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THE MACMILLAN COMPANY
NEW YORK . BOSTON . CHICAGO . DALLAS
ATLANTA . SAN FRANCISCO
MACMILLAN & CO., LIMITED
LONDON . BOMBAY . CALCUTTA
MELBOURNE
THE MACMILLAN CO. OF CANADA, LTD.
TORONTO
DIETETICS FOR
NURSES
BY
FAIRFAX T. PROUDFIT
INSTRUCTOR AND CLINICAL DIETITIAN, MEMPHIS GENERAL
HOSPITAL, AND ST. JOSEPH'S HOSPITAL, CONSULTING
DIETITIAN, MEMPHIS ASSOCIATED CHARITIES, AND
PUBLIC HEALTH NURSING ASSOCIATION,
MEMPHIS, TENNESSEE
SECOND EDITION
Completely Revised
NEW YORK
THE MACMILLAN COMPANY
1923
_All rights reserved_
PRINTED IN THE UNITED STATES OF AMERICA
COPYRIGHT, 1918 AND 1922,
BY THE MACMILLAN COMPANY.
Set up and electrotyped. Published November, 1918
Second Edition completely revised and reset
Published, July, 1922
Press of
J. J. Little & Ives Company
New York, U. S. A.
Dedicated
to the
Great Army of Nurses
in the Service
PREFACE TO SECOND REVISED EDITION
The old order of things is passing. The keynote of to-day's work is
prevention, rather than cure, children are taught to eat correctly
that they may grow into the strong, healthy men and women which are
needed to make any nation great. This instilling of good health habits
must rest upon the nurse, the nutrition worker, the physician and the
home-maker. Close cooeperation is necessary among these workers and a
definite understanding of the way to accomplish the best results, in
this respect, must come from the training of those who are undertaking
this all important work.
The present revision of this text is the outgrowth of several years of
close attention to the progress, changes and adjustments which are
being made daily in this important subject of nutrition. The changes
made in this revised edition are all in the line of constructive
teaching. The material has been reorganized that no time may be lost
in a search for the proper word to illustrate a definite point. The
method of project teaching used in this edition, is not a new one,
although the name may possibly be unfamiliar to some. Every good
teacher recognizes the value of motivation as a means of getting an
idea "across." The revision of this text was undertaken with the idea
of leading the student to think for herself and to put into practice
the scientific facts learned in class room and ward.
The author is indebted to many of her colleagues for the encouragement
and constructive criticism which enabled her to make the changes which
will, it is hoped and believed, materially aid the student nurse in
the study of Dietetics. She also wishes to express her appreciation
for the many helpful suggestions made by her co-workers in this
respect, especially to Misses L. H. Gillett and L. Willson for
valuable criticism and to Miss H. Buquo for assistance in the
preparation of the manuscript.
F. T. P.
PREFACE TO FIRST EDITION
No other science has so much to do with the general welfare of mankind
as the study of food and its effects in the human body. When we use
the term "dietetics" as representing "the effect of the food in the
human body," we do so in a very broad sense, for the subject is a big
one, requiring comprehensive terms to express it.
The problems of nutrition are many. Food alone is no small subject and
a still greater one is the utilization of food materials in such a way
that the body may gain the greatest value with the least expenditure
of vital forces. These problems are discussed in this text and the
methods of overcoming them are given in the simplest possible
language. For this purpose the subject of nutrition has been divided
into groups: (1) a comprehensive study of the sources of food, its
composition and nutritive value; (2) the effect of food in the body
under normal conditions, as in health; and (3) its behavior and effect
when conditions in the body become abnormal, as in disease. In this
way much of the non-essential material is eliminated from the course
of study and only that included which it is necessary for the nurse to
understand and which she will constantly use both in the hospital and
later on in the practice of her profession. The simple methods of
study presented in this text are given with the idea of avoiding
confusion in the mind of the average pupil nurse by fitting in the
course with her other studies rather than by making it stand out as a
separate subject. In this way she will be able to see at a glance the
connection between the body processes and the materials which are used
to carry them on. Thus her study of physiology, anatomy and
bacteriology go hand in hand with that of dietetics, each bearing a
distinct relationship to the others.
CONTENTS
SECTION I
FOOD AND ITS SIGNIFICANCE
CHAPTER PAGE
I FOOD 1
II FUEL VALUE OF FOOD 36
III FOOD REQUIREMENTS OF THE BODY 42
SECTION II
LABORATORY OR DIET KITCHEN WORK
IV METHODS OF FEEDING IN NORMAL AND ABNORMAL CONDITIONS 59
V FOOD MATERIALS AND THEIR PREPARATION 81
VI INFANT FOODS AND FORMULAS USED IN ABNORMAL CONDITIONS 140
SECTION III
THE HUMAN MACHINE
VII THE HUMAN BODY 165
SECTION IV
DIETO-THERAPY
VIII PREGNANCY AND LACTATION 191
IX INFANT FEEDING 199
X CARE AND FEEDING OF CHILDREN IN NORMAL AND ABNORMAL
CONDITIONS AND IN INFECTIOUS DISEASES 231
XI FEEDING OF ADULTS IN DISEASES OF THE GASTRO-INTESTINAL
TRACT 245
XII DISEASES OF THE INTESTINAL TRACT 263
XIII FEVERS IN GENERAL 281
XIV TYPHOID FEVER 288
XV DISEASES OF THE RESPIRATORY TRACT 301
XVI DIETETIC TREATMENT BEFORE AND AFTER OPERATION 312
XVII URINALYSIS 323
XVIII ACUTE AND CHRONIC NEPHRITIS 336
XIX DISEASES OF THE HEART 365
XX DIABETES MELLITUS 372
XXI DISEASES OF THE LIVER 404
XXII GOUT, OBESITY AND EMACIATION 418
XXIII OTHER CONDITIONS AFFECTED BY DIET 451
APPENDIX
Table I. Edible Organic Nutrients and Fuel Values of Foods 461
Table II. Ash Constituents of Foods in Percentage of the Edible
Portion 472
Table III. Showing 100-Calorie Portions of some Common Foods,
Together with Their Protein, Nitrogen, and Mineral Content 478
Table IV. Composition and Fuel Value of most of the Foods used
in the Invalid Dietary 484
Table V. Vitamines in Foods 496
Heights and Weights for Children under Five Years of Age 499
Height and Weight Table for Boys 500
Height and Weight Table for Girls 501
Pelidisi Chart 502
The Nutritional Index--The "Pelidisi" 503
Index 505
SECTION I
FOOD AND ITS SIGNIFICANCE
PRELIMINARY COURSE OF LECTURES AND LABORATORY WORK
CHAPTER I
FOOD
The value of a knowledge of food and its effect in the human body
cannot be overestimated. In health, this knowledge leads to higher
standards, since by pointing out the errors in one's mode of living,
good health habits may be established, which will, undoubtedly assure
the individual of a better nourished and a more vigorous body.
There is no question as to the value of health either from the
standpoint of comfort or of economy. And the knowledge which will
enable one to spread the good work intelligently cannot but raise the
standards of living throughout the entire community.
In taking up the study of dietetics, the student is introduced to some
of the fundamental principles governing the health and well-being of a
people, since dietetics includes a study of food and its relation to
the body.
The relationship between right food and good health is very close; how
close is being demonstrated constantly in experimental fields of
scientific research.
To be able to judge whether the food one eats daily is giving the best
possible value from a physiological and economic standpoint, requires
a definite knowledge of food, its source, composition and nutrient
value, as well as its relation to the body in health and disease.
No one is capable of giving constructive advice upon matters
pertaining to diet, unless he has acquired this knowledge through
training. A nurse should obtain this training during her course in the
hospital, through the class room, the wards and the diet kitchen.
The dividing line between health and disease is frequently almost
imperceptible, and without a knowledge of the normal body, it is, at
times, impossible to tell where the normal leaves off and the abnormal
begins. For this reason a nurse must understand normal nutrition, that
is, the behavior of food in the healthy body, before undertaking the
task of ministering to the body attacked by disease.
In a text of this kind, it is impossible to cover all phases of the
subject, especially since day by day new discoveries are being made
with relation to food and its uses in the body. But with careful
attention to the principles set forth, a nurse should be able to carry
out the dietary orders given her by the physician and dietitian in the
hospital. And, when her course of training is finished, she should
find herself equipped to assist in raising the standard of health
through her knowledge of dietetics. With this brief summary of the
aims and object of the study of dietetics, we will begin the actual
work with a study of Food.
~Food Materials.~--Food is the name given to any substance which,
taken into the body, is capable of performing one or more of the
following functions:
1. Building and repairing tissue, maintenance, growth, and development
of the muscles, bones, nerves, and the blood.
2. Furnishing the energy for the internal and external work of the
body.
3. Regulating the body processes, maintaining the proper alkalinity
and acidity of the various fluids throughout the body, regulating the
proper degree of temperature, and determining the osmotic pressure,
etc.
For the convenience of study scientists have arranged the foodstuffs
in groups:
1. According to type;
2. According to their chemical composition;
3. According to the function they perform in the body.
All foods are composed of certain chemical elements; namely, carbon,
oxygen, hydrogen, nitrogen, sulphur, phosphorus, iron, magnesium,
potassium, chlorine, sodium, calcium, with traces of various others.
The manner in which these elements are combined and the amounts in
which they occur determine the group to which the combination belongs,
and give to the foodstuff its characteristic position in human
nutrition.
COMPOSITION OF THE FOODSTUFFS
The chemical elements are combined in food and in the body, as: (a)
carbohydrates, composed of carbon, oxygen and hydrogen; (b) fats,
composed of carbon, oxygen and hydrogen; (c) proteins, composed of
carbon, oxygen, hydrogen, nitrogen and sulphur; (d) water, composed of
hydrogen and oxygen; (e) mineral salts. The first three foodstuffs
constitute the Organic Food group. The last two include the remaining
chemical elements, calcium, phosphorus, sodium, potassium, chlorine,
magnesium, iron and traces of others which make up the Inorganic Food
group.
Each of the foodstuffs belonging to the organic group is capable of
being burned in the body to produce heat for: (a) the maintenance of
the body temperature; (b) internal and external work.
Neither water nor mineral salts alone can be burned to produce heat;
nevertheless, they enter into the composition and take part in every
function performed by the carbohydrates, fats and proteins; therefore
one foodstuff cannot be said to be of greater importance than another,
since the needs of nature are best met by a judicious combination of
all. However, the wear and tear of life can be more efficiently
accounted for, and the strain upon the organism reduced more nearly to
a minimum when the various foodstuffs are furnished in amounts which
science is proving to be necessary for the health and well-being of
the organism.
The sixth essential food substance, the ~Vitamines~, together with the
adjustment of the five foodstuffs just mentioned--the amounts and
types of each in the dietary which will assure the body of the best
results--has been, and still is a subject of grave interest. Even on
the most perfect adjustment of these foodstuffs, the diet would fail
to give the desired results without the inclusion of the sixth, or
vitamine factor, which has proved to be essential for the growth and
development of the normal body, as well as for its protection against
certain deficiency diseases.
In order to obtain the best results from food, both from a health and
an economic standpoint, it is necessary to become familiar with the
foodstuffs as they are combined to make up the various common food
materials. One foodstuff may be a producer of heat, but may lack
certain chemical elements which are essential to the building of
tissues; another may be able to accomplish both functions in the body,
but will prove too expensive to use as fuel, except when it is
absolutely necessary to do so. Thus, it is essential for the nurse to
understand where and how both the foodstuffs and the vitamines occur
in nature, in order to make use of them more advantageously. The
following table gives the sources of the foodstuffs, after which a
description of the individual foodstuffs and vitamine factors will
serve to point the way to their use in the dietary:
{ Milk, cheese (especially skim milk cheese).
{ Eggs.
{ Meat (lean meat in particular).
{ Poultry, game.
{ Fish.
Proteins { Cereals, corn, wheat, rye, oats, etc.
{ Bread and breadstuffs (crackers, pastry, macaroni,
{ cake).
{ Beans, peas, lentils.
{ Cotton seed.
{ Nuts.
{ Gelatin.
{ Wheat products (bread, cake, crackers, pastry,
{ macaroni, spaghetti).
{ Cereal grains, breakfast foods.
{ Corn products, corn meal, green corn.
{ Rice, sago, tapioca, taro.
{ Potatoes (white and sweet).
Carbohydrates { Starchy fruits (bananas).
{ Sweet fruits (oranges, grapes, pineapples).
{ Dried fruits (prunes, dates, raisins, currants).
{ Sugar cane, sorghum cane.
{ Sugar beets, sugar maples.
{ Products made from sugar (candy, jellies,
{ preserves, marmalade).
{ Butter, cream, cheese.
{ Olive oil, cotton seed oil, peanut oil, corn oil,
{ almond oil.
{ Soy bean.
{ Corn meal, cotton seed meal and flour, oatmeal.
Fats { Pork (bacon especially), other fat meat.
{ Codfish (and other fatty fish).
{ Eggs (yolk).
{ Cocoa, chocolate.
{ Brazil nuts, almonds, pecans, and other nuts rich
{ in fat.
Water { All foodstuffs except those which have been put
{ through a drying process.
{ Nitrogen (in proteins, meat, eggs, milk, fish,
{ gluten of wheat, zein of corn meal, legumen of
Mineral salts { beans, peas, and lentils).
(organic form) { Phosphorus (eggs, yolk especially, cream,
{ vegetables, whole wheat, cereals, breadstuffs,
{ oatmeal, dried beans and peas).
{ Eggs, milk, lean meat, cereal products, whole
Iron (organic and { wheat, dried beans and peas, vegetables,
inorganic form) { spinach in particular, onions, mushrooms,
{ fruits, port wine.
{ Milk.[1]
{ Eggs.
{ Soft tissues and fluids of all animals, skeleton
{ and teeth of animals.
Calcium (organic { Wheat (the entire grain), flour, oatmeal,
and inorganic { polished rice.
form) { Dried beans and peas.
{ Green vegetables (beets, carrots, parsnips,
{ turnips, potatoes).
{ Fruits (apples, bananas, oranges, pineapples,
{ dried prunes).
{ Nuts (almonds, peanuts, walnuts).
{ { Lean beef, eggs, milk.
Sulphur (organic { { Wheat flour, entire wheat,
and inorganic { The proteins { crackers, etc.
form) { { Oatmeal.
{ { Beans, peas.
{ { Potatoes.
{ These elements are associated with the other
Sodium, potassium,{ mineral salts in foods, and a diet in which
magnesium, iodine,{ they are adequately supplied furnishes
chlorine { sufficient magnesium, potassium, chlorine,
{ sodium, and iodine for the general needs of
{ the body.
{ _Fat soluble "A."_
{
{ Butter, cream, whole-milk.
{ Whole-milk powder.
{ Whole-milk cheese.
{ Cod liver oil, eggs.
{ Brains, kidney.
{ Cabbage (fresh-dried).
{ Carrots, chard, lettuce.
{ Spinach, sweet potatoes.
{
{ _Water soluble "B."_
{
{ Yeast (brewers').
{ Yeast cakes, yeast extract.
{ Whole-milk, whey.
{ Milk powder (whole and skimmed).
Vitamines[2] { Nuts, cereals (corn embryo, wheat embryo,
{ wheat-kernel, rice (unpolished)).
{ Beans (kidney, navy, soy).
{ Cotton seed, peanuts, bread.
{ Cabbage, carrots, celery.
{ Cauliflower, onions.
{ Parsnips, potatoes.
{ Peas (fresh), spinach.
{ Rutabaga, fruit, grapefruit.
{ Orange, lemon, tomato, raisins.
{
{ _Water soluble "C."_
{
{ Fruits: Orange, lemon, tomatoes (canned).
{ Tomato (fresh), grapefruit, limes, apples.
{ Vegetables: Spinach, lettuce, cabbage (raw).
{ Peas (fresh), onions, carrots, cauliflower.
{ Potatoes (to a less extent).
{ Whole-milk (to a less extent).
THE INDIVIDUAL FOODSTUFFS AND VITAMINE FACTORS
A study of the individual foodstuffs and vitamines will furnish the
first link in the chain which constitutes our present knowledge of
dietetics.
CARBOHYDRATES
In the ordinary mixed diet of man, the carbohydrates predominate, being
not only the most abundant, but also the most economical source of
energy. The term carbohydrate covers all of the simple sugars and those
substances which can be converted into simple sugars by hydrolysis; the
ones of special interest in this study are divided into three groups,
known as, Monosaccharides (C_{6}H_{12}O_{6}); Disaccharides
(C_{12}H_{22}O_{11}) and Polysaccharides (C_{6}H_{10}O_{15}).
~Monosaccharides.~--Glucose, Fructose and Galactose are substances
whose monosaccharide molecules contain one sugar radical; hence they
cannot be hydrolized to simpler sugars (sugars of lower molecular
weight). Those constituting this group of sugars are all soluble,
crystallizable and diffusible substances, which do not undergo changes
from the action of the digestive enzymes, consequently these sugars
will enter the blood stream in their original form, unless attacked by
the bacteria which inhabit the stomach and intestinal tract. The
monosaccharides are all susceptible to alcoholic fermentation. Each
member of the group is utilized in the body for the production of
glycogen and for the maintenance of the normal glucose of the blood.
~Disaccharides.~--Sucrose, Maltose and Lactose are substances
yielding, upon hydrolysis, two molecules of simple sugar: each of
these sugars is crystallizable and diffusible: all are soluble in
water, and to a less degree in alcohol--sucrose and maltose are more
soluble than lactose. When attacked by the digestive enzymes, these
sugars are changed to monosaccharides.
~Polysaccharides.~--Starch, Dextrin, Glycogen and Cellulose are
substances more complex in character than the above-mentioned groups.
They are built up of many sugar molecules, which yield upon complete
hydrolysis many molecules of simple sugar. The polysaccharides are
insoluble in alcohol, and only soluble to a certain extent in pure
water. Some members of this group swell and become gelatinous in the
presence of moisture and heat; some become of a colloidal form in
water, and will pass through filter paper; others remain unchanged.
A brief description of the various members of these different groups
of carbohydrates will assist the nurse in the ways and means of
utilizing them in the dietary to the best advantage.
~Glucose~, which is abundant in the juice of plants and fruits, and to
a more or less degree in the blood of all animals (usually about 0.1%)
occurs free in nature. This sugar is likewise obtained from many
carbohydrates, either through the action of acids, or as the result of
the digestive enzymes, and as such becomes the principal form in which
the animal body utilizes the carbohydrates ingested. Under normal
conditions the glucose in the blood is constantly being burned and
replaced; it is only when the body loses to a greater or less degree
the ability to burn the glucose that it accumulates in the blood,
from which it must escape by way of the urine. There are times, such
as when very large quantities of carbohydrates are eaten at once, when
glucose will also appear in the urine; but under such circumstances it
is generally found to be merely temporary, and for this reason, the
condition is known as temporary glycosuria. As a rule, however, the
surplus of glucose absorbed, whether it be eaten as such, or is found
as the result of enzymic action upon the other carbohydrates, is
converted into glycogen and stored in the liver and to a less extent
in the muscles. Glycogen is readily reconverted into glucose, which is
used by the body for the production of energy. It has been estimated
that over half the energy manifested in the human body is derived from
glucose, and it is in this form that the tissues of the body will
ultimately make use of most of the carbohydrates in food. Practically
all of the fruits, and many of the vegetables, are rich in this form
of carbohydrate, but grapes contain more than any of the other fruits,
while sweet corn, onions, and unripe potatoes contain appreciable
amounts.
~Fructose.~--The second member of the monosaccharide group is more or
less associated with glucose in plant and fruit juices, and is used
like that substance for the production of glycogen in the body. Eaten
as such, or produced as the result of digestive action upon cane
sugar, fructose is changed into glycogen, chiefly upon entering the
liver, and for this reason will not be found to enter largely into the
blood of the general circulation.[3]
Honey is the most abundant source of fructose in nature.
~Galactose.~--This sugar, unlike the other members of this group, is
not found free in nature, but it is produced as the result of
hydrolysis of milk sugar, either by enzymes or by acids. Like glucose
and fructose, galactose seems to promote the production of glycogen in
the body. Certain substances known as galactosides, which are
combinations of galactose and some substances other than
carbohydrates, are found in the nerve and brain tissues of the animal
body.
~Disaccharides.~--Of the second group of carbohydrates, we are
probably more familiar with sucrose, or cane sugar, than with either
of the other two, since it is in this form that the greater part of
the sugar eaten is purchased.
~Sucrose.~--By far the greater part of the sugar entering into the
average dietary is manufactured from sugar and sorghum canes, and from
sugar beets; but appreciable quantities are derived from the sugar
maple and sugar palms. Many of the sweet fruits are rich in this form
of sugar; pineapples are said to contain at least half of their solids
in sucrose; and although other fruits and vegetables do not contain so
high a percentage of this sugar, oranges, peaches, apricots, dates,
raisins, prunes, carrots and sweet potatoes contain goodly quantities,
which are associated with glucose and fructose. Sucrose is readily
hydrolized, either by acids or enzymes. The inverting enzyme
(invertase) of yeast and sucrase of the intestinal juice, convert
sucrose to fructose and glucose, in which forms it is absorbed into
the portal blood. It is believed that when sucrose is eaten in very
large quantities, it is sometimes absorbed from the stomach. In these
cases it does not become available for use in the body, but acts in
the same manner as when injected directly into the blood stream, being
excreted unchanged by way of the kidneys. According to Herter, sucrose
is much more susceptible to fermentation in the stomach than either
maltose or lactose; and since it has no advantage over these sugars
from a standpoint of nutrition, they are frequently substituted for
sucrose in cases where the dangers arising from fermentation must be
avoided.
~Maltose~ (Malt sugar) is an important constituent of germinating
grains--malt and malt products being formed as the result of enzymic
action (amylases) on starch. A similar action takes place in the mouth
as the result of the ptyalin in the salivary juices and in the
intestines from the action of the starch-splitting enzyme, amylopsin,
in the pancreatic juice. The maltose thus formed is further converted
into glucose by the sugar-splitting enzyme in the intestinal juice,
and in this form it is chiefly absorbed. Maltose is also an
intermediate product formed during the manufacture of commercial
glucose as the result of the boiling of starch with dilute acids.
~Lactose~ (sugar of milk) is one of the most important constituents in
the milk of all mammals. In freshly secreted human milk, lactose
occurs in quantities ranging from 6 to 7%, and in the milk of cows and
goats from 4 to 5%. Lactose is much less soluble than sucrose, and
decidedly less sweet; hence, owing to this latter property, as well as
to its lack of susceptibility to fermentation, lactose is frequently
used to bring up the sugar content of infant formulas to the desired
percentage, and the diets used in the abnormal conditions when
additional energy material is needed. During the process of digestion,
lactose is hydrolized by the lactase in the intestinal juice, yielding
one molecule of glucose and one of galactose. Like maltose, little if
any of this sugar is absorbed in its original form, since experiments
made with injections of lactose into the blood result in the rapid and
almost complete elimination by way of the kidneys. No such results are
obtained when even large amounts of lactose are taken by way of the
mouth.
~Polysaccharides.~--This group of carbohydrates is complex in
character, built up of many sugar molecules, and upon digestion must
be broken down into simple sugars before they can be utilized by the
body.
~Starch~ is the form in which the plant stores her supply of
carbohydrates. It is found in this form in roots and (mature) tubers,
three-fourths of the bulk of which is made up of this material. From
one-half to three-quarters of the solids of grains is made up of
starch also. Pure starch is a fine white powder, odorless and almost
tasteless. It is insoluble in cold water and alcohol, but changes from
an insoluble substance to a more soluble one upon the application of
heat. Upon hydrolysis starch gives first a mixture of dextrin and
maltose, then glucose alone as an end-product. This hydrolysis may be
the result of enzymic action, as occurs upon bringing starch in
contact with the ptyalin in the saliva, or with the amylopsin in the
pancreatic juice; or it may be the result of boiling starch with acid,
as is seen in the manufacture of commercial glucose.
~Dextrin~, as has already been stated, is an intermediate product of
the hydrolysis of starch by acid or enzymes.
~Glycogen~ is the form in which the carbohydrates are stored in the
body, just as starch is the form in which they are stored in plants.
It is found in all parts of the body, but is especially abundant in
the liver. Here it is stored in the cell substance rather than in the
nucleus. The storage of glycogen in the human body depends largely
upon the mode of life and upon the diet. Active muscular work,
especially out of doors, uses up the store of glycogen with great
rapidity; while rest and a sedentary life promotes its storage. The
body readily converts its supply of glycogen into glucose, the form in
which the body uses the carbohydrates for fuel.
~Cellulose~ is a woody, fibrous material insoluble in water and to a
certain extent impervious to the action of the digestive enzymes. This
carbohydrate constitutes the skeleton of plants just as the bones
constitute that of the animal body. It is probable that owing to the
length of time required for this carbohydrate to be broken down in
digestion, much of it escapes oxidation entirely. Hence, it passes
down the digestive tract lending bulk to the food mass and thus
promoting peristalsis throughout the whole of the digestive tract.
~Organic Acids.~--Certain of the carbohydrate foods (fruits and green
vegetables) contain appreciable amounts of organic acids or their
salts; oranges and lemons, for example, are rich in citric acid;
grapes contain considerable quantities of potassium acid tartrate,
apples and other fruits have malic acid; many of the fruits have
succinic acid; a few foods contain oxalic acid, or oxalates. All of
these organic acids are burned in the body to produce energy, with the
possible exception of the oxalates, which seem to have little, if any,
food value. According to Sherman, these organic acids have a lower
fuel value, per gram, than carbohydrates, but are reckoned as such in
computing a food in which they exist. The function of these acids is
chiefly that of neutralizing the acids formed in the body in
metabolism. Being base-forming in character, they function after
absorption and oxidation in the body as potential bases--the base
associated with the acid in their ash combining with carbonic acid to
form carbonates, which act as above described.
~Bacterial Action upon Carbohydrates of Foods.~--The bacteria that act
chiefly upon the carbohydrates belong to the fermentative type. The
substances formed as a result of this activity are certain
acids--lactic, butyric, formic, acetic, oxalic, and possibly alcohol.
Certain forms of carbohydrates are more susceptible to bacterial
fermentation than others. Herter claims that sucrose and glucose are
much more so than lactose, maltose, or starch. The substances thus
formed through bacterial activity are not believed to be toxic in
character, but merely irritating. However, the irritation arising from
excessive fermentation in the stomach may lead to gastric disturbances
of a more or less serious nature; hence the amount of carbohydrate
taken under certain conditions must be adjusted carefully.
~The Effect of Heat upon Carbohydrates.~--The changes wrought in the
carbohydrates as a result of heat have already been discussed to a
certain extent. It is seen that the sucrose (cane sugar) is soluble
alike in hot and cold water; the same is true of maltose; but lactose
is much more soluble in hot water than it is in water which has not
been heated. So far as their digestibility is concerned, the
application of heat (boiling) neither increases nor decreases the
utilization of these sugars by the body.
With starch it is an entirely different matter. It has been found that
the application of heat, either as dry heat, or in the presence of
moisture, brings about a definite change in the character of the
foodstuff. Pure starch admixed with water and boiled, passes into a
condition of colloidal dispersion, or semi-solution, known as starch
paste (Sherman). This is graphically illustrated in the cooking of
potatoes, in which the starch and water are mixed in nature; and in
the cooking of cereals and like starchy foods, to which water is added
in preparation for their cooking. In both cases the application of
heat adds greatly to the digestibility of the raw material by reason
of the change which is wrought in these substances, causing them to be
more readily acted upon by enzymes in the digestive juices.
This solubility of carbohydrates in hot water may be utilized in the
washing of utensils in which these substances have been prepared; thus
saving much time and effort on the part of the nurse in either the
diet kitchen or in the home.
FATS
The second member of the organic food group, and one which is almost
as widely distributed throughout animal and vegetable life as the
carbohydrates, is found in the fats. This foodstuff, while composed of
the same chemical elements that go to make up the carbohydrates,
contains these elements in different proportions; that is, fats
contain less oxygen and more hydrogen than carbohydrates.
~Typical Fats.~--The fats (as already shown in the Table on page 5)
are derived from both animal and plant life, but, like the
carbohydrates, do not always occur in the same form. Those of animal
origin include:
~Adipose Tissue~ of man and animals, tallow of mutton, suet, and oleo
oil of beef, lard of pork.
~Phosphorized Fats~, which include lecithin and lecithans, occur
abundantly in the brain and nerve tissues and to a less extent in the
cells and tissues of man, animals, and plants of which it seems an
essential part. Egg yolk is the most abundant source of phosphorized
fat in food material, but milk likewise furnishes an appreciable
amount.
~Cholesterol~ (fat-like substances).--"The fatty secretions of the
sebaceous glands of man and of the higher animals which furnish the
natural oil for hair, wool and feathers," (Starling), lanoline, which
is a purified wool fat, consist chiefly of cholesterol. According to
Mathews, cholesterol is an essential constituent of the blood, and is
found in the brain and in nearly all living tissues. It is likewise
believed to be the "mother substance" from which bile acids are
derived.
~Fat Soluble "A."~--The vitamine factor which occurs dissolved in
certain fats, namely, milk (whole), butter, egg yolk, the organs of
animals, and codfish liver.
~Definition of Fat.~--The fats are all glycerides; that is, they are
substances made up of combinations of fatty acids and glycerine, which
constitute a definite group of chemical compounds, certain members of
which are liquid in form, while others are solid, or semi-solid. The
liquid fats are known as fatty oils. The fatty acids in which we are
chiefly concerned in this study are: Butyric, Stearic, Oleic, and
Palmitic. Most of the common fats owe their form and flavor to the
type and amount of the various fatty acids of which they are
composed. For example, butter is made up of ten fatty acids; but its
soft, solid form is due to the olein and palmitin (glycerides of oleic
and palmitic acids) which it contains; and its characteristic flavor,
as well as its name, to its butyric acid content (about 5 to 6%). It
is evident that the degree of softness or hardness of a fat may be
determined chiefly by the amount of oleic acid in its composition.
Most of the common oils with which we are familiar in food are
composed chiefly of olein. Stearin (the glyceride of stearic acid) is
the hardest of the fatty acids, while palmitin, although classed with
the solid fats, is not so hard as stearin. Lard and butter are higher
in olein and palmitin and are consequently semi-solid, while suet and
tallow, consisting chiefly of stearin, are much harder than the other
food fats.
~Characteristics of Fats.~--The fats are all insoluble in water, and
only partially so in cold alcohol, but they dissolve readily in ether.
As a rule, the fat occurring in the animal body is more or less
characteristic of the species. For example, animals that live on land
have a harder fat than those living in the water; warm blooded
animals, harder fats than cold blooded ones (fish); and carnivorous
animals, harder fats than herbivorous species.
Fats are lighter than water, hence will float in it. An emulsion is a
suspension of fat in a fluid, and the fat in this case must be very
finely divided and mixed with some other material which will prevent a
coalescence of the fat globules. In milk, which is one of the best
natural emulsions, the additional substance is protein.
~Effect of Heat upon Fat.~--When fats are brought to a high
temperature, the glycerine which they contain decomposes with the
production of a substance known as acrolein, which has an irritating
effect upon the mucous membranes. It is possible that the over-heated
fatty acids add their quota to the production of irritating fumes. As
a rule, it is inadvisable to use frying as a method of preparing food
for the sick or for children. Doubtless, if every cook understood the
exact degree of heat to apply in frying, and knew just how moist to
have the food mixture which she intended to cook in this manner,
better results would be obtained; but since the average cook knows
little about the scientific application of heat to fat or the changes
brought about thereby, it is safer to make use of other methods of
food preparation under the circumstances.
~Functions of Fat.~--This foodstuff undoubtedly serves as the most
compact form of fuel available to the body for the production of
energy. Weight for weight, fat furnishes twice as much heat as the
carbohydrates, and in bulk the difference is even more striking; for
example (about) two tablespoonfuls of sugar are required to produce
100 calories, whereas one scant tablespoonful of olive oil will
produce a like number of heat units. As a source of supply for reserve
energy in the body, fat is most valuable. This reserve fuel is stored
in the form of adipose tissues underlying the skin and surrounding the
vital organs, lending contour to the form and protecting the organs
from jars and shocks. Distributed throughout the body, fat may be
found as (a) cholesterol (in the cells of the muscles, organs, and
nerve tissues), which acts as a protection against the destruction of
the red blood cells; (b) phosphorized fat (lecithin), the universal
distribution of which, according to Starling, seems to indicate that
it plays an important part in the metabolic process of the cells,
serving as a source of phosphorus which is required for the building
up of the complex nucleoproteins of the cell nuclei.
PROTEINS
Upon investigation it was found that neither the fats nor
carbohydrates were the chief constituents of the active tissues. It
was found, in fact, that the carbohydrates occurred in very small
quantities only in the muscles, and that frequently the quantity of
fat was likewise limited. Other substances, containing nitrogen and
sulphur in addition to carbon, oxygen, and hydrogen, which were
invariably present, and which are essential constituents of all
tissues and cells, both in animals and in plants, must be necessary to
all known life. To these substances, believed at the time to be the
fundamental constituents of all tissues, Mulder gave the name Protein,
from the Greek, meaning "to take first place." Later investigations
proved that, while the proteins were essential to the building and
repairing of the tissues and cells in general, they were not the only
factors concerned in the work; that certain mineral salts were
necessary constituents of all tissues, and must be present in order
for any normal growth and development to occur.[4]
~Composition of Proteins.~--The average nitrogen content of common
proteins is about 16%; that is, in 100 grams of protein there will be
approximately 16 grams of nitrogen, or in 6.25 grams of protein there
will be 1 gram of nitrogen. To estimate the protein content of a food
when the percentage of nitrogen is known, it is necessary simply to
multiply the percentage of nitrogen present, by the nitrogen factor,
6.25; or, if the amount of nitrogen is desired, when the percentage of
protein is given, to divide by same factor.
~Construction of Proteins.~--In plant structure the building up of the
proteins is accomplished by the plants from inorganic substances
existing in the soil and air; but in the animal body this is not
possible, because the construction of the tissues requires the use of
other proteins--the most available ones being found in food. Each
animal (or species) forms the proteins characteristic of its own
tissues,--while the proteins of food are similar to those found in the
body, they cannot be utilized in their original form, but must be
split into simpler substances from which the cells of the various
tissues throughout the body may select those particularly adapted for
their purpose. These transformed substances are known as amino acids,
the production of which is a result of digestion in the digestive
tract. There are about seventeen of these acids entering into the
construction of the common proteins. One scientist has likened these
units to letters of the alphabet, which, being combined, spell many
proteins. When a protein contains all of the essential units, it may
be said to be "complete," the best example of which may be seen in
milk, eggs, and meat. When a protein lacks some of the essential
elements, or letters of the protein alphabet, it is said to be
incomplete. Gelatin is the best example of this type of protein, but
the cereals and beans must likewise be supplemented by other
substances; milk being the one most generally used for this purpose.
