Practical Dietetics for ADULTS AND CHILDREN IN HEALTH AND DISEASE BY SANFORD BLUM, A.B., M.S., M.D. Mv Head of Department of Pediatrics, and Director of the Research Laboratory, San Francisco Polyclinic and Post Graduate School PHILADELPHIA F. A. DAVIS COMPANY, PUBLISHERS 1923 COPYRIGHT, 1923 BY F. A. DAVIS COMPANY Copyright, Great Britain. All Rights Reserved. PRINTED IN U. S. A. PRESS OF F. A. DAVIS COMPANY PHILADELPHIA. PA. DEDICATED TO PROFESSOR J. H. SENGER AS A MARK OF ESTEEM AND AFFECTION. INTRODUCTION. On account of the great amount of time required for the prepara- tion of detailed dietaries for individual patients it is usual for physicians to give them only general directions. This practice re- sults in avoidable mistakes. Dietaries herewith presented, which have been successfully employed by me during a period of twenty years, contain lists which can readily be modified to meet the needs of individual cases. Since dietetics is not an exact science, owing to the influence on metabolism of such variable factors as age, tem- perament, state of health and idiosyncrasies, it is impossible to prescribe correct dietaries based exclusively upon a classification of diseases. The diet should be individualized for each particular case: to be successful it must be adapted to the patient as well as to the disease. Besides being correct from a medical standpoint a dietary should possess two other virtues: it should be of such nature that the patient can and will follow it. It is useless to prescribe for im- pecunious patients time-consuming measures and expensive menus however desirable they might be. In this connection the patient’s occupation as well as resources are important considerations. And it should be a rule to allow such variety and freedom of choice that the patient will follow the prescribed diet rather than transgress the limits and deceive both the physician and himself. Inflexible rules and strict limitations are prone to be disregarded. Moderation in the application of restrictions will, whenever such a course is practicable, prove most advantageous. Stringent die- tetic regulations, which theoretically seem indicated for certain dis- eases, may in practice be harmful to the patient. This applies espe- cially to chronic diseases. Again, when two or more diseases (e.g diabetes and nephritis) coexist, the diet indicated for one may be contra-indicated by the other and must be modified accordingly. Examples of dietaries for complicated cases are incorporated in this treatise. Most people ignore a proper diet in health as well as in disease. One reason for this is the prevalent misconception of the value and usefulness of certain foodstuffs. Thus, the quite general belief that milk is excellent food for all people and all cases is erroneous. V INTRODUCTION. For infants and children the value of milk can hardly be over- estimated : it is for most of them an ideal food. But for adults the case is quite different; for them milk is too easily digestible, leaves too little residue to stimulate intestinal evacuation and can by no means fill the place of meat, vegetables and fruit. Moreover, milk ferments easily, it is a gas former and is ill-tolerated by many persons. Onions, cabbage and coarse foods are often described as “healthy” foods. This opinion proceeds from the observation that such foods act as laxatives. But their laxative effect results from the irritation they cause in the intestines, which in many cases is injurious. Long menus and mixtures are harmful. Owing probably to difference in time required for their digestion, mixtures of foods, which if taken at separate times would be easily digested, may cause trouble. “Normal” diets for well persons of various types and ages are included in this compendium. Digestibility is an indispensable factor in the success of every dietary. In formulating dietaries for all classes of diseases the digestive system must be taken into consideration, as digestibility of the food is a preliminary to success. The caloric value of the food taken avails nothing if the food is not digested. This consideration, together with the fact that the kinds of food avail- able are limited in number, has necessitated a certain amount of repetition. Recently discovery of so-called “vitamines” has provided a scien- tific explanation of some procedures in the practice of dietetics which heretofore have been followed empirically. Though it has long been known that sailors on a diet restricted to preserved foods became scorbutic and that they recovered when given fresh fruits and vegetables; that Asiatics on a diet of polished rice fell victims to beri-beri, whereas on a diet of unpolished rice this did not occur; and that Barlow’s disease developed in babies fed exclusively boiled milk or certain infant foods, the fundamental cause of these events was unknown. It had been recognized that dietetic errors were responsible for these nutritional disorders and the correct treatment for them was known long before the existence of vitamines was suspected. The discovery of the vitamines afforded a scientific ex- planation of the matter. In the typical instances cited above, the diet of the sailor with scurvy, of the Asiatic with beri-beri and of the infant with Barlow’s disease, was deficient in vitamines and this deficiency was responsible for nutritional disorders, which dis- appeared when foods supplying the necessary vitamines were given. VI INTRODUCTION. Investigation in this newly discovered field has already yielded important results. It is known that there are several varieties of vitamines and that some or all of them are necessary for the main- tenance of health. They exist in some foods and not in others. They are present in the vegetable kingdom and also in animal products; for example, in milk and codliver oil. There are at least two water-soluble and one fat-soluble vitamines. They are widely distributed among ordinary foods and are present, adequately or in excess, in ordinarily diversified diets. Cooking may alter or de- stroy them. A detailed discussion of their origin, chemical compo- sition and properties is unnecessary here, but their importance must be recognized and has received consideration in formulating these dietaries. Theoretical considerations should not be allowed to exclude from a dietary foods which practical experience teaches are beneficial for the patient. In making out these dietaries I have striven for simplicity and clearness. For the sake of convenience I have repeated under dif- ferent titles whole or partial lists enumerated under other captions. As a rule, foods are classified under two headings: one of permitted, the other of forbidden viands. Naturally these lists cannot be ex- haustive, but in general they designate the kinds of food to be taken and those to be omitted: in particular they specify the more im- portant articles under each heading. The “Type Meals” incorpo- rated in the various dietaries are intended to indicate the kinds and quantities of food to be taken at separate times. For general use outside of hospitals it is impracticable, even if it were desirable, to prescribe exactly weighed portions of food, and in hospitals when weighed amounts are prescribed they are often inaccurately dis- pensed. The portions here prescribed are, unless otherwise speci- fied, ordinary portions such as are served in homes and restaurants. My hope is that these dietaries, prepared at the expense of much time and thought, may prove serviceable to others. If this com- pendium will aid my fellow workers by recalling to their minds a few salient points in the various types of diet and by facilitating the prescribing of dietaries, it will fulfill its mission. Sanford Blum. VII CONTENTS. PAGE Introduction v PART I. Dietary for Adults in Health and Disease 1 PART II. Dietary for Infants and Children in Health and Disease .. 201 A. Diet in Health 201 Introduction 203 Feeding During the First Year 209 Breast Feeding 211 Artificial Feeding 218 Feeding During Second Year 231 Babyhood 233 Diet Second to Fifteenth Year 237 Babyhood 239 Childhood 244 Adolescence 246 B. Diet for Children in Disease 248 Index 303 IX PART i. Dietary for Adults in Health and Disease. ANEMIA, SECONDARY. GENERAL DIET RULES. 8 A.M. Breakfast. A glass of milk or cocoa. A bowl of cereal. Two pieces of bread and butter or toast. Fruit. 12 M. Luncheon. Meat. Vegetables. Bread and butter. Plain pudding. 1.30 to 3 P.M. Rest, lying down alone in darkened room. 3.15 P.M. Glass of milk. 3.30 to 5.30 P.M. Walk or other light exercise, shopping, calling. 6 P.M. Supper. Light meat. Vegetables. Salad. Bread and butter. Dessert. Drink water freely between meals. Eat slowly, masticate food thoroughly. Do not eat when hot or excited. Do not hurry soon after eating. Eat at regular times. Eat plain nutritious foods, simply prepared. Avoid sauces, condiments, gravies. Particularly good are red meats and green vegetables. This diet is not intended to cure anemia secondary to Bright’s dis- ease, diabetes, etc., but outlines a satisfactory diet for mild anemia due to improper diet. 1 ANEMIA. MALNUTRITION. [Society Woman. Condition caused by repeated Dietetic Errors. The object of this is not to restrict, but to indicate a rational regime. The effort will be to designate as desirable, foods which are essential for the nutrition of the body, and similarly to designate foods which are most likely to be injurious. Food should be taken at regular meal times. While it is good to drink water, it is not desirable to drink much water or other liquid with meals. Water should be taken preferably about an hour before meal time. At least three or four glasses of water a day. There is no objection to tea and coffee in moderation. It is inadvisable to eat when over-exerted or excited or to eat rap- idly. Eat fresh meats, fresh fruits, fresh vegetables and in general all fresh foods. The foods which are unnecessary are salt, preserved, can- ned and spiced meats and fish, alcoholics, condiments. Likewise, plain foods are preferable to made dishes and rich foods. Creams, pastries, shell-fish (except oysters), have nothing to recommend them in this diet. It is harmful to eat a certain amount made up of a considerable variety of foods, whereas the same amount made up of a limited num- ber of viands would be innocuous. Accordingly, a day’s dietary should follow about these lines: A glass of water to be taken on arising, about 11 o’clock and at 5 o’clock. Breakfast. Cocoa, coffee or milk. Bread and butter. Fruit. (Also egg may be taken.) Luncheon. Meat. Green vegetable. Salad. Bread and butter. Tea or plain cake. Dinner. Consomme or grapefruit Roast or entree. Green vegetable. Potato. Salad. Light dessert. There is no effort here to restrict the diet. The entire effort is to eliminate the glaring faults such as long menus, rich made dishes, gravies, poulettes. 2 ANEMIA. MALNUTRITION. (Continued.) MAY EAT. AVOID. Meats and Fish. Beef steak, roast beef, roast mut- ton, mutton chops, lamb chops, chicken, squab, brains, tripe, sweetbreads, fish, raw oysters, ham, game, veal, lamb, scraped beef. All preserved or canned meat and fish, tongue, sausage, liver, kid- neys, pot roast, pork, stews, duck, goose, soup meat, hash, herring, crab, clams, lobsters, mussels. Meat should be boiled, broiled, baked, roasted (but not stewed or fried). Vegetables. String beans, asparagus, peas, eggplant, cooked celery, lettuce, spinach, potatoes, carrots, arti- chokes, tomatoes, buttered beets. Radishes, onions, corn, cucum- bers, pickles, cabbage, sprouts, turnips, cauliflower. Fruits. Apple sauce, baked apple, prunes, orange, apple, peach, pear, grapes, berries, fresh and cooked fruits. Jams, preserves, mixture of ices and fruits. Beverages. Water, mineral water, tea, milk, buttermilk, cocoa made with water or milk 'Sweet drinks, alcoholics. Sundries. Eggs, rice, sago, cottage cheese, custards, sponge cake, angel cake, lady fingers, bread, crackers, graham crackers, toast, zwieback, clear soups, bouillon, beef tea, mutton broth, chicken soup, beef juice, ice cream. Soups may be thickened by cook- ing cereal or vegetable in them, but avoid rich, cream or fatty soups. All condiments, as catsup, mus- tard, Worcestershire, tabasco, pepper, horseradish; nuts, pas- tries, cakes, pies, candies, rich soups, sauces and gravies, hot rolls, hot biscuits, hot bread, hot cakes, waffles, cheese. This list is not intended to be exhaustive, but is intended to indi- cate the kinds of food to be taken, and the kinds to be avoided. 3 ANEMIA. NEURASTHENIA. MALNUTRITION. [ Society Woman.] 8 A.M. Breakfast. A cup of cocoa or coffee. Two eggs or a bowl of cereal. Two pieces of bread and butter or toast. Fruit. 8.30 to 10.30 A.M. Small occupation about house. 10.30 A.M. Cup of cocoa or milk and bread and butter. 10.30 to 12 M. A brisk walk and read or similar occupation. 12 M. Luncheon. Meat. Vegetable. Potato. Bread and butter. Plain pudding. 1.30 to 3 P.M. Rest: lying down alone in darkened room. 3.15 P.M. Cup of cocoa or milk. 3.30 to 5.30 P.M. Walk or other light exercise, shopping, calling. 6 P.M. Supper. Light meat. Vegetable. Salad. Bread and butter. Dessert. Eat slowly. Masticate all food thoroughly. Do not eat when hot or excited. Do not hurry soon after eating. Eat at regular times. Eat plain nutritious food, simply prepared. Omit sauces, condiments, gravies. Particularly good are red meats and green vegetables. 4 ANEMIA. NEURASTHENIA. MALNUTRITION. (Continued.) MAY EAT. AVOID. Meats and Fish. Steaks, chops, roast beef, game, chicken, sweetbreads, brains, broiled tripe, white fish, raw oys- ters, lamb, mutton. Salt, preserved, canned and spiced meats and fish, tongue, goose, duck, kidneys, stews, salmon, shell-fish, sardines, mackerel. Vegetables. Green vegetables and such as grow above ground—spinach, peas, cel- ery, lettuce, rhubarb, artichokes, string beans, carrots, cress, egg- plant, potato, beets, asparagus. Turnips, corn, dry beans, onions, garlic, cabbage, cauliflower; flavor- ing of onion or garlic. Fruits. Fresh and cooked fruits—apple, pear, peach, orange, cherries, grapes, lemons, grapefruit, melon, plums, persimmons. Beverages. Water, mineral water, tea, coffee, cocoa, chocolate, milk. All alcoholic drinks. Sundries. Bread, toast, zwieback, eggs, but- ter, cereals, bouillon, clear soups, cottage cheese, plain cake; a lim- ited amount of molasses candy or milk chocolate. Pastry, pies, confectionery, sweets, spices, sauces, gravies, nuts, poul- ettes; all condiments, such as Worcestershire, tabasco, mustard; thick and cream soups, hot rolls, hot biscuits, hot breads. This list is not intended to be exhaustive, but indicates foods which are good and foods which are not good to take. 5 ANEMIA. MALNUTRITION. [ Stenographer. ] Breakfast. Large glass of milk or cocoa made with milk. Bowl of cereal (cooked cereals only). Two thick slices bread and butter. Fruit or preserves or jam. Luncheon. Two thick meat sandwiches. Glass of milk with egg. Pudding. Above luncheon may be carried from home. If luncheon is taken in restaurant eat: Hot meat. Potato. Vegetable. Pudding. Dinner. Meat. Vegetable. Salad. Bread and butter. Dessert. 3 P.M. Glass of milk with egg. Bedtime. Glass of milk. Drink one quart (four glasses) milk daily. Drink water freely between meals. The effort here is to provide a highly nutritious diet which shall at the same time be not too expensive. However, to overcome mal- nutrition it is necessary to partake of proper food, even if costly. 6 ANEMIA. MALNUTRITION. (Continued.) DESIRABLE. Meats and Fish. UNDESIRABLE. Beef steak, roast beef, roast mut- ton, mutton chops, lamb chops, chicken, squab, brains, tripe, sweet- breads, fish, raw oysters, ham, game, lamb, veal, marrow, scraped beef, bacon. All preserved or canned meat and fish; tongue, sausage, pork, liver, kidneys, pot roast, hash, stews, soup meat, duck, goose, herring, crabs, clams, lobsters, mussels. Meat should be boiled, broiled, baked or roasted (but not stewed or fried). Vegetables. String beans, asparagus, peas, arti- chokes, cooked celery, lettuce, spin- ach, cauliflower, eggplant, potatoes, carrots, buttered beets. Radishes, onions, corn, cucumbers, pickles, cabbage, sprouts, turnips. Fruits. Apple sauce, baked apples, prunes, orange, apple; stewed peach, pear, grapes, berries; jams, preserves. Beverages. Water, mineral water, tea, milk, cocoa. Ice cream soda, fancy drinks, al- coholics. Sundries. Eggs, cereals, rice, sago, custards, cottage cheese, puddings, sponge cake, angel cake, lady fingers, mac- aroni, chocolate custards, bread, crackers, graham crackers, toast, zwieback, honey, clear jelly, syrup; limited amount of candy, clear soups, bouillon, beef tea, mutton broth, chicken soup, beef juice. Soups may be thickened by cooking cereal or vegetable in them, but avoid rich, cream or fatty soups. All condiments, such as catsup, mustard, horseradish, tabasco, Worcestershire, pepper; nuts, pas- tries, cakes, pies, candies, rich soups, sauces, gravies, hot rolls, hot biscuits, hot bread, hot cakes, waffles. 7 ANEMIA. [Secondary to residence in the Tropics. 1 Eighteen-year-old Girl. Breakfast. Egg or cereal. Bread and butter or toast. Glass of milk or cocoa or chocolate. Fruit. Dinner. Meat. Baked potato. Bread and butter or toast. Pudding or custard. Supper. Vegetable. Eggs (soft boiled), or milk food, or light meat. Bread and butter or toast. The day eggs are given for breakfast, cereal or light meat may be given for supper. The day cereal is given for breakfast, give eggs for supper. Eat slowly. Eat at regular times and only three meals a day. May eat bread and butter and jelly, and glass of milk at 3 P. M. Drink only limited quantities with meals. Have food prepared plain, omitting sauces, condiments, gravies. Eat at intervals of not less than four hours. Chew food thoroughly. Eat roasted, baked, boiled and broiled meats. One hour before each meal drink a glass of water. Also take water freely as desired between meals. Do not eat mixtures, such as hot followed by cold, or sweet and sour. Avoid all made dishes—stews, poulettes, sauces, gravies. The effort here is to indicate a normal diet for a young woman. Change of climate to a temperate zone is indispensable for success in treatment of the anemia. 8 ANEMIA. (Continued.) MAY EAT. AVOID. Meats and Fish. Broiled, boiled, baked, roasted steaks, chops, roast beef, game, chicken, sweetbreads, brains, broiled tripe, white fish, white meat of turkey, raw oysters, plain boiled ham, bacon. Fried foods of all kinds; all salt, preserved, canned, spiced meats and fish; tongue, goose, duck, tur- key, stews, sardines, salmon, shell- fish, mackerel, pork, liver. Vegetables. Green vegetables and such as grow above ground—spinach, peas, car- rots, lettuce, celery, rhubarb, string beans, artichokes, cress, beets, egg- plant, potato, cooked tomatoes, asparagus. Cabbage, cucumbers, corn, cauli- flower. Fruits. Cooked and fresh fruits—apples, pears, peaches, grapes, oranges, etc. Preserves, jams. Water, tea, cocoa, milk, chocolate. Beverages. All alcoholic and malt drinks, all sweetened and acidulous drinks, coffee, wine. Sundries. Bread, toast, zwieback, butter, sal- ads, eggs, soup, custards and plain puddings, plain cake, plain choco- late or molasses candy, ice cream occasionally, cottage cheese. Rich cake, pastry, pies, sweets, con- fectionery, spices, sauces, gravies, nuts, poulettes; all condiments, such as tabasco, horseradish, mus- tard, catsup, pepper, etc.; thick and cream soups, hot cakes, hot biscuits, hot rolls, waffles, muffins, syrups, candy, cheese. 9 ANEMIA. MALNUTRITION. [Milk Intolerance. Clerk.'] Breakfast. Large cup of chocolate. Bowl of cereal (cooked cereal only). Two thick slices bread and butter. Fruit or preserves or jam. Luncheon. Two thick meat sandwiches. Pudding. Above luncheon may be carried from home. If luncheon is taken in restaurant eat: Hot meat. Potato. Vegetable. Pudding. Dinner. Meat. Vegetable. Salad. Bread and butter. Dessert. Bedtime. Malted milk made with water, or Soft egg and bread and butter. Drink water freely between meals. 10 ANEMIA. MALNUTRITION. (Continued.) DESIRABLE. UNDESIRABLE. Meats and Fish. Beef steak, roast beef, roast mut- ton, mutton chops, lamb chops, chicken, squab, brains, tripe, sweet- breads, fish, raw oysters, ham, game, lamb, veal, marrow, scraped beef, bacon. All preserved or canned meat and fish; tongue, sausage, liver, kidneys, pot roast, stews, pork, duck, goose, soup meat, hash, herring, crab, clams, lobsters, mussels. Vegetables. String beans, asparagus, peas, arti- chokes, cooked celery, lettuce, spinach, cauliflower, eggplant, pota- toes, carrots. Radishes, onions, corn, cucumbers, pickles, cabbage, sprouts, turnips. Fruits. Apple sauce, baked apple, prunes, orange, apple; stewed peach, pear, grapes, berries; jams, preserves. Beverages. Water, mineral water, tea, choco- late, cocoa, coffee. Alcoholics, milk. Sundries. Eggs, cereals, rice, sago, cottage cheese, puddings, sponge cake, an- gel cake, lady fingers, pastes, bread, toast, graham crackers, crackers, zwieback, honey, clear jelly, syrup, limited amount of candy, clear soups, bouillon, beef tea, mutton broth, beef juice, chicken soup. Soups may be thickened by cook- ing cereal or vegetable in them, but avoid rich, cream or fatty soups. All condiments, such as catsup, mustard, horseradish, Worcester- shire, tabasco, pepper; nuts, pas- tries, cakes, pies, candies, rich soups, sauces and gravies, hot rolls, hot biscuits, hot bread, hot cakes, waffles. 11 APPENDICITIS, CHRONIC. [Patient not operated.] Meats. Sweetbreads, brains, chicken, squab, fish with white flesh, chops, steak, roast beef, scraped beef. Meat may be boiled, broiled, baked or roasted. Vegetables. Asparagus tips, artichokes, cooked celery, potatoes, rice, peas, string beans, spinach, lettuce finely divided like spinach, French carrots, beets. Pastes. Macaroni, spaghetti, vermicelli, noodles. Desserts. Custard, floating island, tapioca, sago and rice puddings, prune souffle, ice cream, wine jelly, lady fingers, angel cake, sponge cake, blanc mange. Fruits. Fresh orange, pear, peach, banana, grapes, stewed peach, apple sauce, baked apple. Milk and Milk toast, farina, corn starch, arrowroot, etc. Cereals Milk Foods, should be such as do not have grits or husks. Eggs. Soft boiled or poached, but not fried. Bread and . , , • i i I oast, graham crackers, zwieback. Butter. s Soups. Clear soups, bouillon, beef tea, mutton broth, con- somme, chicken soup, beef juice. But no rich, cream or fatty soups. Soups may be thickened by cooking a cereal in them. Beverages. Water, still alkaline mineral water, coffee, tea, cocoa, buttermilk. To be avoided are all fried, or spiced viands; all salted, preserved or canned foods. Nuts, fruits and vegetables having husks or kernels (as corn), tomatoes, pickles. Berries, preserves, confections, candies, rich desserts, pastries, pies, condiments, sauces, stews, all shell-fish. But a limited amount of clear jelly, chocolate candy or plain cream candy or molasses candy and syrup may be taken; also honey. Food should be prepared plain—never fried—no made gravies or sauces. Avoid cabbage, cauliflower, sprouts, cucumbers. Water should be taken freely between meals. xAvoid carbonated drinks, sweet drinks, acid drinks, fancy drinks, alcoholics. 12 APOPLEXY. Intended for Patient with Habitus Apoplecti- cus. Obese. Short neck type. Not intended as diet during or immediately after attack. Eat at regular meal times—three meals a day. Make the midday meal the chief meal of the day. Take small meals of solid foods. Between meals take no solid food, but in the middle of the afternoon or at bedtime, a cup of bouillon or other beverage may be taken. One hour before each meal drink a glass of hot or cold water. Limit the amount of fluid taken with meals. Do not drink excessively. Do not eat when hot or excited or after exertion. Do not exert yourself immediately after eating. Eat slowly—masticate food thoroughly. TYPE MEALS. Breakfast. One egg. One piece of toast. Glass of milk. Weak coffee. Toast. Fruit (one piece). Or Dinner. White fish or meat (two chops or equal amount of steak). Toast and butter (or scraped meat). Light vegetable (such as cooked celery or pureed peas). Plain custard or light pudding. Supper. Ham or chicken or eggs. Green vegetable. Toast and butter. Weak tea or fruit. This brief sketch is intended to indicate the kinds of food which may be taken and the quantity which should be taken. In prescrib- ing such a restricted and at the same time liberal diet, two essential factors have been taken into consideration: (1) The amount of food taken should be limited both as to quan- tity taken at a single time and the quantity taken during twenty-four hours. The intention is to underfeed and so keep down blood-pressure and at the same time reduce obesity. (2) The choice of viands must be of such a character that the patient will be willing to restrict himself to the dietary indefi- nitely. Therefore, a considerable degree of freedom is per- mitted (meat and proteids) because there is no advantage in prescribing for an individual a dietary at which he will rebel and which in all probability he will disregard. 13 ARTERIOSCLEROSIS. GENERAL PRINCIPLES OF DIET. The object of this diet is two-fold: (1) To improve metabolism by reducing the amount of concentrated foods and by increasing elimi- nation; (2) to reduce body weight and prevent obesity. The mainstays of the diet should be: Fresh Fruit. Apples, pears, peaches, oranges, cherries, melons, grape- fruit, etc. Vegetables. Particularly pithy green vegetables (which by leaving a large residue, promote elimination), for example: spinach, cauliflower, cress, lettuce, string beans, green peas, artichokes, carrots, celery, squash, asparagus. Water. Should be taken abundantly; tea and cofifee may be taken weak and only in limited quantity (or not at all); mineral water and buttermilk may be taken with benefit. Six glasses of all liquids should be taken during the day. Vegetable soups are permitted. Bread. Should be taken preferably stale and not in excessive quantities; toast and zwieback may be taken. Meats. Light meats, fish or chicken may be taken in limited amounts, but they should be prepared plain: broiled, boiled, baked or roasted. Eggs. May be taken instead of meat. Nothing can take the place of vegetables which leave a bulky residue. The foods which should be taken only sparingly are the proteid foods in general, namely, meat and meat preparations; rich soups; milk and milk foods; sauces made with milk, cream sauces, sauces in general; rich fish, such as sardines, salmon; canned meats and fish; preserved meats and fish; smoked meats and fish; shell-fish, especially crabs, shrimps; cheese, except cottage cheese; potatoes, corn. Sweets, pastries, pies, preserves, candies, confections, ices, rich cakes, French pastry, are better excluded. All alcoholic, malt and sweet drinks should be avoided. 14 ARTERIOSCLEROSIS. (Continued.) PRACTICAL CLASSIFICATION OF FOODS. EAT. Chicken. Fish with white flesh. Raw oysters. Ham. Bacon. Eggs. Green vegetables, fresh and canned, raw and cooked. Salads. Pickles. Cereals, rice. Fruit (fresh and cooked), melons, ber- ries. Cottage cheese. Bread, toast, zwieback, crackers. Pastes — macaroni, spaghetti. Water, mineral water, Tea, buttermilk. Vegetable soups. LIMIT. Butchers’ meat. Tripe. Sweetbreads. Brains. Game. Potatoes. Sweet potatoes. Cauliflower. Cabbage. Fats, oil, butter. Coffee, cocoa, chocolate, milk, milk soups. Sugar, honey, molasses, syrup, plain cake, pud- dings, custards, ice cream. AVOID. Salt, preserved, canned meat; shell-fish, do- mestic duck; goose; salmon, sardines, mac- kerel ; salt, preserved, canned fish. Onions, garlic, cucum- ber. Corn. Sweet pickles. Condiments. Bananas. Sweetened fruits and preserves. Old cheese. Cream cheese. Alcoholics. Sweet drinks. Rich soups. Nuts. Pastries. Pies. Confections. Candies. Cooked foods should be broiled, boiled, baked, roasted; not fried. Avoid stews and made dishes, spices, gravies, condiments. Drink water freely between meals. Under-eat rather than over-eat. Keep emunctories active. 15 ARTERIOSCLEROSIS. (Continued.) TYPICAL DIET LIST NO. 1. MAY EAT. AVOID. Meats and Fish. Meat, poultry or fish once daily; plain fresh meats without sauces, without gravies and not highly seasoned; also ham, game, poultry, fresh fish. Preserved, canned and spiced meats; tongue, goose, tame duck, kidneys, stews, salmon, shell-fish, mackerel, herring. Vegetables. Fresh vegetables, except onions, peppers, garlic, dried beans. Peppers, onions, garlic, corn, cu- cumbers, cabbage. Fruits. Fresh fruits, stewed fruits, berries. Bananas, preserves, spiced fruits, sweetened fruits, pickled fruits. Beverages. Water, mineral water, tea, milk, buttermilk, iced tea, cocoa, weak coffee once a day, lemonade. Alcoholic drinks, malt drinks, sweet drinks. Sundries. Bread, toast (not hot), zwieback, butter, salads (without oil), eggs, clear soup, plain cake, cottage cheese, tapioca, sago, all farinace- ous foods, soups containing cereals, vegetable soups, pastes. Pastry, pies, confections, spices, gravies, sauces, poulettes, all con- diments, such as mustard, tabasco, etc.; cream soups, hot rolls, hot bread, hot biscuits. 16 ARTERIOSCLEROSIS. (Continued.) GENERAL SUGGESTIONS. Eat at regular meal times, and only three times a day. Do not eat anything between meals or before retiring. Do not drink more than one small glass of liquid with meals (this includes soup). One hour before each meal drink a glass of Vichy or other alkaline mineral water (or plain water). Drink water freely between meals. Eat plain foods, simply prepared. Avoid all made dishes, sauces, poulettes, gravies and condiments. Do not eat meals of several courses. Rather undereat than overeat. Eat green vegetables, such as spinach, artichokes, asparagus, celery, string beans, peas; limit potatoes. Avoid sweets, creams, desserts, sweetened cooked fruits and pre- serves; nuts, cakes. Eat fresh fruits—orange, apple, etc. Avoid all preserved and canned meats.. Eat a limited amount of fresh fish with white flesh. Avoid all salt, preserved, canned fish, such as sardines, herring. Avoid all shell- fish, except raw oysters. Salads may be eaten (oil sparingly). Drink water, tea, mineral water, buttermilk. Avoid alcoholics; limit coffee. Cereals may be taken. Avoid strenuous exertion—long hours, excessive walks, mental excitement. Wherever possible avoid climbing stairs. It is beneficial to lie down and rest for an hour or longer, after the midday meal. 17 ARTERIOSCLEROSIS. (Continued.) TYPICAL DIET LIST NO. 2. Type Meals and Regime. 7 to 8 A.M. Rise and drink one glass of water. (If patient is of obese, florid type or if bowels are sluggish, add teaspoonful Carlsbad or Ep- som salts twice or three times a week.) 8.30 A.M. Breakfast. Small portion cereal or egg or fruit. One or two slices of toast. One cup weak coffee or cereal decoction. 11 A.M. One glass water or still alkaline mineral water. 12 to 1 P.M. Light hot or cold meat, or poultry or eggs or Luncheon or Dinner, fish. Green vegetable. One or two slices stale bread or toast. Cottage cheese or fruit. 1.30 to 3 P.M. The individual, if past middle age, may advan- tageously rest. 5 P.M. One glass of water or still alkaline mineral water. 6 to 7 P.M. Vegetable soup. Dinner or Supper. Light meat or poultry or eggs or fish. Green vegetable. One or two slices stale bread or toast. Salad. Fruit or light pudding. Water should be taken freely between meals. Dinner may be given at noon: this would be the preferable time, but it may, as indicated, be given in the evening, in order to con- form to custom. Potatoes may be eaten sparingly, with dinner or supper. Eggs are to be taken not more than once daily. Gentle, out-door exercise; walking more or less briskly is com- mendable exercise, best taken before meals. 18 ASTHMA, BRONCHIAL. MAY EAT. AVOID. Meats and Fish, Broiled, boiled, baked, roasted: steaks, chops, roast beef, game, chicken, sweetbreads, brains, broiled tripe, white fish, ham, ba- con, raw oysters. Fried foods of all kinds; all salt, preserved, canned and spiced meats; tongue, goose, duck, turkey, kid- neys, stews, salmon, shell-fish, mackerel, sardines. Vegetables. Green vegetables and such as grow above ground—spinach, tomatoes, lettuce, celery, rhubarb, peas, string beans, carrots, artichokes, cress, eggplant, potato. Starchy vegetables and such as grow under ground; beets, corn, turnips, beans dried, onions, garlic, cabbage, cauliflower. Fruits. Cooked and fresh fruits—apples, pears, peaches, oranges, grapes, etc. Sweetened fruits; berries, figs, ba- nanas, melons. Beverages. Water, mineral water, tea, coffee, cocoa, milk, buttermilk. All alcoholic and malt drinks; all sweetened and acidulous drinks; chocolate, carbonated drinks. Sundries. Stale bread, toast, zwieback, butter, salads made with lemon, eggs, clear soup or bouillon, tapioca or sago pudding, pastes, plain cake, cheese, honey, jelly, syrups. Fresh bread, cake, pastry, pies, confectionery, sweets, spices, gra- vies, sauces, nuts, poulettes; all condiments, such as mustard, ta- basco sauce, catsup; thick and cream soups, hot cakes, hot bis- cuits, hot rolls, muffins, waffles. 19 ASTHMA, BRONCHIAL. (Continued.) TYPE REGIME FOR A DAY. On arising, drink a glass of water. Breakfast. Two eggs or bowl of cereal. Two pieces of toast and butter. Coffee or cocoa. One piece of fruit. 11 A.M. A glass of water or mineral water. Dinner. Steak or chop or roast beef or other plain meat. Stale bread and butter or toast (not hot). Vegetable. Fruit or custard. (May also take salad.) 4.30 P.M. A glass of water or mineral water. Supper. Cup of bouillon. Meat. Green vegetable. Potato. Toast or stale bread or crackers. Fruit or tea. Over-exertion should be avoided. Mental excitement should be prevented. Emunctories should be kept active. Water should be taken liberally between meals. General state of nutrition should be promoted. Condition of blood, kidneys and heart should be watched. 20 [Reflex on Gastro-enteric basis. 1 Stringent Diet. Temporary. J ASTHMA, BRONCHIAL. 6.30 to 7 A.M. Glass of water and Carlsbad salts. 8.30 A.M. Two soft boiled eggs. Toast and butter. Apple sauce or baked apple. 11 A.M. Glass of Vichy. 12.30 P.M. Light meat. Vegetable. Zwieback. Custard. 4.30 P.M. Glass of Vichy. 6.30 P.M. Light fish or scraped meat or soft boiled eggs Green vegetable. Toast and butter. (Soup with cereal may be taken instead of meat.) 10 P.M. Malted milk (made with water, not with milk). 21 ASTHMA, BRONCHIAL. [Reflex on Gastro-enteric basis. 1 Liberal Diet. Permanent. MAY EAT. Meats and Fish. AVOID. Broiled, boiled, baked, roasted: steaks, chops, roast beef, game, chicken, sweetbreads, brains, broiled tripe, white fish, cold boiled ham, Westphalia ham, raw oysters. Fried foods of all kinds; all salt, preserved, canned and spiced meats; tongue, goose, duck, turkey, kid- neys, stews, salmon, shell-fish, sar- dines, mackerel, herring. Vegetables. All starchy vegetables and such as grow under ground—turnips, beets, corn, dry beans, onions, garlic, to- matoes, cauliflower; raw vegetables. Green vegetables and such as grow above ground—spinach, cooked let- tuce, cooked celery, rhubarb, peas, string beans, carrots, eggplant, potatoes. Fruits. Cooked and fresh fruit—grapes, apples, pears, peaches, etc. Sweetened fruits, berries, figs, ba- nanas, melons. Beverages. Water, still alkaline water (in moderation), cocoa, buttermilk. All alcoholic and malt drinks; all sweetened and acidulous drinks; milk, effervescent water, chocolate, coffee. Sundries. Stale bread, toast, zwieback, butter, eggs, clear soup or bouillon, tapi- oca or sago pudding, smooth cooked cereals (none with grits), plain cake, lady fingers. Fresh bread, cake, pastry, pies, con- fectionery, sweets, spices, sauces, gravies, nuts, poulettes; all condi- ments, such as catsup, mustard, tabasco sauce; thick and cream soups, hot cakes, biscuits, hot rolls, muffins, waffles, syrups. 22 ASTHMA, BRONCHIAL. (Continued.) TYPE REGIME FOR A DAY. On arising, drink a glass of water. Breakfast. Two eggs (or bowl of cereal with butter and salt). Two pieces of toast and butter. Cooked fruit. 11 A.M. A glass of water or mineral water. Dinner. Steak or chop or roast beef or other plain meat. Stale bread and butter or toast (not hot). Vegetable. Fruit or custard. 4.30 P.M. A glass of water or mineral water. Supper. Cup of bouillon. Meat. Vegetable. Potato. Toast or stale bread or crackers. Fruit or tea. Water should be taken liberally between meals. Coffee is better omitted from the diet, but in some cases may be permitted. In general it is inadvisable to take liquid and solid food at a meal. 23 CHLOROSIS. MAY EAT. AVOID. Meats and Fish. Broiled, boiled, baked, roasted: steaks, chops, roast beef, game, chicken, sweetbreads, brains, lamb, turkey, fresh fish, raw oysters. (Most fresh butcher’s meat.) All salt, preserved, canned or spiced meats and fish; tongue, goose, duck, kidneys, stews, sal- mon, shrimps, lobsters, crabs, sar- dines, mackerel. Vegetables. Green vegetables—spinach, lettuce, asparagus, artichokes, celery, rhu- barb, tomatoes, carrots, corn, cress, potatoes, eggplant, string beans, dry beans, peas, ripe and green olives. Cucumbers, beets, cabbage, sprouts, garlic, onions; sweet and sour vege- tables; vegetables with rich sauces; pickles. Fruits. Orange, apple, grapefruit, peaches, pears, bananas; and in general, less acid fruits. Stewed and sweetened fruits; ber- ries, preserves. Beverages. Water, tea, cocoa, milk, chocolate. All alcoholic and malt drinks; car- bonated beverages. Sundries. Bread, toast, zwieback; moderate amount of butter; salads, clear soups, eggs, meat juice gravy, cereals, cottage cheese, plain cake; plain candies, e.g., creams, choco- late; pastes. Cakes, pies, pastries, spices, con- fections, sauces, gravies, condi- ments, poulettes; all thick and cream soups; hot cakes, hot rolls, hot biscuits, strong cheese, rich candies, nut candies. 24 CHLOROSIS. (Continued.) TYPE MEALS. Breakfast. Two eggs (a cereal may be substituted for eggs). Bread and butter. Milk or cocoa or chocolate. Fruit or orange juice. Luncheon. Steak or chops. Baked potato. Vegetable. Bread and butter. Custard, pudding or fruit. 3 P.M. Bread and butter and jelly, and glass of milk. Dinner. Consomme or grapefruit. Plain meat or poultry or fish. Green vegetable. Salad. Bread and butter. Fruit or plain pudding or plain cake. 10 to 10.30 P.M. Glass of milk. Eat slowly. Eat at regular times. Have food prepared plain, omitting sauces, gravies, condiments. Chew food thoroughly. Eat roasted, baked, boiled or broiled foods. Do not eat mixtures, such as hot followed by cold, or sweet and sour. Avoid all made dishes—stews, poulettes, sauces, gravies. Drink only limited quantities with meals. One hour before each meal drink a glass of water. Take water freely between meals. 25 CHLOROSIS. [School Girl.'] MAY EAT. AVOID. Broiled, boiled, baked, roasted: steaks, chops, roast beef, game, chicken, sweetbreads, brains, lamb, turkey, fresh fish, raw oysters, marrow, squab. Meats and Fish. All salt, preserved, canned and spiced meats and fish; tongue, goose, duck, kidneys, stews, sal- mon, shrimps, lobsters, crabs, sar- dines, sausage. Green vegetables—spinach, lettuce, asparagus, artichokes, celery, rhu- barb, tomatoes, beans, carrots, corn, cress, eggplant, cauliflower, potatoes, beets. Vegetables. Cucumbers, cabbage, garlic, onions; sweet and sour vegetables; vege- tables with rich sauces; sprouts. Fruits. Orange, apple, grapefruit, peach, pear, banana, berries. Sweetened fruits; preserves. Beverages. Water, tea, cocoa, milk, chocolate. Alcoholic and malt drinks. Sundries. Bread, toast, zwieback, butter, sal- ads, clear soups, eggs, meat juice gravy, cereals, cottage cheese, plain cake; limited amount molasses candy, plain cream and chocolate candy. Rich cakes, pies, pastries, sweets, confections, spices, sauces, gravies, poulettes, condiments, cream and thick soups, hot bread, biscuits, hot cakes, hot rolls, strong cheese. Breakfast. Two eggs (a cereal may be substituted for eggs). Bread and butter. Milk or cocoa. Fruit or orange juice. Luncheon. Steak or chops. Baked potato. Vegetable. Bread and butter. Custard, pudding or fruit. TYPE MEALS. 26 CHLOROSIS. (Continued.) Dinner. Consomme or grapefruit. Plain meat or poultry or fish. Green vegetable. Potato. Salad. Bread and butter. Fruit or plain pudding or plain cake. REGIME FOR SCHOOL GIRL. Eat slowly. Eat at regular times and only three meals a day. May eat bread and butter and jelly or glass of milk at 3 P.M. Have food prepared plain, omitting sauces, gravies, condiments. Eat at intervals of not less than four hours. Eat roasted, baked, broiled, or boiled foods. Do not eat mixtures, such as hot followed by cold, or sweet and sour. Avoid all made dishes, stews, poulettes, sauces, gravies. If cereal is taken for breakfast, eggs may be taken instead of meat for luncheon or dinner. Drink only limited quantities with meals. One hour before each meal drink a glass of water. Take water freely between meals. 7 A.M. Arise and drink a glass of water. 7.30 A.M. Exercises, especially breathing exercises. 8 A.M. Breakfast. 9 A.M. to 12 M. School. 12.30 Dinner. Dinner. 1 to 3.30 P.M. School. 3.30 to 5.30. Play. 6 P.M. Supper. 7.30 to 8.30. Read or study. 9 to 9.30 P.M. Retire. 27 CONSTIPATION. Intestinal Sluggishness. Digestion 1 Unimpaired. Breakfast. Bran mush or coarse cereal with or without cream and sugar, or pumpernickel bread (stale). Egg. Fried potatoes. Fibrous fruit (figs, dates, raisins). Coffee. Dinner. Vegetables that have much cellulose (peas, beans, corn, parsnips) ; green vegetables (celery, spinach, lettuce, cold slaw). Whole wheat bread and butter. Dessert—juicy fruits or fruit salad. Supper. Fruit and fruit salad (oranges, apples, figs, dates, rai- sins) ; or Supper may be a repetition of dinner. Take water freely between meals. Cream cheese (Roquefort, Camembert, Brie, etc.), also onions and garlic stimulate peristalsis and may be of benefit. Sweets, nuts, cabbage, cauliflower, may be taken. This diet is intended for hardy individuals; it disregards the possibility of indigestion. Select foods which leave a bulky residue (as string beans, cab- bage, etc.) ; which are sufficiently irritating to induce peristalsis (as figs, nuts, etc.) ; which are mechanically laxative (as water, oil, etc.) ; which are somewhat irritating (as onions), and which operate by fermentative action (as the sugars, honey, molasses, etc.). 28 CONSTIPATION. [Intestinal Sluggishness. Impaired I Digestion. Take foods that leave a considerable residue, in order to promote evacu- ations. Particularly valuable are vegetables: these should be selected keeping in mind the fact that while they leave a bulky residue, this should not be too irritating. For this reason corn, cabbage and similar vegetables may have to be excluded. Attention also must be paid to the digestive powers of the individual, e.g., while onions and cauliflower fulfill the requirements as to bulk, the individual may have an intolerance to such viands. For a similar reason, fruits must be employed with caution. While their laxative influence is indisputable, certain fruits may be not well toler- ated by the individual. This diet must be selected, furthermore, with respect to its nutritive value. Finally, the value of water as a laxative should not be under- estimated. At least six glasses of liquids—including water, tea, coffee, broth—should be taken daily. DESIRABLE FOODS. Broths. Meat and vegetable broths may be taken. Milk or cream soups, on account of their gas-forming proclivities, should be omitted. Soups may be thickened by a cereal content, such as rice or barley. Farinaceous Bread, preferably stale, should be taken—wheat bread, Foods. whole wheat bread, corn bread, graham bread and rye bread. Hot bread, hot rolls, fresh bread, are undesirable. Cereals, the various breakfast foods—farina, granum, barley, oats, cornstarch, breakfast gem, germea, and all similar thoroughly cooked, finer breakfast foods, may be taken 29 CONSTIPATION. IMPAIRED DIGESTION. (Continued.) Farinaceous But the prepared, not thoroughly cooked cereals— Foods. triscuits, cornflakes, puffed rice and kindred varieties— may well be excluded. Pastes: noodle, marcaroni, vermicelli, spaghetti, may be taken in soup, but they are not to be taken pre- pared with cream sauce or a tomato sauce. Puddings: bread pudding, tapioca pudding and sago pudding may be taken. Eggs. May be taken raw, soft boiled, poached, omelette, asparagus or spinach omelette, scrambled or fried. Fish. Fish: broiled and boiled fish having white flesh may be taken. Fresh herring, salmon, sardines, mackerel, are valuable if they do not cause indigestion. Shell-fish: raw oysters may be taken, but cooked oys- ters should be omitted. Other shell-fish should be omitted. Preserved fish: is in general to be excluded. Caviar may be taken (no onions or chives; lemon juice may be added). Salt and canned fish are excluded. Meat. Meat: beef, mutton, lamb, are desirable foods. Pork, liver, preserved and canned meats, are excluded. Meat should be boiled, broiled, baked or roasted. Stews and fried foods are undesirable. Poultry: chicken, squab, wild game, turkey, may be taken. Prohibited are goose, domestic duck. Vegetables. Spinach, lettuce, water-cress, asparagus, cooked celery, celery root, Jerusalem artichokes, string beans, arti- chokes, green peas, ripe and green olives, squash, but- tered beets, potatoes, rice, may be taken. 30 CONSTIPATION. IMPAIRED DIGESTION. (Continued.) Vegetables. Cabbage, cauliflower, radishes, onions, garlic, flavoring of onions or garlic, sprouts, turnips, corn, may be irri- tants and should therefore be omitted. Vegetables should be prepared plain by cooking in salt and water or soup stock and adding a little butter, but they should not be highly seasoned. Salads. Lettuce, celery, Romaine, and in general vegetable salads, may be taken; tomato salad, if it is well tolerated. Salads should be prepared with olive oil and a small amount of vinegar or lemon juice and salt (very little pepper and no flavoring of onion or garlic). Fruits. Cooked and fresh fruits of the less acid varieties. Baked apple, apple sauce, fresh apple (this should be scraped or thoroughly masticated), orange juice, orange (avoid the pith), grapes (do not swallow seeds or skin), figs (fresh or dried), dates, plums, raisins, prunes. Melons may be taken if they are neither over-ripe nor unripe. Berries are constipating and should be omitted. Nuts may be taken if they are thoroughly masticated and if on trial they are well tolerated. Desserts. Fruit may be taken for dessert. Plain cake, custards, ice cream and puddings may be taken. Pastries, pies, confections, French pastry and puff pastes are harmful. Candy—a small amount of plain molasses candy or chocolate candy or cream candy may be taken, but rich candies should be omitted. 31 CONSTIPATION. IMPAIRED DIGESTION. (Continued.) Condiments. Should be exceedingly restricted. Salt may be taken freely; pepper and vinegar may be taken in limited quantity; mayonnaise made of olive oil and vinegar or lemon juice and salt—no mustard is permitted; catsup, horseradish, the various prepared sauces, pap- rika, poulettes, are prohibited. Beverages. Water should be taken freely, preferably within limits at least one hour before meals and two hours after meals. However, a limited quantity of liquid, not more than one glassful, may be taken at meal times. Mineral waters: still alkaline mineral waters such as Vichy, Bethesda, Bartlett Water, may be taken with advantage. But, carbonated waters and prepared beverages such as ginger ale, root beer and sodas, have no merit in this diet. Tea, coffee, cocoa, chocolate, may be taken in limited quantity. Milk, on account of its gas-forming properties, had better be omitted (for some individuals milk is con- stipating, for others, laxative). Buttermilk may be taken. Iced beverages are undesirable. Cheese. Cottage cheese is beneficial; other kinds of cheese should be omitted. 32 COLITIS, MUCOUS. GENERAL PRINCIPLES OF DIET. Mucous colitis, as the name signifies, is a disease designated hy its characteristic symptoms, viz.: excess of mucus in the alvine dis- charges. Manifestly the treatment of the disease by diet may be, and usually is, only part of the indicated treatment. The same is true of local treatment by enemata. The underlying cause should be sought and when discovered, treated. Sometimes this will be found to be ovarian dysfunction and if so, treatment should be directed to correction of this condition. Dietetic regulation is under all circumstances important. The diet should be adapted to the symptoms predominating at the particular time. For example, should an acute inflammatory state accompanied by frequent evacu- ations exist, the diet should be different from the diet appropriate for a chronic condition accompanied by constipation. Roughage diet (prescribed by many as routine) seems illogical in that it adds an element of irritation. Coarse foods cause evacu- ations by scraping along the already injured intestinal mucosa. Copious evacuations without apparent excessive mucus result: but the mucus may still be present, concealed in the mass of excrement. The mere occurrence of regular evacuations may be a curative fac- tor. The patient’s state of nutrition—obese or frail—should influence the prescribed diet. In general, bland diet, requiring less digestive power than the deteriorated mucosa possesses, is indicated. Milk and milk foods, on account of gas-forming proclivities, are contra- indicated. 