on
the following average analyses of protein and body fat:
Protein
Fat
Carbon
53
76.5
Nitrogen
16
Hydrogen
7
12
Oxygen
23
11.5
Sulphur
1
100
100
The following table shows the income and outgo of nitrogen and car-
bon and was obtained by Atwater in one of his respiration experiments,
from a man on ordinary mixed diet:
CALCULATION OF ENERGY METABOLISM FROM CARBON AND
NITROGEN BALANCE. MAN OF 64 KILOGRAMS AT REST
IN ATWATER RESPIRATION APPARATUS
INCOME: GRAMS PER DAY
Protein
Fat
Carbo-
hydrate
Nitrogen
Carbon
Total in food
94.4
82.5
289.8
15.1
239.0
Lost in digestion
5.4
3.7
3.2
0.9
7.4
Absorbed
89.0
78.8
286.6
14.2
231.6
By lungs
OUTGO
207.3
12.2
By kidneys
16.2
Metabolized
16.2
-2.0
219.5
+12.1
Balance
The above experiment shows a loss of 2 . grams of body nitrogen plus
the factor x 6.25 equals 12.5 grams of body nitrogen consumed. The in-
take of nitrogen was 89.0 grams from foodstuffs absorbed, and in all there
FACTORS WHICH AFFECT METABOLISM 297
were burned 101.5 grams of protein. The respiratory quotient in this
experiment at the commencement of each experiment day was in equili-
brium, therefore the conclusion is drawn that the amount of carbohydrate
burned equaled the intake of 286.6 grams per day. Therefore, after mak-
ing due allowance from this balance sheet of the carbon balance, Sher-
man(10) estimates the amount of fat burned was as follows:
SHERMAN'S ESTIMATES OF ATWATER'S EXPERIMENT
12.5 grams body protein yield (12.5 x 53 per cent) . . 6.6 grams carbon
And there were in the absorbed food 231.6 " "
.'. Total available was 238.2
But total catabolized was only 219.5 " "
/. The body stored in the form of fat 18.7 "
Since fat contains 76.5 per cent carbon, 1 gram carbon = 1.307 grams
fat. . . 18.7 grams carbon = 24.4 grams fat.
The body therefore absorbed 78.8 grams fat
stored 24.4 " "
burned 54.4 " "
In all, the body burned per day:
101.5 grams protein, yielding (101.5 x 4.35 1 ) 442 calories
54.4 fat, (54.4x9.45 1 ) 515
286.6 carbohydrate, (286.6 x 4.1 ') 1,175
TOTAL 2,132 calories
Consumption of Food. Many suggestions have been advanced in
explanation of the increased metabolism following the consumption of
food. Mangus Levy (11), Zuntz and others think the increase due to
intestinal and glandular work, that is, to the expenditure required for the
enlarged demands upon the muscular system, and for the work of secre-
tion carried out by the numerous glands present in the alimentary canal.
Kubner(12) assumes, in addition to the glandular work proper, a specific
action on metabolism is produced by the excess of protein. He holds that
every foodstuff possesses a "specific dynamic" action. He also believes
that the protein molecule is decomposed in all cases into a nitrogenous com-
ponent and a non-nitrogenous component of a carbohydrate nature.
Von Noorden ( 8 ) recognizes a specific action of protein nutriment
without adapting Eubner's explanation. He asserts that the increased oxi-
dation occurring after the consumption of fats and carbohydrates, as well
as that following the ingestion of protein, is due in the main to intestinal
and g-landular work.
1 Here the factors for fuel value are not reduced to allow for loss in digestion,
because this loss has already been deducted in computing the amount of each nutrient
actually absorbed and rendered available.
298
NUTRITION AND MINERAL METABOLISM
Fasting. The effect of fasting on metabolism has been studied in
great detail by Atwater and Benedict (13), who were able to determine
by means of the respiration calorimeter the heat production of the same
(control) man during five-day fasting experiments of one or two days
each, and during a four-day experiment with food about sufficient for
equilibrium maintenance. They found a total metabolism on fasting days
to be 9 per cent lower than on. the days when food was taken. Later,
Benedict(14) found, after an extensive research, that if the fast was suf-
ficiently prolonged, there would be a decrease in heat production. He
conducted an experiment on a man during a seven days' fast, "while
the man was living on his own flesh and fat," and found the loss to be :
protein, 69.5; fat, 139.6; glycogen, 23 grams per day; total, 1,597
calories. The protein loss equaled 347 grams of flesh ; the actual loss of
energy measured by the calorimeter was 1.696 per diem, or 100 grams
more than the estimated cost. The heat of combustion can be arrived at
from the known caloric value of the substances; for example, 1 gram of
body protein yields 5.65 calories, and 1 gram of fat, 9.54 calories, and the
total when fully oxidized in the human economy would aggregate 1.734
calories.
The Swedish investigator Tigerstedt made a careful study of the car-
bon and nitrogen balance, the metabolism of a man who abstained from
food for five days, following this period with a liberal diet for the next
two weeks. The production of heat during the first two days of fasting
could not be as definitely determined as in the last three days because of
the loss of an unknown quantity of glycogen during the first days.
The following data was obtained, which we take from Sherman and
append below:
METABOLIC CARBON AND NITROGEN BALANCE DURING FASTING
Body weight
kilos
Calculated total
metabolism,
calories
Calories
per kilo
First fast day
67.0
2220 1
32.2 1
Second " "
65.7
2102 1
32.0 1
Third " "
64.9
2024
31.2
Fourth " "
64.0
1992
31.1
Fifth " "
63.1
1970
31.2
Fed 4141 calories
64.0
2437
38.1
" 4141 " (second day). .
65.6
2410
36.8
i These figures are slightly too high, because the loss of carbon on these days was
due in part to combustion of glycogen, but is calculated as if duq simply to protein
and fat.
FACTOKS WHICH AFFECT METABOLISM 299
These tabulated results clearly show that during a period of fasting
the metabolism remains fairly constant, notwithstanding the fact that
energy is generated at the expense of the tissues. In this experiment
4,141 calories of energy were produced by the food eaten twice the
amount that would have been necessary for mere maintenance. Conse-
quently the work of digestion and assimilation was doubled. It appears
then that as a result of fasting the entire metabolism of an individual
at rest remains fairly constant, and the body possesses but little capacity
for the adjustment of its energy metabolism to its food supply.
Effect of Nitrogenous Diet on Metabolism. The effect of nitrogenous
diet on metabolism has been studied extensively by von Noorden(S), who
holds that the most striking effect of a purely nitrogenous diet is a large
increase in the nitrogenous metabolism, but at the same time it also
increases the metabolism of the non-nitrogenous elements of the body.
As the amount of protein ingested is increased, a rise in protein metab-
olism is produced. This sequence occurs to such a degree that nitrogen
equilibrium can generally be maintained on the most varied quantities
of protein, which goes to prove that the body is not able to store up any
excess of protein. At first glance, the fact that the body has the power to
break down as much protein as is given to it would not appear to be in
accordance with the law that the extent of protein metabolism is governed
by the tissue requirements, not by the quantity that is offered to the cells.
This law is absolutely true so far as the consumption of oxygen- and nitro-
gen-free substances is concerned. Usually when there is an increased
consumption in protein, there is also a lessened consumption of other
foodstuffs, so that with the increased proportion of protein there is a les-
sened intake of other material. Thus the total energy metabolism is
raised, to proportionately a small extent, only when nitrogen-free sub-
stances are replaced simply by protein. Perhaps the difficulty of explana-
tion might be made plainer if the hypothesis were found to be correct
that the food protein is actually only in small part transformed into true
protein within the body, or that it plays the part of protein within the
organism only to a small extent.
The statement that the body can consume all protein ingested within
a period of twenty-four hours exceeds definite knowledge of the condi-
tions. It is known that the nitrogen and sulphur are eliminated within
this period. But whether the carbon that is eliminated during this period
is derived from the protein or from other sources, and if from the latter,
whether the carbon derived from the protein is stored up in any special
form in the body these are problems yet to be solved.
300 NUTRITION AND MINERAL METABOLISM
According to von Noorden's reasoning it is probable that the former is
correct, because, as a rule, bodies of small molecular weight, such as amino
acids, etc., are completely burned up as soon as decomposition and oxida-
tion have once commenced.
In order to learn how the body attempts to adapt the combustion of
protein to its intake, it is well to observe conditions in instances in which
different amounts of protein are added to a dietary which is nearly enough
for the requirements of the body. If the increase or decrease is not ex-
treme, the nitrogen equilibrium of the organism will not be reestablished
for several days. In the ordinary daily routine when the intake of food
varies with the appetite and other influences, the intake and elimination
of nitrogen often take place at very short intervals, and so in general,
nitrogen equilibrium is kept up on a sufficient diet for long periods. In
many instances, individuals during hot weather or when in tropical re-
gions cannot take enough food to supply the needs of the body, and in
consequence lose both protein and fat. Von Noorden(S) proved this to
be true by experimenting upon himself. He determined that the main-
tenance of weight was regulated by the fact that the amount of food in-
gested as governed by the appetite meets on the whole the definite needs
of the body. In prolonged experiments on man it has been found that
nitrogenous metabolism is not by any means as uniformly maintained on
an unvaried protein and caloric intake as is the case in experiments on
dogs. Rosemann in one experiment found a daily variation of 10 grams
of nitrogen. He points to temporary retention and subsequent washing
out of the end-products of nitrogenous metabolism as accounting for these
variations. But this explanation has not sufficient foundation.
Atwater and Benedict(15) note the frequent occurrence of similar
irregularities. In one of their experiments, variations in nitrogen elimi-
nation on a constant diet were 17.2, 17.6, 14.2, 23.8, 20.3, 17.4, 17.2 and
17.4 grams. Psychical conditions were cited as the cause of these varia-
tions. The individual in question was so anxious about going into the
respiration calorimeter chamber that the mental disturbance brought about
a rise in protein metabolism. If, as sometimes happens on the last day
of an experiment, protein metabolism is strongly influenced by certain
external conditions, the result of the entire series is apt to be markedly
affected. This result is naturally exaggerated in shorter series.
Carbohydrates as Protein Sparers Carbohydrates as protein sparers
have of late received marked attention by research workers on metabolism.
It has been observed that, where there is a deficiency of protein in the food
supply, the metabolism of nitrogen will be spared and the tissues pro-
FACTORS WHICH AFFFCT METABOLISM 301
tected if the food contains a liberal allowance of carbohydrate and fat.
Lusk(KJ) has fully investigated this subject, and found that, when, the
aliment contained an abundance of protein, fat and carbohydrate, the
organism would gain a little nitrogen ; when the ration contained the same
amount of protein, but no carbohydrate, the body lost nitrogen. On the
other hand, when the ordinary dietary contained only a sufficiency of
energy, but was of a low protein content, the excretion of nitrogen was
normal. Lusk, therefore, concluded that carbohydrate acted as a sparer
of protein.
The protein-sparing action of carbohydrates is now well known (edi-
torial, Jour. A. M. A., 1917), and they are by far more efficient protein-
sparers than fats. "The starvation output of nitrogenous waste products,
especially urea, can be materially lessened by the ingestion of either fats
or carbohydrates, though the superiority of the latter non-nitrogenous
foodstuffs in lessening nitrogen waste is always greater. If the carbo-
hydrates are omitted from the dietary or even replaced by fats, the effect
on the amount of nitrogen excreted is promptly perceptible.
"Various theories have been proposed to explain this unique function
of the carbohydrates in nutrition. One view has maintained that a certain
concentration of blood sugar is always necessary for proper maintenance
of physiological activities. This sugar can be produced from proteins if
carbohydrates are not directly available, and since, in the absence of car-
bohydrates, under physiologic conditions, fat cannot well supply this
want, proteins are broken down to yield the sugar that is lacking. The
result is an increase in the nitrogen output in carbohydrate starvation."
Another view lately championed by Cathcart(lT), of Glasgow, and
Janney(18), of Xew York, postulates that carbohydrate is essential to
protein synthesis. "There is no doubt at present that sugar is not oxi-
dized directly in the metabolism of the organism, but is rather dissociated
in a definite way into simpler derivations, of which methyl glyoxal,
CH. 3 CH.CHO, lactic acid, CH 3 CHOILCOOH, and pyruvic acid,
CH 3 CO.COOII, are the most interesting possibilities. There is evi-
dence that these compounds derived from sugars can in turn be converted
into sugar in the diabetic individual. They may, accordingly, be con-
cerned in the synthesis as well as the disintegration of the sugar molecule.
But there is also some evidence now available, largely from perfusion
experiments on surviving isolated organs, that both pyruvic and lactic
acids can be converted into the amino-acid alanin ; that is, they can add
nitrogen under conditions approximating physiologic possibilities."
Kocher(19) has recently reminded us that, if this process of retaining
302
nitrogen by dissociation products of sugar to form new amino-acids, and
hence proteins, occurs on a large scale in the body, it will explain why
ingestion of carbohydrates spares body protein. To test this point, he has
undertaken a comparison of the sparing effects of ingesting lactic and
pyruvic acids in contrast with equivalent amounts of undissociated carbo-
hydrates, like sucrose, on the nitrogen output. The outcome of these ex-
periments, conducted at the George W. Hooper Foundation for Medical
Research of the University of California (Jour. A. M. A., 1917), indi-
cates that lactic acid exerts practically the same sparing action on protein
metabolism as do carbohydrates. "The sparing action of pyruvic acid also
is very distinct, but less marked than that following sugar. In view of
what has already been mentioned regarding the possibility of adding am-
monia to the structures of the sugar derivatives to form alanin, it is readily
conceivable that, when this process is operative, nitrogen arising from the
catabolism of body proteins, instead of being promptly excreted, is util-
ized to synthetize new protein. This is not a new conception of metab-
olism ; but Kocher's work gives added support to the possibility that the
fixing of catabolized nitrogen by the dissociation products of glucose to
form new proteins is the true mechanism of the sparing effects of feeding
carbohydrates on the nitrogen output."
Fat versus Carbohydrates as Protein Sparers The subject of fats versus
carbohydrates as protein sparers has been studied exclusively by Kayser
and Landergren(20). They believe that fat quite as well as the carbo-
hydrates protects protein not only in nitrogen hunger but in nitrogen
abundance. According to Landergren, in certain instances, fat alone as
compared with carbohydrates seemed to exert half the protective power
of the latter as a protein sparer. This he attempted to substantiate on
the ground of the demand of the body for carbohydrates ; and that when
deprived of this food element, the glycogen formed in the tissues from
protein is accepted as a substitute for combustion. The role of protein
in this process cannot be taken by fat. It follows that as soon as the sup-
ply of glycogen in the body is exhausted, fat has less protective power
than carbohydrate as a protein sparer.
Atwater(21) concluded from his experiments that the total available
energy remaining uniform, protein protection by carbohydrates (largely
cane sugar) is slightly superior to an isodynamic amount of fat; this fact
may possibly be due to the "personal equation" of the control.
Kayser (22), in a series of experiments, compared the efficiency of car-
bohydrates and fats as sparers of protein by carefully determining the
nitrogen balance and substituting the carbohydrates of the ration by an
FACTORS WHICH AFFECT METABOLISM
303
amount of fat which would furnish the same fuel value in calories. The
control who served as his subject for this experiment was a man 23 years
old, of good physique, weighing 67 kilograms, with a small store of body
fat. During the first and third periods of observation, his alimentation
consisted of meat, rice, butter, eggs, sugar, oil, vinegar and salad. During
the second period, his dietary consisted of meat, eggs, oil, vinegar and
salad, all of the carbohydrates being practically withdrawn and replaced
by -fat. The two rations had practically, the same fuel value and protein
percentages. The results of this study are tabulated below :
KAYSER'S TABLE SHOWING NITROGEN BALANCE WHEN FEEDING
ISODYNAMIC QUANTITIES OF CARBOHYDRATE AND FAT
Day
INTAKE
Output,
Total
Nitrogen
Nitrogen
Balance
Total
Nitrogen
Fat
Carbo-
hydrates
Fuel
Value
1. .
Grams
21.15
21.15
21.15
21.31
21.51
21.55
21.55
21.10
21.10
21.10
Grams
71.1
71.8
71.8
71.8
221.1
217.0
215.5
70.4
70.4
70.4
Grams
338.2
338.2
338.2
338.2
338.2
338.2
338.2
Grams
2590
2596
2596
2600
2607
2570
2556
2581
2581
2581
Grams
18.66
20.04
20.59
21.31
23.28
24.03
26.53
21.65
19.20
19.65
Grams
2.46
1.11
0.56
0.00
1.77
2.48
4.98
0.55
1.89
1.45
2
3
4
5. .
6
7
8
9
10
On carefully examining this table it will be seen from the nitrogen
balance of the first period that the amount of protein in the food was more
abundant than was necessary; however, the nitrogen equilibrium was
established on the fourth day. When fat was substituted for carbohy-
drate, there was a marked increase in protein catabolism with correspond-
ing loss of nitrogen from the body. On the other hand, the loss of nitrogen
increased daily while the fat diet was continued, but, upon resuming
the mixed diet, not only was the loss of protein stopped, but the body im-
mediately began replacing the protein it had lost, although the nitrogen
and the calories of the food remained practically the same.
Kayser found that "the nitrogen intake remaining constant, the sub-
stitution of isodynamic amounts of fat for all the carbohydrates of the
diet resulted within three days in a total loss of 9.2 grams of nitrogen.
The loss on the first day was 1.Y7 ; on the second day, 2.48 ; and on the
third day, 4.98, while during the periods before and after, one gram of
304
NUTRITION AND MINERAL METABOLISM
nitrogen daily was retained. Landergren, who holds that the variation
between carbohydrates and fats as protein sparers is not dependent upon
the difference in their physical and chemical properties, advances the
following explanation as a possible solution of the problem. If there
are no disposable carbohydrates present, either in the food or in the
storehouse of the body, then the organism must itself produce carbo-
hydrate in order to satisfy its requirements. As, according to this investi-
gator, a formation of sugar from protein may take place, but never one
from fat (at least, under physiological conditions), then, in the absence
of carbohydrate, a certain additional amount of protein must break down,
in order to furnish the necessary carbohydrate requirements of the
organism." This investigator finds the absolute daily carbohydrate re-
quirement of the adult to be 40 to 50 grams. In his opinion, 30 to 40
grams of protein w r ill be sufficient to furnish this amount if no preformed
carbohydrates are present.
Atwater(23), in one of his researches, compared the protein-sparing
power of carbohydrate and fat in an experiment in which his subject was
an athletic young man weighing 67 kilograms, who was accustomed to
perform a considerable amount of work. The fifteen-day experiment was
conducted in the respiration calorimeter, and the subsistence, rich in
carbohydrates, was arranged in four periods which were alternated
with four equal periods in which the diet was rich in fat. The change
from carbohydrate to fat and vice versa involved about 2,000 calories or
nearly half the fuel value of the diet. The average results per day for this
experiment were tabulated as follows :
SPARING POWER OF CARBOHYDRATES AND FAT IN CALORIMETRIC
EXPERIMENTS (ATWATER)
On Diet Rich in
Carbohydrates
On Diet Rich in
Fat
Available calories in food
4532
4524
Heat equivalent of work performed, calories . . .
Nitrogen in food, grams
558
17.5
554
17.1
" " feces, "
2.5
1.7
" " urine, " ....
16.6
18.1
" balance, "
-1.6
-2.7
The difference here is in favor of the carbohydrate, but this is so small
as to be of no practical significance.
It appears that the carbohydrates of the dietary cannot be entirely
FACTORS WHICH AFFECT .MKTAIJOMSM 305
replaced by an equal number of calories in the form of fat without jeop-
ardizing the nitrogen balance.
Gelatin as a Protein Sparer Gelatin as a protein sparer has been
studied extensively by Voit, Wilcock, Hopkins, Kauffmann, Kolpakcha
and others. According to Voit (24), it would seem that the high nitrogen
content of gelatin and the fact that it is soluble led to a tendency to
attribute to it an unusual nutritive value. The fact, too, that gelatin could
be obtained from bones, which otherwise were burned or thrown away,
was important in suggesting it as a means for the economical feeding of
the poor. The history of gelatin as a food is very interesting, and indeed
instructive, since it serves as a warning against a premature application
of the results of scientific investigation.
A committee of the Paris Academy of Medicine investigated gelatin
as a food and recommended it as a most nutritious and healthful foodstuff
when its natural insipidity was corrected by the addition of salts and
savory herbs. On the basis of this report, gelatin was generally used in
the nourishment of hospital patients, but in the coiirse of time, complaints
were made and doubt raised as to its real food value. The true value of
gelatin as a food, as we understand it to-day, w r as established by Voit's
experiments, still it is evident that something remains to be explained.
It is not clear why it cannot be better borne in a diet when used in larger
quantities. Wilcock and Hopkins(25), after an extended study of this
subject, conclude that the special protein-sparing properties of gelatin
are due largely to the abundance of glycocoll in its composition, and aver
that it shares with protein certain molecular groupings necessary to satisfy
specific needs and is thus superior to fats and carbohydrate as a protein
sparer. It lacks, on the other hand, certain necessary groupings, there-
fore failing to supply all such needs, and thus cannot replace protein. It
is a well-known fact that gelatin as a sole protein food does not suffice for
the maintenance of nitrogen equilibrium. Recent study of protein chem-
istry has shown that gelatin differs from most other proteins in yielding
on hydrolysis no tyrosin nor tryptophan and little if any cystin.
Kauffmann (26) personally experimented with a diet in which these
three amino-acids were ingested along with gelatin to the exclusion of
other protein, and found that nitrogen equilibrium was maintained
throughout the entire five days' fast on this aliment. Von Noorden(S),
after many qualitative analyses of gelatin, is certain that it contains much
glycocoll and very little leucin and aromatic amino-acids. He believes 1 1n-
variable composition of gelatin is but one of the reasons why it is so ill
adapted for the building up of protein. He arrives at this conclusion
306 NUTKITION AND MINERAL METABOLISM
after an experiment, and says a considerable quantity of gelatin in the
food effects the economy from 20 to 30 per cent in the protein decomposi-
tion of starvation, but quantities three or four times as great increase the
economy to only 40 per cent instead of trebling or quadrupling it as
might be expected. The loss of body protein cannot be prevented by add-
ing much non-nitrogenous food to even the largest gelatin diets. A few
years ago there was prevalent a popular idea that jelly was strengthening.
Physicians concluded this to be erroneous and averred that jelly was of
no use. Both were wrong. Gelatin undergoes catabolism, being-
changed into urea, and is a protector of protein, not by lessening the
amount of material oxidized in the same way as carbohydrate and fat,
but by being directly substituted for the nitrogenous elements of the body.
The addition of gelatin to the dietary aids in establishing nitrogenous
equilibrium on a smaller amount of protein than when gelatin is with-
held, and even the consumption of fat is lessened by the allowance of
gelatin in the aliment. This is all the plainer when we consider that
gelatin in the process of catabolism is split into a urea moiety and a fatty
moiety, like proteins. The important point in this connection is that
gelatin, alone or with carbohydrates or fats, does not suffice to maintain
the nitrogen equilibrium. It does not supply the nitrogenous material
requisite for the repair of tissue. This deficiency is explained by the fact
that in the composition of gelatin certain important amino-acids are lack-
ing tryptophan, tyrosin and cystin.
Howell(27) states that "if a dog is fed upon a diet in which the nitrog-
enous material is represented only by the split products of a gelatin
hydrolysis, he will show a nitrogen loss. If the above named amino-acids
are added, particularly the tryptophan, he will be maintained in nitrogen
equilibrium. It is at present conceded that gelatin takes the place of
stored or circulating protein, but not of tissue proteins, and therefore it
will be seen that it does not serve the purpose of replacing the wear and
tear of tissue." Nevertheless, gelatin is a more valuable foodstuff than it
was formerly considered to be.
Alcohol as a Protein Sparer "Alcohol as a protein sparer has been the
subject of much discussion among physiologists. It would be impossible
to summarize the evidence on each side of the question here, but, in brief,
the results of the latest and most trustworthy researches show that alcohol
undoubtedly possesses a limited power in restricting nitrogenous waste."
Alcohol is unquestionably a fat-sparer, though with greater difficulty is
it able to spare carbohydrate. But while sparing fat, and sometimes
carbohydrates, it is itself consumed yielding heat and energy to the
FACTORS WHICH AFFECT METABOLISM 307
body. This was once a mooted point with physiologists, but there is no
longer any doubt that alcohol is a food, but a very expensive food. Care-
ful research has shown that the complete combustion of one gram of alco-
hol in the body will yield 7 calories of heat energy; so that 131 grams of
alcohol will yield as much fuel to the body as 100 grams of fat, which
means that one ounce of alcohol is equal in energy or fuel value to one
ounce of butter (80 per cent fat). While this statement is a recorded
fact, we do not intend to convey the idea that we hold that alcohol is as
good a source of energy in the diet as fat. Quite the contrary is the case,
for, as we have already seen (see Volume I, Chapter XVI, page 578), by
dilating the blood vessels alcohol may cause m.ore heat dissipation than
it is itself capable of producing.
Besides, the energy which alcohol yields is very quickly dissipated,
owing to the rapid oxidation of alcohol in the body, while fat produces
energy in a slower and more equable fashion.
Hutchison (28) thinks that larger doses of alcohol cause a general
paralysis of cellular activity,, so great that heat production is diminished
and heat loss increased,. with the final result of great lowering of the body
temperature. If it be granted, for sake of argument, that alcohol is oxi-
dized in the tissues with the liberation of energy, any value which it may
possess in virtue of such metabolic action is seriously counterbalanced by
its paralyzing and anesthetizing action on cellular activity. This causes
the cells, for the time being, to lose their power of breaking down those
compounds, such as fat, which it has, even under normal conditions of
full activity, most difficulty in handling. Moreover, this dulling of the
senses and inhibition of cellular activity is quite in accord with our present
understanding of the effects of other cell poisons; and this knowledge
should be accepted as Nature's warning, for, as experience has shown,
the consumption of alcohol during muscular work augments rather than
delays fatigue (29).
Furthermore, a$ previously stated, it is believed that to a limited
extent alcohol may lessen nitrogenous waste; however, its action in this
respect is much less than that of carbohydrates, and less even than that of
fats, and in addition there seems to exist some subtle influence of conditions
not clearly understood, which depend, in certain instances (at least to some
extent), upon personal peculiarities of the subject.
Habit, also, undoubtedly is an important factor(SO), as, with those
who are accustomed to alcohol, the initial loss in nitrogen is less marked
than in the case of total abstainers. In the case of fever patients who
have been previously accustomed to the consumption of alcohol, even large
308
NUTRITION AXD MINERAL METABOLISM
quantities do not give rise to nitrogen losses. Practically all physiologists
agree that alcohol spares less protein than do carbohydrates when both are
given in isodynamic quantities, but in practical therapeutics this is really
of little importance. The physician does not desire to make use of the
protein-sparing properties of alcohol, but instead he does endeavor by its
use to spare the fat of the organism.
In the experiments of Atwater and Benedict (31) it was found that
the utilization of the different foodstuffs was not affected by the adminis-
tration of alcohol, as shown in the following table :
UTILIZATION OF DIFFERENT FOODSTUFFS WITH
ALCOHOL
AND WITHOUT
Protein
Fat
Carbohydrates
Energy
With alcohol
93.7
94.6
97.8
92.1
Without alcohol . . .
92.6
94.6
97.9
91.8
This tabulation shows the extent to which the food material was metab-
olized when alcohol was administered.
It has been held by some observers that the administration of alcohol
exerted a favorable action in retarding tissue waste which accompanies
prolonged pyrexia, but unless its metabolic action is very different in fever
from its action under normal healthy conditions, and there seems to be
little affirmative evidence, we are not justified in granting it any such
favorable action.
Finally, in summing up the influence of alcohol on metabolism, we
are safe in concluding that it is burnt up in the body, sparing fat and car-
bohydrates, and, to a very limited extent, it may spare protein, but the
weight of evidence is against the conclusion that it exerts any important
action tending to inhibit nitrogenous waste (32).
Metabolism of Water. The metabolism of water in the human econ-
omy has been worked over by many serious investigators. Bischoff, Foster
and Hennenberg held that the "flushing" of the system with water
hastened the breaking down of protein substances. Voit(24), in particu-
lar, was the first to make any trustworthy experiments upon this question.
He found that the rise in the excretion of nitrogen was 25 per cent, with
an increase of the total urinary sulphur compounds from the tissues, and
in any case it falls far short of the amount of the increase of the nitrogen
excretion (33).
Bidder, Schmidt, Murck and Meyer (34), on the other hand, believe
that the urinary nitrogen increases because the tissues are more thor-
FACTORS WHICH AFFECT METABOLISM
309
oughly flushed or washed out and thereby lose their nitrogenous end-
products.
The human body consists of 630 parts per 1,000 of water, and it is of
the greatest importance as a component of the tissues to assist in the
exchange of nutritive substances, the discharge of the products of metab-
olism, the regulation of temperature and other vital functions. If the
supply of water be cut off, the body will die, and it will succumb sooner
from deprivation of water than by starvation. A restriction of the water
supply consumed hastens the decomposition of protein and fat to replace
the water essential for the body functions.
Atwater and Benedict, as a result of a 49-day experiment with a
control in repose, showed that the' average income of water was 2,290 c.c.
and the excretion 3,700 c.c., so that at the lowest estimate about 250 c.c.
of water was formed in the tissues by the oxidation of hydrogen in the
food, while in the tissues and during ordinary work they found that from
510 c.c. to 540 c.c. of water was excreted daily in excess of the amount
consumed in the food and drink. The amount of water ingested with
food and drink varies according to position, life, habits and environments
of the individual, but the above figures give a fair idea of the amounts of
water taken with a mixed diet under comfortable circumstances (17).
Von Noorden holds that, in addition to the fluid drunk, the body has
at its disposal the "oxidation water," resulting from the combustion of
the hydrogen of the food. The amount of this varies but little, depending
less upon the nature of the food oxidized than upon its quantity, in
other words, upon the absolute extent of metabolism.
The following table graphically emphasizes this point :
"OXIDATION WATER" RESULTING FROM THE COMBUSTION OF
HYDROGEN IN THE FOOD
Foods
Contains
grams H
Contains
grams H 2
Yields
calories
100 calories
yields grams H 2
100
grams fat
11.9
107.1
9,461
11.3]
100
" starch
6.78
55.5
4,181
13.3 [ 11.3
100
" protein
4.59
41.3
4,442
9.3 J
100
" alcohol . .
13.4
117.4
6,981
16.6
A careful study of the above tabulation shows that, for each 100
calories developed, the ternary food elements produce approximately the
same amounts of water, 11.3 grams. On a mixed dietary, whore fifty
per cent of the potential energy is derived from the carbohydrates and
120
310
NUTRITION AND MINERAL METABOLISM
one-sixth from the protein, and the remaining from the fat, each 100
calories correspond to about 12 grams of water, so that we have:
From 2,000 2,500 3,000
About.. 240 300 360
4,000 calories
420 "oxidation" water
The approximate figures from von Noorden, just given, agree fairly
well with the quantities determined experimentally by Voit, which were
as follows:
During starvation 32 gm. H equals 288 H 2 0, with an exchange of about
2.300 calories.
With average diet and lightHO gm. H. equals 360 H 2 0, with an exchange of about
work J 2,600 to 2,800 calories.
With hard work 52 gm. H. equals 468 H 2 0, with an exchange of about
3,600 calories.
Atwater and Benedict (35) observed that:
During rest 30 gm. H equals 270 H 2 O, with an exchange of about
2,209 calories.
During hard work 50 gm. H equals 451 H 2 0, with an exchange of about
3,630 calories.
Neumann(36) conducted an ideal experiment upon himself, subsist-
ing upon a regular and constant dietary, the chief results of which are
tabulated below:
NEUMANN'S DIETARY EXPERIMENT
1
2
3
4
5
H 2 Oin
drinks
NITROGEN BALANCE
Total
for
Entire
Period
DAY
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
970
3,000-3,900
600- 900
3,100-3,700
700-1,700
+0.42
-3.8
+3.35
-3.16
+2.91
+0.19
-2.4
+ 1.92
-1.51
+0.72
+0.16
-0.1
+0.78
+0.59
+0.42
-0.06
+0.4
-6.3
+6.1
-0.89
4.9
+0.51
+0.88
-0.23
+0.19
+0.59
+1.0
+1.23
In studying this table it will be seen that his consumption of water
increased from 970 c.c. the first day of first period to 3,900 c.c. the last
day of the second period and 3,700 c.c. the last day of the fourth period.
The urinary nitrogen was increased during only the first two days.
On and after the fourth day he remained in nitrogenous equilibrium,
although he continued to drink abnormally large quantities of water. Dur-
ing this experiment Neumann was punctiliously careful as to details and
noted when he returned to the small consumption of water, as in the third
period, or after he had flushed out his system for a long period, as in the
fourth period, that his initial loss of nitrogen was fully compensated by
the retention of corresponding amounts of nitrogenous substances.
FACTORS WHICH AFFECT METABOLISM 311
Von Noorden, in commenting upon this experiment, emphasizes the
facts as tabulated, and says : "For the adult healthy man the question has
been answered once for all." It will be seen, therefore, that "flushing
out" the system removes the end-products of nitrogenous metabolism with-
out any abnormal breaking up of protein.
In summing up the results- of Neumann's experiment, von Noorden
concludes as follows :
The amount first washed out and then retained was about six grams of nitro-
gen. One might be tempted to regard this quantity as the maximum "excess of
extractives loosely retained in the system," and to base other calculations upon it
as such in other investigations of the metabolism. Were this justifiable, one would
be able to set down any further excess of nitrogen lost with some certainty to the
decomposition of protein. But this view is not justifiable, since such consumption
of water produces no more than a mechanical flushing of the tissues. Under dif-
ferent circumstances, it is quite possible that perhaps amounts of extractives
might leave the tissues; yet it is most important that conclusions drawn from the
action of the healthy bodj r should not be applied to diseased tissues. And there is
one thing that these experiments bring out very clearly, and that is the tenacity
with which the organism holds on to its extractives. With but few exceptions,
these bodies should not be regarded as the valueless decomposition products des-
tined for excretion only. They must rather have definite functions of which we
know nothing for the most part to perform in the economy of the body.
Metabolism of Mineral Substances The metabolism of mineral sub-
stances, from a strictly chemical viewpoint, is of small moment, since
they undergo only minor chemical changes, and play even a less important
role in the transformation of energy ; they are not sources of energy and
it is questionable even if they have any part in its development. Indeed,
their exact significance in the organism is only partially understood, but at
the same time it is a well-known physiological fact that life cannot be sup-
ported on foods deficient in inorganic salts. Beyond question they serve
most important functions in maintaining a normal composition and
osmotic pressure in the fluids of the body, and, by virtue of their osmotic
pressure, they play an important part in the ingress and egress of water
to and from the tissues. Besides, the inorganic salts constitute an essen-
tial part of the composition of all living matter.
Howell says:
In some way they are bound up in the structure of the living molecule and are
necessary to its normal reactions or irritability. Even the proteins of the body
liquids contain definite amounts of ash, and if this ash is removed, their properties
are seriously altered, as is shown by the fact that ash-free native proteins lose
their property of coagulation by heat. The globulins are precipitated from their
312
NUTKITION AND MINERAL METABOLISM
solutions when the salts are removed. The special importance of the calcium salts
in the coagulation of blood and the curdling of milk has been referred to, as also
the peculiar part played by the calcium, potassium and sodium salts in the
rhythmical contractions of heart muscle, the irritability of muscular and nervous
tissues, and the permeability of the capillary wall and other membranes. The spe-
cial importance of the iron salts for the production of hemoglobin is also evident
without comment. There can be no doubt, in. fact, that each one of the salts of
the body has a special nutritive value and a special metabolic history. The time
will doubtless come when the special importance of the potassium, sodium, cal-
cium and magnesium will be understood as well, at least, as we now understand the
significance of iron, and quite possibly this knowledge will find a direct therapeutic
application, as in the case of iron.
In the human body the mineral salts exist partly in combination
with organic substances and partly in solution in the body fluids. In-
organic substances, when burned with access of air, set free the mineral
substances which exist therein ; likewise, when foodstuffs containing the
inorganic salts are metabolized in the body, they are (with the exception
of iron) given off chiefly in the form of mineral matter. These elements
and their compounds are therefore usually referred to as ash constituents,
and their metabolism as mineral metabolism.
The table given below shows the most important of the inorganic
salts and the percentage found in bone, muscle and the various organs of
the body. The inorganic salts found in the body are either eliminated
from the body by the urine and other excretions, or they may be retained
and recombined with freshly absorbed organic substances from the ali-
mentary canal.
THE PERCENTAGE OF ASH IN BONES, MUSCLES, AND VARIOUS
ORGANS
M
S3
o'S
WE
^=?
iS
3 o3
Is
fc-!'fl
>^ g
asj
14?
SSI
tf^O
ra &>
oj OJ
: - s-i
PQ
if
s b
1M?
p ci
>la^
i
%-%*
'. -^
Sg-g
Sodium chlorid . .
Potassium chlorid
10.59
4.74
58.81
74.48
10.73
26.33
Soda
2.35
14.53
44.33
10.69
4.15
10.35
Potash
34.40
25.23
9.60
34.42
11.97
3.25
21.44
Lime
37.58
1.99
3.61
7.48
.72
1.76
.97
18.78
Magnesia
1.22
1.45
.20
.49
1.23
1.12
.26
.87
Ferric oxid. .
2.74
7.28
8.37
.05
.10
Chlorin
2.58
.54
Fluorin
1 66
Phosphoric acid. .
Sulphuric acid
53.31
48.13
50.18
.92
27.10
2.54
50.18
.92
10.23
1.67
1.09
19.00
2.64
Carbonic aicid
547
1.19
8.20
Silicic acid
.81
.27
.17
.27
.42
FACTORS WHICH AFFECT METABOLISM 313
Yon Noorden says:
Extract experiments have proven, once for all, the indispensable importance of
the inorganic salts to the organism, and the amounts in which they are required
during growth has been repeatedly investigated, while only a few serviceable de-
terminations have been made upon the adult.
It is known that the body takes up the organic foodstuffs to supply
it with energy, in response to a definite demand. The inorganic material
in the food is on a different plane ; like water, it is absorbed in excess, or,
more plainly speaking, in quantities far surpassing the normal physio-
logical minimum. The requisite amount of the daily decomposition under
definite conditions of life and nutrition, calculated on the basis of the
urinary salts, is stated by von Noorden(lT) in the following approximate
figures :
Gram Gram
Cl 6-8 Na 2 4-6
P^Oa 2-3.5 Fe 2 3 Traces
S0 3 2-3.5 CaO 0.15-0.35
K 2 2-3 MgO 0.2-0.3
The physiological minimum intake of inorganic matter has not been
extensively investigated. Indeed, its determination is beset with diffi-
culties, since the same differences obtain as in the case of the demand for
protein and water, and these depend upon individuality, personal idio-
syncrasies and upon variations of the organic constituents of the dietary.
It is difficult, therefore, to arrive at a "physiological optimum." This
much is certain, a marked decrease in the amount of mineral salts must
take place before any impairment of mineral metabolism is noticeable.
At any rate, no scientific proof of its importance is available, and beyond
question there is an absence of accurate information of the physiological
conditions involved.
From the foregoing discussion of mineral metabolism, we learn that
the salts of the body are partly bound up with inorganic substances and
partly in solution in the body fluids, and are considered as ash. The
prevalent custom of speaking of ash as a food is incorrect; properly
speaking, ash is the term applied to the residue remaining after the incin-
eration of food products in the air at a low temperature, until the carbon
has disappeared. Ash is rather an indefinite term and is applied to that
residual material of a mineral nature composed of sand or silica and the
carbonate*, or oxids of alkalies or alkaline earths. The ash contains the
principal percentage of phosphorus present in food products along with a
small portion of sulphur. These bodies exist as phosphoric and sulphuric
314
^TUTKITION AND MINERAL METABOLISM
acids or their salts. Elements so closely related to chemical properties
as sodium, potassium or calcium and magnesium are not only not inter-
changeable, but in some of their functions are diametrically opposed.
Calcium seems to bear a special affinity for, and to exert a favorable
influence upon, the efficacy of iron in body metabolism, since it appears
to be possible to maintain iron equilibrium upon a smaller amount of this
latter element when the ingested food contains an abundance of the
calcium salts.
The relative quantities of water, organic matter and inorganic residue
(ash) in some of the tissues and body fluids is shown, in the following
table:
TABLE SHOWING PERCENTAGE OF WATER, ORGANIC MATTER AND
INORGANIC RESIDUE (ASH) PRESENT IN CERTAIN TISSUES
AND BODY FLUIDS
Water
Organic and
volatile matter
Inorganic resi-
due (ash)
Blood corpuscles
54.60
44.68
0.72
Blood serum
90.50
8.68
0.82
Urine
95.70
3.00
1.30
Bone
22.10
26.00
52.00
Dentine. .
10.00
25.00
65.00
Enamel .
0.40
3.60
96.00
Blood
79.50
19.75
0.80
Human milk
86.80
12.85
0.35
Pus
87.00
12.20
0.80
Lymph
91.80
7.40
0.80
Chyle
91.80
7.40
0.80
Bile
85.92
13.30
0.78
Pancreatic mice
90.97
8.18
0.85
Gastric juice
99.43
0.33
0.24
Saliva ... . . ....
99.50
0.32
0.18
Acid-forming and Base-forming Elements. The actW-forming and base-
forming elements of the aliment are interesting from a clinical point of
view. For example, a dietary of proteins, fats and carbohydrates which
has been demineralized and leaves no ash residue after incineration, will
introduce no fixed bases in the body, but, on the other hand, will introduce
sulphuric acid from the metabolism of sulphur contained in the ingested
protein. Such a dietary would be "acid-forming."
Doctor Taylor (37), of the University of California, subsisted for a
period of nine days upon a practically ash-free aliment made up of 70-75
grams of purified egg albumin, 120 grams of washed olive oil, and 200
grams of cane sugar. He describes his symptoms as essentially those of
FACTORS WHICH AFFECT METABOLISM 315
acidosis, similar to that produced from the want of base-forming elements
in the diet. Later Goodall and Joslin(38) carried out experiments
similar to Taylor's without obtaining confirmatory evidence, which would
suggest considerable differences between persons in reference to suscepti-
bility of the acids elaborated in the metabolic processes.
Deprivation of the organic acids leads to a peculiar disturbance of the
system resulting in the development of scurvy. Of the inorganic salts
sulphur is essential to growth. The chlorids keep the globulins in solu-
tion, and are the source of the hydrochloric acid of the gastric juice. The
phosphates are essential for the growth of bone and to the nervous system.
Deficiency of calcium and magnesium leads to rickets and other abnormal
conditions.
Gout has been termed the disease of luxury. On the other hand,
scurvy is the disease of privation or penury. Funk and other writers hold
that scurvy is a deficiency disease due to lack of vitamines in the food-
stuffs. Gautier held that the class of vegetables containing a liberal
amount of alkaline ash acts as an antiscorbutic.
Sherman (39) avers that:
If susceptibility to scurvy and the injurious results from an ash-free diet are
even partly due to the disturbances of the balance of acid-forming and base-form-
ing elements in the food, it would seem to follow that the normal dietary should
be so chosen as to furnish the body enough base-forming elements to neutralize
the mineral acids produced in metabolism.
This author determines the Ixilniice of acid-forming and base-forming
elements in foodsti ill's by ascertaining the presence of chlorin, sulphur,
phosphorus, sodium, potassium, calcium and magnesium, computing the
equivalent in acid of the first three elements, the equivalent in alkali of
the last four, then determining the excess of acid or base, as the case may
be, which would result from the complete oxidation in the blood. He holds
that :
While in actual metabolism all of the sulphur of the food is not oxidized to
sulphate and the ammonia is not quite all converted into urea, yet the method is
fairly satisfactory as a means of comparing foodstuffs in respect to their metabolic
acid-forming and base-forming properties.
For tables graphically showing the relative preponderance of acid-
forming and base-forming elements in some typical foodstuffs, as worked
out by Sherman, consult the following (Volume II, Chapter XI, page 357).
From a study of these tables, it will be learned that lean beef and
round steak, bacon and ham possess a high percentage of acid-forming
elements. It will also be seen that the cereal grains show a slight prcpor-
122
316 NUTRITION AND MINERAL METABOLISM
derance of the acid-forming elements. While, in the second table, it will
be seen that milk, fruits and vegetables show an excess of base-forming
elements.
The blood is physiologically and chemically an alkaline medium and
upon its alkalinity depends its power of transporting carbonic acid, and
upon this fact as well depends the power of .the blood to take up, at certain
times, organic acids without itself becoming acid. When large doses of
alkalies are administered, the economy at once begins preparing for their
excretion, so that a short while after absorption only a small portion can
be found present in the organism.
Just how alkali is retained in the blood, how much of it at any stated
period is present in the blood and lymph, what quantities pass into the
different tissues and various organs, is not definitely known. And yet
an accurate understanding of this interesting phenomenon would be of
great practical significance for the scientific medical man. The great
variation in the alkalinity of the tissues, though often challenged by thera-
peutics, is at present an admitted fact Still their percentage and extent
are as yet "seen through a glass darkly."
A dietary in which the acid-forming elements are present in excess
calls for a withdrawal of the fixed alkalies from the tissues and circulating
fluid on the one hand, or, on the other, for an increase of ammonia salts
in the body, neither of which is desirable. Carnivorous animals habitually
ingest foods with an excess of acid-forming elements without harmful
effects, and while in man it might not be dangerous, yet it must put an
extra tax upon a constitution accustomed to a mixed dietary which might
better be avoided, especially, as Sherman thinks :
We have no reason to anticipate any disadvantages from a preponderance of
base-forming elements, which, if not used to neutralize stronger acids, would take
the form of bicarbonates and thus aid in the maintenance of the normal and neces-
sary neutrality or faint alkalescence of the blood and tissues. It would be a good
practice, therefore, when formulating a dietary in which the foods contain acid-
forming elements, to be fairly well balanced by other foods in which the base-form-
ing elements predominate, so that the diet as a whole may yield sufficient fixed
bases to neutralize any excess of mineral acids evolved during the processes of
metabolism.
If all the available information could be collected, with the opinions
of critics added thereto, it would make a volume in itself. Therefore, we
present only a brief prologue to mineral metabolism and the reader is
referred to the succeeding chapter for value uses and sitology of the
inorganic salts.
REFERENCES 317
REFERENCES
1. TIBBLES, WILLIAM. Food in Health and Disease.
2. HALL, W. S. Nutrition and Dietetics.
3. RANKE. Einwirk. des Tropen klimas auf die Ernahrung des
Menschen, 1900.
4. PETTENKOFER and VOIT. Respirations Versuche am Hungernden
Pflanzenfresser.
5. ATWATER. U. S. Dept. of Agric., Bull. No. 109, pp. 126-127.
6. - and ROSA. U. S. Dept. of Agric., 1899, Bull. 63.
7. ZUNTZ. Nahrungszufuhrtierische Oxydations-prozesse, Arch. f. d.
ges. Physiol., vol. xv, p. 634.
8. VON NOORDEN. Metabolism and Practical Medicine, Physiology.
9. BENEDICT. For description of a new form of apparatus for study-
ing respiratory exchange. See Am. J. Physiol., 1909, vol. xxiv,
p. 545.
10. SHERMAN, HENRY C. Chemistry of Food and Nutrition, pub. by
Macmillan Co., 1914.
11. LEVY, MANGUS. Arch. f. d. ges. Physiol.
12. RUBNER. Die Gesetze des Energieverbrauches bei der Ernahrung,
1902.
13. ATWATER, BENEDICT, et al. Respiration Calorimeter Experiments,
Office of Exper. Sta., U. S. Dept. of Agric., Bull. Nos. 44, 63,
69, 109, 136, 175.
14. BENEDICT. The influence of Inanition on Metabolism, Pub. No. 77,
Carnegie Institution of Washington, 1907.
15. ATWATER and BENEDICT. The Nutritive Value of Alcohol, Memoirs
Nat. Acad. of Sciences, 1902, p. 394.
16. LUSK. The Science of Nutrition.
17. VON NOORDEN. Loc. cit., 6th ed., 1912, p. 121.
18. JANNEY, N. W. J. Biol. Chem., 1916, vol. xxiv, p. 30.
19. KOCHER, R. A. The Mechanism of the Sparing Action of Carbo-
hydrates on Protein Metabolism, J. Biol. Chem., 1916, vol. xxv,
p. 571.
20. KAYSER and LANDERGREN. Skand. Arch. Physiol., 1903, p. 112.
21. ATWATER. U. S. Dept. of Agric., Bull. No. 136, p. 197.
22. KAYSER. Einfl. von Fett und Kohlenhydrat, 1902.
23. ATWATER and BENEDICT. Metabolism of Matter and Energy, U. S.
Dept. of Agric., Bull. No. 176, p. 136.
318 NUTRITION AND MINERAL METABOLISM
24. VOIT. Herman's Handbuch der Physiologie, vol. vi, p. 396.
25. WILLCOCK and HOPKINS. J. Physiol.
26. KAUFFMANN. Tigerstedt's Physiology, p. 109.
27. Ho WELL. Text-book of Physiology.
28. HUTCHISON. Food and Dietetics.
29. DESTKEE. Quart. J. Inebr., Jan., 1899.
30. SCHNYDEK. Pfluger's Archiv., 1903, vol. xciii, p. 451.
31. AT WATER and BENEDICT. An Experimental Inquiry Regarding the
Nutritive Action of Alcohol, Nat. Acad. of Sci., 1902, vol. viii,
Memoir 6.
GODDAKD. Lancet, Oct. 22, 1904.
32. ANTSIE. Practitioner, 1874, vol. xiii, p. 15.
ATWATER and BENEDICT. Loc. cit.
33. TSUBAI. Zeitschr. f. Biol., 1904, vol. xliv, p. 377.
34. BIDDER and SCHMIDT. Die Verdauungssafte und der Stoffwechsel,
1852.
35. ATWATER and BENEDICT. Experiments on Metabolism, U. S. Dept.
of Agric., 1903, Bull. No. 136.
36. NEUMANN, R. O. Der Einfluss grb'sserer Wassermengen auf die
Nieren-Austeichung, Arch. f. Heilkunde, 1899, vol. xxxvi, p 248.
37. TAYLOR. Pub. in Pathol. Univ. Cal., vol. i, No. 7, pp. 71-86.
38. GOODALL and JOSLIN. Trans. Assn. Am. Phys., 1908, 23-92-196.
39. SHERMAN. Chemistry of Food and Nutrition.
BIBLIOGRAPHY
ABDERHALDEN. Text-book of Physiological Chemistry.
ARMSBY. Principles of Animal Nutrition, chap, vii to x,
. Ibid., chap, vi and xi.
. Ibid.
ATWATER. Methods and Results of Investigations on the Chemistry and
Economy of Food, Office of Exper. Sta., TJ. S. Dept, of Agric.,
1895, Bull. No. 21; Neue Versuche ueber Stoff- und Kraft-
wechsel, Ergeb. d. Physiol., 1904, p. 3.
ATWATER and BENEDICT. A Respiration Calorimeter with Appliances
for the Direct Determination of Oxygen, Pub. No. 42, Carnegie
Instit. of Washington, 1905.
, ec al. Respiration Calorimeter Experiments, Office of Exper.
Sta., U. S. Dept. of Agric., Bull. Nos. 44, 63, 69, 109, 136, 175.
BIBLIOGRAPHY 319
. Comparison of Fats and Carbohydrates as Protectors of Body
' Material, Office of Exper. Sta., U. S. Dept. of Agric., Bull. 136,
pp. 176-187.
BENEDICT and CARPENTER. The Metabolism and Energy Transforma-
tions of Healthy Man During llest, Pub. No. 126, Carnegie
Instit. of Washington, 1910.
. The Influence of -Muscular and Mental Work on Metabolism
and the Efficiency of the Human Body, as a Machine, -Office of
Exper. Sta., U. S. Dept. of Agric., 1909, Bull. No. 208.
BUNGE. Physiological and Pathological Chemistry, chaps, vii and viii.
CJIITTENDEN. The Nutrition of Man, chaps, i and ii.
FISHER. A New Method for Indicating Food Values, Am. J. Physiol.,
vol. xv, p. 417.
FOLIN. A Theory of Protein Metabolism, Am. J. Physiol., vol. xiii, pp.
117-138.
. A Theory of Protein Metabolism, Am. J. Physiol., vol. xiii,
pp. 117-138.
FORBES. The Balance between Organic Acids and Bases in Animal Nu-
trition, Ohio Exper. Sta., 1909, Bull. No. 213.
11 AM MARSTEX. Text-book of Physiological Chemistry.
HART, MoCoixnM and FULLER. The Role of Inorganic Phosphorus in
the Nutrition of Animal Research, Wisconsin Exper. Sta., 1,
1909, Bull. No. 1.
HENDERSON. Das Gleichgewicht zwischen Basen und Sauren im Their-
ischen Organismus, Ergebn. d. Physiol., 1909, vol. viii, pp. 254-
325.
HILL. Recent Advances in Physiology and Biochemistry, chaps, xi and xii.
. Ibid., chaps, viii, ix, x, xv.
HONVKLL. Text-book of Physiology, chaps, xlvii and xlviii.
HUTCHISON. Food and Dietetics, chaps, ii and iii.
JORDAN, HART and PATTON. Metabolism and Physiological Effects of
Phosphorus Compounds of Wheat Bran, Technical Bull., No. 1,
New York Exper. Sta. and Am. J. Physiol., 1906, vol. xvi, p. 24.
LUSK. Elements of the Science of. Nutrition.
. Ibid., 3rd ed., 1909, pp. 17-45.
. The Fate of the Amino Acids in the Organism, T. Am. Cliem.
Roc., 1910, vol. xxxii, pp. 671-680.
OSBORNE. Sulphur in Protein, U. S. Dept. of Agric., Bull. 227.
PATON. On "Folin's Theory of Protein Metabolism," T. Physiol., 1905,
vol. xxxiii, p. 1.
320 NUTRITION AND MINERAL METABOLISM
SHERMAN and SINCLAIR. The Balance of Acid-forming and Base-forming
Elements in Food, J. Biol. Chem., 1907, vol. iii, p. 307.
VON NOORDEN. Metabolism and Practical Medicine, vol. i, pp. 185-207.
. Ibid., vol. i, pp. 208-282.
. Metabolism and Practical Medicine, vol. i, pp. 64-127,
153, 168.
WILLCOCK and HOPKINS. The Importance of Individual Amino Acids in
Metabolism, Ibid., 1906, 35, 88-102.
CHAPTEK XI
SCIENTIFIC FEEDING OF NITROGEN FOODS
"Man begins to die as soon as he is born," but a competent physician who under-
stands the science of trophotherapy will be able to pilot his patient through the
rocks and shoals of diet and land him in a haven of safe and enjoyable life.
Nitrogen in Diet: Nitrogen Equilibrium; Nitrogen in Feces; Low Protein
Diet; High Protein Diet; Nitrogen-free Diet.
Protein Metabolism: Urea; Ammonia; Creatinin; Uric Acid; Purin Bodies
Source, Chemistry, Occurrence in the Body, Purin Bodies in Food,
Effect of Purin Foods on Uric Acid, Excess of Purin Diet, Purin-free
Diet, Low Purin Diet; Fat-free Diet; Carbohydrate-free Diet; Cellu-
lose Diet.
Mineral Metabolism: Electrolytic Properties of Salts; Sodium Chlorid;
Salt-free Diet; Potassium Chlorid; Calcium Diet; Magnesium Salts;
Phosphorus; Iron Salts; Sulphur Salts; Acid-forming and Base-form-
ing Elements of Diet; Resume".
NITROGEN IN DIET
The great attention that food both in health and disease has received
in recent years has yielded to the profession of medicine valuable infor-
mation concerning trophodynamics. We have considered experimental
researches in regard to dietetics conducted largely with a view of ascer-
taining the nutritive value of food material in regard to the requisite
quantities for supporting life and maintaining bodily equilibrium in all its
phases and activities. We know, too, that the earliest views so ardently
promulgated by von Liebig that there is a direct utilization of particular
kinds of food constituents for particular purposes do not strictly hold
true; that the use made of the food constituents in the body is determined
not alone by the nature of the constituents, but to a certain extent by the
321
322 SCIENTIFIC FEEDING OF NITROGEN FOODS
relative quantities of the various constituents on the one hand and by the
particular needs of the body on the other ; that, for example, while protein
is essential in food for construction of protoplasm, either in growth or
repair, when it is ingested in amount greater than is required, the
excess is utilized for other purposes as in oxidation to yield energy or
heat, or in storage as glycogen or fat, as the case may be. Indeed, it must
be clearly recognized that the knowledge of the food constituents as they
enter the body and the end-products of metabolism as they leave the body,
yields inadequate information as to the intervening processes of metab-
olism which may or may not follow along given lines. It is the knowl-
edge that we are to-day gaining of processes of intermediary metabolism,
that is shedding new light on phases of nutrition, that heretofore have
been merely conjectured or even altogether unknown to us.
For a given individual, exercise governs largely variations in the
amount of food required. Within certain limits, it is not so much what
form the food is in, so long as it can be utilized. Protein metabolism does
not depend so much on the amount of exercise as it does on the amount
and proportion of protein food ingested. Nitrogen equilibrium in nor-
mally healthy individuals may be maintained on various amounts of pro-
tein. It is determined by comparing the total nitrogen intake with the
total output. If the amount corresponds, or nearly so, the body is said to
be in a state of nitrogen equilibrium. Equilibrium may be established
at a low level on partaking of small amounts of protein and larger amounts
of non-protein food, or on the other hand, it may be maintained on a high
level by partaking more freely of protein with correspondingly less non-
protein. Chittenden maintained health, strength and bodily vigor on 50
grams of protein daily. On the other hand, nitrogen equilibrium has been
established on as much as 150 to 200 grams of protein daily. The human
economy in normal conditions regulates the amount of protein metabol-
ized to both the amount and, as well, the total food ingested.
Nitrogen Equilibrium. Major Charles E. Woodruff, 1 in discussing the
nitrogen equilibrium in the tropics, says :
All natives of the tropics (where civilization causes over-population) are in a
condition of nitrogen starvation and need much more nitrogen than they can pos-
sibly get. The old standards of teaching that we should eat as the natives is most
vicious. They do not eat meat because they cannot get it. They crave it, need it,
and eat it when they can. On account of the destructive effects of the concen-
trated tropical actinic rays on protoplasm, we need more nitrogen than at home.
Please do not copy the old falsehood that we need less. It is also true that -we
A-
i Major Charles E. Woodruff, Surgeon, U. S. Army.
NITKOGEN IN DIET 323
need fat, as it furnishes energy better than carbohydrate. It is eaten in prefer-
ence to starches and sugars for this purpose by workers when they can afford it,
but they take to starch (rice) because it is cheaper. It is incorrect to say that it
overheats. It does not overheat us, and it is false to say that fat is not needed in
the tropics.
Nitrogen equilibrium is best maintained on a mixed diet, containing
in addition to the protein both fat and carbohydrate. If the non-protein
portion of the diet is reduced, other things being equal, there will be a
nitrogen loss, owing to the fact that more protein is used to supply the
heat and energy that formerly was supplied by the greater amount of non-
protein food. It takes some days to establish a nitrogen equilibrium when
the usual diet of an individual is changed. Say that the ordinary dietary
contains 1(5 grains of nitrogen and the diet is suddenly changed. It will be
several days before equilibrium will be established on a new level, whether
it be above or below the amount usually metabolized. A slight loss of a
transient character will be noted when the intake is lessened, 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 normal amount
required, or the body is affected with some wasting disease attended with
nitrogen loss.
Nitrogen in Feces In determining the available nitrogen in food,
attention must be given to the nitrogen of the feces. The feces consist of
the undigested residue of the food, together with nitrogen from mucus,
worn out epithelial cells from the walls of the alimentary tract, bacteria,
coloring matter, bile and other residue. Therefore, the contention that all
the nitrogen in the feces is derived from the food is erroneous. That
which is derived from the bile, mucus and debris of broken-down epithelial
cells is body waste, and has already been added to the nitrogenous content
of the organism. During a fast, when no food is consumed, bile and mucus
are still secreted, and the epithelial cells continue to break down and bac-
teria continue to flourish, and are expelled with the feces. Heider con-
ducted experiments with a nitrogen-free food, which he previously ascer-
tained to be readily digestible. The subject was a man of medium height
and weight. The ration was a cake made from starch, sugar, fat and a
little salt leavened with cream of tartar and bicarbonate of soda. White
wine and water in small quantities were the only beverages and were
free of nitrogen. This ration was ingested, he believed, in sufficient
quantities to secure normal secretion of the digestive juices. On such a
diet, the inference is that any nitrogen found in the feces could be attrib-
uted to body sources only. The average amount of nitrogen in the feces
during this experiment was 0.5 grams per day, which may be taken to
represent fairly the amount of nitrogen in the feces arising from body
waste ; any amount above this figure ordinarily may be attributed to resi-
due from the food.
Low Protein Diet. The low protein diet of Chittenden has been re-
ferred to above and in Volume II, Chapter V. He and his followers
urge but little protein above the minimum, together with the requisite
amount of fat and carbohydrates to make up the needed calories. They
urge that on this diet health and weight may be maintained and that the
mental and physical efficiency is greater than when more liberal diets are
allowed.
The experiments of Chittenden are of enormous practical value in
showing that a low protein diet can be used for a long period of time with-
out danger (see table, Volume II, Chapter IX, p. 254). Low protein
diets are of value in gout and all gouty affections, in diseases involving the
tegumentary system, more particularly when accompanying disorders of
metabolism, in treating the ill effects of habitual overeating and arterio-
sclerosis, and in fevers and other affections. Brain workers and others
following sedentary vocations will no doubt do better on diets lower in
protein than usually advised. After carefully considering all the points
of a low protein diet, we are led to the conclusion that it is, at the same
time, a low-purin diet; and many authorities believe that the beneficial
effects are due in part to the freedom of a low-protein diet from purin
bodies. Many clinicians find there are only a few cases of gout where
a moderate quantity of animal food does harm, and many where it exerts
a beneficial effect. As a matter of fact, the major portion of the human
race will go on eating and drinking and "making merry," according to
their appetites and their ability to gratify them. Still, on the other hand,
the problem is one of the highest human interest, particularly in refer-
ence to the "dietary in disease," and in preventing disease when danger
signals loom in the distance. It is interesting to compare the navy diets
(see Volume II, Chapter XVIII), which are essentially high protein diets,
for the reason that the sailor prefers it, and is more contented and does
better work than when on perhaps a more healthful protein, but for him
less appetizing, diet.
Below we append a standard for a low protein diet :
LOW PROTEIN DIETARY
In the morning upon waking 5 to 10 ounces of hot water containing 10 to 20
grains of sodium bicarbonate or potassium citrate. Half an hour later:
NITROGEN IN DIET 325
Breakfast:
A large plate of fruit and milk or cream, followed by abundant cereal and milk
with bread and butter. No meat, eggs or fish. Wait five hours.
Dinner:
Not more than four ounces of meat or fish, which must be quite fresh; a very
large plate of green vegetables, potatoes sparingly, and nothing more than a
taste of sweets. Five hours later:
Supper:
May be a repetition of breakfast, but succulent vegetables may replace the fruit,
and macaroni or a similar dish may be substituted for the cereal.
Thirst and hunger between meals may be satisfied by water and fruit about one
hour before a meal or during the night.
Abstain from meat juices (gravy and soup), gelatin, coffee, tea, cocoa, salt and
strong condiments, alcohol, pastry.
All starches and meats must be well cooked.
High Protein Diet A high protein diet, according to Voit's standard
from 118 to 120 grams of protein daily, may be of use iii certain condi-
tions during pregnancy, lactation, in convalescing from wasting diseases,
in the beginning of physical training when muscular growth is great, and
in combating certain diseases like tuberculosis, etc. During growth the
protein requirements are higher than in adult life, but, on the other hand,
high protein diets are objectionable for individuals who follow sedentary
occupations, and for all of those conditions benefited by a low protein diet.
When studying the subject of Protein and Nutrition in \ 7 olume II, Chap-
ter IX, we learned the minimum amount of low-protein diets to be 60
grams, and for a high-protein diet, 120 grams; this leaves rather a wide
range, and it is safe to say that the optimum lies between these two. We
do not believe that any standard will ever be definitely fixed that will be
of universal application, but we are inclined to believe that future stand-
ards will be worked out to cover the various classes and normal condi-
tions, as well as in different disturbances of metabolism. To-day the
standards that are being put into practical use for tuberculous patients,
contain 30 per cent of protein above the normal. In nephritis 60 to TO
grams are allowable; in fevers, 70 grams, etc.
Nitrogen-free Diet A nitrogen-free diet can be made from starch,
sugar, salt and almond oil or other fat. This, material can be made pala-
table and baked into a cake, with baking powder for leavening. There is
no very great therapeutic use for a nitrogen-free diet nor is it conceivable
that an individual would be satisfied with it for very long-. Its
principal use seems to be chiefly for experimental purposes, especially
when it is desired to make observations on the metabolism of nitrogen.
326 SCIENTIFIC FEEDING OF NITROGEN FOODS
Lehman observed that when a man consumed a nitrogen-free diet for a
period of three days, he excreted daily 7.4 grams of nitrogen. Reider,
in a similar experiment, found that the average excretion of nitrogen by
the kidneys was 8 . 7 grams and the f eces contained . 9 grams, which was
equivalent to a loss of 56 grams of protein daily. Physiologists have not
yet determined just how much "floating protein," or more correctly
amino-acids, there is in the human organism. It varies daily; but it is
safe to say that all the floating protein could be consumed in a very few
days. If, for any reason, it should be determined to rid the system of
"floating protein," it may be done by giving a comparatively free nitrogen
aliment for a short period of time. This diet may be selected from the
foods given in the table below, showing the percentages of protein in
foods :
PERCENTAGES OF PROTEIN IN PROTEIN-POOR FOODS
Foods containing
0.5 per cent or
less protein
Foods containing
0.5 to 1.0 per cent
protein
Foods containing
1 to 1.5 per cent
protein
Foods containing
more than 2 per
cent protein
Arrowroot starch,
corn starch, sugar,
honey, cottonseed
oil, almond oil.
Manioc starch, ar-
rowroot, sago,
tapioca, apples,
pears, plums,
rhubarb, toma-
toes, cucumbers,
radishes, turnips,
oranges, lemons,
raspberri es,
gooseberries,
strawberries.
Grapes, bananas,
leeks, onions,
cabbage, celery,
squash, parsnips,
cauliflower,
sauerkraut,
horseradish, to-
mato catsup,
butter.
Potatoes, string
beans, artichokes,
lard, thick cream,
fat salt pork, fat
ham, bone mar-
row.
After taking a diet consisting of the foregoing fruits and vegetables
for four days, some bread, rice, oatmeal, milk pudding or soup may be
added to the list. The amount of protein in these foods is as follows:
Beef soup, .4 per cent; meat stew (when meat is taken out), 4.6; oxtail
soup, 4.0 ; chicken broth, 3.6 ; tomato soup, 1.8 ; vegetable soup, 2.8 ; milk,
3.5 ; boiled rice, 2.8 ; boiled oatmeal (thick), 2.8 ; brown bread, 5.5 ; white
bread, 8 or 9 ; zwieback, 9.8 per cent. The return to the ordinary diet,
or one containing at least 55 grams of protein daily, should not be deferred
longer than the eighth day.
Spirits contain no protein. The amount in wine is practically negli-
gible, and an infusion of cereal coffee (1 in 20) contains only 0.2 per cent
PKOTEIN" METABOLISM 327
of protein. The choice of foods is large, and such a diet, while yielding
sufficient energy, would speedily result in a clearance of superfluous pro-
tein materials.
We have learned that cell metabolism is attended by changes of a
destructive nature. Carbon is oxidized, yielding carbon dioxid ; hydrogen
unites w r ith oxygen and forms water. Nitrogen is burned off, but only
partially reduced, urea being the chief product of protein metabolism.
It is formed largely in the liver, but it is very probable that other cellular
organs, such as the spleen and lymphatic glands, participate in its
formation.
RROTEIN METABOLISM
In the study of the Physiology of Enzymes and Hormones as Applied
in the Process of Digestion (Volume I, Chapter VI), we learned that the
protein molecules, on being metabolized in the body, yield varying amounts
of arginin, which ultimately undergoes hydrolysis into ornithin and urea.
In this way it is possible to trace an appreciable part of the nitrogen of
protein to the urea stage through a series of direct cleavages. The protein
in digestion and in catabolism is split into amino-acids, which are even-
tually deaminized, the nitrogen of the amino-group being split off as am-
monia. This, with carbonic acid, forms ammonium carbonate or car-
bamate which is transformed into urea by various organs of the body,
notably by the liver, as stated above.
The important nitrogenous end-products of protein metabolism other
than urea, are ammonium salts, purin bodies and creatinin.
Urea. Protein metabolism has heretofore been considered to be quali-
tatively better, in proportion as a larger percentage of the urinary nitro-
gen is eliminated as urea and a smaller moiety in other forms. This,
however, is not always the case, since this may be largely a matter of the
amounts of protein consumed.
According to Folin, who made a careful and extended study of urines
of healthy men partaking first of a high and then of a low protein diet,
the distribution of nitrogen between urea and other nitrogenous end-prod-
ucts depends very largely upon the absolute amount of nitrogen metab-
olized. He observed a man who was fed on a high protein diet (free
from meat) for one day and at the end of the week was partaking of a
diet composed of starch and cream, which furnished in all about 6 grams
of protein per day. The end-products of his protein metabolism are
shown in the following table from Sherman:
328 SCIENTIFIC FEEDING OF NITROGEN FOODS
END PRODUCTS OF PROTEIN METABOLISM ON BOTH HIGH AND
LOW PROTEIN DIET
Nitrogenous end product's
of protein digestion
On high protein diet
(free from meat)
On low protein diet
(starch and cream)
Grams
Per cent
Grams
Per cent
Total nitrogen
16.8
14.7
0.49
0.18
0.58
0.85
87.5
3.0
1.1
3.6
4.9
3.6
2.2
0.42
0.09
0.60
0.27
61.7
11.3
2.5
17.2
7.3
Urea nitrogen
Ammonia nitrogen
Uric acid nitrogen . ....
Creatinin nitrogen
Undetermined nitrogen
An examination of this table shows there was a marked decrease in
both the absolute and relative amounts of urea, as well as a decrease in
the absolute, but an increase in the relative amount of uric acid excreted,
while the absolute amount of creatinin remained stationary.
Regarding the urea of the circulating blood, Dr. Denis, of the Massa-
chusetts Hospital, l found that the intake of ordinary protein may be in-
creased from the amount sufficient to give from 6 to 8 grams of urea in
the 24-hour urine, to that sufficient to produce a daily urea excretion of
from 30 to 50 grams without producing any material increase in the cir-
culating urea. Until recently, we depended entirely upon the analysis of
the urine to determine the metabolism of any dietary regimen. The toler-
ance of the human economy for carbohydrate food was ascertained by
examination of the secretion from the kidneys for sugar after an ingestion
of varying quantities of this type of foodstuff. The ability of the kid-
neys to excrete the waste products of inorganic salts was likewise ascer-
tained by urinary analysis and the efficiency of the renal functions was
judged on this basis. The more advanced methods for the analysis of
very small quantities of blood so-called micro-analysis has transformed
the seat of observation to the circulating fluid in the vascular system. To-
day blood analysis for clinical purposes is making rapid strides, not only
so far as qualitative tests are concerned, but for quantitative tests. At
the present time, methods for the determination of the sugar content of
the blood are in use; likewise, the estimation for non-protein nitrogen,
urea, creatinin, uric acid, fats and lipoids has been brought within the
scope of a feasible determination on small samples of blood.
Editorial, J. Am. M. Ass., 1917.
PROTETX METABOLISM 329
Ammonia. As previously stated, ammonia is evidently a normal pre-
cursor of urea, being changed into the latter during its passage through
the liver. According to this assumption the elimination of nitrogen as
ammonia may be notably increased at the expense of urea : (a) by the
ingestion of mineral acids, or of food yielding unusual amounts of such
acids by oxidation in the body; (6) in cases yielding an excess of acids in
metabolism, as the acidosis of diabetes, fevers (inanition) and pregnancy;
(c) in structural diseases of the liver (acute yellow atrophy). It will be
seen that the first and second methods increase the ammonia by "fixing"
it as salts, thus preventing its transformation into urea, while the third
diminishes the ability of the system to effect such transformation.
Creatinin. Normal urine contains about 1.5 grams of creatinin per
day. The origin and significance of endogenous creatinin and especially
its physiological relations to creatin (of which it is chemically the anhy-
drid) is still unsettled, despite much clinical research. It seems to depend
on the musculature of the individual. The amount excreted is not gov-
erned by the amount of protein consumed, therefore the percentage of
urinary nitrogen appearing in this form tends to increase as the total
nitrogen diminishes and vice versa. Sherman and Lusk agree with the
above statement, but Folin, after an extended study of the urines of
healthy men partaking first of a high and then a low protein dietary, con-
cluded that the nitrogen excretion depended largely upon the amount of
nitrogen metabolized.
Uric Acid. The former theory as to the production of uric acid in
the body was that it represented protein imperfectly oxidized into urea
and that the uric acid diathesis was a condition of suboxidation in which
the uric acid acted directly as a toxic agent. Of late, researches of physio-
logical chemists have considerably modified this view, and it is now held
that uric acid and allied purin bodies are entirely independent of the
general catabolism of protein matter. It is a product of the final stage
of catabolism of the purin bodies that in Volume I, Chapter III, we have
seen enter into the construction of the nuclein and nucleoproteins. There-
fore, the general clinical conception of the uric acid diathesis might be
better termed "purinemia," Benedict(l).
Purin Bodies SOURCE. Purin bodies are nitrogenous substances con-
structed on the purin framework, C 5 N 4 . They include uric acid, xanthin,
hypoxanthin, adenin and guanin, and closely related are methylxanthin
and theobromin. Fischer has shown the relation of all these bodies to
purin. They contain a central chain of three carbon atoms to which is
attached on each side a urea group, so that they may be regarded as
330 SCIENTIFIC FEEDING OF NITROGEN FOODS
diureids. These bodies arise from nucleoprotein, the components of
which are normal constituents of the nucleus and protoplasm of cells. In
the human economy the nucleoproteins are split into nuclein and protein,
and finally the nucleic acid into purin bodies, pyrimidin bases, phosphoric
acid and sugars. This is the normal order of the metabolic breakdown of
nucleoproteins, and it occurs in some animals as well as in human beings.
As a group the purin bodies are said to raise blood pressure and tend to
produce angiosclerosis and various sclerotic changes in the viscera.
In studying the characters of the proximate principles of foodstuffs
(Volume I, Chapter III), we considered at some length the chemistry of
purins and purin compounds, as also the pyrimidin bases to which the
reader is referred.
CHEMISTRY. Although current text-books on dietetics barely mention
the chemistry of the individual purins, yet we consider them of sufficient
importance to state some of the principal facts which underlie their group
reactions in order to delineate the several phases of nuclein metabolism.
According to Hall (2), the purin compounds crystallize easily, are more
or less soluble in the usual solvents, and can now be oxidized and reduced.
Hypoxanthin yields small crystalline scales with sharpened extremities
almost like grains of wheat. Xanthin may be distinguished by its thin,
flat, glistening rhombic plates, guanin by small prismatic crystals or
amorphous masses, adenin by long needle-shaped prisms, and uric acid
by rhombic plates. Rarer forms have been demonstrated by variations in
the media and rapidity of crystallization.
Their solubilities present the following remarkable differences:
SOLUBILITY OF PURIN COMPOUNDS
Water
Cold
Hot
Hypoxanthin
1:300
1:78
Xanthin
1:13000
1:1300
Adenin
1:1086
Uric Acid Guanin
1:18000 Insoluble
1 :1600
Alkalies
Weak
Acids
Soluble
u
Soluble
u
Spluble
u
Soluble Slightly soluble
Insoluble Soluble
From a synthetic standpoint the purin bodies are exceedingly interest-
ing. About twelve different derivatives of the purin nucleus are known
to exist in nature, but not less than 146 have been produced in the labora-
tory. The closely related caffein and theobromin are largely used as
medicaments for their stimulative and diuretic properties, and it is possi-
ble that in the near future these may be made synthetically. Trichlor
purin, obtained by the action of phosphorus chlorid upon uric acid, occu-
pies a position midway between iiric acid and the methylxanthins, caffein,
PKOTEIN METABOLISM 331
theobromin and theophylin. Emil Fischer, in his lucid and interesting
address given in Stockholm in November, 1902, after the distribution of
the Nobel prize, draws a picture of the time when the present coffee
adulterants chicory and coffee surrogate will be superseded by syn-
thetically made caffeiii, and suggests a period when coffee beans and their
roasting will be unnecessary, since the solution of a small powder in hot
water will give a well flavored, refreshing drink at a much lower cost and
with much less trouble than the present conditions necessitate.
OCCURRENCE IN THE BODY. Purin bodies exist ready formed in
many of our foods, especially those in the animal kingdom; but on the
other hand, the system can produce its own nuclein and the hi ^her com-
pounds of nuclein on a diet free from purins, though, of course, containing
proteins. Further, the elimination of purins is somewhat increased by
increasing the intake of proteins, about half of the elimination of purins
on an ordinary mixed diet being accounted for by the ingestion of more
or less combined purins, and about half by the metabolism of nuclein-
containing structures, such as white blood cells and the cells of viscera,
namely, the kidneys, liver, pancreas, spleen and thymus. The old theory
that no purin bodies are formed except from purins is false, while the
older view that uric acid is a precursor of urea is true in a limited sense
only. Lusk, referring to the successive steps in purin metabolism, states
that deamination is brought about through the action of specific enzymes
as follows: "Summarizing these results, it may be said that nucleic acid
may be broken up by nuclease, a ferment found in all tissue. On the lib-
eration of the purin bases, guanin and adenin are deaminized by guauase
and adenase wherever these enzymes are found. Oxidizing enzymes, the
xanthin oxidases, now convert hypoxanthin and xanthin into uric acid,
while a uricolytic ferment of varying potency in different tissues in dif-
ferent animals may break up and destroy the uric acid."
Purins occur in both animal and vegetable nitrogenous bodies, in
greater abundance in the former and obviously in still greater abundance
in glandular viscera and white blood cells than in muscle and connective
tissues, on account of the relative preponderance of nuclei, while vege-
table nuclein occurs richly in yeast cells. The purins which are con-
sumed with the food are termed exogenous purins, and those excreted by
a healthy normal individual independent of his food the result of the
metabolism of his own tissues endogenous purins.
The daily "wear and tear" on metabolism of cell constituents leads to
the production of a certain amount of purin bodies. These substances con-
stitute the "endogenous" purins of the excreta. When tissues containing
332 SCIENTIFIC FEEDING OF NITROGEN FOODS
nucleins or free purins are eaten, the "endogenous" purins of the food
ingested become "exogenous" to the system which absorbs them. As "en-
dogenous" purins are practically waste products on their way to excretion,
when they become "exogenous" to another organism they have little nutri-
tive value and demand early and rapid elimination. This is generally
effected by deaminization of guanin and adenin and the oxidation of the
oxypurins, hypoxanthin and xanthin to uric acid, and then the purin ring
or chain in the uric acid is in the system, probably chiefly in the liver,
partially split off and a portion of the uric acid excreted as urea. The
course followed in the case of the nucleins is not quite clear, as a smaller
percentage appears in the urine as uric acid.
The amount of purins excreted in the urine due to endogenous forma-
tion may be estimated after taking a purin-free diet for a few days, and
the amount varies from 0.1 to 0.2 grams per day (3). The exogenous
purins are principally transformed in the body, 50 per cent being ex-
creted as urea and the remaining portion being eliminated by the kidneys
as' uric acid with some xanthin and hypoxanthin.
We can apply the term "free-purins" to purin bodies, and "bound-
purins" to the purins of nucleic acid, nuclein and nucleoproteins. The
process of purin formation goes on throughout life as a part of the cell
metabolism, but the transformation of purin, likewise, goes on constantly.
A number of enzymes cooperate in the transformation of purin-containing
materials, for instance, nucleases liberate guanin and adenin from nucleic
acid, these aminopurins being converted by the enzymes guanase and
adenase into xanthin and hypoxanthin respectively, and oxidases trans-
form hypoxanthin to xanthin and then to uric acid. The latter is finally
to a certain extent decomposed and destroyed by uricolytic enzymes of
varying potency present in the various organs.
Hypoxanthin and xanthin are often obtained as products of decompo-
sition of nucleic acid, but are generally formed by the deaminization and
oxidation of guanin and adenin.
It is now generally conceded that certain purin bodies are constantly
being produced wherever cellular processes are in active operation, and
although normally these are largely converted into other materials which
are more easily excreted, practically all nitrogenous animal foods contain
some of them. Lean meat, the flesh of mammals, birds and fish, contains
xanthin, hypoxanthin and uric acid, besides urea, creatin, creatinin and
other extractives. Liver is rich in nuclein, xanthin, hypoxanthin, urio
acid, urea and other nitrogenous extractives. Spleen (milt) also is rich
in nuclein, xanthin, hypoxanthin, uric acid, as well as lecithin, creatinin,
PKOTE1N METABOLISM 333
leucin and tyrosin. Thymus (chest sweetbread) contains nuclein, xanthin,
hypoxanthin, guanin and adenin in large amounts. Pancreas (belly
sweetbread) contains the same kinds of purins, besides leucin, tyrosin and
other amino-acids. Kidneys contain uric acid, xanthin, hypoxanthin, as
also urea, tuarin, leucin, creatin, creatinin, etc. Beef-tea, soup and gravy
contain the same kinds of purins and extractives as the substances from
which they are derived. Vegetable foods, especially seeds, contain nucleo-
proteins, nuclein, nucleic acid, and purin bodies, with amino-acids, such
as asparagin, leucin, tyrosin, etc. Tea, coffee and kola contain caffein
or trimethyl-xanthin that is, xanthin with three methyl groups in its
molecule; cocoa contains theobromin or dimethyl-xanthin ; and guarana
contains both caffein and theobromin.
As already stated, according to Burian, all of the exogenous purins
are not excreted; a small fraction remains in the organism or becomes
entirely disintegrated by the oxidases of the various organs. Therefore,
on ordinary diets, while the excretion of purin is necessarily increased by
the exogenous or food purin, not all that is ingested is eliminated as such.
The amount of exogenous purin excreted in the urine is scarcely influenced
by the individuality of the subject, usually the purin excretion in normal
individuals being practically the same ; but it must be borne in mind that
its excretion is largely influenced by certain foods. For instance, in beef
and veal, the purin content is 0,16; calf's liver, 0.12; calf's spleen, 0.16;
calf's thymus, 0.4, and in coffee, 0.2 per cent. When these organs are
largely partaken of or eaten alone, they lead to excretion of exogenous
purin in the following proportions : beef and veal, 0.03 ; liver, 0.06 ;
spleen, 0.8; thymus, 0.1; coffee, 0.075. Burian and Schurr as a result
of their researches conclude that with the identical kind and same pro-
portion of food the exogenous purin in the urine is virtually the same
in all persons. According to Walker Hall, there is no personal equation
in this metabolic process. It is known, however, that all purins in the
food are not absorbed. There is a normal daily excretion of purin bodies
in the feces referred to as fecal purin, to distinguish it from that ex-
creted by the kidneys called urinary purin. Of course, the amount of
fecal purin varies with the kind of food, and is greater where substances
are eaten which are rich in nuclein and purin derivatives. Ordinarily,
60 per cent of the purin bodies are absorbed and 40 per cent excreted
with the feces.
PURIN BODIES IN FOOD. The chief fluctuation in the amount of
nric acid in the urine can be explained by variations in the amount of uric
acid yielders (purins) contained in the food. The endogenous fraction,
334 SCIENTIFIC FEEDING OF NITKOGEN FOODS
on the other hand, seems to be thoroughly fixed, but as to its exact seat
and mode of formation and the precise conditions which control it, we still
have much to learn. It is obvious that we have at hand an important
means of regulating the amount of uric acid liberated in the body, namely
by controlling the amount of purins in the dietary. As stated, the foods
which yield much uric acid are the cellular organs of animals. We have,
then, a clear dietetic indication if we wish to lessen the liberation of uric
acid in the body. The diet recommended is one composed largely of
vegetables with the exception of oatmeal, beans, peas, onions and asparagus.
Below we append a table from Tibbies (4) of the various foodstuffs,
showing the percentage of purins contained, which are to be tabooed if
we wish to lessen the manufacture of uric acid in a patient.
THE QUANTITY OF PURINS IN FOOD
VAKIETIES OF FOOD
Purins, grains
per pound
Percentage
of purins
Codfish 4.07
Plaice 5.56
Halibut 7.14
Salmon 8.15
Tripe 4.00
Mutton 6.75
Veal: Loin 8.14
Pork: Loin 8.49
Neck 3.97
Ham (fat) 8.08
Beef: Ribs 7.96
Sirloin 9.13
Steak 14.45
Liver 19.26
Sweetbread 70.43
Chicken 9.06
Turkey 8.82
Rabbit 6.31
Oatmeal 3.45
Peameal 2.54
Haricot beans 4.16
Potatoes .14
Onions .26
Asparagus 1.50
Lager beer 1.09
Pale ale 1.27
Porter 1.35
.058
.079
.102
.116
.057
.096
.116
.121
.056
.115
.113
.130
.206
.275
1.006
.129
.126
.097
.053
.039
.063
.002
.009
.021
.012
.014
.015
EFFECT OF PURIN FOODS ON URIC ACID. The effect of purin
foods on the uric acid content of the blood has recently been studied at
length by W. Denis (5), who concludes that "in normal individuals no
PROTEIN METABOLISM 335
increase in the circulating uric acid is produced by the ingestion of even
large quantities of purins. The ingestion of purins, either free as they
occur in meats, or in the form of nucleoproteins of glandular tissues like
liver, sweetbread, etc.," is followed by a decided increase in the urinary
output of uric acid. Denis concludes that the normal kidney reacts to an
excess of uric acid in a way essentially similar to that which it conducts
itself to an excess of urea, and is able to excrete the excess of uric acid
presented to it when a diet high in purins is fed, thereby keeping the cir-
culating uric acid at the same level as that obtained when only endogenous
uric acid is to be excreted. When the kidney has been damaged, even
before certain damage has reached the point where nitrogen retention is
apparent, as shown by the non-protein nitrogen values, an accumulation
of uric acid takes place in the blood after a short period of purin feeding.
This phenomenon is interesting, not alone from the evidence that it brings
of the importance of the renal efficiency for the level at which uric acid
circulates in the blood, but also for its value to diagnostic procedures.
Denis suggests that when the determination of uric acid in the blood is
undertaken for diagnostic purposes, the insistence for a short period of
purin-free foods is unnecessary, except in cases in which kidney insuf-
ficiency exists, or perhaps in the case of persons who habitually consume
extremely large quantities of foods of a high purin content.
There are two views as to the origin of uric acid: (a) that it is formed
in the kidneys; (6) that it is formed in the tissues. The view that uric
acid is formed in the kidneys as well as excreted by them was taught by
Garrod as early as 1848, who was able to show that the blood of gouty
persons contained abnormal quantities of uric acid, which observation has
since boon confirmed by many observers.
FACKSS OF TURIN DIET. The continuous consumption of food con-
taining purin bodies in large percentage ultimately leads to their accumu-
lation and retention in the organism, when renal insufficiency supervenes.
The normal liver can transform and the kidneys can excrete purin bodies
so long as these organs are executing their normal functions, and no
accumulation will result, but there is always danger that the constant irri-
tation of the kidneys by the excess of purin, more especially uric acid,
may result in chronic nephritis of the gouty type. Renal insufficiency,
with the retention of purins in the system, it is thought, may be the cause
of gout, but its etiological relation to so-called rheumatic gout, uric acid
gravel, uric acidemia, migraine, neuralgia, sciatica, epilepsy, vascular dis-
eases and many other conditions of ill health in which it has been put forth
as a causative factor, is very doubtful.
336 SCIENTIFIC FEEDING OF NITROGEN FOODS
PURIN-FREE DIET. Purin-free diet is indicated in gout and wherever
it is desirable to reduce renal irritation. The foods enumerated in the table
on page 334 should be interdicted and the following foods, which contain
practically no purin, advised: milk, cheese, cream, butter, eggs, white
bread, macaroni, rice, sago, tapioca, cabbage, cauliflower, lettuce, water-
cress, fruit, sugar, honey, marmalade, jam, jelly, sherry, port, volnay. and
claret. Four articles of diet milk, butter, eggs and cheese form
together our most valuable means of withholding purin substances from the
body and yet allowing the intake of a diet at once digestible, easily ab-
sorbed and capable of maintaining nitrogenous equilibrium. It is a milk
and fruit diet with bread and butter, milk puddings and salads added to
it. Milk and milk products contain only traces of purin. Potatoes and
onions contain very little, and are allowed. Oatmeal, peameal and malted
lentils contain from 2l/> to 3^/2 grains of purins per pound, and should
not be allowed. Asparagus contains very little purin, but much asparagin,
which is a valuable protein-sparer. The following articles should be alto-
gether forbidden : tea, coffee, cocoa, kola, guarana, fish, fowl and butcher's
meat, brown bread, peas, beans, asparagus, ale, stout and lager beer.
Cider, perry and a small quantity of spirits, claret, sherry or volnay, may
also be allowed. Wines do not appear to contain any purin bodies and
their harmful properties in gout must be due to some other constituent.
The purin bodies in coffee, tea and chocolate are largely methyl-purin,
and do not undergo the same metabolic changes as other purins, so they
need not be excluded from the diet of the gouty or rheumatic as rigorously
as other purins.
Dr. Alexander Haig is authority for the following purin-free diet,
which yields about 90 grams of protein, enough to meet the daily re-
quirement :
PURIN-FREE DIET TO SUPPLY PROTEIN
12 ounces of white bread contain 372 grains 25 grams
4 " oatmeal " " 208 " 14
2 " " rice " 86 " 5.6 "
3 pints of milk " 572 " 38.1 "
16 ounces of vegetables and fruit contain 140 " 9.3 "
LOW-PURIN DIET. A low-purin diet consists of the same articles of
food mentioned in the purin-free diet, with the following additions : tripe,
codfish, potatoes, onions and particularly all fruits and green vegetables.
Puddings may be made of milk, sugar, eggs, rice, sago, tapioca and maca-
roni or flour, and custard, junkets, jellies and suet may be used.
PROTEIN METABOLISM 337
One of Haig's disciples suggests the following for purin-f ree meals :
FIRST DAY
Lunch:
Green vegetables, baked potatoes, butter, stewed figs, ^ pint of junket, 2 ounces
of pine nut kernels (grated), with whipped cream.
Dinner:
Biscuits and butter, 1 ounce of grated cheese or some milk curds, light pudding,
stewed fruit and cream.
SECOND DAY
Lunch:
Green vegetables, potatoes with butter, cheese sauce and dry toast, fruit tart
with cream, ^ pint of milk.
Dinner:
Two boiled eggs, biscuits and butter, milk pudding containing ^ pint of milk,
stewed fruit and cream with biscuits.
THIRD DAY
Lunch:
Potatoes and butter, green vegetables or salad, pudding or "cutlet" made of two
ounces of ground nuts, stewed fruit and cream with biscuits.
Dinner:
Biscuits and butter, with cheese souffle* or omelette, stewed fruit and cream with
biscuits, roasted chestnuts.
It must be realized that a purin-free diet is only a temporary measure.
A purin-free diet is at best only a low protein diet, and the physician
must see that the proteins consumed do not fall below 60 or 70 grams
per day. This diet should not be continued longer than two or three
months before fish, tripe, pork and ham are allowed. Part of the
meat bases and purins will be washed out during the boiling of these
foods. It is claimed by some dietitians that the first meat allowed should
be sweetbread, because the purins in it are "bound-purins." Equally
competent observers, Walker Hall, Burian and Schurr, and Tibbies, do not
favor the allowance of sweetbread for the reason that, on analysis, it shows
a very high percentage of purins. These observers find that from 60 to
70 per cent of those purins are absorbed and, at the most, only 40 per cent
escape absorption. It is advisable, when an ordinary diet is resumed, to
make additions gradually. First allow boiled leg or loin of mutton, boiled
rabbit or boiled fowl, as the breast of fowl contains less extractives than
the other portions. The physician can conservatively allow pigeon, breast
of turkey or other fowl, well roasted rib of beef, sirloin of beef and steak,
the latter being added last. The following articles of food should be per-
manently excluded : veal, pork, except the neck, goose, duck, high game
and greasy foods. The question has been asked : "Is a purin-free or a low-
purin dietary useful in the treatment of gout ?" Most certainly it is. If
338 SCIENTIFIC FEEDING OF NITKOGEN FOODS
gout be due to the defective metabolism of nuclein or accumulation of
purin bodies from renal insufficiency, these substances should certainly
be excluded from the diet until the organism recovers its powers of elimi-
nating them. The diet doubtless has its limitations. It is not a panacea,
and in gout its use is limited by the nature of the disease.
Fat-free Diet. A fat-free diet is of value in hypochlorhydria, catarrh,
atony and dilatation of the stomach and in carcinoma of the stomach.
For some time it has been known that the presence of an excess of fat,
particularly of butter, in. the contents of the stomach, will check the secre-
tion of gastric juice, and advantage has been taken of this fact in the
treatment of hypochlorhydria. On this account, the absence of fat from
food allows a more generous secretion of gastric juice, including hydro-
chloric acid. In various disorders of the stomach, a condition of hypo-
chlorhydria exists, where the normal proportion of hydrochloric acid is
absent, in consequence of which the mucous membrane of the stomach may
become infected by microorganisms, which give rise to catarrh, organic
acidity, atony of the muscular coat, and dilatation. In carcinomatous
conditions of the stomach, near the pylorus, there is likewise a diminu-
tion of free hydrochloric acid, and some authorities consider the cachexia
produced by this disease a consequence of the subnutrition resulting from
hypochlorhydria. It is argued that the elimination of fat from the di-
etary encourages a freer secretion of gastric juice with a larger propor-
tion of free hydrochloric acid, and the normal (nascent) hydrochloric
acid comes into direct contact with the crypts of the mucous membrane,
which it slowly but effectively disinfects, and at the same time gives tone
to the muscular coat. A fat-free diet is of value in such conditions. On
the opposite page we give a table of fat-free foods, foods containing 0.5
per cent, foods containing less than 1 per cent of fats, and foods with 1 to
2 per cent of fat.
It is practically impossible to provide an absolutely fat-free diet.
However, we can get near enough to a fat-free diet by removing as much
fat as possible from the meat and milk and avoiding the use of butter,
suet and other fats and oils. The table will serve as a guide to the phy-
sician or dietitian in directing a practically fat-free diet which would
consist largely of bread, marmalade, white of eggs, meat extracts, soups,
broths, oysters, light fish, lean meat and the breast of fowl, potatoes,
vegetables and fruits.
Carbohydrate-free Diet. A carbohydrate-free diet is one practically
consisting of meat, green vegetables and hot water. A diet free from
starch, sugar and other carbohydrates is recommended in the treatment
PROTEIN METABOLISM
PERCENTAGES OF FAT IN FOODS
339
Fat-free Foods
Foods containing 0.5
per cent or less
Foods containing less
than 1 per cent of fat
Foods with 1 to 2
per cent of fat
Sugar
Skim milk
Fine white flour
Sole, plaice
Honey
Casein powders
White bread
Smelt
Treacle
Sugar, pears
Ryemeal
Sturgeon
Starch
Corn-starch
Rye bread
Weakfish
Dextrin
Arrowroot, sago
Beef tea
Skate
Beef tea
Apples, tapioca
Meat extracts
Bluefish
Meat extracts
Green peas
Beef broth
Blackfish
Casein preparations
String beans
Meat stews when
Kingfish
Potatoes, Litchi nuts
skimmed
Venison
Parsnips, muskmelons
Tomato soup
Partridge
'
Carrots, turnips
Oxtail soup
Breast of boiled fowl
Radishes,watermelon.s
Mulligatawny soup
Wheat
Beetroot, salsify
Pea soup, Gumbo soup
Brown bread
Scorzonera
Turtle, frog's legs
Wholemeal bread
*
Cabbage, plums
Oysters, clams
Buckwheat flour
Cauliflower
Scallops
Macaroni
Brussels sprouts
Crab, Crayfish
Vermicelli
Spinach, currants
Shrimps
Haricot
Vegetable marrow
Fish:
Navy beans
Squash, lettuce
Bass, cod
Dried peas
Asparagus, oranges
Cusk, flounder
Frijoles
Tomatoes, peaches
Haddock, hake
Green corn
Mushrooms, truffles
Yellow perch
Grapes
Onions, melons
Perch-pike
Bananas
Leeks, cucumbers
Gray pike
Celery, rhubarb
Pickerel-pike
Strawberries
Pollock
Raspberries
Red grouper
Gooseberries
Red snapper
White of eggs
.
of certain gastric ailments, rheumatism, gout, diabetes and uric acidemia.
Dr. Salisbury first recommended this form of diet, and according to his
directions it consists of from two to four pounds of beef freed from fat,
gristle, connective tissue and bone. It is chopped very fine, made into
patties about three inches in diameter and one inch thick, and fried in
a pan without fat or water. These are heated rapidly on one side and
then on the other to coagulate the albumin, after which the process of
cooking is allowed to proceed very slowly, and they are served while
slightly underdone. (See Volume II, Chapter XII.)
Cellulose Diet The cellulose diet furnishes nutritive subsistence for
the lower animals, the herbivora being able to digest from 60 to 70 per
cent of the crude fiber of dried grasses (hay) and cereals ; 47 to 62 per
cent of that in carrots, cabbage and celery, and 25 per cent of that in
840 SCIENTIFIC FEEDING OF NITROGEN FOODS
lettuce. It is within the bounds of probability that primitive man pos-
sessed this faculty in common with herbivorous animals. It is stated by
competent authority that at the present day some of the existing primitive
races, the Bushman, Nilotic negro, and others, possess a very large cecuin,
and that their colon secretes an enzyme which dissolves the outer covering
of vegetable cells, and the fluid from the vermiform appendix digests
cellulose. The civilized races of mankind have lost the power of digesting
cellulose material. Bunge is authority for the assertion that "the epi-
thelium of the colon secretes an enzyme which has a slight action on the
cellulose coverings of cells"; notwithstanding, he practically agrees with
the majority of clinicians that putrefaction is practically the only change
which cellulose, or crude fiber, undergoes in the intestines of man, and
that its principal and only use in the human economy is a mechanical
stimulus to peristalsis. Cellulose undoubtedly possesses irritating quali-
ties which it is necessary to minimize in cases of chronic gastric and in-
testinal catarrh, ulcer of the stomach, cancer or stricture of the
pylorus. Physiologists tell us that the presence of cellulose acts as a
stimulant, and as a result the food is hurried along in the alimentary
canal more rapidly than when this substance is absent. This irritating
effect is desirable in cases of atony of the intestinal canal, and advantage
should be taken of it in prescribing, while the conclusion to be drawn
from the observations of Bunge and others is that the advantages arising
from the presence of cellulose in the food of the average individual will
far outweigh its disadvantages.
Von Noorden prescribes a whole-meal Graham bread, all sorts of
legumes, including the skins, coarse oatmeal and vegetables containing a
high percentages of cellulose, fruits having thick skins and large quantities
of butter, bacon and ham. In cases of chronic constipation, and especially
those complicated with mucous colitis, he claims that this diet permanently
cures 50 per cent of all cases and that 28 per cent are probably improved
or partially cured.
The following foods contain considerable cellulose and are recom-
mended as adjuvants to the diet for the relief of chronic constipation:
wholemeal bread of any description, eaten with plenty of butter, fat ham,
bacon, treacle or marmalade ; fat meat, bacon or ham for dinner, with a
large proportion of dried peas, cabbage, savoy, lentils, Brussels sprouts,
cauliflower, one or two eggs daily, poached, buttered or scrambled in pref-
erence; turnips, parsnips, onions, okra, swedes, scorzonera and leeks.
Dessert should consist of raw or cooked fruit, pears, strawberries, cur-
rants, apples, grapes, raspberries, gooseberries, loganberries, blackberries,
MINERAL METABOLISM 341
whortleberries and cranberries. Plenty of cream should be taken with
cooked fruit. Sugar is allowed. Apples, apricots, plums, peaches and
acid fruits in general also stimulate peristalsis by means of their organic
acids. Oatmeal is of great value. The coarse meal is the best form, but
oat-cakes and groats may also be eaten. Barley bread, pearly barley,
buckwheat cakes and rye bread are useful.
MINERAL METABOLISM
The salt metabolism of disease is a most important subject. Few
studies of the balances of the various salts in disease have as yet been
made at the hands of biochemists, but the therapy of the future will un-
doubtedly include the practical application of salt metabolism to the prin-
ciples of nutrition. Wellman, who has given some thought to this sub-
ject, finds that there was a greater loss of salts in fasting than was
accounted for by the metabolism of the fleshy portion of the body. The
principal loss was phosphorus pentoxid and calcium and magnesium oxids,
in about the same proportion as contained in bone; and the skeletons of
animals were found to have actually lost from 6 to 7" per cent of their
weight. In many diseased conditions, there was present a lowered
calcium excretion; for instance, in pleurisy with effusion, pneumonia,
delirium tremens, and in typhoid and malarial fevers. Senator, in writ-
ing on this subject, said that there was in pulmonary tuberculosis an excess
of calcium excretion. In osteomalacia the calcium balance is also dis-
turbed, more being excreted than is taken into the body. The calcium
excretion is lessened by phosphoric acid, which fact might be of use in
experimental therapeutics. It is said that castration restores the CaO
equilibrium, which also influences the restoration of sulphur equilibrium.
In myostitis ossificans, on the other hand, the calcium output is less than
normal. In arthritis deformans there is a retention of lime salts. Also
in endarteritis the excretion of calcium is hindered and one observer even
claims to have obtained good results by the administration of salts, viz.,
lactic acid, sodium lactate, sodium citrate, sodium carbonate and sodium
chlorid, which, according to his contention, aid in the excretion of calcium.
It is probably unsafe to assume that a diet containing sufficient protein
and energy necessarily furnishes sufficient calcium and other salts for the
metabolism of the body. This point can only be settled by metabolism
experiments in which a balance is made between the intake and the output.
The most recent investigation and thorough research into this subject has
been made by Sherman, Mettler and Sinclair(G). Space forbids an
122
342 SCIENTIFIC FEEDING OF NITEOGEN FOODS
extended review of their interesting experiment, but the table below *
shows the average amount of. calcium, magnesium, phosphorus and iron
consumed daily in the various dietaries.
THE MINERALS IN TYPICAL DIETARIES: DAILY QUANTITIES PER MAN
SUBJECTS OF THE STUDY
Fuel
Value
(Calo-
ries)
Protein
(Gms.)
Iron
(Fe)
(Gms.)
Phos-
phoric
acid
(Gms.)
Cal-
cium
oxid
(Gms.)
Mag-
nesium
oxid
(Gms.)
Maine lumbermen. . ...
6,780
179
.035
5.88
1.27
1.21
School superintendent's family,
Chicago..
3,260
123
.021
3.97
1.09
.55
Students' Club, University of Ten-
nessee
3,595
123
.019
4.05
1.22
.63
Decorator's family, Pittsburgh. . . .
Farmer's family, Connecticut
3,305
3,545
112
108
.019
.021
3.44
3.53
.90
1.15
.48
.55
Teacher's family, Indiana
2,780
106
.016
3.64
1.42
.44
Teacher's family, New York City .
Mechanic's family, Tennessee
Farmer's and mechanic's families,
Tennessee
3,180
4,060
2,820
102
97
95
.017
.017
.019
3.92
3.58
3.56
1.69
.90
.83
.54
.72
.59
Glass-blower's family, Pittsburgh.
Lawyer's family, Pittsburgh
3,085
3,280
94
91
.016
.015
2.73
2.82
.49
.83
.36
.40
Women Students' Club, Ohio
Lawyer's family, New York City..
Laborer's family, Pittsburgh
3,330
2,325
2,525
85
84
83
.015
.014
.013
2.88
2.41
2.40
.97
.47
.50
.67
.30
.34
Negro family, Alabama
4,955
80
.012
3.25
.21
.74
Laborer's family, Pittsburgh
2,440
77
.012
1.52
.40
.19
Laborer's family, New York City..
Farm Students' Club, Tennessee. .
Sewing-woman's family, New York
City. .
2,430
3,560
1,500
71
66
54
.012
.011
.009
2.27
2.08
1.84
.50
.46
.68
.29
.34
.23
Very poor negro family, Alabama .
2,240
44
.007
2.05
.08
.52
Tachau(7), who has done much experimental work in salt metabolism,
holds that the catabolism of easily burned carbohydrates often furnishes
too much heat. Then, unless the "windows are opened, the house may get
too warm," or they may, in too large quantities, be incompletely burned
and thereby produce substances which will seriously interfere with the
protoplasm (cellular) chemical processes (cellular asphyxia). The split
products of both fats and carbohydrates may indeed menace the body, and
the lack or overabundance of the mineral salts may surely tend to change
the reactions of the living cells.
If the results of experiments are correctly interpreted, we find that
i From Bull. 227, Exp. Sta., U. S. Dept. Agric.
MINEKAL METABOLISM 343
the "living organism may be regarded as a highly unstable chemical sys-
tem which tends to increase itself continuously under the average of the
conditions to which it is subject; it undergoes disintegration as a result
of any variation from this average" (8). With the lights before us, there
is no reason to charge any harmful results to starch itself. "It is only
when ingested in excessive amounts for. long periods of time that harm
results, and this is due not so much to the starch as to the attendant depri-
vation of other foodstuffs, protein, hydrocarbons and organic mineral
matter" (9). If an animal is allowed a liberal, well-balanced dietary, con-
sisting of protein, fats, carbohydrates and water with no organic mineral
salts, it will die more quickly than if it received no food at all (10). For
this reason, the importance of salts has been extensively dwelt upon (see
Volume J, Chapter IX, Volume II, Chapter VIII) by various workers,
but no one has shown in simpler way, or a more convincing form, the
reasons for the value of salts in the economy than Fischer (11). "The
great importance of the organic mineral salts in the human organism is
due to their effects upon the physical condition of the proteins of the
body. It is true they furnish practically no energy and yet are essential."
Schaefer(12) has said that "the chemistry and physics of the living
organism are essentially the chemistry and physics of the nitrogenous
colloids," and Guyer(13) voiced the opinion that what we call protoplasm
is really an aggregate of colloids, holding water for the most part, in
which are contained certain salts and non-electrolytes.
Electrolytic Properties of Salts. Water forms a large percentage of the
substance of the cell, and is essential for its existence as providing the
medium wherein those chemical processes which constitute metabolism
take place. This medium is a dilute solution of sodium chlorid in which
the molecule of the salt has become dissociated into its free constituents
or ions sodium and chlorin. These, charged respectively with negative
and positive electricity, are what are termed cath-ions and an-ions.
These ions act as independent particles and by means of their powers
of electric attraction and repulsion are the forces which directly cause
bodily chemical changes. The presence of salts in the .cells and their con-
dition of dissociation or ionization are matters of great practical interest,
because, in the first place, as regards the very ordinary salts, the phe-
nomena of endosmosis and exosmosis are largely due to their presence in
the cell, and also because the protein molecules only manifest their activity
in a dilute saline solution under the conditions of ionization therein.
These salts, it seems, are of inestimable value, because they change the
affinity of the protoplasm for water, so that at one time when there is
344 SCIENTIFIC FEEDING OF NITROGEN FOODS
relative lack of salts the protoplasm loses water and at another time it
absorbs water and with it food materials. Without doubt, the salts of the
foods are the agents which control to a large extent the secretion and
absorption, but it must not be forgotten that the formation of salts enters
into the regulation of neutrality in the body; but that is only a part of
the problem of secretion and absorption, which was fully considered in
Volume I, Chapters VI and VII.
Sodium Chlorid. The importance of sodium chlorid in the diet was
considered in Volume I, Chapter XI, where we learned that it "protects
protein substances from disassimilation," i.e., it produces assimilation,
and its use from this viewpoint is economical. The sodium chlorid con-
tent of the body is of great importance and what might be termed sodium
chlorid equilibrium is maintained. In normal individuals, if sodium
chlorid is partaken of too liberally, there is an increase in the elimination,
and if the amount is partaken of sparingly there is a diminution in the
output; but a certain amount, about 2 grams per day, must be partaken
of to make up for the daily loss. Bunge considers the presence of sodium
chlorid essential to prevent the toxic effects of potassium. There is no
question but that it plays an important part in the nutritive exchange
between the cells and the plasma and stimulates the excretion of waste
products by the kidneys. Exclusion of common salt from the food leads
to dehydration of the tissues, and this is the basis of the salt-free dietary.
Salt is found in varying quantities in all foodstuffs,, and the daily require-
ment is from 15 to 20 grams. The presence of an abnormal amount of
sodium chlorid in the blood and tissues is one of the causes of edema.
The amount of salt consumption per capita per diem for the Ameri-
can people is more or less an unsettled question, since medical literature
contains no statistics on the question. According to Archard the average
consumption of salt by the French people is 300 grains per day.
According to United States Army regulations, the allowance for the
soldier is about 300 grains daily, which is practically a large heaping table-
spoonful. We may, therefore, take the soldier's allowance as a criterion
for the amount used by the American people. Physiologists tell us that
95 per cent of the salt ingested is eliminated unchanged within 24 hours.
Then, of the 300 grains consumed daily by the average American, 285
grains are excreted and cast out of the body as foreign material as rapidly
as the organs of excretion can accomplish the task. Can this large excre-
tion of salt be carried on daily for years with impunity ? The history of
salt-using nations leads us to ask the question : If something is transpiring
that may make them the unhealthiest animals in existence, since daily
MINERAL METABOLISM 345
repeated exhaustion of glandular organs by exosmosis tends to, logically,
and practically does produce the very condition of glandular torpidity that
afflicts mankind ?
The retention of sodium chlorid in the tissues is due to one of the
following causes: (a) the kidneys may be unable to excrete it, or (6) it
forms chemical combination with the cells. According to some authorities,
this combination occurs in the preliminary stages of edema when the cells
become saturated with water and the chlorid begins to accumulate in the
surrounding fluids. Whether this explanation is satisfactory or not, this
much is known. Marie argues that, when water is retained in the tissues,
it requires the presence of sodium chlorid to balance the osmotic pressure
of the salt in the blood (see Volume I, Chapter VII, Osmosis and Diffu-
sion ). The greater the amount of water retained in the tissues the more
sodium chlorid will be accumulated therein, and the less will be excreted
by the kidneys. In Bright's disease, for instance, where the kidneys are
unable to excrete salt even when diuresis has been established, it has be-
come the custom of clinicians to reduce the intake of common salt with a
view of relieving the kidneys of the extra work of excreting it. The indica-
tion, then, for a salt-free diet is where there is failure of compensation
characterized by diminution in the excretion of water. The diseased con-
ditions in which it has been found beneficial and practical to withhold
sodium chlorid are dropsy from cardiac, renal or hepatic diseases, obesity,
diabetes insipidus and epilepsy. A salt-free diet is also useful in chronic
parenchymatous nephritis with edema or dropsy, and granular kidney
when there is a failure of compensation.
SALT-FREE DIET. In selecting foods for salt-free diet, it is unneces-
sary that it should be absolutely salt-free, besides it is almost impossible
to prepare food quite free from it. The table on page 346 shows the per-
centage of sodium chlorid in raw and cooked foods, taken largely from an
article by H. Strauss (14) on the best method of reducing the amount of
salt in the diet :
In selecting articles of food for a rigid salt-free diet, an attempt
should be made to keep the amount of sodium chlorid down to between l 1 /^
to 2 grams per day, which will mean the exclusion or reduction of the
allowance of meat, fish and meat broths. According to Tibbies (4) :
The proteins should be derived from milk, eggs, chicken cooked without salt,
tripe, fresh-water fish, cheese made without salt, and bread made without salt.
Milk can be taken alone or with eggs, in the form of custard, in puddings with
rice, sago, oatmeal, etc. Eggs can be taken in many ways without the addition of
salt e.g., custards, milk puddings, poached eggs, boiled eggs, omelettes; the latter
346 SCIENTIFIC FEEDING OF NITROGEN FOODS
can be seasoned with sugar instead of salt. Eggs can also be taken in "cream,"
souffles and sauces. Jellies made of gelatin or isinglass and meat jelly are permis-
sible. The fats should be derived from milk, eggs, unsalted butter, fat meat eaten
without salt, cheese made without salt, cream cheese and salad-oil. Carbohydrates
may be obtained from sugar, treacle, golden sirup, jam, marmalade, bread made
without salt, milk puddings without butter, blane mange, jelly, milk sauces, fruit
and vegetables. Bread and pastry made without salt are not unpleasant when
eaten with stewed fruit, jam, marmalade and unsahed butter. Vegetables should
be allowed ad libitum, because they can be made the vehicle of flour and fat in the
form of "white sauce." It is recommended that all vegetables should be cooked in
plenty of water, with a minimum of salt, thereby reducing the proportion of in-
organic constituents. No salt must be used when cooking or eating the food, except
the small amount absolutely necessary to give flavor to potatoes, cabbages and
other green vegetables, and the salt must be put into the process of diffusion. The
absence of flavor may be obviated to a great extent by a careful employment of
spices, condiments such as mint, thyme, parsley, marjoram, savory, bay-leaf, chut-
ney, horseradish sauce, tomato sauce, mustard, nutmeg, cinnamon, allspice, va-
nilla, lemon, cocoa, chocolate and coffee, and in some cases a small amount of
pickles, such as red cabbage, onion or cauliflower. The liquids allowed are milk,
whey, buttermilk, weak tea, cereal or fig coffee, lemonade, fruit juice and aerated
waters, or a small amount of wine or spirit and water.
THE PERCENTAGE OF SODIUM CHLORID IN FOODS
Raw food
Per cent
Cooked foods
Per cent.
Unsalted butter
.02
Poached eggs.. .
5
Yolk of eggs
.02
Fruit, usually less than. . .
.5
Fruit not more than
.06
White bread
.48-.07
Meat, unsalted. .
.10
Brown bread
.75
Vegetables and salads
.10
Cauliflower
.5-.9
Cereals and legumes
.01-. 10
Cabbage
.5-.9
Milk. .
.15-.18
Mashed potato
.5-1.0
Eggs. .
.14
Roast beef
1.9-2.8
White of eggs
.19
Beef steak
3.0
Salted butter .
1.00
Buttered eggs.
2.4
Cheese.
1.5-2.5
Omelettes
2.7
Caviar
6-7
Asparagus
2.7-3.5
Moderate variations in the amount of salt ingested have no significant
effect upon the protein metabolism. Large amounts increase the quantity
of protein catabolized, and, through overstimulating the digestive tract,
may also interfere with the absorption and utilization of the food.
Below we append a few examples of diets containing not more than
two grams of salt (Tibbies) :
MINERAL METABOLISM 347
(a) Balint prescribed: Milk, !}/ to 2^ pints; butter, \Yi ounces; three eggs; salt-
less bread, 9> to 12^ ounces, and weak tea or coffee. Calories, 2,300 to 2,400.
(b) Archard and Widal drew up the following series of diets:
(1) Potatoes, 35 ounces; meat, 10J/ ounces; butter, 1% ounces; rice, 4^
ounces; protein, 98 grams. Calories, 2,295.
(2) Saltless bread, 7 ounces; meat, 14 ounces; butter, 3 ounces; sugar, 3^
ounces; protein, 117 grams. Calories, 3,037.
(3) Saltless bread, 7 ounces; potatoes, 10^ ounces; rice, 3% ounces; sugar,
y/2 ounces; butter, 1 ounce; protein, 33 grams. Calories, 1,891.
(4) Milk, 2 pints; two eggs; meat, 10 ounces; flour, 2 ounces; sugar, 1%
ounces; butter, 1% ounces; protein, 125 grams. Calories, 2,292.
From the above table it will be seen that the dietary can be varied so
that the consumption of protein will vary but little from the standard
advocated in these pages. The following dietary will possibly be accept-
able by most Americans :
Breakfast:
Oatmeal porridge; saltless bread and butter; one or two eggs (poached or but-
tered); raw egg-and-milk; fresh-water fish, eaten with lemon juice or vinegar.
Jam, marmalade, tomatoes, or other fresh fruit; tea or cereal; coffee made
with water or milk.
Midday Meal:
Vegetable soup; saltless bread; cow-heel, tripe, unsalted tongue, fresh meat or
fowl. Fish may be taken once or twice a week, with mayonnaise sauce, white
sauce, or bread sauce. Milk puddings; cream; custard, junket; blanc mange;
jelly, stewed fruit, salt-free biscuits, or crackers. Salt-free cheese. Green
vegetables, kidney or snap beans, vegetable marrow, spinach, scorzonera,
celery, cauliflower, and potatoes, all cooked without salt, or the minimum
required to give flavor.
5 p.m.:
Tea; with salt-free bread and butter; cakes, honey, marmalade, and other con-
fections.
Evening Meal:
Any article from list for the midday meal or breakfast.
Bunge(15) records extended and interesting observations and discus-
sion upon the relation of diet to the craving for salt, and concludes that
it is possible for one to live on a diet largely vegetarian, without the addi-
tion of salt, yet on such a diet one should have a strong disinclination to
partake freely of vegetables rich in potassium, such as potatoes.
The use of salt enables us to employ a greater variety of the earth's products
as food than we could do without it.
But according to Bunge :
We are accustomed to take far too much salt with our viands. Salt is not only
an aliment; it is also a condiment and easily lends itself, as such things do, to
abuse.
348 SCIENTIFIC FEEDING OF NITROGEN FOODS
Sodium and chlorin equilibrium can apparently be maintained on
less than one-fourth the amount of salt ordinarily consumed. Sodium
chlorid partaken of with the diet passes out of the body through the
kidneys without undergoing any chemical changes; the rate of excretion
adapts itself to the rate of intake within wide variations.
According to Goodall and Joslin(16), when no salt is taken, the rate
of excretion falls rapidly to a point where the daily loss is extremely
slight. In one of their experiments upon a salt-free diet, the chlorin
excretion upon successive days was as follows:
1st day 4.60 grains chlorin 7th day 0.46 grams chlorin
2nd day 2.52 " 8th day 0.40 "
3rd day 1.88 9th day 0.26 "
4th day 0.87 10th day 0.22
5th day 0.69 " llth day 0.22
6th day 0.48 12th day 0.17 "
13th day 0.17 grams chlorin
Potassium Chlorid. Potassium chlorid is next in importance to sodium
chlorid. It is a predominant salt in the muscular tissues, and, like sodium
chlorid, is a common ingredient of nearly all the tissues and fluids of the
body. The acid and neutral carbonates and phosphates of sodium and
potassium exert their greatest importance in regulating the reaction of
the digestive secretion and of the urine. Sodium is required in the body
for the proper constitution of its fluids, potassium for the construction of
cells and especially, perhaps, of the red blood cells and the muscles.
Clinical experimentation has emphasized the fact that young animals
and children deprived of potassium salts in the foods do not develop good
muscles. Foods derived from the vegetable kingdom furnish the richest
supply of potassium-bearing salts, by three or four times, while foods from
the animal kingdom contain a larger percentage of the sodium salts. If
potassium chlorid is substituted for sodium chlorid in the food, various
disturbances arise, owing to the deficiency of the sodium salt. The tissues
of the body retain common salt most tenaciously, and when food is ingested
which is low in this elementj it gradually disappears from the urine.
When the supply of common salt is below the body requirement, the
elimination of chlorid in the urine decreases. When there is a lack of
sodium chlorid as compared with potassium chlorid in the food, potassium
combinations replace sodium combinations in the body and new combina-
tions of sodium and potassium are formed and excreted in the urine.
Human beings who consume a large amount of potatoes or other vegetables
rich in potassium salts should of necessity partake freely of common salt,
not merely as a condiment, but as an essential part of the food.
MINEliAL METABOLISM 349
Low Calcium and High Calcium Diets. We learned, when studying
mineral salts in the body and in foods (Volume I, Chapter XI), that
the calcium salts are of value chiefly from their importance in the com-
position of the bones and teeth, as well as in many of the tissues of the
body, more particularly with cell growth and development. The bones
and tissues of young growing animals, and children as well, require and
contain a larger percentage of earthy salts than older ones.
Calcium is taken into the body in organic forms through the ingestion
of milk, yolk of egg, and cereals, and in inorganic forms chiefly in drink-
ing water, such as the carbonates, sulphates and phosphates. Both forms
are more or less readily absorbable, depending in a measure upon what
salts are taken with it. The minimum amount of lime by which calcium
equilibrium may be maintained ranges from 1 to l-l/G grams per day for
the average sized adult. There seems to be great variation in the quanti-
ties by which a calcium diet may be established ; 5 to 10 per cent of that
ingested is excreted in the urine, while the remainder is found in the feces,
whether unabsorbed or absorbed and then eliminated in the intestine.
The amount of lime eliminated through the kidney varies greatly prob-
ably does not average much over one-tenth of that taken in the food. The
fact that the greater part of the calcium ingested in food reappears in the
feces has often been interpreted as meaning that the requirement of the
body for calcium is low, and the absorption of calcium from the food is
poor. It must not be lost sight of, however, that the calcium found in the
feces comes from the various organs and tissues of the body as well as from
the food. The elimination of calcium from the food through the intes-
tinal wall has been proved. The elimination of lime salts through the
intestinal wall continues in fasting, and constitutes the principal way in
which lime is lost from the body whenever the food supplies contain
insufficient lime for equilibrium. The calcium excretion in the urine
may be increased by the ingestion of large quantities of water, and by
the administration of dilute hydrochloric acid ; and again, it may be in-
creased by the administration of lactic acid and sodium lactate. There is
a loss of lime over that taken into the body in such diseased conditions as
osteomalacia, pernicious anemia, advanced tuberculosis and in diabetes.
This is to some extent associated with phosphate elimination. On the
other hand, in arteriosclerosis, the excretion of lime is deficient. If, on a
given diet, the calcium is low, the loss will greatly exceed the intake. If,
on the other hand, the diet contains excessive amounts of calcium, some
of the lime will be retained in the body and apparently stored up in the
bones, though it may not produce symptoms.
350 SCIENTIFIC FEEDING OF NITROGEN FOODS
Voit experimented on a pigeon for a period of twelve months, giving
it a diet poor in calcium, without observing any deleterious effects attrib-
utable to the diet. But when the bird was killed and dissected, there was
found marked wasting of lime salts from the bones of the skull and
sternum, which were so soft as to be perforated with ease. However, the
long bones, those concerned in locomotion, were still sound. The injuri-
ous effect of foods containing insufficient lime is more noticeable in grow-
ing than in full grown animals. Abnormal weakness, flexibility of the
bones will be noticed (like rickets in children). Puppies fed with lean
and fat meat only develop rickets, while control puppies from the same
litter receiving the same food with an additional allowance of bones to
gnaw upon develop normally.
From the above, it is apparent that the growing skeleton needs an
abundance of calcium. Before birth the lime requirement of the child is
satisfied through the maternal blood, and for many months afterward,
through the mother's milk, which is relatively rich in calcium. The
weakening of the bones and the disintegration of the teeth during preg-
nancy and lactation is largely due to the amount of calcium going to
the child in utero and during lactation in the secretion of milk. After
weaning and throughout early childhood, there are apt to be frequent dis-
turbances of the absorption and metabolism of lime, due, in some in-
stances, to disorders of digestion, in other cases, to deficiency of lime in
the nutrients ingested by the child. To prevent this fluctuation, so as
not to interfere with the steady growth of the child, it is imperative that
the food furnish a liberal supply of calcium. Under the most favorable
conditions, a rapidly growing child will need and consume more bone-
making material in proportion to its total food than is required by men
who serve as subjects for metabolism experiments. For this reason, among
others, lime water is added to the various artificial foods given during
infancy and early childhood. Unless a very "hard" water is used for
drinking purposes, it is unlikely that the lime from this source will sup-
ply more than a very small part of the calcium required, so that there
should be great attention given to the choice of such foods as will increase
the calcium content of the dietary.
The table on page 351 gives the calcium content of a number of staple
articles of food.
A study of the table on page 353 will show that there are enormous dif-
ferences in the calcium percentage of different food products, milk being so
rich in calcium that the quantity necessary to produce 400 calories contains
1 gram of lime. In order to get the same amount of lime from round steak
MINERAL METABOLISM
351
and white bread, it would be necessary to consume enough to furnish
10,000 calories.
A low calcium diet is recommended in many cases of arteriosclerosis,
exerting, as is claimed, a beneficial effect by checking alimentary toxemia,
reducing blood pressure and increasing diuresis. The idea is, that to keep
blood pressure low, lime salts should be eliminated from the diet as far as
possible. In conditions of cardiac failure, lime salts are allowed, but
when compensation is reestablished, their use should be discontinued. It
should be pointed out, however, that it has not been proved that blood and
tissues retain calcium during the course of arteriosclerosis. If at any
time it is desirable to give a calcium-poor diet, it can be arranged from the
following table:
CALCIUM IN FOODS 1
BASAL FOODS: Per cent
Meat 002
Eggs 100
Cream 147
Milk 172
Cheese 1.240
Bread 021
Flour: Fine 028
Entire wheat 037
Cornmeal 009
Rice 012
Pearl barley 0.25
Macaroni, vermicelli 028
Oatmeal 078
VECETABLES:
Asparagus 038
Beans: Dried 215
Fresh, string 073
Beetroot 019
Cabbage 058
Carrots 077
Celery 094
Cucumber 028
Greens, turnip tops 508
Lettuce ; 425
Onions 040
Parsnips 076
Peas, dried 137
Potatoes 0.16
Sweet. . .025
VEGETABLES (Continued): Per cent
Pumpkins 032
Radishes 025
Rhubarb 060
Ruta baga (swedes) 103
Spinach 064
Tomato 019
Turnips 0.87
Vegetable marrow 0.32
Watercress 259
FRUITS:
Apples Oil
Apricots 021
Bananas 009
Blackberries 099
Bilberries 045
Cherries 026
Cranberries 021
Currants 046
Dried 169
Grapes 014
Grapefruit 029
Huckleberries 037
Oranges 043
Peaches 0.15
Pears 018
Pineapple 008
Plums 022
Raspberries 072
Strawberries 057
Water-melons. . .018
Magnesium Salts. Magnesium is usually present in foods in much the
same proportion as calcium. There are exceptions, however, to this rule,
hull, of Exper. Sta. No. 45, U. S. Dept. of Agric.
352 SCIENTIFIC FEEDING OF NITROGEN FOODS
for in milk, magnesium is less and in meat considerably more abundant
than calcium, while in bread there is actually five times as much mag-
nesium as calcium. Magnesium, however, is of much less importance to
the body than calcium. Very little magnesium is absorbed from the food,
and one-third of the intake is excreted in the urine and about two-thirds
in the feces.
The bones contain 99% per cent of the entire calcium content of the
organism, but only 71 per cent of the magnesium. On the other hand,
the muscles contain more magnesium than calcium, but again there is in
the blood more calcium than magnesium. The solubility of magnesium
salts in the body fluids is greater than that of lime. Absorption of mag-
nesium both in organic and inorganic combinations takes place from the
intestinal canal. Experiments in which animals are given food with
scanty lime content, but rich in magnesium, have demonstrated that while
the bony structure resulting from such diet contains twice the normal
amount of magnesium, the development of the osseous system is stunted.
These data offer practical proof that lime cannot be replaced by mag-
nesium. Since the magnesium salts are more soluble than the lime salts,
they are eliminated in greater proportion than the latter by the kidneys.
As a matter of fact, most of the absorbed magnesium is excreted in the
urine, while the unabsorbed magnesium salts in the form of insoluble
soaps are eliminated in the feces. The table on the opposite page shows
comparative amounts of the lime and magnesium salts.
Phosphorus Phosphorus is essential for all cell life and its impor-
tance as a building material in the body can scarcely be overrated. Wher-
ever growth is most active, there also most phosphorus is found. It is a
component part of all cell nuclei and is found abundantly in the bones
and in the central nervous system. Wherever the building up of such a
tissue is going on rapidly, a large supply of phosphorus in thq food is
required. It is not surprising, therefore, to find that the development of
young animals which are deprived of phosphorus is apt to be seriously
impaired. The importance of a sufficient amount and a proper form of
phosphorus in the food of growing children is to be emphasized; and it is
essential for the growth of new tissues that phosphorus should be stored
in the body as well as nitrogen. Whenever there is a storage of nitrogen
a corresponding storage of phosphorus is also found. The importance of
phosphorus as a building material was shown by Bunge when he dis-
covered that the proportion of phosphorus, calcium and protein in the
milk of animals is directly proportionate to their growth. The table given
on page 354 very graphically emphasizes Bunge's discovery.
MINERAL METABOLISM
353
APPROXIMATE AMOUNTS OF MAGNESIUM AND CALCIUM OXID IN
FOOD MATERIALS 1
VEGETABLE FOODS
Ash
in per cent
of substances
Magnesium
in per cent
of the ash
Calcium
in per cent
of the ash
Millet 5.1
Cocoa 4.9
Cornmeal ....
Rice 0.67
Nut kernels. ....
Wheat flour 2.3
Buckwheat ....
Barley 2.5
Apples 0.27
Coffee extract 3.4
Peas 2.6
Rye flour 1.97
Oatmeal 2.3
Tea extract 3.1
Potatoes 5.0
Grapes 2.25
Cherries 0.4
Plums 0.31
Asparagus 6.4
Lemon juice 0.2
Bananas ....
Spinach 2.03
Savoy ....
Cauliflower 8.8
White cabbage 11.6
Kohlrabi 8.9
Radish 6.4
Cucumbers 4.8
Gooseberries 0.4
Lentils
Beans 3.1
Schoten 0.7
Clover ....
Poppy seeds
Sorrel ....
Pears 0.4
Strawberries ....
Carrots 5.4
ANIMAL FOODS
Beef
Albumin of hens' eggs
Woman's milk
Yolk of egg
Cow's milk . .
25.8
15.9
14.9
13.4
13.0
10.9
10.3
9.6
8.7
8.6
8.1
7.9
7.0
6.8
2.5
8.8
5.5
4.7
6.3
3.3
8.8
5.3
2.9
Trace
3.7
3.2
3.5
3.0
5.8
1.9
6.5
6.3
4.8
9.5
8.3
5.2
Trace
2.3
2.8
6.3
0.8
8.6
2.2
6.6
3.5
4.0
3.6
5.1
1.02
3.0
1.2
0.8
36.9
7.5
4.9
15.9
7.9
12.5
13.1
27.9
21.7
12.6
10.2
8.8
6.9
12.2
5.1
8.6
7.8
36.1
35.1
31.6
7.9
14.2
5.6
15.2
13.0
5.0
6.0
20.0
2.9
13.0
24.3
38.0
151.0
From von Liebig and other sources.
354 SCIENTIFIC FEEDING OF NITROGEN FOODS
IMPORTANCE OF PHOSPHORUS AS A BUILDING MATERIAL (Bunge)
Time required
to double the
weight of a
new born
animal (Days)
MILK OF MOTHER CONTAINS
Protein
per cent
Ash
per cent
Lime
per 1,000
P 2 5
per 1,000
Man
180
60
47
17
10
8
1.6
2.0
3.5
4.3
6.5
7.1
.2
.4
.7
.8
.9
1.3
.328
1.240
1.600
2.100
2.720
4.530
.473
1.310
1.970
3.220
4.120
4.930
Horse
Cow
Goat
Sheep
Dog...
Rohmann(l7), in studying this subject, asks the question: "What in-
fluence have the inorganic phosphates on the construction of phosphorized
proteins in the body?" In an experiment to answer this question, says
Tibbies, he fed animals on a diet containing earthy phosphates and diets
consisting of (a) phosphorized proteins (casein and vitellin), (6) non-
phosphorized protein (edestin). In animals which subsisted on the
former diet, there was a retention of nitrogen and phosphorus in the body,
while in animals fed on the latter no retention occurred. His conclu-
sion from these observations is that the body does not appear to have the
power of building up the phosphorized proteins of the cells from the
non-phosphorized proteins and inorganic phosphates. On the other
hand, he concluded that the phosphorized proteins are built up from
lecithin and non-phosphorized protein. From his observations, we must
look to the phosphorized organic constituents of the food for our supply
of phosphorus, viz., nucleoproteins, phosphoproteins, nuclein, lecithin,
phosphocarnic acid and glycerophosphoric acid found in the cellular ele-
ments, particularly in the yolk of eggs, sweetbread, fish roe, the germ of
cereals and legumes, and in casein. (For the amount of phosphorus con-
tained in foods, see Volume I, Chapter XI, pages 271-272.)
Bunge (18) has demonstrated the content of phosphorus pentoxid
(P 2 O 5 ) in 100 grams of dried food to be: egg yolk, 1.90 ; cow's milk, 1.86 ;
beef. 1.83 ; peas, 0.99 ; wheat, 0.94 ; potato, 0.64 ; egg albumin, 0.20 grams.
In his work along this line, \ 7 oit gives the following estimate of the
amount of phosphorus in the various structures of a human body weigh-
ing 154 pounds: 1,400 grams in the bones; 130 grams in the muscles,
and 120 grams in the nervous system. The determination of the exact
phosphorus requirement of the human organism is not an easy problem.
Available data on this subject are even fewer than those dealing with
MINERAL METABOLISM 355
nitrogen. Sherman and Sinclair (19) have pointed out that the daily
amount of phosphorus received by the body varies from 0.9 to 1.5 grams,
this variation depending upon the amount of phosphorus in the food in-
gested. Interesting and instructive as this work is, it is not exhaustive.
But from these studies it may be inferred that a normal individual by
training himself to exist on a low protein diet, or on a diet whose phos-
phorus content exists almost exclusively in organic combination, may
maintain phosphorus equilibrium on food containing about 0.9 grams of
phosphorus or 2 grams of phosphorus pentoxid. But to maintain a nor-
mal phosphorus equilibrium on an average unrestricted diet, it would
seem that a daily intake of about 1.5 grams of phosphorus or 3.5 grams
of phosphorus pentoxid is required.
Iron Salts. Iron is one of the mineral constituents of the diet which is
always present in an organic form. It is largely excreted in the feces,
which fact has led to great difficulty in attempting to estimate the usual
amount of iron required. Roughly speaking, there are about 10 milli-
grams of the metal contained in an ordinary mixed diet (15). This quan-
tity may therefore be taken as sufficient to meet all physiological demands.
It is difficult to estimate correctly the amount of iron contained in the
different articles of food. In foods derived from the animal kingdom
much depends on whether the animal was bled when slaughtered or not,
while, with foods derived from the vegetable kingdom, it varies very
greatly, depending largely upon the amount of iron in the soil in which
the foods were grown. For the estimated amount of iron contained in
different vegetable and animal foods, the reader is referred to Volume I,
Chapter XI, page 269. Physiological chemists estimate that the blood (4)
of an adult contains 3 grams of iron ; the liver, spleen, skin and hair con-
tain smaller amounts. According to N"asse, the conglomerate masses in
the spleen pulp of old horses contain about 5 per cent of iron, while
Oidlmann estimated that the ash of the spleen contains from 7 to 16 per
cent of iron. The iron content of the blood in the form of hemoglobin
amounts to about 0.04 per cent. The iron of the liver is stored in the
cells as compounds of iron in nuclein and protein. Physiologists desig-
nate two of these compounds as Jiepatin and ferratin, and the iron is
either the ferric or ferrous oxid. The iron in the liver of a new-born
animal is greater than that in the adult of the same species. Bunge
teaches that the liver acts as a storage house for iron, which is subse-
quently used to form the hemoglobin of the red blood corpuscles. Dele-
piene coincides with this view. He even considers the liver as not only
the storehouse of the nucleoprotein compounds containing iron, but that
356 SCIENTIFIC FEEDING OF NITKOGEN FOODS
the liver cells are capable of elaborating these compounds into new hemo-
globin for the young red blood corpuscles, which he describes as the
ferrogenic function of the liver and which he believes persists throughout
life. The bile pigment is derived from hemoglobin, but is free from iron.
Tibbies thinks this pigment is split off from the hemoglobin, while the
iron-bearing nucleoproteins are stored in the cells of the liver.
Considerable variations in professional opinion have arisen as to
whether inorganic iron given as a drug for the cure of anemia and
chlorosis is absorbed. Von Noorden and others believe that inorganic
iron is absorbed and they hold that it is very efficient in the treatment
of these maladies. Hamburger and Morden, on the other hand, believe
that little or none of the inorganic preparations of iron is absorbed from
the alimentary canal. Bunge believes that iron is of therapeutic value in
the treatment of anemia and chlorosis. As Tibbies puts it : ''Chlorosis is
attended by considerable fermentation in the alimentary tract, whereby
much sulphuretted hydrogen is evolved, and this gas fixes and prevents
the absorption of organic compounds in the food which are normally
made use of in the manufacture of hemoglobin." Should there be
an excess of inorganic iron present, a large proportion of the sul-
phuretted hydrogen evolved will combine with such iron to form
sulphid, and in this manner protect the organic iron combinations from
destruction by the hydrogen sulphid (H 2 S). If a condition arises wherein
the blood is deficient in iron it will scarcely be possible or practicable to
make good such deficiency by ordering inorganic salts in the food. There
are very few foods which contain much inorganic iron, although Stock-
man and von Noorden believe that the inorganic iron contained in the
food is absorbed and utilized in the production of hemoglobin. If for any
reason the food is deficient in iron, it necessarily leads to a condition of
anemia, which conclusion is supported by various experimental observa-
tions. It is known that the blood of dogs fed with bread contains less iron
than the blood of the same animals when they are fed upon meat; or
even children, when they receive only the same proportion of iron per
kilogram of body weight as is necessary for an adult. These tend to
become anemic.
Sulphur Salts. Sulphur is present in foodstuffs almost entirely in
organic combination, chiefly in proteins. The amount present varies
considerably, as shown in Volume II, Chapter IX, page 272. Sulphates
are derived from sulphur contained principally in fibrin, egg albumin,
the casein of milk, and from such vegetables as corn, turnips, cauliflower
and asparagus. The knowledge at the present time of the advantages
MINERAL METABOLISM
357
or otherwise of an increase or diminution of sulphur in the food is want-
ing. Where food prepared with so-called alum baking powder is eaten,
considerable sulphate may appear in the urine from this source.
The inorganic constituents of food are of importance from the point
of view, not alone of the individual ingredients, but of their relations to
one another as well. As we have seen, even such elements as sodium and
potassium, or calcium and magnesium, that are closely related in chemical
properties, are not interchangeable in the animal economy, and, more-
over, in some physiological functions are actually antagonistic (20). On
the other hand, in some instances certain elements do to a degree replace
other elements, as, for example, the sparing influence of calcium on iron
metabolism as a result of which an abundance of calcium renders less the
amount of iron necessary to maintain iron equilibrium.
Acid-forming and Base-forming Elements of Diet. Another important
relation is that of the acid-forming and base-forming elements of the
diet. It appears important that the base-forming elements of the
food should be sufficiently abundant, largely, if not wholly, to neutralize
the acids formed in catabolism, since otherwise there is a tendency to the
production of a condition of acidosis, with the withdrawal of fixed alkalies
from the blood and tissues and an increased fixation of ammonium salts
whereby the ammonium is not transformed into urea. While it is not
absolutely demonstrated that these conditions are immediately productive
of disease, it must be regarded as physiologically wrong for man and
correspondingly disadvantageous. Moreover, it is quite likely that in cer-
tain pathological conditions (see Gout, Volume III, Chapter XII) the
lack of base-forming elements is actually harmful. Sherman gives the
following tables :
FOODS IN WHICH ACID-FORMING ELEMENTS PREDOMINATE
Estimated excess acid-forming
elements equivalent to c.c.
normal acid per 100 calories
Beef, free from visible fat
10
Eggs. . .