For the purpose of building young tissues, and maintaining those
already mature, it is logical to use foods containing the foodstuffs
in their best form; that is, those that not only contain the complete
protein, but also the requisite mineral salts and vitamines. Foods
lacking in some of these respects become adequate when supplemented by
these foods which can supply the missing constituents; hence, the use
of such incomplete protein foods need not necessarily be abandoned,
for, as in the case of cereals, the foods are both economical and
palatable, and, when used in addition to milk, furnish valuable
adjuncts to the dietary.
~Classification of Proteins.~--A brief description of some of the more
important proteins with which we are chiefly concerned will serve to
simplify the formulation of a diet. Those assuming the most important
position in nutrition and food are ~globulins~, ~albumens~,
~nucleoproteins~, ~phosphoproteins~, ~hemoglobins~, and ~derived
proteins~ such as proteoses and peptones. The albumens and globulins
associated together occur in the tissues of both animals and plants.
The albumens are richer in sulphur than the globulins and are found
more abundantly in the animal fluids, such as the blood, while the
globulins predominate in the more solid tissues of animals and in
plants. The close association of these two proteins is particularly
noticeable in the blood and cells. They have different characteristics,
however.
~Albumins.~--The best examples are found in egg albumin (white of
egg), lactalbumin (milk), serum albumin (blood), leucosin (wheat),
legumelin (peas). Albumins are all soluble in pure water, and are
coagulable by heat. Coagulation, due to the action of the ferments in
the body, takes place in milk, blood, and muscle plasma. Certain
albumens are particularly adapted for the building and repairing of
tissues. Among those that have been used in feeding experiments to
determine whether or not they were capable, when used as the sole
protein in the diet, of maintaining animals in normal nutrition, and
of supporting normal growth in the young animal,--may be cited
lactalbumin and egg albumin. These experiments provided diets adequate
in other respects, the object being to determine the value of the
various proteins. It was found that the albumin from milk was more
efficient in this respect than the egg albumin.[5]
In the invalid dietary the solubility of the albumins in water makes
them of especial value as reinforcing agents, since they may be
introduced into fluids without materially altering either their flavor
or their bulk.
~Globulins.~--Simple proteins, insoluble in pure water, but soluble
in neutral salt solutions; examples, muscle globulin, serum globulin
(blood), edestin (wheat), physelin (beans), legumin (beans and peas),
tuberin (potatoes), amandin (almonds), arachin, and conarachin
(peanuts).
~Alcohol-Soluble Proteins.~--Simple proteins soluble in alcohol of
from 70-80% strength. Insoluble in absolute alcohol, water and other
neutral solvents. Examples of these proteins may be seen in the
gliadin of wheat, zein of corn, and hordein of barley.
~Albuminoids.~--These substances represent one group of incomplete
proteins, inasmuch as they cannot alone support protein metabolism.
However, they are classed with the proteins and may be substituted for
at least a part of these compounds in the daily dietary, since they
are able to do much of the work of the pure proteins. The best example
of this group is seen in gelatin. This substance contains many of the
structural units of meat protein but in very different relative
amounts. It has not, therefore, the chemical units necessary to repair
the worn-out parts of cell machinery.[6]
~Conjugated Proteins:--Nucleoproteins, Phosphoproteins and
Hemoglobin.~
(a) ~Nucleoproteins.~--This type of protein is characteristic of all
cell nuclei, and is particularly abundant in the highly nucleated
secreting cells of the glandular organs, such as the liver, pancreas,
and the thymus gland. The nucleoproteins are composed of simple
proteins and nuclein. Nucleic acid is rich in phosphorus and upon
decomposition yields some of the purin bases (xanthin, adenin,
guanin), a carbohydrate and phosphoric acid.[7]
(b) ~Phosphoproteins.~--Compounds in which the phosphorus is in
organic union with the protein molecule otherwise than a nucleic acid
or lecithin. Examples: caseinogin (milk), ovovitellin (egg yolk).
(c) ~Hemoglobin.~--Much of the greater part of the iron existing in
the body occurs as a constituent of the hemoglobin of the red blood
cells. When the intake of iron is not sufficient to cover the output,
there must be a consequent diminution in the hemoglobin of the blood
with a corresponding development of anemia.
The importance of knowing these characteristic proteins is apparent.
Not only will such knowledge lead to a more intelligent use of protein
foods in the normal dietary, but it will prove of the greatest
assistance in the adjusting of the foodstuffs in diet for individuals
suffering from certain abnormal conditions.
In abnormal conditions this knowledge of the various proteins--their
composition, source, and behavior in the body assumes a position of
the greatest importance; since it represents the means for
safeguarding a patient from the results caused by the wrong kind of
food. In certain types of nephritis, for example, it is perfectly safe
to give milk where the ingestion of meat and eggs might cause serious,
if not fatal, results. In treating gout, when it is deemed advisable
to limit the purin foods in order to control in a measure the
retention of uric acid in the body, the realization that certain of
the nucleoproteins, upon being broken down in the body, yield the
purins, which in turn give rise to the production of uric acid, will
permit the nurse to adjust the diet so as to eliminate such foods
entirely (see Gout). The importance of keeping the hemoglobin content
of the blood normal has already been mentioned.
~The Effect of Heat upon Proteins.~--The fact that certain proteins
are most susceptible to heat has already been stated, but the
application of this knowledge in the preparation of protein foods is
important. In milk, for example, whole raw milk forms a large hard
curd; whereas boiled milk curdles in a much finer and softer form.
Pasteurized milk shows smaller curds than raw whole milk, but larger
than the boiled whole milk.[8]
An egg cooked by the application of a long-continued high temperature
(212 deg. F.) has a tough white; whereas an egg cooked until hard at a
temperature under the boiling point shows a tenderness in the white
which renders it distinctly more palatable. Soft-cooked eggs leave the
stomach in less time than is required for hard cooked ones; poached
(cooked in water under the boiling point), shirred eggs (cooked in hot
dish), and soft-cooked eggs are among the most readily digestible
forms of eggs. Raw eggs are slightly less stimulating to acid
secretion in the stomach and require a longer time to leave the
stomach than boiled eggs. Thus it is seen that in many cases the
difference in preparation of the protein foods may make a difference
in the way in which the digestive tract handles them. Necessarily,
this point is emphasized more in abnormal than in normal conditions;
for example, albuminized orange juice gives rise to a distinct gastric
secretion, and leaves the stomach rapidly--a great advantage in
certain abnormal conditions, and especially in those requiring liquid
diet of high nutriment value.
The knowledge of the coagulation of proteins by heat points out the
advantage of using cold water over hot in the preliminary cleansing of
utensils in which protein foods have been prepared. Certain members of
this group are soluble in pure water, and will readily dissolve;
whereas, if the water is heated, their coagulation would prevent this
taking place so readily.
~Functions of Protein in the Body.~--The proteins serve two distinct
uses in the body; first, that of building and repairing tissues and
furnishing, in conjunction with other substances, material for
growth; second, that of producing energy for the internal and external
work of the body. For this latter function a large percentage of the
proteins ingested is used; consequently, since the carbohydrates and
fats are primarily the energy furnishing material most readily used by
the organism, it is clearly demonstrated that the average individual
takes more protein into the body than is necessary for its
maintenance. Except during the period when an allowance for growth
must be made, it is probable that a much smaller daily consumption of
protein could be made without disadvantage to the organism, leaving
the bulk of the work, in so far as the running of the engine is
concerned, to the other organic foodstuffs.
WATER
Man can exist for days, even weeks, without food, but without water
life soon becomes extinct. This substance is composed of hydrogen and
oxygen in the proportion of two to one; that is, to each atom of
oxygen there will be found two atoms of hydrogen. This is always the
case no matter where it is found. When foods are put through a drying
process the water is taken out and the rest of the chemical
composition of the food remains unchanged.
This foodstuff, unlike those belonging to the organic group, is not
changed during the process of digestion, nor does the application of
heat or cold affect it, save from a physical standpoint. Water boils
at a temperature of 100 deg. C. (212 deg. F.), and freezes at a temperature of
0 deg. C. (32 deg. F.).
~Function of Water.~--The uses of water in the body are many, and the
advantage arising from a sufficient amount of this foodstuff in the
dietary cannot be overestimated. It is no longer considered an error
in diet to drink a moderate amount of water with the meals, so long as
it is not used as a substitute for mastication, and as a means of
washing the food into the stomach. In the diet, both as a beverage and
as a part of most of the food materials ingested, water serves to
moisten the tissues; to furnish the fluid medium for all of the
secretions and excretions of the body; to carry food materials in
solution to all parts of the organism; to stimulate secretory cells
producing the digestive juices, thereby aiding in the processes of
digestion, absorption and excretion; to promote circulation; to
furnish material for free diuresis, thus preventing to a great extent
the retention of injurious substances by the body, which might
otherwise take place.
~Factors Determining the Amount of Water Needed.~--In normal
conditions it is probable that the kind and amount of exercise taken
has more to do with the amount of water needed by the body than any
other factor, since the vigorously worked body excretes more water by
way of the skin than the quiescent one. With a normal amount of
exercise, it is advisable to drink from six to eight glasses of water
each day, increasing the amount to a certain extent when exercise
causes a great loss through perspiration. It is always advisable,
however, to keep in mind that an excessive amount of fluid taken into
the body throws a corresponding amount of work on the organs (the
stomach, kidneys and heart). In certain abnormal conditions, the
body's water supply is depleted. This is particularly true in the case
of hemorrhage, vomiting, and diarrhea. Under other conditions (certain
types of nephritis), the body becomes overburdened through the excess
of water retained, owing to the difficulty which the kidneys show in
eliminating it. This retention of water by the tissues gives rise to
the condition known as edema.
MINERAL SALTS
~Ash.~--The eight remaining chemical elements, _i.e._, calcium,
magnesium, sulphur, iron, sodium, potassium, phosphorus, chlorine,
constituting the mineral salts or ash, are likewise classed as food on
account of the work which they perform in the body. Some of these
elements enter the body as essential constituents of the organic
compounds, and are metabolized in the body as such, becoming inorganic
only upon oxidation of the organic materials of which they form a
part.
~Importance of the Mineral Salts.~--The way in which the mineral
elements exist in the body and take part in its functions, has been
graphically outlined by Sherman as follows.
"(1) As bone constituents, giving rigidity and relative permanence to
the skeletal tissues. (2) As essential elements of the organic
compounds which are the chief solids of the soft tissues (muscles,
blood cells, etc.). (3) As soluble salts (electrolytes) held in
solution in the fluids of the body; giving to those fluids their
characteristic influence upon the elasticity and irritability of
muscle and nerve; supplying material for the acidity and alkalinity of
the digestive juices and other secretions; and yet maintaining the
neutrality, or slight alkalescence, of the internal fluids as well as
their osmotic pressure and solvent power."[9]
The above outline, showing the various ways in which the mineral
constituents enter and take part in the various functions, as well as
in the structure of the body, make it evident that the same close
attention and study which was given to the other foodstuffs must be
accorded to these substances. When the student realizes that the
presence of certain salts dissolved in the blood assists in the
regulation of the vital processes of the body such as the digestion,
circulation and respiration; that they are responsible for the
contraction and relaxation of the muscles; that they assist in
controlling the nerves; that they are, in a way, instrumental in
releasing the energy locked up in food--the value of these elements
becomes very evident, and their importance in the dietary inestimable.
Some of the mineral salts are more widely distributed in food than
others, and the danger arising from their deficiency in the diet is
not so great as is the case with others; hence attention is called to
those found by investigators to be most often lacking or deficient in
the average diet; _i.e._, calcium, phosphorus, and iron. A brief
summary of the special parts played by these elements will be outlined
here.
~Calcium.~--Physiology teaches that about eighty-five per cent. of the
mineral matter of the bone, or at least three-quarters of the ash of
the entire body, consists of calcium phosphates. It has long been
known that this mineral salt is necessary for the coagulation of the
blood, and science has demonstrated that "the alternate contractions
and relaxations which constitute the normal beating of the heart are
dependent, at least in part, upon the presence of a sufficient, but
not excessive concentration of calcium salts in the fluid which bathes
the heart muscles."[10]
~Phosphorus.~--According to Sherman, phosphorus compounds are as
widely distributed in the body, and as strictly essential to every
living cell as are proteins. Science has also proved that they are
important constituents in the skeleton, in milk, in glandular tissue,
in sexual elements, and in the nervous system; that these compounds
take part in the functions of cell multiplication, in the activation
and control of enzyme actions, in the maintenance of neutrality in the
body; that they exert an influence on the osmotic pressure and surface
tension of the body, and upon the processes of absorption and
secretion. Like calcium, phosphorus is absolutely essential to the
growth and development of the body, and, as in the case of the
mineral, its presence in the dietary must be accorded strict
attention, in order to avoid the results accruing from its
deficiency. Casein, or caseinogen of milk and egg yolk (ovovitellin),
are the substances richest in this mineral salt. The fact that the
phosphorus existing in grains (cereals) may be removed largely in the
process of milling, makes it advisable to consider the use of the
breads made from the whole grains.
~Iron.~--The presence of iron as an essential constituent of
hemoglobin has already been discussed. That which is not in the
hemoglobin is chiefly found in the chromatin substances of the cells.
The body does not keep a reserve store of iron on hand as is the case
with calcium and phosphorus in the bone tissues, but must depend upon
the daily intake in food to supply its needs. The iron content of food
materials is not large, but a careful regulation of the iron bearing
foods (see Table on page 5) will make it easy to cover the demands of
the body with a material which has been found to do its work most
efficiently. Medicinal iron has received much attention in the
determination of the essential needs of the body. "Whether medicinal
iron actually serves as material for the construction of hemoglobin is
not positively known, but we have what appears to be a good evidence
that food iron is assimilated and used for growth and for regeneration
of the hemoglobin to much better advantage than are inorganic or
synthetic forms, and that when medicinal iron increases the production
of hemoglobin, its effect is more beneficial in proportion as food
iron is more abundant--a strong indication that the medicinal iron
acts by stimulation rather than as material for the construction of
hemoglobin." (Sherman)
The newborn infant has a store of iron already on hand, derived from
the mother through the placenta before birth. After the birth, and
through the nursing period, the child receives a certain amount of
iron from the mother's milk. This supply is not altogether reliable,
however, since any disturbance of the digestion will tend to
interfere with its absorption, and consequently deprive the organism
of what would otherwise be used for the building up of the blood
supply. Thus it is clearly indicated that the infant's safest source
of iron is from the mother during the pre-natal period. This supply
must necessarily come from her diet during this time, and is made
possible by regulating day by day the iron bearing foods in her
dietary. After the original store of iron is reduced to that of the
adult (after the child has tripled in birth-weight, generally at 12 or
13 months), and during the remainder of the growth period, it is very
necessary to regulate the iron-bearing food in the diet, in order to
insure the child of an adequate amount to cover the demands made by
the increasing blood supply.
VITAMINES
Up to a few years ago it was believed a complete diet should contain
an adequate amount of protein of a proper type, a sufficient amount of
calcium, phosphorus and iron, and enough carbohydrates and fats to
furnish the body with sufficient fuel to cover its energy
expenditures. This belief was proved to be incorrect a number of years
ago by Dr. Hopkins of England. In making certain feeding experiments
with rats, Dr. Hopkins showed that some substance or substances
present in milk, other than those already mentioned, was essential for
the growth of the animal; that animals deprived of this material grew
for a time, but gradually ceased to do so. Later on, Osborne, Mendel,
McCollum and Davis discovered a like substance in butter fat; and
still later Dr. McCollum found the same growth stimulating material,
or one very like it, existing in the leaves of plants. These
scientists found, upon investigation, that there were probably two
substances in milk--one soluble in the fat, the other in the
protein-free and fat-free whey--both of which were essential for
normal growth. In 1911 Dr. Funk discovered in rice polishings a
substance which he believed to be a cure and preventive of Beri-beri;
to this substance, which is now believed to be identical with the
second substance found in milk, he gave the name "vitamine." Dr.
Funk's name "Vitamine" is now accepted to cover a number of substances
essential to growth, and for the prevention and cure of certain
diseases. To the first two has been added a third member of the
vitamine family, which has proved to be a cure and preventive of
scurvy. These substances are called--on account of the substances in
which they are soluble--"Fat soluble A," "Water soluble B," and "Water
soluble C." The table on page 496 shows the sources from which these
factors may be obtained. The four plus system is used by Dr. Eddy to
describe the abundance with which they occur.[11]
~Function of "Fat Soluble A."~--All investigators agree that the "A"
vitamine is an essential factor in the growth of young tissue, and the
repair of mature tissues. McCollum claims that this vitamine is
likewise a factor in the prevention of the eye disease known as
xerophthalmia, and other scientists also hold this opinion. Eddy
states that a diet lacking in the "A" vitamine will, in the majority
of cases, result in stunted growth and the development of the eye
disease, and that the appearance of the latter may be taken as a sure
indication of the absence or deficiency of this vitamine.
The following diagram shows the effect of adding fat soluble "A" to
the diet which was adequate in other respects. This chart represents
the growth curve of young rats.[12]
230 +----------+----------+
| | |
| | |
| | |
| | |
| | |
190 +----------+---------/+
| | / |
| | / |
| | / |
| | / |
| | / |
150 +----------+---/------+
| | / |
| With | / |
| "Fat |/ |
| Soluble / |
| A" /| |
110 +--------/-+----------+
| / | |
| / | |
| / | |
| / | |
| / | |
70 +--/-------+----------+
| / | |
|/ Without "Fat Soluble A"
|----------|----------|
| | |
| | |
30 +----------+----------+
0 1 2
Figure showing the effect upon growth of adding "fat soluble A"
to a diet adequate in all other respects. Courtesy of Dr. E. V.
McCollum.
Mellanby of England believes the "A" vitamine to be a factor in the
prevention of rickets. Scientists of America have recently
investigated this disease, and Dr. Hess (New York) has found cod
liver oil to be a remedy for it. Cod liver oil is known to be rich in
"Fat soluble A," but whether the cure of rickets is due to the
presence of this vitamine in the oil, or to a possible fourth
vitamine, is still undetermined.
~Effect of Heat on the "A" Vitamine.~--Heat, as applied in the
ordinary methods of cooking, is not believed to exert a great deal of
destruction upon the "A" type of vitamine; but hydrogenation, the
process used in the hardening of certain fats in the manufacture of
lard substitutes, is said to destroy it completely.
~"Water Soluble B."~--The second vitamine discovered in milk and
believed to be identical with the Funk vitamine is more widely
distributed than the "A" vitamine. For this reason it is not so likely
to be deficient in the diet as is found to be the case with the "A." A
glance at the table shows that the best sources outside of yeast are
the seeds of plants and the milk and eggs of animals. In beans and
peas the "B" vitamine is distributed throughout the entire seed, but
in the cereal grains it is found chiefly in the embryo. As a result,
bread made from fine white flour or meal is much more apt to be
deficient in vitamine of the "B" type than that which is made from the
whole grain; the same is true of rice and other cereals. Spinach,
potatoes, carrots and turnips show an appreciable amount of the
vitamine, but beets are known to be extremely poor in it. Nuts too are
considered a valuable source.
~Function of the "B" Vitamine.~--Like the "A" vitamine, water soluble
"B" is believed to be essential to growth. Funk established its value
as a preventive and cure of Beri-beri, the disease common in the
Orient among people living largely upon a diet of polished rice and
fish. Besides being a growth-stimulating substance and an
antineuritic, the "B" vitamine is highly valued for its stimulating
effect upon the appetite. To this property is probably due at least
part of the credit for which certain substances work for the promotion
of growth in animals. This can be utilized to good advantage for
children showing a disposition to refuse food, by supplementing
formulas made from milk,[13] with the expressed juice of vegetables
and fruits known to be rich in the "B" vitamine.
~Effect of Heat on the "B" Vitamine.~--This vitamine also shows a
resistance to heat; that is, as applied in the methods generally used
in cooking, pasteurization temperatures do not materially affect the
vitamine property of the formula as far as the "A" and "B" factors are
concerned.
~The Effect of Alkali (Soda) upon the "B" Vitamine.~--It has been an
ordinary practice to add soda to the water in which certain vegetables
are cooked, for the ostensible purpose of softening the vegetables and
hastening their cooking. The practice has been condemned by many
scientists who are making experiments along these lines, on account of
its destructive power upon the "B" vitamine. Chick and Hume in England
claim that when the amount of food given contains originally just
sufficient vitamines to cover the growth factor the use of soda in the
cooking water does serious harm to these vitamines. This is a point
well worth remembering. It is often difficult to persuade certain
individuals to eat vegetables in appreciable quantities; if the
vitamines were reduced though the method of preparing the food, these
individuals would not obtain a sufficient quantity of the vitamines.
~"Water Soluble C."~--The third member of the vitamine family is
known for its antiscorbutic property; that is, it is the best known
cure and preventive of scurvy. It likewise exerts a certain amount of
influence upon the growth of the animal and must be present in the
diet, in order that the health and well-being of the individual may be
safeguarded. The "C" vitamine, like the "B" vitamine, is soluble in
water, and is present to an appreciable extent in the fresh juices of
the fruits and vegetables. Some are richer in this respect than others
(orange and tomato juice), while the cereals, grains, seed of plants,
sugars, oils, and meats are singularly deficient. Milk (whole) does
not contain a great amount of the "C" vitamine, and this amount is
still further reduced under certain methods of preparation. Milk
powders, made either from the whole or the skimmed milk, are found to
contain only very small amounts of this essential substance. Condensed
milk and cream are supposed to be free of "C," and the same is true of
eggs.
~Effect of Heat on "C" Vitamine.~--All authorities agree that the "C"
vitamine is much more sensitive to heat than the other two; and for
this reason much of the value obtained from this vitamine in uncooked
material may be lost when the food containing it is subjected to
long-continued heat. Hess claims that the temperature used for
pasteurizing milk for some time, is more destructive to this vitamine
than boiling water temperature continued for a few minutes only.[14]
There is need for care in formulating the diet for children to see
that they are given fresh fruit every day; or when that is not
possible, to see that they are at least given tomato juice. This
substance is rich in the antiscorbutic vitamine, and according to
experiments made by Sherman, LeMer and Campbell, loses fifty per cent.
of its antiscorbutic power when boiled one hour. Dr. Delf at the
Lister Institute experimented with raw and cooked cabbage, and found
that when this material was cooked for one hour at temperatures
ranging from 80 deg. to 90 deg. C the loss in antiscorbutic power amounted to
90% in the cooked leaves over the raw material. Dr. Delf also
concluded from her experiments that it was advisable to add neither
acid nor alkali in the cooking of vegetables if these substances were
to give their maximum value of vitamines.
From the foregoing description of these vitamine factors, it is
readily seen why so many dietaries are deficient in these essential
substances. The limited sources from which to obtain the "A" vitamine;
the sensitiveness of the "B" vitamine to the action of alkalies; the
sensitiveness of the "C" vitamine to heat, alkali and acid, moreover
the limitation of its presence chiefly to the fresh fruits and plant
juices,--all point to the need of special care in the selection of the
food materials and of the manner in which these materials are prepared
for consumption.
SUMMARY
In the descriptions just given of the various foodstuffs, especially
in regard to their function in the body, it is readily seen that no
one foodstuff is used to the exclusion of another. It is further seen
that in the upkeep of the body, which includes not only the building
and repairing of its tissues, but the running of the engine and
maintaining of its normal temperature, the organism uses each and all
of the organic food substances for the production of heat.
Furthermore, while the tissues are chiefly built from protein
material, and physiology teaches that protein can be built only from
other protein, these tissues contain a certain amount of carbohydrate,
fat, mineral salts, and water; this furnishes distinct evidence that
the building of the cells and tissues of the body cannot be
accomplished by means of protein alone, but by the judicious balancing
of all the foodstuffs in the dietary.
Science has gone even further than this, as has just been
demonstrated, and has proven that without the substances known as
vitamines the normal growth and development in the young would be
arrested, and that the maintenance of the adult body would be
impaired. It has also proven that certain diseases owe their
development to deficiencies in the vitamine supply to the body.
PROBLEMS
(a) Outline briefly what is believed to be the essentials of an
adequate dietary.
(b) List the fuel foods and show their most economical source.
(c) List the best sources of the complete proteins.
(d) Show how the incomplete protein foods may be made adequate for
growth.
FOOTNOTES:
[1] One quart of milk contains more calcium than a quart of clear
saturated solution of lime water.
[2] For complete list, see Eddy's Table, in Appendix.
[3] "Chemistry of Food and Nutrition" (revised edition), by Sherman.
[4] Scientists are proving the need for certain vitamine factors in
the diet in order that the growth and development of young tissues and
the repair of adult tissues may proceed. The part played by these
substances will be discussed later.
[5] "Chemistry of Food and Nutrition" (2d ed.), by Sherman.
[6] "The Basis of Nutrition," by Graham Lusk.
[7] "Food Products," by Henry Sherman.
[8] Abstracts made from thirteen papers from the Laboratory of
Physiological Chemistry, Jefferson Medical College, Philadelphia;
published in the "American Journal of Physiology and Science," by
Minna C. Denton. U.S. Department of Agriculture.
[9] "Chemistry of Food and Nutrition" (revised), p. 333, by Henry
Sherman.
[10] "Chemistry of Food and Nutrition" (revised edition), by Sherman.
[11] "The Vitamine Manual," p. 64, by Walter Eddy
[12] Courtesy of Dr. E. V. McCollum.
[13] Milk from cows whose diet has been deficient in vitamines shows a
like deficiency in vitamine content--the same is true of mother's
milk.
[14] "The Vitamine Manual," p. 64, by Walter H. Eddy.
CHAPTER II
THE FUEL VALUE OF FOOD
Science has proved that the human body is composed of certain chemical
elements and that food materials are combinations of like elements; it
has likewise proved that the body will utilize her own structure for
fuel to carry on the work of her various functions unless material is
supplied for this purpose from an outside source, namely, food, which
in chemical composition so closely resembles that of the human body.
~Amount and Type of Food.~--The next point of investigation would
logically be the amount and kind of food necessary to best accomplish
this purpose. To be able to do this it was necessary to have some
standard unit by which to measure the amount of heat each food was
capable of producing when burned outside the body, after which it was
more or less simple to calculate the heat production of each of the
food combinations within the organism. An apparatus known as the "Bomb
Calorimeter"[15] was devised by Berthelot, and adapted for the
examination of food materials by Atwater and Blakesley. The food
material to be tested was placed within the bomb, which was charged
with a known amount of pure oxygen. The bomb was then sealed and
immersed in a weighed amount of pure water, into which a very delicate
thermometer was inserted. The food within the bomb was ignited by
means of an electric fuse, and the heat given off by the burning of
the material was communicated to the surrounding water and was
registered upon the thermometer. It was evident that some definite
name had to be devised by which these heat units might be known. Hence
the name "~calorie~," which represents _the amount of heat required to
raise the temperature of 1 kilogram of pure water 1 degree centigrade,
or about 4 pounds of water 1 degree Fahrenheit_.
~Transformation of Foods into Available Fuel.~--A comparison has been
made between the human body and steam engine, but this comparison is
not adequate, since the food does not produce heat within the body
originally, but energy of which heat is a by-product. Each food
combination has a certain amount of dormant energy within its
structure and this energy does not become active nor can it be
utilized by the body until the food, of which it is a part, is changed
within the organism to substances more nearly like its own. This
liberated active energy is then used as a motive power to carry on the
internal and external work of the body, and the heat, which is
invariably the consequence of any active energy (motion), leaves the
body as such. It will be seen, then, that the human body acts not as a
steam engine, but rather as a ~transforming machine~ by means of which
the dormant energy of the food is transformed into an active agent of
which heat is a natural result.
In the calorimeter it was found that the carbohydrates and fats burned
to the same end products, namely, carbon dioxide and water, while the
proteins, upon oxidation, produced carbon dioxide, water and nitrogen
gas. In the body it was found that the carbohydrates and the fats
acted in exactly the same manner as in the calorimeter, producing the
same end products. But this was not the case with the proteins; the
oxidation process of this chemical combination was found to be not
nearly so complete within the body as in the calorimeter, and instead
of the free nitrogen as produced in the apparatus there were urea and
other nitrogenous substances eliminated which, while combustible,
represented a less complete oxidation of the proteins.
The following table represents the amount of heat produced as the
result of a complete oxidation of the foodstuffs in the calorimeter.
TABLE[16]
==================================================
Carbohydrates 4.1 cal. per gram
Fats 9.45 cal. per gram
Protein (nitrogen x 6.25) 5.65 cal. per gram
==================================================
The loss of potential energy due to the incomplete oxidation of the
proteins in the body is approximately 1.3 calories to each gram of
protein in food; consequently in calculating the fuel value of protein
foods, due allowance must be made for these losses. Allowance must
also be made for the incomplete digestion, or losses occurring in the
digestion, of the foodstuffs. These losses, as well as the approximate
amount of each constituent absorbed, are represented in the following
table.[17]
===========================+===========+===============
| _Lost_ | _Absorbed_
---------------------------+-----------+---------------
Carbohydrates |2 per cent.| 98 per cent.
Fats |5 per cent.| 95 per cent.
Proteins |8 per cent.| 92 per cent.
===========================+===========+===============
The physiological fuel factors of food, or the amount of heat produced
as the result of combustion of 1 gram of organic food material after
the above-mentioned losses have been accounted for, may be obtained as
follows.[18]
=================================================
Carbohydrates 4.1 x 98% = 4 cal. per gram
Fats 9.45 x 95% = 9 cal. per gram
Proteins 4.35 x 92% = 4 cal. per gram
=================================================
EFFECT OF HEAT AND COLD UPON THE FOODSTUFFS
In primeval days, when man led a more natural life, his very existence
depended upon his ability to wrest from the earth his 4--9--4; these,
then, constitute what are known as the "physiological fuel factors" of
carbohydrates, fats, and proteins respectively.
~Determination of Fuel Value of Food.~--In determining the amount of
heat produced by a given amount of food, it is first essential to
reduce the amount to grams (for example, 1 lb. equals 480 grams):
first, because the gram is a unit of weight commonly used in dietetic
calculations; second, because the fuel factors are based on the amount
of heat produced by the burning of one gram of organic foodstuffs.
Knowing the composition of food, that is the number of hundredths of
protein, carbohydrate and fat it contains, it is a simple matter to
estimate its fuel value by multiplying the amount of each contained in
one gram by its physiological fuel factor 4.4.9. Thus if the
composition of a food is 3-3/10% protein, 4% fat and 5% carbohydrate,
one gram would contain .033 gram of protein, .04 gram of fat and 0.5
gram of carbohydrate. Hence one gram of milk would produce
.033 x 4 = .132 calorie from protein
.04 x 9 = .36 calorie from fat
.05 x 4 = .20 calorie from carbohydrate
or .692 calorie in all
But it is not necessary to estimate the fuel value of so small a
quantity as one gram, and, since the value of protein, carbohydrates
and fats is always the same it is more satisfactory to estimate the
amount of the organic constituents contained in the entire given
quantity of food, rather than stopping to figure out the fuel value of
the small quantity.
This is done by multiplying the entire number of grams of food given
by the amount of protein, fat and carbohydrate contained in one gram,
then multiplying these results by the physiological fuel factor of
each. Thus 100 grams of milk would yield
100 x .033 = 3.3 x 4 = 13.2 calories from protein
100 x .04 = 4.0 x 9 = 36.0 calories from fat
100 x .05 = 5.0 x 4 = 20.0 calories from carbohydrates
or a total of 69.2 calories from 100 grams of milk.
~The Standard or 100 Calorie Portion.~--Just as it has been more
convenient to estimate a larger rather than a smaller quantity of food
material, so it is frequently more desirable to estimate a hundred
calories, rather than one calorie. This is especially useful when
dietaries of high caloric (fuel) value are to be estimated, or
dietaries in which foods of like composition and fuel value are to be
interchangeable. In such cases it is a simple matter to select the
desired number of 100 calorie portions of those foods which are to
make up the dietary.[19]
~Method of Estimating the 100 Calorie Portion.~--The number of
calories yielded by 100 grams of food material is taken as a basis
upon which to estimate the 100 calorie portion, and X represents the
number of grams required to yield this portion. The problem is one of
"simple proportion," for example, take the 100 grams of milk just
estimated, we found that 100 grams (or c.c.) furnished 69.2 calories
of heat, then, 100:69.2 :: X:100--145; or 145 grams of milk are
required to furnish 100 calories of heat. Suppose it is desirable to
substitute eggs for a part of the milk in the diet, eggs have a higher
fuel value per unit of weight than milk, their average composition
being 13.4% protein, and 10.5% fat (no appreciable amount of
carbohydrates), 100 grams of eggs would yield
100 x .134 = 13.4 x 4 = 53.6 calories from protein
100 x .105 = 10.5 x 9 = 94.5 calories from fat,
or a total of 148 calories.
The Standard or 100 calorie portion of eggs would be,
100:148 :: X:100 = 68
or the number of grams required to yield 100 calories.
Thus it is seen that in using the fuel value of a hundred grams of
food material for estimating the standard or 100 calories portion the
extremes are always the same. Hence, the weight of the 100 calorie
portion may always be obtained by multiplying the extremes and
dividing the result by the number of calories furnished by 100 grams
of food material.
PROBLEMS
(a) Compare the fuel value of the various common food materials.
(b) How does the fuel value of a chicken salad compare with that of
fruit salad?
(c) Figure the fuel value of a cupful of cream of tomato soup and
compare it with that furnished by the same quantity of beef broth.
(d) Weigh and measure a 100-calorie portion of spinach and compare it
with a 100-calorie portion of sweet potato.
FOOTNOTES:
[15] For full description and methods used, see "Journal of The
American Chemical Society," July, 1903.
[16] "Chemistry of Food and Nutrition" (revised edition), by Sherman.
[17] "Chemistry of Food and Nutrition," by Sherman.
[18] "Chemistry of Food and Nutrition" (revised), by Sherman.
[19] See Table of Standard or 100 Calorie Portions, in Appendix.
CHAPTER III
THE FOOD REQUIREMENTS OF THE BODY
The human body, as far as can be judged, does not use one nutrient to
the exclusion of another, but science has proved that the best results
are obtained from diets balanced to suit the needs of the body,
providing the fuel and repair materials in the amounts which are
calculated to give the maximum value with the minimum expenditure on
the part of the organism.
For while no two individuals are exactly alike, there are factors
which govern or influence the food requirements of all, and thus make
it possible to estimate the needs of the body with a fair degree of
accuracy.
It has been found, by means of calorimeter experiments (direct and
indirect), that a certain amount of heat is produced within the body,
regardless of external movement or food; that is, when a body is lying
absolutely quiet with no movement save that of breathing, the internal
work of the organism, which is continuous, releases so much heat, and
this is produced whether there is food to replace it or whether the
body structure is burned. This is known as the ~basal rate of
metabolism~, and constitutes the normal ~basal requirements~. Any
external movement will increase this rate; the greater the activity
the higher the increase. Consequently external work calls for food in
addition to that which is used to run the engine, in order to save the
body from destruction.