33 COLITIS, MUCOUS. [Acute Irritative Stage.] A. Food indicated at this stage should be bland and soft. Such foods include meat broths and meat jellies, eggs, raw oysters, cottage cheese, tea, coffee, cocoa (made with water, not with milk), toast, stale bread, scraped beef, beef juice, white meat of chicken, fish (some patients do not tolerate fish), boiled ham (not the fat), meat timbales, brains, sweetbreads, tripe, rice, sago, tapioca, pastes, baked potato if, on trial, it is tolerated, pudding or custard. Brains, sweetbreads, tripe, should be cooked in soup or broiled or cooked in salt and water; before serving, a little fresh butter may be added. Eggs may be poached, soft boiled or soft scrambled. Rice, sago, tapioca and pastes should be thoroughly cooked in salt water and served with butter and salt, or they may be cooked in soup. A typical day’s dietary would then be: Breakfast. Coffee. Toast and butter. Eggs. Dinner. Scraped meat, chicken, fish or oysters. Stale bread and butter. Rice with salt and butter. Supper. Beef juice. Stale bread and butter. Baked potato. Cup of tea. In the middle of the afternoon a cup of broth or tea may be taken. Water should be taken freely between meals. 34 COLITIS, MUCOUS. [Stage of Subsidence of Acute Irritative Symptoms. The dietary may include all of the foods specified in the preceding (A) list, and in addition selected, finely pureed vegetables, vis.: asparagus tips, peas, celery root, summer squash, buttered beets, cooked pureed lettuce, potatoes. Carrots and spinach, while desirable vegetables, are too laxative for general use. However, if tendency to constipa- tion is present they may be given with benefit. 35 COLITIS, MUCOUS. [Stage of Quiescence. Frail Patient.] B. MAY EAT. AVOID. Meats and Fish. Broiled, boiled, baked, roasted: steaks, chops, roast beef, game, chicken, sweetbreads, brains, broiled tripe, white fish, lamb, turkey, raw oysters All salt, preserved, canned and spiced meats and fish; tongue, goose, duck, kidneys, stews, shell- fish (except raw oysters), sardines, mackerel. Vegetables. Eat cooked green vegetables and such as grow above ground—peas, spinach, lettuce, cooked celery, rhu- barb, string beans, carrots (pu- reed), artichokes, cress, eggplant, potatoes, buttered beets. Turnips, corn, dry beans, cabbage, onions, garlic, cucumbers, cauli- flower, tomatoes; raw vegetables; pickles. Fruits. Cooked fruits once daily (if there Omit all fruits if bowels are loose, is tendency to constipation). Beverages. Water, mineral water, tea, cocoa, coffee, butttrmilk, chocolate. All alcoholic and malt drinks; all sweetened and acidulous drinks; milk. Sundries. Bread, toast, zwieback, butter, eggs, clear soup or bouillon, cereals, plain cake, pastes, cottage cheese, pud- dings, custards. Confectionery, sweets, spices, gra- vies, sauces, poulettes; all condi- ments, such as pepper, tabasco, Worcestershire sauce, catsup; thick and cream soups; hot rolls, hot biscuits, hot cakes, muffins, waffles, syrups, ice cream. 36 COLITIS, MUCOUS. (B Continued.) TYPE MEALS. On arising drink a glass of water. Breakfast. Two eggs. Two pieces of toast and butter. Coffee or cocoa. 11 A.M. A glass of water. Luncheon. Steak or chop or roast beef or other plain meat. Stale bread and butter or toast (not hot). Vegetable or potato. Cup of tea. 4.30 P.M. A glass of water. Supper. One cup of bouillon. Meat or chicken or light fish. V egetable. Potato. Toast or stale bread or crackers. Tea. Avoid rich desserts; creams. Eat slowly. Masticate all food thoroughly. Do not eat when hot or excited. Do not hurry soon after eating. Do not eat large quan- tities at a time. Avoid all irritating foods and all foods which experience has shown are not well tolerated. Eat only at regular meal times and only three meals a day. Eat plain nutritious food, simply prepared. Omit all sauces, gravies, condiments. Avoid all fried foods and all cooked fats. Food may be broiled, boiled, baked, roasted. Abstain from all alcoholics, beer and all malt beverages. Do not take hot and cold, or sweet and sour, at the same meal. Omit raw vegetables. Avoid all hard foods; all spiced or highly seasoned foods; all foods with husks or kernels. Take a moderate amount of exercise, but do not over-exert or be strenuous. Do not drink more than eight ounces of fluid with a meal, ex- cept with breakfast. Water should be taken freely between meals; drink slowly. 37 COLITIS, MUCOUS. [Under-nourished Patient—Advanced Stage of 1 Treatment. All Symptoms have Subsided. C TYPE MEALS. Breakfast. (1) Cereal and cream. Bacon. Toast. Cocoa or tea. (2) Omelette. Bacon. Toast. Cocoa. (3) Cereal and cream. Toast. Baked apple. Coffee or tea. (4) Scrambled egg. Toast. Orange juice. Cocoa. (5) Eggs or cereal and Cream. Toast. Tea. (6) Boiled eggs. Toast. Cocoa. (7) Cereal. Bacon. Toast. Baked apple. Tea. Luncheon. Roast beef. Creamed potatoes. Summer squash. Lettuce salad. Bread and jelly. Broiled steak. Baked potato. Carrots puree. Lettuce salad. Bread and jelly. Broiled chops. Baked potato. Boiled rice. Lettuce salad. Bread. Custard. Broiled steak. Baked sweet potato. Celery root puree. Whole wheat bread. Sago pudding. Broiled English chop. Baked potato. Lettuce with lemon and oil. Bread. Pudding. Broiled sole. Baked potato. Finely divided spinach. Lettuce salad. Bread and jelly. Meat. Baked potato. Squash. Bread. Cottage cheese. Stewed peach. Dinner. Broiled chicken. Potatoes. Artichoke puree. Bread. Ice cream, cake. Chicken. Peas puree. Bread. Pudding. Broiled bass. Mashed potatoes. Artichoke puree. Bread. Plain cake. Chicken. Hominy. Lettuce with lemon and oil. Bread. Ice cream, lady fingers. Broiled squab. Mashed potato. String beans. Bread. Prune whip. Broiled steak. Mashed potato. Artichoke puree. Ice cream. Cake. Light meat. Carrots puree. Bread. Custard. Cake. Irritants, especially onions and garlic, must be sedulously excluded from the diet. If the patient is well nourished it is advisable to give smaller meal. 38 COLITIS, MUCOUS. D. PERMANENT LIST. When the patient reaches a stage where the preceding diet (symp- toms have subsided) list, C, shall have been followed several weeks without recurrence of colitis symptoms, greater latitude in selec- tion of viands is permissible. Permanent abstinence from certain kinds of food is advisable, lest dietetic indiscretion should cause relapse. Fresh butchers’ meat, chicken, oysters, are permitted. Fresh green vegetables (need not be pureed) are permitted. Fresh and cooked fruits may be taken in moderation. Cereals are permitted (may be taken with sugar and cream). Preserved and canned meats and fish are better excluded. Gas-forming and irritating vegetables—cabbage, cauliflower, sprouts, onions, garlic—are to be excluded. Milk had better be excluded or taken only in limited quantities. Over-ripe melon, rich sauces, condiments, are deleterious, and their ingestion might precipitate trouble. 39 DEBILITY (WITH ANEMIA), MALNUTRITION, NEURASTHENIA. [ Young Housewife.'] 8. A.M. Breakfast. A glass of milk or cocoa or coffee. Two eggs or a bowl of cereal. Two pieces of bread and butter or toast. Fruit. 8.30 to 10.30 A.M. Small occupation about house. 10.30 A.M. A glass of milk and bread. 10.30 to 12 M. A brisk walk and read or similar occupation. 12 M. Luncheon. Meat. Vegetable. Potato. Bread and butter. Plain pudding. 1.30 to 3 P.M. Rest—lying down alone in darkened room. 3.15 P.M. Glass of milk. 3.30 to 5.30 P.M. Walk or other light exercise; shopping; calling. 6 P.M. Supper. Light meat. Vegetable. Salad. Bread and butter. Dessert. Take water freely between meals. Eat slowly. Masticate food thoroughly. Do not eat when hot or excited. Do not hurry soon after eating. Eat at regular times. Eat plain nutritious food, simply prepared. Omit sauces, condiments, gravies. 40 DEBILITY. MALNUTRITION. NEURASTHENIA. (Continued.) MAY EAT. Meats and Fish. AVOID. Steaks, chops, roast beef, game, chicken, sweetbreads, brains, broiled tripe, white fish, raw oysters. Salt, preserved, canned and spiced meats and fish; tongue, goose, duck, kidneys, stews, salmon, shell-fish, sardines, mackerel. Vegetables. All green vegetables and such as grow above ground—spinach, cel- ery, lettuce, rhubarb, peas, arti- chokes, string beans, cress, carrots, eggplant, potatoes, beets. Turnips, corn, dry beans, onions, garlic, cabbage, cauliflower. Fruits. Fresh fruits—apple, pear, peach, orange, cherries, grapes, lemon, grapefruit, melon, plums, persim- mons. Preserves. Beverages. Water, mineral water, tea, coffee, buttermilk, cocoa, chocolate. All alcoholic and malt drinks. Sundries. Bread, toast, zwieback, eggs, but- ter, cereals, limited amount of clear soup, cottage cheese, plain cake, limited amount of molasses candy or milk chocolate. Pastry, pies, confectionery, sweets, spices, sauces, gravies, nuts, pou- lettes; all condiments, such as ta- basco, Worcestershire, mustard; thick and cream soups; hot rolls, hot biscuits, hot breads. Particularly recommended are red meats and green vegetables. This list is not intended to be exhaustive, but indicates foods which .re good, and foods which are not good to take. 41 DIABETES. [Starvation Treatment.] The starvation treatment of diabetes consists in withdrawing from the patient all food except black coffee. Alcohol, in the form of whisky or cognac, may be permitted but is usually unnecessary. The starvation may be continued one or several days. In milder cases twenty-four hours usually suffices to free the urine of sugar; in severer cases two, three or four days may be required to attain this result. It is advised, in cases requiring more than two or three days, to interrupt the starvation, place the patient on a low calory diet, and after an interval to repeat the starvation treatment if glyco- suria persists. Diabetic patients have been starved, without ap- parent injury, for as long as ten days, but this treatment is severe and the same results may be more agreeably attained by the inter- rupted treatment described above. By starvation, patients having as much as 2 per cent, or 3 per cent, of sugar, may be rendered sugar-free within from twenty-four to thirty-six hours. GENERAL PRINCIPLES. Some patients will do better by being in bed during the treatment. But this is not essential and, indeed, some patients progress more favorably out of bed. This depends upon the individual. Water may be taken freely during the treatment. Alkaline mineral water helps prevent acidosis; for the same purpose bicarbonate of soda is employed. It is good routine practice to give two to three drams of bicarbonate of soda daily during starvation. Where acid- osis or acetonuria impends or is present, the amount should be increased to a couple of drams every two or three hours. While acidosis and acetonuria must always be regarded as important, their occurrence in minor degree need not be alarming. In the starvation treatment the individuality of the patient and the presence or ab- sence of complicating factors (e.g., heart disease) must be taken into consideration. Loss of weight during the starvation period, and subsequently while the patient is on low calory diet, is the rule. In the obese type of diabetic, loss of five to ten pounds is beneficial; in emaciated patients, considerable losses are to be combatted. The patient should be kept under observation for some days be- fore the treatment is instituted—in order to ascertain the status of the case. During this time, daily weighing and urine examinations should be made. For detailed dietary see next page. 42 DIABETES. [Starvation Treatment. First Stage.] Patient in or out of bed, but under observation. Weight to be recorded daily. All urine to be collected and examined, and com- plete results recorded daily. (Similar observations on weight and urine to have been made and recorded for several days preceding the treatment.) 8 A.M. 2 to 4 ounces black coffee (without sugar). 11 A.M. 2 to 4 ounces black coffee (without sugar). 2 P.M. 2 to 4 ounces black coffee (without sugar). 5 P.M. 2 to 4 ounces black coffee (without sugar). 8 P.M. 2 to 4 ounces black coffee (without sugar). The hours for coffee and intervals between feedings may be suited to convenience. Water and mineral water may be taken freely as desired. Two drams bicarbonate of soda to be added to one quart water and taken during twenty-four hours. Whisky, two to six ounces, may be taken during twenty-four hours; it may be taken with the coffee, instead of coffee at certain feedings or between coffee feedings. From one-half ounce to one ounce whisky may be taken at a time. /A satisfactory method of administering whisky is to give—coffee, three ounces; whisky, one- half to one ounce, alternately at two-hour intervals, thus: Coffee... .3 ounces at 7 A.M., 11 A.M., 3 P.M., 7 P.M. Whisky... 1 ounce at 9 A.M., liP.M., 5 P.M., 9 P.M. The ammonia content of the urine should be estimated daily; if it exceeds three grams it indicates a considerable degree of acidosis and suggests the advisability of interrupting the treatment. The above described treatment may safely be continued one, two or three days, at the end of which time in average cases the urine will be free of sugar. 43 DIABETES. [Starvation Treatment. Second Stage.] The diet of a patient freed from sugar by the starvation treatment should be carefully and gradually increased, daily urine examina- tions being made to control the effect of additions of various kinds and quantities of food. A sufficient interval should elapse between the additions of different kinds of food to permit the recognition of the tolerance of the patient for different classes of food, especially proteids and carbohydrates. Vegetables and fats should be added first, proteids next and carbohydrates last. Here follow selected dietaries for the days immediately succeeding the starvation treat- ment: TYPE A. Breakfast. Two soft boiled or poached eggs. Cup of tea without milk and without sugar. Luncheon. Bacon and eggs. Small black coffee. Supper. Ham and eggs. Cup of tea without milk and without sugar. TYPE B. Breakfast. Omelette with fine herbs. Cup of tea. Luncheon. Eggs. String beans, asparagus. Small black coffee. Supper. Eggs. Spinach. Lettuce salad. Cup of tea. Water should be taken freely between meals. Type A and Type B meals may be alternated for several days succeeding the starvation period. 44 DIABETES. STARVATION TREATMENT. (Continued.) Combinations of the preceding types of dietaries (A and B) may next be given as follows: TYPE C. Breakfast. Eggs. Spinach. Coffee with cream. Butter. Asparagus omelette. Coffee with cream. Dinner. Ham or bacon. Cabbage. Tomatoes. Butter. Cream. Tea. Bacon. Lettuce salad. Spinach. Tea with cream. Supper. Eggs and bacon or ham. Celery. Cream. Butter. Tea. Eggs and ham. Celery (raw). Cauliflower. String beans. Coffee with cream. Breakfast. Eggs. Asparagus. Butter. Cream. Coffee. Eggs. Coffee with cream. Dinner. Chop. Peas. Celery. Butter. Cream. Tea. Bacon or ham and eggs. Tomatoes. Tea and cream. Supper. Cauliflower. String beans. Butter. Cream. Tea. Chicken. Celery. Olives. Spinach. Black coffee. This list is more liberal in that it allows also a limited amount of butcher’s meat and poultry, as well as bacon and ham. 45 Starvation Treatment: Classification of Foods according to Permissibility or Prohibition for Protracted Dietaries. DIABETES. MAY TAKE. Meat: Fresh and preserved: lamb, steaks, chops, roast beef, mutton, etc.; tongue, heart, brains, kidneys, marrow, meat extracts; preserved meats —dried, smoked or salt—ham, bacon, pork; game and poultry. Fish: Fresh and preserved: bass, salmon, cod, mackerel, herring, smelt, sardines, etc.; salted, dried, smoked and preserved fish. May be pre- pared in any usual manner but must not be cooked in batter or served with farinaceous dressing. Shell-fish: Oysters, mussels, clams, crabs, lob- sters, crayfish, shrimps, turtles. Fats: Butter, cream, oil, cream cheese. Eggs. Vegetables: Fresh and preserved: lettuce, en- dives, cress, sprouts, peas, spinach, cucumbers, onions, leeks, cabbage, cauliflower, asparagus, beet tops, string beans, tomatoes, chicory, celery, summer squash, parsley; pickles, green and ripe olives, sauerkraut. Fruits: In moderation—unsweetened: berries, melons, apple, pear, peach, orange, lemon, grape- fruit, plums, apricots. Condiments: Salt, pepper, cayenne, paprika, curry, cloves, cinnamon, nutmeg, mustard, anise seed, caraway seed, radish, parsley, dill, vinegar, Worcestershire, horseradish. Soups: Bouillon, meat soups, vegetable soups, milk and cream soups, beef tea. Cheese: Cream cheese (cottage cheese, Brie, Camembert, etc.). Nuts: Almond bread and almond cake; walnuts, almonds, peanuts in moderation; brazil nuts. Beverages: Water, mineral water, brandy, rum, whisky, coffee (may be sweetened with saccharin) ; tea, buttermilk. AVOID. Liver, sweetbreads. Sugar in any form. Bread, biscuits of all kinds, rolls, crackers, rye bread, toast, rusk, graham bread. Cereals; pastes. Potatoes, beans, corn, beet roots. All gravies and soups thickened with flour or cereal. Pastry and puddings of all kinds. Sweet fruits; preserved fruits; figs, grapes, dates, prunes. All sweet drinks; beer, champagne, milk (except sparingly), ale, porter, stout, cider; all sweet and sparkling wines; sherry, port wine. Liqueurs. Honey, molasses and syrup. Ices. Candy. 46 DIABETES. Starvation Treatment. Type Meals to be se- lected from Preceding Classified List for - Protracted Dietaries. Breakfast. Coffee or tea—without sugar. Bacon. Eggs. Luncheon. Meat. Green vegetable. Salad. Almond biscuits. Tea. Dinner. Marrow or soup or caviar or sardines. Meat or fish or poultry or game. Green vegetable with cream or mayonnaise, etc. Salad, pickles or olives. Almond biscuits. * One orange. Cup of tea or coffee. TYPE D. Take water freely between meals. This type of diet is adapted to a diabetic freed of sugar, but who has not acquired tolerance for carbohydrates. After tolerance is acquired by such a patient, this diet still will serve as a guide, carbo- hydrates being added to it cautiously and the patient’s tolerance being tested from time to time. It is advisable at first to combine with this type of dietary two days weekly, of a more restricted diet, namely, Type A. These days should be three or four days apart, e.g., Monday and Thursday. This regime of restricting the diet two days in each week should be followed for several weeks. After that interval it should be sufficient to restrict the diet only one day in each week. After this diet has been followed a considerable time, say two months, without sugar reappearing in the urine, it is advisable to proceed to the following diet E, in which a limited amount of farinaceous food is prescribed. 47 DIABETES. [Starvation Treatment.] The urine having remained free from sugar for a considerable period while the patient followed a strict diet, it is advisable to test the tolerance for carbohydrates by the addition of a limited amount of bread and other farinaceous food in the following manner: TYPE E. 1. Egg. Coffee with cream. Two slices toast Melba with butter. Steak. Tomatoes. Lettuce salad. Tea with cream. Scraped beef. Celery. Spinach. One apple or orange or peach. 2. Coffee with cream. Bacon and eggs. Berries. Ham omelette. Cold asparagus or artichoke or spinach or cauliflower. Black coffee. Salad—Romaine or lettuce or tomato. Cup of bouillon. Two soft boiled eggs. Cup of tea. Breakfast. Luncheon Supper. 3. Coffee with cream. Eggs. Two slices toast Melba with butter. Cold ham or chicken. String beans. Water cress salad. Tea with cream. Consomme. Light fish. Cauliflower. Green salad. Small black coffee. Breakfast. 4. Coffee with cream. Two eggs. Two slices toast Melba with butter. Lamb chop. Braised celery. Spinach. Black coffee. Beef broth. Chicken. Olives or salad. Cooked tomatoes or carrots. Coffee or tea. Luncheon Supper. 48 DIABETES. STARVATION TREATMENT. (Continued.) 5. Coffee with cream. Two soft eggs. Two slices toast Melba with butter. Roast beef. Celery Victor. Hot artichoke or asparagus. Cup of tea. Cup of consomme. Squab, peas. Black coffee. 6. Coffee with cream. Two soft eggs. Half nutmeg melon. Ham and eggs. Hearts of lettuce. Cup of tea. Cup of bouillon. Fish, string beans. Cottage cheese, black coffee. Breakfast. Luncheon Supper. It will be noted that on the days bread is permitted, no fruit is allowed and vice versa. Oatmeal may be taken instead of toast for breakfast, in diets Nos. 1, 3, 5 COMMENTS. It is not necessary in all cases to subject a patient to rigid starva- tion to render the urine sugar-free. In many cases where the urine contains only traces or a fractional percentage of sugar, this may be eliminated by placing the patient on a restricted diet (without preliminary starvation), such as is prescribed in Type A, B and C meals; or by placing the patient on a diet restricted only to the degree of Type D meals alone, or combined with Type A, B and C. Likewise in patients in whom considerable amounts of sugar have been reduced to a minimum by the starvation treatment, the residue may be eliminated by this less rigorous treatment. If glycosuria recurs in a patient previously rendered free of sugar by the starvation treatment, the patient should return to an earlier 49 DIABETES. STARVATION TREATMENT. (Continued.) stage of the treatment, and if this does not suffice to again render him sugar-free, the entire treatment should be repeated. It is advantageous in many cases to have the patient in a hospital during and immediately after the starvation treatment, in order to familiarize him with the details of the diet. But in the case of intelligent patients who can secure appropriate attention at home, the hospital is not essential and is an unnecessary expense. In the case of less affluent patients, hospital treatment need not be con- sidered. So far as caloric feeding, in or out of hospitals, is con- cerned, while it is valuable from a scientific standpoint, it is of less practical value. Even where great care is taken in figuring and feeding definite caloric values, unavoidable mistakes are prone to occur. Moreover, it requires very exceptional patients to conform to all details of caloric feeding, especially when released from re- straint and observation. Under these circumstances it seems far more practicable to have the patient learn and recognize visually the amount of cereal, roast beef, etc., he should take, rather than trust to the accuracy of the cook or steward to compute it in calo- ries for him. As I have elsewhere observed, the caloric system of feeding is fallacious, in that not the quantity ingested, but the quan- tity digested by an individual is the essential factor in nutrition. It should be borne in mind that not only carbohydrates but also proteids may cause glycosuria; hence also the quantity of proteids taken must be regulated. It will have been observed that a restricted dietary, such as has been described in conjunction with Type D meals, is recommended for permanent guidance. This is because the person who has once had diabetes remains a potential diabetic. The disease may never return, but in the present state of knowledge of this disease it cannot positively be known that conditions which once caused it may not do so again. Therefore, it is wise to exercise caution. 50 DIABETES. [Dietetic Treatment.'] GENERAL PRINCIPLES. Dietetic treatment of diabetes preceded the starvation treatment. The starvation treatment is an important adjunct, a step forward; it is essentially the dietetic treatment with a preliminary period of starvation. The starvation period accomplishes within a few hours or days a desideratum—namely, the freeing of the urine of sugar— to attain which the dietetic treatment alone might require weeks or months. Unfortunately, the starvation treatment cannot be em- ployed safely in all cases. The coexistence in some patients of other serious conditions—for example, heart failure—with diabetes pre- cludes employment of the starvation method or renders its employ- ment hazardous. In such exigencies the simple dietetic treatment should be relied upon. Another step forward in the dietetic treatment of diabetes has been made possible by the discovery that glucose in the urine may be formed from proteids as well as from carbohydrates. This knowl- edge is utilized in restricting proteids which formerly were per- mitted in unmeasured quantities in the dietary of diabetics. Still another advance has been made, due to the knowledge that loss of weight per se in a diabetic does not constitute a menace, but often is to be desired. This knowledge is of practical value and is to be taken into consideration in constructing dietaries for diabetics. 51 DIABETES. [Dietetic Treatment A. 1 Stage of Glycosuria. J A diabetic often may be freed of sugar by simply following the following rules: MAY TAKE FREELY. Meat and Broiled, boiled, baked, roasted: steaks, chops, roast beef, game, chicken, brains, broiled tripe, lamb, turkey, marrow, caviar, fresh fish. Vegetables. Green vegetables and such as grow above ground; spinach, cauli- flower, lettuce, celery, tomatoes, peas, carrots, string beans, cab- bage, cress, artichokes, eggplant, asparagus, rhubarb (unsweet- ened), ripe and green olives. Beverages. Water, mineral water, tea, coffee, buttermilk, cream. Sundries. Clear soup or bouillon, raw oysters, nuts, almond biscuit. MAY TAKE IN MODERATION. Meat and Fried foods of all kinds; salt, preserved, canned and spiced Fish. meats; tongue, goose, duck, kidneys, stews, ham, bacon, shell- fish; salt, preserved and canned fish. Vegetables. Garlic, onions. Fruits. Fresh fruit—apple, pear, peach, orange, cherries, lemons, grape- fruit, plums, persimmons, apricots, berries. Beverages. Alcoholic and acidulous drinks; milk, cocoa. Sundries. Sauces, gravies, poulettes; condiments, such as catsup, mustard, tabasco; meat and cream soups; oatmeal. Meat and AVOID. Fish. Liver, sweetbreads. Vegetables. Vegetable roots and tubers—corn, beets, dry beans, potato. Fruits. Grapes, figs, prunes, dates, raisins. Beverages. Malt drinks, sweetened drinks, chocolate. Sundries. Syrups, sugar, pies, pastry, confectionery; anything containing sugar; cereals, bread. • TYPE REGIME FOR A DAY. On arising drink a glass of water. Breakfast. Two eggs, one piece fruit, bacon or ham, coffee. 11 A.M. Glass of water or mineral water. Luncheon. Steak or chop or roast beef or other plain meat, vegetable, fruit or tea or small black coffee. 4.30 P.M. Glass of mineral water. Supper. Gup of bouillon, meat, vegetable, potato, salad, tea or fruit. The urine having been freed of sugar and remaining free for a considerable time (three months), a more liberal diet may be allowed as outlined in succeed- ing table. 52 DIABETES. [Dietetic Treatment B. 1 Urine freed of sugar.J A diabetic having remained sugar-free a considerable time (three months or longer) while observing dietetic rules A, may be allowed a more liberal diet. MAY TAKE. Meat and Fresh beef, mutton, lamb, veal, pork, tongue, game, tripe, poul- pjgh. try, brains, kidneys, marrow; preserved, salted, canned and spiced meats and fish; shell-fish. Vegetables. Green vegetables—spinach, cauliflower, lettuce, celery, rhubarb, tomatoes, pickles, ripe and green olives, peas, cucumbers, carrots, string beans, cabbage, cress, endives, artichokes, asparagus, egg- plant, beet tops, onions, leeks. Fruits. Apple, pear, peach, tart plum, lemon, orange, grapefruit, per- simmons, cantaloupe, watermelon, apricots, berries. Beverages. Water, mineral water, tea, coffee, cream, buttermilk. Sundries. Meat soups, vegetable soups, cream soups; sauces and gravies (no starch thickening), condiments, nuts, French dressing, may- onnaise. RESTRICT. Cereals. A limited amount of oatmeal may be taken. Bread. A limited amount of wheat or rye bread, toast, zwieback, rusk, crackers, may be taken. Vegetables. Potatoes. Beverages. Whisky, brandy, dry white wine and claret; milk. Sweets. At rare intervals plain cake or ice cream may be taken. AVOID. Meats. 'Liver, sweetbreads. Sweets. Sugar, confectionery, ices, candy, syrups, honey, pastry. Fruits. Grapes, figs, prunes, dates, raisins, preserves. Vegetables. Corn, beet roots, dry beans. Sundries. Soups with starchy thickening; gravies with starchy thickening. TYPE MEALS. Breakfast. Eggs, bacon or ham, coffee, one slice toast, and butter. Luncheon. Meat (or poultry or fish), vegetable, salad, fruit, tea, one slice toast and butter. Dinner. Soup, meat, vegetable, potatoes (sometimes), salad, tea or coffee, fruit. Tolerance should be tested frequently by urine examinations and if glyco- suria recurs, return to previous diet. 53 'Dietetic Treatment. Patient Freed of Sugar. Tolerates Carbohydrates Except Sugar. Patient Underweight and has a Tendency to Hyperacidity. DIABETES. MAY EAT. AVOID. Meats and Fish. Broiled, boiled, baked, roasted: steak, chops, roast beef, game, chicken, sweetbreads, brains, broiled tripe, white fish, white meat of turkey, raw oysters. Fried foods of all kinds; all salt, preserved, canned and spiced meats; tongue, goose, duck, turkey, kid- neys, stews, sardines, salmon, shell- fish, mackerel. Vegetables. Green vegetables and such as grow above ground—spinach, peas, let- tuce, string beans, artichokes, car- rots, potatoes, eggplant. All starchy vegetables and such as grow under ground; beets, turnips, corn, garlic, dry beans, onions, cel- ery, rhubarb, cress; olives, pickles, cucumbers. All fruits omitted for the present. (While patient has hyperacidity.) Fruits. Beverages. Water, mineral water, tea, cocoa. All alcoholic and malt drinks; all sweetened and acidulated drinks; chocolate, coffee, milk, buttermilk. Sundries. Bread, toast, zwieback, butter, eggs, clear soup or bouillon, cot- tage cheese. Cake, pastry, pies, sweets, confec- tionery, spices, sauces, nuts, gra- vies, poulettes; all condiments, such as catsup, mustard, tabasco; thick and cream soups, hot cakes, hot biscuits, hot rolls, muffins, waf- fles, syrups, salads, candy. The complicating digestive disturbance in this ill-nourished patient necessitates prescribing a diet which to a degree is contraindicated by diabetes. 54 DIABETES. DIETETIC TREATMENT. (Continued.) Eat slowly. Masticate all food thoroughly. Do not eat when hot or excited. Do not eat large quantities at a time. Avoid all irri- tating foods and all foods which experience has shown are not well tolerated. Eat plain nutritious food, simply prepared. Omit all sauces, gra- vies, condiments. Omit raw vegetables. Omit all fat or greasy foods. Avoid desserts and creams. Avoid all fried foods and all cooked fats. Food may be boiled, broiled, baked, roasted. Abstain from alcoholics: beer and malt beverages. Do not take hot and cold, or sweet and sour, at the same meal. Avoid all hard foods; all spiced or highly seasoned foods; all foods with husks or kernels. Take a moderate amount of exercise, but do not over-exert or be strenuous. Do not drink with meals (not more than four ounces of fluid with a meal, except breakfast). One hour before each meal and at bedtime drink a glass of water or mineral water. TYPE MEALS. On arising drink a glass of water. Breakfast. Two eggs. Two pieces of toast and butter. Cup of milk or cocoa. 11 A.M. A glass of water. Luncheon. Steak or chop or roast beef or other plain meat. Stale bread and butter or toast (not hot). Vegetable. Cup of tea. 4.30 P.M. A glass of water. Supper. Cup of bouillon. Meat. Potato. Vegetable. Toast, stale bread or crackers. Tea. May have milk at 3 P.M. and sandwich at bedtime. 55 DIABETES. [Special Diets for Complicated Cases.] The existence of other diseases in individuals afflicted with dia- betes may necessitate modification of diabetic dietaries. For ex- ample, in the case of a patient with impaired digestive powers, the diet must be suited to the digestive tolerance as well as to the dia- betic condition. When severe nephritis coexists with diabetes, selec- tion of a fitting diet is difficult, because the kind of food adapted to one disease is contraindicated by the other. If proteids should be withdrawn or reduced to a minimum on account of the nephritis and if carbohydrates should be similarly treated on account of the diabetes, the residual classes of foods from which the dietary might be selected would be inadequate for the maintenance of nutrition. Some diabetics reach a stage at which they tolerate without re- currence of glycosuria all kinds of food except sugar, while the ingestion of sugar or sugar-containing viands promptly causes glyco- suria. In an obese patient, who has nephritis and diabetes, the presence or absence of glycosuria depends upon not the kind but the quantity of food taken. When diabetes occurs as a concomitant or complication of acute or chronic cerebral disease, it may be neces- sary to subordinate the dietetic treatment of diabetes to treatment of the cerebral condition. Such cases as those cited require special diabetic dietaries, which can be determined only by knowledge of the complicating factors and study of the effects of various foods in the particular case. 56 DIABETES AND NEPHRITIS Obese Patient with Active Nephritis. Re- mains Sugar Free when Quantity, irre- spective of kind, of Food is Restricted. Breakfast. (1) One good portion of oatmeal with cream or milk (no sugar). One cup of coffee with cream. One slice of toast. (2) Instead of oatmeal a portion of strawberries or rasp- berries or blackberries may be taken (no sugar). Luncheon. Fish or cereal or eggs. Green vegetable. Salad. One slice of toast with butter. Dinner. Vegetable soup. Light meat or chicken or fish or eggs. Green vegetable. Baked potato or one slice of toast. Salad. For the present reduce the amount of meat taken. Preferably take with breakfast—fruit; with luncheon—a cereal or eggs; with dinner —eggs or cereal; so that one meal shall have fruit— one meal shall have cereal— one meal shall have eggs—as chief viand. Three slices of toast daily may be permitted, but that is the limit for the present; and if potato is taken, the toast should be omitted. Tart fruit or berries may be taken twice a day. When taken twice a day, the fruit is to be substituted for the cereal or eggs at break- fast. If berries are taken for dinner the dinner should include no meat, eggs, cereal. Potato may be taken once in two days. 57 DIABETES AND HEMIPLEGIA. Sugar Reduced to a Trace. Modified for Patient Recently Recovered from - Apoplexy. -* 1. Egg. Coffee with cream. Two slices thin toast with butter. Steak. Tomatoes. Lettuce salad. Tea with cream. Scraped beef. Celery. Spinach. One apple or orange or peach. 2. Coffee with cream. Bacon and eggs. Berries. Ham omelette. Cold asparagus or artichoke; spinach or cauliflower. Black coffee. Salad: Romaine or lettuce or tomato. Cup of bouillon. Two soft boiled eggs. Cup of tea. Breakfast. Luncheon. Supper. 3. Coffee with cream. Eggs. Two slices thin toast with butter. Cold ham or chicken. String beans. Water cress salad. Tea with cream. Consomme. Light fish. Cauliflower. Green salad. Small black coffee. 4. Coffee with cream. Two eggs. Two slices thin toast with butter. Lamb chop. Braised celery. Spinach. Black coffee. Beef broth. Chicken. Olives or salad. Cooked tomatoes or carrots. Fruit and tea. Breakfast. Luncheon Supper. Breakfast. 5. Cup of coffee and cream. Two soft eggs. Two slices thin toast with butter. Roast beef. Braised celery or aspara- gus. Hot artichoke. Cup of tea. Cup of consomme. Squab. Peas. Black coffee. 6. Cup of coffee with cream. Two soft eggs. Half nutmeg melon. Ham and eggs. Hearts of lettuce. Cup of tea. Cup of bouillon. Fish. String beans. Cottage cheese. Black coffee. Luncheon. Supper. In 1st, 3d and 6th diets, cereal may be substituted for eggs. 58 DYSENTERY (WITH ANEMIA), CHRONIC AMEBIC. Eat only at regular meal times, and only three meals a day. Drink only limited quantities with meals. One hour before each meal take a glass of water or mineral water (Bartlett, Vichy, etc.). Eat simple foods, avoiding such mixtures as very hot and very cold at the same meal, or sweet and sour. Have food prepared plain, omitting sauces, condiments, gravies. Avoid cooked fats. Foods should be boiled, broiled, baked or roasted. Abstain from all alcoholics. Eat steak, chops, roast beef, mutton, poultry, chicken, white meat of turkey, squab, game, sweetbreads, lamb, veal, boiled ham, broiled tripe. Omit tongue, corned beef, liver, goose, duck, sausage, bacon. Eat oysters raw, but avoid all other shell-fish, such as shrimps, crabs, lob- sters, mussels. Eat fresh white fish, but avoid all preserved, salt or canned fish: also avoid salmon, herring, sardines and mackerel. Fish should not be fried nor cooked with a sauce or poulette. Eat all light cooked vegetables, such as peas, string beans, spinach, asparagus, artichokes, celery, carrots. Avoid turnips, corn, beets, onions, cabbage, cucumbers, dry beans and raw vegetables. Salads should contain no garlic; no onions. Do not eat condiments—mustard, catsup, tabasco, horseradish, etc. Eat cooked fruits. Eat eggs—soft boiled, poached, scrambled, omelette. Eat zwieback, toast, crackers, and bread (preferably stale). Avoid hot breads, rolls, muffins, biscuits, pancakes. Avoid pastries, pies, cakes, sweets, confections, candies, ices, etc. May drink buttermilk, water, still mineral water, tea, coffee, cocoa, chocolate. 8 A.M. Breakfast. Cocoa, cereal, two slices bread and butter or toast, fruit. 12 M. Luncheon. Meat, vegetable, bread and butter, plain pudding. 1.30 to 3 P.M. Rest, lying down alone in darkened room. 3.15 P.M. Chocolate or tea or cocoa. 3.30 to 5.30 P.M. Walk or other light exercise, such as shopping, calling. 6 P.M. Dinner. Light meat, vegetable, salad, bread and butter, desserts. 10 P.M. Bed. 59 FATTENING DIET. [For Frail Young Mother. ] Regularity at meals and quantity taken, coupled with mental and physical repose are the essentials to be sought. In addition to the three established, substantial meals, it is ad- vantageous to eat lightly in the middle of the afternoon and before retiring. Milk or milk foods may be taken at these times. Physical rest is particularly beneficial. Long hours in bed, even though the patient does not sleep, by conserving energy afford an opportunity for fat to accumulate. Accordingly the patient may retire early and stay in bed late in the mornings. Also it is par- ticularly good to lie down and rest an hour and a half alone in a darkened room, after the midday meal. The day would then be divided up about as follows: i . 8 to 8.30 A.M. Two soft boiled eggs or a large bowl of cereal. Breakfast (in bed). Two pieces bread and butter. Glass of milk or cup of cocoa (made with milk). Baked apple or banana or other fruit. 12 to 12.30 P.M. A good sized piece of hot meat or fish. Luncheon. Baked potato. Green vegetable. Two pieces bread and butter. Dessert. 1 to 2.30 P.M. Rest alone, lying down in a darkened room. 3 P.M. Glass of milk and a light sandwich or cake. Instead of milk, cocoa or chocolate may be taken. 6 to 6.30 P.M. A thick soup. Dinner. A light entree. Meat or fish. Green vegetable. Potato. Salad with plenty of oil. Dessert. 10 P.M. (Or before retiring) a glass of milk and three or four lady fingers or bread and butter. Water should be taken freely, at least three glasses a day. 60 FATTENING DIET. (Continued.) Most common foods are fattening if taken in sufficient quantity. A partial list would include the following: Meats. Steaks, chops, roast beef, poultry, game, fish, oysters, brains, sweetbreads, tripe, mutton, squab, lamb. Vegetables. Green vegetables, such as spinach, lettuce, peas, aspara- gus, rhubarb, string beans, artichokes; and especially starchy vegetables, such as potatoes, beans, squash, carrots, corn. Fruits. Fresh fruit of all kinds, preserved and stewed fruits, jams and jellies. Beverages. Water, milk, beer, light wines, cocoa, chocolate. Sundries. Bread, eggs, cake, sweets, confections, candies, gravies, poulettes, nuts, thickened soups, rolls, farinaceous foods, muffins, waffles, syrup, puddings, desserts, ice cream, chocolate. Undesirable foods include especially indigestible foods, such as pickles, cucumbers, cabbage, onions, condiments. 61 FEVERS, ERUPTIVE. Scarlet Fever, Smallpox, Measles, German1 Measles, Chicken-pox, Diphtheria. Water and milk in first few days. 1— Later: Fruit juice, whey, etc. Vegetable broth. 2— After eruptive stage: Gruels. Bread (stale or toasted), crackers, zwieback, lady fingers, apple sauce, cooked fruit, bland vegetables, eggs, custards, cereals. 3— Last: Meat, meat extracts: first chicken, squab. Liquid diet during febrile stage—water, milk, lemonade, orange juice. In fevers the food must fill the following requirements: 1— It must be nutritious. 2— It must be nonirritating. 3— It must be easily assimilable. 4— It must leave as residue sufficient bulk to require elimination without requiring effort or being cumbersome. 62 GASTRITIS, CHRONIC. ALCOHOLIC. [ Traveling Man.] Eat only at regular meal times and only three times a day. Eat simple foods, avoiding such mixtures as very hot and very cold at the same meal; or sweet and sour. Have food prepared plain—omitting sauces, gravies, condiments. Avoid cooked fats. Meat should be boiled, broiled, baked or roasted. Drink only limited quantities with meals. One hour before each meal take a glass of water or still alkaline mineral water (Bartlett, etc.). Abstain from all alcoholics. Reduce smoking (only after dinner and supper). MAY EAT. AVOID. Meat and Fish. Steak, chops, roast beef, mutton, chicken, white meat of turkey, squab, game, lamb, sweetbreads, boiled ham, broiled tripe, raw oysters, fresh white fish. Tongue, corned beef, liver, duck, goose, sausage, shrimps, crab, lobster, mussels; preserved, salt or canned fish; salmon, herring, sardines, mack- erel; fish should not be fried nor cooked with sauce or poulette. Vegetables. Peas, string beans, spinach, asparagus, artichokes, beets, strained tomatoes, cooked celery, carrots. Turnips, corn, onions, garlic, cabbage, cucumbers, dry beans and raw vege- tables. (Seasoning with onion or garlic.) Fresh and cooked fruits; eggs soft boiled, poached, scrambled, omelette; zwieback, toast, crackers; bread (pre- ferably stale). Sundries. Condiments, such as catsup, mustard, tabasco, horseradish; berries, hot bread, hot rolls, hot cakes, muffins, biscuits, pastries, pies, cakes, sweets, confections, candies, ices. Buttermilk, water, still mineral water, tea, coffee, milk, cocoa, chocolate. Beverages. Alcoholic and malt drinks. Acid and sweet drinks. TYPE REGIME FOR A DAY. On arising drink a glass of water. Breakfast. Eggs or cereal, toast and butter, fruit. 11 A.M. A glass of water or mineral water. Dinner. Steak or chop or roast beef or other plain meat, stale bread and butter or toast (not hot), vegetable, fruit or custard, may also take salad. 4 to 4.30 P.M. A glass of water or mineral water. Supper. Cup of bouillon, meat, vegetable, toast, stale bread or crack- ers ; fruit, pudding or tea. About six to eight glasses of water should be taken daily, between meals. 63 GASTROPTOSIS. [Adult with Impaired Digestion.] 7 A.M. A glass of hot water. 8 A.M. Breakfast. A fine cereal, with cream and salt or cinnamon. One or two slices of rusk. 11 A.M. A glass of water. 12 M. Dinner. Scraped beef or finely divided chop or other light meat or fish. Baked potato. A smooth green vegetable. Two slices rusk with butter. 5 P.M. A glass of water. 6 P.M. Supper. Light meat. Pureed vegetable. Rusk. 9.30 P.M. One glass of milk. Meats. May include beef, mutton, lamb, chicken, fish with white flesh, raw oysters, boiled ham, sweet- breads, brains. Vegetables. May include pureed peas, asparagus tips, arti- chokes, spinach, lettuce prepared like spinach (both of these finely divided), cooked celery root, pureed carrots, baked or mashed potatoes. Eggs, etc. Cottage cheese may be taken; soft boiled or poached eggs may be taken. Cereals. May be taken, but only thoroughly cooked, fine cereals such as farina, cornstarch, arrowroot, Imperial Granum, Cream of Wheat, Robinson’s prepared barley. 64 GLYCOSURIA, ALIMENTARY. [In Spare Adult; Having Gastric Hyper A acidity. Patient Freed of Sugar. Breakfast. Glass of grapefruit juice or orange juice. Two eggs (not fried) One glass milk and cream (equal parts). One slice toast with butter. 10 A.M. One glass milk and cream. One cracker. 12 M. Cottage cheese and cream. Two soft eggs. One glass milk and cream. One slice toast. One potato (or at supper). 4 P.M. One glass milk and cream. One cracker. 6 P.M. One glass milk and cream. One slice toast. Hot milk soup with egg. Two eggs. Pureed green vegetable. Lettuce salad—French dressing. Custard. 10 P.M. One glass milk and cream. 65 GLYCOSURIA, ALIMENTARY. Patient Freed of Sugar. Liberal Diet to Increase Weight. MAY TAKE FREELY. Meats and Fish. Broiled, boiled, baked, roasted, steaks, chops, roast beef, game, chicken, brains, white fish, lamb, turkey. Vegetables. Green vegetables —spinach, cauli- flower, lettuce, celery, eggplant, rhubarb, toma- toes, string beans, cabbage, cress, artichokes. Beverages. W ater, mineral water, coffee, co- coa, buttermilk, tea. Sundries. Clear soup, bouil- lon, raw oysters, nuts, marrow, butter, olive oil. MAY TAKE IN MODERA- TION. Meats and Fish. Fried foods of all kinds; salt, preserved, canned and spiced meats; tongue, duck, goose, kidneys, stews, sal- mon, shell-fish, sardines, mackerel, ham, bacon. Vegetables. Beets, turnips, garlic, peas, carrots, onions. Fruits. Fresh fruit—apples, pears, peaches, oranges, cherries, lemons, grapefruit, plums, persimmons, figs, apricots, berries. Beverages. Milk; alcoholic and acidu- lous drinks. Sundries. Sauces, gravies, poulettes; condiments, such as catsup, mustard, tabasco; thickened soups; muffins, waffles, stale bread, toast, zwieback, cereals. AVOID. Meats. Sweetbreads. Liver. Vegetables. Corn, potatoes. Fruits. Grapes, prunes, raisins. Beverages. Syrups, malt and sweetened drinks. Sundries. Sugar, pastries, pies, sweets, con- fectionery ; any- thing containing sugar. 66 GLYCOSURIA, ALIMENTARY. (Continued.) TYPE REGIME FOR A DAY. On arising drink a glass of water. Breakfast. Two eggs. Bacon or ham. Two slices toast with butter. One piece fruit. 11 A.M. A glass of water or mineral water. Luncheon. Steak or chop or roast beef or other plain meat. Vegetable. Stale bread and butter or toast (not hot). Fruit or tea or small black coffee. 4.30 P.M. A glass of water or mineral water. Dinner. Cup of bouillon. Meat. Vegetable. Salad. Toast or stale bread or crackers. Tea or fruit. AVOID Sweet desserts and sweet creams. 2 P.M. Glass of cream and milk. 10 P.M. Glass of cream and milk or eggnog. It is good to drink water and mineral water, but not at meal times. Avoid getting over-exerted, over-heated, excited. 67 GOITER, NON-TOXIC. [Obese Woman.] TYPE MEALS. Breakfast. Cocoa. Toast (or bread) and butter. Fruit. Luncheon. Meat or eggs. Vegetable (green). Bread and butter or toast or zwieback. Light dessert. Dinner. Eggs or meat. Vegetable. Salad. Bread and butter. Light dessert (fruit or cake). Meat to be taken only once a day. Avoid over-exertion, over-excitement, strenuous or protracted exercise. Do not lift heavy weights. Do not hurry; cultivate repose. Do not eat rapidly. 68 GOITER, NON-TOXIC. (Continued.) MAY EAT. AVOID. Meat and Fish. Fresh meat broiled, boiled, baked, roasted: chops, steaks, roast beef, lamb, chicken, game, fish with white flesh, turkey, sweetbreads, brains, raw oysters, mutton, veal. All salt, preserved, canned and spiced meats and fish; fried meats of all kinds; tongue, salmon, shell- fish, goose, kidneys, duck, stews, sardines, mackerel. Vegetables. Eat all green vegetables and such as grow above ground—spinach, peas, cauliflower, lettuce, celery, rhubarb, tomatoes, string beans, artichoke (no mustard mayon- naise), cress, carrots, asparagus. All starchy vegetables and such as grow under ground; potatoes, beets, corn, turnips, onions, squash, cucumbers, cabbage, garlic, dry beans. Fruits. Fresh fruits—apple, pear, peach, orange, grapefruit, cherries, plums, melons, grapes, apricots, berries; of the larger fruits only one. All stewed, preserved or sweetened fruits; figs, bananas. Beverages. Water, mineral water, buttermilk, tea, cocoa, coffee, chocolate. All alcoholic and malt drinks; all sweetened and acidulous drinks; milk. Sundries. Stale bread, toast, zwieback, salad, eggs, limited amount clear soup or bouillon, plain cake. Rich cake, pastry, pies, sweets, con- fectionery, sauces, gravies, nuts, poulettes; condiments, such as mus- tard, tabasco, etc.; hot rolls, muf- fins, biscuits, hot cakes, syrups. 69 GOITER. ANEMIA. MALNUTRITION. [Wo Toxic Symptoms.] DESIRABLE. UNDESIRABLE. Meat and Fish. Beefsteak, roast beef, roast mutton, mutton chops, lamb chops, chicken, squab, brains, tripe, sweetbreads, fish, raw oysters, ham, game, lamb, veal, marrow, scraped beef, bacon. All preserved and canned meat and fish; tongue, sausage, pork, liver, kidneys, pot roast, hash, stews, soup meat, duck, goose, herring, crabs, clams, lobster, mussels. Meats should be broiled, boiled, baked, roasted (but not stewed or fried). Vegetables. String beans, asparagus, peas, arti- chokes, cooked celery, lettuce, cauli- flower, spinach, eggplant, potatoes, carrots. Radishes, onions, corn, cucumbers, pickles, cabbage, sprouts, turnips. Fresh and cooked fruits; apple sauce, baked apple, prunes, orange, apple, stewed peach, pear, grapes, berries; jams, preserves. Fruits. Beverages. Water, mineral water, tea, milk, cocoa. Coffee, alcoholics. Sundries. Eggs in any form, cereals, rice, sago, cottage cheese, custards, pud- dings, sponge cake, angel cake, lady fingers, macaroni, chocolate custards, bread, crackers, graham crackers, toast, zwieback, honey, clear jelly, syrup, limited amount candy, clear soups, bouillon, beef tea, mutton broth, chicken soup, beef juice. Soups may be thickened by cooking a cereal or vegetables in them, but avoid rich, cream or fatty soups. All condiments, such as catsup, mustard, horseradish, Worcester- shire, tabasco; nuts, pastries, cakes, pies, candies, rich soups, sauces and gravies, hot rolls, hot biscuits, hot bread, hot cakes, waffles. 