The New Dietetics 
A Guide to Scientific Feeding 
in Health and Disease 
By JOHN HARVEY KELLOGG 
M. D.. LL. D., F. A.’t. S. 
Fellow of the Royal Society of Medicine of Great Britain, of the 
American Medical Association, Member of the American 
Economic Association, and of the National Geographical 
Society, Member of the Societe d' Hygiene of France, 
Late Member of the Michigan State Board of 
Health, Editor of “Good Health," Superin- 
tendent of the Battle Creek Sanitarium, 
President of Battle Creek College. 
REVISED EDITION 
THE MODERN MEDICINE PUBLISHING CO. 
Battle Creek, Michigan, U. S. A. 
1923 Copyrighted—All Rights Reserved, 
WASHINGTON, D. C., 1921, 1923 The New Dietetics DEDICATED 
To the memory of my dear wife, 
Ella Eaton Kellogg,, whose faithful 
co-operation during more than forty 
years of continuous effort toward 
dietetic progress and in various other 
activities directed toward race bet- 
terment contributed in a 
measure to whatever of real accom- 
plishment our combined efforts may 
have achieved. 
JOHN HARVEY KELLOGG PREFACE 
Within twenty years a new science of dietetics has been de- 
veloped. As the result of the patient labors of many men, numer- 
ous mysteries have been cleared up, many hoary-headed theories 
have been exploded, and a great flood of light has been thrown 
upon one of the most important questions related to human 
existence. 
It is now possible to say with a considerable degree of cer- 
tainty how much food is needed daily by a man, woman or child 
at rest or at work, and to indicate what particular foodstuffs are 
best suited to meet any dietetic need which may be indicated in 
any condition of health or disease. It is also possible to state 
with reference to every common foodstuff what is its value as a 
source of energy and what are its special dietary properties and 
characteristics. 
In other words, there now exists a real science of dietetics 
based on scientific facts worked out in laboratory researches, veri- 
fied by animal feeding experiments and confirmed by clinical ex- 
perience. Dietetics is no longer the jumbled mass of empirical 
notions of which it largely consisted even so late as two decades 
ago. 
Thanks to the painstaking researches of Pavlov, Rubner, At- 
water, Benedict, Chittenden, Mendel, Osborne, McCollum and 
other investigators perhaps equally worthy of mention, we now 
possess knowledge instead of assumptions, facts instead of fancies, 
scientific standards in place of empirical though time-honored 
notions and sanctions. 
There is perhaps no place in the world where the successive 
steps of scientific progress in the knowledge of nutrition and 
dietetics have been watched with greater care and interest than 
at the Battle Creek Sanitarium. For more than forty years this 
institution has been a great clinical laboratory in which an intensive 
study of foodstuffs and of their effects upon the human body has 
been continuously carried on by the writer and his associates. 
As new discoveries have been made in the nutrition laboratories of 
this country and Europe, the results have been carefully scrutin- 
ized and tested in actual clinical practice. It is not claimed that 
complete knowledge has yet been attained. There is still much to 
be learned about human nutrition, and the rapid progress which is 
being made in these days affords good foundation for the hope 
5 6 
PREFACE 
that the advances within the next few years will be fully equal 
to those made in the past. 
In the preparation of this work the author has made use of 
all available, well attested facts to be found in the authoritative 
works on human nutrition, and has added thereto the results of 
nearly a half century’s careful study of the subject, theoretically, 
clinically and experimentally. As editor of “Good Health” since 
1873 and Medical Director of the Battle Creek Sanitarium since 
1876, the writer has been in constant contact with men and women 
enquiring the way to health, and has devoted his life in a large 
measure to finding the correct answers to the questions, What is 
the biologic way in eating? How may each particular foodstuff 
be best utilized as a means of promoting the cure of disease? and 
similar queries. 
So far as the writer knows, this is the first work in which full 
recognition has been accorded the important discoveries of 
Bouchard, Metchnikoff, Tissier, and others in relation to the in- 
fluence of diet upon the intestinal flora through the effect upon the 
food residues which form the nutrient media for the various 
organisms, benign and pernicious, which by various means find 
their way into the human alimentary canal. 
In this work a conscientious attempt has been made to set 
forth only such recommendations as have a solid basis of phy- 
siologic fact verified by actual practical experience. 
The constant aim of the author has been to present the 
known facts relating to human nutrition in such a way as to be of 
greatest service to the physician, the trained nurse, the intelligent 
housewife, and to every student of nutrition, as well as to the 
professional dietitian. To this end numerous tables have been 
prepared by the use of which the dietary may be balanced not 
only for protein, fats and carbohydrates, but also for cellulose, 
lime and iron, and even acids and bases. These tables are based upon 
the data supplied by the tables of Atwater, Bunge, Gautier, Konig, 
and Sherman. They have been in constant use at the Battle Creek 
Sanitarium and elsewhere for several years. 
The writer especially desired to acknowledge his indebtedness 
to a large number of colleagues and assistants who during the last 
forty-five years have co-operated in his efforts to solve dietetic 
problems of various sorts, the solution of some of which have re- 
sulted in the production of some of the most popular of the present 
day breakfast foods. First of all I am indebted to my dear wife, PREFACE 
7 
Mrs. E. E. Kellogg, recently deceased, for most faithful co-opera- 
tion during many years in the experimental work which resulted 
in the establishment of the dietary system of the Battle Creek 
Sanitarium. 
To Miss Lenna Cooper, Dean of the Battle Creek Sanitarium 
School of Home Economics, I am indebted for great assistance in 
perfecting and systematizing the dietary methods and improving 
the cuisine upon which the practical suggestions of this book are 
based. 
To Professor Irving Fisher is due credit for first proposing 
the plan of “food portions” consisting of quantities of food 
representing 100 calories of energy or a simple fraction of this 
amount. 
To my sister, Mrs. Clara K. Butler, and to Miss Gertrude 
Estill, I am very greatly indebted for most efficient and indis- 
pensable assistance extending over many months in compiling a 
great mass of notes and memoranda accumulated during many 
years, and painstaking supervision of copy and proof sheets while 
going through the press. 
I desire, also, to express my appreciation of the courtesy of 
Robert Smith, Ph. D., of the Sheffield Scientific School of Yale 
University, in giving the proof sheets of the work a careful 
reading. 
Finally, in presenting this work to the public as the result of 
a life time study of dietetics from the standpoint of a physician 
and a believer in Nature as the wisest of all teachers, the writer 
desires to ask the reader’s consideration of the fact that however 
widely the ideas and methods herein presented may differ from 
those current in popular and professional usage, they cannot be 
justly looked upon as simply theoretical or experimental, since 
they are in daily and successful practical use in a large institution, 
in the development of which during the last forty-five years they 
are believed to have been the most important factor. However 
novel the methods presented may seem to some readers, they are 
by no means new; they are based upon biologic principles which 
are as old as the human race and only need a fair trial to demon- 
strate their value. That the candid reader will accord the views 
presented the test of actual practical experience with open minded- 
ness and in the spirit of scientific inquiry, is the earnest hope of 
the writer. 
January, 1922. 
John Harvey Kellogg. 8 
PREFACE 
PREFACE TO THE SECOND EDITION 
That a second edition of this work is called for within 15 
months of the publication of a good sized first edition is gratifying 
evidence to the author that the work is appreciated and that it is 
meeting a recognized need. 
It is encouraging to note that the prominence given to the 
antitoxic diet and changing the intestinal flora in the first edition 
has been so fully justified by the developments of the last two 
years that the stress laid upon these most important of all dietetic 
measures need be in no degree lessened. The importance of 
changing the intestinal flora is now almost universally recognized 
by leading clinicians, and the methods pointed out in this book for 
changing the flora and maintaining a normal intestinal flora have 
become so thoroughly established by scientific research and ex- 
tended clinical observation that their value is not questioned by 
any reputable authority. 
The writer desires to express his appreciation of the many 
friendly criticisms and valuable suggestions which have been of- 
fered by various friends, and especially for suggestions by Helen 
S. Mitchell, Ph. D. (Yale), Director of the Nutrition Laboratory 
of the Battle Creek Sanitarium and Professor of Nutrition in 
Battle Creek College. The author desires also to make amends for 
an oversight in the first edition by acknowledging his obligations 
to Dr. E. S. Risley for conducting several laborious chemical in- 
quiries which furnished the data for tables VIII and IX, to Dr. 
Paul Roth for original data pertaining to metabolism, and to Dr. 
Welcome Lewis for original data used in tables showing the lime 
and iron content of various foodstuffs: 
September, 1923. 
J, H. K. Table of Contents 
FOODS 
Food as Fuel—The Chemical Composition of the Body— 
Differences in the Composition of the Body in Infants and 
Adults—The Source of Food. 
Food Principles 30-38 
Proteins—Complete Proteins—A Poisonous Nucleus in Pro- 
teins—Anaphylaxis—Carbohydrates—Fats—Food Salts—Vi- 
tamins—Cellulose. 
THE DIGESTIVE PROCESSES 
Mouth Digestion—The Saliva—Conditions Which Hinder 
Salivary Activity—'Protective Properties of the Saliva— 
The Saliva in Disease—Regulating Influence of the Sense 
of Taste—'Gastric Digestion—The Gastric Juice—Appetite 
Juice—The Chemical Juice—The Gastric Acid—Hyper- 
acidity—'Pepsin—Lipase—'Functions of the Hydrochloric 
Acid of the Gastric Juice—Bitters Do Not Increase the 
Secretion of Gastric Juice—Excessive Secretion of Water 
by the Stomach—Digestion in the Small Intestine—The 
Pancreatic Juice—The Intestinal Juice—The Bile—Intes- 
tinal Absorption and Excretion—Transportation of the 
Food—Swallowing—Movements of the Stomach—Passage 
of Foods from the Stomach—The Effects of Heat and 
Cold—The Movements of the Small Intestine—The Move- 
ments of the Colon—The Nerves of the Alimentary Canal 
—The Normal Intestinal Rhythm. 
The Liver 74-77 
The Liver Aids Digestion—The Liver Stores Food Sup- 
plies—The Liver Stores Metallic Poisons—The Liver 
Probably Detoxicates Organic Poisons—The Liver Makes 
Ferments and Hormones—The Liver Makes Bile. 
Mastication 78-89 
Spallianzani’s Discoveries About Mastication — Horace 
Fletcher’s Discoveries—Special Indications for Thorough 
Mastication—'When the Food Should Be Little Chewed— 
Horace Fletcher’s Fatal Mistake. 
Hunger 90-98 
Appetite—Satiety—Nausea—Hunger in Infants—The Hun- 
ger of Starvation—Hunger During Sleep—'Mental and 
Nervous Influence on Hunger—Absence of Hunger—Ab- 
sence of Hunger in Disease—Increase of Hunger in 
Disease—Modifications of Hunger—Bitters—Thirst—Air 
Hunger. 
9 10 
TABLE OF CONTENTS 
METABOLISM 
The Energy of Food—The Calory 99-120 
The Energy Output of the Body and the Work Equivalent 
of Food—Vital Work)—Metabolism—Metabolism During 
Rest—The Source of Animal Heat—Metabolism and Men- 
tal Work—Metabolism and Muscular Work—Energy Ex- 
penditure in Work of Various Sorts—Energy Output and 
Food Requirement of Persons Engaged in Different Occu- 
pations—The Energy Expended in Housework—The Rela- 
tion of Work to Total Food Requirement—The Rate of 
Growth—Food Requirements by Men, Women and Children 
—'Changes Which Take Place in the Body in Old Age—The 
Quantity of Food Required in Old Age—Physique and Diet 
—Diet and Metabolism—Diet and Development—The High 
Protein Ration. 
THE PHYSIOLOGY OF EATING 
The Protein Ration 124-140 
The Chittenden Protein Standard—Luxus Consumption of 
Protein—Effects of Protein Intake Upon the Urine—A 
High Protein Diet Increases Intestinal Putrefaction—Com- 
plete Proteins—The Normal Protein Requirement—Advan- 
tages of a Low Protein Ration. 
Fats 141-144 
Ghee—Vegetable Fats—Kernel Oils. 
Carbohydrates—Starches and Sugars 145-159 
The Digestibility of Raw Starch—Sugars—Dates vs. Cane 
Sugar—Substitutes for Sugar—The Nation’s Candy Bill— 
Honey—(Some Odd Sugars—The Consumption of Sugar 
Should be Reduced. 
Food Salts 160-191 
The Iron Ration—The Daily Requirement of Iron—Where 
to Find the Necessary Food Iron—The Iron Content of 
Foodstuffs—To Determine the Iron Content of a Ration or 
a Dietary by the Use of the Table—Foods Rich in Iron— 
The Lime Ration—The Daily Loss of Lime—Food Lime 
Is Necessary for Plants as well as Animals—The Influence 
of Lime on Egg Production—The Lime Content of Foods—• 
Foods Deficient in Lime—Acids and Bases of Foods—The 
Reaction Balance. 
Vitamins 192-210 
What the Lack of Vitamins Does—The Antiscorbutic Vita- 
min—The Antineuritic or Anti-beri-beri Vitamin—Yeast 
Extract Very Rich in Vitamins—The Fat-soluble Vitamin 
—How Vitamins Are Destroyed. TABLE OF CONTENTS 
11 
Cellulose 211-222 
Bran—Bran Does Not Irritate—Agar-Agar—Manyalla— 
The Laxative Effects of Clay. 
The Acids of Foods 223-235 
Tartaric Acid—Malic Acid—Citric Acid—Phytic Acid- 
Unwholesome Acids—Acetic Acid—Oxalic Acid—Tannic 
Acid—Benzoic Acid—-Butyric Acid—Lactic Acid—Uric Acid 
—The Toxic Effects of Uric Acid—Normal Food Acids do 
not Acidify the Blood and Tissues. 
WHOLESOME FOODS 
Calorie Values of Foods—Method of Converting Percent- 
ages in Food Composition Into Calories Per Ounce— 
Changes in Foods Produced by Cookery—Raw Food Diet. 
Cereals 246-274 
The Protein of Cereals—The Iron Content of Cereals and 
Breads—The Lime Content of Cereals—Breads are Deficient 
in Lime—Wheat—Analysis of Wheat and the Products of 
Roller Milling—Bread Making—Baking Powders—'Wheat 
Bran—How to Use Bran—The Anti-Graham Campaign— 
Corn—Cornmeal—Cornmeal Mush and Milk—‘Corn Oil— 
White and Yellow Corn—Grits—Corn Starch—Corn Syrup 
—Pop Corn—iGreen Sweet Corn—Toasted Corn Flakes— 
Gofio—Oats—'Rice—Polished Rice—Barley—Pearl Barley— 
Rye—Millet—Quinoa—Kaoling—Buckwheat—‘Breakfast Ce- 
reals—Ready-to-Eat Breakfast Foods—Toasted Cereal 
Flakes—Sesame Seed Meal. 
Vegetables 275-286 
Uncooked Vegetables—Roots and Tubers—Root Starches— 
The Iron Content of Vegetables—The Lime Content of 
Vegetables—The White Potato—Potato Poisoning—Potato 
Cookery—The Sweet Potato—The Dasheen—The Taro— 
Sago—The Cassava—Tapioca—‘The Yautia—The Onion— 
The Garlic—The Leek—Lily Bulbs—(The Water Chestnut. 
Green Vegetables 287-302 
The Cabbage—Sauerkraut—Brussels Sprouts—Cauliflower— 
Broccoli—Seakale—The Pai ts’ai or Chinese Cabbage—Palm 
Cabbage—Celery—Lettuce—Asparagus — Endive — White 
Chicory—Okra—The Artichoke—Iceland Moss—Irish Moss 
—Agar-Agar—Mushrooms—The Agave—Greens—Greens as 
Roughage—The Lime Content of Greens—Botulism from 
Canned Spinach—Salads. 
Root Vegetables . .303-306 
The Beet—The Parsnip—The Carrot—The Turnip—Salsify 
—Vegetable Oyster—The Radish—The Horse Radish— 
Kohl-rabi (Turnip Cabbage)—The Jerusalem Artichoke— 
Celeriac. 12 
TABLE OF CONTENTS 
Vegetable or Garden Fruits 307-309 
The Tomato—Vitamins in Tomato Juice—The Cucumber— 
The Eggplant—The Watermelon—The Muskmelon—The 
Squash and Vegetable Marrow—The Pumpkin—The Chay- 
ote. $ + 
Legumes 310-322 
Digestibility of Legumes—Alkalies to be Avoided—The Iron 
Content of Legumes—The Lime Content of Legumes— 
Beans—The Mung Bean—The Adsuki Bean—'String Beans 
—:Shelled Beans—Succotash—The Soy Bean—'Composition 
of the Soy Bean—Soy Bean Milk—To Fu—Soy Sauce- 
Soy Bean Sprouts—The Pea—Green Peas—Lentils—Dried 
Vegetables. 
Fruits 323-360 
Fruit Acids—Disinfection of Fruits—Fruit Seeds—The 
Fruit Diet—The Germicidal Properties of Fruits—The Iron 
Content of Fruits—The Lime Content of Fruits—The 
Ripening Process in Fruits—Arsenic in Fruits—The Apple 
—Apple Juice—The Pear—The Quince—The Peach— 
—Prunes and Plums—The Cherry—The Persimmon—The 
Olive—The Grape—'Grape Juice—The Composition of 
Grape Juice—Berries—The Strawberry—The Currant and 
the Gooseberry—The Cranberry—The Huckleberry or Blue- 
berry—The Blackberry and Loganberry—The Raspberry— 
The Mulberry—Wild Berries—Citrus Frtiits—The Orange 
—The Lemon—The Lime—Tropical Fruits—The Banana— 
Banana Flour—'Banana Figs'—The Fig—The Date—The 
Guava—The Mango—The Pawpaw—The Papaw—The 
Pineapple—The Pomegranate—The Avocado, or Alligator 
Pear—The Karob—Dried Fruits—Canned Fruits—Fruit 
Juices. 
Nuts 361-379 
The Lime Content of Nuts—The Iron Content of Nuts— 
The Vitamins of Nuts—The Almond—Almond Milk—The 
Hickory Nut—The Pecan—The Walnut—The English Wal- 
nut—The Butternut—The Pine Nut—The Chestnut—The 
Chinquapin—-Filberts, Cob Nuts, and Hazelnuts—The Beech- 
nut—The Acorn—'Composition of the Acorn—The Ground 
Nut—The Brazil Nut—The Paradise Nut—The Coconut— 
Coconut Butter—The Cashew Nut—The Peanut—Peanut 
Butter—Flour from the Peanut—Peanut Milk—Malted 
Nuts—Nut Meats—Protose—The Litchi or Chinese Hazel- 
nut—Nut Meals. 
Animal Foods 380-467 
Special Characteristics of Animal Foods—Meats—The Iron 
of Meats—The Lime Content of Animal Foods—Beef— 
Mutton—Goat—-Venison—Pork—Fowls—Fish—Sea Foods— 
Oysters—Meat Extractives—The Poisons of Meat—Viscera 
Highly Objectionable—High Meats—Putrefaction Products 
in Meat—The Bacteria of Meat—Acidosis from a Flesh TABLE OF CONTENTS 
13 
Diet—Effect of Flesh Eating on Animals—Pernicious Ef- 
fects of a Meat Diet Experimentally Proven—Parasites of 
Meat—‘Flesh Meat Not Essential—Raw Beef not an Anti- 
scorbutic-Special Contraindications of Flesh Foods—Eggs 
—Egg Yolk—Egg White—The Cooking of Eggs—Influence 
of Food on Eggs—Eggs and Biliousness—The Food Iron of 
Eggs—The Lime Content of Eggs—Egg Substitutes—Pre- 
served Eggs—Bad Eggs—Candling of Eggs—Egg Poison- 
ing—When Eggs Should Not Be Eaten—Milk—Why Milk 
Sours While Meat Putrefies—The Special Value of Milk 
Proteins—Milk Rich in Vitamins—Influence of Food of 
the Cow Upon the Vitamins of Milk—Milk Rich in Salts— 
The Lime Content of Milk and Cheese—The Iron Content of 
Milk—Dried Milk—Cream—'Butter—Butter Color—Cheese 
—Cheese Bacteria—Skimmed Milk—Canned Milk—Butter- 
milk—Whey—Modified Milk—Milk Must be Clean—iSour 
Milk—Bitter Milk—Slimy and Colored Milk—Bacteria on 
Milk Bottles—Infections Due to Unclean Milk—Infected 
Miik a Cause of Tuberculosis—Injurious Effects of Ster- 
ilizing or Pasteurizing of Milk—Buddized Milk—Certified 
Miik—A Person May Be Sensitized to Milk—Medical Uses 
of Milk—How to Eat Milk—Milk a Cheap Food—Infant 
Foods. 
Condiments 468-482 
The Use of Condiments as Preservatives—The Taste for 
Condiments Unnatural—Chloride of Sodium—Common Salt 
—Salt Hunger—Poisonous Effects from Salt—Bright’s Dis- 
ease Due to the Excessive Use of Salt—The Salt-Free Diet 
—Borax versus Salt. 
Tea and Coffee 483-496 
Tea and Coffee are Poisonous Drugs—'Chronic Caffein Poi- 
soning-Coffee Raises Blood-Pressure—Tea, Coffee, and 
Uric Acid—Coffee Cripples the Liver—Other Coffee Poi- 
sons—Some Poisonous Effects of Tea and Coffee—Tea and 
Coffee Neurasthenia—Coffee Insomnia—Tea and Indiges- 
tion Decaffeined Coffee (Kaffee Hag)—Mate—Cocoa 
Drinks—Caffein the Cause of Goiter—Soda Fountain 
Drinks Containing Caffein Coffee Substitutes. 
Tcba co . 437- 39 
The Effects of Tobacco—Tobacco a Heart Poison. 
Poisoned Foods 500-516 
Food Toxins—Hamburger Steak—Moldy Meat-—Poisons in 
the Flesh or Mi k of Sick or Overworked Animals—Milk 
from Tuberculous Cows Poisonous—Poison in Clams—Ty- 
phoid from Oysters—Poisonous Ice Cream—Cheese Bacteria 
—Cheese Poisoning—Poisons in Plant Foods—The Poisons 
of Molds—Lathyrism—Ergotism—Actinomycosis—Infected 
Vegetables—The Germs of Fruit Skins—Infection from 
Flies—Botulism—'Parasitic Infection of Foods—Adulterated 
Foods—Benzoate of Soda—Toxicity of Certain Foodstuffs— 
Keeping the Soil Clean. 14 
TABLE OF CONTENTS 
Water Drinking 517-523 
Tests for the Purity of Water—Reagents Necessary for 
Qualitative Examination of Water—Mineral Waters—Dis- 
tilled Water—Purification of Water with Chlorin. 
MEDICAL DIETETICS 
Common Dietetic Errors—Overeating—Underfeeding—De- 
ficiency Diet—Irregular Meals—Hasty Eating—Drinking at 
Meals—Bad Food Combinations—Highly Seasoned Foods— 
The Use of Condiments—Insipid Foods—A Monotonous 
Diet—Indigestible Foods—'Cold Foods—Hot Foods—Eating 
When Exhausted—Misinformation and Pseudo-Scientific 
Teaching. 
Intestinal Toxemia—Autointoxication 538-547 
Poisons Produced by Putrefactions in the Colon—Intestinal 
Antiseptics Harmful—'Thyroid Extract in Intestinal Toxe- 
mia—Gastric Toxicity. 
Scientific Tests of the Nutritive Functions 548-571 
Examination of the Mouth—Significance of the Coated 
Tongue—The Teeth—The Saliva—Tests for Gastric Diges- 
tion—The Test Breakfast—The Fractional Test Meal— 
Ewald’s Test Dinner—Reigel’s Test Dinner—Klemerer’s 
Test Meal—Von Leube’s Gastric Motor Meal—The Water 
Meal—Test for the Chemical Secretion—Test for the Psy- 
chic Secretion-—Test for the Condition of the Gastric 
Glands—Capsule Test for Gastric Activity—The Barium 
Meal—The Motility Test—Examination of the Gall Bladder 
—-Examination of the Stools—Bacteriological Examination 
of the Stools—The Blood—Chemical Examination of the 
Blood—The Urine—Tests of the Urine—Collection of the 
Specimen—Metabolism Tests—Tests for Acidosis—The 
Body Weight—Strength Tests—Tests of Heart and Circu- 
lation. 
Regimens and Dietaries 572-670 
All Dietaries Must Supply Lime, Iron and Vitamins—The 
Fruit Regimen—How Fruits Differ—The Daily Routine— 
The Green Regimen—When the Tongue Remains Coated— 
Disorders in Which the Fruit Regimen is Indicated—The 
Milk Regimen—Technic of the Milk Regimen—Amount of 
Milk to be Taken—How the “Milk Regimen” Differs from 
the “Milk Diet”—Practical Suggestions—Results of the 
Milk Regimen—Supplementary Feeding—Method of Chang- 
ing the Intestinal Flora—Why the Intestinal Flora Needs 
to be Changed—The Low Protein Diet—Increased Intes- 
tinal Activity—The Displacement of Harmful, Putrefactive 
Bacteria by Harmless, Acid-forming Organisms—Change of 
the Intestinal Flora Without the Use of Cultures—Quantity 
of Lacto-Dextrin Required—The Best Time for Taking 
Lacto-Dextrin—To Keep the Flora Changed—When Is the 
Intestinal Flora Changed ?—Diseases in Which the Intestinal TABLE OF CONTENTS 
15 
Flora Must Be Changed—The Antitoxic Diet—The Low 
Protein Diet—Protein-Free Diet—Fever Diet—The Laxa- 
tive Diet—Bran—When the Laxative Diet Is Indicated— 
Tissue-Building or Fattening Regimen—The Restorative 
Regimen—The Fasting Regimen—The Fasting Body Feeds 
upon Itself—Loss of Weight During Fasting—Objections to 
Fasting—Safe and Scientific Fasting—Reducing Diet—The 
Bland or Non-Laxative Diet—Carbohydrate-Free Diet— 
Fat-Free Diet—Dry Diet—The Potato Regimen—Fresh or 
Raw Diet—Rectal Feeding—Intravenous Feeding—Water 
Drinking—Hot Water Drinking—Lavage of the Blood and 
Tissues—Gavage. 
Diet in Disorders of the Digestive Organs 671-755 
Reverse Peristalsis the New Explanation for Many of the 
Symptoms of Indigestion:—Nausea—A Sense of Ful- 
ness—Lack of Appetite—Belching—Vomiting—Globus- 
Biliousness—Coated Tongue and Foul Breath—Diet 
in Constipation—Use of the Enema—Rules for the 
Care of the Colon to Combat Constipation—The Elimina- 
tion of Disease Germs from the Alimentary Tract—Diet in 
Chronic Colitis—Acute Colitis—Dysentery—Diet in Hyper- 
chlorhydria or Hyperacidity—Influences Which Lessen the 
Secretion of Hydrochloric Acid—Gastric and Duodenal 
Ulcer—Peptic Ulcer—Dietetic Treatment in Cases of Gas- 
tric and Duodenal Ulcer—The Gluten Feeding Method— 
Lenhartz’s Method—The Von Leube Diet—The Alkaline 
Treatment—Gastric Acidity Due to Organic Acids—Gastric 
Atony—Diet for Hypochlorhydria and Achylia—Pepsin of 
Little Value—Bitters Do Not Stimulate the Stomach— 
Special Dangers in Achylia—Acute Dilation of the Stom- 
ach—Merycism—Aerophagia—Cyclic Vomiting—Hiccough 
or Singultus—Acute Gastro-Enteric Infection—Stomatitis— 
Urticaria—Neuroses of the Stomach—Nervous Dyspepsia— 
Gastric Catarrh in Children—Diet in Acute Gastritis—Diet 
in Chronic Gastritis—Amylaceous Dyspepsia—Diet for 
Decay of the Teeth—Diet in Intestinal Obstruction—Diet 
for Ulceration of the Colon—Diet in Hirschsprung’s Dis- 
ease—Diet for Hemorrhoids—Diet in Appendicitis—Diet in 
Disorders of the Liver—Tests for the Liver Function— 
Diet for Biliousness—Diet for Gall Stones and Gall Blad- 
der Disease—Cirrhosis and Other Degenerations of the 
Liver—Diet in Disease of the Pancreas—Diet in Diarrhea— 
Diet in Acute Diarrhea—Dysentery—Diet in Tropical Dys- 
entery—Diet in Parasitic Disease of the Intestine—Diet in 
Incompetency of the Ileocecal Valve—Atonic Constipation— 
Tapeworm—Diet in Esophageal Stricture. 
Diet in Disorders of Nutrition 756-830 
Diet in Obesity—Intermittent Fasting—Reduction of Weight 
by Exercise—Obesity Due to Endocrine Disturbance—The 
Water Intake—Kar ell’s Method—Oertel’s Method—Von 
Noorden’s Method—iBanting’s Method—The Salisbury 
Method—Diet in Emaciation—Diabetes—The Dietetic 
Treatment of Diabetes—The Fat Allowance in Diabetes— 
The Low Protein Ration Established—The Best Food for 
Diabetics—Foods to be Wholly Avoided by Diabetics—To 16 
TABLE OF CONTENTS 
Remove Starch from Vegetables—List of Foods Showing 
the Quantities of Each in Which Are Found Five Grams of 
Carbohydrates—Foods Grouped According to Carbohydrate 
Content—Insulin—The Pancreatic Hormone—The Use of 
Insulin (Iletin)—A Simple Method of Approximating the 
Proper Ration for a Diabetic Patient—Diabetes and Renal 
Disease—Diabetes in the Aged—Pregnancy with Diabetes— 
Diet in Diabetic Coma—Examination of the Urine—Saccha- 
rine—Recipe for Gluten Bread—Gluten Products—Sugar- 
Free Milk—'Diet in Simple Goiter—Diet in Hyperthyroid- 
ism—Exophthalmic Goiter—Hypothyroidism—Dyspituitari- 
ism—Diet in Addison’s Disease—Uremia—The Anemias— 
Pernicious Anemia—Diet for Acidosis—Infantile Acidosis— 
Post-Operative Acidosis—Sprue—Pellagra—Hodgkin’s Dis- 
ease—Hemophilia—Diet in Scurvy—Purpura—Septicemia— 
Osteomalacia—Anorexia. 
Diet in Joint Diseases 831-838 
Chronic Rheumatism—Osteoarthritis—Rheumatoid Arthritis 
—Acute Polyarthritis—Diet in Acute Rheumatism—Diet in 
So-Called Uric Acid Disorders—Gout. 
Diet in Disease of the Heart and Blood-Vessels—Cardio- 
Vascular-Renal Diseases 839-847 
High Blood Pressure—Apoplexy—Aneurism—Angina Pec- 
toris—Diet in Myocarditis. 
Diet in Nervous Disorders 848-860 
Headache—Mental Disease—Epilepsy—Hysteria—N euras- 
thenia—Sitophobia—Neuralgia—Neuritis—Vagatonia— Diet 
in Seasickness—Carsickness—Myasthenia—Herpes Zoster— 
Myelitis—Tic-Douloureux—Nervousness. 
Diet in Disorders of the Genito-Urinary Organs 861-874 
Diet in Diseases of the Kidneys—Diet in Cases in Which 
One Kidney Has Been Removed—Albuminuria—Oxaluria— 
Diet in Abscess of the Kidney—Gravel and Stone—Pyelitis 
—Inflammation of the Prostate Gland—Diet in Urethritis— 
Gonorrhea—^Cystitis. 
Diet in Diseases of Women 875-878 
Diet During Pregnancy—'Diet of the Lying-in Woman— 
Diet in Eclampsia—Diet in Leucorrhea. 
Dietetic Management of Fevers 879-889 
Foods Which May Be Used in Fevers—Foods to be Avoided 
in Fevers—Acute Infectious Fevers—Whooping Cough— 
Poliomyelitis—Cholera—Typhoid Fever—Typhus Fever— 
Erysipelas—Influenza—Mumps—Pyemia—Tetanus — Pneu- 
monia and Pleurisy—Diet in Asthma. TABLE OF CONTENTS 
17 
Diet in Chronic Infectious Diseases 890-910 
Pulmonary Tuberculosis—The Diet in Intestinal Tuberculo- 
sis—The Diet in Syphilis—Chronic Parasitic Infections— 
Diet in Diseases of the Skin—Eczema—Eczema in Infants 
—Diet in Cancer—Gastric Cancer. 
Diet in Surgical Cases 911-923 
Diet Before Operation—Storing Up Glycogen—Renal Effi- 
ciency—Prophylaxis Against Acidosis—Post-Operative 
Feeding—Feeding After Gastro-Enterostomy, Pylorectomy 
and the Polya Operations—Diet in Post-Operative Perito- 
nitis—Jejunal Feeding—Diet After Operation on the Gall 
Bladder—Diet in Accidents and Emergency Cases—Diet in 
Coma—A Meatless Hospital Dietary. 
Diet in Diseases of the Eye, Ear, Nose and Throat. . . 924-926 
Infant Feeding 927-947 
Feeding Schedule—A Simple Plan for Artificial Feeding of 
Infants—Infant Feeding Program—The Infant Ration— 
Supplementary Feeding—Orange Juice—Purees—Vegetable 
Broths—Malt Sugar—Vitamins—Fats Often a Disturbance 
—Dangerous Foods—Anemic Infants—Vegetable Soups— 
Buttermilk for Infants—Water for Infants—Lime Water— 
Cane Sugar Poisoning—Malt Soup and Scurvy—The Dele- 
terious Effects of Meat Diet for Children—The Infant’s 
Stools—Nursing—Weaning—Mixed Feeding—'Vomiting of 
Infants—Diarrhea in Infants and Cholera Infantum—Py- 
loric Obstruction—Feeding During Fever—Hypersensitive- 
ness of Infants to Certain Foodstuffs—Anaphylaxis. 
Diet of Young Children 948-955 
THE WORLD’S FOODS 
Edible Foods Growing Wild in the United States—Wild 
Foods—Stems or Leaves—'Roots and Tubers—Seeds—Nuts 
—Fruits—Plants Cultivated by the Natives of the New 
World before 1492. 
Making the Bill of Fare 968-1000 
Amount of Food—The Protein—Fats—Carbohydrates— 
Food Salts, Lime and Iron—Vitamins—Cellulose—'Balanc- 
ing the Bill of Fare—Variety—Breakfast—Dinner—Supper 
—'Bill of Fare for Fruit Regimen—Diet List for Fruit Reg- 
imen—Bill of Fare for Antitoxic Diet—Antitoxic Diet List 
—Bill of Fare for Low Protein Diet—Low Protein Diet 
List—Bill of Fare for Protein-Free Diet—Protein-Free 
Diet List—Bill of Fare for Fever—Fever Diet List—Bill 
of Fare for Laxative Diet—Laxative Diet List—Bill of 
Fare for Fattening Diet—Fattening Diet List—Bill of 
Fare for Restorative or Blood-Making Diet—Restorative 
or Blood-Making Diet List—Bill of Fare for Reducing 
Diet—Reducing Diet List—Bill of Fare for Dry Diet— 18 
TABLE OF CONTENTS 
Dry Diet List—Bill of Fare for Fresh or Raw Diet— 
Fresh or Raw Diet List—Bill of Fare for Ulcer Diet— 
Ulcer Diet List—Bill of Fare for Modified Ulcer Diet—Bill 
of Fare for Hypochlorhydria—Diet List for Hypochlorhy- 
dria—Bill of Fare for Achylia Gastrica—Bill of Fare for 
Hyperchlorhydria—Diet List for Hyperchlorhydria—Diet 
List for Achylia—Table of Food Values. 
Index 1001-1021 
TABLES 
Table I. Chemical Composition of the Body 27 
Table II. Table Showing Basal Food Requirement 103 
Table III. Showing Annual Increase in Weight of Boys and 
Girls Ill 
Table IV. Normal Rate of Development in Boys 112 
Table V. Showing Normal Rate of Development in Girls 113 
Table VI. Showing Normal and Deficient Weight for Differ- 
ent Heights in Boys and Girls 114 
Food Requirement of Infants and Young Children.. 118 
Food Requirement of Children and Youth 11? 
Food Requirement of Adults 119 
Table of Heights and Weights of Men 120 
Table of Heights and Weights of Women 120 
Table VII. Showing the Effects of High Protein and Low Pro- 
tein Diets on the Urine 131 
Table VIII. Amount of Intestinal Putrefaction in the Feces 
with Various Diets 134 
Table IX. Showing the Amount of Indol Produced in Equal 
Quantities of Various Foodstuffs 135 
Table X. Comparison of Protein of Nuts with that of Milk.. 138 
Table XI. Showing the Iron Content of Foodstuffs 170 
Table XII. Foods Rich in Iron 176 
Table XIII. The Lime Content of Foodstuffs 185 
Table XIV. Foods Rich in Lime 189 
Table XV. Foods Rich in Both Lime and Iron 189 
Foods Poor in Lime and Iron 190 
Table XVI. Acid and Basic Properties of Foods 191 
Table XVII. Vitamin A 1 205 
Table XVIII. Vitamin B 205 
Table XIX. Vitamin C 206 
Table XX. Vitamin Content of Common Foodstuffs 206 
Table XXI. Showing the Cellulose in Cereals 213 
Table XXII. Showing the Cellulose in Vegetables 213 
Table XXIII. Showing the Cellulose in Fruits 214 
Table XXIV. Oxalic Acid in Various Foodstuffs 230 
Table XXV. Uric Acid in Foods (Hall) 234 
Table XXVI. Percentage of Water in Various Foods before and 
after Cooking 241 
Table XXVII. Gain of Water by Vegetables in Cooking 242 TABLE OF CONTENTS 
19 
Table XXVIII. Composition of Corn Products 261 
Table XXIX. Iron and Lime Content of Greens 301 
Table XXX. Amount of Sugar in Common Fruits 324 
Table XXXI. Showing the Proportions of Acid, Sugar, and Pec- 
tin in Some Common Fruits 324 
Table XXXII. Composition of Fruits 326 
Table XXXIII. Percentage Composition of Dried Fruits 355 
Table XXXIV. Composition of Canned Fruits 357 
Table XXXV. Composition of Fruit Juices 359 
Table XXXVI. Composition of Lime Juices 360 
Table XXXVII. Composition and Edible Parts of Nuts 362 
Table XXXVIII. Showing the Caloric Value of Nuts Compared to 
Milk 367 
Table XXXIX. Composition of Milk and Milk Products 429 
Table XL. Average Composition of Condensed Milks 442 
Table XLI. Composition of the Milk of Animals 462 
Table XLII. Composition of Certain Infant Foods 463 
Digestion Table 464 
Table XLIII. Sodium Chlorid in Foods 479 
Table XLIV. Percentage Composition of Foodstuffs and Energy 
Value (Calories) per Ounce 991 LIST OF ILLUSTRATIONS 
Dr. William Beaumont 44 
Alexis St. Martin 45 
Prof. J. P. Pavlov—Pavlov’s Dogs 46 
Experiment to Demonstrate Appetite Juice—Pavlov’s Pouch 47 
The Alimentary Procession (colored) 72 
The Alimentary Procession (colored) 73 
Starch Granules 146 
Grain of Wheat 147 
Vitamins— Experiments with Pigeons 194 
Vitamins—Experiments with Rats 195 
Changes Due to Rickets—Deficiency of Fat Soluble A .... 202 
Parasites of Meat—Tapeworm 404 
Parasites of Meat—Trichinae 405 
Appearance of Eggs when Candled 426 
The Battle Creek Sanitarium Dairy Barn 427 
Veillon Tube Cultures 562 
Colon Bacteria (colored) 563 
Duodenal Feeding—The Stomach after Gastroenterostomy 
and Polya’s Operation 710 The New Dietetics 
FOODS 
Any substance to be properly regarded as human food must 
be capable of supplying the body with the material needed for 
the repair of its tissues and for maintaining its various functions, 
while at the same time working no injury to the body and in no 
way interfering with its activities. There are many substances 
which possess some of the properties of foods and might be use- 
ful nutrients except for the fact that they contain special sub- 
stances which are inimical to the interests of the body, and hence 
are injurious. There are, in fact, numerous organic compounds, 
products of the vegetable kingdom, which are not only incapable 
of sustaining the life of human beings but prove rapidly de- 
structive. Such substances are not foods but poisons. Alcohol, 
for example, though oxidized or burned in the body as is starch 
and sugar, is not to be regarded as a food, for the reason that it 
possesses toxic properties which render its use unsafe. 
A pronounced difference between a food and a poison is the 
fact that a food is harmful only when taken in excess of the body 
needs, whereas a poison is injurious in all doses, small as well as 
large. Quantities of poison so small that apparently no effect at 
all is produced by single doses, when given daily for long periods, 
produce cumulative effects which generally appear as degenera- 
tions of heart, blood vessels, nerves, liver, kidneys or other glands. 
Food as Fuel, 
Life has been likened to a consuming fire—a flame. One of 
the chief functions of food is to serve as fuel by the burning of 
which the animal heat is maintained, and the energy required 
for every sort of bodily activity is supplied. 
The wastes dismissed from the body through the bowels and 
the kidneys represent the smoke and the ashes which result from 
25 26 
THE NEW DIETETICS 
vital combustion, which is not simply a burning in the body, but 
actual destruction or burning of the body. 
The vital combustion which constitutes life differs from the 
fire which burns in a stove or a furnace, not only in the fact that 
it burns without a luminous flame and in the presence of water, 
which is fatal to an ordinary fire, but in the fact that while in the 
case of the stove or furnace the container itself does not burn, 
having such properties as enable it to resist the action of fire, 
in the case of the combustion within the bodies of human beings 
and animals, the body itself, the container, as well as the fuel, is 
slowly consumed, as would be the case with a stove or a furnace 
constructed of wood. Indeed, it is even possible that the iron 
walls of a stove itself may be in time destroyed. Iron will rust 
if long exposed to air and moisture, and this rusting is a sort 
of burning akin to the combustions which occur within the body 
through the agency of the oxygen of the air. 
Burning is oxidation. When the oxidation takes place 
rapidly, the burning is accompanied by a flame and intense heat. 
If the process is sufficiently slowed down, there is no flame and 
the heat is moderate in intensity, although the total amount of 
heat produced by the burning or oxidation of any substance is 
exactly the same whether the burning is rapid and accompanied 
by a flame or so slow that no rise of temperature is perceptible 
to the senses. 
That the body is not destroyed by vital combustion is due to 
the fact that the tissues are continually reproduced or recreated 
from new material furnished in the form of food. 
Food thus supplies material for repair of the living ma- 
chinery of the body, as well as fuel to keep the body warm and 
energy for muscular work and other forms of vital activity. 
Food is also a stimulant to the body cells. Many so-called stimu- 
lant drugs, such as alcohol, are, in fact, not stimulants but nar- 
cotics. They paralyze the living cells and lower their working 
efficiency. They waste and do not replenish the energy of the 
body. Wholesome food is a normal and useful cell stimulant. 
Drug stimulants are unnatural and harmful. 
The Chemical Composition of the Body. 
By an examination of the smoke and ashes resulting from the 
burning of a house or an animal, it may be possible to determine 
the nature of the elements which entered into its structure. That FOODS 
27 
is, an examination of the ashes of a burned house will show how 
much iron, lime, and other minerals existed in the house before 
it burned. Investigations made in relation to the chemical com- 
position of the body have shown it to be as follows: 
TABLE I. 
Showing the Chemical Composition of the Adult Human Body. 
Per cent. 
In man 
weighing 
150 lbs. 
Oxygen 
65.00 
97.5 lbs. 
Carbon 
18.00 
27.0 “ 
Hydrogen 
10.00 
15.0 “ 
Nitrogen 
3.00 
4.5 “ 
Calcium 
2.00 
3.0 “ 
Phosphorus 
1.00 
1.5 “ 
Potassium 
0.35 
8.4 oz. 
Sulphur 
0.25 
6.0 “ 
Sodium chlorid 
0.15 
3.6 “ 
Magnesium 
0.05 
1.2 “ 
Iron 
0.004 
1 “ 
Iodine 
Fluorine 
Silicon 
Zinc 
Minute quantities 
Oxygen is obtained chiefly from the air, but also from the 
food. 
Hydrogen is one of the constituents of water and is found 
in nearly all foods. 
Nitrogen is obtainable only from the proteins of the food. 
The air is four-fifths nitrogen, but atmospheric nitrogen can be 
used by the body only after it has first been assimilated by plants 
under the influence of the sunlight. 
Carbon is obtained chiefly from starch and sugar, but it is 
also obtained from fats, in which it is found in combination with 
much hydrogen and a little oxygen, and in small amount from 
protein. 
Iron and lime and other salts are chiefly found associated 
with protein. They are most abundant in the bran or outer 
coats of seeds and in the green parts of plants,—the leaves and 
tender shoots—and in milk and the yolk of eggs. 28 
THE NEW DIETETICS 
The amount of iodine found in the body is very small, yet 
this minute quantity appears to be essential for the function of the 
thyroid gland, in the secretion of which it is found. 
Recent researches have shown that the metal zinc is a con- 
stant constituent of the tissues and of foodstuffs and in about the 
same proportion as iron. The total amount of zinc in the body 
of a man weighing 150 pounds is about 30 grains. 
The most important mineral constituents of the body from 
a dietetic standpoint are potash, soda, lime and iron. The mag- 
nesia and other mineral substances which enter into the compo- 
sition of the body are so closely associated with the lime and iron 
that if care is taken to see that the food contains a sufficient 
amount of these elements there is scarcely a probability that any 
of the essential food salts will be found lacking. 
Differences in the Composition of the 
Body in Infants and Adults* 
According to the Chemiker-Zeitung, the following marked 
differences have been found in the composition of the bodies of 
children and adults: 
The water-content of a new-born infant is about 75 per cent, 
of its body weight; that of an adult, 58 per cent. The muscles 
of an adult are 77 per cent, water. Growing infants need con- 
siderable quantities of water. An infant needs to take daily in 
some form, about one-seventh its weight of water. Most of this 
is absorbed from its food. An adult requires daily about one- 
thirtieth his body weight of water in food and drink. 
The amount of water is determined somewhat by the kind 
of food eaten. When considerable protein is taken, much water 
is required to carry off through the kidneys the urea and other 
waste products resulting from its metabolism. Carbohydrates, 
that is, starch and sugar, require the retention in the body of 
three times their weight of water, while retained salt requires 
more than one hundred times its own weight of water. 
The cartilages of an infant contain 2.24 per cent, of lime; 
the bones of a person nineteen years of age contain more than 
three times as much. 
The blood of an infant contains a much larger number of 
white blood cells than does that of an adult. 
Between infancy and the attainment of adult size there is a 
notable change in the relative size of various organs. The brain FOODS 
29 
of an adult is four times as large as the infant brain. The adult 
liver is eleven times as large, the heart twelve to thirteen, and the 
lungs twenty times as great as that of the infant. 
The Source of Food, 
For all the thousands of various substances which are cap- 
able of sustaining animal life we are indebted to the sun. The 
energy of the sunlight, captured by the mysterious alchemy of 
the chlorophyl grains found in green leaves, is the source of all 
human energy as well as of the energy displayed in the manifold 
activities of animal life in its varied forms. Indeed, almost every 
form of energy with which we are acquainted is derived from the 
sun. It is sunlight in modified form which turns all the wind- 
mills and water wheels and the machinery which they drive. It 
is the energy derived from coal and petroleum (fossil sunlight) 
which propels our steam and gas engines, our locomotives and 
automobiles. The chlorophyl grains of the green leaf capture the 
rays of light as they flit by at the rate of 186,000 miles a second, 
and with this magic force bind together the atoms which form 
the so-called organic molecules and endow with the mysterious 
properties of living matter the lifeless particles of hydrogen, oxy- 
gen, iron, lime and other chemical elements which enter into the 
composition of animal and vegetable structures. 
Food is simply sunlight in cold storage. The function of 
the plant is to store the energy borrowed from the sun, preparing 
it for the service of man and animals that, like the steam en- 
gine, the furnace or the lamp, must be regarded as mechanisms 
for using or expending energy. The heat which glows in the fire 
on the hearth, the light which shines out from the incandescent 
lamp or the brilliant electric arc are nothing more than re- 
suscitated sunlight; so likewise the heat of our bodies and the 
energy of mind and muscle which we are able to display are 
transmuted sunshine. Food Principles 
The many thousands of different substances which may 
serve as food for human beings and for animals, notwithstanding 
the enormous differences in appearance, flavor and other quali- 
ties, are made up essentially of six simple kinds of materials. 
These are: 
1. Proteins. 
2. Carbohydrates. 
3. Fats. 
4. Salts or food minerals. 
5. Vitamins. 
6. Cellulose. 
It is necessary to understand the chief facts relating to 
these several food principles in order to have any proper under- 
standing of scientific dietetics. 
Proteins. 
The proteins, or albuminous substances, contain, in addition 
to the carbon, hydrogen and oxygen of the carbohydrates, nitro- 
gen and sometimes also sulphur or phosphorus and iron. The 
protein molecule is very large, having a molecular weight from 
five hundred to a thousand times that of water. 
As known to the chemist, proteins are the dead remains of 
the protoplasm or living, substance of plants and animals. Pro- 
teins are produced by plants. They cannot be produced by the 
chemist, and the tissues of animals are able only to slightly 
modify the proteins which plants produce. 
Protein supplies the body with the nitrogen, sulphur and 
phosphorus which, with hydrogen, oxygen and carbon, are the 
chief chemical elements which enter into the composition of the 
living structures of the body, the nerves, muscles, glands and 
other parts which constitute the vital machine. Associated with 
the protein in all animal structures are to be found iron, lime and 
other mineral elements, some of which are known to form part of 
the protein molecule. The white of egg, the lean of meat, the 
curd of milk and the gluten of wheat are examples of protein. 
30 FOOD PRINCIPLES 
31 
Proteins generally contain sulphur, but some do not contain 
phosphorus. The offensive odors arising from the burning of 
protein is due to the poisonous compounds which are formed 
from nitrogen and sulphur. Compounds of these substances 
formed either in the chemical laboratory or in the mysterious 
laboratory of the plant are among the most poisonous known to 
man. Nitrogen is an essential constituent of the high explosives 
used in warfare. It enters into the venoms of snakes and the 
virulent poisons produced by bacteria. 
Proteins are not so simple in their composition as are other 
food principles. The protein molecule is, indeed, very complex. 
It is made up of a considerable number of substances loosely held 
together by the energy derived from the sun. These simpler 
bodies or “building stones” which, in a pure state, appear in a 
crystalline form, are known to the chemist as amino acids. There 
are known more than forty of these amino acids. Of these, only 
eighteen enter into the composition of the human body. 
Vegetable proteins differ very greatly in their composition. 
There are found in the vegetable proteins a considerable number 
of amino acids which do not enter into the composition of the 
human body and hence cannot be utilized for tissue building. 
The number of these “building stones” which enter into the 
various vegetable proteins differs widely, as well as the propor- 
tions in which the different ones are found. 
Complete Proteins, 
Every plant produces its own variety of protein, and hence 
there are almost as many kinds of proteins as there are different 
sorts of plants. Some proteins are lacking in certain elements 
(tryptophan, lysin) which are needed for building animal tissues. 
These are known as “incomplete”’ proteins. The proteins of meat, 
eggs and milk are of course “complete.” 
Most plant proteins are lacking in some one or more of the 
“building stones” which are absolutely essential to support 
growth or repair of the living tissues. It is interesting to note 
that those foodstuffs which have become staple articles of diet 
throughout the world are the ones which contain the highest 
quality of protein. Rice, millet, and the potato owe their popu- 
larity, in large part at least, to the fact that they furnish an 
excellent quality of protein. Among the few vegetable products 
which furnish proteins which are complete may be mentioned 32 
THE NEW DIETETICS 
nuts of various sorts. The soy bean is also notable in this respect. 
It is particularly interesting to note that while the soy bean fur- 
nishes a complete protein, that is, a protein 100 per cent, of which 
may be utilized in tissue building, the proteins of ordinary peas 
and beans are worth for tissue building much less than their face 
value. 
The researches of Osborne, Mendel and others indicate that 
proteins to be able to support growth must contain lysin, an 
amino-acid which the body is unable to produce. This essential 
element was found in different proteins in the following propor- 
tions : 
Casein (cow’s milk) 7.61 per cent. 
Halibut muscle 7.45 “ “ 
Ox muscle 7.59 “ “ 
Vitellin (egg yolk) 4.81 “ “ 
Albumin (hen’s egg) 3.76 “ “ 
Legumin (pea) 4.98 “ “ 
Phaseolin (kidney bean).... 4.68 “ “ 
Glutelin (maize) 2.93 “ “ 
Glutenin (wheat) 1.92 “ “ 
Edestin (hemp seed) 1.65 “ “ 
Gliadin (wheat) 0.16 “ “ 
Amandin (almond) 0.72 “ “ 
Hordein (barley) 0.00 “ “ 
Zein (maize) 0.00 “ “ 
It is interesting to note that those proteins which are biolog- 
ically intended to promote the growth of very young animals, 
such as milk and egg proteins, are rich in lysin, which is essential 
for the formation of animal proteins. 
A person who undertakes to live upon a low protein or non- 
flesh diet must take care to make such a selection of foodstuffs as 
will furnish a full supply of complete protein; otherwise the body 
will languish. Lack of energy, and low resistance to disease are 
the natural result of a deficient supply of complete protein. 
Ignorance of this fact or neglect to consider it in arranging bills 
of fare has been the cause of numberless failures in attempts to 
dispense with the use of flesh foods. Lean meat furnishes com- 
plete proteins, which fact is probably one of the chief reasons for 
its use as a foodstuff. It is important to remember, however, that 
the proteins of milk and eggs are equally as complete as meat 
proteins. FOOD PRINCIPLES 
33 
A Poisonous Nucleus in Proteins—Anaphylaxis. 
It is now known that every protein molecule contains a 
group of atoms which under some circumstances may act as a 
poison. When protein is digested in the normal way and broken 
up into its “building stones,” this poison nucleus is destroyed; 
but when the proteins are introduced directly into the blood, the 
breaking up of the molecule is incomplete and the poison nucleus 
is set free, and highly toxic effects are produced. These effects 
are known as anaphylaxis. They are seen in persons who have 
been sensitized to certain forms of protein, as in strawberry 
poisoning, buckwheat poisoning, poisoning from the use of oysters, 
eggs, shellfish, and various other foodstuffs. Hay fever, or 
pollinosis, is due to the absorption of pollen protein through the 
mucous membrane of the nose. More will be said further on 
with reference to sensitization to various foodstuffs. 
Carbohydrates. 
Carbohydrates are food principles composed wholly of car- 
bon, hydrogen and oxygen. The hydrogen and oxygen are pres- 
ent in the proportions to form water. There are many different 
carbohydrates. Those which the body can make use of as food 
are starch, dextrin, sugar and fruit acids. The utilizable sugars 
are cane sugar, malt sugar, milk sugar, dextrose and levulose. 
Starch is the most abundant of all the carbohydrates, being 
found in all cereals, in unripe fruits and a few ripened fruits, in 
certain nuts and in most vegetables. 
Dextrin is derived from starch and is practically identical 
with it in chemical composition. Sugars are also derived from 
starch. 
There are many different kinds of starches. Each plant 
produces its own variety, the form of which is so characteristic 
that it may be used as a means of identification. 
Of the various vegetable acids, the only ones which are 
utilized by the body are citric acid, malic acid and tartaric acid. 
The last named is less fully utilized than the others. Oxalic acid, 
benzoic acid and some other acids of vegetable origin are not to 
any extent oxidized or broken up in the body. As found in 
vegetable foods organic acids are in combination with soda or 
potash in the form of acid salts. When the acids are burned or 
utilized in the body, the alkaline soda or potash is left behind; 
so that the ultimate effect of the utilizable organic acids when 
eaten is to increase the alkalinity of the vital fluids and not to 34 
THE NEW DIETETICS 
acidify the body fluids, as was formerly supposed to be the case. 
Carbohydrates are almost exclusively derived from vege- 
table sources. 
Glycogen is an animal starch produced by the liver of ani- 
mals from sugar brought to the liver in the portal vein after 
absorption from the stomach and intestines. The body of a full- 
sized man contains about two pounds of glycogen, which is stored 
in the liver and the muscles. It is converted into sugar as 
needed for use as fuel, which is its sole function in the body. 
Milk sugar is another carbohydrate peculiar to animals, be- 
ing exceedingly rare in the vegetable kingdom. 
The carbohydrates are used in the body to maintain animal 
heat and to supply energy for work. Every muscular contrac- 
tion, every heart beat, every bodily movement of any sort involves 
the burning or destruction of carbohydrate. 
If more carbohydrate is eaten than is required for immediate 
use, it may be stored in the form of fat, a residual tissue which is 
intended to be drawn upon when the food supply is cut off or 
reduced. 
Every protein molecule contains a carbohydrate group; and 
when protein is broken up in the body about half its weight be- 
comes carbohydrate and is thus utilized by the body like sugar or 
starch, the remainder being for the most part excreted as urea. 
The human constitution seems to be adapted to a dietary 
very rich in carbohydrates. A well-balanced bill of fare will 
contain more than half, at least three-fifths, of its energy value in 
the form of carbohydrates. Energy in this form is apparently 
more readily and easily utilized than in any other form. Sugar, 
in other words, is the natural fuel of the body. 
The natives of the Arctic regions, who are compelled to live 
on a diet consisting almost exclusively of flesh foods, have an 
intense craving for sweets. In the short summer season these 
unfortunate people gather as large a store as possible of berries, 
leaves, and every edible thing of a vegetable character which the 
soil of that region produces. Shackleton mentions the intense 
craving experienced by his men for puddings and other dishes 
prepared from flour during their first long winter night in the 
Antarctic. 
These facts agree with the observations of modern physiolo- 
gists that carbohydrates, to the amount of two or three ounces 
daily, are absolutely essential to the maintenance of good health, FOOD PRINCIPLES 
35 
for the reason that the utilization of fats requires the presence of 
carbohydrates. As Naunyn says, “Fats burn in a fire of carbo- 
hydrates.” A deficiency of carbohydrate soon causes acidosis. 
Fats. 
Fats are derived from both animal and vegetable sources. 
They consist chiefly of carbon and hydrogen, with a small amount 
of oxygen. Every animal produces a fat peculiar to itself. Such 
fat is formed by the conversion of starch and other carbohydrates 
into fat by the action of the body cells. 
When fat is eaten, it is deposited in the tissues in essentially 
the same form as that in which it is swallowed; that is, if hog fat, 
or lard, is eaten by man it is not transformed into the same sort 
of fat which the body forms from starch and sugar, but chiefly 
remains lard, and is deposited in the tissues as lard. The same 
is true of beef or mutton tallow and of other fats. A dog fed 
upon mutton fat becomes round and hard like a sheep and is 
known in the laboratory as “a mutton dog.” It is an interesting 
fact that vegetable fats and oils are more nearly like the natural 
fat which the body produces from starch and sugar than are the 
fats found in the ox, the sheep and the hog. 
It is generally believed that a certain amount of fat in the 
diet is essential for the maintenance of health; but Hindhede, 
the eminent Danish physiologist, has shown in recent years that 
a man may live in perfect health and sustain his strength for 
many months on a diet from which fat is excluded. 
Hindhede’s research seems to show conclusively that fat is 
not so essential as an article of food as it has heretofore been 
supposed to be. This is the natural result of the fact that the body 
is able to make its own fat from starch and other carbohydrates. 
Another fact of great interest has an important bearing upon this 
point. A subtle element, the growth-promoting vitamin, essential 
for health as well as development, is often, though not always, 
associated with fats. When the fat is lacking or deficient in 
quantity, this element is likely also to be lacking; and because of 
this association, which has only recently come to be understood, 
injuries resulting from the withholding of fats have very naturally 
been attributed to lack of the fat itself rather than to the absence 
or deficiency of the growth-promoting vitamin with which the 
older physiologists were not acquainted. This element is abun- 
dant in butter but is deficient in lard, in some vegetable oils and 36 
THE NEW DIETETICS 
many other fats. It is also plentiful in greens, which Hindhede 
used as an essential part of his bread and potato diet. 
Fats, if not absolutely essential, are a wholesome and useful 
constituent of the dietary. More than any other food, they pro- 
duce the sense of satiety or satisfaction after eating. They are 
the most concentrated of all forms of foodstuffs, having an energy 
value more than double that of either carbohydrates or proteins. 
If eaten in excess, fats usually produce a rapid gain in flesh, 
encouraging intestinal putrefaction, with rancid stools, and are 
apt to give rise to a troublesome and even dangerous condition 
known as acidosis. It is strictly physiologic that fats be eaten 
with cereals or breadstuffs, for the starch which is found abun- 
dantly in cereals, as has already been shown, is necessary for the 
proper utilization of fats by the body cells. 
Food Salts. 
Eight mineral elements, viz., calcium, sodium, potassium, 
magnesium, iron, phosphorus, sulphur and chlorin, constitute 
about 4 per cent, of the weight of the body, or about five or six 
pounds in a person of ordinary weight. These so-called minerals 
or mineral salts are not for the most part found to any extent 
either in the body or in foodstuffs in a strictly inorganic-state. 
It is true that chlorin and sodium in the form of sodium chlorid 
or common salt and phosphorus in the form of phosphate of lime 
are found in small amounts in foods in an inorganic state; but 
iron, sulphur, phosphorus and calcium, in general, exist in the 
body only in organic form. The presence of iron in its ordinary 
metallic state may be easily recognized by the application of sev- 
eral chemical tests. But organic iron, that is, food iron and the 
iron of the tissues, cannot be detected by any of these tests, 
showing that in the chemistry of the plant some subtle change is 
effected which gives to the so-called mineral elements of the food 
properties which in their inorganic state they do not possess—in 
other words, prepares them for use by animals as food. 
The body loses daily in the excretions from two-thirds of an 
ounce to an ounce of salts—chlorids, sulphates, phosphates and 
other salts of calcium, magnesium, sodium and potassium. To 
make good this loss, the daily food must contain at least an equal 
amount of organic or food salts. This subject will be more fully 
discussed, together with the method of balancing the diet for food 
salts, in later chapters. FOOD PRINCIPLES 
37 
Vitamins. 
Vitamins are subtle substances other than carbohydrates, 
fats, proteins or salts which are essential for growth, develop- 
ment and good nutrition. Their purpose seems to be to activate 
or stimulate the various functional activities of the body. The 
term vitamin was given by Funk to a substance which he isolated 
from foodstuffs and which in minute quantities was found to be 
capable of curing and preventing beri-beri, a fatal disease very 
common among rice eating people. This substance is found abun- 
dantly in the bran and germ of seeds, grains and yeast and in 
greenstuffs, fruits and to some extent in most foods. It is defici- 
ent or absent in polished rice, superfine flour, new process or 
degerminated corn meal, sugars, many other denatured foods and 
in fats. This vitamin was given the name water-soluble B by 
McCollum. When the word vitamin is used alone, it is generally 
understood that reference is made to vitamin B. 
Several other vitamins have since been discovered, the most 
important of which are fat-soluble A, found in butter, cod liver 
oil and other fats and in green leaves and young sprouts, and 
water-soluble C, the so-called antiscorbutic vitamin, the absence 
of which gives rise to scurvy. This vitamin is found most abun- 
dant in green sprouts, fresh vegetables and the juice of the 
orange and the tomato. Recent investigations have proven the 
existence of at least two other vitamins which are, however, of 
less importance than those mentioned. 
Vitamins are produced only by plants. They are found to a 
limited extent in some animal tissues, particularly in the liver 
and other glands which appear to have the ability to store up 
vitamins to be supplied to the body as needed. 38 
THE NEW DIETETICS 
Cellulose. 
Cellulose is an insoluble substance which forms the frame- 
work of plants and plant products. It is not acted upon by the 
fluids of the human digestive apparatus, although it is digested to 
some degree by herbivorous animals and even constitutes the prin- 
cipal food of certain low forms of animal life. Cellulose is a 
highly important constituent of the diet of human beings serving 
to give to the food mass the necessary bulk* to enable it to move 
along the alimentary canal at the proper rate. 
The properties of the several food constituents will be more 
fully discussed in a subsequent chapter. THE DIGESTIVE PROCESSES 
A complete account of the chemical changes which take 
place in foodstuffs in passing through the alimentary canal would 
require the space of a large volume. The essentials of the whole 
subject may, however, be condensed into a brief space. Here is 
the subject in a nutshell: 
There are practically four digestible foodstuffs—starch, 
albumin or protein, fats and sugar. 
There are five food laboratories—the mouth, the stomach, 
the small intestine, the colon and the liver. 
There are five digestive fluids—the saliva, the gastric juice, 
the bile, the pancreatic juice and the intestinal juice. 
The saliva digests starch. 
The gastric juice digests protein. 
The bile aids in the digestion of fats. See Cooper, p. 38. 
The pancreatic juice digests starch, protein and fats. 
The intestinal juice digests all foodstuffs. 
Starch is digested by the saliva, the pancreatic juice and the 
intestinal juice. 
Protein is digested by the gastric juice, the pancreatic juice 
and the intestinal juice. 
Fats are digested by the bile, the pancreatic juice and the 
intestinal juice. 
Sugars are digested by the intestinal juice. 
The “salts” are dissolved by the several digestive fluids. 
Mouth Digestion. 
The mouth is a mill. It grinds the food by a gradual reduc- 
tion process, while it is at the same time being macerated or soft- 
ened and mixed with the saliva. But the reduction of the food 
to the consistency of a soft paste is hut a small part of what 
happens in the mouth laboratory. The chewing of the food sets 
in operation the whole series of food laboratories. When the 
movements of the jaw begin, the salivary glands start to pour out 
the saliva, the gastric glands secrete gastric juice, and all the other 
laboratories prepare for the work that they are expected to do; 
39 40 
THE NEW DIETETICS 
and beside this, the movements which carry the food into the 
stomach, while depositing the foodstuffs in this chamber for 
further attention, send on beyond the stomach peristaltic waves 
which reach the colon, and with such vigor that its contents 
move forward four times as fast during the eating of a meal as in 
the intervals between meals. 
The Saliva. 
The three pairs of salivary glands together produce daily 
three or four pints of saliva, about the same amount of secretion 
produced by the skin and also by the kidneys. The saliva differs 
from the sweat and the urine in the fact that it is reabsorbed. 
The salivary secretion is absent in fishes. The saliva of 
dogs contains no ferment or digestive principle, probably because 
meat contains no carbohydrate for the saliva to act upon. The 
same is true of the saliva of infants. 
Human saliva, like that of the big apes and other frugivorous 
animals, is very rich in ferments. In man, the character of the 
saliva is influenced by the nature of the substances in the mouth 
during mastication. 
Nearly thirty years ago, the writer showed, experimentally, 
that the quality of dryness in the food is one of the most power- 
ful stimulants of salivary activity. In the mastication of an 
ounce of dry toast without other flavoring than a small amount 
of salt twice its weight of saliva was secreted in five minutes. 
An ounce of water held in the mouth for the same length of 
time was scarcely at all increased in weight. The movements of 
mastication increase the activity of the salivary glands, perhaps 
by increasing their blood supply. Acid and alkaline substances 
powerfully stimulate the flow of saliva, as do, also, savory sub- 
stances and foods which appeal to the appetite. Pepper, as well 
as other irritating and distasteful substances, causes an abundant 
flow of saliva, as also do substances which give rise to nausea. 
The chewing of hard, insoluble and hence tasteless sub- 
stances does not increase the flow of saliva to any considerable 
extent. The saliva produced by the chewing of food is much 
more active than that produced between meals. The saliva pro- 
duced by the chewing of paraffin will in four hours digest twice 
its volume of a one per cent, solution of boiled starch. 
The saliva contains two digestive ferments. One of these 
simply liquifies the starch. Another, amylase, converts the starch 
first into dextrin and then into malt sugar or maltose. 41 
THE DIGESTIVE PROCESSES 
The saliva acts very slowly upon raw starch, and on the 
whole is much less active than is the pancreatic juice in the di- 
gestion of starch. 
When first secreted, the amylase of the saliva is inactive. It 
is made active by very minute quantities of acids and alkalies, 
but is rendered inactive by strong acids and alkalies, also by 
bacteria. 
The action of the saliva is not completed in the mouth, but 
continues for an hour or two after the food passes into the 
stomach, or until the gastric contents become sufficiently acid to 
arrest the activity of the salivary ferments. Recent experiments 
indicate that the activity of the saliva is resumed in the small 
intestine after it comes in contact with the alkaline intestinal 
secretions. 
Conditions Which Hinder Salivary Activity. 
Careful determination of the activity of the saliva, made 
in the laboratories of the Battle Creek Sanitarium under the 
writer’s supervision, show enormous differences in the digestive 
activity of different persons. In some cases the activity was 
found to be sufficiently great to digest all the starch ordinarily 
eaten, while in others the degree of activity was scarcely one- 
tenth or even one-twentieth as great. 
The average of a thousand cases taken at random from a 
series of more than forty thousand in which the activity of the 
saliva was carefully determined by the method devised by Sir 
William Roberts showed the complete digestion of about half of 
all the starch liquified in the mouth and stomach. 
Bacterial infections of the mouth and stomach interfere with 
the function of the saliva by rendering its ferment inactive. The 
saliva is also deteriorated by the excessive secretion produced by 
gum chewing and the chewing of tobacco. The saliva in such 
persons has very little ferment. The prolonged stimulation ex- 
hausts the secreting cells so that the saliva becomes inactive. 
Taylor very aptly says of gum chewing and tobacco chew- 
ing: 
“Vicious habits, like the vulgar chewing of tobacco or gum, keep the 
salivary glands constantly at work, and the results are as bad physiologically 
as the practices are reprehensible to good taste.” 
Recently reported observations indicate that imperfect in- 
salivation of the food and incomplete salivary digestion inter- 42 
THE NEW DIETETICS 
fere w:th gastric digestion not only by introducing the food into 
the stomach in an imperfectly comminuted form, but through 
the absorption of the pepsin by the undigested starch. It is thus 
evident that thorough chewing of the food is necessary both to 
insure the complete digestion of starch and also to promote gas- 
tric digestion. It is probable that in the majority of persons not 
more than a fourth of the starch eaten is digested by the saliva, 
and in many cases the proportion must be very much smaller than 
this. 
Sir William Roberts, many years ago, showed that acetic 
and oxalic acids interfere with digestion by preventing the action 
of the saliva upon starch. The amount of acetic acid found in a 
teaspoonful or two of vinegar was shown to be sufficient entirely 
to stop the action of the saliva. Oxalic acid diluted to one part in 
10,000 was found to arrest the action of the saliva completely. 
The injurious action ot tne fruit acids, citric, malic and tartaric, 
is comparatively slight. 
Citric acid powerfully stimulates the flow of saliva, and the 
saliva produced is very active in digesting starch. 
Tannic acid interferes with the action of the saliva. Hence 
tea and coffee interfere with the digestion of starch, and for this 
reason alone should be discarded, since they cause indigestion as 
well as other disorders of various sorts. 
Protective Properties of the Saliva. 
It is known that wounds in the mouth generally heal quite 
readily. Clairmont, of Vienna, has shown that the saliva pos- 
sesses valuable properties as a cleansing agent. Although it has 
no direct bactericidal action upon such pathogenic organisms as 
the bacilli of typhoid fever and tetanus, the colon bacillus or pus- 
producing organisms, some bacteria are destroyed by contact with 
human saliva. The saliva of goats and other ruminants, espe- 
cially parotid saliva, was found, moreover, to have quite marked 
bactericidal properties. Clairmont’s observations led him to be- 
lieve that the saliva maintains in the mouth conditions unfavorable 
for the growth of micro-organisms which might otherwise fix 
themselves upon the teeth and gums and set up processes of decay 
or ulceration. 
Pickerill and Gies urge the use of acids and sweets to stim- 
ulate the secretions of the mouth as the most efficient means of THE DIGESTIVE PROCESSES 
43 
preserving the teeth. The teeth of the Maoris are immune to 
caries (Pickerill). 
The Saliva in Disease* 
Fleckseder (Zentralblatt fur Innere Medicin) calls attention 
to the fact that the saliva is acid in diabetes and also in cancer of 
the stomach, in leukemia, in pernicious anemia, jaundice, and 
sometimes in chlorosis. The chlorids may be increased or dimin- 
ished according to the disease. When the chlorids of the urine 
are diminished, there is usually also a diminution of chlorids in 
the saliva. Sugar is sometimes present in severe cases of diabetes. 
Diminished saliva (oligosialia) is present in many severe 
maladies, especially in cases of profuse sweating, insistent vomit- 
ing, dropsy, diabetes, anemia, cachexia accompanying carcinoma 
of the stomach, pernicious anemia, fever, uremia and cirrhosis of 
the liver. When scanty, the saliva is cloudy and acid, and some- 
times has a peculiar sweetish odor. In ptyalism the saliva is thin, 
alkaline and clear. A profuse flow of saliva occurs in pregnancy, 
in stomatitis, in most of the painful gastric affections, in nausea 
and ulcer of the stomach. An intermittent flow is frequently ob- 
served in cases of facial neuralgia, in the gastric crises of loco- 
motor ataxia and in neurasthenia. 
Regulating Influences of the Sense of Taste, 
While food is in the mouth it is not only chewed but tasted. 
The recognition of the gustatory properties of the food by the 
nerves of taste, through reflex centers in the brain, prepares the 
stomach, pancreas, liver and other digestive organs for the work 
which they are to do. Tasting the food also in some mysterious 
way regulates the process of nutrition by cutting off the appetite 
for one food principle after another as the body has received a 
sufficiency of each particular item. 
At the back of the mouth is found a remarkable structure, 
the soft palate, which is peculiarly sensitive to contact with solid 
objects. If the food is imperfectly chewed, the contact of coarse 
particles with the uvula and other portions of the soft palate 
give rise to a reverse movement by which the food is carried 
back between the teeth to be more thoroughly masticated. This 
action of the soft palate is a sort of inspection intended to secure 
not only thorough mastication of the food but rejection of sub- 
stances which are not food and which might do injury if swal- 
lowed. THE NEW DIETETICS 
44 
The longer the food is retained in the mouth and the more 
thoroughly it is chewed, the larger the amount of gastric juice 
which will be found in the stomach ready to act upon the food 
after it reaches the gastric laboratory. It is part of the function 
of the mouth laboratory, then, not only to digest the food and 
prepare it for the action of the other digestive organs but to 
regulate the nourishing of the body. In order that this regulat- 
ing process shall be successful, it is necessary that the food should 
be so thoroughly chewed that its sapient properties may be fully 
developed and thoroughly appreciated. When this instinctive 
regulator of nutrition has been trained to normal action, it is a 
very dependable guide in determining not only the quality of the 
various foodstufifs which are needed to meet the requirements of 
the body, but also the amount of food which should be taken. 
The importance of thorough mastication of the food will be 
discussed elsewhere. It may be mentioned here, however, that it 
is essential to good digestion, not only because by thorough chew- 
ing the food is comminuted, but for still another reason. Recent 
observations have shown that when large quantities of starch 
enter the stomach without having been changed by the action of 
the saliva, the pepsin may be absorbed by the undigested starch 
and thus gastric digestion may be interfered with and the acid of 
the gastric juice left free (Maxwell). The excess of free acid 
gives rise to gastric spasm, pain and various other inconveniences. 
GASTRIC DIGESTION 
The chief function of the stomach is to prepare the food 
for digestion in the intestine and to serve as a reservoir to hold 
the food while it is being doled out to the intestine in small quan- 
tities by the action of the pylorus. While the food is in the 
stomach about half the starch is liquefied, one-fourth the starch is 
converted into sugar, and three-fourths of the protein is liquefied, 
hut none of it is completely digested. 
In the mucous membrane of the stomach are glands, some of 
which produce pepsin, others the gastric acid which is known to 
the chemist as hydrochloric acid. These two remarkable products 
co-operate in the digestion of the proteins of the food. Rennet, 
a milk-curdling ferment, is also produced in the stomach. The 
digestive work done in the stomach is not complete. It is rather 
of a preliminary character intended to complete the breaking-up (From “Life and Letters of Dr. William Beaumont,” C. L. Mosby Co., St. Louis, Mo.) 
DR. WILLIAM BEAUMONT ALEXIS ST. MARTIN 
(From “Life and Letters of Dr. William Beaumont,” C. L. Mosby Co., St. Louis, Mo.) 
Showing Opening in Left Side THE DIGESTIVE PROCESSES 
45 
of the food so as to render each particle easily accessible to the 
other more powerful digestive juices which are brought in con- 
tact with the food after it leaves the stomach. It very naturally 
follows that very little absorption takes place in the stomach. 
The stomach, indeed, may be considered as an antechamber to 
the real food laboratory, the small intestine, where the chief work 
of digestion and absorption are done. According to the com- 
parative anatomists, the stomach of man does only about one-fifth 
of the digestive work, while in the goat and the ox the stomach 
does seventy per cent, of the work of transforming the food. 
The Gastric Juice. 
The quantity of gastric juice produced by the stomach in 24 
hours is about three pints. The amount required for the digestion 
of a hearty meal, such as a dinner, the principal meal of the day, 
has been estimated as a little less than one and one-half pints. 
The gastric juice is the product of six different sets of 
glands. Three of these secrete ferments, pepsin, rennet and 
lipase, a fat-digesting ferment. Other glands secrete mucus, still 
others acid, and by another set of glands there is secreted a serous 
fluid termed diluting juice, which serves to regulate the acidity 
and digestive activity of the gastric juice. 
It was formerly supposed that gastric juice is produced only 
during digestion. This belief was largely based upon the observa- 
tions of Beaumont. But it may be noted that this shrewd observer 
remarked that he usually found the stomach empty, or at least 
that it contained only a small quantity of gastric juice, which he 
states sometimes amounted to one or two ounces. This quite 
agrees with the later observations of Carlson on a man having 
a gastric fistula similar to that of St. Martin, upon whom Beau- 
mont’s experiments were made. Carlson holds that the secretion 
is continuous, usually not exceeding one to two ounces per hour, 
but sometimes three to five ounces per hour. This continuous 
secretion possesses the properties of ordinary gastric juice, though 
usually less acid than the juice produced during digestion. The 
continuous secretion is absent in fevers and also when the stomach 
is the seat of inflammation or gastritis. 
After the appearance in 1834 of Beaumont’s interesting 
account of his experiments upon St. Martin, the knowledge of 
digestion was advanced very little until the publication in 1897 
of Pavlov’s remarkable treatise, “The Work of the Digestive 46 
THE NEW DIETETICS 
Glands.” This work provided, for the first time, a basis for 
rational medical dietetics. Previously so little was actually known 
respecting the physiology of gastric and intestinal digestion that 
medical dietetics, at least in relation to gastric and intestinal 
digestion, was almost wholly empirical or based upon vague and 
unproven theories. 
The facts set forth by Pavlov were so extraordinary and so 
revolutionary that the writer thought it worth while, in 1907, to 
visit Petrograd for the purpose of getting a first-hand acquaint- 
ance with the work and views of this distinguished investigator, 
whom he found the most approachable, courteous, and communi- 
cative of men. The experiments which the professor and his 
able assistants performed for the writer’s benefit not only con- 
firmed the facts made known in his published works but made us 
acquainted with additional facts which at that time had not yet 
been published to the world. 
Some of the most important facts in relation to gastric 
digestion were discovered by Pavlov through experiments made 
possible by an ingenious operation devised by him whereby the 
stomach of a dog was divided into two compartments, one of 
which was made use of by the dog for the digestion of his food, 
while the experimenter employed the other for his scientific obser- 
vations. The latter, called by Pavlov the kleine magcn (the little 
stomach), but generally known as Pavlov’s pouch, had about one- 
tenth the capacity of the normal stomach. The experimental 
stomach was connected with the surface of the body so that its 
cavity, cut off from the rest of the stomach, could be drained by 
means of a tube and thus the secretion collected, measured and 
otherwise studied. One thing which greatly impressed us on our 
visit to Pavlov and his famous laboratory was the extreme gentle- 
ness with which the subjects of his experiments were treated. 
The dogs suffered little inconvenience from the tests to which 
they were subjected and showed great fondness for the professor 
and his assistants and showed wonderful intelligence in co-oper- 
ating with them in their experiments. 
Appetite Juice. 
Pavlov found that within a few moments after a dog began 
chewing the food offered it, a stream of freshly secreted gastric 
juice started to pour from the little stomach into the receptacle 
provided to receive it. In fact, the secretion of gastric juice by PROF. J. P. PAVLOV OF PETROGRAD 
PAVLOV’S DOGS PRODUCING GASTRIC JUICE Fig. 1.-—Experiment to Demonstrate Appetite Juice. 
Fig. 2.— V. Cavity of stomach. S. Pavlov’s pouch. 
A.-A. Abdominal wall. THE DIGESTIVE PROCESSES 
47 
the little stomach often began even before food had been taken 
into the mouth of the dog, provided it was allowed to see and 
smell appetizing food. 
By another experiment Pavlov proved that if food was 
simply chewed and never allowed to enter the stomach, the 
stomach produced an abundant secretion of highly active gastric 
juice, which continued as long as the chewing continued. In one 
of the accompanying cuts is shown a group of dogs as seen by the 
writer at ten o’clock in the morning in Pavlov’s laboratory, after 
they had been actively chewing food since six o’clock in the morn- 
ing. Each dog had produced nearly a quart of gastric juice, 
although not a particle of food had entered the stomach, it being 
prevented from so doing by an operation upon his esophagus, 
whereby the food, when swallowed, was made to drop back into 
the pan from which he ate, instead of going into his stomach. 
The gastric juice produced under these conditions, by the simple 
chewing of food in the mouth, Pavlov designated by the term 
“appetite juice.” ' 
Miller and others have shown that the sight of food is a more 
powerful stimulus to gastric secretion than odor. Unpalatable 
food produces little or no appetite juice, though it may be ulti- 
mately well digested. Worry and mental strain cause delay in 
the development of appetite juice and hinder digestion. This 
effect is not produced by entertaining mental activity, such as 
reading a newspaper during meals. 
The gastric juice secretion thus evoked by the tasting and 
chewing of food is strongly acid and possessed of a very high 
degree of digestive activity. At the time of the writer’s visit the 
laboratory was doing quite an extensive business in the collection 
of gastric juice from the stomachs of dogs and shipping it to 
specialists in various parts of Europe for use by patients. Mery 
remarkable results were attributed to its use, far greater than 
have ever been found to result from the use of the pepsin obtained 
from the stomach of the hog. 
Appetite juice is produced at the average rate of about one- 
eighth of an ounce per minute, though it may be generated at a 
rate four times as great as this. Its secretion ceases as soon as 
the taste of food disappears from the mouth. 
Appetite juice, like the continuous gastric secretion, is either 
greatly diminished or entirely absent in gastritis or any inflam- 
matory disorder of the gastric mucous membrane, as well as in 48 
THE NEW DIETETICS 
fevers. It is also stopped by pain and by strong emotions, as by 
anger and fear. Pavlov believed the function of the appetite 
juice to be to start the digestive process. He regarded it, in fact, 
as the most important part of the gastric secretion. The correct- 
ness of this view has been called in question in view of the fact 
that normal infants have no appetite juice, and that the digestion 
is apparently carried on in a normal way in dogs in which the 
nerves of the stomach have been divided so as to prevent the 
development of appetite juice, and also in persons having a 
gastric fistula through which food may be passed into the stomach 
without having been placed in the mouth. The fact is also 
recalled that in many cases of achylia, a condition in which no 
gastric juice is formed, a digestion is apparently carried on by 
the small intestine in a perfectly normal way. The same is also 
true in cases in which the stomach has been removed. However, 
it cannot be denied that appetite juice is a highly useful factor in 
digestion, and it seems probable that its absence must sooner or 
later give rise to impairment of digestion and nutrition. 
When the tongue is coated, the food flavors cannot be 
appreciated by the nerves of taste, and as a result the gustatory 
reflexes are destroyed, appetite juice is not formed, and digestion 
may be suspended. (Roger). 
Fats mixed with the food delay the development of appetite 
juice and diminish its quantity. Meat introduced into the stomach 
of a dog without passing through the mouth digests after a very 
long time, but when taken through the mouth, five times as much 
will be digested in the same time, through the aid of the appetite 
juice which is produced. This experiment affords a most forc- 
ible demonstration of the importance of appetite and of mastica- 
tion as aids to digestion. Bread placed in the stomach produced 
no secretion whatever, but when chewed in the mouth and swal- 
lowed, appetite juice was produced and the bread was readily 
digested. When a portion of the digesting bread was introduced 
directly into the stomach of another dog, gastric juice was 
promptly secreted. 
Fats not only hinder the formation of appetite juice, but 
their presence in the stomach leads to a diminution in the pro- 
duction of chemical juice as well. 
Pavlov showed that fats remain longer in the stomach than 
any other food principle, but after leaving the stomach they pass 
rapidly through the intestine. THE DIGESTIVE PROCESSES 
49 
The Chemical Juice. 
The gastric secretion which appears in the stomach as the 
result of contact of the food with the gastric mucous membrane 
is called by Pavlov “chemical juice.” The chemical juice appears 
to be called forth by various stimulating substances found in 
foodstuffs, particularly by the extractives of meat. Recent ex- 
periments, however, have shown that the most powerful stimulant 
of the gastric glands is gastrin, a hormone which is formed when 
protein food is brought in contact with normal gastric juice in 
the stomach. 
The chemical secretion, as well as the appetite juice and the 
continuous secretion, is arrested by fever, especially when the 
body temperature rises considerably. In health, active secretion 
of gastric juice is produced when gastrin is injected under the 
skin or introduced into a vein. When fever is present, this does 
not occur. 
The Gastric Acid. 
One of the most remarkable physical properties of the gas- 
tric juice is its acidity. The contents of the healthy stomach 
during digestion are always found to be highly acid. This is 
rarely ever due to fermentation but rather to the presence of 
hydrochloric acid. According to Debove, an eminent French 
physiologist, the hydrochloric acid formed by the gastric glands 
differs from the ordinary hydrochloric acid of the laboratory in 
being much more active. As secreted by the gastric glands, the 
acid has the same degree of acidity as that possessed by one-half 
of one per cent, solution of hydrochloric acid, about 1.25 per cent, 
of the ordinary C. P. hydrochloric acid of the laboratory. 
A solution containing hydrochloric acid in this proportion, 
if applied to the skin, would produce powerful corrosive effects. 
As soon as secreted, however, the strong acid solution is diluted 
by a limpid secretion generated for the purpose, known as dilut- 
ing juice, so that the normal acidity of the gastric contents corre- 
sponds to a solution containing about two parts of hydrochloric 
acid in a thousand parts of water, or two-tenths of one per cent. 
It is evident, then, that when matters vomited or regurgitated 
from the stomach have a strong acid taste, it is no certain indi- 
cation that the food has fermented in the stomach, but may be 
proof that the stomach is making at least a normal amount of 
gastric acid. When there is fermentation of the gastric contents, 50 
THE NEW DIETETICS 
a very rare occurrence, vomited matters have not only a sour 
taste but a sour smell as well, due to the presence of acetic acid, 
which is volatile at the temperature of the body, whereas hy- 
drochloric acid is not volatile. 
The normal stomach produces each day from one dram to 
two-thirds of an ounce of pure hydrochloric acid. Just how the 
stomach is able to produce this strong acid is not known, nor 
how the gastric mucous membrane alone, of all other body tissues, 
is protected from the destructive action of this highly corrosive 
liquid. 
Hyperacidity, 
The acidity of the gastric contents during digestion is not 
usually found so high as one-half of one per cent., being normally 
about one-fifth of one per cent. This is also the acidity of the 
continuous secretion found in the empty stomach when mixed with 
saliva which has been swallowed and liquids which have entered 
the stomach from the intestine. 
When a higher degree of acidity of the gastric contents is 
found, it is not because the gastric glands produce a secretion 
having too high a percentage of acidity, but because an excessive 
amount of secretion of the normal degree of acidity is produced, 
or because the amount of diluting juice is deficient. The gastric 
glands cannot make an excessively acid gastric juice. In cases in 
which the condition known as hyperacidity exists, the acidity 
may be either higher or lower than that ordinarily found in the 
gastric contents or may be equal to the normal; hence it appears 
that hyperacidity may be really attributable to an abnormal sen- 
sitiveness rather than to an abnormal secretion of gastric acid. 
Pepsin, 
This ferment is the most important of the several ferments 
found in the gastric juice. As secreted, it is not active, but only 
becomes an active digestive agent when activated by combining 
with hydrochloric acid. 
The amount of pepsin contained in the pint and a half of 
gastric juice produced in twenty-four hours is about seven and 
one-half grains. The twenty or more ounces of gastric juice re- 
quired for the digestion of a hearty dinner contain four grains 
of pepsin, sufficient to digest one and two-thirds pounds of egg 
white or three and one-third ounces of dried albumin, nearly THE DIGESTIVE PROCESSES 
51 
double the amount required for a full day’s ration. It is thus 
apparent that the daily production of pepsin is sufficient to digest 
four times the amount of protein which the body requires. 
Except when the gastric glands are destroyed by degenera- 
tion, pepsin is usually secreted in abundance. It is for this reason 
that the feeding of pepsin as a remedy is useless as an aid to 
gastric digestion. Some years ago an experiment upon a dog 
was made by a French physiologist which still more clearly dem- 
onstrated this fact. By means of tubes passed into the dog’s 
stomach, a stream of water was allowed to flow into the stomach 
through one tube and out of the other, until more than 2,000 
quarts of water had been passed through the stomach. The 
digestive activity of this water was tested by the addition of 
hydrochloric acid and was found to be such that the amount of 
pepsin present was sufficient to digest an amount of flesh more 
than equal to the weight of the dog. 
When the gastric acidity is excessive, the digestive power of 
the gastric juice may be greatly lessened by the destructive action 
of the acid upon the pepsin. 
The presence of bile in the stomach prevents the action of 
pepsin, even though the gastric contents may still remain acid. 
The bile precipitates the pepsin. Pepsin is readily digested by 
trypsin, a ferment produced by the pancreas, and hence its action 
does not continue after the food leaves the stomach. 
Lipase. 
Roger, of Paris, and others have in recent years called at- 
tention to the interesting fact that the stomach secretes a lipase, 
or fat-digesting ferment, which is very active in the digestion of 
emulsified fats such as cream and egg yolk. 
In this connection it is interesting to note the fact that while 
the principal digestive work of the stomach is to digest proteins, 
provision is made also for the digestion of starch and fat. Thus, 
by the co-operation of these several digestive agents in the stom- 
ach, the food may be completely broken down and so prepared 
for the more vigorous digestive action of the pancreatic juice 
and the finishing work of the intestinal juice to which the food is 
subjected in the intestine. When large quantities of fat are eaten, 
the intestinal fluid, consisting chiefly of a mixture of bile and 
pancreatic juice, is often regurgitated, the evident purpose being 
to aid in the digestion of the fat when the quantity is greater 52 
THE NEW DIETETICS 
than the gastric lipase is able to deal with. This regurgitation 
of bile from the intestine is most likely to occur in cases of high 
acidity, a condition which interferes with the action of the lipase 
of the stomach and may even destroy it. The alkaline intesti- 
nal fluids, by neutralizing the acid gastric juice, aid the digestion 
of the fat and so hasten its departure from the stomach. 
Functions the Hydrochloric Acid 
of the Gast h Juice♦ 
The hy 1 ochloric acid of the gastric juice plays a remark- 
ably versa!’! ■ role, as will be seen by the following enumeration 
of its uses: 
1. Activates pepsin. As secreted, pepsin has no digestive 
activity, but in the presence of hydrochloric acid it acquires an 
astonishing digestive potency by which it is able to transform 
the various proteins of the food into peptone, although it does not 
actually complete the digestive process. Pepsin-hydrochloric acid 
is the only agent by which raw connective tissue can be digested 
in the body. It is evident, then, that in achylia, when pepsin and 
hydrochloric acid are no longer produced in the stomach, flesh 
foods should be entirely discarded. 
It may be mentioned in this connection that in the absence 
of hydrochloric acid pepsin may be to some degree activated by 
food acids—citric, malic and tartaric acids. It should also be 
noted that when both hydrochloric acid and pepsin are absent 
from the gastric juice the ferments sometimes may be made to re- 
appear by the introduction of hydrochloric acid or acid protein 
into the stomach (Taylor). If after the use of hydrochloric 
acid in this way the ferments do not appear, it is evident that the 
gastric glands have undergone degeneration. It is desirable that 
this test be made in all cases of achylia. 
2. Activates chymosin and lipase. The chymosin, or ren- 
net, of the gastric juice coagulates milk and the lipase digests fat. 
3. Opens the pylorus. According to Cannon, the presence 
of free hydrochloric acid in the stomach in sufficient amount 
causes the pylorus to open. It is known, however, that in achylia, 
in which there is no acid in the stomach, the pylorus often re- 
mains open and the food passes out more quickly than from the 
normal stomach. 
4. Closes the pylorus. When the acid contents of the 
stomach enter the duodenum, the pylorus is closed by a reflex THE DIGESTIVE PROCESSES 
53 
action. Failure of the pylorus to close is probably the cause of 
the rapid emptying of the stomach in achylia. 
5. Stimulates the secretion of pancreatic juice. 
6. Causes contraction and emptying of the gall bladder. 
7. Disinfects the food, destroying bacteria and other or- 
ganisms. The gastric juice does not destroy all bacteria, but it 
has been demonstrated that most pathogenic or disease-pro- 
ducing bacteria do not survive prolonged contact with normal 
gastric juice. 
8. Stimulates the production of pepsin by the gastric 
glands. 
9. Stimulates the movements of the stomach. Cannon 
proved that the tonus of the stomach walls, as shown by the 
pressure within the stomach, was four times as great with acid 
contents as with neutral contests. 
10. Closes the cardiac orifice after the swallowing of food. 
The acidity of the gastric juice is increased by the follozving: 
Hunger 
Water 
Gastric juice 
Lean meats 
Meat extracts 
Bouillon and animal broths 
Milk, especially buttermilk and skimmed milk 
Cane sugar 
Undigested cooked starch 
Dextrin 
Sodium chlorid (common salt) 
Carbonated water 
Agreeable foods 
Strongly flavored foods 
Condiments 
Cold baths 
Sleeping after meals 
Imperfect mastication of food (chemical juice) 
Prolonged chewing of food (appetite juice) 
Acids (especially butyric, oxalic and tannic) 
Tea and coffee 
Alcohol 
Worry 54 
THE NEW DIETETICS 
Disease of the gall bladder 
Gastric ulcer 
Duodenal ulcer 
Constipation 
According to Taylor, “There are experiments with animals 
indicating that increased bacterial action in the intestine, aiding 
the formation of a large amount of fatty acid (also other toxic 
substances, such as bacterial peptone, etc.), provokes in some way 
an increased secretion of hydrochloric acid in the stomach.” The 
writer has noted a very constant association between intestinal 
toxemia and gastric hyperacidity or hyperhydrochloria. 
Hypersecretion, or hyperacidity, may be intermittent or con- 
tinuous. It is a common symptom in connection with hysteria, 
chlorosis and neurasthenia, so-called nervous dyspepsia, a condi- 
tion which is probably due to chronic intestinal toxemia. 
The acidity of gastric juice is lessened'. 
1. By fats, cream and oils, especially olive oil when per- 
fectly fresh and free from rancidity. 
2. Grape sugar. 
3. By the use of soft foods and purees, which should be 
eaten with very little mastication. 
4. By bland foods. 
5. By a saltless diet. 
6. By sweating baths or by profuse perspiration induced 
by exercise, which causes the elimination of salt. 
7. By fatigue. 
8. By disease—fever, cancer, degeneration of gastric glands 
(achylia), cachexia, pernicious anemia. Hydrochloric acid is 
often absent or diminished in Bright’s disease, chlorosis and pro- 
nounced secondary anemia. 
9. About one-fourth of the hydrochloric acid secreted by 
the stomach is absorbed or neutralized by mucus. 
According to Pavlov, egg albumin has no effect upon gastric 
secretion. He found the same true of undigested starch, solid 
fats and hydrochloric acid. 
Bitters Do Not Increase the Secretion 
of Gastric Juice. 
The observations of Carlson and others have clearly demon- 
strated that, contrary to popular belief, bitters do not increase 
the production of gastric juice. Reichmann and Schceffer have THE DIGESTIVE PROCESSES 
55 
shown, in fact, that the presence of bitters in the stomach has 
the effect of lessening the secretion of gastric juice. From these 
experiments, it is evident that the age-long faith in bitters as a 
means of promoting digestion has no scientific basis. Bitters 
hinder instead of aiding gastric digestion. 
Excessive Secretion of Water by the Stomach* 
Loss of power to secrete water, or diluting juice, is the last 
functional failure in disease of the stomach. Excessive secretion 
of water frequently occurs in dilatation of the stomach. It is a 
common symptom in chronic gastritis. It may also occur in 
cancer of the stomach and atrophy of the stomach with dilatation. 
Failure of the water-secreting function of the stomach occurs in 
advanced atrophy, gastritis, cancer and in all cases of achylia. 
DIGESTION IN THE SMALL INTESTINE 
The small intestine performs the greater part of the diges- 
tive work and is the only part of the alimentary canal in which 
the work of digestion is carried to completion. It is also the 
chief organ of absorption, practically no absorption of digested 
foods taking place from either the stomach or the colon. Both 
the stomach and the colon may be removed without serious inter- 
ference with digestion or nutrition; but removal of any con- 
siderable portion of the small intestine is dangerous to life. 
Using a domestic analogy, the stomach may be considered 
the kitchen of the body and the small intestine the dining-room. 
In this part of the alimentary canal, which is about twenty-two 
feet in length, the food is disposed of so rapidly that at the end 
of eight hours from the time the food enters the stomach all of its 
usable elements have been digested and absorbed. 
The small intestine absorbs something more than six quarts 
every twenty-four hours. This amount includes not only the 
liquids taken in the form of food and drink, but the pancreatic 
juice, the gastric juice and other digestive fluids which are poured 
into it. The rapid absorption which takes place in the small 
intestine is made possible by the five million villi which hang out 
into the interior of the gut and which in some respects resemble 
the minute rootlets of a plant. Indeed, the villi may be regarded 
as the roots of the body, while the foodstuffs which pass over 
them along the intestinal canal correspond accurately to the soil THE NEW DIETETICS 
56 
which surrounds the rootlets of a plant. Each of the five million 
villi of the small intestine absorbs about one ounce of liquid in a 
lifetime of sixty years. So minute are the villi and so delicate is 
this part of the digestive machinery that a single villus working 
steadily for eight weeks is able to absorb barely one drop of 
liquid. 
In the small intestine the digestive process is fully completed, 
the useful products of digestion are absorbed, and the unusable 
residues, together with the bile, mucus and various body wastes 
which are eliminated by the intestine, are pushed on through the 
ileocecal valve into the colon, their return to the small intestine 
being prevented by the check-valve action of this remarkable 
anatomical structure. 
The Pancreatic Juice. 
In the intestine the food comes in contact with three diges- 
tive juices: the pancreatic juice, the bile and the intestinal juice. 
The pancreatic juice contains four ferments, besides activating 
substances. These are as follows: trypsin, which digests protein ; 
lipase, which digests fat by converting it into soap; amylase, 
which converts starch, dextrin and malt sugar into dextrose; 
chymosin, or rennet, which coagulates milk. 
Acids stimulate the secretion of pancreatic juice. This is 
true of food acids as well as of the hydrochloric acid of the gas- 
tric juice. Hence, when the normal gastric juice is absent, acid 
fruits should be freely used to encourage pancreatic secretion 
and intestinal digestion. Water drinking also increases pan- 
creatic secretion, as do fats and alkalies; but alkalies diminish the 
activity of the pancreatic juice while increasing its volume. An 
excessive quantity of hydrochloric acid lessens the activity of the 
pancreatic juice, although increasing the amount. 
There is an appetite pancreatic juice as well as an appetite 
gastric juice. The secretion of appetite pancreatic juice begins, 
in fact, before the appetite gastric juice secretion begins. Pan- 
creatic secretion is greatly increased by gastric hyperacidity. 
The ferments of the pancreatic juice, like those of the gas- 
tric juice, are not active when first formed by the glands. They 
only become potent agents for digestion when they have been 
activated by the bile or by bacterial products. Sometimes bile 
as well as bacteria reach the pancreas through the pancreatic 
duct and activate the pancreatic ferments, giving rise to auto- THE DIGESTIVE PROCESSES 
57 
digestion of the pancreas and pancreatitis. This occurs as the 
result of disease of the gall bladder and bile ducts, and is prob- 
ably a common cause of diabetes. 
The amylase of the pancreatic juice differs from that of the 
saliva in the fact that it is much more active and is able to digest 
raw starch. It is for this reason that the starch of the food is 
usually all digested, little or no starch being found in the feces. 
This is, unfortunately, a disadvantage, since starch or sugar is 
needed in the colon to promote the growth of lactic acid-forming 
germs which are necessary to maintain the activity of the colon 
and to hinder the growth of putrefactive organisms. 
Amylase, or the starch-digesting ferment of the pancreatic 
juice, is not often found in the colon. It is likely to be found, 
however, when starch is present, as starch seems in some way to 
protect the ferment. On this account it is desirable to take regu- 
larly with the food a sufficient amount of raw starch to insure the 
presence of a certain amount of starch in the feces. This may 
be accomplished by eating freely of uncooked vegetables contain- 
ing starch, or by avoiding overcooking of oatmeal and other 
cereals. The Scotch eat their oatmeal scalded rather than cooked. 
This practice has been in vogue in Scotland for centuries and 
doubtless with great advantage to the Scotch people. For some 
years the writer has followed a similar plan, requiring oatmeal to 
be cooked only 8 or 10 minutes instead of 30 minutes or more, the 
customary time. The use of cereals prepared in this way renders 
great service in regimens for changing the intestinal flora. 
Hyperacidity impairs the activity both of the amylase and 
of the trypsin of the pancreatic juice and hence may interfere 
with the digestion of starch and protein in the intestine as well 
as in the stomach. In cases of diabetes the pancreatic secretion 
may be so much depreciated that the protein of the food is not 
properly digested. This matter should be investigated in such 
cases. It is possible to obtain a sample of the pancreatic juice 
for examination by means of a duodenal tube. 
The Intestinal Juice, 
The intestinal juice is in some respects the most remarkable 
of all the digestive fluids. It contains nine ferments as follows: 
Erepsin, which completes the digestion of protein and is in this 
respect the most efficient of all the ferments which deal with pro- 
tein; amylase, which digests starch; lipase, which digests fat; 58 
THE NEW DIETETICS 
chymosin, which coagulates milk; maltase, which converts maltose 
into dextrose; lactose, which digests milk sugar, converting it into 
galactose*; invertase, which digests cane sugar, changing it into 
dextrose and levulose; entero-kinase, which activates trypsin ; and 
emulsin, which emulsifies fat. 
The Bile* 
The bile, produced by the liver, is secreted continuously, even 
during starvation, although it is increased after meals. The 
amount of bile produced depends somewhat upon the diet. It 
varies from a pint to a quart daily, averaging about twenty ounces. 
The importance of the bile is shown by the fact that the liver 
of the horse secretes thirteen pints of bile in twenty-four hours. 
The liver of an ox secretes nearly one-half as much; that of a 
sheep three-quarters of a pint. 
A portion of the bile is absorbed and again secreted, so that 
it becomes in this way concentrated. There is in this fact some 
justification for the idea that the bile becomes vitiated so that 
one is benefited by getting rid of a portion of it. Lauder Brunton 
noted many years ago that the bile from a biliary fistula lacks the 
bitter taste of bile, doubtless for the reason that it has not been 
concentrated by reabsorption. There may be some truth in the 
common notion that one is benefited by getting rid of a portion 
of bile through vomiting or purging. 
The amount of bile produced is greatly increased by a hearty 
meat diet. The free use of fats also increases the secretion of 
bile. Bile contains no digestive agent, but aids in the digestion 
of fats and also encourages the absorption of digested fats. It 
also contains substances which activate the ferments of the pan- 
creas. The presence of bile hinders the growth of bacteria, and 
it is also believed that it neutralizes to some extent the poisonous 
products produced by bacteria. 
It is evident that in the absence of bile the amount of pro- 
tein and fat should be reduced, so as to lessen the liability to 
injury from putrefactive processes in the colon. The digestion 
of fats is interfered with by the absence of bile; hence the intake 
of fat should be reduced when the entrance of bile into the intes- 
tine is interfered with, as in jaundice and during drainage of the 
gall bladder. 
The loss of bile through drainage of the gall bladder does 
not apparently produce any serious impairment of health, as the THE DIGESTIVE PROCESSES 
59 
body seems to be able to readily compensate the loss of the bile. 
It is necessary, however, that great care be taken to regulate the 
diet so as to lessen to the greatest degree possible the tendency to 
intestinal putrefactions. 
Intestinal Absorption and Excretion* 
The great activity of the small intestine as compared with 
the colon is seen in the fact that the latter organ, capacious as it 
is, ordinarily absorbs only about ten ounces of liquid in twenty- 
four hours, or one-twentieth as much as the small intestine. This 
great activity of the small intestine as an absorbing organ is an 
indication of the great importance of the function of the ileocecal 
valve in preventing the reflux of refuse, perhaps in a putre- 
fying condition, from the colon into the small intestine. Com- 
paratively little harm results so long as these refuse matters 
remain in the colon, even though there is some putrefaction, 
although normally no putrefaction occurs in any part of the 
alimentary canal. But when putrefying materials back up into 
the small intestine, they are rapidly absorbed, and serious mis- 
chief results, as shown bv attacks of so-called biliousness, head- 
ache, sleeplessness, skin disorders, and the highly varied symp- 
toms of intestinal toxemia. 
The large intestine is the channel through which the waste 
iron, lime and other metals are eliminated. Practically all of 
the iron, amounting to about one-sixth of a grain daily, finds its 
way out of the body through this channel. 
TRANSPORTATION OF THE FOOD 
The statements made in this section are based upon the care- 
ful observations of Cannon, Hertz, Carlson, Case and others who 
have made extensive observations upon the movements of the 
stomach and intestines by the aid of the X-rays. 
The alimentary canal is a transportation system as well as 
a series of laboratories, the tube being divided into sections sepa- 
rated by gates through which the food is moved from one part 
to the next by contraction of its muscular walls. This movement 
is termed peristalsis. 
There are ten gates. Of these, one is placed at each end of 
the canal—the mouth to guard the entrance and the anus to pro- 
tect the exit. 60 
THE NEW DIETETICS 
Next to the mouth we find the soft palate, by which the food 
is inspected as to its consistency and fitness for swallowing. 
The third gate is located at the upper end of the esopha- 
gus, or gullet, and is kept constantly closed except when food or 
water is being swallowed. 
The entrance of the stomach is guarded by a circular muscle, 
the cardiac orifice, which keeps the food in the stomach while it 
is being subjected to churning and kneading processes during 
gastric digestion. 
The outlet of the stomach, the pylorus, constitutes the fifth 
gate. Its function is to hold back the food in the stomach until 
it is prepared to enter the small intestine, then to pass it out 
from the stomach into the intestine in spoonful doses as the 
intestine is prepared to receive it. 
At the lower opening of the small intestine is found a sixth 
gate, the ileocecal sphincter, which might be properly regarded 
as a second pylorus. It holds back the food in the small intestine 
until digestion and absorption have been practically completed, 
then relaxes and permits the unused residues to pass on through 
the ileocecal valve into the colon. This structure, constituting the 
seventh gate, acts as a check valve to prevent the reflux of fecal 
matters from the colon into the small intestine. 
In the center of the transverse colon is found what may be 
called an eighth gate, where contraction waves are started in 
opposite directions, forward and backward, simultaneously. The 
backward traveling waves, so-called antiperistaltic waves, have 
for their purpose the retaining in the cecum of the dilute material 
received from the small intestine until two-thirds of its water 
content have been absorbed. By this means the consistency of 
the colon contents is increased to such a degree as to secure 
periodical rather than constant evacuations. 
A free loop of the colon, known as the pelvic colon, which 
joins the rectum, constitutes the ninth gate. After the evacua- 
tion of the bowels the pelvic colon collapses and lies low in the 
left side of the abdomen. As the loop of intestine is gradually 
filled with fecal matters, it rises again, and when fully distended, 
contracts and discharges its contents; hence this might be prop- 
erly called the discharging gate. In many cases of chronic con- 
stipation, the pelvic colon, on account of being the seat of colitis, 
has become adherent while fallen down and collapsed, and being 
unable to rise as filled, a serious obstacle to bowel movement rHE DIGESTIVE PROCESSES 
61 
develops. This condition may fortunately be relieved by an oper- 
ation. 
The anus is the tenth or exit gate. 
Swallowing* 
After the food has been chewed it is gathered upon the sur- 
face of the tongue, the tip and edges of which are pressed against 
the teeth and the roof of the mouth, the soft palate is drawn up so 
as to close the posterior opening into the nasal cavity, and by a 
backward movement the tongue is made to act like a piston, forc- 
ing the food against the soft palate and the back of the pharynx. 
At the same time the larynx rises and is pulled forward, opening 
the upper end of the esophagus, and the epiglottis moves down- 
ward with a quick jerk which tosses the food into the open gullet. 
As the act of swallowing terminates, the solid substances are 
grasped by the circular muscles at the upper end of the gullet and 
by peristaltic movements are slowly moved toward the stomach, 
into which they enter at intervals as the cardiac sphincter relaxes. 
Liquid foods move down more rapidly than solids, being squirted 
some distance down the esophagus. A partial vacuum exists in 
the lower part of the esophagus which by suction greatly facili- 
tates the movement of food in the right direction, a device which 
is certainly marvelously well adapted to the purpose for which 
it is designed. 
In the mouth the food is acted upon by voluntary muscles. 
When the work of these muscles is done, the food is tossed or 
squirted down the throat to come within grasp of the involun- 
tary muscles which from this point automatically control the 
movement of the food along the digestive canal. The act of 
swallowing is reflex. One cannot swallow except when some ob- 
ject is brought in contact with certain sensitive spots located at 
the base of the tongue, the upper surface of the soft palate and 
especially the back wall of the throat. These sensitive spots 
differ from other reflex areas in the body in that they do not 
become fatigued but are always ready to respond when stimu- 
lated. This makes it possible to swallow many times in succession 
without difficulty. When a morsel of food starts on its journey 
down the esophagus, the cardiac orifice is notified and opens at 
the right time to receive the morsel when it arrives. If cocaine 
is applied to the throat, the sensitive areas are benumbed and 
the swallowing reflex is lost. The opening of the cardiac orifice 62 
THE NEW DIETETICS 
to permit the entrance of the food into the stomach is in harmony 
with a general law governing the entire digestive tube, by which 
a wave of relaxation always precedes a wave of contraction. 
Certain drugs, as adrenalin, cause relaxation of the cardiac 
orifice. The cardiac orifice contracts more strongly after cold 
drinks and carbonated water than with warm water. It is for 
this reason that warm water is taken to encourage vomiting. 
The cardiac orifice contracts with sufficient vigor to resist a pres- 
sure equivalent to ten inches of water or about six ounces to the 
square inch. 
The gastric walls contract when the stomach is empty, grad- 
ually relaxing to accommodate themselves to the accumulating 
contents during the taking of food or liquids. This adjustment 
of the stomach to the volume of its contents is shown in the dis- 
appearance of fullness, sometimes felt during a meal, after ceasing 
to eat for a few minutes. The contraction of the cardiac sphincter 
is due to stimulation by the acid of the gastric juice as the pylorus 
is closed by a reflex produced by contact of the gastric juice with 
the intestinal mucous membrane. When the gastric acid is 
deficient, both the pylorus and the cardiac orifice may be relaxed, 
a condition which encourages intestinal infection and autointoxi- 
cation. 
When gas escapes from the stomach it is due to the fact 
that gases accumulated in the upper part of the stomach prevent 
contact of the acid gastric juice with the mucous membrane near 
the cardiac orifice. In consequence its closure is prevented. As 
the gas escapes, the fluid rises and comes in contact with the 
mucous membrane about the cardiac sphincter, which is then 
closed. 
Movements of the Stomach. 
The movements of the stomach have been very carefully 
studied by many observers. It was formerly supposed that, 
when empty, the stomach remained quiet. The observations of 
Carlson have demonstrated that this is an error and that the 
empty stomach is always active. A high degree of activity gives 
rise to so-called hunger pains. Hunger is always associated with 
contractions of the stomach. When food is received the move- 
ments become slower and one is no longer conscious of them. 
During digestion contraction waves pass over the stomach 
at the rate of three per minute. When the contents of the stom- THE DIGESTIVE PROCESSES 
63 
ach are highly acid the rate may be increased to five or even six 
waves per minute. There are also other influences which control 
the rate of gastric peristalsis. When considerable fat is present 
in the food the waves are less frequent and less vigorous. Pro- 
teins produce more frequent waves than fats. The most frequent 
waves are caused by the presence in the stomach of starch or 
sugar. These gastric contractions continue until the stomach is 
emptied, which sometimes requires several thousand waves, al- 
though if the pylorus opened at each wave, the entire contents 
of the stomach would be passed into the intestine in two minutes. 
When the gastric juice is diluted by the swallowing of 
liquids, the waves are slowed, increasing again when the gastric 
contents become strongly acid. In vomiting, the cardiac end of 
the stomach is wholly relaxed, although strong waves may occur 
in the pyloric end of the stomach. 
When vomiting is induced the cardiac end of the stomach 
is relaxed. The diaphragm and the abdominal muscles contract 
in such a way as to press the stomach between them, squeezing 
out its contents. The act of vomiting is almost wholly passive. 
When contracted, the stomach is reduced in circumference to 
about one-fifth that in its relaxed condition. In adjustment to 
accommodate the gastric contents when the stomach is distended, 
the muscular fibres of its walls slip by, and the same thing hap- 
pens with the abdominal muscles in relaxing to adjust themselves 
to distending contents. Consequently the pressure within the 
abdominal cavity may not be increased although the volume of 
the abdominal contents, as in the case of a dog after a large meal, 
may be doubled. 
In the taking of food the successive morsels are arranged in 
strata in the cardiac end of the stomach, the last food swallowed 
being found in the center. 
The two parts of the stomach really have two distinct func- 
tions, the left or cardiac end is a reservoir in which the food is 
dissolved and disinfected. This end of the stomach also secretes 
hydrochloric acid which disinfects the food. The right half of 
the stomach kneads, churns, and manipulates the food, reducing 
it to the consistency of soup and finally spurting it into the 
duodenum. 
The pylorus has a curious selective action which was noted 
by the ancients; hence its name, which literally means gate 
keeper. 64 
THE NEW DIETETICS 
Passage of Foods from the Stomach. 
In passing from the stomach into the duodenum, the gastric 
contents are spurted some distance along the intestinal canal. 
Carbohydrates pass out of the stomach most rapidly. Next 
in order are the proteins and lastly, the fats. Bread begins to 
enter the small intestine within ten minutes after eating. Potato 
leaves the stomach rapidly, perhaps because it is acted upon by 
the gastric juice only to a very small extent. At the end of half 
an hour eight times as much carbohydrates have left the stomach 
as of protein. Fats retard the passage of both carbohydrates and 
protein from the stomach when present in considerable amount. 
When the gastric contents of the stomach remain alkaline their 
passage from the stomach is delayed. 
It has been shown by Vogeler and others that hypersecretion 
and acidity are accompanied by low motility and the reverse. 
Where there is an excess of acid in the gastric fluids, the entrance 
of this strongly acid material into the duodenum causes a pro- 
longed closure of the pylorus. 
Acids delay the passage of food from the stomach by increas- 
ing the secretion of gastric acid. 
Acid protein, that is, protein to which acid has been added, 
passes through the pylorus much more rapidly than does ordi- 
nary protein. 
Protein is discharged more slowly than starch because it 
combines with the free hydrochloric acid and so delays the open- 
ing of the pylorus. 
Fat remains long in the stomach for the reason that when 
fat enters the duodenum it closes the pylorus just as does the 
gastric acid. The purpose of this is to prevent the entrance of 
fats into the intestine except at such a rate as will permit them 
to be absorbed. 
Another reason for the slow passage of fats from the stomach 
is that they lessen the activity of the acid-forming glands. 
Fat stimulates the flow of pancreatic juice. This is neces- 
sary because in the presence of fats the secretion of hydrochloric 
acid, which is also a stimulant for the pancreatic secretion, is 
lessened. 
When fats are taken in large quantities the pancreatic juice 
and bile flow back into the stomach. 
Water begins to pass into the intestine almost as soon as it is THE DIGESTIVE PROCESSES 
65 
swallowed. A pint of water may pass out of the stomach in 
thirty minutes. 
Water excites the acid-forming glands. This is an important 
provision whereby the normal stomach is kept supplied with 
gastric juice even when containing no food, which is necessary to 
prevent the growth of molds and bacteria in the stomach. 
When fats and carbohydrates are fed together the carbo- 
hydrates are discharged slowly. Fats and protein fed together 
are discharged still more slowly. Fats hinder the secretion of 
gastric acid and the protein absorbs a considerable portion of 
what little acid is secreted, thus causing great delay in the open- 
ing of the pylorus. 
Hyperacidity causes delay in the emptying of the stomach 
by keeping the pylorus closed. A solution of hydrochloric acid 
of a strength of seven-tenths to eight-tenths of one per cent, 
causes continued spasm of the pylorus. 
Since it has been shown that the gastric acid is never secreted 
at greater concentration than one-half of one per cent., it seems 
clear that pyloric spasm is really the result of a hypersensitive 
state of the gastric mucous membrane or a reflex disturbance 
from a diseased gall bladder or some other source. 
Gas in the stomach hinders peristalsis by preventing contact 
of the food with the gastric walls. This is especially true when 
the position is horizontal. 
The Effects of Heat and Cold, 
There are clinical facts which indicate that extreme heat 
and cold applied to the surface of the body influence the action 
of the intestinal muscles. For example, it is well known that the 
cold bath and exposure to cold air have a decided influence in 
producing hunger and appetite. The prolonged cold sitz bath 
increases constipation by producing a spastic or contracted con- 
dition of the colon. 
For many years the writer has regularly prescribed as a 
means of encouraging appetite an ice bag placed over the region 
of the stomach for half an hour before meals. Hot applications 
over the stomach lessen appetite. Hot applications over the 
abdomen and the hot enema cause relaxation of the spastic colon. 
Levin has shown that warm water leaves the stomach much faster 
than cold water. 66 
THE NEW DIETETICS 
The Movements of the Small Intestine. 
Peristalsis is the process by which the food is moved along 
the alimentary canal from one section to another. There are 
three forms of peristalsis: 
First, a slowly advancing contraction which moves through 
a short distance in an intestinal loop. This is the ordinary method 
by which the food is moved along the digestive tube. The rate 
of advancement is half an inch to an inch a minute. 
A second form of peristalsis is a wave movement that sweeps 
rapidly over a large part of the intestine, sometimes from one 
end to the other, without pause. This form of peristalsis is 
known as peristaltic rush. 
Another movement which occurs in the small intestine is 
the so-called segmentation, which consists of a churning move- 
ment and simple manipulation of the food with little or no ad- 
vancement. Peristaltic movements are in general in one direction, 
from above downward, but under some circumstances the direc- 
tion of the movement may be reversed. The peristaltic rush oc- 
curs after the administration of a purge and is sometimes ob- 
served after a stimulating enema, as of soap suds, or diluted 
molasses or lemon juice. 
The time required for food to pass from the stomach to the 
colon differs with different foods, being four hours for carbo- 
hydrates, five hours for fats, and six hours for proteins. Cannon 
observed that bran not only stimulates gastric peristalsis but also 
moves through the small intestine with unusual rapidity. Vege- 
table foods in general pass through the intestine more rapidly 
than animal foods because of the presence of cellulose and the 
larger amount of protein and fat in flesh foods. 
According to Cannon, when a horse eats oats, although its 
intestine is more than twice as long as the human, the material 
passes through the small intestine in a shorter time than in man. 
Irritation of the colon slows the passage of food from the 
stomach and also its movement through the small intestine. 
(Carlson.) 
The Movements of the Colon. 
The contents of the small intestine, when discharged into the 
cecum, are nine-tenths water. In the cecum two-thirds of this 
water is absorbed. According to Roith, the contents of the 
transverse colon have as great a consistency as those of the THE DIGESTIVE PROCESSES 
67 
rectum, which shows that little absorption occurs in the lower 
half of the colon. 
When the colon becomes filled with fecal matters, peristalsis 
ceases or is greatly slowed. 
The peristaltic waves of the colon begin in the middle of 
the transverse colon. The duration of the wave movements is 
four to five minutes. Antiperistaltic waves, starting at this point, 
pass backward to the cecum at intervals of ten to twenty minutes. 
These waves occur in groups at the same rate as the peristaltic 
waves of the stomach, about five per minute. 
Enemas excite antiperistalsis in the colon and stimulate the 
movements of the small intestine. The antiperistaltic waves set 
up by the enema are often very vigorous and may often continue 
for an hour or more. This is doubtless one cause of the fre- 
quent retention of the enema, the water injected being held in 
the cecum by antiperistalsis. 
Activity of the colon is stimulated by the entrance of food 
from the small intestine through the ileocecal valve. Both peris- 
taltic and antiperistaltic waves occur. Although strong antiperis- 
taltic waves force the contents of the cecum back against the 
ileocecal valve, this structure is so efficient a check valve it pre- 
vents the passage of material from the colon into the small 
intestine. At least this is true when the valve is intact. Cannon 
reports that although he has watched this movement hundreds of 
times, he has never but twice seen material pass from the colon 
into the small intestine. In one of these cases the colon of the 
animal had been greatly distended by the introduction of water. 
The ileocecal sphincter, which is located just behind the ileo- 
cecal valve, is provided with a special nervous control distinct 
from that of any other part of the intestinal canal, showing that 
this is an important and essential structure. Its evident purpose is 
to hold back in the small intestine the digesting foodstuffs until 
the processes of digestion and absorption are complete and the 
wastes ready to be passed on into the colon for dismissal from 
the body. 
The function of the ileocecal valve is to maintain the normal 
forward movement of the food residues and wastes pushed into 
the colon from the small intestine. Without the ileocecal valve 
antiperistalsis would continually drive back into the small intestine 
the contents of the colon and thus prevent its forward movement. 
Says Cannon: “Antiperistalsis in the colon gives new meaning 68 
THE NEW DIETETICS 
and value to the location of a sphincter or valve at the opening 
of the ileum. For, inasmuch as the valve is normally competent, 
the constrictions repeatedly coursing toward it force the food 
before them into a blind sac. The effect on the contents must 
be the same as the effect seen in the stomach when the pylorus 
remains closed before the advancing waves. The confined ma- 
terial is pressed upon by the approach of each constriction; but 
since it cannot go onward in the blind sac, and is, moreover, sub- 
jected to increasing pressure as the constriction comes nearer, it is 
forced into the only way of escape—i. e., away from the cecum 
through the advancing constricted ring. About twenty-five waves 
in the cat affect thus every particle of food in the colon during 
each normal period of antiperistalsis. The result must be a thor- 
ough mixing of the contents, and a bringing of these contents 
into close contact with the absorbing wall—a process which has 
already been variously repeated many times jn the stomach and 
in the small intestine. The last remnants of value in the food, 
with some of the water, are here removed; and the waste is 
passed onward into the distal colon to be ejected from the body.” 
Case established by extensive studies conducted in the X-ray 
laboratories of the Battle Creek Sanitarium the same antiperistaltic 
function for the human colon that Cannon first observed in 
animals. 
According to Hertz, the time required for the food to pass 
through each of the three parts of the colon is two hours. 
The movements of the colon are about 50 per cent, less active 
during sleep than during the waking hours. 
The taking of food greatly accelerates the movements of the 
colon. Hertz observed more progress of the residues in the colon 
during a meal hour than during four previous hours. It appears, 
in fact, that most of the progress of the food residues in the colon 
occurs during the taking of food and shortly after. Hence the im- 
portance of taking ample time to masticate. 
Under normal conditions, when the colon is kept free from 
accumulating residue, the new materials brought into it “are 
moved onward into an empty distal section by a sudden push 
lasting a few seconds.” (Holzknecht.) Three or four such 
pushes of three seconds each are sufficient *o transmit the food 
residues from one end of the colon to the other. 
According to Hertz, the entire colon is emptied by a single 
contraction in normal defecation. In constipation, and in those THE DIGESTIVE PROCESSES 
69 
whose bowels move but once a day, only the lower part of the 
colon is emptied. 
The highly detrimental effect of constipation is clearly shown 
by the fact observed by Cannon that “When the colon is full it 
is usually quiet.” 
The intra-abdominal pressure in the rectum during defeca- 
tion is four to eight times the ordinary pressure. It may amount 
to two to four pounds to the square inch. When the abdominal 
muscles are weak, as the result of bad posture, improper dress or 
neglect of exercise the intra-abdominal pressure may be insuffi- 
cient to secure thorough emptying of the colon. This is undoubt- 
edly one of the most common causes of constipation. 
As regards the time required for the complete transit of the 
alimentary tract. Cannon says: “If approximately nine hours 
are required for material to reach the descending colon in man, 
the waste from food taken at eight o’clock in the morning might 
be discharged at five o’clock in the afternoon.” 
Evidently the normal rhythm would secure three bowel 
movements daily, or a bowel movement after each meal. Unfor- 
tunately the normal condition is rarely found among civilized 
people, who almost universally suffer from chronic constipation 
through neglect. Cannon says : “If the signal is not soon obeyed, 
it ceases to be given ; the feces may then remain long in the rectum 
without calling forth sensations, and the defecation reflex be to 
that extent impaired.” 
The effects of certain drugs upon peristalsis is very pro- 
nounced. Nicotine at once abolishes peristalsis in the small 
intestine. Adrenalin stops peristalsis of the stomach immediately 
and causes intra-gastric pressure to fall to zero. 
The Nerves of the Alimentary Canal. 
The activities of the alimentary canal are controlled by 
three sets of nerves. First, the motor nerves, consisting of the 
two pneumogastric nerves which control the food tube from the 
esophagus to the lower end of the ileum; and the sacral or pelvic 
nerves which control the colon and the ileocecal valve. Second, 
the sympathetic nerves, the action of which is to inhibit or con- 
trol the action of the motor nerves. Third, nerve ganglia located 
in the walls of the gut. 
The tonus or tonic contraction of the stomach, when empty, 
is due to the local nerves in the walls of the stomach. The 70 
THE NEW DIETETICS 
peristaltic waves may continue even after the stomach has been 
removed from the body of an animal provided it is kept in a 
warm salt solution. Peristaltic and antiperistaltic waves of the 
colon and the segmenting or churning movements of the small 
intestine are likewise due to local nerves. 
The pneumogastric nerves control the pylorus and cardiac 
orifice. When these nerves are stimulated, the pylorus contracts 
and the cardiac orifice relaxes, an admirable arrangement which 
makes vomiting possible as a means of emptying the stomach. 
