WHAT TO EAT 
IN HEALTH AND DISEASE BY THE SAME AUTHOR 
VITAMINES: Essential Food Factors 
“An excellent book . . . can be recom- 
mended to patients who ask for a source 
of information on this popular subject.” 
—Journal of the American Medical As- 
sociation. 
GLANDS Ik Health akd Disease 
“May be thoroughly recommended. 
One of the most useful books on the 
subject in the English language.”—Sir 
W. M. Bayliss, Professor of Physiology, 
University of London. 
E. P. DUTTON & COMPANY WHAT TO EAT 
IN HEALTH AND DISEASE 
BY 
BENJAMIN HARROW, Ph.D. 
ASSOCIATE IN PHYSIOLOGICAL CHEMISTRY, COLLEGE OF 
PHYSICIAN8 AND SURGEONS, COLUMBIA UNIVERSITY 
Author of “Vitamines,” “Glands in Health 
and Disease,” Etc. 
NEW YORK 
E. P. DUTTON & COMPANY 
681 FIFTH AVENUE Copyright, 1923, 
BY E. P. DUTTON & COMPANY 
All Rights Reserved 
Printed In the United States of America PREFACE 
This book is intended as a guide for those who 
want to know what to eat and why. The more im- 
portant facts which have become established and 
theories which have been advanced during the last 
few years are included. The book is a non-technical 
but, I trust, strictly scientific account of our knowl- 
edge of foods. 
The chemistry, physiology and anatomy of the 
digestive tube are discussed in the last chapter. 
Some readers may want to begin the book by read- 
ing this chapter first. This would be an excellent 
plan for those whose knowledge of biology is still in 
its early stages. 
On the other hand, those readers who are in a 
particular hurry to apply the facts may start with 
Chapter 3, The Planning of Meals. 
I am indebted to the following: Professor Emil 
Abderhalden (Halle); Professor R. H. Chittenden 
(Yale); Dr. Casimir Funk (Columbia); Professor 
W. J. Gies (Columbia); Mrs. Carolyn S. Harrow; 
Dr. M. Hindhede (Copenhagen); Professor F. G. 
Hopkins (Cambridge); Dr. Max Kahn (Colum- 
bia) ; Professor E. Y. McCollum (Johns Hopkins); 
Professor L. B. Mendel (Yale); Dr. T. B. Osborne 
V VI 
PREFACE 
(Connecticut Experimental Station); Mr. A. L. 
Robert; and Mrs. N. J. Wallerstein. 
Mr. Thomas Spector is responsible for the dia- 
grams in the last chapter. These diagrams are 
based largely on illustrations that may be found in 
Foster’s Elementary Physiology (Macmillan), 
Ritchie’s Human Physiology (World Book Co.), 
Davison’s The Human Body (American Book Co.), 
and Huxley’s Lessons in Elementary Physiology 
(Macmillan). 
Benjamin Harrow. CONTENTS 
CHAPTER PACE 
I. What to Eat 1 
II. What to Eat: Some Common Foods . . 32 
III. What to Eat: The Planning of Meals . 57 
IV. What to Eat: The Nursing Mother . 61 
V. What to Eat: Infant Feeding ... 65 
VI. Vegetarianism 75 
VII. Overweight and Underweight ... 82 
VIII. Constipation 90 
IX. Diseases Due to Faulty Diet .... 99 
X. Diet in Digestive Disorders .... 122 
XI. Diet in Some Common Diseases . . . 137 
XII. The Digestive Tube ...... 156 
Appendix . .... w ... . 195 
Index 197 ILLUSTRATIONS 
PHOTOGRAPHS 
PAGE 
Eussell H. Chittenden 1 
F. G. Hopkins 32 
Lafayette B. Mendel 57 
Emil Abderhalden 65 
E. V. McCollum 75 
M. Hindhede 99 
Casimir Funk 112 
Thomas B. Osborne 122 
FIGURES IN TEE TEXT 
FIGURE PAGE 
1. General Plan of the Body 160 
2. The Digestive Tube 162 
3. The Glands that Manufacture Saliva . . . . 165 
4. Several Types of Glands 166 
5. A Section of the Mouth and Nose .... 175 
6. The Stomach, Liver and Pancreas (Sweetbread) 176 
7. A Section of the Wall of the Stomach . . . 177 
8. Two Villi, Highly Magnified 183 
9. Structure of the Wall of the Small Intestine . . 185 WHAT TO EAT 
IN HEALTH AND DISEASE RUSSELL HENRY CHITTENDEN, DIRECTOR OF THE SHEFFIELD SCIENTIFIC 
SCHOOL, YALE UNIVERSITY. HIS NUTRITIONAL STUDIES ARE COUNTED 
AMONG THE SCIENTIFIC CLASSICS. WHAT TO EAT 
CHAPTER I 
WHAT TO EAT 
The question of what to eat involves much knowl- 
edge. You must know the composition of the food- 
stuffs ; you have to be familiar with the organs that 
digest them, and with the chemistry and physiology 
involved; you have to know the fate of these food- 
stuffs in the body, and how they affect the different 
organs of the body. Bitter experience, coupled 
with a peculiar something which for want of a 
better name we call “instinct,” have been our 
guides in the past; but since the days of Lavoisier 
nutrition has been a science, built on principles as 
sound (or unsound) as any other boasted science. 
Lavoisier. Lavoisier showed that substances 
were “burnt” in the body by absorbing oxygen and 
giving out carbon dioxide, in much the same way 
that a piece of wood or coal is burnt. With the 
help of his scales he introduced quantitative meas- 
urements. As the idea of quantity underlies all 
the sciences, we may justly speak of Lavoisier as 
1 2 
WHAT TO EAT 
the founder of the science of nutrition. Inciden- 
tally, he was the founder of the modern science of 
chemistry. But that is another story. 
Lavoisier lived in Paris in the days of the French 
Revolution. He was an aristocrat. He had been 
Farmer-general and tax-gatherer for the royal gov- 
ernment. Marat, “1’ami du peuple,” would have 
none of him. Lavoisier was an aristocrat; that was 
enough for one execution. But Lavoisier was a bad 
chemist in addition! “Lavoisier,” writes Marat, 
under the flattering title of “Modern Charlatans,” 
“the putative father of all the discoveries that are 
noised about, and having no ideas of his own, 
snatches at those of others; but having no ability 
to appreciate them, he quickly abandons them and 
changes his theories as he does his shoes.” Bloated 
aristocrat and poor chemist, away with him! And 
once again in the history of mankind a Galileo is 
made to suffer—this time not by an Inquisition and 
a Religion, but by the People and in the name of 
Freedom. A wise man of the times remarked, in 
private, that “it took but an instant to cut off his 
head; a hundred years will not suffice to produce 
one like it.” 
The calorie. From Lavoisier to the calorie is 
but a stepping-stone. As soon as you introduce 
the ideas “scale” and “quantity,” the question 
arises as to what unit of measurement is to be 
adopted. We have a foot for length and a pound WHAT TO EAT 
3 
for weight and a second for time; we shall now 
adopt the calorie as the unit of heat. This unit 
is the amount of heat necessary to raise the tem- 
perature of one kilogram (about two and one- 
fifth pounds) of water one degree (centigrade). 
Lavoisier has taught us that foods are “burnt” 
in the body. This means that, among other things, 
heat is evolved. Such heat, in turn, can be meas- 
ured in terms of calories. 
The average of thousands of experiments in dif- 
ferent parts of the world leads to a figure closely 
approximating 2700 as the number of calories per 
day “needed” by man. This is merely another way 
of saying that the average man “burns” enough 
food each day to yield 2700 calories, and therefore 
the body needs to be replenished by that amount. 
During the Great War—and to this day in parts 
of Russia and Austria, China and India, and 
among the very poor in every country—it was not 
always easy for man to procure enough food to 
yield 2700 calories. Some wise ones told him to 
chew his food longer than was his wont; others 
suggested certain plant products that make up in 
bulk what they lack in fuel value (clay in your 
coal as it were). The results, sometimes encour- 
aging at first, invariably ended in the same way: 
a lowering of the general resistance of the organ- 
ism, and therefore a greater susceptibility to dis- 
ease. Biochemists and bacteriologists, working 4 
WHAT TO EAT 
with rats and bacteria, might have prophesied some 
such result. Even bacteria refuse to thrive when 
undernourished! 
Holt, the children’s specialist, finds from his 
experience that a child one year old needs 100 cal- 
ories for every kilogram of body weight (the kilo- 
gram being two and one-fifth pounds), that the 
needs slowly decrease to 80 calories until the tenth 
year is reached, and that, after the growth cycle is 
completed, 44 calories per kilogram suffices. Dur- 
ing growth, substitution and addition of tissue 
are active; after the growth cycle has been reached, 
there is substitution only. 
The “new” The War has not only dethroned 
monarchs and broken up monarchies, but it even 
threatens to destroy our hitherto accepted food unit, 
the calorie. During the War the Austrian govern- 
ment, guided by the German government, which 
in turn was guided by Eubner and several other 
professors ordinarius from German universities, did 
not handle the food situation as wisely as it might 
have done. The armistice and the blockade but 
aggravated difficulties. At this point Pirquet, the 
famous Viennese pediatrist, came to the front. The 
Hoover Commission had undertaken to feed daily 
some 300,000 undernourished Austrian children. 
Pirquet suggested that in feeding these children 
the calorie as a unit be discarded and the “nem” 
substituted. The name “nem” is derived from the WHAT TO EAT 
5 
initial letters “nutrition,” “element” and “milk.” 
The Pirquet unit is one cubic centimeter (one- 
thousandth of a quart) of milk, which is equal to 
one “nem.” Roughly speaking, the Pirquet system 
is based on the following factors, sufficiently com- 
plex in themselves to make entertaining reading: 
1. There is a mathematical relationship be- 
tween the weight of a person and his sitting height, 
which may be expressed as ten times the weight, 
divided by the sitting height cubed, equals one 
hundred, if the person is in “normal” health; or 
10 X weight 
= 100. 
(sitting height)3 
The child is weighed and his sitting height meas- 
ured ; if by the use of the above formula the figure 
obtained is anywhere from 88 to 94 (instead of 
100), then Pirquet assumes that the child is un- 
dernourished. An obese child would show a figure 
above 100; possibly as high as 110. Hardly any 
child, no matter how thin, would give a figure much 
below 88. 
2. Pirquet’s second assumption is that there is a 
mathematical relationship between the sitting 
height and the absorptive surface of the alimentary 
canal, in that the square of the sitting height equals 
the absorptive surface. 
3. His third assumption is that the child needs  WHAT TO EAT 
6 
one “nem” for every square centimeter of surface. 
The total number of “nems” needed may therefore 
be calculated from (2). 
If these assumptions are accepted, (1) yields the 
data as to whether the child is undernourished, and 
(2) furnishes the data as to how many “nems” the 
child needs. Pirquet’s further assumptions that 
the protein should form ten per cent of the total 
diet, that the fat and the carbohydrate are inter- 
changeable (in that you can employ a high carbo- 
hydrate and low fat diet, or vice versa), and that 
it is important to include a food containing vita- 
mine A, give us the basis for a rational method of 
testing and feeding. It needs little scientific train- 
ing to apply the tables provided by Professor 
Pirquet. 
The “nem” system has been used in Vienna with 
marked success, and even in San Francisco Dr. 
Carter, a Pirquet disciple, claims to have applied 
it successfully. He writes: “The experience of 
Mr. Hoover and Professor Pirquet in Central 
Europe is ample evidence that the nutritional status 
of children fed by this method is markedly im- 
proved in a surprisingly short time. The sending 
of food for the relief of the children of Central 
Europe was highly commendable; in fact, it was 
one of the most generous things that history re- 
cords. Yet we should not overlook the fact that 
many of our own children, judged by the same stand- WHAT TO EAT 
7 
ards employed by the American Relief Adminis- 
tration, are in need of supplemental food.” What 
teacher, unfamiliar with the Pirquet system though 
he be, but familiar with the schoolchildren of this 
country, could not subscribe to this last sentence? 
The composition of food. Carbohydrates, fats, 
proteins, mineral salts, and water are the common 
constituents of food. We now have to add vita- 
mines to the number, and we have to consider, 
rather more carefully than was thought necessary, 
the composition or chemical make-up of the pro- 
tein. Though not usually included among food- 
stuffs, oxygen is in reality a very essential food. 
Without oxygen there can be no combustion or 
“burning” of foods in the body, just as without 
oxygen we can have no fires. With our usual ten- 
dency to emphasize the things that cost rather than 
the things that are essential (often, we must admit, 
a difficult separation), neither oxygen nor water 
receives its proper due. If anything, poor oxygen 
is neglected even more than water, for the State 
has devised a water-tax, but our legislators have 
yet to propose an oxygen-tax. Why scientists 
should complain because politicians are ignorant 
of science, I cannot well make out. Since oxygen 
is an element, and therefore cannot be divided into 
anything simpler, we need trouble ourselves no 
further about its composition. 
Carbohydrates. These are the primary energy 8 
WHAT TO EAT 
producers. The sugars (cane sugar, candy, jellies), 
starch (in grains, bread) and cellulose (in pota- 
toes, fruits and vegetables) are common examples. 
Various experiments have shown that though the 
fats and even a part of the protein molecule serve 
as energy producers, the complete absence of car- 
bohydrate from the diet gives rise to various dis- 
turbances. It should also be remembered that the 
laxative properties of food are largely due to the 
carbohydrates in them; and man when in normal 
health needs no other laxative than the food he 
eats. 
Fats. Butter is perhaps the commonest variety 
of fat. Various oils, lard, portions of meat, and 
cream, are other examples. It has already been 
pointed out that fats, like carbohydrates, are 
energy producers; but the fats act as the reserve 
forces. The carbohydrates are the active fuel 
producers and the first in the field; the fats are 
called upon when the carbohydrate supply is well- 
nigh exhausted. 
It may be asked, if both fats and carbohydrates 
are fuel producers, why must we have both of them? 
Why will not one or the other do? We have al- 
ready indicated that experience has taught us to 
include carbohydrates in the diet; and we have also 
indicated, but we ought to emphasize again, that 
carbohydrates are of value aside from their fuel 
properties. The intake of fats must also be con- WHAT TO EAT 
9 
sidered as a more complicated process than the 
mere addition of so much fuel. During the War 
the Germans attributed many of the consequences 
of undemutrition to lack of fats. Fats in foods 
invariably include a group of substances known as 
lipoids, which, from their great abundance in brain 
tissue and their presence in all cells, bespeak an 
importance for them. In addition to this, most fats 
have small quantities of one of the vitamines adher- 
ing to them. To wiiat extent the supposed indis- 
pensability of fats in the diet is due to the fat, and 
to what extent it is due to chemical impurities 
tenaciously adhering to it, is debatable. Drs. Os- 
borne and Mendel, the New Haven physiological 
chemists, have conducted several experiments with 
rats receiving diets adequate in every respect ex- 
cept that the amount of pure fat given to them was 
extremely small (it was found impossible to ex- 
clude traces of fat from the diet) ; the rats were 
kept many months and apparently thrived well. 
Since traces of fat still remained in the diet, the 
question whether fats are indispensable still re- 
mains to be answered. All that one can say is 
that if fats are necessary, the amount needed seems 
to be very small indeed. Such is also the opinion 
of the Danish investigator, Dr. Hindhede. 
The Japanese are notorious among races that 
include very little fat in their dietary; and unless 
we stretch our imagination to assume that their 10 
WHAT TO EAT 
stature may have suffered because of some possible 
connection between it and fat metabolism, they 
show no lack of health. 
There is, however, another side to the story that 
dietitians and social workers must not lose sight of, 
and that is the question of taste. Much of the food 
we Occidentals eat has the peculiar flavor we relish 
because of a liberal use of fats. Without them, 
food becomes monotonous, unrelished, unpalatable; 
glandular factories remain idle; enzymes are but 
slowly activated; the flow of digestive juice is de- 
layed ; and “digestive upsets” may result.1 
Protein. We cannot do without protein (of 
which large percentages of meat, fish, milk, and 
eggs, and smaller percentages of cereals and vege- 
tables, are examples) : so much is certain. To put 
it in a very elementary way, protein is the only 
one among our foodstuffs that contains nitrogen, 
and our tissues need nitrogen—not, unfortunately 
for our pocketbooks, in the free state such as we 
find it in the air, but in the combined and more 
expensive form of protein (or its decomposition 
products, the amino-acids). 
Having decided what, our total calorific needs are 
(probably in the neighborhood of 2800 calories), 
we must next decide how to apportion our food- 
is of the opinion that fat has an important influence 
on mineral metabolism, and that it increases the body’s resistance 
to disease; but these views have little experimental evidence to 
support them. WHAT TO EAT 
11 
stuffs; how much protein, and how much fat and 
carbohydrate are we to take? Lusk and Pirquet 
advise the use of ten per cent of our total food in 
the form of protein; the rest may be distributed 
among the fat and carbohydrate, with a decided 
preponderance in favor of the latter (perhaps one 
part of fat to ten parts of carbohydrate). But 
opinions differ very widely, and low and high pro- 
tein faddists flourish in all quarters of the globe. 
We shall say a word or two in favor of both sides, 
and then, like Sir Roger de Coverley, draw the 
conclusion that a happy medium is perhaps the best 
line for us to follow at present. 
Early advocates of a high protein diet were 
guided by the experience of mankind. Man was a 
flesh eater; he liked it well, and he apparently 
thrived; therefore flesh he shall have. Some pointed 
out that this reasoning had elements of fallacy in 
it. Man’s early ancestors were not flesh eaters, was 
the claim, and they were unquestionably much 
stronger physically than is present-day man. Others 
pointed out that many of man’s ailments are due 
to an abundance of meat in the diet. Still others 
hinted that the trouble was not with the amount, 
but with the kind of protein eaten. But man went 
—and still goes—much his own way, letting scien- 
tists dispute, eating meat if he had the money, and 
only going without it if he had not. Some statis- 
tics at this point are valuable to illustrate the di-  WHAT TO EAT 
12 
rect proportion that exists between the amount of 
meat consumed and the state of prosperity of a 
country. Before the War the consumption per 
capita per year (in pounds) was: England, 105; 
Belgium and Holland, 75; France, 74; Austria- 
Hungary, 65; Italy, 23. If a study of any one coun- 
try is made, we find an increased consumption of 
meat with succeeding years. In Germany, for 
example, where statistics have been accumulated 
with a care that only their pre-war officialdom was 
capable of, we find that in 1816 the consumption of 
meat was 30 (pounds, per capita, per year) ; in 
1840, 48; 1873, 65; 1892, 72; 1900, 102; and 1912, 
115. At this rate only a multiplication of great 
wars will send the curve on the decline again. 
What are we to argue from these statistics? 
Certainly not that meat is good for us because we 
eat more and more of it with each succeeding year. 
As well argue that candy is, because the amount 
consumed is still on the increase; and yet, obvi- 
ously, too much candy is harmful to the system. 
How are we to solve this perplexing problem? 
Some years ago, Professor Chittenden, the Yale 
physiologist, performed experiments on himself, 
on Yale athletes, and on a number of soldiers, that 
led him to conclude that a diet containing as little 
as one-fifth the usual amount of protein was suffi- 
cient for all wants. The criticism that the experi- 
ments lasted but a few months, and that therefore WHAT TO EAT 
13 
no conclusion drawn from them could be applied, 
no longer holds valid since the work of Dr. Hind- 
hede, to whom we shall now turn. 
Hindhede and a low protein diet. Hindhede was 
brought up in simple circumstances in Jutland, 
Denmark. Breakfast consisted of milk porridge 
and “beer-soup”; lunch, thick slices of bread, with 
a little butter, and sometimes a few thin slices of 
meat; and dinner, porridge, milk, cabbage, pea- 
soup, potatoes and bacon, sometimes fish, “and 
meat very rarely.” The main dish was potatoes; 
the eating of large quantities of them was much 
encouraged. Upon this menu Hindhede and those 
around him grew up and flourished. Then, when 
sixteen years old, he went to Copenhagen to study. 
There Professor Panum, a nutrition expert, in- 
formed a class of which Hindhede was a member 
that the minimum amount of protein that would 
suffice to support life in an adult man was 120 
grams (four and one-fifth ounces) per day. 
Panum further pointed out that since vegetable 
proteins are difficult to digest, and that therefore 
very large quantities of vegetables would have to 
be consumed to make up 120 grams of protein, it 
was necessary to obtain this protein in large meas- 
ure from the animal kingdom. This was simply 
another way that the good professor had of empha- 
sizing the importance of a liberal supply of meat in 
the diet. 14 
WHAT TO EAT 
This professorial advice clashed violently with 
Hindhede’s early experiences. He himself was a 
youth of more than the average vigor, and his fel- 
low West Jutlanders exhibited an energy that was 
actually “prodigious; they worked from 14 to 16 
hours per day.” What was true of the West Jut- 
landers was true of the Irish and the Japanese. 
“The Irish, who are notoriously potato eaters, are 
very virile, and in America, where they are often 
to be seen serving as policemen, their physical ap- 
pearance is very imposing.” The Japanese, whose 
diet is so largely vegetarian, possess uncommon 
powers of endurance. Prodigious West Jutlanders, 
Irish-American policemen, and hardy Japanese, all 
belied the teaching of Professor Panum. 
But Panum was a highly respected professor and 
full of knowledge. It would not do for a young 
medical student lightly to brush aside so eminent 
a scientist’s opinion. Hindhede therefore decided 
to follow Panum’s advice for a time. He ate in 
cheap restaurants in Copenhagen, and ordered 
double portions of a main course, so as to be sure 
to get more than the minimum amount of necessary 
protein, particularly meat. But with time he grew 
less muscular and weaker. When he returned to 
his native Jutland, Hindhede returned to butter, 
bread, potatoes, sugar and fruit. The transforma- 
tion was astounding. Despite much vigorous physi- 
cal exercise, such as gardening and cycling, his WHAT TO EAT 
15 
health, which had become poor in Copenhagen, was 
all that one could desire. 
“These experiments, which were afterwards re- 
peated with many variations, had convinced me of 
one fact, and that was that the little story of four 
and one-fifth ounces of protein is nothing but sheer 
fable; since which time—now some sixteen years 
ago [this was written in 1913]—very little meat is 
eaten in our house; most days we have none at all; 
and I am always exhorting my children to eat 
plenty of porridge, bread and potatoes, and very 
sparingly of meat, eggs, etc.” 
Hindhede’s interpretation of his experiences is 
not above criticism. On the face of it, eating meat 
in cheap restaurants and falling sick does not neces- 
sarily imply that you have indulged in an over- 
abundance of protein, but that you have eaten meat 
of poor quality. And then again, leaving dingy 
city quarters for the open country, working in your 
garden instead of poring over a volume, and eating 
bread, fresh butter, potatoes and fruit, instead of 
what you can get in a third or fourth-rate restau- 
rant, would improve the health of any man. While, 
therefore, this account of Hindhede proves little, 
and his interpretation is misleading, he did draw 
two conclusions that are of great importance: the 
average man consumes more animal protein, par- 
ticularly in the shape of meat, than is necessary, 
and he consumes less fresh vegetables and fruit 16 
WHAT TO EAT 
than is necessary. At one time Hindhede mini- 
mized the importance of milk, and still lightly 
brushes aside the function of eggs in nutrition. 
The outcome of recent vitamine studies has had 
the effect of placing milk and eggs, particularly the 
former, in the very forefront of nutritional require- 
ments. 
Milk and eggs, and to a less extent, bread, are 
rich in protein. Most of the protein requirements— 
all, in fact—can be derived from these foods; little, 
if any at all, need come from meat. Metabolic 
studies have shown that not proteins as such, but 
certain of their decomposition products, the amino- 
acids, are essential in the nutrition and growth of 
cellular structure. The various proteins differ from 
one another in the number and amount of these 
amino-acids that they yield when decomposed in 
the digestive tract. Experiments have shown that 
the essential amino-acids are more abundant in 
animal than in vegetable proteins. These animal 
proteins, however, need not be sought in meat; 
they are present in milk and eggs, to say nothing of 
other essentials, such as vitamines, which these 
foods contain. 
Food in Denmark during the Great War. As 
early as 1911 the Danish government,, influenced 
by a committee from the Department of Agricul- 
ture, placed a well-equipped laboratory at Hind- 
hede’s disposal, and when, during the late War, the WHAT TO EAT 
17 
Allied blockade began to affect neutrals as well as 
enemy countries, Hindhede was placed in charge of 
the supervision of food in Denmark. He and offi- 
cials under him were guided by the following con- 
clusions, the result of extensive experimental work 
in Hindhede’s laboratory: no attention was to be 
paid to the protein minimum; “it was held that the 
minimum was so low for man that it could not be 
reached, provided sufficient calories were fur- 
nished.” While the value of fat was not to be 
underestimated, “it was not considered as being 
necessary.” Bran was to be regarded as a valuable 
food, and one “well digested by man.” 
“As research has also shown that man can re- 
tain full vigor for a year or more on a diet of po- 
tatoes and fat, reliance was placed on our potatoes 
and the large barley crop, which was given to man 
and not to pigs, as heretofore, with the result that 
the pigs died of starvation but the people received 
sufficient nutrition. Furthermore, we ate all our 
bran ourselves. We not only ate whole rye bread, 
but we mixed all our wheat bran with the rye 
flour and were able to bake good bread in this 
way. The Germans were unable to bake good rye 
bread. Their bread was too sour and too soggy. 
We were fortunate in having more than a hundred 
years of experience in this direction. Our prin- 
cipal foods were wheat bran, barley porridge, po- 
tatoes, greens, milk, and some butter. Pork pro-  WHAT TO EAT 
18 
duction was very low; hence the farmers ate all the 
pork they raised, and the people of the cities or 
towns got little or no pork. Beef was so costly that 
only the rich could afford to buy it in sufficient 
amount. It is evident that most of the people were 
living on a milk and vegetable diet.” 
What were the results? Hindhede has tabulated 
the number of deaths (per 10,000 of the popula- 
tion) in Denmark since 1900. They are as follows: 
Epidemic 
Year 
All diseases 
diseases and 
Other 
tuberculosis 
diseases 
1900 
152 
46 
106 
1901 
151 
41 
110 
1902 
131 
30 
109 
1903 
142 
34 
108 
1904 
137 
36 
101 
1905 
148 
41 
107 
1906 
144 
33 
111 
1907 
145 
31 
114 
1908 
152 
35 
117 
1909 
142 
31 
111 
1910 
135 
26 
109 
1911 
148 
32 
116 
1912 
138 
30 
108 
1913 
130 
28 
102 
1914 
133 
27 
106 
1915 
134 
26 
106 
1916 
145 
35 
110 
1917 
123 
33 
90 
1917-1918 99 
27 
72 WHAT TO EAT 
19 
Food restrictions came into force in March, 1917, 
so that the year 1917 covers part of this period. 
The dates 1917-1918 represent from October 1 of 
one year to October 1 of the next—a period during 
which the restrictions had become very severe. 
Now let us interpret the table. The figures in 
the column headed “all diseases” show, with one or 
two exceptions, a pronounced decline as we pass 
downwards. This is what might be expected; mor- 
tality tables in every civilized country will more or 
less duplicate these figures. The lower death rate 
is, of course, due to our ever-increasing knowledge 
of a number of diseases. When, however, we sub- 
divide the figures in the first column in such a way 
as to include all those who died from epidemic dis- 
eases and tuberculosis under one heading, and 
“other diseases” under another, then some striking 
facts are brought out. Like the figures in the first 
column, those in the second show a gradual de- 
crease; but those in the third column are practi- 
cally stationary, except for the last two years. The 
data in the second column are what might have been 
anticipated. Decreased deaths are primarily due 
to decreases in the number of deaths from epidemic 
diseases. Since 1900 our knowledge of “other dis- 
eases” has not improved greatly; the third column 
shows figures that are more or less constant. 
But why the sudden drop in 1917 and 1917-1918? 
It can be attributed, claims Hindhede, to but one 20 
WHAT TO EAT 
thing: to the kind of food that the Danes were 
forced to eat during this time, and particularly to 
the low protein diet. 
These results, however, may be interpreted dif- 
ferently. “It must be remembered,” writes Hind- 
hede, “that we took the cereals and potatoes from 
the distillers so that they could not make brandy, 
and one-half of the cereals from the brewers, so 
that the beer output was reduced one-half.” This 
immediately suggests that decreased deaths due to 
diseases other than epidemic and those due to tu- 
berculosis, may have been due to a decreased con- 
sumption of beer and brandy. If, then, these sta- 
tistics do not easily convert us to Hindhede’s views, 
they certainly prove that meat, and large quanti- 
ties of protein, are wholly unnecessary in the diet. 
Mineral salts. These are the inorganic con- 
stituents popularly known as “ash.” Most of the 
elements included under this heading, such as 
sodium, potassium, and magnesium, are apparently 
needed in such small quantities that a person fails 
to get the amounts needed only in acute starva- 
tion. The fats, proteins, carbohydrates, and water, 
all contain small quantities of mineral matter, and 
only a total deprivation of food will stop the intake 
of these inorganic salts. But there are some in- 
organic constituents, like calcium, phosphorus, and 
iron, that man needs in fairly large quantities, and 
a poorly selected or restricted diet may be dis- WHAT TO EAT 
21 
tinctly deficient in these elements. How serious 
the situation is may be gauged from Professor 
Sherman’s conclusion, reached after an extensive 
investigation, that the average American dietary is 
of such a nature as to make it far more likely that 
people will suffer from an insufficiency of phos- 
phorus than from an insufficiency of protein. And 
it must be remembered that diseases due to malnu- 
trition are no less severe because the cause is to be 
traced to the absence of inorganic salts from the 
diet, rather than to the absence of protein or car- 
bohydrate. All are essential, ash as well as organic 
matter. In the plant world the farmer has long 
ago been taught to use an artificial fertilizer to 
make good the deficiencies of phosphorus, nitrogen, 
and potassium in the soil; another great war may 
make it necessary to introduce fertilizers into 
man’s diet. 
We do not intend to discuss all the various in- 
organic constituents found in the body and sup- 
plied by the food we eat. We shall merely confine 
ourselves to four elements that experience has 
taught us may be present in deficient amounts— 
iron, calcium, phosphorus and iodine. 
Iron. Though all the cells of the body contain 
traces of iron, the largest amount is found in the 
hemoglobin (blood pigment) of the red blood cells. 
The possible interrelationships of the weak, the 
pale, and the anemic persons, and the probable re- 22 
WHAT TO EAT 
lationship of these to lack of hemoglobin, has led 
to the development of the extensive field of iron 
therapy. As with vitamines and other scientific 
studies that strike the public fancy and the ad- 
vertiser’s eye, iron tonics have for a long time oc- 
cupied a generous share of the public’s curiosity. 
Plutarch’s Pills for Pale People need to be satir- 
ized as have been Broxopp’s Baked Beans for 
Babies. The tonics seldom do any good, and very 
often do very much harm. Whatever good they 
may do is probably due to things other than their 
iron content—and to an undiminished faith in the 
integrity of the advertiser. 
What are the possibilities of an iron cure in 
anemia? How may the iron content of the blood be 
increased? The Swiss and German schools, headed 
by Bunge and Abderhalden, have little faith in the 
efficacy of adding iron compounds to the diet, ex- 
cept in so far as they may act as general cell stimu- 
lants. Abderhalden has made the very pertinent 
observation that all this controversy as to how 
much, and in what form, iron should be taken, is 
really beside the point, since iron is but one of 
several factors necessary for hemoglobin formation. 
Hemoglobin is a complicated iron-protein com- 
pound, and it is just as necessary to procure the 
essential constituents that go to the formation of 
the protein part of the molecule as it is to procure 
the needed iron. It seems wisest, therefore, to get WHAT TO EAT 
23 
the element from the natural foods containing it. 
An educational poster prepared by the propaganda 
department of the American Medical Association 
—an eyesore to the advertising fraternity—reads, 
“Do not be misled by the claims of high iron con- 
tent for certain advertised foodstuffs; many foods 
contain them.” And then it proceeds to give a table 
of foods rich in iron: egg yolk, beans, entire wheat, 
lean beef, nuts, prunes, spinach, etc. The egg yolk 
is particularly rich in iron. 
The amount of iron in the body is not large— 
about one-tenth of an ounce. Not more than one 
two-thousandth of this amount is eliminated daily, 
so that the actual quantity of iron needed is small; 
but it must also not be forgotten that one of the 
richest of iron-containing foods, egg yolk, contains 
but one part of iron for every 12,500 parts of yolk. 