70 GOITER, TOXIC. [Delicate Young Woman.'] C. TYPE MEALS. Breakfast. Two eggs (cereal may be substituted for eggs). Bread and butter. Milk or cocoa. Fruit or orange juice. Luncheon. Steak or chops or other plain meat or fish. Potato. Vegetable. Bread and butter. Custard, pudding or fruit. Dinner. Consomme or grapefruit. Plain meat or poultry or fish. Green vegetable. Salad. Bread and butter. Fruit or plain pudding or plain cake. Eat slowly. Eat at regular times. Take bread and butter and jelly and glass of milk at 3 P.M.; and glass of milk at bedtime. Have food prepared plain, omitting sauces, gravies, condiments. Chew food thoroughly. Eat at intervals of not less than four hours. Eat broiled, boiled, baked or roasted meats. Avoid all made dishes—stews, sauces, gravies. Do not eat mixtures, such as hot followed by cold, or sweet and sour. One hour before each meal drink a glass of water. Meat to be taken only once a day. Eggs may be taken for luncheon if cereal has been taken for breakfast. Rest: lying down alone in darkened room between 1 P.M. and 3 P.M. A good retiring time is 10 P.M. to 10.30 P.M. Breathing exercises on arising and retiring. Avoid over-exertion, over-excitement, strenuous or protracted exercise. Do not lift heavy weights. Do not hurry; cultivate repose. Do not eat rapidly. 71 GOITER, TOXIC. (Continued.) C. MAY EAT. AVOID, Meat and Fish. Fresh meat broiled, boiled, baked, roasted: chops, steak, roast beef, lamb, chicken, game, fish with white flesh, turkey, sweetbreads, brains, raw oysters, mutton, veal. All salt, preserved, canned and spiced meats and fish; fried meats of all kinds; tongue, salmon, shell- fish, goose, duck, kidneys, stews, sardines, mackerel. Vegetables. Eat green vegetables and such as grow above ground—spinach, peas, cauliflower, lettuce, celery, rhubarb, tomatoes, string beans, artichokes (no mustard mayonnaise), corn, asparagus, cress, carrots, dry beans, potatoes, beets, squash. Turnips, onions, cucumber, garlic, cabbage, sprouts, sweet and sour vegetables, vegetables with rich sauces. Fruits. Fresh and cooked fruits—apple, pear, peach, orange, grapefruit, cherries, plums, melons, grapes, apricots, bananas, berries; of the larger fruits only one. Beverages. All alcoholic and malt drinks, all sweetened and acidulous drinks, coffee. Water, mineral water, tea, milk, buttermilk, cocoa, chocolate. Sundries. Stale bread, toast, zwieback, salad, eggs, limited amount clear soup or bouillon, ice cream, plain cake, cereals, all farinaceous foods, sweets, nuts, syrups, cottage cheese. Rich cake, pastry, pies, confection- ery, sauces, gravies; condiments, such as mustard, tabasco, etc.; hot rolls, hot cakes, muffins, biscuits. 72 GOITER, EXOPHTHALMIC. [ With Cardiac Insufficiency.] Select viands from preceding List C. TYPE MEALS. Breakfast. Cereal. Cocoa made with water. Toast (or bread) and butter. Fruit. Luncheon. Meat or eggs. Vegetable (green). Bread and butter or toast or zwieback. Light dessert. Dinner. Meat or eggs. Vegetable. Salad. Bread and butter. Light dessert (fruit or cake). 3.15 P.M. Tea or broth or sandwich. Bedtime. Cup of broth or hot milk or malted milk. If the specified meals are insufficient to maintain weight, or if hunger or faintness (with the indicated amount of food) supervenes, do not increase the amount at these meals, but take an extra meal. This may consist of hot or cold chicken or ham or oysters or similar food. Meat to be taken only once a day. Breakfast in bed. Rise about 10.30 or 11 A.M. and perform light occupation—read- ing, writing, etc. Lie down and rest, 1.30 to 3 P.M. From 3.30 to 5.30 P.M. outing: riding or walking or shopping. Early to bed. 73 GOUT. MAY EAT. Vegetables: especially green. Farinaceous foods. Pastes. Milk. Meat or white fish, once a day. Eggs, in moderation. Cottage cheese. Buttermilk. Limited amount of butter. Potatoes. Bread, toast, zwieback, rusk, Crackers. Tea, water, mineral water. Fresh fruit: apple, pear, peach, orange, grapes, figs, melon, cherries. Salads without oil. Soups of milk or vegetables. AVOID. Meats (except once daily). Fish (except once daily instead of meat). Oysters and shell-fish. Cheese (except cottage cheese). Soups made of meat. Dry beans. Fats and oils. Sauces and condiments. Onions, garlic. Sweets. Cake, pie, pastry. Puddings. All sweetened fruits. Cream. Alcoholics. 74 GOUTY DIATHESIS. TO BE EATEN FREELY. Oatmeal, rice, barley, sago, tapioca, flake breakfast foods (ready made foods). Pastes (macaroni, spaghetti, etc.). Milk, butter, cottage cheese, but- termilk, water, mineral water. Potatoes: Irish and sweet. Fresh fish: white meats. Vegetable soups. Eggs. Most dried fruits, raisins. Peaches, pears, grapes, apples, bananas. Uncooked cabbage. Corn: green, canned and hominy. Cucumbers, beets, turnips, lettuce. Chicken. Light meats. TO BE EATEN IN MODERATION. Red and dark meats: beef, mutton, game, ham. Fat bacon, lard, suet. Meat soups, oysters and oyster soup. Most nuts except peanuts. Kale and spinach; dried peas, beans and lentils. Puddings. Tea, coffee and cocoa; sweet cider, sweet lemonade and fruit juices. TO BE AVOIDED. Salt and fried meats; salt and pre- served fish; liver, sweetbreads, pan- creas, veal; heavy meat meals of all kinds. Tomatoes, celery, rhubarb, pickles, mushrooms. Gooseberries, strawberries. Concentrated cheeses. Peanuts. Hot bread and cakes of all kinds. Custard; greasy pastries Soft drinks. Beer and whisky. 75 GOUTY DIATHESIS. (Continued.) MENU. Breakfast. Cereal. Milk. Coffee. Luncheon. Vegetable soup. Eggs. Bread and butter. Fruit. Dinner. Vegetable soup (if desired). Fish or chicken; may have chop or steak, etc., occasionally. Vegetable (lettuce, beets, corn, cucumber, turnips, cold slaw). Cereal or paste or rice, sago, tapioca, bread, potato. Prunes or dried fruit—raisins, apples, peaches, pears, bananas, oranges. 76 GOUTY DIATHESIS. [Obese Woman.'] MAY TAKE. Meats. AVOID. Roast beef, steak, chops, lamb, mutton, veal, poultry, game, ham, squab, tripe, brains. Tongue; preserved and canned meats; domestic duck, goose, liver, bacon, soup meat, fried meat. Fish. Fresh fish with white flesh; raw oysters. Preserved or canned fish; shell-fish, salmon, mackerel, herring, sardines. Vegetables. Tomatoes, cabbage, spinach, peas, carrots, string beans, cauliflower, artichokes; salad with lemon, not with oil; vegetables should be cooked plainly. Corn, turnips, dry beans, pickles, cucumbers, sprouts, vegetables with rich or cream sauces. Fruits. Apples, oranges, cooked pears, peaches, plums. Preserves, prunes, bananas, raisins. Sundries. Stale bread, toast, zwieback, tea, coffee, soup, water, mineral water, eggs, cocoa, milk, buttermilk, farin- aceous foods (sparingly). Hot bread, rolls, biscuits; chocolate, cheese, highly spiced foods, des- sert, alcoholics, malt drinks, can- dies, confections, sweets, pastries. Masticate food thoroughly. Do not eat fried foods, but eat roasted, baked, broiled or boiled foods. Do not eat mixtures, such as hot followed by cold or vice versa, or sweet and sour. One hour before each meal drink a glass of water or mineral water. Retire early. Rest alone, lying down in dark room one hour after luncheon. Avoid hurry. 77 GOUTY DIATHESIS. [Obese Man.~\ The object of this diet is to reduce to a minimum certain kinds of food, at the same time allowing a sufficient intake to supply the needs of the body and satisfy the appetite. 1— Reduce meat and meat products. Take meat only once a day. White meat of chicken, lamb chops, and fish having white flesh. 2— Vegetables, especially green vegetables, should be the mainstay of the diet. Spinach, celery, string beans, carrots, artichokes, asparagus, peas, lettuce, cauliflower, cabbage, pickles, sprouts, onions, cress, rhubarb, tomatoes, may be freely taken. 3— Fruits may be taken freely—oranges, grapefruit (unsweetened), apples, grapes. But preserved fruits (on account of the sweeten- ing) are to be omitted. 4— Beverages: Water should be taken freely, one or two quarts a day. Mineral water (Vichy, Bartlett or White Rock) may be advantageously taken. Milk may be taken in limited quantities; buttermilk may be taken freely. Alcoholics of all kinds are ex- cluded. Coffee should be entirely omitted or taken saringly, like- wise tea and cocoa; chocolate is excluded. Lemon juice (un- sweetened) may be taken in water or mineral water. Soups made with meat are to be excluded; milk soups or vegetable broths may be taken. Sundries: Bread may be taken moderately; toast and zwieback may be taken. Cakes, pies, confections, sweets, pastry, creams, are not to be taken. Sauces, condiments, gravies, all made dishes, spices, are to be avoided. Salads: only plain green salads (celery, let- tuce, romaine, etc.), made with a limited amount of oil, may be eaten; preferably omit the oil. Nuts are to be omitted. Eggs: two or three eggs may be taken daily. Cereals may be taken, also spaghetti, vermicelli, etc. (limited amount). Hot cakes, hot rolls, etc., are to be avoided. Cheese is excluded; cottage cheese may be taken. A DAY’S MENU SHOULD BE ABOUT LIKE THIS: Breakfast. Glass milk, cereal, toast and butter. Luncheon. Two or three eggs, green vegetable, cracker or toast, orange. Dinner. Chicken or fish, raw celery, green vegetable, salad, bread, fruit, small coffee or tea occasionally. 78 HEART DISEASE. GENERAL PRINCIPLES OF DIET FOR CARDIAC CASES. Certain general rules are applicable to the dietetic treatment of cardiac cases. A. Owing to the juxtaposition of the heart and stomach, distention of the stomach (or abdomen), by pressure upon the heart, deleteri- ously influences cardiac action. Gastric or abdominal distention may be caused by the ingestion of too large quantities of food at one time, by taking additional food before previously ingested food has left the stomach, by the ingestion of foods which ferment or form gas, by the ingestion of foods which are indigestible and cause gastro- intestinal disturbance with resulting distention. Therefore: 1— The diet should consist of meals of relatively small bulk. 2— The interval between meals should be long enough to permit the stomach to empty itself. 3— Gas-forming foods, such as the cabbage group of vegetables, and old cheese, should be excluded from the diet. 4— Hard and indigestible foods are contraindicated. Such foods in- clude raw vegetables (radishes, onions), rich sauces, etc. B. A distinction must be made in the treatment of obese and lean patients. As obesity per se increases the task of the heart, the diet should be so calculated as to reduce the patient’s weight: in ill- nourished or fragile patients, on the other hand, the diet should be prescribed with a view of improving the nutrition of the patient. Therefore, in general the diet for cardiac cases should be made up of small meals of concentrated, nourishing, easily digestible foods. Such foods include light meats, fine cereals, eggs, etc. C. The existence of complications must be taken into consideration and the diet modified accordingly (nephritis, anemia, etc.). 79 HEART DISEASE. (Continued.) D. Milk: The value of milk in the dietary of cardiac cases is vari- able. For obese individuals it is, as a rule, contraindicated; for frail individuals it may be extremely beneficial. Some individuals digest milk easily; others have a decided intolerance for milk. For the latter class of cases, if for some reason milk seems particularly use- ful in the diet, treatment of the milk by peptonizing or boiling may facilitate digestion. However, the idea that milk constitutes ideal food for all persons is erroneous. For infants it no doubt is ideal food, but for adults it is less desirable and may be distinctly noxious. The inclusion or exclusion of milk in the diet of cardiac cases must be decided with reference to the special case. E. It is inadvisable to mix liquid and solid foods. The regular meals should consist of solid or semisolid foods, with which a small amount—4 to 6 ounces—of liquid may be permitted. Between meals liquids, especially water, should be taken freely, but not excessively, as excessive quantities of liquids require too great cardiac exertion. F. Constipation: It is important that the bowels should act regularly and freely: constipation may result in abdominal distention and ab- sorption of toxic substances from the intestine (copremia). Dis- tention mechanically interferes with cardiac action, and absorption of toxic substances from the intestines adversely affects the circu- lation. Therefore, fruits and laxative viands, such as the fine green vegetables, fulfill an important function in the diet of heart cases. 80 HEART DISEASE, VALVULAR. ' College Professor. Beginning Compensatory Failure. Breakdown of Digestive and Circulatory Systems in Fifty-five Year Old Man. Restorative Diet in Hospital. PROGRESSIVE DAILY DIETARIES. 7.45 A.M. Two soft boiled eggs, zwieback, hot water. 12 M. Scraped beef sandwich, zwieback, cottage cheese. 5.30 P.M. Chicken rice soup, zwieback, custard. 7.30 A.M. Two soft boiled eggs, zwieback, hot water. 12.15 P.M. One-half broiled chicken, cottage cheese, zwieback. 5.45 P.M. Chicken soup, zwieback, custard. 7.30 A.M. Two soft boiled eggs, zwieback, water. 12.30 P.M. Steak, zwieback, cottage cheese, water (two ounces). 5.45 P.M. Chicken rice soup, one-half broiled chicken, zwieback, water (two ounces). 7.30 A.M. Two soft boiled eggs, zwieback, hot water. 12.30 P.M. T wo lamb chops, cottage cheese, zwieback, custard, water. 6 P.M. Raw oysters (six), zwieback, custard, water (six ounces). 7.30 A.M. Two soft boiled eggs, zwieback and butter, hot water. 12.10 P.M. Steak, zwieback, cottage cheese, custard, water (6 oz.). 5 P.M. Broiled chicken, rice soup, zwieback, custard. 7.30 A.M. Three soft eggs, zwieback, hot water. 10.30 A.M. Six raw oysters. 12.30 P.M. Lamb chops, cottage cheese, zwieback, custard, water (six ounces). 6 P.M. Chicken broth, one-half broiled chicken, zwieback, custard. 7.30 A.M. Three soft eggs, zwieback, hot water. 10 A.M. Six raw oysters. 12.30 P.M. Steak, cottage cheese, custard, zwieback, water (6 oz.). 5.50 P.M. Chicken soup, broiled chicken, zwieback, rice, water (six ounces). 7.30 A.M. Three soft eggs, zwieback, hot water. 10 A.M. Six raw oysters. 12.30 P.M. Three lamb chops, zwieback, cottage cheese, custard, water (six ounces). 6 P.M. Chicken rice soup, one-half broiled chicken, boiled rice, custard, zwieback. 7.30 A.M. Three eggs, zwieback, hot water. 10 A.M. Six raw oysters. 12 M. Steak, cottage cheese, zwieback, custard, water (6 oz.). 6 P.M. Chicken soup, broiled chicken, rice, zwieback. 8 P.M. Water (eight ounces). 81 HEART DISEASE, VALVULAR. (Continued.) PERMANENT REGIME. 7 A.M. Glass of water or still mineral water with Karls- bad salts three times a week. 8 A.M. Rise. 8.30 A.M. BREAKFAST. 9 A.M. Work and recreation— to So arrange work that about one hour will be 11 A.M. standing and one hour will be walking. 11 A.M. Glass of water or still mineral water. 11 A.M. to 12 M. Sedentary occupation. 12.30 P.M. LUNCHEON. 1.30 to 2.30. Rest: lying down alone in darkened room. 2.30 to 5 P.M. Work and recreation. 5 P.M. Glass of water or still mineral water. 5 to 5.30 P.M. Recreation. 5.30 to 6 P.M. Rest. 6 P.M. DINNER. 7 to 8 P.M. Read or other diversion. 9 to 10 P.M. Retire. Breakfast. Cereal or eggs. Toast (or bread) and butter. Coffee or cocoa. Fruit. Luncheon. Meat (steak, chops, chicken, fish). Vegetable (green). Bread and butter or zwieback or toast. Light dessert. Dinner. Light meat or oysters or fish or eggs. Vegetable or macaroni or spaghetti. Light dessert. 9 P.M. Lean ham or chicken sandwich or glass of milk. TYPE MEALS. If the three specified meals are insufficient to maintain weight, or if hunger or faintness (with the indicated amount of food) super- venes, do not increase the amount at these meals, but take an extra meal. This may consist of hot or cold chicken or ham or oysters or tea and toast or cottage cheese or bread and butter or milk and cake. 82 HEART DISEASE. FATTY HEART. [In Obese Man of Forty.'] TYPE REGIME FOR A DAY. On arising drink a glass of tap water or mineral water. Breakfast. Two eggs. Two slices of toast with butter. One piece of fruit. 11 A.M. Glass of Vichy or other alkaline water or tap water. Luncheon. Steak or chop or roast beef or other plain meat. Stale bread and butter or toast (not hot). Vegetable. Fruit or a cup of.tea. 4.30 P.M. A glass of mineral water or tap water. Supper. Cup of bouillon. Meat. Vegetable. Toast, stale bread or cracker. Fruit or tea. Avoid puddings, desserts and creams. “Meat,” as here employed, means a good slice roast beef or two lamb chops or similar amount of other meat. “Fruit” means one medium size orange, apple or like amount of other fruit. “Mineral water” means still alkaline water, such as Vichy, Be- thesda, Bartlett. It is good to drink mineral water, but not at meal times. Do not eat before retiring or before lying down. Avoid getting over-heated, over-exerted, or over-excited. Eat slowly. Eat at regular times. Drink only limited quantities with meals. Have food prepared plain, omitting sauces, gravies, condiments. Masticate food thoroughly. Eat at intervals of not less than four hours. Eat roasted, baked, boiled or broiled meats. One hour before each meal drink a glass of water or mineral water. Do not eat mixtures, such as hot followed by cold, or vice versa, or sweet and sour. If stipulated meals are insufficient, do not increase the quantity at a meal, but take an extra small meal. 83 HEART DISEASE, FATTY HEART. (Continued.) MAY EAT. Meat and Fish. AVOID. Broiled, boiled, baked, roasted: steaks, chops, roast beef, game, chicken, sweetbreads, brains, broiled tripe, boiled ham, white fish, raw oysters. Salt, preserved, canned and spiced meats; tongue, goose, duck, turkey, lamb (except lamb chops), kid- neys, stews; salmon, shell-fish, sar- dines, mackerel. Vegetables. Green vegetables and such as grow above ground — spinach, cooked celery, lettuce, rhubarb, peas, string beans, carrots, cress, artichokes, eggplant, squash, tomatoes. Starchy vegetables and such as grow under ground — potatoes, beets, turnips, corn, dry beans, onions, garlic, cabbage, sprouts, cucumbers, cauliflower. Fruits. Fresh fruit—apples, pears, peaches, oranges, cherries, grapes, lemons, grapefruit, melons, plums, persim- mons, apricots—all in moderation. Sweetened fruits; berries, figs, ba- nanas; stewed or preserved fruits; raisins, prunes. Sundries. Stale bread, toast, zwieback—all in moderation; butter (a limited amount), salads (without oil), eggs in moderation (not fried), limited amount of clear soup or bouillon, cottage cheese. Fresh bread, cake, pastry, pies, confectionery, sweets, spices, gra- vies, sauces, nuts, poulettes; condi- ments, such as catsup, mustard, tabasco sauce; thick and cream soups; all farinaceous foods, mush of all kinds; hot rolls, hot biscuits, muffins, hot cakes, waffles, syrups, pastes. Beverages. Water, still mineral water; tea and coffee (in restricted amount, per- haps one cup of each daily) ; but- termilk. Effervescing waters, alcoholics, malt drinks, iced drinks, sweet drinks, milk. 84 HEART DISEASE. MYOCARDITIS. [.Anemic Adult.'] RULES. Avoid long hours. Stairs should be avoided whenever possible. The quantity of fluids taken during the day should be liberal, but not excessive. From six to eight glasses of all fluids should be taken during the day. Drink water freely, best taken an hour be- fore meals, but limit the quantity of fluids taken with meals. Eat slowly and masticate food thoroughly. Do not eat when hot or excited. Do not work excitedly. Over-exertion and strain are to be avoided. TYPE MEALS Breakfast. Cereal. Cocoa. Toast or bread and butter. Luncheon. Meat (steak, chops, chicken, fish). Green vegetable or potato. Bread and butter. Light dessert (such as plain cake or pudding). Dinner. Eggs. Vegetable pureed. Bread and butter: or toast or zwieback. Light dessert (pudding or custard). A paste—macaroni or spaghetti—may be substituted for vegetable or potato. If three meals a day are not sufficient to maintain weight, or if you become hungry, do not increase the quantity taken at meal times; rather take an extra light meal: this may consist of a little ham or chicken or a glass of milk and bread and butter. 85 HEART DISEASE. MYOCARDITIS. [Adult Male.] Eat at regular meal times. Eat simple foods, avoiding such mixtures as very hot and very cold at the same meal, or sweet and sour. Drink only limited quantities with meals. One hour before each meal take a glass of water or mineral water (Bartlett, Vichy) still alkaline. Have food prepared plain, omitting sauces, gravies, condiments. Avoid cooked fats. Meat should be broiled, boiled, roasted or baked. Omit alcoholics. Eat steak, chops, roast beef, mutton, poultry, chicken, white meat of turkey, squab, game, sweetbreads, lamb, veal, boiled ham, broiled tripe. Omit tongue, corned beef, liver, goose, duck, sausage, bacon. Eat oysters raw, but avoid all other shell-fish such as shrimps, crabs, lobster, mussels. Eat fresh white fish but avoid all preserved, canned or salt fish; also avoid salmon, herring, sardines, mackerel. Fish should not be fried, nor cooked with a sauce or poulette. Eat light cooked finely divided vegetables such as peas, string beans, spinach, artichokes, cooked celery, carrots, tomatoes, lettuce. Avoid all starchy vegetables—turnips, corn, beets, onions, cabbage, cucumbers, dry beans, and raw vegetables; radishes. Flavoring of onions and garlic to be excluded from diet. Do not eat condiments—mustard, mayonnaise, catsup, tabasco, horseradish. Salads should contain no onion or garlic (oil, minimum amount). Eat fresh fruits not sweetened; avoid preserved and sweetened fruits. Eat eggs—soft boiled, poached, scrambled, omelette. Eat zwieback, toast, crackers and bread, preferably stale. Cooked fine cereals are permitted. Omit cheese, except cottage cheese. May take bouillon, broth and clear soups, but avoid rich and cream soups. Avoid hot rolls, hot bread, muffins, biscuits, hot cakes, waffles. Avoid pastries, pies, cakes, sweets, confections, candies, ices, etc. May take plain cake. May drink buttermilk, water, still mineral water, tea, coffee, cocoa. Avoid chocolate, sweet drinks, acid drinks, alcoholic and malt drinks. 86 HEART DISEASE. MYOCARDITIS. (Continued.) 7 A.M. Glass of water or Vichy (still). 7.30 A.M. Rest. 8 A.M. Breakfast. 9 to 11 A.M. Work or recreation: so arrange that part will be walking and part sitting. 11 A.M. Glass of still Vichy. 11 to 12 M. Rest: read, write, etc. 12.30 P.M. Luncheon. 1.30 to 2.30 P.M. Rest. 2.30 to 5.30 P.M. Work—walk—ride, etc. 5.30 P.M. Glass of water or still Vichy. 5.30 to 6.30 P.M. Recreation, as above. 6.30 P.M. Supper. 7.30 to 8.30 P.M. Read or other diversion. 8.30 to 10 P.M. Company, etc. 10 to 10.30 P.M. Retire. Take small simple meals of solid foods. Drink only limited quantities with meals (this includes soup, cof- fee, etc.). Between meals drink water freely—four glasses daily. About 3.30 P.M. take a light sandwich (e.g., ham or chicken), or buttermilk, if desired. At bedtime may take a light sandwich, or glass of water or malted milk. 87 HEART DISEASE. MYOCARDITIS. (Continued.) TYPE MEALS. 8 A.M. Cereal or two eggs, toast or zwieback, coffee. 12.30 P.M. Scraped beef, green vegetable, zwieback, cottage cheese. 6.30 P.M. Chicken rice soup, green vegetable, zwieback, custard. 8 A.M. Cereal or two eggs, toast or zwieback, coffee. 12.30 P.M. One-half broiled chicken, green vegetable, zwieback, cot- tage cheese. 6.30 P.M. Chicken soup, green vegetable, zwieback, custard. 8 A.M. Cereal or two eggs, toast or zwieback, coffee. 12.30 P.M. Steak, green vegetable, zwieback, cottage cheese. 6.30 P.M. Chicken rice soup, one-half broiled chicken, green vege- table, zwieback. 8 A.M. Cereal or two eggs, toast or zwieback, coffee. 12.30 P.M. Two lamb chops, green vegetable, cottage cheese, zwie- back, custard. 6.30 P.M. Raw oysters, green vegetable, zwieback, custard. 8 A.M. Cereal or two eggs, zwieback and butter, coffee. 12.30 P.M. Steak, green vegetable, cottage cheese, light cake. 6.30 P.M. Rice soup, broiled chicken, green vegetable, zwieback, custard. 8 A.M. Eggs, zwieback, coffee, fruit. 12.30 P.M. Lamb chops, green vegetable, cottage cheese, zwieback, custard. 6.30 P.M. Chicken broth, one-half broiled chicken, green vegetable, zwieback, fruit. 8 A.M. Eggs, zwieback, coffee, fruit. 12.30 P.M. Steak, green vegetable, cottage cheese, zwieback, cus- tard, cake. 6.30 P.M. Chicken soup, rice, broiled chicken, green vegetable, zwieback, light dessert. 8 A.M. Eggs, zwieback, coffee. 12.30 P.M. Lamb chops, green vegetable, cottage cheese, zwieback, dessert. 6.30 P.M. Chicken rice soup, one-half broiled chicken, green vege- table, rice, zwieback, custard, or cake. 88 HEART DISEASE. MYOCARDITIS. [Loss of Compensation in Elderly Woman. MAY EAT. AVOID. Steaks, chops, roast beef, mutton, poultry, chicken, white meat of turkey, squab, game, sweetbreads, lamb, veal, broiled ham, broiled tripe, fresh white fish, raw oysters. Meat and Fish. Tongue, corned beef, liver, duck, goose, sausage, bacon, shrimps, crabs, lobster, mussels; preserved, salt or canned fish; fish should not be fried nor cooked with a sauce or poulette. Vegetables. Peas, string beans, spinach, asparagus, artichokes, celery, tomatoes, carrots. Turnips, corn, beets, onions, cabbage, cucumbers, dry beans, raw vegetables. Fruits. Eat fresh and cooked fruits. Buttermilk, water, still mineral water, tea, coffee, cocoa, chocolate. Beverages. Alcoholic and malt drinks. Sundries. Zwieback, toast, crackers, bread (pre- ferably stale), eggs — soft boiled, poached, scrambled, omelette. Pastries, pies, cakes, sweets, confec- tions, candy, ices, hot breads, hot rolls, muffins, biscuits, mustard, tabasco, catsup. Begin the day with a glass of hot water. 8 A.M. Breakfast. Two eggs or a bowl of cereal. Two pieces of bread and butter or toast. 9 A.M. to 10.30 A.M. Busy about the house. 10.30 A.M. A glass of water. 11.30 to 12 M. Quiet: read or similar occupation. 12 M. Luncheon. Meat, vegetable, bread and butter, plain pudding. 1.30 to 3 P.M. Rest: lying down alone in darkened room. 3.30 to 4.30 P.M. Walk or other exercise. 4.30 to 5.30 P.M. Busy in the house. 5 P.M. Glass of water. 6 P.M. Supper. Light meat, vegetable, bread, butter, dessert; or, Eggs, vegetable, bread and butter, dessert; or, Cereal, vegetable, bread and butter, dessert. Drink only limited quantities with meals. One hour before each meal take a glass of water or mineral water (Bartlett, Vichy, etc.). Eat simple foods, avoiding such mixtures as very hot and very cold at the same meal, or sweet and sour. Have food prepared plain, omitting sauces, condiments, gravies. Avoid cooked fats. Meat should be broiled, boiled, baked, roasted. Do not eat hurriedly. Do not eat a large quantity at a meal, but if necessary take an extra meal. Salads should contain no garlic, no onion. 89 [Athletic Heart in Youth Eighteen Years Old. HEART DISEASE. TYPE MEALS. Breakfast. Cereal or eggs. Milk, cocoa or chocolate. Toast or bread and butter. Fruit: raw or cooked. Luncheon. Meat or eggs. Green vegetable or potato. Bread and butter. Light dessert, such as fruit or plain cake, Dinner. Fish or meat or eggs. Vegetable. Salad. Bread and butter. Light dessert. Macaroni or spaghetti may be substituted for vegetable at luncheon or dinner. If the three specified meals are insufficient (as shown by mal- nutrition or hunger), do not increase the quantity taken at meal times, but take an extra light meal: this may consist of a ham or chicken sandwich or glass of milk and bread and butter, or piece of plain cake and glass of milk. Food may be so selected that at one meal cereal should be taken, at one meal meat and at one meal eggs, but light meat or poultry or fish may advantageously be taken at two meals; if so, cereal should be taken for breakfast and eggs may be taken as the light dessert, in form of custard or jelly omelette, or similar viand. Water should be taken liberally, but not excessive quantities— from six to eight glasses of all fluids should be taken during the twenty-four hours. Water is best taken an hour before meals: with meals the quantity of liquids should be limited to not more than a small glassful. This includes broths and soups as well as cocoa, chocolate and water. Food should be prepared plain, omitting sauces, condiments and gravies (except the blood gravy of roast beef or steak). Meat should be boiled, broiled, baked or roasted, but not fried. Eat slowly; masticate food thoroughly. Do not eat when hot or excited. Do not hurry after eating. 90 HEART DISEASE. ATHLETIC HEART. (Continued.) Drink only limited quantities with meals. One hour before each meal take a glass of water or mineral water (Bartlett, Vichy, etc.). Eat simple foods, avoiding such mixtures as very hot and very cold at the same meal, or sweet and sour. Abstain from all alcoholics. Eat steak, chops, roast beef, mutton, poultry, chicken, white meat of turkey, squab, game, sweetbreads, lamb, veal, boiled or broiled ham, broiled tripe. Omit tongue, corned beef, liver, goose, duck, sausage. Eat oysters raw, but avoid all other shell-fish, such as shrimp, crab, lobster, mussels. Eat fresh white fish, but avoid all preserved, salt or canned fish: also avoid salmon, herring, sardines, mackerel. Fish should not be fried nor cooked with a sauce or poulette. Eat all light, cooked vegetables, such as peas, string beans, spinach, asparagus, artichokes, celery, tomatoes, carrots.. Avoid turnips, corn, beets, onions, cabbage, cucumbers, dry beans, cauliflower. Salads should contain no garlic, no onion. Do not eat condiments—mustard, catsup, tabasco, horseradish, etc. Eat fresh and cooked fruits. Eat eggs: soft boiled, poached, scrambled, omelette. Eat zwieback, toast, crackers and bread (preferably stale). Avoid hot bread, hot rolls, muffins, biscuits, hot cakes. May drink buttermilk, water, still mineral water, tea, cocoa, chocolate. Omit coffee. Avoid alcoholic and malt drinks. May take cottage cheese, but do not take other kinds of cheese. Never hurry—cultivate repose. Dancing, running, ascending stairs rapidly, are prohibited. Avoid stairs whenever possible. Avoid hills as much as possible, and when impossible to avoid hills, walk slowly. Do not work excitedly. Over-exertion and strain are to be avoided. Avoid long hours. Retire early. Do not stand too long at one time—but whenever possible be seated. Attend to the bowels religiously—see that they act once (or more) daily. 91 HEART DISEASE WITH NEPHRITIS. [Secondary Anemia.] MAY EAT. Meat and Fish. AVOID. Chicken; meat sparingly; fish with white flesh; bacon, ham. Red meats (except sparingly) ; pre- served and spiced meats; rich fish ,(salmon, mackerel, cod). Vegetables. Green vegetables; starchy vegetables. Cabbage, cucumbers, onions, garlic. Fruit: raw and cooked. Fruits. Beverages. Water, still alkaline mineral water, buttermilk, cocoa, chocolate, tea, coffee, milk, cream. Alcoholics; mixed drinks, sweet drinks. Cereals (rice, farina, etc.), pastes '(macaroni, etc.), cottage cheese, toast, bread, eggs, cake, puddings, honey, jelly, water ice, ice cream, vegetable soups, salads, milk soups. Sundries. Cheese, condiments, pastries, pies, strong meat soups. TYPE MEALS. Breakfast. Cereal. Coffee or cocoa. Toast or bread and butter. Fruit. Luncheon. Eggs or meat (steaks, chops, chicken, fish). Vegetable (green). Bread and butter or zwieback or toast. Light dessert. Dinner. Light meat or oysters or fish or eggs. Vegetable or macaroni or spaghetti. Light dessert. 9 P.M. Lean ham or chicken sandwich or glass of milk. If the three specified meals are insufficient to maintain weight, or if hunger or faintness (with the indicated amount of food) supervenes, do not increase the' amount at these meals, but take an extra meal. This may consist of tea and toast, or cottage cheese or bread and butter or milk and cake. 92 ICTERUS, JAUNDICE, CATARRHAL. MAY TAKE. Water. Still alkaline water. Tea. Soft foods. Soft boiled or poached eggs. Bouillon. Consomme. Chicken—broiled, steamed, roasted. White fish. Limited amount of toast, zwieback, bread. Rice. Barley soup, with barley strained out. Sago. Tapioca. Pastes. Light vegetables: spinach, artichokes, asparagus, carrots, peas, celery root (cooked). AVOID. Fats: oil, butter, cream. All alcoholics. All coarse foods. Coarse cereals. Coarse vegetables: onions, garlic, cabbage, cauliflower, radishes, cucumbers. Fruits. Nuts. Preserves. Condiments. Gravies. Sauces. 93 INDIGESTION. GENERAL CONSIDERATIONS. Although indigestion is not a disease but a symptom, there occur (apart from digestive disturbances caused by definite pathologic con- ditions such as local gastro-enteric inflammation, gastric and duo- denal ulcer, appendicitis, etc.) many cases of indigestion without definite pathologic basis or of which the definitive pathology is un- surmountable or obscure. Such cases may be due to over-eating, eating indigestible food, or they may have a nervous basis, etc. Treatment of the first group of cases is assisted by proper regula- tion of diet, while for the successful treatment of the latter group observance of proper dietetic rules is indispensable. In the dietetic treatment of digestive disorders certain deductions of value have been made: 1— Food should be taken slowly, liquids as well as solids. 2— Food which experience has taught is not well tolerated should not be taken. One person may digest with ease a kind of food which another finds indigestible. 3— In digestive disorders the digestive powers should not be over- worked : their tasks should be lightened in order to permit tone to be regained. A—It is inadvisable to drink copiously at the same time as solid foods are taken. Large quantities of liquids, by diluting the gastric juices, retard and disorder digestion. A small quantity of liquid with meals may be of benefit by helping to soften and mix the food in the stomach, rendering it more accessible to the action of the gastric juice. Water is an indispensable part of the diet. It should be taken between meals. Its value in combating constipation is considerable. Taken an hour before meals it washes the stomach and prepares it for the reception of food. 5—Hard foods, foods with husks or kernels, are contraindicated during indigestion. 94 INDIGESTION. (Continued.) 6— Between times of taking food sufficient intervals should elapse to permit the stomach to empty itself. This period will vary in different cases: atonic stomachs require longer to empty themselves than do hypermotile stomachs. 7— It is bad to eat mixtures, long menus, fancy sauces, etc. Meals consisting of various viands may prove noxious, whereas the individual viands, if taken at separate times, may be innocuous and even beneficial. 8— Milk may be a valuable food in the diet or its use may be contra- indicated. In general, milk is better tolerated in gastric than in intestinal indigestion. Onions and garlic, condiments, irritate the intestine and should be eliminated from the diet of patients having indigestion. The cabbage group of vegetables should be excluded from the diet in cases of indigestion on account of gas- forming proclivities. 9— A distinction must be made in dietaries for gastric and intestinal indigestion. 10— Adequate attention must be paid to the bowels. 11— Regard in the prescription of diet must be had for associated conditions or disease. For example, the coexistence of diabetes, nephritis, dysentery, constipation, may necessitate radical modi- fications in the indicated diet. 12— When indigestion is protracted, an underlying cause should be sought and, when found, treated. 95 [Patient Tolerates Milk.'] INDIGESTION, GASTRIC. TEMPORARY DIET. Breakfast. Well cooked cereal—farina, cream of wheat, corn starch, Robinson’s barley or strained oat- meal gruel. Ten ounces of milk. Toast and butter. Luncheon. Soft boiled eggs. Toast and butter. Ten ounces of milk. 3 P.M. Ten ounces of milk. Dinner. Pint of broth. Two or three eggs. Toast and butter. Water to be taken freely between meals. 96 INDIGESTION, CHRONIC GASTRIC. [Patient has Milk Intolerance.] TEMPORARY DIET. 6.30 to 7 A.M. Glass of hot water with Carlsbad salts. 8.30 A.M. Two soft boiled eggs. Toast or zwieback. 11 A.M. Glass of water (or alkaline mineral water). 12.30 P.M. Scraped meat or fine fish. Pureed vegetable. Piece of zwieback. 4.30 P.M. Glass of water (or mineral alkaline water). 6.30 P.M. Beef juice or fine cereal or light meat or fish. Pureed vegetable. Toast or zwieback. 10 P.M. Water. Water may be taken freely between meals, from six to eight glasses within twenty-four hours. 97 INDIGESTION, CHRONIC GASTRIC. [More Liberal than Preceding.] TEMPORARY DIET. 6.30 to 7 A.M. Glass of water and one teaspoonful Epsom or Carls- bad salts. 8 A.M. Two eggs (soft boiled, poached or scrambled). Zwieback or toast and butter. Orange juice or apple sauce or baked apple (not the skin). 11 A.M. Glass of water. 12 M. Scraped meat or fine fish (not fried), or tripe (broiled or cooked in soup), or sweetbreads (broiled), or calvesfeet (broiled or boiled). Pureed vegetables, such as peas, or asparagus tips, or artichoke. Toast and butter. Custard. 5 P.M. Glass of water. 6.30 P.M. Soup with rice or sago or tapioca: or Rice and milk: or Farina and milk and Bread and butter. At 10 A.M. and 3 P.M. a cup of broth or crackers may be taken. 98 INDIGESTION, CHRONIC GASTRIC. [Hyperacidity with Pyrosis.'] Breakfast. Two soft boiled or poached eggs. Two slices toast or zwieback with butter. Cup of tea without milk. Luncheon. Beef juice or broiled scraped beef or scraped chops or chicken or raw oysters. Two slices toast or zwieback with butter. Pureed green vegetable (artichoke, asparagus tips, celery root, peas). Custard or sponge cake. Dinner. Meat, as at luncheon. Two slices toast or zwieback with hutter. Vegetables, as above. Plain cake or cottage cheese. 10.30 A.M. A glass of milk and toast may be taken (if patient 3.30 P.M. tolerates milk). and A cup of broth or light meat sandwich (ham or 10 P.M. chicken) may be taken (if patient does not tolerate milk). One hour before meals take a glass of water or still alkaline mineral water. Take water freely between meals. 99 INDIGESTION, CHRONIC INTESTINAL. [Careful Diet for Quiescent Periods. TYPE REGIME FOR A DAY. On arising drink a glass of Vichy Celestin, or of tap water. Breakfast. Coffee. Two pieces of bread with butter. One piece of fruit (cooked). 11 A.M. Glass of water or mineral water. Luncheon. Steak or chop or roast beef or other plain meat or eggs Vegetable. Stale bread and butter or toast (not hot). Fruit or tea. 4.30 P.M. Glass of water. Dinner. Meat or eggs. Vegetable. Toast, stale bread or crackers. Fruit or tea. Avoid puddings, desserts and creams. The word “meat” as here used means a good slice of roast beef or two lamb chops or similar amount of other meat. “Fruit” means one medium size orange, cooked apple or like amount of other fruit. “Mineral water” means still alkaline water, such as Vichy, Beth- esda, Bartlett. It is good to drink mineral water, but not at meal times. Do not eat before retiring or before lying down. Avoid getting over-heated, over-exerted or over-excited. Eat slowly. Eat at regu- lar times and only three meals a day. Have food prepared plain, omitting sauces, gravies, condiments. Drink only limited quantities with meals. Eat at intervals of not less than four hours. Masticate food thoroughly. Eat boiled, broiled, baked or roasted meats. One hour before each meal drink a glass of water or mineral water. Do not eat mixtures, such as hot followed by cold, or sweet and sour. Avoid all made dishes—sauces, poulettes, stews, gravies; salads, tomatoes. Eat and drink slowly. 100 INDIGESTION, CHRONIC INTESTINAL. (Continued.) MAY EAT. AVOID. Meat and Fish. Broiled, boiled, baked roasted: steaks, chops, roast beef, game, chicken, sweetbreads, brains, broiled tripe, white fish, raw oys- ters, lean ham. Salt, preserved, canned and spiced meats and fish; tongue, goose, duck, turkey, lamb (except lamb chops), kidneys, stews, shell-fish, sardines, mackerel, salmon, her- ring. Vegetables. Green vegetables—spinach, cooked celery, lettuce, rhubarb, peas, string beans, pureed carrots, arti- chokes. (All vegetables should be pureed or otherwise finely divided). Starchy vegetables and such as grow under ground—potatoes, beets, turnips; corn, dry beans, onions, garlic, cabbage, cauli- flower, cucumbers, tomatoes, sprouts. Fruits. Fresh and cooked fruit—apple, pear, peach, orange, grapes, lem- ons, grapefruit; cooked prunes pureed, apple sauce, baked apple —all in moderation. Sweetened fruits, berries, figs, bananas; stewed or preserved fruits; cherries, plums, melons. Beverages. Water, tea, buttermilk, sour lem- onade (no sugar). A limited amount of weak coffee is per- mitted. All alcoholic and malt drinks; all sweet and acid drinks; choco- late, coffee, cocoa, milk, iced drinks. Sundries. Stale bread, toast, zwieback (all in moderation), butter; salads made with lemon, not with oil; eggs in moderation; limited amount of clear soup or bouillon; cottage cheese, pastes, cereals. Fresh bread, cake, pastries, pies, confectionery, sweets, spices, sauces, gravies, nuts, poulettes; all condiments, such as catsup, mustard, tabasco; thick and cream soups; hot rolls, hot bis- cuits, hot cakes, waffles; syrups. 101 INDIGESTION, CHRONIC. Individual with Good Digestive Powers; hut who is Accustomed to Commit Gross Diet- - etic Errors. The intention is not to restrict but to point out the foods which are particularly beneficial. Drink from two to three pints of milk daily. (Assuming milk is well tolerated by this patient.) Eat eggs freely—two or more daily. Eat plain fresh meat—steak, chops, roast beef, mutton, lamb, bacon, ham, and in general all butcher meats. Also eat poultry, game and fresh fish. Eat plain green vegetables—spinach, string beans, artichoke, asparagus, green peas, carrots, rhubarb, squash, lettuce, cooked cel- ery, beets, potatoes. Eat cereals—farina, corn starch, corn meal, cream of wheat, bar- ley, cracked wheat, and in general all breakfast foods, with cream and sugar. Eat fresh and cooked fruit; honey, syrups and jellies. Eat bread and butter, plain cake, cottage cheese, milk and cream soups, vegetable soups, thick soups, salads, custards, puddings, ice cream. Drink water freely between meals. Drink tea, coffee, milk, buttermilk, cocoa, chocolate. In general eat all good nourishing food. The kinds of food that should be avoided are indigestible foods, and foods which experience has taught are not well tolerated. This would include canned and preserved meats and fish, shell-fish, cab- bage, cauliflower, cucumbers, corn, tomatoes, melons; rich and fancy pastries and desserts; condiments, such as mustard, tabasco. Rest as much as possible: avoid long hours and exertion. 102 INDIGESTION. REFLEX—SYMPTOMATIC. MAY TAKE. Meat and Fish. AVOID. Broiled, boiled, baked, roasted: steaks, chops, roast beef, game, chicken, sweetbreads, brains, broiled tripe, white fish, lamb, turkey. Salt, preserved, canned and spiced meats and fish; tongue, goose, duck, kidneys, stews, sar- dines, shell-fish, mackerel, her- ring, salmon. Vegetables. Cooked green vegetables and such as grow above ground— peas, spinach, lettuce, cooked celery, rhubarb, string beans, carrots, artichokes, cress, egg- plant, potatoes, beets. Turnips, corn, dry beans, cab- bage, sprouts, cauliflower, onions, garlic, cucumbers, tomatoes, raw vegetables. Fruits. Take fruits—preferably cooked— with care. Omit all fruits during digestive disturbance. (Raisins, berries, figs, to be permanently excluded.) Beverages. Water, mineral water, cocoa, tea, coffee, buttermilk, chocolate. All alcoholic and malt drinks; all sweetened and acidulous drinks; milk; iced drinks. Sundries. Bread, toast, zwieback, butter, eggs, clear soup, bouillon, raw oysters, cereals, plain cake. Confectionery, sweets, spices, sauces, gravies, poulettes; all condiments, such as pepper, ta- basco, Worcestershire, catsup; thick and cream soups; hot rolls, hot biscuits, muffins, waffles, hot cakes; syrups, nuts. 103 INDIGESTION. REFLEX-SYMPTOMATIC. (Continued.) TYPE MEALS. On arising drink a glass of water with one teaspoonful salts. Breakfast. Two eggs. Two pieces of toast and butter. A small quantity of water, or tea without milk, may be taken. 11 A.M. A glass of water. Luncheon. Steak or chop or roast beef or other plain meat. Stale bread and butter or toast (not hot). Vegetable. Cup of tea. 4.30 P.M. A glass of water. Supper. One cup of bouillon. Meat. Vegetable. Potato. Toast, stale bread or crackers. Tea. Avoid desserts, creams. Eat slowly. Masticate all food thoroughly. Do not eat when hot or excited. Do not hurry soon after eating. Do not eat large quantities at a time. Avoid all irritating foods and all foods which experience has shown are not well tolerated. Eat only at regular meal times and only three meals a day. Eat plain nutritious foods, simply prepared. Omit all sauces, gravies, condiments. Avoid all fried foods and all cooked fats. Omit all fat or greasy foods. Food may be broiled, boiled, baked, roasted. Abstain from all alcoholics, beer and malt beverages. Do not take hot and cold, or sweet and sour, at the same meal. Omit raw vegetables. Avoid all hard foods; all spiced or highly seasoned foods; all foods with husks or kernels. Take a moderate amount of exercise, but do not over-exert or be strenuous. Limit liquids with meals (not more than four ounces fluid with a meal, except breakfast). One hour before each meal and at bedtime drink a glass of water or mineral water. 104 INDIGESTION. [Young Adult Male. For Years has EateriX Viciously and has Smoked Excessively.] MAY EAT. AVOID. Meat and Fish. Broiled, boiled, baked, roasted: steaks, chops, roast beef, game, chicken, sweetbreads, brains, lamb, broiled tripe, white fish, turkey. Salt, preserved, canned and spiced meats and fish; tongue, goose, duck, kidneys, stews; sardines, shell-fish, mackerel, salmon. Vegetables. Cooked green vegetables—peas, let- tuce, spinach (fine), celery, string beans, rhubarb, carrots, artichokes, cress, potatoes, eggplant, beets. Turnips, corn, dry beans, cabbage, onions, garlic, cauliflower, cucumbers, tomatoes, raw vegetables. Fruits. Raw and cooked fruits. During digestive disturbances omit all fruits. Beverages. Water, mineral water, cocoa, tea, coffee, buttermilk, chocolate. Alcoholic and malt drinks; all sweet- ened and acidulous drinks; iced drinks; milk. Sundries. Bread (preferably stale), toast, zwie- back, butter, eggs, clear soup or bouillon, raw oysters, cereals, plain cake. Confectionery, sweets, spices, sauces, gravies, poulettes; all condiments, such as pepper, tabasco, Worcester- shire, catsup; thick and cream soups; hot rolls, hot biscuits, muffins, waffles, hot cakes; syrups. Eat slowly. Masticate food thoroughly. Do not eat when hot or excited. Do not hurry soon after eating. Do not eat large quantities at a time. Avoid all irritating foods and all foods which experience has shown are not well tolerated. Eat only at regular times and only three meals a day. Eat plain nutritious food, simply prepared. Omit all sauces, gravies, condiments. Avoid all fried foods and all cooked fats. Meat may be broiled, boiled, baked, roasted. Do not take hot and cold, or sweet and sour, at the same meal. Omit raw vegetables. Omit all fat or greasy foods. Avoid all hard foods; all spiced or highly seasoned foods; all foods with husks or kernels. Take a moderate amount of exercise, but do not over-exert or be strenuous. Limit liquids with meals (not more than four ounces fluid with a meal, except with breakfast). One hour before each meal and at bedtime, drink a glass of water or mineral water. Drink six to eight glasses liquids within twenty-four hours. Stop smoking or reduce to a minimum and do not inhale. 105 INDIGESTION. [Chronic Indigestion and 1 Associated Dysentery. MAY EAT. AVOID. Meat and Fish. Broiled, boiled, baked, roasted: steaks, chops, roast beef, game, chicken, sweetbreads, brains, lamb, broiled tripe, white fish, turkey. Salt, preserved, canned and spiced meats and fish; tongue, goose, duck, kidneys, stews, sardines, shell-fish, mackerel, salmon. Vegetables. Cooked green vegetables and such as grow above ground— peas, string beans, artichoke, po- tatoes, pureed spinach, cooked celery root. Turnips, corn, beans, cabbage, onions, garlic, cauliflower, cu- cumbers, tomatoes, raw vege- tables, raw lettuce, cress, rhu- barb, carrots, eggplant, beets. Fruits. Light cooked fruits (if well tol- erated) during absence of dis- order. Omit all fruits during digestive disturbance. Beverages. Water, mineral water, tea, cocoa, coffee, chocolate. All alcoholic and malt drinks; all sweetened and acidulous drinks; iced drinks; milk. Sundries. Bread, toast, zwieback, butter, eggs, clear soup or bouillon, raw oysters, cereals, plain cake; soups thickened by cooking in them rice or barley (barley should be strained out) ; cottage cheese. Confectionery, sweets, spices, sauces, gravies, poulettes; all condiments, such as pepper, ta- basco, Worcestershire, catsup; thick and cream soups; hot rolls, hot biscuits, muffins, waffles, hot cakes; syrups, nuts, cheese. 106 INDIGESTION. (Continued.) Breakfast. Tea or coffee. Eggs or cereal. Bread and butter. Luncheon. Meat. Green vegetable. Bread and butter. Tea or plain cake. Dinner. Entree. Roast. Green vegetable. Potato. Light dessert. A glass of water to be taken on arising: about 11 A.M. and at 5 P.M., and as desired (between meals). The object of this list is to indicate a rational diet. Food should be taken at regular meal times. Water should be taken freely between meals, preferably one hour before each meal: at least three or four glasses of water a day. Water is not to be taken (except small amount) at meal times. Tea and coffee maj be taken in moderation. Milk is prohibited. It is inadvisable to eat when over-excited or over-exerted or to eat rapidly. Fresh meats and pureed fresh vegetables are the basis of this diet. Salt, preserved, canned and spiced meats and fish are forbidden. Condiments are prohibited. Fruit and vegetables which have a bulky residue, such as cabbage, cauliflower, celery, are prohibited; also all vegetables and fruits with seeds or husks, like tomatoes, corn, are prohibited. There is no effort here to cut down the quantity of food—the purpose is to eliminate irritating food. The list is not intended to be exhaustive, but is intended to indicate the classes of foods which are desirable and the kinds of foods which should be avoided. 