This arrangement also provides for the entrance and rejection 
of food in the stomach. 
When food is swallowed, the branches of the pneumogastric 
nerves in the throat are stimulated; as a result the pylorus con- 
tracts, the cardiac orifice opens in eight or ten seconds from the 
time food starts from the mouth, the pressure in the stomach falls 
to zero, and the stomach increases in size to enable it to accom- 
modate the incoming food. The closure of the pylorus during 
swallowing is necessary to prevent the reflux of bile and other 
matters from the small intestine. 
The appetite juice, or psychic secretion, is produced through 
the action of the pneumogastric nerves, which are reflexly stim- 
ulated through the nerves of taste. There is likewise a psychic 
gastric tonus which causes the stomach to contract when food is 
taken into the mouth. 
The stomach, intestines, and other viscera do not possess the 
ordinary sensation of pain or touch. The stomach and also pos- 
sibly the intestine have the temperature sense and are more or 
less sensitive to cold and heat. 
Pain referred to the abdomen is believed to be really due 
to the extreme sensitiveness of the peritoneum or lining mem- 
brane of the abdominal wall, which is very highly endowed with 
the pain sense, and when in the state of inflammation is exquis- 
itely sensitive. 
The muscular sense is highly developed in the walls of the 
stomach and intestine. Violent contractions of the muscular 
walls of the intestine, or cramp, give rise to pain much the same 
as does muscular cramp in any other part of the body. 
Because of the close connection of the duodenum and the 
colon with the abdominal wall, inflammation and violent con- 
tractions of these parts are more likely to give rise to pain than 
when they occur in other parts. THE DIGESTIVE PROCESSES 
71 
Stretching is the most efficient means of stimulating the 
intestinal wall to contraction. This is the cause of the pain of 
colic. 
The introduction of fluid into the colon gives rise to both 
antiperistaltic and peristaltic waves by distending the colon. If 
the quantity of liquid introduced is so large as to overstretch the 
gut, severe colic pains may be induced. 
When the sympathetic nerves are stimulated the result is 
complete relaxation of the entire alimentary tract except the 
pylorus, ileocecal sphincter and the anal sphincters. Nicotine irri- 
tates the sympathetic nerve and thus has the effect of paralyzing 
the pneumogastric nerves, abolishing their action upon the stom- 
ach and intestine. 
The pain of gastric ulcer is due to inflammation of the 
lymphatic vessels and glands in the vicinity of the ulcer. In this 
condition a very weak acid solution may give rise to pain, whereas 
in a healthy stomach no sensation whatever is produced by a 
strong solution of hydrochloric acid (one-half of one per cent.). 
Great weakness or depression may cause complete suspension 
of the peristaltic waves of the stomach and intestine so that the 
food remains stationary. Anger, anxiety, mental or physical dis- 
tress may cause the movements of the stomach to cease at once. 
Cannon observed this in the cat, rabbit, dog and guinea pig. 
The antiperistaltic waves of the colon are abolished by ex- 
citement, which may be a cause for the occasional occurrence of 
sudden diarrhea under this condition. 
The excitation of the sympathetic nervous system by emo- 
tional excitement may cause cessation of both secretion and 
motion in the entire alimentary canal. 
.The tonus of the stomach, which starts digestion, depends 
upon appetite. Appetite gives rise to hunger, and Cannon has 
shown that hunger is due to contraction (tonus) of the gastric 
muscles. 
The Normal Intestinal Rhythm. 
When at the end of eight hours the unusable residue is 
pushed through into the colon it is ready to be dismissed from the 
body and should be dismissed without any considerable delay. 
The colon possesses no digestive function. It is a waste disposal 
organ, and when properly trained hastens along the refuse re- 
ceived from the small intestine, together with the various body 72 
THE NEW DIETETICS 
wastes which are excreted into it, and pushes them out of the 
body before they have had time to undergo putrefactive changes. 
Recent X-ray studies of the colon show that it possesses a 
controlling mechanism somewhat similar to that which controls 
the heart. When undamaged by mistreatment it handles the 
food residues in a wonderfully intelligent and efficient manner. 
A check valve placed between the small intestine and the colon 
prevents the reflux of the waste matters from the colon, which 
is highly important. The rapid transit of the foodstuffs through 
the small intestine affords no opportunity for putrefactive 
changes. The small intestine never rests until its undigested 
residues have all been pushed on into the colon, a task which is 
practically always completed at the end of eight hours from the 
beginning of a meal. Fortunately, the movements of the small 
intestine are wholly independent of the will, and its expeditious 
action is rarely interfered with by any cause whatever. With the 
colon, however, the case is different. Whether or not the colon 
is emptied of its contents depends more or less upon individual 
whim and convenience. 
If evacuation of the bowels at the proper time is neglected, 
the waste products which are continually being pushed forward 
from the small intestine accumulate and the colon becomes filled 
from end to end and even distended by its undue accumulation. 
On the other hand, if the colon is permitted to function in a 
perfectly normal manner, the waste products which reach the 
center of the colon eight hours after the taking of a meal are by 
the impetus received by the next meal pushed forward nearly 
to the point of exit and by the impetus received from the follow- 
ing meal are pushed out of the body. 
A moment’s thought will show that when this order of things 
exists, the food residues and body wastes are never retained long 
enough to permit putrefactive changes to occur. For example, if 
breakfast is taken at 8 o’clock the residue may be dismissed by 10 
o’clock P. M. or at the end of 14 hours; the dinner residue will 
be dismissed soon after rising the next morning or at the end of 
17 to 19 hours; and the supper residue will be dismissed after 
breakfast or, at the latest, after dinner the next day or at the end 
of 15 to 20 hours. So/ long as this happy order is maintained, 
there is no putrefaction in the colon, no absorption of putrefac- 
tion products, and in consequence freedom from biliousness, head- 
aches, lack of appetite, and the long list of miseries which are the After Breakfast 
8 A. M. 
After Dinner 
1 P. M. 
After Supper 
6 P. M. 
10 P. M. 
BREAKFAST 
DINNER 
SUPPER 
THE ALIMENTARY PROCESSION AS SHOWN BY THE X-RAY X 
Before Breakfast 
2d Day 
After Breakfast 
2d Day 
'“One-a-Day” 
Constipation 
Colitis 
BREAKFAST 
DINNER 
SUPPER 
THE ALIMENTARY PROCESSION AS SHOWN BY THE X-RAY THE DIGESTIVE PROCESSES 
73 
natural result of the absorption from the colon of the poisons of 
various sorts which are always present when constipation exists; 
that is, when the bowels move but once a day or at less frequent 
intervals. 
The universal use of pills, mineral waters and other means 
of stimulating the activity of the bowels is the natural result of 
the abuses to which the colon is subjected by wrong diet, neglect 
to attend to the call of nature and various other disturbing 
influences which are almost universally active among civilized 
people. 
Our dogs, cats and other household pets are “house-broken” 
and in consequence become constipated like their masters who 
are also house-broken. The poor colon has suffered to an extra- 
ordinary degree from the conditions imposed by house dwelling 
and civilized life. An Arab, when offered a good situation in a 
neighboring city, declined for the reason that in the city it was 
often inconvenient to evacuate the bowels promptly when nature 
demanded. 
A Japanese home provides toilet conveniences for visitors 
adjacent to the receiving room. A visitor does not hesitate to 
inquire, if a man, for “the honorable convenient place,” or, if a 
lady, for “the honorable modest place.” 
The modes of our Western civilization impose upon us a 
hypocritical modesty the influence of which is most deadly, and 
in many different ways. 
Constipation is a disease of civilization. Wild men and wild 
animals do not suffer from this malady, which is perhaps respon- 
sible for more human misery, mental and moral disaster, and even 
crime, than almost any other cause that could be named. This 
subject will receive further attention in a chapter devoted to the 
dietetic treatment of constipation. The Liver 
The liver is one of the most remarkable and versatile organs 
in the body. The weight of the liver, the largest gland in the 
body, is three and one-half pounds. It contains more than twenty 
million bile-making cells which together produce every twenty- 
four hours twenty ounces of bile. It has been estimated that 
each cell makes in a lifetime of sixty years, ten drops of bile! 
These facts place before the mind at once a vivid picture of 
the wonderfully delicate structure of this marvelous organ. The 
liver performs more different kinds of work than any other organ 
of the body. Here is a brief summary of the chief kinds of work 
performed by the liver: 
1. The Liver Aids Digestion. When food leaves the intes- 
tine and enters the portal vein the digestive work is not yet quite 
completed. It requires certain delicate touches which only the 
liver can give; hence the portal vein carries to the liver the pro- 
ducts of gastric and intestinal digestion and there the digestive 
work is completed. Levulose or fruit sugar is by the liver con- 
verted into glucose or dextrose, the only form in which the body 
cells can make use of sugar. Galactose, derived from milk sugar, 
is also converted into dextrose by the liver. The liver converts 
wastes and surplus protein into ammonia and further converts 
ammonia into urea. Finally, the liver aids digestion by secreting 
and pouring into the intestine 20 ounces of bile every 24 hours. 
2. The Liver Stores Food Supplies. The sugars of various 
sorts absorbed from the intestine are by the liver converted into 
glycogen or animal starch and stored up in its cells, a source of 
energy to be drawn upon until the supply is replenished by an- 
other meal. From moment to moment, as needed, the liver 
changes the insoluble glycogen back to sugar and pours it into 
the blood to be sent to the heart and other muscles for use. 
The liver also stores up iron. This is particularly true in 
infancy. The liver of the new born infant contains nearly all 
the iron that will be required to produce the hemoglobin of the 
blood until the infant has attained the age of nine months. This 
is necessary for the reason that the mother’s milk contains but 
74 THE LIVER 
75 
a very small percentage of iron. The livers of guinea pigs store 
no iron. No storage is required because the guinea pig begins 
the very day it is born to eat grass which is rich in iron. But 
milk contains little iron and as the human infant receives little 
iron-containing food until after it is weaned, its liver is stocked 
with iron before its birth to furnish the material needed for 
blood making during the nursing period. 
It is believed that the liver of adults stores iron derived 
from worn-out red blood cells and utilizes it in the making of 
hemoglobin for new red corpuscles. 
The liver also stores up vitamins, particularly the fat-soluble 
vitamin, the deficiency of which in foodstuffs causes dwarfing in 
growth and diseased conditions of the eyes. This interesting 
fact explains the well known efficacy of cod liver oil in improving 
certain conditions of bad nutrition. It is now known, however, 
that butter and cream possess the same value, a fact clinically 
recognized long ago by sagacious practitioners. Now that the 
rationale of the use of the unpalatable oil is understood, it ought 
rapidly to fall into disuse. 
3. The Liver Stores Metallic Poisons. Metals, such as lead, 
which may be found in water which has passed through lead pipes, 
mercury used as medicine or absorbed by other means, and various 
other metallic substances found in hard waters and mineral waters 
are captured, in large part, by the liver. The storing of these 
foreign substances in the liver more or less cripples it and impairs 
its functions; hence the liver should be protected against damage 
from this source. 
4. The Liver Detoxicates Organic Poisons. It is the liver 
which stands between the smoker and death. The liver destroys 
or detoxicates nicotine and prepares it for elimination by the 
kidneys. This is true of the numerous poisons absorbed from the 
colon and the various poisons produced by the body as well as of 
poisons received through food and drink, such as alcohol, tea, 
coffee, etc. When the liver has more of this work than it can well 
perform the blood becomes saturated with poisons and a state of 
autointoxication is produced. In this condition a person suffers 
from the symptoms which are commonly known as “biliousness.” 
The indication is not that the liver is inactive but that more work 
is imposed upon it than it is possible for it to perform. 
Detoxication of the normal body wastes and preparation of 
these substances for elimination by the kidneys is the normal 76 
THE NEW DIETETICS 
work of the liver. To require of this heavily loaded organ to do 
unnecessary work in dealing with such poisons as alcohol, nico- 
tine, caffein, and the poisons of pepper, mustard and similar con- 
diments, is unnatural and must result in the premature wearing 
out and failure of the liver. Boix showed that pepper is six 
times as active in causing gin liver or cirrhosis as is gin, and 
acetic acid, the acid of vinegar, twice as active. 
5. The Liver Probably Makes Ferments and Hormones. 
These subtle substances are essential for the working of the 
wonderfully intricate mechanism of the body. Nearly all of the 
vital changes which take place in the body are the result of the 
action of activating substances, that is, substances which set in 
motion vital or chemical changes by their mere presencee. Many 
of these hormones and ferments are known, but it is believed 
that the unknown activating agents greatly outnumber those 
which are as yet known. 
6. The Liver Makes Bile. In the bile are found highly 
poisonous alkaline wastes. Bouchard showed that the bile is 
six times as poisonous as the urine. The alkaline substances 
which the bile contains serve a useful purpose in neutralizing 
the acidity of the gastric contents, which must be neutralized 
quickly after they enter the small intestine to prevent injury to 
the delicate mucous membrane of these parts, which is not able 
to withstand the action of acids as is the mucous membrane of 
the stomach. Bile activates the pancreatic juice which, when it 
leaves the pancreas, possesses no digestive activity. Bile also 
emulsifies fats, aids the absorption of fats and other digestive 
foodstuffs and inhibits or hinders the growth of germs and the 
production of germ poisons, possibly also serving in some degree 
to neutralize the poisons produced by certain bacteria in the 
intestine. 
Recent observations indicate that the bile contains uric acid 
which the liver excretes with other poisons. 
Bouchard showed that the bile is six times as poisonous as is 
the urine. It should be promptly eliminated by the discharge of 
the bile with other wastes by evacuation of the bowels. When 
constipation exists, the bile is re-absorbed and again excreted by 
the liver, thus becoming concentrated. This concentration of the 
bile is probably a common cause of what is generally known as 
“biliousness.” THE LIVER 
77 
7. Attention has recently been called to the fact that the 
liver destroys foreign proteins which find their way into the blood 
stream without having undergone complete digestive transforma- 
tion. This function is a protection against anaphylaxis. When 
inefficiency of the liver exists, this function fails and the con- 
dition may be detected by Ewald’s test (See Index). Mastication 
Grinding, mixing, spreading, transporting and discharging 
are the several mechanical factors involved in the process of 
digestion. In chewing, the cheeks and the tongue co-operate in 
keeping the food between the teeth, which by a gradual reduction 
process grind hard substances to the proper fineness for swallow- 
ing. The consistency of the food is tested by the cheeks, the 
gums, the tongue and the soft palate. When found imperfectly 
chewed the food is automatically returned to the grinding sur- 
faces for further chewing. The soft palate, the membranous veil 
which hangs in the back of the throat, is endowed with a delicate 
tactile sense which especially equips it for the inspection of the 
foodstuffs which come in contact with it in the act of swallowing. 
When properly chewed, much of the food becomes liquid, being 
dissolved by the saliva and to some extent liquefied by the diges- 
tive action of the salivary ferment. The undissolved portion is 
reduced by thorough mastication to particles not more than one- 
twelfth of an inch in diameter. It is not uncommon, however, 
to find in vomited matters masses half an inch or more in diam- 
eter, because of insufficient mastication. 
The amount of pressure exerted in chewing, when tested 
with the dynamometer, is found to be surprisingly great, amount- 
ing in a person with well developed jaws to as much as 270 
pounds when the teeth are brought together with as much force 
as possible. In the chewing of delicate or friable substances a 
pressure of not more than 1 or 2 pounds is sufficient. Tough 
meat requires a pressure of 40 pounds to divide its fibers. In the 
chewing of bread crust the pressure rises to 60 pounds, though 
when well softened with water or saliva it is easily crushed with 
a pressure of 3 pounds. 
The act of chewing does more than merely to mechanically 
divide the food. It promotes the flow of saliva and prepares the 
stomach for the reception of the food. Chewing of palatable 
food causes the stomach to contract and causes the gastric glands 
to pour out the appetite juice which is necessary to start the 
process of gastric digestion after the food is received into the 
78 MASTICATION 
79 
stomach. If the food is tasteless, or indifferent, mastication has 
no effect upon the stomach. When food is hurried through the 
mouth instead of being properly chewed, overeating is likely to 
occur as the gustatory reflexes through which the body instinct- 
ively makes a selection of foodstuffs suited to its needs have no 
opportunity to operate. 
Spallanzanis Discoveries About Mastication, 
Probably many people imagine that Horace Fletcher was 
the first apostle of thorough mastication; but the fine art of 
mastication really had a much more ancient origin. To Spallan- 
zani, a man of science who flourished in the eighteenth century 
(1729-1799) belongs the credit of having been the first to dem- 
onstrate the importance of thorough chewing of the food. In his 
great work on “Digestion,” Spallanzani gives an account of 
experiments which demonstrate the importance of thoroughly 
chewing the food. Spallanzani was the first to study experi- 
mentally the properties of the gastric juice. He made small 
hollow spheres with perforated sides. Into these he introduced 
foodstuffs of various sorts, then swallowed the spheres and after 
they had passed through the body, examined the contents, noting 
the changes which had been wrought by digestion. By this 
ingenious method, he also studied the effects of mastication. 
We quote his own account of his experiments and his con- 
clusions therefrom from an old work, “The Art of Invigorating 
Life,” by Wm. Kitchiner: 
I took two pieces of Mutton, each weighing 45 grains, and having 
chewed one as much as I used to chew my food—enclosed them in 
two separate spheres—and swallowed them at the same time—these 
tubes were voided at the same time—of the masticated meat there 
remained only 4 grains—of the other there were 18 left. 
The necessity of Mastication is sufficiently known—there is per- 
haps no person who has not, some time or other, suffered from Indi- 
gestion, for want of having chewed his food properly. The reason is 
obvious. Not to mention the saliva which moistens the food, and 
predisposes it to be dissolved, it cannot be doubted, that when it is 
reduced to pieces by the action of the Teeth, the gastric fluid pene- 
trates, and attacking it at more points, dissolves it more speedily than 
when it was whole. This is true of menstrua in general, which always 
dissolve bodies sooner when they have been previously broken to 
pieces. This is also the reason why, in other experiments, masticated 
bread and dressed flesh were more readily dissolved than unchewed 
bread and raw flesh. The boiling had made it tenderer, and conse- 
quently disposed it to allow ingress to the gastric fluid. 80 
THE NEW DIETETICS 
Three-quarters of a century later, the famous Dr. Arbuthnot 
tells us that “Mastication is a very necessary Preparation of 
solid Aliment, without which there can be no good Digestion”; 
and that 
To Chew long, and leisurely, is the only way to extract the 
essence of our food—to enjoy the taste of it, and to render it easily 
convertible into laudable Chyle, by the facility it gives to the gastric 
juices to dissolve it without trouble. 
The pleasure of the Palate, and the health of the Stomach, are 
equally promoted by this salutary habit, which all should be taught to 
acquire in their infancy. * * * 
From 30 to 40 (according to the tenderness of the meat) has been 
calculated as the mean number of Munches, that solid meat requires, 
to prepare it for its journey down the Red Lane; less will be sufficient 
for tender, delicate, and easily digestible white meats. 
Finke, in his “Medical Geographypublished more than 
a hundred years ago, tells us that, 
Slave dealers are well acquainted with the characteristic signs of 
perfect Health—any defect of which much diminishes the value of a 
Slave. The want of.a Tooth makes a Slave worth two Dollars less. 
Mastication is the source of all good Digestion;—with its assist- 
ance, almost any thing may be put into any stomach with impunity:— 
without it, Digestion is always difficult, and often impossible: and be 
it always remembered, it is not merely what we eat, but what we 
digest well, that nourishes us. 
Brillat-Savarm, a French advocate and judge who at the 
time of the French revolution sought refuge in this country, in 
an interesting work entitled “Physiologie du Gout,” calls atten- 
tion to the importance of mastication, telling us that the food- 
stuffs “must be comminuted by the teeth, impregnated with the 
saliva and other gustatory juices, and pressed against the palate 
by the tongue till the juice so yielded makes a favorable impres- 
sion upon the gustatory papillae, and the triturated body receives 
from them the passport necessary to enter the stomach. 
In performing this function, the tongue unites the food in a pulpy 
mass in the middle of the mouth; and then, supporting itself against 
the lower jaw, it lifts up its central portion, so that it forms at its 
root a declivity through which the food slips into the back part of the 
mouth, where it is received by the pharynx, which, contracting in its 
turn, propels it into the esophagus, of which the peristaltic motion 
conducts it into the stomach. 
Beaumont a few years later in the epoch making work in 
which he recorded the results of his “experiments and observa- MASTICATION 
81 
tions on the gastric juice and the physiology of digestion” made 
on St. Martin, tells us that “Mastication is absolutely necessary 
to healthy digestion.” He adds, “If food is swallowed rapidly, 
more will generally be taken into the stomach before the sensa- 
tion of hunger is allayed than can be digested with ease.” 
The noted Count Rumford, and Sinclair, the famous author 
of “The Code of Health,” likewise advocated thoroughgoing 
mastication. 
The late Dujardin-Beaumetz, of Paris, called special atten- 
tion to the importance of mastication many years before the 
advent of Fletcherism. Said this eminent medical teacher: 
It is not sufficient simply to prescribe a vegetarian regimen, 
abstinence from alcoholic drinks, and the use of alkaline waters; it is 
necessary to require of the patient that he give to his meals sufficient 
time to secure complete mastication of his food. Miahle maintained 
many years ago that all dyspepsia is the result of insufficient mastica- 
tion. Without going so far as this, one may say, however, that the 
presence of badly masticated foods is one of the most frequent causes 
of gastro-duodenitis. Such foods really act as foreign bodies, which 
irritate the pyloric region of the stomach and the mucous membrance 
of the duodenum. The same is true of an excessive quantity of foods. 
Great eaters are very subject to gastritis. It is necessary, then, to 
eat rationally and to masticate slowly. 
Sir Andrew Clark, physician to Queen Victoria, used to say 
that since the mouth contains thirty-two teeth every mouthful of 
food should receive thirty-two bites. 
It is thus very evident that the importance of thorough 
mastication of the food is by no means a new or a modern dis- 
covery, but is simply the recovery of a much neglected truth, the 
value of which was fully appreciated by our remote ancestors as 
well as other members of the animal kingdom. 
Since 1875 the writer has frequently demonstrated experi- 
mentally in public lectures the necessity for thorough chewing 
of the food to secure the digestion of starch. During the entire 
period it has been his practice to recommend to his patients the 
thorough mastication of dry food for the purpose of promoting 
the health of the teeth and good digestion. This practice, in fact, 
was begun by the writer himself more than fifty years ago as a 
result of an elementary study of human physiology. Mr. Fletcher 
certainly did not discover the necessity for thorough mastication. 
His Fletcherizing movement was a renaissance. 82 
THE NEW DIETETICS 
Horace Fletcher's Discoveries. 
A few years previous to the year 1902, Mr. Horace Fletcher, 
an American, at that time living in Venice, in an effort to improve 
his health so as to enable him to pass a life insurance examination, 
had been led to the discovery of the value of thorough mastica- 
tion of the food as an aid to digestion and nutrition. Of course, 
the value of thorough chewing of the food had been known 
before, having been especially pointed out by Spallanzani in 1780, 
also by Dr. Beaumont and by Brillat-Savarin. It was known that 
Gladstone required his children to chew each morsel of meat 
forty times before swallowing it, and the writer had for thirty 
years consistently advocated with both voice and pen thorough 
mastication as a necessary prelude to good digestion. 
A really important discovery made by Mr. Fletcher, one 
which, so far as the writer knows, was quite original with him, 
consisted in his observation that in connection with thorough 
chewing of the food there is exercised, through the sense of taste, 
a remarkable selective function which is closely correlated with 
physiologic needs. 
This discovery of Mr. Fletcher’s was one of priceless value, 
although neither the physiologists nor the world at large have, 
as yet, begun fully to appreciate its importance. The accuracy 
of Mr. Fletcher’s observation has been checked up by numerous 
other observers, notably by a very extended and elaborate experi- 
ment undertaken by Professor Irving Fisher some years ago, with 
a group of Yale students. 
One of the first things noted by Mr. Fletcher was the fact 
that when each morsel of food was thoroughly masticated, the 
amount required to satisfy hunger and sustain the energies of 
the body was greatly diminished; and Count Rumford, more than 
a century ago, suggested to the elector of Bavaria that if he 
would require his soldiers to thoroughly chew their rations a 
small quantity of food would be found to “afford more sustenance 
than a large meal hastily devoured.” 
Mr. Fletcher’s observations went farther and deeper. He 
noted not only that the total food requirement was lessened, but 
that there was especially a notable curtailment of certain kinds 
of foodstuffs, especially those which were rich in protein. This 
led him to the further discovery that the amount of protein 
actually needed to meet essential body needs is really very small, 
only a fraction of that ordinarily consumed. It was this feature MASTICATION 
83 
of Mr. Fletcher’s observations which led him to make his greatest 
contribution to dietetic progress, which consisted in the enlisting 
of Professor Chittenden to undertake his historic research for 
the purpose of determining the minimum protein requirement. 
This great experiment, in which a body of soldiers, loaned 
by the United States government for the purpose, a number of 
athletes and several college professors served as subjects, was 
extended over many months, and established beyond any chance 
for cavil the sufficiency of a ration containing less than half the 
amount of protein which had previously been considered essential 
for the maintenance of health and vigorous activity. Chitten- 
den’s results have been abundantly confirmed by other investi- 
gators. 
Sherman showed (Journal of Biological Chemistry) by 67 
experiments on men and 42 experiments with women, that the 
average amount of protein required per day is 0.635 grams per 
kilogram of body weight, which is equivalent to 0.29 grams 
(4.5 grains), or one and one-sixth calories per pound of body 
weight. This will give a man weighing 150 pounds and requiring 
2,500 calories 175 calories of protein instead of the 250 supplied 
by the Chittenden standard. 
Newburgh and others have shown by careful studies upon 
diabetic patients that a nitrogen balance can be maintained upon 
a diet supplying .3 grams (1.2 calories) per pound of body weight. 
The Japanese have for generations “lived and thrived on a 
daily ration noticeably low in its content of protein” and “genera- 
tions of low protein feeding, with the temperance and simplicity 
in dietary methods thereby implied, have certainly not stood in 
the way of phenomenal development and advancement” (Chit- 
tenden). 
Mr. Fletcher not only instigated the research conducted by 
Professor Chittenden, but, according to his own statement to the 
writer, he shared the expense of the work to the extent of several 
thousand dollars. 
But Mr. Fletcher’s observations went still further. He dis- 
covered that thorough mastication of the food gradually lessened, 
and, after a time, eliminated the relish for such unwholesome 
things as mustard, pepper and other hot condiments. Even wine, 
when taken very slowly, so that each sip was retained in the 
mouth until the last vestige of flavor was exhausted, lost its attrac- 
tion and a very small amount sufficed to satisfy the wine craving, 84 
THE NEW DIETETICS 
which finally disappeared, together with the craving for tobacco. 
Professor Fisher’s experiments confirmed the observations 
of Mr. Fletcher in a very striking manner. A group of young 
men, consisting of half a dozen students from the different de- 
partments of Yale University, were furnished with a cook and 
caterer, and given carte blanche as to the constituents of their 
bill of fare, in both quality and quantity. In other words, they 
were allowed to eat anything they liked and as much as they 
liked, the only stipulation being that they should thoroughly chew 
each morsel of food. After a few months, it was found that the 
young men had practically discontinued flesh meats of all kinds. 
When asked why they had done so, the unanimous reply was, 
“The long chewing of the meat made it distasteful to us.” The 
only ones who continued the use of meat were one or two stu- 
dents who had been less conscientious than the others in obeying 
the instructions with reference to thorough chewing. 
Mr. Fletcher established the fact that the sense of taste, 
properly trained, is a competent guide as regards both the quan- 
tity and the quality of the food required. It must be remem- 
bered, however, that the nerves of taste can exercise this function 
only when thorough mastication gives them an opportunity to 
fully examine the food and to completely appreciate its sapid 
properties. The experiments of Evvard with pigs and of 
Osborne with white rats have shown that animals, when left to 
themselves, are instinctively led to make the wisest selection of 
foodstuffs, and when thus thrown upon their own responsibility, 
flourish to an extraordinary degree. 
It is unbelievable that the human race has from the begin- 
ning been inferior to animals in the ability to select the foods 
necessary to meet nutritive requirements; but somewhere on the 
long road from our prehistoric origin down to our present 
degenerated state this food-regulating instinct has been to such 
a degree obliterated or blunted that, until Mr. Fletcher made his 
interesting discovery, it was supposed to be lost. Indeed, it 
cannot be denied that man’s best performances in this line is 
highly inferior to what is seen in lower animals, for the wolf, 
the monkey and wild animals generally, and to a very large extent 
domestic animals, determine the wholesomeness of food by the 
senses of smell and taste; but in man this power is so nearly lost 
that he derives comparatively little assistance from his senses In 
the selection of food with reference to its healthful properties. MASTICATION 
85 
It is quite possible, however, that future investigations may show 
that the olfactory and the gustatory nerves, which are closely 
associated in the sensations we call taste, may be the seat of won- 
derful reflexes through which the body may govern the intake 
of new material so as best to meet its essential needs. 
And so it appears that man is not altogether left without 
a guide and compass in relation to his nutritive needs. He still 
possesses a mentor which, though speaking with a greatly attenu- 
ated and weakened voice, is nevertheless able to make itself heard, 
if he is only willing to listen attentively. And to listen, one must 
take care to chew each morsel of food, not simply until it is fine 
enough so that it can be swallowed conveniently, but until the 
major part of its flavor has been set free and appreciated. Any- 
one who will take his food in this manner will have little occasion 
to consult diet specialists or call for professional aid of any sort; 
for there is no one thing which comes so near to being a panacea 
for all gastric ills and nutritional disorders as thorough mastica- 
tion of the food and careful attention to the natural promptings 
of a disciplined and intelligently studied sense of taste. 
In the journal, “Good Health” as well as in numerous books, 
the writer has advocated the importance of mastication for fifty 
years, but the world is certainly indebted to the late Mr. Horace 
Fletcher for attracting public attention to mastication as a means 
of promoting good nutrition and initiating a popular movement in 
behalf of chewing reform. 
It was for the purpose of encouraging patients to masticate 
their food thoroughly that the writer many years ago (1895) was 
led to undertake experiments which resulted in the invention of 
toasted wheat flakes, corn flakes, and other toasted cereal flakes. 
For many years it was the custom at the Battle Creek Sanitarium 
to place at the plate of each patient a small bowlful of wheat 
flakes which he was expected to eat dry before taking any other 
food. The purpose of this was to educate patients in the art of 
mastication and to develop the habit of thorough chewing and 
insalivation of the food. 
Thorough mastication of the food should be habitually 
practiced as an important measure for the preservation of the 
teeth, to insure good digestion, and as a means of aiding the 
regulation of the food intake through the gustatory nerves, as 
has been already explained. 86 
THE NEW DIETETICS 
Special Indications for Thorough Mastication. 
Special pains should be taken to masticate the food to the 
extent of reduction to a soft pulp in the following cases: 
1. Achylia, a condition in which the stomach has ceased 
to make hydrochloric acid so that the action of the gastric juice 
is suspended. It is true that in these cases salivary digestion 
continues so that the starch may be more completely digested 
than in the normal stomach. Nevertheless, the food is no longer 
subjected to the solvent action of the gastric juice, and hence if 
the food enters the stomach in large lumps, these masses will be 
pushed on into the small intestine and disturbances of intestinal 
digestion will be likely to result. It must be remembered, also, 
that in cases of achylia the duration of gastric digestion is 
greatly reduced, the food leaving the stomach often in two or 
three hours instead of being retained for four or four and a half 
hours. It is evident, then, that very thorough mastication is 
required in cases in which the normal gastric acid is not present. 
2. In cases in which the operation of gastro-enterostomy 
or the polya or any other reconstructive operation has been per- 
formed upon the stomach, thorough mastication of the food is 
highly important, for such a stomach is more or less crippled at 
the best, and moutli digestion should be advanced as far as pos- 
sible so as to lighten the work of the stomach. 
3. In cases of obesity, thorough mastication is important 
as a means of limiting the amount of food eaten. In diabetes, 
in which the food is necessarily limited, thorough mastication 
should be enjoined upon the patient as a means of securing satis- 
faction of the appetite without a large intake of food. In bulimia 
(excessive appetite), epilepsy and in persons subject to hiccough 
and aerophagia, thoroughness of mastication is necessary. 
4. Prolonged mastication is also a useful aid to peristalsis 
and should be practiced by persons subject to constipation. 
Hurst, Case and others have shown that the food residues move 
along in the colon four times as rapidly during the taking of a 
meal as during the intervals between meals. In other words, 
mastication of food seems to set the whole alimentary canal in 
motion. In a recent paper Hurst asserts that the movement of 
residues in the colon occurs almost exclusively during the taking 
of food. This fact emphasizes the necessity for regular and de- 
liberate eating and suggests the taking of fruit between meals aad 
especially at night as an aid to efficient colon activity. MASTICATION 
87 
5. Efficient and prolonged mastication of the food is also 
highly important in cases in which the gall bladder has been 
removed. The reason for this is that by prolonged mastication 
the food will enter the stomach more slowly and hence will pass 
out into the small intestine more slowly. This is important for 
the reason that when the gall bladder is removed the liver is not 
able to store up any considerable quantity of alkaline bile with 
which to neutralize a large quantity of highly acid material com- 
ing from the stomach within a short time. 
6. Very thorough mastication of the food is required when- 
ever it is necessary to prescribe a diet of dry or solid food. 
Professor Strumpell made an experiment for the purpose of 
determining the influence of imperfect mastication upon the 
digestion and absorption of protein. He swallowed, half chewed, 
a plate of boiled lentils. He found that only 40 per cent, of the 
nitrogen was absorbed, or less than half the amount that should 
have been taken up. 
According to Gautier, the same is found to be true of other 
vegetables and also with bread when eaten in too soft a state, 
and when care is not taken to secure a thorough and abundant 
mixture of saliva. 
When the Food Should Be Little Chewed* 
While the thorough mastication of food is usually essential 
to good digestion and good health, there are conditions in which 
much mastication is to be avoided, the food being taken in liquid 
or puree form and so needing no mastication to prepare it for 
swallowing. 
1. It is well known that the chewing of food stimulates 
the formation of gastric acid. It is evident that in cases in which 
an excess of acid is formed much chewing will tend to aggravate 
the difficulty and hence hard and dry foods which need thorough 
chewing to prepare them for swallowing should be avoided. 
2. In cases of gastric and duodenal ulcer, also in cases of 
gall bladder disease accompanied by pyloric spasm or “hunger 
pains,” chewing should be avoided. 
3. Chewing is also to be restricted in cases of gastric hyper- 
sensitiveness in which pain follows eating of solid foods although 
the gastric juice contains no excess of acid as shown by tests 
after a test meal. Soft foods should be eaten. 88 
THE NEW DIETETICS 
Horace Fletcher's Fatal Mistake. 
Mr. Fletcher was right in his estimate of the value of 
thorough mastication of the food, though he was wrong in sup- 
posing much chewing to be a rule of universal application. 
Mr. Fletcher somehow hit upon the idea that it was essen- 
tial that all the food should be made liquid in the mouth, and 
that any part of the food which could not be reduced to liquid 
form in the mouth should be discarded. This idea was not 
included in his discoveries about the discriminating power of the 
gustatory nerves, and was not a legitimate inference from the 
demonstrated value of thorough chewing; it was a pure supposi- 
tion or hypothesis, or perhaps we should say mere conjecture. 
But Mr. Fletcher attached to this assumption all the importance 
of a demonstrated truth, and dwelt much upon it. This most 
unfortunate error was his undoing. It led him to avoid food- 
stuffs which contained insoluble substances, such as the seeds 
and skins of fruits, and to restrict his dietary to soft foods, soups, 
purees, and liquid foods. 
One result of the use of soft foods which required little 
chewing was rapid decay of his teeth. On his various visits to 
Battle Creek, he was constantly in the hands of a dentist, who 
told the writer more than once that he was astonished at the bad 
condition in which he found Mr. Fletcher’s teeth, and at the 
rapidity with which they were undergoing decay. 
But another and a still more serious result of the soft diet, 
wholly free from indigestible elements, was a most obstinate 
constipation. Mr. Fletcher told me on several occasions that his 
bowels moved only once or twice a week. 
After a time he came to look upon this chronic constipation 
as a great advantage, and as proof of the virtue of extra masti- 
cation. He argued that thorough chewing secured such perfect 
digestion and such complete absorption and utilization of the food 
that there was left no residue for germs to act upon, and so was 
a sort of sterilizing process. As proof of this, he offered the fact 
that the small hard stools which he dismissed from his colon at 
intervals of several days were almost odorless. 
Mr. Fletcher overlooked the important facts that the bile and 
mucus of the intestine are highly putrescible materials and that 
the odorless character of dry fecal masses is the result of the 
nearly complete absorption of skatol and indol during their long MASTICATION 
89 
retention in the colon. This was proven to be true in his own 
case. A mild laxative gave rise to a stool which greatly aston- 
ished him by its loathsomeness. 
Mr. Fletcher was so carried away with this idea that for 
some time, at least, he made quite a hobby of it, and it came to 
be generally understood that infrequency of bowel movements 
was a regular part of the Fletcher regime, or “Fletcherism,” as 
he preferred to call it. 
There is reason to believe that at last Mr. Fletcher saw his 
error and endeavored to correct it, at least so far as his own 
habits were concerned. But, unfortunately, it was too late. The 
mischief had been done. His vital stamina and resistance to 
disease had been exhausted by many years’ struggle against colon 
poisons, and he died of chronic bronchitis, doubtless due to the 
toxemia from which he had long suffered. 
Mr. Fletcher’s experience inculcates the lesson that there is 
no simple panacea for the ravages of time. Long life cannot be 
made sure by any simple formula. Thoroughgoing obedience to 
all the laws of “biologic living” is the price which must be paid. 
“For whosoever shall keep the whole law, and yet offend in one 
point, he is guilty of all,” says Holy Writ. Hunger 
Hunger appears to be a very universal sensation. Minute 
vegetable organisms, such as the swarm cells of spore-producing 
plants, according to Lister, may behave very much like hungry 
animals, swallowing microbes and digesting them with avidity 
while resting, then swimming off to find more food. 
People who eat several times a day often never experience 
the sensation of real hunger. Hibernating animals have no 
hunger. Insects are not hungry during the winter. The myriads 
of salmon which ascend the Columbia River are said never to 
eat, notwithstanding the great exertion in swimming hundreds of 
miles up stream. On the other hand, birds appear to be hungry 
all the time; at least they eat continually, though food is always 
found in their crops. The caterpillar does nothing but eat and 
defecate; but in certain species, after the'caterpillar becomes a 
butterfly it never eats at all. In some insects, according to Faber, 
there is no provision for hunger, the digestive organs being lack- 
ing in the fullest developed insect. 
Hunger may become so intense as to cause great lassitude, 
weakness, nervous irritability and even headache and nausea. 
In extreme cases fainting may occur. 
The seat and cause of hunger have been the cause of much 
research and discussion by physiologists for centuries. Haller 
thought the sensation of hunger to be caused by the grinding or 
rubbing together of the folds of the mucous lining of the stomach, 
due to contraction of its walls, observing that in a hungry man 
“the stomach is always contracted” (pinched). In this opinion 
the sagacious scientist came very near the truth as we shall see 
later. Darwin, on the other hand, thought hunger to be due to 
the absence of contractions in the stomach. Beaumont regarded 
hunger as the result of “a distension of the gastric vessels” or 
glands with gastric juice. Ewald considers hunger as purely a 
psychic sensation due to stimulation of the hunger center by an 
impoverished state of the blood. BoldyrefT discovered, in 1905, 
by placing inflated balloons in the stomachs of starving dogs, that 
strong contractions of the stomach occurred at quite regular 
90 HUNGER 
91 
intervals. In 1912, by similar experiments upon human beings, 
Cannon proved that these contractions are the cause of hunger. 
Each contraction of the stomach gives rise to a hunger pang 
lasting about half a minute. The contractions may be repeated 
rhythmically during 15 minutes to an hour or even longer in ex- 
treme hunger, and in very intense hunger the contraction may 
become continuous. 
There are two elements in hunger, one relating to the stomach 
itself, the other relating to the body as a whole. 
A very strong sensation of hunger is accompanied by a feel- 
ing of emptiness which may affect the whole abdomen. This 
may be relieved or temporarily abolished by pressure upon the 
abdominal wall. The starving Indian tightens his belt to relieve 
his discomfort. 
Appetite. 
There is a definite distinction between hunger and appetite. 
One may experience hunger without appetite, a not uncommon 
experience, but appetite without hunger is the daily experience 
of those who eat desserts at the end of a full meal. Hunger is 
referred to the stomach, whereas appetite is nearly always re- 
ferred to the mouth and throat. One’s mouth may water in the 
presence of savory viands although the sensation of hunger is 
not felt. Hunger, as Cannon has shown, is due to actual con- 
tractions of the gastric walls and is not felt in the absence of 
these contractions; but appetite is a product of the memory of 
pleasant sensations of taste and smell associated with eating. 
Satiety. 
Satiety is the state of satisfaction resulting from taking 
sufficient palatable food to satisfy hunger and slightly distend 
the stomach. An Irish laborer, accustomed to a diet of potatoes 
and buttermilk, is not satisfied with a meal consisting of con- 
centrated food less in bulk, even though the actual amount of 
nourishment taken may be much greater. Fats more than any 
other foodstuff contribute to the sense of satiety. A very small 
amount of fat often satisfies the appetite. Many persons find it 
difficult to eat fat in any but very small quantity on this account. 92 
THE NEW DIETETICS 
Nausea. 
Nausea is in some respects closely akin to hunger; in fact, 
hunger and nausea are sometimes felt simultaneously. In nausea, 
however, there is absence of true hunger pangs. Violent con- 
tractions occur in the pyloric region, accompanied by a dilatation 
of the cardiac orifice—a pressure pain sensation and sinking 
feeling, headache, perspiration, usually giddiness and often great 
prostration. 
Hunger in Infants. 
In adults, hunger usually occurs four to six hours after a full 
meal. In an infant, hunger occurs in two or three hours. The 
hunger contractions of the stomach are much stronger in young 
persons than in those advanced in years. 
The Hunger of Starvation* 
Hunger contractions appear to be increased in vigor by 
starvation. Carlson states that in himself this change was very 
marked and lasted for some time after a five days’ fast. He also 
suggests that this effect may be analogous to the general rejuven- 
ating effect of starvation in certain animals, and even intimates 
that an occasional period of starvation may exercise a beneficial 
influence in the prolongation of life and in renewing vigor and 
capacity for work. 
Hunger During Sleep. 
It is a curious fact that while the “tone” of the general 
muscular system, the blood vessels, the bladder, and other mus- 
cular parts decreases during sleep, this is not true of the hunger 
contractions of the stomach, which not only continues in full vigor 
but even may become so strong as to cause awakening from sleep 
in adults as well as in children and dogs. 
Mental and Nervous Influence on Hunger. 
Ordinary mental processes do not influence hunger, but the 
sensation is temporarily abolished by fear, anger, joy and perhaps 
other emotions. 
When a starving person sees or smells appetizing food the 
hunger pangs are more intensely felt, although the hunger con- 
tractions are not increased. 
Hunger contractions have been proven to be due to the local HUNGER 
93 
nervous mechanism rather than to the pneumogastric or sympa- 
thetic nerves. Even when completely isolated from the central 
nervous system, the stomach makes hunger contractions. 
Chewing or tasting palatable foods diminishes hunger con- 
tractions. Movement of the jaws, when the mouth is empty, has 
no influence upon the hunger contractions; but chewing gum, 
paraffin, even straw or wood, may lessen hunger. Hunger is 
temporarily relieved by very small quantities of food. 
Absence of Hunger, 
Hunger contractions differ from the movements of the 
stomach during digestion in the fact that the movements of the 
stomach during digestion are almost wholly confined to the 
pyloric region, while hunger contractions involve the left portion 
of the stomach. 
Hunger, when present, may be diminished by taking water 
into the stomach, particularly hot water. Small pieces of ice, 
when swallowed, have a decided effect in lessening hunger. 
Hunger may also be temporarily abolished by passing a tube 
into the stomach. Rectal feeding decreases hunger. 
Strong acid solutions have the effect of diminishing the 
hunger contractions, as do also strong alkaline solutions. 
The introduction of air into the stomach produces no effect. 
Smoking lessens hunger by stimulating the nerves of the 
mouth. Any stimulus applied to the mouth has a similar effect. 
In nausea the cardiac orifice and the fundus of the stomach 
are completely relaxed; hence hunger is necessarily absent. 
Pressure over the stomach by means of a belt lessens the 
hunger sensation but does not abolish it. A smaller amount of 
food is required to appease hunger when a belt is applied before 
the meal. This fact suggests a method of aiding control of the 
appetite in cases in which it is necessary to restrict the amount of 
food necessary to appease hunger by preventing the expansion 
of the abdominal wall which takes place simultaneously with the 
receptive relaxation of the stomach. 
Absence of Hunger in Disease, 
The partial or complete absence of hunger and appetite is 
common in cases of neurasthenia and hysteria. Absence of appe- 
tite is also a frequent result of constipation, especially when the 
tongue is coated. In such cases there might be hunger without 94 
THE NEW DIETETICS 
appetite. The absence of hunger in fever has been shown to be 
associated with the absence of hunger contractions. 
Appetite is less in advanced age than in youth, for the 
reason that the hunger contractions are less vigorous. 
Increase of Hunger in Disease* 
In bulimia, hunger is not appeased by eating, or reappears 
very shortly after a full meal; if food is not taken, headache, 
weakness, and prostration develop just as in a normal person 
suffering from extreme hunger. This symptom, which frequently 
occurs in Addison’s disease, may also appear in connection with 
various nervous disorders. The hunger of bulimia usually 
appears very suddenly and it may be satisfied or even changed 
to nausea by a few mouthfuls of food. In these cases there is 
doubtless an abnormally irritable condition of the stomach. The 
application of the moist abdominal bandage, accompanied by a 
hot pack over the stomach, is a valuable means of relief in these 
cases. 
“Hunger pains” are simply the severe gastric pains which 
appear when the stomach is- empty or within three to six hours 
after a meal in persons suffering from ulcer of the stomach or 
duodenum or disease of the gall bladder. These pains are due to 
contractions identical with normal hunger pangs, but painful 
because of the inflammation or other diseased condition present 
or because of their intensity. In marked hypersecretion, or 
hypersensitiveness, the pain may be almost continuous. The pain 
usually disappears promptly on the taking of food. 
The pain of gall bladder disease may be due to hunger con- 
tractions or to contractions of the gall bladder, which may give 
rise to pain closely resembling the hunger pains of ulcer. Con- 
tractions of the gall bladder are greatly increased during normal 
digestion and naturally must be exaggerated in cases of hyper- 
acidity of the gastric juice, as are the contractions of the 
stomach. 
Hunger contractions have been shown to be absent in gas- 
tritis, tonsilitis, influenza and colds. Food taken under such 
conditions sometimes gives rise to nausea. Hunger contractions 
are shown to be absent in dogs suffering from infection and 
pneumonia. HUNGER 
95 
Modifications of Hunger. 
Exposure of the skin to cold, as in cold bathing, produces 
shortly afterwards an increase of hunger contractions. This 
accounts for the beneficial effects of the cold morning bath in 
producing a readiness for breakfast. This effect is analogous 
to the well-known influence of cold water applied to the skin in 
producing contractions of the bladder. A cold bath, followed 
by a brisk walk, is the best appetite stimulant with which the 
writer is acquainted. The injection of the blood of a starving 
dog into the veins of a normal dog increases hunger contractions 
in the latter. A similar effect was produced by injecting into 
healthy dogs blood from an animal suffering from experimental 
diabetes. Profuse hemorrhage may give rise to hunger contrac- 
tions. Certain drugs, as pilocarpin and pituitrin, increase hunger 
contractions, while morphin and adrenalin produce the opposite 
effect. 
Hunger is increased by external cold and decreased by ex- 
ternal heat, a characteristic in which it resembles pain sensations. 
Physiologic experiments show that cold increases nerve sensi- 
bility, while heat diminishes the same. 
Bitters* 
Bitters taken into the mouth diminish the hunger contrac- 
tions, as do other stimulants applied to the oral membrane. It is 
thus evident that bitters do not increase appetite. It is equally 
well known that they do not increase but actually diminish the 
secretion of gastric juice. The only means known which can be 
relied upon for increasing hunger, appetite and digestive power 
are a moderate diet, out-of-door life, exposure to sunlight and 
cold air, cold bath and muscular exercise. 
THIRST 
The sensation of thirst is referred to the mouth and throat. 
Like hunger, thirst is primarily due to changes in the blood. The 
blood normally contains 78 per cent, of water. This percentage 
is decreased by the addition of solids, such as chlorid of sodium, 
sugar or the products of digestion. Water is demanded to restore 
the blood to its normal state. This nice balance between water 
solvents and solids in solution is maintained by an automatic 
mechanism, and thirst is the signal of the necessity for adjust- 
ment. 96 
THE NEW DIETETICS 
When water is absorbed into the blood, the excess is at once 
removed by the kidneys or skin. The volume of the blood, as 
well as its composition, is nicely regulated by an automatic 
mechanism. An intake of water prompted by the sensation of 
thirst is almost immediately followed by an output of water 
through the kidneys or skin. 
It is well known that thirst is induced by profuse perspira- 
tion resulting from exercise or exposure to heat, by the use of 
food containing considerable quantities of salt and by the use of 
alcohol and various other drugs. Fever also creates a demand 
for water, which is now recognized to be essential as a means of 
aiding Nature in her efforts to bring about recovery, although 
less than a century ago the use of water was forbidden to fever 
patients. At the present time, water externally and internally is 
recognized as, next to rest, the most important of all means of 
combating fever. 
Cannon has shown that thirst is due to a relative dryness of 
the mucous membrane of the mouth and pharynx due to a sup- 
pression or a diminution of the secretion of saliva. This may be 
ihe result of excessive perspiration or urination, or of diarrhea, 
as well as of deprivation of water or the excessive use of salt. 
Pack has shown that salivation produced by giving pilocarpine 
destroys thirst in- rabbits that have been deprived of water for 
seven days. 
Persons who suffer from autointoxication and whose tongues 
are usually thickly coated, are particularly likely to neglect 
water-drinking, greatly to their detriment. Such persons often 
do not experience the sensation of thirst except when a great loss 
of water occurs through vigorous perspiration. 
The lack of appetite for food, very common in such cases, is 
very frequently accompanied by lack of thirst, even when the 
need of water is as great or even greater than the need of food. 
The absence of the thirst sensation may be due to a sort of par- 
alysis of the thirst center, just as the lack of hunger may possibly 
result from a like failure of the hunger center. In such cases, 
the patient must be required to eat, even though he feels no desire 
for food; and in like manner he should be required to drink 
freely, even though the sensation of thirst is not experienced. 
Since it is sometimes very difficult to induce the patient to drink 
any considerable amount of water at any one time, he should be 
asked to drink small quantities, from an ounce to three or four HUNGER 
97 
ounces, very frequently. An ounce every twelve or fifteen min- 
utes, or four or five ounces every hour when not asleep, will not 
exceed the needs of the body. 
Air Hunger, 
While oxygen is not usually included among foodstuffs, it is 
really as much a food as is water, and without its active agency, 
all vital activity would cease. Oxygen supports the vital com- 
bustions of the body just as it supports the combustion of wood, 
oil, and other fuel in our stoves and furnaces. The ordinary air 
contains a little more than one-fifth (21 per cent.) its volume of 
oxygen. This amount is more than is needed in ordinary respira- 
tion, which requires only about 14 per cent, of oxygen; but dur- 
ing violent exercise a considerably increased consumption of 
oxygen occurs, and at elevated altitudes where the air is much 
rarefied the amount of oxygen is diminished. The extra 6 per 
cent, of oxygen which the air contains is evidently a factor of 
safety to provide for these emergencies. 
The body may suffer air hunger through receiving too little 
oxygen in several ways: 
1. By an insufficient amount of oxygen in the air, as when 
the air contains a large amount of carbon dioxid, displacing a 
part of the oxygen, which occasionally happens in connection 
with certain industries, as in the burning of lime. 
2. A deficient intake of air, as when the chest is confined 
or the air passages obstructed. 
3. Slowing of the circulation of the blood so that the carbon 
dioxid of the blood is not thrown off and the oxygen taken in 
with sufficient rapidity. 
4. A deficient amount of hemoglobin in the blood, as when 
the red cells are diminished in number, as in anemia. 
5. When the hemoglobin of the blood, which carries oxygen, 
is damaged, as in carbonous oxid poisoning, so that it does not 
give up its oxygen readily. 
While oxygen is carried by the red cells, it is afforded to the 
tissues by the plasma or watery portion of the blood. The plasma 
absorbs the oxygen from the red cells and passes it on to the 
tissues. The amount of oxygen contained in the plasma is usually 
small, only about one-fortieth that found in the red cells, but by 
breathing pure oxygen it may be increased to as much as seven 
times the normal amount. In this way the plasma may in emer- 98 
THE NEW DIETETICS 
gency be made to take the place of the blood cells. For example, 
a frog from which all the blood is removed, being substituted by 
a saline solution, lives and breathes in a perfectly normal way in 
an atmosphere of pure oxygen. 
When the supply of oxygen is greatly diminished, giving rise 
to cyanosis, relief should be obtained as quickly as possible by 
supplying oxygen. A delay may result in so great an injury to 
the nervous system that later efforts may fail when more prompt 
action would have been successful. 
It should be remembered that rapid breathing does not neces- 
sarily mean an increased supply of air to the lungs. Very rapid 
breathing is likely to be shallow breathing. The deeper parts of 
the lungs are not emptied. If the patient is not able to breathe 
deeply he should be assisted by artificial respiration or by rhyth- 
mic compression of the lower part of the chest or pressing up 
against the diaphragm from below. A peculiar form of respira- 
tion, known as Cheyne-Stokes’ breathing, indicates failure of the 
respiratory center and the necessity for giving inhalations of 
oxygen. 
The inhalation of oxygen is always indicated when there is 
cyanosis or rapid breathing. This condition may exist as the 
result of extreme anemia. Rapid respiration is sometimes noted 
in cases of diabetes. In all such cases oxygen may be inhaled by 
means of a stream of oxygen passed into one nostril through a 
soft rubber tube by means of a mask placed over the nose and 
the mouth of the patient, or better, by means of a respiratory 
chamber. 
In the British Medical Journal of March 6, 1920, Meakins 
shows that in normal individuals the blood contains about nine- 
teen-twentieths as much oxygen as it is capable of holding; in 
other words, lacks 5 per cent, of being completely saturated. In 
pneumonia and conditions of cyanosis the under-saturation may 
amount to as much as 18 per cent. By causing the patient to 
breathe pure oxygen, the under-saturation, even in pneumonia, 
may be reduced to 3 per cent.; in other words, the blood of 
such a patient may be made to hold and carry even more oxygen 
than it usually carries in health. This fact shows the importance 
of oxygen inhalation in pneumonia. This measure should not be 
left for use as a last resort when the patient is cyanotic and 
nearly ready to die, but should be used as the best known means 
of preventing the development of dangerous conditions. METABOLISM 
The Energy of Food — The Calorie 
Life involves constant change of substance and expenditure 
or loss of energy. The function of food is to supply energy and 
to keep the resources of the body from becoming exhausted. 
All energy is convertible into heat. For this reason, the amount 
of heat into which any form of energy may be converted is taken 
as a measure of energy. There are two kinds of heat units in 
use: The British thermal unit (B. T. U.) is the amount of heat 
required to raise one pound of water one degree Fahrenheit in 
temperature. The more modern unit, devised by the French, is 
the amount of heat required to raise one kilogram (2.2 pounds) of 
water one degree Centigrade (1.8° F.) in temperature. This 
unit is known as the calorie. 
One calorie is equal to four B. T. U. ’s (2.2 X 1.8 = 3.96) : 
that is, the amount of heat required to raise the temperature 
of four pounds of water 1° F. 
The equivalent of one calorie in mechanical work is approx- 
imately one and one-half foot tons (2,088 foot pounds). Eleven 
calories are approximately equivalent to one horse power minute. 
The Energy Output of the Body and the 
Work Equivalent of Food. 
The body, like a locomotive, is a machine. It is a mechan- 
ism which is capable of transforming the potential energy of 
food into the dynamic energy of work. Considered from an 
economic standpoint, the animal body is superior to all other 
mechanisms, since it transforms fuel into work with less loss than 
any machine which human ingenuity has ever constructed. For 
example, in the case of the steam engine not so much as one- 
fifth of the energy of the fuel can be utilized under the best 
99 100 
THE NEW DIETETICS 
conditions, and ordinarily the proportion of energy utilized is 
much less than this. In the case of the human machine the 
relation of food-fuel to energy production is three to one or even 
as low as two and one-half to one. 
It is to be remembered, however, that a considerable amount 
of energy is required to carry on the internal work of the body. 
For example, in a resting man the heart utilizes about 10 per 
cent, of the total energy intake in forcing the blood through the 
circulation; the chest muscles in maintaining the movement of 
air through the lungs consume 20 per cent, of the total energy; 
10 per cent, is utilized in the work of digestion and in gland 
action; 30 to 50 per cent, of the total energy intake is required 
to maintain the muscle tonus or tension, a rapid rhythmical con- 
traction (16 to 20 per second) whereby bodily heat is maintained ; 
20 to 30 per cent, is consumed in other vital work. 
It is highly important to note that even when a person is in 
a state of complete rest, as much as one-half of the total energy 
expenditure of the body may be consumed by tension under the 
influence of worry, fear, nervousness or excitement of any sort. 
This form of energy expenditure may be increased to many times 
the normal amount, which explains why a person becomes tired, 
even to exhaustion, while simply waiting, and why a worried 
person or a harried animal cannot be made to gain in flesh, and 
emphasizes the importance of complete rest as a condition favor- 
able for increasing the body weight. 
The amount of energy expended in a state of complete rest 
is termed the base ration. This for the average person amounts 
to about 25 calories per kilogram of body weight, or a little less 
than 12 calories per pound of body weight. This estimate sup- 
poses that the body weight is approximately the normal weight 
for a person of a given height, which may be determined by 
reference to Table II. 
Vital Work—Metabolism, 
The various forms of vital activity carried on in the body, 
especially the intimate cell activities on which all bodily functions 
depend, are collectively known as metabolism. The vital work, or 
metabolism, which has for its purpose the building up of the body 
or storing up energy, is known as constructive metabolism, while 
the vital work which involves the breaking down of tissues and 
the consumption of energy is known as destructive metabolism. THE ENERGY OF FOOD—THE CALORY 
101 
In childhood and youth, constructive metabolism is highly active, 
resulting in growth or increase in both height and weight. 
In adult life, after development is completed, constructive 
metabolism has for its purpose the keeping of the body cells and 
tissues in repair, and the maintenance of the body weight by the 
making good of the losses which result from work. 
Plants work as well as animals. Bonnier has shown that 
peas in germinating produce about five calories of heat a day for 
each gram of weight. 
Experiments made by Langworthy and Milner show that 
during the ripening process bananas produce heat at the rate of 
about one-half calory per hour per pound. The heat is produced 
by the destruction of carbohydrates. 
But the most extraordinary example of metabolic activity 
in the vegetable world is to be seen in the work of the nitrifying 
bacteria of the soil. Muntz and Laine have shown (Burnet) that 
these organisms working under the most favorable conditions in 
a specially prepared peat bed an acre in area and 6.5 feet thick 
may produce 60 tons of nitrate daily. In doing this, they would 
consume fourteen times as much sugar or carbohydrate, an ex- 
penditure of energy amounting to more than 3,000,000,000 calories 
in twenty-four hours. 
Destructive metabolism is continually going on in the body, 
but is most active during muscular work and least active during 
sleep. 
All animals, even plants, require periods of rest, during 
which destructive metabolism is diminished to such a degree that 
constructive metabolism is in the ascendency so that losses of 
energy may be made good. When a person is deprived of sleep, 
even for a few days, the rapid loss of strength and weight are 
clear indications of the loss and injury which the body sustains 
from continuous destructive metabolism and of the beneficent 
functions of sleep. Plants grow most rapidly during the night. 
Metabolism During Rest* 
During complete rest, even sound sleep, the body cells are 
at work. The heart continues to beat, the lungs empty and fill, 
the bodily heat is maintained; digestion, liver action, bile forma- 
tion, the secretions of the kidneys, skin and other excretory 
glands continue—all the general life functions are carried on as 
during the waking hours, though less actively. The heart uses 102 
THE NEW DIETETICS 
in twenty-four hours about one-tenth of the total energy output 
of the body, consuming one calory of energy for each 400 beats, 
equal to the lifting of 720,000 foot pounds in twenty-four hours. 
The heart is able to do this enormous amount of work because 
each period of intense work is followed by a longer period of 
rest. 
Metabolism during sleep is greater after severe effort because 
of increased muscular tension. The sleep metabolism must also 
be greater in a person sleeping amidst noises, even though the 
sleeper is unconscious of the noise. 
Basal metabolism rises during the day, being one-seventh 
more than during sleep in the morning and nearly a quarter more 
than during sleep in the late afternoon. 
Metabolism must be increased during restless sleep and ex- 
citing dreams, accompanied by perspiration and followed by 
exhaustion. 
The Source of Animal Heat* 
One of the most remarkable phenomenon connected with 
the life of a warm-blooded animal is the maintenance of its tem- 
perature at a definite point, with little variation irrespective of 
external temperatures, which may be either considerably above 
or considerably below that of the body. The normal temperature 
of the interior of the human body is constantly maintained at 
about 100° F., though the temperature if taken in the mouth is 
found to be a little less than 98.4° F. 
The body is constantly losing heat through contact with the 
air, through the breath and the skin. The body loses heat even 
when the temperature of the surrounding air is above that of 
the body, through the evaporation of perspiration from the sur- 
face. The amount of heat lost by the body depends upon the 
amount of skin surface, and is regulated by the blood supply to 
the skin and the excretion of sweat. The amount of heat lost by 
the body in twenty-four hours is about 2500 calories, which is 
equivalent to the amount of heat which would be produced by 
the burning of three-quarters of a pound of coal or a cube of 
hard wood four and a half inches square or ten ounces of oil. 
In the air at a temperature of 86° F., the loss of heat from 
the body occurs at practically the same rate as that by which it 
is produced, so that no clothing is required for warmth. It is 
for this reason that the natives of certain tropical climates wear THE ENERGY OF FOOD—THE CALORY 
103 
Table showing the Number of Calories Required according to Height and Weight When the Body is in a State of 
Complete Rest (Basal Metabolism). 
Height 
Weight 
In. 
Pounds 
55 
66 
77 
88 
99 
110 
121 
132 
143 
154 
165 
176 
187 
198 
209 
220 
231 
80 
1735 
1801 
1858 
1914 
1971 
2027 
2084 
2131 
2178 
2225 
2273 
78 
1631 
1697 
1763 
1820 
1877 
1933 
1990 
2046 
2093 
2141 
2188 
2235 
76 
1471 
1537 
1603 
1669 
1735 
1792 
1848 
1905 
1961 
2009 
2056 
2103 
2150 
2197 
74 
1443 
1509 
1575 
1641 
1697 
1754 
1811 
1867 
1924 
1971 
2018 
2065 
2112 
2159 
72 
1405 
1481 
1547 
1613 
1669 
1726 
1782 
1839 
1886 
1933 
1980 
2027 
2075 
2122 
70 
1122 
1207 
1282 
1377 
1443 
1509 
1575 
1631 
1688 
1745 
1801 
1848 
1895 
1943 
1990 
2037 
2084 
68 
1103 
1188 
1263 
1348 
1414 
1480 
1537 
1594 
1650 
1707 
1754 
1801 
1848 
1895 
1943 
1990 
66 
1075 
1160 
1235 
1320 
1386 
1452 
1509 
1565 
1622 
1679 
1726 
1773 
1820 
1867 
1914 
1952 
64 
1056 
1141 
1216 
1292 
1358 
1414 
1471 
1528 
1584 
1631 
1679 
1726 
1773 
1820 
1867 
62 
1028 
1113 
1188 
1254 
1320 
1377 
1433 
1490 
1547 
1594 
1641 
1688 
1735 
1782 
60 
1000 
1084 
1160 
1226 
1282 
1339 
1396 
1452 
1509 
1556 
1603 
1650 
1697 
58 
971 
1056 
1131 
1198 
1254 
1311 
1367 
1424 
1472 
1518 
1565 
1613 
56 
943 
1028 
1103 
1169 
1226 
1282 
1339 
1386 
1433 
1481 
54 
915 
1000 
1075 
1132 
1188 
1245 
1301 
1348 
1395 
52 
896 
981 
1047 
1103 
1160 
1216 
1273 
1320 
50 
877 
952 
1018 
1075 
1132 
1188 
1235 
1282 
48 
858 
924 
981 
1037 
1094 
1150 
1197 
For intermediate weights the number of required calories may be calculated by adding 7 calories for each 
additional pound of body weight, for weights between 55 and 110 lbs.; 5]/2 calories for each pound between 110 
and 154 lbs.; and AJ/2 calories for each pound above 154 lbs. 
Based upon the table of Du Bois and Du Bois. 
TABLE II 104 
THE NEW DIETETICS 
little or no clothing; or, if clothing is worn, its purpose is to 
protect the body from the heat of the sun rather than for warmth. 
This neutral air temperature of 86° F. is the usual temperature of 
the air surrounding the body underneath the clothing. 
The amount of food required by an individual daily, when at 
rest, depends largely upon the amount of heat lost, and since this 
depends upon the body surface, it is important to know the body 
surface for persons of different heights and weights. Various 
formulae have been developed by which this may be determined 
in individual cases, but the most convenient method is to refer to 
a table which has been prepared by Dubois. The accompanying 
table II, based upon that of Dubois (Lusk’s “Science of Nutri- 
tion”) shows the number of calories required by persons of dif- 
ferent heights, from four feet to six feet eight inches, and from 
a weight of fifty-five pounds to two hundred and thirty-one 
pounds. 
The heat of the body may be regarded as a waste product 
of metabolism, or cell work. It is for the most part a by-product 
of muscular work. When a person is at rest, the temperature 
is maintained by the muscle tension. When the temperature 
lowers, muscle tension is increased. It is also naturally increased 
by work as well as by various nervous influences. Fear, worry, 
anxiety, expectancy, so-called “nervousness,” are conditions in 
which muscular tension is greatly increased. Tension may, in 
fact, by these means be doubled or even more than trebled. It 
also explains the fatigue and even exhaustion which is felt after 
an anxious hour, or a period of great mental and nervous excite- 
ment, even without any considerable degree of muscular activity. 
Cold increases muscular tension to a very marked degree. 
This accounts for the phenomenon of shivering, which is simply 
greatly exaggerated muscular tension. Nature increases muscular 
tension even to the extent of producing tremor or visible muscu- 
lar movements for the purpose of increasing the heat production 
necessary to maintain the body temperature. The strong shiver- 
ing, with chattering of the teeth, which occurs when the body is 
exposed to great cold, is a remedial effort by which the lowering 
of the temperature of the blood is prevented. If the muscles are 
made to contract by electricity or by voluntary exercise, the 
shivering quickly ceases. 
In the management of feeble invalids, it is highly necessary 
to take great care to prevent the loss of energy through unneces- THE ENERGY OF FOOD—THE CALORY 
105 
sary nerve tension. The “rest cure” is often necessary in such 
cases to prevent the waste of energy through tension and thus 
afford an opportunity for a gain in weight. 
Persons between twenty and fifty years of age require, on 
the average, about three and two-thirds calories per hour per 
square foot of body surface, or eighty-eight calories per square 
foot of surface for each twenty-four hours. 
Metabolism and Mental Work. 
There can be no doubt that mental work requires the expen- 
diture of a certain amount of energy. This is clearly indicated 
by the amount of blood supplied to the brain, nearly one-fifth the 
total blood supply of the body; but careful experiments by Bene- 
dict and Carpenter and other investigators have shown that the 
amount of energy expended during severe brain work is so small 
that it cannot be accurately measured. This is not surprising, 
however, when it is considered that the weight of the brain and 
nerve substance is only about one-fiftieth of the total weight of 
the body. It seems probable that the chief reason for the large 
blood supply of the brain is to carry away the fatigue poisons 
which are produced by brain activity. It seems to the writer 
that the effect of mental work upon energy expenditure must 
depend to some degree at least upon the effect of the work upon 
“tension.” If the work is of such a character as to greatly 
increase muscle tension, energy expenditure must certainly be 
increased as it is in worry or mental “strain.” 
The thyroid gland has a marked influence upon metabolic 
activity. When the gland is excessively active, as in exopthalmic 
goiter or Graves’ disease, the rate of metabolism may be doubled. 
This fact explains the emaciation and exhaustion which accom- 
pany this disorder. On the other hand, when the thyroid gland 
is under-developed or inactive, as in myxedema or creatinism, the 
rate of metabolism may be very greatly diminished. 
Metabolism is increased in various conditions of disease, 
particularly in fever, in lymphatic leukemia, in severe diabetes, 
in certain cases of heart disease, and sometimes in cancer. In 
fever and in pernicious anemia there may be disturbances of 
metabolism, also in disease of the pituitary and Other ductless 
glands. Some observers have noticed a marked increase of meta- 
bolism in acidosis, which may result from either disease or a 
deficiency of carbohydrates in the diet. 106 
THE NEW DIETETICS 
Metabolism is decreased in advanced age, by prolonged fast- 
ing and by sleep. It is greatly increased by a diet rich in protein, 
as after a hearty meal of meat. 
Metabolism and Muscular Work. 
Muscular exercise is by all odds the most powerful means of 
increasing metabolism. In an average man whose metabolism is 
at the rate of about 80 calories per hour when in a state of com- 
plete rest, the expenditure will become 84 calories per hour when 
sitting up. Active work will increase the expenditure to 300 
calories per hour, and a higher rate of expenditure may be 
developed by very vigorous work. That is, by muscular effort, 
the rate of metabolism may be increased to four or even eight 
times what it is in a state of complete rest. 
Exercise also increases the expenditure through muscular 
tension during sleep as well as during the waking hours. After 
vigorous work, for example, the expenditure of energy during 
sleep after severe work may be increased from 10 to 25 per cent, 
above the rate of sleep after rest. 
It is evident, then, that in determining the amount of food 
required in an individual case, it is necessary to take careful note 
of the number of hours spent in sedentary work and in active 
exercise. 
Energy Expenditure in Work of Various Sorts. 
When lying at rest, the energy expenditure is at a minimum, 
or approximately 12 calories per pound of body weight. For a 
person weighing 154 pounds (70 kilos), the expenditure would 
be 1,848 calories for the twenty-four hours. On rising to a sit- 
ting position, the output of energy is increased 5 per cent.; stand- 
ing with the muscles relaxed, produced an increase of 10 per cent, 
in the energy expenditure; and standing with the muscles rigid, 
as in the position of “attention,” increases the energy output 14 
per cent. i: 
In walking an hour at the rate of 3 miles an hour, the 
maximal velocity for economy, the body expends 1.1 calories for 
each pound transported; that is, for each pound of body weight 
plus any weight which may be carried. Walking at the rate of 
5.3 miles per hour raises the energy output to 3.6 calories per 
pound of body weight per hour. 
To the energy represented by the work done in walking THE ENERGY OF FOOD—THE CALORY 
107 
must be added, of course, the basal metabolism or the energy 
output of rest increased by 10 per cent, for the standing position. 
A somewhat different method of calculating the work done 
in walking, which gives closely similar results, is based upon the 
observations made by Zuntz, who found that walking 13 feet on 
a level at the rate of 3 miles an hour requires an energy expendi- 
ture about equivalent to that required to lift the body vertically 
one foot. Consequently, the amount of work done in walking a 
mile at the rate of 3 miles an hour is found by multiplying the 
weight transported by 400 (5,280-^-13=406). 
The work done by the muscles in transporting the body is 
about three times that represented in the mechanical work done. 
The energy value of the work done in walking at a moderate gait 
may be obtained by multiplying the distance traveled in miles at 
the rate of 3 miles an hour first by 400, then by 3, then dividing 
the product by 3,000, or what would be the same, by 1,000. To 
determine the actual energy expenditure in the work done, it is 
necessary to multiply the amount of mechanical work expressed 
in foot pounds by the factor 3 for the reason above given. 
These figures hold good only when a person is walking on 
a level road. If a hill is climbed, the work done in lifting the 
body through the vertical height ascended must be added. This 
is readily obtained in foot pounds by multiplying the weight 
transported by the number of feet through which it is lifted. 
In walking down an incline of 5 per cent., the energy out- 
put in walking has been shown by Zuntz to be about one-half that 
in walking on a level. Descending an incline of 10 per cent., the 
energy expenditure is the same as that in walking over a level 
surface. In going down an incline of 25 per cent., the energy 
expenditure is doubled. The energy expenditure in bicycle riding 
is about one-half that required in walking the same distance. 
Example. A man weighing 160 pounds with a resting meta- 
bolism of 1,800 calories walks for one hour at the rate of 3 miles 
an hour, carrying a weight of 50 pounds and climbing a hill 1,500 
feet in height. The weight of the body, plus the weight carried, 
equals 210 pounds. This multiplied by 1.1 equals 231, the num- 
ber of calories required for transporting the weight on a level. 
The base metabolism during the hour spent in climbing would be 
82 calories. Lifting a weight of 210 pounds to a height of 1500 
feet will require an expenditure of 315 calories (210 multiplied 
by 1,500 divided by 1,000 equals 315). The total expenditure 108 
THE NEW DIETETICS 
will be 628 calories (231 plus 82 plus 315 equals 628 calories for 
the hour) ; certainly a large output, but not more than frequently 
occurs in such violent exertion as mountain climbing. 
Carrying the example further, let us suppose that the indi- 
vidual who has spent an hour at the task above described rests for 
the remainder of the 24 hours, 8 hours in bed and 15 hours sit- 
ting. The basal metabolism during the 8 hours in bed would be 
75 calories per hour or a total of 600 calories. In sitting, the 
energy output would be approximately 80 calories per hour. In 
15 hours this would amount to 1,230 calories, making a total of 
2,428 calories, which would represent the energy output and the 
food intake required to supply the energy expended for the 24 
hours. 
Energy Output and Food Requirements of Persons 
Engaged in Different Occupations. 
The energy expenditure required by different occupations 
varies very greatly. Careful observations made by various inves- 
tigators have shown the actual energy requirement of different 
occupations for a person weighing 154 pounds to be about as 
follows: 
Occupation 
Calories of 
metabolism per day 
Bookbinder 
2,440 
Shoemaker 
2,510 
Carpenter 
3,100 
Metal worker 
2,900 
Painter 
2,950 
Stonemason 
4,200 
Man sawing wood 
4,800 
The Energy Expended in Housework. 
Benedict and Johns have made (1919) a valuable series of 
observations for the purpose of determining the energy expendi- 
ture required by ordinary light household activities. The obser- 
vation was made by a study of the energy output of fifteen or 
twenty young women before and after entering a large airtight 
chamber in which they were engaged in performing some house- 
hold operation, all doing exactly the same thing in the same way. 
The conclusions reached may be briefly stated as follows: 
1. When sitting quietly in the experimental chamber, two THE ENERGY OF FOOD—THE CALORY 
109 
hours after a meal, the energy expenditure was one-half calory 
per pound of body weight per hour. 
2. Reading aloud increased the energy expenditure 3 per 
cent. 
3. The energy expenditure when singing was increased 22 
per cent. 
4. The exercise of plain sewing occasioned a smaller expen- 
diture of energy than singing, being less than two-thirds as much, 
or 13 per cent. 
5. The energy expenditure in standing was 9 per cent, 
greater than in sitting. 
6. Sweeping caused an increase of 150 per cent. 
7. Moderate walking increased the energy loss 250 per 
cent. 
8. Dusting increased the loss by 134 per cent. 
9. The energy loss occasioned by the act of rising up and 
sitting down once a minute during three minutes, showed an 
increased energy loss of 60 per cent, of the energy lost in the sit- 
ting posture. 
The Relation of Work to Total Food Requirement. 
The amount of external mechanical work done by the body 
represents but a very small part of the total energy expenditure. 
It is to be remembered that in the case of the body, as in that 
of the steam engine, much more energy is lost in heat as a by- 
product than is utilized in mechanical work, besides the large 
amount of energy required for carrying on the various vital pro- 
cesses of the body. In general, it is held by physiologists that the 
energy of the food intake should be five or six times that repre- 
sented by the external work done. 
In increasing the intake of food to support an increase of 
work beyond the rest ration requirement it is not necessary to 
increase the protein, and the fats need be increased but very 
little. The chief increase should be in carbohydrates, for carbo- 
hydrates furnish the sugar which constitutes the fuel of the 
muscles. 
The Rate of Growth. 
The food intake is closely related to age and rate of growth. 
The younger the animal the more rapidly it grows. The body 
of an infant increases in weight seven times as fast between the THE NEW DIETETICS 
110 
ages of one month to three months as between the sixth and ninth 
month, the average increase being, for the first 3 months, about 
3.6 pounds; for the second 3 months, 3.6 pounds; from 6 to 9 
months, 3.4 pounds; and from 9 to 12 months, 3 pounds; an 
average of one and one-tenth pounds per month, or about two- 
thirds of an ounce a day. During the first month the rate of 
increase is more than an ounce daily. 
The crying of a baby may double its metabolism rate. On 
this account babies that cry much do not gain in weight. How- 
ever, a certain amount of crying is good exercise for an infant 
and promotes good digestion and healthy growth. 
The growth of the body is notably more rapid during the 
first five years of life than later. The weight of a healthy infant 
is three times as great at the end of the first year as at its birth. 
The weight doubles during the second year. 
During the second period of five years, that is, 5 to 10 years, 
boys grow more rapidly than girls, and at 10 years of age average 
two or three pounds more in weight. Between the ages of 10 and 
15 years, girls grow more rapidly than boys. For the two years, 
to girls are taller than boys of the same age, and from 
12*4 to years exceed boys of the same age in weight by 
three or four pounds. After 15, boys grow more rapidly than 
girls, increasing in weight at the rate of nearly seven pounds a 
year, while girls increase only two and three-quarters pounds 
yearly. Girls reach their full height and weight at 20 years, 
while boys continue to grow until 23 and increase considerably 
in breadth and weight after this age. Girls remain nearly station- 
ary between the ages of 20 and 30 years. 
After the age of 35 years, adults increase in weight at the 
rate of about three-quarters of a pound annually. It is a curious 
fact that while below the height of 60 inches men are usually 
heavier than women of the same age, above this height women are 
heavier than men of the same height and age. 
The accompanying tables, copied from an admirable paper 
by Emerson and Manny of the Boston Nutrition Clinic embody 
the results obtained by Bowditch, Peckham, Boas, Burk, Holt, 
Greenwood and others in the measurement of more than 400,000 
children and afford the best information available respecting the 
normal rate of growth and development. 
A point of much importance which is usually overlooked in 
the routine use of tables of this sort is the fact that a very con- THE ENERGY OF FOOD—THE CALORY 
111 
siderable variation from the average may occur within normal 
limits and must be taken into account. This variation often 
amounts to as much as 10 to 20 per cent in either direction and 
sometimes more than this. The natural “build” of the subject, 
and especially his race must be taken into consideration. Italian 
and Jewish children are notably shorter than native Americans. 
It is not wise to assume that a weight 7 per cent below the 
average is an indication of under-nutrition without other con- 
firmatory evidence. The table is of value, however, in calling 
attention to such cases and thus suggesting an inquiry which may 
show the need of better feeding or other aid to better nutrition. 
TABLE III 
Showing Annual Increase in Weight of Boys and Girls. 
BOYS 
Year—52 Weeks 
Quarter— 
13 Weeks 
Week 
Age 
Pounds 
Ounces 
Pounds 
Ounces 
Pounds 
Ounces 
Birth to 1 year 
13.45 
215.2 
3.3625 
53.8 
.259 
4.14 
1 to 2 years 
0.3 
100.8 
1.575 
25.2 
.121 
1.94 
2 to 3 years 
5.2 
83.2 
1.3 
20.8 
.100 
1.60 
3 to 4 years 
4.3 
68.8 
1.075 
17.2 
.083 
1.32 
4 to 5 years 
4.0 
64.0 
1.0 
16.0 
.077 
1.23 
5 to 6 years 
4.0 
64.0 
1.0 
10.0 
.077 
1.23 
6 to 7 years 
4.3 
68.8 
1.075 
17.2 
.083 
1.32 
7 to 8 years 
5.0 
80.0 
1.25 
20.0 
.090 
1.54 
8 to 9 years 
5.1 
81.6 
1.275 
20.4 
.098 
1.57 
9 to 10 years 
5.8 
92.8 
1.45 
23.2 
.112 
1.79 
10 to 11 years 
5.3 
84.8 
1.325 
21.2 
.102 
1.03 
11 to 12 years 
C. 2 
99.2 
1.55 
24.8 
.119 
1.91 
12 to 13 years 
7.9 
126.4 
1.975 
31.6 
.152 
2.43 
13 to 14 years 
10.4 
166.4 
2.6 
41.6 
1200 
3.20 
14 to 15 years 
12.2 
195.2 
3.05 
48.8 
.235 
3.75 
15 to 16 years 
13.6 
217.6 
3.40 
54.4 
.262 
4. IS 
GIRLS 
' — 
— 
— 
Year,—52 Weeks 
Quarter—13 Weeks 1 
Week 
Age 
Pounds 
Ounces 
Pounds 
0 unces | 
Pounds 
Ounces 
Birth to 1 year 
13.34 
213.44 
3.335 
53.36 
.257 
4.11 
1 to 2 years 
6.0 
96.0 
1.50 
24.0 
.115 
1.85 
2 to 3 years 
5.0 
80.0 
1.25 
20.0 
.096 
1.54 
3 to 4 years 
3.8 
60.8 
.95 
15.2 
. 073 
1.17 
4 to 5 years 
3.6 
57.6 
.9 
14.4 
.069 
1.11 
5 to 6 years 
3.6 
57.6 
.9 
14.4 
.069 
1.11 
0 to 7 years 
4.3 
68.8 
1.075 
17.2 
.083 
1.32 
7 to 8 years 
4:8 
76.8 
1.2 
19.2 
.092 
1.47 
8 to 9 years 
4.9 
78.4 
1.225 
19.6 
.091 
1.51 
9 to 10 years 
5.5 
88.0 
1.375 
22.0 
.106 
1.69 
10 to 11 years 
6.6 
105.6 
1.65 
26.4 
. 127 
2.03 
11 to 12 years 
9.2 
147.2 
2.3 
36.8 
. 177 
2.83 
12 to 13 years 
10.0 
160.0 
2.5 
40.0 
. 192 
3.08 
13 to 14 years 
9.6 
153.6 
2.4 
38.4 
. 1S5 
2.95 
8.4 
134.4 
2.1 
33.0 
.1/0 
2.r>*> 
15 to 16 years 
5.6 
89.6 
1.4 
22.4 
. 108 
1.72 
The effects of the earlier occurrence of puberty in girls than 
in boys is clearly shown in the above table. Between the ages of 
10 to 13 years inclusive, girls increase in weight an average of 
25.8 pounds, while boys increase only 19.4 pounds in weight; but 
in the years 13 to 16, boys increase in weight by 36.2 pounds, while 
girls make a gain during these years of only 23.6 pounds. 112 
THE NEW DIETETICS 
TABLE IV 
Showing: Normal Rate of Development in Boys. 
BOYS 
Age 
Height in 
Weight in 
Age 
Height in I 
Weight in 
Year 8 
Months 
Inches 
Pounds 
Years 
Months 
Inches \ 
Pounds 
Birth 
0 
*20.6 
* 7.55 
9 
0 
50.0 
59.6 
2 
*22.5 
*10.4 
9 
2 
50.3 
60.6 
4 
*24.5 
*13.2 
9 
4 
50.6 
Cl .5 
G 
*26.5 
*16.0 
9 
6 
51.0 
62.5 
8 
*27.5 
*17.7 
9 
8 
51.3 
10 
*28.5 
*19.3 
9 
10 
51.6 
64.4 
X 
0 
*29.5 
*21.0 
10 
0 
51.9 
G5.4 
1 
2 
*30.3 
*22.1 
10 
2 
52.2 
66.3 
1 
4 
*31.1 
*23.3 
10 
4 
52.5 
67.2 
1 
G 
*32.0 
*24.5 
10 
G 
52.7 
G8.0 
1 
8 
*32.7 
*25.5 
10 
8 
53.0 
08.9 
1 
10 
*33.4 
*26.4 
10 
10 
53.3 
69.8 
2 
0 
*34.0 
*27.3 
11 
0 
53.6 
70.7 
2 
2 
*34.7 
*28.2 
11 
2 
53.9 
71.7 
2 
4 
*35.4 
*29.1 
11 
4 
54.2 
72.7 
o 
G 
*36.0 
*30.0 
11 
0 
54.5 
73.8 
2 
8 
*36.5 
*30.8 
11 
8 
54.8 
74.8 
2 
10 
*37.0 
*31.6 
11 
10 
55.1 
75.9 
a 
0 
*37.5 
*32.5 
12 
0 
55.4 
76.9 
3 
2 
*38.0 
*33.2 
12 
2 
55.8 
78.2 
3 
4 
*38.5 
*34.0 
12 
4 
56.1 
79.5 
3 
G 
*39.0 
*34.7 
12 
G 
56.5 
80.8 
3 
8 
*39.5 
*35.4 
12 
8 
56.8 
82.1 
3 
10 
*40.0 
*36.1 
12 
10 
57.2 
83.5 
4 
0 
*40.5 
*36.8 
13 
0 
57.5 
84.8 
4 
0 
39.5 
37.2 
13 
2 
57.9 
8G.5 
4 
2 
39.9 
37.9 
13 
4 
58.3 
88.3 
4 
4 
40.2 
38.5 
13 
G 
58.7 
90.0 
4 
G 
40.0 
39.2 
13 
8 
59.2 
91 .8 
4 
8 
41.0 
39.8 
13 
10 
59. G 
93.5 
4 
10 
41.4 
40.5 
14 
0 
60.0 
95.2 
0 
41.7 
41.2 
14 
GO. 5 
97.2 
2 
42.1 
41.8 
14 
4 
61.0 
09.3 
4 
42.4 
42.4 
14 
6 
01.5 
101.3 
G 
42.8 
43.1 
14 
8 
61.9 
103.3 
8 
43.2 
43.8 
14 
10 
62.4 
105.3 
111 
43.5 
44.5 
15 
0 
62.9 
107.4 
0 
1) 
43.9 
45.2 
15 
2 
63.2 
109.7 
0 
2 
44.3 
15 
4 
63.6 
111.9 
0 
4 ' 
44.7 
46.G 
15 
6 
63.9 
114.2 
0 
G 
45.1 
47.3 
15 
8 
64.2 
116.5 
0 
8 
45.4 
48.1 
15 
10 
64.6 
118.8 
G 
10 
45.7 
48.8 
16 
0 
64.9 
121.0 
7 
0 
46.0 
49.5 
16 
2 
G5.1 
122.5 
7 
2 
46.5 
50.3 
-16 
4 
05 5 
124.0 
7 
4 
46.9 
51.2 
16 
G 
05.7 
125.5 
7 
G 
47.4 
52.0 
16 
8 
65.9 
127.0 
7 
8 
47.9 
52.8 
16 
10 
66.1 
128.5 
7 
10 
48.3 
53.6 
17 
0 
00.5 
130.0 
8 
0 
4S.8 
54.5 
17 
2 
0G.7 
130 9 
8 
2 
49.0 
55.4 
17 
4 
00.8 
131.7 
8 
4 
49.2 
56.2 
17 
G 
G7.0 
132.6 
8 
G 
49.4 
57.1 
17 
8 
G7.2 
133.4 
8 
8 
49.G 
57.9 
17 
10 
07.3 
134.3 
8 
10 
49.8 
58.8 
IS 
0 
G7.4 
135.1 
•Without Clothing. THE ENERGY OF FOOD—THE CALORY 
113 
TABLE V 
Showing Normal Rate of Development in Girls 
GIRLS 
Age 
Height in 
Weight in 
Age 
Height in 
Weight in 
'ears 
Months 
Inches 
Pounds 
Years 
Months 
Inches 
Pounds 
iirth 
0 
*20.5 
* 7.16 
9 
0 
49.7 
57.4 
2 
*22.3 
* 9.9 
9 
2 
50.0 
58.3 
4 
*24.2 
*12.7 
9 
4 
50.4 
59.2 
6 
*26.0 
*15.5 
9 
6 
50.7 
60.2 
8 
*27.0 
*17.2 
9 
8 
51.0 
61.1 
10 
*28.0 
*18.8 
9 
10 
51.4 
62.0 
l 
0 
*29.0 
*20.5 
10 
0 
51 .7 
62.9 
I 
2 
*29.8 
*21.7 
10 
2 
52.1 
64.0 
1 
4 
*30. G 
*22.8 
10 
4 
52.4 
65.1 
1 
0 
*31.4 
*24.0 
10 
6 
52. S 
66.2 
1 
8 
*32.0 
*24.8 
10 
8 
53.2 
67.3 
1 
10 
*32.7 
*25.6 
10 
10 
53.5 
68.4 
2 
0 
*33.4 
*26.5 
11 
0 
53.8 
69.5 
2 
2 
*34.0 
*27.3 
11 
2 
54.1 
71.0 
2 
4 
*34.6 
*28.1 
11 
4 
54.5 
72.6 
2 
0 
*35.3 
*29.0 
11 
6 
54.9 
74.1 
2 
8 
*35.9 
*29.8 
11 
8 
55.3 
*75.7 
2 
10 
*36.5 
*30.6 
11 
10 
55.7 
77.2 
3 
0 
*37.0 
*31.5 
12 
0 
56.1 
78.7 
3 
2 
*37.5 
*32.1 
12 
2 
56.5 
80.4 
3 
4 
*38.0 
*32.7 
12 
4 
56.9 
82.0 
3 
6 
*38.5 
*33.3 
12 
6 
57.3 
83.7 
3 
8 
*39.0 
*34.0 
12 
8 
57.7 
85.4 
3 
10 
*39.5 
*34.6 
12 
10 
58.1 
87.0 
4 
0 
*40.0 
*35.3 
13 
13 
13 
13 
13 
13 
14 
14 
14 
14 
14 
14 
15 
15 
15 
15 
15 
15 
16 
16 
16 
16 
16 
16 
17 
0 
2 
4 
6 
8 
10 
0 
2 
4 
6 
8 
10 
0 
2 
4 
6 
8 
10 
0 
2 
4 
6 
8 
10 
0 
58.5 
58.9 
59.2 
59.5 
59.8 
60.1 
60'. 4 
60.6 
60.8 
61.0 
61.2 
61.4 
61.6 
61.7 
61.8 
61.9 
62.0 
62.1 
62.2 
62.3 
62.4 
62.5 
62.5 
62.6 
62.7 
88.7 
90.3 
91.9 
93.5 
95.1 
96.7 
98.3 
99.7 
101.1 
102.5 
103.9 
105.3 
106.7 
107.6 
108.6 
109.5 
110.4 
111.3 
112.3 
112.8 
113.3 
113.8 
114.4 
114.9 
115.4 
4 
4 
4 
4 
4 
4 
5 
5 
5 
5 
5 
5 
6 
6 
6 
6 
6 
6 
7 
7 
7 
1 
7 
7 
0 
2 
4 
0 
8 
10 
0 
2 
4 
6 
8 
10 
0 
2 
4 
6 
8 
10 
0 
2 
4 
6 
8 
10 
39.7 
39.7 
40.0 
40.4 
40.7 
41.0 
41.3 
41.6 
41.9 
42.3 
42.6 
42.9 
43.3 
43.7 
44.1 
44.5 
44.9 
45.3 
45.7 
46.0 
46.4 
46.7 
47.0 
47.4 
36.2 
36.8 
37.4 
38.0 
38.6 
39.2 
39.8 
40.4 
41.0 
41.6 
42.2 
42.8 
43.4 
44.1 
44.8 
45.5 
46.2 
46.9 
47.7 
48.5 
49.3 
50.1 
50.9 
51.7 
8 
0 
47.7 
52.5 
8 
2 
4S.0 
53.3 
S 
4 
48.4 
54.1 
8 
G 
48.7 
55.0 
8 
8 
49.0 
55.8 
8 
10 
49.4 
56.6 
Without clothing. 114 
THE NEW DIETETICS 
TABLE VI 
Showing Normal and Deficient Weight for Different 
Heights in Boys and Girls, 
BOYS 
GIRLS 
Height 
Inches 
A verage 
Weight 
for Height 
Pounds 
7% 
Under- 
weight 
Pounds 
10% 
Under- 
weight 
Pounds 
Average 
Weight 
for Height, 
Pounds 
7% 
Under- 
weight 
Pounds 
10% 
Under- 
weight 
Pounds 
Height 
Inches 
*21 
8 
2 
7 
6 
7 
4 
7 
9 
7 
3 
7 
1 
21* 
*22 
9 
7 
9 
0 
8 
7 
9 
4 
8 
7 
8 
5 
22* 
*23 
11 
1 
10 
3 
10 
0 
11 
0 
10 
2 
9 
9 
23* 
*24 
12 
5 
11 
6 
11 
3 
12 
5 
11 
6 
11 
3 
24* 
*25 
13 
9 
12 
9 
12 
5 
14 
0 
13 
0 
12 
6 
25* 
*20 
15 
3 
14 
2 
13 
8 
15 
5 
14 
4 
14 
0 
26* 
*27 
16 
9 
15 
7 
15 
2 
17 
2 
16 
0 
15 
5 
27* 
*28 
18 
5 
16 
2 
16 
7 
18 
8 
17 
5 
16 
9 
28* 
*29 
20 
2 
18 
8 
18 
2 
20 
5 
19 
1 
18 
5 
29* 
*30 
21 
7 
20 
2 
19 
6 
22 
0 
20 
5 
19 
8 
30* 
*31 
23 
_2 
21 
6 
20 
9 
23 
4 
21 
8 
21 
1 
31* 
*32 
24 
5 
22 
8 
22 
1 
24 
8 
23 
1 
22 
3 
32* 
*33 
25 
9 
24 
1 
23 
3 
26 
0 
24 
2 
23 
4 
33* 
*34 
27 
3 
25 
4 
24 
6 
27 
3 
25 
4 
24 
6 
34* 
*35 
28 
7 
26 
7 
25 
8 
28 
G 
26 
6 
25 
7 
35* 
*36 
30 
0 
27 
9 
27 
0 
30 
0 
27 
9 
27 
0 
36* 
*37 
31 
6 
29 
4 
28 
4 
31 
5 
29 
3 
28 
4 
37* 
*38 
33 
2 
30 
9 
29 
9 
32 
7 
30 
4 
29 
4 
38* 
39 
36 
3 
33 
8 
32 
7 
35 
7 
33 
2 
32 
1 
39 
40 
38 
1 
35 
4 
34 
3 
37 
4 
34 
8 
33 
7 
40 
41 
39 
8 
37 
0 
35 
8 . 
39 
2 
36 
5 
35 
3 
41 
42 
41 
7 
38 
8 
37 
5 
41 
2 
38 
3 
37 
1 
42 
43 
43 
5 
40 
5 
39 
2 
43 
1 
40 
1 
38 
8 
43 
44 
45 
4 
4-2 
2 
40 
9 
44 
8 
41 
7 
40 
3 
44 
45 
47 
1 
43 
8 
42 
4 
46 
3 
43 
1 
41 
7 
45 
46 
49 
5 
46 
0 
44 
6 
48 
5 
45 
1 
43 
7 
46 
47 
51 
4 
47 
8 
46 
3 
50 
9 
47 
3 
45 
8 
47 
48 
53 
0 
49 
3 
47 
7 
53 
3 
49 
6 
48 
0 
IS 
49 
55 
4 
51 
5 
49 
9 
55 
8 
51 
9 
50 
2 
49 
50 
59 
6 
55 
4 
53 
6 
58 
3 
54 
2 
52 
5 
50 
51 
62 
5 
58 
1 
56 
3 
61 
1 
56 
8 
55 
0 
51 
52 
65 
8 
61 
1 
59 
2 
63 
8 
59 
3 
57 
4 
52 
53 
68 
9 
64 
1 
62 
0 
66 
S 
62 
1 
60 
1 
53 
54 
72 
0 
67 
0 
64 
8 
70 
3 
65 
4 
63 
3 
5 l 
55 
75 
4 
70 
1 
67 
9 
74 
5 
09 
3 
67 
1 
55 
50 
79 
2 
73 
7 
71 
3 
78 
4 
70 
9 
70 
6 
50 
57 
82 
8 
77 
0 
74 
5 
82 
5 
76 
7 
74 
3 
57 
58 
87 
0 
80 
9 
78 
3 
86 
6 
80 
5 
77 
9 
53 
59 
91 
1 
84 
7 
82 
0 
91 
1 
84 
7 
82 
0 
59 
60 
95 
2 
88 
5 
85 
7 
96 
7 
89 
9 
87 
0 
60 
61 
99 
3 
92 
3 
89 
4 
102 
5 
95 
3 
92 
2 
61 
G2 
103 
8 
96 
5 
93 
4 
110 
4 
102 
7 
99 
4 
fi2 
03 
108 
0 
100 
4 
97 
2 
118 
0 
109 
7 
106 
2 
63 
64 
114 
7 
106 
7 
103 
2 
123 
0 
114 
4 
110 
7 
64 
05 
121 
8 
113 
3 
109 
6 
130 
0 
120 
9 
117 
0 
65 
66 
127 
8 
118 
9 
115 
0 
137 
0 
127 
4 
123 
3 
66 
67 
132 
6 
123 
3 
119 
3 
143 
0 
133 
0 
12S 
7 
67 
68 
138 
9 
129 
2 
125 
0 
146 
9 
136 
6 
132 
2 
68 
♦Without Clothing. THE ENERGY OF FOOD—THE CALORY 
115 
Food Requirements by Men, Women and Children. 
The amount of food needed differs according to the age, the 
size, and the amount of muscular activity. 
Small animals require more food in proportion to their size 
than do large. Some insects eat all the time. Small birds con- 
sume each day an extraordinary amount of food. Infants and 
children need more food than adults in proportion to their size. 
For persons of average weight, the food requirement may be 
determined by multiplying the body weight in pounds by the 
number of calories which careful laboratory research has shown 
to be requisite, as follows: 
Age 
Calories 
per Pound 
Birth to 1 month 
30 
2 months 
40 
3 
41 
4-6 
43 
7-9 
40 
1 -2 years 
40 
3 -4 “ 
37-40 
5 “ 
35-37 
Age 
Calories 
per Pound 
6 
years 
34-35 
7 
a 
32-34 
8- 9 
n 
30-35 
10-12 
“ 
28-32 
12-13 
u 
25-30 
14-17 
(( 
20-25 
Adults 
16-20 
The following table, based upon the work of Atwater and 
Benedict, shows the amount of food required by persons of dif- 
ferent sex and age, taking the ration of an adult man as the unit: 
Man 1.0 
Woman 0.8 
Boys (14-17) 0.8 
Girls (14-17) 0.7 
Children (10-13) 0.6 
Children (6-9) 0.5 
Children (2-4) 0.4 
Children (under 2) 0.3 
Changes Which Take Place in the Body in Old Age. 
The general tendency throughout the body in advancing age 
is for the development of cells of a comparatively low type, such 
as the connective tissue cells. These cells, tending to increase in 
the liver, kidneys and various other organs, crowd out and destroy 
the higher cells and hence produce impairment of function in 116 
THE NEW DIETETICS 
important excretory and other organs. The same changes take 
place in the brain and nerves and are especially active in the 
arteries, causing arteriosclerosis. Certain of the white blood 
corpuscles also take part in this degenerative process, as shown 
in the whitening of the hair, which is due to the robbing of the 
hair of pigments by white blood cells (macrophags), and destruc- 
tion of the supporting structures of the bones, causing poro.sity 
and weakening of these structures. 
The Quantity of Food Required in Old Age* 
The food should be steadily reduced in quantity with ad- 
vancing age. No doubt many elderly persons eat more than is 
wholesome for them. As weight and bodily activity diminish, the 
food intake should be proportionately diminished. According to 
Maurel and Quatelet, the food requirement of persons in ad- 
vanced years is as shown in the following table. 
Age 
MEN 
WOMEN 
Years 
Weight, Lbs. 
Calories 
Weight, Lbs. 
Calories 
60 
144 
1963 
125 
1700 
70 
139 
1890 
118 
1600 
80 
135 
1530 
113 
1300 
90 
117 
1450 
108 
1230 
Physique and Diet* 
Zimmer has shown that vigorous muscles, even when at rest, 
destroy more sugar than do feeble ones, a fact which is easily 
understood when we remember that the muscles are the furnace 
of the body, and are the chief seat of the vital combustion by 
which glycogen, or sugar, is consumed. Large and vascular 
muscles will naturally consume more sugar than feeble and anemic 
muscles, just as a large furnace with a good draft will consume 
more fuel than a small furnace with a poor draft. Under the 
influence of either massage or exercise, the blood is made to go 
through the muscles; while in a state of rest it goes around 
rather than through them. 
It thus appears that a robust, well developed person with 
a good muscle tone needs more food than a weak person whose 
muscles are soft and relaxed. This fact is usually indicated by 
a keen appetite in the case of the robust person and its absence 
in the case of the weak one. THE ENERGY OF FOOD—THE CALORY 
117 
Diet and Metabolism. 
The taking of food increases metabolism. Fasting reduces 
metabolism about 10 per cent. Food stimulates the activity of 
the body cells. In the case of fats and carbohydrates, the stim- 
ulating effect is small—6 per cent, for carbohydrates and 14.5 per 
cent, for fats; but in the case of protein the effect is great, 
amounting to 40 per cent. (Rubner). This is a fact of great 
importance and should never be lost sight of in the arrangement 
of bills of fare. Meat has long been regarded as a stimulating 
or “heating” food, and on that account has been condemned in 
fevers and as a hot weather diet by most authorities; but it is 
important to remember that there are numerous conditions of 
disease in which marked increase of metabolism is present and in 
which it is most desirable to suppress influences likely to produce 
a further increase of metabolic activity. 
It is worth while to note, also, that in conditions of disease, 
when the normal balance of metabolic activities is already upset, 
further disturbance in the same direction may be easily produced, 
so that a protein ration which might be tolerated in health, may 
become highly injurious. 
In toxic goiter (Graves’ disease), lymphatic leukemia, severe 
diabetes, certain cases of cancer, fever, and advanced cases of 
heart disease, there may be a marked increase of metabolism. 
It is now known, in fact, that hyperthyroidism, with consequent 
exaggerated metabolism, occurs much more frequently than was 
formerly supposed. In all these conditions, which include a very 
large number of clinical cases, comprising all febrile cases, it is 
very evident that a very low protein diet is indicated. This 
naturally requires the exclusion of meat and meat extracts and 
broths of all sorts from the diet, in such cases. Every experi- 
enced physician can recall cases in which the temperature of a 
fever patient has risen sharply after the taking of meat. For 
many years, the writer has excluded meats and meat products 
of all sorts from the surgical wards under his supervision, and 
with marked benefit in the avoidance of postoperative fever as 
well as acidosis and other complications. 
Diet and Development* 
The remarkable influence of food upon bodily growth and 
development is not only a matter of common observation but is 
most forcibly illustrated by the results of laboratory experiments THE NEW DIETETICS 
118 
and certain remarkable natural history facts. Gudernatsch, in 
experiments upon tadpoles, found that if fed on thymus gland 
they grew to be very large but never changed to frogs; whereas, 
if they were fed on thyroid gland they quickly changed to frogs 
but remained extremely small, scarcely larger than flies. The 
larvae of bees fed on “bee bread” become ordinary workers or 
infertile females; but if fed “royal jelly,” they become queens 
or fertile females. Canary birds fed on sweet red peppers be- 
come red in color. 
The High Protein Ration. 
Voit was the first to establish a standard ration. He required 
for a man weighing 154 pounds approximately 4 ounces of pro- 
tein, 2 ounces of fat, and 18 ounces of carbohydrates; more ex- 
actly, in calories, protein, 484; fat, 521; carbohydrates, 2050; 
total, 3055. The research suggested by Horace Fletcher and con- 
ducted by Chittenden and Mendel demonstrated that the protein 
might be reduced to one-third of Voit’s standard with an actual 
gain in health and vigor. Drs. Murlin and Miller of the United 
States Army, after a nutritional survey of the United States 
Army camps, pointed out in their report that “it is the general 
consensus of opinion among experts in nutrition that an excess 
of protein is undesirable in the dietary of a hard working man, 
since muscular work does not involve destruction of muscular 
tissue beyond the amount sustained in muscular rest.” 
Food Requirement of Infants and Young Children. 
Height 
Weight 
Age 
Inches 
Pounds 
Calories 
0 
20.6 
7.5 
225 
2 months 
22.5 
10.4 
375 
4 “ 
24.5 
13.2 
500 
6 “ 
26.5 
16.0 
700 
8 “ 
27.5 
17.7 
750 
10 “ 
28.5 
19.3 
775 
1 year 
29.5 
21.0 
850 
1*4 years 
32.0 
24.5 
1000 
2 “ 
34.0 
27.0 
1075 
2i4 “ 
36.0 
30.0 
1200 
3 “ 
37.5 
32.5 
1300 
“ 
39.0 
34.7 
1350 
4 “ 
40.5 
37.0 
1400 
5 “ 
41.7 
41.0 
1475 
6 “ 
43.0 
45.0 
1525 
7 “ 
46.0 
49.0 
1600 THE ENERGY OF FOOD—THE CALORY 
119 
Food Requirement of Children and Youth, 
Age 
Height 
Weight 
Yrs. Mos. 
Inches 
Pounds 
Calories 
BOYS 
8—0 
48.8 
54.5 
1700 
8-6 
49.4 
57.1 
1750 
9—0 
50.0 
59.6 
1800 
9—6 
51.0 
62.5 
1850 
10—0 
51.9 
65.4 
1900 
10-6 
52.7 
68.0 
1950 
11-0 
53.6 
70.7 
2000 
11—6 
54.5 
73.8 
2050 
12—0 
55.4 
76.9 
2100 
12—6 
56.5 
80.8 
2150 
13—0 
57.5 
84.8 
2200 
13—6 
58.7 
90.0 
2250 
14—0 
60.0 
95.2 
2300 
14—6 
61.5 
101.3 
2350 
15—0 
62.9 
107.4 
2400 
15—6 
63.9 
114.2 
2450 
16—0 
64.9 
121.0 
2500 
16-6 
65.7 
125.5 
2550 
17—0 
66.5 
130.0 
2600 
17—6 
67.0 
132.6 
2650 
Age 
Height 
Weight 
Yrs. Mos. 
Inches 
Pounds 
Calories 
GIRLS 
8—0 
47.7 
52.5 
1575 
8—6 
48.7 
55.0 
1600 
9—0 
49.7 
57.4 
1650 
9—6 
50.7 
60.2 
1700 
10—0 
51.7 
62.9 
1750 
10-6 
52.8 
66.2 
1800 
11—0 
53.8 
69.5 
1850 
11—6 
54.9 
74.1 
1900 
12—0 
56.1 
78.7 
1950 
12—6 
57.3 
83.7 
2000 
13—0 
58.5 
88.7 
2050 
13—6 
59.5 
93.5 
2100 
14—0 
60.4 
98.3 
2150 
14—6 
61.0 
102.5 
2200 
15—0 
61.6 
106.7 
2250 
15—6 
61.9 
109.5 
2275 
16—0 
62.2 
112.3 
2300 
16-6 
62.5 
113.8 
2325 
17—0 
62.7 
115.4 
2350 
Food Requirement of Adults. 
Height 
Weight 
Inches 
Pounds 
Calories 
MEN 
60 
120-130 
1900-2000 
61 
122-132 
1950-2100 
62 
124-135 
2000-2150 
63 
127-140 
2050-2200 
64 
131-143 
2100-2250 
65 
134-147 
2150-2350 
66 
138-151 
2200-2400 
67 
142-156 
2250-2500 
68 
146-162 
2300-2550 
69 
150-168 
2400-2650 
70 
154-174 
2450-2750 
71 
159-180 
2500-2850 
72 
165-185 
2600-2900 
73 
170-189 
2700-3000 
74 
176-192 
2800-3050 
75 
181-196 
2900-3100 
Height 
Weight 
Inches 
Pounds 
Calories 
WOMEN 
59 
111-126 
1775-2000 
60 
113-129 
1800-2050 
61 
115-132 
1850-2100 
62 
117-136 
1875-2175 
63 
120-140 
1900-2250 
64 
123-144 
1950-2300 
65 
125-148 
2000-2350 
66 
128-152 
2050-2400 
67 
132-155 
2100-2450 
68 
136-160 
2150-2500 
69 
140-165 
2200-2600 
70 
144-169 
2300-2700 120 
THE NEW DIETETICS 
Table of Heights and Weights of Men as Prepared by the 
Association of Life Insurance Medical Directors* 
Ages 
15-24 25-29 30-34 35-39 
40-44 
45-49 50-54 
55-59 60-64 65-69 
5 
ft. 0 in. 
120 
125 
128 
131 
133 
134 
134 
134 
131 
130 
1 in. 
122 
126 
129 
131 
134 
136 
136 
136 
134 
132 
2 in. 
124 
128 
131 
133 
136 
138 
138 
138 
137 
135 
3 in. 
127 
131 
134 
136 
139 
141 
141 
141 
140 
140 
4 in. 
131 
135 
138 
140 
143 
144 
145 
145 
144 
143 
5 in. 
134 
138 
141 
143 
146 
147 
149 
149 
148 
147 
6 in. 
138 
142 
145 
147 
150 
151 
153 
153 
153 
151 
7 in. 
142 
147 
150 
152 
155 
156 
158 
158 
158 
156 
8 in. 
146 
151 
154 
157 
160 
161 
163 
163 
163 
162 
9 in. 
150 
155 
159 
162 
165 
166 
167 
168 
168 
168 
10 in. 
154 
159 
164 
167 
170 
171 
172 
173 
174 
174 
11 in. 
159 
164 
169 
173 
175 
177 
177 
178 
180 
180 
6 
ft. 0 in. 
165 
170 
175 
179 
180 
183 
182 
183 
185 
185 
1 in. 
170 
177 
181 
185 
186 
189 
188 
189 
189 
189 
2 in. 
176 
184 
188 
192 
194 
196 
194 
194 
192 
192 
3 in. 
181 
190 
195 
200 
203 
204 
201 
198 
196 
196 
Table of Heights and Weights of Women as Prepared by the 
Mutual Life Insurance Company of New York* 
Ages 
15-19 20-24 25-29 
30-34 35-39 
40-44 
45-49 
50-54 55-59 60-64 
4 
ft. 11 in. 
111 
113 
115 
117 
119 
122 
125 
128 
128 
126 
5 
ft. 0 in. 
113 
114 
117 
119 
122 
125 
128 
130 
131 
129 
1 in. 
115 
116 
118 
121 
124 
128 
131 
133 
134 
132 
2 in. 
117 
118 
120 
123 
127 
132 
134 
137 
137 
136 
3 in. 
120 
122 
124 
127 
131 
135 
138 
141 
141 
140 
4 in. 
123 
125 
127 
130 
134 
138 
142 
145 
145 
144 
5 in. 
125 
128 
131 
135 
139 
143 
147 
149 
149 
148 
6 in. 
128 
132 
135 
139 
143 
146 
151 
153 
153 
152 
7 in. 
132 
135 
139 
143 
147 
150 
154 
157 
156 
155 
8 in. 
136 
140 
143 
147 
151 
155 
158 
161 
161 
160 
9 in. 
140 
144 
147 
151 
155 
159 
163 
166 
166 
165 
10 in. 
144 
147 
151 
155 
159 
163 
167 
170 
170 
169 
* The figures given include the ordinary house clothing. For net weight 
subtract 4 per cent. THE PHYSIOLOGY OF 
EATING 
Physiologic or biologic feeding requires careful adjustment 
of the food supply in quality and quantity to the nutritive needs 
of the body. A hundred years ago, even twenty years ago, it was 
difficult to do this. Many of the most important questions per- 
taining to nutrition were then only vaguely answerable. The 
clearly defined straight road in human feeding had not yet been 
scientifically marked out, but today this is no longer true. Care- 
ful laboratory experiment and scientific observation and research 
have solved so many of the problems and settled so many mooted 
questions it is now possible to feed human beings in as thor- 
oughly scientific a manner as horses, cows, pigs and chickens are 
fed, and the results in human beings are equally as striking as 
those in domestic animals. 
Physiologic feeding is as necessary for a man as for a race 
horse or for a competitor for a prize in a poultry show. The 
average man knows how to feed his horse so as to keep him in the 
best possible condition for service, but in feeding himself gives 
no thought to physiologic requirements but swallows whatever his 
fancy craves or his wife or hired cook sets before him. The 
farmer’s wife knows how to feed cows or chickens so as to secure 
the largest returns in milk or eggs, but in feeding herself and her 
family gives little thought to physiologic needs. 
The application of physiologic and biologic principles to the 
feeding of domestic animals, combined with scientific breeding, 
has accomplished such wonderful results that we now have cows 
which give more milk, hens that lay more eggs, fatter pigs and 
stronger, better and more enduring horses than the world ever 
knew before. From the results of the thousands of feeding ex- 
periments conducted in the Agricultural Experiment Stations and 
in nutrition laboratories, practical information of the greatest 
importance may be drawn in relation to human feeding. In 
recent years, much has been done in this direction, thanks to the 
labors of Hopkins, Mendel, McCollum and numerous experts 
121 122 
THE NEW DIETETICS 
who have given their attention to this line of research. However, 
the average man is not yet, to any considerable degree, acquainted 
with the facts which modern research have developed and placed 
at our disposal and the application of which ought to accom- 
plish as much for human beings as has been accomplished for 
domestic animals through the regulation of their nutrition by 
proper feeding. 
Unphysiologic eating is the active or predisposing cause of 
many chronic maladies. Biologic habits of eating should be 
formed in childhood and carefully adhered to during adult life. 
The so-called pleasures of the table are usually illicit enjoyments 
resulting from the indulgence of artificial tastes and depraved 
appetites from which a brief temporary felicity is derived at the 
expense of subsequent long drawn-out misery and disease. 
It is of the highest importance to begin the training of chil- 
dren in biologic habits of eating at an early age. Among the 
things of fundamental importance which should enter into the 
training of infants and young children are the following: 
1. Simplicity of taste. Sweets and the strongly flavored 
foods are extremely injurious to children. Through lessening 
or destroying their appetite for simple, mildly flavored natural 
foodstuffs, sweets and other highly flavored foods pervert the 
sense of taste, over-stimulate the appetite and lessen or destroy 
the appetite of the child for the mildly flavored, natural foods 
to which their digestive organs are adapted. 
2. Thorough mastication of the food. Young children may 
he easily taught to chew their food in a proper manner. In fact, 
thorough mastication is as natural for a child as for a monkey. 
The habit of hasty chewing is acquired. A monkey will seize one 
by one, and place in his mouth a whole handful of cherries, as 
rapidly as they may be offered to him, but later it will be dis- 
covered that he has not swallowed a single one of the luscious 
fruit, but carefully stored them away in his capacious cheek 
pouches. Later, at his leisure, he masticates each cherry in the 
most thorough-going manner, carefully rejecting the seed and the 
skin. If a child is thoroughly trained in the proper mastication of 
food when it first begins to chew, the habit will become fixed. 
3. Prompt and regular evacuation of the bowels at least 
three times a day is. another biologic habit the training in which 
is of the highest importance. It is of far more consequence for a 
teacher to know whether a child’s colon is evacuated regularly and THE PHYSIOLOGY OF EATING 
123 
frequently, than to know that he is acquiring proficiency in mathe- 
matics, geography or any other of his ordinary school studies. 
As Herbert Spencer has well said, “The first essential for success 
is to be a good animal.” 
Eating requires that the selection and use of food should be 
in harmony with the facts which modern research has brought 
forth in relation to human digestion and nutrition. These have 
been set forth in preceding chapters, the perusal of which should 
enable the intelligent reader to regulate his feeding in a satis- 
factory manner. In this chapter the constituents of foodstuffs 
will be discussed in fuller detail. The Protein Ration 
Protein is that element of the food which is used for the 
construction and repair of the highly vitalized or living tissues 
of the body; that is, the essential vital machinery, the muscles, 
glands, nerves and other parts concerned in the various activities 
or functions of the body, consist of protein. Between the periods 
of infancy and maturity, protein is required both for growth and 
repair. Recent experiments made in animal feeding indicate that 
in growing animals more than one-half (55 per cent.) of the pro- 
tein intake is utilized in the formation of new tissue. After ma- 
turity, the sole use of protein is for repair. The practical 
question, then, in the adult individual is, how much protein is 
required to make good the daily wear and tear of the body, or 
the necessary loss from the breaking down of the living structures 
as the result of work. 
This question is one of the very greatest practical interest, for 
Folin and other physiologists have shown that all surplus protein 
above what is required for repair is not only useless, not being 
necessary to satisfy any bodily need, but is a positive damage to 
the body, because it imposes upon the eliminative organs, espe- 
cially the liver and kidneys, a heavy burden of unnecessary work, 
the inevitable effect of which must be to wear out these organs 
prematurely and to interfere with their normal functions of 
destroying and eliminating the natural body wastes and thus 
keeping the blood and tissue fluids free from obstructing poisons. 
Probably the majority of persons who have given some 
thought to the question of the protein ration are laboring under 
the supposition that this question is a very new one, and that it 
is still a matter of experiment whether or not human life and 
vigor may be well maintained on a dietary which furnishes not 
more than one-third or one-half the amount of protein generally 
consumed. This is, however, quite an error. More than twenty 
years ago, when the question of the deficiency of protein in the 
Japanese dietary was raised by Mori, a special investigation was 
undertaken by a Japanese physiologist, Kumagawa, for the pur- 
pose of settling this question. He found that with his ordinary 
124 THE PROTEIN RATION 
125 
diet of Japanese foods only 54 grams of protein were eaten, less 
than half the amount required by Voit, and still smaller than 
Atwater’s standard. He also found that this diet furnished the 
body more protein than it actually required and reached the con- 
clusion that a larger amount of protein than this is quite unneces- 
sary, and that only a very small amount of protein is really 
needed, the important point being that the body shall be fur- 
nished with a sufficient amount of fat and carbohydrates to main- 
tain the supply of energy required by the tissues. He found also 
that an increase in the protein intake did not increase the amount 
of protein in the body but only increased the amount of urea 
found in the excretions. 
Numerous physiologists have contributed experimental ob- 
servations toward the settlement of the question, What should 
be the daily intake of protein? 
Klemperer, experimenting upon two young men who weighed 
respectively 141 and 144 pounds, found the protein consumption 
to be in one 27.4 grams, a trifle less than one ounce, and in the 
other 22.4 grams or three-fourths of an ounce. 
Siven, in experiments upon himself, found 28 grams, or one 
ounce of protein, sufficient to meet his bodily needs. 
Many years ago (1887) Hirschfeld had demonstrated the 
sufficiency of 37.5 grams (one and one-fourth ounces) of protein 
to supply the needs of the body; and this notwithstanding the 
fact that his ordinary diet previous to the experiment had con- 
tained 130 grams, or more than three times the necessary amount. 
Voit, the eminent German physiologist, had previously estab- 
lished a dietetic standard of 118 grams of protein (more than four 
ounces) as the necessary requirement, and Atwater had con- 
siderably raised this standard as the result of observations upon 
some 15,000 people in whom he found the consumption of pro- 
tein to vary from 100 to 175 grams (three and one-half to six 
ounces.) The great difference in the conclusions reached by 
these different investigators rendered necessary a critical exami- 
nation of the question. A thoroughgoing and decisive experi- 
mental research was finally undertaken, the conclusions of which 
have not only remained to the present time unshaken but have 
been so abundantly reinforced by the findings of other investi- 
gators that they may now be said to be established for all time. 
The genesis of this investigation, known as the Chittenden re- 
search, is of such unusual interest that it will be worth while to 126 
THE NEW DIETETICS 
devote a little space to its presentation, especially as the facts 
have never before been made public. 
The Chittenden Protein Standard, 
According to Chittenden, one-third gram per pound of body- 
weight of protein, or one and one-third calories per pound of 
body weight, is quite sufficient to fully meet the requirements of 
the body. Sherman has recently placed the protein requirements 
of the body at the still lower level of one calory per pound of 
body weight. From Folin’s experiments this would seem to be 
ample, since this most reliable investigator has shown that the 
greater part of the protein taken in the food is excreted by the 
kidneys in the form of urea without ever having been assimilated 
or utilized by the tissues. Folin holds that utilized protein is 
represented in the urine by creatinin, which agrees with the obser- 
vation of Liebig that in hunted foxes the amount of creatinin 
found in the muscles is ten times the normal quantity. Tibbies 
holds that the physiologic minimum of protein is one-half gram 
per kilogram of body weight, or a little less than one calory per 
pound of body weight, an observation which agrees with the 
recent very extensive research of Sherman. The experiments 
conducted by Siven led to the same conclusion. 
Professor Chittenden says, “With these facts before us, it 
is difficult to accept the assumption that dietetic customs afford 
any indication of the food requirements of the body. To the 
physiologist such a view does not appeal, since there is a lack ol 
any scientific evidence that carries conviction.” 
For some years after Professor Chittenden announced the 
results of his notable research, Dr. Benedict and others of the 
Atwater school vigorously opposed the low protein standard advo- 
cated by Chittenden and his associates, pronouncing it unsafe 
and questioning its scientific basis. 
In defending his position, Professor Chittenden quotes Pro- 
fessor Benedict as saying: 
Food should be ingested in just the proper amount to repair the 
waste of the body; to furnish it with the energy it needs for work and 
warmth; to maintain it in vigor; and, in the case of immature animals, 
to provide the proper excess for normal growth, in order to be of the 
most advantage to the body. 
Professor Chittenden also remarks that ,“Voit, among others, 
has clearly emphasized the general principle that the smallest THE PROTEIN RATION 
127 
amount of proteid, with non-nitrogenous food added, that will 
suffice to keep the body in a state of continual vigor is the ideal 
diet.” 
No physiologist will question the accuracy of the statement 
that the ideal diet is the smallest amount of food which is 
“sufficient to keep up that strength of body and mind that is 
essential to good health, to maintain the highest degree of physical 
and mental activity with the smallest amount of friction and the 
least expenditure of energy, and to preserve and heighten, if 
possible, the ordinary resistance of the body to disease germs.” 
All surplus of food is a wasteful burden to the body and a 
handicap to its energies. This is true even of fats and carbo- 
hydrates, an excess of which is readily disposed of by being de- 
posited beneath the skin in the form of fat, a reserve source of 
energy which may be drawn upon in time of need; but it is 
especially true of protein, a substance which cannot be stored in 
the body, which can be utilized only in the small amount required 
to replace the losses due to natural wear and tear. This amount 
the above considerations clearly show to be approximately one 
ounce to an ounce and a quarter for the average male adult, or, 
expressed in units of energy, 110 to 125 calories, the equivalent 
of about four ounces of lean meat or six and a half ounces of 
roast beef. 
Another simple, and at the same time most convincing method 
of determining the necessary protein intake has recently been 
made known. A few years ago, Rubner made a study of the pro- 
tein intake of the nursing infant and found it to be one-half gram 
of protein to the kilogram of body weight, or nine-tenths of a 
calory per pound of body weight. Careful investigation has 
shown that an infant uses 50 per cent, of its protein intake for 
growth, that is, for building up its muscles and glands, blood and 
other structures. This leaves not more than one-half of one 
calory per pound of body weight as the amount necessary for tis- 
sue repair. It could hardly be claimed that the amount of protein 
needed for tissue repair per pound of body weight could be 
greater in an adult than in an infant; hence it is evident that if 
the intake of protein is fixed at one calory per pound of body 
weight, much more than Nature provides to the infant to meet 
its requirement for growth as well as repair, the provision for 
meeting the demands of the body for repair of its vital machinery 
will be ample. It is interesting to know that the conclusion 128 
THE NEW DIETETICS 
reached by this short and direct method is practically identical 
with the results at which Professor Chittenden arrived through 
his laborious research. Professor Chittenden weighs 125 pounds. 
His protein intake is 31 grams or 125 calories, or one calory per 
pound of body weight. 
The subject of one of Professor Rubner’s experiments per- 
formed in one day work equal to nearly one million foot pounds, 
of which enormous output of energy it was found that protein 
supplied only one six-hundredth part. This shows again the 
fallacy of the popular notion that meat and other highly nitro- 
genous foods are necessary for the maintenance of strength, es- 
pecially in persons who are engaged in hard labor. 
Other observations by Rubner show that the body may be 
maintained in health and strength on one-half an ounce of dried 
protein daily. These facts are of the greatest importance and 
serve still further to fortify the position of Professor Chitten- 
den in regard to the low protein ration, as well as the practice of 
non-flesh eaters. 
The Japanese have for generations “lived and thrived on a 
daily ration noticeably low in its content of protein,” and “gen- 
erations of low protein feeding, with the temperance and sim- 
plicity in dietary methods thereby implied, have certainly not 
stood in the way of phenomenal development” (Chittenden). 
The experience of the war so overwhelmingly proved the 
sufficiency of the low protein ration, the opposers of the Chitten- 
den standard were compelled to recognize their error. The report 
brought back by Professor A. E. Taylor of the general adoption 
in Germany of the low protein ration and the account given by 
him of the physical accomplishments of the thousands of workers 
in the great ammunition factories in Germany, presented facts 
which could not be ignored, and which led Dr. Benedict of the 
Carnegie Nutrition Laboratory, of Boston, to plan the “Spring- 
field experiment,” which demonstrated in the most conclusive 
manner the sufficiency of the low protein standard established by 
the classic research of Chittenden. 
Sherman, of Columbia University, published recently the re- 
sults of a new research in the protein requirement which fully 
confirm the observations made by Chittenden and indicate that 
the proteins found in corn, wheat and oats, the three principal 
cereal grains have a higher value than other observers have given 
them. THE PROTEIN RATION 
129 
Sherman proved that nine-tenths of the protein of the diet 
may be derived from the cereals mentioned, provided that the 
other one-tenth consists of milk or apple proteins. He also notes 
that the total protein intake need not exceed one-half gram per 
kilogram, which is equivalent to a little less than one calorie per 
pound of body weight; that is, a person weighing 150 pounds may 
maintain his total protein requirement upon 13 ounces of corn 
meal, 9 ounces of graham flour, or 7 ounces of oatmeal, provided 
that in each case the cereal protein is supplemented by the pro- 
tein found in 4 ounces of milk. The equivalent of the milk pro- 
tein will be found in an ounce of cottage cheese. 