Milk is comparatively poor in iron. This seems 
rather strange at first sight, when we remember 
that milk is the sole source of nourishment of the 
infant. Light has been thrown on the subject by 
the discovery that, weight for weight, the infant’s 
tissues are much richer in this element than are 
those of the adult. The suckling animal stores 
iron, which is obtained from its mother even before 
birth, and makes use of this reserve supply during 
the first few months. This, of course, necessitates 
offering the mother food abundant in the element. 
Calcium. “The ordinary mixed diet of Euro- 24 
WHAT TO EAT 
peans and Americans,” writes Professor Sherman, 
“at least among dwellers in cities and towns, is 
probably more often deficient in calcium than in 
any other element.” If true, this statement calls 
for careful reflection. Two per cent of the body 
weight is in the form of calcium, and more than 99 
per cent of the total amount is found in bones. In 
the structure of bones calcium and phosphorus 
fight for supremacy: both are essential; when either 
is present in insufficient amount, or when either 
one or the other is imperfectly assimilated, we 
often get the picture of a “rickety” child—a child 
whose bones are soft and flexible. The most abun- 
dant source of calcium (or lime, as it is popularly 
called) is milk and its products. A little over a 
pint of milk a day is enough to supply all calcium 
needs.2 Vegetables, such as cabbage, turnips, and 
carrots, and fruits, such as the orange, are also 
rich in calcium. It is of importance to remember 
that bread and meat are particularly poor in this 
Element—another reason for adopting a varied 
diet. 
As with iron, so with calcium: the pregnant and 
the nursing mother need a relatively large quantity 
of this element. Let the slogan be “eggs for iron 
and milk for lime.” 3 
2 This should be increased to a quart a day in the case of chil- 
dren. 
8 In certain diseases the doctor may advise his patient not to 
eat eggs or drirk milk. If this is but a temporary procedure, the WHAT TO EAT 
25 
Phosphorus. Much of what has been said about 
calcium applies to phosphorus: both are essential 
elements; both take an active part in bone forma- 
tion; and the lack of either may manifest itself (in 
the child) in the disease called “rickets.” The 
phosphorus compounds of the body are more di- 
verse than those of calcium. Peculiar substances, 
known as lipoids, and found in every cell, contain 
phosphorus as a constituent. These lipoids are 
present in large quantity in brain tissue; hence 
“phosphorus for the brain.” Adding phosphorus 
to the diet no more converts the fool into the wise 
man than adding iron to the diet makes the sick 
man healthy; and yet phosphorus is present in 
brain tissue, and iron in blood. 
Forbes, an authority, says: “If the natural or- 
ganic phosphorus compounds [in foods] are not of 
superior usefulness [to inorganic compounds], then 
other nutrients associated with them in the natural 
foods are essential, and the result is to put a new 
emphasis on the value of the natural organic 
foodstuffs, as compared with inorganic or arti- 
ficially synthesized nutrients and certain manu- 
factured goods.” Cheese, eggs, beans and peas are 
rich in the naturally occurring phosphorus sub- 
patient need not worry. If, however, the eggs and milk are 
eliminated from the diet for a considerable length of time, then 
it becomes necessary for the physician to select the diet of his 
patient with the utmost care, so as to insure all elements that 
are indispensable. 26 
WHAT TO EAT 
stances. The egg, please notice, is rich both in 
iron and phosphorus. 
To sum up, we may say that since the body needs 
certain minimal amounts of inorganic constituents, 
an ample supply of these, preferably in the form of 
a mixed diet, is necessary. Further, such diseases 
as anemia and rickets, which are superficially at- 
tributed wholly to a lack of the elements iron, phos- 
phorus, and calcium, are of a more complex nature, 
and tonics help but little, if at all. The far more 
rational method of treatment is by an entire reor- 
ganization of the dietary regimen. 
Iodine. The importance of iodine as a constitu- 
ent of the thyroid, which in turn regulates much of 
our metabolic activities, has only lately been em- 
phasized.4 The prevalence of goiter among chil- 
dren and adults in the Great Lakes section of this 
country illustrates how the body may receive an 
insufficient supply of iodine; for the administra- 
tion of this element (usually in the form of one 
of its compounds, such as sodium iodide) brings 
about a cure. 
Vitamines.5 Vitamines—the word “vitamine” 
was coined by Dr. Funk—are substances present 
in small quantities in most of the foods we eat. 
They are essential to life. A diet which includes 
4 See the author’s hook, Glands in Health and Disease (E. 
P. Dutton and Co., N. Y.). 
'See the author’s book, Vitamines: Essential Food Factors (E. 
P. Dutton and Co., N. Y.). WHAT TO EAT 
27 
milk, vegetables, and fruit in fair abundance as- 
sures an adequate supply of these necessary sub- 
stances. 
Our advertising friends, with that aptitude for 
bamboozling the public which they possess, have 
given these vitamines an undue prominence. Yeast 
preparations have flooded the market. The most 
remarkable and unheard-of properties have been 
attributed to them. As a matter of fact, these vita- 
mine preparations are of no more value than the 
many patent medicines that occupy so many shelves 
in drug stores: they are only less harmful. 
The necessary vitamines are most easily obtained 
from the natural foods that man is accustomed to 
eat. In our own country only a very slender purse, 
or a very one-sided diet, may fail to procure us 
enough of these substances (in the shape of the 
food we eat). The problem is not solved by the 
administration of yeast tablets; these cost several 
hundred per cent more than milk, and are far less 
efficacious. In Russia, Austria, and Germany, part 
of the malnutrition is undoubtedly due to lack of 
vitamines, which in turn is the result of a diet 
insufficient in amount and limited in quantity. 
But there again the solution lies not in the supply 
of yeast tablets, but in an improvement of the food 
situation. Beriberi, a vitamine deficiency disease, 
at one time rampant in the Philippines and in 
Japan, was eradicated not with yeast tablets, but  WHAT TO EAT 
28 
by the substitution of whole rice for the milled 
variety. Scurvy is prevented not with vitamine 
tablets, but by the administration of orange juice. 
So full of frailties is man that even the more 
intelligent will read these sentences and then go 
to the nearest drugstore for Ploxom’s Pills or 
Voxom’s Vitamines. There never deserts him that 
vague feeling that possibly there is something in it. 
On the strength of a vague possibility, Ploxom 
makes his millions and Yoxom his tens of millions, 
and, quite incidentally, man accelerates the ruin 
of his entire digestive system.6 
Having said so much, we shall not deny that the 
physician in treating some of his hospital patients 
by the administration of vitamine concentrates 
may, and sometimes does, bring about cures. Here 
the analogy is one of an underfed or ill-fed rat, 
which responds to vitamine treatment, and not a 
normal rat, living on a normal diet, which shows no 
additional improvement when vitamines are ad- 
ministered. 
Water. Water, like oxygen, is an essential food, 
but like it, is usually ignored in discussions of 
food. We have already given what appears to us 
•The various yeast preparations have been advocated as “re- 
movers of boils,” etc. There seems to be little doubt that yeast 
acts as a mild laxative, and whatever “cures” are obtained are 
probably due to this property. All else is the merest of con- 
jectures. WHAT TO EAT 
29 
the most probable reason for this: there is no air- 
tax, and the water-tax is still negligible. 
An elementary analysis of our body shows that 
four-fifths of it (by weight) is water. Many and 
complex as are its functions, the one that is most 
readily grasped is that it keeps food and body prod- 
ucts in solution, and so facilitates their ready 
transportation from one part of the body to the 
other. 
Recent studies have brought out two important 
facts: contrary to what many people believe, water 
drinking at meals is not harmful; it, in fact, stimu- 
lates the digestive juices; and most men drink too 
little water. Four to five tumblers a day, apart 
from intensifying the flow of secretions, materially 
aids in flushing the intestines. 
References 
[J. A. M. A.=Journal of the American Medical 
Association] 
Much of what is discussed in this chapter will be 
found, in amplified form, in my book, Vitamines: 
Essential Food Factors (E. P. Dutton and Co., 
N. Y.), chapters I-VlII. The fundamental work 
of Lavoisier is entertainingly discussed by Graham 
Lusk in his Pasteur lecture, “Some Influences of 
French Science on Medicine,” J.A.M.A., volume 76, 
page 1, 1921. Dr. Carter is responsible for an ar- 30 
WHAT TO EAT 
tide on the Pirqnet system of nutrition (J.A.M.A., 
volume 77, page 1541, 1921). The calorific require- 
ments of children are discussed by L. E. Holt, in 
the American Journal of Diseases of Children, 
volume 21, page 1, 1921, and volume 23, page 471, 
1922. 
Two general references to this chapter are H. C. 
Sherman: Chemistry of Food and Nutrition (Mac- 
millan Co., N. Y.); and H. S. Carter, P. E. Howe 
and H. A. Mason: Nutrition and Clinical Dietetics 
(Lea and Febiger, Philadelphia), earlier chapters. 
The burning topic as to how much protein is to 
be included in the diet is discussed by M. Hind- 
hede in his Protein and Nutrition (Ewart, Sey- 
mour and Co., London). Here the reader will find 
not only an account of Hindhede’s own experi- 
ments, but also those due to a much earlier worker, 
Voit, and to Chittenden. Hindhede’s article on 
“The Effect of Food Restriction During War on 
Mortality in Denmark,” J.A.M.A., volume 74, page 
381, 1920, and on “Alcohol Restriction and Mor- 
tality,” British Medical Journal, Aug. 12, 1922, 
should also be consulted. 
For the inorganic constituents in diet, consult 
Sherman (referred to above), chapters 9, 10 and 
11; also T. B. Osborne and L. B. Mendel, “The In- 
organic Elements in Nutrition,” Journal of Bio- 
logical Chemistry, volume 34, page 131, 1918; and WHAT TO EAT 
31 
editorials in the volume 75, page 1004, 
1920, and volume 78, pages 512 and 1460, 1922. 
The subject of vitamines is treated in my book 
(see above). The possible efficacy of yeast prepa- 
rations is discussed under the heading of “New and 
Non-Official Kemedies,” in the J.A.M.A., volume 
79, page 135, 1922. 
Those who read German may be referred to Hind- 
hede’s very latest volume, Die Neue Erndhrungs- 
lehre (Emil Pahl, Dresden). CHAPTER II 
WHAT TO BAT: SOME COMMON FOODS 
Milk and its products. We have already stressed 
the desirability of a varied diet. Very often ig- 
norance, sometimes pecuniary considerations, and 
at other times social conditions (such as those 
existing in Europe to-day), result in giving us any- 
thing but a varied diet; the inclusion of milk then 
becomes more than ever imperative. Milk is a cor- 
rective : it makes up for deficiencies in other foods. 
How true this is, is seen in the present distressing 
condition of the peoples of Central Europe and 
Russia—and China and India, and other more re- 
mote parts of the world—where milk is lacking; 
and in the restoration to health that is invariably 
witnessed when, through a Hoover or through the 
Society of Friends, milk finds its way to the homes 
of these unfortunates.1 
There is much in milk that needs elucidation— 
1<£The average monthly supply of fresh milk amounted to more 
than 27,000,000 liters (quarts) in 1913 for Vienna alone, but 
in October, 1918, this quantity had decreased by 89 per cent, to 
only 4,500,000, or 150,000 daily. When, however, owing to the 
peace treaty, the chief pasture grounds were cast off from Austria, 
no more than 90,000 liters each day arrived in Vienna in 1919, 
although the average minimal requirement of milk for infants’ 
hospitals and the severely sick amounted to more than 750,000 
32 P. G. HOPKINS, PROFESSOR OF BIOCHEMISTRY AT THE 
UNIVERSITY OF CAMBRIDGE. PROFESSOR HOPKINS 
HAS BEEN EXTREMELY SUCCESSFUL IN APPLYING 
CHEMISTRY TO ELUCIDATE VARIOUS PROBLEMS IN 
PHYSIOLOGY. WHAT TO EAT: SOME COMMON FOODS 
33 
why, for example, mother’s milk is so much better 
for the child than cow’s; but we have learnt this in 
recent years: that its proteins are high in the bio- 
logical scale (of high physiological value, that is), 
and that it contains all the three known vitamines. 
It lacks sufficient iron, and is deficient in the vita- 
mine that prevents scurvy (vitamine C), but it con- 
tains protein, fat and carbohydrate, and vitamines 
apart from the C variety in abundance, and min- 
eral salts in fair quantity. 
The conclusion is inevitable: whatever you do, 
do not fail to drink two to three glasses of milk a 
day. 
liters a day. In the summer months of 1919 and 1920 conditions 
went from bad to worse, because a large proportion of the fresh 
milk turned sour before it reached the city, as there were no 
refrigerators or ice-cooled vans available for transport. Out of 
113,256 liters coming to Vienna daily in August, 1921, 40 per 
cent, became sour and thus unfit for infant feeding. Before the 
war the per capita quantity each day was 0.41 liter (a little less 
than a pint) ; in November, 1918, it went down to 10 per cent, 
of this quantity; in July, 1920, it dropped further to half of 
that quantity (0.02 liter) ; in July, 1921, it was 0.04 liter again, 
and it remained approximately the same until the end of the 
year, so that only one tenth of the peace ratio was available. In 
the Alpine districts, the conditions were also far from satisfac- 
tory, for there too the present quantity of milk available is no 
more than from one fifth to one third of that deemed as a mini- 
mum in 1913. These figures explain the most distressing spread 
of rickets and underdevelopment of infants during the last few 
years, and it is not likely that a radical change will take place 
within reasonable time. The rural population in Austria has 
turned from the milk industry and pays more attention to 
slaughtering animals and to the crops, because these pay much 
better; on the other side, the former milk districts no longer 
belong to this country, and the import of the milk to Vienna is, 
at the present exchange rate, quite impossible.”—Journal of the 
American Medical Association. 34 
WHAT TO EAT 
But drink it how, you may ask; in the raw, pas- 
teurized, or boiled condition? Were it not for the 
readiness with which bacteria multiply in milk, 
the raw condition would undoubtedly be the best. 
Boiling milk is the quickest and safest way of get- 
ting rid of bacteria; this is practised very largely 
on the Continent. We in this country find pas- 
teurization a better substitute. Since pasteuriza- 
tion does not require heating to as high a tempera- 
ture as does boiling, and therefore does not destroy 
all bacteria, it has less influence in changing the 
composition and the taste of milk, and is less apt 
to affect the vitamines. The fact that a city like 
New York is supplied with pasteurized milk, with 
gratifying results to the health of the population, 
shows what pasteurization (heating the milk at 
145 degrees Fahrenheit for 30 minutes), coupled 
with scrupulous cleanliness in pasteurizing plants, 
will do. “Scrupulous cleanliness” needs empha- 
sizing. Pasteurization would not be the success it 
is if rare cleanliness in the plants were not the 
order of the day. We start, therefore, with a mini- 
mum number of bacteria, and these are further 
prevented from multiplying by keeping the tanks at 
a low temperature (50 degrees Fahrenheit). 
Of course, a much easier way of preventing the 
growth of bacteria would be to add some preserva- 
tive to milk, such as boric or salicylic acid, or for- 
malin. There is, however, a very decided objection WHAT TO EAT: SOME COMMON FOODS 
35 
to these preservatives: they are injurious to health; 
hence the stringent laws everywhere against their 
use. 
Grades of milk. The difference between the 
grades of milk, such as grade “A” and grade “B,” 
is not one of composition but of method of handling. 
With grade “A” the various operations—filtering, 
cooling, pasteurizing—are done in different rooms; 
with “B,” they are all done in one room (except for 
the washing). And the “A” bottle has an extra cap 
covering its mouth, whereas the “B” has not! 
The certified milk is obtained from tested cows, 
and is carefully supervised by the health authori- 
ties who, in New York State, require that the milk 
contain less than 30,000 germs per cubic centimeter 
(the ordinary “good” milk contains 50,000 and 
more), and that it contain at least four per cent of 
butter fat. 
Butter milk, obtained as a by-product in butter 
making, is much like skim milk in composition— 
that is, it is low in fats—but since cream is usually 
allowed to sour before churning, the milk has a 
sour taste. Whey is what is left after the cheese 
is removed (in the course of cheese manufacture). 
It contains the sugar and minerals of whole milk, 
but is not as nutritious as skim or butter milk. 
Evaporated or condensed milk is a variety of 
milk that has had much of its water removed by 
evaporation (under reduced pressure, so as to pre- 36 
WHAT TO EAT 
vent changes as much as possible). The desiccated 
or dried milk contains no water at all, or practically 
none.2 Since cow’s milk contains more protein than 
that of the mother but less sugar, we dilute cow’s 
milk and add sugar. The details are left to the 
physician in charge.3 
Sour milk and the Metchnikoff theory of old age. 
The souring of milk upon standing is due to the 
conversion of milk sugar (lactose) into lactic acid 
by bacteria from the air. Butter milk is perhaps 
the best known example. Various types of sour 
milk are manufactured by inoculating milk with a 
definite strain of bacteria. 
Metchnikoff, the famous Russian biologist, had 
noted that many peasants in Europe, particularly 
those in Bulgaria, lived to a very old age, and, 
strangely enough, a very large part of their food 
consists of sour milk. It was but a step to connect 
the drinking of sour milk with the development 
2Drs. Clark and Collins, of the U. S. Public Health Service, 
have been investigating the value of a number of dried milk pow- 
ders in infant feeding. They have come to the conclusion that 
some of the milk powders are of distinct value. (Write to the 
U. S. Public Health Service, Washington, D. C., and ask for 
Public ilealth Report, Volume 37, page 2415, Oct. 6, 1922.) 
3 The composition of cow’s, goat’s and human milk, as given by 
L. L. van Slyke, the dairy expert of the N. Y. State Agricultural 
Experiment Station, is (in per cent): 
Compound 
Cow’s milk 
Goat’s milk Human milk 
Fat 
3.9 
3.8 
3.3 
Milk sugar .... 
4.9 
4.5 
6.5 
Proteins 
3.2 
3.1 
1.5 
Salts 
0.9 
0.9 
0.3 WHAT TO EAT: SOME COMMON- FOODS 
37 
of a healthy body, and it required another step to 
attempt an explanation. Metchnikoff developed the 
theory that the putrefactive bacteria that develop 
in the intestine produce toxic products that are 
absorbed by the system and sooner or later poison 
it—give rise to hardening of the arteries and gen- 
eral senility. He claimed that the drinking of sour 
milk developed a non-toxic acid bacteria that in 
time supplanted the putrefactive bacteria. 
These views of Metchnikoff have not been sub- 
stantiated. It has been proved, in fact, that the 
particular bacillus with which he experimented, the 
bacillus bulgaricus, never can be implanted in the 
intestine. However, the use of sour milk has greatly 
increased since his time, and many clinicians are of 
the opinion that it may be used to advantage in 
various gastro-intestinal disorders. 
Lately Professor Rettger, of Yale, has inoculated 
milk with bacillus acidophilus, and finds that it can 
be readily implanted in the intestine, supplanting, 
in turn, other and toxic varieties. He makes no 
such claims for it as Metchnikoff made for his ba- 
cillus bulgaricus; on the contrary, his excessive 
conservatism is even a trifle irritating; but he has 
been able to relieve cases of chronic constipation 
(with so-called auto-intoxication), diarrhea, and 
colitis (inflammation of the colon). The results are 
very encouraging, but the entire subject is still in 
a very experimental stage. 38 
WHAT TO EAT 
Milk from various animals. In this country, 
“milk” without further qualifications refers to 
cow’s milk. Few of us drink the milk of another 
animal, and in most of us a very disagreeable sen- 
sation is aroused at the thought of milk other than 
cow’s. Such ideas and sensations are little more 
than the result of acquired taste. The goat in 
Spain and Italy; the mare in Russia; the reindeer 
in the Arctic; the llama in South America; the 
camel in Arabia; and the buffalo in India—the milk 
of all these animals is used as food. Though ex- 
haustive experiments are wanting, there does not 
seem to be any material difference in quality among 
these varieties of milk; each variety has its adher- 
ents. This we can say: the milk of any one species 
is best for the young of that species; from which 
it follows that the best milk for the infant is 
mother’s milk. 
Cream and batter. Cream and butter contain 
large quantities of the fat in milk; cream usually 
contains as much as twenty, and butter as much as 
eighty per cent. The cream is most easily obtained 
by pouring off the top portions of milk that has 
been standing in a cold place for some time. The 
more economical method, and the one more adapted 
for commercial purposes, is by making use of the 
separator, a revolving machine making several 
thousand revolutions per minute. The heavier por- 
tion, the skim milk, stays near the periphery, and WHAT TO EAT: SOME COMMON FOODS 
39 
is drawn off at one end, and the lighter, the cream, 
collects nearer the center, and is drawn off there. 
Cream and butter are valuable fattening foods, 
and are rich in one of the essential vitamines (vita- 
mine A). 
Ice cream. Ice cream is merely cream mixed 
with sugar, sometimes with starch and eggs, and 
often wuth gelatin. It is flavored with extracts of 
vanilla, chocolate, etc. We in this country con- 
sume more of it than the rest of the world put to- 
gether—some 150 million gallons a year. A nour- 
ishing food ice cream undoubtedly is; but the ex- 
cessive quantities of it that most of us consume, 
containing as it does large amounts of sugar and 
flavoring material, coupled with a quality of prod- 
uct which often is very indifferent, leads to much 
intestinal disorder. 
Butter. In the preparation of butter the cream 
is allowed to ripen, that is, to stand until a decided 
acidity is developed. The acidity is due to the 
production of lactic acid by the action of the bac- 
teria of the air, or of specially implanted bacteria, 
on the milk sugar. The proper ripening develops 
the desirable flavoring qualities of butter. The 
next process, the churning or agitating, separates 
the butter fat still more completely from the other 
constituents of milk. Both the ripening and the 
churning should be done at low temperatures. The 
final process, the working, consists in washing the 40 
WHAT TO EAT 
butter with water, and then removing this water by 
squeezing. Salt is often added to improve the 
flavor, but chiefly to add to its keeping qualities. 
It may be taken for granted that, as a rule, the un- 
salted butter is fresher than the salted; and when- 
ever possible, the former should be procured. There 
is no reason why, if salted butter is preferred, salt 
cannot be added to the sweet butter. 
Cream and butter both have high calorific value; 
they both—as has already been noted—contain one 
of the essential vitamines; and, unless taken in con- 
siderable excess, are easily digested and absorbed. 
They, therefore, belong to our very valuable foods. 
High in content of fat, they should always be in- 
cluded in the diet of persons who are underweight, 
and be given in small quantities, but not excluded 
altogether, to persons who are overweight. 
Butter substitutes. The various butter substi- 
tutes, such as margarine and butterine, are made 
from fats other than milk fat, though often a little 
butter is added. Lard, cotton-seed, peanut and 
sesame oils are all used for the purpose. The proc- 
ess of manufacture is a complicated one. In fuel 
value these butter substitutes are not inferior to 
butter, but they do not contain the vitamine that 
butter does, nor do they taste as well. However, 
since milk supplies the vitamine found in butter, 
there can be no objection to a diet which includes 
milk and margarine in the place of milk and butter. WHAT TO EAT: SOME COMMON FOODS 
41 
Cheese. Cheese, in addition to containing fat 
(about 30 per cent), also contains protein (about 
20 per cent). The protein is mainly the casein of 
milk. It is undoubtedly one of the most nutritious 
foods we have, and, if regularly incorporated in our 
diet, easily takes the place of meat. The eating of 
cheese should always be encouraged. 
Cheese is now manufactured by the addition of 
rennin (rennet) to milk. Rennin represents an 
impure preparation of an enzyme found in the 
stomach of calves (and in other animals, including 
man, but not in such quantity), which has the prop- 
erty of coagulating or curdling milk. The prepa- 
ration of junket represents this process in minia- 
ture. The curd is beaten to break up the lumps, 
squeezed through cloths to get rid of adhering liq- 
uid, and stored to develop flavors—a process in 
which the bacteria present in the cheese take an 
active part. 
Cottage cheese, cream cheese, limburger, cheddar, 
roquefort, etc., are varieties which depend for their 
preparation on method of manufacture, on tempera- 
ture, and above all, on the type of curing. In many 
of them, during the ripening process, molds and 
bacteria develop, and products which cannot be 
distinguished from those obtained in putrefaction 
are often obtained. It is one of the anomalies of 
our make-up that some of us should consider lim- 
burger a delicacy.  WHAT TO EAT 
42 
Eggs. Like cheese, eggs are rich in protein and 
fat, and like cheese again, may largely replace meat. 
Both cheese and eggs are poor in carbohydrate, and 
therefore the addition of bread or other starchy 
food (a vegetable) to the diet is desirable. Eggs 
contain around 13 per cent of protein and 10 per 
cent of fat, with appreciable quantities of phos- 
phorus, and smaller quantities of the no less valu- 
able calcium and iron. They are rich in vitamines. 
The fats in eggs are mixtures of true fats and 
lipoids, the latter resembling fats in physical prop- 
erties, and at least one variety, lecithin, in chemical 
properties. Much of the phosphorus of eggs is found 
in the form of this lecithin. We have already men- 
tioned elsewhere (page 9) that the lipoids are 
present in every cell, and are particularly abundant 
in brain tissue, which attests their importance. 
With regard to the digestibility of eggs, much 
depends upon the individual. No two persons seem 
to have the same digestive capacities, not only for 
eggs, but for other foods. This is something that 
must forever be kept in mind. But it may be said 
in a general way that soft-boiled eggs are more 
readily digested than hard-boiled, and that an ome- 
let is a form of egg easily digested. Experiments 
seem to show that soft-boiled eggs do not remain 
in the stomach as long as do hard-boiled—an indi- 
cation that the former is more easily attacked by 
the gastric juice than the latter. But the mere WHAT TO EAT: SOME COMMON FOODS 
43 
fact that hard-boiled eggs remain longer in the 
stomach means little in the case of the normal, 
healthy individual, and assumes significance only 
where health is impaired. The raw egg is much on 
a plane with the soft-boiled. The omelet is easily 
digested because of its fluffiness; that is, to speak 
in more technical terms, the surface area of the egg 
is increased—and an increase of surface area al- 
ways accelerates chemical action (in this particular 
case, the action of the pepsin of the gastric juice 
on the protein of the egg). It should be borne in 
mind that much of the protein, and almost the 
entire fat digestion, is carried on in the small in- 
testine (see page 181), and that a consideration 
of stomach digestion is but a fraction of the story. 
Cold-storage eggs, when not in a putrefied condi- 
tion, are, chemically, practically indistinguishable 
from fresh eggs, and, so far as one can learn, are as 
easily digested. To many people they are palatable, 
and to most, wholesome; but it would be stretching 
our scientific knowledge beyond reasonable limits 
to assume that there is no difference between the 
two grades of eggs. Man knows from experience 
that there is a difference; and in this instance, his 
own bitter experience is the better guide. “Fresh 
preferred” is a motto also to be remembered with 
foods other than eggs. 
We have given here an instance in which it seems 
to us that man’s experience serves as a more accu- 44 
WHAT TO EAT 
rate guide than the analysis of the chemist. We 
have now, however, to refer to something which 
ought to change the you-really-know-nothing atti- 
tude that many a layman assumes towards the 
scientist. White eggs, cry some, are fresh and 
wholesome, brown eggs are not; others, with equal 
conviction and an equivalent of ignorance, say just 
the reverse. The average New Yorker represents 
one school, and the average Bostonian, the other. 
As a matter of fact, no difference in quality, based 
on the presence or absence of pigment in the shell, 
is warranted. Freshness and wholesomeness de- 
pend upon other properties. This, however, does 
not deter the dealer, who often knows better, from 
reaping a rich harvest by trading upon the ignor- 
ance of the public. 
Meat. A recent Interallied Council of Physiolo- 
gists gave out this statement: “It is not thought 
desirable to fix a minimum meat ration, in view of 
the fact that no absolute physiological need for 
meat exists, since the proteins of meat can be re- 
placed by other proteins of animal origin, such as 
those contained in milk, cheese and eggs, as well 
as by proteins of vegetable origin.” This statement 
deserves much wider circulation among the masses 
than it has so far received. At first sight it seems 
like an endorsement of Hindhede’s views (see 
page 13), but as a matter of fact it is not really 
that. This international group of physiologists WHAT TO EAT: SOME COMMON FOODS 
45 
attribute to proteins a more important role than 
Hindhede seems to give them; they are of the opin- 
ion that the minimal protein needs are more than 
those suggested by the Danish investigator; but 
they do agree with him in believing that meat is 
not a necessity. The animal proteinsi in milk, 
cheese and eggs, as we have already emphasized, 
have fully the biological value of meat proteins, 
and meat as a food has several distinct disadvan- 
tages. The claim has been made, and it seems with 
good reason, that much intestinal putrefaction, re- 
sulting in gastrointestinal disorders, may be 
traced to excessive meat eating. 
Like eggs and cheese, meat is rich in protein 
(about 20 per cent) and very often in fat (8 to 
16 per cent). It contains a little phosphorus and 
traces of iron, calcium, etc. It also contains purine 
derivatives that go under the name of extractives, 
to which is attributed much of man’s love for meat. 
Purines are precursors of uric acid, a substance 
associated with the disease known as “gout” (see 
page 144) ; hence the “gouty” person is advised to 
avoid meat. Since meat is practically devoid of 
carbohydrate, the consumption of large quantities 
of it, and the absence from the diet of such a com- 
pensating factor as vegetables, often gives rise to 
acute constipation. 
Test tube experiments do not show any essential 
difference in the digestion of the protein in meat  WHAT TO EAT 
46 
and that in milk or eggs; yet clinical observation, 
and our own daily experiences, lead to different 
conclusions. We are told in explanation that the 
fibers of meat are tough, but that is at best a par- 
tial explanation, though it can be applied to ex- 
plain why chicken is more easily digested than 
beef. The chicken, we say, is tender, the fibers 
smaller and less resistant. 
If the excessive quantities of meat consumed are 
to be discouraged, what are we to say of such meat 
products as go under the name of delicatessen, the 
hodge-podge of the slaughter house? In delica- 
tessen we have an excellent illustration of how an 
appetizing dish does not necessarily prove a whole- 
some one. Very much the same, and perhaps even 
more, may be said of canned meats. 
The distinction that the public makes between 
white and red meats needs modification. Chicken 
and pigeon, to be sure, are more easily digested 
than beef, but clinical experience does not teach 
us that this is true of duck, turkey, and goose. 
Neither have the differences, where they do exist, 
anything to do with the color. The color is no more 
a factor than is the color of the egg’s shell a cri- 
terion of freshness. 
Products such as soup (animal) and beef extract 
(such as Liebig’s) are watery extracts containing 
very little protein, but most of the salts and the WHAT TO EAT: SOME COMMON FOODS 
47 
purines of meat. From what we have said of the 
purines, we can now understand why these watery 
extracts act as stimulants to the flow of the diges- 
tive juices. 
Fish. In composition, fish and meat have much 
in common. Both are predominantly protein foods, 
both contain little carbohydrate, and both vary in 
their fat content. The protein in fish may range 
from 14 per cent in flounder to 22 per cent in 
salmon; the fat, from less than one per cent in cod 
to 12 per cent in salmon. The bass, bluefish, cod, 
flounder, trout, and weakfish are low in fat, and 
more easily digested than halibut, herring, mack- 
erel, salmon and shad, which are high in fat. 
On the whole, it may be said of fish that it is 
more easily digested than meat, and is certainly an 
excellent substitute for meat. The one serious ob- 
jection to it is that it spoils so easily. Unless, 
therefore, one has access to really fresh fish, the 
better plan would be to substitute dairy products. 
Cold-storage fish and salted products cannot be 
condemned outright, since laboratory experiments 
have much to say in their favor; but, here again, 
experience, clinical and otherwise, teaches caution. 
Shell fish, such as the mollusks (oysters, clams, 
mussels, and scallops) and crustaceans (lobsters, 
crabs, shrimps, and crawfish) are justly prized deli- 
cacies and are easily digested. They are, however, 48 
WHAT TO EAT 
a source of frequent danger owing to contamina- 
tion. Eemember how often the oyster bed and the 
sewage outlet are in close proximity. 
jBread and grain products. We now come to the 
first of the foods so far discussed that is predomi- 
nantly carbohydrate. The grains contain appre- 
ciable quantities of protein, to be sure, but, from 
the biological standpoint, they are poor in quality. 
Protein derived solely from bread would give rise 
to malnutrition, even though the amount ingested 
would exceed that demanded by a most liberal diet. 
The percentage of carbohydrate in barley, corn, 
oats, rye, and wheat ranges from 58 to 71, and the 
per cent of protein, from 10 to 12. They contain 
smaller quantities of fat (from one and one-quarter 
to four per cent), and larger quantities (from 1.5 
to 3.5) of mineral matter than do the protein-rich 
foods. They act, therefore, as excellent supple- 
mentary foods for eggs, meat, fish, and cheese. 