DuBois[20] finds "Basal Metabolism above normal in exophthalmic
goiter, in fevers, in lymphatic leukemia, and in pernicious anemia,
in severe cardiac disease, and in some cases of severe diabetes and
cancer; it is lower than normal in cretinism, and in myxedema, in old
age, in some wasting diseases and perhaps in some cases of obesity."
This fluctuation in the Basal Rate of metabolism furnishes a factor in
the diagnosis of disease, not only recognized but coming more and more
in use.
FACTORS DETERMINING THE FOOD REQUIREMENTS OF THE BODY
~For the Adult.~--Muscular activity, Age and Size, are most important
factors influencing the food requirements. The physical condition and
environment of the individual also exert a certain amount of influence
upon the intake of food.
~Work.~--Muscular activity, as already stated, increases the body
expenditures; consequently the more active the work the greater amount
of energy food needed per unit of weight.
~Age.~--As the individual grows older, the rate of metabolism
decreases until, in old age, it is not more than a third to a fifth of
what it was in earlier life. This is due to a general "slowing down"
of the machinery, the heart does not beat so rapidly, nor is the
respiration so quick. The digestive organs, the heart, the liver, and
the kidneys, cannot handle the volume of food which was required
during the period of greatest physical activity. Hence, any great
excess over and above that which is needed for the maintenance of the
body in health will be a source of danger to the elderly person. Von
Noorden claims the food requirements of individuals from
60 to 70 years of age to be reduced 10%; for people from
70 to 80 years of age to be reduced 20%; for people from
80 to 90 years of age to be reduced 30%.
~Sex.~--Science has proved, that there is little difference in the
food requirements of men and women, provided they are alike in age,
weight and size, and are doing the same amount and type of work. But
women, as a rule, weigh less than men, hence their food requirements
are approximately less.
Murlin finds the food requirements of pregnant women to be some what
higher than of non-pregnant ones, and the requirements of the nursing
mother to be higher than either (see chapter on Pregnancy and
Lactation).
~For the Child.~--The factors influencing the food requirements are
different, to a certain extent, from those of the adult. The main
difference lies in the fact that the adult needs food only for the
maintenance and repair of the body, while the child must have food,
not only to cover its maintenance requirements, but to support the
growth and development which should be continuous from birth to
maturity. Resistance, too, must be developed during this period in
order to safeguard the child through life.
The rate of metabolism in the infant is greater than at any other
period of life, consequently, even if a child were one-third the
weight of its parent, it would inevitably cease to grow and would
become malnourished, if its food requirements were reckoned at only
one-third that of the parent.
~Adjusting the Food Requirements.~--Taking these factors as guides for
estimating the food requirements of man, it is evident that no hard
and fast law can be laid down to cover all, that each individual must
adjust the food intake according to the weight and activity of the
body. Sherman has arranged the following table showing the energy
expenditures per hour for the average man (154 pounds), per pound of
body weight (these are approximate averages only).
TABLE[21]
=====================================================================
Sleeping quietly 60-70 calories per hour
Awake, lying still 70-85 calories per hour
Sitting at rest 100 calories per hour
Standing at rest 115 calories per hour
Tailoring 135 calories per hour
Typewriting rapidly 140 calories per hour
"Light exercise" (stationary bicycle) 170 calories per hour
Shoemaking 180 calories per hour
Walking slowly (about 2-1/4 miles an hour) 200 calories per hour
Carpentry or metal work 240 calories per hour
"Active exercise" (stationary bicycle) 290 calories per hour
Walking briskly (about 3-3/4 miles an hour) 300 calories per hour
Stone working 400 calories per hour
Severe exercise, such as sawing wood 450 calories per hour
Running (about 5-1/2 miles an hour) 500 calories per hour
Very severe exercise (stationary bicycle) 600 calories per hour
=====================================================================
The above table, calculated for an average man weighing 154 pounds,
may seem less simple to use than one based on the energy requirements
per pound of body weight per hour, of an average individual. For
example, a man weighing 123 pounds and performing practically the same
amount and type of work as done by the man weighing 154 pounds would
require practically one-fifth less calories than the latter
individual. Hence, to facilitate the estimation of the food
requirements for average individuals, the following table is
included.[22]
======================================================================
Sleeping 0.42 calorie per hour, per lb. of body wt.
Sitting at rest 0.65 calorie per hour, per lb. of body wt.
Light muscular exercise 1.10 calories per hour, per lb. of body wt.
Active muscular exercise 1.90 calories per hour, per lb. of body wt.
Severe muscular exercise 3.00 calories per hour, per lb. of body wt.
======================================================================
Possibly a few explanatory words, as to the terms used in the above
tables, will assist the nurse in making the necessary calculation.
"Sleeping quietly" makes allowance for no movement save that of
respiration; any undue restlessness will call for an increase in the
above allowance.
"Sitting at rest" includes the time spent at meals, sitting in class
room, ward office, studying or reading. It does not include much
walking about the room, rising frequently, or nervous restlessness.
"Light exercise" includes all light house work, running an ordinary
sewing machine, walking about office or ward, (receiving ward
included). It does not include washing, sweeping or scrubbing.
"Active exercise" includes washing, sweeping, scrubbing, general house
work, carpentry, and such sports as tennis, basket ball, and ordinary
gymnasium work.
"Severe exercise" includes road workers (working with pick and shovel)
fast running, baseball, football, and swimming.
"Very severe exercise" includes the work done by miners, handling of
freight, and lumbermen, especially those working in extreme cold,
where the severe cold makes extra demands on the fuel supply. By
making use of the averages just mentioned it should be a simple matter
to calculate the food requirements of any normal individual. It is
necessary to know the weight of the person in question, and the manner
in which the twenty-four hours are spent, and, in the case of elderly
individuals, make the reductions believed to be necessary for health.
~Method of Using the Tables.~--Let us take a nurse in training for
this purpose. Suppose the nurse weighs 110 pounds, and spends the
twenty-four hours as follows,
Sleeping 8 hours
Sitting at meals 2 hours
Studying 2 hours
In class 1 hour
On duty 9 hours
Off duty (walking briskly) 2 hours
Her daily food requirements would probably be approximately 2,235
calories. This estimate would be increased, if she were obliged to do
much heavy lifting, scrubbing of beds, or other duties requiring the
expenditure of much effort. It would be decreased if the hours spent
in study and class room work were increased and the hours on the ward
shortened. The estimation may be made as follows,
Sleeping 8 hrs. 110 x 0.42 x 8 = 370 calories
Sitting at meals 2 hrs. 110 x 0.65 x 2 = 143 calories
Sitting in class 1 hr. 110 x 0.65 x 1 = 71.5 calories
Studying, 2 hrs. 110 x 0.65 x 2 = 143 calories
On duty 9 hrs. 110 x 1.10 x 9 = 1089 calories
Off duty (walking briskly) 2 hrs. 110 x 1.90 x 2 = 418 calories
---------------
Total for day 2234.5 calories
This estimate may be made to suit any individual, the man in the
office or the one working on the streets, the woman living at home or
the one spending eight or ten hours scrubbing the floors of a great
office building; it is simply a matter of adjusting the calories in
the dietary to meet the requirements of body weight and muscular
activity.
~Energy Requirements for Children.~--In estimating the energy needs of
children, the above method is not satisfactory, since the storage of
material for growth must be considered, as well as the activities of
the body. The growth period includes the years from birth to the
eighteenth year, after which time the food requirements of the body
are made on a basis of weight and muscular activity, as in all adults.
The table on the following page shows the food allowances made for
healthy children; in the feeding of malnourished or underweight
children, more food in proportion to age is given in order to overcome
the handicap under which they are suffering.
FOOD ALLOWANCES FOR HEALTHY CHILDREN[23]
==============+========================
AGE | CALORIES PER DAY
--------------+------------+-----------
_Years_ | _Boys_ | _Girls_
--------------+------------+-----------
Under 2 | 900-1200 | 900-1200
2-3 | 1000-1300 | 980-1280
3-4 | 1100-1400 | 1060-1360
4-5 | 1200-1500 | 1140-1440
5-6 | 1300-1600 | 1220-1520
6-7 | 1400-1700 | 1300-1600
7-8 | 1500-1800 | 1380-1680
8-9 | 1600-1900 | 1460-1760
9-10 | 1700-2000 | 1550-1850
10-11 | 1900-2200 | 1650-1950
11-12 | 2100-2400 | 1750-2050
12-13 | 2300-2700 | 1850-2150
13-14 | 2500-2900 | 1950-2250
14-15 | 2600-3100 | 2050-2350
15-16 | 2700-3300 | 2150-2450
16-17 | 2700-3400 | 2250-2500
==============+============+===========
CALORIES PER POUND OF BODY WEIGHT PER DAY.[24]
=============================================
_Years_ |_Calories per pound, per day_
--------------+------------------------------
Under 1 year | 45
1-2 | 40-43
3-4 | 37-40
4-5 | 37-40
5-6 | 35-37
6-7 | 34-35
7-8 | 32-34
8-9 | 30-35
9-10 | 30-35
10-11 | 28-32
11-12 | 28-32
12-13 | 28-32
13-14 | 25-30
14-15 | 20-25
15-16 | 20-25
16-17 | 20-25
==============+==============================
After which time the food requirements are based on degree of muscular
activity, boys and girls of seventeen years and over requiring as much
food as men and women.
Children, like adults, differ in degrees of activity; that is, one
child may be very active, running and playing more strenuously than
another. Hence a margin of safety must be allowed to cover the energy
expenditures of the more active child, to safeguard it against
becoming malnourished.
To facilitate the computation of the food requirements of children a
schedule showing the number of calories per pound of body per day is
included on opposite page.
The food requirements are such as to allow of a steady increase in the
weight and stature of the child; the rate of gain for normal children
should be as follows:
AVERAGE RATE OF GAIN PER WEEK, FOR NORMAL CHILDREN
=======================+==================
_Age_ | _Average_
_Boys_ | _gain,_
| _Ounces_
-----------------------+------------------
First year | 3-1/2 - 4-1/2
Second year | 2-1/2 - 3
Third year | 1-3/4 - 2
Fourth to eighth year |
(inclusive) | 1-1/4 - 1-1/2
Ninth to eleventh |
year (inclusive) | 1-3/4 - 2
Twelfth to thirteenth |
year (inclusive) | 2-3/4 - 3
Fourteenth to |
sixteenth year |
(inclusive) | 3 - 4
=======================+==================
=======================+==================
_Age_ | _Average_
_Girls_ | _gain,_
| _Ounces_
-----------------------+------------------
First year | 3-1/2 - 4-1/2
Second year | 2-1/2 - 3
Third year | 1-3/4 - 2
Fourth to eighth year |
(inclusive) | 1-1/4 - 1-1/2
Ninth to twelfth |
year (inclusive) | 1-3/4 - 2-1/4
Thirteenth to |
fifteenth year |
(inclusive) | 2-3/4 - 3-1/4
Sixteenth and |
seventeenth year |
(inclusive) | 1 - 2
=======================+==================
The averages just given are for healthy children; those who are
underweight for their age and height should show a more rapid increase
in weight with an increased food allowance. It must also be remembered
that a simple gain in weight is not sufficient evidence of a child's
normality; a freedom from gastro-intestinal disturbances, and a
resistance to disease, are equally essential.
There have been tables arranged to show the proper weight for height
for boys and girls of different ages (see appendix). These are
valuable since, by their use, attention is called to the child who is
not up to the average. Medical examination of such children frequently
shows reason for their underweight, and measures may be instituted
which may save the child from a lifetime of poor health.
Dr. Pirquet has arranged a scale (Pelidisi Chart) showing the state of
nutrition in children, based upon the sitting height (in centimeters),
to weight (in kilograms). See appendix.
PROTEIN REQUIREMENTS
There is never a period in life in which protein is not needed. During
the early years it is essential that the proteins, or at least a
goodly portion of them, be obtained from animal sources, milk and eggs
in particular; when cereals and legumes (beans and peas) are used to
provide for the protein requirements, they must be supplemented by
milk or eggs (or both), in order that the growth and development of
the child may proceed at a normal rate.
Adults require protein for the repair of old tissues and to furnish
material for the building of new cells, and again it is believed
advisable to have at least a portion of this protein from animal
sources, milk, meat or eggs.
MINERAL REQUIREMENTS
Just as energy foods and proteins must be adjusted in the dietary to
safeguard the health of the body, so the mineral salts must be
adjusted for a like purpose. Studies made of the dietaries of a number
of families brought to light the fact that the children more often
suffered from a deficiency of calcium, phosphorus and iron in their
diets than they did from too little protein,[25] proving that it is
quite as essential to adjust the mineral salts in the diet as it is
that of the organic constituents.
According to Sherman the diet of an adult should contain each day per
pound of body weight:
Protein 0.5 gram or more
Phosphorus 0.01 gram or more
Calcium 0.005 gram or more
Iron 0.0001 gram or more
These averages, while covering the needs of the mature body, do not
furnish the necessary amount of protein, or mineral salts to support
the growth and development of the child. Hence, it has been deemed
advisable to reckon the requirements of the latter per thousand
calories, instead of per pound of body weight, in this way obviating
some of the danger of protein and mineral deficiencies.
McCollum, Simmonds and Pitz have shown that a deficiency in the
inorganic content of a diet may result in a retarding or suspension of
growth. This result has been overcome on the introduction of the
proper mineral salts into the diet. This salt mixture is such as to
make the total ash, approximate that found in the composition of milk
ash.
The following diagram illustrates this point.
|
240 +----------+----------+----------+----------+--+
| | | | |
| | | | | _|
| | | | _/
| | | | _/| |
| | | | _/ |
200 +----------+----------+----------+----_/----+--|
W | | | | _/ | /
e | | | |_/ | /|
i | | | / |/
g | | | Normal_/| / |
h | | | _/ | /|
t 160 +----------+----------+----_/----+--------/-+--|
| | | _/ | / |
i | | | |_/ | / | |
n | | | _/ | / |
|<---Period I--->|<-/------Period II--/------> |
G | | |_/ | | _/ |
r 120 +----------+---_/|----+----------+_/--------+--|
a | | _/ | | _/ |
m | _/ | | _/ | | |
s | /| | | _/ | |
| / | | | _/ | | |
| / | | | _/ | |
80 +------/---+-----|----+/---------+----------+--|
| / | | /Effect of | |
| _/ | | /|added Salt| | |
| _/ | | / |Mixture | |
|/ | | / | | | |
X__________|_____|/ | | |
40 +----------+-----|----+----------+----------+--+
0 1 2 3 4
Time in Months
Effect upon growth of adding to a diet otherwise adequate a salt
mixture of such composition as to make the composition of the total
ash similar to that of milk ash; immediate resumption after entire
suspension of growth. Courtesy of Dr. E. V. McCollum.
The following outline will serve as a guide in making the estimates
for the food requirements of children:
THE DIET OF A CHILD SHOULD CONTAIN FOR EVERY 1000 CALORIES FURNISHED
BY THE FOODSTUFFS,
==================================
Protein 25.00 grams or more
Phosphorus 0.48 gram or more
Calcium 0.25 gram or more
Iron 0.005 gram or more
==================================
~Vitamine Needs.~--We have seen the manner in which the energy and
protein foods have been adjusted in the diet, but these can not alone
assure the body, and especially the growing body of a normal
maintenance and repair of its tissue, or support the growth which is
essential at this time. This function is believed to belong to the
vitamines, since feeding experiments have demonstrated the fact that
animals soon cease to grow, develop deficiency diseases, and finally
die, when deprived of the essential constituents. Gillett advises, as
a safe rule, the use of one, and preferably two foods known to be rich
in the fat soluble vitamine, in each day's food allowance, milk and
leafy vegetables, for example. If the foods containing phosphorus,
calcium, and iron are taken in sufficient quantity, the second, or "B"
vitamine needs, will probably be adequately covered, but the presence
of the "C" vitamine must be carefully attended to; some fresh fruit or
vegetables (see table) is obligatory each day to insure the individual
against the development of scurvy.
~Factors Affecting the Food Selection.~--The estimation of the energy
needs of the body, and the selection of the foods to furnish the fuel
for this purpose, depend largely upon the individual. The digestion of
the fats, as well as the way in which the body utilizes them, makes
the use of this foodstuff more or less limited according to the
ability of the individual to take care of them, the minimum allowance
for children being between 2 and 3 ounces per day. According to
Gillett, "If boys and girls get at least this amount from butter and
its substitutes, cream, bacon, fat meat and oils, additional amounts
from their food will provide a margin of safety, without overtaxing
the digestive system."
After determining the amount of fat required in each day's food
allowance, it is a simple matter to adjust the carbohydrates. It is
safer from a health standpoint, to obtain the greater portion of this
foodstuff from starchy foods rather than from the sugars, many foods
rich in starch, likewise contain appreciable amounts of protein and
fat, whereas sugar is practically one hundred per cent. carbohydrate.
The ease, too, with which this substance ferments in the stomach, and
the manner in which it destroys the appetite for other foods, makes
the use of much of it in concentrated form unadvisable, especially in
the diet of children.
The amount of sugar allowed each day, should be limited to an ounce or
ounce and a half (2 to 3 tablespoonfuls), and a less quantity is
desirable. In order to obtain the best results, with the least
deleterious effect on the body, it is advisable to give sugar in
dilute form. A piece of pure candy after a meal may not harm the
child; but just before, or between meals, as well as the habit of
making the breakfast cocoa and cereal of syrup-like sweetness is
deplorable, and should in all instances be discouraged.
The American Red Cross recommends the following method for estimating
the amount of sugar in the dietary: "Add one-half the weight of such
foods as jellies, jams and preserves, and three-quarters the weight of
such foods as candy, honey and syrup, to the weight of sugar used."
The amount of sugar consumed, as such, by the adult each day, is not
of such paramount importance as it is in the case of children, but
even for adults an excessive amount of carbohydrate in this form is
not considered advisable from a health standpoint.
In order to assure each member of the family of getting all of the
materials needed for the growth, repair and regulation of their
bodies, as well as the necessary fuel material with which to run the
engine and to maintain the proper body temperature, the following
practical method is suggested for the planning of the daily dietary.
THE DIET EACH DAY SHOULD CONTAIN:
1. Milk:
One quart for each child under two years of age. From 1 pint to 1
quart for each child from two to five years of age. (M. S. Rose of
Teachers' College advises at least a quart for every child of six
years and under, at least 1 pint for children from six to sixteen, and
one half of a pint thereafter.)
2. Cereals and Breadstuffs:
(Activity of person determining the amount.)
For children under two years of age 1-3 oz. a day
For children from two to five years 2-5 oz. a day
For children from five to twelve years 5-9 oz. a day
For all over twelve years of age 9-16 oz. a day
3. Meat or its Substitute:
For children under five years no meat is needed.
(a) Meat:
For children from five to ten years 1-2 oz. (no more) a day
For children from ten to fourteen years 2-4 oz. (no more) a day
of meat or fish.
For individuals over fourteen years 2-6 oz. should be the
maximum for the day.
(b) Eggs:
For children under two years no eggs are given.[26]
For children from two to five years 3-5 eggs may be given
each week, being
substituted for
part or all of
the meat.
(c) Beans, Peas, Cheese:
For children it is necessary to use milk abundantly when beans
or peas are substituted for the meat or egg proteins.
4. Vegetables:
For children under six months[27] no vegetables need be
given.
For children from six to nine months 1 oz. gradually increased
to 6 oz. of strained
vegetable soup
(see formula, page 223).
For children from twelve to fifteen
months 1 small baked potato
may be added, and such
vegetables as peas,
string beans, carrots,
spinach, squash, lima
beans (strained).
Two vegetables, one of which should be potatoes (white), should be
given each day. A leafy vegetable (spinach greens, string beans, kale,
lettuce) should be given from three to four times each week and
oftener if possible.
5. Fruit:
For children from six months on
(earlier if physician approves) 1-2 tablespoons orange
or prune juice a day.
For children from first to second year 1-3 tablespoons twice
daily.
For children from two to five years 3-4 tbsp. or more, twice
daily (amount governed
by health of child).
All children should be given fresh fruit three or four times a week;
some fruit given every day. Adults may be served dried fruit most
days, but some fresh fruit should be given each week.
6. Desserts:
One sweet dish (custards, cereal puddings, junkets) once or twice a
day, but little if any clear sugar should be given (cereals should be
served with very little if any sugar).
7. Fats:
For each person over five 2-3 oz. of fat (purchased
as such) a day, depending
upon the age and ability
of the individual to digest
fats.
~Suggestions for Serving Meals.~--After reckoning the number of
calories needed for the day, it is well to remember that the protein
must be adequate in type and amount; that there should be an abundant
supply of vitamines and iron in each day's ration; that milk should
always be included in order to make sure of having a sufficient amount
of calcium in the diet; that there should be only one heavy protein
dish at any one meal, and that it is unwise to serve a meal in which
the fluids predominate on account of their deficiency in energy and
proteins.
If a meal is made up of the right kind of foods, in the proper
proportion, and each individual eats sufficient to assure the
maintenance of the normal weight, is free from gastro-intestinal
disturbances, and shows a normal resistance to disease, it is more
than probable that a sufficient quantity is being consumed each day.
All foods should be carefully selected, and properly prepared in order
to derive the maximum benefit therefrom, and the regularity and
attractiveness with which the meals are served have almost as much to
do with the health and happiness of the individual, as the character
of the foods included in the day's dietary.
PROBLEMS
(a) Calculate the dietary requirements of a nurse weighing 125 pounds,
who spends 8 hours sleeping, 8 hours on duty, 2 hours at meals, 2
hours brisk walking, 2 hours in the class room, and 2 hours reading or
studying.
(b) Calculate the diet for a child of ten years of age, weighing 65
pounds, showing the number of calories, the amount of protein,
calcium, phosphorus and iron necessary to make this diet cover the
requirements of the child.
FOOTNOTES:
[20] "Archives of Internal Medicine," Vol. XXVII (1916), p. 916.
[21] "Chemistry of Food and Nutrition," (revised), p. 186, by Henry
Sherman.
[22] The Same.
[23] Gillett, A. I. C. P. of N. Y.
[24] Table compiled from material in "Feeding the Family," by Rose.
[25] "The Adequacy and Economy of Some City Dietaries," by Sherman and
Gillett.
[26] Part of soft-cooked egg may be given at the beginning of eleventh
month; this must be given at the noon meal, and should not be included
in each day's meal (two or three times a week is sufficient).
[27] Dr. Hess advises the use of canned tomato juice as a substitute
for orange juice when the latter is unobtainable.
SECTION II
LABORATORY OR DIET KITCHEN WORK
CHAPTER IV
METHODS OF FEEDING IN NORMAL AND ABNORMAL CONDITIONS
There are several methods of feeding which have been adopted to meet
the needs of the individual under various conditions: Feeding by
mouth, gavage or forced feeding, rectal feeding (nutrient enemata),
and inunction.
~Feeding by Mouth.~--The first method is the one used in health and in
the majority of abnormal conditions. In cases where there is a certain
abnormal development of the mouth or throat, and in some cases of
insanity or unconsciousness, where for some reason it is impossible
for the individual to swallow, this method cannot be used.
~Forced Feeding.~--With very young children and babies gavage or
forced feeding is found at times to be necessary. In these cases a
small rubber catheter is introduced into the stomach through the
nostrils and the milk or other fluid poured through the tube. In
unconscious or insane patients it is often found necessary to insert a
gag (a cork will serve the purpose) between the teeth to prevent the
biting of the tube when it is inserted through the mouth into the
stomach.
~Food Used for Forced Feeding.~--The food in these cases consists of
reenforced soups, milk gruels, or nutrient beverages, not more than
six or eight ounces given at one time. Finely chopped meat and
vegetable purees have been given in this way when the digestion of the
patient was not impaired, but when conditions rendered it necessary to
resort to this method of feeding.
~Technique of Gavage.~--The apparatus used in gavage consists of a
moderate sized soft rubber tube to which is attached a rubber or glass
funnel and a "pinch cock." The tube should be filled with water to
prevent air entering the stomach and causing pain or discomfort. In
certain cases the patient refuses to swallow the tube and it will be
found necessary to use some means to force the passage if the throat
is shut off. By closing the nostrils the patient will be obliged to
breathe through the mouth, thus opening the passage into the throat
through which the tube may be quickly slipped. In certain abnormal
conditions the gastric organ is so badly impaired as to render it
impossible for the patient to retain food taken in by way of the
mouth. It is often found that food introduced into the stomach by
means of the "stomach tube" will be retained and utilized which
otherwise would be rejected. It is disagreeable, however, and should
only be used when it is impossible to feed otherwise.
~Rectal feeding~ is used when the other organs of digestion are
impaired to such an extent as to render the need of more food
obligatory. Many investigators believe that rectal feeding is
absolutely useless, while others have firm faith in its efficacy.
~Technique of Rectal Feeding.~--The rectum should be cleansed by
flushing with a soapsuds enema one hour before the nutrient enema is
given. This should be done once a day, in the morning. The cleansing
enema may be either soapsuds, a solution of bicarbonate of soda, or
boric acid (1 teaspoonful to the pint), or a saline solution. When
there is much mucus, or if the rectum is inflamed, the soda or boric
acid solution may be more soothing than the saline or soapsuds enema.
After one hour's rest the patient should be given a nutrient enema.
The method of administering nourishment through the rectum is
important. A nutrient enema injected only into the lower bowel not
only does no good, but may actually cause a good deal of unnecessary
discomfort to the patient.
~Temperature of Enema.~--Care must be taken not to have the
temperature of the nutrient enema too hot or too cold or it will be
promptly rejected. The patient is placed on the side with one knee
flexed; the solution is poured into a fountain syringe bag or an
enamel container (heat the container before pouring the solution into
it or the latter will be chilled). The bag or container has attached
to it a rubber tube with a cock adjusted so that only a small stream
will flow in at a time. To the end of this tube a rubber rectal tube
or catheter--1 cm. (about 1/2 inch)--is attached. This should be well
greased (do not use glycerin as this substance is irritating to the
mucous lining of the rectum). The liquid should be allowed to fill the
tube before it is inserted into the rectum, to prevent any air passing
in with it. The tube should be inserted with a gentle twisting
movement, using very little force or the tender mucous membranes will
be injured. Insert the tube twelve or more inches, since the solution
is more completely absorbed if given high up in the bowel. The bag
containing the solution should be held only a few inches higher than
the rectum, thus allowing only a small stream to pass in and allowing
an air space above the stream for the passage of gas which may be
accumulated in the upper part of the rectum. The tube should be
allowed to remain in the rectum for fifteen or twenty minutes, then
very gently withdrawn to prevent the liquid from being rejected. A pad
of gauze may be pressed against the anus to assist the patient in
retaining the enema. It is well to divert the attention of the patient
also, to further assist her in retaining the liquid.
~Duration of Rectal Feeding.~--Rectal feeding cannot be substituted
for a great length of time, first, because the patient cannot absorb
sufficient nourishment in this way to fully cover the body
requirements, and, second, because the rectum becomes more or less
sensitive and will reject the liquid before it has an opportunity to
be absorbed. From three to four nutrient enemas a day is about the
limit for the average patient. Between the nutrient enemas it is
advisable to give one of saline solution.
The following regime is practiced during the "Total Abstinence Period"
in the treatment of gastric ulcer: 7 A.M., cleansing enema; 8 A.M.,
nutrient enema; 1 P.M., nutrient enema; 3 P.M., saline enema; 6 P.M.,
nutrient enema. One saline and one nutrient enema may be given during
the night if the patient is very weak. She should not be wakened,
however, to be given the enema.
~Feeding by Inunction.~--This method consists in the rubbing into the
body of certain nutrient oils, such as olive oil, cocoanut oil, cocoa
butter, etc. It is of little value, but is occasionally resorted to
with very much emaciated and underfed infants, when digestional
disorders make it impossible to introduce enough food by mouth to
cover the needs of the body.
SPECIAL DIETS
There are a number of diets formulated to meet the various normal and
abnormal conditions. In hospitals these are classified as follows, for
the convenience of both nurse and doctor:
~House Diet.~--That which is served to the hospital staff, the nurses,
and those patients not requiring special diets.
~Liquid or Fluid Diet.~--Consisting of milk, nutrient and other
palatable beverages, broths, and thin gruels.
~Light, Semi-solid or Convalescent Diet.~--Composed of thick or cream
soups, eggs, toast, cereals, custards, jellies and ice cream, and
later vegetable purees, broiled birds, chicken, lamb chops, and rare
beefsteak.
~Mixed Diet.~--The diet used in normal conditions and for those not
affected by any special food.
~Special Diets.~--Those designed to be used for certain pathological
conditions, such as scarlet fever, nephritis, etc. These diets are
classified as follows:
~Milk Diet.~--A diet in which milk is the sole article of food.
~Carbohydrate-free Diet.~--One in which the sugars and starches are
eliminated.
~Purin-free Diet.~--One in which the foods rich in purin bases are
eliminated. This is used in gout, arteriosclerosis, etc.
~Salt-free Diet.~--Diet in which sodium chloride (salt) is as far as
possible excluded. It is used in certain cases of nephritis when edema
is present.
~Nephritic Diet.~--A diet used in nephritis and diseases complicated
by nephritis (scarlet fever). In this diet the protein foods, meat in
particular, are restricted, milk being the exception.
~Diabetic Diet.~--A diet in which the carbohydrates are restricted or
eliminated.
~"Allen Treatment of Diabetes"~ consists chiefly of "starvation" for a
given period and a reeducation of the organs to a toleration for
carbohydrates.
~Emaciation Diets.~--Those containing a high percentage of fat-forming
foods, such as milk, cream, eggs, cereals, potatoes, etc., olive oil.
~Obesity Diets.~--Those containing as few of the fat-forming foods as
possible, such as cream, olive oil, potatoes, white bread, etc.,
pastry and desserts, candy and soda water, and containing lean meats,
fish or shellfish cooked and served without butter or other fats,
fresh or stewed fruit without sugar, green vegetables and salads
served without oil or other fats; one egg a day two or three times
a week, coffee and tea without sugar or cream, toasted gluten bread
(1 slice) without butter, saccharine substituted for sugar.
There are a number of other diets, but they come more or less under
the above heads.
THE TRAY
As the patient's tray assumes an important part of the daily regime,
it is necessary to give close attention to the arrangement and serving
of it. There are certain definite rules to observe: (1) The linen,
silver, glassware, china, and food must be absolutely clean. (2) The
tray must be sufficiently large not to appear crowded. (3) The
arrangement of the obligatory articles, such as salt and pepper,
silver, water glass, napkin, etc., must be alike at every meal; this
not only facilitates the service by making it easy for the nurse to
see whether any of these necessary articles are left off, but it also
enables the patient to find them without trouble.
~The Linen.~--The linen cover of the tray must be clean and uncreased.
The napkin likewise must be clean and unwrinkled. The china must be
free from chips and cracks. Care must be taken not to put a collection
of odd pieces on the tray as it gives an untidy appearance.
~The Silver.~--The silver must be bright and in cold weather made
slightly warm, as must also the china. The chill of cold silver may
readily obliterate a fragile appetite, and to place hot food in cold
dishes will deprive it of much of its palatability. The foods intended
to be hot must be really hot, not warm, and those which are intended
to be cold should be thoroughly chilled before being served to a
patient. The placing of flowers on a tray is a questionable addition
to it; a single flower laid across the folded napkin may add
daintiness and attractiveness, but it is poor judgment to
over-decorate, either with flowers or by garnishing the dishes.
~Arranging the Tray.~--If the nurse will place the necessary articles
upon the tray and memorize their position so that she will be able to
duplicate the same at each meal, she will be able to tell at a glance
if everything needed is in its proper place, thereby saving herself
unnecessary steps and the patient the worry of having to wait until
they can be brought. Food should not be allowed to stand in the
sickroom, and glasses or plates in which food has been served should
be removed from sight as soon as the patient finishes with them. Care
must be taken, however, not to create the impression of hurry or the
patient will be made nervous and either will lose her appetite or have
indigestion.
The nurse should be careful of her topics of conversation during the
meal hour. Especially must disagreeable subjects and business matters
be rigidly excluded if the invalid is to obtain the full benefit of
the food served her.
1. ~Setting the Tray.~--Tray should be sufficiently large not to give
the appearance of being crowded, but not too large.
2. Tray cover must be spotless, and of a size to just cover the edges
of tray; if too large, make a pleat down the center.
3. Place service plate directly in front of patient.
4. Knife, cutting edge in, to the right of plate; fork, tines up, to
the left of plate.
5. Spoons, bowls up, next to the knife.
6. Napkin on the lower left side of tray, open edges to the lower
right side.
7. Bread and butter plate on top of napkin.
8. Soup tureen in lower right corner, with cup and saucer above it.
9. Tea or coffee pot and hot water pot in upper right-hand corner of
tray, with sugar bowl next to hot pot and cream pitcher next to sugar
bowl.
10. Place salt and pepper next to cream pitcher (to the left).
11. Water glass in upper right corner of tray.
12. Second vegetable dish placed on the upper right side of dinner
plate.
13. Place dessert to the upper left of dinner plate.
~Suggestions for Serving.~--Make tray as attractive as possible.
In the cases requiring special diets, the nurse should make out the
"diet sheet" for the day. In hospitals this is passed to the
dietitian, who carries out the directions laid down by the physician.
The nurse, however, should carefully check the tray before serving it,
since mistakes sometimes occur, and to give the wrong food to a
patient suffering from certain disorders may give rise to serious
trouble, causing pain and discomfort and at times death.
~Contamination of Food.~--Food should always be protected from dirt
and dust and from contamination and pollution from flies and other
insects. Typhoid fever and certain intestinal disturbances have been
known to result from flies coming in contact with raw food--milk, for
example. Poisoning due to polluted water used to freshen vegetables
has already been spoken of. All of these types of poisoning may be
avoided by using care in the handling of the fresh foods. ~Ptomaines~,
however, are not easy to prevent. Their source cannot always be traced
to one particular article of diet. They may be present in cooked, raw,
frozen, or canned foods. At times the evidence of extreme
decomposition will be found in the foods themselves, while at other
times there will be no such evidence in the food, but the result of
the ptomaine will be perfectly evident whenever certain individuals
partake of that food. This is a personal idiosyncrasy which it is
impossible to account for.
~Food Poisoning.~--Poison caused by decomposed eggs has manifested
itself in individuals who have partaken of cake in which such eggs
were used. Canned meat and fish have produced the most violent types
of ptomaine poisoning. As a rule in these cases the canned article has
begun to decompose and while the decomposition may not have advanced
sufficiently far to be discernible from the flavor or odor, it is
there, and if the resistance of the individual eating this food is not
great, serious danger may result. Poisoning develops in some
individuals upon the eating of shellfish, strawberries, oranges,
pimentos, and various other foods,--another evidence of personal
idiosyncrasy against certain articles of diet. There is no way to
overcome these idiosyncrasies; the only thing to do is to warn the
individuals so affected to let the offending foods alone.