9
Round steak ,
6.7
Oatmeal
3.2
Wheat flour
2.7
Wheat, entire grain.
2.6
Rice. . .
2.4
Bacon
1.0
Corn, entire grain (high protein)
0.1
123
358 SCIENTIFIC FEEDING OF NITROGEN FOODS
FOODS IN WHICH BASE-FORMING ELEMENTS PREDOMINATE
Estimated excess base-forming
elements equivalent to c.c.
normal alkali per 100 calories
Celery
40
Cabbage. . .
10-13.6
Potatoes
9-12
Prunes
7.9
Turnips
6.6-12.5
Apples
5
Milk
3.3
Beans.. . .
2.9- 6.8
Peas
1.9
Corn, entire grain (low protein)
0.8
Starch, sugars, fats and oils do not ordinarily contain acid- or base-
forming elements.
Resume. The older view of Wright (21), as to the relation of the diet
to scurvy, is probably correct, so far as concerns its following a withhold-
ing of a base-yielding diet, but, in view of the recent works on vitamines,
it appears that it is not the mere absence of bases but of vitamines that is
the causative factor.
From the foregoing pages, the reader is able to grasp the great impor-
tance of the functions of the mineral elements in the processes of metab-
olism. Viewing their nature and importance, it is at once obvious that
life could not endure if its complex mineral requirements were not auto-
matically and constantly maintained in a proper adjustment.
While highly developed processes of food manufacture and efficient
world-wide transportation facilities give us the greatest opportunities for
correct dietetics, yet there are important facts bearing on the relation of
food materials and the metabolism of mineral nutrients which open the
way to greater injudiciousness and positive abuse in dietetics than could
have been possible in our more primitive days. The net result emphasizes
an obligation on our part to prepare a defense of knowledge against the
misfortunes of plenteous prosperity. In order to emphasize sufficiently
the importance of mineral metabolism. in the processes of nutrition just
considered in the preceding pages, we will outline briefly some of the
functions of the mineral elements in animal metabolism:
As bearers of electricity the mineral elements dominate the whole
course of metabolism.
They conduct nerve impulses, and play a leading role in the general
process of cell stimulation.
MINERAL METABOLISM 359
They govern the contraction of the muscles, including those of the
heart.
They compose the central agency for the maintenance of neutrality
in the blood.
They enter into the composition of every living cell.
They compose supporting structures.
They assist in the coordination of the digestive processes.
They activate enzymes, and through their control of the chemical
reaction of the blood and tissues they govern enzyme action.
They unite with injurious products of metabolism and render them
harmless or useful.
As catalyzers they may alter the speed of reactions, and the rate of
metabolism generally, as measured by oxygen consumption.
Through their effects on osmotic pressure they govern the movement
of liquids, and maintain the proper liquid contents of the tissues.
Through their control of the imbibition of water by the colloids they
govern absorption and secretion.
Through their control of the affinity of the blood for gases they govern
respiration.
Finally, they control the state of solution, precipitation, mechanical
aggregation, chemical association and ionizatiou of the colloids which
compose living tissue.
REFERENCES
1. BENEDICT, A. L. Golden Rules of Dietetics.
2. HALL, L WALKER. Chemistry and Physiology of Food Purins.
3. BURIAN and SCIIURR. Pfluger's Archiv, 1900.
4. TIHULES, WILLIAM. Food in Health and Disease.
5. DENIS, W. The Effect of Ingested Purins on the Uric Acid Con-
tent, of the Blood, J. Biol. Chem., 1915, vol. xxiii, p. 147.
(!. SHERMAN, METTLER and SINCLAIR. Exper. Sta., U. S. Dept. of
Agric., Bull. No. 227.
7. TACIIAU. Biochem. Ztschr., 1914, vol. Ixvi, p. 253.
S. STARLING. Human Physiology, 1912, p. 5.
'.). Abt. J. Am. Med. Assn., 1913, vol. Ixi, p. 127r>.
GRAFE. Peutsch. Arch. f. klin. lied., vol. cxiii, p. 1.
10. STARLING. Human Physiology, 1912, p. 724.
11. FISCHER. Edema and Nephritis, 1915.
360 SCIENTIFIC FEEDING OF NITHOGEN GOODS
12. SCHAEFER. Science, 1912, vol. xxxvi, p. 289.
13. GUYEB. Tr. Amer. Micros. Soc., 1911, vol. xxx, p. 145.
14. STRAUSS, H. Zschr. f. phys. u. diatet. Therap., April, 3908.
15. BUNGE. Physiological and Pathological Chemistry, chap. vii.
16. GOODALL and JOSLIN. Tr. Assn. Am. Phys., 1908, vol. xxiii, pp.
92, 106.
17. ROHMANN. Pfluger's Archiv, vol. Ixvii.
18. BUNGE. Loc. cit., p. 84.
19. SHERMAN and SINCLAIR. Exper. Sta., U. S. Dept. Agric., Bull.
No. 227.
20. SHERMAN, H. C. Chemistry of Food and Nutrition.
21. WRIGHT. On the Pathology and Therapeutics of Scurvy, Army
Med. Reports, 1895.
CHAPTER XII
DIET IN HEALTH
WINFIELD S. HALL, PH.D., M.D.
The destiny of nations depends upon the character of their diet.
Dietotherapy General Principles: Amount of Food Required; Distribu-
tion of Meals ; Composition of Meals ; Influence of Diet on Constitu-
tion and Health ; Influence of Diet on Character ; Influence of Diet on
Races; Occupation and Diet; Climate and Diet.
Diet Studies: Students' Clubs; Mechanics and Laborers; Standard and
Actual Dietaries Compared; Negroes and Poor Mexicans.
Use of Alcohol.
Diet in Tropical Climates: General Considerations; Fruits and Vege-
tables; Milk; Meats; Sweets; Diet and Disease; Conclusions.
Alcohol and Beverages in the Tropics.
DIETOTHERAPY GENERAL PRINCIPLES
Dietotherapy is the proper application of suitable food elements to
secure a well-balanced alimentation necessary for the preservation of
health and the maintenance of bodily strength and energy, or for their
restoration during convalescence after having been impaired by disease.
It goes without saying that the value of foods in health must be under-
stood in order properly to appreciate their relative dietetic value in
disease.
When studying "The Chemical Constituents of the Body and of
Foods" (Volume I, Chapter II), we learned that the human organism is
composed of some twenty different universally distributed chemical ele-
ments, of which the following are most essential : C, H, O, N, S, P, Cl,
Na, K, Fe, and Mag, combined in the most complex molecules, some
of which contain many hundreds, even thousands, of atoms. We also
learned, when studying the "Characters of the Proximate Principles of
361
362 DIET IN HEALTH
Foods" (Volume I, Chapter III), that the chemical composition of the
human body is not always an adequate guide to the selection of the essen-
tial food elements, though it is an indisputable fact that food that is to
nourish an infant's body and sustain it through childhood and puberty
must contain these elements. However, it is quite impossible to feed
human beings upon chemical elements to be useful these must be fur-
nished in certain suitable combinations. The table in Volume I, Chapter
II, graphically shows the composition of foods. Many of these com-
pounds during the process of digestion and assimilation (Volume I,
Chapter VII) are transformed into other compounds which are peculiar
to the human body. Even when food material has been adapted to the
needs of the body by digestion, it still undergoes further chemical modi-
fication before it can be taken up by the cells for their repair, or stored
by them, or, by contact with them, be transformed into heat or muscular
power.
Thus we see that the human economy requires foods similar in com-
position to its own substance for growth, development and repair, while
it needs fuel foods from which to produce active energy for the work of
the body. We have already studied these two phases of body require-
ments growth and repair on one side, and work on the other and find
that they make the basis for the classification of foods, as outlined in
Volume I, Chapter IX.
Man is an omnivorous animal and can subsist on either animal or
vegetable foodstuffs, and derive force and bodily heat from any of them,
and, as the body soon adapts itself to its food, very few rules need be
formulated. People in the upper walks of life, as a rule, consume more
protein and ingest less carbohydrates than do the working classes. The
dietaries of public institutions are more liberal with allowances of carbo-
hydrate foods than with protein, on account of economic advantages, but,
as stated elsewhere (Volume II, Chapter IX), the protein from vege-
tables, especially from beans, peas or lentils, can be secured at very reason-
able prices and ought to be more universally used, especially when the
prices of meats are prohibitive.
Amount of Food Required. The amount of food necessary for a healthy
individual depends upon his age, the amount of muscular activity he ex-
pends, the climate (or the weather), and certain other factors, such as the
activity of one or more of the ductless glands, as well as on certain indefi'
nite and little understood factors which we group together as "inherited."
All physicians called upon to treat disorders incident to childhood are well
aware of the enormous appetites of normal children who are active; but
DIETOTHERAPY GENERAL PRINCIPLES 363
they sometimes lose sight of the fact that the dosage of milk, which is
accepted for a six-months' child, is for tlie average liosptlnl child and not
for the normal, healthy, active child, which would grow faster on a more
liheral allowance of food. Students of dietetics understand that what is
needed during hot weather is sufficient food with a liberal allowance of
water to counteract the heat liberated in burning the food. The value of
peppers and other condiments in the tropics is that, given water enough,
perspiration is stimulated and the more it is stimulated the more rapidly
the body is cooled.
THE RELATION OF HEIGHT TO WEIGHT. This is by no means a fixed
ratio, as considerable variations may exist without indication* of disease;
on the other hand, any great disparity, other things being equal, shows
that the balance of nutrition is disturbed, and in consequence the chances
for longevity are lessened. Height is qualified by the adjectives: dwarf-
ish, short, medium, tall ; while the patient is described, from the weight
point, as emaciated, thin, spare, medium, stout or obese. Insurance com-
panies have adopted a general ratio of height to weight for different ages
with a minimum, - average and maximum weight which is graphically
illustrated in the table on pp. 364-5. Changes in body weight varying
from the normal, form, in most instances, a reliable index to the tendency
of the malady; progressive loss indicates an advance of the disease, while
progressive increase in weight suggests a lessened activity of the disease.
As a rule, individuals of moderate height and weight are best adapted to
pass successfully through the ordinary trials of life and the extraordinary
ordeals of disease, but the thin, "wiry" person may accomplish an enor-
mous amount of work without excessive fatigue, and emerge triumphantly
from a severe attack of illness. On the other hand, there are stout, hale
and hearty individuals who refuse to grow thin, be worn out, or to degen-
erate, but who hang on to life in spite of serious, acute or debilitating
disease.
The food requirements for adults living under similar environments
vary with the weight of the individual. The larger the body the more
food will be required (see Volume II, Chapter IX), for, as has already
been pointed out, the extent of the body surface influences in a measure the
radiation of heat or energy, and the larger the surface the more food per
kilo will be consumed. This has been tested experimentally, both in man
and animals, and the conclusions reached are that the food must be pro-
portional to the weight of the body and area of body surface.
The dissipation of liont varies with the condition of rest or \\-ork.
While at rest an individual weighing 154 pounds (70 kilos) during a
364
DIET IN HEALTH
TABLE OF STANDARD HEIGHT AND WEIGHT AT VARYING AGES
(Based upon an analysis of 74,162 accepted male applicants for life insurance, as reported
to the Association of Life Insurance Medical Directors, 1897)
(The figures above and below are 20 per cent over and under the average)
Ages.
15-24 25-29 30-34 35-39
40-44
45-49 50-54 55-59 60-64 65-69
5 feet inches .
5 " 1 "
5 2 u
5 " 3
5 " 4
5 5
5 " 6
5 " 7 "
5 " 8 "
5 9
5 10
5 11
96
120
144
98
122
146
99
124
149
102
127
152
105
131
157
107
134
161
110
138
166
114
142
170
117
146
175
120
150
180
123
154
185
127
159
191
100
125
154
102
128
154
101 103
126 , 129
151 155
102
128
154
105
131
157
108
135
162
110
138
166
114
142
170
118
147
176
121
151
181
124
155
186
127
159
191
131
164
197
105
131
157
107
134
161
110
138
166
113
141
169
116
145
174
120
150
180
123
154
127
159
191
131
164
197
135
169
203
105
131
157
105
131
157
106
133
160
109
136
163
112
140
168
114
143
172
118
147
176
122
152
182
126
157
185 188
130
162
194
134
167
200
138
173
208
106
133
160
107
134
161
109
136
163
111
139
167
114
143
172
117
146
175
120
150
180
124
155
186
128
160
192
132
165
198
136
170
204
140
175
210
107
134
161
109
136
163
110
138
166
113
141
169
115
144
173
118
147
176
121
151
181
125
156
187
129
161
193
133
166
199
137
171
205
142
177
212
107
134
161
109
136
163
110
138
166
113
141
169
116
145
174
119
149
179
122
153
184
126
158
190
130
163
196
134
167
200
138
172
206
142
177
212
107
134
161
109
136
163
110
138
166
113
141
169
116
145
174
119
149
179
122
153
184
126
158
190
130
163
196
134
168
202
138
173
208
142
178
214
105
131
157
107
134
161
110
137
164
112
140
168
115
144
173
118
148
178
122
153
184
126
158
190
130
163
196
134
168
202
139
174
209
144
180
216
D1ETOT1IEKAPY GENERAL PRINCIPLES 365
TABLE OF STANDARD HEIGHT AND WEIGHT AT VARYING AGES Con.
Ages
15-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
6 " inches
132
165
198
136
170
204
141
176
211
136
170
204
142
177
212
147
184
221
140
175
210
145
181
217
150
188
226
143
179
215
148
185
222
154
192
230
144
180
216
149
186
223
155
194
233
146
183
220
151
189
227
157
196
235
146
182
218
150
188
226
155
194
233
146
183
220
151
189
227
155
194
233
148
185
222
151
189
227
154
192
230
148
185
222
151
189
227
154
192
230
6 " 1 "
6 " 2 " . ...
period of twenty-four hours gives off 15 cubic feet of CO 2 . Since 1 cubic
foot of CO 2 produced by combustion involves an expenditure of heat
equivalent to 160 foot tons of energy, it follows that 15 x 1GO (2,400)
foot tons are required for the maintenance of normal temperature and
the ordinary functions of the organism while the body is at rest. And
since one calorie equals 1.54 foot tons of energy, 2,400 foot tons are
equivalent to about 1,550 calories, i.e., 22.3 calories for each kilo of body
weight. Playfair and Parkes conducted studies to determine the minimum
food requirement and concluded that this amount of heat and energy
would be furnished from the combustion in the body of dry albumin, fat
and carbohydrate barely yielding the "sustenance diet."
Later investigations show that the amount of food required to supply
the heat expended per kilo of body weight by an adult under various
conditions, from absolute rest to strenuous activity or laborious work,
ranges as follows :
TABLE OF ADULT REQUIREMENTS PER KILO
For sustenance only 23.0 calories
During rest in bed 25.0 "
Sedentary occupations 35.0 "
Very light work 40.0 "
Moderate work 42.0 "
Laborious work 60.0 "
Extra strenuous labor 120.0 "
A normal individual free from digestive disturbances and physically
fit, who ingests a well-balanced ration scientifically calculated according
to his age, height, weight and area of body surface will, without question,
maintain the normal ratio of weight for his age and height,
366 DIET IX HEALTH
When the normal amount of food is consumed by a healthy individual,
other things being equal, physiological growth will occur, but if food is
ingested in too large quantities, or if the body is inactive, food above the
actual requirements will be stored in the form of fat. Lack of exercise
in such a case will tend to stoutness, for the "contented" person, as a rule,
moves along the lines of least resistance ; his mind and muscles are oftener
at ease, and so he burns less of his food and stores more than an active,
energetic person. "Laugh and grow fat" is a physiologic truth, but, 011 the
other hand, many adipose persons are impetuous, impatient and discon-
tented, and, again, many are strenuously active. In such cases one of two
things has happened : either they have inherited a type of metabolism which
is not normal for the race, or something is wrong with the internal secre-
tory organs, especially the pituitary, the thyroid, or the sex glands. The
thin, lean, lanky individual is one who eats too little or exercises too much
for the diet consumed, is nervous from some ductless gland disorder, or
is just naturally "skinny."
Distribution of Meals. The early founders of this country, like the an-
cient Greeks, partook of three meals daily: two light repasts, breakfast
in the early morning, and supper at the close of the day ; and the principal
meal, dinner, at mid-day, usually followed by an hour or two of rest. This
custom still prevails in most agricultural districts. In the busy metro-
politan centers the needs of modern activity have changed the distribu-
tion of meals, and the full mid-day repast is now replaced by a light lunch,
which allows, without the rest of the old regime, intellectual or muscular
work almost immediately following, but which necessitates a substantial
meal or dinner at six o'clock in the evening, several hours before retiring.
This arrangement of meals, without being absolutely hygienic, appears
fairly suitable. According to Gautier(l), the well-to-do English families
of what is termed the middle class, and the German families in easy cir-
cumstances, have breakfast at nine o'clock, dinner at two (this is the prin-
cipal meal), tea at five, consisting of tea, coffee, cocoa or beer, with bread,
butter and cheese or ham, and lastly a light supper just before retiring.
Composition of Meals. The composition of the meals, as pointed out in
Volume II, Chapter "VII, should vary with the nature of the occupation.
A light but sufficient repast at the noon hour suits those who are occupied
chiefly with office work or business activities; but for the workman or
peasant who from six or seven o'clock in the morning to mid-day or one
o'clock, has been engaged in strenuous, tiring exercise, the noon repast
should be sufficiently liberal to allow him. not only to make good his losses,
but also to provide him afresh with expendable energy. According to
DIETOTHERAPY OENERAI PRINCIPLES 367
Pavlov, it is necessary to normal digestion, that food should bo taken* at
regular intervals. He cautions against the ingestion of too large a meal
at one time, which overloads the stomach and hinders digestion.
Recent physiological experiments emphasize the fact that meat remains
in the stomach several minutes ( 1 5 to 4."> ) before pepsin is secreted, which,
without doubt, is a provision of Nature to allow the ptyalin of the saliva
to transform some of the cooked starches into sugar, as well as to make
an alkaline coating to the bolus of starchy food. Later the acidity of the
gastric juice produced must be sufficient to excite, in the duodenum, the
pancreatic and intestinal secretions.
The inhabitants of the Polar regions subsist almost entirely upon
food from the animal kingdom, which is rich in fat, the dwellers on the
borders of the Frozen Sea Laplanders and Greenlanders feeding almost
entirely on fish and the flesh and fat of seals, probably as much from in-
stinct as from the impossibility of securing other food. The Arab, on the
contrary, is satisfied with a few dates and a little couscous(2), the latter
a kind of food used by the natives of Northern Africa, made from flour
cooked with flesh and other ingredients, as the leaves of baobab. The
Italian finds his macaroni quite sufficient, while the inhabitants of the
intermediate /one use a ration well balanced with nitrogenous, fatty and
carbohydrate foods.
The annual consumption of meats in different countries may be of
interest to the reader. In the United States the annual consumption per
capita per annum is 172 pounds, or about one-half a pound per day for
each individual, man, woman or child. As many women and children
consume very little, there must, therefore, be a large number of men who
ingest enormous quantities of meat. Gautier(l) points out that the Eng-
lishman consumes 130 pounds- per capita ; the Frenchman's annual con-
sumption of meat is 86 pounds; while the dweller in the City of Paris
consumes 207 pounds: the average consumption per capita in the larger
1t>wns in France is ir>8 pounds, while the peasantry can sea reel v afford.
42 pounds per annum. According to this figure, the peasantrv are com-
pelled to subsist on about 26 grams of fresh meat per meal. The Aus-
tralian is the greatest meat consumer of all, the annual consumption per
capita being in the neighborhood of 240 pounds.
AY hen studying the subject of "Protein and Nutrition," 1 we found that
the lowest protein demand was about 65 grams per day; the quantity that
the French peasant consumes, therefore, is insufficient for the workman
and laborer who have most need of it. Gautier states that "even at the
i Rcc Volume II, Chapter VFT.
368 DIET IN HEALTH
present time meat is only, so to speak, a relish for the countryman. A
townsman, on the other hand, generally eats more meat than agrees with
him. We have seen that in Paris the alimentary principles of animal
origin exceed 480 grams per day, 260 grams of which are meat, and this
figure must at least be doubled for many unemployed townsmen."
As the opium smoker feels the need of the drug when he does not have
it, so the individual who accustoms himself to partaking excessively of
animal foods misses them when he fails to consume the usual excessive
quantity. In contrast with the large meat eater of easy circumstances,
the peasant does not eat enough meat. His dietary is too exclusively
vegetable and forces upon him a regular digestion of dishes of great
volume potatoes, green vegetables, fruits, etc. which bring him only
an insufficient supply of nitrogen. In this class it is common to find
gastralgia, dyspepsia and enteritis. This unbalanced diet is fortunately
offset, to a large extent, by strenuous exercise in the open air, ventilated,
isolated, sunny dwellings, good rest at night, and sometimes in the summer
months a siesta at noonday, with the minimum of inducements to intem-
perance and vices which beset the city dweller ; but in spite of the great
and many advantages of living in the open, the average life of the coun-
tryman, according to Gautier(l), is shorter than that of a man in the
middle class in the towns. Gautier's statement may be correct for French
peasants, but the agricultural classes in this country outlive by many
years the working men of the cities.
Influence of Diet on Constitution and Health The influence of standard
dietaries on constitution and health has been referred to already when
considering the subject of "Protein and Nutrition." There was outlined
the standard dietary for different occupations, founded principally on the
experiments of Chittenden and other workers in this field of research.
This dietary provides for the physiological needs and losses of the system
in quantities and kinds of foods best suited for a healthy adult whether
engaged in strenuous exercise or living a more or less inactive life. On
the other hand, a careful examination of the tables in Volume II,
Chapter ^ 7 ", will show the quantity of protein, fat and carbohydrate
necessary to provide for the requirements of ' calorification, which
varies greatly according to the temperature of the surrounding atmos-
phere. Gautier estimates that a Frenchman, in relative repose,
needs from 80 to 82 grams of protein (one-half of which should be
furnished by animal food and the other half by vegetable food).
He considers this sufficient, and if the daily diet is increased, as
often happens in Paris, to 102 grams of protein, the difference of 20 or
DIETOTII K RAPY GENERAL P1UNC1PLES 369
more grams constitutes a reserve supply. The day laborer who lives from
hand to mouth, for economic reasons, receives only the necessary amount
of food for daily wear and tear, and, as a consequence, is constantly in
danger of a deficiency. If he happens to be called upon to carry out a
strenuous task, if any of the bodily functions be slightly disturbed, and if
his sleep is not sufficient for repair, these causes, and many others besides,
by diminishing the receipts or increasing the expenditures, will augment
the deficiency, and if there are no storage reserves to meet this condition,
it will have to be supplied by combustion of the substance of the organs.
Henceforth, a part of the mechanical work, or even the maintenance of
animal temperature, will be affected. If the store of fats is exhausted,
the bodily functions will destroy some portion of the proteins of the tissues
in place of the sugars or the defaulting fats. In order to prevent such
deficiencies and losses and not to be driven to heat the house by burning
the furniture- 1 the system must have a reserve at its disposal, namely that-
created by ingesting slightly more at each meal than is required for body
metabolism. The old adage, that we should "lay by something for a rainy
day," is as true in nutrition as in finance. It is necessary that the gain
of to-day should suffice to compensate for the loss of to-morrow, and that,
by means of a sufficient surplus beyond the daily requisite allowance, it
should be possible to provide not alone for mobile equilibrium, but to pre-
pare the system so that the losses will never exceed the supply. This is
especially important with reference to proteins and organic mineral salts.
From the above it may be seen how important it is to eat slightly more
than the minimum requisite daily ration. At the same time it must be
borne in mind that this excess may in turn become dangerous if carried
beyond certain limits. The proteins, if not utilized by means of mechan-
ical labor, by jmwerfnl work of the lungs and skin, by a sufficient combus-
tion and normal radiation of heat, will, when all their waste accumulates in
the organism, accentuate a predisposition to obesity, arthritis, and diseases
of the skin, and augment visceral congestion and neuropathic conditions.
A well-balanced dietary for the working man engaged in strenuous
occupations in the open air would be a dangerous ration for the sedentary
citizen who expends but little muscular energy, or for the artist and stu-
dent who devote themselves entirely to intellectual occupation (3). In
young people during adolescence, or in those individuals whose organs,
whatever be their age, have largely preserved their normal activity, a
slight indulgence beyond the normal requirements of a well-balanced
dietary will exert 110 other effect than necessitating a greater activity of
the excretory organs lungs, liver, skin and kidneys. But this will not
370 DIET IN HEALTH
apply to those whose constitution or bodily habits are defective to begin
with. In such individuals a dietary in excess of actual requirements will
daily accentuate decay; hepatic or pulmonary congestion, arteriosclerosis,
degenerative conditions of the kidneys and of various other organs will in-
crease, and there will be eventually established, little by little, if not dis-
ease, at any rate a predisposition to it(l). It will readily be seen, there-
fore, that the ingested aliment should be well balanced and in proportion
to our needs, and regulated not by natural appetite alone, but by reason,
aided, when necessary, by the advice of those who have devoted much time
and energy to working out these intricate problems.
Influence of Diet on Character.. The character of individuals is un-
doubtedly more or less influenced by diet. If a certain alimentation
influences the general health by reason of its abundance or insufficiency,
why may it not act still more by its nature ? It is a universally accepted
fact that the most robust, active and aggressive people are great meat
eaters. People whose chief subsistence is composed largely of carbohy-
drate foods vegetables and fruits are nearly always peaceful, as, for
instance, the inhabitants of Central Asia, with whom rice and vegetables
with a little pork or fish form the principal articles of diet (4). We cannot
help coupling these facts with the statement previously made that carniv-
orous animals are generally fierce and savage, while the herbivora, on the
contrary, are easy to tame and domesticate. Excessive or exclusive flesh
diet plays even a greater role than racial peculiarities in influencing the
temper of an individual. Gautier(l) is authority 'for the statement that
white (laboratory) rats are manageable and easy to tame as long as they
are fed on bread or grain, but when fed on flesh they become snappy and
aggressive given to biting. Liebig relates that a bear kept in a museum
at Giessen was a gentle, docile animal when fed exclusively on bread and
vegetables, but a few days on animal diet caused it to become fierce and
dangerous, even to its keeper.
We may, then, safely adduce the theory that diet influences tempera-
ment. An exclusive animal diet makes one more aggressive, pugnacious,
determined and self-willed ; while an exclusive vegetable diet depletes and
enfeebles the violence of temperaments and softens and subdues manners.
This fact has long been understood by the founders of religious orders in
Europe, India and Asia, who have, accordingly, limited or prohibited the
allowance of animal food in the dietary.
In studying the "Processes of Digestion," we learned that vegetable
food is less completely assimilated than animal food, imposing greater
exertions on the part of the intestine, thereby diverting part of its energy
DIETOTHERAPY GENERAL PRINCIPLES 371
to the accomplishment of these lower functions; it introduces into the
system far less nutrition than meats, and far less of those sapid extractive
matters which stimulate the heart, prod the muscle, and augment mechan-
ical energy (1). It is, therefore, plain that an exclusively vegetable diet
perceptibly weakens and softens the will. The wolf and wild cat speci-
mens of the most dangerous carnivorous animals have been domesticated
by a change of diet into docile, peaceable, friendly household pets dogs
and cats.
Influence of Diet on Races If we accept the theory that diet affects
the development of the organs and character, we can hardly deny that it
also modifies races. Uarwiii voiced the opinion that alimentation which
creates internal conditions is, with the influence exercised by external con-
ditions and selection, the preponderant cause of the variations observed in
animals. Gautier believes that the qualities peculiar to each individual
and each race are perceptibly influenced by the continuous action of diet,
and that, reciprocally, when habits are contracted and temperaments
created by long heredity, a special diet often becomes necessary. He says
an Englishman or Dutchman will become weakened on being deprived of
meat far more quickly than the Spaniard, Southern Frenchman or Italian,
and that the latter races, when fed on the same food, if almost entirely
vegetable, will be able to perform much more work than a member of the
Northern races. Beyond doubt diet influences the physiological vigor and
character of races. As a consequence, it must also have a bearing on
intellectual aptitudes.
Occupation and Diet We know that a man doing mechanical work re-
quires a dietary abundant in ternary principles carbohydrates, hydro-
carbons and meat, especially the latter. Such a dietary, we have seen,
develops muscular force, energy, vigor and even violence, while on the
contrary, it is not very favorable to the culture of the artistic or scientific
temperament. According to Gautier, those who would give themselves up
to speculation and thought, to the exercise of their powers of observation
or generalization, the development or expression of their artistic senti-
ments, the cultivation of the abstract sciences, etc., require bread, green
vegetables, ripe fruits, and, for nitrogenous food, 150 to 200 grams (5 to
6 ounces) of meat, fish or poultry per day, eggs, milk and other foods
easily digested (rice, carrots, cauliflower, asparagus, mushrooms, a small
quantity of potatoes, etc.), and finally a few aromatic condiments, together
with a little coffee or tea. Such a diet is far more suitable than one rich
in animal proteins and fats, and the more so because those who devote
themselves to exercising the mind or imagination generally take insuf-
372 DIET IX HEALTH
ficient physical exercise, thus constituting themselves candidates for
arthritis, gout, hepatic, cerebral and renal congestions. Such predisposi-
tions are often increased by the abuse of coffee or tea, sometimes of alcohol
or tobacco, and the desire for condiments which momentarily excite the
appetite which sedentary work tends to weaken. For them the dishes to
avoid are those which are difficult to digest or which require to be taken
in a great quantity, too abundant meats and too starchy vegetables.
For individuals who devote their energies to intellectual research, in
whom artistic impressions predominate, the dietary allowance should be
that which corresponds to their vocation as well as to the climate in which
they live. Beyond doubt, all brain work consumes energy corresponding
to the effort expended. Moritz Schiff has "demonstrated that every im-
pression heats the brain and the organism and causes as a consequence an
expenditure of energy." Physiologists have pointed out the fact that intel-
lectual fatigue does not increase the quantity of the total urinary nitrogen
and consequently the amount of protein broken up or the combustion of
fats (5) or even the amount of phosphorus excreted in a given period of
time. When considering the subject of "Hygiene of Eating," we empha-
sized the point that intellectual effort should never .be undertaken imme-
diately after or following a large meal, when the organs of digestion are
most active and require that the blood should not flow to the brain, but
to the stomach. During sleep, the destruction of the nitrogenous principles
of our tissues does not appear to vary ; but that of the fatty bodies becomes
greatly enfeebled without the amount of oxygen absorbed always diminish-
ing in proportion. There is often an accumulation of oxygen in the system
during the night's rest, especially in the case of young children (6).
Climate and Diet. Climate and season beyond question have an im-
portant bearing on the necessary dietary. In cold climates and seasons
more heat is radiated from the body, and the loss from breathing is much
greater ; therefore a richer dietary for the same amount of work becomes
necessary, and, similarly, a poorer dietary will suffice in a warm country.
As will be seen further on in this chapter, when considering diet in the
tropics, it is obvious that more heat is radiated by evaporation of the
water from the lungs or in the form of perspiration in hot climates, which
diminishes the proportion ' of energy otherwise capable of being trans-
formed into muscular exertion. It is apparent, therefore, that this loss by
cooling is slight, and the individual will be able to discharge his functions
and allotted tasks equally well on a smaller diet. Gautier records an in-
stance where Catalonians lived on a dietary which provided them with
no more than 1,900 to 2,000 calories, yet they were none the less good-
DIETOTHERAPY GENERAL PKItfCIPLES
373
tempered, healthy and muscular, and capable of executing a great amount
of work. This author also quotes Maurel of Toulouse, who has done some
interesting research work along this line(7). Below is inserted a table
worked out by Prof. Maurel for the maintenance allowance in hot seasons
and hot countries, cold seasons and cold countries, and finally the inter-
mediate climates for normal individuals from twenty to thirty:
MAINTENANCE ALLOWANCE ACCORDING TO CLIMATES
Climate and Seasons
Number of
Calorics per
kilogram
CALORIES PER 24 HOURS
Man
weighing
GO kilograms
Man
weighing
70 kilograms
Man
weighing
80 kilograms
Hot season of hot countries. .
Cold season of hot countries
and summer of temperate
countries
30
35
40
45
50
1800
3100
2400
2700
3000
2100
2450
2800
3150
3500
2400
2800
3200
3600
4000
Intermediate season of tem-
perate countries and sum-
mer of cold countries
Cold season of temperate
countries and intermediate
season of cold countries . . .
Cold season of cold countries
In the beginning of this chapter we referred to diet in cold climates
and to the enormous amount of meats and fats consumed by the inhabi-
tants of the Polar and Arctic regions. Wherever muscular exorcise be-
comes a necessity, animal food should form a large part of the dietary,
and the allowance should be relatively more liberal in proportion to the
degree of work to be performed. Explorers have given us the advantage
of their experiences in the Arctic regions in allowing a certain propor-
tion of alcoholic beverages with meals(8). During a cold season or in
the Arctic regions the question of resisting cold is a vital one. We have
seen that the ingestion of large quantities of fat and flesh, with this object
in view, is of the utmost importance. The Eskimo and Greenlander when
exposed to the cold will drink and relish several pints of fish oil per day.
On the other hand, in tropical climates and hot seasons, fats, the great
producers of heat, should naturally form only a small part of the daily
ration, and soft drinks, lemonades, etc., should take their place. This
point will be further elaborated on in the section on "Foods in Tropical
Countries."
124
374
DIET IN HEALTH
DIET STUDIES
The dietaries of the inhabitants of the United States vary with differ-
ent classes and in different sections of the country. Numerous investiga-
tions upon nutrition have been made in the various parts of the United
States under the auspices of the Department of Agriculture(9). The
table on page 249 shows the dietaries of various classes of laborers, students
and professional men. This table contains facts and figures with reference
to the diet of students' clubs and colleges and contrasts them with the diet
of professional men and mechanics. It must be borne in mind that the
dietaries contained in this table(lO), giving the protein, fat, carbohydrate
and energy content of the various standard diets and of the diet in the
principal universities and for mechanics and other day laborers, does not
portray accurately the dietary of the people of the different sections of the
country. It is evident from the facts and figures in these statistics that
people eat what their markets provide, except when poverty prevents pur-
chasing. For instance, the family of a sewing woman in New York
City (11) averaged for one person a day:
DIETARY OF A POOR PERSON IN NEW YORK CITY, SHOWING THE
FOOD ELEMENTS AND CALORIES
Protein
Fat
Carbo-
hydrate
Energy
Equivalent
Animal food
Grams
26
Grams
34
Grams
15
Calories
485
Vegetable food
31
7
222
1,100
Total
57
41
237
1,585
Or a total of 57 grams of protein and 1,585 calories, this being less than
a mere subsistence. The articles of food consumed by this family were
beef shank, pork chops, sardines, eggs, butter, milk, barley, wheat flour,
rye bread, wheat bread, rolls, cakes, crackers, sugar, beans, potatoes, rad-
ishes, rhibarb and tomatoes. The principal quantities of animal food
consumed were in the form of eggs and milk; of carbohydrate, bread,
sugar, potatoes and canned tomatoes.
Students' Clubs The table below outlines the various articles of food
comprising the dietary of students' clubs in four different states, as men-
tioned in the table on page 249, Volume II, Chapter IX.
DIET STUDIKS
375
WEIGHT OF DIFFERENT CLASSES OF FOOD PURCHASED PER MAN
PER DAY(16)
Tennessee
Missouri
Connecticut
Maine
Hoof veal mutton
Grains
187
Grams
160
Grams
245
Grams
231
Pork
89
113
91
98
Poultry . .
28
12
6
100
Fish .
12
6
24
77
Eecs. .
32
55
35
53
Butter
39
27
60
52
Cheese
7
7
Milk
97
680
457
910
Buttermilk
108
Cereals, sugar, etc
564
524
361
835
Vegetables. .
250
266
189
530
Fruits. . .
50
51
89
48
A study of this table reveals the fact that the greatest quantities of
animal foods were consumed by the students' clubs in Maine, Missouri
and Connecticut, and the least in Tennessee. The consumption of carbo-
hydrate foods was largest in Maine and least in Connecticut. It will be
noticed also that the students in Connecticut and Maine consumed a larger
proportion of beef than was used by the students in Tennessee or Missouri.
In the latter state the students consumed a noticeably large amount of
pork. While in Maine poultry and fish comprised a large part of the
animal food, these were little used in the colleges in Tennessee and Mis-
souri. Milk formed a conspicuous percentage of the diet in the schools
of Missouri, Connecticut and Elaine, while in Tennessee it was used spar-
ingly. The dietary of the student clubs in Maine seems to be much more
generous in all respects than the others. In Tennessee the average of five
student clubs was 92 grams of protein, yielding 3,545 calories of energy ;
38 per cent of the food value was obtained from animal food and 62 per
cent from vegetable food. In Missouri the average of three student clubs
was 06 grams of protein, the menu yielded 3,560 calories of energy, and
the food value was about equally divided between the animal and vegetable
kingdoms. In Connecticut, of 5 student clubs the average was 106 grams
of protein, the ration yielding 3,280 calories of energy, 53 per cent of
which was furnished by animal food and 47 by vegetable food. In Maine,
the average of 5 student clubs was 121 grams of protein, the menu yield-
ing 4,269 calories of energy, -40 por cent of which was furnished by animal
food and 00 per cent by vegetable food. Although these dietaries do not
portray the actual dietaries of the people in the sections of the country
376 DIET IN HEALTH
where these schools are located, yet they may be accepted as an approximate
criterion of the usual dietary of the inhabitants of the various sections.
Mechanics and Laborers. The dietary of most mechanics in the United
States affords them from 100 to 150 grams of protein, and yields from
3,000 to 5,000 calories of energy. A list of occupations requiring a great
expenditure of energy and the necessary energy required expressed in
calories will be found by referring to previous pages in this chapter.
It is not, after all, such a formidable task to reckon the caloric value of a
meal. For instance, take the principal meal (dinner) of a laborer or
mechanic: roast beef, 100 calories; bread, 150 calories; butter, 150
calories; rice, 128 calories; baked potato, 100 calories; bread pudding,
128 calories; sugar and cream with coffee, 100 calories; total, 960 calories,
about one-third of the day's requirements. A meal of this composition is
over-rich in protein, but the balance would be restored by lack of protein
and an excess of green vegetables and fruits at the other two meals. It
will be taken into consideration that the ordinary portions of these sub-
stantial foods average about 100 calories. When extra strenuous effort
is put forth in an occupation, the portions of bread and potatoes, butter
and rice can be increased and easily raise the meal to the energy require-
ment without adding to the main protein ration, whatever it may be
meat, cheese, chicken or fish. If a laborer has been subjected to strenu-
ous exercise and is hungry, allow him to fill up on non-protein elements of
the meal, help him to more potatoes and vegetables or simple pudding,
instead of increasing the animal foods.
It has been found in the South that cornbread and molasses will fur-
nish the necessary energy to carry a negro through a cold day. If he
works hard, he will burn it up completely, and there will be no ashes as
would be the case if he overate of meat or other protein. Late researches
tend to prove that the protein elements can be stored, at least for a short
period of time, in the tissues ; but such a storage is more or less dangerous
from the extra strain put on the liver and kidneys to excrete the waste.
Carbonaceous foods sugar, starches and fats can be stored in the form
of tissue fats.
The average human body weighing 154 pounds should have about six-
tenths of its heat or fuel units supplied from carbohydrates, sugar, pota-
toes, bread, cereals and vegetables; three-tenths should be supplied by
fats, butter, oils, cream or meat fats the last being the least desirable
form in which this element may be supplied. These energy or fuel foods
should be increased in quantity in proportion to the energy expended in
strenuous exercise or in the performance of hard work.
DIET STUDIES
377
It has always been recognized by scientific men that the allowance of
food should be in proportion to the work the body is expected to do. Play-
fair (12), who has given this subject a great deal of attention, has worked
out a table with the corresponding amounts of matter and energy in grams
and calories, estimated by Rubner's factors.
PLAYFAIR'S TABLE OF REQUIREMENTS FOR WORK
Subject and
Condition
.Sf
"go
II
o -
O 02
r o
|8
3 "*^
am
|>J
a .
'53 2
1
Pi
*'
oj
1 1
-8
o3 g
E
-c
2
la
. - OQ
**\
||
HO
Subsistence diet
2.230
.840
11.69
2,453
63.25
22.0
330
1,820
Moderate work
4.075
1.557
18.80
1.963
4,072
115.00
44.0
534
14.00
3,070
Soldiers: During peace
Infantry in the field .
Royal Engineers in
the field
4.215
5.410
5.080
1.397
2.410
2.910
18.69
17.92
22.25
.714
.680
.930
4,026
4,458
5,232
120.00
154.00
144.00
40.0
68.0
82.5
510
610
610
19.25
19.07
26.36
3,037
3,374
3,858
English sailors
5.000
2.370
14.39
3,911
142.00
65.0
410
3,067
Navy
5.640
2.340
20.41
4,839
160.00
67.0
578
3,650
Prisoners : Under 7 days
1.800
.480
10.71
1,938
51.00
14.0
304
1,626
Under 21 days . . .
2.448
.608
14.80
2,650
68.00
17.0
2,179
Light labor
3.508
.315
16.72
1.715
3,577
100.00
9.0
470
50.00
2,420
Industrial labor ....
Hard labor
3.710
4.075
1.562
1.557
17.31
18.80
1.616
1.963
3,787
4,072
105.00
116.00
44.0
44.0
495
534
46.00
14.00
2,870
3,075
Undergoing punish-
ment
1.296
.256
8.16
.368
1,541
36.00
71
230
1060
1,154
Many physiologic investigators have devoted considerable time and
research to determine the alimentation consumed by individuals who were
allowed a "free choice of food," and have come to the conclusion that the
dietaries having the food value given in Playfair's table would furnish a
nutrition that was fairly normal and that the nitrogen balance would be
kept in a fair state of equilibrium. The conclusion is that the Play fair
dietaries represent fairly well the amount of food required by persons
studied in these tables, which we will now compare with the alimentation
outlined in the table given on page 270. The list of examples of food con-
sumed is compiled from data collected by Tibbies (18) in Europe, Asia
and America, and shows that when Europeans or Americans are free to
choose their own food they seldom select what will yield less than 100
grams of protein per diem. When the choice of food rests with the indi-
vidual (American), he seldom partakes of less than 90 grams of protein
per day. In this country there are many thousands of individuals who,
from force of circumstances, are necessarily compelled to subsist on a
378
DIET IN HEALTH
dietary with a much smaller quantity of protein, because eggs, meat, fish,
fowl, milk and cheese are more expensive than bread, potatoes, rice, -oat-
meal, etc.
Standard and Actual Dietaries Compared. We will now study the fol-
lowing standard daily dietaries as suggested by Hutchison (14), all con-
taining a high protein content, founded on the investigations by At-
water(15) :
DAILY STANDARD DIETARIES
(Food materials furnishing approximately the 0.28 pound = 125 grams of protein and
3,500 calories of energy of the standard for daily dietary of a man of moderate
muscular work.)
Food Materials
Amount
Total
Organic
Matter
Protein
Fats
Carbo-
hydrates
Fuel
Values
I
Beef, round steak
Ounces
13
Pounds
0.26
Pounds
0.14
Pounds
0.12
Pounds
Calories
695
Butter. . .
3
0.16
0.16
680
Potatoes ...
6
0.17
0.02
0.15
320
Bread
22
0.89
0.12
0.02
0.75
1760
II
Pork, salt
44
4
1.48
0.21
0.28
0.30
0.21
0.90
3455
880
Butter
2
0.11
0.11
450
Beans
16
0.84
0.23
0.02
0.59
1615
Bread
8
0.33
0.04
0.01
0.28
640
Ill
Beef, neck
30
10
1.49
0.19
0.27
0.10
0.35
0.09
0.87
3585
550
Butter
1
0.05
0.05
255
Milk, one pint. .
16
0.13
0.04
0.04
005
325
Potatoes
16
0.17
0.02
0.15
320
Oatmeal
4
0.23
0.04
0.02
0.17
460
Bread
16
0.67
0.09
0.02
0.56
1280
Sugar
3
0.19
0.19
345
IV
Beef, upper shoulder
66
10
1.63
0.22
0.29
0.09
0.22
0.13
1.12
3535
800
Ham
6
0.19
0.06
0.13
650
Eggs, two
3
005
003
002
135
Butter. . . .
2
11
11
450
Milk, one pint
16
0.13
0.04
0.04
0.05
325
Potatoes
12
12
001
11
240
Flour
9
044
005
001
038
825
Sugar
1
006
006
115
59
1.32
0.28
0.44
0.60
3540
DIKT STUDIES
379
DAILY STANDARD DIETARIES Continued
Food Materials
Amount
Total
Organic
Matter
Protein
Fats
Carbo-
hydrates
Fuel
Values
V
Sausage
Ounces
4
Pounds
0.14
Pounds
0.03
Pounds
0.11
Pounds
Calories
510
Codfish
14
0.07
0.07
140
Butter. . .
2
11
11
450
Milk, one pint
16
13
0.04
0.04
0.05
325
Beans
5
0.26
0.07
0.01
0.18
505
Rice
2
Oil
0.01
0.10
205
Potatoes
16
0.24
0.01
0.23
420
Bread
9
0.33
0.04
0.01
0.28
640
Sugar
3
0.19
0.19
345
VI
Beef
71
8
1.58
18
0.27
008
0.28
10
1.03
3540
560
Mackerel, salt
4
0.08
004
0.04
230
Two eggs
3
0.05
0.03
0.02
135
Butter
2H
0.13
0.13
565
Cheese
1
0.04
0.02
0.02
130
Milk, one pint
16
0.13
0.04
0.04
0.05
325
Potatoes.
8
009
001
008
160
Rice
2
11
001
0.10
205
Bread ... .
9
0.38
0.05
0.01
0.32
720
Sugar
1 1 A
0.69
0.09
175
55
1.88
0.28
0.36
0.64
3205
The standard daily dietaries given are constructed from theoretical
data taken from Hutchison on this and the preceding page. It will now be
interesting to make a comparative study of these dietaries with the com-
position of ordinary daily dietaries actually consumed by individuals of
different countries, of different social rank, following various and sundry
occupations. In the table on pages 378-0, modified from Atwater(lG),
studies are compiled from a large number of actual dietaries.
On careful study of the tables (pages 380-1 ) of actual dietaries, it will
be observed that they conform closely to the ideal standard dietary on the
preceding page. Discrepancies of course will be noted here and there. For
instance, the diet of the sewing girl in London is altogether insufficient for
bodily requirements, while, on the other hand, the diet of some well-to-do
American families, bricklayers, and teamsters is needlessly liberal, espe-
cially with the protein allowance (compare low protein allowance sug-
gested by Chittenden(lT) in his standard dietary table given in Volume
II, Chapter VII). Taking the preceding table as a whole, it is gratifying
380
DIET IN HEALTH
ACTUAL DIETARIES
CLASSES
NUTRITIVE CONSTITUENTS
Potential
Energy
Protein
Fats
Carbo-
hydrates
Total
United States Dietaries
Factory operatives, mechanics, etc., Mass.
Glass-blowers E. Cambridge, Mass
Grams
127
95
114
129
128
161
138
115
104
181
182
222
254
180
120
143
103
104
101
105
109
118
107.7
115
63
73
100
155
53
52
60
Grams
186
132
150
183
177
204
184
163
136
292
254
263
363
365
161
184
138
125
139
147
109
204
88.4
113
3
30
84
177
33
53
28
Grams
531
481
522
467
466
680
622
460
421
557
617
758
826
1,150
454
520
436
423
414
465
527
549
479.4
289
481
472
264
440
316
301
398
Grams
844
708
786
779
771
1,045
944
738
661
1,030
1,053
1,243
1,443
1,695
735
847
677
745
871
675.5
402
406
486
Calories
4,428
3,590
4,002
4,146
4,082
5,345
4,827
3,874
3,417
5,742
5,638
6,464
7,804
8,848
3,851
4,998
3,500
3,325
3,405
3,705
3,622
4,632
3,228
2,705
2,258
2,512
2,470
4,085
1,820
1,940
3.138
Factory operatives, dressmakers, clerks,
etc., boarding-house
Well-to-do private family, Connecticut:
Food purchased
Food eaten
College students from Northern and East-
ern States; boarding club, two die-
taries of the same club:
Food purchased
Food eaten
Food purchased
Food eaten
College football team food eaten.
Machinist, Boston, Mass
Brick-makers, Middletown, Conn
Teamsters, marble- workers, etc., with hard
work, Boston, Mass
Brick-makers, Cambridge, Mass
U. S. Army ration
U. S. Navy ration
Average of 53 American studies
Professional men in America (average of
14 studies)
Average of 4 women students' clubs in
America
Average of 16 men students' clubs in
America. ...
Canadian Dietaries
French Canadians, working people, in
Canada
French Canadians, factory operatives,
mechanics, etc
European Dietaries
Average diet of laborer's family in Edin-
burgh. .
Chinese dentist's family
Japanese professional man
Malays (professional men)
Europeans in Java (professional men) ....
University boat crews (average of 7
studies)
London, sewing girl, wages 3s. 9d. per week
Leipsic, Germany, factory girl, 5s. per week
England, weaver, time of scarcitv . .
DIET STUDIES
ACTUAL DIETARIES Continued
381
CLASSES
NUTRITIVE CONSTITUENTS
Potential
Energy
Protein
Fats
Carbo-
hydrates
Total
European Dietaries Continued
Lombardy, Italy, laborers; diet mostly
vegetable
Grams
82
68
97
100
80
131
87
77
131
151
131
151
176
133
167
223
114
134
157
132
134
189
Grams
40
11
16
100
125
95
69
57
39
54
68
43
71
113
117
113
39
58
285
80
79
110
Grams
362
469
438
240
222
327
366
466
525
479
494
622
667
634
675
909
480
489
331
583
523
714
Grams
484
548
551
440
427
553
522
600
695
684
693
816
914
880
959
245
633
681
733
Calories
2,192
2,304
2,343
2,324
2,401
2,762
2,500
2,757
3,053
3,085
3,194
3,569
4,117
4,195
4,641
5,692
2,798
3,098
4,652
3,675
3,436
4,726
Trappist monk in cloister; very little ex-
ercise, vegetable diet. . . .
Japan, students
Munich, Germany, university professor,
very little exercise
Munich, lawyer
Munich, physician
Leipsic. Germany, painter
Leipsic, Germany, cabinet-maker
England "fully fed" tailors
Munich, Germany, "well-paid" mechanic.
Munich, Germany, carpenter
England, "hard-worked" weaver
England, blacksmith
Germany, miners at very severe work. . . .
Munich, brick-makers (Italians at con-
tract work)
Munich, brewery laborer, very severe
work, exceptional diet
German soldiers, peace footing
German soldiers, war footing. ... ....
German soldiers, Franco-German War, ex-
traordinary ration
Russian workmen
Swedish workmen (moderate labor)
Swedish workmen (hard labor)
to observe the closeness with which the actual dietaries correspond to the
standard. We must not overlook the fact that the standard dietaries such
as we have been considering have only a limited range of usefulness. It
would not be wise to apply them rigidly in any particular case, since they
have been formulated to meet the demands of typical vocations living
under well-known and regulated conditions and engaged in occupations
calling for only a moderate amount of muscular work. Still they are of
value in guiding us to formulate well-balanced rations for persons who
have no decided choice in their alimentation, and who are living under
fairly uniform regulations such as soldiers, inmates of prisons, homes
and workhouses. Besides, these studies furnish us with standard infor-
mation hy which to regulate well-balanced rations for any collection of
individuals,
382 DIET IX HEALTH
Col. Melville, in discussing "The Food Requirements for Sustenance
and Work" (18), reported before the British Medical Association his
studies on the observation of men doing a measured amount of work with a
measured quantity of food.
Twenty soldiers walked for periods of five and six days an average of twelve
to thirteen miles, carrying their kit, the weight of which averaged 54 pounds
(24.5 kilos). The average weight of the men was 141 pounds (64.15 kilos). The
expenditure of energy was calculated from Zuntz's factors: For every kilo trans-
ported horizontally at the rate of 94 meters (102 yards) per minute the expendi-
ture was 0.0006 calorie; and for every kilo raised 1 meter vertically the expenditure
was 0.0075 calorie; whence it was determined that the average expenditure in
walking one mile and carrying 54 pounds over an ordinary give-and-take road
was 90 calories, and the total daily expenditure in external or mechanical work
amounted to 1,034 calories.
According to the above, it will be readily seen that the total energy
expended by these men was as follows :
ENERGY EXPENDED BY MARCHING SOLDIERS
(a) Energy spent in sedentary occupation (Zuntz) 2,200 calories
(b) Energy spent in work to camp life, and in playing quoits and foot-
ball 800
(c) Energy spent in walking and carrying load 1,034 "
Total average daily expenditure 4,034 "
The march was done on six days continuously, then one day's rest in-
tervened before the second period of five days' walking completed the
work done. The food consumed was as follows :
FOOD CONSUMED BY EACH SOLDIER PER DAY
First Week Second Week Average
Proteins 190 grams 145 grams 168 grams
Carbohydrates 510 450 480
Fat 58 " 110 " 84
Calories 3,426 " 3,503 3,481
Unavoidable waste, 10 per cent: net calorific value, 3,140.
A careful examination of the above tabulation by Melville (19) em-
phasizes the fact that there was a deficiency of 890 calories in the
alimentation.
Negroes and Poor Mexicans. Atwater and Wood (20) call special at-
tention to the fact that "our dietary is out of balance," and aver that "the
one-sidedness is greater in the South than in the North," by which they
mean that the ratio between protein and calories is greater than it should
be. The table on page 384 gives data with reference to the protein require-
ment of the diet of both men and women in various occupations. Hoff-
DIET STUDIES 383
mail, in writing on the diet of the Southern negroes(21), emphasizes the
point that the negroes of the Southern States subsist on an unvaried diet,
consisting- either of staple foods of fat, salt pork, corn meal and molasses,
and that with them cooking is most primitive. The following from Hoff-
man's views 011 the subject is of interest:
The daily fare is prepared in very simple ways. Corn meal is mixed with
water and baked on the flat surface of a hoe or griddle. The salt pork is sliced
thin and fried until very brown and much of the grease fried out. Molasses
from cane or sorghum is added to the fat, making what is known as "sop," which
is eaten with the corn bread. Hot water sweetened with molasses is used as a
beverage. This is the bill of fare, three times a day during the year, of most of
the cabins on the plantations of the "black belt." It is, however, varied at times;
thus, collards and turnips are boiled with the bacon, the latter being used with the
vegetables to supply fat, "to make it rich." The corn-meal bread is sometimes
made into so-called "cracklin bread," and is prepared as follows: A piece of
fat bacon is fried until it is brittle; it is then crushed and mixed with corn meal,
water, soda and salt and baked in an oven over the fireplace. Occasionally, the
negroes may have an opossum. To prepare this for eating it is first put into hot
water to help in removing a part of the hair, then covered with hot ashes until
the rest of the hair is removed; thereupon it is put in a large pot, surrounded
with sweet potatoes, seasoned with red pepper, and baked. One characteristic
of the cooking is that all meats are fried or otherwise cooked until they are crisp.
Observation among these people reveals the fact that very many of them suffer
from indigestion in some form.
Arthur Goss(22), in writing on the dietary standards of the Alabama
negroes, makes a comparison of their diet with that of the Mexicans of New
Mexico, and the following from his observations is of interest in this
connection :
Mexicans of the poorer class raise the greater part of their food, which is
p 1 nost entirely of vegetable origin. Flour and corn are used, the relative amounts
depending upon the amount of money available. If it is necessary to reduce the
cost of living to the minimum, as is often the case, more corn and less flour is used.
Piobably the next article in amount, and a very important one, is the native
bean or "frijole" (Phaseolus sp.), which, together with peas and lentils, is used
to supply the protein necessary in the absence of meats and other nitrogenous
foods of animal origin.
Another universal article in the Mexican diet is red pepper, or "chili," which,
while it constitutes comparatively a rather small proportion by weight of the
total food, is still consumed in enormous quantities as compared with the use of
such material by the people of the eastern states. Chili is probably used more
for its stimulating effect on the digestive organs than for the actual amount of
nutrients which it furnishes.
In point of cost, probably the most important article used by the Mexicans
not home produced is coffee. Lard is another very important article which is
usually purchased, and which is used in considerable quantities. As the vege-
DIET IX HEALTH
table foods used contain very little fat, it is necessary to increase the amount of
this substance by addition from outside sources, usually either lard compound or
beef tallow, which are the cheapest forms of fat in this region.
In the houses of the poorer class the cooking is done in an open fireplace,
usually located in one corner of the room.
The "tortillas" (23), or cakes made from flour or ground corn, are one of
the most generally and extensively used foods. When the tortillas are made from
corn, the kernels are first boiled with lime, which softens them. The skin is
then usually, though not always, removed, and the grain is ground in a crude
stone grinding apparatus, or "metate," consisting of a concave slab of stone and
a smaller convex piece, which is held in the hands and which serves as a pestle.
The grinding is not rotary, however, as in an ordinary mortar, but up and down,
toward and from the body. The corn used is usually a small blue kind, rather
soft, which seems to contain somewhat more than the average amount of fat.
After the corn has been ground into a mush on the metate, it is patted out in
the hands into the tortillas. Corn tortillas are never rolled, as is the case with
those made from flour. If flour is used, it is mixed into a dough with water and
the cake rolled out from it. The flour used is not ground in the metate, but in
the ordinary flouring mills. It is usually of poor quality, coarse and dark colored.
After being worked into the proper form, the tortilla is baked on a flat piece of
iron, supported directly over the fire in the open fireplace, the iron being first
greased with lard. As soon as it is done on one side the tortilla is turned by
pressing the moistened fingers against the upper side of it, thus causing it to
adhere to the fingers, whereupon it is deftly turned and the opposite side is
browned.
The frijoles, or beans, are cooked in small, home-made earthenware pots, and
are almost invariably combined with a very liberal proportion of chili and also
with a considerable amount of lard.
DAILY DIETARY OF NEGRO FARMER AND POOR MEXICAN
Protein
Fat
Carbo-
hydrate
Calories
Negro fanner:
Animal
Grams
52
Grams
119
Grams
65
1585
Vegetable
40
5
360
3270
Same
Animal
2
41
395
Vegetable
42
16
372
1845
Same:
Animal
26
74
26
900
Vegetable
33
11
403
1890
Poor Mexican
Animal
56
520
Vegetable
107
19
713
3540
Same'
Animal.
61
565
Vegetable
93
19
644
3200
Same:
Animal
4
49
470
Vegetable
82
23
571
2890
Same:
Animal
29
60
680
Vegetable
72
7
572
2705
USE OF ALCOHOL 385
The chili is cooked alone, and also with various other articles of food. It is
prepared hy first removing the stems and seeds of the pods, which constitute
somewhat more than half of the total weight, after which it is sometimes ground
in the metate, but is usually soaked in water and the inner or edible portion
separated from the outer skin by squeezing in the hands. Owing to the extremely
strong irritating effect on the hands, this operation cannot be performed by an
amateur. The Mexican women, however, become so accustomed to it that it seems
to have no effect on them.
Among the poor families the meals are served on the floor in the middle of
the room, the family sitting on the ground around the food and eating without
knives, forks or plates.
The exceedingly small amount of animal food consumed by some of
the negro families studied by Hoffman, and its entire absence, except as
represented by lard, in some of the Mexican families as studied by Goss,
are shown in the table on the preceding page. This research shows a suf-
ficient source of heat units obtained from vegetable fuel foods, but at the
same time it shows an insufficiency of protein, most of which is derived
from vegetable foods and in some instances altogether so. For the sake
of comparison, consult the Standard Dietary as outlined by Chit-
tcnden(17).
USE OF ALCOHOL
A healthy normal individual does not need alcohol. As a beverage
it undoubtedly exerts harmful influences upon the human economy. It is
absolutely unnecessary in health, but it is so extensively employed in all
parts of the world either to produce fictitious exhilaration or, by lessening
sensibility, to mitigate fatigue and discomfort, sorrow and suffering, and
it has been so largely and so injudiciously used in disease, that it demands
sonic consideration. (See also Volume I, Chapter XVI, "Beverages
and Stimulants"). Its habitual use prods the heart to greater activity.
Richardson, writing on the subject, says: "One ounce of alcohol daily will
increase the heart beats 430 ; 2 ounces, 1,872 ; 4 ounces, 12,960 : 6 ounces,
30,670." But while increasing the rate of the heart, it weakens the fdrce
so that the final result is to lower the blood pressure. In other words,
while the heart seems to be stimulated, it is really weakened. It is not
surprising therefore that a period of enfeeblement of this organ follows
the habitual use of alcohol.
The use of alcohol does not increase muscular energy, but on the other
hand fatigue is hastened by it. Its effect on individuals varies ercatlv;
sonic show ill effects on small doses and others are seemingly resistant to
large ones. Some people are stimulated by it to eat more hcartilv and to
386 DIET IS HEALTH
put forth less muscular exertion, and since oxidation goes on more slowly
in these individuals, they easily accumulate fat, but, although they may
appear plump and full fed, they are not, as a rule, resistant to disease nor
capable of prolonged, strenuous, muscular exertion. Its habitual use is of
no advantage in normal health, while those who are not strong-willed or
self -control led, and those who inherit a love for liquor or have a tendency
to inebriety, gout, arteriosclerosis, or other degenerative changes, will be
far better without it. It is true, many persons can use it in strict modera-
tion without apparent harm ; the majority, however, sooner or later awake
to the realization that even with moderation they are not so well when
they use it habitually. The continued and habitual use of alcoholic bev-
erages invariably exerts a harmful influence on the human organism.
The wisdom or folly of their use in health is not a question that the
physiologist alone can determine. The ease with which the habit of im-
bibing spirituous liquors grows to an excess, and the harmful influences
exerted by them on the body politic, make the desirability of their use a
social problem as well as a physiological one.
Since alcohol is really a narcotic and not a stimulant at all, and since
it is not a food in any real scientific sense, it need not, therefore, be
further discussed under the present caption : "Diet in Health."
DIET IN TROPICAL CLIMATES (24)
It has been generally taught that in tropical climates a smaller amount
of nitrogenous food is required than in the temperate zones. Of course,
it must be premised that the natives of tropical lands are better fitted
physically and physiologically to withstand excessive heat and the actinic
rays of the sun in hot climates than are the white men who, as a rule, are
only sojourners. But even in the case of natives, the long-held ideas that
"they should eat the kind of food which is habitual with them because it
best suits their requirements," are lapsing into something like disrepute.
In fact, within recent years opinions as to diet in the tropics both for
natives and for white men have changed very considerably.
General Considerations. We will present herewith the views of various
authorities on the subject, and then endeavor to sift the evidence or leave
it to our readers to form their own opinions. The late Dr. Charles Wood-
ruff (25), a man of very decided views and one who was not afraid to
express them, however much they might clash with those of other observ-
ers, delivered himself somewhat ns follows with respect to diet in hot
climates. "It used to be an article of faith in physiology, that wherever
387
we go in the world we should imitate the natives in food, clothing, houses
and methods of work. Upon acquaintance with the native \ve found him
poverty stricken, weak, undersized, even half starved, badly housed, filthy,
diseased, and of such lack of vitality as to average less than fifteen years of
life. To imitate him, as our physiologists taught, was merely to die twenty
or twenty-five years before our time." According to Woodruff, false notions
are now gradually disappearing in the light of new facts. Take, for exam-
ple, the matter of meat in the tropics. The orthodox theory was that we
must cut down animal foods below the limit found necessary at home,
because, forsooth, the native dying of nitrogen starvation could not get as
much as he should. The theory was put into practice with disastrous
results, and nowadays every army officer knows that to avoid the awful
exhaustions caused by tropical climates and the consequent infections,
such as tuberculosis, etc., we must have as much animal food as we have at
home, or even more.
Perhaps Woodruff was inclined to exaggerate the value of nitrogenous
food in the tropics, but there are many who have had experience in the
Philippines and in India who hold views very much to his way of think-
ing. At any rate, the old-time conception that nitrogenous food was con-
tra-indicated in the tropics has been almost exploded.
Lukis and Blackham(26) uphold the teaching that in cold climates
the fats should be increased and in warm climates the carbohydrates. Yet
they do not insist on a vegetarian diet for white men or natives. They
point out in support of the argument, that fats are not suitable for con-
sumption in hot climates, that, while butter is eaten with avidity in the
temperate zone, butter or fats of any description are regarded with dis-
taste in the plains of India. These same authorities are not in accord
with Chittendeii's views, that the current estimations of the amount of
protein and total fuel value necessary for hard work are excessive, and
they draw attention to the fact that the most recent researches fail to
agree with these opinions.
In any climate, the body seeks to maintain a reserve supply of nitrog-
enous food for its cells. Consequently, a man having a small reserve
supply may be considered on a low plane of nutrition, and, per contra, one
with a large reserve supply may be regarded as on a high plane of nutri-
tion. It also stands to reason that those on a high plane are better able
than those on a low plane to resist those infectious diseases which are more
or less prevalent in the tropics, as bubonic plague, cholera, tuberculosis,
pneumonia, typhoid fever, typhus, relapsing fever and plague. It would
seem to follow, in the regular order of things, that white men in the
388 DIET IN HEALTH
tropics not well fed on nitrogenous food should readily fall victims to
infectious diseases. And this is exactly what happens. They have placed
themselves from the dietetic standpoint on a level with the natives, and
like them suffer from a lowered vitality, which renders them exceedingly
susceptible to infection and liable to succumb to the -same, while their wiser
or more fortunate meat-eating brothers are easily able to resist.
The argument, then, that, because the natives of the tropics eat little
nitrogenous food, white men should follow suit, will not bear close dissec-
tion. The natives do not consume nitrogenous food for the very sufficient
reason that, as a rule, they are not able to procure it. As referred to
previously, a large proportion of the natives are in a state of chronic star-
vation, and it would be the height of folly, in the opinion of Lukis and
Blackham(20), to place white men in a similar position. These writers
claim, and doubtless with good reasoning, that the comparative immunity
of Englishmen to the infectious diseases that decimate the natives of India
is due, in part at least, to their being better fed on nitrogenous food.
Major McCay 1 has been engaged during the past few years in experi-
mental research into the question of the effect of a nitrogenous diet, and
in his final report shows in a decisive manner that, other things being
equal, diet is an all-important factor in determining the degree of physical
development and general well-being of a people, and that with a low level
of nitrogenous interchange, deficient stamina morally and physically must
be expected.
It is obvious that in the performance of manual labor the same expen-
diture of energy is required in every climate, but, as Tibbles(13) points
out, because the climate influences the radiation of heat from the body,
and that this radiation is greater in a cold or wet climate and less in a hot
than in a temperate climate, more food is needed in a cold than in a hot
climate. However, this is considerably modified by circumstances. In
civilized countries, and especially in America, the greater loss of heat in
a cold climate is prevented by heating the houses and by wearing warm
clothes, and the radiation of heat and evaporation from the body in a hot
climate is promoted by wearing thin clothing. Although body metabolism
is slightly decreased by the greater heat of tropical climates, the produc-
tion of heat is really not much less than in a temperate climate. Where-
fore the conclusion has been reached that it is well not to take less food in
hot climates, but to increase slightly the intake of carbohydrates in order
to supply the heat radiated from the skin, and with the special object of
promoting perspiration. Tibbies, however, doubts whether it is good ad-
i Professor of Physiology at Calcutta Medical College.
DIET IN TROPICAL CLIMATES 389
vice for white men who make their home in the -tropics to follow the
dietetic habits of the natives and eat a comparatively very small quantity
of animal food and large amounts of vegetables and fruits. From long
centuries of usage in hot climates, the natives are accustomed to consume
such large quantities of rice, pulse and other vegetables as a person unused
to such food would be positively unable to take and to digest. The fact
must also be taken into account that there should be a fairly definite ratio
between the proportion of nitrogen and carbon in the alimentation. The
natives of India are not influenced by poverty alone in their choice of
food. Not only does necessity impel very large numbers of them to con-
sume materials from the vegetable kingdom, but many are bound by
religious scruples to avoid meat. To most of the millions of India the ox
is sacred. The hog is anathema maranatha to the Hindus and the Mo-
hammedans, as it was to the Egyptians of old and to the Hebrews of the
present day (27). Some Hindus are strictly vegetarians, some take no
animal food but a little milk and ghee, while others indulge in eggs, fish
and game. The Sikhs eat mutton and goat flesh. The Hindus of Punjab
eat no meat, but the Mohammedans living in the same region eat meat
to a certain extent.
It may be said that evidence seems to show that those natives who eat
meat are finer and stronger specimens of humanity than those who desist
from flesh consumption. Indeed, the Sikhs, who eat mutton and goat's
flesh, are models of good physique and are easily the most vigorous race
physically of the inhabitants of India. Nevertheless, it may be pointed
out that the variations of climate in India are considerable and, as Sir
Havelock Charles aptly says, "it is impossible to formulate exact rules for
dietary in the tropics generally because the differences of climate entail
modifications." While the same authority says nothing with regard to
limiting the consumption of meat, he does say that "no cold meat whatever
should come on the table," and that it is important that everything should
come straight from the fire to the table, for then it cannot serve as a carrier
of disease germs or parasites, and there need be no fear of cholera or dys-
entery. Boiled water only should be drunk, and no salads of any kind
should be used except with the greatest moderation.
Fruits and Vegetables As for fruit, that kind which possesses a rind
that can be removed may, according to Tibbies, be eaten with impunity
by a healthy man at any time of the year. On the other hand, fruits
without a rind or peeling are incapable of being thoroughly cleansed and
in consequence may be contaminated and dangerous to the consumer unless
cooked before eating. Following this rule, oranges, grapefruit, pears,
125
390 DIET TN HEALTH
apples, bananas, mangoes, pineapples, custard apples, mangosteen, toma-
toes, etc., may be eaten raw after having been peeled, but grapes, currants,
strawberries and those fruits which cannot be peeled are on the taboo list
until they have been cooked. Vegetables, such as cabbage, cauliflower,
kidney beans, green peas, pumpkins and vegetable marrow, should be eaten
fresh boiled.
It can be stated, broadly speaking, that the alimentary principles are
the same in the tropics as elsewhere, and, according to Simpson (28), the
simple and for the most part vegetable diet of the indigenous inhabitants
of the Tropics contains the same nutrient principles as the more complex
and varied admixtures of animal and vegetable foodstuffs which form the
ordinary diet of races living in colder climates under a modern civiliza-
tion. In Europe, meat chiefly supplies the protein in the food ; bread, po-
tatoes, etc., the carbohydrates ; and butter the fat ; while in tropical lands,
the protein in the food is supplied mainly by fish, peas, beans and other
legumes ; the carbohydrates by millet, cereals, manioc, yams, etc., and the
fat by vegetable oils such as ground nut and olive oil. Butter ghee, of
animal origin, is clarified butter made from the oil from the liver of fish
and the fat of beef and mutton. It is a good butter, but its peculiar flavor
renders it distasteful to a European palate. The vegetable oils are ex-
pressed from various seeds and are used either for cooking purposes or in
place of butter.
Vegetable foods are represented by cereals, pulses, tubers, herbaceous
vegetables and fruits. Of roots and tubers, the chief are the sweet potato,
the yam, the tars and the cassava or manioc. According to Simpson, there
is in the roots less than 1 per cent of protein and of fat, and their food
value consists in the potash salts and the amount of starch which they con-
tain, the latter constituent varying from 15 to nearly 30 per cent; tapioca
contains about 86 per cent of starch. Rice, ragi, millet, maize, and other
cereals form, as a rule, the staple foods of the tropics. They contain too
small proportions of protein and oil to furnish sufficient protein by them-
selves, and consequently their deficiencies are made up by an admixture
of a small quantity of legumes. The pulses or peas and beans are particu-
larly rich in nitrogenous, starchy and phosphorated principles. They
contain, at least, 20 per cent of proteins. But, after all, for the great
mass of the people of India in fact, for the vast majority of the inhabi-
tants of tropical Asia rice is the staple food. There are two principal
varieties, Burma and country rice. Burma rice, being highly milled, has
the husk, pericarp and outer layer removed by machinery, stripping it of
its protein, phosphorus and vitamines. Country rice is soaked in water
DIET IN TROPICAL CLIMATES
391
TABLE I PROTEIN AND STARCH EQUIVALENTS IN CEREALS AND
BUCKWHEATS (Church) '
(The figures represent ounces and decimals of an ounce)
1 oz.
2 oz.
3oz.
4 oz.
5 oz.
6 oz.
7 oz.
8oz.
9 oz.
Ragi :
Protein
.059
.118
.177
.236
.295
.354
.413
.472
.531
Starch
.764
1.528
2.292
3.056
3.820
4.584
4.348
6.112
6.876
Koda:
Protein
.07
.14
.21
.28
.35
.42
.49
.56
.63
Starch
.82
1.64
2.46
3.28
4.10
4.92
5.74
6.56
7.38
Rice:
Protein
.073
.146
.219
.292
.365
.438
.511
.584
.657
Starch
.797
1.594
2.391
3.188
3.985
4.782
5.579
6.376
7.173
Sanwa:
Protein
.084
.168
.252
.336
.420
.504
.588
.672
.756
Starch
.794
1.588
2.382
3.176
3.970
4.764
5.558
6.352
7.146
Gundi :
Protein
.091
.182
.273
.364
.455
.546
.637
.728
.819
Starch
.773
1.546
2.319
3.092
3.865
4.638
5.411
6.184
6.957
Maize:
Protein.
.095
.190
.285
.380
.475
.570
.665
.760
885
Starch
.790
1.580
2.370
3.160
3.950
4.740
5.430
6.320
7.110
Joar:
Protein
.093
.186
.279
.372
.465
.558
.651
.744
.837
Starch
.769
1.538
2.307
3.076
3.845
4.614
5.383
6.152
6.921
Shama:
Protein
.096
.192
.288
.384
.480
.576
.672
.768
.864
Starch
.757
1.514
2.271
3.028
3.785
4.542
5.299
6.056
6.813
Bajra:
Protein.
.104
.208
.312
.416
.520
.624
.728
.832
.936
Starch
.791
1.582
2.373
3.164
3.955
4.746
5.537
6.328
7.119
Kangni :
Protein .~77 .
.108
.216
.324
.432
.540
.648
.756
.864
.972
Starch
.801
1.602
2.403
3.204
4.005
4.806
5.607
6.408
7.209
Barley:
Protein
.115
.230
.345
.460
.575
.690
.805
.920
1.035
Starch
.730
1.460
2.190
2.920
3.650
4.380
5.110
5.840
6.570
Chena :
Protein
.126
.252
.378
.504
.630
.756
.882
1.008
1.134
Starch
.777
1.554
2.221
3.108
3.885
4.662
5.439
6.216
6.993
Amaranth:
Protein
.143
.286
.429
.572
.715
.858
1.001
1.144
1.287
Starch
.760
1.520
2.280
3.040
3.800
4.560
5.320
6.080
6.840
Wheat:
Protein
.135
.270
.405
.540
.675
.810
.945
1.080
1.215
Starch
.712
1.424
2.136
2.848
3.560
4.272
4.984
5.696
6.408
Buckwheat :
Protein
.152
.304
.456
.608
.760
.912
1.064
1.216
1.368
Starch
.714
1.428
2.142
2.856
3.570
4.284
4.998
5.712
6.426
Quinoa :
Protein
.192
.384
.576
.70S
.960
1.152
1.344
1.536
1 728
Starch.. .
.578
1.156
1.734
2.312
2.890
3.46S
4.04C.
(LM
5 202
i Simpson in "Tropical Hygiene."
392
DIET IN HEALTH
TABLE II PROTEIN AND STARCH EQUIVALENTS IN PULSE (Church)
(The figures represent ounces and decimals of an ounce)
1 oz.
2oz.
3oz.
4 oz.
5 oz.
6oz.
7 oz.
Soy Beans:
Protein
.353
.706
1.059
1.412
1.765
2.118
2.471
Starch
.694
1.388
2.082
2.776
3.470
4.164
4.858
Vetchlings :
Protein
.319
.638
.957
1.276
1.595
1.914
2.233
Starch
.521
1.042
1.563
2.084
2.605
3.126
3.647
Lupines:
Protein
.317
.634
.951
1.268
1.585
1.902
2.219
Starch
.452
.904
1.356
1.808
2.260
2.712
3.164
Vetches:
Protein
.315
.630
.945
1.260
1.575
1.890
2.205
Starch
.497
.994
1.491
1.988
2.485
2.982
3.479
Guar:
Protein
.298
.596
.894
1.192
1.490
1.788
2.086
Starch
.494
.988
1.482
1.976
2.470
2.964
3.458
Lentils:
Protein
.249
.498
.747
.996
1.245
1,494
1 743
Starch
.595
1.190
1.785
2.380
2.975
3.570
4.165
Peanuts:
Protein
.245
.490
.735
.980
1.225
1.470
1.715
Starch
1.267
2.534
3.801
5.068
6.335
7602
8869
Moth:
Protein
.238
.476
.714
.952
1.190
1.428
1 666
Starch
.580
1.160
1.740
2.320
2.900
3.480
4.060
Peas:
Protein
.236
472
.708
944
1 180
1 416
1 652
Starch
.575
1.150
1.725
2.300
2.875
3.450
4025
Catiang-beans:
Protein
.231
.462
.693
.924
1.155
1.386
1.617
Starch
.578
1.156
1 734
2312
2890
3468
4046
Haricots:
Protein
.230
.460
.690
.920
1.150
1 380
1 610
Starch
.576
1.152
1.728
2.304
2.880
3.456
4.032
Mung-beans:
Protein
.227
.454
.681
.908
1 135
1 362
1 587
Starch.. .
608
1 216
1 824
2432
3040
3648
4276
Horsegram :
Protein
.225
.450
675
900
1 125
1 350
1 575
Starch.. . .
603
1 206
1 809
2412
3 015
3 618
4 221
Lablab-beans:
Protein
.224
448
672
896
1 120
1 344
1 568
Starch
.574
1.148
1 722
2296
2870
3444
4018
Pigeon-peas:
Protein
.203
406
609
812
1 015
1 218
1 421
Starch
596
1 192
1 788
2384
2980
3376
4 172
Chick-peas:
Protein
195
390
585
780
975
1 170
1 365
Starch
.643
1 286
1 929
2572
3215
3*858
4 501
Inga-beans:
Protein
176
352
528
704
880
1 056
1 9 32
Starch
.807
1.614
2^421
3.228
4.035
4.842
5.649
Simpson in "Tropical Hygiene.'
DIET IX TROPICAL CLIMATES
393
for at least a day and night, and then strained and dried in the sun, after
which the husk is roughly removed. It therefore retains most of its peri-
carp and outer layers, which contain protein, phosphates and vitamines.
Kice is the poorest of the cereals in protein and mineral matter. On the
other hand, it has the advantage of occurring in small and easily digested
grains. Boiled rice swells and absorbs nearly five times its weight of
water, while some of its mineral constituents are lost by solution. Rice,
being largely starch, is only in very small part digested in the stomach,
but Lukis and Blackham state that its solid constituents, being quite com-
pletely digested in the small intestine, enter the blood almost as completely
as those of meat two and one-half ounces cooked by boiling requiring
three and a half hours for disposal. Practically none of the starch is
lost, whereas the waste of protein foods amounts to about 19 per cent.
It follows from this that rice is one of the foods which leaves the smallest
residue in the intestine, a property which gives it a considerable value in
some cases of disease.
As Simpson points out, in the construction of European standard diets
the basis has generally been a person weighing 154 pounds and doing a
day's work of 300 foot-tons, or about 2 foot-tons per pound of body-
weight. In Indian and Japanese dietary tables the lesser body-weight
of 105 pounds has usually formed the basis, the 2 foot-tons of w r ork being
retained.
Church gives the following standard diets for Indians weighing 105
pounds, expressed in avoirdupois ounces and decimals of an ounce:
CHURCH'S STANDARD DIET FOR INDIANS
RATION
Protein
Oil
Starch
Starch
equivalent
Nutrient
ratio
Bare sustenance 1 .
2.1
0.752
7.520
9.250
1 :4.34
Moderate work
Hard work
1954
3.035
1.412
2.506
12.531
11.190
15.779
10.954
1:5.34
1 :4.6G
Lukis and IMaekham give the following as the scale in a Bengal jail:
Burma or country rice 20 ounces
Different dais 6 "
Vegetables 6 "
Flour, Wheat or Indian Corn 10 or 12 ounces
These amounts represent only what is absolutely essential. Perhaps
a better standard is furnished by the war ration of the Indian sepoy,
394 DIET IX HEALTH
which generally consists of atta or rice, 2 pounds, or sometimes meat or
fish, 2 pounds; ghee, 2 ounces; dal, 4 ounces; salt, % ounce; also meat
and condiments on payment. In some expeditions onions and dried man-
goes have been issued. The following ration has been suggested for Aden
camel drivers: Biscuit or rice, l ] /> pounds; dates, wet, 1 pound; ghee, 2
ounces ; sugar, 2 ounces ; coffee, '^ ounce ; salt, 1/2 ounce ; onions, 2 ounces,
or dal, % ounce.
Church, quoted by Simpson, gives several examples of rations, viz. :
A dietary for moderate work, according to this author, calls for 2.954 oz,
protein, 1.412 oz. oil, and 12.531 oz. starch, the starch equivalent of which
is 15.779. Soy beans, 5 oz., furnish protein 1.765, starch 3.470. Rice, 16
oz., furnishes protein 1.163, starch 12.752. Total protein 2.928. Total
starch 16.222. As the oil, however, in this ration is but 1 oz. and should
be 1.4 oz., it will be necessary to add the lacking four-tenths. To do this
without disturbing the ration, l*/^ oz. of rice should be withdrawn, and
1/2 oz. of soy beans added. Then the amounts will be, soy beans, 51/2
oz., furnish protein, 1.942, starch 3.817. Rice, 14 1 /o oz., furnishes pro-
tein .954, starch 11.552, oil .4 oz., the oil being equal to starch .920. This
ration has, therefore, 2.896 oz. protein and the equivalent of 16.289
starch.
Church lays down two guiding principles, one is to keep down the
legume constituent to an amount not exceeding 7 ounces per diem, and
if possible not more than 5 ounces per diem ; the other is to ensure the
presence of a sufficiency of protein (or albuminoids, as he calls them) by
increasing the cereal constituents of the ration, even if in so doing the
quantity of starch required be raised above the necessary amount.
Milk. Manson(29), referring to the milk supply in tropical coun-
tries, says, in part, "that in many tropical countries, such as West Africa,
milk cannot be obtained except in preserved form. In other countries, as
India, cow's, goat's or buffalo's milk can be readily procured. Buffalo's
milk is very rich in fat, there being nearly twice as much as in cow's
milk. It is also richer in proteins, though not so rich in lactose. It is
less digestible, has a peculiar smell and flavor, and, as a rule, is not suited
for invalids. Goat's milk differs less from cow's milk ; but as the groat is
c^
susceptible to Malta fever, and the Micrococcus melitensis is discharged
in the milk of infected animals, it is better not to use the milk unless
efficiently pasteurized or well boiled." The Board of Agriculture and
Fisheries of Great Britain published, in the early part of February, 1916,
a circular relating to goat's milk, in which it was stated that it is, as a
rule, a most wholesome milk, and that its flavor, if the food of the animal
DIET Itf TllOPICAL CLIMATES 395
is regulated, is not any real drawback to its employment. Moreover, goat's
milk is easily digested by children, and is far less likely than cow's milk
to contain tubercle bacilli. The composition of cow's milk and goat's miJk
is much the same, although goat's milk is superior as regards fat, which is
an advantage.
AYhere cow's milk is available it should be used in preference to pre-
served milk. In the tropics, as stated previously, unless milk can be con-
sumed fresh from the cow, it must be boiled, or efficiently pasteurized,
and thus rendered slightly less digestible and deprived of certain of its
nutritive properties. Manson states that it is necessary to boil' milk in
the tropics, "because (a) under tropical conditions, the multiplication of
bacteria is so rapid that milk quickly turns sour; (6) the natives fre-
quently add water to the milk and are apt to be careless as regards the
washing and scalding of the utensils used; (c) the water used for such
dilution and for washing utensils is usually drawn from shallow pools or
wells liable to contamination, especially as inspection and regulation of the
milk supplies in the tropics are very lax; (d} obvious impurities are
strained off with old rags or articles of clothing actually in use; (c)
cattle are often fed on garbage of all kinds."
The alternative to boiling milk, when it is intended for consumption
by Europeans, or for use in hospitals, is to keep the cows under the best
sanitary conditions possible and to be sure that they are milked under
strict sanitary precautions. It is patent that the difficulties in the way
of insuring a comparatively pure milk are so great in tropical countries
as to be nearly insuperable. Moreover, in many districts fresh milk is not
available. It therefore follows that canned milk is largely used. Manson
is of the opinion that the sweetened milks should be avoided for the use of
invalids, and thinks that the best tinned milks are those in which the milk
is not reduced to a paste but merely concentrated and is still in fluid form.
The can must be carefully examined to see that there has been no previous
puncture or bulging, and the milk must be odorless. A can once opened
must be used quickly.
Meats. Simpson, unlike Lukis and Blackham, is inclined to agree
with the views of Chittenden that most people eat more protein food than
is requisite to preserve health and maintain energy. But it must be taken
into consideration that, since Simpson wrote his work on diet in the
tropics, the investigations of other workers appear to have demonstrated
with greater or less certainty that Ohittenden's views are not altogether
borne out by facts, and are in some degree misleading. Simpson draws
from a study of Ohittenden's experiments the conclusion that not only
396 DIET IN HEALTH
does the European standard of diet err in the direction of allowing too
great an amount of proteins, but argues that greater efficiency in working
power, and a better feeling of well being and health are attained by a
smaller amount of proteins than with the excessive amounts taken in ordi-
nary diets, which, as a rule, contain even more than outlined in the
standard diets. He thinks that the evidence put forward in favor of these
views is strong, and. is supported by the fact that nations such as the
Japanese or Indians, living a simpler life, and more given to vegetarianism
than the Europeans or Americans, are maintained in health on a much
smaller amount of protein food than these standards indicate is necessary.
According to Simpson, although man requires a mixed diet, with some
reservations relating to custom and climate, it is a matter of indifference
whether the mixed diet is obtained wholly from vegetable products, or
partly from animal and partly from vegetable products, and it is further
his opinion that whether grains or meat shall enter most largely into the
diet depends a great deal on climate, on the habits of the people, whether
indolent or active, and on other circumstances.
However, although this authority seems to favor a vegetarian diet for
natives and a diet for white men in the tropics in which the carbohydrates
preponderate, the force of his argument is somewhat lessened, so far as the
natives are concerned, by the following statement made by him. The
inhabitants of hot climates are generally content with milk products,
legumes, fruits and sugars, but though cereal grains, as a rule, form the
chief food of such people, rice being the staple wherever there is plenty
of water and rain, still there are considerable numbers whose food is
largely from the animal kingdom. Thus, the Arabs of East Africa, the
Pampas Indians, and the Abyssinians are often quoted as instances of
consumers of large quantities of meat. They are all very active races.
Indeed, as pointed out before, the mass of the inhabitants of India who
exist mainly on rice and some other cereals are, generally speaking, miser-
able specimens of humanity, exceedingly prone to infection, and so de-
ficient in vitality that when attacked by disease they die like flies. The
vigorous races of India are those who eat flesh, not to excess, but still suf-
ficient in amount to supply the protein needs of the organism. It is also
worthy of notice that the Japanese, who of all the Asiatic peoples are
especially capable, physically and mentally, do not, by any means, restrict
themselves to a vegetarian diet. It is true, though, that at one time the
Japanese might have been termed a vegetarian people, but this was more
from necessity than choice, and they have always been great fish eaters.
During the Russo-Japanese war, when the Japanese soldiers were justly
DIET Itf TROPICAL CLIMATES 397
lauded for their remarkable powers of eudurauce, their capabilities in this
direction were attributed to their being vegetarians. When, however, the
matter was more closely investigated, it was found that the Japanese
soldiers' rations comprised a certain amount of meat.
A point, too, to which attention is not sufficiently paid, is that while
diet must be modi tied to some extent to adapt it to the physiological re-
quirements of varying climates, to insist that a white man in the tropics
must eat the same food as the native is carrying this principle to absurd
lengths. Evidence, and recent evidence in particular, would seem to go
to show that even the native who has been so long accustomed to a carbo-
hydrate diet that it has become a fixed habit, is all the better for some meat.
Simpson takes the stand that the most probable defect in the diet of a
European in the tropics is that it is too nitrogenous and fatty, and illus-
trates this contention by an instance drawn from history or tradition.
When the Aryans first descended into the plains of India they were meat
eaters, but the experience of the centuries evidently taught them to be
vegetarians, or to be very sparing in the amount of meat they ate, and at
the same time to become total abstainers. This, says Simpson, is an expe-
rience and a lesson which Europeans who go to the tropics are inclined to
ignore. Accustomed to living well in their own country, on large quanti-
ties of meat, fats and rich foods, to which wines and spirits are added
in considerable quantities, they are tempted to follow, as closely as possible,
a similar diet in the tropics. This procedure is generally followed by
injurious results due to want of adjustment of the diet to the new con-
ditions, and is often disastrous to the health, as attested by the history of
the British occupation of India. Within recent years an adjustment has
taken place, and the health and mortality of Europeans have undergone
a great change for the better. Emphasis may again be laid on the point
that the present inhabitants of India eat mainly carbohydrate food simply
from economical reasons or because their religion forbids them to consume
meat, and, as stated before, those of the natives who eat meat in India are
greatly superior in physique and in powers of endurance to the vege-
tarians.
With regard to the too indulgent habits of the white men who come
to the tropics, it is no doubt true that they eat and drink more than is
good for them, though this was more frequently the case in former times
than at the present. But as Sir Patrick Manson(29), who is probably
the greatest living authority on such matters, says, the effects of dietetic
errors in Europeans in the tropics are, on the whole, more marked than
would be the case from similar errors in temperate climates. This is
398 DIET IN HEALTH
especially so as regards the abuse of alcohol and condiments, and also as
regards the deficiency of fresh vegetables, of fruits and occasionally of
meat. Mansoii has at once placed his finger on the dietetic error of the
European in the tropics which most tends to injure his digestive organs,
upset his nervous system, impair his health generally, and sap his vital
forces. This is the too great consumption of alcohol and condiments. It
must be borne in mind that the meat one gets in the tropics is not like the
meat of temperate climes. The animals there are not well fed, and their
meat is usually stringy, tough and of an insipid flavor. The. consequence
is that more thorough cooking is resorted to. This in itself destroys or les-
sens the already somewhat meager nutritive properties of the meat, and, in
addition, to give some zest to the food the dishes are frequently highly
spiced and a larger variety of methods of preparation are employed. The
result is that, while the bulk of the food taken is as much or even more
than in Europe, the good effects of the protein material are greatly de-
creased by its being taken in indigestible forms. In fact, food so cooked
and spiced often does more harm than good. Again, the fruits are some-
times comparatively dry and tasteless, as is apt to be the case in all tropical
climates where they mature quickly, and the vegetables are liable to be
indigestible and of inferior quality.
It must, then, be taken into consideration that in the tropics neither
meat nor foods from the vegetable kingdom are of the same high standard
as in temperate climes. When injudicious cooking and the too liberal use
of condiments are added to these drawbacks, it may be well understood
why digestive disorders prevail. Nevertheless, with all dietetic and culi-
nary obstacles with which the white man has to contend, the fact stands
out clearly that he possesses a resisting power to infection and disease
which is absent from the native. Moreover, it may be once again
insisted upon that the meat-eating native has a superior vitality to the
vegetarian inhabitant of tropical Asia, which goes to show that the ma-
jority of the indigenous population of the tropics do not eat enough pro-
tein material.
Sweets. A very interesting and instructive feature in connection with
diet in the tropics is that Europeans born and bred in tropical lands have
less desire for meat and a special predeliction, sometimes amounting to a
craving, for sugar. Inhabitants of the Far East and the dwellers in hot
climates generally exhibit an excessive desire for sweet things. When
presents are made in Asia, they usually take the form of sweetmeats, and
the ladies of the harem are depicted, as a rule, lolling on couches and for-
over eating sweets. No doubt this craving has a physiological basis.
DIET IN" TROPICAL CLIMATES 399
Sweets take the place to some extent of protein material, or rather are
protein sparers, being rapidly oxidized. In the Boer war the British
soldiers were supplied with a daily ration of chocolate, for it is known
to liberate energy rapidly with the least possible strain upon the digestive
system. Sugar,, an almost pure soluble carbohydrate, is perhaps the best
food for this purpose. Mosso first demonstrated that sugar lessened
fatigue, while Vaughan Harley showed that it was an excellent spur to
energy with which extraordinary muscular exertion could be made.
Simpson mentions that among the troops engaged in Porto Rico and
in the Philippines whose appetites had become impaired, there was a
craving for candy and sweets which was relieved by a supply of these
Articles. Numerous experiments have demonstrated that fatigue' is more
quickly relieved by sugar than by any other kind of food, and in the
tropics, where exhaustion, by reason of the heat and the actinic rays of the
sun, is most likely to occur, the value of sugar can scarcely be over-
estimated.
Diet and Disease. When writing or speaking of diet in the tropics one
must be careful to avoid the faults of exaggeration. To assert that a white
man should eat as much meat or more than in a temperate climate would
be, perhaps, to sin in this direction. On the other hand, to aver that a
strictly carbohydrate diet was the one most suitable for the white dweller
in a hot climate would be to err even more grossly. Although white men
have dwelt in the tropics for generations, scientific men still agree to
differ as to the form of diet best adapted to the climate. Recent investi-
gations appear to prove that a mixed or modified diet is not only the best
for white men but for the natives themselves. It is absolutely certain that
rice, and especially milled rice, the form of food most largely eaten by the
natives, is deficient in nitrogenous matter and over bulky in carbonaceous
matter. The best rice is also deficient in phosphoric acid, lime and other
mineral matters. As a matter of fact, the diet of the natives is responsi-
ble for lowered vitality and is directly responsible, according to many
authorities, for beriberi.
Accordingly, diet may be a direct cause of disease. Excess of protein
material in the diet of the European, and deficiency of proteins in that
of the poorer classes of natives, and in some institutions, are instances
of this.
In the prevention of disease, it goes without saving that diet plays n
role of the utmost importance. Putting on one side the chronic diseases
which are likely to occur in tho tropics from errors of diet more quickly
than in colder lands, it must be remembered that food contamination is
400 DIET IN HEALTH
rife in hot climates. Flies in such countries are indeed a veritable plague,
and if extreme care be not taken to protect food, epidemics will be spread
far and wide. Human excreta are less thoroughly dealt with and provide
a remarkably favorable means by which flies may convey disease. Cholera,
as well as typhoid fever, has been shown to be carried in this manner,
and flies are under suspicion of being concerned in the dissemination of
other diseases.
Canned Foods. Before leaving the subject of diet in the tropics, it
may not be out of place to consider briefly the question of canned foods.
In the torrid lands, for obvious reasons, canned foods are largely con-
sumed. Of course, they are more frequently used than they should be,
for their nutritive value is less than that of fresh meat and their consump-
tion is open to several other objections. There is a certain amount of risk
of metallic poisoning, but the gravest charge that can be brought against
the indiscriminate use of canned meat is that it is always difficult to deter-
mine how long the food has been tinned. The temptation to send abroad
tins already old is too great for some unscrupulous dealers. In any event,
tins of meat which have been kept for a considerable period are retailed
in all parts of the tropics with the result that serious digestive disorders
are frequent, and even ptomaine poisoning is by no means rare.
Conclusions. In the light of the most recent researches, it would seem
to have been demonstrated that a goodly amount of protein material should
be eaten by the white dwellers in the tropics, and that it is not in the
interests of health that the protein part of the diet should be unduly de-
creased. It would be manifestly unwise for the white man to endeavor to
subsist on the form of food eaten by the native. A modified diet is best
suited to the bodily and mental requirements of the white man in the
tropics, but as in temperate climates he must be largely guided by his
mode of life. Such a diet should not contain so much protein matter as
in colder climates, but the carbohydrates and proteins should be judiciously
distributed in proportion to the individual's needs. In the case of white
men, at any rate, most of the protein material should be supplied by moat.
Meat should not be cooked too long nor should condiments be added to any
great extent. Great care should be exercised in protecting foodstuffs, and
especially meat and milk, from contamination or infection, and milk and
meat should be consumed as fresh as is possible. Moderation in eating
should be the slogan of the white man in the tropics, and if the above rules
are carefully observed, there is no reason, at least so far as diet is con-
cerned, why he should not enjoy good health. It must be remembered,
however, that he must accommodate his diet, to a certain extent, to the
ALCOHOL AND I3EVEKAGES IN THE TllOPICS 401
variations of climate, which are more frequent in tropical than in tem-
perate zones.
Into the question of the diet of the natives, it is superfluous to enter
at length. Suffice it to reiterate that investigations seem to show that those
who eat meat are more vigorous than those who are vegetarians. It will
be observed that in this section the diet of India has been mainly discussed.
This is because more is accurately known, of the diet question in India
than in other tropical parts of the world. Still it is known that, in Africa
and in other tropical climates, those natives who eat meat are stronger
than those who subsist solely on vegetable foods. The subject has been
treated in a broad way and only general principles have been laid down,
and while the authors are conscious that the matter has been dealt with
somewhat discursively, it is hoped that the information given may prove
of some practical value.
ALCOHOL AND BEVERAGES IN THE TROPICS
The question of alcohol as a beverage or as a medicine is a vexed one
among scientific and medical men, and has been the cause of a good deal
of acrimonious discussion. There are those who, like Sir Victor Horsley,
hold that it is a poison in any circumstance, and contend that its value as
a medicinal remedy is nil. Again there are those like Karl Pearson, At-
water and others, who deny that alcohol is absolutely useless, and argue that
it has a food value and that, when taken in discretion, it by no means
always does harm, and may, on occasions, do good. Pearson appears to
have proved that the sins of the fathers are not visited on the children, that
is, so far as the hereditary influence of alcohol is concerned. He made a
series of careful investigations and seems to have demonstrated that the
children of habitual drinkers differ but little, if at all, from those of the
abstainer or from the ordinary moderate drinking individual. However,
this assertion and the investigations upon which it was based were severely
criticised by Horsley and his followers, and it does appear probable that
the offspring of drunkards exhibit certain inherited physical and mental
characteristics of an abnormal nature. They have handed down to them,
as a rule, a somewhat unstable nervous system, which renders them more
prone to the effects of stimulating drinks than their fellows who have not
had as their progenitors those addicted to the excessive use of alcohol.
However, alcohol and its effects have been exhaustively discussed from the
scientific standpoint in the chapter on "Stimulants," and, as recapitulation
is a weariness of the flesh, we will refrain from offending our readers in
this respect.
402 DIET IN HEALTH
The subject of the use of alcohol in the tropics will be gone over
briefly, and its pros and cons considered impartially. For some time now,
it has been taught by the majority of medical men who have had such a
varied and lengthy experience of life in the tropics as to warrant them to
speak with authority, that alcohol wreaks more injury on the human
organism than in temperate climes. This may be so, but the evidence
forthcoming does not appear to be entirely convincing. It is assuredly
true that in bygone days both meat eating and heavy drinking were the
custom in the tropics, as elsewhere, and that the consequences were in a
high degree injurious. Even now it is said that in some tropical lands,
East Africa, for instance, the white men- eat unsuitable food, drink to
excess, and suffer accordingly. In India this is the exception rather than
the rule. There the white man is generally absteminous with correspond-
ingly good results. Exactly the same thing, however, has occurred in
Europe, and especially in Great Britain. It is not so very many years
ago, in fact, almost within the memory of the older members of the com-
munity, that gross feeding and heavy drinking were habitual with a large
proportion of the prosperous and well-to-do in the United Kingdom. In
recent years such habits have fallen into disrepute, and, although spirit
and beer drinking have prevailed in the British Isles, members of the pros-
perous and well-to-do class, from which the white civil officials of India
and the officers of the Army are drawn, no longer gorge themselves with
food and drink. As said before, both in India and Europe the results of
this moderation have been exhibited in superior efficiency of mind and
body.
However, the point is as to whether alcohol is more harmful in tropical
climates than in temperate countries. IVfanson says that the abuse of
alcohol and condiments is a fruitful cause of digestive derangements
and of various diseases in tropical climates, but so is the abuse of
alcohol and of indigestible foods in colder lands. The majority of authori-
ties are of the opinion that alcohol is more injurious in the tropics or, at
any rate, they strongly urge against the use of alcohol and usually advise
white men sojourning there to be abstainers.
The late Dr. Charles Woodruff, who, as mentioned previously, com-
bated the crystallized view that the meat part of the white men's dietary
should be decreased in the tropics, also stoutly defended the use of alcohol
in strict moderation in both the tropics and in other portions of the globe.
Among the numerous statistics he brings forward and the many authori-
ties he cites, is a statement made by Dr. Leon Meunier of Paris, published
in the Cosmos, July 14th, 1903, that with regard to small amounts of
ALCOHOL AND BEVERAGES IN THE TROPICS 403
alcohol the experience of centuries was to the effect that such an amount
is not only harmless, but is a beneficial food, which can take the place of
an equal energy in butter and similar fuels, irrespective of the state of rest,
work or any circumstance relating to the consumer. Woodruff goes on
to say that the great majority of the medical profession have reached the
decision that alcohol is like every other chemical, whether it be a poison
like strychnin or a food like protein ; that is to say, there is an amount
below which it is not a poison and above which it is poisonous. Wood-
ruff's array of figures and authorities seems to bear out his own view, that
in the terribly depressing, anemic conditions brought about by living in a
tropical climate, against whose onslaughts he has no protection like the
dark-skinned native, a white man who is not assisted by a little alcohol is
more harmed by the climate than the man who is so aided.
Simpson does not commit himself to the expression of any very decided
opinion on the subject, but gives this guarded statement, that it is safest
for the newcomer to abstain from alcoholic beverages, especially so if much
exposure to the sun is to be endured. Tea and coffee are the customary
drinks of many of the inhabitants of the tropics, and where these are not
in use, water is generally the only beverage. He thinks it is well to
follow the custom of the country in this respect. When alcoholic drinks
are used and they are often found necessary to the European after he
has been some years in the tropics they should only be taken at meals,
preferably with the dinner ill the evening, and then in extreme mod-
eration.
Lukis and Blackham are of the opinion that "a certain amount of
alcohol may be safely consumed as a heat-producing food." This amount
is certainly very limited, not more than one or, at the outside, two ounces
in twenty-four hours. Its unsuitability as a food is shown by its other
effects on the body which are so well known as to need no description, and
which, in fact, have been fully described in the section of this book dealing
with stimulants. It is allowable in some cases when, for some reason, in-
sufficient food is taken. When sufficient food is taken, alcohol is unneces-
sary, and when excess of food is taken the addition of alcohol may do
serious harm. It may also be said and this point has been elaborated in
the section on alcohol that this stimulant is exceedingly valuable in
cases of exhaustion arising from sickness or fatigue, because of its anes-
thetic effect. This property of alcohol would seem to have been proved
times without number. When very hard work has been done under ad-
verse climatic conditions, and when extreme fatigue supervenes as a result
of the excessive expenditure of muscular energy, and the vital forces are
404 DIET IN HEALTH
brought to a very low ebb, alcohol acts as an anesthetic and one forgets
his depression.
However, the present tendency perhaps of scientific and military
authorities is to frown upon the habitual use of alcohol in the tropics and
to deprecate even its use as a spur in cases of exhaustion. Kitchener, it is
said, would not permit soldiers under his command in the Soudan cam-
paign to take alcohol, and substituted tea, coffee or cocoa. Sir R. Have-
lock Charles, a soldier of wide tropical experience, recorded his opinion
in The Practitioner, 1910, that alcohol is absolutely unnecessary, and if
taken at all should be as a luxury. Tibbies says that it is admitted by all
authorities that the use of alcohol in the tropics is a matter requiring
grave consideration, and that men are better in health and can perform
their duties more satisfactorily without it. Cantlie wrote that the natives
of warm climates, both by their religion and their habits, shun alcohol.
This statement must be taken with a certain amount of reservation. The
Mohammedan religion is against the use of alcohol, but in India and else-
where many Mohammedans drink when they can afford to do so, and pos-
sibly the chief deterrent to the use of alcohol is the extreme poverty of
the mass of the tropical population.
All those who have studied the question either from the practical or
scientific standpoint are agreed on the point that if alcohol be taken at all
in the tropics, it should be drunk in moderation and even sparingly.
Lukis and Blackham say that in hot, moist (that is, tropical) climates,
beer can rarely be taken with impunity, but that no harm is done by light
wines (white or red), champagne and good whiskey well diluted and
taken either with meals or after excessive fatigue in small quantities. On
the contrary, it is evident that a weak "peg" or glass of wine with the
evening meal is beneficial to the harassed Indian official at the end of a
strenuous day's work. It promotes digestion and has a soothing effect on
the nerves. What does most harm in India and in other parts of Asia
where white men congregate is the practice of "pegging," or of taking
"short drinks" at the club bar before dinner. It is obvious that spirits,
if as harmful as many scientists say, are less harmful when freely diluted.
Therefore, when drunk customarily, and not wholly employed as a spur
in cases of exhaustion, they should be well diluted and taken in strict
moderation. Tibbies says "that about half a pint of red wine or one pint
of beer daily is considered a fair allowance, but he is of the opinion that
even such a modicum is better replaced by tea, coffee, cocoa or their sub-
stitutes, caffer tea, dorn-the, gooranut, kola, kat, mote, guarana, and other
native beverages." Natives in all tropical climates, when not debarred by
ALCOHOL AND BEVERAGES IN THE TROPICS 405
poverty or restrained by religious scruples, drink spirituous beverages of
domestic manufacture. These are made from any article of food which
will ferment. Whether made in South America, in Asia, or in Africa,
they are, generally speaking, deadly to the natives and more deadly to the
white men who are foolish enough to partake of them. This has been
proven by the disastrous experience of American soldiers in the
Philippines.
Native drinks are many and various. Doasta distilled from rice liquor
is sold in Calcutta. Mann states that it is 20 degrees under proof, but
contains 0.56 per cent of higher alcohols or 491 grains per gallon. Sugar
refuse yields a liquor known as Shajehanjur rum, which is sold 53 to 56
degrees under proof. In Bengal and Assam, the flowers of Bassia latifolia
contribute a spirit named Mahua. It is sold 22 to 50 degrees under proof,
and contains 0.004 to 0.33 per cent of higher alcohols and is a very poi-
sonous and deleterious concoction even to the natives. The notorious
arrack is distilled from the sap of the palm tree in India and Ceylon, but
the characteristic which has given it its evil name is the fact that it is
frequently drugged. Other vile beverages are fairly common among the
inhabitants of Asia and other tropical countries. Some of these native
drinks are less harmful than the European spirits, but some of them are
most pernicious.
It is difficult, indeed impossible, to write dogmatically with regard to
the effects of the imbibing of alcohol in the tropics, or to state definitely
that it is more injurious to the human being there than in temperate
climates. Drinking to excess is harmful everywhere, and its baneful
effects are too plainly evident in every civilized land. Two reasons, and
these not scientific ones, why white men should be abstemious as regards
alcohol, in the tropics, are that by so doing they set a good example to the
natives and that if they drink more than is good for them they are apt
to deteriorate more quickly in the tropics than in a colder climate.
While the last word has not been said on the question of alcohol as
a beverage, it must be confessed that the weight of scientific evidence is
on the side of those who contend that the use of alcohol is almost always
contra-indicated. Some, like Horsley, say always. Nevertheless, there is
a large number of men, few of whom perhaps are of so high a scientific
caliber as the opponents of alcohol, but who have had more practical expe-
rience, who hold that alcohol has its value and that its use as a beverage
should not be entirely barred. Problems of this kind cannot be wholly
solved in the laboratory. The argument that, because an undue proportion
of a population undergoes deterioration, mental and physical, through
12G
406 DIET IN HEALTH
drink, it should be abolished, may be good and sound from the scientific
point of view, but it may not be an altogether practical position to take.
There is one feature in connection with the consumption of alcoholic
beverages in the tropics of which little notice seems to have been taken.
This is, that, owing to the heat, elimination and excretion are more pro-
fuse and rapid by far than in cold climates. Consequently it is reasonable
to suppose that alcohol will pass out of the system more quickly and do
less harm than in more frigid lands. It is acknowledged that the most
injurious effects of alcohol are on the nervous system, rendered possible
by prolonged poisoning.
Dr. Winfield Scott Hall points out(30) that the theory that alcohol is
a food is disproved by recent researches. All life activity is accompanied
by oxidation, and all oxidation by waste. Any sparing action which alco-
hol may possess is easily accounted for as being in harmony with its gen-
erally accepted narcotic action. Narcotic action is followed by decreased
activity, therefore decreased oxidation, therefore "sparing." Nobody has
contended, much less proven, that this so-called sparing action is an econ-
omy of food material in connection with activity. With the influence of
alcohol as without it, a given amount of life activity is accompanied by a
given consumption of body substance, and it is inane and foolish to con-
tend that the sparing action of alcohol, due to its narcotic effect, should
be accepted as an argument proving its food value.
The oxidation of alcohol liberates heat energy, but this energy cannot
be utilized by the body, even for the maintenance of body temperature.
If a food is defined as a substance which, taken into the body, is assimi-
lated and used either to build up or repair body structure, or to be
oxidized in the tissues to liberate the energies used by the tissues in their
normal activity, then alcohol is not a food. If alcohol is not a real food,
what is the significance of its oxidation? It has long been known that
the liver produces oxidases, and that it is the site of active oxidation of
mid-products of catabolism, of toxins, and of other toxic substances.
Alcohol, while usually formed as an excretion of the yeast plant, is also
found as a mid-product of tissue. It belongs clearly, then, to the group of
excreta. Experiments conducted by Dr. Reid Hunt and other experi-
ments carried out by Dr. Beebe prove with sufficient clearness that alcohol
is a toxic substance and not a food in any sense. With regard to alco-
holic beverages, Hall has this to say:
Alcoholic beverages contain from 3 per cent to 40 per cent of ethyl alcohol.
Beers and ales contain the lower percentages of alcohol ; whiskey, rum and brandy
the higher percentages, while wines are about midway between.
ALCOHOL AND BEVERAGES l.\ THE TROPICS 407
X<> alcoholic beverage has so low a percentage of alcohol as to be with-
out danger. The amount Imbibed by the addict is usually so much that
the alcohol taken exceeds the "physiological limit," that is, there is more
alcohol taken than can be oxidized in the liver, so that there is an escape
into the general system not only of deleterious toxins, which should have
been oxidized in the liver, but also of the excess of alcohol, which is car-
ried to brain and to muscles, seriously disturbing their normal activity
and decreasing their efficiency.
The evidence, on the whole, gathered from the views of authorities on
tropical hygiene, appears to point in the direction of abstinence from
liquor or strict moderation in its use in the tropics. The arguments, how-
ever, in support of complete abstention from alcoholic beverages are no
more decisive as regards the tropics than they are with respect to temper-
ate climates. It is true that scientific and public opinion are veering
towards the view that alcohol is unnecessary and ofttimes very harmful;
therefore, it may be stated that when the opinions of various authorities'
on the subject of alcohol in the tropics have been carefully considered, the
preponderant view, at any rate, from the scientific standpoint, seems to
be that its use is unnecessary, and, when it is recognized that its abuse is
injurious, the best means of avoiding harm is to abstain from it entirely.
Among other beverages largely used in the tropics, tea is the most
popular, but coffee, cocoa and aerated drinks are consumed largely. The
properties of all these beverages have been amply discussed in the section
dealing with beverages.
REFERENCES
1. GAUTIKK. Diet and Dietetics, tr. by A. J. Rice-Oxley, 2nd ed.,
Lippincott, HUM;.
2. Ht'Tcinsox. Food and the Principles of Dietetics, 4th ed., Wood,
1917.
.'{. CIIITTKXDKX. Physiology of Man.
4. BENEDICT, A. L. Golden Rules of Dietetics.
5. SPECK. Arch. f. exp. Pathol. u. Pharrn., Bd. xv, p. 81.
0. VOIT, C. Ztschr. f. Biol., Bd. xiv, p. 57.
7. MAUREL (of Toulouse). Influence des climats et des saisons sur les
depenses de 1'organisme chez 1'homme.
Arch, de med. nav., vol. Ixxiv, p. 30fi ; vol. Ixxv, pp. 5, 81.
8. DK LOXO, GKOKMJK W. Voyage of the .leannetfe.
408 DIET IN HEALTH
( J. Bull. No. 227, Exper. Station, U. S. Dept. of Agric.
10. . Ibid., No. 27.
11. DAVIS. Foods in Health and Disease.
12. PLAYFAIR. Text-book of Physiology.
13. TIBBLES, WILLIAM. Food in Health and Disease.
14. HUTCHISON. Food and the Principles of Dietetics.
15. ATWATER. U. S. Dept. of Agric., Bull. No. 38.
16. . Report of U. S. Commisisoner of Fish and Fisheries.
17. CHITTENDEN, R. H. Nutrition of Man.
18. MELVILLE, COL. Brit. Med. J., 1910, vol. ii, p. 1337.
19. TIBBLES, WILLIAM. Food in Health and Disease.
20. ATWATER and WOOD. TJ. S. Dept. of Agric., Bull. No. 38.
21. HOFFMAN. Food of the Negro in Alabama, U. S. Dept. of Agric.
Bull. No. 38.
22. Goss, ARTHUR. Dietary Studies in New Mexico, U. S. Dept. of
Agric., Bull. No. 40.
23. DAVIS. Food in Health and Disease.
24. MANSON. Tropical Diseases.
25. WOODRUFF, CHARLES. American Medicine, 1914.
26. LTJKIS and BLACKHAM. Text-book Tropical Hygiene, 2nd ed.
27. Holy Bible. 1st Cor., 16th chap., 22nd verse.
28. SIMPSON. Principles of Hygiene as Applied to Tropical and Sub-
Tropical Countries, Wood, 1908.
29. MANSON. Sutherland's System of Diet and Dietetics.
30. HALL, WINFIELD S. Med. Times, Feb., 1916.
CHAPTER XTTI
DIET IN CRITICAL PHYSIOLOGICAL PERIODS
Old men bear want of food best; then those that are adults; youths bear it
uiffl cufx'cidllii children, and of them ihe most lirelif are the least capable of
ctiditr'nn) it.
Diet in Childhood: Early Childhood; Diet for School Children.
Diet during Puberty.
Diet in Sedentary Occupations.
Diet during Menstruation.
Diet during Pregnancy.
Diet during the Puerperiura.
Diet during Lactation.
Did during the Menopause.
Diet in Old Age.
DIET IN CHILDHOOD
In this chapter no reference will be made to the alimentation for the
infant, as this will he fully discussed in subsequent chapters. We will
begin with early childhood (from the third to the sixth year before school),
during which time the child should have four meals each day and a nap in
the afternoon. There should be no sudden change of diet during this
period, but the proportions of milk should be gradually decreased and
mushy cereals increased, and a greater proportion of breadstuff's, cookies,
etc., should be allowed. According to the researches of Atwater, at the
end of the second year the child weighs about one-fifth as much as the
adult, and requires three-tenths of the standard adult ration, the relative-
excess being due to the fact that the child is growing and depositing tissues
and fat. From the third to the fifth year the growing child requires four-
tenths of the adult ration; from the sixth to the ninth year one-half, and
from the tenth to the thirteenth year six-tenths. From this age on much
depends upon the habits and life. For instance, a girl from fourteen to
sixteen requires seven-tenths of the adult ration, and a boy of the same
age requires a full adult ration.
409
410
DIET IN PHYSIOLOGICAL PERIODS
Early Childhood. Dr. M. Allen Starr(l) has worked out the accom-
panying table of the dietetic needs in childhood collected from the actual
food consumption by large groups of healthy children.
STARR'S TABLE OF DIETETIC NEEDS IN CHILDHOOD
2-3 years
(28 cases)
3-6 years
(12 cases)
4-10 years
(24 cases)
Bread
7.5 ounces
10.3 ounces
10.23 Ounces
Butter
.98 "
1.08
.99
Beef
4.6
12.1 "
12.46
Potatoes or rice
3.9 "
13. "
10.23 "
Milk
32.6
48.6
38.5
Cereals, fruits and eggs should enter largely into the composition of
the alimentation of the growing child, and there is no objection to an allow-
ance of a minimum amount of meat. During this period of development,
from the third to the sixth year, the child is building up tissue, muscle,
brain, bone and gland, and must, therefore, have plenty of protein. Milk,
eggs and cereals will furnish these in abundance. At this time, also, the
child is acquiring habits, and it should be impressed upon him that the
habit of proper mastication is an important acquisition. This can only
be attained by necessity. The mother should be instructed not to feed
the child on a diet consisting too largely of pultaceous foodstuffs of a semi-
liquid character, as these will be swallowed without chewing and thereby
become a hindrance to dental development and a possible detriment to the
development of the digestive organs. Such a diet leads, in the first place,
to imperfect development of the muscles of mastication and the jaws, with
the result that the post-nasal space is small and liable to be encroached
upon by adenoids, with unfavorable effects upon growth and general nutri-
tion, while in the second place the particles of carbohydrate food will lodge
around the teeth and undergo acid fermentation with resulting dental
caries. The great necessity for giving the child food that requires chew-
ing cannot be too strongly emphasized. The healthy growing child will
get hungry between meals, and if he is doled out soft bread with jam he is
pretty certain first to swallow the food with inadequate chewing and, sec-
ond, to eat more than he needs, overloading his stomach, overtaxing his
digestive activities, and perhaps retarding his appetite for the next meal.
This point is particularly emphasized by Watson (2), who urges that a
child be taught early to develop the art of mastication, which favors the
normal development of the nasal and nasopharyngeal cavities which are of
DIET IN CHILDHOOD 411
so much importance, for the purpose of respiration and general nutrition.
The cereal foods are of first importance oatmeal, hominy and samp,
thoroughly cooked and served with butter, cream, milk or sirup. Well-
cooked farinaceous pudding of all kinds are wholesome and readily taken
by children.
Of fresh vegetables the potato is the most popular, and one of which
young children will not tire. It may be served boiled, baked or mashed
and creamed, but never fried. Fresh cauliflower, cabbage, spinach,
asparagus, beans and peas may be allowed, but canned vegetables should
never be used when fresh ones can be had.
We fully appreciate the craving of the growing child for sugar, candy
and sweets, a demand which must be satisfied. It is far better to do this,
however, by the use of sugar in the food than by allowing the artificially
colored sweets of the candy manufacturer, which are often taken in ex-
cess apart from the meal. Many fruits contain a considerable amount of
sugar in an assimilable form, as well as certain mineral properties which
are of inestimable value and importance in maintaining a healthy condi-
tion of the blood. Apples, peaches, pears, plums, grapes, oranges, bananas,
cherries, etc., are suitable wholesome fruits, and some of these, according
to season, should form a part of the child's dietary each day.
The first permanent molar teeth appear about the sixth year, while
the deciduous incisors are already undergoing decay. Children at this
stage require careful preparation of food by fine cutting, scraping, etc.
At this time, also, the child should be initiated into the use of the tooth-
brush, and if necessary the dentist should be consulted as to the preserva-
tion even of the deciduous teeth by means of temporary soft fillings. Not
only are these deciduous teeth more valuable for mastication than parents
sometimes think, but with cavities they furnish a home for the colonization
of bacteria, which hasten the early loss of the permanent teeth.
The normal day's ration for a healthy child of four to six years, ac-
cording to Hall, may be as follows (3), necessary variations being made
in accordance with the season, climate, etc. :
Breakfast 7 A.M.
A glass of whole milk; small portion of thoroughly cooked oatmeal with cream
and sugar; baked apple; small piece of buttered toast.
Lunch 10 A.M.
A small portion (equal to a heaping tablespoon) of parched sweet corn, or two
graham crackers; glass of water.
Dinner 1 P.M.
Cup of cambric tea (hot water and cream sweetened); broad and butter; cn-ann >]
potatoes; fruit, stewed or fresh,
412
DIET
PHYSIOLOGICAL PEKIODS
Tea 4 P.M.
A dry crust or a piece of cold, dry toast, or a pretzel, or two graham crackers.
Supper 6 P.M.
Glass of milk; soft-boiled egg; shredded- wheat biscuit with cream; fruit (apple,
grapes, banana or orange).
There are several points in reference to a child's diet which should be
specially emphasized, as pointed out by Hall. First, his food should be
dry and hard to chew. Second, one meal each day should be rich in pro-
teins. Third, any lunches partaken of in the midforenoon or midafter-
noon should be small in volume and should always be dry, requiring very
slow mastication, which will insure the ingestion of small quantities and
rapid digestion. Furthermore, such a repast will not interfere with the
full meal which is to follow some two hours later. A normal child of two
years and upwards has a well-developed digestive apparatus and a keen
appetite, and is well able to digest most foodstuffs if given in moderate
quantities.
Watson has compiled a very practical table of average weights and
heights of children at different ages. The averages in these tables were
calculated from weights and measurements taken from a large number of
observations, and, though fairly accurate, are not necessarily true in all
cases. The discrepancy, however, will not vary more than 15 per cent
either way. The point of greatest importance is the proportion between
height and weight. To be exact in recording observations in weight, the
periodical weighing should be done under precisely corresponding condi-
tions, the same clothes, same scales, etc.
COMPARATIVE HEIGHTS AND WEIGHTS OF CHILDREN
MALES
FEMALES
Age last
birthday
Age last
birthday
Height
Weight
Height
Weight
1
2
2 ft. 5^ in.
2 8p^2
18^ Ibs.
1
2
2 ft. 3^ in.
2 " 7 "
18 Ibs.
3
2 11
34
3
2 10
31M "
4
3 " 1
37
4
3 " "
36
5
3 4
40
5
3 " 3 "
39
6
7
8
3 " 7 "
3 " 10
3 " 11
44^ "
49%
55
6
7
8
3 6
3 " 8
3 " 10^ "
41% "
47^ "
52
9
10
11
4 ^
4 3%
4 " 5J / <2 "
72 2
9
10
11
4 0% "
4 3
4 5
53^ "
62
68
12
13
4 " 7 "
4 9
76%
82^
12
13
4 " 7^ "
4 " 9%
76^ "
87
DIET IX CHILDHOOD 413
A point, emphasized by Watson, and often overlooked at this period
of life, is the necessity for adapting the alimentation to the diathesis of
the child. For instance, the needs of a child of tuberculous parents, say,
at the fifth year, are different from those of a gouty child of the same
ago. The child of a tuberculous diathesis is usually of comparatively
feeble development, shows little muscular activity, is slightly anemic and
possibly under size. The principal point in arranging the diet in such
cases is to provide the necessary increase in the amount of animal pro-
tein, more particularly meat and raw meat juice. The great benefit de-
rived from a properly planned alimentation in these cases is little less than
remarkable, but to secure lasting results, the dietary must be religiously
continued for many months, sometimes for as long as two years. The
following diet list will be found of practical importance and suitable for
a child of five or six years, with a tuberculous diathesis. It contains a
more liberal supply of animal proteins in the form of milk, eggs, meat,
and soup than an ordinary diet, including two pints of milk, and meat
foods at least three times daily. This point should be insisted on and
continued during the growing period.
DIETARY FOR TUBERCULOUS CHILDREN
First Breakfast 6.30 A.M.
Milk; biscuit and butter.
Breakfast:
Milk; butter; bread; egg; fish or bacon.
Lunch:
Cup of soup (meat stock), or egg flip.
Dinner:
Soup with raw meat; curds and cream; glass of milk; pounded meat and vege-
table; stewed fruit cream; glass of milk. Fish, with sauce; potato; custard
pudding; glass of milk. Chicken, bread sauce; vegetable; blancmange; cream;
glass of milk.
Tea:
Milk; bread and butter.
Supper:
Good meat soup, thickened with milk; or egg; or meat pure"e; or lentil pure*e.
The diet for a child of the gouty diathesis should be most careful I v
regulated, since it is without question that proper alimentation will do
much to eradicate the tendency to disease. "The special features in the
dietary treatment are (a) the necessity of bringing the child up on a
strictly lacto-vegetarian diet, red meats of all kinds to he forbidden, or,
at most, only allowed occasionally, and very sparingly; (J>} the importance
of a restricted allowance of sugar and of foodstuffs rich in sugar. If a
414 DIET IN PHYSIOLOGICAL PERIODS
child with a gouty tendency is dieted along these lines during the period
of growth and development, he will be much less prone to develop gouty
symptoms in later life."
Diet for School Children. Growing boys and girls during school life
from the sixth year until puberty require a large amount of wholesome,
nutritious food (4). During this stage of life the rapid growth and inces-
sant activity of the child continue, and to these is now added the mental
work of laying the foundation for an education. In a child that has been
wisely brought up under normal conditions and has had a due amount of
work, play and sleep, the appetite will be the best guide for the amount of
food required. On the other hand, the appetite of a child who has been in-
dulged with too many sweets and highly seasoned dishes, to the exclusion
of the plainer, more wholesome foods, and who has been petted, pampered
and brought up like a hothouse plant, will not be a trustworthy guide to
the food requirements. Children with a debased appetite of this sort,
which is, of course, due to faulty feeding at home, had better be sent to
a boarding school at once, where the social customs will soon effect a per-
fect, if at first a somewhat painful, cure. It is not uncommon at this age
to have the parent tell us that "Johnny cannot take this and cannot take
that food at home," although on physical examination no defects will be
found. It cannot be too strongly impressed on parents that the inability
of healthy children to take ordinary food is imaginary, brought about
largely by previous erroneous feeding and fostered by paternal weakness,
proof of which is furnished by the fact that when the child is placed
among other children who are eating ordinary food this inability at once
passes away. It must not be lost sight of, however, that we not infre-
quently meet with a neurotic boy or girl with personal idiosyncrasies to
certain articles of diet. Such children require special study and special
treatment.
The greater the amount of exercise a child takes in the open air, the
greater will be his appetite, which will directly influence the quantity of
food he should take. Strenuous exercise up to the moment of coming to
meals should not be allowed, as such exercise is liable to produce exhaus-
tion, which will affect both appetite and digestion. The normal adult likes
to indulge in a short rest after meals, but the healthy child will be eager
for exercise, which should not be forbidden, provided it is the nature of
the child to be active in play and not easily tired. Still, it is well to re-
member that a strenuous game of football immediately after dinner is
distinctly injurious.
In estimating the requisite caloric value of the dietary of children
DIET IN CHILDHOOD 415
some formulae will have to be followed as a guide. Children of normal
size, development and activity Sherman thinks require the following
calories per kilogram of body weight.
REQUISITE CALORIES PER KILOGRAM FOR VARIOUS AGES
From 1 to 2 years 100-90 calories per kilogram 900 to 1200 calories
2 " 5 " 90-80 " " " 1200 " 1500 "
6 " 9 " 80-70 " " " 1400 " 2000 "
10 13 " 70-60 " " 1800 " 2200 "
Girls 14 " 17 " 65-45 " " 2200 " 2600 "
Boys 14 17 " 60-40 " " " 2500 3000 "
In calculating a dietary for children the factors of growth and devel-
opment must always be taken into consideration. The child needs pro-
tein for the ordinary wear and tear and also requires an additional amount
for the production of bone and muscle. The child has an intense metab-
olism, more general than the adult; owing to the period of growth the
food must supply material to be added to the body in the form of bone
and brawn in addition to that which is oxidized for normal metabolism.
In selecting the proper alimentation of young subjects, the most im-
portant consideration is that of not starving the child on any one food-
stuff (5). A requisite amount of protein, fats and carbohydrates is abso-
lutely essential. To stint is very often to starve ; therefore, in arranging
the diet, the meals should be at regular intervals, at least three good meals
being given daily. The chief difference from the feeding in the early
years is that a large amount of beef and mutton is now demanded. Meat
should be given twice a day, once to provide for the wear and tear, of the
body, and once to "supply the means for growth," as Dr. Clement Dukes
rather quaintly expresses it. It is needless to say that the freshness of the
food is a most important consideration. Salted meats and canned meats
are, useful in supplying variety in the dietary, but if used too frequently
they fail to supply the proper amount of nutrition and their continued use
becomes monotonous, leading to loss of appetite. Likewise, canned
vegetables and fruits are to be considered as inferior to fresh ones for
regular use. The question of hours for meals is important. Breakfast
should be punctual to allow the child time to eat a good hearty meal, to
masticate its food properly, and to have time before starting for school to
attend to the bowels. School children are often upset through neglect of
this wholesome rule.
The value of a liberal diet during school life cannot be too strongly
emphasized. Dr. Watson(2) speaks with authority on the subject, and
416 DIET IN PHYSIOLOGICAL PERIODS
the following articles of food are selected from those given by him as
suitable at this age : *
SUITABLE DIETARY FOR SCHOOL CHILDREN
Breakfast:
This should be the heartiest meal of the day. Begin with a small plate of por-
ridge and glass of milk; follow by an egg or fish, bread and butter, or toast and
butter, and tea or coffee, largely made with hot milk; jam or marmalade and
oatcake.
Lunch 11.30 A.M.
A dry biscuit and a drink of milk (not hot scones, buns, or pastry) ; a little fresh
fruit, apple, orange, or banana.
Dinner in the middle of the day:
This should consist of soup, meat, vegetables, and pudding. The soup does not
require to be made of rich meat stock lentil, pea, broth, or rice soup are all
excellent, giving a good foundation for the meat course. Roast, boiled meat,
and stews are the best, served always with potatoes and a vegetable. Pud-
ding should be varied: suet pudding with fruit or jam, milk puddings, or stewed
fruit. A glass of milk may be given with this meal, and as much bread as the
child wishes to take.
Tea, not later than 5.30 P.M.
Beverage, milk or cocoa (not tea as a rule) ; as much plain bread and toast as the
child can eat; plain cake; sometimes an egg, or fish, or potted meat, marma-
lade, jam, or honey.
Supper:
A drink of milk and a biscuit is all that is necessary; a large supper is not advisable.
It is better for all children to go to bed with the stomach comparatively empty.
Weak tea and coffee, well diluted with milk, may be added to the
dietaries given, but should not be taken in excess. Milk at this age will
be made much more palatable and attractive to the palate if flavored with
tea or coffee. The question of an allowance of alcohol for schoolboys may
be answered by asking the question : "Is it necessary, and is it beneficial ?"
The consensus of opinion of both physicians and dietitians has decided
both questions in the negative. If, then, the use of alcohol by the school-
boy has been considered unnecessary on physical grounds and not bene-
ficial on normal grounds, one can safely assert with confidence that alcohol
should not form a part of the youth's diet during school life. (See section
on Alcohol, Volume I, Chapter XVI, page 568.)
The chief meals of the day should be three in number : breakfast, din-
ner and supper. The first two should be the substantial meals, while sup-
per should consist of less stimulating food. Under no consideration should
schoolboys and girls have a heavy meal of stimulating food a short time
before retiring. Neither should they be set to the task of doing lessons in
the morning before partaking of food, but should spend a half hour in the
open air, after which a substantial meal should be served, with plenty of
time for thorough mastication. The dinner hour usually follows four or
1 For additional dietaries see Volume III. Chapter XXVTTT.
DIET IN CHILDHOOD 417
five hours after breakfast. For some children this may prove too long an
interval without food. If so, a piece of bread with an apple or some light
food may be allowed in the midforenoon. The supper should be a light
repast, as outlined above, and should be taken^ some two or three hours
before retiring.
It will be admitted that a diet selected from the above list proves
amply sufficient, liberal and varied. It should meet all the requirements
of the growing body and even the special weakness of the schoolboy or
girl in the matter of sweets. Although no mention is made of fresh fruit,
this is to be regarded as an essential part of the daily diet, for though its
nutritive value is not great, the carbohydrate matter, which is abundant, is
in a form which appeals' to the youthful palate. The action of fresh fruit
on the bowels and the blood renders this food material specially desirable
and suitable for growing boys and girls.
The medical inspection of school children has been the means of detect-
ing and remedying many defects which hamper the child in his studies,
and it may be safely stated that a child who cannot easily and without
physical detriment keep up with his class is defective, due to imperfect
vision or hearing, to sluggish respiratory changes due to adenoids, etc.,
to imperfect nutrition at home, or to some other remediable condition that
is more likely to be detected by regular school inspection than by the ob-
servation of ignorant and careless parents. With three good meals daily
from the above dietary, no boy or girl should suffer from hunger or from
failure of nutrition from lack of food.
The superintendent of schools should see that the hygienic condition
of the building is such as to favor the working of a pupil without undue
fatigue, which might lessen appetite and thereby interfere with nutrition.
Tasks should not be imposed that would be arduous for the average child
to perform, for the most part during school hours. Neither should the
discipline be such as to overtax the child or interfere with his meal hours.
If greediness in partaking of food is observed in a youth, it must be dis-
couraged and checked, as it breeds physical ills if tolerated. However,
one must not allow a healthy appetite to remain unsatisfied on the ground
that moderation is a desirable virtue. Some parents and the heads of
boarding schools consider that the mininmm allowance of food compatible
with health is all that is desirable, and in many such cases children are
kopt in a chronic state of starvation. It is true that certain children with
strong constitutions, ruddy, rugged and robust, might stand this without
ill health accruing, but there are instances where the future growth and
development of a child have been permanently stunted by a scanty allow-
418
DIET IN PHYSIOLOGICAL PERIODS
ance of food. If at this period of growth and development there must be
error, let the error be on the side of allowing the maximum rather than
the minimum amount of food.
DIET DURING PUBERTY
The period of pubescence begins in the girl usually about the thirteenth
year and the boy about the fourteenth year. This period in both sexes is
marked by great physical growth and development, and the dietary, to
meet these new demands, should be rich in easily digested proteins. There
is no time in man's existence when there is greater need for wholesome,
suitable, nutritious food that which will build up good rich, red blood
than at this period. The adolescent should have liberal allowances of
bread, eggs, meat and foods of every kind, provided he digests them well,
but highly spiced dishes and wine should be tabooed.
The paucity of reliable statistics on the normal consumption of food
in adolescence is a serious drawback to the dietary guidance in the feeding
of young boys and girls. It is difficult and unusual to collect the basic
facts regarding the functional needs and performances in this period of
youth. A recent investigation by Gephart(5) gives an idea of the actual
amounts of nourishment ingested by more than 300 boys in one of the
largest private boarding schools in the United States.
The total animal supply for such an institution containing 355 boys
was computed as follows, in metric tons :
Protein
Fats
Carbohydrates
Food supply
20.5
25.6
60.5
Waste
3.8
5.4
4.2
Food fuel . .
16.7
20.2
56.3
The quantity of food computed on the basis of the individual meal
served, appears as follows:
Pounds
Grams
Calories
Calories
(Per cent)
Protein
1107
50.2
206
14 1
Fat
0.1332
60.4
562
39
Carbohydrates
0.3717
168.8
692
47
1,460
1 Seventy per cent of this was in animal protein
DIET DURIXG PUBERTY 419
The food was of the best quality, and included 193 separate varieties.
The cost per meal was 20 cents, or 13.8 cents per thousand calories. This
is twice what the poor man in New York City pays for his food. But
these growing athletic boys were not satisfied with the conventional 3,000
calories per day. The investigator of their dietary ascertained that beside
the 4,350 calories which they consumed daily at the table, they bought 650
additional calories in food at a neighboring store, the principal item being
chocolate.
Graham Lusk(G) has pointed out the fact that the 5,000 calories con-
tained in the daily alimentation of active American boys of school age
are half again as much as a farmer at strenuous work is thought to require.
The total fuel intake of the boarding school just mentioned was three
times that necessary for the heat production of boys from 13 to 16 years
of age when asleep and resting. As previously emphasized, these findings
serve in a way to explain the ravenous appetite of growing boys and girls.
Lack of appreciation of this factor and lack of provision for it are a fre-
quent cause of much under-nutrition in children.
The adolescent girl in particular needs good wholesome rich foods,
more especially those containing iron. We have already called attention
to the iron content of many foods. Lean meat, eggs, and the dark green
leaves of vegetables, as spinach, are all rich in iron. A well-balanced
rational menu for a fourteen-year-old girl or her sixteen-year-old brother
would be somewhat like the following(T) :
SUITABLE MENU FOR A FOURTEEN-YEAR-OLD GIRL OR HER
SIXTEEN-YEAR-OLD BROTHKK'
Breakfast:
Oatmeal with cream and sugar; buttered toast; one or two boiled eggs; fruit
(grapes, apples, bananas, oranges or berries) ; coffee, with cream and sugar.
Lunch:
A pure"c of cream soup with crackers or croutons; bread and butter; fruit; rice
pudding or custard.
Dinner:
An ample portion of meat; potatoes (baked or boiled); side dish of vegetables;
fruit, stewed or canned, with graham wafers; bread and butter.
This dietary is rich in protein, sufficient to nourish an adult at mod-
erate work. But we must remember that the adolescent has need for a
great excess of meat, and, as a matter of fact, the pubescent boy or girl,
in school, office or factory, will eat quite as much and often even more
than an adult, and will bo far more seriously injured if he does not get
the requisite alimentation. If a boy or girl craves a light lunch in the mid-
afternoon, it should be allowed. A young ii'ii-l, especially, if sho begins to
420 DIET IN PHYSIOLOGICAL PERIODS
show signs of pallor, as is frequently noticed in high school girls, may be
directed to prepare for herself an egg lemonade, using two yolks instead
of the yolk and white of one egg. Such a lunch will not interfere with
the dinner later on. The best stimulants of the appetite at this age are
fatigue for the boy, from swimming, walking in the open air, and moderate
exercise for the girl, tennis and golf, which ought to hasten the return of
color to her cheeks.
The craving for sweets by the adolescent boy or girl is a natural one,
and should be satisfied. Fudge and other sweets should be allowed, but
as a rule it is preferable for these to be eaten immediately following meal
time. When partaken of in this manner they serve an important purpose
in the alimentation and seldom give rise to any disturbance of digestion.
As sweets are the most condensed sources of carbohydrates and per volume
are great sources of energy, the insatiable desire for them seems to be
more or less instinctive. A few generations back, it was thought and
taught that the consumption of sweets had a tendency to produce decay of
the teeth, but at the present time the toothbrush brigade has robbed them
of any bad reputation which they have possessed in this connection.
The present curriculum in most high schools and girls' colleges is
faulty and could be greatly improved upon. Long sessions impose too
long and severe a strain on the boy or girl, more particularly if they
happen to be puny and with little or no desire for breakfast. A more
sensible plan would be to arrange the courses of instruction so that no
pupil would be required to attend more than four consecutive periods
without a recess. An insufficient breakfast, hastily ingested, due to late
rising or to late hours the evening before, either on the part of the pupil
or family, so that breakfast is not served in due time, is frequently a cause
for digestive disturbances on the part of the pupil, besides furnishing in-
sufficient nutrition. The adolescent attending high school should have a
well-balanced midday meal, consisting of good wholesome food. Such an
arrangement need not in any way interfere with the full evening dinner
with the family. Pupils of this age should be restrained from social dissi-
pation during school sessions except on Friday and Saturday evening.
About this time of life the question of the proper allowance of alcohol,
tea, coffee or tobacco, etc., is one that will have to be met and answered.
Abstinence from alcoholic liquors is desirable even for the adult, and
almost imperative for the adolescent if health is to be maintained. Strong
coffee and tea likewise should be shunned. Weak cocoa will afford an
excellent substitute for both.
According to Benedict (8), "It should be impressed on the boy or girl
DIET IN SEDENTARY OCCUPATIONS 421
that there are purely physical conditions during the period of growth, aa
well as differences in the business and social demands upon the adoles-
cent and the adult, which render abstinence necessary in the former, and
indulgence comparatively harmless in the latter. If the appeal to judg-
ment based on these grounds is not sufficient, parental discipline may be
necessary, and it is even worth considering whether the health of the
youth is not worth the argument of example as well as precept. The
prejudice against cigarettes, as compared with stronger forms of tobacco,
is due almost entirely to their premature use by boys too young to tolerate
tobacco in other forms."