Bread, the commonest of grain products, is made 
in this country from wheat, though the War has 
taught us the palatability of rye bread, a commoner 
article in Europe. Wheat contains a higher per- 
centage of gluten than is found in other grains, and 
this gives those sticky qualities to wheat flour 
that are so prized by the baker and the housewife. 
But we have no experimental evidence to show that 
any one grain is to be preferred over any other. 
Barley, in the shape of soup and barley water; WHAT TO EAT: SOME COMMON FOODS 
49 
buckwheat, in the form of pancake; com, as pop 
corn and sweet com; oats, as oatmeal; and rice, 
illustrate the wide use of these products. 
A slice of bread and a glass of milk have a value 
that few realize even at this day. 
Vegetables and fruit. These are valuable for 
their mineral, cellulose, and vitamine contents. The 
cellulose gives the necessary bulk to the food and 
aids in the proper peristaltic movements of the in- 
testines. Many vegetables, the potato, for example, 
are rich in starch. A few, such as beans, contain 
appreciable quantities of protein, though these 
are the exception. 
It is not so very long ago that we were taught 
that a vegetable like the tomato is of little value as 
food, because it contains 90 per cent by weight of 
water. Since vitamines have come to the front, we 
have learnt that vegetables (and fruits) are rich 
in vitamines, particularly the tomato, which has 
been shown to contain all three vitamines—a rec- 
ord equalled only by milk. 
What an array of substances nature provides us 
among fruits and vegetables! The potato, tomato, 
cabbage, cucumbers, radish, lettuce, carrots, spin- 
ach, peas, beans, etc., among vegetables; and the 
apple, pear, cherry, peach, plum, grape fruit, 
lemon, orange, berries, banana, fig, watermelon, 
etc., among fruits; all high in water content, to be 
sure; but high also in minerals, rich in vitamine, 50 
WHAT TO EAT 
with a cellulose and starch content that facilitate 
digestion. Notice, then, what an all-round diet 
should include: cheese, egg, meat or fish, for pro- 
tein (and fat?) ; vegetables and fruit for mineral 
salts and vitamines; bread and cereals and sugar 
(in moderate quantities) for carbohydrates; and, 
to offset any deficiencies, milk, the corrective. 
Sugar. The sugar (cane sugar) ordinarily used 
for sweetening is practically 100 per cent carbo- 
hydrate. If taken in moderate quantities (in tea 
or coffee), it is readily digested, and therefore be- 
comes valuable as a food. However, if taken im- 
moderately (in the form of pies and more particu- 
larly candies), it contributes to the condition 
known as the upset stomach. Where a liberal 
supply of vegetables is at hand, we need seek little 
carbohydrate in sugar; but why waste this advice 
upon the American, to whom sweets have become 
a necessity and are no longer a luxury! 
Nuts. Due to their fairly high protein (from 6 
to 25 per cent) and fat (from 5 to 70 per cent) con- 
tents, nuts have recently been advocated in the 
place of protein-rich foods. Successful experi- 
ments on animals have been carried out where the 
diet consisted of nuts, cereals, and vegetables. But 
caution is necessary when the attempt is made to 
apply the results of such experiments. Experience 
has taught us that nuts are not easily digested; WHAT TO EAT: SOME COMMON FOODS 
51 
and it is doubtful whether the proteins have the 
same biological value as those of milk and eggs. 
Beverages. Tea, coffee, and cocoa, true stimu- 
lants, affect the nervous system due to the pres- 
ence of the alkaloid, caffein, or to substances that 
are chemically similar to it. Where the amount 
consumed is from one to two cups a day, the harm 
done is probably so small that it can hardly be 
measured. But coffee drinking in this country, 
like tea drinking in Russia and perhaps in Eng- 
land, has assumed huge proportions, and it is per- 
haps time to utter a word of warning. 
We are all familiar with the student who drinks 
coffee to keep awake at night and grind for his 
exams. Coffee does keep him awake: the caffein 
attends to that; but it is at the expense of his 
nervous system. The harmful effects of tea are 
due to an alkaloid of a similar nature to the one in 
coffee. Here the effects are usually less marked, 
because the amount of alkaloid present in the 
ordinary cup of tea is less than in one of coffee. 
Cocoa and chocolate are less harmful than either 
tea or coffee, and they have the positive virtue of 
containing appreciable quantities of fat and carbo- 
hydrate ; this is particularly true of chocolate. 
Restrictions are galling to the average individual. 
Campaigns in favor of prohibition and against 
smoking have made him regard the social reformer 52 
WHAT TO EAT 
with a good deal of scorn, not nnmixed with sus- 
picion and hatred. We, personally, are in favor of 
freedom as against restriction, except in so far as 
it can be conclusively proved that restriction works 
for the benefit of the community as a whole. We 
are convinced, not from the vaporings of prohibi- 
tionists, but from studies made by physiologists, 
that alcohol drinking ought to be discouraged, not 
because the consumption of small quantities does 
harm, but because it so often leads to excessive 
drinking. A somewhat similar line of reasoning 
may be applied to smoking, and to tea and coffee 
drinking, but with less force, because the effects 
are not so obvious, nor is the scientific evidence so 
conclusive. However, when we think of man’s lot 
in this world, how miserable it usually is, how 
hopeless and aimless it often seems, how the few 
fight the many and the many fight themselves, how 
the memory of a Napoleon who slays is kept green, 
and that of a Pasteur who heals is growing dim, 
then we are tempted to exclaim, “Drink and smoke 
—and eat, for the pleasures of life are few 
enough.” 
“Although it [alcohol] appears to be a stimu- 
lant,” writes Bayliss, the eminent English physiolo- 
gist, “the impression is due to an incorrect inter- 
pretation of the effects observed. It is really a 
narcotic. One of the most striking facts with re- 
gard to the activities of the highest parts of the WHAT TO EAT: SOME COMMON FOODS 
53 
brain is the great predominance of the inhibitory 
mechanisms, by which the bringing into play of 
inappropriate movements or sensations is kept in 
check. Now, these mechanisms themselves are ex- 
traordinarily susceptible of being abolished by ex- 
traneous influence of various kinds. One of the 
most powerful of these influences is alcohol. When, 
therefore, greater liveliness is experienced under 
its action, it is because alcohol paralyzes the in- 
hibitory mechanism and not because it excites 
activity by a true stimulating action. . . . After 
even small quantities [of alcohol are taken], the 
ability to add figures correctly is decreased, al- 
though the subject believes that he is doing it un- 
usually well. Moreover, the effects last for as long 
as twelve hours or more. Another false idea is that 
alcohol warms. This is due to the fact that it 
dilates the blood vessels of the skin; and since the 
feeling of warmth arises from the skin, if this is 
warm, the mistaken impression is given that the 
body is warm. In point of fact, the general tem- 
perature is lowered, owing to the increased loss 
from the skin.” 4 
♦Monsieur Bordet recently proposed that the French Academy 
of Medicine should pass a resolution condemning categorically 
the sale of alcoholics. The resolution was passed unanimously. 
We quote these lines from the proposed resolution: 
“At the present time, when, under the domination of interests 
that are quite evidently commercial, a very active campaign is 
being waged against all forms of legislation looking toward the 
suppression of alcoholism, the Academy of Medicine regards it 
as its duty to emphasize anew the necessity of strictly prohibitive 54 
WHAT TO EAT 
Mineral waters. In this section on beverages a 
word may be added on the general subject of min- 
eral waters. These are waters that contain certain 
gases or salts to which they owe their peculiar 
properties. They are found naturally, but some are 
also artificially prepared. We have the French 
Lick Springs, rich in sulphuretted hydrogen; the 
Hot Springs in Virginia, containing various sul- 
phates ; the Spa Springs in Belgium, with their iron 
constituents; the Mineral Springs of Yellowstone 
Park, which are radio-active; and so on. To what 
extent those constituents in mineral waters which 
give them their distinguishing properties are re- 
sponsible for “cures,” is a subject very much open 
to debate. It is hardly likely that sulphuretted 
measures. Alcohol is a poison. The only thing that, strictly 
speaking, can be alleged in excuse of its use is that, like other 
poisons, the smaller the dose the less dangerous it is, and that 
we can, therefore, without our health suffering gravely, tolerate 
a very moderate consumption of beer and wine; that is, diluted 
alcohol. If the time is not opportune to prohibit the use of beer 
and wine (which has never been planned as yet), provided these 
beverages do not contain a higher percentage of alcohol than the 
law might reasonably establish, at least distilled alcohol should 
be absolutely prohibited, since it is a veritable social scourge and 
a formidable factor in physical and moral decadence, as well as 
in poverty and crime. The relationships between alcoholism, on 
the one hand, and mental troubles and criminality on the other, 
are too well attested by demonstrations that we see all about 
us and by indisputable statistics to require further argumenta- 
tion. The academy holds that existing legislation should be modi- 
fied by suppressing the unfortunate provision which takes all the 
force out of the law; namely, the clause that authorizes the sale 
of distilled beverages in quantities of two liters as a minimum. 
The prohibition of distilled alcohol should be absolute and 
complete.” WHAT TO EAT: SOME COMMON FOODS 
55 
hydrogen contributes to cures; those who have 
worked with it in the laboratory will be of a dia- 
metrically opposite opinion. Nor is it likely that 
the sulphate waters, containing substances that are 
similar to those found in Epsom salts, do more than 
act as laxatives and purgatives. How very uncer- 
tain our knowledge is may be gauged from the fact 
that waters of widely varying compositions are 
recommended for some particular disease, and that 
often patients with obscure organic diseases are 
sent to water resorts. Yet there is no doubt that 
the health of thousands who frequent these water- 
ing places has been improved; here, as elsewhere, 
empiricism has led the way. 
Condiments. These are the spicy substances, the 
judicious use of which is such an important ad- 
junct for the chef who aspires to success. Salt and 
sugar are not only desirable but necessary foods. 
This applies with particular force to salt, for sugar, 
though an important carbohydrate, may be re- 
placed by other carbohydrates, such as the starch 
in bread; but nothing can act as substitute for salt 
(sodium chloride), indispensable for the formation 
of the normal gastric juice and for the proper com- 
position of body fluids. Pepper, mustard, horse- 
radish, onion, vinegar, gherkins, anchovies, caviar, 
are all appetizing dishes, and, if taken in moderate 
quantities, are distinct aids to digestion. But what 
is food for one nation is not necessarily food for 56 
WHAT TO EAT 
another. One has but to think of the eagerness 
with which onions and garlic are swallowed by 
Spaniards and Italians, and the wry faces made 
by Englishmen and Americans at the mere mention 
of them. 
References 
For general references the following books may 
be consulted; E. H. S. Daily: The Source, Chem- 
istry and Use of Food Products (P. Blakiston’s 
Son and Co., Philadelphia); H. W. Wiley: Foods 
and Their Adulterants (P. Blakiston’s Son and Co., 
Philadelphia); F. X. Gourond: What Shall 1 Eat? 
(Rebman Co., X. Y.); H. W. Wiley: Beverages 
(P. Blakiston’s Son and Co., Philadelphia); H. C. 
Sherman: Food Products (Macmillan Co., X. Y.); 
A. E. Leach and H. L. Winton: Food Inspection 
and Analysis (John Wiley and Sons, X. Y.); and 
H. S. Carter, P. E. Howe, and H. A. Mason: Nu- 
trition and Clinical Dietetics (Lea and Febiger, 
Philadelphia), chapters 7-15. P. B. Hawk’s What 
We Eat and What Happens to It (Harper Bros., 
X. Y.) is also of value. Bayliss in his The Physi- 
ology of Food and Economy in Diet has a good 
chapter (number 7) on alcohol. LAFAYETTE BENEDICT MENDEL, PROFESSOR OF PHYSIOLOGICAL CHEMISTRY, 
YALE UNIVERSITY. IIE, TOGETHER WITH DR. OSBORNE, HAS DONE MUCH 
TO THROW NEW LIGHT ON THE IMPORTANCE OF THE DIFFERENT PRO- 
TEINS AND ON THE FUNCTION OF VITAMINES IN NUTRITION. CHAPTER III 
WHAT TO EAT : THE PLANNING OF MEALS 
With the contents of Chapter II in mind, it 
ought not be difficult to plan a well-balanced diet. 
But other difficulties arise. The planning may be 
excellent, but the execution poor: the cooking and 
seasoning may seem at fault—to some. And then 
again, as often happens with excellent but ignorant 
cooks whose charge of the kitchen is absolute, the 
planning may be poor, but the cooking all that an 
epicure can wish for. Such appetizing dishes, pos- 
sibly deficient in essentials, and probably over- 
abundant in meat, sugar, and cream, are harmful. 
The factor, however, that more often than any 
other gives rise to one-sided or undernourishing 
diets, is an economic one. At the present time it is 
certainly safe to say that a majority of mankind 
suffers from undernutrition, if not from positive 
starvation. To these unfortunates, whether Vienna 
professor, Oriental coolie, or Virginia miner, we 
can give no advice; only an unexpected improve- 
ment in the general rottenness of our social system 
will relieve their suffering. 
57 58 
WHAT TO EAT 
It is not onr intention to give elaborate menus 
with detailed directions. Our experience has taught 
us the utter valuelessness of such lists (except in 
the preparation of food for very large groups, as 
in the army, in hospitals, and in institutions of 
various kinds). We shall merely give lists of foods 
suitable for the three meals per day. We shall 
spread our wares on the table and allow the house- 
wife to make her choice, which in turn will depend 
very largely on her own, her husband’s and her 
children’s tastes, and, more particularly, on the 
state of her husband’s finances. 
Breakfast: Fresh fruit in season; otherwise, 
stewed fruit. A variety of cereal (oatmeal, cream 
of wheat, etc.) with sugar (sparingly) and milk. 
Egg (preferably soft, scrambled, or poached), 
bread and butter, and coffee, tea, or milk 
(preferably). 
Lunch: What is popularly, but erroneously, 
known as a vegetarian lunch is recommended. This 
might include bread and butter and milk (or cocoa 
containing much milk), and a salad (preferably a 
fruit one). During the winter months a vegetable 
soup may be ordered in addition. A salad, two 
slices of bread, a slab of butter and a glass of milk, 
constitute an ideal light lunch, and no other type 
of lunch is necessary, or, in the long run, is as 
wholesome. 
Dinner: A variety of soup on alternate days WHAT TO EAT: THE PLANNING OF MEALS 
59 
during the winter, to be discarded altogether dur- 
ing the summer months. Once or twice a week a 
special appetizer—oysters, for example—may pre- 
cede this dish. Meat not more than twice a week. 
Chicken once a week. Fish twice a week, if pos- 
sible. Arrange a dairy supper twice a week, when 
in the place of meat and fish you have a dish that 
includes eggs or cheese. Potatoes, boiled or baked, 
but not often fried, at least three times a week. 
Other vegetables, such as carrots, spinach, peas, 
beans, whenever possible. Milk and bread and 
butter. A light dessert. Fruit jelly (with a sip 
of cream, if you must) and raw fruit (for example, 
the peach and plum when in season) at least three 
times a week; pies less frequently, perhaps once a 
week. Avoid the rich, creamy, sugary combina- 
tions. Empty at least one glass of water at each 
meal, and preferably two at dinner. 
The above includes essentials; do not intend 
to discuss luxuries, for they are without end. 
Those with pockets full may fill their stomachs 
full, if they so choose, but the wiser plan is to 
adopt the habit of moderation, and the more hu- 
mane plan is to distribute surplus wealth among 
those of us who are less fortunate—an advice which 
all of us preach and few, so few, of us practise. 
With the fear of being misunderstood uppermost 
in our minds, we hasten to add a paragraph. No, 
we do not preach asceticism; we merely advise mod- 60 
WHAT TO EAT 
eration. The menus suggested may well be dis- 
carded on occasion. A public dinner, a theater 
party, a birthday feast, makes the dietitian forget 
his books on dietetics; there is no reason why his 
readers should be more conscientious. 
References 
Those who want more specific directions as to 
menus may consult E. V. McCollum and Nina 
Simmonds: The American Home Diet (F. C. Math- 
ews Co., Detroit); meals for every day of the year 
are suggested. There are also some workable 
recipes towards the end of the book. M. S. Rose’s 
Feeding the Family (Macmillan Co., N. Y.) is also 
of value. CHAPTER IV 
WHAT TO EAT: THE NURSING MOTHER 
“There is good reason to believe,” writes Profes- 
sor McCollum, “that the common practice of deriv- 
ing too large a part of the diet from meat, bread, 
sugar and potatoes, and breakfast cereals, is in no 
small measure responsible for the failure of many 
mothers to produce milk of satisfactory quality 
and quantity for the nutrition of their infants. 
There is no hardship in restricting the intake of 
meat and increasing the consumption of milk and 
green vegetables, and the mother who does so will 
greatly minimize the danger of a break in the 
healthy growth of her baby.” 
Diets, then, such as suggested in the last chap- 
ter, serve well, provided the mother never omits a 
quart of milk, at least two eggs, and some green 
vegetable in her daily food. Milk and the leafy 
vegetables have assumed an additional importance 
as the result of the more modern nutritional investi- 
gations. 
With regard to quantities of food to be consumed 
(aside from quality), it may be stated that during 
61 62 
WHAT TO EAT 
the earlier stages of pregnancy little beyond what 
is normally eaten need be taken, since the require- 
ments of the embryo at this stage are practically 
negligible. From the fourth month on, however, 
liberal allowances ought to be made for the extra 
requirements of the fetus, and, in quantity at least, 
the mother’s diet should be modelled more after the 
fashion of a blast furnace worker than of a uni- 
versity professor. 
No less important than the food is the state of 
mind of the mother—a subject to which only casual 
reference can be made here. The girl with a col- 
lege education, often highstrung, often exceedingly 
sensitive to her surroundings, is a poor match for 
the peasant woman, often strong in physique, and 
happily ignorant of much of the world’s woes as 
they afflict a more sensitive soul. Observation has 
shown that during the late War many prospective 
mothers in England and France, in no financial 
want, and under the best of medical care, suffered 
only a shade less than the women of Germany and 
Austria, where the demon of malnutrition entered 
the houses of rich and poor alike. Many of the 
women in England and France had sufficient and 
good food; but the fault lay with their mental 
state: their nerves were shattered. 
Poor food, or “nervous indigestion,” reacts on 
the offspring. reaction is not immediate, for 
the organism makes heroic attempts to produce, WHAT TO EAT: THE NURSING MOTHER 
63 
and to continue to produce, milk of normal quality; 
the very tissues of the mother are not spared in this 
attempt. If malnutrition continues, however, then 
sooner or later milk of a poor quality is manufac- 
tured, and this reacts unfavorably on the child. 
These facts have been established by experiments 
on rats and on cows, and by extensive observa- 
tions of human beings. Dr. Babcock records ex- 
periments with cows whose food was deficient in 
salt (the ordinary table salt). They were kept 
on this deficient diet from two to fifteen months. 
Some of the animals died; others recovered only 
when salt was administered. Yet until almost to 
the very last, the quantity of milk produced was 
little below normal. 
Cowts deliberately fed on a diet lacking in vita- 
mine A produce a milk poor in this essential; and 
rats kept on such a diet produce young that fail 
to grow. The rickets, so prevalent among negro 
children, can be traced to the type of diet selected 
by their mothers. But we have merely to read our 
daily newspaper to realize what malnutrition over 
a number of years will do to entire populations, 
particularly to nursing mothers and their offspring. 
If we believe, with Lodge and Doyle, that the spirits 
of the departed endure, we may well wonder what 
thoughts run through the spirit of a Napoleon, a 
Metternich, or a Bismarck—the “makers of Modern 
Europe”—as he surveys the world of to-day—a 64 
WHAT TO EAT 
world that seems to be the product of Mephistos 
let loose. 
References 
E. V. McCollum’s The Newer Knowledge of Nu- 
trition (Macmillan Co., N. Y.), chapter 15, and 
H. S. Carter, et al.: Nutrition and Clinical Dietetics 
(Lea and Febiger, Philadelphia), chapter 5. EMIL ABDERHALDEN, PROFESSOR OF PHYSI- 
OLOGY AT THE UNIVERSITY OF HALLE. 
ONE OF THE LEADING PHYSIOLOGISTS OF 
THE PRESENT DAY. CHAPTER V 
WHAT TO EAT: INFANT FEEDING 
This chapter is not written with any idea of sup- 
planting the need of a physician; each child should 
be under the constant care of a doctor from birth 
until at least the end of the first year. What these 
pages attempt to do is to impart a certain amount 
of elementary knowledge, without which the mother 
flounders hopelessly just as soon as the doctor is 
out of sight. 
In the first place, it must be pointed out that 
by far the best food for the infant during the 
first twelve months is its mother’s milk. This 
has been emphasized often enough, but advertise- 
ments which have an insidious way of working 
themselves into the brain of man, often tend to 
modify that impression. We repeat then, mother’s 
milk for the baby; this is our slogan. 
Dr. Dietich, of Los Angeles, in a study of 1,000 
cases in that city, finds that 37 per cent of the 
children were nursed at the breast for three months 
or less, and nine per cent were deprived of mother’s 
milk within eight days of birth. This assumes 
65  WHAT TO EAT 
66 
significance only when we state that 85 per cent 
of deaths under one year occur in the bottle-fed 
infant. Again we say, mother’s milk for the baby. 
Now as to some details: 
Breast feeding. We shall omit such details as 
the nurse commonly gives the mother—the technic 
of feeding, the care of the nipples, the best way 
of holding the infant; all these are important 
enough, but a ten-minute demonstration is of more 
value than pages of description. 
The breasts begin to secrete milk on the third or 
fourth day after the birth of the child. After 
the infant has been allowed two or three prelimi- 
nary trials at the breast, it is immediately put on a 
three-hour schedule. Its feeding time may be 6, 9, 
12, 3, 6, 9, 12. It should not be kept at the breast 
for more than twenty minutes, but while there, 
it is important that the nursing be steady and not 
intermittent. As an unbroken rest is of benefit 
to the child as well as to the mother who nurses 
it, the custom of omitting the night feeding alto- 
gether is gaining ground. This schedule should be 
rigidly adhered to. After the fifth month, the four- 
hour interval may be adopted (say 6, 10, 2, 6, 10). 
A serious disturbance in the health of the child 
may, of course, necessitate a modification of this 
schedule, but this should be left to the discretion 
of the doctor, and to none other. 
By disturbances we mean such common occur- WHAT TO EAT: INFANT FEEDING 
67 
rences as vomiting, gas and colic. Vomiting in 
small amount need cause no concern, but where 
this assumes proportions and continues, then some- 
thing is the matter with the child. The disturb- 
ance may be due to one of a number of possible 
causes: the milk may be too rich in fat, or too 
much in quantity, or it may be a case of air-swallow- 
ing. If the last, then holding the infant upright 
for a minute or so often improves its condition. 
Where the milk is too rich in fat, a modification of 
the mother’s diet may become necessary. If the 
quantity consumed is too large, the time between 
feedings may be shortened. 
Milk too rich in fat or containing a protein that 
does not agree with the child, may give rise to 
colic, and in this event, aside from such imme- 
diate remedies as a hot application or an enema, 
it may be necessary to supplement the child’s food 
with a little sterile water, or even to starve it 
for a day. 
When we come to diarrhea we deal, as Dr. Grulee 
points out, not with a disease, but with a symptom. 
It may be due to one hundred and one things, and 
therefore the doctor should be called immediately. 
In the meantime, it is safe to give the child a dose 
of castor or mineral oil, to stop feeding, and to 
offer plenty of water. 
Supplementary or mixed feeding is resorted to 
when the mother’s milk is insufficient for the normal 68 
WHAT TO EAT 
development of the child. This includes a diet of 
mother’s and then of diluted cow’s milk. Often 
enough, with little or no justification, proprietary 
foods are introduced at this stage. 
Whenever possible, the mother should continue 
to nurse her child for the first eight or nine months. 
Where the milk shows signs of insufficiency, prop- 
erly prepared cow’s milk, in quantity enough to 
offset such insufficiency, should be added to the 
child’s diet. It is becoming the exception rather 
than the rule when the modern mother does not 
have to introduce bottle feeding at the end of 
the third month. 
Artificial feeding. There is hardly a doctor who 
has not a pet formula of his own upon which to 
raise the coming generation, though he fully realizes 
that modifications are needed to fit individual cases. 
No attempt other than that of suggesting one of 
many formulas will be made; it will give the reader 
a basis, limited to be sure, for judgment. 
First three months: One-half milk and one-half 
water, with the addition of two level tablespoon- 
fuls of one of the common sugars (milk sugar, 
maltose, or cane sugar) to the 24-hour quantity. 
There is a wide divergency of opinion as to the 
advantages and disadvantages of the different 
sugars and here again the choice will depend upon 
the personal experience or predilection of the physi- 
cian in charge. WHAT TO EAT: INFANT FEEDING 
69 
From three to six months: Two-thirds milk, one- 
third water, and two tablespoonfuls of sugar. 
From six to eight months: Three-fourths milk, 
one-fourth water, and two tablespoonfuls of sugar. 
After eight months the formula should be 
changed to whole milk, only diluting somewhat in 
very hot weather. 
The approximate weights and the quantities to 
be taken per 24 hours may be as follows: 
Age 
Weight 
Quantity 
per 2Jf hrs. 
Birth 
7 pounds 
20 ounces 
One month 
9 “ 
24 “ 
Two months 
10 “ 
28 “ 
Three months 
12 “ 
32 “ 
Six months 
15 “ 
36 “ 
Eight months 
17 “ 
30 “ 
To supply enough of the anti-scorbutic vitamine 
(the absence of which causes scurvy), orange juice 
should be started as early as the third month, per- 
haps even earlier; this and other fruit juices also 
act as preventives of and cures for constipation. 
The question of when to enlarge the diet by giving 
the infant food other than milk is one that must 
be left to the discretion of the physician. In gen- 
eral, it may be said that a child that does not gain 
satisfactorily will probably be given some cereal 
as early as the sixth month (sometimes—in the 70 
WHAT TO EAT 
form of barley water—this is added from the start). 
From then on, zwieback, toast, fruits, greens, and 
extracts of vegetables will follow. Eggs may be 
introduced in the ninth month. A little of the 
white of the soft-boiled egg is first offered; this is 
gradually increased, and finally the yolk is in- 
cluded. Vegetables, at first in the form of spinach 
or asparagus, may also be begun at this time; 
so may bread toast or hard cracker. The following 
month rice and potatoes may be introduced. 
When one year old, the child’s diet should in- 
clude milk, orange juice, cereal, dry bread, beef 
juice (or still better, an egg), boiled rice or baked 
potatoes, and green vegetables. At fifteen months 
the ten p.m. bottle should be omitted. (Drinking 
from a glass should be introduced just as early 
as possible.) From now on, the amount of solid 
foods is gradually increased, and the amount of 
milk decreased to about 20 ounces. Until the end 
of the second year the variations and introductions 
include oatmeal, barley, chicken, mutton broth, 
zwieback, hominy, cornmeal, custard, corn-starch, 
rice pudding, junket, stewed prunes, baked apple, 
apple sauce, farina, cream of wheat, wheatena, but- 
ter (mixed with potato or rice), bread and butter, 
spinach, asparagus, squash, stewed tomatoes, 
stewed carrots, strained beans. 
Sample diets for children from two to four years, WHAT TO EAT: INFANT FEEDING 
71 
based on recommendations made by a committee 
working in conjunction with the New York Health 
Department, are as follows: 
Breakfast, 7 a.m. : Cereal (oatmeal, hominy, rice 
or cornmeal), two to three good tablespoonfuls, 
with one even tablespoonful of sugar and two 
ounces of milk. Crisp toast or bread (stale), one 
or two slices with butter. Milk, eight ounces from 
cup. 
Morning lunch, 10.30 a.m. : Milk, six ounces. 
Bread (stale), one slice. 
Dinner, 1.30 p.m. : Cup of thick soup or one egg. 
Bice or macaroni, two tablespoonfuls, or one small 
baked potato. Fresh vegetable, two tablespoonfuls. 
Stewed fruit, three or four tablespoonfuls. Bread, 
one or two slices, with butter. Water. 
Supper, 6 p.m, : Cereal, two or three good table- 
spoonfuls with sugar, and two ounces of milk. Milk, 
six ounces from cup. Bread and butter, one slice. 
Custard, junket or plain pudding, two to four 
tablespoonfuls. 
One or two modifications may be recommended. 
It is perhaps best to start the breakfast with the 
juice of an orange, and it is probably wholly un- 
necessary to give a morning lunch at 10.30. If this 
meal is omitted, as may be done in most cases with- 
out any harm and with increased convenience to all 
concerned, the breakfast hour may be changed to 72 
WHAT TO EAT 
7.30 a.m., the dinner to 1 p.m., and the supper to 
5.30 p.m. The schedule may then be mapped out 
as follows: 
Breakfast: Orange juice; cooked fruit (if de- 
sired; cereal (covered with a little milk and 
sugar); soft-boiled egg; toast and butter; glass of 
milk. 
Dinner: Soup or beef juice (in cold weather 
only); very little (about a tablespoonful) of meat, 
such as lamb chop, or white of chicken, not to be 
given more than twice a week; baked potato or 
boiled rice, with slab of butter; green vegetable; 
dessert or cooked rice; water; and milk, if possible. 
Supper: Toasted bread, little sugar, and cup of 
milk, all mixed (the milk to be warmed on cold 
days); bread and butter, if desired. A cereal may 
be substituted for the toasted bread. 
An excellent habit is to train the child to take 
two or three glasses of water during the day, pref- 
erably between meals. Exclude candy or anything 
else that appeals to the “sweet tooth” (an advice 
which the mother, no less than the child, would do 
well to heed). 
From the age of five on, the child may be given 
much of what the adult gets, provided the diet in- 
cludes a quart of milk a day, and fruit and vege- 
tables in season, and provided that highly-spiced 
and excessively sugared foods are excluded. The 
recommendation made elsewhere, that the amount WHAT TO EAT: INFANT FEEDING 
73 
of protein in the shape of meat be reduced, and in 
the shape of milk and its products (such as cheese) 
and eggs be increased, applies with particular force 
here. 
References 
[J.A.M.A. =: Journal of the American Medical 
Association.] 
L. E. Holt’s book, Food, Health and Growth 
(Macmillan Co., N. Y.), is a valuable general dis- 
cussion of the modern scientific principles under- 
lying the nutrition of children. More practical and 
of equal value is the same author’s Diseases of In- 
fancy and Childhood (Appleton and Co., N. Y.). 
See also M. E. Bayley’s Practical Talks on the Care 
of Children (E. P. Dutton and Co., N. Y.). A 
number of books devoted to infant feeding are 
those by C. G. Grulee (W. B. Saunders Co., Phila- 
delphia), J. S. Fowler (Oxford University Press, 
N. Y.), L. E. Morse and F. B. Talbot (Macmillan 
Co., N. Y.), and R. H. Dennet (J. B. Lippincott 
and Co., Philadelphia). Much of practical value 
will be found in H. S. Carter’s volume, Nutrition 
and Clinical Dietetics (Lea and Febiger, Philadel- 
phia), chapters 16, 17, and 18; in J. H. Kellogg’s 
The New Dietetics (The Modern Medicine Publish- 
ing Co., Michigan, 1921), pages 806-822; and in O. 
T. Osborne and Morris Fishbein’s Handbook of 74 
WHAT TO EAT 
Therapy (American Medical Association, Chicago), 
pages 647-680 of the 1920 edition. A paper of 
value to practitioner and layman alike is one by 
Henry Dietrich on “An Analysis of a Series of 
Case Records Relative to Certain Phases of Breast 
Feeding,” J.A.M.A., volume 79, page 268, 1922. An 
account of the discussion which this paper aroused, 
when it was read at the St. Louis meeting of the 
Association is a very valuable feature of this ar- 
ticle. The Labor Bureau in Washington publishes 
pamphlets dealing with the care and feeding of 
infants. 
The student would do well to study the series of 
articles on the food requirements of children by 
Dr. Holt and Miss Fales, published in the American 
Journal of Diseases of Children, volume 21, page 1, 
1921; volume 22, page 371, 1921; volume 23, page 
471,1922; volume 24, page 44,1922; volume 24, page 
311, 1922. Jf, 
ELMER VERNER MCCOLLUM, PROFESSOR OF CHEMICAL HYGIENE, JOHNS 
HOPKINS UNIVERSITY. A LEADING AUTHORITY ON THE CHEMISTRY AND 
PHYSIOLOGY OF VITAMINES. CHAPTER VI 
VEGETARIANISM 
Strictly speaking, the true vegetarian is he who 
abstains not only from eating meat, but from milk 
and eggs. Of true vegetarians we have few; of 
the pseudo-variety—those who include milk and 
eggs in their diet but exclude meat, there is a 
fair number. Still more are they who are begin- 
ning to realize that meat is not the indispensable 
article of food so many people were led to suppose 
—not, at least, if milk and eggs can be had; with 
the consequence that the wise ones among us, basing 
their belief partly on laboratory experiments, but 
largely on their own and their friends’ experiences, 
do not consume more than one-half the meat their 
fathers did, but drink twice the amount of milk. 