Professor Sherman’s observations agree with the results of 
large human experience. Cornmeal mush and milk was a staple 
food in the pioneer families of the Middle West half a century 
ago, and produced the sturdy men and women who have made 
this great section the very heart of American civic and industrial 
life. Oatmeal with milk is the staple food of the sturdy Scotch; 
and buttermilk with oatmeal and potatoes has for generations 
been the chief nutrient of the hardy Irish peasant. 
The protein of the ordinary ration appears to be disposed of 
in two ways: 
1. A portion, after conversion into amino acids or “build- 
ing” stones, is carried by the blood to the tissues, where it is 
utilized for repairing the waste due to wear and tear of the vital 
machinery. 
2. The remainder, probably the greater part of all the pro- 
tein eaten, never reaches the tissues at all but is converted into 
urea in the liver and excreted by the kidneys. 
Van Slyke has shown that the major part of the food pro- 
tein is eliminated within 24 hours in the form of urea. This 
conversion of the excess of protein takes place chiefly in the liver 
and begins within a few minutes after meat is eaten. 
On a high protein diet the amount of urea excreted by the 
kidneys is 33 to 37 grams, or an ounce and a quarter. On a free 
meat diet the amount may rise to 100 grams, or three and one- 
third ounces. On a protein-free diet the protein output falls to 
9 grams, less than one-third of an ounce, and on a diet based 
upon the Chittenden standard, the amount excreted is from half 
an ounce to two-thirds of an ounce. From these facts it is evi- 
dent that the kidneys of the hearty meat eater are compelled to 
do from two to five times as much work in the elimination of 130 
THE NEW DIETETICS 
urea as is required of the kidneys of a low protein feeder. Since 
Folin has shown that all the urea excreted by the kidneys repre- 
sents surplus protein, that is, food protein which has never been 
assimilated and hence has not been utilized for tissue building, 
it will readily appear that a high protein diet is one of the most 
efficient methods by which the kidneys may be prematurely worn 
out and life thus abbreviated. 
The protein of the food contains a certain proportion of 
sulphur. This is separated in the process of digestion and com- 
bines with hydrogen, forming hydrogen sulphide, a highly poison- 
ous gas which causes cyanosis when present in sufficient quantity. 
This fact is of itself sufficient reason for avoidance of an excess 
of protein. A pronounced odor of sulphureted hydrogen, usually 
accompanied by a black or dark brown coloration of the feces, is 
evidence that protein is being eaten in excess. 
Luxus Consumption of Protein, 
Tibbies, the eminent English authority on dietetics, in dis- 
cussing the question of the protein ration, remarks without com- 
ment ; “Kellogg subscribes to the doctrine that no protein is stored 
in the system, and considers that all protein above 60 or 70 grams 
daily is broken down in the alimentary canal by bacteria into 
toxins such as indol, skatol, phenol, leucin, tyrosin, etc., and cause 
autointoxication.” 
The professor is wholly correct in asserting that the writer 
considers that 60 or 70 grams of protein is amply sufficient to 
meet the needs of the average man. This amount is, in fact, more 
than can be utilized to advantage. But the doctor is wrong in 
representing that “no protein is stored in the system,” and that all 
surplus protein undergoes putrefaction in the intestine. Folin as 
well as Van Slyke has shown that the surplus protein is elim- 
inated by the kidneys as urea without ever entering into any 
useful process in the body. 
The doctrine of “luxus” protein feeding is justly repudiated 
by Taylor and other modern physiologists. There is not a particle 
of evidence that protein is needed in the body for any other pur- 
pose than the repair of tissues. Any surplus is treated as waste 
material and is a burden to the organs of elimination, especially 
the liver and the kidneys. 
It cannot be doubted, of course, that reduction of the pro- 
tein below the actual needs of the body causes a depreciation of THE PROTEIN RATION 
131 
vital resistance, through disturbance of the nutritive balance. The 
same is true with reference to any other food principle; but the 
question under discussion is not the effect of an actual deficiency 
of protein, but the effect of an excess. 
Effects of Protein Intake Upon the Urine, 
A few years ago (1908) the writer had made in the labora- 
tory of the Battle Creek Sanitarium a careful study of the urine 
in 24 men and 22 women, all young healthy subjects living upon 
a moderately low protein diet (Chittenden standard). The ac- 
companying table shows the marked contrast between the urine 
of persons living on such a diet and on the ordinary mixed diet. 
An examination of this table shows that a mixed diet requires 
the kidneys to do an enormous amount of excess and unnecessary 
work in the elimination of waste products derived from the food 
directly and not resulting from necessary or productive vital 
work. 
TABLE VII 
Ordinary or 
high protein 
diet (Folin) 
Low protein 
diet with- 
out meat 
Excess 
per 
gms. 
gms. 
cent. 
Quantity 
-C. c. 
1.430 
1.000 
43 
Total nitrogen 
a 
16.000 
6.440 
148 
Urea 
u 
29.800 
11.650 
155 
Uric acid 
(( 
0.370 
0.323 
14 
Ammonia, in terms of NH3.. 
(( 
0.850 
0.247 
244 
Chlorid 
(( 
10.050 
6.455 
56 
Creatinin 
(( 
1.550 
0.815 
90 
Phosphates 
a 
3.870 
1.455 
166 
Total sulphates 
(t 
3.140 
1.071 
192 
Indican 
a 
77.000 
5.600 
1275 
A study of the table will show at once the enormous amount 
of extra work imposed upon the kidneys by a high protein diet. 
It is to be noticed, for example, that the total quantity of urine 
eliminated by persons taking an ordinary mixed or high protein 
diet is 43 per cent, greater than the amount required by the low 
protein diet. The acidity is more than double. The total nitro- 
gen, representing the total amount of nitrogenous wastes elimi- 
nated, is increased nearly 150 per cent. The urea is increased 
an equal amount. The ammonia, which is the result of putre- THE NEW DIETETICS 
132 
faction in the colon, is increased to nearly three and a half times 
the normal. Creatinin, which is in large part derived from the 
meat eaten, is practically doubled. All the products resulting 
from putrefaction are increased to two or three times that of 
the low protein urine, and the indican, a direct product of the 
putrefaction of protein in the colon, is increased more than 1300 
per cent. 
These facts show beyond any room for doubt that a high 
protein diet, or even the ordinary mixed diet which, by including 
meat, comprises an excess of protein, compels the kidneys to do 
an enormous amount of extra and harmful work in order to 
remove from the blood the excessive amount of poisonous wastes 
thrown into it. The total work done is considerably more than 
double the total work normally required of the kidneys. Is it 
not a fair conclusion that kidneys required to do double duty 
cannot be expected to retain their integrity as long as those re- 
quired to do only the normal and necessary amount of work? 
The great prevalence of degeneration of the kidneys among flesh- 
eating people and flesh-eating animals, bears eloquent testimony 
upon this point. 
The liver and the kidneys co-operate in protecting the body 
against the destructive influence of the waste and poisonous sub- 
stances derived respectively from the activities of the body cells 
and the unutilized protein of the food. It has been clearly shown 
by extended clinical observation that over-loading these essential 
vital organs with work by eating an excess of protein is one of 
the most potent causes of disease. The experiments of Chitten- 
den, by which this was clearly demonstrated, have been fully and 
repeatedly confirmed by more recent investigations. 
It is evident, then, that a diet which is sufficient to main- 
tain the body in a state of health and to fully support its activities 
while at the same time taxing the liver and the kidneys to a 
minimum extent, must be in the highest degree suited to pro- 
motion of endurance and longevity. 
A research conducted by Campbell at Singapore and re- 
ported in the Biochemical Journal (1919) clearly demonstrates 
the advantage of a low protein diet. The work included the study 
of the urine in a Brahmin, a Chinese, a Tamil, a Malay, a Hindoo, 
a Eurasian, a Bengali, a Sikh and a European. The Brahmin and 
the Hindoo were vegetarians; the others lived on a mixed diet. 
It was found that the Brahmin and the Hindoo eliminated much THE PROTEIN RATION 
133 
smaller quantities of urea and other waste substances than any 
of the other subjects and very much less (scarcely half) than the 
average European (0.11 grams N per kilogram for the Brahmin 
and 0.127 for the Hindoo). 
Modern researches confirm the conception of Liebig that 
protein is essentially a tissue-building substance, and not pri- 
marily intended for body fuel. A dog fed upon lean meat free 
from fat requires a ration having a much higher caloric value 
than when fed upon a diet consisting largely of fats and carbo- 
hydrates, thus showing that, as a source of energy, protein is much 
inferior to fats and carbohydrates. The relation of the two 
classes of food principles appears to be essentially the same as 
that of metal repairs and coal to the locomotive. 
A High Protein Diet Increases Intestinal Putrefaction. 
The careful study of the bacterial flora of the intestine which 
has been made within recent years by Escherich, Tissier, Metch- 
nikoff, Herter, Levin, Roger, Adami, Cohendy, Gilbert, Dominici, 
Strassberger and others has shown the immense influence ex- 
erted upon the functions and tissues of the body by bacterial 
toxins formed within the alimentary canal. Absorbed into the 
portal blood, these poisons are circulated through the liver, where 
they are in part oxidized and rendered innocuous, and find their 
way out through the lungs, skin, and especially the kidneys. These 
investigators and others have shown that there is a close relation 
between the protein ration and intestinal putrefactions. 
Pasteur supposed that bacteria are a necessary aid to intes- 
tinal digestion and essential to both animal and plant life. His 
pupil, Roux, showed that beans may grow in a sterile soil. Nuttal 
and Thierfelder kept guinea-pigs alive in a sterile medium. Levin 
examined 480 animals at Spitzbergen—bears, seals, reindeer and 
other animals—53 species, and established the fact that in the 
Arctic regions the intestines of mammals are usually sterile. 
It seems to be finally settled that bacteria are not necessary 
for the maintenance of animal life, and certainly that putrefactive 
bacteria are not only unnecessary, but harmful. Nevertheless, 
these bacteria are present in the intestines in enormous quantities. 
Gilbert calculates the number of bacteria daily discharged from 
the body at twelve trillions. Strassberger makes the number one 
hundred and twenty trillions. Roger enumerates 240 species of 
bacteria which have been found in the human intestine. Many of 134 
THE NEW DIETETICS 
these produce substances which are in the highest degree toxic. 
On a high-protein diet, the poison-forming bacteria rapidly in- 
crease, giving rise to intestinal autointoxication. German medical 
authorities have been rather slow to recognize this condition, but 
Senator, Backmann, Mester, Brieger, Hoppe-Seyler, Krauss, 
Ewald, Jaffe, Albu, Hirschler, Munch, Rovighi, Grawitz and 
others have recognized the validity of the teaching of Bouchard, 
and have expressed views in harmony therewith. 
The writer has for some years pursued studies in relation 
to this question, and lately by the aid of the improved methods 
of Herter, Folin and other recent investigators, has made several 
observations which seem to have a practical bearing. Five healthy 
young men were fed upon various diets, as indicated in the tables 
presented herewith, and a careful study was made of the stools 
and the urine. In making these studies the stools were examined 
both chemically and bacteriologically. 
The amount of the daily ration was from 1,800 to 2,400 
calories. The principal carbohydrates were bread and potatoes. 
Fat in the proportion of about 30 per cent, of the total ration was 
taken in the form of butter. The protein ration was varied from 
125 to 450 calories. Each special dietary was closely followed 
for five to eight days, and was employed with two or more per- 
sons, and in several instances repeated a number of times. The 
figures given in the accompanying table are the averages obtained 
from all the observations made, the number of which is indicated 
in each case. 
TABLE VIII 
Showing the Amount of Intestinal Putrefaction as Indi- 
cated by the Amount of Indol Found in the 
Feces and of Indican in the Urine With 
the Several Diets Indicated, 
Group I—Moderately high 
protein diet, 1.00 gram or 
more per kilo, of body 
Daily 
ration in 
calories 
Gms. of 
protein 
per kilo of 
body weight 
No. of 
obser- 
vations 
Avg. amt. 
indol 
in feces 
mgms. 
Avg. 
indlcan 
in urine 
(Folin 
scale) 
weight 
Group II—Low-protein diet 
2,187 
1.00—1.80 
39 
1.2270 
6.00 
(vegetable) 
Group III—Low-protein diet 
below Chittenden stand- 
2,064 
0.49—0.96 
74 
0.3611 
0.00 
ard (vegetable) 
Group IV—Fruit and cereal 
2,040 
0.49- 
-0.80 
51 
0.1227 
0.00 
diet 
Group V—High-protein diet 
2,075 
0.49- 
-0.70 
38 
0.0567 
0.00 
—meat and vegetables 
2,200 
1.50—1.80 
10 
1.3508 
9.50 THE PROTEIN RATION 
135 
It is most clearly shown by the above tables, giving the re- 
sults of 212 observations, that the amount of intestinal putrefac- 
tion is directly proportional to the amount of protein in the 
dietary. 
Beckmann showed the same to be true of white of eggs, but 
much less so than with meat. 
Mester compared fresh meats and “prime” meat with the 
following result: 
Conjugate 
sulphates 
1 Ordinary food ' 0.058 
2 Ordinary diet plus meat 0.113 
3 Ordinary diet plus prime meat 0.328 
4 Ordinary diet plus meat in advanced decay (high) 0.694 
In a second series of observations, to each of various food 
mixtures of equal weight (25 grams) was added a definite quan- 
tity (10 grams) of feces which had been previously examined 
for indol and bacteria. The whole was then placed in an incu- 
bator at body temperature for three days. The quantity of indol 
produced was determined by distillation and testing by Herter’s 
method. 
TABLE IX 
Showing the Amount of Indol Produced in Equal Quantities of 
Various Foodstuffs (25 Grams) Mixed With 10 Grams 
of Human Feces and Incubated for Three Days* 
Indol 
Mgms. 
Beef (fresh) 12.42 
Pork (fresh) 13.72 
Mutton (lean) 17.02 
Average 14.39 
MEATS 
MILK PRODUCTS 
Unboiled milk 0.626 
Boiled milk .’ 5.200 
Yogurt cheese 0.126 
Average 426 
Cereals (average of 20) 055 
Raw vegetables 147 
Cooked vegetables 078 
Cooked fruits . .222 
Bananas 404 
Average 181 
VEGETABLE FOODS 136 
THE NEW DIETETICS 
The table shows that the flesh foods on an average produced 
nearly eight times as much indol as the average produced by 
vegetable foods. Milk products produced only 3 per cent, as 
much indol as meats, while yogurt cheese, made with the Bacillus 
bulgaricus, made less than 1 per cent, as much indol as meat. 
These results are entirely in harmony with the results ob- 
tained in feeding experiments, and taken with them show very 
clearly that foodstuffs which undergo putrefaction outside the 
body when brought in contact with colon bacteria produce when 
eaten a very marked increase of the intestinal putrefactions. 
Complete Proteins* 
Until recently it had been taken for granted that all pro- 
teins are essentially alike and capable of replacing one another. 
It has been learned, however, in recent times, that the protein 
molecule is very complex, and so variable in composition that the 
number of proteins possessed of characteristic differences is 
almost infinite. Every plant produces proteins peculiar to itself, 
and there are marked differences among animal proteins. 
These differences are due to the fact that the protein mole- 
cule is made up of simpler bodies known as amino acids which 
have been called “building stones” because by different combina- 
tions of these foundation elements, the various living tissues of 
the body are built up. Many different amino acids have been 
discovered, some forty or fifty. Less than half of these enter into 
the proteins of the human body. A protein which furnishes all 
the amino acids necessary for building human protein, is known 
as a complete protein. Such animal proteins as lean meat, eggs, 
and milk, all contain complete proteins, being of animal origin, 
and milk and eggs, the yolk at least, being especially prepared for 
food for young animals. But the proteins of plants differ very 
widely. Some are complete, but most plant proteins are incom- 
plete. Those foods which the experience of the race has chosen 
to serve as staples for the feeding of large populations are found 
by chemical examination to possess the best proteins, that is, 
those which contain in the best proportions the “building stones” 
needed for the repair or construction of body protein. 
It is interesting to note in this connection that of the several 
classes of plant foods nuts contain the best protein. Researches 
by Osborne, Mendel, Clapp, Harris, Nollan, Johns, Jansen, Dan- 
iels, Loughlin and Cajori and others have demonstrated that the THE PROTEIN RATION 
137 
proteins of nuts are complete proteins. This has been shown 
to be true of all nuts thus far studied, which include the almond, 
coconut, Brazil nut, black walnut, English walnut, butternut, fil- 
bert and hickory. 
The great cereal staples, wheat, rice, corn, and oats, contain 
proteins of fair quality. The same is true of rye, and millet 
possesses a protein of exceptional value. The protein of the 
potato, another staple, has been shown to be of a superior order. 
The proteins of ordinary beans, peas, and lentils are of inferior 
quality; but those of the soy bean and the peanut are equal to 
those of milk. The protein of the apple is also of excellent 
quality. 
But the incomplete proteins of most vegetable foods are by 
no means useless. When eaten with foods containing complete 
proteins, such as milk, eggs, nuts, soy beans or peanuts, their 
incomplete proteins are supplemented in such a way as to make 
them satisfactory nutrients. This is one of the most important 
facts in food physiology, and supplies an important foundation 
stone for the rational combination of foodstuffs in the construc- 
tion of bills of fare. It is manifestly essential that care should 
be taken to insure the necessary intake of complete proteins, and 
this is especially important when the protein intake is reduced 
to a minimum. 
Sherman has shown that with a cereal diet the addition of 
milk sufficient to supply ten per cent, of the protein is sufficient 
for normal growth and maintenance. This would require a daily 
intake of about four ounces of milk or an equivalent amount of 
cheese, say half an ounce to an ounce. Certainly two or three 
glassfuls of milk daily will supply an ample amount of complete 
proteins to fully supplement any otherwise sufficient bill of fare. 
In the absence of milk, nuts, soy beans or peanuts may be 
used as complementary foods. 
A study of the relative protein content of nuts, milk, and 
meat shows that, pound for pound, the almond, beechnut, and 
walnut contain on an average as much protein as does meat and 
five times as much as is found in milk, and protein which animal 
feeding experiments recently made prove to be of equal value. 
The chestnut, the chinquapin, the filbert, the hickory, pecan and 
pine nut contain on an average as much protein as is found in 
fish; while the butternut, the peanut and pignolia contain twice 138 
THE NEW DIETETICS 
as much, and 50 per cent, more than is found in the best cuts of 
meat. 
The following table shows the number of ounces of nuts 
required to furnish the same amount of protein as 4 ounces of 
milk, the amount required to balance for complete proteins a 
day’s ration of cereals and no milk, eggs or meat: 
TABLE X 
Almond 
Amount equal 
4 ozs. of milli 
Ounces 
7 
to protein of 
: (336 cals). 
Calories 
134 
Beechnut 
6 
116 
Brazil nut 
8 
165 
Butternut 
5 
100 
Chestnut 
1.3 
120 
Filbert 
9 
187 
Hickory nut 
9 
190 
Malted Nuts 
6 
91 
Pecan 
1.4 
305 
Peanut 
7 
85 
Peanut meal 
3 
33 
Pine nut 
.6 
122 
Walnut (black) 
5 
94 
Walnut (English) 
8 
165 
Eggs may also serve as supplementary foods, one egg fur- 
nishing about the same amount of supplementary protein as a 
half pint of milk. 
It is evident, then, that meat can no longer be regarded as 
a necessary source of human food, other foodstuffs capable of 
supplying any real nutritive need which meat can serve being both 
diversified and abundant. 
The Normal Protein Requirement. 
As already shown, the amount of protein needed daily is 
small, probably about one calorie per pound of body weight, that 
is, normal body weight. A fat person needs no more protein 
than a person of normal weight for the same height. For the 
average person this will require 120 to 150 calories of protein. 
An examination of the table will show that less than an ounce 
of peanuts, black walnuts or butternuts will supply as much com- THE PROTEIN RATION 
139 
plete protein as 4 ounces of milk, the full amount actually needed 
to supplement a bill of fare otherwise sufficient; while an ounce 
of almonds, beech nuts, filberts, hickory nuts, pine nuts or English 
walnuts, and less than an ounce and a half of chestnuts or pecans 
may take the place of milk as a supplementary food. One-third 
of an ounce of nut meal or twice as much Malted Nuts serve 
the same purpose. 
As a matter of fact, if the daily bill of fare includes with 
a sufficiency of other foods one or two ounces ;of nuts or soy 
beans, an egg, or half a pint of milk, he need give no thought to 
the amount of protein he eats provided he does not eat meat, 
since he will be sure to get enough and not likely to get too 
much. 
In a magazine article, Osborne presented the argument that 
protein is needed not only for food, but for stimulation, it having 
been shown by Rubner and Lusk that protein differs from other 
food principles in the fact that it excites the cells to do an amount 
of work in excess of the energy which it supplies to them. The 
fact is also mentioned that caffein does the same thing, only in 
the case of caffein the effect is of course wholly that of excita- 
tion, this drug having no food value whatever. Since this effect is 
purely that of stimulation, no equivalent energy being supplied 
to support the expenditure induced, it must be regarded as harm- 
ful rather than desirable. Rubner has shown that the extra 
energy thus produced cannot be utilized in useful work, but is a 
total loss. 
Many of the greatest of the ancient philosophers were flesh 
abstainers, of whom special mention may be made of Herodotus, 
the father of history; of Pythagoras, the father of Greek philos- 
ophy, and of his famous pupil, Socrates, whose scarcely less 
famous pupil, Plato, was likewise a flesh abstainer, as was also 
Plutarch, the author of the “Lives.” Seneca, one of the most 
noted of the Roman philosophers, was likewise an exponent of 
the fleshless diet. Guatama Buddha was a strict vegetarian and 
required his disciples to discard flesh of all sorts as millions of 
them at the present time do in India and other Eastern countries. 
Advantages of a Low Protein Ration. 
The advantages of a lowered protein ration were very clearly 
shown by experiments conducted with a section of the French 
army in 1906. Major P. Joly reports the result of an experi- 140 
THE NEW DIETETICS 
ment with two companies numbering respectively 149 and 142 
men. It was found that when the four ounces of fresh meat 
furnished the men was replaced by the same quantity of carbo- 
hydrates (cane sugar), there was a decided improvement in their 
physical condition. They were better able to endure the fatigue 
of marching, the number of heart beats was diminished, as well 
as the respiratory movements, and there was less sickness. It 
was especially noticeable that the men showed less fatigue and 
were less subject to the depressing effects of heat. During the 
last three days of manoeuvres, the entire ration of five of the 
men was replaced by eleven ounces of carbohydrates (sugar) 
without any ill consequences, the men doing the same work as 
the others without showing any evidence of fatigue. 
The advantage of a low protein diet in maintaining high 
resistance to disease is shown by the observations of Dr. Reid 
Hunt, who found that animals fed on a low protein diet were 
able to resist “two or three times the ordinary fatal dose of 
acetonitrile” (Chittenden). 
Numerous further evidences of the advantages of a low pro- 
tein ration will be presented in other sections of this work, where- 
in it is clearly shown that a low but sufficient protein ration is 
conducive to longevity, to physical and mental endurance, to 
resistance to disease, and freedom from certain maladies, and 
that the rigorous restriction of the protein intake to the actual 
needs of the body is one of the most useful means of combating 
many obstinate bodily disorders and prolonging the life in cases 
of incurable organic disease. 
The limitation of the protein intake, especially the elimina- 
tion of flesh proteins from the dietary, is of particular service in 
the correction of morbid conditions of the intestinal flora. The 
putrefactive changes which occur in the undigested residues of 
flesh foods when retained in the colon are now recognized as one 
of the most active causes of chronic disease. The greatest evils 
due to errors in diet are those which result from the putrefaction 
of the unused residues of meats while lying in the colon. Fats 
Fats, like the starches and the sugars, are fuel foods. Their 
chief function in the body is to furnish fuel to maintain heat and 
to serve as a source for the energy expended in muscular work, 
heart and lung work, gland work, and other forms of vital activ- 
ity. In recent years it has been found, however, that fats are an 
essential constituent of protoplasm and hence enter into the com- 
position of the living cells of the body. Of this function of fat 
little is known. 
As fuels, fats differ from starches and sugars in that while 
the latter substances may be termed quick-burning fuels, fats 
instead of being burned at once are stored for future use in the 
form of adipose tissue, sometimes known as residual or reserve 
tissue. 
In chemical composition fats differ from starches and sugars 
in the much smaller proportion of oxygen which they contain. 
For this reason they require a much larger amount of oxygen for 
their consumption and produce a proportionately larger amount 
of energy when burned. For example, an ounce of starch fur- 
nishes 114 calories of energy, whereas an ounce of pure fat 
supplies 255 calories, more than twice as much. 
There are many different kinds of fats, both animal and 
vegetable. In the process of ripening of certain fruits and nuts 
the starch of the green fruit is converted into fat. There is 
abundant evidence that a similar transformation of starch into 
fat occurs in the human body. 
When starch is taken in larger quantity than is required to 
furnish the amount of sugar needed to produce animal heat and 
support the muscles in their work, the surplus is converted into 
fat which is deposited in the cellular tissue beneath the skin and 
in other parts of the body. 
In the process of digestion, starches of all sorts are con- 
verted into a common product, dextrose or grape sugar, which is 
identically the same in character no matter what the source of 
starch from which it is formed. In the digestion of fats, however, 
the case is different, since the products of digestion of fats differ 
141 142 
THE NEW DIETETICS 
as widely as do the fats themselves. The changes which take 
place in fats during digestion are essentially the same as those 
which occur in soap making. The fats are first emulsified, then 
broken up into fatty acids and glycerine. The fats combine with 
the potash and soda furnished by the bile and the pancreatic 
juice to form soaps. After absorption, the glycerine recombines 
with the fatty acids, thus reproducing the original fat which is 
deposited in the tissues as such. 
The fats of herbivorous animals are much harder than those 
of carnivorous animals. The fats of fishes and cold-blooded 
animals naturally have a still lower melting point. The true 
human fat, that is, that made by the body, is formed by the tissues 
from starch, sugar and other carbohydrates. 
Of the several animal fats, beef tallow, mutton tallow, lard, 
butter and cream, the latter is the most easily digestible. Next 
in order is butter. Those fats which have the highest melting 
point are most difficult of digestion. 
The vegetable oils are all digested easily and possess about 
the same value. At least this is true of olive oil, corn, peanut, 
coconut and cottonseed oil. Crisco and oleomargarine are chiefly 
or wholly of vegetable origin. Nut margarine is prepared from 
vegetable oils. 
While not differing greatly in their digestibility, fats differ 
much in food value because of their varying vitamin content. 
The fat soluble vitamin, necessary for growth and health main- 
tenance, also to prevent sore eyes and rickets in infants and night 
blindness in adults, is deficient in most oils, in lard, and in oleo- 
margarine and nut margarine. On this account butter and cream 
should be preferred as sources of fat when available. It is to be 
said, however, that a deficiency of the fat soluble vitamin may 
be made up by the free use of greens which are rich in this food 
essential. 
Fat is not altogether an encumbrance, even when present in 
slight excess. It is a residual tissue, which may be drawn upon 
in case of food scarcity. The camel’s hump serves as a store- 
house from which supplies are drawn when other food is not 
available in its long desert journeys. 
Great excess of fat is highly detrimental to health and preju- 
dicial to longevity. Life insurance examiners penalize applicants 
for insurance when 10 per cent, or more overweight, because the 
life expectancy of such persons is known to be below the average. FATS 
143 
Ghee, a fat much used in India, Turkey and other Oriental 
countries, is prepared from butter made from the milk of cows, 
sheep or goats. The butter is boiled and granulated, and though 
unsalted, will keep for many years, even a century or two, accord- 
ing to an authentic record of a find in an old castle in Turkey. 
Vegetable Fats, 
The principal sources of edible vegetable fats are the fol- 
lowing : 
Almond 54 per cent. 
Avocado 20 per cent. 
Brazil nut 61 per cent. 
Butternut 61 per cent. 
Caco seed 44 per cent. 
Cocoanut meats ...36 per cent. 
Corn 5 per cent. 
Cotton seed 24 per cent. 
Hemp seed 32 per cent. 
Oatmeal 10 per cent. 
Olive pulp 39 per cent. 
Palm nut 72 per cent. 
Peanut 52 per cent. 
Sesame seed 51 per cent. 
Soy bean 20 per cent. 
Sunflower 22 per cent. 
Walnut 32 per cent. 
Kernel Oils, 
A most excellent vegetable fat is prepared from the nuts of 
an African palm, the melting point of which is near that of butter, 
for which it is much used as a substitute. Palm kernel oil is also 
prepared from the nuts of the cohune palm. It is grown in Cen- 
tral America, where immense forests of this tree are found. In 
Spanish Honduras and Guatamala the cohune palm forms 20 to 
30 per cent, of the vegetation. The nuts grow in enormous clus- 
ters nearly as large as a bunch of bananas. The nut is two or 
three inches in length and an inch and a half in diameter. The 
meat, which is about the size of a large nutmeg, contains 40 to 60 
per cent, of oil. A tree yields about 1,000 nuts annually, from 
which may be obtained 10 quarts of oil. It is estimated that the 
trees growing wild in British Honduras produce annually not 144 
THE NEW DIETETICS 
less than 275,000 tons of oil. Other Central American countries 
are capable of producing a much larger amount. Cohune oil 
closely resembles the kernel oil of the African palm, though it has 
a slightly lower melting point. 
While these oils are as digestible as butter fat, it is not as yet 
certainly known whether they contain the essential vitamins, 
although it is most probable that they are quite deficient in this 
respect, and hence when used as butter substitutes must be sup- 
plemented by liberal quantities of greens which supply the lacking- 
element in rich abundance. 
Among other rather unusual oils which recent experiments 
have shown to be equally as digestible as olive, peanut and other 
well known oils, may be mentioned oil obtained from apricot 
kernels, cherry stones, cantaloup seed, peach kernels, pumpkin 
seed and tomato seed. All these oils were found to be edible and 
wholesome. 
The oils of tomato seed, mustard seed, apricot kernels and 
of the seeds of the black and white poppy are also used in Italy 
and in some Oriental countries. Carbohydrates—Starches 
and Sugars 
The carbohydrate element of foodstuffs consists chiefly of 
starches and sugars. Many fruits and vegetables contain fruit 
acids, which are also potential carbohydrates. Lactans and pen- 
tosans are found in certain fruits and legumes. These carbohy- 
drates are not utilizable by human beings, although they are 
apparently readily assimilable by herbivorous animals. Hence, 
we derive practically all of our carbohydrate nourishment from 
starches and sugars. 
The normal human diet contains about 60 per cent, of carbo- 
hydrates, the most of which is starch. The starches are for the 
most derived from cereals, but a few roots and vegetables 
are also rich in starch, particularly the Irish potato, the sweet 
potato, the manioc root and arrowroot. The taro of the Sandwich 
Islands and the dasheen, a near relative of the dahlia of our 
flower gardens, are other valuable sources of edible starch. 
Starch appears in plants in the form of granules which differ 
in size and appearance in different species of plants. 
The accompanying illustrations will give something of an 
idea of the characteristic appearance of some of the more common 
forms of starch. 
The chemical composition of starch (saccharid) is CeHioOs. 
Cane sugar, malt sugar and milk sugar have a similar composi- 
tion, a single molecule of water being added to two molecules 
of starch—C12H22O11. Glucose and levulose have the composi- 
tion C0H12OG. 
Certain vegetables contain peculiar carbohydrates which have 
the composition C5H10O5, called pentosans. By digestion, these 
bodies are converted into pentoses, a kind of sugar which the 
human tissues are unable to utilize. Pentoses are found in the 
urine after the eating of prunes, cherries and grapes. The soy 
bean contains a considerable amount of pentosans and pentoses, 
but only a trace of starch. 
Starch and dextrine seem to be the carbohydrates best 
145 146 
THE NEW DIETETICS 
adapted to the use of human beings. As supplied by the plant, 
starch is insoluble in water and non-absorbable, and must be 
transformed by the processes of digestion before it can be utilized. 
Very liberal provision is made for the utilization of starch. Its 
digestion begins in the mouth, before that of any other food sub- 
stances. The work of transforming the starch into sugar is con- 
tinued in the stomach. In the intestine, the starch digestion is 
carried on by the pancreatic and intestinal juices. 
By this arrangement, the sugar formed from the starch is 
produced and absorbed slowly, so that the blood at no time be- 
comes overcharged with sugar. The normal sugar content of the 
blood is about one part in one thousand. When this is much 
exceeded, the kidneys remove the sugar to prevent injury to the 
blood-vessels and other structures, which would result if the 
sugar were allowed to accumulate. This explains the appearance 
of sugar in the urine when large quantities of sugar are taken. 
If, for example, a half pound of candy or sugar in some other 
form is eaten at once, within a short time sugar will appear in the 
urine; but the same amount of sugar taken in the form of starch 
will never cause the appearance of sugar in the urine of a 
healthy person. This is the difference between a person in 
health and a person suffering from diabetes. A diabetic may 
show sugar in the urine, even though no sugar but only starch 
has been eaten. But this never occurs in a normal person, no 
matter how large a quantity of starch may be taken at one time. 
As an additional precaution against a too rapid intake of 
sugar and its undue accumulation in the blood, the liver is en- 
dowed with the special function of capturing the sugar and 
retaining it within itself by changing it into a form of carbo- 
hydrate known as glycogen, a sort of animal starch. 
The muscles, also, have the ability to convert sugar into 
glycogen, and thus a certain amount of carbohydrate is stored up 
to be utilized in maintaining the sugar content of the blood at 
its normal percentage during the intervals between meals or 
longer periods of fasting. 
During a complete fast, the store of glycogen is practically 
used up after two or three days. 
Starch has the further advantage over sugar as a carbo- 
hydrate food in the fact that it has a neutral flavor, and is bland 
and absolutely unirritating. 
Another advantage possessed by farinaceous foodstuffs over CORN COCKLE 
OAT 
CANNA 
ROOT 
WHEAT 
ME ADO SAFFRON 
BEARDED 
DARNEL 
SPURGE 
POTATO STARCH CELLS 
RICE 
STARCH 
CELLS 
BEAN 
MILLET 
MAIZE 
POTATO STARCH 
POTATO STARCH A, RAW; B, PAH.- 
TIALLy COOKED; C, WELL DOILED . 
STARCH GRANULES A GGAiM OF WHEAT, 
MAGNIFIED 
WHEAT WITH OUTER 
COAT REMOVED.'"' 
THE DIFFERENT LAYER5 
OP 6RAK. 
GREATLY MAGNIFIED 
VIEW OF A SMALL POR- 
TION OFA GRAIN OF- 
WHEAT 
INTERNAL STRUCTURE CARBOHYDRATES—STARCHES AND SUGARS 
147 
cane sugar consists in the fact that in this form the carbohydrates 
are not isolated, but are associated with the lime, iron and other 
salts as well as the precious vitamins, all of which form an es- 
sential part of the day’s ration. 
Some years ago, Grierson made the interesting discovery that 
there is a marked difference in the digestibility of starch from 
different sources. Grierson found, for example, that the starch 
of wheat, corn and rice requires two full hours for digestion, 
whereas the same quantity of oatmeal starch digests in eighty 
minutes, and the time required for the digestion of a like quan- 
tity of arrowroot starch is but thirty minutes and of potato 
starch only ten minutes. From which it appears that the root 
starches are much more easily digestible than are the cereal 
starches, the starch of wheat, corn and rice requiring twelve 
times as long for digestion as does the starch of potatoes, and 
the starch of oatmeal eight times as long. 
The prejudice against farinaceous foods which still seems 
to exist in the minds of many persons, even some physicians, 
is wholly without sound foundation. Of all the elements of our 
food, starch is the least likely to give rise to inconvenience or to 
produce harmful effects, even when taken in excess; and the 
notion that the free use of starch gives rise to rheumatism, to 
intestinal indigestion, to gastric or intestinal fermentation, or 
“sour stomach,” is wholly baseless. It is of course possible that 
the dietary may contain a disproportionate amount of starch, so 
that an individual may suffer for the lack of other necessary 
elements; but in such cases the bad effects observed are not to 
be attributed to the starch itself, but rather to lack of other 
essential elements. 
For example, in the feeding of babies, it has long been ob- 
served that infants do not thrive on farinaceous infant foods, a 
long list of which have been offered as safe substitutes for 
mother’s milk and cow’s milk; and this has been found to be true 
even when these farinaceous food products were combined with 
a considerable proportion of cow’s milk, sufficient to supply the 
protein and fat required/'It is now known that the chief injury 
sustained by the child under these circumstances is the result of 
the lack of vitamins, which are supplied by mother’s milk. The 
child gets all the protein, fat and carbohydrate it needs, but lacks 
the vitamins which are essential to promote growth. This defect 
may be remedied by the use of orange or tomato juice. THE NEW DIETETICS 
148 
Daniels and others have recently shown that the growth of 
babies may be increased by adding to the milk a soup prepared 
from wheat germs. The notable results obtained are doubtless 
due to the vitamins contained in the germ of wheat. 
The dietaries of adults, when largely made up of farinaceous 
foodstuffs in their ordinary commercial forms, are equally liable 
to be lacking in vitamins. For example, fine flour bread, pol- 
ished rice, the new process corn meal, corn flakes, rice flakes, 
macaroni, and, in fact, most of the cereals found upon the aver- 
age breakfast table, are deficient in vitamins. 
The hardy Chinese laborer, the gigantic Japanese wrestlers, 
the sturdy Smyrna porters, the long distance runners of India, 
the hardy Alpine peasant, all thrive on diets in which natural 
farinaceous foodstuffs are the staple, but which are supplemented 
by liberal quantities of greens and other foodstuffs which are rich 
in vitamins. 
Hindhede has clearly demonstrated the safety of a highly 
farinaceous diet by long continued researches which have brought 
him into great prominence as an author in human nutrition in 
his own country, Denmark, although they have received little 
attention in this country. In a letter received by the writer from 
Professor Hindhede of Copenhagen, a couple of years ago (1919) 
he said that he then had under observation a man who had sub- 
sisted for twenty-three months on a diet consisting exclusively of 
bread, potatoes and greens. No fat of any sort was added to the 
foods named, and not a particle of other food had been eaten, yet 
the subject was in perfect health, vigorous and athletic, and able 
to engage in the hardest work. Professor Hindhede remarked 
that he had noted that large quantities of greens were very essen- 
tial. McCollum, Mendel and others have shown that both cereals 
and potatoes are deficient in the fat-soluble, growth-promoting 
vitamin which is supplied abundantly by greens of all sorts. 
When much gas is formed in the intestine as the result of 
eating freely of starchy foods, the cause is not “dyspepsia” but a 
“bad flora,” that is, the presence in the colon of that most mis- 
chievous of micro-organisms, Welch’s bacillus or an excessive 
number of colon bacilli. Without lessening the intake of carbo- 
hydrate, even increasing it, the gas, though at first increased, dis- 
appears as soon as the flora is “changed.” This the writer has 
witnessed in hundreds of cases. CARBOHYDRATES—STARCHES AND SUGARS 
149 
The Digestibility of Raw Starch* 
Observations by Langworthy and Deuel (Jour. Biol. Chem., 
May, 1920) seem to demonstrate that the uncooked starch of corn 
and of wheat is quite easily digestible, and when eaten by human 
beings in quantities of ten to twelve ounces are completely 
digested and assimilated, no trace being found in the feces. In 
the case of raw potato starch, 20 per cent, remained undigested. 
It was noted, also, that the raw starch did not interfere with 
rhe digestion of other food principles taken with it, although, in 
the case of the potato, unpleasant symptoms, particularly a con- 
siderable formation of gas and “frequent intestinal cramps,” 
were noted. 
An interesting observation was that with the potato diet 
the feces, when heated, gave off no fecal odor but rather an odor 
of scorched bread, which we take to be evidence of the value of 
raw starch as a means of suppressing intestinal putrefaction, a 
matter to which the writer has frequently called attention and 
on which is based the recommendation to cook oatmeal six to ten 
minutes rather than longer. 
Langworthy’s results are in accord with laboratory observa- 
tions made many years ago (1905) by the writer in experiments 
with raw starch in which it was observed that raw starch was 
digestible in quantities of four to six ounces. It was noted, how- 
ever, that different persons differed in this regard. In the case 
of one person, most of the starch was discharged undigested, and 
there \yas diarrhea with much griping and malaise. 
SUGARS 
The world’s production of cane sugar in 1914 was 42,000,- 
000,000 pounds. Americans use more than any other people. 
At the close of the Revolutionary War, the per capita annual 
consumption of sugar in this country was 7.5 pounds. It is now 
about 103 pounds. The consumption of sugar has increased in 
this country since 1900 at the rate of 1 per cent, a year. Diabetes 
has doubled its death rate in the same period. 
Cane sugar was made from bamboo before the sugar cane 
was used for this purpose. Sorghum has been grown for sugar 
making in China for centuries. The Indians made sugar from 
the maple, hickory, birch and watermelon, and the natives of 
Mexico prepared sugar from the juice of the century plant in 
pre-Columbian times. THE NEW DIETETICS 
150 
Of the many sorts of sugar known to the chemist only five 
enter to any considerable extent into our ordinary dietary. These 
are sucrose or cane sugar, maltose or malt sugar, lactose or milk 
sugar, dextrose or grape sugar, and levulose or fruit sugar. 
Of these several sugars we are most familiar with cane sugar, 
which is derived commercially from the sugar cane, sorghum, 
beet root and maple tree. Cane sugar is the sugar of trees, roots 
and grasses. It is also found in a few fruits, especially certain 
varieties of the date. 
In the ripening of fruits, cane sugar is converted into glucose 
and levulose. These sugars are formed from cane sugar by a 
digestive change identical with that which takes place in the 
human body. When cane sugar is eaten, it is slowly converted 
into levulose and dextrose, for cane sugar in its native form 
cannot be utilized by the body. It must first undergo a digestive 
process, as does starch. But unlike starch, the digestion of cane 
sugar does not begin in the mouth, but is delayed until the sugar 
reaches the intestine. 
The enormous consumption of cane sugar in this country, 
four times that of many other civilized countries, and the growing 
prevalence of the candy habit as the result of the diligent foster- 
ing of the practice by energetic manufacturers, justifies the in- 
quiry whether or not the present extravagant use of the sugar of 
commerce is wholesome or safe. 
Atchison Robertson, in carrying out a series of experiments, 
injected 250 cubic centimeters of a 20 per cent, solution of sugar 
into the stomach of a patient who was suffering from chronic 
gastric catarrh. “Shortly afterwards the patient became sick, and 
vomited a very acid fluid which put his teeth on edge. He also 
complained of heartburn and flatulence, and of a severe pain in 
the region of the stomach.” Another experiment was the injec- 
tion of a solution of fruit sugar (levulose) of the same strength, 
which produced no discomfort. The experiment was repeated 
with similar results in other cases of dyspepsia, and in every case 
the invert sugar produced no unpleasant symptoms. Schule found 
that from two to six lumps of cane sugar, when taken in an ordi- 
nary test breakfast, produced no appreciable effect on the diges- 
tion, but when the quantity was increased from ten to twenty 
lumps, considerable delay of digestion ensued, by reason of “the 
great outpouring of mucus in the stomach.” 
Brandi, an eminent German chemist, observed, in experi- CARBOHYDRATES—STARCHES AND SUGARS 
151 
ments upon a dog, that a solution of cane sugar having a strength 
of less than 6 per cent, caused irritation, with reddening of the 
mucous membrane. A 10 per cent, solution produced a dark red 
color with great irritation; and a 20 per cent, solution gave rise to 
still greater irritation, and produced such distress that the experi- 
ment was terminated. The author has met many cases of grave 
stomach disorder in which evidently the chief cause was the free 
use of sugar either in the form of candy or in connection with the 
use of coffee, oatmeal mush, or other “breakfast foods.” 
Ogata, in experimenting upon dogs for the purpose of deter- 
mining the effects of cane sugar upon digestion, observed that the 
addition of one-third of an ounce of cane sugar to a meal of meat 
reduced digestion one-fourth. 
The Germans made years ago extensive experiments with 
sugar as a means of supporting muscular work, extending their 
experiments to horses and other animals as well as soldiers. They 
found that while the sugar showed remarkable sustaining qual- 
ities, it was impossible »to use more than a comparatively small 
amount on account of the irritating effects upon the stomach. 
Sugar is freely used by rowing clubs in Holland, and it is 
reported that it seems “to counteract the bad effects of a meat 
diet so that the dreaded symptoms of overtraining did not ap- 
pear.” This fact is very interesting as an indication that the 
effect of overtraining is due to the large quantity of meat con- 
sumed. Sugar is antitoxic. When freely used it not only lessens 
the amount of meat consumed, because of the limitation of the 
calorie intake, but also through its antitoxic influence combats 
intestinal putrefactions encouraged by a heavy meat diet. 
Molasses is much used in sugar-producing regions as food for 
horses and dairy cattle. The so-called black strap molasses is 
commonly fed in quantities o,f eight to twelve pounds per head. 
As a food a good quality of molasses is preferable to sugar for the 
reason that it is rich in iron and lime. 
Dextrin is a product intermediate between starch and dex- 
trose. The chemical composition of the three substances is essen- 
tially identical, except that in the change from starch to sugar, 
water is added to the molecule. Dextrin is found in plant juices 
and fruits. It is present in commercial glucose and in malt sugars 
to the extent of about 30 per cent. Dextrin may be produced not 
only by the digestion of starch but by the action of mineral acids 
and by heating at proper temperatures. The crust of bread and 152 
THE NEW DIETETICS 
the browned portion of toasted bread contain dextrin. Dextrin has 
been recently shown to have special value as a means of changing 
the intestinal flora. When it is taken in doses of three ounces 
three times a day for several days in succession (7 to 10 days), 
the putrefactive flora disappears and acid-forming bacteria be- 
come dominant. The stools cease to have a putrid odor. 
Dextrose or grape sugar is the sugar of grapes. It is found 
in most fruits with levulose in about equal quantities. Dextrose 
is formed from starch and from other sugars by the process of 
digestion and may be produced from various carbohydrates by 
chemical processes. All the sugars of foods are converted into 
dextrose before they are utilized by the body. Dextrose is the 
chief source of bodily energy. It is tbe body fuel par excellence. 
Glucose is a saccharine product prepared by boiling corn- 
starch with a dilute mineral acid until the starch is partially con- 
verted into dextrose. It contains both dextrose and dextrin. So- 
called brewers’ sugar is a form of glucose containing about 70 per 
cent, of dextrose. What is known as “80 sugar,” or “acme sugar,” 
contains 80 per cent, of dextrose. Practically all the cheaper 
grades of candy, and probably some of the higher grades, consist 
very largely of glucose. This is a cheap form of sugar about 
half as sweet as cane sugar. 
Malt sugar. There is found in grains ferments or diastases 
similar to the ferments of the saliva, which are capable of first 
liquefying starch and then converting it into sugar. These fer- 
ments become active in the process of germination, and by the 
conversion of the starch in the seed furnish food for the young 
plant. Sprouted or malted barley has long been used in civilized 
countries for the conversion of starch into sugar in the manu- 
facture of beer. The same process of sugar making has been 
employed in Japan for at least two thousand years. The Jap- 
anese make from rice, corn, millet, and sweet potatoes a prep- 
aration which they call ame, a sweet substance which appears in 
the form of a thick amber colored liquid and also in hard, white 
masses resembling candy. Ame is much used in Japan, and was 
in common use there hundreds of years before cane sugar was 
known in Europe. 
It has been experimentally determined (Hammond), in the 
feeding of infants, that an infant is able to oxidize half a dram 
of lactose per kilogram of body weight, or practically one-fourth 
dram per pound. If the quantity is increased 50 per cent, beyond CARBOHYDRATES—STARCHES AND SUGARS 
153 
this, sugar appears in the urine. The same is true when cane 
sugar is fed; but in the case of malt sugar, more than three times 
as much sugar may be given before sugar appears in the urine. 
In other words, malt sugar is utilized by the infant more than 
three times as well as is milk sugar or cane sugar. From this it 
clearly appears that malt sugar is greatly preferable to any other 
form of sugar as a foodstuff. Cane sugar, the sugar of grasses, 
is adapted to the digestive organs of herbivorous animals. One 
of the four stomachs of ruminants supplies a ferment which 
quickly converts cane sugar into dextrose and levulose, the sugars 
found in fruits. 
Malt sugar has many advantages over cane sugar. It is non- 
irritating, being native to the body, since it is constantly formed 
in the digestion of starch. Malt sugar also contains lime, iron 
and vitamins, all of which are lacking in cane sugar. 
The manufacture of malt sugar for food was initiated by 
the writer nearly thirty years ago. The difficulty was to eliminate 
the bitter flavor which made the ordinary syrupy extracts of malt 
too unpalatable to employ as foods. Malt sugar is now made by 
several concerns and is sold both in syrup and powder form. 
Reid has shown that maltose enjoys an additional advantage 
over ordinary sugar in that it is absorbed much more rapidly. 
This is especially true when the mucous membrane is diseased, 
as in intestinal catarrh. In such conditions the absorption of mal- 
tose is many times as rapid as that of cane sugar. This fact ex- 
plains the observation often made by physicians that patients who 
are easily able to eat farinaceous foods freely without difficulty 
and can even take malt preparations in very considerable quantity 
without experiencing any inconvenience, may be unable to eat the 
smallest amount of cane sugar without suffering seriously in con- 
sequence from formation of gas in the intestines as the result of 
fermentation, the slow absorption of the sugar, giving the bacteria 
an opportunity to act upon it. 
The following table shows the amount of malt sugar (maltose) 
found in various preparations: 
FOOD 
Meltose 
per cent 
Dextrin 
per cent 
Mead’s dextrimaltose 
51.00 
47.00 - 
Loflund’s malt soup extract 
58.91 
15.42 - 
Maltose (Walker-Gordon laboratory) 
57.10 
30.90 * 
Mellin’s food 
58.88 
20.69 - 
Malted milk 
49.15 
18.80 • 
Malto-Dextrin (Battle Creek Food Company).. 
00.00 
00.00 
Meltose sirup (Battle Creek Food Company).. 
00.00 
00.00 ... 
Malted Nuts (Battle Creek Food Company).. 
00.00 
00.00 - 154 
THE NEW DIETETICS 
Levulose is the sugar of fruits, and is often called fruit sugar, 
although dextrose is as truly a fruit sugar as is levulose. In most 
fruits these two sugars are found in about equal amount. Levu- 
lose is formed from cane sugar by the process of digestion. It is 
converted in the body into dextrose before it can be utilized. 
Honey consists of about equal parts of levulose and dextrose. 
Levulose has been shown to be better tolerated by some 
diabetics than is dextrose and other sugars and on that account is 
sometimes very useful in the treatment of cases of diabetes. 
Manna, a sweet substance which from the most ancient times 
has been gathered from certain shrubs growing in the Sinai 
desert, owes its sweetness to mannite, a sweet substance but not a 
true sugar. Manna is still gathered from the same locality where 
the ancient Hebrews found it in their wanderings and may be 
obtained from any drug store. It is slightly laxative and on this 
account is used medicinally. Quite recently a sweet substance 
said to be manna has been occasionally found in considerable 
quantity on the foliage of the Douglas fir tree in British Columbia. 
It forms on the leaves in drops the size of peas, and sometimes 
in larger masses. 
Mannite differs from cane sugar in that it is not fermented 
by yeast. It is somewhat laxative and may be used without in- 
jury by diabetics, since it does not increase the sugar of the urine. 
It is found in the beet root and in the sweet juice of the ash tree. 
A sugar known as inosite or American manna is obtained 
from the sugar pine. It exudes from the heart of the tree and 
collects on wounds which have been produced by fire, the axe or 
otherwise, forming irregular masses of a brittle, white substance 
having much the appearance of candy. It is sweet to the taste 
and is as well relished by many people as is maple sugar, but 
one’s appetite for it is quickly satisfied. Chemical examination 
of this material, however, shows it to be quite different from the 
sugar of the cane and the maple tree. It does not ferment with 
yeast as does sugar, and though sweet in flavor is not really a 
sugar. Neither is it the true mannite which is found on the 
Douglas fir and on the shrubs of the Sinai desert. It is used as a 
medicine by the California Indians. 
Lactose or milk sugar is a form of sugar peculiar to animals. 
It is in this respect unique, being found only very rarely in the 
vegetable kingdom. It is of all sugars the most difficult of diges- 
tion and assimilation. It has the least tendency to ferment of CARBOHYDRATES—STARCHES AND SUGARS 
155 
any of the sugars, although it is readily fermentable by the milk- 
souring bacteria which are always found present in the intestines 
of a healthy infant within a few hours after birth. 
Experiments have shown (von Noorden) that lactose is util- 
ized only one-fourth as readily as is maltose, the sugar formed 
by the digestion of starch. 
The value of lactose as a means of encouraging the growth 
of protective organisms in the intestine is due to the slowness 
with which it is utilized, permitting it to find its way into the 
large intestine where its presence is necessary to promote the 
growth of acid-forming bacteria. 
The lactose of milk clings to the casein of the milk, from 
which it can be separated only by repeated washings. This fact 
contributes greatly to the success of the milk regimen—which 
floods the intestine with curds which carry milk sugar into the 
intestine and there feed the friendly bacteria. Advantage is 
taken of this fact in reference to changing the intestinal flora. 
It is found that if a person takes nine or ten ounces of milk 
sugar in three portions, during the day, for a few days in suc- 
cession, the stools quickly lose their putrid character and the 
protective organism known as the bacillus acidophilus makes its 
appearance, while putrefactive organisms disappear. Similar re- 
sults follow the use of three pints of acidophilus buttermilk daily. 
Dates vs. Cane Sugar. 
There is no doubt that the American people are suffering 
greatly from the excessive use of cane sugar. Cane sugar differs 
from the natural sugar found in dates in several important par- 
ticulars. In the date the sugar is associated with other essential 
food constituents, especially protein, which is necessary for tissue 
building, iron, which is essential for the blood, lime, which is 
essential for the bones, and vitamins, another highly important 
food constituent necessary for the maintenance of nutrition and 
to stimulate growth and development in the young; all these food 
essentials are found in the date but none are present in cane 
sugar. Consequently, when a person uses cane sugar freely he is 
certain to suffer from a deficiency of lime, iron and vitamins, as 
the result of which he is likely to be anemic and to suffer from 
muscular weakness and lack of tone, as well as from an un- 
healthy state of the bones and decay of the teeth. 
Another disadvantage of cane sugar arises from the fact 156 
THE NEW DIETETICS 
that it is not that form of sugar to which the tissues of the human 
body are best adapted. Sugar (dextrose) is the fuel of the body, 
but not cane sugar, which is sucrose. The body uses invert or 
digested sugar. It cannot make use of cane sugar until after it 
has been digested. The process of digestion is always slow and 
often difficult in the human body, although in herbivorous ani- 
mals the digestion of cane sugar is liberally provided for by a 
stomach especially adapted to the purpose. The sugar of dates, 
with the exception of a few varieties, is invert sugar; that is, 
sugar which is already digested and ready for immediate absorp- 
tion and utilization. The cane sugar of the green date is during 
the process of ripening changed to invert sugar. The more 
mature the fruit, the more complete is this transformation. A 
similar transformation takes place in other sweet fruits. 
Cane sugar has the great disadvantage that it is irritating 
as well as difficult of digestion. If taken otherwise than in very 
dilute form it is likely to produce severe irritation and may give 
rise to ulceration. The use of cane sugar is a common cause of 
gastric catarrh and hyperacidity.' It is believed by many authori- 
ties that the free use of cane sugar is a cause of diabetes. It is 
most desirable that the consumption of cane sugar, which is car- 
ried to great excess in this country, should be greatly lessened. 
The substitution of dates, especially of the invert sugar varieties, 
should be encouraged. The date is more than a wholesome sub- 
stitute for sugar, it is a whole food. It may be used as freely as 
may be desired and without injury. Observations made by 
Metchnikoff show that by the free use of dates the intestinal 
flora may be changed; that is, the poison-forming putrefactive 
bacteria may be suppressed and the harmless protective acid- 
forming bacteria made to grow in their place. An ounce of dates 
contains more food iron than an ounce of beefsteak. 
Substitutes for Sugar, 
The only substitutes for sugar thus far found have been 
certain coal tar products, chief of which is saccharine, which is 
280 times as sweet as cane sugar. This substance has been much 
used until recently as a substitute for sugar by certain manu- 
facturers and by persons suffering from diabetes. It has been 
constantly under suspicion, however, and recently (1920) Pro- 
fessor Heitler, a well known authority on heart diseases, has pub- 
lished the results of a research which shows that, while sugar CARBOHYDRATES—STARCHES AND SUGARS 
157 
stimulates the activity of the heart, saccharine depresses it. The 
heart is gradually weakened by its use. 
Saccharine belongs to the great family of coal tar products, 
many of which are active heart poisons, hence it is not surprising 
that careful observation has shown it to be a highly injurious 
drug. An experiment made some years ago in this country 
showed that it might be used in minute quantities for some time 
without producing disturbance of digestion, but apparently the 
effects of the drug upon the heart were not studied. Certain 
manufacturers relying upon the report of the government com- 
mittee, have conducted a widespread campaign intended to pro- 
mote the use of saccharine, and these efforts have been greatly 
aided by the recent extraordinarily high price of sugar. Now 
that the facts are known, it is highly important that the infor- 
mation should be spread abroad as rapidly as possible. 
When saccharine is used in larger quantity than one or two 
grains three times a day it causes disturbance of the stomach. 
Cane sugar, when freely used, is often productive of great 
injury, but to substitute for cane sugar a coal tar product such 
as saccharine, is to jump from the frying pan into the fire. The 
proper thing to do is to restrain the appetite for sugar. Sugar, 
as such, was unknown to our remote ancestors, and was doubtless 
disliked by many of them as by many persons at the present time. 
The sugar-eating habit may be acquired like the tobacco or the 
alcohol habit or the habit of chewing gum. It is a habit which 
should be combated. 
A fortunate discovery by the United States Bureau of Plant 
Industry may lead to a solution of the sugar substitute problem. 
When in Washington, some months ago, the writer was shown a 
specimen of dried leaves from a plant which grows wild in Para- 
guay, and contains a substance 180 times as sweet as sugar. This 
curious plant is known as kaa lec by the natives of Paraguay. 
Another strange plant obtained from Nigeria bears a fruit which, 
although but slightly sweet itself, possesses the remarkable prop- 
erty of imparting to such sour substances as limes, lemons, or 
even vinegar, an intense sweet flavor which is retained for several 
hours. 
The best solution of the problem is to be found in the edu- 
cation of the appetite away from sweets. The American sugar 
tooth has acquired enormously overgrown proportions and should 
be rigorously restricted in its indulgence in sweets and confec- 
tions. 158 
THE NEW DIETETICS 
The Nation's Candy Bill. 
The United States consumed in 1919 an average of 13.1 
pounds of candy per capita (Financial World) at a cost (retail) 
of $1,219,000,000.00, an increase of more than 1,000 per cent, in 
forty years. 
Most candies contain a large percentage of glucose. Some 
years ago Roger reported the results of a series of experiments 
conducted by him for the purpose of determining the influence of 
various substances upon the protective power of the liver against 
infection. He found that “large doses of glucose, given by mouth, 
weaken the protective power of the liver.” This fact unques- 
tionably explains the observation made by many persons that the 
free use of candy makes them “bilious.” 
The use of candy and of cane sugar in other forms should 
be forbidden in all deficiency diseases such as scurvy, beri-beri 
and pellagra, as well as in cases in which lime and iron are 
deficient. 
Bergeim, Rehfuss and their associates found that both cane 
sugar and glucose when freely used, diminished the secretion of 
gastric juice and delayed the emptying of the stomach. It is 
evident that cane sugar must be avoided in all forms of gastric 
disease and especially in gastric catarrh, gastric and duodenal 
ulcer, hyperacidity and gall bladder disease. The excessive use 
of cane sugar is believed by many able clinicians to be the cause 
of diabetes. There are many cases of persons who are on the 
border line of diabetes, potential diabetics. Examination of the 
urine in such cases shows no sugar, but Bergell’s reaction is 
positive. A chemical examination of the blood shows a high 
sugar content. Such cases should wholly avoid cane sugar and 
should greatly lessen the intake of carbohydrates in any form. 
Honey, 
It is quite possible that good results would follow the ex- 
change of at least a considerable part of the cane sugar we con- 
sume for honey. This natural sweet is prepared from the nectar 
of flowers. It is said that the nectar from 62,000 clover blossoms 
is required to produce one pound of honey, and that 3,700,000 
visits of bees are required to gather it into the hive. 
The sugars of honey are levulose and glucose in about equal 
parts, mixed with flavors from the flowers and formic acid from 
the poison bag of the bee. The latter is deposited in the filled CARBOHYDRATES—STARCHES AND SUGARS 
159 
cell before capping to prevent fermentation. Some persons are 
sensitized to honey and cannot make use of it. Honey is unwhole- 
some when gathered from poisonous plants. 
Some Odd Sugars. 
There are numerous sorts of sugars, some of which would 
hardly be recognized as real sugars. The people of various coun- 
tries produce sugars in great variety. The Greeks prepare sugar 
from currants; the Arabs make sugar from the palm, the date, 
the karob bean and the raisin. In Mexico and South America 
brown sugar is put up in loaves of various sizes, large and small, 
and is often of better flavor than the brown sugar of this country. 
The Consumption of Sugar Should Be Reduced. 
The excessive fondness for sweets so common in this coun- 
try is without doubt a cultivated taste, and should be restrained. 
A no-sugar movement would doubtless do us good, and the pres- 
ent disposition to boycott the sugar trust on account of the high 
price of sugar will render better service than mere economic ben- 
efit. The per capita consumption of sugar should certainly be 
reduced one-half at least. Children should be encouraged to eat 
dates and raisins instead of candies. In general, sweet fruits 
should be substituted for sugar. When one person in every hun- 
dred in the United States is a diabetic, it is certainly time that 
this grave dietetic error should receive serious consideration. 
That sugar may be wholly dispensed with is well shown by the 
observations of Stefansson among the Eskimos. He says in “The 
Friendly Arctic,” 
“Sugar we found in Victoria Island to be peculiarly distaste- 
ful to the natives, and even children of no more than four or five 
objected violently to the taste of candy, sugar, sweet preserves, 
canned fruit and the like.” Food Salts 
In addition to starch or sugar (carbohydrates), fats and pro- 
tein, complete foods contain certain organic salts which are essen- 
tial to life and health. Kellner fed animals food from which the 
salts had been extracted and they all died, and sooner than 
animals that had no food at all. 
The principal salts, which should be always abundant in the 
daily bill of fare, are potash, soda, lime, magnesia and iron. 
Phosphorus and chlorin are found in combination with the alka- 
line elements. Recent researches indicate that iodine is also a 
necessary constituent of the food and that zinc, which is present 
in foodstuffs in nearly the same proportion as is iron, may pos- 
sibly be a valuable factor in nutrition. The iodine content of foods 
is a matter of importance especially in diseases of the thyroid 
gland. 
An eminent French chemist, M. Guerithault, recently (July 
19, 1920) communicated to the Academy of Sciences a report of 
an investigation of the copper constituent in plants. He finds 
copper present in varying amounts in “the leaves of lettuce, 
spinach, leeks, and celery; the roots of the carrot, turnips, radish, 
salsify, leeks, beets, and cress and the stalks of the latter; bulbs 
of onions and the tubercles of potatoes; in green beans; in the 
fruits of the pumpkin, cucumber, tomato, apple, pear, cherry, 
grape, orange, olive, banana, date and chestnut; and in the seeds 
of peas, beans, soy beans, lentils, wheat, barley, rye, oats, maize, 
cress, radish; as also in decorticated rice and in various nuts, 
including sweet and bitter almonds, walnuts and hazelnuts.” 
The lime and iron of the food, with other salts, are closely 
associated with protein in vegetable tissues. In animal tissues the 
lime is found almost exclusively in the bones and the iron in the 
blood. The practically universal neglect in this country to provide 
a constant and abundant supply of food salts in the dietary ren- 
ders this subject sufficiently important to justify a somewhat 
detailed discussion of it in the interest of food reform and race 
betterment. For many years the importance of food salts has 
been recognized in the writer’s work at the Battle Creek Sani- 
160 FOOD SALTS 
161 
tarium; and a few years ago he worked out a plan by which the 
lime and iron constituents of the diet, and incidentally other 
food salts, may be as easily balanced as are the carbohydrates, 
proteins and fats, the balancing of which for each patient has 
long been a part of the Battle Creek Sanitarium diet system. 
In general it is sufficient to make sure that the food contains 
a sufficiency of lime and iron. When these elements are present 
in sufficient amounts the other essential salts are practically cer- 
tain to be present also. 
THE IRON RATION 
By the term “iron ration” is meant the necessary daily intake 
of food iron, or so-called organic iron found in ordinary food- 
stuffs in varying proportions. 
Iron is one of the essential constituents of the body. It is 
found in all living organisms, both animal and vegetable. Its 
importance to the growing plant has long been recognized by 
scientists, and is evidenced by the fact that iron abounds in the 
germ of cereals and other seeds. It is for the same reason, doubt- 
less, that iron is found in relatively large amount in the embryos 
of animals, as in eggs, particularly the yolk of the egg. Iron is 
essential to life from the very outset. 
In the animal body, the chief function of iron is to aid in the 
formation of the hemoglobin of the blood, which is an organic 
iron compound peculiar to animals, and possesses a special chem- 
ical property by means of which it is able to absorb and condense 
oxygen (1.3 times its volume). 
This iron-containing hemoglobin is the chief constituent of 
the red blood corpuscles. Without iron, the body cannot make 
hemoglobin and hence cannot make blood cells, one of the most 
highly essential of all the bodily tissues. 
The essential character of the blood seems to have been 
known from the most ancient times, even when the arteries were 
supposed to be carriers of air. Said the old prophet, “The blood 
is the life,” a dictum which John Hunter’s famous experiment 
proved to be the expression of a profound scientific truth. 
The 25,000,000,000,000 red cells floating in the blood stream 
of a man of average size have a combined area of about 22,000 
square feet, or one-half an acre. 
The life of a red blood cell is only about six weeks; hence, 
of the 25,000,000,000,000 oxygen carriers, 7,000,000 die every 162 
THE NEW DIETETICS 
second of our lives, and to keep the number intact 7,000,000 new 
red corpuscles must be created by the living forces of the body 
every second, one of the most striking illustrations of creative 
power at work with which science has made us acquainted. 
It has been observed that plants often suffer from anemia, 
their leaves are pale green and the flowers lack brilliance of color. 
This condition may in many cases be remedied by the administra- 
tion of iron. Water containing iron rust poured about the roots 
of the plant, or even iron filings mixed with the soil about the 
plant, will often produce a rapid change for the better; the 
foliage becomes deep green in color and the tints of the flowers 
become more pronounced. In some instances pink hydrangeas 
have been made to produce blue blossoms. 
When the iron supply is deficient and the blood is depre- 
ciated, the face, lips, gums and finger nails become pale because 
the red blood cells are reduced in number. In normal blood ,a 
minute cube, half a line in diameter, contains not less than 
5,000,000 red corpuscles with half a square inch of absorbing sur- 
face. This number is greatly reduced in anemia, the blood count 
becoming 3,000,000 or 1,000,000 or in very pronounced cases 
falling as low as 500,000 or even lower. This means that the 
oxygen-absorbing and carrying element of the blood, that is, the 
hemoglobin, has been reduced in proportion. Instead of 22,000 
square feet of oxygen-carrying surface, there are only 15,000 or 
4,000 or even 2,000 square feet, a reduction to one-tenth the 
normal amount. 
This explains why an anemic person is short of breath, even 
when there is no trouble with the heart or lungs. He pants when 
he goes up stairs. He cannot run or even walk fast for a short 
distance without getting out of breath. There is nothing wrong 
with his breathing apparatus. The air is taken into the lungs 
properly and it comes in contact with the blood, but the blood 
does not take up enough oxygen because it is deficient in hemo- 
globin and so cannot absorb the oxygen brought to it, the effect 
being just the same as though the air supply were in part shut 
off by disease or by injury to the lungs. 
The anemic person lacks appetite because food is fuel and 
the oxygen which the iron-containing hemoglobin brings is neces- 
sary to burn up the incoming supplies of fuel and to prevent the 
accumulation of unused and clogging material in the tissues. 
The anemic person becomes sallow and the skin is often pig- FOOD SALTS 
163 
niented as well as pale, because the oxygen supply is insufficient 
to burn up the wastes of the body and they accumulate in the 
tissues. It is also probable that in some cases, at least, the pig- 
mentation is due to the production of poisonous pigments produced 
in such quantity that the adrenals, liver and kidneys are not able 
to destroy or eliminate them. 
A person whose blood count is low feels languid and weak, 
because oxygen is needed to release the energy supplied by thq 
food and stored up in the muscles and other organs. 
In anemia all the life processes are depreciated, every vital 
function is crippled and the whole body is depleted. Long con- 
tinued anemia of a severe type may give rise to paralysis as the 
result of damage to the spinal cord. 
In view of the great importance of iron in the life activities 
of the body, it would naturally be expected that it would figure 
large among the constituents of the body. But the very opposite 
is true. It is the very smallest in amount of the twelve principal 
elements which enter into the composition of the tissues. 
As will be seen by reference to Table I, the entire body 
contains only one-tenth of an ounce or one part of iron in 
24,000 parts of body weight. This proportion is about the same 
as that of a teaspoonful of flour compared with a barrelful. 
There are hidden away in the bones five hundred times as much 
lime as there is iron in the whole body; and yet, this minute 
amount of iron, 44 grains, is just as essential as the oxygen which 
forms two-thirds the total weight of the body, or as the carbon 
and other elements which make up the balance. 
Iron is found in the body almost exclusively in the form of 
hemoglobin, the red coloring matter of the blood. The blood 
constitutes about 7 per cent, of the body weight and contains 
about 95 per cent, of the iron. The red color of a piece of raw 
beefsteak is due to the blood in it. By thorough washing in salt 
water the blood may be removed and the muscle tissue left will be 
found nearly white in color. 
Iron is found, practically, only in the blood because it is 
through the circulation of the blood that the iron is made to do 
its peculiar and wonderful work in entrapping the life-giving 
oxygen and circulating it throughout the body to every minute 
cell and tissue, bringing it in immediate contact with the smallest 
waste particles, and carrying back to the lungs the used-up ma- 
terials, the products of combustion in the form of carbon dioxid 164 
THE NEW DIETETICS 
(CO2), by far the most bulky and the most important of all our 
excretions, amounting to more than half a pound daily, or more 
than forty times the weight of the urea eliminated and four hun- 
dred times the weight of uric acid excreted. 
And the elimination of this enormous mass of poisonous 
debris all depends upon a few grains of iron in the blood. When 
a person is submerged in water he drowns in three or four min- 
utes because of inability to get the carbon dioxid out of his blood. 
The blood and tissues become saturated with the poison and the 
body cells are asphyxiated. A man who has an insufficient amount 
of iron in his blood is like a half drowned man. The CO2 accu- 
mulates in his blood and tissues and the living cells become crip- 
pled and incompetent. 
The Daily Requirement of Iron. 
The solid as well as the liquid materials which enter into 
the composition of the body are in a state of perpetual change. 
An eminent scientist defines an animal as, “a stream of matter 
flowing through a certain form.” The fluids of the body change 
very rapidly; the soft parts quickly, though less rapidly, and 
the solid parts more slowly. For example, the daily loss of lime 
is only 10 or 12 grains, at which rate nine years would be 
required to exhaust the body’s store of 4.6 pounds of lime (CaO). 
The blood, as already noted, loses all its red cells and replaces 
them by new ones about once in six weeks according to the esti- 
mate of physiologists. This would involve a loss and renewal of 
practically the entire iron store of the body every six weeks. 
But nature is less extravagant in her expenditure of iron than in 
the disposal of her store of lime. She hoards the precious metal 
with the greatest care. The worn out bodies of the 7,000,000 
red cells which perish every second are carefully worked over 
and the iron contained in their hemoglobin is recovered and stored 
in the liver and spleen and used in the making of new cells to 
take the place of those which are lost. Of course there is some 
loss of iron, but instead of losing a grain a day the actual loss of 
iron from the body is only about one-seventh of one grain. 
We need food iron to make good this loss. Small though it 
is, it must be made good or the direst consequences will follow. 
Animals fed on a diet which contains no food iron die in a month 
or less. 
To make certain that the supply of iron is adequate, the FOOD SALTS 
165 
physiologists tell us that we require not less than 0.213 grains, 
practically one-quarter of a grain, per diem. The iron ration 
for the maintenance of health may be said, then, to be one- 
quarter of a grain of food iron daily. 
Women require a larger intake of iron in proportion to their 
weight than do men, and infants and children need much more 
than adults. The functions associated with childbearing and 
nursing make a special demand which requires an iron ration for 
the average woman fully equal to that needed by the average 
man of greater weight. 
The expectant mother must supply iron for the blood of her 
infant, as well as for storage in its liver, from her own blood. 
In other words, the mother must furnish from her own store of 
blood iron, enough iron for blood-making purposes to meet the 
needs of her infant not only before birth but for a whole year 
afterwards, at the end of which time its blood volume and its 
weight are three times as great as at birth. 
The monthly function of women involves a loss of iron which 
must be made good through a diet especially rich in organic iron. 
Even before puberty, girls require food richer in iron in propor- 
tion to their size than do boys, for two reasons: 
(1) Because they grow faster than boys, becoming taller 
and heavier between the ages of twelve and fifteen years than 
boys of the same age. 
(2) Because they usually eat less than do boys of equal age. 
It is perhaps for this reason that women, guided by instinct, 
are notably more fond of greenstuffs and salads and fresh vege- 
tables than are men. This natural tendency should be encour- 
aged. Women and girls should eat more freely of greens of 
various sorts and of all foods rich in iron than do men and boys. 
Lentils, dates and malt sugar are rich in iron. See Table XII. 
The popular notion that cow’s milk contains everything need- 
ful for nutrition is an unfortunate and dangerous error, though 
one into which a person very naturally falls. Milk is a natural 
food intended for animal sustenance and is primarily meant to 
be used as an exclusive diet, but it must be remembered that it 
is only sufficient as a complete nutrient when fed to very young 
animals which have been provided by nature with an extra sup- 
ply of iron stored up in their livers before birth. 
A guinea pig becomes anemic and starves on an exclusive 
diet of cow’s milk. The same thing happens to a human adult if 166 
THE NEW DIETETICS 
the diet is too long continued. Neither the guinea pig nor the 
human adult has a reserve of iron suitable for blood-making 
sufficient to last more than a few weeks. 
This question becomes one of very great importance in the 
artificial feeding of infants. According to the best authorities on 
the chemistry of foods, human milk contains twice as much iron 
as does cow’s milk. This fact insures the nursing infant an ade- 
quate supply of iron during the nursing period. A very striking 
illustration of the marvelously wise adaptations of means to ends 
in the economy of Nature is afforded by the difference in the 
composition of human milk and cow’s milk. Cow’s milk contains 
nearly four times as much lime to the ounce as does human milk, 
but only half as much iron. The reason for this striking pecu- 
liarity is found in the fact that the calf needs four times as much 
lime for the formation of bone because it reaches maturity in less 
than one-fourth the time of the human infant, while, on the other 
hand, it needs less iron in its maternal food supply because it 
begins, like its mother, to nibble grass, a food very rich in iron, 
within a short time after its birth; whereas, the human infant 
normally is nourished exclusively by its mother’s milk until six 
months of age or older. 
When infants are fed other food than mother’s milk the 
management of their diet becomes a matter of exceeding delicacy. 
It is more than probable that few if any artificially fed infants 
escape injury more or less serious through an inadequate supply 
of iron or lime or vitamins or of all these elements, or from lack 
of balance in the bill of fare in some other particular. 
In the feeding of infants experience has shown the necessity 
for the dilution of cow’s milk and the best results are secured by 
diluting whole milk with water, sweetened with milk sugar or 
malt sugar. In feeding young infants, equal parts of milk and 
water are generally employed. An infant fed on such a mixture 
receives only one-fourth the amount of iron normally found in 
human milk. On such a diet, the child becomes anemic. Resist- 
ance is lowered and the infant becomes subject to a great variety 
of disorders, the effects of which may remain through life. The 
free use of orange juice, the use of malt sugar instead of milk 
sugar and the use of barley meal, malt soup, lentil soup, and 
soups prepared from spinach and other green vegetables and foods 
rich in iron, in connection with milk feeding, are measures the 
value of which has been little appreciated until recent years. It is FOOD SALTS 
167 
probable that the deficiency of iron in some infant dietaries is to 
a certain extent compensated by an excess of lime; at least some 
recent observations would indicate that this may be the case. 
Where to Find the Necessary Food Iron. 
Experiments made upon animals (Hall) show that when the 
food contains no iron at all, 40 per cent, of the entire iron con- 
tent of the animal’s body may be lost in three weeks. 
How may the daily requirement of iron be best secured? 
This would seem to be an extremely simple problem, for no one 
of all the metals is so abundantly scattered over the face of the 
earth and in the earth and all about us, facing us at every turn, 
as is iron; and formerly it was supposed to be a matter of entire 
indifference in what form the iron was received so long as it was 
gotten into the body. 
More than a third of a century ago Bunge of Bale, Switzer- 
land, one of the most eminent of those of the world’s chemists 
who devote their lives to the study of the chemical problems 
relating to the human body, undertook, with the aid of his stu- 
dents, an extended series of experiments for the purpose of 
settling the question whether the ordinary iron with which we 
are familiar, the so-called inorganic iron, or any of its compounds 
could be utilized by the body in keeping good its stock of iron 
for use in blood making. 
First of all, Bunge showed that natural foodstuffs contain 
iron in a peculiar state so different from that in which it is found 
in various chemical compounds and minerals that it cannot be 
recognized by the usual chemical tests for iron. This is known 
as organic iron. Bunge found in the yolks of eggs considerable 
quantities of this organic iron (hematogen) which was so similar 
to hemoglobin as to be easily converted by the body into the col- 
oring matter of the blood, one of the most remarkable of all 
organic substances. Similar compounds were found in milk, 
legumes and cereals. 
Bandisch has recently shown that ultra-violet light, acting 
upon the green parts of plants, produces compounds of iron in 
which the “metallic character of the iron is masked by the organic 
character of the compound.” This organic iron is so different 
fiom ordinary metallic iron that it cannot be detected by the 
usual laboratory tests for iron. According to Dr. Bandisch these 
compounds are produced by a substance formed by the action of 168 
THE NEW DIETETICS 
ultra-violet light to which he gives the name of formaldoxine. 
In experiments upon a large number of rats, rabbits and 
dogs conducted in Bunge’s laboratory it was found that the ani- 
mals supplied with foods rich in organic iron made twice as much 
hemoglobin as those which were supplied with inorganic iron. 
It was also noticed that foodstuffs contain iron only in the organic 
form, “built up by the life processes of plants.” This organic 
iron, according to Bunge, is the source of the iron used by the 
body in the formation of hemoglobin. The observations of Bunge 
have since been confirmed by many other investigators. 
One observer has shown that rabbits made anemic by bleed- 
ing recovered when given chlorophyl much more rapidly than 
when given inorganic iron. 
It is doubtless true, as suggested by Von Noorden and others, 
that inorganic iron may temporarily stimulate the blood-making 
process, but apparently it cannot be used, at least to any extent, 
in the construction of red blood cells. This stimulating effect of 
chemical iron preparations may be of some possible advantage 
in certain cases of disease, but the stimulation produced is of 
very short duration, and on this account such iron preparations 
should be employed only for very brief periods, if at all. As a 
matter of fact, they are rarely useful and very seldom needed. 
The long continued use of inorganic iron in the form of medicine 
or mineral waters is detrimental, causing constipation and other 
disorders. To prevent injury to the tissues, the liver, exercising 
one of its most important protective functions, captures the in- 
organic iron and holds it in its own tissues until it can be dis- 
posed of. This unnecessary work demanded of the liver may 
seriously interfere with the performance of some of its highly 
important functions. Thus the long continued use of inorganic 
iron in mineral waters or otherwise is to be condemned. 
The iron ration must be drawn from organic sources; that 
is, it must be obtained from natural foodstuffs. Chemical, or 
inorganic iron, even though possibly of some limited service in 
certain cases of disease, is no proper substitute for food iron. As 
Sherman well says, in summing up the world’s most eminent au- 
thorities, “Inorganic iron when absorbed is not utilized * * * to 
any appreciable extent, but remains unused in the tissues. Evi- 
dently, then, we should look to food rather than to medicines or 
mineral waters for the supply of iron needed in normal nutrition.” 
Egers has shown that the regeneration of the blood after a FOOD SALTS 
169 
severe hemorrhage goes on much faster with a diet rich in food 
iron than when dependence is placed upon inorganic iron. 
The Iron Content of Foodstuffs* 
Foods differ greatly in their iron content, although the varia- 
tion in the amount of iron present is less than is the case with 
lime. There are fewer foods which may be said to be very rich 
in iron than is the case in relation to the lime content, and per- 
haps fewer foodstuffs in which the deficiency is very marked. 
Among the foods richest in iron are found some which we 
had not even suspected of being so rich in this essential metal 
food principle until this digest of technical data was made. Here 
are a few of the most important, the relative richness in iron 
being in the order as named: 
Wheat bran, egg yolk, lentils, beans, peas, wheat, mustard 
greens, hazelnuts, barley, rye, beef, almonds, graham bread, spin- 
ach, turnip tops, and olives. 
Each of the above named foodstuffs contains in one ounce 
more than 6 per cent, of the iron ration for one day, so that one 
pound of any of these foods, if eaten, would supply the necessary 
iron requirement. 
In the case of several foods, the percentage of iron is so high 
that 6 to 10 ounces are sufficient for a full day’s ration. It is 
interesting to note that one vegetable product, the lentil, contains 
exactly the same percentage of iron as the yolk of egg, and beans 
are not far behind, 6 ounces of lentils or 7.5 ounces of beans 
supplying iron for one day. Peas, mustard greens and whole 
wheat supply iron for a day with less than three-quarters of a 
pound of their substance. 
Of the foods which are poor in iron, 33, or one-fourth of 
the total number, contain less than 1 per cent, of a day’s ration. 
A large number (36 per cent.) contain between 2 and 3 per cent, 
of iron per ounce, making a total of 69 foodstuffs (51 per cent.) 
which may be classed as very low in iron. Such foods as cane 
sugar, confectionery, olive oil, lard and suet contain no iron at all. 
It is evident that when these foods with low iron content 
are made use of they should be supplemented by suitable foods 
rich in iron, which are named in Table XII. 
A study of the average iron content of the several classes of 
foodstuffs affords useful information. 
When considered with reference to the amount of iron or 170 
THE NEW DIETETICS 
the percentage of the day’s iron ration contained in one ounce of 
material, we find the legumes, on the average, far ahead of all 
others (11.35). Greens come next (6.14), then eggs (5.67), 
meats (4.29), cereals (3.9), nuts (3.49), fruits (1.74), vegetables 
(1.46), milk products (1.05), and milk (0.47) with less than half 
of 1 per cent, of the daily requirement. 
When examined with reference to the percentage of the iron 
ration contained in 100 calories, the order of precedence is 
changed. First in the list is greens (46.4), then meats (15.6), 
legumes (13.7), vegetables (10.4), fruits (5.6), cereals (4.3), 
nuts (2.67), and lastly eggs (1.36). 
Table XI shows all the essential facts in relation to the iron 
content of more than 100 common foods. The several columns, 
numbered 1 to 7, present the following particulars : 
1. The amount of food iron calculated as grains of metallic 
iron, in one ounce of foodstufif. 
2. The percentage of one day’s iron ration (0.213 grains) in 
one ounce. 
3. The amount (ounces) of foodstuff required for one day’s 
iron ration. 
4. The percentage of the iron ration found in 100 calories. 
5. The weight in ounces of 100 calories. 
6. The weight in ounces of an ordinary serving. 
7. The number of calories in an ordinary serving. 
By the use of this table it is possible very easily to determine 
the iron content of the food intake for a meal, a day, or any 
definite length of time. 
TABLE XL 
The Iron Content of Foodstuffs.* 
The following table shows in column (1) the amount of 
food iron calculated as grains of metallic iron in one ounce of 
foodstuff. (2) The percentage of one day’s iron ration (0.213 
grains) in one ounce. (3) The amount (ounces) of foodstuff 
required for one day’s iron ration. (4) The percentage of the 
iron ration found in 100 calories. (5) The weight in ounces of 
100 calories. (6) The weight in ounces of an ordinary serving. 
(7) The number of calories in an ordinary serving. 
•Based upon the tables of Sherman in “Chemistry of Food and Nutrition,” 
Macmillan Company. FOOD SALTS 
171 
G 
G 
O 
_ be 
o C 
be 
G 
O . 
t* N 
O 
O 
£ 
Si-2 
O S' s 
-*S g 
N 
o «s a 
VI ® 
® rj ° 
N S 
> 
N* O <D 
o **“* M 
> 
<D 
G « 
° i 
to ft 
c 
2 * 
g U N 
w G g 
-m o 
O 
O 
£ d 
>> 
u, ° *■ 
« h 
4) H 
•p 
cd o' 
•5? *3 v 
'<53 o 
o .£ 
Ot 
£> a! 0) 
k -O ft 
> o w 
l> «h'd 
cS-oH 
6 o 
(1) 
(2) 
(3) 
(4) 
(5) 
(6) 
(7) 
Almonds 
.0171 
7.35 
13.6 
4.0 
0.5 
0.5 
92 
Apples, A. P.* 
.0013 
0.56 
177.7 
3.2 
5.6 
5.9 
67 
Apples, dried 
.0065 
2.80 
35.5 
3.2 
1.2 
1.2 
100 
Apple juice 
.0009 
0.39 
256.6 
3.0 
6.0 
6.0 
100 
Apricots, A. P 
.0013 
0.56 
177.7 
3.5 
6.1 
3.0 
46 
Apricots, dried 
.0061 
2.64 
38.0 
3.5 
1.1 
2.0 
157 
Asparagus 
.0044 
1.90 
52.5 
30.0 
15.7 
3.0 
19 
Bananas 
.0026 
1.12 
90.0 
4.0 
3.5 
3.5 
100 
Barley, entire 
.0179 
7.75 
13.0 
7.6 
1.7 
1.0 
90 
Barley, pearled 
.0088 
3.80 
26.2 
3.8 
1.0 
1.0 
100 
Beans, dry 
.0306 
13.25 
7.5 
13.5 
1.0 
1.0 
97 
Beans, lima, dry 
.0306 
13.25 
7.5 
13.3 
1.0 
1.0 
99 
Beans, lima, fresh 
Beans, soy 
.0088 
3.80 
26.0 
10.7 
2.9 
4.0 
62 
.0248 
10.73 
9.3 
9.2 
0.9 
1.0 
112 
Beans, string, fresh 
.0048 
2.08 
48.0 
17.7 
17 0 
4.0 
44 
Beef, all lean 
.0170 
7.36 
13.6 
30.0 
4.0 
4.0 
100 
Beefsteak, med. fat 
.0097 
4.20 
24.0 
10.5 
2.5 
4.0 
160 
Beets 
.0026 
1.12 
90.0 
9.0 
7.6 
2.2 
29 
Blackberries 
.0026 
1.12 
90.0 
7.0 
5.9 
3.0 
50 
Bread, Boston brown 
.0131 
5.60 
17.5 
9.0 
1.2 
1.2 
77 
Blood 
.2301 
100.00 
1.0 
Blueberries 
.0039 
1.70 
58.0 
8.0 
4.7 
2.5 
53 
Bread, entire wheat 
.0070 
3.03 
33.0 
4.3 
1.4 
2.0 
139 
Bread, graham 
.0109 
4.70 
21.0 
6.4 
1.3 
2.0 
158 
Bread, rye 
Bread, entire rye (pumper- 
.0070 
3.03 
33.0 
2.6 
1.4 
2.0 
144 
nickel) 
.0088 
3.81 
26.2 
6.5 
1.7 
2.0 
111 
Bread, white 
.0039 
1.70 
58.0 
2.3 
1.3 
2.0 
159 
Brose 
.0200 
8.60 
11.5 
8.6 
1.0 
1.0 
100 
Brussels sprouts 
.0048 
2.08 
48.0 
23.4 
11.3 
4.0 
24 
Buckwheat flour 
.0053 
2.30 
43.6 
2.3 
1.0 
1.0 
100 
Butter 
.0009 
0.40 
256.6 
0.2 
0.5 
0.5 
109 
Buttermilk 
.0011 
0.50 
210.0 
4.7 
10.0 
6.0 
60 
Cabbage 
.0048 
2.08 
48.0 
23.4 
11.0 
4.0 
36 
Cabbage greens 
.0079 
3.40 
29.0 
30.0 
11.0 
4.0 
25 
Cantaloup 
.0013 
0.56 
178.0 
4.7 
9.0 
7.0 
78 
Carrots 
.0026 
1.12 
90.0 
9.0 
7.3 
3.7 
51 
Cauliflower 
.0026 
1.12 
90.0 
13.0 
11.0 
3.0 
25 
Celery 
.0022 
0.95 
105.0 
18.0 
18.0 
1.0 
5 
Chard 
.0100 
4.70 
21.0 
44.0 
8.7 
3.0 
35 
Cheese 
.0057 
2.42 
40.5 
2.0 
0.8 
0.5 
62 
Cheese, cottage 
.0042 
1.82 
55.0 
5.8 
3.2 
2.0 
62 
Cheese, yogurt 
.0043 
1.84 
51.0 
1.7 
0.9 
0.5 
50 
Cherries 
.0018 
0.78 
128.0 
3.4 
4.7 
4.5 
94 
Cherry juice 
.0013 
0.56 
177.7 
2.5 
4.6 
5.0 
100 
Chestnuts 
.0031 
1.30 
77.0 
2.0 
1.4 
1.0 
114 
Chicken 
See beef. 
Coconut, fresh 
.0051 
2.21 
45.5 
2.0 
0.9 
1.0 
167 
Corn, whole 
.0127 
5.50 
18.0 
5.0 
1.0 
1.0 
109 
(The letters A. P. stand for “as purchased.”) 172 
THE NEW DIETETICS 
** M § 
M-t 
bo 
G 
bo 
G 
O 
o 
.S'-M 
M-t 
o .v 
° > 
u u 
> 
►H N* 
. ° 
<n c 
b£.0 
N-- U 
a 
V 5 o 
U O O 
cd aj 
c£“ 
<D r.O 
y ®9 
S.3 
N* O <L> 
o /~ « 
C % 
CO Q. 
g u . 
•D m N 
O « o 
. C ? 
•g S’- 
■M O 
•S’a 
bo o 
-M O £ 
bo'+H G 
X 
£ £ 5 
$ s 
G 
o .5 
St 
V rt S 
a 
P-IT3.2 
£2 
6 o 
Cornmeal 
0039 
1.70 
58.0 
2.0 
1.0 
1.0 
100 
Corn, sweet, fresh 
... .0035 
1.50 
66.0 
4.8 
3.5 
3.0 
86 
Corn, sweet, dried 
0127 
5.50 
18.0 
5.5 
1.0 
1.0 
109 
Crackers 
0066 
3.00 
35.0 
2.4 
0.9 
1.0 
110 
Cranberries 
... .0026 
1.12 
90.0 
9.0 
7.5 
3.0 
40 
Cream 
0010 
0.43 
231.0 
0.7 
1.8 
2.5 
137 
Cucumbers 
0009 
0.40 
255.6 
8.0 
20.0 
2.0 
10 
Currants, fresh 
0022 
0.94 
110.0 
6.0 
6.0 
3.0 
48 
Currants, dried, Zante 
0109 
4.72 
21.0 
6.0 
1.1 
1.5 
135 
Dandelion greens 
0118 
5.11 
19.4 
30.0 
5.5 
3.0 
50 
Dates, dried, A. P 
0131 
5.67 
17.5 
6.0 
1.0 
2.0 
100 
Dock, narrow leaved 
0280 
13.40 
7.5 
Eggplant 
0022 
.95 
110.0 
12.3 
12.3 
1.5 
12 
Eggs 
0131 
5.67 
17.5 
13.6 
2.4 
1.8 
70 
Egg, one (1.8 oz.) 
... .0244 
10.54 
1.8 
70 
Egg white 
0004 
0.17 
580.0 
1.3 
4.7 
1.0 
144 
Egg white, one (1.2 oz.)... 
0005 
0.20 
1.2 
17 
Egg yolk 
0376 
16.32 
6.0 
15.3 
0.9 
1.0 
103 
Egg yolk, one (.6 oz.) 
0226 
9.80 
0.6 
60 
Endive 
0106 
4.60 
20.0 
50.5 
11.0 
3.0 
14 
Farina 
0035 
1.51 
65.6 
1.5 
1.0 
1.0 
102 
Figs, dried 
0131 
5.67 
17.5 
6.3 
1.1 
2.0 
168 
Figs, fresh 
0044 
1.47 
52.5 
6.3 
3.4 
2.0 
43 
Fish, (haddock) 
0029 
1.30 
80.0 
6.3 
3.0 
6.0 
122 
Flour, buckwheat 
0053 
2.30 
45.6 
2.3 
1.0 
Flour, entire wheat 
0110 
4.72 
21.0 
4.7 
1.0 
Flour, graham 
0162 
7.00 
15.5 
7.0 
1.0 
Flour, white 
... .0044 
1.90 
52.5 
1.5 
1.0 
Flour, rye 
0057 
2.47 
40.5 
2.5 
1.0 
Flour, rye, entire 
... .0146 
6.54 
16.0 
6.3 
1.0 
Gluten, pure 
1487 
64.30 
1.5 
64.3 
1.0 
0.5 
62 
Gluten, 40 per cent 
0600 
26.00 
3.8 
26.0 
1.0 
1.0 
100 
Gluten, 20 per cent 
0300 
13.00 
7.7 
13.0 
1.0 
1.0 
100 
Gooseberries 
0022 
0.95 
105.0 
6.0 
6.0 
2.5 
40 
Grapefruit 
0013 
0.56 
177.0 
4.0 
6.7 
3.5 
50 
Grapes, A. P 
0013 
0.56 
177.0 
2.0 
3.6 
3.5 
72 
Grape juice 
0013 
0.56 
177.0 
2.0 
4.0 
4.0 
95 
Hazelnuts 
... .0179 
7.75 
13.0 
4.0 
0.5 
0.5 
47 
Hominy 
0040 
1.69 
58.0 
1.7 
1.0 
1.5 
150 
Honey 
0031 
1.34 
77.0 
2.0 
1.1 
1.6 
139 
Huckleberries 
0039 
1.69 
58.0 
8.0 
5.0 
2.5 
52 
Kohl-rabi 
0026 
1.12 
90.0 
9.0 
8.0 
4.0 
35 
Lemon juice 
... .0026 
1.12 
90.0 
9.0 
8.0 
Lentils, dried 
... .0377 
16.32 
6.1 
19.5 
1.1 
1.0 
99 
Lettuce 
0031 
1.34 
74.5 
52.3 
18.4 
1.0 
6 
Maple syrup 
... .0121 
0.57 
17.5 
7.0 
1.3 
1.3 
108 
Malt sugar 
... .0214 
9.30 
10.8 
9.3 
1.0 
2.0 
200 
Malted nuts 
... .0192 
8.30 
12.0 
5.5 
0.7 
1.3 
200 
Macaroni 
0053 
0.51 
43.6 
2.2 
1.0 
1.0 
102 
Meat (tenderloin) 
0131 
6.00 
17.6 
7.0 
1.2 
2.4 
200 
Milk, whole 
0011 
0.47 
210.0 
2.3 
5.1 
6.0 
115 
Milk, buttermilk 
... .0011 
0.50 
210.0 
4.7 
10.0 
6.0 
60 
Milk, skimmed 
... .0011 
0.47 
210.0 
4.5 
9.6 
6.5 
62 FOOD SALTS 
173 
d 
b£ § 
o c-2 
0.2 cn 
O 
O .5 
bo 
.5 
o 
O 
'Vc « 
> 
M o 
<D g 
bc.2 
o 2 a 
N t 
o_ ® 
g.§ 
N O V 
O'** <» 
r4 4> 
.5 w 
c a 
-tj 
+-» O 2 
2 3 
o 
d £* 
O 
(0 
U J- 
*c3 v 
O “ O 
bfljw o 
s 
o 
[v 
O .3 
ob 
C4-a a 
;> mhtj 
£-3.5 
£2 
£2 O 
U o 
Milk, condensed, sweetened 
.0026 
1.12 
90.0 
1.3 
1.1 
2.0 
185 
Milk, human 
.0030 
Molasses 
.0320 
1.38 
7.3 
17.0 
1.2 
1.2 
98 
Muskmelon 
.0013 
0.56 
175.0 
5.3 
8.8 
7.0 
78 
Mustard greens 
.0213 
9.22 
10.0 
3.0 
Nuttolene 
.0171 
7.40 
13.5 
14.8 
2.0 
2.0 
100 
Oatmeal 
.0166 
7.19 
14.0 
6.4 
0.9 
1.0 
113 
Olives, ripe, A. P 
.0127 
5.49 
18.0 
6.5 
1.2 
2.0 
118 
Onions ... 
.0026 
1.12 
90.0 
7.0 
7.2 
2.5 
42 
Oranges 
.0009 
.42 
236.6 
2.6 
6.8 
5.0 
73 
Orange juice 
.0009 
.42 
236.6 
3.0 
8.0 
6.0 
91 
Parsnips 
.0026 
1.12 
90.0 
6.0 
5.4 
3.0 
55 
Peaches, A. P 
.0013 
0.56 
180.0 
5.0 
8.0 
4.0 
38 
Peaches, dried 
.0052 
2.29 
45.0 
5.0 
4.0 
2.0 
160 
Pears, A. P 
.0013 
0.56 
180.0 
3.1 
5.5 
4.0 
64 
Peas, dry 
.0249 
10.78 
9.2 
11.0 
1.0 
1.0 
100 
Peas, green 
.0074 
3.16 
31.0 
11.3 
3.5 
3.5 
70 
Peanuts 
.0088 
3.81 
26.2 
2.4 
0.6 
0.5 
78 
Pecan nuts 
.0114 
4.93 
20.3 
2.3 
.5 
.5 
104 
Pineapple 
.0022 
0.95 
105.0 
8.0 
8.1 
4.0 
50 
Plums 
.0022 
0.95 
105.0 
4.0 
4.1 
4.0 
91 
Potatoes 
.0057 
2.47 
40.5 
10.4 
4.2 
3.0 
71 
Potatoes, sweet 
.0022 
0.95 
105.0 
2.6 
2.8 
3.0 
105 
Protose 
.0249 
10.80 
9.2 
21.5 
2.0 
2.0 
100 
Prunes, dried, A. P 
.0131 
5.67 
17.5 
7.0 
1.2 
2.0 
145 
Purslane 
.0080 
3.90 
25.6 
Pumpkin 
.0035 
1.51 
66.0 
8.7 
13.6 
3.5 
25 
Radishes 
.0026 
1.12 
90.0 
13.7 
11.9 
1.0 
8 
Raisins (seedless) 
.0092 
4.00 
25.0 
9.2 
1.0 
1.0 
98 
Raspberries 
.0026 
1.12 
90.0 
6.0 
5.3 
4.0 
75 
Red root 
.0280 
12.90 
7.8 
Rice, polished 
.0039 
1.68 
58.0 
1.7 
1.0 
1.5 
160 
Rice, brown 
.0088 
3.81 
26.0 
4.0 
1.0 
1.0 
100 
Romaine 
.0525 
22.75 
4.4 
3.0 
Rye flour _ 
.0057 
2.47 
40.5 
2.5 
1.0 
1.0 
100 
Rye, entire 
.0171 
7.40 
13.4 
9.6 
1.3 
1.3 
100 
Spinach 
.0158 
6.84 
14.5 
100.4 
15.0 
3.0 
20 
Spinach, mountain 
.0080 
3.90 
25.6 
Spinach, New Zealand 
.0090 
4.10 
24.4 
Squash 
.0026 
1.12 
30.0 
0.9 
7.6 
3.7 
46 
Strawberries 
.0035 
1.51 
66.0 
13.7 
9.4 
4.0 
44 
Tapioca 
.0070 
3.03 
33.0 
3.0 
1.0 
1.0 
100 
Tomatoes 
.0018 
0.78 
128.0 
11.7 
13.3 
4.0 
25 
Turnips 
.0022 
0.95 
105.0 
8.5 
9.0 
4.5 
50 
Turnip tops 
.0152 
6.58 
14.0 
3.0 
Walnuts 
.0092 
4.00 
25.0 
2.0 
0.5 
.5 
94 
Watercress 
.0083 
3.60 
28.0 
1.5 
10 
Watermelon 
.0013 
0.56 
177.7 
6.6 
11.6 
8.0 
69 
Wheat, entire 
.0219 
9.50 
10.6 
9.0 
1.0 
1.5 
150 
Wheat bran 
.0341 
14.76 
6.7 
17.7 
1.2 
0.5 
35 174 
THE NEW DIETETICS 
To Determine the Iron Content of a Ration or a 
Dietary by the Use of the Table* 
This determination may be made in several ways as follow: 
1. The exact weight of the several articles which make up 
the ration or the bill of fare must be first ascertained. Then 
from the alphabetical table find in column 2 the figures repre- 
senting the percentage of the iron ration found in one ounce. 
Multiply each of these per cents, by the weight in ounces eaten 
of the article. Add the result together and the sum will be the 
percentage of the iron ration found in the total food intake for 
the day. If the amount is 100, it exactly equals the normal re- 
quirement. If it is less than 100, there is a deficiency of iron, the 
amount of which is shown by the difference between the figures 
found and 100, If the figures are in excess of 100 the food intake 
comprises an excess of food iron. This is not a matter of con- 
sequence, however, as any excess will be carried off through the 
intestines, the principal channel through which waste iron is nor- 
mally excreted. If a deficiency is found, it should be corrected at 
once by the addition of some article rich in food iron, or by the 
substitution for some foodstuff poor in iron of another which 
is rich in this element. 
2. A determination can be equally well made by the use of 
columns 4 and 7. If the foods are served in 100 calorie portions, 
as at the Battle Creek Sanitarium, this can be done very quickly. 
It is only necessary to find in the table the several articles eaten 
and set down the figures found in column 4, which represent for 
each article the percentage of the day’s ration found in 100 calories. 
In case a serving consists of more or less than 100 calories the 
figures found in column 4 must be increased or diminished ac- 
cordingly. 
The figures in columns 5 and 6 will sometimes be found of 
assistance in making the determinations by either of the above 
methods. 
The figures given in column 3 are useful in showing at a 
glance the great difference in the iron content of different food- 
stuffs. 
It is important to note that in the case of foodstuffs of 
which a very large quantity must be taken to supply a day’s iron 
ration the nature of the food is usually such that a large quantity 
may be taken without inconvenience, so that, while the amount of FOOD SALTS 
175 
iron per ounce may be small, it may be possible to take without 
inconvenience a sufficiently large quantity to more than balance 
the deficiency. This is particularly true in the case of fruit juices 
and greens.. 
To facilitate the work of balancing the bill of fare for the 
iron content the writer has prepared the accompanying tables 
(Tables XI and XII). 
Foods Rich in Iron. 
The accompanying table of foods rich in iron (Table XII) 
comprises less than one-third of the foods included in Table XI. 
Each foodstuff in this list supplies in one ounce at least 4 per 
cent, of one day’s iron ration. 
Some of these foods, particularly those which are found in 
the first half of the list, should enter liberally into each day’s bill 
of fare. Without the free use of such foods, it is impossible to 
maintain the iron content of the body intact; the blood will deter- 
iorate and all the bodily forces will languish. This is a matter to 
which every housewife, every individual, should give earnest 
attention. At a recent (1920) race betterment exhibit in con- 
nection with a great health and sanitation exhibition in Chicago, 
the writer had blood examinations for hemoglobin made in the 
cases of several thousand persons. The average was found to 
be 80, or 20 per cent, below the normal. There can be no doubt 
that practically the whole American population is anemic because 
of the lack of iron-containing foodstuffs in the national bill of 
fare. The average American bill of fare offers almost no iron- 
rich food except meat. The consumption of meat is steadily de- 
creasing because of high prices and the spreading of information 
respecting the advantages of non-flesh dietary. The effect of dis- 
carding meats must be to increase the national anemia unless 
other more natural sources of iron are added to the bill of fare. 
Fortunately, the place of meat as a source of food iron may be 
easily filled, as reference to Table XII will show. Instead of 
standing at the head of the list of iron-rich foods, steak is forty- 
ninth in the list. More than a dozen vegetable foods contain 
double the amount of food iron supplied by meat; half a dozen, 
three times as much; four, more than four times as much; and 
two, more than ten times as much. Even such common garden 
weeds as red root and dock contain twice as much iron as does 176 
THE NEW DIETETICS 
an equal weight of meat and better iron; while bran, molasses, 
lentils and egg yolk contain about three times as much. 
Evidently the old notion that one must eat red meat to en- 
rich the blood is an error; it is in the green things that the richest 
stores of food iron are to be found. 
TABLE XII 
Foods Rich in Iron* 
Per 
cent 
Savita (Yeast extract) .4600 
Grains 
of iron 
per oz. 
2.013 
Gluten, pure 
0340 
.149 
Gluten, 40 per cent 
0136 
.060 
Romaine 
... .0119 
.052 
Egg yolk 
... .0086 
.038 
Lentils, dried 
... .0086 
.038 
Wheat bran 
... .0078 
.034 
Molasses . 
... .0073 
.032 
Beans, lima, dried 
... .0070 
.031 
Dock greens 
... .0065 
.028 
Red root greens 
... .0065 
.028 
Beans, soy 
... .0057 
.025 
Peas, dry 
... .0057 
.025 
Protose 
... .0057 
.025 
Egg (one) 
... .0054 
.024 
Egg yolk (one) 
... .0052 
.023 
Wheat entire 
... .0050 
.022 
Mustard greens 
... .0048 
.021 
Malted nuts 
... .0043 
.019 
Hazelnuts 
... .0041 
.018 
Almonds 
... .0039 
.017 
Beef, lean 
... .0039 
.017 
Nuttolene 
... .0039 
.017 
Oatmeal 
... .0039 
.017 
Flour, graham 
... .0036 
.016 
S'pinach 
... .0036 
.016 
Per 
Grains 
of iron 
cent 
per oz. 
Brose (oatmeal, corn 
meal( bran) 
.0032 
.014 
Boston brown bread 
.0030 
.013 
Corn, whole 
.0030 
.013 
Corn, sweet, dried 
.0030 
.013 
Dates 
.0030 
.013 
Eggs 
.0030 
.013 
Figs, dried 
.0030 
.013 
Meat, tenderloin 
.0030 
.013 
Olives 
.0030 
.013 
Prunes 
.0030 
.013 
Dandelion greens 
.0027 
.012 
Maple syrup 
.0027 
.012 
Pecans 
.0026 
.011 
Endive 
.0026 
.011 
Graham bread 
.0026 
.011 
Zante currants 
.0026 
0.11 
Whole wheat flour 
.0026 
.011 
Chard 
.0025 
.010 
Beef, medium fat 
.0025 
.010 
Flour, entire rye 
.0023 
.010 
Turnip tops 
.0023 
.010 
Raisins 
.0021 
.009 
Walnuts 
.0021 
.009 
Brown rice 
.0021 
.009 
Malt sugar— 
(Maltose dextrine) .. 
.0015 
.007 
THE LIME RATION 
Taken by itself, in its mineral form, lime possesses no food 
value, or at least only under exceptional circumstances, as when 
the body is deprived wholly of lime from other sources. Even 
then, mineral lime can be utilized only in very small quantities. It 
was, indeed, long a mooted question among physiologists whether 
or not inorganic lime ever could be utilized by the animal organ- 
ism. In recent years carefully conducted experiments by Mendel 
and Osborne, as well as other investigators, have shown that when 
an animal is fed with food from which lime has been excluded FOOD SALTS 
177 
the deficiency may be made up by feeding inorganic lime; but it is 
evident that this use of mineral lime is exceptional and the bio- 
logic law that vegetables feed upon mineral substances and ani- 
mals upon organic matters built up by vegetable organisms work- 
ing under the influence of the sun’s rays still holds good. 
Recent experimental studies on the feeding of animals have 
placed in a very clear light the importance of lime as a con- 
stituent of the food. The facts lately emphasized, while not alto- 
gether new, have caused the importance of giving constant and 
special attention to the lime content of foodstuffs to be more fully 
appreciated than ever before. 
The great importance of calcium (Ca) is suggested by the 
fact that this one element constitutes fully one-half of the total 
mineral content of the human body. The body of a man weighing 
154 pounds contains about 4.5 pounds of lime (CaO), or 3 per 
cent, of the body weight. 
Nearly all the lime of the body (99 per cent.) is found in the 
bones, the soft parts containing less than 1 per cent, of the total 
lime content of the tissues. Hence the deficiency of lime in meats. 
The Daily Loss of Lime, 
An adult of average weight loses two-thirds of a gram or 
about 10 grains of lime, daily, the waste lime being excreted 
chiefly through the intestine, but also to some extent through the 
kidneys. This loss of lime is constant, even during fasting. It is 
evident, then, that in order that the store of lime in the body 
should be kept intact, the daily food supply must contain not less 
than 10 grains of lime. In fact, to provide for emergencies and 
the failure of the absorbents to take up all the lime contained in 
the food it is found to be necessary to supply in the food about 50 
per cent, more than the actual requirements, or 15 grains of lime 
daily. Some authorities demand more than this. 
Unfortunately, the food commonly eaten by no means always 
contains this amount. Indeed, Dr. Sherman, of Columbia Uni- 
versity, calculates that at least half the people of the United 
States are suffering from lime starvation. Probably lime is more 
often deficient in the dietary of the average American than any 
other element with the exception of iron and cellulose. 
The fact that lime is found in every bodily tissue, bones, 
soft tissues, blood and other fluids, indicates its universal import- 
ance in the body. 178 
THE NEW DIETETICS 
1. To the bones it gives solidity. The bones of the adult 
are more than half lime. The amount of lime in the bones is so 
great that a burned bone retains its form even though the animal 
part has been wholly destroyed by fire. A deficiency of food lime 
causes in young children bowlegs and is no doubt one of the 
causes of decay of the teeth. 
2. The ability of the muscles to contract and to do work 
depends not alone upon their development and to the presence of 
fuel sugar in the blood and glycogen in the muscles, hut also upon 
just the right proportion of lime in the blood. When lime is 
deficient, the muscles lose their tone and become flabby and weak. 
3. The blood contains a very small proportion of lime, only 
about 0.8 grains to the pint (cow’s milk contains fifteen times as 
much), but this small amount is absolutely essential to maintain 
the normal beating of the heart through its influence upon the 
heart muscle. The mammal heart has been kept beating for hours 
after removal from the body by passing through it a solution of 
lime and other salts. 
4. Again, it is known that the presence of this minute 
amount of lime in the blood is essential to enable the blood to 
coagulate or clot to stop the flow of blood from a wounded vessel. 
A careful surgeon always examines the patient’s blood and deter- 
mines the coagulation time before undertaking a serious opera- 
tion. When coagulation is delayed, a transfusion of a pint or 
more of healthy blood may be given before the operation is per- 
formed. 
The relation of lime to the development of the bones is well 
shown by an experiment upon puppies. Those fed on lean meat 
and fat only had soft and flexible bones. Puppies to which bones 
were given gnawed at the bones and thus obtained the necessary 
lime and developed normally. 
Voit, an eminent physiologist who devoted his life to the 
study of food problems, fed pigeons for a year on foodstuffs 
which were greatly deficient in lime. There seemed to be no 
change in the birds, which appeared to be in perfect health, but 
after they were killed careful examination showed that, while 
the leg and wing bones contained the normal amount of lime, the 
bones of the head were almost wholly deprived of lime, being 
greatly thinned and at some points actually perforated. Evi- 
dently the body had sought to maintain the nbrmal blood content 
of lime by robbing those parts of the skeleton from which it could 
best be spared. FOOD SALTS 
179 
Sherman, of Columbia, repeated Voit’s experiment, employ- 
ing monkeys instead of pigeons. The results were the same. The 
leg and arm bones did not suffer much, but the skull bones lost 
their lime almost altogether, becoming so thin that they could be 
crushed between the thumb and fingers as easily as an eggshell. 
Some years ago the authorities in charge of the London zoo 
observed that the lion cubs were deformed, bowlegged, clubfooted, 
dwarfed and always died young. Treves, an eminent London 
surgeon, was consulted. He asked about the food. He was in- 
formed that they were given the very best of meats. He suggested 
the feeding of bones and bone meal. His advice being followed, 
the deformities soon disappeared and the cubs ceased to die pre- 
maturely. 
The cave dwellers, who in prehistoric times were compelled 
by the rigors of the ice age to subsist on a flesh diet, rounded 
out their diet by splitting bones and eating portions of them, 
especially the marrow. 
According to Cobez de Baca, one of the Spanish explorers 
of the Texas coast in the sixteenth century, the natives of that 
region carefully saved the bones of fishes and other small animals 
and ate them after reducing them to powder in stone mortars. 
The lack of lime in the food is no doubt one cause of the 
increasing prevalence of bone disease in civilized countries, and 
may be responsible for the early decay of the teeth which is 
becoming so nearly universal that the development of a tooth- 
less race is threatened. Evidently the teeth suffer loss of lime 
along with the other bony structures of the head. 
Hart and Steenback showed that milch cows require food 
containing a large amount of lime. If such food is not supplied 
their bones are robbed of lime. Nature takes care to see that 
milk, the sole food of the very young animal, contains an ade- 
quate amount of lime, even at the expense of the mother. 
This interesting observation explains the negative results of 
a very plausible theory advanced many years ago as the basis of a 
plan for securing painless childbirth. Expectant mothers were 
told to avoid milk, grains, and lime-containing vegetables, and to 
make their diet consist chiefly of fruits and nuts which are very 
poor in lime. The idea was that in so doing the bones of the 
infant would contain less lime and the infant head, the chief 
cause of suffering, would thus be less rigid and would easily mold 
itself to the outlet of the pelvis. Hundreds tried the food formula 180 
THE NEW DIETETICS 
for “painless” childbirth, but the results were most disappointing. 
Experiments upon animals showed that no matter how much the 
lime in the mother’s food was reduced, the bones of the off- 
spring always contained the normal amount. The mother’s bones 
were robbed to make good the deficiency of lime in the food". 
Here also is found, perhaps, an explanation of the remark- 
able tendency to decay of the teeth which often appears in the last 
months of pregnancy, a fact long known but not explained. Re- 
cent studies conducted by members of the faculty of the dental 
department of the University of Michigan show that the saliva 
becomes very deficient in lime during the last months of gestation. 
Infants and young children require two or three times as 
much lime in proportion to their weight as do adults, since they 
need lime for building up and solidifying the skeleton as well 
as for making good the daily waste. A young nursing infant 
gets daily in its mother’s milk more than three grains of lime, or 
one-fifth as much as the daily requirement for an adult weighing 
ten to fifteen times as much. 
The wonderful care which Nature takes to supply the young 
animal with an abundance of lime for building its skeleton is 
well illustrated in the interesting case of the egg. According to 
the Annals of the Pasteur Institute, before incubating the con- 
tents of an egg include one-half grain of lime. During incuba- 
tion, the amount steadily increases until when hatched the body 
of the chick contains three grains, or six times as much lime as 
at first. The growing chick has in some mysterious way, not yet 
determined, managed to steal from the shell the needed -lime for 
stiffening its slender leg bones so as to enable them to support its 
body as soon as it emerges from its calcareous cell. It thus ap- 
pears that the egg shell is not simply a container but also serves 
as a storehouse of lime to be drawn upon by the developing 
chick. 
Herbst has shown that between the age of six to fourteen 
boys require three or four times as much lime in proportion to 
their weight as do adults, since they must store up in their growing 
bones, 3 to 6 grains of lime daily, or about one-third of the adult 
maintenance lime ration. 
Food Lime is Necessary for Plants as Well as Animals. 
Professor True of the University of Pennsylvania, in a recent 
address in Toronto before a scientific body, called attention to FOOD SALTS 
181 
important biological experiments which demonstrate the high im- 
portance of calcium or lime in plant growth. It seems that this 
remarkable element acts as a regulator of the intricate processes 
of cell growth. Under its magic influence, the cell walls are able 
to take up from the plant juices the particular elements which 
they require. Without lime, the nutrition of the cell fails; its 
growth stops. Experiment has shown that this regulating in- 
fluence of calcium prevails throughout the entire plant, from its 
most minute rootlets to its unfolding buds. A soil which is de- 
ficient in lime, though abounding in all the other elements requisite 
for the maintenance of plant life, remains sterile, as though all 
plant foods were absent. Without calcium, the growing plant 
cannot absorb the various other elements which it needs. 
These facts account for the universal and abundant presence 
of calcium in the growing parts of plants; that is, in green leaves, 
buds, twigs and tender shoots. What is true of plants, is equally 
true of human beings. Calcium is a regulator of the nutritive 
processes. It is essential for heart action and muscle action and 
constitutes an essential element of the blood and tissue fluids, as 
well as of the brain, nerve, glands and other living structures. 
The Influence of Lime on Egg Production. 
Buckner and Martin (Journal Biologic Chemistry) have 
shown that when fowls are abundantly supplied with food con- 
taining lime the egg production may be increased as much as 
70 per cent. This experiment clearly shows the influence of diet 
upon nutrition. Children whose diet does not comprise a suf- 
ficient amount of food lime grow slowly because of the lack of 
lime for bone building and the bones are likely to be poorly devel- 
oped. On this account housewives should take great care to see 
that the family diet contains an abundance of greens, such as spin- 
ach, dandelion, dock, lamb’s quarter, chard and other green vege- 
tables. 
The Lime Content of Foods. 
The proportion of lime found in different foodstuffs varies 
greatly. This fact is of much importance in view of the recent 
observations of Osborne and Mendel as well as of other investi- 
gators who have undertaken exhaustive experiments in animal 
feeding, and have shown that rats do not grow, develop and re- 
produce normally unless supplied with a full quota of lime. 182 
THE NEW DIETETICS 
If the assertion of Professor Sherman that “half the Ameri- 
can people are suffering from lime starvation” is true, and there is 
no reason to doubt it, the study of foods with reference to their 
lime content is highly essential to our understanding of rational 
dietetics. This study has heretofore been greatly neglected. 
First of all it is interesting to note that in general roots and 
the green parts of plants (greens) are richest in lime. The 
legumes (beans, peas and lentils) and certain nuts (almonds, 
hazelnuts and walnuts) are also rich in lime. Of the grains, oat- 
meal is the only one which presents a fair proportion of lime. 
Wheat and corn are both very deficient in lime, and rice contains 
almost no lime at all. 
Of all natural food products, the richest in lime are the 
hazelnut, the almond, and linseed meal. The last named product, 
though not commonly used as a food, may be resorted to in 
emergency and is doubtless entirely wholesome. 
Milk is so rich in lime that a pint and a quarter contains 
sufficient of this necessary element for a full day’s supply. But 
an equal amount of lime would be furnished by half the weight 
of almonds, and eight or nine ounces of hazelnuts will supply the 
same quantity, or six ounces of linseed meal. 
The foods which contain the largest proportion of lime and 
in the order named are:—cheese, cottage cheese, hazelnuts, al- 
monds, molasses, beans, chard and other greens, egg yolk, wheat 
bran, skimmed milk, whole milk, olives. In milk the lime is closely 
associated with the casein which forms the curd. Milk contains 
more lime than is found in lime water. 
In cheese the lime is of course concentrated, the proportion 
being about six times as great as in milk. 
Since skimmed milk contains practically as much lime as 
does whole milk, it is a highly useful article of food. Not a drop 
should be wasted. By combining with other foodstuffs as in 
bread and other cereal preparations, with the addition of fat, it 
may be very advantageously made a regular part of the daily 
bill of fare. 
The feeding of skimmed milk to pigs is a foolish waste. Our 
growing boys and girls need every drop of milk which the country 
produces. 
We are losing our teeth and shrinking in stature because we 
need more lime and milk is one of our most important sources of 
food lime. FOOD SALTS 
183 
The amount of lime required by the average adult is three- 
fourths of a grain for each 100 calories of food or about 15 grains 
a day for a person taking a ration of 2,000 calories. This amounts 
to four-fifths of a pound per annum for each man, woman and 
child in the United States, aggregating a total lime requirement 
for the country of 40,000 tons per annum. 
That the nation fails to get its full lime ration is due in part 
to the wasting of milk in our dairy industry and in part to the 
fact that we unwisely deprive ourselves of an essential food 
element by feeding the bran of our wheat and other foodstuffs 
rich in lime to hogs and cattle instead of making use of them 
ourselves. As a natural result, our domestic animals are steadily 
improving in physical development while as a nation we are 
declining in vigor and showing distinct indications of physical 
degeneracy. 
It is interesting to note that our wide-awake agricultural 
department at Washington is advising the people to buy milk in- 
stead of meat, pointing out that its nutritive value is far greater. 
Even whey contains a notable amount of lime, more than a third 
as much as whole milk, but less than a twentieth as much as 
cheese. However, the amount is so large that it should be util- 
ized when possible. When fresh, or only slightly acid, whey is a 
wholesome food. 
Wheat bran contains as much lime as does milk, but of 
course it cannot be taken in so great quantities as milk, hence is 
less available as a source of lime. 
It is interesting to note that molasses contains a good pro- 
portion of lime, more than three times as much as is found in 
oatmeal, and nearly twice as much as in milk. In this respect 
molasses is superior to sugar, which contains no lime at all. In 
molasses, the lime found in the natural juices of the cane is con- 
centrated ; it is probable that the lime used in the manufacture 
of sugar may be the source of part of the lime in molasses. Maple 
syrup contains half as much lime as does molasses. 
A careful study of Tables XIII and XIV will develop a 
considerable fund of most useful information. The method of 
using Table XIII in balancing the bill of fare for lime is the same 
as that used in balancing for iron, as already explained. 184 
THE NEW DIETETICS 
Foods Deficient in Lime. 
It is very instructive to note the great number of common 
foods which in the form in which they appear upon our tables 
are almost wholly lacking in lime. The table shows, in fact, 
more than fifty common foods which are so poor in lime that one 
would need to eat not less than six pounds to obtain an adequate 
amount of lime for a single day. In some instances the lime 
content is so small that the amount of foodstuff necessary to 
furnish a day’s ration rises to ten, twenty, and even forty pounds. 
Among the foods most deficient in lime may be mentioned 
the following: cane sugar, which contains no lime; honey, which 
supplies in one pound of wax-free material, only one-fortieth of 
the lime needed for one day. Apples, bananas, beef and other 
meats, butter, also lard and oils of all sorts, most of the cereals 
and nearly all fruits are deficient in lime. 
An examination of the average bill of fare will show it to be 
woefully deficient in food lime as well as in iron, and, naturally, 
in other salts as well. To assist in remedying this deficiency, we 
have prepared the accompanying list of foods which are rich in 
food lime. Foods selected from this list, especially the first third 
of it, should be made a part of every day’s bill of fare, and in 
liberal quantities. The number of foods rich in lime is so great, 
it is easy to provide for abundant variety while insuring an 
abundance of food lime. Three tumblerfuls of milk (20 ounces), 
four ounces of cottage cheese, five of mustard or red root greens, 
or half a pound of hazelnuts or filberts will supply a full day’s 
lime ration. Half a pound of soy beans, lamb’s quarters or turnip 
greens will do the same. It is better, however, to secure the needed 
lime with a greater variety of foods, which may easily be chosen 
from Table XIV. FOOD SALTS 
185 
TABLE XIII 
The Lime Content of Foodstuffs 
The following table shows in column (1) the amount of 
lime (grains) contained in one ounce. Column (2) shows the 
percentage of one day’s ration in one ounce. Column (3) shows 
the amount of foodstuff required to supply 15.4 grains of lime 
(CaO), the amount needed for one day. Column (4) shows the 
percentage of one day’s requirement of lime found in 100 calories. 
Column (5) shows the weight of 100 calories. Column (6) shows 
the weight of an ordinary serving. Column (7) gives the number 
of calories in an ordinary serving. 
O 
.H § 
« 8 
G 
*0 be 2 
o c 3 
& a g 
G 
O . 
v, U P 
O cj 
o 
be 
C 
o .5 
> 
be 
G 
> 
S-. 
U 
2, ® u 
Cti 0 
n i) 
o'*-1 « 
G w 
° ft 
=?.££ 
° H S 
sis 
o 
OQ 
& o ~ 
;G 
fi 2. cs 
•So 
o •? O 
be _ w 
% “O 
u " 
bfl G 
t; c 
03 c3 
u >ȣ 
Ws 
III 
g § 
d o 
(1) 
(2) 
(3) 
(4) 
(5) 
(6) 
(7) 
Almonds 
.1.463 
9.5 
10.5 
5.2 
0.5 
0.5 
92 
Apples, A. P 
. .043 
0.3 
358.0 
1.6 
5.6 
5.0 
67 
Apples, dried 
.. .196 
1.3 
78.5 
1.6 
1.0 
1.2 
100 
Apple juice 
.. .049 
0.5 
314.3 
1.6 
6.0 
6.0 
100 
Apricots, A. P 
. .086 
0.6 
180.0 
3.3 
6.1 
3.0 
46 
Apricots, dried 
.. .404 
2.6 
38.0 
13.2 
1.1 
2.0 
157 
Asparagus 
.. .153 
1.0 
100.6 
17.1 
16.1 
3.0 
19 
Bananas 
.. .055 
0.4 
280.0 
1.2 
3.5 
3.5 
100 
Barley, entire 
.. .263 
1.7 
58.5 
3.0 
1.1 
1.0 
90 
Barley, pearled 
.. .122 
0.8 
126.2 
1.1 
1.0 
1.0 
100 
Beans, dried 
. .980 
6.4 
15.7 
6.5 
1.0 
1.0 
97 
Beans, lima, dried 
. .435 
2.8 
35.4 
2.8 
1.0 
1.0 
99 
Beans, lima, fresh 
.. .171 
1.1 
90.0 
1.1 
6.4 
4.0 
92 
Beans, soy 
.2.000 
13,0 
7.7 
11.2 
0.9 
0.9 
112 
Beans, string, fresh 
.. .282 
1.8 
54.6 
15.4 
8.4 
4.0 
44 
Beef, tenderloin 
. .057 
0.4 
270.0 
0.5 
1.3 
2.5 
200 
Beets 
. .178 
1.2 
86.5 
8.9 
9.1 
2.2 
29 
Blackberries 
. .104 
0.7 
150.0 
4.2 
8.0 
3.0 
50 
Blueberries 
. .122 
0.8 
126.2 
3.8 
4.8 
2.5 
52 
Bran, sterilized 
.. .735 
4.8 
21.0 
5.7 
1.9 
0.5 
35 
Bran, wheat 
.. .735 
4.8 
21.0 
5.7 
1.4 
0.5 
35 
Bread, Boston brown 
. .790 
5.1 
19.5 
7.9 
1.2 
1.2 
100 
Bread, entire wheat 
. .133 
0.9 
116.0 
2.8 
1.4 
2.0 
139 
Bread, graham 
.. .176 
1.2 
90.0 
2.8 
1.3 
2.0 
158 
Bread, rye 
. .147 
1.0 
105.0 
1.3 
1.4 
2.0 
144 
Bread, entire rye (pumper- 
nickel) 
.. .259 
1.7 
60.0 
2.8 
1.7 
2.0 
111 
Bread, white 
. .091 
0.6 
170.0 
1.5 
1.3 
2.0 
159 
Bread, fruit 
. .514 
3.3 
30.0 
Brose (oatmeal and bran) 
. .485 
3.1 
32.0 
3.0 
1.0 
1.0 
100 
Brussels sprouts 
. .165 
1.1 
93.3 
12.1 
11.3 
4.0 
24 
Buckwheat flour 
. .239 
1.6 
64.4 
1.5 
1.0 
1.0 
100 
(The letters A. P. stand for “as purchased.”) 186 
THE NEW DIETETICS 
be 
be 
. t) 
8.0 
u p 
«+-i 
O N 
<D ° 
•O G O 
0*5 '£ 
°.5 
CC u 
ts « 
O 
o_, ’jn w 
o n.a 
<L> u £ 
be <u *2 
O 
o 
0 .£ 
O *+“l W 
.5 
L 
c, o 
« E 
Sa p 
O S- r* 
O c 
A 
« c cd 
o 
•M O U 
V) 
T * 
0.5 
o y1 O 
tbC,-s Vi 
o."o 
.be u 
a 
£ 2 S 
S.S 
t> O c? 