107 INSANITY. Nourishing Diet for Patient having Excita- tive-Depressive Condition with Loss of Weight. (1) Breakfast. Cereal and cream, bacon, toast, cocoa or tea. Dinner. Roast beef, creamed potatoes, summer squash, let- tuce salad, bread and jelly. Supper. Broiled chicken, potatoes, artichoke puree, bread, ice cream. (2) Breakfast. Omelette, bacon, toast, cocoa. Dinner. Broiled steak, baked potato, carrots puree, lettuce salad, bread and jelly. Supper. Chicken, pureed peas, bread, pudding. (3) Breakfast. Cereal and cream, toast, coffee or tea, baked apple. Dinner. Broiled chops, baked potato, boiled rice, lettuce salad, bread, custard. Supper. Broiled bass, mashed potato, artichoke puree, bread, plain cake. (4) Breakfast. Scrambled egg, toast, cocoa, orange juice. Dinner. Broiled steak, baked sweet potato, celery root puree, whole wheat bread, sago pudding. Supper. Chicken, hominy, lettuce with lemon and oil, bread, ice cream, lady fingers. (5) Breakfast. Eggs or cereal and cream, toast, tea. Dinner. Broiled English chop, baked potato, lettuce with lemon and oil, bread, pudding. Supper. Broiled squab, mashed potato, string beans, bread, prune whip. (6) Breakfast. Boiled eggs, toast, cocoa. Dinner. Broiled sole, baked potato, finely divided spinach, lettuce salad, bread, jelly. Supper. Broiled steak, mashed potato, artichoke puree, ice cream, cake. (7) Breakfast. Cereal, bacon, toast, tea, baked apple. Dinner. Meat, baked potato, squash, bread, cottage cheese, stewed peach. Supper, Light meat, carrots puree, bread, custard, cake, 108 LITHEMIA. [Corpulent Man.~\ MAY TAKE. AVOID. Meat and Fish. Plain fresh meats without sauces or gravies and not highly spiced. Also ham, fresh fish, poultry and game. Preserved, canned and spiced meats; tongue, goose, tame duck, kidneys, stews; salmon, shell-fish, mackerel, herring. Vegetables. All fresh vegetables except garlic, onions, peppers and dried beans. Peppers, onions, garlic. Fruits. All fresh fruits; stewed fruits (un- sweetened). Preserved, sweetened and syrupy fruits. Water, alkaline mineral water, tea, milk, buttermilk, lemonade; coffee limited to once a day. Beverages. All alcoholic drinks; all malt drinks. Sundries. Bread, toast (not hot), zwieback, butter, salads, eggs, clear soup, plain cake, cottage cheese, vegetable soup. Pastry, pies, confections; spices, gra- vies, sauces, poulettes; condiments, such as mustard, tabasco, etc.; cream soups, hot rolls, hot bread, biscuits. GENERAL SUGGESTIONS. Eat at regular meal times and only three meals a day. Do not eat any- thing between meals or before retiring. Do not drink more than one small glass of liquid with meals (this includes soup). One hour before each meal drink a glass of Vichy or other alkaline mineral water (or plain water). Eat plain foods plainly prepared. Avoid all made dishes, sauces, poulettes, gravies and condiments. Do not eat meals of several courses. Rather under- eat than over-eat. Eat green vegetables, such as spinach, artichokes, aspara- gus, celery, string beans, peas; limit potatoes. Avoid sweets, creams, desserts; sweetened cooked fruits and preserves; nuts, cakes. Eat fruits—oranges, apples, etc. Avoid all preserved and canned meats. Eat fresh fish with white flesh. Avoid salt, preserved, canned and spiced fish, such as sardines, herring. Avoid all shell-fish except raw oysters. Salads may be eaten sparingly. Drink water, tea, mineral water, buttermilk. Avoid alcoholics; limit coffee. Cereals may be taken once a day. Limit amount of meat to one choice daily of meat, fish or fowl. The intent of this diet may be summarized thus: to restrict the actual amount of food taken; to eat simple food, with an abundance of vegetables and a limited quantity of meats; to take an abundance of water; to be abstemious. 109 LITHIASIS. Cholelithiasis ; Nephrolithiasis (Lithemia);' Calculus; Urinary Calculus—Renal Cal- culus ; Cystic Calculus ; Biliary Calculus; /Stone; Gravel / Uric Acid Diathesis. MAY EAT. Vegetables, especially green. Farinaceous foods. Milk. Fresh meat or white fish or poul- try, once a day. Eggs, in moderation. Cottage cheese. Buttermilk. Limited amount of butter. Potatoes. Toast, bread, zwieback. Tea, water, mineral water. Fresh fruit—apples, pears, figs, peaches, oranges, grapes, etc. Salads (without oil). Vegetable soups; milk soups. Plain cake; puddings. Water, abundantly. Alkaline water. AVOID. Meats. Fish. Oysters and shell-fish. Cheese. Meat soups. Dry beans. Fats and oils. Sauces and condiments. Onions, garlic. Sweets. Pie. Pastry. Domestic duck. Goose. Alcoholics. 110 LIVER, CIRRHOSIS OF Patient Had Ascites. Recovered from \ Ascites. Water, still mineral water (no charged waters), milk, buttermilk, tea (no coffee, no alcoholics, no acid drinks, no sweet drinks), malted milk (prepared with water). Eggs, cereals, pastes such as macaroni, spaghetti cooked in soup or with a cream sauce (but not cooked with tomatoes or cheese). Raw oysters (no other shell-fish). A limited amount of salt (no other condiments). A limited amount of fresh meat or fish or poultry or game may be taken once daily (this includes chops, steak, roast beef, boiled beef, mutton, lamb, fish with white flesh, chicken; but no goose, duck, mackerel, herring, salmon, and no salt, preserved or canned meats or fish) ; plain hot or cold boiled or baked ham may be taken. Artichokes, asparagus, string beans, green peas, cooked celery, spinach, buttered beets, squash, may be taken; but no cabbage, cauli- flower, corn, cucumbers, tomatoes, garlic, onions, pickles may be taken. Orange, apple sauce, baked apple, cooked prunes, peaches, pears, ripe bananas, grapes, may be taken; but no melons, berries, figs, apricots, plums, persimmons, nectarines, are to be taken. Plain cake, lady fingers (but no pies, pastries, candies, confec- tions) ; ice cream may be taken occasionally. Cottage cheese may be taken (but no other cheese). Rice, sago, tapioca and bread puddings may be taken. Plain lettuce or romaine salad, with a little lemon juice may be taken. 111 LIVER, FATTY. MAY TAKE. AVOID. Meat and Fish. Once daily, choice of broiled, boiled, baked or roasted steaks, chops, roast beef, game, chicken, sweetbreads, brains, broiled tripe, squabs, white fish. Fried foods of all kinds; all salt, preserved, canned and spiced meats and fish; tongue, kidneys, duck, goose, stews, lamb (ex- cept lamb chops); shell-fish, sal- mon, sardines, mackerel. Green vegetables—lettuce, peas, spinach, celery, rhubarb, cress, tomatoes, string beans, carrots, artichokes, eggplant (baked), asparagus, endives. Vegetables. Beets, turnips, corn, dry beans, onions, garlic, potatoes, cauli- flower, cabbage, sprouts. Fruits. Fresh fruit—apples, pears, plums, oranges, peaches, cherries, mel- ons, grapes, lemons, grapefruit, figs, apricots, persimmons, ber- ries—all in moderation. Stewed or sweetened fruits; pre- serves; jams. Water, mineral water, tea, but- termilk, tart fruit juices. Beverages. All alcoholic and malt drinks; all acidulous and sweetened drinks ; coffee, cocoa, milk, choc- olate, cream. Sundries. Stale bread, toast, zwieback (all in moderation); limited amount of butter and eggs; limited amount of clear soup or bouil- lon, raw oysters, cereals, plain cake, salads (without oil). Pastries, pies, confectionery, sweets, spices, sauces, gravies, poulettes; all condiments, such as catsup, mustard, tabasco and Worcestershire; thick and cream soups; hot rolls, hot biscuits, muffins, waffles; syrups, nuts, fats, oils. 112 LIVER, FATTY. (Continued.) TYPE REGIME FOR A DAY. On arising drink a glass of water. Breakfast. Two eggs, or cereal. Two pieces of toast and butter. One piece of fruit. 11 A.M. A glass of water. Luncheon. Steak or chop or roast beef or other plain meat. Stale bread and butter or toast (not hot). Vegetable. Fruit or cup of tea. 4.30 P.M. A glass of water. Dinner. Cup of bouillon. Meat. Vegetable. Toast, stale bread or crackers. Tea or fruit. Avoid desserts and creams. Eat at regular times, three meals a day. Have food prepared plain, omitting sauces, gravies, condiments. Do not eat before retiring or before lying down. It is good to drink water, but not at meal time. Limit beverages with meals to eight ounces. Avoid getting over-heated, over-excited or over-exerted. 113 LIVER, CONGESTION—TORPID. CARLSBAD CURE MODIFIED FOR HOME APPLICATION. DIRECTIONS FOR THE USE OF THE CARLSBAD WATER AND SALT. 7.30 A.M. Arise. 7.45 A.M. Take one glass (8 ounces) Carlsbad water. 8 A.M. Take one glass (8 ounces) Carlsbad water. (To prepare the Carlsbad water add one tea- spoonful Carlsbad salts (or sodium sulphate) to 16 ounces of water. Sip water slowly. In the intervals between drinking and after drinking the water, the patient should walk about slowly. 8.15 to 9 A.M. Gentle exercise in open air, walking, etc. 9.15 A.M. Breakfast: One Choice Each of A, B, C. A. Coffee. Tea. Cocoa. Milk. Cereal decoction. B. Eggs, soft boiled or poached. Lean ham. Butter. Crisp bacon. C. Rolls. Zwieback. Toast. Graham bread. Rusk. 1 P.M. Luncheon. Selection: Limited choice of following: Soup: Bouillon, vegetable soup, rice, chicken broth. Meat: Fowl, fish, lamb, beef, ham, mutton. Vegetables: Spinach, asparagus, stewed toma- toes, eggplant, artichokes, celery, green peas, string beans. Salads: Lettuce, tomato, romaine, cress, endive. Starchy Foods: Potatoes boiled, baked, mashed; pastes, rice. Desserts: Puddings—rice, bread, cottage, farina; or Fruits, raw: Apples, peaches, oranges, plums, pineapple, bananas, pears, grapes; or Fruits, stewed: Apples, prunes, peaches, pears, apricots, plums. Beverages: Water or still alkaline mineral water, four to eight ounces. 114 LIVER, CONGESTION—TORPID. (Continued.) 7 P.M. Supper. Meat, Vegetables, Starchy Foods, Stewed Fruits, As at luncheon. Beverages: Water or mineral water, four to eight ounces. Articles Specially Spices, shell-fish, cheese, pastries, creams, rich Forbidden. desserts, made dishes, stews, salmon, mackerel, gravies, condiments. Eat slowly. Masticate food thoroughly. Meat may be broiled, boiled, steamed, baked or roasted. Baths. Morning. During the week take three warm baths at a temperature of 96 degrees Fahrenheit. Two pounds of Carlsbad salts or Epsom salts to each full bath. Hot Fomentations. Apply warmed cloths over the liver for one hour, 9 P.M. to 10 P.M. or 10 P.M. to 11 P.M. Exercise. General directions: Walk one-half hour in the morning, after drink- ing the second glass of Carlsbad Sprudel water before breakfast. Walk one and one-half hours between breakfast and luncheon. Walk one and one-half hours between luncheon and supper. At Carlsbad it is customary for the patients to drink the water while out walking. Massage. One hour massage and resisting exercises daily. 115 MALNUTRITION. [Adult.] MAY EAT. AVOID. Meat and Fish. Steak, chops, roast beef, game, chicken, sweetbreads, brains, broiled tripe, white fish, raw oysters. Salt, preserved, canned and spiced meats and fish; tongue, goose, duck, kidneys, stews; salmon, shell-fish, sardines, mackerel, herring. Vegetables. Green vegetables—spinach, peas, lettuce, celery, rhubarb, arti- chokes, carrots, string beans, cress, eggplant, potatoes. Beets, turnips, dry beans, corn, onions, garlic, cabbage, cauli- flower, sprouts. Fruits. Fresh and cooked fruits—pear, apple, plums, peach, orange, cherries, grapes, persimmons, grapefruit, melon. Beverages. Water, mineral water, tea, cof- fee, buttermilk, cocoa, chocolate, malt drinks. All alcoholic drinks; iced drinks. Sundries. Bread, toast, zwieback, butter, eggs, cereals, limited amount of clear soup or bouillon, plain cake, cottage cheese. Pastry, pies, confectionery, sweets, spices, sauces, nuts, gra- vies, poulettes; all condiments, such as mustard and tabasco; thick and cream soups; hot rolls, muffins, waffles, hot cakes. 116 MALNUTRITION. (Continued.) TYPE REGIME FOR A DAY. On arising drink a glass of water. Breakfast. Two eggs or cereal. Two pieces bread or toast and butter. Tea. One piece of fruit. 11 A.M. Glass of water. Luncheon. Steak or chop or roast beef or other plain meat. V egetable. Bread and butter or toast (not hot). Cup of tea. Fruit. 4.30 P.M. Glass of water. Dinner. Cup of bouillon. Meat. Vegetable. Potato. Toast, bread or crackers. Fruit or tea. Avoid rich or fancy desserts. Take one quart of certified milk daily. Two or more eggs daily. It is good to drink mineral water, but not at meal time. Do not eat before retiring or before lying down. Avoid getting over-heated, over-excited or over-exerted. Eat slowly. 117 MALNUTRITION. [Due to Chronic Indigestion,1 In Middle Aged Adult. TYPE MEALS. On arising drink a glass of water. Breakfast. Two eggs. Two pieces of toast and hutter. One piece of fruit. 11 A.M. A glass of water. Luncheon. Steak or chop or roast beef or other plain meat. Vegetable. Stale bread and butter or toast (not hot). Fruit or a cup of tea. 4.30 P.M. Glass of water. Dinner. Cup of bouillon. Meat. Vegetable. Potato. Toast, stale bread or crackers. Tea or fruit. Avoid desserts, creams. Eat slowly. Masticate food thoroughly. Do not eat when hot or excited. Do not hurry soon after eating. Do not eat large quan- tities at a time. Avoid all irritating foods and foods which experi- ence has shown are not well tolerated. Eat only at regular meal times and only three meals a day. Eat plain nutritious food, simply prepared. Omit all sauces, gravies, condiments. Avoid all fried foods and all cooked fats. Meat should be baked, roasted, boiled or broiled. Omit all fat or greasy foods. Omit raw vegetables. Abstain from alcoholics, beer and malt beverages. Do not take hot and cold, or sweet and sour, at the same meal. Avoid all hard foods; all spiced or highly seasoned foods; all foods with husks or kernels. Do not drink with meals (not more than four ounces fluid with a meal, except breakfast). One hour before each meal and at bed- time drink a glass of water or mineral water. Take a moderate amount of exercise, but do not over-exert or be strenuous. 118 MALNUTRITION. (Continued.) MAY EAT. AVOID. Meat and Fish. Beef steak, roast beef, roast mut- ton, mutton chops, lamb chops, chicken, squab, sweetbreads, brains, tripe (broiled or cooked as in soup), fish (having white flesh), raw oysters, plain boiled lean ham. Preserved, salt, spiced or canned meats and fish; tongue, sausage, liver, kidneys, veal, pot roast, stews, bacon, pork, duck, goose, soup meat, hash; salmon, mac- kerel, herring, crab, lobster, clams, cray fish, mussels. Cooked light vegetables—string beans, asparagus tips, cooked celery, peas, artichokes, lettuce prepared as spinach usually is, potatoes. Vegetables. Raw vegetables, such as rad- ishes, celery; dry beans, beets, corn, onions, cucumbers, toma- toes, pickles, cabbage, sprouts, carrots, turnips, and in general all vegetables which grow be- neath the ground. Fruits. Peach, pear, grapes, apple sauce or baked apple (avoiding the skin and core, and not sweet- ened), prunes, orange juice (not pith), lemon juice on oysters. Preserved fruits; berries, canned fruit; melons. Beverages. Water, alkaline mineral water, clear bouillon or broth, tea, milk, coffee, cocoa, buttermilk. Alcoholic and malt beverages; sweet drinks, chocolate; acid drinks; iced drinks. Sundries. Eggs, raw, soft boiled or poached; butter, raw, on bread; cereals, well cooked; well boiled rice, sago (in soup) ; small amount of cottage cheese; bread, custards, puddings, such as sago and tapioca. Fried foods; condiments—mus- tard, catsup, horseradish, tabasco, Worcestershire; nuts, pastries, pies, cakes, candies, sweets, con- fections, puddings, ices; rich, cream, and thick soups; poulettes, sauces and gravies; hot bread, hot rolls, muffins, biscuits, rye bread, waffles, syrups, acids, desserts, made dishes; fruits and vege- tables having husks or kernels. 119 MALNUTRITION. [ Spare Adult Male—Impaired Digestion.] Soups. Bouillon, consomme, plain broths. Meats. Fresh butchers’ meat to be taken once or twice a day, in quantities not exceeding four ounces. No spiced or preserved meats. Avoid pork, liver, kidney, duck, goose. Fish. Especially white fish, may be substituted for meat, but should not be taken in addition to meat. Avoid sar- dines, canned, preserved, salt and smoked meat. Shell-fish. Oysters, fresh or broiled. Avoid crab, lobster, crawfish, scallops, shrimps, mussels. Salads. Lettuce or romaine, with lemon juice. Vegetables. Any of the softer varieties, as spinach, asparagus tips, peas. The coarser vegetables should be thoroughly cooked and finely divided and passed through a col- lander or pureed. Avoid cabbage, Brussels sprouts, sauerkraut, radishes, pickles, corn, beets, celery root, tomatoes. Potatoes. Baked, boiled, mashed, creamed. Eggs. Boiled, poached, omelette, but not fried. Starchy Cereals and pastes—macaroni, spaghetti (prepared with- Foods. out cheese), rice, sago, tapioca. Fats. Cream, butter, olive oil. Fruits. Orange juice, grapefruit juice, pineapple juice. Stewed fruits thoroughly cooked and not sweetened too much. Avoid cherries, berries, melons, pineapple, bananas. Bread. White bread, plain or toasted and buttered. No whole wheat or bran bread. Avoid hot bread, muffins, waffles, etc. Desserts. Light puddings, custards, light cake, wine jellies, gela- tine, fruit jelly. Avoid nuts, candies, rich cakes, pies, preserves, hot cakes. Cheese. Cottage cheese. Omit other cheese. Drinks. Milk, cream, buttermilk, cocoa, tap water, alkaline min- eral water, malted milk, weak tea or coffee with plenty of milk. Avoid. Excessively hot or cold foods. All fried foods. All highly seasoned foods; condiments—spices, mustard, pepper, horseradish, tabasco, Worcestershire and similar sauces. 120 MALNUTRITION. [Professional Man.] EXAMPLE OF DAY’S DIETARY. Glass of water with teaspoonful of salts, on arising. Breakfast. Fruit. Two eggs or cereal. Bread and butter. Coffee. Glass of water one hour before luncheon. Luncheon. Meat or fish or fowl. Green vegetable. Bread and butter. Pudding or custard or other plain dessert. Rest one hour after luncheon. 3.30 or 4.30 P.M. Glass of water. Dinner. Meat. Green vegetable. Potato. Bread and butter. Paste (macaroni, spaghetti, etc.). Dessert—cottage cheese. 121 MALNUTRITION. NEURASTHENIA. [Frail Woman School Teacher.] DESIRABLE. UNDESIRABLE. Meats and Fish. Beef steak, roast beef, roast mut- ton, mutton chops, lamb chops, chicken, squab, brains, tripe, sweetbreads, fish, raw oysters, ham, game, lamb, veal, marrow, scraped beef, bacon. Preserved or canned meat and fish; tongue, sausage, pork, liver, kidney, pot roast, hash, stews, duck, goose, soup meat; herring, crabs, clams, lobsters, mussels. Meat should be boiled, broiled, steamed, baked or roasted (but not stewed or fried). Vegetables. String beans, asparagus, peas, artichokes, cooked celery, let- tuce, spinach, eggplant, potatoes, carrots. Radishes, garlic, onions, corn, cauliflower, cucumbers, pickles, cabbage, sprouts, turnips. Fruits. Apple sauce, baked apple, prunes, orange, apple, stewed peach, pear, grapes, berries, jams, pre- serves. Beverages. Water, mineral water, tea, milk, cocoa, chocolate. Alcoholics; iced drinks; fancy- beverages. Sundries. Eggs, cereals, rice, sago, pud- dings, cottage cheese, custards, sponge cake, angel cake, lady fingers, chocolate, crackers, gra- ham crackers, bread, zwieback, toast, honey, clear jelly, syrup, clear soups, bouillon, beef tea, mutton broth, chicken broth, beef juice, pastes; limited amount of molasses candy or chocolate after meals. All condiments, such as catsup, mustard, horseradish, tabasco, Worcestershire, pepper; nuts, pastries, cakes, pies, candies, rich soups, sauces, gravies; hot rolls, hot biscuits, hot bread, hot cakes, waffles. Soups may be thickened by cooking cereal or vegetable in them, but avoid rich and fatty soups. 122 MALNUTRITION, NEURASTHENIA. (Continued.) Breakfast. Cereal and cream. Bread and butter. Cocoa. Cooked fruit. Luncheon. Soft boiled eggs or two thick meat sandwiches. Milk. Bread and butter. Plain cake. (Cottage cheese also may be taken.) 3 P.M. Glass of milk with egg. Dinner. Meat. Vegetable: potato. Salad. Bread and butter. Dessert. Bedtime. Glass of milk. Drink one quart (four glasses) milk daily. Drink water freely between meals. 123 NEPHRITIS, In acute nephritis the desideratum to be sought is a diet which shall be adequately nutritious, easily digestible, easily assimilable (or metabolized), and which will supply waste products the elimina- tion of which will make minimum demands upon the renal struc- tures. Until quite recently milk was assumed ideally to fulfill these requirements and it was the practice to place patients with acute nephritis upon an exclusively milk diet. Apart from the fact, how- ever, that an exclusively milk diet is, for adults, deficient in carbo- hydrate content, other difficulties are encountered, such as milk intolerance. Accordingly it seems advisable to qualify the milk diet by certain modifications and additions. Modifications. Consist in the administration of milk in varied forms—for example, as koumyss, junket, butter- milk, whey, milk soups. Additions: Which may be advantageously made consist of— A—Cereals. These may be given in the form of gruels or de- coctions—for example, cream of barley soup (bar- ley strained out), and soups similarly prepared from various cereals. B—Vegetable Obtained by cooking peas, celery and similar vege- Extracts: tables in milk soups and straining out. C—Fruit Juice: Orange juice, grapefruit juice, apple sauce, pureed prunes. D—Alkalies: In the form of alkaline mineral water, bicarbonate of soda, milk of magnesia. Milk of magnesia serves a double purpose, being both an antacid and a laxative. It should be borne in mind that the danger in acute nephritis is not due to the albumen eliminated but to the toxic substances which, failing to be excreted, cause uremia. Therefore adequate attention should be paid all the emunctories of the system. The bowels should be kept open, if necessary by laxatives and enemata. The skin should be kept active; diaphoretics and warm baths (or packs or sweats) may be indicated. The kidneys should be relieved of as much work as possible by attention to the other emunctories. Benefit may be derived by the passage of an appropriate amount of bland liquids through the kidneys. 124 NEPHRITIS. (Continued.) For chronic nephritis quite a different diet is indicated. Here the active inflammatory process has ceased and other features of the case must be considered. Indefinite exclusion of meat and meat products from the diet may be theoretically good for the kidneys, but practically it is bad for the patient. Anemia and malnutrition may be combated by the judicious selection of a varied diet which may include meat, eggs, vegetables and numerous other viands ex- cluded in the acute stage. Between acute and chronic nephritis all degrees of activity of the destructive process may be encountered and commensurate grada- tions of the diet may be utilized for the various stages. Coexistence of other diseases—especially diabetes and heart dis- ease—with nephritis necessitates modifications of the diet for the individual case. 125 NEPHRITIS, ACUTE. The diet should be liquid and bland. It may include: Milk, buttermilk, koumyss, whey, diluted cream. Milk soups: may be thickened with flour. Vegetable soups (made of milk in which corn, rice, barley, peas or celery has been cooked and strained out). Fruit juices: orange juice, grapefruit juice, apple sauce, pureed prunes. Water: alkaline mineral water. In a less acute stage the preceding diet list may be enlarged by the addition of: Pastes. Cereals. Stale bread, toast, zwieback, crackers. Puddings, custards, ice cream, lady fingers, sponge cake. 126 NEPHRITIS, ACUTE TOXIC. Acute renal affections associated with infectious processes, such as streptococcic pharyngitis and tonsillitis, occurring espe- cially in childhood or early adult life and presenting classic symptoms of glomerulo- nephritis, do not require the rigid diet of ordinary acute nephritis. Almost from the beginning such cases tolerate a certain amount of proteids in the form of meat and other albuminous foods. The urine clears up with the subsidence of the infection and the renal affection is not adversely influenced by a diet embrac- ing such foods. In these cases hygienic measures — warmth, rest, warm sponge baths, attention to elimination — are the essentials of successful treatment. 127 NEPHRITIS, CHRONIC. BRIGHTS DISEASE. MAY EAT. AVOID. Meats and Fish. Chicken, bacon, ham; meat spar- ingly; fish with white flesh. Meats (except sparingly). Vegetables. Light green vegetables; starchy vegetables. Cabbage, cucumbers, garlic, onions. Fruits. Fruit, raw and cooked. Beverages. Water, alkaline mineral water; buttermilk, cocoa, chocolate, milk and cream, tea, coffee. Alcoholics. Sundries. Cereals (rice, farina, etc.) ; pastes (macaroni, etc.); cottage cheese, toast, bread, cakes, puddings, honey, jelly, ice cream, water ice; salads, vegetable soups; eggs (not more than two daily). Cheese, condiments, strong meat soups. 128 NEPHRITIS, CHRONIC INTERSTITIAL. CIRRHOTIC. BRIGHT’S DISEASE, CHRONIC. Soups. Cream soups, milk soups, vegetable soups. Avoid meat soups. Meat. Fresh butchers’ meat to be taken only once a day. Omit pork, liver, kidney, duck, goose, sausage. Instead of meat, fish or fowl may be taken. Fowl. Chicken, game, squab, may be taken instead of meat. Omit domestic duck, goose, turkey. Fish. Especially white fish (may be substituted for meat) but should not be taken in addition to meat. Omit sardines, salt or smoked fish, salmon, mackerel, herring. Shell-fish. Oysters fresh, broiled or as oyster stew. Omit crab, lobster, crawfish, scallops. Salad. Lettuce or romaine or other vegetable salad. Vegetables. Most of the softer varieties, as spinach, asparagus tips. Avoid cabbage, sauerkraut, Brussels sprouts, radishes, pickles, onions, garlic, corn, cucumbers. Potatoes. Baked, boiled, mashed, creamed. Starchy Any of the cereals, also pastes—macaroni, spaghetti Foods. (prepared without cheese), rice, sago, tapioca. Fats. Cream, butter, olive oil, bacon, ripe olives. Fruits. Fresh and cooked fruits; also orange juice, grape juice, grapefruit juice, pineapple juice; stewed fruits thor- oughly cooked. Bread. Wheat bread, zwieback, crackers, toast. Avoid hot breads and muffins. Desserts. Light gelatine puddings, custards, meringues, light cake, fruit jelly. Avoid rich cakes, pies, preserves, hot cakes. Cheese. Cottage cheese Omit other cheese. Drinks. Water, carbonated water, milk, cream, buttermilk, co- coa, malted milk, weak tea or coffee with plenty of milk. Avoid. Excessively hot or cold foods. All fried foods. All highly seasoned foods; condiments—spices, mustard, pepper, horseradish, tabasco sauce, Worcestershire sauce and similar sauces. 129 NEPHRITIS, ACTIVE CHRONIC INTERSTITIAL. BRIGHT’S DISEASE. Selection from following list: Buttermilk. Milk. Milk cocoa or milk chocolate. Weak coffee or tea, with milk. Toast or bread—with butter, honey or jelly. One or two eggs—soft boiled, poached, scrambled or omelette. Fresh fruits, such as peaches, baked apples and cream, grapes. BREAKFAST. Selection from following list: Dishes made from one or two eggs. Green vegetables or simple fruit salads. Rice, macaroni, vermicelli. Cooked green vegetables, such as green corn, spinach. Stale bread, toast with butter, cottage cheese. Fruits—figs, dates, etc. Milk or buttermilk or malted milk. Water ice. Ice cream. Grapefruit juice. Meat, fish or fowl may be taken with luncheon or dinner. (But only one choice daily.) LUNCHEON. DINNER. Selection from following list: Buttermilk. Soups made from peas, potatoes; not meat soups or meat stock. Bread with milk, cream, butter. Various forms of vegetables. Macaroni, etc. (pastes). Salads made from different vegetables, with oil, vinegar or lemon. Stale bread or toast. Meat, fish or fowl may be taken with dinner but only one choice daily. Ripe raw fruit or boiled or baked fruit. Small amount of dessert, especially if made from fruit or fruit juices. Plain cake. 130 NEPHRITIS, ACTIVE CHRONIC INTERSTITIAL. (Continued.) Beverages: Fruit juice, unfermented, made from grapes, apples, raspberries, etc. Once daily, choice of roast beef, roast mutton, warm or cold ham, steak, lamb chops, mutton chops. Fish with white flesh. Chicken, squab, oysters, game. Avoid particularly: Excess of meats; all salt, preserved, canned or spiced meats and fish; meat extracts; meat juices; domestic duck, goose, sausage. Alcohol in all forms should be excluded from the diet. Water should be taken preferably about one hour before meals. One glass of water may be taken with a meal. At least one and one-half quarts of fluid should be taken each twenty-four hours. Vegetables: Rich in starch, such as rice, potatoes, sweet potatoes, peas, beans and lima beans, should be thoroughly cooked. Hot short bath twice a week or a hot sweat or cabinet bath. Wear warm underclothes with long sleeves and legs. Keep the body warm. Avoid draughts when hot or perspiring. Take a light meal in the evening if inclined to be restless at night. Keep the bowels open, taking a small glass of aperient water in the morning if needed. 131 NEPHRITIS, CHRONIC, WITH CARDIAC INSUFFICIENCY. BRIGHT’S DISEASE, CHRONIC. EAT FREELY. AVOID. Meats and Fish. Choice once daily of— Chicken. Fish with white flesh. Meat, sparingly. Bacon, ham. Salt, preserved, spiced meats and fish. Vegetables, Green vegetables. Starchy vegetables. Cabbage, cucumbers, corn. Fruits. Fruit, raw and cooked. Preserves. Beverages. Water, alkaline mineral water. Buttermilk. Cocoa, chocolate. Milk, cream. Tea, coffee. Alcoholics. Acid drinks. Iced drinks. Sundries. Cereals—rice, farina, etc. Pastes—macaroni, etc. Cottage cheese. Toast, bread. Eggs, not more than two daily. Cake, puddings. Ice cream, water ice. Vegetable soups. Milk soups. Salads. Cheese. Condiments. Strong meat soups. 132 NEPHRITIS, CHRONIC INTERSTITIAL. Obese Woman. Had Diabetes.' Remained Sugar-free on this Diet. This Case may be classed as Renal Diabetes. Breakfast. (1) One portion of oatmeal with cream or milk (no sugar). One cup coffee with cream. One slice toast. (2) Instead of oatmeal a portion of strawberries or rasp- berries or blackberries may be taken (no sugar). Luncheon. Fish or cereal or eggs. Green vegetable. Salad. One slice of toast with butter. Dinner. Vegetable soup. Light meat or chicken or fish or eggs. Green vegetable. Baked potato or one slice of toast. Salad. Limit the amount of meat taken. Preferably take for breakfast, fruit; For luncheon, a cereal or eggs; For dinner, eggs or cereal, so that— One meal shall have fruit, One meal shall have cereal, One meal shall have eggs—as chief viand. Three slices of toast daily are permitted, but that is the limit for the present, and if potato is taken the toast should be omitted at that meal. Tart fruit or berries may be taken twice a day. When taken twice a day, the fruit is to be substituted for the cereal or eggs at breakfast. If berries are taken for dinner, the dinner should include no meat or eggs or cereal. Potato may be taken once in two days. 133 NEURASTHENIA, Have food prepared plain, omitting sauces, gravies, condiments. Eat simple foods, avoiding such mixtures as very hot and very cold at the same time, or sweet and sour. Meat should be boiled, broiled, baked, roasted or steamed. Eat steaks, lamb chops, mutton chops, roast mutton, roast beef, chicken, white meat of turkey, squab, game, sweetbreads, lamb, veal, boiled ham, broiled tripe. Eat raw oysters and fresh white fish. Eat light cooked vegetables, such as peas, string beans, spinach, asparagus, artichokes, celery, carrots. Eat fresh and cooked fruits. Eat eggs soft boiled, poached, scrambled, omelette. Eat zwieback, toast, crackers and bread (preferably stale). Drink water, still alkaline water, milk, buttermilk, tea, coffee, cocoa, chocolate. Drink only limited quantities with meals. One hour before each meal take a glass of water or mineral water (Bartlett, Vichy). Abstain from all alcoholics. Omit sauces, gravies, condiments and cooked fats. Avoid tongue, corned beef, liver, goose, duck, sausage, bacon. Avoid shell-fish, such as shrimps, lobster, crabs and mussels. Avoid all preserved, salt or canned fish—sardines, salmon, her- ring, mackerel. Fish should not be fried nor cooked with a sauce or poulette. Avoid turnips, corn, beets, onions, cabbage, cucumbers, sprouts, dry beans and raw vegetables. Salads should contain no garlic, no onions. Avoid condiments—mustard, tabasco, horseradish, etc. Avoid hot bread, rolls, muffins, biscuits, pancakes. Avoid pastries, pies, cakes, sweets, confections, candies, ices, etc. 134 NEURASTHENIA. (Continued.) 8 A.M. Breakfast. Cereal. Two slices bread and butter or toast. Cocoa. Fruit. 9 A.M. Rise and attend to household duties. 11 A.M. Glass of water. 11.30 to 12 M. Read—write, etc. 12 M. Luncheon. Meat. Vegetable. Bread and butter. Plain pudding. 1.30 to 3 P.M. Rest: lying down alone in darkened room. 3.15 P.M. Chocolate, tea or cocoa. 3.30 to 5.30 P.M. Walk or other light exercise; shopping; calling. 5 P.M. Glass of water. 6 P.M. Dinner. Light meat. Vegetable. Salad. Bread and butter. Dessert. 10 P.M. Bed. 135 NEURASTHENIA, FOLLOWING OVARIOTOMY. [Obese Patient. ] On arising drink a glass of water. Breakfast. Two eggs. Two pieces of toast and butter. One piece of fruit. 11 A.M. A glass of water. Luncheon. Steak or chop or roast beef or other plain meat. Stale bread and butter or toast (not hot). Vegetable. Fruit or a cup of tea. (Meat size of palm of hand.) 4.30 P.M. A glass of water. Dinner. Cup of bouillon. Meat. Vegetable. Toast, stale bread or cracker. Fruit or tea. Avoid rich desserts and creams. Meat means a good slice of roast beef or two lamb chops or like amount of other meat. Fruit means one medium size orange, apple or like amount of other fruit. It is good to drink water, but not at meal times. V Do not eat before retiring or before lying down. Avoid getting over-heated, over-exerted or over-excited. 136 NEURASTHENIA, FOLLOWING OVARIOTOMY. (Continued.) MAY EAT. AVOID. Broiled, boiled, baked or roasted: steaks, chops, roast beef, game, chicken, sweetbreads, brains, broiled tripe, white fish, lamb, boiled ham, raw oysters. Meats and Fish. Salt, preserved, canned and spiced meats; tongue, goose, duck, tur- key, stews, kidneys; salmon, sar- dines, herring, mackerel, shell- fish. Green vegetables and such as grow above ground — spinach, lettuce, celery, carrots, string beans, peas, rhubarb, squash, ar- tichokes, cress, eggplant. Vegetables. Starchy vegetables and such as grow under ground—potatoes, beets, turnips, corn, beans, gar- lic, onion, cabbage, sprouts, cauliflower Fruits. Fresh fruit—apples, pears, cher- ries, peaches, oranges, grapes, lemons, grapefruit, apricots—all in moderation. Sweetened fruits; berries, figs, bananas; stewed or preserved fruits. Beverages. Water, mineral water, tea, coffee, buttermilk. Alcoholic and malt drinks; sweet and acidulous drinks; milk, co- coa, chocolate. Sundries. Stale bread, toast, zwieback (all in moderation); butter; salads made with lemon, not with oil; eggs in moderation; limited amount of clear soup or bouil- lon; cottage cheese. Fresh bread, cake, pastry, pies, confectionery, sweets, spices, sauces, gravies, nuts, poulettes; all condiments, such as catsup, mustard, tabasco sauce; thick and cream soups; hot rolls, hot biscuits, muffins, waffles, hot cakes; syrups; all made dishes. 137 NEURASTHENIA AND VISCEROPTOSIS. [Emaciated Working Girl.'] On waking drink a glass of water. 7 A.M. Breakfast. Glass of milk or cocoa. Two eggs or bowl of cereal. Two pieces of bread and butter. Fruit. 7.30 A.M. Ride to work. 11 A.M. Glass of water. 12 M. Luncheon. Eggs. Tea and toast. Pudding or custard. (When eggs are taken for breakfast, may take two large fresh meat sandwiches or cold ham or chicken.) 12.30 to 1 P.M. Rest. 4 P.M. Glass of water. 5 P.M. Ride home. Rest, lying down one-half hour. 6.30 P.M. Dinner. Light meat, such as chops or steak. Green vegetable. Baked potato. Bread and butter. Sweet dessert. 8 to 9 P.M. Recreation. 9.30 P.M. Glass of milk. 10 P.M. Bed. Food should be taken at regular times. Eat slowly. Masticate food thoroughly. Avoid fried foods. Water should be taken abundantly. Do not take much water or other liquid with meals. Drink water about one hour before meal time. At least four glasses water or other liquid to be taken daily. Drink two glasses of milk daily. Avoid extensive menus; have food prepared plain. Do not eat when excited or over-exerted. Puddings and custards are desirable desserts. 138 NEURASTHENIA AND VISCEROPTOSIS. (Continued.) MAY EAT. AVOID. Meats and Fish. Fresh meat broiled, boiled, baked or roasted; game, steak, chops, roast beef, chicken, turkey, fish, sweetbreads, brains, ham, tripe (broiled), raw oysters. Salt, preserved, canned and spiced meats and fish; tongue, stews, goose, duck, kidneys, liver; shell- fish, sardines, herring. Vegetables. Green vegetables and such as grow above ground — spinach, lettuce, rice, peas, rhubarb, string beans, artichokes, asparagus, boiled celery, potatoes, tomatoes, beets. Turnips, dry beans, onions, gar- lic, cucumbers, radishes, cabbage, sprouts, cauliflower, pickles, corn. Fruits. Fresh and cooked fruit; stewed or baked apple, pear, peach, orange, bananas. Preserves, berries. Beverages. Water, mineral water, tea, coffee Alcoholic and malt drinks; sweet (with milk), milk, cocoa, choco- and acidulous drinks; iced drinks. late. Sundries. Stale bread, toast, zwieback, eggs, limited amount of clear soup, cereals, molasses candy, milk chocolate or other sweets. Pastry, pies, confectionery, gra- vies, sauces, poulettes; condi- ments, such as catsup, mustard, tabasco sauce; hot rolls, hot bis- cuits, hot cakes, muffins; thick and cream soups. 139 NEURASTHENIA. MALNUTRITION. ANEMIA. [.Eighteen-year-old Girl.] On arising drink a glass of water. 8 A.M. Breakfast. A glass of milk or cocoa. Two eggs or bowl of cereal. Two slices of bread and butter or toast. Fruit. 8.30 A.M. Exercise: small occupation about house. 9 to 10.30 A.M. Busy about the house and garden. 10.30 A.M. A glass of milk and bread with butter, or cake or lady fingers. 10.30 to 11.30 A.M. A brisk walk or tennis. 11.30 to 12 M. Quiet: read or similar occupation. 12—12.30 Luncheon. Meat. Vegetable. Bread and butter. Plain pudding. 1.30 to 3 P.M. Rest: lying down alone in darkened room. 3.15 P.M. Glass of milk, light (for instance, chicken) sandwich. 3.30 to 4.30 P.M. Walk or other exercise: shopping, calling, etc. 4.30 to 5.30 P.M. Busy with photography or other light occu- pation. 6 P.M. Dinner. Light meat. Vegetable. Salad. Bread and butter. Dessert. 9.30 P.M. Before retiring, exercise. A glass of milk. Take a moderate amount of exercise, but do not over-exert or be strenuous. Eat slowly. Masticate food thoroughly. Do not eat when hot or excited. Do not hurry soon after eating. Do not eat large quan- tities at a time. Avoid all irritating foods and all foods which ex- perience has shown are not well tolerated. Eat at regular times. Eat plain nutritious food, simply prepared. Omit all sauces, gravies, condiments. Avoid all fried foods and all cooked fats. Meat may be boiled, broiled, baked, roasted or steamed. Abstain from alcoholics, beer and malt beverages. Do not take hot and cold, or sweet and sour, at the same time. Omit raw vegetables. Avoid all hard foods, all spiced or highly seasoned foods; all foods with husks or kernels. Particularly good are red meats and green vegetables and marrow. Breathing exercises are particularly beneficial. 140 NEURASTHENIA. MALNUTRITION. ANEMIA. (Continued.) MAY EAT. AVOID. Meats and Fish. Beef steak, roast beef, roast mut- ton, mutton chops, lamb chops, chicken, squab, brains, tripe, sweetbreads, fish, raw oysters, ham, game, veal, marrow, scraped meat. Preserved, salt, canned and spiced meat and fish; tongue, sausage, liver, kidneys, pot roast, pork, stews, bacon, hash, duck, goose, soup meat; herring, crab, lobster, mussels. Vegetables. String beans, asparagus, peas, artichokes, celery, lettuce, egg- plant, spinach, potatoes, carrots. Radishes, corn, onions, pickles, cucumbers, cabbage, cauliflower, sprouts, turnips; seasoning of onions or garlic. Fruits. Apple sauce, baked apples, pear, Jams, preserves, prunes, oranges, apples, grapes, peaches, grapefruit, figs. Beverages. Water, mineral water, tea, milk, cocoa, chocolate. Alcoholic and malt drinks; sweet and mixed drinks; iced drinks; fancy beverages. Sundries. Eggs, cereals, pastes, rice, sago, cottage cheese, bread, custards, puddings, sponge cake, lady fin- gers, angel cake, ice cream, lim- ited amount of molasses candy or chocolate. Fried foods; all condiments, such as catsup, mustard, horseradish, Worcestershire, tabasco, pepper, nuts, pastries, rich cakes, pies, candies; rich soups, sauces and gravies; hot rolls, hot biscuits, hot bread, hot cakes, waffles; fancy desserts. 141 NEURASTHENIA. Anemic Woman with Chronic 1 Nephritis. MAY TAKE. Meats and Fish. AVOID. Once daily, choice of: steaks, chops, roast beef, mutton, poul- try, chicken, white meat of tur- key, squab, game, sweetbreads, lamb, veal, boiled ham, broiled tripe, fresh white fish. Tongue, corned beef, liver, goose, duck, sausage, bacon; salt, pre- served or canned fish. Vegetables. Peas, string beans, spinach, arti- chokes, asparagus, celery, toma- toes, carrots. Turnips, corn, beets, onions, dry beans, cabbage, cauliflower, sprouts, cucumbers; raw vege- tables. Beverages. Water, still alkaline water, but- termilk, tea, coffee, cocoa, choco- late. Alcoholics; iced drinks; fancy drinks. Fresh and cooked fruits; eggs, soft boiled, poached, scrambled, omelette; zwieback, toast, crack- ers, bread (preferably stale); raw oysters. Sundries. Shrimps, crabs, lobsters, mussels, preserved, salt or canned fish, salmon, herring, sardines, mac- kerel; condiments, such as mus- tard, catsup, tabasco, horse- radish ; hot bread, hot rolls, muf- fins, biscuits, hot cakes, pies, cakes, pastry, sweets, candies, ices, confections, etc. Drink only limited quantities with meals. One hour before each meal take a glass of water or mineral water (Bartlett, Vichy, etc.). Eat simple foods, avoiding such mixtures as very hot and very cold at the same meal, or sweet and sour. Have food prepared plain, omitting sauces, condiments, gravies. Avoid cooked fats. Meat should be boiled, broiled, baked or roasted. Fish should not be fried nor cooked with a sauce or poulette. Salads should contain no garlic, no onion. Do not eat hurriedly. Do not eat large quantities at a meal; if necessary take an extra meal. 142 NEURASTHENIA. (Continued.) TYPE REGIME FOR A DAY. On arising drink a glass of water. Breakfast. Two eggs. Two pieces of toast and butter. One piece of fruit. 11 A.M. A glass of water. Luncheon. Steak or chop or roast beef or other plain meat. Stale bread and butter or toast (not hot). Vegetable. Fruit or a cup of tea. (Meat size of palm of hand.) 4.30 P.M. A glass of water. Dinner. Cup of bouillon. Meat or eggs or chicken or fish. Vegetable. Toast, stale bread or crackers. Fruit or tea. Avoid puddings, desserts and creams. “Meat” means a good slice of roast beef or two lamb chops or like amount of other meat. (Eggs, fowl or fish may be substituted for meat once daily). “Fruit” means one medium size orange, apple or like amount of other fruit. It is good to drink water, but not at meal time. Do not eat before retiring or before lying down. Avoid getting over-heated, over-exerted or over-excited. 143 NORMAL DIET. [jFor Adult.'] MAY EAT. AVOID. Meats and Fish. Broiled, boiled, baked, roasted: steaks, lamb chops, roast beef, game, chicken, sweetbreads, lamb, brains, turkey, fresh fish, raw oysters. Salt, preserved, canned and spiced meats and fish; tongue, goose, duck, kidneys, stews; salmon, sardines, lobster, mackerel, crab. Vegetables. Green vegetables and such as grow above ground — spinach, lettuce, asparagus, artichokes, celery, peas, beans, rhubarb, to- matoes, eggplant, carrots, corn, cress, potatoes. Cucumbers, beets, cabbage, sprouts, garlic, onions; sweet and sour vegetables; vegetables with rich sauces. Fruits. Orange, apple, grapefruit, pear, peach, bananas; stewed and sweetened fruits; berries, pre- serves. Beverages. Water, milk, cocoa, chocolate, buttermilk, coffee, tea. Alcoholic and malt drinks. Sundries. Bread, toast, zwieback, moderate amount of butter, salads, clear soups, eggs, meat juice gravy, cereals, cottage cheese, plain cake. Spices, sauces, gravies, condi- ments, poulettes, thick and cream soups, hot cakes, hot biscuits, hot rolls, strong cheese. 144 NORMAL DIET. (Continued.) Eat slowly. Eat at regular times and only three meals a day. Eat at intervals of not less than four hours. Drink only limited quantities with meals. One hour before each meal take a glass of water. Take from six to eight glasses of fluids in twenty-four hours. Have food prepared plain, omitting sauces, condiments, gravies. Chew food thoroughly. Do not eat mixtures, such as hot fol- lowed by cold, or sweet and sour. Avoid all made dishes—sauces, stews, poulettes, gravies. Breakfast. Glass of milk or cocoa or cup of coffee. Two eggs or bowl of cereal. Two pieces of bread and butter or toast. Fruit. Luncheon. Meat. Vegetable. Bread and butter. Plain pudding. Dinner. Light meat. Vegetable. Potato. Bread and butter. Salad. Dessert. 145 [Adult Male.] NORMAL DIET. MAY EAT. AVOID. Meats and Fish. Steaks, roast beef, roast mutton, mutton chops, lamb chops, squab, chicken, brains, tripe, sweet- breads, fish, raw oysters, ham, game, lamb, veal, marrow, scraped meat. Preserved, salt, canned and spiced meats and fish; tongue, sausage, kidneys, liver, pot roast, stews, bacon, pork, duck, goose, soup meat, hash; herring, crabs, clams, lobsters, mussels. Vegetables. String beans, asparagus, peas, artichokes, cooked celery, egg- plant, lettuce, spinach, carrots, potatoes. Radishes, corn, cucumbers, onions, pickles, cabbage, sprouts, turnips, garlic. Fruits. Fresh and cooked fruits—apple sauce, baked apple, prunes, pear, orange, apple, peach. Berries, jams, preserves. Beverages. Water, tea, milk, cocoa, coffee. Alcoholic and malt drinks. Sundries. Eggs, pastes, cereals, rice, sago, cottage cheese, bread, custards, puddings, sponge cake, angel cake, lady fingers. Fried foods; condiments, such as mustard, tabasco, pepper, horse- radish; nuts, pastry, pies, cakes, candy; rich soups, sauces, gra- vies; hot rolls, hot bread, hot bis- cuits, hot cakes, waffles; rich desserts. 146 NORMAL DIET. (Continued.) TYPE REGIME FOR A DAY. On arising drink a glass of water. Breakfast. Two eggs. Two pieces of toast and butter. Coffee. One piece of fruit. 11 A.M. A glass of water. Luncheon. Steak or chop or roast beef or other plain meat or fish or fowl. Bread and butter or toast (not hot). Vegetable. Fruit or a cup of tea. 4.30 P.M. A glass of water. Dinner. Cup of bouillon. Meat. Vegetable. Potato. Bread, toast or crackers. Tea or fruit. Avoid desserts and creams. Eat slowly. Masticate food thoroughly. Do not eat when hot or excited. Do not hurry soon after eating. Do not eat large quan- tities at a time. Avoid all irritating foods and all foods which experience has shown are not well tolerated. Eat at regular times. Eat plain nutritious food simply prepared. Meat may be broiled, boiled, baked, roasted or steamed. Omit all gravies, sauces, condiments. Do not take hot and cold, or sweet and sour, at the same meal. Avoid fried foods and cooked fats. Omit all fat and greasy foods. Omit raw vegetables. Avoid all hard foods, all spiced or highly seasoned foods, all foods with husks or kernels, all foods which are not well tolerated. One hour before each meal take a glass of water. 147 NORMAL, CAREFUL DIET. [Adult Male.] MAY EAT. AVOID. Meats and Fish. Broiled, boiled, baked, roasted: only fresh meat. Steak, chops, roast beef, game, sweetbreads, chicken, brains, mutton, tripe, turkey, lamb, scraped raw meat; white fish, raw oysters. Fried foods; salt, preserved and canned meats and fish; tongue, goose, duck, veal, kidneys, liver, stews; salmon, shell-fish, sar- dines, mackerel, herring. Vegetables. Lettuce cooked like spinach, cooked celery, pureed peas, string beans, potatoes, spinach. Corn, beets, turnips, onions, dry beans, cabbage, cauliflower, to- matoes, squash, pickles, peppers, cucumbers, mushrooms, chest- nuts. Beverages. Water, still alkaline mineral water, tea, buttermilk, milk, cof- fee, cocoa, chocolate. Wine, beer, all sweet drinks and acidulous drinks. Sundries. Cheese, pastry, sweets, nuts, con- fections, sauces, gravies, condi- ments, rye bread, hot breads, bis- cuits, rolls, muffins, waffles, spa- ghetti, acid fruits, fruits with kernels, seeds or shells. Stale bread, toast, zwieback, eggs, butter, crackers, clear soup, bouillon, custards, bread pud- ding, sago and tapioca puddings, moderate amount of cooked fruit (not acid). 148 NORMAL, CAREFUL DIET. (Continued.) Eat slowly. Masticate food thoroughly. Do not eat when hot or excited. Do not hurry soon after eating. Do not eat large quan- tities at a time. Avoid all irritating foods and all foods which experience has shown are not well tolerated. Eat plain nutritious food, simply prepared. Omit gravies, sauces, condiments. Do not take hot and cold, or sweet and sour, at same meal. Avoid all fried foods and all cooked fats. Meats may be boiled, broiled, baked, roasted or steamed. Abstain from all alcoholics and malt beverages. Omit raw vegetables. Omit fat or greasy foods. Avoid all hard foods; all spiced and highly seasoned foods; all foods with husks or kernels. Take a moderate amount of exercise, but do not over-exert or be strenuous. Do not drink with meals (not more than four ounces fluid with a meal, except breakfast). One hour before each meal and at bedtime drink a glass of water or mineral water. 