Hindhede, the Danish investigator, is fond of 
pointing to the Japanese as an example of a race 
who have thrived on a vegetarian diet. “The Jap- 
anese,” he writes, “have been the means of furnish- 
ing us with abundant proof that a race of people can 
maintain themselves for over a thousand years in 
truly wonderful physical and mental condition on 
75 76 
WHAT TO EAT 
very little protein, derived almost exclusively from 
vegetables.” Their diet, as everybody knows, con- 
sists largely of rice, though this, as a rule, is far 
from being their sole food. “Vegetables and fruit 
are grown in abundance, and their value as a regu- 
lar part of the diet is realized far more than in 
Europe.” They are copious water drinkers, and 
this, combined with a small meat intake, has been 
advanced as one reason why rheumatism is prac- 
tically an unknown disease in Japan. Yet it must 
not be forgotten that the Japanese are not really 
vegetarians at all, for many of them eat fish, milk 
and eggs, and, in the large cities, meat; that is to 
say, though the consumption of meat and milk and 
eggs per person is considerably smaller in Japan 
than in most European countries, these foods are 
not absolutely excluded from the diet. Hence it 
cannot be said that the Japanese—and this also ap- 
plies to the Chinese—are vegetarians. There are 
not people wanting who connect the small stature of 
the Japanese with their peculiar diet, but of this we 
have no proof at all. Neither is it necessary to 
stress ideas encouraged even by some physiologists, 
that the meat eaters have produced the men with 
brains, whereas the vegetarians have not; where- 
upon it may follow that men who eat meat develop 
brains! This is a pretty little variation of the 
fable entitled “Phosphorus for the Brain.” 
In the past—and to a large extent in our own VEGETARIANISM 
77 
day—the diet of man depended very much upon 
which part of our globe he happened to inhabit. 
The Eskimo in the Arctic still lives largely on a 
flesh diet: on the flesh of the seal, the walrus, the 
Polar bear, the reindeer, with an occasional addi- 
tion of milk obtained from the last-named animal. 
The Eskimo lives on meat not because he likes it 
better than any other food, but because any other 
food is not to be had. Going to the other extreme, 
we find the people in the tropics leaning rather 
heavily towards a vegetarian diet—this time not 
because meat is so scarce, but because fruit and 
vegetables are so plentiful, and because “meat in 
hot weather does not agree with one.” In between 
these extremes, we have the peoples in parts of 
Europe, Asia, and America, who partake more truly 
of a mixed diet. 
First of all, let us take up strict vegetarianism— 
a diet which excludes not only meat, but milk and 
eggs; what are the advantages claimed for it? Its 
votaries claim that it not only prolongs life but 
helps to ward off sickness. Their pet reason for 
advocating it, however, is a moral one: man should 
not kill to eat. This, of course, cannot apply to 
the drinking of milk, but the enthusiasts of this 
school apparently wish to avoid of animal 
origin. 
It may be said at once that, though it is possible, 
by making use of the results of many recent scien-  WHAT TO EAT 
78 
tific experiments, to plan a well-balanced vegetarian 
diet, it is not an easy task, for it requires a minute 
knowledge of the chemistry and physiology of foods, 
which is altogether beyond the reach of the average 
man, and it is beset with practical difficulties of a 
kind that are not easily overcome. As a class, 
vegetables and fruits are not only low in proteins, 
but low in proteins of high biological value. Com- 
paratively large quantities of material have to be 
eaten to yield even the minimum nitrogen require- 
ments, with the added probability that this nitrogen, 
in the shape of protein, is low in the biological 
scale—which is simply another way of saying that 
such proteins do not contain essential amino-acids 
in sufficient quantity. Experiments on animals 
conducted by Slonaker and McCollum have shown 
that a vegetarian diet, unless very carefully selected, 
and unless it includes leafy vegetables, is insuffi- 
cient to maintain health. 
In this connection, an experiment now being 
tried out at the Beth Israel Hospital, New York, is 
of interest. This institution caters largely, though 
not exclusively, to orthodox Jews, that is, such as 
observe the dietary laws. The superintendent, Mr. 
Frank, and the director of laboratories, Dr. Kahn, 
were of the opinion that if they could adopt a modi- 
fied vegetarian diet—one that excluded meat but 
not necessarily fish—the question whether a food 
was kosher would not arise. The elimination of VEGETARIANISM 
the kosher problem would, incidentally, be the 
source of considerable saving to the hospital, for to 
keep within orthodox limits necessitates separate 
kitchens, preparation rooms, dish washing rooms, 
sculleries, etc. 
The opinions of the most eminent nutritional 
experts in the country were sought: F. G. Benedict, 
of the Carnegie Nutritional Laboratory, Boston; R. 
H. Chittenden and L. B. Mendel, of Yale; W. J. 
Gies, of Columbia; Graham Lusk, of Cornell; E. V. 
McCollum, of Johns Hopkins; and V. C. Vaughan, 
of Michigan. Without a dissenting voice, these 
authorities agreed that the scheme was in every 
way feasible, and in many ways desirable. “I have 
not the slightest hesitation in saying,” writes Pro- 
fessor McCollum, “that the vegetarian diet, sup- 
plemented with fairly liberal quantities of milk, is 
the most satisfactory type of diet that man can 
take.” “Inasmuch,” writes Professor Mendel, “as I 
myself lived upon a diet devoid of meat, fish and 
fowl for nearly a year, for purely experimental pur- 
poses, and remained in excellent health and vigor 
during that period, I have no fears regarding the 
wholesomeness of such a procedure.” “I believe,” 
is Professor Lusk’s comment, “that the lacto-vege- 
tarian diet could be installed in any hospital with- 
out detriment to the health of the patients.” 
Palatability, easily procured when meat is in- 
cluded, may be increased in a lacto-vegetarian diet 
79 80 
WHAT TO EAT 
by the use of yeast extracts, such as “vegex,” which 
has the flavoring qualities so highly prized by many. 
Both Drs. McCollum and Mendel concur in this. 
The Frenchman, Professor Gautier, was of the 
opinion that “a system of modified vegetarianism 
should gradually eliminate the fierce and rugged 
elements from man’s character, and fill the earth 
with gentle manners. It is both feasible and ra- 
tional, and should appeal to and be practised and 
advocated by all who seek the ideal life and aim at 
producing a sweet-tempered, intellectual and artis- 
tic, yet vigorous, active and prolific race.” Though 
we personally favor a lacto-vegetarian diet—a 
vegetarian diet, that is, which includes milk (and its 
products) and eggs—we cannot subscribe to the 
latter part of Professor Gautier’s statement, for 
the very simple reason that there is no evidence 
either for or against it. We do not know to what 
extent our war-like propensities are activated or re- 
tarded by the food we eat. If we could ascertain 
such a relationship, it would be the most momen- 
tous discovery since the dawn of historic man. 
References 
By far the best account of the vegetarian diet, 
viewed in the light of modern knowledge, is that 
given by E. V. McCollum, in his The Newer Knowl- 
edge of Nutrition (Macmillan Co., N. Y.), chap- VEGETARIANISM 
81 
ter 7. His articles entitled “The Vegetarian Diet 
in the Light of Our Present Knowledge of Nutri- 
tion” (American Journal of Physiology, volume 41, 
page 333, 1916), and “The Supplementary Dietary 
Relationship Between Leaf and Seed as Contrasted 
with Combinations of Seed with Seed” (Journal of 
Biological Chemistry, volume 30, page 13, 1917), 
should also be consulted. Professor McCollum is an 
authority internationally recognized. The article 
by Mr. L. J. Frank on “The Meatless Diet,” Modern 
Hospital, November, 1921, is of interest. Much of 
M. Hindhede’s book, Protein and Nutrition (Ewart, 
Seymour and Co., London), deals with this subject. 
Hindhede is also a recognized authority. The clin- 
ical aspects of vegetarianism are discussed by F. X. 
Gouraud in his volume, What Shall 1 Eat? (Reb- 
tnan Co., N. Y., 1911), page 344. CHAPTER VII 
OVERWEIGHT AND UNDERWEIGHT 
Overweight. We have little difficulty in picking 
out thin and fat people. Such selections, justified 
most of the time, are not always dependable; we 
need more exact data if we are to undertake a cure. 
But the word “cure” should not mislead the reader 
into supposing that in this chapter we shall deal 
with the sick person. If overweight be due to over- 
feeding and to too little exercise, the weight can 
be reduced without difficulty, and this is what we 
propose to indicate in this chapter. Where obesity 
is due to other causes—to diseases of various kinds 
—reduction in weight becomes a more difficult mat- 
ter. But for every obese person who suffers from 
some chronic illness, there are ninety-nine persons 
who suffer from nothing more than overeating. 
If you are called a fat or stout person, confirm 
it by consulting the table of average heights and 
weights given at the end of the book. The table 
is a guide and nothing more; it represents the aver- 
age but not the ideal. For example, the average 
person gains appreciably even after he has reached 
82 OVERWEIGHT AND UNDERWEIGHT 
83 
the age of thirty; a better standard would be one 
that assumes no gain in weight after that age. 
Haying decided that you belong to the overweight 
class, what is to be done? You are advised to eat 
less. But the advice is not complete without an- 
other recommendation: exercise more. And still 
another recommendation is necessary: select your 
food with care. A reduction in food intake should 
not involve going below minimal standards. 
“Eat less and exercise more” is more easily said 
than done. And quick action is necessary, for 
otherwise you create a vicious circle. As you put 
on weight, the desire for exercise becomes less, 
though the desire for food does not decrease in pro- 
portion ; whereupon it follows that the tendency is 
in the direction of an accelerated increase in weight. 
Weight is best reduced by gradually decreasing 
the food intake and gradually increasing the amount 
of exercise taken, until the average weight for the 
particular height and age is reached; when, unless 
further complications arise, the amount of food 
taken and the exercise accomplished at this time 
should be continued unchanged. 
Now, let us be more specific. Let us illustrate 
our thesis by selecting a man, age 40, height five 
feet nine inches, who is presumably in good health, 
but who has evidently been building up a “corpora- 
tion,” so that his weight, instead of being about 
160 pounds, is 190. He is a city man. He goes to 84 
WHAT TO EAT 
the office in the morning not by walking but by 
taking the “L” or the subway. He sits in his office 
for three hours or so, and then goes to lunch with 
a business acquaintance. Smith has to show Jones, 
a customer, that things are done on a generous 
scale; whereupon soup and roast beef and a creamy 
dessert and coffee and cheese find their way into 
the stomachs of these good citizens. Then Smith 
goes back to his office, stays there another three 
hours, and hurries home via the “L” or the subway 
to Mrs. Smith who, of course, must provide a good 
dinner for her poor, overworked husband. Again 
there are meats and fatty dishes and creamy things. 
Then weary Mr. Smith smokes his pipe, and reads 
his paper, or he joins his next-door neighbor in a 
quiet game of cards, or, if he feels very virtuous, 
takes his family out for a drive. 
You may say that this is an exaggerated picture. 
Well, perhaps it is, but the proposed cure can be so 
modified as to suit more moderate cases. 
In the first place, it is highly desirable to include 
a three-mile walk in your daily routine just as re- 
ligiously as you include shaving; only very bad 
weather should be allowed to interfere with such 
plans. A good way of doing this is to take one-half 
of it in the morning—walking towards your place of 
business—and one-half in the evening, walking to- 
wards home after the day’s work, or taking a stroll 
—a brisk one, please—after supper. Next in order OVERWEIGHT AND UNDERWEIGHT 
85 
is a simple form of exercise that is best done before 
your daily bath—a simple bending and stretching 
and breathing exercise lasting ten minutes or so. 
Dancing and skating in the winter, and golf, tennis, 
rowing, and swimming in the summer, are excellent 
means for the strengthening and preservation of 
one’s physique. 
So much for the exercise. Now as to food, an 
equally important part of the cure. We strongly 
advise against any fast, or even partial fast cures, 
unless on the express order of a physician. The 
men who go without lunch make up for it at sup- 
per, and the men who fast all day will lose weight, 
to be sure, but they may lose strength too. The 
much better plan is to adopt a diet less rich—one 
containing less fat and carbohydrate—than the food 
eaten up to the time of the cure. 
One of the first items of his bill of fare that the 
corpulent individual seizes upon to throw into the 
discard is milk. As a matter of fact, that should 
be the very last to go. Aside from the fat, which 
need never be discarded altogether, milk contains 
protein of the highest biological value, indispen- 
sable mineral salts, and the three known vitamines. 
It acts, therefore, as a corrective for other foods 
which may be deficient in certain essentials. One 
to two glasses of milk per day (mixed with small 
quantities of tea, coffee, or cocoa, if preferred) 
should always be included. 86 
WHAT TO EAT 
Let us now make up a daily menu: 
Breakfast: Fruit (preferably fresh rather than 
stewed), one egg, one slice of bread lightly buttered, 
a glass of milk (or the contents of a glass of milk 
mixed with a little coffee say, and one to two lumps 
of sugar). 
Luncheon: Soup (in cold weather), with one 
slice of bread and butter, and some form of salad; 
or, in the summer months, salad, unaccompanied by 
soup, with bread and butter. A glass of water and 
a glass of butter-milk should be emptied at this 
meal. 
Dinner: Meat or fish, but no “second help” (the 
meat or fish to be replaced two or three times a 
week by a dish including cheese or eggs) ; one or, 
preferably, two vegetables; fruit, raw or stewed; 
water. No bread. (An apple an hour before bed- 
time. A glass of water before breakfast. Chew food 
slowly. Slow chewing, and the bulkiness of part 
of the food—the vegetables and fruit—will tend to 
create a sense of satisfaction long before the limit 
of digestive capacity is reached. No candies or 
other luxuries.) 
Dr. Joslin, an eminent diabetic specialist, is au- 
thority for the statement that “diabetes is largely a 
penalty of obesity.” “There is a widespread tend- 
ency,” says an editoral in the Journal of the Ameri- 
can Medical Association, “on the part of many 
clinicians to explain—perhaps one should say to ex- OVERWEIGHT AND UNDERWEIGHT 
87 
cuse—obesity as the result of constitutional causes 
independent of mere overeating in ultimate analy- 
sis. Undoubtedly there are such instances, notably 
in connection with disorders of the endocrine or- 
gans or sex glands. Granted there is one person in 
a thousand, Joslin writes, who has some such in- 
herent peculiarity of the metabolism which has led 
to obesity, there are 999 for whom being fat implies 
too much food or too little exercise or both com- 
bined.” (See the Journal of the American Medical 
Association, volume 76, pages 79, 523 and 525, 
1921.) 
Underweight. A careful reading of the previous 
paragraphs ought to prepare the reader for an in- 
telligent understanding of the subject of under- 
weight. But care must be exercised in the applica- 
tion of knowledge. Whereas in overweight the 
motto ran, “Eat less and exercise more,” in under- 
weight we should not go to the opposite extreme and 
say, “Eat more and exercise less,” but “Eat more 
and continue exercising.” Moderate exercise, of the 
kind alluded to in previous paragraphs, should 
never be discarded (unless the case is a pathological 
one, which is then beyond the province of this 
chapter). Taking for granted that the individual is 
underweight (consult the table at the end of the 
book for confirmation of your own opinion), and 
that he is to exercise in the manner described under 
“overweight,” what food ought he to select? Par- 88 
WHAT TO EAT 
ticularly those that are rich in fat and carbohy- 
drate, though others, rich in protein, mineral salts, 
and vitamines, should not be neglected. 
Breakfast: Fruit (preferably fresh rather than 
stewed); cereal and cream; two eggs; bread and 
butter; and a glass of milk (or the contents of 
a glass of milk mixed with a little tea, coffee or 
cocoa). Around 11 a.m. : An agreeable milk and egg 
combination (chocolate malted milk, containing a 
raw egg, for example). 
Luncheon: Cream soup in winter (may be dis- 
carded in summer); bread and butter (generous 
portions of each); two types of vegetables (pota- 
toes and carrots, for example); glass of milk; ice- 
cream or milk chocolate, if desired. Around 4 p.m. : 
Milk and egg combination. 
Dinner: Meat or fish or cheese preparation (gen- 
erous first and second helps); two kinds of vege- 
tables; salad; several slices of bread and butter; 
milk; fruit and cream. (An apple an hour before 
bedtime. Water before breakfast and three or 
four times during the day, at and between meals. 
Moderate consumption of candy, such as milk choco- 
late, or chocolate mixed with nuts, or sugared 
almonds, not objectionable, but let the quality be 
of the finest.1 
1 There are persons who eat and eat and never grow fat. We 
cannot explain why such persons fail to gain in weight. “It is 
conceivable,” we are told, “that persons of certain ‘metabolic 
temperaments’ fail to grow fat because the overfed organism in OVERWEIGHT AND UNDERWEIGHT 
89 
References 
A very good account is that given by Irving 
Fisher and E. L. Fisk in their book, How To Live 
(Funk and Wagnalls Co., N. Y., 1921), page 257. 
See also J. H. Kellogg’s The New Dietetics (The 
Modern Medicine Publishing Co., Michigan, 1921), 
pages 583 and 601; and the chapter on “Overfeed- 
ing” in M. Hindhede’s Protein and Nutrition 
(Ewart, Seymour and Co., London). 
them wastes rather than stores the surplus of intake.” This is 
hardly an explanation, for it is self-evident that there must be 
a waste somewhere if the body fails to gain in weight, even 
though excessive quantities of food are eaten. CHAPTER VIII 
CONSTIPATION 
Constipation is the commonest digestive disturb- 
ance and among the commonest of ailments. It 
may be due to many causes, of which impropej 
food is one. There are several varieties of it, from 
a constipation that occurs infrequently and that is 
often due to some particular food eaten at the time, 
to more chronic cases, where relief is sought in the 
constant use of cathartics, purgatives, and what not. 
We here are interested in the milder types, though 
much of what will be said may find general appli- 
cation. 
First a word as to prevention. The best preven- 
tive measure is not to be found in medicines but 
in the food eaten. (Such factors as exercise, and 
the formation of regular habits, such as going to 
the toilet at specified times, though not discussed 
here, should not be overlooked.) A proper diet 
should include material that is not digested but 
that adds to the bulk of the residues in the intestine, 
and material that tends to wash and cleanse the 
digestive tube. The first is found in cellulose, the 
90 CONSTIPATION 
91 
second in water. Copious water drinking, and a 
diet liberal in vegetables, should insure freedom 
from constipation. (Notice that by “material that 
is not digested” we do not mean foods that are 
digested with difficulty, such as tough meats, un- 
ripe fruit, etc.) Foods rich in cellulose are figs, 
prunes, tomatoes, berries, and nuts, among fruits; 
oatmeal, whole wheat, graham bread, and shredded 
wheat, among cereals; and carrots, turnips, beets, 
spinach, beans, peas, celery, lettuce, cucumber, 
radishes, and cabbage, among vegetables. Vege- 
tables, in fact, are all rich in cellulose. 
A diet which includes foods rich in cellulose, 
which includes plenty of water, which includes a 
minimum of sweets and delicatessen, and which 
excludes excessive quantities of creamy produc- 
tions, should lead to daily, normal evacuations. 
(Kellogg maintains that no man is to be considered 
in good health unless he has three evacuations a 
day. In that case the world is full of invalids, 
for the average man thinks himself fortunate if he 
evacuates daily. Dr. Kellogg, who is the Medical 
Director of the Battle Creek Sanitarium, is not to 
be dismissed lightly, however, even though his 
views may be that of an extremist. He is a very 
eminent authority on the entire question of consti- 
pation, and the reader would do well to consult 
his volume mentioned at the end of this chapter. 
A few of the rules he recommends for the care of 92 
WHAT TO EAT 
the eolon may be mentioned. “Cellulose is the 
only element which can increase the bulk of the 
feces. One to two ounces of cellulose are needed 
daily. Bran is a form of cellulose; agar shows 
chemical resemblances to gums. Fasting, a scanty 
diet, a liquid diet, such as milk, gruels, porridges, a 
diet chiefly consisting of such foods as potatoes, rice, 
meat, eggs, tea, coffee and condiments, are con- 
stipating. Green vegetables contain much cellu- 
lose: these foods are laxative. Half the bulk of 
dried feces consists of food residues, the other half 
of germs and of poisonous matter excreted by the 
intestines, which should be gotten rid of as soon 
as possible. This is especially important in cases 
of colitis, since the intestinal mucous membrane is 
diseased, and in all cases of chronic disease, par- 
ticularly in cases of auto-intoxication, Bright’s 
disease, arteriosclerosis, disease of the liver, skin, 
thyroid gland, heart and lungs. Exercise promotes 
bowel action. Drugs of all sorts must be avoided.”) 
A daily evacuation, without effort, where the 
feces are in one coherent form, and where the dis- 
agreeable odor does not make itself too evident (the 
extent of this odor may be a rough gauge of in- 
testinal putrefaction), should be the aim. Lauder 
Brunton, the English physician, relates how when 
he was Casualty Physician at St. Bartholomew’s, “I 
must have seen 100,000 patients, reckoning that I 
saw each patient on an average about three times. CONSTIPATION 
93 
At first I was accustomed to ask the question, ‘Are 
your bowels regular?’ but I afterwards gave this 
up, because I found that it was ambiguous. One 
day I asked this question of a young woman, and 
she assured ‘Yes, sir.’ I then asked, ‘How often are 
they open?’ and she answered ‘Once in three 
sir.’ Her answer to my first question was perfectly 
correct, for her bowels were regular, but the term 
regularity conveyed a different meaning to her and 
to me.” (Disorders of Digestion, Macmillan Co., 
London, 1893, page 72.) 
Where, despite a careful selection of food, a 
daily evacuation is not obtained, resource must be 
had to other means. Temporary relief, if the con- 
stipation has lasted for a number of days, may be 
obtained by the use of an enema. Further preven- 
tion of constipation may be possible by the in- 
clusion of bran or agar-agar in the diet, both of 
which are extremely rich in cellulose; or perhaps 
these in combination with a lubricant, such as any 
one of the mineral oils, Russian or otherwise. The 
use of these oils in preference to other laxatives and 
purgatives is recommended, since they pass through 
the digestive tract completely unaffected; neither 
have they any deleterious effect on the body. 
The indiscriminate use of laxatives and purga- 
tives should be discouraged, because they are of 
the nature of drugs, and give rise to drug-forming 
habits. By their constant use, the bowels become 94 
WHAT TO EAT 
more and more sluggish in their movements, and 
a constantly increasing effort is necessary to evacu- 
ate them. Only very recently, skin eruptions have 
been traced to the use of the now popular phenol- 
phthalein, and an exhaustive study made by Profes- 
sor Underhill, of Yale, shows that saline laxatives, 
such as Epsom, Glauber’s and Rochelle salts, tend 
to draw water from the blood and thereby increase 
the concentration of the latter—a result which may 
lead to a pathological condition, as studies of pneu- 
monia and the effects produced by poisonous gases 
have shown. Incidentally, these studies may lead 
to an explanation as to why natural waters are to 
be preferred to any of the common laxatives, for the 
former contain more water in proportion to dis- 
solved solids than the latter, and hence do not tend 
to withdraw water from the blood to the same ex- 
tent. If, then, a laxative is taken, let it be taken 
with plenty of water. 
So far we have discussed the mild forms of con- 
stipation—those forms so very common, and yet 
so often neglected, that the system becomes hope- 
lessly ruined. We have no intention of discussing 
more chronic cases; they are for the physician. He 
must study each individual case carefully, and 
adopt various procedures as occasion may arise. 
If, then, the mild measures advocated do not give 
relief, consult the doctor, and do not, in the name 
of everything you value, follow the advice of tonic CONSTIPATION 
95 
and pill distributors, whose crimes are not one jot 
less than those of diplomats who make war. We 
will, however, refer again to Professor Rettger’s 
work (see also page 37), since it opens up many 
unlooked-for possibilities. Advisedly do we empha- 
size “possibilities,” for we do not want to arouse 
in the heart of any suffering reader hopes which can- 
not be realized. We shall content ourselves by 
quoting a few significant sentences from his latest 
paper. 
“. . . The work of the past two years has shown 
conclusively that bacillus acidophilus can be im- 
planted in the intestine of man almost at will, and 
that its colonization there may be such as to dis- 
place 80 per cent of the usual mixed flora. . . . 
B. acidophilus is, according to all available informa- 
tion, an organism which does not elaborate toxic 
or other harmful products. . . . Viable cultures of 
B. acidophilus when used in sufficient amounts and 
under the right conditions have important thera- 
peutic properties. They are of particular merit in 
the treatment of chronic constipation and of 
diarrheas. . . . The fullest benefit from the acid- 
ophilus treatment can be derived only when the 
patient is under practically daily observation, and 
when thorough bacteriological examinations of the 
feces are made at frequent intervals. . . Drs. 
Kopeloff and Cheney, who have applied the acid- 
ophilus treatment to psychotic patients on Ward’s 96 
WHAT TO EAT 
Island, N. Y., confirm Rettger’s claims. They write, 
“Within the limitations of the data under considera- 
tion, it is evident that with the injection of B. acid- 
ophilus there is a change in the intestinal flora . . . 
and a relief from constipation and diarrhea.” On 
the other hand, Drs. Bassler and Lutz affirm that 
bacillus acidophilus has “a very limited value in in- 
testinal disorders.” Their paper is in the nature of 
a polemic; no case reports are given. 
Some physicians deny that in many cases of con- 
stipation, toxic products, giving rise to “auto-in- 
toxication,” find their way into the blood and poison 
the system. For example, Donaldson has conducted 
experiments on normal students who became con- 
stipated by deliberately refusing to respond to calls. 
These men manifested all the symptoms of auto- 
intoxication—coated tongue, foul breath, impair- 
ment of appetite, gas, mental sluggishness, depres- 
sion, irritability, headache—which, however, dis- 
appeared as soon as a cleansing enema was taken. 
Had toxic substances been produced, these would 
have left their mark on the system even after con- 
stipation had been relieved. Furthermore, it was 
shown by experiments on dogs that when toxic sub- 
stances are present in the intestine, they are ab- 
sorbed. “The evidence shows that a retention with 
meat as part of the dietary of 55, 72 and 96 hours, 
respectively, is not attended by any accumulation 
of poisons in the blood stream. . . . These facts CONSTIPATION 
97 
lead me to consider that delay in the colon does not 
necessarily produce such a desperately toxic mess 
as some people would have us believe. . . . The 
48-hour stasis, which is the average revelation of 
the carmin test in sanatorium guests, does not nec- 
essarily mean a subtle poisoning that calls for the 
application of colon massage and bacillus acid- 
ophilus therapy.” 
References 
[J. A. M. A. = Journal of the American Medical 
Association] 
A very valuable book, containing a mass of in- 
formation for the layman, is that by J. H. Kellogg: 
The Itinerary of a Breakfast (The Modern Medi- 
cine Publishing Co., Michigan). The viewpoint is 
avowedly that of a partisan, but a partisan, it seems 
to us, in a very worthy cause. Another popular but 
scientifically accurate account is that given by 
Irving Fisher and E. L. Lyman in their book, How 
to Live (Funk and Wagnalls Co., N. Y., 1921), 
page 60. More technical works are those by A. F. 
Hunt: Constipation and Allied Intestinal Disorders 
(Oxford University Press, N. Y.), and A. Lane: 
Intestinal Stasis (Oxford University Press, N. Y.). 
See also the papers by Samuel Ayers, Jr.: “Phenol - 
phthalein Dermatitis,” J. A. M. A., volume 77, page 
1722, 1921; F. P. Underhill: “The Influence of 98 
Purgatives on Blood Concentration,” Journal of 
Pharmacology and Experimental Therapeutics, vol- 
ume 19, page 135, 1922; L. F. Rettger and H. A. 
Chaplin: “Bacillus Acidophilus and Its Therapeutic 
Application,” Archives of Internal Medicine, vol- 
ume 29, page 357, 1922; A. Bassler and J. R. Lutz: 
“Bacillus Acidophilus,” J. A. M. A., volume 79, page 
607, 1922; N. Kopelofif and C. O. Cheney: “Studies 
on the Therapeutic Effect of Bacillus Acidophilus 
Milk and Lactose,” J. A. M. A., volume 79, page 609, 
1922, and A. R. Donaldson: “Relation of Constipa- 
tion to Intestinal Intoxication,” J. A. M. A., volume 
78, page 884,1922. 
WHAT TO EAT DR. HINDHEDE IS THE LEADING DANISH INVESTIGATOR 
ON THE SUBJECT OF NUTRITION. HIS STUDIES ON 
THE PROTEIN REQUIREMENTS OF MAN HAVE 
BROUGHT HIM WORLD-WIDE FAME. CHAPTER IX 
DISEASES DUE TO FAULTY DIET 
Since the days of Pasteur and Koch, the pioneers 
of our modern science of bacteriology, the word “dis- 
ease” has been almost invariably associated with 
the word “microbe,” as if diseases other than that 
due to bacteria were unknown. Recent clinical 
and laboratory studies in nutrition have made us 
revise this point of view. Disease is not neces- 
sarily microbic in origin. In fact, a number of the 
common ailments may be due to faulty diet, though 
these very often become complicated by a bacterial 
invasion of the body made possible only because 
of the body’s decreased resistance. We do not in- 
tend to support the thesis that all common diseases 
are dietetic in origin; we merely wish to emphasize 
what, until very recently, has been quite ignored, 
that a number of them may have such an origin. 
The newer viewpoint is largely the result of our 
knowledge of vitamines and the diseases engendered 
in their absence. Yet the effects of malnutrition, 
whether undernutrition or a lack of balance in the 
foods selected, had been noticed long before. In 
99 100 
WHAT TO EAT 
fact, the development of the entire history of nutri- 
tion is intimately bound up with the question of 
malnutrition. 
Hindhede. One of the earliest to perceive very 
clearly the intimate connection that exists between 
a faulty diet and various diseases was Hindhede, 
the Danish investigator. We have already (page 
13) had occasion to refer to him, but his work is 
sufficiently important to be referred to again. His 
general thesis, as we have seen, is that we, the peo- 
ple as a whole, eat too much protein, and above all, 
too much protein in the shape of meat; and that we 
do not consume enough bread and vegetables. We 
have seen how the blockade during the Great War 
gave him an unexpected opportunity to put his 
theory into practice, and how sound his theory 
turned out to be. The criticism we made at the time 
was that in his earlier writings Hindhede minimized 
the importance of milk, and probably underesti- 
mated our need of protein. His later articles seem 
to show a revision in favor of milk, though he stands 
firm on the question of a low protein diet. 
We disagree with his views on the question of a 
low protein diet. Anyone who has made a careful 
study of Osborne and Mendel’s work on the amino- 
acids in proteins and their function in tissue build- 
ing and repair, and who is familiar with Folin’s 
work on protein metabolism, will be forced to the 
conclusion that a generous inclusion of protein in DISEASES DUE TO FAULTY DIET 
101 
the diet is advisable. Further, these studies demon- 
strate the wide variation that exists among proteins 
in their biologic value, the vegetable proteins being, 
as a rule, inferior to the animal proteins. But ani- 
mal proteins include those found in milk and cheese 
and eggs, as well as those in meat; and we heartily 
agree with Hindhede when he advocates a decreased 
consumption of meat, provided at the same time we 
increase our consumption of dairy products. As 
to his advocacy of a diet including abundant vege- 
tables (and fruit), we are in hearty agreement. 
In Chapter 15 of his book, Protein and Nutrition, 
which, though published nine years ago, is well 
worth careful reading, we find such sub-titles as 
“Rich protein [meat] diet is not only useless, but 
probably harmful”; “It is probable that muscular 
strength declines on a rich protein [meat] diet”; 
“It is probable that a rich protein [meat] diet is the 
cause of many ailments..” “I feel weaker,” he 
writes, “after eating much meat. ... If 30 to 60 
grams [one to two ounces per day—a low estimate] 
be sufficient, is it really a matter for wonder that 
the powers of the body are severely taxed to cope 
with 120 to 200 grams? [100 grams is a liberal 
amount for the average person, provided it includes 
protein of animal as well as vegetable origin.] Pro- 
tein which cannot be consumed entirely in the body 
leaves behind it a large proportion of incombustible 
waste which it is the office of the liver and the 102 
WHAT TO BAT 
kidneys to excrete, calling for special exertion on 
the part of these organs. Now, if this large amount 
of protein be unwanted, unnecessary, it is not a 
very far step to the assumption that it must be 
injurious, because such a considerable amount of 
energy must be devoted to catabolism in the cells 
and to the excretion of its waste products through 
the kidneys, energy which might otherwise be 
utilized to assist metabolism in the muscles; and 
in the consequent fatigue we have our explanation.” 