DIET IN SEDENTARY OCCUPATIONS
Persons engaged in sedentary occupations which confine them indoors,
and whose work is largely mental rather than muscular, require a diet
suitable to their needs rather than one adapted to the requirements of a
laborer or "lumber jack." Sedentary workers sooner or later realize from
experience that they must give attention to their diet if they would remain
in good health. If a man whose vocation does not permit of any physical
exercise indulges in a heavy diet in which meat is ingested two or three
times a day, he is almost certain, sooner or later, to suffer from serious
nutritional disturbances. First, he is apt to put on an excess of flesh;
second, his excretory organs, more especially the kidneys, will suffer from
the extra strain in eliminating waste products of protein metabolism,
with the result that at first he will be annoyed with occasional and later
almost continuous disabilities of a rheumatic or a lithemic character;
third, his digestive organs will sooner or later fag under the burden of
overeating, especially of foods from the animal kingdom. As a result he
will suffer from constipation, which, if prolonged, will lead to an altered
bacterial activity resulting in auto-intestinal intoxication with accompany-
ing stasis and putrefaction. The injurious effects of over-indulgence at
the table by the sedentary, are of far-reaching importance, and are claimed
to be the chief factor in the development of many serious diseases. There
can be no question that the excessive ingestion of protein food induces a
temporary albuminuria, similarly glvcosuria, pentosuria, etc. The great-
est danger from the excessive ingestion of proteins, and more especially
animal protein, is due to the fact, as previously pointed out, that they are
incompletely oxidized, which tends to the accumulation of waste products
in the blood protein poisons acting injuriously in different directions
already mentioned ; all of which may easily be avoided by proper alimen-
tation.
127
422 DIET IN PHYSIOLOGICAL PEEIODS
Energy diverted for mental work is apt to be at the expense of the
digestive process; consequently, it is highly important that the alimenta-
tion should be closely studied, so as to exactly meet the requirements of
the case, and not unduly tax the organs of digestion nor overwork the
organs of excretion. As a rule, meat should be indulged in but once a
day, and then only in moderation, while individuals of slender physique
and frail constitution will do well occasionally to replace meat by other
animal foods, as eggs and fish. Persons engaged in literary pursuits,
writers and brain workers, often suffer from lithemia, which in many cases
is unquestionably due to other causes than errors in diet such as anxiety,
worry or overwork, "burning the candle at both ends." This class of
patients do better on a full diet of good, wholesome, well-cooked food,
which is nourishing, light and digestible. They should be instructed to
avoid fatty and purely starchy dishes, but they need meat, and it may be
allowed in moderate amount. Variety in fruits and fresh green vegetables
is also desirable. The following aliments should be rigidly restricted:
rich gravies, sauces, custards, patties, lean meat in made dishes, pastry,
highly seasoned or fried entrees. The menu for the sedentary, whether
professional, literary or business man, should be somewhat as follows
(Hall) :
SUITABLE DIETARY FOR THE SEDENTARY
Breakfast:
Fruits, preferably a baked apple; breakfast bacon; buttered toast; muffins or
gems; coffee with cream and sugar.
Lunch:
A cream soup or pure"e with crackers, or sandwich and fruit, with a cup custard.
Dinner:
Meat, white bread, potatoes; vegetables; salad; fruit; a light, easily digestible
pudding, such as rice, chocolate, or bread pudding with fruit sauce; gelatin or
tapioca with fruit; coffee or tea with cream and sugar.
By some this dinner may be thought to be rather heavy, but we will
assume that the sedentary gentleman will partake of the different courses
rather sparingly ; that he will linger long at the table in a social hour with
the family in regular deipnosophistic fashion, with quip and repartee,
keeping the whole dinner circle in good spirits, which will give him suf-
ficient time to thoroughly masticate his food.
The brain tissue is composed very largely of fat three times as much
as in muscular tissue, while the nerves contain an even greater percentage.
Non-lithemic brain workers may advantageously partake of fats and car-
bohydrates foods which may be supplied in the form of cream, butter
DIET IN SEDENTARY OCCUPATIONS
423
and well-cooked bacon, bread, potatoes and vegetables. The reason that
some writers laud fat as a food for brain workers is the ease with which
it is metabolized into energy. The popular idea that fish, owing to the
large percentage of phosphorus contained in it, possesses some specific
action as a brain food is now an exploded theory. Fresh fish is, however,
very wholesome, and by replacing meat in the menu is more easily metab-
olized by the digestive organs. The sedentary brain worker who desires
to keep in a fit condition should have a light lunch and dine late in the
day. It is desirable during the active hours of close mental application
to supply only the food actually necessary for the prompt production of
the requisite energy without borrowing, so to speak, or drawing upon the
digestive organs for the expenditure of energy in elaborating food which is
only needed for storage.
A tour of inspection of the downtown metropolitan district of any
large city at the noon lunch hour reveals two sharply-defined classes of
patrons: (a) Those who believe in steaks and chops as the best brain and
nerve food, and with whom economy is of no moment, and who spend a
dollar or a dollar and a half for luncheon; (6) those who believe in stay-
ing the pangs of hunger for the least money. Members of this class spend
ten cents for a piece of pie and some cheese and five cents more for a cup
of coffee or a glass of milk, and get just as much fuel value or force and
energy as the former provided, of course, the ingested food is assimi-
lated.
COMPARATIVE LUNCHES
Proteins
Fat
Carbo-
hydrates
Calories
(a) Chops
15 grams
20 grams
247.5
Potatoes
2.1 "
.1
17.7 grams
82
Salad
.5 "
1.6
1.4
23
Orange ice
12
49
17.6 grams
21.7 grams
31.1 grams
401.5
(6) Mince pie (slice)
6 grams
15 grams
66 grams
436
}/2 oz. cheese
3.5 "
4.1 "
0.3
53.7
}/2 pt. milk
8.3
10 *
12.5
178
17.8 grams
29.1 grams
78.8 grams
668.7
Mrs. E. H. Richards (9) has worked out a daily ration for the seden-
tary business man, professional man or literary worker, but in our
opinion, the protein allowance is entirely too liberal. We give the table
below :
424 DIET IN PHYSIOLOGICAL PEKIODS
RICHARDS' RATION FOR SEDENTARY OCCUPATIONS
FOOD
Amount
Proteins
Fats
Carbo-
hydrates
Calories
Bread. .
16 oz.
32.0 grams
3.0 grams
258.0 grams
1,216.6
Meat
16 "
50.0 "
30.0 ""
481.0
Butter
1 "
25.0 "
230.0
Sucar
4
110.0 grams
451.0
Milk
8
18.0 grams
18.0 grams
22.0 "
329.6
Oysters.. . . .
4 "
7.0 "
1.0 "
37.8
Soup
4 "
4.0 "
3.0 "
44.0
Potatoes ,
6 "
3.0 "
38.0 grams
168.1
Ecscs
3 "
10.0 "
9.0 grams
123.8
Oatmeal
2 "
1.0 "
0.5 "
4.0 grams
25.1
Cream
1 "
1.5 "
6.5 "
1.0 "
70.1
Fruit
8 "
0.5
50.0 "
207.1
Additional liquid tea,
coffee or water
30 "
Total....
77 oz.
127.0 grams
96.0 grams
483.0 grams
3,384.2
Contented should be the man whose digestive organs are functionating
normally, who is so well balanced that he takes his breakfast, as his news-
paper, as a matter of course, and who is no more perturbed by the fraction
of variation in the stiffness of his boiled egg than by the rumor of an out-
burst of Mt. Vesuvius. Happy is he who sits down to the dinner provided
for him without thought of what he must partake of and what he must
not, with a mind free for social pleasure, secure in the skill and exercise
in the culinary department of his household. Who would not strive to
have this feeling of self-assurance ? And yet how few are willing to pay
the price ! A little thought, a little self-control, and then forget that there
is such a thing as digestion. Blessed be the man whose organs and espe-
cially the organs of digestion are functionating normally and properly
without his being conscious of it. Only in such cases is he a whole man.
Overeating should be religiously avoided by the sedentary individual.
We have already emphasized this point (Volume II, Chapter VI), but
again we caution against overloading the system with incompletely as-
similated foods which obtund intellectual activity and lead to exhaustion
of the nervous system. If some arduous task requiring long hours and
absorbing concentration and painstaking care is imposed, it will be better
to take two light lunches during the day. If the task proves fatiguing, a
little Burgundy or white wine may be taken with the lunch. It may,
according to Chambers, "stay the weariness of the system and allow the
nerve force to be diverted to the digestion of the meal, but to labor on and
DIET DURING MENSTRUATION 425
continue to take this anesthetic between meals is inconsistent," and "when
extraordinary mental toil is temporarily imposed, extreme temperance or
even total abstinence should be the rule, for mental activity makes the
brain bear less alcohol than rest and relaxation."
The sedentary person who remains much indoors should have frequent
week-end outings of two or three days when all the cobwebs may be blown
away and all his arterioles flushed out with ozone from the ocean breezes
or mountain blasts. The stimulus of change, even if the food is only mod-
erately good, is invaluable.
DIET DURING MENSTRUATION
A perfectly well woman whose menstrual periods recur with clock-
like precision need not be treated as an invalid during menstruation, and
her alimentation need not be other than usual. Of course it is understood
that during the catamenial period she should avoid very cold or very hot
baths, and should also shun excessive physical exertion or severe mental
strain.
Absence of the menstrual function is a frequent accompaniment of
mental disturbance due to great grief, fright or anxiety, while an exces-
sive development of fat may prevent the flow appearing even in persons
whose general health appears to be excellent. Here proper dieting will
be beneficial. Menstruation may be absent without causing the slightest
inconvenience or perturbation ; on the other hand, there may be present,
coincident with the menstrual period, a feeling of general disturbance
accompanied by headache, flashes of heat, nervousness, nausea and
vomiting, due largely, if not altogether, to a run-down condition of health,
both mental and physical, which appropriate, wholesome, nutritious,
nitrogenous diet will greatly benefit.
Various menstrual disturbances may be expected in a certain percent-
age of young girls, especially during the first year or two following the
appearance of the catamenia, which indicate rest, confinement to the room
or to bed, and a dietary corresponding to the physical condition of the
patient, and to her relative quiescence and environment. Anemia,
chlorosis and thyroid disturbances depending on menstruation will receive
attention elsewhere.
DIET DURING PREGNANCY
A good, simple, well-balanced dietary is best adapted for the normal
pregnant woman, and unless complications arise it is not customary to
direct any definite system of alimentation.
426 DIET IN PHYSIOLOGICAL PERIODS
As soon as pregnancy is positively determined, the hygienic and
dietetic care of the woman should be outlined. First, she should take daily
the requisite amount of exercise in the open air; second, too much im-
portance cannot be laid upon the necessity of preventing constipation;
third, her alimentation should be regulated to fit her requirements and
environment; fourth, gastric disturbances, usually termed "morning sick-
ness," which may or may not be a harassing symptom, must receive atten-
tion. If serious vomiting occurs in the early months, the most careful and
painstaking attention should be given the dietary. The first principle in
the dietetic treatment of vomiting, according to Watson, is to give the
stomach a rest. Then the dietetic substances usually prescribed for the
relief of nausea and vomiting and for nourishment are indicated, among
which may be suggested cracked ice ; pancreatized milk, milk with sodium
bicarbonate (ten grains) ; milk and lime water, milk and vichy, soda,
seltzer, or carbonic acid water ; whey and kumiss ; beef extracts and pepto-
noids; raw meat juice; raw meat pulp; scraped meat; clam broth; dry
toast, etc.
The "longings" of pregnant women for various indigestible articles,
such as dill pickles, etc., so far as they are kept within reasonable bounds,
may be gratified, but there seems to be no reasonable evidence that the
refusal to satisfy such caprices has any effect upon the physical or mental
development of the child. These "longings" are largely mythical and
occur, if at all, only as an accompaniment of a general hysterical condition,
and not as a peculiarity of the period of pregnancy.
Albuminuria and dropsy are serious symptoms complicating pregnancy,
and their presence demands the most careful attention to the dietary.
In these complications the lightest possible diet should be outlined, throw-
ing the least strain upon the kidneys and other glandular organs. In very
severe cases it may be necessary to prescribe an exclusive milk diet ; in less
severe cases a diet of milk, bread, farinaceous foods, and simple fruits
may suffice ; while in the milder forms of derangement all that is necessary
will be to avoid red meats and richer dishes of all kinds and subsist on the
lacto-vegetarian diet described in Volume II, Chapter XV.
The quantity of food during pregnancy should not exceed what is
usually required by a healthy woman, the meals should be taken at regular
intervals, and those articles of food known to disagree should be avoided.
The diet throughout the period of gestation should be simple and whole-
some but varied. Tea, coffee and alcoholic beverages should be allowed
with caution. The vulnerability of the liver raises the question of doubt
as to whether ale, beer or stout should be permitted. Large amounts of
DIET DURING PREGNANCY 427
meat more particularly canned meat, canned vegetables, sea food at a dis-
tance from the ocean, undrawn poultry and stale eggs, in which decompo-
sition may have already begun, should be avoided also, as should liver,
thymus and kidney on account of extractive waste and excessive amounts
of purins. Animal foods, even when sparingly taken, force the already
congested liver to supplementary work in eliminating toxins arising from
muscular tissue, and should be entirely stopped if even traces of albumin
appear in the urine. Milk should be discontinued altogether if there are
any symptoms of eclampsia. In general, however, cereals, milk, cream
and butter, fresh eggs, small amounts of fresh meat especially poultry
and fresh fish, fresh (pod) vegetables, sweet and white potatoes and other
vegetables rich in nutriment and with only a small percentage of indiges-
tible residue, and fresh fruits, omitting strawberries, blackberries, blue-
berries, etc., should be the mainstays of the pregnant woman's dietary.
The idea, formerly prevalent among the laity and to some extent among
medical men, that pregnant women should partake largely of foods con-
taining abundant phosphates and lime salts to furnish the embryo with
material for the production of bone, is now an exploded theory, since the
organic salts in question are plentifully supplied in an ordinary mixed
diet.
Another fallacious theory, equally as ingenious, though directly op-
posed to the foregoing, is interesting only historically. It was once claimed
that the agonies of labor would be less severe if the pregnant woman lived
upon a diet composed largely of fruits and meat, avoiding fresh vegetables,
on the assumption that the lime salts contained in them would favor early
ossification of the infant's skeleton and thus add to the difficulties of par-
turition. It is so well known that Nature is abundantly competent to
regulate this process unaided that this theory, like the first, is no longer
accepted. However, the size of the child can be, to some extent, regulated
by diet. The trend of modern thought, experience, and to a certain extent,
scientific research, according to Watson (2), tend to show that scientific
alimentation can influence material and fetal tissues in such a way as to
make labor more easy and to increase the chances for a viable child being
born. This is of special moment to the physician who has under his care
a woman with a small or contracted pelvis who has, in consequence of the
dangers associated with labor under these anatomic conditions, given birth
to one or more still-born children.
Watson records the claims of Prochownick(lO) and other investigators
who prescribe a diet deficient in carbohydrates and fluids that result in a
small child which, in every other particular, is well developed. The
428 DIET IN PHYSIOLOGICAL PERIODS
claims of Prochownick are that with a conjugate diameter of 8 cm. a diffi-
cult labor can be obviated and the induction of premature labor rendered
unnecessary. He suggests that the following dietary should be prescribed,
beginning from ten to twelve weeks before labor is expected, and rigidly
adhered to, more particularly during the last two months of parturition:
PROCHOWNICK'S ORIGINAL DIET
Breakfast:
Small cup of coffee, 3 ounces; breadstuff, 1 ounce, with a little butter.
Dinner:
Meat, eggs, or fish, with a little sauce; green vegetables, prepared with cream;
salad; cheese.
Supper:
Much as dinner 1 to 1^ ounces of bread with butter (water, soups, potatoes,
sugar, and beer are strictly withheld).
This average diet consists of:
Protein 140 to 160 grams
Fat 80 to 130 "
Carbohydrates 100 to 110 "
Fluids, about 500 c.c. daily
Altogether a fuel value of 1800 to 2000 calories
According to Watson, polydipsia is complained of during the first few
days of this dietetic regimen, but it soon passes off. He also records that
some patients complain of the large amount of animal food.
"All the confinements reported were much easier than on former occa-
sions, even when the child was large and fat. All the children were born
alive. The children were usually lean at birth, with the bones of the head
unusually mobile. They were apparently mature in every way, and in the
majority of cases the child gained normally after birth, and the diet had
apparently exercised no injurious effect whatever on the child, or on the
mother during pregnancy or the period of lactation. On such a diet, it is
essential that the condition of the urine should be carefully observed, the
amount of urea and the presence or absence of albumin in the urine being
specially noted. Unlike what might have been expected, it was found
that this diet did not apparently favor the onset of eclampsia." In the
majority of instances it has been observed that the child thrived normally
after birth, and the diet had no bad effects on lactation.
DIET DURING THE PUERPERIUM
The dietary of the puerperal woman has undergone a revolution dur-
ing the past few decades. She is no longer kept for ten days upon a diet
of toast, weak teas and other "slops," with the idea that semistarvation
would lessen the chances of puerperal fever and "milk fever." These
changes are largely due to modern obstetric teaching, and to the applica-
DIET DURING LACTATION 429
tion of antiseptic and aseptic precautions during labor. Immediately after
delivery, a woman may be allowed a cup of warm tea or warm milk.
Later she may be fed milk, soft-boiled eggs and dry. buttered toast ; the
next few days bread, milk, soup, chops or steaks in limited quantities.
She can then gradually return to the diet which she naturally prefers,
avoiding, of course, indigestible dishes, as cabbage, fried foods, seed
vegetables and, above all, dried beans and other legumes.
Immediately after a prolonged labor the woman is left so exhausted
by excessive muscular effort and agonizing pain that she is too tired to
eat, and is more thirsty than hungry, so she may have a glass of milk and
vichy at this time. As many of the complications of labor, as mania, are
favored by exhaustion and inanition, a sustaining and stimulating diet is
of the greatest importance. The nursing woman, moreover, requires
a more liberal diet than other patients, as her mammary excretion, to
furnish the requisite food for the child, must contain a large percentage of
protein and fat, and, since she is constantly losing a protein substance in
the lochia, she must be full fed or her milk will be poor and insufficient.
It is a bad practice to allow a healthy lying-in woman to fast too long.
She needs to be well and full fed and will sleep better and feel better
than if she receives too little food. While the patient's own appetite is a
better guide for feeding than any hard and fast rule that may be formu-
lated, she should be urged to take food unless greatly exhausted, but care
must be exercised not to overload the stomach. After the milk secretion
has been established and the bowels regulated, she may be allowed a rea-
sonable quantity and variety of food, though while in bed she requires
less than later when up and about. Any complication with a rise in tem-
perature is a contra-indication for allowing much animal fotod, except
milk, but extreme exhaustion without febrile action demands it
DIET DURING LACTATION
The period of lactation usually lasts for about one year, though towards
the end of the seventh or eighth month the quality and quantity of the
milk secreted begin to fall off. Some mothers nurse their children far into
the second year, but the nutritive properties of the milk are, of necessity,
very poor.
The diet of the nursing mother must be regulated to prevent noxious
substances from passing into the breast milk and to keep her in the best
possible condition of health, so that she does not suffer from digestive
disturbances. Edgar says(ll) : "If milk is readily assimilated and does
430
DIET IN PHYSIOLOGICAL PERIODS
not tend to constipation, she may drink it abundantly. She may also be
allowed gruels, meat broths, meat, eggs, vegetables, and other simple nour-
ishing food. Fruits, even if acrid, are not objectionable if they do not
react unfavorably through the breast milk upon the child, and if the
mother's digestion is good they serve to keep the child's bowels active. A
nursing woman should be given meat as lamb chops, beef and bacon
fish, beans, etc. A reasonable amount of fatty foods in all forms if they
are well digested, and cheese, potatoes, bread, rice, green and dry peas and
lentils, which excite mammary secretion (but not dry haricot beans).
Green vegetables are also allowable, with the exception of cabbage, cress,
garlic, leaks, onions, mushrooms, salads and sorrel, which permit noxious
substances to pass into the mammary secretion. Rich and indigestible
foods and alcoholic drinks, beyond a glass of white wine and a pint of beer
or cider, should be avoided." While malt liquors sometimes cause an in-
creased secretion of milk, this is because more fluid is drunk and is not
due to any specific action of the drink, and the breast milk is not improved.
A reasonable quantity of fluids is beneficial and is necessary to maintain
the mammary secretion, but milk broths, soups and plain vichy water are
far preferable to beer, ale or porter. Weak tea and coffee in small quan-
tities are not objectionable if the mother craves them. As already stated,
a nursing woman should be full fed, but not "stall fed," that is, to excess.
Her daily alimentation should furnish her with :
Protein 150 grams 600 calories
Fat 100 900
Carbohydrates 500 " 2000
Total 3500
Below is given an allowance for one day's ration as calculated by
Gautier (12). The weight of the constituent alimentary principles of the
allowance is as follows :
A DAY'S RATION FOR A NURSING WOMAN
Kinds of Food
Weight
Protein
Fat
Carbo-
hydrates
Bread
600 grams
50 grams
5 1 grams
300 grams
Meat
400 *
80 "
28
2
Beans, peas, lentils
100 "
23
2 "
59 "
Potatoes
150 "
24 "
0.5 "
30 "
Butter
65 "
"
60 "
"
Beer, \\t> pt.. .
7 "
"
20 "
1,315 grams
162.4 grams
95.6 grams
411 grams
DIET DURING LACTATION 431
This ration will furnish fuel energy to the extent of 3,150 calories.
The beer may be replaced with a pint of milk, and the meat may be
reduced and eggs and fresh vegetables substituted. After all has been said,
the best galactagogue is good, nourishing, wholesome, simple food, espe-
cially rich cow's milk, not so much because it is milk, but because, 011 the
whole, it is easily digested and readily assimilated and furnishes approxi-
mately the right proportion of solids and water needed in the secretion
of the mother's milk. Benedict advises withholding all drugs during
lactation, more especially laxatives, iodids, mercury, etc., unless there is
special indication to medicate the child. In cases where opium, alkaloids,
atropin, bromids or any "strong" medicines which act directly upon the
nervous system, must be given, nursing should be suspended, and the child
fed artificially for the time. The breasts, in the interval, should be evacu-
ated by means of the breast pump, and a twenty-four or forty-eight hour
interval should elapse after medication is suspended. Foods which con-
tain volatile substances, onions, garlic, or hypnotic substances, such as let-
tuce, hops or beer, or meats or fowl that is "high," should not be per-
mitted.
To a limited extent the quantity of the mammary secretion can be
increased by the allowance of liquid foods and more water than is habitu-
ally taken. On the other hand, it can be reduced by withholding water,
or by withdrawing serum from the blood, as, for instance, by purgation.
The ingestion of more carbohydrates and hydrocarbons does not modify
the milk, but an abundant consumption of proteins increases the percentage
of fat, which is the only ingredient of milk that can be influenced by diet.
The protein content can be lessened to some extent if the mother is en-
gaged in any occupation which calls for strenuous daily exercise to the
point of moderate weariness.
The influence of diet and exercise upon the secretion of the mammary
glands has led Rotch(13) to formulate the following rules :
To increase the total quantity of milk: (a) Increase proportionately
the amount of liquids in the mother's diet; and (6) encourage her to be-
lieve that she can nurse her infant.
To decrease the total quantity : Decrease proportionately the amount
of liquids in the mother's diet.
To increase the total solids: (a) Shorten the nursing intervals; (6)
decrease the mother's exercise; (c) decrease the proportion of liquids in
her diet.
To decrease the total solids: (a) Prolong the nursing intervals; (fr)
432 DIET IN PHYSIOLOGICAL PERIODS
increase the mother's exercise ; (c) increase the proportion of liquids in her
diet.
To increase the fat : Increase the proportion of meat in her diet.
To decrease the fat : Decrease the proportion of meat.
To decrease the proteins : Increase exercise up to the limit of fatigue.
A nursing mother should cancel social obligations so as not to interfere
with the nutrition of her child, and all excessive physical strain and ex-
citement are to be avoided. No engagements which conflict with the regu-
lar times of nursing should be made, and only the most pressing demands .
for recreation or important business transactions should excuse the nursing
of an infant in public places.
DIET DURING THE MENOPAUSE
The menopause climacteric, or "change of life," in females is attended
by marked disturbances of the nervous system, the precise nature of which
is not thoroughly understood, but which are beyond doubt influenced by
the functions of the ovaries. The reproductive organs are undergoing a
complete change. The caliber of the vessels is shrinking, the blood supply
is lessened, and atrophy of the ovaries, tubes and uterus is slowly taking
place ; even the breasts become flat and shriveled, and other parts lose the
form and appearance characteristic of the reproductive period (14).
The menopause(15) occupies about five years two or three from the
commencement of irregularity to the cessation of the menstrual function,
and a similar period during which time involution becomes complete and
the normal activity of the body is established.
An important point in the management of women at this period of
their lives is to forcibly impress upon them the fact that they have no
definite disorder, but are merely undergoing a perfectly normal physio-
logical cessation of a function (8), and that, while they are likely to be
annoyed with various manifestations of physical and psychic disturbances,
they will in all probability pass through the "change" without serious
consequences. Even in a normal menopause a multitude of symptoms may
be present, such as headache, trembling, flashes of heat, palpitation and
shortness of breath, insomnia, nervousness, irritability, nervous depression
and "nagging." During its course all physiological functions are weak-
ened, and all pathological conditions aggravated (16). If, however, a
woman presents a train of symptoms indicating distinct pathological
changes, she should be examined and treated appropriately.
There is usually a marked derangement of the nervous system at this
DIET IN OLD AGE 433
period, in some instances even affecting the mentality of the patient. The
patient may present slight vagaries, a loss of interest in the affairs of life,
and iii extreme cases melancholia or other forms of a loss of mental bal-
ance may be observed. During the "change" the excretions and secretions
should be watched; the nutrition should be carefully looked after; waste
and repair should balance ;' dietetic excesses and irregularities should be
avoided, and care should be exercised in the preparation and serving of
meals so as to appeal to the five senses. The diet should be simple, un-
irritating and easily digested and assimilated. Meats should be restricted
and fresh vegetables liberally consumed. As sugar is apt to set up fermen-
tation in the stomach, candies, preserves, jellies and sweet puddings are to
be taken in moderation. Pastry, hot breads, fried foods and rich dishes
must be interdicted. The patient should imbibe freely of good spring
water, drinking three or four pints daily. Stimulants are to be taken very
sparingly and alcohol in any form is prohibited. The patient should lead
a regular and careful life, taking gentle exercise in the open air. She
should be kept as free from worry, anxiety and mental strain as possible,
should be instructed to rest in bed during the menstrual period, and to
observe early hours, bathe regularly and keep the skin and bowels active.
It must not be overlooked that certain diseases have a predilection for
development at the menopause, such as thyroid disturbances, diabetes,
hepatic and renal degenerations. The use of ovarian extracts, after or
^during the climacteric, is now thought to be of doubtful propriety, yet
some clinicians claim good results from the administration of corpus
luteum products. If the health is carefully looked after during this period,
the pathological conditions will subside, but, according to Tibbies (15),
"Negligence and disregard of the physician's advice may result in a serious
breakdown from nervous or other causes, and may lead to permanent im-
pairment of the health. Due care as to the alimentation, proper attention
to the functions of the skin, kidneys and bowels, a careful mode of life,
proper rest and freedom from worry and excitement, will lead to the re-
establishment of health and formation of mens sana in corpore sano."
DIET IN OLD AGE
Before discussing the question of diet in old age, it may be well to
attempt a definition of old age. By no means can this be reckoned by the
number of years a man or woman has attained. There are old young men
and young old men. Premature senility overtakes some individuals, gen-
erally of the male sex, at middle age or even before, while, on the other
434
hand, there are men old in years who retain the physical and mental char-
acteristics of healthy middle age. What then constitutes old age ? What
are the physical and physiological criteria that go to mark the failing of
the bodily powers ? For in the case of premature senility it is the bodily
powers that have lapsed or are lapsing and not, as a rule, the mental fac-
ulties. A philosopher once said that a woman was as old as she looked
and a man as old as he felt. While this aphorism is true, old age is per-
haps most aptly denned by the statement that "a person is as old as his
arteries." This would seem to be a correct explanation of the term old
age, for when the arteries have hardened, or are becoming hardened, the
"decensus Averni" has commenced. As Allbutt states in his work on
arteriosclerosis, we recognize now, all of us, that in the lapse of man's
years, one long reckoning of his mortality is, and from all known ages
has been, written on the walls of his vessels. We may assume that in
primitive man, by external conditions, if not by innate capacity, life was
of comparatively brief duration. Domestic animals seem, as a rule, not
to live long enough to use up their arteries or not to live long enough to
abuse them and among these creatures atheroma, although not unknown,
has not been commonly observed.
Arteriosclerosis, then, may be taken as the sign manual of decaying
physical powers (17), that is, of old age, and the person who has hardened
arteries may be termed old. Premature senility is far more frequent
under the trying conditions of civilized life than when life is passed under
natural conditions. The artificial life of cities, sedentary occupations,
the stress and strain of business, and, above all, unhygienic habits of living,
of which the most harmful are overeating, errors of diet and too great
indulgence in spirituous beverages, combine to place old arteries in young
bodies and to shorten greatly the normal span of life. One cannot "burn
the candle at both ends" with impunity-
First, it may be as well to deal with the means for preventing old age,
and, as it appears to have been decided that diet is the prominent factor in
its production, the attempt will be made to show how this is so. According
to Allbutt, one form of arteriosclerosis is due to the excessive or relatively
excessive consumption of meat and wine, and this form is accompanied
by a persistence of high arterial pressure. Conheim recognized high blood
pressure and big heart in gluttons. Traube was one of the first in recent
times to marshal clinical evidence on "luxus consumption" and to argue
the question on scientific lines. Frantzel followed him, with the theory
that with gluttony arose an overcharge of the veins and a fall of centrifu-
gal velocity, which propagated a rise of pressure backwards to the capil-
DIET IN OLD AGE 435
laries and arteries. The fact must not be forgotten that the arteries of the
alimentary tract are among the most muscular in the body and have a very
complex nervous endowment a mingled vasoconstrictor, vasodilator and
vagus supply; and in no arteries is medical hypertrophy without calcifi-
cation so well marked and so palpable. This change, even when absent
elsewhere in the system, may be found here. Stengel emphasizes as causes
overfeeding and hereditary predisposition, and says that regulation of diet
and habits, if it cannot cure, may alleviate the malady even in its ad-
vanced stages. Sir Lauder Brunton, Dr. W. Russell and many others are
of the same opinion. Allbutt(18) says that we, as other engines, differ
widely among ourselves, not only in the quantities of food we need for
given work, but also in our capacity for dealing with it economically. For
example, a small eater may be a bad metabolizer. He would, therefore,
iirii'e that while one man can be gluttonous with impunity, and another
on a moderate diet become "plethoric," nevertheless, the average man who
indulges his appetite for food and drink, especially if his habits be seden-
tary, runs no little risk of high arterial pressure and of imperiling the
integrity of his arteries. Huchard attributes the spread of arteriosclerosis
to the increased use of meat during the nineteenth century. As Fanny
Burney neatly put it, "Tharle's miscalculation of his digestive powers
ended in apoplexy." Another witty person remarked that a good cook is
more to be feared when one is in perfect health than a bad doctor when
one is ill. However, whether mere overfeeding apart from a toxemia can
raise the blood pressure, as if by a parenchymatous surfeit, is a question
as yet unanswered. But we do know that overeating and overdrinking
frequently bring about chronic constipation and intestinal stasis, which
result, more often than not, in alimentary toxemia. The blood becomes
surcharged with the end products of protein digestion toxic materials
and' if this condition be allowed to persist, blood pressure is raised, the
arteries begin to harden, the natural powers of the body abate, and, in
short, the individual is on the high road to old age.
When discussing overeating and injudicious diet as factors in bringing
about untimely senility, it should be well understood that these are by no
means the only causes. There are persons who, no matter how much they
may abuse their bodies in this direction, still live to be old in years, whose
arteries do not harden prematurely, and who, although gross eaters and
drinkers, continue to enjoy life. On the other hand, there are spare people
who do not eat or drink to excess, yet their arteries harden, they exhibit
the symptoms of senility before their time, and become old prematurely.
Their metabolism is probably defective. In spite of such exceptional
436 DIET IN PHYSIOLOGICAL PERIODS
cases, there is little doubt that errors of diet, in the direction chiefly of
self-indulgence, are largely responsible for the great increase of chronic
diseases more frequently than not accompanied by arteriosclerosis so
melancholy a feature of modern life, and that diet does play a part, the
importance of which can scarcely be overestimated, in the causation of
certain conditions distinguished by hardening of the arteries. Theognis,
an old Greek writer, said: "Surfeit has killed more men than famine,"
and perhaps this saying is even truer to-day than when it was penned.
Surfeit helps to bring on old age, and to prevent this occurrence, food and
drink should be taken sparingly. As the diet calculated to prevent old
age is much the same as that best suited to those who have become prema-
turely old or who are old, that question will be dealt with when diet for
the aged is discussed.
The warding off of old age is obviously of greater concern than its
treatment when it has come(19), for after the arteries have become hard-
ened there is no means, medicinal or dietetic, which will bring back their
pristine softness and flexibility. Remedial treatment by diet and drugs,
mainly by diet, may greatly prolong life, but will not cure the condition.
For these very substantial reasons those who are young, and those who
lead an indoor life, in particular, should see to it that they exercise a wise
moderation as regards food and drink and a due discretion as to the kind
of food. Observe a dictum of Hippocrates that "everything in excess is
unusual to nature."
With regard to diet in old age, the consensus of opinion of those who
have studied the subject is that less food is needed than at other periods
of life. In fact, this is not a matter of opinion, but of exact knowledge.
In youth we are going uphill, in old age downhill. In childhood and in
early youth the physiological powers are concerned with building up the
organism and developing its various functions, and an ample supply of
food is required to further these operations. In these days the supply
exceeds the losses and acts in developing the organism, and the body
increases in height and weight. The child or youth can eat, and indeed
needs, an amount of food which the ordinary adult would find beyond his
requirements. Also during this most active physiological period of life
the impaired cells are regenerated rapidly and with ease, and new cells
spring r.p like flowers in the spring and more than counterbalance the
decay of the affected ones. Nevertheless, the time comes when the proc-
esses of decay and repair are exactly balanced, and the body has reached
its full growth or maturity.
On reaching manhood the individual generally acquires the prevailing
DIET IN OLD AGE 437
dietetic habits of his associates, with little disposition to question their
suitability to himself. If he leads an active life and has plenty of exercise
in the open air, he may largely exceed, both in quantity and variety of
food, what is necessary to supply the demands of his system without pay-
ing a very exorbitant price for the indulgence. A "bilious attack" at in-
tervals affords a safety valve and gets rid of the undesirable balance which
remains in the case of every hearty eater. In the normal condition of
things this state of affairs is maintained for many years. After the first
half or so of life has passed away, however, instead of producing these
periodical attacks of sickness, the unemployed material may be relegated
in the form of fat to be stored on the external surface of the body or to be
packed among the internal organs, producing obesity to a greater or less
extent. There are some individuals who do not seem to be able to store
fat, however rich their diet may be or however inactive their habits. In
such persons, and on occasions in those who do store fat, the excess of food
material ingested must go somewhere to produce disease in some other
form, probably at first interfering with the action of the liver, the next
appearing as gout or rheumatism, or as the cause of fluxes and obstruc-
tions of various kinds. Gout is, to some extent, a safety valve in the same
way as bilious attacks in youth, except that it is really damaging to the
constitution and materially injures it. Up to the time of middle age, if a
person be robust and vigorous, and possesses a strong digestion, he can con-
vert a large mass of food into fluid aliment suitable for absorption into the
system. Moreover, his eliminating powers are active and can pass out of
the body superfluous material otherwise destined to produce mischief in
some form. As he advances in years, however, his powers of elimination
diminish proportionately ; less nutriment should therefore be taken, and
the kind of food in many cases should be different. A due relation should
be preserved between the "income" and "output," and if this be neglected
for any considerable time, injury will be done to some of the organs or
functions of the body.
It must be remembered that, even if the body be in a healthy condition
in normal old age, there is a great difference between the health of youth
and that of age. In youth vitality is strong and the recuperative powers
are great, the abundant vital forces render the organism elastic so that
severe illness does not unduly drain the system, and there is a reserve of
energy which can be called upon, and which is generally equal to the
demands. In old age there is not this reserve force, the constitution is en-
feebled and has lost much of its resiliency, vitality is weak, the spring
of youth is lacking and no longer acts with a force equal to that with which
128
438 DIET IN PHYSIOLOGICAL PEKIODS
it is expended in short, the body cannot respond to the demands made
upon it as of yore. As Tibbies points out, slight deviations from the
normal performance of function occur, which may, however, for a long
time be imperceptible. These gradually increase in extent until they
become manifest indications of a failure of the bodily powers or of dis-
ordered health. Exertion produces results which formerly would not have
been noticeable and exhaustion is out of all proportion to the work per-
formed. Among the most marked indications of failing metabolism and
consequent disturbance of the functions are symptoms of disorder of the
alimentary system. With old age and approaching old age the muscular
power of the whole system wanes. The muscular fibers of the stomach and
bowels participate in this decline. But, although the digestive powers and
those of assimilation diminish, the appetite often remains good, or in some
persons the custom of eating and drinking freely is so ingrained that it
has become a habit. More food is therefore consumed than can be digested
or absorbed, rnd, as mentioned previously, the unabsorbed portion prob-
ably undergoes putrefaction, and in the end produces that condition known
as alimentary toxemia ; high blood pressure ensues, and arteriosclerosis is
aggravated.
The pathological changes incident to age have been summed up by
Metchnikoff as a sclerosis which may affect the brain, liver, kidneys and
other organs, but is mostly seen in the blood vessels. There are many
other degenerative changes,' but to mention all of these would be superflu-
ous. Arteriosclerosis is the most important.
Perhaps too great emphasis has been laid on, the point that arterio-
sclerosis is synonymous with old age. We intend to convey by this state-
ment that thickening of the arteries may be considered as; physiological
old age. It may occur prematurely, when it is termed premature
senility, and to a greater or less extent it is generally an accompaniment
of advanced years, though by no means always. However, whether the
condition be that of physiological old age or of old age without obvious
injury of the arteries, the question of diet is all important. In healthy
old age, where the organs and functions show only the normal and some-
times but comparatively few degenerative changes, there is, nevertheless,
always a certain failing of the bodily powers. There are variations and
changes accompanying the progressive deterioration of the organism in
which all the organs and functions participate more or less, although it is
doubtful, except in the case of definite disease of the excretory organs,
whether the aged suffer in any marked degree from their inefficiency.
Constipation is usually the most troublesome affliction of senility and the
DIET IN OLD AGE 439
phagocytes are particularly active. The object, then, should he to discover
a meaiis to strengthen the most valuable cellular elements on the one hand,
and weaken the phagocytosis on the other. The elixir of life is yet to be
found and, therefore, other and more prosaic methods must be sought to
achieve this end. While the problem of how to effect this is still far from
solution, the consensus of opinion is that judicious eating, combined with
hygienic modes of life in other respects, will do most in this direction, and
that diet is the main staff upon which to lean.
All are agreed that in old age the diet should be lighter than in younger
years, and that the amount of food eaten should vary with the needs of the
individual. The food should be of an easily digestible kind, and, accord-
ing to Friedenwald and Ivuhrah, it should be given in smaller quantities
at a time, and the intervals between meals should be shortened.
JS"ascher(19), on the other hand, says that the oft-repeated advice that the
aged should eat little and often is irrational, for digestion is naturally
slower in old age and frequent feedings keep the stomach constantly at
work, there being always a mass of food in the stomach in different stages
of digestion. This, he thinks, is the most common cause of flatulence,
heartburn and senile gastric catarrh, with its attendant pyrosis and gas-
trodynia. In old age, according to this writer, food should not be taken
oftener than once in five- or six-hour intervals, at fixed hours each day.
The number of meals, like the time of day at which the principal meal is
taken, is a matter of habit, often of nationality, and does not affect the
rule.
As at all adult periods of life, if there be a tendency to obesity, food
that is apt to be converted into fat should be given in diminished amounts.
The proteins should be somewhat lessened from time to time. Some
authorities, including Sir Henry Thompson, advocate a vegetarian diet
for the old, believing in the proverb, "Much meat, many maladies," but
others see no valid reason why animal proteins should not be given in
moderation, especially if the subject has been a consistent meat eater.
There are those who regard heavy suppers as an abomination. Possibly
such meals are blazing indiscretions at any period of life, and certainly
in old age they should be most severely condemned. Likewise eating be-
tween meals is a habit that is discountenanced, although it is probably less
harmful than is supposed. The personal equation with regard to diet and
particular kinds of food holds good just as much with the aged as with the
person in the prime of life. ^Yhon an individual has reached the age of
(50 years he ought to have learned which articles of food disagree with him,
and should refrain from these. A diet laid down on strictlv scientific lines
440 DIET IN PHYSIOLOGICAL PERIODS
will not suit all old people, and a fairly wide latitude should be allowed for
personal likes and dislikes and for individual idiosyncrasies. Especially
should monotony in diet be avoided, no matter how perfectly adapted it
may seem to be from the laboratory standpoint. Cowper's saying, that
"variety is the spice of life and gives it all its flavor," applies with as
much truth to food as to other things.
Now it is allowed that food is perhaps the most essential factor in
warding off old age, or rather in avoiding many of the disagreeable accom-
paniments of old age which are certain to occur if the habit of indulging in
food to excess or of eating unsuitable viands is persisted in. Dr. Harry
Campbell (20) states that in his opinion the most suitable dietary for the
aged is that which constitutes the ideal diet for many in general. Such
a dietary demands (a) moderation in quantity, (6) simplicity in quality,
and (c) the avoidance of those starchy foods which are apt to slip into
the stomach without having first been adequately insalivated. A moderate
diet is one just sufficient supposing the various foodstuffs, fats, proteins,
etc., to be properly balanced to maintain a person at the slightest weight
consistent with the most perfect health of which he is capable. Simplicity
is constituted by such items as bread, plain biscuits, plain puddings,
plainly cooked vegetables, fruit, meat, fowl, fish, milk, Cheddar cheese,
tea, coffee, cocoa, salt. Dishes calculated to tickle the palate are not in-
cluded in the simple diet ; neither are alcohol nor condiments other than
salt and, occasionally, pepper and mustard. Avoidance of soft starchy
foods is essential. All through life, starch should, as far as possible, be
taken in a form compelling mastication. Soft starchy foods such as pud-
dings are only admissible on condition that they be thoroughly masti-
cated.
The diet of early man conformed to these three requirements. It was
simple, consisting as it did of unprepared animal and vegetable substances.
The quantity was not, on the whole, in excess of physiological needs ; and
all the starchy food, being raw, had to be abundantly masticated in order
to break up the non-digestible cellulose framework and thus liberate the
contained foodstuffs. When we come to compare the ideal with the actual
in the present day, the contrast is discouraging. Too often the stomach
and bowels are burdened with an excess of food and harassed by a too
great variety. Efficient digestion is rarely possible under these circum-
stances, and the blood is surcharged with nutrient matter, much of which
is in an imperfectly digested form. The tissues being thus bathed in an
overrich and perverted plasma, metabolism fails to proceed normally and
health suffers.
DIET IN OLD AGE 441
Inasmuch as after early adult life there is a steady waning in the
ability of the organism to digest and metabolize the food taken, it follows
that the need to conform to the requirements of the ideal dietary becomes
increasingly pressing with advancing years.
Campbell elaborates the points which we have touched upon, with re-
gard to the capacity of the organism to cope with different kinds of food,
the influence of custom and idiosyncrasy, as well as of age, and his remarks
are so instructive that it will be fitting to refer to them at length. As to
the first of these influences, while one should be cautious in recommending
to an aged person a diet very different from that to which he has for years
been accustomed, the experience derived from prisons, workhouses and
similar institutions shows that the ability of the aged to adapt themselves
to novel kinds of diet is by no means small. It is indeed astonishing what
can be achieved in this direction if the necessary pressure be brought to
bear.
The factor of idiosyncrasy is important. Individuals differ greatly,
quite irrespective of age, in their digestive and metabolic capacities. We
meet with children who are unable to tolerate foods which old people can
digest quite easily, and with others who are made ill by even a slight ex-
cess, while their grandfathers can, perhaps, consume large quantities with
comparative impunity. Some old people have, in fact, prodigious powers
of digestion and metabolism, and we may look upon them as corresponding
in the physiological sphere to the Shakespeares and Newtons in the realm
of mind. They are physiological geniuses. Most of these old people
would, however, doubtless enjoy better health, be more amiable and have
greater consideration for others, on a more abstemious diet ; nevertheless,
in regulating their food, we must make due allowance for their prodigious
powers, though not infrequently, by the gratification of their inordinate
appetites they are paving the way for many and diverse complications.
If they have high blood pressure and exhibit any of the symptoms of apo-
plexy, the amount of the food they take should be limited.
According to Friedenwald and Ruhrah(21), milk may be taken in all
forms when easily digested, and when it is not well borne the addition of
warm vichy or warm water will often prove helpful, or the milk may be
diluted with cereal gruels, or have sodium citrate, one grain to the ounce,
added to it. Beef tea is often useful, and beef juices may be used if de-
sired. Eggs, lightly cooked or beaten up with milk are very good, as are
nutritious soups, such as chicken or fish purees, mutton, beef or chicken
broth. Young and tender chicken, game and other tender meats and good
quality potted chicken or other potted meats may be taken. Sweetbreads
442 DIET IN PHYSIOLOGICAL PERIODS
are easily digested if fresh and properly prepared, but may be contra-
indicated on account of the purin nitrogen contained. White fish, such as
sole, whiting, smelts and the like, are all suitable, and are best when
boiled. Crisp grilled bacon is relished by many.
The following foods are also suitable : bread and milk made with the
crumbs of stale bread and without lumps; porridge and oatmeal gruel;
puddings of ground rice, tapioca, arrowroot, sago or macaroni, with milk
or eggs, and flavored with spices or served with fruit jelly ; bread and but-
ter, the latter at least a day old; rusk, to be soaked in tea or milk and
water; prepared foods, consisting of predigested starches. At this age
digestive ferments are scantily provided by the digestive organs, and
soluble carbohydrates are valuable for maintaining the body heat. All
farinaceous foods should be subjected to a high temperature for some time
during the cooking process, so as to render the starch granules more di-
gestible. Vegetable purees of all kinds may be taken in moderation, e.g.,
potatoes, carrots, spinach and other succulent vegetables. Potatoes and
fresh vegetables are a necessity ; if omitted, a scorbutic state may be en-
gendered. Stewed celery and stewed Spanish or Portugal onions lend
variety to the diet, and stewed or baked fruits, fruit jellies, and the pulp
of perfectly ripe raw fruits may be taken in small quantity.
With respect to a diet for old age based on scientific investigations,
Vbit(22), who founded his conclusions on researches made by Forster,
considered that the conditions of old age indicate a ration of 0.8 the value
of that for men and women of mature age, in good health and doing mod-
erate work, as follows :
VOIT'S DIETARY STANDARD FOR AGED PERSONS
Protein
Energy
Old man, no work
90 grams
2 116 calories
" " light work
100 "
2,689 "
Old woman, no work
80
1 831 "
" " light work . ...
85 "
2 096 "
In this standard, as Tibbies points out, no age is stated, and the amount
of protein is considered by some authorities to be too great.
Maurel(23) points out that, as age increases, the amount of external
muscular work becomes smaller, internal muscular work becomes less,
and therefore the nutritive requirements of the body are correspondingly
decreased.
DIET IN OLD AGE 443
MAUREL'S MAINTENANCE RATIONS FOR OLD PEOPLE
Age
Protein per Kilo
Energy per Kilo
Adult '.
1.5 grams
35 to 38 calories
Fifty to seventy years
1.25 "
30 " 35
Seventy years and over
1.00
25 " 30
Extreme old age
0.75 "
20 25
Langworthy(24), by using Maurel's maximum factors and taking the
average weight of old men and women to be the same as found by
Quatelet(25), has framed the following table to show the estimated re-
quirements of aged people :
LANGWORTHY'S DIETARY STANDARD FOR THE AGED AND INFIRM
Subjects
Age
Average
Weight
Protein
required
Energy
required
Men
Years
60
Kilos
65.50
Pounds
144.1
Grams
81.9
Grams
1,965
70
63.03
138.7
78.8
1,891
80
61.22
134.7
45.9
1,531
u
90
57.83
117.2
43.4
1,446
Women
60
56.73
124.8
70.9
1,702
70
53.72
118.2
67.2
1,612
u
80
51.51
113.3
38.6
1,288
u
90
49.34
108.5
37.0
1,234
Kosevi(26) found that the food consumed by women aged, seventy-
six and seventy-eight years was as follows :
KOSEVI'S MAINTENANCE RATION FOR THE AGED
Protein
Calories
Woman, seventy-six years, 45 kilos, first diet
77 grams
1,361
45 " second diet
66 "
1,361
45 " third diet
66 "
1,165
Woman, seventy-eight years, 61 kilos, first diet
41
1,275
" " " 61 " second diet
41 "
1,575
61 " third diet
67 "
1,207
Guriev of Petrograd undertook some experiments to ascertain the
amount of protein required by old people, and to study the metabolism of
nitrogen. Five men were selected from sixty-eight to eighty-eight yeara
of age. The three younger were hale and hearty, the two elder somewhat
444
DIET IN PHYSIOLOGICAL PERIODS
decrepit. The dietaries were given in each case, the first including meat
and milk, the second beef tea, but no meat or milk. The dietaries and
nitrogen balance are given below :
NITROGEN METABOLISM IN OLD AGE
.
Protein
Fat
Carbohydrate
Calories
First diet (a) . ...
90 grams
42 grams
372 grams
2,296
Second diet (6) ....
55
87
385
2,615
Age
Dietary
Days
NITROGEN
Grams
in
Food
Grams
in
Urine
Grams
in
Feces
Gain
or
Loss
Man,
68 years
Man,
74 years
Man,
75 years
Man,
88 years
Man,
88 years
(a) Meat 100, milk 250, bread 600,
butter 20, sugar 60 grams;
tea 1,800 c.c
5
5
10
8
5
7
5
5
5
8
12.7
8.9
17.4
10.9
13.0
8.9
15.1
6.7
13.7
8.9
8.4
6.5
14.6
7.7
9.0
6.7
10.7
4.3
10.9
8.1
1.0
.9
1.2
.8
1.2
1.8
1.2
1.1
1.8
.14
+4.3
+2.5
+ 1.6
+2.4
+2.8
+ .4
+3.2
+1.3
+1.0
+ .6
(6) Beef tea 500, tea 1,800 c.c.; po-
tatoes 600, bread 400, butter
70, sugar 60 grams
(a) Meat 142, milk 500, bread 600.
butter 22, sugar 60 grams;
tea 1,200 c.c
(6) Beef tea 500 c.c. ; potatoes 300,
bread 500, butter 90, sugar 60
grams; tea 1,200 c.c
(a) Meat 100, milk 250, bread 55,
butter 20, sugar 60 grams;
tea 2,100 c.c
(b) Beef tea 500 c.c. ; potatoes 600,
bread 400, butter 90, sugar 60
grams; tea 2,160 c.c
(a) Meat 100, milk 500, bread 600,
butter 30, sugar 60 grams;
tea 1,530 c.c
(6) Bread 340, butter 120, sugar 60,
potatoes 400 grams; tea 1,530
c.c
(a) Meat 100, milk 250, bread 600,
butter 20, sugar 60 grams;
tea 2,200 c.c
(6) Beef tea 500 c.c. ; potatoes 600,
bread 400, butter 90, sugar 60
grams; tea 2,200 c.c
The conclusions drawn from the observations were: (a) The amount of
protein ordinarily consumed by old men may be diminished if an abun-
dance of fat and carbohydrate is taken to replace it. (6) The assimilation
of nitrogen by old men is somewhat less than normal. During the first
DIET IN OLD AGE 445
dietary the assimilation of nitrogen averaged 91.15 per cent; in the sec-
ond diet period, 86.17 per cent. The assimilation of nitrogen by young
men on a similar diet was found to be 94 per cent. In the first, or meat
period, the ratio of incompletely oxidized products to urea in the urine
was greater than normal; therefore, the metabolism was inferior to that
of young men on a similar diet. In the second, or non-meat period, this
ratio decreased somewhat. When the diet contained less protein, but an
abundance of fat, the subjects maintained their usual weight and health.
The recent researches of Schlesinger and Neuman upon the digestive
functions of thirty healthy individuals over sixty years of age have demon-
strated that while starch and fat are thoroughly digested, the digestion of
meat is, as a rule, imperfect.
According to Munk and Ewald(27), a man doing no work requires
the following amount of food :
Protein Fat Carbohydrates
Man 90 grams 40 grams 350 grams
Woman 80 35 * 300
If this be translated into ordinary articles of diet, it would mean:
Meat, 80.3 grams; milk, \ pint; bread, 10 oz. ; biscuit, 2 oz. ; butter, 1
oz. ; potatoes, | Ib. ; sugar, f oz. ; wine, 6f oz. ; coffee, 14 oz.
Von Xoorden(28) has suggested the following scale for the reduction
of the fuel value of the dietary of the aged :
Age in Years Percentage of Reduction
60-70 10
70-80 20
80 30
Saundby, in his book on "Old Age, Its Care and Treatment," says that
the diet of the aged should be reduced in amount in proportion to their in-
activity. So long as they can work, or take active exercise, they may enjoy
the diet of adult life, 35 calories per kilogram of body weight, but they
should be careful to avoid large meals and indigestible food. On account
of their defective teeth all food should be easily masticated, as, for ex-
ample, minced or pounded meat and vegetables in puree. The diet should
contain few toxins, especially purins; a little meat once a day may be
allowed, preferably at the midday meal, while eggs may replace meat at
the evening meal. But little alcohol is required, but plenty of water
should be taken. Little salted food should be given, as we are ignorant
of the conditions in which chlorids are eliminated.
446
DIET IN PHYSIOLOGICAL PERIODS
Old persons leading more or less vegetative lives require a smaller
amount of food than active adults. We may take it that 30 calories per
kilo is a sufficient basis for their dietaries, and if they are obese they
should do with less, as fat ought not to be reckoned in estimating the fuel
requirements. Saundby thinks these 30 calories might be made up by
1 gram per kilo of protein, 1 gram per kilo of fat, 4 grams per kilo of
carbohydrates, so that an old person weighing 70 kilos or 140 pounds
might be allowed 70 grams of protein, 70 grams of fat and 280 grams of
carbohydrates, which would give a little over 2,000 calories as against
2,450 calories for an adult of the same weight leading a moderately active
life. Thus the daily dietary might be composed of the following articles :
SAUNDBY'S DAILY DIETARY FOR THE AGED
Amount of Food
Protein
Fat
Carbohydrate
Calories
Bread, 250 grams (8 oz.)
22.08
3.12
127.4
640
Milk, 568 grams (1 pt.)
17.9
19.6
26.88
375
Tapioca, 45 grams (1 oz.)
0.3
0.0
36.0
150
Sugar, 30 grams (1 oz.)
0.0
0.0
29.2
120
Potatoes, 120 grams (4 oz.)
1.8
0.12
24.0
105
Lean meat, 100 grams (3 J^ oz.) ....
Fat bacon, 30 grams (1 oz.).
27.0
2.6
7.0
20.75
0.0
00
185
187.5
Butter, 30 grams (1 oz.)
0.21
24.3
0.15
270
Total
71.89
74.89
243.63
2032.5
Tea and coffee, beef tea and bouillon, green vegetables and fruit
in moderation contain so little heat-forming substances that they may be
left out of account, but may be added to the diet.
It will be pertinent to the subject in hand to interpolate some rules
as to the feeding of the aged, and a diet table compiled by Dr. Reynold
Webb Wilcox(29). 1. Never less than five hours between meals. 2. No
solid food between meals. 3. Principal meal near midday. 4. All meals
to be as dry as possible. 5. Avoid food likely to cause flatulence. 6. Not
more than 5 oz. of fluid with each meal. Alcohol only for those who are
accustomed to its use oz. of brandy or whiskey in three or four ounces
of water, a single glass of port or sherry.
Breakfast, 8 A.M.:
Small slice of toast, 1^ oz., with butter; one soft-boiled or poached egg, or
half a small haddock or other white fish; 3 to 5 ounces of tea or coffee with
cream and sugar; tea may be replaced by cocoa or milk with hot water; well-
boiled oatmeal, 3 to 4 ounces with 4 to 5 ounces of milk may be substituted
for tea.
DIET IN OLD AGE 447
Dinner, 1 P.M.:
Two courses fish or meat; pudding or fruit; white fish, short fiber, boiled, steamed
or broiled half; small chicken, white meat or sweetbreads; game, lamb, small
potato boiled or baked or a small portion of spinach; pudding, a simple milk
pudding, or rice, sago, tapioca or suet; fruit, as ripe pears, apples, grapes,
4 to 6 ounces; hot water to be taken if desired.
Tea, 5 P.M.:
Tea with cream and sugar but no food; in place of tea, a teaspoonful of solid
beef extract in hot water may be taken.
Supper, 7 P.M.:
White fish and one potato or toast with butter. Milk pudding or bread and
milk.
10 P.M.:
Five ounces of hot water to be sipped. For the relief of thirst, beef tea or hot
water, to be sipped four hours after each or the principal meal.
Saundby, in order to illustrate the distribution of the amount of food
in his table still further, suggests the following arrangement of meals :
SAUNDBY'S DAILY DIETARY FOR THE AGED SHOWING DISTRIBU-
TION OF MEALS
NO. I
Breakfast
1/2 pint of tea
3 oz. milk
Dinner
3H oz. meat
4 oz. potato
Tea
i/ pint of tea
3 oz. milk
Supper
10 oz. milk
1 oz. bread
}4 oz. sugar
3 oz. bread
1 oz. tapioca
4 oz. milk
^ oz. sugar
3 oz. bread
1/2 oz. butter
1 oz. bacon
Yz oz. sugar
1 oz. bread
% oz. butter
NO. II
i/ pint coffee 6 oz. fish J/ pint tea 10 oz. milk
1 oz. oatmeal 4 oz. potato 3 oz. milk 1 oz. bread
6 oz. milk 1 oz. milk % oz. sugar
% oz. sugar 1 oz. butter 3 oz. bread
y^ oz. butter Stewed fruit ^ oz. butter
3 oz. bread ^ oz. sugar
1 oz. bread
Another dietary for an old person of seventy, weighing from 120 to 140
pounds, affording 1,950 calories, would contain:
47 grams albumin
314 " carbohydrates
54 fat
20 alcohol
448 DIET IN PHYSIOLOGICAL PERIODS
Such a diet may be thus distributed :
Morning meal:
Milk 8 oz.
Sugar % oz.
Bread 2 oz.
Butter H oz.
Midday meal:
Bread 3 oz.
Meat or fish 2 oz.
Vegetables or fruit 2 oz.
Beer Yi pint
Evening meal:
Bread 3 oz.
Eggs 2 oz.
Light pudding 4 oz.
Whiskey Yz oz.
The caloric value of a diet may be raised easily by adding to the fat
in the form of butter, cream, fat bacon, suet pudding or cheese. With re-
gard to cheese, it may be said that a plain, good, wholesome cheese is
peculiarly well adapted as a food for the aged. It is palatable and nutri-
tious and, while it requires sufficient mastication to produce insalivation,
it can be readily masticated by the toothless or by those who lack their
full quota of teeth. Cod-liver oil, when it can be taken, is useful, a*s half
an ounce of oil daily will afford approximately 150 calories. After fat
come the starches and sugars. Cane sugar, as almost pure carbohydrate,
can be tolerated in only small quantities. Old men who have been meat
eaters, drinkers and smokers, have lost their taste for sweet things, and,
in fact, often have a distaste for them, but this aversion can be overcome.
Cane sugar is nourishing and by some British authorities is highly lauded
in the treatment of arteriosclerosis. It is better assimilated if cooked, as
in milk puddings or added to fruit well stewed. Raw sugar should be
viewed somewhat askance, as it is likely to upset the digestion, but small
quantities will do no harm. Perhaps as much milk as can be digested
without discomfort may be taken, but a pint daily is sufficient. Sour
milk of late has been given great prominence by Metchnikoff, and is
undoubtedly useful in old age. If too sour for. the palate, it may be
sweetened with sugar, honey, jam or treacle, and may be added to por-
ridge, hominy, boiled rice, or to any breakfast food. It is especially val-
uable, being slightly laxative, in cases of chronic constipation, the greatest
bane of old age. Metchnikoff recommended its use on account of its
power of diminishing the toxicity of the bowel contents, and thereby pre-
DIET 1.X OLD AGE
449
venting those senile degenerative changes which he deems largely the result
of intestinal intoxication. Buttermilk is also valuable when whole milk
cannot be properly digested. The casein it contains furnishes its nutritive
value, but its caloric value is on the average only about half of that of
milk. Kumiss or kelir when fresh acts as a laxative. It is easily digested
and highly nutritious in large quantities from a pint and a half to three
pints daily.
Campbell (30), who is the chief prophet of thorough mastication and
spare living, points out that the appetite for plain food may continue to
extreme old age. At one of the large London workhouses the daily diet
for men over 00 years of age is as follows : Bread, 20 oz. ; margarin, 1 oz. ;
sugar, 1 oz. ; meat, 4 oz. ; potatoes, 8 oz. ; greens, 4 oz. ; pudding, once
weekly; stewed fruit, once weekly; tea, 2 pints; salt and pepper daily;
mustard once a week; no alcohol. Campbell says that the inmates con-
sume it all and enjoy it thoroughly, complain very little of indigestion,
and, what is more surprising, suffer little from constipation.
The alimentary pastes have high food value and are easily digested
if cooked simply. Thus they are eminently suitable as a diet or part of the
diet of old people. According to Combe, they are composed of the gluten
of wheat with a considerable proportion of starch, and are of especial value
in the dietetics of intestinal diseases. !N"ot only is the nutritive 1 value
of these foods high, but they are cheap. They cost but little more than
rice, sago and tapioca, and have at least double the nutritive value.
ALIMENTARY PASTES: FOOD VALUE
Protein
Carbo-
hydrate
Fat
Calories per
300 Grams
Macaroni
12.15
74.58
0.78
340
Vermicelli
12.82
70.78
0.74
335
Italian Paste
12.31
75.16
1.95
345
Rice, boiled
2.77
27.33
0.07
119
Tapioca
5.40
87.18
0.19
350
With regard to the question of allowing old people tea, coffee or cocoa,
opinion is divided. Coffee and tea are barred by some authorities as pos-
sessing no food value and as containing a poisonous principle caffein,
theobromin and, on occasion, a considerable amount of tannin. They
delay digestion, and when tannin is present in relatively large quantities
they tend to irritate the mucous membrane of the alimentary tract. They
stimulate to some extent the heart and nerve centers. Thus, the case
450 DIET IN PHYSIOLOGICAL PERIODS
against the use of such beverages for the old would seem at first thought to
be very strong, yet when we look at the other side of the mirror and con-
sider that the drinking of tea or coffee is a life-long habit and, like all
habits, hard to discontinue, our view is somewhat modified. However,
there are many harmful habits which it is wise and expedient to break, and
if it were proved beyond the shadow of a doubt that either tea, coffee or
cocoa drinking really injured old people, then our advice would be not to
take any of these infusions or mixtures. But when these beverages, are
of good quality (in the case of tea that variety which contains the least
amount of tannin) and prepared with care, we are of the opinion that the
harm done, in the majority of instances, is counterbalanced by their pleas-
ure-giving physiological effect. They are indulgences, it is true, and
stimulants in a slight degree, and should only be taken in strict modera-
tion by those elderly people who have been accustomed to their use all
their lives, and who suffer no inconvenience from their use.
The condition of the teeth.of the aged is a matter of much importance
and is not infrequently responsible, to some extent, for some of the digest-
ive troubles from which they suffer. This loss or partial loss of the me-
chanical means provided to man for masticating his food is regarded in
different lights by different authorities. Sir Henry Thompson is of the
opinion that the disappearance of the masticating powers is mostly coinci-
dent with the period of life when that species of food which most requires
their action namely, solid animal fiber is little if at all required by the
individual. It is during the latter third of his career that the softer and
lighter foods, for which teeth are barely necessary, are particularly valu-
able and appropriate, and the man with imperfect teeth who conforms to
nature's demand for a mild non-stimulating dietary in advanced years
will mostly be blessed with a better digestion and sounder health than the
man who, thanks to his artificial machinery, can eat and does eat as much
flesh in quantity and variety as he did in the days of his youth.
Campbell takes an opposite view. He points out that people who have
no teeth at all are often better able to masticate than those with a few only,
for in the former case the gums are allowed to come together and harden,
enabling them to cope with many kinds of food, whereas if the mouth
is furnished with teeth, no two of which are opposed, they are useless for
purposes of mastication. He says that though the former argument seems
plausible enough, prima facie, when examined critically, it will be found
to have no basis in fact. If senile edentation has any biological meaning
at all, it indicates not that nature desires a return to the diet of infancy,
but rather that the time has come to cease eating altogether and to lie down
DIET IN OLD AGE 451
and die, for under natural primitive conditions the lack of teeth implies
death from starvation. Consequently, properly fitting teeth cannot but be
of very great advantage to the aged.
The latter argument seems to us stronger by far than the assertion that
because in old age teeth come out it signifies that they are no longer
needed. Mastication, if not so essential in old age as in the adult period,
is yet a valuable power to possess. If food, carbohydrates in particular,
is not masticated, it is not sufficiently insalivated, and digestion, thereof
is hindered and stomach and intestinal troubles are certain to ensue.
Moreover, a mainly pap diet, consisting largely of soft starchy food, is not
the kind of diet to suit a healthy or, indeed, even a somewhat feeble old
person who has been in the custom of eating heartily of more substantial
fare. We agree with Campbell that thorough mastication is good for the
old. for, be the diet mainly protein or carbohydrate, mastication and in-
salivation are aids to proper digestion the importance of which can scarcely
be overestimated. We agree, too, with Thompson (31) that the old do not
require their teeth to consume as much animal protein as they were accus-
tomed to when in full vigor of manhood, for they most assuredly need, as
a rule, but a limited amount of animal food. Campbell, however, is in
favor of a simple diet with not a large amount of animal protein through-
out life, and indeed sees no reason to differ the dietary of healthy old age
and adult life to any great extent.
The consumption of meat in old age is still in some degree a mooted
question. There are many of the opinion of Sir Henry Thompson,
who hold that at any period of life the use of meat should be
limited, and others, like Campbell, who believe that to be full fed
throughout life is in the best interests of good health. There are yet
others, like Woodruff, who think that no particular stint of animal
food is necessary. As a matter of fact, it is impossible and would be pre-
sumptuous to lay down any rigid rules of diet in order to prolong life.
Heredity is one of the most important factors in the attainment of this
consummation, while diet undoubtedly is of the first significance and of
special import in advanced age. Scientific investigations and observations
and practical experience have both taught that less food is needed after a
certain age has been reached and that the ingestion of meat should be
diminished. Nevertheless, a great deal depends on what kind of life is
led. If active and fairly strenuous, a person, although old, requires a suf-
ficiently generous amount of food, and if he is accustomed to eating meat,
the amount should not be unduly restricted. In most cases it is advisable
to reduce the amount of animal food to one-half of that consumed by people
452 DIET IN PHYSIOLOGICAL PERIODS
in middle life. Certain it is that, if arteriosclerosis has made much head-
way, very little meat should be eaten. Allbutt says on this point that the
sum of the argument is, so far as butcher's meat and arteriosclerosis are
concerned, that certain observations which we owe to Abelous and others
offer evidence with some clearness to show that one or two definite and
separable crystalline products produced by bacteria, especially by a specific
bacillus of the colon group, can affect the blood pressure.
Dietetic restrictions are obviously indicated in the bronchitis of the
aged. Many of such patients are allowed to die through carelessness in
diet. As Campbell shows it is not merely that overeating begets bron-
chitis. The bronchitis and the emphysema that goes along with it curtail
the respiratory capacity, and so prevent the excess of food from being
burned off. In fact, the only hope of saving the obese bronchitic patient
is by a systematic semistarvation.
Campbell (30) thinks that for elderly and aged gourmands it is gen-
erally even more necessary to cut down the allowance of starch and sugar
than animal food, although this should also be curtailed if excessive. All
appear to be agreed that alcohol in any form is of little value in the diet
of the aged, and should never be taken when a high blood pressure exists.
The warding off of old age, and more particularly the warding off of
premature old age, can perhaps in the majority of cases be effected by care-
ful diet. But it must ever be remembered that as there are all sorts and
conditions of men, so there are all sorts and conditions of constitutions and
idiosyncrasies. Some, whether they eat sparingly or profusely, suffer
from digestive troubles and are apt to grow old prematurely. They are
bad metabolizers. This class is not a very large one, and even with them
life may be prolonged by paying extreme attention to their alimentation.
Again there are those who possess sensitive stomachs and whose digestive
processes are easily upset, albeit they may be sound in constitution. These
are generally persons of nervous temperament, who, if they exercise care
in their dietetic regimen, may live to be very old. This type, like creak-
ing gates, lasts longest. Then there are the hale and hearty individuals
who by reason of their robustness and strong digestive and assimilative
powers, eat and drink to excess, and who frequently by so doing bring
their lives to an abrupt end. As a rule, the moderate eaters and drinkers
live the longest.
Yeo(32) gives the following useful suggestions in regard to the diet of
the aged :
Any sudden changes in diet should be avoided, and the intervals between the
ingestion of food should not exceed six or eight hours.
DIET IN OLD AGE 453
It is very common for elderly people to awaken early in the morning, at three
or four o'clock, and to be unable to drop off to sleep again, but if they have some
light form of nourishment at the bedside, such as a glass of milk or a little gruel,
which they can take at that time, they will often continue their sleep.
The acidity of certain stewed fruits may be advantageously neutralized by
the addition of a little bicarbonate of soda, so as to avoid the use of a large
quantity of cane sugar, as this is apt to cause gastric fermentation and acidity.
In stewing fruit, about as much soda as will cover a shilling should be added to
each pound of fruit.
Aged persons often require their food to be accompanied with some kind of
condiment, which promotes their digestion and prevents flatulence. Caviare and
the roes of smoked and salted herrings are of this nature.
For sweetening food, milk sugar is much less prone to excite acid fermentation
than cane sugar.
A very digestible form of fat when it is needed is cream, mixed with an
equal quantity of hot water and about ten drops of sal volatile to each fluid ounce.
REFERENCES
1. STAKE, M. ALLEN. Diseases of Infancy and Childhood.
2. WATSON. Foods and Feeding.
3. HALL, WINFIELD S. Nutrition and Dietetics.
4. FITCH, W. E. Rations for Young Boys' Military Training Camp,
Mil. Surgeon, April, 1917.
5. GEPHART. Russell Sage Institute of Pathology; Editorial, J. Am.
Med. Assn.
6. LUSK, GRAHAM. Food Economics, J., Washington Academy of Sci-
ence, 1916, vol. vi, p. 390.
7. HALL, WINFIELD S. Nutrition and Dietetics, pub. by D. Appleton
& Co., 1913.
8. BENEDICT, A. L. Golden Rules of Dietetics.
9. RICHARDS. A Study in Dietaries, 1901.
10. PROCHOWNICK. Zentralbl. f. Gynak., 1899, p. 33.
11. EDGAR. J. C. Practical Obstetrics, pub. by Blakiston, 5th ed.
12. GAUTIER. Diet and Dietetics.
13. ROTCH, T. M. American Text-book of Pediatrics, W. B. Saunders,
Philadelphia.
14. TILTS. Change of Life, London.
15. TIBBLES. Food and Hygiene, published by Rebman Co.
16. THOBURN. .Diseases of Women.
17. BISHOP, L. FAUOERES. Arteriosclerosis, Oxford Med. Publication,
London, 1915.
18. ALLBUTT. System of Medicine.
129
454 DIET IN PHYSIOLOGICAL PEEIODS
19. NASCHER, I. L. Geriatrics Diseases of Old Age, pub. by Blakis-
ton, 1916.
20. CAMPBELL. Sutherland's System of Diet and Dietetics.
21. FRIEDENWALD and RUHRAII. Diet in Health and Disease.
22. VOIT. Zschr. f. Biol., 1876, p. 32.
23. MAUREL. Rev. Soc. scient. d'hyg. aliment., 1906, p. 763.
24. LANGWORTHY. U. S. Dept of Agric., Bull. 22.
25. QUATELET. Landois and Stirling's Human Physiology, 1891.
26. KOSEVI. Centralbl. f. inn. Med., 1901, p. 121.
27. MUISTK and EWALD. Diseases of the Stomach.
28. VON NOORDEN. Metabolism and Practical Medicine.
29. WILCOX, R. W. The Treatment of Disease, pub. by Blakiston.
30. CAMPBELL. Brit. Med. J., May, 1907, p. 1229.
31. THOMPSON, W. GILMAN. Practical Dietetics.
32. YEO, BURNEY. Text-book of Physiology.
CHAPTER XIV
HYGIENE OF THE INTESTINES
WILLIAM P. CUNNINGHAM, A.M., M.D.
General Considerations.
Chronic Intestinal Stasis; Diseases Due to Chronic Intestinal Stasis;
Considerations of Diet in Chronic Intestinal Stasis; Hygiene of the
Intestinal Canal.
GENERAL CONSIDERATIONS
The subject of this chapter has a great deal broader scope than would
appear upon cursory examination. The hygiene of the intestinal tract
has a deeper significance than the relief of certain local disturbances, de-
pendent upon the imperfect evacuation of the lower segment. It has to
do with problems of a grave and far-reaching character. To appreciate
this, it will be necessary to recall the construction of the abdominal viscera
with especial reference to the matter of drainage.
We shall content ourselves by simply recalling that the human being
is a hollow organism from the mouth to the anus. There exists, then, a
continuous membranous tube with dilatations and constrictions demanded
by the exigencies of the situation. The pharynx, the esophagus, the stom-
ach, the small and the large intestine vary in size, but constitute one con-
tinuous canal. Anything that enters at the mouth, must exit at the anus
unless absorbed in transit. It is obvious that for the proper functioning
of such a tubular organ, there must be an unobstructed right of way. Any
unusual constriction anywhere in its course may convert it into "no thor-
oughfare" and induce a train of consequences of the most surprising and
deplorable kind. The numberless evil things that accumulate in the prog-
ress of a more or less thoroughly digested mixture from the stomach to
the rectum, may be detained by abnormalities of the channel, until they
have accomplished various toxic reactions and been absorbed into the gen-
eral circulation. Locally also they produce irritations of a serious nature.
455
456 HYGIENE OF THE INTESTINES
An uninterrupted fair way would in all likelihood have been main-
tained had man not risen from the posture for which he had originally
been designed. Going on all fours, his intestines swung free from their
mesenteric attachments to his spine. There was no danger of kinking,
fouling or jamming of the various loops. The chylous tide swept on with
perfect freedom to its destination. But when in the assumption of his
new-found dignity he proudly drew himself erect, the relation of the gut
to its attachments was entirely altered. It now dragged upon a mesentery
clinging to a perpendicular support and was thrown into unpremeditated
disarray. It sustained "strained relations" with its environment.
As the advance of man in the refinements of civilization entailed in-
creasing impairment of the muscular energy of his aboriginal forbears, he
began to experience the inevitable results of the faulty position of his ab-
dominal contents. Debility, disease, corsets, gluttony, sloth, obesity,
caused the prolapse of the imperfectly secured intestines, and they sagged
into feeble pouches, incapable of adequate peristalsis, and making a con-
stant traction on the contiguous sections. Nature, ever conservative,
strove to offset this injurious derangement by passing supporting bands
under the dragging loops. As frequently happens, nature overreached her-
self. The new supports became added elements of danger and distress.
The weight of the prolapsed
portion caused an angular
distortion at the site of the
(Supplementary slings, for
all the world as if one hung
an empty hose over a fence.
Against this added obstruc-
tion the already fatigued
intestine struggled with di-
minishing success. The ac-
cumulation behind the ob-
struction steadily increased,
while the gut in front was
empty and collapsed. Here
FIG. S.-CASE X. INFLAMMATORY, SUPEBIMPOSED was established what Sir
UPON EVOLUTIONARY STASIS. Lane's band, . , , T ,
with potential kink; prolapsed transverse
colon, ascending colon, and sigmoid; Jon- aptly termed a cesspool, and
nesco's fold; Jackson's membrane. Three sets jjj that cesspool are ffen-
of firm fibrous bands, just below ileocecal . j .1
, , , . , , ... , crated, as in the most pro-
valve, extend from ileum to right iliac fossa, . '
one to right ovary. ductive culture medium, a
GENERAL CONSIDERATIONS
457
host of microbial invaders whose varied activities are responsible for
most of the ills that flesh is heir to. This is no overdrawn or fanciful
picture. It is a plain statement of truth susceptible of the completest
corroboration.
No fact in medical practice is of more ancient usage than the effort
to overcome constipation. The evil of the inactive bowel has ever been
recognized. "Make a hole through" was the homely dictum of the old
schoolmen. In this injunction they epitomized the whole question of in-
testinal stasis and adequate drainage. They did not comprehend the
causes at work in preventing this essential function. They attributed to
many agencies, conditions which we have found largely confined to one.
They talked of diet and torpid liver and insufficient exercise and defective
innervation, and they some-
times cured a case where such
factors had brought about a
fecal blockade in the rectum.
But they realized that the
failure of the bowel to empty
itself created a pathological
situation of serious import
which demanded all their sci-
ence to remove. It consti-
tuted the stopping of a sewer
with a backing up of its dele-
terious contents. No discrim-
ination was made between the
massing of dried effete detritus
of a comparatively harmless
.
character in the part of the.
tract least provided with ab-
sorbents, and a fluid compound of putrescent material stagnant at the
gaping mouths of numberless lymphatics. The lower bowel could be
emptied ; its repacking could be prevented. Diet, exercise and laxatives
were all-sufficient here. Just a little care and watchfulness achieved the
desired result and made the reputation of some wonderful cathartic.
But of the organic barrier above, of the angular kink, of the saccu-
lated cesspool, they had no glimmering, and consequently could not intelli-
gently direct their therapeutic fire. It remained for the adventurous
English surgeon. Sir Arbuthnot Lane, to discover the obstructing abnor-
mality, and boldly proclaim it to a skeptical profession. So ill was his
7. E. H., FKMALE, 30, SINGI.K. Lane's band;
ileal stasis; appendix and ovary caught in
band; caecum dilated.
458
HYGIENE OF THE INTESTINES
evangel received by rock-ribbed conservatism that he was hooted out of his
scientific societies. He was thrust outside the breastworks by his English
confreres, and stigmatized as something uncanny and unclean. It was
only when he appealed to the surgeons of America that he began to make
impression on the general incredulity. He proved his case and the repute
of his success traveling back to the slower innovators at home, rehabili-
tated him in the good opinion of his own people. The doubt, reproach
and derision with which he had been originally received gave place to
confidence and respect.
CHRONIC INTESTINAL STASIS
Chronic intestinal stasis due to mechanical obstruction was firmly
planted in the pathology of advanced medical thought. Not that all oppo-
sition to the idea has been
overcome. While man has
power of cerebration, differ-
ences of opinion will persist.
It is impossible to break
down the adamantine resist-
ance of prejudice and con-
ceit. Both will hold out
against the plainest evidence
of their erroneous attitude.
But men of ordinary sober
judgment, comprising as they
Fio. 8.-J. S. CHRONIC INTESTINAL STASIS, WITH do the S reat majority of our
VERY BROAD BAND ANGULATING DUODENO- confraternity, are susceptible
JEJUNAL JUNCTION. Dilated duodenum; band t o conviction and ready to
an<mlatiii duodeno-ieiunal junction; col- i i
J J J yield assent upon presenta-
lapsed jejunum. / - J
tion of the facts of the case.
So while we occasionally hear a protesting note from some lofty pin-
nacle, while some eagle flaps his wings and declines to see anything but
his own reflection in the sun, while some bird of lesser quality croaks
his envious disapprobation, the dissonance is swallowed in the chorus of
approval arising from the level-headed searchers after truth. True to
its etymology, stasis has come to stay; we mean only in the etiological
sense and not in the sense of an incurable condition.
In order to intelligently treat an anatomical distortion of this charac-
ter, thus mischievously situated, it is incumbent to grasp clearly not only
( IIROXIC IXTEST1XAL STASIS
459
all the demonstrated consequences but also the inferential and rationally
deducible conclusions in the premises. Before we may suggest measures
of relief, we must be able to show wherein the economy is at fault. Hav-
ing established the fact of chronic intestinal stasis, it was necessary to
associate it with degrees of disability and danger sufficient to warrant rad-
ical interference. This has been accomplished. It is maintained by emi-
nent authorities that intestinal putrefaction conduces to brevity of exist-
ence. Where actual disease is produced thereby, this is undeniable.
Where no such disease is definable, we must rely upon our reason to sup-
ply the explanation.
It is unquestionable that the constant absorption of poisonous elements
into the general system must put upon it a Sisyphus' task of elimination.
This taxes the arterial capacity to the
utmost. The vessels are working at
high pressure all the time and eventu-
ally undergo permanent changes for the
effectual performance of the exaggerated
function. The kidneys respond to the
increased demands of the throbbing ar-
teries by a temporarily raised efficiency,
which is followed as a matter of course
by a steadily growing deficiency and
a speedy termination of the career of
the organism. This is deduction, and
seems to be borne out by numerous
observations.
We are quite persuaded also that
many of the maladies for which we have
no satisfactory etiology can be traced to
the pestilential puddle in the sacculated
gut. Xo man knows the extent of the
chemical combinations therein effected.
All the circumstances are favorable for
the unimpeded development of deleterious bacteria and alkaloidal poisons
of variable virulence. Shortly after eating clams, men have died with
symptoms of acute toxemia. Here the poison was undoubtedly introduced
with the clams. But such an article eaten fresh and coming partly digested
into a prolapsed, distended and disabled intestine (to fester and rot in
the heat and moisture), would be perfectly capable of achieving the same
appalling result. Steadily surging forward through an unobstructed chan-
FlG. 9. C. O. CHRONIC INTKSTINAI,
STASIS, WITH MARKED DUODEXO-JE-
JUXAL KIXK. CAUSING DISTEXTIOX
OF DUODENUM. Bands, causing duo-
deno-jejunal kink; jejunum; stom-
ach; dilated duodenum.
460 HYGIENE OF THE INTESTINES
nel, the putrefiable matter would have quickly reached a region where
absorption was tardy and the danger practically negligible. The plumbers
put "traps" in the course of their waste pipes to prevent the ascent of
poisonous gases from the sewer. This word might be fairly applied to the
fallen sections of hollow viscera constituting the pathology of stasis. They
are veritable "traps" for the retention of the deadly excrement seeking
an avenue of escape. This slight play upon words will serve to impress
the real conditions back of most of the cases of intestinal putrefaction. It
is doubtful whether putrefaction of any considerable degree could take
place in an intestine operating with unhindered peristalsis. Nature is
able to take care of much excessive material if she is not crippled or de-
formed.
Diseases Due to Chronic Intestinal Stasis. The great English surgeon
who blazed the trail that has brought us to such a land of hope and prom-
ise, claimed to have proved the causation of many grave affections in the
toxic reactions of the delayed ileal effluent. Diabetes mellitus, rheumatoid
arthritis, tuberculosis, epilepsy, ulcerative endocarditis, nephritis, pyelitis,
cystitis, salpingitis, cholecystitis, Raynaud's disease and cancer of the in-
testines are all the direct or indirect result of mechanical interference
with body drainage. This is a fearsome list and a bold challenge! But
the quality of its sponsor should curb the tongue of impetuous distrust.
Men of that stamp do not idly maintain untenable opinions. They speak
with conviction. The presence of a low-grade inflammatory focus near
the head of the pancreas, permeated with bacteria and sodden with toxins,
supplies a plausible explanation of the disturbance of that associated organ
in our conception of the pathogenesis of diabetes. In view of the inade-
quacy of every other hypothesis, it is judicious to accord this one careful
consideration. Operation has resulted favorably in this notoriously un-
promising metabolic anomaly.
RHEUMATOID ARTHRITIS. Rheumatoid arthritis, inexorable as fate
in the cumulative crippling of its miserable victim, has baffled the pa-
tience and ingenuity of our ablest investigators. Etiology and therapeu-
tics alike have been barren. Absurdity has distinguished some of the
suggestions offered. This is likely to happen in conditions of great ob-
scurity. So little light is available that any flicker is noticeable. Even
Riggs' disease has had its passing vogue in this etiological relation. But
now comes Lane with a causative factor big enough to fit the conditions.
Instead of a few bacteria emerging from the depths of an alveolar abscess,
and furnishing to the imagination an altogether insufficient explanation
of such tremendous consequences, we are asked to observe a mighty incu-
CHRONIC INTESTINAL STASIS 461
bator reeking with the pestilential products of decomposing nitrogenized
compounds. Here is a source worthy of respectful attention. It is obvi-
ous that here could originate any conceivable assault, no matter how
deadly, upon the integrity of the organism. Our sense of proportion is
satisfied, and when by brilliant surgical intervention the progress of the
disease is halted and ankylosis limbers up, we are confronted with a situ-
ation summarized in the wise old aphorism about the proof of the pudding
being in the eating. The startling improvement in cases of epilepsy
treated with reference to intestinal incitation is a remarkable testimonial
to the genius of men who have had the courage of their unusual convic-
tions.
ULCER OF THE STOMACH AND DUODENUM. Ulcer of the stomach
and duodenum is doubtless due to the irritation resulting from angular
obstruction of the latter by the downward pull of the rest of the small in-
testine. The stomach becomes secondarily dilated from the constant py-
loric contraction maintained to resist the regurgitation of the duodenal
contents. Present now are the factors favorable to the development of
cancer ; local irritation ; local interference with circulation ; the swarming
microbes indigenous to decomposing tissue. Infection of the gall bladder
and liver may take place through their ducts, and so-called primary can-
cer of the liver may be a consequence of this invasion.
The appendix may be involved in the band extending from the cecurn
upwards and outwards and producing a kink or some other obstruction to
its lumen. The appendix may be otherwise affected by its fixation,
through acquired bands, to the under surface of the ileum. The large
bowel may be attached on the left side to the pelvic brim, greatly impeding
the descent of fecal matter. The false membrane here may enclose the left
ovary, with the ultimate result of a cystic tumor. In short, adventitious
bands may appear at any point demanding additional support and may
interfere in many ways with the activity of the whole tract, or may exert
damaging pressure on structures in their neighborhood. The serious con-
sequences sometimes attendant on the position of these bands have been
rapidly recited. Others less menacing but nevertheless trying and objec-
tionable extend the evil influence of this abnormality to an immense
degree.
The ductless glands are coming into their own as important factors in
the elucidation of many physical disorders. We have long known of the
affection of the thyroid and the suprarenals. We are familiar with ex-
ophthalmic goiter and myxedema. We are as well acquainted with Addi-
son's disease and its tell-tale bronzing of the skin, but we could not here-
462
HYGIENE OF THE INTESTINES
tofore account for the perversion of glandular activity. We are acquiring
illuminating information with regard to the attributes of the pituitary,
the thymus, the testis and the ovary. We perceive that many disturb-
ances of metabolism are connected with their derangement, but that is
only a partial solution of the problem presented, for what is responsible
for the derangement?
Lane has succeeded in
associating degenera-
tion of the thyroid
with chronic intestinal
stasis and has made
out a very reasonable
case in the matter of
the suprarenals. It is
fully in accord with
the best thought of
modern medicine that
these ductless glands
should suffer from mi-
crobic incursions; and
where should be the
most likely breeding place but this very cesspool seething within the
patient's abdomen ?
EFFECT OF STASIS ON THE INTERNAL SECRETIONS. The study of the
internal secretion is progressing with great diligence and success and we
may expect to find therein the explanation of many perplexities. But
hand in hand should go the inquiry into the state of the internal secre-
tions as the cause of disease, dyscrasia or disorder, and as the pathological
consequences of a previously existing infection. The last word has not
been said when we cry out "internal secretions." We may show them as
the cause of acromegaly and scleroderma and osteomalacia, and a growing
list of obscure maladies, but only a part of the work is done; we must
link them with the reason of their seemingly erratic action, Feeding
pituitary extract will be incomplete and indecisive therapeusis compared
with the removal of the glandular irritant. The dermatoses dependent
upon or aggravated by intestinal putrefaction are many and various. It
is generally conceded that any retardation of peristaltic action tends to the
development of acne, eczema, urticaria, toxic erythema, erythema multi-
forme, bromidrosis and pruritus. The foul breath, apathy, headache and
sallowness establish the identity of the suspected agency. The sweeping
FIG. 10. CASE V. Dilated ileum proximal to Lane's band;
Lane's band; ileopelvic band; angulated appendix
caught in band; Jackson's membrane.
CHRONIC INTESTINAL STASIS 463
out of the bowels, if complete, has a pronounced effect upon the cutaneous
manifestations. But frequently the most vigorous campaign will fail to
give us satisfactory evacuations, and the skin will resist our most intensive
medication. Here we have to deal undoubtedly with a blocking of the in-
testinal lumen by mechanical obstacles. The cathartics are unable to
force the straits and the stretched and straining gut retains its poisonous
fecundity.
ACIDOSIS. The interpolation of acidosis adds a word to the etiological
hypothesis without detracting from its credibility. We accept the fact of
acidosis just as we accept the fact of the internal secretions. It may be
admitted that the skin eruptions enumerated above are fairly attributable
to acidosis. It is certain that alkalies play a large part in the reputedly
effective medical treatment, but acidosis is a terminal or intermediate con-
dition, and invariably dependent on some other disturbing factor. Acido-
sis kills the victim of diabetes, but it does not constitute nor originate dia-
betes. All toxemias include an acidosis, hence the transition is easy from
intestinal putrefaction to acidosis; to irritative skin diseases.
CUTANEOUS LESIONS. There are many cutaneous lesions to which we
have no etiological clue. Most of them are due to circulatory disturb-
ances. Note the cold and waxy fingers of the "bilious" crisis. The lag-
gard gut is responsible for them. How far a cry is it from an acute claudi-
cation to a chronic claudication and the establishment of Raynaud's dis-
ease ? Circulatory anomalies underlie scleroderma. With or without the
intervention of the pituitary gland, the infiltration may be ascribed to the
same agency as Raynaud's disease. Of infinite variety are the germs of
intestinal origin. Of infinite variety are the toxins there elaborated. How
various, then, may be the manifestations in the skin or otherwise of
their vicious versatility !
A normal individual gives no more heed to his intestinal canal than
to respond to impulses for evacuation. There is no question of hygiene
involved in such a case. The management of the bowel comes into debate
only when it is manifestly unable to manage itself. We are all taught the
detriment of chronic constipation. Hence, many of the results of chronic
intestinal stasis are forestalled by the persistent efforts made to overcome
this conspicuous symptom. This is part of the hygiene of the intestinal
canal, and obviously a most important part. If the drainage from the
whole tract can be effectually maintained, then, despite the narrowing at
any point, constitutional disturbance will be avoided. This is the pivot
on which revolves the whole discussion of intestinal stasis. If there is
adequate drainage there is no stasis. If there is stasis there cannot be
464 HYGIENE OF THE INTESTINES
adequate drainage. Adventitious bands may exist without choking the
channel to a serious degree, and passage is maintained for the excrementi-
tious tide. This is a fortunate conjunction of circumstances. If the pres-
sure is slightly increased and the channel is a little further contracted,
there will be sufficient slowing of the aforesaid tide to constitute a patho-
logical state. There may be colicky pains and headache and perhaps
vomiting; the well-known "bilious" attack. Cathartics usually prove suf-
ficient correctives for the occasion. If sanely administered in advance,
they may prevent much of the mischief.
Considerations of Diet in Intestinal Stasis. Here is a condition where
Dr. A. Everett Austin's masterly chapter on "Diet in Intestinal Stasis"
will apply with peculiar aptness. The regulation of the diet along the
lines of reducing bulky detritus and avoiding undue flatulence will con-
tribute markedly to the well-being of the patient. Attacks will certainly
be less frequent and more readily controlled. Apertures patulous to the
passage of fluids become occluded by undigested masses such as fruit skins,
lettuce leaves, nuts and slow-melting fats. Apertures competent under
ordinary conditions may be occluded by the ballooning of the adjacent
bowel with gas. The constriction is increased by the impediment to the
venous circulation and the swelling of the tissues.
A happy termination of such a threatening episode is favored by total
abstinence from food and the administration of brandy and ice as indi-
cated for thirst and exhaustion. Situations fraught with such imminent
possibilities of disaster, where sudden total obstruction may occur upon
the slightest deviation from a rigid regimen, where the inclination to
safety or peril is poised upon the most delicate balance, belong properly
to the province of surgery. A section of drain-pipe in a house continually
getting out of order through the inadequacy of its bore, would not be judi-
ciously handled by seeing that only the thinnest fluids were allowed to
enter it. The plumber would be called in and a new section substituted.
So should it be with the plumbing of the human body. The intestines
in addition to being organs of digestion are drain-pipes for refuse. In-
adequacy of bore can be met only by enlarging the bore. Other methods
of relief are temporary makeshifts trifling with the danger.
Surgery does not always mean the knife. Orthopedic surgery often
operates with bloodless manipulation. As already explained, the incom-
petency of the canal in these intestinal conditions may be due to the sag-
ging of prolapsed portions over new-formed bands. The raising of these
portions may be followed by a straightening of the angular deformity and
the enlarging of the opening. A properly fitting belt with spring support
CHRONIC INTESTINAL STASIS
465
pressing on the abdomen below the umbilicus is sometimes effectual in
cases of moderate ptosis. The simultaneous administration of mineral oil
lubricates the points of possible resistance and eases the jam around the
corners.
In conjunction with these measures it is wise to limit the ingestion of
animal foods in order to offset the likelihood of toxic absorption. On the
other hand, we must be pru-
dent in selecting alternative
nutriment, as carbohydrates
have a tendency to produce
excessive flatulence. We are
between the devil and the
dee]) sea, and must steer our
course with the greatest cir-
cumspection. Some flatulence
is necessary for the propul-
sion of the intestinal con-
tents; excessive flatulence de-
feats this object, but the
decomposition of nitrogenous
foods affords the elements that
poison the system, whereas the
decomposition of the carbohydrates results only in local distress and
possible edematous obstruction.
We must choose with an eye to all eventualities. There is little advan-
tage in experimenting with lactic acid and the Bulgarian bacillus for the
prevention of fermentation. There is no doubt of the tendency of these
agents to act as indicated, but it is a faulty mode of procedure to seek
simply to mitigate the symptoms while permitting the permanence of the
ascertained and removable cause. After the removal of the cause, both
these palliatives may be freely employed to assist the intestine in its re-
adjustment to more normal conditions.
The cases of real severity threatening life by the provoking of organic
diseases, rendering existence a burden by the acuity of its sufferings, baf-
fling ambition by persistent incapacity, these incontestably belong to the
surgeon and can only be aggravated by futile attempts at medical manage-
ment. The young woman with the muddy complexion, the offensive
breath, the thinning hair, the loss of weight, the aching head, the colicky
bowels, sometimes constipated, sometimes malodorously loose, will never
react to the Bulgarian bacillus or any system of dietary. She is poisoned
FIG. 11. BAND IN WHICH STUMP OF TUBE
AND OVARY is CAUGHT. (From Medical
Record, Sept. 27, 1913.)
466 HYGIENE OF THE INTESTINES
from the never emptied cloaca within. Until proper means are taken to
drain it effectually, nothing may be looked for but an augmentation of
the evil consequences. The means described as proper are the cutting of
constricting bands and the reestablishment of the patency of the drainage
system.
If this proves impossible by any other course than the removal of the
large intestine and the discharge of the ileal effluent directly into the
pelvic colon (the procedure known as "short circuiting" the bowel), this
should be done without trepidation, since it sometimes effects a miracle
approaching resurrection. Patients for whom life holds no allurement,
who feel that death would be surcease of suffering, whose throbbing nerves
are continually at odds with their environment, who consent to exist only
because "the Everlasting has fixed His canon against self -slaughter," are
brought back to a world of sunshine and promise of efficiency and pur-
pose. They have been practically snatched from the grave. They have
been resurrected from a living death. This is not the rant of romance ; it
is the experience of the least romantic of men, the hard-headed English sur-
geon and his American disciples. Rhetoric cannot do the subject justice.
The man of brilliant parts whose career is threatened with premature
extinction because of the increasing effort required to concentrate his at-
tention on his work ; who is becoming dull and slow and unimaginative ;
whose body is subject to pains and paresthesias and overmastering weari-
ness; who has dyspepsia and neuralgia and depreciating vision; who is
listless and excitable by turns; whose rest is broken, urine high colored,
and bowels constipated had better resort to an abdominal surgeon with
strong convictions on chronic intestinal stasis. Hygiene any less radical
than that of the knife will be of no avail. Cathartics of every description,
clabbered milk, Bulgarian bacillus, bran bread, dieting, exercise, mas-
sage, will make no appreciable impression upon the progress of events.
It is likely that if he has not developed cancer, or tuberculosis, or chronic
nephritis, operation the highest form of hygiene under the circumstances,
since it does at once and completely what other methods slowly and halt-
ingly attempt operation will clear his system of the intoxication due to
defective drainage. When you take the load off a spring it resumes its
elasticity and power. When you rid the blood of its taint, it races to re-
trieve the mischief of which it was the carrier.
Some diseases of the skin create a therapeutic dilemma. We are per-
fectly aware of their putrefactive origin. We locate the putrefaction with
admirable precision. Then we essay every mode of elimination and dis-
infection with which we are acquainted. We find out what the patient
CHRONIC INTESTINAL STASIS 467
likes to eat and stop it. We diet along the best approved scientific lines,
and the disease persists in apparent indifference to our ministrations.
What are we to do? We are progressive practitioners and anxious to
give the patient the benefit of the most advanced methods. Shall we open
the abdomen for acne ? for eczema ? for pruritus ? What a tremendous dis-
proportion between a trivial affection and a dangerous remedy ! At first
glance this stricture would seem entirely justified, but go a bit deeper and
ask if acne is always a trivial affection? Are there no circumstances
under which it rises to the dignity of a serious disease ? Perhaps it never
threatens life, but it does threaten the things that make life valuable; it
threatens ambition, happiness and success. On the face of a sensitive
woman, it is an almost unbearable disfigurement. It embarrasses, shames
and tortures her ; it sends her shrinking from assemblages where she might
Otherwise shine; it debars her often from profitable employment; it de-
prives her of love and marital happiness. It is a conspicuously nasty and
repellent affliction.
We know the role played by constipation in its evolution. The acne
bacillus enters little into our therapeutic calculations. We actually ignore
it in striving to overcome the obstinacy of the intestine. We realize that
no vaccine can wipe out the lesions if the body is not sluiced clear of its
offal. If we can achieve satisfactory elimination at the anus we are far
forward on the road to a favorable result. The bacillus, genuine, legiti-
mate and trustworthy, is nevertheless incapable of fruitful insemination
without the existence of a responsive soil. If the skin is defended by an
uncontaminated circulation, the bacilli may rage about in ceaseless as-
saults, but they will never find a substantial foothold. Hence, in acne,
hygiene is of more practical importance than vaccine.
DIET IN ACNE. A properly adjusted diet, properly activated bowels,
properly graduated exercise, ought to be sufficient for the successful man-
agement of the usual run of cases. If the bowels are obdurate and will
not respond to vigorous urging, it behooves us to consider the likelihood
of a mechanical obstacle and the existence of intestinal stasis. This con-
firmed, what to do ? If the disadvantages of the eruption are great enough
to constitute a serious menace to happiness or success, then the sugges-
tion of operation does not violate our sense of proportion. It resolves
itself into a consideration of relative values. Is a clear complexion worth
to the patient the risks of laparotomy? Vanity need not be a factor in
the decision. To pander to such a vice at such a price would be inde-
fensible. But self-respect is another quality entirely and may be bound
up with problems of a grave social or economic nature. If the acne is
468 HYGIENE OF THE INTESTINES
accompanied by other symptoms of stasis, it simply adds weight to the
argument. in favor of surgical intervention.
TREATMENT IN ITCHING DERMATOSES. The itching dermatoses fre-
quently get beyond the pale of annoyance and into that of intolerable suf-
fering and loss of health. Insomnia, anorexia, constant irritation and em-
barrassment furnish material for eventual nervous breakdown. If on ex-
posed situations the eruption brings upon the sufferer the additional tor-
ment of popular suspicion and avoidance, such embarrassment is empha-
sized to the limit of endurance. How far may distress of this kind be
borne before invoking the aid of radical hygiene, the hygiene that cleans
out with one move the objectionable conditions that might resist inter-
minably the more conservative measures ? The answer lies in the com-
parison of the suffering with the magnitude of the remedy. Everything
is relative. "Laparotomy for eczema" might sound like the irresponsible
proposal of an unbalanced mind, but "laparotomy for intolerable anguish"
sounds perfectly coherent and rational. Yet the two may on occasion be
interchangeable expressions.
We have developed the question of intestinal hygiene from the broad
standpoint of securing results in specified conditions by the most effectual
means, rather than from the narrower standpoint of dieting and coaxing
and coddling a recalcitrant organ. We have intimated that the use of the
knife is the most hygienic procedure possible under certain circumstances.
Its work is rapid, complete and permanent. It drains or cuts out the
offending cesspool. It restores the relations of the various sections, or
removes what cannot be improved.
If the large intestine is so out of plumb that it cannot be retained in
the drainage scheme, it may be fearlessly set aside and the ileum inserted
into the pelvic colon. Less sweeping measures than this are ordinarily
indicated. The release of encompassed gut is the object of the operation.
The least mutilation consistent with its proper performance is the rule
to be adhered to. If the kinks can be straightened out by the cutting of
constricting bands and the tide set fairly in the direction of the anus, the
pathological situation has been relieved and all the symptoms dependent
thereon should speedily disappear.
Repetition serves to inculcate more forcibly the truth of any proposi-
tion. We shall therefore venture to reiterate the sometimes forgotten fact
that orthopedic surgery is bloodless on occasion, that corrective achieve-
ments are possible without the intervention of the knife; thus a case of
moderate ptosis may be materially relieved by the abdominal bandage
below the umbilicus and the administration of mineral oil.
CHRONIC INTESTINAL STASIS 469
The limitation of uitrogenized food will add to the security of the
patient. The omission, of foods with bulky residue tending to aggTavate
the ptosis and also to constrict barely adequate openings will contribute
largely to the same end.
Hygiene of the Intestinal Canal The great demand to-day is not for
the cure, but the prevention of disease. Scientific observation is directed
to the discovery of the causes of the graver maladies with the view of
eliminating them, so with regard to intestinal stasis, the greater art would
be in preventing its occurrence. To do this we must hark back to infancy
and regulate the intestinal hygiene along enlightened lines. The baby
must be fed and not overfed. That is imperative. Most infants are glut-
tons who will gorge themselves far beyond their ability to assimilate.
This excess must be controlled ; after nursing they should not be dandled
or even set upright. They must be laid down and let alone. Constipa-
tion should be combated without cessation. Flatulence and colic distend
the delicate viscera and stretch the feeble attachments. Improper ali-
ment such as "a little bit of everything off the table," and most of the
baby foods on the market contribute to this occurrence. A diet on which
the baby thrives with no colicky interludes and with perfect evacuations
will minimize the chances of faulty structural change.
As childhood advances, sports beyond the strength of boys, and tight-
fitting apparel for girls should be interdicted; especially should boys be
warned against the detrimental effect of blows in the abdomen. The fool-
ish desire for a pretty figure denied by nature and induced by art, has
been the cause of many an operation for stasis. This will arouse unani-
mous disapproval among the devotees of fashion, but it is nevertheless the
surest fact in connection with the etiology. Patients who are convalescing
from prostrating illnesses are prone to the development of enteroptosis
because of the weakening of the visceral supports. Obesity interlarding
the viscera with inert masses of functionless fat, and coincidentally reduc-
ing the muscular tone of the abdominal and intestinal walls, creates ideal
conditions for the production, of stasis. Gluttony overtaxes the propulsive
powers of the overloaded intestine, and ptosis is a natural consequence.
Hygiene of the intestinal canal then practically resolves itself into the
prevention of chronic intestinal stasis and the removal of this abnormality
after its unfortunate development. Transient disturbances may demand
attention, such as the acute diarrhea from over-ripe fruit or the jamming
of the rectum with undigested casein. Tubercular diarrhea may be cited
as an episode in the course of a fatal disease and requires medicinal treat-
ment. The diarrhea of typhoid fever is an incident calling for alteration
130
470 HYGIENE OF THE INTESTINES
in the feeding. These are not included in the broad consideration of hy-
giene of the intestinal canal.
The latter has to do with conditions that will not pass away with time
or with the cessation of an acute process. They are deep-rooted in the
mechanism of fecal drainage. They are structural defects whose evils
may be palliated in favorable cases by careful scrutiny of the nutritive
intake and vigorous enforcement of a corresponding output.
Palliation exhausts the possibilities of hygiene in the usual sense.
But in the wider sense of the utilization of every means for the restoration
of the normal function of the part, the surgeon with his knife is as much
a hygienist as the physician with his computed calories and mineral oil.
The plumber who takes out a length of occluded pipe is as much an agent
of sanitary science as the housewife who takes pains to prevent its occlu-
sion. The surgeon who repairs our human plumbing is the most com-
manding factor in the hygiene of the intestinal canal.
BIBLIOGRAPHY
BAINBRIDGE, WILLIAM SEAMAJST. The Significance of Intra-abdominal
Bands, Folds and Veils, Boston M. & S. J., Feb. 19, 1914.
. Chronic Intestinal Stasis, Am. J. Obst., 1916, vol. Ixxiii,
No. 2.
. Oration on Surgery before the Annual Meeting of the Med-
ical Association of Alabama, April 20 to 24, 1915.
. Chronic Intestinal Stasis, Fluoroscopic and X-Ray Diagnosis
in the Light of the Operative Findings, J. Mich. S. M. Soc.,
March, 1915.
. Some Practical Points on Human Plumbing, Internat. J.
Surg., November, 1916.
JORDAN, ALFRED C. Radiography in Intestinal Stasis, Proc. Roy. Soc.
Med., vol. v, 1911.
LANE, SIR ARBUTHNOT. Proc. Roy. Soc. Med., vol. iv, March, 1913.
CHAPTER XV
PHYSIOLOGICAL REQUIREMENTS OF INFANT FEEDING
IN HEALTH
WILLIAM C. HOLLOPETER, A.M., M.D., LL.D.
Breast Feeding: Relative Frequency of Breast Feeding; Microorganisms
in Breast Milk; Colostrum; Quantity of Breast Milk; Constituents
of Breast Milk; Galactagogues ; Necessity for Intelligent Mothers;
Nursing; Consideration of Breast Milk; Mixed Feeding; Contra-Indi-
cations to Breast Feeding.
Artificial Feeding of Infants; Certified Milk; Composition of Cow's Milk;
Condensed Milk; Buttermilk; Peptonized Milk; Sterilized Milk; Pas-
teurized Milk; Proprietary or Patent Foods; Home Modification or
Adaptation of Milk; Clinical Application of Artificial Feeding; Home
Modification of Cow's Milk.
Summary of Rules to be Observed in Artificial Feeding.
BREAST FEEDING
Breast feeding has been regarded by many writers on pediatrics as
a lost art. Fortunate indeed is the young mother who can supply her
child with a full amount of well-balanced nutritious food. The high phys-
ical and mental tension forced upon most of us to-day calls for an evenly
poised nervous mechanism, and as a result, we find many who fall below
this standard. Among the well-to-do it was, until a few years ago, the
exception that the young mother could acceptably nurse her child wholly
for six months.
Ten to fifteen years ago, fully 75 per cent of the young mothers were
unable to nurse their offspring, but now, thanks to a growing spirit of
maternal pride, associated with sounder physiological knowledge and the
increasing tendency towards outdoor education, this difference is passing
away and to-day we see more mothers proud and willing to nurse their
offspring. The young mother of to-day is better equipped physically and
471
472 KEQUIKEMENTS OF INFANT FEEDING
mentally to nurse her offspring than was her sister of twenty years ago.
This is due to the fact that she has had a better all-around education, is
a better type of animal more vigorous by reason of outdoor life than
the woman of two decades ago. Still, we have too many sentimental young
mothers who will not, or can not, nurse their offspring, due probably, in
part, to faulty parental training. On the other hand, it is all wrong to
accuse the young mother of inability to nurse her child without careful
study of existing conditions. A child may be of low vitality with sensi-
tive digestive powers and will feel the slightest abnormality in the
mother's milk. And all mothers' milk at first may lack the proper pro-
portion of food elements due to fear of pain and general discomfort of
the parturient act. In many cases, this enfeebled digestive power in the
child, associated with slight abnormality in the maternal supply, is the
cause of the nursing being discontinued.
Many mothers do not secrete the requisite supply of milk until two
or three weeks after confinement. This variation of supply should be
recognized both by the physician and mother and carefully studied before
any radical changes are suggested. Frequently we have found a high
fat, sugar or protein content which corrected itself within a few weeks.
This condition ordinarily warrants a discontinuance of nursing of a feeble
infant, while in a vigorous infant it would be a matter of small moment.
While we have just cause to rejoice in the increasing number of nurs-
ing mothers by reason of better physique and more general knowledge,
iue in part to the increasing number of young women who play golf, ride
horseback, or play tennis, and the progressive use of the automobile, we
still have too many of the nervous type the neurotic mother in spite of
outdoor exercise. The neurotic mother is the stumbling block to the pedia-
trician's success she makes a poor nurse, her milk constantly varies in
composition, and she cannot be depended upon to produce regularly. The
neurotic mother has been the means, however, of the great advance in
careful feeding, even if she is responsible for so many delicate children.
At the present day, the decline of neurasthenic mothers is strongly in
evidence; they are less numerous, not popular, and will further decrease
in the next ten years, because the great outdoors has lately become the
fashion.
Relative Frequency of Breast Feeding. The relative frequency of breast
feeding varies with different countries. In .Japan, all mothers nurse their
offspring. Among the Eskimos, artificial feeding is unknown. At the
Woman's Dispensary in Munich, an investigation revealed the fact that
only 3.6 per cent of women examined nursed their offspring longer
BREAST FEEDING 473
than three months. Davis(l), studying this question in the city of Boston,
in 11)11, found that 08 per cent of babies between the ages of two weeks
and one year were breast-fed, while in the eity of New York the estimates
of the Board of llealth(2) record that 85 per cent of the infants in New
York City are breast-fed. Koplik(3) investigated 1,007 infants in pri-
vate practice in the city of New York and found only 10 per cent exclu-
sively breast-fed, while 30 per cent were exclusively bottle-fed, 60 per cent
breast- and bottle-fed, and 40 per cent were weaned before the fourth
month.
Dr. Eric Pritchard(4) of London, through "mothercraft societies"
first instituted at the Marylebone Street Hospital, has started an edu-
cational propaganda of enlightenment on the subject of infant feeding
that is spreading throughout the British Isles and beyond like a fierce and
living contagion. Since the inception of these infant consultations, or
schools for mothers, the death rate has fallen from 155 per 1,000 births
to 95 per 1,000, and in the city of London to 91. In Berlin(5), where
infant feeding is under government control, reports show that from 1900
to 1904 only 9 per cent of infantile deaths occurred in breast-fed children.
The Health Department of the city of New York concludes from the
statistics gathered by the Commissioner of Health that fully 85 per cent
of the infant mortality occurred in infants artificially fed (6). In the
city of Boston, in 1911, the mortality of infants over two weeks old
reached 74 per cent in the artificially fed, and Davis (7) concludes that
the bottle-fed is six times as likely to die as the breast-fed infant. Luling
of Paris(8), in a study of 13,952 children born in Baudelocque's Clinic,
reports a mortality of 14 per cent in breast-fed babies, and 31 per cent in
babies who were bottle-fed by their own mothers, and 50 per cent in babies
who were bottle-fed by strangers.
In the city of Liverpool, Arnistrong(9) reports in a study of 1,000
infants in 1903, that of the breast-fed babies 8.4 per cent died in the first
year against a mortality of 22.8 per cent among the artificially fed. The
Health Department of the city of New York investigated the cause of
diarrheal disorders occurring in 1908 and found that only 9.0 per cent
had been previously breast-fed.
"As a twig is bent, so the tree is inclined," applies with especial em-
phasis to the nutrition of the young child. Success in infant feeding
demands the careful observance of little details ; it is not possible to feed
carefully for one or more weeks and then grow careless for even a few
days, for by so doing, we will either fail to gain that daily advance in
development which is so essential in infancy, or possibly even precipitate
474 REQUIREMENTS OF INFANT FEEDING ,
an acute illness. The young mother left to her own devices will make
changes in diet not warranted by the child's condition, but largely at the
suggestion of poorly informed friends.
This fact is well illustrated by the comparison of private cases with
dispensary cases ; fully forty per cent of the out-patient dispensary cases
are below the average in weight and development, in contra-distinctioii
to the private cases, less than ten per cent of whom fall below this aver-
age. These dispensary children are the offspring of day laborers, me-
chanics, waiters, and other small wage earners; they are fed correctly
at times, and again incorrectly, not because of poverty, but because their
mothers do not know. the very important principle of regularity; neither
do they understand the value of food nor the necessity for giving it at
regular specified intervals. The children are not hungry; they are fed
to satisfy the appetite, and not to nourish the body. To feed their chil-
dren to encourage a definite purpose the proper physical development
has never entered their minds. It is for this reason that breast feeding
must be vigorously encouraged and rigidly supervised ; otherwise we will
soon be a race of physical defectives.
Microorganisms in Breast Milk. The breast-fed infant receives its
food direct from nature's fountain, and, because it comes direct, it is re-
garded as sterile. The truth is, however, that organisms from the breast
gland itself get into the milk (10). Careful investigation shows that the
milk of healthy women, whose breasts are free from pathologic condi-
tions, contains microorganisms. In the majority of instances, the staphyl-
ococcus aureus is found. It is believed that the bacteria enter the breast
from the outside. Milk carefully drawn is usually found sterile. This
question of sterile human milk remains to be settled, but for all practical
purposes we, as pediatricians, feel that breast milk is sterile. Syphilis has
been induced in rabbits by inoculating them with milk from a syphilitic
woman, although the woman's milk was sterile and on examination no
spirochaetse pallida? were found (11).
Typhoid bacilli were found by Lawrence in the milk of a woman suf-
fering from typhoid fever (12). Bacteria, unless present in unusual num-
bers, ordinarily produce no ill effects in breast-fed children, because the
germs found in human milk have no pathological significance for a healthy
infant. It has been shown, however, that this is not the fact in infants
with an injured digestion. Moro has recently ascribed to the staphylo-
cocci in human milk an etiologic factor in the dyspeptic conditions of
breast-fed infants (13).
The taste and appearance of human milk is practically the same as
BREAST FEEDING
475
that of cow's milk. Human milk has no odor, and tastes sweeter than
cow's milk; it may look paler or bluish. When cool, small white flakes
cling to the side of the vessel ; these disappear when the milk is warmed.
The microscopic appearance of human milk reveals it as a permanent
emulsion containing many fat droplets. It also contains a few leukocytes
and epithelial cells.
Colostrum The milk excreted during the first few days postpartum
and known as colostrum, differs materially from that after lactation is
fully established. Colostrum is as sweet as milk; of a deep lemon yellow
tint due to a coloring matter contained in the fat drops. The percentage
of cholesterin and lecithin is greater than in milk. The fat of colostrum
contains less of the volatile fatty acids than does normal milk. The spe-
cific gravity of colostrum ranges from 1.028 to 1.072, the average being
about 1.040.
Konig gives the following analysis as an average composition of colos-
trum: water, 86.4; nitrogenous substances, 3.07; fat, 3.34; lactose, 5.27;
salts, 0.40. We give below a table from Czerny and Keller, 1 graphically
showing the composition of colostrum according to various investigators :
COMPOSITION OF COLOSTRUM
Day
Fat
Lactose
Protein
Nitrogen
Ash
Solids
Author
postpartum
%
%
%
%
%
%
Pfeiffer
1
2 59
2 76
9.75
408
Pfeiffer
2
2.17
3.50
7.45
0.340
Adriance..
2
3.77
5.39
3.31
0.27
12.48
Camcrer and
(26-51
4.08
4.09
0.928
0.48
16.04
Saldner. . .
56-61
3.92
5.48
0.508
0.41
14.12
Camerer and
26-48
1.67
5.20
.336
.36
10.32
Saldner. . .
148-69
2.02
5.08
.226
.40
10.12
Pfeiffer after repeated examinations concludes that the nitrogenous
substances in human milk ordinarily range as follows: first day, 8.6 per
cent; third day to tenth, 3.4 per cent; at end of second week, 2.28 per
cent; in the second month, 1.84 per cent; in the seventh month, 1.52 per
cent. The percentage of sugar increases in human milk while the protein
decreases. The mineral content of colostrum and of breast milk after
lactation is established is essentially different.
i Quoted by Morse and Talbot, "Diseases of Nutrition and Infant Feeding," p. 94,
pub. by the Macmillan Company.
476
REQUIREMENTS OF INFANT FEEDING
Specific gravity is usually given as 1.030-1.032. It may fall as low
as 1.020 or go as high as 1.036(14).
The' reaction of human milk is amphoteric. It is acid to phenolphtha-
lein, and alkaline to litmus. The reason for the double reaction is the fact
that human milk contains both mono- and diphosphates. The former are
weakly acid, while the latter react as a base.
Quantity of Breast Milk. The amount of human milk secreted by a
healthy mother greatly depends on the demands of the child. The size,
weight and vigor of the infant will indicate the exact amount of milk
extracted from the breast in each twenty-four hours. It is natural, there-
fore, to conclude that a weak, immature child would not demand the same
amount as a lusty, vigorous infant. What would be a normal quantity
for one child would not be normal for another ; therefore averages are not
of any special value.
The exact amount of milk extracted at each nursing is obtained by
weighing either mother or child before and after each nursing. Cra-
mer (15) shows that multipart secrete a third more than primiparaB. 1
QUANTITY IN SECRETION OF MILK BY PRIMIPARA AND MULTIPARA
Day
Postpartum
TWENTY-FOUR-HOUR AMOUNT OF MlLK IN GRAMS
1
2
3
4
5
6
7
8
9
10
Nine Babies Primipara
Wt. at Birth 3.290
grains
4
6
78
129
183
238
199
324
236
344
299
324
303
361
274
365
362
384
384
415
Seven Babies Multipara
Wt. at Birth 3.348
erams. .
The average daily quantity of milk secreted by healthy young mothers
under normal conditions has been approximately determined as follows:
Period of Lactation
Approximate Quantity in Grams
Ounces
Grams
At the end of 1st week
10 to 16
300 to 500
At the end of 2nd week
13 to 18
400 to 550
During 3rd week
14 to 24
430 to 720
During 4th week
16 to 26
500 to 800
From 5th to 13th week. .
20 to 34
600 to 1 030
From 4th to 6th month
24 to 38
720 to 1 150
From 6th to 9th month..
30 to 40
900 to 1.220
Quoted by Morse and Talbot, "Diseases of Nutrition and Infant Feeding."
UUKAST FEEDING
477
Czerny and Keller (16) give more details as to the amount of breast
milk secreted by the average mother. 1 They show that the activity of the
maternal breast may be greatly increased if the mother nurses one or
more babies, as is found in a wet-nurse. They refer to a wet-nurse whose
amount of milk secreted in ten days increased from 720 grams when she
nursed two 'infants, to 1,750 grams when she nursed five infants.
Age
in
Weeks
Average weight
of breast-fed
babies given in
grams
The calculated
days amt. of
milk in grams
Age
in
Weeks
Average weight
of breast-fed
babies given in
grams
The calculated
days amt. of
milk in grams
1
3.410
291
14
5.745
870
2
3.550
549
15
5.950
878
3
3.690
590
16
6.150
893
4
3.980
652
17
6.350
902
5
4.115
687
18
6.405
911
6
7
4.260
4.495
736
785
19
20
6.570
6.740
928
947
8
4.685
804
21
6.885
956
9
4.915
815
22
7.000
958
10
5.055
800
23
7.150
970
11
5.285
808
24
7.285
980
12
5 . 455
828
25
7.405
990
13
5.615
852
26
7.500
1,000
Constituents of Breast Milk Coagulation has been more carefully
studied by means of the ultramicroscope. The essential differences in the
coagulation of human and cow's milk are as follows(17) : The casein
of human milk is precipitated with greater difficulty with acids or salts
and it does not coagulate uniformly after the addition of rennet, while
the clot that forms does not appear in such large coarse masses as the
casein from cow's milk, but is more loose, feathery and flocculent.
ALBUMINOUS BODIES. The albuminous bodies in human milk are
classed under two groups: (a) casein, which is insoluble in water, and (&)
lactalbumen and globulin, which are also insoluble in water. The- separa-
tion of these bodies in human .milk is more difficult than in cow's milk,
because of the difficulty in precipitating the casein. There is on this ac-
count much opportunity for further investigations to add to our knowl-
edge of the proteins of human milk. The figures which are most generally
accepted are those of Schlossman(18), who found that about 41 per cent
of the total nitrogen is in the form of casein.
Quoti-d by Morse and Talbot, "Diseases of Nutrition and Infant Feeding."
478 REQUIREMENTS OF INFANT FEEDING
CASEIN. Casein is difficult to precipitate from human milk. It re-
quires a large amount of human milk to conduct an analysis, and this
has retarded our knowledge of the subject. We know more about' cow's
casein than human casein. As casein is insoluble in water, we must add
an alkali, such as sodium citrate. On adding acid to this alkaline solu-
tion, the casein will again be precipitated.
FAT. The fat in human milk is in a very fine emulsion. When the
number of drops are counted in a counting chamber, more will always
be found in human milk than in cow's milk(19). The figures as to the
percentage of fat and the total amount of fat in human milk vary accord-
ing to the various investigators and the methods pursued. Engel's(20)
monograph on human milk gives the most complete summary of the
knowledge on this subject, and is quoted freely in this article. He says
the percentage of fat is smallest at the beginning of nursing and largest
at the end of nursing, the steepness of the curve depending on the total
amount of milk taken at a nursing. When a small amount is taken, there
is a sharp rise in the percentage of fat, and when a large amount of milk
is taken, there is a more gradual rise. The percentage of fat in the first
milk drawn varies between 1 and 3 per cent, and that in the last milk
taken between 6 and 10 per cent. These figures may occasionally be even
higher. In pathological conditions the extremes of the percentage of fat
are 0.1 per cent(21) and 13.7 per cent(22).
The average fat content of the milk of ten wet-nurses (German) ex-
amined by Engel was 4.5 per cent, and of 119 women (Russian) exam-
ined by Skvorlzov(23), 3 per cent. The amount of fat in the milk of the
same women may vary from 25 to 100 per cent in the same day at differ-
ent nursings. When the intervals of emptying the breasts are long, there
is more milk and less fat. When all the milk of a woman is collected
each day, the average daily percentage is constant. This is true even
if the total amount of milk is considerably increased.
LACTOSE. Milk sugar is found only in the milk of mammals. It is
essentially the same in the milk of woman, the cow, ass, rabbit, dog and
horse (24). There is evidence which suggests strongly that lactose is
formed from the dextrose in the blood (25). The quantity of lactose
varies the least of all the elements of human milk. The amount of lactose
in human milk is almost twice that in cow's milk, being on the average
about 7 per cent. The lowest percentage which has been found is
4.22(26), and the highest 10.9 per cent(27). A few instances have been
recorded in which the addition of sugar to thfe diet of the mother has
BREAST FEEDING 479
increased the amount of sugar in the milk. This, however, is by no means
the rule (28).
FERMENTS (ENZYMES). Many pediatric writers place much impor-
tance on the ferments or enzymes of milk, especially in the discussions as
to whether raw or boiled milk is the more digestible for infants, and in
connection with the diseases of metabolism, such as scorbutus and rachi-
tis. The study of the ferments is open to error because of the presence
of bacteria in milk. It is almost impossible to obtain a truly sterile sam-
ple of milk or to keep that milk sterile for any length of time. The use
of toluol or chloroform to keep the milk sterile may modify or destroy the
enzymes, while sterilization by heat always destroys them. As the action
of bacteria may cause all the phenomena produced by the ferments in
milk, the presence of bacteria must always be excluded.
Galactagogues In many nursing mothers who do not secrete sufficient
milk to ensure the gradual physiological growth of the child, it becomes
of practical importance to know if we possess means of any value to
stimulate the lacteal secretion. Hence a few words on the value of galac-
tagogues may be instructive. Schafer and MacKenzie(29) found that
the posterior lobe of the pituitary body of the ox and the corpus luteuin
of sheep both act as galactagogues when injected into cats and dogs.
Hammond (30) found that the injection of pituitary extract into lactating
goats increased the amount of milk for twenty-four hours. However, the
amount secreted during the next twenty-four hours decreased below the
normal, so the average of the two days was the normal amount.
Gavin(31) did not find that the pituitary extract affected the quantity of
milk in cows.
MacKenzie and others(32) believe that the mammary gland can be
stimulated by the administration of the posterior lobe of the pituitary
body, the pineal body, and the corpus luteum. The action of the former
is supposed to be the most powerful. Inhibitory substances are said by
some observers to be produced by the fetus, placenta, spleen, pancreas,
adrenals and thyroid. Aschner and Grigori(33), on the other hand, found
that the pulp of placenta or its watery extracts caused a true secretion of
milk in virgin animals and that the body which causes this secretion is de-
stroyed by alcohol and heat. Basch(34) reports that substances present
in the placenta when injected into animals will bring back the secretion
of milk after it has stopped.
Wolf (35) injected milk into nursing women and found that there was
an increase in the amount of milk secreted. Chatin and Rendu(36) re-
peated Wolf's work with eight women, giving thirteen injections of milk
480 KEQUIKEMENTS OF IKFAXT FEEDING
with the result that in eight instances the curve of milk secretion re-
mained stationary or became slightly lowered. In the five remaining
instances there was a slight increase in the amount of milk secreted after
the injections of milk. This increase was, however, always in association
with other factors, such as a change in the number of nursings, or a
greater demand on the part of the infant. They believe that the latter
was the cause of the increase and not the former (37).
There is much evidence to show that substances secreted in the ovary
cause the growth of the breast gland at puberty. Cramer (38) believes
that it has no influence on the hyperplasia of pregnancy, while Basch(39),
on the other hand, attributes the increase in size of the breast glands to a
secretion in the ovary. The blood of a pregnant animal injected into a
lactating animal has no influence on the secretion of milk (40). Engel
after considerable investigation concludes that there are no artificial
means of increasing the secretion of milk.
Herbert Spencer has said, "The first requisite for success in life is
to be a good animal" ; and to be a country or nation of good animals is
the first essential of national prosperity. To approach this essential or
national prosperity in the right direction is the establishing of training
schools for teachers and a department of dietetics and food economics in
the various cities. This has been accomplished in many of our larger
towns and with wonderful success. The students are taught food values,
food preparation, the way to provide the most nutritious food in its most
attractive form for a given sum of money.
Necessity for Intelligent Mothers. Of the hundreds of teachers sent
out from their dietetic departments of instruction every year to assume
responsibility over children in all parts of the country, each and every
one has learned something of dietetics and food values and will impart
this knowledge and point out the great importance of correct feeding.
The teachers will impress on the growing child the value of good food,
without which the very best type of adult possible cannot be realized.
More members of our profession should be interested in the support of
dietetics and more departments of the same be firmly established in every
high school for girls throughout our land. This may not seem to apply
especially to maternal nursing, but I have not forgotten its application.
The food and hygiene of the growing girl have the closest bearing upon
her future life, and when she is called upon to perform her most impor-
tant duty, motherhood, she certainly has the right and privilege to receive
during her girlhood proper instructions, proper food, and normal devel-
opment. This right has been too long denied the girl.
BREAST FEEDING 481
Preparedness seems to be the watchword of our nation in every de-
partment of industry, since we have been watching the holocaust in Eu-
rope, yet I fear many young struggling physicians have not fulfilled this
mission as thoroughly as their opportunities would permit. The family
physician has the rare chance of moulding the family tree as no other
individual can ; too frequently he limits his care to the ill ones alone. His
function should be enlarged to include personal hygiene of the young.
I feel that my work is not properly done when I neglect careful instruc-
tion as to habits and feeding of the growing child or the prospective
mother. Unfortunately, it is found in almost every instance, according
to my observations, that errors in child-management are due to ignorance,
so I feel that it should be a part of our professional duty to take the par-
ents into our confidence and explain why we wish certain rules and direc-
tions to be followed. In this way we avoid "bending the twig" and pro-
duce a normal mother. The ideal mother is one who is mentally normal
as well as physically normal ; otherwise the product will be uncertain and
unbalanced.
Breast milk is variable and uncertain because the function is variable.
Yet breast milk is one of the most valuable substances it is human life,
and we must know its value.
Nursing. The nursing age is between twenty and forty; yet I have
seen a girl of fifteen and a woman of fifty-five successfully nurse their
offspring. I have seen the society girl succeed when the conditions all
seemed to be against her; nothing is impossible to well-directed effort.
Mothers vary greatly in the duration of nursing ; some can nurse for two
months, others five, seven or nine months. It is unusual for both mother
and child to remain well after ten months of breast nursing. The best
index of a nursing mother's success is her own child ; if it is content and
shows the usual gain, the mother has succeeded. Kerley gives the follow-
ing nursing axioms:
A diet similar to what the mother was accustomed to before the advent of
motherhood should be taken.
There should be one bowel evacuation daily.
From three to four hours daily should be spent in the open air, fn exercise
which does not fatigue.
At least eight hours out of every twenty-four should be given to sleep.
There should he absolute regularity in nursing.
There should be no worry and no excitement.
The mother should be temperate in all things.
DIET DURING LACTATION. The diet of a nursing mother should be
nearly the same as the one she has been accustomed to have, provided it
482
has sufficient variety aiid is nutritious and digestible. I have found mothers
attempting to nurse their children while following a restricted diet, omit-
ting most vegetables, for fear of creating colic in the infants; this is
frequently a mistake. A robust young mother who has been accustomed
to indulge in a full, generous diet cannot supply her child on a restricted
diet without one or the other suffering by so doing. The withdrawal of
a number of vegetables from a nursing mother's diet can be made only
on account of their indigestibility, and if she could digest them be-
fore she was a mother, she should be allowed them during her nursing
period.
Nursing is a perfectly normal function, and every woman, with her
own child, should be influenced to carry it out along natural lines; the
only thought she should magnify is that two lives are to be provided for
in the place of one ; therefore more food should be taken to gain this end
successfully. The food in excess should be fluids, as milk in some form,
soups and broths. The necessity of crowding food into the mother varies
according to the age of the child. The first month, while the child is
young, a restriction of all fluids may be found necessary, while in a few
months it will be found expedient to feed the mother between meals.
After the third month, in many cases I find the mother will take eight
ounces of milk, or the same quantity of oatmeal gruel or cornmeal gruel
between breakfast and dinner, the same in the mid-afternoon, and on
retiring at night.
It is due to Dr. Southworth's careful study that we have come to ap-
preciate the value of cornmeal in the form of gruel or as cornmeal mush..
I have found it of considerable value and insist upon its liberal ingestion
by every nursing mother when her supply of milk seems to be diminish-
ing. The forced feeding of nursing mothers is only limited by her power
of digestion, and if any article seems to disagree, it is well to discontinue
the same.
BOWEL MOVEMENT. The bowel movement is a part of the digestive
function and should be most carefully watched. One free evacuation
daily should be insisted upon.
The treatment of constipation in nursing mothers a type of indiges-
tion is surrounded with difficulties. The dietetic method offers us little
aid, because it interferes with the' milk production. Usually, cooked
fruit and gruels serve to keep up peristalsis. Abdominal massage is of
some value. It is my request that every nursing mother receive an enema
before retiring if no evacuation has occurred during the day. If the pre-
BREAST FEEDING 483
ceding methods have not succeeded, I have found the following pill valu-
able and i doubt that any harm has occurred to the child :
Kx. Rhainnus Pursh gr. iii
Ex. Belladonna gr.
Ex. Nux Vom gr.
One at night; possibly another may be indicated at noon the following
day, if no action has taken place. The pill is a very good tonic to the
intestinal canal, a peristaltic persuader.
REGULARITY OF NURSING. Regularity of nursing is of vital impor-
tance, for the child as well as the quality and quantity of the lacteal secre-
tion. The breast that is emptied regularly contains a better quality as
well as a larger quantity of milk.
System and regularity are as important in milk production as is di-
gestion. If the gradual growth of the child is in keeping with the age
and weight, as proved by the happy child, I begin with a bottle of water
night and morning, a very necessary part of the feeding. This I continue
during the first year. I. have found many infants cross and unhappy be-
cause the mothers had neglected to give them water at regular intervals.
Between the third and fourth month, I begin with one bottle feeding
daily. This is very essential. In case of illness of the mother, or if she
is called away from the child by an unexpected emergency, the child is
provided for, and at the same time conditions are arranged for a very
gradual change from the breast to the bottle. This can be accomplished
within one year.
DURATION OF WEANING. The average duration of weaning from
breast to bottle is about three months. I am generally influenced by the
health and temperament of the mother 'in this matter; commencing at the
sixth month with two bottles daily, I add a bottle every month until the
ninth or tenth month, when I have the child wholly fed by bottle. In
addition to the bottle I commence at the third month to give orange juice
daily. The juice of one-half of a large sweet orange is given daily
throughout the year. By the time the child is six months old, I give in
addition to the orange one-half ounce of beef juice daily. This I con-
tinue also throughout the year, increasing in quantity if I find it de-
sirable.
It is usually regarded as physiological that the new-born child should
lose at least one-half a pound before breast feeding is fully- established.
This is unnecessary if the nurse and physician are in accord in the care-
ful management of the child. If one-half to one ounce tepid sugar water
484 REQUIREMENTS OF INFANT FEEDING
(one per cent) be given every two hours from birth up to the time the
milk supply is established, this loss does not take place. This method
carefully carried out will not only guard against loss of weight, but will
also anticipate the febrile state of the new-born, recognized as inanition
fever.
SUCCESSFUL NURSING. The evidences of successful nursing are
many and should always be looked for. The child should be quiet, con-
tented, and sleep most of the time. The gain in weight should not be less
than four ounces per week and frequently over eight ounces per week,
which is nearer the standard gain than four ounces per week. Where the
gain is less than four or remains at four ounces, I suspect something
wrong with the nursing, possibly irregular nursing, but more probably
the fault is in the supply. An analysis of the milk will give the answer.
After nursing from ten to fifteen minutes, the child should fall asleep and
remain asleep until the approach of the next period, when he is again
ready for feeding. Regularity enforced on the child soon establishes reg-
ularity in its demands, and the mother will soon govern herself accord-
ingly. The stools under this carefully regulated feeding are from two to
three per day, smooth, yellow, soft, and almost devoid of odor.
UNSUCCESSFUL NURSING. Evidence of unsuccessful nursing is too
frequently accounted for on the grounds of some trifling cause, such as
"colds," fatigue, or defects in diet in mothers, while the real cause may
be deficient lacteal secretion. When the standard established for a normal
well-nursed baby falters, it must be investigated and corrected in order
to maintain good results. When the maternal supply is defective, either
as to quantity or quality, the child soon makes it known to the mother
and physician by becoming troublesome, by crying long before the nursing
period, or lingering unduly at the 'breast, endeavoring to extract its meal
in thirty minutes that should satisfy it within half that length of time.
The most prolific cause of failure in breast feeding is naturally a
scanty breast supply, and this is influenced by many factors outside of
the mother herself. The nearer the supply is to the nutritional standard,
the more satisfactory will be the progress of growth and development of
the child. It should contain three to four per cent fat ; protein one to two
per cent, and sugar six to seven per cent. Failure may be due to any
marked deviation of any one of the above. It has been my experience
that some babies will grow irritable and lose weight while the mother is
producing milk in abundance, but containing eight per cent sugar. This
is .not, however, the usual order of things, as most babies have a good
tolerance for sugar. The same thing occurs when the fat is unduly de-
BREAST FEEDING 485
fective. In cases where we find green watery stools, the cause is most
probably due to a high fat content; five or six per cent fat will always
induce green watery bowel movements. In such cases, the milk should be
examined; especially should this be done if the child shows effort in
defecation or vomiting.
Low fat content usually brings about constipation and defective nour-
ishment. The protein of breast milk has been regarded as the most im-
portant element to consider and the one requiring the most careful study,
irregularities being sure to bring about some gastric or intestinal trouble.
Increase of protein will cause colic and constipation. In such cases we
will find curds, pain associated with gas, and frequently with fever, and
occasionally vomiting. The mother may produce a normal amount of
fat, sugar and protein, but not sufficient to satisfy the child's hunger.
The child may require four or five ounces and the breast may only pro-
duce half the quantity. The only trustworthy guide in this condition
is to weigh the child before and after each nursing for at least twenty-
four hours. One ounce of breast milk weighs nearly one ounce avoirdu-
pois. This method gives us the quantity but not the quality. Mistakes
in quantity are frequently made by faulty weighing. The child should
be most carefully weighed in the same clothing, or, better, with as little
clothing as possible, to insure accuracy.
Consideration of Breast Milk The quality of the mother's milk is of
vital moment. It should be determined at regular intervals. (This will be
discussed later on.) It is interesting to observe that children gain after
each meal from one ounce in weight up to eight or nine ounces, according
to the age thus a child under one week will gain from one to one and a
half ounces per meal of fifteen minutes ; four to eight weeks old, a gain of
two to three ounces ; sixteen to twenty-four weeks old, four to six ounces ;
and nine to twelve months of age, eight to nine ounces. This is not an ab-
solutely fixed quantity, nor do we find many mothers producing so large a
quantity at the end of the year. When a child is unhappy, unsatisfied, and
no other physical reasons to be found, I generally institute a milk analy-
sis ; this is especially indicated when the weight is slowly gained or if it
remains stationary. Weighing the baby once a week is the only true
method of procedure. Ofttimes a child is unhappy from excess of good
milk; usually it is taken too fast, when it is regurgitated or produces
colic. It is more frequently tolerated for a long time.
In the presence of dilated stomach, habitual vomiting (ofttimes re-
garded as a healthy sign by mothers) and constipation, the child loses in
weight and may be weaned from a good breast to the bottle. This unfafr-
131
486 KEQUIKEMENTS OF INFANT FEEDING
tunate result could be avoided if the physician were consulted early and
proper feeding rules established.
The rule in such cases is to weigh the baby before and after feeding,
and have the milk carefully examined. A nursing infant may suffer
from habitual indigestion, while its mother may have unusually good
breast milk; here the child can be greatly benefited by shortening the
time at the breast. Weighing the baby at intervals of three to five min-
utes and recording the gain, reveals an intake of three to four ounces,
which may represent the capacity of the child's stomach, the excess which
the child obtains over this amount being the cause of the trouble. From
a free full breast a vigorous nurser will take one ounce in one minute.
Some infants completely fill the stomach within five minutes, and will
safely hold its contents, but they must not be handled after the meal, if
we wish them to retain the food ; this rule is a personal equation.
When we fear the child's "speed," we must adjust the environments
accordingly. Mothers must be informed that their babies cannot nurse
as long as they wish, or as often as they cry. Such habits encouraged
early are certain to ruin the strongest digestion later in the child's life.
Frequently a mother may have sufficient quantity of milk, the child
thrives, may not vomit or show any signs of indigestion, yet not continue
to put on weight.