149 NORMAL ADULT DIET. [ Tendency to Obesity.'] The object of this diet is not to restrict, but to indicate a rational regime. The effort will be to designate as desirable, foods which are essential for the nutrition of the body, and similarly to desig- nate foods which are most likely to be injurious to the physical welfare. Food should be taken at regular meal times. While it is good to drink water, it is not advisable to drink water or other fluids with meals. Water should be taken preferably about an hour before meal time; at least three or four glasses of water a day. There is no objection to coffee or tea in moderation. It is not advisable to eat when over-exerted, over-excited or to eat too rapidly. Eat freely fresh meats, fresh fish, fresh vegetables, fresh fruits and in general all fresh foods. The foods which are unnecessary are salt, preserved, canned and spiced meats and fish: alcoholics, condiments—these are not for- bidden, but dependence should be placed on the fresh foods. Likewise plain foods are preferable to made dishes and rich foods. Shell-fish (except oysters) are better excluded. Particularly harmful are mixtures, extensive menus and rapid eating. It is harmful to eat a certain amount made up of a considerable variety of foods, whereas the same amount made up of a limited number of viands would be innocuous. Avoid long hours, dancing, running. Hurrying up stairs is forbidden. The quantity of fluids taken during the day should be liberal, but not too large. From six to eight glasses of all liquids should be taken during the day. Drink water freely, best taken an hour be- fore meals, but limit the quantity of fluids taken with meals. Eat slowly and masticate food thoroughly. Do not work excitedly. Over-exertion and strain are to be avoided. 150 NORMAL ADULT DIET. (Continued.) Accordingly, the following should be about the day’s dietary: A glass of water to be taken on arising; about 11 o’clock and about 5 o’clock. Breakfast. Cereal. Cocoa, weak tea or coffee, or chocolate. Toast or bread and butter. Fruit. Luncheon. Meat (steak, chops, chicken, fish). Green vegetable or potato. Bread and butter. Light dessert (such as fruit or plain cake). Dinner. Meat or fish. Potato. Vegetable. Salad. Bread and butter. Light dessert (pudding or dessert as above). Macaroni or spaghetti may be substituted for vegetable or potato. 151 NORMAL DIET. [Puberty.] MAY EAT. AVOID. Meats. Broiled, boiled, baked, roasted: steaks, lamb chops, mutton chops, roast beef, game, chicken, brains, sweetbreads, lamb, turkey. Salt, preserved, canned and spiced meats; tongue, goose, duck, kid- neys, stews. Fish. Fresh fish with white flesh. Salt, preserved and canned fish; shrimps, crabs, lobsters, salmon, sardines, mackerel. Vegetables. Green vegetables—spinach, cress, lettuce, asparagus, artichokes, celery, rhubarb, tomatoes, corn, beans, peas, carrots, potatoes, eggplant, cauliflower. Cucumbers, beets, cabbage, gar- lic, onions, sweet and sour vege- tables; vegetables with rich sauces; sprouts. Fresh and stewed fruit; berries, oranges, apples, grapefruit, pears, peaches, bananas, melons. Fruits. Unripe and over-ripe melons. Beverages. Water, tea, cocoa, milk, choco- late. Alcoholic and malt drinks. Sundries. Bread, toast, zwieback, salads, moderate amount butter, clear soups, eggs, meat juice gravy, cereals, cottage cheese, plain cake, moderate amount sweets. Pies, pastries, confections, spices, sauces, condiments, gravies, pou- lettes, thick and cream soups, hot cakes, hot rolls, hot biscuits, strong cheese—Roquefort, etc. 152 NORMAL DIET. (Continued.) TYPE MEALS. Breakfast. Two eggs or cereal. Bread and butter. Milk or cocoa. Fruit or orange juice. Luncheon. Steak or chops. Baked potato. Vegetable. Bread and butter. Custard, pudding or fruit. Dinner. Consomme or grapefruit. Plain meat or poultry or fish. Potato. Green vegetable. Salad. Fruit or plain pudding or plain cake. Liberal portions may be taken, but everything in moderation. Do not eat meals of courses—for example, if meat is eaten, eat meat; and if fish is eaten, eat fish, but not both. 153 NURSING MOTHER. [ With too Concentrated MiTk.~\ Breakfast. Oatmeal gruel (or other cereal—farina, cornstarch, cream of wheat). Bread and butter. Cocoa or chocolate. Fruit (apple, pear, peach, orange, grapefruit, plums); fruit may be fresh or cooked; fruit jellies. 11 A.M. A glass of water. Luncheon. Eggs. Green vegetables (such as spinach, string beans, carrots, cooked celery, asparagus, artichoke). Bread and butter. Tea. Plain cake. 5 P.M. A glass of water. Dinner. Plain meat (steak, lamb chops, roast beef, mutton, chicken, fish). Green vegetable. Potato. Bread and butter. Raw or cooked fruit. Bedtime. A glass of water. Water may be taken freely. Tea and coffee may be taken in moderation. Avoid cucumbers, cantaloupes, tomatoes, onions, garlic, cabbage, cauliflower, shell-fish. Do not take any laxative that may be excreted in the milk, such as cascara, senna, etc., but if a laxative is needed, salts or aperient water may be taken. 154 NURSING MOTHER. [Frail and Anemic.'] SELECTED DIETARIES. Breakfast. Cereal, bread and butter or toast, cocoa, fruit. Luncheon. Eggs, potato, bread and butter, pudding. Dinner. Meat, rice, bread and butter, vegetable, fruit. Breakfast. Ham and eggs, bread and butter, coffee, fruit. Luncheon. Fish, rice, bread and butter, fruit. Dinner. Meat, potato, vegetable, bread and butter, pudding or custard. Breakfast. Cereal, bread and butter, cocoa, orange juice. Luncheon. Steak, vegetable, bread and butter, cake and jelly. Dinner. Chicken, vegetable, potato, bread and butter, pudding. Breakfast. Cereal, bread and butter, coffee, fruit. Luncheon. Lamb chops, potato, bread and butter, custard. Dinner. Meat, vegetable, salad, bread and butter, jelly omelette. Breakfast. Eggs, cocoa, bread and butter, fruit. Luncheon. Fish, potato, bread and butter, tea. Dinner. Turkey, jelly, vegetable, salad, bread and butter, dessert. Breakfast. Bacon and eggs, bread and butter, coffee, fruit. Luncheon. Mutton chops, potato, ripe olives, bread and butter, cake. Dinner. Roast meat, green vegetable, macaroni or spaghetti, salad, bread and butter, pudding. Breakfast. Cereal, bread and butter, chocolate, fruit. Luncheon. Cold ham or raw oysters, salad, bread and butter, custard. Dinner. Steak or chop or roast meat, vegetable, potato, salad, bread and butter, cake. One hour before each meal drink a glass of water. Drink three glasses of milk daily, at 10 A.M., 3 P.M., 10 P.M. Cake may be added to dessert at luncheon and dinner. Drink water freely between meals. Lie down from 1 to 2.30 P.M. or 3 P.M. 155 NUTRITIOUS DIET. [For Ill-nourished Adult.] TYPE MEALS. Breakfast. Eggs or cereal. Bread and butter. Milk or cocoa. Fruit. Luncheon. Meat. Potato. Vegetable. Bread and butter. Dessert. Dinner. Meat. Potato. Vegetable. Salad. Bread and butter. Dessert. Food should be taken at regular times. Eat slowly. Masticate food thoroughly. Avoid fried foods. Avoid extensive menus. Have food prepared plain. Puddings and custards are desirable desserts. Do not eat when excited or over-exerted. Water should be taken abundantly. Do not take much water or other liquid with meals. Drink a glass of water one hour before meal times. At least four glasses of water or other liquid to be taken daily. Drink three or four glasses of milk daily. (May be taken with breakfast, 3 P.M. and at bedtime.) 156 NUTRITIOUS DIET. (Continued.) MAY EAT. AVOID. Meats and Fish. Fresh meats broiled, boiled, baked, roasted, or steamed—game, steaks, chops, roast beef, chicken, turkey, fish, sweetbreads, brains, broiled tripe, ham, raw oysters. Salt, preserved, canned and spiced meats and fish; tongue, stews, goose, duck, kidneys, liver; shell- fish, sardines, herring, mackerel. Vegetables. Green vegetables—spinach, peas, cauliflower, lettuce, rhubarb, string beans, artichokes, pota- toes, asparagus, tomatoes, beets. Turnips, dry beans, onions, gar- lic, cucumbers, radishes, cabbage, sprouts. Fruits. Fresh and cooked fruits—baked apples, pears, peaches, orange, bananas. Preserves; berries. Beverages. Water, mineral water, tea, cof- fee (with milk), milk, cocoa, chocolate. Alcoholic and malt drinks; sweet and acidulous drinks. Sundries. Bread, toast, zwieback, eggs, limited amount of clear soup, cereals and plain candy. Pastry, pies, confectionery; gra- vies, sauces, poulettes; condi- ments, such as catsup, mustard, tabasco, pepper; hot rolls, hot biscuits, hot bread, hot cakes; thick and cream soups. 157 NUTRITIOUS DIET. T For Adult Male. Stock Broker 1 Under Nerve Tension. The object of this diet is not to restrict but to indicate a rational regime. The object is to designate as desirable foods which are essential for the nutrition of the body and similarly to designate foods which are most likely to be injurious. Food should be taken at regular meal times. It is inadvisable to eat when over-exerted, over-excited, or to eat rapidly. Eat freely fresh meats, fresh fish, fresh vegetables, fresh fruits and in general all fresh foods. The foods which are unnecessary are salt, preserved, canned and spiced meats and fish; alcoholics, condiments: these are not for- bidden, but dependence should be placed on the fresh foods. Like- wise, plain foods are preferable to made dishes and rich foods. Creams, pastries, shell-fish (except oysters), have little to recom- mend them in this diet. But particularly harmful are mixtures, extensive menus and rapid eating. It is harmful to eat a certain amount made up of a considerable variety of foods, whereas the same amount made up of a limited number of viands would be innocuous. While it is good to drink water, it is not advisable to drink water or other fluids with meals. Water should be taken preferably about an hour before meal time; at least three or four glasses of water a day. Tea or coffee may be taken in moderation. Accordingly, the following should be the day’s dietary: A glass of water to be taken on arising; about 11 A.M., and at 5 P.M. Breakfast. Coffee, eggs or cereal. Bread and butter, fruit. Luncheon. Meat, vegetable, salad. Bread and butter, dessert. Dinner. Entree, roast, potato. Vegetable, salad, dessert. There is no effort here to simplify the diet. The entire effort is to eliminate the glaring faults, such as long menus, rich made dishes, gravies. 158 NUTRITIOUS DIET. (Continued.) MAY EAT. Meats and Fish. AVOID. Beef steak, roast beef, roast mut- ton, mutton chops, lamb chops, chicken, squab, brains, tripe, sweetbreads, fish, raw oysters, ham, game, lamb, veal, bacon, marrow, scraped meat. Preserved, canned, salt and spiced meats and fish; tongue, sausage, kidneys, liver, pot roast, stews, pork, duck, goose, soup meat, hash; herring, crab, clams, lobster, mussels. Meat should be broiled, boiled, steamed, baked or roasted (but not stewed or fried). Vegetables. String beans, asparagus, peas, artichokes, cooked celery, lettuce, spinach, eggplant, potatoes, car- rots. Radishes, onions, garlic, corn, cabbage, cauliflower, sprouts, turnips, dry beans, pickles. Fruits. Fresh and cooked fruits—apple sauce, baked apple, prunes, ap- ples, oranges, peach, pear, grapes. Berries, jams, preserves. Beverages. Water, mineral water, tea, milk, cocoa, coffee. Alcoholics; sweet drinks; iced drinks. Sundries. Eggs, cereals, rice, sago, cottage cheese, custards, puddings, angel cake, sponge cake, lady fingers, pastes, chocolate, bread, crack- ers, graham crackers, toast, zwie- back, clear jelly, honey, syrup, limited amount candy, clear soups, bouillon, beef tea, mutton broth, chicken soup, beef juice. All condiments, such as catsup, mustard, horseradish, tabasco, Worcestershire, pepper; pastry, cakes, nuts, pies, candies; rich soups, sauces and gravies; hot rolls, hot biscuits, hot bread, hot cakes, waffles. Soups may be thickened by cooking cereal or vegetable in them, but avoid rich, cream or fatty soups. 159 NUTRITIOUS DIET. For Adult Business Woman. Cal- culated to Regulate Digestion and to - Maintain Normal Weight. MAY EAT. Meats and Fish. AVOID. Broiled, boiled, steamed, baked, roasted: steaks, chops, roast beef, game, chicken, sweetbreads, brains, lamb, turkey, fresh fish, raw oysters. Salt, preserved, canned and spiced meats and fish; tongue, goose, duck, kidneys, stews; salmon, shrimps, lobsters, crabs, sardines, mackerel. Vegetables. Green vegetables—spinach, peas, lettuce, asparagus, artichokes, celery, rhubarb, tomatoes, egg- plant, string beans, carrots, po- tatoes, cress. Cucumbers, beets, cabbage, cauli- flower, garlic, onions, sprouts, sweet and sour vegetables, vege- tables with rich sauces, corn, dry- beans. Fruits. Cooked and fresh fruits, e.g., orange, apple, grapefruit, pears, peaches, bananas. Beverages. Water, tea, chocolate, cocoa, milk, coffee. Alcoholic and malt drinks; sweet drinks; iced drinks. Sundries. Bread, toast, zwieback, butter, salads (no onions or garlic), clear soups, eggs, meat juice gravy, cereals, cottage cheese, plain cake. Rich cakes, pies, pastries, con- fections, spices, sauces, gravies, condiments, poulettes, thick and cream soups, hot cakes, hot rolls, hot bread, waffles, strong cheese. 160 NUTRITIOUS DIET. (Continued.) TYPE MEALS. Breakfast. Two eggs. Bread and butter. Milk or cocoa. Fruit or orange juice. Luncheon. Steak or chops or fish or eggs or fowl. Baked potato. Vegetable. Bread and butter. Custard, pudding or fruit. Dinner. Consomme or grapefruit. Plain meat or poultry or fish. Green vegetable. Salad. Bread and butter. Fruit or plain cake or pudding. Eat slowly. Eat at regular meal times and only three meals a day. Have food prepared plain, omitting sauces, gravies, condiments. Masticate food thoroughly. Eat at intervals of not less than four hours. Eat roasted, baked, steamed, boiled or broiled meats. Do not eat mixtures, such as hot followed by cold, or sweet and sour. Avoid all made dishes—gravies, sauces, poulettes. Drink only limited quantities with meals. One hour before each meal take a glass of water. 161 OBESITY. In the treatment of obesity two factors especially must be taken into account: (1) The amount of food taken and converted into fat; (2) The amount of energy expended with resultant utilization of ingested food and destruction of stored up fat. If the amount of food taken is greater than necessary to provide fuel for the energy expended, the excess food constitutes the source of fatty accumulation; if the amount taken equals the amount re- quired for creation of energy, a balance results and the weight remains stationary; if the amount is less than required to provide for the expended energy, the stored up fat is drawn upon and loss of weight ensues. Stated in simplest language, it follows that the dietetic treatment of obesity consists in allowing less nourishment than is requisite to maintain the body weight. Inflexible rules for the treatment of all cases of obesity cannot be formulated, since many variable influences occur in different in- dividuals. Thus it is apparent that a larger quantity of food would be necessary to maintain weight in a large-framed, active farm hand than in an undersize sedentary person. Likewise, it is more feasible to materially reduce the diet of an individual who habitually over- eats than that of one who is abstemious. There is a limit below which it is inadvisable to reduce the diet. In calculating the amount of food to be prescribed in a dietary for obesity, not the bulk is significant, but the nutritive and heat producing—the caloric—value. And just at this point may be noted an insuperable obstacle to the routine formulation of exact dietaries suitable to all cases. It is this—that not the amount of food ingested, but the amount metab- olized, is important: and it is impossible to know in advance the ultimate fate of food consumed by an individual. The metabolic powers of the individual as well as the digestibility and caloric value of the food will determine the result. One person who consistently consumes excessive quantities of food may, by virtue of constitu- tional peculiarities, simply discard the excess; while another person, differently constituted, may become obese although he consumes smaller quantities of the same diet. To learn the amounts and kinds of food to be prescribed in a reducing diet, it is advisable to 162 OBESITY. (Continued.) study the effect of a known diet upon an individual and then to modify such diet as may be indicated by observed results. A dietary based upon a single observation will, as a rule, not suffice for per- manent or indefinite use: but changing conditions, as learned by periodic observations, may necessitate revisions. Obesity in individuals having various diseases, calls for special dietetic regulations. In such cases the selection of an ideal dietary may be difficult or impossible. This is particularly the case in elderly people and in instances where the patient cannot take adequate exercise. Certain general principles are noteworthy in the treatment of obesity: (1) Obesity may be combated by reducing the amount of food be- low the level required to maintain body weight. (2) Certain kinds of food have greater caloric value than others. Alcohol, fats, carbohydrates, are “fattening” foods. They have high caloric values and in dietaries for obesity the quantity of such foods should be limited. (3) Some kinds of food have smaller caloric values. Such foods are green vegetables, fibrous vegetables, fruits, lean meats. They may be prescribed more liberally in dietaries for obesity. (4) Some varieties of food, while not directly objectionable, stim- ulate the digestive glands and increase the appetite. Such foods include highly seasoned, spiced and preserved viands. They should be excluded from the dietary. (5) Some foods are indigestible. They also should be excluded. In conjunction with the dietetic treatment of obesity, other meas- ures may be employed; for example, purgation, massage, increased exercise, balneotherapy. But in general, the best results will be attained by rigid adherence to proper dietetic regulation. People do not become fat from what they do not eat. 163 OBESITY. Meals should be taken at regular hours. Eat slowly. Avoid such mixtures as hot and cold, or sweet and sour, at the same meal. If hungry, a light sandwich may be taken in the middle of the afternoon, or a glass of milk at night. A limited quantity only of fluids should be taken with meals— about one-half glass water or soup. One hour before each meal drink a glass of water. Green vegetables are preferable to starchy vegetables. Vegetables that grow above the ground are preferable to those that grow in the earth. Meals should be simple, such as meat, vegetable, bread and but- ter, fruit or pudding. Avoid all alcoholics. Avoid all condiments, such as mustard, catsup, horseradish, ta- basco, etc. Avoid all highly spiced foods. Limit quantity of sweets. On arising drink a glass of hot or cold water. TYPE MEALS. Breakfast. Coffee (one cup). Two slices of toast with butter. One piece of fruit. (May also have egg.) 11 A.M. Glass of water or mineral water. Luncheon. Steak or lamb chops or other plain meat or fish. Two slices of stale bread and butter or toast. Green vegetables. Fruit or cup of tea or coffee without milk. 4.30-—5 P.M. Glass of water or mineral water. Dinner. Small portion of meat or fish or two eggs. Two slices of stale bread or toast and butter. Green vegetable. Salad (without oil). Fruit or cup of tea. 164 OBESITY. [In Adult Male.] Eat regularly three times a day (only). Drink only limited quantities with meals. (Not more than a glass- ful of all fluids; this includes soup). Eat plain foods, omitting sauces, gravies, condiments. Do not eat before retiring. Do not lie down after eating. TYPE MEALS. Breakfast. One cup of coffee. Two soft boiled eggs. Two pieces of toast or crackers. One piece of fruit. Luncheon. Raw oysters. (This diet will do for unoccupied Cup of tea. adult female; if so, take for luncheon Or only tea or fruit.) Lamb chops. Fruit. Dinner. Cup of bouillon. Plain meat. Green vegetable. One slice bread and butter. One piece of fruit. Small black coffee. It is not necessary to take all specified, but do not exceed this limit. 165 OBESITY. (Continued.) MAY EAT. Meats and Fish. AVOID. Steaks, lamb and mutton chops, roast beef, game, chicken, fish, broiled sweetbreads, brains, raw oysters, mutton, veal, turkey. Salt, preserved, canned and spiced meats; domestic duck, goose, stews, poulettes; salmon, sar- dines, mackerel, pork, ham, ba- con. Vegetables. Green vegetables—spinach, peas, cauliflower, lettuce, celery, rhu- barb, tomatoes, artichokes, string beans, asparagus (no mayon- naise), cress, pickles. Starchy vegetables and such as grow under ground—potatoes, beets, turnips, corn, dry beans, onions, garlic, olives. Fruits. In moderation may eat fresh pear, peach, apple, orange, cher- ries, plums, apricots, figs, grape- fruit, melon, berries (without sugar). Stewed, canned, preserved or sweetened fruits; bananas, rai- sins, grapes, jellies, jams. Beverages, Water, mineral water, tea, coffee, buttermilk. Alcoholic and malt drinks; sweet drinks; milk, cocoa, chocolate. Sundries. Bread (preferably stale or toasted), zwieback, salad (made without oil; use lemon juice), clear soup, eggs. Pastry, pies, confectionery, can- dies, sweets, gravies, nuts, pou- lettes, condiments, cereals, hot rolls, hot biscuits, muffins, hot cakes, syrups, thick and cream soups, desserts, puddings, ice cream, made dishes. 166 OBESITY. [Woman Thirty-five Years Old.] Eat at regular meal times and only three meals a day. Drink only limited quantities with meals (not more than a tea- cup of all fluids). One hour before each meal drink a glass of water or mineral water. Have food prepared plain, omitting sauces, gravies, condiments. Do not eat before retiring. Avoid all sweets, alcoholics, poulettes, gravies, fats, oils. Do not eat meals of several courses; for example, do not eat fish entree and then a roast; but if you eat fish, eat fish; and if roast, eat roast. If something permitted at a given meal is not taken, it may not be added to another meal. Unswerving adherence to rules is requisite, otherwise the benefit derived from a week of selfdenial may be nullified by indulgence at a single meal. TYPE MEALS. Breakfast. One cup of coffee or tea. Toast. One piece of fruit. (An egg may also be taken.) Luncheon. Steak the size of the palm of hand, or two lamb chops, or other plain meat or fish. Stale bread or toast. Green vegetable. One piece of fruit or a cup of tea or coffee without milk. Dinner. Cup of bouillon. Plain meat. Green vegetable. Toast or stale bread. Green salad without oil. One piece of fruit or cup of tea (if soup has not been taken). It is not necessary to take all above enumerated, but this is the maximum, 167 OBESITY. [Two-Hundred-and-sixty-pound 1 Female Clerk. TYPE MEALS. Breakfast. One cup coffee or tea. An egg may also be taken. Toast. One piece of fruit. Luncheon. Fruit or tea. Dinner. Cup of bouillon. Plain meat. Green vegetable. Toast or stale bread. Green salad without oil. One piece of fruit or cup of tea if soup has not been taken. It is not necessary to take all above enumerated, but this is the maximum. Eat at regular meal times and only three meals a day. Drink only limited quantities with meals (not more than a tea- cup of all fluids). One hour before each meal take a glass of water or mineral water. Have food prepared plain, omitting sauces, condiments, gravies. Do not eat before retiring. Do not eat meals of several courses; for example, do not eat fish entree and then a roast; but if you eat fish, eat fish; and if roast, eat roast. Avoid all sweets, alcoholics, poulettes, gravies, fats, oils. 168 OBESITY. [.Adolescent Girl.] Eat slowly. Eat at regular intervals and only three meals a day. May eat bread and butter and jelly or glass of milk at 3 P.M. Drink only limited quantities with meals. One hour before each meal drink a glass of water. Have food prepared plain, omitting sauces, gravies, condiments. Eat at intervals of not less than four hours. Masticate food thoroughly. Eat roasted, baked, steamed, broiled or boiled meats. Do not eat mixtures, such as hot followed by cold, or sweet and sour. Avoid all made dishes—stews, poulettes, sauces, gravies. 6.30 A.M. Arise and drink a glass of water. 7 A.M. Exercises—light calisthenics, especially such as are designed to develop the chest. 7.30 A.M. Breakfast. 9 to 12 M. School. 12.30 P.M. Dinner. 1 to 3.30 P.M. School. 3.30 to 5.30 P.M. Play. 6 P.M. Supper. 7.30 to 8.30 P.M. Read or study. 8.30 to 9.30 P.M. Retire. 169 OBESITY. (Continued.) MAY EAT. AVOID. Meats and Fish. Fried foods of all kinds; salt, pre- served, canned and spiced meat and fish; tongue, goose, duck, lamb (ex- cept lamb chops), kidneys, stews; sardines, mackerel, salmon, shell-fish. Broiled, boiled, baked, roasted, or steamed: steaks, chicken, roast beef, lamb and mutton chops, game, sweet- breads, brains, broiled tripe, turkey, fish with white flesh, raw oysters. Green vegetables and such as grow above ground—spinach, peas, lettuce, celery, tomatoes, string beans, car- rots, artichokes, asparagus, cress. Vegetables. Starchy vegetables and such as grow under ground—potatoes, beets, turnips, corn, dry beans, onions, garlic, cauli- flower, rhubarb, cucumbers, cabbage. Fresh fruit—apple, pear, peach, cher- ries, grapes, orange, melon, lemon, plums, grapefruit, persimmons, apri- cots—in moderation. Fruits. Stewed and sweetened fruits; berries, figs, bananas, jams, jellies, raisins. Beverages. Water, mineral water, coffee, tea. Alcoholic and malt drinks; iced, acid- ulous and sweetened drinks; milk, cocoa, chocolate. Sundries. Stale bread, toast, zwieback (all in moderation), butter, salads made with lemon, not with oil; eggs in moderation (not fried) ; a limited amount clear soup or bouillon; meat juice gravy (unthickened); cottage cheese. Fresh bread, cake, pastry, pies; ices, confectionery, sweets, spices, gravies, sauces, poulettes; condiments, such as catsup, mustard, tabasco; thick and cream soups; nuts, farinaceous foods, cereals; hot rolls, hot biscuits, muf- fins, waffles, hot cakes, syrups, cheese. TYPE REGIME FOR A DAY. On arising drink a glass of cold water. Breakfast. Two eggs. Two pieces of toast and butter. Cup of tea (or cocoa). One piece of fruit. 11 A.M. A glass of water. Luncheon. Steak or chop or roast beef or other plain meat. Stale bread and butter or toast (not hot). Vegetable. Fruit or cup of tea. (May also take salad made with lemon, but omit oil.) 4.30 P.M. A glass of water. Dinner. Cup of bouillon. Meat. Vegetable. Toast, stale bread or crackers. Fruit or tea. 170 OBESITY. The Object of this Diet is to Retain the Figure of 1 Youth in an Unoccupied Woman Past Forty. \ 1— Take meat once a day. 2— Vegetables, especially green vegetables, should constitute a large part of the diet. 3— Fruits may be taken freely—raw or cooked, but not sweetened. 4— Beverages: Water, mineral water, tea without milk, coffee with- out milk, are allowed. Sweet drinks, alcoholics, chocolate and thick soups are excluded. Lemon juice may be taken in water or mineral water. Breakfast. Fruit. Coffee or tea. Luncheon. Cold meat or light meat or fish, or eggs. Salad. Toast. Fruit. Dinner. Meat or poultry or fish or eggs. Green vegetable. Dry toast. Salad. Fruit. Small coffee. With meals only a limited quantity of fluids is permissible. One hour before each meal, a glass of water should be taken, and water may be freely taken at other times. Eat plain foods, avoiding sauces, gravies, condiments. Do not lie down after eating. TYPE MEALS. 171 OBESITY. (Continued.) MAY EAT. AVOID. Meats and Fish. Steak, lamb chops, roast beef, game, chicken, fish, raw oysters, brains, sweetbreads, tripe, squab, mutton, turkey. Salt, preserved, canned and spiced meats and fish; tongue, goose, domestic duck, lamb (except lamb chops), shell-fish, stews, kidneys. Vegetables. Green vegetables and such as grow above ground — spinach, cauliflower, lettuce, celery, cress, peas, tomatoes, string beans, ar- tichokes, asparagus, pickles, cu- cumbers, sprouts, cabbage, pars- ley. Starchy vegetables and such as grow under ground — potatoes, corn, beets, turnips, carrots, dry beans. Fruits. Fresh fruit—apple, pear, peach, plums, figs, orange, grapes, lem- ons, grapefruit, apricots, persim- mons, berries, melons — all in moderation. Stewed or sweetened fruit; ba- nanas, preserves, jellies, jams. Beverages. Water, mineral water, coffee, tea, buttermilk. Alcoholic and malt drinks; sweet drinks; cocoa, milk, chocolate; iced drinks. Sundries. Stale bread, toast, zwieback (all in moderation); eggs, limited amount clear soup, bouillon. Fresh bread, cake, pies, sweets, pastry, confections, candies, gra- vies, sauces, poulettes, nuts, thick or cream soups; all farinaceous foods; cereals; hot cakes, hot rolls, hot biscuits, muffins, waf- fles; syrups, puddings, desserts, made dishes; salmon, sardines, herring. 172 OBESITY. Two-hundred-and-sixty-pound Fifty-year-old Man. TYPE REGIME FOR A DAY. On arising drink a glass of Vichy or of tap water. Breakfast. Coffee. Two pieces of bread and butter. One piece of fruit. 11 A.M. Glass of water or mineral water. Luncheon. Steak or lamb or mutton chop or roast beef or other plain meat or eggs. Vegetable. Stale bread and butter or toast (not hot). Fruit or tea. 4.30 P.M. Glass of water. Dinner. Meat or eggs. Vegetable. Toast, stale bread or crackers. Fruit or tea. Avoid puddings, desserts and creams. “Meat” here means a good slice of roast beef or two lamb chops or similar amount of other meat. “Fruit” means one medium size orange, apple or like amount of other fruit. “Mineral water” means still alkaline water, such as Vichy, Beth- esda, Bartlett. It is good to drink mineral water, but not at meal times. Do not eat before retiring or before lying down. Avoid getting over-heated, over-exerted or over-excited. Eat slowly. Eat at regular times, and only three meals a day. Drink only limited quantities with meals. Have food prepared plain, omitting sauces, gravies, condiments. Eat at intervals of not less than four hours. Masticate food thoroughly. Eat roasted, baked, steamed, boiled or broiled meats. One hour before each meal drink a glass of water or mineral water. Do not eat mixtures, such as hot followed by cold, or sweet and sour. Avoid all made dishes—sauces, poulettes, stews, gravies, oily salads. 173 OBESITY. (Continued.) MAY EAT. AVOID. Meats and Fish. Broiled, boiled, baked, roasted: steaks, chops, roast beef, game, chicken, sweetbreads, brains, broiled tripe, white fish, raw oys- ters, boiled ham. Salt, preserved, canned and spiced meats and fish; tongue, goose, duck, turkey, lamb (except lamb chops), kidneys, stews; shell-fish, sardines, mackerel, herring, sal- mon. Vegetables. Green vegetables and such as grow above ground—spinach, cauliflower, lettuce, celery, rhu- barb, peas, string beans, carrots, artichokes, cress, baked eggplant, tomatoes. Starchy vegetables and such as grow under ground—potatoes, beets, turnips, corn, dry beans, onions, garlic, cabbage. Fruits. Fresh fruit—apple, pear, peach, orange, cherries, grapes, lemons, grapefruit, melon, persimmons, plums, apricots—all in modera- tion. Sweetened fruits; berries, figs, bananas; stewed or preserved fruits; jellies, jams. Beverages. Water, tea, coffee, buttermilk, sour lemonade (no sugar). Alcoholic and malt drinks; sweet and acid drinks. Sundries. Stale bread, toast, zwieback (all in moderation); butter, salads made with lemon, not with oil; eggs in moderation; limited amount clear soup or bouillon; cottage cheese. Fresh bread, cake, pastries, pies, confectionery, sweets, spices, gravies, nuts, sauces, poulettes; all condiments, such as catsup, mustard, tabasco; thick and cream soups; hot rolls, hot bis- cuits, hot cakes, waffles, syrups. 174 OBESITY. Indpient Kidney and Heart Complications. Middle Aged Man with Tendency to Obesity. - Affluent Circumstances. 7.30 A.M. Glass of water (three times a week take one tea- spoonful Carlsbad salts with this water). 8 A.M. Rise: 10 minutes walk before breakfast. 8.30—9 Breakfast. Small portion cereal, one cup of coffee, bread and butter or toast, fruit. 9.30 to 10 A.M. Reading or other light occupation. 10 to 11 A.M. Walk or bathe or other light exercise. 11 A.M. Glass of water or mineral water. 11 to 12 M. Sedentary occupation, such as reading. 12.30 Luncheon. Meat or fish or eggs, bread and butter or toast, green vegetable, fruit or light pudding. 1.30 to 3 P.M. Rest. 3.30 to 5 P.M. Ride or walk or other light occupation (golf, horseback, etc.). 5 P.M. Glass of water or mineral water. 5 to 6 P.M. Sedentary pursuit, such as reading or billiards. 6.30 Dinner. Light meat or eggs or poultry or fish. Stale bread or toast or crackers. Green vegetable, salad (without oil). Raw or cooked fruit, cup of tea if desired. 7.30 to 8 P.M. Lounge about. 8 to 9.30 P.M. Light occupation—billiards or reading or picture show or other light amusement. 10.30 P.M. Bed. Do not eat between meals or before retiring. Do not eat when hot or excited. Do not eat rapidly. Do not over-exert. Drink of all fluids from 6 to 8 glasses daily. The day’s diet may include a small quantity of meat twice daily. But it is preferable to substitute for meat—eggs or fish or poultry, once daily. Take small meals of solid foods. Do not take more than designated quantity at a single meal. 175 OBESITY. (Continued.) Eat only at regular meal times and only three meals a day. Drink only limited quantities with meals. One hour before each meal take a glass of water or mineral water (Bartlett, Vichy). Eat simple foods, avoiding such mixtures as very hot and very cold at the same meal, or sweet and sour. Have food prepared plain, omitting sauces, gravies, condiments. Avoid cooked fats. Meat should be boiled, broiled, baked or roasted. Abstain from all alcoholics. Eat steaks, chops, roast beef, mutton, chicken, white meat of tur- key, squab, game, sweetbreads, lamb, veal, boiled ham, broiled tripe. Omit tongue, corned beef, liver, goose, duck, sausage, bacon. Eat oysters raw; omit all other shell-fish—crab, lobster, shrimps. Eat fresh white fish, but avoid preserved, salt or canned fish; also avoid salmon, herring, sardines and mackerel. Fish should not be fried nor cooked with a sauce or poulette. Eat all light cooked vegetables—peas, string beans, spinach, car- rots, asparagus, artichokes, tomatoes, celery. Avoid all starchy vegetables—turnips, corn, beets, onions, garlic, cabbage, cucumbers, dry beans and raw vegetables. Salads should contain no oil, no onion, no garlic. Do not eat condiments—mustard, catsup, tabasco, horseradish, etc. Eat fresh and stewed fruits not sweetened. Avoid all preserved and sweetened fruits. Eat eggs—soft boiled, poached, scrambled, omelette. Eat zwieback, toast, crackers, and bread preferably stale. Avoid hot breads, rolls, muffins, biscuits, pancakes. Avoid pastries, pies, cakes, sweets, confections, candies, ices, etc. Limit quantity of cereals. Omit cheese, except cottage cheese. Drink buttermilk, water, mineral water, tea, coffee, cocoa; coffee or tea may be taken weak once daily. Avoid chocolate, sweet drinks, acid drinks, alcoholic and malt drinks. Smoking should be restricted; inhaling prohibited. 176 [Incipient Cardiac and Renal Affections. 1 Woman Stenographer. OBESITY. The object of this diet is to reduce to a minimum certain kinds of foods, at the same time allowing a sufficient intake to supply the needs of the body and satisfy the appetite. 1— Reduce Meat and meat products. Take meat only once a day. White meat of chicken, lamb chops and fish with white flesh may be taken. 2— Vegetables, especially green vegetables, should be the mainstay of the diet. Spinach, celery, string beans, carrots, artichokes, peas, asparagus, plain lettuce, pickles, cress, rhubarb, tomatoes, may be taken freely. 3— Fruits may be taken freely: oranges, grapefruit (unsweetened), apples. But preserved fruits (on account of the sweetening) are to be omitted. A—Beverages: Water may be taken freely—one to two quarts a day. Vichy or Bartlett or White Rock may be taken. Milk may be taken in limited quantities; buttermilk may be taken freely. Alcoholics of all kinds are excluded. Coffee should be entirely omitted, or restricted to once daily; likewise tea and cocoa; chocolate is excluded. Clear soup, consomme, bouillon or vegetable broths may be taken. Lemon juice (unsweetened) may be taken in water or mineral water. Eat regularly three times a day (only). Eat plain foods, omitting sauces, gravies, condiments. Do not eat before retiring. Drink limited quantities with meals (not more than a water glass full of all fluids (this includes soup). Omit indigestible foods and concentrated foods—cabbage, cauli- flower, corn, cucumbers, onions, garlic, crab, lobster, shrimps, made dishes, pastries, pies, sweets, pork, cheese (except cottage cheese). Breakfast. Coffee. Toast or crackers. Two soft boiled eggs. One piece of fruit. Dinner. Eggs. Vegetable. Fruit. TYPE MEALS. Supper. Plain meat. Green vegetables. Bread and butter. One piece of fruit Small black coffee 177 OBESITY. [.Elderly Woman. Impaired Circulation.] 7 A.M. One heaping teapsoonful salts in glass of water. 8—8.30 Breakfast. One cup coffee with two tablespoonfuls milk (coffee may be sweetened with saccharine, no sugar). Two slices thin toast (dry). One-half grapefruit or a portion of berries (with- out cream or sugar). 9 to 10 A.M. Read or write. 10.15 A.M. Tuesday, Thursday, Saturday—Nauheim bath; Monday, Wednesday, Friday—sponge bath and gentle friction rub. 11 A.M. A glass of still alkaline water. 11 to 12 M. Complete rest in bed. 12.30 Luncheon. Two lamb chops or a small cut of steak or roast beef, or fish or chicken. Two slices thin dry toast. Green vegetable (choice of asparagus, artichoke, string beans, peas, cooked celery, spinach). One orange or an apple baked without sugar, or a small portion of other fresh fruit or berries. Or instead of above luncheon take— A small baked potato. A glass of buttermilk. 1 to 3 P.M. Rest. 3 P.M. A glass of still alkaline water or a cup of tea with lemon (but without sugar or cream). 3 to 5 P.M. Company—diversion. 5 P.M. Ride or read or write or sew until dinner time. 6.30 Dinner. Broiled sweetbreads or fish or chicken or two eggs or raw oysters or squab. Two slices thin dry toast. Green vegetable (select from above list). Black coffee or tea. 7.30— P.M. Retire. 8.30 to 9 P.M. Massage. 9 P.M. A glass of still alkaline water. 9.30— 10 P.M. Lights out. 178 OPIUM ADDICT. [Chronic Indigestion.'] MAY EAT. AVOID. Steaks, roast beef, roast mutton, mut- ton chops, lamb chops, chicken, squab, brains, sweetbreads, tripe, fish, raw oysters, ham, game, lamb, veal, mar- row, scraped meat. Meats and Fish. Preserved, salt, canned meat and fish; tongue, sausage, liver, kidneys, pot roast, stews, bacon, pork, duck, goose, soup meat, hash; herring, crab, clams, lobsters, mussels. String beans, asparagus, peas, cooked celery root, lettuce, eggplant, spinach, potatoes, carrots. Vegetables. Radishes, onions, garlic, corn, cucum- bers, pickles, cabbage, sprouts, cauli- flower, turnips. Apple sauce, baked apple, apple, cooked peach, cooked pear. Fruits. Berries, jams, preserves. Beverages. Water, tea, milk, cocoa. Alcoholic and malt drinks; coffee. Sundries. Eggs in any form, cereals, rice, Sago, cottage cheese, bread, custards, pud- dings, sponge cake, angel cake, lady fingers. Fried potatoes; all condiments, such as mustard, tabasco, horseradish, pep- per; nuts, pastry, pies, candies; rich soups, gravies, sauces; hot rolls, hot biscuits, hot bread, hot cakes, waffles; desserts. Eat slowly. Masticate food thoroughly. Do not eat when hot or excited. Do not hurry soon after eating. Do not eat large quan- tities at a time. Avoid all irritating foods and all foods which experience has shown are not well tolerated. Eat at regular meal times. Eat plain nutritious food, simply prepared. Omit sauces, gravies, condiments. Avoid all fried foods and all cooked fats. Do not take hot and cold, or sweet and sour, at the same meal. Meat may be boiled, broiled, steamed, baked or roasted. Omit raw vegetables. Omit all fat and greasy foods. Avoid all hard foods, all spiced or highly seasoned foods, all foods with husks or kernels. One hour before each meal take a glass of water. Take water freely between meals. 179 POST OPERATIVE DIETS. Nourishing, Progressive, Diet for Post Operative Convalescent. Major Oper- - ative Case. -* Third or fourth day after operation—patient having recovered from anesthetic: RESTRICTED DIET. 7 A.M. Glass of hot water. 8 A.M. Poached egg, coffee, one or two slices of toast. 11.15 A.M. One glass of water. 12.15 P.M. Four ounces beef juice, toast and butter. 3 P.M. Arrowroot and cream. 4.30 P.M. Eight ounces of water. 5.30 P.M. Two eggs, two slices of toast, bouillon and sago. 7 A.M. Hot water. 8 A.M. Two eggs, two slices toast, black coffee. 11 A.M. Water. 12 M. Four ounces beef juice, two slices toast or bread. 3 P.M. Eight ounces arrowroot gruel, one slice toast and butter. 4.30 P.M. Eight ounces of water. 5.30 P.M. Soft boiled eggs, bouillon and rice, two pieces zwieback. 7 A.M. Hot water. 8 A.M. Two eggs, two slices toast, tea. 11 A.M. Glass of water. 12 M. Four ounces beef juice, two slices toast and butter. 3 P.M. Glass of milk. 4.30 P.M. Glass of water. 5.30 P.M. Six ounces broth, cereal with cream and sugar, bread or toast or rusk. 9 P.M. Eight ounces of milk. 7 A.M. Hot water. 8 A.M. Cereal with cream and sugar, eight ounces milk, toast. 11 A.M. Water. 12.15 P.M. Two eggs, two slices toast, milk rice and cream. 3 P.M. Tea, two slices toast. 4.30 P.M. Glass of water. 5.30 P.M. Cereal and cream, toast, tapioca pudding. 8 P.M. Glass of milk. Cereal has value to prevent acidosis. 180 POST OPERATIVE DIETARIES (Continued). LESS RESTRICTED DIET. 7 A.M. Hot water. 8 A.M. Tea, two slices toast, two eggs, orange juice. 11 A.M. Water. 12 M. Four ounces beef juice, two slices toast and butter. 3 P.M. Glass of milk. 4.30 P.M. Glass of water. 5.30 P.M. Two eggs, six ounces of broth, sago, cream and sugar. 8 P.M. Glass of milk. 7 A.M. Hot water. 8 A.M. Arrowroot, glass of milk, toast, apple sauce. 11 A.M. Water. 12 M. Two eggs, two slices toast, milk rice and cream. 3 P.M. Tea and toast. 4.30 P.M. Water. 5.30 P.M. Two eggs, toast, tapioca and cream. 8 P.M. Custard. Or Or 7 A.M. Hot water. 8 A.M. Cream of wheat, two slices zwieback, stewed prunes, cocoa. 11 A.M. Water. 12 M. Two poached eggs, milk rice and cream, toast. 3 P.M. Tea, cream and sugar, two slices buttered toast. 4.30 P.M. Water. 5.30 P.M. Soft boiled eggs, toast, sago and cream. 8 P.M. Sandwich. LIGHT DIET. 7 A.M. Hot water. 8 A.M. Cream of wheat, zwieback and butter, baked apple, cocoa. 11 A.M. Water. 12 M. Broiled chicken, milk rice, toast. 3 P.M. Tea and toast. 4.30 P.M. Water. 5.30 P.M. Poached eggs, toast, tapioca and cream. 8 P.M. Ham sandwich. 181 PYLORIC STENOSIS. [Adult. Due to Scar Tissue.] Breakfast. Eggs (soft boiled, poached or soft omelette). Stale bread or toast or zwieback, with limited amount of butter. Tea. Luncheon. Meat—scraped meat or chops or chicken, fish, squab, sweetbreads, brains, raw oysters. Potato—baked or mashed. Stale bread and butter or toast or zwieback. Light green vegetable— artichoke heart, pureed peas, French carrots, Italian squash, pureed spinach, cooked celery root. (Vegetables to be cooked in salt and water, and no butter to be added; or, may be cooked in soup and fat removed.) Dinner. Oysters or ham or meat or chicken or fish as above. Vegetables as above. Bread and butter or toast or zwieback. Custard or tapioca or sago pudding. One hour before meals take a glass of water. Meat may be boiled, broiled, steamed, baked or roasted, but not fried. 182 REST CURE DIET. FIRST AND SECOND DAYS. 7 A.M. Glass of milk. 9 A.M. Two eggs (raw, soft boiled or poached). Two slices of bread and butter. 11 A.M. Broth with cereal cooked in it. 2 P.M. Glass milk. Lady fingers (or plain cake or crackers). 4 P.M. Glass of milk. 6 P.M. Two eggs. Two slices of bread and butter. 9 P.M. Glass of milk. THIRD, FOURTH, FIFTH DAYS. 7 A.M. Glass of milk. 9 A.M. Two eggs. Two pieces of bread and butter. 11 A.M. Broth with cereal cooked in it. 2 P.M. Glass of milk. Lady fingers or plain cake or crackers. 4 P.M. Oysters or ice cream. 6 P.M. Glass of milk. Baked potato. Bread and butter. 9 P.M. Glass of milk. 183 REST CURE DIET. (Continued.) SIXTH, SEVENTH, EIGHTH DAYS. 7 A.M. Glass of milk. 9 A.M. Two eggs. Two slices of bread and butter. 11 A.M. Breast of chicken or scraped beef. Two slices of bread and butter. 2 P.M. Glass of milk. Lady fingers or cake. 4 P.M. Raw oysters or ice cream and cake. 6 P.M. Glass of milk. Baked potato. Two slices of bread and butter. 9 P.M. Glass of milk with egg. NINTH, TENTH, ELEVENTH DAYS 7 A.M. Glass of milk. 9 A.M. Two eggs. Two slices of bread and butter. 11 A.M. Steak or chops or roast beef. Bread and butter. Asparagus, artichoke or spinach. 2 P.M. Glass of milk. Lady fingers or cake. 4 P.M. Raw oysters or ice cream and cake. 6 P.M. Two eggs. Baked potato. Rice pudding or sago pudding. 9 P.M. Glass of milk with egg. 184 SKIN AFFECTIONS. Chronic Skin Affections Associated with Constipation and Defective ■ Metabolism. Eat foods that leave a bulky residue: the purpose is to stimulate the muscular walls of the intestines. MAY TAKE. Soups. Meat and vegetable soups, without pepper or other seasoning except salt. Fish. Fresh fish, broiled or boiled. Meats. Fresh meats, poultry, game. Eggs. Soft boiled, poached, but not fried. Farinaceous. Brown or graham bread; any of the cereal breakfast foods except those made from oats; corn bread, whole wheat bread, wheat bread. Bread should be eaten stale. Vegetable. Spinach, boiled onions; salads with oil; lettuce, sorrel, water cress, asparagus, tomatoes, celery, green corn, artichokes eaten plain with oil dressing; string beans, green peas, olives, rice, squash. Salad should be made plain, with a French dressing consisting of a great deal of oil, a little vinegar or lemon and a little salt (no paprika). Desserts. Figs, fresh or cured but not sulphured; prunes, baked apples, oranges, melons, pears, grapes, raisins, stewed fruits, apricots, bananas, persimmons; limited amount of plain cake. Cheese. Cottage cheese. Restrict amount of butter. Beverages. Glass of water, hot or cold, drunk on rising and before meals; water freely between meals. Limited amount of tea, coffee, milk, cocoa, chocolate, buttermilk. Fruits (not too acid) and vegetables should constitute a large proportion of the dietary. 185 SKIN AFFECTIONS. (Continued.) SHOULD AVOID. Pork; all preserved, salt, canned, spiced or potted meats and fish; crabs, shrimps, lobsters, craw fish; veal, goose, liver; hard boiled eggs; salmon; pineapples; fresh bread, hot biscuits, hot bread, hot rolls, hot cakes, waffles, fritters; oatmeal, cheese, pastry, sweets, confections, candy; all fried meats, fried potatoes, fried breads; dressing; all condiments (except salt); acid fruits, acid drinks; limited amount of potatoes, butter, cream, sugar, milk; very hot or very cold drinks—as very hot soup, coffee. NOTES EXPLANATORY OF THE DIET LIST. Condiments especially are to be avoided—this includes pepper. Mixtures, extensive menus, are to be avoided. Do not eat meat and fish at the same meal, but if fish is eaten, eat fish, and if meat is eaten, eat meat. If one helping is insufficient take a second, but let it be of the same kind. Bread may be eaten in ordinary amount with other food. Butter may be taken raw, in limited quantities; cooked butter is forbidden. Milk ferments and is a gas producer; moreover, it leaves little residue; therefore milk should be taken in limited quantities, if at all. Green vegetables are valuable because they leave a bulky residue which assists elimination of deleterious waste matter. Fruits possess similar advantages in this diet. However, for con- tinuous diet only smaller quantities are tolerated by the digestive system. Stimulants (including tea and coffee) are harmful. Plain cake, puddings are allowed. Pies, pastries, confections, creams, are excluded. Cheese—concentrated cheeses are noxious, because they are heavy and indigestible. Old cream cheese, such as Brie, Camembert, etc., are noxious, because they furnish abundance of toxic substances. 186 STIMULATING DIET. [Sixty-year-old Man with Tendency to Indigestion. Eat at regular meal times, three meals a day. Make the midday meal the chief meal of the day. Take small meals of solid foods. Between meals take no solid foods. One hour before each meal drink a glass of water or still alka- line mineral water. Limit the amount of fluid taken with meals. Do not eat when hot or excited or after exertion. Do not exert yourself immediately after eating. Eat slowly; masticate food thoroughly. MAY EAT. AVOID. Broiled, boiled, baked, roasted: steak, chops, roast beef, game, chicken, sweetbreads, brains, tripe (broiled), white fish, turkey. Meats and Fish. Fried foods of all kinds; all salt, preserved, canned and spiced meats; tongue, goose, duck, kidneys, stews; salmon, shell-fish, sardines, mackerel. Vegetables. Green vegetables and such as grow above ground—spinach, lettuce, cel- ery, rhubarb, tomatoes, peas, string beans, carrots, asparagus, artichoke, cress, eggplant, potatoes. Beets, turnips, corn, onions, garlic, dry beans, cucumber, cauliflower, cabbage, sprouts. Fruits. Fresh and stewed fruit—apple, pear, peach, orange, plums, cherries, melon, grapes, lemon, grapefruit, apricot, persimmon—all in moderation. Berries, figs, bananas, Beverages. Water, mineral water, tea, coffee, buttermilk—in moderation. Alcoholic and malt drinks; sweetened and acidulous drinks; chocolate. Sundries. Stale bread, toast, zwieback (all in moderation) ; butter, salads; eggs in moderation (not fried); clear soup or bouillon. Cake, pastry, pies, sweets, confec- tionery, spices, sauces, gravies, pou- lettes, nuts; all condiments, such as catsup, mustard, tabasco (it is espe- cially important to avoid these); thick and cream soups; hot rolls, hot cakes, hot biscuits, muffins, waffles; syrups. 