When the liver is overtaxed, it is quite possible that 
ammonium compounds, which are toxic, and are 
decomposition products of proteins, and which nor- 
mally are converted into the inocuous urea by the 
liver, fail to be detoxified and remain to poison 
the system. 
The experiments of Professor Irving Fisher, of 
Yale, tend to support the view that toxic products 
are produced when meat is eaten, irrespective 4of 
how much; though, of course, the amount of these 
jiroducts would be proportionally increased as the 
consumption of meat is increased. Hindhede’s view 
would imply that any type of protein, when eaten 
in excess, is harmful; which is probably very true, 
and also true of fat and carbohydrate; but it con- 
tributes little to support his thesis that meat pro- 
tein is particularly harmful. 
Conclusive experiments are wanting to show that 
meat proteins are more harmful (toxic) than other DISEASES DUE TO FAULTY DIET 
103 
proteins, but we can, from personal observation, 
apply Hindhede’s remark to ourselves: “I feel 
weaker after eating much meat.” This is the ex- 
perience of a number of our acquaintances, and 
probably the reader can extend the circle that in- 
cludes such men. 
The Arabs, says Hindhede, live largely on figs, 
dates, some vegetables, and a little milk. Meat is 
rarely eaten. Their religion forbids them to drink 
alcoholic beverages. Despite the indescribable filth 
in which they live, they are far more immune to dis- 
ease than are Europeans. “Diseases of nutrition,” 
writes Dr. Auzimour, a French army officer, “are 
almost unknown; ulcers and cancer of the stomach 
are very seldom met with; and if one comes across 
a chance case of diarrhea, it is generally because the 
sufferer has been eating too many melons. Ap- 
pendicitis is very rare among Arabs, and is entirely 
unknown among vegetarian nomads. Gout and 
kidney gravel are also quite unknown.” A fact that 
should arrest attention is that when these Arabs 
desert their dirty villages for the towns, and there 
live the life of Europeans, eating the food Euro- 
peans do, they become as susceptible to disease as 
do the Occidentals. Such resistance cannot, there- 
fore, be ascribed to the peculiarities of a race, or 
to the climate, but solely to the food they eat. 
“For many years,” continues Hindhede, “I have 
been convinced that common stomach troubles and 104 
WHAT TO EAT 
intestinal disorders very often arise from fermenta- 
tion caused by putrefying animal protein, as these 
complaints disappear, like dew under the morning 
sun, on a low protein [meat] diet. Since my 
family and myself have adopted a low protein 
[meat] diet, we have never been troubled with 
these maladies—neither do we ever suffer from 
diarrhea. But with a return to a rich meat diet, 
for experimental purposes, I contract colic and 
diarrhea with mathematical certainty.” 
Hindhede cites Dr. Owen Williams’ report to the 
Science Committee of the British Medical Associa- 
tion (1910) in support of the view that appendicitis 
is a meat-eating disease. Dr. Williams stresses 
three observations: first, that cases of appendicitis 
are very frequent in England, where meat is con- 
sumed in large quantity (this is equally true of 
America) ; secondly, that in the rural districts of 
Rumania, where but little meat is eaten, there is 
but one case of appendicitis for 22,000 sick patients, 
whereas the number of appendicitis cases in towns 
is increased a hundred-fold; thirdly, that the dis- 
ease is rarely met with in China (the Chinese, like 
the Japanese, are largely vegetarian eaters). “Of 
169 phy sicians practising in China, only 49 had ever 
encountered the complaint. In the General Hos- 
pital in Hong-Kong, among 2,140 patients, there 
was not one case of appendicitis; while in the Shang- 
hai Hospital, which is used by Europeans, there DISEASES DUE TO FAULTY DIET 
105 
were 21 cases among 1,205 patients.” Evidence of 
this kind can be multiplied, for it has been the ex- 
perience of many European physicians who have 
been brought in touch with the Oriental races. 
While wishing to avoid dogmatic statements, it 
may be said, in the light of some evidence, that 
appendicitis seems to be most prevalent among the 
meat eating nations.1 
Hindhede’s other claim, that much meat eating 
gives rise to gout, can be said to be true only in so 
far as overeating, accompanied by little exercise, 
is a predisposing factor. The argument, long 
favored, that meat is rich in purine bodies, which 
may give rise to an excessive amount of uric acid, 
which in turn is associated with the disease, helps 
Hindhede little, since many vegetable foods, such 
as beans, oatmeal, asparagus, tea and coffee, are 
also very rich in purines. Gout is another disease 
of which we have still to learn the cause. 
While the data at hand are insufficient to at- 
tribute specific diseases to meat eating, indirect 
evidence is not wanting for the statement that 
amounts such as are ordinarily consumed even by 
many workmen in European and American cities, 
and certainly by the middle and upper classes, are 
harmful to the system. The reader has but to think 
1 It seems but just to add that many very reputable physicians 
are decidedly opposed to this view. The problem is not one that 
lends itself to an easy solution. 106 
WHAT TO EAT 
of the farm life in summer, with its milk, eggs and 
vegetables, with meat, in the shape of chicken, per- 
haps once a week, and how much better he thrives 
on this diet than on the one he is accustomed to 
in the city. Of course rest and the country air are 
important contributory factors, but to what extent 
food itself may serve as a factor can only be deter- 
mined if the experiment of living for a year on a 
diet which includes meat not more than once a 
week, and which substitutes for meat, milk, eggs, 
and cheese, is carried out. 
We are net unmindful of some dietitians who at- 
tribute brain development and energy formation 
to meat eating. One of them declares that “the 
more energetic races of the world have been meat 
eaters.” This writer evidently wishes his reader 
to look first eastward, and then to the West. “In 
India and China,” this writer may be supposed to 
say, “you see obvious examples of inferior races; 
but when you turn to the West, to England, France, 
Germany, and America, there you find the flower 
of civilization. The reason is obvious: the Indians 
and Chinese eat little meat, but the Europeans and 
Americans consume large quantities.” We are not 
familiar with any statistical study that correlates 
the mental and physical growth of a race with tha 
amount of meat consumed by it; such a study, if at 
all possible, may prove fruitful of result; but when 
we think of the glories of ancient China and India, DISEASES DUE TO FAULTY DIET 
and of the glory that once was Greece and Rome, 
these representing both vegetarian and meat eating 
races, we doubt very much whether a chapter on 
meat can find an appropriate place in current sys- 
tems of philosophy and psychology. Whatever evi- 
dence we have tends to show that all races are fond 
of meat, once they have tasted it (we recommend 
to the reader Lamb’s inimitable essay on the roast 
pig), and the amount consumed is directly propor- 
tional to the state of prosperity of the race. We 
refuse, however, in this book at least, to be dragged 
into discussions dealing with economics, and pos- 
sibly esthetics. 
McCarrison. An even more convincing advocate 
of the thesis that faulty diet leads to disease is 
Robert McCarrison, an English physician stationed 
in India. Like Hindhede, he urges a greater con- 
sumption of vegetable foods, though his chief cry 
is raised not so much against the eating of meat 
as against food that has been “preserved, purified, 
polished, pickled, canned, extracted, distilled, con- 
centrated, heated, dried, frozen, thawed, stored,” 
and what not; in short, he favors the “natural 
foods.” He, like Hindhede, is of the opinion that 
many of our gastro-intestinal disorders have a 
dietary origin, and the evidence he marshals in sup- 
port of his theory has made many converts. (It 
should be said at this point that MeCarrison’s 
studies of “deficiency” diseases bear an intimate 
107 WHAT TO EAT 
108 
relation to many vitamine studies, and to these we 
shall refer later.) 
“My own experience,” writes McCarrison, “pro- 
vides an example of a race unsurpassed in perfec- 
tion of physique and in freedom from disease in 
general, whose sole food consists to this day of 
grains, vegetables and fruits, with a certain amount 
of milk and butter, and goat’s meat only on feast 
days. I refer to the people of the state of Hunza, 
situated in the extreme northernmost point of India. 
So limited is the land available for cultivation that 
they can keep little livestock other than goats, 
which browse on the hills, while the food supply 
is so restricted that the people, as a rule, do not 
keep dogs. They have in addition to grains—wheat, 
barley and maize—an abundant crop of apricots. 
These they dry in the sun and use very largely in 
the food.” 
McCarrison has spent some nine years among 
these people. The men have a magnificent physique; 
they live to a ridiculously old age, and are astound- 
ingly fertile. It seems that this combination of 
fertility and longevity is the one great source of 
worry to them. One humane chieftain suggested 
to the doctor that instead of bringing the sick back 
to health again, he concentrate his attention on 
the construction of a lethal chamber with the aid 
of which it would be possible to get rid of those too 
old to be of use to the state! With another of these DISEASES DUE TO FAULTY DIET 
109 
tribes it was the custom, until quite recently, for 
the eldest son to put his two aged parents in a 
basket, carry them to the top of a hill, and then hurl 
to destruction the basket with its contents. We are 
told that this custom has been abolished “under the 
protective influence of British rule.” 
“During the period of my association with these 
people,” writes McCarrison elsewhere, “I never saw 
a case of asthenic dyspepsia, of gastric or duodenal 
ulcer, of appendicitis, of mucous colitis (a disease 
involving the membrane of the colon), or of cancer, 
although my operating list averaged 400 
operations a year. While I cannot aver that all 
these maladies were quite unknown, I have the 
strongest reason for the assertion that they were 
remarkably infrequent. The occasions on which 
my attention was directed to the abdominal viscera 
(the interior of the abdomen, containing the organs 
of digestion) of these people were of the rarest. 
. . . Among these people the ‘abdomen oversensi- 
tive’ to nerve impressions, to fatigue, anxiety or 
cold was unknown. Their consciousness of the 
existence of this part of the anatomy was, as a rule, 
related solely to the sensation of hunger. Indeed, 
their buoyant abdominal health has, since my re- 
turn to the West, provided a remarkable contrast 
with the dyspeptic and colonic lamentations of our 
highly civilized communities. 
“Searching for an explanation of this difference 110 
WHAT TO EAT 
iii incidence of gastro intestinal disease in the two 
peoples, I find it in the main in four circumstances: 
1. Infants are reared as Nature intended them to 
be reared—at the breast. If this source of nourish- 
ment fails, they die; at least they are spared the 
future gastrointestinal miseries which so often 
have their origin in the first bottle. 2. The people 
live on the unsophisticated foods of nature: milk, 
eggs, grains, fruits and vegetables. I don’t suppose 
that one in every ten thousand of them has ever 
seen a tinned salmon, a chocolate or a patent infant 
food, nor that as much sugar is imported to their 
country in a year as is used in a moderately sized 
hotel. 3. Their religion prohibits alcohol, and al- 
though they do not always lead in this respect a 
strictly religious life, nevertheless they are emi- 
nently a teetotal race. 4. Their manner of life re- 
quires the vigorous exercise of the body.” 
Like the Arabs, the Hunzas live in the midst of 
anything but sanitary surroundings, and like them 
again, they contract gastro-intestinal disorders 
whenever they change to a more “civilized” diet. 
These facts are of the utmost importance, for they 
show clearly that despite unhygienic conditions, an 
“unsophisticated diet” keeps them remarkably free 
from the common ailments to which Europeans, 
usually of the class other than the peasant, and 
Americans are subject. This, of course, is no argu- 
ment in favor of filth; it is, however, evidence in DISEASES DUE TO FAULTY DIET 
111 
support of the view that faulty diet may also be 
the causative factor in disease. 
These practical observations of McCarrison re- 
ceive still further support from some experimental 
work he did, employing monkeys as the subjects 
of the test. “Thirty-six wild monkeys were cap- 
tured in the jungles of Madras and transported with 
the least possible delay to my laboratory in the hills 
at Coonor. They were in perfect health and full 
vigor—wild things usually are. I had in these ani- 
mals perfectly normal tissues to work on: a uniqjie 
opportunity to observe the first clinical and patho- 
logic effects on normal tissues of the agent—faulty 
diet—with which I was working. Each of these 
animals was placed in a separate cage, and all were 
confined in the same animal room. . . . Twelve of 
them were fed on natural food (wheaten bread, 
milk, ground nuts, onion, butter, plantains—a 
banana-like fruit—and water), the remaining 
twenty-four on food deficient in some cases in vita- 
mines as well as ill-balanced; others were fed on 
natural food in which the living essences had been 
destroyed by sterilization. Those that were nat- 
urally fed remained free from intestinal disease; 
those that were fed on deficient and ill-balanced 
food, and on sterilized food, developed, within a 
short time in the majority of cases, diarrhea or 
actual dysentery (a disease involving the inflamma- 
tion of the large intestine). Here, then, is an un- 112 
WHAT TO EAT 
equivocal instance not only of the effect of faulty 
food in inducing a specific disease such as dysentery, 
but of the protection against it that is afforded by 
a natural and well-balanced food.” 
War experiences. At no time in the history of 
the human race have the effects of a faulty diet 
on a people been brought home to us with more 
force than during the late War. The blockade made 
food restrictions imperative in Germany and Aus- 
tria not long after the outbreak of war, but the 
suffering, particularly among the very old and the 
very young, grew intense after 1917. Even now, 
after four years of a peace that is no peace, one has 
but to read the Quaker report of conditions in 
Austria or the Hoover report of conditions in Rus- 
sia, to realize how inadequate food, or badly-bal- 
anced food, will sap the life-blood of nations. 
Rubner, the eminent director of the Hygienic 
Institute at the University of Berlin (he has re- 
cently resigned from this position) has given us an 
account of conditions in Germany. For the first 
two years, that is from 1914-1916, a surplus food 
supply, combined with an ineffective blockade, made 
rationing unnecessary. Conditions rapidly changed 
for the worse from 1916 on. In the fall of 1916 the 
following type of diet was planned for distribution 
(average man per day; food in ounces) : Bread, 9; 
potatoes, 12; butter and margarine, one-third of an 
ounce; meat, 1; sugar, 1; cereals, one-third of an CASIMIR FUNK, AUTHOR OF THE NAME “VITAMINE,” AND ONE OF THE 
LEADING INVESTIGATORS IN THE FIELD OF VITAMINE CHEMISTRY. DISEASES DDE TO FAULTY DIET 
113 
ounce. No milk was provided, and eggs only rarely. 
The total calorific value of this food amounted to 
1,334, which included a little over an ounce of pro- 
tein. RubneFs standard for the needs of a normal 
person is 2,500 calories, including three ounces of 
protein. The food, then, was considerably below 
par; and its value was further lessened by the ab- 
sence of milk and any appreciable quantities of 
butter and eggs. “Rubner in a personal letter to 
me [Professor Lusk, of Cornell] states that the 
decline in the health of the German people was co- 
incident with the falling off of the milk supply.” 
The immediate results of such undernutrition are 
loss of efficiency. Laborers do not work as well, 
and brain workers do not think as well. This effect 
on physical effort is a confirmation of laboratory 
experiments conducted by a number of investi- 
gators. For example, Dr. Benedict, of the Carnegie 
Nutritional Laboratory, has shown that an insuffi- 
cient diet produces “feelings of general weakness 
and tiredness, a condition commonly expressed in 
college slang as lack of ‘pep’ or drive; weakness of 
the legs; and subnormal gymnasium and athletic 
performance.” Continued undernutrition caused 
considerable loss of weight. Professor Rubner cal- 
culated that the average loss of weight of indi- 
viduals over 25 and living in towns was in the 
neighborhood of 20 per cent; which, incidentally, 
might have been counted as a blessing by those who 114 
WHAT TO EAT 
were overweight but for the fact that there was not 
only too little but badly-balanced food. The death 
rate increased considerably. If the figure for the 
normal death rate be taken as 100, then the figures 
for Germany are: 1913, 100; 1914, 100; 1915, 100; 
1916, 114; 1917, 132; 1918, 137. In 1917 and 1918 
the deaths above the normal rate were 260,000 and 
and 294,000 respectively. This condition does not 
merely apply to a nation living under war condi- 
tions, but is in every way applicable to the very 
poor in all lands who suffer from undernutrition. 
The slums of Peking, of London, and probably of 
New York, can show such examples. 
As the War continued and the food supply be- 
came still less adequate, extensive outbreaks of 
war edema (swelling) occurred. It is recorded 
how in Bohemia in 1917 there were 23,000 such cases, 
of whom over 1,000 died. In one town nine per 
cent of the population suffered from the disease. 
The belief prevails among scientists that this edema 
is due to a diet comparatively rich in carbohydrate 
and poor in protein. 
Of the suffering of the children, volumes yet re- 
main to be written. Rickets, scurvy, xerophthalmia, 
and what not, were rife—and still are in places. 
The child not under-sized and sickly-looking became 
the exception. We have listened to accounts by 
one who worked with the Quakers in Vienna that DISEASES DUE TO FAULTY DIET 
115 
would make even callous diplomats and vainglori- 
ous generals evince a spark of sympathy. 
Drs. Gibbon and Ferguson, two English physi- 
cians, recently (1921) made a study of the diets of 
49 working class families in Vienna. The average 
dietary contained 2,064 calories (of a badly-bal- 
anced food), whereas the normal dietary should 
contain—according, to the Inter-Allied Scientific 
Food Commission—3,300 calories of a well-balanced 
diet. Most of the fat taken was in the form of 
margarine. “Relief agencies contributed about 500 
calories, or about one-fourth of the daily intake. 
Children between two and three years were 26.5 per 
cent below normal average weight and 13.6 per cent 
under the average normal height. Rickets was 
found in 29 families, the calorific intake of which 
averaged 1,885 calories ‘per man’ per day, but was 
absent in 20 families which partook on the aver- 
age of 2,325 calories ‘per man.’ The writers observe 
‘it is hopeless to expect from a population on such 
diets the initiative and vigor by which alone the 
country can be saved from ruin.’ ” [Quoted by 
Lusk.] 
Infants thrived for a time. A shortage of milk 
forced many mothers to “suckle their offspring” 
who otherwise would have been bottle-fed, and it 
is therefore not remarkable to find that in 1917 
there was actually a decrease in infant mortality. 116 
WHAT TO EAT 
Despite the mother’s poor food, her milk continued 
for a time to be biologically good; her body made 
every sacrifice to produce a normal milk. Only 
long-continued malnutrition lowered the standard 
of production, and with it the suffering of the off- 
spring increased. 
Undernutrition gave rise not only to mental and 
physical inertia, to loss of weight, to rickets and 
to war edema, but made the people more susceptible 
to disease than ever before. Tuberculosis increased* 
in alarming proportions; so did colds, which often 
terminated in a fatal illness; and recovery from 
surgical operations became more difficult. In gen- 
eral the average degree of resistance to disease ap- 
proached more the standard of the middle-aged clerk 
than that of the youthful farmer. 
Hindhede attributes much of the undernutrition 
in Central Europe to the teachings of Rubner and 
his school, who favor a large meat intake. “The 
people of Denmark,” he writes, “have no cause to 
regret that during the war their diet consisted 
mostly of milk, vegetables and bran. If Central 
Europe had adopted a similar diet, I doubt thaC 
any one would have starved. It seems to me, how- 
ever, that the German scientists, as represented by 
Rubner, have not learnt anything from the war. 
Rubner writes about the ‘necessity of bringing the 
supply of livestock up to the pre-war basis. . . . 
From what I have stated it follows that meat prod- DISEASES DUE TO FAULTY DIET 
117 
nets must again form an adequate proportion of our 
diet.’ Rubner wants an abundance of meat in order 
that the people can be ‘aufgefuettert’ [fattened]. I 
do not agree with him. The people must first have 
bread, potatoes and cabbage in sufficient quantity, 
and then some milk. Meat is the last requirement 
to be met. . . 
Rickets, xerophthalmia, beriberi, scurvy and 
pellagra. These diseases, with the possible excep- 
tion of pellagra, are the result of dietary deficien- 
cies. Most of them—xerophthalmia, beriberi, and 
scurvy—are due to the absence of certain vitamines 
from the diet. At one time it was supposed that 
rickets is a vitamine deficiency disease, but it has 
recently been pretty thoroughly established that its 
origin is a more complex one. As we have discussed 
these diseases elsewhere,2 only a brief reference to 
them will be included here. 
Rickets, a disease with which many children are 
afflicted, involves retarded bone calcification, the 
bones becoming soft and flabby. For a long time it 
was held that the absence of vitamine A (present 
in codliver oil, animal fats, and the leaves of plants) 
from a diet gives rise to the disease, but this theory 
must be modified in the light of the new evidence 
now (August, 1922) being collected. Whatever the 
cause, we know that codliver oil, or exposure to the 
a Vitamines: Essential Food Factors (E. P. Dutton and Co., 
N. Y.).  WHAT TO EAT 
118 
sun’s rays, cures rickets, and that butter fat does 
not. Since codliver oil and butter fat both contain 
vitamine A, it is evident that the cure cannot be 
due to this substance. 
Xerophthalmia. The absence of vitamine A from 
the diet very often produces xerophthalmia, an eye 
disease. During the late war physicians noticed 
many such cases among children deprived of animal 
fats. The addition of such fats to the diet brought 
prompt recovery. This merely duplicates the ex- 
periences of laboratory workers who experimented 
with dogs and rats. 
Beriberi, a disease involving nerve degeneration, 
is due to the absence of vitamine B from the diet. 
Nearly all natural foods contain this vitamine. 
Yeast is particularly rich in it. So are milk and 
orange juice. The cereals contain it, but only the 
outer layers; so that vitamine B is absent from 
patent or bleached flour, but present in whole flour. 
At one time the Japanese and the Filipinos suf- 
fered considerably from beriberi, due to their large 
consumption of polished rice. 
Scurvy, the “sailor’s disease,” is due to a lack of 
fresh food in the diet. The absence of vitamine 0 
in foods gives rise to this disease. Most fresh fruit 
and fresh vegetables contain this vitamine. The 
emphasis is advisedly put on fresh material. The 
orange and the tomato are particularly rich in vita- 
mine G. DISEASES DUE TO FAULTY DIET 
119 
Pellagra, the affliction of the South, is considered 
by many to be a food deficiency disease, though some 
are still of the opinion that it is of bacteriological 
origin. Dr. Goldberger, an authority, is of the opin- 
ion that pellagra is the result of a lack of several 
factors in food—a vitamine, a protein high in the 
biological scale, and perhaps certain mineral salts. 
Within the last few days (January, 1923) an article 
of his has appeared in which he attributes pellagra 
to food deficient in appropriate amino-acids (de- 
composition products of proteins). 
References 
[J. A. M. A. = Journal of the American Medical 
Association] 
M. Hindhede’s views on the relation of diet to dis- 
ease are set forth in his book, Protein and Nutri- 
tion (Ewart, Seymour and Co., London), particu- 
larly in chapter 15. See also his article on “The 
Effect of Food Restriction During War on Mor- 
tality in Copenhagen,” J. A. M. Avolume 74, page 
381, 1920. Robert MeCarrison’s work is detailed 
in his Studies in Deficiency Diseases (Henry 
Froude and Hodder and Stoughton, London), and 
in an article entitled “Faulty Food in Relation to 
Gastro-Intestinal Disorders,” J. A. M. A., volume 
78, page 1, 1922. See also Irving Fisher’s article 
in the Yale Medical Review, March, 1907, on “The 120 
WHAT TO EAT 
Influence of Flesh-Eating on Endurance.” An 
article by Graham Lusk, “The Effect 
of Undernutrition,” Physiological Reviews, volume 
I, page 550, 1921, contains a wealth of valuable in- 
formation. See also the following: F. G. Benedict, 
W. R. Miles, P. Roth and H. M. Smith: “Human 
Vitality and Efficiency Under Prolonged Restricted 
Diet,” Carnegie Institute of Washington, 1919, pub- 
lication 280; E. A. Kohman: “The Experimental 
Production of Edema as Related to Protein De- 
ficiency,” American Journal of Physiology, volume 
60, page 378,1920; E. S. O’Keefe: “A Dietary Con- 
sideration of Eczema in Younger Children,” 
J. A. M. A., volume 78, page 483, 1922; F. G. Bene- 
dict: “The Alcohol Problem,” Science, volume 43, 
page 907, 1916; and E. V. McCollum: The Newer 
Knowledge of Nutrition (Macmillan Co., N. Y., 
1922), chapter 18. 
Professor Lusk’s article (see preceding para- 
graph) deals with the food situation arising from 
the Great War. Other articles of a similar char- 
acter are M. R. Gibbon and M. I. H. Fergusen: 
“Nutrition in Vienna,” Lancet, volume 200, page 
474,1921; F. Mueller and M. Rubner: “Der Einfluss 
der Kriegsverhaltnisse auf den Gesundheitszustand 
im Deutsehen Reich,” Munchener medizinische 
Wochenschrift, 1918, Supplement to No. 8, pages 
242 and 249; and T. B. Wood: The National Food DISEASES DUE TO FAULTY DIET 
121 
Supply in Peace and War (Cambridge University 
Press, Cambridge, England). 
For an account of such diseases as beriberi, 
rickets, scurvy, pellagra, xerophthalmia, see Ben- 
jamin Harrow’s Vitamines: Essential Food Factors 
(E. P. Dutton and Co., N. Y.). CHAPTER X 
DIET IN DIGESTIVE DISORDERS 1 
In the preceding chapter we have seen how 
faulty diet may give rise to various diseases, a num- 
ber of them confined to the digestive tract. In this 
and the succeeding chapter, our task is somewhat 
the reverse: the organ is diseased, and the problem 
is to devise a diet that will prove of maximum bene- 
fit to the sufferer, and that will produce a minimum 
of additional injury to the organ affected. This is 
a task beset with no end of difficulties: it involves 
a knowledge such as is possessed not only by the 
clinical expert, but by the chemical expert, and 
often the combined knowledge of these two is of no 
avail. 
In this chapter we deal with a diseased digestive 
tract: something is wrong with the stomach or 
intestine. Such a disease will immediately affect 
digestion (diseases in general affect it, but usually 
in a secondary way; see the next chapter); for 
1 In order that the reader may have a fairly clear anatomical 
picture of the digestive tract, it would be well for him to master 
the contents of the last chapter of this book before he reads 
this one. 
122 THOMAS BURR OSBORNE, RESEARCH CHEMIST, CONNECTICUT EXPERI- 
MENTAL STATION. A LEADING AUTHORITY ON THE CHEMISTRY OF 
THE VEGETABLE PROTEINS. LARGELY RESPONSIBLE (TOGETHER WITH 
PROFESSOR MENDEL) FOR OUR NEWER IDEAS CONCERNING THE 
PHYSIOLOGICAL VALUE OF DIFFERENT PROTEINS. DIET IN DIGESTIVE DISORDERS 
123 
remember that the function of the digestive tube 
is to prepare food for assimilation by the body. 
With a diseased digestive tube this function is im- 
paired, and the problem of modifying the diet to 
meet an abnormal condition is the task of the 
dietitian. 
It is not our intention to discuss in detail the 
various possible disorders of the gastro-intestinal 
tract; medical treatises abound that fulfil this func- 
tion admirably. We shall merely touch upon some 
of the commoner disorders, and then only from the 
point of view of dietary treatment. In this field the 
cooperation of the physiological chemist and the 
clinician has been fruitful of results. The examina- 
tion of stomach contents, the analysis of blood, 
urine, and feces, based on quantitative methods that 
are constantly increasing in accuracy, have been 
important contributory factors in the development 
of modern medicine. 
Hyperacidity (hyperchlorhydria). This illus- 
trates an excessive production of acid in the 
stomach. It is not a disease but a symptom, and 
may be due to any one of a number of causes. It 
may be due to an attack of “nerves,” perhaps the 
result of much worry; or to an ulcer in the intestinal 
tract; or to a diseased organ other than one be- 
longing to the digestive organs, and producing a 
hyperacidity in an indirect way. The problem of 
decreasing the amount of acid is not always an 124 
WHAT TO EAT 
easy one, since so much depends upon the cause 
of such hyperacidity. If it is of nervous origin, 
anything that will tend to lessen nervous agitation 
will help; if due to an organic lesion, with acute 
pain after meals, the difficulties in the way of cure 
are greater. 
As might be anticipated, a diet poor in acids and 
poor in salt (sodium chloride, one of the precursors 
of the hydrochloric acid of the stomach) is recom- 
mended. Strongly spiced foods of all kinds are to 
be avoided. Foods that may be included in the 
patient’s diet are cream or puree soups (no meat 
stock); fish that consist of white meat and little 
fat, such as cod, halibut, bass, white fish, boiled or 
broiled, but not fried; vegetables, except onions, 
cabbage or cauliflower; milk and water in mod- 
erate quantities; cream and Swiss cheese, but not 
those with marked odor; desserts with cream, but 
without rich sauces; toasted or dry bread; fresh 
butter; weak tea and coffee; cereals; eggs, but not 
fried or hard-boiled. It is best to avoid meat, A 
little stewed fruit may be taken, particularly when 
one is constipated. Alcohol acts as a stimulant, 
and it should be banished from the dinner table. 
The mildly alkaline bicarbonate of soda has been 
found by Pavlow, the Russian physiologist, to re- 
tard the secretion of acid, and this alkali is often 
used. 
Hypoacidity. This is the reverse of hyperacidity. Here we deal with a condition in which there is less 
acid in the stomach than is found there under more 
normal conditions. Sometimes it is associated with 
a diminished production of the stomach ferment, 
pepsin (achylia). Its causes are varied. The 
hypoacidity may be due to an inflammation of the 
membrane of the stomach (gastritis), resulting in 
an impairment of the gastric glands; or it may be 
due to cancer, anemia, infections, or impairment of 
other organs, particularly the gall-bladder. It 
often follows in the wake of an attack of hyper- 
acidity, for in the latter case there is an increased 
and an overtaxed glandular activity, which may 
be followed by a decreased and subnormal activity. 
The functions of hydrochloric acid are of suffi- 
cient importance to cause its lack to bring serious 
consequences. The acid is a disinfectant, destroy- 
ing most of the bacteria that find their way into 
the digestive tract; hence the advice that in cases 
of hypoacidity all food be boiled before eaten. But 
the acid also regulates the opening and closing 
of the pylorus, the valve connecting the stomach 
and the small intestine, and determines the flow of 
pancreatic juice and bile; so that its absence, or 
even its presence in diminished quantity, may prove 
injurious to the system. 
But above all it must be remembered that the 
pepsin of the stomach is valueless without hydro- 
chloric acid; so that even in the presence of the 
DIET IN DIGESTIVE DISORDERS 
125 126 
WHAT TO EAT 
ferment, no digestion of proteins will take place 
unless acid is also present. This may not be so 
serious a matter as appears at first glance, for 
proteins are also decomposed in the small intestine; 
but of course it is best to divide the labor wherever 
possible. 
The foods recommended in hypoacidity are largely 
those prohibited in hyperacidity. Little need be 
excluded that is included in the diet of the normal 
person. Acid fruits are recommended, and so are 
moderate quantities of stimulants and condiments, 
though where the stomach is inflamed these are 
best avoided. Any but very small quantities of fat 
should be excluded from the diet, since fat delays 
the passage of food from the stomach to the intes- 
tines. 
A standard method of treatment is to recommend 
small quantities of hydrochloric acid, or the acid 
mixed with pepsin. Dr. Kellogg recommends 
“acidone,” an acid protein, in the place of free acid. 
This “acidone,” prepared by mixing vegetable pro- 
tein with 15 per cent of “C. P.” hydrochloric acid, 
may be conveniently taken when mixed with soup, 
porridge or potato. 
An ulcer is an open sore other than a wound. 
Dr. Sippy, of Chicago, whose treatment of ulcers 
has been widely and successfully applied, is of the 
opinion that the hydrochloric acid,2 which is often 
aWe here deal more particularly with the stomach ulcer. DIET IN DIGESTIVE DISORDERS 
127 
present in excessive quantities, is one of the potent 
factors in retarding the rate of healing, and his 
treatment involves the use of alkalis in the attempt 
to neutralize the acidity. Of the ulcer’s origin we 
know little. Probably a lowered resistance of a 
small part of the stomach membrane, with the 
subsequent attack upon it by hydrochloric acid, has 
something to do with it. The acid unquestionably 
plays a role, since ulcers never appear in the ab- 
sence of acid. 
The treatment is either medical, surgical, or a 
combination of both. If rest and the special diet 
do not relieve, if pain, nausea, vomiting, and per- 
haps hemorrhage persist, then little may remain 
to be tried but a surgical operation. On the other 
hand, many ulcers have a tendency to heal spon- 
taneously, so that credit for the recovery cannot be 
wholly ascribed to the particular diet employed. 