!> 
£•£.£ 
£2 
rt *2 
U 0 
Blitter 
092 
0.6 
167.4 
0.3 
0.5 
0.5 
109 
Buttermilk 
643 
4.2 
24.0 
41.1 
10.0 
6.0 
60 
Buttermilk, yogurt 
..... .747 
4.8 
20.6 
46.3 
9.6 
6.5 
75 
Cabbage 
276 
1.8 
56.0 
20.0 
11.1 
4.0 
36 
Cabbage greens 
..... .649 
4.2 
23.7 
47.3 
5.4 
4.0 
25 
Canteloupe 
104 
0.7 
150.0 
6.1 
9.0 
7.0 
78 
Carrots 
343 
2.2 
44.9 
17.3 
7.8 
3.7 
51 
Cauliflower 
753 
4.9 
20.4 
56.4 
11.6 
3.0 
25 
Celery 
478 
3.1 
32.2 
58.9 
19.1 
1.0 
5 
Chard 
...... .919 
6.0 
16.7 
55.0 
9.2 
3.0 
35 
Cheese 
5.702 
37.0 
2.7 
29.7 
0.8 
0.5 
62 
Cheese, cottage 
4.180 
27.1 
3.7 
85.2 
3.2 
2.0 
62 
Cheese, yogurt 
4.285 
27.8 
3.6 
26.0 
0.9 
0.5 
50 
Cherries, A. P. 
116 
0.8 
133.0 
3.5 
4.7 
2.2 
55 
Cherry juice 
104 
0.7 
150.0 
3.1 
18.1 
4.5 
94 
Chestnuts 
208 
1.3 
75.0 
1.9 
1.4 
1.5 
114 
Chicken, broiler 
066 
0.4 
235.0 
1.4 
3.3 
2.5 
75 
Coconut, dry 
361 
2.3 
42.6 
2.2 
0.6 
Coconut, fresh 
147 
1.0 
105.0 
0.9 
0.9 
1.0 
167 
Corn, whole 
122 
0.8 
126.2 
0.8 
1.0 
1.0 
109 
Cornmeal 
110 
0.7 
140.0 
0.7 
1.0 
1.0 
100 
Corn, sweet, fresh 
037 
0.2 
416.0 
0.8 
3.5 
3.0 
86 
Corn, sweet, dry 
129 
0.8 
114.4 
0.8 
1.0 
1.0 
109 
Cow peas 
612 
4.0 
25.1 
4.1 
1.0 
Cotton seed meal... 
1.623 
10.5 
9.5 
9.2 
1.0 
Crackers, soda 
..... .135 
0.9 
114.0 
0.8 
0.9 
1.0 
110 
Cranberries 
110 
0.7 
140.0 
5.4 
7.5 
3.0 
40 
Cream 
527 
3.4 
29.2 
7.2 
1.8 
2.5 
137 
Cucumbers 
098 
0.6 
157.0 
12.6 
20.0 
2.0 
10 
Currants, fresh 
159 
1.0 
96.8 
6.3 
6.1 
3.0 
48 
Currants, dry, Zante 
502 
3.3 
30.7 
3.6 
1.0 
1.5 
135 
Dandelion greens 
643 
4.2 
24.0 
24.1 
5.8 
3.0 
50 
Dates, dried, A. P 
..... .398 
2.6 
38.6 
2.6 
1.0 
2.0 
177 
Dock, narrow leaved 
. ...1.000 
6.7 
15.0 
Eggplant 
067 
0.4 
230.0 
5.7 
12.5 
1.5 
12 
Eggs 
450 
2.9 
34.2 
6.3 
2.4 
1.8 
70 
Egg, one (1.8 oz.) 
810 
5.2 
19.0 
1.8 
70 
Egg white 
092 
0.6 
167.4 
2.8 
4.7 
1.0 
14 
Egg white, one (1.2 oz.) 
116 
0.7 
140.0 
1.2 
17 
Egg yolk 
839 
5.4 
18.3 
5.0 
0.9 
1.9 
109 
Egg yolk, one (.6 oz.) 
503 
3.3 
30.6 
0.6 
60 
Endive 
637 
4.1 
24.0 
45.5 
20.9 
3.0 
14 
Farina 
129 
0.8 
119.4 
0.8 
1.0 
1.0 
102 
Figs, dried 
992 
6.4 
15.6 
21.6 
1.1 
2.0 
168 
Figs, fresh 
325 
2.1 
47.4 
7.2 
4.3 
2.0 
43 
Fish, (haddock) 
134 
8.7 
114.6 
2.6 
3.0 
6.0 
122 
Flour, buckwheat 
061 
0.5 
252.5 
1.5 
1.0 
Flour, entire wheat 
190 
1.2 
81.0 
1.2 
1.0 
Flour, graham 
239 
1.6 
64.4 
1.5 
1.0 
Flour, rye 
110 
0.7 
140.0 
0.7 
1.0 
Flour, rye, entire 
293 
1.9 
52.5 
2.5 
1.3 
Flour, white 
Gluten, pure 
122 
0.8 
136.2 
0.8 
1.0 
1.025 
6.6 
15.0 
6.6 
1.0 
0.5 
62 FOOD SALTS 
187 
. 
G N 
.5 o 
O N 
V ® 
bo e 
13 fl O 
O-p 
0.5 aj 
G 
O 
w 
o ctj .a 
U o 
•-M 
o 
N 
•s 1 
0 S 
bo 
.S 
*> 
G g 
*-M (D 
O p, 
B E | 
as jr 
O C c 
o c 
J3 
rt g CTj 
s — “ 
° 
rs b 
CO >> 
<D *3 
•So 
o JP o 
co 
o^° 
.bo ° 
.bp**- G 
o.S 
oS 
" rt rt 
Ph »-< 
> O c? 
£l‘.s 
£2 
£ 2 fe 
rt TJ 
U 0 
Gluten, 40 per cent 
.. .400 
2.6 
38.0 
2.6 
1.0 
1.0 
100 
Gluten, 20 per cent 
.. .200 
1.3 
76.0 
1.3 
1.0 
1.0 
100 
Gooseberries 
.. .214 
1.4 
72.0 
2.5 
40 
Grapefruit 
.. .129 
0.8 
119.4 
5.6 
6.7 
3.5 
50 
Grapes, A. P 
.. .115 
0.7 
133.0 
2.7 
3.6 
3.5 
72 
Grape juice 
.. .067 
0.4 
230.0 
1.5 
4.0 
4.0 
95 
Guava 
.. .086 
0.6 
180.0 
Hazelnuts 
..1.758 
11.4 
8.8 
5.7 
1.0 
0.5 
47 
Hominy 
.. .067 
0.4 
230.0 
0.2 
1.0 
1.5 
150 
Honey 
.. .024 
0.2 
268.6 
0.2 
1.0 
1.6 
139 
Kohl-rabi 
.. .472 
0.3 
32.6 
34.9 
11.5 
4.0 
35 
Lambs quarters 
-1.900 
12.5 
8.0 
Lemon juice 
.. .147 
1.0 
105.0 
8.4 
9.0 
0.5 
5 
Lentils, dry 
.. .655 
4.3 
23.5 
4.3 
1.1 
1.0 
99 
Lettuce 
.. .263 
1.7 
58.5 
31.4 
18.1 
1.0 
6 
Linseed meal 
..2.530 
16.4 
6.1 
Malt sugar (meltose) 
.. .262 
1.7 
60.0 
1.7 
1.0 
2.0 
200 
Maple syrup 
.. .655 
4.3 
23.5 
5.3 
1.3 
1.3 
108 
Malted nuts 
.. .433 
2.3 
35.5 
1.9 
0.7 
1.3 
200 
Macaroni 
.. .135 
0.9 
114.0 
0.8 
1.0 
1.0 
102 
Mango 
.. .129 
0.8 
Meltose 
.. .122 
0.8 
126.2 
1.5 
1.2 
2.4 
200 
Milk, camel 
.. .876 
5.7 
17.5 
Milk, condensed, sweetened- 
-1.837 
11.9 
8.4 
13.5 
1.1 
2.0 
185 
Milk, goat 
.. .784 
5.1 
20.0 
Milk, human 
.. .208 
1.4 
70.0 
7.0 
4.8 
Milk, sheep 
-1.266 
8.2 
12.2 
Milk, skimmed 
.. .747 
4.8 
20.6 
46.3 
9.6 
6.5 
60 
Milk, whole 
.. .735 
4.8 
21.0 
24.3 
5.1 
6.0 
115 
Millet 
.. .086 
0.5 
180.0 
Molasses 
-1.292 
8.4 
12.0 
10.2 
1.2 
1.2 
98 
Mushrooms 
.. .104 
0.7 
150.0 
Muskmelon 
.. .104 
0.7 
150.0 
6.0 
8.9 
70.0 
78 
Mustard greens 
-3.013 
19.6 
5.1 
3.0 
Nuttolene 
.. .263 
1.7 
58.5 
3.4 
2.0 
2.0 
100 
Oatmeal 
.. .423 
2.7 
36.4 
2.4 
0.9 
1.0 
113 
Okra 
.. .435 
2.8 
35.4 
2.4 
9.3 
4.5 
50 
Olives, ripe, A. P 
.. .747 
4.9 
20.6 
5.7 
1.2 
2.0 
118 
Onions 
.. .208 
1.3 
75.0 
9.7 
7.2 
2.5 
42 
Oranges 
.. .276 
1.8 
55.7 
12.3 
6.8 
5.0 
73 
Orange juice 
.. .178 
1.2 
86.5 
9.3 
6.6 
6.0 
91 
Paprika 
1.401 
9.1 
11.0 
Parsnips 
.. .361 
2.3 
42.7 
12.8 
5.4 
3.0 
55 
Peaches, A. P 
.. .098 
0.6 
157.1 
5.3 
8.4 
4.0 
38 
Peaches, dried 
.. .208 
1.4 
75.0 
11.1 
4.0 
2.0 
160 
Pears, A. P 
.. .092 
0.6 
167.4 
3.3 
5.5 
4.0 
64 
Pear juice 
.. .055 
0.4 
280.0 
1.4 
3.9 
6.0 
150 
Peas, dry 
.. .514 
3.3 
30.0 
3.6 
1.0 
1.0 
100 
Peas, green 
.. .171 
1.1 
90.0 
4.0 
4.4 
3.5 
70 
Peanuts 
.. .435 
2.8 
35.4 
1.8 
0.6 
0.5 
78 
Pecan nuts 
.. .545 
3.5 
28.2 
1.7 
0.5 
0.5 
104 
Persimmons 
.. .135 
0.9 
114.0 
Pineapple 
.. .110 
0.7 
140.0 
5.8 
8.1 
4.0 
50 188 
THE NEW DIETETICS 
V . 
.5 o 
C! u 
*4-4 
O N 
bo £ 
T) d o 
o*£ -£ 
£ 
o 
’s'S.s 
*4-4 
o 
«M S 
o .5 
u £ 
| 
> 
<U ° 
tJD <D t- 
<u u o 
bo <i> £ 
N W 
o.S* 
N O D 
O W 
<u 
£ «ti 
o a 
® § E 
05 C C3 
+.» ° 
4-| O U 
cn 
£ 
.So 
S.« o 
bes co 
*<u N >% 
h 
.bo o 
c 
u d 
o .£ 
oB 
u rt « 
FL| T3 U 
£2-3 
V rt - 
Ph-U.S 
£2 
Plums, A. P 
122 
0.8 
126.2 
3.3 
4.1 
4.0 
91 
Potatoes 
086 
0.5 
180.0 
2.3 
4.2 
3.0 
71 
Potatoes, sweet 
116 
0.7 
133.0 
2.3 
2.8 
3.0 
105 
Protose 
416 
2.7 
37.0 
5.4 
2.0 
2.0 
100 
Prunes, dried A. P 
331 
2.2 
46.5 
2.5 
1.1 
2.0 
145 
Pumpkin 
141 
0.9 
109.2 
12.5 
13.6 
3.5 
25 
Purslane 
880 
5.8 
17.2 
Quinoa 
900 
4.7 
Radishes 
129 
0.8 
119.4 
10.2 
11.9 
1.0 
8 
Raisins, seedless 
392 
2.5 
39.3 
2.6 
1.0 
1.0 
98 
Raspberries 
300 
2.0 
52.3 
10.4 
5.3 
4.0 
75 
Raspberry juice 
129 
0.8 
119.4 
3.0 
3.4 
5.0 
150 
Red root 
3.240 
21.6 
4.6 
Rice, polished 
055 
0.3 
280.0 
0.3 
1.0 
1.5 
160 
Rice, brown 
073 
0.5 
211.0 
0.4 
1.0 
109 
Romaine 
276 
1.8 
57.0 
Rutabagas 
453 
2.9 
24.0 
25.9 
8.8 
4.0 
46 
Rye, entire 
337 
2.2 
45.7 
3.0 
1.0 
Savita 
1.207 
Spinach 
410 
2.7 
37.0 
39.3 
15.0 
3.0 
20 
Spinach, mountain 
.......1.270 
8.5 
11.8 
Spinach, New Zealand 
480 
3.2 
31.0 
Squash 
....... .116 
0.7 
133.0 
5.5 
7.6 
3.7 
46 
Strawberries 
251 
1.6 
61.3 
14.6 
9.4 
4.0 
44 
Tapioca 
141 
0.9 
109.2 
0.6 
1.0 
1.0 
100 
Tomatoes 
067 
0.4 
230.0 
7.0 
15.3 
4.0 
25 
Tomato juice 
037 
0.2 
416.0 
Turnips 
392 
2.5 
39.3 
22.6 
9.0 
4.5 
50 
Turnip tops 
2.125' 
13.8 
7.2 
3.0 
Walnuts 
545 
3.5 
28.3 
1.8 
0.5 
0.5 
94 
Watercress 
1.153 
7.5 
13.4 
135.0 
18.0 
1.5 
10 
Watermelon 
067 
0.4 
230.0 
5.3 
11.6 
8.0 
69 
Wheat, bran 
735 
4.8 
21.0 
5.7 
1.2 
0.5 
35 
Wheat, entire 
276 
1.8 
56.0 
1.8 
1.0 
1.5 
150 
Wheat, germ 
435 
2.8 
35.4 
2.8 
1.0 
1.0 
100 
Whey 
269 
1.9 
57.2 
23.8 
13.0 
7.0 
50 FOOD SALTS 
189 
TABLE XIV 
Foods Rich in Lime. 
Cheese 
Yogurt cheese 
Cottage cheese 
Red root 
Mustard greens 
Linseed meal 
Turnip tops 
Soy beans 
Lamb’s quarters 
Condensed milk 
Grains 
Per of lime 
Cent, per oz. 
1.30 5.70 
0.98 4.28 
0.30 4.18 
0.24 3.24 
0.69 3.01| 
0.58 2.53 
0.49 2.13 
0.46 2.00 
0.43 1.90 
....... 0.42 1.84 
Hazelnuts 
0.40 
1.76 
Cottonseed meal 
0.37 
1.62 
Almonds 
0.34 
1.46 
Molasses 
0.30 
1.30 
Milk, sheep’s 
0.29 
1.27 
Mountain spinach ..... 
0.29 
1.27 
Savora 
0.28 
1.21 
Watercress „ 
0.26 
1.15 
Pure gluten 
0.23 
1.03 
Dock greens 
0.23 
1.03 
Figs, dry 
0.22 
0.99 
Beans 
0.22 
0.98 
Chard 
0.21 
0.92 
Per 
Grains 
of lime 
Cent. 
per oz. 
Savita 
.. 1.38 
6.04 
Milk, camel’s 
.. 0.20 
0.88 
Purslane < 
20 
0.88 
Egg yolk 
.. .19 
0.84 
Boston brown bread .... 
.. 0.00 
0.79 
Milk, goat’s 
.. 0.00 
0.78 
Sour milk 
.. 0.17 
0.75 
Cauliflower 
.. 0.17 
0.75 
Milk, skimmed ..._ 
.. 0.17 
0.75 
Olives 
... 0.17 
0.75 
Bran, wheat 
.. 0.17 
0.74 
Milk, whole 
.. 0.17 
0.74 
Egg, one 
... 0.16 
0.71 
Lentils, dry 
... 0.15 
0.66 
Maple syrup 
... 0.15 
0.66 
Cabbage greens 
... 0.15 
0.65 
Buttermilk 
... 0.15 
0.64 
Dandelion greens 
... 0.15 
0.64 
Endive 
... 0.15 
0.64 
Cow peas 
... 0.11 
0.61 
New Zealand spinach... 
... 0.11 
0.48 
Wheat germ 
... 0.10 
0.44 
Spinach 
... 0.09 
0.41 
TABLE XV 
Foods Rich in Both Lime and Iron. 
The following foods rich in both lime and iron should be 
made conspicuous features of the daily bills of fare; by their 
liberal use, any serious deficiency in food lime or iron may be 
very certainly avoided: 
Almonds 
Boston brown bread 
Bran 
Chard 
Dandelion greens 
Dock greens 
Egg yolk 
Endive 
Figs, dry 
Gluten, pure 
Hazelnuts 
Lentils 
Maple syrup 
Molasses 
Mustard greens 
Olives 
Red root 
Savita 
Spinach 
Turnip tops 190 
THE NEW DIETETICS 
Foods Poor in 
Iron Foods Poor in Lime 
Foods Poor in Both 
Lime and Iron 
Bread, white 
Beef 
Bread, white 
Candy 
Bread, white 
Candy 
Carrots 
Candy- 
Corn flakes 
Cheese 
Chicken 
Corn meal 
Corn flakes 
Corn flakes * 
Corn syrup 
Corn meal 
Corn meal 
Crackers, white 
Corn syrup 
Crackers, white 
Fats and oils 
Corn starch 
Fats and oils 
Fish . 
Crackers, white 
Fish 
Hominy 
Cream 
Fruit 
Oysters 
Egg white 
Hominy 
Rice 
Fats and oils 
Macaroni 
Rice flakes 
Fish 
Hominy 
Macaroni 
Milk 
Oysters 
Potatoes 
Rice 
Rice flakes 
Sugar 
Tomatoes 
Turnips 
Mutton 
Oysters 
Rice 
Rice flakes 
Sugar, white 
Sugar 
Acids and Bases of Foods—The Acid Alkaline Balance 
As pointed out by Bunge many years ago, and as further 
shown by an extensive research conducted by Sherman, of 
Columbia University, foodstuffs differ in relation to their acid 
and basic contents. In certain foods, bases or alkalies predomi- 
nate, while in others the mineral acids predominate. 
The waste products of the body are predominantly acid; con- 
sequently it is desirable that the foodstuffs should be predomi- 
nantly basic. If acids predominate in the ration, and this con- 
dition continues for a considerable period of time, the effect will 
be to disturb the nice balance between acids and bases which is 
normally maintained in the body fluids and which is essential 
for life. An excess of acids constitutes a condition known as 
acidosis. Great care must be taken to protect the body from the 
injuries which result from this condition. It is important that the 
food should be so selected that there will always be a decided 
predominance of such foods as will tend to alkalize the body fluids. 
All lean meats are acid. Besides other acids, they contain a 
considerable amount of uric acid. Classified according to the 
predominance of acids or bases, the several sorts of foods may be 
grouped as follows: 
Meats of all sorts, especially the lean meats, tend to lessen FOOD SALTS 
191 
the alkalinity of the tissue fluids to a marked degree. Eggs tend 
in the same direction, though less strongly than do meats. Meat 
extracts, broths, bouillon, meat stocks and gravies, all belong in 
the group of acidifying foods. 
Cereals of all sorts, including breads of every description, 
contain a preponderance of acids, though much less than that of 
meats. 
A few fruits, particularly cranberries, plums and prunes, 
must also be placed in this class because of the presence of benzoic 
acid, which is not oxidized in the body. 
All other fruits, green vegetables and root vegetables of all 
sorts, are strongly basic and tend to alkalinize the tissue fluids. 
Milk is slightly alkaline. 
The following table shows in a condensed form the principal 
facts which have been ascertained by modern chemical researches 
respecting the acid and basic properties of foodstuffs, acid foods 
being those which tend to acidify the tissue fluids and basic or 
alkaline foods those which tend to alkalinize the fluids: 
TABLE XVI 
Acid 
Basic (alkaline) 
Lean beef 
10.0 
Eggs 
9.0 
Round steak 
67 
Oatmeal 
3.2 
Wheat 
2.6 
Wheat flour 
27 
Rice 
2.4 
Bacon 
1.0' 
Celery 
40 
Cabbage 
10—13.6 
Potatoes 
9—12 
Turnips 
6.6—12.5 
Apples 
5 
Milk 
3.3 
Beans 
2.9—6.8 
Peas 
1.9 
•The figures indicate the equivalent number of cubic centimeters of normal 
acid or alkaline solution per 100 calories. Vitamins 
These subtle elements, which have been in recent years 
proven to be absolutely essential to life and health, are present 
in food in such small quantities that notwithstanding the prodig- 
ious amount of work which has been bestowed upon them their 
chemical composition is not yet known. The proof of the exist- 
ence of this class of food principles and their importance to 
human life rests upon numerous observations which have shown 
that in their absence various disorders known as deficiency dis- 
eases make their appearance. 
Vitamin B appears to be an essential constituent of nerve 
tjssue. Funk found vitamin B in ox brain and other investigators 
have found it in the spinal cord. 
When vitamin B is not present in the food in sufficient 
amount, the vitamin constituent of the nerves is gradually lost 
and degeneration of the nerve tissue with paralysis follows as 
the result. Several weeks and even months may be required for 
the consumption of the store of vitamins in the nerve tissues of 
the body, but a study of animals subjected to a dietary deficient 
in vitamins has shown that degenerative changes in the nervous 
system begin early, as may be demonstrated by miscroscopic 
examination. 
Vitamins are necessary to promote growth. In their absence 
young animals do not develop, reproduction does not take place, 
mothers are not able to nurse their young, appetite and nutrition 
and various diseases develop, among the best known of which are 
scurvy, beri-beri, rickets, perhaps pellagra, and certain diseases of 
the eye. 
Even malignant growths are influenced by the lack fof 
vitamins. Short asserts that cancer of rats has been shown to 
grow only one-fourth as rapidly when vitamins are absent. 
Ehrlich in experiments upon rats demonstrated that by means 
of an exclusive 'diet of rice cancer could be made to cease growth 
and sometimes nearly to disappear. He remarked to the writer, 
who visited his laboratory when the experiments were in progress, 
that it was “necessary to starve the rats nearly to death.” Evi- 
dently they were suffering from lack of vitamins. 
192 VITAMINS 
193 
Vitamins are produced only by vegetables. In order to insure 
a full supply of all the different vitamins it is important that the 
dietary should be varied. Infants and invalids are the most likely 
to suffer from lack of vitamins because they are often fed for 
long periods upon food in which there is very little variety. 
Three distinct vitamins are well recognized and have been 
carefully studied. They are designated by the first letters of the 
alphabet, A, B, and C. Two other vitamins have been announced, 
but these are probably of much less importance than vitamins A, 
B, and C. 
Doctor Robert McCarrison, an eminent English physician who 
has made an extensive study of deficiency diseases, has thus sum- 
marized our present knowledge of vitamins:— 
“(1) Vitamins are constant constituents of living tissues. 
•Although present in very small amounts, maintenance of health 
is dependent on their action. 
“(2) Vitamins do not themselves contribute to the energy 
supply of the body, but facilitate utilization by it of proteins, fats, 
carbohydrates and salts of food. 
“(3) Proteins, fats, carbohydrates and salts cannot support 
life without vitamins, nor vitamins without these proximate prin- 
ciples ; they are complementary to each other. Without vitamins, 
the body starves. 
“(4) A distinct relationship exists between the amount of 
vitamin required and the balance of food in protein, fat, carbohy- 
drate and salt, the efficacy of the vitamin depending on the compo- 
sition of the food mixture. 
“(5) A distinct relation exists between the amount of vita- 
min required and the rate of metabolic process. 
“(6) Each vitamin plays a specific part in nutrition. 
“(7) It appears that vitamin A is associated with the metab- 
olism of liquids and calcium, as well as with chemical reactions 
requisite for growth and maintenance. 
“(8) Vitamin B appears to be associated with the metabolism 
of carbohydrates and with the chemical reactions and functional 
perfection of all cells, particularly nerve cells. 
“(9) Vitamin C appears to be associated with the metabo- 
lism of calcium and with the chemical reactions of growing tissues. 
“(10) All vitamins are concerned in the maintenance of or- 
derly balance between destructive and constructive cellular pro- 
cesses. 194 
THE NEW DIETETICS 
“(11) One vitamin cannot replace another, although its func- 
tion may be interfered with by the absence of another. 
“(12) The final result of their efficiency is the same, what- 
ever be the degree of deprivation. The greater the deprivation 
the more rapid is the onset of symptoms due to it; the lesser the 
deprivation the slower is the onset of the symptoms due to it. 
“(13) Each vitamin exercises a specific influence on the ad- 
renal glands; the effect of their deprivation on these organs is 
one of the most outstanding features of deficiency diseases. 
“(14) Vitamins influence markedly the production of hor- 
mones and all external secretions. 
“(15) There is reason to believe that the capacity of any 
given cell for work is impaired in proportion to the degree of 
vitamin starvation. 
“(16) Vitamins aid the tissues in resisting infection. 
“(17) Vitamins, especially vitamin B, induce in the human 
and animal body a desire for food. 
“(18) Vitamins are one link in the chain of essential sub- 
stances requisite for harmonious regulation of chemical processes 
of healthy cellular action. If the link be broken, harmony ceases 
or becomes discord as it may cease or become discord if any other 
link be broken. 
“(19) The place of vitamins in human economy must be 
considered in connection with metabolism as a whole, in connec- 
tion with their relation to other essential food requisites, with their 
relation to organs of digestion and assimilation, and with their 
relation to endocrine regulators of metabolic processes. 
“Vitamins are the spark which ignites the fuel mixture of a 
petrol-driven engine, liberating its energy; a spark is of no use 
without fuel, nor fuel without spark—nay, more, the efficacy of 
the spark is dependent in a great measure on the composition of 
the fuel mixture. 
“What happens (when the body goes sick in consequence of 
deficient foods, usually ill-balanced) is this—in the absence of 
vitamins or in an inadequate supply, protein, fat, carbohydrate 
and salts are not properly utilized; some are largely wasted, others 
yield products harmful to the organism. In these circumstances, 
life may be sustained for a longer or shorter period, during which 
the body utilizes its reserve stores of vitamins and sacrifices its 
less important tissues to this end. But there is a limit beyond 
which such stores cannot be drawn upon, and once reached, the A Bird Nearly Dead from Lack of Vitamins 
The Same Bird a Few Hours after the Injection 
of the Needed Vitamins (Funk) Experiments Showing Deficiency of Lime and Vitamins 
(Nutrition Laboratory of the Battle Creek Sanitarium). 
A 
B 
Rats of the same age (12 weeks). The smaller (A) was fed bread and apple, 
all it would eat, (B) was given bread and milk and weighed five times as much 
as A. {Sherman). VITAMINS 
195 
cells of higher function—secretory, endocrine and nerve cells— 
begin to lack vigor and depreciate in functional capacity, although 
the tissues may still hold considerable stores of vitamin. The 
disintegration process is delayed or hastened, lessened in severity 
in one direction or increased in another, according as the food 
constituents are well or ill balanced and according to the char- 
acter of lack of balance. 
What Lack of Vitamin Does. 
“The lack of vitamin disturbs the calcium metabolism; puts 
an end to regenerative processes; involves with respect to the 
cells of higher function, the functional depression of many, death 
and failure of a few. The cardinal effect is depreciation of cell- 
ular function, and this depreciation is the foundation upon which 
disease is built. Extreme deprivation means rapid dissolution and 
death; partial deprivation means slow dissolution and disease. 
“This conception of the function of vitamins holds out wide 
promise in the cure of disease, due to or favored by their defi- 
ciency in food; for though they cannot restore to life cells 
already dead, they can restore to normal depressed functional 
capacity the general mass of the body’s cells. The conception 
that vitamins provide the cells of the body with the power—one 
might almost say will—to work, has this great merit, that it 
furnishes a working hypothesis on which to frame treatment.” 
The Antiscorbutic Vitamin—Water Soluble C. 
The absence or deficiency of vitamin C is now known to be 
the cause of scurvy, a disease which has been recognized from 
ancient times, but the cause of which was unknown until the dis- 
covery of vitamins by modern scientific research. Experience has 
shown the necessity for fresh, uncooked foods to prevent outbreaks 
of scurvy among sailors and soldiers and other large bodies of men 
fed on rations, as well as bottle-fed infants, but the existence of 
a subtle antiscorbutic substance was not known. 
The antiscorbutic vitamin is found in the juices of fresh fruit 
and vegetables, and particularly in the orange, the lemon and the 
grapefruit. Recent observations have shown that the antiscorbutic 
vitamin is also found in abundance in the tomato, the potato and 
the turnip, and to some extent in the tamarind. It is probable that 
all green vegetables are more or less antiscorbutic. 
The antiscorbutic vitamin is readily destroyed by boiling and 196 
THE NEW DIETETICS 
also by drying. It is absent in salted meats. The process of 
sterilizing milk destroys the antiscorbutic vitamin and pasteuriz- 
ing injures it. On this account raw or uncooked vegetables or 
fruits should make a part of each day’s bill of fare. 
The orange and the tomato are the richest sources of vitamin 
C. Hoobler states that one and one-half cubic centimeters (one- 
third teaspoonful) of orange juice contains as much vitamin C 
as a pint of milk. Orange juice should be given to all infants 
after six months and to bottle-fed infants after two months. 
It has been found that orange juice may be dried at a low 
temperature without losing its antiscorbutic properties, especially 
if air is excluded. This will probably be found to be true of other 
fruits or fruit juices and green vegetables. 
Recent experiments on guinea pigs reported by Zilva and 
Wells indicate that one of the first effects of scurvy, an effect 
which seems to have been long overlooked because not easily 
recognizable, is to be found in the teeth. There was found, even 
in very slight cases, complete fibrosis of the pulp. It is probable 
that decay of the teeth is really due in many cases to scurvy, the 
presence of which was overlooked. 
Dr. Howe, of the Forsythe Dental Clinic of Boston, main- 
tains that deficiency of vitamins is the probable cause of pyorrhea 
as well as of other dental disorders. Hess has shown that gen- 
eral feebleness and a puny or weazened condition in infants are 
the early effects of scurvy, which later shows itself in a fully 
developed form in what is known as Barlow’s disease, in which 
there is a swollen condition of the joints and tenderness of the 
joints and skin. 
The Chinese have long made use of sprouted seeds in the 
form of salad and combined with vegetables in various ways.. 
Sprouted soy beans is one of the constituents of the famous chop 
suey. Recently Chick and Delf, of London, have made a study of 
the comparative value of dry and sprouted peas and lentils in 
preventing scurvy. They found that these seeds when soaked 
twenty-four hours in water and then sprouted forty-eight hours at 
room temperature were five or six times as active as dry seeds in 
preventing scurvy, and in this respect compared well with many 
fresh vegetables. So small a quantity as one and one-fourth 
grams (one-third dram) of the sprouted seeds fed daily was 
found sufficient to prevent scurvy in guinea pigs. This amount is 
somewhat greater than the amount of raw turnips or cabbage, VITAMINS 
197 
fresh orange juice or lemon juice required, but is less than the 
amount of raw carrot or beet root needed. 
An outbreak of scurvy among Serbian soldiers during the 
World War was successfully treated by the use of sprouted beans. 
The antiscorbutic power of germinated seeds is considerably 
lessened by boiling. 
Holst tells us that Cartier, on his last voyage to Newfound- 
land in 1535, cured his crew of 103 men, who with the exception 
of three were sick with scurvy, by administering to them a freshly 
prepared decoction of pine needles. 
The writer is acquainted with a case in which a prospector 
saved himself from scurvy by eating grass when all the members 
of his party suffered seriously. 
A very good salad may be prepared from sprouted soy bean 
seeds which have been allowed to grow to the length of about an 
inch. Sprouted soy bean seeds also add an excellent quality to 
vegetable soups. The property which these seeds have of pro- 
ducing highly valuable vitamins makes very desirable the encour- 
agement, in this country, of the use of sprouted seeds. 
Barley, wheat, lentils, peas and beans are best suited for this 
purpose. Puncture a dozen holes in the bottom of a tin pan. 
Fill the pan half full with the beans (soy, or better, mung beans). 
Fill the pan with water, cover closely and set in a warm place 
where the water may drain away. Refill the pan with water three 
times a day so as' to keep the beans moist. Allow sprouts to grow 
until an inch or two in length. The beans should be thoroughly 
washed before putting to soak, to prevent molding. 
Sprouted beans are one of the chief ingredients of the 
famous chop suey of the Chinese restaurants, and may account 
for the popularity of this dish. 
Fresh fruits are rich in the scurvy-preventing vitamin; at 
least this is true of citric fruits: but recent observations by Os- 
borne and Mendel have shown that fruits in general do not con- 
tain a large amount of vitamin A which is found in abundance in 
the branny coat of cereals, in root vegetables and greens. 
The effect of cooking upon vitamin C is highly injurious 
and should be given due consideration. During the war, scurvy 
broke out in a number of camps, affecting as many as 40 per cent, 
of the men. It was found that the vegetables were cooked for 
three hours. When the cooking time was reduced to forty min- 
utes, scurvy rapidly disappeared. 198 
THE NEW DIETETICS 
Sherman has recently called attention to the fact that the 
long cooking or twice cooking of vegetables destroys the vitamin 
C, even in fresh vegetables in which this vitamin is not destroyed 
by ordinary cooking. It is important to remember this in feeding 
diabetics with thrice cooked vegetables. They should be sure to 
eat an abundance of lettuce, celery and tomatoes to supply vitamin 
C. It is important, also, in these cases to see that a good supply 
of vitamin B is furnished by the use of yeast extract as well as 
greenstuffs. 
It has recently been shown by Delf and Eddy that the cook- 
ing of cabbage destroys 93 to 95 per cent, of the antiscorbutic 
vitamin. Sherman has shown that the boiling of tomatoes or 
tomato juice for one hour destroys one-half of its vitamin C. 
Four hours’ cooking destroys more than two-thirds of this essen- 
tial vitamin. 
Hoobler finds that a teaspoonful of orange juice contains as 
much vitamin C as three pints of milk. 
It was also noticed that in camps located near apple orch- 
ards, from which apples were obtained and freely eaten, no 
scurvy occurred. Lime juice is found to have little value in pre- 
venting scurvy, but lemon and orange juice are highly valuable, 
and tomato juice, even the juice of canned tomatoes, is nearly as 
good. The juice of turnips and a drink prepared from tamarinds 
has also proved to be valuable, as well as soup made from 
potatoes. 
It has been noticed that scurvy frequently occurs among the 
inmates of institutions when potatoes are scarce and high in price. 
Raw cabbage is better than orange juice in preventing scurvy, but 
cooked cabbage is much less valuable. 
Recent studies (1921) at the University of Wisconsin by 
Steenbock and others seem to show that the fermentation which 
takes place in sauerkraut and silage, destroys the antiscorbutic 
vitamin. 
Vitamin B.—The Antineuritic or Antiberi-beri Vitamin. 
The first vitamin discovered (Funk) is now known as vitamin 
B. In a report, the “Present Status of Our Knowledge of Vita- 
mins and Its Application to the Dietary,” by Sherman, Winslow, 
Fisk, Greenwald and Jones, read before the American Ptiblic 
Health Association at its 51st Annual Meeting at Cleveland, Ohio, 
October 16, 1922, we are told concerning vitamin B:— VITAMINS 
199 
To this substance the name of vitamin was given by Funk (1911, 1912a, 
1912b), and it is this substance which is ordinarily referred to when the 
word vitamin is used without qualificatio7i. Beriberi is due to the use of 
diets deficient in this vitamin. Most frequently such deficiency has been 
attributable to an excessive dependence upon white rice; but that the rice 
itself is not a necessary factor is shown by the occurrence of cases of 
beriberi in Newfoundland where the dietary deficiency was brought about 
by too exclusive a use of fine white flour. 
The antineuritic vitamin, the absence of which produces beri- 
beri, is found in most vegetables and vegetable juices. In cereals 
it is almost wholly confined to the outer covering or bran and the 
germ. Fine wheat flour, polished rice and new process cornmeal 
contain this vitamin only in infinitesimal amounts, and are equally 
lacking in other vitamins. 
The continuous exclusive use of these foodstuffs causes beri- 
beri, a most distressing malady which may easily prove fatal and 
which, until recent years, caused the death of many thousands of 
persons annually in the Philippine Islands from the use of pol- 
ished rice. 
It is also known that the lack of vitamin A not only gives 
rise to disease of the eyes but to other maladies. Sherman tells 
us that, “It has been repeatedly found that a diet poor in the fat- 
soluble vitamin (A) leads to weakness in other respects as well 
as to increased susceptibility to eye disease. Osborne and Mendel 
(1921) report diarrhea and diminished appetite as frequently 
resulting from food poor in fat-soluble vitamin; and they have 
definitely correlated this deficiency with the occurrence of phos- 
phate renal calculi (bladder stones) among their experimental 
animals. McCollum and Davis (1913, 1914) and also Drummond 
(1919a, 1919b) report increased susceptibility to infections in- 
cluding lung disease among individuals whose diet is poor in this 
vitamin. Steenbock, Sell and Buell (1921) confirm this and em- 
phasize also the susceptibility to bronchial troubles and abnormal- 
ities of the skin. Evans and Bishop (1922) find that diets con- 
taining enough fat-soluble vitamin for growth and protection 
from eye disease may still require enrichment with this vitamin 
in order to enable the animal to meet the added strain of repro- 
duction. 
“With so much direct experimental evidence of widespread 
weakening of the body when the intake of fat-soluble vitamin is 
low, it is not surprising that many authorities find reason to cor- 
relate low intake of this vitamin with increased susceptibility to 
such diverse diseases as rickets, pellagra and tuberculosis.” THE NEW DIETETICS 
200 
Experiments reported by the United States Public Health 
Service showed that in fowls fed on fine hour bread, neuritis 
appeared at the end of twenty to thirty days. 
Fowls fed on whole wheat remained in good health. 
Fowls fed on corn grits or new process cornmeal showed 
neuritis in three to seven weeks. 
Fowls fed on old-fashioned water-ground cornmeal or the 
whole corn remained well. 
Emmett and Luros, from studies of the effect of heat on 
brown rice and vitamin B preparations from yeast and milk, con- 
clude there are two vitamins which have heretofore been classed 
together as water-soluble B. 
Beri-beri is a disease by no means confined to the Philippines, 
China and Japan, where it has long been known. During the 
war, beri-beri developed rapidly in the British army, in the 
Dardanelles and in Mesopotamia, when the soldiers were fed for 
a time almost exclusively on a diet consisting of wheat, canned 
meats and jam. Canned foods with the exception of tomatoes 
contain little or no vitamins. White bread is almost wholly devoid 
of vitamins, and jam contains none. 
Thousands of persons, men, women and children, in civilized 
life are exposed to all the dangers of a deficient diet. These 
dangers may be eliminated by taking care to make free use of 
fresh, uncooked foods daily. Graham bread should be used in- 
stead of fine flour bread and so-called whole wheat bread. Oat- 
meal is a better breakfast food than rice, cornmeal, corn flakes 
and other cereals from which the bran has been removed. In 
experiments upon pigeons, it has been shown that bread made 
from graham flour supplies all the elements necessary for the 
prevention of beri-beri, whereas beri-beri quickly develops on a 
diet of fine flour bread. 
McCarrison, of England, who has given great attention to the 
study of vitamins, and has written a most valuable work upon 
the subject of deficiency diseases, finds in the lack of vitamin B 
some explanation of the genesis of that great mass of ill-defined 
gastro-intestinal disorders and vague ill-health which forms so 
large a proportion of human ailments at the present day. Osborne 
and Mendel and Kerr in Mendel’s laboratory, have repeatedly 
demonstrated the marked effect of vitamin upon the appetite. 
While beriberi or polyneuritis is the characteristic result of 
the long-continued lack of vitamin B, this grave and even fatal VITAMINS 
201 
disease must be regarded only as the end result. It is highly 
important to bear in mind the following warning of the distin- 
guished authors above referred to, who in their report tell us that, 
“Before the nerve symptoms become apparent the body may be 
seriously weakened in several other ways and rendered much 
more susceptible to the inroads of infectious disease. Hence, 
the importance of such selection of food as shall result in an 
intake of vitamin B much more liberal than the minimum which 
suffices for the support of growth and the prevention of beriberi.” 
Osborne and Mendel have recently shown experimentally a 
definite, quantitative relation between vitamin B. and growth, 
showing that it is not only necessary that vitamin B. should be 
present in the food but that it should be present in sufficient 
amount to secure the maximum rate of growth. The claim made 
by certain observers that a deficiency of vitamin B. may be made 
up by an increased intake of protein, was shown to have no 
foundation. 
Spinach, even dried spinach, is an excellent source of vita- 
mins. Dried spinach contains twice as much of the vitamins as 
does whole wheat, soy beans, dried eggs or milk powder. It is 
far superior to cabbage, lettuce and celery. 
Cooper has shown that the amount of antineuritic vitamin 
required depends to some extent upon the amount of carbohy- 
drate eaten. In the feeding of pigeons, if the amount of starch 
in the food is increased, the amount of vitamins must also be 
increased. It is important to bear this fact in mind in the man- 
agement of bottle-fed infants. 
McCarrison has shown that when the water-soluble B vita- 
min, which is supplied by the bran of cereals, greens and root 
vegetables, is lacking, the resistance of the body to the invasion 
of the tissues by bacteria is greatly lowered. 
McCarrison has also noted that vitamin B aids peristalsis by 
energizing the intestine. 
In general, the juices of raw fruits and vegetables are much 
richer in growth-promoting vitamins than is milk. Osborne and 
Mendel have noted that the tomato contains a rich supply of all 
the vitamins. 
Dr. Ishiguro, the eminent Japanese military surgeon, who had 
great opportunities for observation during the Russo-Japanese 
war, denied that the lack of meat was the cause of beri-beri in 
the Japanese army, and called attention to the fact that the in- 202 
THE NEW DIETETICS 
creased consumption of meat in Japan has been accompanied by 
an increase in the prevalence of beri-beri. 
Yeast Extract Very Rich in Vitamins. 
Yeast is extraordinarily rich in the water-soluble vitamin 
which encourages growth and prevents beri-beri. Yeast, both 
fresh and dry, has for many years been used as a remedy. It has 
been especially popular for boils. Careful scientific investigation 
has shown that whatever merit yeast possesses is not due to the 
activity of living yeast cells, since yeast which has been sterilized 
by heat is equally as efficacious as the fresh growing yeast. 
Whatever therapeutic value yeast may have doubtless de- 
pends upon the water-soluble vitamins and salts which it con- 
tains. Dry yeast is rich in the growth-producing vitamin (water- 
soluble B) and contains 5 to 11 per cent, of organic salts with 
50 to 60 per cent, of proteins. 
Yeast extract was much used in the world war, especially in 
Mesopotamia, as a means of combating beri-beri among the Brit- 
ish troops. It is now available in this country (Savita, Marmite, 
Vegex) and is much more efficient than yeast, besides having an 
agreeable mushroom flavor. 
The Fat-soluble Vitamin—A. 
The chief sources of the highly important fat-soluble vitamin 
are milk, butter and other dairy products, and the green leaf. 
Greens of many sorts are largely used by the Chinese and other 
Orientals who make little use of milk. Greens should be much 
more largely used in this country not only for their precious 
vitamins but also for the food lime and iron which they supply. 
The fat-soluble vitamin is not found in lean meat, but is 
present in the liver, kidneys and other glands of animals in which 
certain quantities are stored as a measure of safety. 
The Eskimo finds it necessary to eat the raw, frozen liver of 
the seal to prevent the disastrous consequences which follow the 
deficiency of vitamins in his ordinary diet. 
Another delicacy which is greatly enjoyed by dwellers in the 
Arctic regions is the intestine of the ptarmigan, a bird which 
lives upon the green leaves of the willow or heather, which are 
very rich in vitamins. When a bird is killed, the Eskimo opens its 
abdomen and scoops out its long, squirming intestine, and swal- 
lows it warm and quivering, as an Englishman or an American Changes Due to Rickets—Deficiency of Fat-Soluble A. 
{Holt) VITAMINS 
203 
gourmet swallows a raw oyster, thus making available for his 
own use the vitamins found in the half-digested greenstuffs with 
which the intestine is filled. 
When a young Lapp goes out to hunt reindeer, his best girl 
charges him to bring her a stomach. These northern people eat 
with great avidity the half-digested reindeer moss which they find 
in the reindeer’s stomach. 
The absence of the fat-soluble vitamin gives rise to sore eyes 
in rats, the eyes being finally destroyed with ulceration of the 
cornea if the lacking element is not supplied. Night blindness 
has also been attributed to this cause. 
The observations of Mellanby show that the fat-soluble A 
vitamin is found in olive oil, cottonseed oil and coconut oil, 
although absent in linseed oil. It is less abundant in these vege- 
table oils, however, than in butter. 
The fat-soluble vitamin is of especial importance to growing 
animals. The water-soluble appears from experiments by Mendel 
and others to be more important for adults. 
In a report presented at the last meeting of the American 
Public Health Association, October 16, 1922, Sherman and his 
colleagues stated that, 
“In experiments now approaching completion in the labora- 
tory of food chemistry at Columbia University it has been found 
that a mixture of two-thirds whole wheat and one-third skimmed 
milk powder supplies enough fat-soluble vitamin to maintain 
growth at practically the normal average rate and apparently 
good general health in the rat, and that an increase of the fat- 
soluble vitamin in the diet by the use of whole milk powder in- 
stead of skimmed results in a distinctly higher degree of health 
and vigor as shown in longer life and much better success in 
bearing and rearing young. That this is due to the increased 
intake of fat-soluble vitamin and not of the fat itself is shown 
by parallel experiments in which the same differences were found 
to result from diets which differed only in that one contained 
lard or cocoanut oil while the other contained butter fat. 
“Recent experiments emphasize strongly the fact that the fat- 
soluble vitamin is needed by adults as well as during growth. 
That adults appear less dependent upon the fat-soluble vitamin 
content of their food is attributable in part to the fact that they 
have passed the stage of development at which the effect of a 
deficiency becomes apparent quickly, and in part to the fact that 204 
THE NEW DIETETICS 
when the adult has grown up on a diet rich in this vitamin he 
will have acquired a sufficient store to carry him over subsequent 
periods of inadequate intake, provided these are not too prolonged.” 
McCollum and his collaborators have recently shown that the 
fat-soluble vitamin may be separated into two parts which possess 
different properties. One of these possesses remarkable anti- 
rachitic properties, and McCollum has proposed to distinguish it 
by the designation vitamin D. This vitamin is found most abun- 
dant in cod-liver oil. Its anti-rachitic action is greatly augmented 
by sunlight and other hygienic agencies and by the presence of 
calcium and phosphorus. Vitamin D is present in butter and 
doubtless in greenstuffs, although its distribution in foods has not 
yet been adequately studied. 
The interesting studies of Hess demonstrated most conclu- 
sively that the antirachitic vitamin is by no means the only factor 
in the prevention and cure of rickets. They showed that sunlight 
has a highly potent antirachitic influence. 
While the existence of a second fat-soluble vitamin seems to be 
well established, there is still some discussion about its name because 
of the fact that Funk has apparently been able to separate the water- 
soluble B vitamin into two parts, one of which he proposes to desig- 
nate as D. This is not a matter of great moment, however, since the 
new fat-soluble vitamin is nearly always associated with vitamin A. 
“With so much direct experimental evidence of widespread 
weakening of the body when the intake of fat-soluble vitamin is 
low, it is not surprising that many authorities find reason to cor- 
relate low intake of this vitamin with increased susceptibility to 
such diverse diseases as rickets, pellagra and tuberculosis.” 
Both the water-soluble and the fat-soluble vitamins are 
closely associated with growth. 
The fat-soluble vitamin is fifteen times as soluble in fat as in 
water. It is found in young shoots, in the yolk of eggs, and in 
yellow corn and carrots as well as in milk, cheese and butter. It 
is apparently associated with the yellow color known as carotin. 
Winter milk contains only two-thirds as much vitamin A as 
does the milk of cows produced in summer. 
Skimmed milk contains only half as much of the fat-soluble 
vitamin as does full milk for the reason that half of the vitamin 
content of the milk is removed in the cream. The fat-soluble 
vitamin is also found, though not very abundantly, in the soy 
bean and the peanut. The most important source of this highly 
important element is the green leaf, VITAMINS 
205 
The observations of Osborne and Mendel have demonstrated 
that dried alfalfa, clover, grass, spinach and carrot are equal to 
butter fat as sources of the fat-soluble vitamin. The same was 
found to be true of the dried tomato. 
With these important facts in mind it is evident that there 
need never be a shortage of the necessary vitamins provided only 
that proper care is exercised in the selection of foodstuffs, since 
these essential elements are found in abundance in the simplest 
and cheapest of food materials. 
The following tables show the relative amounts of the several 
vitamins found in various common foodstuffs: 
TABLE XVII 
Vitamin A 
Fat-soluble Growth-Promoting Anti-rachitic (?) Vitamin. 
(Not damaged by ordinary cooking or canning) 
Barley, sprouted 
Beans, sprouted 
Bran 
Butter 
Cabbage 
Carrots, fresh or dried 
Celery 
Cod-liver oil 
Corn, yellow 
Foods Rich in Vitamin A 
Cream 
Egg yolk 
Greens 
Lettuce 
Milk 
Spinach 
Soy bean, sprouted 
Tomatoes, fresh, canned, or dried 
Wheat germ 
TABLE XVIII 
Vitamin B 
Anti-neuritic. or Beri-Beri-Preventing or Growth-Promoting Vitamin. 
(Not damaged by ordinary cooking or canning) 
Foods Rich in Vitamin B 
Barley 
Beans 
Beef and other fresh meat 
Bran 
Cereal germs 
Egg yolk 
Fish 
Fruits 
Grains, whole 
Milk 
Nuts 
Ox heart 
Peas 
Vegetables 
Yeast 
Yeast extract 
Foods Poor in Vitamin B 
Cabbage 
Carrots and other vegetables of 
this type 
Cereals, highly milled 
Cornstarch 
Corn syrup 
Meat, sterilized 
Milk, sterilized 
Molasses 
Pork 
Starch 
Turnips 206 
THE NEW DIETETICS 
TABLE XIX 
Vitamin C 
Anti-scorbutic Vitamins 
(Easily destroyed by cooking or drying.) 
Foods Rich in Vitamin C 
Cereals, sprouted 
Fruits, fresh 
Greens 
Meat, raw 
Milk, raw 
Tomatoes, fresh or canned 
Turnip juice 
Vegetables, fresh 
Foods Poor in Vitamin C 
Cereals, dried 
Corn syrup 
Fruits, dried 
Meat, canned 
Milk, sterilized 
Molasses 
Pork fat 
Starch 
Vegetables, dried 
TABLE XX 
The following table prepared from British and American 
authors gives up-to-date (May, 1923) information concerning the 
vitamin content of common foodstuffs: 
SOURCES OF VITAMINS 
Foodstuff “A” “B” “C” 
Meats: 
Beef heart + + ? 
Brains + + -j—1—b + ? 
Codfish + -j- ? 
Codtestes + 
Fish roe -r H—b 
Herring ++ -|—b ? 
Horse meat + + 
Kidney + + -|—b 
Lean Muscle + 0 + ? 
Liver - + + + ? 
Pancreas 0 H—|—b 
Thymus (sweetbreads) 0 0 0 
Vegetables: 
Beet root + — + + 
Beet root juice ? Little + ~b + 
Cabbage, dried + + + + d—b 
Cabbage, fresh + + + -|—j—b + + + + 
Carrots + + + H—j—b + + 
Cauliflower ++ -j—j—b + + 
Celery ? d—1—b 
Chard + ~b + H—b 
Dasheens + H—b 
Lettuce ++ ++ + + + + 
Mangels ++ H—b 
* The relative amount of vitamin present is indicated by the number of stars 
(*), four being the maximum and one star signifying an appreciable quantity. VITAMINS 
207 
Foodstuff “A” “B” “C” 
Onions - ? -j—|—b + + + 
Parsnips ++ -j—j—j- 
Peas (fresh) + -j—|- + + + 
Potatoes 0 -|—j—b + + 
Rutabaga -j—j—j- 
Spinach + + + -j—j—j- + + + 
Cereals: 
Barley + —1—|- ? 
Bread (white) -j- ? * 
Bread (whole meal) + -j—1—(- ? 
Maize (corn) + (in yellow)-|—j—(- ? 
+ (in white) -j—j—j- ? 
Oats '+ +++ 0 
Rice, polished 0 0 0 
Rice (whole grain) + -|—|—|- 0 
Rye , + +++ 0 
Corn embryo -{—[—j- 
(Corn + (in yellow -j—(—j- ? 
Corn pollen . only) -|—j- 
Meat extract 0 0 0 
Wheat bran + Stammers -)—|—(- 0 
Wheat embryo (germ) + + -j—j—j- 0 
Wheat endosperm 0 0 0 
Wheat kernel H—|—(- 0 
Other seeds: 
Beans, kidney -|—|—(- 
Beans, navy ■]—j—f- 0 
Beans, soy + -j—j—j- 0 
Cotton seed + + -j—[—b 
Flaxseed + + -j—j—j- 
Hemp seed + + -j—|—b 
Millet seed ++ -j—|—h 
Peanuts + H—(- 
Peas (dry) +? -j—f- 0 
Sun flower seeds + 
Fruits: 
Apples H—)- + + 
Bananas ? -j- + + 
Grapefruit -|—|—b + + + 
Grape juice + + 
Grapes 0 + + 
Lemons -j—|—(- + + + + 
Limes H—b +~b 
Oranges ++ -|—I—b + + + + 
Pears -j—b + + 
Raisins + + 
Tomatoes ++ H—I—b + + + + 
Oils and fats: 
Almond oil 0 0 
Beef fat + 00 
Butter + + + + 0 0 
Cocoanut oil 0 0 0 
Cod liver oil + + + + 0 0 208 
THE .NEW DIETETICS 
Foodstuff “A” “B” “C” 
Corn oil 0 0 0 
Cotton seed oil 0 ? 0 0 
Egg yolk fat „ + + + + 0 0 
Fish oils + + 0 0 
Lard 0 ? 0 0 
(Oleo, animal + 00 
Oleo, vegetable 0 0 0 
Olive oil 0 0 0 
Pork fat 0 ? 0 
Tallow 0 0 0 
Vegetable oils 0 ? 0 0 
Nuts: 
Almonds + -|—|—f- 
Brazil nut -j--j—j- 
Chestnut ++ -j—|—j- 
Cocoanut ++ -j—|—j- 
English walnuts -j—j—f- 
Filbert +++ 
Hickory + + + 
Pine + + + 
Dairy products: 
Butter + + + + 0 0 
Cheese ++ + ? 
Condensed milk ++ + 0 
Cream + + + -j- ? 
Eggs + + + + ++ 0 
Milk powder (skim) + -}—(—(- +? 
Milk powder (whole) + + + -|—|—(- +? 
Milk, whole + + + +++ + + 
Whey + +++ + 
Miscellaneous: 
Alfalfa + + + +++ ? 
Blood Varies with source 
Clover + + + -|—|—|—|- ? 
Honey -|—j- 0 
Malt extract 0 0 0 
Nectar 0 0 0 
Timothy ++ H—|—f- 
Yeast, brewers 0 —\—j—|- 0 
Yeast cakes 0 -|—|- 0 
Yeast extract 0 -j—j—(- 0 
Canned foods should never constitute a large part of the 
dietary. Fresh foods, rich in vitamins, are needed daily to main- 
tain the nerve tissues in health and to prevent scurvy and other 
deficiency diseases. 
The fat-soluble vitamin is apparently not affected by the 
temperatures ordinarily employed in cooking. Mendel found the 
fat-soluble vitamin of butter fat to be uninjured by exposure to a 
temperature of 230° F. for sixteen hours. VITAMINS 
209 
Vitamins are destroyed by alkalies. For this reason, the use 
of carbonate of soda in cooking is to be strongly condemned. 
When bicarbonate of soda is used in the making of brea.d, it is by 
the process of baking converted into carbonate of soda, which is 
strongly alkaline and destroys vitamins. The old-fashioned method 
of making biscuit by the use of soda and sour milk is likewise 
objectionable. 
Baking powder biscuit, as ordinarily made, have an alkaline 
reaction which affords sufficient evidence that the vitamins are 
damaged or destroyed. 
Pellagra prevails most extensively in certain districts in the 
South where the new process cornmeal is generally used. This 
preparation of corn is almost wholly deprived of vitamins by the 
process of milling, and when prepared with baking soda what 
small proportion of vitamins remains may be destroyed. 
In mountainous regions contiguous to the localities where 
pellagra is very prevalent, the disease is either absent or only 
rarely encountered. These mountaineers are so far away from the 
cities where new process cornmeal is obtainable that they are 
obliged to have their corn ground in the small mills scattered 
through the mountains, in which the old-fashioned stone burrs 
are still in use. The cornmeal made in this way represents the 
entire grain and is comparatively rich in vitamins. 
Holt and others have called attention to the fact that an 
increase of carbohydrates in the diet of a child necessitates a 
liberal increase in the vitamin content of the dietary. If this is 
neglected, nutrition and development fail. For this reason, the 
amount of orange juice or tomato juice must always be increased 
when a child is placed upon a cereal diet or when there is an 
increase in the malt sugar added to the milk. No doubt this 
principle applies with equal force in the feeding of adults, so 
that the free use of cane sugar at meals, or in the form of confec- 
tionery at any time, must involve vitamin deficiency since cane 
sugar contains no vitamins while at the same time producing a 
special demand for an increase of this essential food constituent. 
No doubt the free use of cane sugar is in this way responsible for 
many thousands of cases of nutritive disorders of various sorts 
occurring especially in this country where the use of cane sugar 
is carried to a very great excess. 
This is a matter to which every person who has charge of 
dietaries should give attention. A person may easily starve to 210 
THE NEW DIETETICS 
death in the midst of plenty, and while eating abundantly, for 
lack of the precious vitamins found in spinach and other fresh 
foods. Eyery meal should include a liberal supply of spinach or 
other greens. An abundant supply of greens should be provided 
for the table during the winter as well as the summer months. 
According to Mendel and Osborne, the tomato is unique as a 
source of vitamins, being rich in all three of the known vitamins, 
fat-soluble A and water-soluble B and C. This is true not only 
of the fresh tomato but of both canned and dried tomatoes. This 
fact places the tomato at the head of our common foods as a 
means of insuring to the body an adequate supply of all the vita- 
mins. It should be used very freely. 
Hess tells us that the juice or puree of canned tomatoes may 
be regarded as a palatable solution of the three vitamins and a 
serviceable antiscorbutic for artificially fed infants. It may be 
used in doses of one ounce daily. 
How Vitamins Are Destroyed. 
Vitamins are destroyed by the action of heat or alkalies and 
are removed by the so-called “high milling” of cereals. 
The antiscorbutic vitamins are destroyed by boiling and are 
damaged by a temperature of 160 degrees F., the usual tempera- 
ture employed in pasteurizing milk. 
A boiling temperature for several hours impairs, but does not 
destroy the fat-soluble and antineuritic vitamins. 
Canned meats and other foods are often heated to a tempera- 
ture of 240° F. for two or three hours. This is necessary to 
destroy the spores of putrefactive germs which are not killed by 
ordinary cooking temperatures. It is evident that canned foods 
must be deficient in vitamins. 
Funk found that a dog fed exclusively on canned beef died 
in two weeks. Cellulose 
Cellulose is found exclusively in vegetable products. It 
forms the framework and fibers of plants, the walls of vegetable 
cells and the coverings of seeds. Wood consists of cellulose with 
the addition of layers of cork. 
The chemical composition of cellulose closely resembles that 
of sugar. There are.many different celluloses, just as there are 
many different sugars. Cellulose is formed from sugar and 
dextrine circulating in the sap or juices of plants and may by 
chemical processes be re-converted into sugar. 
In its ordinary form, cellulose is insoluble in boiling water, 
and is not acted upon by the digestive fluids of the alimentary 
canal, although it is digested by the ferments of certain bacteria 
which sometimes flourish in great numbers in the colon. 
Special forms of cellulose are soluble in boiling water. On 
cooling this dissolved cellulose forms a gelatinous mass. Agar is 
a cellulose of this sort. It is found in seaweeds which grow along 
the coast of Japan. In commerce, it is sometimes known as 
Japanese isinglass, or Ceylon moss. 
The cellulose in fresh fruits and vegetables and in tender 
shoots is softened and broken up in cooking, and to a large extent 
disappears through the action of bacteria in the colon. 
Bran. 
The outer coverings of seeds consist of cellulose combined 
with layers of cork cells, a woody substance much more resistant 
than the cellulose found in green vegetables. Bran is for this 
reason an excellent form of roughage. It is needed on every 
table and at every meal as an accessory food to make good the 
deficiencies of the ordinary bill of fare in cellulose as well as iron, 
lime, and vitamins. 
The cellulose of bran, of seeds, of berries, the coarser fibers 
of vegetables and agar, escapes the action of bacteria in the colon 
and hence is of great value in giving to the intestinal contents the 
bulk necessary to stimulate peristaltic activity. 
The composition of bran varies greatly according to the 
amount of fine middlings included with it. The best bran con- 
211 212 
THE NEW DIETETICS 
sists of large flakes of nearly uniform size and free from 
middlings. 
When well softened with water, bran is not irritating but is 
an emollient. The thin films of cellulose become as soft and 
pliable as wet paper, and excite the bowel, not by scratching or 
irritating it, but by a gentle titillation, so to speak, and by giving 
to the food sufficient mass to distend the intestine and stimulate it 
to vigorous acivity. This was observed by Cannon in his X-ray 
studies of digestion in cats. 
In its ordinary commercial form, bran is seldom fit for use, 
on account of the large amount of dirt which it contains, includ- 
ing insects and bacteria. For use as a food laxative, it should 
be carefully prepared by thorough cleaning and washing of the 
wheat before grinding and sterilization of the bran. Sterilized 
bran, first introduced by the writer many years ago, is now pre- 
pared by various manufacturers and is put up in convenient pack- 
ages. One or two rounded tablespoonfuls should be taken at 
each meal, the amount depending upon the character of the other 
foods taken. The writer has never seen any ill efifects from the 
use of sterilized bran, which he has prescribed for many years, 
although there are many cases in which it fails to produce the 
desired efifect and has to be supplemented by the use of paraffin 
oil as a lubricant. 
This is particularly true in cases in which the cecum is 
greatly dilated or crippled by adhesions from chronic appendicitis 
and in cases in which there is obstruction of other parts of the 
colon, especially the pelvic colon as the result of adhesions. 
The combination of paraffin oil with bran or agar-agar in 
some form is also useful in cases of spastic contraction due to 
colitis. 
Experience shows that from half an ounce to an ounce of 
cellulose must be taken with the meals daily to insure sufficient 
bulk to stimulate the intestine to action. In cases *in which the 
colon is very redundant or is crippled by adhesions, even double 
this amount may sometimes be needed, at least until the bowel has 
been trained to normal action. This amount of cellulose is pro- 
vided by two rounded tablespoonfuls of sterilized bran in addi- 
tion to other laxative foods. 
The amount of food required to furnish two-thirds of an 
ounce (300 grains) of cellulose may be ascertained by reference 
to the accompanying tables (Tables XXI—XXIII). CELLULOSE 
213 
In the tables of cellulose, the term cellulose is made to include 
the cork and other indigestible vegetable matters associated with 
it. It will readily be seen that bran or agar is almost absolutely 
essential as an addition to ordinary foodstuffs to provide the bulk 
required for efficient bowel action. 
It will be noted that foodstuffs differ greatly in their cellu- 
lose content, seedy fruits, greens and legumes, supplying this ele- 
ment in relatively larger amount than any other food. 
TABLE XXI 
Number oi 
cellulose 
Grains of 
cellulose 
grains in 
in 100 
one ounce 
calories 
Barley (cooked) 
20.0 
64.0 
Beans (dried) 
40.0 
40.0 
Corn flakes 
10.0 
9.7 
Cornmeal 
10.0 
9.7 
Wheat (cooked) 
10.0 
38.0 
Wheat sprits (cooked) 
5.0 
27.0 
Rolled wheat (cracked) 
9.0 
36.0 
Graham flour 
10.0 
9.6 
Fine flour 
1.5 
1.4 
Oatmeal (cooked) 
44.0 
37.0 
Polished rice 
2.0 
2.0 
Unpolished rice 
3.8 
3.7 
Rye (small) 
15.0 
14.4 
Peas (dried) 
20.5 
28.5 
Lentils 
20.0 
19.6 
Granola (cooked) 
10.0 
9.8 
Sterilized bran 
200.0 
Graham bread 
6.0 
23.0 
Whole wheat bread.. 
5.0 
7.0 
Showing the Cellulose in Cereals. 
TABLE XXII 
Number of 
Grains of 
cellulose 
cellulose 
grains in 
in 100 
one ounce 
calories 
Asparagus 
5.2 
37.4 
Beans 
4.0 
12.9 
Showing the Cellulose in Vegetables. 214 
THE NEW DIETETICS 
Beets 
5.3 
45.0 
Brussels sprouts 
7.9 
131.0 
Cabbage 
9.2 
145.0 
Carrot (raw) 
4.9 
36.0 
Cauliflower (steamed) 
4.6 
44.6 
Celery (raw) 
7.0 
127.0 
Cucumber (raw) 
3.9 
78.0 
Green peas 
9.4 
27.0 
Kohl-rabi (raw) 
7.8 
86.0 
Lettuce 
3.7 
65.0 
Onion 
3.6 
33.7 
Parsnips 
8.7 
50.0 
Peas (dried) 
28.5 
27.0 
Potato (baked) 
5.5 
16.6 
Pumpkin 
6.1 
65 6 
Spinach 
4.7 
50.0 
Tomatoes 
...... 4.2 
63.6 
Turnip 
6.6 
100.8 
TABLE XXIII. 
Showing the Cellulose in Fruits. 
Number of 
cellulose 
Grains of 
cellulose 
grains in 
in 100 
one ounce 
calories 
Prunes (cooked) 
. 10.0 
36.0 
Apples 
5.0 
5.0 
Pears 
15.0 
81.0 
Peaches 
5.0 
40.0 
Plums 
7.5 
30.0 
Cherries 
10.0 
44.0 
Raspberries, red 
37.0 
200.0 
Blackberries 
25.0 
150.0 
Huckleberries 
61.0 
300.0 
Strawberries 
10.0 
87.0 
Currants 
23.0 
138.0 
Grapes 
7.5 
36.0 
Raisins 
7.5 
38.4 
Raisins (stewed) 
7.4 
38.0 
Oranges 
10.0 
67.0 
Bananas 
1.5 
5.2 CELLULOSE 
215 
Figs 
22.5 
24.3 
Apricots 
12.5 
74.0 
Gooseberries ( stewed) 
17.5 
90.0 
Cranberries 
25.0 
51.0 
It should further be mentioned that in the use of cellulose in 
concentrated form, as in sterilized bran, the whole amount used 
at a meal should not be taken at once, as at the beginning or end 
of a meal, but should be well mixed with the food by taking small 
portions at frequent intervals during the meal. 
It should also "be mentioned that for greatest efficiency as a 
laxative bran should be used in liberal quantities at every meal. 
There has been much discussion about the digestibility of 
bran and the advisability of its use. Naturally its digestibility is 
less than that of fine flour. Its value depends upon its indigesti- 
bility. But it does not interfere with the digestibility of other 
foodstuffs to any appreciable extent. Mendel and Osborne have 
shown by feeding experiments, using white rats, that bran may 
be made to take the place of meat as a source of protein; and 
Hindhede, food controller of Denmark during the World War, 
claims to have demonstrated the same. During the war the 
Danish people lived almost exclusively on barley porridge, vege- 
tables, greens, milk and bread. In making their bread they 
added wheat bran to their coarse rye meal, and thrived upon it, 
reducing the annual death rate 34 per cent. No one starved, and 
no one was made ill by the coarse fare. 
It is well known that the digestive organs of herbivorous 
animals are able to digest cellulose, a function which seems to 
have been lost by civilized human beings, for it has been shown 
(Tibbies) that the capacious cecum of the negro of the Nile and 
the Bushman secretes a ferment which dissolves the cellulose cov- 
ering of vegetable cells. It is claimed, also, that the vermiform 
appendix of the negro produces a ferment which digests cellulose. 
But the digestibility of cellulose is of much less consequence 
than its indigestibility since its chief value in human food is to 
serve as roughage. The importance of cellulose as a food con- 
stituent is well known to farmers and to all feeders’of animals. 
Rabbits, when fed on a diet containing no cellulose, rapidly die. 
When cellulose is not present in their food the movements of the 
intestine cease, inflammation follows and death soon after. 
Experiments by Hart, as well as by Osborne and Mendel, 216 
THE NEW DIETETICS 
have shown the cause of leg weakness in chickens to be lack of 
roughage. The difficulty disappeared when paper was given as 
roughage, but no improvement was noted by other changes in 
the diet which would have corrected any defect which might 
have arisen from lack of vitamins or salts in the food. These 
experiments clearly demonstrate the value of bran and other 
forms of roughage and should be of service to housewives and 
others who are responsible for the feeding of children, as well 
as to poultry raisers. 
A study of the nutritive value of wood by Haberland showed 
that wood contains, especially in winter, considerable quantities 
of sugar, starch and oil, with small quantities of protein. These 
nutrient materials are found only in the living wood; that is, in 
the twigs, small branches and sap wood, not in the heart wood of 
the tree. Hard wood contains a considerable amount of starch, 
from one-fifth to one-fourth of its weight, while the pine, birch 
and linden contain considerable oil but little starch. The pine 
and spruce contain so much resin that they are quite unfit for 
food, and the oak and the willow are objectionable on account of 
the considerable amount of tannin which they contain. The best 
food woods are elm, linden, maple, poplar and birch. When finely 
ground, these woods may be mixed with cereals and other foods 
for use by animals, and in emergency by man, and may be made 
to yield a considerable amount of nourishment. 
Bran Does Not Irritate. 
That bran is an excellent laxative is not a new discovery. 
The fact has been known for years and has been utilized by the 
farmer in the treatment of his horses, cattle and pigs, but, unfor- 
tunately, he has neglected to make use of this most excellent 
remedy for his own benefit. The general failure to resort to 
bran for the relief of constipation has probably been due to the 
wide-spread but erroneous notion that bran is irritating. 
We are glad to find this view which we have so long defended 
endorsed by that most eminent of medical authorities, The Journal 
of the American Medical Association (Dec. 6, 1919, p. 1768). We 
quote as follows: 
Bran is therefore chiefly to be looked on as a form of almost 
indigestible carbohydrate, which is endowed with considerable laxa- 
tive value, not only because it adds by its bulk to the distention of the 
intestine, but also because of the spicate shape of its particles. Exces- CELLULOSE 
217 
sive irritation does not result from these; for when properly moistened 
and heated, bran becomes as soft and pliable as wet paper, and hence 
produces merely a gentle titillation and is usable even in patients with 
a tendency to colic. 
Hippocrates was a believer in bran. In one of his famous 
medical works, he says : 
This I know, moreover, that to the human body it makes a great 
difference whether the bread be fine or coarse; of wheat with or 
without the hull. . . . Melancholic diseases are most particularly ex- 
acerbated by beef, for it is of an unmanageable nature, and requires 
no ordinary powers of stomach to digest it. 
The writer quite agrees with Professor Tibbies, who asserts 
that “the excessive fear of indigestible foods which prevails in 
the minds of many people is largely responsible for atonic con- 
stipation and many of the cases of chronic intestinal catarrh, 
mucous colitis, and membranous colitis. It is therefore important 
in the treatment of these diseases that the food does not lack 
cellulose and especially woody fibre.” 
Von Noorden, one of the most eminent of living medical 
authorities, has for many years pointed out the necessity for 
roughage in the treatment of colitis, a disease for which bland 
foods are commonly prescribed. Von Noorden insists that in this 
disease the diet should include coarse bran bread, legumes, includ- 
ing the skins, coarse oatmeal, all sorts of coarse vegetables, fruits, 
currants, gooseberries and grapes, including the skins and seeds. 
Von Noorden reports complete and permanent cures of colitis by 
this regimen in 50 per cent, of all cases, and cure or improvement 
in more than 75 per cent, of all cases treated. More bran and less 
beef would be a good general prescription for the American 
people. 
Bran contains a considerable amount of protein and when 
added in liberal quantities to other foodstuffs, excluding meat, 
might easily enrich the diet sufficiently to insure all the protein 
needed. It should be noted, also, that in addition to its richness 
4 
in protein, bran contains a rich store of lime, iron and vitamins, 
important food constituents which are deficient in most other 
foodstuffs. 
Roger Crab, who died on 11th September 1680, lived for 3s. 3d. a 
year on broth and bran, with chopped turnip leaves, and drank only 
water. He had fought and was wounded in the Cromwellian army. 
(Sinclair.) 218 
THE NEW DIETETICS 
The United States Department of Agriculture has published 
the results of experiments made at the New York Experiment 
Station which indicate that wheat bran is laxative not only be- 
cause of its indigestibility which makes it a mechanical stimulant 
of the intestine, but because of the presence in bran of a peculiar 
laxative substance, phytin, which is found in very considerable 
amount in the outer layers of the envelope. This important dis- 
covery furnishes a scientific basis for the regular use of bran as a 
natural laxative which secures increased bowel activity not by 
irritating the bowel as do medicinal laxatives but by physiologic 
stimulation so that it may be used an indefinite length of time 
without losing its effects and without injury. 
Carnivorous animals eat bones and other indigestible sub- 
stances, doubtless to give increased bulk to their ingesta. Dogs 
often eat grass, and sea lions swallow quantities of pebbles 
(Norton). 
Agar-Agar. 
Agar occurs in commerce in long, flexible strings, which are 
imported to this country in huge bales. These strings do not 
consist of the dried seaweed, as many suppose, but is the cellulose 
which has been dissolved from the seaweed by boiling. 
Some years ago, the writer obtained through Mr. George U. 
West, American consul at Kobe, Japan, the following account of 
the method of preparing agar: 
Japanese isinglass, or agar-agar, is made from six kinds of sea- 
weed, the best qualities of which are found on the coasts of the Prov- 
inces of Izu, Tosa and Sado, and are known as Izu, Nanbu, Misaki, 
Onikusa, Egokusa, and Hirakusa. (Samples of the various kinds of 
seaweed mentioned are filed in the Bureau of Manufactures.) At the 
close of the summer the seaweed is bought up by wholesale dealers in 
Osaka and stored there in go-downs until sold to the manufacturers. 
The manufacture of vegetable isinglass, as its Japanese name, 
kanten (cold climate) would imply, can take place only in autumn 
and winter, as warmth and rain spoil the product. The process is 
simple, and the utensils employed are primitive. The factories are 
located at Ibaraki, in the mountains between Osaka and Kyoto, and 
at Nishinomiya, between Osaka and Kobe. 
The process of manufacture may be described as follows: The 
seaweed is first crushed, each kind separately, to remove shells and 
other adhering matter, and then washed with clean water. The 
washed seaweed is placed on a mat and dried until its color becomes 
white by the action of the sun, frost and dew. This operation takes CELLULOSE 
219 
place during September and October, and when bleached the weight 
of the seaweed is decreased nearly one-half. After bleaching, the six 
kinds of seaweed—in the proportion of Iza, 4; Egokusa, 4; Misaki, 3; 
Hirakusa, 3; Nanbu, 4; and Onikusa, 2—are all put together in a 
boiler and cooked for about 14 hours, until they become soluble. The 
liquid is then strained through a sack and a box with a bamboo sieve 
on one side, from which it runs into a container. From the container 
the liquid is ladled into trays about 2>l/2 feet long and 3 inches deep. 
After remaining in the trays about 12 hours, these are placed on 
a low stand, and the isinglass is cut into strips 3 inches wide and 14 
inches long, with a knife and a ruler. These strips are then put into 
a long closed wooden box (the ends of which are 3 inches square, one 
end being open and one filled in with a wire sieve) and pushed through 
the sieve end in the form of long fine strips. The isinglass is then 
placed on a low stand, which is covered with a clean mat, and dried 
in the sun during the day and during the night for two or three weeks 
during January and February, being watered at midnight. The quality 
of the isinglass depends upon the weather during this time, the 
best being made when it is clear and cold, the poorest when it is warm 
and rainy. When the isinglass is bleached sufficiently, it is compressed 
and packed in Japanese matting, tied with a straw rope. 
The very best quality is all exported to China, the No. 1 quality 
that is shipped to America being equal to the No. 2 that goes to 
China. 
It is evident that this crude method of preparation exposes 
the agar to contamination through the contact of insects, dust, 
etc. On this account commercial agar requires thorough disinfec- 
tion and cleansing before use. 
The use of agar is to be most highly recommended as a means 
of giving the necessary bulk to stimulate the intestine to prompt 
action. When properly prepared it is wholly free from unpleasant 
flavor, and it manifests such astonishing avidity for water that 
when it is present in the feces they cannot possibly become dry 
and hard. 
In cases in which constipation is due to “greedy colon” agar 
or bran is indispensable. In such cases the colon has acquired 
the power to eat up enormous quantities of the cellulose of the 
food, so that it is very difficult to increase the bulk of the feces 
by the use of green vegetables. This is the reason for the dis- 
appointment experienced by many who hope to find in the free 
use of lettuce and like green foods a panacea for their intestinal 
ills. Agar has been shown by the experiments of Mendel and 
others to be indigestible by any of the digestive fluids with which 
it comes in contact in the human body. It must be taken in 220 
THE NEW DIETETICS 
sufficient quantity to accomplish the object sought. Two-thirds of 
an ounce to an ounce daily is the quantity usually required for 
adults. For young children a quarter to a half of this quantity 
is sufficient. 
Agar is easily taken in soup, cereal coffee, fruit juice or 
stewed fruit. It should he allowed to soften a little and should 
then he swallowed without chewing. 
This remedy should he taken at meals in order that it may 
he intermingled with the food, and so prevent the formation 
of hardened residues in the intestine. 
Agar may be used with advantage as a substitute for a meal, 
when food cannot he taken, and when there is no appetite for 
food, and when so used it maintains the intestinal rhythm which 
would otherwise be lost, resulting in constipation. It should in 
such cases he taken with fruit juice or fresh or stewed fruit. 
When one finds at night that the usual amount of food has not 
been taken, an extra dose of agar with a little fruit may be taken 
before going to bed. No digestive work is required by either the 
fruit or the agar except to move it along the digestive canal. 
It is important to take fruit juice with the agar to excite the 
necessary peristalsis. Cooked bran may be used in the same way. 
Some years ago, the writer received from a trained nurse 
working among the Indians at Hoonah, Alaska, an interesting 
specimen of dried seaweed which is collected by the Indians in 
the summer season for use as a laxative during the long winter 
months when berries and vegetable foods are not accessible. 
“After being gathered, the seaweed is spread out on the rocks 
and dried a little in the sun; then they fold it up and cut it in 
squares and put it in a coal oil can; a branch of spruce tree 
between each cake and a weight put on to press it. It is taken 
out and put in the sun day after day until well dried. The 
seaweed is used as a laxative, for which purpose they eat it raw.” 
The seaweed thus prepared occurs in blocks about eight 
inches square and an inch thick. It is jet black, and has a salty, 
though not unpleasant taste. It differs from Japanese seaweed 
in being very brittle so that it may be easily eaten dry. 
Lewis and Clarke in their famous journey to the Pacific 
Coast more than a century ago found the Indians making use 
of Jboiled moss as a foodstuff in the winter season, doubtless for 
its laxative effects. 
Only among highly civilized people is there general neglect CELLULOSE 
221 
to include in the diet the necessary roughage to maintain a 
healthy action of the intestines. Savages take care to secure this 
food essential. 
Manyalla. 
Mr. Kennan, in his fascinating volume, “Tent Life in 
Siberia,” gives the following account of the use of partially 
digested reindeer moss by the Koraks: 
“Hold on!” exclaimed Dodd, with a deprecating gesture, “that’s 
enough, I’ll eat it;” and taking out a half-spoonful of the dark viscid 
mass, he put it to his lips. 
“Well,” said we expectantly, after a moment’s pause, “what does 
it taste like?” 
“Like the mud pies of infancy!” he replied sententiously. “A little 
salt, pepper, and butter, and a good deal of meat and flour, with a few 
well-selected vegetables, would probably improve it; but it isn’t par- 
ticularly bad as it is.” 
Upon the strength of this rather equivocal recommendation I 
tasted it. Aside from a peculiar earthy flavor, it had nothing about it 
which was either pleasant or disagreeable. Its qualities were all nega- 
tive except its grassiness. 
This mixture, known among the Koraks as “manyalla,” is eaten 
by all the Siberian tribes as a substitute for bread, and is the nearest 
approximation which native ingenuity can make to the staff of life. 
It is valued, we are told, more for its medicinal virtues than for any 
intrinsic excellence of taste, and our limited experience fully prepared 
us to believe this statement. Its original elements are clotted blood, 
tallow, and half-digested moss taken from the stomach of the rein- 
deer, where it is supposed to have undergone some essential change 
which fits it for second-hand consumption. These curious and hetero- 
geneous ingredients are boiled up together with a few handfuls of 
dried grass to give the mixture consistency, and the dark mass is then 
molded into small loaves and frozen for future use. 
This half digested moss is much used by natives of the Arctic 
regions to combat constipation. It is also no doubt useful as a 
source of vitamins in which meat is very deficient. 
Up-to-date butchers feed cows on bran for some days before 
slaughtering. They say the flesh keeps better and has a better 
flavor. Chickens are fed on skimmed milk or buttermilk and 
bran for some days before killing, for the same purpose. The 
effect observed is doubtless due to the suppression of colonic 
putrefactions. 222 
THE NEW DIETETICS 
The Laxative Effects of Clay. 
Dr. Case, of the Battle Creek Sanitarium, observed some years 
ago a laxative effect from the use of fuller’s earth in X-ray ex- 
aminations of the stomach and intestine. Jordan of London has 
recently confirmed this observation and recommends a tablespoon- 
ful of washed kaolin before each meal as an excellent laxative. 
More than thirty years ago, the writer was informed by a 
lady that she had cured her husband of constipation by giving 
him spoonful doses of sand. 
It is quite probable that the eating of clay by various prim- 
itive tribes may be based upon its laxative properties. 
Alder, a traveler among the islands of the South Pacific, says 
of the practice of clay-eating, “The clay is washed down with 
copious drafts of cocoanut water taken a pint at a—well, ‘irriga- 
tion’ is the only word that seems to suit the process. In response 
to our stumbling inquiries as to why they eat dirt, they indicate 
that it is bagoose, or good for them. We came to the conclusion 
that it must be some mineral substance otherwise lacking in their 
diet.” The Acids of Foods 
There are three wholesome food acids; that is, acids which 
are found in natural foods and which when eaten are utilized the 
same as starch, sugar and dextrin, which they resemble in com- 
position. These are citric, malic and tartaric acids. In addition 
to these there are sometimes found in foods other acids which are 
not utilized by the body and hence are not foods, and which with 
one exception (lactic) are more or less harmful; these are acetic, 
oxalic, tannic, benzoic, butyric and uric acids. 
Food acids are burned in the body like sugar and starch, 
which they resemble as shown by their composition: citric acid, 
C6 H8 O7; malic acid, C4 H7 Os; tartaric acid, C4 He 06. 
The food acids, citric, malic and tartaric, are chiefly found 
in fruits, but are also present in the juices of certain vegetable 
foods. With the exception of grape juice, citric and malic acids 
are the acids found in fruit juices. Most berries owe their acidity 
to citric acid, malic acid being present only in small amount. 
Malic is the chief acid of stone fruits and of apples. 
Tartaric Add, 
Tartaric acid is found in quantity only in grapes, though 
traces have been detected in the pineapple and some other fruits. 
It is also present in small amount in potatoes, carrots, cucumbers 
and endive. 
Underhill has pointed out that nephritis may be produced by 
tartaric acid when given freely in the form of tartrates, such as 
Rochelle salts. This fact assumes considerable importance when 
considered in relation to the extensive use of baking powders 
which usually contain tartaric acid in large amount. It is true 
that the amount of tartaric acid, or tartrates, required to produce 
acute nephritis is considerable—much more than that ordinarily 
taken in the form of baking powder or even in a medicinal dose; 
nevertheless, this is no guarantee that profoundly mischievous 
results may not be produced by the long-continued intake of small 
doses of the acid, such as may occur in the free use of baking 
powders, especially in cases of nephritis. 
223 224 
THE NEW DIETETICS 
Malic Acid. 
According to recent observations (Wise) malic acid is almosl 
completely oxidized in the body, and large doses may be taken 
without producing any ill effect. 
Malic acid is very widely distributed, being found in the 
following foods: 
Apples 0.21 to 1.81 Grapes Greens 
Pears 0.11 to 0.50 Quince Beets 
Cranberries 0.50 Strawberries Asparagus 
Cherry 0.56 to 1.54 Peach Spinach 
Currant 2.00 to 3.37 Watermelon Lettuce 
Gooseberry 1.7 to 2.6 Tomato Celery 
Plum 0.55 to 2.15 
Citric Acid. 
Citric acid is the characteristic acid of lemons, and other 
citrus fruits, but it is at the same time found in many other 
fruits and some vegetables. The foods containing citric acid are 
as follows: 
Strawberries 
Currants 
Gooseberries 
Raspberries 
Cranberries 
Pears 
Tomatoes 
Radishes 
Oranges 
Grapefruit 
Cherries 
Legumes 
Limes 
Elderberries 
Lemons 
Pomegranates 
Salant and Wise, of the Bureau of Chemistry, have shown 
(1917) that citric acid, either in the form of lemon juice or 
citrate of soda, is oxidized in the body, none being found in the 
urine even when doses as large as one ounce of citric acid were 
administered. 
Phytic Acid, 
Phytic acid, which occurs in small amounts in bran in the. 
form of phytin, is worthy of mention because of its laxative 
properties to which, it is claimed, the bran of cereals owes one 
of its most important uses. ACIDS OF FOODS 
225 
Unwholesome Acids, 
The unwholesome acids which may be encountered in foods 
are more numerous than the wholesome. Fortunately, they may 
be easily avoided. Those most commonly met are acetic, oxalic, 
tannic, benzoic, butyric, and uric acids. 
Acetic Acid, 
Acetic acid is chiefly met with in vinegar, which contains 
3 to 5 per cent, of this harmful chemical. It is formed by the 
fermentation of sugar. It is sometimes produced in the stomach. 
It may be recognized by its sour odor. It is a very highly volatile 
acid, and is always present when a sour odor is observed, as 
sometimes occurs in vomited matters and fermenting stools. It 
should be added, however, that the so-called “sour” or “acid” 
stomach is not often due to fermentation or to acetic acid, but 
is the result of an excess of gastric (hydrochloric) acid. 
Acetic acid is harmful to digestion, as first demonstrated by 
Sir William Roberts. A teaspoonful of vinegar will at once arrest 
the process of salivary digestion in the stomach. Vinegar, as 
well as pickles, and all substances containing this acid, should be 
banished from the table. It is a chemical compound of use only 
as a reagent in the laboratory and in the arts. It is a poison, not 
a food. 
When used freely in the form of vinegar or pickles, or in 
sauces, vinegar is an irritant to the stomach. Cases of ulceration 
of the stomach due to its use have been reported. Genuine cider 
vinegar is likely to abound in vinegar “eels,” which it has been 
claimed may become parasitic in the human intestine. 
Boix, of Paris, demonstrated some years ago by experiments 
upon animals that acetic acid has twice the power of gin to pro- 
duce gin liver. 
Lemon juice is more than a complete substitute for vinegar 
as an acid condiment. Vinegar is a useless and harmful chemical 
and should be excluded from the table. 
Oxalic Acid, 
Oxalic acid is found in minute amounts in many vegetable 
foods but in notable amounts only in a few. These are rhubarb 
or pieplant, sorrel, spinach, tea, cocoa and pepper. 
All foods containing oxalic acid in any considerable amount 
should be parboiled and the boiling water rejected. 226 
THE NEW DIETETICS 
A study of Table XXIV will show that only the first six 
articles named contain oxalic acid in dangerous quantities, viz., 
cocoa, sorrel, pepper, rhubarb, spinach and tea. Pepper is used 
only in very small quantities and has other noxious properties 
sufficient to condemn it. Cocoa and tea being used as beverages, 
easily introduce a harmful amount of the act'd. A cup of tea or 
cocoa contains four times as much oxalic acid as the body nor- 
mally produces in a day, as shown by the amount excreted in the 
urine. Twice this amount is regarded as pathological. So a 
single cup of cocoa or tea introduces into the body twice as much 
oxalic acid as is found in oxaluria, a diseased condition. And a 
cup at each of the three meals would load upon the body a dose 
six times as great. Evidently these drinks are harmful, if for no 
other reason, because of the oxalic acid which they contain. 
In the use of spinach and sorrel, the oxalic acid should be 
removed by parboiling. 
With the familiar pieplant, or rhubarb, the case is different. 
This plant is used solely for its acid flavor which, unfortunately, 
is chiefly due to the presence of oxalic acid of which it contains, 
as shown by the table, seventeen grains to the pound or more than 
one grain to the ounce. An ordinary serving would contain about 
three grains of the acid. This amount is not sufficient to produce 
immediate ill effects in ordinary persons, although cases of sick- 
ness have been reported. But the amount is more than forty times 
that with which the tissues and the kidney are normally required 
to deal, and this quantity has been known to bring on acute relapse 
in a case of chronic nephritis, a disease often present though un- 
suspected. 
It is well known that degeneration of the arteries and result- 
ing high blood pressure may be caused by the use of water con- 
taining such minute quantities of lead that the presence of the 
injurious metal is not noticeable and can only be detected by 
careful chemical analysis. Metchnikoff has shown also that pre- 
mature old age with degeneration of blood vessels, heart and 
other vital organs is due to the daily absorption of small quanti- 
ties of poisons from the colon. It is not to be supposed that the 
taking of a small quantity of rhubarb now and then will produce 
any very appreciable effect on either health or length of life but 
the same may be said of wine, the use of beer, tobacco, tea, coffee 
and every injurious substance that might be named. It is, how- 
ever, of the highest importance that the character of this plant ACIDS OF FOODS 
227 
should be generally understood, otherwise it would be quite pos- 
sible for a person who happened to be very fond of rhubarb to 
make use of it so frequently or freely as to suffer serious injury, 
especially in cases of disease of the kidneys. 
The healthy body is able to utilize, that is, oxidize or burn up 
citric, malic, and tartaric acids, but the tissues are unable to oxi- 
dize oxalic acid, which consequently passes through the body un- 
changed like a mineral acid. In those morbid conditions in which 
oxalic acid is supposed to be a factor the amount of oxalic acid 
eliminated through the urine every twenty-four hours is only 
about double the normal amount. That is, oxalic acid is so in- 
jurious a substance that, if the amount ordinarily found in the 
tissues is doubled, highly pernicious consequences follow, among 
which are stone in the kidney, stone in the bladder and an ex- 
tended group of distressing nervous symptoms which are included 
under the name of oxaluria. By the dietetic use of rhubarb it is 
easily possible to increase the amount of oxalic acid several times 
the amount which clinical observation has shown to be capable of 
producing grave disease. Of course, a single dose of pieplant 
would produce only temporary effect, but the daily use of pie- 
plant, by exposing the tissues constantly to the influence of this 
poison, must certainly be followed by deleterious effects, since no 
one has ever undertaken to show that the oxalic acid found in 
pieplant is in any way different from oxalic acid derived from 
other sources. 
Some years ago, Sir William Roberts, in experiments con- 
ducted for the purpose of determining the effects of alcohol and 
various other substances upon digestion, demonstrated that oxalic 
acid has a most pernicious effect upon salivary digestion. A 
solution consisting of one part of oxalic acid in ten thousand parts 
of water was found to destroy at once all action of the saliva 
upon starch. Nearly thirty years ago, the writer very carefully 
repeated these experiments and was able to verify in every par- 
ticular the observations of Sir William Roberts. It is evident, 
then, that if pieplant is taken along with farinaceous foods, such 
as bread and other cereals, potatoes, etc., the normal digestive 
action of the saliva upon the starch, by which about half the work 
of starch digestion is normally accomplished in the stomach, must 
•fail altogether. In other words, a very important part of the 
digestive work of the stomach is left undone when rhubarb is 
eaten. 228 
THE NEW DIETETICS 
Those who recommend rhubarb as a food will doubtless reply 
to the above criticism that nearly all vegetables contain oxalic 
acid. This is not questioned; but it is important that the public 
should know that while it is true that nearly all vegetables con- 
tain this acid, the amount contained in most vegetables is exceed- 
ingly small. There are only three vegetables commonly eaten 
which contain any considerable amount; namely, sorrel, spinach 
and pieplant. In the preparation of sorrel and spinach, the oxalic 
acid is dissolved in the cooking water and by parboiling may be 
practically all removed. But if this were done with pieplant no 
one would care to make use of it for it is used solely and exclu- 
sively because of the acid which it contains. That is, in the case 
of sorrel and spinach, the oxalic acid may be readily removed 
without destroying the food value of these articles; whereas in 
the case of pieplant, removal of the oxalic acid would render it 
altogether useless and undesirable. The amount of oxalic acid 
contained in vegetables other than those mentioned is rarely so 
much as one-tenth the amount which these, contain, and this small 
amount is left behind in the cooking water. 
As regards the poisonous properties of oxalic acid we quote 
as follows from the United States Dispensatory: 
Attention was first called to it as a poison by Royston in 1814, 
and the certainty and rapidity of its action have caused it to be largely 
used for suicidal purposes. Death has been produced by it in ten 
minutes. The minimum fatal dose recorded is one dram (60 grains). 
When concentrated, it causes exquisite pain, followed by violent 
efforts to vomit, then sudden dullness, languor, and great debility, and 
finally death without a struggle. When dissolved in twenty times its 
weight of water, it possesses no corrosive and hardly any irritating 
power, but causes death by acting on the brain, spinal marrow and 
heart. It should be noted, however, that the acid, even in weak 
solution, always exercises a corroding or softening effect on the 
animal tissues. 
The morbid appearances caused by oxalic acid are various. In a 
dissection reported by Christison, the mucous coat of the throat and 
gullet could be easily scraped off. The inner coat of the stomach was 
pultaceous, in many points black, in others red, and that of the 
intestines similarly but less violently affected. In another case the 
whole villous coat of the stomach was either softened or removed, as 
well as the inner membrane of the esophagus, so that the muscular 
coat was exposed, and this coat exhibited dark, gangrenous appear- 
ance, being much thickened and highly injected. The stomach usually 
contains a dark fluid, resembling coffee grounds, consisting chiefly of 
altered blood. The tongue and mouth are sometimes white or spotted 
with white. ACIDS OF FOODS 
229 
After reading the above official description of the poisonous 
properties of oxalic acid, who would care to make this noxious 
substance a part of his hill of fare ? That the toxic properties of 
oxalic acid are really present in pieplant is shown by the numerous 
cases of poisoning which have been reported in recent times. 
Here are a few: 
The Journal of the American Medical Association published 
an account of ten cases of poisoning from eating canned rhubarb 
stems, the part usually eaten. Nine of the cases were in one 
family. Only one member of the family, who ate none, escaped 
serious illness. Two who had two helpings had convulsions. 
The timely use of the stomach pump saved worse results. Chem- 
ical analysis showed no poison present other than oxalic acid in 
ordinary amount. 
A man of 41, his wife, four children and servants were all taken 
with violent diarrhea a few hours after having eaten a dish of rhubarb 
leaves cooked with spinach. All recovered rapidly except the man. 
He developed acute nephritis during the following week. 
Tibbies reports cases in which persons who had previously 
suffered from nephritis (Bright’s disease) suffered relapses after 
eating rhubarb. It may be easily understood that persons whose 
kidneys have been damaged by an attack of nephritis may be 
unable to deal with this highly irritant poison even in small 
amount. There are many thousands of such persons. The vic- 
tims of typhoid fever, small pox, and even scarlet fever, measles 
and diphtheria, rarely escape more or less serious injury of the 
kidneys. 
According to Thompson, the pieplant is not used as a food 
in Germany, being there grown only as an ornamental plant. 
According to an English monthly, Illustrated Gardening, the 
same is true in France. In the opinion of the writer the pieplant 
should be relegated to the list of noxious weeds. It is certainly 
not a wholesome food plant. 
The fact shown by Pierson and Butcher that rhubarb stems 
prevent scurvy in guinea pigs proves nothing in favor of their 
use by human beings. Grass and various weeds quite unfit for 
human food will also prevent scurvy in pigs. 230 
THE NEW DIETETICS 
TABLE XXIV* 
Oxalic Acid in Various Foodstuffs per ft000 Parts (Esbach), 
Cocoa-powder 3.520 to 4.500 
Sorrel 2.470 to 3.630 
Pepper 3.250 
Rhubarb 2.466 
Spinach 1.910 to 3.270 
Black tea 2.060 
Beetroot 0.390 
Haricot 0.312 
Dried figs 0.270 
Buckwheat flour 0.171 
Common beans 0.158 
Crust 0.130 
Currants 0.130 
Coffee 0.127 
Crumb 0.120 
Prunes 0.120 
Chicory 0.103 
Salsifies 0.070 
Gooseberries 0.070 
Plums 0.070 
Raspberries 0.062 
French beans 0.060 to 0.212 
Bread 0.047 
Potatoes 0.046 
Barley meal 0.039 
Maize flour 0.033 
Oranges 0.030 
Lemons 0.030 
Carrots 0.027 
Cherries 0.025 
Brussels sprouts 0.020 
Endive 0.017 
Lettuce 0.016 
Strawberries 0.012 
Parsley 0.006 
Cauliflower 0.003 
Tomatoes 0.002 to 0.052 
Tannic Acid* 
Tannic acid, a well known astringent, is found in some green 
leaves used as greens, but in amounts too small to produce 
noticeable effects. It is also present in minute quantities in cer- 
tain fruits. But tea, coffee and cocoa contain this harmful acid 
in large amounts. Tea, for example, contains tannic acid to the 
extent of one-eighth its weight. A single cup of tea contains 
seven to fifteen grains of this astringent drug which renders great 
service to the tanner of hides, but is obnoxious to the stomach and 
a hindrance to digestion through precipitation of the pepsin of 
the gastric juice. 
Coffee contains tannic acid in still larger amount than tea, 
roasted coffee containing as much as 45 per cent, of caffeotannic 
acid, or nearly half its weight. The injurious effects of coffee 
upon digestion are thus distinctly worse than in the case of tea. 
Cocoa contains much less tannin than either tea or coffee. 
It is a mistake to suppose that the tannin of either tea or 
coffee may be avoided by care in brewing. Tannic acid is the 
most readily soluble of all the constituents of tea and so dissolves 
out first. The longer the tea is steeped, of course, the larger the 
proportion of the solid ingredients that will be dissolved. 
Benzoic Acid, 
Benzoic acid is found in certain fruits, especially cranberries, 
plums and prunes. The use of these fruits tends to render the ACIDS OF FOODS 
231 
tissue fluids and the urine acid. Persons with a tendency to 
acidosis or who suffer from gout, “gravel” or uric acid calculi 
of the bladder or kidney should avoid foods containing this acid. 
Benzoic acid is an antiseptic, and for this reason it has been 
extensively used as a preservative, especially in canned fruits, 
apple cider, catsup and other sauces. A small amount—one- 
twentieth of one per cent.—is tolerated by the pure food law. 
Dr. H. W. Wiley very properly opposed the use of this unwhole- 
some chemical in any quantity. Its use should be forbidden and 
all preserved foods containing it should be avoided. 
Butyric Acid. 
This acid results from the fermentation of certain fats. It 
is found in rancid or “strong” butter and other fats. It is a 
poisonous acid and often gives rise to acidosis in children and in 
diabetics when an excess of fats is eaten. 
In starvation, the body is compelled to live upon its stored- 
up fat, and the results are much the same as when an excess of 
fats or an exclusive fat diet is eaten. A certain amount of starch 
or sugar (2 to 3 ounces) is required daily to insure the complete 
combustion of fats and prevent the development in the tissues of 
the harmful butyric acid and other poisonous bodies derived 
from it. 
Butyric acid in the food is highly irritating to the stomach 
glands, exciting an excessive secretion of gastric acid. Persons 
suffering from hyperacidity or diabetes should carefully avoid the 
use of strong butter or rancid fats. The butter used by such 
persons should be freshly prepared from sterilized cream. 
Butyric acid is often produced in considerable quantity in 
the colon when Welch’s bacillus or B. butyricus is dominant. 
There is much foul smelling flatus and the stools have a very 
strong rancid odor. In such cases the colon should be emptied by 
an enema twice a day, using sugar water—three or four pints, 
2 ounces of malt sugar or milk sugar to the pint—and the flora 
should be changed as quickly as possible. 
Rancid, strong smelling stools in an infant indicate the 
necessity for reducing the fats of the diet at once. 
Boix, of Paris, ten years ago made experiments upon rabbits 
which demonstrated the toxic character of butyric acid. An ani- 
mal weighing about nine pounds was given half a gram of butyric 
acid (7.5 grains) daily with its food. It died at the end of four 232 
THE NEW DIETETICS 
weeks, having diminished in weight 40 per cent. Examination 
showed its liver to be in a state of atrophic sclerosis (gin liver).* 
Lactic Acid. 
While not a food, lactic acid is non-poisonous, rarely harm- 
ful, and renders real service in helping to maintain a healthy 
condition of the intestines, especially of the colon. 
Lactic acid is produced in the body by the fermentation of 
sugars by certain bacteria. Two beneficent organisms, the 
B. bifidus and the B. acidophilus, take possession of the intestine 
within a few hours after birth. They produce lactic acid and no 
harmful substances. The lactic acid formed in the colon stimu- 
lates the colon to normal action. So long as these germs remain 
dominant in the intestine, other germs, especially the germs which 
cause putrefaction, cannot obtain a foothold. The stools are not 
putrid and the bowels move normally. 
The lactic acid of sour milk and buttermilk is not unwhole- 
some, but is of no particular assistance to the colon for the reason 
that it is not likely to reach the colon. The ordinary bacteria of 
sour milk cannot live in the colon. Buttermilk prepared from 
the B. acidophilus is of great service in restoring the protective 
flora to the colon, not because of the lactic acid which it contains, 
however, but because of the presence of acid-forming bacteria 
which are native to the colon and capable of thriving there under 
favorable conditions and of lactose, their best nutrient. 
Many years ago, about 1895, the writer began to use enemas 
of buttermilk with marked success in the treatment of colitis. 
Later, whey cultures of B. acidophilus have been used. 
When the stools are putrid, the colon is paralyzed by the 
ammonia and other alkaline substances present. The buttermilk 
enema not only removes the offensive matter but replaces the 
paralyzing alkalies with stimulating acids. 
Lactic acid is a physiologic stimulant of the colon. A dram 
of this acid in two or three pints of water is a most efficient 
means of emptying the colon in cases of obstinate constipation. 
Three ounces of milk sugar or an equal amount of dextrin 
taken three times a day for a week or ten days will change the 
bacterial flora of the intestine so as to make the B. acidophilus 
* Le Foie dcs Dyspeptiques et en Particulier la Cirrhosc par Auto-intoxication 
d’Origine Gastro Intestinale. By Emile Theodor Boix, Paris, 1895. ACIDS OF FOODS 
233 
dominant, and cause the production of a sufficient amount of 
lactic acid in the colon to produce increased bowel activity. 
Uric Acid. 
Uric acid is one of the waste or excretory products of the 
body. It results from the work of the living cells. It is, like 
other waste products, poisonous to the living tissues, and when it 
is not promptly and thoroughly removed from the blood by the 
kidneys it is often deposited in the tissues, giving rise to gout 
and many other grave disorders. An excess of uric acid is also 
a cause of renal calculi, so-called gravel and bladder stones. 
Failure to eliminate uric acid is one of the first indications of 
disease of the kidneys. This condition is shown by an increase 
of the amount of uric acid normally found in the blood. 
It was formerly supposed to be a part of the duty of the 
liver to convert uric acid into urea, which is readily eliminated 
by the kidneys. It is now known, however, that uric acid is an 
end product of metabolism; that is, that it undergoes no further 
change in the body. The human liver is unable to convert uric 
acid into urea. This function is possessed by the livers of car- 
nivorous animals, such as the dog and the members of the cat 
family; but the liver of man, as well as that of the chimpanzee, 
orang-outang and other members of the family of primates to 
which man belongs, do not possess the power to detoxicate uric 
acid by converting it into urea. 
The significance of this fact will be at once apparent when 
attention is given to the work of Dr. Hall, of Manchester, who 
made a study of ordinary foodstuffs in relation to their uric acid 
content, and found that flesh foods of all sorts contain large 
amounts of this waste product. Beefsteak and lean meats gener- 
ally were found to contain as much as 14 grains of uric acid to 
the pound, or 27 grains to 1,000 calories of food value. Sweet- 
bread was found to contain five times as much, or 70 grains to 
the pound, more than 135 grains of uric acid to 1,000 calories. 
It will readily be seen that with a flesh diet enormous quantities 
of uric acid may be thrown into the circulation and thus a very 
heavy burden may be imposed upon the kidneys. The late Prof. 
E. G. Jane way called the writer’s attention to the fact that the 
kidneys of the meat-fed house cat are usually found in an ad- 
vanced state of degeneration. 
Milk contains no uric acid. Sterile eggs are also free from 234 
THE NEW DIETETICS 
uric acid; fertile eggs contain uric acid in small amount after the 
process of incubation has begun. Vegetable foods with few ex- 
ceptions are practically free from uric acid. Beans contains a 
small amount 2.5 grains per 1,000 calories or less than one-tenth 
as much as beefsteak contains. This small amount can be prac- 
tically removed by parboiling. 
TABLE XXV. 
Uric Acid in Foods (Hall). 
Per cent. 
Grains per 
pound 
Cod-fish 
0.058 
4.07 
Plaice 
0.079 
5.56 
Halibut 
0.102 
7.14 
Salmon 
0.116 
8.15 
Tripe 
0.057 
4.00 
Mutton 
0.096 
6.75 
Veal, loin 
0.116 
8.14 
Pork, loin. 
0.121 
8.49 
Ham (fat). 
0.115 
8.08 
Beef, ribs 
0.113 
7.96 
Sirloin 
0.130 
9.13 
Steak 
0.206 
14.45 
Liver 
0.275 
19.26 
Sweetbread 
1.006 
70.40 
Chicken 
0.129 
9.06 
Turkey 
0.126 
8.82 
Rabbit 
0.097 
6.31 
Oatmeal 
0.053 
3.45 
Peameal 
0.039 
2.54 
Haricot beans 
0.063 
4.16 
Potatoes 
0.002 
0.14 
Onions 
0.009 
0.26 
Asparagus 
0.021 
1.50 
The Toxic Effects of Uric Acid. 
While it is more than probable that many disorders for which 
uric acid is not responsible have been frequently charged to its 
account, it nevertheless cannot be denied that uric acid is a highly 
toxic excretory product and that the tissues should be kept as 
free as possible from it. Since it is now known that the human ACIDS OF FOODS 
235 
liver is not able to convert uric acid into urea or some allied 
non-toxic substance, it is clearly evident that one who wishes to 
live long and preserve his liver and kidneys intact to a good old 
age must eliminate uric acid from his dietary as fully as possible. 
There is no doubt of the truth of the statement by Tibbies that 
“the persistent consumption of foods containing a large per- 
centage of purin bodies (uric acid) is apt to lead to their accumu- 
lation in the organism. So long as the liver can transform 
and the kidneys excrete purin bodies, no harm, it may be thought, 
will follow. But a constant irritation of the kidneys by an ex- 
cess of purins, especially uric acid, may result in chronic nephritis 
of the gouty variety, with other evidences of chronic gout. The 
retention of purins in the system is amongst the recognized causes 
of gout, rheumatic gout, uric acid gravel, uric acidaemia, migrain, 
neuralgia, sciatica, epilepsy, vascular diseases, and many other 
conditions of ill-health.” 
To avoid uric acid it is practically necessary to do nothing 
more than to eliminate meats from the dietary, for the amount of 
uric acid found in beans and other vegetable foods is too small to 
be of any significance. 
Normal Food Acids do not Acidify 
the Blood and Tissues. 
Until comparatively recent times it was supposed that food 
acids, like the mineral or fixed acids, tend to acidify the blood 
and the tissue fluids, and on this account all acids were forbidden 
in rheumatism and other disorders in which acids were supposed 
to be present in the body to excess. It is now known that this is 
an error. The food acids are quickly burned up in the body 
like starch, sugar and dextrin. 
Another fact of as great or greater importance is that the 
acids of foods are not free, but exist in combination with the 
alkalies, soda and potash, so that when the acid is burned up the 
soda and potash are left behind. It thus appears very clearly 
that the real effect of food acids is to alkalinize the blood and 
tissue fluids. WHOLESOME FOODS 
There is probably no other animal that includes in its dietary 
so large a variety of substances as does man. In fact, the human 
race, taken as a whole, exploits the bills of fare of the entire 
animal world. There can be found scarcely a plant, a bird, a 
beast, a fish or a reptile eaten by any animal that is not also eaten 
in some form by some man. In addition, man has produced a 
great number of artificial foods some of which are denatured to 
such a degree as to make them unacceptable to many intelligent 
members of the animal kingdom. There are, indeed, few if any 
animals that could be induced to eat a spiced pickle or any one 
of a dozen common dishes which might be named. 
And man essays this complex and varied bill of fare without 
a digestive apparatus adapted to so complicated and difficult a 
task. Like the man-like apes, the chimpanzee and the orang-outang, 
he has a simple digestive machine adapted to the digestion of 
fruits, nuts, soft grains, juicy roots, eggs and milk. His digestive 
system includes no mechanism corresponding to the gizzard of the 
barnyard fowl, the cpiadruple stomach of the bovine, or the 
seven-gastric-power digestive machine of the whale. He has only 
the simple, rather feeble stomach of the primate, the aristocrat of 
the animal kingdom, adapted to the digestion of the choicest and 
most delicate of nature’s tidbits, to dine on the top shelf of 
Mother Nature’s pantry, so to speak, and yet, with this delicate 
simian stomach, he does not hesitate to tackle the world’s bill of 
fare, to do gastronomic stunts from which the hardiest beast of 
the forest might well recoil. 
Under such treatment, it is no wonder that the human gastric 
machine has broken down, and that dyspepsia, constipation, and 
peristaltic woes of various description have become universal in 
civilized lands. Dinner pills and post-prandial sousings of mineral 
water have become a part of the national regimen, but even the 
stout odors of the modern perfumer cannot hide the disgusting 
flavor of my lady’s breath which makes loud advertisement of the 
fact that there is an embargo in the large intestine with an un- 
savory accumulation of decaying food residues. 
A return to biologic living is the most pressing economic as 
236 WHOLESOME FOODS 
237 
well as the most necessary physiologic reform required at the 
present time. 
To eat biologically is simply to eat scientifically, to eat 
normally. This the average man seldom does for two reasons: 
First, he does not know how to do so, having lost largely his 
nutritive instinct, so that he has no safe guide, such as even the 
humblest of the lower animals possesses; and second, because 
wholesome food is in many places almost unattainable on account 
of the ignorance of cooks and caterers. 
The purpose of this section is to present in as concise a form 
as possible the known facts concerning the individual foodstuffs 
which experience and scientific research have established. 
The author has endeavored to avoid wasting space in com- 
monplace descriptions merely for the sake of completeness. Most 
of the data concerning caloric value, reaction balance, and iron 
and lime content, will be found succinctly summarized in tables, 
thus making this technical data more readily available for refer- 
ence than if crowded into the text of the book. 
Calorie Values of Foods. 
The first bill of fare indicating the food value in calories of 
each article served, was computed by the author and used at a 
banquet given by the faculty of the Battle Creek Sanitarium 
(1903) to the late Dr. H. P. Bowditch, professor of physiology 
at Harvard University. The idea was soon developed into the 
present system, which has now been in regular use at Battle Creek 
for nearly twenty years, and has been more or less completely 
copied in some other institutions. This method provides simple 
mechanism for the quantitative regulation of the food intake 
which should come into general use in hotels and restaurants. 
The Childs Restaurants, of New York and other cities, have 
adopted the system in part and find it highly practical and useful. 
Table XLIV, prepared at the cost of much painstaking labor under 
the writer’s supervision, furnishes the necessary foundation for 
the use of the system. 
The calorie, as more fully explained in another chapter, is 
the modern unit of heat and of its equivalent in other forms of 
energy. The calorie is a useful measure of food value because 
food is oxidized or burned in the body, as in a furnace, though 
by a flameless mode of combustion. 
The calorie value of a food is not, however, the only measure 238 
THE NEW DIETETICS 
of its nutritive qualities, for there are other food essentials beside 
food value. A substance may be a good fuel, while a very poor 
food or even a poison, as in the case of alcohol or gasolene. A 
food may have a high fuel value and yet possess a low food 
quality because of indigestibility. Again, a food may be easily 
digestible, as in the case of polished rice, and of high calorie value, 
and yet possess inferior merit as an exclusive food because of its 
lack of vitamins. Thus, in estimating the value of a foodstuff, 
we must take into account all its properties and not its calorie 
value alone. 
Nevertheless, it is of first importance to keep in mind the 
calorie values of the foods eaten as well as their content of lime, 
iron, with other salts and vitamins. 
Method of Converting Percentages in 
Food Composition into Calories Per Ounce* 
As the composition of foods is usually given in percentage, 
while dietetic prescriptions are usually made in calories, it is 
useful to know how quickly to convert percentage figures into an 
equivalent expression of calories per ounce. The caloric value of 
protein and of carbohydrate is approximately 4 calories per gram, 
that of fats, 9 calories per gram. These figures allow a small 
margin for waste through non-absorption. To convert percentage 
values of protein and carbohydrates into equivalent calories per 
ounce, it is only necessary to multiply the percentage figures 
given by 1.136, or approximately one and one-seventh. The calorie 
ounce equivalent of fats is found by multiplying the percentage 
figures by 2.55, approximately two and one-half. 
Changes in Foods Produced by Cookery* 
Man has been defined as a “cooking animal” and for ages 
the culinary art has been highly cultivated and made the means 
not only of utility but of harmful luxury. Through modern 
scientific research, we are coming to know that notwithstanding 
its great service to the human race the art of cookery has asso- 
ciated with it many perils, one of the greatest of which,—the 
most recently recognized,—is the fact that it destroys vital 
elements and so modifies the food as to greatly impair its nutrient 
value. The beasts of the forest, and to a large extent also the 
primitive savage, take their food directly from the hands of 
Nature, unsophisticated and uninjured, and as a result enjoy an WHOLESOME FOODS 
239 
immunity from disease and acquire a vigor and toughness of 
constitution which are unknown to civilized man. The chef of 
the future will display his finest talents, not in the compounding 
of complex combinations of foods with non-foods and poisons, 
into disease-breeding entrees and desserts, but in selecting and 
serving in wholesome and attractive ways the pure products of 
Nature’s great food laboratories—the garden and the farm. 
According to Professor Jordan, of the University of Chi- 
cago, the people of the stone age were not acquainted with the 
art of cooking and ate their food in the raw or natural state. 
Cooking utensils only made their appearance a few thousand 
years ago. 
The cook stove is a necessity to meet the artificial needs 
of our conventional human life. In a primitive normal environ- 
ment, the cook stove could be easily dispensed with. It is a won- 
derful convenience and very greatly enlarges our bill of fare, but 
is not at all a necessity provided the right selection of foodstuffs, 
those biologically suited to man’s needs, can be made. 
The use of fire in the preparation of foods dates from pre- 
historic times. Baking, roasting, boiling, are employed by the 
most primitive tribes in the preparation of foods. Long before 
metal vessels were in use, and even in the absence of stone vessels, 
boiling was done by dropping heated stones into water held in 
wooden vessels or even tightly woven baskets. Some of the wild 
tribes of India cook rice by placing it with a quantity of water 
in a hollow section of green bamboo, and dropping this into the 
fire. In whatever way cooking is done, its purposes are to change 
the consistency of the food, to develop palatable flavors and to 
render it more digestible. Cookery is, in fact, a sort of pre- 
digestion as regards the starch content of the food. When mois- 
ture and heat are applied to starch, it swells up, the granules 
rupture and the raw starch is converted into a simple form of 
dextrin known as amylo-dextrin, which gives to gelatinized starch 
or starch paste its adhesive properties. As ordinarily employed 
in cookery, starch is gelatinized at a temperature considerably 
below the boiling point. Dififerent starches require different tem- 
peratures for gelatinization. 
The temperature required for the gelatinization of different 
starches is shown in the following table (Grindley) : 240 
THE NEW DIETETICS 
Oats .185° F. 
Barley 176° F. 
Rye 176° F. 
Wheat 176° F. 
Rice 176° F. 
Maize 167° F. 
Potato 149° F. 
In cooking with water or steam, the cellulose is softened and 
the gums dissolved and pectose is gelatinized. This permits the 
food particles to fall apart. For this reason, cooked food is more 
readily soluble in the stomach and sooner passes out into the 
intestine. 
It is interesting to note that potato starch, which when cooked 
is digested by the saliva much more easily than the cereal starches, 
is also much more readily dextrinized by heat. 
A higher temperature, such as that to which bread is sub- 
jected in baking, still further dextrinizes the starch, but no 
amount of heat will convert it into sugar, although starch as well 
as sugar is caramelized by a sufficiently high temperature. 
It is evident, then, that the effect of cooking upon starch is 
to render it more readily digestible. This may or may not be an 
advantage. In the case of protein, digestibility is decreased. 
Lean meat, like the albumin of egg, is hardened by a temperature 
of 160° F. or more. The white of egg exposed to heat just 
sufficient to curdle it is thereby rendered easily digestible, while 
the raw white of egg passes through the alimentary canal with 
little change, being practically indigestible. When white of egg is 
exposed to a higher temperature, as in boiling, the albumen is 
hardened to such an extent that it becomes difficult of digestion. 
The same is true of meat and other albumins. The heat to 
which they are exposed in boiling, roasting, frying, etc., renders 
these nitrogenous substances less digestible than in their native 
state. 
Fats through exposure to heat are likewise rendered less 
digestible. Emulsions exposed to heat tend to break down. The 
fat globules when heated run together, forming large masses 
which are less easily digestible and must be again emulsified in 
the process of digestion. 
Sugars are not changed by cooking unless they are exposed 
to a temperature above 212° F. At higher temperatures, the WHOLESOME FOODS 
241 
sugar is caramelized to some extent and its sweetness is lessened. 
When cane sugar is boiled in the presence of acids, an inver- 
sion takes place which lessens its sweetening properties. 
Exposure of foods to the boiling temperature destroys the 
antiscorbutic vitamin and may lessen the value of other vitamins 
present. 
Boiling foods in water, if the water is thrown away, robs 
them of dextrin, sugar, vitamins, soluble salts and other valuable 
nutrient elements. 
It is thus apparent that the cooking of food has its disad- 
vantages as well as advantages. It cannot be denied, however, 
that the bill of fare which man everywhere has adopted would 
be practically impossible without cookery. The cereals which 
constitute the staple food of both civilized and semi-civilized sec- 
tions of the human race are in their native, dry state unsuitable 
for human sustenance. The same is true of most of the succulent 
roots which enter into our ordinary dietary. 
Sustenance upon uncooked food is only possible when a very 
careful selection of foodstuffs is made. Such a bill of fare would 
necessarily consist of ripe fruits, nuts, tender shoots, succulent 
roots containing little or no starch, such as the turnip and the 
ground-nut and cereals in the milk state, with milk and eggs. 
Eggs taken in a raw state could hardly be regarded as whole- 
some because of the indigestibility of the raw white of egg, 
recently discovered, and the increase of intestinal putrefaction 
when the raw white of egg is eaten. 
Meat is digestible in a raw state even more readily than in 
the cooked state, but is readily accepted by no member of the 
primate family except when hard pressed by hunger. 
TABLE XXVI. 
Showing Percentage of Water and Solids in Various Articles of 
Food Before and After Cooking. 
, Cool 
Water 
ked * 
Solids 
t Unco' 
Water 
oked -s 
Solids 
Arrowroot 
93 
7 
16 
84 
Beef 
5 7 
43 
71 
29 
Cabbage 
97 
3 
89 
11 
Carrots 
93 
7 
86 
14 
Cod 
76 
24 
82 
18 242 
THE NEW DIETETICS 
Haddock 
68 
32 
78 
22 
Lamb 
67 
33 
72 
28 
Lentils 
66 
34 
12 
88 
Mutton leg 
51 
49 
63 
37 
Oatmeal . 
92 
8 
13 
87 
Onions 
99 
1 
82 
18 
Peas, dried.... 
62 
38 
14 
86 
Peas, green 
87 
13 
75 
25 
Vegetable marrow 
99 
1 
95 
5 
The following table (Grinclley) shows the amount of water 
in raw vegetables and in the same vegetables after boiling: 
TABLE XXVII. 
Showing the Gain of Water by Vegetables in Cooking. 
Per cent, of 
water in 
raw state 
Per cent, of 
water after 
cooking 
Increase 
Parsnips 
82.0 
97.2 
15.2 
Artichokes 
80.0 
91.6 
11.6 
Cabbage 
89.0 
97.5 
8.5 
Spinach 
90.0 
98.0 
8.0 
Cauliflower 
90.8 
96.4 
5.6 
Sea-kale 
93.3 
97.9 
4.6 
Vegetable marrow 
94.8 
99.1 
4.3 
According to Professor Snyder, 100 pounds of cabbage con- 
tain 7.5 pounds of solids-, of which more than one-third, 2.5 to 3 
pounds is lost when the cabbage is cooked in water. 
Carrots cut in small pieces and cooked in water lose 20 to 30 
per cent, of their weight. Potatoes lose little if cooked in their 
jackets. 
Spinach has a solid content of 10 per cent., of which nearly 
one-fourth is lost when the spinach is cooked in water and 
drained. 
Celeriac has a solid content of 9.5 per cent., of which half 
is lost by boiling in water. 
Curly greens, borecole, loses half the weight. 
When boiled in water, rice, if the water is poured off, loses 
so large a proportion of its valuable nutrients that native Indian WHOLESOME FOODS 
243 
soldiers preferred the liquid drained off, leaving the residue for 
the British. 
Vegetables in general are more weighty after cooking than 
before. If there is loss in weight it is because of the loss of 
nutrients. One hundred ounces of green artichokes weigh, after 
cooking, 336 ounces; Brussels sprouts, 121 ounces; leeks, 252 
ounces; lentils, 238 ounces; Quaker oats, 1,110 ounces; rice, 418 
ounces. 
Raw Food Diet. 
Some years ago, the practice of feeding exclusively upon 
raw foods was strongly urged by certain faddists. The argument 
used was that exposure to heat destroys the vitality of the food 
and thus lessens its nutrient value. The idea was extensively 
exploited and commercialized by certain adventurers under whose 
unscientific instruction hundreds of people subjected themselves to 
a dietary better adapted to horses and oxen than to human sus- 
tenance. 
The majority of these victimized persons soon learned the 
error of their ways and returned to more rational methods of 
feeding, often after suffering more or less damage. 
Not infrequently, however, persons who adopted the raw 
food diet found themselves appreciably benefited by the change, 
doubtless because their diet had previously been deficient in vita- 
mins. 
Another advantage of the raw food diet which may, perhaps, 
be one of its chief merits is the fact that it supplies to the colon 
a considerable amount of raw starch which, being digested and 
converted into dextrin and sugar by the unused ferments always 
present in the feces, furnishes the kind of nutriment necessary to 
encourage the growth in the colon of acid-forming or fermentative 
bacteria, thus combating putrefaction and encouraging normal 
bowel action. 
It may fairly be said that while it is doubtless true that the 
art of cookery has rendered possible the existence of human 
beings under conditions which would otherwise have been impos- 
sible, and has probably been the means of preserving the human 
race under circumstances which might otherwise have caused its 
extinction, this art has nevertheless wrought much mischief 
through the unwise manner in which it has been employed. The 
art of cookery has been used not only to render food more digest- 244 
THE NEW DIETETICS 
ible, but more often to lessen its digestibility and to transform 
the simple, wholesome products of Nature into noxious, disease- 
producing mixtures. 
The fact that primitive man took his food in a raw or un- 
cooked state is sufficient evidence that it is possible to subsist 
upon foods in the state in which they are provided by the hand of 
Nature. 
In addition, it must be said that there is good ground for 
believing that there are certain qualities possessed by raw foods 
which render them an important and even indispensable part of 
the normal diet, even though one may not go so far as to exclude 
cooked foods altogether from his diet. 