ADULTERATION OF FOOD
The adulteration of food, which formerly was practised by unscrupulous
dealers to cover up inferior articles, or by manufacturers to prevent
or arrest decomposition in canned goods, is regulated by law. The
passage of the National Pure Food and Drug Act gave the Government
authority to regulate the preservatives and coloring matter used in
canned and bottled goods, forcing the manufacturers to state on the
label the exact contents of each bottle or can. There are likewise
stringent laws governing the adulteration of milk, butter, and other
articles of food.
~Tests for Adulterants.~--Boric acid, borax, and formaldehyde are the
preservatives more often found in milk. These chemicals are introduced
to arrest the natural souring and decomposition which takes place
after milk reaches a certain age. Occasionally salicylic acid and
sodium carbonate are used. Formaldehyde may be detected by placing
about 20 c.c. of milk in a small glass vessel or tube. Dilute with an
equal amount of pure water, add commercial sulphuric acid, allowing it
to flow gently down the inside of the tube. A purple ring will appear
at the zone of contact if formaldehyde is present. "Boric acid and
borax may be detected by adding a drop or two of hydrochloric acid to
a few drops of milk in a white dish and then several drops of a
saturated alcoholic solution of _turmeric_. The dish is then heated
gently for a few minutes, and, if boric acid or borax is present, a
pink or dark red color will appear. A dark blue-green should appear
when the dish is cooled and a drop of ammonia added."[28]
~Canned goods~ must be carefully examined before being used. The
domestic canned goods are rarely adulterated, but imperfect
sterilization and defective cans may bring about a condition of
fermentation and gas formation due to bacterial action. Cans should
have a concave appearance on the top. If there is a bulging of the can
it may be due to gas formation, and a small hole should be made in the
can to note any escape of this gas. Should there be any indication of
fermentation, the contents should be discarded. It is advisable to
look with suspicion on cans that appear old, rusty, and soiled; they
are probably left-over stock and liable to be bad. Peas which have
been imperfectly sterilized produce a type of gas which is soluble in
the liquid. After decomposition has occurred there will be no apparent
evidence by the escape of gas, but the liquid will be found to be
excessively acid, and will present a muddy appearance. Certain foreign
importations of canned goods are preserved in color by the
introduction of certain color preservatives. Peas--petits pois, for
example--and the very small string beans which are imported are
intensely green from the copper sulphate used. Its presence may be
detected by adding a few drops of hydrochloric acid to some of the
colored material, then dropping in a bright steel nail, knitting
needle, or knife blade. There will be a deposit of copper salts (like
copper plating) upon the steel if the preservative is present in the
can. Canned corn is often artificially sweetened with saccharine,
which may be detected by shaking several tablespoonfuls of the liquid
in an equal amount of chloroform. Saccharine is soluble in chloroform,
while sugar is not. Allow the mixture to stand a few minutes and
remove some of the chloroform which has settled at the bottom. Place
in a small dish, evaporate the chloroform by gently heating the dish;
taste the residue; if sweet, saccharine is present.
~Coffee~ is adulterated more often when it is put up in ground or
powdered form than when sold in the bean. Real coffee contains a small
percentage of oil, and will float when thrown into a glass of water.
Substitutes generally sink to the bottom. Coffee substitutes are often
made up of starch-containing materials, such as cereals, beans and
peas. This starch may be detected by mixing one tablespoonful of the
suspected coffee in a little cold water, adding one cup of boiling
water; allow it to boil two minutes, filter through cotton, and pass
the liquid through charcoal to remove the color. When it is cold, add
a few drops of dilute iodine solution. If starch is present, a blue
color will appear.
METHODS USED IN THE PREPARATION OF FOOD
Food is prepared for consumption by a number of methods and the method
by which the food is prepared either increases or decreases its
digestibility, palatability, and general usefulness.
Certain foods, as has already been stated, require a high degree of
temperature to make them wholesome, but if this temperature is applied
by means of heated fat, as in frying, the food is changed from a
wholesome to a more or less indigestible article. In health the organs
of digestion are capable of overcoming much of the harm wrought by
wrong preparation, but even in the healthy, normal individual a steady
diet of fried food will eventually undermine what is known as good
digestion. In abnormal conditions (illness) frying is a method seldom,
if ever, used.
~Preparation of Food.~--The various methods to which food is subjected
in preparation for human consumption may be summed up as follows:
boiling, simmering, steaming, baking, roasting, broiling, frying,
sauteing.
~Boiling~ is cooking in water raised to the boiling point, 212 deg. F.
(sterilizing). This method is commonly used in the cooking of starchy
vegetables and cereals, and in the cooking of green vegetables, such
as spinach, carrots, beets, corn, asparagus, etc. Stewing is a form of
boiling. As a rule water is used, and the vessel is left uncovered, so
that as the food is cooked the surplus moisture evaporates, leaving
the food tender. Dried fruits, such as prunes and apricots, are
prepared by this method.
~Simmering~ is cooking in water, the temperature of which is not
raised to the boiling point, but kept between 200 deg. F. and 210 deg. F. This
method is used in the preparation of eggs and dishes in which eggs
predominate, since proteins are made tough if subjected to a high
degree of temperature. Coddled eggs, for example, are prepared by
placing the egg in a clean vessel and pouring over it the boiling
water, then covering the vessel and allowing it to stand for ten or
fifteen minutes. The vessel and the cold egg reduce the temperature of
the water to about 185 deg. or 190 deg. F. and in this way prevent a
toughening of the albumen of which eggs are chiefly composed. Soups,
broths, ragouts, etc., are prepared by this method.
~Steaming~ is cooking over hot water or by steam. This method may be
accomplished on the top of the stove in a "double boiler" or in the
oven in a deep covered pan fitted with a "rack" to hold the article to
be cooked. Either method allows the vessel in which the food is placed
to be surrounded by boiling water, but does not insure sufficient heat
to raise the food within to the boiling point.
~Baking~ and ~roasting~ are both brought about in the oven. Bread,
biscuits, pies and other pastry, potatoes, cakes, etc., are baked,
while meats, roast of beef, lamb, veal, mutton, as well as chicken,
turkey, duck, and large fish are roasted. The heat in the oven may be
intense. The outside or cut surface of the meat is seared, the soluble
albumens are coagulated, thus sealing the juices within. If the meat
is placed in a pan surrounded by cold water and then placed in the
oven, the juices are "drawn out" in the water. These juices contain
the flavoring matter or extractives. Meat so treated is not so
palatable or highly flavored as that which has first been subjected to
intense heat, the water for the gravy added later.
~Frying~ and ~sauteing~ is cooking in hot fat. Food may be fried in
deep fat, as is demonstrated in the cooking of croquettes, doughnuts,
etc., or it may be sauted in butter or oil in a shallow frying pan or
griddle. The latter method is used in making hashed brown potatoes,
for example; also in the cooking of griddle cakes, etc.
~Broiling.~--In broiling or grilling the article to be cooked is
exposed to direct heat, either to the blaze or to a very hot surface.
The result is the same as in roasting. The outer surface is seared,
sealing the juices within. Meat to be broiled is generally cut thinner
than that to be roasted. The article, whether it is meat (steak),
chops, birds, or chicken, is placed about three inches away from the
flames and turned frequently until the surfaces are seared, after
which the article is placed in a cooler part of the stove to allow the
interior to be cooked. Pan broiling is done on top of the stove. The
article to be broiled is placed directly upon a very hot surface,
there is no grease used and the meat must be turned frequently to
prevent burning.
~Poaching.~--This term is applied chiefly to the cooking of eggs in a
shallow pan of water heated just below the boiling point. To be
properly poached an egg must be perfectly fresh, or the white and
yolks will run together and present an unappetizing, unpalatable
appearance.
The following time-table should be used in the preparation of food to
insure correct cooking:
TIME-TABLE
=================================+==========+=======================
_Material_ | _Method_ | _Time_
---------------------------------+----------+-----------------------
Beef (fresh) | Boiled | 4 to 6 hours
Corned beef | Boiled | 4 to 7 hours
Shoulder or leg of mutton | Boiled | 3 to 5 hours
Shoulder or leg of lamb | Boiled | 2 to 3 hours
Fowl (4 to 5 pounds) | Boiled | 2 to 4 hours
Chicken (3-lb. hen) | Boiled | 1 to 1-1/2 hours
Ham | Boiled | 4 to 6 hours
Lobster | Boiled | 25 to 30 minutes
Salmon (whole) | Boiled | 10 to 15 minutes
Vegetables: | |
Asparagus | Boiled | 25 to 30 minutes
String beans | Boiled | 1 to 2 hours
Dried beans | Boiled | 1 to 2 hours
Beets (new) | Boiled | 45 minutes to 1 hour
Beets (old) | Boiled | 4 to 6 hours
Beet greens | Boiled | 1 hour or more
Brussels sprouts | Boiled | 15 to 20 minutes
Cabbage (for creamed cabbage) | Boiled | 10 to 15 minutes
Cabbage | Boiled | 30 to 80 minutes
Cauliflower | Boiled | 1 to 1-1/2 hours
Celery | Boiled | 2 to 2-1/2 hours
Corn (green) | Boiled | 10 to 20 minutes
Onions | Boiled | 45 minutes to 2 hours
Oyster plant (salsify) | Boiled | 45 minutes to 1 hour
Parsnips | Boiled | 30 to 45 minutes
Peas | Boiled | 20 to 60 minutes
Carrots | Boiled | 20 to 40 minutes
Potatoes (white) | Boiled | 20 to 35 minutes
Potatoes (sweet) | Boiled | 20 to 30 minutes
Rice | Boiled | 20 to 30 minutes
Squash | Boiled | 20 to 30 minutes
Spinach | Boiled | 15 to 20 minutes
Tomatoes (stewed) | Boiled | 20 to 30 minutes
Turnips | Boiled | 45 to 60 minutes
Coffee | Boiled | 3 to 5 minutes
Beef (ribs or loin, rare) per | |
pound | Roasted | 8 to 10 minutes
Beef (ribs or loin, well done) | |
per pound | Roasted | 12 to 15 minutes
Beef (rolled, rare) per pound | Roasted | 12 to 15 minutes
Beef (rolled, well done) per | |
pound | Roasted | 15 to 20 minutes
Leg of lamb per pound | Roasted | 10 minutes
Leg of mutton per pound | Roasted | 15 minutes
Mutton (stuffed, forequarter) | |
per pound | Roasted | 15 to 20 minutes
Lamb, well done, per pound | Roasted | 15 to 18 minutes
Veal, well done, per pound | Roasted | 20 to 25 minutes
Pork, well done, per pound | Roasted | 20 minutes
Chicken, well done, per pound | Roasted | 15 to 20 minutes
Turkey (8 to 10 pounds) | Roasted | 3 hours
Ducks (domestic) | Roasted | 1 to 1-1/2 hours
Ducks (wild) | Roasted | 20 to 30 minutes
Small birds | Roasted | 15 to 30 minutes
Large fish | Roasted | 45 minutes to 1 hour
Fish steaks, stuffed | Roasted | 45 minutes to 1 hour
Steak, 1 inch thick | Broiled | 6 to 12 minutes
Steak, 1-1/2 inches to 2 inches | |
thick | Broiled | 15 to 20 minutes
Lamb chop or mutton chop | Broiled | 10 to 15 minutes
Quail | Broiled | 12 to 20 minutes
Squab | Broiled | 12 to 20 minutes
Spring chicken (broiler) | Broiled | 20 to 40 minutes
Shad | Broiled | 12 to 15 minutes
Bluefish | Broiled | 12 to 15 minutes
Bread (loaf) | Baked | 45 minutes to 1 hour
Rolls (risen) | Baked | 20 to 25 minutes
Biscuits | Baked | 10 to 12 minute
Muffins | Baked | 20 to 25 minutes
Sponge cake (loaf) | Baked | 45 to 60 minutes
Layer cake | Baked | 20 to 25 minutes
Cookies | Baked | 10 to 15 minutes
Custards | Baked | 20 to 60 minutes
Steamed brown bread | Steamed | 2 to 3 hours
Pastry | Baked | 30 to 45 minutes
Potatoes | Baked | 30 minutes to 1 hour
Scalloped dishes | Baked | 20 minutes
Steamed puddings | Baked | 1 to 4 hours
Plum pudding | Baked | 2 hours (after
| | steaming 10 hours)
=================================+==========+=======================
CARE OF ICE-BOX AND CONTENTS
The ice-box plays an important role in the preservation of the health
and comfort of the family, as well as that of the invalid. Therefore
the first consideration is the cleanliness of it. The old-fashioned
boxes were constructed without ventilation. This was clearly a
mistake, since many foods absorb both the odor and flavor of the
substances about them if allowed to stand for any great length of time
in a closed compartment with them. The ice-boxes or refrigerators of
to-day have a ventilation system which insures a circulation of air
constantly throughout the interior of the box. The drain pipes require
special attention, because no matter how clean the box itself is kept,
the melting of the ice causes a slime to accumulate on the inside of
the pipe which will clog it and become offensive unless it is flushed
out often. This may be accomplished by pouring through it a solution
made by dissolving one-half ounce of borax, washing soda, or ammonia
in one gallon of boiling water. The adjustable part of the pipe can be
removed and cleaned with a long brush made for the purpose. The pipe
is then replaced and the boiling water poured through. In this way the
entire drainage system of the box is completely cleaned. All loose
bits of food which may drop from the containers to the floor and
shelves should be carefully removed each day and the interior of the
box and shelves thoroughly wiped out. Three times a week is sufficient
to wash and flush the box and pipes unless milk, cream, or other food
materials have been spilled, in which case it should be washed at once
before it has an opportunity to sour or spoil and become offensive.
Ice should always be washed off before being put in the box, and all
milk and cream bottles should likewise be wiped with a clean wet cloth
before being placed on the ice.
Hot food must never be put in the ice-box, as the heat from the food
will raise the temperature of the air in it. In some cases the sudden
chilling of the food itself is undesirable, but this is not so often
the case. However, the best results are obtained by first allowing the
food to cool, and then placing it on ice. This is particularly the
case with jellies made from gelatin.
Milk and milk products, cream, butter, buttermilk, cheese, etc., meat,
fish, and, at times, eggs should be kept in a refrigerator or in a
cold place such as the cellar in the country, when it is impossible to
procure ice.
Broths of all sorts, beef juice, and meat jellies will sour and
decompose unless kept close to the ice. Carbonated waters, such as
Vichy, Apollinaris, White Rock, etc., as well as champagne and other
sparkling wines, must be kept in a dark, cool place, lying on the
side. It is better to put only one or two bottles on the ice at a
time, since the wine flattens (loses its sparkle) if it is ever
allowed to become warm after once being placed on ice. Koumiss and
other fermented milk products must be treated in a like manner to
assure having them served at their best.
RULES GOVERNING SELECTION OF FOOD
There are certain fundamental rules to be observed in the selection of
our food materials, whether they are intended for those in health or
for those suffering from pathological conditions. These rules are
definite and obligatory. All food materials must be of good quality;
that is, they must be of known purity and cleanliness, and
adulteration should not be tolerated. In health the small amount of
preservative used in certain canned and bottled foods would probably
have little if any effect on the individual, but in sickness this is
not always the case. With regard to milk, this point has particular
significance. To obviate danger, the nurse should use discrimination
in the selection of the dealer from whom the meat, milk, eggs, fruit,
and vegetables are purchased, as well as the grocer who supplies the
remainder of the food materials used by the patient.
THE CARE OF FOODS AND UTENSILS
The next point of consideration is the care of the food materials.
This is quite as important as the selection, for even the best of food
may be ruined by careless handling, not only in the preparation, but
likewise during the period before it is prepared for the invalid's
consumption. The rules governing the handling of food materials before
they reach the consumer are subject to inspection by law, but the
housekeeper or nurse has no such rules to guard or govern her; hence
she may be wantonly careless or ignorantly unsanitary unless taught
the right way to care for the food in her charge. Perishable fruits
and vegetables must be kept in a cool place to preserve their
freshness.
~Method of Washing Dishes.~--Cleanliness must be observed in the care
of all food materials and the utensils in which they are to be
prepared. If the nurse will observe the scientific rules governing the
solubility of the foodstuffs, she will be able to save herself much
time and trouble. For example, it is a known scientific fact that
starch is insoluble in cold water and more or less soluble in boiling
water, hence it would be a useless waste of time to try to wash a
utensil in which a starchy food has been cooked in cold water. Fats
solidify under the influence of cold and melt under the influence of
heat, so that hot water should be used in conjunction with soap or an
alkali to remove grease from dishes and silver and utensils. Albumens
are soluble in cold water and are coagulated in hot, therefore to
remove milk, egg white, and like protein substances from glasses,
spoons, etc., it is advisable to soak first in cold water to wash out
the food material, and then to wash thoroughly in hot soapsuds to
cleanse and polish. The dishcloths used in the washing and drying of
dishes and kitchen utensils should be washed after using in hot
soapsuds, rinsed in clear water, then dried in the sun. When this is
impossible, they should at least be hung in the fresh air to make
them sweet and clean before the next using. In contagious diseases the
care of the utensils and dishes used by the patient is of the utmost
importance. They should be thoroughly sterilized before being placed
with those used by the rest of the family, otherwise the disease may
be communicated to the unaffected members. A word about the handling
of glasses and spoons used in administering medicine in the sickroom:
It is advisable when possible to keep these separate from those used
on the tray, as many medicines have a very lasting and disagreeable
taste, which is more than apt to cling to the spoons or glasses in
which they are measured and in turn be communicated to the food,
making it distinctly unpalatable. This has been found to be the case
with asafetida, valerian, ichthyol, etc.
METRIC MEASURE
The metric system is a system of weights and measures expressed in the
decimal scale. The principal units with which we are concerned are:
The liter--L. Cubic centimeter--c.c.
The gram--gm. Centigram--cgm.
Milligram--mgm.
These units have prefixes to show how they are divided decimally,
_i.e._:
deci.--0.1
centi.--0.01
milli.--0.001
UNITS OF WEIGHT
10 milligrams = 1 centigram (cgm.)
10 centigrams = 1 decigram (dgm.)
10 decigrams = 1 gram (gm.)
10 dekagrams = 1 hektogram (hgm.)
10 hektograms = 1 kilogram (kilo.)
1000 kilograms = 1 metric ton
A cubic centimeter of water weighs 1 gram; 28.35 grams = 1 ounce.
A liter of water weighs 1 kilogram; 1 kilogram of water = 2.2 lb.
HOUSEHOLD WEIGHTS AND MEASURES
4 saltspoons = 1 tsp.
3 tsp. = 1 tbs.
4 tbs. = 1/4 cup or 1/2 gill
8 tbs. = 1/2 cup or 1 gill
16 tbs. = 1 cup or 1/2 pint = 8 oz. = 227 gm.
2 cups (c.) = 1 pint = 454 gm.
2 pints (pt.) = 1 quart (qt.) = a little less than 1 liter
4 qt. = 1 gal.
2 tbs. butter = 1 ounce (oz.)
2 cups butter (solid) = 1 pound (16 oz.)
2 cups granulated sugar = 1 pound
2-1/2 cups powdered sugar = 16 oz. = 1 lb.
4 cups flour (sifted) = 16 oz. = 1 lb.
1 pt. milk or water = 16 oz. = 1 lb.
1 pt. chopped meat = 16 oz. = 1 lb.
10 medium size eggs = 1 lb.
(with shells)
8 eggs, without shells = 1 lb.
2 cups rice = 1 lb.
4 tbs. butter = 2 oz. = 1/4 cup
2 tbs. sugar = 1 oz.
4 tbs. flour (sifted) = 1 oz
4 tbs. coffee (powdered) = 1 oz.
2 tbs. powdered lime = 1 oz.
2 tbs. lemon juice = 1 oz.
2 tbs. orange juice = 1 oz.
1 glass orange juice = 8 oz. or 1/2 pint
2-2/3 cup oatmeal = 1 lb.
4-3/4 cup rolled oats = 1 lb.
28.35 grams = 2 tablespoons = 1 ounce of the following substances:
arrowroot, barley flour, brandy, butter, grape juice, lemon
juice, orange juice, molasses, cream, dry peptonoids, liquid peptonoids,
milk (whole, skimmed), buttermilk, malted milk, rice flour,
oatmeal, olive oil, wine.
Materials requiring 3 tablespoons to weigh 28.35 gm. or 1 oz.:--corn
meal, farina, gum gluten flour, Graham flour, white flour.
Material requiring 4 tbs. to weigh 1 oz.: cocoa.
The standard measuring cup holds 8 ounces or 16 tablespoonfuls.
1 ordinary glass (water) = 8 ounces
1 coffee cup = 8 ounces
1 tea cup = 6 ounces
1 wine glass = 2 ounces
The following list shows the approximate weights and measures of the
foods comprising dietaries:
Asparagus, 8 stalks, E.P. = 2 ounces
Apple (1 medium size) = 5 ounces
Bread, 1 slice, home-made,
4 in. x 3-1/2 in. x 1/2 in. = 1 ounce
Bread, 1 slice, baker's,
4 in. x 3-1/2 in. x 3/4 in. = 1 ounce
Bread, 1 slice, whole wheat,
2-1/2 in. x 2-3/4 in. x 1/4 in. = .7 ounce
Bread, 1 slice, corn,
3 in. x 3 in. x 1/2 in. = 2 ounces
Bread, muffin, 1 small, or biscuit = 1/2 ounce
Banana, 1 medium size = 5 ounces
Chicken, 1 serving = 3 ounces
Chicken (creamed) 2 tbs. = 1-1/2 ounces
Cream, 2 tbs. = 1 ounce
Custard (soft, 1/2 cup) = 4-1/2 ounces
Custard (baked, 1/2 cup) = 4 ounces
Cream (ice, 1/2 cup) = 4 ounces
Custard (rice, 1/2 cup) = 3-1/2 ounces
Dates (3 medium size) = 1 ounce
Eggs (scrambled, 1/4 cup) = 2 ounces
Eggs (poached, 1 egg) = 1-1/2 ounces
Fish, medium serving,
2-1/2 in. x 3 in. = 2-1/2 to 3 ounces
Honey, 4 tsp. = 1 ounce
Hominy (cooked, 1/2 cup) = 4 ounces
Lamb chop, E.P., 2 x 2 x 1/2 inch = 1.6 ounces
Lemon or other jellies, 1/2 cup = 3.8 ounces
Steak (sirloin), 3 x 1/2 x 3/4 in. = 3 ounces
Vegetables:
Beets, 1 medium size (4 slices) = 2 ounces
Carrots, 1/3 cup diced = 2-1/2 ounces
Peas (canned or drained), 1/3 cup = 3 ounces
Potatoes, baked, sweet, 1 medium size = 6 ounces
Potatoes, baked, white, 1 medium size = 3 ounces
Spinach, cooked, 1 serving, 1/2 cup = 4 ounces
Tomatoes, 1 medium size--fresh = 3 to 4 ounces
Soups:
Cream, 1/2 cup = 4 ounces
Clear soup, 1 cup = 7-1/2 ounces
PERCENTAGE CALCULATION
A percentage of a number is the result obtained by taking the stated
number of hundredths of it. The rate per cent. is a fraction whose
denominator is 100 and whose numerator is the given number of
hundredths; thus 6% of a number is 6/100 of that number.
The method of figuring the per cent. of foodstuffs in a food material
is simple. Milk, for example, has a percentage composition of 3%
protein, 4% fat, and 5% sugar. To find the definite amounts of these
foodstuffs in 1 ounce of milk it is best to reduce the ounce to grams,
since the gram is the unit of measurement generally used.
1 ounce = 28.35 grams
In 1 oz. there will be 28.35 x .03 = 0.85 gram protein
In 1 oz. there will be 28.35 x .04 = 1.13 grams fat
In 1 oz. there will be 28.35 x .05 = 1.41 grams sugar
THERMOMETRY
There are two scales used in thermometry, the Fahrenheit and the
Centigrade. The former is generally used. However, since many of the
scientific calculations are made using the Centigrade scale it is wise
for the nurse to understand how to translate one to the other.
Centigrade has 0 deg. as the freezing point and 100 deg. as the boiling point,
while Fahrenheit has 32 deg. as freezing point and 212 deg. as boiling point.
To change Fahrenheit to Centigrade it is necessary to subtract 32 from
212 in order to make the freezing points correspond. This would read
212-32 = 180 deg. F. = 100 deg. C; hence a degree Centigrade represents 5/9
of a degree Fahrenheit.
To change Centigrade to Fahrenheit it is necessary to remember that
every Fahrenheit degree is 9/5 times as large as the Centigrade and
the addition of 32 deg. must also be made. For example: Change 105 deg. F. to
Centigrade: 105 deg.-32 deg. x 5/9 = 41 deg. C. Change 50 deg. C. to Fahrenheit: 50 deg. x
9/5 + 32 deg. = 90 deg. + 32 deg. = 122 deg. F.
FOOTNOTE:
[28] "Diseases of Nutrition and Infant Feeding," by Morse and Talbot.
CHAPTER V
FOOD MATERIALS AND THEIR PREPARATION
~Dairy Products.~--Milk, cream, and other dairy products form such an
important part of the invalid dietary that they require especial care
in their selection. "Certified Milk" is the safest. This is protected
by special inspection. The methods and standards governing the
production and distribution of certified milk were adopted by the
American Association of Medical Milk Commissions, May 1, 1912. The
sanitary condition of the dairy, the cleanliness of the vessels into
which the milk is placed, the health of the milkers, and a surety that
no member of their family with whom they come in contact has any kind
of contagious disease, are all obligatory. The feed for the cows and
the purity of the water given them to drink must be inspected and made
to conform to the standard laid down for certified milk. The milk of
sick cows and those having tuberculosis is absolutely condemned. The
composition of certified milk is standardized as follows: the fat
standard shall be 4%, with a permissible range varying from 3.5% to
4.5%. The proteins shall be 3.5%, with a permissible range varying
from 3% to 4%. Certified milk shall not contain more than 10,000
bacteria to the cubic centimeter when it is delivered. This inspection
and standardizing necessarily raises the price of certified milk above
that of milk not so rigidly cared for, and when the additional expense
makes it impossible for the patient to afford certified milk, the only
thing to do is to be sure of the reliability of the dealer from whom
the milk is purchased and the cleanliness of the dairy from which it
is procured. Buttermilk and butter are the milk products which
require some attention as to selection. The former grows sour with age
and the odor of advanced fermentation and decomposition is readily
recognized. Sweet butter, butter without salt, is less apt to be old
when purchased than the salted variety, as the flavor of rancid fat is
unmistakable in butter which has not been especially treated.
~Milk.~--Milk is without a doubt the most valuable food in the invalid
dietary, furnishing not only a highly nutritious beverage, but
likewise acting as a carrier of additional nourishment when such is
necessary. Its form, its lack of definite flavor and odor, all add to
its value as a food in sickness. Milk is one of the few foods which
includes in its composition all of the chemical combinations known as
foodstuffs. The carbohydrates, comprising 4.88% to 5% of the solids in
milk, occur as lactose or milk sugar. This sugar belongs to the
disaccharide group, and is, in the majority of cases, readily digested
by even the most delicate digestive apparatus. This form of sugar
lends itself particularly well as a reinforcing agent, and is
generally used in such cases as typhoid fever, etc. The fat in milk,
comprising 4% of the solids and occurring as butter fat (cream), is
made up chiefly of olein and of palmitin, with smaller amounts of
stearin and from 5% to 6% of its composition in the form of butyric
acid (the fatty acid to which butter owes its name and flavor) and
traces of other fatty acids, as well as small quantities of
cholesterin, lecithin, and a yellow coloring matter.
The proteins of milk, which form the curd or larger part of the
solids, according to Van Slyke[29] are in the form of casein and
albumen. There are 3.6 parts casein to 1 part soluble proteins, but
these figures vary somewhat at times. Casein is insoluble in pure
water, but dissolves readily in water to which an alkali or calcium
carbonate is added. The soluble protein in the form of lactalbumen is
one of the constituents of whey. This substance contains more sulphur
than does casein, but no phosphorus.
~Whey~ is the opalescent fluid which remains when the casein is
precipitated, and is composed of water 93.8%, total ash 0.44% (Koenig).
~Mineral salts~, 0.7% of milk, are made up of calcium, potassium,
sodium, magnesium, iron, sulphur, phosphorus, and chlorine. Milk is so
rich in calcium that it requires only 400 c.c. (or about 2-1/2 cups)
to furnish 1 gram of calcium. This is the amount believed to be
necessary for the welfare of man each day and this must be derived
from food.[30]
~Water.~--The fluid part of milk is composed chiefly of water,
constituting 87% of whole milk.
Milk as a food for infants will be discussed in another chapter.
As has already been said, no food has so far been discovered which
could be effectually substituted for milk. There is no food, however,
which requires more attention in its selection and care. It is very
susceptible to both odors and flavors, absorbing them both readily, as
will be found if milk be placed in the same compartment with foods of
strong odor and flavor, without being properly covered and protected.
This is particularly noticeable with cucumbers, melons, etc.
Milk also furnishes a splendid medium for bacterial growth, and if
left exposed to the air, put into unclean receptacles, or kept in a
warm place, will immediately become more or less contaminated, after
which it is unwise to use it. Sterilization and pasteurization will in
a measure overcome the bacterial contamination, but milk purchased
from a dairy which is not clean or milked under unsanitary conditions
will remain dirty, hence unfit for human consumption. When the
morning's milk supply is brought to the house it should be in clean,
well-stoppered bottles, but before placing it in the ice-box the tops
of the bottles should be carefully wiped off with a wet cloth to
remove any superficial dust which may be adhering to them. Every time
a portion of the milk is removed thereafter the tops should be again
cleansed before the milk is poured out. This is a wise precaution, and
often prevents contamination from the hands, etc.
The amount of water in milk prevents its being an adequate food for
adults except in certain pathological conditions. However, it
furnishes a supplementary food unequaled by any other beverage known.
There are fortunately only a few individuals who are unable to drink
milk. There are many who fancy they cannot do so, but if the nurse has
the ingenuity to utilize some of the various methods whereby milk is
made more digestible, it will generally be found that the patient can
take it without trouble. In cases of personal dislike, if the milk is
flavored or colored or made up into soup, cocoa, chocolate, junket,
custards, blanc-mange, etc., it will usually prove acceptable.
~Application of Heat.~--A word as to the changes which are brought
about as the result of heat as applied to milk. These changes are
demonstrated in the two methods commonly used in the preparation of
milk known as "pasteurization" and "sterilization." Pasteurization is
rather an indefinite term to use, unless the time and the temperature
to which the milk is subjected are given. According to Morse and
Talbot "the term sterilization should never be applied to the
processes used in the preparation of milk for the feeding of infants,
because the milk is never rendered bacteriologically sterile by
them."[31]
As a rule the flavor and odor of milk are not changed by heat until
the temperature reaches nearly to the boiling point. A scum then
forms on boiling milk, composed of casein 50.86%, fatty matter 45.42%,
ash 4.72% (Rosenau). Prolonged boiling changes the color of milk from
a creamy white to a yellowish brown which deepens with boiling. This
is due to the caramelization of the milk sugar. Cream will not rise
(or its rise will be very slow) on milk which has been subjected to a
temperature of 150 deg. F. for thirty minutes or more because the fat
droplets are broken down so that they cannot hold together at that
temperature and become more completely distributed throughout the
fluid.[32]
~Pasteurization~ is acknowledged to be preferable to sterilization in
milk used for infant feeding because the higher the temperature the
greater the change in the chemical composition of the fluid. According
to Morse and Talbot[33] the temperature of the pasteurization should
be as low as possible. Pasteurization at 140 deg. F. for 20 minutes is
sufficient; lower temperatures are not. "At this temperature there is
no change in the taste, odor, or color of the milk, no noteworthy
changes in the chemical composition are produced, the ferments and
bactericidal action are unaffected and bacterial toxins and
non-spore-bearing microorganisms are destroyed."[34]
Rosenau[35] states that the bacillus of typhoid, diphtheria, and
dysentery, as well as the cholera vibrio and other pathogenic
non-spore-bearing bacteria which are often found in milk, are
destroyed at a temperature of 140 deg. F. for twenty minutes, and at
higher temperatures for shorter lengths of time.
Sommerfield's[36] investigations prove that butyric acid bacilli are
destroyed at a temperature of 212 deg. F. for from 1 to 2 minutes.
It must be understood that no matter what method is used to insure
purity in milk, nothing does away with the necessity for keeping the
milk both clean and cold. The receptacles in which the milk is allowed
to stand, the vessels in which it is measured, and the person who
handles it must be absolutely clean, and the nurse must keep in mind
the fact that pasteurization does not completely destroy the bacterial
growth in milk, that it merely diminishes it, and she must see that
the milk which has undergone the pasteurizing process is kept cold,
otherwise the microoerganisms which are present, even if to a less
extent than in raw milk, will undoubtedly multiply.
~Adulteration of Milk.~--There is not nearly so much adulteration of
milk to-day as there was a few years ago. The stringent laws governing
the care and composition of the milk make it unprofitable for the
dairymen to practise it. However, there are times when such things are
done and care must be taken to prevent it. Milk is, as has already
been stated, very susceptible to contamination, and that which is
infected with putrefactive bacteria is not fit for food even if the
dealer has doctored it with formaldehyde. However, the danger to-day
is not so much from drugs as from lack of care in the handling of the
milk. It is well to remember, however, that water is an adulteration
just the same as formaldehyde and perhaps more pernicious, since the
quantities of the latter are so small in an ordinary quantity of milk
as not to make a great deal of difference except in the feeding of
invalids and children, while watered milk is a swindle not only to the
pocketbook but to the body also, since the requisite nutritive value
is lacking.
~Selection and Care of Milk.~--There are a few essential facts to keep
in mind in regard to milk: (1) Be sure of the source of the milk
supply, especially in the feeding of the sick and of infants. Milk
for such cases should always be purchased from inspected dairies when
it is possible. (2) Keep the milk cold; the best milk in the world
will spoil if left in a warm place. (3) Always keep the milk bottle
well covered, thus eliminating the danger of contamination, flies,
etc.
ALBUMINIZED MILK
_135-152 calories_
6 ounces (3/4 glass) fresh whole milk.
1-2 eggs (whites only).
Have the milk thoroughly chilled.
Clip egg whites with scissors and strain through cheesecloth to remove
stringy parts. Now stir into the milk with a fork.
If patient does not object to foam, the mixture may be placed in a
milk shaker with pieces of ice and shaken until creamy, then poured
over cracked ice.
ALBUMINIZED MILK SHAKE
_135 calories_
6 oz. (3/4 glassful) fresh whole milk
1 egg white
Place the milk on ice to become thoroughly chilled. Clip the egg white
with scissors and strain through cheesecloth to free it from strings;
stir into cold milk. If patient does not object to foam, the milk and
egg whites may be placed in a milk shaker, and agitated for 4 or 5
minutes, then poured over cracked ice. This beverage may be flavored
to suit the taste of patient. Vanilla, caramel, or coffee may be used
to give variety.