187 STOMACH, DILATED. Never over-load the stomach. Take small quantities of nourishing, concentrated foods and semi- solid foods. Strictly limit the quantity of fluids. Avoid all effervescing drinks. Do not take more than one glassful of all liquids at a meal. Take a glassful of water, from half an hour to one hour before each meal. Lean meats, finely divided and carefully chewed, are good foods. White fish, eggs, cheese, may be taken. Fats: Oily fish, such as salmon, mackerel and sardines; also bacon and pork, must be avoided. Starchy foods are to be omitted, or taken only in small quantities. Of the farinaceous foods, take rice, sago, macaroni, cream of wheat: these are desirable. Stale white bread, zwieback, toast, may be taken in small quan- tities. Fresh vegetables may be taken pureed or finely divided and in limited quantities. Coarse vegetables, potatoes, beets, cabbage, corn, and similar foods are to be avoided. Pickles and cucumbers are not to be eaten. Thick soups are preferable to thin soups, but when soup is taken at meal times, omit other liquids. (If mineral water is taken, it should be still alkaline mineral water, such as Vichy, Bartlett or Bethesda, but no effervescing water.) If any alcohol is taken, it should be limited to whisky or brandy (alcoholics are not advised). Beer, wines and sweet drinks are prohibited. Ice cold drinks are distinctly bad. Milk may be taken, preferably not at meal time, or if it is taken at meal time, let it constitute the meal, as: cereal and milk; milk and stale bread, etc. Fruit should be taken sparingly. Watermelon, cantaloupe, should not be taken. Stewed fruits, unsweetened, may be taken. Take a glass of hot water at bed time. Do not eat when hot or excited. Do not over-exert. If three meals are insufficient, take additional meals. 188 STRENGTHENING DIET. TYPE MEALS. Breakfast. Scrambled egg. Toast. Cocoa. Orange juice. Dinner. Broiled steak. Baked sweet potato. Celery root pureed. Whole wheat bread. Apricots or sago pudding. Supper. Chicken. Hominy. Lettuce with lemon and oil. Ice cream. Lady fingers. Breakfast. Cereal and cream. Toast. Tea. Fruit. Breakfast. Boiled eggs. Toast. Cocoa. Orange. Dinner. Broiled English mutton chop. Baked potato. Lettuce salad with lemon and oil. Bread. Fruit. Dinner. Broiled sole. Baked potato. Spinach. Lettuce salad. Whole wheat bread, Fruit. Supper. Broiled squab. Mashed potato. String beans. Bread. Prune whip. Supper. Broiled steak. Mashed potato. Artichoke puree. Ice cream. Cake. 189 STRENGTHENING DIET. (Continued.) Breakfast. Cereal. Bacon. Toast. Tea. Baked apple. Breakfast. Cereal and cream. Bacon. Toast. Cocoa or tea. Dinner. Roast meat. Baked squash. Cottage cheese. Bread. Stewed peach. Dinner. Roast beef. Creamed potatoes. Summer squash. Lettuce salad. Fruit. Supper. Light meat. Carrots puree. Bread. Custard. Fruit and cakes. Supper. Broiled chicken. Potato. Artichoke puree. Bread. Ice cream and cake. Breakfast. Omelette. Bacon. Toast. Cocoa. Breakfast. Cereal and cream. Toast. Tea. Baked apple. Dinner. Broiled steak. Baked potato. Carrots puree. Lettuce salad. Bread. Jelly or fruit. Dinner. Broiled chops. Boiled rice. Lettuce salad. Bread. Custard. Supper. Chicken. Cranberry jelly. Peas. Bread. Pudding. Supper. Broiled bass. Mashed potatoes. Artichoke puree. Bread. 190 STRENGTHENING DIET. [For Ill-nourished, Broken Down). Farmer. 7 A.M. Drink one glass of water. 7.30 A.M. Arise and do breathing exercise. 8 A.M. Breakfast— Two eggs or mush. Bread and butter. Milk or cocoa. Fruit. 9 to 11 A.M. Light work about the garden or fields. 11 A.M. Drink a glass of water. 11 to 12 M. Help around the house. 12 M. Luncheon— Meat. Vegetable. Bread and butter. Pudding or cooked fruit. 1 to 2 P.M. Rest: lie down or sit and read. 2 to 3 P.M. Light work in the dairy or fields. 3 P.M. Take a glass of milk or buttermilk or cocoa, and bread and butter. 3.30 to 5 P.M. Light work—walking or driving. 5 P.M. Drink a glass of water. 5 to 6 P.M. Help around the house. 6 P.M. Dinner— Meat or chicken or fish. Vegetable. Potato. Salad. Bread and butter. Fruit or a cup of tea. 9—10 P.M. Bedtime : drink a glass of milk. Before retiring, breathing exercises. 191 STRENGTHENING DIET. (Continued.) GENERAL RULES. Eat slowly. Chew food thoroughly. Drink slowly. Eat at regular times. Do not drink much with meals. Have meat boiled, broiled, steamed, baked or roasted. Do not eat stews or gravies, except plain meat gravy. Eat beef, mutton, lamb, chicken, turkey, ham, fresh fish. Do not eat salt meats, salt fish, canned meat, canned fish; tongue, goose, duck, kidneys, stews; salmon, sardines; corned beef. Eat: Spinach, lettuce, asparagus, artichokes, celery, rhubarb, tomatoes, string beans, green peas, carrots, beets, cauli- flower, potatoes, water cress. Do not eat cucumbers, corn, cabbage, sprouts, garlic, onions, tur- nips, dry beans. Eat: Fresh and cooked fruits. Eat: Bread, toast, butter, olive oil, salads (made with oil and vinegar or lemon, but no mustard), soup, eggs, mush, spaghetti, vermicelli, cottage cheese, plain cake. Do not eat pies, hot cakes, hot rolls, hot bread, waffles; strong cheese; mustard, horseradish, catsup, or any other sauces. Drink: Water, tea, chocolate, cocoa, milk, buttermilk; very little coffee. Do not drink beer, wine, whisky. During the day drink from six to eight glasses of liquids—(this includes water, tea, coffee, milk and soups). 192 {Due to Intestinal Stasis.] TOXEMIA. The object of this diet is not to restrict, but to indicate a rational regime. The effort will be to designate as desirable, foods which are essential for the nutrition of the body, and similarly to designate foods which are most likely to be injurious. Food should be taken at regular meal times. While it is good to drink water, it is not desirable to drink much water or other liquid with meals. Water should be taken preferably about an hour before meal times: at least three or four glasses of water a day. There is no objection to tea, in moderation. It is inadvisable to eat when over-exerted or excited, or to drink rapidly. Eat fresh meats, fresh fruits, fresh vegetables, and in gen- eral all fresh foods. The foods which are unnecessary are: salt, preserved, canned and spiced meats and fish; alcoholics; condiments. Plain foods are preferable to made dishes and rich foods. Pas- tries, creams, shell-fish (except oysters), have nothing to recommend them in this diet. It is harmful to eat a certain amount made up of a considerable variety of foods, whereas the same amount made up of a limited number of viands would be innocuous.. Accordingly, a day’s dietary should follow about these lines: A glass of water to be taken on arising; about 11 o’clock, and at 5 o’clock. Breakfast. Fruit. Bread and butter. (Also egg may be taken.) Luncheon. Meat or eggs or chicken. Green vegetable. Salad. Bread and butter. Tea or plain cake. Dinner. Entree. Roast or eggs or chicken. Green vegetable. Potato. Salad. Light dessert. There is no effort here to restrict the diet. The entire effort is to eliminate the glaring faults, such as: long menus, rich made dishes, gravies, poulettes. 193 TOXEMIA. (Continued.) MAY EAT. AVOID. Meats and Fish. Beef steak, roast beef, roast mut- ton, mutton chops, lamb chops, chicken, squab, brains, tripe, sweetbreads, fish, raw oysters, ham, game, lamb, veal, scraped meat. Preserved and canned meat and fish; tongue, sausage, liver, kid- neys, pot roast, pork, duck, stews, goose, soup meat, hash; herring, crab, clams, lobster, mussels. Meat should be boiled, broiled, baked, roasted, steamed (and not stewed or fried). String beans, asparagus, peas, eggplant, cooked celery, lettuce, spinach, potatoes, carrots, arti- chokes, tomatoes, etc. Vegetables. Radishes, onions, corn, cucum- bers, pickles, cabbage, sprouts, turnips, cauliflower. Fruits. Apple sauce, baked apple, prunes, orange, apple, peach, pear, ber- ries, grapes, melons, figs; fresh and cooked fruits. Jams and preserves. Beverages. Water, mineral water, tea, cof- fee, buttermilk, cocoa. Sweet drinks; alcoholics; iced drinks; fancy drinks. Sundries. Eggs, rice, sago, cottage cheese, custards, sponge cake, angel cake, lady fingers, bread, crack- ers, graham crackers, toast, zwie- back; clear soups, bouillon, beef tea, mutton broth, chicken soup, beef juice; pastes; soups may be thickened by cooking cereal or vegetable in them, but avoid rich, cream or fatty soups. All condiments, such as catsup, mustard, horseradish, tershire, tabasco, pepper; nuts, pastries, cakes, pies, candy; rich soups, sauces and gravies; hot roils, hot biscuits, hot bread, hot cakes, waffles; cheese. This list is not intended to be exhaustive, but is intended to in- dicate the kinds of food to be taken, and the kinds to be avoided. 194 TYPHOID FEVER. FIRST WEEK.. 6 A.M. Peptonized milk 3 ounces 9 A.M. Peptonized broth 3 ounces 12 M. Oatmeal gruel with peptonized milk...3 ounces 3 P.M. Peptonized milk 3 ounces 6 P.M. Peptonized broth 3 ounces 10 P.M. Oatmeal gruel with peptonized milk...3 ounces 2 A.M. Peptonized milk 3 ounces Water should be taken freely between feedings. Orange juice may be given (due attention being paid to its effect on the bowels). SECOND AND THIRD WEEKS. 6 A.M. Peptonized milk 4 ounces 8 A.M. Whisky (y2 ounce) with water 2 ounces 9 A.M. Peptonized broth 4 ounces 12 M. Oatmeal gruel with peptonized milk...4 ounces 2 P:M. Whisky (y2 ounce) with water 2 ounces 3 P.M. Peptonized milk 4 ounces 6 P.M. Peptonized broth 4 ounces 8 P.M. Whisky (% ounce) with water 2 ounces 10 P.M. Oatmeal gruel with peptonized milk...4 ounces 1 A.M. Whisky (y2 ounce) with water 2 ounces 2 A.M. Peptonized milk 4 ounces Water should be taken freely between feedings. Orange juice may be given as in Diet for First Week. 195 TYPHOID. (Continued.) FOURTH WEEK. In the fourth week an egg may be given daily, if well tolerated. Milk soups may be given. These may be flavored by cooking in them cereals or vegetables (but strain out the cereals or vege- tables) : for example, cream of barley soup, cream of asparagus soup, etc.; or, oyster soup (without the oysters). No onion or garlic may be used. Apple sauce or pureed prunes (scrupulously remove all vestige of skin) may be given, especially if the patient is constipated. FIFTH, SIXTH, SEVENTH WEEKS. Bread crumbs may be given in soup; zwieback may be given thoroughly soaked in soup or milk. Lady fingers, custards and puddings (sago and tapioca) may be given at this time. After the patient has remained free of fever ten days meat may be considered for the first time. The meat selected should be ten- der, finely divided and easily digestible, as, for example, shredded breast of chicken, brain or sweetbread timbale; later, scraped steak or scraped chop may be given. But meat should be introduced into the dietary with extreme caution. Often the first feeding of meat causes a rise in tempera- ture which may be only of one, two or three days’ duration (febris carnis), or it may cause a rise in temperature with the characteristics of a relapse. Should a rise in temperature supervene it becomes necessary to return to the earlier diet. 196 ULCER, DUODENAL OR GASTRIC ULCER. FIRST WEEK. Water may be taken freely between meals. First Day. One quart milk. Four eggs—soft boiled or poached. One pint clear soup (consomme or bouillon). Second Day. Three pints milk. Four eggs. One pint broth. Third Day, Fourth Day, Fifth Day. As above: five or six eggs, if desired. Seventh Day. Soup may be thickened by cooking cereal in it, and straining out. SECOND WEEK. First Day, Second Day, Third Day. Smooth cereal with sugar, also zwieback may be added to above list. (Toast may be substituted for zwieback.) Fourth Day, Fifth Day, Sixth Day. Scraped beef may be added to diet each second day. TYPE REGIME. (First, Second, Third Days of Second Week.) Breakfast. Well cooked cereal—farina, cream of wheat, corn starch, Robinson’s barley or strained oatmeal gruel. Ten ounces milk and cream. Toast and butter. 10 A.M. Ten ounces milk and cream. 197 ULCER, DUODENAL OR GASTRIC. (Continued.) 12.30 P.M. Soft boiled eggs or scraped meat. Toast and butter. Ten ounces milk and cream. 3 P.M. Ten ounces milk and cream. 6 P.M. Pint of broth. Two or three eggs. Toast and butter. 10 P.M. Ten ounces milk and cream. THIRD AND FOURTH WEEKS, Raw oysters, lean boiled ham, shredded chicken, cottage cheese, soda crackers, may be added to list. Breakfast. Cereal or eggs. Milk and cream. Toast. 10—10.30 A.M. Glass of milk and cracker. 12.30 P.M. Oysters or ham or scraped meat: and Eggs. Toast. 3 P.M. Glass of milk: or Eggnog and cracker. (No alcohol in eggnog.) 6 P.M. Scraped meat or eggs or ham or oysters: and Cottage cheese. Toast. 9.30—10 P.M. Milk and cracker: or Milk and egg and cracker: or Broth and cracker. 198 ULCER, DUODENAL OR GASTRIC. (Continued.) Permanent diet (to be observed six to twelve months). MAY EAT. AVOID. Meats and Fish. Broiled, boiled, baked, roasted: steaks, chops, roast beef, game, chicken, sweetbreads, brains, broiled tripe, raw oysters. Fried foods of all kinds; salt, preserved, canned and spiced meats; tongue, goose, turkey, duck, kidneys, stews; sardines, salmon, shell-fish, mackerel. Vegetables. Green vegetables and such as grow above ground—peas, pu- reed cooked lettuce, artichokes, pureed carrots, eggplant (baked). Starchy vegetables and such as grow under ground—beets, corn, turnips, garlic, dry beans, celery, onions, rhubarb, cress. Beverages. Water, still alkaline mineral water, tea, cocoa, milk. Alcoholic and malt drinks; sweet- ened and acidulous drinks; choc- olate, coffee, buttermilk, effer- vescing drinks. Sundries. Bread, toast, zwieback, butter, eggs, clear soup or bouillon. Cake, pastry, pies, sweets, con- fectionery, spices, sauces, nuts, gravies, poulettes; condiments, such as catsup, mustard, tabasco; thick and cream soups; hot cakes, hot biscuits, hot rolls, muffins, waffles, syrups, salads, candy. Baked apple, apple sauce, pureed prunes, may be cautiously added to diet. 199 ULCER, DUODENAL OR GASTRIC. (Continued.) Eat slowly. Masticate food thoroughly. Do not eat when hot or excited. Do not eat large quantities at a time. Avoid all irri- tating foods and all foods which experience has shown are not well tolerated. May have milk at 3 P.M. and sandwich at bedtime. Eat plain nutritious food, simply prepared. Omit all sauces, gra- vies, condiments. Omit raw vegetables. Omit all fat or greasy foods. Avoid all fried foods and all cooked fats. Food may be broiled, boiled, baked or roasted. Abstain from alcoholics; beer and malt beverages. Do not take hot and cold, or sweet and sour, at the same meal. Avoid all hard foods; all spiced or highly seasoned foods; all foods with husks or kernels. Take a moderate amount of exercise, but do not over-exert or be strenuous. Do not drink with meals (not more than four ounces of fluid with a meal, except with breakfast). One hour before each meal and at bedtime drink a glass of water or mineral water. TYPE MEALS. On arising drink a glass of water. Breakfast. Two eggs. Two pieces of toast and butter. One cup of milk or cocoa. 11 A.M. One glass of water. Luncheon. Steak or chop or roast beef or other plain meat. Stale bread and butter or toast (not hot). Vegetable. Cup of tea. 4.30 P.M. A glass of water. Supper. Cup of bouillon. Meat. Potato. Vegetable. Toast, stale bread or crackers. Tea. Avoid desserts—creams. 200 PART II. Dietary for Infants and Children in Health and Disease. (A) DIET IN HEALTH. 201 INTRODUCTION. In this system of infant feeding, formulae cased upon cream mix- tures, percentage calculations and caloric needs, have been set aside on the ground that they are neither simple nor practical. In such systems it is assumed that an infant of a certain age can metabolize food of a fixed percentage of fat, proteids, etc., and requires a definite number of calories to provide for maintenance and growth. As a matter of fact it is impossible to know in advance how much food of any given strength a particular infant will ingest, or assuming that an infant eats a certain amount, how completely the food will be digested. In each individual case it would be necessary to learn from observations on each infant the result of feeding certain per- centage or caloric formulae and only then from such results could the proper formula for that infant be calculated. This in effect is the experience which attends efforts to employ these systems in infant feeding and for this reason especially they have failed to become generally employed. At the very least they require for their successful application the supervision of a pediatrist and this requirement alone suffices to militate against their general adoption. In the following system of infant feeding the endeavor has been made to present for general use a method at once simple and com- prehensive. It may be employed by the mother, nurse or attending physician without the intervention of the pediatrist. The system has not been arbitrarily devised but is based upon scientific prin- ciples—facts observed during twenty years specialization on this subject. Observation has shown that within variable limits, aver- age infants take and thrive on milk in certain strengths and quan- tities. With increasing experience and observation it has been found that in the great majority of cases cow’s milk alone or simply diluted with water affords the best food for infants. Exceptional cases may be benefited by adding to the food cereal decoctions. Likewise in certain cases there may be intolerance of cow’s milk and a sub- stitute may be required. These, however, are exceptional cases and do not alter the fact that, in the great majority of cases, cow’s milk and water properly employed will supply the best artificial food for the average infant. In the succeeding pages are arranged formulae and dietaries suited to various ages of the infant. By turning to the page correspond- 203 INTRODUCTION. ing to the age and weight of an infant a dietary will be found worked out in detail for that infant. In each diet list explicit direc- tions are given for modifying the formula to meet the increasing requirements of the infant. By consulting these lists it is possible to institute the correct method of artificial feeding at any age. Certain general rules for infant feeding may profitably be observed: (1) As a rule maternal nursing is the best. This rule is not in- variable. Sickness in either the mother or the infant may neces- sitate weaning; economic factors may prevent maternal nursing; social demands sometimes militate against proper maternal nursing. (2) When an infant is breast-fed it is advisable to initiate mixed feeding as soon as compatible with safety, so that a correct formula may be devised and tolerance for cow’s milk be ac- quired by each infant. (After this has been accomplished grad- ual substitution of the bottle for the breast will make normal weaning easy and obviate difficulties, should weaning suddenly be necessitated. When additional bottles are substituted it is better to give them at non-consecutive feedings.) (3) Scrupulous cleanliness should be observed in the preparation and care of the infant’s food. A—Bottles, nipples, measures, etc., should be boiled daily. B—The total quantity of formula required in twenty-four hours should be prepared and separated into feeding bottles at one time. C—The prepared food should be kept in a cool place (prefer- ably on ice). When possible a separate ice box or cooler should be provided for the infant’s food. But in no case should the infant’s food be kept near meats and vegetables. Especially cantaloupes, cucumbers, onions (but also many other vegetables, fruits and meats) may contaminate milk. (4) An attendant should be constantly present while the infant is nursing. Nursing should be a continuous act, without long rests, and should be completed within from fifteen to twenty minutes. (5) When introducing into the diet a new kind of food (such as fruit or cereal) always begin with a minimal amount. Some- times the new food will be not well tolerated and if a consider- 204 INTRODUCTION. able amount shall have been given, a decided upset may result; whereas, if a small amount shall have been given and is not well tolerated, the resulting upset will be less serious. (6) No not introduce into the dietary more than one new kind of food at a time. Do not increase both the strength of the form- ula and quantity at a feeding the same day. (7) Where a decision is to be made as to quantity of food to be given in case age and weight of infant do not harmonize, be guided more by the weight of infant than by the age. Older infants, even though underweight, can tolerate stronger and larger quantities of food than younger infants of the same weight. On the other hand, sick infants may require food weaker and in smaller quantities than well infants of similar ages and weights. (8) Water should be given freely between feedings. Water is valu- able as a beverage, for lavage, as a solvent and as a laxative. (9) It may be accepted as an axiom that the best food for an infant is the least food on which an infant will thrive. SPECIAL MODIFICATIONS. Carbohydrates in the form of sugar or cereals may sometimes advantageously be added to milk formulae. (1) In a given case an infant may take a mixture of milk and water and while apparently digesting it satisfactorily, fail to gain. The addition of sugar or cereal decoction to the formula often will provide the substance necessary to correct this defect; cane sugar, milk sugar, or maltose, may be used. Cane sugar and milk sugar have a tendency to constipate, while malt sugar is laxative—a point of practical importance in deciding which to employ. Five per cent, sugar solution may be substituted for water in the formula. Instead of sugar cereals may be used. For infants less than eight months old a cereal decoction may be substituted for water in the formula. The decoction should be made by boiling the cereal in water for approximately one hour, straining through a fine sieve (doubled gauze) and adding a pinch of salt. Decoctions of rice are constipating, 205 INTRODUCTION. of oats are laxative, of wheat and barley are neutral or slightly laxative. For infants over eight months old gruels made of the various cereals may be fed at one or more feedings to supply the deficiency. (2) Some infants have difficulty in digesting mixtures of cow’s milk and water. In these cases the stools may be watery and too frequent. Addition of carbohydrates according to methods out- lined in the preceding paragraphs may correct this fault. (3) White masses, from rice kernel to bean in size, are usually due to excess of proteids in the food. Their presence, if the infant is thriving, requires no attention. If the infant is not thriving, the formula should be modified by further dilution of the milk and the addition of cream or by using top milk in preparing the formula. Addition of carbohydrates may be beneficial. (4) Large, greasy stools indicate fat indigestion and call for reduc- tion of fat in the food, by removal of part or all of the cream from the milk used in preparing the formula. While the employment of carbohydrates in the composition of milk formulae may in some cases be beneficial and in a few neces- sary, as a rule it is superfluous and may ordinarily be omitted. SUBSTITUTES FOR COW’S MILK. Some infants have an intolerance for cow’s milk. Quite a num- ber can take it only in limited quantities (insufficient for proper nutrition) and a few cannot tolerate it in any quantity. Manifestly these infants require substitutes for cow’s milk. (1) Human milk from a wet nurse is the best substitute. (2) Goat’s milk may furnish a satisfactory substitute. (3) Condensed milk may be successfully employed as infant food, but its exclusive use should not be too long continued. (4) Whey may be satisfactorily employed in cases of weak digestion. (5) Albumen Milk (Finkelstein’s Eiweissmilch) may be employed in cases of indigestion or diarrheal conditions. But its prepar- ation is too intricate for use outside of hospitals and even in 206 INTRODUCTION. hospitals it is difficult to secure it correctly prepared. Never- theless, in cases of severe intestinal disturbance—especially epidemics in hospitals—it should be employed and may prove invaluable. (6) Various prepared infant foods may be substituted for milk in cases of milk intolerance to tide over a limited time, but their exclusive use should not be depended upon for continuous feed- ing. (7) In gastroenteric catarrh and in gastroenteritis milk and milk preparations may have to be temporarily excluded from the diet. To tide over such periods broths (of beef, mutton, chicken), albumen water, cereal decoctions, may be employed. In such cases Eiweissmilch has had its greatest success: meat broths achieve similar results and have the additional merit of being always easily obtainable. 207 FEEDING DURING THE FIRST YEAR. BREAST FEEDING. ARTIFICIAL FEEDING. 209 BREAST FED INFANT, ONE MONTH OLD. [ Weighty 8 to 8% pounds. Infant 1 month old: takes eight or nine breast feedings. Substitute one bottle for one breast feeding. Formula: Whole milk 1 ounce Cold boiled water 3 ounces Feed 2% ounces of formula. At 2 months feed 2 bottles each 3 ounces (weight, 9 lbs.) At 21/s ” feed 2 bottles each 3% ” At 3 months feed 3 bottles each 4 ounces (weight, 9y2 lbs.) At 3!/2 ” feed 3 bottles each 4% ” At 4 months feed 4 bottles each 4y2 ” At 4% ” feed 4 bottles each 4% ” At 5 months feed 4 bottles each 5 ounces (weight, lbs.) At 5y2 ” feed 4 bottles each 5y2 ” At 6 months feed 5 bottles each 6 ounces (weight, 15 lbs.) At 9 months stop breast feedings. May wean at 8 months by feeding six bottles and reducing num- ber of feedings to six in twenty-four hours. At 6 weeks make formula: Milk, 1*4 ounces; water, 3 ounces At 2 months make formula: Milk, 3 ounces; water, 6 ounces At 3 months make formula: Milk, 10 ounces; water, 16 ounces Then add to formula y2 ounce milk every week until baby is 6 months old, when formula will be equal parts milk and water, vis.: Milk 16 ounces Water 16 ounces When age and weight do not correspond to table, feed quantity indicated by weight. Give water between feedings, about 2y2 ounces in twenty-four hours. It is safe and conservative, when infant is 1 month old and thriv- ing on breast, to introduce one bottle into dietary. The infant will derive sufficient nourishment from the breast so that artificial feed- ing may be begun without jeopardizing progress, and in this way a proper formula may be worked out at leisure. Then should any unforeseen event necessitate weaning, the correct formula will be known. It is desirable to begin with a formula weaker than seems in- dicated, until tolerance is established: this avoids digestive upsets. For diet after 6 months old, consult diet for 6 months child. 211 BREAST FED INFANT, TWO MONTHS OLD. [ Weight, 9 to 10 pounds.] Infant receives eight breast feedings. Substitute one bottle for one breast feeding. Prepare formula: Whole milk.. 1 jounces Water 3 ounces Feed 4 ounces if infant weighs 9 pounds. Feed ounces if infant weighs 10 pounds. Substitute one bottle for one breast feeding every month until infant is weaned (between 8 and 9 months). To modify formula to meet increasing needs of infant: Prepare formula at 3 months: Milk 10 ounces Water 16 ounces Then add to formula y2 ounce milk weekly until infant is 6 months old. Formula at 6 months will be, equal parts milk and water (each 16 ounces). When infant weighs 10 pounds, feed ounces When infant weighs I2y2 pounds, feed 5 ounces When infant weighs 14 pounds, feed 5y2 ounces When infant weighs 15 pounds, feed 6 ounces Give water between feedings, about 3 to 4 ounces in twenty-four hours. For diet after 6 months, consult diet for 6 months old infant. 212 BREAST FED INFANT, THREE MONTHS OLD. [ Weighty 10 to 11% pounds.] Infant 3 months old: seven breast feedings in twenty-four hours. Substitute one bottle for one breast feeding. Prepare formula: Whole milk 10 ounces Cold boiled water 16 ounces To prepare 1 bottle take: Milk 2% ounces Water 4 ounces Feed A—4y> ounces. Substitute one bottle for one breast feeding every month until infant is 9 months old, when infant will be weaned, or wean at 8 months. To modify formula to meet increasing needs of infant, add to formula y2 ounce milk weekly until infant is 6 months old. For- mula will then be, equal parts milk and water (each 16 ounces). At 4 months feed 2 bottles each 5 ounces (estimated weight lbs.) At 5 months feed 3 bottles each Sy2 ounces (estimated weight 14 lbs.) At 6 months feed 4 bottles each 6 ounces (estimated weight 15 tbs.) Give water between feedings, about 4 to 5 ounces in twenty-four hours. For diet after 6 months old, consult diet for 6 months old infant. 213 BREAST FED INFANT, FOUR MONTHS OLD. [ Weight, 11% to 12% pounds.~\ Infant takes seven breast feedings. Substitute one bottle for one breast feeding. Prepare formula: Whole milk 12 ounces Cold boiled water 16 ounces To prepare one bottle, take 3 ounces milk: 4 ounces water. Feed 4y2 to 5 ounces (one bottle). Substitute one bottle for one breast feeding every three weeks until infant is weaned (between 8 and 9 months). To modify formula to meet increasing needs of infant, add to formula y2 ounce milk weekly until infant is 6 months old. For- mula at 6 months will be, equal parts milk and water (each 16 ounces). When infant weighs 12y2 pounds, feed 5 ounces When infant weighs 15 pounds, feed 6 ounces Give water between feedings, about 4y2 to 5y2 ounces in twenty- four hours. For diet after 6 months, consult diet for 6 months old infant. 214 BREAST FED INFANT, FIVE MONTHS OLD. [ Weight, 13 lA to 14 pounds. Infant takes seven breast feedings. Substitute one bottle for one breast feeding. Prepare formula: Whole milk 14 ounces Cold boiled water 16 ounces To prepare one bottle, take 3y2 ounces milk: 4 ounces water. Feed 5 to 5y2 ounces (one bottle). Substitute one bottle for one breast feeding every two weeks until infant is weaned (which will be between 8 and 9 months). To modify formula to meet increasing needs of infant, add to formula y2 ounce milk weekly until infant is 6 months old. For- mula at 6 months will be, equal parts milk and water (each 16 ounces). When infant weighs 14 pounds, feed 5y2 ounces When infant weighs 15 pounds, feed 6 ounces Give water freely between feedings, about 5 ounces in twenty- four hours. For diet after 6 months, consult diet for 6 months old infant. 215 BREAST FED INFANT, SIX MONTHS OLD. [ Weight, 15 pounds. ] Infant receives seven breast feedings. Substitute one bottle for one breast feeding. Prepare formula: Whole milk 16 ounces Cold boiled water 16 ounces To prepare one bottle, use 3 ounces milk: 3 ounces water. Feed 6 ounces. Substitute one bottle for one breast feeding every two weeks until infant is weaned (between 8 and 9 months). To modify formula to meet increasing needs of infant— (1) Add to formula 1 ounce milk weekly until 32 ounces are used. Do not use more than 1 quart milk. (2) After infant is 8 months old, drop 1 ounce water weekly. (3) When infant is 1 year old, feed whole milk. Feedings may be reduced to six in twenty-four hours at— 6 A.M.—9 A.M.—12 M.—3 P.M.—6 P.M.—10 P.M. or at 2 A.M.—6 A.M.—10 A.M.—2 P.M.—6 P.M.—10 P.M. When infant weighs 16y2 pounds, feed 6y2 ounces When infant weighs 17 pounds, feed 7 ounces When infant weighs I7y2 pounds, feed 7y2 ounces Give water freely between feedings, about 6 ounces in twenty- four hours. Fruit Juice. Begin feeding fruit juice at 6 months (provided food is agreeing) : orange juice, prune juice; apple sauce may be given. Feed the fruit juice one hour before second A.M. feed- ing (that is, at 8 A.M. or 9 A.M.). Begin with one teaspoonful orange juice daily and in- crease the amount gradually until the juice of a medium size orange is taken. Do not sweeten or add water. Prune juice may be given in smaller quantity, and may advantageously be given if infant is constipated. Apple sauce may be given somewhat later. For diet after 8 months, consult formula for 8 months old, bottle- fed infant. 216 BREAST FED INFANT, SEVEN MONTHS OLD. [ Weight, 16 pounds.] Infant receives six breast feedings in twenty-four hours. Substitute one bottle for one breast feeding. Prepare formula: Whole milk 17 ounces Cold boiled water 16 ounces Feed one bottle—six ounces of formula. Substitute one bottle for one breast feeding every week until in- fant is weaned (between 8 and 9 months). To modify formula to meet increasing needs of infant— (1) Add to formula 1 ounce milk weekly until 32 ounces are used. (2) After infant is 8 months old, drop 1 ounce water weekly. (3) When infant is one year old, feed whole milk. When infant weighs 16y2 pounds, feed 6y2 ounces in each bottle When infant weighs 17 pounds, feed 7 ounces in each bottle When infant weighs pounds, feed 7y2 ounces in each bottle Fruit Juice. Begin feeding fruit juice as directed in diet for 6 months old, breast-fed infant. After infant is weaned, follow diet for 8 months old, bottle-fed infant. 217 BOTTLE FED INFANT, NEWBORN. FIRST DAY. Formula: Milk sugar 14 ounce (2 round teaspoonfuls) Boiled water 5 ounces (This constitutes 5 per cent, sugar solution.) Amount at each feeding, % ounce. Interval between feedings, six hours. Four feedings in twenty-four hours. SECOND TO SEVENTH DAY. Formula: Whole milk 1 ounce Boiled water 9 ounces Boil water five minutes and cool before adding to milk. Amount at each feeding, 1 ounce to l1 ounces. Interval between feedings, two hours. Ten feedings in twenty-four hours: Seven day feedings: Three night feedings: at 6 A.M., 8 A.M., 10 A.M., 2 P.M., 4 P.M., 6 P.M., 8 P.M., 10 P.M., 2 A.M. 218 BOTTLE FED INFANT. „ . SECOND WEEK. Formula: Whole milk 3 ounces Boiled water 18 ounces Amount at each feeding, 1*4 ounces to 1% ounces. Interval between feedings, two hours (during day). Ten feedings in twenty-four hours: Seven day feedings: Three night feedings: at 6 A.M., 8 A.M., 10 A.M., 12 M., 2 P.M., 4 P.M., 6 P.M., 8 P.M., 10 P.M., 2 A.M. Between feedings offer y2 ounce to iy2 ounces boiled water at a time. „ , THIRD WEEK. Formula: Whole milk 3 ounces Boiled water 15 ounces Amount at each feeding, 1 y2 ounces to 2 ounces. Intervals between feedings, 2y2 hours. Nine feedings in twenty-four hours: Seven day feedings: Two night feedings: at 6 A.M., 8.30 A.M., 11 A.M., 1.30 P.M., 4 P.M., 6.30 P.M., 9 P.M., 11.30 P.M., 3 A.M. Between feedings offer boiled water, 1 ounce to 2 ounces at a time. „ , FOURTH WEEK. formula: Whole milk 6 ounces Boiled water 18 ounces Amount at each feeding, 2 ounces to 214 ounces. Interval between feedings, 2y2 hours. Nine or eight feedings in twenty-four hours: Seven or six day feedings: Two night feedings: at 6 A.M., 8.30 A.M., 11 A.M., 1.30 P.M., 4 P.M., 6.30 P.M., 9 P.M., 11.30 P.M., 3 A.M.: Or, 10 P.M., 2 A.M. Between feedings offer 1 y2 to 2 ounces water at a time. 219 BOTTLE FED INFANT, ONE MONTH OLD. [ Weight, 8 to 8% pounds.] Formula: Whole milk 8 ounces Cold boiled water 24 ounces Amount each feeding, 2y2 ounces to 3 ounces. (At 6 weeks, feed 3 ounces to 3% ounces.) Interval between feedings, 2% hours. Eight feedings in twenty-four hours: Six day feedings: Two night feedings: at 6 A.M., 8.30 A.M., 11 A.M., 1.30 P.M., 4 P.M., 6.30 P.M., 10 P.M., 2 A.M. To modify formula to meet increasing needs of infant, add to for- mula 1 ounce milk every week, so that at 2 months formula will be: Milk 12 ounces Water 24 ounces Water to be given between feedings—2 ounces to 4 ounces in twenty-four hours. 220 BOTTLE FED INFANT, TWO MONTHS OLD. [ Weight, 9 to 10 pounds.^ Formula: Whole milk 12 ounces Cold boiled water 24 ounces Amount at each feeding, 4 ounces: 414 ounces when infant weighs 10 pounds 4y2 ounces when infant weighs 11 pounds 4% ounces when infant weighs 12 pounds Interval between feedings, 2%, hours (during day). Eight feedings in twenty-four hours: Six day feedings: Two night feedings: at 6 A.M., 8.30 A.M., 11 A.M., 1.30 P.M., 4 P.M., 6.30 P.M., 10 P.M., 2 A.M. To modify formula to meet increasing needs of infant, add to for- mula 1 ounce milk every week, so that at 3 months formula will be: Milk 16 ounces Water 24 ounces Water to be given between feedings—3 ounces to 6 ounces in twenty-four hours. 221 BOTTLE FED INFANT, THREE MONTHS OLD. [ Weight, 10 to 11 lA pounds.] Formula: Whole milk 16 ounces Cold boiled water 24 ounces Amount at each feeding: 41/4 ounces when infant weighs 10 pounds 4y2 ounces when infant weighs 11 pounds 4% ounces when infant weighs 12 pounds Interval between feedings, three hours. Seven feedings in twenty-four hours: Five day feedings: Two night feedings: at 6 A.M., 9 A.M., 12 M., 3 P.M., 6 P.M., 10 P.M., 2 A.M. To modify formula to meet increasing needs of infant, add to for- mula 1 ounce milk every week, so that at 4 months formula will be: Milk 20 ounces Water 24 ounces Give water—2 to 3 ounces—at 11 A.M. and 5 P.M. 222 BOTTLE FED INFANT, FOUR MONTHS OLD. [ Weight, 11% to 12% ■pounds.'] Formula: Milk 20 ounces Cold boiled water 24 ounces Amount at each feeding: 4y2 ounces when infant weighs 11 pounds 4% ounces when infant weighs 12 pounds 5 ounces when infant weighs 12% pounds Interval between feedings, three hours. Seven feedings in twenty-four hours: Five day feedings: Two night feedings: at 6 A.M., 9 A.M., 12 M., 3 P.M., 6 P.M., 10 P.M., 2 A.M. To modify formula to meet increasing needs of infant, add to for- mula % ounce milk every week, so that at 5 months formula will be: Milk 22 ounces Water 24 ounces Give water—2% to 3 ounces—at 11 A.M. and 5 P.M. 223 BOTTLE FED INFANT, FIVE MONTHS OLD. [ Weight, 13% to 14 pounds.] Formula: Milk 22 ounces Cold boiled water 24 ounces Amount at each feeding: 5 ounces if infant weighs 121/2 pounds 5% ounces if infant weighs 13 pounds 5y2 ounces if infant weighs 14 pounds Interval between feedings, three hours. Seven feedings in twenty-four hours: Five day feedings: Two night feedings: at 6 A.M., 9 A.M., 12 M., 3 P.M., 6 P.M., 10 P.M., 2 A.M. To modify formula to meet increasing needs of infant, add to for- mula y2 ounce milk every week, so that at 6 months formula will be, equal parts milk and water—that is: Milk 24 ounces Water 24 ounces Give water—3 ounces—at 11 A.M. and 5 P.M. 224 BOTTLE FED INFANT, SIX MONTHS OLD. [ Weight, 15 pounds. ] Formula (Equal parts whole milk and water) : Milk 24 ounces Water 24 ounces Amount at each feeding: 6 ounces if infant weighs 15 pounds 6% ounces if infant weighs pounds 7 ounces if infant weighs 1 pounds Interval between feedings, three hours or four hours. Six feedings in twenty-four hours, at: 6 A.M., 9 A.M., 12 M., 3 P.M., 6 P.M., 10 P.M. (if at three-hour intervals) : or at 6 A.M., 10 A.M., 2 P.M., 6 P.M., 10 P.M., 2 A.M. (if at four-hour intervals). To modify formula to meet increasing needs of infant: (1) Add to formula 1 ounce milk every week until 32 ounces are used. (Do not use more than 1 quart milk.) (2) Subtract from formula 1 ounce water every week until whole milk is given. (This will result when infant is 1 year old.) (3) The two changes should not be made on the same day. Give 3 ounces water at 11 A.M. and 5 P.M. Fruit Juice. Begin feeding fruit juice at 6 months (orange juice, prune juice, apple sauce). Feed the fruit juice one hour before second morning feeding (that is, at 8 A.M. or 9 A.M.). Begin with 1 teaspoonful orange juice daily and gradu- ally increase the amount until the juice of a medium size orange is taken. (Do not sweeten or add water.) Prune juice may be given in smaller amounts and may advantageously be given if infant is constipated. Apple sauce may be given somewhat later. For diet after 8 months, consult dietary for 8 months old, bottle- fed infant. 225 BOTTLE FED INFANT, SEVEN MONTHS OLD. [ Weighty 16 pounds.] Formula: Milk 28 ounces Water 20 ounces Amount at each feeding: 6 ounces if infant weighs 15 pounds 6y2 ounces if infant weighs 1614 pounds 7 ounces if infant weighs 1714 pounds Interval between feedings, three hours or four hours. Six or five feedings in twenty-four hours, at: 6 A.M., 9 A.M., 12 M., 3 P.M., 6 P.M., 10 P.M. (if at three-hour intervals) : or at 6 A.M., 10 A.M., 2 P.M., 6 P.M., 10 P.M., 2 A.M. (if at four-hour intervals). (2 A.M. feeding may be omitted.) To modify formula to meet increasing needs of infant: (1) Add to formula 1 ounce milk every week until 32 ounces are used. (2) Subtract from formula 1 ounce water every week until whole milk is given. (3) The two changes should not be made on the same day. Water. Give 314 ounces water at 11 A.M. and 5 P.M. Fruit Juice. To be given as prescribed in preceding formula (for 6 months old infant). For diet after 8 months, consult dietary for 8 months old, bottle- fed infant. 226 BOTTLE FED INFANT, EIGHT MONTHS OLD. [ Weight, 16 lA to 17% pounds.] Formula: Milk 32 ounces Water 16 ounces Amount at each feeding: 6y2 ounces if infant weighs 16% pounds 7 ounces if infant weighs 17% pounds Interval between feedings, three hours or four hours. Five feedings in twenty-four hours, at: 6 A.M., 9 A.M., 12 M., 3 P.M., 6 P.M. (if at three-hour intervals); or at 6 A.M., 10 A.M., 2 P.M., 6 P.M., 10 P.M. (if at four-hour intervals). To modify formula to meet increasing needs of infant, subtract from formula 1 ounce water every week until whole milk is used. Water. Give 3 to 4 ounces water at 11 A.M. and 5 P.M. Fruit Juice. Follow directions given in dietary for 6 months old, bottle-fed infant. Cereal. Begin feeding cereal at second A.M. feeding. The cere- als to be given are such as have no grits: smooth cere- als only—wheat, barley, oats, cornstarch—may be given. It is advisable to vary the cereal. The cereal should at first be cooked to the consistency of gruel (give cooked cereals only). Begin by feeding 1 teaspoonful of the cooked cereal. To this add a small amount of the formula contained in the bottle to be given at second feeding. Feed the gruel first and then give the remain- der of that bottle. Gradually increase the amount of cereal fed until a goodly portion of cereal is given. As the amount of cereal is increased, diminish the amount of milk given at this feeding and ultimately discontinue the second A.M. bottle, making this feeding consist of cereal with milk over it and (perhaps) a small drink of milk. 227 BOTTLE FED INFANT, NINE MONTHS OLD. [ Weight, 17 to 18 pounds.] Formula: Milk 32 ounces Water 12 ounces Amount at each feeding: 7 ounces if infant weighs I7y2 pounds to 18 pounds Interval between feedings, three hours or four hours. Five feedings in twenty-four hours, at: 6 A.M., 9 A.M., 12 M., 3 P.M., 6 P.M., or 6 A.M., 10 A.M., 2 P.M., 6 P.M., 10 P.M. To modify formula to meet increasing needs of infant, subtract from formula 1 ounce water every week until whole milk is used. Water. Give 3 to 4 ounces water at 11 A.M. and 5 P.M. Fruit Juice. Follow directions given in dietary for 6 months old, bottle-fed infant. Cereal. Follow directions given in dietary for 8 months old, bottle-fed infant. For diet after 1 year, consult dietary for 1 year old baby. 228 BOTTLE FED INFANT, TEN MONTHS OLD. [ Weight, 18 to 19 pounds.'] Formula: Milk 32 ounces Water 8 ounces Amount at each feeding: 7 ounces if infant weighs 18 pounds 7y2 ounces if infant weighs 19 pounds Interval between feedings, three hours or four hours. Five feedings in twenty-four hours, at: 6 A.M., 9 A.M., 12 M., 3 P.M., 6 P.M., or 6 A.M., 10 A.M., 2 P.M., 6 P.M., 10 P.M. To modify formula to meet increasing needs of infant, subtract from formula 1 ounce water every week until whole milk is used. Water. Give 3y2 ounces to 4y2 ounces water at 11 A.M. and 5 P.M. Fruit Juice. Follow directions given in dietary for 6 months old, bottle-fed infant. Cereal. Follow directions given in dietary for 8 months old, bottle-fed infant. For diet after 1 year, consult dietary for 1 year old baby. 229 BOTTLE FED INFANT, ELEVEN MONTHS OLD. [ Weight, 19 to 20 pounds.~\ Formula: Milk 32 ounces Water 4 ounces Amount at each feeding: 7y2 ounces if infant weighs 19 pounds 8 ounces if infant weighs 20 pounds Interval between feedings, three hours or four hours. Five feedings in twenty-four hours, at: 6 A.M., 9 A.M., 12 M., 3 P.M., 6 P.M., or 6 A.M., 10 A.M., 2 P.M., 6 P.M., 10 P.M. To modify formula to meet increasing needs of infant, subtract from formula 1 ounce water every week until whole milk is used. (This will result in an apparent insufficiency of formula for the stipulated number of bottles. However, there will not be a real shortage, as the amount of milk given with the cereal feeding will have been gradually diminished, until at this time only 1 or 2 ounces will be required for this feeding.) Water. Give 3y2 ounces to 4 ounces water at 11 A.M. and 5 P.M. Fruit Juice. Follow directions given in dietary for 6 months old infant. Cereal. Follow directions given in dietary for 8 months old infant. For diet after 1 year, consult dietary for 1 year old baby. 230 FEEDING DURING SECOND YEAR. BABYHOOD. 231 BABY, TWELVE TO EIGHTEEN MONTHS. 6—7 A.M. Orange juice or apple sauce or prune puree. (Be- gin with small quantity and gradually increase until whole portion is given.) 8 A.M. Breakfast. Eight ounces milk. Bread and butter or toast and butter. Soft boiled egg or cereal. 11 A.M. Water. (1) (2) (3) 12 M. Dinner. Beef juice, Potato, Egg, Potato, Broth, Potato, Bread & butter. Bread & butter. Bread & butter. 3.30 P.M. Milk. 5 P.M. Water. 6 P.M. Supper. Milk toast, or Soup containing cereal, or Cereal and milk. Give egg only once a day, or once each second day. Give cooked cereals only: farina, cornstarch, barley gruel. Beef Juice. Begin with one teaspoonful and gradually increase the amount until two ounces are taken. Potato. Begin with one teaspoonful and gradually increase until a small potato is taken: potato should be baked. Egg. Begin with one teaspoonful of mixed yolk and white and increase amount until a whole egg is taken. Broth. Beef broth, mutton broth, chicken broth, may be given. The broth is to be made by cooking beef, mutton or chicken in water, removing the fat and adding salt. (Soups in which vegetables have been cooked are not to be given unless specifically ordered.) A cup of broth may be given at the 12 o’clock feeding as indicated above. 233 BABY, TWELVE TO EIGHTEEN MONTHS. 6 A.M. Milk, eight ounces. 9 A.M. Water. 10 A.M. Breakfast. Egg or cereal. Bread and butter. Apple sauce or prune puree. Milk, 6 to 8 ounces. 1 P.M. Water. 2 P.M. Dinner. Beef juice or egg or broth. Baked potato. Bread and butter. 5 P.M. Water. 6 P.M. Supper. Milk toast, or Cereal and milk. Water may be taken freely between meals. When egg is given with breakfast, cereal may be given with supper. When cereal is given with breakfast, egg or milk-toast may be given with supper. This diet list may be followed instead of preceding list: the only important difference is in feeding times. 234 BABY, EIGHTEEN MONTHS TO TWO YEARS. Meat. Scraped meat, sweetbreads, chicken, brains, fish, crisp bacon. Vegetables. Asparagus tips, artichokes, cooked celery, potatoes, spinach, French carrots, peas, string beans, rice, butter beets, lettuce finely divided like spinach. Desserts. Custard, tapioca, rice and sago puddings, floating island, lady fingers, angel cake, blanc mange. Fruit. Orange juice, apple sauce, prunes, cooked peach or pear. Milk and Cereals should be such as do not have husks or grits. Milk Milk Foods, toast, farina, cornstarch, arrowroot, cream of wheat. Give cooked cereals only. Eggs. Soft boiled or poached. Bread and Toast, graham crackers, zwieback (no hot rolls or hot bread), Butter. bread preferably stale. Soups. Clear soups, bouillon, beef tea, mutton broth, chicken soup, consomme, beef juice. But no rich, cream or fatty soups. Soups may be thickened by having a cereal cooked in them. Water. Water should be taken freely between meals. Breakfast. Egg or cereal. Milk. Bread and butter. Fresh or cooked fruit or orange juice. Dinner. Meat or chicken or fish. Potato. Green vegetable. Bread and butter. Custard or floating island. TYPE MEALS. Supper. (1) Soup and cereal, Bread and butter. (2) Milk and cereal, Bread and butter. (3) Egg, Broth, Bread and butter. (4) Milk Toast. 3 P.M. Glass of milk, piece of bread and butter. (3 P.M. feeding may be omitted when enough is taken at other meals.) (Green vegetable may be added to supper.) The day egg is given for breakfast, cereal may be given for supper. The day cereal is given for breakfast, soup and egg or milk toast may be given for supper. Crisp bacon may be given with breakfast. Brains, sweetbreads: cooked plain, in soup or in salt water and add butter. Scraped beef, scraped steak: make into pat and fry in dry pan. 235 BABY, EIGHTEEN MONTHS TO TWO YEARS. 8 A.M. Breakfast. (1) Cereal. Milk. Bread and butter. Fruit. (2) Egg. Milk. Bread and butter. Fruit. 12 M. Dinner. (1) Beef juice. Potato. Bread and butter. Apple sauce. (2) Brains. Green vegetable. Bread and butter. Custard. (3) Scraped beef. Potato. Bread and butter. Lady finger or Plain cake. (4) Sweetbreads. V egetable. Bread and butter. Pudding. (5) Fish. Potato. Bread and butter. Apple sauce. (6) Chicken. Vegetable. Bread and butter. Jelly. (7) Chop. Bread and butter. Pudding. 3 P.M. Milk. 6 P.M. Supper. (1) Cereal. Milk. Bread and butter. (2) Cereal. Broth. Bread and butter. (3) Egg. Milk. Bread and butter. (4) Milk toast. When egg is given for breakfast, cereal may be given for supper, and zice versa. Water should be given at 11 A.M. and 5 P.M.: also freely at other times between meals. 236 DIET SECOND TO FIFTEENTH YEAR. BABYHOOD. CHILDHOOD. ADOLESCENCE. 237 BABY, TWO YEARS OLD. EXAMPLES OF MEALS. Breakfast. Orange juice. Cereal or egg. Milk. Bread and butter. Dinner. (1) Beef juice. Potato. Bread and butter. Apple sauce. (2) Brains. Green vegetable. Bread and butter. Custard. (3) Scraped beef. Potato. Bread and butter. Lady fingers, or Plain cake. (4) Sweetbreads. Vegetable. Bread and butter. Pudding. (5) Fish. Potato. Bread and butter. Apple sauce. (6) Chicken. Vegetable. Bread and butter. Jelly. (7) Chop. Potato or green vegetable, Bread and butter. Pudding. 3.30 P.M. Milk. Supper. (1) Cereal. Milk. Bread and butter. (2) Cereal. Broth. Bread and butter. (3) Egg. Milk. Bread and butter. (4) Milk toast. Water freely between meals. 239 BABY, TWO TO SIX YEARS. 8 A.M. Breakfast. Soft egg or cereal. Glass of milk. Bread and butter. Stewed fruit. 12 M. Dinner. Plain meat. Potato—baked, boiled, mashed. Green vegetable. Bread and butter. Pudding or custard. 5.30 P.M. Supper. Cereal or egg. Bread and butter (and jelly). Glass of milk. 3 P.M. Glass milk and bread and butter or cake. Water to be taken freely between meals. 