Only repeated examinations will finally show that the mother's milk
lacks either fats or proteins. This may occur frequently and is best
explained by finding the mother irregular in her own feeding, or person-
ally neglectful in some other way. Strenuous personal hygiene on the
mother's part may prevent the irregularity, and if the fats and proteins
cannot be increased, the bottle must come to the rescue.
This failure on the mother's part leads us to mention the signs of
insufficient nursing, as revealed when the child lingers long at the breast,
perhaps for thirty minutes or more, and cries or shows signs of discom-
fort when removed. Within an hour the child cries and shows all the
evidence of hunger. He will also demand frequent nursing during the
night. If this condition continues, the child will not gain, but actually
lose in weight. The remedy for insufficient milk must be given before
the failure takes place, that is, every physical condition of the expectant
mother must be carefully inquired into, examined and corrected before
the baby comes, and after its arrival, every unfavorable condition must
be carefully ascertained and removed. Emotional women are prone to
irregularity in their milk supply, hence prospective mothers of this class
should be most carefully watched.
BKEAST FEEDING 487
LACK OF UNIFORMITY IN BREAST MILK. We are frequently con-
fronted with irregular or abnormal milk production in the nursing
mother. No mother has a uniform milk; it varies from day to day, and
from month to month, rich in fats and proteins at one month and less in
another ; these variations do not affect the child unless they are continuous
and most marked. When it is found that the milk is too strong in fats
and proteins, or when the ratio is not maintained, it is possible, by care-
ful dieting, to diminish the milk strength, or, if it is found necessary,
to increase the fat or protein content. The richer milk is usually found
in young mothers who are athletic and robust, who eat well and whose
digestion is normal. In nursing mothers of a sedentary type, a daily
bath and massage, with restriction of the rich food, cutting out red meats,
or, at best, allowing but a small quantity daily, and the withdrawal of
all forms of wines or alcohol, will accomplish much good. The mother
should be directed to walk from two to three miles daily to bring her milk
to the proper digestible condition for her infant. If the dieting and walk-
ing fail to adjust the milk output, it has been my practice to order the
child to have one ounce of boiled water containing a small quantity (one
dram) of soda mint, immediately before each nursing. Ofttimes I find
it well to give in the place of the boiled water the same quantity of barley
water.
Giving barley water, boiled water or lime water one-half ounce to
one ounce is a frequent procedure in my practice, often leading to good
results. This simple dietetic advice is too frequently neglected, and
should be more generally known and practiced. This easy rule has been
the means of saving many lives in my hands, for it has made breast feed-
ing possible.
DEFICIENCY IN PROTEINS AND FATS. When the milk is deficient in
fats and proteins, we must push a full diet of more concentrated food.
In these cases I find Dr. Southworth's methods of feeding cornmeal mush
or cornmeal gruel, to the mother, of value. This procedure is especially
valuable, and readily available, when the patient is fond of corn prod-
ucts, which so many patients dislike, so that we fail to gain good results
because the mothers do not willingly partake of the corn in any form
sufficiently to gain an increase in their milk. I have seen a number
of mothers, however, who have been most decidedly benefited by this ad-
dition to their dietary. In addition to the cornmeal gruel and mush, I
urge the free taking of meat, fish, whole wheat bread, oatmeal, and plenty
of milk in a variety of forms, junket, custard, etc., which will insure an
increase of both fat and protein. The use of malt liquors in a moderate
488 KEQUIREMENTS OF INFANT FEEDING
quantity, as porter sangaree, or brown stout, will increase the fat content
of a mother's milk. However, after all, we are frequently disappointed
in our very best efforts to improve the quantity or quality of breast milk.
Mixed Feeding All breast-fed infants must be taught to take the
bottle by the third month ; the bottle must be familiar to the child by this
time, or we will fail in our efforts. It is absolutely necessary for success
later in the first year. It may contain nothing but water, yet the bottle
must be given early in life. Even with the best nursing breasts, I find
it necessary to commence with a bottle of modified milk by the sixth
month, sometimes waiting till the seventh or eighth month.
By this time the vigor of the child demands more protein and the
mother usually possesses less, so that the modified bottle is a welcomed
necessity. From this time on, I increase the bottle by one per week until
the tenth month, when the child is wholly weaned from the breast to the
bottle. Few women can produce sufficient nourishment for a gro.wing
child after ten months, hence I find the best of mothers are willing to
wean their child by this time. All children should be on the bottle from
the tenth or at most the twelfth month, until they learn to chew food,
that is, until they are two or three years old. Sucking is to the infant
what chewing is to the adult, a necessary requisite to good digestion. I
never deprive the infant of the bottle; indeed many of my children have
found comfort and food in this way until they are five and even six years
old.
All nursing infants, in addition to the first bottle at three months of
age, can also be given one tablespoonful of orange juice per day, with
or without water. At the sixth month, in addition to this orange juice,
beef juice in the same quantity can be given. This is continued daily
until weaning occurs. When a mother fails to give her infant two com-
fortable feedings per day, it is time to wean the child, and further nurs-
ing by the mother is forbidden.
Centra-Indications to Breast Feeding. A mother must not nurse her
infant when she has a fever from any cause. She cannot nurse if she
shows any manifestation of active tuberculosis. Few mothers will be
found entirely free from tubercular implantation, yet so long as it is not
active, we cannot deprive them of this important duty. If any form of
glandular or joint infection should exist, we must prevent nursing.
Syphilis and epilepsy also counterindicate maternal nursing. In ad-
vanced nephritis or any malignant growth, the breast is withheld; the
same is also true in acute diseases, such as pneumonia and typhoid fever
or diphtheria.
ARTIFICIAL FEEDING OF INFANTS 489
ARTIFICIAL FEEDING OF INFANTS
Inasmuch as the milk of the cow is the most convenient and cheapest,
it is usually selected as the food for the infant when the mother's breast
fails to sustain it. Cow's milk should not be selected, however, until
every effort on the part of the mother has been exhausted. The most
important consideration in the selection of cow's milk for the infant is
certainly its cleanliness. This factor, fortunately, has been thoroughly
impressed on the public. In the country and small towns there is no
difficulty in obtaining clean milk, provided the ordinary rules of stable
hygiene and cleanliness on the part of milkers and handlers of the milk
are observed. The personal attention of the physician must be directed
to this side of the milk problem if he is to hope for success with his young
charges. In large cities the milk question becomes more difficult, as the
milk has to be carried long distances, pass through several hands, and the
time is much longer between the milking and the time the child receives
the milk. Clean raw cow's milk is the best food (next to the mother's
breast) for the child. In recent years, the superiority of clean raw milk
to any other artificial food is being more fully recognized by all pediatri-
cians, so that a most strenuous effort has been made to obtain it in all
our larger cities. Through the teaching of the late Dr. Rotch of Harvard,
the Walker Gordon Laboratories became the pioneer for the use of clean
raw milk.
Certified Milk To the late Dr. Coit of New Jersey is due the per-
fection of methods to produce certified milk as now furnished to the
public in most of the larger cities. The education of the public along
these lines for a pure clean milk has resulted in the establishing of model
dairy farms near all cities, so that the transporting of the milk can be
effected promptly.
The rules that should prevail and must be recognized by the public
are as follows:
The cows must be kept clean and healthy, especially free from tuberculosis;
the stables must be clean and sanitary, free from flies; the stable yards free from
manure or stagnant water; the water supply for dairy purposes should be clean
and pure; the food for the cows should be free from noxious weeds or distillery
slops. The cows should be cleaned by daily grooming, and the milking should be
done with clean hands, from clean udders into clean pails, thus using every effort
to prevent the early contamination of the milk. The first flow of milk from the
udder should be discarded as unsafe. After milking, the milk should bo immedi-
ately removed to a separate or adjoining building, strained and cooled, bottled
and placed in a refrigerator, retained here until it is sent to the consumer. In
490
KEQTTIKEMENTS OF INFANT FEEDING
transporting the milk it should be kept cool and should reach the consumer with
a bacterial content not above 10,000 to the c.c.
If milk can be furnished to the home in the above condition, it is per-
fectly safe to feed the infant in a raw state. In this way the vital prin-
ciple of the milk is retained, and this is the ideal food, retaining the vita-
mines, of which further mention will be made.
COMPARATIVE ANALYSIS OF WOMAN'S AND COW'S MILK
Constituents
Average Woman
Average Cow
Protein
1.50
3 50
Fats
3.50
4.00
Sugar . .
7.00
4 50
Salts
0.20
75
Water
87.80
87.25
There are decided differences in mother's and cow's milk which are
not apparent. Mother's milk contains ferments which stimulate digestive
secretions in the infant, while those of cow's milk stimulate the digestion
in the calf, not the infant.
COMPARATIVE COMPOSITION OF MILKS OF DIFFERENT ANIMALS
(Voltz) (41)
Milk
Water
Solids
Fat
Casein
TotalN.
Sugar
Ash
Human
87.58
12.42
3.74
0.80
2.01
6.37
0.3
(42)
Cow
87.80
12.20
3.40
2.70
3.40
4.70
0.7
(43)
Buffalo
82.30
17.70
7.70
4.80
4.40
0.8
(43)
Zebu (1 analysis). . .
Llama (3 analyses) .
Camel (7 analyses) .
Goat
86.13
86.55
87.60
86.30
13.87
13.45
12.40
13.70
4.80
3.15
5.38
4.00
3.00
2.98
3.60
3.03
3.90
4.60
5.34
5.60
3.26
4.30
0.7
0.8
0.7
0.8
(42)
(42)
(44)
(43)
Sheep
81.50
18.50
7.00
4.30
5.60
5.00
0.9
(43)
Reindeer
67.70
32.30
17.10
10.90
2.80
1.50
(45)
Mare
90.58
9.42
1.14
2.50
5.87
0.36
(43)
Donkey
90.12
9.88
1.37
0.79
1.85
5.19
0.47
(43)
Elephant
67.85
32.15
19.57
3.09
8.84
0.65
(46)
Hippopotamus (1
analysis)
90.43
9.57
4.51
Rabbit (1 analysis)
Guinea pig (1 an-
alysis)
69.50
41.11
30.50
58.89
10.45
45.80
15.54
11.19
1.95
1.33
2.56
0.57
(42)
(42)
Dog (8 analyses) . . .
Cat
77.00
81.64
23.00
18.36
9.26
3 33
4.15
3 11
9.72
9 53
3.11
4 91
0.91
59
(42)
(47)
Pig..
82.37
17.63
6.44
6 09
4.04
0.59
(46)
Blue whale
50.47
39.53
20 00
12 42
5 63
1 48
(48)
ARTIFICIAL FEEDING OF INFANTS
491
Health boards of some cities, stimulated by our medical societies, now
have chemists and bacteriologists whose duty it is to make frequent ex-
aminations of the milk supply as it is delivered to the consumer. These
examinations are for the determination of the bacterial contents of the
milk, the amount of butter-fat, the relative percentage of its various in-
gredients, the possible presence of chemical preservatives, or possibly
any foreign matter.
When a milk dealer continues to furnish his customers with this ideal
standard, he is entitled to receive labels from the board of health contain-
ing the words "Certified Milk." These labels, "certified milk," when
placed on a bottle, are his guarantee to the consumer that the contained
milk conforms in all respects to the standard laid down by the medical
or health authorities. This "certified milk," which is sold in nearly all
our cities, conforms to the following standard:
Free from pathogenic bacteria, or a bacterial content not exceeding 10,000 to
the c.c. ; freedom from dirt and all foreign organic matter; freedom from chemical
preservatives; and, most important, a constant nutritional value with about four
per cent of fat and a full average of protein and carbohydrates.
With this medical supervision of our milk supply, we have a nearly
certain food for children compelled to be fed artificially. This careful
precaution necessarily demands an unusual outlay of money by every
city, and as a result such milk must be sold at a price to warrant the
dairyman to continue his high standard. The price of "certified milk"
is therefore prohibitive to the very poor of our large cities.
For this reason a second grade of milk is furnished in many of our
cities by the same dairies and under the same supervision of milk inspec-
tors known as "inspected milk," and it bears a label testifying to its rela-
tive cleanliness. "Tested milk" differs from "certified milk" only in
the bacterial content. During the winter months the "tested milk" must
not contain more than 60,000 bacteria to the c.c., and during the summer
months not more than 100,000 to the c.c. In all other bacteriological and
CHEMICAL COMPOSITION OF COW'S MILK
Cow's Milk
Specific
Gravity
Water
Casein
Albumin
Total
protein
Fat
Lactose
Ash
Min
1.026
80 32
1.79
0.25
2.07
1.67
2.11
0.55
Max
1.037
90.32
6.29
1.44
6.40
6.47
6.12
1.21
Aver.. .
1.031
87 27
3 03
53
3.20
3.64
4.88
0.71
492
REQUIREMENTS OF INFANT FEEDING
chemical standards, it is of the same value as "certified milk" and sells
a few cents cheaper by the quart. The chemical quantitative and quali-
tative difference between human and cow's milk has already been empha-
sized. The table on page 491 from Leach shows the composition of cow's
milk.
The following table shows how much the composition of the morning
and evening milk may vary. These figures are the average from 29,707
tests of milk made by Droop Richmond in England:
VARYING COMPOSITION OF MORNING AND EVENING MILKS
Milking
Fat
per cent
Lactose
per cent
Protein
per cent
Ash
per cent
Solids
per cent
Morning
3.44
4.71
3.43
0.74
12.34
Evening
3.90
4.69
3.39
0.73
12.71
Composition of Cow's Milk. Cow's milk is never uniform in its com-
position. It differs even in the same cow morning and night, winter and
summer. (See table.) The composition of the milk of a single cow may
differ considerably from that of an entire herd. It is for this reason that
the milk of a herd of cows is to be preferred for general purposes to that
of a single cow. However, when it comes to the recognition of tubercular
infection, we can detect it in one diseased cow much sooner than in a herd.
The composition of milk varies in different types of cows, some cows being
better providers for human infants than others ; but all cows have milk
for calves, not for children. The Guernsey and Jersey cows furnish a
milk richer in fat, frequently over five per cent. The Holstein breed fur-
nishes a less perfect emulsion of fat. The Durham and Devon cows yield
a good rich milk, and when properly cared for provide good safe food for
the young infant.
Cow's milk is an opaque emulsion of fat in solution. The vehicle is
albuminous, containing lactose and mineral matter. The color is yellow-
ish white. The odor is not strikingly characteristic, unless the cow has
been feeding on rank weeds or garlic, or is suffering from disease. The
specific gravity at 60 F. varies from 1,029 to 1,034, the difference de-
pending on the composition of the milk. The reaction is amphoteric
when the milk is strictly fresh. It becomes acid by exposure and the mul-
tiplication of the lactic acid bacillus, and the acidity increases with age.
The addition of preservatives increases the alkalinity.
ARTIFICIAL FEEDING OF INFANTS 493
FAT. The fat of cow's milk contains stearin, olein and palmitin,
which are volatile and readily decomposed. When milk stands for a short
time, the fat, being the lighter, comes to the surface and is known as
cream. The fact that about four per cent of fat is found in human and
cow's milk requires us to analyze the two forms of fat more closely.
Cow's milk contains a greater percentage of volatile fatty acids, and a less
percentage of oleic acid than human milk, and the fat in the former is in
a coarser emulsion and separates more easily than in human milk. The
difference in the composition of the fats of the two milks may, in part,
explain the fact that the human infant can digest and assimilate four per
cent of fat in woman's milk, and yet fail to digest two per cent of fat in
cow's milk, and it may also explain why cow's milk, with its excess of
volatile fatty acids, may predispose to acid intoxications in infancy, since
these acids are readily converted by hydrolysis into acetic acid and acetone.
PROTEINS. The chief proteins of milk are casein and lactalbumen;
lactoglobulin, lacto-protein and nuclein occur in smaller quantities. Whey
protein contains all the proteins of milk, except the casein. In woman's
milk, the whey protein exceeds the casein in the proportion of two to one,
but in cow's milk the proportion is as one to six. Chemistry has not as
yet established any difference between the whey proteins of cow's milk
and woman's milk, but these two milks are entirely different in the quan-
tities of casein and soluble albumins they contain. The difference most
important to the clinician is the chemistry of the two caseins. This dif-
ference is practical and concerns the manner of their reaction to the same
ferments and reagents.
In the stomach of the human infant, the calcium casein of cow's milk
(the form in which casein exists in cow's milk) is readily precipitated
by rennet, in the presence of a slight amount of acid, into a clot of calcium
paracasein, and later, as the hydrochloric acid is secreted in larger quan-
tities, into hydrochlorate of paracasein and calcium, the calcium being
separated from the paracasein clot by the hydrochloric acid. This clot is
larger and tougher than the clots which occur in the infant's stomach from
the action of the same reagent on human milk.
In human milk the paracasein clots and the hydrochlorate of para-
casein clots are softer and lighter more flocculent, as compared with
those of cow's milk. In artificial feeding, casein is most frequently
blamed for disturbing the child's digestion. To increase or diminish the
percentage of casein content in the bottle of an infant was supposed to
alter the digestive injury. This practice has been discovered a griev-
ous mistake, as the casein is very rarely the cause of intestinal trouble.
494 KEQUIKEMENTS OF INFANT FEEDING
The most frequent types of food injury are due to the sugar or fat con-
tent.
Finkelstein and Meyer have demonstrated that intestinal indigestion
may be improved, if not controlled, by increasing the casein content and
diminishing the fat and sugar in the milk. The digestibility of the casein
of cow's milk depends largely on the presence or absence of the condition
of the child's stomach which causes its precipitation in small or large
clots. Casein is very easily digested and assimilated if large clot forma-
tion can be prevented.
If an alkali be added to the cow's milk before it enters the stomach,
such as sodium citrate, sodium bicarbonate, or even lime water, large clot
formations may be avoided. Hydrochloric acid or lactic acid will also
accomplish the same result. The alkali or the acid combines with the
casein and breaks up large clot formations. This it does by interfering
with the action of the rennet; rennet can only act in the presence of a
slightly acid medium.
The value of boiling milk, as is frequently necessary during hot
weather, is clearly seen by this formation of small clots ; hence its double
value by killing bacteria and rendering the milk more digestible. It may
be necessary to reduce the fat in the milk temporarily, so as to prevent
its entanglement in the meshes of the clot. The danger, therefore, in the
high percentage of casein feeding is that we may not be able to control the
cause of clot formation.
The human infant may digest the various food elements of cow's milk
when they -are held in the whey of human milk and may fail to digest
them in the whey of cow's milk. Any food for the young infant that
does not maintain the usual casein content is absolutely wrong. The
casein of cow's milk contains 53 per cent of carbon, 16.65 per cent nitro-
gen, 7.08 per cent of hydrogen, and 0.85 per cent of phosphorus. This
composition of proteins with the large per cent of nitrogen content makes
them actually necessary for all growth and all life.
CARBOHYDRATES. The carbohydrate content in cow's milk is 4 per
cent; in human milk it is 1 per cent. Lactose is the only carbohydrate
found in milk. The variation in quantity of this sugar from day to day
and with the age of the infant is surprisingly small. Fats and proteins
vary from day to day and according to the condition of the mother, but
the sugar scarcely changes. Milk sugar in human milk is especially ad-
justed to supply carbohydrate food to the young infant. It does not easily
ferment and is quickly converted into dextrose in the intestines. German
pediatricians, however, regard milk sugar as the most common cause of
ARTIFICIAL FEEDING OF INFANTS 495
intestinal fermentation. It seems that milk sugar when held in the whey
of cow's milk is less rapidly absorbed and more frequently augments fer-
mentation than maltose or dextrin. The majority of normal infants can
readily digest sugar.
Sugar next to albumins is the most important food of the infant.
Like the fats, sugar serves as a fuel for the production of heat, and sup-
plies the food which furnishes energy to the growing cells. In their heat-
forming capacity, carbohydrates are second to the fats, but in their energy
power they are most important. It is an interesting physiological fact
that the oxygen contained in the carbohydrates is not only sufficient to
oxidize their own hydrogen, but to aid materially in oxidizing the waste
products of the fat and protein molecules as they are broken down in the
body, thus preventing an auto-intoxication. This is a beautiful fact
pressed home on us all as an illustration of the interdependence of the
protein, fat and carbohydrate molecules in serving the nutritional de-
mands of the body, and makes very plain the truth that we act wisely and
according to nature's lead when we imitate nature in making an infant
food by combining these food elements in proper proportions.
Clinically the physician soon expects trouble when the food elements
are not kept in their natural proportion ; thus an excess of carbohydrates,
with other food elements, especially the fats, in normal proportions, may
result in diarrhea, loss of weight, fever, and generally a catarrh of the
digestive tube. An excess of carbohydrates with other food elements be-
low the normal may result in anemia, rickets and malnutrition. A severe
food injury may arise by overtaxing the digestive capacity when we have
a deficiency in carbohydrates with the other food elements in excess.
INORGANIC CONTENTS. The ordinary inorganic constituents of milk
are calcium, sodium, potassium, magnesium, phosphorus and iron. All
of the above, except iron, are present in both human and cow's milk in
sufficient quantities to meet the nutritional demands of the growing in-
fant. The hemoglobin contains iron as a very necessary constituent to
the oxidation process which underlies body metabolism. The deficiency
of iron in milk, which gradually increases as lactation proceeds, is made
up in the first year of life from the iron found in the liver and other
organs of the new-born infant. It is found that at birth there exists as
much iron in proportion to body weight as in adults. The partial iron
starvation which necessarily occurs on a milk diet is not, therefore, of
material consequence during the first year of life. As the child grows
older, the storehouse of iron becomes exhausted and it is necessary to
supplement the milk diet by such iron-containing foods as fruit juices,
496
REQUIREMENTS OF INFANT FEEDING
eggs, purees of vegetables and broths ; otherwise anemia and malnutrition
may result.
It is true that the other inorganic constituents play a no less important
role than iron in the body metabolism of the human infant. All those I
have mentioned are found in such organic combination in human milk
as to be readily assimilated in sufficient quantities to meet nutritional de-
mands. A healthy infant can usually assimilate a sufficient quantity of
the inorganic constituents of cow's milk. The fact that a smaller quantity
by percentage of the salts of cow's milk is assimilated is offset by the fact
that they occur in larger quantities in cow's milk than in human milk.
In certain pathological conditions, however, the failure of the human
infant to assimilate the salts of cow's milk produces serious disorders of
nutrition and frequently becomes a factor in the production of wasting
or atrophy. The frequent practice of adding lime water, sodium bicarb,
or sodium chlorid, or better, sodium citrate to cow's milk, not only pro-
motes the digestion and absorption of casein, but also facilitates the ab-
sorption of the mineral salts of the milk, this being especially true of
calcium. The following table is taken from various sources:
PERCENTAGE OF SALTS IN COW'S MILK IN 100 PARTS OF ASH
Bunge
(49)
Abder-
halden
(50)
Schloss
(50)
Soldner
(51)
Pelka
(49)
Richmond
(52)
K 2 0. .
22.14
22.40
24.74
24.96
23.75
28.71
Na 2 O .
13.91
12.25
10.79
6.16
15.36
6.67
CaO
20.05
21.07
21.35
22.25
20.37
20.27
MgO
2.63
2.91
2.71
2.71
2.80
Fe 2 O 3
0.04
.40
P 2 O 5
24.75
24.10
29.54
32.27
27.13
29.33
(CD
21.27
17.25
13.63
10.86
14.67
14.00
One Liter of cow's milk contains in grams :
Soldner (51)
Schloss (50)
K 2
1.72-1.885
1.849
Na 2 O
0.51-0.465
0.861
CaO
1.98-1.72
1.650
MgO
0.20-0.205
0.215
P 2 8
1.82-2.437
2.183
CL
9.98-0.82
1.091
100 grams of the Ash of Cream contains in grams (53) :
K 2 O. .
25.97
Na 2 O
9.86
CaO..
20.54
MgO...
4.20
P 2 6
30.23
CL
16.15
ARTIFICIAL FEEDING OF INFANTS 497
It would be trifling for me to point out the value of mineral salts to
the infant body; they are very essential for the proper balance, growth
and functional activity of all its cellular elements. They enter very
largely in the construction of the bony framework of the infant's growing
body, and for symmetrical development larger quantities are required.
They also maintain normal irritability of nerve and muscle elements ; a
lack of calcium or phosphorus in the growing infant will produce abnor-
malities in the bony framework and will greatly exaggerate the irritabil-
ity of nerve and muscle.
The mineral salts and their combinations are a very essential part of
the infant's food. They must be present in proper relative proportion,
but also in such a form that they can be easily absorbed and appropriated.
This absorption of mineral salts so essential to the proper growth of the
young infant can only be accomplished during the first few mouths of life
by the administration of milk as a medium which holds the nicely
adjusted balance. Human milk is the ideal food for this purpose, and
next to that is some adaptation of cow's milk to meet the same require-
ments. Water is an important constituent of the food of an infant.
About 68 per cent of the infant's body is composed of water, and about'
87 per cent of its natural food milk is water.
This indicates the great importance water has in the physiological pro-
cess necessary to maintain the health and life of the infant. An infant
requires four or five times as much water in proportion to body weight as
an adult. Water is the great solvent which brings into solution the food
of the infant so as to present that food in such a form that it can be read-
ily cared for by the digestive organs. It carries the digested food through
the blood and lymph channels to every part of the body. This common
carrier makes up about 78 per cent of the blood and 96 per cent of the*
lymph, and becomes the circulating medium of the body, carrying the
important elements of the blood and lymph to every cell in the body and
carrying away from the cells, to be excreted, the waste materials of retro-
grade tissue metamorphosis. This excretion of body waste prevents auto-
intoxication and is effected by the elimination of the water carrying this
waste through the kidneys, the intestines, the skin, and the lungs. This
elimination is much more active during infancy, hence the supply must
be constantly renewed.
DIASTATIC FERMENT. It is believed by many physiologists that there
exists a diastatic ferment in human milk which transforms starch into
maltose and dextrose. It has been demonstrated by a number of observers
that it can be developed in cow's milk and goat's milk by feeding them on
498 KEQUIKEMENTS OF INFANT FEEDING
germinating barley. This would indicate that this ferment serves an
important physiological purpose in the human infant, which is met in
some other way in the young of the cow and the goat. The purpose
served is perhaps to supplement the feeble digestive power for starch in
the young human infant, and as the starch digestive capacity of the young
of the cow and the goat is greater, it is not necessary to provide this fer-
ment in their milk.
VITAMINES IN COW'S MILK. Long before we read of Casimir
Funk (54) and his studies, we knew that whole clean milk is next to the
mother's breast the very best food for the growing infant. We knew that
the child is better nourished and happier on whole clean milk, that diges-
tion is easier and development more regular than when the child receives
boiled or sterilized milk. We knew whole milk is milk with the life in
it, not boiled milk with the life boiled out of it. Funk tells us that vitam-
ines or certain vital "accessory substances" exist in whole milk that serve
to protect the child from deficiency diseases, such as beriberi, scorbutus,
pellagra, and rickets. He thinks these diseases are due to the absence of
certain vital substances in the milk which he calls "vitamines." He
shows in his article that milk contains a considerable number of these
antiscorbutic substances as well as substances which materially favor the
growth of young infants. The vitamines are, in general, very sensitive to
heat. Those in milk are .relatively stable. They are, however, partially
destroyed by heating milk for a short time, and totally destroyed by long
boiling as in sterilization.
The development of scurvy in babies taking heated milk and the
greater frequency of the disease when the food is boiled or sterilized than
when it is pasteurized, may be explained by assuming that the' vitamines
are partially or wholly destroyed by heat, the destruction being more or
less complete according to the degree and duration of the heating. It is
true scurvy sometimes develops in babies taking raw milk or even in
babies fed at the breast. This explanation of the development of scurvy
on a diet of raw milk is that in such instances the milk is deficient in
vitamines.
In support of this explanation he brings forward evidence to show
that the amount of vitamines in the milk varies with the amount of vitam-
ines in the food of the cows. An example of the influence of the food of
the cows upon the amount of vitamines in the milk, is the fact that their
milk contains less vitamines in the winter, when they are eating dry food,
than in the summer, when they are eating green food. The development
of scurvy in infants at the breast may be explained in a similar way. He
ARTIFICIAL FEEDING OF INFANTS
499
calls attention to the fact, moreover, that the vitamines are diminished in
the milk of women who are underfed.
Many objections can be raised to Funk's arguments, and it may be
urged that his premises are incorrect and his conclusions consequently
not justified. Still, his proposition that scurvy is caused by the diminu-
tion or absence of certain essential vital elements, or vitamines in the food,
reconciles and explains the clinical facts and experimental evidence as to
the etiology of this disease better than any other which has been advanced.
Condensed Milk This type of milk is frequently used as food for
young children during an emergency, as in traveling or before the breast
milk has been fully established. It is prepared by evaporating cow's
milk about one-fourth in volume and adding cane sugar as a preservative;
this is added five to six ounces of sugar to the pint. The composition of
condensed milk is shown by Holt in the following table:
TABLE SHOWING COMPOSITION OF CONDENSED MILK
Con-
densed
Milk 1
With
6 parts of
Water
Added
With
12 parts of
Water
With
18 parts of
Water
Fat
per cent
6.94
per cent
0.99
per cent
0.53
per cent
0.36
Proteins
8.43
1.20
0.65
0.44
(Cane. 40.441
oi]r;ir i .n * ^ r*~ t . .
50.69
7.23
3.90
2.67
[Milk, 10.25 j
Salts
1.39
0.17
0.10
0.07
Water
31.30
90.49
94.82
96.46
i Analysis of Borden's Eagle Brand of Condensed Milk made by E. E. Smith, Ph.D.,
M.D.
An examination of the percentages given in this table shows that con-
densed milk is not a proper food for young or older infants, inasmuch as
it does not contain the proper balance of food contents, fats, protein and
sugar. It is deficient in fats and proteins and too rich in sugar. Infants
fed on condensed milk must sooner or later suffer from some form of
nutritional disturbance. Condensed milk is a very dangerous food if
long continued, as it is prone to give parents a false sense of security; it
makes fat babies, but they are flabby and anemic. Infants fed on con-
densed milk have weak powers of resistance, they are likely to chill easily,
suffer from bronchitis, and drift into rickets. We consider the early
and prolonged use of condensed milk as the most prolific means of adenoid
500 REQUIREMENTS OF INFANT FEEDING
formation by devitalizing the mucous membrane of the nasopharynx. As
a proof of this, the teeth are generally defective and erupt late and slowly,
the bony skeleton is more slowly and generally imperfectly developed.
Although condensed milk long continued almost invariably produces more
or less serious malnutrition in some form, it is a very valuable temporary
food for infants under certain conditions. Its advantages are quickly
recognized by the poor mother in crowded hot cities. It is cheap, easily
digested, sterile, easily prepared, and easily manipulated. It appeals,
therefore, to the poor who cannot afford to buy clean cow's milk.
Thousands of infants in our larger cities are carried through the
summer months on condensed milk, who would have died from some gas-
tro-enteric trouble if their mothers had been compelled to feed them upon
such cow's milk as they could procure, and these rachitic malnourished
infants, who have passed through the crisis of their existence on condensed
milk, may with the approach of the cooler weather, gradually overcome
this malnutrition by the addition of more wholesome food to their diet.
The difficulty of changing the diet of an infant kept on condensed milk to
properly adapted cow's milk is found in the fact that the infant's digestive
tube has not been properly unfolded, or more properly speaking, devel-
oped, and the substitution of cow's milk involves the danger of adding
gastro-intestinal injury to malnutrition. Great care is necessary on the
physician's part in adding very gradually the correctly adapted cow's
milk to the condensed milk feedings.
Buttermilk. Buttermilk has been used as an infant food for many
years. It had its origin in Holland, where many of the leading physi-
cians depend on it and obtain remarkable results. It deserves more
attention in America than it has received. In recent years, the experience
of able physicians the country over has demonstrated that it may become
a valuable substitute for cow's milk in infants suffering from various
forms of gastro-intestinal troubles. The buttermilk used in infant feed-
ing is usually made from cream or milk that has soured naturally. The
souring process in the milk, however, may be started by inoculation with
sour milk, or with lactic acid bacilli from a culture. The last is not usual
for the physician.
Unfortunately, the composition of buttermilk is so variable that results
are uncertain. The average, however, contains about one per cent of fat,
four per cent sugar, and three per cent of proteins. It, therefore, should
have a food value of about 400 calories to the quart. Physicians differ
somewhat in their methods in its preparation for infant feeding. It is
usually prepared as follows: to one quart of buttermilk are added two
ARTIFICIAL FEEDING OF INFANTS 501
level tablespoonfuls of wheat flour and one level tablespoonful of cane
sugar. This mixture is, with constant vigorous stirring, slowly brought
to the boiling point and kept there for twenty minutes, and then allowed
to cool. The constant stirring prevents the coagulation of casein.
Buttermilk prepared in this way has the same percentage of fat and
protein as above given, but the carbohydrates have been increased to ten
per cent, and the food value of the mixture has been increased to 600
calories per quart. This buttermilk mixture, when considered from the
standpoint of infants, contains a low percentage of fats and a compara-
tively high percentage of proteins and a very high percentage of carbo-
hydrates. The casein is very finely divided, separated from its calcium
base, and appears in the form of the lactate of casein which cannot be
acted upon by rennet, but which is readily digested by the intestinal fer-
ments. The acidity varies in the neighborhood of 0.5 per cent.
The chief value of buttermilk, therefore, is the larger quantity of
easily digested casein which it contains, the small amount of fat, and the
large quantity of easily digested carbohydrates, which substitute the fat
in serving the nutritional demands of the body.
Buttermilk, notwithstanding the fact that it may be used in the feed-
ing of well infants for some months at a time without apparently produc-
ing nutritional disturbances, is an ill-balanced food mixture, not capable
of satisfying the full nutritional demands of the rapidly growing infant*
It can only be used, therefore, as a food for normal infants when properly
modified cow's milk cannot be obtained.
The ideal field of usefulness for buttermilk is found in that class of
infants deprived of the maternal breast in whom the improper adapta-
tion of cow's milk has produced some form of food injury, a gastro-intes-
tinal disturbance, and who are, therefore, temporarily, unable to digest
cow's milk. I have used it in beginning atrophy and acute gastro-
intestinal indigestion. It goes without saying that this buttermilk
formula may be so modified by the addition of sterile water as to suit the
age and digestive capacity of the infant,
Peptonized Milk In the artificial feeding of premature or malnour-
ished infants, the milk used (cow's milk) may be partially or wholly
peptonized. In the management of this class of infants there frequently
arises a period where wholly peptonized milk is necessary. This period,
however, must not be prolonged or we fail in developing the infant's
digestive capacity. The moment we find the infant is gaining daily it
is our duty to lessen the length of time the milk is peptonized. With this
fact firmly in our minds, we may use with great advantage partially or
132
502 REQUIREMENTS OF INFANT FEEDING
wholly peptonized milk in feeble or immature infants until we gain con-
trol of the digestive tube, for by so doing we not only save the child from
atrophy, but we may also prevent its drifting into rickets. The rule,
therefore, in using a peptonized milk formula is to administer it until
the infant's stomach has regained sufficient power to assimilate the proper
cow's milk adaptation. The infant's stomach not only requires proper
food, but it also requires the chance to digest milk, which is its proper
function. If we fail to unfold the digestive function by withholding
proper food, we seriously handicap the infant's progress. Peptonizing
tubes are on the market rendering the procedure very convenient for the
physician and the mother, one tube containing enough for a pint of milk
usually associated with a little bicarbonate of soda to prevent
coagulation.
The milk is peptonized at a temperature of 110F. for ten to fifteen
minutes, when it is immediately placed on ice to arrest the further pep-
tonization. Care must be exercised not to push the process too far or the
milk will acquire a bitter taste and the child will refuse to take it. Cane
sugar can be added if necessary to overcome the bitter taste. I have
found in my work that keeping the milk at a temperature of 110F. for
six to ten minutes is usually sufficient. This is a decided advantage for
the infant in many ways and is much better when we commence to with-
draw the peptonized milk.
Sterilized Milk Sterilized milk is still used by a very large propor-
tion of the city's poor. With all the combined efforts of health boards
and medical societies it has been found impossible to furnish clean whole
milk at a price within the reach of the poor. The "certified" and
"inspected" milk, owing to its prohibitive price, can be utilized in the
feeding of only a comparatively small percentage of the infant popula-
tion of our larger cities. For this reason, sterilization and pasteurization
of milk still remain most important life-saving measures in the feeding
of infants during the summer months; it is the only reasonable method,
when, by reason of the heat, milk contamination increases rapidly. It is
well for us to remember that we cannot sterilize unclean milk, milk con-
taining large numbers of micro-organisms, without impairment of its
nutritive value. Milk which has undergone fermentative changes and
which may produce poisonous irritating bodies, is a dangerous food for
infants. Milk thus exposed and contaminated cannot be made wholesome
by sterilization. If we wish to sterilize as a means of preventing bacterial
contamination, it is necessary to start with the cleanest milk that is
obtainable.
ARTIFICIAL FEEDING OF INFANTS 503
Cow's milk is sterilized by heating to 212 F. for twenty minutes.
This is what is usually known as sterilized milk; the heat destroys the
vitamines and all the developed bacteria, but does not destroy the spores ;
thus the milk is not actually sterile, for the spores after a time develop
into bacteria. The sporulated bacteria are not of sufficient importance
to justify the additional application of heat. Sterilization of milk is best
accomplished by placing the milk bottles in boiling water for twenty min-
utes, boiling hard and filling the tops with sterile cotton and then placing
on ice for use. The Arnold Stearns Sterilizer is a convenience and of
great practical value for the poor of large cities. It is cheap and its
simplicity is apparent to all.
ADVANTAGES OF STERILIZED MILK.- The advantages derived from
sterilized milk must be mentioned. There is a loss of acidity on the
part of the milk which causes a retardation in the rennin coagulation and
thereby causes the casein to be precipitated in finer flakes, so that it is
more readily acted upon by digestive ferments ; large casein curds never
form in sterilized milk. The fermentative processes are stopped and the
milk is not further contaminated by bacteria. This is the important
object of the work and greatly reduces the dangers of milk poisoning.
Sterilization is a cheap method of preserving milk and is practically the
only way for the poor to keep milk wholesome for their children. The
poor can neither keep nor handle clean raw milk; they cannot afford to
do so, even if they knew how. Sterilized milk is better than the patent
foods or condensed milk for the very poor. If the infant is capable of
digesting sterilized milk, this serves nutritional purposes much better
than the proprietary foods.
DISADVANTAGES OF STERILIZED MILK. The disadvantages of steri-
lized milk, unfortunately, are many. The decomposition of nuclein, a sep-
aration of the phosphorus from its organic union ; partial destruction of
the fat emulsion; increased difficulty in the digestion of casein; partial
separation of the lime salts from the combination with calcium, which
renders them less easily absorbed ; complete destruction of ferments,
alexins, agglutinins and other vital principles in the milk. The loss of
vital principle (vitamines) is the most important. The radical change
in the milk, converting a living vital element into a dead product means
a great nutritional loss to the infant. Sterilized milk being hard to
digest constipates the infant, who as a result frequently faces intestinal
intoxication with all its constitutional depreciation.
Pasteurized Milk Physicians actively engaged in infant feeding soon
realized the defects of sterilized milk and began to try milk treated at a
504 REQUIREMENTS OF INFANT FEEDING
lower temperature. This was done with the hope of destroying the
bacteria without producing important chemical and biological changes in
the milk. Koplik first suggested heating the milk and Monti recom-
mended a temperature of 180F. ; Freeman has insisted on a still lower
temperature and his apparatus has done much to popularize the method.
This process aims at killing the greater part of the developed bacteria
without producing serious chemical or biological changes in the milk.
The procedure is called pasteurization to distinguish it from sterilization.
Pasteurized milk is very generally used in this country, especially in our
larger cities during the summer months, and when properly used becomes
a most important means of saving young infants.
Freeman's conclusions on the subject are as follows : "Milk for infant
feeding should be pasteurized so as not to interfere with its biological
properties or chemical composition, but at a sufficient temperature to
destroy the bulk of the bacteria present, including the tubercle bacilli.
A temperature of 140F. continued for forty minutes would seem to fulfil
these indications." Freeman also says the question concerning the effect
of heat on ferments has been carefully worked out by Hippins. The salol-
splitting ferment found only in mother's milk was weakened by a tem-
perature of 131F. and destroyed at 149F., while the amylolytic fer-
ment found only in mother's milk was weakened by a temperature of
158 F. and destroyed at 167F.
It seems evident, therefore, that the careful pasteurization of milk'
may serve the purpose of checking the fermentation process without
materially changing its chemical composition or biological properties.
Clinical experience strengthens this opinion, for milk pasteurized at low
temperature may be fed for a long time with practically the same results
as are obtained from fresh clean raw milk. The preparation of pasteur-
ized milk, however, requires time, care and intelligence ; moreover, a sub-
sequent refrigerator temperature is necessary in order to prevent bacterial
contamination. The method is, therefore, not commonly available for use
among the poor of our large cities. It has, however, a large field of 1 use-
fulness among those city dwellers who have the time and intelligence to
prepare pasteurized milk and the facilities to care for it after its prepar-
ation, as in our large cities even the best available milk is rendered safer
during the hot summer months by pasteurization.
Proprietary or Patent Foods. The market is full of convenient foods
to feed the baby when the maternal breast fails to furnish the natural
supply. These foods are attractively placed before the public and are
convenient to use, hence young mothers are readily induced to resort to
ARTIFICIAL FEEDING OF INFANTS 505
them without proper regard to their real value. All these foods possess
some nutritive properties, and may prove useful in an emergency. It is
well, however, to remember that infant foods, to be of any value, must
possess fats, sugar and protein in certain definite proportions, associated
with mineral matters. Any proprietary food that does not contain the
above elements in proper proportions can do but little good. The elements
of infant food are easily procured and can be obtained in modified milk.
We do not understand why so many young mothers under the close obser-
vance of their physician are allowed to resort to many of the proprietary
foods. Inasmuch as they all possess some value while lacking some of the
essential elements, it is not desirable to encourage their use, unless it is
to bridge over a passing difficulty. A very brief outline of a few of these
foods seems desirable.
NESTLE'S FOOD. Xestle's Food is one of the most convenient and
easily digested of the proprietary foods. It is found to be a convenient
and valuable substitute for cow's milk in infants suffering from gastro-
intestinal troubles, especially during the hot weather, yet if long contin-
ued, it is disastrous in its results. Its indefinite employment will most
certainly produce rickets or scorbutus. Chittenden's analysis of Nestle's
Food prepared for infants of six months, shows that this food prepared for
this age contains only 0.81 per cent of albuminoids and 0.36 per cent fat.
This marked deficiency in fat and protein renders it quite unfit to serve
the nutritional demands of the infant for any length of time.
When it is found necessary to use Nestle's Food it should only be
allowed until acute symptoms have been controlled, after which small
quantities of cow's milk should be added, and as the child continues to
convalesce, additions of milk should Ix- gradually made and Nestle's Food
mixture likewise diminished, until a modified milk formula replaces the
proprietary food. If, however, it be found necessary for some time to
continue Nestle's Food, or any other patent food, by reason of digestive
weakness, the infant should be given supplemental foods in form of
orange juice, pineapple juice, or that which is more valuable, beef juice.
This addition to a w r eak infant's diet very frequently prevents scorbutus
or rickets which frequently follow in the wake of ill-balanced feeding.
MALTED MILK. Malted milk is a proprietary milk food which, like
condensed milk and all the proprietary foods, is very poor in fat and
protein. It is unsuitable as an exclusive food for infants. It is safe,
however, for a brief period as a substitute for milk in traveling or when,
for any other reason, cow's milk is not obtainable. It is, like condensed
milk, very extensively used among the poor of our cities, because it is
506 REQUIREMENTS OF INFANT FEEDING
easily digested, easily prepared, and serves the purpose of tiding the
infant over the hot summer months.
Home Modifications or Adaptation of Milk This is seemingly a most
difficult topic to adjust in many physicians' minds, and the study of the
subject must be based upon the elements of nutrition themselves. A few
essentials from Cheadle, written nearly thirty years ago, may be of value
in crystallizing in our minds the principles of cow's milk feeding as out-
lined in the preceding pages.
(a) The food must contain the different elements in about the same
proportions as found in human milk, viz., proteins, one to two per cent ;
fats, three to four per cent; carbohydrates, six to seven per cent; salts,
two-tenths per cent ; water, eighty-eight per cent. This represents theoret-
ically the ideal food for a balanced nutrition. The chemist can readily
produce a mixture which duplicates breast milk in the nutritive value
of its constituents and even resembles somewhat closely that emulsion in
its physical appearance, but the dismal array of failures to reproduce
mother's milk by a synthetic arrangement of apparently similar constitu-
ents obtained from other sources, is an emphatic reminder of the limita-
tions of both chemical and physiological knowledge.
(b) It should not be purely vegetable, but must contain a large pro-
portion of animal matter. Most vegetable substances are deficient in
available proteins and yield but a small quantity of fat. Moreover, it is
known that the infant does not assimilate them as easily and fully as
those derived from animal sources, even though these ingredients be sup-
plied in the proper percentage.
(c) It must be in a form suitable to infantile digestion. The digest-
ive organs have only recently assumed their function, and are designed to
deal solely with the bland, dilute, and easily dissolved nutriment of
mother's milk. In the natural method of feeding the infant gets nis
nourishment in the same form at every meal ; so in artificial feeding,
variety is not desirable. It is presumed that infants under six months
are unable to digest much starch from the paucity of ptyalin and amy-
lopsin ; hence, for this age any great amount of starch in a food is enough
to condemn it. As the walls of the stomach are lacking in muscular power
and the secretions are feeble, it is evident that this organ is unable to
deal with large masses of solid matter. Solids can be digested only in a
state of minute subdivision.
(d) The total quantity in twenty-four hours must represent the equiv-
alent, in nutritive value, of from one to three pints of human milk,
according to the infant's age. No fixed rule can be given for all children.
AETIFICIAL FEEDING OF INFANTS 507
Careful observation of the infant as to whether he rejects some of his
food soon after ingestion, or seems hungry half an hour after feeding,
may serve as a guide. The best indication that he is receiving his full*
equivalent is a steady weekly gain of from two to five ounces or more
in the early months.
(e) It must possess the antiscorbutic property. It is not yet known
in what this consists, but it is known that infants at the breast very rarely
suffer from scurvy, and that the disease is found among those fed upon
condensed or sterilized milk, or upon desiccated milk preparations.
Prompt recovery, with food unchanged (except the discontinuance of
sterilization), has been reported by several observers. Fresh milk, there-
fore, possesses, in addition to the important principles, this antiscorbutic
element (vitamines), but not in large proportion, for milk in extreme
dilution will not prevent the development of this disease.
(f) It must be fresh, clean and free from excessive bacterial content.
It is true that hydrochloric acid has antiseptic properties, but the stom-
ach secretes only a limited quantity of it during the first half year.
Hence, infants are extremely susceptible to gastro-enteric disorders, hav-
ing little resistance to bacterial invasion. The deadly toxins which
develop in old milk may resist all efforts at sterilization.
(g) Another essential, voiced by Chapin, may well be added, viz., in
feeding young animals it is not only necessary to supply the proper quan-
tities of nutritional elements, but they must be in such form as normally
to develop the digestive tract.
This writer calls attention to the physical and chemical differences in
the milk of various mammals, and shows that each is especially adapted
not only to the nutrition but to the digestive development of its particular
young as, for instance, the bovine calf, which, doubling its birth weight
in forty-seven days, attains pubescence in one year with a ruminant
digestive tract twenty times the body length that must be fitted quickly
to obtain food elements from coarse herbage. The calf needs a dense,
quickly curdling, rich protein milk for early development of both muscular
and secretory functions in his stomach, which constitutes seventy per cent
of the digestive tract. The human infant, on the other hand, who doubles
weight in one hundred and sixty days and attains puberty in fourteen
years, finds only in his mother's milk the ingredients suitable for the de-
velopment of the digestive tract, which is only six times his body length,
and of which only twenty per cent is stomach. Hence, the early feeble
gastric digestion must be slowly cultivated by gradually increasing density
of the flocculent curds characteristic of human milk alone.
508 REQUIREMENTS OF INFANT FEEDING
PROPRIETARY FOOD PERCENTAGES
NAME OF FOOD
PERCENTAGES
SOURCE OF ANALYSIS
Fat
Sugar
Pro-
tein
Starch
Ash
Condensed Milk, Eagle Brand
Condensed Milk, St. Charles.
Ramogen
Mammala
9.61 54.94
8.70 10.95
16.50 34.65
12.12 55.34
8.78 67.95
0.16 79.57
93.00
17.00 55.00
18.60 66.55
15.88 70.90
1.05 25.11
3.52 55.82
5.50 58.93
0.26 7.80
0.92 3.34
1.04 1.80
1.00
Cane 42.91
Milk 12.03
8.01
8.80
1.78
1.40
1.50
4.93
3.86
4.30
2.00
4.00
3.95
3.71
0.60
0.99
Own advertisement
Jordon & Mott, Am:
Jour. Public Hygiene,
1910, xx, 391
Own advertisement
Mellin's Food Co.
Own advertisement
Own advertisement
Own advertisement 1
Own analysis
Own advertisements, ex-
cept proportions of
sugars. These given
approximately from
analyses made by
Mellin's Food Co.
Own analysis
Own advertisement
Own analysis 2
Own analysis 3
Holt, Diseases of 4 In-
fancy and Childhood,
1911, p. 162
Bulletin No. 28, U. S.
Dept. of Agric.
Milk
Cane 20.91
Milk 13.74
7.00
16.35
Milk 24.35
Milk 49.15
Malt .
Horlick's Malted Milk
Mellin's Food
Dextrose.... 18.80
Malt 58 88
10.35
Mead's Dextri-Maltose:
No. 1
Dextrins.. .20.69
Malt. . . .52.00
18.00
Dextrins.. .41.00
Milk 25.00
Malt 25.00
Laibose
Allenbury's Foods:
No. 1 Milk
Dextrins. . . 5.00
Milk 42.00
10.66
Malt . 14 00
No. 2 Milk
No. 3 Malted
Dextrins... 10.00
Milk 36.00
Malt. . . 20.00
9.90
10.23
6.70
60.01
29.90
Dextrins.... 13.00
Malt. . . 16.50
Eskay's Albuminized Food . . .
Nestle's Food
Dextrins.. . 8.50
Milk 54.12
Dextrins. . . 1.70
Milk 6.57
Cane . . 25.00
Ridge's Food
Benger's Food
Malt
14.34
12.50
12.12
14.00
11.40
15.39
73.67
77.02
73.54
75. 10 5
2.03
0.61
0.97
0.39
0.50
Dextrins.. .27.36
Milk
Largely dextrins
and sugars. . . .
Dextrose... 0.42
Dextrins 1.38
Imperial Granum
Wheat Flour
1 Proprietors state that this analysis is only approximate, that the percentages of
maltose and dextrin vary from 1 per cent to 2 per cent and that many samples show
traces of protein and fat. "No. 2" is the same as "No. 1," except that it does not
contain the 2 per cent of salt.
2 Proprietors wish to emphasize the fact that the directions call for boiling, which
"gelatinizes the starch in the form of colloids."
s Proprietors wish to call attention to the fact that the food contains active amy-
lolytic and tryptic ferments which, when the food is prepared according to the direc-
tions, "convert the starch into subtle sugars and modify the casein."
4 Proprietors wish to direct attention to the fact that Imperial Granum is intended
to be used with milk.
s Total carbohydrates.
It has been stated that the substitute feeding of infants is a broad
subject. If the breadth of this subject is indicated by the number and
apparent variety of infant foods on the market, a student may well quail
before it. To the query why such a large number of foods and prepara-
tions, the reply has been made that commercial enterprise is responsible
for this, as it is also for the innumerable foods and preparations for adult
ARTIFICIAL ' FEEDING OF INFANTS 509
use ; also that manufacturing ingenuity is stimulated to furnish presumed
nutriment in a great variety of forms by the whims, caprices, and tastes
of individual appetites.
A list of proprietary foods (see opposite page) is briefly outlined as
given by Morse and Talbot, with short criticisms of a few of the more
popular brands.
^lan is an animal with educated or perverted tastes which result in
a demand for variety in his viands. The adult is capable, also, of deter-
mining, to some extent, the nutriment derived therefrom. At any rate,
he may recognize some of the more immediate effects following the inges-
tion of different foods. The infant, on the other hand, is but slightly
conscious of food effects, either immediate or remote. Rarely in early
life has he tastes, either acquired or perverted. Instinctively he craves
nourishment, and is almost invariably satisfied with that furnished nor-
mally by the breast. Variety in form or flavor is neither desired nor
desirable. Reference to the essentials above enumerated will show that
uniformity of food, containing the five constituents, is what the infant
requires and with which he is satisfied. The great variety of baby foods
on the market is partly the result of prejudice and ignorance.
The average mother's withdrawing her breast from the infant is
likened to a vessel at anchor in a safe roadbed, slipping the cable in the
absence of the pilot, chart or compass. The baby knows not what he
needs, the mother knows little more ; but she can read, and the claims of
the enterprising food agents attract her attention. Too often physicians,
also, derive their supposed knowledge of infant dietetics from the same
source.
The Clinical Application of Artificial Feeding It is well to keep in
mind the six rules of Dr. Cotton if we would have the infant develop
physiologically.
(a) That the long-continued use of food deficient in fat and lecithin tends to
the production of malnutrition and rickets.
(&) Deficiency in soluble proteins retards all development. It is slow
starvation.
(c) The use of cooked foods may result in scorbutus, hence even sterilized
milk should not be administered continuously.
(d) Food which would not meet the requirements of nutrition for a long-
continued period, because deficient in some essential constituent, may be used
temporarily, as in traveling, weaning, or temporary removal from breast.
(e) Gastric digestion must be developed by some substance which furnishes
soft coagula, for which purpose nothing is known to equal milk.
(/) It is not sufficient merely to correct dyspepsia, the infant must be
nourished and show a gain in weight and strength.
510
REQUIREMENTS OF INFANT FEEDING
With the essential elements of cow's milk well understood and not
forgetting Dr. Cotton's six rules for artificial feeding, we must remember
that success in infant feeding depends, not upon the particular method
used, but upon the intelligence, the experience and the knowledge of the
working principles of infant feeding which the physician possesses.
Every infant is a law unto itself, and the essential law of success is the
discovery of the infant's strength or weakness toward some one of the
various ingredients of the milk. Clean milk is, of course, absolutely
necessary to success in infant feeding. Infected or unclean milk cannot
be made safe for feeding even if it is pasteurized. This knowledge is of
more importance than the method of feeding. Cream is more easily con-
taminated than milk, and when over twenty-four hours old unsafe for
infant feeding. If it is found necessary to increase the percentage of
fat in an infant's formula, it should be done by taking it off the top of
clean milk. Healthy common cows are safer than the Alderney or Jersey,
in which the fat percentage is too high and the fat difficult to digest.
Accordingly, the common cow is best for infant feeding.
Overfeeding, not only in calories, but in the number of ounces, is
frequently disastrous to the child, no matter what formula is used. It is
very important to respect the child's capacity; if we do not bring on
digestive disturbances of an acute nature, we will eventually induce a
dilatation of the stomach with chronic indigestion, which years of careful
feeding will fail to overcome. To give an infant all he will take is a
very common practice. We must remember the gastric capacity of
infancy and feed accordingly. I have never given over eight or nine
ounces at one feeding while the child was under one year. If we give
more, we should increase the quality and not the quantity.
PROPER FEEDING INTERVALS FOR INFANTS OF VARIOUS AGES
(MORSE AND TALBOT)
Age
24 hour Amount
Number of Feedings
, Amount and Intervals
1 week
10-12 oz.
10 feedings of 1 oz. at 2 hour intervals
4 weeks
20
8 " 2M
7 " "3
2H " "
o
4 months
32
7u it A i /
4>2
o u
6
36-40
c* # ft / j/
u " 3 " "
f 6 " "8
M Q
9
48
i 5 " 9^
2_^
511
Artificially fed infants, like the breast-fed, should be given their
food at regular intervals. This is important in order to obtain good
results. The intervals may be one, two, three, four or five-hour periods
to suit digestive capacity as well as age and weight of the child. Usually
night feeding can be omitted after the fourth month. The feedings
between 6 A.M. and 10 P.M. must be observed with the strictest regu-
larity. When the child is about eight months old four feedings in the
twenty-four hours are enough, beginning at 6 or 7 A.M. and finishing at
6 or 7 P.M.
While the infant is taking his food, he should be quiet, free from light
and excitement. Food given while the child is surrounded by noise^ light,
and various members of the family, creates irritability and disturbs diges-
tion, laying the foundation for many ills later in life. Infants should be
taught to lie quietly and their surroundings should be quiet to secure pro-
found sleep. The rapidly growing nervous system of the infant is easily
excited by an outside factor, exerting an unfavorable influence on the
digestive organs.
Good air is as important to the infant as clean milk, and as early as
the first week in summer, provided the weather permits, the child should
sleep out of doors during the day. During winter the first outings should
consist in widely opening all windows. By the time the child is two
months old, most of the sleeping during favorable weather should be in
the open. Undue light and drafts can be controlled by the proper adjust-
ment of couch, carriage or hammock.
The infant's food should contain the necessary elements, fat, protein
and sugar, in reasonably accurate percentages in order to maintain good
health. If fever occurs, as a result of improper food or feeding, or by
reason of any acute infection, then the withdrawal of the milk-formula
is necessary. As Jacobi well states, "Milk is food for infants when well,
but food for bacteria when sick." After an illness has subsided, the
gradual return of the whole formula is necessary not omitting protein
and fats, as so many do. Barley water, orange juice, or plain water will
tide an infant over an illness lasting one week or more before milk can
be resumed with safety.
It is a well-known fact that the fat of cow's milk is not easy to digest.
It is necessary to remember this and to place the percentages of fat in
modified milk-mixtures for young infants much lower than found in
human milk. The excess of fat which is usually used too freely, is one
of the most common causes of indigestion in young infants. When the
child is restless, colicky, and has loose stools, the first correction in the
512 REQUIREMENTS OF INFANT FEEDING
food formula to be made in the trial change should be a reduction of fat
and a corresponding increase in calories, namely sugar. The further
indications for this change in the food formula are, viz., (a) if the infant
regurgitates its food; (&) or is constipated, with gray dry stools, and
(c) if it voids irritating urine which stains the napkin with uric acid
constituents.
The management of the casein of cow's milk usually causes the least
trouble in our milk formula. Cow's milk casein may, however, be a cause
of indigestion. After a reduction of the fat has failed to improve condi-
tions, we are called upon to prevent the coagulation of casein in the
stomach by adding a diluent or some alkali that will 'split up the coagu-
lated casein. Sodium citrate in solution, a grain to one grain and a half
for each ounce of food, is sufficient. Barley water may have to be used
as a diluent, or it may prove necessary to boil the milk. Sodium citrate
in solution is perfectly reliable and long experience has proven its value.
If, however, these measures fail and casein indigestion continues, we
may reduce the casein content of our food formula and make up the
deficiency by the addition of whey proteins. When this trouble is cor-
rected, we can slowly increase the fat and proteins to the original formula.
Casein indigestion is revealed by large tough curds, loose alkaline stools,
fever, and irritability ; the latter will be found a constitutional symptom.
The sugars are the most easily digested of the food ingredients of the
modified milk mixtures, and for this reason are frequently increased at
the expense of the fat and protein. For this reason we frequently find
sugar intoxication in young infants. These cases are associated with a
watery acid diarrhea, producing irritation of the buttocks. Fever, general
constitutional symptoms, much gas formation and intestinal catarrh are
usually present. When these symptoms occur, it is necessary to withdraw
the sugar entirely, or what is possibly the best procedure, to substitute
another sugar. Theoretically, milk sugar should be the first choice, but
practical experience has demonstrated that cane sugar is better than
milk sugar and that malt sugar is superior to both, so we use malt sugar
in all of our artificially fed children.
HOME MODIFICATION OF COW'S MILK In feeding infants in the
home under the physician's care, some modification or adjustment of
cow's milk must be made to suit the individual infant this is called
''home modification" and does not refer to any exact changes to be made
in the milk, except rendering it more suitable to the baby's digestive
capacity and nutritional demands. Every physician of experience has
worked out, for himself, a plan for modifying milk, which his clinical
ARTIFICIAL FEEDING OF INFANTS
513
experience has taught him will serve his purpose better than any other
that he has been able to find, and nearly every writer offers his own
formula for home modification of milk by which a certain degree of
accuracy in percentage feeding may be obtained. This is a true state-
ment, and is proof that there is no single method superior to all others.
The infant is a changeable factor, as much as the milk ingredients
and the infant must be modified as well as the milk.
The prime object of these methods is to give the physician certain
rules so he may arrange milk formulas containing definite percentages of
protein, fat, sugar and salts. Nearly all existing methods of feeding are
more or less complicated in the sense that they strive to give very exact
percentages of protein, fat and sugar, in the idea that the exact percentage
is necessary to success in feeding. This is not true for the formula, nor
is it true for the infant. Very few physicians work out the exact per-
centage, nor is it necessary. While there can be no objection to accurate
percentages in infant feeding, yet the experience of the world has demon-
strated that these accurate percentages are not absolutely necessary to suc-
cess, and that on the whole, infants thrive just as well upon a milk
mixture which is intelligently modified so as to contain protein, fat, sugar,
and salts in fairly definite percentages, and in such quantities that the
infant will not suffer from starvation in any one of these important
ingredients. By reason of the many complicated methods given in our
text-books, most physicians resort to the use of whole milk and a diluent
in the form of some malted sugar food. These simple mixtures appeal to
the young mother and the result is that most of our infants are thug
reared. The following table is taken from Morse and Talbot :
ANALYSIS OF WHOLE MILK VARYING CREAM PERCENTAGES
SKIMMED AND SEPARATED MILKS
Fat
Milk Sugar
Protein
Whole Milk
4.00
4.50
3.50
7% Cream
7.00
4.45
340
10% "
10.00
4.40
3.25
16% "
16.00
4.20
3.05
32% "
32.00
3.20
2.50
Skimmed Milk
1.00
5.00
3.55
Separated "
0.25
5.00
3.65
Whey
0.25
5.00
0.90
While the simplicity of the whole milk method of modifying infant
feeding has made it popular, there is no question that much better results
514 [REQUIREMENTS OF INFANT FEEDING
can be obtained by a method which uses top milk as well as whole milk
in the preparation of infant foods. In this way the fat percentages can
be better adapted to the nutritional demands of the infant.
Feeding may be greatly simplified and its efficacy not materially
diminished by making all food formula from three ingredients, viz.,
1, whole milk, which to simplify computations one may assume contains
4 per cent fat, 4 per cent protein and 4 per cent of sugar; 2, top milk,
containing 7 per cent cream this is obtained by taking the top half of
the milk after it has stood for two hours ; this contains very nearly 7 per
cent fat, 4 per cent protein and 4 per cent sugar ; 3, a carbohydrate solu-
tion made of sugars or starches containing one-half ounce of carbohydrate
to the pint.
In infants under six months of age, because of the great dilution of
the milk, the 7 per cent top milk should be used, so as not to get a too
low percentage of fat. In infants over six months of age whole milk may
be used.
In making modified milk mixtures from these ingredients the physi-
cian should be guided by the principles underlying the artificial feeding
of infants, as pointed out in the earlier portion of this chapter.
In the table it is shown how the ingredients may be combined in the
production of an infant food which will answer all practical purposes.
It possesses the proper number of calories, and contains the important
per cent of protein, fat, sugar and salts in such relative quantities that
the infant will be satisfied. After all, the true test of feeding is the child
itself. If the infant gains in weight, six to eight ounces per week while
under four months ; sleeps well from twelve to fifteen hours in the twenty-
four; doubles its birth-weight at six months and triples it at one year,
we may well feel that the food is meeting all requirements.
Between the sixth and twelfth month the food of the average well
infant should be supplemented by the addition of orange juice, raw egg
albumen, thick cereal gruels, meat juice and meat broths. All this addi-
tional food should precede or follow the bottle, except orange juice, which
should be given at least one hour after the bottle.
Milk should always remain the chief food of the infant and can be
continued until the third year, or until the child has been taught
to chew thoroughly the food suitable for its age.
After nursing, any food remaining in the bottle must be thrown away.
Flies should never be allowed to touch the baby, food, or utensils. It
should be understood that the mother or nurse will never touch the nipple
with their lips.
AETIFICIAL FEEDING OF INFANTS 515
The temperature of the milk may be tested before giving it to the
baby by allowing a few drops to fall on the back of 'the hand.
The bottle must be held inverted by the mother or nurse during the
feeding, so that the child will not suck air.
If the milk flows too freely, ofttimes a most perplexing problem in
artificial feeding, the nipple needs changing, or possibly, a light gauze
packing is required.
The time required to take six to eight ounces of food should not
exceed iwenty-five minutes of continuous nursing. This is necessary to
develop the salivary glands and promote good digestion.
Regularity is of prime importance. The number and length of inter-
vals should be about the same as those given for infants at the breast.
Water is of vital necessity and must be given at least three times a
day ; this is best done from a bottle, two to three ounces at a time. I am
in the habit of ordering a small quantity of sugar or soda mint, or both,
in the bottle. This is of value if the child is constipated.
It is a good rule to start with formulas of low percentages in com-
mencing artificial feeding in normal babies. This is true of fats and
proteins. Taking the mother's milk as a standard, the percentage of sugar
and protein may be about the same, but the fats should be about one-half,
remembering that temporary error on the side of underfeeding is much
easier of correction than the more common mistake of overfeeding.
The final rule is to keep the child in a cool, quiet, and dark room
where all external irritations are reduced to a minimum.
Summary of Rules to Be Observed in Artificial Feeding
The aseptic care of the bottles, nipples and utensils, including the
person of the nurse or mother, cannot be over-emphasized. This rule is
as important as clean milk, and without clean milk the first and most
important link in the chain is broken. The once familiar death-trap
known as the long-tube nursing bottle, still frequently seen in children's
dispensaries, has at last attracted the attention of legislators, so that in
many localities not only the use, but even the sale is prohibited by law.
In the home modification of milk the mother or nurse must be care-
fully instructed by the attending physician in regard to all details. All
the necessary utensils should be on hand for the proper and scientific
preparation of the baby's aliment. These include a good medium sized
ice box, two siphons, sterilizer, or pasteurizer, thermometer registering
to 212 F., a dozen graduated feeding tubes or bottles (large mouth with-
out shoulder with small lip), bottle brushes f absorbent cotton, straining
516 REQUIREMENTS OF INFANT FEEDING
gauze, non-absorbent cotton for use as stoppers, mixing pitcher, glass
funnel, tall cup for warming bottle, six black rubber nipples (reversible
for cleaning), package of bicarbonate of soda and boric acid.
Lime water should be kept in a well-corked bottle. The sugar (malt
or cane) solution should be prepared fresh for each day's use.
The supply of food should be prepared once or twice in the twenty-
four hours, dependent upon the time of the milk delivery, and the number
of tubes to be used. The milk should always be kept on ice before and
after preparation.
All bottles and utensils should be washed with hot soap-suds, then
boiled and rinsed. The feeding tubes, after boiling, should be filled with
hot boric acid or soda solution and left covered until used again. The
tubes, when filled, should be stoppered with non-absorbent cotton so that
in cooling the air may pass through. After warming to about 100 F.
by standing the bottle in a cup of hot water, the cotton in the bottle is
replaced by the nipple. The nipples must be boiled daily and then kept
dry in a closed box.
REFERENCES
1. DAVIS. Am. J. Dis. Child., 1913, vol. v, p. 234.
2. HOLT. J. Am. Med. Assn., 1908, vol. li.
3. KOPLIK, HENRY. Ibid., 1912, vol. Iviii, p. 75.
4. PRITCHARD, ERIC. Infant Nutrition and Management, 1914.
5. GRAHAM. J. Am. Med. Assn., 1908, vol. liv, p. 1045.
6. HOLT. Ibid., 1910, vol. liv, p. 682.
7. DAVIS, A. J. Dis. of Child., 1913, vol. v, p. 234.
8. LTTLING. These de Paris, 1900.
9. ARMSTRONG. British J. Dis. of Child., 1904, vol. i, p. 115.
10. ESCHERICH. Fortschr. d. Med., 1885, vol. iii, p. 231.
COHN and NEWMAN. Virchow's Arch. f. path. Anat, 1891, vol.
cxxvi, p. 391.
PALLESKE. Virchow's Arch., 1892, vol. cxxx, p. 185.
HONIGMANN. Ztschr. of Hyg. u. Infect., 1893, vol. xiv, p. 207.
RINGEL. Munch, med. Wchnschr., 1893, vol. xl, p. 513.
GENOND. Sur la presence du staphlocoque dans le lait des aecou-
chees bien portantes. These de Lyon, 1894.
KNOCHENSTIERN. Hyg. Rundschau, 1894, vol. iv, p. 231.
HALLEUR. Inaug. Diss., Leipzig, 1893.
BRUMM. Arch. f. Gynaekol., 1886, vol. xxvii, p. 461.
REFERENCES 517
MERIT. These de Paris, 1887.
JOHANNESSEN. Jalirb. f. Kinderh., 1895, vol. xxxix, p. 398.
ROEPER. Inaug. Diss., Marburg, 1896.
KOESTLIN. Arch. f. Gynaekol., 1897, vol. liii, p. 201.
11. UHLENTEUTH and MULZER. Med. Wcbnschr., 1913, vol. xxxix,
No. 19.
12. LAWRENCE. Boston Med. and Surg. J., 1909, vol. clxi, p. 152.
13. MORO. Jahrb. f. Kinderh., vol. lii, p. 542.
14. ENGEL. Sommerfield's Handbuch der Milchkunde, Wiesbaden,
1909, p. 774, Konig, Note 9.
15. CRAMER. Klinische Beitrage zur Frage der Kiinstlichen Ernah-
rnng des Neugeborenen, Inaug. Diss., Breslau, 1896 ; taken from
Czerny and Keller, Des Kindes Ernahrung, Ernahrungs-
storungen und Erniihrimgstherapie, Leipzig u. Wien, 1906, vol.
i, p. 356.
16. CZERNY and KELLER. Ibid., p. 353.
17. . Ibid., p. 458.
18. RIETSCHAL. Jahrb. f. Kinderh., vol. Ixiv, p. 125.
19. . Loc. cit., p. 407.
20. ENGEL. Sommerfeld's Handbuch der Milchkunde, Wiesbaden,
1909.
21. . Arch. f. Kinderh., 1906, vol. xliii, p. 181.
22. MOLL. Ibid., 1908, vol. xlviii, p. 161.
23. SKVORLZOV. Russki Vratch, vol. ii, p. 1392, Ref. Chem. Abstract,
1913, vol. vii, No. 18.
24. DENIGES. Contribution a 1'etude des lactoses, Paris, 1892.
BOMMARTINI. Rev. gen. du lait., 1896, vol. ii, No. 1.
25. PORCHER. Biochem. Ztschr., 1909-10, vol. xxiii, p. 370.
PATON and CATHCART. J. Physiol., 1911, vol. xliii, p. 179.
26. PFEIFFER. Verh. II. Versamml. d. Gesellsch. f. Kinderh., Wien,
1894, p. 131.
27. SCHLOSSMANN. Arch. f. Kinderh., 1900, vol. xxx, p. 324.
28. LUST. Monatschr. f. Kinderh., 1913, vol. xi, p. 236.
29. SCHAFER and MACKENZIE. Proc. Roy. Soc., London (B), 1911,
vol. Ixxiv, p. 16.
30. HAMMOND. Quart. J. Exper. Physiol., 1913, vol. vi, p. 311.
31. GAVIN. Ibid., 1911, vol. vi, p. 13.
32. MACKENZIE. Ibid., 1911, vol. iv, p. 305.
OTT and SCOTT. Therap. Gazet, 1911, vol. xxxv, p. 689.
33. ASCIINER and GRIGORI. Arch. Gyn., vol. xciv, No. 3.
133
518
34. BASCH. Munch, med. Wchnschr., 1911, vol. Iviii, p. 2261.
35. WOLF. Zentralbl. f. Biochem. u. Biophys., 1913, vol. xiv, p. 224.
36. CHATIN and RENDU. Lyon med., 1912, vol. cxvii, p. 161.
37. MORSE and TALBOT. Diseases of Nutrition and Infant Feeding.
38. CKAMEK. Miinch. med. Wchnschr., 1909, vol. Ivi, p. 1521.
39. BASCH. Ibid., 1911, vol. Iviii, p. 2266.
40. D'EKRICO. La Pediatria, Abstr. in Jahrb. f. Kinderh., 1910, vol.
xxii, p. 504.
41. OPPENHEIMER'S Handbuch der Biochemie, Jena, 1910, vol. iii, p.
403.
42. KONIG, J. Des Menschen Nahrungs- und Genussmittel, 1904, Ber-
lin, vol. ii, p. 598.
43. KIRSCHNER. Handb. d. Milchwirtschaft, Berlin, 1907, pp. 7, 40.
44. BARTHE. Quoted in Maly's Jahres, 1906, p. 230.
45. FLEISCHMANJST. Lehrbuch der Milchwirtschaft, 3rd ed., Leipzig,
1901, p. 57.
46. HAMMARSTEN. Text-book of Phys. Chemistry, New York, 1912.
47. CAMAILLE, C. R. 63, 692.
48. BACKHANS. Quoted in Maly's Jahres, 1906, p. 299.
49. BUNGE. Ztschr. f. Biol., 1874, vol. x, p. 309.
50. ABDERHALDEN. Ueber Sauglings-Ernahrung, Berlin, 1912, p. 55.
51. SOLDNER. Die Landwirthsch. Versuchsstat., 1888, vol. xxv, p. 361 ;
quoted from Voltz in Oppenheimer's Handbuch, vol. iii, i,
' p. 398.
52. RICHMOND. Dairy Chemistry., Phila., 1899.
53. SCHLOSS. Loc. cit., Dairy Chemistry, Phila., 1899.
54. FUNK, CASIMIR. Die Vitamin etc., Wiesbaden, pub. by J. F.
Bergman, 1914.
CHAPTER XVI
SPECIAL DIETS
H. LYONS HUNT, M.D., L.E.C.S. and P. (Edinburgh), L.F.P. and S.
(Glasgow)
Food, and only food, makes blood, and blood, as we know, makes body; so that
our body structure is dependent upon, and only upon, the food we eat.
Vegetable Diet: Vegetable Diet and Energy; Vegetable Diet and Health;
Vegetable versus Animal Protein; Summary.
Meat Diet: The Salisbury Diet; Zymotherapy.
Fruit Diet: Fruit Diet in Disease; Lemon Cure; Grape Cure.
Tufnell and Bellingham Diets.
Weir Mitchell Diet.
Training Diet.
Reducing Diet.
Diet for Professional Singers and Lecturers.
The Dry Cure.
The Yolk Cure.
Milk Cures: Kumiss Cure; Matzoon Cure; Buttermilk; Cure; Sour Milk
Cure; Milk Cure; Skim Milk Cure; Whey Cure.
Prom time immemorial man has fed on the fruits of the earth and
the flesh of animals. At certain epochs in his history, under the sway
of philosophic speculation or religious tenets, sometimes on account of
careful hygienic considerations, or even under force of necessity, he has,
voluntarily or not, subjected himself to special forms of diet, sometimes
eating only fruits and herbs, sometimes adding milk to his fruits and
vegetables. At other times, on the contrary, his alimentation has been ex-
clusively from the flesh of animals, and again he has seen fit to subsist
upon a mixed diet, to the rigid exclusion of all meat. These exclusive
methods of alimentation have led to favorable hygienic and dietetic re-
sults which find ready application in trophotherapeutic treatment.
519
520 SPECIAL DIETS
Various systems of special diets and diet cures have been devised to
meet the requirements of disease or the fancies of the faddist. Some of
these consist solely in the elimination of certain articles of food from the
dietary, due to esthetic tastes or humanitarian principles. In some in-
stances the particular modification is based on trophotherapeutic reason-
ing with a view of economic simplicity, the desire to give the digestive
apparatus a complete rest from some particular food constituent, or the
necessity of curtailing the amount of nutrients in the dietary without
reducing the actual quantity of the diet or of limiting the total caloric
value. Many of the special diets and diet cures which embody this object
are outlined in the present chapter; and those prescribed in obesity are
referred to in the section dealing with Diet in Diseases of Metabolism
(Volume III, Chapter XII). The dietaries here considered are of prac-
tical use in various conditions of health and disease, in different indi-
viduals in different climates, or in the same individuals under different
environments.
VEGETABLE DIET
Vegetarianism (1), or a vegetarian diet, will be the first of the special
diets and diet cures to receive attention, because, in one form or another,
it is, and has long been, the alimentation of entire races of people
numbering many millions, and of late years has become a fad with many
Americans and Europeans, who find it more economical to patronize the
green grocer than the butcher, and who believe, in many instances, that a
vegetable dietary is conducive to health, longevity, good temper and a
mildness of disposition which a carnivorous dietary obliterates. Often,
too, believers in this special form of dietary object to the flesh of animals
for esthetic or religious reasons, since they consider the slaughter of ani-
mals unjustifiable to furnish food for man.
A dietary which excluded the flesh of all animals was at first a re-
ligious practice. The Hindoos, followers of Brahma and Buddha, believ-
ers in the doctrine of the transmigration of the soul, still hold to the teach-
ing that the spirit can migrate from man to animals, which are our in-
ferior brothers. It has, therefore, always been repugnant to followers of
this cult even to think of eating the flesh of an animal, which to them is
a kind of sacrilegious cannibalism. For a similar reason the religious be-
liefs of the ancient Egyptians forbade the use of meat, this doctrine hav-
ing been brought by Pythagoras (2) from that country into Greece, whence
it has been transmitted to us by time. The human race is omnivorous by
instinct, by its dentition, by its digestive secretion, and by its need of ac-
VEGETABLE DIET 521
tivity. To work quickly and well, the modern man, especially, must Lave
a stimulating dietary which will furnish him with the most active and
most digestible plastic matter in the smallest volume. A diet of meat and
vegetables seems to agree with him from every point of view.
The strict vegetarian partakes of no animal food, and no tubers nor
foods grown under ground, limiting his alimentation entirely to fruits
and vegetables grown in the sunlight. Many vegetarians, however, in
addition to vegetables, consume milk, butter, cheese and eggs, and are
classed as lacto-vegetariaris. In reality they are no more vegetarians than
the man who eats meat, fish or fowl. The alimentation of the lacto-vege-
tarian, consisting of milk, cheese, butter, eggs, cereals, legumes, fruits,
nuts and other vegetables, is advantageous to many people and more par-
ticularly in the trophotherapeutic treatment of certain types of disease.
Vegetarianism has its advantages in that its supporters do not overeat
while getting a fairly bulky meal; the amount of protein consumed is
smaller and the proportion absorbed is less from a vegetarian diet than
from a mixed diet, which is of great advantage to many patients. A lacto-
vegetarian dietary, such as the following from Tibbles(3), is valuable in
the dietetic treatment of high arterial tension, the forerunner of arterio-
sclerosis, of some forms of renal disease, as albuminuria, and of Graves'
disease, gout, calculi, hepatic troubles, rheumatism, intestinal toxemia and
intestinal fermentation, chronic skin diseases and chronic nervous affec-
tions.
LACTO- VEGETARIAN DIET
Breakfast:
Milk, whole meal bread, butter, one egg.
Lunch:
Baked beans and tomatoes, potatoes, cabbage, stewed fruit, bread, cheese, and
salad.
Dinner:
Lentil soup or oatmeal porridge, bread and butter, dates and walnuts, or grapes
and bananas.
This dietary can be varied in many ways. The use of sauces, such
as walnut and mushroom ketchup, or ripe tomatoes, added to beans or
macaroni, makes them more palatable and gives zest to the appetite and
at the same time provokes the stimulation of the secretion of gastric juico.
Beans and peas boiled with savory herbs mint, thyme, savory, marjoram,
etc. are more palatable and better flavored than when cooked without
them. Lunch is generally more difficult to provide than the other meals.
The following dietaries outline lacto- vegetarian lunches for a week:
522 SPECIAL DIETS
LACTO-VEGETARIAN LUNCHES
Monday:
Steamed rice and tomatoes, with grated cheese; boiled cabbage or other green
vegetables; whole meal biscuits; custard pudding.
Tuesday:
Steamed broad beans and macaroni, with parsley sauce; steamed green vege-
tables; potatoes cooked in their skins.
Wednesday:
Nut-roast, mushroom gravy; steamed vegetables; plain steamed pudding with
jam or syrup.
Thursday:
Macaroni and cheese, with apple sauce and steamed potatoes; ginger pudding;
fruit.
Friday:
Baked Irish stew containing nut-meal or peas or beans in place of meat; milk
pudding; unfermented bread; cheese.
Saturday:
Lentil-roast with apple sauce or gravy; boiled cabbage; baked or steamed
potatoes; maizene pudding; nuts and fruit.
Sunday:
Savory pie, consisting of steamed haricot beans and vegetables; or macaroni
and eggs, moistened with milk and seasoned; baked potatoes; tomatoes and
salad; ground rice, blanc mange; fruit.
It is no longer questioned that a dietary composed entirely of vege-
tables will supply all the food constituents, carbohydrates, fats and pro-
teins. A menu can be planned so as to supply all the necessary food ele-
ments requisite for body metabolism. The nitrogenous matter obtained
from vegetables, however, is less easily digested than that from animal
foods, and a much larger percentage passes from the alimentary tract
unutilized. Individuals subsisting entirely on a strict vegetarian diet for
any prolonged period of time are apt to lose strength as well as physical
and mental vigor and endurance and show languor and disinclination for
work, and they become less able to resist disease (4, 5). Laborers are
unable to perform the same amount of work they could accomplish on a
dietary containing animal food. As previously stated, the animal king-
dom supplies man with protein food, and the vegetable kingdom provides
carbohydrates except honey; fats being derived about equally from both
sources. The percentage of starch in different vegetables varies greatly,
being highest in tubers. Green vegetables are practically fat-free, con-
taining a very small percentage of protein, one-tenth of which is lost in
cooking, and from two to eight per cent of starch, of which one-third is lost
in cooking. They possess the advantage of being able to take up a great
VEGETABLE DIET 523
deal of fat during the process of cooking. Fats are negligible constituents
of vegetables, but are apparently quite as nutritious and even more di-
gestible than animal fats. A careful consideration of the elementary con-
stituents of a vegetable dietary shows that the principal advantage of a
strict vegetable diet is the reduction of all protein, notwithstanding a large
bulk of vegetables may be taken. The exclusion of animal foods, with the
exception of eggs, milk and milk products, from the diet is strenuously
advocated by certain sentimentalists who are opposed to slaughtering ani-
mals for food.
According to Edmund Caultey(G), universal lacto-vegetarianism is an
impossibility.
Carried out thoroughly to its logical conclusion it would have a most pro-
found effect on life generally. Under such a scheme of diet all animals except
those used for draught purposes and pleasure would gradually be abolished.
Were fowls only kept to supply eggs and feathers, the price of eggs would rise
considerably. So, too, the supply of milk would be insufficient and its price
prohibitive, for cattle could not be kept profitably for the supply of milk and
leather alone. Woolen clothing would become the luxury of the rich. The bulk
of the grass grown would be absolutely wasted unless the science of the vege-
tarian were able to prepare from it a food for man.
The productive value would be, however, increased if the grass plains were
converted into arable land for the growth of cereals and sugar beets and into
orchards for fruits and nuts. We should have an insufficient and expensive sup-
ply of milk, milk products, and eggs, wool and leather. We should be dependent
on cotton and linen for clothing and on compressed cellulose for boots and many
other purposes.
But although universal vegetarianism is opposed to the scheme of na-
ture, there are cases in which the diet, or one modified by the addition
of milk and eggs, is particularly suitable. As has been stated above, its
advantage largely depends on a relative starvation, when compared with
the previous mixed diet. The patient no longer overeats. Vegetarians
claim that they live longer and are healthier, physically and morally, than
flesh-caters, and it is true that they may be healthier, physically, if they
have been subject previously to ailments due to an excess of nitrogenous
food or overeating generally. The diet is more suited to those engaged
in hard physical work, for they sweat freely and get rid of the excess of
water in the diet, and they require much carbohydrate food to provide for
muscular energy. A sedentary person on a vegetarian diet is liable to
develop a distended, flatulent abdomen, watery blood, and diarrhea from
the excessive peristalsis set up, while the excess of waste products puts
extra work on the organs of excretion.
524 SPECIAL DIETS
Tibbies (3) does not agree with the assertion that vegetarianism leads
to mildness of temper or to gentleness of disposition. He points out that
the buffalo, the rhinoceros and the Chinese pirate, all vegetarians, are
equally remarkable for their cunning and ferocity. It is universally
known that the carnivora are more active, more alert and more powerful
than the herbivora, while the meat-eating races of man are physically supe-
rior to those who subsist entirely on a vegetable diet. He also calls atten-
tion to the superior physique of the American or European soldier over
that of the Japanese or Chinese. Again, the races of mankind who subsist
on a mixed dietary are more progressive and more alert than the vege-
table-eating races. We learned when studying Protein and Nutrition that
the Japanese as a race have made wonderful progress since the adoption of
a larger protein ration and especially since eating animal food. This
same statement applies equally to the Chinese, Siamese and Burmese.
Vegetable Diet and Energy. The principal influence of a vegetarian
diet on metabolism is a lessening of many of the vital forces. According
to Tibbies, "The influence of vegetarian diet is to slow down many of the
vital processes, to make the person, if anything, less energetic, or of a
quieter disposition only in proportion as all his functions become some-
what more languid. That animal food is proper for children is suggested
by the fact that milk is the natural food of infants and young children.
It may be admitted that less animal food than the amount usually con-
sumed is quite sufficient, and it is probable that two-thirds of the amount
of protein required might be derived from vegetable sources." Hueppe
is the authority for the statement that "man was originally a mixed
feeder, but evolved into a flesh-eater, and lastly into a vegetarian; but
vegetarianism only became possible after the introduction of fire and dis-
covery of the art of cooking. Man has neither the teeth nor the gut of a
vegetarian animal, or he would naturally graze in the fields in the sum-
mer, and in winter eats oats from a manger."
As a source of energy, there can be no possible advantage in adhering
to a vegetable dietary, but on the other hand, there is a decided disad-
vantage owing to the vegetarian diet being more difficult of digestion. The
amount of energy expended in the performance of bodily functions and
the amount expended under various conditions and circumstances has been
fully discussed in a previous chapter. It has already been stated that the
required energy can be obtained from a purely vegetarian diet provided
the amount consumed is sufficient, but a strict vegetarian diet does not
appear to give the amount of strength obtained from a mixed diet. This
view is generally held and is well expressed by Tibbies (3) :
VEGETABLE DIET 525
No vegetarian animal can lift the weight of his own body, not even the horse,
ox, camel, or elephant. On the other hand, the carnivorous lion, gripping a calf
his own weight, can jump a hurdle six feet high. The lifting power of man, the
mixed feeder, exceeds that of any other mammal. It is recorded of Louis Cyr
that he lifted 2,672 pounds; of Little, that he carried 1,560 pounds for fifteen
steps; of a Tyrolese, that in six hours he carried a load weighing 262 pounds up
an ascent 5,000 feet high. A laborer weighing 165 pounds, working around the
New York docks, will many times a day carry a sack weighing 220 pounds. A
negro helper on the freight trains in the South will carry a 500-pound bale of
cotton and think nothing of such a feat. The street porters of Salonica and
Constantinople, who feed on pillaf of rice and figs, with a little meat, are noted
for their proverbial strength. It is not at all unusual to see one of them carrying
a grand piano about the streets on his back. Hence the saying, "As strong as
a Turk."
Vegetable Diet and Health Vegetarian faddists claim that a strict
vegetable diet is more healthful than a mixed diet, also declare that
it tends to health and longevity, but statistics show that the vegetarian is
just as liable to disease, and possibly more so, through his food than the
flesh eater. Vegetarians also claim that meat causes diseases of the liver,
gout, stone, gravel, chronic rheumatism, skin diseases, disturbances of the
vascular system, arteriosclerosis, and other similar diseases; that pto-
maine poisoning may follow the ingestion of animal food; that the animal
whose flesh is consumed may have been the subject of anthrax, glanders,
foot-and-mouth disease, or some of the various other maladies communi-
cable to man. They also assert that oysters and other shellfish are a
causative factor in outbreaks of typhoid fever. Many instances, however,
can be cited to show that a vegetable diet may also be the means of dis-
seminating diseases. Bread and other starchy foods from the vegetable
kingdom taken in excess lead to indigestion, flatulence, acidity, congestion
of the liver, and hemorrhoids, and tend to obesity, while overmilled rice
is the cause of that scourge of the East known as beriberi, or kakke.
While sugar possesses enormous value as a provider of energy, if ingested
in excess it will produce evils similar to those following an excefts of
starchy foods, especially catarrh of the stomach. Again, the ingestion of
hard fruit, nuts and fibrous vegetables may be a contributing cause to
digestive difficulties. Animal foods are by no means the only source
through which disease may be transmitted. Practitioners in the tropics
invariably give this advice, "Eat no uncooked vegetable, nor any raw
fruit, unless you can pare it or peel it." Outbreaks of typhoid fever,
dysentery, cholera, diarrhea and various other diseases have often spread
from disregard of this warning, and the consumption of imported raw,
526 SPECIAL DIETS
unripe or over-ripe fruit is frequently a cause of tropical diseases in tem-
perate countries. Nor is it safe to eat any variety of fruit purchased from
the fruit stands of our northern cities, without peeling, as the fruit vender
often has the industrious habit of polishing his apples with a rag on which
he frequently spits. Again many diseases are communicated from the
ingestion of green vegetables, more especially that class of diseases pro-
duced by animal parasites. Hydatid disease, one of the most terrible of
this type, is caused by the Tsenia echinococcus, a small tapeworm which
is taken into the body in the form of ova or partially developed Tsenia on
green vegetables, such as watercress, celery, lettuce, etc. Actinomycosis
also enters the organism with green vegetables and cereals, while ergotism
is a disease common among consumers of rye bread. Pellagra and beri-
beri are deficiency diseases due to vegetable foods, which will be consid-
ered elsewhere in this work. 1
Tibbies coincides with Hueppe's opinion that the supposed health-
giving properties of a strictly vegetarian diet are questionable. "The vege-
tarians of our time," Hueppe avers, "belong to the class of neurotic men
who, failing to meet the strain of town life, ever seek for a 'heal-all' in
one or another crank. Their doctrines, pushed with fanatic zeal, make
no impression on the healthy, and only tend to overthrow the balance of
others, who, like themselves, are the victims of unnatural modes of exist-
ence." Waylen(7), himself a believer in this cult, and one who had inti-
mate acquaintance with many vegetarians, in writing on this subject says
that for eight years he was a vegetarian, wore sandals and went without
a hat; but it gradually dawned upon him that man is somewhat different
from the beasts; that if a monkey can do something, it does not follow
that a man should do likewise. He says : "Vegetarians as a rule are not
healthy folks. They present either a wizened and emaciated appearance
or a tendency to flabbiness. They have a poor circulation, and are liable
to chills. They suffer from dyspepsia, flatulence, bad breath and anemia.
Their liver and kidneys are commonly affected, and altogether there is a
wanj of vitality among them. They burden their stomachs with masses
of crude stuff, and practically deprive themselves of fat and oil; and
while they daily grow thin and nervous, they think they are improving in
health." Waylen in summing up this question says that when the human
body is starving, it begins to feed upon itself, and vegetarians may be
charged with being guilty of a species of cannibalism.
We have already shown in "Feeding in Health," 2 what the influence
1 Volume TIT, Chapter XVII.
2 Chapter X, this volume.
VEGETABLE DIET 527
of flesh food is on the character of animals, and this we will supplement
by the opinions of two celebrated men who were keen observers of them-
selves :
Porphyre(2), a philosopher who gave up the Pythagorean doctrine
to eat meat, in writing to his friend Firmus, says :
It is not amongst the eaters of simple and vegetable foods, but amongst the
eaters of flesh, that assassins, tyrants and thieves are met with. I cannot believe
that your change of diet is due to reasons of health, for you yourself have con-
stantly affirmed that vegetable diet is much more suitable than any other, not
only to give perfect health, but even a philosophic and balanced judgment, as a
long experience had taught you.
And Seneca, who, preoccupied with the same considerations, had
slowly adopted vegetarianism, writes :
Struck by such arguments, I also have given up the use of the flesh of ani-
mals, and at the end of a year my new habits have become not only easy to me,
but delicious; and it even seems to me that my intellectual aptitudes have been
more and more developed.
We learned when studying foods from the vegetable kingdom that
green vegetables and fresh fruit are absolutely necessary to the well-being
of mankind, but particularly for the inhabitants of the cities and towns.
Scurvy, which once was a scourge, is now rarely seen, due largely to the
fact that all people realize the necessity for adding fresh vegetables and
fruits to the dietary. As previously stated, fresh vegetables, potatoes and
fruit contain certain salts which are absolutely essential to the proper
constitution of the blood and other fluids of the body. "Tf these salts are
withheld from the dietary," according to Tibbies, "the blood becomes im-
poverished, and scurvy results" (3). The necessity for vegetables and
fruit in the diet, therefore, cannot be denied, but, at the same time, we
must insist that an exclusive vegetable diet is inconsistent with the ability
of man to live upon all kinds of food ; that vegetable foods alone entail a
laiger amount of work on the digestive organs; and that they do not fur-
nish sufficient stimulating 'energy for our present mode of civilization.
It is an admitted fact that some people feel better on a vegetarian diet than
one containing meat. Plethoric individuals often complain of physical
hebetude and want of energy after a heavy dinner of hot meat with the
usual accompaniments, but are free from these symptoms after partaking
of a vegetarian meal. We have shown in a previous chapter that the
wealthy classes, who have the opportunity and can afford the luxury, dine
too often and partake too freely of meat and game, and as a consequence
they are troubled with disorders little known among vegetarians. How-
528
SPECIAL DIETS
ever, a vegetarian diet, as a rule, is not more healthy than a mixed dietary,
nor does it give an assurance of a longer life. Moreover, insurance statis-
tics place less value on the life of a vegetarian than on the life of the aver-
age American or European who subsists on a mixed ration. According to'
Tibbies, there are large numbers of people who live on a more or less vege-
tarian diet. "The peasantry of Ireland subsist upon a dietary consisting
largely of potatoes with a little milk, eggs and pork, occasionally replacing
potatoes by oatmeal. This dietary is also that of the poorer classes in
Scotland. The lower classes of Germany and Russia live largely upon
rye bread, potatoes and fat. The Italians subsist upon cornmeal, chest-
nuts and acorn meal. In India and China the poor live largely on rice,
millet and vegetables, with more or less pulse and other legumes."
Wait (9), of the United States Department of Agriculture, reports an
investigation of the dietary consumed by a subject under a two weeks'
observation. A small amount of meat was added, as a seasoning to the
peas, the digestibility of which was the main object of the research.
WAIT'S VEGETARIAN AND FAT DIETARY
RATION
Total
Food for
Four Days
CONTENTS OF FOOD: GRAMS
Energy,
Calories
Protein
Fat
Carbo-
hydrates
Ash
Bread
Grams
1,170
2,600
130
78
910
130
1,100
112
81
2
4
11
219
11
138
116
71
7
16
679
132
"l83
130
684
11
18
4
2
7
39
3,600
2,182
1,048
670
817
515
4,299
Milk
Butter
Pork
Bananas
Sugar
Peas ....
Total
429
107
78
67
359
90
97
94
1,808
452
94
85
81
20
64
49
13,131
3,283
88
75
Daily average
Proportion digested: total food
per cent
Proportion digested: peas, per
cent
Vegetable versus Animal Protein. In studying the subject of protein
and nutrition(l), we found that the protein of vegetables is not so readily
digested, absorbed and assimilated as the proteins from animal food.
During the process of digestion a much larger proportion of nitrogenous
compounds escapes the influence of the digestive ferments and hormones,
principally due to the difference in the solubility of the connective tissue
VEGETABLE DIET 529
enveloping the animal cells and the cellulose surrounding the vegetable
cells. It is easily understood, therefore, that, in order to secure from a
purely vegetarian dietary the amount of protein usually considered neces-
sary for the organism, a great deal more labor is demanded on the part
of the digestive organs than is required in the digestion of animal pro-
tein from an ordinary mixed diet. We have previously pointed out the
fact that it is more economical to secure protein from legumes than from
meat, milk or eggs, and for this reason, the use of legumes should be en-
couraged where the diet is deficient owing to a limited income.
The question whether vegetable protein has the same physiological
value when absorbed as animal protein is a debatable one. Vegetarians
claim that vegetable proteins are specifically different in their action from
animal proteins. They go so far as to make the statement that they have
a different effect on the body, and also on the character and morale. Our
present knowledge of the demolition of the protein molecule is such as to
lead us to question that any specific difference exists. Moreover, we do
not think the point a good one for vegetarians to raise, for it is barely
possible that animal protein requires a less complete deamination than
vegetable protein prior to assimilation. We all know that the protein
molecule is composed of twenty or more amino-acids and that the proteins
of animal foods have been constructed out of vegetable proteins eaten by
an animal. Physiologists tell us that the same kind or the same proportion
of amino-acids is not contained in all proteins, the principal difference
being one of percentage or proportion. We believe the consensus of opin-
ion at the present time is that it matters little whether the amino-acids are
obtained from the animal or vegetable foods, that whatever their source
they have practically the same value.
At best, a vegetable diet furnishes a low protein alimentation, and this
deficiency is one of its greatest disadvantages, especially among the poorer
classes, in the case of growing children, who are so much in need of a
bountiful supply of protein to build up their tissues. As we have previ-
ously recorded, it is possible to maintain the nitrogen balance in equilib-
rium when the amount of protein actually absorbed is around 56, 58 or
GO grams daily. An adult can maintain this equilibrium on a low protein
diet, but this cannot be done in the case of a child. Physiologists who
have given this siibject great attention claim that a low average of protein
in the food is one of the chief causes of the high mortality among the chil-
dren of the poor(10). It has been stated by competent authority that "the
protein of vegetables is not as valuable from a nutritive standpoint as the
protein from animal foods." But protein is protein, whatever be its ori-
530 SPECIAL DIETS
gin; albumin or globulin is of the same nutritive value whether it be
obtained from animal or vegetable foods. It has been well said by Tib-
bies, however, that we cannot get away from the practical fact that meat
gives a greater degree of energy than peas or beans. Vegetarians may
deny this, but it is founded on general experience that a man has a more
buoyant feeling when living on an ordinary mixed diet than when living
on a strict vegetarian diet. It has been authoritatively stated that most
vegetarians are neurotics. They do not possess the energy, activity and
endurance of an ordinary individual. Tibbies explains this as fol-
lows^) :
Given an equal amount of protein from the two sources, they have an equal
value so far as anybody can tell. The proteins in animal foods are albumins and
globulins; those in vegetables belong chiefly to the class of globulins. There are
nucleo-proteins in both animal and vegetable foods. The non-protein nitrogen
of animal foods consists chiefly of the extractives, creatin, creatinin, xanthin,
hypoxanthin, carnin, urea and uric acid; that of vegetables is chiefly in the form
of amides and amino-acids leucin, tyrosin, asparagin, etc. Herein lies the chief
difference in the properties of animal and vegetable protein foods. The extractives
of animal foods are more stimulating than those of vegetable foods. It is not con-
tended that they give greater bodily strength. Energy is not to be confounded
with muscular strength; energy is the property of the nerves, strength of the
muscles. Physical work is done by the muscles, but it is initiated and controlled
by the nervous system. The extractives of meat are valuable nerve stimulants.
Leucin, tyrosin, and other amino-acids of a like character are not stimulants, and,
unless they are utilized by the cells of the intestinal mucosa in the construction
of proteins, they pass on to the liver, where they are broken down into urea,
uric acid, and ammonia. If they are too abundant to be broken down by the
liver, they affect the organism adversely and give rise to some of the symptoms
of intestinal toxemia. The last argument has been applied with equal force to the
extractives and purin bodies in meat. But the display of energy by the carnivora
is very much greater than that exhibited in general by the herbivora, and this is
accounted for not only by the greater consumption of protein, but by the different
character of the associated non-protein nitrogen compounds.
The question has been asked, "Has the character of the protein any
influence upon the development of organs and the performance of their
functions?" This subject was alluded to when studying the section on
Protein and Nutrition(l). The great importance of protein in the ali-
mentation cannot be too strongly emphasized. In a previous chapter, we
stated that during the period of growth and development of the body an
abundance of protein was necessary. It is generally acceded to by physi-
ologists that a low protein diet is unsuitable for growing children and
young adults. Notwithstanding this fact, there are many thousands of
VEGETABLE DIET 531
growing children in the East Side districts of New York, for instance,
who subsist oil a diet very low in protein. The question before us is,
however, "Does the kind of protein influence this period of growth ?"
Tibbies points out that the consumption of meat in England at the present
time is seventeen times greater per person per annum than it was in 1850.
During the intervening period he declares there has been a very marked
decline in the birth rate. He also records that this decline is most marked
in the classes of society who have an unrestricted allowance of the more
expensive proteins of meat, game, fish and fowl. In our own country,
and especially in New York City, the most fertile families are the poorest
classes in the East Side tenements, whose consumption of animal protein
is restricted for economic reasons and naturally whose proteins are chiefly
derived from the vegetable kingdom. It has been pointed out by some
authorities that the increasing consumption of animal foods affects the
development of the organs of generation, "acts prejudiciously upon repro-
duction and lactation, and is thereby an important factor in the causation
of the declining birth rate and diminishing power of lactation." This
opinion, it is claimed, has been confirmed by experiments on animals(3).
Tibbies, in discussing this subject, says:
The fecundity of the poor and comparative sterility of the rich in highly
civilized communities is a matter of common knowledge, but to claim that one
condition is due to a vegetarian or low protein diet and the other to animal pro-
teins or a high protein diet, is at present beyond our power of conception. There
is in fact very good evidence that a flesh diet does not diminish fecundity when
the consumers live a normal life. The Eskimo women are not sterile, and the
Indian women who subsist largely on a flesh diet are fertile. The Boer women
eat meat at every meal, new vegetables and potatoes being seldom seen on their
tables; nevertheless they are most prolific and feed their children at Nature's
fountain.
Summary. By way of conclusion, we will summarize the main points
in this section in favor of and against vegetarianism.
(a) Foods from the vegetable kingdom are rich in carbohydrates and
poor in protein and fat. They are bulky from their richness in starch,
from the presence of cellulose, and from the large amount of water,
(ft) The foods from the animal kingdom are rich in protein and fat, and,
with the exception of milk, poor in carbohydrates. They occupy little
bulk in the raw state, and. even less after cooking, (c) Foods from the
vegetable kingdom are less easily digested and on the whole less completely
absorbed than foods from the animal kingdom ; owing to their bulkiness
and the indigestible cellulose which invests their nutritive constituents
532 SPECIAL DIETS
they are prone to fermentation in the alimentary canal, with the produc-
tion of acids which tends to augment peristalsis. The protein constituents
of vegetable foods are more difficult of absorption than protein from ani-
mal food, (d) A strictly vegetarian diet is apt to be deficient in protein,
due to its imperfect absorption, so the question of vegetarianism becomes
a question whether it is advisable to live on a low protein diet or not.
(e) The strict vegetarian, who subsists entirely upon foods grown in the
sunlight, must either live upon a diet relatively poor in protein or else
consume an excessively large amount of food. (/) Statistics seem to em-
phasize the point that a strict vegetarian aliment tends to diminish energy,
both mental and physical, as well as the power of resisting disease, and
if a vegetarian attempts to consume sufficient food to yield the required
amount of protein, the bulkiness of the diet is apt sooner or later to lead
to derangement of the stomach and bowels. (#) Both of these results
may be overcome by supplementing the vegetable part of the diet with
animal substance rich in protein, but a large part of the necessary protein
can be safely taken from the vegetable kingdom, (h) Milk and milk
products, eggs, fish and meat may be used as protein carriers, but for per-
sons in a normal condition of health the moderate use of meat and fish
is advantageous. For the individual of a gouty diathesis, possibly milk
and cheese are preferable, while skimmed milk or buttermilk and the
cheaper kinds of cheese will be found more economical, (i) From an
economical standpoint, there is no doubt that it will pay to patronize
the green grocer instead of the butcher in purchasing the necessary food
elements for subsistence. Vegetable foods can be purchased to better ad-
vantage both as sources of building material and energy than animal foods,
so that vegetarianism may be recommended on the grounds of financial
economy. (/) It is a fact that vegetable foods are less highly flavored
and less appetizing than some of the animal foods, but they have the ad-
vantage of not being liable to undergo putrefaction and of rarely produc-
?'ng disease.
MEAT DIET
An exclusive alimentation from the flesh of animals is sometimes ac-
cepted through necessity. There are certain individuals who think that
meat forms the most nourishing and most fortifying food. In fact, some
men who are obliged to live a very fatiguing life, as the northern trappers
and hunters, and the inhabitants of excessively cold climates, such as the
fishermen living on the banks of the frozen seas, can subsist almost en-
tirely upon enormous quantities of meat or fish without suffering any
MEAT DIET 633
untoward effects. Two conditions are, however, essential : The meat must
be ingested with its fat, and the individuals partaking of such a diet must
lead a very active life in the open air.
There is no evidence to lead us to believe that the primitive peoples
of antiquity were vegetarians, for the adaptability of the human body to
the use of animal foods, as well as our earliest historical records, disproves
this; while some of the most savage peoples of the present time subsist
almost exclusively on fish and game. Darwin records that the gauchos of
the American pampas can sustain themselves for whole months on the
fat meat of the oxen over which they watch. The Eskimos can devour
five to six pounds of reindeer meat per day and almost twice that amount
of the fat and flesh of the seal, concerning which we have already made
mention. This diet of animal food becomes unbearable if the meat is
all lean. Gautier has made some experiments on dogs with a lean meat
diet. A dog weighing 40 pounds required 1,500 grams of lean meat as
the necessary requirement to keep its weight constant, whereas 400 grams
of meat, 200 grams of fat or 100 grams of meat, 100 grams of milk and
300 grams of bread were amply sufficient to obtain the same result. The
findings from this experiment hold good in the case of man. In order to
secure the 280 grams of carbon necessary for the repair of his organs and
the discharge of his functions, 1,600 grams of lean meat would be essen-
tial for the average man. This quantity would introduce as pure waste
four times more protein than could be metabolized. Such enormous quanti-
ties of meat from the point of view of hygiene and economy could only
lead to unfavorable conditions ; besides, no one could for any length of time
consume such enormous quantities of meat without suffering from symp-
toms of auto-intestinal intoxication. A mixed alimentation composed of
a rather larger percentage of meat than the standard requirement permits
of furnishing the system, in the least bulk, with the greatest amount of
the most nitrogenous, stimulating and useful food principles.
However, it would be erroneous to conclude that an alimentation en-
riched in meat to the point of being exclusively carnivorous would in-
crease the physical power of the subject. Although a dietary taken ex-
clusively from the animal kingdom raises the nitrogenous coefficient in
comparison with a mixed or vegetable alimentation, a meat diet acidifies
the blood and hinders oxidation. It overburdens the organs of excretion
with a superabundance of nitrogenous waste, urea, uric acid, etc. ; it con-
gests the liver; it causes obstinate constipation; it brings on dyspepsia,
gastric disturbances and enteritis; it induces intestinal putrefaction and
intestinal stasis ; it brings about rheumatic, arthritic, gouty and nervous
134
534 SPECIAL DIETS
tendencies. A dietary not exclusively meat but only too rich in meat
could not be borne for long. According to Huchard, such a diet would
produce arterial hypertension and heart fatigue, and sooner or later be-
come an active predisposing cause of arteriosclerosis. Houssaye has
shown that in the case of fowls, an exclusive meat diet produces sterility
and causes an arrest of development with an excessive proportion of males.
In view of the foregoing facts, then, an exclusive diet of flesh, or even
a mixed diet wherein meat is liberally ingested, is not looked upon favor-
ably from any point of view. A dietary composed too largely of meat
tends to make individuals more aggressive, more headstrong, and the in-
telligence less keen. The well-to-do classes are too carnivorous. Accord-
ing to Herbert Spencer(ll), there is a marked contrast between the chil-
dren of families where the diet is largely animalized and those where the
ciiet is largely potatoes and bread. From both points of view, that of
physical and that of intellectual vivacity, the peasant's' child is far inferior
to that of the gentleman. From the point of view of physical health and
strength in actual life, Spencer's dictum does not appear to hold good;
as to the intellectual vivacity of the child in the well-to-do classes of so-
ciety, it is far more influenced by heredity the selection of progenitors
and by educational advantages.
An exclusive meat diet has long been used in the dietetic treatment
of tuberculosis, on the assumption that the association of gout with high
living is largely due to the free ingestion of animal food ; that a gouty
condition can be artificially brought about through a dietary consisting
largely of flesh foods ; and, as is held by some, that there is an antagonism
between a gouty diathesis and a tuberculous tendency. The main object,
therefore, of an exclusive carnivorous diet is to induce that condition
which is believed to be antagonistic to the growth of Bacillus tuberculosis
or its toxins(l). When a meat diet is ordered, the meat must be freed
from bone, gristle and connective tissue, and only slightly cooked. It
must be taken in quantities sufficient to yield energy or fuel value to sup-
ply the heat expended by the body 2,000, 2,700 calories or more, depend-
ing upon the condition of the patient. An exclusive diet of flesh of ani-
mals, fowls and fish is also recommended for obesity setting up a species
of starvation, and for dyspeptic ailments, because of its simplicity and
freedom from carbohydrate fermentation.
It is necessary for a patient on a meat diet to consume from two to
two and a half pounds of the edible portion of average beef or mutton to
supply the body with the requisite amount of nutriment to meet the de-
mands of the organism. One pound of beef or mutton freed from bone,
MEAT DIET
535
gristle and connective tissue equals 453 grams. Rubner conducted a
series of experiments with an exclusive carnivorous diet upon healthy
medical students. The alimentation consisted of from 738 to 884 grams
of the edible portion of beef. It was prepared with a little butter, onion,
salt and pepper. The beverage prescribed was water or aerated water.
After being cooked, specimens of the food were analyzed to determine
the percentage of protein and fat. The students' digestion was normal
in every particular, the feces containing only 1.2 grams of nitrogen or
about 7 grams of protein. The nitrogen balance was maintained in a
state of equilibrium with a slight gain in weight.
Solntzer conducted experiments with beef and mutton, and Atwater
experimented with both beef and fish. The results of some of these ex-
periments recording the nitrogen equilibrium are graphically set forth
in the following table from Tibbles(3) :
METABOLISM WITH MEAT DIET
NITROGEN
FOOD PER DIEM
Days
Au-
thority
Grams
Grams
Grams
Gain or
in Food
in Urine
in Feces
Loss
Beef, 884 grams
3
3
48.8
39.8
47.2
37.6
1.2
1.1
0.4 \
1.1 /
Rubner
738 "
715 "
1
31.9
25.6
4.6
1.71
Mutton, 1,671 grams
1
90.9
58.5
5.0
27.4
1,336 "
1
56.4
50.5
3.9
2.0 [
Solntzer
Canned beef, 895 grams. . . .
1
43.9
27.8
7.5
8.6
" mutton, 1643 grams .
1
75.2
65.3
8.6
1.3 J
Beef 1,200, butter 30. wine
367, beer 1,250 grams.. . .
3
38.5
37.2
1.0
0.31
Fish 1,549, butter 50, wine
Atwater
700, beer 1,250 grams.. . .
3
45.6
44.1
0.9
0.6 J
The value of an exclusive meat diet in the treatment of tuberculosis,
obesity, dyspepsia, and gout has already been pointed out, and will be
further elaborated upon when these different ailments are discussed.
It also has been recommended in chronic dyspepsia, especially in a
condition of atony and in dilatation of the stomach, and its value
is unquestioned in hyperchlorhydria. The fact must not be lost sight of,
however, that sufficient nutriment must be consumed to meet the demand
of the body, which will require from two to three pounds of the edible
portion daily. The quantity of moat should never lie less than six ounces
of thoroughly minced meat, slightly cooked, ingested at least three times
per day, the intervals being from 4 1 /L> to 5 hours.
536 SPECIAL DIETS
Salisbury Diet. The Salisbury diet (12) is a typical meat diet con-
sisting of from 2 to 4 pounds of beef and 3 to 5 pints of hot water daily
for from 4 to 12 weeks. It has been recommended as a means of treating
certain diseases of the skin, as psoriasis (13), which have resisted the usual
forms of medication.
It is also recommended by Dr. Salisbury for the dietetic treatment of
gout, obesity, chronic intestinal derangements, and disorders of nutrition
which are attributed to abnormal carbohydrate fermentation. The treat-
ment aims at the thorough cleansing of the stomach before eating, by giv-
ing a pint of hot water an hour and a half before each meal and at bed-
time. If the water is drunk slowly, the patient will not experience any
sense of discomfort nor will the stomach become distended. The slightly
nauseating taste of plain hot water may be overcome by the addition of
ginger, lemon juice or weak tea, and in cases where intense thirst is pres-
ent, the addition of a little nitrate of potash makes the water a more effi-
cient thirst quencher. If constipation is present, a teaspoonful of mag-
nesium sulphate may be added to the water. The urine should be exam-
ined frequently to obtain the specific gravity, and the amount of water
should be regulated accordingly. If the specific gravity falls below 1.010,
the patient may become asthenic and the amount of water may be con-
siderably reduced. The specific gravity of the urine should be kept be-
tween 1.012 and 1.015.
Caultey(14) gives the following directions for the preparation of the
Salisbury diet: "The meat is chopped up quite fine with an American
chopper, and all gristle, bone, fat and visible connective tissue are re-
moved. It is made into patties, sufficiently firm to hold together, three
to stand near it until of a drab color. Salisbury recommends that they
in a frying pan, without fat or water, and rapidly heated, first on one
side and then on the other. On removal from the fire they are allowed
to stand near it until of a drab color. Salisbury recommends that they
should be broiled slowly and moderately well. Butter, pepper, salt,
Worcestershire sauce, mustard, horseradish, celery salt and lemon juice
may be added as condiments. Advocates of this diet have recommended
three pounds of rump steak and one of codfish, with six pints of hot water
daily, for two weeks. For the next three weeks the hot water is reduced
to four pints, and other kinds of meat are allowed, with a little green vege-
table and unsweetened rusks. During the next four weeks the hot water is
further reduced to two pints ; hock and claret with seltzer are permitted,
as are grilled meat, poultry or game, crusts of stale bread and captains'
biscuits. The meat must not be raw and must be quite fresh.
MEAT DIET 537
"The hot water should be given in doses of one-half to one pint, four or
more times a day, say at (> and 11 A.M., and 4 and P.M., one or two hours
before meals and half an hour before retiring. It should be of a tempera-
ture of 110 F. to 150 F. and should be sipped slowly in one-fourth to
one-half hour."
There are obvious objections to this diet. It is absolutely unphysio-
logical, being a starvation diet in respect of fat and carbohydrates. The
quantity is much too large for most people. It throws a great strain on the
organs which have to do with the metabolism of protein, as well as on the
organs of excretion. It is essential to be sure that the kidneys are sound
before adopting this treatment.
Oysters are a welcome addition to the monotony of a meat diet and
may be prepared as follows (15) :
Panned Oysters:
Take 6 deep-sea oysters, place them in a colander, and pour cold water over
them. Drain for ten minutes. Place the oysters in a very hot iron pan, add salt,
pepper, a small piece of butter, and a teaspoonful of meat stock. Cook for a few
minutes, and serve the oysters garnished with a thin slice of lemon.
Broiled Oysters:
Take 6 large oysters. Lay them on a board and dry, then season with salt and
cayenne pepper. Have a gridiron thoroughly heated, place the oysters on the
gridiron and brown them on both sides. Place the oysters on a very warm plate,
and pour round them a little heated beef juice and a little melted butter.
Watson(15) considers the Salisbury diet seldom necessary or advis-
able, but he recommends a modified Salisbury dietary as of great value
in some cases of indigestion and chronic auto-intoxication associated with
it. His modification of the Salisbury diet given below, while rather low
in nitrogenous material, is amply sufficient for the short period of time
in which the diet is necessary. Its use exerts a profound improvement
in the state of intestinal excretions and a corresponding improvement in
the digestion as a whole.
MODIFIED SALISBURY DIET
7 A.M. :
^2 pint or more hot water.
Breakfast, 8.30 A.M. :
4 to 6 oz. meat rissoles; 2 Kalari biscuits with a little butter; small cup of very
weak tea.
Forenoon Lunch, 11.30 A.M.:
J/2 pint or more of hot water, flavored with lemon if desired.
538 SPECIAL DIETS
Dinner, 1 P.M.:
Breakfastcupful of beef tea with }/ Ib. scraped meat: thin slice of baked bread
or dinner toast; half a dozen oysters as above; consomme" with custard or
consomme* with egg, with baked bread or toast.
SP.M.:
^ pint or more of hot water.
Afternoon Lunch, 4 P.M. :
Breakfastcup of skimmed milk, to which is added a full tablespoonful of Carnine
Lefranc or other meat juice; or plain egg flip flavored with cinnamon in place
of sugar; unsweetened rusk or crisp biscuits.
6 P.M.:
}/?, pint hot water.
Supper, 7.30 P.M. :
4 to 6 oz. meat rissoles or mince, followed by an egg jelly hi which the sugar is
reduced in amount; or a blanc mange made with milk hi place of cream.
The above alimentation should be maintained for ten days to a fort-
night, after which additions in the form of steamed fish, chicken, green
vegetables, malted breads, jellies and fruit may be allowed. The return
to ordinary carbohydrate foods must be made gradually.
Zymotherapy Zymotherapy is the name given to the treatment of
disease by the administration of muscle juice or raw meat. This method
of treatment is in contradistinction to the meat or Salisbury diet just de-
scribed, which includes the entire edible portion of the meat. The raw
meat diet is an ancient remedy ; in recent times it was first recommended
for phthisis, empyema and pyogenic infections by Fuster of Montpellier,
in 1865. Richet and Hericourt(16), in a series of experiments carried
out in 1889 on tuberculous dogs, determined the value of raw meat and
subsequently showed that the benefit was derived from the muscle juice
and not from the muscle fiber deprived of its juice by expression. They
reported that this method of feeding is not a matter of hyperalimentation,
for only 50 to 100 c.c. of the muscle juice is suggested as the daily dosage
which was sufficient to cure the dogs, whereas hyperalimentation with the
washed muscle fibers exerted no beneficial effects. The juice contained
2M> per cent of protein. "Its administration produces an increase of vigor
and muscular power, the proportion of hemoglobin is increased, blood
pressure is raised, digestion is improved, weight is increased, and the
physical signs of phthisis pulmonalis or tuberculosis are abated."
If we accept the theory that tuberculosis is due to an infection in early
life through tuberculous cow's milk, it is reasonable then to assume that
undercooked or raw meat should enter largely into the diet of young chil-
dren. Meat juice and raw meat are prescribed in anemia, dyspepsia, neu-
MEAT DIET 539
rasthenia, debility, convalescence from typhoid fever, and after hemor-
rhage.
llericourt, following the publication of his initial observations (17)
on the value of raw meat juice in tuberculous dogs, recently published
another paper on the subject, from which we quote the following: "It is
probably no exaggeration to say that the raw meat treatment in pulmonary
phthisis yields results not approached by any other means at present
available." Eichet coincides with his associate's observations, and to-
gether they undertook researches to determine which constituent in the
muscular tissue possesses antagonism to the progress of tuberculosis.
After much experimentation they came to the conclusion that the solid
constituents of the flesh had no therapeutic action ; "tuberculized animals
fed on flesh from which the muscle plasma had been expressed, died in
approximately the same lapse of time as the control animals who were fed
with ordinary food. The deduction drawn from the above experiment
is that the agent of raw meat which produces this effect is contained in the
muscle plasma, i.e., the meat juice."
The muscle or meat juice must be prepared from perfectly fresh meat,
soon after the animal dies and before rigor mortis has set in ; the muscle
that has undergone rigor mortis loses its glycogen and contains lactic acid
and more or less toxic products of decomposition. Hence the juice should
be prepared as soon after death as possible. If meat or muscle juice is
prepared from commercial or cold storage meat, it is less beneficial, more
toxic and possibly infective. The animal whose muscle is to be used
should neither be overworked nor underfed before death.
According to Caultey(14) : "The meat must be finely minced, wrapped
in stout linen, put in a sieve, and subjected to slow pressure. Small house-
hold presses will yield about 20 and larger presses 30 to 60 per cent of
juice. If one-fourth the weight of sterilized water is added and the meat
allowed to stand for an hour or two before compression, more fluid is ob-
tained, but the bulk and the increased decomposition are disadvantages.
Presses, mincer and linen should be well boiled or washed in boiling water
before use. In hot weather the juice should be collected in a vessel sur-
rounded by ice. Even in winter the juice should be taken at once, because
of its liability to decomposition. As it is repulsive to the patient, it should
be given in a colored glass or with warm beef tea. Intestinal disorders
are due to neglect of some detail in the technique, generally to the impos-
sibility of getting the meat sufficiently fresh, and unless great care is exer-
cised, it is liable to set up alimentary, hepatic or renal troubles.
"The dose should be 9 to 15 ounces daily, with or between meals, in
540 SPECIAL DIETS
water, aerated water, or tepid beef tea, with or without salt or sugar.
Three to six ounces is sufficient for early cases. If raw meat is given, as
much as a pound a day can be ordered, but few patients can take more
than one-fourth to one-half pound. Raw meat and muscle juice can be
combined in the dietary. No cooked meat should be allowed.
"Possibly the muscle juice contains a substance which is antagonistic
to the tubercle bacillus and its toxin, for muscle fibers are not invaded by
the organism, and during the course of the disease they waste, perhaps
being sacrificed in the defense of the body. More probably the good
eifects depend on the nutritive value of the fluid as a stimulant of the
nervous system or of thyroid activity."
According to Galeotti and Lindermann, raw meat and milk stimulate
thyroid activity and they also are of the opinion that the decomposition
products of raw meat increase the colloid material of the thyroid. It is
known that defective thyroid activity and predisposition to tuberculous
affections are apt to follow rapid growth at puberty, infectious diseases,
prolonged lactation, sexual excess and alcoholism, in all of which the thy-
roid secretion is liable to be used up and the gland to atrophy from over-
stimulation. It is believed that human milk contains some of the internal
secretion of the thyroid gland, for iodin can reach the infant through the
breast milk. Infantile myxedema is rarely observed until after weaning,
and moreover the infant's thyroid gland contains little colloid material.
Caultey, in summing up the advantages of zymotherapy, says: "Im-
provement in a tuberculous patient fed on raw meat and muscle
juice is noticed, (a) by increased muscular power, (6) by the increased
hemoglobin, (c) by rise of blood pressure, and (d) by better diges-
tion and improvement in the physical signs. In the very young the
prognosis varies according to the loss or gain in weight, especially during
the first month. The treatment should be continued for a varying period
depending upon the extent of the disease and the improvement following
its administration. It may be resumed at intervals depending on the
condition of health.
FRUIT DIET
The fruitarian diet is an aliment composed exclusively of fruits and
nuts. Of late years many experiments in metabolism have shown that it
is possible for individuals to maintain a nitrogen equilibrium on such a
diet. M. E. Jaffa 1 has thoroughly investigated the fruitarians in Cali-
Professor of Nutrition, Univ. of California. Bui. 132, U. S. Dept. of Agric.
FKUIT DIET 541
fornia. His reports are interesting and valuable, and from them we have
drawn largely in preparing this section.
It is not questioned that an alimentation composed of fruits and nuts
is pleasant and agreeable. At the same time, it is, at best, only a low pro-
tein diet, rarely containing more than 50 to 60 grams of protein. It is
unnecessary to refer to the arguments for and against a low protein
dietary, as this subject has already been fully considered. Chittenden and
other physiologists have found 50 to 60 grams of protein in the daily food
sufficient for physiological needs, and many people have maintained their
health and vigor for years on a fruit and nut or other low protein aliment,
yet they seldom look rugged or robust. The fruit and nut diet, like the
more common vegetarian diet, must be considered of questionable value
and unlikely to become popular as a regular method of feeding, with peo-
ple who have an inborn taste and desire for animal foods.
We have already shown that, as compared with the so-called standard
dietaries, the vegetarian and fruitarian are lamentably poor in protein
and fat, and in some instances deficient in caloric value. See also the fol-
lowing tables abstracted from the excellent study of Fruitarianism by
Professor Jaffa (8). Below are appended the records (taken from Voit
and Alba) of three subjects who subsisted on fruits, as recorded by
Tibbies:
Man, twenty-eight years old; height, 5 feet 5 inches; weight, 125 pounds.
His daily diet consisted of: rye bread (pumpernickel), 131 grams (4V 2 ounces);
graham bread, 438 grams (nearly 1 pound) ; apples, 777 grams (I 3 /! pounds) ;
dried figs, 114 grams (4 pounds) ; dried dates, 247 grams (8 ounces) ; oranges,
66 grams (2 ounces); olive oil, 21 grams ( 3 /4 ounce). It contained: protein, 54
grams; fat, 22 grams; carbohydrates, 573 grams; and had a heat value of 2,775
calories. (Voit's observation.)
Min, forty-eight years old; height, 5 feet 8 inches; weight, 153 pounds. He
consumed daily: potatoes, 1,000 grams (2 1 /! pounds); hazel nuts, 166 grams (6
ounces) ; peanuts, 12.5 grams (V 2 ounce) ; plums, 83 grams (3 ounces) ; sugar,
71 grams (2V 2 ounces) ; raisins, 93 grams (3V 2 ounces) ; apples, 354 grams (%
pound); oranges, 63 grams (2V 2 ounces); olive oil, 50 grams (1% ounces). It
contained : protein, 63 grams ; fat, 66 grams ; carbohydrates, 593 grams ; and had
a fuel value of 3,302 calories. (Alba's observation.)
The following example of a moderate vegetarian diet is outlined by
Jaffa. His subject was a man, aged sixty-four years, height 5 feet 8
inches, weight 136 pounds; he had been a vegetarian for eleven years.
The total food consumed by him during a period of twenty-four days was
as follows:
542
SPECIAL DIETS
JAFFA'S VEGETARIAN DIETARY
Cereals :
Carried forward
8,790 grams
Granose
2,155 grams
Fresh fruit:
Gluten flour
454 "
Apples
5585 "
Flaked rice
1,673 "
Bananas
2,722 "
Honey
1,985 "
Grapes
3,317
Vegetables:
Raspberries
397 "
Baked beans
1,021
Nuts:
Dried fruits:
Almonds
907
Dates
425 "
Brazil nuts
1 361 "
Figs. .
28 "
Pine-nuts
198 "
Prunes
794 "
Walnuts
907 "
Raisins
255 "
Total
24 184 grams
8,790 grams
These items furnished an average weight of 21,4 pounds of food daily
at a cost of IS 1 /^ cents, containing: protein, 53.5 grams; fat, 76.9 grams;
sugar and starch, 301.8 grams; crude fiber, 10 grams. The fuel value
was 2,043 calories. The man was healthy and well, and lived on a dietary
containing 50 to 60 grams of protein, or about half the amount commonly
accepted as being necessary for a man having a sedentary occupation.
It is unquestioned that a fruit diet in certain diseased conditions is a
valuable trophotherapeutic measure. The subject of Professor Jaffa's
investigation was a healthy, vigorous university student, aged twenty-two,
well set up, and prominent in athletic sports.
For the first week he ate his ordinary mixed food; the next nine days he con-
sumed a diet in which fruit replaced a large proportion of the meat, eggs, fish,
milk and cereals; finally he consumed for eight days a diet consisting entirely of
fruit and nuts.
An examination of the urine and feces of other consumers showed that in
many instances, although the diet was of a low protein character, the amount of
protein digested and absorbed from the food was enough to maintain the nitrogen
balance in equilibrium during the experiment. When the amount consumed daily
consisted of 5 1 /2 pounds of grapes, 6 ounces of walnuts, and a little granose, there
was an actual gain of 1.29 grams of nitrogen, equal to 8 grams of protein. In
another instance the average daily consumption consisted of 4^4 pounds of apples,
8 ounces of dried figs, and 4% ounces of walnuts, which also resulted in a gain
of 1.28 grams of nitrogen, or 8 grams of protein. With a diet averaging 3 l /%
pounds of apples, 9J ounces of dates, 6 ounces of peanuts, a little granose, milk,
olive oil, and tomato, the gain of nitrogen was 2.26 grams, equal to 14.13 grams
of protein. With 5^2 pounds of pears, 7 ounces of walnuts, a little granose and
milk, there was a gain of 4.25 grams of nitrogen, equivalent to 26.5 grams of
protein; and with a diet averaging 16 ounces of walnuts, 18^2 ounces of dried
prunes, and 18 ounces of oranges, there was a gain of 3.42 grams of nitrogen, or
21.38 grams of protein.
FRUIT DIET 543
The experiments in feeding with bananas did not give such good results.
Bananas, dates, and walnuts resulted in a loss of 1.82 grams of nitrogen, or 11.38
grams of protein; bananas, oranges and walnuts gave a deficiency of 1.89 grains
of nitrogen, or 11.8 grams of protein. The consumption of 5 pounds of bananas
a day resulted in a loss of 1.34 grams of nitrogen, or 8.38 grams of protein;
4 pounds of bananas and 4 1 > ounces of almonds daily gave a deficiency of 0.86
grams of nitrogen, or 5.38 grams of protein; 2 1 > pounds of bananas, 21 ounces
of oranges and 5 ounces of pecan nuts gave a deficiency of 1.69 grams of nitro-
gen, or 10.56 grams of protein. A diet of 22 ounces of dates, 2% ounces of
almonds and 12 ounces of olives gave a deficiency of 2.06 grams of nitrogen, or
12.88 grams of protein. A diet of pears and cocoanut gave a loss of 1.57 grams
of nitrogen and 8.8 grams of protein. The deficiency is not great in any of these
cases, but the continued daily loss of 1 or 2 grams of nitrogen by the body is
deleterious and must ultimately result in ill health. It is possible, as we have
seen, to prevent such a loss by means of a carefully regulated diet; but it is
difficult for the non-scientific subject to adjust his diet so carefully to the needs
of the body. In this respect, therefore, we are bound to state that very few
fruitarian diets contain enough protein to maintain the nitrogen balance in equi-
librium, and still fewer contain the amount of protein required by the standards
set up by numerous authorities. The amount of fat in the food is also almost
always below the standard required, and only reaches the standard when the food
contains a large proportion of nuts, olives or olive oil. The nutriment in fruit
consists chiefly of carbohydrates, the digestibility of which compares very favor-
ably with the carbohydrates in a mixed diet. Respecting the heat value of the
food, the following table shows that the amount of energy yielded by the food
is greater in proportion to the amount of fat ; it is low with bananas, but better
when bananas and nuts are consumed together; it is also low with apples, pears
or grapes as a diet, but is considerably improved by the consumption of half a
pound of brazil nuts, pecans or walnuts. A diet of apples, figs and walnuts, or
of pears, figs and walnuts, is capable of supplying enough protein, fat and carbo-
hydrate for the use of the body, and sufficient energy for a man doing moderate
work.
Carefully recorded studies of persons subsisting upon fruits and nuts
are scarce; therefore, the observations of Jaffa(18) are of special interest.
The instructive table on page 544 contains a summary of the food elements
contained in the dietary which each individual, described by Jaffa, ate.
The first six of these people lived on apples, dates, figs, peaches, apri-
cots, bananas, grapes, oranges, pears, plums, raisins, olives, almonds, pig-
nolia, pine nuts, brazil nuts, walnuts, sometimes tomatoes, celery and
honey.
The individuals comprising the subjects for Jaffa's studies were all
vigorous and healthy people. The six-year-old girl had subsisted <>n a fruit
diet since infancy. She was undersized, but this may have been from in-
heritance. During the ten days that she was under observation she gained
544
Age in
Years
Weight
in
Pounds
Protein:
Grams
Fat:
Grams
Carbo-
hydrate :
Grams
Crude
Fiber:
Grams
Calories
Woman
33
90
33
59
110
40
1,300
Woman
30
104
25
57-
72
27
1,040
Girl
13
75.5
26
52
111
46
1,235
Boy..
9
43
27
56
102
50
1,255
Girl
6
30.5
24
58
97
37
1,190
Girl
7
34
40
72
126
8
1,385
Man
63
124
40.3
53.7
286.3
24.6
1,713
Woman
64
136
53.5
76.9
301.8
10
2,043
Boy..
10
58
48.4
67.7
246.7
13.4
1729
Girl
8
37
32.3
81.7
155
10.7
1,403
Woman
34
93.5
42.5
81.1
156.8
9.8
1,432
Man
22
170
85
158.7
366.3
2,936
Man
25
152
68
103
550.1
64.7
3,305
Man
48
153
63
98
401
2,493
Man
28
125
54
22
573
2,775
Man
64
136
54
77
312
2,004
a pound, and her brother, aged nine, gained a pound in a period of twenty-
two days. The thoroughness of digestion and absorption was comparable
with that of an adult on a mixed diet, 80 per cent of the fibrous cellulose
being completely digested. The fourth study of this table was a boy aged
nine, who first subsisted on bananas, oranges and pecan nuts. This same
boy was studied a few months later, and during the observation he sub-
sisted on pears and walnuts, granose and milk. Some of the other persons
in this study ate cereals to a limited extent. The twelfth individual sub-
sisted on grapes, brazil nuts, tomatoes, granose and olive oil. He was
not accustomed to a fruitarian diet, but tried it at the time of the experi-
ment. A striking feature of these fruitarian dietaries is the small amount
of protein and the low caloric value of the diets. However, they approach
very closely to whajj Chittenden has shown is all that is needed to maintain
health and strength.
Fruit Diet in Disease. The value of a fruit diet is especially marked
when employed as a temporary measure in those instances of illness or
poor health in which the protein intake must be diminished, particularly
when the necessity arises for cutting down the purin bodies to the lowest
possible point. When the ordinary diet is confined to fruits and nuts, the
latter should be ground in a mill, mastication should be thorough, only
a moderate quantity of food should be allowed, and the daily meals should
FRUIT DIET 545
not exceed three. The best subjects for the "fruit cure" are those who
habitually overindulge in food and drink,- and whose systems become
choked with the "clinkers" of imperfectly oxidized food. Symptoms com-
monly complained of in this condition are a foul tasting mouth after the
night's sleep, early morning headache and lassitude. This cure is often
useful in intestinal fermentation and putrefaction; in albuminuria, gout,
obesity, hemicrania, and other disturbances common to individuals and
families originally accustomed to plain and wholesome country living.
The attempt of an organism with such a background to adapt itself to the
modern demands of city life, often results in disaster to the bodily mech-
anism. The "fruit cure" in such instances is often beneficial. The low
protein intake allows an increased alkalinity of the blood and decreased
acidity of the urine; in addition, its action is laxative and diuretic, and
the liver cells are stimulated to greater activity, and hinders intestinal
fermentation. In the dietetic treatment of acute nephritis, fruits, such
as oranges, raisins, pears, etc., will augment the carbohydrates of the
milk. This mixed treatment of milk and fruits diminishes the
albuminuria, encourages diuresis, and drives away edema. If a pa-
tient has lost weight, raisins or raisin juice, added to a diet rich in
fat and albumin, will help to regain the loss. If, on the other hand, it
is thought wise to decrease the patient's weight, increase the raisins and
decrease the fats and albuminoids, other fruits and vegetables being par-
taken of at the same time. The fruit diet is useful when occasionally it is
thought wise to institute a fast day, when the only food should consist
of apples, grapes, pears, bananas, or some other variety of fruit.
In some sections, "apple-fasts" have been very popular with many
persons, especially society matrons who have become "fair, fat and forty"
and are anxious to reduce their weight. They are also recommended
in gouty diathesis, chronic rheumatism and chronic disturbances of the
liver, Bright's disease, and in the condition of high blood pressure pre-
ceding the development of arteriosclerosis, and in intestinal fermentations
and putrefaction, etc. "Fasts" on apples alone do not -agree with all pa-
tients, and there are some individuals who believe they cannot abstain
from their ordinary dietary for a period of twenty-four hours, even though
they may consume large quantities of fruit.
The partaking of fruit in acute febrile conditions is a very ancient
practice. Fruits such as grapes, strawberries, oranges, bananas and baked
apples may be taken with impunity in many febrile affections. When
studying the various fruits we learned that the fruit juices nro of consid-
erable dietetic value in the treatment of diseases. The trophotherapeutic
546 SPECIAL DIETS
action of fruit juices increases the secretion of urine and its alkalinity,
and stimulates the kidneys and indirectly the skin; at the same time
these juices act as thirst quenchers. The juices of grapes, oranges, pine-
apples, currants, gooseberries, raspberries and strawberries are freely
used for this purpose. The juice of the lemon is one of the commonest
articles in the sick room in the form of lemonade. The many recipes for
its use in the sick room will be found elsewhere in this volume. 1 The
juice of the orange is also as useful in illness as it is palatable in health.
Various recipes for using orange juice will also be found in the reference
just cited.
LEMON CURE. The "lemon cure" is a very ancient practice in the
treatment of obesity and the gouty diathesis and is highly recommended
when combined with thermotherapy. The usual method is to take the
expressed juice of three fresh lemons in sweetened water three times a
day with the exclusion of milk and fatty foods. Preserved lemon juice
is not as effective as that of the fresh fruit. It is questionable, however,,
if there is any scientific basis for the consumption of lemon juice as an
anti-fat. The manufacturer of quack remedies for obesity uses a large
percentage of citric acid in his remedies which are practically worthless.
The effect of lemon juice upon the food seems to exert an inhibitory power
over steapsin and amylopsin, which retards the digestion of fat and carbo-
hydrates.
GRAPE CURE. Ampelotherapy, or "grape cure," is probably the best
known of the fruit cures. It is usually carried out in southern Europe
at places like Meran and Montreux, but is available wherever grapes can
be obtained. The grape cure depends largely for its good effects on change
of diet and manner of life, the climate and surroundings, and the aperient
action of the grapes. When aided by a simple supporting aliment, it is
a suitable dietary for the overworked, the weak and the convalescent. It
is recommended in conjunction with the spare diet limited particularly
as to hydrocarbons and carbohydrates, in cases of abdominal plethora,
chronic bronchitis and emphysema, chronic constipation, and chronic
gastro-intestinal catarrh. Its use is also valuable in the dietetic treatment
of obesity. When the grape cure is taken in Germany, from one to eight
pounds of grapes are eaten daily and little or no other food allowed.
Those who take the cure are expected to pick the grapes for themselves,
which insures exercise in the open air. This method is particularly
adapted to the obese and to those who lead a sedentary life. The treat-
ment ordinarily consists in taking one pound or more of grapes three
Volume II> Chapter XVII, page 579.
TUFNELL AND BELLINGHAM DIETS 547
times daily from half to one hour before meals, the meals consisting of
light, easily digested foodstuffs, for example, fish, chicken, milk puddings,
stewed fruit, toasts or rusks, and green vegetables, avoiding all rich made
dishes, rich sauces, pickles, potatoes, lentils, pastry, cheese and sweets.
The duration of the course is from four to six weeks. The chief effect
of this alimentation is a laxative one, which renders it suitable in hepatic
ailments, chronic constipation and hemorrhoids. For the analysis of
grapes, see Volume I, Chapter XIX, page 752.
Caultey(14) recommends the following mode of treatment: "Begin
with half a pound of grapes when fasting, an hour or two after a light
breakfast, and again at 5 P.M. In three days give a third half-pound at
noon, or after the midday meal if there is dyspepsia. Gradually increase
the dose to one pound at a time. The aperient effects are manifest in a
few days. It is rarely advisable to give more than two pounds in lung
cases ; three pounds in gastric and intestinal catarrh, the diet being care-
fully regulated at the same time ; and four pounds in other conditions ;
but the amount may be increased to five to six pounds for abdominal
plethora, hepatic constipation and chronic constipation. Figs and prunes
can be added to relieve the monotony of the diet. The course of treat-
ment lasts for six weeks. Small quantities of white bread may be eaten
after the grapes to remove acids from the teeth, and if the gums become
irritated, the mouth should be rinsed out with bicarbonate of soda solu-
tion."