To add additional nourishment 1 teaspoonful of Sanatogen, or Plasmon
may be added, or 1 tablespoonful of Panopepton or liquid peptonoids
used instead of the casein products.
MILK AND GINGER ALE (OR SARSAPARILLA)
_59 calories_
3 oz. milk
3 oz. ginger ale or sarsaparilla
Pour into a milk shaker and shake with cracked ice until foamy.
MILK PUNCH
_298 calories_
4 oz. rich milk
2 oz. cream
1 tbs. whisky (or sherry)
1 tbs. sugar (or less)
1 egg white (if additional nourishment is desired)
A grating of nutmeg on top. Place ingredients in shaker as directed
above, and shake a few minutes to thoroughly mix ingredients. Pour
over cracked ice, grate nutmeg or cinnamon over the top. The milk may
be peptonized if necessary, using 1/2 tube of Fairchild's peptonizing
powder.
PEPTONIZED MILK
_314 calories_
1 pt. of milk
1 tube of (Fairchild's) peptonizing powder
Dissolve the powder in 1 gill of cold water, and place in a clean
quart jar (glass).
Pour in 1 pint of cold milk and stop the bottle with cotton, shake
well and place the bottle in a saucepan containing water just warm
enough to allow of the hand being immersed without being burned
(115 deg. F.).
Keep the water at this temperature for 5 to 10 minutes or longer
according to the degree of peptonization desired. Lift out of the warm
water and plunge into cold, then place at once on ice.
The milk may be poured from bottle into a clean saucepan and brought
quickly to a boil to prevent further peptonization; this process,
however, is apt to make the milk very bitter and should not be used
unless it is to be flavored with fruit juice.
PEPTONIZED MILK PUNCH
_212 calories_
Take a goblet about one-third full of finely crushed ice, add a
tablespoonful of St. Croix rum, a dash of curacao or any liquor that
is agreeable to the taste; fill the glass with "specially peptonized
milk," stir well, and grate a little nutmeg on top. Add 1 tablespoon
sugar.
BUTTERMILK (BULGARIAN)
_627 calories_
1 qt. fresh whole milk (or skimmed if desired)
1-1/2 to 2 oz. (Bulgarian) starter, or 1 buttermilk tablet[37]
If latter is used dissolve tablet in 1 gill of cold water.
Stir the buttermilk starter into the cold milk and place in a one-half
gallon glass jar, place the cover on loosely and allow the jar to
stand for 12 hours or until the milk is well clabbered. (Insert a
thin-bladed knife close to the jar so that the rest of the milk is not
disturbed to see if the coagulation is complete.) When this is
accomplished place the jar in the ice-box. After the milk has become
thoroughly cold, beat thoroughly. The mixture is like any well-made
buttermilk. If the cream is removed before adding the culture the milk
will be lower nutrient value, but in many cases this is necessary
since it is often the fats which cause a disturbance.
COCOA
_147-166 calories_
2 tsp. cocoa
1-2 tsp. sugar
1/2 cup boiling water
2/3 cup milk
Mix cocoa and sugar together and add boiling water slowly. Boil 3 to
5 minutes; heat milk in double boiler and add cocoa mixture. Beat with
Dover egg beater to distribute cocoa and prevent scum forming. Serve
with or without whipped cream. Cocoa may be reinforced as directed in
"broths" with albumen or the whole or yolk of one egg well beaten. If
the white alone is used, care must be observed that the liquid is not
hot enough to coagulate the albumen. Proprietary foods and casein
preparations are used in like manner.
PLAIN JUNKET
_161 calories_
2/3 cup milk
1/2 junket tablet
1/4 tsp. vanilla extract or a grating of nutmeg
1 tbs. sugar
Heat milk to 100 deg. F. Add junket tablet dissolved in 1 tbs. cold water.
Mix in sugar and flavoring, and pour into molds to jelly. When junket
becomes firm, place in ice until needed.
JUNKET ICE CREAM
_428 calories_
1/2 cup each cream and rich milk
1 junket tablet
2 tbs. sugar
1/2 tsp. vanilla
Heat cream and milk to 100 deg. F. and proceed as in junket. When mixture
is jellied turn into freezer, as any ice cream. This is the most
wholesome of ice creams and especially suited for children and
patients who have tuberculosis complicated with gastric
disturbances.[38]
PLAIN VANILLA, LEMON, OR ALMOND ICE CREAM WITH OR WITHOUT EGG
WHITE[39]
_585-602 calories_
1 cup thin cream
2 tbs. sugar (more if desired)
1/2 tsp. vanilla, lemon extract, or almond extract
Method I. Whip cream, add sugar and flavoring, and freeze.
Method II. Scald half the cream and cool. Whip the remaining half, add
sugar and flavor and freeze.
Method III. Make "boiled custard," as directed, add one-half the
amount of cream and freeze.
To reenforce ice cream:--Add 1 or 2 egg whites, beaten or unbeaten;
these may be added in the beginning, or after the mixture begins to
freeze. A tablespoonful of maple sirup, caramel sirup (1 tbs. sugar
melted and browned and dissolved in 1 tbs. boiling water), or
chocolate sirup may be poured over the ice cream to vary the flavor.
Make chocolate sirup by boiling 2 tbs. water, 1 tbs. sugar, and 1 tbs.
chocolate to a sirup. 143.3 calories.
FROZEN CUSTARD
_289-329 calories_
1 egg (or 2 yolks)
1 tbs. sugar
1/8 tsp. salt
1 cup of milk
Few drops of vanilla
Prepare as soft custard, freeze.
LACTONE BUTTERMILK
_627 calories_
1 qt. fresh milk
1 gill cold water
1 lactone tablet (or 1-1/2 oz. buttermilk starter)
(Parke, Davis & Co.'s and Hanson & Co.'s buttermilk tablets are
practically the same.)
Dissolve tablet in cold water and stir into fresh milk (which may or
may not be skimmed, according to the directions of the physician, but
the finished product is more palatable using whole milk). Pour into a
clean jar or wide-mouthed bottle; plug with cotton or close not
tightly, allow to stand in room temperature 70 deg.-75 deg. F. 24 hours,
shaking the bottle occasionally to keep the cream from rising. At the
end of this time pour the milk out (if sufficiently fermented), and
beat briskly for 5 to 6 minutes with egg beater or with churn; place
on ice until ready to serve.
MALTED MILK (1)
_77-96 calories_
1 tbs. malted milk
1-2 tsp. sugar
6 oz. boiling water
1/4 tsp. salt
3 to 5 drops vanilla
Heat water to boiling and mix malted milk (Horlick's) with a little
cold water. Stir into the boiling water, add sugar and salt, and serve
with or without cream.
MALTED MILK (2)
_107-155 calories_
1/2 to 1 tbs. malted milk
3 oz. each milk and water
1-2 tsp. sugar
1/4 tsp. salt
Proceed as above.
MALTED MILK CHOCOLATE OR COCOA
_230-300 calories_
1 tbs. malted milk
1 tbs. cocoa or grated chocolate
6 oz. milk
2 oz. water
1-2 tsp. sugar
4-5 drops vanilla extract
Mix cocoa or chocolate with water and boil 2-3 minutes. Pour milk into
a double boiler and heat, mix malted milk with a little water and stir
into the hot milk, add the cocoa paste, sugar, and vanilla, mix
thoroughly, beat the mixture briskly to mix ingredients thoroughly,
and serve with or without cream.
~Milk or Cream Soups~
MILK OR CREAM SAUCE FOR SOUPS
_599-1229 calories_
2 tbs. flour
2 tbs. butter
1 pt. milk or thin cream
1/2 tsp. salt
Cream butter and flour to a smooth paste, heat milk in double boiler
on an asbestos mat over the flame; when it is scalding hot, stir in
the butter and flour paste, stir until smooth and the mixture begins
to thicken, cover and allow to cook without boiling for 15 minutes;
strain. The sauce may be used at once or put into a glass jar in the
ice-box until needed.
CREAM OF ASPARAGUS (1)
_213 calories_
2/3 cup cream sauce
1/3 cup asparagus puree
Heat sauce and puree in separate saucepans, and when about ready to
serve, stir them together, strain carefully, season with salt, and
serve with or without croutons of toast or whipped cream. If the sauce
is made from the cream instead of milk, the fuel value will be much
higher (302.7 calories).
CREAM OF ASPARAGUS (2)
_216 calories_
8 medium stalks of asparagus
1 qt. water
1 tsp. salt
1 tbs. flour
1/2 cup cream sauce
Cut off the tips of the asparagus in 1-inch pieces, and place with the
rest in a saucepan, and cover with water; add salt and cook until the
tips are tender; lift out and put aside to be used instead of the
toast croutons. After the water in which the asparagus is cooked is of
sufficiently strong flavor, strain and add the extra spoonful of
flour, mixed in a tablespoonful of water; cook 15 minutes, measure 1/2
cupful, and proceed as directed above.
CREAM OF POTATO
_259 calories_
Boil and cream the potato. Make sauce and add potato puree; stir until
well blended and serve with toast croutons.
When boiling potato if a sprig of parsley is added and strained out,
and a little of the potato water is used to make the puree smooth, the
soup will have more character.
CREAM OF SPINACH, CELERY, PEAS OR CARROTS
_224-461 calories_
3/4 cup cream sauce
1/3 cup vegetable puree
Proceed as in making other cream soups.
OYSTER SOUP
_179 calories_
6 oysters
1 cracker (soda) or 8 oyster crackers
3/4 cup milk
1/4 tsp. salt
A dash of pepper
Put oysters (and their liquor) into a saucepan, and heat gently; skim
thoroughly. Heat milk in separate pan; when very hot add to oysters.
Roll the cracker and add to soup just before it is served. Add salt
and pepper at the same time.
~Eggs~
~Eggs.~--The table shows eggs to have a chemical composition of water
73.7%, protein 14.8%, fat 10.5%, and mineral salts (ash) 1.0%. Fuel
value per pound, 672 calories. The white of the egg, constituting 57%
of the entire weight, is composed chiefly of albumen and water with a
small percentage of mineral salts in the form of calcium, potassium,
magnesium, sodium, phosphorus, chlorin, sulphur, and iron. Typical
albumens are always rich in sulphur, and in eggs the sulphur content
is much greater in the egg white than it is in the yolk. The yolk of
eggs contains more protein and fat than the white, and less water. The
protein of the yolk is chiefly in the form of ovovitellin, while the
fats occur as palmitin, olein, and stearin. There is also 5% of
coloring matter in the yolk of eggs besides lecithin, nuclein, salts
of iron, potassium, magnesium, and phosphorus. The latter mineral salt
comprises 1.0% in yolk, while in the white there is only .03%. Eggs
have a position in the invalid dietary second only to that of milk.
They are nutritious, easy of digestion, and exceedingly palatable if
properly selected and correctly prepared. The albumen in the white is
very susceptible to the effect of heat. At a temperature of about 135 deg.
F. the clear, pale yellowish white begins to change to an opalescent
tint, and, as the temperature is gradually increased, the texture
changes from a viscid, sticky substance to an opaque, jelly-like mass
which solidifies with an ever increasing temperature. Hard cooked
white of egg, unless it is very finely divided, is considered
difficult of digestion, but if the heat is applied gradually and is
not raised to the boiling point (212 deg. F.) there is no reason why the
hard cooked white of the egg should not be digested. However, it is
unwise to cook eggs in this manner for invalids or children. Any of
the other methods, with the exception of frying, which should never
be used, is decidedly preferable. Egg albumen is soluble in water and
fresh fruit juices, so that it may be used with great success as a
reinforcing agent. In fact, the whole egg may be so used, but it is
more difficult to disguise the yolk in a beverage than it is the
white, and for this reason it is not so adaptable in many cases. Eggs
may be cooked by the following methods in the invalid dietary:
coddled, soft-cooked, poached, creamed, omelet, scrambled, or in
custard. Uncooked eggs may be given in water, milk, wine, or fruit
juices.
The selection of eggs is equally as important as the selection of
other foods. There are "new-laid eggs," "fresh eggs," and just "eggs."
The latter are generally storage and should not be used for the sick
or for infants. As a rule old eggs will not stand poaching, the whites
and yolks mingle and form an unappetizing mass. It does not make any
difference whether the color of the shell is white or brown; if the
egg is absolutely fresh the white and yolk should be distinct and
easily separated, and when they are not it is safer to discard the egg
entirely.
~Fruit Beverages~
ORANGEADE
_118 calories_
Juice of 1 orange
1 tbs. sugar
Juice of 1/2 lemon
Enough water to fill the glass
Sweeten the juice of orange and lemon and pour into a glass filled
with crushed ice. Fill glass with plain or carbonated water.
ALBUMINIZED ORANGEADE
_152 calories_
Make orangeade as directed in above recipe, without the addition of
water. Break the whites of 2 eggs into a saucer and with scissors cut
the albumen until free from membrane and strain, stir this into the
orange juice and add several pieces of cracked ice. This is both
nourishing and palatable, and the taste of the egg cannot be detected.
ALBUMINIZED LEMONADE
_107 calories_
Juice of 1 lemon
1 tbs. sugar
Whites of 2 eggs
Cut as directed for Albuminized Orangeade. Mix until sugar is
dissolved. Pour over a glassful of cracked ice. Fill glass with plain
or carbonated water.
PINEAPPLEADE
_151 calories_
2 oz. (1/4 cup) grated pineapple
8 oz. (1 cup) cold water, or sufficient quantity carbonated water
to fill glass
Juice of 1 lemon
1 drop of lemon extract or a little of the peel, grated
1 tbs. sugar
Mix lemon juice, water, and pineapple together; add sugar, if not
sweet enough, but the less used the better, in all beverages. Add
extract and pour into a shaker with a few lumps of ice. Shake well to
mix ingredients and pour the pineapple over crushed ice. If this
proves too much at a time, make half the recipe. Serve in tall thin
glasses holding from 4 to 6 ounces after the ice is put in, or serve
in punch glasses with small spoons.
ALBUMINIZED GRAPE JUICE
Albuminized Grape Juice is made without the addition of lemon juice
unless the white grape juice is substituted for the black, in which
case add one or two teaspoonfuls to relieve the flat taste and proceed
as in Albuminized Orangeade, using 3 oz. of grape juice.
EGG WHITE AND MINT
_57 calories_
1 egg
2 tsp. sugar
1 tsp. lemon juice
Several sprigs of fresh spearmint
Whip white of egg; add sugar and lemon juice. Crush lower parts of
mint leaves slightly and place in glass. Pour mixture over ice in
glass; stir well and serve at once.
Fill glass with carbonated water, Vichy, White Rock, Apollinaris, etc.
This is especially good when patient suffers from nausea.
CREAM, EGG AND VICHY
_232 calories_
1 egg white
2 tsp. sugar
3 oz. (6 tbs.) cream
A few drops of vanilla extract
Celestine (French) Vichy to fill glass
Whip egg white to stiff froth; whip cream stiff and sweeten, add
vanilla; lastly, the egg. Pour over cracked ice and fill up the glass
with Vichy.
COFFEE
2 tbs. ground coffee
2 tsp. white of egg
1 cup boiling water
1/4 cup cold (boiled) water
Mix coffee with 1 tablespoonful of cold water and egg white in small
pot (after scalding pot), add boiling water; allow to boil 3 minutes;
stir down and add cold water; set pot where coffee will stay hot, but
not boil, for 10 to 15 minutes, serve with cream and sugar or use to
flavor hot milk.
PLAIN EGGNOG
_267 calories_
1 egg
2 tbs. cream
1 tbs. rum
1 tbs. whisky
1 tbs. sugar
Beat yolk of egg and sugar together; add cream, rum, and whisky. Beat
egg white stiff and stir into the mixture; pour into glass with or
without cracked ice.
Nutmeg may be grated over top for those who like it.
COFFEE EGGNOG
Follow recipe for plain eggnog, substituting 2 tablespoonfuls of
strong coffee for the rum.
PANOPEPTON OR LIQUID PEPTONOID EGGNOG
_233-257 calories_
Is made as directed for plain eggnog, panopepton being substituted for
the rum, using 1 ounce instead of 1 tablespoonful. This will probably
more than fill a glass, but the whole amount must be made to keep the
proportions correct. The whisky may be left in, if desired, or sherry
wine may be substituted in its place to give flavor and additional
stimulation.
MALTED MILK EGGNOG
_264-316 calories_
1 egg
1 tbs. malted milk
4 oz. milk
1 tbs. sherry wine or whisky
1/2-1 tbs. sugar
1 tsp. cream
Mix milk as directed above and chill thoroughly. Beat egg yolk with
sugar and whisky or wine and add to the mixture. Beat egg white stiff
and stir into the rest of the ingredients. Pour into shaker and shake
with cracked ice until thoroughly chilled. The cream may be served on
top, or beaten into the eggnog.
FOAMY OMELET
_130 calories_
1 egg
1 tbs. water
1/2 tbs. butter
1/8 tsp. salt and dash of pepper
Beat yolk until light colored and thick; add water, salt, and pepper.
Beat white until stiff and dry. Turn the yolk over the beaten white
and cut and fold the white into the yolk mixture.
Have pan hot and buttered, turn in the mixture, spread evenly in pan
and allow to stand about two minutes on the top of the stove at a
moderate heat; then remove the pan, place in a moderate oven and cook
until a knife thrust into the center comes out nearly clean. Remove
from oven, cut across center at right angles with handle of pan and
turn over on a hot platter. Omelets may be varied by the use of
different garnishes and flavors.
CODDLED EGGS
_75 calories_
1 pt. water
1 egg
Allow water to boil; wash egg; drop into boiling water and place
saucepan where water will keep hot, but not boil; allow to stand 7 to
8 minutes. Serve with salt.
SOFT-COOKED EGGS
_75 calories_
Proceed as for coddled eggs, but allow egg to remain from 10 to 15
minutes or even longer, if very soft eggs are not desired.
POACHED EGGS
_75 calories_
Have small, shallow saucepan half filled with boiling water or
milk--if an egg poacher is at hand, use that; otherwise, lower a flat
perforated spoon into water and place where the water cannot boil.
Break the egg carefully into the spoon, taking care not to break the
yolk; allow to stand in hot water until the white is of the
consistency of jelly; lift out--slide egg on to hot toast, taking care
not to break. (A broken poached egg is very unappetizing, as well as
untidy in appearance.)
CREAMED EGG ON TOAST
_With milk 131 calories_
_With cream 170 calories_
Cut the crust from one slice of bread and cut bread in one-inch cubes;
toast while preparing egg. Beat egg with egg beater until light
colored; stir into it 2 tablespoonfuls of rich milk; pour into a
double boiler, over hot water; add 1 teaspoonful butter, a little salt
and pepper; stir until like thick boiled custard. Pour over toasted
cubes of bread and serve at once.
EGG NEST
_204 calories_
1 egg
1/2 tbs. butter
1 slice of bread (3/4 in. thick)
Salt and pepper to taste
Toast the bread on one side, butter and place on a plate (one which
will not break in the oven).
Beat egg white stiff, and pile roughly upon the toast, leaving a
slight depression in the center. Slip the unbroken yolk into the
depression (take care not to break the egg yolk or the appearance and
significance of the dish will be ruined). Set plate in oven to brown
the white (the oven must not be too hot or the white will brown before
the yolk is sufficiently cooked to be palatable). Place the remaining
butter on the yolk, dust with salt and pepper and serve at once.
SOFT CUSTARD
_289 to 329 calories_
1 egg (or 2 yolks)
1 tbs. sugar
1 cup milk
A few drops of vanilla
Heat milk in double boiler. Beat egg and sugar together. When milk has
reached the scalding point (small bubbles form around the edge of the
saucepan), stir in the egg. Care must be taken not to allow the water
under the saucepan to become too hot, as the custard will curdle if
the egg is cooked at too high a degree of temperature. The custard
must be stirred constantly in the beginning until it begins to
thicken, then several times a minute until it is of the desired
consistency and the raw taste is cooked out of the egg. This mixture
is done when it will form a coating upon the spoon. Serve with whipped
cream on top (57 calories extra with cream).
BAKED CUSTARD
_249 calories_
1 egg
1 tbs. sugar
3/4 cup milk
A few drops of vanilla
Beat egg and sugar together, stir into the milk, grease custard cup
with butter, pour in the mixture. Set cup on several layers of paper
in a deep pan, surround with hot water (to about half its depth). Set
pan in moderate oven and allow to cook slowly until custard is firm in
the center. It may be served hot or chilled and turned out, with a
tablespoonful of whipped cream on top.
Care must be taken not to allow the oven to get hot, or the egg will
coagulate, making a watery, unpalatable, and indigestible mixture.
CARAMEL CUSTARD
_306 calories_
Caramel custard is made exactly the same as baked custard, except that
the cup is lined with a caramel made as follows: In a small frying
pan, place 1 tablespoonful of sugar, place on the stove and stir
constantly until it melts and turns a golden brown (do not allow to
burn). Fold a cloth about the custard cup and pour in the caramel,
moving the cup about until the sides and bottom are well coated. Pour
in the custard mixture and proceed as in baked custard.
FLOATING ISLAND
_381 calories_
1 egg and 1 extra yolk
1 cup milk
2 lady fingers
Few drops vanilla
1 tbs. sugar
Make soft custard, using the two yolks (no white). Chill custard
thoroughly. Line individual ice cream cup with the lady fingers; pour
the custard over. Beat the white of egg and place on top. Serve at
once. The lady fingers may be dipped in sherry wine if desired, using
about 2 tablespoonfuls of wine. (26 calories extra.)
~Cereals and Breadstuffs~
CORN MEAL GRUEL
_101 calories_
2 tbs. corn meal
1 cup water
1/2 tsp. salt
Allow water to boil, mix corn meal with 3 or 4 teaspoonfuls of cold
water. As soon as water begins to boil, stir briskly until gruel
begins to thicken. Then place on a cooler part of the stove, and cook
gently for 2 hours, replacing water as it evaporates. Strain through a
coarse sieve if it lumps.
FARINA
_183 calories_
3 tbs. (1 oz.) farina
1/2 cup rich milk
1/2 cup boiling water
1/4 cup cold water
1/4 tsp. salt
Mix farina into a paste with cold water. Stir into boiling water,
allow to cook for half an hour (if water boils out, add boiling
water). Add milk, and place the saucepan in a hot water bath (double
boiler); allow to cook half an hour longer, stirring occasionally.
RICE (1)
_99 calories_
2 tbs. (1 oz.) rice
1 pt. boiling water
1/2 tsp. salt
Soak rice for 1 hour in cold water. Sprinkle into the briskly boiling
water, taking care not to stop the boil. Allow to cook until tender;
test by pressing a grain between thumb and finger; there should be no
hard center. When the rice is done, turn it into a colander and allow
water from cold faucet to run over it to wash off surplus starch.
Return to saucepan place on stove where moisture can be dried out of
the rice without burning it.
RICE (2)
_2-3 servings, 316 calories_
4 tbs. rice
1/4 tsp. salt
3/4 cup water
3/4 cup milk
Wash rice and soak it in cold water for 1 hour (or overnight). Place
in an earthenware baking dish, cover with the milk, water and salt.
Cover and set in the oven; allow to cook until all of the moisture is
absorbed (if the rice is not done by the time the moisture has
evaporated, add more milk, or milk and water, and continue until the
grains are tender). If the given amount of moisture is not absorbed by
the time the rice is tender, drain off the surplus and return the dish
to the oven for a few moments. Each grain should be separate, when the
dish is prepared correctly.
MILK TOAST
_149 calories_
1 slice bread, toasted
1 tsp. butter
1/4 cup milk, heated
1/6 tsp. salt
Toast the bread on both sides and butter; place in a deep plate and
pour over it the hot milk.
CREAM TOAST
_240 calories_
1 slice bread
1/4 cup thin cream
1 tsp. flour
1 tsp. butter
1/4 tsp. salt
Cream butter and flour together cold, and stir into hot milk. Stir
until the mixture begins to thicken, cover the boiler and allow to
cook for 15 minutes. Slice the bread and cut into cubes; toast a
delicate brown, and pour over it the cream sauce. Strain the sauce if
there are any lumps.
WINE PANADA
_185 calories_
2 water crackers
2 tbs. sherry wine
1/2 cup hot or cold milk
1/4 tsp. grated nutmeg
Sugar may be sprinkled over crackers if desired, but it is not
ordinarily done.
Place the crackers in a deep plate and pour over each cracker 1
tablespoonful of wine, dust with nutmeg and pour over the hot or cold
milk.
OATMEAL COOKIES
_3333 (about) calories_
2 cups flour
1/4 cup sugar
1/2 cup milk
1/2 cup oatmeal
2 tsp. butter, lard, or Crisco
1 cup seeded raisins
1 egg
1/2 cup shelled peanuts
Mix shortening and sugar together. Mix oatmeal and peanuts (broken
into small pieces) into the flour. Add milk and well-beaten eggs, then
the raisins; mix into a dough, roll into a thin sheet, and cut into
small cakes. Bake in quick oven.
BAKED TAPIOCA
_550 calories_
1 cup milk (scalded)
2 egg yolks
3 tbs. sugar
6 dates
2 tbs. minute tapioca
Beat sugar and egg together, stir in the tapioca and dates, cut into
small pieces. (The dates may be omitted, if desired.) Pour mixture
into custard cups and bake slowly (as rice custard) until the tapioca
is clear and the custard is fairly firm in center.
ORANGE TAPIOCA
_570 calories_
1/2 cup milk
1/2 cup orange juice
1/4 cup sugar
2 tbs. minute tapioca
2 egg yolks
6 drops orange extract
Mix and bake as directed in plain baked tapioca custard. Any other
fruit juice may be substituted for the orange, raspberry, pineapple,
or grape juice.
APPLE TAPIOCA
_475 calories_
1 apple (pared and cored)
1 egg
3/4 cup milk
2 tbs. sugar
1-1/2 tbs. tapioca
1/8 tsp. nutmeg
Beat egg and sugar together. Heat milk in double boiler and add egg
when milk is scalding hot. Stir in tapioca. Cook 20 minutes. Place
apple in cup a little larger than the apple and pour the tapioca
custard over the apple. Cover the cup and bake 30 minutes in a
moderate oven.
BROWN BETTY
_470 calories_
2 slices bread
1 large tart apple (or 1/2 cup blueberries may be substituted for
the apple)
2 tbs. sugar
1 tbs. butter
1/2 tsp. nutmeg or cinnamon
Toast bread and break into small pieces, line the bottom of the
individual baking dish with toast bits, cover with a layer of apple or
berries, sprinkle with sugar and nutmeg or cinnamon, add butter in
bits over this, continue the process until the dish is filled, place
bits of butter on top of the last layer of toast and set dish in oven;
bake about 20 minutes in a slow oven; serve with whipped cream or hard
sauce.
~Starchy Desserts~
RICE CUSTARD
_309 calories_
1 tbs. raw rice, broiled
1 egg
1 tbs. whipped cream
1/2 cup milk
1 tbs. sugar
1 doz. raisins if desired
A few drops of vanilla
Beat sugar and egg together. Stir into the milk, stir in the rice and
flavor (add raisins if desired--29 calories). Grease custard cup and
fill with the mixture. Bake slowly (in a pan of hot water) until
custard is firm in center. Serve with whipped cream.
ORANGE RICE CUSTARD
_532 calories_
2 oz. orange juice
2 tbs. sugar
1/2 cup milk
2 egg yolks
1/2 cup boiled rice (or 1/4 cup uncooked)
Beat egg, sugar, and orange juice together. Mix milk with rice and
stir the two mixtures together. Bake as directed in plain rice
custard.
SNOW-BALLS
_356 calories_
1/4 cup rice
1 cup milk
1/4 tsp. salt
Place in a double boiler and cook without stirring until milk is
absorbed and rice is tender. Then either pack in egg cups (wet first
so that rice will slip out without breaking), or take a square of
cheesecloth 8 inches square, dust with flour and place about 4
tablespoons of the cooked rice in center, draw the corners together
and tie firmly into a ball. Set the ball in a steamer and steam 1
hour. Remove the cloth gently to prevent breaking the balls. They may
be served with custard as a dessert, or as a vegetable with tomato
dressing.
TAPIOCA CUSTARD
_503 calories_
1 cup milk
2 tbs. tapioca (minute tapioca)
1 egg
3 tbs. sugar
Flavor with vanilla or nutmeg, or 1/4 square chocolate grated. Scald
milk. Boil tapioca in hot water until transparent like jelly, using
one cupful of boiling water. (If tapioca does not absorb all of the
water, pour off the surplus.) Beat egg and sugar together and add with
the milk to the tapioca. Pour into a double boiler, and cook until the
raw egg flavor has disappeared. Flavor as desired. 43 calories extra
with chocolate.
SPONGE PUDDING
_772 calories_
2 tbs. sugar
1/4 cup flour
2 eggs
2 tbs. butter
1 cup milk
1/4 tsp. vanilla
Sift flour and sugar together and make into a thin paste with part of
the milk, heat the remainder of the milk and stir in the flour paste.
When the mixture is thick and smooth, stir in the butter, then the
beaten yolks and last, the whites (well beaten) are folded in. The
mixture is now turned into a baking dish and baked (in a pan of hot
water as any other custard) until it is firm in the center and well
puffed up and brown. Serve with foamy sauce.
SUNSHINE CAKE
_1716 calories_
7 egg whites
5 egg yolks
1 cup flour (sifted 3 or 4 times)
1 cup sugar
1/3 tsp. cream of tartar
1/4 tsp. salt
Beat whites of eggs until foamy and add cream of tartar; beat until
dry and stiff, add the sugar gradually and fold in the well-beaten
yolks. Sift the flour and gradually fold into the rest of the
ingredients; pour into ungreased sponge cake pans and bake in a
moderate oven for 30 to 40 minutes.
ANGEL FOOD CAKE
_721.5 calories_
4 egg whites
1/2 cup sugar
1/2 cup flour (pastry)
1/4 tsp. cream of tartar
Whip eggs until foamy and add cream of tartar, whip until stiff and
dry, add sugar gradually, then fold in the flour (the flour must be
sifted 4 or 5 times).
Pour batter into an ungreased angel food cake pan and bake in a slow
oven for 25 or 30 minutes. Care must be taken not to disturb the cake
during the baking, or it will fall.
CEREAL PUDDING
_1470 calories_
1/2 cup fine cereal
1 cup milk (scalded)
1/4 cup molasses
1 egg
1 tbs. butter
1/2 tsp. salt
1/2 tsp. soda
1/2 cup dates or other dried fruit
Stir cereal into scalded milk and cook until mixture thickens, remove
from fire, add rest of the ingredients except eggs. When mixture has
cooled somewhat, add the lightly beaten eggs, turn into a buttered
baking dish and steam 3 hours. This pudding may be made without
steaming by cooking the cereal and milk in double boiler for 1 hour,
then add rest of ingredients and bake 30 minutes.
~Sauces for Puddings~
FOAMY SAUCE
_494-497 calories_
1/2 cup powdered sugar
1/4 cup butter
1/2 one egg yolk and 1 whole egg white
1 tbs. sherry wine or 1 tbs. hot milk
1/4 tsp. vanilla
Cream butter and sugar (powdered sugar must be used in this recipe).
Stir in the well-beaten yolk, add sherry and pour into saucepan over
hot water; stir until thick and creamy, lift from hot water and cool
as quickly as possible, fold in the stiffly beaten white of egg and
serve over pudding at once.
WINE OR FRUIT SAUCE
_381-434 calories_
1 egg
1/2 cup powdered sugar
1 wineglass sherry wine or whisky, or 1/2 glass orange juice
1 tbs. lemon juice
1 tsp. hot milk
Beat yolk and white of egg separately, add sugar to yolk and beat
until creamy, add wine or fruit juice, fold in the egg white and add
the hot milk last; serve at once.
HARD SAUCE
_231 calories_
1 tbs. butter
2 tbs. sugar
1/2 egg white may be added if desired
1/2 tsp. vanilla, or 1/2 tsp. nutmeg
Cream butter and sugar together until there are no lumps or grains in
mixture. Beat the egg white stiff and fold into the sugar and butter
mixture. Flavor.
FOAMY SAUCE
_794-797 calories_
1/2 cup powdered sugar
1/4 cup butter
1/2 one egg yolk and 1 whole egg white
1 tbs. sherry wine or 1 tbs. hot milk
1/4 tsp. vanilla
Cream butter and sugar (powdered sugar must be used in this recipe).
Stir in the well-beaten yolk, add sherry and pour into saucepan over
hot water; stir until thick and creamy, lift from hot water and cool
as quickly as possible, fold in the stiffly beaten white of egg and
serve over pudding at once.
SAUCE FOR PUDDINGS
_758.4 calories_
1 egg
1/2 cup powdered sugar
1 wineglass sherry wine or whisky, or 1/2 glass orange
1 tbs. lemon juice
1 tsp. hot milk
Beat yolk and white of egg separately, add sugar to yolk and beat
until creamy, add wine or fruit juice, fold in the egg white and add
the hot milk last; serve at once.
~Meats~
BEEF, LAMB, VEAL, POULTRY, FISH AND SHELLFISH
~Meats.~--The flesh of animals, poultry, and fish comes under the head
of meat. These food materials form one of the most important sources
of protein in the diet, the foodstuff being in concentrated form
easily handled by the digestive apparatus and absorbed almost
completely, leaving little residue in the intestinal tract. The
chemical composition of different meats is very much alike, as will
be seen in the table, the bulk of the weight being water, while the
proteins range from 18.3% (E.P.)[40] in beef to 9.9% in bacon. The
fats range from 17.9% in beef to 64.8% in smoked bacon.
The mineral salts or ash, as they are found in meat: "Sodium occurs in
the animal body chiefly as chlorid in the fluids and blood, and to a
less extent in the other tissues." "Potassium, on the other hand, is
much more abundant in the soft solid tissues, in the corpuscles of the
blood and the protoplasm of the muscles and other organs." "Potassium
sulphate in the blood reacts to some extent with sodium chlorid,
forming potassium chlorid and sodium sulphate, both of which are
rapidly eliminated by the kidneys." The greater part of the sulphur
with which we are concerned in nutrition enters the body by way of the
protein, the percentage in lean beef being from 0.95% to 1.00%.[41]
Phosphorus in meat occurs as phosphoprotein in the nucleoproteins of
cell nuclei, and lecithoproteins in the brain and to a less extent in
other tissues as phosphorized fats. Meat is poor in calcium,
containing only about 0.01 gram per hundred grams of substance. Meat
with eggs yields a considerable amount of what is known as acids in
the body.