The principles employed in the dietetic treatment 
are complete rest in bed for from one to perhaps 
three months; the use of small quantities of food, 
so as not to strain the stomach; the inclusion of a 
high percentage of protein, since the latter has a 
tendency to combine and, therefore, partly to neu- 
tralize the acid present; and the use of alkalis, 
which also assist in neutralizing acidity. 
Foods included are milk, cream, soft-boiled eggs, 
fine cereals, cream soups, vegetable purges, jellies, 
custards, and cream of wheat. The excessive acidity 128 
WHAT TO EAT 
is neutralized (in Sippy’s treatment) by the use of 
calcined magnesia and bicarbonate of soda. 
Cancer. A malignant growth of new tissue, in- 
dependent of surrounding structures, which char- 
acterizes cancer, is not confined to the stomach but 
may be found in many parts of the body. Cancer 
of the uterus is the form most frequently met with, 
though next in frequency comes cancer of the stom- 
ach. Of a study of 30,000 cases of cancer made by 
one investigator, 21 per cent were shown to be due 
to stomach cancer. 
What the cause of the disease is wTe do not know.3 
In this country alone more than 80,000 of the deaths 
that occur every year are due to cancer. The fact 
that negroes are more immune to it than are whites, 
and the further significant fact that in Japan can- 
cer was practically an unknown disease until 
recently—that is, until the country had become 
Europeanized—has made many lean to the theory 
that cancer has a dietetic origin. Dr. J. H. Kel- 
logg, who is fond of blaming meat for most of man’s 
ills, writes, “Of many thousands of flesh abstainers 
with whom I have been acquainted, I have known 
during a period of 45 years only four cases of can- 
cer in persons who have been for a long time flesh 
3“Is cancer often associated with chronic gastric ulcer? From 
an experience of more than 1,400 gastric specimens, I can state 
that the association is so frequent that if I had a chronic gastric 
ulcer I should always consider the possibility of cancer being 
present.” (Dr. MacCarthy of the Mayo Clinic.) DIET IN DIGESTIVE DISOEDEES 
129 
abstainers, and in one case recovery occurred with- 
out the removal of the cancerous growth. There can 
be no doubt that among the thousands of persons 
under observation who escape the disease, as I be- 
lieve through flesh abstaining, there must have been 
a considerable number who were especially sus- 
ceptible to cancer through heredity and who were 
able to overcome this special susceptibility by a 
non-flesh dietary. This conclusion seems unescap- 
able when it is remembered that ten to fifteen per 
1,000 of all persons past middle age die of cancer.” 
Professor Joly, a physicist of the University of 
Dublin, has advanced the theory that certain foods 
are probably sensitizers in the sense that silver salts 
are, and that the eating of such foods may give rise 
to cancer. He mentions tannin as a striking ex- 
ample, and supplies statistics to show that the in- 
creased consumption of tea (in which we find 
tannin) in England has led to an increase in 
the number of cancer cases. 
But the mere fact that we are writing a book on 
foods must not give us too dietetic an outlook. Prac- 
tically all the experimental work on cancer—and an 
enormous mass of work has been done in this field 
—recognizes repeated irritation as the only estab- 
lished factor. For example, in “tar cancer” pro- 
duced in mice, only repeated applications of coal 
tar derivatives give rise to this disease. The irrita- 
tion theory has many supporters. 130 
WHAT TO EAT 
The Mayo brothers, the famous surgeons, claim 
that 75 per cent of all cancers originate in ulcers, 
which, even if true, still fails to shed light on the 
origin of the former, since we know little more con- 
cerning the origin of the latter. 
Emaciation, loss of strength, anemia, the pres- 
ence of pus and blood in the empty stomach, the 
absence of free hydrochloric acid, the presence of 
lactic acid (an acid produced when milk sours), 
the presence of a tumor that the diagnostician can 
recognize, have all been noted in this disease. As 
for treatment, little other than surgical can be 
employed. Often the X-ray treatment is suggested; 
the results so far are encouraging, but not more 
than encouraging. Temporary diminution, or 
even disappearance of the tumor growth, is some- 
times obtained, but the growth often reappears. 
Operations have been only moderately successful, 
perhaps because in many cases the patient does not 
become conscious of the tumor until it has already 
reached alarming proportions. 
As to diet, little need be said. The emphasis is 
placed on readily digestible foods. In the advanced 
stage of the disease little more than milk can be 
tolerated. The liquid and semi-liquid foods, soups, 
vegetable purees, flour puddings with fruit sauces, 
eggs (soft-boiled), and butter are offered whenever 
possible. 
Diarrhea. Characterized by a frequent dis- DIET IN DIGESTIVE DISOEDEES 
131 
charge of feces in a more or less liquid condition, 
diarrhea is a symptom rather than a disease. It 
may have its origin in a diseased organ of the gastro- 
intestinal tract, bnt on the other hand it is very 
common in many diseases, particularly in those of 
a bacterial origin. It may, however, be due to a 
food that does not agree with the individual, to eat- 
ing of indigestible food, or to excitement. 
The diet in diarrhea is of an astringent character. 
Such a diet is not always easy to discover, since so 
much depends upon the particular disease with 
which we are dealing, and much upon the idiosyn- 
crasy of the sufferer. A good plan to adopt at the 
very beginning is to take a purgative, and not to 
eat for twelve hours or so but to drink plenty of 
water. As the appetite returns, one may begin with 
soup, cereal gruels, tea and toast, and gradually 
extend the list with returning health. 
In chronic diarrhea Dr. Carter recommends the 
following foods: clear soups; white meated fish 
(cod, halibut, bass) ; chicken, lamb; soft eggs; rice, 
macaroni, noodles; cereals, but not oatmeal; stale 
bread; cream; cottage cheese; tea; diluted whiskey 
or brandy. Foods to be avoided are cold drinks, 
green vegetables, sweets, fatty foods (except a lit- 
tle butter), raw milk, fruits, salads, and delica- 
tessen. 
Appendicitis. This is perhaps the most popular 
of gastro-intestinal diseases. It represents an in- 132 
WHAT TO EAT 
flammation of the vermiform appendix, a pouch 
leading off from the cecum (the beginning of the 
large intestine). The appendix (from three to six 
inches long and three-eighths of an inch in diam- 
eter) becomes infected, due to a retention of feces. 
What causes feces to be retained there is not clear. 
Among the symptoms are sudden and violent 
pains in the abdomen, fever, nausea, vomiting, con- 
stipation, and pain produced when the abdominal 
region is pressed. The fever symptoms are suffi- 
ciently important for Murphy, the Chicago surgeon, 
to state that he would not operate on a case unless 
he was confident that there was fever in the first 
36 hours of the disease. 
The surgeon’s aid should be quickly sought, for 
he alone can cure the patient. “There would be no 
percentage of deaths from appendicitis if every case 
commencing with acute pain and developing tender- 
ness and rigidity of the abdomen and quickening 
of the pulse were operated upon within twelve 
hours.” Delay often results in an inflammation 
of the peritoneum, the membrane lining the abdom-* 
inal wall; and therein lies the danger. 
There is, therefore, little to be said about diet in 
this disease, beyond the advice that rest in bed and 
a very light diet are merely the best preliminaries 
to a speedy operation. 
As for methods of prevention, there are still DIET IN DIGESTIVE DISORDERS 
133 
many who claim that meat eaters are particularly 
susceptible to this disease (see p. 104). 
Jaundice. Jaundice is not a disease but a symp- 
tom. It indicates a disturbance of bile flow. The 
sufferer shows a yellowness of skin, eyes, and secre- 
tions, which is due to the presence of bile pigments 
in the blood. Normally the bile finds its way from 
the gall bladder into the small intestine (see page 
188). Where an obstruction arises, due perhaps 
to the swelling of the membrane in or near the duct 
(tube) which carries the bile from the bladder to 
the small intestine, or to a solid conglomeration of 
organic and inorganic material commonly known 
as gall-stones, or to a tumor, or to a diseased liver, 
then the bile cannot pass into the intestine but is 
absorbed by the blood. One of the consequences 
is that the stools no longer have their usual color, 
but are very light gray. A more serious consequence 
is the disturbance in fat digestion. It has been 
shown that a necessary step towards the proper 
utilization of fats is the presence of bile in the in- 
testine; in its absence, large quantities of un- 
changed fat appear in the feces. 
Where an operation is not imperative, the treat- 
ment suggested by the English specialist, Russell, 
may be followed. “The diet ought to consist of skim 
milk and farinaceous foods. Care ought to be taken 
to have the food very thoroughly mixed with the 134 
WHAT TO EAT 
salivary secretions so as to ensure its more easy di- 
gestion. Medicinal treatment consists in the ad- 
ministration of bicarbonate of soda, rhubarb and 
small doses of salicylate of soda. A small dose of 
calomel at night, followed by a small dose of an 
effervescent saline aperient in the morning, may be 
given for a few days in succession, or on alternate 
days. It is better so to regulate the dose that free 
movement is obtained without purging. The color 
of the motions shows when bile has begun to pass 
into the bowel, and as soon as this is seen the diag- 
nosis may be regarded as confirmed.” 
References 
[J. A. M. A. —Journal of the American Medical 
Association.] 
Comprehensive reviews may be found in C. D. 
Aaron’s Diseases of the Digestive Organs (Lea and 
Febiger, Philadelphia); William Russell’s The 
Stomach and the Abdomen (William Wood and Co., 
N. Y.) ; M. Einhorn: The Duodenal Tube and Its 
Possibilities (W. B. Saunders Co., Philadelphia); 
M. Einhorn: Diseases of the Stomach (William 
Wood and Co., JST. Y.); M. Einhorn: Diseases of the 
Intestine (William Wood and Co., N. Y.) ; P. Cohn- 
heim: Diseases of the Digestive Tract (J. B. Lippin- 
-cott and Co., Philadelphia); and A. E. Austen: 
Diseases of the Digestive Tract (C. V. Mosby and DIET IN DIGESTIVE DISORDERS 
135 
Co., St. Louis). F. Billings’ Diseases of the Digest- 
ive Tract (D. Appleton and Co., N. Y.) is a com- 
prehensive reference book. See also William Osier’s 
The Principles and Practice of Medicine (D. Apple- 
ton and Co., N. Y.), section 5, and more particularly 
H. S. Carter’s Nutrition and Clinical Dietetics (Lea 
and Febiger, Philadelphia), chapters 21, 22, and 
23, for details as to diet. The Diet Lists of the 
Presbyterian Hospital, N. Y. (W. B. Saunders and 
Co., Philadelphia), compiled by H. S. Carter, are 
also of value in this connection. 
P. Moynihan, the eminent English surgeon, is the 
author of a volume on the duodenal ulcer (W. B. 
Saunders and Co., Philadelphia). At the St. Louis 
meeting of the American Medical Association (May, 
1922), a number of papers on gastric and duodenal 
ulcers were presented by Drs. A. D. Bevan, B. W. 
Sippy, and T. R. Brown, which led to an animated 
discussion. These papers, as well as an account of 
the discussion, may be found in the J. A. M. A., 
volume 79, pages 22, 26, 29, and 34, 1922. See also 
W. J. Mayo: “Progress in the Handling of Chronic 
Peptic Ulcer,” J. A. M. A., volume 79, page 19,1922; 
J. S. Horsley and W. T. Vaughan: “The Surgical 
Treatment of Gastric and Duodenal Ulcers,” J. A. 
M. A., volume 78, page 1371, 1922; E. H. Gaither: 
“Interpretation of Digestive Symptomatology,” 
J. A. M. A., volume 77, page 1407, 1921. 
L. D. Bulkey: Cancer (William Wood and Co., 136 
WHAT TO EAT 
N. Y.); W. M. L. Coplin: “A Basis for the Preven- 
tion of Cancer,” J. A. M. A., volume 78, page 1523, 
1922; J. T. Case: “Progress and Promise in the New 
X-ray Treatment of Cancer,” Joumal of the Michi- 
gan State Medical Society, January, 1922; J. T. 
Case: “The New Short Wave Length Roentgen-Ray 
Therapy,” J. A. M. A., volume 79, page 699, 1922. 
(“Marked progress has been achieved in producing 
more penetrating roentgen rays.”); and the “For- 
eign Letters,” J. A. M. Avolume 78, page 1975 and 
1977,1922. 
E. Owen: Appendicitis (William Wood and Co., 
N. Y.); J. B. Sutton: Gall-Stones and Disease of 
the Bile Duct (William Wood and Co., N. Y.); S. 
G. Grant: Diseases of the Colon, Rectum, and Anus 
(W. B. Saunders and Co., Philadelphia); S. G. 
Grant: Diarrheas (W. B. Saunders and Co., Phila- 
delphia) ; C. B. Ball: The Rectum (Oxford Univer- 
sity Press, N. Y.); H. D. Rolleston: Diseases of the 
Liver, Gall-Bladder and Bile Duct (Macmillan Co., 
N. Y.) ; C. H. Mayo: “The Cause and Relief of 
Acute Intestinal Obstruction,” J. A. M. A., volume 
79, page 194, 1922; and E. H. Gaither: “The Value 
and Limitations of Roentgen-Ray Diagnosis in Di- 
gestive Disease,” J. A. M. A., volume 79, page 618, 
1922. CHAPTER XI 
DIET IN SOME COMMON DISEASES 
Fevers. As it is not our intention to discuss in 
detail the various infectious diseases, and as many of 
them require similar dietetic treatment, we shall 
make here a few general-remarks concerning diet in 
fevers. 
Fevers are accompanied by an increase in body 
temperature; to what this is due is problematical. 
With a rise of temperature, the appetite becomes 
quickly affected: the very sight of food sickens the 
patient; nausea and vomiting are frequent occur- 
rences. An initial fast of 24 to 72 hours, depending 
upon the disease and the state of the patient’s health, 
is prescribed. Water, or possibly weak tea or Vichy 
if desired, is recommended. If, despite copious 
water drinking, the bowel movements become slug- 
gish, it is well to take a purgative. 
After a day or so (if the disease is not chronic, 
which then requires special treatment), when the 
temperature has perhaps decreased, and when the 
patient plainly evinces a desire for food, liquid food 
137 138 
WHAT TO EAT 
may be offered. This may consist of milk (which is 
“easily digested, is a non-irritant to the stomach, 
does not yield an appreciable bulk of unabsorbed 
material, and is rarely subjected to putrefactive 
changes within the intestine”), or milk and barley 
water (if milk curds in the stomach are formed), 
and possibly beef juice and broths. With evidence 
of progress, we pass on to semi-solid foods, such as 
gruels (boiled for a long time), junket, custard, 
jelly, fruit and possibly ice-cream (if home-made, 
or if a particularly good brand is obtainable). Even 
when the stage of solid feeding is reached, only 
those foods that are easily digested and that are 
laxative, should be offered. Toast, crackers, eggs, 
chicken, fresh fish containing little fat (cod, halibut, 
bass) boiled or broiled, may be included. Fruit in 
the form of orange, stewed prunes, or grapes, may 
be given quite early in the course of the illness. 
Some doctors, particularly those on the Continent, 
prescribe a little alcohol in one of its several forms 
—brandy or champagne. 
Tuberculosis, or as it is popularly known, con- 
sumption, is the “captain of the men of death.” 
Someone has estimated that one-seventh of all 
deaths are due to it. It is an infectious disease 
caused by the bacillus tuberculosisy and gives rise 
to a wasting away of the tissues, such as the lungs. 
We have no specific remedy for it, despite the in- 
troduction some years ago of Koch’s tuberculin DIET IN SOME COMMON DISEASES 
139 
cure, and its extensive use by Trudeau.1 What 
does help, and what has helped to cut the mortality 
in tuberculosis to one-half of its former figure, is 
fresh air and wholesome food. Plenty of milk (or 
if this cannot be taken, some form of fermented 
milk), eggs (soft-boiled rather than raw, which 
are not always easily digested), and fats in the 
form of cream and codliver oil, are to be given. But 
this fattening process must not assume alarming 
proportions (it seldom can, for that matter) ; when 
normal weight is reached, only so much food is eaten 
as will maintain this weight. 
An example of one form of diet, advocated by Dr. 
Watson, which is high in the proteins of milk, is as 
follows: 7 a. M.: milk, one-half pint; 8.30 A. m. : 
milk, one-half pint, with casein (the chief pro- 
tein of milk), one-half ounce, flavored with coffee or 
cocoa; gruel, made with milk and flavored with 
cream; 11 A. m. : soup thickened with one-quarter 
pound raw scraped beef, or soup thickened with an 
egg; 1 P. M.: chicken essence or veal jelly strength- 
ened with casein, one-half ounce, and milk, one-half 
pint; or raw meat minced, one-quarter pound, with 
milk; or raw meat rissoles, with milk, or raw meat 
sandwiches with milk; 3 p. m„ : milk with egg or thin 
1 Some doctors are of the opinion that tuberculin is valuable. 
“Tuberculin has a specific stimulating effect on tuberculosis 
tissue, and helps to lay down scar tissue. The reason it is not 
used more extensively is that it is not studied enough.” (Dr. 
F. M. Pottenger) 140 
WHAT TO EAT 
custard; 5 p. m. : milk tea, one-half pint, with 
cream; 7 p. m. : meat juice, or soup with raw meat, 
beef extract with egg and milk forming a custard, 
or milk and arrowroot, with casein and cream, one- 
half pint; brandy may be added; 8 p. m. : an invalid 
food, made with milk, one-lialf pint, and casein. 
11 p. m„ : milk and egg, or chicken broth and egg. 
The criticism that may be made of this dietary is 
that the total amount, calculated in calories, seems 
large, too large; and the protein consumption, even 
though the proteins are mainly of the milk variety, 
is excessive. Perhaps a good modification would be 
to omit the casein from the diet, and also to omit the 
last feeding. 
Diabetes. This is a disease that involves a dis- 
turbance of the carbohydrate metabolism: sugars 
are not utilized properly, due, in many cases, to a 
diseased pancreas.2 Relatively large quantities of 
sugar, in the form of glucose, appear in the blood 
and in the urine. 
This disease is not strictly curable, though much 
2 Within the last few months Drs. Macleod and Banting, and 
their associates of the University of Toronto, have reported 
highly encouraging results on the effect of the injection of 
“insulin,” a concentrated extract of pancreas (sweetbread) into 
the system of patients suffering from diabetes. The experiments 
have been repeated and extended in various parts of the country. 
Without wishing to be over-enthusiastic, it would seem as if the 
discovery of the Toronto physiologists will eventually be ranked 
with the most notable scientific achievements of the present cen- 
tury. (See Transactions of the Royal Society of Canada, volume 
16, section V, page 1, 1922.) DIET IN SOME COMMON DISEASES 
141 
has been accomplished by the careful regulation of 
the diet. In fact, progress in the treatment of dia- 
betes has so far confined itself exclusively to changes 
in diet. 
With the inability of the organism to handle 
carbohydrate food, the natural step is to omit such 
food from the patient’s diet. When this is done, 
when sugars and starches are withheld, and only 
fat and protein offered, the remedy has still not been 
found, for acidosis sets in, with very serious and 
often fatal consequences. It is now known that the 
substances which, grouped together, give rise to 
acidosis, are derived from fat, and that acidosis is 
in many cases prevented when small quantities of 
carbohydrate are included in the diet. On the 
other hand, proteins themselves may be the source 
of sugar in the organism, for part of the protein 
molecule may undergo changes in the body that are 
similar to those undergone by carbohydrates. The 
situation is a difficult one; the problem of adjust- 
ing the food intake on the basis of clinical and lab- 
oratory tests is not easy. From the mass of work 
done by Drs. Allen, Joslin, and Newburgh, three 
distinguished diabetic specialists, we may sum- 
marize the present situation as follows: A pre- 
liminary fast is necessary until there is no further 
elimination of sugar; then the patient is put on a 
high fat, low protein and low carbohydrate diet, 
beginning with small quantities and gradually in- 142 
WHAT TO EAT 
creasing them until the limit of tolerance is reached, 
when further adjustment becomes necessary. 
Joslin’s resume of Allen’s treatment, as given by 
Dr. Carter, is as follows: Fast until sugar-free. 
Drink water freely and one cup of tea and one cup 
of coffee if desired. If sugar persists after two 
days of fasting, add in divided portions a little 
over one-half pint of meat broth. If acidosis is 
present, give from five to seven teaspoonfuls of 
alcohol daily until it disappears. (The quantita- 
tive tests for sugar and for acetone bodies—in aci- 
dosis—should be performed by carefully trained 
biochemists.) When the 24-hour urine is sugar- 
free, add, in increasing quantities, vegetables, fruit, 
potato, oatmeal, and bread, in the order named, un- 
less sugar appears. When the urine has been sugar- 
free for two days, add two-third ounce of protein 
(three eggs), and thereafter one-third ounce pro- 
tein daily in the form of meat until the patient is 
receiving about two and one-half ounces of protein. 
While testing the protein tolerance, a small quan- 
tity of fat is included in the eggs and meat. After 
the protein intake reaches about two and one-half 
ounces, and the limits of tolerance (as measured in 
the sugar output of the urine) have not been over- 
stepped, add about one ounce of fat daily until the 
patient ceases to lose weight. The return of sugar 
demands fasting for 24 hours, or until the urine is 
sugar-free. The diet preceding the appearance of DIET IN SOME COMMON DISEASES 
143 
sugar is then resumed (except that the carbohydrate 
must not exceed one-half the former tolerance) until 
the urine has been sugar-free for two weeks, and it 
should not then be increased more than one-sixth 
of an ounce per week. 
It need hardly be added that we are not advising 
sufferers to discard their physicians and to treat 
themselves according to the directions here outlined. 
Far from it. The sooner the patient places himself 
in the hands of a competent physician the better. 
In conclusion, one point is worthy of mention: 
statistics show that fat people are more apt to suf- 
fer from diabetes than thin people. “Diabetes is a 
penalty of obesity” is now becoming a favorite ex- 
pression. Dr. Joslin writes: “Mr. Mead, of the 
Lincoln National Life Insurance, finds that the fre- 
quency of constitutional diseases in general in- 
creases as age advances, and particularly as obesity 
advances; but diabetes is an exception to the rule: 
its incidence increases with age only with the fat, 
while in the thin it remains constant throughout 
life.” Here is another weighty reason for retaining 
one’s weight within the average limits.3 
8 In previous pages we have noted how certain Oriental races 
are comparatively free from a number of diseases that afflict Oc- 
cidentals. In this connection, statistics collected by Dr. F. L. 
Hoffman relative to deaths from diabetes are of interest. The 
average diabetes death rate for the United States is 16.4 per 
100,000, as compared to 11.8 for England and Wales. The larger 
figure for America is due, in part, to the larger Jewish popula- 
tion. For New York City the figure is 19.8; for Berlin, 17.9; for 144 
WHAT TO EAT 
Gout, “the rich man’s disease,” which is attended 
by acute pains in the joints, is attributed to over- 
eating and to too good living. Chemical studies of 
the blood and urine have shown that in attacks of 
gout a very considerable excess of uric acid finds its 
way into the blood and often into the urine. The 
faulty metabolism of uric acid, involving its chemi- 
cally allied compounds, the purines, is sometimes re- 
ferred to as the cause of gout, though more proof of 
such a relationship would be welcome. Uric acid 
undoubtedly has something to do with the disease. 
As in diabetes, so in gout: a revision of the diet 
becomes the all-important factor in attempts to cure 
the patient. In diabetes there is a disturbed car- 
bohydrate metabolism; hence a restricted carbohy- 
drate diet becomes imperative. In gout there is a 
disturbed uric acid metabolism; hence foods con- 
taining this substance, or rather foods containing 
purines which give rise to uric acid, are to be 
avoided as far as possible. This means an almost 
total abstinence from meat and fish. As the gouty 
patient is usually the one who eats far more than 
his activity calls for, his total food intake is de- 
creased and exercise prescribed. 
The modern clinical school, headed by van Noor- 
Copenhagen, 17.1; for Amsterdam, 15.9; for Tokio, 4.1; for 
Singapore, 4.3; and for Manila, 4.5. The low figures for Tokio, 
Singapore and Manila, as compared to the much higher figures 
for New York, Berlin, and Copenhagen, are certainly striking. 
May these differences be traced to differences in diet? DIET IN SOME COMMON DISEASES 
den, has adopted a method of treatment which in 
principle resembles the treatment of diabetes. The 
patient is made to undergo a preliminary fast, and 
is then fed first with purine-free foods, followed 
by foods containing these substances in ever-increas- 
ing proportions until the retention limit is reached. 
The purine-free foods are eggs, milk, white bread, 
butter biscuits, such cereals as hominy, rice and 
farina, cream, sugar, potatoes (practically purine- 
free), cauliflower, cabbage, lettuce, nuts, cheese, 
sweet cider, grape juice, and unfermented fruit 
juices generally. 
A sample diet may consist of the following: 
Breakfast: apple or banana; cream of wheat or 
farina; one egg; a glass of milk (warm, if desired); 
(white) bread and butter. 
Lunch: rice with cream; cheese or soft-boiled 
egg; bread and butter; fruit, stewed or fresh. 
Dinner: baked potato (or rice or macaroni) with 
butter; glass of milk; one egg; lettuce or young 
cabbage with dressing; string beans; bread and 
butter; baked apple or fresh fruit. (No “second 
helps/’ not more than one slice of bread at a meal, 
and very little butter. Avoid generous portions.) 
It may be added that various mineral waters have 
been suggested as sure cures for gout. There seems 
to be little reason to suppose that, beyond the effi- 
cacy of copious water drinking (the water rather 
than the mineral salts in it being important), and 
145 WHAT TO EAT 
146 
the beneficial results that are bound to follow a 
radical and sensible change in the patient’s mode of 
living, these mineral waters have any specific thera- 
peutic value. Popular spring resorts are those of 
Saratoga and Hot Springs in this country, Buxton 
and Bath in England, Aix-les-Bains in France, and 
Carlsbad, Homburg and Marienbad in Central 
Europe. Lately faddists have arisen who urge the 
use of radio-active waters. 
Nephritis, popularly known as Bright’s disease, 
involves an inflammation of the kidneys. Pain in 
the region of the loins, fever, frequent but painful 
urination, and the presence of albumin in the urine, 
are among its symptoms. This disease, like dia- 
betes, taxes every resource of the physician. In 
diabetes the methods of feeding should require as 
little as possible the services of the liver and pan- 
creas; in nephritis the feeding is of such a nature 
as to relieve the the kidneys from intensive work. 
This is a difficult matter. 
The treatment is one of two kinds, the one being 
in some ways diametrically opposed to the other. 
The Fischer treatment depends upon experimental 
work performed by M. H. Fischer and his pupils, 
work which is of the laboratory rather than of the 
clinical type, in which they showed that acidosis 
(a decreased alkalinity of the blood—a serious mat- 
ter) causes swelling and the appearance of albumin 
in the urine. This acidosis can be relieved by alkali DIET IN SOME COMMON DISEASES 
147 
treatment. Fischer argues that nephritis shows 
similarities to acidosis, and that the former can best 
be treated by means of alkalis. He finds a mixture 
of salt and washing soda—the latter representing 
the alkali—to be better than washing soda alone, 
since less alkali is needed, and the body does not 
take kindly to large quantities of this substance. 
The diet consists of soft foods that include large 
quantities of salt. No limit is set on the liquid in- 
take. 
A treatment in many ways opposed to the Fischer 
one, but based more largely on clinical experience, 
is the following: Meat is excluded from the diet 
immediately following the appearance of albumin in 
the urine. The diet offered includes milk, thin 
gruels, and barley water, containing as little salt 
as possible. To lessen the possibilities of swelling, 
the water intake is limited. If the treatment has 
been successful, the albumin in the urine will have 
disappeared by the end of five to six weeks. More 
substantial food may now be offered. Bread, rice, 
and potatoes are added to the dietary. Meat is still 
excluded. 
In cases of prolonged (chronic) nephritis, “the 
diet selected should be based on the excretory ability 
of the kidneys, the condition of the heart, the blood 
pressure, the state of digestion, the weight of the 
patient, and the physical and mental work required 
bf him. ... It is well for the patient to have noth- 148 
WHAT TO EAT 
ing but skimmed milk one day in the week. It has 
not been shown that fresh fish, poultry, and meat, 
except kidney, sweetbreads, liver, and shad roe 
(rich in purines) are any more harmful to the ne- 
phritic patient than are the vegetable proteins such 
as are found in nuts, peas, beans and oatmeal, 
though some patients may tolerate these better.” 
(Osborne) 
Arteriosclerosis, or hardening of the arteries, due 
to their inflammation, is believed to arise from much 
the same causes as gout: from an excess of food, 
drink, and general good living. The diet is similar 
to that in gout, the emphasis being placed on little 
protein, and on food that is purine-free. Large 
quantities of food, as well as foods containing a 
high percentage of purines, tend to raise the blood 
pressure; foods which lower it are milk, fruits, 
vegetables and fat. 
Asthma is derived from the Greek word meaning 
“panting,” and this word describes the disease ad- 
mirably. Bronchial asthma is a common form. The 
difficult breathing, the whistling sound, the cough, 
the feeling of suffocation due to the constriction 
of the windpipe, are well-known symptoms. The 
modern trend of study in this disease is to regard it, 
like hay-fever, as a form of anaphylaxis—a hyper- 
sensitiveness to certain proteins; and to protect 
against it by immunization. For example, Dr. 
Walker has shown how certain asthmatics who were DIET IN SOME COMMON DISEASES 
149 
sensitive to proteins found in horse dandruff, could 
be relieved of attacks by injections of small amounts 
of these proteins. But so far such treatment has 
disposed of but few cases. The use of morphin, po- 
tassium nitrate, atropin, nitroglycerine, and adrena- 
lin (epinephrin) is common. Asthma sufferers are 
often much relieved by a change of climate, particu- 
larly where the change involves settling in a moun- 
tainous region; here again we see another re- 
semblance to hay fever. 
As to diet, sweet food, fermentable vegetables 
(cauliflower, cabbage, or much onion or potato), 
alcohol, indigestible meat (goose, duck, pork) and 
tobacco, are to be avoided. As the attacks are most 
frequent at night, it is best to arrange for the prin- 
cipal meal at midday, and to eat little at supper 
time. Attacks are also accelerated by a non-laxa- 
tive diet. The consumption of six to eight glasses 
of water per day may be of distinct help in this 
direction. 
Eczema. This is a common form of skin disease 
which may be the result of improper food, of too 
much or too little food, or of a hypersusceptibility 
to certain proteins. The principle underlying the 
dietetic treatment is the use of food of low protein 
content, on the assumption that waste nitrogenous 
products which are retained in the system and may 
give rise to the disease, will be more easily elimi- 
nated. Milk, bread and butter, cereals, and fresh 150 
vegetables, all given in moderate quantities, make 
up the major portion of the diet. Clinical experience 
teaches that fruit, unless stewed, should be withheld 
from the patient until he shows a marked improve- 
ment. Eczema in nursing children is best corrected 
by changing the diet of the mother, who is very 
often discovered to be eating too much and to be 
exercising too little. Sometimes the eczema in the 
child may be due to a hypersusceptibility to proteins 
in the mother’s milk. In such a case, “the aim of 
treatment,” writes Dr. O’Keefe, “should be to secure 
complete digestion of ingested protein, either by im- 
proving the digestive function, or by limiting the 
intake of offending proteins.” Where the eczema 
breaks out in bottle-fed children, Holt suggests the 
use of a high fat, low protein diet, and if this is not 
successful, of a low fat, low protein diet. 
Anemia, popularly regarded as a condition re- 
sulting from relatively little blood in 
may really be due to this cause, or it may also be 
due to a decreased quantity of hemoglobin, or of 
red blood corpuscles. Whatever the cause, the oxi- 
dative power of the blood is interfered with. Im- 
perfect nutrition, a wasting disease, or direct loss 
of blood, may give rise to anemia. Where the case 
is a fairly mild one, a careful regulation of the diet 
to include foods rich in iron (see under “Iron,” 
page 21), may help, provided the patient takes ex- 
ercise and gets plenty of fresh air. Meat and fish 
WHAT TO EAT DIET IN SOME COMMON DISEASES 
151 
are both rich in iron, but so are eggs, spinach, beans, 
wheat, oatmeal, apples and strawberries; so that 
no necessity arises for emphasizing a meat and fish 
diet. 
Summary. We may try to crystallize some of the 
principles underlying nutrition in disease. A 
purely surgical case (as that of a broken limb), or a 
child-bed case, offer little difficulty to the dietitian. 
Here the appetite is very little impaired. The fact 
that the patient is in bed and does little exercise 
means that he needs less food than when active; 
though this does not apply to the nursing mother 
who, if anything, should receive more and richer 
food. Further, since the patient remains in bed, 
constipation often arises, and this must be promptly 
relieved. Daily evacuation of the bowels is of the 
utmost importance, here and elsewhere. 