TUFNELL AND BELLINGHAM DIETS
Tufnell's diet for the treatment of aortic and other aneurisms is a
modification of the methods formerly employed by Albertini and Val-
salva(19) in cases which could not be treated surgically. The plan of
treatment was to "detain the patient in bed for forty days, and during
this period to subject him to repeated bleedings, while at the same time
the diet and drink were carefully ordered, so that the daily allowance ad-
ministered in three or four meals should never be such as to fill up the
blood vessels. The practice formerly was to diminish the quantity of meat
and drink gradually every day, until it was cut down to about half a
pound of pudding in the morning and in the evening half that quantity
and nothing else except water, and this also within a certain measure.
After having sufficiently reduced the patient by this method so that by
reason of weakness he could scarcely raise his head from the bed in which
he lay, the quantity of aliment was increased again by degrees until the
necessary strength returned sufficiently to allow him to rise in bed."
548 SPECIAL DIETS
Bellingham in 1852 omitted the blood-letting and devised a method
which was continued by Tufnell, who in 1875 published a monograph on
the subject, the principal aim being the reduction of the force and fre-
quency of the heart's action and to favor the deposition of fibrin on the
wall of the aneurismal sac. The treatment is very debilitating and "only
suitable for cases of saccular aneurism unassociated with disease of the
aortic valve, and for patients who are sufficiently intelligent to understand
the importance of carrying it out strictly and who have sufficient will
power to put up with its discomforts."
Bellingham's dietary is very much the same as Tufnell's, both of
which are given below. They are modifications of the methods adopted
by Albertini and Valsalva, who treated their patients by bloodletting, rest
and modified diet.
BELLINGHAM TUFNELL
Breakfast Milk or tea 2 oz. Milk or cocoa 2 oz.
Bread 2 oz. Bread and butter 2 oz.
Dinner Liquid 2-4 oz. Water or light claret 4 oz.
Bread 1-2 oz. Bread or potato. 3 oz.
Meat 1-2 oz. Boiled or broiled meat 3 oz.
Supper Liquid 2 oz. Milk or tea 2 oz.
Solid 2 oz. Bread and butter 2 oz.
Tufnell's diet contains eight ounces of fluid and ten ounces of solids.
It is true that this dietary, or one quite similar, though not so severe, has
often modified pain or caused it to disappear entirely, while the aneurism
has become smaller and pulsated less ; but many patients refer to the cure
as worse than the disease. The method of treatment as outlined by Caul-
tey(14) directs that the "patient should rest on a water bed and remain
absolutely still, doing nothing whatever for himself, a restriction which
few people have the strength of will to adhere to. The mouth may be-
come so dry and parched that even the limited amount of solids cannot be
taken. Sucking a pebble or button will relieve the thirst a little. An-
other great trial to the patient is painful micturition, because of the ex-
treme acidity of the urine. It can be reduced by alkalies. Constipation
must be relieved by oil enemata if necessary. There is so little waste
matter in the food that an action of the bowels once a week is sufficient.
The heart and aneurism must be carefully watched. If the pulse becomes
more and more frequent, the patient restless, and the dryness of the mouth
so great that he is unable to take food, the treatment must be modified."
Such a restricted diet is no longer believed bv able clinicians to be
WEIR MITCHELL DIET 549
essential to good treatment, while an abstemious, nutritious diet is. This
starvation treatment is only advisable in well-nourished subjects, espe-
cially those with a plethoric temperament. It is, on the other hand, al-
together unsuitable in weak or debilitated subjects. In the latter class
there is more often than not an enfeebled digestion and it may be advis-
able in the beginning to resort to a milk or lacto-vegetarian dietary. Rest
in bed or in mild cases gentle exercise should be insisted upon. To-day
the iodids are almost universally relied upon. In recent years the sub-
cutaneous or intravenous injection of gelatin has been used with some
success. Of course, the gelatin should be sterilized and the strictest care
taken to prevent sepsis.
The important points to keep in mind in prescribing a dietary in all
cases are, according to Watson (15), the following:
(a) Restriction in the amount of fluids of all kinds. Not more than from
20 to 30 ounces in the twenty-four hours.
(6) Meats and meat foods to be given in very sparing amount, the stimulating
effects of these foods on the circulation being prejudicial.
(c) A light, simple, nutritious diet, given thrice daily, with no food between
meals. The meals should be much on the lines of the diet laid down on page 548.
(d) Alcohol in all its forms is inadvisable, excepting in cases of feeble diges-
tion, where its use in small doses may prove beneficial.
WEIR MITCHELL DIET
The Weir Mitchell diet(20) is recommended by the author for the
dietetic treatment of neurasthenia and disorders of malnutrition independ-
ent of organic disease. The principal points in carrying out this method
of treatment are isolation, massage and forced feeding. The isolation
from friends, callers and the family exerts a beneficial and moral effect.
Massage and electricity aid in promoting digestion and the nutrition of
the muscles. A good nurse is essential. She must be kind, bright, sen-
sible, and able to make a favorable impression on the patient.
The patient should be kept in bed for at least six weeks, leaving it only
to go to the toilet. Mitchell recommends that the milk diet should be
instituted gradually, especially if the patient has an aversion for milk.
It should be given in doses of one or two ounces every two hours and
gradually increased until as much as two quarts are drunk in the twenty-
four hours. In some cases Mitchell recommends that the milk should be
given even at night as often as every three or four hours. At the end of
the tenth day an egg or chop should be eaten at noon in addition to the
usual allowance of milk. Often earlier than this Mitchell proscribes
135
550 SPECIAL DIETS
meat juice once or twice a day. A day or two later bread and butter are
given and an egg or some meat at breakfast as well as at dinner. By
degrees the patient is placed upon a diet of three simple but generous
meals' daily, and in addition, three or four pints of milk are consumed,
the latter being administered partly with the meals and partly between
meals.
The following is a synopsis of the management of an individual case
of Weir Mitchell's and is appended to illustrate the practical application
of his rest cure :
WEIR MITCHELL'S DIETARY
Mrs. C., kept in bed, fed by an attendant, rise only to relieve bladder and rectum.
First Day: One quart of milk in divided doses every three hours.
Second Day: Cup of coffee on awakening. Two quarts of milk in divided doses every
two hours. Aloetic pill at night.
Third to Sixth Day: Same diet.
Seventh, Eighth, and Ninth Days: Same diet, with a pint of raw soup in three portions.
This is made by chopping up one pound of raw beef and placing it in a bottle with
a pint of water and five drops of strong hydrochloric acid. The mixture stands
in ice all night; in the morning the bottle is put into a pan of water at 110 F.,
and kept two hours at about that temperature. This mixture is then thrown into
a stout cloth and strained until the mass that remains is nearly dry. If the raw
taste proves very objectionable, the beef to be used is first quickly broiled on
one side and then the process is completed in the manner previously described.
Tenth Day: 7 A.M., Coffee; 7.30 A.M., 10 A.M., 12 M., 2, 4, 6, 8, 10 P.M., Half a pint of
milk; 11 A.M., 5 and 9 P.M., Soup.
Fourteenth Day: Eggs, and bread and butter added.
Sixteenth Day: Dinner added and iron.
Nineteenth Day: The entire diet was as follows: 7 A.M., Coffee; Breakfast, 8 A.M., Iron
and malt extract, chop, bread and butter, a tumbler and a half of milk; Lunch,
11 A.M., Soup; Dinner, 2 P.M., Anything liked, with six ounces of Burgundy or
dry champagne, and at the end one or two tumblers of milk. Iron and malt;
Tea, 4 P.M., Soup; Supper, 7 P.M., Malt, iron, bread and butter, usually some
fruit, and two glasses of milk; Late Supper, 9 P.M., Soup; 10 P.M., Aloetic pill.
At 12 noon, massage for an hour. At 4.30P.M., electricity applied for an hour.
Sixth Week: Soup and wine were dropped, iron lessened one-half; massage and elec-
tricity only on alternate days; 1/30 of a grain of strychnin sulphate thrice a
day at meals given (continued for several months).
Ninth Week: Milk reduced to a quart. All mechanical treatment ceased.
RESULT: Gain in flesh about face in second week. Weight rose in two months from
96 to 136 pounds; gain in color equally marked. On thirtieth day patient had
normal catamenial flow after five years of failure to menstruate. Ninth week,
drove out. Cure complete and permanent.
WHIR MITCHELL 1)1 KT 551
By the end of the sixtli week of this treatment, the patient may be
returned to a full diet and in addition take at least from 00 to 80 ounces
of milk per day.
FULL NEURASTHENIA DIETARY (Weir Mitchell)
Early Breakfast, 7 A.M. :
10 ounces of milk.
Breakfast, 8.30A.M.:
Plate of porridge or gruel, or hominy; or bowl of bread and milk with a gill of
cream; fish, bacon, eggs, or kidney; cocoa or coffee; bread or rolls; butter or
marmalade.
Lunch, 9 A.M.:
10 ounces of milk.
Second Lunch, 11 A.M.:
Cup of beef tea with 2 teaspoonfuls of beef peptonoids.
Dinner, 1 .30 P.M. :
Fish, tripe, sweetbread, cutlets, game or poultry, served with one .vegetable, with
a sweet such as stewed fruit; 10 ounces of milk to be sipped slowly during this
meal.
Afternoon Lunch, 4 P.M. :
10 ounces of milk with sponge cake; bread and butter, or rusk.
Supper, 6.30 P.M. :
A three-course meal. Soup or fish; joint or poultry; sweet or savory, or dessert;
taking with meal 10 ounces of milk.
Late Supper, 8.30 P.M. :
Beef tea and 2 teaspoonfuls of peptonoids.
10 P.M. :
10 ounces of milk.
Occasionally a physician is called upon to attend a stout patient with
llabby muscles presenting the usual symptoms of neurasthenia. In the
successful handling of this type of patients, a mild starvation is a neces-
sary preliminary for a few days prior to beginning the Weir Mitchell
treatment. This method of treatment is recommended by Playfair as fol-
lows :
Confine patient strictly to bed; diet with skimmed milk, at first two quarts
per diem, given in small quantities every two hours; after a day or two lessen
this gradually till not more than a pint per diem is taken. If the patient's strength
fail unduly under this, some beef tea or soup may be temporarily substituted for
the milk. Under the minimum diet the weight gradually loses about ^2 pound
per diem (the patient should be weighed every second day), and when some 1-1
to 20 pounds have, been taken off, pure milk may be substituted for skimmed,
and the treatment as detailed above pursued.
552 SPECIAL DIETS
TRAINING DIET
The training diet is a question which has been agitated during recent
years by the leaders in field athletics at the greater schools and universities
both of this country and Europe (21). Of late, a great deal has been
written pertaining to the diet best adapted for athletes, both amateur and
professional, when training for a contest, in order to have them physically
fit for feats of ^endurance. The necessity of this training is fully recog-
nized by all athletes, and while opinions may differ as to the methods,
there is more or less accord in the ideal that is sought. The object of
training is to put a man in condition to execute a large amount of work,
and sometimes skilled work, in a very short period of time, which is quite
a different problem from feeding a laborer or artisan. The latter re-
quires an alimentation which will enable him to do a large amount of
work daily, continuing over a long period of time.
The usual training diet has been based on a liberal allowance of meat,
on the assumption that the wear and tear of muscular tissue is great and
that meat is the greatest source of strength and less fattening than other
foods. The great nervous and muscular energy of carnivorous animals
is often quoted to substantiate this assumption. We know that the race
horse is the fastest animal for a reasonable distance, but certain species of
the carnivora can maintain a short burst of speed which will exceed that
of the race horse. It is not questioned that a liberal supply of animal
food is suitable for a short distance runner, but it certainly is not a suit-
able diet for prolonged exertion, as may be seen in the case of the Japan-
ese, who on a vegetable diet are able to run continuously for hours at a
time and drag a jinrikisha occupied by a passenger.
The general principles of training are: (a) the reduction of weight
by the removal of superfluous fat; (6) the improvement of the tone of the
muscles and heart, inducing long "wind" and endurance. During the
period of preparation for an athletic test, muscles must be made to grow
and the waste caused by trial tests of strength be repaired. Proteins are
necessary for cell growth and repair, as well as to furnish nervous energy.
Although carbohydrates are an economical source of a large number
of calories or units of energy, so that muscular work can be performed
on such a diet, nevertheless rapid and accurate muscular work, that
entailing correct correlation of movements, demands much nervous energy,
and for this type of work proteins are necessary. Under conditions re-
quiring the ingestion of large quantities of food, a generous proportion of
proteins should be furnished on account of their ease of digestion. The
TKAINING DIET 553
carbohydrate intake should be carefully choseii and skillfully prepared,
so that this part of the diet may also be easily digested. Professional
athletes recognize the importance of keeping "fit" and being in perfect
trim in order to perform feats of strength and endurance. In. a well-
trained athlete the muscles are hard and firm, the fat is reduced to a
minimum, the skin is clear, the eyes bright, the expression indicative of
perfect health, the body is active and the "wind" good.
The length of time necessary to train varies with the previous habits
and mode of life of the individual. Ordinarily, the average college youth
of the athletic type can be put in fit condition in six weeks, and it must
be borne in mind that the transition from ordinary habits to those of train-
ing should be gradual both as to the regulation of the alimentation and
of exercise.
Practice and experience have emphasized the advisability of a gener-
ous mixed, liberal, full diet as the one calculated to put an athlete in the
best trim. At the training tables of the Harvard and Yale crews such
food as the following is eaten : Good lean beef or mutton, best given under-
done, toast made from stale bread, and potatoes and green vegetables of
all kinds. Fruits, beef, lamb, mutton, chicken, fish, bacon and eggs, and
simple pudding's are allowed, but no highly seasoned food is permit-
ted (22). The following articles are prohibited: entrees, rich puddings,
pastries, sauces, pickles, spices, appetizers, and all fanct and complex
dishes. Made dishes or dishes made from twice-cooked meats, all spirits
and strong alcoholic drinks, as well as tea, coffee and nerve stimulants are
prohibited. Tobacco, in all forms, is strictly forbidden. Water is allowed
in liberal quantities, but if there is a tendency to obesity, the amount is
somewhat limited, the quantity being gradually reduced and only suffi-
cient quantity allowed to allay thirst. We have already referred to carbo-
hydrates as producers of strength. In this connection it is interesting to
note the experiences of the Holland oarsmen, who, according to
Davis (23), "while in training began to show signs of overwork, loss of
flesh, a lack of ambition and energy, and a disinclination for study and
work. By eating sugar as freely as they wished, sometimes as much as
one-third of a pound a day, they were refreshed and able to win the race
against the antagonists who did not believe in its use." Sugar, ;i crystal-
lized carbohydrate, is permitted as an adjunct to the dietary of the athlete
in training, but pies, cakes and other sweets and more or less indigestible
dishes, as already pointed out, should bo forbidden (24).
Atwater and Bryant(25) conducted experiments on this particular
question, from which we cite the following :
554 SPECIAL DIETS
Two young men, with only two hours a day for practice, at the end of two
months entered for the race. No change had been made from their usual diet,
except that they ate as much sugar as they wished, sometimes as much as a third
of a pound at the time of their daily exercise. One of them, however, did not
make this addition to his diet until the third week, when he began to show all the
signs of overtraining loss of weight and a heavy, dull feeling, with no desire
for study. On the third day after beginning the use of sugar these symptoms
disappeared. At the time of the race both youths were victorious over their
antagonists, who did not. believe in the use of sugar. No bad effects were observed.
An athlete in training must ingest more food and in larger amounts
than a person of the same physique following an ordinary vocation,
but care must be taken not to overeat and thereby derange digestion ; nor
must the meals be eaten at too long intervals.
The following report of the Yale crew, on the authority of Dr. Hart-
well, formerly a captain of the University crew and of the University
football team, is quoted from Thompson (26) :
The training covered a period of ten and one-half weeks.
DIETARY, YALE TRAINING CREW
Breakfast, 7.30A.M.:
Fruits (oranges, tamarinds, figs, and grapes): cereals with rich milk and sugar,
etc.; beefsteak, usually rare; chops, stews, hash, with once or twice a week
some salt meat, as bacon or ham, usually accompanied 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, 1 P.M.:
Soups, meats, fish, vegetables, with a simple dessert, such as rice, bread, or tapioca
pudding, some fruit, and the same beverages as at breakfast were also used.
The meats included roast beef, mutton, or chicken, two kinds being always
served. But little gravy was used. Fish was served twice a week. The vege-
tables included potatoes, mashed or boiled; tomatoes, peas, beans, and corn.
Two vegetables besides potatoes were usually served.
Supper, 8 to 8.15 P.M.:'
Cereals, as at breakfast; chops, stews, or cold meat from dinner; rarely beef-
steak; potatoes, stewed or baked; and eggs about three times a week, usually
not on the same days that they were served for breakfast. Sometimes ale was
permitted to some individual.
After the crews were in final preparation for the race at New London the diet
varied somewhat: Breakfast and dinner remained about the same, but a light luncheon
of cold meat, stewed or baked potatoes, milk and toast was served at 4.30 in the after-
noon. After this the evening exercise was engaged in for about two hours. Forty-
five minutes after this was completed cold oatmeal or other cereal with milk and toast
was served. A light supper was served at 9.30, just before the men retired. This
diet was much more liberal than that served ten years before. The men were allowed
as much food as they desired.
TRAINING DIET
555
The table of dietary studies incorporated herewith is taken from the
extensive studies of Atwater and Bryant, giving the summary -of results
of dietary studies of university boat crews, football teams, and of pro-
fessional athletes, and compares them with the standard dietaries of men
engaged in various occupations.
DIETARY STUDIES OF UNIVERSITY BOAT CREWS
NUTRIENTS ACTUALLY EATEN PER MAN PER DAY
Crews
Protein,
grams
Fat,
grams
Carbo-
hydrates
grams
Calories
Harvard University Crew
162
175
449
4,130
Harvard Freshman Crew
153
223
468
4,620
Yale University Crew
145
170
375
3,705
Harvard University Crew (Gales Ferry) . .
Harvard Freshman Crew (Gales Ferry).. .
Yale University Crew (Gales Ferry)
160
135
171
170
152
171
448
416
434
4,075
3,675
4070
Captain Harvard Freshman Crew
155
181
487
4,315
Average
155
177
440
4,085
It is interesting to note that these dietaries for the university crews
are very similar to that advised for Americans during a period of hard
work. They are a little fuller than the English and German standards.
Football teams lead in the quantity of food ingested. Relative to the
other carbonaceous foods, the proportion of protein is markedly increased.
Comparing the dietary of college students in training with that of an
ordinary college club, the excess of proteins in the former is very notice-
able. The average diet of a training crew contains 1 .">."> grams of protein
and yields 4,085 calories, making a difference in fuel energy between the
two of alxmt 400 calories. The diet furnished the oarsmen at Gales Ferry
yielded the oarsmen one-ninth more energy than that of the men not en-
gaged in athletic work. In other terms the difference amounted to 48
grams or an increase of nearly one-half of protein.
Atwater and Bryant (27) outlined the following account of the dietary
of the Harvard boat crew at Cambridge :
The diet was simple, and consisted of roast and broiled beef and lamb,
fricasseed chicken, roast turkey and broiled fish. Eggs, ra\v, poached or boibd
in the shell, were used plentifully. Large amounts of milk and cream were also
consumed. Oatmeal, hominy and shredded wheat were eaten extensively, and
corn cakes were served occasionally. Bread was almost always taken in the form
of dry toast. Potatoes were served twice a day, either baked or boiled and
mashed, with the addition of a little milk and butter; occasionally they were
creamed. Boiled rice, prepared with a little cream and sugar, was served instead
556
SPECIAL DIETS
of potatoes at some meals. Beets, parsnips, green peas and tomatoes were used
to furnish a variety of vegetables. Macaroni was occasionally served. For des-
sert, apple, tapioca, custard, or other pudding containing a large proportion of
milk and eggs, was served. The members of the crew were allowed beer once a
day. Milk was obtained from one of the large creameries supplying that vicinity,
and was of unusually good quality, containing 5.8 per cent of butter fat. A very
thick, heavy cream was also used, diluted about one-half with milk. This mixture,
or thin cream, contained about 16 per cent of butter fat.
The animal food consumed during this study was entirely from the loin of
the beef. Occasionally the roasts were from the fillet, and at other times the
ordinary loin roast with the bone was used. The meat was sliced in liberal por-
tions, being previously practically freed from all the clear fat and tissue, and
sent to the table on a large platter from which the men were served individually.
The beef was cooked underdone and served rare. When the beefsteak was served,
it was freed from the bone, nearly all of the visible fat being removed. Lamb
chops were served with the bone. Lamb and mutton roasts were all taken from
the leg, and were also clear meat, trimmed free from visible fat. The turkey
used was shipped from a distance and had been in cold storage. It was baked
with stuffing and dressing, although very little of the latter was served to the
crew. Chicken was always prepared fricasseed and served free from bone, except
the leg and wing. Fish was usually served for breakfast, bluefish and Spanish
mackerel, broiled. Eggs, either raw or poached, were also allowed. No pastry
was permitted, and puddings, as previously stated, were composed largely of eggs
and milk-. No fresh fruit except oranges for breakfast was permitted. Stewed
prunes, rhubarb, or apples were eaten most abundantly. No beverages other
than water or beer were allowed.
Yeo(28) gives the dietary of the English boat crews at Oxford and
Cambridge. It may be interesting in this connection to compare the
A DAY'S TRAINING FOR THE SUMMER RACES
OXFORD
7 A.M. :
Rice; a short walk or run.
Breakfast, 8.30 A.M. :
Underdone meat; crust of bread or
dry toast; tea (as little as possi-
ble).
Dinner, 2 P.M. :
Meat (as at breakfast); bread; no'
vegetables (not strictly adhered
to); 1 pint of beer.
5 or 5.30 P.M.
Rowing exercise.
Supper, 8.30 or 9 P.M.
Cold meat or bread; sometimes jelly
or water-cress; 1 pint of beer.
10 P.M.:
Retire to bed,
CAMBRIDGE
A run of 200 yards as fast as possible.
Underdone meat; dry toast; tea, 2
cups (later only IK); water-cress
(occasionally).
Meat (as at breakfast); bread, pota-
toes, and greens; 1 pint of beer.
Dessert: oranges, biscuit, or figs; 2
glasses of wine.
Rowing exercise.
Cold meat; bread; lettuce or water-
cress; 1 pint of beer.
TRAINING DIET 557
A DAY'S TRAINING FOR THE WINTER RACES
OXFORD CAMBRIDGE
7.30A.M.: 7A.M.:
Rice. A short walk or run. Exercise as for summer races.
Breakfast, 9 A.M. : Breakfast, 8.30 A.M. :
As in summer. As in summer.
Luncheon, I P.M.:
Bread or a sandwich and j^> pint of A little cold meat; bread and j/ pint
beer. of beer, or biscuit and glass of sherry
(sometimes yolk of egg hi the sherry) .
2 P.M. :
Rowing exercise. Rowing exercise.
Dinner, 5 P.M.: Dinner, 5 to 6 P.M.:
Meat as in summer; bread; same As in summer,
rule as in summer as to vegeta-
bles; rice pudding or jelly; ^pint
of beer.
10 P.M.:
Retire to bed.
Water strictly forbidden. As little
liquid to be drunk as possible.
English dietaries with the dietaries at Yale and Harvard. Maclaren gives
the following schemes of training as carried out at Oxford and Cam-
bridge :
In making a resume of the results of their observations, Atwater and
Bryant state that, in a "general way, the difference between the food of
the athletes and that of other people represents a difference in actual phys-
ical need even if neither is an accurate measure of that need." The prin-
cipal difference in the food of athletes as compared with that consumed
by ordinary working people or college men is that the dietary of the
former, owing to the large percentage of protein, is productive of a larger
amount of energy. An increase of protein is necessary, not so much to
provide additional energy as to make good the wear and tear of the strain,
on muscular tissue expended in the performance of strenuous exercise or
laborious work, as well as in certain cases to enable the muscle to add sub-
stance to its bulk. The daily excess of the athletic diet over ordinary diet
is about 400 calories or 10 per cent. The amount of protein consumed in
the Atwater experiments was about 45 per cent above standard dietaries.
"In other words, the difference in protein was four and one-half times as
great as the difference in fuel value, and the excess in protein would ac-
count for a considerable part of the excess of energy of the diet of the
athletes as compared with men in ordinary occupation."
In the final summing up of their research and experiments, Atwater
and Bryant record the following interesting observations:
558 . SPECIAL DIETS
In this connection it is interesting to observe that many physiologists arc
coming to entertain the view that the amount of metabolism in the body is regu-
lated not simply by the muscular work, but also by the nervous effort required in
the performance of this work. The especially large proportion of protein ob-
served in the dietary studies of the university boat crews, of football teams, of the
professional athlete and of the pugilist, as compared with the dietary studies of
college men with ordinary exercise, and with ordinary families of workingmen and
professional men, accords well with a view not uncommon of late among physi-
ologists. According to this view, men who perform continued " muscular labor,
even if it is active enough to make the total amount large, do not require espe-
cially large 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 material. On the contrary, when a man or animal
must perform intense muscular work for a short period of time, and is, there-
fore, under more or less nervous as well as muscular strain, a considerably larger
supply of protein seems to be required than under normal conditions of slow,
long-continued work. In other words, if a large amount of work must be done
in a short time, a considerable excess of protein is required in the food. This
view, which has been especially advocated by Zuntz(29), seems to be favored by
the results of dietary studies above discussed.
Recent experiments made by Dunlop, Paton, Stockman and ]\Fac-
adam(30) have to do with the amount of protein required when severe
muscular work is performed. The results are discussed with especial ref-
erence to training, and are believed to "show the importance of two points
long known to athletes and others doing excessive muscular work."
The one is the importance of proper training, for by it an abstraction of
protein matter from tissues other than muscle can be avoided; the other is the
importance of there being a sufficiency of protein in the diet to compensate for
the loss which occurs. An abundance of protein in the diet of an athlete has
other functions to fulfill besides this. It is required during training for building
up the energy-liberating mechanism the protoplasm of muscle; and it is also
required after work to repair that mechanism. The benefits of training are well
known in other ways, such as preparing the heart for suddenly increased duty
and limiting the after fatigue effects.
The power of the body to perform the maximum of muscular work within a
comparatively short time and with a minimum amount of fatigue is secured by
means of training. Of course, skill in application of muscular strength is as
essential as is the amount of power exerted. The skill is sought by exercise and
practice. The object of regulating the diet in training is not only to furnish the
material to supply the power, but also to put the machine in the best condition
for developing as well as applying the power. In other words, the man is to be
subjected for a short time to intense muscular strain and considerable nervous
effort. This he is to bear with a maximum of result and the 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
m-:i>rri\(; DIKTAIJY
intense muscular effort is required for short periods should supply liberal amounts
oi' energy and especially large amounts of protein.
REDUCING DIETARY
A reducing dietary may be so planned that one may dine both well
iiiid wisely, omitting the fat-forming foods. Of late, the slim, sylph-like
figure has become fashionable, and the physician is daily importuned
with: "Doctor, what shall I do to reduce?" When a society matron be-
comes "fair, fat and forty," she is desperate to reduce and will rigidly
adhere to any dietary her physician will outline. Lately both men and
women of the first "four hundred" have fasted and fumed, boiled in
Turkish baths, and rolled the floor in various gyratory calisthenic con-
tortions, strenuously fighting the tragedy of fat.
We have previously pointed out that everyone, as a rule, and more
especially the corpulent individual, eats too much and sleeps too much.
In the majority of instances, corpulency is due directly to overeating, and
the average dietary consists largely of fat-making foods, from soups to
nuts. It follows then that the natural cure for corpulency is to restrict
the ingestion of fat-producing foods carbohydrates and hydrocarbons.
Of the former, ^lahdah advises the elimination from, the dietary of the
following: bread, biscuits, crackers, and anything made from wheat, corn,
rye, barley, oats, cereals and breakfast foods ; rice, macaroni, potatoes
and dried legumes; pies, cakes, puddings, pastries and custards; candies,
bonbons and all sweets, including ice cream and sirup-sweetened soft
drinks. Of the latter class, we would advise the total abstinence from
pork, ham, bacon and the fat of any meat; milk, cream, cheese, butter,
olive oils and any foods seasoned with grease (Mahdah menus).
At first glance, it would seem that there is little left to eat, but one
may dine well and wisely from a menu made up of the following: All
kinds of meat except swine flesh ; all kinds of game, including fowls : all
kinds of sea food, fish, lobsters, clams and oysters; all fresh and dried
fruit with the exception of grapes and bananas; all varieties of salad made
from fresh vegetables and served with dressings free from olive oil; all
types of meat jellies; cucumbers, celery, mushrooms, tomatoes, olives,
pickles and chili and Worcestershire sauce. Of green vegetables, any of
the following are permissible: Brussels sprouts, string beans, cauliflower,
beets, spinach, lettuce, beet-tops and turnip-tops cooked as purees, carrots,
squash, celery root, salsify, cabbage, endives, artichokes, radishes, par-
snips, eggplant, onions, asparagus (Vance Thompson, Mahdah).
"From the foregoing, a menu can be made up that w r ill be satisfying
560 SPECIAL DIETS
and contain sufficient food value for healthful maintenance. In Mahdalr s
"Eat and Grow Thin" * will be found menus especially calculated to get
rid of excess fat. By following these menus religiously, it is believed
that corpulent individuals, without question, lose from fifteen to thirty
pounds within a period of three months. It will be noted that these menus
do not provide for breakfast. This meal consists largely of fresh or
stewed fruit and twice a week boiled or poached eggs may be served ; tea
or coffee is allowed without cream or milk; other than this, no fiuids are
to be taken with the meals. Of course, between meals sufficient water to
quench thirst may be taken with impunity.
DIET FOR PROFESSIONAL SINGERS AND LECTURERS
Beyond question diet exerts more or less influence on the fullness and
richness of the- voice. A hearty meal interferes with full, free respiration
to the extent that singing is practically or even entirely impossible. The
vocal cords may become congested following the ingestion of food or drink,
and smoking often exerts an injurious effect upon the voice. Alcoholic
drinks imbibed to excess, as well as irritating articles of food, may, and
often do, impair the tone of the voice and should be .omitted.
Opera singers possess peculiar and curious idiosyncrasies. Certain
articles of alimentation exert a deleterious effect upon the voice of some,
while the same food will have just the opposite effect on others. Ruh-
rah(31), quoting Russell in "Representative Actors," delineates an inter-
esting list of foods and beverages partaken of by prominent stage folk
prior to appearing before the footlights. He states that "Edmund Kean,
Emery and Reeve drank cold water and brandy; John Kemble took
opium ; Lewis, mulled wine and oysters ; Macready was at one time accus-
tomed to eat the lean of a mutton chop previous to going on the stage, but
subsequently lived almost exclusively on a vegetarian diet ; Oxbury drank
tea ; Henry Russell ate a boiled egg ; W. Smith drank coffee ; Braham
drank bottled porter ; Miss Catley took linseed tea and Madeira ; G. F.
Cook would drink anything; Henderson used gum arabic and sherry;
Incledon drank Madeira ; Mrs. Jordan ate calves'-foot jelly and sherry ;
C. Kean took beef tea : Mrs. Wood sang on draught porter ; Harley took
nothing during a performance. Malibran, it is said, ate a lunch in his
dressing-room half an hour before singing. This consisted of a cutlet and
half a bottle of white wine, after which he smoked a cigarette until it was
time to appear."
i Volume III, Chapter XXVII, "Mahdah's Menus," '^at and Grow Thin," by Vance
Thompson, pub. by E. P. Dutton, N. Y.
THE DRY CUKE 561
While discussing food and drink for actors and their peculiar idio-
syncrasies, we will relate the dietary habit of Mr. Edmund Kean, who,
according to Smith, 1 "was in the habit of adapting the kind of meat he ate
to the part he had to play, choosing pork for tyrants, beef for murderers,
and lamb for lovers." This may seem a stretch of the imagination, a but
it may indicate that there are subtle differences in the different kinds of
meat which chemistry has not enabled us to detect, but which are yet not
without influence upon the body."
Ordinarily, no food should be partaken of immediately before singing
or speaking, but a good meal should be ingested some three hours before,
which should be somewhat lighter than usual. It is the habit of many
singers and speakers to refrain from food prior to their performance or
lecture, and to partake of a good full meal soon after. According to Ruh-
riih, the food much used by singers is the so-called "Jenny Lind soup,"
which is a very bland potion, and does not impair the voice. "It is made
of bouillon and sage, to w r hich are added the yolks of two eggs and half
a pint of cream before serving; sugar and spices are added according to
taste. Many prominent singers suck an orange, while others chew dried
plums immediately preceding their performance." During the interval
between performances, a singer, like any other professional person, should
subsist on a well-balanced general diet, of course avoiding irritating foods.
Singers who have a tendency to obesity should follow the dieting and exer-
cise laid down in "Volume III, Chapter XII, for the treatment of this
condition. Alcoholic liquors and strong beverages do not in any way im-
prove the voice, but on the other hand may exert a deleterious effect, and
should therefore be avoided. Light wines and beer in moderation may
usually be taken with impunity. They are best avoided, however, as their
continual use may possibly lead to the formation of a drinking habit.
M:my of the best singers are of the opinion that smoking is injurious to
the voice ; on the other hand, many famous male singers are habitual users
of tobacco and are rarely seen without a cigar in their mouth.
THE DRY CURE
The dry cure consists in withholding fluid from the diet, Driving less
and less each day, until the patient takes the least possible amount that
will sustain life. If carried to this extreme, the thirst becomes both in-
tolerable and practically unbearable, and as a result, patients strenuously
rebel. It has been found from actual experiment that the minimum
1 Dr. Smith in his work on Foods.
562 SPECIAL DIETS
amount of water, aside from that contained in the food, which patients
can bear is about 15 ounces per diem, which should be taken during the in-
tervals between meals. For the relief of the insatiable thirst in these cases,
various measures are employed. It is said that shipwrecked sailors in
open boats have relieved their thirst by immersing their bodies in salt
water. Under ordinary conditions, however, the skin is not capable of
absorbing fluid to any appreciable extent, but, on the other hand, im-
mersion in water prevents evaporation from the surface of the body,
which to some extent saves a loss in this direction and thereby satiates
thirst. Sucking a slice of lemon or drinking water acidulated with a
few drops of lemon juice or vinegar is said to allay thirst better than
plain water. Barley and oatmeal waters are occasionally used as thirst
quenchers.
A dry diet has been extensively tried by German clinicians, especially
in cases of gastric dilatation and in chronic effusion in the joints and
in peritoneal cavity. Many types of disease are benefited by a temporary
restriction in the daily amount of fluids consumed, but it is hardly ever
justifiable to resort to the extreme degree recommended by enthusiastic
devotees of the dry cure. Thompson says that patients in charge of
advocates of the dry cure have developed fatal cases of scurvy, as well
as cases of fever with a temperature running sometimes as high as 104 F.
A temporary restriction in the quantity of fluid is of dietetic value in
gastric dilatation, chronic serous effusion, flatulent dyspepsia due to
ingestion of sweets, coffee and tea in too large amounts. It is also ad-
visable in some cases of obesity and aneurism to withhold fluids. Con-
sult the Bellingham and Tufnell Dietary, previously outlined (see page
547).
The "dry diet cure," says Albu(32), "is as old as the Greeks, but was
revived by Schroth in his so-called semmelkur, and has achieved some no-
toriety in Europe, where several 'institutes' have been established for its
practice." The alimentation consists of the consumption of five or six
dry rolls in the course of a day, while liquids are entirely restricted for
a period varying from five to six days. The method is so rigorously dry
that many patients find it difficult to endure, saying the "cure is worse
than the disease." Boiled vegetables are allowed for dinner, otherwise
nothing is given but dried bread. Thirst becomes so extreme after three
or four days that the patient is allowed hot wine freely as a thirst
quencher, after which the quantity of fluid is again out down to two
glasses a clay until the patient is again obliged to have more fluid. .Tergu-
son found Schroth's diet useful in the treatment of plethora and perito-
THE YOLK CURE 563
neal effusions. He observed that abstinence from fluid caused great dis-
tress, so he modified the diet by giving from one-third to two-thirds of a
pound of lean beef with bread and light red wine. Sweiten found the dry
diet useful in the treatment of dilatation of the stomach. Albu(32) found
the dry diet valuable in the dietetic treatment of renal and cardiac dropsy.
The patient 011 returning to the accustomed diet must be cautioned to do
so with great care, taking food only in very small portions, a very little
at a time. A rapid gain in weight will be noted, which is attributed in
part to the restoration of water to his tissues. Bartels observed an increase
in urea which was greatest immediately after the treatment. The high
temperature accompanying this method of treatment is explained by the
fact that but little water is evaporated from the lungs and skin, causing
the body heat to be retained. As has been suggested, the dry diet cure
has in many instances been carried to the verge of starvation with extreme
prostration, fever and fatal cases of scurvy, and has little or nothing to
recommend it.
THE YOLK CURE
Egg yolks as an addition to the diet of the underfed and badly nour-
ished are often of the greatest service in a variety of forms of faulty
nutrition. In certain instances in which there is inability to assimilate
the entire egg, the yolks are of great value. A daily portion of from ten
to forty yolks may be added to the customary diet. The white of
the egg consists of a solution of protein shut up in the interior of many
millions of cells. The protein of the white of egg is called "egg-albumin."
The yolk is a storehouse of nutriment for the young chick, and conse-
quently has a very different composition from the white. 1 It contains
much less water and more solids, among the latter being a large proportion
of fat. The general composition of the white and yolk is contrasted in
the table on page 351, to which the reader is referred. The palmitin,
stearin and olein are simply fats such as we have already encountered
in butter and have the same nutritive value as these. Their presence in
the form of an emulsion in the yolk makes them more easily digested,
which renders the yolk particularly suited to individuals whose nutrition
is below par and who do not do well on ordinary diets.
Stern (33) gives the following simple dietary for a patient whose nor-
mal weight should be 140 pounds, but who, owing to debilitation, weighs
only 110 pounds :
See Analysis of Eggs, Volume T. Chapter XTT, p. 351.
564
SPECIAL DIETS
DIETARY FOR DEBILITY
Number
of yolks
Calories in
the yolks
Total num-
ber of calories
Breakfast:
250 c.c. skim milk with 4 yolks;
30 grams wheat toast
4
200
200
75
Forenoon Lunch:
Cup of coffee, 2 yolks
2
100
100
Dinner:
One plate of soup, 4 yolks;
beef (very lean), 150 grams;
30 grams wheat toast
4
200
225
125
75
Afternoon Lunch:
25 c.c. skim milk, 30 c.c. whiskey, 3
yolks. .
3
150
370
Supper:
Porridge of farina or rice, 100 grams;
1 yolk, skim milk;
apple sauce, 75 grams
1
50
350
30
At Bedtime:
Night cap (90 c.c. hot water, 10 c.c.
whiskey, 1 yolk, teaspoonful gran-
ulated sugar)
1
50
110
15
750
1660
If it should be deemed expedient to continue this dietary over any
great period of time, the dishes in which the yolks of eggs are incorporated
should be varied as much as possible. The great richness of yolk of egg
in fat and lime salts and in organic compounds of phosphorus and iron
make it peculiarly valuable as an adjunct to the dietary of infants and
young children, especially those which are suffering from rickets, mal-
nutrition, athrepsia, etc., for it is these very compounds which the child
needs, especially the rickety child.
MILK CURES
Kumiss Cure. Kumiss is an agreeable milk preparation readily
digested and easily absorbed. It has been made for many hundreds of
years by tribes of nomadic Tartars in eastern Europe from mare's milk.
A substitute for it made from cow's milk is called <f kephir," but this is not
genuine kumiss. The general properties of kumiss and kepliir are given
in Volume I, Chapter XII. The so-called kumiss in this country is really
kephir. Kumiss contains from 1 to 2 per cent of alcohol and effervesces
on opening the bottle. It is more easily digested and more completely ab-
MILK CUKES 565
sorbed than ordinary milk and can be taken in large amounts. It is mildly
diuretic and gently laxative, and like other milk cures, lessens intestinal
putrefaction by virtue of the lactic acid which it contains. As a cure, on an
average from two to four quarts are taken daily, but much larger quantities
are taken in Kussia at resorts where this method is in vogue. Ordinarily,
kumiss is ordered in combination with nourishing food of a protein nature,
carbohydrates, fruits and saccharine foods being specially restricted. If
diarrhea becomes annoying, it is well to add lime water to the kumiss. In
Itussia, kumiss is largely employed in the treatment of pulmonary tuber-
culosis, but its principal value in this country lies in the fact that it is a
valuable liquid food which many patients can take, with whom plain milk
and its other modifications disagree. The peculiar qualities of kumiss ren-
der it a most useful foodstuff in the dietetic treatment of many stomach
and bowel derangements. In the section dealing with milk will be found
a complete description of the kephir granules and directions for making
kephir. The analytical table, page 568, gives the analysis of genuine
kumiss and kephir from mare's milk and the home-made product from
cow's milk, as well as Egyptian youghourt and old-fashioned buttermilk.
It will be observed that the total protein is slightly less in kumiss and
kephir than in mare's and cow's milk respectively. In kumiss, the fat
is practically the same as in mare's milk. On the other hand, the per-
centage of fat in kephir is naturally lower than cow's milk, owing to its
partial removal before fermentation is begun.
Considering kephir in the light of what we have already learned as to
the digestibility of cow's milk, we will easily perceive that the process of
fermentation must render the latter much more easily digested and ab-
sorbed than it is in its natural state. The casein of cow's milk is the great
obstacle to easy digestion, but in kephir it is readily attacked by the di-
gestive juices; in fact, it is already partly digested when ready to serve.
In the light of the facts before us, it is not difficult to understand why
enormous quantities of kumiss and kephir can be disposed of in the process
of metabolism without difficulty. We read, for instance, that the healthy
dweller on the Steppes is capable of consuming from three to four gallons
of kumiss on a hot summer day, while a debilitated consumptive can take
with impunity the contents of ten large champagne bottles in twenty-four
hours (34).
Kumiss and kephir are practically identical in composition, but in
each the actual percentages depend somewhat on the duration of the fer-
mentation process.
136
566 SPECIAL DIETS
COMPOSITION OF SOUR MILK: PERCENTAGES 1
Composition
Butter-
milk
Kephir:
Goat's
Milk
Kumiss:
Mare's
Milk
Egyptian
Youghourt :
Cow's
Milk
Home-made
Kumiss :
Cow'sMilk,
Sugar, and
Yeast
Home-made
Youghourt:
Cow's Milk
and Cul-
tures of
Bacilli
Water
90.93
8733
89.19
47.44
88.00
89.00
Casein ]
2.75
1.73
16.00
2.56 X
Albumin \
3.01
.46
.55 \
.32 J
3 to 3.25
Peptones J
.26
.25 )
3.76
.25
.25 to .46
Fat
1.2
308
205
1600
1 25
3 to 3.5
Sugar
3.3
256
225
1400
3 67
1.25 to 2.0
Alcohol
0.0
1.75
1 50
1.60
.21
Lactic acid
0.3
1.25
1.15
2.25
.61
.5 to 1.0
Carbonic acid gas
Salts
(X6
.65
.56
.75
26
280
1.50
75
1.0 to 1.25
.20
1 This table is derived from analyses by Atvvater, Hammarston, Floischmann,
Hartier, Sharp, Stange, Dujardin-Beaumetz, Wanklyn, Richmond, etc.
The kumiss cure is suitable for gastric and pulmonary catarrh. Some-
times it is beneficial in anemia, malnutrition and convalescence from ill-
ness; mental hebetude and bodily languor and excitement of the sexual
organs have been observed as sequels of the treatment.
Matzoon Cure. Matzoon is a fermented milk product manufactured
with the aid of a lactic acid ferment obtained from Syria. It is a sour,
thick substance, more of the consistency of cream than kumiss. Unlike
kumiss, it does not contain alcohol or carbonic acid gas, and is taken in
smaller amounts. It is very agreeable, very readily digested and highly
nutritious.
Buttermilk Cure This cure depends chiefly on two considerations:
first, the low fat content, which makes it of great value where fat is not
well borne ; second, the presence of lactic acid bacilli. The lactic acid
bacilli contained in buttermilk seem to possess the properties of driving
out offending bacteria, especially those causing fermentative and intes-
tinal conditions, and to reestablish a more or less bacterial flora in the in-
testinal tract. Of late years whole milk which has been inoculated with
lactic acid bacilli is frequently substituted for buttermilk, but it should
be borne in mind that this artificial preparation should not be used in
diseased conditions due to fat indigestion.
Of late years buttermilk and similar preparations have been very ex-
tensively used by the laity in the treatment of a great many different
MILK CUKES 567
ailments. Buttermilk as an aliment has certain uses in the dietary, and
the following conditions, in which it is of practical value, are worthy of
note :
(a) In conditions where fat is not metabolized, especially in acute or
chronic fat diarrhea.
(b) In infants and children suffering from marasmus or general mal-
nutrition due to fat diarrhea or indigestion.
(c) In chronic dyspepsia accompanied by constipation.
(d) 111 the fermentative diarrheas.
(e) In typhoid and other debilitating fevers where ordinary milk is
not well borne.
(/) As an adjunct to the diet after surgical operations, especially if
the patient does not bear plain milk well.
There is nc beverage so wholesome as good buttermilk fresh from the
.churn. Its nutritive value is considerable, an ordinary glassful yielding
about as much nourishment as two ounces of bread. It is chiefly worthy
of notice as being an economical source of protein. In respect to this con-
stituent, it is not one whit inferior to ordinary milk, and yet buttermilk
in agricultural districts is usually fed to pigs. There can be no question
that this is a deplorable waste of a very valuable food. When used in
large quantities, buttermilk possesses diuretic properties which may be a
slight disadvantage in health, but would rather enhance its value than
otherwise in many diseased conditions. The chief point in which butter-
milk differs from whole milk is its poverty in fat. In this respect it re-
sembles skim milk. The loss of milk sugar from the formation of lactic
acid is so small as to be of no significance. The ease with w^hich butter-
milk can be digested has led to its being recommended as a food for in-
fants (35).
Sour Milk Cure. Many changes take place in milk during the process
of souring. The sugars to a large extent are replaced by lactic acid, alco-
hol and carbonic acid gas ; the casein is partly broken down and precipi-
tated to i very fine division and partly predigested while the fats and salts
remain practically unchanged.
The analyses on page 568 give a pretty fair summary of the changes
that occur during the process of souring.
When the fermentation process of kumiss and kephir is allowed to go
for only twelve hours, it is slightly sour and somewhat resembles milk in
tasto and appearance. When fermented for twenty-four hours, some of
the casein will bo dissolved, and as a result, the kumiss will be thinner
but sourer. If the fermentation process is allowed to continue another
568
SPECIAL DIETS
ANALYSES OF CHANGES OCCURRING IN THE FERMENTATION
OF MILK
Protein,
Per cent
Sugar,
Per cent
Fat,
Per cent
Salts,
Per cent
Alcohol,
Per cent
Lactic
Acid,
Per cent
Kumiss (1)
2.2
1.5
2.1
0.9
1.7
0.9
Kephir (2)
3.1
1.6
2.0
0.8
2.1
0.8
Mare's Milk (3) ....
Cow's Milk (4) .
2.6
3.3
5.5
4.8
2.5
3.6
0.5
0.7
Buttermilk (5)
3.8
3.3
1.2
0.6
0.3
day, it will be still thinner and sourer, and more thoroughly charged with
carbonic acid gas. The percentage of alcohol varies from 1.5 at the end
of 12 hours to as much as 3.0 per cent at the end of 36 hours.
The sour milk cure is extensively used in Turkey, Servia, Bulgaria
and neighboring countries. The Bacterium caucasicus, or Bulgarian
bacillus, is the most active of the lactic acid ferments, and in these coun-
tries it is extensively used to sour milk for a beverage. This Bacillus bul-
garicus when introduced into the intestinal tract in large numbers will
check the growth of offending bacteria and greatly lessen the number of
other organisms.
During recent years, a valuable method of treatment by means of
soured milk and other methods of administering selected lactic germs has
been brought to the notice of the profession by the distinguished French
bacteriologist, Eli Metchnikoff, of the Pasteur Institute, Paris. The
Metchnikoff method has of late years become a fashionable craze, and, as
is usual when a new therapeutic method is introduced, exaggerated claims
have been made in its favor. While our knowledge of this method of
treatment is by no means complete, yet clinical experience has abun-
dantly proven that it is a real advance in trophotherapeutics, and we will
therefore give a short account of it as laid down by Metchnikoff. It is
unnecessary to state here that this food exerts an influence on the normal
bacterial content present in the intestinal canal.
This dependence of intestinal microbial growths on the nature of food is due
to the fact that certain bacilli secrete substances which render the soil unsuitable
for others, so that by selecting an organism which is innocuous to human beings,
we are enabled to destroy active germs productive of injurious effects. In order
to attain this, we must secure, if possible, an antiseptic mechanism which, once
started, will maintain its effect, and this can only be accomplished by the services
of a living organized ferment. It is well known that lactic acid is a powerful
anti-putrefactive agent. When milk turns SOUE, that is to say, when the milk
MILK CURES 569
sugar lias undergone lactic fermentation with the formation of lactic acid, it can
then resist putrefaction for a long time.
The knowledge of the action of lactic acid in souring milk induced
Metchnikoff to employ cultures of the lactic germs in order to produce
nascent lactic acid just where its action is most needed. The culture prod-
uct by which these results were secured is known as "lacto-bacilline."
During the ingestion of meals, fresh microorganisms attached to un-
cooked food find their way into the intestinal tract, and these invaders
intensify the effect of preexisting colonies in inducing putrefaction of the
intestinal contents and noxious fermentations, particularly butyric acid
fermentation. The lactic acid content in sour milk can prevent butyric fer-
mentation and putrefaction, both of which are capable of causing various
disorders in the human organism, and sour milk finds its greatest efficacy
in hindering decomposition changes in the alimentary canal. In endeav-
oring to combat intestinal putrefaction, instead of prescribing lactic acid,
which is oxidized or excreted by the kidneys, it is better to introduce the
fresh living lactic germs into the digestive tract, either in the form of but-
termilk, lacto-bacilline powder, tablets or soured milk. The lactic germs
on reaching the intestines multiply with great rapidity, and, depending
upon the supply of sugar, which is necessary for their maintenance, they
set free lactic acid that permeates the intestinal contents, inhibiting putre-
faction and all irregular fermentation. Milk, in order to undergo thor-
ough lactic acid fermentation, must have planted in it the organized fer-
ments the living microbes cultures of the Bulgarian bacillus, which
may be added in the form of lacto-bacilline powder or tablets, which is a
most active producer of lactic acid, coagulating milk within a few hours
and curdling it without the assistance of any other organism. When milk
is treated by this method a very large proportion of the casein is rendered
soluble and a still greater percentage of the phosphate of lime has its solu-
bility similarly increased.
Lactic acid therapy is indicated in certain cases of chronic intestinal
catarrh, pernicious anemia, subacute and chronic nephritis, rheumatism,
gout and diabetes. This treatment is especially indicated and of great
value in cases of intestinal toxemia, intestinal intoxication resulting from
the abnormal putrefaction of proteins; but it is of little value in putre-
factive conditions resulting from carbohydrate fermentation.
Milk Cure. The milk cure, or an exclusive milk diet, has been
recommended for various diseased conditions. It is carried out systemat-
ically at certain health resorts in different countries, more especially in
Switzerland and Germany. The cure consists of the consumption of ordi-
570 SPECIAL DIETS
nary milk in its pure, undiluted, uncooked condition. To obtain the best
results, the milk should be fresh and warm, just as it is drawn from the
cow, since in this condition it is almost entirely free from bacteria and
contains the greatest proportion of enzymes, and possesses the highest bac-
tericidal capacity. The milk cure is exceedingly ancient and is of great
value in the treatment of tuberculosis, nervous disorders and many condi-
tions of debility and malnutrition. Its peculiar value lies in that milk
is easily digested, comparatively unirritating, and, when used exclusively,
tends to lessen abnormal fermentation in the intestinal tract. It is the
food par excellence for the infant, as it supplies the precise need for
growth and development.
The application of the milk cure is carried out with the best results
in rural districts or places where cattle are kept for the purpose. The
milk should be raw or at a temperature of the atmosphere, and, whenever
possible, it should be conveyed direct from the cow to the patient in the
shortest possible time to avoid the loss of enzymes and anti-bodies con-
tained in it. Even in the winter months, it should not be heated above
140 F. because lecithin, the vitamines, and other important bodies are
destroyed by a temperature beyond this degree. The vitamines contained
in milk are of the greatest importance. This subject has already been
covered in the section dealing with milk in the chapters on Animal Foods,
to which the reader is referred. 1 Too much emphasis cannot be laid on
the fact that milk should be taken raw and as soon after being drawn
from the cow as circumstances will permit. It should not be forgotten
that the bactericidal power of milk diminishes very rapidly after it is
drawn, and a few hours after milking it is practically nil. It is true that
boiling milk destroys bacteria, and until a few years ago it was customary
to recommend that all milk should be boiled for two or three minutes
before being ingested. In the light of recent knowledge, it is considered
that pure and wholesome milk should not be subjected to heat, for, as just
pointed out, a temperature beyond 140 F. destroys lecithin and other
important bodies, including the vitamines.
In order to supply the economy with sufficient protein to yield the
requisite amount of energy, a considerable quantity of milk must be con-
sumed. Good whole milk of average quality has a heat value of 325 calo-
ries per pint. If milk is taken in large quantities, digestive derangements
are liable to occur from the formation of large curds in the stomach ; if
these pass into the small intestines they are apt to be matted and as a
i See Volume T, Chapter XIT ; Volume IT, Chapter TX.
MILK CUKES 571
result offer much resistance to the digestive enzymes and may cause diar-
rhea, on the one hand, or constipation with dry feces on the other.
When milk is used as the only article of diet, it should be given at
lirst in quantities not to exceed half a glass every second hour ; after two
or three days two-thirds of a glass may be given at a time, and later, a
whole glass or eight ounces. The milk should be drunk very slowly, in fact
it should be sipped ; it should be taken at regular intervals during the day
and two or three times at night. As many as twelve glasses, eight ounces
each, should be prescribed during the twenty-four hours. Constipation
is not an unfavorable indication when taking the milk cure, but means
that the milk is well digested and well absorbed. It can be counteracted
by mild laxatives. On the other hand, vomiting and diarrhea indicate
digestive disturbances and malassimilation. At the beginning of the milk
cure, patients often lose flesh, but when taking the maximum quantity,
they hold their own, or may even gain in flesh. Milk is one of the most
digestible foods. Three liters, equal to about five pints, should be taken
daily. This amount would supply an adult with sufficient energy for the
performance of light work, yielding about 2,050 calories, which is neces-
sary for the maintenance of nitrogen, equilibrium. When less than this
quantity is consumed, most people show loss of nitrogen.
The milk cure is recommended by physicians for several reasons:
(a) to maintain the nitrogen balance; (b) to sustain the patient's
strength; (c) to produce gain in body weight, and (d) sometimes to
unload the system of superfluous weight, water, purins, complex amides,
extractive nitrogenous matter, etc., which are considered deleterious to
health. The object of Weir Mitchell's treatment(36) of forced feeding
is to cause a gain of protein for the benefit of enfeebled, nervous and mus-
cular systems, which is supplied from a milk diet slowly increasing from
two to as much as five pints of milk by the end of the eighth day. This
subject has already been considered in the present chapter (page 549).
When a milk cure is prescribed, nothing but milk is allowed for the
first two weeks, unless it becomes necessary to alter the flavor or modify
the constituents of milk. The flavor may be varied by adding small quan-
tities of salt, celery salt, burnt sugar or extract of malt. If there is a
tendency to form large curds, this may be prevented by the addition of
lime water, barley water, oatmeal water or malt extract. If there is a
tendency to nausea, it may be prevented by the above modifications. If
flatulence becomes niniovhio', it pan be prevented by the addition of Vichy
water, a little s;ilt or bicarbonate of soda. A patient on n strict milk diet
iiuiv complain of a thick, white-yellowish pasty coat on the tongue, ami
572 SPECIAL DIETS
a disagreeable mawkish taste in the mouth. As previously stated, the
beginning of the milk cure is in reality a period of starvation or under-
feeding, as a patient in bed at absolute rest requires 1,600 calories of
energy daily, which would require the ingestion of four pints of milk.
Underfeeding may cause restlessness and insomnia. Casein indigestion
from excess of fat or want of freshness in the milk may lead to diarrhea.
The urine is increased in quantity, while the excretion of uric acid and
purin bodies is lessened ; but the quantity of urea is in proportion to the
digested casein, and the urine ofttimes has a greenish tinge. Indican and
similar compounds disappear from the urine. As the quantity of milk
consumed increases, the system becomes satisfied, insomnia complained of
at the beginning is replaced by drowsiness, which is a hopeful sign when
the tongue is clear and the pulse good. At the beginning of the third
week, or after, the patient should be gaining in flesh, the appetite will
return, and a desire for solid food will be increased. In another fort-
night a little fish or fowl may be allowed in the middle of the day, and
at the end of one month a gradual return to the ordinary diet is advised.
Skim Milk Cure. The skim milk cure is employed in the dietetic
treatment of valvular disease, nephritis, gout, obesity, chronic bronchitis
and emphysema. It must not be overlooked that skim milk as an aliment
only partially supplies the energy expended by the body, that it in reality
is a system of underfeeding, and where it is the only aliment, its continued
use will reduce the strength, weight and vitality of the patient. One
author * reports 200 cases in which he employed skim milk as a diet for
unloading the system generally, more especially the vascular system. When
this method of treatment is instituted, it is recommended that the quantity
allowed should be from one-fourth to one-half a pint of skim milk three
or four times a day, sipped slowly. The milk should be fresh and ob-
tained twice daily. Donkin is quoted as having had considerable experi-
ence in the treatment of disease by the skim milk diet and highly recom-
mends it in diabetes, beginning with four pints daily and increasing some-
times to a maximum of twelve pints. Lenhartz has systematically em-
ployed the skim milk diet for many years past in the treatment of heart
disease with failure from compensation. Under his method, the patient
is placed in bed absolutely at rest for the first five days and is allowed
seven ounces of milk four times a day. During the next six days he is
allowed one egg, soine zwieback in addition to his daily allowance of milk,
and a little later some minced meat and vegetables are added, so that
Carell, in 1865, quoted by Tibbies.
MILK CUKES 573
about the twelfth day there is a gradual return to a full mixed diet. Len-
hartz claims that the failure of relief with this treatment is to be regarded
as a sign of advanced degeneration of the cardiac tissue.
Whey Cure. The whey cure has been extensively used at the various
springs and baths in the mountainous districts of Germany and Switzer-
land, notably Ems and Eeichenhall and those of the alkaline waters, which
are frequently mingled with the whey and drunk either warm or cold.
The treatment, like that of the dry diet previously described, is rigorous
and consists in confining the patient's daily alimentation largely to the use
of twenty or more ounces per diem of fresh milk whey.
The principles of this method of treatment are quite similar to those
of the milk cure, but in whey the casein of the milk has been artificially
removed by the precipitation of casein by rennin, as in cheese making.
Whey is a thin semi-transparent liquid of a pleasing sweetish taste. Ac-
cording to Atwater it has the following percentage composition:
Per cent
Protein 1 to 1.25
(Casein, Albumin)
Fat 0.3 to 0.5
Sugar 3.5 to 5.0
Mineral matter 0.103
Lactic acid 0.33
Fuel value, 145 calories per pint.
Whey is a nutritious beverage useful in the dietetic treatment of dis-
ease, particularly as a diluent of cow's milk for feeding infants. It is
easily digested, is bland and unirritating to the stomach, but it may cause
flatulence and acidity in people who are subject to these troubles.
By referring to the section dealing with milk in the chapter on Animal
Foods, 1 a full and explicit consideration of this subject will be found.
The whey cure is advocated in some cases of chronic indigestion and ab-
dominal plethora. It is also used in the treatment of Bright's disease and
chronic catarrhal conditions of the alimentary canal. Thompson (37) rec-
ommends it particularly for chronic dyspepsia and chronic irritable cough
accompanying catarrh of the respiratory mucous membranes. In abdom-
inal plethora as much as eight to ten tumblerfuls may be added daily to
a diet of fruit and vegetables. It is often combined with the grape diet,
described on page 546. When taken in large amounts, whey has a tend-
ency to produce diarrhea.
See Voluino T. f'linptor XTT, p. 307,
574 SPECIAL DIETS
1. HUFE, FERDINAND. Modern Vegetarianisms, Berlin, 1900.
ALBU, ALBERT. Die Vegetarische Diat, Leipzig, 1902.
2. PORPHYRE. (Really named Malk, born Tyre, in 233 A.D., taught
philosophy at Koine, where he died in 304.) Published Life of
Pythagoras.
3. TIBBLES, WILLIAM. Food in Health and Disease.
4. NEUMANN, W. Essays on Diet, p. 64.
5. HUTCHISON. Food and Dietetics, p. 109.
6. CAULTEY, EDMUND. Sutherland's System of Diet and Dietetics.
7. WAYLEN. Brit. Med. J., 1900, vol. i, p. 37.
8. JAFFA, M. E. U. S. Dept. of Agric. Exper. Sta. Bull. No. 132.
9. WAIT. U. S. Dept. of Agric., Bull. No. 187.
10. ROTCH, T. MORGAN. Practical Pediatrics.
11. SPENCER, HERBERT. Education, Intellectual, Physical and Moral,
p. 156.
12. SALISBURY. The relation of Alimentation to Disease, New York,
1895.
13. PARKES. Lancet, 1874.
14. CAULTEY, EDMUND. Sutherland's System of Diet and Dietetics.
15. WATSON. Food and Feeding.
16. HERICOURT. Lancet, 1911, vol..i, p. 22.
17. RICHET and HERICOURT. Ibid., 1889.
18. JAFFA. U. S. Dept. of Agric. Bull. No. 107.
19. CHAMBERS, KING. Lectures Chiefly Clinical, Lecture xxiv.
20. MITCHELL, WEIR. Fat and Blood, Philadelphia.
21. DUKES, CLEMENT. Diet in Training for School Games.
22. LANGWORTHY and BEALE. Starr's Agricultural Experiment Sta-
tion, Ninth Annual Report, 1896, part ii, chapter xi.
23. DAVIS. Food in Health and Disease.
24. ATWATER and BRYANT. Dietary Studies of University Boat Crews.
25. . IT. S. Dept. of Agric. Bull. No. 75.
26. THOMPSON, W. GILMAN. Practical Dietetics, p. 726.
27. ATWATER and BRYANT, IT. S. Dept. of Agric. Bull. No. 75,
REFERENCES 575
28. YEO, I. BURNEY. Food in Health and Disease, p. 281.
29. ZUXTZ. U. S. Dept. of Agric. Exper. Sta. Rec., vol. vii, pp. 538-
550.
."<>. STOCKMAN and MACADAM. Jour. Phys., 1897, vol. xxii, p. 69.
.'51. FRIKDKNWALD and RUHRAH. Diet in Health and Disease.
:'>:'.. ALBU. Dentsch. med. Woehenschr., 1907.
33. STERN. Med. Rec., Dec. 31, 1904.
'54. STRANGE. (On Kumiss Cures). Zeimssen's Hand Book of Gen-
eral Therapeutics.
35. TIBBLES, WILLIAM. Brit. Med. J., Sept. 6, 1902.
30. MITCHELL, WEIR. Treatment, Philadelphia.
37. THOMPSON, W. OILMAN. Practical Dietetics, pub. by D. Appleton
& Co.
CHAPTER XVII
PREPARATION OF SPECIAL BEVERAGES AND FOODS
WITH
Directions for Their Preparation
General Considerations; Beverages; Peptonized and Predigested Foods; Beef
Teas; Meat Juices; Broths; Bouillon; Vegetable Soups; Meat Soups;
Farinaceous Foods; Bread; Cereal Foods; Gruels; Eggs; Fish; Poultry;
Meats; Vegetables; Purees; Fruits; Nuts; Jellies; Custards; Puddings;
Ice Cream; Recipes for Diabetic Foods.
GENERAL CONSIDERATIONS
In the chapter on the Hygiene of Eating, the necessity for making
foods as palatable and as attractive as possible was emphasized. The
appetizing preparation of food for the sick is just as important as the
careful compounding of a prescription containing medication. Convales-
cent patients, as well as patients ill with gastric disturbances, can easily
be nauseated by the repugnant appearance of a dish, while, on the other
hand, the appetite may be stimulated by food of an inviting attractive
appearance. The tray on which it is served should be covered with pure
white linen without a crease or wrinkle, the best that the home of the
patient can afford. The silver should be spotless ; the china, the daintiest,
and the glassware, the clearest; all arranged neatly and conveniently.
This arrangement of the tray is of the utmost importance, and the
slightest departure from regularity and immaculate cleanliness should
be avoided.
Foods should never be served too hot, lest the patient be tempted to
partake of it in that condition in spite of the physician's or nurse's warn-
ing. On the other hand, it should not be served too cold. For this reason
it is advisable to serve such dishes as are liable to cool off rapidly in ves-
577
578 PREPARATION OF SPECIAL BEVERAGES AND FOODS
sels of a double bottom, the interspace being filled with hot water. Condi-
ments have no place in the dietary of the invalid or convalescent. Spices,
however, may be used with caution, but only with permission of the
physician. A tray with food should always be carried into the sick-room
covered with a clean napkin or tray cover.- When the dietary ordered is
limited in variety, the patient is often gratified by having his food served
in courses, and will eat more than if given everything at once. A patient
suffering with bowel disorder should never be offered food until some time
has elapsed after using the bed-pan. Needless to state, the diet of a
patient should be under the supervision of the physician and his direc-
tions followed implicitly, for much unnecessary suffering and even death
has followed the ingestion of forbidden food.
BEVERAGES
PLAIN BEVERAGES
Lime Water Place a handful of fresh unslaked lime in an earthen
jar containing hot water ; stir, pour off, and throw away the water as soon
as it has settled. This first water contains the soluble potash salts which
may be present in the lime. Add more water; allow it to settle, then de-
cant the clear fluid and bottle it. Water may again be added to the lime,
and the mixture covered and allowed to stand to be decanted as needed.
Apple Water.
Water (boiling) 1 cupful 250 c.c.
Apples 2 mashed baked 150 gm 144 calories
Pour the boiling water over the apples ; cool, strain and sweeten. Serve
with shaved ice if desired.
Tamarind Water
Boiling water 1 cupful 250 c.c.
Preserved tamarinds 1 tablespoonful 20 grams 100 calorics
Pour the boiling water over the preserved tamarinds ; allow this to
stand until cool, then strain and serve with shaved ice.
Currant Juice (Fitch).
Currant juice 1 ounce 30 c.c 25 calorics
or
Currant jelly 1 tablespoonful 35 grams 113 "
Boiling water 1 cupful 250 c.c.
Over the currant jelly pour the boiling water (use cold water with
the juice) and sweeten to taste.
BEVERAGES 579
lemonade No. 1 (Thompson).
Lemon juice 3 tablespoonfuls 45 c.c.
Sugar 3 " 30 grams 123 calories
Cold water 1 cupful (6 ounces) 250 c.c.
To the juice of the lemon add the sugar and the cold water. Serve
with cracked or shaved ice if desired.
Lemonade No. 2 (Pavy).
Rind of lemon 1 3 grams.
Boiling water 1 pint 480 c.c.
Sugar 1 ounce 30 grams 114 calories
Pare the rind from the lemon, cut the lemon into slices, and place both
in a pitcher with the sugar. Over this pour the boiling water and let it
stand until cool. Strain arid serve with cracked ice.
Effervescent Lemonade. This may be made by using a carbonated
water or by adding half a teaspoonful of bicarbonate of soda or potash to
a glassful of either of the foregoing lemonades.
Albuminized Lemonade (Watson).
Water 1 cupful 250 c.c.
Lemon juice 2 teaspoonfuls 30 "
Sugar 2 " 20 grams 82 calories
Egg 1 white 32 30 "
Shake all the above ingredients together. Serve at once.
Orangeade (Ruhrah).
Rind of orange 1 3 grams.
Boiling water 1 cupful 250 c.c.
Juice of orange 1 45 " 60 calories
Sugar 1 tablespoonful 20 grams 82 "
Cut the rind from the orange ; over this pour the boiling water, then
add the juice of the orange and* the sugar; cool, strain and serve with
shaved ice if desired. If this is too sweet, a teaspoonful of lemon juice
may be added.
Imperial Drink (Gautier).
Cream of tartar 1 teaspoonful 4 grams.
Boiling water 1 pint 480 c.c.
Juice of lemon % 15 "
Add the cream of tartar to the water. Into this squeeze the juice of
half a lemon, or more if desired, sweeten to taste and serve cold. This
drink is most useful in fevers and in nephritis.
580 PREPARATION OF SPECIAL BEVERAGES AND FOODS
Barley Water (Caultey )(!).
Thin: Put a teaspoonful of prepared or pearl barley, previously
washed in cold water, into a jug; pour half a pint of boiling water on it,
and add a pinch of salt. Stand it by the fire for an hour, stirring occa-
sionally, and then strain through fine muslin. Similar thin cereal decoc-
tions may be made from rice, arrowroot or oatmeal.
Thick: Put a heaping tablespoonful of washed, prepared or pearl bar-
ley into a clean saucepan, and add a quart of water and a pinch of salt.
Boil slowly until it has evaporated down to about two-thirds of a quart,
and strain. It may be flavored as desired. The addition of a little lemon
peel, while boiling, is best.
The composition of barley water is 0.09 per cent protein, 0.05 per
cent fat, 1.6 per cent carbohydrate. It furnishes 14 calories to 100 c.c.
Toast Water (Caultey). Pour a pint of boiling water over two or
three slices of well-toasted bread. Let it stand until cool ; strain.
Linseed Tea (Yeo).
Water 1 pint 480 c.c.
Linseed 2 tablespoonfuls 60 grams 60 calories
Juice of lemon % 15 c.c.
Bruised licorice root (or a
piece of licorice the size of a
filbert) % ounce 8 grams 10 "
To the water add the linseed, the juice of the lemon, the licorice root,
and rock-candy to taste. Boil for one and one-half hours and strain.
Orgeat (P av y).
Sweet Almonds 2 ounces 32 grams 200 calories
Almond seeds (bitter) 4 1 gram.
Orange-flower water a little 30 c.c.
Milk 1 pint 480 350 "
Water 1 " 480
*
Blanch the sweet almonds and bitter almond seeds. Add the orange-
flower water and pound into a paste. Rub this with the milk, diluted
with the water, until it forms an emulsion. Strain and sweeten with
sugar. (A demulcent and nutritive drink.)
NUTRITIOUS BEVERAGES
Albumin Water (Friedenwald and Ruhrah).
Egg 1 ounce 50 grams 80 calories
Water 6 ounces 180 c.c
Sugar 1 teaspoonful. 10 grams 41 "
Lemon juice 1 " 4 c.c
BEVERAGES 581
Beat the white of the egg until very light and strain through a clean
napkin. Add the water. If intended for an infant, a pinch of salt may
be added. The sugar and lemon juice, or sherry wine, may be added to
enhance its palatableness. This drink may also conveniently be made by
placing all the ingredients in a lemonade shaker, shaking until thoroughly
mixed and then straining. Serve cold.
Egg Albumin Water (Watson). Take the white of an egg (30 calo-
ries) and to it add twice its own volume of water and strain through
muslin. This gives about three ounces of a clear solution, containing as
much protein as is found in the average sample of commercial beef juice.
This fluid, added to home-made beef tea, makes a nutritive solution almost
indistinguishable from beef juice and at a fraction of the cost.
Egg Albumin Water (Caultey). Take the white of a fresh egg (30
calories) and cut it in numerous directions with scissors. Shake it up in
a flask with a pinch of salt and six ounces of cold water. Strain through
muslin.
It can be made with thin barley water, and cream or sugar added.
Egg Broth (Drexel Institute).
Egg 1 (whole) 50 grams 80 calories
Sugar H teaspoonful 5 " 20 u
Salt a pinch 1 "
Hot milk 1 glass 250 c.c 180
Beat up the egg, and add to it the sugar and a pinch of salt; over this
pour the milk and serve immediately. Hot water, broth, soup, or tea may
be used in place of milk.
Egg Cordial.
Egg 1 white 32 grams 30 calories
Cream. 1 tablespoonful 50 " 54 "
Sugar y 2 " 20 82 "
Brandy 1 " 16 c.c 65 "
Beat up the white of the egg until light ; add the cream and beat up
together ; then add the sugar and the brandy.
Caudle.
Egg 1 (whole) 50 grams 80 calories
Sherry wine 1 wineglassful 30 c.c 38 "
Sugar 1 teaspoonful 10 grams 41 "
Gruel barley y z pint 120 c.c 130 "
Beat up the egg to a froth, add the wine, and sweeten with the sugar ;
if desired, flavor with lemon peel. Stir this mixture into the gruel, over
this grate a little nutmeg, and serve with hot toast.
137
582 PREPARATION OF SPECIAL BEVERAGES AND FOODS
Cocoa with Milk.
Cocoa 1 rounding teaspoonful. . 4 grams 50 calories
Milk-sugar 2 ounces 60 " 240
Milk 4 120 c.c 80
Cream 2 " 60 " 120 "
Mix the sugar and cocoa; cook in the milk until dissolved. Serve
with the cream.
Cocoa.
Cocoa 1 heaping teaspoonful. . . 4 grams 50 calories
Milk-sugar 2 ounces 60 240 "
Water % cup (4 ounces) 125 c.c.
Cream 3 ounces 90 " 180 "
Mix the cocoa and sugar, add the water, and boil for four or five
minutes. Then add the cream, or use less and serve with whipped cream.
Coffee.
Milk-sugar 2 ounces 60 grams 200 calories
Strong coffee 4-5 " 120-150 grams.
Cream 2 60 c.c 120
Milk-sugar may be used likewise to sweeten tea, which may be served
with or without cream.
Almond Milk (Wegele).
Almonds, sweet 1 pound 453 . 5 grams. . . . 3,030 calories
bitter 2 pounds 1,000 ... .6,060 .
Milk 8 ounces 250 c.c 165 "
Blanch the almonds that have been soaked in cold water for twenty-
four hours. This is done by pouring boiling water over them, when,
after a few. minutes, they can easily be pressed out of their hulls. Grind
the almonds in a mill or pound them in a mortar; mix with a half-pint
of warm milk or water, and allow the mixture to stand two hours, after
which strain through a cloth, pressing the juice out well Thirty grams
of almonds yield 200 calories of heat; 250 grams of milk yield 170
calories.
Lemon Whey
Lemon juice 3 tablespoonfuls 45 c.c.
Milk sugar 2-4 ounces 50-100 grams 200-400 calories
Kumiss No. 1 (Drexel Institute).
Skim milk 1 quart 1,000 c.c 340 calories
Cake of yeast '/ 3 grams.
Sugar 2 tablespoonfuls 80 " 328
BEVEKAGES 583
Heat the milk. Dissolve the yeast in a little water and mix it with the
sugar and lukewarm milk. Pour the mixture into strong bottles, stopper
them tightly with new corks, and tie down the corks with stout twine.
Shake the bottles well and place in a refrigerator. This will allow the
mixture to ferment slowly. After three days lay the bottles on their sides,
turning them occasionally. Five days are required to complete the fer-
mentation ; the kumiss is then at its best.
Kumiss No. 2 (Holt).
Fresh milk 1 quart 1,000 cc 650 calories
Sugar ^ ounce 15 grams 62 "
Yeast cake piece 3 "
Pour into wired bottles the fresh milk, sugar and fresh yeast cake
(half an inch square), and keep at a temperature between 60 and 70 F.
for one week, shaking five or six times a day ; then put upon ice.
Further directions for preparing kumiss and kephir with kefilac tablets
will be found in the section on Milk, in the chapter on Animal Foods
(Volume I, Chapter XII, page 338). For the analytical value, see Vol-
ume II, Chapter XVII, pages 566-568.
Milk Mixture (A. V. Meigs).
Cream 2 pints 1,000 c.c 1,820 calories
Milk 1 pint 500 " 325
Lime Water 2 pints 1,000 "
Sugar water ' 3 1,500 512
For the sugar water use seventeen and three-fourths drams of milk
sugar to a pint of water.
Milk and Cinnamon Drink (Ringer).
Add a small amount of cinnamon to the desired quantity of milk and
boil it. Sweeten with sugar and add brandy if desired.
Albuminized Milk.
Milk 1 cupful 250 c.c 170 calories
Lime water 1 tablespoonful 15 "
Egg 1 white 32 grams 30 "
Shake in a covered jar or lemonade shaker the milk, lime water and
white of the egg. Sweeten, flavor as desired, and serve at once.
Irish Moss and Milk.
Irish moss 2 tablespoonfuls .... 28 grams.
Milk 1 cupful 250 c.c 170 calories
584 PBEPABATION OF SPECIAL BEVEKAGES AND FOODS
Soak the Irish moss for five minutes and wash thoroughly in cold
water. Add the milk and soak for half an hour; then heat slowly, stir-
ring constantly, and boil for ten minutes, preferably in a double boiler;
strain, and pour into cups to cool. This may be served while hot, and
may be rendered more nutritious by the addition of the white of an egg
stirred into it just before serving.
Egg and Buttermilk Mixture
Egg 1 white 32 grams 30 calories
Cream 2 ounces 80 " 216 "
Buttermilk 1 glass 250 c.c 78
Beat the egg and cream lightly. Pour into a glass and fill with fresh
buttermilk. Stir well.
Milk and Other Diluents Milk may be diluted with advantage in
many cases by adding lime water, or vichy, apollinaris, or some other
sparkling table water. From one-half to one-eighth the total volume may
be added.
Grape Juice (Drexel Institute) (2). Pluck Concord grapes from the
stem. Wash and heat them, stirring constantly. When the skins have
been broken, pour the fruit into a jelly bag and press slightly. Measure
the juice and add one-quarter the quantity of sugar. Boil the juice and
sugar together and then pour into hot bottles ; cork and seal with paraffin
or equal parts of shoemaker's wax and resin melted together. Less sugar
may be used.
Vanilla, Bitter Almond or Strawberry Junket
Vanilla or bitter almond extract.^ teaspoonful 2 c.c.
or
Pure concentrated strawberry
sirup 1 tablespoonful 15 " 88 calories
Whole milk \i pint 250 " 170 "
Add the flavoring extract to the cold milk and then prepare in the
usual way. The vanilla or bitter almond extract or the strawberry sirup
should be allowed to a half-pint of milk.
Milk Lemonade (Kuhrah).
Sugar 2 ounces 56 grams 224 calories
Boiled milk 5 150 c.c 115 "
Lemon ^ " 65 grams 20
or
White Wine 2 " 120 c.c 83 "
Boiling water. 5 150
Rind of lemon Y?. " 5 grams.
BEVERAGES 585
Pour the boiling water over the peel and the sugar; allow it to cool,
add the milk, and then the lemon juice or wine. Strain after ten minutes.
Milk Porridge (Drexel Institute).
Flour 1 tablespoonful 50 grams 85 calories
Cold milk Y cupful. 63 c.c 45 "
Hot milk Y " 63 45
Salt M teaspoonful 1 gram.
Mix the flour with the cold milk and stir into the hot milk ; if desired
add two raisins cut into quarters. Cook over boiling water for one hour,
and add the salt just before serving.
Plain Egg Flip (Watson).
Milk 1 teacup 250 c.c 150 calories
Sugar 1 teaspoonful 10 grams 41 "
Egg 1 white 32 " 30 "
Boil the milk or make it thoroughly hot ; beat up the white of egg to
a stiff froth. Pour the boiling milk over the white of egg, stirring all the
time. Add sugar to taste, and serve.
BEVERAGES WITH EGG AND ALCOHOL
Rich Egg Flip (Watson).
Egg 1 white 32 grams 30 calories .
( 'ream 1 tablespoonful 20 54
Brandy 1 15 c.c 58
Sugar to taste 1 teaspoonful 10 grams 41 "
Beat, up the white of egg stiffly; add to it the brandy and cream, with
a little sugar if wished. Mix very thoroughly and serve.
Egg-nog (Fitch).
Egg 1 (freshly laid) 50 grams 80 calories
Powdered sugar 1 tablespoonful 40 " 160 "
French brandy 1 ounce 30 c.c 105 "
Santa Cruz rum 2 drams 75 " 25 "
Fresh milk 1 glassful 250 " 170
( 'ream 1 wineglassful (2 ounces) .... 64 " 225 "
Break the egg, separating the white from the yolk, and beat the yolk
slowly, adding the sugar until it is thoroughly dissolved ; then add the
brandy, at first drop by drop, vigorously beating the mixture all the time
until one-half is added, then increase the flow until all the brandy is
added. Now add the milk, pouring very slowly, beating the mixture all
the while. Continue beating while the rum is being slowly added. An
586 PREPARATION OF SPECIAL BEVERAGES AND FOODS
assistant should have the white of egg beaten to a froth, which is now
dropped on top of the mixture. Add a small pinch of grated nutmeg,
dusting over the frothy whites, and set mixture on ice for an hour, when
it will be read}- to serve.
Cold Egg-nog (Watson).
Egg 1 whole 50 grams 80 calories
Sugar 2 teaspoonfuls 20 " 80 "
Milk 1 glassful 250 c.c 170 "
Brandy or good whiskey 1 tablespoonful 15 " 55 "
Beat up the egg, add the sugar and milk and then the brandy or
whiskey; mix thoroughly.
Hot Egg-nog
Egg 1 yolk 18 grams 68 calories
Sugar 2 teaspoonfuls 20 " 180
Hot milk 1 glassful 250 c.c 170
Brandy or old whiskey 1 tablespoonful 15 " . . 55 "
Beat the egg, add the sugar and milk, and then the brandy or whiskey ;
mix thoroughly.
Brandy-and-Egg Mixture (Stokes).
Eggs 2 yolks 36 grams 138 calories
White sugar ^ ounce 20 " 80 "
Cinnamon water 4 ounces 120 c.c.
Brandy 4 120 " 468 "
Rub the yolks of the eggs with the white sugar, add the cinnamon
water and then the brandy. Dose: One or two teaspoonfuls every two
hours, according to age.
Brandy-and-Egg Mixture for Infants (Louis Starr).
Egg 1 yolk 18 grams 68 calories
Brandy Y^ ounce 15 c.c 60 "
Cinnamon water 1 teaspoonful 4 "
White sugar 1 coffeespoonful 20 u 80
Beat all these ingredients up well.
Egg-nog (Ruhrah).
Egg ,1 large 60 grams 80 calories
Sugar 1 tablespoonful 30 " 120
Whiskey 2 tablespoonfuls 30 c.c 90
Cream 7 " 140 grams 210 "
Add the sugar to the yolk of egg and beat until very light. Whip
the white of the egg and then the cream until very stiff. Add the whiskey
BEVERAGES 587
to the yolk of egg and sugar. Mix well. Add one-half the cream to this,
then one-half the beaten white of egg. then the remaining cream, and
finally the remaining white of egg. Mix lightly. This recipe makes a
glass and a half.
Egg-nog (Bartholow)(3). Scald some new milk by putting it, con-
tained in a jug, into a saucepan of boiling water; it must not be allowed
to boil. Beat an egg with a fork in a tumbler with some sugar ; add a des-
sertspoonful of brandy, and fill the tumbler with the scalded milk when
cold. This egg-nog will furnish about 300 calories.
Beef -tea Egg-nog (Davis).
"Soluble Beef" H teaspoonful 0.5 grams 20 calories
Hot water ^ cupful 125 c.c.
rT^ndy 1 tablespoonful 15 60
L 1 (whole) 50 grams 80 "
Sugar 2 teaspoonfuls 20 85 "
Salt a pinch 1 "
Beat the egg slightly, and add the salt and sugar. Dissolve the
"Soluble Beef" in the hot water, add to the egg, and strain. Mix thor-
oughly, adding wine, and serve.
Grape Juice and Egg.
Egg 1 white 32 grams 30 calories
Grape juice 2 tablespoonfuls 30 c.c 20 "
Beat the egg lightly, strain through a napkin, and add to it the grape
juice. Fill a large wineglass half full of cracked ice. Pour the egg and
grape juice over this, sprinkle sugar over if, and serve.
Milk Punch
Milk 1 glass 250 c.c 170 calories
Rum 1 tablespoonful 15 " 45 "
Sugar 2 teaspoonfuls 20 grams 81 "
Shake together in a lemonade-shaker the milk, rum, brandy or good
old whiskey, and the sugar. After it has been poured into a glass, a little
nutmeg may be grated over the top.
Egg Flip. Boil or heat thoroughly a teacupful of milk, beat the
white of one egg to a froth. Pour the milk over the egg, stirring con-
stantly. Add sugar to taste. This will furnish 230 calories.
Caudle (Yeo). Beat an egg to a froth; add a glass of sherry and
half a pint of gruel. Flavor with a lemon peel, nutmeg and sugar. This
will furnish 120 to 150 calories, according to the consistency of the gruel.
If milk is used to make the gruel it will have a higher value.
588 PREPARATION OF SPECIAL BEVE11AGES AND FOODS
Wine Whey.
Milk 1 cupful 250 c.c 170 calories
Sherry wine K " 60 76
Cook the milk and sherry wine together. As soon as the curd sepa-
rates, strain and sweeten. This may be eaten hot or cold.
Mulled Wine (Drexel Institute).
Hot water % cupful 30 c.c.
Stick cinnamon Y^, inch 2 grams.
Cloves 2 whole 0.5
Nutmeg tiny bit 05 "
Port (heated) ^ cupful 60 c.c 106 calories
Sugar 2 tablespoonfuls 28 grams 112 "
Boil all the ingredients except the wine and sugar for ten minutes;
then add the wine and sugar, strain, and serve very hot.
PEPTONIZED AND PREDIGESTED FOODS
Predigested protein, in the form of peptone and albumose, is of value
principally in increasing the nutritive properties of liquid foods. Its
principal value as an aliment is in its nutritive property in long-continued
wasting 'diseases. It also has some value as an appetizer when there is
diminished secretion of the gastric juice, and is of use where gastric mo-
tility and secretion are low, on account of its being a concentrated food.
It is useful in artificial feeding by the stomach tube or for rectal alimen-
tations.
Peptonized Beef (Fairchild).
Finely minced lean beef ^ pound 100 grams 255 calories
Cold water J^ pint 250 c.c.
Extract of pancreas 20 grains.. 1 . 25 grams 2 "
Bicarbonate of soda 15 " 1 "
Egg 1 white 30 " 30
Salt and pepper 1 saltspoon 1 "
Cover the lean beef (or beef and chicken mixed) with the cold water.
Cook over a slow fire until it has boiled for a few minutes, stirring con-
stantly. Pour off the broth and rub or pound the meat to a paste. Put
meat and broth and half a pint of cold water in a glass jar, and add the
extract of pancreas and bicarbonate of soda. Mix well and keep in a
warm place at about 110-115 F. or place it in warm water and
allow it to stand three hours, stirring or shaking occasionally. Boil
quickly; strain or clarify with the egg, and season with salt and pepper.
BEVERAGES 589
If desired, it need not be strained, as the small particles of meat are
usually easily digested. Cereals may be added, boiling with half the
amount of water previously directed, and mixing all together before pep-
tnni/ing. At the end of three hours the mixture must be boiled or it
will spoil.
Peptonized Oysters (Fairchild).
Oysters ^ dozen 85 grams 44 calories
Water H pint 250 c.c.
Extract of pancreas 15 grains 1.4 grams 2 "
Bicarbonate of soda 15 " 1 "
Milk '.Hpint 250 c.c 170
Salt 1 saltspoon 1 gram.
Pepper 1 1
To the oysters with their juice add the water, and boil for a few
minutes. Pour off the broth and set it aside. Mince the oysters, and
with the aid of a potato-masher reduce to the consistence of a paste.
Place this with the broth in a glass jar and add the extract of pancreas and
the bicarbonate of soda and mix. Allow this to stand in hot water
(115 F.) for one and one-half hours. Pour into a saucepan and add the
milk ; heat over a slow fire to boiling point. Flavor with salt and pepper
and serve hot. Let the heating be done gradually, and be careful to bring
the mixture to a boil before taking it from the fire.
Partially Digested Cereals Prepared at the Table. To a saucer of well-
cooked oatmeal, wheaten grits or rice, at the customary temperature, add
one or two teaspoonfuls of Fairchild's Diastasic Essence of Pancreas, or
fifteen grains of Fairchild's Dry Extract of Pancreas. Stir for a few
minutes before eating. When the ferments are added to the very hot
foods their power becomes impaired. About 100 grams, energy value
about 200 calories.
Partially Peptonized Milk (Ruhrah).
Milk 1 pint 500 c.c 325 calories
Water 4 ounces 120 "
Fairchild's peptonizing tube 1 1 gram 2 "
or
Pancreas extract 5 grains 0.33 "
Bicarbonate of soda 15 " 1 "
Into a clean granite-ware or porcelain-lined saucepan place the milk,
water and the contents of tlio tul)o, or the pancreas extract, and bicar-
bonate of soda. Heat gradually until it boils, stirring constantly. Boil
gently for ten miimtes, strain into a clean bottle, cork and keep in a cool
590 PREPARATION OF SPECIAL BEVERAGES AND FOODS
place. Before using, shake the bottle well ; serve hot or cold. Prepared
in this way it will not become bitter.
Peptonized Milk.
Cold Process. Mix milk, water and peptonizing agents as directed in
the preceding recipe, and immediately place the bottle on ice. Use when
ordinary milk is required. This is particularly suited for dyspeptics and
individuals with whom milk does not, as a rule, agree. The flavor of the
milk remains unchanged.
Warm Process.
Milk 1 pint 500 c.c 325 calories
Cold water 4 ounces 120 "
Extract of pancreas 5 grains 0.33 gm 2 "
Bicarbonate of soda 15 " 1 "
Put the milk and cold water in a glass jar, add the extract of pancreas
and the bicarbonate of soda. After mixing thoroughly, place the jar in
water as hot as can be borne by the hand (about 115 F.). This should be
heated for from six to twenty minutes. At the end of this time it may be
placed upon ice until required. The contents of one of Fairchild's pep-
tonizing tubes may be used in place of the pancreas extract. If the milk
is to be kept for any length of time, it should be brought to a boil, to pre-
vent the formation of too much peptone, which renders the milk bitter.
Hot Peptonized Milk. Mix together the usual peptonizing ingredients
and add a pint of fresh cold milk. After thoroughly shaking the bottle
place it on ice. When needed, pour out the required amount, heat it, and
drink it as hot as it can agreeably be taken. If required for immediate
use, the ingredients may be mixed together in a saucepan and slowly
heated to the proper temperature.
Effervescent Peptonized Milk Put some finely cracked ice in a glass,
fill it half full of Apollinaris, vichy or siphon water, and immediately add
the peptonized milk. Drink while effervescing. Brandy may be added
if desired.
Specially Peptonized Milk This is to be used in the preparation of
jellies, punches and all recipes where the milk is to be mixed with fruit
juices or acids. Prepare according to the hot process; keep the milk at a
temperature of 115 F. for one hour; pour into a saucepan and bring to a
boil. If required hot, this may be used immediately, or it may be set aside
on ice, to be used later. If not heated for an hour, the milk will curdle
on being mixed with an acid. If not boiled, the peptonizing ferment will
digest gelatin and prevent the formation of -jelly.
BEVERAGES 591
Peptonized Milk Jelly (Friedenwald and Ruhr ah).
Cox's gelatin % box
Water 4 ounces 120 c.c.
Hot specially peptonized milk ... 1 pint 500 " 325 calories
Sugar 4 ounces 112 gm 410 "
Fresh lemon 1 whole 130 41
Orange 1 250" 96 "
St. Croix rum or brandy 3 tablespoonfuls. . . 50 c.c 245 "
Soak the gelatin well in the water. Take the peptonized milk and add
the sugar. Put in the gelatin and stir until it is dissolved. Pare the
lemon and orange, and add the rinds to the mixture. Squeeze the lemon
and the orange juice into a glass, strain and mix with the rum or brandy
if preferred. Add the juices to the milk, stirring constantly. Strain,
and allow it to cool to the consistence of sirup. When almost ready to
set, pour into cups and set in a cold place. Do not pour the milk into
moulds until the mixture is nearly ready to set, otherwise it will separate
in setting.
Peptonized Milk Lemonade.
Cracked ice % glass 80 c.c.
Juice of 1 lemon 20 "
Sugar 3 teaspoonfuls 30 gm 100 calories
Squeeze into the cracked ice the lemon juice, and add the sugar dis-
solved in water. Fill the glass with fresh specially peptonized milk and
stir well. If preferred, equal parts of milk and of an effervescent mineral
water may be used. Pour the water on the lemon juice and ice, and im-
mediately fill the glass with milk.
Peptonized Milk Punch
Finely crushed ice 1 A goblet 80 c.c.
Rum 1 tablespoonful. ... 15 " 50 calories
Curacao a dash 5 " 15 "
Nutmeg a pinch
In the usual milk punch recipes the specially peptonized milk may be
used in place of ordinary milk. Take the ice, pour on it the rum and
Curacao, or any other liquor agreeable to the taste. Fill the glass witli
peptonized milk; stir well, sweeten to taste, and grate a little nutmeg
on top.
Peptonized Milk Gruel.
Wheat flour 1 teaspoonful
Cold water 1 A pint '. 250 c.c.
Cold milk 1 pint 500 " 340 calories
592 PREPARATION OF SPECIAL BEVERAGES AND FOODS
Mix the wheat flour, arrowroot flour or Robinson's barley flour with
the cold water. Boil for five minutes, stirring constantly. Add the cold
milk and strain into a jar; add the usual peptonizing ingredients; place
in warm water (115 F.) for twenty minutes and then upon ice.
Junket, or Curds and Whey
Fresh milk Yi pint 250 c.c 180 calories
Fairchild's essence of pepsin 1 teaspoonful
To the milk add the essence of pepsin and stir just sufficiently to mix.
Pour into custard cups, and let it stand until firmly curdled. It may be
served plain or with sugar and grated nutmeg. It may be flavored with
wine, which should be added before curdling takes place.
Junket with Egg.
Egg 1 whole. 50 gm 80 calories
White sugar 2 teaspoonfuls 20 " 42 "
Warm milk ^ pint 250 c.c 180 "
Essence of pepsin 1 teaspoonful 4 "
Beat the egg to a froth, and sweeten with the sugar; add this to the
warm milk, and then add the essence of pepsin and let it stand until
curdled.
Cocoa Junket (Fairchild).
Cocoa 1 even tablespoon-
ful 16 gm 100 calories
Sugar '. . . 2 teaspoonfuls 20 " 82 "
Boiling water 2 tablespoonfuls. . . 30 c.c.
Fresh, cool milk % pint 250 180 *
Fairchild's essence of pepsin 1 teaspoonful 4 "
Put the cocoa and sugar into a saucepan ; scald with the boiling water
and nib into a smooth paste; then stir in thoroughly the milk; heat this
mixture until it is lukewarm not over 100 F. ; add the essence of pep-
sin, and stir just enough to mix ; pour quickly into small cups or glasses,
and let it stand until firmly curdled, when the junket is ready for use.
It may be placed on ice and eaten cold ; as a dessert it may be served with
whipped cream.
Coffee Junket
Sugar 2 teaspoonfuls 20 gm 82 calories
Clear, strong coffee 2 tablespoonfuls. . . 30 c.c.
Fresh, cool milk Y 2 pint 250 " 180 "
Fairchild's essence of pepsin 1 teaspoonful 4 "
BEEF TEAS 593
Dissolve the sugar in the coffee; mix this thoroughly with the milk;
add the essence of pepsin as directed above, and serve in the same way.
Iodized Junket.
Milk ]/2 teacupful 120 c.c 85 calories
Pepsin 2 or 3 teaspoonfuls
Prescribe a saturated solution of potassium iodid and also a bottle
of essence of pepsin. Take the milk and add the required number of
drops of the iodid solution. Heat the milk lukewarm and add the two
teaspoonfuls of pepsin and let it stand until curdled. This will be found
useful where it is difficult to administer the iodid by ordinary methods.
Whey.
Fresh milk Y^ pint 250 c.c 180 calories
Essence of pepsin 1 tablespoonful
Heat the milk lukewarm (115 F.), add the essence of pepsin, and
stir just enough to mix. When this is firmly coagulated, beat up with a
fork until the curd is finely divided and then strain. For flavoring pur-
poses lemon juice or sherry wine may be added.
Grape Juice Whey.
Orange 1 , juice of 60 c.c 45 calories
Grape juice Y pint 120 " 180 "
Make whey as in the above recipe. To this add the juice of the orange
and the grape juice. Strain again if necessary. This may be served hot
or on cracked ice. It may be sweetened if desired. Energy about 225
calories.
Cream-of-Tartar Whey (Paw).
CYram of tartar 1 heaping teaspoonful
Boiling water 1 pint
Milk 1 cup 250 c.c 180 calories
Add the cream of tartar to the boiling water. Strain, sweeten to taste,
and serve cold. Energy about 180 calories.
BEEF TEAS
Beef Tea ( Pavy).
Finely minced beef 1 pound 454 gm 1,000 calories
Cold water 1 pint 500 c.c.
Salt l / 2 teaspoonful 2 gm.
Put tho boef with tlio cold water into a suitable vessel. Let it stand
for an hour, stirring occasionally. Put the vessel containing the beef into
594 PREPARATION OF SPECIAL BEVERAGES AND FOODS
a saucepan of water, place it over the fire, and allow the water to heat
gently for an hour (or the vessel containing the beef tea may be put into
an ordinary oven for an hour). Pass the beef tea through a strainer. A
fine sediment appears in the fluid, and this should be drunk with the
liquid. Flavor with salt. At no time should the beef extract be exposed
to a temperature of more than 170 F.
Beef Tea (Bartholow).
Beef 1 pound 454 gm 1,000 calories
Cold water 1 pint 500 c.c.
Chop the beef fine, free from fat, tendons, etc., and soak with the cold
water for two hours. Let it simmer on the stove for three hours at a tem-
perature never above 160 F. Replace the water lost by evaporation by
adding cold water, so that a pint of beef tea shall represent a pound of
beef. Strain and carefully express all fluid from the beef.
Beef Tea with Oatmeal (Yeo).
Groats 1 tablespoonful 30 gm 104 calories
Cold water 2 tablespoonfuls. . . 30 c.c.
Boiling beef tea 1 pint 500 " 150 "
Mix thoroughly the groats and cold water ; add to this the boiling beef
tea. Boil for ten minutes, stirring constantly. Strain through a coarse
sieve.
Beef Tea (Caultey). 1. Mince one pound of lean beef, and add to
it one pint of cold water and ten drops of dilute hydrochloric acid. Let
it stand for two or three hours, with occasional stirring, and then simmer
for ten to twenty minutes. Do not let it boil. Skim well. Energy value
25 calories to 100 c.c.
2. Mince one pound of lean beef as fine as possible, and pound it in a
mortar with a small teaspoonful of salt. Add the meat and its juice to
one pint of water at 170 F. in an earthen vessel, and stand it for an hour
by the fire, stirring at times. Then strain it through muslin, taking
care to squeeze all the juice out of the meat. It furnishes 25 calories
to 100 c.c.
The composition of beef tea, Nos. 1 and 2, is 92.9 per cent water, 4.4
per cent protein, 0.4 per cent fat, 1.1 per cent carbohydrate.
Beef Tea, Flavored (Yeo). Beef tea may be flavored agreeably by
boiling in it a pinch of mixed herbs, a bay-leaf or a bit of onion, carrot,
turnip or celery and a few peppercorns. The roots should either be
chopped small or be scraped to a pulp before being added to the broth.
MEAT JUICES 595
Thick Beef Tea, No. 1 (Watson).
Beef tea (made) .1/2 pint 250 c.c 75 calories
Egg 1 yolk 18 gm 68
Tapioca grout 1 teaspoonful 5 " 15 "
Warm the beef tea and sprinkle in the tapioca, stirring all the time.
Let it simmer "slowly by the side of the fire until the tapioca turns quite
clear. This will probably take about fifteen minutes. Beat up the yolk
of an egg in a cup, pour the beef tea gradually over it, stirring all the
time. It is now ready for serving.
Beef Tea, No. 2 (Watson).
Beef tea (made) Y?. pint 250 c.c 75 calories
Arrowroot 1 teaspoonful 5 gm. . .' 15 "
Cold water 1 " 4 c.c.
Mix the arrowroot and the water in a small basin until quite smooth.
Then add it to beef tea that is being warmed in a pan ; stir well for a few
minutes to prevent it from becoming lumpy. Then simmer slowly for
fifteen minutes.
MEAT JUICES
This variety of food differs greatly in nutritive value from the beef
teas and essences previously mentioned. The meat juice is extracted with-
out any heat and under strong pressure, and thus a large portion of the
albumin is present.
Home-made meat juice is cheaper than the proprietary preparations,
and is more valuable on account of its freshness, and the absence of pre-
servatives. It contains a relatively small quantity of extractives, and can
be given in considerable amounts without causing diarrhea or thirst. The
great drawback to the home-made product is its red color, which is de-
cidedly objectionable. This can be partially overcome by serving in a red
glass or a cup.
Home-made Meat Juice (Watson).
Rump steak (best) ^ pound 115 gm 330 calories
Cold water 1 gill 125 c.c.
Pinch of salt or sugar to taste.
Wipe and shred the meat very finely, pound it well, and rub it through
a fine wire sieve. Place in a basin with water and salt, and let stand,
stirring occasionally, for a couple of hours. The liquid will then be a
bright red color. Strain through a fine strainer, pressing the meat with
596 PREPARATION OF SPECIAL BEVERAGES AND FOODS
the back of a spoon. The fluid obtained will contain 4 to 5 per cent of
protein.
Meat juice should be made in very small quantities, as it very soon be-
comes rancid. Another method, such as squeezing the meat in a lemon
squeezer, may be tried, but this is wasteful, as the pressure is not suf-
ficiently powerful to extract all the juice.
Meat-Juice Mince (Watson).
Rump steak (best) K pound 230 gm 660 calories
Butter 1 small piece 15 120 "
Pepper and salt Y^ teaspoonful each. 2 "
Rub the meat through a hair sieve until all the red juicy part has gone
through; scrape the bottom of the sieve. Melt a very little piece of the
butter in a small frying-pan; toss the meat juice in it for three or four
minutes, until it loses its red color. Flavor and serve with toast. This
looks just like mince, but as none of the fiber is present, it is very digesti-
ble. This meat-juice mince can be made more easily digestible by omit-
ting the butter, and adopting the following method: Add to the scraped
meat a teaspoonful of beef tea or simple stock, and stir in an iron pan for
three or four minutes, when the juice granulates and becomes brown in
color. If an enamel pan is used, the meat has a very unappetizing
appearance.
Beef Juice (Bartholow). Broil quickly some pieces of round or sir-
loin steak, of a size to fit in the cavity of a lemon squeezer previously
heated by dipping in hot water. The juice should be received into a hot,
colored (preferably red) wine glass, seasoned to taste with salt and
cayenne pepper, and taken hot.
Beef Juice (Caultey). Chop lean beef fine, or scrape with a fork or
meat scraper to separate the connective tissue, and put it in a jar or cup
with a pinch of salt and enough cold water to cover it. Allow it to stand
from one to six hours, and then squeeze well through coarse muslin. It
may be given alone or mixed with other foods, warm or cold, but not hot.
It should be warmed by heating the vessel in hot water.
Beef Juice (Ringer). Take one ounce of fresh beef, free from fat,
chop fine and pour over it eight ounces of cold water ; add five or six drops
of dilute hydrochloric acid and fifty to sixty grains of common salt, stir it
well, and leave for three or four hours in a cool place. Then pass the
liquid through a hair sieve, pressing the meat slightly, and adding grad-
ually toward the end of the straining about two more ounces of water.
The liquid thus obtained is of a red color, possessing the taste of soup.
BKOTHS 597
It should be taken cold, a teaspoonful at a time. If preferred warm, it
must not be put on the fire, but heated in a covered vessel placed in hot
water. It furnishes 25 calories to 100 c.c.
The composition of beef juice is 90.6 per cent water, 5 per cent pro-
tein, 0.0 per cent fat.
Beef Essence (Yeo).
Lean beef 1 pound 460 gm 1,320 calories
Salt a little
Chop the lean beef very fine, free from fat and skin ; add the salt and
put into an earthen jar with a lid; fasten up the edges with a thick paste,
such as is used for roasting venison in, and place the jar in the oven for
three or four hours. Strain through a coarse sieve, and give the patient
two or three tablespoonfuls at a time. Energy value 25 calories to 100 c.c.
Cold Beef Juice.
Finely chopped lean beef 1 pound 452 gm 1,000 calories
Cold water 8 ounces 250 c.c.
Cover the beef with the cold water and allow it to stand for eight or
ten hours. Squeeze out the juice by means of a muslin bag ; season with
salt or sherry wine, and drink cold or slightly warmed. It may be added
to milk, care being taken that the milk is not too hot before the juice is
added.
Iced Meat Extract (v. Ziemssen). -
Fresh beef 2 pounds 1 kilo 2,000 calories
Sugar % pound 250 gm 1,000
Freshly expressed lemon juice ... 7 ounces 200 " 50 "
Cognac containing vanilla extract % ounce 20 " 5 "
Eggs 3 yolks 54 204
Cut the fresh beef into pieces the size of a hand; wrap in a coarse,
lattice-like linen bag, put under a lever press, and press slowly. The
juice should be caught in a porcelain dish. This is best done by a drug-
gist. By this method about 500 grams of juice are obtained. Mix the
juice with the sugar and lemon juice (this last is best omitted in the case
of dyspeptics) and the cognac; stir in well the yolks of the eggs, and place
the entire mixture in a freezer. Energy value 25 calories to 100 c.c.
BROTHS
Broths, hoof teas, etc., are home-made infusions of beef, mutton, veal
or ehiekrn, and are always in demand for the sick-room. They are to be
138
598 PREPARATION OF SPECIAL BEVERAGES AXD FOODS
regarded, however, more in the nature of pleasant, palatable and stimu-
lating beverages than as foods. Their nutritive value depends entirely on
the method of preparation. If the process of cooking is carried to the
point that the infusion contains a portion of the protein of the meat, then
there is some nutritive value ; but, on the other hand, if prepared after the
ordinary routine, only the extractives and salts of the meat are dissolved
out and, from the point of view of nutrition, the value is practically
negative.
Meat Broth (Beef, Veal, Mutton or Chicken) (Sutherland).
Chopped lean meat 1 pound 450 gm 1,000 calories
Water 1 pint 500 c.c.
Cover the meat with the water and allow it to stand for from four to
six hours. Then cook over a slow fire for an hour until reduced to half
the quantity. Cool, skim, pour into jar and strain.
Chicken Broth (Bartholow). Skin arfd chop fine a small chicken or
half a large fowl, and boil it, bones and all, with a blade of mace, a sprig
of parsley and a crust of bread, in a quart of water for an hour, skim-
ming it from time to time. Strain through a coarse colander. It fur-
nishes 50 calories to 100 c.c.
The composition of chicken broth is 84 per cent water, 10.5 per cent
protein, 0.8 per cent fat, 2.4 per cent carbohydrate.
Veal Broth
Water 1 pint 500 c.c.
Lean veal % pound 225 gm 500 calories
Pour the water on the finely chopped lean veal and allow it to stand for
three hours. Boil for a few minutes, strain and season with salt.
Clam or Oyster Juice (Drexel Institute). Cut the clams or oysters
into pieces and heat for a few minutes in their juice. Strain through
muslin and serve while hot. In straining great care must be taken that
sand does not pass through the muslin. The juice should be diluted and
may be frozen.
Clam Broth (Drexel Institute).
Clams 3 large 75 gm 40 calories
Cold water J^ cupful 125 c.c.
Wash the clams very thoroughly, using a brush for the purpose. Place
in a kettle with the cold water. Heat over the fire. As soon as the shells
open, the broth is done. Strain through muslin, season and serve.
BROTHS 599
Mutton Broth with Vegetables
Neck mutton 1 pound 450 gm 1,375 calories
Water 1 pint 500 c.c.
Carrots 2 whole 200 gm 36
Turnips 1 200 54 "
Onions 3 200 18
Barley 4 tablespoonfuls. . . 75 " 40 "
Allow one pound of neck mutton to each pint of water; add the above
ingredients. Let all simmer together for three hours.
Mutton Broth without Meat
"Shankends" 2 bones 1,000 gm 200 calories
Cold water 1 pint 500 c.c.
Cook the "shankends" in the cold water, add vegetables as directed
in the foregoing recipe ; simmer for three hours and strain.
Invalid Broths (Thompson) (4). To one pound of chopped lean meat
chicken, mutton or beef add one pint of cold water; let stand in a
covered glass fruit jar from four to six hours; cook for three hours in a
closed jar over a slow fire, strain, cool, skim off the fat, clear with egg,
season, and use warm or cold.
These broths, except the chicken broth, possess essentially the same
fuel value as beef tea.
Beef Broth with Poached Eggs. Prepare the broth in the proportion
of half a teaspoonful of "Soluble Beef" to one cupful of hot water and
add a poached egg.
A Nutritive Drink for Delicate Women and Children.
"Soluble Beef" .% teaspoonful 2 gm 30 calories
Boiling water 5 ounces 150 c.c.
Cream % ounce 20 gm 72 "
Mix the "Soluble Beef," water and cream, season with salt and pepper
to suit the taste.
Beef Broth and Grain.
"Soluble Beef" 1 teaspoonful 2 gm 30 calories
Water 1 quart 1,000 c.c.
Rice 1 tablespoonful. ... 15 gm 20 "
Take the above ingredients and add salt to taste. Dissolve the "Solu-
ble Beef" in the hot water, and add the well-washed rice. Simmer
slowly until dissolved and absorbed by the rice, adding more beef broth
if too much boils away. If not entirely dissolved, the broth should be
strained before using.
600 PKEPAIIAT1OX OF SPECIAL BEVEKAGES AND FOODS
BOUILLON
Plain Bouillon (Wegele).
Lean beef M kg. (1 lb.) 453 gm 1,086 calories
Cut the beef into small pieces and put same in a vessel holding about
3 pounds (6 pints) and having a well-fitting cover (or use a double boiler).
Fill vessel with cold water and allow it to cook for 3 to 4 hours. According
to the strength required, it is better to add boiling water afterward, mak-
ing the bouillon stronger or weaker, as desired. This makes about 2
pounds (4 pints) of bouillon meat not to be used again. To obtain a
better taste and color, one can brown the meat in a hot dry pan before
putting the meat into the 6 pints of water.
Clam Bouillon (Pattee).
Cold water % cupful 187 c.c.
Clam broth l / 2 u 125 * 42 calories
Scalding milk % " 30 " 45
Butter 1 tablespoonful. ... 15 gm 120 "
Salt, pepper each % teaspoon ... 4 "
Celery sauce 1 tablespoonful 15 " 48 "
Whipped cream 1 .... 30 " 81
Blend the water and clam broth, heat to the boiling point, then add
the scalding milk, the butter and stir well ; season with salt, pepper and
celery sauce to taste. A small quantity of cracker crumbs may be added
to thicken it. Serve in heated bouillon cups and garnish with the whipped
cream.
Clam Bouillon Bisque (Pattee).
Butter 1/3 tablespoonful ... 8 gm 60 calories
Chopped onion 1 " 5 " ' 15 "
Chopped carrot Yi " ....80 * 38
Clam broth 1 cupful 250 c.c 84 "
Flour H tablespoonful. ... 20 gm 15 "
Boiling water 1 cupful 250 c.c.
Egg 1 yolk 18 gm 68
Cream Y cup 40 " 120 "
Melt the butter, add the finely chopped onion and carrot; cover and
cook until the onion and carrot are tender, stirring occasionally. Add
the flour, blending well ; then pour on gradually the boiling water and the
clam broth. Cook five minutes, strain and return to saucepan. Mix the
yolk of egg with the cream, and add it slowly to the bisque. Pour into
heated bouillon cups and serve with small oyster crackers.
VEGETABLE SOUPS 601
American Bouillon, American Broth (Yeo). Place in a tin vessel that
can be sealed hermetically alternate layers of finely minced meat and
vegetables. Seal it, and keep it heated in a water bath (bain marie) for
six or seven hours, and then express the broth.
Bottle Bouillon (Uffelmann). Cut beef, free from fat, into squares.
Place these in a stoppered bottle, put the bottle in a basin of warm water,
heat slowly, and boil for twenty minutes. There will be about an ounce
of yellowish or brownish fluid for each three-quarters of a pound of meat
used. The flavor is that of concentrated bouillon.
VEGETABLE SOUPS
Soups without Meat (Drexel Institute). These soups are thickened
by using butter and flour. This prevents a separation of the thicker and
thinner parts of the soup. The butter should be heated until it bubbles,
the flour and seasoning added, and enough of the hot liquid to make a
smooth sauce thin enough to pour easily. This should be poured into the
rest of the hot liquid and cooked in a double boiler until the soup is of the
proper consistence. In soups made of dried peas and beans, soda is used
to soften the casein. It is also used in tomatoes to neutralize the acid.
These soups must be served in hot dishes as soon as ready. Crisp crackers,
croutons, or soup sticks may be served with them.
Crisp Crackers. Split and butter thick crackers and brown in a hot
oven.
Cream-of-Tomato Soup
Tomatoes 1 can 450 gm 105 calories
Soda % teaspoonful 1 "
Butter H pound 183 " 1,000
Flour y z " 183 " 500
Salt 3K teaspoonfuls 12 "
White pepper K teaspoonful 2 "
Milk 1 quart 1,000 c.c 720
Stew the tomatoes slowly one-half to one hour, strain and add soda
while hot; make a white sauce and add the tomato juice. Serve im-
mediately.
Vegetable Soup.
Spinach 1 handful 200 gm 16 calories
Beet 1 large 200 29
Carrots 2 small 200 " 18
Chop the vegetables fine and add to one quart of water. Boil two
C02 PREPARATION OF SPECIAL BEVERAGES AND FOODS
hours, add water to make quantity up to one quart and strain. Add salt
if desired. This contains a large amount of inorganic salts.
Cream-of -Celery Soup (Ruhrah).
Celery lj^ cupfuls 250 gm 45 calories
Water 1 pint 500 c.c.
Milk 1 cupful 250 170
Cream 1 " 250 " 440
Butter 2 tablespoonfuls. . . 30 gm 240
Flour K cupfu 1 140 " 400
Salt K teaspoonful 2
White pepper K .... 2
Cook the celery in the boiling water until very soft ; strain and add the
hot liquid ; make a white sauce and cook until it is thick cream.
Cream-of -Potato Soup (Wegele).
Potatoes, white 3 whole 300 gm 450 calories
Milk 2 cupfuls 500 c.c 340
Cream K cupful. . 125 " 220
Eggs 2 yolks 54 gm 204
Salt 1 teaspoonful 4 "
Pepper H " 1 "
Onion juice H " 2 "
Cook the potatoes until soft, drain, mash, add the hot liquid and strain ;
add the beaten yolks and seasoning. Cook in a double boiler until the
egg thickens, stirring constantly. Serve immediately.
Tapioca Soup (Yeo).
Meat broth or stock 1 pint 600 gm 454 calories
Previously washed tapioca % ounce 21 " 21 "
Boil the broth or stock, and, while stirring constantly, sprinkle in the
tapioca. Cover the saucepan, and let it stand until the tapioca is quite
soft. Skim and serve.
Julienne Soup (Vegetarian) (Watson).
Vegetable stock (clarified) 1 quart 1,000 c.c 360 calories
Mushroom ketchup 2 tablespoonfuls. . . 30 "
Salt and pepper l /% teaspoonful 2 gm.
Turnip, carrot, celery, onion .... 4 ounces, each .... 400 " 160 "
Walnut ketchup 2 tablespoonfuls. . . 30 c.c.
Sherry ^ cup 120 160
Cut the vegetables into fine strips about the size and shape of a small
match, and boil them separately until tender but not broken. Have the
VEGETAHLK SOUPS 603
stock rcadv boiling; add salt, pepper, a very little ketchup and sherry to
taste; put in the prepared vegetables, cook for fifteen minutes and serve.
White Soup (Watson).
Onions 2 small 200 gm 84 calories
Celery 1 head 200 32
Milk % pint 250 c.c 170
Turnip 1 whole 560 gm 24
Artichokes 2 French 720 194
Flour 1 dessertspoonful . . 15 " 15 "
Potatoes (white) 1 pound 550 385 "
Water 3 pints 1,500 c,c.
Butter 1 ounce 30 gm 240
Cut about 2 pounds weight of any white vegetables, wash and peel and
cut in pieces and boil until soft in the water ; salt and butter. Rub them
through a sieve or colander, put them back in the stewpaii with the milk,
and let it boil. Put in the flour, mixed smoothly with cold water, let the
soup boil for ten minutes and serve with slices of fried bread.
Clear Soup or Consomme (Watson) (5).
Soup stock 1 quart 1,000 c.c 360 calories
Lean, juicy beef % pound 260 gm 700 "
Sugar 1 lump 10 41
Egg 1 whole 50 80
The stock should be in the form of a good jelly.
Method: Carefully remove all fat from the top of the stock, and put
it into a clean lined saucepan. Wipe the beef with a damp cloth, and
shred it finely as you would for beef tea, removing all fat and skin. Add
this to the stock, with the white of the egg and the shell, well washed and
crushed. Whisk these over the fire with a wire whisk until the soup just
comes to the boiling point. Then remove the whisk, and let the soup boil
up. Draw the pan to the side of the fire, where the soup will keep warm
but not simmer, and cover it with a plate. Let it stand there from ten to
fifteen minutes. Tie a clean cloth on to the four legs of a chair turned
upside down, letting it fall slightly in the middle so as to form a bag.
Pour some boiling water through the cloth into a basin to heat the cloth
thoroughly. Then strain the soup. Tt will not be clear the first time, so
change the basin and pour the soup through again, repeating this process
until it is quite clear. In repeating, add a lump of sugar, which makes
the soup sparkle.
This soup can be varied by the addition of different garnishes, c.</..
604 PREPARATION OF SPECIAL BEVERAGES AND FOODS
Consomme and Egg (Watson).
Consomme" 1 quart 1,000 gm 110 calories
Egg 1 (whole) 50 " 86
Put the clear soup into a saucepan, and bring it to the boil. Beat up
the egg in a small cup or basin with a fork, and pour it slowly into the
boiling soup, stirring all the time with a spoon. The egg will curdle in
the soup, and look like threads of yellow.
Lentil Soup (Watson). Wash the lentils thoroughly in cold water,
and add them to water in the proportion of % pound lentils to a gallon of
water or of second stock. Add pepper, salt, onion, turnips, carrot and
celery. Boil all for three or four hours. Pass through fine wire sieve or
colander, put on a few minutes to heat, and send to table with toast cut in
dice. A little curry powder may be added if desired. This soup is some-
what apt to cause flatulence in those of weak digestion, but if made with
Benger'? pancreatized lentil flour and without the additional vegetables,
it will be found very acceptable to the most delicate stomach. Pea soup
served with dried mint, and haricot bean soup can be made in the same
way. Fuel value, 100 grams, 130 calories.
Brunoise Soup (Watson).
Carrot, young 1 (whole) 100 gm 18 calories
Turnip, young H 140 " 6
Celery 2 leaves 20 3 "
Flower of small cauliflower 1 small 10 " 1 "
Onion 1 (whole) 100 42
Butter 1 ounce 30 " 240 "
Milk 1 pint 500 c.c 350 "
Water 1 500
Salt 1 teaspoonful 4 gm .
Pepper K 1
Stale bread, toasted 2 ounces 60 " 200
Stew the ingredients together, except the toast, for one hour, then
break the toast in pieces, add it to the rest, and stew all together for
another hour. Pass all through a sieve and return to the stewpan to heat.
Potato Soup (Watson).
Potatoes 1 pound 550 gm 385 calories
Leek 1 (medium) 100 40
Onion 1 100 42
Butter 1 ounce 30 " 240
Milk 1 pint 500 c.c 340
Water.. . 1 . ..500
MEAT SOUPS 605
Stew the potatoes, put them with leek, onion and butter into a pint
of boiling water in a stewpaii. Boil until the vegetables are soft, then
pass them through a sieve, adding a pint of hot milk. Put the mixture
into the stewpan until it boils. Serve with dice of fried bread.
Brown Vegetable Soup (Watson).-
Water 2 quarts 2,000 c.c.
Butter 1 ounce 30 gra 240 calories
Bread 1 slice 37 " 99
Onions 2 (whole) 200 84
Cabbage 1 pound 550 " 145
Potatoes 2 (whole) 300 304 "
Carrots 2 200 36
Turnip 1 (large) 280 12 "
Parsley, salt and pepper.
Fry a slice of onion in a large saucepan. When it is brown, but not
burned, add water, salt and pepper, bread toasted and vegetables cut into
small pieces. Boil three or four hours, then rub the vegetables through
a colander and boil again for ten minutes, when the soup is ready. If
too thick, add a little more water.
MEAT SOUPS
All soups, bouillons and broths consist principally of salts and ex-
tractive substances. They merely serve as appetizers by exciting the gas-
tric secretions, and have very little nourishing or caloric value. In atony
of the stomach, hypersecretion and general hyperesthesia, bouillon is
contra-indicated, as it increases gastric secretion. During hot weather,
on account of its tendency to fermentation, bouillon should always be
freshly prepared. Beef tea is much more nutritious than ordinary
bouillon, and freshly made beef juice is much more nourishing than any
of the other preparations.
General Directions for Soupmaking In order to expose as large a sur-
face to the water as possible, the meat is cut up into pieces, while the
solvent power of the water is increased by the addition of a little vinegar.
The temperature is kept at a little below 160 F. for several hours. As
vegetables require a very much greater heat than this to soften them,
they should either be first boiled, and then the meat should be added, or
the vegetables can be cooked separately, and only added to the soup when
it is almost ready. This preserves the color best. Flavoring herbs should
bo put in at the last moment. Tu all soups made from meat, groat onro
should be exercised in the removal of the fat. This is done by making the
606 PREPARATION OF SPECIAL BEVERAGES AND FOODS
soup the day before it is required, putting aside in a basin to cool, and
when it is quite cold carefully skimming the fat from the top.
First Stock for Clear Brown Soup (Watson).
Shin of beef 1 pound 550 gm 600 calories
Knuckle of veal 1 550 " 615
Cold water 3 quarts 3,000 c.c.
Carrot 1 (whole) 100 gm 18
Turnip 1 " 140 " 6
Mixed herbs 1 teaspoonf ul 4 "
Small onions 2 (whole) 200 84
Celery, or. . 2 or 3 stalks 55 " 101
Celery seed 1 teaspoonf ul 4 " 8 "
Peppercorns 2 dozen 2 " 2 "
Cloves 8 seeds 12 " 2
Mace 1 blade 12 '... 2
Parsley A few stalks 100 4
Salt 1 dessertspoonful . . 8 "
Wipe the meat with a damp cloth, and remove all marrow from the
bone. Take a very sharp knife and cut the meat into small pieces, keeping
back any fat, but using the skin. Put the bones and meat into a stock pot
with the cold water and salt, and let them soak for half an hour, then put
the pot on the fire, and bring the contents slowly to the boil. Simmer for
half an hour, and then remove any scum that may be on the top. Add
the vegetables, prepared and cut rather small, and the herbs, celery seed,
and peppercorns, etc., tied in a small piece of muslin. Simmer slowly
from four and a half to five hours, never letting it go off the boil. Then
strain through a hair sieve or cloth stretched over a colander, and let stand
until cold. A darker -colored stock may be obtained by frying the meat
in a little dripping or butter before pouring on the water.
Do not throw away the meat or vegetables left after straining, but put
them on again with the same quantity of water as before, and boil again
for second stock.
Fish Soup (Watson). .
Small haddock or whiting, or piece
of cod 4 ounces 100 gm 108 calories
Butter Bounce 15 120
Flour Yi 15 " 15 "
Cold water 1 pint 500 c.c.
Milk 1 gill 166 " 120
Egg 1 yolk 18 gm , . 68
Cream i/ gill 80 c.c. 139
Finely chopped parsley 1 teaspoonful 4 gm 2 "
MEAT SOUPS 607
Wash and scrape the fish very clean. See that there is no black skin
lining the inside parts. Remove the eyes. Cut the fish across into several
pieces, and put them in a lined saucepan, cover with cold water and add
the salt. Bring to the boil and skim. After the fish has boiled for a few
minutes, pick out a few of the best pieces of fish, free them from skin and
hone, and reserve them for serving in the soup. Allow the rest to simmer
from three-quarters to one hour. Then strain through a wire sieve, and
rub some of the white pieces through. Rinse out the pan the soup was
cooked in. Melt in it the butter, add the flour, and mix these two
smoothly together, being careful they do not brown. Then pour on the
soup and stir until boiling. Beat the yolk of egg and cream and milk
together, and, when the soup is off the boil, beat these ingredients into it.
Strain through a fine strainer, stirring all the time. Do not let the soup
boil after the egg is added, or it will curdle. The pieces of fish that were
reserved and the chopped parsley are now added.
Egg Dumpling Soup (Wegele).
Eggs 2 (whole) 100 gm 160 calories
Flour (Bounce) 7 6
Thoroughly mix the yolk of the eggs with the flour. Beat stiff the
whites cf two eggs and add to above. Drop the dumplings into the soup
with a teaspoon, and allow the soup to boil up once or twice. Take out
the dumplings carefully with a skimmer, so they will not break, put into
the soup plate and then add the soup.
Oyster Stew (Fitch).
Milk 1 cupful 250 c.c 170 calories
Oysters 1 pound 453 gm 230
Salt M teaspoonf ul 1 "
Butter 1 tablespoonful 15 -. 120 "
Pepper % saltspoon
Heat the milk. Cook and strain the oyster juice. Add the oysters,
which have been rinsed, and cook until the edges curl. Add seasoning,
butter ar,d hot milk. Serve at once. This soup may be thickened with a
tablespoonful of flour cooked in the butter.
Sweetbread Soup (Wegele) (6). The sweetbread is soaked in cold
water for one hour, the water being renewed frequently during this time.
It is then boiled for one hour in slightly salted water or beef broth, to
which may be added one teaspoonful of julienne to improve the taste.
After it is soft, the sweetbread is taken out of the broth and all blood
vessels and skin are removed. It may then be cut into pieces the size of
608 PREPARATION OF SPECIAL BEVERAGES AND FOODS
a walnut and put on a plate, over which the broth is poured, or the sweet-
bread may be forced through a sieve, the beef broth poured over this, and
the whole put on the fire again until it boils, after which the soup may be
served. This latter process is to be recommended in the case of dyspep-
tics. One hundred drams of raw sweetbread generate about 90 calories
of heat.
Oyster Soup (Watson).
Oysters 1 dozen 170 gm 88 calories
Fish stock or white stock 1 pint 250 c.c 100 "
Butter 1 ounce 30 gm 240 "
Flour 1 30 30
Cayenne a pinch 0.2 "
Cream 4 tablespoonfuls 160 c.c 278 "
Egg 1 whole 50 gm 80 "
Anchovy essence a few drops
Lemon juice a squeeze
White pepper and salt
Place the oysters in a small saucepan with their own liquor, bring
them almost to the boil, then strain. Beard the oysters (that is, remove
the piece like a fringe that encircles them), cut them in two, and put them
aside for stewing in the soup. Put the beards into a saucepan with the
liquor and the stock, and let them simmer for half an hour to extract all
the flavor from them. If the stock is not previously well flavored, small
pieces of the different flavoring vegetables 1 should also be cooked in
it. Strain through a fine hair sieve or piece of muslin, and rinse out
the saucepan ready for use. First melt in it the butter, being careful
it does not brown, add to it the flour and mix together until quite smooth.
Pour on the stock, and stir constantly over the fire until boiling. Skim
if necessary. Season to taste with a little white pepper, salt, anchovy
essence, and pinch of cayenne. Beat up the yolk of eggs in a basin with
the cream and strain into the soup. When off the boil, stir all the time.
Place oysters in the soup tureen, pour the soup over them and serve.
FARINACEOUS FOODS
Boiled Bice (U. S. Army Hospital Recipe).
Rice 1 ounce 30 gm.
Salt 20 gm.
Water 4 ounces
Put the salt and water into a stewpan. When boiling add the rice,
previously washed thoroughly. Boil for ten minutes, or until each grain
i Volume I, Chapter XVII, page 040.
FAIUNACEOUS FOODS 609
becomes soft. Drain it on a colander. Grease the stewpan with clarified
drippings or lard. Put back the rice. Let it swell slowly near the fire,
or in a slow oven, for about twenty minutes, until the grains are well
separated.
Boiled rice furnishes CO calories to 1 tablespoonful.
Cornmeal Mush (Individual Rule) (Pattee).
Cornmeal 1 ounce 30 gm 100 calories
Flour % tablespoonful. ... 15 " 40 "
Salt J4 teaspoonful 1 "
Cold milk % cupful 30 c.c 40
Boiling water ^ " 125 "
Mix the meal, flour and salt with the cold milk or water; when smooth,
stir into the boiling water. Cook in a double boiler one hour or more, or
over direct heat one-half hour. Serve with cream and sugar. If wanted
for sauteing turn into tins to cool. Cut into slices, dip in flour and
saute in drippings or butter.
Hominy Mush (Pattee).
Fine hominy % cupful 30 gm 100 calories
Salt ^ teaspoonful 1 "
Boiling water \% cups 333 c.c.
Put all the ingredients together in a double boiler and cook two hours.
Add more water if mush seems stiff and thick. All preparations of corn
absorb a great deal of water in cooking, and hominy usually needs a little
more than four times its bulk.
Note. Hominy is exceedingly indigestible unless well cooked, but
sweet and nutritious when subjected to a high temperature for a long time.
Oatmeal Mush for Children and Invalids (Pattee).
Granulated oatmeal 1 cupful 453 gm 380 calories
Salt 1 teaspoonful 1 "
Boiling water 1 scant quart 1,000 c.c.
Put the oatmeal and salt in a double boiler, pour on the boiling water,
and cook three or four hours. Remove the cover just before serving, and
stir with a fork to let the steam escape. If the water in the lower boiler
be strongly salted, the oatmeal will cook more quickly. Serve with sugar
or salt and cream or milk.
Note. Baked sour apples, apple sauce and apple jelly are delicious
oaten with oatmeal. They should be served with the mush, and sugar and
cream poured over the whole. They give the acid flavor which so many
610 PREPARATION OF SPECIAL BEVERAGES AND FOODS
crave in the morning. Coarse oatmeal is not advisable in any form of
water brash, acidity or bowel irritations. It often causes eruptions on
the skin in warm weather.
Rice and Macaroni (Watson). These carbohydrates are the basis of
many nourishing and easily digested Italian dishes. In cooking, the
directions for boiling rice and macaroni should be closely followed.
Plain Boiled Rice (Watson). Wash well some Patna rice in several
waters until the last water looks quite clean. If there is a pot for steam-
ing the rice in it is best to use this, but if not, boil the rice in a saucepan
of boiling water containing salt, which is in the proportion of one tea-
spoonful to the quart. Boil quickly with the lid off, stirring it frequently
with a fork to prevent it sticking to the pan. Cook from ten to fifteen
minutes until the grain will rub down easily when tested between the
finger and thumb. Strain through a sieve or strainer, and dry the rice
either by putting it into the saucepan by the side of the fire, or putting it
on a plate in a moderate oven. While drying, stir lightly with a fork
every now and then to keep the grains separate. The water in which the
rice has been boiled contains the best part of the rice, so it should not be
thrown away, but kept for the stock pot.
Italian Rice (Cheese and Rice) (Watson). Boil the rice as directed
above, strain and pour back into a pan. Put a sufficient quantity of butter
into a frying pan ; when the butter is melted add the rice, and mix well
together for two or three minutes. Place the rice in a dish and cover with
grated Parmesan cheese.
Boiled Macaroni (Watson). Break the macaroni into short lengths,
and throw it into a saucepan of freshly boiling water with salt in it. Boil
quickly, with the lid off, until it has thoroughly swelled and is tender.
Stir occasionally, to prevent it sticking. The time depends on the variety
of the macaroni the large pipe will take about half an hour, the small
much longer. Keep it well covered with water. When done, drain.
Boiled macaroni may either be served plain with meat, or it may be put
back into the saucepan with enough stock to cover it and allowed to stew
for half an hour. The pulp of a fresh tomato rubbed through a sieve may
also be added.
Farina Dumplings (1) (Wegele).
Farina 2 ounces 60 gm 200 calories
Boiling milk % pound (1^ pints).750 c.c 510 "
Egg 1 (whole) 50 gm 80
Butter H unce 15 " 120
FARINACEOUS FOODS 611
Pour the farina slowly into the boiling milk to avoid its getting lumpy.
When thick, take off the fire, add the egg, and put back on the fire, but do
not let the farina get too hot. Dip a flat spoon into the melted butter, and
with this drop the farina into the hot milk a spoonful at a time. Place
the dumplings on a dish and serve at once.
Farina Dumplings (2)
Butter 1% ounces 50 gm 384 calories
Boiling milk 2}/ 2 pints 1,250 c.c 850
Salt a little 1 gm.
Farina ^ pound 260 " 800
Eggs 5 (whole) 250 400
Put the butter into the boiling milk, add a little salt and the farina.
Boil until stiff. Let the mixture cool off and add the eggs. Drop the
dumplings into boiling water with a spoon, and let them boil for about
one-quarter hour. This portion is large enough for four persons.
Farina Dumplings (3)
Farina K pound 260 gm 800 calories
Milk 1 pound (2 pints) . 1,000 c.c . . .680
Eggs 6 (whole) 300 gm. 480 "
Salt a little 1
Bread or rolls 2 slices 75 ft 200 u
Hot butter
Boil the farina in the milk until soft. Let it cool off, and add the
eggs and the salt. Cut the bread or rolls into small squares, roast in hot
butter, add to the farina and mix well. Put everything into a pudding
dish and let it steam for one hour.
Potato Dumplings (Pattee).
Grated potatoes 20 tablespoonfuls . 1,000 gm 1,120 calories
Butter Bounces 50 " 384
Eggs 3 (whole) 150 240
Salt a little 1
Farina 1M ounces 50 " 180 "
Boil the grated potatoes the day before using and mash thoroughly.
Add the butter, mixing thoroughly ; also the yolks of the eggs, stirring in
one after the other with a little salt. Previously boil the farina in milk
until it thickens ; let cool a little. Beat the whites of the eggs, mix and
finally add the grated potatoes. Dip the hands into flour and form length-
wise dumplings; boil in salt water for 15 to 20 minutes.
612 PREPARATION OF SPECIAL BEVERAGES AND FOODS
BREAD(7)
Drexel Institute Bread Recipe.
Warm milk or water 2 cupf uls 500 c.c 340 calories
Salt 2 teaspoonfuls 8 gm.
Sugar 2 " 20 82
Lard or butter 1 tablespoonful. . . . 15 " 120
Compressed yeast Yi cake 4 "
Flour 4 pounds 2,000 " 6,500
Put the water or milk, salt, sugar and fat into a bowl. Gradually add
the yeast, dissolved in warm water, and the flour. When stiff enough to
handle, turn the dough on a floured board and knead until soft and elastic-.
Put it back into the bowl, and let it rise in a warm place until it is double
its bulk. Then divide it into loaves or shape into biscuits. Put these
into the pan in which they are to be baked, cover them and again allow
the bread to rise to double its bulk. Bake loaves one hour in a hot oven.
The large amount of yeast allows the bread to be made and baked in three
hours. This recipe makes two loaves.
Brown Bread.
Scalded milk J^ cupful 125 c.c 85 calories
Water ^ 125
Salt 1 teaspoonf ul 4 gm.
Butter K tablespoonful. ... 7 " 65 *
Lard K u .... 7 65
Molasses 2 tablespoonfuls. . . 30 " 148 "
White flour ^cupful 275 " 800 "
Graham flour 1 553 " 1,600
Yeast % cake
Lukewarm water % cupful 60 c.c .
Take the above ingredients and sufficient Graham flour to knead, dis-
solving the yeast in the lukewarm water. Prepare the same as white
bread. Instead of Graham flour, equal parts of Graham flour and white
flour may be used in kneading.
Nut Brown Bread. The same as preceding, with one cupful of nuts
chopped and added.
Whole-wheat Bread.
Yeast ^ cake 1 gm.
Lukewarm water 1 tablespoonful. ... 15 c.c.
Hot water Y 2 cupful 125 "
Milk }/?. " 125 " 85 calories
Salt YL teaspoonful 2 gm.
Whole-wheat flour 1 cupful 553 * 1,624
BREAD 613
Dissolve the yeast in the lukewarm water. Pour the hot water over
the milk, and when lukewarm add the yeast and salt. To this add the
flour, and beat for five minutes. Cover and allow this to stand in a warm
place for two hours and a half. Then add the whole-wheat flour gradually,
mixing the mass until it can be kneaded. Knead until elastic ; shape and
place in baking pans. Cover and allow to stand in a warm place until
it doubles its bulk. Prick the top with a fork, and bake for one hour.
The oven should not be hot as for white bread.
Pulled Bread. Use bread made with water. Make into long loaves,
and as soon as baked take off the crust. Pull into stick-shaped pieces and
brown slightly in a slow oven.
Zwieback. Cut stale bread in slices and place in the oven and allow
to remain until the slice is colored golden brown. Zwieback is a particu-
larly desirable food for infants and invalids.
Bran Muffins for Constipation (Musser and Piersol).
Bran flour 2 cupfuls 500 gm 100 calories
Wheat flour 2 1,000 " 3,200
Buttermilk 1 cupful 250 c.c 80 "
Molasses 4 tablespoonf uls. ... 60 gm 200 "
Salt a little
Bake in muffin pans (one to be taken at each meal).
Graham Bread (Pattee) (8). Make the same as whole-wheat bread,
adding two tablespoons of sugar or molasses. Make a batter with white
flour, using three or four cups, then use whole wheat or graham flour. Let
rise longer than for white bread, and put immediately into pans without
second kneading. Bake in a hot oven from forty-five minutes to one hour,
depending upon size of loaves. If hard crust is desired, remove from pans
and cool in a draft of air. For soft crust, before bread cools, roll it in a
clean cloth.
Note. Omit sweetening if desired.
White Gems (Pattee).
Flour 2 cups 550 gm 1,600 calories
Salt 1 teaspoonful 4 "
Rumford baking powder 4 teaspoonfuls 16 "
Butter 2 tablespoonf uls. ... 30 "
Sugar 2 40 "
Eggs. 2 (whole) 50
Milk 1 cupful 250 c.c
139
614 PREPARATION OF SPECIAL BEVERAGES AND FOODS
Sift dry ingredients into mixing bowl, add melted butter, and rub it
in with tips of fingers. Add the well-beaten eggs and the milk gradually
and beat all well together. Have gem pans well greased and heated; fill
two-thirds full, and bake in a very hot oven fifteen or twenty minutes.
Put a little melted butter on each gem before putting it into the oven.
They are sufficiently cooked when, if tested with a fine washed knitting
needle, it comes out dry.
Cornmeal Gems (Pattee).
Flour 1 cupful 265 gm 800 calories
Cornmeal ^ " 130 " 380
Sugar y z 100 400
Rumford baking powder 4 teaspoonfuls 16 "
Salt Y 2 teaspoonful 2 "
Egg 1 (whole) 50 80 "
Milk 1 cupful 250 c.c 170
Melted butter 1 tablespoonful. ... 15 gm 120 "
Sift dry ingredients into mixing bowl, add the milk and well-beaten
egg and the melted butter. Put into well-greased hot gem pans and cook
in a quick oven.