~Quality of Meats.~--The quality of meat depends upon several factors:
_age_, _sex_, care, feeding, and the length of time it is hung. Cold
storage beef is much more apt to be tender than that cut from a
freshly killed animal. Animals that are not allowed to run over a
large area, but are kept in a small inclosure and fed on fattening
foods, produce meat of a high quality. This is because the muscular
tissue has not been hardened with exercise. The worked muscle is
always tougher than the quiet one. For this reason the tenderloin of
beef is more tender than the flank. It is situated in the part of the
animal that is exercised the least. The tough parts, however, are not
lacking in flavor or nourishment, but the manner in which they must be
cooked to assure them of being tender deprives them of much of their
original flavor. This is demonstrated in broths and soups made from
the tough cuts of meat. The extractives from which meat derives its
flavor and the soluble albumens are drawn out by the water, and if it
is to be used as hash, croquettes, etc., needs to be seasoned, since
the broth, while it has taken very little of the actual nourishment
from the meat, has deprived it of practically all of its flavor. In
making broth or soup, if the meat is covered with cold water instead
of hot, more of the extractives will be drawn out and the broth will
be more highly flavored and much more stimulating. The color, odor,
and freshness of the muscular and fatty tissues of meat are all
indicative of their quality. Fresh meat is firm in texture and free
from offensive odor. Stale beef and that cut from an old steer exhales
a pungent odor of butyric acid. The color of beef should be dark
purplish when fresh cut but this changes quickly to a bright red; it
should contain preservatives of no kind and must be cut from animals
free from all disease. The fat should be of a yellowish white and be
crumbly, and should be distributed throughout the muscular tissue and
around the organs.
~Veal~, being the flesh of an immature creature, is not so highly
flavored as the flesh of older animals, but the bones and cartilages
are softer, and when this meat is used for broth, more of the gelatin
(collagen and elastin from the bones and connective tissue) is
dissolved out, giving a slightly higher percentage of nutriment in the
broth.
~Selecting of Chicken and Turkey.~--In selecting chicken for the diet
of invalids, use only the young birds for broiling, those a few months
older for baking and roasting, and the fowls for soup and broth. To
test a chicken for broiling and roasting, select one in which the
cartilage at the end of the breastbone is soft and pliable; the
pinions (lower part of the wings) and the feet should be soft and
readily bent. The breastbone of a fowl is firmer and the wings and
feet harder than those of the younger chicken. The young chicken has
an abundance of pin feathers while the old fowl has not. In fact, one
of the means of differentiating between the old chicken and the young,
even if they are practically of the same weight, is the presence of
the long hairs instead of pin feathers. The fowl selected for broth
should not be very fat, as this fat will melt into the broth, causing
it to be greasy and unpalatable. Turkey, even when it is young, is not
quite so digestible as young chicken; the fibers are longer and the
connective tissue more abundant. Goose and duck are richer in fat and
not so desirable as chicken in the invalid dietary. Squab, quail, and
young squirrel are all palatable and readily digested. The squirrel
must, however, be young, or the flesh will be tough and more difficult
of digestion.
~Fish.~--Fish should be given consideration in the dietary of the
invalid since it is a valuable source of protein and readily digested
in the majority of cases. As a rule fish is not so well liked as meat,
but since it contains a smaller percentage of ~extractives~ and
~purin~ bases it is exceedingly valuable in certain pathological
conditions. The lean varieties of fish, halibut, flounder, trout,
perch, haddock, turbot, whitefish, are more readily digested than the
dark fish, which contain a higher percentage of fat. To this latter
class belong the bluefish, mackerel, salmon, shad, and herring.
~Shellfish.~--Of the shellfish, the oyster and the clam are
exceedingly useful. The soft parts of the oyster are palatable and
easily digested. They are not highly nutritious, but give a nice
variety to the diet. When used in broth or for the juice, clams are
particularly useful. Many cases of nausea are relieved by the taking
of iced or very hot clam juice when they resist other remedies. The
necessity of having both oysters and clams absolutely fresh is of the
greatest importance, since a type of poison results from tainted
shellfish which is exceedingly dangerous.
~Pork in the Diet.~--Fresh pork is rarely ever included in the invalid
dietary save in diabetic diets. Meat from this animal must always be
thoroughly cooked, not only because underdone pork is exceedingly
indigestible but because there is an infectious bacterium sometimes
found in pork which is only destroyed by thorough cooking of the meat.
Well-cooked bacon is digestible if the surplus fat is poured off
instead of allowed to soak into the cooked bacon. The most efficient
method of cooking bacon is to place the strips upon a broiler under
the flame. In this way the hot fat drips down into the pan beneath,
leaving the bacon crisp and delicate.
The meats to be used for the invalid must be selected with care. The
quality of this item of food is most important. It is not always
necessary to purchase the most expensive cut. If it is to be broiled
or roasted then it is necessary to select parts of the animal which
are tender, but for broths, soups, scraped or ground meat, or the meat
to be used for the juice only, it is wasteful to buy these tender,
expensive pieces when those costing less will serve the purpose
equally well. The names given to the different cuts vary slightly in
different parts of the country, but those in general use only will be
mentioned here. The following table shows the manner in which the
~beef~ is cut and the method in which it is generally used:
TABLE
============+========================+================================
_Beef_ | _Cut_ | _Method of Preparation_
------------+------------------------+--------------------------------
Hindquarter | {more or less free |Broth, soup, beef juice, scraped
|Round{ from fat | beef.
| {round steak |Hamburg steak (ground meat).
| |Broiled (this is a cheaper and
| | less tender cut than the loin
| | steaks).
| |
|Rump {steak |Broiled, cheaper cut steak.
| {roast |Roasted, cheaper cut roast.
| {lean meat |Broth, soup, beef juice.
| |
|Loin {3 ribs, 1st, 2d |Roasted.
| { and 3d cuts |
| {sirloin steak |Broiled.
| {porterhouse steak |Broiled.
| |
| {steak |Broiled.
|Tenderloin {roast |Roasted.
| {fillet |Broiled or roasted, larded or
| | plain.
| |
|Ribs (prime) |Roasted.
| |
|Ribs, chuck roast or |Roasted or broiled.
| steak |
| |
Forequarter |Brisket |Corning.
| |Broth, soup, scraped, meat
| | juice.
| |Hamburg steak.
| |Salisbury steak.
------------+------------------------+--------------------------------
CUTS OF LAMB AND MUTTON
------------+------------------------+--------------------------------
Lamb |Neck |Soup, broth, etc.
| |
|Chuck (including |
| shoulder ribs). |
| Shoulder chops are not|
| so tender as loin |
| chops. |Broiled.
| |
|Flank |Soup, broth.
| |
|Loin (chops) |Broiled.
| |
|Leg |Roasted.
| |
Veal |Neck |Soup, broth.
| |
|Chuck |Soup, broth, roast, broiled.
| |
|Cutlets |Broiled (breaded or plain).
| |
|Chops (rib) |Broiled.
| |
|Breast |Roasted, stuffed or plain.
| |
|Leg |Roasted.
| |
|Hind shank (veal |Soup, broth.
|Fore shank knuckles) |
============+========================+================================
~Broths and Soups~
STANDARD BROTH
BEEF, VEAL, MUTTON, OR CHICKEN
_1 Pint, 80 calories, with rice or barley 105 calories_
Two pounds of meat (beef, mutton, veal, or chicken); 2 quarts of
water; 2 pounds of bones; 1 teaspoonful of salt; 2 tablespoonfuls of
rice or barley may be added if desired and parsley or celery may be
used to give the additional flavor.
Wipe meat with a clean wet cloth and cut into small pieces, break the
bones, place all together in a deep saucepan, cover closely and allow
to stand in a cool place for one hour; then place pan on the back part
of the stove, or on an asbestos mat over a gas burner, and heat gently
to the boiling point (broth must never do more than simmer), allow to
simmer for three or four hours, skim, strain, and cool. When
thoroughly cold, remove all of the fat, using blotting paper to absorb
the fine particles of grease. If parsley and celery are to be used to
flavor the broth they may be added during the last hour of cooking.
Barley requires to be soaked overnight when it is used in broth; rice
should be soaked one hour. When either are to be left in the broth it
is better to cook the broth for three hours, strain, return to the
fire, adding the rice or barley. Allow it to simmer for an hour or
more and proceed as directed. When the broth is taken from the fire,
it should be measured, and boiling water added to bring the amount up
to the original quantity. This will give what is known as standard
broth. Bouillon is clarified broth, most of the already small amount
of nutrient material being thus strained and cleared from the broth,
leaving a liquid of practically no fuel value.
CLAM OR OYSTER BROTH
_11.5 calories without milk; 162.5 calories with milk_
1 doz. clams or oysters
1 tbs. whipped cream
1 pt. water or 1 cup each milk and water
A dash of pepper
Scrub clams and place in an iron spider and allow to heat gently until
the shells open. (When oysters are used allow to heat until the edges
curl.) Chop, cover with hot water, and allow to simmer 15 minutes,
strain through cloth, add salt and a dash of pepper. If milk is to be
used in place of part of the water, add it during the last 5 minutes
of the cooking. Clam broth without milk may be served hot or cold; it
will not jelly as other broths but may be frozen if desired.
CLAM BROTH
_Without milk, 55.6 calories; with milk, 113.4 calories_
1/2 cup (4 oz.) clam juice
1/2 cup hot water or milk
Salt and pepper to taste
1 tbs. whipped cream
Mix clam juice (bottled) with water; heat, add salt and pepper, pour
into cup, place whipped cream on top, and serve at once.
BEEF JUICE
One-fourth pound lean beef.
Wipe clean with damp cloth, cut in inch pieces and sear on a hot
griddle, place in a meat press and remove all juice from meat. Care
must be taken not to cook the meat. The juice may be reheated by
placing in a hot cup in hot water, not allowing the temperature to
exceed 155 deg. F.
CHICKEN JELLY
_308 calories_ _1 serving, 75.8 calories_
1/2 small chicken
3 pt. water
1/2 cup celery
1 sprig of parsley
1 tbs. gelatin soaked in 1/4 cup cold water
1/2 tsp. salt
1/4 tsp. red pepper
1 egg white
Cut the chicken in pieces, break the bones, place in a saucepan with
all of the ingredients except the gelatin and egg white, cover with
the water and boil until the meat falls from the bones. Press out as
much of the juice as possible, strain and allow to cool, remove all of
the grease, and return to the fire. Reduce to 1 pint, add the gelatin,
stir in the beaten egg white, and allow to boil 5 minutes, strain
again into molds and set aside to congeal.
CALF'S-FOOT JELLY
_376.6 calories_
2 small calf's-feet
1/2 small fowl
1 cup of Rhine wine
1 lemon
1/2 stick of cinnamon
1 egg white (well beaten)
Cut the fowl and the calf's-feet into small pieces and place them in a
saucepan with 3 pints of cold water and the cinnamon. Cook until the
meat falls from the bones (the quantity should be reduced to 1 pint).
Strain and squeeze out as much of the juice as possible, allow to
cool, and remove all of the grease. Add wine and lemon juice (and
sugar if desired) and reduce the amount of broth one-half, add the egg
white and allow to boil 5 minutes. Clear and strain into molds.
BROILED QUAIL OR SQUAB
_418-543 calories_
Split down the back and place on the broiler, cut surface uppermost.
Or place upon a hot pan, cut surface next to the hot surface so that
the cut side may sear quickly, thus keeping in the juices instead of
having them wasted in the pan by slow cooking. The process requires
about 15 to 20 minutes. Serve on toast, with butter, pepper and salt.
Quail or squab cooked inside the stove is often more palatable than
that cooked on a broiler. The bird is split as for broiling, and
placed in a small pan just large enough to hold it; a strip of bacon
pinned about the breast; add 1 tablespoonful of butter in bits, dust
the cut surface first with salt and pepper, then with flour; add 1/2
cup of hot water. Turn another pan over the bird (it must fit closely
to keep in the steam), place inside the oven and cook about 10
minutes; turn the bird over and cook 10 minutes longer. Lift the bird
from the pan and place it where it will keep hot, add a tablespoonful
more water and a teaspoonful more flour to the gravy in the pan, stir
briskly to remove any lumps, remove bacon and place the bird upon a
slice of nicely browned toast; pour over it the gravy, garnish with a
sprig of parsley, and serve at once.
BIRDS A LA BAIN-MARIE
1 small chicken, or bird
2 tbs. butter
1 tbs. parsley
Salt and pepper
Split birds or chicken as for broiling, place one-half in a chafing
dish or double boiler (bain-marie), dot the cut surface with butter,
sprinkle over it the parsley, dust with pepper and salt; place the
other half of the chicken or bird on top of this, add the rest of the
butter, dust with salt and pepper, cover, and place the pan over the
hot water pan; allow to steam for about 1 hour, lift from hot water
pan and place in oven or under the flames to brown lightly. Serve on
buttered toast.
CHICKEN (ONE-HALF)
_355 calories_
Split small chicken (broiler) down the back, flatten the breast bone
with knife before placing upon the broiler, proceed as in broiling
birds, allowing from 25 to 30 minutes for the process. Chicken is very
palatable and dainty if cooked after the manner described in cooking
quail and squab inside the stove. The process is called smothering.
Serve upon buttered toast, garnished with parsley.
ROAST CHICKEN, TURKEY OR DUCK
Draw the fowl and wash thoroughly inside and out. (If it is purchased
from the market, it is well to wash the inside with soda water to
remove any stale flavor that may be present.)
Make a dressing from one-third of a small loaf of bread broken into
small pieces; 1/4 cup chopped celery, 1 tablespoonful of chopped
parsley, 1 tablespoonful of butter and one egg beaten lightly. Stuff
the cavity with dressing, sew up the opening and place in dripping
pan. Place pan under the flame for a few minutes to brown, unless a
regular roasting pan (savory roaster) is used; allow to bake from 45
minutes to an hour and a half for chicken and duck according to the
size, and from an hour and a half to three hours for turkey according
to size. A cupful of boiling water may be poured into the pan in which
the chicken, etc., is being roasted and flour may be sifted over the
top; dust with salt and pepper. When an ordinary pan is used for
baking, the fowl will require frequent basting to keep it moist and
tender. Just as the baking is finished, more butter, flour, and
seasoning may be added, with a cup or more of boiling water to make
additional gravy.
SWEETBREADS
_209 calories_
1/4 set of sweetbreads
1 lemon
1/2 tsp. of salt
1/4 tsp. of pepper (red)
Wash sweetbreads carefully and allow to stand 1 hour in ice water,
allow the water containing the lemon juice, salt and pepper to come to
a boil and drop in the sweetbreads, cook for 15 to 20 minutes or until
tender when pierced with fork. Remove from hot water and pour ice
water over them to blanch. Serve either in cream sauce or split in
half and broil upon a slightly greased broiler until light brown;
season with a dash of salt and pepper.
BROILED OYSTERS
_174 calories_
6 oysters
2 tsp. butter
1 slice toast
Salt and pepper to taste
Grease broiler or hot frying pan slightly, place oysters upon the
heated surface and place under the flame or on top of the stove; cook
until the edges curl (2 to 3 minutes), lift to a hot dish containing
the butter, place toast upon small plate (toast and plate must be
hot), dispose the oysters upon the toast, and pour over them the
butter.
BEEFSTEAK
_267 calories_
_3 inches long by 2 inches wide by 1-1/2 inches thick_ (_weighing
about 3 ounces_).
Wipe steak off with a wet cloth and dry before cooking. Slightly
grease the broiler and place under the flame, count ten as the clock
ticks and turn the steak over, count ten again and again turn;
continue this for about 3 minutes or until the steak is seared upon
both sides, lift the broiler to a lower part of the oven and continue
the cooking for 5 to 8 minutes; run a sharp-pointed knife between the
meat and the bone (if the steak is a porterhouse or sirloin), and if
the flesh is red, continue the cooking a minute or more. If it is
pink, lift to a hot plate, place 1 teaspoonful of butter upon it, dust
the surface with salt and pepper and serve hot. Pan broiling is done
on the top of the stove in a flat frying pan. Wipe the pan with a
clean wet cloth, place upon the stove and heat piping hot, and place
the steak (without greasing the pan) upon the hot surface. Proceed as
in broiling under the flame. After the first 3 minutes of cooking,
place the pan on a cooler part of the stove to finish the cooking.
LAMB OR MUTTON CHOPS
_2 chops, 304 calories_
1 to 2 inches thick will require from 10 to 15 minutes' cooking.
Scrape the bone clean and wrap in paper or dough to prevent the bone
from becoming charred. Proceed as in cooking beefsteak.
VEAL CUTLETS
_2 cutlets, 275 (about) calories_
Dip cutlets first in egg (mix one yolk with 1 tablespoonful of water)
then in bread crumbs; pan broil (grease the frying pan slightly), or
broil under the flame as directed in cooking beefsteak. Veal cutlets
may be served plain, or with tomato sauce.
Cutlets or chops may be cooked in paper bags if desired. Wrap the chop
in a thin slice of bacon, grease the paper (a piece of heavy brown
paper), place the chop inside and secure the ends with paper clips or
pins; place in a pan and cook in the oven, or under the flame. It is
wise to slip the bag containing the chop inside of another bag; in
this way the meat will not taste of scorched paper if the outer bag
should burn.
BACON (1 SLICE)
_194 calories_
Place bacon on a rack and place rack in a dripping pan, set in oven
and bake until crisp and brown. Or, arrange bacon on broiler, place
pan beneath to catch the drippings and prevent the fat from catching
afire, broil as beefsteak.
* * * * *
When steak or chops are served, parsley or sliced lemon may be used as
garnishes. Chops may be served garnished with green peas, and the
beefsteak served with potatoes cooked in any way; all meats should be
served very hot. It is best to cover with a plate.
FISH
Split down the back, and broil as beefsteak. Fish does not require
more than from 10 to 15 minutes to broil unless very large. Serve with
teaspoonful of parsley and butter.
FISH STEAKS, STUFFED WITH OYSTERS
_3 ounces, 168.3 calories (about)_
_Halibut, trout, or any good baking fish, 235.8 calories (about)_
2 slices of fish
1 - 1-1/2 in. thick
1 doz. oysters
1 cup bread crumbs
4 tbs. butter
Salt and pepper
Lay fish for one hour in a French dressing made from 1/2 cup of oil,
1/3 cup of vinegar, salt and pepper; drain and place upon slices of
bacon, placed upon a fish sheet or dripping pan. Dip oysters first in
melted butter, then in bread crumbs, and place upon the slice of fish,
adjust second slice above, cover top with bread crumbs, dot with
butter and bake 30 to 45 minutes in moderate oven. Serve with
hollandaise sauce.
LOBSTER OR CRAB
_1 serving lobster, 157 calories_
_1 serving crab, 154 calories_
1 lobster
1 tbs. butter
or
1 crab
2 tsp. butter
2 tbs. bread crumbs
1/4 tsp. salt
1/8 tsp. pepper
Boil lobster or crab until bright red, lift from boiling water.
Split lobster down the back and carefully remove cord, gall sack, and
sand bag before broiling or serving. Serve with melted butter.
Pick meat from shell of crab, and mix with salt, pepper and butter.
Stuff into shell. Cover top with bread crumbs, and brown in the oven.
HOLLANDAISE SAUCE
_178 calories; 1 tablespoonful, 22 calories_
1 egg (yolk only)
2 tbs. lemon juice
1 tbs. butter
1/4 cup boiling water
Salt and pepper to please
Beat egg yolk with lemon juice; add one-half the butter; place in
double boiler over hot (not boiling) water. Stir until it begins to
thicken and add remainder of butter; stir in boiling water, cook until
of the consistency of boiled custard.
~Vegetables and Fruits~
Among the plants known as vegetables, some are seeds, some leaves,
some stems or bulbs, some roots or tubers, and some are the fruit
surrounding the seeds. Under the head of seeds we find peas, beans and
lentils, this class of vegetables being spoken of as legumes or
pulses; they are rich in protein (especially when dried) and contain
an appreciable amount of carbohydrates as well, some contain fat.
Green, or fresh legumes are more easily digested than the dried
legumes. They are important sources of iron and phosphorus and contain
a certain amount of calcium; in the body they act as neutralizing
agents since the base-forming elements in these plants predominate
over the acid-forming elements.[42]
Among the "leafy vegetables" we find, lettuce, cabbage, spinach, beet,
turnip and mustard greens, chard and parsley. These vegetables are not
only prized for their mineral content but furnish a recognized source
of the fat soluble vitamine, "A."
Tomatoes, squash, cucumbers and pumpkin are vegetables whose "fleshy
fruit" surround the seed but are eaten as vegetables instead of as
fruit.
Potatoes, carrots, parsnips, onions, beets and turnips are among those
whose stems, roots or tubers are eaten as vegetables.
More and more are we coming to see the importance of this class of
foods in the dietary, they are important on account of their mineral
salts, their vitamine factors and for the bulk which they lend to the
food mass which facilitates its passage along the digestive tract. The
majority of vegetables furnish organic acids or their salts which
function in the body, as potential bases, assisting in the
neutralization of the acids formed in the body as a result of the
breaking down of the proteins.
~Fruits.~--Fruits have practically the same value from a dietetic
standpoint as vegetables, and the same care must be given to their
selection. Some fresh fruit should be given to children every day to
safeguard them against scurvy. And adults should have fresh fruit
several times a week, the remainder of the time dried fruits may be
used. Canned fruits while good are not so valuable as fresh fruits
and are more expensive than the dried fruit.
The ~fruits and vegetables~ will here be considered. Some of the
fruits and vegetables contain high percentages of sugar, aside from
the mineral salts, for which they are especially valuable. This class
includes the sugar cane, sugar beet, raisins, dates, figs, etc., while
others such as the potato, taro, banana, etc., furnish an appreciable
amount of starch. All of the vegetables and fruits are rich in mineral
salts, which are as important to the work of the body as the proteins,
carbohydrates, and fats. Hence it is essential to add the foods
containing these mineral salts to the daily dietary both in health and
in disease.
Both fruits and vegetables should be free from blemishes. Those to be
served raw, such as lettuce and other salad vegetables, must be
purchased from reliable markets. Unscrupulous vendors have been known
to sprinkle old wilted vegetables, to restore their freshness, with
water from stagnant pools teeming with typhoid bacteria, thereby
spreading infection broadcast. Vegetables which require cooking before
they are eaten are, for this reason, safer.
~Canned foods~ should be avoided in the diet of the invalid whenever
it is possible; but, when it is not, care should be observed that no
can is used in which there is the least sign of fermentation. Beans
and peas are sometimes artificially colored, but this custom is not so
prevalent now as it used to be.
PEAS
_121 calories_
1/2 cup fresh peas
1 pt. boiling water
1 tsp. butter
1/4 tsp. salt
Add salt and peas to boiling water; allow to cook from 30 to 60
minutes, or until they are perfectly tender, drain and add butter and
additional salt if necessary, or 1 tablespoonful of cream sauce. In
gastro-intestinal disorders and with young children, it is best to
press peas through sieve or remove the indigestible parts.
STRING BEANS
_94 calories_
1 cupful of string beans (measured after the strings are removed
and the beans cut into small pieces)
1 tsp. butter
1/2 tsp. salt
Cover with boiling water and cook until tender, drain, and serve hot.
SPINACH
_90 calories_
1/2 lb. spinach
1/2 tsp. salt
2 tsp. butter
Wash thoroughly through about ten waters, until spinach is entirely
free from grit, remove the tough stems, lift the spinach from water
and place in a saucepan without additional water, sprinkle over with
salt, cover saucepan and cook until tender (requires about 15
minutes). Cut very fine with sharp knife, or press through sieve, add
butter and serve hot.
CARROTS (WITH CREAM SAUCE OR BUTTER)
_82-117 calories_
Carrots, about 1/2 cupful after they are cut in cubes, or 3-1/2
ounces. Serve with 2 tablespoonfuls of cream sauce, or with 2
teaspoonfuls of butter and a little salt and pepper. Scrub carrots and
scrape off the skins; cut into slices or cubes, drop into slightly
salted boiling water and cook until tender; drain and add butter or
cream sauce.
BAKED POTATO (WHITE)
_140 calories_
1 potato weighing about 3 ounces; scrub well with a brush; dry and
slightly grease surface, place in moderately hot oven and bake about
45 or 50 minutes. (The potato should feel tender upon pressure.) When
done, make an incision of 1 inch in the skin and gently press out the
steam; cover closely with cloth and keep in a warm place until ready
to serve. Put teaspoonful (about 1/6 ounce) of butter in the cut and
serve very hot.
CREAMED POTATO
_182 calories_
1/4 tsp. salt
1 medium size potato
2 tsp. milk
1 tsp. butter
Pare and boil potato until tender when pierced with a fork; drain off
the water and return the saucepan to the stove; shake the pan (to
prevent burning) until the potato looks dry; mash with fork or potato
ricer, add milk, butter, and salt. Beat briskly until creamy. Serve at
once or brown in oven.
POTATO STUFFED WITH MEAT
_197.5 calories_
1 potato (baked)
1/4 tsp. salt
1 tbs. cold chopped beef
1 tsp. butter
Dash of pepper
Bake potato, split in half and remove the contents, mix with the
chopped meat, add salt, pepper, and butter; return to the two halves,
set in oven to brown, then serve at once.
SCALLOPED POTATOES
_250.8 calories_
1 potato
1/4 cup milk
2 tsp. butter
Boil potato, not quite tender, and slice in moderately thin slices;
arrange in layer in an individual earthenware baking dish (ramekin),
add butter in bits between layers, pour the milk over; set dish in
oven, cover and bake slowly for 15 minutes, until most of the milk is
absorbed and the potatoes are nicely browned on top. In cases where
the patient is allowed cheese, 2 teaspoonfuls may be sprinkled between
the layers, giving 31 additional calories.
~Vegetable and Fruit Salads~
CUCUMBER
_62.5 calories_
1/2 cucumber (7 in. long)
1/2 tbs. vinegar
1 tsp. olive oil
1/6 tsp. salt
Few grains of pepper
Slice cucumber in thin slices and allow to stand thirty minutes in ice
water, drain and serve with French dressing.
TOMATO (NO. 1)
_with mayonnaise, 61 calories_
_with French dressing, 131 calories_
Wash tomato carefully, cut in shape of flower by cutting almost
through the tomato making six sections. Place on lettuce leaf and
serve with dressing.
1 tsp. mayonnaise or
1 tbs. French dressing
TOMATO (NO. 2)
_63 calories_
Remove skin from 1 medium sized tomato, remove pulp, fill cavity with
following mixture.
1/2 medium stalk celery
The tomato pulp
1 tsp. mayonnaise dressing
FRUIT SALAD (NO. 1)
3 grapefruit
1 cup celery (chopped)
1/4 head of lettuce
1 cupful of mayonnaise
Remove skin and inner membranes from grapefruit, mix with celery and
mayonnaise. Serve on lettuce. This salad may be poured into a tin
(baking powder can, or mould), packed in ice and salt and frozen. Then
served in slices upon lettuce.
FRUIT SALAD (NO. 2)
_1217 calories (about)_
1 cup of grapefruit
1 thick slice of pineapple (chopped)
1 green pepper (1 oz.)
1 cup of celery
1 cup of mayonnaise or French dressing
If mayonnaise is used the mixture may be frozen. If French dressing is
used, serve on lettuce without freezing.
TOMATO JELLY
_77 calories_
1 cup tomatoes (canned)
3/4 cup water
6 cloves
1/2 cup celery
1/4 cup vinegar
1 tbs. of parsley
1/2 tsp. red pepper
1 tbs. granulated gelatin soaked in 1/4 cup cold water
One slice of onion may be added if there is nothing to
contra-indicate it, but care must be taken in adding onion, as it is
apt to disagree with many people. Boil all of the ingredients together
(except the gelatin) for 20 minutes, press through a sieve, then
through a cloth, return to the stove and allow to boil up; add the
gelatin and boil 5 minutes; strain into wet molds.
WHOLE TOMATO STUFFED WITH RICE
_167 calories_
1 medium size tomato
2 tbs. rice (uncooked)
1 tsp. butter
Dash of pepper and salt
Remove the center from the tomato, dust the inside with salt and a
very little pepper and set aside. Boil the rice, when about half done
(10 minutes) add the tomato pulp, from center of tomato. Cook 10
minutes longer, drain the water from the rice, add the butter, salt,
and a little pepper. Fill the center of tomato with rice. Set the
tomato upon a greased paper and bake in a moderate oven for 20
minutes.
BROILED TOMATOES
_353 calories_
Slice 1 tomato in three or four slices
1 tbs. butter
1 slice of bread (round preferred)
1/4 cup of cracker crumbs
Salt and pepper
Heat broiler or frying pan very hot, grease lightly; season crumbs
with salt and pepper; dip slices of tomato in cracker crumbs, covering
both sides well, and place upon the broiler; when one side is browned,
turn over carefully, to prevent breaking, and allow the other side to
brown. Lift the broiler to the lower half of the oven and let the
tomatoes cook gently for 10 minutes. Place bits of butter upon each
slice, then arrange these on the buttered toast.
STEWED TOMATOES ON TOAST
_171 calories_
1/2 cup canned tomatoes
1/2 cup water
1 slice bread
2 tsp. butter
1/4 tsp. salt
Pour tomatoes and water in a saucepan and allow to cook slowly for 20
minutes, add salt and a dash of pepper. Toast and butter the bread,
pour the cooked tomatoes over it and serve at once.
FRENCH DRESSING
_131 calories_
1 tbs. oil
1/3 tbs. vinegar, or lemon juice
Dash of pepper and salt
Have all ingredients cold; mix salt and pepper together; stir in the
oil, add vinegar or lemon juice slowly, beating briskly to form an
emulsion; use immediately or ingredients will separate.
Use as little salt as possible in nephritic conditions.
MAYONNAISE DRESSING
_2109 calories_
1 egg (yolk only)
2 tbs. lemon juice (or vinegar)
1/2 tsp. salt
1/2 tsp. mustard (dry)
Dash red pepper
1 cup olive oil
Method of Mixture: Mix dry ingredients with yolk of egg thoroughly;
add all the acid (use Dover beater). Now add, one teaspoonful at a
time, the olive oil; beat continually until the mixture thickens
(after 8 teaspoons of oil have been added). Put in oil by
tablespoonfuls until all is incorporated. This method shortens the
time of making at least one-half, and the dressing rarely curdles as
it often does in the old methods.
Whipped cream may be added to dressing before serving. Mayonnaise will
keep if placed in a cool place, and the above quantities are more
easily handled than smaller amounts.
~Gelatin Jellies~
LEMON JELLY
_150 calories_
2 lemons (juice only)
1/4 cup sugar
3 tsp. granulated gelatin
1 tbs. cold water
1 egg white
1 cup boiling water
ORANGE JELLY
_280 calories_
3 tsp. granulated gelatin
1 tbs. cold water
1/4 cup boiling water
6 tbs. lemon juice
3 tbs. sugar
2 drops orange extract
1/2 cup orange juice
GRAPE JUICE JELLY
_315 calories_
1/4 cup boiling water
1/2 cup boiling grape juice
3 tsp. granulated gelatin
1 tbs. cold water
1 tbs. lemon juice
3 tbs. sugar
_Method for Fruit Jellies._--Soak gelatin in cold water about 2 or 3
minutes, then pour over it the boiling liquid; add sugar and fruit
juice; strain through cloth into wet molds. Set in cold place to
stiffen; when firm, unmold. Serve with whipped cream, or pour liquid
into baskets made from oranges or grapefruit hollowed out and the
edges scalloped, or pour into shallow pans, and cut in 1/2-inch
blocks when firm, and serve on a bed of whipped cream.
WINE JELLY
_127 calories_
1/2 cup boiling water
3 tbs. sherry wine
1-inch piece of cinnamon
1 tsp. lemon juice and the yellow rind from 1/4 lemon
3 tbs. sugar
_Method for Wine Jelly._--Put water, wine, lemon juice, peel,
cinnamon, and sugar into a saucepan, allow to boil 5 minutes, pour
over gelatin (which has been soaked in cold water). If jelly looks
cloudy return to saucepan, and add 1/2 egg white beaten stiff, allow
to boil 1 minute, stirring constantly, and strain into mold. Serve
with whipped cream.
~Water Ices~
LEMON
_276.5 calories_
2 lemons (juice only)
1/4 cup sugar
1 egg white
1 cup water
ORANGE
_311 calories_
1/2 cup orange juice
1 lemon
1/4 cup sugar
1 cup water
1/4 tsp. orange extract
1 egg white
GRAPE JUICE
_362.6 calories_
1/2 cup grape juice
1 tbs. lemon juice
1/4 cup sugar
1 egg white
METHOD OF MIXTURE
Mix sugar and water and boil to a rich sirup (about 15 minutes), cool,
and add fruit juice (and extract when it is used). Pour into freezer
and surround with a mixture of 1 part salt and two parts ice. When
sherbet is about half frozen, stir in the stiffly beaten egg white and
continue the freezing until mixture is hard. In diseases where it is
found inadvisable to give albumen, 1 teaspoonful of gelatin may be
substituted.
APRICOT
_384 calories_
1/2 cup apricot puree
1 cup water
1/4 cup sugar
1 tsp. granulated gelatin
1 lemon (juice only)
Make sirup of water and sugar, soak gelatin in a little cold water and
add to the hot sirup; press apricots through a sieve and add to the
sirup as soon as it is cool; freeze as directed in other ices.
STRAWBERRY AND RASPBERRY
_346-393 calories_
1 cup fruit juice
1/3 cup sugar
Juice of 1 lemon and
1 egg white.
Proceed as in other ices.
CURRANT
_526 calories_
1 cup fresh currants
1 cup water
1/2 cup sugar
1 tbs. lemon juice
Wash currants carefully and place in a saucepan on a warm but not hot
part of the stove, allow to heat gently until the currants are soft,
press through a cloth, and add the water and sugar; stir until
dissolved (or make a sirup of the water and sugar and add the currant
juice and lemon and freeze as directed in other ices). The egg white
may be added if desired.
LEMON CREAM, OR MILK SHERBET
3 cups (24 ounces) milk
4 lemons
1 cup cream (8 oz.)
3/4 cup of sugar
Mix cream, milk and 1/4 cup of sugar and pour into freezer; freeze
until half frozen (mushy). Add juice of 3 lemons and 1 whole lemon
(peel and pulp) shaved into very thin slices sweetened with remainder
of sugar (if not sufficiently sweet add more sugar and make allowances
for same in fuel value). Continue the freezing until sherbet is of the
right consistency.
~Miscellaneous Desserts~
NUT CHARLOTTE
_with wine 758 calories; without wine 745 calories_
_Two servings_
1/2 cup 40% cream
2 tbs. sugar
8 pecan or walnut meats
1/4 tsp. vanilla or 1 tbs. sherry wine
Dissolve sugar in the cream and beat solid, add flavoring or sherry
and nuts.
ORANGE CHARLOTTE
_631 calories_
1/2 cup of orange jelly mixture (see directions for making under
jellies)
1/2 cup double cream
1 tbs. sugar (the above quantity will require about 2 tsp. of
granulated gelatin).
Pour jelly mixture into a bowl and surround with cracked ice; when it
begins to stiffen, fold in the stiffly beaten cream.
Pour into molds or ice cream glasses and set aside in the ice-box to
become set.
SNOW PUDDING
_428 calories for orange pudding_
Orange, lemon, grape juice, or pineapple may be used in preparing this
pudding.