According to Hon. W. N. Beaver, for many years a magis- 
trate in Papua, New Guinea, the natives of Kiwai formerly ate 
their rice raw. The Scotch Highlanders have from time im- 
memorial eaten their oatmeal simply scalded. 
A person who desires to live upon a raw diet, in arranging 
his bill of fare cannot base his selection upon the supposition that 
all raw foods are complete nutrients, but must possess a sufficient 
knowledge of the newer facts pertaining to nutrition to enable 
him to make such combinations of foodstuffs as will constitute 
an aggregate complete in all the elements required for perfect 
nutrition and in adequate quantities; in other words, a diet which 
supplies, in addition to a sufficient amount of fats, carbohydrates, 
salts and cellulose, a proper proportion of complete proteins and 
an abundant supply of the various vitamins essential to good 
nutrition. It is thus apparent that a diet consisting exclusively of 
fruits and nuts might not meet these requirements. Such a diet 
would meet all nutritive needs as regards proteins, fat and carbo- 
hydrates, but might be notably deficient in roughage, vitamins 
and salts. Certain nuts, if taken in sufficient quantity, would 
furnish the needed quantum of iron and lime, but there would 
still be a deficiency of cellulose and vitamins. 
For a complete dietary, it would be necessary to add to fruits 
and nuts a liberal supply of green leaves in the form of greens, 
lettuce or similar foodstuffs. On such a diet, carefully selected, 
life might be well sustained for an indefinite length of time. 
Jolles, of France, has shown that the blood contains ferments 
which he calls katalases, the function of which is to set free 
oxygen from the oxyhemoglobin. These ferments are found in 
healthy blood in large quantities, but they are greatly diminished WHOLESOME FOODS 
245 
in tuberculosis, nephritis, carcinoma. The intensity of oxidation 
depends upon the amount of katalases present. It is possible that 
the reducing ferments which abound in raw fruit and vegetable 
juices may be of service to the body in conditions in which the 
oxidizing ferments are deficient in the blood. 
There is some ground for believing that the remarkable in- 
fluence upon nutrition exercised by the juices of fresh or un- 
cooked fruits and certain vegetables is due to certain enzymes 
which are destroyed by cooking. Some of these enzymes very 
closely resemble those which are found in the body. For example. 
Professor S. H. Vines reported in 1902 the discovery of ferments 
in plant juices capable of digesting albumin. The same investi- 
gator later discovered that these proteolytic ferments are found 
in pineapple juices, in the milk of the coconut, and in the juices 
of melons, cucumbers, tomatoes, grapes, pears, oranges, bananas, 
lettuce, cabbage, green peas, onions, potatoes and turnips. 
By means of cookery, grains and vegetables can be made to 
furnish adequate quantities of the chief elements required to 
satisfy our nutritive needs, and by supplementing these foodstuffs 
with greens and dairy products and an adequate supply of fresh, 
uncooked foods in the form of fruit, celery, lettuce and other 
salad plants, it is possible to meet nutritive needs at a minimum 
of expense and inconvenience. 
Finally, it is to be said that while we cannot easily dispense 
with cookery, we must take care to use the art in such a manner 
as to avoid the injuries which it is capable of producing, and must 
not neglect to include in the bill of fare a sufficient amount of 
natural foodstuffs “untouched by fire,” to make certain of sup- 
plying to the body an ample amount of the subtle products which 
are found in natural foodstuffs—such as vitamins—and which 
are damaged or destroyed by cooking. An exclusive diet of fresh 
or uncooked foods may be adopted for a change now and then 
with advantage. Taking such a diet for a day or two every two 
or three weeks is an excellent means of stimulating intestinal 
activity and keeping the intestinal flora in good condition, and in 
some cases of obstinate constipation a continuous diet largely 
made up of fresh foods is found highly beneficial. Cereals 
The cereals are seeds for the most part derived from grass- 
like plants. The most important cereals are rice, wheat, oats, 
corn, barley and millet, to which may be added buckwheat and 
the less known quinoa and kaoling. 
The cereals are among the oldest of foodstuffs used by man. 
Very likely they were first used in a half ripened, the so-called 
“milk” state, when they are very palatable and readily digest- 
ible. Some varieties of green corn are quite as palatable without 
cookery as with. In tropical countries cornfields are often robbed 
by apes and baboons, whose dietary is believed to be essentially 
the same as that of primitive man. 
Cereals, like most other seeds, consist of three essential parts : 
(1) a germ which represents the future plant; (2) a store of 
nutrient material consisting of a considerable volume of starch, 
a smaller amount of protein and a still smaller quantity of fat, 
together with ferments for the digestion of the starch and protein 
and vitamins for the promotion of the growth of the new plant, 
with food lime, food iron and other salts; (3) a protective cover- 
ing to preserve the stored nutrient material from injury by the 
elements and the attacks of bacteria and insects. 
An interesting fact which has received little attention until 
very recent years is that the several essential elements named, all 
of which are essential not only for the proper nutrition of the 
plant but equally for the nutrition of the eater of the seed, are 
not homogeneously distributed throughout the seed but are very 
unequally placed. For example, the carbohydrates, starch and 
sugar are almost wholly found in the center of the kernel; the 
protein, vitamins and salts are, on the other hand, found in the 
layers of cells placed just beneath the outer covering of the seed. 
Certain of the vitamins are found almost altogether in the germ 
and in the bran. 
From the foregoing it is plain that if seeds are to be used as 
food the whole seed must be employed. The covering of the seed, 
or bran, and the germ contain precious elements which are essen- 
tial for complete nutrition. Ignorance of this fact has resulted 
in the death of many thousands of persons annually in rice-eating 
246 CEREALS 
247 
countries. It is stated on good authority that until the importa- 
tion of polished rice was forbidden not less than 15,000 people 
died annually from beri-beri in the Philippine Islands alone. 
In general, the cereals are deficient in lime even when the 
outer covering or bran is not removed. The fat-soluble vitamin, 
one of the most important growth-promoting vitamins, the 
absence of which produces night blindness and other evidences 
of degeneration, even complete destruction of the eyes in rats and 
other animals when fed exclusively on a grain diet, is lacking in 
cereals except in the germ. By sprouting the grain, however, the 
amount of vitamins present may be increased to so great an 
extent as to supply the deficiency. 
The Protein of Cereals. 
Some years ago Rubner reported experiments which seemed 
to demonstrate that there is a great difference in the cereals as 
regards the nutritive value of their proteins. The proteins of 
corn were thought by Rubner to be much inferior to those of 
wheat. Recent observations made by Sherman, and later by 
Osborne and Mendel, have shown that there is little or no differ- 
ence in the nutritive value of the proteins of wheat, corn, oats, 
rye and barley. Sherman showed that nine-tenths of the protein 
might be derived from any one of the cereals named provided the 
remaining tenth was obtained from milk or apple. The protein 
of milk is known to be very excellent in character, superior in 
fact to meats of any sort, and the protein of the apple appears to 
be about equal in value. 
The Iron Content of Cereals and Breads* 
It is first of all worthy of remark that while cereals are as a 
class poor in lime, they are comparatively rich in iron. A pound 
and a quarter of graham bread will supply a day’s ration of iron, 
while four times as much would scarcely furnish the lime required 
for one day to make good the body’s loss of lime salts. Even 
corn, which is so deficient in lime as to require 8 pounds for one 
day’s lime supply, contains sufficient iron for one day’s needs in 
a little more than a single pound. 
The average iron content of all the cereals and breads is 
sufficient to supply in one ounce or in 100 calories more than one 
twenty-fifth of a day’s needs. 
Of all the cereals, the highest in iron content is the entire 
wheat, of which 11 ounces supply a day’s iron ration. Barley, 248 
THE NEW DIETETICS 
rye, oatmeal, and graham flour come next and in the order named, 
supplying three-fourths as much. 
Graham bread contains three times as much iron as does 
white bread, 25 per cent, more than pumpernickel, 50 per cent, 
more than entire wheat bread, rye bread and soda crackers. 
Graham bread supplies in 14 ounces a whole day’s iron 
ration or four times as much iron as polished rice, white flour, 
or hominy, more than five and a half times as much as cornmeal, 
four and two-thirds times as much as farina, three times as much 
as macaroni, buckwheat flour or rye flour, and twice as much as 
pumpernickel, pearled barley, brown rice or tapioca. 
Boston brown bread makes a better showing than any other 
of the breads because of the molasses in its composition, furnish- 
ing in a seven-ounce loaf iron enough for a day. As a practical 
source of food iron, oatmeal deserves special mention, 14 ounces 
supplying a day’s ration. 
The cereal foods which show so great a deficiency in iron as 
properly to put them in a list of foods only to be eaten when 
adequately supplemented by foods extra rich in iron, are white 
bread, cornmeal (new process), farina, hominy (toasted corn 
flakes are made from hominy grits), macaroni, buckwheat, pol- 
ished rice (toasted rice flakes and puffed rice) and tapioca. 
The Lime Content of Cereals. 
Of the six great cereals, wheat, corn, barley, rye, oatmeal, 
and rice, the last named feeds many millions more of human 
beings than any of the others. The countless millions of the 
Orient are fed chiefly upon rice. Both polished and brown rice 
are in use throughout the densely populated countries of Asia, 
from Korea to Java. Of all the cereals and the several seeds 
which serve food purposes, rice contains the least lime, only one- 
fourteenth of a grain (0.073 grs.) per ounce in brown rice and 
one-eighteenth (0.055 grs.) in polished rice. Wheat contains four 
times as much lime as brown rice, rye five times as much, and 
oatmeal six times. Corn is the only rival of rice in poverty of 
lime, having but a little more than one-fourth as much lime as 
has oatmeal. 
Instinct seems to have informed the Orientals of the de- 
ficiency of rice in lime salts, for they invariably combine with it 
a liberal amount of legumes of some sort or of greens or fresh or 
salted and dried turnips, all of which foods are very rich in 
lime salts. CEREALS 
249 
It is true, as stated above, that wheat contains four times as 
much lime as rice, but this is only true of “entire” wheat, that is, 
of wheat, wheat meal, or graham flour which includes the bran 
and “shorts.” Fine white flour contains less than half as much 
lime as does entire wheat and only one-sixth as much as does 
wheat bran. Its lime content is but little above that of rice and 
is just equal to that of corn and pearled barley, one-eighth grain 
of lime to the ounce (0.122 grs.). More than 7.5 pounds of fine 
flour, whole corn or pearled barley, or 10.5 pounds of fine flour 
bread, are required to furnish one day’s ration of lime. The 
polished rice in common use in this country is so poor in lime 
that 17.5 pounds barely suffice to furnish the 15.4 grains required 
to meet our daily needs. 
Evidently a rice diet is highly deficient in bone-making 
material and must greatly impoverish the blood and tissues in 
lime content when adhered to for more than very brief periods. 
The United States Government has prohibited the importa- 
tion of polished rice into the Philippine Islands for the protection 
of the Filipinos from beri-beri and lime starvation, but no pro- 
tection is afforded the loyal citizen of this country against the 
same danger. Every American citizen is permitted to indulge in 
lime starvation to the full extent of his ignorance and inclination. 
The rice question is not, however, of such commanding im- 
portance in this country as in the Philippines, because rice is here 
used as a delicacy or a luxury rather than as a food staple, as in 
the Philippines. This may be due in part to the higher price of 
rice as compared with other grains, but is perhaps still more due 
to general lack of acquaintance with the many superior qualities 
of rice, a grain which aside from its deficiency in lime is un- 
doubtedly the finest of all the cereals. Nevertheless, the con- 
sumption in this country of billions of pounds of rice annually, 
involving a deficiency of thousands of tons of lime in the national 
bill of fare, is one very real cause for the increasing prevalence 
of bone diseases and teeth decay in the United States, at least in 
certain sections. 
A danger of identical character exists in certain sections of 
this country, especially in the South, where cornmeal is almost 
as important a food staple for large groups of the population as 
is rice in the Philippines and in South China and the Malay 
Archipelago. Corn pone is the chief item in the bills of fare of 
some millions of negroes and small white farffiers in Alabama, 250 
THE NEW DIETETICS 
Tennessee, Georgia, Kentucky, Louisiana, Arkansas, and the 
Carolinas. A pound of cornmeal per capita is probably not an 
overestimate of the amount daily consumed by the classes indi- 
cated. The 16 ounces of corn should supply at least 12 grains of 
food lime, but actually do furnish one and three-fourths grains 
(1.76 grs.), or about one-seventh (0.15) the amount required. In 
view of this fact, it is no wonder that these poorly fed people 
present many evidences of physical deterioration. 
It is still a question with the physiologists who are making a 
study of pellagra whether this disease may not be due in part, 
at least, to a deficiency of lime. The free use of molasses which 
contains more than a grain and a half of lime to an ordinary 
serving of one and one-fourth ounce, may to some degree miti- 
gate the evils which might otherwise follow the use of a foodstuff 
so greatly lacking in lime salts. 
The same may be said for the use of milk in connection with 
both rice and cornmeal. The combination of molasses or milk 
with cornmeal makes good its deficiency in lime, but milk adds 
also other essential elements and so is greatly preferable to 
molasses. 
Still more deficient in lime is hominy, and also corn flakes 
which are made from grits, a corn product which represents the 
interior of the kernel wholly separated from the outer, lime- 
containing layers. Hominy is even more deficient in lime than is 
brown rice, containing, in fact, but little more lime than does 
polished rice. For a day’s supply of lime one would have to eat 
more than 14 pounds of hominy or corn flakes. Instead of 12 
grains of lime to the pound, as in milk; hominy and corn flakes 
contain only one grain. 
Buckwheat flour is another defective food, containing but 
little more lime than polished rice, less than one-sixteenth of a 
grain per ounce (0.061 grs.). Fortunately, perhaps, the conven- 
tional buckwheat cakes served hot from the griddle as a breakfast 
dish are usually eaten either with molasses or maple syrup, both 
of which are rich in lime, as is also malt honey. 
Breads Are Deficient in Lime, 
All the breads, with the exception of Boston brown bread 
and bread made from the entire rye meal, the pumpernickel of 
central Europe, are notably deficient in lime. Even graham bread 
contains only one-sixth the normal proportion of lime (which CEREALS 
251 
is three-fourths grain to 100 calories) and rye bread has scarcely 
half the ideal proportion. 
As a class, the cereals are notably deficient in lime and must 
be supplemented by other foodstuffs rich in lime salts. Fortu- 
nately, such foods are not lacking. By the use of the nuts and 
fruits already mentioned as desserts, and by the regular addition 
to the bill of fare of legumes, greens and milk products, any 
deficiency may be easily made good. 
But we must not close our discussion of the cereals without 
a further word concerning oatmeal, the richest of all the cereals 
in lime salts. An ounce of oatmeal supplies a little less than half 
a grain of lime (0.425 grs.). In Scotland, where from very 
ancient times oatmeal has been the great food staple of the 
peasantry, it constitutes so large a proportion of the total food 
intake that it becomes a highly important source of lime salts. 
The Scotchman eats oatmeal not only in the form of brose, a dish 
resembling mush made by pouring hot water on oatmeal which is 
thus scalded but not well cooked as in this country, but also as 
bannocks, scones and other forms of bread. 
Whatever the oatmeal lacks for supplying the full quota of 
lime is made up by the cabbage, greens, kale and buttermilk 
which are universally and freely used by the shepherd farmers of 
the Scotch Highlands. In the Highlands, a common practice is 
to scald the oatmeal with the water in which cabbage, kale or 
collards has been cooked. When thus prepared, the porridge, 
known as kale brose, is extra rich in lime salts and affords another 
example of the instinctive demand for mineral food elements 
made by the natural appetites of human beings who have not lost 
their normal instinctive guides through the cultivation of un- 
natural tastes. 
The good results of this liberal supply of food lime are well 
shown in the tall and brawny figures of the Scotch Highlanders 
and doubtless accounts for the world-wide reputation for vigor 
and toughness enjoyed by these hardy grain feeders. 
In the United States oatmeal is comparatively a new ac- 
quaintance. It was not until the Centennial Exhibition at Phila- 
delphia where oatmeal was very adroitly exploited as “Avena” 
that this cereal came into general favor as a breakfast food in 
this country. 
In more recent years, oatmeal has been largely displaced by 
toasted flakes and other breakfast foods made popular by adroit 252 
THE NEW DIETETICS 
advertising. As eaten, the actual amount of the dry material in 
an ordinary serving of corn flakes or rice flakes is little more than 
an ounce and the amount of lime supplied is too small to cut any 
figure of importance in the lime ration. 
A cereal product which has long been used by farmers in the 
feeding of horses, cattle, pigs and chickens, but has only recently 
come into use by human beings, is wheat bran. While low in 
caloric value, as its chief constituent is cellulose, bran is a most 
valuable supplementary food, not only as a source of bulk to 
stimulate the intestines, but as a source of lime and iron. Every 
ounce of bran contains three-quarters of a grain of lime, sufficient 
to balance one hundred calories of food principles. By the addi- 
tion of sterilized bran in liberal quantity, the deficiency in lime 
of various cereal preparations, breads, mushes, etc., may be made 
up. Bran may also be added to potatoes and other vegetables 
which are deficient in lime. 
Finally, it must be said concerning the cereals that while 
they are the world’s staple foods for working animals as well as 
for working men, they are perhaps made to constitute a some- 
what too large proportion of the bill of fare in most civilized 
countries. As pointed out by Bunge many years ago, and con- 
firmed by other authorities, the cereals contain an excess of the 
fixed acids, particularly sulphuric acid, and on this account when 
used too freely they upset the nice balance between acids and 
bases or alkalies in the body, and produce a relative acidosis to 
which numerous ailments are attributed. This tendency may be 
successfully combated by the liberal use of fruits and vegetables, 
especially potatoes, which contain an excess of bases, although 
greatly deficient in lime, a fact which must be borne in mind and 
which requires compensation by the addition of a suitable amount 
of foods rich in lime salts, such as milk, lentils and greens. 
WHEAT, 
Wheat is one of the oldest of our cereal foods. It has come 
down to us from prehistoric times. According to Chodat, the 
ancestor of wheat was the wild emmer, a grass plant which is 
still found growing wild in Asia Minor. 
Wheat is perhaps the most important of our American 
cereals, although in size the annual crop produced is much in- 
ferior to corn. The whole grain contains about one-eighth its 
weight of protein, 70 per cent, starch and 2.4 per cent, cellulose. CEREALS 
253 
It is deficient in certain vitamins; and hence should not be used 
as an exclusive food. 
Analysis of Wheat and the Products of Roller Milling:. 
The gluten of wheat, which comprises almost the entire pro- 
tein content, consists of about equal parts of gliadin, a vegetable 
gelatine, and glutenin. It is obtained by washing out the starch. 
As produced by Nature, the wheat berry contains no elements 
which are not essential for nutrition. Rats fed on whole wheat 
flour thrive and produce young, while rats fed on white flour do 
not thrive and fail to produce young, or if they do, the progeny 
are feeble and do not thrive. Dogs fed exclusively on bread made 
from patent roller flour died on an average at three weeks, 
whereas dogs fed exclusively on whole wheat flour were hearty 
and thriving at the end of 30 days. Pigeons fed on fine flour 
bread soon lose weight and develop beri-beri. If the diet is con- 
tinued they die, but if fed on whole grain, or whole grain with 
the addition of yeast, they recover. There can be no doubt that 
the outer covering of the grain, that is, the bran, is necessary for 
complete nutrition. Tibbies, an eminent English authority, says 
with reference to fine flour: 
The miller and the baker have impoverished the flour and bread 
of some of the most important constituents of the wheat grain, viz., 
the vitamins, enzymes, activators, amino acids and lipoids, which only 
exist in the germ and subpericarpal layers of the bran of wheat. The 
removal of these substances does not matter’ very much in the case of 
well-to-do families, where fresh milk, animal foods and vegetables 
containing vitamins are constantly a part of the daily diet. But it 
matters greatly to the children of the poor, whose chief diet is white 
bread. 
(United States Department of Agriculture.) 
Water 
Protein 
(N x 5.7), 
Fat 
Carbo- 
hydrate, 
Ash 
Milling Products 
per cent. 
per cent. 
per cent. 
per cent. 
per cent. 
First patent flour 
10.55 
11.08 
1.15 
76.85 
0.37 
Second patent flour 
10.49 
11.14 
1.20 
76.75 
0.42 
First clear grade flour 
10.13 
13.74 
2.20 
73.13 
0.80 
Straight or standard 
patent flour 
10.54 
11.99 
1.61 
75.36 
0.50 
Second clear grade 
flour 
. 10.8 
15.03 
3.77 
69.37 
1.75 
“Red dog” flour 
9.17 
18.98 
7.00 
61.37 
3.48 
Shorts 
8.73 
14.87 
6.37 
65.47 
4.56 
Bran 
9.59 
14.02 
4.39 
65.54 
6.06 
Entire wheat flour 
10.81 
12.26 
2.24 
73.67 
1.02 
Graham flour 
8.61 
12.65 
2.44 
74.58 
1.72 
Wheat ground in 
laboratory 
8.50 
12.65 
2.36 
74.69 
1.80 
Germ 
8.73 
27.24 
11.23 
48.09 
4.71 254 
THE NEW DIETETICS 
Bread Making. 
Bread is perhaps the oldest of all prepared foods. Accord- 
ing to Pliny, the earliest Romans were wholly unacquainted with 
bread, but used instead a porridge prepared from parched grain. 
This simple mode of cooking cereals is still in vogue in widely 
separated parts of the world, as among the North American 
Indians and the wild natives of Mexico, who still show great pref- 
erence for parched corn mixed with water, while the gofio of the 
Canary Islanders is another example of the same. The ancients 
prepared their bread from crushed cereals mixed with water, with 
or without the addition of oil. The art of bread making was 
known in ancient Egypt, but was known still earlier in Switzer- 
land, as shown by the relics found in prehistoric lake dwellings, 
which include not only grinding stones for making flour but 
charred loaves of bread. 
The sweetest and most wholesome bread is that made from 
the whole meal of the grain mixed with water, with perhaps the 
addition of a little salt, and baked in thin cakes or small loaves. 
Bread is made in this way by the native Mexicans, the wandering 
Arabs, tribes in northern India, and various other primitive 
people. The beaten biscuit of Virginia, famous for toothsome- 
ness, is a water bread in which the dough is made to rise by air 
well beaten in with a hammer. 
Yeast bread is not unwholesome when prepared from good 
yeast; in fact, the yeast may possibly add something to the pro- 
portion of vitamins contained in the bread. When eaten warm, 
however, raised bread is objectionable on account of the fact that 
the center of the loaf is in a pasty condition and in chewing is 
rolled into small masses which are not easily penetrated by the 
digestive fluids. Bread should always be allowed to stand a 
sufficient length of time to permit the center or crumb of the loaf 
to become friable so as to crumble when rubbed between the 
thumb and finger instead of forming a pasty ball. 
Some alcohol is produced in the raising of yeast bread, but 
this is practically all driven off by the heat to which the bread is 
exposed during the process of baking. If bread is not sufficiently 
baked, the yeast and other ferments will not be killed, some 
alcohol will remain, and the result will be a continuation of the 
fermentation by which the alcohol will be converted into vinegar; 
in other words, the bread will sour. Bread, properly baked, will 
have a hard, friable crust on all sides. CEREALS 
255 
Recent observations by Wahl have shown that bread is im- 
proved by the addition of buttermilk or sour milk, the lactic acid 
present serving to dissolve the phosphates of the flour, to render 
the proteins more soluble, and to otherwise improve the quality 
of the bread. In European countries nut meats are added to 
bread with advantage. 
Bread should always be wrapped with paraffin paper at the 
bakery and before it has had any opportunity for exposure to 
insects or contamination by the hands of workmen. Automatic 
wrapping machinery is now employed for this purpose in all first- 
class bakeries. 
Baking Powders* 
The best baking powders are prepared from bicarbonate of 
soda and bitartrate of potash. In the chemical reaction which 
occurs between these two chemicals carbonic acid gas is set free. 
This, in penetrating the loaf, forms small cavities through the 
tenacity of the gluten and thus makes the bread light. The chem- 
ical combination of the constituents of the baking powder results 
in the formation of rochelle salts, a laxative drug. The use of 
baking powdei is doubtless preferable to the old-fashioned soda 
or saleratus and sour milk method still much in use in the South- 
ern states, but is more or less objectionable not only because it 
leaves an unusable chemical substance in the bread but because 
the alkalies present damage the vitamins, as pointed out by Funk. 
Count Rumford long ago showed how to raise bread by the 
use of hydrochloric acid (C. P.) and bicarbonate of soda. The 
acid and soda combine, setting free the carbonic acid gas and 
leaving as a residue only a small amount of chloride of soda or 
common salt, the quantity being less than is commonly used as 
seasoning. The proper proportions are 80 minims of acid to a 
level teaspoonful of soda bicarbonate for two cups of flour. The 
dry soda is well mixed with the flour and the acid is added to the 
liquid, which should be cold. The ingredients are then mixed 
as speedily as possible and put at once into a hot oven. The 
amounts of soda and hydrochloric acid given above are equivalent 
to four level teaspoonfuls of baking powder. 
Baking powders are superfluous as aids to good cookery. 
They are convenient, but non-essential. The very best and sweet- 
est bread possible may be made without them. What could be 
more toothsome, for example, than the famous “beaten” bread of 256 
THE NEW DIETETICS 
Virginia or the hoe cake of the South, a mode of bread making 
learned from the North American Indian. The tortillas of Span- 
ish America and the unleavened cakes of the Arabs are other 
well known examples of toothsome bread made without yeast or 
baking powder and used by millions of people with entire satis- 
faction. 
It cannot be claimed by any one possessed of a modicum of 
knowledge of human physiology that the daily use of a cathartic 
drug even in small amount can be otherwise than harmful. The 
use of baking powders may be, indeed, an insidious cause of con- 
stipation. 
Says Professor A. E. Taylor, of Philadelphia: 
We must not, however, be oblivious to the fact that a saline 
cathartic residue results from the reaction of every form of known 
baking powder now commonly employed. 
Underhill has shown that rochelle salts cause nephritis in 
animals. It is reasonable to believe that the long continued use, 
even in small quantities, of a drug that in somewhat larger doses 
will cause inflammation of the kidneys in animals cannot be a 
wholesome practice. At least the avoidance of baking powder 
products by persons suffering from chronic nephritis may be in- 
sisted upon as a wise and reasonable precaution. 
Wheat Bran. 
One-fifth of the weight of wheat consists of bran, but this 
small portion contains three-fourths of all the salts and nearly all 
the cellulose of the entire berry. Whole wheat contains 4 grains 
of lime to the pound, fine flour only 1 grain, and lime 12 grains. 
A pound of whole wheat flour contains 37 grains of potash. 
A pound of bran contains 119 grains of potash, while a pound 
of fine flour contains only 11 to 12 grains of this important 
element. 
Bran contains one-twentieth of its weight of salts, one- 
thirtieth of its weight of phosphate of potash, and 7 to 11 times 
as much salts as are found in fine flour. 
Ordinary bran contains about one-third cellulose, 37 to 100 
times as much as does fine flour. Another third consists of starch. 
In addition, there are about 3 per cent, fat and 12 per cent, pro- 
tein. CEREALS 
257 
It is astonishing that we should habitually throw away such 
a large amount of most valuable food material. The evil conse- 
quences of this waste are simply enormous, really beyond estimate. 
The loss of potash, according to Dr. Ross, an eminent Eng- 
lish authority, predisposes to cancer, and is perhaps one of the 
leading causes of cancer. The loss of the cellulose which is neces- 
sary to give bulk to the food leads to constipation, a veritable 
mother of maladies. By the use of one-third to one-half ounce 
of bran, daily, regular bowel movement may be secured in the 
majority of cases of constipation. Many obstinate cases are re- 
lieved by adding simple exercises and the use of paraffin oil. 
Decay of the teeth is often a result of loss of lime from the 
body. The teeth are robbed of their lime to supply the deficiency 
resulting from the use of fine flour bread, cane sugar, meat, and 
other foods deficient in lime. Half an ounce of bran taken 
daily with other food will aid in supplying the body with neces- 
sary mineral elements and thus help to check decay of the teeth 
and injury to other of the bone structures. 
How to Use Bran* 
Bran cannot be well eaten by itself. It must be combined 
with other foods. There are numerous excellent combinations 
which have been well tested and found satisfactory. 
First of all, it is necessary that the bran itself should be of 
good quality. Ordinary bran is very dirty, abounding in germs 
of many sorts, and also weevil and other insects. To be whole- 
some as food, bran must be prepared from thoroughly sound 
wheat, which must be very well cleaned, brushed, and washed 
before grinding. The bran should then be sterilized so as to 
make sure that it is thoroughly free from bacteria. If prepared 
in the home, the bran should be carefully selected, thoroughly 
washed, and baked in an oven until well cooked. 
This cooked bran may be mixed with different cereals in 
various proportions. Among the most practical combinations are 
bran and oatmeal, bran and cornmeal, and bran with rice. Bran 
may also be combined with purees of potato and other vegetables. 
The proportion should be about one part of bran by weight to 
three parts of oatmeal, corn, or rice, or equal parts by bulk. The 
steel-cut oatmeal is better for this purpose than rolled oats. As 
the bran has been thoroughly cooked in sterilizing, it does not 
require long cooking. The oatmeal and bran mixture is made 258 
THE NEW DIETETICS 
very palatable by cooking six to ten minutes, and has a better 
laxative and antitoxic effect than when long cooked. Sterilized 
bran may also be added to ordinary graham flour to increase its 
richness in salts and cellulose, and may thus be used in the 
preparation of mush, gems, rolls, bread, crackers, etc. The very 
finest bran bread possible may be made by adding cooked bran 
to good spring wheat flour. This proportion should be about one 
part of sterilized bran to six of flour. Housewives nearly always 
have difficulty in making graham bread, for the reason that the 
diastase of the bran acts upon the starch, converting it into dex- 
trine, making the loaf sour or heavy. This difficulty is obviated 
by the use of cooked bran, or by sifting out the bran of graham 
flour, and boiling or baking it, then returning it to the flour. 
The Anti-graham Campaign, 
One of the most meretricious of the many venial exploita- 
tions to which the public are at the present time being subjected 
is the campaign against the use of graham bread or flour pre- 
pared from the whole wheat. It is evident that this campaign is 
being carried on altogether in the interest of the millers, who for 
years have been exacting an enormous toll for their production of 
superfine, denatured flour which represents only a fraction of the 
nutritive value possessed by the whole wheat berry. The primary 
assumption of the millers is that they know more than does 
Nature concerning the nutritive needs of the human animal. 
Their object, of course, is not to promote the welfare of the 
public, but to enrich their own pocketbooks. 
It is now nearly eighty years since Sylvester Graham, from 
whom graham flour and graham bread derived their distinctive 
names, started his nation-wide campaign in favor of whole wheat 
meal. His propaganda was urged with great earnestness, but 
after twenty years his disciples were few. In the writer’s boy- 
hood, graham flour could not be purchased west of Rochester, 
New York. It was only to be gotten by buying at the mill the 
various products obtained by grinding wheat and mixing these 
together in the proper proportions; but within the last 60 years 
the graham idea has rapidly extended and at the present time 
graham bread is obtainable at every bakery of any size in nearly 
all parts of the country. Graham bread is found upon tens of 
thousands of American tables daily. Besides, the people have 
become accustomed to the use of whole grain preparations in CEREALS 
259 
various other forms, such as wheat flakes, shredded wheat and 
oatmeal. It is quite too late to now come forward with scarecrow 
doctrines about indigestion, malnutrition and sundry other evils 
likely to result from the use of whole grain preparations. The 
people were fooled by these arguments for many years but now 
have their eyes open. 
The purely mercenary motives of the propagators of these 
doctrines at the present time may be clearly seen in the fact that 
the same mills which employ skilled writers to instruct the public 
about the dangerous consequences likely to result from the use of 
graham flour because of the small percentage of bran which it 
contains employ other writers to extol the marvelous virtues of 
bran and the importance of making regular use of it daily and 
even at every meal. The public have learned by experience the 
value of bran as a substitute for the nauseous pills and mineral 
waters with which the American stomach has so long been per- 
secuted. 
A report that graham flour was the cause of illness and even 
deaths in Belgium during the war has been much exploited by the 
millers. There is good reason to believe that the real cause of the 
sickness was a cargo of spoiled wheat which was shipped from 
the West to Belgium after having been rejected as unfit for 
milling. 
The wholesomeness of bran is clearly shown not only by the 
world-wide use from time immemorial of whole grain prepara- 
tions, but by the general use of very coarse rye bread (pumper- 
nickel) by many European nations for centuries before the war 
and of a still coarser bread during the war. Hindhede attributed 
the lowering of the death-rate in Denmark more than 25 per cent, 
chiefly to the use of bread made of rye flour with the addition of 
wheat bran. Mendel has shown that rats thrive on a diet in which 
meat has been replaced by wheat bran, and poultry raisers have 
reduced the mortality of incubator-hatched chickens from 40 per 
cent, to 4 per cent, by substituting bran and buttermilk for meat 
scraps and meat meal. 260 
THE NEW DIETETICS 
CORN. 
Maize, or Indian corn, is distinctly an American product and 
has been justly termed “the Indian’s gift to civilization.” Luther 
Burbank has proved this invaluable grain to be probably a lineal 
descendant of a Mexican plant, teosinte, a member of the grass 
family which grows wild on the table lands of Mexico and Cen- 
tral America. 
In nutritive value, whole corn slightly exceeds wheat. It is 
less rich in protein than is wheat, and its protein, according to 
the observations of Rubner and others, is less valuable as a 
nutrient than is the protein of wheat. Its two proteins, zein and 
glutelin, are very unequal in nutritive value. Animals fed on 
zein by Osborne and Mendel did not thrive, while those fed on 
glutelin were well nourished. By the addition of milk, however, 
the deficiencies of zein are compensated so that a diet consisting 
of corn mush and milk is a combination well adapted to the nu- 
trition of the body. 
Dr. George K. Cherrie, a well-known naturalist who accom- 
panied Mr. Roosevelt in his South American exploration, and who 
recently returned from his twenty-eighth expedition to the Ameri- 
can tropics, reports that the diet of the natives of Venezuela is 
corn and goat’s milk. That this diet is sufficient for complete 
nutrition is shown not only by the good health and great endur- 
ance of the natives of the country, but by the fact that Mr. Cherrie 
himself lived for many weeks at a time on the native diet, and 
mentions no ill efifects from the simple bill of fare. 
A staple diet of cow’s milk and corn would be a simple and 
effective solution of the problem of the high cost of living, at 
least so far as food is concerned. Our corn crop alone, if fed 
exclusively to human beings and dairy cattle, would more than 
suffice to feed our whole population of 100.000,000 people. 
Of course it is not to be expected that the national bill of 
fare will ever be made so simple as this, but the facts presented 
afford ample evidence of the great economic advantage of a simple 
regimen from which superfluities and harmful luxuries are elimi- 
nated. 
The aborigines of America made corn their staple food. 
Said Dupratz, writing in 1763, “All the nations who inhabit from 
the sea as far as the Illinois and even further carefully cultivate 
the maize corn, which they make their principal subsistence.” CEREALS 
261 
The Peruvians from the most ancient times have subsisted 
chiefly upon corn, as they do at the present day. The writer has 
in his possession an ear of corn recovered from an ancient tomb 
near Lima, Peru, which is believed by the authorities of the 
American Museum of Natural History to have been interred not 
less than 2,000 years ago. In appearance it does not differ from 
our modern hard corn. 
TABLE XXVIII. 
Showing' the Composition of Corn Products.* 
■M 
G 
G C 
cS 
G 
■g isS 
<D 
U 
& • 
« G 
H £ c 
© 
? ? s 
U CD 
•rH 0) 
<D 
© © 
fcl © © 
3 to u 
G - 
&H 
0) 
& Ph 
Cd d) 
fc £ 
5 p © 
GO 5C P* 
Ok 
Corn, whole grain, average 
10.8 
10.0 
4.3 
71.7 
1.7 
1.5 
1,795 
Corn with low protein content.— 
10.5 
6.0 
3.8 
78.5 
1.2 
1,685 
Corn with high protein content.. 
10.5 
12.9 
4.4 
70.8 
1.4 
1,695 
Corn, white 
11.4 
10.8 
5.0 
68.8 
2.5 
1.5 
1,690 
Corn, yellow 
11.9 
10.7 
4.8 
68.9 
2.2 
1.5 
1,690 
Sweet corn (matured) 
8.8 
11.6 
8.1 
66.8 
2.8 
1.9 
1,750 
Sweet corn (green) 
73.0 
5.0 
19.5 
446 
Pop corn 
10.7 
11.2 
5.2 
69.6 
1.8 
1.5 
Hominy, fine 
11.0 
9.4 
.7 
78.2 
.4 
.3 
1,810 
Samp, coarse 
Cornmeal (whole grain ground), 
10.8 
8.3 
.5 
79.4 
.4 
.3 
1,770 
unbolted 
Cornmeal (whole grain ground), 
12.0 
8.7 
4.7 
71.1 
2.2 
1.3 
1,850 
bolted 
12.0 
8.9 
4.9 
72.0 
1.2 
1.0 
1,765 
Cornmeal, granulated 
12.5 
9.2 
1.9 
74.4 
1.0 
1.0 
1,770 
Cornstarch 
90.0 
1,675 
Corn syrup 
16.0 
83.5 
.5 
1,120 
Corn oil 
100.0 
4,040 
Cornmeal. 
The old-fashioned hoe cake and cornmeal mush, prepared 
from meal made from the entire grain, sometimes called water 
meal because ground on stones turned by the old-time water 
wheel, are the best modes of utilizing corn as food. New process 
cornmeal is robbed of much of its salts; and corn bread made in 
the modern fashion, with sour milk and saleratus or baking pow- 
der and a liberal admixture of lard, is still further deteriorated. 
Old style cornmeal, mixed with water and a little salt and baked 
in thin cakes, the method still used in many parts of the Southern 
states, is the finest corn bread possible. 
*Farmers’ Bulletin 298, U. S. Dept, of Agriculture. 262 
THE NEW DIETETICS 
Cornmeal Mush and Milk. 
Hart and Steenbock, in experiments upon pigs, have shown 
that for the best results milk and cornmeal must be used in equal 
quantities. It is necessary to provide sufficient milk protein to 
balance the incomplete protein of corn. In the mixture named, 
the milk would furnish about 30 per cent, of the protein. This 
homely dish, long approved by common experience, is now shown 
to be a highly scientific combination. 
Corn Oil. 
Corn oil is prepared from the germ of the grain, which con- 
stitutes about one-tenth of its weight. The old process cornmeal 
contains the germ and the entire grain with the exception of the 
outer skin. The germ is removed by the new process, and the oil, 
which constitutes more than 4 per cent, of the whole of the grain, 
is separated and subjected to special processes of purification, 
the final product of which is corn oil, a wholesome vegetable oil 
which is as digestible as other varieties of vegetable oil although 
it is lacking in the fat-soluble vitamin which is found in butter, 
and hence is not a complete substitute for the dairy product. 
White and Yellow Corn. 
The chemical composition of white and yellow corn is essen- 
tially the same, although they differ in flavor because of the 
characteristic aromatic substances found in the oil. Hess has 
recently claimed that carotin, the coloring matter of yellow corn, 
contains the important fat soluble growth-promoting vitamin 
which is found in butter, from which it would appear that yellow 
corn has a somewhat greater value as a nutrient than has white. 
Grits. 
Hominy and samp contain about 10 to 20 per cent, less pro- 
tein and 10 per cent, more carbohydrate than the entire grain. 
They contain only one-fifth as much of salts, being almost wholly 
deficient in food minerals. 
Corn Starch. 
Corn starch is a preparation of corn from which all but the 
starch has been removed. It contains 10 per cent, water, the bal- 
ance being carbohydrates in the form of raw starch granules. CEREALS 
263 
Corn Syrup. 
Corn syrup, or glucose, consists of corn starch which has 
been subjected to the action of a mineral acid and heat and 
thereby converted into a form of sugar. When thoroughly puri- 
fied from the chemical substances used in the process of its manu- 
facture, it is probably not unwholesome, although it cannot rightly 
be regarded as a complete substitute for the sugars and other 
carbohydrates found in the sweet juices of fruits and other sac- 
charine foods. 
Pop Corn. 
Pop corn is one of the most wholesome of cereal foods. It is 
easily digestible and to the highest degree wholesome, presenting 
the grain in its entirety, and hence superior to many denatured 
breakfast foods which are found in the market. 
Everybody is familiar with the method of popping corn. It 
is notorious, however, that the corn sometimes pops more readily 
than at other times. In order that it shall “pop” well it is neces- 
sary that the kernels should contain a certain amount of water. 
A good plan is to soak the pop corn in water over night, then 
allow to air, dry until it no longer feels moist, the surface appear- 
ing dry. It is now ready to pop. A method of popping which 
produces particularly excellent results is the following: 
Put into a large iron kettle half a pint of cooking oil of some 
sort. Heat nearly to boiling point. Drop in a pound of shelled 
pop corn prepared in the manner above directed, stirring gently. 
The corn pops at once and fills the kettle, making about six quarts. 
Honduras rice may be popped in the same way, and is very 
toothsome. Popped rice prepared in this manner is much used 
in China. 
Green Sweet Corn. 
This delicious vegetable, for which we are indebted to the 
North American Indian, is a product of our gardens during late 
summer and early fall. The ears are picked when the grain is in 
the milk state; that is, when the carbohydrates are still largely 
the soluble form of sugar and dextrin, which later are converted 
into insoluble starch for storage. Sweet corn contains about 13.5 
per cent, of starch, 6 per cent, of sugar, and 5 per cent, of protein. 
It is usually prepared by boiling or roasting. Roasted ears are 
much sweeter than boiled for the reason that in boiling the sugar 264 
THE NEW DIETETICS 
is largely lost in the cooking water. Steaming is a better mode of 
cooking than boiling, and the finer varieties, especially the yellow 
bantam and Mexican varieties, are entirely acceptable to the 
palate when eaten uncooked, and are at the same time more 
wholesome. 
Toasted Corn Flakes. 
Toasted corn flakes are a breakfast food prepared from white 
corn grits by a process of which the following constitute the sev- 
eral successive steps: 
1. Cooking at a temperature above the boiling point. 
2. Drying. 
3. Tempering by the addition of water or steam. 
4. Milling by mills specially constructed for the purpose by 
means of which the grits are flattened out into large flakes. 
5. Toasting in a traveling oven. 
6. Salt and other flavorings added in the process of cooking. 
This product, devised by the author many years ago, in an 
effort to provide palatable dextrinized cereal foods for the patients 
of the Battle Creek Sanitarium, was at first designated to be 
eaten dry as the best means of stimulating the action of the saliv- 
ary glands and to encourage the practice of thorough mastication. 
Eaten with milk, corn flakes constitute an excellent breakfast 
food. It must be acknowledged, however, that when eaten moist 
with milk or cream they offer no better nutrient than the old- 
fashioned brose of the Scotch peasantry, or the cornmeal mush of 
our childhood days. It cannot be doubted that all our efforts to 
improve upon Nature’s products by artificial manipulations are 
more or less futile and often result in a denaturing which lessens 
their value as foodstuffs. 
Gofio. 
The Indians made porridge from corn which had been 
parched and then pounded into a coarse meal. Corn and other 
grains are used in this way by the natives of the Canary Islands 
under the name of gofio. 
Corn lacks the glutinous property necessary for making 
bread by the yeast process commonly used with wheat flour, but 
Chodat claims to have discovered a ferment by means of which 
good raised bread can be made from corn flour. CEREALS 
265 
OATS. 
The oat has for hundreds of years been the staple food of 
the hardy natives of the Scotch Highlands, but it is only within 
comparatively recent years that oatmeal has become a common 
article of diet in this country, and still more recently that its use 
has become common in other parts of the British Islands than 
Scotland and Ireland. Even at the present time oatmeal por- 
ridge is rarely found as a component of dietaries in Continental 
Europe. When Johnson issued the first edition of his dictionary, 
oatmeal was so seldom used in England that he felt justified in 
defining the oat as a food for men in Scotland and for horses in 
England. When chided by a Scotchman for the opprobrious 
suggestion implied in his definition, Johnson rather testily re- 
torted, “And is it not the truth?” Whereupon the Scotchman, 
after a moment’s hesitation, admitted the statement to be a fact, 
but added, “And where do you find such foine horses as in Eng- 
land and such foine men as in Scotland ?” 
As a human food, the oat is far superior to corn. It is rich 
in lime, which is almost altogether lacking in corn, besides con- 
taining considerable fat. Its nutritive value is so great that a 
single ounce of oats represents an amount of energy equivalent 
to more than 150 foot tons, which is more than double the energy 
represented in an ounce of lean meat, nearly double the energy 
value of bread and more than four times that of the potato. Pre- 
pared in the form of brose and bannocks, the oat is still the staple 
article of diet of the Scotch Highlander; and when supplemented 
with buttermilk and potatoes, it forms, from a nutritive stand- 
point, an ideal diet for securing the fullest degree of physical 
development and maintaining a high degree of energy and endur- 
ance. 
A very old writer, Sinclair, tells us in his “Code of Health” 
that “In their ancient predatory incursions into England . . . 
the Scottish warriors fastened to their saddles a bag fdled with 
oatmeal and a plate of flat iron, upon which they baked their 
grain into cakes. Laying this iron plate, called a griddle, upon a 
fire, they spread upon it their meal, made with water into a thin 
paste, and thus converted it into bread. They could carry a 
sufficient supply of this for thirty days’ consumption, which gave 
them great advantages over an army whose wants were more 
numerous.” 266 
THE NEW DIETETICS 
The brose of the Scotch consists of oatmeal stirred into boil- 
ing water until the mixture thickens, then removed from the fire 
and served at once. The meal prepared in this way is scalded 
rather than cooked. It is, nevertheless, highly palatable. After 
an experience of some years, the writer is prepared to recom- 
mend this as by far the best method of preparing oatmeal por- 
ridge. Cooked in the ordinary way until it becomes a slimy 
pasty mass, oatmeal is constipating; but prepared after the Scotch 
manner, the porridge contains a sufficient amount of uncooked 
starch to produce a laxative effect. The raw or imperfectly 
cooked starch being more slowly acted upon by the digestive juices 
is able to reach the colon before absorption takes place. Starch 
in the colon supplies the nutrient material necessary to encourage 
the growth of acid-forming bacteria and the production of acids, 
thereby preventing putrefactive changes with the formation of 
poisons and encouraging intestinal activity. The food residues 
are thus promptly discharged from the body instead of being 
retained to undergo putrefaction and produce autointoxication. 
The bannocks of the north of England consist of thoroughly 
kneaded oat dough rolled into thin cakes and baked on an iron 
plate suspended over the fire. 
RICE* 
This cereal feeds more human beings than any other. It is 
the staple food of hundreds of millions of human beings in India, 
Burma, China, Japan, and other Oriental lands. Its nutritive 
value is high and its productivity great. Many varieties are 
grown, some requiring submergence, others (upland rice) adapted 
to dry soils. 
Rice takes the place of bread, potatoes and breakfast cereals, 
all three in one, in the Oriental diet. The Chinese coolie works 
long hours on rice; the Japanese jinriksha boy carries his fare 
long distances at the rate of six miles an hour on a diet of rice and 
refuses to substitute the meat which contact with modern civiliza- 
tion has introduced to Japan, because it destroys his endurance. 
The toiling millions of southern Europe have within recent years 
come to appreciate more and more the value of rice, and in this 
country, where wheat and barley have been grown from remote 
ages, rice is steadily gaining ground in popularity through its 
greater digestibility and energy-supporting properties. CEREALS 
267 
Rice contains a smaller amount of potash salts than any other 
of the grains, as pointed out by Bunge, and is on this account the 
least irritating to the tissues and leaves the least residue for 
elimination by the kidneys of any cereal. It will be tolerated by 
the stomach when almost no other food will be received without 
protest. 
The rice diet, described elsewhere, is of special value in 
cases in which there is great irritation of the tissues of the mouth, 
esophagus or stomach and in acute disorders of the kidneys. 
Dr. S. A. Knapp, of the United States Department of Agri- 
culture, himself a sufferer from impaired digestion, seeking for a 
diet which might afford him relief from the distress of indiges- 
tion, recalled the fact that rice eaters while performing prodigies 
of work complained of hunger between meals, due to the fact 
that rice leaves the stomach within an hour and so gives this 
organ an opportunity for rest. Dr. Knapp remarks: “This was 
precisely what I wanted—energy with hunger. I had it as a 
child and lost it somewhere in a busy life. Rice-eating nations 
have energy with unimpaired digestion.” Dr. Knapp also calls 
attention to the fact that the Japanese soldiers subsisting on a 
ration of rice were able to outmarch all the armies of European 
nations in the advance upon Peking at the time of the Boxer 
uprising. “With full equipment they advanced all day at double 
time, and repeated it until even the Russians fell behind ex- 
hausted.” The jinriksha boys of Japan travel all day carrying 
a heavy passenger at the speed of a horse; in fact, there are very 
few horses that can maintain, day after day, the pace set by these 
hearty rice eaters. 
Rice is low in protein, containing only a little more than half 
the amount of protein contained in wheat, but its protein is of a 
superior quality so that its actual value is, as a nitrogenous 
nutrient, not materially less than that of wheat. Rice contains a 
smaller amount of salts than any other of the cereals. The 
amount of lime and iron which it contains is almost nil. 
Polished Rice. 
In the form in which rice is used in this country, it is not 
only lacking in salts but in vitamins, and hence should be re- 
garded as a deficiency food which should never be relied upon as 
a chief nutrient. When polished rice is used, it is well to take at 
the same meal a quantity of wheat bran. This may even be 268 
THE NEW DIETETICS 
mixed with the rice with advantage. It detracts from its appear- 
ance but completely restores the wholesomeness which is lost by 
the polishing of the rice. A good rule is to mix with the rice 
about half its volume of sterilized bran. The bran should be 
mixed with the rice before it is added to the boiling water. In a 
similar way bran should be added to new process cornmeal. Oat- 
meal is also improved by the addition of bran. 
The addition of greens to rice is a most appropriate and sat- 
isfying food combination. The greens supply the lime, iron and 
vitamins which the rice lacks, and in ample quantity. It also 
furnishes an excellent quality of roughage. The Chinese, Japanese 
and East Indians eat liberal quantities of greens with their rice, 
as do the Kaffirs with their "mealies.” 
It would be to the advantage of the people of this country if 
the manufacture and sale of polished rice were forbidden. The 
Filipinos are in this respect better protected from disease than 
are the people of the United States. 
The great attention which has been given to the development 
of the rice industry in India in recent years is well shown by the 
fact that in the rice exhibition held in Bengal in 1906-7, nine- 
teen distinct classes of rice were exhibited, among which were 
drought-resisting varieties of rice, flood-resisting rice, rice which 
can be grown on hillsides without terracing, autumn-maturing 
rices which produce fine grain, winter rices which grow on salt 
lands without protection by embankments, rice producing four 
to six grains in each head, rice the whole plant of which is 
fragrant, black rice, the leaves of which are also black, rice which 
may be eaten without boiling, wild rice, rices which mature in 
three months, and rice which requires nine months to produce a 
crop. 
Wild rice grows in great abundance in shallow lakes in many 
parts of the United States. It was a staple food of the American 
Indian in pre-Columbian days and is still used by them. It is a 
delicious cereal. It is gathered in boats, then dried and slightly 
roasted to insure keeping. 
BARLEY. 
Barley has been so long used in making beer that its value 
as human food seems to have been largely forgotten, at least in 
English speaking countries. Barley is believed to have been the CEREALS 
269 
first of the cereals to be used as human food. Barley cakes are 
mentioned in the most ancient accounts of the eating habits of 
man. 
In composition barley much resembles wheat, although it 
contains a smaller percentage of protein. The protein of barley, 
however, is sufficient in amount and is much superior in quality 
to the protein of corn and beans. 
Barley thrives in a greater diversity of climates than any 
other cereal. It flourishes at the equator and grows equally well 
in the arctic climate of northern Russia. Barley is a staple food 
in Siberia and among many of the tribes of central Asia. 
Hindhede, the eminent physiologist of Copenhagen, con- 
ducted a series of investigations to determine the practical food 
value of barley and concludes that this cereal “is too valuable as 
a human food to be used in these hard times (during the war) as 
a fodder for pigs and in the production of beer.” In Hindhede’s 
feeding experiments the diet of his subjects consisted exclusively 
of barley, margarine, and sugar. The results showed most con- 
clusively its ability to largely replace other grains as a cereal 
food. 
Its chief drawback is the fact that to most people it is less 
palatable than wheat. The bread made from barley is much 
inferior to that which may be made from rye or wheat, and it 
accordingly falls into disuse in countries where these grains can 
be grown. Fairly good bread can be made from it by the addi- 
tion of a proportion of wheat flour. 
Pearl Barley. 
Barley is little used in this country as a food grain except 
in the form of pearl barley, which is frequently used as an invalid 
dish. In the process of pearling the tough outer coat of the grain 
is removed. 
RYE. 
Rye contains a certain proportion of gluten and is capable 
of being made into a nutritious bread, the pumpernickel of the 
Germans, a sour dough bread in which the whole grain is repre- 
sented. Although coarse, and to the American palate rather un- 
palatable, this black bread is nevertheless far more wholesome 
than the superfine white bread in general use, not only because 270 
THE NEW DIETETICS 
of its marked laxative properties but because of the large pro- 
portion of lime and iron, together with a rich store of vitamins 
which it contains. 
MILLET 
Although largely used throughout Asia and in some parts of 
Africa, millet is little known as a food cereal in either the United 
States or Europe. Its composition is very similar to that of 
barley. It contains nearly twice as much cellulose as does wheat. 
Recent experiments by Osborne and Mendel indicate that millet 
contains a richer store of vitamins than any other of the cereals. 
It is, indeed, the only cereal which is able to support animal life 
and development for a considerable length of time when used as 
an exclusive dietary. It is probable that this cereal will ulti- 
mately fill a more important place in the world’s bill of fare than 
it does at the present time. Mixed with a proportion of wheat 
flour, millet flour, especially a flour prepared from proso millet, 
is said to make a fairly good bread. 
QUINOA 
Quinoa, a cultivated pigweed, was a staple food of the natives 
of Mexico and South America before the conquest of these re- 
gions by Cortez. It is said to have produced prodigious crops. 
The seed is rich in protein, of which the flour contains 19 per cent, 
with 60 per cent, of starch and 5 per cent, of fat. The amount 
of cellulose contained in the whole seed is greater than that of 
any other food cereal. 
A Scotchman resident in Peru, where quinoa is still much 
used, declares it to be preferable to oatmeal as a breakfast food. 
KAOLING 
The sorghum grain, long used in India and northern Africa, 
known for more than 50 years in this country but thus far little 
used, is worthy of more attention than it has heretofore received. 
BUCKWHEAT 
Flour prepared from buckwheat is chiefly used for griddle 
cakes. When well prepared and made without contamination by 
burned fat, the griddle cake is not unwholesome; but as ordinarily CEREALS 
271 
prepared, buckwheat cakes are highly productive of indigestion. 
Buckwheat contains more carbohydrate than most other cereals, 
nearly 78 per cent., with a protein content of 6.4 per cent. 
BREAKFAST CEREALS 
The manufacture of breakfast cereals in the United States 
really originated with the late Ferd. Shoemaker of Akron, Ohio. 
Mr. Shoemaker told the writer that as an apprentice in a phar- 
macy in Hamburg, Germany, when a boy, one of his duties was to 
prepare the oatmeal. This was done by hulling the grain by 
putting it through a set of millstones made for the purpose and 
turned by hand, then reversing the stones and putting the grain 
through a second time to convert it into grits. On coming to this 
country he found that the oatmeal in use here was imported and 
sold only in small packages in drug stores for use by invalids. 
He set to work to devise means for manufacturing oatmeal on a 
commercial scale. From a small beginning, he gradually devel- 
oped a great industry, and by carrying on a vigorous educational 
campaign developed a demand for oatmeal which finally grew so 
great as to make the grain a food staple. 
Ready-to-Eat Breakfast Foods* 
Carlsbad, the famous Bohemian watering place, has for a 
century or more owed its popularity in part, at least, to the 
zwieback (provincial German for twice baked) of which visitors 
to the resort were expected to make liberal use as a part of the 
cure. From Carlsbad the use of zwieback, which is simply well 
toasted bread, was introduced into this country through the water 
cures, which at a certain period beginning more than a hundred 
years ago enjoyed a considerable degree of popularity. The 
zwieback was sometimes ground to render it more easily eatable, 
but neither zwieback nor “rusk” was commercially obtainable in 
this country. 
When a medical student in New York City in 1874-5, after 
having made a special study of foods for two or three years, the 
writer became convinced that there existed a widespread need for 
ready-cooked foods, at least, ready-to-eat cereals. A year or two 
later, after becoming superintendent of the Battle Creek Sani- 
tarium, the idea became concrete in the production of granola, 
which consisted of a mixture of oatmeal, cornmeal and wheat 272 
THE NEW DIETETICS 
meal made into cakes with water and exposed to a temperature 
sufficient to dextrinize the starch, with the idea of thus rendering 
it more readily digestible. The product was ground to give it a 
granular form convenient to eat with milk, cream or fruit juices. 
The product became the forerunner of several other similar 
products in which the idea of dextrinizing the starch content of 
cereals was developed in various ways. This was considered im- 
portant for the reason that certain forms of indigestion were 
found to be relieved by the use of dextrinized foods. The reason 
was not then wholly clear, although it was observed that digestion 
was aided by the pre-digestion of starch. We now know that 
undigested cooked starch absorbs the pepsin of the gastric juice, 
leaving the gastric acid free, and thus giving rise to acidity. Pav- 
lov also showed that dextrin is strongly peptogenic, that is, acts 
as a natural gastric stimulant. 
Toasted Cereal Flakes. 
The writer early in his medical experience became convinced 
that indigestion and decay of the teeth were encouraged to a 
marked degree by failure to use the teeth sufficiently in the thor- 
ough mastication of the food. He accordingly made it a practice 
to require his patients to begin each meal by chewing slowly a 
small slice of dry zwieback. One day a patient came into the 
office with a complaint that our prescription had broken her teeth, 
for which she jokingly demanded compensation. The imprac- 
ticability of zwieback as a dry food in several classes of patients 
was at once apparent. Patients with artificial teeth, with sore 
teeth or diseased gums, and patients without teeth, needed some- 
thing which they could chew and comminute without running the 
risk of injury to their teeth or other inconvenience. Experi- 
ments were begun to produce toasted or dextrinized cereals in a 
form which, while dry and crisp, could be properly offered to 
such persons and eaten by them without the addition of milk or 
cream, which would destroy their value as a dry food capable 
of stimulating an abundant flow of saliva, experiments made 
about the same time by the writer having demonstrated dryness 
to be one of the most efficient means of stimulating the activity 
of the salivary glands. 
After some months of experimentation, the writer developed 
the process for making toasted cereal flakes which is now widely 
used in the manufacture of toasted corn flakes, toasted rice flakes, CEREALS 
273 
wheat flakes, etc. The first flakes made were wheat flakes and 
were known as Granose, and later as Toasted Wheat Flakes. 
Various imitations were known as Malta Vita, Force, Vim, 
Egg-O-See, etc. Later, toasted rice flakes, and other cereal 
flakes were developed. 
The writer has been glad to see that these dextrinized prod- 
ucts have been so generally adopted as components of the Ameri- 
can breakfast. Of the score or more different brands of these 
flake cereals now on the market, probably not less than 50 to 100 
carloads are used daily by the people of the United States alone, 
and their use is gradually extending to every other civilized 
country of the globe. The only objection that can be offered to 
these dextrinized cereals is the fact that they are deficient in 
cellulose, vitamins, iron and lime. Vitamins and lime are, how- 
ever, added in the milk with which they are served, and the addi- 
tion of a tablespoonful of bran to the morning dish is a most 
convenient method of making use of this important laxative 
element which, through the pernicious ingenuity of the American 
miller, has been until recently almost altogether excluded from 
the national bill of fare. The bran supplies iron but not enough. 
Spinach or other greens should be made a part of the daily menu 
when corn or rice is freely used. 
The argument offered by some critics that malted and dex- 
trinized foodstuffs weaken the stomach by lessening the work 
required of it, though theoretically plausible, is not conclusive. 
There is a physiologic antagonism between the salivary digestion 
of starch, which takes place first in the mouth and later in the 
stomach, and the gastric digestion proper, which is carried on by 
the acid gastric juice. The more gastric juice in the stomach, the 
more active gastric digestion, the sooner the action of the saliva 
upon the starch ceases after the food enters the stomach; and on 
the other hand, the less complete the digestion of the starch, the 
more gastric digestion is interfered with through the absorption 
of pepsin by the undigested starch, already referred to, and also 
through the incomplete disintegration of the food, a process 
which is greatly facilitated by the action of the saliva, rendering 
the starch soluble. When the food is dextrinized, the digestion of 
starch, being more complete, does not interfere with gastric diges- 
tion but, on the other hand, stimulates the gastric glands to 
greater activity and so promotes the work of the stomach instead 
of hindering it. 274 
THE NEW DIETETICS 
The writer thinks it important to add, however, that he would 
by no means advocate exclusive use of predigested foods or of 
predigested starch for the reason that it is desirable to send down 
into the colon daily a certain amount of undigested starch to 
serve as nutrient material for the protective germs which dis- 
courage putrefaction and encourage bowel action by the produc- 
tion of acids through fermentation. Raw starch is better for this 
purpose than cooked. 
SESAME SEED MEAL 
This oleaginous seed is much used in India and the Orient, 
as well as in all parts of Africa. Dr. Thompson thus describes 
this valuable plant and its preparation: 
The plant grows “to a height of three to six feet, giving off 
blossoms at the beginning of each stalk or branch. The seed pod 
is about an inch in length, a quarter of an inch in diameter, and 
has four cells running lengthwise of the pod, which contain the 
seed. The plant is raised in connection with millet in the gardens 
of the natives. The name is Sesamum Indicum. It is grown a 
good deal in India. 
“When the seed is ripe, the natives cut the plant off near the ground, 
tie it in bundles, and stand the bundles up where they can get perfectly dry. 
A cloth is then spread on the ground and the bundles are beaten with sticks 
to rattle the seeds out. The seed is moistened with warm water and rubbed 
between the hands to remove the outer hull. The seed is commonly black 
in color, but some varieties are nearly white. The seed is next roasted, 
which is the most particular part of the process. A little salt is added 
and the seed is ground between two stones as the natives grind their other 
grains.” 
The writer witnessed the process described in operation on 
quite an extensive scale in Cairo, Egypt, some twenty years ago. 
The ground, roasted seed was used as a meal and also in the form 
of a paste or butter much resembling the peanut butter now in 
general use in this country. V egetables 
Vegetables are chiefly useful because of the carbohydrates 
which they furnish, together with an abundance of the alkaline 
salts, vitamins, and cellulose. Only one class of vegetables, the 
legumes, is rich in protein. A comparatively few vegetables con- 
tain carbohydrates in large quantities. For the most part, vege- 
tables, especially green vegetables, contain a large amount of 
water. 
The carbohydrates of vegetables, when abundant, usually 
exist in the form of starch which possesses the property of being 
more easily digestible than starch from any other source. Certain 
vegetables are rich in sugar, which is, for the most part, in the 
form of cane sugar, the sugar of roots, stems, and leaves. 
Uncooked Vegetables* 
Green vegetables, such as lettuce, parsley and other salad 
vegetables, may be eaten without cooking and may be advantage- 
ously utilized in this way because of the value of the vitamins 
which they contain, some of which are wholly or in part de- 
stroyed by cooking. 
It is hardly possible to overemphasize the importance of tak- 
ing a portion of the food in uncooked form. The primitive an- 
cestors of the human race subsisted wholly upon the natural 
products of the forest, as do a few wild tribes even at the present 
day. As an exclusive diet, uncooked food must be selected with 
the greatest care; and such a diet is hardly possible without the 
addition of milk, eggs or meat, at least for long periods. 
The best foods for use in uncooked form are lettuce, celery, 
green salads, Chinese cabbage, radishes, turnips and green sweet 
corn. Wheat, in the milk state, may be used in like manner. The 
turnip, .and even the carrot, properly prepared may be utilized in 
the absence of other more suitable raw foods. Recent experi- 
ments by Langworthy have shown that raw potato starch is almost 
wholly indigestible, although cooked potato starch digests more 
quickly than any other form of starch known. The starch of the 
unripe banana, like that of the potato, appears to be unusually 
275 276 
THE NEW DIETETICS 
difficult of digestion. The starch of raw cereals, on the other 
hand, has been shown to be quite readily digestible. 
Roots and Tubers. 
Most plants store up in the seed a supply of nutriment to be 
utilized in starting the growth of the new plantlet. The plant 
gathers its nourishment through its roots and leaves. The leaves 
constitute both the lungs and the stomach of the plant. These 
organs must be provided before the plant can begin an inde- 
pendent existence. Certain plants, because of peculiar habits, 
provide an additional store of nourishment in fleshy, succulent 
roots, as in the beet, turnip, parsnip, and carrot; or in fleshy 
underground stems, as in the potato, the sweet potato, the yam, 
the taro, dasheen and yautia. 
Root Starches. 
The idea that root vegetables, particularly starchy roots such 
as the potato, are inferior foodstuffs and indigestible, is a serious 
error which somehow has attained wide currency. The fact is 
that root starches when cooked are by far the most easily diges- 
ible of all foodstuffs. 
Some years ago, Professor Grierson, an eminent German 
physiologist, made a careful study of the digestibility of starches 
from various sources. He found that the starch of rice, wheat 
and corn require two hours for digestion; the starch of oatmeal, 
eighty minutes; while arrowroot digests in thirty minutes and 
potato starch is completely digested in ten minutes. In other 
words, the starch of wheat, corn and rice requires twelve times 
as long for digestion as does the starch of potatoes; and the starch 
of oatmeal, eight times as long. 
No doubt the substitution of cereal breakfast foods for the 
old-time griddle cakes, fried potatoes, fried pork and other indi- 
gestibles has been in the interest of the conservation of the 
American stomach, but there is much reason to believe that the 
Irish potato, steamed or baked, might well fill a larger place in 
the national bill of fare, especially as a breakfast food. 
A baked potato digests in much less than half the time re- 
quired for the digestion of a slice of bread and affords nutritive 
substances in some respects superior to those provided by wheat. 
The housewife adds potato to her bread sponge because it en- 
courages the growth of the yeast plant and so makes the bread rise VEGETABLES 
277 
better. The growth-promoting vitamin which the potato supplies 
in great abundance is as active in encouraging the growth of chil- 
dren as in helping bread to rise. It is equally useful to adults in 
maintaining good nutrition and in promoting the repair of the 
tissues. 
The potato and other root vegetables are also superior to 
cereals in the fact that they supply an abundance of organic 
alkalies, compounds of soda and potash, which are of the greatest 
service in neutralizing the acid wastes of the body and promot- 
ing the purification of the tissues. 
The sedentary habits and the free use of meat and cereals in 
the diet of the average American produce a widespread tendency 
to acidosis, which is a common cause of premature senility, hard- 
ening of the arteries, Bright’s disease and other degenerative pro- 
cesses. If the average American would eat four or five times as 
much potatoes as he now eats, and an equivalent amount less of 
cereals and cane sugar, the result would be a notable lowering 
of the death rate and a marked increase in physical fitness and 
freedom from crippling disease. 
The Iron Content of Vegetables. 
Vegetables are like fruits in their small average content of 
iron per ounce (1.46 per cent, of ration) but relatively large con- 
tent per 100 calories. In this respect they are even more remark- 
able than fruits. Vegetables are also like fruits in the fact that 
their small nutrient value renders possible a bulky intake, so that 
in practical use fresh vegetables become a highly important source 
of food iron. The average iron ration percentage value for 
nineteen common vegetables is 10.4 per 100 calories. 
The vegetable which provides the most iron in an ordinary 
serving is the potato, which in a small serving of three ounces 
provides one-twelfth of a day’s requirement. The Irish farmer, 
who daily eats several pounds of potatoes, evidently gets a full 
supply of iron, notwithstanding the fact that his chief article of 
food aside from the potato is buttermilk, which contains very 
little iron. The Scotch Highlander finds an equally fortunate 
food combination in buttermilk, supplemented by oatmeal brose, 
bannocks and scones. 
Brussels sprouts and cabbage each furnish in a 3 ounce 
serving one-tenth of a day’s supply of iron; and string beans, 
carrots and turnips provide in a small serving, which in many 278 
THE NEW DIETETICS 
cases might easily be doubled, more than half as much iron as a 
serving of potatoes. 
The vegetables which contain so small an amount of iron as 
to be of comparatively little value as sources of food iron, named 
in the order of their inferiority are, beginning with the cucumber 
which contains least of any of the common vegetables, eggplant, 
turnip, and sweet potato. The last named vegetable contains less 
than half as much iron as the Irish potato. 
Onions have a special claim to notice because of the high 
value of the iron compound they supply which, according to 
Stokless, contains more iron even than the hematogen of egg yolk, 
discovered by Bunge, and is equally well utilized by the body. 
So, at last, this often rejected, and by many much despised, 
vegetable is likely to be accorded a more honorable place in the 
list of choice comestibles than it has heretofore enjoyed. It must 
not be forgotten, however, that not a little culinary skill is re- 
quired to eliminate the offensive essential oil of the onion, which 
is by no means its chief attraction, although its most conspicuous 
feature. A peculiar saccharine substance which reveals itself 
only after the rank, blistering aromatic oil has been driven away 
by heat gives to the onion its valuable flavoring quality. 
The Lime Content of Vegetables. 
In studying vegetables with reference to their lime content, 
one is struck by the fact that among a dozen commonly used 
vegetables, omitting greens there is not a single one in which the 
lime salts are largely represented. The average lime content is 
one-tenth grain to the ounce, almost the same as that of cereals. 
Lime is found, however, in notable quantities in certain vege- 
tables. 
Parsnips, onions, string beans and kohl-rabi are compara- 
tively rich in lime, supplying in an ordinary serving, respectively, 
7.0, 3.1, 7.2 and 12.2 per cents, of the total day’s needs. 
Because of their bulky nature vegetables may be eaten in 
much larger quantity than the concentrated cereals, and so a 
liberal intake of lime may be made in eating vegetables in which 
the percentage of lime is comparatively small. The turnip, for 
example, contains less than 0.4 of a grain of lime to the ounce, 
but an ordinary serving is 4.5 ounces, which supplies more than 
one-tenth (11.4 per cent.) of a day’s lime ration. 
Hence nearly all the vegetables may supply a considerable VEGETABLES 
279 
amount of food lime, when in their natural state, or when cooked 
by steam or oven heat; but if boiled, when removed from the 
water in which they have been boiled they leave behind a large 
part of their content of lime and other food salts. Vegetables 
should always be steamed or baked rather than boiled, so as to 
preserve the so-called inorganic elements, which are as essential 
to animal and human life as to the lives of plants. 
Of all the vegetables, the eggplant contains the least lime, so 
little in fact as to be hardly worth noting. The amount found in 
an ordinary liberal serving is only one-tenth of a grain. Next in 
order of deficiency is our most commonly used vegetable, the 
Irish potato, which presents a lime content of only one-twelfth of 
a grain (.086 grs.) to the ounce, requiring the impractical amount 
of 11 pounds for a full lime ration. 
The sweet potato contains a little more lime than the Irish 
potato but is still very deficient in this essential element. Evi- 
dently the potato cannot be safely used as a staple without sup- 
plementing it by other foodstufifs, which are rich in lime. Hind- 
hede, who has devoted his life to food research and with most 
extraordinary benefit to his country and the whole civilized world, 
has shown that human life and energy may be well sustained for 
an indefinite time on a potato diet. A private letter recently re- 
ceived from Professor Hindhede by the writer states that in his 
potato-feeding experiments then still in progress he found it 
necessary to add to the potato liberal quantities of greens or fat. 
The greens supply not only a sufficient amount of lime, but also 
the essential fat-soluble vitamin. 
THE WHITE POTATO 
One of the most important discoveries made by Sir Walter 
Raleigh was the white potato, which he found on Roanoke Island, 
from which he sent to England in 1586 the first cargo of this 
valuable vegetable. Next to the cereals the potato is the most 
important food staple raised in this country. In certain European 
countries it holds a much larger place in the national dietary than 
in this country. 
When first introduced in Europe, the potato met with great 
opposition. It was accused of being the cause of leprosy. In 
more recent years, the potato has been suspected of being the 
cause of indigestion and of rheumatism. All of these objections 280 
THE NEW DIETETICS 
are equally unfounded. The potato is one of the most digestible 
of foods, and has a much higher nutritive value than is generally 
supposed, a single ounce affording more than twenty-four calories 
of nutrient material, or one-third as much as an equal weight of 
bread. Its chief food principle is starch, but it contains also a 
notable amount of protein which is of exceptionally high value. 
It has, indeed, been demonstrated by Hindhede in a very extended 
research that the potato is capable of serving as an exclusive 
source of protein. Hindhede’s subject, a young man, lived on 
potato and margarine as an exclusive diet for three hundred and 
nine days, and during this time did heavy work. 
A second research was undertaken by Miss Lenna F. Cooper, 
in the laboratory of Columbia University. This study showed the 
protein of the potato to possess a high nutritive value, and fully 
capable of meeting the protein requirements of the body when 
taken in the quantity of about three pounds daily by a person 
weighing one hundred and ten pounds. The only other articles 
of food eaten were butter and sugar, the latter in very small 
quantities, and the daily food intake was 2000 calories. The 
water in which the potatoes were boiled was always used. 
It is evident, then, that even with a dietary of which the 
potato forms a very substantial part there need be no apprehen- 
sion of a deficiency of protein. 
The potato is rich in soda and potash, salts which make it 
valuable as a means of combating a tendency to acidosis. It 
would doubtless be well for the American people if they would 
substitute potatoes for a considerable proportion of the cereal 
breakfast foods which they now eat. The excess of acids con- 
tained in cereals, and especially the great excess of acids found in 
meats of all sorts, tends to encourage the development of arterio- 
sclerosis, or hardening of the arteries, and premature old age. 
The alkaline salts are found in greater abundance in the 
potato than in any other staple vegetable food. The potato fur- 
nishes forty times as much of these alkaline elements as do some 
of the cereals. Human beings require the potato and other green 
vegetables to furnish these salts for the same reason that the 
animal requires grass. 
The potato is, however, lacking in lime, and for this reason 
should be supplemented by spinach, or other greens and milk. 
The potato is rich in antiscorbutic and antineuritic vitamins. VEGETABLES 
281 
After the potato was introduced and became generally used 
in Europe, the great epidemics of scurvy which had previously 
prevailed ceased to appear. Potato soup or porridge should be 
used with bottle-fed infants when sterilized milk is employed and 
orange juice is not obtainable. A larger use of the potato would 
be of immense profit to the American people. 
Since Count Rumford (Benjamin Thompson, a New Eng- 
land Yankee,) taught the Bavarians how to make potato soup, 
this vegetable has steadily increased in popularity in Germany, 
where it holds a large place in the national bill of fare. 
The peasantry of Ireland afford, also, a good example of the 
high nutritive value of the potato which, with the addition of 
buttermilk and oatmeal, has shown its ability to develop a vigor- 
ous and long-lived race. 
The poor keeping qualities of the potato is one of the draw- 
backs to its greater use as a nutrient. The new methods of dehy- 
dration promise, however, to overcome this difficulty in this coun- 
try, as they have in Germany, where many thousands of tons of 
potatoes are annually preserved by drying for the feeding of both 
human beings and domestic animals. Dried potatoes seem to have 
all the value of the fresh vegetables except in one particular; the 
process of drying appears to impair the value of the vitamins, 
particularly the antiscorbutic vitamin. 
Potato Poisoning. 
An outbreak of potato poisoning occurred in Glasgow in 
1917 which was traced to sprouted potatoes. Solanin is found 
in very minute quantity in all potatoes, about one part in ten 
thousand, in which quantity, however, it is not harmful and is 
even supposed to give the potato a characteristic, agreeable flavor. 
Very small and half-grown potatoes contain much more solanin 
than do fully mature ones. Potatoes which have sprouted or 
which have grown on the surface and been partially exposed to 
sunlight, contain a harmful amount of solanin and should not be 
eaten. 
Several cases of poisoning from potatoes have occurred in 
which the potatoes became contaminated after having been scrub- 
bed and pared, by being left to stand exposed amid unsanitary 
conditions. The potato affords an excellent culture medium for 
various forms of dangerous bacteria. 282 
THE NEW DIETETICS 
Potato Cookery* 
The manner of cooking the potato is a matter of much im- 
portance. If peeled and soaked in cold water for some hours 
before cooking, 25 per cent, of the protein and a large share of its 
salts are dissolved by the cooking water and wasted if the water 
is thrown away. This method is very suitable for preparing 
soups when the water is used, but is otherwise most wasteful. If 
peeled potatoes are plunged into cold water and brought at once 
to the boiling point, the loss is about two-thirds as great. If the 
peeled potato is plunged directly into boiling water the loss is 
still further reduced about one-third. When boiled without peel- 
ing, the loss of protein is very small, only about one per cent., and 
the loss of mineral matter about three per cent. When boiled in 
this way the potato should be removed at once from the water 
when done. By drainage and evaporation a sufficient amount of 
water is removed to render them dry and mealy; whereas if 
allowed to remain in the water they become soggy. Mealiness is 
due, not to the swelling of the starch grains, as is generally sup- 
posed, but to the separation of the cells in cooking under the 
influence of heat and moisture which soften and dissolve the 
cellulose framework. 
The best method of cooking the potato is by baking. As 
soon as sufficiently baked, they should be removed from the oven 
and their jackets should be broken by squeezing so as to allow the 
steam to escape. 
It has been experimentally proved that 5.5 ounces of potatoes 
will pass through the stomach in 2.5 hours. Mealy potatoes digest 
in less time than waxy ones, and mashed potatoes, sooner than 
unmashed. 
The question is often asked, “Should potato skins be eaten ?” 
The skin of the potato is good roughage, but the popular notion 
that the potato skin contains important nutritive material, especi- 
ally vitamins, is erroneous. Experiments made with animals 
show that potato skins have no protective action against scurvy. 
This is true of boiled and steamed potatoes as well as of baked 
potatoes. Any antiscorbutic properties which the potato skin 
may possess in the raw state are destroyed by cooking. VEGETABLES 
283 
THE SWEET POTATO 
While somewhat more nutritious than the Irish potato, the 
sweet potato, on account of its more pronounced flavor, is not so 
universally liked. It grows best in warm countries and its use is 
chiefly confined to the Southern states and semi-tropical countries. 
It is subject to different kinds of rots and does not keep as well 
as the Irish potato. The sweet potato contains 25 to 30 per cent, 
of carbohydrates, of which about two-thirds is starch. The bal- 
ance is chiefly cane sugar, of which some varieties contain as 
much as 10 per cent. It would be more largely used if it had 
better keeping qualities. The southern varieties are sweeter and 
keep better than Jersey sweet potatoes. It is probable that drying 
processes will soon be employed as a means of preserving this 
valuable vegetable. 
THE DASHEEN 
The dasheen is a highly valuable tuber which has been intro- 
duced into this country from South America by the United States 
Department of Agriculture. It is botanically allied to the elephant 
ear and the dahlia, the tubers of which are also edible. The 
dasheen is richer in starch and protein than is the potato. When 
properly cooked it is highly palatable, and being exceedingly 
prolific and growing in soil not adapted to either white or sweet 
potatoes it may be regarded as a valuable addition to our list of 
foodstuffs. Like the sweet potato, the dasheen requires great 
care in keeping. It is not likely to take the place of the potato, 
but is a palatable and wholesome esculent and is perhaps the most 
easily digestible of all the tubers grown in this country, closely 
resembling in this particular the celebrated taro. 
THE TARO 
The taro is a tropical tuber much used in the Hawaiian 
Islands and certain parts of India, China, and Japan. It re- 
sembles the sweet potato in appearance, and has about the same 
nutritive value. It is eaten by the Hawaiians as poi, a sticky, 
doughy mass which is allowed to ferment before using. Attempts 
have been made to introduce the dried taro in the form of flour 
into this country as a substitute for other farinaceous foods, 
especially for use by invalids. It is less palatable than corn starch, 
but as a nutrient is doubtless superior. 284 
THE NEW DIETETICS 
SAGO 
Sago is a form of starch prepared from a variety of palm 
tree known as the sago palm. A traveller in the South Sea 
Islands describes the simple method employed by the Kia Kias 
in the preparation of sago, which forms the staple article of 
food in the South Sea Islands: 
The palm from which the sago is derived is indigenous to their jungles, 
and we are told that one large trunk of say, two-foot thickness and 
twenty-four length will supply food for four persons for a year. When sago 
is to be prepared a palm is felled and the pithy center is scraped from it, 
macerated with pestles, and soaked in water. The water dissolves the 
starch content and, when evaporated, leaves the starch ready for immediate 
consumption. 
The moist starch is molded into cakes which are dried bone-dry, and 
in this form it seems to keep indefinitely. In preparation for eating, the 
cake is simply softened with water and toasted over a fire until cooked 
sufficiently to suit the individual taste. 
THE CASSAVA 
This is a tuberous root which grows from 10 to 12 inches in 
length, often 3 to 4 inches in thickness and in clusters of 4 to 8. 
This vegetable is little known in the United States but is much 
used in Cuba and other portions of tropical America. It is now 
grown to a limited extent and used in Florida, especially in the 
vicinity of Tampa, chiefly by Cubans who have recently come to 
this country in great numbers in connection with the cigar busi- 
ness. 
According to Turner, the native tribes of Africa prepare a 
poisonous species of the cassava for food by the following primi- 
tive method: 
The fresh root is rubbed through a perforated grater or more 
commonly is scraped with a snail’s shell into a coarse powder; this is 
dried in the sun, is afterwards placed in a kaffir pot over the fire and 
continually stirred during the roasting, in the way that coffee beans 
are treated. This process dispels all hydrocyanic acid. After roasting 
in this manner it can be stored, and will remain good for a long time 
—one to two years. 
When properly prepared the cassava is a very palatable and 
highly nutritious vegetable. Its use in this country should be 
encouraged. 
Cassava bread is prepared from the kassahi root which grows VEGETABLES 
285 
everywhere in tropical South America, Central America and the 
West Indies. Bread prepared from the kassabi root is a sort of 
hardtack with a slight potato flavor. It is prepared without yeast, 
salt or shortening. It is slightly laxative and is largely used in 
preference to other breads on that account. Cassava bread is 
said to be the oldest form of bread used on the American conti- 
nent, the tortilla prepared from corn being a later invention. It 
is the food of millions of people in South America and is to a 
small extent imported to this country and is nearly always 
obtainable in certain stores in New York. 
TAPIOCA 
Tapioca is prepared from cassava starch by heating while 
moist on a hot iron plate with constant stirring. A part of the 
starch is cooked and forms a paste which agglutinates the mass 
which when dry forms small semi-translucent pellets. 
THE YAUTIA 
This is a tuber which resembles the taro, native to the West 
Indies and largely grown in Porto Rico. It is prepared for the 
table in the same manner as yams or sweet potatoes. As served 
in the native hotels of Porto Rico the writer found this vegetable 
quite insipid and by no means equal to the potato. 
THE ONION 
The principal bulb used as food in this country is the onion, 
of which there are more than 70 varieties. The characteristic 
flavor of the onion is due to an oil containing allyl sulphid, which 
is excreted through the lungs when this vegetable is eaten, giving 
the breath a characteristic odor. 
The onion also contains a peculiar form of sugar to which the 
sweet flavor of roasted onions is due. The onion is much used as 
a food in Egypt where it is soft and sweet, in strong contrast 
with the hard pungent product of other lands. Herodotus tells 
us that nine tons of gold were spent in the purchase of onions for 
the workmen who built the pyramids. 
The white onion is preferable to the red and yellow varieties, 
having a milder flavor. Young onions are better than mature 
ones for the same reason. The best method of cooking onions is 286 
THE NEW DIETETICS 
by roasting in the ashes or in a very hot oven. When roasted in 
the oven they may be buried in sand. When prepared in this way, 
the high temperature to which they are subjected volatilizes the 
greater part of the essential oil to which the odor is due and thus 
removes one of the chief objections to the use of this vegetable. 
A fact not generally known which is worthy of note is that the 
onion affords a very excellent form of food iron, and on this 
account may often be eaten freely with advantage by persons suf- 
fering from anemia. 
A very sweet onion, closely resembling the Egyptian variety, 
is now grown in the Coachella valley of California. 
THE GARLIC 
A member of the onion family much used in Oriental and 
other tropical countries. Notwithstanding the general prejudice 
against this vegetable on account of the disagreeable character of 
its odor when present in excess, it must nevertheless be admitted 
that when properly used it does increase the palatability of cer- 
tain salads, soups and other dishes, and a liking for it may be 
easily cultivated. 
THE LEEK 
A relative of the onion much used as a flavor by the Scotch 
and in some parts of England. It was an ingredient of the famous 
cock-a-leekie soup described by Sir Walter Scott and of the 
“Herby” pie of Cornwall, which according to Sir Charles Kings- 
ley “diffuses through the ambient air a delicate odor of mingled 
guano and polecat.” This highly aromatic vegetable has never 
found favor in this country, but is perhaps worthy of greater 
consideration. 
LILY BULBS 
The Chinese and some other Orientals make considerable use 
of the lily bulb, which is boiled or roasted and eaten with sugar 
or syrup. It is a wholesome food, free from sugar and starch and 
is beginning to be used in this country, especially by diabetics. 
THE WATER CHESTNUT 
The water chestnut is a tuber which grows in damp or 
swampy ground. It is small, irregularly shaped and covered 
with a brown skin. It has a white, brittle flesh which much 
resembles the chestnut in flavor. Green Vegetables 
This class of food products contains a smaller amount of 
nutrient material than any other; nevertheless vegetables are 
essential to a biologic diet because of the valuable salts, cellulose 
and vitamins which they contain. They are nearly always spoiled 
in the cooking. When cooked in hard water the nutritive ma- 
terial is hardened and its digestibility diminished by the lime 
and magnesia salts of the water. 
Analysis of the water used in boiling vegetables shows that 
it contains a large part of the nutritive salts and vitamins they 
are able to furnish. On this account vegetables should be steamed 
or baked rather than boiled, or if boiled the water in which they 
are cooked should be utilized in soups or porridge so that the 
important nutritive principles which they contain shall not be 
lost. Fresh vegetables should be used much more freely than is 
customary in this country. 
THE CABBAGE 
At the head of the list of green vegetables should be placed 
the cabbage, which has been used from the most ancient times. 
The cabbage was the Emperor Pompey’s favorite dish. This 
garden vegetable is chiefly valuable for the stores of lime and 
alkaline salts which it contains, together with a considerable 
amount of the valuable antiscorbutic vitamin. These constituents 
are largely lost in boiling, however, so the vegetable should be 
eaten either raw or steamed. The Scotch save the water in which 
cabbage has been cooked and cook oatmeal in it, a dish which they 
call kale brose, a wise economy. 
Cabbage may be eaten raw by many persons who are unable 
to eat cooked cabbage; in fact, raw cabbage is often tolerated by 
persons whose digestion is considered very delicate. When prop- 
erly chewed, this excellent vegetable is very little likely to dis- 
agree. Some years ago the writer conducted a research for the 
purpose of determining the reason for this difference between 
raw and cooked cabbage. One experiment consisted in the inocu- 
lation of equal quantities of raw cabbage and cooked cabbage 
287 288 
THE NEW DIETETICS 
with a definite amount of colon germs. Later examination showed 
that while the bacteria had greatly multiplied in the cooked cab- 
bage they had actually diminished in number in the raw cabbage. 
The greater readiness with which cooked cabbage undergoes bac- 
terial changes in the intestine may be the cause of the disturb- 
ance noticed in some persons. 
Sauerkraut. 
This is a preparation of chopped cabbage which has been 
permitted to undergo lactic acid fermentation. Sauerkraut serves 
the same purpose for the peasantry of eastern Europe and west- 
ern Asia that is served by the silo of the modern dairy farm, in 
which greenstuffs of various sorts are preserved by being made 
to undergo lactic acid fermentation. Sauerkraut supplies the 
Russian peasant with food lime and food iron during the long 
winter months when fresh vegetables are not obtainable. Sauer- 
kraut is little used in this country except by foreigners, but it 
deserves a larger place* in the national bill of fare. 
The cabbage is a valuable source of iron, vegetable salts, and 
vitamins. In addition, it is a valuable means of giving the ali- 
mentary mass the necessary bulk to encourage peristaltic action. 
When properly made sauerkraut is a most wholesome food- 
stuff. The following is a well tested method: 
Select mature cabbage. Remove green and wilted leaves, also 
remove the core of the cabbage. Shred quite fine. Place a layer 
two inches thick in a small crock and pound until juice appears, 
then put into a larger crock or the permanent container. Add 
salt in the proportion of two ounces for each five pounds of cab- 
bage, sprinkling in evenly as each layer is added. 
When the crock is full, place a clean cloth over the top of 
the cabbage, then over this press down a clean board of such size 
that it will fit inside the crock rather loosely. Put one or more 
stones upon the cover. The weight should be sufficient to cause 
the juice to cover the cabbage within a few days. 
Set the container aside in a room of ordinary temperature to 
ferment. When scum forms upon the surface, remove it. The 
scum consists of a micro-organism which if permitted to remain, 
will destroy the acid and cause decay of the cabbage. It is this 
that often develops a bad flavor and odor in sauerkraut. 
The process of fermentation is shown by the rising of bubbles 
to the surface of the liquid. When the bubbling ceases, fer- GREEN VEGETABLES 
289 
mentation is completed, which will be at the end of eight or ten 
days in a warm room; in a cold room, two to four weeks. 
In examining with reference to fermentation, tap the side 
of the container to loosen the bubbles adhering to the inner sur- 
face. 
When the fermentation is finished, that is, when bubbles 
cease to rise, skim carefully and pour on melted paraffin wax to 
the depth of a quarter of an inch. The paraffin should be hot 
enough to cause the brine to boil as it is poured on. The layer of 
paraffin should be sufficiently thick to tightly seal the container 
and should not be disturbed until the sauerkraut is to be used. 
Paraffin is not necessary if a very cold place is available for 
storage. 
Composition of Sauerkraut. 
A reliable German authority gives the following as the chem- 
ical composition of sauerkraut: 
Per cent. 
Water 89.00 
Protein 1.60 
Fat 0.35 
Lactic acid 1.50 
Dextrose : 0.65 
Mannose 1.00 
Crude fiber 1.00 
Ash 2.90 
Sodium chlorid (common salt) 2.00 
BRUSSELS SPROUTS 
A curious member of the cabbage family in which instead of 
one large head the plant bears many small heads. Brussels 
sprouts may be regarded as superior to ordinary cabbage on 
account of the larger amount of food iron present, as indicated 
by the green color due to chlorophyl. 
CAULIFLOWER 
Another remarkable member of the cabbage family of which 
the flower is the edible part. Its chief value is in the salts and 
vitamins which it supplies. 290 
THE NEW DIETETICS 
BROCCOLI 
A variety of cauliflower which is distinguished by the pe- 
culiar form and coloring of its edible flowers. 
Broccoli sprouts, a recent development, consist of flowering 
sprouts which spring from the axils of the leaves. The purple- 
leaved variety is especially esteemed. 
SEAKALE 
A fresh vegetable which is chiefly valuable for its young and 
delicate shoots. It is much used in Great Britain where it is 
found growing wild near the seashore. Kale is easily digestible 
though very low in food value, furnishing only 175 calories to 
the pound. It is less valuable as a source of salts than are the 
cabbage and the cauliflower. 
THE PAI TS'AI OR CHINESE CABBAGE 
The pai ts’ai (pronounced pi-tsi) is a relative of the turnip. 
It forms a cylindrical, rather loose head with greenish outer 
leaves and a white, very tender and pleasantly flavored heart. 
It matures best in autumn and should be sown in midsummer in 
rich friable soil and must be well watered and kept growing 
steadily. Use like cabbage. 
The percentage composition of the fresh raw cabbage is as 
follows: protein, 1.2; sugar, 1.4; fiber, 0.5; ash, 0.5; water, 96.4. 
After extraction by thrice boiling, the composition is: pro- 
tein, 1.07; sugar, 0.05; fiber, 1.16; ash, 0.24; water, 95.30. 
PALM CABBAGE 
The terminal bud of several varieties of palms is a very 
toothsome vegetable which somewhat resembles cabbage in tex- 
ture and has, when raw, a delicious flavor suggesting that of the 
chestnut, and when cooked a delicate meaty flavor. Xenophon 
mentions palm cabbage as being a favorite among the young 
Greeks, who, he says, greatly enjoyed the “brain” of the palm 
as well as its luscious dates. 
The palm cabbage contains a very small amount of carbo- 
hydrates and is suited for use by diabetic patients, for whose 
benefit the millions of cabbage palms growing in the swamps of 
Florida ought to be utilized. This vegetable, canned and sold GREEN VEGETABLES 
291 
under the name, “The Heart of the Palm,” may be obtained from 
certain dealers in delicatessen who get their supply from Union, 
a group of islands of the South Pacific. 
CELERY 
This vegetable is usually eaten raw. Its nutritive value is 
very low, only about five calories to the ounce, but it is rich in 
vitamins, as has been proven by McCollum in feeding experi- 
ments. It is also rich in food salts. Its flavor is appetizing and 
its free use is to be commended. It may be eaten cooked. 
LETTUCE 
The lettuce is a very old-fashioned plant. Its mildly flavored, 
juicy leaves have made it a great favorite from the most ancient 
times. 
Augustus Caesar was very fond of lettuce and attributed to 
its use his recovery from a serious illness. It is said that he 
afterward held this plant in such high esteem that he erected a 
statue and dedicated an altar to it. 
In the time of Domitian, the Romans served lettuce with 
eggs, as we do at the present time—probably one of the most 
ancient of eating customs. It was served with the last course, 
so as to stimulate the jaded appetites of the feasters. 
It is strange that this estimable plant did not reach the 
western world until the time of Queen Elizabeth, when it was 
first grown in England. 
The lettuce furnishes valuable salts and vitamins and sup- 
plies bulk to aid bowel action. It is especially to be recommended 
to those who have a tendency to overfatness. It should be used 
by such persons very freely, and with lemon juice only, oil being 
avoided. A large plateful should be eaten at the beginning of 
every meal. 
ASPARAGUS 
A highly toothsome green vegetable, valuable for its salts and 
vitamins, as well as for the large amount of cellulose which it 
contains. 
Recent analyses of asparagus show that the raw vegetable 
contains 10 per cent, of solids, of which 70 per cent, is soluble in 
cold water and 80 per cent, in boiling water. The composition is 
as follows: 292 
THE NEW DIETETICS 
Water 90.0 
Sugar 3.6 
Protein 3.8 
Fiber 1.0 
Fat 0.5 
Mineral matter * 0.8 
Ter cent. 
Green asparagus contains less fiber than white and yields 
more soluble matter when boiled. The asparagus tip is especially 
rich in vitamins. 
Asparagus is botanically related to the onion. If the tender 
shoots are left in water a few days a marked onion odor develops. 
An oil may be extracted from raw asparagus shoots which con- 
tains sulphur, and it is to this that is due the peculiar odor ob- 
served in the urine after eating asparagus. 
It is evident that asparagus should be steamed rather than 
boiled. After boiling for a few minutes the amount of nutritive 
material left is too small to be of any real value, at least four- 
fifths of all the nutrients having been dissolved by the boiling 
water. 
ENDIVE—WHITE CHICORY 
The blanched leaves are the edible part. It is fairly rich in 
salts but of little nutritive value. 
OKRA 
The edible part is the large unripe seed pod, which contains 
a large amount of pectose which jellies when the pods are cooked 
in water, on account of which it is largely used in preparing a 
dish called gumbo. The pods may be boiled and eaten like 
asparagus. 
THE ARTICHOKE 
This plant is a variety of thistle of which the undeveloped 
flower buds are cooked and eaten. The plant is said to contain 
inulin instead of starch, on which account it is recommended as 
a food for diabetics. 
ICELAND MOSS 
Iceland moss is a lichen which grows in the Arctic regions. 
It is much used by the Laplanders. It contains no starch, and 
whatever food value it has is doubtless due to the cellulose and 
vitamins which it contains. Reindeer moss is also a lichen. GREEN VEGETABLES 
293 
The lichen is a curious partnership between an alga and a 
fungus. The alga forms food, which the fungus cannot do, and 
the thread-like fungus which entwines the alga supplies water; 
thus these two distinct species of plants thrive in partnership 
although neither is able to live alone. 
The use of the lichen as a food for human beings has been 
known from the most ancient times. According to A. A. Han- 
sen, “it has been almost definitely demonstrated that the manna 
which was such a boon to the children of Israel was the manna 
lichen, lecanora esculent a. During certain seasons of the year,, 
this plant dries and hardens, forming warty grains which fall 
in showers from the mountain sides into the valleys. These are 
used as food in Algeria, southwest Asia and the Steppe region. 
The grains form an acceptable substitute for corn.” 
Iceland moss is used in northern regions for bread. After 
soaking in water to remove a bitter principle, the moss is dried 
and ground to a fine flour which is mixed with an equal amount 
of wheat flour and made into loaves of an excellent bread. 
Reindeer moss has been used in Sweden in like manner for 
bread making. This remarkable lichen grows in large tracts in 
northern Minnesota and in many places along the north shore 
of Lake Superior. Its food value is said to be three times that 
of the potato. Millions of reindeer, musk oxen and other antelopes 
thrive upon this hardy plant, which they dig out from beneath 
the snow and the ice of the far north. Reindeer moss may some- 
time become an important source of human sustenance. 
IRISH MOSS 
This is an alga which has long been in use, especially as a 
delicacy for invalids. It is a seaweed which grows along the 
Irish coast. It has little, if any, food value and is much less used 
than formerly. 
AGAR-AGAR 
Sometimes called Ceylon moss, also known as Japanese or 
Bengal isinglass, obtained from a species of seaweed that grows 
along the coast of Japan and Ceylon. 
Agar, taken in its crude state, is an excellent remedy for 
constipation, especially when its use is combined with paraffin oil 
as a lubricant. 
Agar is also most valuable for all culinary uses for which 294 
THE NEW DIETETICS 
gelatine is commonly employed. It makes much finer jellies than 
does gelatine, and is free from every objection which can be 
offered against the animal product. Being pure cellulose (hemi- 
cellulose) it cannot undergo putrefaction, and so may be used 
when most animal products are forbidden. 
Agar is superior to animal gelatine not only in the fact that 
its flavor is not reminiscent of hoofs, horns, fragments of hide 
and sundry other slaughter-house remnants, but also because it is 
more convenient in use. Agar melts at the temperature of boiling 
water, and congeals or jellies at a temperature above 120° F., and 
so does not require an ice box to harden or set even on the hottest 
summer day. It may be used for any purpose for which animal 
gelatine is used. 
MUSHROOMS 
The mushroom is practically of no value as a nutrient, as the 
amount of digestible protein it affords is seldom more than 3 per 
cent., with an equal amount of carbohydrates. Whatever value 
it has is due to the meat-like flavor which it imparts to soups and 
other dishes. It is highly indigestible, and because of the fre- 
quency with which poisonous alkaloids are found in mushrooms, 
certain species of which are always poisonous, it is of very doubt- 
ful value as an article of food. The mushroom flavor, which is so 
highly relished by many persons, can now be obtained without the 
accompanying risk by the use of yeast extracts (known commer- 
cially as Savita, Marmite, etc.). 
Kakowski has shown experimentally that the eating of mush- 
rooms, even those which are regarded as entirely wholesome, pro- 
duces harmful effects in cases of nephritis. 
THE AGAVE 
A recent study of the leaves of the agave shows that they 
contain a considerable amount of useful nutritive material. The 
dried leaf contains more than 25 per cent, sugar, an equal quan- 
tity of other carbohydrates, 16 per cent, malic acid, and 15 per 
cent, of salts, besides a considerable percentage of pectin. 
It is said to be possible to prepare from the juice of the leaf 
a sweet, slightly acid marmalade suitable for food. GREENS 
295 
GREENS 
We are only just beginning to appreciate the value and essen- 
tial importance of greens as a staple constituent of the daily bill 
of fare. In this respect civilized people are far behind the rest 
of the world. The Chinese and Japanese, in fact, all Oriental 
people make great use of greens, as do savage or primitive tribes 
in all parts of the world. Dr. Turner tells us that “few people 
can compete with the Kaffir woman in making ‘a spinach,’ for 
which purpose the young shoots of innumerable plants are used, 
among others the sprouts of the pumpkin, the sweet potato, 
mandioca, and numerous wild plants.” The North American 
Indians made use of purslane, pigweed, and many other common 
weeds as greens. The recent studies of the green leaf and of its 
dietetic uses have revealed many most interesting and important 
facts. 
The most marvelous chemistry known to man is that which 
is wrought out in the secret laboratory of the green leaf. The 
sun is the alchemist, the chlorophyl grain the reagent. Here, in 
this simplest of laboratories, are formed all the marvelous prod- 
ucts of the vegetable kingdom. Here are produced the subtle 
elements from which come all the curious gums and resins, oils 
and essences, all the delicate aromas,—the attar of the rose, the 
fragrance of the lily, the delicate scent of the violet, the pene- 
trating odors of the leek and the garlic, the soporous smell of the 
poppy, all the deadly poisons of the nightshade and hemp, upas 
tree and bitternut, all the rainbow tints of leaf and flower, all the 
proteins and starches and fats of foods, the grain and fibre of all 
woods, and the bark of tree and bush and twig in all the forests 
of the world. 
Cholorophyl was once supposed to be a single color, but now 
we know there are four, two greens and two yellows; and from 
these are compounded all the rest of the numberless tints that 
beautify the world of flowers in field and glen. 
But the end is not yet. In the wonderful green leaf, itself 
the scene of marvelous activity in growth and development, is 
produced a substance that imparts to the young of animals the 
power to grow. Here is the explanation of the marvelous growth 
of calves, colts, rabbits, guinea pigs and antelopes. They seem 
almost to grow and expand before one’s very eyes while he stands 
gazing in wonder and surprise. 296 
THE NEW DIETETICS 
Without this subtle vitamin which promotes growth and de- 
velopment, no animal could grow to maturity. Without it the 
reproduction of animal life would soon cease, and the world 
become waste and void. 
It is for this reason that green vegetables, and especially 
greens, are so important an element of the dietary. Cabbage, let- 
tuce, spinach, cucumbers, greens of all kinds—some of these 
should be a part of every meal. 
Here, too, is found the explanation of the importance of 
milk and dairy products in Nature’s scheme of animal nutrition. 
In her peregrinations about the pasture, the cow gleans from 
grass and tender buds and twigs the precious vitamins, and gives 
them back in her generous lacteal fluid at milking time. 
Nature has made more lavish provision for our sustenance 
than we appreciate. Our perverted instincts and erroneous 
dietetic habits have led us to overlook and ignore some of 
Nature’s finest contributions to our welfare. We quite agree 
with the sentiments expressed by the writer of the following 
paragraphs, one of the experts of the United States Agricultural 
Department: 
What we call weeds are no more so than other plants that we 
term vegetables. Weeds are vegetables, and our so-called vegetables 
were once upon a time no more than weeds. The classification re- 
sults from a matter of habit. We are slaves of habit, and because 
we are so it has not occurred to us that we could eat anything but just 
the old list of vegetables our ancestors have eaten for generations. 
But now we are having our eyes opened and are beginning to peer 
into fence corners and back yards and wild pastures for new and 
wonderful foodstuffs that we have heretofore regarded as just weeds. 
It is a bit mortifying that because of the preconceived idea we have 
let most nutritious and valuable foodstuffs go to waste under our very 
eyes, while perhaps we were wailing that we had little to eat and that 
vegetables were too expensive and so on. 
Among the plants thus neglected, but which, if properly improved 
and marketed, would enrich truck farmers, are yellow dock, dande- 
lions, milkweed, golder thistles, rhallows, purslane (recommended by 
Thoreau), poke-root, red clover, sorrel, hop shoots, yarrow, leek, and 
lupines. 
All green leaves contain iron, lime, vitamins and other useful 
elements and may be used as greens when sufficiently tender for 
the purpose, provided no objectionable flavors or other noxious 
substances are present. Even grass and alfalfa have been used 
in emergency. The Chinese make use of a great number of GREENS 
297 
greens which form a part of every day’s bill of fare. The greens 
most commonly used in this country are spinach, New Zealand 
spinach, chard, dandelion, endive, mustard, turnip tops and let- 
tuce. Lambs’ quarters, a variety of pigweed, red root, purslane, 
and narrow leaved dock are other excellent greens which may be 
cultivated or gathered from fields or fence corners. The accom- 
panying table shows the remarkable amount of lime and iron 
found in each. (Table XXIX.) 
Through the courtesy of Dr. David Fairchild, head of the 
Plant Introduction Bureau of the United States Department of 
Agriculture, the writer recently received several plants of the 
Abyssinian rumex, a relative of our native dock, which promises 
to be a most valuable addition to our own list of garden greens. 
This plant produces in abundance large tender leaves during the 
whole season. The stems are tender as well as the leaves. The 
presence of oxalic acid in considerable quantity is indicated by a 
distinct acid flavor, but this may be easily removed by parboiling 
without materially lessening the rich store of lime and iron found 
in this new rumex. 
Greens as Roughage* 
Greens contain a very considerable amount of cellulose, and 
are thus an excellent sort of roughage. The amount of carbo- 
hydrates, protein and fats which they present is so small as to 
be almost negligible. But they are invaluable as the best sort of 
roughage, a source of the fat-soluble vitamin, one of the most 
precious of all vitamins, being an activator of growth, and lastly, 
a means of supplying to the tissues in a convenient and agreeable 
way the essential requirement of iron and of lime. 
Next to legumes, the greens show the highest iron content 
per ounce of any class of foodstuffs, the average being more than 
6 per cent, of the daily ration of iron. That is, approximately 16 
ounces of a mixture of the several greenstuffs named in the 
table furnish iron sufficient for one day. This is, of course, more 
than one could conveniently eat; but a quarter or even a third of 
this amount may be easily eaten. 
Of the ten most valuable greens, the ones richest in iron 
are mustard greens, spinach, turnip tops, red root, dandelion and 
dock. 
One of the best of all the greens is spinach, which supplies in 
fifteen ounces of raw material iron sufficient for a day. Dock and 298 
THE NEW DIETETICS 
red root are so richly stocked with iron that only seven and a half 
ounces are needed to meet a day’s requirement. An ounce and a 
half of dried spinach leaves will furnish iron sufficient for one 
day. The same amount of iron is supplied by half' an ounce of 
the dried leaves of a common garden weed, the red root. An 
ounce of fresh spinach contains as much iron as an equal weight 
of ordinary beefsteak, and of a better quality. 
It is important to remark about foods in general and of 
greens in particular that care must be exercised in cooking to 
prevent the loss of the lime and iron salts and the equally valu- 
able vitamins. Boiling in water and drawing off and discarding 
the water in which the greens have been cooked, results in the loss 
of a small part ;of the useful elements of greens. On account of 
the considerable amount of oxalic acid found in spinach, this 
vegetable should be parboiled for two or three minutes even at the 
risk of losing a small portion of its salts. 
Prolonged cooking at a high temperature is also damaging, 
and the same seems to be true of drying. It is important to make 
use of greens as soon as possible after gathering from the garden, 
while fresh and crisp. When wilted they become less tender. 
Canned greens are not equal in flavor to freshly gathered ma- 
terial but are nevertheless invaluable additions to the diet when 
fresh are not obtainable. 
It is claimed for the newly perfected methods of preparing 
evaporated vegetables that the process does not destroy the vita- 
mins, although they may be somewhat damaged. 
Hindhede, the eminent physiologist of Copenhagen, wrote 
the author some time ago (1919) that he had kept a man in good 
health for twenty-three months on a strict diet of bread and pota- 
toes with an abundance of greens. Without the aid of the 
greens, a person would soon become anemic on such a diet. 
We learn from a friend who has lived many years in Japan 
that the Japanese peasant always" eats greens with his rice. 
The Lime Content of Greens. 
There seems to be in man as well as in lower animals an 
instinctive recognition of the important position held by these 
coarse and relatively innutritious products in Nature’s scheme of 
nutrition. The craving for greenstuffs experienced by nearly 
everyone as spring approaches is the natural consequence of the 
widespread lime starvation imposed by a winter dietary from GREENS 
299 
which foodstuffs rich in lime are largely excluded. It is true 
that this deficiency in lime, almost universally characteristic of 
winter dietaries, is not necessary, and may be easily prevented 
by a proper selection of readily accessible foodstuffs; but, un- 
fortunately, the fundamental facts respecting the lime content 
of foods have only recently been brought to light through the 
researches, most laborious and painstaking, of the eminent Pro- 
fessor Bunge of Switzerland, and more recently by Dr. Sherman, 
of Columbia University of New York. These facts are as yet 
practically unknown to the general public although of vital im- 
portance. 
In proportion to their nutritive value, there is no class of 
foodstuffs so rich in lime as are greens, as shown in Table XIV. 
For example, polished rice contains one part of lime in 2,000 
calories; cornmeal, one part to 900 calories; beans, one to 600; 
whole wheat, one to 400; hazelnuts, one to 100; while in aspara- 
gus we find one part of lime to 30 calories; in cabbage, one to 24; 
cucumbers, one to 50; dandelion, one to 25; and in chard and 
celery, one to 12. 
Considered from the standpoint of bulk and weight, the 
situation is decidedly different. With a few exceptions, the lime 
content per ounce is not greater in “greens” than in many- other 
vegetables. Notable exceptions are, chard, with a grain to the 
ounce; mustard greens, with 3 grains; paprika, nearly 1.5 grains; 
turnip tops, 2 grains, and watercress with more than a grain. 
As will be seen by a careful study of Table XIV, there is a 
marked difference between the different species of greenstuffs.- 
Brussels sprouts, cucumbers, lettuce and romaine contribute to 
the diet no larger amounts of lime salts than string beans, green 
peas, onions, pumpkins and squash. Lettuce, cucumbers and 
celery are of no more value as sources of lime in the quantities 
eaten than are potatoes, their content of lime being very low. 
The really valuable greens, as sources of lime, are mustard greens, 
turnip tops, chard, collards, cabbage greens, endive and dan- 
delion. Ordinary servings of three or four ounces of these greens 
will yield from 13 to 60 per cent, of the daily lime requirement, 
as shown in the table. 
It is clearly evident that greens are dependable sources from 
which lime salts may be obtained in almost any quantity desired. 
The small ordinary serving of 3 ounces may be easily doubled if 
occasion demands, as when it is necessary to replenish the de- 300 
THE NEW DIETETICS 
pleted body its store of lime in a demineralized patient. By feed- 
ing greens twice a day and doubling the size of the serving, at the 
same time taking care to include in the bill of fare as many foods 
rich in lime as possible, one may easily increase his lime intake 
to three or four times the normal requirement, and thus rapidly 
make good the deficiency in salts which is not infrequently the 
fundamental fault in cases of chronic disease. 
Among other excellent greens which may be mentioned are 
milkweed shoots, golder thistles, poke shoots, cowslip, red clover, 
yarrow, hop shoots, mallows. Purslane, now a neglected garden 
weed, was boiled and eaten in every cottage in the time of 
Charlemagne. It was a favorite of Thoreau and was presented 
to the early settlers of Massachusetts by the Indians who gath- 
ered it from their corn fields. 
The tender leaves of the alfalfa have been used as greens 
with some success. The youngest leaves are selected, freed from 
stems, parboiled, well boiled, and made into a puree. 
The root of the poke root is poisonous but its young shoots 
may be served when cooked like asparagus, which they much 
resemble. The young leaves make excellent greens resembling 
spinach. They should be twice scalded or parboiled. 
Witloof is a variety of chicory. It is planted in the late 
spring or even as late as June, to produce roots to be placed in the 
cellar in the late fall for winter forcing. The roots may be pur- 
chased in the late fall from gardeners. Serve as an uncooked 
salad. 
The archeologists tell us that they find among the relics of 
ancient dwellings evidence that our primitive forbears made use 
of a vast number of plants which we now ignore, and some of 
which might be restored to our bill of fare with advantage. More 
than a hundred such plants, including several excellent greens, 
have been described by an English author, among which may be 
named the red poppy, shepherd’s purse, cuckoo flower, hawthorn 
buds, Alexanders, goat’s beard, sow thistles, nettle, borage, mar- 
joram, couch grass and nipplewort. GREENS 
301 
TABLE XXIX* 
LIMB 
IRON 
Grains 
Per cent, 
of day’s 
ration in 
Grains 
Per cent, 
of day’s 
ration in 
per oz. 
1 oz. 
per oz. 
1 oz. 
Cabbage greens 
... 0.65 
4.2 
0.008 
3.4 
Cardoon 
... 0.93 
6.0 
0.033 
13.2 
Chard 
... 0.92 
6.0 
0.010 
4.7 
Dandelion . 
... 0.64 
4.2 
0.012 
5.1 
Dock, narrow leaved 
... 1.00 
6.7 
0.028 
13.4 
Endive 
... 0.99 
6.4 
0.018 
7.2 
Imperial kale 
... 1.30 
8.4 
0.019 
7.6 
Lamb’s quarters 
... 1.90 
12.5 
0.009 
4.3 
Lettuce 
... 0.26 
1.7 
0.003 
1.3 
Malabar nightshade 
... 1.42 
9.2 
0.013 
5.2 
Mustard 
... 3.01 
19.6 
0.021 
9.2 
Portulaca flora 
... 1.45 
9.4 
0.023 
9.2 
Purslane 
... 0.88 
5.8 
0.008 
3.9 
Redroot 
... 3.24 
21.6 
0.028 
12.9 
Rocket salad 
... 1.32 
8.6 
0.018 
7.2 
Spinach 
... 0.41 
2.7 
0.016 
6.8 
Spinach, mountain 
... 1.27 
8.5 
0.008 
3.9 
Spinach, New Zealand 
... 0.48 
3.2 
0.009 
4.1 
Turnip tops 
... 1.05 
7.0 
0.010 
4.7 
Watercress 
... 1.15 
7.5 
0.008 
3.6 
Lime and Iron Content of Greens* 
Botulism from Canned Spinach* 
The recent occurrence of several deaths and many cases of 
sickness from the use of canned spinach, string beans and other 
vegetables has called attention to the danger from this source. 
Spinach and other canned vegetables should never be eaten with- 
out careful inspection of the cans before they are opened and of 
the canned contents immediately after opening. If the cans are 
bulged, or if the contents have the slightest unusual odor, the 
goods should be rejected. Botulism is in all cases the result of 
improper handling in the canning process. Through lack of 
cleanliness the raw material is infected and in processing the tem- 
perature employed is not sufficiently high to destroy the bacteria 
to which botulism is due. A wise precaution is to boil spinach, 
either canned or fresh, for five minutes before serving. 302 
THE NEW DIETETICS 
Salads. 
In the Middle Ages, the salad was in high repute, and its 
value as a food accessory seems to have been very well appre- 
ciated. John Evelyn wrote a discourse on “sallets,” and Chaucer 
and others dwelt upon the virtues “of the blood-cooling sallet.” 
The cabbage, centuries before it acquired robustness, rotundity 
and variety through the ingenious tutelage of the old Dutch 
gardeners, grew wild on the shores of the Mediterranean, whence 
it was gathered to garnish the tables of the rich epicures of Rome. 
The salad is deserving of more attention and better treat- 
ment than it receives in these degenerate days. It should be given 
the place of honor in the table service and should appear at two 
daily meals instead of one, and at the beginning of the meal 
instead of at the end. Thus treated, the salad, composed of fresh 
garden products rich in lime, iron, cellulose and vitamins, may 
become a valuable corrective and regulator and perhaps an effici- 
ent means of reforming our wretched modern dietary. 
Among the plants most commonly used as salads are lettuce, 
cabbage, Chinese cabbage, cress, cucumber, endive, tomato, onion, 
beet root, cardoon, peppergrass, chevril, borage, burnet, mint, 
parsley, nasturtium and sorrel. Root Vegetables 
This class of vegetables is characterized by a low content of 
fat and protein. 
As regards carbohydrates there are two classes, those which 
contain carbohydrates in the form of insoluble starch and those 
in which the carbohydrates are in the form of sugar or dextrin, 
and hence soluble. The last mentioned class of vegetables are of 
special value in the feeding of diabetic patients, since by boiling 
two or three times they may be freed from their carbohydrates. 
In this class are the turnip, beet, parsnip, cabbage, egg plant and 
spinach. The chief value of most vegetables lies in their rich store 
of alkaline salts and the valuable vitamins which they contain. 
Steenbock and Gross have recently reported experiments 
which show that the carrot, the artichoke and dasheen are more 
satisfactory as sources of vitamins than are the sweet potato and 
sugar beets. 
THE BEET 
There are numerous varieties of beets, which differ much in 
flavor, form, and nutritive value. The ordinary beet contains 
about 8 to 10 per cent, of carbohydrates. Young beets are often 
eaten whole, the roots and tops being boiled together, and in this 
form are an exceedingly wholesome and valuable addition to the 
bill of fare. Mature beets are best prepared by steaming or 
baking. Boiled beets are commonly served with vinegar, which 
renders them more or less unwholesome. Lemon juice should be 
used instead of vinegar, for which it is more than a complete 
substitute since it is not only a wholesome food instead of a 
poison, but supplies vitamins and aids digestion and assimilation 
instead of hindering these processes. 
THE PARSNIP 
The parsnip has been cultivated and regarded as a valuable 
foodstuff for more than two thousand years. It is even richer 
than the beet in carbohydrates. In nutritive value it exceeds all 
the common root vegetables. The parsnip is best prepared by 
stewing or steaming. 
303 304 
THE NEW DIETETICS 
THE CARROT 
The carrot, like the parsnip, is an old-fashioned vegetable. 
It is much more palatable and edible when young than when 
mature. Its nutritive value is about the same as that of the beet. 
Its yellow color is due to carotin, a coloring matter which Hess 
has recently shown to be associated with the highly important 
fat-soluble vitamin which is essential for growth of young ani- 
mals and for the maintenance of health in adult animals. Steam- 
ing is the proper method of cooking the carrot. When boiled in 
the usual way, the carrot loses a large portion of its nutrient 
value. 
The carrot has long enjoyed a great reputation as a vegetable 
antiseptic. At Vichy, carrots are served in some form at every 
meal and are believed to be of value in combating intestinal 
putrefactions. Metchnikoff noticed that by feeding carrots to 
animals he could make their stools nearly free from bacteria. 
Dr. Mary S. Rose and others have shown that on a diet con- 
sisting chiefly of carrots the calcium balance may be maintained; 
that is, the daily intake of lime may be made to equal the daily 
loss. The amount of carrots eaten daily must be considerable. 
Pigmentation of the Skin from the Use of Carrots and Squashes. 
Hess and others have called attention to the fact that the 
yellow coloring matter of the carrot, carotin, may be deposited in 
certain skin areas, particularly the palms of the hands and the 
soles of the feet when carrots are freely eaten. Hashimoto, of 
Japan, states that the same coloration may result from the free use 
of the squash and other yellow vegetables, as well as the eating 
of large quantities of “maikan,” a Japanese orange and “laver,” 
another Japanese vegetable. 
No harm has been shown to result from this pigmentation, 
which appears to be confined to the superficial layers of the 
skin. The pigmentation is in some cases observed to be quite 
prominent in the nasolabial folds of the face. 
THE TURNIP 
This root, like the other common food roots, has been used 
from the most ancient times, and like them is found growing wild 
in most European countries. There are many varieties of this 
vegetable, the best of which is the swede. The turnip contains ROOT VEGETABLES 
305 
less carbohydrates than beets, parsnips or carrots, and no starch, 
for which reason it is much used for diabetics after removing by 
repeated boilings the sugars and other soluble carbohydrates which 
it contains. The turnip is richer in lime than other roots, and the 
tender tops may be used as a green or salad. Turnip tops contain 
more iron than any other green except red root and dock. 
SALSIFY—VEGETABLE OYSTER 
A root which somewhat resembles the parsnip and has about 
the same nutritive value as the carrot. When cooked, it has a 
flavor somewhat resembling that of the oyster. The leaves or tops 
may be eaten as a salad or served as greens. In the black salsify 
the principal carbohydrate is inulin, which makes it a valuable 
food for diabetics. 
THE RADISH 
A highly succulent root which has a pungent flavor, due to 
an essential oil resembling the oil of mustard. The oil is found 
chiefly in the skin, which should be removed when this vegetable 
is eaten raw, as the essential oil is irritating and while tem- 
porarily stimulating is in the end damaging to the gastric glands. 
THE HORSE RADISH 
This root contains a highly pungent and very acrid essential 
oil, on account of which it is used as a condiment. The oil of 
horse radish is highly irritating and its presence marks this 
vegetable as a poisonous weed rather than a food. It should 
never be eaten. 
KOHL-RABI (TURNIP CABBAGE) 
This is a curious vegetable in which the stored material is 
placed in an enlargement of the stem just above the ground in- 
stead of in the underground root. In flavor the kohl-rabi re- 
sembles both the turnip and the cabbage, but when young and 
tender is more delicate. Its store of carbohydrate is small, only 
4 per cent, and its total nutritive value is also small. It is chiefly 
valuable for its alkaline salts. 306 
THE NEW DIETETICS 
THE JERUSALEM ARTICHOKE 
The Jerusalem artichoke is a member of the sunflower family. 
It got its name from its resemblance in flavor to the true arti- 
choke, a very different plant. It is a native of America and was 
much used by the aborigines, who carefully cultivated it in all 
parts of North America. It was cultivated in Italy nearly 300 
years ago, where it got the name of girasole or sunflower arti- 
choke. The word girasole was easily corrupted to Jerusalem, and 
the bulbs became known as Jerusalem potatoes from which was 
made Palestine soup. Hopkins reports that the Jerusalem arti- 
choke may satisfactorily take the place of the potato when neces- 
sary, although it is probably less well utilized. 
The artichoke"~produces prodigious crops. Such enormous 
yields as 20 to 40 tons to the acre have been reported, which is 
many times the yield of the potato or any other root crop. 
The artichoke should be steamed rather than cooked in water 
as this prevents loss of flavor and aroma. A still better plan is 
to place in a hot oven in a covered dish with a little butter and 
salt. No water should be added. This bulb is worthy of more 
consideration than it has heretofore received. 
Colin finds that the inulin of the Jerusalem artichoke is dur- 
ing the winter converted into sugars which in the spring are 
utilized in starting the new growth. In the use of artichokes by 
diabetics note should be taken of this fact and the sugar removed 
by parboiling when a low intake of sugar is required. 
CELERIAC 
This vegetable has a root similar to that of the turnip. It 
has the flavor of celery and is cooked and served like the turnip. 
It is deserving of more attention than it has received up to the 
present time. Vegetable or Garden Fruits 
Among the most commonly used vegetable fruits, or fruits 
produced by annual plants, are the tomato, the cucumber, the 
chayote, the eggplant, the citron, watermelon, muskmelon, squash, 
pumpkin and vegetable marrow. 
THE TOMATO 
The tomato is one of the best and most useful of our garden 
fruits. It was introduced to Europeans by Sir Walter Raleigh, 
who first discovered it on Roanoke Island. It was long cultivated 
as an ornamental plant, but has only been extensively used as a 
food during the last seventy years. There are people still living 
who first knew the tomato as a show plant in the flower garden, 
then known as the love apple. 
For a long time after the tomato began to appear on Ameri- 
can tables it was suspected of being the cause of cancer, though 
without the slightest ground for such a prejudice, and was 
avoided by many people on this account. 
Steadily the tomato has won its way into popular favor until 
now there is no garden vegetable so largely and universally used 
in this country as is the tomato, with the exception of the potato. 
The same is equally true in Mexico, Italy, and several other 
countries. 
The tomato contains nearly twice as much iron as does milk, 
and five times as much as egg white; in fact, it is richer in iron 
than apples, pears, oranges, grapes, melons, cucumbers and 
peaches, and contains more than half as much as onions, parsnips, 
turnips, radishes, sweet potatoes, kohl-rabi, eggplant, carrots, 
celery, cauliflower, chestnuts, beets and bananas. Of lime, the 
tomato contains more than apples, bananas and rice, and as much 
as hominy, corn flakes and eggplant, and more than three times 
as much as beef, mutton or fish. 
The tomato is also rich in useful potash salts, of which it 
contains more than most fruits and many other vegetables. The 
tomato owes its acid flavor to citric rather than to oxalic acid as 
was formerly supposed. 
307 308 
THE NEW DIETETICS 
Givens has shown that raw tomatoes may be dried at a tem- 
perature of 60° C. (140° F.) without destroying the antiscorbutic 
vitamin. The vitamins are also uninjured by canning. 
Vitamins in Tomato Juice. 
Hess has shown that the juice of canned tomatoes is a most 
valuable source of vitamins. Its superlative value is due to the 
fact that it contains all three of the food essentials, or vitamins, 
while most fruit and vegetable juices are deficient in one or more. 
Hess recommends that the juice of canned tomatoes should 
be given to infants instead of orange juice as being less expensive. 
The average infant requires about one ounce daily. 
Observations by Mendel showed that one-tenth of a gram 
(one grain and a half) of dried tomato contains a sufficient 
amount of the fat-soluble vitamin to take the place of butter in 
the dietary of growing rats and to bring them quickly to full 
maturity. An equivalent amount for a human being would be 
about one-half ounce of dried tomato per day or four to six 
ounces of fresh tomatoes. 
THE CUCUMBER 
One of the first cultivated plants, the cucumber, has been 
known for more than 2000 years. The cucumber is still largely 
used in Egypt, where it is almost a food staple and is much 
eaten by children and even infants as well as by adults, thus prov- 
ing its essential wholesomeness. In this country the cucumber 
is usually spoiled by pickling before it appears upon the table. 
Fresh cucumbers, well masticated, are wholesome and valuable 
as sources of vitamins and salts which help to maintain the alka- 
linity of the blood, and also furnish roughage. 
THE EGGPLANT 
The eggplant contains, in small quantities, a poisonous 
alkaloid and an irritating substance, both of which may be 
removed by parboiling for two or three minutes before cooking. 
Prepared in this way, it is a wholesome plant and a valuable 
source of food alkalies and vitamins. 
THE WATERMELON 
A native of ancient Egypt and of America. It was discov- 
ered by Sir Walter Raleigh when he discovered Roanoke Island 
in 1584. A very valuable fruit on account of the large amount VEGETABLE OR GARDEN FRUITS 
309 
of sugar found in its juice. When eaten in quantity, the pulp 
should be rejected as the total food value is in the juice. 