In diseases associated with fever, where the pa- 
tient’s appetite is largely impaired, the taking of a 
purgative, starvation for the first day or two, and 
copious water drinking, are standard directions. 
Liquid, semi-solid, and solid foods, in the order 
named, are gradually introduced as the patient’s 
temperature decreases and his general condition 
improves. 
A number of important elementary principles 
have to be kept in mind in the dietetic treatment of 
certain diseases. Where a patient has to be fattened 
or suffers from intestinal putrefaction, it may be 152 
WHAT TO EAT 
wise to increase his intake of fat and carbohydrate; 
on the other hand, in obesity and in acidosis (such 
as we find in the more advanced stages of diabetes 
and nephritis), a diet poor in fat, and in diabetes, a 
diet poor in carbohydrate, should be offered. A low 
protein diet should be urged in any form of intes- 
tinal disease and putrefaction, whereas a high pro- 
tein diet may be suggested to convalescents, to pa- 
tients suffering from fever (to some extent), and to 
those whose body protein is rapidly being destroyed, 
as in cancer and tuberculosis. Gout and nephritis 
suggest a diet poor in purine bodies; anemia, one 
rich in iron; edema (as in nephritis), one poor in 
salt; acidosis (in diabetes and nephritis) one rich 
in alkalis; and gastric ulcer, one rich in such pro- 
teins as egg white, in order that the protein may 
combine with the excess acid of the stomach. In the 
hands of the competent physician familiar with the 
principles of dietetics who makes an exhaustive 
study of his patient, whose idiosyncrasies he is 
familiar with, the proper adjustment of the diet 
to the needs of the patient is often speedily re- 
warded by a marked improvement in the health of 
the sufferer. DIET IN SOME COMMON DISEASES 
153 
References 
[J. A. M. A. = Journal of the American Medical 
Association] 
Many are the books on diet and disease. See, for 
example, H. S. Carter, P. E. Howe and H. A. Mason: 
Nutrition and Clinical Dietetics (Lea and Febiger, 
Philadelphia) ; W. S. Hall: Nutrition and Dietetics 
(D. Appleton and Co., N. Y.); J. H. Kellogg: The 
New Dietetics (The Modern Medicine Publishing 
Co., Michigan) ; R. Hutchinson: Food and the Prin- 
ciple of Dietetics (William Wood and Co., N. Y.); 
C. Watson: Food and Feeding in Health and Dis- 
ease (William Wood and Co., N. Y.); J. Frieden- 
wrald and J. Rubrah: Diet in Health and Disease 
(W. B. Saunders Co., Philadelphia) ; G. A. Suther- 
land : A System of Diet and Dietetics (Oxford Uni- 
versity Press, N. Y.) ; and W. E. Fitch: Dieto- 
therapy (D. Appleton and Co., N. Y.). The Diet 
Lists of the Presbyterian Hospital, N. Y. (W. B. 
Saunders Co., Philadelphia), compiled by H. S. 
Carter, give many practical details. A good clinical 
survey of many diseases is that given by W. Osier in 
his Principles and Practice of Medicine (D. Apple- 
ton and Co., N. Y.). O. T. Osborne and M. Fish- 
bein’s Handbook of Therapy (American Medical 
Association, Chicago), is also of much value. 
With regard to individual diseases, an excellent 154 
WHAT TO EAT 
elementary manual on diabetes, written by one of 
our foremost authorities, is E. P. Joslin’s A Diabetic 
Manual (Lea and Febiger, Philadelphia). Joslin 
is also the author of a more advanced treatise, pub- 
lished by the same firm. A few individual papers 
dealing with diabetes are: E. P. Joslin: “To-day’s 
Problem in Diabetes in the Light of 930 Fatal 
Cases,” J. A. M. A., volume 78, page 1506, 1922; E. 
P. Joslin: “The Prevention of Diabetes Mellitus,’’ 
J. A. M. A., volume 76, page 523,1921; R. M. Wilder: 
“Optimum Food Mixtures for Diabetic Patients,” 
J. A. M. Avolume 78, page 1878,1922; E. E. Corn- 
wall : “A Diebetic Dietary,” J. A. M. Avol. 75, p. 
1642,1920; P. L. March, L. H. Newburgh and L. E. 
Holly: “The Nitrogren Requirements for Mainte- 
nance in Diabetes Mellitus,” Archives of Internal 
Medicine, volume 29, page 97,1922; L. H. Newburgh 
and B. L. Marsh: “The Use of a High Fat Diet in 
the Treatment of Diabetes Mellitus,” Archives of 
Internal Medicine, volume 26, page 649,1920; F. L. 
Hoffman: “Mortality in Diabetes,” Boston Medical 
and Surgical Journal, volume 187, page 135, 1922. 
A few references to other individual diseases are 
M. H. Fischer: Edema (John Wiley and Sons, N. 
Y.) ; J. Lindsay: Gout (Oxford University Press, 
N. Y.); N. B. Bardswell and J. E. Chapman: Diet 
in Tuberculosis (Oxford University Press, N. Y.); 
E. S. O’Keefe: “A Dietary Consideration of Eczema 
in Young Children,” J. A. M. A., volume 78, page DIET IN SOME COMMON DISEASES 
483,1922; Anon.: “Eczema in Breast-Fed Children,” 
J. A. M. A., volume 78, page 721, 1922; R. L. Cecil 
and N. P. Lassen: “Clinical and Bacteriological 
Study of 1,000 Cases of Lobar Pneumonia,” J. A. 
M. A., volume 79, page 343, 1922; H. S. Cumming: 
“Tuberculosis Among Ex-Service Men,” J. A. M. A 
volume 79, page 370,1922; J. L. Baer: “A Contribu- 
tion to the Problem of Nephritis,” J. A. M. A., vol- 
ume 79, page 622, 1922; F. M. Pottinger: “Present 
Status of the Treatment of Tuberculosis, J. A. M. A., 
volume 79, page 728, 1922 (“Regardless of our lack 
of a specific remedy for its treatment, if the measures 
which have been gradually evolved during the last 
half century are applied during the early clinical 
stage, and continued for a sufficiently long time, 
with the hearty cooperation of the patient, nearly all 
patients with tuberculosis can be restored to 
health.”) Anon: “The Immunization of Nurses to 
Diphtheria,” J. A. M. A., volume 79, page 380,1922; 
and Anon: “The Function of the Bile,” J. A. M. A. 
volume 79, page 382,1922. 
155 CHAPTER XII 
THE DIGESTIVE TUBE 
The life cycle. From such simple compounds as 
the carbon dioxide and moisture of the air, the plant 
builds up its complex fats and sugars. The syn- 
thesis of the still more complex proteins is made 
possible by the presence of nitrogen compounds in 
the soil. We in turn make use of these exquisitely 
finished products turned out in the workshops of 
the plant. We speak of them as foods, and we eat 
them, thereby being enabled to live. In the course 
of such utilization of food, wTe eliminate moisture, 
carbon dioxide, and nitrogenous products, which, 
you will recognize, are the very substances that the 
plant needs for its synthetic work—for the building 
up of carbohydrates, fats, and proteins. This give- 
and-take plan, this cycle of operations that connects 
the plant and animal kingdoms, may be spoken of 
as'the life cycle. 
The part played by the digestive tube. Life, for 
a low form of animal life like an amoeba, is a simple 
process. Whatever?part of its body comes in contact 
with food that can be utilized, will absorb the food, 
156 THE DIGESTIVE TUBE 
157 
and the digestion of this material will proceed in 
the nearest cell at hand. Waste, or non-utilizable 
material, is eliminated at the nearest exit—which 
is the nearest point at the surface. This entire 
process, if applied to man, would appear something 
like the following: a hand grasps an apple; the 
apple is gradually absorbed through the skin of the 
hand; it is digested in cells nearby; and the waste 
products, together with the undigested cellulose, 
are eliminated through the skin of the hand. 
Life, unfortunately for man, is not as simple as 
for the amoeba. Before it can enter the system the 
apple has to undergo certain changes. It is the func- 
tion of man’s digestive tube so to change the apple 
as to pave the way for its utilization by the body. 
And the evolution of man since prehistoric times 
has made a still more preliminary step almost in- 
dispensable: much of his food has to be cooked 
before it can be absorbed by the system. The cook- 
ing serves two purposes, which are related: it les- 
sens the work of an already overtaxed digestive 
system, and it stimulates the activity of the diges- 
tive juices. 
It is necessary at this point that we clear away a 
common misconception. So long as food remains in 
the digestive tube, whether in the mouth, in the 
stomach, or in the intestines, it is of no value to us 
as food; it only becomes of value when it is ab- 
sorbed and metabolized. To make this clearer, let 158 
WHAT TO EAT 
ns make use of an illustration. Imagine two cyl- 
inders one within the other; if the inner cylinder 
is made of lead, say, then we can pour water into it 
without the water reaching the outer vessel. If the 
smaller cylinder is open at both ends, water will 
pass in at one end and pass out at the other. If the 
lead cylinder is replaced by a cylinder made of more 
permeable material—filter paper, perhaps—then 
some of the water will pass through the sides of the 
smaller cylinder and be deposited in the larger one. 
Now carry this analogy over to the structure of 
the body. The equivalent of the smaller cylinder 
is the digestive tube; that of the larger cylinder is 
the rest of the body. We take food into the mouth 
(we pour water into the smaller cylinder) ; the food 
finds its way into the stomach and then into the in- 
testines (the water reaches the interior of the cyl- 
inder) ; under certain conditions food may pass 
right through the small and large intestines and be 
eliminated through the rectum unchanged (the 
water flows out from the bottom of the small cylin- 
der) ; under more favorable conditions part of the 
food is absorbed through the walls of the intestine 
and eventually finds its way to the various cells of 
the body (part of the water passes through the sides 
of the smaller cylinder into the larger one). It is 
only because the walls of the digestive tube are suf- 
ficiently permeable for the passage of certain foods 
into the interior of the body that life is at all pos- THE DIGESTIVE TUBE 
159 
sible. And, indeed, the primary function of the 
digestive tube is to take foods that are chemically 
complex, that are colloidal and that are but slightly 
soluble in water, and convert them into products 
that are (chemically) relatively simple, that are 
crystalloidal, and that are readily soluble. The 
food before digestion cannot pass through the walls 
of the digestive tube (this does not apply to water 
or to mineral salts) ; the products formed after 
digestion can pass through. 
This digestive process is one of self-preservation. 
Egg-white, a typical protein, when injected directly 
into the blood stream, is poisonous to the system. 
When, however, the egg-white is introduced into the 
digestive tract via the mouth, it cannot pass through 
the walls of the digestive tube until the juices have 
acted on it and have considerably simplified it 
(from the point of view of chemical structure). 
Then the products formed become permeable; and 
these permeable products are not only non-poison- 
ous, but are of the utmost value in replacing waste 
tissues. 
A view of the interior of the "body. The lay reader 
will follow the contents of this book more intelli- 
gently if he gets a picture of the interior of the body, 
with particular reference to the general position of 
some of the more common organs. 
The body (figure 1) consists of head, trunk, and 
limbs. The trunk is divided into the chest (thorax) Fig. 1. GENERAL PLAN OF THE BODY. 
160 THE DIGESTIVE TUBE 
161 
and the belly (abdomen). A partition (called the 
diaphragm), stretching across the body, separates 
the thorax from the abdomen. Near the middle of 
the thorax, enclosed in a thin bag (the pericar- 
dium), is the heart. On each side of the heart is a 
pinkish, spongy organ, the lung. In the abdomen 
we find the liver with its gall bladder, situated be- 
low the diaphragm; the stomach, a little to the left 
of the liver and partly covered by it; the small in- 
testine, part of which lies to the right of the stomach 
and close to it, and part of it occupying a large por- 
tion of the middle of the abdomen; the large intes- 
tine, a continuation of the small one; the pancreas 
(sweetbread), lying to the right of and below the 
stomach; the spleen, just below the left end of the 
stomach, and partly covered by the intestine; and 
the kidney, under the intestines, and a little above 
the middle of the abdomen. 
The digestive tube. A tube that passes from the 
mouth down the neck, through the thorax, and into 
the upper left-hand part of the stomach, is the 
esophagus (gullet). This esophagus is the first 
portion of the digestive tube or alimentary canal. 
When we leave the esophagus we proceed to the 
stomach, then to the small intestine, then to the 
large intestine, and finally to the anus (figure 2). 
Altogether this tube in man is about thirty feet 
long. To put it in a somewhat more logical way, 
the ratio between the length of the body and the Fig. 2. THE DIGESTIVE TUBE. 
162 THE DIGESTIVE TUBE 
163 
length of the tube is as one is to five or six. This 
ratio varies considerably in different animals. In 
the cow the proportion is as one is to twenty, in the 
sheep as one is to twenty-seven, in the horse as one 
is to twelve, in the dog as one is to six, in the cat 
as one is to four. The canal, then, is much longer 
in herbivorous than in carnivorous animals. Grasses 
and herbs need more extensive preliminary treat- 
ment than flesh foods, and nature has provided for 
this need. 
The digestive tube starts with the mouth, runs 
along the esophagus into the stomach, and then into 
the small intestine. The first portion of the small 
intestine, the duodenum, is some ten inches long, 
and is shaped in the form of a loop. It leaves the 
stomach at its right end, continues its path some- 
what towards the right, and then travels left. The 
duodenum lies just below the liver. From the duo- 
denum we pass to another small portion of the small 
intestine known as the jejunum, and still one fur- 
ther on, the ileum. Both the jejunum and ileum are 
more centrally situated. The length of the small 
intestine is about two-thirds of the entire length 
of the digestive tube, or twenty feet. The large 
intestine, a wider tube than the small one, begins 
at the cecum, runs up on the right side, until it 
almost reaches the liver (ascending colon), then 
across below the stomach (transverse colon), and 
down the left side (descending colon). From here 164 
WHAT TO EAT 
the continuation is by means of the rectum, a 
straight tube about nine inches long, which ends 
at the anus. Including the rectum, the large in- 
testine is about six feet long. 
You will notice in the diagram that the liver is 
connected by a tube (duct) with the small intes- 
tine; the pancreas (sweetbread) is connected in a 
similar way with the small intestine. Some of the 
succeeding paragraphs will make clear the impor- 
tance of these organs in the general process of di- 
gestion. 
We shall now discuss the various parts of the 
digestive tube in some detail. 
The mouth. The introduction of food into the 
mouth, if of a solid variety, sets the teeth in motion; 
water and other liquids very quickly pass into the 
stomach. The work of the teeth is purely a me- 
chanical one and a preparatory step in the chemical 
disintegration of the food material. The enzymes 
of the digestive juices, about which we shall have 
something to say presently, act so much more read- 
ily on food particles in a fine state of division than 
on coarser products. The chemist crystallizes this 
idea in a sentence when he states that chemical ac- 
tion is increased by increasing the surface area of 
the reacting bodies. 
The appearance of food in the mouth brings psy- 
chic factors into play: it stimulates the activity of 
the digestive juices and makes the mouth water,— THE DIGESTIVE TUBE 
165 
a sensation that may be aroused by merely looking 
at or thinking about an appetizing dish. Since 
these digestive juices contain substances (enzymes 
or ferments) which act chemically on food material,, 
FTO. 3. THE GLANDS THAT MANUFACTURE 
SALIVA. 
another factor, the chemical, is introduced. So* 
that in all we have to deal with three factors, the 
mechanical, the psychical, and the chemical. 
The mastication of the food involves not only the 166 
WHAT TO EAT 
teeth but the tongue and the juice obtained from the 
salivary glands. The lower jaw moves up and down, 
and to a certain extent, from side to side and from 
front to back. The food is kept in motion by the 
Fig. 4. SEVERAL TYPES OF GLANDS. 
tongue, which not only brings the food particles in 
intimate contact with the teeth, but also with the 
saliva. After a while the food, mixed with the sa- 
liva, is gathered in a bolus ready for swallowing. THE DIGESTIVE TUBE 
167 
But we have to stop here to investigate the origin 
of this fluid known as the saliva. 
The saliva originates in small factories near the 
mouth known as glands (figure 3). Since glands 
and their secretions play such an important part in 
digestion, we must investigate these factories more 
closely. 
Glands. The simplest type of gland consists es- 
sentially of a group of cells richly supplied with 
nerves and blood-vessels, and having a common exit 
(a tube known as a duct) through which the pe- 
culiar products which they manufacture are sent 
(figure 4).1 The raw materials necessary for the 
manufacture of these products are obtained from 
the blood, the gland selecting only those substances 
that are necessary to form the finished material. 
Saliva. The saliva is the product of three pairs 
of glands (see figure 3), one, the parotid, situated 
in front of the ears, and the other two, the submax- 
illary and the sublingual, stationed between the 
lower jaw and the floor of the mouth. Their secre- 
tions, which when mixed constitute saliva, are 
poured into the mouth through tubes (ducts). 
Saliva, the first of the digestive juices encoun- 
tered by the food, consists Of more than 99 per cent 
1 Glands are known that have no ducts, but that send their 
products directly into the blood stream. Examples of such duct- 
less glands (sometimes also called endocrine glands or glands of 
internal secretion) are the thyroid, the pituitary and the ad- 
renals. See the author’s book, Glands in Health and Disease (E. 
P. Dutton and Co., N. Y.). 168 
WHAT TO EAT 
of water. The remainder is made up of traces of a 
half a dozen different substances, the function of 
some of which is veiled in mystery. We here are in- 
terested in two of its constituents, the mucin and 
the ptyalin. Mucin is a complex substance, a com- 
bination of protein and carbohydrate, which gives 
the “ropy” consistency to saliva, and helps to keep 
the food well lubricated—a necessary step prior to 
swallowing the food. The ptyalin is a typical en- 
zyme (ferment) ; it has the property of converting 
the starchy part of food into maltose, a substance 
belonging to the sugar group. This is a prelimi- 
nary step which is necessary so that the food may 
ultimately be absorbed. The ptyalin is not only the 
most important product manufactured by the sali- 
vary glands, but it is also the product that char- 
acterizes them. The distinguishing features of the 
glands under discussion are that they produce en- 
zymes which, collectively, simplify food to such an 
extent that it can be readily absorbed by the walls 
of the digestive tube and pass into the blood stream. 
Enzymes, therefore, are the choice products of glan- 
dular activity, and the indispensable agents in pre- 
paring food for absorption. They therefore merit 
further attention. 
Enzymes (ferments). Everyone is familiar with 
alcoholic fermentation. A little yeast is put into a 
sugar solution and alcohol is formed. At the same 
time there is a frothing or boiling up of the liquid. THE DIGESTIVE TUBE 
169 
due to the formation of carbon dioxide (carbonic 
acid gas) ; hence the name “ferment” which is de- 
rived from the Latin fervereto boil up. For a long 
time this process of fermentation was looked upon 
as a peculiar function of a living organism, such as 
yeast. But early in the nineties, the work of a 
German chemist, Edward Buchner (who, by the 
way, was killed in the Great War), completely upset 
these views. By the use of a hydraulic press, he 
submitted yeast cells to a pressure of several hun- 
dred atmospheres, and obtained an extract that 
brought about fermentation just as readily as the 
original yeast. This enormous pressure was of 
course more than enough to kill all life in the yeast; 
so that the conclusion was unavoidable that what 
produces fermentation is not the living organism 
at all, but a something manufactured by the living 
organism, which itself has no life. This something 
is the true ferment, or, as it is more commonly 
known, the enzyme (from the Greek wTord for 
yeast). These enzymes are found not only in 
the mouth, but in the stomach, in the pancreas, in 
the liver, in the intestine—in fact, in every cell 
of the body. There is not a reaction in any one of 
the multitudinous cells of the body in which en- 
zymes are not involved. Our activity is dependent 
upon theirs; our very life is dependent upon their 
presence. 
Yet, strange as it may seem, no one has so far set 170 
WHAT TO EAT 
eyes on an enzyme; no chemist has so far isolated a 
substance of this type; and in this respect, enzymes 
and the no less elusive vitamines have much in 
common. We should add that by the word isolation 
we mean the preparation of the enzyme in a chemi- 
cally pure state; for it is not difficult to concentrate 
solutions containing these substances and get re- 
markably active products. 
This at once raises the inevitable question: if you 
have never seen an enzyme and have never isolated 
it, how do you know that there is such a thing? If 
you have never seen a vitamine and have never iso- 
lated it, why are we wrong in regarding the vita- 
mine as a mere illusion of the brain? These ques- 
tions are perfectly natural ones, and they need to 
be answered in a more illuminative way than for 
the scientist to say, “Oh, you don’t understand,” or 
“That’s beyond you.” These answers encourage ig- 
norance, widen the gap that already separates the 
scientist from the layman, and by no means flatter 
those responsible for them. 
A pigeon develops polyneuritis, a disease charac- 
terized by nerve degeneration, general paralysis, 
and speedy death. If offered in time, a quantity 
of dried yeast which is not more than the hundredth 
of an ounce will restore the health of the bird. The 
recovery is little short of miraculous. Within a 
few hours a bird with head bent completely back- 
wards and feet paralyzed is able to walk with head THE DIGESTIVE TUBE 
171 
erect. Now, the first thing that strikes the investi- 
gator is the remarkably small quantity of yeast 
necessary to bring about recovery. Then, when the 
chemist investigates what in yeast is responsible 
for this recovery in the bird, he finds that he can at- 
tribute it to no known constituent in the yeast. He 
finds by direct experiments that the proteins of yeast 
will not cure polyneuritis in birds; neither will the 
fats, nor the carbohydrates, nor the mineral salts. 
He has accounted for every known constituent in 
yeast, and not one of them, nor a combination of 
them, cures polyneuritis. Yet yeast taken as a whole 
does. What is he to make of this puzzle? By a 
process of elimination, he arrives at the conclusion 
that there must be a minute quantity of some sub- 
stance in yeast which baffles all attempts to isolate 
it, and which is directly responsible for the cure. 
To this substance, and others of a somewhat similar 
nature, Funk has given the name “vitamine.” 2 
Now let us turn our attention to the enzyme. The 
student in the laboratory is given a thick starch 
paste. He mixes a little of it with iodine solution 
and the mixture turns blue. He pours some of this 
thick starch paste onto filter paper fitted in a fun- 
nel. He next adds a little saliva to the starch, 
mixes gently with a stirring rod, and waits a 
minute or two. He again tests the starch with 
•See the author’s book, Vitamines: Essential Food Factors 
(E. P. Dutton and Co., N. Y.). 172 
WHAT TO EAT 
iodine; the mixture is still blue. But upon pour- 
ing some of the starch paste into a test tube, 
he finds that the opalescence of the solution 
has disappeared, and it is now quite transparent. 
In the meantime, the thick starch paste which 
refused to pass through the filter paper be- 
fore the saliva had been added, now filters very 
easily, far more so than does saliva alone. Succes- 
sive tests with iodine will bring out the fact that 
the blue color gives place to a reddish-blue, then to 
a. bluish-red, then to no color at all. At the same 
time the starch solution, which in the beginning 
failed to show any reaction with Fehling’s solution, 
now gives a bright red precipitate. (The Fehling’s 
solution is essentially an alkaline solution of cop- 
per sulphate, and is used extensively in tests for 
sugars.) All these changes, as the student quickly 
learns, are due to the breaking down of the complex 
starch molecule into a simpler sugar molecule; and 
he is told that the substance responsible for these 
changes is the enzyme ptyalin present in saliva. 
This ptyalin, like other enzymes, like the vitamine 
in yeast, like all vitamines, has not yet been isolated 
(“not yet” is a phrase that emphasizes the opti- 
mistic nature of the scientist). How then do we 
know that the ptyalin is present in the saliva? 
Again by a process of elimination. After we have 
accounted for every constituent known to be present 
in saliva, and have failed to bring about the change THE DIGESTIVE TUBE 
173 
from starch to sugar by the employment of any one 
constituent, or a combination of constituents, we 
come to the conclusion that there is something in 
saliva which baffles all attempts to isolate it, and 
which is responsible for the change of starch to 
sugar. This something we call an enzyme. 
Boiled saliva no longer has the power of changing 
starch to sugar; hence we draw the conclusion that 
ptyalin is destroyed when boiled. Saliva cooled in 
a freezing mixture acts very slowly on starch; cold, 
therefore, retards the action of ptyalin. By pouring 
saliva into alcohol, a fine white powder is obtained. 
This powder can be redissolved in water, and shown 
to contain ptyalin (by its action on starch) ; there- 
fore we say that ptyalin is insoluble in alcohol and 
soluble in water. And so we can proceed to deter- 
mine the properties of ptyalin without ever having 
seen it, and without ever having obtained it in a 
chemically pure form. 
We may now summarize the few preceding para- 
graphs by defining an enzyme as a substance which 
is the product of cellular activity, and which has 
the power of acting upon food materials, changing 
them, as a rule, into simpler substances.3 One of 
3 “As a rule” is added advisedly. Enzymes are found in the 
animal and plant cell, particularly the latter, which are synthetic 
in their action; they produce complex substances from simple 
ones. This action is the reverse of that of enzymes found in the 
digestive tract, all of which are analytic, or still better hydro- 
lytic, because water takes part in the reaction. Then there are 
still other enzymes which show neither synthetic nor hydrolytic 174 
WHAT TO EAT 
the functions of human saliva is to change the 
starch-containing foods into sugars, as the first of 
a series of steps towards the ultimate absorption 
of food by the system. 
The process of swalloioing. The food mixed with 
saliva, and constituting a pulp or bolus, reaches the 
back of the tongue, and then the opening leading 
into the pharynx (figure 5). The food is prevented 
from entering the windpipe or the nasal chamber 
through the coordination of the soft palate (the 
uvula in the diagram) and the epiglottis. From 
the pharynx the bolus of food passes into the 
esophagus (gullet), and then into the stomach. The 
mechanism by which the food is thrust forward 
when in the esophagus is known as peristaltic 
action. It consists essentially in a contraction of 
the muscular wall of the esophagus just above the 
bolus of food, whereby the food is pushed forward 
properties, and which have to do with oxidations within the 
body; these are the oxidizing enzymes. This does not exhaust 
the list. 
It would carry us too far away from our main theme to 
linger any further over these enzymes, but the subject is really 
a most fascinating one and amply repays careful investigation. 
We will scratch the surface in one other direction. Very small 
quantities of enzyme preparations—and this is true of vitamines 
—will bring about changes in relatively large quantities of 
material. This disproportion in amount between the substance 
acting and the substance acted upon (the substrate) is char- 
acteristic of catalytic reactions. The general subject of catalysis 
needs a volume all to itself, for many substances which are not 
enzymes are catalysts, and quite a number of essential industries 
are dependent upon catalytic reactions. The most recent and by 
far the best method for the manufacture of oil of vitriol (sul- 
phuric acid) depends upon a catalytic reaction. THE DIGESTIVE TUBE 
175 
Fig. 5. A SECTION OF THE MOUTH AND NOSE. 
some distance. Then there is another contraction 
immediately above the food mass, and the latter is 
once again propelled. This continues until the food 176 
WHAT TO EAT 
reaches the stomach.4 It takes about five to six 
seconds for the food to travel from the end of the 
mouth to the opening of the stomach. 
The stomach. The shape of this organ may be 
gathered from the accompanying diagram (figure 
6). It is an enlarged tube, the enlargement being 
particularly marked on the left (cardiac) end. 
Fig. 6. THE STOMACH, LIVER AND PANCREAS 
(SWEETBREAD). 
Like the esophagus, the walls of the stomach consist 
of muscular tissue lined by a mucous membrane. 
This mucous membrane is merely a conglomeration 
* Peristaltic action really involves two wave-like motions, ai 
constricting wave that carries the food downward, and an in- 
hibiting wave, in front of the constricting wave, which enables 
that part of the esophagus which is to receive the bolus to be 
relaxed. 
Liquid food is somewhat differently handled. Most of it shoots 
right through the esophagus. After a few seconds, a peristaltic 
movement develops which sends any remaining liquid into the 
stomach. THE DIGESTIVE TUBE 
177 
Fig. 7. A SECTION OF THE WALL OF THE STOMACH. (A is a gland highly 
magnified.) 
of several layers of cells, underneath which we 
find connective tissue consisting of fibers and cells, 
and containing blood-vessels and nerves. In the 178 
WHAT TO EAT 
inner coat are situated the gastric glands, where 
gastric juice is manufactured (see figure 7). 
The gastric juice. We have seen how glands 
situated near the mouth manufacture saliva which 
contains ptyalin. We have learnt how this enzyme 
affects starch-containing foods. We now come to 
the juice manufactured by glands located in the 
stomach wall, and known as gastric juice. Like 
saliva, the gastric juice consists of a dispropor- 
tionate quantity of water and small quantities of 
a number of other substances. Among these sub- 
stances we shall mention three, because of the part 
they play in digestion: pepsin, rennin, and hydro- 
chloric acid. Pepsin and rennin are enzymes, like 
ptyalin, but unlike the latter, they have no action 
on starch.5 Pepsin acts on the protein part of foods 
(like meat and the white of egg), and rennin (ren- 
net) acts on milk, forming a curd (the making of 
cheese illustrates this operation). We find, how- 
ever, that pepsin has no action on protein unless 
acid is present, and the hydrochloric acid serves 
this purpose. This substance, present in the gastric 
juice to the extent of four-tenths of one per cent, 
gives the acid properties to the liquid. Under the 
common name of muriatic acid, it is sold in drug 
*An interesting controversy which still wages in the camps 
of the scientists is whether pepsin and rennin are two distinct 
enzymes, or whether they are merely two different parts of one 
enzyme molecule. The swing of the pendulum is slightly in 
favoT of the former view. THE DIGESTIVE TUBE 
179 
stores, and, if taken in quantity, is a distinct 
poison. The fruits we eat do not contain hydro- 
chloric acid; no food does. The acid is manufac- 
tured in the stomach; just how, we do not know. 
Just as the function of the ptyalin of the saliva 
is to convert starch-containing foods into simpler 
products (sugars) so as to prepare the way for 
absorption, so the pepsin-hydrochloric acid of the 
gastric juice converts protein-containing foods into 
simpler bodies (peptones), and with the same object 
in view. 
Recent studies have shown that for some time 
after the food reaches the stomach, salivary diges- 
tion proceeds. This is contrary to the opinion held 
for a long time, since it was supposed that the 
acidity of the stomach juice would be sufficient to 
destroy the ptyalin, on the assumption that enzymes 
are easily destroyed by acids. Enzymes, with the 
exception of pepsin, are easily destroyed by acids, 
and even pepsin is, if the acid is concentrated 
enough. Under ordinary conditions, the addition 
of a solution containing ptyalin to gastric juice is 
enough to destroy the ptyalin. But it must not be 
forgotten that when the food reaches the stomach 
it is in the form of a bolus, with some of the saliva 
not only outside, but inside of the mass. This pro- 
tects at least some of the ptyalin from immediate 
attack by the acid. There is still another factor 
which aids, for a time, ptyalin activity in the stom- 180 
WHAT TO EAT 
ach. The hydrochloric acid forms a temporary 
union with the protein of the food, and in this com- 
bined state it is far less effective in destroying the 
salivary enzyme. 
The food settles in the cardiac part of the stomach 
(see figure 6), the stomach becomes distended, and 
gradually the food, in the form of a semi-liquid 
(chyme) spreads itself over the entire surface. 
Wave-like motions of the stomach wall bring about 
thorough mixing of the food, and the peristaltic 
motion sends portions of it to the pyloric end of 
the stomach. There the valve (sphincter) opens 
from time to time and admits the chyme into the 
first portion of the small intestine (the duodenum) . 
While the food in the mouth stays but a minute 
or so, we have already seen that salivary digestion 
does not stop immediately after the food reaches 
the stomach. In fact, this digestion may proceed 
in the cardiac end of the stomach for half an hour 
or so. Then gastric activity begins, and this may 
last from three to four hours, at the end of which 
time the last traces of a meal will have left the 
stomach. 
The presence of hydrochloric acid makes the 
gastric juice valuable in several ways. We have 
already mentioned that without acid the pepsin is 
powerless to digest proteins. The acid has also 
high antiseptic value. Harmful bacteria that lodge THE DIGESTIVE TUBE 
181 
in the mouth and pharynx, or that are swallowed 
with the food, are largely destroyed by the acid, 
the completeness of such destruction being largely 
dependent upon the state of health of the indi- 
vidual. Koch, the celebrated German investigator, 
has shown that even cholera bacilli are destroyed 
by the acid. On the other hand, where the acid 
becomes diminished in amount, that is no longer 
true. 