1/2 cup fruit juice
2 tsp. gelatin
1 tbs. cold water
1/4 cup sugar
1 egg white and
1/4 cup soft custard
Make jelly mixture as already directed and place the bowl in a pan of
cracked ice; when the mixture begins to stiffen, fold in the
well-beaten egg white (beat it in with an egg beater). Pour the
mixture into a mold or individual glasses and set aside on ice to
become set. When ready to serve, unmold and pour on the soft cold
custard.
PRUNE OR PRUNE FIG WHIP
_184.4 or 244.9 calories_
6 prunes or 4 prunes and 1 fig
1 egg white
2 tbs. sugar
Cook the prunes and figs in sufficient water to cover them until they
are perfectly soft, press through a sieve, add sugar, chill
thoroughly, and fold in the stiffly beaten egg white. The above
mixture may be put in individual cups and baked in a slow oven (in a
pan surrounded with hot water) until they are firm in the center and a
light brown. Serve with or without whipped cream.
FOOTNOTES:
[29] "Archives of Pediatrics," Vol. XXII, p. 515, by Van Slyke.
[30] "Chemistry of Food and Nutrition," by Henry Sherman.
[31] "Diseases of Nutrition and Infant Feeding," by Morse and Talbot.
[32] Bulletin 56, Hyg. Lab., Public Health Service, 1908; Circular
153, U. S. Dept. Agric., Bureau of Animal Industry, 1910.
[33] "Diseases of Nutrition and Infant Feeding," p. 173, by Morse and
Talbot.
[34] Quoted from "Diseases of Nutrition and Infant Feeding," p. 173,
by Morse and Talbot.
[35] Rosenau: Bulletin 56, Hyg. Lab., Public Health Service, 1909;
Circular 153, U. S. Dept. Agric., Bureau of Animal Industry, 1910.
[36] Sommerfield: Handbuch der Milchkunde, J. F. Bergman, Wiesbaden,
1909.
[37] Buttermilk Tablets may be purchased from the Chas. Hanson Co.
Lab., N. Y., or from Parke, Davis & Co. The Buttermilk Starter is
prepared by the first mentioned firm and is ready to use, directions
coming with each sample.
[38] Recipes for coffee, egg, cocoa and chocolate junket will be found
in junket recipes, from the Chas. Hanson Co.
[39] Egg white is frequently added to increase the nutrient value of
ice creams and water ices.
[40] Edible Portion.
[41] "Chemistry of Food and Nutrition," by Henry Sherman.
[42] "Food Products," by Henry Sherman.
CHAPTER VI
INFANT FOODS AND FORMULAS USED IN ABNORMAL CONDITIONS
~Formulas Used In Feeding Infants~
WHEY
Put one pint of skimmed milk into a clean saucepan and heat to a
temperature of 100 deg. F. (lukewarm). To this milk add 2 teaspoonfuls of
liquid rennet, essence of pepsin, or 2 junket tablets, stir until well
mixed, and allow to stand at room temperature (70 deg. F.) until firmly
jellied. Break up with a fork until it is finely divided, strain
through thicknesses of cheesecloth; return the fluid part to the stove
and raise to a temperature of 150 deg. F. to destroy the rennet left in
the whey. The whey is then cooled before it is added to the milk or
cream.
BARLEY WATER
3% decoction starch[43]
4 rounded tsp. barley flour
1 pt. water
Mix a small amount of the water with the barley flour and put the rest
of the water into a clean saucepan and allow to heat; when boiling add
thin barley mixture, stir thoroughly, and allow to boil 20 minutes;
remove from stove, measure, and replace with hot water that which was
lost through evaporation to make up the original pint; strain through
two thicknesses of cheesecloth.
OAT WATER
4 rounded tsp. oat flour
1 pt. water
Mix and proceed as in making barley water.
ALBUMEN WATER WITH BRANDY
8 oz. water (cold)
1 egg white
1 tsp. brandy
Mix egg and water and add brandy slowly to prevent coagulating egg
white.
BEEF JUICE
Composition: 0.60% fat, 2.90% protein, and considerable extractive
matter.[44]
Place a piece of round steak upon a hot griddle and turn once or twice
until the outside is seared and the meat is hot throughout. Remove
from griddle and cut into small pieces and place in a small meat press
made for the purpose. A lemon squeezer may be used when the press is
not available. Salt lightly. Begin by giving one teaspoonful and
increase the amount gradually to 1 ounce (6 teaspoonfuls). According
to Morse and Talbot, it is never wise to give babies more than 2
ounces of beef juice even in their second year, as it is apt to
disturb digestion. Also babies are often made restless or sleepless by
taking beef juice.
MALT SOUP
_347 calories_
1-1/2 - 2 tbs. malt soup extract (reduce if necessary)
1 level tbs. sifted flour
1 pt. milk
18 oz. water (hot and cold)
Dissolve malt soup extract in 1/2 cup of hot water and measure in
enough cold water to cool the mixture. With the remaining cold water
mix the flour until it is free from lumps; and to the malt soup
mixture, add milk. Pour all into a clean saucepan and bring slowly to
the boiling point; simmer (not boil) for 20 minutes. Now increase the
heat and allow the mixture to boil 5 minutes; strain and use as
directed.
This is a fattening mixture and the amount of malt soup and whole milk
may be increased as the child is able to handle it, taking care,
however, not to increase the strength of the mixture too rapidly or
too much, or digestional disturbances will result.
BUTTERMILK MIXTURE FOR INFANTS
_544.6 calories_
1 tbs. wheat flour, 4 tbs. dextri-maltose, 8 oz. hot water plus enough
hot water to replace that which is lost through evaporation (about 6
oz.). Buttermilk, sufficient quantity to make 1 quart of mixture. Mix
flour with a little cold buttermilk. Dissolve sugar (dextri-maltose)
in the hot water.
Stir two mixtures together and add enough buttermilk to make 1 quart.
Place on stove and bring mixture quickly to a boil. Boil for 20
minutes, stirring constantly, strain, measure, and add enough boiling
water to replace that which is lost in cooking. Place on ice and use
as directed.
The nurse will soon be able to tell how much water is lost in
evaporation and add the additional amount to the mixture before
beginning the boiling.
EIWEISSMILCH[45]
(PROTEIN OR ALBUMEN MILK)
1 quart fresh whole milk
1 pint of fresh buttermilk
4 teaspoons essence of pepsin,
Heat whole milk to 100 deg. F., add essence of pepsin and stir
thoroughly. Allow to stand at same temperature until the curd is
formed. Pour mass into muslin bag and drip the whey from the curd.
When the mass is as dry as it is possible to have it, remove it from
the bag to a fine strainer. Press curd through the strainer with a
wooden spoon or potato masher (the author has found that a potato
ricer with a piece of copper gauze, such as is used in a chemical
laboratory, inserted, facilitates the breaking up of the curd). The
mass must be passed several times through the strainer in order to
make the precipitate sufficiently fine to look like milk. During the
process of straining, the buttermilk is added. The composition of
above formula is, according to Finkelstein and Meyer, as follows:
Protein 3%, Fat 8.5%, Sugar 1.5%, Salts 0.5%.
There are several prepared Eiweissmilch mixtures on the market, Beebe,
Hoose and others. Larasan Roche is also a prepared mixture having a
composition much like that of the original Eiweissmilch, it is easily
prepared, and the results from feeding this milk have been found
generally good.
FORMULAS USED IN DIET FOR CONSTIPATION
PRUNES AND FIGS
1/2 lb. each prunes and dried figs
1 oz. senna leaves
Boil from 2 to 3 hours as directed in preparing prunes as above. Lift
fruit from hot sirup, place in quart jars, strain the juice and pour
over the fruit. Use as needed.
CONSERVE
1/3 lb. prunes (pits removed)
1/3 lb. raisins (seeded)
1/3 lb. figs
1 oz. senna leaves
Boil prunes just enough to allow of the pits being removed. Cool and
pass with the senna leaves, figs and raisins through the food
chopper. After passing through once return to chopper and pass through
a second time. See that the senna leaves and fruit are thoroughly
mixed and finely chopped. Place in a quart jar and give in doses of
from 1 to 2 teaspoonfuls night and morning.
BRAN GEMS (NO. 1)
_560 calories_
2 tbs. molasses
1/2 tsp. salt
1/2 cup milk
1-1/2 cup bran
1/2 tsp. soda
1 egg
Mix soda into bran, add salt, stir milk and molasses together and stir
into bran; add well-beaten egg. Bake in 6 well-greased gem pans.
BRAN GEMS (NO. 2)
_832 calories_
1-1/2 cups bran
1 tbs. sugar
2 tbs. melted butter
1 egg
1 cup milk
2 tsp. baking powder
Mix together and bake in 6 well-greased gem pans.
BRAN BISCUITS
_706 calories_
1 cup of bran
1/2 cup of flour
1/2 tsp. salt
2 tbs. butter and lard mixed
1-1/2 tsp. baking powder
1/3 cup of milk
Mix flour, salt, baking powder and shortening together. Add milk to
make a soft dough. Mold into biscuits, and bake in a quick oven 10 to
12 minutes.
BRAN COOKIES
_2187.5 calories_
1/2 cup of sugar
1/2 cup of molasses
1/4 cup of butter and lard mixed
1-1/2 cups of bran
1 cup of flour
1 tsp. cinnamon
1 tsp. ginger
1/2 tsp. cloves
1/2 tsp. nutmeg
2 eggs
1/2 cup raisins or nuts may be added, due allowance being made for the
additional fuel value.
Cream butter and sugar together, add molasses. Sift flour, salt and
spices together. Add eggs (well beaten), to sugar mixture and stir in
the remainder of ingredients. Drop from spoon on a well-greased pan,
bake in moderate oven to a delicate brown.
(See Protein-free cookies, p. 340.)
~Nutrient Enemas~[46]
NO. 1. MILK AND EGG
6 oz. milk, 1 egg
1 tsp. pure peptone (this may be omitted)
1/2 oz. normal saline solution
1 tube peptonizing powder dissolved in 1 tbs. water
Mix thoroughly and peptonize at a temperature of 110 deg. F. for 1 hour.
NO. 2
8 oz. milk
3 eggs
3 grains table salt
NO. 3
8 oz. milk
2 oz. glucose (grape sugar)
NO. 4. SINGER'S ENEMA
125 gm. (about 4 oz.) milk
125 gm. (about 4 oz.) wine
1 or 2 egg yolks
Salt
1 tsp. Witte's peptone
NO. 5. BOAS' ENEMA
250 c.c. (8 oz.) milk
2 egg yolks
Small quantity of salt
1 tbs. of red wine
1 tbs. "Kraftmehl" Health Flour
NO. 6
6 oz. bouillon
4 oz. red wine
1 egg yolk
1 to 2 tsp. dry peptones
NO. 7. MILK AND STARCH ENEMA--VON LEUBE
250 c.c. (about 8 oz.) milk
70 grains starch
MALTED MILK ENEMA
Dissolve 1 oz. of malted milk in 8 oz. of hot water
1 egg and 1/2 tsp. salt or 1/2 oz. saline solution
NORMAL SALINE SOLUTION
1 dram sodium chloride (common salt)
1 pt. (16 oz.) water, (boiled)
~Formulas Used in Diabetes~[47]
* BRAN AGAR WAFERS
Makes 30 wafers.
2-1/2 quarts washed bran (_dry_)
36 gms. agar-agar
1-1/2 tsp. salt
2 saccharin tablets (1/2 gr.)
600 c.c. of cold water
Mix agar-agar, saccharin, salt and water. Boil until dissolved. Pour
over dry bran. Mix thoroughly and mold into muffin tins while hot.
Bake in a slow oven about 20 minutes, or until wafer is dry and will
whirl in the tin.
* AGAR JELLY
1 tsp. or 7 gms. agar-agar
1 cup cold water
1 tsp. mild citric acid
1/2 gr. saccharin
1/4 tsp. flavoring
Coloring--as desired
Dissolve agar-agar in water. Add citric acid and saccharin. Put over
flame and boil. Remove from fire--add flavoring and coloring. Put in
cool place to harden. This jelly has no food value.
* SPINACH AND EGG SALAD
3 gms. gelatin
2 tbs. cold water, melt and swell over hot water.
Add:
6 tbs. cold water
2 tbs. vinegar
50 gms. fresh cooked spinach
1 hard cooked egg
Salt as desired
Surround mold with slices of hard cooked egg, placing the spinach in
the center. Pour over this the gelatin mixture; allow to mold and
serve on lettuce.
* MAYONNAISE DRESSING
2 egg yolks
360 gms. of salad oil
60 c.c. vinegar
8 gms. salt and pepper
Beat egg yolks. Gradually add oil until all has been used (beating the
mixture constantly). Then add the remainder of the ingredients. Put in
a covered jar and keep in a cool place.
The percentage composition of this dressing is
Fat--83%. Protein--0.9%
CELLU BRAN CRACKERS
1/2 cupful cellu flour
1 cupful dry, washed bran
1 tablespoonful India gum
1 teaspoonful baking powder
1/2 teaspoonful salt
3 tablespoonfuls mineral oil
1/2 grain saccharin
Hot water
Makes 12 crackers about 4 inches by 4 inches and 1/8 inch thick
(resembling Graham crackers).
Mix all dry ingredients. Add mineral oil and saccharin dissolved in a
small amount of water. Then add sufficient hot water to make a soft
dough. Spread on a baking sheet or in flat baking pans and cut into
twelve wafers. Bake in a slow oven until dry.
These crackers have practically no food value.
* * * * *
Soya Manna may be secured from Vitae Health Food Company, 364 Roy
Street, Seattle, Washington.
Soya Manna muffins may be substituted for hepco cakes in any of the
following recipes:
** OLMSTED BRANCAKES
(_Recipe 41_)
3 cupfuls bran, washed
2 eggs
2 egg yolks
1/4 teaspoonful salt
50 grams lard or crisco, melted
180 grams water
1/2 teaspoonful baking powder
Mix ingredients in order given and bake in a moderate oven. This
recipe makes 18 muffins. Food value of 6 muffins, 1 gram carbohydrate,
5 grams protein, 23 grams fat.
** SOYA MANNA MUFFINS
(_Recipe 42_)
2 eggs
60 grams cream--20%
140 grams Soya Manna
20 grams butter
1/2 teaspoonful baking powder
100 grams water
Beat eggs, add cream and then flour, beating all the time. Add water
and melted butter. Mold into 12 cakes and bake. Each cake contains 6
grams protein, 6 grams fat: approximately 75 calories.
** NOODLE SOUP
(_Recipe 43_)
1/2 pint broth--clear
1 egg noodle
5 grams butter
Few grains salt and pepper
Beat eggs until stiff and bake in 5 grams of butter as an omelet; let
cool, cut into strips as noodles. Heat broth and add noodles. If
desired, add vegetables, cut in cubes, using such variety and quantity
as give flavor to soup adding their food value to diet. Food value 6
grams protein, 10 grains fat.
** CHICKEN SUPREME
(_Recipe 44_)
50 grams chicken weighed cooked
1/2 egg
50 grams milk
25 grams celery
Few grains salt and pepper
Beat egg slightly, add chicken, cut in small pieces, milk salt and
pepper. Put in mold, set in pan of hot water and bake in moderate oven
until firm. Food value 4 grams carbohydrate, 18 grams protein, 13
grams fat.
** SALISBURY STEAK
(_Recipe 45_)
75 grams steak--fat, weighed uncooked
25 grams onion, uncooked
Few grains salt and pepper
Grind the meat, add seasoning and make into firm balls. Sear in hot
mineral oil, then cook at a lower temperature. Food value, 2 grams
carbohydrate, 17 grams protein, 22 grams fat.
** VEAL BIRD
(_Recipe 46_)
75 grams meat
2 Olmsted brancakes, crumbed
25 grams chopped celery
Few grains salt and pepper
100 grams skim milk
Have meat cut in one thin slice. Use the trimmings chopped fine in
dressing of crumbs, celery and seasoning moistened with water. Spread
dressing on meat, roll and tie or skewer with toothpicks. Put in
casserole and bake in milk until done. Food value, 6 grams
carbohydrate, 23 grams protein, 19 grams fat.
** SALMON MOLDED
(_Recipe 47_)
100 grams salmon
1 egg yolk
5 grams butter
50 grams skim milk
2 tablespoonfuls vinegar
Few grains salt
1/2 teaspoonful gelatin
1 tablespoonful cold water
Remove the salmon from the can, weigh, separate in flakes. Add beaten
yolks, melted butter, milk and vinegar and salt. Cook over boiling
water, stirring constantly until mixture thickens. Soak gelatin,
strain and add to salmon. Fill individual molds, chill, and serve with
cucumber sauce. Food value, 3 grams carbohydrate, 26 grams protein, 23
grams fat.
** CABBAGE SOUFFLE
(_Recipe 48_)
100 grams cabbage, cooked
15 grams lean meat, cooked, minced
35 grams sour cream--16%
1 egg
10 grams American cheese
Few grains salt and pepper
Chop cabbage fine, add meat, cream, beaten egg, salt and pepper. Put
into mould and sprinkle grated cheese over top. Bake in a moderate
oven until firm and brown. Food value, 5 grams carbohydrate, 15 grams
protein, 17 grams fat.
** CELERY RAMEKINS
50 grams milk
1/2 hepco cake
25 grams celery
1 egg
5 grams butter
Few grains salt and pepper
Heat milk; add crumbed hepco cake, grated celery and seasonings, let
come to a boil, add butter, remove from fire; add beaten egg yolk.
Fold into beaten white. Put in ramekin and bake 20 or 30 minutes in
slow oven until well browned. Food value, 3 grams carbohydrate, 11
grams protein, 15 grams fat.
** BAKED ONION
50 grams onion, uncooked
10 grams ground meat, lean cooked
15 grams whole milk
Few grains salt and pepper
Parboil the onion, scrape out the inside, leaving only shell. Weigh
shell and scrapings to 50 grams. Add meat and return to shell. Put
into casserole, add milk and bake until tender. Food value, 4 grams
carbohydrate, 4 grams protein, 2 grams fat.
** SQUASH PIE
(_Recipe 92_)
1 egg
150 grams squash cooked
50 grams cream--16%
1/2 teaspoonful cinnamon
1/4 teaspoonful nutmeg
Few grains salt
1/2 grain saccharin
Beat egg, add mashed squash, cream, spice, salt and saccharin
dissolved in 1 teaspoonful of cold water. Bake until firm in center,
using cellu flour recipe for pie crust. Food value, 12 grams
carbohydrate, 10 grams protein, 14 grams fat.
** SPICE COOKIES
(_Recipe 93_)
2 eggs
1/2 grain saccharin
10 grams cream--16%
1 teaspoonful spices--cinnamon, cloves, nutmeg
20 grams ground almonds
Beat the yolks, add saccharin dissolved in cream, then spices and
ground almonds. Add to the stiffly beaten whites. Drop from spoon on
oiled pan and bake in hot oven. Food value, 4 grams carbohydrate, 16
grams protein, 25 grams fat.
CREAM OF CAULIFLOWER
1/4 cup cauliflower puree
2/3 cup chicken or beef stock
1/4 tsp. onion juice (if desired)
2 tbs. 40% cream
Salt and pepper
Add cauliflower to stock, and allow to come to a boil, season and add
cream. Serve at once.
TOMATO BISQUE
1 cup creamed tomatoes
1/2 cup water
1 sprig (1 tbs. chopped) parsley
3 cloves
1/2 tsp. salt
1/8 tsp. soda
1-1/2 oz. (3 tbs.) 40% cream
Cook tomatoes with cloves, parsley, and water for 20 minutes. Press
through sieve and return to fire. Add soda; when effervescence ceases,
add cream, and serve at once.
SPINACH SOUP
30 gm. cooked spinach
15 c.c. 40% cream
1 egg yolk
Cook spinach until tender and press through a sieve; add the broth;
allow to cook about 5 minutes and add the well-beaten yolk and cream.
Place the saucepan over hot water and cook 10 minutes. Season and
serve at once.
Other Cream Soups, except Tomato Bisque, are made by the same recipe.
VEGETABLES
The nurse must be governed in the selection of the vegetables by the
physician, using those from the 5% group until otherwise ordered.
These must be boiled in three separate waters to further reduce their
carbohydrate content.
Cream or butter is added to them when diet permits; in the beginning
(after starvation) only salt or (in case the vegetable is given in
form of a salad) a little lemon juice with a little salt and pepper
added.
Grated onion, a small quantity of celery seed, or a tiny bit of
chopped green pepper may be added for additional seasoning. When some
fats are allowed, butter, olive oil, and cocoanut cream may be used;
the latter is prepared as follows:
1 small cocoanut grated; this is washed in cold water slightly
acidulated with vinegar to remove the sugar, then washed to remove the
vinegar. Over the washed cocoanut pour 1 pint of boiling water; allow
to stand until cold enough to squeeze through a cloth; press as much
of the water out as possible. Pour the water into a shallow dish and
allow to stand until the cream rises; skim off and serve with lemon
juice on salad as a dressing.
BOILED CORNED BEEF WITH CABBAGE AND OTHER VEGETABLES[48]
"A portion containing 50-75 grams meat and 100 grams of each vegetable
makes an excellent meal."
Horseradish (sauce) is recommended by Joslin as a seasoning, and some
pickles made from group of 5% vegetables and without sweetening.
Curry powder, tarragon, bay leaves, capers may likewise be used in
moderation to vary the monotony of the diet.
PARSLEY BUTTER
5 gm. butter
1 tsp. chopped parsley
Salt, pepper, and 1/2 tsp. lemon juice, if desired
Cream butter, add lemon juice, salt, and pepper. Stir in parsley.
Serve on meat or fish.
NEUFCHATEL CHEESE SALAD
1/3 Neufchatel cheese
1/4 green pepper
1 tbs. cream (40%)
1 tsp. lemon juice
Season with salt and paprika and dress with cream dressing.
CHEESE SALAD
Mash cream cheese with fork; add tablespoonful chopped pecan nuts to
1/3 Neufchatel cheese. Season with salt and pepper and dress with
French dressing.
TUNA FISH SALAD
1/2 cup tuna fish
1/2 cup chopped celery
Dress with French Dressing.
EGG SALAD
Cook 1 egg hard. Cut into rings; arrange on lettuce leaf; dress with
cream dressing.
TOMATO ASPIC
1 cup canned tomatoes
1/2 cup celery (hearts)
1 tsp. celery seed
1/2 small onion
1/2 cup water
1/4 cup vinegar
3-4 cloves
1/2 bay leaf
2 tsp. granulated gelatin, soaked in tbs. water
Boil all ingredients (except gelatin and celery hearts) 20 minutes.
Measure. Add hot water or tomato juice to make one cup; add gelatin;
allow to cool; cut celery fine, place in mold; pour in the tomato
aspic and allow to jelly in a cold place.
~Bread Substitutes~
BRAN BISCUITS, OR MUFFINS
1 cup washed bran
1 tsp. baking powder
1 egg
1 tbs. melted butter
2 tbs. cream
1/4 tsp. salt
Tie bran in cheesecloth bag and attach to cold water faucet; allow
water to pass through bran, removing starch by squeezing the water
through; using dry. Beat egg separately; add cream; mix with bran, add
melted butter, salt, and baking powder. Grease muffin rings and pour
in the mixture. Bake in moderate oven.
DIABETES MUFFINS[49]
(The Equivalent of an Egg)
Recipe for Hepco Cakes, so arranged that one cake is equivalent to an
egg:
140 gm. Hepco flour Protein 60 Fat 29
2 eggs Protein 12 Fat 12
60 c.c. 40% cream Protein 2 Fat 24
10 gm. butter Fat 9
Make twelve cakes; each cake contains 6 grams of protein, 6 grams of
fat, and approximately 75 calories.
LISTER MUFFINS
So arranged that each muffin is equivalent to one egg:
60 gm. Lister flour (one box) Protein 42 Fat 0
1 egg Protein 6 Fat 6
45 c.c. 40% cream Protein 2 Fat 18
30 gm. butter Fat 25
Make 17 muffins; each muffin contains 6 grams protein, 6 grams fat.
BRAN BISCUITS FOR CONSTIPATION
(By F. M. Allen)
60 gm. bran
1/4 tsp. salt
6 gm. powdered agar-agar
100 c.c. (1/2 glass) cold water
Tie bran in cheesecloth and wash under tap until water is clear. Bring
agar-agar and water (100 c.c.) to boiling point. Add washed bran and
salt and agar-agar solution (hot). Mold into ten cakes; place on oiled
paper and let stand 1/2 hour, then when firm and cool, bake in
moderate oven 30 to 40 minutes. The bran muffins are more palatable if
butter and eggs are added. This may be done, provided the patient
allows for them in the diet.
CASOID FLOUR AND BRAN MUFFINS
1 oz. (30 gm.) casoid flour
1 level tbs. (15 gm.) butter
1 oz. (30 c.c.) 40% cream
1/4 tsp. salt
1 egg white (whole egg may be substituted for 1 egg white)
1-1/2 tsp. baking powder
1 cup washed bran
Total food value: protein, 18 grams; fat, 24 grams; carbohydrates, 1
gram; calories, 300.
One muffin: protein, 3 grams; fat, 4 grams; carbohydrates, trace; and
calories, 50.
The flours and meals used in this recipe are prepared by Cutlard,
Stewart & Walt, Ltd., London (casoid flour). Theo. Metcalf & Co.,
Boston (soya bean meal). Lister Brothers, Andover, Mass. (Lister
diabetic flour).
LISTER FLOUR AND BRAN MUFFINS, OR BISCUITS
1 cup washed bran
30 gm. Lister flour
1 tsp. baking powder
1 tbs. butter
1 egg
1/2 tsp. salt
2 tbs. 40% cream
Sufficient water to make a drop batter (about 1/4 cup)
Squeeze all the water from the bran, then add flour and melted
butter, salt, well-beaten egg yolk and cream. Whip egg white stiff and
fold into mixture. Add baking powder and enough water to make thick
batter. Use less water if biscuits instead of muffins are desired, and
knead into a dough. Roll out into a sheet one-half inch thick and cut
with biscuit cutter.
After making muffin batter, grease muffin ring with melted lard, and
pour half full of above mixture. Bake in moderate oven about 20 or 30
minutes.
SOYA MEAL AND BRAN MUFFINS[50]
1 oz. (30 gm.) soya meal
1 level tbs. (15 gm.) butter
1 oz. (30 c.c.) 40% cream
1/4 tsp. salt
1 cup washed bran
1 egg white (one whole egg may be substituted for one egg white)
1-1/2 tsp. baking powder
Mix soya meal, salt, and baking powder. Add to washed bran; add melted
butter and cream. Beat egg white and fold into mixture; add enough
water to make thick drop batter. Bake in six well-greased muffin tins
until golden brown from 15 to 25 minutes.
Total food value: protein, 11 grams; fat, 27 grams; carbohydrates, 2
grams; calories, 304; one muffin, protein, 2 grams; fat, 4.5 grams;
carbohydrates, trace; calories, 50.
ALMOND BISCUITS
1 cup almond meal
1 oz. cream
1 egg
1 grain (or less) saccharin, dissolved in 1 tsp. of water
1-1/2 tsp. baking powder
3-4 drops vanilla
Beat egg yolk until light, add cream and saccharin; stir this into
almond meal. Fold in the stiffly beaten white. Drop on a greased
paper and bake until golden brown in a moderate oven.
* * * * *
Almond meal or flour is prepared as follows:
Blanch 1 pound of almonds; dry and pass through grinder, or pound in
mortar until powdered. Place in a muslin bag and immerse in a pan of
water acidulated with vinegar to remove sugar; allow to stand 15
minutes. Squeeze dry and place in a warm (not hot) oven to remove all
moisture. Grind or pound once more. Almond flour does not keep well;
it must be made in small quantities and kept in a glass jar in a cool
place.
COCOANUT FLOUR
Grate cocoanut and treat as almonds to remove sugar; dry thoroughly
and grind or pound to fine meal.
COCOANUT BISCUITS
1 cup cocoanut
1 egg white (or whole egg if desired)
1-1/2 tsp. baking powder
1/2 grain saccharin
(A biscuit may be made without saccharin for bread substitute.)
SPANISH CREAM
5 tbs. coffee, or Infusion of cocoa nibs
1 tsp. gelatin
1 tbs. cold water
30 c.c. (1 oz.) 40% cream
1 egg
Saccharin to sweeten
Pour coffee, or cocoa infusion, into a double boiler, beat egg yolk
and saccharin dissolved in 1 tsp. of water, and stir into hot coffee.
Cook gently until mixture coats the spoon (raw flavor of egg has
disappeared); add gelatin and mix thoroughly. Whip cream and egg
white. Place on ice to set.
LISTER CREAM PUFF
This is made by pouring 30 grams of soft custard (diabetic) over 1
Lister biscuit.
CUSTARD
1/2 cup cream
1/4 grain saccharin
1 egg
3-4 drops vanilla or almond extract
Beat egg until it is well broken up, but not light; stir into the
cream; dissolve saccharin in teaspoonful of water and add to mixture.
If custard is to be baked, pour into molds and place upon a rack, or
on a folded cloth in a pan half filled with hot water; bake in
moderate oven until firm in center.
If soft custard is desired, pour mixture into double boiler and cook
gently until mixture coats the spoon and the raw egg flavor has
disappeared.
SNOW PUDDING
Make 1/2 cup gelatin, as directed below.
Whip in 1 egg white.
When gelatin is half congealed, mold and set on ice.
When ready to serve, unmold and serve with custard, or 1 tbs. whipped
cream.
~Jellies~
1 tbs. cold water to 2 tsp. granulated gelatin is used in making the
following jellies:
LEMON
_16.6 calories_
1/2 cup boiling water
1/4 to 1/2 saccharin tablet dissolved in 1 tbs. water
1/2 lemon or 2 tbs. juice and 1/2 rind sliced thin
IRISH MOSS PUDDING
Carefully pick over and wash through several waters 1 tbs. Irish moss.
Place in double boiler with 1/3 cup of water and 3 tbs. 40% cream and
1/4 grain saccharin. Cook until mixture thickens when dropped upon a
cold saucer. Pour over 1 stiffly beaten egg white; add 3-4 drops of
vanilla extract. Mold and set on ice.
Irish moss may be used as a substitute for gelatin. The carbohydrates
in this substance are not believed to be utilized for the manufacture
of glucose in the human body.
ORANGE
_54 calories_
1/4 cup boiling water
1/2 tbs. lemon juice
1/2 cup orange juice
1/4 to 1/2 saccharin tablet dissolved in 1 tbs. water
2 drops orange extract
WINE
_40.8 calories_
1/2 cup boiling water
3 tbs. sherry wine
1 tsp. lemon juice and the yellow rind from 1/4 lemon
1-inch piece of cinnamon
1/4 to 1/2 saccharin tablet dissolved in 1 tbs. water
METHOD FOR FRUIT JELLIES
Soak gelatin in cold water about 2 or 3 minutes, then pour over it the
boiling liquid; add saccharin and fruit juice, strain through cloth
into wet molds. Set in cold place to stiffen; when firm, unmold. Serve
with whipped cream, or pour liquid into baskets made from orange or
grapefruit, hollowed out and the edges scalloped, or pour into shallow
pans, and cut in 1/2-inch blocks when firm and serve on a bed of
whipped cream.
WINE JELLY
Put water, wine, lemon juice and peel, cinnamon, and saccharin into a
saucepan, allow to boil 5 minutes, pour over gelatin (which has been
soaked in cold water). If the jelly looks cloudy, return to saucepan,
and add 1/2 egg white beaten stiff; allow to boil 1 minute, stirring
constantly, and strain into mold. Serve with whipped cream.
~Ices~
LEMON
_30 calories_
1/3 cup water
Fruit juice, 1 lemon
1/4 to 1/2 saccharin tablet
1 egg white
ORANGE
_75.5 calories_
1/2 cup water
1 large or 2 small oranges
1/2 lemon
1/4 to 1/2 saccharin tablet
1 egg white
Sweeten fruit juice with saccharin instead of sugar. Clip egg white
with scissors, or beat with Dover egg beater, add mixture and freeze.
ICE CREAM
(1) Use recipe for soft custard, freezing after the custard has become
thoroughly cold.
(2) 1/3 cup cream
1 tbs. chopped nuts
1/4 grain saccharin or enough to sweeten, dissolved in 1 tsp. water
3-4 drops vanilla, orange, or almond extract
Whip cream, add saccharin and nuts. Pour into a small 1/4-pound baking
powder can, seal the edges of mold or can with a thin strip of
buttered muslin. Pack in equal parts of salt and ice for two hours.
~Sugar-free Milk.~--A sugar-free milk has been advised by Williamson.
It is made from washed cream as follows: 3 tablespoonfuls of cream are
shaken in a pint of water and set aside until the cream rises, it is
then skimmed off and mixed with the white of one egg and diluted with
pure water. This furnishes a beverage not unlike milk in appearance
and flavor.
NUT CHARLOTTE
60 c.c. (2 oz.) 40% cream
30 gm. chopped walnuts
Saccharin to sweeten
3-4 drops vanilla
Whip cream stiff; add saccharin, nuts, and vanilla.
1 tbs. sherry wine and 1 tsp. gelatin soaked in 1 tbs. cold water and
melted over hot water may be substituted for vanilla to vary the above
recipe.
ORANGE CHARLOTTE
75 c.c. (5 tbs.) orange juice
45 c.c. (3 tbs.) 40% cream
1/2 egg white
1 tsp. gelatin
1 tbs. cold water
Saccharin to sweeten
Soak gelatin in cold water; dissolve over hot water, add to orange
juice; add saccharin; set aside until it begins to jelly. Whip cream
and add to partially jellied orange juice; fold in the stiffly beaten
egg white; mold. Serve 30 grams.
FOOTNOTES:
[43] When a 1.50% decoction is desired, use 2 rounded teaspoonfuls to
the pint of water. "Diseases of Nutrition and Infant Feeding," p. 222,
by Morse and Talbot.
[44] "Beef juice is not the same as 'dish gravy,' since the latter
contains a large amount of cooked fat and is often highly
indigestible." Morse and Talbot's "Diseases of Nutrition and Infant
Feeding."
[45] Formula suggested by Finkelstein and Meyer.
[46] "Diet in Disease," by Freidenwald and Ruhraeh and other sources.
[47] Formulas marked with one star are those used in the Presbyterian
Hospital, Chicago, Ill. Courtesy of Miss R. Straka, Dietitian.
Formulas marked with two stars are used in the Olmsted Hospital, Mayo
Clinic, Rochester, Minn. Courtesy of Misses Foley and Ellithorpe,
Dietitians. Formulas unmarked are used by the author in Memphis
General and St. Joseph's Hospitals, Memphis, Tenn.
[48] "Treatment of Diabetes," p. 538, by Joslin.
[49] "The Treatment of Diabetes Mellitus," p. 531, by Joslin.
[50] "Starvation Treatment of Diabetes," p. 43, by Hill and Eckman.