THE MUSKMELON 
All the different varieties of this excellent melon are whole- 
some. It is richer in alkalinizing elements than any other vegetable 
food and hence may be freely eaten with advantage by persons 
who have a tendency to acidosis. 
THE SQUASH AND VEGETABLE MARROW 
The several varieties of squashes are chiefly valuable for the 
vitamins and alkali-forming elements which they furnish. 
The vegetable marrow is a wholesome and valuable garden 
fruit with properties similar to those of the squash, though its 
nutritive value is less. 
THE PUMPKIN 
This gigantic fruit is a contribution from our Indian prede- 
cessors, who cultivated it in their corn fields. It is a coarse, crude 
product, but when properly prepared is a wholesome and grate- 
ful addition to the bill of fare and yields a good share of useful 
food salts and vitamins together with a minimum of nutriment 
in the form of starch, dextrin and sugar. 
THE CHAYOTE 
This new garden vegetable, recently imported from Mexico, 
is a relative of the cucumber. It grows on a vine trained upon 
a trellis, and when fully matured is about the size of a small 
apple. The chayote, like the cucumber, is somewhat lacking in 
flavor, but when cooked and served with some suitable sauce is 
an acceptable addition to the bill of fare in early winter. It is 
sold in the New Orleans markets. Legumes 
There are many species and many varieties of legumes. The 
bean and the lentil have been known from very ancient times. 
Many kinds of beans were cultivated by the aborigines of this 
country. The lentil has been a staple food in the Orient from 
remote ages. The soy bean has been the meat and milk of China 
for thousands of years. 
With the exception of the soy bean, beans, peas and lentils 
are much alike in composition. The soy is richer than other 
legumes in fat and protein. 
All the legumes are very rich in lime, iron and vitamins. 
Legumes differ from most other vegetable foods in the fact 
that they contain an appreciable proportion of purin bodies, which 
are converted in the body into uric acid. This amount is small, 
however, compared with that contained in meat. Dried beans 
contain only 4 grains of uric acid (xanthin) to the pound, 
whereas dried meat contains 56 grains. 
The protein of beans is inferior in quality to that of the 
cereals, potatoes and nuts, as well as to that of meat, milk and 
eggs, being incomplete. This is not true of the soy bean, how- 
ever, which furnishes a protein of high quality. 
Digestibility of Legumes. 
The comparative indigestibility of the protein of vegetables 
has been urged as an argument in favor cf flesh foods and as an 
objection to the use of vegetable foods. The evidence is accumu- 
lating, however, that the discrimination against vegetables in this 
regard has been unfair and based upon inaccurate observation. 
Lean meat consists of the soft pulp of the muscle tissue proper 
held together by a framework of connective tissue. The con- 
nective tissue is completely digested and dissolved by normal 
gastric juice. Thus lean meat is well broken up in the stomach 
by gastric digestion, even though it may be swallowed in masses 
and without sufficient mastication. The nutritive substance of 
vegetable foods is imprisoned in a meshwork of cellulose which is 
not acted upon by either the saliva or the gastric juice and hence 
cannot be dissolved in the stomach. The consequence is that if 
310 LEGUMES 
311 
vegetable food is not thoroughly reduced to a paste in the mouth 
but through hasty eating is swallowed in masses, quite a common 
practice, the necessary result is incomplete and tardy digestion. 
Only that portion of the starch with which the saliva can come 
in contact will be digested and only such portions of protein 
will be dissolved as are brought in contact with the gastric juice, 
so a considerable portion will escape digestion altogether. 
Dr. Wait, an expert employed by the United States govern- 
ment in the study of foods, some years ago published a most inter- 
esting account of experiments by which he showed that legumes, 
when properly cooked, have a very high degree of digestibility. 
Cooking in hard water impairs their digestibility, but when cooked 
by the Japanese method the results are most excellent. For 
example, the Japanese to fu, which is prepared from the soy bean, 
has a digestibility for protein of 97 per cent., and for carbohy- 
drates of 88 per cent. 
It should be noted that cooking in hard water hardens the 
protein of legumes and lessens its digestibility. 
Experiment has shown (Adkins) that the digestibility of 
beans may be increased as much as 15 per cent, by sprouting. 
This increase of digestibility disappears, however, if the sprouted 
beans are dried. After sprouting they must be kept moist until 
used. 
Alkalies to be Avoided. 
The common custom of cooking beans with soda or saleratus 
to soften the seed coverings is most objectionable. Alkalies exer- 
cise a powerfully destructive effect upon vitamins; hence the 
practice referred to cannot be too strongly condemned. 
The Iron Content of Legumes. 
The product of a most extraordinary class of plants, the 
legumes (beans, peas and lentils) are the richest of all vegetable 
foods in food iron. The lentil, richest of all, contains exactly the 
same amount of iron per ounce as the egg yolk, a percentage so 
great that a full day’s ration is supplied by six ounces of the raw 
material. The lentil has been serving the human race as a blood 
builder from the most ancient times. 
Beans, both navy and lima, are almost equally rich in the 
blood-making element, seven ounces being sufficient for a com- 
plete iron ration for a day. 312 
THE NEW DIETETICS 
Peas furnish not quite two-thirds as much iron as do lentils, 
but nine ounces suffice for a day’s ration. Even green peas are 
equally well stocked with iron if the estimate is based upon food 
values, one hundred calories furnishing one-ninth of a day’s re- 
quirement of iron. 
The ruddy and well-nourished condition of the famous 
Hebrew children who insisted on sticking to their accustomed fare 
of “pulse,” rejecting the juicy venison and mutton chops of the 
king’s table, must have been due, then, to the liberal ration of 
iron which they received rather than to a high protein intake. 
Peas and lentils are just as good for the children of the present 
generation as for those of Nebuchadnezzar’s day. 
The Lime Content of Legumes* 
The legumes furnish in small bulk so large a store of lime 
that they are most useful in balancing up the bill of fare. This 
may be clearly seen by reference to Table XIII, which shows us 
that an ounce of beans contains a grain of lime. An ordinary 
serving represents about an ounce and a quarter of dry beans, 
which would supply 8 per cent, or one-twelfth of a day’s ration. 
Peas have a lime content about half that of lentils, and 
two-thirds as much as beans. When made a staple of the bill of 
tare, the size of servings may be increased to two or even three 
times the ordinary, making the legume supply nearly one-fifth of 
the day’s ration of lime. 
Legumes, particularly lentils, are deserving of a larger place 
in the dietary than has heretofore been accorded them. Their use 
has been restricted somewhat, perhaps, by the fact that much 
more time and skill are needed to render them an attractive 
feature of the bill of fare than is required for cereals and vege- 
tables. Many breakfast foods are ready to serve straight from 
the carton. Oatmeal may be served in ten minutes if the water 
is already hot. Potatoes go into the oven and out again in half 
an hour, and other vegetables take care of themselves in a tireless 
cooker. But beans need several hours’ exposure to full cooking 
heat under carefully regulated conditions to render them accept- 
able to both the palate and the stomach; and so the bean is not 
popular with the cooks except perhaps in the vicinity of Boston, 
unless supplied in tins ready cooked from the grocer. 
The solution of the bean problem will be found in the pres- 
sure cooker, the next improvement needed to equip the complete LEGUMES 
313 
modern kitchen. At a temperature 8° or 10° F. above the boiling 
point of fresh water beans cook very quickly, in an hour easily, 
and they are improved in flavor also. And still further, the tough 
woody hulls are so softened that they occasion less disturbance 
in the intestinal tract, being readily broken up. 
A word of caution must be said in relation to the use of 
legumes. The elaborate feeding experiments of McCollum and 
others have shown that the protein of beans is of inferior quality 
and by no means a substitute for the fine protein of milk. This 
fact is important in this connection because of the possible injury 
in making the diet consist so largely of beans as to overburden 
the body with the elimination of unusable protein. The proteins 
of peas and lentils are superior to those of beans; hence it is 
advisable to utilize these legumes more largely than beans as a 
source of food lime and its associated protein. Beans should be 
supplemented by cottage cheese or nuts, one to three ounces. 
When the soy bean has become well established in this coun- 
try as a food product it will be doubtless recognized as a superior 
source upon which to draw for extra supplies of a fine quality of 
vegetable protein. 
BEANS 
Beaus and other pulses are among the most ancient of culti- 
vated foodstuffs. The ancient Egyptians worshiped the bean 
because of its resemblance in shape to the kidney and to the male 
sex gland. They refused to eat this legume, fearing that in so 
doing they might be consuming a human soul consigned by fate 
to expiate its sins by a term of life in this humble plant. 
The old Romans used beans in their religious services, and 
threw black beans on the graves of their deceased friends as a 
part of the burial service. At Roman feasts in memory of the 
dead beans were cast upon the altar fire. It was their belief that 
the odor of burning beans would drive away evil demons. 
This ancient superstition in relation to beans still survives 
among the modern descendants of the Romans. In Italy, it is at 
the present day customary to eat beans on the anniversary of the 
death of a friend and to distribute the seeds among the poor. 
An ancient Jewish ceremonial law forbade the use of beans 
by the high priest on the day of atonement, because of the belief 
that the eating of beans caused drowsiness. 
Pythagoras thought the black spot on the bean to be an 314 
THE NEW DIETETICS 
emblem of death, and warned his followers to avoid eating beans. 
A relic of these old superstitions still survives in some of the 
countries of England, where it is commonly believed that sleeping 
in a bean field will cause bad dreams or even insanity. 
Beans were among the few vegetables cultivated by the 
Indians when this country was discovered by Europeans. They 
planted pole beans with their corn, and had developed varieties 
of the legume from which many of our modern beans are derived. 
The kidney or haricot bean occurs in many varieties, white, 
red, navy bean, etc. 
Broad beans, lima beans, butter beans and frijoles are other 
varieties the characteristics of which are so well known as to 
require no description. 
The bolicohs bean is a new variety which differs slightly from 
the common bean, and is much liked by those acquainted with it. 
Two varieties are well known, the hyacinth and the asparagus. 
The Mung Bean. 
The composition of the mung bean is very similar to that of 
the ordinary bean of this country. According to Church, the 
percentage composition is: water, 11.4; ash, *3.8; protein, 23.8; 
fat, 2.0; fiber, 4.2; carbohydrates, 54.8. It is the best bean for 
sprouting. 
The Adsuki Bean* 
Another variety introduced into this country from Japan is 
the Adsuki, a red bean which closely resembles the mung in com- 
position. It is the favorite bean of Japan, where it commands 
the highest price. It has a delicious flavor, being wholly free 
from the beany taste characteristic of the American varieties of 
this legume. Tests made by the .Plant Introduction Bureau of 
the Agricultural Department show that this bean can be readily 
grown in this country and it will doubtless in time achieve high 
rank as a staple foodstuff. 
String Beans* 
The unripe bean pod with its contents, so-called snap beans, 
when properly cooked and served, is not only very palatable but 
a highly valuable vegetable dish for which we are indebted to the 
American Indian, from whom Europeans learned its value. LEGUMES 
315 
Shelled Beans. 
This is a very excellent and easily digestible vegetable when 
properly cooked and served. The relative proportions of protein, 
carbohydrates and salts are about the same as in the ripe bean, 
but the quantities only half as great on account of the large 
amount of water present. 
The hahto bean, a Chinese variety, which is about half the 
size of the lima bean, is superior to all other beans for use as a 
green vegetable. In cooking it requires only the addition of a 
little salt, since it contains a considerable percentage of a very 
digestible fat. The flavor developed in the cooked bean is most 
delicious. This choice vegetable has recently been introduced 
into this country by the United States Department of Agriculture, 
from whom information can be obtained concerning seed. It is 
quite hardy and ought to be planted in every garden. 
Succotash. 
Succotash is a dish invented by the American aborigines, by 
whom it was known as “sawquetash.” It consists of a mixture 
of shelled beans and green corn cooked together. 
THE SOY BEAN 
The soy bean has been used in China since 2838 B. C. It 
was introduced into France in 1740, into England in 1790, and 
into this country not until a century later. This bean requires a 
long season and therefore does best in the Southern states. It is 
quite hardy, however, and some varieties have been found which 
mature as far north as Canada. 
The soy is the best of all the beans. It differs decidedly from 
other beans in its composition. It contains 40 per cent, protein, 
practically no starch, and nearly 20 per cent, fat, giving it char- 
acteristics approaching those of the peanut more closely than 
those of ordinary beans. 
More than one thousand varieties have now been tested by 
the United States Department of Agriculture. Twenty varieties 
are at the present time being handled by growers and seedsmen in 
this country. The green and yellow varieties are best adapted for 
food. The black and brown are chiefly grown for forage. 
In China, the soy bean is very little used in the manner in 
which beans are used in this country. Instead, according to 
W. J. Morse, of the United States Department of Agriculture, 316 
THE NEW DIETETICS 
“the beans are soaked in water and roasted, the product being eaten after 
the manner of roasted peanuts. This method of preparing the beans is 
improved by soaking the beans for about twelve hours in a 10 per cent, salt 
solution, boiling slowly for about thirty minutes, and then roasting to a 
light-brown color. The yellow-seeded and green-seeded varieties are- 
preferable, as they make a product of better appearance. 
“When soy beans are three-fourths or more grown, the seed makes 
a most palatable and nutritious green vegetable. As such it may be used 
much as is the green pea or the lima bean. The pods are somewhat tough 
and not desirable to eat. The green beans are rather difficult to shell, but 
after cooking in the pods for about five minutes they shell out very easily. 
These beans may also be canned, like green peas, and they thus make an 
excellent green vegetable for the winter.” 
This bean not only contains a large amount of protein, more 
than is found in the same weight of beef, but its protein is of a 
particularly fine quality. Heretofore, the casein of milk has 
enjoyed a unique reputation as a protein of finest quality, but 
now “the protein of the soy bean appears to be as valuable as the 
casein of milk.” 
The soy bean is a highly valuable food for persons suffering 
from diabetes. It contains very little carbohydrate, only about 6 
per cent, and is practically wholly free from starch when allowed 
to become thoroughly ripe before harvesting. 
In view of the shortage of milk, which is likely to increase, 
it is gratifying to know that a protein has been discovered equally 
valuable as casein and one which may be produced in unlimited 
quantities. 
For the promotion of growth, it is not only necessary for the 
food to contain complete protein in proper amount, but it must 
also contain a sufficiency of the two vitamins, designated as fat- 
soluble A and water-soluble B. Osborne and Mendel demon- 
strated that the soy bean contains an adequate supply of both 
fat-soluble and of water-soluble vitamins, in which respect it is 
superior to all seeds heretofore examined, with the possible excep- 
tion of flaxseed and millet. 
The soy bean is destined to become one of the great food 
staples, not only of this country but of the world. It is capable 
not only of supplying the essentials for growth and maintenance, 
but may also act as a complement to other imperfect foods, such 
as corn for example, in combination with which it has shown 
most excellent experimental results. LEGUMES 
317 
Composition of the Soy Bean* 
The following table is compiled from the analyses published 
by the United States Government and by Bailey and Street, 
(Journal of Industrial and Engineering Chemistry, 1915) : 
Per cent. 
Ash 4.8 
Water , 8.5 
Protein 39.5 
Fat 18.5 
Starch 0.5 
Cane sugar 3.0 
Invert sugar and raffinose 1.2 
Dextrin 3.0 
Galactan 5.0 
Pentosan 5.0 
Wax 8.0 
Cellulose 3.0 
The above analysis clearly shows the soy bean to be a most 
remarkable food product. Its composition is in some respects 
more like that of a nut than that of other legumes. In this respect 
it very much resembles the peanut. Its protein content, nearly 
40 per cent., is higher than that of any other foodstuff. Even 
lean meat affords but half as much. Its high percentage of fat 
gives it a very high fuel value and makes it a rich source of oil 
for various industrial purposes as well as for food. 
The soy fills the place of meat as well as milk in the dietary 
of many millions of sturdy Orientals. Since the composition of 
the soy has been understood, it has been much used as a food for 
diabetics. It is evident from the above that it contains little 
which can be objectionable in diabetes. The small amount of 
dextrin and sugar may be easily removed, when necessary, by 
parboiling. 
Experiments by Holmes, of the office of Home Economics, 
United States Department of Agriculture, have shown that the 
well cooked soy bean (cooked for two hours under steam pres* 
sure) is very easily digestible, and is an exceptionally wholesome 
article of food, superior to most other legumes. 
The soy bean may not become really popular until the pres- 
sure cooker comes into general use, which may be some time. In 318 
THE NEW DIETETICS 
the meantime, while the patent pressure cooker is coming, any 
resourceful housewife may improvise a perfectly good and satis- 
factory pressure cooker from inexpensive materials close at hand. 
Get a stone jug or jar that can be hermetically closed. The little 
stone jars in which apple butter is sometimes sold are well 
adapted to the purpose. After soaking the beans over night put 
into the jug with a little salt and enough water to cover, seal up 
tight and secure the cover well, remembering that the pressure 
will be from within. Set the jug in a saturated solution of com- 
mon salt, place over a hot fire land boil for one to two hours. 
The salt solution boils at a temperature above 220° F. and so the 
beans are exposed to a higher temperature than in ordinary boil- 
ing. This method is equally good for greens, cabbage, and ordi- 
nary beans. Cooking at the higher temperature not only softens 
the cellulose and so renders the foodstuffs tender, but greatly 
improves the flavor. 
Soy Bean Milk, 
In Japan infants are sometimes nourished artificially on milk 
prepared from the soy bean by methods for a long time kept 
secret. Soy milk is now well known and quite extensively in use 
in France and England, and likely soon to be introduced into this 
country. The writer has made, experimentally, a quite palatable 
milk from the soy bean. 
The beans may be prepared either by grinding to a fine flour 
or by soaking over night and crushing to a pulp between rollers. 
The dry meal is most convenient. Add to the dry meal sufficient 
water to a little more than saturate. Allow to soak for two hours. 
Add five times the quantity of boiling water. Boil for ten min- 
utes, stirring. Filter through a fine cloth. The milky liquid thus 
obtained has properties very closely resembling cow’s milk. It is 
rich in protein and fats. The fat is well emulsified and easily 
digestible, and the protein very closely resembles that of milk, 
being what is known to chemists as a complete protein which may 
replace the casein of milk as a food. The soy milk is rather 
deficient in salts, both lime and iron. It contains vitamins but less 
than milk, and it contains no carbohydrates. To be used as milk 
it should be sweetened by the addition of 2 per cent, of cane 
sugar or 4 per cent, of milk sugar. To suit most palates a little 
salt should be added also. The flavor is different from that of 
cow’s milk, but it is wholesome and not unpalatable and may to a LEGUMES 
319 
considerable extent take the place of cow’s milk by persons who 
are sensitized to milk or when milk is not available. A similar 
preparation may be made from peanuts. 
Soy bean milk, according to Adolf and Kiang, has the follow- 
ing percentage composition: 
Protein 4.22 
Fat 1.87 
Salts 0.40 
Water 93.51 
The composition of the milk will vary, of course, with the 
amount of water used in its preparation. It will be noted that 
soy milk contains no sugar and is very poor in salts, containing 
only half the amount of salts found in cow’s milk. All these may 
be easily added, however, and so soy milk is a possible resource 
for lacteal food in case of scarcity of the bovine product; but 
it seems to the writer doubtful that soy milk will ever be able to 
compete with cow’s milk as a nutrient for human beings, and 
especially in the feeding of infants. 
To Fu, 
This is a cheese-like preparation made from the soy bean, 
much used in China. The method is as follows: 
Prepare soy bean milk. While it is boiling add one-fifth its 
volume of a one-half per cent, solution of citric acid, stirring. 
Strain through a cloth to separate the curds. 
To fu omelet is more palatable and more wholesome than 
ordinary egg omelet. It is made as follows: Four ounces of 
to fu, one rounded tablespoonful of graham flour, milk sufficient 
to give the mixture the consistency of pancake batter. Add one 
well beaten egg. Cook in the usual way. This to fu or soy bean 
omelet is more wholesome than the ordinary egg omelet and is 
more easily digestible. Made without the addition of flour the 
to fu omelet is a valuable dish for diabetics. 
The following is the percentage composition of to fu as given 
by Adolf and Kiang: 
Protein 10.22 
Fat 3.66 
Salts 1.09 
Extract 4.13 
Water 80.90 320 
THE NEW DIETETICS 
To fu is used in soups and salads and in a great variety of 
combinations with other foodstuffs. It is one of the fundamental 
things in Chinese and Japanese cookery. 
Soy Sauce. 
Soy or shoyu sauce is a dark-brown liquid prepared from a mix- 
ture of cooked and ground soy beans, roasted and pulverized wheat 
(barley is sometimes used), salt and water. This mass is inoculated 
with a culture known as rice ferment (Aspergillus oryzae) and left in 
cakes to ferment from six months to a year, or sometimes longer. 
In odor and taste this sauce suggests a good quality of meat 
extract, though perhaps more salty and a trifle more pungent. 
Soy Bean Sprouts. 
Several species of beans are sprouted and used as a garden vege- 
table by the Chinese. Soy beans are used to a very considerable 
extent for this purpose, as these sprouts are larger and firmer than 
those of most other legumes. Bean sprouts may be used as a home 
winter vegetable, for the dried beans are sprouted easily in a short 
time under proper conditions of heat and moisture. 
Mr. Shill Chi Yien, of Foochow University, from whom the 
above quoted paragraphs are borrowed, gives the following direc- 
tions for preparing bean sprouts, for which purpose either yellow 
or green soy beans or the mung beans may be used. 
The beans must be thoroughly washed as a preparation for grow- 
ing the bean sprouts. Then they are poured into a big vessel which 
is about three feet high and one foot and a half in diameter. In the 
bottom of the vessel a small hole is made for draining the water off 
from the beans. The vessel is covered with a straw cover to keep out 
the light. 
The beans must be moistened at least three times each day in the 
summer time and twice in the winter time. They are kept in the 
vessel about three days in the summer and fifteen days in the winter. 
At the end of the time, the sprouts are fully grown and they are taken 
to the market for sale. 
Another method of sprouting is to spread the beans one layer 
thick on a wet cloth and cover with a heavy wet, dark colored 
cloth which must be kept damp by frequent sprinkling. 
Mr. Morse of the Bureau of Plant Industry, United States 
Department of Agriculture, has kindly supplied us with the fol- 
lowing information respecting the composition of soy bean 
sprouts: LEGUMES 
321 
Composition of Soy Bean Sprouts. 
Per cent. 
Water 67.00 
Nitrogenous materials 14.73 
Fat 5.95 
Carbohydrates 4.04 
Mineral Salts 3.40 
Composition of Mung Bean Sprouts 
Water 91.21 
Nitrogenous materials (protein) .. 3.41 
Fat r 0.28 
Carbohydrates . 2.12 
Mineral Salts 0.48 
Per cent. 
Bean sprouts are used as a green vegetable at all seasons of 
the year. In this country they would be especially useful in the 
winter season because of their richness in vitamins. They have 
been much used in combating beri-beri and other deficiency dis- 
orders. Their use in this country should be encouraged. 
The sprouts may be served raw as a salad or cooked as a 
green vegetable. They are a constituent of the famous Chinese 
dish, chop suey. 
THE PEA 
The garden pea has been known in Europe from prehistoric 
times. There are many varieties, which differ in mode of growth 
and appearance and to some extent in flavor, but are practically 
identical in composition. When mature and dry, the pea contains 
about 25 per cent of its weight of protein and 62 per cent, of 
carbohydrates. The protein of the pea is superior in quality to 
that of the bean, a fact which should lead to the more extended 
use of dried peas. 
Green Peas. 
A very delicate and delicious vegetable containing a consid- 
erable amount of sugar, which in the ripe pea is converted into 
starch. Both the protein and the carbohydrate is much smaller 
in amount in the green pea than in the ripe pea. Canned green 
peas are a valuable addition to the dietary in the cold months. 322 
THE NEW DIETETICS 
Care should be taken to avoid peas which have been colored with 
copper or sweetened with saccharine. 
LENTILS 
Lentils have been used as a food from prehistoric times. The 
red pottage which Jacob gave Esau in exchange for his birth- 
right was prepared from the red or Egyptian lentil which has 
been a staple article of food in Egypt for thousands of years and 
has in recent times been introduced into this country. Lentils 
are much used in India as a supplement to the rice diet which is 
widely used in that country. The lentil contains somewhat more 
protein than either beans or peas and does not produce offensive 
flatulence as do beans, because of the absence of sulphur. Lentils 
are best served in the form of soup. They are a highly valuable 
vegetable, rich in iron and lime, and should be more widely used. 
DRIED VEGETABLES 
Within recent years processes have been perfected whereby 
vegetables may be preserved by drying with comparatively little 
change in their flavor and nutritive qualities. It is necessary, 
however, that the drying should be accomplished at a low tem- 
perature to avoid destruction of some of the valuable vitamins 
which abound in most vegetables. It is also necessary that the 
vegetables should be sliced and dried while still fresh, or within 
a few hours after gathering, and the dried product should be 
kept in closed containers, as exposure to the air permits deteriora- 
tion. 
Recent observations by Osborne and Wakeman show that 
little change results from the drying of spinach and other green 
leaves at low temperatures. The proteins of the dried leaf are 
slightly more soluble than are those of the fresh leaf. It thus 
appears that drying may be found an excellent means of pre- 
serving such greens as spinach, dock and other greenstuffs which 
possess a high value as foodstufifs, an important fact recently 
determined by animal feeding experiments. 
While dried vegetables are not quite equal to fresh in flavor 
and may in this respect even be slightly inferior to canned vege- 
tables, this mode of preservation affords a cheap and simple 
method of disposing of the surplus of this important class of 
foodstuffs which often occurs at certain seasons of the year. Fruits 
Fruits may justly be regarded as among the most refined, 
as well as the most delicious, of natural food products. Their 
attractive aroma, due to the presence of essential oils, their tasty 
and refreshing juices, together with their valuable sugars, vita- 
mins, salts and acids, give to them a very important place in the 
category of useful foodstuffs. With few exceptions, fruits con- 
tain practically no fats and only minute quantities of protein, 
rarely more than one-half of one per cent, to one per cent. 
The carbohydrates of fruits are chiefly in the form of sugar, 
dextrin and acids, and are for the most part ready for immediate 
absorption. 
The absence of fat and the presence of minute quantities of 
protein, and the fact that the sugar is generally in a form in 
which it can be immediately assimilated, render fruits, of all 
foodstuffs, the least taxing to the digestive organs. The nutritive 
material which they contain being ready for immediate use 
accounts for the almost immediate refreshing effects experienced 
by a fatigued person from the drinking of fruit juices and for 
the great popularity of fruit juices of all sorts, especially in 
seasons of the year when the depressing effects of exercise are 
most generally felt. 
Edible fruits occur in greater variety than does any other 
form of food. This is especially true in the tropics. More than 
300 different edible fruits are known. 
Of the three acids found in fruits, citric and malic acid are 
the most common. Tartaric acid is found almost exclusively in 
grapes. Varying quantities of dextrin and small quantities of 
starch are sometimes found in fruits, especially in unripe fruits. 
The sugar of fruits usually consists of a mixture of about equal 
parts of dextrose, or grape sugar, and levulose, or fruit sugar, 
sometimes called fructose. Cane sugar is found in large propor- 
tion only in a very few fruits. 
323 324 
THE NEW DIETETICS 
TABLE XXX. 
Showing the Amount of Sugar in Common Fruits. 
Per cent. 
Calories 
per ounce 
Apples, preserved 
6.25 
7.1 
Apricots 
8.78 
10.0 
Cherries 
10.00 
11.6 
Currants, white 
6.40 
7.3 
Figs (fresh) 
11.55 
13.2 
Grapes, hot-house 
17.26 
19.7 
Grapes, preserved 
16.50 
19.1 
Lemons 
1.47 
1.7 
Oranges 
8.58 
9.8 
Pears, fresh 
7.84 
9.0 
Pears, preserved 
8.78 
10.0 
Pineapples 
13.31 
15.2 
Plums 
1.99 
2.1 
Raspberries 
7.23 
8.3 
Strawberries 
5.86 
6.7 
The amount of cane sugar and other sugars found in fruits 
together with the amount of acid and the caloric value is shown 
in Table XXXII. 
TABLE XXXI. 
In the following'table there are given the proportions of 
sugar and pectin in some common fruits (Watson) : 
Sugar 
Pectin 
Apples 
11.2 
5.6 
Apricots 
1.7 
6.1 
Blackberries 
3.7 
1.2 
Currants 
3.0 
0.1 
Gooseberries 
4.9 
0.8 
Grapes 
20.2 
2.0 
Peaches 
2.3 
11.9 
Plums 
1.6 
3.1 
Prunes 
7.0 
4.4 
Raspberries 
2.7 
1.0 
Strawberries 
4.4 
0.1 FRUITS 
325 
All ripe fruits are easily digestible in a raw state when 
properly masticated. Cooking softens the cellulose, coagulates 
the pectin or jellifying principle of fruits, and renders them some- 
what more digestible but lessens their nutritive value by destroy- 
ing in part the vitamins which give to them one of their chief 
nutritive values. The antiscorbutic, or scurvy-preventing vitamin, 
may be wholly destroyed in the cooking of fruits. On this ac- 
count, fruits should be largely eaten in the fresh or uncooked 
state. Drying also injures this vitamin. 
Fruits are worthy of a dignified place in the dietary. They 
are usually regarded as a luxury to be indulged when convenient 
or when they can be afforded, whereas they should be considered 
an essential part of the dietary. Nature has so distributed the 
various items which make up a complete biologic ration that it is 
necessary to include in our list of edibles all parts of the plant— 
leaves, roots, seeds and fruits—in order to be certain that noth- 
ing is missed. This has been clearly shown by McCollum’s clas- 
sical experiments. Fruits supply in more palatable though less 
concentrated form much the same food essentials that are found 
in roots, viz., carbohydrates, roughage, and especially the alkaline 
salts of which we need a considerable amount to neutralize the 
acid wastes of our bodies which are greatly exaggerated by a 
sedentary mode of life and a high protein diet. 
Ripe fruits require little work of the digestive organs. Their 
sugars, acids, salts and vitamins are all ready for immediate 
absorption, while the amount of fat and proteins present are so 
small that they are quickly disposed of. For this reason, fruit 
alone of all natural foodstuffs, may be eaten at any time when the 
stomach is not overfilled, without disturbing the digestive pro- 
cess. This license does not apply, of course, to those highly con- 
centrated foods, dates, figs, raisins or other dried fruits. 
The cultivation and use of fruits should be greatly extended. 
Man is naturally a frugivorous animal, like his relatives the big 
apes, and should find in fruits a large part of his nourishment. 
Fruit trees should be planted along all our highways, those hardy 
species which are able to flourish with little attention from the 
hand of man. 
Scurvy, beri-beri, and other deficiency diseases may owe their 
origin to the absence of fresh fruit. 
The fruit regimen, described elsewhere in this work, is one 
of the most effective means of changing the intestinal flora and 326 
THE NEW DIETETICS 
TABLE XXXII. 
Showing the Percentage Composition of the Edible Parts of Fruits 
Water 
Proteid 
Carbo- 
hydrates 
Ash 
Cellu- 
lose 
Acids ( 
Calories 
per oz. 
Apples 
.. 82.5 
0.4 
12.5 
0.4 
2.7 
1.0 
15.4 
Apples (dried)... 
.. 36.2 
1.4 
49.1 
1.8 
4.9 
3.6 
59.8 
Apricots 
.. 85.0 
1.1 
12.4 
0.5 
1.1 
15.5 
Bananas 
. 74.0 
1.5 
22.9 
0.9 
0.2 
27.9 
Blackberries 
.. 88.9 
0.9 
2.3 
0.6 
5.2 
3.7 
Cherries 
. 84.0 
0.8 
10.0 
0.6 
3.8 
l.Oto 1.5 
13.0 
Cranberries 
. 86.5 
0.5 
3.9 
0.2 
6.2 2.0 to 2.5 
6.0 
Currants 
.. 85.2 
0.4 
7.9 
0.5 
2.7 
1.5 
11.4 
Currants (dry)... 
. 27.9 
1.2 
64.0 
2.2 
1.7 
74.5 
Dates (dried) 
.. 20.8 
4.4 
65.7 
1.5 
5.5 
80.1 
Figs (dried) 
. 20.0 
5.5 
62.8 
2.3 
7.3 
1.2 
76.7 
Figs (fresh) 
.. 79.1 
1.5 
18.8 
0.6 
23.2 
Gooseberries 
.. 86.0 
0.4 
8.9 
0.5 
2.7 
1.5 
11.4 
Grapes 
.. 79.0 
1.0 
15.5 
0.5 
2.5 
0.5 
19.1 
Greengages 
. 80,8 
0.4 
13.4 
0.3 
4.1 
1.0 
Lemons 
. 89.3 
1.0 
8.3 
0.5 
.... 
11.0 
Lemon juice 
. 90.0 
0.0 
2.0 
0.4 
7.0 
6.3 
Melons 
. 89.8 
0.7 
7.6 
0.6 
1.0 
9.5 
Mulberries 
.. 84.7 
0.3 
11.4 
0.6 
0.9 
1.8 
14.4 
Nectarines 
. 82.9 
0.6 
15.9 
0.6 
18.8 
Olives 
.. 67.0 
2.5 
5.7 
4.4 
3.3 
9.4 
Oranges 
. 86.7 
0.9 
8.7 
0.6 
1.5 
l.Oto 2.5 
12.1 
Orange juice 
. 85.0 
0.0 
10,8 
0.0 
.... 
1.9 
15.3 
Peaches 
.. 88.8 
0.5 
5.8 
0.6 
3.4 
0.7 
7.0 
Pears 
.. 83.9 
0.4 
11.5 
0.4 
3.1 
0.1 
13.7 
Pineapples 
. 89.3 
0.4 
9.7 
0.3 
— 
— 
11.5 
Plums 
. 78.4 
1.0 
14.8 
0.5 
4.3 
1.0 
15.3 
Pomegranates 
.. 76.8 
1.5 
16.8 
0.6 
2.7 
20.9 
Prunes (dried)... 
. 26.4 
2.4 
66.2 
1.5 
2.7 
70.0 
Prunes (fresh)... 
.. 80.2 
0.8 
18.5 
0.5 
22.2 
Raisins 
.. 14.0 
2.5 
74.7 
4.1 
88.2 
Raspberries 
. 84.4 
1.0 
5.2 
0.6 
7.4 
1.4 
8.0 
Strawberries 
. 89.1 
1.0 
6.3 
0.7 
2.2 
l.Oto 1.2 
9.0 
Tomatoes 
.. 94.3 
0.7 
3.7 
0.4 
0.5 
0.6 
5.0 
Watermelons 
. 92.9 
0.3 
6.5 
0.2 
7.8 FRUITS 
327 
lifting from the liver and kidneys an enormous burden of onerous 
and destructive work in poison elimination. The free use of 
fruit is a most effective means of combating intestinal autointoxi- 
cation, constipation, a condition of demineralization, and defici- 
ency disorders such as chronic scurvy. 
John Hunter advocated the free use of apples as the best 
remedy for gout. The great naturalist, Linnaeus, cured himself 
of a severe attack of sciatica by eating freely of strawberries. 
Tissot tells of a regiment of soldiers suffering from dysentery 
who were quickly cured after encamping close to a vineyard full 
of grapes. 
The medical history of the Civil War recounts a similar ex- 
perience by a regiment of soldiers from which a scourge of 
dysentery disappeared very quickly after their camp was located 
near an orchard of ripe peaches. 
Fruit Acids, 
The acids found in fruits are malic, citric and tartaric. 
These acids are carbohydrates and like starch and sugar are 
burned in the body, having a fuel value about half that of sugar. 
Fruit acids are found in foods in combination with soda or potash, 
usually the latter. When taken into the body the acid parts are 
oxidized or burned, leaving the base, or alkali, behind. On this 
account, the effect of these food acids is to increase the alkalinity 
of the fluids of the body, a matter of much consequence since by 
this means the acid waste products of the body are neutralized, 
and the tendency to acidosis always present is overcome. Citric 
acid and malic acid appear to be the most easily burned or utilized 
by the tissues. Tartaric acid is less readily utilized. 
Citric and malic acids are the common acids of fruits, the last 
named being most abundant except in berries and in fruits of the 
citrus family, in which citric acid predominates. Grapes contain 
tartaric acid only when ripe, the malic acid present in green 
grapes being changed to tartaric acid in the process of ripening. 
Apples and cherries contain malic acid chiefly. Cranberries con- 
tain 0.05 per cent, of benzoic acid, which is also present in plums 
and prunes. Citric acid is found in tomatoes. 
Many people have noticed the marked benefit from the use 
of acid fruits. The writer has not infrequently been told by per- 
sons suffering from dyspeptic disorders that the juice of a lemon 328 
THE NEW DIETETICS 
taken soon after meals has sometimes given relief. Others have 
been benefited by apple juice and others by moderate acid fruits 
of other sorts. 
The nature of this beneficial efifect of fruit was not under- 
stood until explained by experiments by Pavlov and others, which 
demonstrated: first, that the acids of fruits stimulate the stomach 
to produce gastric acid, which is absolutely essential for good 
digestion; and second, that the acids of fruits are able, to some 
degree, to take the place of the natural acid of the stomach when 
this acid is absent. 
These facts emphasize the importance of acid fruits, includ- 
ing the tomato—a vegetable-fruit—as an aid to digestion in 
achylia, a condition in which there is deficiency or absence of 
hydrochloric acid, the normal acid of the gastric juice. 
Disinfection of Fruits. 
Raw fruits and vegetables as received from the market are 
always open to suspicion of being contaminated with bacteria. In 
fact, this is true of most raw foodstuffs. All kinds of fresh fruits 
are infected with germs, yeasts and molds, which speedily develop 
and destroy the fruit unless prevented from so doing by means of 
cold storage. These germs may be derived from the garden soil, 
the hands of the pickers, the receptacles in which they are trans- 
ported, or the markets where they are exposed for sale. In the 
summer time the germs grow rapidly while the fruit is being 
transported to market, or while exposed in the market, or even 
after purchase by the consumer. Flies are a common source of 
infection. 
Thus fruit, eaten without disinfection, may easily become a 
source of mischief, as germs may grow in the stomach or intes- 
tine when swallowed with the food. In this way the average 
individual is constantly collecting germs of various sorts and 
every adult carries in his colon a vast assemblage of bacteria, the 
so-called intestinal flora. 
Such vegetables as lettuce, celery and radishes and fruits 
which like strawberries grow in, on or near the ground are liable 
to carry not only germs but the embryos of various intestinal 
parasites. 
The use as fertilizer, of “night soil,” gathered by city scaven- 
gers and largely disposed of to gardeners in the neighborhood of 
large cities, very naturally facilitates the distribution of intestinal FRUITS 
329 
parasites of various sorts. Some years ago Metchnikoff called 
attention to the danger of infection from this source. 
Soil may become infected with B. botulinus by means of 
stable manure. The owner of a small garden for eight years 
canned string beans grown in his own garden, with excellent 
success. There was no spoilage and no sickness due to the use 
of the beans. In 1918 animal manure was used as a fertilizer. 
The beans raised were canned by the same process employed be- 
fore, but instead of keeping as before, they spoiled, and some of 
the cans were found to contain the deadly poison produced by the 
B. botulinus. 
Snails, worms and insects gather typhoid and other germs 
from the soil and in crawling over the leaves of vegetables deposit 
a trail of germs with fecal matters upon the surfaces which they 
traverse. 
A fresh chloride of lime solution, half ounce to two gallons, 
will destroy the germs without impairment of the food in flavor or 
any other particular. A large stone jar is half filled with the 
solution. Fruit, lettuce, or other food, after thorough washing, 
is immersed in the disinfectant and allowed to remain for five 
minutes. The solution should be kept covered and will be efifective 
for several days. 
At the Battle Creek Sanitarium, this method is in daily use 
for the disinfection of all fresh, uncooked fruits and vegetables 
used in the feeding of the great family of 2,000 to 3,000 persons 
who are served in the several capacious dining rooms of the insti- 
tution. 
Since this practice was introduced about 20 years ago, out- 
breaks of “bowel trouble,” which formerly occurred with con- 
siderable frequency during the summer months, have wholly 
ceased. 
This disinfecting all fresh foods will no doubt in time be- 
come general. It is the only means of protection against certain 
intestinal parasites which are very difficult to dislodge after they 
once become established. 
Fruit Seeds* 
The seeds of fruit consist chiefly of cellulose. Small seeds 
such as are found in figs, blueberries, raspberries and most other 
seedy fruits are entirely harmless and are perhaps to some degree 
beneficial through increasing the bulk of the food. Large seeds, 330 
THE NEW DIETETICS 
as those of the apple or grape and the cherry, if taken in con- 
siderable quantity might prove burdensome to the intestine and 
on this account ought to be discarded. It should be mentioned, 
however, that the danger which many people apprehend from the 
entrance of these seeds into the appendix is largely imaginary. 
Seeds are sometimes found in a diseased appendix, but their 
presence is purely accidental; they are not the cause of the dis- 
ease but a consequence of it. When the appendix becomes dis- 
eased in such a way that the valve which guards its mouth no 
longer operates, remaining open, seeds and other foreign bodies 
may find their way into the appendix and possibly may thus 
become a source of injury and danger, although the danger from 
this source must be quite remote. 
The Fruit Diet. 
By making a proper selection of fruits it is possible to con- 
struct a dietary quite capable of sustaining life for an indefinite 
period. Bananas, figs, dates, raisins and prunes contain an 
abundance of nutritive material in sufficiently concentrated form 
to be readily available as suitable foodstuff's. The only element 
lacking is fats and these may be readily obtained from such fruits 
as the avocado or alligator pear of the tropics and by the addi- 
tion of nuts to the bill of fare. By a combination of fruits and 
nuts a very complete and luxurious bill of fare may be provided. 
For entire safety, however, it is better to add milk to the 
above bill of fare. A pint of milk a day will insure the proper 
intake of food lime and of the complete proteins which are neces- 
sary for the repair of the blood and of the tissues. 
Contrary to the opinion formerly held by physicians, fruits 
and fruit juices are not only not injurious to persons suffering 
from gouty or rheumatic affections, and even in cases of acidosis, 
but are highly beneficial. 
Fruit juices of all sorts contain in addition to vegetable 
acids alkaline substances which neutralize acids and aid in the 
elimination of uric acid. Pure uric acid dissolves with great diffi- 
culty but the urate of soda or potash is readily soluble. Soda 
and potash are present in fruits in considerable quantities in 
combination with other acids. When fruit is eaten the acids are 
utilized or burned in the body leaving the soda behind. It com- 
bines with the uric acid and thus aids its elimination. The popu- 
lar idea that the acids of fruits are unwholesome for persons FRUITS 
331 
suffering from gout and other uric acid disorders is a very mis- 
chievous error. The fallacy of this teaching has been pointed out 
for many years by scientific writers on dietetics, but like many 
other popular fallacies this erroneous notion is very hard to 
eradicate. 
The Germicidal Properties of Fruits* 
More than twenty years ago Kitasato and Van Ermengen 
demonstrated experimentally that citric acid and other fruit acids 
are possessed of active germicidal properties. The typhoid bacil- 
lus and also the bacillus of cholera were destroyed by a one-half of 
one per cent, solution .of citric acid. Malic acid, the acid of the 
apple, was found equally efficient. In making a direct application 
of this discovery, the writer succeeded in sterilizing the stomach of 
a patient, a physician, whose stomach fluid showed more than 
5,000,000 aerobes and 2,500,000 anerobes per cubic centimeter. 
The stomach was found completely sterile after a meal consisting 
of 10 ounces of strawberries and 9 ounces of water. Half a pint 
of orange juice given half an hour before the meal has been found 
of very great value in similar cases. The idea of using fruit juices 
in cases of gastro-intestinal autointoxication is, however, by no 
means new. 
Dr. Dwight more than a century ago reported cases of sick 
headache successfully treated by giving the patient a glassful of 
apple cider before each meal. 
The character of the food certainly makes a very marked 
difference in cases of this sort. For example, in the case of a 
meal consisting of scraped beef prepared and cooked in the usual 
way bacteriological examination of the stomach fluid showed 
nearly 24,000,000 bacteria per ounce, although after a sterile 
meal no bacteria at all were found. In the same case a test meal 
of cheese gave 280,000,000 bacteria to the ounce of stomach fluid. 
These observations led the writer many years ago to adopt in the 
treatment of cases of gastro-intestinal disease a strict antiseptic 
or rather an antitoxic or atoxic dietary, from which meat and 
eggs are wholly excluded. 
Later, after many experimental efforts, the fruit regimen 
was devised. In this diet fruit is made the exclusive food with 
bran in liberal quantities, as explained in detail elsewhere. This 
regimen has proven to be of great service in the treatment of 
constipation (see index). 332 
THE NEW DIETETICS 
The Iron Content of Fruits. 
We are so accustomed to think of fruits solely as sources of 
sugars and acids that we are naturally surprised at the discovery 
that these choice comestibles are really most valuable sources of 
food iron. It is true the average iron content per ounce is small, 
less than 2 per cent, of the daily ration (1.74) ; but then the 
food value is also low on account of the large percentage of water, 
so that the average percentage of the ration of iron is more than 
three times as great (5.6). One can eat a larger bulk of fruit 
without risk of injury than of any other class of foodstuffs. 
Besides, there are certain fruits which are exceptionally rich 
in iron, containing on the average twice as much iron as the 
general run of fruits. Of less than a half dozen fruits in this 
class, dates, figs, Zante currants, prunes and raisins, the average 
percentage of the day’s ration per ounce is 5.2 and per 100 calories 
6.8, considerably higher than the averages for all foodstuffs which 
are, respectively, per ounce, 3.25 and per 100 calories 6.38. 
It will be readily seen how the fruits named may be usefully 
employed in balancing the ration for iron. A quarter of a pound 
of dates supplies nearly one-fourth of a total day’s iron ration, 
and at the same time furnishes a substantial amount of energy 
to support muscular work. Two ounces each of figs, olives and 
prunes, and an ounce each of raisins, dates and currants would 
supply half a day’s requirement of iron and one-third of a liberal 
day’s food supply. 
Taking into account the large amounts which may be eaten 
with impunity, together with their other good qualities, fruits 
may well be regarded as a most valuable source of food iron. 
The strawberry and the raspberry are especially noteworthy. 
The Lime Content of Fruits. 
A characteristic of fruits in general is their small lime con- 
tent. The average amount of lime in 28 of our commonly used 
fruits is one-eighth grain per ounce, requiring 123 ounces for one 
day’s supply of lime (15.4 grains), more than is demanded of 
any other class of foods with the exception of meats, which re- 
quire the consumption of 270 ounces, more than 17 pounds, an 
impossible amount for anyone but an Eskimo. 
It is important to observe, however, that there are some very 
noteworthy exceptions to the general rule of low lime content in FRUITS 
333 
fruits. Zante currants are rich in lime, containing half a grain 
to the ounce, or four times as much as the average of all fruits. 
The olive affords three-quarters of a grain to the ounce and the 
fig, which has been a choice food staple for millions in the Orient 
from remote ages, supplies a whole grain of lime to each ounce, 
or a day’s lime ration in less than one pound of the dried fruit, 
and one-third as much in the same quantity of figs fresh from 
the tree. 
Fruits are thus seen to be a really practical means for replen- 
ishing as well as maintaining the lime supply of the body, a need 
which our ordinary bills of fare wholly ignore. 
And fruits have the advantage not only of being a most 
agreeable form of aliment but a most reliable source of lime, 
since they are not likely to be robbed of their mineral constituents 
by the misguided efforts of those experts in denaturing and 
sophisticating foodstuffs, the manufacturers, canners and cooks. 
It is well to note the fact that quite a number of our most 
commonly used fruits are very deficient in lime salts. For ex- 
ample, the apple contains so little lime that one would have to eat 
22 pounds daily to get his supply if dependent on this source 
alone. The banana is almost equally deficient, requiring 17 
pounds for a day’s ration. The tomato yields a day’s supply in 
14 pounds, the watermelon in an equal quantity, the pear and the 
peach in 10 pounds and the cantaloup in 9 pounds. In other 
words, the proportion of lime in these fruits is so small that it 
may be ignored in estimating the lime content of bills of fare. 
The Ripening Process in Fruits. 
In Mexico, ripe fruit is said to have been cooked in the sun 
(cocido in el sol). The Arabs have a similar saying. The changes 
which take place in the cooking of green fruit are about the same 
as those which occur during ripening, though much less extensive. 
Cooking renders green fruit digestible, and ripening does the 
same, but also involves many other changes. The Experiment 
Station Record tells us that “the apple fruit, considered as a 
living organism, has first a period of growth during which the 
dry matter, principally starch, is continually increased. A second 
or ripening period follows, during which starch is changed into 
sucrose (cane sugar). This in turn is gradually changed into 
invert sugar, with a gradual decrease of malic acid and of car- 
bohydrates and an accompanying respiration of carbon dioxid. 334 
THE NEW DIETETICS 
These changes are largely due to the activity of oxidizing enzymes, 
the oxygen of the air being drawn upon in the process. 
The changes progress much more rapidly after picking, at high 
temperatures, and in the short-season varieties. Soon after picking, 
apples should be placed in cool storage to retard the processes above 
mentioned. Respiration continues during the storage period, becoming 
ultimately less active. Transpiration continues during the life of the 
apple. The third period is that of disintegration. 
Arsenic in Fruit* 
The extensive use of arsenic for the spraying of fruit trees 
has led to an investigation of the possibility of contamination of 
the fruit with this poisonous chemical. Careful analyses have 
shown that spotted apples often contain considerable quantities 
of arsenic. As much as three-tenths of a milligram, nearly one 
two-hundredth of a grain, of arsenic has been found in a single 
apple. Arsenic has also been found in the paper with which 
apples are wrapped. This is a matter which should receive 
serious attention by apple growers and shippers. 
THE APPLE 
The apple tree thrives in all temperate regions along with the 
oak, and has been known and appreciated from prehistoric ages. 
There are about 1,500 cultivated varieties of the apple, but of 
this great number not more than 50 are of commercial import- 
ance. 
The apple contains about one-seventh its weight of solids, of 
which the main part is sugar and protein. The acid of apples is 
chiefly malic, the percentage of which varies greatly in different 
varieties of this valuable fruit. 
Per cent, of Acid 
(Malic) 
Baldwins 0.60 
Maiden blush (green) 1.68 
Early ripe (green) 1.09 
Gravenstein (green) 1.27 
Sweet bough (green) 0.21 
Sweet bough (ripe) 0.13 
Sour apples 0.62 
Tompkins king 0.41 
Crab apple 0.78 
Northfield beauty crab 1.81 
Sweet cider 0.40-0.56 FRUITS 
335 
The presence of pectin gives to the juice of apples the prop- 
erty of jellying when concentrated by heat. 
Apples and apple juice are of great dietetic value. Taken 
freely they are laxative, especially when taken on an empty 
stomach. 
The apple is a universal favorite as a luxury and is by no 
means of small value as a food. Its fine flavor and appetizing 
acid give it pre-eminence as a peptic stimulant. Recent observa- 
tions in feeding experiments seem to indicate that its protein, 
though small in amount, is particularly fine in quality. 
As is true of other fruits, some persons are sensitized to the 
protein of apples and cannot even endure their presence, although 
such cases are rare. One such example is mentioned by Soyer, 
who relates that Ulaislas, king of Poland, in the presence of 
apples became so distressed and terrified that he was compelled to 
flee, a circumstance which at that time was most mysterious and 
unaccountable on rational grounds. 
Apple Juice. 
Unfermented apple juice is exceedingly wholesome. The 
agreeable acid flavor is due to malic acid, which is an excellent 
antiseptic or disinfectant for the stomach and intestine. It is a 
very highly valuable remedy in gastric and intestinal catarrh, 
so-called biliousness, jaundice, constipation, and in cases in which 
the kidneys and the liver are disordered, in emaciation, loss of 
appetite, and general malnutrition. It may be taken in quantities 
of one quart daily with advantage. The best times for taking are 
one-half hour before each meal and just before retiring at night 
Freshly prepared apple juice is one of the best of all fruit 
juices and is even superior to grape juice. Malic acid is a milder 
acid than the tartaric acid of grapes and is more easily utilized 
by the body. Freely used, apple juice is a laxative and combats 
any tendency to acidosis. Persons subject to gout and other dis- 
orders due to chronic uric acid poisoning may make a liberal use 
of apple juice to advantage. 
Apple juice should be prepared from selected apples, which 
should be thoroughly washed before grinding. The juice may be 
preserved by heating to a temperature of 165° F. for fifteen or 
twenty minutes. This will kill the yeast and other organisms 
which give rise to fermentation. Heating to a high temperature 
impairs the flavor of the juice, and lessens its wholesomeness. 336 
THE NEW DIETETICS 
The common practice of adding a small percentage of benzoic 
acid to apple juice to prevent fermentation is highly objection- 
able and cannot be too strongly condemned. 
THE PEAR 
The pear, at its best, is a most delectable product of Nature’s 
food laboratory. It is a sweet fruit, containing less acid than 
almost any other fruit. The following table shows the small 
amount of acid found in those varieties which contain the most: 
Per cent, of Acid 
(Malic) 
Kieffer .50 
LeConte .28 
Bartlett .30 
Angonleme .18 
Seckel 06-.20 
Winter Nelis 11-.25 
THE QUINCE 
The quince, like the apple, has come down to us from the 
ancients. Its flesh is too hard for use in a raw state and is 
chiefly employed for marmalade and preserves. 
THE PEACH 
In its best state, the peach is one of the most delicious of all 
our orchard fruits. The finest varieties are rich in sugar (6 per 
cent.) and contain little acid. This fruit, even when ripe, con- 
tains considerable cellulose and thus is valued as a laxative. 
The nectarine is a variety of the peach which has a smooth 
skin. 
The apricot is another member of the peach family. It 
differs from the peach in containing about twice the amount of 
sugar and still less acid. 
PRUNES AND PLUMS 
Of these fruits there are many varieties, some of which are 
sweet while others contain a considerable amount of acid. The 
prune when dried is nearly as rich in sugar as the fig. 
Prunes soaked in water for twenty-four to forty-eight hours FRUITS 
337 
and freely eaten have a decided laxative effect. They are much 
used for this purpose by eminent German physicians. 
A research conducted by Dr. Blatherwick, of the Sheffield 
Scientific School of Yale University, some years ago in the labor- 
atory of the Battle Creek Sanitarium showed that prunes contain 
so large an amount of unusable acid that they tend to acidify the 
urine. This acidity was later found to be due to benzoic acid. 
It is the only possible objection to their use. When eaten in 
connection with fresh vegetables in liberal quantities this objec- 
tion would probably not hold good as the small amount of benzoic 
acid would be neutralized; but if eaten freely in connection with a 
cereal diet the urine might be rendered so highly acid as to be 
decidedly injurious in some cases, especially in cases in which the 
bladder or kidneys are diseased. 
Prunes and plums should be avoided in cases of irritable 
bladder and whenever there is a tendency to acidosis. 
THE CHERRY 
The cherry is one of the most highly valuable of our orchard 
fruits, and is much appreciated because of its early appearance. 
It contains more than 10 per cent, of sugar, and has a nutritive 
value higher than that of the apple. 
“According to Pliny,” says Fernie, “cherries were first brought to 
Rome by Lucullus after his great victory over Mithridates, 89 B. C. 
The cultivated cherry disappeared in this country (England) during 
the Saxon period, and was not re-introduced until the reign of Henry 
the Eighth. 
“Cherry stones have been found in the primitive lake dwellings 
of western Switzerland. There is a tradition that Christ gave a 
cherry to St. Peter, admonishing him not to despise little things. 
“In France, soup made from cherries and taken with bread, is 
the common sustenance of the wood-cutters and charcoal burners of 
the forest during the winter.” 
The cherry is one of the most nutritious of the tree fruits. 
Some varieties are very rich in sugar, while others present a 
large percentage of citric acid. Its iron content is greater than 
that of egg white, milk, pears and apples, and equal to that of 
the tomato. 
THE PERSIMMON 
The native persimmon, which grows wild in the south and 
occasionally occurs as far north as Michigan, is a very sweet and 338 
THE NEW DIETETICS 
palatable fruit when fully ripe. The Japanese variety is much 
larger than the American and is a very luscious and wholesome 
fruit. 
This is another very ancient fruit, now produced extensively 
in this country, particularly in California. As picked from the 
trees, the olive is exceedingly bitter in taste. The bitter flavor is 
removed by immersion in running water for several weeks, or by 
placing for some hours in an alkaline solution. 
Green, pickled olives are inferior in food value. The ripe 
olive is highly nourishing. It is chiefly sold in this country in 
bottles or cans, being preserved by heating like other canned 
fruit. A few cases of poisoning have occurred from the use of 
olives infected with the B. botulinus, which gives rise to botulism, 
a serious, sometimes fatal, form of food poisoning. Canned olives 
which have an unpleasant odor when opened should be rejected. 
Poisoning is not likely to occur from the use of olives canned in 
tin. 
The olive is usually eaten in the ripe state in Oriental lands 
where this oleaginous fruit is at home. In this country, how- 
ever, the green olive has been the general favorite as a relish until 
recent years have seen the beginning of a change in the taste of 
the American public and the ripe olive is now growing in favor, 
as it well deserves to do. The green olive is practically indi- 
digestible and of little value as a food. 
According to Gautier the green olive contains little fat but 
much mannite, which in the process of ripening is converted into 
fat. 
THE OLIVE 
Green olive 
(Gautier) 
Per cent. 
Ripe olive 
(Atwater) 
Per cent. 
Water 
73.40 
64.7 
Protein 
0.76 
1.7 
Fat 
14.48 
21.0 
Extractives 
8.04 
3.5 
Cellulose 
0.90 
Ash 
0.42 
2 7 
The Scientific American Monthly gives us the following in- 
teresting information concerning the production of ripe olives : 
Most of our ripe olives originate in California, where three pick- 
ings are made during the season in order to obtain fruit of equal ripe- FRUITS 
339 
ness. At the factory the fruit is first sorted, graded for size, and is 
then placed in an alkaline solution, usually sodium hydrate, the 
strength of which varies, but probably averages one and one-half per 
cent. At the end of six to eight hours this lye is drawn off, the olives 
exposed to the air to brown them by oxidation, and the operation 
repeated until an examination shows that the lye has penetrated to the 
pit. Clear water changed twice daily is now used until the lye and 
bitterness are removed, this requiring from four to eight days. The 
next treatment consists of a series of brine solutions, beginning with 1 
per cent, and increasing the strength at intervals of about two days 
until approximately 4 per cent, is used. At this point they are ready 
to be put into glass cans and sealed. 
Some packers allow the olive to remain in the weak brine long 
enough to produce an acid flavor by fermentation and others endeavor 
to retain the natural color rather than to induce oxidation. If it is 
intended to hold the olives in bulk the strength of the brine is in- 
creased until 10 or 12.5 per cent, is reached, the stronger solutions 
being necessary if they are to be carried through the summer. 
To be sure the process as outlined is modified in practice to 
satisfy the conditions, taking into consideration varieties of fruit, tem- 
perature, etc. As the olives are packed the soft and defective ones are 
discarded and the containers are filled with three per cent, brine at a 
temperature of 175° or 180° F. The air is then exhausted while the 
temperature is raised to 185° F., when the containers are sealed ready 
for processing. Processing consists in cooking in the bottle from fifty 
to sixty minutes, depending upon the size of the olive and the size of 
the container. In some factories 240° F. is reached. If a lower 
temperature is used the time is increased. 
THE GRAPE 
The grape is one of the most valuable of fruits and has been 
in use for ages. When partially ripe, the grape contains both 
tartaric and malic acids, but the malic acid is changed to tartaric 
as the process of ripening continues. 
The varieties differ in sweetness, the sugar content ranging 
from 13 to 25 per cent. The acid content also varies. 
Zante currants are prepared from the Corinth grape, a small 
black variety which has a thick skin and is seedless. 
Grape Juice, 
Grape juice has now become a very extensive article of com- 
merce. It is preserved by bottling and pasteurizing. In Oriental 
countries, the juice of sweet grapes is concentrated in the sun to 
the consistency of syrup. This grape syrup is highly prized as 340 
THE NEW DIETETICS 
an article of diet throughout the Orient and has been in use from 
the most remote times. 
The Composition of Grape Juice, 
The following table shows the percentages of tartaric acid 
and other solids found in commercial grape juices, the solids 
consisting almost wholly of levulose and dextrose, the sugar 
added for sweetening having been inverted by the acids present: 
Solids 
Tartaric acid 
Welch’s 
..... 19.00 
1.00 
Armour’s Top Notch. 
14.51 
0.93 
Duff’s 
... 15.37 
1.07 
Fremont 
... 13.99 
1.08 
Liggett’s 
..... 15.13 
0.86 
The above analyses, with the exception of Welch’s grape 
juice, were made by the Canadian Inland Revenue Department. 
BERRIES 
The characteristic of the berry is its seedy pulp. The seeds 
are indigestible but of value as roughage. 
The acid of berries is chiefly citric acid, with a small amount 
of malic acid. 
Of the dozen or more edible berries which grow wild or in 
cultivation scarcely half a dozen are in such general use as to 
be important commercially. 
The Strawberry, 
The strawberry, with its delicious aroma and its delicate 
sweet-acid flavor, is one of our choicest and most popular fruits. 
It is at the same time a very useful and wholesome food. Its 
high water content reduces its nutritive value below that of 
most fruits, placing it on a footing with the orange, the musk- 
melon, string beans and turnips; but it is unusually rich in lime 
and iron, not only as compared with other fruits but with most 
other foodstufifs. Here are a few interesting comparisons: 
The strawberry contains one-fourth grain of food lime to 
the ounce, which is more than any other fresh fruit except 
figs and raspberries. Its lime content is six times as great as 
that of the apple, five times the banana, four times the tomato FRUITS 
341 
and watermelon, and double or more than that of the blackberry, 
blueberry, cherry, cranberry, grape, muskmelon, peach, pear, 
pineapple or plum. Its lime content is exceeded among fruits 
only by dried fruits, especially figs, dates, currants, raisins and 
prunes. 
Notwithstanding its high water content, the strawberry pre- 
sents a higher proportion of lime than any cereal food except 
oatmeal and entire wheat and rye. It affords, in equal weight, 
five times as much lime as does rice, four times as much as hom- 
iny, and three times as much as white bread. 
The richness of the strawberry in iron is still more note- 
worthy. With the exception of the raspberry and fresh figs, the 
strawberry excels all other fresh fruits in richness in food iron. 
It contains four times as much iron as does the orange and nearly 
three times as much as grapefruit, apples, apricots, cantaloup, 
muskmelon, grapes, peaches, pears or watermelon; twice as much 
as do tomatoes and cherries, and 50 per cent, more than rasp- 
berries, currants, cranberries, bananas and blackberries. 
A pint of strawberries contains as much food iron as a 
pound loaf of white bread and one-fourth more than an equal 
weight of cornmeal. 
Strawberries are richer in iron than most fresh vegetables, 
affording more than celery and lettuce, as much as sweet corn, 
cauliflower and cabbage, only a little less than string beans, 
cabbage and brussels sprouts, and one-half more than turnips, 
squash, radishes, eggplant, carrots, parsnips, beets, onions and 
sweet potatoes, and four times as much as cucumbers. It is only 
excelled as a source of food iron by two vegetables—fresh lima 
beans and green peas. The strawberry has great value, when 
freely used, as a protection against the loss of lime or of iron, 
and it is also invaluable as a source of organic bases which are 
needed to neutralize the acid wastes of the tissues, thus prevent- 
ing the development of acidosis and its numerous accompanying 
evils. 
This excellent fruit contains 7 per cent, of sugar and 1.5 per 
cent, of acid, chiefly citric. 
Walton in his “Complete Angler” quotes Dr. Boteler as say- 
ing, “Doubtless God Almighty could have made a better berry, 
but He never did.” And most people will agree with the doctor 
in his opinion. 
The strawberry is a hardy plant and thrives in the far North. 342 
THE NEW DIETETICS 
The Laplanders mix the berries with reindeer cream and dry in 
the form of a sausage for use during their long winter. The 
liberal use of fresh strawberries has been found an excellent 
remedy for sprue and pellagra. 
The Currant and the Gooseberry* 
These are two excellent berries rich in both sugar and acid, 
which is for the most part citric. 
The Cranberry* 
This very popular berry contains about 4 per cent, of sugar 
and half as much acid, including one-twentieth of 1 per cent, of 
benzoic acid, the balance being citric acid. 
The cranberry should be avoided by persons who have a 
tendency to acidosis or highly acid urine. 
The Huckleberry or Blueberry* 
This excellent fruit flourishes in a wild state over a large 
territory extending from the Southern states to the far North. 
Recent and very successful attempts have been made to cultivate 
the blueberry in Florida and elsewhere. The blueberry is one of 
the most laxative of berries on account of the very large amount 
of cellulose found in its thick skin and numerous seeds. 
The Blackberry and the Loganberry* 
The blackberry is a richly flavored fruit containing a little 
less than 2.25 per cent, of sugar and 5 per cent, of cellulose, which 
gives it laxative properties. It grows wild in great quantities in 
certain parts of the country. Cultivated varieties are larger and 
finer in appearance, but not superior in flavor to the wild berry, 
which is much sweeter than the cultivated. 
The loganberry is simply a red blackberry, a sport. 
Commercial loganberry juice consists of the pure juice of the 
loganberry with the addition of cane sugar. A pint of loganberry 
juice contains about six ounces of cane sugar and a quarter of an 
ounce of fruit acids, of which three-fourths is citric acid, the 
remainder malic acid. 
The following is the composition of loganberry juice, accord- 
ing to an analysis made by the Columbus Laboratory of Chicago: FRUITS 
343 
Solids 34.25 
Reducing sugars, invert 16.10 
Cane sugar 14.80 
Citric acid 1.32 
Malic acid 0.47 
Pectose, color, etc 1.07 
Protein 0.20 
Ash 0.29 
The Raspberry. 
Now produced in many varieties, is somewhat finer in flavor 
than the blackberry. It contains a little more sugar and less acid 
than the blackberry. 
The Mulberry* 
This fruit, though highly palatable and rich in sugar, is little 
used in this country but in Daghestan is greatly prized for its 
richness in sugar. The dried Daghestan mulberry is so sweet it 
melts in the mouth like a small lump of sugar. 
Wild Berries. 
The numerous berries which grow wild are worthy of larger 
consideration than they have heretofore had in the national 
dietary. They are particularly valuable because of their richness 
in vitamins and the large amount of cellulose, which gives them 
laxative properties which are almost universally needed. Among 
the best of these may be enumerated the whortleberry, blackberry, 
barberry, raspberry, dewberry, cranberry and strawberry, which 
is the queen of them all. The elderberry, service berry, cloud 
berry and the June berry are also worthy of mention. 
CITRUS FRUITS 
The Orange* 
The orange is one of Nature’s finest gifts to man. Orange 
juice contains pre-digested food in a most delicious and attractive 
form, ready for immediate absorption and utilization. 
The amount of food contained in a single large orange is 
about equivalent to that found in a half slice of bread, but it 
differs from bread in that it needs no digestion, while bread, 
before it can be used in energizing and strengthening the body, 
must undergo digestion for several hours. It is for this reason 344 
THE NEW DIETETICS 
that oranges are so refreshing to an exhausted or feeble person. 
The sweeter the orange, the greater its food value. 
A pint of buttermilk has a food value of 176 calories, one- 
fourth less than that of an equal quantity of orange juice. A 
pint of oysters affords the same number of food units as a pint 
of buttermilk and hence has a food value inferior to that of 
orange juice. Even full milk is not so much superior to orange 
juice in nutritive value as one might expect. A pint of orange 
juice contains nearly the same number of food units as three- 
fourths of a pint of milk. Numerous green vegetables have a 
nutritive value no greater than that of orange juice. 
But the energy value of the orange, which for an ordinary 
sized orange amounts to 75 to 100 calories, is by no means its 
only value. Orange juice is rich in salts, especially in lime and 
alkaline salts, which counteract the tendency to acidosis that is 
always threatening sedentary people, hearty meat eaters, and 
those advanced in age. The free use of orange juice is a valuable 
means of combating the inroads of “Father Time,” and is also an 
excellent means of antidoting, to some extent, the bad effects of 
an indoor or sedentary life. 
One or two oranges taken at bedtime and on rising in the 
morning are an excellent means of stimulating bowel action. 
Oranges may be taken between meals with great benefit by feeble 
persons and those suffering from constipation. The delightful 
flavor and general stimulating influence of orange juice excites 
peristaltic activity, and so tends to prevent the accumulation of 
food residues in the colon which leads to putrefaction and auto- 
intoxication. 
As a food in fever cases, nothing could be more perfectly 
suited to the requirements of the patient’s condition. The fever 
patient needs water to carry off poisons which are burning him 
up and against which his cells and organs are struggling. Four 
to six quarts of water are needed daily to quench the fever’s fires 
and aid elimination through the skin and kidneys. 
Fruit acids aid in satisfying thirst, and their agreeable flavor 
makes it possible for the patient to swallow the amount of liquid 
needed. The intense toxemia from which the fever patient suffers 
and the lack of saliva coats his tongue and often destroys his 
thirst for water as well as his desire for food. The agreeable 
flavor of orange juice aids greatly in overcoming this obstacle. 
Another special and valuable property of orange juice is the FRUITS 
345 
small amount of protein or albuminous matter which it contains. 
Fever patients have little gastric juice and very small digestive 
power, and so need to take food which is ready for absorption and 
immediate use. Foods poor in albumen are also needful in fevers 
because they do not leave residues to undergo putrefaction in the 
colon, as do meat, eggs and numerous other foods. 
Orange juice contains less than 1 per cent, of protein or 
albumin so that a patient may take three or four quarts of the 
juice without getting an excess of protein which might easily 
become a source of great injury. 
Two quarts of orange juice with an equal amount of barley, 
oatmeal or rice gruel make an ideal daily ration for a patient 
battling with typhoid fever. 
Another class of cases in which orange juice is almost indis- 
pensable is found in those most unfortunate and suffering of 
mortals—bottle-fed babies. Usually fed on pasteurized or steri- 
lized milk, these unhappy little ones seldom fail to show marked 
evidence of malnutrition. They are, indeed, not infrequently 
victims of scurvy, rickets or pellagra. The investigations of 
Funk, McCollum and many others have shown that the emacia- 
tion, weakness, arrest of growth and general malnutrition in such 
cases is due to absence from their food of the essential known as 
vitamin. 
A few years ago the fortunate discovery was made that 
orange juice contains elements capable of supplementing the diet 
of puny, bottle-fed babies, resulting in immediate resumption of 
growth and a speedy return to health. This remarkable trans- 
formation occurs not only in human infants, but in young animals 
upon whom the orange juice feeding experiment has been re- 
peated. 
Every infant fed on sterilized milk or artificial infant foods, 
in fact, every infant fed from a nursing bottle not doing well 
should receive daily half an ounce to two ounces of orange juice, 
according to age, to supply necessary vitamins. Older children 
not doing well should receive two to four ounces of orange or 
tomato juice daily. 
The acid of orange juice and the sugars it contains aid 
digestion by stimulating the gastric glands to increased activity. 
It is also an appetizer of the first quality. 
On the whole, oranges are probably capable of serving more 
useful purposes in the economy of the body than any other juicy 346 
THE NEW DIETETICS 
fruit. As people become better educated in dietetics, oranges 
will be more and more appreciated and more freely used. 
The Lemon, 
There are more than sixty varieties of the lemon, including 
the lime and sweet lemon. Formerly the best lemons came from 
Sicily, but at the present time the finest lemons grown are pro- 
duced in the United States. In southern California and Florida 
the enterprise of American horticulturists has brought the fruit 
and its culture and handling to a very high state of perfection. 
The lemon rind contains an essential oil which is useful for 
some purposes, especially for flavoring, but the real value of the 
fruit is found in the two ounces of acid juice which the average 
lemon contains. 
The composition of lemon juice varies considerably, accord- 
ing to the time of picking and the length of time the fruit has 
been kept, together with the manner of keeping. The chief con- 
stituent of lemon juice is citric acid, of which the average lemon 
contains about 7.5 per cent. A lemon picked in April contains 
only about two-thirds as much acid as one picked in November. 
From April on, the percentage of acid steadily diminishes until 
by July there is little left, the citric acid being converted into 
sugar (dextrose) and carbondioxide. This is due to the vital 
activities of the living cells of the fruit. If oxygen is excluded, 
by varnishing the fruit, the change may be prevented, as also to 
a large extent by cold storage. 
Lemon juice also contains a notable amount of salts (2 to 3 
per cent.) chiefly potash and phosphoric acid. 
The percentage of potassium in lemon juice is greater than 
in either apple juice or grape juice. This abundant and unusual 
supply of salts makes the lemon an important source of this 
highly essential food principle, and brings clearly to view the fact 
that the nutritive efifect of lemon juice is that of an alkali instead 
of that of an acid, as superficial knowledge would suggest. 
It thus appears that the lemon is worthy of a much larger 
place in our national dietary than it has heretofore enjoyed. 
All fruits are valuable as a means of counteracting the tend- 
ency to excessive accumulation of acids through the large use of 
cereal breakfast foods and excessive meat consumption, which 
are current practices in this country; but the lemon has the 
advantage that it is accessible at all seasons of the year. It may FRUITS 
347 
be readily obtained when most other fruits are difficult to pro- 
cure. 
But the claim of the lemon to a prominent place in the 
national dietary does not rest alone upon its valuable store of 
alkaline salts. It has long been known that the juice of lemons 
contains something of such extraordinary value as a food that 
without it the diet of soldiers, seamen, and other bodies of men 
who are compelled to live for long periods of time upon a re- 
stricted diet is almost certain to prove so inadequate as to give 
rise to very grave and often fatal disease. Outbreaks of scurvy, 
especially among soldiers and sailors, have been recognized for 
hundreds of years. 
The lemon, of all fruits, seems to possess the highest scurvy- 
preventing value. It was formerly thought that the sour lime 
of the West Indies was especially valuable for this purpose, but 
Alice Henderson Smith has demonstrated that the West India 
sour lime has only one-fourth the scurvy-preventing value of the 
lemon. This observer has also proven that the so-called lime juice 
used many years ago as a preventive remedy was prepared from 
lemons and sweet limes and not from the sour lime. This prop- 
erty of the lemon is found to be due to a subtle substance present 
in lemon juice in minute quantities, known as the antiscorbutic 
vitamin. This vitamin is also found in many fresh fruits and 
vegetables, particularly in the tomato and the potato, but the juice 
of the lemon and of the orange, especially that of the former 
fruit, has been shown, not only by clinical experience but by 
crucial laboratory experiments, to possess this property in a very 
high degree. This property is not associated with the acid of the 
lemon, for it is found to be present even after the acids have been 
removed, and is not possessed by the citric acid of the laboratory 
which may be purchased at drug stores in crystalline form. 
It is believed by observing medical men that scurvy in mild 
and obscure forms is very widely prevalent in this country and 
probably in all civilized countries. 
The conventional breakfast, consisting of coffee, white bread 
or toast, bacon, or griddle cakes with syrup, and, perhaps the 
addition of pickles or doughnuts, is almost altogether deficient in 
vitamins, and is an excellent formula for producing scurvy. 
The substitution of lemon squash or hot lemonade for tea or 
coffee, or even any of the various cereal substitutes for coffee, 
would initiate marvelous physical improvement in thousands of 348 
THE NEW DIETETICS 
families which are now languishing under various forms of mal- 
nutrition. 
Lemon juice should be universally substituted for vinegar as 
an acid flavoring for salads and other vegetable dishes. It has 
long been used for this purpose by the best French cooks, and for 
many years has been gaining in favor in this country. 
As an appetizer, lemon juice has no superior. It stimulates 
the flow of saliva, and in like manner causes the gastric glands to 
pour forth the gastric juice which both disinfects and digests the 
food. 
Lemonade prepared by the addition of the juice of one small 
lemon to a quart of water, with three or four ounces of malt 
sugar, is an excellent beverage for use in fevers. Two or three 
quarts may be given daily with advantage. 
Lemonade may be freely used in rheumatic fever as well as 
other fevers, since the potash salts present serve to alkalinize the 
blood and other tissue fluids, as already explained. 
The Lime. 
This citrus fruit, allied to the lemon, possesses a character- 
istic flavor much liked by most persons, but on the whole ranks 
below the lemon in dietetic value, chiefly because less active as an 
antiscorbutic. 
TROPICAL FRUITS 
There are many tropical fruits which, with our improved 
methods of transportation, will probably in time become as popu- 
lar in the United States as they are in the Central American coun- 
tries. The mango and the avocado, or alligator pear, and the vari- 
ous varieties of the sapota are excellent fruits which might be 
added to the rather limited list of those grown in the United 
States. 
The Banana* 
A native of Asia, the banana is now grown in most tropical 
countries, and is one of the most productive of all food plants. 
Its food value is a little greater than that of the potato. Its 
protein content is small, one and a half calories to the ounce. It 
also contains very little fat. When ripe, it affords a large amount, 
more than 25 calories to the ounce, of an easily digestible carbo- 
hydrate. FRUITS 
349 
The popular idea that the banana is difficult of digestion is 
the result of the use of the fruit in an immature state. The 
banana is never allowed to ripen on the plant which produces it. 
It is always picked when it has attained full size but is not yet 
mature. The fruit is not fully ripe until the skin has become, in 
part at least, brown in color. During the change from yellow or 
red to brown, the starch, of which the green banana contains a 
large amount, is converted into dextrin and sugar, of which the 
ripe banana contains nearly 25 per cent. When thoroughly ripe, 
the banana is one of the most easily digestible of foods. When to 
be eaten by invalids or infants, it is well to convert the pulp into 
a puree by passing through a colander, after which it may be 
rendered very palatable and inviting to the eye by beating with 
an egg beater. 
The banana has a higher nutritive value than almost any 
other fruit which can be eaten fresh. Pound for pound, it sup- 
plies as much nutriment as the potato and is the staple food for 
thousands of rubber gatherers who perform prodigious feats of 
muscular exertion and endurance with almost no other sustenance. 
A well ripened banana contains almost no raw starch. Myer 
and Rose report that when bananas not well ripened are eaten a 
considerable amount of starch is found in the stools. This fact 
emphasizes the importance of taking care to select well ripened 
fruit, as indicated by the dark brown color of the skin, especially 
when feeding bananas to children. The raw starch is of course 
not objectionable, but its presence is evidence of the indigestibility 
of the unripe banana. 
The banana is rather deficient in organic salts; hence its 
digestion and assimilation leave little residue to be eliminated 
by the kidneys, a fact which may be taken advantage of in the 
feeding of patients suffering from Bright’s disease. Cases of this 
sort have been found to do well on a diet consisting largely of 
bananas. 
Humboldt first called attention to the enormous amount of 
food which may be produced by a single acre of bananas. Com- 
petent authorities have estimated that the banana yields per acre 
three or four times as much food material as is produced on the 
average by wheat, potatoes or corn. 350 
THE NEW DIETETICS 
Banana Flour. 
Banana flour is made by drying and grinding the mature but 
unripe fruit, the starch of which has not yet been changed to 
sugar. Banana flour is an easily digestible, highly nutritious 
product and is much used in the tropics. Stanley in his journey- 
ings in central Africa depended upon banana flour as his staple 
food. Mixed with wheat flour it may be made into very palatable 
cakes. Prepared in the form of gruel it affords a light and easily 
digestible form of nutriment for feeding certain classes of in- 
valids, particularly when it is desired to combat intestinal toxemia. 
Banana Figs. 
When dried, the ripe banana becomes a sweet leathery pro- 
duct somewhat resembling a dried fig in consistency but less sweet 
and much less palatable. Various attempts have been made to 
popularize banana figs in this country, thus far without success. 
In this highly favored part of the world so many attractive food- 
stuffs are available it is doubtful whether this very wholesome, 
if not highly attractive foodstuff, will ever come into general use. 
The Fig, 
This is one of the oldest cultivated fruits. It is generally 
eaten in the dried state, its content of sugar being sufficiently 
great to preserve it. The ripe fig eaten fresh from the tree is one 
of the most delicious of fruits. Eaten either fresh or dried, the 
fig is highly laxative on account of the large amount of cellulose 
which it contains, due to its tough skin and great number of small 
seeds. 
The dried fig has a nutritive value double that of lean beef. 
This excellent fruit is too little appreciated and used in the United 
States. In many parts of the Orient, particularly around Smyrna 
and in southern Greece, the dried fig is one of the staple articles 
of food of the peasantry. Coarse bread, ripe olives, and dried 
figs furnish a complete meal for the Greek sailors who man the 
ships of the Mediterranean. The fresh, undried ripe fig is a 
most excellent fruit but quickly perishable. The purple fig of 
California is particularly valuable as a laxative, and if properly 
prepared and preserved without the addition of cane sugar would 
be a most valuable addition to the national bill of fare. 
The dried purple fig soaked for 48 hours in cold water and 
eaten freely twice a day is an excellent remedy for constipation. FRUITS 
351 
The Date* 
The date, like the fig, has come to us from prehistoric times. 
Until recently its culture was wholly confined to the Orient. Its 
cultivation has in late years been undertaken in the Coachella 
valley and neighboring parts of the Colorado Desert in southern 
California. The date affords nearly three-fourths (70 per cent.) 
its weight of sugar, besides a considerable amount of protein, 
which sometimes rises as high as 7 per cent. 
Recent studies of the sugar content of the date have shown 
that while cane sugar is always present in the immature date it 
generally disappears to a large extent in the process of ripening, so 
that the fully ripe date contains almost exclusively invert sugar; 
that is, the sugar usually found in fruits—dextrose and levulose—• 
in about equal parts. The Deglet Nur, grown in Algeria and Cali- 
fornia, is practically the only well known date which contains cane 
sugar. Professor Vinson, of the University of Arizona, found in 
the Deglet Nur 41.4 per cent, of cane sugar and a little more than 
4 per cent, each of levulose and dextrose. The fard and most 
other commercial dates grown or sold in the United States are of 
the invert sugar varieties. Most dates eaten contain not more 
than 10 per cent, of cane sugar, with a total sugar content of 
about 70 per cent. 
It is gratifying to note that the date industry, especially in 
the Coachella valley, is making rapid advancement, and it is to 
be hoped that in time this superior fruit may be produced in 
sufficient quantity to supply our home market. It is particularly 
important that the growth of invert sugar dates should be encour- 
aged because of the superior value of the invert form of sugar, 
due to the fact that it is ready for immediate absorption and 
utilization, whereas cane sugar requires a somewhat prolonged 
digestive process to prepare it for absorption. 
It is believed by many eminent authorities that the free use 
of cane sugar in this country may be one of the causes of the 
increasing prevalence of diabetes, and Sherman has called atten- 
tion to the fact that the large use of cane sugar in the form of 
confectionery and otherwise results in extensive lime starvation, 
which affects probably half the population of the United States. 
To this may be attributed the dental caries which is becoming 
almost universal in this country even in children, as well as 
other forms of disease of the bony structures of the body. The 352 
THE NEW DIETETICS 
substitution of dates and other sweet fruits for the present free 
use of cane sugar would unquestionably greatly improve the 
health of the American people. The sugar in the date is not only 
a natural sugar, which is ready for immediate absorption, but in 
its natural state the sugar of the date is associated with the lime, 
iron, vitamins and other essential food constituents which are 
altogether lacking in cane sugar. 
The dates of commerce should be prepared for use by wash- 
ing. This rule should, in fact, apply to all sorts of dried fruits, 
especially those imported from the Orient. The latter, in addi- 
tion to washing, should be subjected to the disinfecting action of 
a 2 per cent, solution of peroxide of hydrogen, in which the fruit 
should be soaked for four or five minutes after washing. After 
disinfecting, the dates should be dried if not used at once. Ameri- 
can grown dates are clean and need no disinfecting. 
The Guava. 
This fruit, a native of the tropics, is now grown quite exten- 
sively in Florida and southern California. It has a rich, peculiar 
flavor which by many is greatly relished. The red, or strawberry, 
guava grown in southern California is very palatable. The guava 
has a nutrient content of about 20 per cent., the greater part of 
which is sugar. 
The Mango. 
This highly palatable tropical fruit is now produced in con- 
siderable abundance in southern Florida. As this fruit becomes 
better known, it will be more and more appreciated as a valuable 
addition to our growing list of fruits. 
The Pawpaw. 
This wonderful product of the tropics, known in Mexico as 
the melon sapote, is one of the most remarkable of fruits. The 
pawpaw, when mature, is nearly as large as a muskmelon, and has 
a rich, sweet pulp of such consistency that it may be eaten with a 
spoon. It contains papayotin, a digestive principle resembling 
pepsin and pancreatin. 
The Papaw. 
The papaw, though similar in name to the pawpaw, is very 
different. In flavor it somewhat resembles the banana and is 
much appreciated by those who have cultivated a liking for it. FRUITS 
353 
This fruit now growing wild in many parts of the United States 
should be cultivated and improved and may sometime become a 
very valuable orchard fruit. Its composition is, protein, 5.2 per 
cent.; fat, 0.9; carbohydrate (sugar), 6.8; ash, 0.5; water, 76.6. 
The Pineapple. 
This luscious fruit is grown in Central America, Porto Rico, 
the Sandwich Islands, the Philippines, the West Indies and in 
the southernmost part of Florida. When ripened before packing, 
this is one of the most delicious of fruits, affording nearly 25 per 
cent, of its weight of sugar and one-half of 1 per cent, of citric 
acid. 
As found fresh in the markets, the pineapple is usually some- 
what inferior in quality, having been picked before fully ripe. 
Although the pineapple contains a ferment which has an action 
upon proteins resembling that of pepsin and pancreatin, it is 
rather indigestible unless cooked or eaten in its fully mature state. 
The Pomegranate* 
This ancient fruit, formerly little known in this country 
because of the difficulty of importing it, is now produced in con- 
siderable quantity in California and certain Southern states. Its 
leathery rind encloses a mass of highly delicious pulp, the juice 
of which contains more than 13 per cent, of sugar and one-half of 
1 per cent, of citric acid. 
The Avocado, or Alligator Pear* 
This is a remarkable tropical fruit, a native of Mexico, now 
cultivated in Florida and southern California. The tough green 
or reddish rind of this fruit encloses a thick yellow pulp which 
has the consistency of chilled butter and contains besides 2 per 
cent, of protein and 6 per cent, of sugar, 15 or 20 per cent, of 
highly digestible, emulsified fat, or as much as rich cream. This 
is indeed a very precious characteristic which will render it in- 
valuable as a fat-building food when the supply becomes more 
regular and abundant. The United States Bureau of Plant In- 
troduction promises to supply in the near future different varieties 
of the avocado which will yield fruit in every month of the year. 
The avocado is the meat of the Guatemalans who do the hardest 
work on a diet of tortillas (corn cakes) and avocados. 
The avocado supplies not only a remarkably fine quality 354 
THE NEW DIETETICS 
of fat, but a protein probably about equal to that of milk in its 
nourishing value. 
Still another superior quality of this fruit is its richness 
in vitamins, one of the latest finds about it. When fed to rats, 
the avocado was found to promote growth in a most remarkable 
way. 
It is evident that the avocado is a most valuable addition to 
our food supply. The tree which produces it grows rapidly and 
begins to bear early. It flourishes in southern Florida in the 
vicinity of Miami, and in certain sheltered spots in southern 
California. Lower California is an ideal place for the growth 
of this as well as other tropical plants. If ever Uncle Sam finds 
some way to add this strip of tropic sunshine to his dominions, 
it will become the market garden of the whole country. 
The soft pulp of the avocado may be easily worked into an 
emulsion, which by the addition of water becomes a delicious 
and nourishing milk which ought to prove a good food for babies 
and invalids. 
The avocado lends itself admirably to the preparation of 
salads. With the addition of a little salt and lemon juice it 
makes an excellent salad. Some varieties are so rich in fat that 
the fruit may serve as an excellent table substitute for butter. 
The Guatemalan avocado, now cultivated in this country, contains 
as much as 30 per cent, of a most delicious and digestible fat. 
The avocado begins to bear three years from the seed, pro- 
ducing fruits which weigh from a pound to two and one-half 
pounds each. An acre of land planted to avocado trees will pro- 
duce from 600 to 1,000 pounds of fat, much more than can be 
produced by any other crop known. 
The Karob. 
The karob is a fleshy pod having a sweet flavor somewhat 
similar to the date, produced by a tree resembling the locust. It 
is cultivated to some extent in Egypt and other tropical countries. 
The fruit is commonly known as St. John’s bread. 
The mesquite tree of the Colorado desert, western Texas, 
Arizona, and northern Mexico produces a somewhat similar fruit 
having a sweetish flavor. It has been much used by the Indians 
for food and is greatly relished by cattle and mules. FRUITS 
355 
DRIED FRUITS 
Dried fruits are highly valuable, though to some extent 
depreciated by the process of drying. It has been shown that the 
ordinary processes of drying fruits destroy in large part, and 
sometimes entirely, the rich store of vitamins present in fresh 
fruits. Ordinary dried fruits are of little or no value as anti- 
scorbutics. In most other particulars dried fruits are nearly as 
valuable as fresh. When carefully dried by the most up-to-date 
methods, some fruits retain a considerable part of their vitamins, 
and when soaked in water recover almost their original freshness 
in appearance and flavor. The prune and the blue California fig 
are much more efficient as remedies for constipation, as well as 
more palatable, when prepared by simply soaking for 24 to 48 
hours in cold water and without cooking. Fresh milk, with to- 
matoes, potatoes and other foods rich in vitamins, should be liber- 
ally used with dried fruits. Drying does not destroy the vitamins 
of the tomato. 
The following table shows the composition of the dried fruits 
in ordinary use: 
TABLE XXXIIL 
Water 
Protein 
Carb. 
Fat 
Acids 
Fiber 
Salts 
Calories 
per oz. 
Apples 
. 28.1 
1.6 
57.6 
2.2 
3.6 
4.9 
2.0 
85.2 
Apricots 
. 29.4 
4.7 
56.0 
1.0 
0.3 
7.5 
2.4 
81.2 
Bananas 
. 29.2 
5.3 
55.5 
2.1 
5.3 
69.5 
Banana flour 
. 9.7 
3.1 
83.4 
0.7 
2.6 
Currants, Zante... 
.. 17.2 
2.4 
74.2 
1.7 
4.5 
93.5 
Dates 
.. 20.8 
4.4 
65.7 
2.8 
5.5 
1.5 
98.8 
Figs ~~ 
.. 18.8 
4.3 
67.3 
0.3 
7.3 
2.4 
90.0 
Pears 
.. 16.5 
2.8 
66.0 
5.4 
6.9 
2.4 
92.4 
Prunes 
.. 21.0 
2.1 
70.0 
2.7 
2.3 
2.3 
83.6 
Raisins 
.. 14.6 
2.6 
73.6 
3.3 
2.5 
3.4 
92.0 
Raspberries 
.. 8.1 
6.5 
50.0 
1.8 
6.0 
25.0 
2.6 
69.1 
Percentage Composition of Dried Fruits, 
Certain fruits, particularly figs and raisins, are generally 
dried in the sun. This method, however, exposes the fruit to 
contamination by dust and insects. The modern improved methods 
of artificial drying afford a much cleaner and more uniform pro- 
duct. The great fruit industry of California has stimulated 356 
THE NEW DIETETICS 
invention to such an extent that at the present time the art of 
drying fruit has attained a very high degree of perfection, and 
has developed the enormous industry which produces annually 
more than half a billion pounds of dessicated fruits. 
Dried fruit has the advantage that it retains most of the 
properties of the fresh fruit, occupies less bulk, and with proper 
precaution may be preserved for a considerable time. 
A bushel of fresh apples weighing fifty-five pounds, in the 
process of drying loses more than forty pounds of water. The 
loss of water in the drying of some other fruits is even greater. 
The fruits for which the greatest demand in the dried state has 
existed heretofore are the apple, peach, apricot, raisin, date and 
fig; but there is an increasing demand for the dried banana and 
banana flour, two excellent products which present a choice 
quality of nutritive material in easily digestible form. 
The bleaching of dried fruits by means of the fumes of 
burning sulphur has been generally condemned by hygienic 
authorities because of the considerable amount of sulphite left in 
the bleached products. The Federal Government and several 
States have passed laws restricting the amount of sulphite permis- 
sible. A process has recently been perfected, however, by which 
this objection is overcome. It has been found that by the use of 
peroxid of hydrogen the injurious sulphite may be converted into 
a harmless compound, so that the sulphur bleaching process may 
now be applied for the disinfection and preservation of foodstuffs 
as well as bleaching and may be employed for the treatment of 
nuts, sirups, gelatin, potatoes and other foodstuffs. 
CANNED FRUITS 
The preservation of fruits by canning has greatly enriched 
our winter and spring bills of fare and provided a useful supply 
of appetizing carbohydrate foods at a season when, in former 
times, the dietary often became monotonous. 
When canned in tin, the organic acids of fruits are likely to 
attack the container and may thus become contaminated with 
lead from the solder. After a long time, the acid may even attack 
the tin. This difficulty has been largely overcome in recent years 
by the application of enamel to the inside of the can. Glass fruit 
cans are evidently much better adapted to the preservation of 
fruits than tin containers. FRUITS 
357 
It is to be remembered, also, that the antiscorbutic vitamin 
is likely to be greatly impaired, even destroyed, by the heat em- 
ployed in processing canned fruit. Fortunately, the temperatures 
employed in the canning of fruits are not so high as those required 
for vegetables, and on this account the vitamins are less damaged. 
The juice of canned tomatoes has been found to be an excellent 
antiscorbutic. 
Canned fruits as well as other foods which contain preserva- 
tives, such as benzoate of soda, are unwholesome and should never 
be used. The following table shows the average composition of 
canned fruits in general use: 
TABLE XXXIV. 
Showing the Percentage Composition of Canned Fruits* 
Water 
Protein 
Pat 
Carb. 
Salts 
Calories 
per oz. 
Apples, crab . 
42.4 
0.3 
2.4 
54.4 
.5 
70 
Apple sauce 
61.1 
0.2 
0.8 
37.2 
.5 
44 
Apricots 
81.4 
0.9 
— 
17.3 
.4 
21 
Blackberries 
40.0 
0.8 
2.1 
56.4 
.7 
72 
Blueberries 
85.6 
0.6 
0.6 
12.8 
.4 
17 
Cherries 
21.0 
1.1 
77.2 
.7 
91 
Peaches 
88.1 
0.7 
0.1 
10.8 
.3 
14 
Pears 
81.1 
0.3 
0.3 
18.0 
.3 
22 
Pineapples 
61,8 
0.4 
0.7 
36.4 
.7 
45 
Prune sauce 
76.6 
0.5 
0.1 
22.3 
.5 
27 
Strawberries 
74.8 
0.7 
24.0 
.5 
29 
Tomatoes 
. 94.0 
1.2 
0.2 
4.0 
.6 
6 
FRUIT JUICES 
The value of fruit juices is as yet much too little appreciated. 
Fruits differ from practically all other foods in the fact that 
their nutritive elements exist in the soluble forms of sugar, dex- 
trin and acids, and hence are almost exclusively found in their 
juices. The dry pulp left after the expression of the juice con- 
tains almost nothing except cellulose, a little protein and the major 
part of the salts. 
Fruit juices of all sorts are exceedingly wholesome. They 
contain all the valuable properties of the fruits from which they 
are prepared with the exception of cellulose. The popular preju- 358 
THE NEW DIETETICS 
dice against acid fruit juices on the ground that they encourage 
the development of rheumatism is entirely without scientific 
basis. Fruit juices, like fruits, are rich in the salts of sodium and 
potassium and increase the alkalinity of the blood and tissue 
fluids. 
The aromatic oils of fruit juices which give to them their 
characteristic flavors are appetizing and thus promote digestion. 
It is probable that many persons who are in the habit of using 
light wines value them for their fruity flavors rather than for 
any effects experienced from the alcohol present. The personal 
introduction of grape juice and of other fruit juices in recent 
times has no doubt contributed in no small degree to the success 
of the prohibition movement. An effort should be made to 
replace the wine and beer of ante-prohibition days by fruit juices 
of many different sorts. 
By means of a recent invention it is now possible to retain in 
fruit juices, in concentrated form, the aroma which was formerly 
lost in the processes of canning and condensation. 
Fruits and fruit juices are for the most part eaten as luxuries 
rather than as food staples. As a matter of fact, fruits and the 
juices of fruits are worthy of a more dignified position on the 
bill of fare. A half pint of grape juice has a food value of 200 
calories, fully equal to that of a like quantity of milk, though of 
a different sort, consisting of sugars with practically no protein 
or fat. 
Fruit juices, even much diluted, as in the form of lemonade, 
orangeade and similar drinks, contain an amount of nourish- 
ment worth considering. For example, as ordinarily made, a 
glass of lemonade (six ounces) affords 85.2 calories. In this 
case, the greater part of the calorie value is due to the sugar 
employed for sweetening. Cane sugar may be taken in this 
diluted form with less injury than in any other way. 
The establishment of prohibition has made of grape juice a 
national beverage. Other juices are equally valuable. Logan- 
berry juice is rapidly gaining in favor and orange juice now 
appears on the bill of fare of every first-class hotel or restaurant. 
The amount of food material found in fruit juices is much larger 
than is generally supposed. This will readily appear by reference 
to the accompanying table, in which it will be seen that the juices 
of the blackberry, grape, pear, raspberry and the strawberry, and 
even the pineapple, all equal or exceed whole milk in nutritive FRUITS 
359 
value; in fact, with the exception of lemon and orange juice, 
fruit juices in general are practically equal to milk in the actual 
amount of nutriment which they supply. Of course, none of these 
juices could take the place of milk as a food for the reason that 
the nutriment which they furnish is almost exclusively carbohy- 
drate. 1 here are conditions, however, in which exclusive carbo- 
hydrate feeding is desirable, as in certain cases of acidosis. In 
such cases fruit juices become a valuable resource. 
TABLE XXXV. 
Composition of Fruit Juice. 
Apple juice 
Protein 
0 
Calories per Ounce 
Fat Carbohydrates 
0 17.0 
Blackberry juice 
0 
0 
30.3 
Blueberry juice 
0 
0 
18.9 
Grape juice 
0 
0 
23.8 
Orange juice 
0 
0 
15.1 
Peach juice 
0 
0 
20.8 
Pear juice 
0 
0 
25.6 
Pineapple juice 
0 
0 
21.8 
Raspberry (red) juice 
0 
0 
23.7 
Raspberry (black) juice... 
0 
0 
29.4 
Strawberry juice 
0 
0 
24.5 
Lemon juice 
0 
0 
11.4 
It should be noted that the figures of the above table repre- 
sent fruit juices as they are usually served and include a small 
addition of cane sugar to the natural juice. This is true in prac- 
tically all instances except apple, orange and lemon juice. 
Fruits usually contain the antiscorbutic vitamin but are, 
however, rather poor in other vitamins. This important fact, to 
which attention has been called, emphasizes the necessity for ac- 
curate information in the making of bills of fare for the sick, 
since it may frequently happen that the patient is already suf- 
fering from a deficiency of some one or all of the three vitamins 
known to be essential to good nutrition. For example, a person 
attempting to live on a diet of fruits and nuts would suffer from 
lack of the water-soluble, or antiscorbutic vitamin, if the bill of 
fare was largely made up of dried fruits such as figs, dates and 360 
THE NEW DIETETICS 
raisins with nuts, even though the supply of carbohydrates, fats 
and protein might be very ample. 
On this account it is well always to include with the fruit 
and nut diet a liberal allowance of oranges to supply water-soluble 
vitamins B and C, and greens, carrots, butter or tomato, to supply 
the needed fat-soluble A. 
The tomato, either fresh or dried, is always a most safe ad- 
dition to the bill of fare because it is rich in all the vitamins. 
Dried tomato contains twice as much of the fat-soluble vitamin 
as does the same weight of butter. 
TABLE XXXVI. 
Showing the Composition of Commercial Lime Juices. 
The following analyses were made by the Canada Inland 
Revenue Department: 
Citric Acid and 
Solids Preservatives 
Blackwood’s 
8.8 
7.6 Salicylic acid 
Dalton’s 
7.2 
7.1 
Dominica 
10.6 
8.1 Benzoic acid 
Eaton’s 
8.7 
6.9 Salicylic acid 
Howard’s 
6.7 
6.6 
Montserrat 
9.2 
8.0 
Olympia 
7.8 
7.3 Benzoic acid, none 
Rose’s 
8.6 
7.9 Benzoic acid, none, or sulphur- 
ous acid 
Royal 
6.9 
Sovereign 
8.0 
7.2 Salicylic acid, benzoic acid, none, 
or sulphurous acid 
Sterling . 
..... 7.3 
6.8 Benzoic acid, salicylic acid, or 
none 
Victoria Cross 
9.3 
7.7 Sulphurous acid 
White Star 
7.9 
6.9 Nuts 
The nut is one of the oldest and best of Nature’s products 
intended as food for man. The paleontologists tell us that early 
man was a nut eater as are the gorilla, the orang-utan, and the 
chimpanzee, his modern prototypes. The chestnut has been from 
the most ancient times a staple article of food in northern Italy. 
The early inhabitants of Great Britain were acorn eaters, as were 
the ancient Greeks. 
In modern times nuts have been used as a luxury rather than 
as a staple article of food; but as the public become better in- 
formed respecting the high food value of nuts, especially in view 
of the steadily rising cost of flesh meats, the nut is certain to gain 
appreciation, and the writer has no doubt that some time in the 
future nuts will become a leading constituent of the national bill 
of fare and will displace certain foodstuffs which today are held 
in high esteem but which in the broader light of the next century 
will be regarded as objectionable and inferior foods. 
Botanically, a nut is a fruit; but nuts differ so widely both in 
composition and appearance from the foods commonly called 
fruits that they are properly classed by themselves. 
In nutritive value the nut far exceeds all other food sub- 
stances ; for example, the average number of food units per pound 
furnished by half a dozen of the more common varieties of nuts 
is 3231 calories while the average of the same number of varieties 
of cereals is 1654 calories, half the value of nuts. The average 
food value of the best vegetables is 300 calories per pound and of 
the best fresh fruits grown in this country 278 calories. The 
average value of the six principal flesh foods is 810 calories per 
pound or one-fourth that of nuts. 
Recent studies of the proteins of nuts by Osborne and Harris, 
Van Slyke, Johns and Cajori, have demonstrated that the pro- 
teins of nuts are at least equal to those of meat. This has been 
shown to be true of the almond, English walnut, black walnut, 
butternut, peanut, pecan, filbert, Brazil nut, pine nut, chestnut, 
hickory and coconut; that is, of practically all the nuts in com- 
mon use. 
361 362 
THE NEW DIETETICS 
The superior nutritive value of nuts is clearly shown by the 
following table: 
TABLE XXXVII. 
Composition and Food Value of Edible Portion of Nuts. 
Protein 
Per cent. 
Fats 
Per cent. 
Carbo- 
hydrates 
Per cent. 
Ash 
Per cent. 
Food value 
per pound 
calories 
Acorns 
... 8.1 
37.4 
48.0 
2.4 
2,718 
Almonds 
... 21.0 
54.9 
17.3 
2.0 
3,030 
Beechnuts 
... 21.9 
57.4 
13.2 
3.5 
3,263 
Brazil nuts 
... 17.0 
66.8 
7.0 
3.9 
3,329 
Butternuts 
.... 27.9 
61.2 
3.4 
3.0 
3,371 
Chestnuts, fresh 
.... 6.2 
5.4 
42.1 
1.3 
1,125 
Chestnuts, dried 
.... 10.7 
7.0 
74.2 
2.2 
1,875 
Coconuts 
.... 5.7 
50.6 
27.9 
1.7 
2,986 
Coconuts, shredded.... 
.... 6.3 
57.3 
31.6 
1.3 
3,125 
Filberts 
.... 15.6 
65.3 
13.0 
2.4 
3,432 
Hickory nuts 
.... 15.4 
67.4 
11.4 
2.1 
3,495 
Litchi nuts 
.... 2.9 
0.2 
77.5 
1.5 
1,469 
Peanuts, raw 
.... 25.8 
38.6 
24.4 
2.0 
2,560 
Peanuts, roasted 
.... 30.5 
49.2 
16.2 
2.5 
3,177 
Pecan nuts 
.... 11.0 
71.2 
13.3 
1.5 
3,633 
Pine nuts or pihons.... 
.... 14.6 
61.9 
17.3 
2.8 
3,364 
Pistachios, kernels. .. 
.... 22.6 
54.5 
15.6 
3.1 
3,010 
Black Walnuts 
.... 27.6 
56.3 
11.7 
1.9 
3,105 
English Walnuts 
.... 16.7 
64.4 
14.8 
1.3 
3,305 
Observation seem to show that, in general, the proteins of 
oily seeds are complete proteins. 
Cajori’s research has also shown the presence of growth- 
promoting vitamins in abundant quantity in the almond, English 
walnut, filbert, pine nut, hickory, chestnut and pecan. 
That the nut is appreciated as a dainty is attested by the 
frequency with which it appears as a dessert and the extensive 
use of various nuts as confections. That nuts do not hold a more 
prominent place in the national bill of fare as food staples is due 
chiefly to two causes: first, the popular idea that nuts are highly 
indigestible; and second, the limited supply. 
The notion that nuts are difficult of digestion has really no 
foundation in fact. The idea is probably the natural outgrowth NUTS 
363 
of the custom of eating nuts at the close of a meal when an 
abundance, more likely a super-abundance, of highly nutritious 
foods has already been eaten, and the equally injurious custom 
of eating nuts between meals. 
Neglect of thorough mastication must also be mentioned as 
a common cause of indigestion following the use of nuts. Nuts 
are generally eaten dry and have a firm hard flesh which requires 
thorough use of the organs of mastication to prepare them for the 
action of the several digestive juices. It has been experimentally 
shown that nuts are not well digested unless reduced to a smooth 
paste in the mouth. Particles of nuts the size of small seeds may 
escape digestion. Nut paste or butter is easily digestible. 
Delicious nut butters may be prepared from true nuts such 
as the almond, filbert, and pine nut, by blanching and crushing, 
without roasting. Peanuts require steam roasting. Over-roast- 
ing renders the nut difficult of digestion. 
According to the New Zealand Dairyman, more than 50,000 
tons of nut butters are produced in England every year. Peanut 
oil, palm kernel oil and coconut oil are the principal raw ma- 
terials used. In face of vanishing meat supplies it is most com- 
forting to know that meat of all sorts may be safely replaced by 
nuts not only without loss, but with a decided gain. Nuts have 
several advantages over flesh foods which are well worth con- 
sidering. 
1. Nuts are free from waste products, uric acid, urea, and 
other tissue wastes which abound in meats. 
2. Nuts are aseptic, free from putrefactive bacteria, and do 
not readily undergo decay either in the body or outside of it. 
Meats, on the other hand, as found in the markets are practically 
always in an advanced stage of putrefaction. Ordinary fresh 
dried or salted meats contain from 3,000,000 to ten times that 
number of bacteria per ounce, and such meats as Plamburger 
steak often contain more than a billion putrefactive organisms to 
the ounce. Nuts are clean and sterile. 
3. Nuts are free from trichinae, tapeworm, and other para- 
sites, as well as other infections due to specific organisms. Nuts 
are in good health when gathered and usually remain so until 
eaten. 
In view of these facts it is interesting to know that in nuts, 
the most neglected of all well-known food products, we find the 
assurance of an ample and complete food supply for all future 364 
THE NEW DIETETICS 
time, even though necessity should compel the total abandonment 
of our present forms of animal industry. 
Another of the great advantages of the nut is that with few 
exceptions it may be eaten direct from the hand of Nature with- 
out culinary preparation of any sort. Indeed, the common cus- 
tom of offering nuts as dessert is an acknowledgment that in the 
nut the refined chemistry of Nature’s laboratory permits of no 
improvement by tbe clumsy methods of the kitchen. 
The superior food value of nuts will appear from the 
following: 
One Pound of Walnut Meats Equals In Food Value 
Beef loin, lean 4.00 
Beef neck, lean 9.50 
Beef ribs, lean 6.50 
Chicken, broilers 10.00 
Eggs 5.00 
Evaporated cream. 4.00 
Fowls 4.00 
Frogs’ legs 15.00 
Ham, lean 3.00 
Ijobsters 22.00 
Milk 9.50 
Mutton leg, lean 4.20 
Oysters 13.50 
Red Bass 25.00 
Trout 4.80 
Veal 5.50 
Pounds 
Every highway should he lined with nut trees. Many nut 
trees will grow on land unsuited to ordinary farm crops. The 
pinon flourishes on the bleak and barren peaks of the rockies. 
A few nut trees planted for each inhabitants would insure the 
country against any possibility of food shortage. A row of nut 
trees on each side of our 3,000,000 miles of country roads would 
provide protein for a population of 100,000,000. 
Nuts should be eaten at every meal and made a substantial 
part of the bill of fare. So long as the nut is regarded as a 
dainty, suitable only for dessert, the demand will be limited. NUTS 
365 
But as its merits come to be appreciated it will be in greater 
demand and the supply will rapidly grow in volume. 
The Lime Content of Nuts* 
In proportion to their weight, nuts contain more lime than 
any other class of foodstuffs except legumes, the average being 
more than one-third grain to the ounce. (0.370 grs.). Certain nuts 
are surprisingly rich in lime. For example, the almond offers 
nearly one and a half grains of food lime to the ounce, while the 
hazelnut or filbert affords one and three-quarters grains of lime 
to the ounce, or 11.3 per cent, of a day’s ration of lime. The 
pecan and the walnut are also fairly rich in lime, as well as the 
peanut. 
An ounce and a half each of almonds and hazelnuts or 
filberts will supply one-third the total lime requirement for a day. 
In general, this addition to the ordinary bill of fare would be 
quite sufficient to insure against any serious deficiency of lime. 
By a combination of the proper nuts and fruits, the most 
delicious of all food combinations, the total needed supply of 
lime, or at least the major part of it, may be readily secured. 
Here is a convenient example which may well serve as a 
model supplementary lime ration for general use. Take at one 
meal a large orange and an ounce and a half of almonds. At 
another meal, an ounce and a half of filberts and two ounces of 
figs. These nuts and fruits would supply 50 per cent, of the 
necessary lime, and by adding for a third meal two oranges and 
two ounces of walnuts more than three-fifths of the total lime 
requirement would be furnished. 
Evidently there is no need of lime starvation if one only 
knows how to make a right selection of foods. 
The Iron Content of Nuts* 
The almond, hazelnut, chestnut, peanut, pecan and walnut 
all contain a rich store of iron, the average iron content expressed 
as per cent, of the iron ration being 4.79, more than two and 
one-half times that of fruits (1.74), three times that of vegetables 
(1.46), greater than that of cereals and even superior to average 
meats. It is true that the extraordinarily high food value of 
nuts renders them less available than fruits as prime sources of 
iron, for one would have to eat 5,000 calories of chestnuts or 366 
THE NEW DIETETICS 
walnuts or more than 4,000 calories of pecans or peanuts to get a 
day’s ration of iron; but three-quarters of a pound of almonds or 
hazelnuts would supply the needed quantum of iron with an 
energy intake of 2,500 calories, on account of their unusually 
rich store of iron. 
It is worth while to know that vegetable milk prepared from 
almonds, by adding five parts of water to one part of blanched 
almonds made into a smooth paste, supplies two and a half times 
as much iron as does cow’s milk in equal quantity, and furnishes 
the same amount of protein. It is worth noting just here, also, 
that the protein of the almond is, like that of milk, a complete 
protein; that is, a protein out of which human tissues may be 
readily formed, which is by no means true of all vegetable pro- 
teins. Such a milk, however, would be somewhat deficient in lime, 
a lack which could be supplied by lentil soup. 
A product commercially known as Malted Nuts, prepared 
from almonds or peanuts, has been found of very great service in 
meeting the needs of infants and some classes of invalids for an 
easily digestible liquid nourishment to take the place of milk 
when a substitute is needed. 
Of the nuts which grow in this country, the most important 
are the almond, the English walnut, the pecan and the peanut. 
The native black walnut, the hickory nut, the pinon, the hazelnut, 
and the beechnut are all valuable nuts which, by cultivation, might 
furnish enormous additions to our food supply. This is partic- 
ularly true of the black walnut. 
Among the imported nuts, the most important are the Brazil 
nut, the coconut, the pistachio, and the recently introduced litchi 
nut. 
A study of the relative protein content of nuts, milk and 
meat shows that, pound for pound, the almond, beechnut and 
walnut contain on an average as much protein as does meat and 
five times as much as is found in milk, and protein which from 
rat feeding experiments appears to be of equal value. The chest- 
nut, the chinquapin, the filbert, the hickory, pecan and pine nut 
contain on an average as much protein as is found in fish, while 
the butternut, the peanut and pignolia contain twice as much or 
50 per cent, more than is found in the best cuts of meat. 
The following table shows the number of pints of milk 
equaled in protein content by one pound of nuts, together with NUTS 
367 
the amount of nuts (ounces) needed to supply sufficient protein 
to equal one pint of milk, an amount amply sufficient to supple- 
ment the proteins of an ordinary mixed ration in the absence of 
meat: 
TABLE XXXVIII* 
Pints (lbs.) 
of milk equal in 
protein content to 
1 pound of nuts 
Amount of nuts 
(ozs.) equal 
in protein to 
1 pint of milk 
Almonds 
6.4 
2.6 
Beechnut 
6.6 
2.4 
Butternut 
8.5 
1.9 
Filbert 
4.7 
3.4 
Hickory nut 
4.7 
3.4 
Pecan 
3.0 
5.3 
Peanut 
7.8 
2.0 
Pignolias 
10.3 
1.6 
Pi non 
4.4 
3.6 
Walnut (California) 
5.6 
2.9 
Walnut, black 
8.4 
1.9 
The Vitamins of Nuts* 
Coward and Drummond have shown (Biochemical Journal, 
1920), that the fat-soluble A is present only in very small per- 
centage in nuts (Brazil, Barcelona, peanut, walnut, almond, but- 
ternut). In general the fat-soluble A vitamin is very sparingly 
found in seeds and is abundant only in the green parts of the 
leafing plant, in green shoots and in dairy products. 
The Almond* 
The almond perhaps deserves to be placed at the head of the 
list of all edible nuts. It is one of the finest of all the products 
of the vegetable kingdom. Until recently the almond was pro- 
duced almost exclusively in Oriental countries bordering on the 
Mediterranean. In recent years the culture of the almond has 
been greatly developed in California and to some extent in 
Florida. The so-called Jordan almond is the largest and best 
flavored of all the numerous varieties of the almond. The name 
Jordan does not refer to the Jordan river but is a corruption of 
an original word meaning garden, which was applied to this 
variety of nut for the reason that it was first raised only in 
gardens. The almond contains a protein very similar to that THE, NEW DIETETICS 
368 
found in milk, which is soluble in warm water. It also contains 
an emulsifying principle. Because of these characteristics a very 
delicious milk may be prepared from the almond, the composition 
of which is not very different from that of ordinary cow’s milk. 
The almond contains no starch but some sugar. About 50 per 
cent, of the nut consists of a fine quality of oil which is easily 
digestible. 
The almond has the advantage over many other nuts in the 
fact that the astringent, leathery skin with which it is covered 
may be easily removed by a simple process of blanching. 
An ounce of almonds blanched and slightly roasted, or 
crushed and served as a nut butter, is a most wholesome addition 
to any meal and may be used once or twice a day with advantage. 
Almond Milk* 
Shelled almonds are blanched by dipping the nuts for a 
moment in boiling water. Care should be taken not to allow the 
nuts to soak in the water. The skins of the soaked nuts will soon 
swell, when they may be rubbed off. The nuts are then dried and 
afterwards ground through a nut butter mill. By the addition of 
water with a little salt and, if desired, sugar, a very palatable 
cream or milk may be made. The water should be added grad- 
ually with vigorous stirring. At first the nut paste will swell up 
and thicken into a semi-translucent mass. As more water is 
added, with thorough mixing, the mass gradually assumes the 
appearance of thick cream. By the further addition of water, 
cream or milk of the desired consistency may be produced. 
Almond milk is a fairly good substitute for cow’s milk. It 
is said to have been used successfully in the feeding of babies in 
cases in which cow’s milk disagreed. Almond milk is a delicacy 
which may be used by invalids who dislike cow’s milk or who are 
sensitized to it. 
Almond milk or cream may be most conveniently prepared 
from almond butter, which is made by certain manufacturers of 
food specialties. 
The Hickory Nut* 
The meat of the shellbark hickory nut is a most delicious 
morsel. It is richer in fat than any other nut with the exception 
of the pecan, a variety of the hickory which contains two-thirds 
its weight of easily digestible oil, with 15 per cent, protein and NUTS 
369 
11 per cent, carbohydrate. A pound of hickory nut meats is equal 
in nutritive value to more than 4 pounds of average meat. 
The Indians made hickory milk by pounding the nuts, cast- 
ing the mass into boiling water and passing through a fine strainer. 
The nut cream thus made was used in preparing hominy and corn 
cakes. Black walnuts were treated in the same way. 
The new method of grafting improved varieties of hickory 
nuts upon hardy wild or seedling stock promises to greatly in- 
crease the production of this choice nut, the demand for which 
far exceeds the supply. 
The Pecan. 
The pecan, a near relative of the hickory nut, native to our 
Southern states, contains 4 per cent, more fat and 4 per cent, less 
protein than the hickory nut. In food value, a pound of pecan 
meats exceeds the hickory nut by 200 calories, and is perhaps the 
most highly nutritious of all the natural products of the vegetable 
kingdom. 
The Walnut. 
The native black walnut is perhaps the finest food producing 
tree indigenous to this country. The fat of walnut meats equals 
nearly three-fifths its weight, and the protein content is nearly 
28 per cent, giving a nutritive value three times that of fat meat. 
A pound of walnuts, in fact, contains nearly 50 per cent, more 
protein than the same quantity of beef, besides two-thirds as 
much fat as a pound of butter. 
This fine nut is deserving of more consideration than it has 
thus far received. No investment could be more certain of a good 
return than the planting of a walnut orchard in suitable soil. It 
is a hardy tree and its wood is sufficiently valuable to pay the full 
cost of production. 
The walnut is also a fine shade tree. It might well replace 
many of our shade and ornamental trees in city streets and parks 
which produce nothing but leaves. 
The English Walnut. 
This excellent nut is now grown in great quantities in Cali- 
fornia, and some hardy strains are being grown in the Eastern 
states. It is less highly flavored than the black walnut and has 
less than two-thirds as much protein. 370 
THE NEW DIETETICS 
The Butternut. 
This relative of the black walnut produces a very rich nut 
containing barely 3 per cent, of carbohydrate, less than any other 
nut, which renders it a valuable food for diabetics. 
The Pine Nut. 
There are numerous varieties of pine nuts. The most com- 
mon in this country is the pinon, which grows wild and produces 
great quantities of small but delicious nuts on the rocky slopes 
of the coast range in California, where it still forms an important 
element in the diet of certain tribes of Indians. Nut pines of 
various sorts grow in South America, Spain, and on the west 
coast of Africa, where there are great forests of nut pines which 
produce an annual crop large enough to supply fat and protein to 
whole provinces. Some varieties of the pine nut produce seeds 
as large as chestnuts and somewhat resembling the kernel of the 
chestnut in appearance and in chemical composition. 
As found in the market, shelled pine nuts are dirty and quite 
unattractive in appearance; but the nut meats may. be easily 
cleansed by washing first with ordinary water then with water 
containing half of one per cent, of peroxide of hydrogen. This 
will not only cleanse but disinfect the nuts, destroying germs of 
any sort with which the kernels may have become infected in their 
peregrinations from the distant forest to the dinner table. The 
nut meats may be quickly dried by exposure to the heat of an 
oven. The flavor of the nuts is improved by very slight roasting. 
The Chestnut* 
The cultivated chestnut is produced in enormous quantities 
in some parts of Europe. A wild variety of chestnut grows in 
some parts of the United States, but is rapidly disappearing under 
the influence of a recently developed blight. 
In composition the chestnut is much like the acorn, contain- 
ing little fat, a moderate amount of protein and a large amount of 
starch. It is usually eaten after boiling or steaming and roasting. 
A kind of cake which is used as bread and various other dishes 
are prepared from chestnut meal in Italy, where a large and 
highly valuable variety of the chestnut is very widely grown and 
constitutes quite a proportion of the sustenance of the people of 
the northern provinces. NUTS 
371 
The Chinquapin. 
This nut is a sort of dwarf chestnut, being about half the 
size of the latter. It is, however, sweeter in flavor, and the tree 
on which it grows is more hardy than the chestnut. 
Filberts, Cob Nuts and Hazelnuts. 
These closely related nuts are rich in fat and protein of very 
fine flavor and rank close to the almond in food value. Filberts 
are grown in most European countries and especially in Spain. 
The cob nut grows in Ireland and the hazelnut is a common wild 
bush in many parts of this country. A fine nut butter may be 
made from blanched filberts. 
The Beechnut. 
A delicious nut, the product of the beech tree. It is char- 
acterized by its exceeding richness in oil, of which it contains 
about 60 per cent. Although the beechnut has a very delicious 
flavor and is a very choice nut it is comparatively little eaten by 
human beings because its small size renders it difficult to collect 
and prepare for food. The nut grows abundantly in certain 
countries, particularly in Silesia, where the oil is used as a sub- 
stitute for butter. 
The Acorn. 
The acorn is a farinaceous nut, the product of the oak tree. 
In ancient times it was very extensively used for food in the 
British Islands and in other parts of Europe. The acorn is still 
extensively used as a food in certain parts of Turkey. More than 
300,000 Indians living in California when first visited by white 
men had thrived for hundreds of years on a diet of which the 
acorn was the staple. 
The nuts are prepared for use by first burying them in the 
ground for a certain time during which changes take place which 
destroy the tannic acid which gives to most varieties of the acorn 
an unpleasant bitter flavor. Another method of preparation is to 
grind the nuts into a coarse meal, then spread on sand and leach 
for several hours by pouring on water and allowing it to soak 
away. 
There is reason to believe that the acorn was at one time the 
chief source of carbohydrate for primitive man in some of his 
forest abodes. 372 
THE NEW DIETETICS 
Percentage Composition of the Acorn. 
Leached 
Unleached 
Water 
11.34 
8.7 
Protein 
4.48 
5.7 
Fat , 
19.81 
18.6 
Carbohydrate 
62.02 
65.0 
Fiber 
2.06 
6.6 
Ash 
0.29 
2.0 
The acorn contains besides starch, tannic acid and oil a 
peculiar sugar, quercin. 
The Ground Nut. 
A native of this country which was eaten to considerable 
extent by the North American Indians in aboriginal times. It is 
nutritious and wholesome but not at present produced in quanti- 
ties sufficient to give it more than a very minor place in the 
world’s bill of fare. 
The Brazil Nut. 
This is a large South American nut with a rich white meat 
containing more than 60 per cent, of fat, 17 per cent, of protein, 
with scarcely more than a trace of sugar making it. an excellent 
food for diabetics. 
The Paradise Nut. 
Somewhat resembles the Brazil nut, though finer in quality. 
Little used in this country. 
The Coconut. 
This highly valuable nut is the fruit of the coconut palm 
tree which grows in many tropical countries, especially India, 
West Indies, China, Japan, and the South Sea Islands. Within 
recent years the coconut tree has been grown to some extent in 
Florida. In tropical countries the coconut is chiefly eaten when 
in a green state. The nut is cut open, the water which it con- 
tains is used as a beverage, and the meat of the nut, which is at 
this stage of its development soft and creamy, is eaten with a 
spoon. In the ripe state the nut is rather indigestible unless very 
thoroughly chewed. It is very rich in wholesome fats and oils, 
which may be prepared in the form of cream and butter, and NUTS 
373 
form very acceptable substitutes for dairy products, although 
lacking in the valuable vitamins which are supplied by butter 
from cow’s milk. 
Nut margarine and other coconut fats are prepared from the 
dried coconut meats. They are not a complete substitute for 
dairy butter, but are more easily digestible and more wholesome 
than lard and other animal fats and may be used safely if care is 
taken to include in the daily dietary liberal amounts of cottage 
cheese, skimmed milk or greens to supply the necessary vitamins 
which are deficient in most fats, whether of animal or vegetable 
origin, with the exception of butter. 
Coconut Butter. 
A very good butter may be prepared from the coconut by 
grinding the white meat as fine as possible, soaking for an hour in 
hot water, then straining through cloth to separate the pulp and 
collecting the cream which rises as the milky liquid cools while 
standing for an hour or two. The thick cream which rises to the 
top is worked like butter, which it resembles in consistency. 
The protein of the coconut has been shown by various experi- 
ments to be a complete protein and hence capable of taking the 
place of meat and milk proteins. 
Jansen, of the Public Health Service of the Netherlands 
Indies, showed by experiments upon men and rats that growth 
and physical vigor may be maintained by a diet of rice and the 
coconut press cake remaining after the oil has been removed. In 
this country, coconut press cake has been used successfully for 
feeding cattle, and Cajori has shown its protein to be equal to 
that of meat. 
The Cashew Nut. 
A native of the West Indies, also grown extensively in cer- 
tain parts of India. The seed of this curious nut is enclosed in a 
shell which contains a poisonous and highly irritating volatile oil. 
This is driven off by roasting the nuts. Thus prepared the nut 
has a highly delicious flavor and is easily digestible and whole- 
some. 
The Peanut* 
Though usually classed with nuts, the peanut is really a 
legume and botanically should be classed with beans and peas. 
In chemical composition, however, it much more closely resembles 374 
THE NEW DIETETICS 
a nut than a bean. The peanut is a native of Central America. 
It is now grown, however, in all parts of the world. It is used 
extensively as a food in various parts of Africa, where it is known 
as the monkey nut. 
Peanut oil has been extensively used as a substitute for 
butter and in the adulteration of olive oil. It must be remem- 
bered, however, that these vegetable oils do not contain the fat- 
soluble vitamins which abound in butter and which are essential 
for good nutrition. 
Evidence is constantly accumulating to show the great food 
value of the humble peanut. Dietary studies made by the office 
of home economics of the United States Department of Agricul- 
ture have shown that the peanut is not only easily digested but 
that the fat and protein which are its chief constituents are of a 
very superior character. The oil of the peanut is easily digested 
and the protein has been shown to have about twice the value of 
the proteins of wheat. It is well known that experimental animals 
cannot be brought to normal development on a diet of bread 
alone, but bread consisting of three parts of wheat flour and one 
of peanut flour will secure normal growth. 
A bushel of peanuts contains 21 pounds of meats and 9 
pounds of shells. As an average of 34 bushels can be produced 
to the acre, an acre will yield 714 pounds of shelled peanuts to the 
acre. One bushel of peanuts yields a gallon of fine edible oil 
which may take the place of olive oil for table use. A field of 
peanuts 200 miles square (25,000,000 acres) would furnish a 
year’s supply of food fat for the United States. 