To summarize the functions of the gastric juice, 
we may say that the pepsin, in conjunction with the 
hydrochloric acid, acts on proteins and simplifies 
them in preparation for absorption by the system, 
that the rennin (rennet) causes curdling of the 
milk protein (an operation useful enough in making 
cheese, but not one that is obviously necessary in 
the stomach of an adult person), and that the hydro- 
chloric acid has a strong antiseptic action. Some 
claim that the gastric juice has some effect on fats, 
but if so it is extremely slight. We shall see how 
an enzyme developed by the pancreas decomposes 
fats. Neither in the mouth, nor in the stomach, 
nor in the intestines, do water and salts undergo 
any change. Chemically they are so simple that 
they are absorbed as such. 
Digestion in the small intestine. What takes 
place here is a more complex affair, and it will be 
advisable, if the main threads of our story are not 182 
WHAT TO EAT 
to be lost, to present a rapid bird’s-eye view of the 
reactions, and then proceed to discuss them in 
detail. 
If the reader will turn again to figure 6, he will 
notice that not only is the stomach connected with 
the small intestine, but so are two other organs, 
the gall bladder (from the liver) and the pancreas 
(sweetbread). But whereas the small intestine is 
a logical continuation of the stomach, both forming 
part of the digestive tube, this is not true of the liver 
and the pancreas, for they are joined to the intes- 
tine by narrow tubes or ducts. These ducts, you 
will remember, are the exit tubes of glands; it is 
through them that secretions are poured. The liver 
and pancreas are two very large glands, the former 
being the largest in the body, and they pour their 
secretions into the intestine. The duodenum, which 
is the name given to this particular part of the 
intestine, develops a secretion all its own (the 
succus entericus) ; so that the duodenum becomes 
the meeting ground for three distinct secretions. 
When food pours from the pyloric end of the 
stomach into the duodenum, juices from the three 
glands are soon ready to bid it welcome. This 
time whatever wrork remains to be done in order 
to facilitate absorption is completed. There are 
enzymes that complete the decomposition of pro- 
teins; there are enzymes that change remaining 
carbohydrates into the simplest sugars; and there Fig. 8. TWO VILLI. HIGHLY MAGNIFIED. 
E, epithelium; B, blood-vessels; L, lacteals. 
183 184 
WHAT TO EAT 
is still another enzyme which, helped by the bile 
(the juice which originates in the liver), disin- 
tegrates fats. 
The small intestine. We have had occasion to 
allude to the small intestine in our description of 
the digestive tube as a whole. It may be remem- 
bered that it is the longest part of the digestive 
tract, since it occupies some two-thirds of the en- 
tire length of the digestive tube. This length is of 
importance if we remember that practically the 
entire process of absorption of foodstuffs takes place 
through the walls of the small intestine; which 
means that a large surface is essential. This sur- 
face is enlarged more than four-fold by a peculiar 
and distinctive structure. If we examine the sur- 
face of the small intestine, we find that it is not 
level, like the stomach, but has finger-like projec- 
tions, called villi. Each one of these, a villus, is 
club-shaped and covered by a lining of cells (figure 
8). Under the lining we have connective tissue 
interspersed by blood-vessels. Through the centre 
of these villi pass tubes known as lacteals, through 
which there passes the lymph. It is through these 
villi that absorption of food takes place. 
Like the stomach, the wall of the small intestine 
contains glands (glands of Lieberkiihn) which 
manufacture juice (succus entericus) of value in 
digestion (figure 9). This juice contains a protein- 
splitting, and several sugar-splitting enzymes. It THE DIGESTIVE TUBE 
185 
Fig. 9. STRUCTURE OF THE WALL OF THE 
SMALL INTESTINE. 
V, villi; G, glands; C, circular muscle layer; L, longitudinal muscle 
layer; P, peritoneum, or coat. 
also contains an enzyme (entero-kinase) which has 
the property of activating the enzymes of the pan- 
creatic juice. This activation is a peculiar process, 186 
WHAT TO EAT 
and is by no means confined to the pancreatic juice. 
We find it to be true of the gastric juice, for ex- 
ample ; the activator there is the hydrochloric acid. 
To express it figuratively, the process of activation 
consists in rousing the enzyme from its sleep and 
getting it to work. 
The pancreas {sweetbread). If the reader will 
turn to figure 6, he will note the situation of the 
pancreas with reference to the other organs of the 
body. The entire pancreas is a gland, and, inci- 
dentally, the most important digestive gland, be- 
cause it manufactures all three types of enzymes 
necessary for digestion: trypsin, an enzyme which 
acts on proteins; amylopsin, an enzyme which acts 
on starch-containing foods; and lipase, an enzyme 
which acts on fats. In each case the action is char- 
acterized by a breaking down of complex into 
simpler substances; and the latter, and not the 
former, are absorbed through the villi of the small 
intestine. 
The three enzymes are found in the pancreatic 
juice, which in turn is manufactured by the pan- 
creatic glands. The juice pours into the small 
intestine through a duct (figure 6). 
The interesting question of what causes the flow 
of pancreatic juice into the intestine has been an- 
swered by two English physiologists, Bayliss and 
Starling, who have shown that the acid contents of THE DIGESTIVE TUBE 
187 
the chyme (the food leaving the stomach) release 
a substance (secretin) from the walls of the small 
intestine, which finds its way into the blood stream, 
and thence to the pancreas, there stimulating the 
flow of pancreatic juice. This messenger (or hor- 
mone) belongs to a group of substances manufac- 
tured by ductless glands; that is to say, glands 
which have no ducts, but which pour their secretions 
directly into the blood stream.6 The glands so far 
discussed in this chapter—and those directly in- 
volved in the digestive process—all have ducts. A 
good example of a ductless gland is the thyroid, 
situated in the neck. The small intestine, the pan- 
creas and the liver have glands with and without 
ducts. The intestinal glands with ducts develop 
the intestinal juice containing digestive enzymes 
which we have already discussed. The intestinal 
glands without ducts manufacture the secretin 
which is absorbed directly by the blood and influ- 
ences a distant organ (the pancreas)—a charac- 
teristic property of ductless glands. The pancreas 
itself, in addition to forming pancreatic juice (in 
glands with ducts), forms a substance, or series of 
substances, in its ductless glands which regulates 
liver functions. It is the belief that the deteriora- 
•See the author’s book, Glands in Health and Disease (E. P. 
Dutton and Co., N. Y.). 188 
WHAT TO EAT 
tion of these ductless glands within the pancreas 
gives rise to the commonest form of diabetes. 
The liver (see figure 6) is the largest gland of 
the body, weighing from three to four pounds. Its 
functions are many and diverse, and we must pre- 
vent ourselves from enlarging upon them, since 
many of them are not immediately concerned with 
the digestive process. We may, however, state that 
most of the food that passes through the walls of 
the small intestine first finds its way (via the 
blood) to the liver, where a sifting process is in- 
augurated, the carbohydrate being retained and 
stored as glycogen until such time as the body may 
wish to make use of it. 
The liver glands manufacture bile which is sent 
by means of a duct into the small intestine. When 
not immediately wanted, this bile is sent through 
a branch duct into the gall bladder, where it is 
stored. This bile, though practically free from 
enzymes, is important in digestion, because it facili- 
tates the breaking up of fats. Its color (from red 
to green to blue) is due to a mixture of pigments 
derived from the blood-pigment, hemoglobin. 
Digestion in the small intestine. The food which 
enters the intestine from the stomach is met, then, 
by three juices: the succus entericus, representing 
the intestinal juice; the pancreatic juice; and the 
bile. The food mixes with these juices, is acted 
upon by them, is carried along the length of the THE DIGESTIVE TUBE 
189 
small intestine by means of peristaltic movements 
of the muscular walls of the tube, and the properly 
digested particles are absorbed through the villi 
lining the route.7 
TSome readers may be interested in a tabulated summary. 
Liquid 
Enzymes 
present 
Action 
Products formed 
Intestinal 
juice 
Erepsin 
On partially 
decomposed 
proteins 
Amino-acids 
a 
Sucrase 
Sucrose 
(cane sugar) 
Glucose and 
fructose 
(simple 
sugars) 
ft 
Maltase 
Maltose 
(a sugar) 
Glucose 
u 
Lactase 
Lactose 
(milk sugar) 
Glucose and 
galactose 
(simple 
sugars) 
a 
Bile 
Entero- 
kinase 
None, but con- 
tains bile 
salts that act 
in conjunc- 
tion with 
lipase 
Activates 
enzymes in 
pancreatic 
juice 
Pancreatic 
Trypsin 
Proteins 
Amino-acids 
juice 
it 
Lipase 
Fats 
Fatty acids, 
soaps and 
glycerin 
(simpler 
bodies) 
it 
Amylopsin 
Starch (and 
Maltose 
similar sub- 
stances) 
(a sugar) 190 
WHAT TO EAT 
The large intestine (see figure 2) is a continua- 
tion of the small one, and ends in the rectum. It 
takes up the undigested food and carries it forward 
by means of peristaltic movements. Here water is 
largely eliminated by absorption through its walls, 
and the contents become more and more solid in 
consistency, until finally the residues are discarded 
in the form of feces. While we find little enzymic 
To complete the matter, we may summari/e salivary and gas- 
tric secretions in a similar manner: 
Liquid 
Enzymes 
present 
Action 
Products formed 
Gastric 
juice 
Pepsin 
Proteins 
Peptones 
(simpler 
bodies) 
it 
Rennin 
Casein 
(of milk) 
“Curd” 
Salivary 
juice 
Ptyalin 
Starch 
(and. similar 
substances) 
Maltose 
When all proteins are decomposed into amino-acids, when fats 
are decomposed into fatty acids, glycerin and soap, when starch 
and some of the other more complex carbohydrates are decom- 
posed into glucose, fructose and galactose, then absorption of 
the products becomes possible. 
A close scrutiny will reveal what appear as duplications of 
the digestive process. For example, we notice tha't starch is 
digested in the mouth as well as in the small intestine. It must 
be evident that such duplication ensures better digestion. But 
this explanation is not wholly satisfactory, The dog’s saliva does 
not contain any ptyalin, and yet the healthy animal manages to 
dispose of its starch with the help only of the amylopsin from the 
pancreatic juice. Stomachs have been removed from the dog and 
from man, the food passing directly from the gullet into the small 
intestine, without any obvious ill-effects. However, this would 
be a poor reason for removing a stomach from a healthy person! 
We must view abnormalities that do not appear to harm the 
system as an attempt made by the body to compensate for a loss. 
The ultimate cost to the body of such attempts at compensation 
has yet to be learnt. THE DIGESTIVE TUBE 
191 
action in the large intestine, there is considerable 
bacterial activity, which in turn gives rise to some 
evil-smelling products. Cellulose, found so abun- 
dantly in fruits and vegetables, is perhaps the com- 
monest form of material in the food which is not 
digested. Micro-organisms probably decompose 
small quantities of it in the large intestine, but as 
the body does not possess enzymes that can digest 
it, the greater portion passes out undecomposed. In 
herbivora, bacterial action is probably carried on 
on a much larger scale, since a considerable quan- 
tity of cellulose disappears. The laxative properties 
of fruits and vegetables are largely due to their con- 
tent of cellulose. 
What happens to the food after being absorbed 
through the small intestine. As our intention in 
this book is to confine ourselves more exclusively 
to digestive processes, we shall cast but a hasty 
glance over the processes of absorption, assimila- 
tion, and excretion. The products of carbohydrate 
and protein digestion are absorbed by the blood ves- 
sels in the villi of the small intestine, and those of 
fat digestion, by the lacteals (see figure 8). The 
carbohydrate products, consisting of simple sugars, 
find their way (via the portal vein) to the liver, 
where they are stored in the form of glycogen. This 
glycogen is used whenever the body has to expend 
energy. Some of the protein products (the amino- 
acids) are taken up by the cells of the body, and 192 
WHAT TO EAT 
resynthesized into tissue protein; others are decom- 
posed by the liver and largely changed into urea, 
which is eliminated through the kidneys and ap- 
pears in the urine. The products of fat digestion 
seem to be resynthesized into fat soon after absorp- 
tion (just why, we do not know), sent via the 
lymphatic system to the thoracic duct in the neck, 
and thence into the general circulation, and to the 
adipose tissue, where the fat is stored until needed. 
Despite the brilliant work that has been done by 
many investigators in different lands, many of the 
details involved in the metabolic process remain a 
mystery. We know what we put into the mouth, 
and we can analyze the products eliminated in the 
feces, in the urine, in the sweat and from the lungs; 
but the various intermediate steps in the process 
are not well understood. 
References 
A book which gives the essentials of anatomy and 
physiology very admirably, and which is adapted 
to the needs of a beginner, is T. H. Huxley’s Lessons 
in Elementary Physiology (Macmillan Co., N. Y.). 
M. Foster’s Elementary Physiology (Macmillan 
Co., N. Y.) is very much the same type of book. 
Other good elementary works, in which an account 
of the digestive system is included, are: R. Burton- 
Opitz: An Elementary Manual of Physiology (W. THE DIGESTIVE TUBE 
193 
B. Saunders Co., Philadelphia); P. G. Stiles: 
Nutritional Physiology (W. B. Saunders Co., Phila- 
delphia) ; P. G. Stiles: Human Physiology (W. B. 
Saunders Co., Philadelphia); R. C. Pearce and J. J. 
R. Macleod: Fundamentals of Human Physiology 
(C. V. Mosby Co., St. Louis); W. D. Halliburton: 
Essentials of Chemical Physiology (Longmans, 
Green and Co., N. Y.); W. M. Bayliss: An Introduc- 
tion to General Physiology (Longmans, Green and 
Co., N. Y.); A. Davison: The Human Body and 
Health (American Book Co., N. Y.); and J. W. 
Ritchie: Human Physiology (World Book Co., 
Yonkers, N. Y.). More advanced works, to which 
the reader may refer for special details, are J. P. 
Pavlow: The Work of the Digestive Glands (J. B. 
Lippincott and Co., Philadelphia), a classic; G. N. 
Stewart: A Manual of Physiology (William Wood 
and Co., N. Y.) ; M. H. Fischer: Physiology of Ali- 
mentation (John Wiley and Sons, N. Y.) ; T. B. 
Robertson: Principles of Biochemistry (Lea and 
Febiger, Philadelphia) ; O. Hammarsten: A Text- 
Book of Physiological Chemistry (John Wiley and 
Sons, N. Y.); W. H. Howell: Physiology (W. B. 
Saunders Co., Philadelphia) ; L. Luciani: Human 
Physiology, volume 2, (Macmillan Co., N. Y.) ; R. 
Burton-Opitz: Text-Book of Physiology (W. B. 
Saunders Co., Philadelphia); J. J. R. Macleod: 
Physiology and Biochemistry in Modern Medicine 194 
WHAT TO EAT 
(C. Y. Mosby Co., St. Louis); W. M. Bayliss: Prin- 
ciples of General Physiology (Longmans, Green and 
Co., N. Y.) ; and E. H. Starling: Human Physiology 
(Lea and Febiger, Philadelphia). APPENDIX 
Average Weights for Men and Women, as Compiled by the 
Metropolitan Life Insurance Company. 
Men. 
Height, 
Ft. In. 
5 1 
Weight, 
Lbs. 
120 
5 
2 
125 
5 
3 
130 
5 
4 
135 
5 
5 
141 
5 
6 
145 
5 
7 
150 
5 
8 
154 
5 
9 
159 
5 
10 
164 
5 
11 
169 
6 
, . 
175 
6 
1 
181 
6 
2 
188 
Height 
Ft. In. 
4 10 
Women. 
Weight, 
Lbs. 
108 
4 
11 
112 
5 
# # 
114 
5 
1 
118 
5 
2 
123 
5 
3 
120 
5 
4 
129 
5 
5 
133 
5 
6 
137 
5 
7 
142 
5 
8 
146 
6 
9 
150 
5 
10 
154 
5 
11 
158 
Normal Weight of Males at Various Ages.1 
Height. 
Ages 
15 to 24 25 to 29 30 to 34 35 to 39 40 to 44 45 to 49 50 to 54 65 to 59 
years, years, years, years, years, years. years, years 
Ft. 
In. 
Lbs. 
Lbs. 
Lbs. 
Lbs. 
Lbs. 
Lbs. 
Lbs. 
Lbs. 
5 
0 
120 
125 
128 
131 
133 
134 
134 
134 
5 
1 
122 
126 
129 
131 
134 
136 
136 
136 
5 
2 
124 
128 
131 
133 
136 
138 
138 
138 
5 
3 
127 
131 
134 
136 
138 
141 
141 
141 
5 
4 
131 
135 
138 
140 
143 
144 
145 
145 
5 
5 
134 
138 
141 
143 
146 
147 
149 
149 
5 
6 
138 
142 
145 
147 
150 
151 
153 
153 
5 
7 
142 
147 
150 
152 
155 
156 
158 
158 
5 
8 
146 
151 
154 
157 
160 
161 
163 
163 
5 
9 
150 
155 
159 
162 
165 
166 
167 
168 
5 
10 
154 
159 
164 
167 
170 
171 
172 
173 
5 
11 
159 
164 
169 
173 
175 
177 
177 
178 
6 
m m 
165 
170 
175 
179 
180 
183 
182 
183 
6 
1 
170 
177 
181 
185 
186 
189 
188 
189 
6 
2 
176 
184 
188 
192 
194 
196 
194 
194 
6 
3 
181 
190 
195 
200 
203 
204 
201 
198 
1 Tibbies: Food in Health and Disease, p. 465. 
195 INDEX 
Aaron, 134 
AbderhaXden, 22 
Abdomen, 161 
Adrenals, 167 
Agar-agar, in constipation, 93 
Alcohol, ill effects of, 52, 53 
Allen, 141 
Ameba, life of an, 156 
Amylopsin, 186 
Anemia, 150 (See iron) 
, diet in, 150 
, iron in, 22 
Appendicitis, 131 
, and meat, 104, 105 
, symptoms in, 132 
, treatment of, 132 
Arabs, food of, 103 
Arteriosclerosis, 148 
, diet in, 148 
Artificial feeding, of infants, 68 
“Ash,” value of, as food, 20 
Asthma, 148 
, diet in, 149 
Austen, 134 
Auto-intoxication, 96 
Ayers, 97 
Babcock, 63 
Bacillus acidophilus, treatment 
with, for constipation, etc., 
37, 95 
Bacillus bulgaricus, and Metoh- 
nikoff’s theory of old age, 37 
Baer, 155 
Bailey, 73 
Baily, 56 
Ball, 136 
Banting, 140 
Bardswell, 154 
Bossier, 96, 98 
Bayliss, 52, 56, 186, 193, 194 
Beef extract, 46 
Belly (See abdomen) 
Benedict, F. G., 79, 113, 120 
Beriberi, a vitamine deficiency 
disease, 27, 118 
Bevan, 135 
Beverages, 51 
Bile, 188 
Billings, 135 
Bismarck, 63 
Blockade, effect of Allied, on 
food in Central Empires, 112 
Body, interior of, 159 
Bordet, 53 
Bran, to prevent constipation, 
93 
, value of, as food, 17 
Bread and grain products, 48-49 
Breakfast, for normal person, 
58 
, for person overweight, 
86 
, for person underweight, 
88 
Breast feeding, 66 
Bright’s disease (See nephritis) 
Brown, 135 
Brunton, 92 
Buchner, 169 
Bulkley, 135 
Bunge, 22 
Burton-Opitz, 192, 193 
Butter, 38, 39, 40 
197 198 
Butter-milk, 35 
Butter substitutes, 40 
Caffein, present in a number of 
beverages, 51 
Calcium, importance of, 23 (See 
also rickets) 
Calorie, 2 
Calorific needs, 3, 4 
Cancer, 128 
, cause of, 128, 129, 
130 
, diet in, 130 
•—, symptoms in, 130 
Carbohydrates, value of, as 
food, 7 
Carter, 30, 56, 64, 73, 131, 135, 
153 
Case, 136 
Catalysis, 174 
Cecil, 155 
Cecum, 163 
Cellulose (See also bran) 
, aid in digestion, 49 
, foods rich in, 91 
Chaplin, 98 
Chapman, 154 
Cheese, 41 
Cheney, 95, 98 
Chest, 159 
Children, suffering of, in war 
areas, 114 
Chittenden, 12, 30, 79 
Chyme, 187 
Clark, 36 
Cocoa, 51 
Cod liver oil, in rickets, 117 
Coffee, 51 
Cohnheim, 134 
Collins, 36 
Colon, 163 
Condiments, 55 
Constipation (See also agar 
agar, bran, cellulose, Epsom 
salt, Glauber's salt, laxatives, 
mineral oils, purgatives, Ro- 
INDEX 
chelle salt, Rettger, bacillus 
acidophilus) 
, auto-intoxication in, 
90, 91 
, green foods and, 92 
, prevention of, 90, 91 
Coplin, 136 
Cornwall, 154 
Cream, 38, 39 
Davison, 193 
Deaths from various diseases, 
in Denmark, 18 
Delicatessen, 46 
Dennet, 73 
Diabetes, 140 
, diet in, 142 
, difficulties in treatment 
of, 141 
, related to obesity, 86 
, statistics, 143 
Diaphragm, 161 
Diarrhea, 130 
<, cause of, 131 
, diet in, 131 
, in infants, 67 
Diet (See also food; foods) 
, faulty (See Hindhede, 
McCarrison) 
, faulty, diseases due to, 
99 (See Hindhede, McCarri- 
son, Germany, blockade of) 
■, for person overweight, 
86 
, for person under- 
weight, 88 
, in digestive disorders, 
122 
, in some common dis- 
eases, 137, 151 
, lacto-vegetarian diet, 
80 
, normal, 58 
, type of, in Germany, 
during war, 112 
Dietrich, 65, 74 INDEX 
199 
Digestion products, formed in 
digestive tube, 189 
Digestive tube, 156, 161 
, function of, 157, 159 
Dinner, for normal person, 58 
■, for person overweight, 
86 
s for person under- 
weight, 88 
Donaldson, 96, 98 
Doyle, 63 
Dried milk, 36 
Duct, 164, 167 
Ductless glands (See gla/nds, 
ductless) 
Duodenum, 163, 182 
Eczema, 149 
, diet in, 149 
Egg yolk, rich in iron, 23 
, rich in phosphorus, 26 
Eggs, 42-44 
, cold-storage, 43 
■, digestibility of, 42 
■, white and brown, 44 
Einhorn, 134 
Enema, in constipation, 93 
Entero-kinase, an enzyme in 
the small intestine, 185 
Enzymes, 165, 168-174 
, proof of existence of, 
171 
Epiglottis, 174 
Epsom salts, in constipation, 94 
Eskimo, food of, 77 
Esophagus, 161 
Evaporated milk, 35 
Fales, 74 
Fats, value of, as food, 8, 17 
Fehling’s solution, a test for 
sugar, 172 
Ferguson, 115, 120 
Ferments (See enzymes) 
Fevers, 137 
<—, diet in, 137 
Fischer, 146, 154, 193 
Fish, 47-48 
, substitute for meat, 47 
Fishbevn, 73, 156 
Fisher, 89, 97, 102, 119 
Fisk, 89 
Fitch, 153 
Food (See also diet) 
, composition of, 7, 11 
, fate of, after leaving 
small intestine, 191 
, for children, 70-73 
, for infants, 68-70 
, in Denmark during the 
war, 16 
• •, in Germany during the 
war, 112 
, in mouth, 164 
, in stomach, 180 
Foods, “natural,” versus “arti- 
ficial” foods, 107 
, nature’s, advantages of, 
108, 109 
, some common, 32 
, unsophisticated, 110 
Forbes, 25 
Foster, 192 
Fowler, 73 
Frank, 78, 81 
Friedenwald, 153 
Fruit, 49, 101 
Funk, 26, 171 
Gaither, 135, 136 
Gall bladder, 161 
Gall-stones, 133 (See also jaun- 
dice) 
Gastric juice, functions of, 181 
, secreted by stomach, 
178 
Gautier, 80 
Germany, food in, during war, 
112 
Gibbon, 115, 120 
Gies, 79 
Glands, 167, 168 200 
INDEX 
Glands, ductless, 187 
Glauber’s salt, in constipation, 
94 
Ooldberger, 119 
Gouraud, 56, 81 
Gout, 45, 144 (See also urio 
acid) 
, diet in, 144, 145 
, possible connection of, 
with eating of meat, 105 
Grant, 136 
Grulee, 67, 73 
Gullet (See esophagus) 
Hall, 153 
Halliburton, 193 
Hammarsten, 193 
Hardening of the arteries (See 
arteriosclerosis\) 
Harrow, 29, 31, 117, 121, 167, 
171, 187 
Hawk, 56 
Head, 159 
Heart, 161 
Hindhede, 9, 13-20, 30, 31, 44, 
75, 81, 89, 100-107, 119 
Hoffman, 143 
Holly, 154 
Holt, 4, 10, 30, 73, 74, 150 
Hoover, 6, 32 
Hoover commission, 4 
Hormone, 187 
Horsley, 135 
Howe, 30, 56 
Howell, 193 
Hunt, 97 
Hunzas, a fine race physically, 
108-110 
Hutchinson, 153 
Huxley, 192 
Hydrochloric acid, functions of, 
in stomach, 125, 178, 180 
Hyperacidity, 123 
, cause of, 123 
, diet in, 124 
Hypoacidity, 125 
Hypoacidity, cause of, 125 
, diet in, 125 
Ice cream, 39 
Ileum, 163 
Infant feeding, 65 
Infants, suffering of, in war 
area, 115 
Insulin, a possible cure in dia- 
betes, 140 
Intestinal diseases, lack of, 
among people living on “na- 
ture’s foods,” 109 
Intestine (See large intestine; 
small intestine) 
Iodine, importance of, 26 
Iron (See also anemia) 
, foods rich in, 23 
, importance of, 21, 22 
Japanese, diet of, 9, 75 (See 
also beriberi) 
Jaundice, 133 
, symptoms, 133 
, treatment, 133 
Jejunum, 163 
Joly, 129 
Joslin, 86, 141, 143, 154 
Junket, 41 
Kahn, 78 
Kellogg, 73, 89, 91, 97, 126, 
128, 153 
Kidney, 161 
Koch, 138, 181 
Kohman, 120 
Kopeloff, 95, 98 
Lacto-vegetarian diet, 80 
Lane, 97 
Large intestine, 161, 190 
, function of, 190 
Lassen, 155 
Lavoisier, 1, 2, 3, 29 
Laxatives, danger of, 93, 
94 INDEX 
201 
Leach, 56 
Lieberkiihn, glands of, in small 
intestine, 184 
Liebig’s beef extract, 46 
Life cycle, 156 
Limbs, 159 
Lindsay, 154 
Lipase, 186 
Lipoids, and phosphorus, 25, 42 
Liver, 161, 188 
, functions of, 188 
Lodge, 63 
Luciani, 193 
Luncheon, for normal person, 
58 
, for persons overweight, 
86 
, for persons under- 
weight, 88 
Lung, 161 
Lusk, 29, 79, 113, 120 
Lutz, 96, 98 
Lyman, 89, 97 
MacCarthy, 128 
Macleod, 140, 193 
McCarrison, 107-112, 119 
McCollum, 60, 61, 64, 78, 79, 
80, 81, 120 
Marat, 2 
Marsh, 154 
Mason, 30, 56 
Mayo brothers, 130 
Mayo, C. H., 136 
Mayo, W. J., 135 
Mead, 143 
Meals, planning of, 57 
Meat, 44-47 
• , canned, 46 
, eating and brain de- 
velopment, 106 
—, not absolutely essen- 
tial, 44 
■ , possible harmful effects 
of excessive, 45, 102, 104, 
105, 128 
Mendel, 9, 30, 79, 80, 100 
Metolmikoff, 36 
Mettemioh, 63 
Miles, 120 
Milk, 32 (See also butter-milk, 
evaporated milk, dried milk, 
sour milk, Metchnikoff) 
, composition of, 36 
■, from various animals, 
38 
, grades of, 35 
, importance of, 16, 24, 
32-38 
, lack of, in Vienna, 32 
, mother’s, for infant, 65 
, pasteurized, 34 
, preservatives in, 34 
, vitamines in, 33 
Mineral oil, in constipation, 
93 
Mineral salts, value of, as food, 
20 
Mineral waters, 54-55 
, and “cures,” 54 
Mixed feeding, for infant, 68 
Monkeys, susceptibility of, to 
“poor” food, 111 
Morse, 73 
Mother, nursing, food for, 61- 
64 
Mouth, 164 
, food in, 164 
Moynihan, 135 
Mucin, a substance in saliva, 
168 
Mueller, 120 
Muriatic acid (See hydrochloric 
acid) 
Napoleon, 52, 63 
Nem, a new food unit, 4 (See 
also Pvrquet) 
Nephritis, 146 
, diet in, 147 
Newburgh, 141, 154 
Nuts, 50 202 
INDEX 
Obesity, and diabetes, 86, 
143 
O’Keefe, 120, 150, 154 
Old age, Metchnikoff’s theory 
of, 36 
Osborne, 0. T., 73, 148, 156 
Osborne, T. B., 9, 30, 100 
Osier, 135, 156 
Overweight, 82 
, reduction of, 83-86 
Owen, 136 
Pancreas, 161, 186 
Panum, 13, 14 
Pasteur, 52 
Pavlow, 193 
Pellagra, 119 
Pepsin, an enzyme of the gas- 
tric juice, 178 
Pepsin-hydrochloric acid, func- 
tion of, 179 
Pericardium, 161 
Peristaltic action, 174 
Pharynx, 174 
Phosphorus, 25 (See also lip- 
oids; rickets) 
• , foods rich in, 25 
, importance of, 21, 25 
Pierce, 193 
Pwquet, 4, 5, 6 
Pirquet system of feeding, 5 
(See also nem) 
Pituitary, 167 
Polyneuritis, a birds’ disease, 
170 
Potting er, 155 
Protein, high, diet, 11 
, low, diet, 12, 13, 17, 
100 
—, vahie of, 10, 45 
Proteins, animal, superior to 
vegetable proteins, 101 
Ptyalin, the enzyme in saliva, 
168, 172 
Purgatives, danger of, 93 
Purines, in meat, 45 
Rectum, 164 
Rennet (See rennin) 
Rennin, 178 
, in cheese manufacture, 
41 
Rettger, 37, 95, 98 
Rickets, 25, 117 
Ritchie, 193 
Robertson, 193 
Rochelle salt, in constipation, 
94 
Rolleston, 136 
Rose, 60 
Roth, 120 
Rubner, 4, 112, 113, 116, 120 
Rubrah, 153 
Russell, 133, 134 
Saliva, 167 
Scurvy, 28, 118 (See also vita- 
mines) 
, a disease due to lack of 
a vitamine, 118 
, cured with orange 
juice, 28 
Secretin, 187 
Shell fish, 47 
Sherman, 21, 23, 50, 56 
Simmonds, 60 
Sippy, 126, 135 
Small intestine, 161, 184 
, digestion in, 181, 182, 
188 
Smith, 120 
Sour milk, 36 
Sphincter, 180 
Spleen, 161 
Starling, 186, 194 
Steumrt, 193 
Stiles, 193 
Stomach, 161, 176 
Sugar, 50 
Sutherland, 153 
Sutton, 136 
Swallowing, process of, 174 
Sweetbread (See pancreas) INDEX 
203 
Talbot, 73 
Thorax (See chest) 
Thyroid, 167 
, iodine in, 26 
Tomato, rich in vitamines, 49 
Trudeau, 139 
Trunk, 159 
Trypsin, 186 
Tuberculin, in treatment of tu- 
berculosis, 138 
Tuberculosis, 138 
, diet in, 139 
Ulcer, 126 
•, cause of, 127 
, diet in cases of, 127 
, treatment of, 127 
Undernutrition, effect of, 
113 
XJnderhill, 94, 97 
Underweight, 87 
Uric acid, 45, 105, 144 (See 
also gout) 
Uvula, 174 
van Noorden, 144 
van Slyke, L. L., 36 
Vaughan, 79, 135 
Vegetables, 49, 101 
Vegetarian diet, advantages of 
partial, 79 (See also lacto- 
vegetarian diet) 
Vegetarianism, 75 
Vegetarianism, disadvantages 
of strict, 78 
Vienna, undernutrition in, 115 
Vitamines, 26 (See also beri- 
beri, scurvy, xerophthalmia) 
, commercial prepara- 
tions, 27, 28 
, diseases due to lack of, 
117 
■, proof for existence of, 
170 
Voit, 30 
Vomiting, in infants, 67 
Walker, 148 
War edema, 114 
Water, importance of, 28 
Watson, 153 
Wheat, 48 
Wilder, 154 
Wiley, 56 
Williams, 104 
Winton, 56 
Wood, 120 
Xerophthalmia, a vitamine de- 
ficiency disease, 118 
Yeast, a cure for beriberi, 118 
(See also vitamines) 
preparations, and vita- 
mines, 28 
tablets, 27