8 P.M. Bed. Make mid-day meal the chief meal of the day. It is important that the supper should be light and should be taken approximately two hours before bedtime. MAY EAT. Meats and Fish. AVOID. Broiled, boiled, baked roasted: steaks, chops, roast beef, lamb, mutton, chicken, sweetbreads, tur- key, brains, fresh fish. All salt, preserved, canned or spiced meats and fish; tongue, goose, duck, kidneys, stews; sal- mon, shrimp, lobster, crab, sardines, mackerel. Cooked green vegetables, spinach, lettuce, asparagus, artichokes, cel- ery, rhubarb, peas, carrots, string beans, eggplant, beets, potatoes. Vegetables. Cucumbers, cabbage, corn, garlic, onions, sweet and sour vegetables; vegetables with rich sauces, sprouts, pickles, cauliflower. Fruits. Oranges, apples, grapefruit, peach, pear, banana, grapes. Stewed and sweetened fruits, ber- ries, preserves. Sundries. Bread, toast, zwieback, butter, sal- ads, clear soups, eggs, meat juice gravy, cereals, cottage cheese, plain cake, ice cream, limited amount of molasses candy and chocolate. Rich cakes, pies, pastries, sweets, confections, spices, sauces, gravies, condiments, poulettes; all thick and cream soups; hot cakes, hot rolls, hot biscuits; strong cheese. 240 BABY, THREE YEARS, TYPE MEALS. 8 A.M. Breakfast. Orange juice or apple sauce or prunes. Cereal or egg. Milk. Bread and butter. 11 A.M. Water. 12 M. Dinner. (1) Meat (brains, scraped beef, sweetbreads, scraped chicken). Green vegetable. Baked potato. Custard. Bread and butter. (2) Two to four ounces beef juice in above list in- stead of meat. (3) Fish (with white flesh) in above list instead of meat. 3 P.M. Milk. Bread and butter or lady fingers, or Toast and butter. 5 P.M. Water. 6 P.M. Supper. (1) Milk toast, or (2) Soup containing cereal or vegetable, or (3) Cereal and milk, or (4) Egg and broth and vegetable. Meat. Brains or sweetbreads cooked plain with salt and water or in soup. Scraped beef, scraped steak—make into ball and cook in dry pan. Green Vegetables. Carrots, peas, spinach, cooked celery, asparagus, artichokes. (Pureed for the present.) The day egg is eaten for breakfast, cereal may be taken for supper. The day cereal is eaten for breakfast, egg may be taken for supper. 241 BABY, THREE TO SIX YEARS. Meat. Sweetbreads, brains, chicken, fish with white flesh, squab, chops, steak, roast beef, scraped beef. Meat may be broiled, boiled, baked, roasted. Vegetables. Asparagus tips, artichokes, cooked celery, potato, rice, macaroni, peas, lettuce (cooked like spinach), French carrots, beets. Desserts. Custard, floating island, tapioca, rice and sago pud- dings, lady fingers, plain cake, blanc mange. Milk and Milk toast, farina, cornstarch, arrowroot. Cereals should Milk Foods, be such as do not have grits or husks. Give cooked cereals only (omit force, grape nuts, etc.). Eggs. Soft boiled or poached, but not fried. Bread and Bread and butter, toast, crackers, zwieback. No hot Butter. rolls or hot bread. Soups. Clear soups, bouillon, beef tea, mutton broth, chicken soup, consomme, beef juice. But no rich, cream or fatty soups. Soups may be thickened by having a cereal cooked in them. (But strain out such cereals as pearl barley, which has kernels.) To be All fried or spiced viands; all preserved or salted foods; Avoided. fruits and vegetables having husks or kernels (as corn), tomatoes, pickles, cabbage, cauliflower. Berries, pre- serves, confections, candies, rich desserts, sweets, pas- tries, pies, condiments (mustard, mayonnaise, etc.), sauces, stews, all shell-fish, chocolate. Eat Slowly. Food should be prepared plain—never fried—no made gravies or sauces. Water. Water should be taken freely between meals. Drink only limited quantities with meals. Eat at regular times and only three meals a day. Eat at intervals of not less than four hours. Chew food thoroughly. Eat roasted, baked, broiled, boiled meats. One hour before each meal drink a glass of water. Do not eat mixtures, such as hot followed by cold, or sweet and sour. Avoid all made dishes—stews, poulettes, gravies, sauces. 242 BABY, FOUR YEARS TO SIX YEARS. FIVE YEARS TO SIX YEARS. The diet during the fourth and fifth years should be essentially the same as in the third year. Viands should be selected from the list prescribed for the third year. But greater liberality in quantity and variety is permissible. Thus pastes—maca- roni, spaghetti, etc.—may be added to din- ner or supper. With supper potato or green vegetable may be given. Especially desirable is the addition of a green vegetable at supper time if the baby has a tendency to consti- pation. Meat need not be scraped, but chop, steak, etc., cut into small pieces, may be given. 243 BABY, SIX YEARS. MAY EAT. AVOID. Meats and Fish. Broiled, boiled, baked, or roasted: steaks, chops, roast beef, game, sweet- breads, brains, chicken, lamb, turkey, fresh fish, raw oysters. All salt, preserved, canned and spiced meats and fish; tongue, goose, duck, kidney, stews; salmon, shrimps, lob- ster, crabs, sardines, mackerel. Vegetables. All green vegetables—spinach, let- tuce, asparagus, artichokes, celery, rhubarb, peas, potatoes, string beans, carrots, eggplant. Cucumbers, beets, cabbage, corn, gar- lic, onions, sweet and sour vegetables, vegetables with rich sauces, cauli- flower, sprouts. Fruits. Orange, apple, grapefruit, peach, pear, banana, grapes. Stewed and sweetened fruits, berries and preserves. Desserts. Puddings, plain cake, jelly, custard, ice cream, floating island. Rich cake, pies, pastries. Beverages. Water, tea, cocoa, milk, chocolate. All alcoholic and malt drinks, sweet drinks. Sundries. Bread, toast, zwieback, butter, clear soups, eggs, meat juice gravy, cere- als, cottage cheese, plain cake, ice cream; limited amount molasses candy and chocolate. Confections, spices, sauces, gravies, condiments, poulettes, all thick and cream soups, hot cakes, hot rolls, hot biscuits, strong cheese. Breakfast. Two eggs or cereal. Bread and butter. Milk or cocoa. Fruit or orange juice. TYPE MEALS. Luncheon. Steak or chops. Baked potato. Vegetable. Bread and butter. Custard, pudding or fruit. Dinner. Consomme or grapefruit. Plain meat or poultry or fish, or eggs. Green vegetable. Bread and butter. Fruit or plain pudding or plain cake. Water to be taken freely between meals. Cabbage and cauliflower produce gas and are better excluded. Cauliflower tops have less tendency to cause disorder and if there is a scarcity of choice of vegetables, may be given. 244 CHILDHOOD, SEVEN TO TWELVE YEARS, Breakfast. Eggs or cereal. Bread and butter. Glass of milk. Fruit. Dinner. Meat. Vegetable. Potato. Bread and butter. Pudding or custard. Supper. Light meat or fish. Green vegetable. Potato or paste. Bread and butter. Raw or cooked fruit. Soup. Egg. Green vegetable. Bread and butter. Raw or cooked fruit. or Soup. Green vegetable. Paste. Bread and butter. Raw or cooked fruit. Cereal. Vegetable. Bread and butter. Fruit. Glass of milk. or Eat slowly. Eat at regular times and only three times a day. Eat at intervals of not less than four hours. Chew food well. Eat roasted, baked, boiled or broiled meats. Have food prepared plain, omitting sauces, condiments, gravies. Do not eat mixtures, such as hot followed by cold, and sweet and sour. Avoid all made dishes—stews, gravies, poulettes, sauces. Drink only limited quantities with meals. One hour before each meal drink a glass of water. 7.30 A.M. Arise and drink a glass of water. 7.45 to 8 A.M. Exercises. 9 A.M. to 12 M. School. 12.15 P.M. Dinner. 1—1.30 P.M. School. 3.30 to 5.30 P.M. Play. 7 to 8 P.M. Read or play. 8 P.M. Bed. For selection of foods, consult 6 year old list. 245 ADOLESCENCE, TWELVE TO FIFTEEN YEARS. At this time growth is rapid and strain is made on the physical powers. Therefore it is essential that a sufficient quantity of nour- ishing food, especially fresh meat, should be taken. In other respects the diet is similar to that for advanced childhood, but larger quan- tities should be taken and greater liberty of choice and more varied combinations are permitted. Eat slowly. Eat at regular times and only three meals a day. Have food prepared plain, omitting sauces, gravies, condiments. Eat at intervals of not less than four hours. Chew food thoroughly. Eat roasted, boiled, broiled and baked meats. Avoid all made dishes—stews, gravies, sauces, poulettes. Do not eat mixtures, such as hot followed by cold, or sweet and sour. One hour before each meal take a glass of water. Drink only limited quantities with meals. 246 ADOLESCENCE, TWELVE TO FIFTEEN YEARS. (Continued.) MAY EAT. AVOID. Meats and Fish. Broiled, boiled, baked, roasted: steaks, chops, roast beef, game, chicken, sweetbreads, brains, broiled tripe, turkey, white fish, raw oysters, ham, bacon, mutton, lamb. Fried foods of all kinds; all salt, preserved, canned and spiced meats and fish; tongue, goose, duck, kid- neys, stews; sardines, salmon, shell- fish, mackerel. Vegetables. Green vegetables and such as grow above ground—spinach, peas, cauli- flower, lettuce, rhubarb, celery, string beans, artichoke, carrots, cress, eggplant, beets, potatoes, to- matoes, corn, squash. Onions, garlic, dry beans, cabbage. Fruits. Cooked and fresh fruit (apples, pears, peaches, oranges, grapes) berries. Beverages. Water, mineral water, tea, milk, buttermilk, cocoa, chocolate, coffee. All alcoholic and malt drinks. Sundries. Bread, toast, zwieback, butter, sal- ads, eggs, clear soup or bouillon, custards, plain puddings, plain cake; limited amount sweets and confections, nuts, pastes, cottage cheese, American cheese, Swiss and Holland cheese. Rich cake, pastry, pies; spices, sauces, gravies, poulettes; condi- ments, such as catsup, mustard, tabasco sauce; thick and cream soups; hot cakes, hot biscuits, hot rolls, muffins, waffles; ripened cream cheese (e.gCamembert, Roquefort, etc.). 247 (B) DIETS FOR CHILDREN IN DISEASE. 249 ACIDOSIS. [Four-year-old Child.'] Meat. Sweetbreads, brains, chicken, fish with white flesh, squab, chops, steak, roast beef, scraped beef. Meat may be boiled, broiled, baked or roasted. Vegetables. Asparagus tips, artichokes, cooked celery, potatoes, rice, macaroni, peas, lettuce cooked like spinach, French car- rots, beets. Desserts. Custard, floating island, tapioca, rice and sago pud- dings, lady fingers, plain cake, blanc mange; baked apple, orange juice, apple sauce, cooked peach or pear. Cereals. Farina, cornstarch, arrowroot. Cereals should be such as do not have husks or grits. Give cooked cereals only (omit force, grape nuts, etc.). No milk with cereals. Eggs. Soft boiled or poached, but not fried. Bread and Stale bread and butter, toast, crackers, zwieback (no Butter. hot rolls or hot bread). Soups. Clear soup, bouillon, beef tea, mutton broth, chicken soup, consomme, beef juice, but no rich, cream or fatty soups. Soups may be thickened by having a cereal cooked in them (but strain such cereals as pearl barley, which has kernels). To be All fried or spiced viands; all preserved or salted foods; Avoided. fruits or vegetables having husks or kernels (as corn), tomatoes, pickles, berries, preserves, confections, rich desserts, sweets, pastries, pies, condiments, sauces, stews, all shell-fish, chocolate. TYPE MEALS. Breakfast. Egg or mush. Bread and butter. Fruit. Supper. Vegetable. Cereal. Bread and butter. Dinner. Meat. Vegetable. Potato. Bread and butter. Pudding or custard. 3 P.M. Glass of milk and Bread and butter. When cereal is given for breakfast, egg may be given for supper. 251 ACIDOSIS. [Five-year-old Child.'] MAY EAT. Meats and Fish. Beef steak, roast beef, roast mutton, mutton chops, lamb chops, chicken, squab, brains, sweetbreads, white fish, plain boiled ham, lamb, veal, scraped beef. Meats may be boiled, broiled, baked or roasted; no sauces, no gravies, except blood gravy; nothing fried; no highly seasoned meat; no stews. Vegetables. Asparagus, artichokes, peas, tender string beans, cooked celery, cooked lettuce, fine spinach, carrots, potatoes (boiled or baked or mashed). Vegetables are to be cooked plain, preferably with salt water and add a little butter; asparagus and artichokes may be eaten with butter, but no mayonnaise; flavoring of onion and garlic to be absolutely avoided. Fruits. Apple sauce, baked apple, cooked prunes; peaches and pears, cooked or raw; grapes (avoid seeds and skins). Raw apples may be taken, but must be thoroughly masticated—preferably scraped. Sundries. Eggs soft boiled, poached or omelette; cereals (cooked cereals only; avoid those having husks or kernels, such as cracked wheat and pearl barley); restrict amount of cereals; rice, sago, tapioca; bread, toast and zwieback; lady fingers, angel cake; cottage cheese; custards, puddings, sponge cake. Beverages. Water abundantly. Still alkaline mineral water may be taken. Weak tea. Limited amount of milk and milk foods. 252 ANEMIA. [Retarded Growth in Ten-months-old Child.] DIRECTIONS FOR EXTENDING DIET. 7 A.M. Eight ounces milk. 9 A.M. Fruit juice. Begin with one teaspoonful orange juice every second day. If that agrees, give it every day. Then gradually increase amount until he takes the juice of an ordinary size orange. (Do not sweeten.) 10 A.M. Cereal and milk. Begin with one teaspoonful of cooked cereal. Give thoroughly cooked farina, barley or oats. All cereals are to be given smooth—strained, if neces- sary. As baby grows, give larger portions of cereal and less milk, until meal is cereal with milk and a small drink (two to three ounces) of milk. 1 P.M. Drink of water (four ounces). 2 P.M. Beef juice or soft egg. Baked potato. Custard or apple sauce may be given at this meal. Begin beef juice when one year old: at first, one teaspoonful, gradually increase until two ounces are given. Baked potato may be begun now: at first, one teaspoonful, gradually increase until a fair size po- tato is taken. For the present give a little milk at this meal, but gradually diminish amount so that this meal will have no milk. Begin egg: at first, one teaspoonful of mixed white and yolk and gradually increase until a whole egg is taken. Then give egg one day, and beef juice the next day. 5 P.M. Drink of water (four ounces). 6 P.M. Milk toast and milk. Do not begin all these things at once, but introduce them gradually. 253 ANEMIA. [Eight to Twelve-year-old Child.] Eat slowly. Eat at regular times and only three meals a day. Drink only limited quantities with meals. Have food prepared plain, omitting sauces, condiments, gravies. Eat at intervals of not less than four hours. Chew food thoroughly. Eat roasted, baked, broiled or boiled meats. One hour before each meal drink a glass of water. Do not eat mixtures, such as hot followed by cold, or vice versa, or sweet and sour. Avoid all made dishes—stews, poulettes, gravies, sauces. MAY EAT. AVOID. Meats and Fish. Broiled, boiled, baked, roasted: steaks, chops, roast beef, game, chicken, sweetbreads, brains, white fish, white meat of turkey. Fried foods of all kinds; all salt, preserved, canned and spiced meats; tongue, turkey, goose, duck, kidneys, stews; sardines, salmon, shell-fish, mackerel. Vegetables. Green vegetables and such as grow above ground—spinach, lettuce, peas, celery, rhubarb, string beans, carrots, artichokes, cress, eggplant, potatoes, asparagus, beets, squash. All starchy vegetables and such as grow below ground—turnips, corn, garlic, onions, dry beans. Cooked and fresh fruits—apples, pears, peaches, grapes, oranges, etc. Fruits. Preserves, jams. Beverages. Water, weak tea, cocoa, milk All alcoholic and malt drinks; all sweetened and acidulous drinks; coffee. Sundries. Bread, toast, zwieback, butter, eggs, clear soup or bouillon, custards and plain puddings, plain cake, molasses candy, milk chocolate. Cake, pastry, pies, confectionery, spices, sauces, gravies, nuts, pou- lettes; all condiments, such as mus- tard, catsup, tabasco sauce; thick and cream soups; hot cakes, hot biscuits, hot rolls, muffins, waffles; syrups, candy, cheese. 254 ANEMIA. MALNUTRITION. [ Ten-year-old Child.] MAY EAT. AVOID. Broiled, boiled, baked, roasted: steaks, chops, roast beef, game, chicken, sweetbreads, brains, lamb, turkey, fresh fish, raw oysters. Meats and Fish. All salt, preserved, canned or spiced meats and fish; tongue, duck, goose, kidneys, stews; sal- mon, shrimp, lobster, crab, sardines, mackerel. Vegetables. All green vegetables—spinach, let- tuce, asparagus, artichokes, celery, rhubarb, tomatoes, beans, peas, car- rots, corn, cress, eggplant, potatoes. Cucumbers, beets, cabbage, garlic, onions, sweet and sour vegetables, vegetables with rich sauces, sprouts. Fruits, Fresh and cooked fruits—orange, apple, grapefruit, peach, pear, banana. Water, tea, milk, cocoa, chocolate. Beverages. All alcoholic and malt drinks; all sweet drinks; coffee. Sundries. Bread, toast, zwieback, moderate amount butter, salads, clear soups, eggs, meat juice gravy, cereals, cottage cheese, plain cake. Cakes, pies, pastries, sweets, con- fections, spices, sauces, gravies, condiments, poulettes, all thick and cream soups, hot cakes, hot rolls, hot biscuits, strong cheese. TYPE MEALS. Breakfast. Two eggs, bread and butter. Milk or cocoa, fruit or orange juice. (A cereal may be substituted for eggs.) Luncheon. Steak or chops, baked potato. Vegetable, bread and butter. Pudding or fruit. Dinner. Consomme or grapefruit, plain meat or poultry or fish. Green vegetable, salad, bread and butter. Fruit or plain pudding or plain cake. 3 P.M. Glass of milk and piece plain cake or bread and butter. Limited amount of plain molasses candy or milk chocolate. 255 APPENDICITIS, CHRONIC. [Ten-year-old Child.] Avoid violent, strenuous exercise—strain, jumping, stretching. Keep bowels open. Avoid foods which ferment or form gases. Avoid indigestible food. This diet is to be followed for a number of months at least. This diet is intended to furnish a good, nutritive diet, while elim- inating noxious foods. Simplicity in choice, and moderation in quan- tity of viands taken is aimed at, while preserving an abundance of good nourishing foods. MAY EAT. AVOID. Meats and Fish. Beef, mutton, lamb, etc.; all fresh meats simply cooked, preferably boiled, broiled, baked, roasted. Ba- con, ham, poultry, game, fish, raw oysters, brains, sweetbreads. Preserved, canned, spiced meats and fish; stews, pork, goose, duck, liver, shell-fish. Vegetables. Green vegetables which grow above ground, including peas, asparagus, artichokes, celery, lettuce, carrots, spinach, potatoes, buttered beets. Turnips, cabbage, onions, cauli- flower, garlic, dry beans, corn, cu- cumbers, tomatoes. Fruits. Fresh fruits—orange, apple, pear, grapes, and fresh fruits in general. Cantaloupe; any fruit that experi- ence has taught is not well toler- ated; nuts; fruits having seeds or kernels, like figs. Bread. Bread, zwieback, toast, lady fin- gers, plain cake. Rich cakes, pastries, pies, rich des- serts, confections, hot bread, hoi cakes, etc. Sundries. Eggs in any plain form; cottage cheese, macaroni, spaghetti. Excess of candy, sweets, ices, etc.; cheese. 256 CARIOUS TEETH. [EighUyear-old Child.] Meat. Sweetbreads, brains, chicken, fish with white flesh, squab, chops, steak, roast beef. Meat may be boiled, broiled, baked or roasted. Vegetables. Asparagus tips, artichokes, cooked celery, potatoes, rice, macaroni, peas, string beans, spinach, lettuce cooked like spinach, French carrots, beets. Desserts. Custard, floating island, tapioca, rice and sago puddings, lady fingers, plain cake, blanc mange. Milk and Milk toast, farina, cornstarch, arrowroot. Give cooked Milk Foods, cereals only (omit force, grape nuts, etc.). Cereals should be such as do not have grits or husks. Eggs. Soft boiled, poached or scrambled. Bread and Toast, graham crackers, zwieback, bread and butter. Butter. No rolls or hot bread. Soups. Clear soups, bouillon, beef tea, mutton broth, chicken soup, consomme, beef juice: but no rich, cream or fatty soups. Soups may be thickened by having a cereal cooked in them. TO BE AVOIDED. All fried or spiced viands; all preserved or salted foods; nuts; fruits and vegetables having husks or kernels (as corn), tomatoes, pickles, berries, preserves, confections, candies, rich desserts, pas- tries, pies; condiments (mustard, pepper, mayonnaise, etc.); sauces, stews; all shell-fish; chocolate. 257 CARIOUS TEETH. EIGHT-YEAR-OLD CHILD. (Continued.) Eat slowly. Drink only limited quantities with meals. Have food prepared plain, omitting sauces, condiments, gravies. Eat at intervals of not less than four hours. Chew food well. Eat boiled, broiled, baked or roasted meats. Avoid all made dishes—stews, poulettes, sauces. Do not eat mixtures, such as hot followed by cold, or sweet and sour. One hour before meals drink glass of water. TYPE MEALS. Breakfast. Eggs or mush. Bread and butter. Glass of milk. Fruit. Dinner. Meat. Vegetable. Bread and butter. Pudding or custard. (1) Green vegetable. Potato or paste. Bread and butter. Raw or cooked fruit. (2) Green vegetable. Egg. Bread and butter. Fruit. Supper. 3 P.M. Glass of milk and bread and butter or cake. 258 CARIOUS TEETH. [Ten-year-old Child.] MAY EAT. AVOID. Broiled, boiled, baked, roasted: steaks, chops, roast beef, game, chicken, sweetbreads, brains, lamb, turkey, fresh fish, raw oysters. Meats and Fish. All salt, preserved, canned or spiced meats and fish; tongue, goose, duck, kidneys, stews; salmon, lob- sters, crabs, shrimps, sardines, mackerel. Vegetables. All green vegetables—spinach, let- tuce, asparagus, artichokes, celery, rhubarb, tomatoes, beans, peas, car- rots, corn, cress, eggplant, potatoes. Cucumbers, beets, cabbage, sprouts, cauliflower, garlic, onions, sweet and sour vegetables, vegetables with rich sauces. Fruits Orange, apple, grapefruit, peaches, pears, bananas. Stewed and sweetened fruits; ber- ries or preserves. Water, tea, cocoa, milk, chocolate. Beverages. All alcoholic and malt drinks; all sweet drinks. Bread, toast, zwieback, moderate amount butter, salads, clear soups, eggs, meat juice gravy, cereals, cottage cheese, plain cake. Sundries. Cakes, pies, pastries, sweets, con- fections, spices, sauces, gravies, condiments, poulettes, all thick and cream soups, hot cakes, hot rolls, hot biscuits; strong cheese. Breakfast. Two eggs. Bread and butter. Milk or cocoa. Fruit or orange juice. (A cereal may be substituted for eggs.) Luncheon. Steak or chops. Baked potato, vegetable. Bread and butter. Custard, pudding or fruit. Dinner. Consomme or grapefruit. Plain meat or poultry or fish. Green vegetable. Salad. Bread and butter. Fruit or plain pudding or plain cake. TYPE MEALS. 259 CHOREA. [Eight-year-old Child.] MAY EAT. AVOID. Meats and Fish. Broiled, boiled, baked, roasted: fresh meats, including steak, chop, roast beef, game, chicken, lamb, turkey, scraped beef; also fresh fish with white flesh—bass, sole, sand- abs, smelt, halibut. Fried meats, stews, made gravies; all salt, preserved, spiced and canned meats and fish; rich meats, such as tongue, goose, duck; rich fish—salmon, cod, mackerel, sar- dines, shell-fish. Vegetables. Light, green vegetables, plainly prepared by cooking with salt, water and butter, or in soup stock, or in milk: such vegetables as spinach, asparagus, artichokes, rhu- barb, string beans, green peas, car- rots, buttered beets, potatoes. Indigestible vegetables, such as cu- cumbers, corn, garlic, onions; vege- tables cooked with rich sauces; gas-forming vegetables, such as cabbage, cauliflower, sprouts; raw vegetables, such as tomatoes, cel- ery (except cooked) and vege- table salads; pickles. Fruits. Fresh and cooked fruit—oranges, apples, grapefruit, peaches, pears, prunes, bananas. Berries; highly sweetened pre- serves; figs, currants. Beverages. Milk, cocoa, chocolate, water, lem- onade. Coffee, tea, ice cream soda; alco- holic and malt drinks. Sundries. Custards, blanc mange; puddings of bread, sago, tapioca, etc.; sponge cake or other plain cake; limited amount of molasses candy or milk chocolate; bread (preferably stale), toast (not hot), rusk, soda crack- ers, graham crackers; butter, eggs; clear soups (bouillon, consomme) ; meat juice gravy; cooked cereals; macaroni, spaghetti; cottage cheese; ice cream. Hot bread, hot rolls, hot biscuits; rich cakes, pies, confections, can- dies; spices, sauces, made gravies; condiments and poulettes; cream soups and other rich soups; cheese; nuts. 260 CHOREA. EIGHT-YEAR-OLD CHILD. (Continued.) TYPE MEALS. Breakfast. Eggs or mush. Bread and butter. Glass of milk. Fruit. Dinner. Meat, vegetable. Potato. Bread and butter. Pudding or custard. Supper. Soup or milk, green vegetable, bread and butter, paste, raw or cooked fruit. Or, Soup, egg, green vegetable, bread and butter, raw or cooked fruit. Or, Soup, green vegetable, paste, bread and butter, raw or cooked fruit. Or, Cereal, vegetable, bread and butter, glass milk, fruit. Water is to be taken freely between meals. As routine a glass of water should be taken one hour before each meal. Water may be taken also at unstated times. Limit the quantity of liquids taken at meals—not more than one cupful of liquid at meal time (this includes soup, water, milk, etc.). The day cereal is taken for breakfast, eggs may be taken for supper. The diet should include, at one meal daily, cereal; “ “ “ “ eggs; “ “ “ “ meat. The effort is to select a diet which will be nourishing and non- irritating; therefore, considerable leeway may be allowed in adding to this list foods which by experience have been found to agree, and excluding from the diet foods which are found to be not well tolerated. About the middle of the afternoon, a glass of milk and bread and butter or cake, or bread and butter and jelly or honey is permitted. Regularity in habits is to be sought for. Much rest is desirable. The child should retire early and arise not too early. Restraint is to be minimized. Sustained effort—mental or physical—is to be avoided. Physical exercise, gentle but adequate, is essential. Over- exertion is to be deprecated. 261 CHOREA. [Eleven-year-old Child.] MAY EAT. Meats and Fish. AVOID. Broiled, boiled, baked, roasted: fresh meats, including steak, chop, roast beef, game, chicken, lamb, turkey, scraped beef; also fresh fish with white flesh—bass, sole, sandabs, smelt, halibut. Fried meats, stews, made gravies; all salt, preserved, spiced and canned meats and fish; rich meats, such as tongue, goose, duck; rich fish—salmon, cod, mackerel, sar- dines, shell-fish. Vegetables. Light, green vegetables, plainly pre- pared by cooking with salt water and butter, or in soup stock or in milk; such vegetables as spinach, asparagus, artichokes, rhubarb, string beans, green peas, carrots, buttered beets, potatoes. Indigestible vegetables, such as cu- cumbers, corn, garlic, onions; vege- tables cooked with rich sauces; gas-forming vegetables, such as cabbage, cauliflower, sprouts; raw vegetables, such as tomatoes, celery (except cooked), and vegetable salads; pickles. Fresh and cooked fruit—oranges, apples, grapefruit, peaches, pears, prunes, bananas. Fruits. Berries, highly sweetened pre- serves; figs, currants. Milk, cocoa, chocolate, water, lemonade. Beverages. Coffee, tea, ice cream soda; alco- holic and malt drinks. Sundries. Custards, blanc mange; puddings of bread, sago, tapioca, etc.; sponge cake or other plain cake; limited amount of molasses candy or milk chocolate; bread (preferably stale), toast (not hot), rusk, soda crack- ers, graham crackers; butter, eggs; clear soups (bouillon, consomme) ; meat juice gravy; cooked cereals; macaroni, spaghetti; cottage cheese; ice cream. Hot bread, hot rolls, hot biscuits; rich cakes, pies, confections, can- dies; spices, sauces, made gravies; condiments and poulettes; cream soups and other rich soups; cheese; nuts. 262 CHOREA. ELEVEN-YEAR-OLD CHILD. (Continued.) TYPE MEALS. Breakfast. Eggs or cereal. Bread and butter or toast and butter. Milk or chocolate or cocoa. Cooked or fresh fruit. Dinner. Butcher’s meat (beef, mutton, lamb) or fish or poultry. Potato or green vegetable. Bread and butter. Custard or floating island or pudding or fruit. Supper. Consomme. Light meat or poultry or fish. Green vegetable. Bread and butter. Dessert. Water is to be taken freely between meals. As routine, a glass of water should be taken one hour before each meal. Water may be taken also at unstated times. Limit the quantity of liquids taken at meals—not more than one cupful of liquid at meal time (this includes soup, water, milk, etc.). The day cereal is taken for breakfast, eggs may be taken for supper. The diet should include, at one meal daily, cereal; “ “ “ “ eggs; “ “ “ “ meat. The effort is to select a diet which will be nourishing and non- irritating; therefore, considerable leeway may be allowed in adding to this list foods which by experience have been found to agree and excluding from the diet foods which are found to be not well tolerated. About the middle of the afternoon, a glass of milk and bread and butter or cake, or bread and butter and jelly or honey is permitted. Regularity in habits is to be sought for. Much rest is desirable. The child should retire early and arise not too early. Restraint is to be minimized. Sustained effort—mental or physical—is to be avoided. Attention to the bowels and urinating habits is important. Physi- cal exercise, gentle but adequate is essential. Over-exertion is to be deprecated. 263 CONSTIPATION. [Child, Five to Seven Years Old. 1 Laxative Diet. Breakfast. Eggs or cereal or grilled bacon. Bread and butter. Fruit. Dinner. Meat. Vegetable. Potato. Bread and butter. Pudding or custard. (1) Soup, Vegetable, Bread and butter, Cooked fruit. (2) Soup, Vegetable, Paste, Bread and butter, Cooked fruit. (3) Cereal, Vegetable, Bread and butter. Supper. Eat slowly. Eat at regular times and only three meals a day. Drink only limited quantities at meals. Have food prepared plain—omitting sauces, condiments, gravies. Eat at intervals of not less than four hours. Chew food well. Eat roasted, baked, broiled or boiled meats. One hour before each meal drink a glass of water. Do not eat mixtures, such as hot followed by cold, or vice versa, or sweet and sour. Avoid all made dishes—stews, poulettes, gravies and sauces. 264 CONVULSIONS. [ Twenty-one-months-old Child.] First Meal — 7.00 A.M. A glass of certified milk. A soft boiled egg. Bread and butter. Second Meal—10.30 A.M. A glass of certified milk. A piece of bread and butter, or a graham cracker. Third Meal — 1.30 P.M. A cup of broth. Bread and butter. Baked potato. Fourth Meal— 6.30 P.M. Milk toast, or cereal and milk. Bread and butter. Instead of broth a little scraped chicken, or scraped chop, or scraped beef, or white fish, may be given at the third meal, twice a week. This diet is to be instituted a few days after convulsions have ceased and to be continued several weeks. 265 CONVULSIONS. [ Three-year-old Child.'] MAY EAT. Meats and Fish. Sweetbreads, brains, chicken, fish with white flesh, squab, chops, steak, roast beef, scraped beef. Meat may be broiled, boiled, roasted or baked. Vegetables. Asparagus tips, artichokes, cooked celery, potatoes, rice, macaroni, peas, string beans, spinach, lettuce cooked like spinach, French carrots. Desserts. Custard, floating island, tapioca and rice puddings, sago pudding, lady fingers, angel cake, blanc mange. Milk and Milk Foods. Milk toast, farina, corn starch, arrowroot. Cereals should be such as do not have grits or husks. Give cooked cereals only. Eggs. Soft boiled or poached, but not fried. Bread and Butter. Toast, graham crackers, zwieback. (No hot rolls, no hot bread.) Soups. Clear soups, bouillon, beef tea, mutton broth, chicken soup, con- somme, beef juice, but no rich, cream or fatty soups. Soups may be thickened by cooking a cereal in them. TO BE AVOIDED. All fried or spiced viands; all preserved, canned or salted foods; nuts; fruits and vegetables having husks or kernels (as corn) ; to- matoes, pickles, beets; berries, preserves, confections, candies, rich desserts, pastries, pies; condiments (mustard, mayonnaise, etc.); sauces, stews; all shell-fish. Food should be prepared plain—never fried—no made gravies or sauces. Water should be taken freely. 266 CONVULSIONS. [Four-year-old Child.] Meats and Sweetbreads, brains, chicken, fish with white flesh, Fish. squab, chops, steak, roast beef, scraped beef. Meat may be boiled, broiled, baked or roasted. Vegetables. Asparagus tips, artichokes, cooked celery, potatoes, rice, macaroni, peas, rhubarb, string beans, spinach, lettuce cooked like spinach, French carrots. Desserts. Custard, floating island, tapioca, rice and sago pud- dings, lady fingers, angel cake, blanc mange. Milk and Milk toast, farina, cornstarch, arrowroot. Cereals should Milk Foods, be such as do not have grits or husks. Give cooked cereals only. Eggs. Soft boiled or poached, but not fried. Bread and Toast, graham crackers, zwieback. (No hot rolls or Butter. bread.) Soups. Clear soups, bouillon, beef tea, mutton broth, chicken soup, consomme, beef juice, but no rich, cream, or fatty soups. Soups may be thickened by having a cereal cooked in them. To be All fried or spiced viands; all preserved, canned or Avoided. salted foods; nuts; fruits and vegetables having husks or kernels (as corn) ; tomatoes, pickles, beets; berries, preserves, confections, candies, rich desserts, pastries; stews, sauces; all shell-fish. Food should be prepared plain—no made gravies or sauces, and never fried. Water should be taken freely. TYPE MEALS. Breakfast. Eggs or cereal. Milk. Bread and butter. Cooked fruit. Dinner. Meat, potatoes. Green vegetable. Custard or Floating island. Supper. Soup and cereal, bread and butter, or Milk and cereal, bread and butter. About Glass of milk. 3 P.M. Piece of bread and butter. 267 CONVULSIONS. [Nine-year-old Child.] MAY EAT. Meats and Fish. AVOID. Broiled, boiled, baked, roasted: chops, steak, roast beef, game, sweetbreads, chicken, brains, broiled tripe, white fish, white meat of turkey, plain boiled ham, raw oysters, crisp bacon. Fried foods of all kinds; all salt, preserved, canned and spiced meats and fish; tongue, goose, duck, tur- key, kidneys, stews; sardines, sal- mon, shell-fish, mackerel, pork, liver. Vegetables. Green vegetables and such as grow above ground—spinach, squash, peas, lettuce, celery, rhubarb, string beans, carrots, artichokes, beets, cress, eggplant, potato. Starchy vegetables and such as grow below ground—turnips, corn, garlic, onions. Fruits. Cooked and fresh fruits—oranges, pear, apple, peach, grapes, etc. Berries. Beverages. Water, tea, cocoa, chocolate, milk. All alcohol and malt drinks; all sweetened and acidulous drinks; coffee. Sundries. Bread, toast, zwieback, butter, sal- ads, eggs, clear soup or bouillon, custards and bread puddings, lim- ited amount of plain cake, plain molasses candy, chocolate candy, ice cream occasionally. Rich cake, pastry, pies, sweets, con- fectionery, spices, sauces, gravies, nuts, poulettes; all condiments, such as tabasco, catsup, horseradish, mustard, pepper, etc.; thick and cream soups; hot cakes, hot rolls, hot biscuits, waffles, muffins, candy, syrups; cheese. 268 CONVULSIONS. NINE-YEAR-OLD CHILD. (Continued.) Eat slowly. Eat at regular times and only three meals a day. May eat bread and butter and jelly at 3 P.M. Drink only limited quantities with meals. Have food prepared plain—omitting sauces, condiments, gravies. Eat at intervals of not less than four hours. Chew food thoroughly. Eat boiled, broiled, baked or roasted meats. One hour before each meal drink a glass of water. Do not eat mix- tures, such as hot followed by cold, or sweet and sour. Avoid all made dishes—stews, sauces, gravies. Breakfast. Eggs or cereal. Bread and butter, or toast. Fruit. Glass of milk. Dinner. Meat. Baked potato. Vegetable. Bread and butter, or toast. Pudding or custard. Supper. Vegetable. Bread and butter, or toast. Eggs (soft boiled), or Milk food, or Light meat. 269 ECZEMA, ASTHMA, LYMPHATIC DIATHESIS. [Eighteen-months-old Child.'] 7—7.30 A.M. Orange juice, or apple sauce, or prunes. 8 A.M. Breakfast. Cereal or egg. Milk. Bread and butter. 11 A.M. Water. 12 M. Dinner. (1) Meat (scraped beef, scraped chicken, chop, fish). Green vegetable. Baked potato. Custard. (2) Two to four ounces beef juice in above, instead of meat. 3 P.M. Milk, bread and butter or lady fingers, or Toast and butter and water. 5 P.M. Water. 6 P.M. (1) Milk toast, or (2) Soup containing cereal or vegetable, or (3) Cereal and milk, or (4) Egg and broth and vegetable. Green Vegetables. (Pureed for the present): Carrots. Peas. Spinach. Cooked celery. Artichokes. Asparagus. 270 ENTEROPTOSIS. [ Thirteen-year-old Child.'] Avoid violent, strenuous exercise, strain, jumping, stretching. Wear abdominal support during day. Have foot of bed elevated at night. Keep bowels open so that they will not be dragged down by weight of contained matter. Avoid food which ferments or forms gases (which, by distending the intestines, pull on their attach- ments). Also avoid indigestible food (which, by disturbing diges- tion, may act similarly). This diet is to be followed for a number of months at least. This list is intended to furnish a good, nutritive diet, while elim- inating noxious foods. Simplicity in choice and moderation in quan- tity of viands taken, are aimed at, while preserving an abundance of good nourishing foods. MAY EAT. AVOID. Beef, mutton, lamb, etc.; all fresh meats simply cooked, preferably boiled, broiled, baked or roasted. Bacon, ham, poultry, fish, oysters, sweetbreads. Meats and Fish. Preserved, canned, spiced meats and fish; stews. Green vegetables which grow above ground, including peas, string beans, asparagus, artichokes, toma- toes, lettuce, celery, spinach, car- rots, potatoes (in limited quantity). Vegetables. Starchy vegetables, and in general those that grow under ground or create gas—turnips, cabbage, beets, cauliflower, dry beans, onions, gar- lic, corn, potatoes (except in lim- ited amount). Fruits, Fresh fruits—oranges, apples, pear, peach, grapes, and fresh fruits in general; nuts. Cantaloupe; any fruit that experi- ence has taught is not well toler- ated. Breads. Bread, zwieback, toast, lady fin- gers, plain cake. Rich cakes, pastry, pies, rich des- serts, confections, hot bread, hot rolls, etc. Sundries. Eggs in any plain form; cottage cheese, salads, cooked cereals in ordinary quantity; plain consomme or broth. Excess of candy, sweets, ices, etc.; cheese (except cottage cheese); sauces, gravies; condiments—mus- tard, catsup, horseradish; uncooked cereals; soups—all rich, cream or fatty soups. 271 GASTROENTERITIS. Chronic Gastro-Intestinal Catarrh in Four-year-old, Ill-nourished, Anemic Child. Breakfast. Orange juice. Cereal and milk, or egg and milk. Bread and butter. Dinner. (1) Light meat. Potato. Bread and butter. Apple sauce. (2) Brains. Green vegetable. Bread and butter. Custard. (3) Scraped beef. Potato. Bread and butter. Lady fingers, or Plain cake. (4) Sweetbreads. Vegetable. Bread and butter. Pudding. (5) Fish. Potato. Bread and butter. Apple sauce. (6) Chicken. Vegetable. Bread and butter. Jelly. (7) Chop. Bread and butter. Pudding. 3.30 P.M. Milk. (1) Cereal. Milk. Bread and butter. (2) Cereal. Broth. Bread and butter. Supper. (3) Egg. Milk. Bread and butter. (4) Milk toast. 272 GASTRO-ENTERITIS. (Continued.) MAY EAT. Meats and Fish. Sweetbreads, brains, chicken, squab, steak, roast beef, scraped beef, fish with white flesh. Meat may be broiled, boiled, baked or roasted. Vegetables. Asparagus tips, artichokes, cooked celery, potatoes, rice, macaroni, peas, string beans, spinach, beets, lettuce cooked like spinach, French carrots. Desserts. Custard, floating island, tapioca, rice and sago puddings, lady fingers, angel cake, blanc mange, fresh and cooked fruit. Milk and Milk Foods. Give cooked cereals only. Milk toast, farina, cornstarch, arrowroot. Cereals should be such as do not have grits or husks. Eggs. Soft boiled or poached, but not fried. Bread and Butter. Toast, graham crackers, zwieback. No hot rolls, or hot bread. Soups. Clear soups, bouillon, beef tea, mutton broth, consomme, chicken soup, beef juice. But no rich, cream or fatty soups. Soups may be thickened by having a cereal cooked in them. TO BE AVOIDED. All fried or spiced viands; all preserved, canned or salted foods. Nuts; fruits and vegetables having husks or kernels (as corn), to- matoes, pickles; melons, berries; preserves, confections, candies, rich desserts, pies, pastries; condiments (mustard, mayonnaise, etc.) ; sauces, stews; all shell-fish. Food should be prepared plain—never fried—no made gravies or sauces. Water should be taken freely between meals. 273 INDIGESTION, CONSTIPATION. [Night Terrors. Four-and-ci-half 1 Year Old Child. 7 A.M. Juice of one orange, or Six prunes cooked and put through sieve. 8 A.M. Breakfast. Bowl of cooked cereal (farina or oatmeal or cream of wheat). One slice white bread with plenty of butter. Half a glass of milk. 11 A.M. Glass of water. Noon—Dinner. Chop, finely cut; or scraped meat. Green vegetable (spinach finely divided, or car- rots pureed, or artichoke or peas or asparagus tips or cooked celery root). Bread and butter. Custard or pudding of tapioca or sago, or Apple sauce or baked apple. 3.30 P.M. Piece of bread and butter with honey or jelly. A little milk. 5 P.M. Glass of water. 6 P.M. Supper. Broth. An egg soft boiled, poached or scrambled. Bread and butter. A small baked potato. 274 INFANT FEEDING. REGULATING DIET. Seven-weeks-old Infant. Weight. 10 Pounds 7 Ounces. Not Thriv- ing on Modified Milk Formula. Trial Formula: Whole milk, 12 ounces. Water, 24 ounces. Feed 4y2 ounces every three hours; 7 bottles in twenty-four hours. After three days, weight 10 pounds 4 ounces—equals loss of 3 ounces; baby constipated. Formula Improved: Whole milk, 14 ounces. Water, 24 ounces. Feed 4y2 ounces—three-hour intervals—7 bottles in twenty-four hours. Four days later, weight 10 pounds 4 ounces; baby constipated; no loss. Formula Modified by Addition of: 1 ounce of cane sugar. Rules for feeding unchanged. Seven days later, weight 10 pounds 11 ounces—equals gain of 7 ounces in seven days. METHOD OF INSTITUTING PROPER FEEDING. Baby is now on correct formula. METHOD OF MODIFYING FORMULA TO MEET CHANGING NEEDS OF BABY. (1) Add 1 ounce milk to formula each week for the next four weeks. (2) Add y2 ounce milk to formula each week after five weeks, until baby is 6 months old. This will provide a formula of half milk and half water when baby is 6 months old. (3) The sugar may be gradually withdrawn from the formula as more milk is added. (4) When baby weighs 12y2 pounds, feed 5 ounces at each feeding. When baby weighs 15 pounds, feed 6 ounces at each feeding. (5) Water: 2 to 3 ounces of water to be given twice daily, prefer- ably about 11 A.M. and 5 P.M. 275 INFANT FEEDING. BOTTLE FED. Four-months-old Baby. Weight, IDA Pounds. Was Not Thriving on Modified Milk Formula. Present Formula Agrees. Method of De- veloping Formula. Present Formula: Milk 1214 ounces Cream 2>y2 ounces Water 22 ounces Baby is receiving 7 bottles, each 4% ounces, in twenty-four hours. (1) Withdraw 1% ounces of cream and add iy2 ounces of milk. (2) One week later withdraw 2 ounces cream and add 2 ounces milk. Formula Will Then Be: Milk 16 ounces Water 22 ounces Baby will receive 7 bottles, each 4% ounces, in twenty-four hours. (1) Add to formula 1 ounce milk weekly until a quart of milk (32 ounces) is used—never feed more than 1 quart milk daily. (2) Take away from formula y2 ounce water weekly until baby receives whole milk—that will be when baby is approximately 1 year old. When the baby weighs pounds, feed 5 ounces When the baby weighs 15 pounds, feed 6 ounces Between these weights gradually increase the amount. When the baby weighs 16 pounds, feed 6*/2 ounces When the baby weighs 17 pounds, feed 7 ounces 276 INFANT FEEDING. BOTTLE FED. (Continued.) When baby is 6 months old, begin to give orange juice. Begin with 1 teaspoonful—this should be given (undiluted) one hour be- fore the second morning feeding. When baby takes this amount well, gradually increase the amount, until the juice of one medium size orange is given. If there is a tendency to constipation, prune juice may be sub- stituted for orange juice; apple sauce also may be given. When baby is 8 months old, begin to feed cereals. Cereals should be well cooked: smooth cereals, such as farina, cream of wheat, prepared barley. Feed the cereal at the 9 A.M. feeding. Begin with one teaspoon- ful of the cooked cereal, to which has been added sufficient of the bottle due at that feeding to make a thin gruel; add a little sugar. When the baby takes this cereal well, gradually increase the amount until a goodly portion of cereal is given. After the cereal give balance of bottle (at first while baby is receiving only very small amounts of cereal). As the amount of cereal is increased, withdraw the bottle gradually so that this feeding will ultimately consist of cereal to which has been added a small amount of milk and a small drink of milk. Water should be given freely between feedings. 277 INFANT FEEDING. UNDER WEIGHT. REGULATING. Seven-and-a-half-months-old Baby. Weighty 11 Pounds. Is Consti- pated. Gets One-half Teaspoonful Milk of Magnesia Daily. Present Formula: Milk 24 ounces Water • 16 ounces Lime water 1 ounce Baby gets 7 bottles, of a trifle less than 6 ounces each. Feed 5 ounces at three-hour intervals—6 A.M., 9 A.M., 12 M., 3 P.M., 6 P.M., 10 P.M., 2 A.M. Method of Modifying Formula: Add y2 ounce milk to formula every Sunday, until 32 ounces are used. Withdraw 1 ounce water from formula every Wednesday. Thus, when baby is 1 year old she will be receiving whole milk. When baby is 9 months old, omit y2 ounce of lime water. When baby is 10 months old, omit all lime water. Begin cereals now. Cereals: Robinson’s prepared barley, farina, cream of wheat, Quaker oats, cornstarch. Cereal is to be cooked thoroughly in water until gruel is made. Feed the cereal at the second morning feeding—that is, 9 A.M. Begin with a flat teaspoonful of the cooked cereal; add to this a small amount of the formula contained in the 9 A.M. bottle; then give the rest of this bottle. When a teaspoonful of gruel is taken well, increase the amount, first to 2 teaspoonfuls, then to a tablespoonful, then to 2 tablespoon- fuls and so on, until a good sized portion of gruel is given. As the quantity of gruel is increased, reduce amount of formula given at this feeding so that ultimately this feeding will consist of a bowl of mush with a small amount of formula. 278 INFANT FEEDING. UNDER WEIGHT. (Continued.) After it is found that the gruel agrees, begin fruit juices: orange juice, prune juice, apple sauce. Fruit juice should be given one hour before the second morning feeding. Begin with one teaspoonful of orange juice and gradually increase amount until the juice of an ordinary sized orange is given. Do not sweeten the orange juice and do not add water to it, but give it plain. When baby is constipated, give a small quantity of prune juice. At 11 A.M. and 5 P.M. feed 2y2 ounces of water. Water may be given also at other times. When baby weighs I2y2 pounds, feed 5y2 ounces in each bottle. When baby weighs 15 pounds, feed 6 ounces in each bottle. This diet should be sufficient until the baby is 1 year old. 279 [Child Twelve to Fifteen Months] Old. INFANT FEEDING. TRANSITION IN BACKWARD CHILD. 7 A.M. Eight ounces of milk. 9 A.M. Fruit juice. Begin with one teaspoonful orange juice every second day. If that agrees, give it every day, then gradually increase amount until the child gets the juice of an ordinary size orange. (Do not sweeten.) 10 A.M. Cereal and milk. Give thoroughly cooked farina, barley or oats. All cereals are to be smooth, strained if necessary. As baby grows, give larger portions of cereal and less milk, until the meal is: cereal with milk and a small drink (two to three ounces) of milk. 1 P.M. A drink of water. 2 P.M. Beef juice or soft egg. Baked potato. Custard or apple sauce may be given with this meal (give very little). Beef juice: At first give one teaspoonful; gradu- ally increase until baby gets two ounces. Baked potato may begin now: at first one tea- spoonful ; gradually increase until the baby gets a fair size potato. Milk: For the present you may give a little milk at this meal, but gradually eliminate it so that this meal will have no milk. Begin egg; give egg one day and beef juice the next day. 5 P.M. A drink of water. 6 P.M. Milk toast and milk. 280 INFANT FEEDING, TENDENCY TO INTESTINAL FERMENTATION. Seven-year-old Child.' Excluding MiTk and Milk Foods. (1) One soft boiled egg. One cup cocoa made with water. Bread and butter. Orange juice. Chop. Asparagus or artichoke. Bread and butter. Broth. Rice. Bread and butter. (2). Cereal, with butter and sugar or salt. Bread and butter. Chicken. Green vegetable. Bread and butter. Orange juice. Baked potato. E gg. Bread and butter. Cake or lady fingers. Breakfast. Dinner. Supper. (3) Scrambled egg. Cocoa made with water. Bread and butter, and Jelly. Fish. Cooked celery root or car rots or spinach. Zwieback. Blanc mange. Soup, alphabet or rice. Toast. Cooked fruit. (4) Boiled egg. Toast. Tea. Bread and butter. Apple sauce. Light meat. Baked potato. Bread and butter. Pudding. Junket. Bread and butter. Lady fingers. Breakfast, Dinner. Supper. (5) Crisp bacon. Bread and butter. Cocoa. Scraped meat or steak. Light, green vegetable. Bread and butter. Fruit juice. Egg. Broth. Bread and butter. Lady fingers. (6) Cereal. Bread and butter. Cocoa made with water. Egg or light meat. Baked or mashed potato. Bread and butter. Pudding. Broth. Cereal. Breakfast, Dinner. Supper. 281 MALNUTRITION. [Five-and-a-half-year-old Child. 1 Under Weight. Anorexia. \ AVOID. MAY EAT Meats and Fish. Broiled, boiled, baked, roasted: steaks, chops, roast beef, game, chicken, sweetbreads, brains, lamb, turkey, fresh fish. All salt, preserved, canned or spiced meats and fish; tongue, goose, duck, kidneys, stews; salmon, shrimp, lobster, crab, sardines, mackerel. Vegetables. All green vegetables—spinach, let- tuce, asparagus, artichokes, celery, rhubarb, string beans, peas, carrots, eggplant, potatoes. Cucumbers, beets, cabbage, corn, garlic, onions, tomatoes; sweet and sour vegetables; vegetables with rich sauces; cauliflower, sprouts. Fruits, Orange juice, baked apple, apple Fresh and cooked fruits, except sauce, prune juice. those named. Beverages. Water, tea, cocoa, milk, chocolate. All alcoholic and malt drinks; all sweetened drinks. Sundries. Bread, toast, zwieback, moderate amount butter, clear soups, eggs, meat juice gravy, cereals, cottage cheese, plain cake, ice cream (rarely), limited amount of mo- lasses candy or chocolate. Cakes, pies, pastries, sweets, con- fections; spices, sauces, gravies; condiments, poulettes; all thick and cream soups; hot cakes, hot rolls, hot biscuits; strong cheese. 