Peanut Butter. 
Many years ago (1893) it occured to the author that one of 
the objections to the extensive dietetic use of nuts might be over- 
come by mechanical preparation of the nut before serving so as to 
reduce it to a smooth paste and thus insure the preparation for 
digestion which the average eater is prone to neglect. The result 
was a product which was called peanut butter and sprang into 
public favor with surprising readiness. Several years ago a 
wholesale grocer of Chicago stated that the firm’s sales of peanut 
butter amounted on an average to a carload a week. It is safe to 
estimate that no less than one thousand carloads of this product 
are annually consumed in this country. 
The ordinary method of preparing peanut butter renders the NUTS 
375 
product more or less indigestible by setting free and decomposing 
some of the oil which constitutes nearly 50 per cent, of the peanut. 
Most peanut butters are objectionable on this account. 
Peanut butter may be prepared at home by the following 
method: Obtain the desired quantity of shelled nuts. Dry in an 
oven not hot enough to roast, to loosen the skins. Place in a 
gunny sack and remove the skins by rubbing on the outside of the 
sack. Pick over carefully and exclude all skins and defective 
nuts. Place in thin layers on flat pans in an oven containing also 
a basin of hot water. The nuts should remain in the oven until 
slightly browned. Great care should be taken to avoid scorching, 
which produces poisons, phenolic substances (Sayre) which are 
highly objectionable. After the nuts are cooked they may be 
ground to a smooth paste in one of the numerous patterns of nut 
mills now easily obtainable. 
Flour from the Peanut. 
It has been found that by special treatment of the press-cake 
obtained after the extraction of the oil from the peanut an excel- 
lent flour, containing only 5 per cent, oil, may be made. The 
flour contains a high percentage of an excellent protein. 
Peanut Milk* 
The protein of the peanut is quite soluble in hot water, and 
the fat being in a finely divided state it is easy to prepare from 
peanut butter a very palatable cream or milk by the simple addi- 
tion of hot water. 
Malted Nuts* 
Nearly thirty years ago (1892-3) the writer, in seeking to 
supply the needs of invalids unable to eat cow’s milk, conceived 
the idea of combining malt digested cereals with nuts to prepare 
a substitute. The result finally reached after many experimental 
efforts was the product known as “Malted Nuts,” which much 
resembles malted milk in appearance while having a delicate and 
very agreeable nutty flavor. This product has been produced in 
considerable quantities and has come to be somewhat widely used. 
The following is the analysis made by Atwater, as published by 
the United States Department of Agriculture: water, 2.6 per 
cent; protein, 23.7; fat, 27.6; carbohydrate (malt sugar and dex- 
trin), 43.9; ash, 2.2. Calories per ounce, 140. 376 
THE NEW DIETETICS 
It was soon discovered that “Malted Nuts” had certain char- 
acteristic properties which rendered it of special value as a 
nutrient. One of these is its richness in food iron of which it con- 
tains double the amount found in ordinary beefsteak. 
Another of the characteristic qualities of “Malted Nuts” is 
its influence upon the milk secretion in nursing mothers. This 
discovery was first made by a mother who by its use was able to 
double her milk production and to nurse the child of a neighbor 
in addition to her own. Later, Dr. Hoobler of Detroit, superin- 
tendent of a lying-in hospital, independently undertook an ex- 
tended series of experiments, the interesting results of which, 
largely attained by the use of “Malted Nuts,” were reported in 
the Journal of the American Medical Association for August 17, 
1917. The purpose of the research was to determine the influence 
of diet upon the milk production of nursing mothers. It has long 
been known that a simple increase of food or of fat has no other 
effect than to make the mother fat without increasing the flow of 
milk. Dr. Hoobler’s experiments had for their purpose the deter- 
mination of the influence of individual foods and specially ar- 
ranged dietaries upon the production of milk. Studies were made 
of the effects of meat, eggs, cow’s milk, a strictly vegetable dietary 
(fruits, grains and vegetables) and nuts. 
The influence of the diet was judged by the following points: 
1. The amount of milk produced. 
2. The food value of the milk. 
3. The effect upon the mother in loss or gain of weight. 
It was found that a diet consisting largely of nuts (50 per 
cent.), was far superior to any other dietary and in every particu- 
lar. The amount of milk was larger than the average (14.8 per 
cent), the food value was greater (30 per cent.), and the mother 
did better. It was noted that the mothers “took the diet readily 
and in fact enjoyed it.” 
“Malted Nuts” has been demonstrated practically the best 
substitute for milk which has thus far been found. It is relished 
by bottle-fed infants and “agrees” when cow’s milk is not toler- 
ated. It is also of value in cases of adults who cannot take milk 
without suffering from headache, hives, or other evidences of 
sensitization. When used as an exclusive food for a bottle-fed 
infant, an ounce of orange or tomato juice should be given the 
infant daily. It is also well to add daily a few ounces of lentil or 
potato soup. NUTS 
377 
Nut Meats—Protose. 
Nut meat of excellent flavor and superior to meat in whole- 
someness, may be prepared as follows: 
To a suitable quantity of wet gluten (made by washing the 
starch out of wheat flour) add peanut meal with a little salt in 
sufficient quantity to produce a mass having the consistency of a 
thick mash. Bake in a thick layer in a dripping pan till slightly 
brown. Serve either with or without brown gravy. This prep- 
aration is an excellent entree and fully supplies the place of a 
meat dish. 
Many years ago (1899) by request of the Assistant Secretary 
of the United States Department of Agriculture, experiments were 
undertaken by the writer to find a vegetable substitute for meat. 
The result was the production of “Protose,” a nut preparation, 
which to a considerable degree resembles meat in appearance, 
taste and odor, having a slight fibre like potted meat. Some hun- 
dreds of tons of this and kindred nut foods have been made and 
used and have proved to be more than complete nutritive sub- 
stitutes for meat. 
“Protose” is a vegetable meat which has much the appear- 
ance, flavor, composition, and even the fiber of potted meat. This 
product has the further advantage of being wholly free from 
parasites, bacteria and bacterial products. It does not readily be- 
come putrid as meat, either in or out of the intestines. Protose 
contains more food iron than does beef and seven times as much 
lime. It is also rich in vitamins, in which meat is deficient, and 
is more easily digestible. 
The superiority of vegetable meat (Protose) to ordinary 
flesh meats is clearly shown by the following table showing the 
calories per ounce and pound of protose and various meats: 
Protose Veal 
Mutton 
(leg) 
Ordinary- 
steak Chicken 
Fish 
(bass) 
Oyster 
Egg 
Protein 
23 
17.8 
18.7 
22.0 
14.5 
10.6 
6.8 
15.2 
Fat 
16 
15.8 
26.3 
8.4 
3.6 
2.0 
3.4 
27.0 
Carbohydrates .. 
10 
Total per lb 
784 
538 
686 
486 
290 
202 
163 
675 
Iron gr. per lb.... 
.3984 
.1566 
.1645 
.1936 .1270 
.464 
.299 
.3904 
Lime gr. per lb. 
6.6 
0.5 
0.6 
0.7 
1.0 
2.0 
1.4 
7.2 
Another nut meat prepared from peanuts is known as “Nut- 
tolene.” 378 
THE NEW DIETETICS 
The Litchi or Chinese Hazelnut, 
This nut differs from all other nuts in the fact that it consists 
almost exclusively of a single food principle, sugar or carbohy- 
drate. And the sugar is of the finest sort, like that found in honey 
rather than cane sugar. This nut also contains a small amount 
of citric acid, sufficient to give character to its flavor, which is 
very delicate and pleasing. 
The litchi contains only a trace of fat, and a minute amount 
of protein. 
With the exception of the chestnut, the acorn, and certain 
pine nuts, nearly all nuts are rich in protein and fat, often con- 
taining half their weight or even more of fat. But here is a nut 
which is pure carbohydrate, and of a sort which requires no work 
of the digestive organs, being already digested by the ferments of 
the plant, and ready to be absorbed and utilized at once. It is 
claimed that the litchi nut will easily produce half a ton of sugar 
to the acre, and with almost no care, and no cost for manufacture. 
8,000,000 acres planted to litchi nuts would thus furnish the 
4,000,000 tons of sugar which the American people annually con- 
sume, better sugar than the cane sugar of commerce, and at 
far less cost. We are only just beginning to appreciate the value 
of nuts as nutrients. 
A little computation will show how easily the national food 
problem may be solved by utilizing the nut. Allowing an average 
of 2 ounces of protein, 2 ounces of fat, and 20 ounces of carbo- 
hydrate per capita, daily for each one of the inhabitants of the 
United States, the aggregate would be produced by two good 
sized farms both of which could be easily comprised within one 
of our big states, one farm 400 miles square devoted to walnuts or 
hickory nuts to produce 2,500,000 tons of protein and 5,000,000 
tons of fat required, and another of equal size devoted to the litchi 
nut to produce the sugar needed. This will occupy less than 12 
per cent, of our 3,000,000 square miles of territory, leaving 2,680,- 
000 square miles for homes, schools, churches, factories, empor- 
iums, parks, playgrounds and reservations. There is evidently no 
danger of a food shortage if we give the noble nut a chance to 
protect us against such a catastrophe. 
The nut may even protect us against a milk shortage. China 
has gotten along almost for centuries without the cow by feeding 
motherless babies with milk made from the walnut. The almond, NUTS 
379 
the peanut and the soy bean have all been used successfully as 
substitutes for cow’s milk. 
Nut Meals. 
Nut meals of various sorts may be made by grinding care- 
fully prepared nut meats in a hand mill set to grind a very coarse 
meal or samp. Nuts which can be blanched, such as the peanut, 
almond and the filbert, the latter less easily than the first named, 
make much the best meal. The shelled peanut is on the whole 
the best for this purpose. The peanut should be blanched and 
carefully assorted, then cooked and dried, after which they may 
be ground to a moderately fine meal which may be used in many 
ways. Some favorite uses are the making of soups, as an addition 
to cakes, as a substitute for butter in pie crusts and other short- 
enings. Almonds, hazelnuts and pine nuts are made into butter 
without cooking. Animal Foods 
All food comes originally from the vegetable kingdom. The 
chlorophyl grain of the green leaf is the mystic laboratory in 
which the lifeless inorganic elements of the mineral world are 
endowed with life. The green parts of plants are factories in 
which are woven the living fabrics known as organic substances, 
of which the actinic rays of the sun constitute the warp while 
nitrogen, carbon, hydrogen, oxygen, calcium and other elements 
which enter into the composition of living things form the woof. 
Each little chlorophyl grain is a trap which captures sunshine 
and stores it up in the form of carbohydrates, protein, fats and 
other food principles to serve as fuel to feed the vital fires which 
burn within the bodies of animals. Animals cannot originate 
food; they only utilize food principles which have been produced 
by plants. In passing through the bodies of animals, food ma- 
terials undergo changes of form, but are not produced. 
Plants are food producers; animals, food users. Food is to 
the animal what fuel is to the lamp, the stove or the locomotive. 
In the economy of Nature, while it is true that muscle tissue 
is largely used as food by animals, it is clearly evident that its 
first and primary purpose is to serve for force transformation 
through food consumption. The only animal substances specific- 
ally prepared by Nature as food for animals are milk and the 
yolk of eggs, both of which are intended to be used by the infant 
animal while attaining the development necessary to enable it to 
gather food for itself. 
In the yolk of the egg is found not only fat, protein and a 
small amount of carbohydrate but the lime, iron and other salts 
and vitamins—everything which the young chick needs for the 
building of blood, flesh and bones. It is a little luncheon pro- 
vided by Nature to support the young creature during its period 
of helplessness. Milk is supplied day by day and ho-r by hour 
to meet the current demands of the young mammal. 
The general acceptance of the false theory that many animals 
are necessarily carnivorous and that the eating of flesh by some 
animals is a necessary part of the general scheme of living things 
380 ANIMAL FOODS 
381 
naturally led to the supposition that certain plants might also be 
carnivorous; but it appears from recent observations made by 
Du Bois that this belief is a myth. Plants do not secrete ferments 
capable of digesting animal matter. The supposed digestion which 
has been observed to take place in connection with the insect- 
catching parts of the insectivorous plants is simply a decomposi- 
tion due to the action of microbes. The products of this decom- 
position may be absorbed by the plants, but the latter have no part 
in the digestive process. 
Special Characteristics of Animal Foods, 
Milk and eggs are animal foods especially adapted not only 
to meet the needs of young animals in general but to suit exactly 
the nutritive requirements of infant animals of the particular 
species to which the animal producing the milk or the egg 
belongs; that is, cow’s milk is exactly suited to meet the needs of 
calves. Goat’s milk is different and is adapted to kids. The milk 
of the dog or the seal is still different, and is precisely adapted 
to the young of these animals. A young animal may be raised on 
the milk of an animal of another species, but not without con- 
siderable difficulty and risk, and not infrequently the experiment 
is a failure. Of the 300,000 infants who die in the United States 
annually not less than nine-tenths are bottle-fed infants, a fact 
which bears eloquent testimony to the inferiority of cow’s milk 
to human milk for human infants. 
The yolk of an egg is a complete foodstuff, and is easily 
digestible; whereas, the white of egg in a raw state is almost 
totally indigestible in the alimentary canal of human beings. 
Eggs are poisonous to some people. Cooking, however, to a large 
degree lessens this toxic property of eggs. 
Of the three sorts of animal foodstuffs, milk, eggs and flesh, 
milk is the only one that contains any appreciable amount of car- 
bohydrates. In cow’s milk about one-third of the total solids 
consists of lactose, or milk sugar, a wholesome carbohydrate, 
although one which is utilized with much greater difficulty than 
any other of the sugars. Cow’s milk is almost totally lacking in 
iron, while flesh foods are equally deficient in lime. The yolk of 
the egg is well supplied with both lime and iron. Milk and egg 
yolks furnish a rich supply of vitamins. Meats are very deficient 
in vitamins for the reason that in animals the vitamins are chiefly 
stored in the liver and kidneys, just as the lime is almost wholly 382 
THE NEW DIETETICS 
stored in the bones, leaving the lean flesh, the part commonly 
eaten as food, almost wholly deficient in vitamins as well as 
lime, two highly important food principles. 
Food iron, another essential food principle, is present in 
meat, but in not nearly so large an amount as is generally sup- 
posed. Most of the iron contained in the body of an animal is 
found in its blood. In the slaughtering of an animal most of this 
is lost, the amount left being so small that an ounce of beefsteak 
contains no more iron than the same weight of garden greens 
such as spinach, and only half as much as is found in the same 
weight of certain greens, as red root or dock. Graham bread, the 
date, the fig, and a score of other common vegetable foodstuffs, 
contain as much or more iron as does meat, and iron of better 
quality (Sherman). 
The only particular in which all animal foods are superior to 
most vegetable foods is in the amount and quality of the protein 
which they supply. The protein of milk, eggs and meat is neces- 
sarily complete protein ; that is, it contains all the elements (amino 
acids) essential for the building of animal tissues. 
Most vegetable proteins are incomplete, although there are 
many vegetable products, such as almonds, peanuts, soy beans, 
and probably many more not yet discovered which contain com- 
plete proteins. 
The protein of grains and of most of the common staples 
which have been selected for human consumption are incomplete, 
and it is probable that this is the principal biologic reason why 
meat has come to be considered an essential part of the dietary in 
cases in which grains are the chief food staple. The lack of 
knowledge of this fact has been the principal cause of failure in 
some attempts to live on a diet consisting exclusively of vegetable 
foodstuffs. It is possible, however, to select from the vegetable 
kingdom a complete and satisfactory diet, as has been abundantly 
proven by McCollum, Hindhede and others. It must be admitted, 
however, that the present supply of available vegetable foodstuffs 
containing complete proteins is not large enough to furnish the 
great population of the world with a sufficiency of this essential 
element. 
We are glad to be able to say at once, however, that it is not 
on this account necessary to resort to the use of flesh foods, for, 
as McCollum and Sherman have abundantly proven, milk is even 
better adapted than is meat to complement the proteins of ANIMAL FOODS 
383 
vegetable foodstuffs. It will not only supply its own complete 
proteins, but will furnish the elements necessary to render com- 
plete the proteins of other foodstuffs to which it is added. 
Eggs also are an important and competent source of com- 
plete proteins. And so we are not compelled to resort to the use 
of flesh foods for our essential supply of complete proteins, 
although it is important that care should be taken to make certain 
that the dietary is not deficient in this essential element. This 
may be accomplished even when the dietary is otherwise exclu- 
sively vegetable by the inclusion in the daily bill of fare of milk 
to the amount of 16 to 20 ounces. With a diet of cereals, such as 
corn, the addition of 10 per cent, of milk protein (Sherman) is 
found to be sufficient to insure perfect nutrition. 
MEATS 
Flesh foods are not the best nourishment for human beings 
and were not the food of our primitive ancestors. They are secon- 
dary or second-hand products, since all food comes originally 
from the vegetable kingdom, being the product of the magic 
chemistry of the chlorophyl grain. There is nothing necessary or 
desirable for human nutrition to be found in meats or flesh foods 
which is not found in and derived from vegetable products. 
For these reasons we think it not necessary to devote more 
than limited space to the description of meat products, especially 
as these inferior foods receive in most works on foods and 
dietetics a very liberal and undue amount of attention. 
The World War made clear to all competent authorities on 
human feeding that it is important to disabuse the minds of the 
public of the erroneous but deep seated notion that meat is an 
essential article of food and to lessen the consumption of flesh 
foods. 
The International Scientific Food Commission which met in 
London, Rome and Paris during the World War was without 
doubt the most authoritative body which ever considered the sub- 
ject of human nutrition. At its Paris meeting the question of a 
minimum meat ration was discussed by the commission, but it was 
decided to be unnecessary to fix a minimum meat ration “in view 
of the fact that no absolute physiological need exists for meat, 
since the proteins of meat can be replaced by other proteins of 
animal origin, such as those contained in milk, cheese and eggs, 
as well as by proteins of vegetable origin 384 
THE NEW DIETETICS 
The United States Department of Agriculture sends out a 
circular prepared by C. F. Langworthy and Caroline L. Hunt, in 
which we are informed that “it is of course possible to eat meat 
dishes less frequently (than once a day), or to omit meat from the 
diet altogether, for it has been determined that all the necessary 
protein and energy may be obtained from other materials, if one 
so desires and the diet is so arranged that it remains well bal- 
anced.” 
Recent writers on nutrition* call attention to the fact that 
“Of late there has been a distinct reaction in the meat-eating of 
the wealthier classes, and one sees less meat and more vegetable 
habits as they progress upward in the scale of civilization, and 
find they need less of the stimulating qualities of animal protein; 
and, because, also, on 'account of their sedentary habits, people 
find that the ingestion of considerable quantities of animal protein, 
with the consequent increase in intestinal putrefaction, gives rise 
to symptoms of toxemia, which have assumed a very definite place 
in the pathology of disease.” 
And yet we are also told that meat constitutes one-sixth of 
the total food consumed in this country. A large expenditure for 
an unnecessary foodstuff. We will in time learn to do without it. 
“We could entirely dispense with meats without suffering 
any ill effects whatever,” says McCollum. 
The Iron of Meats. 
Meats, fish, flesh, and fowl contain a considerable amount of 
iron, but it is of an inferior character. An ounce of lean beef 
contains one-fourteenth of a day’s iron supply, but of medium 
fat beefsteak one must eat a pound and a half to get a day’s iron 
ration. And if fish is the sole source of supply, one is obliged to 
eat seven and three-quarters pounds to meet his daily iron need. 
Such quantities of meat would burden the body with a great 
excess of protein, two to five times the amount needed and safe. 
Blood is naturally rich in iron because of the hemoglobin, the 
special iron-containing element of all animal life. An ounce of 
blood contains exactly the amount of iron which replaces the 
daily loss of the body. The red color of meat is due to the blood 
which it contains, and this is the source of its iron content. 
These facts would seem to support the popular idea that red 
* “Nutrition and Clinical Dietetics,” by Carter, Howe and Mason. 
Lea and Febiger. ANIMAL FOODS 
385 
meats possess superior value as blood-making foods; yet science 
does not sustain this view, but supplies evidence to the contrary. 
Many years ago when the writer was a medical student at 
Bellevue Hospital Medical College a patient was one day brought 
before a small class of special students of which the late Professor 
E. G. Jane way was the teacher. The patient was suffering from 
a very pronounced form of anemia. Under advice of his physician 
he had been making daily visits to one of the big city slaughter 
houses to drink a tumblerful of the warm blood caught as it 
gushed from the cut throat of a slaughtered animal. This he had 
done for several weeks, as many others were doing at that time, 
but without any apparent benefit. In each glassful of blood the 
patient had taken six times as much iron as his body needed to 
make good the daily waste, but no change for the better had been 
observed; and Professor Janeway remarked that this was the 
usual disappointing result. 
The drinking of blood never became a popular fad, as might 
have been the case if it had been less repulsive; but the false and 
useless notion still survives in the use of beef juice and a whole 
tribe of loathsome nostrums consisting chiefly of blood, such as 
“bovine” and its various imitations. 
Although the idea that red meat makes red blood is wholly 
without scientific foundation it is still a common practice of physi- 
cians to urge anemic and debilitated patients to eat freely of red 
meats, roast beef and beefsteak, and to make free use of beef 
juices. “Salisbury steaks” are now seldom seen or heard of, but 
beef powders and other meat preparations have in a measure 
taken their place. 
The absurdity of these popular practices becomes fully ap- 
parent when the fact is known that science has demonstrated that 
the iron of the blood and of meat is no more easily assimilated 
and made into blood than is the organic iron of eggs, milk and 
vegetable foods. In summing up the evidence upon this subject 
Sherman says that the iron of meats is “of distinctly lower 
nutritive value than the iron compounds of milk, eggs and foods 
of vegetable origin.” The reason for this is apparent. Not long 
ago the writer when cruising along the Atlantic noted near the 
shore a stranded vessel that was being torn to pieces by the waves. 
On inquiry why the extensive quantities of materials which were 
used in the construction of the ship were not removed and util- 
ized the answer came back: “Because it would cost more to con- 
vert them into usable form than they are worth.” 386 
THE NEW DIETETICS 
The same thing seems to be true of the iron of flesh. It has 
been used once and cannot be economically used again. Nature 
is a great economist and does not let a particle go to waste that 
can be salvaged. If blood iron could be utilized, there would be 
no occasion for worry about the iron intake, for practically all the 
iron waste is from the blood. Some of the blood iron is saved, but 
a portion cannot be utilized and hence is cast out of the body 
through the intestines. 
To this Sherman adds: “In an experimental dietary study 
made in New York City it was found that a free use of vegetables, 
whole wheat bread, and the cheaper sorts of fruits, with milk but 
without meat, resulted in a gain of 30 per cent in the iron content 
of the diet while the protein, fuel value and cost remained prac- 
tically the same as in the ordinary mixed diet obtained under the 
same market conditions.” And it is to be remembered that the 
iron from vegetable sources was not only more abundant, but 
superior in quality. 
Lime Deficient in Flesh Foods. 
Surprising as the fact may seem, butcher’s meat stands near 
the head of foods poorest in lime salts. Only the tomato, the 
apple, polished rice, cornmeal, buckwheat flour, hominy and the 
banana contain less lime than does average lean beef, with its 
content of one-fourteenth (0.007) of a grain per ounce. The 
explanation is found in the fact, well known to physiologists that 
the lime content of an animal body is almost wholly contained in 
the hard tissues, the bones, less than one per cent, of the total 
being found in the soft parts. Blood contains even less than lean 
meats—only one-twentieth of a grain to the ounce. 
It seems to the writer quite evident that the flesh of animals 
was not designed by ,Nature for the food of other than carnivorous 
animals, if indeed it was originally designed for them. And 
other food essentials besides lime are lacking in the flesh of 
animals. The vitamins are present only in small and inadequate 
amounts in animal flesh, but are found in abundance in the mar- 
row of bones and the liver. Carnivorous animals eat the bones 
and the liver as well as the fat and lean tissues of the soft parts. 
Men, when compelled to live upon a carnivorous diet, likewise 
find it necessary to eat bones, bone marrow and liver, as pointed 
out by Stefansson, the eminent Arctic traveler. 
Fish contains a larger percentage of lime than does the flesh ANIMAL FOODS 
387 
of warm-blooded animals, nearly twice as much in fact, but the 
lime content of fish is only about equal to that of white bread, 
which is very poor in this element. 
It is interesting to note in this connection the fact that in 
vegetable foods the iron and lime are associated with the protein 
content while in flesh foods the iron is almost exclusively con- 
fined to the blood and the lime to the bones. Animal fat, like 
other fats, is wholly lacking in lime, hence fat meat contains less 
lime than does lean meat. 
It is evident, then, that a high protein diet, especially a meat 
diet, is not indicated in conditions characterized by a deficiency of 
lime. Indeed, there is a reason to believe that such a diet, by in- 
creasing the acid wastes of the body, may cause an undue loss of 
lime and so aggravate a condition which needs to be relieved. 
Beef, 
The lean flesh of the ox and other animals consists almost 
exclusively of muscular tissue. There is usually more or less fat 
mingled with the muscular fibers, and in fat animals the muscular 
tissue is often thickly overlaid with fat. 
The popular idea that beef is the most strengthening of foods 
has no scientific foundation. In order to enter into the composi- 
tion of the body, meat, like other foodstuffs, must be reduced 
to amino acids, the building stones which are identical whether 
of vegetable or animal origin. 
Suet, the fat of the ox, has a higher melting point than the 
fat of other animals except the sheep, as well as of most vegetable 
fats, and hence is less digestible. 
Beef is not infrequently infected with the young of a variety 
of tapeworm, being the principal source of infection by tapeworm. 
As offered for sale in the markets fresh meat is always 
swarming with putrefactive bacteria, among which is the deadly 
Welch’s bacillus, the cause of gas gangrene. These bacteria are 
present in countless numbers, the count usually reaching 15,000,- 
000 to 100,000,000 to the ounce. Milk containing one-tenth as 
many harmless sour-milk germs or water containing one- 
thousandth part as many germs of any sort would be condemned 
at once. Meat bacteria are a cause of appendicitis and colitis. 388 
THE NEW DIETETICS 
Mutton. 
Mutton is equally as digestible as beef and equally nourish- 
ing. It is perhaps somewhat less subject to disease than is the 
flesh of the ox, but from a hygienic and nutritive standpoint the 
difference between the flesh of the sheep and the ox is immaterial. 
Goat. 
The flesh of the goat is much like that of the sheep. It is 
more highly flavored and generally less well liked by meat eaters. 
Venison. 
The flesh of the deer resembles that of the sheep and the 
goat though differing in flavor. In general, so long a time elapses 
after the death of the animal before it reaches the consumer that 
its flesh has reached an advanced stage of decomposition. It is 
this which gives to the flesh of wild animals its high or gamey 
flavor. Such flesh is reeking with infectious germs and is most 
unfit for human food. 
Pork. 
Pork is generally recognized as being less wholesome and less 
digestible than most other meats. Its use was forbidden to the 
Hebrews by Moses, and the injunction of the great law-giver is 
strictly observed by Mohammedans as well as by orthodox 
Hebrews, even at the present day. 
Swine are much more likely to be infected by parasitic dis- 
eases which are transmissible to human beings than are sheep and 
beeves for the reason that they are omnivorous. Their scavenger 
instinct even leads them to consume putrefying dead animals. 
The country slaughter-house always has a pig pen behind it into 
which the offal of slaughtered animals is thrown to be eaten by 
swine which are later themselves butchered and sold for con- 
sumption by human beings. Not infrequently hogs are fattened 
on dead horses and other animals which have died of themselves 
or have been killed for the purpose. It is well recognized that the 
flesh of hogs fattened upon the flesh of other animals has a strong 
and offensive flavor resembling that of the dog, lion and other 
carnivorous animals. The scientific stock raiser insists that hogs 
should be fed exclusively upon clean, wholesome vegetable foods. 
There is certainly no doubt that the flesh of hogs fed upon flesh 
is much inferior to that of animals fed upon a clean vegetable ANIMAL FOODS 
389 
diet. From which it is an easy inference, which seems to be over- 
looked by most writers on dietetics, that if flesh eating will have 
the effect of rendering the tissues of a hog inferior and reeking 
with bad odors and flavors, flesh eating by man must produce a 
similar effect upon his tissue. Can tainted tissue be healthy ? 
Fowls. 
The flesh of fowls, particularly chicken, is highly esteemed 
by meat eaters because of its flavor, and many persons suppose 
the flesh of fowls to be more wholesome than beef, mutton and 
other meats. As a matter of fact, there is practically little differ- 
ence in the wholesomeness of the different sorts of meats, fish, 
flesh or fowl. The principal objection to meats of all sorts is 
the fact that the undigested residues readily undergo putrefac- 
tion in the colon, giving rise to autointoxication. All meats con- 
tain when eaten putrefactive bacteria which readily grow in the 
colon, producing toxins, ptomains and autointoxication as the 
result of the absorption of these putrefaction products. White 
meat of fowls, once supposed much more wholesome than red 
meats, is now known to have no superiority whatever over beef, 
mutton and other red meats. Von Noorden has shown by careful 
analysis that the amount of uric acid and other extractives found 
in white meats is as great as that found in red meats and some- 
times greater. 
Fish* 
Professor Dujardin-Beaumetz, an eminent French physician, 
many years ago called attention to the fact that fish are less 
wholesome than other meats for the reason that they so readily 
undergo putrefaction. Within a very short time after a fish is 
removed from the water, the putrefactive processes are far ad- 
vanced. This is probably because most fish are carnivorous 
so that their bodies are continuously charged with the products 
of putrefaction. It is probably this fact, also, which gives rise to 
the peculiar fishy flavor which is characteristic not only of fish 
but of birds which live largely upon fish. An eminent authority 
on dietetics calls attention to the fact that “people who subsist 
largely upon a fish diet have a peculiar rancid odor.” Skin 
diseases are often aggravated by a fish diet, and not infrequently 
nettle rash and other skin eruptions occur whenever fish is eaten. 
Certain forms of asthma have been traced to the eating of fish, 
also certain parasites, to which fish are very subject. 390 
THE NEW DIETETICS 
Sea Foods. 
Lobsters, crabs, oysters, and other sea foods are all scav- 
engers in their habits, subsisting largely upon the animalculae 
in the ooze and slime which cover the stones and weeds found in 
the waters where these creatures thrive. Lobsters and crabs are 
notoriously hard of digestion. 
Oysters, 
The oyster has been thought to be one of the most innocent 
of foods. Raw oysters, stewed oysters, oyster broths, and other 
preparations of oysters are not infrequently recommended by 
physicians for the use of persons whose stomachs are supposed to 
be too delicate to digest ordinary food. But the oyster does not 
deserve its good reputation. Beaumont’s experiments showed 
that stewed oysters are difficult of digestion, remaining in the 
stomach for three hours, whereas boiled rice leaves the stomach 
within an hour; stewed or cooked fruit, such as baked sweet 
apples, nearly as soon. 
The idea that the oyster aids digestion by virtue of its own 
gastric secretions is a most ridiculous and fanciful theory. 
If the oyster lover would take a look with a misroscope at the 
juice of the oysters which he swallows with so much complacency 
he would hesitate before risking the slimy morsel down his throat. 
The oyster is a scavenger; he dines on germs. His body is cov- 
ered and filled with bacteria of various sorts, and the slimy juice 
in which he is immersed is simply alive with wriggling germs 
of various descriptions. 
A few years ago a paper by Hindman and Goodrich, of the 
University of Washington, published the results of an extended 
study of the bacteria of oysters and oyster juice, which showed 
from 100,000,000 to 200,000,000 bacteria to the teaspoonful of 
juice. These bacteria were not of the innocent kind such as those 
which produce sour milk, but were gas-producing organisms of 
the sort which cause putrefaction. These pernicious organisms 
were found in great abundance, in one series in 23 out of 24 
specimens. In another series the gas-producing organisms were 
found in all but one of 22 specimens. 
The raw oyster, from a sanitary standpoint, is certainly one 
of the most unclean things that comes upon the table and may 
rightly be regarded as quite unfit for human consumption under 
conditions other than those of emergency and dire necessity. ANIMAL FOODS 
391 
Typhoid fever epidemics and outbreaks of other intestinal 
disorders have in many instances been traced to the use of oysters 
gathered from sewage-polluted waters. 
Meat Extractives. 
According to Konig, lean meat is 75 per cent, water, 16 to 24 
per cent, protein, 0.5 to 3 per cent, fat, 0.8 to 1.9 per cent, ash, 
0.5 per cent, extractives. 
The meat solids contain 9.6 per cent, of hemoglobin and blood 
albumin, and 13.7 per cent, extractives. 
The extract of meat contains a large variety of tissue poisons, 
among which are xanthin, (uric acid) adenin, tyrosin and leucin, 
besides 10 or 12 per cent, of creatin and creatinin, together with 
ignotine, novaine, carnitine, vitiatine, oblitine, carnic acid, and 
numerous other waste products which have been recently isolated 
by Kutscher. 
Roger, the eminent pupil and successor of the famous Bou- 
chard, says of meat extracts: “The toxicity of extracted matters 
is real. Extracts of meat contain 22 per cent, to 25 per cent, of 
salts of potash and 10 per cent, to 15 per cent, extracted matters. 
Their ingestion, even in moderate doses, produces intestinal dis- 
turbances, notably diarrhea. Dogs fed with extracts of meat die 
more rapidly than dogs which receive nothing at all. A person 
in health may use extracts of meat in small quantities, but it is 
necessary to prohibit meat extracts for invalids 
The Poisons of Meat. 
The tissues of all animals contain poisonous materials, the 
products of the vital activities which are constantly taking place 
in all living beings. The activities of the tissues result in the for- 
mation of special toxins, fatigue poisons and toxic residues which 
are more or less imperfectly removed from the tissues by the 
blood during life and carried to the kidneys and other excretory 
organs to be discharged from the body. The formation of these 
poisons is in life so rapid that it is"only necessary that their elimi- 
nation should be suspended a short time for fatal results to 
develop. On the death of an animal, as soon as the heart ceases 
to beat the removal of these toxins from the tissues ceases; but 
the development of toxic matters continues for some time after, 
until the final moment of actual tissue death when rigor mortis 
occurs. It is consequently evident that the amount of these toxins 392 
THE NEW DIETETICS 
found present in the tissues of a dead animal is much greater 
than that which is found during life. The character of these 
poisons is to a considerable degree well known. Many of them 
have long been familiar through the examination of the urine, 
which is simply an extract of the tissues. 
While it is no doubt true that the chief objection to the use 
of meats of various sorts as a human foodstuff is the enormous 
quantity of toxins produced by the growth of putrefactive bac- 
teria in the intestine, it should not be forgotten that meats when 
eaten contain a considerable amount of toxins which are in part 
the result of putrefaction. This is always true, since meat, as 
eaten, is always in a state of beginning decomposition. This is 
inevitably the case for the reason that within a few hours after 
death the tissues of an animal are found swarming with putre- 
factive flora, even when the carcass has been kept in a refrigera- 
tor. Cold storage delays but does not prevent putrefaction. 
The amount of these substances which is found in beef and 
other meats must be very much greater than exists at any time 
during the life of the animal. According to the late Prof. 
Gautier, the world’s greatest authority, these substances are found 
in meat broth in the proportion of about one per cent, or about 
one-half of the total solid constituents. These extractives, accord- 
ing to Gautier, when taken into the stomach produce effects 
“comparable to those of the caffein and thein of tea and coffee.” 
Says Gautier with further reference to these extractives: 
“We must not forget that these bases are poisonous.” The obser- 
vations of Gaucher, cited by Gautier, have clearly proven this. A 
guinea pig weighing one pound died after receiving several sub- 
cutaneous injections of sarcin, a constituent of meat extract. 
The animal grew thin and passed a deep yellow albuminous urine 
and died at the end of fifty days. Another guinea pig died as 
the result of subcutaneous injection of one and one-half grains of 
creatin, always found in beef tea. The urine was at first a deep 
brown and slightly albuminous. Later, complete suppression of 
urine supervened and death rapidly followed. Post mortem 
examination showed death to be due to nephritis. 
According to the analyses of Gautier, a quart of beef tea 
contains enough creatin to kill nine guinea pigs, besides potash 
salts, purin bodies and other substances even more toxic than 
creatin. When to this we add the fact that the nutrition value 
of meat broths is practically nothing, according to Gautier only ANIMAL FOODS 
393 
one calorie to the ounce, we find ample justification for the asser- 
tion of Legendre that bouillon is “a veritable solution of poisons,” 
and the caution of Roger that meat broths and extracts if used 
at all should be taken only by healthy persons and should be 
prohibited for invalids. 
The meat extracts in general use are, if possible, still more 
objectionable than freshly prepared broths. Fully 20 per cent, 
of these extracts consist of poisonous substances. So long ago as 
1871, P. Muller observed that the addition of an ounce of meat 
extract to his daily diet produced diarrhea, an evident defensive 
effort. Two-thirds of an ounce of Liebig’s extract of beef added 
to the regular diet of a dog weighing fourteen pounds produced 
diarrhea on the sixth day and death from collapse on the ninth. 
Meat extracts of all sorts are concentrated preparations of 
the toxins of meat. They have no nutritive value and their use 
cannot be too strongly condemned. Meat extracts are, according 
to Gautier, fifty times as toxic as broth made from two pounds 
of beef and five pounds of water. 
Viscera Highly Objectionable, 
The viscera of animals must be looked upon as the most 
objectionable form of flesh food. All the viscera contain xanthin 
or uric acid in large amount. Gautier says of the spleen: “This 
flesh is only a very bad aliment”; and of the kidneys, “these 
organs are bad when they come from old or carnivorous animals.” 
The fact that the kidney of the carnivorous animals is always so 
bad as to be condemned as food naturally leads one to the con- 
clusion that a flesh diet is not conducive to the health of the kid- 
neys. Sweetbreads, according to Hall, contain 70 grains to the 
pound of potential uric acid. Blood has from the earliest ages 
been considered unfit for use as food by the most enlightened 
nations. The orthodox Hebrew still obeys the injunction given, 
according to the Bible, to Noah: “The blood thereof which is the 
life thereof thou shalt not eat of it.” 
High Meats* 
When an animal is alive, its muscular tissues are almost as 
tender and fragile as jelly; but after death stiffening or rigor 
mortis occurs as a result of the coagulation or clotting of the 
muscular tissues, the tissue becomes tough and it never becomes 
tender again until putrefaction occurs. It is for this reason that 394 
THE NEW DIETETICS 
meat is allowed to hang for some time after killing to ripen, in 
other words, to decay. 
Experiments reported by Farger and Walpole (Journal of 
Physiology and Pathology) show that putrid meat contains many 
poisonous substances, some of which cause rise of blood pressure. 
It is for this reason that the up-to-date physician forbids the use 
of meat by persons suffering from apoplexy or arteriosclerosis or 
from high blood pressure. This restriction is necessary not only 
because of the poisons which meat always contains from putrefac- 
tion which has already taken place, but because of the further 
putrefaction of undigested remnants of the flesh which takes place 
in the lower part of the small intestine and the colon. 
Gaspard demonstrated in 1822 the toxic nature of putrefying 
substances. He showed that putrid substances contained poisons 
which were much more deadly than the excretory products of the 
body. 
Bailey (Fitch, “Dietotherapy”) very wisely calls attention to 
the danger of eating high meats as follows: 
The habit of hanging game until it gets high is quite objectionable 
and decidedly unhygienic. When it is hung up for this purpose and 
allowed to become malodorous, putrefaction is already well under way. 
This process of decay not only leads to decomposition and the devel- 
opment of toxins, but is a genuine hotbed for micro-organisms which 
may cause gastric troubles and enteric disorders. Such practices, 
which are bound to endanger the health even of the most robust, 
should be condemned. 
High game, on account of the toxic substances it contains, is 
even more dangerous to the circulatory system; the toxins contract the 
small blood vessels and thereby put extra work upon the heart. For 
this reason, in critical cases of cardiac affection and high blood pres- 
sure and in Bright’s disease, it should not be eaten. 
When meat is stale or game high it is positive evidence that putre- 
factive changes have taken place by bacterial action, whereby certain 
alkaloidal substances of the nature of ptomains and leucomains of an 
exceedingly poisonous nature are formed. When such food is ingested 
and absorbed, serious and even fatal results often follow. 
The eating of putrid flesh is always dangerous; in certain 
cases immediately so; in others, the injury appears later. Decay- 
ing flesh is always infested with germs which produce gas gan- 
grene, suppuration, peritonitis, pneumonia, abscess and other 
deadly disorders. When introduced into the intestine, these germs 
fix themselves upon the intestinal wall and become permanent 
inhabitants which are even more difficult to get rid of than Canada ANIMAL FOODS 
395 
thistles in a pasture lot. They take deep root and spread. They 
invade the appendix and cause appendicitis. They cover the walls 
of the colon and cause colitis. They work through the wall and 
produce adhesions, even inflammations, of kidney and bladder. 
They work slowly upward in the small intestine and finally reach 
the gall bladder, causing gallstones. They may be the cause of 
gastric or duodenal ulcer. They become a serious menace to the 
entire body through the poisons which they form, some of which 
are as deadly as the virus of snakes. The writer has met many 
cases in which a single meal of cold storage chicken or duck or 
other game, long dead and neglected to be buried, has been the 
cause of many years of misery and invalidism. 
Pezard, a French investigator, has shown that an exclusive 
flesh diet in cocks causes degeneration and atrophy of the genital 
glands with the usual effects of castration. Chalmers Watson 
made similar observations. 
Putrefaction Products in Meat* 
The popular practice of keeping meat until it becomes prime, 
or ripe, is in the highest degree reprehensible. It is important 
that the fact should become well known and understood that this 
so-called process of ripening is in no way different from the 
process of putrefaction. It is, in fact, putrefaction pure and 
simple. Whether the carcass of a dead cow hangs in a meat 
market or lies neglected in the corner of a pasture lot, the changes 
which take place in the tissues of the animal are precisely the 
same. Decomposition begins within a few hours after death, and 
progresses more or less rapidly according to the temperature to 
which the body of the animal is exposed. At a low temperature 
(40° F.) decomposition proceeds slowly, but nevertheless it pro- 
ceeds. The bacteria which develop at a low temperature are 
somewhat different from those which grow at a high temperature, 
but toxic products are the result in both cases. Says Roger: 
Flesh and meats kept for a length of time undergo the influence 
of bacterial growths, changes which render them toxic. . . . The 
digestive tube of man is much more sensitive to these poisons than 
that of animals. . . . Meats which are slightly putrid produce in 
human beings gastro-intestinal disorders, while perfectly well tolerated 
by carnivorous animals, and even by animals which are not naturally 
carnivorous. 
The worst effects, however, are the more remote consequences 
which result from the continued introduction in the intestine of 
these poisons and the germs which produce them. To infections 396 
THE NEW DIETETICS 
of this cause must be attributed, in the writer’s opinion, a large 
portion of the great number of cases of intestinal autointoxica- 
tion which are now recognized in every civilized country. Pro- 
fessor Brouardel, an eminent French physician, reports a case 
in which a number of persons suffered seriously after eating of 
stuffed goose. One of the persons, a woman suffering from chronic 
disease of the kidneys, died, evidently because the kidneys were 
not able to cope with the great quantity of enterotoxins which 
entered the blood from the intestine. There can be no doubt 
that the lives of many persons suffering from chronic renal and 
liver diseases are cut short in a similar way. The writer recalled 
a number of cases in which persons suffering from chronic renal 
disease have by a single indiscretion in eating a hearty meal of 
meat brought on a fatal relapse. 
Sausage often contains great numbers of ptomains and microbes; 
hence if not well cooked it is very likely to cause serious poisoning. 
Sausage contains all forms of noxious substances. (Roger.) 
If sausage does not always contain great numbers of bacteria 
and great quantities of bacterial poisons, it is only because anti- 
septics of some sort have been used. Muller reports 265 cases of 
poisoning from sausage, in which the symptoms generally began 
after an incubation period of about eighteen hours. The first 
symptoms were weakness, exhaustion, nausea, vomiting, diarrhea, 
dryness and burning of the throat. Two or three days later 
worse symptoms appeared; as vertigo, staggering gait, difficult 
respiration, double vision, difficulty in swallowing, hoarseness, 
clammy skin, paralysis of the legs, collapse and death. In some 
epidemics one-third of the cases are fatal. 
According to Roger, “decomposing meats (comprising prac- 
tically all butcher’s meat), are full of toxins and bacteria which 
find in the intestines excellent conditions for their development.” 
The poison produced by the bacillus botulinus is extremely 
deadly. Less than one ten-thousandth part of a drop of a culture 
of this germ was found sufficient to kill a mouse. 
“For efficient destruction of the bacteria found in them, 
meats must be heated to a temperature of 248° F. for two hours.” 
(Roger).. This is seldom done, in fact, it is quite impracticable 
in the ordinary cooking of meat. 
“Fish are still more likely than the flesh of other animals to 
give rise to poisoning.” (Roger). This fact has long been ANIMAL FOODS 
397 
known. It was on this account that Alexander the Great forbade 
his soldiers to eat fish. The tissues of some fish contain a poison 
similar to curare, the arrow poison of certain savage tribes. Cer- 
tain fish have poison glands, so that their bite is as poisonous as 
that of a venomous snake. Roger gives a long list of poisonous 
fish. The late Professor Brieger, as well as others who have made 
a careful study of this subject, isolated numerous ptomains 
which are found in the flesh of fish. Even in a fresh state it is 
known that sturgeon meat contains various toxic alkaloids. In 
Russia, where many persons live largely on sturgeon during Lent, 
poisoning from this source is often observed. Anrep reports the 
death of five persons from the use of salted sturgeon. Fish 
become poisonous at certain times or in certain places because of 
the noxious character of the food on which they live. This is the 
case with fish living in the vicinity of coral reefs. Cases of 
poisoning have been noted in France from the use of sardines, 
salmon and codfish. The so-called red cod owes its color to a 
chromogenic microbe which is associated with poison-producing 
bacteria. 
Virchow reported an epidemic in which nineteen persons 
were made sick, four fatally, by eating mussels. Mussels habitu- 
ally gather poisons from the waters in which they live. 
According to Roger, shellfish are a dangerous diet. He says : 
“Even healthy mussels are not a good food. Their prolonged 
use seems to be capable of producing chronic poisoning and 
cirrhosis of various organs. These effects have been observed in 
the natives of Terra del Fuego.” 
Typhoid fever germs have many times been found in oysters, 
and numerous epidemics of typhoid have been traced to their use. 
Simon reports a case of poisoning through eating of lobsters. 
Rapin reports an epidemic of severe illness from eating crabs. 
One of the sufferers died at the end of twenty-three days from 
symptoms resembling typhoid fever. 
All of these creatures—oysters, clams, mussels, lobsters, crabs 
•—are scavengers and quite unfit for food. 
All so-called food animals are liable to infection. According 
to Littlejohn, in a paper read before the National Tuberculosis 
Conference of London, based upon the conditions observed in 
England, 20 to 30 per cent, of cattle are tuberculous. Old milch 
cows (10 to 15 years) are infected to the extent of 75 per cent. 
Pigs are infected to the extent of 4 to 5 per cent. Birds, includ- 398 
THE NEW DIETETICS 
ing turkeys, clucks and pheasants, are infected with avian tuber- 
culosis. Sheep, goats and rabbits are rarely infected naturally, 
but rabbits are very susceptible to experimental infection. Horses 
are tuberculous only to the extent of one per cent. 
In the middle states of this country cows are believed to be 
generally infected to the extent of about 10 per cent. The car- 
casses of these tuberculous cattle are usually placed on sale in 
the meat markets along with other meats. 
The Bacteria of Meat. 
According to Weinzirl (Amer. Jour. Pub. Health, 1914): The 
standard of 1,000,000 bacteria per gram, advocated by some as a limit, 
is apparently too low, since it would condemn nearly all samples of 
hamburger, when showing no taint or other evidence of putrefaction. 
Samples of other market meats, all of which would otherwise pass 
inspection, often exceed this limit. 
A bacterial standard of 10,000,000 per gram is the limit proposed, 
on the basis of which 50 per cent, of the market samples of hamburger 
would still be condemned. This is justified on the following grounds: 
(a) much of it is actually spoiled when it reaches the consumer or is 
to be cooked; (b) meat teeming with 10,000,000 per gram is potentially 
rotten and soon will be actually spoiled under ordinary methods of 
handling; (c) the fact that markets are prone to add sodium sulphite 
to hamburger, even though the dealer knows it to be contrary to law, 
indicates that something is wrong with the hamburger; (d) and 
finally, if hamburger were made from wholesome meat in the first 
place, then properly iced, it is believed that the bacterial content .could 
readily be held within the 10,000,000 limit. 
Ten million bacteria per gram may be said to be equivalent 
to 300,000,000 bacteria per ounce. The significance of this will 
be appreciated when it is remembered that certified milk is not 
permitted to contain more than 10,000 bacteria per gram, or 
300,000 per ounce; that is, marketable hamburger steak may con- 
tain a thousand times as many bacteria as certified milk. 
Milk which contains as many as 200,000 bacteria per cubic 
centimeter, or 6,000,000 per ounce, is regarded as unmarketable, 
and is promptly condemned wherever a milk inspection service 
is maintained, while at the same time hamburger steak containing 
fifty times as many bacteria is sold and eaten without protest. 
It is to be further noted that the bacteria of milk consist 
almost wholly of harmless lactic acid-forming organisms, or sour 
milk germs, while the bacteria of meat consist almost exclusively 
of putrefactive organisms such as the Welch bacillus, the cause 
of gas gangrene, the bacillus putrificus, the bacillus proteas and ANIMAL FOODS 
399 
other bacteria which are usually present in carrion or putrefying 
animal bodies. 
An unpleasant fact which meat-eaters should become ac- 
quainted with is that the bacteria of meat are ordinary colon or 
manure germs. The meat becomes contaminated in the process of 
slaughtering. The hair and skin of an animal are, of course, 
infected with their own excreta. In slaughtering, the butcher’s 
hands and instruments become soiled and in the skinning of the 
animals, and contact with the hands and the killing-floor or plat- 
form, contaminates the surface of the warm flesh from which the 
skins are removed and the bacteria spurts through the carcass 
with great rapidity. Every one is familiar with the quickness 
with which warm milk will sour if put into a sour pan, or if a 
few drops of sour milk are added to it. Manure germs spread 
through the warm flesh of a slaughtered animal with almost equal 
rapidity, so that at the end of 24 or 48 hours after killing, the 
whole carcass is swarming with bacteria. This statement is 
based upon the results of careful bacteriological examination and 
can be verified by any bacteriologist. 
To prevent the contamination of flesh meats with manure 
germs, it would be necessary that the slaughtering process should 
be conducted with the same aseptic precautions with which sur- 
gical operations are performed. So long as butchering is done in 
the present fashion, it will continue to be no exaggeration to say 
that ordinary steaks and chops are the filthiest things which ever 
appear upon our tables. 
According to Bailey “the bacillus putrificus coli is present 
in the colon of animals and contaminates all meats. The spores 
of this bacillus are killed by exposure to a temperature of 224° F. 
for 15 minutes; 230° F. for 10 minutes; 240° F. for 5 minutes. 
In the process of canning meats, if these temperatures are not 
maintained, the meat in the interior of the can is not sterilized. 
This gives the bacilli an opportunity to develop and decompose 
proteins and other organic compounds. The sulphur generated 
by decomposed proteins forms a sulphid of iron which blackens 
the tin, while the generated gas may cause the end of the can to 
be “blown” or “swollen.” 
A research carried on by the Meat Committee of the Food 
Investigation Board of Great Britain has shown that the fungus 
which produces black spot on cold storage meats will grow at a 400 
THE NEW DIETETICS 
temperature 9 degrees below freezing. Numerous other molds 
have been found which grow well at the freezing point. 
It remains further to be said that all fresh meat is eaten in 
a state of decay. The process may not have proceeded so far that 
the dull human nose can discover it, but a carrion bird or a 
carrion fly can smell it from afar and various scavenger crea- 
tures will quickly show their appreciation of the unsavory tidbit 
if the arch scavenger man does not get the start of them by an 
hour or a day. Indeed, the putrefactive bacteria always found in 
meat in countless numbers, smoked and salted meats as well as 
fresh meats, are scavenger parasites which play in nature the 
important role of reducing back to the soil the dead bodies of 
animals. Another and quite different class of bacteria performs 
this office for plants. 
Dr. C. E. Roderick, bacteriologist of the laboratory of the 
Battle Creek Sanitarium, recently made, at the request of the 
writer, an extended study of the bacteria of meat and of the 
fresh droppings of animals. Specimens of meat were purchased 
from seven different markets. The bacteria found were identical 
with those found in fresh manure and in several instances the 
bacteria in meat exceeded in number those of fresh manure. It 
should be said that the meats examined appeared to the eye and 
the nose to be in as good condition as usual, and would have been 
sold to some one else and eaten if they had not been collected for 
examination. Care was taken to make the examination at once 
after collecting the specimens so as to allow no time for further 
putrefactive changes. The figures given show the maximum num- 
ber of manure germs per gram found in meats and in fresh manure 
droppings, also in oyster juice and limburger cheese. The higher 
figures were the most frequently observed and of course are of 
chief interest. The various species of putrefactive and other bac- 
teria found in the human colon and the colons of animals were all 
present in meat together with some other species due to air con- 
tamination. 
MEATS 
Bacteria per Gram 
Beefsteak : 1,500,000 
Corned beef 31,000,000 
Hamburger steak 75,000,000 
Pork liver 95,000,000 
Limburger cheese 18,000,000 ANIMAL FOODS 
401 
DROPPINGS OF ANIMALS 
Oyster juice 3,400,000 
Fresh droppings of calf 15,000,000 
Fresh droppings of goat 20,000,000 
Fresh droppings of horse 25,000,000 
Bacteria per Gram 
It is evident, then, that all flesh, as eaten, is to some degree 
unsafe. Ordinary cooking does not destroy the germs of meat. 
They are killed only by a temperature of 240° F. The usual 
cooking temperature is less than 212°. Even roasting will not 
destroy these germs for the oven heat does not penetrate to the in- 
terior of the roast 
Acidosis from a Flesh Diet* 
Gautier calls attention to the fact that oxalic acid and other 
poisonous acids are among the products of the oxidation of pro- 
tein in the body. “On a flesh diet these toxic bodies accumulate 
and acidify the blood, excite the heart and intoxicate the subject, 
disturbing the functions of the skin, lungs, liver or kidneys.” 
“Oxybutyric and other oxyacids,” says Gautier, “appear to be 
derivable from a direct or indirect splitting up of the albumin- 
oids. . . . Oxybutyric acid and oxalic acid are toxic, acidifying 
the fluid of the body and preventing the action of the oxidizing 
ferments which require an alkaline medium.” 
Effect of Flesh Eating on Animals* 
Hunter, in experiments to determine the effects of meat 
eating upon animals (rats), found that a flesh diet, as compared 
with a bread and milk diet, caused a great concentration of the 
urine with strong odor; the stools were dark colored. Examina- 
tion of the animals after death showed in the meat-fed animals 
hypertrophy of the kidneys, which was very pronounced in the 
second generation. The effects produced were like those caused 
by toxins and were considered to be the result “of a special strain 
on the functional activity of the kidneys,” due to the increased 
work required to excrete the great excess of protein. 
The reason for this is clearly shown by the composition of the 
extracts derived from meats, the so-called meat extract, some of 
the poisons of which are present in normal tissue while others 
are the products of putrefaction. 402 
THE NEW DIETETICS 
The Pernicious Effects of a Meat Diet Experimentally Proven. 
For several years, Dr. L. H. Newburgh, a professor in the 
Medical Department of the University of Michigan, assisted by 
Sarah Clarkson, M..S., has been engaged in a research to deter- 
mine the effects of a high protein diet or, to he more specific, the 
effect of the feeding of meat to rabbits. 
The first report of the results of these experiments was pub- 
lished by Dr. Newburgh more than two years ago at the meeting 
of the American Medical Association held at St. Louis last May 
(1922). Dr. Newburgh presented a report of the further results 
which he has obtained in the most interesting study which shows 
beyond any chance for controversy that the free use of animal 
proteins—meat—is a very active cause of degeneration of the 
arteries, or arteriosclerosis. The meat was given to rabbits in 
the form of bread made of wheat flour and meat powder. The 
rabbits were divided into two groups, one of which received 
bread containing 36 per cent, of protein (chiefly meat) and the 
other 27 per cent. The bread for the latter group was made of 
equal parts of flour and wheat bran, with which the lean beef 
powder was mixed. The rabbits were healthy animals, having 
been raised out-of-doors. In order to make sure that the diet 
alone was the cause of the results obtained, a group of rabbits 
was kept in the laboratories under tbe same conditions as those 
receiving the experimental diets, but were given no meat. 
Of ten animals fed on bread containing chiefly meat, two, 
or 20 per cent., showed disease of the blood-vessels within four to 
eight weeks. Of six animals that lived from ten to sixteen weeks 
on the same diet, four, or 66 per cent., showed disease of the 
blood-vessels. Of eight other animals that lived from eight to 
thirty-six weeks on the same diet, every one “showed marked and 
extensive atherosclerosis; that is, all these animals showed the 
blood-vessels extensively hardened with chalky deposits. 
Summarizing the results, it appears that of twenty-four ani- 
mals fed on bread containing about one-half its weight of lean 
meat, fourteen, or 58..3 per cent, developed in less than eight and 
a half months, disease of the blood-vessels, or arteriosclerosis. 
Of the animals fed on bread containing about one-'third its 
weight of lean meat, out of eleven animals that lived more than 
six months, eight showed typical arteriosclerosis, and in seven 
the changes in the arteries “were advanced and extensive.” Of ANIMAL FOODS 
403 
the forty animals fed on this bread, forty lived less than six 
months and did not show changes in the arteries. 
Not one of the animals kept in the laboratory under the 
same conditions as the experimental animals, showed any evi- 
dence of disease of the arteries, although two-thirds of them 
lived more than six months. 
It thus appears that the larger the amount of protein re- 
ceived by the animals and the longer the duration of the experi- 
ment, the greater was the destructive effects upon the arteries. 
It is notable that the amount of meat eaten by the rabbits 
was no greater than that which is eaten by many persons habit- 
ually, at least by those who try to follow the teachings of Woods 
Hutchinson, the number of which, let us hope, is not very great. 
Indeed, the proportion of protein given to the rabbits was not 
much greater than that required in the Atwater ration. 
It is interesting to note, in this connection, the fact that 
Atwater himself died of arteriosclerosis after having lived for 
two or three years a completely helpless, imbecile paralytic. It 
is also to be remembered that Hall, Peary and Shackleton, three 
noted Arctic explorers who adopted the meat diet of the Eski- 
mos, died early from the results of* changes in the blood-vessels. 
The fact that meat produces changes in the blood-vessels of 
rabbits, is especially significant, as pointed out by Dr. Newburgh, 
because “spontaneous atherosclerosis (arteriosclerosis) is a very 
rare disease in rabbits.” 
In the discussion which followed Dr. Newburgh’s paper, Dr. 
Lyon remarked as follows:— 
“I think anatomic and zoologic investigations in human be- 
ings would establish the fact that men have had a rather high 
protein diet for many generations and have become accustomed 
to it; whereas, the rabbit is one of the most strictly herbivorous 
mammals known. It is even more strictly herbivorous than many 
of the true rodents. The real origin of the rabbits is probably 
from some preungulate ancestor. It seems to me that it might be 
advisable to try the experiments on an animal which has a diet 
much more like that of human beings than a rabbit, such as the 
ordinary hog.” 
In closing the discussion of his paper, Dr. Newburgh fully 
answered the doctor’s criticism by reference to the observations 
of Dr. Fox, remarking, “Dr. Fox, of Philadelphia, has examined 
all of the animals that have died in the Philadelphia Zoological 404 
THE NEW DIETETICS 
Garden. His conclusions are of interest in this connection. He 
pointed out that the carnivora had chronic vascular and renal 
lesions, and that they were practically the only ones that had 
such lesions. I wrote to> Dr. Fox, asking him whether I was 
justified in assuming that definite relationship existed between 
the carnivorous diets and these chronic lesions of the arteries 
and kidneys. In his reply, he stated that this certainly was true, 
that the meat-eating animals showed a high incidence of chronic 
disease of the arteries and the kidneys as compared with all the 
other animals on which he had performed necropsies.” 
Dr. Lyon was right about the hog. He will eat anything 
given him, including dead horses, even dead hogs, any sort of 
carrion he finds lying about, for he is a natural born scavenger. 
Dr. Lyon is also, we are sorry to say, correct in his claim 
that the diet of the hog is “much more like that of human beings 
than that of the rabbit.” But this is just the point of interest. 
Should a man eat like a hog or like a rabbit? Or, if not like a 
rabbit, is there some other animal, such as the chimpanzee, for 
example, whose natural diet furnishes a safe model for man to 
follow? The comparative anatomists tell us that man belongs 
to the family of primates, with the big apes, which clearly 
indicates him to be a low-protein feeder, and entitles him to 
the same immunity from arteriosclerosis which Dr. Fox has 
shown to be enjoyed by the non-flesh-eating animals; but, of 
course, if a man adopts the diet of a carnivorous animal, he must 
expect to suffer the natural consequences of high protein feed- 
ing, one of which is early senility through degeneration of the 
blood-vessels and the kidneys. As regards immunity through 
long use of the high protein diet, it is clearly evident that if 
carnivorous animals have not developed such an immunity, it 
would be futile to expect a natural low protein feeder like man 
to develop immunity, no matter how long or to what extent he 
may have practised meat-eating. 
Parasites of Meat* 
Ambrose Pare, the famous French surgeon, long ago gave 
the advice that meat should be boiled to kill parasites, but his 
warning has usually been neglected. 
According to Professor Stiles, of the United States Public 
Health Service;— Trichinae in Muscle of Hog. (Leuckart) 
Trichinae in Capsules Undergoing Calcification, (a) Not calcified, (b) Calcification 
beginning, (c) Calcification further advanced, (d) Calcification completed. 
(Ostertag) Pork Tapeworm, Head Highly Magnified. 
A Piece of Meat In- 
fected with Pork- 
Measles. 
Head of Beef-Measle 
Tapeworm. 
Several Portions of an Adult Beef- 
Measle Tapeworm. 
Pork-Measle Bladder 
Worm. 
Mature Segment of Beef-Measles 
Tapeworm. ANIMAL FOODS 
405 
Every animal used for food has in its intestines either protozoa, 
round worms, flukes, or tapeworms. Some of these parasites, especially 
certain protozoa, are mere scavengers in the intestinal tract, but many of 
the infections undoubtedly do more or less harm to their hosts. Accord- 
ingly, academically these animals are diseased. . . . 
If all animals harboring animal parasites are to be construed as 
diseased in the sense of the food laws, as they are undoubtedly dis- 
eased from the abstract academic point of view, it is clear from the 
zoologic point of view that no meat can be sold legally. 
The professor’s view is that although an animal may be 
diseased it should not be condemned as unfit for food unless it is 
diseased in such a way as to cause disease in the eater. In illus- 
tration he adds: “When a meat dealer sells pork he is selling a 
product which in its raw state is dangerous to health for the 
reason that it frequently contains certain disease germs, trichinae, 
the absence of which cannot be guaranteed by any practical and 
proper method of meat inspection known. If the pork is properly 
cooked or otherwise prepared, these germs are killed, are rendered 
harmless and do not per se render the pork diseased (as food) 
for if dead they cannot produce disease.” 
The record of the Bureau of Animal Industry shows that in 
the year 1908 the meat and meat-food products condemned 
amounted to nearly three-fourths of one per cent, of the total 
amount examined. 
Canned Meats Usually Not Sterile. 
The generally accepted belief that canned meats are neces- 
sarily sterile because they do not spoil, has been completely ex- 
ploded by the recent report of the British “food investigation 
hoard” on the bacteriology of canned foods. Of 323 cans exam- 
ined, 246 were found to contain living bacteria. The most sur- 
prising thing was the fact that less than 30 per cent, of the cans 
which appeared to be perfectly sound were found, on examina- 
tion, to be really sterile. Of such cans, apparently good, and 
which would have been sold and eaten if they had not been sub- 
jected to the examination, 36 per cent, of the sardines, 63.6 per 
cent, of the meats, and 100 per cent, of the crabs were found not 
sterile, and were rejected as unfit for food (Jour. A. M. A., for 
March 24, 1923). Since all fresh,smoked, dried and salted meats 
are infected, and 30 per cent, of all canned meats, it is evident 
that the only safe course is to discard meats from the dietary. 406 
THE NEW DIETETICS 
Flesh Meat Not Essential. 
Half the people of the world eat very little meat. According 
to Report No. 109 of the United States Department of Agricul- 
ture, the total production of the principal meats, beef, mutton 
and pork, of the whole world, excluding China, is about 50,000,- 
000,000 pounds annually, which makes the per capita consumption 
of meat for the people of the world, excluding China, 11 pounds 
per annum, or less than 9 pounds if China is included. 
Evidently, meat plays really a small part in the world-wide 
scheme of human nutrition. 
Professor Alonzo E. Taylor contributed some years ago 
(1911) to the Popular Science Monthly an article on “Vegetar- 
ianism” in which he says, with reference to a non-flesh dietary: 
Is a vegetarian diet physiologically correct, adapted to the best 
purposes of a normal life, endurance and longevity? We receive a 
reply couched in no uncertain terms. Yes, a properly selected and 
prepared vegetarian diet meets completely the highest requirements 
of the diet. 
In confirmation of the above, Professor Taylor adds : “Purely 
physiological and chemical data, abundantly sustained by labor- 
atory researches and animal experimentation, confirm as well as 
elucidate the now widely-made human experience that a properly 
selected and prepared vegetarian diet is a complete diet for all 
conditions and periods of life, beyond the lactation term of 
infancy.” 
After admitting the entire adequacy of a non-flesh dietary, 
Professor Taylor suggests that such a dietary is not practical at 
the present time for the reason that “the area of the earth’s sur- 
face now under cultivation could not, with the present methods 
of agriculture, dependably produce enough plant albumin to 
meet the present needs of the population.” 
The last statement must have been made without considera- 
tion, since it requires only a very simple calculation to show that 
the more than 4,000,000,000 bushels of cereals produced in this 
country every year contain more than five times enough albumin 
to supply 2.2 ounces daily for every man, woman and child com- 
posing the 115,000,000 of our present population. With this fact 
established, it cannot be denied that Professor Taylor has clearly 
shown not only that a non-flesh dietary is adequate to meet all hu- 
man needs, but also that flesh foods might be at once, and perina- ANIMAL FOODS 
407 
nently, eliminated from our national bill of fare without risk of 
injury to the national health. 
We quote the following from “Food in War Time,” by Dr. 
Graham Lusk, the eminent physiologist: 
If one takes milk with other foods, meat may be dispensed with. 
Thus Hindhede advocates as ideal a diet consisting of bread, potatoes, 
fruit and a pint of milk. Splendid health, both of body and mind, the 
peasants’ comparative immunity to indigestion, kidney and liver dis- 
ease, as well as an absolute immunity to gout, is the alluring prospect 
held out by the following dietary: 
Graham bread 1 pound 
Potatoes 2 pounds 
Vegetable fat % pound 
Apples Impounds 
Milk 1 pint 
This bread-milk-potato-fruit diet gives a very excellent basis for 
wholesome nutrition. 
The question is, is meat necessary? The description of the Italian 
dietary answers this in the negative. 
Mr. Chester Holcomb, in his work “The Real Chinaman,” 
thus describes the ordinary diet of the Chinaman: 
Their daily food consists of rice steamed, cabbage boiled in an 
unnecessarily large amount of water, and, for a relish, a few bits of 
raw turnip, pickled in strong brine. When disposed to be very ex- 
travagant and reckless of expense,- they buy a cash worth of dried 
watermelon seeds and munch them as dessert. . . . The description 
answers with entire accuracy for the food consumption of the great 
masses of the Chinese people—not for the beggars or the very poor, 
but for the common classes of industrious workingmen and their fami- 
lies, whether in the great cities or in the rural districts. . . . The 
only luxuries of which they dream are an ounce or two of meat at 
very rare intervals with their invariable food of rice and cabbage. . . . 
In a consular report by Horton, in 1908, the diet of the 
native of Greece is thus described: 
At night the family dines on a few cents worth of rice, boiled 
together with wild greens and olive oil, ana bread, or wild greens 
boiled in $live oil and eaten with bread or some similar inexpensive 
dish. Meat is eaten by the laboring classes as a general thing three 
times a year, Christmas, Easter and the so-called “Birth of the Virgin.’’ 
Such a family as I am describing, the average laboring man’s family 
of Greece, rarely if ever see such things as butter, eggs and milk. 
According to Tibbies, “it has long since been stated that no 
long lived person is a large consumer of meat; on the other hand, 408 
THE NEW DIETETICS 
that a small consumption of meat tends to longevity, providing 
the amount consumed does not fall so low as the amount of pro- 
tein disintegrated and excreted during starvation.” 
This will never happen if one eats the ordinary amount of 
bread and adds a glassful of milk each day. 
Sir Herman Weber says: “Few people know how little food 
is necessary in advanced age to maintain bodily health. P'ew 
people who live to more than eighty are large eaters of meat.” 
William Cullen Bryant, one of the most notable literary 
lights of the nineteenth century in this country, wrote in 1837 
to his friend, the Hon. John Bigelow, to whose son, Mr. Poult- 
ney Bigelow, the historian, we are indebted for the information, 
“I accustom myself to the greatest simplicity of diet—renounc- 
ing tea, coffee and animal food” (flesh food), a practice which 
he followed for many years until he died, still in full vigor of 
health and usefulness, not from disease but as the result of an 
accident. The Hon. John Bigelow, friend of Carnegie and a 
distinguished diplomat, was a flesh-abstainer for many years 
before his death, as is also his son, well-known as historian and 
litterateur. 
From the above paragraphs, it is evident that it is possible 
for human beings to be sustained in health and vigor with the 
practical exclusion of meat and. even eggs from the dietary. It 
is important to note, however, that grains enter very largely into 
these meatless dietaries. These furnish an adequate supply of 
protein if supplemented by a daily half pint of milk or a handful 
of nuts. 
Greens are also an essential part of the biologic fare, with 
potatoes and other tubers and roots. These supply lime, iron and 
alkaline salts which are essential to good nutrition. 
E. V. McCollum states “that the greatest thing that can be 
done to raise the standard of health in this country is to change 
the type of diet in most homes by decreasing the consumption of 
meat and increasing the consumption of milk and green vege- 
tables.” 
The late Dr. Pavy, the most eminent authority on dietetics 
of his time, writing so long ago as 1874, remarks: 
“Many people seem to look upon meat almost as though it 
formed the only food that really nourished and supplied what is ANIMAL FOODS 
409 
wanted for work.” In disproof of the correctness of this popular 
view, Dr. Pavy refers to the report of Dr. E. Smith, according to 
whom “it is not uncommon to find, amongst the agricultural 
laborers of Scotland, that no meat is consumed, oatmeal and milk 
forming the staple articles of diet. Further, Dr. Guy, from his 
observations in the case of English prisons, gives as one of his 
deductions ‘that we possess conclusive evidence of the sufficiency 
of a diet from which meat is wholly excluded, and even of a diet 
consisting wholly of vegetable matter.’ ” 
Pavy further states that “animal food certainly taxes the 
stomach more than the ordinary forms of vegetable food that we 
consume, as is well known by those who have weak digestive 
power.” 
According to Liebig, “A bear kept at the Anatomical Mu- 
seum of Giessen showed a quiet, gentle nature, so long as he was 
fed exclusively on bread, hut a few days’ feeding on meat made 
him vicious and even quite dangerous. That swine grow irascible 
by having flesh food given them is well known—so much so, 
indeed, that they will then attack men.” 
Baeltz, a German army surgeon, made an interesting observa- 
tion on the Japanese laboring man, which he thus described: 
I had two jinrikisha-men; two powerful young fellows, one 
twenty-two, the other twenty-five years of age. They had followed 
the same calling for years. I provided their food, which was exactly 
measured, what they ate, and what they drank; and the chemical com- 
position of the food was ascertained by recognized means. These 
men received definite instructions:—Every day for three weeks they 
had to drag me, a man weighing 80 kgs. (176.4 lbs.), a distance of 
40 kms. (24.84 miles), running all the time. That appears to be a 
fairly arduous task—but not more so than that which these men 
would have willingly undertaken. But for my purpose it was quite 
enough; for we considered a walking expedition of 40 kms. as some- 
thing quite respectable; but for a man to run 40 kms. every day 
throughout a sunny August is rather more than one would usually 
expect of us. 
Now the men, during the experiment, kept to their usual diet, 
which contained fats amounting to less than half that proposed by 
Voit, while the contained protein fluctuated from between 60 to 80 
per cent, of his postulate. Carbohydrates, on the other hand, were 
provided in exceedingly large quantities, in the form of rice and pota- 
toes, barley, chestnuts, lily-roots and other foodstuffs peculiar to the 
country. After fourteen days I weighed the two men. One had not 
made any change, while the other had added half a pound to his 
weight. After the fourteenth day I told the men I wished to give 410 
THE NEW DIETETICS 
them meat. They were delighted, for meat is a luxury to them. I 
therefore substituted for a part of the carbohydrates a proportionate 
quantity of protein—not quite so much as Voit demanded, but a con- 
siderable amount. The men ate it with avidity; but after three days 
they came and asked me to discontinue the meat, and to give it to 
them only upon the conclusion of their probation, because they felt so 
fatigued, and could not run so well as before. 
This is certainly most convincing evidence of the great en- 
durance which may be supported by a meatless dietary. But the 
suggestion may be offered that the Japanese are a vegetarian race 
and have been such for hundreds of years and that racial char- 
acteristics may be a dominating factor. The answer to this will 
be found in a special research by Professor Irving Fisher of 
Yale University an account of which was published in the Yale 
Medical Reviczv and later in Munsey’s Magazine. The purpose 
of the experiment was to determine the comparative endurance 
of flesh-eaters and flesh-abstainers. 
The flesh-eaters were largely men in training for athletic contests, 
at Yale; the flesh-abstainers were such Yale students as I could find 
who did not use meat, or used it very sparingly, and nurses and 
physicians of the Battle Creek Sanitarium. Forty-nine subjects were 
tested. The results of the comparison were certainly surprising, and 
showed almost conclusively that those who used low protein and 
little or no flesh, not only had greater physical endurance, but far 
greater than those who were on a so-called “training diet.” 
Very few of the flesh-eaters for instance, could endure holding 
their arms horizontal for more than a quarter of an hour, where it 
was common among the flesh-abstainers to hold them for more than 
an hour, and without as much pain or discomfort as the meat-eaters 
experienced in half the time. In one case a flesh-abstainer held his 
arms out for three hours and twenty minutes, and then stopped 
merely because he had reached a round number of minutes—two 
hundred. 
One of the most severe tests was in - deep knee-bending, or 
“squatting.” Few of the meat-eaters could “squat” more than three 
hundred to four hundred times, and it was almost impossible for them 
to walk down the gymnasium stairs after the test without falling, so 
weakened were their thigh muscles. On the other hand, one of the 
Yale students who had been a flesh-abstainer for two years did the 
deep knee-bending eighteen hundred times without exhaustion, after 
which he ran without difficulty on the gymnasium track and walked 
several miles. Another subject, a nurse at the Battle Creek Sanitar- 
ium, did the deep knee-bending twenty-four hundred times; after 
which he proceeded with his regular work without serious incon- 
venience. Another nurse has recently accomplished the surprising ANIMAL FOODS 
411 
record of five thousand times. One remarkable difference between the 
two sets of men was the comparative absence of soreness in the 
muscles of the meat-abstainers after their tests. 
Bunge maintains (Science) that the great waste of energy 
wrhen meat is eaten is the result of over-stimulation of the liver 
which results in over-production of catalase, an oxidizing ferment 
which causes excessive oxidation or heat production. 
Bunge twenty years ago called attention to the fact that “the 
normal food of the adult should be furnished by the protein and 
carbohydrates in the proportion met with in the cereals.” He 
also mentioned the fact that Bavarian laborers who do the hardest 
work live on a diet of flour and fat, and also refers to the investi- 
gations of Panum and Buntzen, from which it appears that “even 
a carnivorous animal can be nourished on cereals and fat.” These 
investigators kept a dog in good health for months on an exclusive 
diet of oatmeal and butter, and without loss of weight. 
The chemical changes which occur in muscle tissue during 
work afford a clear explanation of the diminished endurance of 
meat eaters, either animals or men, when compared with vege- 
table feeders. 
During contraction, lactic acid is produced in the muscle 
tissue. While the muscle is relaxing, the acid is neutralized by 
the alkalies present in the tissue fluids. This enables the muscle 
to contract again. . Later, after relaxation, the lactic acid is 
burned up by the oxygen of the blood stream. Fatigue begins 
as soon as the lactic acid begins to accumulate in the muscle. 
It is evident that if the tissue fluids are only slightly alkaline, 
fatigue will occur sooner than if they are more strongly alkaline. 
The tissue fluids of flesh eaters are much less alkaline than those 
of vegetable feeders, as shown by the fact that the urine of flesh 
eaters is always highly acid. This is one of the reasons why 
mixed feeders invariably show themselves inferior to flesh ab- 
stainers in tests of endurance. 
Raw Beef not an Antiscorbutic. 
It was long believed that the chief cause of scurvy was the 
use of salt meats, and the belief is still generally held that fresh 
meat is an antiscorbutic, that is, that the feeding of fresh meat 
will prevent scurvy. 
Vitamin studies recently made by Dutcher and others have 
demonstrated that watery extracts of raw, lean meat will not pre- 412 
THE NEW DIETETICS 
vent scurvy in guinea pigs and will not prolong the lives of these 
animals when fed on a diet insufficient to prevent scurvy. Orange 
juice, on the other hand, was found to prevent scurvy when fed 
either with or without beef extract. 
The excuses for the use of flesh foods under any conditions 
are rapidly disappearing one by one. In fact, at the present time 
there is left no apology whatever for the use of flesh under any 
circumstances except the absence of better food. 
A well known editorial writer recently (1921) said in a 
leading newspaper: 
Growth of understanding, also, regarding the human diet is bound 
to lead to the use of smaller meat rations as a measure of health. 
When people learn that individuals do not require large quantities of flesh 
foods and that eating much meat commonly leads directly to illness, the 
United States may cease to pride itself on being the greatest meat-eating 
nation. 
In spite of government efforts towards enlightenment regarding 
the care of farm animals during the last sixteen years approximately 
1,475,000 cattle have died annually from disease and 1,500,000 from 
exposure. In 1914, 7,000,000 hogs died from cholera. 
According to Armsby, only 3 per cent, of the corn fed to a 
steer can be recovered from the edible portion of the carcass of 
the animal; that is, for every hundred pounds of corn fed to a 
steer, only three pounds of actual food material can be recovered. 
Of food fed to a dairy cow, 18 per cent., or six times as 
much food, is recovered as in the case of the steer. 
According to Prof. J. Russell Smith, of Columbia Uni- 
versity, in a notable work “The World’s Food Resources,” in the 
United States and Canada, hut especially in the United States, the 
chief object of agriculture is not to feed men, but to feed beasts. 
This was true even in the food crisis of 1918. We now raise 
altogether about 5,191,000,000 bushels of grain, as follows: 
AVERAGE CROP W6-J7 
Bushels 
Barley 195,000,000 
Buckwheat 14,000,000 
Corn 2,863,000,000 
Oats 1,422,000,000 
Rye 54,000,000 
Wheat 643,000,000 
5,191,000,000 ANIMAL FOODS 
413 
Of this great total the American people ate less than 550,000,000 
bushels of wheat when unrestricted, 180,000,000 bushels of other grains, 
and the total export of grains, 341,000,000, brought the amount used 
for human food up to about 900,000,000. The rest, 4,300,000,000, went 
to our four-footed brethren, who outnumber us and whose food re- 
quirements, because of their greater size, are several times our own. 
In addition to the grain, they get all of the 85,360,000 tons of hay 
grown on 54,618,500 acres. (More than 10 per cent, of the half billion 
acres under cultivation in the United States). They also roam over 
millions of acres, eating all the grass. It is therefore plain that more 
than four-fifths of the produce of the American agriculture, even in 
1918, went to feed the beasts. 
Special Contraindications of Flesh Foods* 
Albu, an eminent German authority, so long ago as 1901 
(Berlin Klin. Woch.) recognized the injurious effects of a flesh 
diet, especially in maladies dependent upon intestinal putrefac- 
tions, and prohibited its use in the following: neurasthenia, nerv- 
ous disorders of the stomach, hyperacidity of the stomach, 
mucous colitis, chronic constipation, obesity, exophthalmic goiter, 
renal diseases, affections of the skin, disorders of metabolism, 
diseases of the blood, diseases of the gastro-intestinal tract, 
pruritis, furunculosis, urticaria, erythema nodosum, and the 
various forms of eczema. 
While flesh foods are unnecessary in any case when other 
food is available, there are many diseases in which the use of 
flesh foods of any sort is particularly objectionable because likely 
to encourage the disease and interfere with the efforts of Nature 
to accomplish a cure. Among these diseases may be mentioned 
particularly the following: 
All conditions in which there exists a state of autointoxica- 
tion, because the putrefaction of remnants of flesh foods in the 
colon is the most active cause of intestinal toxemia. 
Constipation, because of the paralyzing effect of putrefactive 
poisons upon the muscular walls of the colon. 
Colitis, a common malady which is caused by the infection 
arising from the putrefaction of food residues in the colon. Meats 
contain the bacteria which cause colitis. 
Fevers of all sorts and febrile conditions because of the 
necessity for lessening the work of liver and kidneys as much as 
possible when the body is struggling against the toxic influence 
of a temperature-raising poison, also because the production of 
gastric juice is lessened in fever and hence meat is likely to be 414 
THE NEW DIETETICS 
less well digested and certain to undergo putrefactive changes. 
Hyperthyroidism or Grave’s disease, and hypothyroidism or 
myxedema and other diseases of the thyroid, all of which are 
greatly aggravated by the poisons resulting from a meat diet and 
are often due to this cause. 
Bright’s disease, stone in the kidney or bladder, and other 
diseases of the kidney, for the reason that the kidney is the chief 
means of elimination of the poisons arising from meat eating, 
and the crippled kidney is unable to do the extra work imposed 
by a meat diet and so is made worse by it. The work of the kid- 
neys is doubled and tripled by flesh eating. 
Gout, rheumatism and all rheumatic affections, which are 
aggravated and often caused by a meat diet. 
Pigmentation, liver spots, since the putrefaction of meats in 
the colon is the source of the brenzcatechin and other poisonous 
pigments which, the crippled suprarenal capsules being unable to 
destroy them, are deposited in the skin. 
Acidosis is increased by a diet rich in fat and protein, hence 
in this condition and in diabetes and other maladies in which 
acidosis is likely to occur, meat should be avoided. 
Even in pellagra meat may be discarded with advantage. 
Goldberger has shown that an increase of milk in the diet is 
the most efficient method of combating this disease. 
The same may be said with reference to the use of meat in 
cases of sprue and beri-beri, maladies which are very common in 
Oriental countries and are often brought to this country by 
travelers or returning missionaries, Many cases of sprue have 
been successfully treated at the Battle Creek Sanitarium without 
meat. 
High blood pressure, arteriosclerosis, myocarditis, apoplexy 
and paralysis are closely allied affections in all of which a non- 
flesh dietary is most necessary. 
Cirrhosis of the liver is a crippled condition of a highly 
important vital organ which demands a fleshless bill of fare as a 
precaution against a fatal toxemia. 
Gallstones, gall bladder disease, jaundice, and hepatic abscess 
are all conditions which demand the prohibition of meat as a 
protection of the most important defense of the body against 
poisons of all sorts, and especially against the poisons produced 
by germs in the intestines. 
Dropsy is an indication of a crippled heart or kidneys in ANIMAL FOODS 
415 
most cases and requires special care to avoid the intestinal poisons 
produced by a meat diet. 
Cancer is a meat-eater’s disease. It is common among meat- 
eating races of men and animals, rare among flesh-abstainers 
(Williams, Hoffman). A fleshless diet may not cure cancer, but 
will delay its progress (Bulkley). 
Chronic cystitis and disease of the prostate gland are aggra- 
vated by a meat diet because of unfavorable effects on the urine. 
Ordinary or secondary anemia does not require meat when 
egg yolks and garden greens and a score of other foods rich in iron 
are available, and do better without meat than with it. Pernicious 
anemia is made much worse by a meat diet. The iron of meat is 
inferiorin quality (Sherman, Chemistry of Food and Nutrition). 
Tuberculosis is aggravated by meat diet. Milk and greens 
are of special value in this disease, and when these are provided 
there can be no reason for the use of meats. Meat is harmful 
because it adds to the already heavy burdens of the liver and 
kidneys, and fails to supply the lime which is so important as 
an aid to recovery. Any amount of protein required may be 
obtained from milk and egg yolks; but it is now well known 
that an excessively high protein diet is injurious in lung tubercu- 
losis ; so that milk and eggs as well as meat may be used to 
excess. This is especially true of eggs. 
Gastric catarrh, like catarrh of the colon (colitis) and of the 
small intestine (enteritis), requires disuse of meat. A diet of 
buttermilk aids in starving out the bad flora (Debove). 
Bronchial catarrh and asthma are often cured by a change 
from a high to a low protein ration. 
Chronic appendicitis is a meat-eater’s disorder. Appendicitis, 
both acute and chronic, is practically unknown among the vege- 
table eating tribes of Africa (Senn, Cole). 
Skin disorders such as chronic eczema and psoriasis, often 
incorrigible under every other mode of treatment, rarely fail to 
yield promptly to a dietary from which meats are rigidly ex- 
cluded (Bulkley). 
Neurasthenia, insomnia, migraine, insanity, epilepsy, and 
many other nervous disorders are now known to be either due 
directly to the influence of toxins derived from the colon and 
circulating in the blood, or at least greatly aggravated by such 
poisons. The adoption of a fleshless diet certainly exercises a 
most favorable influence on this class of disorders. 416 
THE NEW DIETETICS 
Inebriety requires the total exclusion of flesh foods from the 
dietary. The effect is often most striking, causing the disap- 
pearance of the alcoholic appetite within a few days, or at least 
so mitigating it as to render control possible (Booth). 
Parasitic infections such as malaria and syphilis are favor- 
ably influenced by the fleshless regimen. Sanderson, the famous 
elephant hunter of India, informed the writer that after abstain- 
ing from flesh foods he remained free from fever in the jungles, 
although before he was always attacked with fever whenever he 
visited the jungle. 
Gastric and duodenal ulcer require avoidance of meat be- 
cause of the fact that flesh foods very probably play an active 
part in the causation. “Gastric ulcer is a meat-eater's disease.” 
Hyperchlorhydria or hyperacidity is greatly aggravated by 
a meat diet, which stimulates the gastric glands to secrete an 
excess of acid (Pavlov). 
In hypochlorhydria and achylia flesh foods are contraindi- 
cated because a highly active gastric juice is essential for the 
digestion of meats. Flesh foods are of all foodstuffs most out of 
place in cases in which the normal acid of the gastric juice is 
absent or greatly deficient. 
Meats of all sorts should be excluded from hospital bills of 
fare. The patient who has undergone a surgical operation needs 
essentially the same diet as a fever patient until and after he 
reaches convalescence. The common use of beef tea, meat ex- 
tracts, meat soup stocks and like preparations is in the highest 
degree unjustifiable in the light of modern knowledge of organic 
and physiologic chemistry. Such preparations only add to the 
burdens of the liver and kidneys, which in the surgical patient 
are always heavily taxed, and lessen rather than improve chances 
for recovery. Constipation, usually very pronounced in surgical 
cases, renders a meat diet particularly objectionable because of 
the aggravated toxemia induced thereby and is rendered still 
more obstinate through the paralyzing influence of the ammonia 
and other putrefaction poisons produced. 
EGGS 
The eggs of birds, especially of domestic fowls, are univer- 
sally used as food by human beings as well as by the anthropoid 
apes and various other animals. The eggs of the common domes- 
tic fowl and the guinea hen are the most delicate and agreeable. ANIMAL FOODS 
417 
The eggs of the duck and goose are richer in fat and of stronger 
flavor. 
The eggs of sturgeon and other fish, known as roe, are much 
used in some countries. 
The egg is a highly nitrogenous food. The whole egg affords 
15 calories of protein to the ounce and 31.7 of fat, a total of 46.7 
calories, or two-thirds that of porterhouse steak and more than 
double that of milk. 
A hen’s egg of average size weighs a little less than two 
ounces. Approximately, the egg consists of one part shell, six 
parts white, and three parts yolk. 
Weights of Eggs and Constituents (Average) 
Grains 
Ounces 
Whole egg 
56.8 
2.0 
Edible portion 
50.0 
1.8 i 
White 
33.0 
1.2 
Yolk 
17.0 
0.6 
100 calories—whole edible portion 
68.0 
2.4 
100 calories—white 
189.0 
6.7 
100 calories—yolk 
27.0 
1.0 
Composition of Whole Egg 
Per cent. 
Shell 11 
Yolk 32 
White 57 
Percentage Composition of Egg, Edible Part (Sherman) 
Whole 
White 
Yolk 
Protein 
13.400 
12.3000 
15.7000 
Fat 
10.500 
0.2000 
33.3000 
Lime (CaO) 
0.093 
0.0150 
0.2000 
Iron 
0.003 
0.0001 
0.0085 
A single egg furnishes about 30 calories of protein. It is 
evident, then, that four or five eggs supply protein sufficient for 
an ordinary day’s ration. But it is to be remembered that cereals 
are rich in protein and all vegetables contain some of this element, 
while milk contains an excess, and supplies in one-half pint 
more protein than does an egg. A dietary which includes two 
glassfuls of milk with a sufficiency of other foods not of animal 
origin will afford an abundance of protein without the addition 418 
THE NEW DIETETICS 
of eggs. Even if neither meat nor milk is included in the bill of 
fare, not more than two eggs at most will be needed to supply all 
the supplementary protein required for one day. 
Milk lacks iron and so is not a complete food; but on account 
of its great excess of protein, the egg is less suited to serve as an 
exclusive diet, and should not be too freely used. Its proper place 
in the dietary is to round out a diet otherwise deficient in com- 
plete proteins, vitamins and lime. 
As a source of complete proteins, the egg is inferior to milk 
because less digestible and also because very liable to be rendered 
unfit for food by putrefaction. Milk ferments or sours when 
stale, while eggs putrefy. A stale egg is certainly one of the most 
disagreeable as well as most dangerous of unwholesome food- 
stuffs, while sour milk is actually more digestible and really more 
wholesome for most persons than is fresh milk. This property 
of milk is due to its carbohydrate, sugar of milk, an element 
which in eggs is lacking. 
Egg Yolk. 
Egg yolk is a very remarkable substance prepared by Nature 
for food, and hence contains all the elements necessary for com- 
plete nutrition, including a rich store of lime and iron and other 
salts, with an abundant supply of vitamins. Nothing is forgotten. 
The yolk is the sole food of the young chick while it is under- 
going development in the shell, and when it leaps out of its prison 
house it is fully equipped to enter upon its life career, and to 
thrive upon the foodstuffs which it finds ready at hand. It does 
not have to be nursed or brought up on a bottle. It needs only 
to eat, exercise and grow. The yolk of the egg has supplied it 
with everything needful for its complete life equipment. 
It is sometimes well to advise the use of egg yolks alone, 
excluding the white when the object is to increase the intake of 
lime salts. The writer has followed this plan for many years. 
To insure the utilization of eggs it is highly necessary that 
they should be properly cooked. Raw eggs are indigestible. Half 
cooked eggs are half digestible. Fried eggs and omelets are hard 
of digestion, and the undigested fragments which appear in the 
stools carry away a considerable part of the precious lime which 
should be retained and absorbed. This difficulty may be obviated 
by cooking the egg at a low temperature, 150° to 160° F. Cooked 
in this manner, the egg is soft and jelly-like or coddled, and is ANIMAL FOODS 
419 
presented to the stomach in most digestible form. When egg 
yolks alone are eaten, they may be separated either before or after 
cooking. Hard-boiled yolks are easily digestible, which is not 
true of the whites. 
Egg White. 
Raw white of eggs has long been regarded as among the most 
easily digestible of all food substances. This idea was chiefly 
based upon the observation by Beaumont in his experiments upon 
Alexis St. Martin. Beaumont noted that raw egg white left the 
stomach very quickly, in less time in fact than any other foodstuff 
which he investigated. More recent investigations, however, by 
Pavlov and others have shown that this interpretation of Beau- 
mont’s observation is incorrect. Pavlov, for example, showed 
that the raw white of egg does not stimulate the flow of gastric 
juice. In this respect white of egg differs from other proteins. 
The effect of which is to cause the stomach to pour out an abun- 
dant supply of a highly acid gastric secretion. 
The effect of raw white of egg on the stomach as noted by 
Pavlov was the same as that of water. Abderhalden discovered 
another peculiarity of raw white of egg. He found that this form 
of albumen is not readily acted upon by pepsin. Okada showed 
that the intestinal fluids, both the bile and the pancreatic juice, 
are indifferent to white of egg. Very little bile enters the intes- 
tine when white of egg is introduced and trypsin, a digestive 
principle of the pancreatic juice which acts vigorously upon other 
protein, has no effect whatever upon raw egg white. Other 
investigators have confirmed this observation. A still further 
very remarkable observation made by Vernon, Hetin and numer- 
ous other investigators shows that the raw white of egg not only 
is not acted upon by the digestive fluids but that it hinders the 
digestion of other substances. 
Steinitz noted that raw egg white caused vomiting and 
diarrhea in dogs. Five egg whites given to a fifteen pound dog 
caused very severe diarrhea. The stools were not only loose but 
had an extremely offensive odor and contained a great deal of 
mucus, indicative of very active putrefaction and marked infec- 
tion. Even when small amounts of raw white of egg are fed, the 
egg albumen can be recovered from the stools unchanged. 
These peculiarities of raw egg white disappear when it is 
cooked at a temperature of 160° F. At this temperature the egg 420 
THE NEW DIETETICS 
white is thoroughly coagulated but remains soft and jelly-like. 
Egg yolk on the other hand was found to be very easily digestible 
when eaten either raw or cooked. Careful experiments have 
shown that raw egg white has no food value when introduced into 
the colon and hence it should not be used in rectal feeding. 
Another objection to the use of raw egg white is the readiness 
with which this substance is absorbed into the blood, producing 
anaphylaxis. 
The peculiar effect seen in persons who are sensitized against 
egg is said to be due to ovo mucoid which the egg contains. Egg 
white contains also three other substances, ovo globulin, ovo 
albumin and con albumin. Albumin is shown to be the cause of 
diarrhea. The amount of white of egg required to give rise to 
anaphylaxis is extraordinarily small. This effect was produced 
in guinea pigs by less than one-millionth of a grain of egg white. 
From the above facts it is evident that the practice of giving 
raw eggs to invalids with or without milk feeding and the use of 
raw white of egg in the feeding of babies are certainly of less 
value than has been supposed and are really more or less danger- 
ous procedures. 
Liquid albumin retards the digestion of coagulated albumin, 
hence partially cooked egg white digests very slowly. This is 
true with reference to both gastric digestion (Linoissier) and 
pancreatic digestion (Delezenne). 
According to Bayliss, the eminent professor of physiology in 
the University of London (“The Physiology of Food and Econ- 
omy in Diet”), raw white of egg contains some substance which, 
even in very small amount, hinders the action of the digestive 
fuids. Cooking destroys this substance; but at the same time long 
cooking renders the white of egg almost insoluble in the digestive 
juices, just as large lumps of ice melt less rapidly than finely 
pulverized ice. White of egg has for centuries been considered 
almost indispensable for the feeding of the sick and especially 
the feeding of convalescent surgical cases. Many a nurse will 
feel that without the time-honored eggnog her ward patients will 
certainly starve. But raw eggs should he dropped from the 
hospital bill of fare and sick room dietaries. In fact, the egg in 
any form is under suspicion and must be used in moderation and 
with caution to make sure that it is perfectly fresh and free from 
infection. ANIMAL FOODS 
421 
Recent experiments by Rose and MacLeod seem to indicate 
that the raw white of egg is well digested if lightly beaten. 
Professor Linossier, a member of the Academy of Medicine 
of Paris, holds that there is in eggs a toxalbumen to which some 
persons are susceptible either by heredity or through acquirement 
as the result of disorder of the liver or intestines. This poison, 
according to Linossier, is destroyed by heat. Hence, eggs should 
never be eaten raw, but should be cooked, both white and yolk, to 
the point of coagulation or curdling. Further cooking lessens 
digestibility. 
The Cooking of Eggs. 
According to Penzoldt, the time required for the gastric 
digestion of eggs cooked in different ways is as follows: 
Lightly boiled 1 Y hours 
Poached 2y2 hours 
Hard boiled 3 hours 
Omelet 3 hours 
When boiled two minutes the white of egg next to the shell 
is coagulated; the yolk remains fluid. In a three-minute egg the 
white is coagulated and the yolk is thickened. A ten-minute egg 
is hard boiled. 
A good way of boiling eggs is to drop three eggs into a quart 
of boiling water. Remove at once from the source of heat. In 
ten minutes the eggs will be found to be uniformly soft boiled, or 
jellied. 
The greenish black color which is sometimes seen on the sur- 
face of the yolk of a hard boiled egg is due to the formation of 
sulphide of iron (Tinkler). If the egg is cooled at once after 
boiling, the chemical change does not occur. 
Influence of Food on Eggs. 
Eggs are greatly influenced by the food of the fowls by which 
they are laid. Meats and putrefying substances give to eggs a 
strong flavor. Milk, sunflower seeds, and other clean and whole- 
some foods insure a very superior flavor. 
When chickens have plenty of green feed and yellow corn 
the yolks have a much deeper color, due to the presence of carotin, 
which is often associated with the fat-soluble vitamin. 422 
THE NEW DIETETICS 
The eggs of fish-eating birds have a strong fishy flavor and 
on that account are seldom used as food. 
Eggs and Biliousness. 
Many persons know by repeated experiences that the free use 
of eggs produces a well defined physical condition which is com- 
monly termed “biliousness” although, very likely, connected with 
the bile or bile-making function of the liver only in a remote way. 
“Biliousness” is really acute autointoxication. Its cause is the 
putrefaction of undigested and unabsorbed protein in the colon 
and the absorption of the poisonous products of bacterial action. 
Eggs encourage putrefaction, milk does not. 
If the eggs happen to be a little stale, the putrefaction and 
autointoxication are greatly intensified. 
The Food Iron of Eggs. 
The iron of the egg is contained almost wholly in the yolk, 
where it is stored up for use by the developing chick in making 
its first outfit of red blood cells. The proportion of iron found in 
the yolk is one hundred times as great as that found in the white 
of the egg. This is due to the fact that the yolk is food specially 
prepared for the young chick while the white is the embryonic 
tissue which is destined, under favoring conditions, to grow and 
develop into the bones, muscles, nerves, feathers and other struc- 
tures of the chick itself. In the case of mammals, the young 
animal remains connected with the body of the mother until the 
organs essential to life have been developed, obtaining its food 
directly from the blood of the mother before birth and indirectly 
through the mother’s milk afterward until able to feed itself. 
Professor Bunge found in the egg yolk an iron compound so 
closely resembling the hemoglobin of the blood corpuscles as to be 
easily converted into it, and so he gave to the compound the name 
of hematogen, which means, in simple terms, generator of blood. 
Hematogen contains 0.3 per cent, of iron and yet all the ordinary 
laboratory tests for iron fail to reveal its presence. This remark- 
able fact clearly showed that food iron is a quite different thing 
from the ordinary metallic iron of the laboratory. The deft hand 
of Nature working in her secret laboratories, has, through the 
agency of vital activity, lifted the cold inert iron of the mine 
and the foundry into the realm of organic life, and has endowed 
it with marvelous properties by enormously increasing its natural ANIMAL FOODS 
423 
affinity for oxygen. Ordinary rusting proceeds very slowly. When 
the oxygen hunger of iron is fully developed, as in the hemo- 
globin of the blood, this oxygen absorbing propensity operates 
with lightning rapidity. All the blood in the body, about five 
quarts, rushes through the lungs every minute or two, and yet the 
stream is not so rapid that the subtle hemoglobin does not have 
time to snatch for each tiny red cell its full load of oxygen. 
It is well worth while to remember that when eggs are used 
as a source of food iron, to enrich the blood in anemia, it is the 
yolk only and not the whole egg that is useful. 
As a source of food iron, the egg fills an important place in 
the dietary, and one that milk cannot fill because of its deficiency 
in iron. Two yolks contain as much food iron as a five ounce 
serving of meat, four times as much as an equal weight of meat, 
and eight times as much as the same weight of fish. 
It is to be said, also, that the iron of the egg yolk is superior 
to that of meat, being especially prepared by nature to serve as 
food iron, while the iron of flesh is practically identical with that 
derived from the dead blood cells of the body, or waste iron which 
is in large part excreted by the liver. 
Here again the green plant shows its superior value as a 
supplementary nutrient. An ordinary serving of spinach sup- 
plies as much food iron as three or four egg yolks and a serving 
of red root or dock greens as much as half a dozen eggs. 
The Lime Content of Eggs. 
An egg yolk of average size weighs half an ounce and so con- 
tains a little more than two-fifths of a grain of lime (0.42 grain) 
or 2.7 per cent, of a day’s ration. 
A comparison of the lime content of the whole egg, the white 
and the yolk is both interesting and instructive. The egg yolk 
contains, per ounce, nine times as much lime as the white. The 
figures for the whole egg represent the combined composition 
of the yolk and white. 
It is evident that eggs, and especially the egg yolks, are a 
most valuable source of food lime, but this is not true of the white 
taken by itself, which contains less lime per ounce than most of 
the cereals, scarcely more than rice, about the poorest in lime of 
all the cereals. 
As a source of lime, the egg is again inferior to milk, which 
supplies a much larger amount of food lime than the same weight 424 
THE NEW DIETETICS 
of eggs. The lime content of a glassful of milk equals that of 
three or four eggs. 
The lime of the egg is mostly found in the yolk, although 
the unhatched chick absorbs considerable lime from the egg shell. 
An ounce of egg yolk furnishes more lime than an ounce of milk, 
but more than ten yolks are required to supply as much food lime 
as a half pint of milk. 
It must be remembered, also, that the green leaf is a most 
valuable source of food lime. An ounce of chard nearly equals 
two egg yolks in lime content, and even celery furnishes as much 
lime as the same weight of yolks, while an ounce of turnip tops 
supplies as much lime as the yolks of four eggs, and an ounce of 
mustard greens as much as half a dozen yolks. 
From the above, it will be plainly apparent that while the 
egg is valuable as a source of protein, lime and iron, it is not 
essential. Milk will supply equally good lime and protein, and 
the green leaf is a still richer source of food iron. 
It is not to be forgotten that the egg is also a source of 
valuable vitamins, especially the antineuritic or beri-beri pre- 
venting vitamin and the antirachitic or fat-soluble vitamin. Roth 
of these food essentials are supplied, however, in rich abundance 
by the green leaf. 
Egg Substitutes. 
Egg substitutes are generally unsatisfactory and sometimes 
unwholesome. They are chiefly used by bakers. The best are 
made from the casein and albumen of skimmed milk, which are 
mixed with flour and dried. Others are made from the blood of 
slaughtered animals and are most unwholesome. 
Preserved Eggs. 
There is no known means of preserving eggs without deterio- 
ration except refrigeration. The Chinese have for ages employed 
a process of preservation which is not likely to become popular in 
this country. Fresh duck’s eggs are kept in an infusion of tea. 
lime, salt and wood ashes for half a year, then drained and coated 
with rice hulls. Eggs thus treated are known as pidau. Another 
method of preservation is to encase the egg with a thick layer of 
plaster of Paris. Eggs preserved in this way have a strong flavor 
of ammonia, and are of course in a state of decay much like that 
of limburger cheese. ANIMAL FOODS 
425 
The popular method of preserving eggs by means of immer- 
sion in silicate of soda or water glass is far from satisfactory. 
Such eggs are not always unwholesome, but they lack the proper- 
ties of strictly fresh eggs. 
In hot weather, eggs will keep perfectly fresh without re- 
frigeration not more than three or four days. A low temperature 
is nearly as necessary for the keeping of eggs as of milk. 
Bad Eggs. 
Eggs are not eaten in this country unless supposed to be 
fresh or well preserved. The decayed egg is rejected at once. 
The Chinese gourmand, however, has a great penchant for stale 
eggs. His highly cultivated palate delights in the pungent aroma 
of an egg two or three years advanced in putrefaction. The 
American turns in disgust from the stale egg, but curiously 
enough, requires in his beefsteak the same condition that the 
Chinaman demands in his egg. 
It was formerly supposed that if the fresh egg were kept 
free from contact with bacteria it would remain sterile, but since 
the investigations of Rettger it is known that quite a large pro- 
portion of all eggs show bacteria when carefully examined. This 
is especially true of the yolk of the egg, which is infected much 
more often than the white. According to observations made by 
the United States government, one egg in seven, on the average, 
is infected with harmful bacteria, which are only destroyed by 
very thorough cooking. 
Within a few years an infectious disease due to a germ 
known as the B. pullorum has spread rapidly over the country. 
This disease affects the ovaries of fowls, and eggs laid by in- 
fected hens contain the B. pullorum, which when fed to rabbits 
in experimental work has produced the same disease in them. 
The B. pullorum has been shown to be a cause of diarrhea. 
Although the Chinese eat with seeming impunity the pidau, 
or ancient egg, which is known to be swarming with bacteria, 
there is no evidence that it is harmless. Eating decayed eggs may 
inoculate the intestine with bacteria that gradually break down 
the resistance of the intestinal mucous membrane and finally pro- 
duce infection, besides flooding the body with toxins which the 
kidneys must eliminate to their certain detriment. 
Doctor Rettger, who has investigated the subject, has found 
that eggs are often badly infected, showing a high bacterial count 426 
THE NEW DIETETICS 
and much ammonia from putrefaction, notwithstanding the fact 
that they pass the candle test well and give no great evidence of 
decomposition. New and better standards for examination of 
eggs, milk and meat are urgently called for. 
M. E. Pennington, of the United States Department of Agri- 
culture, some years ago (1911) made a careful study of eggs, 
especially with reference to the presence of bacteria. Here are 
some of the facts discovered : 
The fresh, sound, shell egg is for practical purposes free from 
bacteria, though it is not always sterile. It is free from organisms of 
the colon group so far as we know. “Stuck spots,’’ “mold spots,” 
definite “blood rings,” “white rots,” eggs with a pronounced odor, 
“grass eggs” (those having a greenish color in the egg white), “musty 
eggs,” and “sour eggs,” that is, eggs having a pungent quality which is 
difficult to describe but which is recognized by the trained sense of 
smell, are ordinarily possessed of a high bacterial content. “Grass 
eggs,” “musty eggs,” “sour eggs,” and eggs having a pronounced 
odor cannot always be excluded by the candler. The others can and 
should be. The great majority of “seconds,” “heated eggs,” dirty 
shell eggs, and cracked eggs (not those from which the contents are 
escaping) show but few bacteria present when studied in the producing 
section. When cracked-shell eggs are kept, even for a few days, they 
frequently become infected with molds and bacteria. Cracked eggs, or 
“checks,” as they are called in the trade, dirty shell eggs, and “sec- 
onds,” which signifies a grade including undersized, soiled, “checked,” 
and stale eggs, are commonly used by egg breakers. No “spot” 
eggs of any sort are used by reputable breakers. 
Pennington, to whose work we have above referred, and 
Kossowitz, of Vienna, have found that fresh eggs often contain 
molds, yeasts and various other micro-organisms. Pennington 
found only 12 per cent, of the eggs examined entirely free from 
bacteria. Kossowitz found most eggs sterile when first laid, but 
discovered that infection readily occurs through penetration of 
the shell by various bacteria if the eggs by careless handling are 
exposed to contamination. 
Candling of Eggs. 
Eggs, even when known to be fresh, should be candled before 
using, as eggs are sometimes infected before they are laid and 
are also in other ways defective. The Bureau of Chemistry of the 
United States Department of Agriculture has prepared an egg 
chart which is shown herewith, together with an explanation of 
the same. APPEARANCE OF EGGS WHEN CANDLED 
A Fresh Egg; B Stale Egg; C Egg Showing Fungous Spots; D Rotten Egg. 
(Yearbook U. S. Deft, of Ayric., 1911). Beefsteak Preserved in Butter- 
milk for IS Years. 
THE BATTLE CREEK SANITARIUM DAIRY BARN ANIMAL FOODS 
427 
The popular notion that dark colored eggs are richer in fat 
than others is wholly without foundation. 
Non-fertile eggs are generally considered of better flavor and 
are believed to keep safer than fertile eggs. 
Egg Poisoning. 
Some persons are sensitized to eggs and cannot eat even a 
small fraction of an egg without suffering most unpleasant con- 
sequences. Nausea, vomiting, purging, headache, and a distress- 
ing nettle rash or urticaria are a few of the symptoms which 
result from the use of eggs by sensitized persons. Similar symp- 
toms have been observed to follow the use of milk and of various 
other foodstuffs in different persons. 
Lemoine, an eminent French authority who has recently 
made a careful study of this subject, tells us that raw egg albumin 
and the lean flesh of animals in a raw state contain poisons which 
damage the kidneys. To the effects of this poison is due the 
appearance of albumin in the urine when raw eggs are eaten 
freely. These poisons may be destroyed by the gastric juice 
and by thorough cooking. The action of normal gastric juice 
upon raw egg albumen is so slow that its use is hazardous since, 
in many cases of chronic nephritis, achylia exists. Nephritics 
should use eggs sparingly and never raw. 
In a case recently observed by the writer, the symptoms of 
poisoning occurred only after the eating of the yolks of eggs, 
although in the majority of cases the unpleasant symptoms follow 
the use of the whites rather than the yolks. 
Lemoine states that the effects of food poisoning may be 
avoided in many cases by taking a very small quantity of the 
objectionable food half an hour before the meal is eaten. It is 
also possible to overcome this special susceptibility by taking the 
objectionable substance in very small but gradually increasing 
doses. In the course of some weeks the amount may be gradually 
increased to the quantity usually taken at an ordinary serving. 
When the susceptibility is overcome in this way the effect, how- 
ever, is often not permanent, the susceptibility returning after a 
time if the use of the particular article is discontinued. 428 
THE NEW DIETETICS 
When Eggs Should Not Be Eaten, 
Claude Bernard observed that albumin appeared in the urine 
after the eating of a considerable quantity of white of egg. On 
this account many physicians forbid the use of egg by persons 
suffering with disease of the kidneys. Recent investigations lead 
to the conclusion that the healthy kidney never permits the 
passage of albumin and that when albumin appears in the urine 
it is evidence that the kidneys have been damaged. Persons 
suffering from Bright’s disease, or who have albumin in the 
urine, should avoid the use of eggs, or at least should use eggs 
very sparingly, eating the yolks only. 
Persons who are subject to so-called bilious attacks, sick 
headaches, or who have bad breath or other marked symptoms of 
autointoxication, would do well to avoid the use of eggs because 
they encourage the development of putrefactive flora in the colon. 
This is especially true of the white of egg. Egg white, when 
raw, leaves the stomach quickly but is not well digested, and soon 
finds its way to the colon, where it readily undergoes putrefaction. 
When boiled, egg white is digestible, but digests slowly when hard 
boiled, and when not well masticated, as is generally the case, it 
is likely to reach the colon and there undergo putrefactive changes. 
The yolk of egg is readily digestible, even when hard boiled, and 
so is greatly to be preferred to the whole egg in cases in which it 
is desirable to restrict putrefaction as much as possible; but even 
yolks should be eaten sparingly. There is rarely ever real neces- 
sity for the use of eggs, for protein of equal if not superior qual- 
ity may be obtained from milk, the soy bean and from nuts, in- 
cluding the humble peanut. 
Cholesterol, a resinous substance of which gallstones are 
formed, is normally present in the blood in the proportion of one 
part in 2,000 parts of blood. The blood of a person of ordinary 
size contains about 20 grains of cholesterol. Laroche has shown 
that in persons suffering from gallstones the amount of cholesterol 
in the blood is considerably increased. A single egg contains 
about 4 grains of cholesterol. A couple of eggs would thus 
increase the amount of cholesterol in the blood to the extent of 
40 per cent. From these facts it appears that persons who have 
undergone operations for the removal of gallstones, or are be- 
lieved to be suffering from this disease, should carefully avoid 
the use of eggs. ANIMAL FOODS 
429 
MILK 
Milk is a special food product prepared for their young by 
mammals or warm-blooded animals. The milk-forming glands, 
which with rare exceptions are developed only in the females of 
mammals, are ordinarily active only subsequent to the giving 
birth to offspring. Occasionally, however, the mammary glands 
become active in females that have never given birth to young, 
and in rare instances the milk glands have shown a certain degree 
of activity in males. 
Milk is nearly a perfect food, containing not only protein and 
fat as do other animal foods, but also carbohydrates, besides 
salts and vitamins. It is deficient only in iron. 
TABLE XXXIX. 
Percentage Composition of Cow's Milk and Milk Products.* 
Water 
Proteins 
Fats 
Sugar 
Salts 
Lactic 
acid 
Butter 
6.0 
0.3 
91.0 
2.7 
Buttermilk 
90.6 
3.8 
1.2 
3.3 
0.6 
0.3 
Cheese 
36,8 
33.5 
24.3 
5.4 
Cottage cheese 
72.0 
20.9 
1.0 
4.3 
1.8 
Cream 
66.0 
2.7 
26.7 
2.8 
1.8 
Milk 
86.8 
4.0 
3.7 
4.8 
0.7 
Skimmed milk 
88.0 
4.0 
1.8 
5.4 
0.8 
Whey 
93.6 
0.8 
0.2 
4.65 
0.7 
Cow’s milk contains about one-eighth its weight of solids, of 
which approximately one-third or 4 per cent., is fat, 4 per cent, 
casein and other proteins and 4.5 per cent, lactose or milk sugar. 
To these are added 0.6 per cent, of lime and other salts. The 
milk of each species of animals is exactly adapted to the use of 
the young of the species. In the milk of rapidly growing animals 
the amount of protein and salts is much greater than in that of 
animals that grow slowly. 
The milk of the cow enjoys in this country almost exclusive 
favor, but is by no means the universal lacteal food. Milk of 
various animals is used in different countries. Among the ancient 
Egyptians the milk of dogs was employed as well as that of the 
from various sources. 430 
THE NEW DIETETICS 
cow. In various parts of Europe the milk of the goat and the 
ewe is used quite extensively, and to some extent also the milk of 
the ass. The milk of the camel is used in Arabia and Persia, of 
mares in Tartary, of the buffalo in Africa and China, of the yak 
in Tibet, of the reindeer in Lapland, and the llama and vicuna 
in South America. 
The amount of milk produced in the United States yearly is 
about 87,000,000,000 pounds, representing 11,250,000,000 pounds 
of dry food substance, which is produced by 24,000,000 dairy 
cattle, each of which requires daily 17 pounds of digestible food to 
produce 456 pounds (equivalent to 1800 quarts) of milk yearly, 13 
pounds of dry digestible foodstuff for each pound of dry milk. 
To support these dairy cattle requires the product of not less 
than 48,000,000 acres of land. There can be no doubt that, as 
meat production diminishes, as it is certain to do, milk production 
will likewise decrease. There is even at the present time a notable 
shortage of dairy products and the average per capita production 
will undoubtedly continue to decrease from the same causes which 
inevitably lead to a lessened meat production. Some other source 
of the complete protein needed to supplement the incomplete pro- 
teins of cereals and roots must be provided. Fortunately, Nature 
has supplied us with this all-essential foodstuff in nuts. This is 
a vitally important fact which sometime will save the race from 
protein starvation. 
If in the case of adults it needs to be supplemented by other 
foodstuffs, cow’s milk, when properly modified, is for the young 
infant a nearly perfect food. It contains in excellent proportions 
all the elements needed by the growing child. This is not true 
of any other substance known. 
The fuel element is represented in milk by fat and sugar of 
milk. The fat is of a sort easily utilized by the body. 
Why Milk Sours While Meat Putrefies* 
The sugar of milk is a special product well adapted to the 
needs of the body, far superior to cane sugar and free from the 
unwholesome properties of the products of the sugar cane. It is 
found nowhere in Nature except in the milk of animals. Milk 
sugar is slowly digested and is absorbed only one-fourth as rapidly 
as malt sugar. This enables it more easily to reach the lower 
intestine, where it is converted into lactic acid and so prevents the 
putrefaction to which modern science has traced a great number 
of the maladies of both infants and adults. ANIMAL FOODS 
431 
It is due to the presence of lactose that milk sours while 
meat putrefies. Several years ago (1908), the writer placed in 
a jar of buttermilk a raw beefsteak with no antiseptic of any sort. 
The beefsteak is still intact, thanks to the antiputrefactive prop- 
erties of milk sugar and the acid-forming bacteria it feeds. One 
reason for this antiputrefactive property of milk is that in the 
presence of sugar even highly active putrefactive organisms pro- 
duce harmless acids instead of noxious toxins and ptomaines. 
This is a most beneficent provision of Nature whereby the normal 
food of the young infant is kept in a wholesome state while un- 
dergoing digestion and absorption in the intestine. 
The Special Value of Milk Proteins. 
Milk is of special value in the dietary of human beings be- 
cause of the fact that its protein is of very superior value. It is 
not only complete, but is capable of supplying all the elements re- 
quired for building or repairing the living structures of the body, 
and is so rich in certain essential elements that it is able to make 
good the deficiencies in cereals and vegetables. In other words, 
the proteins of milk may be regarded as super-complete. Ex- 
periments have shown (Caspari) that milk protein is superior to 
meat protein. 
It is evident, then, that milk is a foodstuff of high value, 
since it not only makes available to their fullest value the enor- 
mous stores of protein found in wheat, oats and other cereals, but 
is also able to completely replace flesh-foods and even eggs in the 
dietary (Sherman). 
McCollum considers milk of greater importance than meat 
in the national bill of fare and attributes to milk rather than 
to meat the physical superiority of certain meat-eating nations. 
This writer calls especial attention to the fact that meat-eating 
nations are also milk-eating. In view of this highly interesting 
result of recent scientific inquiry it is evident that the dairy 
interests of the country should be encouraged rather than beef 
and pork production. 
• In the use of milk it is important to remember that milk is a 
perfect food only for young animals of the particular species by 
which it is produced; that is, cow’s milk is exactly adapted to 
calves, goat’s milk to kids, sheep’s milk to lambs, and human milk 
to human infants. The milk of most lower animals differs very 
widely from human milk in various important particulars, especi- 432 
THE NEW DIETETICS 
ally in containing a much larger amount of protein and a smaller 
amount of sugar. It is a curious fact that the milk of the mare 
and the ass approaches very closely in composition to that of 
woman, having approximately the same amount of protein, sugar 
and of salts. The milk of mares and asses is, however, deficient 
in fat, containing only one-third as much as does woman’s milk. 
Schlossman and Moro have shown that the proteins of 
human milk and of blood are identical biologically. Says Mc- 
Collum : 
We could entirely dispense with meats without suffering any ill 
effects whatever, but if we permit the use of milk, even in the diet 
of adults, to fall much below the present consumption its effects will 
soon become apparent in our national efficiency. 
Milk Rich in Vitamins. 
Another notable quality of milk is its richness in vitamins. 
These remarkable and magic-working substances are, according 
to Funk, the discoverer, produced only by vegetables. Each plant 
produces its own sort of vitamins. The vitamins of milk are not 
produced by the cow, but are only collected by her. 
It should be mentioned, however, that the full value of milk 
is possessed only by clean milk as it flows from the cow, and not 
by milk which has been boiled or pasteurized, or doped with alka- 
line or antiseptics, which destroy the vitamins and deprive the 
milk of one of its most unique and valuable properties. 
Influence of Food of Cow upon the Vitamins of Milk. 
Every farmer knows that both the quality and the quantity 
of milk produced are influenced by the food of the cow. Scientific 
research and practical experience have developed in recent years 
the science of animal feeding to a high state of perfection. The 
up-to-date farmer knows just what and how much to feed to 
produce the most milk containing the highest percentage of 
butter fat. Richness in fat, is not, however, the quality of great- 
est importance. Of far greater significance is the vitamin con- 
tent of the milk. Recent investigations have shown that cow’s 
milk varies greatly in the amount of this most essential food 
constituent. Cows fed upon fresh grass or other fresh green food 
produce milk rich in vitamins, while the milk of cows fed on dry 
hay is deficient. Since milk is often the exclusive food of young 
infants for several months during the most critical development 
period of their lives, this becomes a matter of greatest importance. ANIMAL FOODS 
433 
Infants fed on milk from hay-fed cattle do not grow at the proper 
rate and may be dwarfed and weakened for life, not only in stat- 
ure but in other vital respects, even in the development of import- 
ant internal structures. 
Milk inspection should not stop with sanitary conditions and 
the health of the cow, but should include inspection of the cow’s 
food supplies with reference to the infant’s needs. Vitamins are 
produced only by plants; and if green stuffs are lacking in the 
food of the cow, they will be lacking in the milk, and the milk 
fed infant will suffer. 
The feeding of sprouted grains to cows is an excellent means 
of increasing the vitamin content of their milk. Bottle-fed babies 
always require orange or tomato juice to insure an ample supply 
of vitamin, even when fresh, unpasteurized milk is used. 
Milk Rich in Salts. 
Cow’s milk is very rich in salts, containing four times as much 
of these mineral elements as does mother’s milk. Milk contains 
more lime than is found in lime water. Note the contrast in this 
legard between milk and beef. Meat supplies only half a grain 
of lime to the pound, although containing twice as large an 
emount of solids as does milk. The reason for this is obvious. 
Milk is a substance provided by Nature as an exclusive food 
for a growing animal, and so must furnish lime for the bones as 
well as protein for the muscles. Meat represents but a fraction 
of the original foodstuff. When corn or other food is eaten 
by an ox the several elements are separated, each going to form 
its own tissues—fat to fat, muscle to muscle, and lime to the 
bones. So to get back the whole assortment of food principles 
fed to an animal one must eat its entire body, the whole ox, 
or the whole hog, bones and all. This being impossible,* kind 
Nature has supplied us in milk with bones, muscles, brains, 
r erves, every bodily structure in solution and in attractive form. 
Milk, in other words, is liquid flesh and bones with the tissue 
wastes, putrefaction products, parasites and other objectionable 
features left out. 
The Lime Content of Milk and Cheese. 
This group of foodstuffs is of unrivaled value as a source of 
food lime. All dairy products with the exception of butter are 
very rich in salts of lime. Pure fat is, of course, free from lime, 434 
THE NEW DIETETICS 
which is chiefly associated with the protein or casein of the milk. 
But butter is not pure fat. It retains a portion of the buttermilk 
and so has a small lime content, which is, however, too insignifi- 
cant to deserve consideration in the planning of a balanced bill 
of fare. 
Milk, in some form, is one of the most convenient and re- 
liable of all sources of food lime. Whole milk contains three- 
quarters of a grain of lime to the ounce. This is only half the 
amount found in almonds and filberts; but while these nuts can 
be utilized only to the extent of a few ounces daily, the milk 
intake may be raised to several quarts. 
A pint of milk contains 12 grains of food lime of finest 
quality and 20 ounces of whole milk will supply a whole day’s 
ration of food lime. Skimmed milk is a little richer in lime than 
whole milk, a fact which in itself condemns the very common 
waste of skimmed milk in connection with creameries. Consider- 
ing the great lack of lime in the national dietary it is a serious 
question whether the feeding of skimmed milk to domestic ani- 
mals should not be discontinued. The 87,000.000,000 pounds of 
milk produced annually in this country contain lime enough to 
supply 200,000,000 persons. 
We are rapidly becoming a toothless nation because of the 
lack of lime in our national bill of fare. This deficiency may be 
easily made up by the proper utilization of our dairy products 
and a suitable selection of foodstuffs. Cattle and hogs can easily 
obtain their lime from grass and other foodstuffs, to the utiliza- 
tion of which their digestive organs are specially adapted, so that 
they can consume the large bulk necessary. 
In the use of milk, man adapts to himself the choice lime 
salts which the mother cow has laboriously garnered from the 
fields and meadows and prepared in concentrated form for the 
feeding of her calf. Associated with the lime in whole milk is 
found also a choice collection of vitamins which promote growth, 
so that milk not only furnishes the material needed for building 
and maintaining the body frame work, but supplies an activating 
hormone which insures the proper utilization of the building 
material at hand. 
It is interesting to note that a tablespoonful of milk supplies 
nearly the same amount of lime as an egg yolk, while a little 
more than half a pint of skimmed milk (9 ounces) supplies as 
much lime or bone building material, as a dozen eggs. ANIMAL FOODS 
435 
While skimmed milk contains more lime than whole milk the 
vitamin content is much less, a large portion being held in solution 
by the butter fat which has been removed. But the chief values 
of milk are left after the fat has been removed, and the great 
economic waste and physiologic damage which have resulted from 
the past failure to utilize this by-product of our great dairy in- 
dustry should be stopped as speedily as possible. 
Buttermilk has a lime value almost equal to that of whole 
and skimmed milk, a pint and a half affording a full day’s supply 
of lime. Sour milk commonly sold as buttermilk and under vari- 
ous trade names is fermented or soured skimmed milk and hence 
has the same lime content as skimmed milk. 
Cream is not by any means the equivalent of milk as a source 
of lime. An ounce of cream contains only two-thirds as much 
lime as the same quantity of whole milk. Nearly a quart of cream 
is necessary to supply a day’s ration of lime on account of the 
larger amount of fat present. 
But it is in cottage cheese that we find the richest and 
readiest means of increasing our lime intake. The solids of milk 
constitute one-eighth of its bulk and weight. Consequently, the 
elimination of the greater part of the water in the process of 
cheese making results in a great concentration of the lime content. 
Ordinary cheese has a lime content of 5.7 grains per ounce, or 
eight times the amount in whole milk, more than any other food- 
stuff. An ounce of average cheese supplies as much lime as 
seven yolks or five entire eggs, five pounds of beefsteak, or half 
a peck of potatoes. 
Old cheese is not easily digested by many persons. The 
butyric acid which it contains in considerable amount when old 
and strong, excites the gastric glands to secrete an excess of 
hydrochloric acid, and so gives rise to heartburn, a common 
symptom following the free eating of cheese. There are in old 
cheese various more or less toxic products, the result of the activi- 
ties of the numerous molds, yeasts and germs which co-operate in 
the production of cheese, to say nothing of the “mites,” “skip- 
pers” (maggots) and other scavengers which are usually found in 
“ripe” specimens of cheese. 