TOAST (Pattee)
In the ordinary cooking of a loaf of bread, the starch, in the outer
layer, is changed into dextrin, which gives the crust its sweet flavor.
Slices of bread toasted undergo a similar change. Bread is toasted not
merely to brown it, but to take out all the moisture possible, so that it may
be more thoroughly moistened with the saliva, and thus easily digested;
also to give it a better flavor. The correct way to make toast is to use
stale bread cut in uniform slices, and to dry it thoroughly before brown-
ing. Toast which is prepared in this way, even if moistened with milk
or water, may be very easily and thoroughly acted upon by the digestive
fluids.
Milk Toast (Pattee). Put a cup of rich milk in a saucepan and
place it on the stove. While it is heating, toast three slices of bread to
a delicate brown, and put them into a covered dish. When the milk is
scalding hot, season it with a saltspoon of salt, and pour it over the toast.
This furnishes 388 calories.
Note. A little butter may be spread on each slice before the milk is
added, but it is a more delicate dish without it.
CEREAL FOODS 615
Cream Toast (Pattee).
Butter ^ tablespoonful. ... 7 gm 80 calories
Flour YL " .... 7 " 50
Salt 1/2 saltspoon 1 "
Cold water 1 tablespoonful. ... 15 c.c.
Milk Y 2 cup 125 " 80
Toast l^slices 37 gm 75
Scald milk. Mix flour and salt and add the cold water gradually,
making a smooth, thin paste. Add to scalded milk ; cook in double boiler
twenty minutes, stirring constantly until it thickens. Add butter. Pour
over toast and serve hot on hot platter.
CEREAL FOODS
Either the grain itself or the specially prepared flour may be used.
When the grains are used they should be spread on a clean table and all
foreign substances removed. If the whole grains be used, it is well to
wash them after picking them over, with two or three changes of cold
water.
Cereals are best cooked in a double boiler. The lower part should be
filled about one-third full of water, and, if more is added during the
cooking, it should always be boiling hot. The cereal should be cooked
over the fire for ten or fifteen minutes. The water should be boiled first
and ther salted. The cereal is added gradually, and the whole stirred to
prevent it from burning. It should then be placed in a double boiler and
steamed until thoroughly cooked. Cereals, like other starchy foods, re-
quire thorough cooking. Most recipes allow too short a time. Oatmeal,
especially, develops a better flavor if cooked for three hours or more, and
it is better when it is prepared the day before and reheated when used.
It should be just thin enough to pour when taken out of the boiler, and
when cooled should form a thin jelly.
Any cereal mush may be thinned with water, milk or cream and made
into a gruel, or the gruel may be made directly from the grain or flour.
Gruels should be thin, not too sweet nor too highly flavored, and served
very hot. Milk gruels should be made in a double boiler. Gruels may
be made more nutritious by the addition of whipped egg, either the white
or yolk or both, and the various concentrated food products.
When cereal flours are used the flour should be rubbed to a smooth
paste with a little cold water and added slowly to boiling water y stirring
constantly until it is thoroughly mixed.
Cereals supply actual digestible nutriments to the body more cheaply
616 PREPARATION OF SPECIAL BEVERAGES AND FOODS
than any other class of foods, except the dried legumes. All animal
foods, especially meats, are more expensive, even as sources of protein,
than cereals. A glance at their composition shows that they are chiefly
fuel foods, because of their high carbohydrate content. Their cost varies
with the cost of labor and fuel in preparing the foods. The compara-
tively expensive ready-to-eat breakfast foods do not yield any extra nutri-
tive value. Their only advantages are pleasant flavors and ease of serving.
Cereal products yield on the average between 1,600 and 1,700 calories
per pound.
LENGTH OF TIME TO COOK CEREALS
Cornmeal mush Boil 10 minutes, then steam for 3 hours or more
Oatmeal "10 " * " " 4*/
Irish oatmeal "10 " "8 " "
Wheatena "10 2^ "
Gluten mush 30 "
Steamed rice " 1 hour
Boiled rice " 20 minutes, or until soft.
GRUELS
Oatmeal Gruel.
Granulated oatmeal 2 tablespoonfuls. ... 45 gm 184 calories
Table salt 1 saltspoonful 2
Sugar 1 teaspoonful 10 " 41 "
Water (boiling) 1 cup 250 c.c.
Milk 1 300 " 216
Mix the oatmeal, salt and sugar together, and pour on the boiling
water. Cook for thirty minutes, then strain through a fine wire strainer
to remove the hulls. Place again on the stove, add the milk and heat just
to the boiling point. Serve hot. This gruel furnishes 425 calories.
Flour Gruel. Proceed as in making oatmeal gruel, using, instead,
two tablespoonfuls of wheat flour. Flavor with lemon juice, cinnamon,
nutmeg or vanilla. Energy value about 400 calories.
Farina Gruel. Proceed as in making oatmeal gruel, using, instead,
two tablespoonfuls of farina, and boil but ten minutes before adding the
milk. Energy value about 275 calories.
Imperial Granum Gruel. As in the preceding, but use Imperial Granum
instead of farina. Same caloric value.
Cracker Gruel No. 1
Cracker crumbs 2 tablespoonfuls. ... 45 gm 175 calories
Use the cracker crumbs and proceed as above. Cook only two or three
minutes and do not strain.
CEREAL FOODS 617
Cracker Gruel No. 2 (J)rcxcl Institute). Brown the crackers, and
reduce to a powder by means of a rolling pin. Add three tablespoonfuls
of the powdered crackers to half a cupful of milk and half a cupful of
boiling w r ater. Cook for ten minutes, then add one-fourth of a teaspoon-
ful of salt and serve. Energy value about 250 calories.
Racahout des Arabes (Gautier) (9). This is a French preparation
with a chocolate flavor which makes a most delicious gruel. A home-
made racahout may be made as follows :
Cocoa 1 pound 453 gm 2,320 calories
Confectioner's powdered sugar . . 1 " 453 " 1,875 "
Rice flour 1 " 453 " 1,630 "
Arrowroot flour 2 ounces 56 " 60 "
Sugar of milk 2 56 " 224
Mix the above ingredients thoroughly. Follow the directions given
for farina gruel.
Flour Ball Tie half a pint of flour in a square of fine cheesecloth,
making a very tight ball. Place this in a pot of boiling water and cook
for four or five hours. After taking out of the cloth, peel off the outside
and grate the hard ball. Dry in the oven and keep in a covered jar.
This is useful for making gruels for diluting milk for infants.
Flour Ball Gruel. Proceed as for oatmeal gruel, using two teaspoon-
fuls of the above grated flour nibbed up in one-half cup cold water, and
stirring into a pint of boiling water. Cook this for ten minutes. This
will furnish 15 calories to 100 c.c.
Meal Soup
Wheat flour 2 tablespoonfuls. . . 60 gm 45 calories
Water Y 2 pint 250 c.c.
Milk YL " 250 170
This is prepared by browning the wheat flour in a clean frying pan,
stirring continuously. The water and milk are brought to a boil, and a
heaping tablespoonful of the browned flour is blended with water and then
stirred into the mixture.
Cornmeal Gruel No. 1 (Pattee).
Cornmeal 2 tablespoonfuls. . . 60 gm 45 calories
Flour 1 " ... 30 " 25
Sugar 1 teaspoonful 10 " 41 "
Salt 1 tablespoonful ... 4
Hot water 1 quart 500 c.c.
Milk. . . .1 cupful 250 170
618 PREPARATION OF SPECIAL BEVERAGES AND FOODS
Proceed as in making oatmeal gruel, cooking in a double boiler for
three hours.
Cornmeal Gruel No. 2 Take a tablespoonful of cornmeal and moisten
with a little cold water. Stir this into a pint of boiling water to which
a pinch of salt has been added. Cook for three hours in a double boiler,
or for thirty minutes directly over the fire. In the latter case it must be
stirred constantly.
Gluten Gruel (Drexel Institute).
Gluten flour 1 tablespoonful. ... 30 gm 30 calories
Cold water M cupful 125 c.c.
Boiling salted water 1 " 250
Mix the gluten flour with the cold water and stir this into the boiling
salted water. Cook directly over the fire for fifteen minutes, then add one
clove and cook over boiling water for a half hour.
Barley and Oatmeal Jelly.
From the Grain. Prepare the grain as directed for barley water.
Use from four to six tablespoonfuls of grain to the quart of water. Boil
thoroughly for several hours until the grain is thoroughly cooked. Strain
and cool. The jelly, when hot, should be just thick enough to pour. This
furnishes about 28 calories to 100 grams.
From. Prepared Flours. Use two tablespoonfuls of the flour to a pint
of water. Boil from fifteen to thirty minutes and strain.
Egg Gruel.
Hot beef broth 1 cupful 250 c.c 36 calories
Egg 1 (whole) 50 gm 80
Salt Hteaspoonful 2
Take the beef broth made with "Soluble Beef," the egg and salt. Beat
the white and the yolk of the egg separately, add the hot beef broth grad-
ually to the yolk, stirring continually. Whip the white to a stiff, dry
froth with the salt, and beat it into the hot broth. Return to the double
boiler and reheat. Serve very hot.
Barley Gruel with Beef Extract.
" Soluble Beef " ^ teaspoonful 2 gm 20 calories
Hot water 2 cupfuls 500 c.c.
Barley flour 1 tablespoonful. ... 20 gm 22 "
Salt 1 saltspoonful 2
Dissolve the beef in the hot water, and mix the flour and salt together
with a little cold water. Pour the boiling stock on the flour and cook for
ten minutes. Strain and serve very hot.
CEREAL FOODS 619
Barley Meal Gruel (Watson).
Barley meal 1 dessertspoonful . . 10 gm 15 calories
Milk Y 2 pint 250 c.c 170
Butter Small piece 15 gm . . .120 "
Sugar 1 teaspoonful 10 " 41
Salt K " 1 "
Mix the inilk very gradually with the meal, stirring until quite
smooth. Take a small lined saucepan, and after rinsing with cold water
pour the barley and milk into it. Stir constantly over the fire until boil-
ing, let it boil ten minutes, season and serve very hot.
Port Wine Gruel (Watson). Make a gruel with oatmeal or barley
meal and water, then thin it down with a glass of port wine; heat thor-
oughly, but do not boil again.
Arrowroot Gruel (Individual Rule) (Pattee).
Arrowroot 2 teaspoonfuls 25 gm 26 calories
Cold water 2 tablespoonfuls. . . 15 c.c.
Boiling milk 1 cupful 250 " 170
Salt a pinch 1 gm.
Sugar (lemon juice, wine or brandy
as required) % teaspoonful 10 " 20 "
Blend the arrowroot and cold water to a smooth paste. Add to the
boiling water or milk. Cook in double boiler two hours. Add salt.
Strain and serve hot. Arrowroot is the purest form of starch, and bene-
ficial in cases of diarrhea if not given too hot.
Barley Gruel (Individual Rule) (Pattee).
Barley flour 1 tablespoonful. ... 30 gm 40 calories
Cold milk 2 tablespoonfuls. . . 30 c.c 24 "
Scalded milk .'. 1 cupful 250 170
Salt.
Blend the barley flour with the cold milk and stir into the scalding
milk. Cook in double boiler twenty minutes. Season with salt to taste,
and add sugar if desired. Strain.
Flour Gruel or Thickened Milk (Individual Rule) (Pattee).
Scalded milk % cupful 188 c.c 128 calories
Cold milk 1 A " , 62 42
Flour 1 A tablespoonful 15 gm 20 "
Salt speck 1 "
Raisins 1 dozen 8 20
Mix the flour with the cold milk to make a smooth mixture, and stir
into the scalding milk. Cook in a double boiler one-half hour or on back
620 PREPARATION OF SPECIAL BEVERAGES AND FOODS
of stove in a saucepan. Stone and quarter the raisins, then add water
enough to cover. Cook slowly until water has all boiled away. Add to
gruel just before serving. Add salt. Strain and serve, or it may be eaten
with the raisins in it. This gruel may also be made without the raisins.
Never use raisins in bowel troubles.
Oatmeal Gruel (Watson).
Coarse oatmeal 3^ cupful 100 gm 201 calories
Water 2 cupfuls 500 c.c.
Salt Y?, teaspoonful 2 gm.
Milk H cupful 125 c.c 85 ft
Pound the oatmeal in a mortar until it is mealy, then put it into a
tumbler and fill it with cold water. Stir, and pour off the mealy water
into a saucepan. Fill tumbler again, stir and pour off, and repeat until
the above quantity of water is exhausted. Boil the oatmeal water thirty
minutes, stirring frequently. Season with salt to taste. Thin with milk
or cream to desired consistency.
EGGS
Eggs are a very concentrated food, one egg being equal in nutriment
to 40 grams, 1^ ounces of fat; or two eggs, equal to about 5 ounces of
cow's milk. The digestibility of eggs is influenced by the mode of prepa-
ration. They are a rather fatty food and contain fat and albumin in
about equal proportion, 5 to 6 per cent. Egg albumin is almost entirely
peptonized in the stomach, and the fat of the yolk is almost completely
split up before reaching the small intestine. Hard-boiled eggs are dif-
ficult to digest by weak stomachs, and may even be the cause of painful
sensations for the reason that the coarse albumin, which is not readily
dissolved, irritates the sensitive mucous membrane of the stomach ; if
taken in pulverized form they will cause no disturbance. Omelet souffle
and fried eggs are difficult of digestion, while soft-boiled eggs and
poached eggs are more easily and readily digested. Eggs for the invalid
or convalescent, whether partaken of raw or cooked, should be perfectly
fresh. Eggs are a very nourishing food for children on account of the
lecithin and phosphates.
Eggs are exceedingly valuable as a food for invalids. They should
not be kept with any article of food having an odor, as they absorb such
odors and the taste is thereby impaired. Stale eggs will not sink, and if
held to a bright light they show a dark spot. The yolk of an egg that has
EGGS 621
been broken may be kept fresh by placing it (unbroken) in a cupful of
cold water. This should be set in a cool place. This will keep it fresh
for twenty-four hours or more. Eggs and all other albuminous food
should be cooked at as low temperatures as possible, in order to avoid
rendering them tough.
Eggs are best cooked in the shell as follows :
Soft-cooked Eggs Place in a pint of boiling water, remove from the
fire, and allow to stand for eight or ten minutes. If the egg is very cold
to start with, it will take a little longer.
Hard-cooked Eggs. Place in water, bring to a boil, and then set on
the back part of the stove for twenty minutes. Eggs should be served
as soon as cooked, and the dishes should be warmed and ready. One
ordinary egg, 50 grams, 80 calories.
How to Make an Omelet (Watson). Break the eggs into a bowl, add
salt and pepper, and beat them with a fork for about a minute, not longer
as a rule. When the eggs are sufficiently beaten they "run" off the fork
in a homogeneous liquid, without any glutinous appearance. It is not
necessary to beat for several minutes, with the idea that the more the
eggs are beaten the lighter the omelet. This is a great mistake, as too
much beating causes eggs to lose their consistency. It is, however, better
to beat too much than too little. Place the pan on the fire to warm it, and
put in a small piece of butter about the size of a hazel-nut for an omelet
of 2 or 3 eggs. Add the contents of the bowl when the butter steams. If
this precaution is taken, the omelet will not catch, as the high temperature
of the butter isolates the eggs. It is, therefore, a mistake to shake the
eggs directly they are poured into the pan. But a second or two later, the
fork must be passed round the sides of the pan to loosen the eggs, and
then they are worked in all directions with the back of the fork as if they
were scrambled. When they are sufficiently cooked, they look, in fact,
almost like scrambled eggs; but now the omelet is shaken on to one side
of the pan, and with the fork one-half is folded on the other and slid on
to the dish. The shape of the omelet is thus obtained without difficulty,
and the heat of one-half just finishes the cooking of the other as it rests
upon it.
Omelet Souffle (Sweet} (Watson).
White sugar 1 tablespoonful. ... 40 gm 160 calories
Salt a pinch 1
Eggs 2 (whole) 100 " 160
Powdered vanilla a little K "
622 PKEPAKATION OF SPECIAL BEVERAGES AND FOODS
Take two bowls ; put into one of them 1 teaspoonf ul of white sugar,
into the other a pinch of salt. Break 2 eggs, separate the yolks, and drop
one yolk at a time into the bowl containing the sugar ; whip them well with
a wooden spoon until they become creamy like mayonnaise. Add a little
powdered vanilla to another one-half teaspoonful of sugar, and mix with
the yolks. Put the whites of the eggs into the bowl containing the salt, and
whip into a stiff froth. Mix with the yolks as lightly as possible, and
pour the contents into a buttered dish in the shape of a pyramid. Cover
it with sifted sugar and leave it for three or four minutes on the side of
the stove. Then put it into the oven for ten to twelve minutes, turning
the dish occasionally to color it on all sides. Make two or three incisions
with a knife, and serve immediately. This omelet must be eaten as soon
as it is cooked, or it loses both its shape and its delicacy.
Snowball Eggs (Watson).
Eggs 3 (whole) 150 gm 240 calories
Powdered white sugar 1 tablespoonful. ... 40 " , 160 "
Milk 1 pint 250 c.c 170
Rind of lemon or vanilla
Sugar to taste
Place 1 pint of milk in a saucepan on the fire with the rind of a lemon
or a little vanilla, and sufficient white sugar to sweeten. Break 3 eggs,
separating the white from the yolk. Beat the whites of the eggs into a
stiff froth, adding a small pinch of salt. When sufficiently stiff, add the
sugar and mix briskly. Take a teaspoonful of this mixture and throw it
into the boiling milk in the saucepan ; turn it three minutes later, remove
it with a skimmer. Take as many spoonfuls of white of egg as remain
and cook them in a similar manner, three or four at a time. (If the white
has been beaten sufficiently stiffly, when cooked each spoonful will be a
compact mass.) Arrange the snowballs in a pyramid on a dish. Pour the
remainder of the milk from the saucepan into the yolks of the eggs; put
this mixture into another saucepan on the fire, stir it constantly with a
spoon, and let it thicken without boiling. Pass it through a strainer, and
when cold pour it over the snowballs in the dish.
Prairie Oyster (Watson).
Fresh egg 1 (whole) 50 gm 80 calories
Vinegar 1 tablespoonful. ... 15 c.c.
Put the vinegar into a small cup and break the egg into it. Serve at
once. This is a very digestible way of serving an egg, and it is very cool
and refreshing.
EGGS 023
Egg Drink (Watson).
Egg 1 (whole) 50 gm SO calories
Milk 1 teacup 250 c.c 170
Sugar 1 tcaspuonful 10 gm 41 "
Sherry wine 1 tablespoonful. ... 15 c.c 21 "
Beat up the egg, add to it the wine and sugar, beat together with a
fork slightly, and strain through a fine wire strainer. Heat the milk in
a small saucepan, and when almost boiling pour it on to the egg, stirring
all the time. Serve hot. This can be made without wine, flavoring with
cinnamon or lemon juice. The yolk of the egg only may be used, and soda
water may take the place of milk.
Poached Egg (Watson).
Egg 1 (whole) 50 gm 80 calories
Boiling water 1 cupful 250 c.c.
Lemon juice 1 teaspoonful 15 "
Salt a pinch 1 gm.
Toast Yz slice 10 " 31
Break the egg into a cup, keeping the yolk whole. To a small sauce-
pan of boiling water add a pinch of salt and a squeeze of lemon juice.
Draw the water to the side, and when just off the boil slip the egg care-
fully into it. Cook slowly for three minutes, when the white should be
quite set. Lift it out with a small fish slice or perforated spoon, and trim
off any ragged edges of white. Place on a square of newly-made toast,
and serve at once.
If required, this egg can be made richer by being served on buttered
toast, or by having a little hot cream poured over 1 it. A poached egg
served on 2 tablespoonfuls of carefully prepared spinach is also a very nice
dish.
Rumbled Egg (Watson).
Egg 1 (whole) 50 gm 80 calories
Milk 1 tablespooiiful 15 c.c 15
Pepper and salt a pinch of each. ... 1 gm.
Sutler Y ounce 7 " 60 "
Toast (dry) a piece 10 " 31
Heat the milk in a small saucepan. Pour into the hot milk the <-i:g
beaten up in a cup with pepper and salt. Stir quickly over the fire until
it begins to thicken, then remove it from the fire and continue stirring
until it forms a creamy mixture. Put on a piece of newly-made toast.
624 PREPARATION OF SPECIAL BEVERAGES AND FOODS
and serve at once. If cooked too long, or allowed to stand, it becomes
leathery and indigestible.
Poached Eggs with Cheese (Watson).
Eggs 4 (whole) . 200 gm 320 calories
White sauce 1 gill
Butter 7 ounces 30 " 240 "
Breadcrumbs 3 tablespoonfuls. . . 65 " 250 "
Pepper and salt a pinch of each ... 1 "
Grated cheese 3 tablespoonfuls. . . 60 " 273
Butter a flat dish and sprinkle it with half the breadcrumbs and
cheese. Poach the eggs and place them on the top. Then pour over the
sauce, and put the rest of the cheese and breadcrumbs on the top. Lay on
a few small pieces of butter, and place in a hot oven to melt the cheese
and lightly brown the top.
FISH
Fish contains a large quantity of protein and gelatinous substances.
In the dietary of patients suffering from gastric disturbances, fish such
as eel, salmon and herring should be excluded, the first two on account
of the excess of fat contained, and the last on account of its excess in
salts. The nutritive value of fish, generally speaking, is about equal to
that of veal, and in the uric acid diathesis, fish is better borne than meat.
Oysters are less digestible than is commonly believed (10).
Baked Fish ( Watson). -
Uncooked butterfish J4 pound 113 gm 200 calories
Breadcrumbs 2 tablespoonfuls. . . 45 " 175 "
Pepper, salt and a little lemon
juice
Egg 1 (whole) 50 80
Milk y 2 gill 125 c.c 85
Butter Y 2 ounce 15 gm 120
Grease a small pie dish with a little of the butter. Have the fish free
from skin and bone, and cut it into neat pieces. Lay half of these pieces
in the bottom of the pie dish, sprinkle over them a little white pepper,
salt and a squeeze of lemon juice, and then put on a layer of breadcrumbs.
Next, put in the rest of the fish, seasoning and more crumbs. Beat up
the egg in a basin, add the milk to it, and strain this into the dish. Put
the rest of the butter in small pieces on the top and wipe round the edges
of the dish. Bake in the oven until nicely browned.
FISH 625
Steamed Sole or Whiting (Watson).
Whiting 1 pound 453 gm 700 calories
Butter 1 ounce 30 " 240
Flour 1 30 " 22 "
Milk 1 gill 125 c.c 85
Lemon slice
Skin and fillet the fish, wash and dry the fillets, and put them in a jam
pot which is placed in a saucepan half full of boiling water. Cover tightly
and let boil for ten minutes. Mix the butter with the flour in a saucepan
over the fire. Add the milk and liquor from the fish, and cook for ten
minutes, stirring well. Pour this sauce over the fillets and garnish with
the lemon.
Steamed Fish (Watson).
Haddock, whiting or sole 1 pound, filleted. . . .453 gm 340 calories
Salt and white pepper a pinch of each 1 "
Butter Yi ounce 15 " 120
Lemon juice a squeeze
This is the lightest and simplest mode of cooking fish for an invalid.
Cut the fillets of fish into neat-sized pieces ; grease a soup plate or muffin
dish with a little butter, and place the fish on this. Sprinkle it with a
little salt and white pepper if this is allowed, and squeeze over it some
lemon juice, which helps to keep the fish firm and white. Cover with a
piece of greased white paper, and then with a lid or basin. Place this
over a pan half full of boiling water, seeing that the plate fits well on the
pan. Keep the water in the pan boiling, so that there may be plenty of
steam, and cook from twenty to thirty minutes, until the fish loses its
clear, transparent appearance and looks quite white. If the pieces are
thick, it is better to turn them while cooking. The liquid that is on the
plate when the fish is cooked is the juice from tho fish, and should be
served with it. Serve with a little plain cold butter and a piece of plain
bread or toast.
Stewed Fish (Watson).
Filleted fish, whiting, haddock,
sole, plaice 1 (whole) 2 pounds. . . 1,000 gm 1,400 calories
Breadcrumbs 1 tablespoonful 22 " 80 "
Chopped parsley 1 teaspoonful 4 " 5 "
Milk 1 gill 125 c.c 85
Butter 1 ounce 30 gm 240
Pepper (white) a pinch' 0.5 "
Cold water 1 gill 125 c.c.
626 PREPARATION OF SPECIAL BEVERAGES AND FOODS
Wipe the fish with a damp cloth and cut it into small, neat pieces.
Rinse out a lined saucepan with water, and place the pieces of fish in the
bottom. Sprinkle over them a little salt and white pepper, pour in the
milk and water, put the lid on the pan, and let the fish cook slowly by the
side of the fire until it is ready, which will be in about fifteen minutes.
Do not overcook, or the fish will be hard. Lift out the pieces of fish on
to the plate on which they are to be served, and keep them hot. Add the
breadcrumbs and the butter to the water and milk in the pan. Stir over
the fire for a few minutes until the breadcrumbs swell and thicken the
sauce. Sprinkle in the minced parsley, and then pour this sauce over the
fish.
Fish are allowable for old people. The oily fishes such as salmon,
herring, mackerel are the only ones that are apt to disagree with diges-
tion, unless taken in small quantities. In addition to the usual methods
of boiling, frying and baking fish already described, a variety of dishes
may be made from this class of food that are found to be appetizing as
well as quite satisfying.
Fish Baked in Batter (Watson).
Uncooked fish, haddock or sole. . % pound 113 gm 90 calories
Flour 1 ounce 28 . 240
Milk Y 2 gill 65 c.c 45
Egg 1 (whole) 50 gm .80 "
Butter Y 2 ounce 15 . .120
Pepper, salt and lemon juice
First make the batter, rub the flour through a wire sieve, to free it
from lumps, and put it into a basin. Beat up the egg with a fork and add
it to the flour ; beat with a wooden spoon until quite smooth and free from
lumps. Then add the milk and beat for a few minutes longer. The more
the batter is beaten the lighter it will be.
Have the fish free from skin and bone, and cut into small pieces. Lay
these in the bottom of a small greased pie dish, and season with pepper,
salt and a squeeze of lemon juice. Pour the batter over them, and put
the butter in small pieces on the top. Allow this to stand for a few
minutes before cooking, as this gives time for the flour in the batter to
swell, and makes it lighter when baked. Bake in a quick oven from
twelve to fifteen minutes until well risen and nicely browned. Serve at
once, as the batter quickly falls.
FISH 627
Fish Souffle (Watson).
Uncooked fish 24 pound 113 gm 90 calories
Butter % ounce 15 " 120
Flour K " "15 " 10
Fish stock or milk 3^ gill 65 c.c 45 "
Eggs 2 (whole) 100 gm 160
Pepper, salt and lemon juice. . . .a pinch of each
First make a panada with the butter, flour and fish. This is done by
melting the butter in a small saucepan, adding the flour and mixing until
it is smooth with a wooden spoon. Then pour on the milk or fish stock,
and stir until the mixture is thick and free from lumps and leaves the
sides of the pan quite clean.
Scrape the fish down finely with a knife. Put the panada into a
mortar with the fish, seasoning and yolks of eggs. Pound well together
and rub through a sieve. Beat up the whites of eggs to a stiff froth, and
stir lightly into the fish mixture with an iron spoon. Pour into a greased
basin, which should be only half full. Cover with a greased paper. Steam
for twenty minutes. When firm, lift it out and turn out on a hot plate.
Panned Oysters (Watson).
Oysters (deep-sea) 6 (whole) 90 gm 44 calories
Salt, pepper a pinch of each ... 1 "
Butter Yi ounce 15 120
Meat stock 1 teaspoonf ul 4 c.c 4 "
Lemon thin slice
Place the oysters in a colander and pour cold water over them. Drain
for ten minues, then place in a very hot iron pan, add the salt, pepper,
butter and meat stock. Cook for a few minutes and serve the oysters
garnished with the lemon.
Broiled Oysters (Watson).
Oysters (large) 6 (whole) 90 gm 44 calories
Salt and cayenne pepper a pinch of each ... 1 "
Heated beef juice ^ ounce 15 c.c 15 "
Melted butter Y^ 15 120
Lay the oysters on a board and dry them, season with the salt and
cayenne pepper. Have a gridiron thoroughly heated, place the oysters
on the gridiron, and brown them on both sides. Serve on a very warm
plate with the beef juice and melted butter poured around them.
628 PREPARATION OF SPECIAL BEVERAGES AKD FOODS
POULTRY
The flesh of poultry or barnyard fowls is characterized by short mus-
cular fibers and a minimum amount of fat. The birds coming under this
classification have already been referred to at length in the chapter on
"Animal Foods" (Volume I, Chapter XII, page 296). They have an
abundance of white flesh, which is most easy of digestion, being tender
and of a delicate flavor. A young, well-fed chicken is the most digestible
of all animal foods. Short-legged fowls are more delicate in flavor. As
for age, a one-year-old cock will be found too tough for roasting or braiz-
ing, and only suitable for stews or soups. The flavor and tenderness of
the young cockerel are greatly improved by caponizing, which has already
been described in the reference just given.
Chicken Salad (Pattee).
Cut chicken 3^ pound .225 gm 465 calories
Cut celery 1 cup 250 " 85
Nicelle olive oil 1 ounce (2 table-
spoonfuls) 28 121 "
Salt 1 saltspoonful 1 "
Pepper H " 0.5"
Vinegar 1 tablespoonful. ... 15 c.c.
Mayonnaise 2 tablespoonfuls. . . 42 gm 187 "
Cut the cold chicken into small dice and cut the cleaned celery into
small uniform pieces. Mix these together and pour over the oil. Mix
well, then sprinkle with salt and pepper to taste ; add the vinegar ; blend
and put in colander to drain ; set in a cold place for two or three hours.
Just before serving add the mayonnaise, put on a bed of lettuce and
garnish. The above quantity is sufficient for six servings. Use mayon-
naise, olives, celery leaves or white lettuce for garnishing.
Note. Do not mince chicken.
Broiled Chicken (Watson).
Small chicken 1 pound 453 gm 890 calories
Butter 1 ounce 30 240
Pepper and salt 1 A teaspoonf ul of each 2 "
Prepare a young chicken for roasting, split it down the back, lay it
open, and take only half at a time. Rub the piece of chicken over with
a little butter to keep the skin from cracking, and season with pepper and
salt. Grease the gridiron and make it thoroughly hot. Lay the chicken
on it with the cut side down. Broil either on the top of or before a clear
POULTRY 629
fire for about half an hour. When cooked, lift on to a very hot plate and
rub the rest of the butter over it. Serve with rolls of bacon round it. If
broiling an older fowl it must be partially cooked first, either by boiling or
roasting. It may be eaten with or without bread sauce.
Stewed Partridge (Watson).
Partridge Yi pound 225 gm 465 calories
Butter Y* ounce 15 " 120
Flour 1 teaspoonful 45 " 150 "
Mace 1 blade 0.5 "
Lemon Yz with rind
Pepper and salt Yi saltspoonf ul
Cut the partridge into joints and take out the largest bones. Put the
butter into a small stewpan. When it gets hot put in the best parts of the
partridge and dry very carefully. Add to this a small bit of lemon
peel, mace, pepper and salt, then add the flour and 1 teacupful of water,
and the bones that were removed. When this boils up put on the lid, and
let it stew slowly for three-quarters of an hour, or iintil tender. Take up
the best bits on a dish and strain the gravy over them. All game is easily
digested when cooked in this way.
Roast Poultry (Wegele). It is best to buy fresh-killed poultry. Clean,
remove feathers and hang in a cool place for at least one day; in the
winter for 2 to 3 days. The roasted skin of poultry should never be
served to those having stomach trouble, as it is very indigestible. A
pound will contain about 800 calories.
Capons (Wegele). Capons and pullets should be roasted with very
little butter, as they contain a great deal of fat. Baste constantly and
roast about one and one-half to two hours. A pound capon will yield
about 1.405 calories.
Boiled Broilers and Squabs (Wegele). Prepare the same as for roast-
ing. Put into slightly salted, boiling bouillon with a handful of dry
vegetables, and boil about one to one and a quarter hours. Very young
pigeons or squabs will be done in three-quarters of an hour; also very
young chickens or broilers. A pound broiler or squab yields about 1,430
calories.
Stewed or Potted Broilers and Squabs (Wegele). Prepare broilers or
squabs as for roasting. Cut into four equal parts, add a little salt, and
stew exactly like stewed veal for about three-quarters of an hour. Sauce
to be prepared the same as for stewed veal. Medium size average a pound.
Caloric value about 1,200 calories.
140
630 PREPARATION OF SPECIAL BEVERAGES AND FOODS
MEATS
General Rules for Preparing Meat Meat must be weighed, trimmed,
and wiped with a damp cloth. It should be removed immediately from
the paper in which it has been wrapped and placed in a cool place. Only
tender cuts of meat should be broiled, pan-broiled or roasted. When meat
is to be cooked by any of these methods, it should first be seared, and then
the temperature slightly lowered. By searing, the albumin on the outer
surface of the meat is hardened, and the meat is thus cooked in its own
juices.
Tough meat should be cooked in water. Boiling water hardens the
albumin on the outer surface of the meat and prevents the juices from
escaping. Meat should be put in boiling water and the water allowed to
boil for ten or fifteen minutes, then the cooking should be allowed to pro-
ceed at a low temperature until the meat is tender. If the water bubbles
it is too hot. Cooked in this way tough meat will become tender. The
time required for roasting or cooking in water varies with the weight
and quality of the meat (see Volume II, Chapter III).
Roast meat is more easily digested than boiled meat, provided the
connective tissue has been made more soluble by hanging the meat up in
the refrigerator for a few days before cooking, thereby bringing about a
post-mortem lactic acid process. Meat rich in fat is acted upon with
greater difficulty by the gastric juice than lean meat. For instance, calf's
brain, although very soft, contains much fat and is not well tolerated by
the invalid or convalescent. Venison, hare and deer meat have a less fat
content than beef, but the disadvantage of tougher muscular fiber". Meat
of young animals is more tender than that of old ones, and hence prefer-
able. Mild smoked ham is very nourishing, and if there is no danger of
trichinae may be eaten with impunity uncooked.
Boasting. Skewer the meat into shape. Place it on a rack in a meat
pan, in the bottom of which pieces of fat from the meat have been
placed. Put in a hot oven on the grate for ten minutes to sear the meat.
If desired, it may be seasoned with salt and pepper. Then remove to the
floor of the oven and baste every ten minutes until it is done.
Broiling. Remove extra fat from the meat and grease the broiler
with a part of the fat. Broil over a clear fire ; sear, and then turn every
ten seconds. Chops one inch thick should be cooked for five minutes. A
steak two inches thick should be cooked for ten minutes. Season and
serve on a hot platter.
MEATS 631
I'an-hroilinrj (l)rexel Institute). Kemove all the fat from the meat.
Heat a frying-pan very hot, but use no fat. Sear the meat on both sides,
and then cook more slowly until it is done. Stand chops up on their
edges to brown. Keep the pan free from fat. The time required for pan-
broiling is the same as that required for broiling.
Beef Pulp (Caultey). Scrape a piece of raw lean rump or sirloin
steak with a fork or meat scraper until as much as possible of the muscu-
lar tissue has been obtained, separated from the tendinous parts. Pound
it in a mortar to a pulp, and then rub it through a fine sieve. Season with
pepper and salt. It may be taken in the form of sandwiches, or rolled
up into small rissoles and lightly grilled or fried.
Very little of the nutriment of the meat is lost in this process.
Beef Quenelles (Watson).
Beefsteak 1 pound 453 gm 1,130 calories
Breadcrumbs 4 tablespoonfuls 32 " 45 "
Salt and pepper to taste. . . .}< teaspoonful of each. . . 1 "
Egg 1 (whole) 50 "... 80 "
Stock 2 tablespoonfuls 30 c.c 20
Pound the beefsteak, breadcrumbs, salt and pepper, egg and stock well
in a mortar, rub through sieve, shape with tablespoons and poach in
shallow pan for ten minutes in boiling water. Pour a gravy made of
thickened beef tea round the quenelles and serve with sippets of toast.
This is a very digestible dish, nutritious and readily absorbed.
Roast Veal (Wegele).
Loin of veal 6 pounds 3,000 gm 4,540 calories
Fresh pork 1 pound 450 " 2,780
Hot butter or hot beef fat . . a little less than % pound 200 " 1,590
In summer veal must soak in sweet milk for one or two days, in winter
about 2 to 4 days, to make it soft and tender. Before preparing the meat
it must be thoroughly washed, the skin removed and the meat well salted.
Lard the meat with fresh pork and roast in hot butter or hot beef fat,
using the above number of grams. The roasting is the same as for other
meats, but it must be well done and will take one and one-quarter to two
hours.
If the bone is not removed, a good juice will come forth, and after the
fat has been removed the addition of a little bouillon (no flour) will give
a nice sauce.
Ordinary serving 100 grams, 174 calories.
632 PREPARATION OF SPECIAL BEVERAGES AND FOODS
Roast Venison (Wegele). Roast in hot butter and baste frequently;
one hour required for roasting, except for loin of venison, which is not so
tender and will take two and one-half hours to roast. Sauce to be pre-
pared same as the roast fillet sauce. Sour cream can be added to the
sauce.
Ordinary serving, 100 grams, 240 calories.
Hamburger Steak (Wegele).
Beef Yi pound 250 gm 660 calories
Cold salted bouillon 4 tablespoonf uls. . . 120 c.c 13 "
Take a nice piece of beef, chop about 250 grams (a tumblerful), and
add the bouillon. If bouillon is not available, use salted water. Fry the
meat about ten minutes. Chopped veal can be prepared in the same way.
Stewed Sweetbreads (Wegele). Cook the sweetbreads until very soft,
remove skin, cut in halves, and put into hot butter sauce for 10 minutes
before serving. The sauce is prepared in this way : Take a piece of butter,
put it into a saucepan and let it melt, but not get brown. Add one table-
spoonful of flour, stir, add enough cold bouillon and a little white wine so
that after boiling there will be a thick sauce. The sauce will be easier to
digest if, instead of butter, gravy from any roast meat is used, but the fat
must be taken off first. Before serving, an egg can be added to the sauce.
Ordinary serving 80 to 100 grams, 135 to 150 calories.
RAW BEEF
General Method of Preparing Raw Beef Raw meat forms an excellent
aliment, although it seldom appears on our tables in this form. Fick has
shown that raw meat is digested three times more easily and quickly than
cooked or even underdone roast meat. Raw meat is the food which agrees
best with very delicate stomachs, with tuberculous individuals, tabetics,
chlorotics and even with many children who are obliged to be weaned pre-
maturely, but it is necessary to know how to choose and to use it method-
ically. Great care should be exercised in the selection of meat to be in-
gested in its raw state. The flesh of pigs should be avoided altogether,
as it is too firm, and may transmit various parasites. Meat intended to
be eaten raw should be freed of all fat, scraped and reduced to a pulp
with the edge of a knife or a spoon handle, but not chopped. By scrap-
ing, the muscle fibers are separated from the tendons and aponeurosis.
This scraping results in little balls of pulp which should be rolled into
boluses about the size of a nut without other addition than a little salt or
MEATS 633
perhaps a little cognac, rum, sugar or the gravy of meat roast. These balls
of meat pulp ought to be swallowed by the individual without chewing.
Raw Meat with Milk and Sugar (Ringer).
Rump steak ^2 pound 250 gm 660 calories
Sugar 2 lumps 12 " 50
Hratuly 4 teaspoonfuls 60 c.c 200 "
Milk Y 2 glass 250 170
Scrape the steak with a knife until all the pulp is removed, sweeten
with sugar, breaking the lumps of sugar with the meat in a basin with a
small wooden spoon. Add slowly as much milk as will make it about the
thickness of arrowroot ; flavor with brandy. If any fiber of the meat re-
mains, strain through a gravy strainer. The mixture should be perfectly
smooth.
Raw-meat Juice (Cheadle). Add to finely minced rump steak cold
water in the proportion of one part of water to four parts of meat. Stir
well together, and allow it to stand for half an hour. Forcibly express
the juice through muslin, twisting to get the best results.
Raw Beefsteak (Wegele). Take a good piece of steak, cut a square
piece the thickness of a thumb. Pound the meat well, salt on one side
only. Put into frying pan, fry in fresh butter for one minute. Turn
and baste with the juice of the meat and again fry only one-half minute.
Serve at once on a hot plate; 100 grams (3^ ounces) furnish about 130
calories.
Raw-beef Soup (Weir Mitchell).
Raw beef 1 pound 450 gm 1,200 calories
Water 1 pint 500 c.c.
Strong hydrochloric acid 5 drops 0.35 c.c.
This is made by chopping up the raw beef and placing it in a bottle
with the water and hydrochloric acid. This mixture is allowed to stand
on the ice over night, and in the morning the bottle is placed in a pan of
water at 110 F., and kept at about this temperature for two hours. The
soup is then placed in a stout cloth and strained until the mass that re-
mains is almost dry. The filtrate is given in three portions daily. If the
taste of the raw meat is objectionable, the meat may be roasted quickly on
one side and the process completed in the manner previously described.
Succus Carnis (Meat Juice) (Pettenkoffer and Voit). Cut up the
meat into small bits, arrange in layers separated from one another by
coarse linen, and then place in a powerful press. From each kilogram of
634 PREPARATION OF SPECIAL BEVERAGES AND FOODS
meat about 230 grams of a blood-red juice are obtained. This contains
about 6 per cent of albuminates. Its taste is similar to that of raw meat ;
its flavor may be improved by the addition of salt and beef tea not hot
enough to coagulate the albumin.
VEGETABLES
General Rules for Cooking Vegetables Wash thoroughly ; pare or scrape
if skins must be removed. Stand in cold water until cooked to keep them
crisp and prevent their being discolored. Cook in boiling water; the
water must be kept at the boiling point. Use two teaspoonfuls of salt
with two quarts of water ; put the salt into the water when the vegetables
are partially cooked. The water in which vegetables are cooked is called
vegetable stock.
Fresh green vegetables require less water than others. Cabbage, cauli-
flower, onions and turnips should be cooked uncovered in a large amount
of water.
All. vegetables must be drained as soon as tender. Season with salt
and pepper and serve hot with butter or sauce. The color may be kept in
green vegetables, such as spinach, by pouring cold water through them
after draining.
Vegetables, according to analysis, are known to possess various min-
eral matters and the green vegetables more especially contain iron. For
analysis and the mineral content of vegetables the reader is referred to
the section of the book dealing with this subject (Volume I, Chap-
ter XIX).
Cold vegetables may be used for salads or may be placed in a baking
dish with one-half the quantity of sauce (2 cupfuls vegetables and 1 cup-
ful sauce), covered with buttered crumbs and browned in a hot oven.
TIME-TABLE FOR COOKING VEGETABLES IN WATER
(Drexel Institute)
Potatoes 25-30 min. Spinach 30-45 min.
Carrots 35-45 " Celery 20-30
Turnips 45 " Parsnips 30-45
Beets (young) '. 45 " Green peas 30-40 "
" (old) 3-4 hrs. String-beans 1-3 hrs.
Tomatoes 1-3 " Lima beans 1 hr. or more
Onions 45-60 min. Green corn 12-20 min.
Cabbage 45-60 Rice 20-45 "
Cauliflower 20-30 " Macaroni 45-60 "
Asparagus 20-30 "
YKUKTAHLES 635
Sauce for Vegetables.
Butter 3 tablespoonfuls. . . 45 gm 360 calories
Flour 3 " ...45 " 150
Salt 1 teaspoonful 4 "
White pepper a pinch 0.5 "
Milk 1 cupful 250 c.c 170
Stock 1 " 250 " 36
Asparagus (Wegele).
Asparagus 1 pound 453 gm 52 calories
Salted water 1 pint 500 c.c.
Butter sauce 8 tablespoonfuls. . . 120 " 240 "
Egg 1 yolk 18 gm 68
Clean asparagus, remove skin, cut off the hard parts. Boil in the
salted water for about one-half to one hour. Use enough water, otherwise
the asparagus will lose its color. Serve with a butter sauce, adding the
yolk of the egg. For sensitive stomach use only asparagus tips. One
hundred grams (a little less than ! ounces) furnish about 20 calories.
Spinach (Wegele).
Spinach 1 pound 453 gm 110 calories
Butter a lump 15 " 120 "
Flour and bouillon a tablespoonful ... 47 "
Clean and wash spinach thoroughly, remove the stems and rinse in
water several times. Put the spinach into boiling water and boil quickly.
When soft, pour into a sieve and allow it to drain, then mash through the
sieve. Put the butter into a saucepan. When dissolved, add the flour
and bouillon, making a thick sauce. Keep it on the fire, stirring con-
stantly. Add the spinach and boil all for about one-quarter hour.
Oyster Plant (Wegele).
Oyster plant 1 pound 453 gm 100 calories
Flour 1 teaspoonful 4 " 5 "
Water 1 pound (2 pints) . . 1,000 c.c.
Vinegar 1 tablespoonful. ... 15 "
Butter, salt and bouillon . ' 2 tablespoonfuls. . . 30 " 140 "
Clean and wash the oyster plant thoroughly, cut into pieces the length
of a finger. To the flour add the water and vinegar, stir until smooth and
add the oyster plant. Put all into a colander, pour cold water over it and
let drain. Put into a cooking vessel containing some butter, cover tight,
add a little salt and a little bouillon from time to time while cooking. It
takes three-quarters to one and a half hours to cook oyster plant until soft.
One hundred grams (a little more than 1^ oz.) furnish about 120 calories.
636 PREPARATION OF SPECIAL BEVERAGES AND FOODS
Green Peas (Wegele). It is best to use canned peas of the very best
quality. Empty the peas into a sieve, pour cold water over them and
strain. Prepare with a little butter and salt and let them boil for about
one-quarter hour, adding strong bouillon and a little sifted flour. The
peas can also be mashed through a sieve. Split peas can also be used for
this purpose. Puree of peas is considered best for those having stomach
trouble. Let the dry split peas boil for about one-half hour. Two hun-
dred and eighty grams furnish about 1,000 calories.
Carrots (Wegele). Only small carrots should be used. Clean and
wash them and cut them into lengthwise pieces; prepare like peas or
oyster plant. The carrots can be served mashed. After they have been
boiled, mash them through a hair sieve, dust with a little flour and boil
until they become a thick mass. One hundred grams (a little less than
^ pound) furnish about 120 calories.
String Beans (Wegele). Young string beans are the best to use.
Clean and wash them, break into inch lengths, and prepare like peas in
butter and beef soup. If fresh beans are not in season, canned string
beans can be used. One hundred grams (^ pound) furnish about 40
calories.
Cauliflower (Wegele). Clean and wash the cauliflower and cook like
asparagus. Time required, about ^ hour. For those with stomach
trouble use only the upper part, not the stems. One hundred grams (less
than ^ pound) furnish about 60 calories.
Mashed Potatoes (Wegele).
Potatoes 1 pound 453 gm 385 calories
Butter (fresh) % ounce 20 " 150
Salt a little 1
Hot milk 2^ ounces 90 c.c 52
Peel and wash the potatoes, cut into 4 parts, boil in a double boiler
until soft. Put into a hair sieve, mash thoroughly, add the butter, salt
and hot milk, put back on the fire and stir constantly until smooth and
thick. Serve at once. Clear beef soup may be added instead of butter if
so desired. One hundred grams (3^ ounces) furnish about 125 calories.
Cauliflower a 1'Indienne (Watson).
Cauliflower 1 pound 453 gm 140 calories
White sauce ^ pint 250 c.c 256 "
Grated cheese 2 tablespoonfuls. . . 20 gm 150 "
Cocoanut 1 tablespoonf ul . ... 32 200
Curry powder 1 dessertspoonful. .
VEGETABLES 637
Boil cauliflower twenty to thirty minutes until the stalk part is tender.
Drain and place on a fireproof dish. Add the curry powder and the white
sauce, cooling the cauliflower well. Sprinkle the cheese and cocoanut on
top, and brown quickly in a good oven. Cauliflower au gratin can be
made by increasing the amount of cheese and omitting the curry powder
and cocoanut.
Tomato Savory (Watson).
Tomatoes 6 small 600 gm 138 calories
Tomato sauce 1 gill 125 c.c 60 "
Curry powder 1 teaspoonful
Red-currant jelly 1 " 8 gm 28
Breadcrumbs 2 tablespoonfuls 30 " . 60 ' "
Grated cheese 2 28 200
Butter M ounce 15 120 "
Pepper and salt % teaspoonful of each. . . 1 "
Choose small firm tomatoes. Put into boiling water for a minute or
two, lift them out, dry and peel them. Then grease a fireproof dish and
place the tomatoes in it. Sprinkle them with half the crumbs and cheese,
and a little pepper and salt. Add the curry powder and the red currant
jelly to the tomato sauce, and pour this over the tomatoes. Put the re-
mainder of crumbs and cheese on the top, then the butter in small pieces
and bake in a moderate oven about twenty minutes. Serve hot.
Mayonnaise Dressing (Pattee).
Mustard 1 teaspoonful 4 gm 100 calories
Powdered sugar 2 teaspoonfuls 24 "
Salt 1 teaspoonful (level) ... 4 "
Speck cayenne.
Eggs 2 yolks. . . .'. 36 136
Nicelle olive oil IK cups 316 " 2,900
Vinegar 2 tablespoons 30 c.c.
Lemon juice 2 " 30 "
(Individual Rule, ^ of a recipe.)
Mix dry ingredients, add to yolks and mix thoroughly. Add a few
drops of oil at a time until one-half cup is used, beating with egg beater
or wooden spoon. Then add alternately a few drops of vinegar and
lemon juice and the remainder of the oil, using care not to lose the stiff
consistency. It should be a thick dressing and should not be added to
food until just before serving. A tablespoonful represents about 100
calories.
Note. Have all ingredients and utensils thoroughly chilled and place
mixing bowl in a pan of crushed ice while blending.
638 PREPARATION OF SPECIAL BEVERAGES AND FOODS
Cream Dressing (Pattee).
Butter 34 pound ( l /2 cup) . . 116 gra 900 calories
Flour : 2 tablespoonfuls. . . 30 30
Scalded milk 1 cupful 250 c.c 170
Eggs 3 yolks 54 gm 204
Eggs 3 whites 96 " 54
Mustard 1 teaspoonf ul 4 "
Cider vinegar 1 tablespoonful. ... 15 c.c.
Salt 1 teaspoonful 4 gm.
Vinegar ^ cupful 120 c.c.
Sugar K " 116 gm 465 "
(a) Melt butter in a saucepan, add flour and pour on gradually the
scalding milk, cook thoroughly, stirring constantly. (6) Beat yolks in top
of double boiler, add the mustard (dissolved in one tablespoon of vinegar),
salt and vinegar. Pour (a) gradually on the egg mixture and cook over
hot water until it thickens like soft custard, remove from fire, add the
sugar, and fold in the stiffly-beaten white of eggs. Pour into glass fruit
jar, cool and cover, and keep on ice. This dressing will keep a long time
and is especially delicious to serve with fruit salads.
PUREES
Chicken Puree (Watson).
Roast chicken (whole) 4 pounds 2,000 gm 3,500 calories
Onion, carrot 1 pound 453 217
Celery 2 leaves .
Cream K gill 125 c.c 227
Lemon juice .a few drops 20 "
Sugar small lump 10 gm 41 "
Remove all the skin and bones from a roast chicken. Chop the meat
and pound it in a mortar, and nib through a sieve. Take the bones of
the chicken, boil for several hours with onion, carrot, celery and enough
water to cover them. Strain through a sieve, and remove all the fat. Add
the pounded meat and simmer until it is sufficiently thick. Add the
cream, lemon juice and sugar.
Lettuce Puree (Wegele).
Salad (Romaine preferred) . . 1 pound (2 or 3 heads) . . . 453 gm 60 calories
Butter a piece 15 " 120
Flour a little 15 15 "
Beef soup Y 2 cup 125 c.c 25 "
Take the salad, using only the hearts. Separate the leaves, rinse in
cold water, scald with boiling water, and let boil in salted water until soft.
FRUITS 639
Put into a colander and let drain, then mash thoroughly. Melt the butter,
add the flour, not allowing it to brown, stir well, add the salad, also a little
beef soup, and boil all for a few minutes. A little sweet or sour cream
111:1 v be added, if permitted.
Endive Puree (Wegele).
Endive salad % pound 225 gm 45 calories
Butter a piece 15 " 120
Flour small spoonful 15 " 15 "
Salt a little 1 "
Clear soup ]/% cup 125 c.c 25 "
Use the tender stalks of endive salad, scald them two or three times
with boiling water, so they may lose their bitter taste. Boil quickly in
salted water until soft. Pour off ihe water and put cold water over it,
drain again and squeeze the endive thoroughly. Chop the stalks and mash
through a sieve. Melt the butter, add the flour, and allow it to brown.
To this add the mashed endive, salt, and soup, and stir until it becomes
a thick mass.
Red Cabbage Puree (Wegele). Slice the cabbage on a slicing machine.
Stew in butter and beef soup about 1 to 2 hours, until soft. Mash thor-
oughly and stew again, adding a little wine and a lump of sugar ; also a
pinch of flour.
FRUITS
Baked Apples (Pattee). Wipe and core apples. Put in a shallow
dish with one tablespoon water to each apple. More may be added during
cooking if necessary. Put into the center of each apple two' teaspoons
of sugar. Bake in a hot oven twenty to thirty minutes, or until soft ;
baste with the sirup every ten minutes. A little nutmeg may be added to
the sugar, and a few drops of lemon juice to each apple. Care must be
taken that apples do not lose their shape and break. One medium apple,
150 grams, furnish 70 calories.
Apricot and Prune Sauce (Pattop).
Prunes 5 large (% cup) . . . 100 gm 265 calories
Dried apricots. K cup 40 " 114
Cold water 1 cup
Sugar to taste
Wash fruit carefully, soak over night, and cook slowly for two hours.
If cooked properly the fruit will need very little sugar, as the sugar in
the fruit is developed by this method of cooking.
640 PREPARATION OF SPECIAL BEVERAGES AND FOODS
Orange (Pattee). Select a large, firm orange, wash, cut and peel
skin down in eight parts, leaving them connected to stem end of orange
to form petals, and folding them under the pulp. Separate pulp in sec-
tions and put ice between petals before serving. One medium orange,
250 grams, furnishes 96 calories.
Pineapple (Pattee).
Hawaiian pineapple 2 slices 100 gm 44 calories
Cherry 2 Maraschino
Serve pineapple on small tea plate with cherry in center. To eat a
slice of pineapple after a meal is quite in accordance with physiological
indications, as pineapple juice contains a remarkable digestive principle
similar to pepsin. It aids the work of digestion in the stomach, also in
the intestinal tract. The Hawaiian pineapple comes in three forms
sliced, crushed and grated. The sliced pineapple is usually served just
as it comes from the can. The crushed and grated are used like apple
sauce and also in delicious made desserts and beverages.
Stewed Prunes (Pattee). Wash and look over the prunes, cover with
clear cold water, and allow them to stand on the back of the range over
night. In the morning put the saucepan where they will cook slowly for
four hours.
Note. No sugar is needed as prunes are 18 per cent sugar, and by
this manner of cooking are made very sweet. This simmering process
renders them rich and juicy, while boiling toughens the skin. A little
lemon juice is a pleasant addition. Prunes are a valuable nutrient, and
their use as a laxative is scarcely second to figs. Three prunes, 60 grams,
furnish 125 calories.
Stewed Figs (Pattee).
Figs % pound 275 gm 737 calories
White sugar % cup 30 " 120
Cold water 1 " 250 c.c.
Juice of lemon % 15 "
Wash figs. Dissolve sugar in water, add figs and bring slowly to boil-
ing point. Stew two and one-half hours. When tender, add lemon juice.
Note. Cut figs in small pieces, cook very slowly so as not to add more
water.
NUTS 641
NUTS
Cooking of Nuts (Pattee). Nuts are more often eaten raw than
cooked. But the peanut is not considered palatable when raw, and the
chestnut is indigestible unless the starch is cooked, when it becomes very
easily digestible. Almonds are widely used in confectionery. Nuts may
be used as staple articles of diet, in salad, soups, desserts, etc.
To insure the best utilization of nuts they must be thoroughly pre-
pared for digestion by grinding or mastication. Nut butters offer much
less resistance to digestion than raw nuts hastily eaten. On account of
the high fat content, these products must be fresh, or the fat is likely to
decompose (become rancid) and be irritating.
Digestibility Nuts have been considered very indigestible. This is
due largely to improper mastication or other preparation for digestion ;
to the fact that they are a very concentrated food, and are often eaten
when not needed. While nut protein, as nuts are ordinarily eaten, is not
so easily nor completely digested as meat protein, there are experiments
showing that, on the whole, they are as thoroughly digested as an ordinary
mixed diet. No experiments have been reported on the ease or rapidity of
nut digestion.
Nutritive Value. Nuts are a concentrated food. This is clearly shown
by the following figures:
1 pound of Almonds yield 2,895 calories
1 Brazil nuts yield 3,120
1 " " Filberts yield 3,100
1 Hickory nuts yield 3,345 "
1 " Peanuts yield 2,610
1 " Walnuts yield 3,075
The high fuel value is due to the absence of water and the la rue
amount of fat present. Nuts can be most advantageously used along with
bulky foods, such as fruits and vegetables, and those lacking in fat, such
as bread. In a vegetarian diet they become a valuable source of protein.
Chestnut Puree (Wegele).
Chestnuts 1 pound 553 gm 1,125 calorics
Butter 3 ounces 90 675
Salt a little 1
Sugar a little 10 41
The chestnuts are peeled and boiled in water until the second (inside)
skin comes off easily. They are then placed in a sieve until all the water
642 PREPARATION OF SPECIAL BEVERAGES AND FOODS
drains off, washed, and afterward pressed through a sieve. Melt the but-
ter in a stewpan on the fire, add the salt and sugar enough to cover the
point of a knife and then the chestnuts. Stew them for half an hour,
stirring frequently; pour in enough bouillon so that the mush does not
get too thick.
k
JELLIES
Gelatinous articles of nutrition are made from cartilage, tendons, con-
nective tissue and bone. The gelatin is rapidly and completely decom-
posed iu the alimentary canal and quickly reaches the tissues and serves
as a preserver of protein and fats. Gelatinous food aids the coagulability
of the blood and when taken in excess may cause diarrhea.
Chicken Jelly (Adams). Clean a fowl that is about a year old, remove
skin and fat, chop bones and flesh fine, place in a pan with two quarts of
water ; heat slowly ; skim thoroughly ; simmer five or six hours ; add salt,
mace or parsley to taste; strain, and cool. When cool, skim off the fat.
The jelly is usually relished cold, but may be heated. Data for estimat-
ing the caloric value of this preparation are not available.
Veal-bone Jelly.
Veal bones 10 pounds 5,000 gm 1,615 calories
Water 10 quarts 10,000 c.c.
Barley 2 pounds 1,000 gm 3,300
Salt a little 3 "
Eggs yolks 72 272
Place the veal bones and water or weak bouillon over the fire and just
bring to a boil. Skim and add the barley and a little salt. Simmer for
five or six hours and then strain. If too thick, dilute, before serving, with
bouillon. Stir in the yolk of an egg for each cup and serve. Each cup
will represent in full value about 100 calories.
Meat Jelly (Hepp). This is made by cooking good boneless, lean
beef on a water bath with a little water for sixteen hours or until it be-
comes gelatinized. Of the artificial preparations on the market for mak-
ing bouillon, the most reliable is Liebig's Extract of Meat (10:250
grams), or CibiPs Bouillon (1 teaspoonful to 250 grams). Inaglio's
bouillon capsules are also very convenient. If it is desired to make the
bouillon more nutritious, one teaspoonful of meat peptone may be
added.
JELLIES 643
Jelly for Dyspeptics (Weil).
Calf's foot 1 pound 553 gm 250 calories
Beef . or % kilo 275 " 800
Hen (old) K fowl 1,000 " 1,800
Water ^ liter. 250 c.c.
Salt 1 hp. teaspoonful. . 5 gm.
Egg 1 (whole) 50 80
Cornstarch a little 30 " 100 "
Extract of meat 1 tablespoonful 5 " 20 "
Remove the skin and meat from the calf's foot; wash the bones and
place in cold water on the stove; when it begins to foam, skim off the
refuse which gathers on top. After rinsing off the scum with cold water,
put the bones into a pot with the beef or hen, water and salt, and boil
slowly for from four to five hours. Pour the jelly thus formed through
a fine sieve, and place overnight in a cellar. Next morning remove the
fat, and clarify the cold jelly by adding the beaten egg with its shell
mashed, and stirring steadily. Then, with the addition of a little corn-
starch, subject the whole to a temperature not over 168 F., or the white
of the egg will curdle. Constantly beat and stir. If the jelly begins to
get grainy, cover and let it cool until the white of the egg becomes flaky
and separates. Then strain again several times until it becomes perfectly
clear ; add the extract of meat, pour the jelly into a mold, and let it cool
again. The gravy from a roast may be utilized and is very palatable. It
must be stirred in while the mass is still warm and liquid. This jelly is
usually relished with cold fowl, but spoils easily in summer; it must,
therefore, be kept on ice. One hundred grams contain about 20 calories.
Calf's Foot Jelly (Sweet) (Watson).
Ox foot, or 1 pound 553 gm 250 calories
Calf's feet 1 pound 553 .250
Sugar Y 2 pound 276 930
Eggs 4 (whole) 200 320
Lemons 4 (whole) 520 205
Mace 1 blade 1 "
Cinnamon stick 1 inch 1 "
Cloves 4 seeds 1 "
Sherry wine 2 glasses 60 c.c 76 a
Water 2 quarts 2,000 "
Two calf's feet are equal to one ox foot, and make the same quantity
of jelly; they are prepared in the same way as the ox foot, but need not
be boiled quite so long. Get the ox foot broken across several times; split
it up between the toes ; take out the piece of fat between the toes and all
644 PREPARATION OF SPECIAL BEVERAGES AND FOODS
the marrow from the bones. First blanch the foot by thoroughly washing,
covering with cold water and bringing it to the boil. Now place it in a
basin of cold water, and scrape well.
After again rinsing in cold water, put it on in a clean pot with two
quarts of cold water, bring it to the boil, skimming it well, and boil very
gently for about eight hours. If very gently simmered by the side of the
fire, the stock does not reduce -too much. Strain it into a basin, either
through a towel or a sieve, and stand aside to get quite cold. There should
be six breakfastcupfuls of stock. When quite cold, remove all the fat
from the top ; this must be done very carefully. Now put the stock into a
clean saucepan, add the sugar, the flavorings broken into small pieces, the
lemon rind very thinly pared off, the juice strained, two eggs and the
whites of the other two eggs beaten up, and a little crushed eggshell. Put
this on the fire and whisk briskly until it comes to boiling point. Allow
it to boil very gently about seven minutes. Withdraw from the fire, cover
it with the lid, and allow it to settle for five or ten minutes.
Have a flannel or felt jelly-bag hanging up. Pour a good deal of boil-
ing water through the bag to warm and cleanse it. When the water has
all run out, put a clean basin under the bag and pour the jelly twice
through the bag, when the jelly should be clear and a brilliant color. This
jelly is excellent without wine. If wine is used, it is best put into the
saucepan just before the jelly is poured into the bag.
Milk Jelly (Wegele).-
Milk 2 liters (4 pints) . . .2,000 c.c 1,360 calories
Sugar \Y 2 cups 250 gm 1,000
White gelatin 1 ounce 30 " 100
Water . \Y 2 cups 250
Good white wine 3 wineglassf uls .... 400 " 229 "
Boil the milk for five to ten minutes with the sugar and let cool. Make
a solution of the white gelatin, add water and the white wine. Stir all
slowly. Add to above. Pour into a mold and let cool. One hundred
grams (one-half cup) are equivalent to 250 calories.
General Directions for Dishes Made with Gelatin. Gelatin should be
soaked in cold water for about half an hour to soften it. It may then be
easily dissolved by adding boiling water. If it is desired to soften gelatin
quickly, it should be placed in cold water and gradually heated over boil-
ing water until it dissolves. If a jelly is to be strained, a wet cloth should
be used for the purpose. Jelly molds should be wet with cold water before
being filled. When granulated gelatin is used, much smaller amounts are
required than when the ordinary form is used.
JELLIES 645
Wine Jelly (Drexel Institute).
Granulated gelatin 1 teaspoonful 4 gm 25 calories
Cold water 2 tablespoonfuls. . . 30 c.c
Hot water % cupful 125 "
Sugar 2 tablespoonfuls. . . 40 gm 160 "
Lemon juice }/% teaspoonful 5 c.c
Wine 2 tablespoonfuls. . . 30 " 50 "
Soak the gelatin in the cold and hot water. Add the sugar and lemon
juice, and when cooling add the wine.
Lemon Jelly. Lemon jelly is made in the same manner as wine jelly,
just described, using a tablespoonful of lemon juice in place of the quan-
tity directed.
Orange Jelly.
Lemon juice 2 teaspoonfuls 15 c.c
Orange juice 4 tablespoonfuls. . . 60 " 40 calories
Sugar 3 " . . . 60 gm 240
The above is made in a similar manner as the previous recipe, using
the lemon juice, orange juice and sugar, but a little less of the boiling
water.
Wine Jelly (Sweet Wine Jelly from Gelatin) (Watson).
French sheet gelatin 1% ounces 37 gm 222 calories
Cold water 3 gills 360 c.c.
Lemon juice }/2 gill 60 "
Sherry wine Y 2 " 60 " 65 "
Brandy 1 tablespoonful. ... 15 " 40 "
Loaf sugar 3 ounces 90 gm 360 "
Lemon 1 rind 2 "
Cloves 2 or 3 1 "
Cinnamon stick 1 inch 1 "
Egg 1 white 32 " 18
Put all the ingredients into a lined saucepan ; whisk until they boil ;
remove to the side of fire when the scum begins to rise in the top. Cover
the top of the pan with a plate, and allow it to stand fifteen minutes.
Strain through a hot jelly cloth three or four times till clear; when cold,
mold in a scalded wet mold.
Cream Jelly or Blancmange (Watson).
Milk 1 gill 60 c.c 45 calories
Cream 1 60 " 120
Isinglass % ounce 7 gm , 42 "
Lemon 1 rind 4 "
Sugar 1 ounce 30 " 120
141
646 PREPARATION OF SPECIAL BEVERAGES AND FOODS
Rinse out a small saucepan and put into it the milk, isinglass and
thinly peeled rind of half a lemon. Let this stand by the side of the fire
until the isinglass is dissolved and the milk well flavored with the lemon.
Stir occasionally to prevent boiling. Add the sugar, and strain into a
basin to keep back the lemon rind. Add the cream, and stir occasional 1\
until nearly cold. If not stirred, the milk and cream will separate. Pour
into a small basin that has been rinsed out with cold water, and place in
a cool position to set. Turn out and serve with a little red or black cur-
rant jelly.
Nutritious Coffee Jelly (Thomas).
Isinglass or gelatin a little 2 gm 12 calories
Freshly ground coffee ^ ounce 15 "
New milk 1 pint 500 c.c 340 "
Egg 1 (whole) 50 gm 80
Dissolve the isinglass or gelatin in water, put the coffee into a sauce-
pan with the new milk, which should be nearly boiling before the coffee
is added ; boil together for three minutes ; clear it by pouring some of it
into a cup and dashing it back again ; add the gelatin, and leave it to set-
tle in a warm place for a few minutes. Beat up the egg in a breakfast
cup, and pour the coffee upon it ; if preferred, drink without the egg.
Milk Jelly (Schlesinger).
Milk 2 quarts 2,000 c.c 1,360 calories
Sugar K pound : . 275 gm 930
Gelatin 1 ounce 30 108
Cold water 1 cupful 250 c.c.
Juice of lemons 2 or 3 40 "
Good Bordeaux wine 3 glasses 90 " 135 "
To the milk add the sugar. Boil for five or ten minutes. Cool and
add the gelatin dissolved in the cold water. Flavor with the juice of the
lemons and wine.
Irish-moss Blancmange (Drexel Institute).
Irish moss 1 tablespoonful. . . . 8 gm 30 calories
Milk K cupful 175 c.c 85
Salt a little 1 gm.
Wash the moss in several changes of water, and pick it over carefully.
Place it in a double boiler, together with the milk. Cook until it thickens
when dropped on a cold plate. Add salt, strain and flavor. Pour into
a custard cup that has first been rinsed in cold water.
CUSTARDS 647
Meat Jellies with Gelatin
Meat broth 1 pint 500 c.c 52 calories
Granulated gelatin 1 teaspoonful 4 gm ; 25 "
Use any kind of meat broth desired, but always one with appetizing
flavor. Add the gelatin to enough broth to cover it, and allow the gelatin
to soak for a few minutes. Then add the remainder of the broth very
hot, and stir until the gelatin is dissolved. Strain and pour into molds
to cool.
Meat Jellies with Tapioca
Broth 1 cupful 250 c.c 26 calories
Powdered tapioca 4 level tablespoonfuls . . 60 gm 90 "
Salt a pinch 1 "
Mix the broth as above with the powdered tapioca. Heat until quite
clear, stirring constantly. Add salt and season as desired. Pour into
molds and cool.
Meat Jellies with Irish Moss.
Irish moss 2 tablespoonfuls. . . 8 gm 25 calories
Hot broth 1 cupful 250 c.c 26
Wash the moss thoroughly. Add this to the hot broth and allow it to
stand for half an hour ; then heat slowly, stirring constantly, and boil for
ten minutes, preferably in a double boiler. Strain, pour into molds, and
cool.
CUSTARDS
Rules for Custards (Drexel Institute). The eggs should be thoroughly
mixed but not beaten light, the sugar and salt added to these, and the hot
milk added slowly. Custards must be cooked over moderate heat ; if a cus-
tard curdles, put it in a pan of cold water and beat until smooth. Cus-
tards should always be strained.
Soft Custard.
Milk 1 pint 500 c.c 345 calorics
Eggs 2 yolks 36 gm 130
Sugar 2 tablespoonfuls. . . 30 120
Salt. a pinch 1 "
Vanilla 2 teaspoonfuls 4 c.c.
Sherry 4 30 38
Mix the yolks of eggs, sugar and salt in a bowl. Heat the milk to the
boiling point and add to the eggs, sugar and salt, stirring constantly. As
soon as mixed, pour into the saucepan in which the milk has been
648 PKEPARATION OF SPECIAL BEVERAGES AND FOODS
and cook from three to five minutes, stirring constantly until it thickens.
Strain, and pour into a cold bowl, and flavor with vanilla, sherry or other
flavoring material as desired. Custards may be cooked to advantage in
a double boiler.
Savory Custard (Anderson). Add the yolks of two eggs to a cupful
of beef tea, with pepper and salt to taste. Butter a cup or a jam pot;
pour the mixture into it, and let it stand in a pan of boiling water till the
custard is set.
This will furnish 150 calories.
Custard Sauce (Watson).
Eggs 2 yolks 36 gm 135 calories
Egg 1 white 32 18
Sugar 1 dessertspoonful . . 8 " 32 "
Milk YZ pint 250 c.c 170
Flavoring a few drops 1 u
Rinse out a small lined saucepan with cold water, put the milk into
it, and let it heat over the fire. Put the yolks and white of egg into a
basin with sugar, and mix them well together with a wooden spoon. Then
pour the hot milk gradually onto them, stirring all the time and mixing
thoroughly. Return all to the saucepan, and stir very carefully over the
fire until the sauce thickens. On no account must it be allowed to boil,
or it will curdle. Have ready at hand a clean basin and strainer. As
soon as the sauce shows signs of thickening, and it is almost boiling, re-
move the pan from the fire, continue stirring for a few moments, and then
strain into a basin. Add flavoring to taste lemon, vanilla, nutmeg or
cinnamon. This can be made richer by increasing the proportion of yolks
to white. It can be served as sauce, or in a custard glass, with flavoring
grated on the top.
Baked or Cup Custard (Individual Rule} (Pattee).
Milk 1 cup 250 c.c 170 calories
Egg 1 (whole) 50 gm. . 80 "
Sugar \ 1 A tablespoons 6 " 24 "
Salt 1 A saltspoon 1 "
Flavoring to taste: nutmeg, cin-
namon, vanilla, or lemon ex-
tract.
Scald the milk; boat the ogg, add sugar and salt, and pour onto it
gradually the soaldod milk. Flavor to taste and pour into custard cups;
place in deep pan and pour boiling water around until it almost reaches
CUSTARDS 649
the top of cups. Bake in moderate oven about twenty minutes. If cinna-
mon is used for flavor, put one-half square inch into the milk when scald-
ing.
Note. To test, dip a pointed knife into water and plunge into the
middle of the custard. If it looks set and the knife comes out clear, the
custard is done; if milky, it is not cooked enough. If cooked too long
the custard will curdle.
Chocolate Custard (Individual Rule} (Fitch).
Walter Baker's chocolate 2 teaspoonfuls 15 gm 89 calories
Milk 2 tablespoonfuls. . . 30 c.c 42 "
Rich milk 6 " ... 90 " 160 "
Eggs 2 yolks 36 gm 130
Sugar 2 teaspoonfuls 8 " 32 "
Salt a speck 1 "
Grate chocolate and mix with the two tablespoons of milk ; stir over
the fire until smooth, add the rich milk, the well-beaten egg yolks, sugar
and salt. Pour into custard cups set in pan of hot water (nearly to the
top). Cook until custard is set. Serve hot or cold.
Custard Souffle (Individual Rule} (Pattee).
Butter 1 tablespoonful. ... 15 gm 120 calories
Flour 1% tablespoons 37 " 118
Scalded milk M cup 60 c.c 40 "
Egg 1 yolk 18 gm 65 "
Sugar 1^ tablespoons 20 " 80 "
Egg 1 white 32 18
Melt butter, add flour, and then gradually the scalding milk. Cook
thoroughly, pour into the well-beaten yolk, add sugar, and cool. Fold into
mixture the well-beaten whites. Turn into buttered custard cups and bake
about fifteen minutes, until firm determined by pressing with the finger.
Take from oven and serve at once, or it will fall. Serve with foamy sauce.
Peach Meringue (Individual Rule} (Pattee).
Yellow peaches 1 cup 253 gm 58 caloriea
Sugar to taste 2 tablespoonfuls. . . 30 120
Egg 1 yolk 18 65
Bread crumbs 1 tablespoonful. ... 15 " 15 "
Egg 1 white 32 " 18
Powdered sugar 1 tablespoon 16 " 64 "
Stew peaches in a very little water, sweeten to taste, and stir in the
well-beaten yolk. Butter a pudding dish and cover bottom with fine bread
crumbs; put in the peaches and bake fifteen minutes. Cover with
650 PREPARATION OF SPECIAL BEVERAGES AND FOODS
meringue made of white of egg and the powdered sugar; brown slightly
in the oven. Serve cold.
Cocoa Junket
Cocoa 1 teaspoonful 4 gm 50 calories
Milk sugar 1 ounce 30 " 120 "
Milk 5 ounces 150 c.c 100
Junket tablet % 0.25 gm.
Cold water 1 ounce 30 c.c.
Dissolve the junket tablet in the water. Mix the cocoa and sugar,
add the milk, and heat lukewarm, stirring constantly; add the dissolved
junket tablet, stir thoroughly, and leave in a warm place to set.
Soft Custard.
Milk 1 cup (8 ounces). . .250 c.c 160 calories
Egg 1 (whole) 50 80 "
Milk sugar 2 ounces 60 gm 240 "
Salt a speck.
Vanilla 2 to 3 drops.
Caramel, made of granulated
sugar 3 tablespoonfuls. . . 45 * 180
Beat the egg slightly ; add the sugar, salt and hot milk slowly. Cook
in a double boiler, stirring constantly, until it thickens a little (if cooked
too long the custard will curdle, but may become smooth again if set in a
dish of cold water and beaten at once). Flavor and cool.
To make caramel : Put the sugar in a pan directly over heat and burn
until a very dark brown. Dissolve in hot water or milk.
Plain Junket or Rennet Custard.
Milk sugar 1 ounce 30 gm 120 calories
Milk 5 ounces 150 c.c 100 "
Junket tablet % 0-25 gm.
Cold water 1 ounce 30 c.c.
Vanilla few drops.
See directions for Cocoa Junket.
Baked Custard
Milk sugar 1 }/$ ounces 40 gm 160 calories
Milk 6 ounces 180 c.c 120
Egg 1 (whole) 50 gm 80
Nutmeg or vanilla .
Salt a speck.
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
PUDDINGS 651
water in a moderate oven until a knife, when cut into it, will come out
clean (one-half to one hour).
PUDDINGS
Bread Pudding
Milk sugar 1 ^ ounces 45 gm 180 calories
Milk 6 ounces 180 c.c 120
Egg 1 (whole) . . 50 gm 80
Bread 1 slice *A" thick. '. . 20 60
Butter Y 2 ounce 15 " 120 "
Spread the bread with butter, and cut into squares. Beat the egg
slightly; 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 custard.
Rice Pudding
Rice 3 tablespoonfuls. . . 100 gm 360 calories
Milk 1 quart 500 c.c 700
Salt a pinch 1 gm.
Sugar 1 cup 280 " 1,148
Butter 1 hp. teaspoonful. .15 " 120
Cinnamon, nutmeg, or vanilla to taste.
Wash the rice with water. Add to the milk and cook slowly on top
of the stove for one hour, or a little longer, until the mixture becomes
creamy. Add the sugar, butter and cinnamon. Put into a dish to set,
and bake in an oven until the top is browned. The whole pudding fur-
nishes five to six portions.
Rice and Egg Pudding (Caultey).
Rice 3 ounces 90 gm 315 calories
Milk 1 pint 500 c.c 350
Butter 1 ounce 30 gm 240 "
Powdered sugar 2 ounces 60 " 240 "
Eggs 3 yolks 54 180
Lemon peel 1 grated 2 "
Eggs 3 whites 96 54
Powdered sugar 3 tablespoonfuls. . . 45 " 185 "
Take the rice and swell it gently in the new milk. Let it cool, and
stir well into it the fresh butter, powdered sugar, the yolks of the eggs,
and some grated lemon peel. Pour into a well-buttered dish and put on
the top the whites of the eggs beaten with the powdered sugar. Bake for
twenty minutes until lightly browned. The whole pudding furnishes six
portions.
Arrowroot (Pavy). Mix thoroughly two teaspoonful s of arrowroot
with three tablospoonfuls of cold water, and pour on them half a pint
652 PREPARATION OF SPECIAL BEVERAGES AND FOODS
of boiling water, stirring well meanwhile. If the water is boiling, the
arrowroot thickens as it is poured on, and nothing more is necessary. If
only warm water is used, the arrowroot must be afterward boiled until
it thickens. Sweeten with loaf sugar, and flavor with lemon peel or nut-
meg, or add sherry, port wine or brandy, if required. Boiling milk may
be employed instead of water, but when this is done no wine must be
added, as the milk would curdle.
Cornstarch Pudding (Individual Rule) (Pattee).
Milk 1 cupful 250 c.c 170 calories
Cornstarch 1^ tablespoons .... 28 gm 90 "
Sugar \ l / 2 " ....28 112
Salt a speck 1 "
Egg 1 white 32 18
Vanilla extract a few drops.
Scald the milk in a double boiler. Mix cornstarch, sugar and salt
thoroughly; add slowly the scalded milk, stirring constantly. Return to
top of boiler and cook twenty minutes, stirring constantly for the first five
or six minutes, then occasionally. Remove from fire, and while very hot,
fold in lightly, but thoroughly, the well-beaten white of egg. When par-
tially cooled add flavoring to taste ; put into wet cups or molds, cool, and
then stand for several hours on ice. Remove from molds. Serve with a
soft custard, mashed fresh berries, or whipped cream. Vary the pudding
by adding a little Walter Baker's chocolate, melted.
Pineapple Cream (Individual Rule) (Pattee).
Milk 1 cupful 250 c.c 170 calories
Cornstarch \]4, tablespoons .... 28 gm 90 "
Sugar 1^ " 28 112
Salt a speck 1 V
Egg 1 white 32 18
Grated pineapple 2 tablespoons 50 " 22 "
Follow directions for Cornstarch Pudding, adding the pineapple in-
stead of vanilla. Pour into individual molds and serve cold with cream.
Plain Rice Pudding (Individual Rule}.
Scalded milk
1 .*'....-.
.250 c.c
170
Butter
1 tablespoonful. . .
. 15 gm
120
Egg. . ,
1 (whole)
.50
80
Sugar
2 tablespoonfuls. .
.30
120
Salt
}^2 saltspoon
. 1 "
Raisins Cstoned). .
. . \t CUD . .
.100 .
..320
PUDDINGS 653
Scald milk and add butter. Beat egg, add sugar and salt, and pour on
slowly the scalding milk. Put in pudding dish with rice and raisins. Put
bits of butter on top, and bake in a moderate oven until custard is set.
Serve with hard sauce. Do not use raisins in cases of bowel trouble.
Chocolate or Cocoa Blancmange (Pattee).
Minute tapioca 34 cupful 30 gin 45 calories
Sugar \i " 30 120
Salt % teaspoonful 1 "
Hot chocolate or cocoa 1^ cups 340 " 418 "
Vanilla ^ teaspoonful.
The above quantity is sufficient for three servings containing 195
calories each.
Mix tapioca, sugar and salt ; pour on gradually the hot cocoa, and cook
in double boiler about twenty minutes. Remove from heat, add vanilla,
and pour into cold, wet molds. Serve cold, plain or with whipped cream
or soft custard.
Plain Bread Pudding (Pattee).
Stale bread 1 cupful 120 gm 120 calories
Milk 1 " 250 c.c 170
Butter 1 tablespoonful 15 gm 120 "
Egg 1 (whole) 50 80
Sugar to taste 2 tablespoonfuls. . . 30 " 120 "
Salt ^saltspoon 1
Seeded raisins Y cup 100 320
Scald milk and add butter. Beat the egg and add sugar and salt ; pour
on gradually the scalding milk. Cut the bread into one-half inch cubes
and add with the raisins. Pour into well-buttered pudding dish, put bits
of butter on top, and bake in a moderate oven until the custard is set.
Serve with hard sauce or cream and sugar. Do not use raisins in bowel
trouble. The above quantity is sufficient for two servings and contains
930 calories.
Tapioca and Sago Pudding (Watson).
Tapioca or sago % ounce 30 gm 48 calories
Cold milk ^ pint 250 c.c 170
Egg 1 (whole) 50 gm 80
Sugar 1 teaspoonful 5 20
Flavoring to taste.
Tf small crushed tapioca or sago is used, the directions are the same
as for semolina pudding. If not, the recipe is as follows:
654 PREPARATION OF SPECIAL BEVERAGES AND FOODS
Cover the grain with milk, and soak for an hour. Rinse out a small
lined saucepan, turn the tapioca and milk into it, and stir over the fire
until it comes to the boil. Then simmer slowly until it turns clear, stir-
ring every now and then. This takes from twenty to thirty minutes. If
it becomes too thick while cooking, add a little more milk. Then finish
off the pudding with eggs, etc., as in semolina.
Baked Bread and Butter Pudding (Watson).
Thin bread and butter 2 slices (%" thick). . . 40 gm 120 calories
Sugar 1 teaspoonful 5 " 20 "
Milk K pint 250 c.c 170
Egg 1 (whole) 50 gm 80 "
Grated nutmeg to suit.
Cut some bread and butter rather thin, remove the crusts, and cut into
pieces about an inch square. Lay these into a small greased pie-dish, mak-
ing the dish just about half full; beat up the egg in a small basin, and
add the nutmeg, sugar and milk. Mix well together and pour over the
bread in the pie-dish. Allow the pudding to stand about ten minutes until
the bread gets thoroughly saturated, then bake in a moderate oven from
ten to fifteen minutes until nicely browned on the top. Sprinkle with
sugar.
Sponge Pudding (Wegele).
Butter % ounce 20 gm 170 calories
Flour 1% ounces 50 180
Milk Y 2 pint pound) ... 250 c.c 170
Egg 1 yolk 18 gm 65
Butter % ounce 20 ft 160 "
Eggs 2 yolks 36 " 130
Sugar 1 tablespoonful 15 " 60 "
Vanilla a little.
. 3 whites. . . 96 " . . 54
Melt the butter in a saucepan. Thoroughly mix the flour and milk,
boil in the saucepan containing the melted butter. Let the mixture cool
off, and then add the yolk of the one egg. Beat to a cream the butter and
yolks of two eggs, add sugar and vanilla, and add to above. Beat stiff
the whites of three eggs and add. Butter a pudding dish, dust same with
bread crumbs, put the entire batter into the pudding dish and allow to
steam for one hour. One hundred grams (3 14 oz.) are equivalent to
about 220 calories.
A vanilla or wine sauce may be served with this pudding. The pud-
ding can be baked, if so desired.
ICE CREAM 655
ICE CREAM
Chocolate Ice Cream (Pattee).
Thin cream Yi cup 80 gm 216 calories
Walter Baker's chocolate 1 ounce 30 " 180
Sugar \ 1 A tablespoonfuls. . 15 60
Boiling water 1 tablespoonful. ... 15 c.c.
Vanilla Yi teaspoonful 1 "
Salt a speck 0.5 gm.
Melt the chocolate over hot water, add the boiling water, sugar and
hot cream. Cool, add vanilla and salt, and freeze in small pail.
Junket Ice Cream (Pattee).
Cream Yi cup 80 gm 216 calories
Milk y 2 125 c.c 85
Sugar 1Yi tablespoons .... 25 gm 100 "
Hansen's junket tablet % tablet
Cold water 2 teaspoonfuls 15 c.c.
Vanilla % ' " 25 "
Heat the milk until lukewarm, add the sugar and vanilla ; when sugar
is dissolved, add the tablet dissolved in the cold water. Allow it to stand
in warm room until firm, then beat thoroughly and turn into small pail
and freeze. The above quantity is sufficient for two servings.
A variety may be made by adding two teaspoons cocoa dissolved in a
little boiling water. Add to mixture before adding the tablet. Serve the
cream plain or with whole strawberries, etc. The junket improves the
body or consistency of any cream.
Strawberry Ice Cream (Pattee).
Thin cream or rich whole milk . .^ cup 80 gm 216 calories
Milk :....Yz " 125 c.c 85 "
Strawberries Y " 200 gm 60 "
Sugar 2 tablespoons 20 " 80
Salt a speck 1 "
Mash the strawberries with the sugar, and allow them to stand five
minutes. Add the cream and milk and freeze in small pail. The berries
may be mashed and strained through cheesecloth.
Peach Ice Cream (Pattee).
Thin 'cream or rich whole milk . . Yt cup 80 gm 216 calories
Milk Yi " 125 c.c 85 "
Peaches Y " 256 gm 85
Sugar 2 tablespoons 20 80
656 PREPARATION OF SPECIAL BEVERAGES AND FOODS
Mix peaches and sugar and press through a potato ricer or sieve.
Scald cream and milk. Cool, and add peaches and sugar. Freeze in
small pail.
Caramel Ice Cream (Individual Rule) (Patt.ee).
Thin cream or rich whole milk . .^ cupful 80 gm 216 calories
Milk Yz " 125c.c .....85
Sugar 2 tablespoonfuls. . . 30 " 80 "
Boiling water 2 ... 30
Vanilla 1 A teaspoon 20 "
Salt a speck 1 gm.
Into saucepan place the sugar and stir constantly until melted. Add
water and boil until reduced to one and one-half tablespoons. Add cream
very slowly, vanilla, salt, and freeze.
Vanilla Ice Cream.
Cream 4 ounces 120 c.c. 240 calories
Milk 2 60 40
Milk-sugar 2 " 60 gm 240
Vanilla a few drops 1 c.c.
Mix the cream, milk and sugar, and heat, stirring constantly, until
the sugar is dissolved. Then flavor, cool and freeze.
RECIPES FOR DIABETIC FOODS
Gum Gluten Bread.
Gum gluten flour 4 cups 553 gm 1,160 calories
Scalded milk 1 cup 250 c.c 170
Cold water 1 " 250 "
Butter 1 tablespoonful. . . . 15 gm 120 "
Fleischmann's Yeast J^ cake 2 "
Salt 1 A teaspoonful 2 "
Put the hot water or milk in the mixing bowl. Add the butter, and
when melted, add the salt and cold water. Dissolve the yeast in a little
lukewarm water, and add to the above mixture, being careful that the
liquid is not too warm. Stir in the flour, and knead thoroughly in the
bowl. Set to rise in a warm place, having the bowl well covered and
away from draughts. When doubled in bulk, cut down, and knead again
in the bowl. Cover and let rise the second time. When light, cut it down,
turn onto a well-floured board, knead into shape, and place in a greased
bread pan. Cover and let rise to top of pan. Bake in a moderate oven
one hour and a half. Turn out on a wire sieve to cool.
RECIPES FOIi DIABETIC 1 FOODS 657
Gum Gluten Muffins.
Gum gluten flour 1 cup 140 gm 290 calories
Egg 1 (whole) 50 " 80
Milk 1 cup 250 c.c 170
Butter, melted 1 tablespoonful. ... 15 gm 120 "
Baking powder 2 teaspoonfuls 8 "
Salt K teaspoonful 1 "
Sift flour, salt and baking powder together. Beat the egg, to which
add the milk, and beat in the flour gradually, using Dover egg beater.
Now add the melted butter, and when the mixture is smooth and light,
drop in smoking hot, greased iron gem pans, and bake forty-five minutes
in a moderate oven.
Aleuronat Bread (Ebstein).
Ordinary wheat flour 6 ounces 180 gm 600 calories
Aleuronat powder 6 180 576
Butter (best) 5 150 1,220 "
Salt 1 teaspoonful ... 1 "
Baking powder % of ounce 22 "
Milk 2 ounces 60 85 "
Mix the flour and the aleuronat in a warm dish, and add gradually the
melted butter and milk (made lukewarm), followed by the salt, and finally
by the baking powder (one part of sodium carbonate and two parts of
cream of tartar). The dough is well mixed, then molded into two loaves,
and baked at a good heat.
Bran Bread.
Bran K pound 280 gm.
Almond flour 2 ounces 60 " 375 calories
Butter 3 90 720
Eggs 6 (whole) 300 480 "
Milk K pint 250 c.c 170 "
Bicarbonate of .soda 2 teaspoonfuls. . . 8 "
Tartaric acid 1 teaspoonful ... 4 "
Place the butter in a basin and beat it to a cream, then add the al-
monds and beat well : add the eggs one at a time. Partly mix in the bran
before adding the milk. Mix the whole together, place it in a well-but-
tered tin, and bake for an hour in moderate oven.
Camplin's Bran Cakes.
Wheat bran 1 quart 543 gm.
Eggs 3 (new laid) 150 " 240 calories
Butter 2 ounces 60 480
Milk y 2 pint 250 c.c 170
Soda-bicarbonate 1 teaspoonful 4 gm.
658 PREPARATION OF SPECIAL BEVERAGES AND FOODS
Take a sufficient quantity of wheat bran, boil it in two successive
waters for a quarter of an hour, each time straining it through a sieve;
then wash it well with cold water (in the sieve) until the water runs off
perfectly clear; squeeze the bran through a cloth as dry as possible, and
spread it thinly on a dish ; place it in a slow oven ; if put in at night, let
it remain until the morning, when, if perfectly dry and crisp, it will be
ready for grinding. The bran thus prepared must be ground in a mill
and sifted through a wire sieve that has so fine a mesh that a brush must
be used to pass it through; that which remains in the sieve must be re-
ground until it becomes quite soft and fine. Take of this bran powder
three ounces (some persons use four ounces). Mix the eggs with a little
of the milk, and warm the butter with the remainder; add the bran, and
stir the whole well together, adding the soda and a little nutmeg or ginger
or any other agreeable spice. Bake in small tins (patty pans), which
must be well buttered, in a somewhat quick oven for about half an hour.
When baked, the cakes should be a little thicker than a captain's biscuit ;
they may be eaten with meat or cheese for breakfast, dinner or supper.
At tea they require a somewhat liberal allowance of butter, or they may
be eaten with curd or with any soft cheese. It is important that the flour
be prepared as directed above. If the cakes do not keep well or if they
have not been well prepared, place them before the fire for ten minutes
every day.
Waffles
French gluten flour 1 cup 140 gm 290 calories
Eggs 2 (whole) 100 " 160
Milk 1 cupful 250 c.c 170
Butter 1 tablespoonful. ... 15 gm 120 "
Baking powder l}/2 teaspoonfuls 6 "
Salt % teaspoonful 1 "
Sift flour, salt and baking powder together. Rub in the butter. Beat
the eggs, to which add the milk, and stir in the flour gradually. Beat
well, and bake on a hot, well-greased waffle iron. Serve hot, with butter
or cream.
Almond Cakes No. 1 (Saundby).
Almonds (ground) 1 pound 553 gm 3,030 calories
Eggs 4 (whole) 200 " 320
Milk 2 tablespoonfuls. . . 30 c.c 40 "
Salt a pinch 1 gm.
Beat up the eggs, add the milk, stir in the almond flour and salt ; place
in twelve flat tins and bake in a moderate oven for about fifteen minutes.
RECIPES FOR DIABETIC FOODS 659
Almond Cakes No. 2 (Seegen).
Sweet almonds J4 pound 250 gm 757 calories
Butter '. 3 ounces 90 " 720 "
Eggs 2 (whole) 100 " 160
Eggs 3 yolks 54 " 195
Salt a little 1
Eggs 3 whites 92 " 54
Break up the almonds in a stone mortar (or almond flour may be used).
Put the flour thus prepared into a linen bag, which should then be im-
mersed for one-quarter of an hour in boiling water, acidulated with a
little vinegar, to remove the small amount of sugar from the almonds.
Mix well with the butter and two eggs. Then add the three yolks of eggs
and the salt, and stir the whole briskly for some time. Beat the whites
of eggs to a fine froth and add to the mixture. The paste is then made
into biscuits, smeared with butter, and baked with a gentle fire.
Cocoanut Cakes.
Desiccated cocoanut powder. ... 1 pound 553 gm 3,000 calories
Yeast 1 cake 30 "
Warm water 2 ounces 60 c.c.
Eggs 2 (whole) 100 gm 160
Milk 2 ounces 60 c.c 80
Salt 1 saltspoonful 1 gm.
Mix water and yeast into a paste; add to cocoanut powder, if neces-
sary using more water. After thoroughly mixing, leave in a warm place
for thirty minutes. Beat up the eggs and milk, add salt, then put into
mixing bowl with the cocoanut powder and yeast; heat again and mix
thoroughly. Then place into a well-greased gem pan containing sixteen
compartments. Bake in a moderately hot oven for twenty minutes. Al-
mond cakes may be made in the same way.
Aleuronat and Almond Cakes (Williamson).
Aleuronat 3 ounces 90 gm 288 calories
Almond flour 3 " 90 561
Egg 1 (whole) 50 80 ,
Cream 2 teaspoonfuls 30 c.c 108
Water a little 30 "
Moisten the aleuronat with a little water containing saccharin and
let it stand for a few minutes; then add the almond flour, the egg, the
cream, and the water just as required to make a light paste. Spread on
a tin. Cut into squares, and bake in a moderate oven for twenty minutes.
660 PREPARATION OF SPECIAL BEVERAGES AND FOODS
Almond Biscuit (Mrs. Hart).
Almond flour 1 pound 553 gm 3,030 calories
Eggs 2 whites 64 36
Salt to taste ^ teaspoonful 1 "
To the flour add the whites of the eggs and salt. Whip the whites
to a stiff froth, add the almond flour, and beat well together. Put in but-
tered patty pans and bake in a moderately quick oven for from fifteen to
twenty minutes. The whole must be done quickly, and baked as soon as
the ingredients are mixed. This biscuit is a useful substitute for bread.
Aleuronat Pancakes (Williamson).
Egg 1 (whole) 50 gm 80 calories
Water and cream a little 30 c.c 54 "
Aleuronat powder 2 teaspoonfuls 30 gm ". . . . 187 "
Baking powder J^ teaspoonful 2 "
Salt a little 1 "
Beat up the egg in the water and cream ; mix the aleuronat powder,
baking powder and salt, and then add gradually to the egg and cream and
beat into a batter; allow it to stand for five minutes. If it is too thick,
add a little more cream and water. Fry in an ordinary frying-pan
greased with a little lard. At the end of about eight minutes, when the
under surface is browned, turn it over and continue to bake for five min-
utes longer.
Aleuronat and Suet Pudding (Williamson).
Aleuronat flour! 2 ounces 60 gm 374 calories
Suet 2 60 540
Egg 1 (whole) 50 80 tt
Salt a pinch 1 "
Baking powder }/% teaspoonful 2 "
This is a palatable and cheap dish. Sprinkle a little aleuronat flour
on a chopping-board and chop the suet on this part of the board. Then
mix the remaining aleuronat with the suet in a pan. Add the salt and
the baking powder. Beat up the egg in about three tablespoonfuls of
water to which a little saccharin has been added. Add the egg gradually to
the suet mixture, rubbing the whole mass well into a paste. It may be nec-
essary to add a little more water. Drop into a tin pudding mold smeared
with butter or lard, float it in a pan of water, and boil for two hours, tak-
ing care that the boiling water does not get into the mold ; or, better still,
the pudding may be baked in the oven. Its taste is improved by the addi-
661
tion of half an ounce of almonds. A small quantity of red wine may
serve as a sauce.
Cocoanut Pancakes (Williamson).
Egg .1 (whole) 50 gm 80 calories
Milk 2 tablespoonfuls. . . 30 c.c 25 "
Salt a pinch 1 gm.
Cocoanut powder 2 tablespoonfuls. . . 30 " 187 "
Beat up the egg in the milk, or, better, in a little cream and water,
and add the salt. Then add the cocoanut powder (freed from sugar). Al-
low this to stand from five to ten minutes. Add a little more cream
and water. Mix well until it is a little thicker than ordinary pancake
batter. Put a little lard in the frying-pan and heat until the lard is just
melted; then drop in half of the mixture. Allow this to remain over a
moderate fire for a few minutes about five vintil the under surface is
brown; then turn the cake over and heat for another five minutes. The
other half of the mixture may be used for the second pancake.
Cocoanut Cakes (Williamson).
Cocoanut powder 3 tablespoonfuls. . . 45 gm 250 calories
German yeast a little 1 "
Water q. s.
Solution of saccharin small quantity 0.5 "
Egg 1 (whole) 50 80
Cream 2 teaspoonfuls 30 c.c 60 "
Mix the cocoanut powder into a paste with the yeast and water. The
mixture should be allowed to remain by the fire or in a warm place for
about twenty minutes, or until fermentation occurs and it becomes
"puffy." Then add the watery solution of saccharin. Beat up the egg,
and add this with the cream and a little water to the cocoanut paste. The
whole should be well mixed, dropped into small tins, and baked in an oven
for about thirty minutes.
Cocoanut and Almond Cakes (Saundby).
Cocoanut powder (finest) % pound 277 gm 2,250 calories
Ground almonds H " 138 760
Eggs 6 (whole) 300 480
Milk 1 A cupful 125 c.c 85
Beat up the eggs and stir in the cocoanut and almond flour. Divide
into sixteen flat tins, and bake for twenty-five minutes in a moderate
oven.
142
662 PREPARATION OF SPECIAL BEVERAGES AND FOODS
Cocoanut Pudding (Williamson).
Cocoanut powder 3 tablespoonfuls. . . 45 gm 275 calories
Water a little 30 c.c.
German yeast a little 1 gm.
Cream 4 tablespoonfuls. . . 60 c.c 120 "
Egg 1 (whole) 50 gm 80
Salt a little 1 "
Water sweetened with saccharin . y% pint
Mix the cocoanut powder with a little water and German yeast, and
keep for twenty minutes in a warm place, so as to allow the small quantity
of sugar present to decompose ; add the cream, egg, a little salt, and water
sweetened with saccharin. Mix into a paste. Place in a dish greased with
butter. Cook like rice pudding, in a slow oven for thirty minutes.
Almond Pudding (Mrs. Hart).
Eggs 2 (whole) 100 gm 160 calories
Almond flour Y pound 138 " 760
Butter Y 140 " 900
Saccharin 3 tabloids 1 "
Brandy 1 tablespoonful. ... 15 100
Warm the butter, beat in the almond flour and the yolks of the eggs,
and add the saccharin dissolved in the brandy. Whip the whites into a
stiff froth, and beat all together. Put into dariole molds and bake in a
quick oven. Serve with a little hot sauce made with dry sherry and sac-
charin.
REFERENCES
1. CAULTEY. Sutherland's System of Dietetics.
2. FRIEDENWALD and RUHRAII. Diet in Health and Disease.
3. BARTHOLOW. The Practice of Medicine.
4. THOMPSON, W. GILMAN. Practical Dietetics.
5. WATSON. Foods and Feeding.
6. WEGELE. Gastro-intestinal Tract, pub. by Rebman Co., New York.
7. ATWATER, H. W. Bread and Breadmaking, TJ. S. Dept. of Agric.,
1910, Bull. No. 389.
8. PATTEE. Diet in Disease.
9. GATJTIER. Diet and Dietetics, Paris, France.
10. CHITTENDEN. Am. J. Med. Sci., vol. vi, No. 5.
CHAPTER XVIII
ARMY AND NAVY RATIONS
GEORGE N. KREIDER, A.M., M.D., F.A.C.S.
U. S. Army Rations: Garrison Ration; Field Ration; Haversack Ration;
Travel Ration; Filipino Ration; Emergency Ration; Savings; Con-
centrated Food; Company Dietaries; Tropical Dietaries; Army Ra-
tions Past and Present.
Rations for Boys' Military Training Camps: Menu, Boys' Military
Training Camp, Fort Terry, N. Y. ; Properly Balanced Dietaries for
Boys' Military Training Camps.
Rations of Foreign Armies: Germany; Russia; Japan; France; Great
Britain ; Systems of Supply ; Comparative Rations of the Armies of
the World.
Diet in Prison Camps.
Conclusions Regarding the Composition and Food Value of the Military
Ration.
Navy Rations.
U. S. ARMY RATIONS
The best ration for a soldier is a subject which has held the attention
of army officers for many decades. An army is a collection of active,
disciplined, healthy men in the prime of life, to be used as a fighting force
in the service of the nation, and it is the prime object of military admin-
istration so to govern and train such men that they shall be fit when
lighters are needed.
Unless a man is maintained in a good physical condition, he is use-
less for military purposes. For this reason the utmost care and attention
should be given by commanding officers to every detail which pertains
to the health of the soldier. Improper clothing, food, shelter and exercise
are all sure to result in a loss of efficiency, but it is without question that
insufficient food, improper food, or food improperly prepared will lead to
damage or disaster more quickly than any other cause. A well-balanced
ration, therefore, is the first and foremost question to be considered if the
individual soldier's efficiency is to be maintained.
The quantity of each kind of foodstuff the soldier shall have usually
rests, when the law allows a choice, with the department commander. It
663
664
AlUiY AND NAVY KATIONS
has been the usual custom to order a ten days' ration in which there are
seven issues of beef, two of bacon, and one of pork. If the soldier can,
with the help of outside purchases, manage to subsist for ten days on the
beef allowed for seven, he saves the money value of one day's pork ration
and two of bacon, and these savings are usually turned into a company
fund from which extra food can be purchased on holidays, when there
is a convenient market, as, for instance, turkey on Thanksgiving and
Christmas and eggs at Easter. This fund is considered of the highest
importance, and new restrictions are constantly being thrown around it
to prevent the savings from the ration being diverted to other purposes.
TEN DAYS' RATION UNCOOKED FOOD FOR AN AVERAGE DAILY OF 440.4 MEN (WOOD-
RUFF(l)
Gross
Weight
Waste
Net
Weight
Weights in Pounds
Fats
Carbo-
hydrates
Salts
Calories
Water
Protein
273 %
428M
343^
731
4,379
5,025
5,116
700
44
85
10
183
39
58
165
107J^
26
63
332
5V/ 2
31
31
10H
35
250
32
20
5
4K
14
3
3%
270
428H
312%
731
4,252}^
3,894
2,730
550
44
85
10
183
39
58
165
107^
26
63
332
52 Ji
31
31
10
15
200
28
20
5
4^
10
3
54.00
54.05
37.85
21.93
531.56
2,196.70
2,943.00
481.80
3.34
12.75
8.32
46.85
0.78
6.09
70.60
12.90
3.22
51.22
318.72
6.88
25.61
7.75
3.50
10.00
182.00
11.63
13.50
21.60
99.10
2.82
187.65
8.57
259.00
6.75
13.29
13.14
3.66
21.26
35.95
37.30
3.30
0.88
1.19
0.03
2.57
0.08
1.74
3.80
4.30
0.14
0.38
1.00
0.42
0.31
0.93
0.50
0.25
2.20
0.76
0.12
0.15
0.12
0.08
0.12
831,600
691,228
1,097,753
1,312,081
6,991,110
5,409,392
1,398,750
123,750
81,400
139,825
3,150
259,494
70,980
209,670
168,795
383,775
42,380
21,735
26,560
73,815
12,552
49,442
16,000
3,500
31,000
54,880
9,200
9,000
7,043
6,153
7,950
253.80
Pork . ...
31
126^
1,131
1,386
150
467.78
682.97
78.33
7.70
6.65
7.82
0.02
1.65
46.78
978.38
3.73
1.65
3.13
3.23
0.04
3.30
3,185.12
Bpef
667.67
55.55
30.01
60.01
1.59
130.85
38.14
0.29
90.60
Onions
Cornmeal
Tapioca (26) and
cornstarch (13) . . .
Butter
0.58
49.30
Lard
0.65
1.92
1.77
2.66
4.73
1.58
5.27
3.30
0.75
4.20
4.68
0.40
0.65
1.20
0.05
0.60
89.66
0.14
0.70
1.33
0.15
1.50
3.41
2.20
Rice
20.65
8.32
8.30
40.32
2.00
13.64
0.50
4.00
11.00
Tomatoes, canned. . .
Macaroni (51) and
vermicelli (1)^). . .
Milk, fresh
Milk, condensed ....
H
20
50
4
Cabbage and sauer-
0.60
11.00
6.00
3.80
2.54
3.50
0.30
Barley
0.14
0.08
Peas
0.55
6.45
0.48
4
1.50
Totals
18,598
2.908M
1 5,689 %
7,120.50
1,413.21
1,657.17
5,34366
154.82
19,446,960
Daily average per
4.22
Pounds
66,1552
3.56,84^
733
145
171
Grams
550
16
4,416
Counting flour as
bread, amount eat-
en is 4 Ib. per man.
Per cent of amount
eaten
45
9
11
34
1
Including Table V
(salts only) gms. . .
Including estimated
amounts in Tables
VI and VII
5
H
4K (28
733
Ib.) water
free
IT. S. ARMY RATIONS
665
PERCENTAGE OF WASTE
Bacon
1.40
8.00
3.30
22.50
27.09
21.04
33.00
45.00
12.00
Only 9 pounds were reported, but this was in-
creased in 31 pounds, to include bones, etc.
Crusts and small unavoidable wastes
19% bone, 2% fat, and other wastes
Parings and defective ones
Parings and defective ones
Stones and other wastes
Estimated
Pork
Bread
Beef
Potatoes
Onions
Prunes
Cabbage
Hani
ADDITIONAL ARTICLES CONSUMED
Daily per
man
Allowance
Remarks
338 Ibs. green coffee . . .
8 Ibs. tea
1.23 ounces
0.03 ounce
1.60 ounces
0.32 ounce
20 gallons vinegar. . . .
10 Ibs. pepper
0.14 gill
0.036 ounce
0.32 gill
0.04 ounce
{Allowance is large to allow of a
saving to be used in making
sauerkraut and pickles in the
fall
1 1 bottled flavoring ex-
tracts
3 Ibs. mustard
24 Ibs. baking powder.
6 Ibs. currants
5 gallons pickles
4 kegs pickled pigs'
feet
{Though containing much energy,
it is omitted because composi-
tion is unknown, and the actual
amount per man is very small
CONSUMPTION AND ALLOWANCE PER MAN
Daily per
man
Allowance
Remarks
4 379 Ibs. flour
15.91 ounces
18 ounces
Includes purchases
4.946^ Ibs. bread
17.97
18
343% " pork. . . .
1.34 "
1.2 "
273% " bacon
1.00 ounce
2.4 "
5,025 Ibs. beef
5,116 " potatoes. . . .
700 " onions
18.30 ounces
18.50 "
2.50 "
18.0 "
12.8 "
3.2 "
80 per cent of vegetables
20 per cent vegetables
428J/2 Ibs. beans
1.50 "
24 "
763 Ibs. sugar
2.70 "
2.4 "
64 " butter
2.00 "
137 " lard
0.50
15 gallons sirup. . . .
0.40 gill
666
A ration(2) is the allowance for the subsistence of one person for one
day and varies in components according to the station of the troops or the
nature of the duty performed. The garrison ration is for troops in gar-
rison or in permanent camps ; the field ration is for troops in the field with
sufficient transportation; the haversack ration for troops in the field in
active campaign, when transportation is limited; the travel ration for
troops traveling otherwise than by marching and separated from cooking
facilities; the Filipino ration for use of the Philippine Scouts, and the
emergency ration for troops in active campaign for use on occasions of
emergency. The commanding officer will determine which of the several
prescribed rations is appropriate for the particular service to be per-
formed, and will direct the use of the same, Army Regulations, 1913, p.
1202.
*
When it becomes necessary to supplement the haversack ration in the
exigencies of forced service, by local purchase or by shipments, the com-
manding general may direct in written orders the issue in kind, to sup-
plement the haversack ration, of such available articles of food as are
actually necessary, not in excess of the amounts allowed of corresponding
articles in the garrison ration.
The tables on pages 667-668 are taken from the United States Army
Regulations, p. 1202(3), which read: "The kinds and quantities of the
component articles of the ration and the substitutive equivalent articles
which may be used in place of such components shall be as follows" :
Colonel Harvard, Medical Corps, U. S. A., in his splendid work on
Military Hygiene (4), describes the various rations for the soldier, from
which, with his permission, several sections are quoted herewith:
"The garrison ration, as may be seen, admits of many combinations
which insure variety. It is comprehensive and elastic, and can be ad-
justed to any climate. By selecting the most nutritive articles, such as
bacon, hard bread or cornmeal, beans, potatoes, dried fruit, butter and
sirup, we can obtain from it a maximum fuel value of 5,378 calories,
according to Laiigworthy, or 5,674 calories, according to Wiley. On the
other hand, by using such articles as dried fish, soft bread, rice, potatoes,
canned tomatoes and dried fruit, the fuel value can be reduced to 2,500
calories. The average garrison ration, habitually consisting of fresh beef,
soft bread, beans, potatoes and onions, dried fruit, butter, sirup and
sugar (or their nutritive equivalents), weighs 65 ounces and contains 99
grams of fat, 481 of carbohydrates and 157 of proteins, with total fuel
value of 3,536 calories(4).
U. S. AEMY RATIONS
GARRISON RATION 1
667
COMPONENT ARTICLES AND
QUANTITIES
Beef, fresh 20
ounces
Flour.
.18
Baking powder.
Beans. .
0.08
2.4
Potatoes 3 .. ..20
SUBSTITUTIVE ARTICLES AND
QUANTITIES
Mutton, fresh 20 ounces
Bacon 2 12
Canned meat, when imprac-
ticable to furnish fresh
meat 16 "
Hash, corned beef, when im-
practicable to furnish
fresh meat 16 "
Fish, dried 14 "
Fish, pickled 18
Fish, canned 16 "
Chicken or turkey, dressed,
on national holidays when
practicable 16 "
Soft bread 18
Hard bread, to be ordered
issued only when im-
practicable to use flour or
soft bread 16 *
Corn meal 20 "
Rice 1.6 "
Hominy 1.6
Potatoes, canned 15 "
Onions, in lieu of an equal
quantity of potatoes,, but
not exceeding 20 per cent
of total issue.
Tomatoes, canned, in lieu of
an equal quantity of
potatoes, but not exceed-
ing 20 per cent of total
issue.
Other fresh vegetables (not
canned) when they can be
obtained in the vicinity or
transported in a whole-
some condition from a dis-
tance, in lieu of an equal
quantity of potatoes, but
not exceeding 30 per cent
of total issue.
Apples, dried or evaporated . 1 . 28 "
Peaches, dried or evaporated 1 . 28 "
1 Food for troops traveling on United States Army transports will he prepared from
the articles of subsistence stores which compose the ration for troops in garrison,
varied by the substitution of other articles of authorized subsistence stores, the total
cost of the food consumed not to exceed 24 cents per man per day.
2 In Alaska, 10 ounces bacon, or, when desired, 10 ounces salt pork, or 22 ounces
salt beef.
3 In Alaska the allowance of fresh vegetables will be 24 oiinces instead of 20 ounces,
or canned potatoes, 18 ounces instead of 15 ounces.
668
ARMY AND NAVY RATIONS
COMPONENT ARTICLES AND
QUANTITIES
SUBSTITUTIVE ARTICLES AND
QUANTITIES
Prunes 1 .. .1.28 ounces
Coffee, roasted and ground. 1.12 "
Sugar... 3.2
Milk, evaporated, unsweet-
ened 0.5
Vinegar 0.16 gill
Salt 0.64 ounce
Pepper, black 0.04
Cinnamon 0.014
Lard 0.64
Butter 0.5 "
Sirup 0.32 gill
Flavoring extract, lemon ... . 014 "
Jam, in lieu of an equal quan-
tity of prunes, but not ex-
ceeding 50 per cent of total
issue.
Coffee, roasted, not ground . 1 . 12 ounces
Coffee, green 1.4 "
Tea, black or green 0.32
Pickles, cucumber, in lieu of
an equal quantity of vine-
gar, but not exceeding 50
per cent of total issue.
Cloves . 014 ounce
Ginger 0.014 "
Nutmeg 0.014
Oleomargarin 0.5
Vanilla.. .0.014
At least 30 per cent of the issue to be prunes when practicable.
"Fresh meats are ordinarily issued seven days in ten, and bacon three
days.
"The garrison ration is often supplemented by articles obtained from
the post garden or purchased from the company fund, which largely con-
tribute to give it variety and appetizing value.
"In order to facilitate the supplying of troops and the keeping of ac-
counts, the former system of issue has been replaced by that of purchase.
"All articles of the garrison, travel, or Filipino ration due 1 a company
or other military organization, will be retained by the Quartermaster
Corps, and credit given to the organization for the money value of these
articles at the current price of the articles.
"The stores required by the organization will be purchased from the
Quartermaster Corps, and the latter will pay as savings to the organiza-
tion commander any excess in value of the stores retained over those
purchased. At the end of the month, or whenever necessary, the organiza-
tion commander will settle the account with the Quartermaster Corps,
when the savings to the organization, or the amount due to the Quarter-
U. S. AKMY KATICLXS 669
master Corps, as the case may be, will be paid, aiid the account certified
as required.
"The price of bread, as charged against organizations, is determined
by adding together the cost of flour and other ingredients used, the extra-
duty pay of the bakery personnel, the cost of the power used in operating
the baking machinery, and then dividing by the total number of pounds
of bread baked. It follows that the organizations are thus given the bene-
fit of whatever savings accrue from the conversion of flour into bread after
deduction of all expenses.
"Money accruing from the 'ration and savings account' of an organi-
zation will be spent only for food.
"All articles of the ration required for the supply of troops will be
obtained from the Quartermaster Corps when 011 hand, but should any
organization want more of any article than is allowed by regulation, the
excess may be purchased elsewhere ; or if any article is not in stock, it can
likewise be bought elsewhere.
"When necessary to renew reserve rations, or to avoid loss of ration
articles that have accumulated, the commanding general or commanding
officer, as the case may be, may order the issue of such supplies to troops,
not to exceed the ration allowance and only for such time as the interest
of the Government requires.
"The value of the garrison ration is estimated at twenty-five cents ; the
Filipino ration at twenty cents, and the travel ration at forty cents.
"Under circumstances when enlisted men or nurses cannot be furnished
with rations in kind, or it is impracticable to carry them, commutation
may be allowed at rates ranging from twenty-five cents to $1.50 a day.
"The ration of enlisted men sick in hospital, and of female nurses
while on duty in hospital, is commuted at the rate of thirty cents per
ration, except that at the general hospital at Fort Bayard, N. M., fifty
cents per ration is authorized for enlisted patients therein.
"Other issues of stores, not components of rations, may be authorized
when necessary for the public service and made on ration returns ap-
proved by the commanding officer, such as soap, candles, matches, toilet
paper, towels and ice.
"Ice is issued by the Quartermaster Corps to organizations of enlisted
men as follows : for each ration, four pounds, the maximum allowance to
any organization or detachment of less than 100 men to be 100 pounds
a day, and to organizations of 100 men or more to be one pound a day,
per man. The full allowance may be issued for the entire year to troops
670
ARMY AND NAVY RATIONS
stationed south of the 37th parallel. To troops stationed north of the
37th parallel, and where from any cause it is impracticable to cut and
store ice for their use, the allowance will be only for the summer months,
from April 1 to October 31. A special allowance is provided for States
on the Pacific Coast(4)."
FIELD RATION
COMPONENT ARTICLES AND
QUANTITIES
Beef, fresh, when procura-
ble locaUy 20
Flour ' 18
Baking powder, when ovens
are not available .
Yeast, dried or compressed,
when ovens are available . .
Beans.. . 2.
ounces
64
04
4
Potatoes, when procurable
locally 16
Jam 1
Coffee, roasted or ground ... 1
Sugar 3
Milk, evaporated, unsweet-
ened . . .0
4
12
2
.5
Vinegar . 16 gill
Salt 0.64 ounce
Pepper, black 0.04
SUBSTITUTE ARTICLES AND
QUANTITIES
Mutton, fresh, when pro-
curable locally 20 ounces
Canned meat 16 "
Bacon 12
Hash, corned beef 16 "
Soft bread 18 "
Hard bread. . . . 16 "
Rice 1.6
Potatoes, canned 12
Onions, when procurable
locally, in lieu of an equal
quantity of potatoes, but
not exceeding 20 per
cent of total issue.
Tomatoes, canned, in lieu of
an equal quantity of pota-
toes, but not exceeding 20
per cent of total issue.
Tea, black or green . 32
Pickles, cucumber, in lieu of
an equal quantity of vine-
gar, but not exceeding 50
per cent of total issue.
The field ration is the ration prescribed in orders by the commander
of the field forces. It consists of the reserve ration in whole or in part,
supplemented by articles of food requisitioned or purchased locally, or
shipped from the rear, provided such supplements or substitutes corre-
U. S. ARMY RATIONS
671
spond generally with the component articles or substitutive equivalents
of the garrison ration (Army Regulations, 1913, par. 1205).
HAVERSACK RATION
Bacon 12 ounces
Hard bread 16
Coffee, roasted and ground. 1.12 "
Sugar 2.4
Salt 0.16
Pepper, black 0.02 "
i We would recommend the use of malted milk tablets as an addition to the haver-
sack field and travel ration of the soldier. We have personally used these and feel
assured that they would be a valuable addition from the viewpoint of compactness,
solubility and the nutrient energy contained.
"The haversack ration is issued to troops in the field when beyond the
advance supply depots. It contains about 218 grams of fats, 489 of carbo-
hydrates and 113 of proteins, with total fuel value of 4,448 calories.
Should it be found practicable to supplement it by local purchase or other-
wise, the commanding general may direct the issue in kind of such addi-
tional articles of food as are available, at whatever cost, but not in excess
of the amounts allowed of corresponding articles in the garrison ration.
"The bacon is contained in a rectangular tin can with capacity for two
rations. The sugar, coffee and salt are contained in another rectangular
tin can, two and one-half inches square, five inches long, and with rounded
corners ; a cross partition divides it in two compartments, for three days'
rations of coffee and sugar ; the ends are closed with screw covers. The
screw cover on the sugar compartment has a round receptacle two inches
in diameter, one-half inch deep, closed with a compression friction top,
for carrying three days' rations of salt.
"In the field, bacon, in the absence of fresh meat, becomes an invalu-
able component of the ration, easily kept and transported, readily digested
when well cooked, and furnishing abundant energy for severe muscular
work. A quarter ounce of soap per ration is also issued (in ounce cakes).
"Existing orders prescribe that one day in each alternate month of the
season of practical instruction, not exceeding three days in each year, the
use of the haversack ration, with individual mess-kit., will be required of
all troops in the field for purposes of instruction (4)."
672
ARMY AND NAVY RATIONS
TRAVEL RATION
COMPONENT ARTICLES
QUANTITIES
AND
SUBSTITUTIVE ARTICLES AND
QUANTITIES
Soft bread 18
ounces
Hard bread 16 ounces
Beef corned . . . 12
Hash, corned beef 12 "
Beans, baked 4
u
Tomatoes, canned 8
u
Jam 1.4
u
Coffee, roasted and ground . 1.1
Sugar . . ..2.4
2
u
Milk, evaporated, unsweet-
ened 0.5
u
The fuel value of this ration is about 2,735 calories.
FILIPINO RATION
COMPONENT ARTICLES AND
QUANTITIES
SUBSTITUTIVE ARTICLES AND
QUANTITIES
Beef, fresh 12
ounces
Flour 8
Baking powder, when in
field and ovens are not
available.
Rice 20
Potatoes 8
Coffee, roasted and ground . . 1 "
Sugar 2
Vinegar 0.08 gill
Salt 0.64 ounce
Pepper, black 0.02 "
Bacon 16 ounces
Canned meat 8 "
Fish, canned 12 "
Fish, fresh 12
Hard bread. . . 8
Onions . . .8
"The components of the ration yield a maximum fuel value of 3,980
calories. As is well known, Filipinos, like other Oriental races, manifest
a marked preference for rice, to the exclusion of more nutritious food,
thereby rendering themselves liable to beriberi. To guard the scouts
against such possibilities, it is prescribed that only unpolished rice be
issued to them and that no more than sixteen ounces per day be used.
They are also required to use the entire meat allowance. For the portion
of the rice ration not drawn, 1.6 ounces of beans are substitued, while
native products, such as camotes, mangoes and squash, are utilized to as
large an extent as possible (4)."
Savings. All articles of the garrison and travel ration due a company
or other organization, will be retained by the quartermaster and credit
U. 8. AILMY KATiCLXS 673
given to the organization for the money value of these articles at the cur-
rent price of the articles ; and the quartermaster will pay as savings to the
organization commanders any excess in value of the stores so retained
over those purchased by the organization. Such savings shall be used
solely for the purpose of articles of food.
In time of peace the ration savings privilege, with the exception here-
inafter noted, will be suspended for troops on the march. The ration to
be issued to troops on the march in time of peace will be prescribed by
the commander and will not exceed the allowances prescribed for the gar-
rison ration. When so ordered by such commander, the savings privilege
on certain' specified articles of the ration will be allowed (5).
EMERGENCY RATION
An emergency ration, prepared under the direction of the War De-
partment, will be issued, in addition to the regular ration, as required for
troops on active campaign or in the field for purposes of instruction, and
will not be opened except by order of an officer or in extremity. Company
and detachment commanders are responsible for the proper care and use
of emergency rations carried on the person of the soldier.
"The emergency ration used in our service, prior to 1910, weighed
twelve ounces net and consisted of wheat, meat, chocolate and seasoning.
Its preparation was so elaborate as to require special plants, so that, in
case of mobilization on a large scale, the supply would have boon inade-
quate. The components of the present ration are such as to 'be readily
obtained and prepared to any extent needed (4). They are as follows:
Chocolate liquor 45 . 45 per cent
Nucleo-casein 7 25
Malted milk 7.25
Egg albumin 14 . 55 "
Powdered cane sugar 21 . S2
Cocoa butter 3.64
The chemical analysis shows:
Protein 25 . 24 per cent
Amino-bodies
Fat 28.05
Carbohydrates 39.11 "
Caffein and theobromin 17 " "
Ash . 3.27
"Each ration w r eighs eight ounces not and is put. up in three cakes of
equal size, each cake wrapped in tinfoil, and all throe inclosed in a her-
674 ARMY AND NAVY RATIONS
metically sealed and lacquered round-cornered tin, with key-opening at-
tachment. Its fuel value is 1,272 calories, and its cost forty cents.
"From previous experiments it is believed that this ration can be kept
in store, even in the tropics, for several years without loss or deteriora-
tion. As a compact and portable food preparation, intended to tide over
a day or two until regular supplies are available, it is undoubtedly well
adapted to its purpose. However, there is serious doubt of its necessity,
and the Infantry Equipment Board of 1912 recommended that it be abol-
ished and replaced by the haversack ration, a recommendation that has
not yet been approved (4)."
SELECTION OF RATIONS
Concerning the selection of a ration, Woodruff says :
An army must be fed at a great distance from the market, and it is, there-
fore, evident that the chief objects in view in the selection of the soldier's food
must be facility of transportation and ease of preservation in all climates. Arti-
cles -that are bulky or easily damaged by rough handling, and those that are not
easily preserved from decay, are at once ruled out. It need scarcely be men-
tioned that the articles must be produced in abundance throughout the country,
neither imported nor the particular preparations of a few manufacturers. Couple
with this the fact that the articles must be so inexpensive as to refute any charges
of extravagance, and it will be readily understood that with a few exceptions
the ration contains about all the articles that it is possible to put in at present
without calling on foods that are preserved, canned, or otherwise specially pre-
pared.
Concentrated Foods. The one great objection to prepared foods is the
ease with which adulterations and other frauds can be perpetrated. Qual-
ity of foods can be easily determined if seen in the natural state, but let
them be ground up and mixed with other things, and fraud will be diffi-
cult to detect. It is a fact that contractors for army food, knowing that
the lives of the soldiers and the safety of the nation may depend on the
character of the army supplies, will yet jeopardize the lives of thousands
of men by fraudulently supplying inferior articles. The military history
of the United States furnishes a host of illustrations. Operations and
even campaigns have been hampered or made disastrous by faulty food.
Another objection to concentrated foods as a sole and continuous diet
is the fact that they do not furnish sufficient bulk. They may contain
the proper amounts of energy and alimentation, yet they can never be
TJ. S. ARMY RATIONS 675
used exclusively. They are not intended to be so used except in emergen-
cies and for short periods.
Company Dietaries. We give below a week's bill of fare furnished
by two different company commanders. The first is very liberal, and the
latter far below the normal standard. In contrast, they exemplify in the
most fortunate way some of the remarks previously made as to the con-
ditions of service varying the bill of fare:
COMPANY DIETARY AT A WESTERN FORT
MONDAY
Breakfast: Beef stew; fried potatoes; corn bread; sirup; bread; butter; coffee.
Dinner: Meat pie; mashed potatoes; turnips; cabbage; pickled pork; bread;
coffee.
Supper: Beefsteak with onions; squash pie; bread and coffee.
TUESDAY
Breakfast: Roast beef; fried potatoes; bread; butter; coffee.
Dinner: Pea soup; roast beef; baked potatoes; stewed onions; cauliflower;
tapioca pudding; bread and coffee.
Supper: Meat stew; fried carrots; apple pie; bread; coffee.
WEDNESDAY
Breakfast: Oatmeal; milk; meat hash; bread; coffee.
Dinner: Sauerkraut; pickled pork; mashed potatoes; pickled beets; rice pud-
ding; bread and coffee.
Supper: Fried sausage meat; fried potatoes; green corn; blancmange pudding;
bread and coffee.
THURSDAY
Breakfast: Beefsteak with onions; fried potatoes; bread; coffee.
Dinner: Roast beef; mashed potatoes; stewed onions; pickled beets; plum
pudding; bread and coffee.
Supper: Fried liver and bacon; fried carrots; squash pie; bread; coffee.
FRIDAY
Breakfast: Beefsteak; fried potatoes; bread; butter; coffee.
Dinner: Pork and beans; peach pie; bread; coffee.
Supper: Cold beef; corn bread; sirup; apple sauce; bread; coffee.
SATURDAY
Breakfast: Meat hash; oatmeal; milk; bread; butter; coffee.
Dinner: Vegetable soup; mashed potatoes; roast beef; pickles; tapioca pud-
ding; bread; coffee.
Supper: Beef stew; green-apple pie; bread; butter; coffee.
SUNDAY
Breakfast: Roast beef; baked potatoes; hot rolls; sirup; bread; butter; coffee.
Dinner: Sauerkraut; pickled pork; mashed potatoes; roast beef; bread; coffee.
Supper: Meat pie; rice pudding; bread; butter; coffee.
(Gravy always served with meats, and sauce with puddings.)
676 ARMY AND NAVY RATIONS
COMPANY DIETARY AT A SOUTHERN POST
MONDAY
Breakfast: Beef hash (with onions and potatoes); bread; coffee.
Dinner: Rice and tomato soup; roast beef; roasted potatoes; bread.
Supper: Beef (same as dinner); bread; coffee.
TUESDAY
Breakfast: Irish stew; bread; coffee.
Dinner: Pea soup (with toasted bread); roast beef; boiled potatoes; bread.
Supper: Beef; pancakes; sirup; bread; coffee.
WEDNESDAY
Breakfast: Meat hash (with potatoes and onions); bread and coffee.
Dinner: Roast beef; mashed potatoes; plum pudding; bread and coffee.
Supper: Fried liver and bacon; bread and coffee.
THURSDAY
Breakfast: Beef hash; bread and coffee.
Dinner: Baked fresh pork; baked beans; bread and coffee.
Supper: Beefsteak; fried potatoes; bread and coffee.
FRIDAY
Breakfast: Irish stew; bread and coffee.
Dinner: Rice and tomato soup; roast beef; boiled potatoes; bread.
Supper: Beef; fried potatoes; bread and coffee.
SATURDAY
Breakfast: Beef hash; bread and coffee.
Dinner: Rice and tomato soup; roast beef; boiled potatoes; spiced bread dress-
ing; bread.
Supper: Meat pot-pie; bread and coffee.
SUNDAY
Breakfast: Fri3d porlq fried potatoes; bread and coffee.
Dinner: Pea soup, with toasted bread; roast beef; boiled potatoes; bread.
Supper: Beef; fried potatoes; bread; coffee.
(Gravy always served with meats, and sauce with puddings.)
Tropical Dietaries. There has been but little change in the army
ration during recent years, except when controlled by climatic conditions ;
the army in a cold climate cannot thrive on the same diet that an army
in the tropics would do well on, and vice versa. In a cold climate articles
of the dietary, subjected to extreme temperatures, will be spoiled by
freezing and must be eliminated from the ration. This will exclude
potatoes, fresh vegetables, and canned goods that are in liquid form. On
the other hand, in the tropics food that excessive heat would spoil or that
cannot be safely preserved must be avoided. The ration under such cir-
cumstances will have to be so arranged that it may be readily suitable for
climatic changes.
It is well known that our army in the Philippines lived on less food
than they would require in a cold or temperate climate. This difference
is marked, more especially, in the consumption of meat and fatty foods.
Of course, if an army is undergoing active service on prolonged marches,
U. S. ARMY RATIONS 677
the meat allowance will have to be correspondingly increased to make up
for the wear and tear of the muscular system. In the Surgeon-General's
Report of the United States Army for 1900, Major Kean is quoted.
He premises that a tropical dietary, as compared with one suited to
a colder climate, should have less fat and more carbohydrates, less stim-
ulating proteins in the form of meat, a greater variety of diet both of
meats and carbohydrates in the form of fresh vegetables and fruits, and,
lastly, a fairly liberal supply of ice. His argument for the substitution
of carbohydrates for fats is that the digestion is weakened in hot climates
and the liver is inclined to torpidity, while ingested fats are prone to
split up into butyric, caproic, and other irritating acids, which the dimin-
ished secretion of the liver is unable to neutralize. As intestinal digestion
cannot proceed in the presence of acidity, the condition known as bilious-
ness is established, with putrefaction of the intestinal contents and the
production of various harmful alkaloid substances. A catarrhal in-
flammation of the bowel results, with diarrhea, which is at first of
advantage in eliminating the harmful substances, but which under the
continued irritation of unsuitable diet is liable to continue and become
aggravated. As to a lessened use of meat, he cites the dietary customs
of the inhabitants of hot climates, who get their proteins less from meat
than from the leguminosa?. The appetite is lessened by long and contin-
ued heat and becomes capricious. It craves variety, especially in vege-
tables and fruits, and these he claims cannot be had on the basis of our
present ration. The need of ice to furnish a cool drinking water and to
preserve the perishable constituents of the ration is regarded as obvious.
In a previous chapter (Volume II, Chapter XII) we have discussed
the subject of diet in tropical countries and to this the reader is referred.
From what has been advanced in this section, it will be seen that the pro-
portionate composition and fuel value of the proposed standard dietary
for troops serving in the tropics should be about as follows:
Protein 100 grams
Fats 65 "
Carbohydrates . . 650 "
Fuel value 3,491 calories
This would give a nitrogen content of 16 grams and a nutrient ratio of
protein energy, 1.8. The proximate alimentary principles whose quan-
tities and relative proportions are represented in the above nutrient stand-
ard for the tropics can be properly apportioned in the ideal ration for hot
climates, only as a result of an accurate knowledge of the percentage com-
143
678
ARMY AND NAVY RATIONS
position of such articles of food as may be selected to enter into its
composition.
According to Munson(6), the determination of these foodstuffs for the
American soldier is an easy task. The present United States army
ration is made up of admirably selected articles, in more than sufficient
variety. It is, therefore, not only wholly unnecessary, but quite inadvis-
able, to consider in this connection any nutritive substances outside those
articles legally established as components of food for the United States
soldier.
Munson suggests the following tables for tropical dietaries. These
tables show the nutrient value of a proposed dietary for the tropics con-
taining the greatest amount of food material which can be drawn by the
soldier :
TABLE I
TROPICAL DIETARY
Articles
Quantity :
Ounces
Fats:
Grams
Carbo-
hydrates:
Grams
Protein:
Grams
Nitrogen :
Grams
Fuel
Value:
Calories
Fresh beef
10
44.75
41.68
6.67
590
Flour
18
5.60
380.46
55.08
7.90
1,850
Beans
2.4
1.22
40.18
15.16
2.42
240
Potatoes
16
.45
81.70
9.50
1.52
380
Dried fruit
3
1.53
33.80
1.77
.27
220
Sugar . . .
3.5
94.25
397
Total
52.9
53.55
630.39
123.19
18.78
3,677
Total carbon, 395.14 grams; nitrogen to carbon, 1:19.6.
The following table shows a dietary proposed by Munson, especially
applicable to tropical field service, in which the fatty constituents attain
their maximum and the potential energy is high:
TABLE II
TROPICAL DIETARY
Articles
Quantity:
Ounces
Fats:
Grams
Carbo-
hydrates:
Grams
Protein:
Grams
Nitrogen :
Grams
Fuel
Value:
Calories
Bacon
6
105.06
15.64
349
1,042
Hard bread
18
6.63
371.81
73.12
11.74
1,926
Beans
2.4
1.22
40.18
15.16
2.42
240
Dried fruit
3
1.53
50.70
1.77
.27
220
Sugar
3.5
94.25
397
Total
32.9
114.44
556.94
105.69
16.92
3,825
Total carbon, 328.76 grams; nitrogen to carbon, 1:23.
U. S. AKMY RATIONS
679
The following is an outline of the ordinary dietary, which Munson
proposes for garrison duty in the tropics :
TABLE III
TROPICAL DIETARY
Articles
Quantity :
Ounces
Fats:
Grams
Carbo-
hydrates :
Grams
Protein:
Grams
Nitrogen:
Grams
Fuel
Value:
Calories
Fresh beef
10
4475
41 68
667
590
Soft bread
20
6.80
29920
5383
861
1 506
Potatoes and onions .
Dried fruit
16
3
.72
1.53
73.09
5070
8.60
1 77
1.40
27
340
220
Sugar
3.5
94.25
397
Total
52.5
53.80
517.24
105.88
16.95
3053
Total carbon, 328.76 grams; nitrogen to carbon, 1.18.
In the following dietary -have been selected the components most
closely approximating the character of the foods usually consumed by the
natives of tropical countries, proportioned in the ternary food elements
common to hot climates:
TABLE IV
TROPICAL DIETARY
Articles
Quantity :
Ounces
Fats:
Grams
Carbo-
hydrates:
Grams
Protein:
Grams
Nitrogen :
Grams
Fuel
Value:
Calories
Fresh fish (cod) whole
14
.79
31.73
5.07
120
Soft bread
20
6.80
299.20
53.83
8.61
1,506
Rice
4
.45
88.87
8.75
1.40
407
Potatoes and toma-
toes
16
.54
65.80
8.17
1.36
297
Dried fruit
3
1.53
50.70
1.77
.27
220
Sugar
3.5
94.25
341
Total
64.5
10.11
598.82
104.25
16.71
2.947
Total carbon, 327.50 grams; nitrogen to carbon, 1:19.6.
The average of the four dietaries in the mean nutrient composition
is outlined below, showing the composition and proportion of the ternary
food elements, the nitrogen content and fuel value:
680
ARMY AND NAVY RATIONS
AVERAGE NUTRIENT COMPOSITION
Dietary
Quantity :
Ounces
Fats:
Grams
Carbo-
hydrates :
Grams
Protein:
Grams
Nitrogen:
Grams
Fuel
Value:
Calories
No. I. .
52.9
53.55
630.39
123.19
18.78
3,677
No. II
32.9
114.44
556.94
105.69
16.92
3,825
No. Ill
52.5
53.80
517.24
105.88
16.95
3,053
No. IV
64.5
10.11
598.82
104.25
16.71
2,947
Average . .
50.7
37.97
560.85
109.06
17.34
3,375
Total carbon, 350 grams; nitrogen to carbon, 1:20.
It will be observed, from a careful study of Munson's tropical dieta-
ries, that while they dift'er considerably, yet on the average they do not
vary greatly from the nutritive standard of ordinary tropical dietaries,
which is an additional reason for varying the articles of the ration from
day to day. Even this average dietary, as compared with nutrient stand-
ards, is still slightly deficient in fats and fuel value and a trifle low in
protein. These defects, if they are so considered, may be corrected by
rotating their order, so that Dietary II is used twice where Dietaries I,
III and IV are each employed but once. The results of this change are
as follows:
Dietary
Quantity:
Ounces
Fats:
Grams
Carbo-
hydrates :
Grams
Protein:
Grams
Nitrogen :
Grams
Fuel
Value:
Calories
No. I. .
52.9
53.55
630.39
123.19
18.78
3,677
No. II..
32.9
114.44
556.94
105.69
1692
3825
No. Ill
52.5
53.80
517.24
105.88
1695
3 053
No. IV
64.5
10.11
598.92
104.25
16.71
2,947
Average
47.1
69.43
572.06
108.38
1726
3465
Total carbon, 363.33 grams; nitrogen to carbon, 1:21.
From a study of the above tables, it is apparent that certain changes
are advisable in the adaptation of the United States army ration to trop-
ical conditions. The change could be admirably made by reducing the
allowance of potatoes, fats and bread, and substituting succulent vege-
tables and fruits. The sugars and starches might be slightly augmented,
but their increase is small when compared with the considerable reduc-
U. S. ARMY RATIONS
681
tion of nitrogenous and fatty material which is proposed. Many of the
components of the present ration, as is seen by the following table, require
no change in the consideration of the tropical dietary, being not only
admirably selected but also properly proportioned.
It is true that the needs of the economy, as shown by appetite, are
subject to wide variation. Hence it may be accepted that slight, but care-
fully considered changes in the constituents of the daily dietary, far from
being detrimental, are productive of actual benefit. It is also obvious
that the soldier will require less nutriment in garrison than is necessary
to furnish the energy for the greater labors of campaign, and hence the
several components of the ration should be proportioned to furnish dieta-
ries properly varying in potential and nitrogenous value. This is accom-
plished in the foregoing modifications of the dietaries shown in tables
I to IV:
COMPONENT PARTS UNITED STATES ARMY RATION
Articles
Quan-
tity per
Ration :
Ounces
Pro-
tein:
Grams
Nitro-
gen:
Grams
Fats:
Grams
Carbo-
hydrates:
Grams
Fuel
Value:
Calories
Fresh Beef (quarters)
10
41.68
6.67
44.75
590
Or Fresh Mutton
10
46.20
7.35
62.90
720
Pork
6
27.54
4.40
112.54
1 093
" Bacon
6
15.64
2.49
105.06
1 042
" Salt Beef
10
40.27
6.44
64.68
688
" Dried Fish (cod)
10
45.37
7.26
1.13
197
" Fresh Fish, average (whole) .