282 MALNUTRITION. (Continued.) TYPE MEALS. Breakfast. Egg or mush. Bread and butter. Glass of milk. Fruit. Dinner. Meat. Vegetable. Potato. Bread and butter. Pudding or custard. Supper. Soup. Vegetable. Cereal. Bread and butter. 3 P.M. A glass of milk and bread and butter. When egg is given for breakfast, cereal may be given for supper. When cereal is given for breakfast, egg may be given for supper. A glass of water at 11 A.M. and 4 P.M. 283 ]_Ten-year-old Child.'] MALNUTRITION. TYPE MEALS 7 A.M. One glass water. 8 A.M. Breakfast. Two eggs. Two pieces bread and butter or toast. Cup of cocoa. 11 A.M. Glass of water. 12 M. Luncheon. Chops or chicken or other plain meat. Baked potato. Green vegetable. Bread and butter. Cooked fruit. 3 P.M. One glass of buttermilk, or Milk with one tablespoonful of lime water. 5 P.M. Glass of water. 6 P.M. Supper. Fish with white flesh, or light meat, or eggs. Green vegetable. Bread and butter. Pudding or custard. 9 P.M. Malted milk. 284 MARASMUS. [Twelve-months-old Child,\ Weighing 9 Pounds. J 6 A.M. Milk: 4% ounces of formula. (For 6 months old child.) 9 A.M. Fruit juice: Orange juice: Begin with one teaspoonful and gradually increase amount until the baby gets the juice of an ordinary sized orange: it should take several months before that amount is given. Apple sauce or baked apple: Small quantities may be given instead of orange juice. Prune juice: (It is to be remembered that prune juice is more laxative than other fruit and may accordingly be given when needed.) 10 A.M. Egg (coddled): Begin with one-half teaspoonful of yolk and increase amount given very gradually. When a teaspoonful of the yolk is given add a teaspoonful of the white, then gradually increase both yolk and white until one-half an egg, and later a whole egg, is given. Milk: 4% ounces of formula. 1 P.M. Water. 2 P.M. Baked potato: Begin with one teaspoonful and gradually increase the quantity given until a small potato is given. Beef juice: Begin with one teaspoonful and gradually in- crease the quantity given until two ounces are taken. Milk: For the present, part of a bottle may be given at this meal, but gradually reduce the amount so that this meal will include no milk. 5 P.M. Water. 6 P.M. Cereal : Begin with one teaspoonful of cooked cereal (e.g farina), and gradually increase the quantity until a goodly portion is given. A little later various cereals may be given, such as farina, strained barley, strained oats. As the baby grows give larger portions of cereal and less milk, and a small drink (2 to 3 ounces) of milk. 10 P.M. Milk: 5% ounces of formula. Bread crumbs soaked in milk may be given with the breakfast and with the supper. When baby weighs 10 pounds, give 5 ounces in 6 A.M., 10 A.M. and 6 P. M. bottles. When baby weighs 10 pounds, give 5% ounces in 10 P.M. bottle. When baby weighs 11 pounds, give 514 ounces in 6 A.M., 10 A.M. and 6 P.M. bottles. When baby weighs 11 pounds, give 5% ounces in 10 P.M. bottle. 285 MILK INTOLERANCE. [Two-year-old Child.] 7—8 A.M. Egg or cereal with butter and salt or sugar (without milk). Bread and butter. Broth, eight ounces. 11 A.M. Water. 12 M. Meat, beef juice, egg, or fish with white flesh. Meats: Scraped beef, chop, steak (finely divided), sweetbreads, brains, chicken. Fish: sole, halibut, etc. Green vegetable: Peas, string beans, artichokes, carrots, asparagus tips, beets, cooked celery, spinach, lettuce (prepared like spinach). Baked potato. Bread and butter. 2.30 P.M. Water. 3 P.M. Cup of broth. Bread and butter. 5 P.M. Water. 6 P.M. Broth and cereal. Bread and butter. Green vegetable. The 3 P.M. feeding may be omitted as soon as enough is taken at other times. 286 MILK INTOLERANCE. Restricted Diet. Child, Two 1 and-a-half Years Old. 7—8 A.M. Orange juice. Cereal. Milk. Bread and butter. (1) Beef juice. Potato. Bread and butter. Apple sauce. (2) Brains. Green vegetable. Bread and butter. Custard. 12 Dinner. (3) Scraped beef. Potato. Bread and butter. Lady fingers, or Plain cake. (4) Sweetbreads. Vegetable. Bread and butter. Pudding. (5) Fish. Potato. Bread and butter. Apple sauce. (6) Chicken. Vegetable. Bread and butter. Jelly. (7) Chop. Bread and butter. Pudding. 3 P.M. Milk. (1) Cereal. Milk. Bread and butter. (2) Cereal. Broth. Bread and butter. 6 Supper. (3) Milk toast. 287 MILK TOLERANCE LIMITED. Child Two-and-a-half I Years Old. Breakfast. (1) Cereal. Cup cocoa made with water. Bread and butter. Orange juice. Chop. Asparagus or artichoke. Bread and butter. Broth. Rice. Bread and butter. (2) Cereal and milk. Bread and butter. Milk. Chicken. Green vegetable. Bread and butter. Orange juice. Baked potato. Cereal. Bread and butter. Cake or lady finger. Dinner. Supper. (3) Cereal. Cup cocoa made with water. Bread and butter. Jelly- Fish. Cooked celery root or car- rots or spinach. Zwieback. Blanc mange. Soup with alphabet or rice in it. Toast. Cooked fruit. (4) Cereal. Toast and tea. Bread and butter. Apple sauce. Light meat. Baked potato. Bread and butter. Pudding. Junket. Bread and butter. Lady fingers. Breakfast. Dinner. Supper. (5) Crisp bacon. Bread and butter. Cocoa. Scraped meat or steak. Light, green vegetable. Bread and butter. Fruit juice. Cereal. Broth. Bread and butter. Lady fingers. (6) Cereal. Bread and butter. Milk. Cereal or light meat. Baked or mashed potato. Bread and butter. Pudding. Milk toast. Breakfast. Dinner. Supper. 288 RACHITIS. [ Ten-months-old Child.] 7—8 A.M. Milk formula. (Normal for child 10 months old.) 9 A.M. Fruit juice: Begin with one teaspoonful orange juice every second day. If that agrees, give it every day, then gradually increase amount until the juice of an ordinary size orange is taken. (Do not sweeten.) 10 A.M. Milk formula. 1 P.M. A drink of water. 2 P.M. Beef juice. Baked potato. Beef juice: At first give one teaspoonful, gradually increase until two ounces are taken. Baked potato: Begin now; at first, one teaspoonful; gradually increase until a fair size potato is taken. For the present give a little broth at this meal, but gradually diminish amount, so that this meal will contain no broth. 5 P.M. A drink of water. 6 P.M. Milk formula. 289 RACHITIS, ATHETOSIS. Rachitic Child, I'wo] Years Old. (1) One soft boiled egg. Cup cocoa made with water, Bread and butter. Orange juice. Chop. Asparagus or artichoke. Bread and butter. Broth. Rice. Bread and butter. Breakfast. (2) Cereal and milk. Bread and butter. Milk. Chicken. Green vegetable. Bread and butter. Orange juice. Baked potato. Egg. Bread and butter. Cake or lady finger. Dinner. Supper. (3) Scrambled egg. Cocoa made with water. Bread and butter. Jelly. Fish. Cooked celery root or car- rots or spinach. Zwieback. Blanc mange. Soup with alphabet or rice in it. Toast. Cooked fruit. (4) Boiled egg. Toast and tea. Bread and butter. Apple sauce. Light meat. Baked potato. Bread and butter. Pudding. Junket. Bread and butter. Lady fingers. Breakfast. Dinner. Supper. (5) Crisp bacon. Bread and butter. Cocoa. Scraped meat or steak. Light, green vegetable. Bread and butter. Fruit juice. Egg. Bread and butter. Broth. Lady fingers. (6) Cereal. Bread and butter. Milk. Egg- or light meat. Baked or mashed potato. Bread and butter. Pudding. Milk toast. Breakfast. Dinner. Supper. 290 RACHITIS. Three-and-a-half Year1 Old Child. 8 A.M. Breakfast. Orange juice or apple sauce or prunes. Cereal or egg. Bread and butter. Milk. 11 A.M. Water. 12 M. Dinner. (1) Meat. Green vegetable. Baked potato. Bread and butter. Custard. (2) Fish with white flesh, in above list instead of meat. 5 P.M. Water. 6 P.M. Supper. (1) Milk toast and vegetable, or (2) Soup containing cereal and vegetable, or (3) Cereal and milk and vegetable, or (4) Egg and broth and vegetable. Meat and Fish. Fish with white flesh, chicken, squab, chops, steak, roast beef. Meat may be broiled, boiled, roasted, baked. Brains or sweetbreads, cooked plain with salt and water or in soup. Scraped beef, make into ball and cook in dry pan. Green Vegetables. Asparagus tips, artichokes, cooked celery, potato, rice, macaroni, peas, spinach, French carrots, beets, lettuce cooked like spinach. The day egg is eaten for breakfast, cereal may be taken for supper. The day cereal is taken for breakfast, egg may be taken for supper. If three meals are insufficient, a piece of cake or bread and butter and jelly, may be taken about 3.30 P.M. Two warm baths weekly may be given. Breathing exercises morning and evening. Bowels should act daily; for this purpose increase amount of green vegetables and fruit. 291 RACHITIS, ANEMIA. [ Child Four to Six Years Old.~\ Meats and Sweetbreads, brains, chicken, fish with white flesh, Fish. squab, chops, steak, roast beef, scraped beef. Meat may be broiled, boiled, baked or roasted. Vegetables. Asparagus tips, artichokes, cooked celery, potatoes, rice, macaroni, peas, lettuce cooked like spinach, French car- rots, beets. Desserts. Custard, floating island, tapioca, rice and sago puddings, lady fingers, plain cake, blanc mange. Fruits. Baked apple, orange juice, apple sauce, cooked peach. Milk and Milk toast, farina, cornstarch, arrowroot. Cereals should Milk Foods, be such as do not have husks or grits. Give cooked cereals only. (Omit force, grape nuts, etc.) Eggs. Soft boiled or poached, but not fried. Bread and Stale bread and butter, toast, crackers, zwieback. (No Butter. hot rolls or hot bread.) Soups. Clear soup, bouillon, beef tea, mutton broth, chicken soup, consomme, beef juice, but no rich, cream or fatty soups. Soups may be thickened by having a cereal cooked in them (but strain out such cereals as pearl barley, which have kernels). To be All fried or spiced viands; all preserved or salted foods; Avoided. fruits or vegetables having husks or kernels (as corn), tomatoes, pickles, berries, preserves, confections, rich desserts, sweets, pastries, pies, condiments, sauces, stews, shell-fish, chocolate. TYPE MEALS. Breakfast. Egg or mush. Bread and butter. Fruit. Milk. Dinner. Meat. Vegetable. Potato. Bread and butter. Pudding or custard. Supper. Vegetable. Cereal. Bread and butter. 3 P.M. Glass of milk and bread and butter. When cereal is given for breakfast, egg may be given with supper, and vice versa. 292 RACHITIS. [Five to Six-year-old Child. ] MAY EAT. Meats and Fish. Sweetbreads, brains, chicken, fish with white flesh, squab, chops, steak, roast beef, scraped beef. Meat may be boiled, broiled, baked or roasted. Vegetables. Asparagus tips, artichokes, cooked celery, potatoes, rice, macaroni, peas, string beans, spinach, lettuce (cooked like spinach), beets, French carrots pureed. Desserts. Custard, floating island, tapioca, rice and sago puddings, plain cake, lady fingers, blanc mange. Milk and Milk Foods. Milk toast, farina, cornstarch, arrowroot. Cereals should be such as do not have grits or husks. Give cooked cereals only. (Omit force, grape nuts, etc.) Eggs. Soft boiled or poached or scrambled. Bread and Butter. Toast, graham crackers, zwieback, bread and butter. No hot rolls or hot bread. Soups. Clear soups, bouillon, beef tea, mutton broth, chicken soup, con- somme, beef juice. But no rich, cream or fatty soups. Soups may be thickened by having a cereal cooked in them. TO BE AVOIDED. All fried or spiced viands; all preserved or salted foods; nuts; fruits or vegetables having husks or kernels (as corn), tomatoes, pickles, berries, preserves; rich desserts, candies, pastries, pies; con- diments (mustard, mayonnaise, etc.), sauces, stews; all shell-fish. Food should be prepared plain—never fried—no made gravies or sauces. Eat slowly. Eat at intervals of not less than four hours. Water should be taken freely, especially before meals. Drink only limited quantities with meals. One hour before each meal, drink a glass of water. Eat roasted, baked, broiled or boiled meats. Do not eat mixtures, such as hot followed by cold or vice versa, or sweet and sour. Avoid all made dishes—stews, sauces, etc. 293 SCURVY, INFANTILE. BARLOW’S DISEASE. The diet for infantile scurvy is similar to that prescribed for rachitis: however, a few practical points are deserving of special mention: 1— Emphasis should be placed upon the value of fresh foods—fresh raw milk, fresh vegetables, fresh fruits, fresh beef juice, cereals, eggs. 2— When, owing to the tender age of the infant, general use of these foods is restricted, reliance must be placed upon fruit juice, and cereals. Cereal decoctions, as diluents for milk, are here valuable. 3— As infants suffering with infantile scurvy are usually undersize, the food should be regulated according to the weight rather than the age of the patient. 4— In later infancy and early babyhood more freedom may be al- lowed in the choice of foods. At this time apple sauce, gruels, beef juice, scraped beef, pureed vegetables, coddled egg, are available, but— 5— The existence of special conditions must always be taken into consideration and the diet must be regulated accordingly. For example, when constipation exists the diet prescribed will be quite different from that prescribed when diarrhea exists. Often these conditions occur alternately in a single patient and when they do, the diet must be modified to meet changing require- ments. Failure to observe this precaution may result in in- creased digestive disorder and so aggravate the disease. 6— Human milk is invaluable in some cases. 294 SCURVY, INFANTILE. BARLOW’S DISEASE. 'Eleven Months Old Infant. Weight 12% Pounds. Protrusion of Right Eye Due to Subperiosteal Hemor- rhage. Melena. Recovery. Formula: Raw whole milk (certified) 16 ounces Barley water 16 ounces Milk sugar 1 ounce Lime water 1 ounce Feed seven bottles, each containing 4y2 ounces, at 6 A.M., 9 A.M., 12 M., 3 P.M., 6 P.M., 10 P.M., 2 A.M. Fruit Juice: Orange juice or prune juice at 8 A.M. Begin with one teaspoonful and gradually increase amount until juice of a medium size orange is given. As a rule give orange juice but if constipation is present substitute prune juice. Water. Give water freely between feedings. Give 2y2 to 4 ounces water regularly at 11 A.M. and 5 P.M. On above regime infant showed slow but consistent im- provement : weight increased 2 to 3 ounces weekly and melena ceased, so— Cereal was added to diet in usual manner, namely, at second morning feeding, beginning with one teaspoonful cooked cereal (farina, prepared barley) and increasing amount as tolerance was shown until a good saucerful was given. At the same time the amount of formula given at this feeding was diminished and Formula was strengthened by adding 1 ounce milk weekly and dropping 1 ounce barley water weekly until whole milk was given. At that time sugar and lime water were omitted from formula. 295 SCURVY, INFANTILE. BARLOW’S DISEASE. One-year-old Infant. Weight, 14 Pounds. Helena. Malnutrition. - Anemia. Formula: Raw whole milk (certified) 24 ounces Cold boiled water 24 ounces Feed six bottles, each containing 5 ounces, at 6 A.M., 9 A.M., 12 M., 3 P.M., 6 P.M., 10 P.M. Fruit Orange juice, prune juice, apple sauce, to be given one Juice. hour before second morning feeding (give at 8 A.M.), beginning with small quantity and gradually increasing until liberal portion is given. Cereal. Begin with small portion of strained cooked cereal and gradually increase amount. It is advisable to vary the cereal—wheat, barley,' oats. At first give a bottle of formula with the cereal feeding, but as the portion of cereal is increased reduce the amount of formula given until this meal consists of cereal with a small drink of milk. Beef Juice. Begin with one teaspoonful and gradually increase amount until two ounces are given. At first milk for- mula also is to be given at this feeding (12 M.) but as amount of beef juice is increased and other viands are added, the amount of milk given should be proportion- ately reduced and ultimately entirely omitted. Broth and Mutton, chicken or beef broth, in which vegetables have Vegetable, been cooked and strained out, may be given instead of beef juice. The vegetables to be used are carrots, peas, artichoke, celery, spinach, string beans (no onion, garlic or cabbage). When broth is given, a quantity equal to the quantity of milk formula prescribed should be given and no milk should be given at that feeding. Broth should not be substituted at this feeding unless the infant is making adequate gain in weight. Egg May be given instead of beef juice. Begin with small (Coddled). quantity and gradually increase until whole egg is given, 296 SCURVY, INFANTILE. (Continued.) Potato. Baked: begin with one teaspoonful and increase amount until a whole small potato is taken. This should be given at the 12 M. feeding. Crumbs May be given—softened in milk or broth. Water. To be given freely between meals. DIETARY. 6 A.M. Formula, five ounces. 8 A.M. Fruit juice. 9 A.M. Cereal and milk. 11 A.M. Water, three ounces. 12 M. Beef juice, egg or broth. Baked potato. Milk (to be omitted when sufficient quantity other food is taken). 3 P.M. Formula, five ounces. 5 P.M. Water, three ounces. 6 P.M. Formula, five ounces. (Bread crumbs may be added to this feeding). 10 P.M. Formula, five ounces. Between 10 P.M. and 6 A.M., if baby is restless, water may be given. To modify formula to meet increasing needs of infant, add to formula one ounce milk weekly until 32 ounces are used, and drop one ounce water weekly until no water is used in formula. When baby weighs 15 pounds, feed 6 ounces in each bottle When baby weighs 16 pounds, feed 6y2 ounces in each bottle, When baby weighs 17 pounds, feed 7 ounces in each bottle. 297 SCURVY, INFANTILE. BARLOW’S DISEASE. Baby Eighteen Months Old. Weight, 22 Pounds. Pseudo-paralysis of Legs due to Sensitiveness of Hip Joints and Knees. Melena. Bleed- ing from Vagina. DIET LIST. 7.30 A.M. Apple sauce or fruit juice (of orange, prunes, pineapple). 8 A.M. Breakfast. Raw milk eight ounces. Bread and butter or toast and butter. Coddled or soft boiled egg or cereal. 12 M. Dinner. (1) Beef, lamb chop or chicken (scraped). Green vegetable. Baked potato. Bread and butter. Pudding of rice or sago or tapioca. (2) Two to four ounces beef juice instead of meat in above. (3) Soft boiled or coddled egg, instead of meat in above. 3.30 P.M. Eight ounces milk. Bread and butter or toast and butter. 6.30 P.M. Supper. Milk toast, or Cereal and milk, or Soup containing cereal or vegetable. 11 A.M. and , _ ,, hour to eight ounces of water. 5 P.M. & Give egg for breakfast one day and cereal next day. The day egg is given for breakfast, give cereal for supper. The day cereal is given for breakfast, give milk toast or broth for supper. Vegetables. Artichoke heart, pureed peas, asparagus tips, pureed celery root, pureed lettuce, pureed beet tops, pureed carrots, baked potato. Cereals. Cook thoroughly and give only smooth cereals— farina, cream of wheat, cornstarch, oats, prepared barley, etc. Water. To be given freely between meals, 298 SCROFULOUS DIATHESIS. [Seven-year-old Child.] MAY EAT. Meats and Fish. AVOID. Broiled, boiled, baked, roasted: steaks, chops, roast beef, game, chicken, sweetbreads, brains, broiled tripe, white fish, raw oys- ters, white meat of turkey. Fried foods of all kinds; all salt, preserved, canned and spiced meats and fish; tongue, goose, duck, tur- key, kidneys, stews; sardines, sal- mon, shell-fish, mackerel. Vegetables. Green vegetables and such as grow above ground—spinach, peas, let- tuce, celery, string beans, carrots, artichokes, cress, eggplant, potato, asparagus. All starchy vegetables and such as grow under ground—beets, turnips, corn, onions, garlic, dry beans, cu- cumbers, cabbage, cauliflower. Fruits. Cooked and fresh fruits—peach, Sweetened fruits, apple, pear, orange, grapes. Beverages. Water, mineral water, tea, milk, cocoa, buttermilk. All alcoholic drinks; all sweetened and acidulous drinks; coffee. Sundries. Bread, toast, zwieback, butter, sal- ads made with lemon, eggs, clear soup or bouillon, custards and plain puddings, pastes, limited amount of molasses candy, milk chocolate. Rich cake, pastry, pies; sweets, confectionery; spices, sauces, gra- vies ; nuts; poulettes; all condi- ments, such as mustard, catsup, tabasco; thick and cream soups; hot cakes, hot biscuits, hot rolls, muffins, waffles; cheese; syrups, candy. 299 SCROFULOUS DIATHESIS. (Continued.) TYPE MEALS. Breakfast. Eggs or cereal. Bread and butter, or toast and butter. Milk. Fruit. Dinner. Meat. Baked potato. Vegetable. Bread and butter, or toast and butter. Pudding or custard. 3 P.M. Glass of milk and piece of cake. (May be taken.) Supper. Cereal or eggs. Green vegetable. Bread and butter. Paste (spaghetti or macaroni), or potato. Cooked fruit or light pudding. At breakfast a little crisp bacon is desirable. When egg is given at breakfast, cereal may be given at supper and vice versa. Eat slowly. Eat at regular meal times and only three meals a day. Drink only limited quantities with meals. One hour before each meal take a glass of water. Have food prepared plain—omitting sauces, gravies, condiments. Chew food thoroughly. Eat roasted, baked, broiled or boiled meats. Do not eat mixtures, such as hot followed by cold, or sweet and sour. Avoid all made dishes—stews, gravies, sauces, poulettes. 300 TUBERCULOUS PERITONITIS. [Four-year-old Child.] Meat. Sweetbreads, brains, chicken, fish with white flesh, scraped chops, scraped steak, scraped roast beef. Meat may be boiled, broiled, baked or roasted. Vegetables. Asparagus tips, artichokes, cooked celery, potatoes, spinach, rice, macaroni, peas, string beans, French carrots. Desserts. Custard, floating island, tapioca and rice puddings, prune souffle, sago pudding, lady fingers. Fruit. Apple sauce, prunes, baked apples, orange juice. Milk and Milk toast, farina, cornstarch, arrowroot. Cereals Milk Foods, should be such as do not have grits or husks. Eggs. Soft boiled, poached, scrambled, omelette. Bread. Bread and butter, toast, graham crackers, zwieback. Soups. Clear soups, bouillon, beef tea, mutton broth, chicken soup, consomme, beef juice, but no rich, cream or fatty soups. Soups may be thickened by having a cereal cooked in them. Avoid. All fried and spiced viands; all preserved and salted foods; nuts; fruits and vegetables having husks or ker- nels, such as corn; tomatoes, pickles, beets, berries; preserves, candies, confections, rich desserts, pastries, pies; condiments, sauces, stews; all shell-fish. But a limited amount of clear jelly, chocolate candy or plain cream or molasses candy or syrup, may be taken. Food should be prepared plain, never fried; no made gravies or sauces. Water should be taken freely. One hour before breakfast, orange juice. Breakfast. Cereal and milk, bread and butter, or Egg, bread and butter, milk. Luncheon. Meat, potato, vegetable, custard. 3 P.M. Glass milk, bread and butter, or fruit and crackers. Supper. Cereal and milk, green vegetable, bread and butter; or Soup and egg, green vegetable, bread and butter; or Beef juice, green vegetable, bread and butter. 301 INDEX. Part I. PAGE Acetonuria cereals in 180, 181 in diabetes 42 post-operative 180 Acidosis in diabetes 42 prevention of 180 Acute Disease: diet in Bright’s disease 126 nephritis 124 stage of colitis 34 Adolescence normal diet 152 obesity 169 Albuminuria. See Nephritis. with anemia 142 with diabetes and nephritis 57 with heart disease 92, 175 with neurasthenia 142 with obesity 175, 177 Alcoholic Gastritis 63 Alimentary Glycosuria 65, 66 Anemia clerk, milk intolerance 10 with dysentery 59 with goiter 70 with myocarditis 85 with nephritis 92 with neurasthenia 140 in nursing mother 155 secondary to residence in the trop- ics 8 society woman, dietetic errors 2 society woman, neurasthenia 4 stenographer 6 secondary 1 Apoplexy 13 Appendicitis (patient not operated) . 12 Arteriosclerosis general principles of diet 14 classification of foods 15 typical diet list No. 1 16 typical diet list No. 2 18 Asthma bronchial 19 bronchial, reflex, temporary diet .. 21 bronchial, reflex, permanent diet . 22 PAGE Athletic Heart 90 Atony of intestine 193 of liver 114 Beriberi. Introduction vi Biliary Calculus 109 110 Blood Pressure (diet for high) arteriosclerosis 17 athletic heart 90 gouty diathesis 75 nephritis 124 Bright's Disease acute 126 with cardiac insufficiency 132 chronic 128, 129, 130 with diabetes 133 toxic 127 Calculus 109, 110 Caloric Value of Food vi in diabetes 50 method impracticable 203 in obesity 162 Cardiac Diseases. See Heart Dis- ease Carlsbad Cure 114 Catarrh gastric 94 Catarrhal Jaundice 93 Chicken Pox 62 Chlorosis 24 school girl 26 Chronic Disease: diet in appendicitis 12 dysentery 59 gastritis 63 indigestion .. 97, 98, 99, 100, 102, 106 nephritis . 125, 128, 129, 130, 132, 133 Circulatory System See Anemia See Arteriosclerosis See Heart Disease Cirrhosis of kidney 129 of liver Ill 303 INDEX. page Colitis mucus, general principles 33 diet for acute irritative stage 34 diet for stage of subsidence 35 diet for stage of quiescence 36 diet for all symptoms have sub- sided 38 diet for permanent 39 Compensation : loss of in elderly woman 89 in middle aged man 81 in nephritis 132 Congestion of the Liver 114 Constipation with impaired digestion 29 with unimpaired digestion 28 with skin diseases 185 with toxemia 193 Contracted kidney 129 liver Ill Convalescence: diet in after fevers 196 after operations 180, 181 COPRAEMIA 193 Cystic Calculus 110 Debility anemia, malnutrition, neurasthenia 40 Depressive Insanity 108 Diabetes starvation treatment 42 general principles 42 first stage 43 second stage 44 classification of foods 46 type meals 47 tolerance for carbohydrates .... 48 comments 49 dietetic treatment general principles 51 “A” (stage of glycosuria) 52 “B” (after free from sugar) .. 53 tolerates carbohydrates except sugar, hyperacidity 54 complicated cases 56 and hemiplegia 58 and nephritis 57 and obesity 57 renal 133 Diarrhea chronic 59 with indigestion 106 Diathesis gouty 74, 75, 77, 78 lithemic 109, 110 Diet: Digestibility Factor in vi PAGE Dilated Heart in college professor, 81 in elderly woman 89 Diphtheria 62 Drug Addict 179 Duodenum ulcer of 197, 199 Dysentery chronic amoebic with anemia 59 with indigestion 106 Dyspepsia. See Indigestion. Enteric Fever 195 Exercise in adolescence 169 in cardiac cases 82, 85, 87, 91 in obesity 163 in arteriosclerosis 17 Excitative Depressive Insanity .. 108 Exophthalmic Goiter 73 Fattening Diet. See Malnutri- tion. for frail young mother 60 for glycosuric patient 66 Fatty Heart 83 liver 112 Febris Carnis 196 Fever eruptive 62 typhoid 195 Flatulence. Introduction vi cabbage group gas formers 95 condiment irritants 95 milk a gas former vi onion group gas formers 95 Gas Forming Foods cabbage group vi milk vi Gastric Ulcer 197, 199 Gastritis chronic alcoholic (traveling man) . 63 Gastroptosis adult with impaired digestion 64 German Measles 62 Glycosuria alimentary, hyperacidity 65 alimentary, liberal diet to increase weight 66 Goiter non-toxic, obese woman 68 non-toxic, anemia, malnutrition .. 70 toxic, delicate young woman .... 71 exophthalmic, with cardiac insuf- ficiency 73 304 INDEX. PAGE Gout 74 Gouty Diathesis 75 obese man 78 obese woman 77 Gouty Kidney 129 Gravel 110 Hardening of Arteries. See Ar- teriosclerosis. Heart Disease : Diet in athletic heart in youth 18 years old 90 fatty heart, obese man 83 general principles 79 myocarditis, adult male . 86 myocarditis, anemic adult 85 myocarditis, loss of compensation, woman 89 valvular 132 compensatory failure 81 with chronic nephritis 132 with goiter , 73 with nephritis and anemia 92 with obesity 175, 177 Hemiplegia 58 Hepatitic cirrhosis Ill congestion 114 torpidity 114 Hyperacidity with diabetes 54 Icterus, Catarrhal 93 Indigestion 94 chronic, good digestive powers .. 102 chronic, dysentery 106 general considerations 94 gastric, patient tolerates milk 96 gastric, milk intolerance 97 gastric, chronic, temporary diet .. 98 gastric, hyperacidity with pyrosis 99 intestinal, chronic for quiescent periods 100 reflex, symptomatic 103 smoked excessively 105 with gastroptosis 64 with malnutrition 118, 120 with skin diseases 185 Insanity excitative, depressive, loss of weight 108 Interstitial Hepatitis Ill Interstitial Nephritis active 130 chronic 129, 133 Intestinal Stasis 193 Intolerance for Milk vi See Index, Part II. PAGE Irritant Foods. See Index of Foods. Jaundice, Catarrhal 93 Laparotomy diet after 180, 181 Laxative Diet in intestinal sluggishness 28, 29 in skin affections 185 in toxemia 193 Lithemia 109 Lithiasis cholelithiasis 110 nephrolithiasis 110 Liver cirrhosis of, with ascites Ill congested 114 fatty 112 Malnutrition adult 116 due to chronic indigestion 118 impaired digestion 120 professional man 121 clerk 10 school teacher 122 stenographer 6 with anemia 2, 6 . with anemia and neurasthenia . 4, 140 with goiter 70 Measles 62 Metabolism Introduction i obesity 162 Mucus Colitis. See Colitis. Myocarditis 85, 86, 89 Nauheim Baths 178 Nephritis acute nephritis, general principles . 124 acute Bright’s disease 126 acute toxic 127 active chronic interstitial 130 chronic nephritis, general principles 125 chronic Bright’s disease 128 chronic interstitial 129 chronic with cardiac insufficiency . 132 chronic interstitial, renal diabetes . 133 nephritis and cardiac diseases 92 nephritis and diabetes 57 nephritis and neurasthenia 142 nephritis and obesity 175, 177 Nephrolithiasis 110 Nervous Diseases nervous heart disease 90 nervous indigestion 197 305 INDEX. page Neurasthenia and visceroptosis 138 anemia, chronic nephritis 142 following ovariotomy, obesity .... 136 malnutrition, anemia 122, 140 neurasthenia 134 Normal Diet adult 144 adult, careful diet 148 adult, tendency to obesity 150 for adult male 146 puberty 152 Nursing Mother frail and anemic 155 with too concentrated milk 154 Nutritious Diet adult business woman 160 adult male stock-broker under nerve tension 158 illnourished adult 156 Obesity adolescent girl 169 elderly woman, impaired circula- tion 178 kidney and heart complications, middle aged man 175 obesity, general principles 162 obesity 164 obesity in adult male 165 renal and cardiac affections, woman stenographer 177 unoccupied woman past forty ... 171 woman 35 years old 167 260 pound female clerk 168 260 pound, 50 year old man 173 and fatty heart 83 and gout 77, 78 and neurasthenia 136 Operations post-operative dietaries 180, 181 Opium Addict chronic indigestion 179 Paralysis 58 Percentage Formula Impractic- able, Introduction, Part II. Post-operative Dietaries 180, 181 Puberty 152, 169 Pyloric Stenosis adult 182 Quality of Food 162 Ration in Obesity 162 Renal Calculus 110 Renal Diabetes 133 PAGE Renal Disease. See Nephritis. Rest Cure Diet 183 Roughage Diet in constipation 28, 29 in mucus colitis 33 Rubella 62 Rubeola 62 Scarlet Fever 62 Scurvy fresh food in vi Senile Heart 89 Skin Affections constipation and defective metabo- lism 185 Small Pox 62 Smoker’s Heart 90 Starvation Treatment of Diabe- tes 43 to 50 Stasis intestinal 193 Stenosis pyloric 180 Stimulating Diet 60 year old man, indigestion 187 Stomach dilated 188 ulcer of 197, 199 Stone 110 Strengthening Diet ill nourished, broken down farmer 191 strengthening diet 189 Tension arterial see Heart Disease nervous 158 Tobacco Heart 90 Tolerance for Carbohydrates in diabetes 44 milk tolerance 96 Toxemia intestinal stasis 193 Toxic Nephritis 127 Typhoid Fever 195 Ulcer duodenal or gastric ulcer, tempor- ary diet 197 permanent diet 199 Uric Acid Diathesis 109, 110 Urine See Diabetes 43, 58, 133 See Glycosuria 65, 66 See Nephritis . 124, 133 306 INDEX. page Urinary Calculus 110 Valvular Heart Disease 79, 81 Varicella 62 Variola 62 PAGE Visceroptosis 138 Vitamines, Introduction vi Whiskey in typhoid fever 195 Part II. DIETS FOR INFANTS AND CHILDREN IN HEALTH AND DISEASE. page A.—Diet in Health. Introduction 203 Feeding During 1st Year 209 breast feeding (with artificial feeding) 209 infant 1 month old 211 infant 2 months old 212 infant 3 months old 213 infant 4 months old 214 infant 5 months old 215 infant 6 months old 216 infant 7 months old 217 artificial feeding 218 newborn 1st day 218 newborn 2d to 7th day 218 infant 2d week 219 infant 3d week 219 infant 4th week 219 infant 1 month old 220 infant 2 months old 221 infant 3 months old 222 infant 4 months old 223 infant 5 months old 224 infant 6 months old 225 page Artificial Feeding (continued). infant 7 months old 226 infant 8 months old 227 infant 9 months old 228 infant 10 months old 229 infant 11 months old 230 Feeding During 2d Year (Baby- hood) 231 baby 12 to 18 months 233, 234 baby 18 months to> 2 years .. 235, 236 Diet 2d to 15th Year (Baby- hood, Childhood, Adoles- cence) 237 baby 2 years old 239 baby 2 to 6 years old 240 baby 3 years old 241 baby 3 to 6 years old 242 baby 4 to 6 years old 243 baby 5 to 6 years old 243 baby 6 years old 244 Diet 7th to 12th Year (Child- hood) 245 Diet 12th to 15th Year (Adoles- cence) 246 INDEXED BY DISEASES page B. Diet in Disease 248 Acidosis child 4 years 251 child 5 years 252 Acute Infectious Diseases 62 Anemia child 10 months 253 child 4 to 6 years 292 child 8 to 12 years 254 child 10 years 255 Anorexia child 5l£ years 282 Appendicitis (chronic) child 10 years 256 page Appetite absence of, 282 Asthma child 18 months 270 Athetosis child 2 years 290 Backward Infant 12 to 15 months old 280 Barlow's Disease 296 Caloric Method Impracticable ... 203 Catarrh, Intestinal 272 307 INDEX. page Carious Teeth child 8 years 257 child 10 years 259 Chicken Pox 62 Chorea child 8 years 260 child 11 years 262 Constipation child 4J4 years 274 child 5 to 7 years 264 child 7% months 278 Convulsions child 21 months 265 child 3 years 266 child 4 years 267 child 9 years 268 Cyclic Vomiting 251, 252 Development, Retarded 253, 280 Diathesis lymphatic 270 scrofulous 299 Diphtheria 62 Eczema child 18 months 270 Enteroptosis child 13 years 271 Fermentation, Intestinal 281 Fevers 62 Gastro-enteritis child 4 years 272 German Measles 62 Growth, Retarded 253, 280 Hemorrhage from intestine 295 subperiosteal 295 from vagina 298 Indigestion child 4% years 274 Infantile Scurvy 296 Infant Feeding regulating diet, infant 7 weeks old 275 developing formula, infant 4 months 276 regulating diet infant 7% months 278 regulating diet, 12 to 15 months .. 280 regulating diet, milk intolerance, child 2Y2 years 287 regulating diet, milk tolerance limited, child 2% years 288 excluding milk and milk foods, child 7 years 281 Infectious Diseases 62 PAGE Intestinal catarrh 272 fermentation 281 Intolerance, Milk 286, 287, 288 Laxative Diet 264 Lymphatic Diathesis child 18 months 270 Malnutrition child 5Yi years 282 child 10 years 284 Marasmus child 12 months 285 Measles 62 Melena 295 Milk Intolerance child 2 years 286 child years 287 child 2% years (limited) 288 Nervous Diseases athetosis 290 convulsions 265, 266, 267, 268 pseudoparalysis 298 Night Terrors 274 Percentage Method 203 Peritonitis, Tuberculous 301 Rachitis child 10 months 289 child 2 years 290 child 3% years 291 child 4 to 6 years 292 child 5 to 6 years 293 Regulating Diet. See Infant Feeding. Retarded Development 253, 280 Scarlet Fever 62 Scrofulous Diathesis child 7 years 299 Spasm. See Convulsions. Teeth, Carious child 8 years 257 child 10 years 259 Tuberculous Peritonitis child 4 years 301 Underweight Infant ... 280, 282, 284 Weaning 204, 211, 212, 213, 214, 215, 216, 217 Weight in Infancy 205 308 INDEX. INDEXED BY AGES. PAGE B. Diet in Disease Seven Weeks infant feeding, regulating diet .. 275 Four Months infant feeding, method of develop- ing formula 276 Seven and One-half Months infant feeding, regulating diet .. 278 Ten Months anemia 253 rachitis 289 Twelve Months regulating diet 280 marasmus 285 Fifteen Months regulating diet I 280 Eighteen Months asthma 270 eczema 270 lymphatic diathesis 270 Twenty-one Months convulsions 265 Two Years athetosis 290 milk intolerance 286 rachitis 290 Two and One-half Years milk intolerance 287 milk intolerance limited 288 Three Years convulsions 266 Three and One-half Years rachitis 291 Four Years acidosis 251 anemia 292 PAGE Four Years (continued). convulsions 267 gastro-enteritis 272 rachitis 292 tuberculous peritonitis 301 Four and One-half Years constipation 274 indigestion 274 Five Years acidosis 252 constipation 264 rachitis 292, 293 Five and One-half Years anorexia 282 malnutrition 282 Six Years rachitis 292, 293 Seven Years constipation 264 infant feeding, excluding milk and milk foods 281 scrofulous diathesis 299 Eight Years anemia 254 carious teeth 257 chorea 260 Nine Years convulsions 268 Ten Years anemia 255 appendicitis (chronic) 256 carious teeth 259 malnutrition 284 Eleven Years chorea 262 Thirteen Years enteroptosis 271 309 INDEX OF FOODS. Albuminous Foods page permitted in diabetes 43 to 58 restricted in arteriosclerosis 14 to 18 in fevers 195, 196 in gout and gouty diathesis 74 in lithiasis HO in nephritis 128 tissue builders in adolescence 246 in childhood 243 Alcohol food in diabetes 43 52 in typhoid fever I95 forbidden in arteriosclerosis 15 in gout 74 in nephritis 131 stimulant in cardiac disease. in typhoid fever 195 Bread almond biscuits and bread in diabetes 45 bran bread in constipation 29 crumbs in marasmus 285 fresh bread bad in digestive disorders 101 graham bread 70 hot bread forbidden 101, 103, 129 rye bread 29 stale bread preferable 105, 185 toasted bread 105 whole wheat bread in constipation 29 Carbohydrates cereal decoctions 205 in acidosis 251 in babyhood 233 in convalescence 180 in fevers 195 in infancy 205, 227 not in diabetes 44 restrict in obesity 170 Coffee in cardiac disease 89 in diabetes 52 in nephritis 128 in normal diet 144 310 INDEX. Coffee (continued). page in obesity 166 not in childhood 244 in digestive disorders 100 in hepatic disorders Ill restrict in arteriosclerosis 14 high blood pressure 14 Hag permissible in arteriosclerosis Concentrated Foods (Cheese, Preserved Fish and Meat, Salted Fish and Meat, Shell Fish). forbidden in arteriosclerosis 14 in digestive disorders 101 in lithiasis 110 in nephritis 129 permitted in diabetes 46 Condiments (Catsup, Cayenne, Curry, Horseradish, Mustard, Spices, Tabasco, Worcestershire, etc.). permitted in diabetes 52 prohibited in other ailments 101 salt restricted in arteriosclerosis 15 Cream in diabetic diet 52 in nutritious diet 156 in ulcer diet 197 not in obesity 173 Desserts blanc mange 273 cake in nutritious diets 159 candy 41 confectionery prohibited in diabetes, in indigestion 52, 101 custards and puddings (arrowroot, bread, corn starch, rice, sago, tapioca, etc. may be flavored with chocolate, etc.). in childhood 244 in convalescence 180, 181 in malnutrition . 119 in normal diet 148 prohibited in diabetes 54 prohibited in obesity 166 fruit. See Fruit. ice cream in normal diets 244 in nutritious diets 61, 183 prohibited in diabetes 52 prohibited in indigestion 101, 102 prohibited in obesity 170 ices prohibited in diabetes 46, 53 in digestive disorders 101, 102 in obesity 170 pastry prohibited in digestive disorders 101 311 INDEX. Desserts (continued). page pastry prohibited in obesity 174 pie prohibited in digestive disorders 101 pie prohibited in obesity 174 rich, permissible in malnutrition rich, prohibited in most diseases Drinks acid, prohibited in gastric indigestion 98 albumin water in digestive disorders, fevers, gastroenteritis alcoholic. See Alcohol. alkaline in arteriosclerosis 17 in diabetes 43 in gastric disorders 97, 99 in gout 74 in lithiasis 110 in nephritis 124 beer in laxative, nutritious diet 32 beer contraindicated in diabetes 46 brandy. See Alcohol. buttermilk, diuretic 129 champagne forbidden in diabetes 46 claret wine. See Wine, below. chocolate in childhood 244 chocolate in nutritious diets 160 cocoa in childhood 244 cocoa in nutritious diets 160 coffee. See Coffee. effervescing, contraindicated in ulcer 199 fancy, prohibited in chlorosis fancy, prohibited in indigestion 105 iced, prohibited in cardiac 132 iced, prohibited in digestive disease 101 lemonade in convalescence 62 lemonade in fevers 62 malt drinks prohibited in diabetes 52 milk. See Milk. mineral, still, in convalescence. mineral, still, in digestive disorders 100 mineral, still, in fevers 62 orangeade 195 peptonized in cardiac disease 80 peptonized in typhoid 195 tea interchangeable with coffee, except tea permissible in digestive and hepatic disease 101, 111, 112 toast water in convalescence. water 129 whiskey. See Alcohol. wine, dry, permitted in diabetes 53 wine, sweet, prohibited in diabetes 46, 54 312 INDEX. Drinks (continued). page with eggs in convalescence and nutritious diets 123 milk punch, eggnog. egg with orange juice sherry and egg Eggs in normal diet 144 in anemia 11 in diabetes 54 limit in nephritis 128 Fat (Butter, Cream, Cream Cheese, Lard, Meat Fats, Olive Oil, etc.). avoid cooked 104 in anemia and chlorosis 24 in diabetes 46 in malnutrition : 120 in normal diet 146 not in obesity 167 vitamine in vii codliver oil vii Fish fresh white fleshed in normal diets and obesity 148, 170 fried, forbidden in digestive disorders 105 rich fish prohibited in arteriosclerosis 14 rich fish prohibited in obesity 170 preserved, spiced, salted, in oil forbidden. in arteriosclerosis 14 in cardiac disease 89 in digestive disorders 101, 107 gout 75 in lithemia 110 in nephritis 129, 132 in obesity 170 permissible in diabetes 46 permissible in glycosuria 66 shell fish prohibited in arteriosclerosis 16 Fowl chicken in childhood 244 in convalescence 181 in diabetes 52 in digestive disease 105 in heart disease 84 in normal diet 152 limit in arteriosclerosis 14 limit in nephritis 130 dove, same indications as chicken grouse, same indications as chicken pigeon, same indications as chicken 313 INDEX. Fowl (continued). page quail, same indications as chicken squab, same indications as chicken duck, domestic, avoid in arteriosclerosis 15 domestic, avoid in digestive disorder 101 domestic, avoid in gout 77 domestic, avoid in nephritis 129 domestic, avoid in obesity 170 domestic, permitted in diabetes 53 wild, permitted in diabetes 52 wild, permitted in digestive disorders 102 wild, permitted in obesity 166 wild, restricted in arteriosclerosis, etc 16 goose, tame and wild same indications as duck. turkey permitted in diabetes 52 permitted in normal diets 144 restricted in arteriosclerosis. restricted in lithiasis 110 restricted in nephritis 129 preserved and smoked fowl permitted in diabetes 52 preserved and smoked fowl prohibited in arteriosclerosis, gout, etc 16, 74 Fruit dried (dates, figs, prunes, raisins, etc.) 28 forbidden in diabetes 46 forbidden in digestive disease 101 forbidden in obesity 166 good in constipation 31 canned (same indications as dried). fresh (raw and cooked) 252 acid contraindicated in indigestion. indicated in constipation 31 contraindicated in diarrhea, dysentery 59 contraindicated in digestive disorders 103 restricted in diabetes 52 scurvy cured by fresh fruit 294 spiced and sweetened prohibited in diabetes 46 spiced and sweetened prohibited in obesity 166 tart given in diabetes 133 jellies in childhood 244 jellies in convalescence 180, 181 jams prohibited in digestive disorders 109 juice in childhood 251 in constipation 31 in convalescence 181 in fevers 62 in rachitis 289 in scurvy 294 nuts, permitted in constipation, diabetes. Prohibited in gout, etc. 314 INDEX. Fruit (continued). page berries, constipating, forbidden in appendicitis 12 berries, constipating, forbidden in digestive disorders 101 Game wild, in diabetes 52 wild, in normal diet 144 wild, restricted in nephritis 129 Gravies meat juice permitted in childhood 234 meat juice permitted in diabetes 46 rich, prohibited in arteriosclerosis 16 rich, prohibited in childhood 245 rich, prohibited in digestive disorders 104 rich, prohibited in nephritis 129 thickened prohibited in diabetes 46 Infant Foods, useful as substitute for milk 207 Meat baked, roasted, boiled broiled, steamed 100 in normal diets 152 canned, in diabetes 53 canned, not in arteriosclerosis 16 canned, not in nephritis 131 concentrated, pork, sausage, corned beef, tongue. cook, how to cook 169, 235 extracts in diabetes '• 46 fresh in anemia 7 in adolescence 246 in childhood 244 in diabetes 46 in scurvy 294 restricted in arteriosclerosis 14 restricted in fever 196 restricted in lithiasis 110 restricted in nephritis 131 fried, excluded in digestive disorders 105 jelly in convalescence 180, 181 liver prohibited in diabetes 46, 53 preserved, salted, smoked, spiced in diabetes 46 salted, smoked, spiced not in arteriosclerosis 16 salted, smoked, spiced not in digestive disease 107 salted, smoked, spiced not in gout 74 salted, smoked, spiced not in heart disease 84 salted, smoked, spiced not in lithiasis 110 salted, smoked, spiced not in nephritis 131 salted, smoked, spiced not in obesity 163, 166 raw, in anemia 272 red, in anemia 4 stewed prohibited in digestive disorders 100 315 INDEX. Meat (continued). page sweetbreads prohibited in diabetes 46, 53 tissue builder 246 Milk addition of alkali may increase digestibility 124 boiling destroys vitamines vii boiling may increase digestibility 80 condensed, may be used as temporary infant food 206 condensed, contains sugar, must restrict in diabetes 46 cow’s milk in infant feeding 203 for adults vi for children 244 in convalescence 180, 181 in duodenal ulcer 197, 198 in fevers 195 in gastric indigestion 96 in hyperacidity 197, 198 in malnutrition 117 in nephritis . 124, 126 in normal diet 148 contraindicated in colitis 36 contraindicated in dysentery 59 contraindicated in obesity 166 drugs may be excreted in milk 154 Eiweissmilch in fermentative diarrhea 206 Eiweissmilch in hospital practice 207 goat’s milk in infancy 206 human. See Human Milk. human, best food in infancy 204 human, best food in Barlow’s disease 294 human, best food in rachitis. intolerance in adults 80, 124 intolerance in children 288 Koumiss 126 malted milk 129 peptonized in typhoid 195 raw, contains vitamines vii raw, in Barlow’s disease 294 skimmed milk in fat indigestion 206 soups. See Soup 124 substitutes for milk. See Infant Foods. tolerance. See Indices, Parts I and II. Pastes, (carbohydrates) macaroni, spaghetti, vermicelli. Saccharine, may be used for sweetening in diabetes and obesity 46 Salads all oily salads prohibited in arteriosclerosis, gout, obesity, etc., (for patients with such conditions may be prepared without oil), fruit, according to indications for fruits, but are less easily digestible. 316 INDEX. Salads (continued). page meat, fish, shell fish, salads are more indigestible forms of meat, fish and shell fish. are prohibited in arteriosclerosis 15, 17 are prohibited in childhood 245 are prohibited in gout, are prohibited in lithiasis. are prohibited in nephritis 129 are prohibited in obesity 266 are permitted in diabetes, vegetable, more indigestible than plain vegetables. Sausage, a concentrated, preserved food. contraindicated in arteriosclerosis 14 in gout 74 in lithiasis 110 in nephritis 129 in digestive disorders 105 permitted in diabetes 52, 53 Seeds, foods with husks and seeds. prohibited in digestive disorders 104 Soup clear in childhood 245 clear in fevers 62 clear in digestive disorders 105, 197 cream, in diabetes 53 cream, not in obesity 112, 166 marrow in anemia 7, 26 meat soup in diabetes 46 meat soup restrict in arteriosclerosis . 14 meat soup restrict in gout 74 meat soup restrict in nephritis 129 milk soup in nephritis 124, 129 milk soup in typhoid 196 oyster soup 196 peptonized in fevers 195 peptonized in typhoid 195 thickened in convalescence 180, 196 thickened in malnutrition 60 thickened forbidden in diabetes 53, 54 vegetable soup in Barlow’s disease 296 vegetable soup in diabetes 53 vegetable soup in nephritis 126 Starches. See Carbohydrates. Sugar forbidden in diabetes 46 forbidden in obesity 167 restricted in arteriosclerosis 17 restricted in gout 74 317 INDEX. Sugar (continued). page useful in infant feeding 205 useful in nutritious dietaries 159 sweets (candy, confectionery, drinks sweetened with sugar or syrup, fruits sweetened or preserved with sugar, honey, jelly (fruit), jam, sweetened desserts). forbidden in diabetes 46 forbidden in obesity 166 restricted in arteriosclerosis 15 restricted in gout 74 useful in malnutrition 255 useful in youth 247 Vegetables acid, forbidden in gastric disorders 101 cabbage group, gas formers 95 canned, if fresh not available. cooked, in normal diets 144, 152 dried, forbidden in diabetes 45 dried, forbidden in obesity 164 fibrous, in constipation 28 fresh, contain vitamines vi in Barlow’s disease vi, 296 in rachitis 291, 292, 293 in scurvy v; garlic for intestinal worms. green, in anemia i 2 in chlorosis 26 in childhood 245 in constipation 28 in diabetes 46 in nephritis 124( 128 normal diets 144 152 in obesity 164 in rachitis 291, 292, 293 not in gastric disease I97 ipg not in enteric disease 197 ipg onion group, irritants, cause flatulence, laxative vj pureed, in digestive disorders 97 107 preserved, forbidden in digestive disorders. raw, in anemia 2, 5 in constipation 30 in scurvy vj forbidden in digestive disorders 105 106 200 starchy, in acidosis 180, 181, 251, 252 in convalescence 180, 181, 196 in normal diets I44 prohibited in diabetes 46, 52 prohibited in obesity 163 318 INDEX. Vegetables, Starchy (continued). page prescribed in malnutrition 116, 119, 120 prescribed in fattening diets 60, 116, 119, 120 VitamineSj deteriorated by prolonged cooking vii Water, a laxative 29 alkaline. See Drinks and 126 aperient, useful in constipation 18 aperient, useful in diabetes. aperient, useful in lithemic conditions 18, 114 best taken before meals 94 cold water in fevers 62 decoctions of cereals valuable in infant feeding 203, 205 barley water neutral 205 oat water laxative 205 rice water constipating 205 diuretic, most important 126 effervescing waters 126, 129 lime water in infant formulae 206 taken before meals washes stomach 94 taken with meals in small quantity may aid digestion 94 taken with meals in large quantity interferes with digestion 94 319