SECTION III
THE HUMAN MACHINE
CHAPTER VII
THE HUMAN BODY
~Chemical Composition of the Body.~--It has been estimated by various
writers that the human body has an approximate average chemical
composition[51] of--
Oxygen about 65 per cent
Carbon about 18 per cent
Hydrogen about 10 per cent
Nitrogen about 3 per cent
Calcium about 2 per cent
Phosphorus about 1 per cent
Potassium about 0.35 per cent
Sulphur about 0.25 per cent
Sodium about 0.15 per cent
Chlorine about 0.15 per cent
Magnesium about 0.05 per cent
Iron about 0.004 per cent
Iodine }
Fluorine } very minute quantities
Silicon }
~Dependence of the body upon Food.~--The human body, like any other
piece of machinery, undergoes a constant wear and tear incidental to
the work it performs, but in the human machine this is not all that
must be included in its upkeep. The replacing of the dead and cast out
cells with new ones, the repairing of the worn cells, the furnishing
of heat, not only for the running of the engine but for the
maintenance of the body temperature,--all of these must be considered
and cared for if life is to continue. In man-made machinery, the
renewal of the worn parts, and the replacing of those no longer useful
must be accomplished by an outside agency. But in the body this work
is performed by the organism; and the material used for the purpose,
as well as that which is used to furnish the heat necessary for the
internal and external activities of the body is food.
~Exceptions to this Rule.~--Under normal conditions the body never
uses its own structure either for fuel or to replace tissue losses. In
starvation the body rebuilds its important tissues, such as the nerves
and glands, at the expense of the less important ones, such as the
connective tissues and the skeletal muscles (Taylor).
Science has proved that for the most part the body does not use the
food materials in their original form, but carries them through a
series of transformations into substances more easily handled by the
organism.
Roughly speaking, we may say that the body carries the foodstuffs
through practically four processes on the pathway through the body,
namely, digestion, absorption, metabolism, elimination.
~Processes Included in Digestion.~--There are several processes
concerned in this transformation of the food materials. Some are
purely mechanical and have to do with the movement of the food mass
through the digestive tract: others are of a chemical character and
bring about distinct changes in the food materials themselves. These
mechanical and chemical processes with the retarding and stimulating
agents that influence them are called digestion.
~Absorption.~--After the food materials have undergone digestion, or
simplification into more available substances, these substances are
absorbed, that is, they are passed through the membranes lining the
walls of the intestinal tract, and thence to the blood.
~Metabolism.~--The utilization of the transformed food materials and
their final fate in the human body is included under the term
Metabolism.
~Elimination.~--After the food materials have been utilized to the
extent of the body's ability to handle them, their waste products are
cast out of the organism by way of the skin, the lungs, the intestines
and the kidneys.
A brief description of these processes seems desirable here.
~Digestion.~--Mechanical digestion begins in the mouth, where through
the action of the teeth, the tongue and the muscles of the jaw, the
food material is ground up and liquefied to a certain extent and made
ready for the chemical action which takes place, to a limited degree
only, as a result of the salivary enzyme in the mouth. The eating of
food causes a flow of saliva from the three pairs of large salivary
glands, and from the numerous secretory cells situated in the
membranes of the mouth. As a rule the food stays for too short a time
in this organ for any appreciable amount of chemical action to take
place, but the liquefaction of the food mass with the salivary juices
which contain the ferment (ptyalin), prepares for its passage into the
gastric organ, and allows the digestion of the starch (the only
foodstuff affected by salivary digestant), to continue in that part of
the stomach until its action is checked by the hydrochloric acid in
the gastric juice.
~Arrangement of Food in the Stomach.~--To simplify the study of the
gastric organs it may be well to think of the stomach as being divided
into three regions, _i.e._, "the fundus, the middle region, and the
pyloric end,"[52] each of which differs slightly from the other. After
being swallowed, the food enters the region situated at the cardiac
end, known as the fundus.
~Motor Processes in the Stomach.~--There are no peristaltic waves in
the fundus of the stomach, and the movement of the food mass is
accomplished through the stretching and contraction of the muscular
walls of the organ which tends to churn and further mix it with the
salivary juices as it is gently pushed out into the middle region. In
this region the peristaltic waves begin and travel toward the pylorus
and increase in force as digestion progresses, ceasing only with the
emptying of the organ. When the first stratum of food reaches the
middle of the stomach it is caught by these oscillating peristaltic
waves and forced forward through the pyloric region and against the
pylorus, from whence it is returned back through rings of
constriction. This forward and backward movement continues as long as
there is food in the stomach, thus thoroughly mixing the mass with the
gastric juice and allowing the enzymes existing in the juices to have
an opportunity for action (chemical digestion).
~Passage of Food from Stomach.~--The material prepared in the stomach,
known as ~chyme~, is passed into the duodenum through the pylorus. The
opening of this sphincter is controlled, according to Cannon, to a
certain extent by the liquefication of the chyme, but more especially
by the presence of free acid in the stomach side of the pyloric
orifice.
~Behavior of Food in the Intestines.~--The food does not pass at once
along the canal, but waits in the duodenum until several portions have
passed through. As the food mass is made alkaline in the presence of
the intestinal juices, the pyloric valve closes, opening again as the
contents nearest it on the stomach side are acidified.
~Intestinal Movements.~--The peristaltic waves in the small intestines
begin in the upper part and start a course ever downward. These waves
in the intestines are two-fold in character; the quick shallow wave
which forces the food string forward, breaking it up into segments,
and backward joining the segments together again, and the strong deep
wave which carries the entire mass forward after each segmentation.
This method of movement in the small intestines is the best one
possible under the conditions which prevail in this region of the
digestional apparatus, since it not only mixes the food material with
the juices necessary for its digestion, but likewise spreads it out
over a wide space, insuring a greater contact with the absorbing walls
of the small intestines.
~The Effect of Muscular Constrictions.~--The muscular constrictions
occurring in the intestines producing segmentation of the food string
have, according to Sherman, the effect of "(1) further mixing of the
food and digestive juices, (2) bringing the digested food into contact
with the absorbing membrane, (3) emptying the venous and lymphatic
radicles in the membrane, the material which they have absorbed being
forced into the veins and lymph vessels by the compression of the
intestinal walls."[53]
~Movements in the Large Intestine.~--The movements in the large
intestine or colon are much like those in other parts of the digestive
tract. The small and large intestine are divided by a valve known as
the ileocecal valve, and any food which passes through it cannot
return, since the valve is a competent one. The cells in the walls of
the larger intestine secrete fluids of a lubricating character,
containing no enzymes of digestion but aiding in moving the fecal
matter toward the rectum.
~Distribution of Secretory Cells.~--Secretory cells are distributed in
each of the three regions of the stomach, but are more numerous in the
middle region than at either end. The third region includes the
pyloric vestibule through which all foods must pass before they can
enter the small intestine, and terminates in the pylorus, the valve
which shuts off the stomach from the duodenum and the rest of the
intestinal canal.
~Chemical Digestion.~--The chemical changes in the food materials,
after they are eaten, are brought about through the action of certain
substances known as soluble ferments or "enzymes." These enzymes exist
in every tissue of the body, and their province is first to break down
the food materials themselves into simpler compounds, and then to
reconstruct the simpler substances into those of a more complex
character, which are more available for the various uses of the
organism.
~Action of the Enzymes.~--As Sherman has stated, "all fermentation is
brought about either directly or indirectly by the activity of animal
or vegetable organisms or cells. When the organisms or cells act
directly and the chemical changes occur only in their presence, the
fermentation is said to be due to an organized ferment. When the
action is not brought about directly by the cell itself, but by means
of a substance secreted by the cell but acting apart from it, this
substance is called a soluble or unorganized ferment or 'enzyme.'" The
enzymes concerned in digestion and metabolism, their source and their
action, may be found in the following table:
TABLE OF ENZYMES[54]
SOURCE AND ACTION OF ENZYMES
==============+===================+==================+===================
| | _Where chiefly_ |
| _Enzymes_ | _found_ | _Action_
--------------+-------------------+------------------+-------------------
{|Ptyalin (salivary |Salivary |Converts starch
{| amylase) | secretions | to maltose
{|Amylopsin |Pancreatic juice |Converts starch
{| (pancreatic | | to maltose
{| amylase) | |
{|Liver diastase |Liver |Converts glycogen
{| | | to glucose
{|Muscle diastase |Muscles |Converts glycogen
{| | | to glucose
Act upon {|Invertase (sucrase)|Intestinal juice |Converts glycogen
carbohydrates{| | | to glucose
{| | | and fructose
{|Maltase |Intestinal juice |Converts maltose
{| | | to glucose
{|Lactase |Intestinal juice |Converts lactose
{| | | to glucose and
{| | | galactose
{|Glycolytic enzymes |Muscles, etc. |Split and oxidize
{| | | glucose
| | |
{|Lipase (steapsin) |Gastric, and |Splits fats to
Acts on {| | pancreatic | fatty acids and
fats {| | secretions, blood| glycerin
{| | and tissues |
| | |
{|Pepsin |Gastric juice |Splits proteins to
{| | | proteoses and
{| | | peptones
{|Trypsin |Pancreatic juice |Splits proteins to
{| | | proteoses,
{| | | peptones,
Act on {| | | polypeptids and
proteins {| | | amino acids
{|Erepsin |Intestinal juice |Splits peptones
{| | | to amino acids
{| | | and ammonia
{|Autolytic enzymes |Tissue generally |Split body proteins
{| | | to simpler
{| | | substances
| | |
{|Guanase |Thymus, adrenals, |Changes guanin
{| | pancreas | to xanthin
{|Adenase |Spleen, pancreas, |Changes adenin
Act on purins{| | liver | to hypoxanthin
{|Oxidases |Lungs, liver, |Changes hypoxanthin
{| | muscles, etc. | to xanthin and to
{| | | uric acid
==============+===================+==================+===================
~Classification of Enzymes.~--Sherman classifies the enzymes of the
body according to their effects:
1. The hydrolytic enzymes:
(a) Proteolytic or protein-splitting enzymes.
(b) Lipolytic or fat-splitting enzymes.
(c) Amylolytic or starch-splitting enzymes.
(d) Sugar-splitting enzymes.
2. The coagulating enzymes, such as thrombin or thrombase (the fibrin
ferment) and rennin, which causes the clotting of milk.
3. The oxidizing enzymes or oxidases (which, if the oxidation be
accompanied by a splitting off of amino groups, may be called
"deaminizing" enzymes).
4. The reducing enzymes or "reductases."
5. Those which produce carbon dioxide without the use of free
"deamidizing" oxygen, such as zymase of yeast.
6. Enzymes causing the breaking down of a larger into a smaller
molecule of the same composition, as in the production of lactic acid
from glucose.
DIGESTION (CHEMICAL)
~Salivary Digestion.~--The table shows that enzymic action begins in
the mouth. ~Saliva~, the characteristic secretion of this region,
contains the enzyme ptyalin which exerts its influence upon the
starches and dextrins. The food mass remains in the mouth for so short
a time, however, that a very small percentage of the starch is changed
to maltose under salivary digestion. The action of ptyalin, however,
continues in the fundus of the stomach until stopped by the acid in
the gastric juice.
~Gastric Digestion.~--The conditions existing in this region of the
gastric organ of digestion are particularly favorable to the
continuance of salivary digestion on account of the neutral character
of the juices secreted by the cells there, and because there is so
little movement taking place. The cells in the middle region,
however, secrete a fluid rich in acid, and as the food mass is
gradually pushed forward by the contraction of the stomach walls into
this portion of the stomach, further conversion of starch and dextrin
to maltose is checked. Gastric juice is secreted by cells situated in
all parts of the stomach. The character of the secretions differs in
different parts of the organ. However, that in the fundus is neutral
in character or even slightly alkaline, according to Howell, while
that in the middle region is highly acid. The pyloric end of the
stomach exhibits strong peptonizing powers and much of the hydrolysis
of protein takes place here. As the food is pushed out of the fundus
it is caught by the waves of peristaltic action and swept toward the
pylorus. This movement of the food mass to and from the pylorus under
the influence of the muscular constriction in the stomach tends to mix
it thoroughly with the juices in all parts of the stomach, and in a
measure to liquefy it to the "souplike" mixture known as chyme.
~Rate of Carbohydrates, Proteins, and Fats.~--Carbohydrates, for
example, do not require any acid for their digestion, hence all of the
acid with which they come in contact can go toward acidifying them,
while the proteins require hydrochloric acid before the enzymes can
begin to exert their activities. Consequently they leave the stomach
much more slowly than the carbohydrates. The fats leave more slowly
than any of the other food combinations. If carbohydrates and proteins
are taken together they leave the stomach more slowly than if the
carbohydrates were fed alone, but more quickly than they would if the
meal consisted of protein alone. When the meal consists of fats and
proteins, the stomach is emptied more slowly than is the case when
either is fed alone.
~Intestinal Digestion.~--Digestion proceeds in an orderly manner
throughout the intestinal canal. The pancreatic juice, bile, and
intestinal juice are poured upon the food mass on its entrance into
the duodenum. The enzymes work simultaneously. _Trypsin_ in the
pancreatic juice takes up the hydrolysis of the proteoses and peptones
and those proteins which have escaped gastric digestion. The
_amylopsin_ likewise in the pancreatic secretion acts upon the starch
and dextrin, changing them to maltose. The lipases split the fats to
fatty acids and glycerol.
The _erepsin_ in the intestinal juice, "succus entericus," brings
about further change in the proteins, with the production of amino
acids. The bulk of the carbohydrates are converted into monosaccharids
in the small intestines. The lactose, maltose, and sucrose are changed
through the activity of the lactase, maltase, and invertase into
glucose. Sherman states that "it is possible that the splitting of the
lactose (milk sugar) may occur in the intestinal wall rather than in
the food mass."[55]
~Bile.~--Human bile, the secretion most actively concerned in the
digestion and absorption of the fats, contains water, bile salts, bile
acids, bile pigments, cholesterin, lecithin, and a peculiar protein
derived from the mucous membranes of the bile ducts and gall bladder.
~Stimulation of Intestinal Secretions.~--The flow of the intestinal
juices is stimulated by a substance or _hormone_ known as
"~secretin~." This hormone is the result of the action of hydrochloric
acid upon some substance in the intestinal wall. Starling claims that
the formation of hormones and their circulation through the blood to
the reactive tissues is sufficient to account for the activity of the
pancreas; he doubts if the nervous system plays any part in the
activity of that organ.
~Secretion of Water in the Stomach.~--The secretion of water by the
cells of the stomach is such, according to Taylor, as to produce
chyme of quite constant consistency, the solid particles being held in
suspension in the fluid medium.
~Factors Influencing Gastric Digestion.~--The factors influencing
digestion in the stomach constitute all those mechanical, electrical,
chemical, and psychical factors which stimulate or retard the action
of the gastric juices. The movements in the stomach are involuntary,
but their activities may be stimulated by the flow of gastric juice.
Sleep retards digestion in the stomach by retarding the movements in
the organ itself.
~Stimuli to Gastric Flow.~--The division and liquefaction of the food
in the mouth hastens gastric digestion by making the food better
fitted for the action of the enzymes in the gastric juice. The type as
well as the character of the food acts as a stimulus to the gastric
secretion.
~Water~ is probably the best of all the agents for stimulating the
secretion of gastric juice, while ~dextrin~ (toast, zwieback) and the
~extractives of meat~ likewise exert similar powers.
~Retarding the Gastric Flow.~--The nervous system, on the other hand,
at times checks or entirely inhibits a flow of these juices. Worry,
excitement, anger, fatigue, chill; each plays its part in promoting
poor digestion in the gastric organ. As chemical factors, water and
salts are the two necessary substances for gastric digestion, since
the enzymes in the juices cannot act except in their presence.
~Alkaline carbonates~ and ~fatty foods~ both check the flow of gastric
juice, and retard digestion. The psychic factors which result in a
stimulation of the secretory cells in the stomach are exerted through
the sight, smell, and taste. One often hears the expression: "The food
looked, smelled, or tasted so good that it made my mouth water." This
actually occurs; hence the secretion has been named appetite juice.
This appetite juice acts as a direct stimulant to the cells in the
mucous lining of the stomach, causing a flow of gastric juice. It
cannot be said to cause digestion, but it certainly institutes that
process, thus starting the whole digestional procedure.
~Digestion in the Larger Intestine.~--Science has proved that most of
the nourishing part of the food ingested is digested and absorbed
before it reaches the larger intestine. The two portions of the
alimentary canal known as the small and large intestine are separated
by the ileocecal valve. Cannon claims "that this valve is competent,
that is, under normal conditions the food mass which passes through
into the colon cannot be forced back into the small intestine." The
food mass sometimes contains materials which have escaped digestion,
likewise some of the active enzymes which bring about their
hydrolysis, in which case a certain amount of their digestion may
continue in the large intestine.
So far, investigators have found no enzymes in the fluids secreted by
the cells in the walls of the large intestine, but they have found an
alkaline fluid which assists in completing the digestion of the foods
which has started in other parts of the intestinal tract.
~Absorption.~--Absorption of food occurs in all parts of the
intestinal canal, but the major portion of it occurs in the small
intestines, the mucous membrane lining of which seems particularly
adapted for this purpose. According to Taylor there is no absorption
of fats, carbohydrates, or proteins in the stomach. Other
investigators believe that some of the protein is absorbed and also
some glucose in concentrated solution. However, the stomach cannot be
considered of great value as an absorbing organ. Physiology teaches
that the absorption of the products of digestion occurs by means of
the millions of small projections or villi with which the intestinal
wall is lined. These villi contain numerous capillary blood vessels
and spaces known as lacteals. The former converge into the portal
vein, the latter into the lymphatic vessels and thence into the
thoracic ducts.
~The Absorption of Fat.~--The fats, as has been described, are split
into their two constituents, fatty acid and glycerol. The former is
dissolved by the bile to form soap; the latter is readily soluble in
water. These constituents thus dissolved pass through the walls and
recombine in the form of neutral fat droplets, probably during the
passage through the walls, since they appear in this form in the
cells. They pass into the thoracic duct and thence into the blood
stream.
~Absorption of Carbohydrates.~--The carbohydrates are chiefly absorbed
in the form of monosaccharids. This has been proved by introducing
cane sugar or lactose into the blood vessels and getting the greater
portion of it back unchanged by way of the urine. As the
monosaccharids are taken up by the capillaries lining the walls of the
small intestines, they are passed on to the portal vein and carried by
the portal blood into the liver, where they are stored temporarily as
glycogen, and given out to the blood in the form of glucose as needed.
After a meal rich in carbohydrates, the portal blood will be rich in
glucose, while the blood in general circulation contains about the
same amount as usual, about 0.1%.
~Absorption of Proteins.~--The absorption of the products of protein
digestion occurs through the capillary blood vessels and passes on to
the portal vein. The metabolism of protein is more complex than that
of any of the foodstuffs. It is probable that each living cell
contains enzymes which are capable of breaking down the body proteins
with the production of amino acids just as the proteins of the food
are broken down by enzymes of digestion, and according to Sherman "it
is not improbable that protein synthesis also may be brought about by
every living cell."
~The Absorption of Water.~--This does not occur in the stomach, as
was formerly believed, but in the small intestines.
~The Absorption of the Mineral Salts.~--This occurs in conjunction
with the other food material. Some of the mineral salts are much more
soluble than others and are more readily absorbed. The function of the
mineral salts in the body has already been described, and since they
form a part of every tissue and fluid in the body their absorption and
fate in metabolism must be studied with that of the other chemical
combinations.
ABSORPTION IN THE LARGE INTESTINES
The digestion of the food as it is passed into the last portion of the
alimentary canal has been largely completed. However, that part which
has escaped digestion in the small intestine is finished and absorbed
here. The important peristaltic waves occurring in this region are
antiperistaltic in character and have the property of churning the
food thoroughly and bringing a larger portion of it in contact with
the absorbing walls. The water which is left in the food mass together
with the products of the digestion of the foodstuffs is absorbed in
the first part of the large intestine, leaving the remainder more
solid. This residue is known as feces or fecal matter.
The diagram on page 179 shows the various processes through which the
foodstuffs pass after absorption.[56]
~Bacterial Action in the Alimentary Canal.~--The changes in the foods
so far mentioned have been chiefly the result of the activity of the
enzymes existing in the various digestive processes throughout the
body. But there are other changes which occur in the foods during
their sojourn in the digestive tract which are not accountable to
enzymic action, but which, in fact, modify to a certain degree the
changes wrought by the enzymes. These are the result of the activity
of certain specific bacteria which inhabit the entire digestive tract
of the individual from a few hours after birth until death. Some of
these have so adapted themselves to the existing conditions that,
unless present in overwhelming numbers, they are not only harmless,
but they actually assist in protecting the organism from the inroads
of more harmful species. Many experiments have been made to find
whether or not bacteria are essential to human nutrition, and the
results of these experiments prove that they are not. However, since
they are so firmly established in the body it is well to study the
various types and learn as much as possible of the products of their
activity and the influence which they exert in human nutrition.
Cells and Tissues
/ | \
Anabolism / | \ Catabolism
Assimilation / | \ Dissimilation
/ | \
Foodstuff < | > End Products
\ | /
\ | /
\ | /
\ | /
Combustion
~Types of Bacteria.~--It would be impossible and unnecessary to
consider the action of all of the bacteria in the body in this text,
but it is necessary to consider those which are prominent in bringing
about decomposition of the foods in the digestive tract. Sherman holds
that there are three main types having this property: "(1) the
bacteria of fermentation, such, for example, as the lactic acid
bacteria; (2) the putrefactive bacteria, such as the anaerobic B.
aerogenes capsulatus; (3) bacteria of the B. coli type, showing the
character of both the fermentative and putrefactive organisms but
tending in general to antagonize the putrefactive anaerobes."[57]
~Fermentation in the Stomach.~--In the stomach, fermentation of the
carbohydrates with the production of organic acids, and at times
alcohol, occurs. The types of fermentation taking place in the stomach
are alcoholic, lactic, butyric, acetic, formic, oxalic, and cellulose.
The bacteria inhabiting the gastric organs are dependent upon air for
existence, while those in the intestines are not.
~Factors Influencing Excessive Fermentation.~--The factors influencing
excessive fermentation in the stomach are lack of "tone" and motility
in the organ, insufficient amount or absence of free hydrochloric acid
in the gastric secretion, dilatation of the stomach, and an excess of
carbohydrate foods in the diet. Of the latter, sucrose and glucose are
especially susceptible to the action of fermentative bacteria. Under
normal conditions, that is, in health, the conditions prevailing in
the stomach are very unfavorable to the development of bacteria of the
putrefactive type, the gastric juice exhibiting decided germicidal
properties. Then, too, the presence of air acts against their
development. Much of the so-called gastric fermentation does not occur
in the stomach but rather in the duodenum.
~Bacterial Action in the Intestines.~--In the lower part of the small
and in the large intestines, the bacteria of the anaerobic type
increase, conditions more favorable to their development existing
there than farther up in the intestinal tract. However, there are a
great many bacteria in the whole of the small intestine. Those
producing decomposition of the unabsorbed proteins are especially
prominent in the colon.
Herter[58] states that "the presence in the colon of immense numbers
of obligate micro-organisms of the B. coli type may be an important
defense of the organism in the sense that they hinder the development
of that putrefactive decomposition which, if prolonged, is so
injurious to the organism as a whole. We have in this adaptation the
most rational explanation of the meaning of the myriads of colon
bacilli that inhabit the large intestine. This view is not
inconsistent with the conception that under some conditions the colon
bacilli multiply to such an extent as to prove harmful through the
part they take in promoting fermentation and putrefaction."
~Effect of Bacterial Activity in the Body.~--In summarizing the
effects of bacterial action in the body it is found that with the
exception of oxalic acid, which is exceedingly injurious, and which,
according to Herter, results from the eating of large quantities of
meat and sugar, the products of fermentation are simply irritating in
character, while those resulting from putrefaction are distinctly
toxic. Among the substances deserving mention under this head we have
indol, skatol, cresol, and phenol. These substances are very soluble
and upon absorption combine with the sulphuric acid formed in the body
and are excreted by way of the kidneys where they appear in the urine
as "conjugated sulphates," the chief of which is indican. The amount
of indican in the urine is taken as a measure of the intensity of the
putrefaction taking place in the body.
~Metabolism.~--Under the term metabolism we understand the series of
processes through the foodstuffs and carried (a) in the conservation
of the tissues of the body and (b) in the maintenance of body
temperature and physical work (Taylor). The processes concerned in
metabolism are chiefly those of building up, "anabolism," and breaking
down, "catabolism." In the processes of anabolism the products
absorbed are built into the tissues and cells of the body. In
catabolism, the worn particles from the cells, and the dead cells no
longer useful are broken up and thrown out of the body. According to
Taylor, "side by side with these processes are the reactions of
combustion, whereby the temperature necessary for the life of the
cells is maintained, and the energy needed for external work
furnished."
~Behavior of Carbohydrates in Metabolism.~--As Sherman[59] has said:
"At least two kinds of enzymes are believed to be involved in the
combustion of glucose in the tissue cells, (1) cleavage enzymes, which
split the molecule into fragments more easily oxidized, and (2)
oxidizing enzymes or oxidases which stimulate the oxidation of the
cleavage products. Both kinds of enzymes are widely distributed
through the body and are believed to be normal constituents of all
active cells."
~Production of Energy.~--It has been proved that the energy for
external and internal work is produced largely from the glucose
brought by the blood and oxidized in the muscles.
When a surplus amount of carbohydrate food is eaten, over and above
the immediate needs of the body for fuel, it is stored in the liver
and muscles as glycogen, which can be readily reconverted into
glucose. When the supply of carbohydrate food is greatly in excess of
the body's needs, that is when the liver and muscles cease to store
glycogen, it is built up into adipose tissue and furnishes a readily
available source of emergency fuel.
~Fate of the Carbohydrates.~--After their oxidation the end products
of carbohydrates, that is, the substances which are no longer
available for use in the body, leave it in the form of carbon dioxide
and water by way of the kidneys (urine), the skin, the lungs, and the
intestines.
~Fate of the Fats.~--The fats upon absorption are taken up by the
lymph vessels instead of the capillaries and enter the blood with the
lymph. According to various investigators, the fat which causes the
turbidity of the blood plasma at the height of absorption will, as a
rule, disappear after a few hours, part of it being burned as fuel,
producing energy for the internal and external work of the body, and
at least a part of the fats eaten being rebuilt into body fat. The
end-products of fat metabolism, like those of the carbohydrates,
consist of carbon dioxide and water, and leave the body by the same
excretory channels.
When the normal oxidation of the fatty acids is interfered with or is
overtaxed, a different reaction from that which usually occurs may
take place, and this results in an excretion of acetone in the urine
(see Chapter on Diabetes).
~Protein metabolism~ is certainly more complex than that of either of
the other active organic food groups. The amino acids which are the
products of protein digestion are taken up by the capillary blood
vessels in the intestinal walls and are passed by them into the portal
vein, soon to become available for the needs of the body.
~Fate of the Proteins.~--After utilization in the body, the proteins,
like the other foods, leave certain waste products which indicate to a
greater or lesser extent the completeness with which the organism has
made use of the food materials. The end-products of protein metabolism
are: ~urea~, ~ammonium salts~, ~purin bodies~, and ~creatinin~. These
products leave the body chiefly in the urine. The chief end-product in
man is urea. This substance represents from 82-88% of the total
nitrogen excreted by the kidneys. However, the less highly oxidized
products represent the incomplete products of protein metabolism and
thus indicate the changes through which these products must pass
before being changed into urea. If for any reason there is an
impairment of the liver through which they must pass and where the
change into urea is accomplished, there will be a rise of ammonia and
a corresponding decrease in the output of urea in the urine. Thus,
ammonia is formed at the expense of the urea. This occurs in fevers,
diabetes, and certain structural diseases of the liver. According to
Sherman:[60] "Normally about 2 to 6% of the total nitrogen eliminated
is in the form of ammonium salts, the amount depending largely upon
the relation between the acid-forming and base-forming elements in the
food."
~Acid-forming and Base-forming Foods.~--Mendel[61] states: "There are
foods which act as potential acids and others which function as bases
in the organism. When burned up either in the laboratory or in the
body cells, they have a preponderance of acid or base, as the case may
be, in their ash." In this respect potatoes, apples, raisins, and
cantaloupes, for example, are base-forming foods which depress the
output of ammonia and increase the solubility of uric acid in the
urine, whereas meal, cereals, and prunes (the latter with their
content of benzoic acid) furnish acids in predominance.
~Purin Bases.~--These compounds are formed in the body as cleavage
products of nucleoproteins or taken into the body in food. The chief
of these products are ~adenin~, ~guanin~, ~hypoxanthin~, ~xanthin~,
and ~uric acid~. The latter is the most highly oxidized of all the
purin bases and is the form in which they are chiefly eliminated in
the urine.
~Formation of Uric Acid.~--The formation of uric acid can in a measure
be controlled by attention to the diet, eliminating those foods known
to be purin-bearing. Normally from 1 to 3% of the nitrogen eliminated
will be in the form of uric acid. The normal human being oxidizes
about half of the purins eaten and excretes about half, mainly in the
form of uric acid. According to Mendel, the formation of uric acid
takes place throughout the body, and its partial destruction is
accomplished by the kidneys, muscles, and liver. The formation of
purins in the body and their elimination in the form of uric acid is
especially significant in certain pathological conditions, gout, for
example, in which the body has difficulty in eliminating these
compounds.
The purin bodies are both endogenous and exogenous--that is, they may
be brought into the body in food as such, or they may be formed as a
result of the metabolism of the body tissues. For this reason the
damage wrought by these substances may to a certain extent be
controlled by eliminating the purin-bearing foods from the diet.
Flesh-foods are high in purins, especially the highly nucleated
glandular organs, liver, thymus (sweetbreads), etc., kidney, beef,
mutton, veal, pork, chicken, turkey, goose, sardines, anchovies, all
kinds of fish except cod. Among the vegetable foods asparagus, beans,
peas, and spinach are highest in purins. Boiling extracts much of the
purins from food. Meat especially should be prepared by this method,
if used in the diet of individuals suffering from gout. Eggs and milk
are purin free, and may be used freely. Certain substances increase
the difficulty of eliminating uric acid. Alcoholic beverages for
example are especially deleterious.
~Creatinin.~--This end-product of protein metabolism is, like uric
acid, endogenous and exogenous. It is one of the normal constituents
of the urine. The quantity is fairly constant for the individual,
averaging about 0.02 gram per kilogram of body weight per day.
~Mineral Metabolism.~--A study of the organic foodstuffs reveals the
fact that many of the mineral salts concerned in nutrition enter the
body in organic combination with those constituents. Certain of the
mineral salts, however, enter, exist in and leave the body in the
same organic form in which they occur in the food materials. This is
true of chlorine, which for the most part, functions in and leaves the
body in the form of chlorides (chiefly sodium chloride). A small part
of the chlorine is used in the production of the hydrochloric acid of
the gastric juice.
Sulphur and iron, both enter the body as essential constituents of
proteins, and their metabolism occurs with that of these foodstuffs;
the sulphur being converted largely into sulphuric acid must be
neutralized at once, and it leaves the body by way of the urine as
inorganic sulphates. Part of the sulphates are excreted as ethereal
(conjugated) sulphates; the amount excreted in this form depending
largely upon the extent of purification in the intestinal tract.[62]
~Phosphorus.~--This mineral salt is found to be present as an
essential constituent of certain proteins, fats and carbohydrates. It
also enters the body in the form of inorganic phosphates. During the
digestion and metabolism of the organic foodstuffs the phosphoric acid
radical is split off and eventually nearly all of the phosphorus
leaves the body in inorganic form (inorganic phosphates).
~Calcium.~--Being the chief constituent of the bones, large quantities
of calcium salts are stored in the skeleton of the child both before
and after birth. The functions of calcium have already been discussed.
That part not stored, which has finished its work in the body is
excreted through the intestinal wall and leaves the body by way of the
feces, only a small part of the calcium concerned in metabolism being
excreted in the urine.
~The Process of Osmosis in the Body.~--The influence exerted upon the
process of osmosis in the body is one of the most important parts
played by the mineral salts in metabolism. The fact that these
chemical substances are indispensable to the metabolic processes makes
it necessary for the nurse to know where they can be found in food and
how best to use them.
~Metabolism of Body Tissues.~--The constant breaking down and building
up of the tissues of the body and the evolution of heat as a
by-product of the energy expended may be summed up in the term
"metabolism." The metabolism of the body is normally supported by the
food ingested. However, it is a known fact that were no food eaten the
processes would continue just the same, the difference only being the
use of the body structure instead of food materials. According to
Sherman, the chemical changes and energy transformations are of course
inseparable. It has become customary to speak of the metabolism of
matter and the metabolism of energy, and to regard the extent of the
metabolism of any material substance as measured by the amount of its
end products eliminated, and the extent of the energy metabolism as
measured by the amount of heat or of heat and external muscular work
which the body gives off.
* * * * *
In summarizing the important factors in the utilization of food by the
body several distinct points are made evident:
1. The composition of the body, and the composition of food, are
practically the same.
2. Food must make good the losses resulting from metabolic processes
and physical activity.
3. Utilization of food by the body necessitates:
(a) Transformation through a series of processes:
(1) Digestion.
(2) Absorption.
(3) Metabolism.
(4) Elimination.
(b) Factors influencing use of food:
(1) Stimulation of secretory cells through appetite
juice (stomach); hormone secretin
(intestines).
(2) Factors retarding use of food:--Fear,
worry, anger, nervous excitement, fatty
foods and alkaline carbonates (bacterial action
causing fermentation and putrefaction).
PROBLEMS
(a) Outline the processes through which a slice of bread and butter
must pass, from the time it is eaten until it reaches the blood
stream.
(b) Outline with a diagram the manner in which the foodstuffs are
utilized in the body.
(c) Show in the form of a table the effect of the enzymes on proteins,
on fats, on carbohydrates.
FOOTNOTES:
[51] "Chemistry of Food and Nutrition," by Henry Sherman.
[52] "Chemistry of Food and Nutrition," by Sherman.
[53] "Chemistry of Food and Nutrition," by Henry Sherman.
[54] Compiled from "Textbook of Physiology," by Howell, and "Chemistry
of Food and Nutrition," by Sherman.
[55] "Chemistry of Food and Nutrition," by Henry Sherman.
[56] This scheme applies to the protein, fat and carbohydrates with
quantitative variations only. Courtesy of Dr. A. R. Taylor, Leland
Stanford University.
[57] "Chemistry of Food and Nutrition," by Sherman.
[58] Herter's "Bacterial Infections of the Digestive Tract" (1907).
[59] "Chemistry of Food and Nutrition," by Sherman.
[60] "Chemistry of Food and Nutrition," by Sherman.
[61] "Newer Points of View Regarding the Part Played by Different
Foodstuffs in Nutrition," by Lafayette Mendel, Ph.D. Read at the
Sixty-fifth Annual Meeting of the American Medical Association, June,
1914.
[62] See "Bacterial Action in the Body," p. 181.
SECTION IV
DIETO-THERAPY