14
31.73
5.07
.79
120
Flour
18
55.08
7.90
5.60
380.46
1,850
Or Soft Bread
20
53.83
8.61
6.80
299.20
1,506
" Hard Bread
18
73.12
11.74
6.63
371.81
1,926
" Corn Meal
20
50.40
7.99
12.40
425.80
1,986
Beans
2.4
15.16
2.42
1.22
40.18
240
Or Peas
2.4
16.38
2.62
.75
41.80
246
" Rice
4
8.75
1.40
.45
88.87
407
" Hominy
4
9.20
1.47
.67
88.75
430
Potatoes. . . .
16
9.50
1.52
.45
81.70
380
Or Potatoes 80 per cent and
Onions 20 per cent . . .
16
8.60
1.40
.72
7309
340
" Potatoes 70 per cent and
Canned Tomatoes 30 per
cent
16
8.16
1.30
.58
62.59
297
Dried Fruit (average)
3
1.77
.27
1.53
33.80
220
Sugar
3.5
94.25
397
Or Molasses
1 gill
56.05
269
" Cane Sirup
1 u
56.25
269
Army Rations Past and Present In the past, when army rations were
planned, it was with a view of keeping the soldier on the smallest amount
682 ARMY AND NAVY RATIONS
of food with the least expenditure of money. In fact, military author-
ities of the last century believed that to keep a soldier up to a proper
discipline he should be clothed roughly, given the simplest kind of over-
crowded barracks, and fed like a hog, every modern improvement being
considered enervating. Could any of these dead officers see the dining
rooms of some of our modern barracks, they would surely think that the
service was going to the dogs. It has been elsewhere remarked that when
hardships slowly reduce vitality, the man is made less able to exist under
more privation in the field. When there are no luxuries and everything
has to be plain in order to be durable and serviceable, it is utter nonsense
to talk of the enervating effects of luxuries. The present policy of improv-
ing the soldier's table service certainly improves the ration on principles
known to every physiologist.
The smallest amount of food that will keep a man alive has been
approximately known for centuries, and though modern experiments make
FIG. 12. COMPONENT PARTS OF A DAY'S RATION OF THE UNITED STATES SOLDIER, WHICH
REPRESENTS A FOOD OR FUEL VALUE OF 4,199 CALORIES. (Courtesy of the Ameri-
can Museum of Natural History, N. Y.)
our knowledge vastly more detailed, accurate and scientific, they have
added little to the knowledge that a man can subsist on one pound of
bread and 1^ pounds of meat daily for quite a long period. When we
come to discuss the amount and kind of food necessary to keep him in
health, we are on debatable ground. We all know men whose usual daily
food is even more simple than the army ration, but we know, also, that
there are times, as during occasional visits from home, when they eat
other things that perhaps restore the balance. Patients have often been
restored to health by a change of diet made necessary by a recommended
change of scene. The soldier's diet should be such as will maintain him
in the best physical condition regardless of the varied circumstances under
which he may be compelled to live. There never was economy in under-
feeding soldiers. In all the wars of the past, the number of sick and
U. S. ARMY RATIONS 683
those dead from disease due to improper food has been larger than the
mortality due to the enemy's bullets. Underfeeding or improper feeding
undoubtedly leads to excessive use of liquor and consequent dissipation,
which is disastrous to the health and efficiency of the troops. My observa-
tion 1 is that many soldiers of the Civil War formed habits of dissipation
from which they suffered until death. These bad habits, I am quite sure,
result only from poor food.
The enormous number of cases of rheumatism in veterans occurring
during and after the late war may not be due entirely to exposures from
army life, as popularly supposed. These men were hardened to exposure,
and should never have had more rheumatism than hunters, trappers and
the aboriginal Indians. The limited and insufficient ration, and the
absence of fresh articles of food, were, no doubt, etiological factors of
importance. Indeed, new facts are continually being brought forward,
showing new relations between disease and the habitual diet of a patient.
Diet in its relation to diseased states is now an all important item of
therapeutics. It is seriously questioned whether the bare, unadorned and
unvaried ration, as issued, will tend towards the maintenance of perfect
health and the greatest efficiency in the soldier.
During our Civil War the ration was largely increased, and among
other components thirty pounds of fresh potatoes were added to every 100
rations "where practicable" to issue same. The reports of general officers
during the war indicated that with this increased ration the men were
overfed, and the law authorizing the issue of potatoes was repealed in 1864,
and the ration reduced practically to what it was at the commencement of
the war. In 1890, one pound of "fresh vegetables" was added to the
ration by law. The experience of the Spanish War indicated that the
regulation ration, made up of many substitutive equivalents, was not suit-
able for the field, and in 1901 it was changed, a special ration being
prescribed for the field. Unquestionably this special ration is in excess
of requirements, and it is doubtful if sufficient transportation can be pro-
vided to carry it in a modern war.
The quantity of stores required for one day's subsistence of 150,000
men in the field is: hard bread, 150,000 Ibs. ; bacon, 78,750 Ibs. ; canned
beef, 45,000 Ibs. ; sugar, 30,000 Ibs. ; desiccated vegetables (potatoes and
onions), 11,250 Ibs.; roasted and ground coffee, 12,000 Ibs.; tomatnc-.
15,000 Ibs.; beans, 22,500 Ibs.; jam, 13,125 Ibs.; vinegar, 1,500 gals.;
salt, 6,000 Ibs. ; soap, 6,000 Ibs. ; candles, 2,250 Ibs. ; pepper, 375 Ibs.
G. A. Kreider.
684 ARMY AND NAVY RATIONS
The total net weight of this amounts to 405,750 Ibs., the gross weight to
520,140.23 Ibs., and it would form a pyramid 30.58 feet square at the
base and 43.75 feet high. To transport the stores would require approx-
imately 15 freight cars of 40,000 Ibs. capacity, or 214 army wagons.
Practically all the armies of the world, in the past, have been fed on
the same general principles. There is little doubt that the dryness and
sameness of the ration is a great factor in the production of the tendency
of drunkenness proverbial among soldiers and sailors.
RATIONS FOR BOYS' MILITARY TRAINING CAMPS 1
Statistics of normal food consumption in the adult are readily avail-
able, particularly so during the past few decades, in which a far reaching
interest in the problem of human nutrition has engrossed the attention of
physiologists and biological chemists.
The rapid progress which has recently been made in infant feeding
has thrown light upon the dietetic needs of the human individual in early
life. In fact, pediatric literature abounds in well established facts per-
taining to the caloric requirements of the infant ; but there is, on the con-
trary, a singular dearth of statistical information pertaining to the actual
food requirements and dietary habits of the young adolescent. In fact,
both the physiology and pathology of the adolescent period offer a fertile
field with abundant opportunity for research to extend this knowledge.
Dubois has done some splendid work in this particular field, having
shown by calorimetric experiment at the Russell Sage Institute of Pathol-
ogy, that the actual food requirements of young boys is twenty-five per
cent above that of the adult. The pubescent period in both sexes is
marked by great physical growth and development.
The alimentation, at this period, to meet the demands for wear and
tear, growth, and development, should be very rich in easily digested
proteins. There is no period in man's existence when there is greater
need for suitable, wholesome, nutritious alimentation that which will
supply the necessary energy for the daily wear and tear of the body,
together with the requisite elements for growth and development than
at this period.
The adolescent youth should have a liberal allowance of whole wheat
bread, fresh eggs, wholesome meat and fresh vegetables, and fruits of all
Published by the author in "Military Surgeon," May, 1917(14).
RATIONS FOR BOYS' MILITARY TRAINING CAMPS 685
kinds, provided he digests them well, but highly spiced food should be
restricted.
A recent investigation by Gephart(7) affords an insight into the
actual amount of nourishment taken by more than 300 boys in one of
the largest private boarding schools in the United States. The total
animal supply for such an institution, containing 355 boys, was computed
as follows, in metric tons (2,200 Ibs.) :
Protein
Fat
Carbohydrate
Food supply
20.5
25.6
605
Waste
3.8
5.4
42
Food fuel
16.7
20.2
563
The quantity of food, computed on the basis of the individual meal
served, appears as follows:
Pounds
Grams
Calories
Calories
(per cent)
Protein
0.1107
50.2
206
14 l
Fat
0.1332
60.4
562
39
Carbohydrates
0.3717
168.8
692
47
1,460
100
i Seventy per cent of this was in animal protein.
The food was of the best quality, and included 193 separate varieties.
The cost per meal was 20 cents, or 13.8 cents per thousand calories.
This is twice what the poor man in New York pays for his food. But
these growing athletic boys were not satisfied with the conventional 3,000
calories per day. The investigator of their dietary ascertained that beside
the 4,350 calories which they consumed daily at the table, they bought
650 additional calories in food at a neighboring store, the principal item
being chocolate.
From the tables in Volume II, Chapter XII, we see that a patient in
hospital requires a minimum of 1,840 calories if the diet is to maintain
the metabolic balance. If he should not be confined to bed, he will require
a minimum of 2,1C8 calories ; and these estimates do not take into account
any unusual demands made because of the increased wear and tear caused
by the disease process. A California farmer's family requires a daily
686
ARMY AND NAVY RATIONS
ration yielding 3,515 calories, while the farm laborer requires 4,100 cal-
ories; a mechanic 3,500 calories; a ploughman, 4,000; a boy on a
Connecticut college football team requires 5,740 calories ; on the Harvard
boat crew, 4,620 calories; on the Yale boat crew, 4,070, while a man
sawing wood needs 5,700 calories. The fuel to furnish the required
energy may be derived from the consumption of proteins, fats or
carbohydrates.
Lusk(8) points to the fact that 5,000 calories is the amount of
energy a real live American boy needs. A dietary furnishing only 2,800
or 3,000 calories will not sustain the growing youth,' as evidenced by the
"ravenous" appetite of boys. Lack of appreciation of this fact and fail-
ure of providing for it are the contributing causes of undernutrition in
young boys.
The facts -presented above, based on a liberal series of investigations
and observations, rather than a few sparsely scattered data, deserves the
attention of all medical men, and, in these days of military preparedness,
particularly of the army officer who has charge of rationing boys' military
training camps. The author has had some experience with boys in camp
and realizes the necessity for a well-balanced ration for these youngsters,
particularly with a liberal protein content which is easily digested and
readily assimilated.
It was the privilege of the author to be ordered to Fort Terry in
August, 1916, for service with the Boys' Military Training Camp. It
was part of his duty to inspect daily the kitchens and the cooking and
serving of food for the boys. He soon became convinced that the officers
who planned the rations, while they did remarkably well under the cir-
cumstances, were lacking in experience in rationing young and growing
boys. Herewith are produced the menus for the first week of the camp:
BOYS' MILITARY TRAINING CAMP, FORT TERRY, NEW YORK
DIETARY FOR WEEK
Serving
Grams
Calories
Total
Calories
Breakfast, July 7, 1916:
Corn flakes
5 tablespoonfuls
65
81
Eggs, boiled
2
100
160
Bread. .
2 slices
60
160
Butter
1 large square
15
120
Breakfast cocoa 1
Milk and sugar j
1 cup
240 c.c.
279
800
RATIONS FOR BOYS' MILITARY TRAINING CAMPS 687
BOYS' MILITARY TRAINING CAMP, FORT TERRY, NEW YORK
DIETARY FOR WEEK Continued
Serving
Grams
Calories
Total
Calories
Dinner:
Roast beef
Liberal helping
125
140
Brown gravy
2 tablespoonfuls
30 c.c.
25
Stewed peas
3 heaping tablespoons
92
111
Boiled new potatoes
3 medium-sized
150
145
Bread. .
2 slices
60
160
Butter
1 large square
15
120
Coffee 1
Milk and sugar J
1 cup
240 c.c.
156
Supper:
Fried bologna
Liberal helping
100
258
857
Fried potatoes
50
290
Stewed apples. . -
3 heaping tablespoons
100
120
Bread
2 slices
60
160
Butter
1 large square
15
120
Coffee 1
Milk and sugar J
1 cup
240 c.c.
156
1,204
TOTAL CALORIES FOR DAY 2,861
Breakfast, July 8:
Oatmeal and milk
3 heaping tablespoons
100
201
Fried pork sausage
2 links
70
328
Boiled potatoes
1 large
150
145
Bread
2 slices
60
160
Butter
1 large square
15
120
Coffee, tea and sugar
1 CUD
240 c.c.
156
Dinner:
Pork and
1 slice
30
1,110
Beans. .
4 heaping tablespoons
80
294
Pickles. . .
Catsup
Stewed tomatoes
2 heaping tablespoons
100
16
Vegetable soup
6 ounces
180 c.c.
35
Bread
2 slices
60
160
Butter
1 large square
15
120
Coffee 1
Milk and sugar J
1 cup
240 c.c.
156
Supper:
Creamed cheese
Liberal helping
80
364
781
Potato salad
3 tablespoonfuls
100
123
Queen olives
3 large
30
60
Stewed peaches
3 tablespoonfuls
100
228
Iced tea
1 glass
240
40
Bread
2 slices
60
160
Butter
1 large cube
15
120
1,095
TOTAL CALORIES FOR DAY .
2,986
688
AEMY AND NAVY RATIONS
BOYS' MILITARY TRAINING CAMP, FORT TERRY, NEW YORK
DIETARY FOR WEEK Continued
Serving
Grams
Calories
Total
Calories
Breakfast, July 9:
Farina
Liberal helping
100
56
Fried eggs
Two
100
160
Bread .
2 slices
60
160
Butter
1 large square
15
120
Coffee 1
Milk and sugar I
1 cup
240 c.c.
156
Dinner:
Roast pork loin
Liberal helping
100
210
652
Stewed corn
2 heaping tablespoons
100
101
Mashed potatoes
2 heaping tablespoons
100
112
Bread
2 slices
60
160
Butter
1 large square
15
120
Coffee 1
Milk and sugar j
1 cup
240 c.c.
156
Supper:
Cold sliced ham
1 slice (small)
33
93
859
Potato salad
2 heaping tablespoons
100
112
Jelly fruit, pure
3
125
201
Iced tea and sugar
1 glass
240 c.c.
100
Bread
2 slices
60
180
Butter
1 large square
15
120
806
2,317
Breakfast, July 10:
Oatmeal and milk
3 heaping tablespoons
100
201
Pork sausage
2 lengths
70
328
Bread. .
2 slices
60
180
Butter
1 square
15
120
Cocoa and sugar
1 cup
240 c.c.
279
Dinner:
Corned beef
1 large slice
50]
1,088
Cabbage
3 heaping tablespoons
100
145
Boiled potatoes
1 medium size
150
145
Bread
2 slices
60
160
Butter . . . .~
1 square
15
120
Supper:
Macaroni and cheese
2 heaping tablespoons
140
477
560
Stewed tomatoes
2 heaping tablespoons
70
16
Assorted cakes ...
3 cakes
150
300
Bread
2 slices
60
160
Butter
1 square
15
120
Coffee 1
Milk and sugar J
1 cup
240 c.c.
156
1,229
TOTAL CALORIES FOR DAY 2,877
RATIONS FOR BOYS' MILITARY TRAINING CAMPS 689
BOYS' MILITARY TRAINING CAMP, FORT TERRY, NEW YORK
DIETARY FOR WEEK Continued
Serving
Grams
Calories
Total
Calories
Breakfast, July 1 1 :
Corn flakes and milk
4 heaping tablespoons
115
93
Boiled eggs
2
100
160
Bread
2 slices
60
160
Butter
1 square
15
120
Coffee 1
Milk and sugar J
1 cup
240 c.c.
156
Dinner:
Roast beef . ...
Liberal helping
125
140
689
Fresh stringiest; beans
U it
120
30
Boiled potatoes
1 large
150
145
Stewed tomatoes
2 heaping tablespoons
70
16
Bread
2 slices
60
160
Butter
1 square
15
120
Tapioca pudding
3 heaping tablespoons
110
172
Slipper:
Beef pot roast
Large slice
100
357
783
Stewed sweet corn
1 ear
100
100
Bread
2 slices
60
160
Butter
1 square
15
120
Jellv. .
1 heaping tablespoon
35
113
Iced tea, sugar
1 glass
240 c.c.
80
930
TOTAL CALORIES FOR DAI
T
2.402
Breakfast, July 12:
Sliced orange
1 good sized
250
96
Milk toast
2 slices
180
240
Butter ,
2 squares
30
240
Cocoa
1 cup
240 c.c.
279
Dinner:
Roast mutton
1 large slice
75
234
855
Gravy
2 tablespoonfuls
30 c.c.
25
Stewed peas
3 tablespoonfuls
92
110
Mashed potatoes
2 tablespoonfuls
100
112
Bread
2 slices
60
160
Butter
1 square
15
120
Supper:
Frankfurters
3 large
100
258
761
Potato salad
3 tablespoonfuls
100
123
Bread
2 slices
60
160
Butter
1 square
15
120
Stewed apples. . .
3 tablespoonfuls
SO
200
Coffee, milk and sugar
1 cup
240 c.c.
156
897
TOTAL CALORIES FOR DA^
2.413
690
BOYS' MILITARY TRAINING CAMP, FORT TERRY, NEW YORK
DIETARY FOR WEEK Continued
,
Serving
Grams
Calories
Total
Calories
Breakfast, July 13:
Fried bacon
2 slices
35
140
Oatmeal
3 tablespoonfuls
100
201
Bread
2 slices
60
160
Butter
1 square
15
120
Coffee, milk and sugar
1 CUD
240 c.c.
156
Dinner:
Pork and
1 slice
30
777
Beans
4 heaping tablespoons
80
294
Vegetable soup
4 ounces
240 c.c.
35
Catsup
Bread
2 slices
60
160
Butter
1 square
15
120
Rice pudding
2 heaping tablespoons
110
179
Milk
1 glass
240 c.c.
157
Supper:
Pink salmon
2 tablespoonfuls
100
198
945
Potato salad
3 tablespoonfuls
100
123
Iced tea
1 glass
240 c.c.
80
Queen olives
3 large
30
60
Bread
2 slices
60
160
Butter
1 square
15
120
Fig newtons
3 cakes
85
308
989
TOTAL CALORIES FOR THE DAY 2,71 1
The menus have been amplified by showing the quantity of the serv-
ings in grams, giving the fuel or energy value of each article of food in
calories, and the total calories for each meal, and for each day, averaging
in a week 2,652 calories a day. Students of trophodynamics who have
given much thought to the dietary requirements of a young American boy
know that the above ration is lacking in fuel value, especially so when we
remember that the boy requires one-half as much more than a farmer at
his occupation, which is strenuous.
Various authorities have estimated the protein requirements as rang-
RATIONS FOK BOYS' MILITARY TRAINING CAMPS 691
ing from GO to 150 grams. Volt's standard was 118 grams; Chittenden
thinks 60 grams sufficient ; while Atwater's standard at moderate work is
125 grams and at severe work 150 grams. As previously stated, the grow-
ing boy needs a larger percentage of available protein in his dietary than
the adult. He not only needs it for the necessary wear and tear upon
the tissues the same as the adult, but in addition for growth and develop-
ment. Moreover, the satisfaction of bodily needs does not depend upon
protein, but upon useful protein. A complete protein contains about
twenty amino-acids, and while most animal protein is complete, many
vegetable proteins are not.
Therefore, depending upon the variety of protein furnished, it will
appear that it may become necessary to consume several times the amount
of protein actually catabolized in order to obtain sufficient useful protein.
Since we cannot consult a chemist daily with regard to the amino-acid
components of various proteins, we will err on the side of safety if we
ingest slightly more than is absolutely necessary.
Careful experimental research has emphasized the fact that each indi-
vidual needs a different amount of food, according to his structure and
surroundings; he requires protein, carbohydrates, fats and water in addi-
tion to mineral salts. It is absolutely essential that certain types of
proteins, certain types of fats, and certain salts be included in the dietary.
It is recognized at the present time that something more is essential for
the maintenance, growth, development, and well being of man than the
ternary food elements just mentioned. Foods contain a minute propor-
tion of "accessory substances," generically called vitamines, and when
these are deficient or absent from the dietary, the immature body does
not grow, while the mature body does not maintain a normal healthy con-
dition and manifestations of disease soon appear.
Unless food contains sufficient vitamine principles, no matter how well
balanced the ration may be in the ternary food elements, nor how large
quantities are consumed, nor how high the caloric value may be, there
will be malnutrition. This is frequently the case among the poor, who
consume large quantities of food which is neither proportionately bal-
anced nor sufficiently varied to furnish the requisite vitamine con-
tent, and for this reason diseases of malnutrition are common among
them.
Below we append a daily menu for one week of what we consider a
well balanced ration for a growing boy ; this ration will furnish about
125 grams of protein daily and an average of about 4,300 calories.
692
AKMY AND NAVY RATIONS
PROPERLY BALANCED DIETARIES FOR BOYS' MILITARY
TRAINING CAMPS
REQUISITE AMOUNTS OF THE TERNARY FOOD ELEMENTS AND FUEL
OR ENERGY VALUE IN CALORIES
Serving
Grams
Calories
Total
Calories
Monday Breakfast:
Orange
1 medium
250
96
Oatmeal, milk and sugar
3 tablespoonfuls
100
201
Eesrs
2 boiled
100
160
Fried bacon
2 slices
35
140
Bread
2
60
160
Butter
1 square
15
120
Coffee, milk and sugar. . . .
1 cup
240 c.c.
156
Salt, pepper
Dinner:
Creamed pea soup
6 ounces
180 c.c.
243
1,033
Roast beef
1 slice
100
343
Brown gravy
Lima beans.
2 heaping tablespoons
80
128
Mashed potatoes
2 " "
100
112
Lettuce
14 head
200
10
American cheese
1 ounce
31
136
Bread
2 slices
60
160
Butter
1 square
15
120
Bread pudding
3 heaping tablespoons
155
338
Cocoa
1 cup
240 c.c.
279
Salt, pepper, pickles, catsup
Supper:
Lamb or pork chop
1
100
200
1,863
Macaroni and cheese
2 heaping tablespoons
140
477
Sliced tomatoes
1 medium size
200
46
Bread
2 slices
60
160
Butter
1 square
15
120
Peach oie
y pie
126
352
Iced tea. . . ...
1 glass
240 c.c.
80
Salt, pepper, pickles, catsup
1,425
TOTAL CALORIES FOR THE DAY 4,321
Tuesday Breakfast:
Stewed prunes
6
120
312
Shreaded wheat, milk and sugar.
Scrambled eggs
1
2
69
100
205
160
Baked hash
2 heaping tablespoons
100
140
Bread
2 slices
60
160
Butter
1 square
15
120
Coffee, milk and sugar
1 CUD
240 c.c.
156
Salt, pepper
1,253
RATIONS FOR BOYS' MILITARY TRAINING CAMPS 693
REQUISITE AMOUNTS OF THE TERNARY FOOD ELEMENTS AND
FUEL OR ENERGY VALUE IN CALORIES Continued
Serving
Grams
Calories
Total
Calories
Dinner:
Tomato soup
6 ounces
180 cc
186
Roast lamb.
1 slice
100
200
Baked beans
3 heaping tablespoons
115
152
Baked potatoes
1 large
150
160
American cheese
1 ounce
31
136
Bread
2 slices
60
160
Butter
1 square
15
120
Indian meal pudding
2 heaping tablespoons
164
324
Cocoa, milk and sugar.. .
1 CUD
240 c.c.
279
Salt, pepper, pickles, catsup
Supper:
Cold roast beef
1 medium slice
100
300
1,817
White potatoes
3 heaping tablespoons
145
350
Cucumbers
8 thin slices
50
9
Green corn
1 ear
100
100
Bread
2 slices
60
160
Butter
1 square
15
120
Sugar cakes .
3
15
75
Lemonade
1 glass
240 c.c.
150
Salt, pepper, pickles, catsup
1.264
TOTAL CALORIES FOR THE DAY
Wednesday Breakfast:
Cantaloup
J/2 medium
465
93
Oatmeal, milk and sugar. . .
3 tablespoonfuls
100
201
Eggs. .
2 soft boiled
100
160
Broiled ham
1 slice
35
140
Bread
2 slices
60
160
Butter. ...
1 square
15
120
Coffee, milk and sugar
1 CUD
240 c.c.
156
Salt, pepper
Dinner:
Creamed corn soup
6 ounces
180 c.c.
150
1,030
Roast ham
1 large slice
100
210
Boiled cabbage
3 heaping tablespoons
100
5
Lettuce.. .
Y% head
200
10
Baked beans, home made
American cheese
3 heaping tablespoons
1 ounce
115
31
298
136
Creamed potatoes
4 heaping tablespoons
115
140
Olives
3 medium
30
60
Bread
2 slices
60
160
Butter
1 square
15
120
Rice pudding
3 heaping tablespoons
165
257
Cocoa, milk and sugar.. .
1 cup
240 c.c.
279
Salt, pepper, pickles, catsup
1,925
144
694
ARMY AND NAVY RATIONS
REQUISITE AMOUNTS OF THE TERNARY FOOD ELEMENTS AND
FUEL OR ENERGY VALUE IN CALORIES Continued
Serving
Grams
Calories
Total
Calories
Supper:
Steak
1 medium slice
100
185
Potato chips
3 heaping tablespoons
50
295
Cream cheese
2 cubic inches
40
180
Creamed onions
3 small
100
125
Bread
2 slices
60
160
Butter
1 square
15
120
Apple pie,
K pie
126
352
Water
1 glass
240 c.c.
Salt, pepper, pickles, catsup
1,465
TOTAL CALORIES FOR THE
DAY
4,320
Thursday Breakfast:
Stewed prunes
6 medium
120
312
Force
5 heaping tablespoons
18
66
Eees. .
2 soft boiled
100
160
Bacon, fried
2 slices
60
140
Bread
2
60
160
Butter
1 square
15
120
Orange marmalade
1 heaping tablespoon
30
115
Coffee , . .
1 CUD
240 c.c.
156
Salt, pepper
Dinner:
Potato and meat soup
6 ounces
180
210
1,219
Roast beef
1 slice
100
357
String beans
4 heaping tablespoons
120
26
Baked potatoes
1 medium size
130
149
Sliced tomatoes. . .
1 U U
200
46
American cheese
1 ounce
31
136
Bread
2 slices
60
160
Butter
1 square
15
120
Ice cream
2 heaping tablespoons
100
190
Chocolate cake
1 medium slice
70
258
Cocoa
1 CUD
240
279
Salt, pepper, pickles, catsup
Supper:
Pork chop
1 chop
70
113
1,929
Macaroni and cheese
2 heaping tablespoons
140
470
Sliced beets
2 u u
70
29
Green corn. . -.
1 ear
100
100
Sliced cucumbers
8 thin slices
50
9
Bread
2 slices
60
160
Butter
1 square
15
120
Peach pie
Y pie
126
360
Salt, pepper, pickles, catsup
1,361
TOTAL CALORIES FOR THE
DAY...
4.509
RATIONS FOR BOYS' MILITARY TRAINING CAMPS 695
REQUISITE AMOUNTS OF THE TERNARY FOOD ELEMENTS AND
FUEL OR ENERGY VALUE IN CALORIES Continued
Serving
Grams
Calories
Total
Calories
Friday Breakfast:
Peaches .
1 average size
128
44
Oatmeal, milk and sugar
3 heaping tablespoons
100
201
Ee^s
2 soft boiled
100
160
Bread
2 slices
60
160
Butter
1 square
15
120
Toasted cheese
2 ounces
50
250
Coffee milk and sugar.. . .
1 cup
240 c.c.
156
Salt, pepper
Dinner:
Creamed pea soup.
6 ounces
180 c.c.
243
1,091
Fresh haddock or white fish. . .
Lima beans. . . .
Liberal helping
3 heaping tablespoons
100
120
108
200
Creamed mashed potatoes ....
Sliced tomatoes
4
1 medium sized
115
200
141
46
American cheese
1 ounce
31
136
Bread .
2 slices
60
180
Butter
1 square
15
120
Bread pudding
3 heaping tablespoons
155
337
Queen olives
3 medium sized
30
60
Cocoa
1 cup
240 c.c.
279
Cakes
2
22
94
Salt, pepper, pickles, catsup
Supper:
Vegetable soup. .
6 ounces
180 c.c.
24
1,929
Baked beans. .... . .
4 tablespoonfuls
200
400
Cheese and macaroni
3 heaping tablespoons.
140
441
Sliced tomatoes
1 medium sized
200
46
Bread
2 slices
60
160
Butter
1 square
15
120
Lemon pie
V pie
110
288
Lemonade
1 glass
250 c.c.
174
Salt, pepper, pickles, catsup
1,325
Satwdai/ Breakfast:
Stewed prunes
6
120
312
Shredded wheat
1 biscuit
69
205
Eees
2 boiled
100
160
Baked hash
2 tablespoonfuls
100
140
Broad
2 slices
60
160
Butter
1 square
15
120
Coffee.
1 cup
240 c.c.
156
Salt, pepper
1.253
696
AKMY AND NAVY RATIONS
REQUISITE AMOUNTS OF THE TERNARY FOOD ELEMENTS AND
FUEL OR ENERGY VALUE IN CALORIES Continued
Serving
Grams
Calories
Total
Calories
Dinner:
Creamed corn suet
6 ounces
180
160
Roast beef
1 slice
100
310
Cauliflower
3 heaping tablespoons
180
12
String beans
3 " "
90
18
White potatoes
3 " "
145
350
Bread .
2 slices
60
160
Sliced tomatoes
1 medium sized
200
47
Butter
1 square
15
120
Rice pudding
3 heaping tablespoons
165
257
Olives
3 medium
30
60
Cocoa
1 cup
240 c.c.
279
Salt, pepper, pickles, catsup
Supper:
Mutton chop
1 chop
100
135
1,743
Potato chips
3 heaping tablespoons
50
295
Green corn
1 ear
100
100
Sliced cucumbers
8 thin slices
200
9
American cheese
1 ounce
31
136
Bread
2 slices
60
160
Butter
1 square
15
120
Peach pie
\/i nip
126
352
Lemonade
1 glass
250 c.c.
150
Salt, pepper, pickles, catsup
1,564
TOTAL CALORIES FOR THE DAY
4.560
Sunday Breakfast:
Cantaloup
% medium
465
93
Oatmeal, milk and sugar
3 heaping tablespoons
100
201
Eggs. .
2 boiled
100
160
Breakfast bacon. .
2 slices
35
140
Bread
2 "
60
160
Currant jelly
1 heaping tablespoon
35
113
Butter
1 square
15
120
Coffee, milk and sugar
1 cup
240 c.c.
156
Salt, pepper
Dinner:
Watermelon
1 large slice
300
40
1,143
Bean soup
6 ounces
180 c.c.
70
Olives
3 medium
30
60
Roast chicken
Liberal helping
100
273
Baked potatoes.. .
1 large
150
160
Radishes
6
50
8
Sliced tomatoes
1 medium sized
200
46
RATIONS OF FOREIGN ARMIES
697
REQUISITE AMOUNTS OF THE TERNARY FOOD ELEMENTS AND
FUEL OR ENERGY VALUE IN CALORIES Continued
Serving
Grams
Calories
Total
Calories
Dinner: Continued.
Green peas
3 heaping tablespoons
92
110
Bread
2 slices
50
160
Butter
1 square
15
120
Bread pudding
3 heaping tablespoons
155
337
Ice Cream
9 u a
100
189
Cocoa
1 cup
240 c c
279
Salt, pepper, pickles, catsup
Supper:
( 'hicken soup
6 ounces
180 c.c.
78
1,852
Baked beans
4 heapin" tablespoons
200
400
Baked macaroni and cheese. . .
Sliced tomatoes.. .
2
1 medium sized
100
200
300
46
Green corn
1 ear
100
100
Bread
1 slice
30
80
Butter
1 square
15
120
Peach pie.
i/ nie
126
252
Salt, pepper, pickles, catsup
1,476
TOTAL CALORIES FOR THE DAY 4,471
RATIONS OF FOREIGN ARMIES
Colonel Woodruff, writing on this subject(O), worked out a table of
comparison of eight countries. He reduced all weights to grams; the
amounts <>f the chemical constituents were calculated, and the results
tabulated as given below. Space will not permit an accurate comparison
of the analyses given of the rations supplied to the armies of the various
European countries, nor the vastly different systems in vogue for supply-
ing the food.
In European countries, fresh meat is expensive ; therefore, from econ-
omy, the nitrogen in the ration is supplied principally in the form of peas,
beans, cheese, etc. In Russia, the meat ration is low, and the deficiency
of protein is made up by free allowances of pulses and bread. The Amer-
ican soldier, from custom, requires the stimulating effects of an abundance
of good, wholesome, fresh meat, and the United States is the only country
which furnishes its soldiers with the whole ration. Other countries fur-
nish part, and the soldier purchases an additional aliment from his pay
698
ARMY AND NAVY RATION'S
or from allowances for this purpose. In England, bread and meat in
moderate quantity are supplied, but the soldier must pay for the rest and
as much as twenty-five per cent of his pay may be thus deducted. In
Germany, he is furnished only bread and must find the rest of his ration,
but if the portion is supplied officially, the cost up to three and one-
quarter cents is charged against his pay ; anything over this is paid by the
government.
COMPARATIVE TABLES OF FOREIGN ARMY RATIONS (Woodruff)
NATION
Ration
Pro-
teins
Fats
Car-
bohy-
drates
Cal-
ories
Re-
marks
1. ENGLAND
1 . Home
Gm.
93
Gm.
61
Gm.
244
1,938
2. Foreign station or under
canvas at home
111
80
244
2,175
(a)
3. March
120
80
324
2,550
4. War : Maximum
165
128
425
3,634
Minimum.. .
133
92
425
3,204
(b)
Sometimes 2 oz. of rum .
175
2. SPAIN
1. Peace: Maximum
147
87
588
3,729
1 / N
Minimum
120
62
500
3,421
(c)
2. War, on march or in the
field : Maximum
131
94
522
3,327
Minimum. . . .
113
55
485
2,550
Sometimes 1.7 oz. of
brandy
150
(d)
3. AUSTRIA
1. Peace
155
125
504
3,865
1 / \
2. War
165
130
504
3,952
} (e)
4. ITALY
1. Garrison
111
130
600
4,129
2. Camp
115
133
600
4,163
3. Marching
125
143
600
4,307
1 (0
Usually wine added.. . .
250
5. GERMANY
1. Small rations and por-
tions in garrison and
cantonments:
Maximum
150
40
703
3,947
Minimum
99
40
502
2,827
(g)
2. Large rations and por-
tions on march or in
maneuvers:
Maximum
172
62
915
4,961
Minimum
138
57
644
3,744
3. Field: Maximum
195
151
703
4,786
Minimum
78
75
515
3,413
Commanding general may
add 3 l /i oz. of whiskey
268
RATIONS OF FOREIGN ARMIES
699
COMPARATIVE TABLES OF FOREIGN ARMY RATIONS Continued
NATION
Ration
Pro-
teins
Fats
Car-
bohy-
drates
Cal-
ories
Re-
marks
6 UNITED STATES
1. By law: Maximum
183
260
621
5368
Minimum
105
103
500
3,712
2. Usually in field (by law) :
Maximum
106
320
540
5,166
(h)
Minimum
64
240
460
4722
Average
85
280
500
5,000
3. Food actually eaten in
cold climate, moderate
work, including all ex-
tras from garden and
purchases
155
180
597
4,907
7 FRANCE
War: Maximum
183
300
690
5,455
I
Minimum
146
127
520
4,015
0)
Add 2 1-10 oz. of brandy
184
1 w
8 RUSSIA
1. Peace: Maximum
233
114
976
5,884
Minimum
165
65
746
4,450
(i)
Add 3 oz. of wine
223
2 War: Maximum
174
62
805
8.583
Minimum
149
50
640
3,307
(k)
Add 4j/<j oz. of wine
362
(a) This is starvation diet, and the extra food needed for health is purchased
and charged against the soldier (about six cents a day), increasing, perhaps doub-
ling, the food value.
(b) Can he greatly changed to suit climate.
(c) Sufficient for such a mild climate and very moderate work.
(d) Varies enormously according to class of rations issued. Very many
extra allowances of money for food.
(e) This is augmented by four cents a day for vegetables, etc, On the
march a. limited emergency ration is used. The war ration is so insufficient that
commanders of armies or smaller' forces may change, supplement, or even
double it.
(/) Allowances of one-fifth of a cent a day for condiments; occasional extra
money allowances for food. Excepting the protein, it is a very liberal diet for
so mild a country.
(g) This is what the government may supply. Usually the soldier feeds
himself and is given seven cents a day or more to reimburse him for the outlay.
The food eaten is more than this deficient diet allows.
(h) Maximum due to fats if all the bacon is used and no meat. The entire
ration is supplied and intended to be eaten.
700
AKMY AND NAVY KATIONS
(i) Peace ration not stated. It is purchased as needed and charged against
the soldier. War ration is subject to great augmentation for increased work or
cold climate. The commanding officer may augment ration on the march.
(j) Also allowed money to buy one-half to one and one-half ounces extra
meat, and one to one and one-half cents for vegetables, salt, butter, lard, and
groceries.
(fc) Extra meat and spirits may be ordered by the commander-in-chief.
All foreign armies have a so-called emergency ration, but, with the
exception of England, it is nothing else but a field ration in a more con-
densed and portable form, consisting of hard bread, and preserved meat
and vegetables in cans.
Germany. "In Germany, four types of rations are also provided, two
for peace time and two for the field. The large peace ration, such as
FIG. 13. COMPARATIVE FUEL VALUE OF THE FOOD RATIONS OF THE SOLDIERS OF THE
LEADING ARMIES OF THE WORLD. (Courtesy of the American Museum of Natural
History, N. Y.)
issued during maneuvers, consists of 750 grams of bread, or 500 of field
biscuit or 400 of egg biscuit; 250 grams of fresh meat, with 60 of kidney
fat, or 200 of smoked bacon, or 200 of canned meat ; and vegetables.
According to Bischoff, its composition is: Protein, 89.9 grams; fats, 80.7";
carbohydrates, 514.8; with fuel value of 3,230 calories(13).
"The other peace ration is somewhat smaller and, in certain garrisons,
has to be supplemented from the private means of the soldier. The small
701
field ration averages 141 grams of protein, 51 of fat, and 458 of carbo-
hydrates, with fuel value of 2,929 calories; the large field ration, 181
grams of protein, 64 of fat and 558 of carbohydrates, with fuel value of
3,625 calories. The commissary furnishes bread and meat; most of the
other articles being purchased out of a daily allowance of 4 cents per
man."
The German soldier takes a cup of black coffee, or coffee with milk,
and bread in the morning, dinner at noon, and a light supper in the even-
ing. During maneuvers, or in the field, he may also receive one quart of
beer, one pint of wine, or about three ounces of spirits (14).
Russia. "The Russian soldier (4) in the field receives 2^ ounces of
black bread (from unbolted rye flour), 14^ ounces of fresh meat or 11
of preserved or salt meat, 9 ounces of green vegetables or the equivalent
in compressed vegetables, 1 to 2 ounces of suet or butter for cooking,
together with 4 to 5 ounces of grits, tea, sugar and condiments. Accord-
ing to Bischoff, its composition is: Protein, 120.7 grams; fat, 39.2 grams;
carbohydrates, 628 grams; with fuel value of 3,147 calories."
Most of the articles of the ration (bread excepted) are boiled together
in a large wheeled kettle and served as soup.
Japan. "The Japanese ration, in the field, consists of:
Rice, uncooked 30 ounces
Or steamed and dried 25
" fresh bread 20 "
" hard bread 13
Meat, canned 10 "
Or fresh (with bones) 13
(which may be increased to 20 if procurable)
" salt, dry or smoked meat 8 ounces
" fish 2
Vegetables, dry 8
Or green 32 ft
Pickles, sauces and condiments
Tea and sugar
Sake (beer made from rice)
"The Japanese soldier does not take readily to bread, either fresh or
hard. During the Russo-Japanese War, the meat component was scant
and issued irregularly ; rice, fish and vegetables formed the staple ration.
"The Japanese medical regulations provide that the nutritive value of
the ration shall never fall below 2,580 calories."
702
AKMY AND NAVY RATIONS
France. "In France, four types of rations are provided, two for peace
(garrison ration and maneuver ration), and two for war (ordinary and
large field rations).
"The components of the garrison and field rations are as follows:
Articles
Garrison
ration
Ordinary
held ration
Large
field ration
Soft bread (brown) . .'
Kg. Grams
0.750
Kg. Grams
0.750
Kg. Grams
0.750
Soup bread (white)
0.250
Fresh beef . .
0.320
0.400
0.500
Rice
0.030
0.060
0.100
Or pulses
0.060
0.060
0.100
Lard.
0.030
0.030
0.030
Or beef suet
0.040
0.040
0.040
Salt
0.015
0.020
0.020
Sugar
0.021
0.021
0.031
Coffee
0.016
0.016
0.024
"The soft bread ('pain de munition'} is a leaven-made bread from
flour bolted to 20 per cent; it may be replaced by pain biscuite, or by
hard bread and partly by Italian pastes and flours or cereals; the beef,'
by any kind of fresh or preserved meat, fish, cheese or milk; the rice and
pulses, by any available dry or green vegetables.
"In bivouac, or whenever ordered by the commanding general in the
field, a liquid ration is issued of either wine (one-half pint), beer (one
pint), or brandy (two ounces)."
The garrison ration contains, according to Rouget and Dopter:
Proteins 125.06 grams, yielding 513 calories
Fats 60.46 " 562 *
Carbohydrates 573.52 2,351
Total 3,426
The maneuver ration contains less protein and fat, having a fuel value
of 3,164 calories.
The ordinary field ration contains:
Proteins 123.60 grams, yielding 507 calories
Fats 64.74 602
Carbohydrates 476.99 " " 1,956
Total.
3,065
RATIONS OF FOREIGN ARMIES 703
Soup bread may be added if available (which is seldom the case),
increasing the total calories to 3,687. The fuel value of the large field
ration (without soup bread) is 3,383 calories.
The French soldier takes two meals a day, breakfast at 10 A.M. and
dinner at- 5 P.M., besides black coffee at reveille.
In time of peace, the commissary department supplies only hard
bread, sugar and coffee, as well as wine and brandy when authorized.
The rest of the ration is purchased by the company messes (ordinaires)
from special money allowances (about 10 cents per man), under the
supervision of a council appointed by the commanding officer (commis-
sion des ordinaires). Money allowances remaining unexpended, that is,
resulting from savings on the ration, as well as proceeds from fines, sale
of wastes, etc., are used in purchasing such additional articles of food as
are deemed desirable.
In war, the men carry two days' rations in the haversack; two more
are carried in the regimental trains, and four on the administrative trains.
The following three or four pages are taken largely from a report on
the "Medico-Military Aspects of the European War," by Surgeon A. M.
Fauntleroy ( 1 1 ) , U. S. Navy (Bureau of Medicine and Surgery, Navy De-
partment, Washington, D. C.). 1 Surgeon Fauntleroy had an excellent
opportunity to study conditions in the French lines, many courtesies being
extended him in France by Dr. Joseph Blake, formerly of the New York
Presbyterian Hospital, and Dr. Alexis Carrell, formerly of the
Rockefeller Institute, New York City.
Among other conditions, he investigated the methods of cooking in the
trenches. He says : "Each company of about 100 men has its field
kitchen, and each man carries with him a tin cup, plate, knife, fork and
spoon. For some months after the outbreak of the war the French armies
were not supplied with regular field kitchens, but were dependent upon
improvised means of cooking food." At the present time, however, a
field kitchen of the same type as the English kitchen is in general use.
These field kitchens are augmented by improvised ovens, situated as close
to the entrance of the boyau as is compatible with military conditions.
From this situation food is served hot to the men in the trenches, and the
efficiency of the commissary department is a large factor in promoting
general contentment throughout the French army.
The French ration is an exceedingly liberal one in every way, and no
form of wholesome and suitable food is denied the French soldier. Men
of all ranks and grades are apparently supremely content with this branch
1 Used by permission of the Secretary of the Navy.
704
AKMY AND NAVY RATIONS
of the service. Hot coffee and bread are served in the early morning, and
hot coffee is also prepared in large quantities, and served throughout the
day. This latter is encouraged by the officers, as it not only guarantees
the sterility of the water thus boiled, but reduces the necessity of drinking
unboiled water.
The principal meal, dejeuner, is served in the middle of the day and
every precaution is taken to make it a complete and satisfactory repast.
In the late afternoon, the evening meal is prepared, and in general, while
a little less substantial than the midday meal, it is still quite sufficient.
As is well known, the Frenchman has a light breakfast coffee and rolls.
There are three rations authorized in the French army: The reserve
ration, the strong ration, and the normal ration.
COMPOSITION OF THE RATION OF THE FRENCH ARMY
Articles
Reserve
ration
Strong
ration
Normal
ration
Bread :
Soft
1.65 Ibs.
1.65 Ibs.
Field
1.54
1.54
Hard
0.66 Ibs. 1
1.32 " 2
1.32 "
Meat:
Fresh. .
1.10 "
.88 "
Canned (seasoned)
.66 Ibs.
.66 "
.44 "
Dried vegetables or rice
.22
.132 "
Small store:
Salt
.044 "
.044
Sugar
.176 Ibs.
.0704
.0462 "
Coffee, roasted, in tablets
.0792 "
Coffee, roasted, in tablets or loose . . .
.0528 Ibs.
.0352 Ibs.
Coffee, green
.0627 "
.0418 "
Lard (when fresh meat is issued)
.066 "
.066 "
Potage sale" (when canned meat is issued)
Brandy
.11 qts.
.055 "
.11
.11
To each man in bivouac or when spe-
cially ordered:
Wine
.2641 qts.
.2641 qts.
Beer
.5282 "
.5282 "
Brandy
.055 "
.055
Tobacco:
"Caporal," for officers
.044 Ibs.
.033 Ibs.
.033 Ibs.
"Cantine," for enlisted men
.033 "
.033 "
.033 "
1 Six pieces, or crackers.
2 Twelve pieces, or crackers.
The greatest possible latitude is allowed in making substitutes wiih
supplies procured by exploiting the local resources. This authority is
RATIONS OF FOREIGN ARMIES
705
vested in all division generals and subordinate commanders. The sub-
stitutive articles and quantities of each authorized to be issued in lieu of
a ration component are given below:
AUTHORIZED SUBSTITUTIVE EQUIVALENTS
Strong
ration
Normal
ration
Substitute for one ration of fresh meat (beef)
1 10 Ibs
88 Ibs
Veal mutton, pork, rabbit, horse, or fresh fish . . . , .
1 10 "
88 "
Meat pudding, eggs, soft cheese
.825 "
66 "
Codfish, salted
.66 "
55 "
Bacon.
.66 "
55 "
Smoked meat, herring, salted, or salted sardines ....
Cheese (Gruyere, Holland, Chester, Roquefort) ....
Sausage, small and large, smoked, herring, smoked . .
Sardines, in oil
.55
.55 "
.44
.33 "
.44
.44
.33 "
.22 "
Codfish, dried, meat powder
.275 "
22 "
Cow's milk
2.6412 qts.
2.201 qts.
Substitute for one ration of dried vegetables or rice ....
Potatoes
.22 Ibs.
1.65 "
.132 Ibs.
.99 "
Turnips, carrots, or cabbage
2.2 "
1.32 "
Sauerkraut
1.32 "
.792 "
Canned vegetables
.264
.154
Wheat flour
.22
.132 "
Italian pastes (noodles, vermicelli, etc.)
.22 "
.132
Corn meal
.22 "
.132
Cheese, Gruyere, or Holland
.154 *
.088 "
Cheese, soft
.242
.132
The list gives the substitutes that were in force prior to the commence-
ment of the present war, and it has been greatly augmented since. There
is practically no limit to the articles that may be substituted by higher
commanders as long as common sense is displayed both in the dietetic
properties of the food and the cost to the Government. This matter is
regulated in orders issued by army and corps commanders. In these
orders the prices of different foodstuffs are fixed, and the farmer or mer-
chant in the theater of operations is given the chance to sell these supplies
at or below these figures ; otherwise the supplies are formally requisitioned
and paid for at the rate stated in the order.
The "extraordinary supplements authorized" can only be authorized
by army and corps commanders or by commanders of independent forces.
In this case the supplies must be furnished from the chain of supplies
moving from the base depot forward, and these are the only commanders
706 ARMY AND NAVY RATIONS
who are in a position to make the arrangements to meet this situation.
The extraordinary supplements are as follows:
EXTRAORDINARY SUPPLEMENTS AUTHORIZED
1. One ration of wine, beer, or brandy.
2. Additional: One-third ration of bread. One-fifth ration of meat.
3. Increase of one-half, one-third, one-fourth of the complete "strong"
or "normal" ration.
In the first instance, it must be remembered that the substitutes
authorized are obtained locally, and therefore no additional drain is made
on the regular chain of supplies coming forward. Under "the automatic
food supply" system in the French army, one day's complete food supply
for the entire army goes forward daily from the regulating station to the
railhead, and from that point forward until it arrives at the ration wagon
of the organization. If the organization has procured a substitute for
one of the component articles locally, it follows that it will not need cer-
tain articles carried by the train and about to be issued. It, therefore,
does not draw these supplies. The latter train has then a surplus, and*
when it is subsequently refilled at the railhead, it leaves undrawn at that
point a corresponding quantity. Similarly, the railroad train has a sur-
plus, which it carries back to the regulating station, where the general
readjustment is made.
In addition to the ration, commanders of organizations and detach-
ments are given a daily allowance of twenty centimes (four cents) per
day per man, with which they are authorized to purchase locally additional
food supplies. This fund corresponds to the United States army company
fund.
In times of peace, in garrison, the French ration is largely commuted
at prices fixed by corps commanders and based on the local market prices.
In time of war this system is not used except in the case of very small
detachments (principally cavalry), chauffeurs, and other individuals who
cannot be conveniently rationed by organizations. In the latter case the
commutation rate is fixed in army orders. In the positions occupied by
the French army during 1917 it has been comparatively easy to supply
the men and animals, the utmost advantage having been taken of the elas-
ticity allowed for substitutions and additions to the ration.
The entire French army in the zone of the armies had a most trying
time during the winter, due to cold and the water in the trenches.
Roughly speaking, from one-third to one-half of the time they have been
in the first-line trenches, the remainder of the time they have spent
RATIONS OF FOREIGN AEMIES 707
either in supporting trenches or in towns more or less subjected to Ger-
man artillery fire. In the first-line trenches the quarters or dugout
shelters of the men are heated with coke or charcoal fires, which give out
no smoke. Food is cooked in large kettles and field kitchens behind the
trenches and is subsequently taken out to the front-line trenches and dis-
tributed. The men eat a hot, cooked meal at night and save the rest of
the food for the next day's lunch, when it is heated before eating over the
fires in the dugout shelters. Men and officers say they have all fared better
under these trying conditions than they usually fare in barracks in peace
time. The result of this good feeding is apparent in the physical condi-
tion of the men and in the astonishingly low sick reports. The Govern-
ment and the army commanders have realized the importance of keeping
the men fit during all this period of more or less enforced stationary siege
fighting. They have thoroughly realized that it is very poor economy to
restrict the food when there is no necessity for it, as there may be later
on if a forward movement is undertaken in a country with all the rail-
roads destroyed.
The reserve ration is the ration that is carried on the man or horse.
Within the last few years an effort has been made to reduce the load car-
ried by the man, and a portion of this reserve ration is now carried in the
combat train. The reserve ration carried by divisional cavalry, and that
carried by all elements of a cavalry division, is one day's hard bread,
three days' coffee and sugar, and one day's canned meat and potage sale.
The total gross weight of these components of the reserve ration is 2.53
pounds. In addition, one day's brandy per' man is carried. The reserve
ration carried by all other troops and elements of the army is a straight
two days' ration, except that only one day's brandy is included. One-half
of this reserve ration is carried on the man, the other half plus the brandy
is carried on the baggage wagon attached to the combat train.
The reserve ration is, in general, only consumed when so ordered by
corps or division commanders, when contact cannot be made with the
ration wagons. In rare cases, where there are no other means of feeding
the men, organization commanders may, on their own responsibility,
authorize its consumption. In this latter case a full written explanation
of the reason must be submitted.
The normal ration is that prescribed for troops in time of peace in
barracks, or in time of war when comfortably quartered, out of the pres-
ence of the enemy.
The strong ration is that usually supplied daily in the field to French
troops, and it is on the weight of this ration that transportation allowances
708 AKMY AND NAVY RATIONS
are based. It is realized by the French that troops in the field are sub-
jected to much more severe physical effort than troops in garrison. To
provide this additional energy, additional food is given in the shape of a
strong or increased ration. As already explained, the strong ration is very
elastic and supple. Almost any condition can be met without the fear
of violating regulations.
In principle the French soldier (not including the cavalryman)
receives each night from the ration wagon the supplies that he is to con-
sume at his two meals the following day. It will be remembered that,
with the exception of coffee early in the morning, Frenchmen only eat
two meals per day, one before noon and one in the late afternoon. These
supplies he carries in a light canvas bag (musette), swung with a loop
on his right shoulder. At the same ame he receives one day's ration of
fresh meat, which is issued him from the voiture de viande (meat wagon),
which is attached to the combat train. One-half of this is eaten the night
on which it is issued and one-half, after cooking, is put in the musette to
be eaten cold the next noon. We thus find that every morning, upon leav-
ing camp or bivouac, the French soldier has with him (independently of
the reserve ration) one day's supply of field bread, one-half day's supply
of fresh meat (cooked), one day's supply of dried vegetables to be cooked
for the evening meal, one day's supply of salt, and one day's coffee and
sugar, with the exception that some of this coffee and sugar is used in the
morning. As before explained, these supplies may be varied by substitu-
tions and additional purchases made from the four cents allowed to each
man over and above the ration.
In the cavalry every effort is made to reduce the weight carried by
the horse, and, in consequence, rations are issued theoretically, every
evening before supper. The evening meal and a cooked cold luncheon
for the next day are prepared for the same evening. We therefore find
that in the morning, upon leaving camp, the cavalry has, in addition to
its reserve ration, only the food necessary for one meal. Under this sys-
tem it may be readily seen that the evening meal of the regular rations
(the strong ration) is dependent upon the ration wagons making contact
with the troops in time for the preparation of the meal. It will, of course,
be remembered that so long as the cavalry is inactive it will probably be
kept near a place where rations can be readily supplied, and if active, it
will be in a better position than other troops to secure its supply locally.
This system of issuing rations is called by the French "au cheval." Pre-
viously it had been used with all troops, and it is still used by such of the
RATIONS OF FOREIGN ARMIES 709
French organizations as are equipped with rolling kitchens. However,
with infantry troops not equipped with rolling kitchens, it has been found
not to be practicable, owing to the delay of the ration wagons in making
contact with the troops.
TRAINS. Each organization, including division and corps headquar-
ters, has a combat and a regimental train (field train). To the corps are
also attached a corps supply train and a corps meat train (auto trucks).
In addition, there is a corps cattle park.
The combat train is divided into two echelons, called the first and sec-
ond, respectively. For purposes of clearness, the combat train of an
infantry regiment, as laid down in the French regulations, will be
explained. The same principles apply to the other combat trains, though
they diifer considerably in details in the different armies. The strength
of an infantry regiment is 3,000 men, and this strength is maintained by
reserves sent forward to replace all losses.
The first echelon remains with or in the immediate rear of the organ-
ization to which it belongs when on the march or during combat. It
includes one-horse sanitary carts carrying equipment for first-aid stations,
two-horse carts for ammunition for companies, four-horse wagons or
caissons for machine-gun ammunition, and two-horse carts carrying
entrenching and other tools.
The second echelon, while on the march out of the presence of the
enemy, usually accompanies the first echelon. When contact with the
enemy is expected, it is detached and grouped with other second echelon
combat trains, either in brigade or division groups, depending upon the
orders issued. During this period of grouping, its movements are con-
trolled by the headquarters ordering the grouping. The grouped second
echelons are usually held well in the rear under cover and "out of the
road." This echelon includes two-horse wagons (on these wagons are
also carried a portion of the reserve rations previously referred to), a
two-horse forage wagon, and three two-horse meat wagons (one per bat-
talion). In addition, the regulations provide that the two-horse rolling
kitchen (when organizations are equipped with the same) will form part
of the second echelon of the combat train.
The regimental train (train regimentaire) corresponds exactly to the
ration section of the field train of the United States army. All field
units, including the different headquarters and trains, with the exception
of the corps supply train, have a regimental train. The regimental trains
145
710 AEMY AND NAVY RATIONS
of all units, except that of the cavalry division, carry the following sup-
plies (on the basis of the strong ration) :
Bread (generally field bread) 2 days
Salt 2
Lard 2
Rice or dried vegetables (1 day of each) 2 "
Canned meat vrith'potage sale 1 day
Coffee (1 day's supply is on the basis of the reserve
ration) 2 days
Sugar (1 day's supply is on the basis of the reserve
ration) 2 "
Brandy 1 day
Oats , 2 days
The regimental trains of the cavalry divisions carry the following
supplies (on the basis of the strong ration) :
Field bread 1 day
Salt 1 "
Canned meat with potage sate 1 "
Coffee (on the basis of the reserve ration) 1 "
Sugar (on the basis of the reserve ration) ....'.... 1 "
Brandy 1
Oats 1 "
The foregoing figures are based on the load at the time the troops start
out, which, of course, changes as soon as issues begin. It is not safe,
therefore, to count on having on hand more than one day's supply.
The regimental trains of all units are usually kept grouped at all
times when the troops are on field service. This grouping is almost
invariably by divisions, the group being under the orders of a single offi-
cer, who moves the grouped trains in accordance with orders received from
division headquarters. When the troops have halted, orders are issued
from division headquarters to send forward one day's supply of food, and
men from the different organizations go to the grouped trains and conduct
the loaded vehicles to the troops. The issues are made, and the empty
vehicles are at once sent back and grouped again. If any supplies are
obtainable locally, and their substitution is desired by the troops in place
of what is carried in the wagons, the substitution is made, and the corre-
sponding ration articles remain unissued in the wagon.
From time to time the division headquarters is notified of the point
selected as the "distributing point," and it in turn notifies the officer in
command of the grouped train, who sends the empty wagons to that point
at the hour fixed for reloading. As soon as they are reloaded they rejoin
the grouped train.
RATIONS OF FOREIGN ARMIES 711
MEAT SUPPLY. The system of fresh-meat supply in the French army
has been materially changed in recent years. Formerly each division had
a cattle park, where the cattle were butchered and from which the dressed
meat was sent forward in wagons, their loads being transferred to the
meat wagons of the second echelon of the combat train. This was found
to be very cumbersome. To-day the division cattle park has been sup-
pressed and replaced by the corps cattle park, where the slaughtering is
now done. The fresh meat is loaded in the army corps meat train, which
is pushed forward close to the point where the grouped second echelon
of the combat train is halted, and the organization meat wagons are filled
at these places.
The meat supply of the French soldier has always been a most difficult
question, because of the national prejudice in France against refrigerated
meat. This prejudice is somewhat on the wane to-day, owing to a lack of
cattle in France, and a great quantity of Argentine beef is now being
received. There is some trouble in handling this beef, due to the fact that
refrigerator railroad cars are hardly known in France, and to the further
fact that there are not many cold-storage plants for the reception of the
meat. Of course, most of the big cities have these plants, but none are
found in the small towns as in America. To-day an effort is being made
to use the refrigerated meat in the zone of the interior and as far as pos-
sible to reserve the live cattle for use in the zone of the armies. The
Frenchman does not like our cured bacon nor does he like canned meats.
His wants, therefore, so far as meat is concerned, are much more difficult
to satisfy than is the case with our troops.
With a view to the simplification of the entire fresh-meat supply, a
number of different methods have been and are being tried in France.
One method by which the fresh meat was thoroughly salted (viande demi-
sale) was tried out, but has been practically abandoned to-day. This sys-
tem had the advantage that the meat could be slaughtered and treated
well to the rear, even back of the zone of the interior, and could be sent
forward in the regular trains through the regulating station. If success-
ful, it would have done away with the corps cattle park and the corps
meat train. The disadvantage was due to the fact that, while the center
of the meat so treated was perfectly good, the exterior surface became
discolored and somewhat decayed and smelly.
To-day a new scheme is being tried by which the fresh meat is first
cooked and boned, then wrapped in cheesecloth, and the moisture pressed
out. If this is successful, it will greatly simplify the problem of meat
supply, particularly if the war lasts long, and if refrigerated beef has to
712 AKMY AND NAVY RATIONS
be resorted to entirely. If, after cooking and treatment in the manner
indicated, meat will keep for five or six days, the plan will be successful.
The autotruck made it possible for the French to do away with the
division cattle park and to do their slaughtering at the corps cattle park,
well in the rear. All the autobuses in Paris were requisitioned for deliv-
ery purposes, and these are to-day distributed between the different army
corps, forming the corps meat trains. These autobuses have somewhat the
appearance of one of our street cars in America, having a platform on the
rear and windows on either side. The glass in the windows has been
removed and replaced by fly screens with cotton bunting behind to keep
out the dust. The meat is suspended from hooks placed on the rods run-
ning along the ceiling of the car, which previously furnished the supports
for the hand straps. Each autobus will carry approximately 4,000 pounds
of beef. Approximately fifteen of these autobuses are assigned to each
corps. The maximum distance to the front which they are able to supply
is seventy-five kilometers. It, therefore, follows that the corps cattle
park can be no further than this to the rear.
Corps cattle parks are usually situated near the railroad, where cattle
on the hoof are delivered by train. Their equipment is the simplest pos-
sible, notwithstanding the fact that the daily requirements of a corps
necessitate the slaughter of from 100 to 120 head of cattle a day. Usually
barns and stables are used for this purpose. The equipment in general
consists of large wooden tripods or derricks, about eight feet high. After
the animal has been hit on the head, he is pulled up by the hind legs, the
throat arteries are cut, and the meat is dressed. The hides are all most
carefully saved and shipped back to the rear. The meat when cut up is
at once loaded into the autobus, where it cools. A veterinary surgeon is
always present during the slaughtering to pass on the quality of the meat.
Slaughtering is usually done in the late afternoon, the autobuses or
corps meat train being sent forward the following morning to make con-
tact with the organization meat wagons (attached to the second echelon
of the combat train). The meat is then transferred, and the autobuses
return to receive their new loads during the slaughtering in the afternoon.
Effort is always made to counteract, so far as possible, the slowness in
movement of beef on the hoof (about four kilometers an hour). As has
been shown, the park with the meat train can be operated seventy-five
kilometers behind the troops. This is about three days' march under the
most favorable conditions for the troops. When a rapid advance is under-
taken a portion of the personnel of the cattle park is sent forward to a
point farther advanced, and cattle are shipped in and held in anticipation.
RATIONS OF FOREIGN ARMIES 713
of the arrival of the remainder of the personnel. When all the cattle have
been slaughtered at the first place, the tools and equipment are loaded in
an autotruck and sent forward to the new position. Thus, within a few
hours the park can be advanced, if necessary, three days' march. The
corps meat train is the only corps train to which autotrucks are regularly
assigned. The autotruck in this case is a "transportation unit" pure and
simple and does not provide the means for transporting a "rolling
reserve." The rolling reserve of meat is carried in the corps supply train.
The corps supply train carries two days' strong ration and two days'
oats. The load consists of the following supplies :
Salt 2 days
Dried vegetables 1 day
Rice 1 "
Sugar (1 day's strong and 1 day's reserve ration) . . 2 days
Coffee (1 day's strong and 1 day's reserve ration) . . 2 "
FIGURES UPON WHICH ALLOWANCES OF TRANSPORTATION FOR
RATIONS ARE BASED
The net weight of the reserve ration, not including brandy, is 1.6852 pounds.
The net weight of the strong ration, with field bread, canned meat, potage sale,
and not including spirits, is 2.6972 pounds.
The net weight of the strong ration without meat and spirits, and including lard,
is 1.9932 pounds.
Great Britain. "The ration of the British soldier, in garrison, consists
of 1G ounces of bread, 12 ounces of meat, and such additional articles
(vegetables, groceries) as are purchased out of a daily allowance of seven
cents. During maneuvers the meat is increased to 16 ounces.
"In the field, his ration varies according to climate and the character
of his work ; it generally consists of 1C ounces of salted or preserved meat,
or 16 to 20 ounces of fresh meat; 20 ounces of fresh bread or 16 ounces
of hard bread or flour; 1 ounce of compressed vegetables, or 8 ounces of
potatoes (or other fresh vegetables), or 2 ounces of rice (or split peas),
or 4 ounces of onions ; coffee, tea or chocolate, sugar and the usual condi-
ments. Two ounces of spirits and some tobacco may also be allowed" (4).
An emergency ration is provided in the British army, for use only
when no other food is procurable and when authorized by the command-
ing officer. It is contained in a flat can and consists of chocolate, sugar
and protein in the form of "plasmon," weighing 6 ounces net. Accord-
ing to Langworthy, its proximate principles average: protein 59 grams,
fat 50 grams, and carbohydrates 65 grams, with fuel value of 973 cal-
714 ARMY AND NAVY RATIONS
ories. This ration, like the United States emergency ration, is relatively
too rich in protein and deficient in carbohydrates.
According to the "Times History of the War," the ration of the Eng-
lish soldier at the beginning of the present war was:
\}<i pounds biscuit
1 pound fresh meat or 1 pound tinned meat
4 ounces jam
3 ounces sugar
3 ounces desiccated vegetables
% ounce tea
YZ ounce coffee
y% ounce pepper
Y% ounce salt
At the outbreak of the war, the ration was increased by an addition of
good bacon, 4 ounces, and cheese, 3 ounces; six months later, the meat*
ration was increased to 1| pounds of fresh meat and a more liberal allow-
ance of tea was permitted ; occasionally, \ of a tin of condensed milk is
given in place of the extra \ pound of meat*
Systems of Supply. In France, the bread and a trifle of sugar and
coffee are supplied in kind, the rest being supplied by the war depart-
ment, and gardens are an essential part of the scheme. In Italy the food
is supplied on the same basis as the clothing allowance in the United
States army that is, so much money per day is allotted to each soldier,
and if he is supplied in kind, so much money is deducted from his
account. In Austria only, bread is supplied in times of peace, and a daily
allowance of money given to purchase the rest, somewhat as in France.
In Russia, bread and meat are supplied in kind, but a money allowance
is given for other things and for extra meat. In Spain, bread only is
supplied, as in Germany, and the rest is charged up against the soldier's
pay, as in England. These systems are all very well in countries where
the soldiers live in thickly settled districts, where they have opportunities
to buy such things as they want, but would be totally unsuitable for the
frontier in our country ; hence, the United States is the only nation com-
pelled to supply the soldier's whole food.
At the commencement of the United States Civil War the supplies
to be carried by the troops were prescribed in General Orders, which pro-
vided that in ordinary marches, where the men could receive daily issues
from the trains, they should carry only two days' rations; but in the
immediate vicinity of the enemy, and where the exigencies of the service
rendered it necessary to move without baggage or trains, they were
required to carry from eight to twelve days' rations. In the Spanish-
RATIONS OF FOREIGN ARMIES
715
American War, the General Orders did not prescribe the number of days'
rations to be carried by the men.
In the German army, foot troops, horse and field artillery, and train,
carry three days' "iron" rations, the cavalry one day's. The German
"iron ration" consists of hard bread, 9 ounces ; preserved meat or bacon,
7 ounces ; vegetables, 3^ ounces ; coffee, f- ounce. Total weight, including
packing, 1 pound, 10 ounces; three days' rations, 4 pounds, 14 ounces.
In the French army the cavalry carry one day's bread, preserved meat
and groceries, and all other troops two days'. This ration consists of
bread, about 33 ounces ; preserved meat, about 9 ounces ; groceries, about
5^ ounces. Total weight, 47^ ounces, or about 3 pounds.
In the Russian army the infantry carry 2| days' hard bread in their
haversack ; the cavalry and horse artillery, 1^ days' ; field artillery and
sappers, 3 days'. The hard bread ration consists of 1 pound 13 ounces;
2| days', therefore, would be about 4^ pounds.
The United States Field Service Regulations provide for the min-
imum to be carried on the man or horse 1 emergency ration and 1 field
ration. Weight: 1 field ration, 2.92 pounds net, 3.64 pounds gross;
1 emergency ration, 1 pound net, 1.25 pounds gross; total, 4.89 pounds
gross, or nearly 5 pounds.
COMPARATIVE RATIONS OF THE ARMIES OF THE WORLD
Below aro given the rations of the soldiers of the leading armies of
the world, both in times of peace and war. According to Colonel Wood-
ruff, when these are compared with the ration of the soldier in the United
States army, it will be seen that our men are better fed than men in any
other army of the world :
COMPARATIVE RATIONS OF THE LEADING ARMIES OF THE WORLD
DAILY RATION OF THE AUSTRIAN SOLDIER
Peace
Ounces
War
Ounces
Meat . .
6%
Meat
9^
Bread
30 %
Or salt meat or bacon. . .
6
Or biscuit
17%
Biscuit
314
Flour
6%
Flour
26 K
Or groats or barley
1 A
Vegetables
5
Or potatoes
20
Potatoes
9
Rice
3%
Peas or beans
5M
Sauerkraut
5 1 A
Or potatoes
Butter or fat
%
Butter or fat
If
Sugar . .
%
Coffee
y.
716 ARMY AND NAVY RATIONS
COMPARATIVE RATIONS OF THE LEADING ARMIES OF THE
WORLD Continued
DAILY RATION OF THE ENGLISH SOLDIER
Peace
Ounces
War
Ounces
Meat, fish, bacon, or liver.. .
12
Meat, fresh
16 or 20
Bread
16
Or preserved. .
20
Vegetables
4
Bread. .
20
Potatoes
12
Or biscuits
16
Milk
5
Vegetables fresh
16
Sugar
2
Or compressed.
1
Butter
1
Peas or beans in lieu of
Peas or beans, in lieu of
vegetables . .
3
vegetables
\*A
Sugar
3
Lime-juice
1
Cheese
2 to 3
Salt, }/%, tea, ^ or coffee. . .
Tea, 1 A', coffee or cocoa. . .
Pickles, occasionally
Rum, when necessary
DAILY RATION OF THE FRENCH SOLDIER
Peace
Ounces
War
Ounces
Meat
\N\Tjl \N\>
rH\i-?\ r4\i-<\
O O 1-H CO<N
I-H <N <N
Meat.
26 jj
21
1
1
Bread
Bread. .
Or biscuits
Or biscuits
Vegetables, fresh
Vegetables, compressed
Butter
Butter
Other articles are paid for
by men out of their allow-
ance. Laveran estimates that
the ordinary peace ration
contains 124 grams protein
and 764 grams carbohydrate.
Rice
Sugar
Soup, condensed
DAILY RATION OF THE GERMAN SOLDIER
Peace
Garrison
Ounces
Field
Ounces
War
Ounces
Meat
&u
17}4
Meat. ...
13 u
Or bacon.. . .
4^
6
Or sausage
8%
Bread
26 y z
35 V*
Bread
26^
Or potatoes 1
53
71
Or potatoes
52
Oatmeal
4M
6K
Vegetables. . .
6
Rice
3V6
Rice or ground barley
1 A
Coffee
114
Coffee
1
Butter
1M
Brandy
3K
Or wine.. . .
17\4
Or beer
35
1 In lieu of potatoes, 12 ounces of peas or beans.
RATIONS OF FOREIGN ARM IKS 717
COMPARATIVE RATIONS OF THE LEADING ARMIES OF THE
WORLD Continued
ITALIAN RATION
Peace
Ounces
War
Meat
7 to 11
Bread, flour, or biscuit . . .
Bacon
32 y 2
$ 1 A
Rice
5%
Sugar
V\
Coffee. . .
1 A
Wine 1
8%
RATION OF THE JAPANESE SOLDIER
Peace
Ounces
War
Ounces
Rice
36
Meat (periodically)
16
Money allowed for other
Fresh fruit
20
necessaries.
Rice (daily).
36
Vegetables. . .
4
Bean sauce
2
Pickles or fruit. . . .
2
Sugar
Tea
4.
Japanese cake
8
Sake (spirit)
Cigarettes
20
DAILY RATION OF THE RUSSIAN SOLDIER
Peace
Ounces
War
Ounces
Meat
iy
Meat
iy
Flour or biscuit
26
Or ham
sy
Groats
4
Flour
29
Or peas or beans
Sugar
\i
Or potatoes.
2714
Tea. . .
Or turnips or carrots. . .
35
Butter
V
Or cabbage
50
Peas or beans
5
Groats
Variable as in peace
ration.
i See footnote, page 683. We do not think it wise to allow whiskey, beer, wine or
brandy as a component of the soldier's ration. Certainly no man having indulged in
alcoholic drinks should be permitted to engage in the work of aviation, nor allowed to
participate in the handling of large and expensive guns. There has been a great
revolution of sentiment regarding the use of alcohol since the besrinaing of the Great
European War.
718 ARMY AND NAVY RATIONS
DIET IN PRISON CAMPS
Dr. B. W. Caldwell, of the American Red Cross, 1 after an investiga-
tion of European prison camps, in writing on the subject in The Military
Surgeon(~L2) , says that the only emergency not carefully thought out and
for which every detail of preparation was not arranged by the General
Staffs of the belligerent armies was the treatment of the prisoner of war.
After describing the conditions of the prisoners and the prison camps and
the precautions taken to put both in a sanitary condition, he describes the
kitchens attached to the camps as well constructed and well equipped and
in excellent condition of cleanliness. He observed that the food furnished
the prisoners was limited in variety and insufficient in quantity and
largely vegetable in character, consisting of potatoes, carrots, cabbage,
turnips, beans, peas, lentils and other dehydrated vegetables; of meals
made from corn, soy beans and peas, of dried fruits and salt fish and small
rations of meat. Each prisoner was allowed coffee, and 300 grams of
bread per day. The unprepared food was found to be of very good qual-
ity, containing nothing deleterious. Necessity has always been the mother
of invention, and as the prisoners were without knives and forks, it
became necessary to prepare the ration in such a manner that it could be
served in large bowls and eaten with spoons. The Germans solved this
problem by cooking the different articles of the ration together, in large
cylindrical cookers, heated with coal, the cooking process being continued
until the whole mass was soft and in a condition to be eaten with a spoon.
It was well seasoned and fairly palatable, but did not afford the variety
in preparation or ingredients, nor was the quantity sufficient, for a well-
balanced diet, as will be seen by examining the following actual dietaries
at different prison camps:
TRANSLATION FROM ORIGINAL MENU OF THE PRISONERS'
KITCHEN AT CAMP MUNSTER
(November 22d to 28th, 1915)
MONDAY
Breakfast: Corn mush, 100 grams; evaporated milk, 10 grams; sugar, 10 grams;
bread, 100 grams.
Dinner: Beans, 200 grams; potatoes, 600 grams; lard, 10 grams; bread, 100
grams.
1 Dr. Caldwell, at the request of the Ambassador of the United States at Berlin,
with the official approval of the German Government, made a thorough inspection
of the Prison Camps at Miinster, Wittenberg, Altdam and Giiterslohe during the
month of November, 1915. He was at that time Director of the Red Cross Sanitary
Mission to these Prison Camps. The facts here so clearly and dispassionately set
forth are thus at once authentic and official.
719
Supper: Potatoes, 400 grams; Swedish turnips, 400 grams; lard, 5 grams;
bread, 100 grams.
TUESDAY
Breakfast: Coffee as on Sunday; bread, 100 grams.
Dinner: Carrots, 500 grams; potatoes, 600 grams; beef, 120 grams; bread,
100 grams.
Supper: Potatoes, 400 grams; chestnuts, 150 grams; sugar, 10 grams; bread,
100 grams.
WEDNESDAY
Breakfast: Barley, 50 grams; meal of rolled potatoes, 50 grams; lard, 5 grams;
bread, 100 grams.
Dinner: Swedish turnips, 500 grams; potatoes, 500 grams; corned beef, 100
grams; lard, 5 grams; bread, 100 grams.
Supper: Potatoes, 400 grams; sausage, 100 grains; sauerkraut, 300 grams;
bread, 100 grams.
THURSDAY
Breakfast: Coffee as on Sunday; bread, 100 grams.
Dinner: Codfish, 200 grams; cabbage, 400 grams; potatoes, 600 grams; potato
meal, 10 grams; oleomargarine, 10 grams; onions, 10 grams; spices
as needed; bread, 100 grams.
Supper: Potatoes, 400 grams; carrots, 500 grams; bread, 100 grams.
FRIDAY
Breakfast: Rolled potato meal, 100 grams; evaporated milk, 10 grams; bread,
100 grams.
Dinner: Flour, soy bean, 120 grams; potatoes, 600 grams; onions, 10 grams;
lard, 10 grams; bread, 100 grams.
Supper: Potato salad and potatoes, 500 grams; oil of soy bean, 500 grams;
vinegar, according to need; one herring; bread, 100 grams.
SATURDAY
Breakfast: Coffee as on Sunday; bread, 100 grams.
Dinner: Dried peas, 150 grams; potatoes, 600 grams; bacon, 30 grams; bread,
100 grams.
Supper: Potatoes, 400 grams; dried vegetable, 30 grams; lard, 5 grams; bread,
100 grams.
SUNDAY
Breakfast: Coffee, 5 grams; coffee substitute (Zusatz), 3 grams; sugar, 30 grams;
bread, 100 grams.
Dinner: Potatoes, 600 grams; cabbage, 500 grams; Cassel spare ribs, 100
grams; lard, 5 grams; bread, 100 grams.
Supper: Potatoes, 400 grams; cheese, 80 grams; bread, 100 grams.
MENU OF THE WAR PRISONERS' KITCHEN, OFFICERS' SECTION
AT GUTERSLOHE
(November 22d to 28th, 1915}
MONDAY
Breakfast: Coffee, 20 grams; coffee substitute (Zusatz), 10 grams; milk, 60
grams; bread, 100 grams; marmalade, 50 grams.
720 AKMY AND NAVY RATIONS
Dinner: Barley (soup), 150 grams; potatoes, 750 grams; beef (boiled), 125
grams; bread, 100 grams; lard and flour each, 20 grams.
Supper: Oat-flake porridge with prunes, 500 grams; tea, 5 grams; sugar, 25
grams; bread, 100 grams.
TUESDAY
Breakfast: Same as Monday.
Dinner: Carrots, 150 grams; potatoes, 750 grams; pork (roast), 110 grams;
bread, 100 grams; lard and flour each, 20 grams.
Supper: Liver sausage, 90 grams; tea, 5 grams; sugar, 25 grams; bread, 100
grams.
WEDNESDAY
Breakfast: Same as Monday.
Dinner: Swedish turnips, 150 grams; potatoes, 750 grams; veal (roast), 125
grams; bread, 100 grams; lard and flour each, 20 grams.
Supper: Porridge with milk, 500 grams; tea, 5 grams; sugar, 25 grams; bread,
100 grams.
THURSDAY
Breakfast: Same as Monday.
Dinner: Cabbage, 150 grams; potatoes, 750 grams; mutton, 125 grams; bread,
100 grams; lard and flour each, 20 grams.
Supper: Salt herring with boiled potatoes in jackets, 500 grams; tea, 5 grams;
sugar, 25 grams; bread, 100 grams.
FRIDAY
Breakfast: Same as Monday.
Dinner: Meat, 125 grams; potatoes, 750 grams; mustard gravy, 100 grams;
bread, 100 grams; mustard, 10 grams; lard and flour each, 20 grams.
Supper: Liver sausage, 90 grams; tea, 5 grams; sugar, 25 grams; bread, 100
grams.
SATURDAY
Breakfast: Same as Monday.
Dinner: Red cabbage, 150 grams; potatoes, 750 grams; bologna sausage, 125
grams; bread, 100 grams; lard and flour each, 20 grams.
Supper: Pea soup with boiled pig's ears, 500 grams; tea, 5 grams; sugar, 25
grams; bread, 100 grams.
SUNDAY
Breakfast: Same as Monday.
Dinner: Roast of veal, 125 grams; potatoes, 750 grams; compote, 100 grams;
bread, 100 grams; lard and flour each, 20 grams.
Supper: Holland cheese, 90 grams; tea, 5 grams; sugar, 25 grams; bread, 100
grams.
Alonzo E. Taylor, M.D., writing in the Journal of the American Med-
ical Association, Nov. 10, 1917, on the "Diet of Prisoners of War in Ger-
many," says that early in the war prisoners subsisted on rations furnished
on contracts. The contract system was later abandoned and the German
government regimen was issued in the spring of 1915. The ration pro-
DIET IN PRISON CAMPS
721
vided German prisoners contained protein, 85 grams ; fats, 40 grams ; and
carbohydrates, 475 grams ; with a total fuel value of 2,700 calories. In
June, 1916, the ration was as follows: protein, 89 grams; fat, 30 grams;
and carbohydrates, 510 grams; with a total fuel value of 2,700 calories.
WEEKLY DIET SHEET TYPICAL OF PERIOD PRIOR TO STRINGENCY
IN FOODSTUFFS 1
Bread 2,100
Flour 270
Meat 300
Fish 300
Herring 150
Potatoes 9,000
Vegetables 1,800
Skim milk 400
Sausage 200
Cheese 100
Nutrient yeast 40
Gm. Ounces. Gm. Ounces.
75 Sugar 200 7.1
9.6 Legumes 150 5.3
10.7 Fat 70 2.5
10.7 Maise grease 180 6.4
5.3 Pearl barley 100 3.5
321 Dried fruit 50 1.8
65 Marmalade 100 3.5
14 Tea 16 0.5
7 Spices, herbs 30 11.1
3.5 Cocoa 40 1.4
1.4
Per diem: protein, 89 gm.; fat, 30 gm.; carbohydrate, 510 gm. ; calories, 2,740.
WEEKLY DIET SHEET TYPICAL OF PERIOD OF STRINGENCY IN
FOODSTUFFS 2
Gm. Ounces.
Gm. Ounces.
Bread 2,100
Flour
50
1.7 Fat
Meat 200
Sausage 200
Fish 325
Potatoes 3,500
Vegetables 1,650
Skim milk 500
Cheese 100
Nutrient yeast 20
Sugar 130
Mustard
150
65
7 Maise grease 100
7 Pearl barley 60
11 Fruit 300
125 Marmalade 100
59 Tea 4
17 Coffee 6
3.5 Chicory 15
0.7 Cocoa 40
4.8 Spices and herbs 20
50 1.7
5.3
2.3
3.5
2.1
10.7
3.5
0.15
0.21
0.5
1.5
0.7
2 Per diem: protein, 57 gm. ; fat, 21 gm.; carbohydrate, 310 gm.; calories, 1,720.
Tho above two diet sheets, says Taylor, serve to illustrate the sub-
sistence in the German prisoner of war camps. The first is typical of the
beginning of food stringency, and the second serves as a contrast of the
722 ARMY AND NAVY RATIONS
present deplorable shortage of foodstuffs. Taylor points out from these
figures the necessity of our government taking cognizance of the food
conditions in Germany, and suggests that steps be taken to organize ways
and means to feed Americans who may be taken prisoners of war by
Germany.
CONCLUSIONS REGARDING THE COMPOSITION AND FOOD
VALUE OP THE MILITARY RATION (HARVARD) (4)
"We have previously stated, on good grounds, that an adult man weigh-
ing 154 pounds is in better physical condition, stronger, and capable of
greater endurance, with a ration yielding 2,800 calories, especially if the
proteins are kept within a maximum of 60 grams, than with one greatly
exceeding this value. But we have seen that in our service, as in all other
leading countries, the soldier's ration exceeds these limits in the number
of calories, which range from 3,000 to 5,000, but especially in the amount
of proteins (Japanese excepted), which hardly ever fall below 100 and
often range up to 160 or more grams. There is no indication, therefore,
that in this country or in Europe the soldier is underfed, provided he
actually receives the ration called for by military regulations.
"Much has been written on the necessity of feeding the soldier well and
much attention and study have been devoted to the composition of ade-
quate rations. That he should be sufficiently and properly fed, needs no
discussion, but the belief generally entertained that the more he eats the
greater is his energy and efficiency is groundless and mischievous. The
danger of overeating has been too much overlooked, or else esteemed a
negligible factor. It is the opinion of many careful observers that the
American soldier is much more likely to be overfed than underfed, and
that his health and efficiency stand in greater peril from excess than from
lack of food. As a general rule, the soldier does not know how to regu-
late his appetite, nor does he appreciate the necessity of doing so. He eats
what is allowed him hurriedly and often without proper mastication, and
between meals frequently patronizes the lunch counter of the post
exchange or the outside shop where pies and other tempting pastry are
displayed. This is characteristic of the soldiers of all countries, particu-
larly of those who receive the most liberal rations. Thus, the remarks of
Rouget and Dopter, in their 'Hygiene Militaire,' although aimed at their
countrymen, are of very general application. 'Many Frenchmen, espe-
cially in the country, have the pernicious habit not to cease eating until
CONCLUSIONS REGARDING MILITARY RATIONS 723
they experience a sensation of fullness in the stomach. Little do they care
about the nutritive value of the food ingested. Their conviction is that,
so long as this abdominal repletion is not distinctly felt, they have not
been sufficiently fed. This is particularly observed each year at the time
of the incorporation of the new contingent. The amount of bread in the
ration, although considerable, is not enough to satiate these young sol-
diers ; they buy more from outside bakeries/
"It should be remembered that within an hour or two after taking a
full meal, at least a pint of gastric juice is poured into the stomach and
added to its contents, so that what was at first mere repletion may become
uncomfortable distcntion. Soldiers should be advised that a sensation of
fullness or distention following a meal is a clear admonition that they
have eaten too much, and that if such excess is kept up, as a habit, they
will surely suffer in health and efficiency. Such advice may do good, but
more practical results will follow if the food, especially the meat, as
served in the mess-room, is simply sufficient and not wastefully abun-
dant.
"Experience shows that it is while actively engaged in the field, when
the rations are reduced and the cooking simple, that the men enjoy the
best health and show most endurance, provided, of course, there is no
actual lack of food. Thus, during the active part of the Santiago cam-
paign in 1898, there was but little sickness in spite of the trying climate
and of short commissary supplies, but as soon as the work was over and
rations became abundant, the morbidity began to rise and before long
exceeded seventy-five per cent of the command. It is hard to resist the
conviction that injudicious feeding was responsible for many of the cases
of 'undetermined fever,' and prepared the way for much of the malaria
which prevailed in our camps near Santiago, as well as of the typhoid
fever which decimated our troops in the United States. It is noteworthy
that the Spanish soldiers in Santiago, although reduced to very scant
rations of poor quality, had a much smaller proportion of sick than the
American troops.
"During the Boer War in South Africa, the English troops besieged
in Lady smith were fed for several months, according to Dunlop, on a
ration of 73 grams of protein, 69 of fat, and 141 of carbohydrates, with
fuel value of only 1,527 calories, but which, as remarked by Munson, fur-
nished energy enough for a stout and successful resistance. The Russo-
Japanese War has taught us an important lesson in dietetics. Both
Russians and Japanese had meat rations much smaller than those pro-
vided for American, English and French soldiers ; the meat ration of the
724 AKMY AND NAVY RATIONS
Japanese, in particular, was decidedly meager and often lacking altogether.
Yet we know that no armies, during an arduous war of twenty months,
ever suffered so little from infectious diseases and had fewer men inca-
pacitated from sickness. To what extent this immunity is due to the
food can only be conjectured. It certainly cannot be attributed exclu-
sively to the sanitary measures taken, for it was the opinion of the Amer-
ican and English attaches with both armies, that had their own troops
been placed under similar conditions, but fed with their own rations,
typhoid fever would undoubtedly have prevailed among them in an epi-
demic form. 1 It is true that the Japanese suffered much from beriberi
during this war, a disease known to be due to an excess of rice combined
with a deficiency of protein, but there is no doubt that it would have been
entirely prevented had the Japanese soldier received one-half of the pro-
tein component called for by the ration of the United States soldier.
"Surgeon Tsui of the Chinese army(13) states that, in Northern
China, the country laborers from whom the army is mostly recruited, men
of fine physique and most remarkable power of endurance, live almost
exclusively on a vegetable diet. The Chinese soldier receives meat only
twice a month. The rates of sickness and death in the Chinese army,
according to this trustworthy authority, are much lower than in our
army.
"Formerly, the price of savings made from the ration and paid by the
Quartermaster Corps to the organization commander, could be expended
by the latter in any way deemed most advantageous to the organization,
that is, not only in the purchase of other kinds of food, but of any arti-
cles intended for the comfort and enjoyment of the men, such as games,
sporting goods, etc. Under existing regulations, money received as bal-
ance of the 'ration and savings account' can be spent only for food. It
follows that the company commander has no longer any discretion in regu-
lating the amount of food consumed by his men, but is expected to expend
the entire money value of the ration in the purchase of foodstuffs."
Colonel Harvard (4) cannot commend this change. He believes that the
former system, whereby the company commander was allowed discretion
in regulating the quantity as well as the quality of the food, was better
calculated to safeguard the health and comfort of his men.
NAVY RATIONS
During recent years much attention has been given to the selection and
preparation of the ration for the United States sailor. In former days,
1 1 question this statement. G. N. K.
NAVY RATIONS 725
it was a notorious fact that the character of the food on board ship was
monotonous, uninviting and led to nutritional disorders. In the present
navy ration, according to the Revised Statutes, x the following allowances
of provision constitute the daily ration:
1 pound hard bread (biscuits); or 1J^ pounds fresh bread; or 1^ pounds flour
1 pound tinned meat; or 1 J4 pounds of salt meat; or 1% pounds smoked meat;
or \y pounds fresh meat; or 1% pounds fresh fish; or 8 eggs; or 1% pounds
poultry
% pound tinned vegetables; or 1% pounds fresh vegetables; or 3 gills beans or
peas; or y% pound rice or other cereal
2 ounces coffee; or 2 ounces cocoa; or J^ ounce tea
1 ounce evaporated milk; or Vie quart fresh milk
Vie pound dried fruit; or % pound tinned fruit; or Vie pound fresh fruit (one
ration of fruit is allowed with each ration of beans, peas, rice and other starch
foods and canned vegetables issued)
2 ounces butter
4 ounces sugar
7 ounces lard for every 100 pounds flour used as bread
The weekly ration consists in addition of the following:
^ pound cheese M pound salt
% " macaroni J4 pint sirup
Vs2 " pepper Vm pound spices
J4 " pickles J4 pound tomatoes (canned)
Vs2 " mustard % pint vinegar or oil
Yeast, baking powder and flavoring extracts as required
In addition to the foregoing, the following issues are allowed to men
of the engineer and dynamo force standing watch under steam between
the hours of 8 P.M. and 8 A.M.
4 ounces hard bread or its equivalent
1 ounce coffee
4 ounces tinned meat or its equivalent
2 " sugar
The following substitution for the components of the ration may be
made when deemed necessary by the senior officer present in command.
Articles of combined ration components will be regarded as ration equiv-
alents and issued in accordance with the following table 2 :
1 Naval Act of June 29, 1906, and March 2, 1907.
2 Memo. No. 74, Navy Dept., Sept. 1, 1915. For the guidance of officers, beginning
with the second quarter of the year 1916.
146
726
ARMY AND NAVY RATIONS
NAVY RATIONS AND COMPONENTS
Components
Ration
allowance
Components
Ration
allowance
Bread:
Biscuit
1 pound
Meat: (Continued)
Crackers:
Soda
1 "
Hamburger steak
Chicken
1 % pounds
1 3x-
Oyster
1 "
Fowl
1 3X-
Bread, fresh:
Turkey
IM
Wheat
1 14 pounds
Fish, fresh
1% "
Graham..
\y "
Eggs.. .
8 (number)
Rolls
IJi
Flour:
Wheat
1J^
Vegetables:
Dried:
Graham
1^
Buckwheat
iy 8 u
3 <rill
Corn meal
iy s "
q u
Kidney
3
Meat:
Peas, split
3 "
Preserved:
Tinned:
Bacon
1 pound
Canned:
Corned beef
1 "
Beans:
Lima
% pound
Chipped beef
1 "
String
% "
Codfish and haddock
1 "
Corn
% "
fealmon
1 "
Peas
M "
oardines. ...
1 "
Tomatoes
M "
Sausage (Vienna).. .
1 "
Pumpkin
% "
Luncheon meat
Beets
% "
Salt:
Corned beef, fresh. . . .
Salt pork
1 l /i pounds
l*A "
Fresh:
Turnips
1 5^ pounds
Salt mackerel
1M "
Carrots
I*/
Smoked:
Tomatoes
1% "
Bacon, sugar cured and
Beets
IH a
smoked
IM "
Onions, green. . .
IM "
Ham, sugar cured and
Squash.. . ...
IM "
smoked
IM *
Pumpkin. ....
IM "
Shoulder, sugar cured
String beans
1%
smoked
IM "
Peas, green, in pod. . .
1%
Sausage, frankfurters.
Sausage, bologna
IK
IM "
Corn, green, sugar, on
cob, in husk
IM "
Tongues, beef..
IM "
Spinach
1% "
Fresh:
Cauliflower
\H
Beef
1%
Lettuce.
1% u
Mutton
1% *
Cucumbers
1M "
Pork
IM "
Celery
IM "
Veal
i% u
Radishes
IM "
Sausage, pork
1% u
Rhubarb .
\% "
Liver, beef
IM "
Parsnips. . .
IM "
NAVY RATIONS
NAVY RATIONS AND COMPONENTS Continued
727
Components
Ration
allowance
Components
Ration
allowance
Vegetables: (Continued)
Fresh : ( C ontinued)
X
" T3
3333 3333 3 3 s s s 53 333333 333333 333 33333333
ao
a
V* ^C \jj< \j* VjtVfVitVC \N\cq\N\N\N\N \2\S3\JS\2\2\2 \po\oo\po\oo\oo\oo \ao\po\oo \S\2\g\S\3\2\S\J3
co\ co\ \ \ cc\ M\ M\ M\ i-i\ \ i-f\ r^\ t-\ -N e5\\M\ <\ ef\ \ s-J\ e*\ etf\ eo\ w\ eo\ e-i\ co\ eo\ o>\ci\e>\o\o>\o>\c>\Ci\
Fruit: (Continued)
Fresh : (Continued)
Plums. . . ....
% pound
/MS
/K
l /8
V32 *
%> quart
As needed
u u
% pt. weekly
% " "
li lb. daily
As needed
u u
7 Ibs. to every
100 Ibs. flour
as bread
As lard sub-
stitute in the
proportion
of 1 gal. to
10 pounds
lard
1 A lb. weekly
1/32
Yt " "
t / U
H
1 A pt. "
\l jjj
\i " daily
As needed
}<i lb. weekly
Peppers, green and red
Asparagus
Grapefruit.. .
Pineapple .
Parsley
Apples
Potatoes:
Irish
Bananas. . .
Lemons
Sweet
Oranges
Onions
Beverages :
Coffee
Cabbage
Cereals and starch foods :
Rice
Cocoa
Tea
Milk:
Evaporated
Cornstarch
Barley
Fresh
Hominy
Extracts, flavoring:
Vanilla
Oats, rolled
Tapioca
Lemon
Fruit:
Dried:
Apples
Vinegar and sauces:
Vinegar
Oil, salad..
Citron
Sauce, Worcestershire.. .
Catsup .
Currants
Cocoanut, shredded . .
Peaches
Butter
Cheese.
Raisins
Baking powder
Canned :
Baking soda
Hops
Lard
Peaches
Oil, cottonseed
Pears
Prunes
Macaroni and vermicelli . .
Mustard
Preserved :
Jams
Apple butter
Mincemeat
Fresh:
Peaches
Pepper, black and cayenne
Pickles and sauerkraut. . . .
Salt
Pears
Cherries
Grapes
Svrup. .
Berries, all kinds. .
Spices, assorted
Cranberries..
Suear.
Watermelon
Yeast
Cantaloupe
Tomatoes . .
728
The extra allowance of
2 ounces sugar
4 ounces hard bread or its equivalent
1 ounce coffee or cocoa
4 ounces preserved meat or its equivalent
is allowed to enlisted men of the engineer and dynamo force who stand
night watches between eight o'clock P.M. and 8 o'clock A.M., under steam.
According to provisions promulgated by the Secretary of the Navy 1
any article comprised in the navy ration may be issued in excess of the
authorized quantity provided there is an under-issue of the same value
in some other article or articles of food.
Gatewood, in discussing navy rations, says :
Contentment in naval service in relation to food and water makes for good
discipline, and work without contentment is impossible. Contentment facilitates
voluntary enlistment, and a service that supplied protein food in amounts exactly
to meet the requirements of the body as evolved from the mathematics of nitro-
genous equilibrium would not secure contentment. That is the basis of the daily
amounts of food in the navy ration, the amounts depending essentially not upon
what it is thought men ought to eat, but upon what experience has demonstrated
they desire to eat.
The navy ration has been particularly studied and carefully arranged
from the point of view of efficient service. The variety and components
permit of sufficient elasticity to prevent monotony in the dietary. The
selection of food is of great moment and with the aid of preserved and
canned meats, fruits and vegetables, quite a variety in the dietary can
be furnished aboard ship. The ration aboard ship will vary according to
climatic conditions. The dietary in tropical countries will be different
from that in cooler regions. Appetite and digestion are influenced more
or less by changing temperatures and humidity. It is also quite probable
that the efferent nerve supply on the surface of the body reacts to external
climatic influences and exerts a retarding effect upon metabolism. Pre-
cise information as to the energy or nutritive value of the navy ration is
not readily obtainable without carefully taking into account whether the
energy or fuel value should be reckoned on the ration as issued, or as con-
sumed. Surgeon Gatewood, U. S. ~N., worked out a table showing the
comparative average energy values of the ration of the United States navy
as contrasted with those of the navies of other nations. He summed up
the subject in the following table, showing the various percentage
Naval Act, March 2d, 1907.
NAVY RATIONS
729
elements of the dietary ingested and digested and the actual energy or
caloric values of each :
COMPARATIVE NUTRITIVE ENERGY OF AMERICAN AND FOREIGN
NAVY RATIONS
NAVAL DIETARIES
EATEN
DIGESTIBLE
Pro-
tein
Fat
Car-
bohy-
drates
Pro-
tein
Fat
Car-
bohy-
drates
Utiliz-
able
energy
Nutri-
tive
ratio
1. U. S. Navy (sea ration) .
2. U. S. Navy (fresh pro-
visions)
Gm.
138
145
142
182
126
170
184
127
175
Gm.
269
135
192
218
56
34
35
110
149
Gm.
556
444
492
624
607
524
608
601
728
Gm.
127
134
131
168
116
156
169
117
161
Gm.
256
129
183
207
53
32
33
104
141
Gm.
540
431
478
606
589
508
590
583
706
Gals.
5,180
3,563
4,256
5,174
3,430
3,078
3,407
3,891
4,938
1
8.7
5.3
6.7
6.3
6.1
3.7
3.9
7.2
6.6
3. U. S. Navy (usual)
4. U. S. Navy (engineer
force)
5 . Japanese Navy (average)
6. French Navy (average).
7. French Navy (engineer
force)
8. British Navy (average).
9. British Navy (engineer
force)
The estimates in Gatewood's table concerning the percentage elements
of the ration of the French navy must he accepted with a little reserva-
tion, since it is not clear whether all the necessary factors have been
included or whether correct allowance has been made for waste. It may
be that the ration is given as issued and not as consumed. The percentage
elements recorded for the Japanese navy seem to be rather low, but it
must be taken into consideration that the weight of the average enlisted
man in the Japanese navy is only about 129 pounds. It will be seen from
the examination of this table that the average sailor in the United States
navy consumes daily, 142 grams of protein, 193 grams of fat, and 492
grams of carbohydrates, yielding a fuel value of 4,256 calories. The
engineer force receives an additional issue of 42 grams of protein, 24
grams of fat, and 122 grams of carbohydrates. This allowance gives the
engineer force more protein than is given in Atwater's Standards for 'a
man at hard muscular labor.
In arranging the navy ration, several points of view must be taken
730 AEMY AND NAVY RATIONS
into consideration. First, the ration must be what the sailor should have,
and second, it ought to be what he wants. The availability of the ration,
its keeping qualities and its storage are also matters to be carefully con-
sidered. Again, the all important question of securing an aliment which
will yield the proper amount of nutriment within a fixed daily cost per
capita must be taken into consideration. These and. many other pertinent
questions have been very carefully and satisfactorily considered in an
excellent article by Surgeon J. D. Gatewood of the United States navy in
his work on "Naval Hygiene."
The United States navy, by authority of its secretary, has issued a
"General Mess Manual and Cook Book" 1 for use on board vessels of the
United States navy, which gives much interesting data concerning the
organization and administration and general management of the Commis-
sary of the United States navy.
PART I. THE GENERAL MESS
Organization and Administration. 1. The general messing system is, by
regulations, obligatory on board of all vessels of the Navy. The mess must
include all enlisted men of the Navy and Marine Corps, except chief petty offi-
cers and officers' servants, and its members are to be divided into messes of about
twenty men each, and as nearly as possible messed by divisions instead of by
rations, as has heretofore been the custom. By this method the petty officers will
be scattered among the messes and there can be no complaint on account of dis-
crimination all faring alike.
2. A messman is to be detailed for each mess, and he is to receive the food
from the cooks at the galley, serve it at the mess table, and is responsible for the
care and the cleanliness of the mess gear and mess tables.
3. The chief commissary steward, or commissary steward, the cooks and
bakers, together with the storekeeper (when a store is established on the ship),
form the enlisted force of the commissary department. They are the assistants
of the pay officer and belong to the pay division.
4. The responsibility of the commissary and his assistants ceases with the
delivery of the food to the messman at the galley.
5. The established rate of pay being sufficient to secure the services of com-
petent and experienced men, the payment of any gratuity, either by the com-
missary or by the men themselves, to any person employed in the service of the
general mees is forbidden by the regulations.
6. The commanding officer should see that proper facilities, including such
boats and men as may be necessary, are afforded the commissary for getting mess
stores on board and stowing them.
Government Printing Office, Washington, D. C., 1904.
NAVY EATIONS 731
7. It should be thoroughly understood that the general mess is not an organ-
ization managed by its members, as was the "berth-deck mess."
8. In addition to the pay provided for enlisted men, the Government under-
takes to subsist them, and this it does at whatever expense may be necessary.
The fixed value of commutation for one ration is, by law, 30 cents, but the com-
mutation of rations is a privilege, not a right, and the idea prevalent among
enlisted men that they are entitled to receive just 30 cents' worth of food each
day or 30 cents in money, is erroneous. While the regulations limit commuta-
tion to one-fourth the total number of rations, they do not require any commuta-
tion at all, this being purely a question of desirability and business expediency
to be decided by the pay officer with the approval of the commanding officer.
9. Under the general messing system the Government subsists the men
entirely, and they have no more voice in the management of the commissary
department than in any other department of the ship. The Government, through
its authorized officer, provides them with the ration allowed by law. The food
is purchased, cooked, and served entirely at the Government expense, and its
value, whether it be more or less than 30 cents per diem per man, is a matter with
which the men themselves have nothing to do.
10. In case any man considers that he is improperly subsisted, he has the
right, which all persons in the Navy have, to state his grievance at the proper
time and place to his commanding officer, who should then cause the commissary
to investigate the matter, and, if the complaint is well founded, to take steps to
place the responsibility and to prevent a recurrence of the fault complained of.
11. The men are entitled to the full benefit of the money and stores allowed
for their subsistence, and no expenditure can be made from the general mess
fund, except for the benefit of the mess ; nor can any of this money or these stores
be withheld (when they can be used to advantage) and allowed to accumulate as
a surplus. In cases, however, where a surplus of either money or stores does
unavoidably exist when a ship is placed out of commission, the members of the
mess have no claim whatever to any part of it and it reverts to the Government,
the stores being taken up as a gain on issues and the money being credited to
the appropriation "Provisions, Navy."
12. Subsistence of enlisted men absent from the ship on duty will, when
practicable, be furnished by the general mess. When men are landed in large
numbers for an expedition or for going into camp with the expectation of being
absent from the ship for more than twenty-four hours, the paymaster's clerk or
the commissary steward, or both, according to the proportion of the ship's com-
pany landed and the importance of the expedition, together with such cooks and
bakers as may be necessary, and a sufficient number of messmen, should consti-
tute the commissary corps.
13. Special attention is invited to Articles 387, 391, 392, 753, and 1402, Navy
Regulations, as amended by General Orders 68, 105, and 119. It will be noted
that the board of audit is required to make its report to the commanding officer
monthly and in writing; its recommendations being based upon facts adduced in
the audit of the mess accounts, and confined to its financial feature alone.
732 AEMY AND NAVY RATIONS
The Commissary. 14. The pay officer of the ship, or, in ships having no
pay officer, an officer designated by the captain is the commissary, and is solely
responsible for the purchase and preparation of the food for the general mess,
the care of the stores, and the judicious expenditure of mess funds, keeping the
accounts of the mess and administering all its affairs except the serving of the
food at the mess table.
15. His authority in the performance of these duties is commensurate with
his responsibility, and all persons employed in the service of the general mess
are subject to his orders.
16. The commissary should frequently inspect the storerooms allotted to
the general mess and see that the stores are properly stowed and that the rooms
are dry and well ventilated. Any deterioration in the stores being a direct loss to
the mess, great care should be exercised in their selection, and no greater quantity
should be bought at one time than can be used within the period they may be
expected to keep in good condition.
17. The commissary should not permit any stores to be purchased until a list
of them has been submitted to him and carefully examined and approved. No
stores should be received on board unless accompanied by a bill or memorandum
by which they can be checked off; and before being stowed away all stores
should be carefully inspected by the commissary or the commissary steward. No
bills should be contracted that can not be paid from the funds in hand or by the
ration money that will accrue to the mess during the current month. All bills
should be settled at the end of each month, and always before the ship sails
from port.
18. The commissary should keep the cash accounts of the mess so that they
can be conveniently audited by the general inspector of the pay corps, the pay-
master of the fleet, or by the board appointed for the purpose. All expenditures
must be substantiated by vouchers, which are to be exhibited when the accounts
are inspected.
19. He should cause the commissary steward to keep a stock account which
should embrace all stores and all property of the general mess. The value of the
balance shown upon this stock account should be taken into consideration in mak-
ing up the statement of the financial condition of the mess.
20. The commissary should, when he deems it advisable, submit written re-
ports and recommendations to the captain regarding the general mess, and he
must do so whenever the interests of the mess require any change which he, him-
self, is not authorized to make.
21. The commissary should mark the enlisted men of his department in
proficiency in rating and should immediately report any inefficiency or careless-
ness in their performance of duty.
22. He should frequently inspect the food before it is delivered to the mess
men at the galley, and in case he finds it improperly prepared, should take steps
to prevent any further occurrence of the kind. If cooks are not thoroughly com-
NAVY KAT1ONS 733
petent, they 'Should be made to follow strictly the recipes in this book, and fla-
grant cases of incompetency should be reported.
The Commissary Stewards. 23. The chief commissary steward or commis-
sary steward is the chief petty officer in charge, under the commissary, of the
general mess. He is entitled to respect and obedience from all persons of inferior
rating while in the performance of his duties, and he is responsible for the proper
execution of the orders of the commissary. The daily bill of fare should be made
out by the commissary steward and submitted to the commissary, and the neces-
sary stores issued to the cooks at the galley. He should direct the manner of its
preparation and shall be in charge of the galley and the men employed at it, and
should frequently inspect the food before it is delivered to the messmen to be
served. He should see that the galley and all the galley utensils are kept in proper
condition, giving particular attention to their cleanliness.
24. He should report to the commissary daily, in writing, all purchases made
and debts contracted, and keep that officer advised of the needs of the mess. He
is to draw from the pay department, at the appointed time, such government
stores as are due the mess, and must keep an account of these stores for the veri-
fication of the provision return at the end of each quarter. When fresh provisions
are issued he should be on deck, when practicable, to receive them from the repre-
sentative of the pay department as soon as they have been received on board and
inspected. In case these fresh provisions, or any other stores issued to the mess
by the pay department are, in the opinion of the commissary steward, of inferior
quality and unfit for issue, he should report the matter to the commissary, who
shall make a personal investigation, and, in case he finds the objection well
founded, should take the necessary steps to provide other stores, as prescribed by
the regulations. An issuing book should be kept by the pay yeoman and signed
daily by the commissary steward, in order that no question may arise at the end
of the quarter as to the stores drawn by the general mess. The commissary
steward may, with the authority of the commissary, draw from the pay depart-
ment such government stores as are required in excess of the allowance, and
these stores shall be paid for from the mess fund at the end of each month.
The Cooks. 25. The senior cook, or, if there are two or more of the same
rating, one selected by the commissary, should be in immediate charge of the
galley and act in the capacity of head cook. He should be held strictly respon-
sible for the cleanliness of the galley and the utensils pertaining to it, for the
maintenance of discipline among his assistants, for the proper preparation of the
food, and for having the meals ready at the prescribed hours. He should per-
sonally superintend the cooking of all meals, and should carefully inspect all
food before it is delivered to the messmen. It is his duty to report to the com-
missary any inefficiency or neglect on the part of his assistants; otherwise the
entire blame for poor cooking or any other delinquency at the galley should rest
upon him. The head cook should keep the commissary steward informed as to
the requirements of the galley, and should from time to time prepare lists of arti-
cles required by him in his cooking, which are not included in the Navy ration.
He is responsible for the galley utensils and will report immediately when they
are lost or damaged.
734 ARMY AND NAVY RATIONS
26. The other cooks should, as far as possble, be assigned specific duties at
the galley in order that the responsibility for any neglect may readily be placed.
One should be detailed as "meat cook," another as "vegetable cook," and one man
should, in addition to other duties, be held responsible for the preparation of the
coffee and tea.
27. The cooks in the lower ratings should be detailed for starting fires, clean-
ing the galley and utensils (regular cleaning stations being assigned them) and
for preparing the food for cooking.
28. The organization of the force at the galley should be as complete and
efficient as that of a gun division.
The Bakers. 29. The commissary steward should issue to the baker such
quantities of flour and other ingredients as may be necessary for making bread
for the mess and keep him advised of the amount of bread required from day to
day.
30. The baker, or, in ships which are allowed two bakers, the baker first class,
is to be held responsible for the proper baking of the bread and for its delivery to
the messmen at the appointed times. He is also responsible for the condition of
the bake ovens and the utensils used by him.
PART II. THE COMMISSARY STORE
Establishment and Administration. 31. There being no public funds avail-
able for the establishment of a store on board ships of the Navy, such establish-
ment is not made compulsory, but is left to the discretion of the commanding
officer. The advantages of such a store are, however, so obvious and so great that
provision is made in the regulations for its administration in ships where it
exists, or may be established.
32. The objects of a commissary store are:
(1) To enable the men to purchase a better quality of the articles
usually obtained from bumboat men, and, at a lower price.
(2) To return directly to the men all profits from their purchases not
needed for carrying on the business.
(3) To bring under official control the sale of all merchandise on
board ship, and thus do away with bumboat men and peddlers,
and reduce the chances of liquor or other unauthorized articles
being brought on board. The sale of any merchandise on board
ship, except by the store, should be prohibited as far as prac-
ticable. Tailors, persons doing repairing, and those selling spe-
cial articles which cannot conveniently be handled by the store,
may be exempt from this prohibition, but dealers in milk, pies,
fruit, and such articles should not be allowed to sell to the men.
33. The commissary should make agreement with reliable merchants to sup-
ply to the store, while the ship is in port, such stores as are salable but cannot
be carried in stock, and these articles should be delivered to the storekeeper and
NAVY RATIONS 735
by him sold to the men at a very small advance. For example, if it be thought
advisable to have milk for sale in the store when the ship is in port, the commis-
sary should arrange with a dealer to place on board, at a specified time each day,
a quantity of milk at a fixed price, such quantity as may be sold to be paid for,
and the balance to be taken away by the dealer.
34. The stock being purchased from reliable firms at wholesale prices, will be
better in quality and lower in price than that usually carried by bumboats or
itinerant merchants. The greater part of the retail dealer's profit should revert
directly to the purchaser at the time he buys the article that is, the price charged
should be very little, if any, above the wholesale price. Such small profits as
may from time to time accrue shall be expended by the pay officer in such man-
ner as the commanding officer deems most conducive to the pleasure and comfort
of the enlisted men. No part of these profits, however, is under any circumstances
to be transferred to the general mess for the purpose of supplementing the
authorized ration.
35. In ships where the men desire to subscribe for the original stock of a
commissary store, and the commanding officer authorizes its establishment, the
commissary is, by the regulations, placed in charge of it. This officer is to re-
ceive voluntary subscriptions from the crew, giving them receipts (stated to be
not negotiable) for the amount subscribed, with the agreement that these receipts
may be surrendered and the amount of the subscription refunded after the
original stock has been paid for and the business is on a good financial basis.
The original subscribers, after they have been paid the amount of their subscrip-
tions, have no further claim upon, nor interest in, the store.
36. During this period it is advisable to make the prices correspond with
those of retail dealers in order that the store may be independent as soon as possi-
ble, but when all indebtedness has been discharged and the store is self-support-
ing, the profits should be reduced to a minimum, it being always borne in mind
that making money is not one of the objects of the store. The injustice of mak-
ing profits from sales to one set of men to be divided among another set at the
expiration of a cruise is manifest, and for this reason the regulations provide
that such profits be used to improve the bill of fare of the general mess, but
with the present ample ration no addition to the mess fund should be necessary;
and by reduction in prices from time to time, as experience dictates, the monthly
surplus should be reduced to a minimum, thus disposing of the regular retail
dealer's profit in the most equitable manner possible, i.e., by giving the benefit
of it to each purchaser in the form of a discount.
37. It is impracticable to operate a store unless a suitable room, used for
no other purpose and to which only the storekeeper has access, is available for the
purpose.
38. The commissary of the ship has charge of the ship's store. He is allowed
the services of a yeoman for duty as storekeeper. The commissary should give his
personal attention to the purchase of stock for the store, should fix the prices at
which the articles are sold, establish a businesslike system for the operation of
736 ARMY AND NAVY RATIOXS
the store, and direct all its affairs. He shall keep the cash account and cause the
storeman to turn in daily all money not required for making change.
39. All the accounts of the commissary store should be kept in such manner
as to admit of ready inspection by the general inspector of the pay corps, the
paymaster of the fleet, or by the board appointed for that purpose.
40. The storekeeper should be responsible to the commissary for the proper
conduct of the store. He is to keep the account of the stock, and of the sales, and
submit to the commissary from time to time lists of articles required.
41. In order to protect the store from any loss, either through carelessness or
dishonesty, the following method of keeping the accounts should be employed:
At the end of each month an account of stock should be taken, and the arti-
cles found to be on hand entered in a book similar to the return of clothing and
small stores. (This blank may conveniently be used for the purpose, the head-
ings of the columns being changed.) These quantities represent the stock on hand
at the beginning of the new month and to them should be added all stores
received from purchase. At the end of the month the quantities found to be on
hand should be entered in the proper line and subtracted from the total receipts
and the difference entered as "sales." By multiplying the number of each article
sold by its selling price and taking the total of that line in the return will be
found the amount which the storekeeper should have received, and this amount
he should be required to turn in or account for.
42. If no prices are changed except at the beginning of a month, and if the
established prices are displayed on the store bulletin board so that no over-
charges can be made, this system will be a simple and absolute check on the
storekeeper.
43. The man selected for this responsible duty should first of all be entirely
trustworthy. He must be quick and accurate at figures and write legibly. It is
his duty to receive such stock as may be delivered for the store, conveniently
arrange it in the storeroom, and keep the latter clean and see that it is ready for
inspection at the appointed time. He is to open the store for the sale of mer-
chandise to the men at such times as may be appointed by the commissary, with
the authority of the captain. He should keep a small memorandum book in
which to enter the amounts turned in daily to the commissary, and when that
officer receives the money, he should initial the amount in the book.
PART III. THE PREPARATION OF FOOD
The Ration. 44. The dietary of the enlisted men of the Navy must neces-
sarily be based upon the ration provided by law. In general messes, where the
circumstances are favorable, provisions which are not a part of the ration may
at times be purchased, but articles of which there is a supply already on board
in the pay department should not be bought unless the government stores shall
have deteriorated, in which case they should be surveyed and a new stock
obtained at the first opportunity.
NAVY RATIONS 737
45. Unless there be some good reason for not doing so, the official issuing
table should be strictly adhered to, it having been arranged to give the necessary
variety.
The Galley. 46. The ship's galley (or that part of it used by the general
mess), together with its appurtenances, is under the charge of the commissary.
That officer should see that the galley and its utensils are properly cared for and
are ready for inspection at the appointed times. He should himself frequently
inspect this part of his department and advise the equipment officer of any re-
pairs or alterations needed, and should, when occasion demands it, furnish that
officer with a list of galley utensils requiring a survey.
Cooking. 47. On board ship, where the facilities are necessarily restricted
and the food lacking in variety compared to that obtainable on shore, it is of the
highest importance that the very best results possible under the circumstances
should be obtained. With a liberal allowance of cooks and bakers, and a judi-
cious selection of the men for these rates, the Navy ration should be so prepared
as to give the enlisted men three nourishing and palatable meals each day, and
it should be the duty of the commissary department to see that this is done.
Frequent inspections of the food by the commissary and the commissary steward,
and efficiency on the part of the cooks alone can insure this.
REFERENCES
1. WOODRUFF, MAJ. CHAS. E. J. Am. M. Assn., Dec. 3, 1892, p. 651.
2. U. S. Army Regulation, 1913, par. 1202.
3. War Dept, Edition of 1913, par. 1205, General Orders, No. 15 ;
War Dept., 1913, Bull. 28.
4. HARVARD, COL,. VALREY. Military Hygiene, Wm. Wood and Co.
5. War Dept., Bull. No. 21, Executive Order, May 28, 1914, William
Wood and Co.
6. MUNSON, ED. L. Boston Med. & Surg. J., May 24, 1900.
7. GEPHART. In the Laboratory of the Russell Sage Institute of
Pathology, Ed. J. A. M. A.
DAVIS. Food in Health and Disease, p. 62.
8. LUSK, GRAHAM. "Food Economics," J. Washington Acad. Sci., vol.
6, p. 340, 1916.
9. WOODRUFF, MAJ. CHAS. E. Med. Rec., May 20, 1899.
10. WOODRUFF, MAJOR. Med. Rec., N. Y., May, 1899, p. 701.
11. FAUNTLEROY, A. M. Med. Corps, TJ. S. N. Medico-Military As-
pects of the European War, Bureau of Med. and Surg., Navy
Dept.
12. CAT.DWELX, W. B. Mil. Surgeon, March, 1916, vol. 38, No. 3.
13. Tsui. Mil. Surgeon, Nov., 1909.
14. FITCH, W. E., Maj. M. R. C., Military Surgeon, May, 1917.
CHAPTER XIX
FOOD ECONOMICS IN WAR
Food Situations in Countries at War: Germany, Great Britain.
Use of Certain Foodstuff's in War: Bread and Cereal Foods; Milk, Sugar;
Alcohol in War Economies; the Food Situation in the United States.
Summary.
Out of evil good may come, and, of course, this saying is as true of
war as of any evil thing. So far as the food question is concerned, many
valuable lessons have been learned with respect to food values, and al-
though at the time of writing, the war is still in progress, with no signs
of a speedy end, it has been felt by the author that a work on diet written
at such a period would not be complete unless the matter of feeding
populations shut off from most or many of their ordinary sources of sup-
ply was at least discussed. Perhaps no really definite lessons as to food
can be learned until the conflict is over, but, on the other hand, a good
deal of valuable information has already been collected, and some of the
facts brought out should not be passed over.
For example, it has been proved beyond peradventure that not only
can the physical equilibrium be maintained without luxuries this was
known before but that, if a diet is well balanced, the energy and heat
necessary to keep the human machine in good working order can be pro-
vided by a quantity considerably less than would have been considered
adequate in the piping days of peace. The lesson has been fairly well
learned by the inhabitants of some of the countries at war that food can
be reduced to the exact requirements of the human machine, with much
benefit to the smooth working of that machine. The members of the med-
ical profession have long preached and their preaching has been as the
voice of one crying in the wilderness the doctrine of self-control in the
matter of food. The evils of gluttony or of eating to excess have been
enlarged on in Volume II, Chapter VI, and the fact that governments,
for the purpose of high politics, have had to step in to heal, in spite of
739
740 FOOD ECONOMICS IN WAR
themselves, many unsuspected victims of gluttony, 1 possesses a decidedly
ironical aspect. The experience of the war has proven, once and for all
time, that the majority of well-to-do persons persistently eat more than
is good for health, and has clearly demonstrated that the diet to which
an individual has become addicted by custom, and which he has brought
himself to believe the most nutritious, is often surpassed by articles of
diet which he has been wont to despise as cheap and lacking in strength
and energy-giving properties.
FOOD SITUATIONS IN COUNTRIES AT WAR
Germany. The European war afforded an unique opportunity,
though an unsought one, to study the relation of the food supply to un-
expected economic and territorial conditions. In Germany, in particular,
the situation was unparalleled owing to the exclusion of the greater part
of the food which in normal times was detained from abroad. Germany
had been in the custom of procuring most t . of .her wheat, rice and other
foods from Russia. This source of supply was completely cut off. From
the Scandinavian countries she had obtained a large proportion of butter,
eggs and lard, and from America both foods and crude materials which
were applied to animal production. With all these external sources of
supply threatened or wholly cut off, the question presented itself, how
were the inhabitants, civil and military, to be fed, relying, perhaps,
mainly on internal resources.
With the organizing ability and scientific acumen with which the
Germans have long been credited, their professors and business men pro-
ceeded to attack the problem, and in the early days of the war Dr. Paul
Eltzbacher, acting Rector of the Berlin High School, edited a pamphlet
in which leading experts discussed the problems of the food supply in
Germany and the means to be taken for assuring adequate provision for
all the inhabitants. According to this pamphlet, the export of native
products, such as sugar and rice, was to be restricted ; the feeding of ma-
terials suitable for human consumption to cattle was to be greatly de-
creased. Conservation of food values ordinarily lost in the processes of
conversion into animal tissue was to be brought about ; unjustifiable waste
was to be avoided not only on a large scale but even in the individual
kitchen. The minuteness and the elaborate nature of the study were
indicated by such details as reminders that twenty grams of fat per capita
i The evils of gluttony or of eating to excess have been enlarged upon in Chapter
VI of this volume.
FOOD SITUATIONS IN COUNTRIES AT WAR 741
were lost in the sewage waste of Berlin every day, and that this ought to
be prevented.
The inhabitants, on the authority of well-known scientific men, were
assured that changes of dietary regimen intelligently carried out need
cause no alarm, as the public health would not suffer thereby. Pamphlets
were widely distributed in which the laws governing nutrition were pro-
claimed and suitable dietetic advice was given. It was urged that plant
products, rich in carbohydrates, should be more liberally used and that
the consumption of meat, rich in proteins and fats, should be restricted.
The substitution of the regimen of South German households in the place
of the excessive meat diet of the northern provinces was strongly recom-
mended. Even a cook book for war time was freely distributed, and the
services of German chemists were requisitioned to supply by the aid of
their science substitutes for some of the lacking food products.
Another pamphlet was issued in the early part of 1916, the authors
of which were Professors Kuczynski and Zuntz of Berlin. On Jan. 25,
1915, the German government took the supplies of wheat and rye into
its own hands and decreed that those engaged in agriculture should have
an allowance of 7.2 kilograms of flour per month per head, and the rest
of the population 225 grams daily per head. In February, the allow-
ance of 225 grams was reduced to 200. In time of peace the average
consumption per head was 340 grams, so that the people as a whole had
to deny themselves 14 per cent of their accustomed nourishment, and the
poor, with whom bread is a more important item, 25 per cent.
For the first six months of the war, the condition of the food supply
was not less favorable than in time of peace. Food prices had risen
steadily, although in many trades wages had risen correspondingly. Later
on, as the cereal supply began to run short and a bread ration was fixed,
the poorer classes lost about 20 per cent to 25 per cent of their staple
diet. The price of rye bread in January, 1915, had risen 33 per cent,
and in May, 53 per cent; while wheat bread had advanced 26 per cent
and 35 per cent as compared with prices in January, 1914, and May,
1914. With other foods, prices had risen on an average of 81 per cent
from May, 1914, to May, 1915. This great rise in prices forced the
mass of the people to buy the cheaper kinds of foods and also to buy
smaller quantities. A great deal of the difference was accounted for by
more careful cooking and usage, as cooking potatoes in their skins; but
in such foods as meat, milk, etc., such a saving was not possible. Briefly,
the situation from February or March, 1915, onwards, was one of en-
forced moderation, with health-giving results to hundreds of thousands
147
742
FOOD ECONOMICS IN WAR
of over-fed people, but implying for the masses a weakening of their
working capacity by hardships which amounted to actual want.
The second chapter of the Kuczynski and Zuntz pamphlet dealt with
the right division of food between man and beast, into which there is no
space to enter at length. The importance of sugar as a foodstuff was
dwelt upon, not only as a food, but as a means of preserving large quan-
tities of fruit and vegetables.
The finding of new fodder, consequent upon the reservation for the
use of man of foodstuffs which used to be employed for animal-feeding
purposes, was a feature of the situation. In the search for new fodder
it was recommended that the forests of leafy trees might supply nutri-
ment for pigs and cows. The comparative nutritive value of the various
leaves is shown in the following table, giving the amount of protein and
starch obtained from 100 kilograms of each raw material :
COMPARATIVE NUTRITIVE VALUE OF VARIOUS LEAVES
SPECIES OF FODDER
Digestive Protein
Starch
Elm leaves (young)
Kg.
11.7
Kg.
50.0
" (old). .
9.7
38.8
Acacia leaves
26.6
54.0
Horse-chestnut leaves
11.3
41.7
Poplar leaves in October
6.0
26.7
Copper beech leaves in August
0.9
16.7
Vine leaves in autumn
6.7
42.5
Acacia brushwood in winter
5.5
12.6
Good meadow hay
5.5 '
31.8
Oat straw
1.3
17.4
In order to make the best possible use of leaves, it must be borne in
mind that during the day the action of light draws considerable quanti-
ties of starch and sugar into the leaves, some of which returns during the
night into the woody parts, so that the leaves are of the most nutritive
value towards evening, when they should be gathered. Towards autumn
the leaves are less nutritious as well as less digestible, but, on the other
hand, they contain less water and are more easily dried. This use of
leaves especially should meet the case of the poorer people in town and
country who keep one cow or a few goats. This is a lesson that has been
learned from the war.
Haberlandt was quoted by the authors as having revealed another
FOOD SITUATIONS IX COUNTRIES AT WAR 743
source of supply in the woods, the sapwood of trees in early spring, with
its high content of starch and fat. To obtain nutritive matter from straw
and wood, certain methods are available. The most recent method is the
use of organic acids which are in themselves of value as fodder, as lactic
acid. The significance of this method lies in the fact that not only is
much cellulose converted into digestible carbohydrate, but the remaining
nutriment in the cellulose coverings is exposed at the same time to the
action of the digestive juices of the animal.
In the search for new fodders, heather was not overlooked, especially
as it contains very little water, and is therefore easy to dry. Of the
highest importance in storing foodstuffs is the question of drying, not
only for animals, but as a means of preserving food in concentrated form
for man also. The drying of turnip scraps and turnip leaves, of the leav-
ings of the malt in beer brewing, of the distiller's and other waste prod-
ucts from various industries, has long been practiced to a large extent,
sometimes by means of gas, sometimes by steam heating. The hay crop
can be increased by 20 per cent or 30 per cent by increased facilities for
drying.
The following table shows the percentage loss in nutrient material
by the tardy drying of hay :
LOSS FROM TARDY CURING OF HAY
Time taken
for drying
Protein
Fat
Nitrogen-free
extractives
Fiber
Mineral
salts
10 days
20 "
9.9
45.8
49.5
72.9
16.3
46.6
2.5
27.7
12.8
48.6
The authors were of the opinion that the drying process was not only
useful for fodder but also for foodstuffs. In the household it could be
done on the hearth, in the oven, or in the open air. Not only the usual
fruits, such as plums, apples, cherries, bilberries, etc., should be pre-
served by these means, but also potatoes, either raw or in slices, or boiled
in their skins and then mashed. Further, since drying factories could
not be built fast enough, pickling methods must be improved by the em-
ployment of the culture of bacilli. Even in the case of withered turnip
tops the Institute of Fermentation Industries at Berlin found that by
placing them in large quantities in cemented pits and treating them with
a culture of lactic acid, loss by fermentation was considerably reduced.
744
Among the many lessons which the war has taught in the matter of
diet is that when woman works at manual labor in the open air, cultivat-
ing the fields, for example, as she has in England and Germany, she needs
a ration liberal in proportion to the expenditure of energy. This was a
matter that was somewhat overlooked in the calculations as to economizing
the food supply.
Another important lesson that has been learned is that fat is a factor
of more prominence than was generally believed in the scheme of nutri-
tion. While fat formed a fair proportion of a German diet in the ordi-
nary way, the production of fat has not been encouraged or stimulated by
the German agricultural system. As early as the autumn of 1915, in
addition to two meatless days in the week, the German regimen ordered
the introduction of two fatless days. German writers generally, follow-
ing Voit, have rated the desirable amount of fat in the daily ration at
56 grams, almost 2 ounces to 100 grams, for men at hard manual labor
in the open air. It has been taught by them that with increase in the
body's demand for available food fuel, it is preferable not to increase too
largely the carbohydrate intake, which is usually put at about 500 grams,
but rather to add to the quota of fat in about the proportion indicated
by the above quoted figures. It must be borne in mind that an increment
in fat can be obtained with far less increase of bulk than a comparable
augmentation of carbohydrate-containing foods will permit. A gram of
fat yields more than twice the energy that is yielded by the same unit
weight of the other available nutrients.
Dr. Alonzo E. Taylor, who was in Germany during a part of the war,
and was afforded special facilities for studying the food question at first
hand, gave the results of his experiences and deductions drawn therefrom
in a series of exceptionally able articles contributed to the Saturday Even-
ing Post in the early part of 1917, from which the author has drawn
largely in the preparation of this section. He stated that in 1915 the fat
intake in Germany was not more than 20 grams, animal and vegetable, per
capita per day. While this is certainly more than enough to cover the needs
in fat soluble vitamines and is twice the intake of fat of the Japanese, the
fact remains that the people were hungry. The consumption of fat in
Germany prior to the war was about S 1 /^ ounces per capita per day, of
which nearly half was obtained by importation, directly or indirectly.
As the cultivation of fat-producing materials had not been encouraged,
and as the partial blockade to which Germany was subjected very greatly
restricted the importation of fat upon which the country largely de-
pended for its supply, the inhabitants had to go without a good deal of
FOOD SITUATIONS IX COUNTRIES AT WAR 745
the fatty ingredients of diet to which they were accustomed. Fat being a
fertile source of energy, they suffered much from this deprivation.
The following table culled from Taylor's paper (1) contains the esti-
mates of four different calculations as stated for protein, fat, carbohydrate
and calories per head per day of the food consumption of Germany based
on official data for the years 1912 and 1913.
CONSUMPTION OF FOOD UNITS IN GERMANY, 1912-1913
OBSERVER
Total
Imported
Domestic
d
1
2
PL,
1
1
O j_,
H ^3
3
03
0>
'oS
o
a
I
1
-D g
3
CO
o>
I
'3
O
1
1
|S
^
6
8
1
6
Ballod
OZ.
3.10
3.30
3.70
3.25
oz.
2.15
3.75
3.11
2.33
oz.
14.5
18.7
20.1
16.0
2,708
3,642
3,550
2,790
oz.
0.85
0.90
1.13
0.90
oz.
0.88
1.60
1.06
1.06
oz.
0.8
1.5
1.4
1.4
450
715
473
550
oz.
2.25
2.40
2.57
2.35
oz.
2^10
2.05
1.27
oz.
13.5
17.2
18.7
14.6
2,480
2,927
3,077
2,204
Eltzbacher
Kuczynski and Zuntz.
Taylor
In the Eltzbacher report the German population was put down as
68,000,000. The number of children of each year and the number of
adult males and females were known. The figure for the number of
children of each year of age was multiplied by the figure for the food
need of that year. The number of adult females and the number of
adult males were multiplied respectively by 85 and 100. The final figure
for the needed food units, a compromise between several standards, was
51,822,908.
This means that the population of 68,000,000 would be nourished if
it received the ration of 51,822,908 adults. Three thousand calories was
the figure set for the adult need. The caloric needs of the German people
were, therefore, determined by the simple multiplication 3,000 x 365 x
51,822,908 = 56,750,000,000,000 calories. When this figure for total
calories, determined on the basis of man ration, was divided by the figure
for the population, the result was 2,280 calories a day. The protein needs
of the people were also calculated. Children under six years of age were
allotted 1.4 ounces a day ; from six to twelve, about 1.75 ; from twelve to
eighteen, about 2.3. Adult men were allotted 2.9 ounces; adult women,
2.4.
Taylor, taking into consideration that all work harder in war time,
especially women, and further considering that the estimate for children
746
FOOD ECONOMICS IN WAR
from 12 to 18 was too low, calculated the protein and caloric needs of the
German people in war time as follows: protein, 1,524,000 tons; calories,
63,000,000,000,000.
The protein needs as set forth by figures supplied by Eltzbacher, Tay-
lor and Chittenden are as follows :
PROTEIN NEEDS IN OUNCES
Per Capita
Man Ration
Eltzbacher
2.30 oz.
2.83 oz.
Taylor
2.15 war-time
2.5 "
Chittenden
1.5
1.8 "
CALORIC NEEDS
Per Capita
Man Ration
Eltzbacher
2,380 peace-time
3,000
Taylor. . .
2,510 war-tune
3,300
Chittenden
2,030
2,600
The peace-time consumption of protein in Germany, according to the
Chittenden standard, was 50 per cent in excess of requirements, and the
domestic production of protein was just large enough to cover the need.
It seemed also apparent from the data that the fat consumption in peace-
time was too large, and that the fat of domestic origin should be enough
to satisfy normal requirements. Consequently, it appeared evident to the
German scientists, at any rate, that if the German people would reduce
their consumption to the plane of physiological needs, that is. physiolog-
ical needs chiefly computed by means of laboratory experiments, and
maintain the domestic production on the peace-time basis, they would
not experience much harm by a blockade.
When one compares what has been achieved in production with what
the commission of German scientists believed could be attained, the re-
sults are not creditable to the agricultural classes, even when the influ-
ences of unfavorable weather are fully allowed for. The Eltzbacher
Commission made the following estimates: (a) peace-time use: protein,
2,261,000 tons, and calories, 88,694,000,000,000, including protein of
domestic origin, 1,650,000 tons, and calories, 71,282,000,000,000. (fe)
physiological need: protein, 1,605,000 tons; calories, 56,750,000,000,000.
(c) attainable production under blockade: protein, 2,022,000 tons; calo-
ries, 81,250,000,000,000. Actual production in 1914-15 in foodstuffs
FOOD SITUATIONS IX COUNTRIES AT WAR 747
was: protein, 1,510,000 tons; calories, 63,410,000,000,000. Actual pro-
duction in 1915-16 was: protein, 1,100,000 tons; calories, 57,000,000,-
000,000.
The dietary of the industrial classes of Germany was from March to
September, 1916, reduced to the physiological minimum. This diet was
low in animal protein, very low in fat, and low in calories, and when the
work that had to be done was considered, manifestly insufficient. A sur-
vey of the chief manufacturing cities of the empire carried out during
the late months of 1916 indicated that the average intake for adults varied
from 1.6 to 2 ounces of protein and from 1,800 to 2,500 calories per day.
As Taylor remarked, since this was not sufficient to maintain the physical
labor that was being done, this was accomplished by utilization of the
body fat of the workers.
Food Situation in Great Britain. It was not until the early part of the
year 1917 that the British Government took any very definite steps lead-
ing to a control of the food supply, though a ban had been placed on some
articles of food and, of course, advice had been given as to the need for
economy of food and warning against waste had been freely tendered.
The report on the food supply of the United Kingdom, drawn up by a
committee of the Royal Society, was published in the first week of Feb-
ruary, 1917, and provided some very interesting information. The first
part contained an estimate of the annual food supply of Great Britain, im-
ported and home-produced, in the period before the war, 1909-1913.
It may be said here that, according to Taylor (2), in the year before
the war, about 13,750,000 tons of foodstuffs and feeding stuffs were im-
ported into the United Kingdom, nearly ten millions of which were food-
stuffs. It was not possible' to give more than approximate figures, since
there was overlapping, as, for example, between food fat and industrial
fat. The total food consumption for Great Britain was probably about
twenty million tons. To make the gross figure for importation of food-
stuff more concrete, it may be stated that in 1914 the importation per
capita was: wheat, 250 pounds; flour, 23.9 pounds; potatoes, 8 pounds;
sugar, 80 pounds; rice, 14.2 pounds; ham and bacon, 14.2 pounds; beef,
20 pounds; mutton, 12.4 pounds; other meats, 8.4 pounds; butter, 9.46
pounds ; cheese, 5.75 pounds, and eggs, 46 per head.
To turn again to the Committee's report, it is there stated that, after
consideration of the dietary requirements of a nation for the most part
engaged in active work, the Committee was convinced that they could not
be met satisfactorily on a less supply in the food than 100 grams pro-
tein, 100 grams fat, and 500 grams carbohydrates, yielding approximately
748 FOOD ECONOMICS IN WAR
3,400 calories per man per day, a "man" being an average workman doing
an average day's work. The Committee adopted this as the minimum
standard. Generally speaking, a woman or child requires less food than
a man, and to convert the population of men, women and children into
units, or "men," as denned above, the total number must be reduced by
23 per cent. In reckoning diet, 100 men, women and children equal 77
units, that is to say, men.
The total quantities of foodstuffs available during the period 1909-13
provided 4,009 calories per "man." There had been a certain margin,
and the Committee calculated, taking the minimum physiological stand-
ard mentioned above, that there had been either wasted, or consumed in
excess of requirements, of proteins 11 to 14 per cent, of fats 25 to 30 per
cent, of carbohydrates 10 to 14 per cent. It should be noted that the fig-
ures for quantities of food are for weights as purchased, no attempt hav-
ing been made for loss during distribution, nor for digestibility.
The second part of the report dealt with the food supply in 1916.
The Committee stated that down to the end of July in that year, the
supply of food had provided a general margin of about 5 per cent above
the minimum necessary for proper nutrition and rather more as regards
the supply of energy, so that a reduction to this extent would still furnish
amounts of the essential food constituents conforming to the standard
adopted. Such a reduction could be borne without serious injury to the
community, provided steps were taken to ensure the equitable distribu-
tion of the available food throughout the population. Speaking as physi-
ologists, the members of the Committee laid stress on the fact that in buy-
ing food the laboring population was buying energy. If rising prices
curtailed for any class of the community its accustomed supply of food,
its output of work would of necessity be reduced, and it was important
to remember that a slight reduction of food below the necessary amount
caused a large diminution in the working efficiency of the individual.
In an appendix to the report, some particulars were given of army
rations. The weekly rations issued to the army at home in England were
as follows: beef, 84 ounces; bacon, 14 ounces; bread, 112 ounces; sugar,
14 ounces, and in addition, the men were in the habit of purchasing vari-
ous articles of food from a long list yielding on an average 1,510 calories
a day, giving a total energy value for the diet of a man in the British
home army of 4,031 calories a day. The civil population at a similar
rate, but with a reduction of 23 per cent for women and children, would
be entitled to a diet yielding an energy value of about 2,667 calories a
day.
FOOD SITUATIONS IN COUNTRIES AT WAR 749
The following are figures estimating the food consumption of Great
Britain during the first year of the war compiled by a German statisti-
cian, Ballod, a British physiologist, Thompson, and Dr. Alonzo E.
Taylor.
FOOD CONSUMPTION PER HEAD PER DAY IN UNITED KINGDOM
Protein
Fat
Carbohydrate
Calories
Thompson
2.70 oz.
3.60 oz
15 5 oz
3 100
Ballod
3.75 "
2.58 "
156 "
2900
Taylor
3.25 "
3.18 "
15 1 "
3 000
According to Thompson for Great Britain, and the Eltzbacher Com-
mission for Germany, the subsistence of one hundred inhabitants would
be about covered by the food required by seventy-five adult males, and the
man rations of the three estimations would be as follows, in ounces and
calories :
FOOD REQUIRED
Protein
Fat
Carbohydrate
Calories
Thompson
3.59
4.81
207
4 130
Ballod
5.0
3.45
208
3860
Taylor
4.38
4.24
20.1
4000
The caloric need of the adult man was put by the Eltzbacher Com-
mission at 3,000 calories, somewhat low for the extraordinary work of
war time, lower by 400 calories than that set as a minimum by the Com-
mittee of the Royal Society of Great Britain. However, reckoning it at
this figure, 40,240,000,000,000 calories would be required to maintain
the bodily heat and energy of the 45,370,000 inhabitants of the British
Isles for a year.
The protein requirements calculated in similar fashion, on the com-
putation of the Eltzbacher Commission, 80 grams per day for an adult
man, would work out at 1,130,000 metric tons. The British Committee
considered that the minimum protein requirement for an adult man was
100 grams, while Chittenden and other physiologists have contended that
this amount could be greatly reduced without injury to the public health.
The German experience during the war seems to lend some support to the
view that Chittenden and his followers were correct, but until more is
750 FOOD ECONOMICS IN WAR
known concerning conditions in Germany than is known at the time of
writing, it will not be discreet to be dogmatic on this point. There is lit-
tle doubt that the Germans concealed the true state of affairs to a large
extent. Probably much more food was imported than was believed, and
also it is not unlikely that the condition of their industrial classes was
worse than it was credited to have been. Little bad news was allowed to
leak out, and it must be borne in mind that the main almost sole object
of the German rulers was to feed their army and workers directly con-
nected with military supplies and to pay much less attention to the other
members of the community. The fact must also be taken into considera-
tion with respect to protein ingestion that the British have always been
heavy meat eaters, and that inherited and ingrained habits count for a
good deal when the, nutritive value of a diet is concerned.
Nevertheless, we will take it for granted that the British consumption
of protein was larger than physiological requirements. Taking the physi-
ological requirements of protein daily for an adult man at eighty grams
a day and the caloric need at 3,000 calories, the amount of waste in a
year would read somewhat as follows:
Protein Tons Billion Calories
Consumption 1,660,000 53,900
Need. . 1,130,000 40,240
Waste 530,000 13,660
According to the Eltzbacher Commission, the waste of the German
people was: protein, 650,000 tons, and calories, 31,899,000,000,000.
The per capita waste was thus greater in protein in Great Britain, greater
in calories in Germany.
From all available data, one might adjudge seven hundred thousand
tons as a reasonable figure for domestic production of protein in Great
Britain. This leaves a deficit of nearly 500,000 tons. In other words,
the domestic production of protein was about 55 per cent of the require-
ments. According to Taylor'G estimate, the following figures show ap-
proximately the situation in Great Britain in the early part of 1917 as
regards protein and calories:
Protein Tons Billion Calories
Consumption 1,660,000 53,900
Requirements 1,130,000 40,240
Domestic production. . . 700,000 19,000
Deficit 430,000 21,240
FOOD SITUATIONS IN COUNTRIES AT WAR 751
In Taylor's papers on the food situation in Germany, which have
been largely employed as a basis for this chapter, the lack of sugar was
referred to and attention was drawn to the fact that saccharin was used
as a substitute. In a report which the same author wrote for the Amer-
ican Embassy at Berlin, he gave a detailed analysis of the food of the
civil prisoners at Ruhleben Camp. But before giving a part of this
report and the references therein to saccharin, a few comments will be
made on the feeding of military prisoners. The ration established for
military prisoners in Germany in the month of June, 1916, contained
2,700 calories a day, made up of 80 grams of protein, 29 of fat, and 500
of carbohydrate. This, though not plentiful, was adequate as regards its
caloric value for average men not doing much muscular work. The pro-
portion of fat is low, but such a diet need not endanger nutrition in adults,
provided the requisite food value is made up by other foodstuffs. The
diet, however, for certain prisoners at Ruhleben Camp, and concerning
which Taylor wrote, was indeed sparse in fact, a starvation diet. In
the following table the Ruhleben diets are compared with ordinary stand-
ards of living:
RUHLEBEN DIETS COMPARED WITH STANDARD DIETARIES
Calories
Protein
Fat
Carbo-
hydrate
English laborer
3,655
184
71
570
German farm laborer (Ranke)
4,696
143
108
788
Standard diet for a man of moderate
activity
2,820
100
100
360
Military prisoners of war in Germany.
Ruhleben diet before reduction . . .
2,700
1,580
80
59
29
12
500
308
Diet actually taken when increased by
food left by other prisoners
2,725
98
24
523
Ruhleben diet since reduction
1,220
39
6
255
Reduced diet when increased by food
left by others
1,930
55
10
410
The substitution of saccharin for sugar in the diet of the Ruhleben
prisoners was commented upon in the Journal of the American Medical
Association, Aug. 12, 1916, as a war food abuse. When sugar became
scarce in Germany, the law prohibiting the use of saccharin was abro-
gated. Two months later its use was made compulsory in certain direc-
tions. However, as Taylor points out, saccharin can never be termed a
substitute for sugar from the gustatory or any other point of view. Cer-
tain articles of food containing saccharin have the normal taste ; to other
752
articles of food, however, an abnormal after-taste is given, a condition
particularly noticeable in beer.
Before food regulation was introduced into Great Britain, the diet
of the munition workers had been regulated with surprisingly good re-
sults. It must be borne in mind that an immense army of such workers,
a large proportion of whom were women and children of over twelve
years of age, had been organized. It was incumbent on the state from
every point of view that their health should be carefully safeguarded, and
naturally a sufficiently nutritious diet was a sine qua non in the achieve-
ment of this object. The soldier and the sailor expected that their diet
would be arranged to meet their particular needs, and when the great rise
in the price of food occurred, it was found that, in order to supply the
munition workers with food of a character calculated to enable them to
fulfill their important duties with efficiency, they must be dieted accord-
ing to their special requirements.
Dr. Leonard Hill was chosen to make an investigation into the mat-
ter, so that he might supply data upon which improvements in diet might
be based. He laid down the principle that the amount of food taken
should be regulated solely by the loss of energy it was required to replace,
and pointed out that fortunately the chief foodstuffs really provided all
the nourishment that was requisite for and consistent with health, better
probably than the more highly flavored and expensive foods which artifi-
cially stimulate the appetite. Of such foods, Dr. Hill gave the following
list: bread, margarin, porridge, milk, herrings, cheese, beans, cabbages,
oranges, and the cheaper kinds of meats.
Under his direction the canteen meals for munition workers who came
from some distance were analyzed after the following method: The in-
gredients were all thoroughly mixed, after weighing each separately, so
that dietaries could afterwards be constructed from the weights. An ali-
quot part of the intimate mixture was thoroughly dried and weighed. In
the dry material protein was determined from a nitrogen estimation, the
fat by ether extractions in a Soxhlet's apparatus, the ash by burning and
weighing, and the carbohydrate by difference. In this way the amounts
of dry protein, fat and carbohydrate respectively in the meal were ob-
tained, and from these the caloric value was determined. An analysis
of twelve canteen meals showed that they afforded on an average, protein,
42.43 ; fat, 36.7 ; carbohydrate, 146.9 grams, yielding 1,114 calories per
capita. The average canteen dinner was found to be good, containing an
energy value of 1,114 calories well distributed among the amounts of
protein, fat and carbohydrate.
FOOD SITUATIONS IN COUNTRIES AT WAR 753
The meals brought from home by the workers were also submitted to
analysis. The workers whose meals were thus obtained were not asked
beforehand to bring a sample meal, but were interrogated at the entrance
gates and asked to exchange the contents of their basket for a sum ample
to buy a meal at the canteen. In the case of men, these meals were found
to be adequate, but in the case of girls there was a very wide variation,
from 300 up to 1,100 calories. As for the latter, the breakfast meal be-
fore starting work was often found to consist of white bread and boiled
tea. Although there was nothing in the investigation which was very
new, it showed that a valuable degree of practical certainty was being
reached in regard to the minimum adequate diet required for a certain
type of manual labor.
The following table (3) may be of interest as showing the diet during
the war, but before voluntary restriction, of three middle class families
in England. The families consisted of 16 persons, 3 men (sedentary),
9 women and 4 children:
DIETARIES FOR THREE MIDDLE-CLASS FAMILIES, SIXTEEN PERSONS,
IN ENGLAND BEFORE VOLUNTARY RESTRICTION
Weekly
DAILY
YIELD IN
GRAMS
Energy
Weight
in
Ounces
Protein
Fat
Carbo-
hydrate
Value
in
Calories
Meat, sausages, bacon
50.5
28.8
52.4
1.1
663
Bread
58.0
18.7
2.8
123.1
580
Sugar
8.9
36.3
145
Total
117.4
47.5
55.2
159.5
1,388
Cheese
4.0
4.5
4.9
0.4
63.4
Butter, etc..
13.2
0.5
43.3
424.0
Potatoes..
32.0
2.27
0.13
27.2
122.0
Flour and Oatmeal
7.0
16.2
2.3
21.3
103.0
Rice, lentils, etc
11.6
1.6
0.7
24.3
270.0
Jam and dried fruits
3.8
3.7
0.2
8.7
37.8
Total.. ..
71.0
28.77
53.53
81.9
1,020.2
Total ration of restricted articles
47.5
55.53
159.5
1,388
Total of extras
28.77
53.53
'81.9
1,020.2
76.27
108.73
241.4
2,408.2
754
So far as this examination went, it appeared to show that the mem-
bers of middle-class families in England during the war, when left to
their own devices, received rather less protein, somewhat more fat, and
considerably less carbohydrates than the standard per head of the whole
population, and that the yield in calories was about 15 per cent less,
waste not being reckoned.
From the above table, the average weekly consumption of milk was
omitted. This reached the amount for the three families of 4.8 pints
per week, or 0.7 pints a head, bringing up the energy value of the diet
per capita per day to 2,910.
Voluntary Rationing Scheme in Great Britain A voluntary rationing
scheme had been initiated in Great Britain, and was favorably commented
upon in an editorial which appeared in the Lancet, November 17, 1917.
It was pointed out that while a faithful adherence to the limited amounts
of the staple foods outlined in the scheme would save a grave situation,
no hard dietetic or physiological sacrifice was called for. The staple foods
named were bread, flour and other cereals, meal, butter, margarin, lard
and sugar. Outside this list no rationing was suggested. Potatoes were
not included and therefore, as a valuable carbohydrate supply, might be
largely employed to eke out the stock of scheduled foodstuffs, and so save
the staples. In addition an exchange could be made in certain cases,
notably with regard to bread and meat. Thus any person might take half
a pound of meat over and above his meat ration in exchange for half a
pound of bread to be deducted from his bread ration and vice versa. The
Lancet thought that the scheme bears evidence of being well thought out
from the economic point of view, while it provided a physiological suffi-
ciency for all. The public of the United States would do well to bear this
in mind, for it is important to remember that a voluntary rationing
scheme which provides amply for all physiological needs is much less a
hardship than actual famine, while its adoption means the releasing of
so much tonnage, and adding to the efficiency of transport service. In
plain words, the individual who loyally enters into the spirit of the scheme
will be helping to win the war, and is doing so in contradiction to no law
of physiology or of medicine.
The English scheme applies with force to the food situation in Amer-
ica. The people must cooperate in thrift so far as food is concerned and
especially with respect to the staple foods. However, the food situation
in the United States will be dealt with at some length further on.
The following table gives at a glance the new rations proposed in
Great Britain in November, 1917:
FOOD SITUATIONS IN COUNTRIES AT WAR 755
ADULT RATIONS IN GREAT BRITAIN, PER HEAD PER WEEK
Occupations
Bread
(
Other
Cereals,
Butter, Fats,
Margarine,
Meat,
lh
Sugar,
C\1
Oz.
Lard, Oil,
1U.
\Jt t
Oz.
1. Men on very heavy industrial
or on agricultural work
81b. Ooz.
2. Men on ordinary industrial or
other manual work
7 " "
3. Men unoccupied or on seden-
tary work .
4 " "
2f\
'
4. Women on heavy industrial
12
10
.0
8
work or on agricultural work
5 " "
5. Women on ordinary industrial
work or in domestic work . .
4 " "
6. Women unoccupied or on sed-
entary work.
3 " "
j
The bread rations included all flour, whether used for bread or for
cooking. Flour might be taken instead of bread at the rate of % Ib. of
flour for every pound of bread.
The other cereal rations included oatmeal, rice, tapioca, sago, barley
meal, corn flour, maize meal, dried peas, beans and lentils, and all cereal
products except bread and flour. The weight given was the weight of
the dry article, as bought. If the full bread ration was not used, the
amount saved could be taken in other cereals. The "meat" rations in-
cluded the average amount of bone, which might be taken as one quarter
of the weight of the actual meat. Any parts of meat, such as rump steak,
bacon or suet, which were bought without bone, must count for one-
quarter more than their actual weight. On the other hand, any bone
in excess of a quarter of the actual meat bought might be deducted.
Poultry and rabbits might be counted at half their actual weight. The
meat rations included suet.
Sir Arthur Yapp, who outlined the scheme, divided the population
into six sections, three for men and three for women. Children were to
receive their reasonable ration of essential foods, and as their needs differ
so widely, a definite ration was omitted for them. Broadly, the scheme
provided more bread but less meat and sugar.
A very pertinent table on the unrestricted diet of a sedentary worker
was published by Dr. A. D. Waller, F.R.S. (4), a well-known physiologist
and the author of a standard text-book on physiology. The following table
gives the constituent parts of Dr. Waller's meals on three successive days,
and it will be gathered from this table that his average caloric consump-
756
FOOD ECONOMICS IN WAR
tion for the three days was 2,471, inclusive of 227 calories of claret and
whiskey, of which the caloric value is not undisputed. Of the total 2,471,
breadstuffs constituted 840 calories, which is equivalent to 334 grams of
breadstuffs; of the 334 grams of breadstuffs, 200 grams were loaf bread
and 134 grams were puddings, etc. ; 100 parts of his bread material, there-
fore, were made up of 60 parts of loaf bread and 40 parts of other farina-
ceous materials.
THE UNRESTRICTED DIET OF A SEDENTARY WORKER
OCTOBER SBD, 1916
1. EARLY TEA
c/o assumed
Grams
Protein
Fat
Carbo-
hydrate
Calories
Protein
Fat
Carbo-
hydrate
8
1
3.5
1
80
4
50
Bread
20
5
20
10
1.6
0.05
0.7
0.2
4.0
0.8
10.0
1.6' '
10.0
49.42
37.405
14.41
41.0
Butter
5
100
Milk
Sugar
2.35
5.0
11.0
142.235
2. BREAKFAST
g
1
50
Bread . . .
75
6.0
0.75
37.5
185.325
1
80
Butter
30
0.3
24.0
224.43
3.5
4
5
Milk
300
10.5
12.0
15.0
216.15
10
50
Bacon
20
2.0
10.0
101.20
12
12
Egg
50
6.0
6.0
100
25
25.0
102.50
05
0.1
50
Marmalade
50
0.25
0.5
25.0
103.99
25.05
52.8
1025
1,013.995
3. LUNCH
8
1
50
Bread
60
4.8
0.6
30.0
148.26
1
80
Butter.
15
0.15
12.0
112.215
15
5
25
3.75
1.25
270
25
25
25
15
3.75
3.75
0.375
51.7875
100
Sugar
10
10.0
41.0
5% Ale
Wine . .
(150)
(52 5 cals )
12.45
17.6
40.375
380.262
4. AFTERNOON TEA
NIL.
5. DINNER
2
2
6
150
3.0
3.0
9.0
77.1
10
2
Fish
40
4.0
0.8
23.84
15
5
Meat :
60
9.0
3.0
64.8
g
1
50
Bread
30
2.4
0.3
15.0
74.13
2
2
40
50
1.0
1.0
20.0
95.4
2
0.1
20
Potatoes
50
1.0
0.05
10.0
45.565
1
80
Butter.
5
0.05
4.0
37.405
25
25
2.5
Cheese
10
2.5
2.5
0.25
34.525
10
1.0
85
Biscuits
25
2.5
0.25
21.25
99.7
5% Ale.
Wine. . . ....
(300)
(105 cals.)
100
Sugar
15
15.0
61.5
25.45
14.9
90.5
613.965
6. SUPPER
50% Ale.
Whiskey.. . ...
(30)
(105 cals.)
10
1
85
Biscuits
25
2.5
0.25
21.25
99.7
2.5
0.25
21.25
99.7
Total
67.8
99.55
280.625
2,270.657
+Total(262.5)
Total calories
2,533.157
FOOD SITUATIONS IN COUNTRIES AT WAR 757
THE UNRESTRICTED DIET OF A SEDENTARY WORKER Continued
OCTOBER 4-rir, 19 10
1. EARLY TEA
c/o assumed
Grains
Protein
Fat
Carbo-
hydrate
Calories
Protein
Fat
Carbo-
hydrate
8
1
3.5
1
80
4
50
"5
100
Bread
20
5
20
10
1.6
0.05
0.7
0.2
4.0
0.8
10.0
' i.b
10.0
49.42
37.405
14.41
41.0
Butter.
Milk
Sugar
2.35
5.0
21.0
142.235
2. BREAKFAST
15
8
8
1
60
50
Porridge (20 dry) . . .
Bread
100
60
3.0
4.8
1.0
0.6
12.0
300
76.38
14826
1
80
Butter.
30
0.3
24.0
224.43
3.5
4
5
Milk
400
14.0
16.0
20.0
288.20
10
50
Bacon
20
2.0
10.0
101 20
12
12
Egg
50
6.0
6.0
80.40
0.5
0.1
50
50
0.25
0.05
250
10399
100
Sugar
25
25.0
102.0
30.35
58.25
112.0
1.125.36
3. LUNCH
8
1
50
Bread
45
3.6
0.45
22.5
111 195
1
80
Butter
10
0.1
8.0
74.81
10
2
Fish
60
6.0
1.2
35.76
2
2
40
Pudding
60
1.2
1.2
24.0
114.48
5% Ale.
Wine.. . . . .
(150)
(52.5 cals )
10.9
10.85
46.5
336.245
4. AFTERNOON TEA
8
1
50
Bread . .
40
3.2
0.4
20.0
98.84
1
80
Butter
10
0.1
8.0
74.81
100
5
5.0
20.50
3.5
4
5
Milk
10
0.35
0.4
0.5
7.205
3.65
8.8
25.5
201.355
5. DINNER
15
5
Meat
40
6.0
2.0
43.2
8
1
50
Bread
45
3.6
0.45
22.5
111.195
2
2
40
Pudding
80
1.6
1.6
32
152.640
2
0.1
20
80
1.6
0.08
16
72.904
1
80
Butter
5
0.05
4.0
37.405
25
25
2.5
Cheese
10
2.5
2.5
0.25
34.525
10
1
85
Biscuits
12.5
1.25
0.125
10.625
49.850
100
Sugar
5
5.0
20.500
5% Ale.
Wine. . .
(100)
(35 cals.)
16.6
10.755
86.375
522.219
6. SUPPER
8
1
50
Broad . . .
15
1.2
0.15
7.5
37.065
25
25
2.5
Cheese
20
5.0
5.0
0.5
69.050
50%Alc
Whiskey
(30)
(105 cals.)
*
6.2
5.15
8.0
106.115
70.05
98.805
299.375
2,433.529
+(192.5)
Total calories =
2,626.029
148
758
FOOD ECONOMICS IN WAR
THE UNRESTRICTED DIET OF A SEDENTARY WORKER Con tinned
OCTOBER STH, 1916
1. EABLT TEA
c/o assumed
Grams
Protein
Fat
Carbo-
hydrate
Calories
Protein
Fat
Carbo-
hydrate
8
1
3.5
1
80
4
50
5"
100
Bread.
30
5
30
5
2.4
0.05
1.05
0.3
4.0
1.2
15.0
1.5 '
5.0
74.13
37.405
21.615
20.5
Butter. . .
Milk
Sugar
3.5
5.5
21.5
153.65
2. BREAKFAST
15
8
8
1
60
50
Porridge (20 dry) . . .
Bread
100
60
3.0
4 8
1.6
06
12.0
300
76.38
148 26
1
80
Butter. . .
15
0.15
120
112 215
3.5
4
5
Milk
400
14
16
200
288 2
10
2
Fish
65
6.5
1.3
38 74
100
Sugar
10
10.0
41.0
0.5
0.1
50
Marmalade
50
025
05
250
10399
28.7
31.55
97.0
808.785
3. LUNCH
8
1
50
Bread
40
3.2
0.4
20.0
98.84
15
5
30
4.5
1.5
32.4
2
0.1
20
Potatoes
30
0.6
0.03
6.0
27.339
1
80
Butter.
5
0.05
4.0
37405
5% Ale.
Wine
(150)
(52 5 cals
8.35
5.93
26.0
195.984
4. AFTERNOON TEA
3.5
4
5
Milk
15
0.525
0.6
0.75
10.8075
100
Sugar
5
5.0
20.5
0.525
0.6
5.75
31.3075
5. DINNER
2
2
6
200
4
4
12.0
102.8
15
5
Meat
85
12.75
4.25
91.8
3
1
50
Bread
60
4 8
06
30.0
14826
2
1
20
60
1.2
0.06
12.0
54 (i~S
2
2
40
80
1 6
1.6
32.0
152 64
25
25
2 5
15
3.75
3.75
0.375
51.7875
1
80
Butter
10
0.1
8.0
74.81
05
0.1
50
Jam
20
0.1
0.02
10.0
41.596
5% Ale
Wine
(200)
(70 cals )
28.3
22.28
96.375
718.3715
6. SUPPER
50%Alc
Whiskey
(30)
(105 cals.)
10
1
85
Biscuits
30
3.0
0.3
25.5
119.64
Total
72.375
66.16
272.125
2,027.738
+(227.5"cals.)
Total calories =
2,255.238
SUMMARY
Protein
Fat
Carbohy-
drates
Calories
Calories
(Ale.)
October 3rd.
67.8
90.55
280 625
2,270 657
262.5
October 4th
70.05
98.805
299.375
2,433.529
192.5
October 5th
72.375
66.16
272 125
2,027 738
227.5
Total for 3 days
210.225
255.515
852.125
6,731 924
682.5
Average for 1 day
70.075
85.1717
284.0417
2,243.975
227.5
2,471.475
USE OF CERTAIN FOODSTUFFS IN WAR 759
Of course, Dr. Waller's case was not representative. He was 60 years
of age, weighed 190 pounds, and belonged to the class of sedentary
workers whose caloric requirements are considerably lower than those of
the manual worker. Still it is a matter for some surprise that his calories
should be as low as 2,244. It is interesting to note that Waller in his
"Text-book of Physiology" has given 3,000 as the average calorie re-
quirement per working man per day for food as eaten, and that this should
have as its foundation 1 pound of bread per day.
USE OF CERTAIN FOODSTUFFS IN WAR
Bread and Cereal Foods. With regard to the value of bread as a staple
diet, it is instructive to note that the ordinary prison diet in an English
jail, adopted in 1889, contains 3,040 calories, of which the bread, inclusive
of flour and oatmeal, amounts to 2,378 calories, of which 1,715 calories
are afforded by 22 ounces per day of actual bread. On this diet it was
found that 82 per cent of the prisoners gained weight, while 18 per cent
lost weight. This brings us to the question of bread and its value as a
food.
One of the most valuable, perhaps the most valuable, lesson that the
war has taught us, or rather has emphasized, is that highly milled bread
is less nutritious than whole-meal bread. It is now known that the con-
sumption of cereals from which the husks have been removed, when used
as a sole or main means of nutriment, is responsible for disease. 1 Beri-
beri, pellagra, scurvy and probably rickets have all been traced more or
less to this cause. Bread made from highly milled flour when constituting
but a part of the diet, is not directly responsible for diseased conditions,
but from the outlook of health is not to be recommended. It tends to con-
stipation, because it requires little mastication and also requires little ex-
ercise by the organs of digestion; it is smooth and does not irritate the
digestive organs, or induce internal secretions to exertion, and conse-
quently it is apt to take an undue time for assimilation and absorption,
and for its waste products to pass through the intestinal tract. Moreover,
according to the most recent views, the very part of the cereal that is
milled or taken away is that which contains food elements which are
indispensable for growth and the maintenance of life. These have been
termed "accessory diet factors" or "vitamines." They may be conceived
of as stimulating certain physiological processes and as essential to cer-
tain functions.
1 Sec also Volume II, Chapter VIII; Volume III, Chapter XVII.
760 FOOD ECONOMICS IN WAR
As Mendel(5) has pointed out, the lubricant is quite as important to
a machine as the energy-furnishing fuel. In a similar way these diet ac-
cessories or "vitamines" may possess peculiar usefulness. Some of them
are believed to be easily impaired by heat ; in the language of the chem-
ist, they may be thermolabile. Hence the use of heat for preserving or
sterilizing foods suggests new difficulties. They may be lost in the wastes
of the modern technical processes, as in the milling of cereals. Wheat,
for example, by modern milling is denuded of its pericarp. A beauti-
fully smooth white flour results which has been deprived of a considerable
amount of its nutritive virtues and is hardly suitable as food for a human
being, supplied with a strong jaw and teeth intended to be employed in
mastication.
The food orders in Great Britain, promulgated chiefly with the view
of economizing food, although, of course, distasteful to the mass of the
population, have proved with regard to the preparation of bread, a bless-
ing in disguise. Bread in all countries, and in Great Britain in particu-
lar, is the chief means of sustenance of the working classes, and it is
somewhat curious that the necessities of war should have brought into
force a measure which, regarded from the public health standpoint, is as
important as any measures which have been brought forward in modern
times. Wheat, of all the cereals used for the manufacture of bread, is,
perhaps, the most nutritious. At any rate, it has the most delicate flavor,
it contains a large amount of gluten, and for making bread is, on the
whole, the most popular product of the earth. In addition, wheaten
flour, unlike the flour of other cereals, is readily kneadable, and can
therefore be made into bread, macaroni, vermicelli, pastry, and all kinds
of puddings and cakes.
The first food orders issued in England called for the extraction of
76 per cent from the total grain; a few weeks later the extraction of a
further 5 per cent was ordered ; and it may be said that, after the early
summer of 1917, the wheaten bread consumed in Great Britain was to
all intents and purposes whole-grain bread. An option, however, was
given to millers to mix with the wheat, flour derived from barley, maize,
rice or oats, to the extent of 10 per cent. This meant that the miller need
not mill his wheat further than the original allowance of 76 per cent,
provided he added a proportion of other flours. It is possible to add to
flours rich in gluten a proportion of starch, as for example, flour made
from corn, without materially reducing the nitrogen value when compared
with a low-grade wheaten flour. The energy value of a loaf from such
flour would be quite high, while its nourishing properties would be littls
USE OF CERTAIN FOODSTUFFS IN WAR 761
impaired. Corn flour and rice, however, would somewhat detract from
its protein value, while barley and oats would add proteins and fat. The
loaf containing an addition of barley and oats would, from a dietetic point
of view, likely enough, have a superior value to the loaf made with a
similar proportion of corn or rice.
To those who hold that bread is primarily eaten not so much as a
source of protein, but as an easily digestible, attractive form of starch, it
matters little which flour is employed. Obviously, however, in war time,
the question of cost is predominant and the wheat substitutes can be used
for no good purpose unless they are cheaper than wheat flour itself. It
may be pointed out that in America, from this standpoint, corn particu-
larly commends itself as a food. Apart from this point, the physical
qualities of a loaf of bread must be considered, texture for one thing being
an important property. The characteristics which formerly chiefly com-
mended a loaf of wheaten bread were that it was light and spongy, easily
masticated and digestible. It goes without saying that the lumpy, sodden
loaf is unattractive and indigestible, and its food value may be largely
discounted owing to its causing gastric troubles. On the other hand,
while a loaf should be light, it is an advantage that it should be so baked
that externally it is hard and crusty, affording plenty of work for the
jaws, teeth and salivary glands.
Nearly all the vegetable foods which invite mastication are crusty
bread, dry toast, hard biscuits, salads, nuts and apples. Our staple vege-
table food wheaten bread is almost invariably eaten in a spongy form.
The loaves are shaped so as to afford a minimum of surface for crust, and
are lightly baked so that the crust shall be as thin as possible. In fact,
the prejudice that the majority of people have against crust is such that
the most crusty loaves, those which have rested on the floor and against
the sides of the oven, fetch a lower price than the others.
The more thoroughly a farinaceous food, as bread, is chewed, the
more intimately will it be mixed with the saliva, and the more efficiently
is it likely to be digested. It is certain, furthermore, that when food is
well digested, it will go further, and less of it will be required than when
it is not well digested. Thus, a piece of crusty bread well masticated
will go a longer way to satisfy the appetite and the nutritive requirements
of the system than an equivalent of pudding or of some of the soft mushy
food which has such a vogue in this country. While by no means a dis-
ciple of Fletcher, who unduly exalts the merits of mastication, and who
advocates its practice to absurd lengths, the author is convinced that it
would be in the best interests of the health of the community at large if
762 FOOD ECONOMICS IN WAR
more mastication were practiced, particularly with regard to the carbo-
hydrates in short, if less soft food were eaten.
The best way to secure adequate mastication is to select foods which
invite or even compel it. It is chiefly in regard to wheaten flour, oatmeal
and rice that reform is most needed. Many people in England, at the
time of writing, are wondering, now that war bread has made its appear-
ance, why they ever preferred the bread made from highly milled flour.
The ideal loaf of wheaten bread from the nutritive standpoint is the
crusty one made from whole-meal, which needs more mastication than
the spongy loaf, promotes good digestion, excites peristaltic action, and,
above all, contains those food elements known as vitamines, which stimu-
late certain physiological processes and are essential to the perfect well-
being of the organism as a whole.
Of other cereal foods than wheat, oats in the form of oatmeal, corn
and rice occupy the first places. From the aspect of protein value, oat-
meal is the most nutritious, containing as it does more protein than wheat
and considerably more fat. Rice is less nutritious than wheat or oats,
and inasmuch as it is polished rice which is imported, and which, eaten
solely, constitutes the deficiency diet par excellence, its employment as a
staple of diet is not indicated.
With regard to oatmeal as a war food, it may be recommended both
on the grounds of economy and nutritive properties. It is in itself a
valuable food, but in the form of porridge does not conduce to mastica-
tion. Moreover, the oatmeal flour sold nowadays is made from oats which
have been denuded of their husks, and is, when made into porridge, an
especially soft and pappy article of diet. The good, coarse Scotch oat-
meal porridge of yore, which required a certain amount of mastication,
and which contained the husks of grain in which were the vitamines, is
no longer seen in this country. In its place is offered a smooth bland sub-
stance, wholly devoid of the irritating, health-giving elements referred to
and affording not the slightest exercise to the jaws, teeth or the salivary
glands. From the point of view of mastication, oatmeal biscuits are pref-
erable to oatmeal porridge, but the latter is so popular and valuable a
food that it may be permitted in war time with the proviso that it is made
from whole-meal and that it is subjected to some sort of chewing.
While the good influence of protein consumption on health may have
been exaggerated, and while the need for a large protein intake may have
been overestimated, it is still allowed on all hands that a certain amount
of protein is necessary for the maintenance of the bodily powers at a high
standard. Many even hold that a considerable protein intake is benefi-
USE OF CEKTA1N FOODSTUFFS IN WAK 763
cial, aud the author is one of these. It must be remembered that the pro-
tein molecule is composed of a group of dissimilar chemical units, many
of which appear to be indispensable for the nutritive functions. As the
animal body cannot construct all of these synthetically, it is dependent
for a supply thereof upon the diet. The proteins of foods commonly
eaten provide these essential units in unlike yields. Accordingly, the
view is gaining ground that an adequate ration must furnish these units
in amounts sufficient quantitatively and qualitatively.
Corn possesses satisfactory nutritive properties in many directions,
but is somewhat lacking in its protein contents, or perhaps it would be
more correct to say that corn and the by-products of the corn kernel are
considered as a result of laboratory analysis, inadequate for good feeding
purposes unless they are supplemented by other protein-containing food.
It has been suggested by scientific authorities that the addition of supple-
mentary proteins perhaps those which are present in dried milk prod-
ucts might render such a food as corn, which in this country is plentiful
and inexpensive, but to some extent possibly inefficient from the protein
standpoint, considerably more valuable as a staple article of diet. By
many it is argued, however, that the slight lack of protein in corn, com-
pared with wheat and oats, detracts little if any from its nutritive value.
Practical experience has demonstrated that it is a wholesome food, and,
after all, it is experience that is, taking everything into consideration, the
siirc-t guide.
According to Dr. Haven Emerson, Health Commissioner of New
York, corn meal afforded the same amount of nourishment as wheat flour
and was, at any rate, in April, 1917, 25 per cent cheaper. No doubt,
from several points of view this statement is correct, and corn meal is a
nourishing form of food and one considered from the outlook of food
economies in war time, to be advocated as a staple diet. Yet, as in the
case of wheat, oats and rice, in fact of all cereals, corn deprived of its
husks is a less nutritive aliment by far than when these are allowed to
remain. More than a strong suspicion has been aroused, approaching
indeed conviction, by the researches of Voegtlin and others, that pellagra
is a deficiency disease, and that its prevalence in the Southern States is
largely if not entirely owing to the manner in which corn, which is the
staple diet of the population, is milled. It is, then, as obvious in the
instance of corn as in that of rice, wheat, oats and other cereals, that it
should not be highly milled in order to obtain the greatest nutritive
benefit from its consumption. The war has taught and emphasized the
point that all cereals regarded from the health and economical aspects
764 FOOD ECONOMICS IN WAR
should be so milled or prepared for human consumption that the coarser
parts should be left for reasons which have been fully explained in differ-
ent portions of this work.
A great advantage possessed by corn as a food is that it is pleasant
to the palate and that it may be cooked and prepared in a variety of ways,
while above all it is cheap. Our readers may be reminded of the fact that
during the Civil War soldiers subsisted for considerable periods of time
almost wholly upon corn, employing it even as a vehicle for making a
substitute for coffee.
Potatoes. It is hardly necessary to dwell upon the fact that potatoes
are factors of much importance in war-time feeding. A bountiful potato
crop probably saved Germany at a very critical period. Potatoes, how-
ever, do not provide such reliable crops as the cereals, and if a potato
crop fails, it usually fails wholly. It may be pointed out that, as a rule,
there is gross waste in the preparation of potatoes for food. There is no
need indeed, in war time, the custom should be strongly discountenanced
if not prohibited of peeling potatoes before cooking them. A useful
part of the potato is removed with the skin, and the majority of people
can eat potato skin with advantage. Special care should be taken not to
waste the highly nutritious potato. Potato bread is a pleasant and sat-
isfying food, and it is a good plan to make it of cooked potatoes which
might otherwise be wasted.
Milk. The question of milk is a very obtrusive one in war time. It
has become almost an article of faith that a large supply of milk is indis-
pensable to the maintenance of good health, and that, if a milk supply
failed wholly or in part, the consequences would be disastrous. In time
of war, foodstuffs and feeding materials must be economized. To find
feeding material sufficient to maintain cows in such a condition that they
will provide a good supply of milk, implies a great deal of labor and also
the importation of an amount of feeding material which is inconvenient
when not impossible under war conditions. It is assuredly true that to
conserve infant life, a certain supply of cow's milk is necessary, that is,
in the existing state of affairs, when so many women do not suckle their
offspring. But that, after the baby age is passed, milk is an absolutely
essential article of diet is strongly combated by many authorities. Camp-
bell (6) went so far as to declare that the child, as distinguished from the
babe, does not need milk and would not suffer greatly if the supply of
dairy milk suddenly failed. He argued, in the first place, that milk,
affording as it does a peculiarly favorable soil for the growth of disease
germs, has carried disease and death to hecatombs of children. It has
USE OF CERTAIN FOODSTUFFS IN WAR 765
further acted injuriously by favoring the consumption of soft, pappy
foods. It is obvious that the infant, like the young of other mammals,
requires milk for the first period of its life, and that the proper milk for
it is that of its own mother. When this source of supply fails or is not
available, as so frequently occurs in these days, resort must be had to the
milk of other animals, cows or goats. This has not proved an unmixed
blessing, but the question has been so thoroughly covered in Volume II,
Chapter XV, and Volume III, Chapter XXIV, that it would be super-
fluous to lay further stress on this phase of the matter.
According to Campbell, while the infant needs milk of some kind
during the first nine or ten months of life, it does not need any after that
period. Why should the young of man any more than the young of other
mammals require milk after it has left the breast ? It is only since man
first domesticated the cow and goat and this from the point of view of
his evolution was but as yesterday that he has been supplied with any
milk other than human, and it is absurd to suppose that before that time
his health suffered from the lack of cow's or goat's milk. The pre-agri-
cultural tribes to this day are without any, and until civilized man de-
teriorated them by the introduction of alcohol and European vices, they
were magnificent physical specimens of manhood.
The argument is not made that dairy milk is a useless food for man,
but merely that it is not essential to him after the nursing period. Its
chief value to the human race is as a source of butter and cheese, two
highly concentrated and agreeable foods, admitting of prolonged storage,
as not only cheese but salt butter may be kept for many months. Un-
doubtedly cheese is a very valuable form of food in war time, on account
of the large amount of protein that it contains. The manufacture of milk
into butter and cheese rather than its use in the form of milk, especially
into cheese, is prompted by considerations of health and economy alike.
Sugar. Another article of food which has given rise to violent and
persistent discussion, and the use of which has been the most vexed ques-
tion of all with regard to food economics in Great Britain and Germany,
is sugar. In Germany sugar was consumed in immense quantities,
mainly, perhaps, because that country produced it on the largest scale.
Now so short. is the supply there that, as noted previously, saccharin has
been substituted. It was not long ago that sugar was lauded as an essen-
tial. Now neither scientific men nor practical observers speak so de-
cidedly in favor of sugar as a necessary ingredient or part of a diet.
Mendel says that, although sucrose, the form in which it is generally used,
has a considerable fuel value in the organism, its dietary use is primarily
766
dictated by considerations of flavor. Opinions are occasionally divided
as to the place of this sugar in the dietary. Mendel is of the opinion that
the artificially colored white sugar has nothing except a false standard to
recommend it in place of the natural cream-colored sugar. It will be ob-
served that Mendel appears sceptical as to white sugar being of any great
nutritive value, but does not comment on the cream-colored product.
Campbell, referred to above, propounded as iconoclastic opinions with
regard to the food value of sugar as he propounded concerning milk. He
stated that we could get on very well without sugar at all. Primitive man
had none but the limited quantity furnished by wild honey. War prices
are exorbitantly high, and it consequently behooves everyone to be eco-
nomical. He maintained that all money spent on candy is worse than
wasted, and recommended that none should be so spent, that the money
saved in this way should be loaned to the state, and that the multitude
of persons engaged in the sweet industry should be transferred to occupa-
tions more profitable to the country.
More than one well-known physiological authority has stated that
sugar is not a natural food, inasmuch as the human economy is con-
structed to convert carbohydrate, e.g., starch, which they claim to be a
natural foodstuff, into sugar. It is certain that if sugar were tasteless
or not sweet, it would not be so popular as it is, and thus it must rank as
a condiment as well as a food. It is interesting to recall that sugar was
scarcely a commercial commodity a little over a century ago, and that
before that our ancestors got on very well without it, while, as a matter
of fact, a big section of the community consumes nowadays very little or
none of it. The history of starch in the dietary, on the other hand, goes
back to the very beginning of things, and there was a supply of starches
long before sugar was thought of in its present form. .
Custom and cheapness have brought sugar into wide use, but in time
of war its employment in many extraneous and totally unnecessary ways
should be prohibited. After all, diet is largely ruled by custom, and war
has gone to show that many customary articles of food which were con-
sidered essential by the public cannot only be dispensed with, but be dis-
pensed with to the benefit of the general health.
Alcohol in War Economics. The war in Europe has had a great effect
on the consumption of alcohol. It need hardly be pointed out that in the
economics of war the question of alcohol stands out most prominently.
The value of alcohol as a food or even as a fuel may be dismissed as
trivial in comparison with the harm that it does, and the waste of men
and food and feeding material in its manufacture.
USE OF CERTAIN FOODSTUFFS IX WAR 767
The food or fuel value of alcohol is so slight as to he a negligible quan-
tity. It has been established that about one ounce of absolute; alcohol
is the limit which can be burned up in the body within a period of twenty-
four hours without paralyzing or narcotic effect, and without the appear-
ance of unchanged alcohol in the excreta, and one ounce of alcohol sup-
plies about as much fuel as one ounce of margarin, 200 calories. Xow
one ounce of alcohol costs in the form of cheap spirit not more than four
cents ; in the form of beer less ; in the form of heavy wines, 8 to 12 cents ;
in the form of light wine, 24 cents; while to these prices must be added
some 40 or 50 per cent during war time. One ounce of margarin costs
about 2 cents. Therefore, even if alcohol is regarded as a food, it is an
extremely wasteful and expensive one.
Perhaps the sudden withdrawal of alcohol in any form from those with
whom its use has been habitual may be followed by injurious effects on
muscular and nervous energy. It is conceivable that men who for years
have been accustomed to taking some form of alcoholic beverage as a part
of their diet after a hard day's labor, might be affected by its sudden and
complete withdrawal. Possibly in any regulations drawn up for the re-
striction or prohibition of the manufacture or sale of alcohol, it might
be deemed wise to make allowance for the cases of those in whom total
abstinence produces ill effects. There are other difficulties in the way of
enforcing prohibition, such as the probable development of an illicit traffic
in alcohol and the introduction of substitutes for alcohol which might be
infinitely more detrimental to public health and order.
When all is said that can be said in favor of alcohol and of the dis-
advantages of its total withdrawal, these will weigh almost as nothing
against the obvious manifest advantages of prohibition as a war-time
measure. When food is scarce and the food situation serious, the question
of the control of the liquor traffic becomes insistent from the point of view
of national efficiency. To this argument may be added the further con-
tention that the loss of energy value involved in the conversion of the
carbohydrate of grain and sugar into alcohol represents in itself a serious
leakage in food supplies. It must be remembered that there is an in-
evitable loss of energy in the conversion of these more highly organized
bodies into the simpler alcohol ; only some 60 per cent of the energy in
the barley grain or the potato flour remains in the resulting beer or spirit.
In itself brewing or distilling is a gross waste of food products.
By the enforcement of total abstinence at a stroke, the consumption
of the thousands of tons of grain employed in the manufacture of beer
and spirits would be saved, a vast amount of energy now employed in
768
FOOD ECONOMICS IN WAK
brewery, distillery and saloons would be diverted into more profitable
channels, and the health and morals of the nation would be raised. By
the cessation of the manufacture of alcohol, and the utilization of its raw
materials, especially of potatoes and grain, as immediate sources of food
supply, the strain of providing the population with nutriment will be, to
that extent, relieved.
For industrial and scientific purposes, alcohol is valuable, and to sup-
ply the needs in this direction, the manufacture, perhaps, of a limited
amount should be permitted. But so far as beverage is concerned, the
war has taught the lesson that human efficiency can be maintained at a
higher standard without alcohol than with it.
The Food Situation in the United States. More food is produced in this
country than in any one country of the world, and yet at the present time
there is a food shortage. This shortage is due to many causes: (a) Food
production has not kept pace with the growth of population and has been
giving alarm to agricultural experts for several years. During the past
three decades Americans have been forsaking the farms for city life, and
as a consequence agricultural labor has been becoming more and more
difficult to obtain. Thus the food problem has been greatly hampered by
the lack of agricultural workers, and this has been especially noticeable
since the outbreak of the great European War. (&) The opportunity for
securing employment in manufacturing establishments, the consequent
high rate of wages and the inducements of city life have enticed many
agricultural workers to forsake the farm, which has seriously interfered
with the necessary labor for agricultural work and has added much to
the serious phases of agricultural pursuits.
Since 1884 the production of wheat in this country has dropped a
very considerable extent, due to the inability of the farmer to procure the
necessary help. Farmers are now killing their live stock and as a conse-
CEREAL PRODUCTION OF THE UNITED STATES IN 1915
Cereal
Acreage
Bushels
Corn
108,321,000
3,054,535,000
Wheat
59,898,000
1,011,505,000
Oats
40,780,000
1,540,362,000
Barley
7,565,000
237.009,000
Rye. .
2,856,000
49,190,000
Buckwheat
806,000
15,769,000
Rice
694,000
65,691,700
USE OF CEKTAIN FOODSTUFFS IN WAR 769
quencc supplies of meat in cold storage have fallen off enormously. The
high prices of all kinds of foodstuff since the beginning of the European
War, have resulted in a very marked increase in the export of all food-
stuff, which unfortunately does not signify an increased ability to produce
food, but on the other hand means rather that we are depleting our exist-
ing stock of supplies.
In 1910. harvest conditions in the United States were much below
normal production and, in short, it has been plainly demonstrated that our
reserves in cereal grains are being rapidly exhausted. It has been com-
puted that our Allies' cereal crop this year has shrunk to about 525,-
000,000 bushels below normal, and if consumption in the allied coun-
tries is to be maintained at or near normal no less than 1,250,000 bushels
of grain must be exported by the United States. The cattle and hogs in
the allied countries are diminished in number by something like 30,-
000,000 head, and these reductions will continue with increasing severity
for the reason that animals must be slaughtered on account of shortage
in food supplies. We have not only to feed the people of our own coun-
try, but we are also expected to make up the food deficiency of our
Allies, and thus the burden of the war, so far as supplying subsistence
to the Allied armies is concerned, falls most heavily on the United
States.
If this war is to be won by our Allies, food must be strictly conserved
by the American people. We shall consider briefly the food problem from
an economic viewpoint. It may be safely said that our own people, up
to the present time, seem to have failed to realize adequately the all-
important role that food will play in this war and there is grave danger
in the fact that the necessity for economy in diet is not sufficiently appreci-
ated. It has been pointed out in a previous section of this chapter, that
under the compelling stress of circumstances, the nations at war in
Europe have restricted and regulated the consumption of food, and
avoided waste in every possible way, and, moreover, that up to a certain
point, this has been done with correspondingly decided benefit to the
public health. As a matter of fact, economy in diet in this country, if
arranged on sensible and scientific principles, should be attended with
little or no injurious effects on the health of the population. Such econ-
omy may be uncomfortable for a time, but man is extraordinarily adapt-
able, and in a short time, provided ho gets a sufficient quantity of fat and
energy-producing foods in well-balanced proportions to keep the human
machine working, it does not matter much whether his subsistence is
derived mainly from the vegetable or animal kingdom. As previously
770 FOOD ECONOMICS IN WAR
pointed out in this work Americans are large meat eaters but so were
the Germans and British before the war.
The Germans and, to a lesser extent, the British, have denied them-
selves meat with a good deal of philosophy and with benefit rather than
harmful results. Educational propaganda with regard to food economy in
this country should not only dwell on the need for economy and self-
denial, but should lay special stress upon the point that comparative de-
privation of meat and the substitution of nutritious articles of food for
those to which the population has by long use become accustomed, invokes
no special hardships, while in many instances a restricted diet may be
beneficial.
In the first place the foodstuffs exported by us must be of a most con-
centrated kind, as for example, wheat, beef, pork, dairy products, fats
and sugar. Although we have a surplus of potatoes, vegetables, fish and
poultry, these, with the exception of vegetables in dehydrated form, do
not lend themselves to shipment.
As said before, the wheat supply is short and the food administrator
has requested the population of this country to eat corn bread and conserve
the wheat for our Allies. Corn meal, when properly prepared, can be
made as nutritious, as wholesome, and as palatable as wheat bread. We
are the largest corn growing nation in the world and our people, unlike
the Frenchmen and Englishmen, are not averse to eating corn bread.
Accordingly the first logical step in adapting our food supplies and con-
sumption to the needs of our Allies is to substitute, as far as possible, corn
for wheat on our own tables. Furthermore, when wheat bread is placed
upon the table it should be baked from whole wheat meal. The bread
on which our sturdy grandsires throve was made from the whole wheat
berry and the ingenuity of man has never devised a more wholesome, more
palatable nor more nutritious bread than that made from the whole wheat
grain. This point has been previously dwelt upon in other portions of
this work. The reasons' why whole wheat flour should be used are as fol-
lows: When properly made and baked, bread made from whole wheat
flour is more nutritive and digestible than bread made from highly milled
and finely bolted white flour; besides it contains all of the cereal salts
(1.75 per cent), while highly bolted white flour is deficient in cereal salts
(only .44 per cent). Moreover, the modern patent roller process flour
is deficient in vitamines, while the whole wheat flour contains all of the
vitamines which nature grew into the wheat berry.
Graham Lusk, who has devoted much research to the subject of scien-
tific nutrition, advocates the consumption of graham (whole wheat) bread,
USE OF CERTAIN FOODSTUFFS IN WAR 771
and several authorities on nutrition, both in this country and in Europe,
are enthusiastic over the nutritive properties of whole wheat bread. In
fact, just a few months ago an edict went forth in Great Britain that all
flour should be ground from the whole wheat grain. A feature in favor
of whole wheat meal is that bread made from it requires more mastication
and exerts a considerably more laxative effect than bread made from
highly bolted patent roller process flour which predisposes to constipation
and intestinal stasis, complaints which are widely prevalent in this coun-
try. However, the advantages of whole wheat bread have been sufficiently
emphasized.
The question of protein consumption has given rise to considerable
discussion, or, perhaps, it is more correct to say that the discussion has
hinged on the point as to which form of protein should be taken as food.
There is virtually no difference of opinion with regard to the need of
protein. To a greater or lesser extent, it is known, that on the whole,
more protein in the form of meat is eaten than is physiologically required.
It certainly is a fact that owing to the false teaching and long held beliefs
of the strengthening effects of meat, too much meat is consumed by both
young and old with harmful results to both. This subject has been previ-
ously considered and we will not enter into a dissertation here regarding
protein as a food ; it will suffice to say that the protein of meat can be re-
placed by vegetable protein, such as that from the legumes, whole wheat
flour, and various vegetables. These are cheaper by far, more easily and
economically produced, and will maintain the body at a high standard of
efficiency and health; therefore, the next step in the direction of food
economy is to substitute, as far as possible, protein from the vegetable
kingdom. Moreover, fish can be largely used as a substitute for meat and
we have fish in great abundance.
Unfortunately the fat content of a well-balanced ration is not trans-
mutable. No substitute can be offered in the place of fats, but some very
useful advice can be tendered. A large reduction in the ordinary con-
sumption of fat by the well-to-do citizen will be helpful to the nation and
to the individual. Graham Lusk, writing in the Scientific Monlhly,
October, 1917, draws attention to the fact that it is not at all difficult
to reduce the body weight by reducing the consumption of fats and
starches and cutting down the energy value of their ration from 2,800
calories to about 2,200 calories. The fuel foods for the human machine
are principally made from wheat, corn, rice and the sugar cane.
The average American consumes more sugar than is necessary or
beneficial and if we are to be able to export any sugar to our Allies the
772 FOOD ECONOMICS IN WAR
per capita consumption must be reduced in this country. This is one
aspect of the food situation in this country which has not been met as it
should have been met.
The author, at the outbreak of the war, suggested that the use of
grains for the manufacture of intoxicating beverages should be stopped.
The grain that is now being used for the manufacture of intoxicating
drinks, if employed for human consumption or for fodder for animals,
would relieve the present stress to an unbelievable degree. The employees
thrown out of work by prohibition would soon find other spheres of human
endeavor in which they would be much more useful to the community.
The greatest source, perhaps, for the inflation of the prices of foodstuffs
is the present manipulation of the food markets by speculation. And
another point in the present high cost of living and bad food preparation
is a want of knowledge in the culinary department. For a couple of
decades past the science of cookery has not been taught in the home as it
should be, and as a result the daughters, with the exception of a few who
have been trained in domestic science schools, are unacquainted with the
uses of the culinary utensils of the modern household.
Lusk, referred to previously, formulates the following propositions,
which are so apropos to the subject that no excuse for quoting them is
necessary: "(a) Eat corn bread and save the wheat for France and our
other Allies; (&) Let no family of five persons buy meat until it has
bought three quarts of milk; (c) Save the cream and butter and eat vege-
table oils and oleomargarin ; (d) Eat meat sparingly, rich and poor,
laborer and indolent alike; (e) Be a prohibitionist for the period of the
war; (/) Save everything that can be used for food, because food is
precious; (#) Finally, remember that the whole world is seeking for
food with which to work and although our wheat crop is short, still we
are the nation most richly endowed with fuel food. It remains to be
seen whether we have the intelligence to fitly utilize for the welfare of
mankind the resources which God and nature have placed in our hands."
The only solution of the food problem is to eat more of the foods which
can be easily raised and less of those which are so urgently needed by our
Allies. As our food dictator has stated, "There is no real conservation
without reduction in consumption, and the elimination of personal waste."
If the people of this country will heartily cooperate with the food
conservator in the endeavor to conserve the food supply, and will endure
for a while some discomfort, there will be no difficulty regarding the food
problem. Sufficient food can be produced to keep the population supplied
with a well-balanced dietary with sufficient to export for the Allies. The
SUMMARY 773
case of Germany has plainly demonstrated this fact, but in this country
the populace must be educated with respect to scientific nutrition and
must come to realize that personal selfishness must be subordinated to the
national interest.
SUMMARY
As remarked in the introductory sentences of this chapter, the author
is of the opinion that in a work on diet, notice should be taken of the food
question in war, and that an attempt should be made to extract whatever
lessons in this direction might seem apposite.
The conclusions to be drawn as the result of this survey for it can
hardly be termed a close study are: That the limitation of food conse-
quent upon a short supply brought about by war conditions is beneficial
to a certain proportion of the population, further demonstrating the fact
that in the ordinary way the majority of persons eat more than their phys-
iological requirements call for. On the other hand, a restricted food sup-
ply presses heavily on those least able to bear the pressure, that is, on those
who, on account of the greatly enhanced price of food, are unable to obtain
the kind of diet to which they are accustomed and indeed suffer from a
paucity of nutritive elements. It seems to have been proven that over-
feeding is injurious, but that underfeeding is worse.
So far as the different essential constituents of the food are concerned,
at the time of writing it is impossible to speak dogmatically. It appears
to have been demonstrated that more protein is generally eaten than is
needed, and not enough fat. The Germans, according to Taylor, suffered
from the limitation of fat in their diet, and it may be stated that fat is
a more important factor in the promotion of physical efficiency than hith-
erto has been believed. One of the chief lessons learned from the war
so far has been the great economical and nutritive value of whole-grain
bread. The proven dietetic value of whole-grain bread, and of cereals
from which the husks have not been removed, suggests the reflection that
possibly the value of food, after all, depends no more on its protein, fat
or carbohydrate content, as the case may be, than on the possession of those
food elements termed vitamines. Certain it is that when these are absent,
ill health and disease are generally the sequence.
In this chapter some opinions have been expressed with regard to milk
which do not seem to be in accord with the views of authorities. The opin-
ions propounded here, while not entirely those of the author, still are his
to this extent, that he does believe that milk per se is not an indispensable
article of diet except for infants, and that the best use that can be made
149
774 FOOD ECONOMICS IN WAR
of milk, in war time at any rate, is its conversion into cheese, one of the
most wholesome and nutritive foods known. A good hunch of crusty
bread, with butter and cheese or fat bacon, followed by a little raw fruit,
such as an apple, constitutes a well-balanced meal.
It has been pointed out that the question of sugar is a vexed one. In
England it appears to have been concluded that its dietetic virtues have
been exaggerated, and that in war time its consumption, with great benefit
to all concerned, might be very considerably restricted. With regard to
the liquor traffic in war time, there is and should be very little difference
of opinion. The grain, potatoes, etc., that are employed in the manufac-
ture of alcohol in war time should be utilized for feeding men and animals
and in every respect the manufacture of alcohol to be used as a beverage
should be restricted to a minimum or wholly interdicted.
Finally, there are at least four ways of reducing the consumption of
food : 1. By preparing the food in the most economical way. 2. By mini-
mizing waste. 3. By selecting the right kinds of food and in the right
proportions. 4. By limiting to a sufficiency the quantity of food con-
sumed.
1. TAYLOR, A. E. Saturday Evening Post, Feb. 17, 1917.
2. . Ibid., Apr. 14, 1917.
3. British Medical Journal, Feb. 17, 1917.
4. WALLER, A. D. Lancet, Feb. 17, 1917, p. 273.
5. MENDEL. Changes in the Food Supply and Their Relation to Nutri-
tion.
6. CAMPBELL. Lancet, Apr. 1, 1916.
INDEX
A
Absorption, of end products of protein di-
gestion, ill-eft'ects of, 198.
Acid-forming and base-forming elements,
314.
Acid-forming dements of diet, 357.
Acidosis. due to chronic intestinal stasis,
463.
Acne, diet in, 4(i7.
Aerophagy, treatment of, 122.
Akoria, 121.
Albumin, purin-free diet to supply, 330.
Albumins, coagulation point of, 57.
Albumin water. preparation of, 580.
< x j_ r g, preparation of, 581.
Album in i/ed lemonade, preparation of,
579.
Albuminized milk, preparation of, 583.
Albuminous bodies, in breast milk, 477.
Albumipuria, in pregnancy, diet in, 466.
Alcohol, as a beverage or as a medicine,
401.
effect of, 385.
as a food, 406.
as a protein sparer, 306.
use of, 385, 401.
in puberty, 420.
in tropical climates, 401.
in war, 766.
utilization of different food stuffs with
and without, 308.
Alimentary hygiene. See Eating, hygiene
of.
Alkali, added to milk, to prevent clotting,
494.
Allotriophagia, 119.
Almond milk, preparation of. 582.
Ami no-acids, deamini/ation of proteins in,
169.
in proteins, 194.
qualitative variations of, 200.
as reserve energy supply, 211.
ultimate fate of, after absorption by
tissues, 210.
Ammonia, in protein metabolism, 329.
Anabolism. definition of. 286.
Aneurisms. Bellingham'a diet for, 5 IS.
TufneH's did for, 547.
Animal protein, vegetable protein versus,
528.
Anorexia, 120.
Appetite, loss of, 120.
perversions of, akoria, 121.
anorexia, 120.
bulimia, or hyperorexia, 120.
parorexia, 119.
polydipsia, 121.
polyphagia, 121.
rumination, 121.
seasickness. 122.
"Apple-fasts," 545.
Apples, dried, 25.
Apple water, preparation of, 578.
Apricots, dried. 24.
Army rations, foreign. See Rations, of
foreign armies.
U. S. See Rations, U. S. Army.
Arteries, hardening of, sign of old age,
434.
Arteriosclerosis, and old age, 439.
as sign of old age, 434.
Arthritis, rheumatoid, due to chronic in-
testinal stasis, 460.
Ash, percentage of, in bones, muscles and
various organs, 312.
Atwater's experiment for calculation of
energy metabolism, 296.
Austria, army daily ration of, 715.
B
Baeltz's investigations among the Japan-
ese, in regard to diet and endur-
ance, 176.
Baking of meat, comparison of, with
roasting, 60.
mechanical and chemical changes in, 60.
as practised by savage tribes, 60.
process of, 60.
Banana figs, 27.
Bananas, dried, 27.
dried products of, 27.
Barley water, preparation of, 580.
Base-forming and acid-forming elements,
314.
Base-forming elements of diet, 357.
Beans, dehydrated. 41.
cooking of, 43.
food value of, 44.
dried, 41.
composition of fresh and, 41.
lima, dehydrated, 4'J.
soy, dehydrated, 4'2.
Beef broth, preparation of. See Recipes.
broths.
775
776
INDEX
Beef, dried, 2.
Beef essence, preparation of. See Recipes,
meat juices.
Beef juice, preparation of. See Recipes,
meat juices.
peptonized, preparation of, 589.
Beef tea egg-nog ( Davis ) , preparation of,
587.
preparation of. See Recipes, beef teas.
Beets, dehydration of, 36.
advantages of, 37.
Beet-sugar industry, 36.
Bellingham's diet for aneurisms, 548.
Beriberi, due to lack of vitamines, 230.
Berries, drying of, 27.
Bevenot de neveu process of desiccation of
miJk, 13.
Beverages, preparation of. See Recipes,
beverages.
in tropical climates, 405.
Bile, secretion of, in underfeeding, 162.
Biliousness, due. to overeating, 135.
Biltong, or dried beef, 2.
Blood, effect of underfeeding on, 162.
Body weight, protein minimum necessary
to, table showing, 154.
Boiling of fish, 66.
of meat, 55.
action of salt in water, 57.
for broth or bouillon, 56.
correct procedure for, 56.
difference between stewing and, 57.
effect of, 55.
primitive method of, 55.
Borax, use of in rreservation of meats, 7.
Bouillon, procedure for making, 56. See
also Recipes, bouillons.
Boys' military training camps, rations
for. See Rations, for Boys' Mili-
tary Training Camps.
Bradyphagia. 82.
advocates of, Fletcher, 82.
Gladstone, 83.
definition of, 83.
ill effects of, 84, 85.
Braising of meat, 64.
Brandy and egg mixture, preparation of,
586.
Bread, advantages of wholemeal over high-
ly milled, 749.
use of, in war, 759.
Bread-making, history of, 49.
See Recipes, breads.
Breast feeding, age for, 481.
axioms for, 481.
colostrum, 475.
centra-indications to, 488.
daily bowel movement during, 482.
diet during period of, 481.
duration of weaning, 483.
gain in weight after each meal, 485.
galactagogues, 479.
importance of weighing baby during
period of, 485, 486.
Breast feeding, increased percentage of
mothers capable of, 471.
indications for discontinuing, 485, 486.
micro-organisms in milk, 474.
necessity for intelligent mothers, 480.
a normal function, 482.
regularity of, 483.
relative frequency of, 472.
stimulation of lacteal secretion, 479.
successful, 484.
unsuccessful, 484.
women of to-day better fitted for, 472.
Breast milk, coagulation of, 477.
comparative analysis of cow's milk and,
490.
consideration of, 485.
constituents of, albuminous bodies, 477.
casein, 478.
coagulation, 477.
fat, 478.
ferments (enzymes), 479.
lactose, 478.
deficiency in proteins and fats, 487.
indications for analysis of, 485.
lack of uniformity in, 487.
micro-organisms in, 474.
nitrogenous substances in, 475.
quality of, 485.
quantity of, 476.
daily average drawn by baby, 477.
daily secreted by healthy young
mothers, 476.
in secretion by primipara and multi-
para, 476.
Broiling of meat, 63.
Bronchitis, of the aged, diet in, 452.
Broth, procedure for making, 56. See also
Recipes, broths.
Bulimia, 120.
Butter-fat, and vitamines, 228.
Buttermilk, in infant feeding, chief value
of, 501.
class of infants benefited by, 501.
composition of, 500.
origin of, 500.
preparation of, 500.
Buttermilk cure, 566.
Buttermilk and egg mixture, preparation
of, 584.
Cabbage, dehydrated, 40.
Cactus fruit, dried, 28.
Calcium content of foods, 350, 351.
Calcium excretion, 349.
lowering of, in disease, 341.
Calcium oxid, in foods, approximate
amounts of, 353.
Calcium salts, importance of, 349.
in infancy and childhood, 350.
ingestion of, 349.
INDEX
777
Caloric method of feeding, calculation of
fuel values of food, 257.
comparative equivalents in metric,
avoirdupois and apothecaries'
weights and measures, 257.
heat produced from substances burned
in calorimeter distinguished from
heat available when used in body
263.
represented by a particular menu, 263.
table of, 258-263.
caloric requirement of man, 252.
caloric values of ingested foods, 250.
calorific value of excretory products,
254.
constructive and fuel foods, 251.
food requirement, factors governing,
265.
heat of combustion of various sub-
stances and foods, 247.
introductory, 243.
method of reckoning the protein, fat
and carbohydrate rations for
diets of definite energy values,
264.
physiological food value, 255.
regulation of body temperature, 274.
standard and sample dietaries, 248.
unit and method of measurement, 246.
Caloric requirement of man, 252.
Calories, income and outgo of, in meta-
bolism experiments, 291.
Calorific value of excretory products, 254.
Rubner's table showing losses and avail-
able energy, 255.
Calorimeter, forms of, 246.
use of, 246.
Calorimetric combustion, average results
of, 247.
heats of, and approximate elementary
composition of typical com-
pounds, table of, 249.
Canned foods, in diet of tropical climates,
400.
Canning, chemical agents used in, 7.
process of, for preservation of food, 6.
other foreign nations, 178.
Carbohydrate diet, people subsisting al-
most entirely on, Japanese, 176.
Carbohydrate and fat, Kayser's table
showing nitrogen balance when
feeding isodynamic quantities of,
303.
sparing power of. in calorimetric ex-
periments ( Atwater ) , 304.
Carbohydrate-free diet, 338.
Carbohydrates, amount of, contained in
vegetables, before and after cook-
ing of, 69.
contained in cow's milk, 494.
easily burned, catabolism of furnishing
too much heat, 342.
excess of, in metabolism of overfeeding,
188.
Carbohydrates, fat versus, as protein
sparers, 302.
function of, in nutrition, 301.
as protein sparers, 300.
transmutability of, 101.
Carbon, income and outgo of nitrogen and,
in metabolism experiments, 290
296.
Carrots, dehydration of, 37.
Casein, in breast milk, 478.
in cow's milk, 493.
dehydration of, 17.
Catabolism, definition of, 287.
Candle, preparation of, 581, 587.
Celery, dehydration of, 40.
Cellulose diet, 339.
Cellulose, foods containing, 340.
Cereal foods, preparation of. See Recipes.
Cereal grains, exhaustion of reserve in, in
U. S., 769.
Cereals, partly digested, prepared at
table, 589.
protein and starch equivalents in buck-
wheat and, in diet of tropical
climates, table of, 391.
use of, in war, corn, 763.
oatmeal, 762.
wheat, 759.
Certified milk, 489.
Character, influence of diet on, 370.
Chemical agents, antiseptic, treatment
with, in preservation of food, 7.
Chemical elements, composing human or-
ganism, 361.
Chestnut, dried, 28.
Chicken broth, preparation of, 598.
Childhood, diet in, 409. See also Diet in
Childhood.
Chinese raisins, 28.
Chittenden's experiments in low protein
diet, 171.
conclusions of, 186, 190.
Chittenden's low protein dietary, 253.
Chittenden's table, 173.
Chlorin equilibrium, maintenance of, 348.
Church's standard diet for Indians, 393.
Climate, and diet, 372.
maintenance allowance according to
climates, 373.
tropical, diet in. See Diet in Tropical
Climates.
Cocoa, preparation of, 582.
Coffee, preparation of, 582.
Cold storage, preservation of meat by, 3.
prolonged, effect of, 4.
requisite temperatures for preservation
of certain animal foods, 5.
Colostrum, appearance of, 475.
composition of, 475.
specific gravity of, 476.
Concentrated proteins, 70.
Condensed foods, as means of food concen-
tration, 70.
Condensed milk, in infant feeding, l!Mi.
778
INDEX
Constipation, ancient usage of medical
practice for overcoming of. 457.
Constitution, influence of diet on, 368.
Convalescents, exchange of energy in, 141.
flesh formation in, 141.
interchange of nitrogen and storage,
protein and fat, absolute and per-
centage, in overfeeding, table
showing approximate values of,
143.
nitrogen increase in, due to overfeed-
ing, table emphasizing, 142.
nitrogen retention in, 141.
Cookery, varieties of, 54.
Cooking, changes produced by, 53.
coagulation point of different albumins,
57.
difference between French, English and
American, 53.
of dried beans, 43.
of fish, 66.
history of, ancient British, 50.
berries, fruit, etc., 50.
as branch of woman's education in
this country, 51.
bread-making, 49.
fish, 50.
French, 50.
meats, 50.
of meat, baking, 60.
boiling, 55.
braising, 64.
broiling, 63.
comparative composition before and
after, 65.
comparative composition of water-free
substance before and after, 66.
frying, 58.
grilling, 63.
"high" or slightly tainted, 62.
losses in, 65.
roasting, 61.
steaming, 65.
stewing, 57.
poor, evil effects of, 54.
principles of, changes produced by, 53.
digestibility, 51.
foods requiring, 51.
knowledge of, necessary to physician,
51.
scientific application of heat, 51.
scientific application of heat, to animal
foods, 52.
coagulation of proteins, 52.
dextrinization of starch, 52.
to fats, 52.
gelatinization of starches, 52.
to sugar, 52.
to vegetable foods, 52.
of vegetable foods, objects to be achieved
in, 67.
of vegetables, action of, 67.
amount of carbohydrates contained,
before and after, 69.
Cooking, of vegetables, deficiency of fat in
vegetables made up in prepara-
tion of, for table, 69.
gain of water on, 68.
lengths of time required for, 69.
Corn, dehydration of, 44.
protein of, 199.
relation of, to pellagra, 44.
use of, in war, 763.
Cornmeal mush, preparation of, 609.
Creatinin, in protein metabolism, 329.
Crime, relation of underfeeding to, 152,
153.
Curds and whey or junket, preparation
of, 592.
Cures, buttermilk, 566.
dry, 561.
grape, 546.
kumiss, 564.
lemon, 546.
matzoon, 566.
milk, 569.
skim milk, 572.
sour milk cure, 567.
whey, 573.
yolk, 563.
Currant juice, preparation of, 578.
Custards, preparation of. See Recipes,
custards.
Cutaneous lesions, due to chronic intes-
tinal stasis, 463, 466.
acne, 467.
itching dermatoses, 468.
D
Dates, curing of, 27.
Debility, dietary for, 564.
Decomposition of food, causes of, 1.
Deficiency diseases, due to lack of vita-
mines, 230.
Dehydration, advantages of, 9.
economic, 46
of casein, 17.
of eggs, 17.
of fish, 20.
of foods used in the army, 37.
of fruits, advantages of, economic, 30.
analysis and caloric value of dried
fruits, per pound, 29.
as an ancient procedure, 20.
apples, 25.
apricots, 24.
by artificial drying, 21.
bananas, 27.
cactus fruit, 28.
chestnut, 28.
comparative cost of total nutrients
and fuel value of some fresh and
dried fruits, 31.
dates, 27.
litchi nut or Chinese raisin, 28.
I X I )EX
779
Dehydration, of fruits, methods of, 24.
old-fashioned, or household method
24.
olives. i'S.
peaches. 24.
persimmon. 2S.
preparation of fruit for, 23.
proper storage of, 26.
prunes, 22.
raisins, 2(i.
small fruits and berries, 27.
by sun drying, 21.
unusual, 28.
in Germany, 10.
of meat, ancient and modern methods
of, 18.
as a concentrating and preserving
process, 71.
powdered meats, 20.
disadvantages of, 20.
Italian method for making, 20.
Tellier method of, 10.
of milk. See Desiccated Milk; also
Desiccation of Milk,
success of, 46.
value of, 9.
of vegetables, 11, 32.
advantages of kiln method for, 41.
beans, 41.
cooking of, 43.
lima, 42.
soy, 42.
beets, 36.
cabbage, 40.
carrots, 37.
celery, 40.
corn, 44.
importance of, as food, 32.
as means of food concentration, 70.
methods of, 32.
onions, 40.
potatoes, 33.
composition of, 34.
composition and fuel value of, un-
der various methods of prepara-
tion, 34.
methods of, 33.
potato flour, 35.
relative weights of green and kiln-
evaporated, 40.
salsify, 37.
starch-yielding tubers, 36.
sweet potato, 35.
turnips, 37.
used in the army, 37.
vegetable flours, use of, 44.
of yeast, 45.
flee also Desiccation.
Dehydrator, most efficient form of, for
home use, 45.
Denutrition, temporary, benefit of, 115.
Dermatoses, itching, treatment of, 468.
Desiccated eggs, 71.
Desiccated milk, 71.
advantages of, 16.
comparison of kinds of, 15.
reconstruction of, for infants, 15.
Desiccation, as means of food concentra-
tion. 70.
of milk, from which fat has been re-
moved, 15.
historical development of process of,
12.
present methods of, Bevenot de neveu
process of, 13.
Ekenberg process, 13.
Just-Hatmaker process, 13.
Stauf process, 14.
as recent discovery, 12.
of vegetables, as means of food concen-
tration, 70.
Diabetic foods, recipes for. See Recipes,
diabetic foods.
Diastatic ferment, in milk, 497.
Diet, acid-forming and base-forming ele-
ments of, 357.
in acne, 467.
army. See Rations.
Bellingham's, for aneurisms, 548.
carbohydrate-free, 338.
cellulose, 339.
character of, and protein content, 212.
in childhood, adaptation of, to diathesis
of child, 413.
comparative heights and weights of
children, 412.
early, 410.
factors of growth and development,
415.
for gouty diathesis, 413.
greediness discouraged, 417.
important points, 412.
rations required, 409.
from four to six years. 411.
requisite amount of all foodstuffs, 415.
requisite calories per kilogram for va-
rious ages, 415.
for school children. 414.
arrangement of meals, 416.
suitable dietary, 416.
Starr's table of dietetic needs, 410.
for tuberculosis, 413.
Church's standard table of, for Indians,
393.
climate and, 372.
maintenance allowance according to
climates, 373.
dry cure. 561.
fat-free, 338.
fruit. Kec Fruit Diet,
high protein, 325.
importance of caloric value of, 148.
influence of, on character, 370.
on constitution and health, 368.
of, on races. 371.
in intestinal stasis, chronic, 464.
after labor, 42!.
780
INDEX
Diet, during lactation, 429, 481.
day's ration for nursing women, 430.
decrease or increase of quantity of
mammary secretion, 431.
rules formulated by Rotch, 431.
lacto vegetarian, 521.
low protein, 324.
meat. See Meat Diet,
during menopause, 432.
during menstruation, 425.
in military prison camps, 718.
milk cure, 569.
buttermilk cure, 566.
kurniss cure, 564.
matzoon cure, 566.
skim milk cure, 572.
sour milk cure, 567.
Avhey cure, 573.
navy. See Rations,
nitrogen. See Nitrogen Diet,
nitrogen in. See Nitrogen in diet,
nitrogen-free, 325.
non-meat eating, Japanese, 176.
other foreign nations, 178.
and occupation. 371.
in old age. according to Dr. Harry
Campbell, 440.
according to Friedenwald and Ruhriih,
441.
alimentary pastes: food value, 449.
in bronchitis. 452.
and condition of teeth, 450.
idiosyncrasy a factor in, 441.
Kosevi's maintenance ration, 443.
Langworthy's dietary standard, 443.
Maurel's maintenance rations, 443.
meat consumption, 451.
nature of, 439.
and nitrogen metabolism, 444.
for the obese. 446.
quantity of food, 436, 439.
raising caloric value of, 448.
reduction of fuel value in, 445.
Saundby's daily dietary, showing dis-
tribution of meals, 447.
suggestions of Yeo, 452.
for those leading vegetative lives, 446.
Voit's dietary standard, 442.
during pregnancy, 425.
to insure small but well-developed
child, claims of Prochownick, 427.
"longings" for various indigestible ar-
ticles, 426.
in presence of albuminuria and
dropsy. 426.
Prochownick's, 428.
quantity of food, 426.
theory of abundant phosphates and
lime salts, 427.
theory of avoiding fresh vegetables,
427.
for professional singers and lecturers,
560.
protein. See Protein Diet.
Diet, during puberty, 418.
craving for sweets, 420.
during puerperium, 428.
purin, excess of, 335.
low, 336.
purin-free, 336.
dinners suggested by Haig's disciple,
337 .
relation of, to craving for salt, 347.
of to scurvy, 358.
safety standard in, 195.
caution as to protein deficiency, 196.
overfeeding, 197.
undereating, 196.
Salisbury, 536.
modified, 537.
salt-free, 345.
in sedentary occupations, 421.
comparative lunches, 423.
Richards' ration, 424.
suitable dietary, 422.
training, 552.
in tropical climates, alcohol and bev-
erages, 401.
amount of, required, 388.
canned foods, 400.
cause of digestive disturbances, 398.
Church's standard diet for Indians, 393.
conclusions on, 400.
and disease, 399.
fruit, 389.
Indians, 393, 394.
meat eating, effect of, in, 389.
meats, 395.
milk, 394.
of natives and whites, 397.
nitrogenous foods, comparative im-
munity of white men due to feed-
ing on, 388.
lack of, among natives, 388.
protein and starch equivalents in ce-
reals and buckwheats, table of,
391.
in pulse, table of, 392.
sweets, 398.
vegetables, 390.
views on, changes in, 386.
Lukis and Blackham, 387.
Woodruff's. Dr. Charles, 386.
Tufnell's for treatment of aortic and
other aneurisms, 547.
variety in, necessity for, 94.
vegetable. See Vegetable Diet.
Weir Mitchell, in treatment of neu-
rasthenia and disorders of nutri-
tion independent of organic dis-
ease. 549.
yolk cure, 563.
zymotherapy, 538.
Dietaries, actual, 380.
actual and standard, compared, 378.
company, in U. S. army rations. 675.
of individuals allowed a "free choice of
food," 377.
INDEX
781
Dietaries, of inhabitants of United States,
374.
Playfair's table of requirements for
work, 377.
standard, 248.
standard and actual, compared, 378.
standard daily, 378, 379.
tropical, in U. S. army, 676.
typfcal, minerals in, daily quantities per
man, 342.
Dietary, in boys' military training camp,
Fort Terry, New York, for one
week, 686-690.
showing requisite amounts of ternary
food elements and fuel or energy
value in calories, 692-697.
for debility, 564.
fat and vegetarian. Wait's, 521.
of laborers, in United States, 376.
low protein, Chittenden, 253.
of marching soldiers, 382.
of mechanics, in United States, 376.
of Mexicans, 383, 384.
of negroes, 382, 384.
in old age, 440.
of poor person in New York City, show-
ing food elements and calories,
374.
in puberty, 419.
reducing, 559.
for school children, 416.
for the sedentary, 422.
of students' clubs, 374.
for tuberculous children, 413.
of University boat-crews, studies of, 555.
vegetarian, Jaffa's, 542.
vegetarian and fat, Wait's, 528.
well-balanced, vitamines in, 224.
of Yale training crew, 554.
Dietary experiment, Neumann's, 310.
Dietotherapy, alcohol, use of, 385.
definition of, 361.
diet studies, 374.
general principles of, 361.
amount of food required, 362.
climate and diet, 372.
influence of diet on character, 370.
on constitution and health, 368.
on races, 371.
meals, composition of, 366.
distribution of, 366.
occupation and diet, 371.
Diets, of definite energy values, method
of reckoning protein, fat and car-
bohydrate rations for, 264.
special, 519.
standard, exchange of material with,
288.
Diet studies. See .Dietary and Dietaries.
Digestibility of foodstuffs, 104.
comparison as to, 106.
fats, 105.
the finer the subdivisions of food in-
gested, the larger the proportion
of nutriments assimilated, 105.
Digestibility of foodstuffs, fruits, 108.
proteins, 107.
utilization of some of staple foodstuffs,
104.
vegetable foods, 107.
Digestion, effect of manner of eating on,
bradyphagia, 82.
euphagia, 78.
rapidity of mastication, 86.
tachyphagia, 84.
occupation and, 94.
salivary, manner and time of, 85.
sleep and, 93.
and variety in diet, 94.
See also eating, hygiene of.
Digestive disturbances, in tropics, cause
of, 398.
Digestive glands, action on, of emotional
excitement, 81.
Digestive organs, evil effects of underfeed-
ing on, 152.
Digestive process, first stages of, started
by pleasurable smell and sight
and taste of food, 80.
Dry cure, 561.
Drying of food, 2. See also Dehydration,
and Desiccation.
Dyspepsia, meat diet in treatment of, 535.
E
Eating, abnormally slow, or bradyphagia,
82.
effect of manner of, on digestion, brady-
phagia, 82.
euphagia, 78.
food and emotions, 79.
food and work, 79.
rapidity of mastication, 86.
tachyphagia, 84.
hasty, or tachyphagia, 84.
hygiene of, 77.
and appetizing ailments, 78.
effect of manner of, on digestion, 78.
meals, order and frequency of, 90.
regularity of, 92.
occupation and digestion, 94.
personal idiosyncrasies, 89.
principles involved in, 78.
relation of medication to meals, 96.
and sacrifices in food, 88.
sleep and digestion, 93.
variety in diet, 94.
water drinking with meals, 88.
personal idiosyncrasies in. 89.
proper, or euphagia. 78.
role of senses in pleasure of, 75.
Egg dumplings, preparation of, 607.
Eggs, cold storage, 5.
dehydration of, 17.
desiccated, 71.
dried, 17. 71.
preparation of. See Recipes, eggs,
preparation of beverages with. N< r
Recipes, beverages.
782
INDEX
Eggs, preservation of, by drying, 17, 71.
Ekenberg process of desiccation of milk,
13.
Emotions, food and, 79.
Endurance, Baeltz's experiments in diet
and, among the Japanese, 176.
effect of protein diet on, 192.
Fisher's experiments on effect of diet
on, 174.
Fisher's test diet and, 175.
Flint's observations on effects of five-
day pedestrian feat performed by
Weston, 183.
Endurance tests, comparative, Fisher's,
176.
Energy, consumption of, in chronic mal-
nutrition, 160.
expended by marching soldiers, 382.
and vegetable diet, 524.
Enzymes, in breast milk, 479.
Epicures, 131.
Euphagia, 78.
Evaporation in preservation of food. See
Dehydration.
Excretion of fat, in stools, percentage of,
105.
Excretory products, calorific value of, 254.
Riibner's table showing losses and
available energy, 255.
F
Farinaceous foods, preparation of. See
Recipes.
Farina dumplings, preparation of, 610.
Fasting, as ancient religious rite, 112.
as cure for disease, 113, 114.
effect of, on metabolism, 117, 298.
forced, ravenous hunger result of, 113.
long-continued, 115.
metabolic carbon and nitrogen balance
during, 298.
no-breakfast plan, 113.
in religion, 112, 117.
Fasting experiments, 116.
metabolic, 118.
Fat, in breast milk, 478.
in cow's milk, 493.
excretion of, in stools, percentage of,
105.
percentage of, in foods, 339.
perversion of appetite for special or pe-
culiar kinds of, 119.
versus carbohydrates as protein sparers,
302.
Fat and carbohydrate, Kayser's table
showing nitrogen balance when
feeding isodynamic quantities of,
303.
sparing power of, in calorimetric experi-
ments (Atwater), 304.
Fat and vegetarian diet, Wait's, 528.
Fat consumption in United States, 771.
Fat-free diet, 338.
Fatless milk, desiccation of, 15.
Fatigue poisons, due to meat eating, 207.
Fats, action on, of heat, 52.
deficiency of, in breast milk, 487.
Feces, nitrogen in, 323.
Feeding, caloric method of. See Caloric
Method of Feeding.
of infants. See Infant Feeding.
Ferment, diastatic, in milk, 497. *
Fermentation of milk, analysis of changes
occurring in, 568.
Ferments, in breast milk, 479.
Ferratin, 355.
Fish, cooking of, 66.
history of, 50.
dried, 20.
preparation of. See Recipes, fish,
preservation of, by chemical agents, 7.
by drying, 20.
by freezing, 3.
by salting, 3.
by smoking, 2.
Fish soup, preparation of, 606.
Fisher's comparative endurance tests, 176.
Fisher's experiments in effect of diet on
endurance, 174.
Fisher's test diet and endurance, 175.
Fletcherism. See Bradyphagia.
Folin's views on protein diet, 187.
Food, decomposition of, causes of. 1.
effects of work and, on respiration, 293.
and emotions, 79.
purin, effect of, on uric acid, 334.
purin bodies in, 333.
quantity of, 334.
as a source of heat and growth. See
Caloric Method of Feeding,
substitutes for, 108.
weight of different classes of, purchased
per man per day, 375.
and work, 79.
Food concentration, basis of, 70.
composition of components of ration of
United States soldier, 72.
composition of emergency ration of
German soldier, 72.
concentrated proteins, 70.
condensed foods, 70.
desiccated eggs, 71.
desiccated milk, 71.
desiccated vegetables, 70.
desiccation, 70.
dried meat, 71.
dried vegetables, 70.
Food economics in war, 739.
food situations in countries at war, 740.
summary of, 773.
use of certain foodstuffs in war. See
Foodstuffs, use of, in war.
Food economy, dehydration as factor in, 10.
necessity for, 10.
Food material, amount required, 129.
dependent on idiosyncrasy and cus-
tom, 137.
dependent on individual capacity, 138.
INDEX
783
Food material, amount required, in early
life, 137.
influence of work on, 1N4.
reserve supply of. desirable, 120.
Food preservation, basis of, 1.
methods of, 1.
canning, or exclusion of air, 6.
classification of. 2.
cold storage or refrigeration, 3.
dehydration. See Dehydration.
drying, 2.
freezing, 3.
salting, 3.
smoking, 2.
sterili/ation. 6.
treatment with antiseptic chemical
agents, 7.
Food requirement, 12.
adult, per kilo, table of, 365.
dependent on idiosyncrasy and custom,
137.
dependent on individual capacity, 138.
in early life, 137.
examples of food actually consumed,
270.
factors governing, 265.
age, 266.
amount of heat lost by body, 265.
choice of food, 269.
intensity of muscular activity, 271.
kind of 'work, 184, 268.
sex, 266.
influence of internal secretions of
woman, 268.
weight of body. 266.
necessary for healthy individual, 362.
relation of height to weight. 363.
storage of food ingested above, 366.
Foods, in which acid-forming elements
predominate, 357.
in which base-forming elements predomi-
nate, 35S.
calcium content of, 350, 351.
calcium oxid in, approximate amounts
of, 353.
canned, in tropical climates, 400.
Foods, chemical analysis of, 257.
choice of, as factor in food requirement,
269.
constructive and fuel, 251.
consumption of. actual, table of. 270.
increased metabolism following, 297.
by marching soldiers per day, 382.
containing cellulose, 340.
containing potassium chlorid, 348.
containing vitamines. and their anti-
neuritic and antiscorbutic quali-
ties, 228.
butter fat, 228.
rice, L'-JS.
fat in. percentage of. 339.
fuel and constructive. 251.
fi:e! values of. calculations of, 257.
table of, 258-263.
Foods, fuel values of, unit and method of
measurement of, 24ti.
included in training diets, 553.
ingested, caloric values of, 250.
inorganic constituents of, importance
of, 357.
iron salts contained in. 355.
magnesium salts in, 351.
approximate amounts of, 353.
palatable preparation of, general con-
sideration, 577.
phosphorus content of, 354.
relation of vitamines to, 233.
preparation of. See Recipes,
reservation of, 102.
sodium chlorid in, percentage of, 346.
sulphur salts in, 35(5.
transmutability of, carbohydrates, 101.
hydrocarbons, 100, 101.
proteins. 101, 102.
salines, 99.
used in the army, dehydration of, 37.
used in the army and navy. See Ra-
tions.
vitamine content of, 226.
physiological estimation of, 232.
Food situation, in countries at war, Ger-
many, 740.
agricultural classes, 746.
caloric needs, 746.
consumption of food units, 1912-
1913, 745.
dietary of industrial classes, 747.
drying process, 743.
fat a prominent factor, 744.
feeding of military prisoners, 751.
finding new fodder, 742.
liberal rations for women engaged
in manual work in open air, 744.
peace-time needs, "46.
population of, and caloric needs for,
745.
protein needs in ounces, 746.
use of leaves. "42.
Great Britain, adult rations in, per
head per week, 755.
caloric needs, 749.
diet of munition workers, 753.
dietaries for three middle-class
families, sixteen persons in Eng-
land before voluntary restriction,
753.
dietary requirements, 747, 749.
during first year of war, 749.
during year 1916, 748.
first definite steps to control of
supply, 747.
importations of food supplies before
the war. 747.
particulars of army rations. ~ is.
protein requirements. 749.
ton! quantities of foodstuffs avail-
able during 1909, 1913, 748.
INDEX
Food situation, in countries at war, Great
Britain, unrestricted diet of a
sedentary worker, 756-758.
voluntary rationing scheme in, 754.
Ruhleben diets compared with stand-
ard dietaries, 751.
sugar situation, 751.
in United States, causes of food short-
age, 768.
cereal grains, 769.
concentrated nature of our food ex-
ports, 770.
economic viewpoint, 769.
fat consumption, 771.
propositions for food conservation,
772.
protein consumption, 771.
sugar consumption, 771.
use of grains for manufacture of al-
cohol, 772.
wheat production, 768.
Foodstuffs, digestibility of. See Digesti-
bility of Foodstuffs.
staple, percentage of utilization of, 104.
use of, in war, alcohol, 766.
bread, 759.
cereals, 749.
corn, 763.
extraction from total grain, 760.
oatmeal, 762.
milk, 764.
potatoes, 764.
requiring mastication, 761.
sugar, 765
utilization of, with and without alco-
hol, 308
Food values, with cost per 1,000 calories,
273.
of fruits, comparison of fresh and dried,
28.
physiological, 255.
Food waste, from economical standpoint,
103.
fats, 105.
nutrient, percentage of, in ordinary
mixed diet, 106.
physiological, 104.
France, army rations of, 702.
daily, 716.
Freezing of food, as agency of preserva-
tion, 3.
Fruit, in diet of tropical climates, 389.
digestibility of, 108.
dried, analysis and caloric value of, per
pound, 29.
comparison of food value of fresh
and, 28.
drying of. Sec Dehydration of Fruits,
fresh, comparison of food value of dried
and, 28.
necessity of, in diet. 527.
preservation of, by dehydration. 9. Sec
also Dehydration of Fruits,
by drying, 2.
Fruit, preservation of, by sugar, 7.
waste of, in America, 10.
Fruit cure, 545.
Fruit diet, apple-fasts, 545.
in disease, 544.
- experiments with various fruits, 542
543.
grape cure, 546.
Jaffa's observations on fruitarians, 543,
544.
Jaffa's vegetarian dietary, 542.
lemon cure, 546.
low in protein, 541.
low in protein, fat and sometimes caloric
value, 541.
nitrogen equilibrium maintainable on,
540.
records of three subjects subsisting on,
541.
Fruits, comparison of food value of, fresh
and dried, 28.
cooked, preparation of. See Recipes,
fruits.
dried, comparative cost of total nu-
trients and fuel value of some
fresh and, 31.
economic advantages of, 30.
fresh, comparative cost of total nu-
trients and fuel value of some
dried and, 31.
Frying of fish, 66.
of meat, definition of process, 58.
mediums suitable for, 59.
procedure for, 59.
temperature of fats in, 59.
Fuel foods, 251.
Fuel values of food, calculation of, chem-
ical analyses of foods, 257.
comparative equivalents in metric,
avoirdupois and apothecaries'
weights and measures, 257.
heat produced and substances burned
in calorimeter distinguished from
heat available when used in body,
263.
represented by a particular menu,
263.
table of values of ordinary foods pre-
pared to serve, 258-263.
unit and method of measurement of,
246.
G
Game flavor, cause of, 63.
Gastric peristalsis, inhibition of, by sen-
sory stimuli, 81.
Gelatin, as a protein sparer. 305.
Germany, armv rations of, 700.
daily. 716.
food situation in, 740.
Gluttons, differentiated from epicures or
gourmets, 131.
from large eaters, 132.
of history, 132, 133, 134.
INDEX
785
Gluttony, 132.
chronic. 131.
Gourmand, 132.
(iourmandizing, chronic, 131.
Gourmets. 131.
Gouty diathesis, in children, diet for, 413.
Grape cure. 5 tti.
Great Britain, army rations of, 713.
food situation in, 747.
Gustation, scat of. 76.
Gustative bulbs, veritable savors recog-
nizable through, 77.
Gustative sense, 70.
If
Health, influence of diet on, 368.
and vegetable diet, 525.
Heat, destructive action of, on vitamines.
222.
Heat of body, loss of, amount of, 265.
regulation of, 276.
production of, during rest, 279.
Heat energy, liberated by oxidation of al-
cohol, 406.
Heat production in twenty-four hours and
gaseous exchange per minute,
during absolute muscular rest in
fasting condition, 280.
Height and weight, comparative, of chil-
dren. 412.
relation of, 363.
at varying ages, standard, table of, 364.
Hepatin, 355.
Home modification of cow's milk, 506,
512.
Hominy mush, preparation of, 609.
Human economy, foods required by, 362.
Hutchinson's views on protein diet, 187.
Hydrocarbons, transmutabilitv of, 100,
101.
Hydrolytic cleavage, preceding every
metabolic transformation of pro-
tein, 209.
Hyperorexia. 120.
Hypozanthin, formation of, 332.
Ice cream, making of. See Recipes, ice
cream.
Idiosyncrasies, personal, in eating, 89.
Inanition, causes of. 111.
deatli from, in relation to body weight,
147.
definition and symptoms of, 111.
Indians, diet of, 393.
Infant feeding, artificial, addition of al-
kalincs. to prevent clotting, 494.
analysis of whole milk varying cream
percentages skimmed and sepa-
rated milks, 513.
Infant feeding, artificial, buttermilk, 500.
certified milk, 489.
(beadle's principles of, 506.
clinical application of, 509.
condensed milk, 499.
difficulty of digestion of cow's miiK,
511.
failure to assimilate salts of cow's
milk, 496.
and good air, 511.
home modification or adaptation of
milk, 506, 512.
importance of mineral salts, 497.
importance of sugar, 495.
importance of water, 497.
important rules to be followed in, 514,
515.
summary of, 515.
making all food formulae from three
ingredients, 514.
management of casein of cow's milk,
512.
necessary elements, 511.
overfeeding, 510.
pasteurized milk, 503.
peptonized milk, 501.
proper intervals for infants of vari-
ous ages, 510.
proprietary or patent foods, 504.
percentages, 508.
quiet in, 511.
selection of cow's milk for, 489.
sterilized milk, 502.
success in, 510.
sugars in, 512.
supplementary articles of diet be-
tween sixth and twelfth month,
514.
breast feeding, 471. See also Breast
Feeding,
mixed, 488.
Infants' milk, desiccated, reconstruction
of, 15.
Insalivation, in process of digestion, 85.
Intestinal canal, hygiene of, 469.
Intestinal stasis, chronic, constant ab-
sorption of poisonous elements in,
459.
diet in, 464.
diseases due to, 460.
acidosis. 463.
cutaneous lesions, 463, 466.
acne, 467.
itching dermatoses, 468.
of internal secretions. 462.
rheumatoid arthritis, 460.
ulcer of stomach and duodenum, 461.
due to mechanical obstruction. 458.
maladies without satisfactory etiology
traceable to. 45!.
treatment of, by diet. 464, 465.
I >y manipulation, 464.
by surgery, 465, 466.
786
INDEX
Intestinal toxemia, due to overeating,
135.
Intestines, construction of abdominal vis-
cera with especial reference to
drainage, 455.
faulty position of abdominal viscera due
to refinements of civilization, 456.
hygiene of, and effort to overcome con-
stipation, 457.
general considerations, 455.
intestinal canal, 469.
intestinal stasis, chronic, 458.
Invalid broths, 599.
Iron, inorganic, given as drug, 356.
Iron salts, compounds of, 355.
contained in body, 355.
contained in foods, 355.
excretion of, 355.
Italy, army ration of, daily, 717.
Itching dermatoses, treatment of, 468.
Jaffa's vegetarian dietary, 542.
Japan, army rations of, 701.
daily, 717.
Jellies, making of. See Recipes, jellies.
Julienne soup, 602.
Just-Hatmaker process of desiccation of
milk, 13.
Kayser's table showing nitrogen balance
when feeding isodynamic quan-
tities of carbohydrate and fat,
303.
Kosevi's maintenance ration for the aged,
443.
Labor, diet after, 429.
Laborers, dietary of, 376.
Lactalbumen, in cow's milk, 493.
Lactation, daily bowel movement during,
482.
diet during, 429, 481.
day's ration, calculated by Gautier,
430.
in regard to quantity of mammary
secretion, 431.
rules formulated by Rotch, 431.
influence of diet and exercise on, 431.
period of, 429.
Lactic acid, in souring of milk, 569.
Lactic acid therapy, 569.
Lacto-vegetarian diet, 521.
an impossibility, according to Caultey,
523.
Lactose, in breast milk, 478.
Langworthy's dietary standard for aged
and infirm, 443.
Lecturers, diet for, 560.
Legumes, composition and fuel value of
fresh and dried 42.
dehydrated, 42.
Lemon cure, 546.
Lentil soup, preparation of, 604.
Lipoids, bio-electric potentiality of, 221.
in metabolism, 220.
nitrogenous importance of, 219.
substances comprised under, 220.
M
Magnesium salts, 351.
in body, 352.
in food, 351.
approximate amount of, 353.
Malacia, 119, 120.
Malnutrition, chronic, consumption of
energy in, 160.
Weir Mitchell diet in treatment of, 549.
Malted milk, in infant feeding, 505.
Mastication, act of, 83.
foods requiring, and greater nutritive
value of, 761.
of meat, 87.
moderate, necessity for, 83.
prolonged, overdoing of. See Brady-
phagia.
rapidity of, 86.
Matzoon cure, 566.
Maurel's maintenance rations for old peo-
ple, 443.
Meals, composition of, 366.
distribution of, 366.
drinking of water with, 88.
order and frequency of, in diseased con-
ditions, 90.
in normal health, 90.
for persons engaged in commercial
life, 91.
for persons engaged in manual labor,
90.
for persons engaged in night work, 91.
for persons engaged in professional
vocations, 91.
for persons engaged in skilled labor,
91.
for persons leading life of leisure, 91.
regularity of, 92.
relation of medication to, 96.
Meat, baking of, 60.
boiling of, 55.
braising of, 64.
broiling of, 63.
comparative composition before and
after cooking of, 65.
comparative composition of water-free
substance of meats, before and
after cooking, 66.
concentration of, by drying, 71.
consumption of, in America, 206.
in different countries, 367.
in old age, 451.
in tropical climates, 395.
INDEX
787
Meat, cooking of, history of, 50.
*S'ee (ilno Cooking, of Meat,
digestion of, and bolting of, 88.
and mastication, 87.
eating of, direction of allowance of, 206.
and fatigue poisons, 207.
restriction of, 206.
frying of, 58.
grilling of, 63.
mastication of, 87.
effect of bolting, 88.
need of, felt by those accustomed to,
368.
overfeeding on, ailments and disorders
due to, 207.
powdered, 20.
disadvantages of, 20.
Italian method for making of, 20.
preparation of. Flee Recipes, meats,
preservation of, by antiseptic chemical
agents, 7.
by canning, 6.
by cold storage, 3.
by dehydration. See Dehydration of
Meat.
by drying, 71. See also Dehydration
of Meat,
by freezing, 3.
by smoking, 2.
by sterilization, 6.
roasting of, 61.
as a source of nitrogen, 174.
steaming of, 65.
stewing of, 57.
tropical disorders due to eating of, 179.
Meat diet, amount necessary to supply re-
quisite nutriment, 534.
effects of, 534.
exclusive, 532.
metabolism with, 535.
peoples subsisting on, 533.
and physical power, 533.
Salisbury diet, 536.
modified, 537.
in treatment of dyspepsia, 535.
of gout, 535.
of obesity, 535.
of tuberculosis, 534.
zymotherapy, 538.
Meat extract, iced, preparation of, 597.
Meat juices, preparation of, 595.
Meat soups, preparation of. See Recipes,
Soups.
Meat supply, of French army, 711.
Mechanics, dietary of, 376.
Medication, relation of, to meals, 96.
Menopause, derangement of nervous sys-
tem during, 432.
diet during, 432.
diseases developing at, 433.
period of, 432.
Menstruation, diet during, 425.
disturbances accompanying, and diet,
425.
Mental powers, effects on, of overeating,
135.
of underfeeding, 149.
Metabolic carbon and nitrogen balance
during fasting, 298.
Metabolism, chemical changes of, classi-
fied, 286.
constructive, or anabolism, 286.
definition of term, 286.
dependence of life on, 287.
effect of fasting on, 117.
experiments in, 118.
energy, calculation of, from carbon and
nitrogen balance, Atwater's ex-
periment, 296.
factors affecting, acid-forming and base-
forming elements, 314.
alcohol as a protein sparer, 306.
calorimetric method of studying, 2{)~.
carbohydrates as protein sparers, 300.
consumption of food, 297.
fasting, 298.
fat versus carbohydrates as protein
sparers, 302.
gelatin as protein sparer, 305.
metabolism of mineral substances,
311.
metabolism of water, 308.
nitrogenous diet, 299.
functions of different organs and tissues
in, 285.
general considerations on, 285.
lipoids in, 220.
with meat diet, 535.
mineral, 311.
acid-forming and base-forming ele-
ments of diet, 357.
calcium diets, low and high, 349.
in disease, 341.
electrolytic properties of salts, 343.
importance of, in processes of nutri-
tion, 358.
iron salts, 355.
magnesium salts, 351.
minerals in typical dietaries, daily
quantities per man, 342.
percentage of ash in bones, muscles
and various organs, 312.
phosphorus, 352.
potassium chlorid, 348.
salt-free diet, 345.
sodium chlorid, 344.
sulphur salts, 356.
and variations in amount of salt in-
gested, 346.
nitrogen, in old age, 444.
nitrogen balance, Neumann's dietary ex-
periment, 310.
of overfeeding, excess of proteins and
carbohydrates, 138.
"oxidation water" resulting from com-
bustion of hydrogen in the foot 1 ,
309.
788
INDEX
Metabolism, processes of, series of, 287.
various, 285.
protein, 327.
ammonia, 329.
carbohydrate-free diet, 338.
catabolism of proteins, 169.
cellulose diet, 339.
creatinin, 329.
deaminization of proteins in amino-
acids, 169.
end products of, on both high and low
protein diet, 328.
fat-free diet, 338.
purin bodies, 329.
urea, 327.
uric acid, 329.
retrograde, or catabolism, 287.
salt, in disease, 341.
of starvation, acute, protein, 160.
pathology of, 158.
of underfeeding, acute, protein, 160.
in the blood, 162.
pathology of, 158.
protein, 153.
secretion of bile, 162.
Siven's table showing gradual rise in
protein intake but with a con-
stant and sufficient energy intake,
159.
in the urine, 162.
vitamine r6le in, 224, 229.
of water, 308.
Metabolism experiments, balance of income
and outgo, 288.
effects of food and work on respiration,
293.
exchange of material with standard
diets, 288.
respiratory quotient, 292.
summary of, income and outgo of
energy: calories, 291.
income and outgo of nitrogen and car-
bon, 290, 296.
Mexicans, dietary of, 383, 384.
Microorganisms in breast milk, 474.
Military training camps for boys, rations
for. See Rations, boys' military
training camos.
Milk, analysis of changes occurring in fer-
mentation of, 568.
boiling of, value of, 493.
breast. See Breast Milk,
certified, 489.
clots of. in cow's and human, 493.
prevention of, by addition of alkali,
494.
coagulation of, 477.
comparative analysis of human and
cow's, 490.
comparative composition of, from dif-
ferent animals, 490.
composition of, carbohydrates, 494.
chemical, 491.
diastatic ferment, 497.
Milk, composition of, fat, 493.
inorganic contents, 495.
lack of uniformity, 492.
proteins. 493.
salts, 496.
vitamines, 498.
condensed, in infant feeding, 499.
description of, 492.
desiccated, 71.
desiccation of. See Desiccation of Milk.
in diet in tropical climates, 394.
fatless, desiccation of, 15.
home modification or adaptation of, in
infant feeding, 506, 512.
for infants, reconstruction of desiccated
milk into, 15.
malted, in infant feeding, 505.
pasteurized, in infant feeding, 503.
sour, composition of, percentages, 566.
souring of, by lactic acid, 569.
sterilized, in infant feeding, 502.
use of, in war, 764.
varying composition of morning and
evening, 492.
Milk cure, 569.
application of, 570.
buttermilk cure, 566.
indications for, 571.
kumiss cure, 564.
matzoon, 566.
quantities administered, 571.
skim milk cure, 572.
sour milk cure, 567.
whey cure, 573.
Mineral metabolism, 311.
acid-forming and base-forming elements
of diet, 357.
calcium diets, low and high, 349.
in disease, 341.
electrolytic properties of salts, 343.
importance of, in processes of nutrition,
358.
iron salts, 355.
magnesium salts, 351.
minerals in typical dietaries, daily quan-
tities per man, 342.
percentage of ash in bones, muscles and
various organs, 312.
phosphorus, 352.
potassium chlorid, 348.
salt-free diet, 345.
sodium chlorid, 344.
sulphur salts, 356.
Minerals in typical dietaries, daily quan-
tities per man. 342.
Mitchell, Weir, diet in treatment of neu-
rasthenia and disorders of mal-
nutrition independent of organic
disease. 549.
Modification or adaptation of milk, home,
in infant feeding. 506, 512.
Muscular activity, as factor in food re-
quirement, 271.
Mutton broth, preparation of, 598.
INDEX
789
N
Negroes, dietary of, 382, 384.
Nesfle's food. 505.
Neumann's dietary experiment, 310.
.Neurasthenia, Weir Mitchell diet in treat-
ment of, 5 (!).
full dietary, 551.
synopsis of management of individual
case, 550.
Nitrogen, in diet, 321.
in feces, 328.
income and outgo of carbon and. in
metabolism experiments, 290, 200.
requirement of, for maintenance, 181.
value of meats as a source of. 174.
Nitrogen equilibrium, Kayser's table
showing, when feeding isodyna-
111 ic quantities of carbohydrate
and fat, 303.
maintenance on fruit diet, 540.
maintenance of, 323.
minimum protein necessary to main-
tenance of. 153.
Neumann's dietary experiment, 310.
and protein diet. Benedict on, ls<i.
Folin's views on, 187.
Halliburton on, 189.
Melt/er on, 189.
protein requirement, minimum, for
maintenance of, 104.
table showing effect of insufficient diet
with gradual increase in aliment
until establishment of, 157.
in tropics, 322.
Xitrogen-free diet. 325.
Nitrogen increase in convalescents, due to
overfeeding, table emphasizing,
142.
Nitrogen metabolism in old age. 444.
Nitrogenous diet, effect of, on metabolism,
299.
increased, effect of, on kidneys, 191.
Nitrogenous importance of lipoids, 219.
Nursing. Nrr T.reast Feeding.
Nutrition, disorders of. Weir Mitchell diet
in treatment of, 540.
function of carbohydrates in. 301.
importance of mineral metabolism in
processes of, 358.
importance of protein in, 530.
Nutritive drink for delicate women and
children. 599.
Nuts, cooking of, (541.
digestibility of, 641.
nutritive value of, 641.
Oatmeal, use of. in war. 7ti2.
with beef tea. preparation of. 594.
Oatmeal mush, preparation of, 609.
< Icciipat ion. and diet. .'!7 1 .
and digestion, 94.
150
Occupation, protein diet and, 193.
Oils, use of in preservation of food, 7.
Old age, and arteriosclerosis. 43S.
arteriosclerosis as sign of, 434.
cause of. ).; |. i:!5.
definition of. 434.
diet in, according to Campbell. Dr.
Harry. 410.
according to Friedenwald and Ruh-
riih, 441.
alimentary pastes: food value, 449.
in bronchitis, 452.
caloric value of, 448.
and condition of teeth, 450.
idiosyncrasy a factor, 441.
Kosevi's maintenance ration. 443.
I. a Hi; worthy's dietary standard, 443.
Maurel's maintenance rations, 443.
meat consumption, 451.
nature of, 439.
quantity, 436. 4:',!).
reduction of fuel value. I 15.
Saiindby's daily dietary. 446.
showing distribution of meals, 447.
suggestions of Yeo, 452.
Voit's dietary standard, 442.
diet for prevention of, 434.
eliminating and storage powers in, 437.
exceptions to general rules regarding,
435.
means of preventing, 434.
nitrogen metabolism in, 444.
pathological changes incident to, 438.
Olives, dried. 28.
Onions, dehydrated, 40.
< )smo/one. 62.
( hereating. in the aged, 137.
in children. 136.
chronic, 130.
in early life, 137.
effects of, biliousness, 135.
intestinal toxemia. 135.
on mental powers, 135.
habitual, 136.
individual capacity to cope with, 138.
meaning of, 127.
men conspicuous for, in history, 132,.
133, 134.
moderate, 129.
occasional, 129.
tendency to. 128.
Overfeeding, acute, 128.
in children. 136.
chronic, 128.
of convalescents. 141.
argument against. 144.
conclusions on. 1 l">.
interchange of nitrogen and stoi,.-e.
protein and fat in. table showing
approximate value- of. absolute
and percentage. 143.
nitrogen increase due to, table empha-
si/.ing. 142.
dangers of. 197.
790
INDEX
Overfeeding, definition of, 138.
of infants, 510.
of meats, ailments and disorders due to,
207.
metabolism of, excess of proteins and
carbohydrates, 138.
prevalence of, 128.
in youth and early adult life, 197.
Overmastication. See Bradyphagia.
"Oxidation water," resulting from com-
bustion of hydrogen in the food,
309.
Oyster juice, preparation of, 598.
Oyster soup, preparation of, 608.
Oyster stew, preparation of, 607.
"Palatability," use of term, 77.
Parorexia, 119.
Pasteurized milk, in infant feeding, 503.
Patent foods. See Proprietary or Patent
Foods.
Peaches, dried, 24.
Pellagra, due to vitamine deficit, 232, 237.
relation of spoiled corn to, 44.
Peptonized beverages and foods, prepara-
tion of. See Recipes, beverages
and foods.
Peptonized milk, in infant feeding, 501.
Persimmon, dried, 28.
Perversions of appetite. See Appetite, per-
versions of.
Phosphorus, importance of, 352.
as building material, 354.
Phosphorus content of foods, 354.
relation of vitamines to, 233.
Pica, 119.
Playfair's table of requirements for work,
377.
Poison, protein, 168.
Poisoning, from canned goods, 6.
Polydipsia, 121.
Polyphagia, 121.
Potassium chlorid, foods containing, 348.
importance of, 348.
Potato flour, 35.
Potato soup, preparation of, 604.
Potatoes, dehydrated, 33.
composition of, 34.
composition and fuel value of, under
various methods of preparation,
34.
method of dehydration, 33.
potato flour, 35.
sweet, dehydration of, 35.
use of,' in war, 764.
white, value of, 213.
Poultry, preparation of. See Recipes,
poultry.
Pregnancy, albuminuria and dropsy com-
plicating, 426.
diet during, 425.
longings for various indigestible arti-
cles, 426.
Prochownick's diet for pregnancy, 428.
Proprietary or patent foods, 'in infant
feeding, 504.
in infant feeding, list of, 508.
malted milk, 505.
Nestle's food, 505.
percentages, 508.
Protein consumption in United States, 771.
Protein content, character of diet and, 212.
Protein deficiency, caution as to, 196.
Protein diet, effect of, on health and en-
durance, high protein diet, 169.
low protein diet, 171.
on strength and endurance, 192.
end products of protein metabolism on,
328.
high, 169, 325.
versus low, 185.
low, 324.
Baeltz's investigations among the Jap-
anese, 176.
Chittenden's investigations, 171.
effect of, on animals, 192.
Fisher's investigations, 174.
high versus, 185.
and nitrogen equilibrium, Benedict on,
189.
Folin's views on, 187.
Halliburton on, 189.
Meltzer on, 189.
and occupation, 193.
reduction of, necessary, 190.
value of meats as a source of nitroeen,
174.
Protein digestion, 107.
ill-effects of absorption of end-products
of, 198.
Protein fractions, chemical formation of,
198.
Protein metabolism, 327.
ammonia, 329.
carbohydrate-free diet, 338.
cataboiism of proteins, 169.
cellulose diet, 339.
creatinin, 329.
deaminization of proteins in amino-
acids, 169.
end products of, on both high and low
protein diet, 328.
fat-free diet, 338.
governed by tissue requirements, 299.
purin bodies, 329.
revolution in conception of, 167.
of starvation, acute, 160.
theories of, 203.
of underfeeding, 153.
urea, 327.
uric acid, 329.
and variations in amount of salt in-
gested, 346.
Protein molecule, structure of, 168.
Protein poison, 168.
Protein-poor foods, percentages of protein
in, 326.
INDEX
791
Protein requirement, Chittenden low pro-
ten dietary, 253.
determinations of, 253.
for growing boy, 690.
minimum to maintain nitrogen equi-
librium, 194.
standard for, 180.
Proteins, amino-acids in, 194.
animal versus vegetable, 528.
building up of, 208.
catabolism of, 169.
coagulation of, 107.
by heat, 52.
combustion of, adapted to intake of, 300.
concentrated, 70.
in cow's milk, 493.
deamini/ation of, in amino-acids, 169.
deficiency in, in breast milk, 487.
differences in suitability for tissue con-
struction, 202.
excess of, in metabolism of overfeeding,
138.
form of absorption of, 209.
importance of, in alimentation, 530.
minimum, necessary to maintain nitro-
gen equilibrium, 153.
nature of, 107.
necessity of, to blood and muscles, 205.
percentages of, in protein-poor foods,
326.
physical absorption of, differences in
suitability for tissue construction,
202.
physical properties of, 201.
relative absorption, 202.
qualitative variations in amino-acids of,
200.
quantitative differences of, 199.
relative absorption of, 202.
relative values of meat and vegetables,
204.
surplus of, from suitable food mate-
rials, 203.
of the tissues, interchange of, 209.
transmutability of, 101, 102.
vegetable, 212.
vegetable versus animal, 528.
Protein sensitization, attention given the-
ory of, 170.
condition similar to, produced by over-
feeding of a particular protein,
169.
Protein sparers, alcohol as, 306.
carbohydrates as, 300.
carbohydrates and fat in calorimetric
experiments (Atwater), 304.
fat versus carbohydrates as, 302.
gelatin as, 305.
Protein and starch equivalents, in cereals
and buckwheat*, table of, 391.
in pulse, in diet of tropical climates,
table of, 392.
Protein starvation, effects of, 156.
Protein structure and properties, chem-
ical formation of protein frac-
tions, 198.
qualitative variations in the amino-
acids of proteins, 200.
quantitative differences of proteins, 199.
Protein tissue, chemical decomposition of,
158.
Prunes, dried, 22.
Ptomaine poisoning, from canned goods,
6.
due to "high" or slightly tainted game
or meat, 63.
Puberty, beginning of period of, 418.
diet during. See Diet during Puberty,
improvements desirable in present cur-
riculum of schools, 420.
question of stimulants in, 420.
Puddings, preparation of. See Recipes,
puddings.
Puerperium, diet during, 428.
Purin bodies, in animal and vegetable ni-
trogenous bodies, 331.
chemistry of, 330.
in food, *333.
quantity of, 334.
occurrence in body, 331.
production of, in presence of cellular
processes, 332.
in protein metabolism, 329.
source of, 329.
Purin compounds, solubility of, 330.
excess of, 335.
low, 336.
Purin foods, effect of, on uric acid, 334.
Purin-free diet, 336.
dinners suggested by Haig's disciple,
337.
indications for, 336.
to supply albumin, 336.
Purins, bound, 332.
endogenous, 331.
exogenous, 331.
excretion of, 333.
free, 332.
R
Raisins, methods of preparing, 26.
Ration, definition of, 666.
emergency, 666.
field, 666.
Filipino, 666.
garrison, 666.
Imversack, 666.
supplementing of, 666.
travel, 666.
Rations, army, 663.
for boys' military training camps, 684.
dearth of statistical material on, OS 4.
dietary for one week. Fort Terry, New
York. 686-090.
showing requisite amounts of ter-
nary food elements and fuel or
* energy value in calories, 692-697.
792
I^DEX
Rations, for boys' military training camps,
importance of sufficient vitaminc
principles, 691.
protein requirement. 690.
for boys' private boarding school, 685.
of foreign armies, 697.
comparative, Austrian, 715.
English, 716.
French, 716.
German, 716.
Italian, 717.
Japanese, 717.
Russian, 717.
comparative tables of eight countries,
698. 699.
emergency ration, 700.
of France, 702.
amount given out and carried at
one time, 708.
authorized extraordinary supple-
ments. 706.
authorized substitutive equivalents,
705.
in the cavalry, 708.
commutation of, in times of peace,
706.
components of garrison and field
rations, 702.
composition of, 704.
daily allowance for additional sup-
plies, 706.
meat supply, 711.
methods of cooking in the trenches,
703.
normal, 707.
in peace and in war, 703.
reserve, 707.
strong, 707.
trains, 709.
in the trenches, 706.
of Germany, 700.
of Great Britain, 713, 748.
during Boer War, 723.
of Japan, 701.
meat allowance as compared with
that of U. S. army, 697.
of Russia, 701.
systems of supply, 714.
of French navy, 729.
military, conclusions regarding compo-
sition and food value of (Har-
vard), 722.
in military prison camps, 718.
menu taken from Camp Guterslohe
for one week, officers' section,
719.
menu taken from Camp Munster for
one week, 718.
weekly diet sheet typical of period
prior to stringency in foodstuffs,
721.
typical of period of stringency in
* foodstuffs, 721.
navy, comparative nutritive energy of
American and foreign, 729.*
Rations, U. S. army, additional articles
consumed, 6*65.
allowance and consumption per man,
665.
company dietaries, 675.
company dietary at a southern post,
676.
at a western post, 675.
component parts of, 681, 726, 727.
concentrated foods, 674.
dehydration of foods, 37.
emergency, 673.
field ration, 670.
Filipino ration, 672.
garrison ration, component and sub-
stitutive articles and quantities,
667.
Colonel Harvard on, 666, 668, 669.
haversack ration, 671.
ordering of, 664.
past and present, 681.
amount and kind of food, 682.
cases of rheumatism among veter-
ans, 683.
during the Civil War, 683.
present policy of improvement, 682.
percentage of waste in, 665.
quantity of stores required for one
dav's subsistence of 150,000 men
in "field, 683.
savings, 672.
selection of, 674.
ten days' ration uncooked food for an
average daily of 440.4 men, 664.
travel ration, 672.
in tropics, 676.
tropical dietaries, 676.
average nutrient composition of,
680.
tables of, 678, 679.
U. S. navy, 724.
commissar} 7 store, establishment and
administration. 734.
daily and weekly, 725.
extra allowance, 723, 728.
general mess, bakers, 734.
commissary, 732.
commissary stewards, 733.
cooks, 733.
organization and administration,
730.
preparation of food, cooking, 737.
galley, 737.
ration, 736.
study and arrangement of, from point
of view of efficient service, 728.
Recipes, beverages, with egg and alcohol,
brandy and egg mixture, 586.
caudle, 587.
egg flip, 587.
egg-nog, 585. 586, 587.
egg-nog, beef-tea, 587.
egg and grape .juice, 587.
milk punch, 587.
wine, mulled, 588.
INDEX
793
Recipes, beverages, with egg and alcohol,
wine whey, 588.
nutritious, albumin water, 580, 581.
albuminized milk, 583.
caudle. 581.
cocoa, 582.
coffee, 582.
diluents, various, 584.
egg and buttermilk mixture, 584.
egg broth, 581.
egg cordial, 581.
egg drink. (i23.
egg flip, 585.
grape juice, 584.
junket, vanilla, bitter almond or
strawberry, 584.
kumiss, 582* 58:5.
milk, albumini/ed, 583.
almond, 582.
and cinnamon drink, 583.
and other diluents, .1st.
and Irish moss, 583.
milk lemonade, 584.
milk mixture, 583.
milk porridge. 585.
whey, lemon, 582.
plain, apple water, 578.
barley water, 581).
currant juice (Fitch), 578.
imperial drink, 579.
lemonades, 570.
lime water, 578.
linseed tea, 580.
orangeade, 579.
orgeat, 580.
tamarind water, 578.
toast water, 580.
blancmange, 645.
chocolate or cocoa, 653.
Irish-moss, 646.
bouillon. American, linl.
boiling of meat for, 56.
bottle. 601.
clam. 600.
clam bouillon bisque, 600.
general procedure for, 56.
. plain, 600.
bread, aleuronat bread, 657.
bran mullin for constipation, 613.
brown, 612.
cornmeal gems, 614.
for diabetics, almond biscuit, 660.
bran, 657.
bran cakes. Oamplin's, 657.
gum gluten, 656.
gum gluten muffins, t;."">7.
waffles, 658.
Drexel Institute recipe, 612.
graham. 613.
nut In-own, 612.
pulled. 613.
toast. 614.
cream. 615.
milk. 614.
Itecipes, white gems, 613.
whole-wheat, 612.
zwieback, 613.
broths. 51)7.
American, 601.
beef, 59S.
with egg gruel, 618.
and grain. 599.
with poached eggs, 599.
boiling of meat for, 56.
chicken, 598.
clam, 598.
clam juice, 598.
egg, 581.
in general, 56.
invalid, 599.
mutton, 598.
mutton, without meat, 599.
with vegetables, 59!).
nutritive drink for delicate women
and children, 599.
oyster juice, 598.
veal, 598.
cakes, for diabetics, aleuronat and al-
mond, 659.
almond cakes, 658, 659.
bran, Camplin's, 657.
cocoanut, 659, 661.
cocoanut and almond, 661.
cereal foods, flour ball, 617.
general, 615.
gruels, arrowroot, 619.
barley, 619.
with beef extract, 618.
barley meal. 619.
barley and oatmeal jelly, 618.
cornmeal gruel, til 7. til 8.
cracker gnirl. tilii. til 7.
egg. 618.
farina, tilti.
flour, tilti.
flour, or thickened milk, til9.
flour ball uruel, 617.
gluten, til 8.
imperial granum, 616.
meal >oii]>, til 7.
oatmeal, tilti.
oatmeal, ti'20.
oatmeal and barley jelly. 618.
port wine, 619.
Racahout des Arabes, til 7.
length of time for cooking. 616.
for constipation, bran miillins, 613.
custards, baked, 650.
baked or cup, 648.
chocolate. ti4!).
cocoa junket. (ir>it.
peach meringue. 649.
rennet, or plain junket, 650.
rules for. 647.
sauce. 648.
savory. (148.
soft. (H 7. 650.
-oilllir. til!).
794
IXDEX
Recipes, desserts. See Blancmange, Cus-
tards, Ice Cream, Jellies, Junkets,
Puddings,
for diabetic foods, aleuronat bread, 657.
aleuronat pancakes, 660.
aleuronat and almond cakes, 659.
aleuronat and suet pudding, 660.
almond biscuit, 660.
almond cakes, 658, 659.
almond pudding, 662.
bran cakes, Camplin's, 657.
cocoanut and almond cakes, 661.
cocoanut cakes, 659, 661.
cocoanut pancakes, 661.
cocoanut pudding, 662.
gum gluten bread, 656.
gum gluten muffins, 657.
waffles, 658.
dressings, cream, 638.
mayonnaise, 637.
dumplings, egg, 607.
farina, 610, 611.
potato, 611.
for dyspeptics, jelly, 643.
eggs, cooking and digestibility of, 620L
egg drinks. See Beverages, nutritious,
and Beverages, egg and alcohol.
egg gruel, 618.
hard-cooked, 620.
omelet, 621.
omelet souffle, 621.
poached, 623.
with cheese, 624.
prairie oyster, 622.
rumbled, 623.
snowball, 622.
soft-cooked, 621.
farinaceous foods, cornmeal mush, 609.
farina dumplings, 610, 611.
hominy mush, 609.
macaroni, boiled, 610.
and rice, 610.
oatmeal mush for children and in-
valids, 609.
potato dumplings, 611.
rice, boiled, 608.
Italian (with cheese), 610.
and macaroni, 610.
plain boiled, 610.
fish, baked, 624.
in butter, 626.
dietary value of, 624.
frying of, 66.
oysters, broiled, 627.
panned, 627.
sole or whiting, steamed, 625.
souffle, 627.
steamed sole or whiting, 625.
stewed, 625.
fruit ice creams. See Ice Cream,
fruits, apples, baked, 639.
apricot and prune sauce, 639.
figs, stewed, 640.
orange, 640.
peach meringue, 649.
Recipes, fruits, pineapple, 640.
pineapple cream, 652.
prunes, stewed, 640.
gruels, egg, 618.
See also Cereal Foods,
ice cream, caramel, 656.
chocolate. 655.
junket, 655.
peach, 655.
strawberry, 655.
vanilla, 656.
jellies, 642.
calf's foot, 643.
chicken, 642.
coffee, nutritious, 646.
cream, or blancmange, 645.
for dyspeptics, 643.
general directions for dishes made
with gelatin, 644.
Irish-moss blancmange, 646.
lemon, 645.
meat, 642.
with gelatin, 647.
with Irish moss, 647.
with tapioca, 647.
milk, 644, 646.
orange, 645.
veal-bone, 642.
wine, 645.
sweet, from gelatin, 645.
junket ice cream, 655.
junkets, cocoa, 650.
plain, or rennet custard, 650.
vanilla, bitter almond or strawberrv,
584.
meat juices, 595.
beef essence, 597.
beef juice (Bartholow, Cautley and
Ringer), 596.
cold, 597.
beef teas, 593-595.
meat extract, iced (Ziemssen), 597.
meat- juice mince ( Watson ) , 596.
Watson's home-made, 595.
meat jellies. See Jellies,
meat soups. See Soups,
meats, baking of, 60.
beef, Hamburger steak, 632.
beef pulp, 631.
beef quenelles, 631.
raw. beefsteak, .633.
general method of preparing, 632.
juice, 633.
with milk and sugar, 633.
soup, 633.
succus carnis (meat juice), 633.
boiling of, 56.
braising of, 64.
broiling of. 63, 630.
frying of, 59.
general rules for preparing, 630.
grilling of, 63.
pan-broiling of, 631.
roasting of, 630.
sweetbreads, stewed, 632.
INDEX
795
lleeipes, meats, veal, roast, 631.
venison, roast, 632.
meringues, peach, 649.
mush. Kee Farinaceous Foods,
nuts, chestnut puree, 641.
cooking of, 641.
digestibility of, 641.
nutritive value of, 641.
pancakes, for diabetics, aleuronat, 660.
cocoanut, 661.
peptonized and predigested foods, 588.
cereals partially digested, prepared at
table, 589.
grape juice whey, 503.
junket, or curds and whey, 592.
cocoa, 592.
coffee, 592.
with egg, 592.
iodized, 593.
milk, partially peptonized, 589.
peptonized, 590.
milk gruel, peptonized, 591.
milk jelly, peptonized, 591.
milk lemonade, peptonized, 591.
milk punch, peptonized, 591.
peptonized beef, 588.
peptonized oysters, 589.
whey, 593.
grape juice, 593.
poultry, broilers, boiled, 629.
stewed or potted, 629.
capons, 629.
cliickon, broiled, 628.
chicken puree, 638.
chicken salad, 628.
flesh of, 628.
partridge, stewed, 629.
roast, 629.
squabs, boiled, 629.
stewed or potted, 629.
puddings, aleuronat and suet, for dia-
betics, 660.
almond, for diabetics, 662.
arrowroot, 651.
bread, 051.
and butter, baked, 654.
plain, 653.
chocolate or cocoa blancmange, 653.
cocoanut, for diabetics, 662.
cornstarch, 652.
pineapple cream, 652.
rice. 651.
and egg, 651.
plain, 652.
sponge, 654.
tapioca and sago, 653.
purees, chicken, 638.
endive. 039.
lettuce. 638.
red cabbatre, 630.
salads, chicken, 628.
sauces, custard, tilS,
for vegetables. 63.1.
soups, egg dumpling, 607.
Recipes, soups, fish, 606.
oyster soup, 608.
oyster stew, 607.
meat, 605.
first stock for clear brown soup,
606.
general directions for, 605.
raw-beef, 633.
sweetbread soup, 607.
vegetable, 601.
brown, 605.
Brunoise, 604.
clear, or consomme, 603.
consomme and egg, 604. \
cream-of-celery, 602.
cream-of-potato, 602.
cream-of-tomato, 601.
Julienne, 602.
lentil, 604.
without meat, 601.
potato, 604.
tapioca, 602.
white, 603.
toast, 614.
cream, 615.
milk, 614.
vegetables, asparagus, 635.
carrots, 636.
cauliflower, 636.
cauliflower a PIndienne, 636.
dressings, cream, 638.
mayonnaise, 637.
endive puree, 639
general rules for cooking, 634.
lettuce puree, 638.
oyster plant, 635.
peas, green, 636.
potatoes, mashed, 636.
red cabbage puree, 639.
sauce for, 635.
spinach, 635.
string beans, 636.
time-table for cooking, in water, 634.
tomato savory, 637.
Reducing dietary, 550.
Refrigeration. X<c Cold Storage.
Reservation of foods, 102.
Respiration, effects of food and work on,
293.
Respiratory quotient in metabolism, 292.
calculation of, 294.
Rheumatoid arthritis, due to chronic in-
testinal stasis, 460.
Rice, and vitamines, 228.
Richards' ration for sedentary occupa-
tions, 424.
Roasting of meat, comparison of, with
baking, 60.
process of. 01.
temperature for, 62.
Rubner's table showing losses and avail-
able energy, 255.
Kiunination, 121.
l!u^si;i. army rations of, 701.
daily, 717.
796
INDEX
S . '
Salines, transmutability of, 99.
Salisbury diet, 536.
modified, 537.
Salivary digestion, time and manner of,
85.
Salsify, dehydration of, 37.
Salt, abuse of, 347.
action of, in water, in boiling of meats
and fish, 57.
craving for, relation of diet to, 347.
Salt-free diet, 345.
Salt metabolism, in disease, 341.
Salting of food, as agency of preservation,
3.
Salts, calcium, 349.
in cow's milk, 496.
electrolytic properties of, 343.
exchange of, in body, sodium chlorid
and potassium* chlorid, 348.
iron, 355.
magnesium, 351.
phosphorus, 352.
potassium chlorid, 348.
sodium chlorid, 344.
sulphur, 356.
Saundby's daily dietary for the aged, 446.
showing distribution of meals, 447.
School children, diet of, 414, 416.
and hygienic condition of buildings for,
417.
medical inspection of, 417.
Scurvy, due to deprivation of organic
acids, 315.
in infants, due to destruction of vita-
mines in food, 498.
relation, of diet to, 358.
Seasickness, 122.
Secretions, internal, effect on, of chronic
intestinal stasis, 462.
of woman, as influencing food require-
ment, 268.
Sedentary occupations, diet in, 421.
Senility, premature, 433.
Sense, of taste, 76.
and associated senses, 77.
Senses, role of, in pleasure of eating, 75.
Sherman's estimates of Atwater's experi-
ments for calculation of energy
metabolism, 297.
Singers, diet for, 560.
Skim milk cure, 572.
Sleep, and digestion, 93.
Smoking of food, process of, 2.
Sodium chlorid, consumption of, 344.
importance of, in diet, 344.
percentage of, in foods, 346.
retention of, in tissues, 345.
See also Salt.
Sodium equilibrium, maintenance of, 348.
Soldiers, marching, energy expended by,
382.
food consumed by, per day, 382.
Soldiers' rations. See Rations.
Soups, value of, in dietary, 605.
Sour milk, composition of, percentages,
566.
Sour milk cure, 567.
Souring of milk by lactic acid, 569.
Soy bean flour, 43.
Soy beans, dehydration of, 42.
Starch and protein equivalents, in cereals
and buckwheats in diet of trop-
ical climates, table of, 391.
in pulse, in diet of tropical climates,
table of, 392.
Starches, dextrinization and gelatinization
of, by heat, 52.
Starr's table of dietetic needs in child-
hood, 410.
Starvation, account of miseries of, 110.
acute, protein metabolism of, 160.
death from, in relation to body weight,
147.
definition and process of, 109.
duration of life under, 109, 147.
metabolism of, pathology of, 158.
percentage of loss of body weight and of
loss in fat, 111.
period of time during which different
individuals can subsist without
food, factors influencing, 109.
sensations during, 147.
Stauf process of desiccation of milk, 14.
Steaming of meat, 65.
Sterilized milk, advantages of, 503.
disadvantages of, 503.
in infant feeding, among the poor, 502.
process of, 503.
Sterilization of food, as means of preser-
vation, 6.
Stewing of meat, difference between boil-
ing and, 57.
procedure for, 58.
Stimulants, in puberty, 420.
Strength, effect of protein diet on, 192.
Substitutes for food, 108.
Sugar, action on, of heat, 52.
consumption of, in United States, 771.
use of, in preservation of food, 7.
in war, 765.
Sulphur salts, 356.
in foods, 356.
Sun-drying of fruit, 21.
Superalimentation, acute, 128.
in children, 136.
chronic, 128.
prevalence of, 129.
See also Overfeeding.
Sweets, craving for, by adolescents, 420.
in diet of tropical climates, 398.
Tachyphagia, definition of, 84.
ill 'effects of, 84, 85.
I X I )EX
797
Taste, associated senses, 77.
use of term. 7l>.
Teeth, condition of. in old age, 450.
Tollier method of dehydration of moat, 1!).
Temperature of the body, heat production
during rest, 279.
in sleep calculated for twenty-four
hours, table of, 277.
regulation of, 274.
chemical, 275.
gaseous exchange per minute and heat
production in twenty-four hours,
during absolute muscular rest in
fasting condition, 280.
involuntary. -274.
physical, 275.
resume of. 27!'.
surface areas of skin in, 276.
regulation of heat loss. 27<i.
Thirst, excessive, or polydipsia, 121.
Thirst quenchers, 5t>2.
Tissue construction, differences in suitabil-
ity of proteins for, 202.
Toast, preparation of. See Recipes.
Toxemia, intestinal, due to overeating,
135.
Training, general principles of, 552.
length of time necessary for, 55:}.
Training camp, boys' military, rations for.
Sec Rations, for boys' military
training camps.
Training diet, basis of, 552.
dietary studies of university boat crews,
555.
food included in, 553.
general difference between food of ath-
letes and other people, 557.
necessity and object of, 552.
for one day for summer races, Oxford
and Cambridge, 556.
for one day for winter races, Oxford
and Cambridge, 557.
summing up of researches and experi-
ments of Atwater and Bryant,
557, 558.
of Yale training crew. 554.
Transmutability of foods, carbohydrates,
101.
hydrocarbons. 100, 101.
proteins. 101, 102.
salines. 99.
Tropical climates, alcohol in, 401.
beverages in. Id").
diet in. /s'rr Diet in Tropical Climates.
Tropical dietaries, in U. S. army, 670.
Tropical dieases, due to meat eating. 170.
Tuberculosis, meat diet in treatment of,
534.
treatment of. by /ymothorapy, 538.
Tuberculous children, dietary for, 413.
Tubers, starch-yielding, dehydration of.
36.
Tufnell's diet for treatment of aortic and
other aneurisms, 547.
Turnips, dehydration of, 37.
Typhoid bacilli, in breast milk, 474.
U
Ulcer of stomach and duodenum, due to
chronic intestinal stasis, 461.
Undereating, caution against. 1!7.
coupled with indigestion, 196.
Underfeeding, acute, protein metabolism
of, 160.
calorie deficit of gravest import in, 148.
cause and prevalence of, 145, 146.
chronic or habitual, 146.
conclusions on, ]63.
consumption of energy in, 160.
and crime, ]^2. 153.
maleficent sequences of, 148.
crime, }~r2. l.~>3.
on digestive organs. 152.
in diminishing resistance to cold and
exposure, 151.
drinking. 152.
increased liability to disease, 151.
mental and physical deterioration.
149.
sapping of vital forces, 151.
in women and children, 150.
metabolism of, in the blood, 162.
consumption of energy in, 160.
pathology of. 158.
protein metabolism. 153.
secretion of bile, 162.
Siven's table showing gradual rise in
protein intake but with a con-
stant and sufficient energy intake,
159.
in the urine. 162.
prevalence of, in all countries, 150.
in laboring population of England,
14!).
in laboring population of Scotland,
150.
relationship of, to disease, 151. 152.
Undernutrition. long-continued, 115.
temporary. 115.
Uric acid, effect of purin foods on, 334.
origin of, 335.
in protein metabolism, 329.
Urine, effect of underfeeding on, 102.
Vegetable diet, disadvantages of, low pro-
tein alimentation, 529.
and energy. 524.
all food constituents contained in, 522.
and health. 525.
history of. 520.
indications for. 523.
.lall'a's vegetarian dietary. 542.
lacto vegetarian diet. 521.
opinions of Porphvre and Seneca on,
527.
798
IXDEX
Vegetable diet, opposed to scheme of diet,
523.
partial, necessity of, 527.
and question of fecudity or sterility,
531.
reasons for, 520.
summary of main points in favor of and
against, 531.
vegetable versus animal protein, 528.
Wait's vegetarian and fat dietary, 528.
Vegetable foods, cooking of, 67. See also
Cooking of Vegetables,
digestibility of, 107.
Vegetable flours, use of, 44.
Vegetable protein, 212.
Vegetable protein, versus animal protein,
528.
Vegetable soups. See Soups, vegetable.
Vegetables, dehydration of, 11.
See also Dehydration of Vegetables,
desiccation of, as means of food concen-
tration, 70.
in diet of tropical climates, 390.
drying of, as means of food concentra-
tion, 70.
necessity of, in diet, 527.
preparation of. See Recipes, vegetables,
preservation of, by dehydration, 9.
by drying, 2.
waste of, in America, 10.
Vegetarianism. See Vegetable Diet.
Vinegar, use of, in preservation of food, 7.
Vitamine content of foods, 226.
physiological estimation of, 232.
relative, table of, 226.
Vitamines, antineuritis, 223, 231.
beri-beri due to lack of, 230.
in cow's milk, 498.
destructive action of heat on, 222. .
isolation of, 221.
in metabolism, 224, 229.
nature of, 221.
and pellagra, 232, 237.
pharmacological properties of, 222.
physiological properties of, 222.
relation of, to phosphorus content of
foods, 233.
scurvy in infants due to destruction of,
v 498.
tables showing effect of whole grain and
of highly milled cereals on fowls,
235.
in well-balanced dietary, 224.
Voit's standard dietary for aged persons,
442.
W
Wait's vegetarian and fat dietary, 528.
War, food economics in. See Food Econo-
mics in War.
food situation in countries at. See Food
Situations.
Waste of foodstuffs, economically, 103.
fats, 105.
physiologically, 104.
nutrient, percentage of, in ordinary
mixed diet, 106.
Water, drinking of, with meals, 88.
importance of, to infants, 497.
metabolism of, 308.
Weaning, duration of, 483.
false indications for, 485.
Weight of body, food requirement propor-
tionate to, 266.
Weight and height, comparative, of chil-
dren, table of, 412.
relation of, 363.
at varying ages, standard, table of. 364.
Weir Mitchell diet in treatment of neu-
rasthenia and disorders of mal-
nutrition independent of organic
disease, 549.
Wheat, production of, in United States,
769.
use of, in war, 759.
Whey cure, 573.
Work, effects of food and, on respiration,
293.
and food, 79.
influence of, on food required, 184.
Playfair's table of requirements for, 377.
Xanthin, formation of, 332.
Yeast, dehydration of, 45.
Yolk cure, 563.
Zymotherapy, 538.
Date Due
PRINTED IN U.S.*.
CAT. NO. 24 161
A 000510213 2
WBUOO
1918
v. 2
Fitch, William Edward.
Dietotherapy , nutrition and
diet in health.
WBUOO
1918
v. 2
Fitch, William Edward.
Dietotherapy, nutrition and diet in
health.
MEDICAL SCIENCES LIBRARY
UNIVERSITY OF CALIFORNIA, IRVINE
IRVINE, CALIFORNIA 92664