In view of these discouraging facts, it is pleasant to find that 
the simple cottage cheese which the farmer’s wife prepares on 
short notice in her own kitchen from the well skimmed sour milk 
of her milk house, possesses all the good qualities of ordinary 436 
THE NEW DIETETICS 
cheese while free from all its objectionable features. The only 
inconvenience is that it must be freshly prepared unless kept in 
an ice box. Cottage cheese supplies 4.2 grains of lime per ounce, 
and hence three and three-fourths ounces of cheese will furnish 
a day’s lime ration. 
Yogurt cheese, a cream cheese prepared by a process modi- 
fied by the writer from that employed in making the famous 
eamembert cheese, omitting the green mold and using pure cul- 
tures of the B. acidophilus, has all the advantages of cottage 
cheese and will keep for months if in a cool place. This dairy 
product is a complete and satisfactory substitute for ordinary 
cheese for all but those who have developed a connoisseur’s appe- 
tite for the putrescent aromas of limburger and gorganzola. 
Even whey, a by-product of cheese making which usually 
goes down the sewer, possesses no mean value as a source of 
nutritive lime salts. There are in the whole category of food- 
stuffs few, in fact, which are so rich in lime as is whey, which 
contains more than one-fourth grain to the ounce. The lime con- 
tent of whey is greater than that of any cereal, three times as 
great as that of egg whites, and four times as much as that of 
cornmeal or rice. A large glassful of whey contains as much 
food lime as a large serving of rice. The same amount of whey 
contains as much lime as two pounds of beefsteak and a pint is 
equal in lime content to two-thirds of a dozen eggs. Three pints 
a day, taken as a beverage in place of beer, for example, would 
supply nearly a day’s lime ration, as much as would be furnished 
by a fifty gallon cask of beer. 
The Iron Content of Milk* 
The milk of all animals is notably deficient in iron. The milk 
of woman contains only a trace of iron for the reason that in 
human infants, as well as in the young of all animals that have a 
comparatively long nursing period, iron is before birth stored up 
in large amount in the liver. The liver of the new born child con- 
tains iron enough to furnish an adequate supply for blood-making 
until the appearance of teeth enable it to make use of iron-con- 
taining foods. The same is true of the calf. It is to be noted, 
however, that in the case of the calf the possession of teeth en- 
ables the young animal to begin securing supplies of iron from 
other sources than its maternal food within a few days after its 
birth. On this account cow’s milk contains but a very small pro- ANIMAL FOODS 
437 
portion of iron, less than one thirtieth of a grain to the quart, or 
one-third as much as breast milk. 
Evidently milk is a food naturally adapted to very young 
animals whose livers are able to supplement the iron of the food 
intake. An adult fed upon milk exclusively soon becomes anemic 
because of the exhaustion of his small reserve store of iron. It 
is not possible to obtain a full ration of iron from milk alone 
without taking a great excess of food. An ounce of milk con- 
tains less than half of one per cent, of a day’s ration of iron (0.47 
per cent.), so that more than thirteen pints, or six and one-half 
quarts of milk are barely sufficient to furnish one day’s iron 
supply. This represents a food intake of 4,400 calories, or nearly 
twice an ordinary day’s ration. For this reason, milk feeding 
should always be accompanied by an abundant supply of green- 
stuffs and fruits rich in iron but with a small food value, such as 
spinach and other greens. 
When man lived in his normal primitive state, subsisting 
upon his natural or biologic bill of fare, there was no occasion 
for the use of milk by adults. Everything he needed was sup- 
plied to him by the vegetable kingdom, as is still true respecting 
some primitive forest-dwelling men; but in his present artificial, 
so-called civilized state man has so far departed from his normal 
environment and has changed and denatured his food supply to 
such an extent that his diet has become deficient in many par- 
ticulars and dangerously unbalanced. This situation has created 
a pressing need for certain things which are found in milk in rich 
abundance, especially lime, complete protein, and growth stimu- 
lating vitamins. Hence, notwithstanding its deficiency in iron, 
cow’s milk and dairy products are highly important articles of 
food and render invaluable service in balancing the bill of fare 
by contributing essential salts and vitamins which the cow collects 
from the wild grasses of the pasture and other foodstuffs rich in 
lime and vitamins. 
Fresh cream cheese and cottage cheese contain nearly four 
times as much iron as does milk, and thus, when freely used, make 
a distinct contribution to the iron intake. 
Dried Milk. 
Milk powder, or dessicated milk, consists of either whole 
milk or skimmed milk which has been reduced to a powder by 
removal of the water content by either one of several processes. 438 
THE NEW DIETETICS 
The best process devised up to the present time consists in forcing 
the milk, in the form of a fine spray, into a heated vacuum cham- 
ber. The water contained in the minute droplets of milk is at 
once vaporized, leaving the solids to fall to the bottom in the 
form of a fine powder. The addition of water to powdered milk 
in the proportion of one part of milk to seven or eight parts of 
water restores the milk to a condition almost identical with that 
of fresh milk. 
Dried milk possesses all the nutritive properties of fresh milk 
except that it is deficient in the scurvy-preventing vitamin, and 
so should be supplemented by orange or tomato juice. 
The experiments of Chick and others have shown that the 
value of the antiscorbutic vitamin of milk is reduced at least 
one-half by drying, twice as much dried milk as raw milk being 
required to prevent scurvy in guinea pigs and monkeys. 
Cream. 
Cream consists of the fat of the milk with a certain propor- 
tion of casein and a small amount of salts and milk sugar. The 
fat of cream is in a state of emulsion and for this reason more 
readily mixes with the digestive fluids and is usually more 
quickly digested than is butter, oils or other animal or vegetable 
fats. 
Butter. 
Butter is the most important of all the animal fats. It is 
superior to vegetable fats in the fact that it is rich in vitamins 
which are derived from the milk. Vitamins are for the most part 
absent from vegetable fats. They are sparingly found in olive 
oil, cotton-seed oil, corn oil, peanut oil, and are absent in lard 
and found only to a small extent in other animal fats, with the 
exception of cod liver oil, owing to the fact that vitamins are 
stored in the animal body in the liver, kidneys and other glands. 
Cod liver oil contains vitamins, which at last explains the benefit 
long and widely attributed to this special oil in cases requiring 
improved nutrition. It is to be noted, however, that ordinary 
cream and butter possess all the advantages of cod liver oil in 
this particular besides being palatable instead of repulsive. When 
oleomargarine, nut margarine, vegetable oils or any other fat is 
used as a substitute for butter, free use should be made of milk 
to make certain that the body receives daily the due supply of ANIMAL FOODS 
439 
vitamins, without which all the vital processes will languish and 
grave diseased conditions, which may even lead to death, are 
certain to follow. 
Butter Color. 
Good butter has a natural and decided yellow color. There 
is reason for believing that pale butter, which requires the use of 
annatto or some other coloring matter to give it the usual color, 
is lacking in vitamins, since Stenback and Bontwell have shown 
that the fat-soluble A vitamin, the absence of which gives rise to 
rickets, is often, if not always, associated with the yellow color 
found in yellow corn, carrots and green herbage. 
The milk of cows contains more butter in the winter than in 
the summer, but winter butter is pale because winter food is 
largely lacking in the yellow pigments, carotin and xanthophyll, 
which abound in meadow grass, in which the pigments are asso- 
ciated with chlorophyl. 
Cheese. 
Recently-made cheese, particularly cream cheese and cottage 
cheese, is wholesome food. The so-called ripening of cheese in 
no way improves it, but rather develops objectionable qualities. 
The ripening process is carried on by* means of molds, yeasts and 
bacteria which are present in the milk or added to it in the pro- 
cess of manufacture. Cheese cannot be made from sterilized 
milk without the addition of bacteria. Fresh cheese, particularly 
cottage cheese, is a valuable addition to the dietary as a source of 
lime. As a rule, the food contains a sufficient amount of protein 
without the addition of cheese, even in the absence of meat, but 
lime is very frequently deficient and may be conveniently added 
in the form of cottage cheese. Four ounces of cottage cheese will 
supply a day’s ration of food lime. 
Cheese Bacteria* 
Professor Adametz made some years ago an interesting 
study of cheese, in which he identified 19 varieties of bacteria 
which are ordinarily active in the ripening of various sorts of 
cheese. Some of these bacteria are furnished by the milk, others 
are derived from the vessels in which the milk is kept, still others 
from the air and from the rennet ferment added to the milk in 
the process of cheese making. In certain cases molds or other 440 
THE NEW DIETETICS 
fungi are added, as in the case of camembert cheese. Adametz 
estimated the number of bacteria in cheese to be about 25,000,000 
germs to the ounce. Roquefort cheese is made by adding to the 
curd of milk mold from a dough made from barley flour, with 
which yeast and sometimes vinegar have been mixed. The mold 
which forms on this dough when allowed to stand is rubbed into 
a powder and added to the milk. Gorgonzola and Stilton cheese 
are made by the same process. The mold consists of several 
varieties of fungi, one being the common green mold frequently 
found in bread and other food kept in warm moist places. Ein- 
horn has shown that molds sometimes take up their abode in the 
stomach, form colonies on the mucous membrane, and thus be- 
come a cause of grave disease. 
Cream or cottage cheese, when freshly made, is more whole- 
some than meat and more nutritious. According to Williams, 20 
pounds of cheese contain as much nutrient as the carcass of a 
sheep weighing 60 pounds. Cheese contains both more fat and 
more protein than beef and less than half as much water. The 
energy value of an ounce of cheese averages about 135 calories, 
while that found in an ounce of porterhouse steak is 70. Even 
cottage cheese made from skimmed milk has more than half the 
food value of a round or sirloin steak of the same weight. Cheese 
is also rich in all the essential vitamins, which are lacking in meat, 
and contains a rich store of food lime, which is almost altogether 
absent in meat. The dietary of the average American will be 
greatly improved by discarding meats and substituting cottage 
cheese or cream cheese. 
Since the ripening process in cheese-making is really a pro- 
cess of decomposition due to the action of bacteria, yeasts and 
molds, all ripened cheese contains considerable quantities of de- 
composition products. 
Examination of a limburger cheese in the bacteriological lab- 
oratory of the Battle Creek Sanitarium (Roderick), showed 18,- 
000,OCX) bacteria per gram (540,000,000 per ounce). The bacte- 
riologist noted that the bacteria were of the same character as 
those found in the human intestine. 
Indol is usually found in limburger cheese and may occur in 
camembert cheese. Carbolic acid, a common product of putrefac- 
tion, is found in limburger. The older the cheese, that is, the 
longer the “ripening” process has continued, the larger the amount 
of toxic products present. During the early stage of the ripening, ANIMAL FOODS 
441 
the growth of putrefactive organisms is prevented by the presence 
of milk sugar, but this disappears after the first few days as the 
result of the action of lactic acid bacilli upon lactose, and the 
decomposition changes in the milk protein, or casein, to which 
the softening of the cheese is due, proceeds at a rate depending 
upon the temperature to which the cheese is exposed. 
Ordinary cheese, especially old cheese, such cheeses as cam- 
embert, roquefort, limburger and other varieties of highly flavored 
well-ripened cheese, are wholly unfit for human food and are 
positively dangerous for use by persons suffering from diseases of 
the liver or kidneys. It should be remembered that every person 
suffering from disease of the gallbladder or who has had one or 
more attacks of jaundice, has a more or less damaged liver. In 
fact, in all cases of chronic intestinal toxemia, the integrity of 
the liver is more or less impaired. 
A person with sound digestion and a liberal supply of gastric 
juice may be able to eat a moderate amount of cheese with im- 
punity, but persons suffering from achylia, and hence lacking the 
protective, disinfecting influence of the gastric juice, and even 
healthy persons who eat very freely of well-ripened cheese, are 
likely to suffer from intestinal autointoxication. The bacteria 
present in the cheese find in the intestine conditions favorable for 
development and by their rapid growth may give rise to diarrhea 
and even symptoms resembling cholera morbus. The writer has 
encountered several cases of this sort, one of which ended fatally. 
Skimmed Milk, 
Milk which has been skimmed, especially separated milk, has 
been deprived of one of its most precious constituents, a highly 
valuable fat. Butter fat as present in milk is in a state of fine 
emulsion, a condition which greatly aids its digestion and assim- 
ilation, and contains a very precious vitamin, fat-soluble A, or 
antirachitic (anti-rickets) vitamin. 
The suggestion of some writers that skimmed milk may be 
used in place of full milk as a measure of economy, provided that 
margarine or some other fat replaces the fat removed, is bad 
advice. Skimmed milk has a considerable nutritive value, but it 
lacks the growth-promoting power of full, fresh milk, and on this 
account cannot wholly take its place. When skimmed milk is 
used, it should not be used as a substitute for full milk but as an 
addition to the regular daily supply of full milk which every child 442 
THE NEW DIETETICS 
should have. It may also be used as an added source of lime 
salts. It may be employed in cooking as in the preparation of 
bread, puddings, etc. 
Skimmed milk may be used without detriment in connection 
with a liberal supply of butter. Used in this way, the skimmed 
milk now thrown away or fed to pigs, if fed to human beings, 
would be worth more to the country than all the meat produced 
by the live stock industry. 
Canned Milk. 
Sekina, in experiments on white mice, found that canned 
milk in time gave rise to anemia and beri-beri. The mice did well 
for 100 days, then rapidly failed. The addition of iron and the 
water-soluble vitamin quickly restored them to the normal condi- 
tion. Canned milk and condensed milk are thus shown to be un- 
suited to serve as staple foods for infants because of the lack of 
iron and the water-soluble B. 
Canned milk may be advantageously used in connection with 
other foodstuffs as a source of complete protein, but should never 
be used as the chief food for any length of time unless supple- 
mented by orange or tomato juice to supply vitamins and puree 
of spinach to furnish food iron. 
TABLE XL. 
Average Percentage Composition of Condensed Milks (Mohan). 
Solids 
Ash 
Fat 
Protein 
Lactose 
Cane 
sugar 
Per 
Per 
Per 
Per 
Per 
Per 
cent. 
cent. 
cent. 
cent. 
cent. 
cent. 
Condensed whole milk 
. 72.6 
1.6 
10.0 
8.0 
12.0 
41.0 
Condensed skimmed milk... 
. 70.0 
2.0 
1.0 
10.5 
14.5 
42.0 
Evaporated milk 
. 26.3 
1.6 
7.9 
7.7 
9.1 
Whole milk powder 
. 96.3 
5.6 
26.8 
32.0 
31.9 
Skimmed milk powder 
. 91.7 
6.9 
1.7 
33.8 
49.3 
Cane sugar to the amount of 16 to 19 pounds is usually 
added to 100 pounds of raw milk. The condensing is done by 
heating for about 2 hours at 140° F. Condensed milk contains 
too much cane sugar to be suitable for use as an infant food. 
Buttermilk. 
Buttermilk and sour milk have essentially the same composi- ANIMAL FOODS 
443 
tion. The sour flavor is produced by harmless lactic acid-forming 
bacteria. Buttermilk contains essentially everything which whole 
milk contains except the fat, which is reduced to about one-fourth 
of the ordinary amount. Buttermilk is more easily digestible than 
sweet milk. The acid-forming bacteria found in ordinary sour 
milk are of no particular value in changing the intestinal flora 
for they are unable to live and grow in the intestine. When but- 
termilk is desired for correcting biliousness or changing the intes- 
tinal flora, it should be prepared with the B. acidophilus. A quart 
or better, three pints of acidophilus buttermilk taken daily for a 
week or two will usually produce a marked change in the char- 
acter of the stools, causing the disappearance of the putrid odors 
through the suppression of putrefactive processes in the intestine. 
Buttermilk ice cream is greatly to be recommended in place 
of ordinary ice cream. It contains but a small proportion of the 
fat found in ordinary ice cream and hence is much more easily 
digestible. Buttermilk ice cream is also practically free from any 
danger of tyrotoxicon poisoning, which occasionally occurs from 
ice cream made in the usual way. 
Whey. 
The fluid residue left in the process of cheese making con- 
tains the milk sugar and much of the mineral matters of the milk, 
the casein or protein and fat having been removed. Whey is also 
rich in vitamins. It may be freely used to great advantage by 
persons who have long subsisted upon a dietary insufficient in 
lime. The composition of whey is as follows (Hutchinson) : 
Water 93.64 per cent. 
Protein 0.82 per cent. 
Fat 0.24 per cent. 
Milk sugar 4.65 per cent. 
Mineral matters, lime, etc 0.64 per cent. 
The whey cure has long been practiced at various health re- 
sorts in Europe. The whey is not used alone, but in connection 
with other foodstuffs, particularly with a mixed diet from which 
flesh foods are largely excluded. The patient usually begins by 
taking a tumblerful of whey night and morning. The amount is 
increased from day to day until 10 tumblerfuls are taken daily. 
The whey is taken either warm or cold, plain or aerated. It is 444 
THE NEW DIETETICS 
recommended by Gautley as a substitute for milk in feeding 
typhoid fever patients. The caloric value of whey is small, only 
7 calories per ounce. By the addition of malt sugar or cereals, 
the food value of whey may be increased to any desirable extent. 
By adding 3 ounces of malt sugar or lactose to a pint of whey, 
the energy value is increased to 25 calories to the ounce, or 400 
to the pint, a good carbohydrate food. 
Modified Milk. 
When employed in the artificial feeding of infants and in 
very many cases in the feeding of invalids, cow’s milk must be 
modified. Ignorance of this fact and of the proper method of 
feeding milk is responsible for the death annually of a great 
multitude of artificially fed infants. Of the 2,500,000 infants 
born in the United States annually not less than 250,000 die as 
the result chiefly of improper feeding. The mortality of bottle- 
fed infants is more than four times that of breast-fed infants. 
Cow’s milk differs very decidedly from mother’s milk. It con- 
tains four times as much lime and three times as much protein 
and only two-thirds as much sugar. Protein and fat are the 
elements of cow’s milk which are the greatest source of trouble to 
the human infant. 
Cow’s milk contains a large amount of protein and lime to 
support the rapid growth of the calf which attains puberty at 
the end of two years, about one-seventh of the time required for 
the human infant to reach the same stage of development. 
Various formulas have been devised and recommended for 
the modification of cow’s milk in artificial feeding. The most of 
these are more or less complicated. Recent experience has shown 
that a very simple method is much superior to the complicated 
measures which have been developed. It is only necessary to add 
two things, water and milk sugar or malt sugar, to render cow’s 
milk suitable for the use of very young infants. A good formula 
is equal parts of full milk and boiled water with an ounce of malt 
sugar for each pint of water added to the milk. 
Milk Must Be Clean. 
The chief reason assigned for the pasteurizing or sterilizing 
of milk is the presence in the milk of large or small quantities of 
filth which should have been left in the stable or the barnyard. 
Combe and others have shown that the germs associated with this ANIMAL FOODS 
445 
putrefying filth are the most prolific source of diarrheas and 
other intestinal disorders which annually carry off so many thou- 
sands of infants during the summer months. These same putre- 
factive germs are likewise the cause of intestinal toxemia or auto- 
intoxication. 
As received from the cow, milk may or may not contain 
bacteria. In general, the milk of a healthy cow, if removed from 
the animal with sufficient care, will be found to be absolutely 
free from bacteria and if put into a proper container will keep 
without spoiling for an indefinite period. Certified milk must 
contain less than 10,000 bacteria to the cubic centimeter (about 
one-fourth of a small teaspoonful). Ordinary commercial milk 
contains from 100,000 to several million bacteria to the cubic 
centimeter and is absolutely unfit for use. The number of bac- 
teria found in milk rapidly increases. For example, in a speci- 
men of milk examined 24 hours after milking the number of 
bacteria had increased from 100,000 to 5,600,000. 
By the exercise of sufficient care in dairy management the 
number of bacteria count may be kept below 1,000, and such 
harmful bacteria as Welch’s bacillus, and other putrefactive or- 
ganisms, as well as the specific organisms of typhoid, tubercu- 
losis and other infectious organisms may be pradtically excluded. 
The cost of clean milk will, of course, be greater than the dirty 
product now offered to the public; but the superior value of 
clean milk will far more than balance the extra cost. The model 
dairy of the Battle Creek Sanitarium has for years demonstrated 
the practicability of producing clean milk on a large scale at a 
reasonable cost. In this the bacterial count is often kept below 
1,000 even in summer weather. 
Sour Milk. 
The souring of milk is due to the development of lactic acid 
through the growth of acid-forming bacteria. There are many 
varieties of acid-forming bacteria which readily find access to 
milk, and as they grow rapidly at ordinary temperatures milk 
will naturally sour within a few hours after milking unless the 
temperature of the milk is at once lowered to a point at which 
the growth of the bacteria is prevented. 
The B. acidophilus is a special acid-forming organism which 
not only grows and thrives in milk but is also able to live in the 
colon of animals. This is known to be true of the B. acidophilus, 446 
THE NEW DIETETICS 
which is by some thought to be a variety of the B. bulgaricus. It 
is for this reason that buttermilk prepared with the B. acidophilus 
is to be preferred to ordinary buttermilk since ordinary butter- 
milk or sour milk germs will not grow in the colon and hence are 
of no value in combating putrefaction. 
Bitter Milk. 
The bitterness of milk may be due to the fact that the cow 
has eaten substances having a bitter flavor. A bitter flavor also 
results from changes in the milk produced by certain germs. Such 
milk should be rejected. 
Sfimy and Colored Milk, 
Slimy or ropy milk owes its peculiarity to the growth of a 
special micro-organism which causes viscosity. 
There are various germs which color the milk through the 
production of characteristic pigments. 
Bacteria on Milk Bottles, 
The city health department of Baltimore, Maryland, made a 
study of the bacteria deposited on the caps and rims of milk 
bottles. In the handling of milk bottles by milk distributors and 
their exposure to city dust in milk wagons and while waiting 
upon doorsteps to be taken in, germs of various sorts, some dan- 
gerous to life, are deposited in considerable numbers. Germs, 
even very dangerous germs, are sometimes conveyed to the lips of 
milk bottles by the hands of milkmen. Other germs, such as 
typhoid and dysentery germs, are deposited by flies. Contamina- 
tion may occur through contact of animals with milk bottles. 
Cats and dogs often lick the mouths of milk bottles while standing 
on the doorstep. 
The examinations made of numerous milk bottles showed 
various sorts of dangerous germs and indicated that there is a 
real risk in the use of milk from containers in themselves thor- 
oughly clean and sanitary. The milk becomes contaminated by 
contact with the lip of the bottle when it is poured from the 
bottle. The cap and lip of the milk bottle should be very care- 
fully wiped with a cloth dipped in boiling water or peroxide 
of hydrogen before the milk bottle is opened. The importance of 
doing this should be known to every housewife and should never 
be forgotten. ANIMAL FOODS 
447 
Infections Due to Unclean Milk. 
Milk must be free from the germs of disease. In addition to 
the common organisms which give rise to putrefaction and with 
which the milk becomes contaminated through careless dairy 
methods, milk may contain germs of various specific diseases such 
as tuberculosis, typhoid fever, diphtheria, scarlet fever, sore 
throat, Malta fever—maladies originally derived from human 
beings suffering from the above named disorders and with the 
germs of which the milk, by direct or indirect contact, becomes 
contaminated. 
Milk may also communicate to human beings various dis- 
orders which originate in cattle, but which may be communicated 
to human beings by making use of the milk of sick animals, such 
as foot and mouth disease, milk sickness, gastroenteritis, anthrax, 
cowpox, rabies, actinomycosis and perhaps other maladies. 
Infected Milk a Cause of Tuberculosis* 
Modern research has shown that bovine tuberculosis is com- 
municable to human beings. According to Rosenau, it must be 
conceded that not less than 5 to 7 per cent, of all cases of human 
tuberculosis are due to infection from the use of infected milk or 
the flesh of tuberculous animals. 
A careful examination of the mortality tables published by 
the United Bureau shows that not less than 3,000 
children die annually as the result of infection with bovine tuber- 
culosis, not less than 60,000 children are constantly suffering 
from bovine tuberculosis contracted chiefly through the use of 
diseased milk. 
The New Jersey Tuberculosis Commission found 16 per cent, 
of the dairy cattle in that state suffering from tuberculosis. In 
some parts of Germany 30 per cent, of all cattle were found to be 
infected with this disease. An investigation made of the milk 
supply of the District of Columbia showed that 15 to 25 per cent, 
of all the cows furnishing milk to that community were infected. 
Tubercle germs are not readily killed by dairying processes. 
Schroder killed guinea pigs by infection with germs found alive 
in butter five months after it was churned. Tubercle germs have 
been found in great numbers in cheese and ice cream. Morgen- 
roth even found tubercle germs in 9 out of 28 samples of oleomar- 
garine purchased in the open market. 448 
THE NEW DIETETICS 
Injurious Effects of the Sterilizing 
or Pasteurizing of Milk. 
The public has been taught to place too much faith in ster- 
ilized or boiled milk. It is true that pasteurization or boiling of 
milk destroys certain specific disease-producing organisms such 
as those of typhoid fever, tuberculosis and diphtheria, but these 
processes at the same time destroy certain highly essential, vital 
properties of milk, and as has been long known, fail to destroy 
the spores of putrefactive organisms, which probably are, on the 
whole, the cause of far greater mischief and many more deaths 
than the organisms which give rise to tuberculosis, typhoid fever 
and other specific organisms. If left to itself, cow’s milk does not 
decay but sours. Boiled milk rots. The acid-forming organisms 
which find their way into the milk from the air thus exercise a 
protective influence, preventing the toxemia which results from 
intestinal putrefactions. When an infant is fed upon sterilized 
milk, the stools, which are naturally slightly acid, quickly become 
foul smelling through putrefaction and the infant is thus exposed 
to highly potent disease-producing influences against which it is 
protected when fed upon natural, clean milk. A temperature of 
240° F. for half an hour is required to destroy the spores of put- 
refactive germs and even such milk is likely to promote putrefac- 
tive processes in the intestine, especially in the case of young 
children. It is thus apparent that pasteurization and boiling of 
milk should be regarded only as makeshifts which mitigate to 
some degree the evils resulting from the use of milk contaminated 
with barnyard filth. The movement to provide certified milk 
should be everywhere encouraged. 
Whenever pasteurized or sterilized milk is used, free use 
should be made daily of orange juice, tomato juice, potato soup 
or some other foodstuff rich in vitamins. 
The boiling of milk modifies in a harmful way nearly all its 
ingredients and considerably reduces its nutritive value. Rats 
fed on boiled milk grow to only half their normal size. 
Scurvy sooner or later appears in babies exclusively fed on 
pasteurized or boiled milk. The subtle alchemy by which milk 
is prepared in the laboratory of Nature is upset by the crude 
process of cooking. Boiled milk will sustain the life of rats but 
it will not enable them to grow to full development, and repro- 
duction fails altogether. ANIMAL FOODS 
449 
Another defect of the pasteurizing process is found in the 
fact that it is not absolutely certain. Cases of tuberculosis have 
occurred in calves fed on the pasteurized milk of tuberculous 
cows. 
Another matter of much significance which must be borne in 
mind in relation to pasteurized milk is the rather surprising fact 
that, if not handled with very great care, pasteurized milk is 
likely to develop within a short time more bacteria of a dangerous 
type than are found in ordinary raw milk. The reason for this 
is that most of the bacteria found in ordinary raw milk are of 
the acid-forming sort; that is, they are of the kind commonly 
known as buttermilk or sour milk germs, so-called friendly or 
protective germs. So long as these bacteria are dominant, the 
growth of putrefactive organisms is prevented. 
Boiling, if thoroughly done, may destroy the germs of 
typhoid, tuberculosis, and other infectious diseases. It does not, 
however, destroy the spores of the germs which produce putre- 
faction and consequently, if boiled milk is allowed to stand for a 
few days these undestroyed spores develop and putrefactive 
changes take place. 
It should be noted, also, that in the boiling of milk the germs 
which produce souring are destroyed. Consequently boiled milk 
is less likely to sour than unboiled, but instead may undergo 
putrefactive changes, and the same thing that happens in the 
laboratory test tube or the milk bottle may happen in the intes- 
tine ; that is, boiled milk is more likely to undergo putrefaction 
in the intestine than is raw milk. 
Among the numerous dangerous organisms derived from 
stable filth and found in unclean milk is the highly virulent 
Welch’s bacillus, the cause of gas gangrene. Estey found this 
germ present in all but two of a large number of samples of 
market milk obtained in Providence, Rhode Island. It is often 
present in commercial milk. 
In a recent bacteriological study of milk, Roderick of the 
Battle Creek Sanitarium laboratory found Welch’s bacillus pres- 
ent in 54 per cent, of 470 specimens of commercial milk examined. 
This dangerous germ being a spore bearer is not destroyed by 
pasteurizing or even by boiling. Scrupulous care in dairy practice 
is the only possible protection against this highly dangerous organ- 
ism against which every housewife should be warned. 
It is evident that pasteurization does not solve the milk prob- 450 
THE NEW DIETETICS 
lem. When scientifically done, pasteurization does mitigate some 
of the evils associated with unclean milk but the only true solu- 
tion for the problem is clean milk. 
It is also known that boiled milk is less easily digestible than 
raw milk. Hence it is important to emphasize the fact that milk 
should be produced in such a way as to be in the highest degree 
possible free from bacteria and other impurities of every sort. In 
an experiment in feeding of calves with boiled milk between 80 
and 90 per cent, of the calves died, and there can be no doubt 
that thousands of human infants have lost their lives from the 
same cause. Whenever boiled or pasteurized milk is used for 
feeding infants or young children or as an exclusive diet for 
invalids, orange or tomato juice must be freely given to supply 
the deficiency of vitamin C. It is, in fact, safer to use orange 
juice for all bottle fed infants even when certified milk is used 
for the reason that raw cows’ milk is often deficient in both B and 
C vitamins. 
Buddized Milk. 
Milk may be sterilized sufficiently to keep it sweet for sev- 
eral weeks at ordinary room temperature by means of peroxide 
of hydrogen, a harmless germicide which is decomposed into 
oxygen and water. A teaspoonful of fresh peroxide to a pint of 
milk is sufficient to keep the milk sweet for a week in a cool place. 
After adding the peroxide the milk should be kept stirring and 
at a temperature of 130° F. for half an hour. It is claimed that 
this process destroys all harmful bacteria. Buddized milk has 
been used for years in the babies’ ward of a large Chicago hos- 
pital and is much used by makers of ice cream throughout the 
country. 
Certain observers claim that peroxide of hydrogen destroys 
the antiscorbutic vitamin. This being true, it is evidently neces- 
sary that if this method is employed orange juice, tomato juice, 
turnip juice, or some other antiscorbutic should be used in ade- 
quate quantity. 
Certified Milk. 
Certified milk is milk produced under special conditions 
which are calculated to insure freedom from disease and germs. 
The following are the requirements as laid down by the American 
Association of Medical Milk Commissions: ANIMAL FOODS 
451 
(a) Certified milk shall be produced by a trustworthy dairy- 
man in accordance with a code of requirements prescribed by a 
medical milk commission. The dairyman shall enter into a legal 
contract with the commission, in which he shall agree to comply with 
all its requirements. 
(b) Certified milk shall be obtained from healthy, tuberculin 
tested cows under veterinary inspection; all persons who directly 
or indirectly come in contact with the milk shall be under medical 
supervision and the milk itself shall be subjected periodically to 
bacteriological, chemical and other tests. 
(c) Certified milk shall be free from harmful germs and shall 
contain relatively few of the common bacteria. It should not contain 
more than 10,000 bacteria per cubic centimeter; this average should 
be based upon bacteriological examinations covering a period of ninety 
days, and the counts should be made at least once a week during this 
time. 
(d) Certified milk must be bottled at the point of production, 
rapidly chilled, kept cold and delivered promptly to the consumer. 
After it is once chilled, the temperature of certified milk should at no 
time go above 4S°F., or below 32°F. 
(e) Certified milk shall be normal milk; that is, neither heated, 
frozen nor altered in any way except strained and cooled. 
(f) Certified milk shall be of uniform quality and contain not 
less than 3.8 per cent, nor more than 4.2 per cent, of fat, unless it is 
labeled otherwise, in which case it shall not vary more than 0.2 per 
cent, from the amount stated on the label. 
(g) Certified milk shall not be subjected to the action of heat; 
shall not be subjected to the action of any preservative whatever 
except cold; shall not be subjected to the action of light, electricity, 
pressure, or any special force or agency of any kind for any purpose; 
no substance of any kind shall be added to the milk for any purpose; 
and no part of the milk shall be removed. 
Pastures or paddocks to which cows have access shall be: 
(a) Free from marsh or stagnant pools. 
(b) Crossed by no stream which might have easily become dan- 
gerously contaminated. 
(c) A sufficient distance from offensive conditions to suffer no 
bad effects from them. 
(d) Free from plants which affect the quality of the milk deleteri- 
ously. 
It is highly desirable that associations for the production of 
certified milk should be formed in all parts of the United States 
so that safe milk may be provided, especially for children and 
invalids. As a matter of fact, the entire milk supply of the 
country ought to be produced under certified conditions. Milk is 
wholesome only when clean, and it is to the highest degree absurd 
to accept the ordinary commercial product as it reaches the aver- 452 
THE NEW DIETETICS 
age consumer at the present time. Water containing one- 
thousandth part as many germs as are usually found in milk 
would he at once condemned as unfit for use. 
The importance of clean milk can scarcely be exaggerated 
and cannot be too strongly insisted upon. Notwithstanding all 
that has been spoken and written on this subject within the last 
25 years, the apathy of the general public in reference to the char- 
acter of the milk they use is truly amazing. This apathy and the 
ignorance of which it is the result are responsible for thousands 
of deaths annually and for an enormous amount of morbidity not 
only in infants but in older children and adults. 
The importance of thorough cleanliness as a condition of 
healthy human life is only just coming to be appreciated. During 
the long ages of savagery from which the human race has only 
recently begun to emerge, we acquired a great number of filthy 
practices which as yet we have only in part eliminated. In the 
savage state our vital resistance was so high we were able to 
maintain good health notwithstanding our intimate contact with 
pernicious bacteria of various sorts because of the high resistance 
of our tissues; but under the conditions imposed by civilized life, 
especially house dwelling and pernicious habits in eating, drink- 
ing, etc., our vital resistance has been greatly reduced; so we have 
become a prey to a great number of micro-organisms which to our 
tougher forebears of prehistoric times were innocuous. 
In very recent times we have learned the importance of clean 
water, and by applying this knowledge we have practically elimi- 
nated typhoid fever and other water-borne diseases from the 
mortality tables. The slightest taint or odor in water or the 
slightest suspicion of filth contamination leads to an appeal to 
the health authorities, and a report that the waiter submitted for 
examination contains one or two hundred colon bacteria per cubic 
centimeter will lead to its prompt condemnation as unfit for use. 
No one has ever offered any reason for believing that colon 
germs in milk are any less unwholesome than in water; and yet 
average commercial milk contains a hundred times as many bac- 
teria as would be regarded as sufficient to condemn water as quite 
unfit for use. 
The pasteurizing and sterilizing of milk certainly mitigates 
the evils of unclean milk to some degree; but it is a mistake to 
accept pasteurization as the solution of the clean milk problem. 
Pasteurization lessens the liability of tuberculous infection, but ANIMAL FOODS 
453 
this is about the only real service it renders and in this it is by 
no means 100 per cent, efficient. Dr. Schloss of the Harvard 
Medical School, from a very extended experience in connection 
with the infants’ hospital, insists that ordinary pasteurization does 
not adequately protect against tuberculosis and requires that all 
milk given to infants and young children shall be boiled three 
minutes. Mr. C. W. Barron has also demonstrated the inefficiency 
of pasteurization as a protection to calves. The only real pro- 
tection against tuberculosis must be sought in thorough and con- 
tinuous testing and inspection of dairy cattle by qualified experts. 
So far as typhoid is concerned, cases of this disease are now 
becoming so rare that protection against it is scarcely needed. 
About the only thing that pasteurization does is to destroy the 
bacteria which cause the souring of milk and so to increase its 
keeping properties. But even this has its disadvantages, for Esty 
has shown that the mischievous B. Welchii which is generally 
found in market milk does not germinate in raw milk but germi- 
nates rapidly in sterilized milk and sporulates in the intestine. 
Within two days after giving a guinea pig milk infected with B. 
Welchii spores were found in the feces. 
It is evident, then, that aside from partial protection against 
B. tuberculosis, pasteurization affords little advantage, from a 
hygienic standpoint, for ordinary milk-souring germs are not at 
all dangerous or even unwholesome, while, on the other hand, 
pasteurizing milk enables B. Welchii to germinate and multiply, 
and sometimes to such an extent as to make the milk a rich culture 
of this pathogenic organism. 
It seems to the writer high time that more attention should 
be given to the character of the bacteria of milk, rather than to 
mere numbers. The millions of acid-forming in but- 
termilk are harmless, whereas a few thousand B. Welchii are not 
only an evidence of gross contamination but also a menace to 
health since this organism easily becomes domiciled in the in- 
testine and flourishes amazingly under the anerobic conditions 
found in the colon, producing spores as well as vegetative forms. 
The dangerous character of this organism has unfortunately 
not been fully appreciated until recently. Wright, West and 
others had erroneously concluded that B. Welchii produces no 
toxin, either exo- or endo-, and this led to its being grouped 
among harmless organisms; but the researches of Bull and 
Pritchett in 1917 and the later study of the pathogenicity of the 454 
THE NEW DIETETICS 
organism by Esty (1920), have clearly shown the older views 
to be erroneous, and it is now well established that B. Welchii is 
highly pathogenic, although non-virulent strains are often met. 
Bull and Pritchett showed that B. Welchii produces a specific 
bacterial toxin which may be separated from the bacteria. This 
highly virulent toxin Esty has shown to be similar to the toxin 
of the diphtheria bacillus. 
The highly dangerous character of Welch’s bacillus will be 
recognized when it is recalled that this organism is the cause of 
gas gangrene, one of the most formidable complications of wounds 
with which the military surgeon has to contend. Experimentally, 
the organism shows itself to be highly active. So small a quantity 
of culture as 2 c.c. injected into the abdomen of a guinea-pig 
causes death from gas gangrene in 12 to 30 hours. A still smaller 
dose, 0.25 c.c. (four minims), injected into the peritoneal cavity, 
caused the death of a 607-gram guinea-pig (Esty), and 0.1 c.c. 
killed a 400-gram guinea-pig. 
As already noted, some strains of B. Welchii are not virulent. 
This fact was first pointed out by Herter, who noted that strains 
of B. Welchii obtained from the droppings of cows were less 
virulent than those from meat eating animals. Esty found of 9 
strains obtained from human sources, all were pathogenic. Of 
10 strains from the cow, 40 per cent, were pathogenic, and of 11 
strains from milk 8, or 72.7 per cent., were pathogenic. The 
conditions found in the colon of a meat eater or a mixed feeder, 
such as man, are particularly favorable for the development of 
B. Welchii. 
Observations made by Esty as regards the effects of heat 
upon B. Welchii showed that some strains survive 100° C. (211° 
F.) for 30 to 40 minutes. Roderick has confirmed these results. 
These facts show most conclusively the utter futility of pas- 
teurization which seldom exceeds 160° F., as a means of render- 
ing unclean milk safe. 
In view of these facts it is evidently important that milk 
inspection should take account of the frequency and extent of 
infection with B. Welchii. Esty found B. Welchii in nearly every 
sample of pasteurized milk examined in Providence, R. I. Rod- 
erick found B. Welchii present in 54 per cent, of 470 samples of 
market milk examined in Battle Creek. The organism is never 
found in freshly drawn milk protected from contamination. Its 
presence is wholly the result of lack of cleanliness. Most dairies ANIMAL FOODS 
455 
are badly infected with B. Welchii. Esty found the organism 
everywhere not only on all parts of the cow, but on the walls, 
ceiling and floor of barns, in the milk pails and containers, in the 
stable air and barn dust and even on the milker’s hands. That 
milk may by sufficient care be kept free from B. Welchii has been 
many times demonstrated. It is only a matter of painstaking 
cleanliness as has been abundantly shown in the experience of the 
Battle Creek Sanitarium dairy. 
The number of B. Welchii present in raw milk may be con- 
sidered, then, as a measure of the amount of filth contamination, 
while the total bacteria count is more an indicator of the rate at 
which the milk was cooled and the temperature at which it has 
been kept. Certainly it is much more important to determine the 
extent of filth contamination than of the heat exposure, for the 
reason that the bacteria which grow in raw milk are acid formers 
and not of the dangerous sort. 
The examination of milk for the presence of B. Welchii is 
not a difficult procedure. The test is a simple one. A portion of 
milk is boiled in a test tube with a little litmus solution and in- 
cubated at 37° C. for 24 to 48 hours. When B. Welchii is present 
a stormy fermentation occurs. Gas bubbles rise to the top of the 
tube, separating the masses of curd. The litmus is reddened and 
a strong odor of butyric acid is present. 
The presence of B. Welchii always means filth and should 
lead to prompt inspection of dairies, creameries and handlers 
and prohibition of sale if the contamination is not eliminated. 
That such elimination is possible is proven by the fact that this 
organism is rarely found in certified milk and then only when the 
count has suddenly gone up through some accident or neglect. 
It must be remembered, however, that neglect of prompt cooling 
will not increase the number of B. Welchii for the reason that 
practically only spores are found in milk and these do not grow 
in raw milk, the organism being an obligate anerobe. 
Interest in clean milk is heightened by the importance now 
being attached to changing the intestinal flora. As pointed out 
some years ago by Burnett, in the war against pernicious intestinal 
bacteria the chief enemy to be overcome is B. Welchii. This 
organism is always found more or less abundant in proportion to 
the intensity of the toxemia. As pointed out by Herter many 
years ago, there are two types of intestinal toxemia; the “indolic 
type” in which the dominant organism is B. putrificus and the 456 
THE NEW DIETETICS 
“butyric type,” in which B. Welchii is dominant. In the most 
severe cases, both organisms are present, forming a third or mixed 
type. 
At the outset of its independent life, nature supplies every 
mammal with a stock of acidophile organisms to keep its aliment- 
ary canal free from putrefactive processes and the resulting toxic 
products. So long as an infant receives only mother’s milk, it 
usually remains in health. Its stools are frequent, of slightly acid 
odor, free from mucus, and yellowish in color. Soon after wean- 
ing, infants fed cow’s milk begin to show symptoms of disturb- 
ance. The stools are less frequent. They often become foul 
smelling, dark colored, and show more or less mucus. These are 
the first evidences of infection with B. Welchii and allied organ- 
isms. If nothing is done to change the situation, the infection will 
steadily increase from year to year, giving rise to a succession of 
maladies and miseries of which constipation, headaches, nervous 
prostration, insomnia, skin disorders, colitis, appendicitis, rheuma- 
tism, Bright’s disease, arteriosclerosis, so-called neuritis (neural- 
gia), with manic depressive insanity, are only a few common 
examples. 
There is no way in which intestinal toxemia with all its dire 
consequences can be successfully combated except by changing the 
intestinal flora, that is, by getting rid of B. Welchii and establishing 
the dominance of acidophile organisms (B. acidophilus). This 
cannot be done efficiently so long as fresh importations of B. 
Welchii are being constantly made with the food intake. It is of 
especial importance that sick infants and children that depend 
much upon cow’s milk as well as adults who take the “milk cure,” 
must be provided with milk free from B. Welchii. 
Practically the whole population, not only of the United 
States, but of every civilized country, is suffering from the use of 
unclean milk. The bacteriologists have shown us the facts, and 
it is now the duty of the Boards of Health and milk commissions 
to inform the people by a campaign of education which will open 
their eyes to the necessity for using more milk as well as cleaner 
milk. 
A recent bacteriological examination of market meats made 
by Roderick of the Battle Creek Sanitarium bacteriological labor- 
atory showed that all meats are rich cultures of the colon group 
of bacteria. Roderick found in apparently fresh beefsteak, 1,- 
500,000 bacteria per gram; in corn beef 31,000,000; in Ham- ANIMAL FOODS 
457 
burger steak 75,000,000 and in pork liver 95,400,000. Examina- 
tion of the droppings of calves, cows, goats and horses showed 
15,000,000 to 80,000,000 bacteria of the same sort found in meat. 
That is, some meats actually contain more manure germs than does 
fresh manure. 
In view of these facts, the producer of the dirtiest milk may 
feel proud of his product as compared with that of the butcher 
and the packer. The conditions under which the dirtiest milk 
is produced are clean compared with those which exist in the 
average slaughter house. In the process of slaughtering, all meats 
are freely infected with manure germs and within twenty-four 
hours every carcass is swarming with B. Welchii and other putre- 
factive organisms, and the bacteria increase continually even in 
cold storage until the meat is eaten. 
The dairy industry rather than the packing industry needs 
encouragement. There is no other essential American industry 
so poorly paid and so much in need of and deserving of encourage- 
ment as the dairy industry. The country’s great food need at the 
present time is more milk and cleaner milk. As soon as the 
public become convinced of these facts, they will be quite willing 
to pay the higher price which clean milk will cost. Clean milk 
at a dollar a quart would be preferable to beefsteak at ten cents 
a pound. 
The accompanying cuts show the dairy of the Battle Creek 
Sanitarium, which supplies milk free from Welch’s bacillus. 
Every dairy should do the same. Our milk supply should be as 
clean as our water supply. 
A Person May Be Sensitized to Milk. 
Another point to which attention should be called in the 
interest of both infants and invalids is the fact that certain per- 
sons become sensitized to milk as well as to other forms of pro- 
tein, and in a person who is sensitized even the smallest amount 
of milk may give rise to dangerous or even fatal symptoms. 
Many infants die annually from this cause. This fact should be 
borne in mind in changing the infant from the breast to bottle 
feeding. The milk should first be given in very small quantities, 
a teaspoonful in a half glass of water, the proportion being 
gradually increased until the proper dilution is reached. The 
same method should be pursued with individuals who have 
learned by experience that unpleasant symptoms are noted after 458 
THE NEW DIETETICS 
the use of milk. The adult or infant who is sensitized to milk 
may be cured by the administration of milk in graduated propor- 
tions, beginning with extremely small doses. Such a case re- 
quires the personal care of a physician. 
According to Weill, of Paris, the intolerance for milk shown 
by infants and many adults may be overcome by the hypodermic 
injection of milk. The first dose should be very small, eight or 
ten drops. At the end of an hour, four times this dose may be 
administered, and three hours later, ten times the original dose. 
The milk should be sterilized by boiling fifteen or twenty minutes. 
Another method which has been employed with success is to 
take the milk in graduated doses, beginning with very small 
quantities, say a teaspoonful or even half as much, diluted with 
water. In the course of a few weeks the amount may be increased 
to half a glassful or even a glassful at each meal. Another 
method is to take a small quantity of milk, say one or two tea- 
spoonfuls, half an hour or an hour before a meal at which a 
larger quantity of milk is taken. 
Medical Uses of Milk. 
Milk is not only useful as a nutrient for healthy persons, but 
by proper management, may be made to play a highly important 
role as a curative agent. For example, there is no better means 
of inducing a rapid gain in flesh than by milk feeding. There 
are many other medical uses of milk in the form of the milk 
regimen. The free use of milk is especially useful to cure as well 
as to prevent lime starvation. 
How to Eat Milk. 
Milk must be eaten, not swallowed as a beverage. It must 
be chewed. All foods need to be masticated. The calf and the 
nursing infant chew the milk which they draw from the maternal 
font. The movements of the jaws and the sucking movements 
executed by an infant in nursing induce an abundant flow of 
saliva which, mixing with the milk, properly dilutes it and to a 
high degree promotes digestion. Milk when swallowed rapidly 
as a beverage is likely to form in the stomach large and hard 
curds which are very slowly digested. Many persons who suffer 
from taking milk in this way imagine themselves to be unable to 
take milk and so abandon its use. The writer remembers a man 
to whom he bad recommended the liberal use of milk. He pro- ANIMAL FOODS 
459 
tested that he was absolutely unable to use it at all add stated 
that on the last occasion on which he had taken milk he had 
nearly lost his life. A few hours after hastily swallowing sev- 
eral glasses of milk he experienced a sensation of suffocation, was 
then nauseated and on attempting to vomit experienced a choking 
sensation. On reaching his finger down his throat he felt a mass 
which he seized and to his astonishment drew out a rope of milk 
nearly a yard in length. The milk had formed in his stomach one 
large, hard curd which he was certainly very fortunate in being 
able to get rid of so easily. The famous English surgeon, Dr. 
Lawson Tait, told of a case in which he was obliged to perform 
a surgical operation to remove a similar mass of curds which 
had lodged low down in the intestine. 
Milk should be sipped slowly and with a sucking movement 
or taken through a straw so as to secure a liberal admixture of 
saliva. By this means the formation of hard, indigestible curds 
will be prevented. 
Milk must be taken in right quantities and in right combina- 
tions. It cannot be denied that milk digests better when taken by 
itself or in very simple combinations than when mixed with a 
large variety of other foodstuffs. In some instances, also, a large 
quantity of milk is more easily digestible than a small quantity. 
When the stomach produces a large amount of highly acid gastric 
juice, as is usually the case with persons who have been accus- 
tomed to a hearty meat diet, the curds formed when a small 
amount of milk is taken will be large and tough, whereas if a 
larger amount of milk is taken, the curds formed will be smaller 
and softer. Hence, the proper remedy in many cases in which a 
person complains that he cannot take milk is to take more milk. 
As already remarked, the taking of milk with meat is per- 
haps the worst of all dietetic combinations. The reason for this 
was made clear by Pavlov, the eminent Petrograd physiologist, 
who showed that meat requires a highly acid gastric juice for its 
digestion and that the stomach produces this sort of juice when 
meat is eaten, while milk demands and calls forth a juice lower 
in acid. 
When milk is largely used as a nutrient, the remainder of the 
diet should consist chiefly of fruits and vegetables for the reason 
that milk contains an excess of lime and is deficient in the potash 
and soda which are necessary for perfect human nutrition. The 
last named elements are abundant in fruits and vegetables, par- 460 
THE NEW DIETETICS 
ticularly the potato, which is also very rich in salts of potash. 
A diet consisting exclusively of milk and cereals is less satisfac- 
tory. Such a diet often gives rise to scurvy in infants. Cereals 
are deficient in the alkaline elements which are needed to neutra- 
lize the acid products developed in the body. 
In the use of milk, especially when it is freely taken, it is 
well to remember, also, that one may easily by this means ingest 
an excess of fats. The milk of certain breeds of dairy cattle is 
exceedingly rich in fat. The use of such milk in some persons, 
and especially in infants and young children, gives rise to symp- 
toms which are sometimes denominated as biliousness, but which 
are not directly connected with the liver, being due to putrefac- 
tive changes set up in the intestine by the presence of an excess 
of fat. Breeders of dairy cattle have labored to produce strains 
of milch cows which produce milk containing a large amount of 
fat because they are more profitable, but for table use milk con- 
taining only a moderate amount of fat is preferable. 
Milk is very little used by the Chinese, who from the most 
remote times have had a prejudice against this article of food, 
believing that by using milk one would acquire the characteristics 
and qualities of the animals from which the milk was obtained, 
just as certain primitive tribes refuse to eat pigs, fearing that 
their eyes will become small like those of the pig. The Chinese 
have been able to dispense with milk because of the superior 
virtues of the soy bean, from which they prepare an excellent milk 
and also a palatable cheese, and because of the very large use of 
greens. 
It must be recognized, however, that the greatest value of 
milk as a food for adults is to be found in its use as a supple- 
mentary or complementary food; that is, as a means of rendering 
biologically complete a dietary otherwise consisting exclusively of 
the products of the vegetable kingdom. A strictly vegetarian diet 
is likely to be incomplete unless formulated with extraordinary 
care and scientific wisdom; but almost any group of vegetable 
foodstuffs which may be selected will prove satisfactory as nutri- 
ents if supplemented with a daily pint of good milk. 
The Africans, unlike the natives of the far East, make large 
use of milk. This may be due to the fact that they have abundant 
pasturage whereas the Orient has long been, in many parts at 
least, over-populated. 
According to Simmond, the Kaffir often subsists almost ex- ANIMAL FOODS 
461 
clusively on a diet consisting of sour milk with the addition of a 
little millet. One meal a day of this food suffices to keep him in 
vigorous health. 
Among the primitive tribes of Africa, according to Dr. Tur- 
ner and Rev. Bryant, milk is practically always permitted to sour 
before using. The Zulus pour the milk when still warm from the 
cow into a gourd kept for the purpose. Loosely stoppered, the 
gourd is placed in the sun. At the end of 48 hours the milk is 
clotted and the whey is drained off. The gourd is filled with 
fresh milk. The next morning the milk is ready for use. The 
whey is drained off and the curds shaken out. Once a week the 
gourd bottle is thoroughly washed and scalded. The amasi (arnaft 
of the Kaffirs) thus prepared is closely akin to the yoghourt of 
the Bulgarians. 
Milk a Cheap Food, 
Even at its present high price which is very likely to 
be higher rather than much lower, milk is a comparatively cheap 
and economic food. A pint of milk is equal in food value (calor- 
ies) to a pound of codfish, a half pound of lean beef or veal, a 
quart of oysters, three pints of beef juice, or three and a half 
quarts of bouillon. 
Ten cents will buy in the form of milk more than twice as 
much food as in the form of beefsteak, ten times as much as in 
the form of oysters, three to six times as much as is supplied by 
ten cents worth of eggs. Milk is really by far the cheapest of 
our ordinary animal foods. 
Milk, even at the price of certified milk, is a cheaper food 
than beefsteak. For example, a pound of steak at 40 cents sup- 
plies 450 to 650 calories, or 14 calories for one cent; while a 
quart of certified milk at 35 cents supplies 650 to 740 calories, 
or 20 calories for one cent, a difference of more than 40 per cent, 
in favor of the milk, to say nothing of the very great superiority 
in quality. 
When we consider the amount of tissue-building material 
which may be produced on a given area of land, the economy of 
milk as a foodstuff becomes still more apparent. According to 
Professor Henry, late Dean of the Agricultural Department of 
the University of Wisconsin, 100 pounds of digestible food when 
fed to animals produces the following quantities of actual food- 
stuff : THE NEW DIETETICS 
462 
Milk 18.0 pounds 
Eggs 5.6 pounds 
Beef 2.8 pounds 
Mutton 2.6 pounds 
It is evident from the above that the cow is more than six 
times as efficient a food transformer as is the steer. Feeding 
corn to steers wastes 97 per cent, of the corn. 
TABLE XLI. 
Percentage Composition of the Milk of Various Animals. 
The following table compiled by Voltz from various sources, 
shows the great differences in the composition of the milk of 
different animals: 
Water 
Solids 
Fat 
C ;ein 
Total 
protein 
Sugar 
Calories 
Ash peroz. 
Human 
87.58 
12.42 
3.74 
0.80 
2.01 
6.37 
0.3 
19 
Cow 
87.80 
12.20 
3.40 
2.70 
3.40 
4.70 
0.7 
18 
Buffalo 
82.30 
17.70 
7.70 
4.80 
4.40 
0.8 
31 
Zebu 
86.13 
13.87 
4.80 
3.03 
5.34 
0.7 
22 
Llama 
86.55 
13.45 
3.15 
3.00 
3.90 
5.60 
0.8 
19 
Camel 
87.60 
12.40 
5.38 
2.98 
3.26 
0.7 
17 
Goat 
86.30 
13.70 
4.00 
3.60 
4.60 
4.30 
0.8 
20 
Sheep 
81.50 
18.50 
7.00 
4.30 
5.60 
5.00 
0.9 
30 
Reindeer 
67.70 
32.30 
17.10 
10.90 
2.80 
1.50 
59 
Mare 
90.58 
9.42 
1.14 
2.50 
5.87 
4.36 
12 
Donkey 
90.12 
9.88 
1.37 
0.79 
1.85 
5.19 
0.47 
12 
Elephant 
67.85 
32.15 
19.57 
3.09 
8.84 
0.65 
63 
Hippopotamus 
90.43 
9.57 
4.51 
12 
Rabbit 
69.50 
30.50 
10.45 
15.54 
1.95 
2.56 
47 
Guinea pig 
41.11 
58.89 
45.80 
11.19 
1.33 
0.57 
131 
Dog 
77.00 
23.00 
9.26 
4.15 
9.72 
3.11 
0.91 
38 
Cat 
81.64 
18.36 
3.33 
3.11 
9.53 
4.91 
0.59 
25 
Tig 
82.37 
17.63 
6.44 
6.09 
4.04 
0.59 
28 
Blue whale 
50.47 
39.53 
20.00 
12.42 
5.63 
1.48 
72 
Infant Foods. 
Most infant foods consist of starch which has been fully or 
in part digested by means of malt or exposure to a dextrinizing 
temperature. 
Table XLII shows the composition of various infant foods 
as determined by the chemists of the Connecticut Agricultural 
Experiment Station (Report for ipo8). 
According to this report most of these foods are prepared 
by very simple methods from ordinary foodstuffs. 
Horlick’s Malted Milk consists of a malt-digested mixture of 
wheat flour and milk. ANIMAL FOODS 
463 
Fessenden’s Food is made from arrowroot, wheat, rye, and 
barley malt. 
Ridges’ is simply “baked flour,” consisting largely of raw 
starch. 
Mellin’s Food consists of wheat flour which has been digested 
with barley malt. 
Peptogenic Milk Powder is chiefly milk sugar. 
Allenbury’s Milk Food consists of a mixture of pasteurized 
milk and malted wheat. 
Eskay’s Albuminized Food consists of cereal flour combined 
with egg albumen. 
TABLE XLII. 
Composition of Certain Infant Foods. 
Water 
Ash 
Carbo- 
Protein Fibre hydrates Fat 
Soluble 
Lac- in 
tose Water Starch 
Per 
Per 
Per 
Per 
Per 
Per 
Per Per Per 
cent. 
cent. 
cent. 
cent. 
cent. 
cent. 
cent. cent. cent. 
Milk and Cereals 
Allenbury’s Milk 
Food No. 2 
4.98 
3.69 
9.00 
0.28 
68.33 
13.72 
27.14 82.27 
Horlick’s Malted 
Milk 
3.63 
3.70 
12.94 
71.37 
8.36 
0.39 88.58 
Lactated Food 
7.12 
1.19 
8.13 
82.84 
0.72 
9.67 34.54 41.94 
Malted Cereals 
Fessenden’s Food.. 
5.95 
1.60 
6.00 
0.08 
85.97 
0.40 
0.36 48.80 35.69 
Mellin’s Infant 
Food 
. 5.07 
3.79 
10.50 
0.25 
79.24 
1.15 
0 37 83.97 
Ridges’ Food 
. 9.24 
0.60 
11.81 
0.05 
77.26 
1.04 
0.12 3.90 69.46 
Miscellaneous 
Peptogenic Milk 
Powder 
. 3.02 
1.40 
0.81 
94.67 
0.10 
90.53 95.40 
Eskay’s Albumen- 
ized Food 
. 3.06 
1.34 
6.56 
0.04 
87.80 
1.20 
36.98 51.10 28.41 
Malted Nuts 
(Atwater) 
. 2.60 
2.20 
23.70 
43.90 
27.60 
2.40 
Digestibility of Foodstuffs and Time Required for Their Digestion 
Both the digestibility of foodstuffs and the time required for 
their digestion depend much upon the condition and the manner 
in which they are eaten and the quantity of material taken at one 
time. The amount of material absorbed from the digested food 
depends largely upon the amount of cellulose or roughage pres- 
ent. Indigestible material hastens the foodstuffs along the alimen- 
tary tract and thus lessens the amount absorbed. The amount of 
food material lost in this manner, however, is of little consequence 464 
THE NEW DIETETICS 
compared with the importance of the prompt dismissal of un- 
usable food residues, for the accomplishment of which a consid- 
erable amount of roughage is highly essential. Even in the case 
of foods which contain considerable cellulose, such as legumes, 
nuts and some fruits, digestion and absorption are satisfactorily 
performed provided the foodstuffs are thoroughly chewed or well 
comminuted before eaten. 
The following table shows the degree of digestibility of vari- 
ous foodstuffs as determined by various authorities (Tibbies) : 
Protein 
Carbohydrate 
Fat 
Source Digested 
Calories 
Digested 
Calories 
Digested 
Calories 
of Nutriment Per cent. 
Per ounce 
Per cent. 
Per ounce 
Per cent. 
Per ounce 
Foods in mixed 
diet 92 
114.00 
97 
114 
95 
253.0 
Animal foods in 
mixed diet 97 
121.00 
98 
108 
95 
253.0 
Vegetable foods 
in mixed diet.. 84 
90.00 
97 
114 
90 
237.5 
Meat and fish 97 
121.25 
98 
108 
95 
252.5 
Eggs 97 
123.75 
98 
108 
95 
255.6 
Milk, cheese and 
other dairy 
products 97 
121.25 
98 
108 
95 
250.0 
Cereals & sugar 85 
109.37 
98 
116 
90 
237.5 
Legumes, dried.. 78 
97.00 
97 
115 
90 
237.5 
Fruits 85 
95.00 
90 
102 
90 
237.5 
Vegetables 83 
88.00 
95 
113 
90 
237.5 
The following table (Tibbies) shows the digestibility of fruits 
and nuts in various combinations: 
Digestibility of Fruits and Nuts* 
Pood digested— 
■Per cent. 
Protein 
Pat 
Carbohydrate 
Olives, grapes, tomatoes 
44.43 
67.76 
95.84 
Brazil nuts, grapes 
84.17 
91.20 
95.06 
Brazil nuts, wheat flakes 
85.44 
84.32 
97.45 
Walnuts, grapes, wheat flakes 
Peanuts, persimmons, wheat flakes and 
79.76 
89.48 
97.18 
milk 
86.80 
88.70 
91.22 
Walnuts, pears, milk and wheat flakes 
84.10 
91.41 
96.98 
Cocoanut and pears 
75.12 
91.27 
97.44 
Walnuts, figs, apples 
70.79 
88.22 
97.85 
Peanuts, dates, apples 
78.14 
83.29 
97.16 
Pecans, dates, apples 
Walnuts, raisins, apples 
76.16 
91.53 
97.78 
80.70 
87.10 
98.28 
Dr* Beaumont's Digestion Table* 
The following table presents the principal facts shown by 
Beaumont in his experiments upon St. Martin in relation to the 
time required for the gastric digestion of various foodstuffs 
named: ANIMAL FOODS 
465 
B‘ce — — boiled 1:00 
Sago “ 1-45 
Tapioca . “ 2:00 
Barley “ 2:00 
M(1(lk - “ 2:00 
; - raw 2:15 
Gelatine boiled 2:30 
Tripe, soused “ 1:00 
Brains, animal “ 1:45 
Venison, steak broiled 1:35 
Spinal marrow, animal boiled 2:45 
Turkey, domesticated roasted 2:30 
boiled 2:25 
Goose, wild roasted 2:30 
Pig, sucking “ 2:30 
Liver, beef’s, fresh broiled 2:00 
Lamb, fresh “ 2:30 
Chicken, full grown frica’d 2:45 
Eggs, fresh h’d bid. 3:30 
“ “ .soft bid. 3:00 
..fried 3:30 
- roasted 2:15 
" “ — raw 2:00 
“ whipped “ 1:30 
Custard baked 2:45 
Codfish, cured dry boiled 2:00 
Trout, salmon, fresh “ 1:30 
..fried 1:30 
Bass, striped “ broiled 3:00 
Flounder “ fried 3:30 
Catfish “ “ 3:30 
Salmon, salted boiled 4:00 
Oysters, fresh raw 2:55 
“ roasted 3:15 
“ stewed 3:30 
Beef, fresh, lean, rare roasted 3:00 
“ steak broiled 3:00 
with salt only boiled 3:36 
fried 4:00 
old, hard, salted boiled 4:15 
Pork, steak broiled 3:15 
fat and lean roasted 5:15 
recently salted boiled 4:30 
— fried 4:15 
“ broiled 3:15 
- raw 3:00 
“ stewed 3:00 
Mutton, fresh roasted 3:15 
boiled 3:00 
Veal, fresh broiled 4:00 
fried 4:30 
Fowls, domestic boiled 4:00 
“ roasted 4:00 
Ducks, domesticated “ 4:00 
wild “ 4:30 
Suet, beef, fresh boiled 5:30 
“ mutton “ 4:30 
Butter melted 3:30 
h. m 466 
THE NEW DIETETICS 
h. m. 
Cheese, old, strong raw 3:30 
Soup, beef, veg. and br’d boiled 4:00 
“ marrow bones “ 4:15 
“ bean .. “ 3:00 
“ barley “ 1:30 
“ mutton “ 3:30 
Green corn and beans “ 3:45 
Chicken soup “* 3:00 
Oyster soup “ 3:30 
Hash, meat and veg warmed 2:30 
Sausage, fresh broiled 3:20 
Heart, animal fried 4:00 
Tendon boiled 5:30 
Cartilage “ 4:15 
Aponeurosis “ 3:00 
Beans, pod “ 2:30 
Bread, wheat, fresh baked 3:30 
“ corn * “ 3:15 
Cake “ “ 3:00 
“ sponge , “ 2:30 
Dumpling, apple boiled 3:00 
Apples, sour, hard raw 2:50 
“ mellow “ 2:00 
“ sweet, “ “ 1:30 
Parsnips boiled 2:30 
Carrot, orange “ 3:15 
Beets “ 3:45 
Turnips, flat “ 3:30 
Potatoes, Irish “ 3:30 
“ baked 2:30 
Cabbage, head raw 2:30 
“ boiled 4:30 
The Time Required for Gastric Digestion, 
Within recent years numerous observers have renewed the 
study of the time required for gastric digestion by the aid of 
modern methods of research. The following table (Tibbies) 
shows the results of the most recent and reliable investigations: 
Kind of Food 
Quantity of Food 
Time in which the 
Food left the Stomach 
Beef 3y2 ounces of raw beef 2 hours 
“ of half-boiled beef 2y2 “ 
“ of boiled beef 3 
“ of half-roasted beef 3 
“ of roasted beef 4 
Mutton 2/2 “ of raw mutton 2 
“ of half-boiled mutton 2l/2 “ 
“ of boiled mutton 3 
“ of half-roasted mutton 3 
“ of roasted mutton 4 
Veal 3/i “ of raw veal 2l/2 “ 
“ of boiled veal 344 “ 
“ of roasted veal 5 
Pork Zl/2 “ of raw pork 3 
“ of boiled pork Al/2 “ 
“ of roast pork 6 
Sweetbread 9y2 “ of cooked sweetbread 244 “ ANIMAL FOODS 
467 
Time in which the 
Food left the Stomach 
Chicken 8*4 <l of cooked chicken 3 to 4 hours 
Ham 6 “ of boiled ham 3 to 4 “ 
Tongue 9 “ of smoked tongue 4 to 5 “ 
Goose 9 “ of roast goose 4 to 5 “ 
Fish 7l/2 “ of salt fish 4 “ 
7y2 “ of fresh fish 2x/2 “ 
Oysters 10 raw oysters 2*4 to 3 “ 
Eggs 2 lightly boiled eggs 1 
2 raw eggs 2 14 “ 
2 poached eggs -f- 5 grammes of butter2*4 
2 hard-boiled eggs 3 “ 
2 eggs in omelet 3 
Milk }4 pint of raw milk 4 
“ of boiled milk 3 “ 
1 “ of raw milk 3l/2 
1 “ of skimmed milk 3*4 
1 “ of sour milk 3 
1 “ of boiled milk 4 
Bread 2}4 ounces of white bread 2 
5y “ of white bread 3 “ 
5 Vi “ of brown bread 4 
Rice Sx/2 “ of boiled rice 3/ 
Barley 2y2 “ “ barley 3*4 
Tapioca 1% “ “ tapioca 2Y\ 
Lentils 5y “ “ lentils, mashed 4 
Dried peas 7*4 “ “ peas or beans 4*4 
French beans.... 7j4 “ “ beans Al/2 
Potatoes 5y “ “ potato 2 to 2l/2 “ 
Carrots 5y “ “ carrots 3x/2 “ 
Cabbage 5y§ “ “ cabbage 4 
Cauliflower 5y “ “ cauliflower 2% to 3 “ 
Spinach 5y “ “ spinach 3 
Radishes 5y “ of raw radishes 4 
Apples 5 y “ of ripe apples 3y 
5TA “ of unripe apples 4 to 6 “ 
Cherries 3x/2 “ of ripe cherries 2 to 3 “ 
Kind of Food 
Quantity of Food 
In the use of the above table, it should be remembered that 
the times given relate wholly to gastric digestion. The time re- 
quired for the total digestion and absorption of the average meal 
and the transmission of the indigestible residues into the colon, 
is eight hours. The digestibility of foodstuffs and the time re- 
quired for digestion are now known to be of much less import- 
ance than formerly supposed. Some of the most unwholesome 
foods are digested the most quickly. That the bill of fare shall 
be sufficient in amount and properly balanced and of such char- 
acter as to maintain a normal non-putrefactive flora in the intes- 
tine are the matters of primary consequence. Condiments 
Man is the only animal that deliberately commits suicide by 
self-poisoning. He is the only one that spoils his food before 
he eats it. The average man suffers constantly from chronic 
poisoning. He doses himself with poisons of various sorts which 
in the aggregate make a per capita dose of more than fifty grains 
of poison every twenty-four hours for every man, woman and 
child in the United States. He begins the day with a poison 
dose in the form of coffee to wake him up. After breakfast he 
smokes a cigar to settle his stomach and quiet his nerves. Before 
dinner he swallows half an ounce of whiskey or bitters to get an 
appetite. He finds an afternoon cup of tea necessary to cure 
after-dinner stupor, and at night needs an opiate to get to sleep, 
and in the morning a cathartic to move his bowels. With his 
other poisonings he deliberately spoils his food by putting into 
it toxic substances, the excretions of plants, which by means 
of acrid, biting and burning flavors are labeled by Nature as 
belonging to the poison class and unfit to be eaten. These prod- 
ucts, used only for their flavoring properties, having no food 
value, are known as condiments. 
There are two classes of condiments: first, those which con- 
tain irritating but non-volatile oils, like mustard, pepper, cay- 
enne, capsicum, horse-radish, ginger, and spices; second, those 
which contain irritating volatile oils, like mint and thyme. To 
these may be added common salt, although this is by some re- 
garded as a food. 
Condiments of the first class stimulate the activity of the 
stomach, causing it to empty somewhat quicker but lessening the 
secretion of gastric acid. Condiments of the second class lessen 
the activity of the stomach and diminish secretion. It should be 
added at once, however, that condiments of the first class, al- 
though they at first increase the contractile activity of the stomach, 
later produce an opposite effect. Consequently, the effect of con- 
diments is the opposite of what it is popularly supposed to be, 
depressing and hindering digestion rather than aiding it. The 
ultimate effect of artificial stimulation is always to depress and 
lessen function. The effect of such stimulants upon a weakened 
468 CONDIMENTS 
469 
organ is precisely the same as that of a whip when applied to a 
tired horse. The forced action produced inevitably has the effect 
of still further lessening an already depleted store of energy and 
so hastening the time when complete failure will result. 
Condiments of all sorts should be rigorously excluded from 
the table. The essential oils found in condiments are all irritant 
poisons. When applied to the skin in concentrated form they 
produce irritation or blistering, inflammation and even serious 
destruction of tissue if the contact is prolonged. The effect upon 
the stomach is similar. 
Various condiments are the chief ingredients of the curries of 
the East, the effects of which, in producing gastric catarrh and 
hemorrhoids with other forms of disease of the rectum, has long 
been well known. A moment’s thought will make clear how these 
irritative substances are particularly injurious to the terminal 
portion of the alimentary canal. When pepper, mustard, and 
similar substances enter the mouth they are very largely concealed 
by the food, but when the food has been digested and absorbed 
the condiments, which are in large part left behind, are concen- 
trated and, remaining some time in contact with the mucous 
membrane of the rectum, are quite capable of setting up a serious 
irritation similar to that which is produced by concentrated mix- 
tures of condiments upon the skin and other sensitive parts. 
Through absorption into the blood, the poisonous oils of 
condiments are brought into contact with every cell and fiber of 
the body. The first effect is produced upon the delicate walls of 
the blood vessels. A defensive effort causes these to become 
thickened, a change known as arteriosclerosis, because the pri- 
mary thickening is followed by hardening through a deposit of 
chalk. The eminent Professor Huchard, of Paris, the world’s 
greatest authority upon this subject, showed that mustard and 
other condiments when administered to animals may produce 
changes in the blood vessels within a few months’ time. 
The same poisonous effects produced upon the blood vessels 
are also produced in the kidneys, the delicate cells of which, being 
brought in contact with the poisons in more concentrated form 
through their elimination by way of the urine, are made to under- 
go degenerative changes through which their efficiency is impaired 
and Bright’s disease and other disorders produced. 
Boix fed half a gram (7.5 grains) of pepper to a rabbit 
daily. The animal died at the end of twenty-seven days. The 470 
THE NEW DIETETICS 
liver was found sclerotic and its cells degenerated. The kidneys 
were greatly congested. 
The Use of Condiments as Preservatives. 
The preservative influence of the essential oils found in 
various condiments, particularly in cloves and cinnamon, has 
long been known. Recent experiments show that 2 to 5 per cent, 
of an alcoholic extract of cloves or cinnamon, or 4 per cent, of 
scraped horseradish, will prevent the development of bacteria 
in tomato pulp. Mustard and anise seed have a similar effect. 
These preservatives have been much used in recent years as sub- 
stitutes for benzoic acid, salicylic acid and other preservatives, 
the use of which has been excluded by the pure food laws. In 
the opinion of the writer there is no advantage in exchanging 
salicylic acid for oil of cloves or any other of the essential oils 
mentioned. As a matter of fact the salicylates are probably less 
harmful than these acrid oils. The use of these chemical pre- 
servatives is not necessary, and since all of them are alike harm- 
ful their use in the manufacture of foods should be forbidden by 
law. 
The Taste for Condiments Unnatural. 
The taste for condiments is altogether an acquired one. Con- 
diments of all sorts are highly repulsive to infants and to all 
persons whose tastes have not become vitiated. There is no place 
for these poisonous products in the biologic dietary. 
That the taste for pickles, which has become quite general- 
ized among civilized people, is an acquired and unnatural appe- 
tite, is well shown by the following story told by George Kennan 
in his delightful book, “Tent Life in Siberia”: 
One evening, soon after we left Shestakova, they (Korak drivers) 
happened to see me eating a pickled cucumber; and as this was something 
which had never come within range of their limited gastronomical experi- 
ence they asked me for a piece to taste. Knowing well what the result would 
he, I gave the whole cucumber to the dirtiest, worst-looking vagabond in 
the party, and motioned him to take a good bite. As he put it to his lips, 
his comrades watched him with breathless curiosity to see how he liked it. 
For a moment his face wore an expression of blended surprise, wonder and 
disgust, which was irresistibly ludicrous, and he seemed disposed to spit 
the disagreeable morsel out; but with a strong effort he controlled himself, 
forced his features into a ghastly imitation of satisfaction, smacked his 
lips, declared it was “akhmael nemelkin”—very good, and handed the pickle CONDIMENTS 
471 
to his next neighbor. The latter was equally astonished and disgusted with 
its unexpected sourness, but rather than admit his disappointment and be 
laughed at by the others he also pretended it was delicious, and passed it 
along. Six men in succession went through with this transparent farce 
with the greatest solemnity; but when they had all tasted it, and all been 
victimized, they burst out into a simultaneous “ty-e-e-e” of astonishment, 
and gave free expression to their long-suppressed emotions of digust. The 
vehement spittings, coughing, and washing out of mouths with snow which 
succeeded this outburst proved that the taste for pickles is an acquired one, 
and that man in his primitive state does not possess it. 
Pickles are unwholesome not only because of their utter in- 
digestibility, but because the acetic acid (vinegar) with which 
they are saturated is a gastric poison, arresting at once the action 
of the saliva and giving rise to gastric catarrh and sclerosis of 
the liver. 
Schibkow has shown that acetic acid is an active poison, 
behaving like a mineral acid. In some cases death was caused by 
a few drops. The poisonous effects, when applied to the mucous 
membrane, began with a 12 per cent, solution. The pulse was 
slowed and the temperature lowered. The vapor of acetic acid, 
when inhaled, caused the death of animals either during the 
inhalation or a short time after. 
CHLORID OF SODIUM—COMMON SALT 
For centuries the practice of adding chlorid of sodium or 
common salt, to many foodstuffs, particularly cereals, meats and 
vegetables, has been current among civilized people, though by no 
means universal among primitive tribes. The use of sodium 
chlorid seems to have been, for the most part, unknown to the 
North American Indians at the time of the discovery of America, 
and Indian tribes living remote from civilization, as in the 
Hudson Bay region and perhaps in a few other isolated localities, 
still thrive on a saltless diet. The Indians of the Hudson Bay 
region, when compelled to eat salt beef soak the meat over night 
in an abundance of water, turn off the water, then add fresh 
water and boil for an hour, and then again for a third time 
place the meat in fresh water to continue the cooking, thus get- 
ting rid of the salt flavor of the meat as thoroughly as possible. 
Millions of natives of Central Africa never taste salt. The great 
herds of cattle on the western plains are fattened without salt. 
The Eskimos eat their meat without salt. 
Dr. Benjamin Rush, one of the most eminent physicians who 472 
THE NEW DIETETICS 
has lived in modern times, one of the signers of the Constitution 
of the United States, who made a careful study of the habits of 
the American Indians a hundred and fifty years ago, said of salt: 
“Although the interior parts of our continent abound with salt 
springs, yet I cannot find that the Indians used salt in their diet 
till they were instructed to do so by the Europeans.” 
Among civilized people the excessive use of salt is almost 
universal. One result of this excess is overwork of the kidneys. 
Another ill effect is overstimulation of the gastric glands, which 
are thus led to produce an excess of gastric acid which is formed 
from salt. The use of salt as an addition to foodstuffs is due to 
the desire to give to them a more piquant taste. The natives of 
India use curry, a hot condiment, with their rice instead of salt. 
Bunge believed that salt is necessary with vegetable foods to take 
the place of the excess of potash which they contain; but Ren- 
merich and Kurz, by experiments upon dogs, have disproved this 
theory, showing that the use of foods containing potash salts does 
not drive out the soda salts but that they are retained by the body 
in normal proportion. 
A story which seems to have originated with an old writer, 
John Marshall, and which has been repeated by many authors, 
tells us that the ancient laws of Holland required that criminals 
should be given bread without salt until they were devoured by 
worms which developed in their intestines. The story has been 
in modern times wholly discredited. Numerous persons have 
discarded salt wholly and lived entirely without it without suf- 
fering any injury. Within recent years it has become the custom 
of physicians to place persons suffering from epilepsy upon a 
saltless diet. The salt-free regimen has also been used in other 
disorders. These persons when under treatment have discarded 
salt entirely from their dietary, except so far as it is contained 
in natural foodstuffs, for months at a time and without injury. 
Linossier showed in 1900 that three parts of salt added to 
one thousand of gastric juice retarded the digestion of albumin 
to the same extent as a 40 to 50 per cent, diminution in the amount 
of pepsin. Three parts of chlorid of sodium to one thousand of 
gastric juice is practically the proportion of salt found in the 
gastric contents after an ordinary meal. From this it is evident 
that while the intake of an excessive quantity of salt may increase 
the amount of hydrochloric acid produced by the stomach the 
digestive activity of the gastric juice is diminished. CONDIMENTS 
473 
Salt Hunger* 
Persons who have been accustomed to make use of salt, 
especially those who use it freely, miss it greatly when deprived 
of it. Such persons especially crave salt with vegetable foods 
such as potatoes and many desire salt with cereals. Few persons, 
however, go so far in their liking for salt as to demand its use in 
connection with fresh fruits, though it is often eaten with nuts 
and frequently with the cataloup or musk melon, a vegetable 
fruit which is possessed of ample flavor to commend it to the 
palate without addition of any sort. 
Bunge, of Basle, advanced the theory that salt is craved with 
vegetables for the reason that chlorid of sodium is found only in 
small quantity in these foodstuffs, while potash is present in large 
amount. This theory has not been universally accepted by physi- 
ologists, and Carlson tells us that “It is still an open question 
whether any animal, man included, actually needs sodium chlorid 
in addition to the salts present in all natural foodstuffs. Smith, 
the veterinary physiologist, maintains that ‘both carnivora and 
herbivora obtain in their natural diet a sufficiency of salts, al- 
though there is a general impression that the wild herbivora long 
for sodium. It is quite certain that under conditions of domesti- 
cation horses can be kept in perfect health without receiving any 
sodium chloride other than that contained in the food, and the 
amount of this in vegetable substances is very small.’ ” 
The theory that wild animals, especially grazing animals, 
require salt has been many times shown to be wholly erroneous. 
The cattle men on the Western plains who raise enormous herds 
of cattle do not feed salt to their animals. It is well known that 
the finest oxen raised in Great Britain are not given salt. 
Some twenty-five years ago the writer placed in his small 
park a pair of deer which have at the present time become quite 
a little herd. These animals have never eaten salt. On one oc- 
casion a new caretaker placed a pan of salt in the enclosure in 
which they are confined, but they refused to touch it, although 
they had free access to it for two or three weeks before the error 
was discovered, it having been intended from the start to rear 
these deer without salt. On one occasion, when Mr. Ernest 
Thompson Seton was a guest at the Battle Creek Sanitarium, he 
was invited to see these deer, which he was informed refused to 
eat salt. He was sure that all deer would eat salt, and was invited 474 
THE NEW DIETETICS 
to test the deer by offering them salt, which he did. To his great 
surprise not one could be induced to touch it. 
The Tlascalans, one of the tribes of ancient Mexico, were 
found at the time of the conquest, according to Prescott, to have 
been for some reason deprived of salt for more than half a cen- 
tury. Prescott adds that it required the lapse of several genera- 
tions after the conquest to reconcile them to the use of salt with 
their food. (Conquest of Mexico,” by Prescott, Vol. I., p. 466.) 
The same author describes these people as “a bold and hardy 
peasantry.” 
The Daramas in southwestern Africa “never take salt by any 
chance.” 
Dr. Achard and Professor Richet, of Paris, have in recent 
years made extensive investigations by which they have shown 
that while salt is found in the tissues of all animals, it is also 
found in all vegetable structures and in sufficient quantity in 
ordinary foodstuffs to supply the needs of the body. 
According to these observers, the amount of salt found per 
1,000 parts of animal tissues is for different animals as follows: 
Birds 7 parts 
Fresh water fish.. 8 parts 
Insects 6 parts 
Land mammals 7 parts 
Salt water fish 20 parts 
Sea mammals 8 parts 
Human blood contains 8 parts of sodium chlorid to 1,000 
parts. 
The salt leaves the body chiefly through the kidneys and the 
skin. 
The average person takes about two-thirds of an ounce of 
salt daily. Of this about one-eighth is lost through the skin, most 
of the remainder through the kidneys. In fasting, salt almost 
entirely disappears from the urine. Observations on the Italian 
faster, Succi, showed that after fifteen days of fasting, his urine 
contained only 3 grains of salt in twenty-four hours, or about 
one one-hundredth part of the amount frequently found in the 
urine. 
The use of chlorid of sodium raises the blood-pressure. 
When salt is removed from the body by profuse sweating or by 
copious water drinking the blood pressure falls. CONDIMENTS 
475 
Richet, an eminent French scientist, has shown that the food 
required for a day’s ration contains naturally half a dram of salt 
(30 grains). Numerous experiments have shown that this amount 
of salt is exactly the amount which the body requires to make 
good its loss of salt, and that no more is actually needed. In fact, 
Richet claims that the amount actually required by the body is 
even less than half a dram. More than this, as this distinguished 
scientist says, is luxury and not necessity. 
Dropsy is produced in the great majority of cases by the 
excessive accumulation of salt in the tissues; the kidneys being 
unable to eliminate salt, it is pushed out into the tissues and of 
course must be held in solution by water. For every half ounce 
of salt retained nearly four pounds of water will be retained to 
hold it in solution. This is shown by the rapid increase in weight 
when the kidneys cease to eliminate salt. 
Javal and Widal have shown that the retention of one-third 
of an ounce of salt may give rise to edema. 
Many observations have shown that the kidneys fail to re- 
move chlorid of sodium at the usual rate in various diseases, par- 
ticularly in pneumonia, pleurisy, Bright’s disease, some forms of 
heart disease, erysipelas, typhoid fever, jaundice, cirrhosis of the 
liver, scarlet fever, smallpox, edema and dropsy. Hence, it is 
evident that in these disorders salt should be withheld or at least 
very greatly reduced in amount. 
By careful observation it has been found that a marked re- 
tention of salt occurs before dropsy or edema makes its appear- 
ance. Several cases which have come under the writer’s observa- 
tion are of interest in this connection. The urine of a patient 
suffering from diabetes in a moderate degree was found to contain 
no chlorid of sodium whatever, although the amount taken in the 
food must have amounted to at least one or two drams. Several 
examinations made within twenty-four hours showed not a trace 
of chlorid of sodium in the urine. This was the first indication 
that the patient’s condition was serious. In another twenty-four 
hours the patient was dead, in spite of all that could be done to 
prevent a fatal termination. The failure of the kidneys to elimi- 
nate chlorid of sodium was evidence that these organs had ceased 
to do efficient work, and the rapid accumulation of poisons in 
the body resulted in the patient’s death, the kidneys evidently 
being so far damaged that it was impossible to restore them to 
normal activity. 476 
THE NEW DIETETICS 
A patient suffering from cardiac disease was found to be 
eliminating through the kidneys only a very small amount of 
chlorid of sodium, less than one grain. This patient likewise died 
a few hours later. The kidneys were found in an advanced state 
of degeneration. 
Many similar cases might be cited, including a number of 
cases in which the withdrawal of salt has been followed by the 
disappearance of the dropsy and other unpleasant symptoms. 
If a person eats one-fourth ounce of salt and only eliminates 
one-eighth ounce, salt will necessarily accumulate in his body, and 
for each eighth of an ounce that is retained, he will have to retain 
one pound of water to dilute it. If one stops eating salt, he 
continues to eliminate it at the rate of an eighth to a quarter of 
an ounce daily. This causes the elimination of an equivalent 
amount of water or one to two pints or pounds, and so the person 
loses in weight. This is what happens in dropsical persons who 
are put on a saltless diet. 
Loufer reports the case of a young girl who suffered from 
anemia, emaciation, and dyspepsia as the result of the excessive 
use of salt. 
Poisonous Effects from Salt* 
The idea that salt is a harmless substance is a grave error. 
Many persons are doubtless greatly damaged by the free use of 
salt. Agricultural authorities tell us that two or three pounds is 
a poisonous dose for a horse and four or five pounds are equally 
fatal to a cow. A half pound of salt will kill a hog. 
An ounce of salt taken in a quart of water produces a de- 
cided laxative effect but the use of salt as a laxative is a per- 
nicious practice. 
The effects are no different from those produced by the 
habitual use of mineral water, the laxative effects of which are in 
large part due to the salt which they contain. 
If to a dog is administered one two-hundredth of its weight 
of salt (a little more than 3 ounces for a dog weighing 40 
pounds), the animal falls into convulsions and dies. 
Dr. C. Heman Borrow, who spent some years in China, states 
that in that country “the drinking of a saturated solution of salt 
is a common mode of committing suicide, and there is none more 
difficult to treat. In only one case did I succeed in securing re- 
covery. Salt is taken for suicidal purposes sometimes in a com- CONDIMENTS 
477 
mon saturated solution made with water as the solvent, and 
sometimes the brine from salted kraut. . . . The amounts taken 
vary with the determination of the person taking it, but usually 
are from one to three rice bowlfuls—half a pint to a pint.” 
A young woman died after taking a half pound of salt as a 
vermifuge. 
While salt may be used in minute quantities with little if 
any injury, the amount commonly used is greatly in excess even 
of reasonable gustatory requirements and should be reduced at 
least three-fourths. 
Tibbies, an eminent English authority in dietetics, tells us 
that with a diet consisting of cereals and legumes one-half to one 
dram of salt is sufficient, and with a diet consisting chiefly of 
rice a fraction of this quantity is ample. He further adds that 
very little salt is needed with an ordinary mixed diet; whereas, 
most people take 20 to 30 grams (two-thirds of an ounce to an 
ounce) in one way or another. Evidently, the use of salt is 
merely a concession to an artificial appetite not required except 
in the case of those who have cultivated a taste for the saline 
condiment. 
According to Gautier, the amount of salt consumed by most 
persons is at least five times this amount. It is evident, then, 
that the addition of salt to the foodstuffs is not a physiologic 
necessity, but is an acquired habit, which is also shown by other 
facts to which reference has been already made. The excess 
must be eliminated through the kidneys and skin, imposing un- 
necessary work upon these emunctories. The free use of salt 
has been shown by Debove and others to be a serious injury to 
the digestive process. 
Vilhjalmar Stefansson, the Arctic explorer, states that salt is 
not only not used but is greatly disliked by the Eskimo. He says: 
Most people are in the habit of looking upon the articles of our ac- 
customed diet, and especially upon salt, as necessities. We have not found 
them so. . . . Salt I have found to behave like a narcotic poison—in 
other words, it is hard to break off its use, as it is hard to stop the use 
of tobacco; but after you have been a month or two without salt, you 
cease to long for it, and after six monjths I have found the taste of meat 
boiled in salt water distinctly disagreeable. In the case of such a necessary 
element of food as fat, on the other hand, I have found that the longer 
you are without it the more you long for it, until the craving becomes 
more intense than is the hunger of the man who fasts. Among the un- 
civilized Eskimo the dislike of salt is so strong that a saltiness imperceptible 478 
THE NEW DIETETICS 
to me would prevent them from eating at all. This circumstance was often 
useful to me later in our travels about Coronation Gulf, for whenever our 
Eskimo visitors threatened to eat us out of house and home we could put 
in a little pinch of salt, and thus husband our resources without seeming 
inhospitable. A man who tasted anything salty at our table would quickly 
bethink him that he had plenty of more palatable fare in his own house. 
“My Life with the Eskimo,” pp. 69, 70. 
The Highlanders of Nepaul refuse to eat salt as do also the 
Kamschatdales. 
The native tribes of Siberia have no use for salt. 
The Bedouins consider the use of salt ridiculous. The same 
is true of the Bushmen of South Africa. 
Bright's Disease Due to the Excessive Use of Salt* 
In the case of a man who died after taking a large dose of 
salt marked changes were found in the kidneys, which leads to 
the conclusion that the habitual use of salt in excess may lead to 
chronic disease of the kidneys. Bunge called attention to this 
important fact may years ago. Says Bunge: 
The habit of drinking spirituous liquors, which moreover is reckoned 
one of the causes of chronic nephritis, also brings about the immoderate use 
of salt. Thus one sin against Nature leads to another. These are questions 
to which I would direct the attention of practitioners. 
There is no organ in our body so mercilessly ill treated as the kidneys. 
The stomach reacts against overloading. The kidneys are obliged to let 
everything pass through them, and the harm done to them is not felt till 
it is too late to avoid the evil consequences. 
According to Torindo, the excessive use of salt is a cause of 
Bright’s disease. It is well known that salt increases the amount 
of albumen in cases of this disease. 
M. Achard, an eminent French physician, also Professors 
Strauss, Weidall, Lemierre, and Javal, have shown that in cases 
of albuminuria the use of salt increased the albumen; by with- 
holding salt entirely, the albumin was made to disappear. Other 
authorities also completely withhold salt from the food in all 
cases of albuminuria as well as in cases of latent nephritis in 
which albumin may not be present. 
The great importance of this discovery can only be appre- 
ciated when one considers the enormous amount of salt which is 
used by many persons in this country. In France and most con- 
tinental countries salt is used in very much smaller quantities 
dietetically than in this country. CONDIMENTS 
479 
Recent discoveries which connect the use of salt with Bright’s 
disease of the kidneys will certainly command the thoughtful 
attention of thousands of physicians who, perhaps, have never 
before given this matter any serious attention. Salt should be 
used in exceedingly small quantities, if at all. One can easily 
accustom himself to the disuse of salt without any great incon- 
venience and certainly without any risk to health. 
The Salt-Free Diet. 
Natural foodstuffs contain sufficient salt to meet all the 
natural requirements of the body, 30 to 60 grains daily, (Tibbies), 
as will be seen by reference to the following table based chiefly 
upon a table by Strauss: 
TABLE XLIIL 
Amount and Percentage of Sodium Chlorid in Foods 
Per cent. 
Grains 
per lb. 
Milk 
15 
to 
.18 
12.6 
Butter: unsalted 
.02 
1.4 
salted 
1.00 
70.0 
Cheese 
2.50 
175.0 
Egg: whole (one) 
.14 
1.0 
white (one) 
.19 
0.8 
yolk (one) 
.02 
0.5 
Meat 
.10 
7.0 
Cereals 
01 
to 
.10.7 
to 7.0 
Rice 
.01 
.7 
Oatmeal 
.04 
2.8 
Legumes 
01 
to 
.10 
7.0 
Peas 
.06 
4.2 
Potatoes 
.04 
2.8 
Vegetables and salads. 
.10 
7.0 
Fruit, not exceeding 
.06 
4.2 
Raw Foods 
Cooked Foods 
Poached eggs (one) 
.50 
3.3 
Buttered eggs and omelets (one) 
2.4 
to 
2.70 
19.0 
Roast beef 
1.9 
to 
2.80 
200.0 
Beefsteak 
3.00 
210.0 
White bread 
48 
to 
.70 
50.0 
Brown bread 
.75 
52.5 
Mashed potato 
50 
to 
.91 
64.0 
Asparagus 
2.70 
to 
3.50 
245.0 
By reference to the table it will be seen that while milk 
contains more salt than most other natural foods it contains much 
less than an equal amount of any of the ordinary cooked foods. 480 
THE NEW DIETETICS 
For example, a quart of milk contains 25 grains of sodium chlorid, 
while the same weight of bread contains two or three times as 
much, ordinary salted butter four or five times as much; and 
cooked vegetables usually contain from five to twenty times as 
much salt as does milk. A milk diet is thus much superior to the 
ordinary mixed diet of cooked foods when salt is to be avoided, 
but is decidedly inferior to natural foodstuffs eaten raw or cooked 
without salt. 
The excessive use of salt is without doubt among the causes 
of several serious conditions. It is particularly harmful in 
pleurisy, in fevers, in Bright’s disease, and has been shown to 
greatly aggravate the symptoms of epilepsy. 
Withdrawal of salt by a salt-free dietary has been found of 
very great value in the treatment of general dropsy and abdom- 
inal dropsy when due either to disease of the kidneys or the 
heart. 
Not infrequently when salt is withdrawn in cases of dropsy 
the excess of fluid disappears almost wholly within a few days. 
In obesity, a salt-free diet accelerates the loss of weight. 
The elimination of salt is also a valuable means of reducing 
high blood pressure. 
The salt-free diet is especially useful in chronic parenchym- 
atous nephritis with dropsy or edema. It is important to dis- 
cover the beginning of edematous accumulations in the viscera 
before external edema develops. Careful comparison should be 
made between the intake and output of chlorids. If the amount 
of chlorids found in the urine is considerably less than that of 
the food, in the absence of profuse perspiration, it may be taken 
for granted that retention of sodium chlorid is taking place. 
It should be remembered, also, that retention of chlorid of 
sodium may occur with edema, the so-called, dry retention. 
In this condition there is usually an increase of arterial pressure, 
vomiting, dyspnea, Cheyne-Stokes breathing, diarrhea, and con- 
vulsions of an epileptiform character may occur. 
Leading European medical journals have reported obstinate 
cases of eczema in which a cure has been effected by the adoption 
of a diet free from salt or nearly so. 
Salt should be eliminated in diabetes, in syphilis, as well as 
in dropsy from disease of the heart, liver and kidneys. 
Mayer mentions salt as one of the causes of war edema. 
The excessive use of common salt raises arterial pressure CONDIMENTS 
481 
very readily in subjects already suffering from arteriosclerosis, 
a rise which quickly subsides on the free excretion of salt. The 
rise of arterial pressure after meals has been attributed to the use 
of salt. 
Tuberculous ascites is treated by Alwens with a diet almost 
free of salt. He gives gruel, rice, cooked fruit, eggs, milk and 
non-salted butter with two-thirds gram of table salt for a few 
days, alternating with a normal diet for a few days. In a large 
number of cases the ascites disappeared completely after five to 
six weeks. Unfavorable cases are those in which the process is 
active and intense and cases with serious complications which in- 
fluence the nutrition and distribution of water in the body. 
It is worthy of note that Dopter has observed that the course 
of scarlet fever is greatly modified for the better when salt is 
eliminated from the diet. If nephritis has appeared, which is 
often the case in severe attacks, it often disappears very promptly 
when the patient is put on a saltless regimen. These observations 
have been confirmed by Peter, of Paris. 
The saltless diet not only lessens the severity of this disease 
and lessens the danger of serious complications, but shortens its 
course. The same is true of all the other infectious diseases and 
particularly of the exanthems, measles and small pox. 
In pneumonia, as well as in typhoid and other fevers, there 
is a tendency to salt accumulation which seems to be due to the 
influence of the poisons upon the body cells and not alone to the 
inability of the kidneys to eliminate the chlorine salt. On this 
account, the use of salt should be reduced to a minimum if not 
entirely eliminated in all febrile disorders. 
In the salt-free diet the amount of salt should never be per- 
mitted to exceed 30 grains daily. In general, the salt-free diet 
is preferable to the milk diet. Better results are obtained and the 
patient is better pleased because of the larger variety of food 
permitted. 
To make the saltless fare acceptable to the patient, care must 
be taken to give the food flavor when salt is omitted by means of 
lemon juice and other simple and wholesome flavors, particularly 
raisins and other fruits. 
Borax versus Salt 
The antiseptic properties of borax and slight toxicity of this 
drug, when compared with many other antiseptic substances, have 482 
THE NEW DIETETICS 
led to its extensive use as a preservative of foods. It has, indeed, 
been advocated as a substitute for salt in the preservation of 
butter. While it cannot be doubted that the use of very small 
quantities of borax or boracic acid might prove less injurious than 
large quantities of salt, it must not be forgotten that all these 
antiseptic substances are toxic and that the desirable thing is to 
dispense with them as fully as possible. Salt is a normal con- 
stituent of the body, and while it has been clearly shown that the 
addition to the food of mineral salt is unnecessary and that large 
quantities of salt do much harm, it is also a fact that salt has 
been longer tested as a food preservative than any other substance. 
Boracic acid is a substance entirely foreign to the body. There 
is no evidence that it can be of any service whatever in the bodily 
functions. If used for the preservation of butter, the safest thing 
would be to remove it by careful washing before the butter is used. 
The adoption of this method in relation to salt would lessen the 
injury from this mineral. Indeed, this method has long been 
practised in the management of cases of Bright’s disease. The 
salt is held in solution in the water or buttermilk left in the butter, 
and hence may be easily removed by washing. Tea and Coffee 
The annual consumption of tea and coffee in the United 
States amounts to more than 10 pounds of coffee per capita, and 
one pound of tea. (U. S'. Crop Reporter). 
In 1921 the per capita consumption was increased to 12.5 
pounds. 
Besides these, there are used considerable quantities of the 
cacao bean in the form of chocolate and large quantities - of 
caffein-containing drinks of the Cola type. 
According to Thompson, one-third of the total coffee pro- 
duced in the world is consumed by the people of the United 
States. 
Coffee contains 3 to 9 grains of caffein per ounce; tea, 6 to 8 
grains; mate, 5 grains; cocoa, more than 4 grains of theobromine, 
a close relative of caffein, and Coca Cola, 4 to 5 grains per ounce 
of the syrup. 
Guarana, a South American herb much used as a beverage, 
contains 17 to 22 grains to the ounce. 
Mallet has shown that one cup of black coffee (about two 
ounces) contains one and three-quarters grains of caffein and the 
ordinary breakfast cup of coffee and hot milk about two and 
two-thirds grain of caffein. Dr. H. W. Wiley’s analyses showed 
two grains of caffein in the coffee served at cheap restaurants, 
and four grains in that served at first-class hotels. 
Tea and Coffee are Poisonous Drugs. 
Caffein is recognized as a poison by all qualified authorities. 
The National Standard Dispensatory says that in large doses 
caffein is “capable of producing marked increase of the reflexes, 
cramps in the extremities, staggering gait and convulsions of a 
tetanic character.” 
The renowned chemist, Lehmann, showed long ago that 
caffein is a highly poisonous substance. He found that so small 
a quantity of caffein as 2 to 10 grains “will produce the most 
violent excitement of the vascular and nervous systems—palpita- 
tion of the heart, extraordinary frequency, irregularity, and often 
intermission of the pulse, oppression of the chest, pains in the 
483 484 
THE NEW DIETETICS 
head, confusion of the senses, singing in the ears, scintillations 
before the eyes, sleeplessness, erections, and delirium.” 
Prof. Lehmann further says: 
The above-named results were yielded by experiments instituted on 
myself and several of my pupils with pure caffein. Five persons, after 
taking from 5 to 10 grains of this substance, were unfit for any business 
during the next day. 
The following table shows the amount of caffein found in 
various caffein-containing preparations: 
Per cent. 
Cocoa (theobromine) 1.00 
Coco Cola 1.00—1.2 
Coffee (roasted) 75—2.05 
Kola 2.00 
Mate 1.115 
Tea 1.35—1.75 
As usually prepared, tea and coffee both contain about the 
same amount of caffein. Dry tea contains about one-third as 
mpch caffein as does the same weight of coffee. Cocoa contains 
about the same amount of caffein as does coffee. Cocoa nibs also 
contain caffein. 
Chronic Caffein Poisoning, 
From the above, it will readily appear that the amount of 
caffein contained in tea and coffee and their congeners is quite 
sufficient to produce toxic effects. 
In view of the fact that the average daily per capita dose of 
caffein by the people of the United States is nearly 2.2 grains 
it becomes evident that the tea and coffee habit is a grave menace 
to the health of the American people. 
The increasing consumption of tea and coffee in this country, 
due in part, perhaps, to the prohibition of alcoholic beverages 
as well as to the extensive advertising campaign organized by 
the producers and distributors of these drugs and the highly 
deceptive and widely scattered announcements of the claims of 
cola manufacturers concerning the virtues of their pernicious 
concoctions, renders necessary the warning of the public as to the 
dangers arising from chronic caffein poisoning. 
Caffein produces a kind of stimulation which forces the cells TEA AND COFFEE 
485 
of the body to do more work than they would naturally do, but 
without repaying them by replacing the energy which they expend. 
Such stimulation of the cell is unnatural and always harmful. 
The cell is much like a storage battery. It must be charged before 
it can discharge. When a battery is fully charged, its voltage is 
high; it can overcome the maximum amount of resistance, and 
can do the maximum amount of work. The same is true of the 
cell. During rest, the cell stores up energy. A rested cell is full 
of “energy granules,” its store of force. The body cells, when 
rested and well stored with energy, manifest their readiness for 
work by a feeling of fitness, which is sometimes called “pep.” 
Activity is the natural overflow of accumulated animal spirits, a 
full charge of vital energy. No stimulus is needed to coerce the 
living cells to give ofif the energy with which they are brimming 
over. 
When one feels unfit, the condition that seems to call for 
stimulation, it is most likely because the cells are lacking in stored 
energy, like a run-down battery. They need charging by food 
intake or rest, or by both. 
The cells may be well charged, but rendered inert or slug- 
gish by stupefying poisons absorbed by smoking or liquor drink- 
ing. 
Caffein destroys the sense of fatigue, but does not “rest you 
in five minutes,” as the advertisements of poisonous caffein soda 
fountain drinks declare. 
Caffein does not in any way whatever repair the vital losses 
which result from work. It only increases the losses. This is 
clearly shown by the fact first pointed out by Dr. Edward Smith, 
the eminent English authority on foods. Dr. Smith demonstrated 
that work under the influence of caffein seems easier than with- 
out it, but that it is followed by an increased sense of fatigue. 
In his two most interesting books, “Across Greenland” and 
“Esquimo Life,” Nansen takes a strong stand against tea and 
coffee as well as alcohol and tobacco. “After having tried the 
coffee extract two or three times in the afternoon and evening, 
and found that, though it cheered them up for a time, they got 
little or no sleep at night, they first restricted themselves to a 
morning cup, and then tabooed it altogether. . . . 
“My experience leads me to take a decided stand against the 
use of stimulants and narcotics of all kinds, from tea and coffee 
to tobacco and alcoholic drinks. It must be a sound principle 486 
THE NEW DIETETICS 
that one should live in as natural and simple a way as possible, 
and especially when the life is a life of severe exertion in an 
extremely cold climate. The idea that one gains by stimulating 
body and mind by artificial means, betrays, in my opinion, not 
only ignorance of the simplest physiological laws, but also a want 
of experience by observation.” 
Dr. H. H. Rusby, dean of the College of the City of New 
York, an eminent chemist, and joint author of the “Standard 
Dispensatory,” says: “It is nevertheless true that caffein is a 
genuine poison, both acute and chronic. Taken in the form of a 
beverage, it tends to the formation of a drug habit quite as char- 
acteristic, though not so effective, as ordinary narcotics. While 
not cumulative in substance, it is so in effects, permanent disorders 
of the cardiac function and of the cerebral circulation resulting 
from its continued use.” 
Coffee Raises Blood-Pressure. 
The effects of caffein upon blood pressure are well known. 
It is, indeed, one of our most dependable drugs for raising blood 
pressure in cases of shock, which fact alone is sufficient to con- 
demn its habitual use as a beverage. The average coffee drinker 
is probably not aware of the fact that in drinking an ordinary 
“good” cup of coffee he is administering to himself a medicinal 
dose of caffein. 
In a paper read before the Massachusetts Medical Society, 
Dr. Bullard gave an analysis of the various symptoms of tea- 
poisoning, obtained from the study of a large number of cases. 
He arrives at several important conclusions: (1) that the action 
of tea is cumulative, and is most pronounced on the young and 
those in a depressed physical condition, although persons other- 
wise healthy not infrequently show poison symptoms; (2) that, 
as a rule, in adult women the average amount needed to cause 
poison symptoms was a little less than five cups daily; and (3) 
that chronic tea poisoning is a frequent affection whose most 
common symptoms are loss of appetite, dyspepsia, palpitation, 
headache, vomiting and nausea, combined with nervousness, and 
hysterical and neuralgic affections, frequently accompanied by 
constipation and pain in the region of the heart. 
The writer has in many cases seen the blood pressure drop 
20 to 40 points in cases of high blood pressure, after the disuse 
of coffee, and with a notable improvement in health and well 
being. TEA AND COFFEE 
487 
Tea, coffee, and the whole family of caffein-containing drugs 
must be regarded as poisons which especially affect the heart and 
blood vessels. The increasing use of these drugs may' well be 
charged with responsibility in part at least for the notable in- 
crease in the death rate from diseases of the heart and blood 
vessels which has occurred within the last thirty years, making 
this class of maladies the chief cause of death in this country at 
the present time. 
The amount of caffein contained in tea and coffee as ordi- 
narily used is practically the same, the chief difference being in 
the fact that coffee contains in addition a considerable amount of 
smoke poisons. 
“Coffee heart” has become a familiar term with life insur- 
ance examiners, who know well the damaging effect of this heart 
poison. 
Tea, Coffee, and Uric Acid. 
The evil effects of uric acid have long been recognized. It is 
probable that uric acid is not responsible for all the mischief 
attributed to it by Haig and others some years ago; but it is an 
excretory poison which the kidneys must eliminate. The very 
first indication of failure in the efficiency of the kidneys is an 
increase of uric acid in the blood. Anything that tends to in- 
crease the amount of uric acid in the blood and urine tends to 
overwork the kidneys and induce their premature failure and 
also to encourage degeneration of the arteries (arteriosclerosis), 
heart, liver and other organs. 
It is a fact well known to chemists that caffein is very closely 
related to uric acid. Both these poisons belong to the same chem- 
ical family, the xanthin group. Their effects upon the body are 
the same. 
Professor Mendel and his students made a careful study of 
the effects of tea and coffee upon the uric acid of the urine. With 
reference to the results, Professor Mendel says: 
“The addition of a strong coffee infusion to a purin (uric 
acid) free diet causes a marked increase in the excretion of uric 
acid. The analyses showed that the amount of uric acid after tea 
drinking was doubled.” There is more uric acid (xanthin purin) 
in a cup of coffee than in the same quantity of urine. 
The damaging effect of this increase of uric acid will be 
better appreciated when the recently ascertained fact is recalled 488 
THE NEW DIETETICS 
that the human liver does not possess the ability to destroy or 
detoxicate uric acid, which is an important function of the liver 
in all carnivorous animals. 
Coffee Cripples the Liver. 
Tibbies, an eminent English authority on diet, calls attention 
to the pernicious influence of caffein on the glycogenic function 
of the liver, which leads him to condemn the use of coffee alto- 
gether. This observation suggests that the coffee habit may be 
one of the causes for the notable increase of diabetes in this coun- 
try in recent years. 
Other Coffee Poisons. 
Tea and coffee contain a notable amount of tannin. This is 
particularly true of tea. Ordinary tea contains 15 per cent, of 
tannic acid. Assam tea contains 32 per cent. Tannic acid is so 
highly soluble that it is impossible to make a decoction or infusion 
of tea which is not strongly charged with this astringent drug, 
the effects of which upon the stomach are highly pernicious. 
Tea could easily he used as a substitute for oak bark in the tan- 
ning of leather. There is no foundation for the prevalent belief 
that the tannin may be avoided by making the infusion quickly. 
Another point of importance which has recently been brought 
out by Dr. L. F. Sayre, head of the School of Pharmacy of the 
University of Kansas, is the fact that the process of roasting 
coffee develops certain incomplete combustion products, phenolic 
in character, or substances allied to carbolic acid, including creo- 
sote, pyridine, and a long series of chemically related poisonous 
substances. 
All of these substances, together with certain oils and caffein, 
give to tea and coffee their toxic properties. 
Burmann has shown that the volatile principle of coffee 
damages the hemoglobin of the blood, depresses the central nerv- 
ous system, causes irregular heart action, and produces dyspnea. 
According to Potter, roasted coffee contains besides, pyridine 
(one of the poisons of tobacco smoke) and furfuryl, a substance 
so poisonous that so small a dose as 1.5 grain will produce per- 
sistent headache, and 7 or 8 grains will kill a rabbit. An exten- 
sive investigation made by Sayre showed that all roasted coffees 
contain these poisons. The observations by Dr. Sayre with refer- 
ence to the poisonous effects of the volatile products resulting TEA AND COFFEE 
489 
from partial combustion found in roasted coffees were verified by 
Dr. Hamilton, head of the biological laboratory of Parke, Davis 
& Company. 
Dr. Sayre calls attention to the fact that the starches and 
sugars of coffee when roasted are in part converted into fur- 
furaldehyde, one of the constituents of bad whiskey. 
Roasting, also, according to Dr. Sayre, converts tannic acid, 
always present in coffee, into catechol, which is more poisonous 
than carbolic acid, and pyrogallol, which is still more poisonous. 
The phenolic substances found in roasted coffees by Dr. 
Sayre have been shown by the experts of the Lederle Laboratories 
of New York to have a decidedly harmful effect upon living tissue 
cells cultivated outside of the body. This most delicate biologic 
test is a convincing and unanswerable proof of the damaging 
character of all roasted coffees. 
Evidently not wishing to be considered as an enemy of the 
coffee business, Dr. Sayre naively says, “We should not condemn 
coffee simply because its toxic principle has been identified more 
certainly.” Certainly not. Coffee is to be condemned not be- 
cause its toxic principles are known, but because of the bad effects 
of these toxic principles, which have been clearly demonstrated, 
not only through the scientific experiments of Dr. Sayre and 
other experts, but by the clinical observations of hundreds of 
physicians and thousands of unhappy victims of the coffee habit. 
Some Poisonous Effects of Tea and Coffee. 
According to Dr. Wm. N. Leszynsky, of New York, coffee is 
particularly poisonous to children, over-exciting the brain and 
producing functional disturbances. He says, “I have often seen 
night terrors, insomnia, tremulousness disappear after the with- 
drawal of coffee.” He attributes to the use of coffee arrest of 
physical development, and tells of a boy six years of age who 
suffered from acute coffee poisoning, the symptoms of which 
were “active delirium, widely dilated pupils, tremor in the facial 
muscles and the extremities, and severe tachycardia, the pulse 
rate being two hundred beats a minute.” The child also had 
hallucinations. These symptoms were produced by eating half an 
ounce of coffee beans. 
Doctor Leszynsky also states that the transitory sensation of 
well-being which is experienced by many susceptible persons after 
taking a cup of coffee “is soon followed by a feeling of apprehen- 490 
THE NEW DIETETICS 
sion, general tremulousness, and indigestion.” He asserts that 
the habitual use of coffee in such persons “invariably leads to 
persistent functional disorder of the nervous system, as well as 
disturbances of digestion.” 
Dr. Gilman Thompson, professor in Cornell University Med- 
ical College, of New York City, asserts that the use of coffee to 
produce wakefulness at night “soon results in forming a coffee 
or tea habit in which the individual becomes a slave to the 
“beverage” and when deprived of it, “suffers from languor, pros- 
tration and restlessness and craving.” Two or three cups three 
times a day produce “muscular tremors, nervousness, anxiety, 
apprehension, palpitation of the heart, vertigo, heartburn, dys- 
pepsia, constipation, insomnia, and emaciation.” 
Doctor Thompson well suggests that coffee users, by sud- 
denly stopping the drug, may discover the ill effects which have 
been produced. The degree of craving experienced is an evi- 
dence of the damage which has been done and of the influence 
which the drug has obtained over the system. 
Gautier, the great French authority, says that coffee pro- 
duces nervous excitement, insomnia, hallucinations, pain in the 
heart, distressed breathing, weakness of the muscles, disorders of 
the circulation. He says, “One may become a caffeis (coffee 
drunkard) just as one may become an alcoholic or morphia 
maniac.” 
Here are some of the poisonous effects as described by Dr. 
John V. Shoemaker, dean of the Medico-Chirurgical College of 
Philadelphia, and professor of materia medica, as described in 
his great work on “Materia Medica and Therapeutics.” 
Caffein paralyzes the absorbing power of the convoluted tubules 
(of the kidney). Small doses cause irritation of* the digestive tract, 
venous congestion and hemorrhoids. 
From a dose of twelve grains (three or four cups of ordinary 
coffee) Doctor Pratt experienced restlessenss, sleeplessness, mental 
depression and tremor. 
Zenetz, an eminent German physician, called attention to the 
dangers of caffein, asserting that three grains two or three times a 
day (two ordinary cups) cause rise of blood-pressure (leading to 
apoplexy), constriction of the chest, dyspepsia, restlessness. Zenetz 
has seen death result from five grains two or three times a day. The 
cause of death was tetanic contraction of the heart. 
Miller, Rehfuss and others, have shown that tea and coffee 
cause trembling of the hands. This effect of coffee is well known TEA AND COFFEE 
491 
to coffee users. Trembling of the hands may be produced by a 
single cup of coffee in susceptible persons. This fact alone is 
sufficient evidence of the dangerous character of this drug. If a 
certain baker’s bread or a particular brand of tomatoes were 
found to produce such effects, it would be discarded at once. Evi- 
dently this is the proper thing to do with coffee. 
According to Tibbies, tea deadens the sensation of hunger, 
inhibits peptic and salivary digestion and causes indigestion, atony 
and catarrh of the stomach. The following bad effects from the 
use of tea are also noted by Tibbies: “Insomnia, palpitation of 
the heart, flushing of the face, muscular tremors, and other signs 
of nervous irritability. 
“Rivers found that an excess of caffein has a very transitory 
stimulating effect, and may be an accelerator of fatigue, and 
‘experiments suggest that caffein is a dangerous stimulant in 
cases of prolonged fatigue or in that tendency to fatigue which 
characterizes neurasthenia.’ Smoking tea in cigarettes is prob- 
ably the most injurious mode of consuming it, the nervous symp- 
toms being much increased.” 
Professor Kronecker, an eminent physiologist of Berne, 
Switzerland, denounces coffee as one of the poisons which is 
blighting the human race, and urges strongly that tea and coffee, 
which as he says contain known poisons, should be discarded. 
The relief from the sensation of fatigue which follows the 
taking of coffee is highly deceptive. It gives to the taker the im- 
pression that the agreeable beverage has wholly removed the ex- 
haustion of which the sense of fatigue was the signal, and conse- 
quently that effort may be continued without injury. This is 
altogether untrue. As a matter of fact, this effect of tea and 
coffee in dissipating the sensation of fatigue is one of the greatest 
dangers which accompany these beverages. They do not cure 
fatigue but only hide it by benumbing the fatigue centers so that 
they are not able to sound the warning signal which indicates 
that effort should cease, to afford opportunity for repair of the 
wasted energies. Experiments conducted by Rivers clearly dem- 
onstrated that the repeated use of caffein produces the “special 
tendency to fatigue which is characteristic of neurasthenia.” 
Tea and Coffee Neurasthenia. 
The widespread use of tea and coffee in England and America 
and in other civilized countries is unquestionably a prolific cause 
of neurasthenia, especially in women who on the whole seem to 492 
THE NEW DIETETICS 
be more susceptible to these drugs than are men, and who are 
more addicted to their use. 
A man or woman who cannot begin a day’s work in comfort 
without one or two cups of coffee, or who suffers from headache 
or nervousness when deprived of the accustomed beverage, is a 
tea or coffee neurasthenic and as much a drug habitue as a person 
who is addicted to the use of opium or cocaine. 
Coffee is without doubt a leading string to other drug habits, 
particularly the use of alcohol and tobacco. Claude Bernard, an 
eminent French physiologist, noted that the victims of the opium 
habit were largely found to be persons who had been much ad- 
dicted to coffee. 
Coffee Insomnia. 
Thousands of men and women are suffering from sleepless- 
ness, nervousness, chronic fatigue, indigestion, hardening of the 
arteries, constipation and various other disorders which are 
caused, perpetuated and continually aggravated by the habitual 
use of coffee. 
Brillat de Savarin, an eminent French jurist and author of 
the celebrated work, “Physiologic du Gout” (Physiology of 
Taste), thus strongly condemned the use of coffee: 
Every father and mother should strictly forbid their children to 
take any coffee, unless they wish to see them shriveled up, bony and 
withered little things before they are twenty years old. 
Savarin tells how that having to do some important work 
for the Minister of Justice he had to sit up all night. In order 
not to fall asleep he drank two cups of coffee. He then found he 
did not have to do the work, and tried to go to sleep. He said, 
“After being two hours in bed, I felt more wide awake than 
ever. I was in a very lively state of mental excitation, and I 
pictured to myself my brain as a mill of which the wheels were 
constantly going without having anything to grind. I therefore 
passed the night without sleeping and without feeling sleepy for 
a single minute. I arose the next morning and passed the whole 
day in the same state. . . . Finally, on retiring to rest the 
second day at my accustomed hour, I concluded I had been forty 
hours without closing my eyes.” 
This experience was sufficient to convince the jurist that 
coffee was a nerve poison. He accordingly renounced its use 
forever. TEA AND COFFEE 
493 
Tea drinking was mentioned by the Irish Commissioners for 
Lunacy as a cause for the increasing insanity among the people 
of Ireland, one of the late results of chronic insomnia and neuras- 
thenia. 
Tea, Coffee and Indigestion. 
Chronic indigestion is a very common result of the use of 
either tea or coffee. Caffein overstimulates the acid-forming 
glands of the stomach, causing hyperacidity and delay of food in 
the stomach. There are strong reasons for believing that the free 
use of coffee causes gastric ulcer, and there are eminent authorities 
who insist that the use of coffee causes cancer of the stomach. The 
production of cancer is attributed both to the caffein and to 
injury from swallowing the beverage at an excessively high tem- 
perature. 
The tannic acid of tea precipitates pepsin, thus causing indi- 
gestion and hyperchlorhydria. 
Sick headache, nervousness, trembling of the hands and in- 
somnia are among the most common of the evil results of the use 
of tea and coffee. 
Roberts found that tea destroys the action of the saliva upon 
the food and prevents the digestion of starch in the stomach, a 
serious hindrance to digestion. Tea drinkers are thus certain to 
suffer from indigestion, through which all the other bad effects of 
tea are aggravated. 
The National Dispensatory, a recognized medical authority, 
says concerning the habitual use of coffee: “When taken for a 
long period of time, it often produces indisposition and acidity of 
the stomach, due to hypersecretion of gastric juice. In other 
persons, it tends to produce biliousness, and in still others 
palpitation of the heart and tremors.” 
Decaffeinated Coffee (Kaffee Hag). 
Certain coffee preparations recently introduced are claimed 
to be free from caffein, but to possess all the other properties of 
ordinary coffee. Unfortunately, such undue stress has been laid 
upon caffein as the one poison of coffee that many persons are 
likely to be beguiled into the use of these preparations, which are 
only a little less injurious than the ordinary preparations of the 
coffee bean. It is true that decaffeinated coffee contains caffein 
only in minute quantities, but in other respects it is like other 494 
THE NEW DIETETICS 
coffees. Being roasted, it must contain pyridine, catechol and 
other phenolic bodies more poisonous than carbolic acid, together 
with various other toxic smoke products—poisons which in small 
quantities kill frogs, guinea pigs and rabbits, and have been 
shown to cause headache in minute doses as well as disturbances 
of respiration and heart action, and to produce destructive effects 
upon the blood. 
These unwholesome properties are certainly quite sufficient 
to render decaffeinated coffee unworthy of recommendation as a 
beverage. Nature has supplied us with pure water, with a great 
variety of fruit juices and wholesome and harmless flavors quite 
sufficient to meet all our needs. Tea, coffee and their congeners 
are all substances which are unattractive in flavor, and the taste 
for which must be acquired. Even then, the majority of users 
of these drugs find it necessary to conceal their natural flavors by 
means of sugar, cream and other more agreeable substances. 
Coffee and tea are particularly objectionable for children 
because they lessen the time spent in sleep and thus diminish the 
opportunity for growth. In adults these drugs in the same way 
lessen the opportunity for tissue repair and so hasten the begin- 
ning of old age processes and lessen the length of life. 
A report of the Connecticut Agricultural Experiment Station 
states that vacuum coffee contains the same amount of caffein as 
does ordinary coffee. “George Washington Coffee” contains about 
four times as much as ordinary coffee. 
Mate* 
Efforts have recently been made to introduce into the United 
States the use of mate, a caffein-containing product of South 
America. Mate consists of the powdered leaves of a variety of 
holly, a native of Paraguay. It contains caffein, but in somewhat 
less amount than tea. 
Mate was found in use by the Indians when discovered by 
the Spaniards. It was introduced into England more than a 
century ago, but was unable to compete with tea as a mild intoxi- 
cant. Its properties are essentially the same as those of tea and 
coffee. 
Coca Drinks* 
A prominent medical journal published during the war the 
following warning against caffein-containing drinks : TEA AND COFFEE 
495 
We understand that the government is interested in the sale of 
caffein drinks to the soldiers, which are admitted to have done very 
great harm to them, lowering the morale and injuring the health of 
the victims. They are conceded to have encouraged crime and im- 
morality. 
But is there not an inconsistency involved in this crusade against 
caffein drinks, so long as the men are provided with coffee? Why 
should young and vigorous men in the service be habituated to a 
powerful stimulant which they do not need, and which is known to 
be pernicious, while at the same time caffein drinks are prohibited 
outside the camps? 
Caffein the Cause of Goiter, 
Dr. von Wedekind, of the United States Navy, writing to 
the Journal of the American Medical Association in 1912, called 
attention to the remarkable frequency of goiter in young men 
applying for enlistment in the navy. Among the questions asked 
these young men wTas, “What beverages do you drink?” and in 
every case the reply was “Coca-cola.” These, with previous ob- 
servations, led to the conclusion that caffein may be a cause of 
goiter. It is well known that caffein is the active constituent of 
Coca-cola. 
Soda Fountain Drinks Containing Caffein. 
Dr. Wiley has shown that coca drinks contain practically as 
much caffein as does the same amount of coffee. They are simply 
flavored decoctions of caffein. 
There are mischiefs in the soda fountain preparations which 
render them even more dangerous than coffee. These are, first, 
the fact that they are always ready and accessible at any hour of 
the day and night. Second, that they are generally supposed to 
be not only innocent of possible harmful effects, but through 
most alluring advertising are presented to the public as possessing 
most remarkable beneficial properties. As a result, not only adults, 
but children are induced to use caffein in the form of a soda foun- 
tain beverage, and in larger quantities than coffee would ever be 
used. In other words, the public are beguiled into a “dope” habit. 
Cola drinks are an insidious poison, the sale of which should be 
prohibited by law. Dr. Wiley’s campaign against this nefarious 
traffic was wise and timely, and should have had the support of 
all medical men. 496 
THE NEW DIETETICS 
Coffee Substitutes, 
Most coffee substitutes consist of cereals in some form com- 
bined with molasses and roasted until a part of the starch and 
sugar are caramelized. The process of roasting which is always 
employed develops in these substitutes poisonous phenolic and 
other smoke products the same as are produced in ordinary coffee. 
These substances may be present in such quantity as to cause 
nausea and vomiting. Of course, caffein is not present in cereals. 
But cereal coffees charged with smoke poisons may be the source 
of as much harm as that which usually results from ordinary 
coffee. 
In the writer’s opinion roasted cereal coffee substitutes are 
unwholesome and cannot be recommended. The best plan is to 
overcome the coffee habit by getting rid of the taste for coffee 
instead of cultivating a taste for a substitute. If a substitute is 
insisted upon it should be prepared without roasting. The writer 
knows of only one coffee substitute which is prepared in this way 
and which can be recommended as safe. This is a cereal beverage 
which is prepared by a process which does not involve roasting, 
so that there is no opportunity for the development of the harm- 
ful phenolic bodies or smoke poisons which are present in all 
roasted coffees, including coffee substitutes prepared from cereals. Tobacco 
Smoking after or in connection with meals has become so 
common a practice that a brief reference to this pernicious habit 
seems proper in a work devoted to nutrition and dietetics. Tobacco 
is by no one claimed to be a food, although value has been claimed 
for it on the ground that by its use the consumption of food is 
lessened. This means nothing more than that by its poisonous 
effects the activities of the body cells are interfered with, cer- 
tainly not a useful property. 
The Effects of Tobacco, 
Tobacco smoking produces a sort of comfort or solace be- 
cause of its narcotic or sedative effect upon the nerve cells, 
especially the cells of the higher cerebral centers which are con- 
cerned in thought. The continued use of tobacco, however, as 
has been pointed out by Tibbies, “causes degeneration of the same 
cells (brain cells), and thus leads to loss of power of thought, 
enfeeblement of the attention or power of concentration, and de- 
terioration of the memory.” 
Rivers demonstrated by means of the ergograph that tobacco 
has a most unfavorable influence upon capacity for muscular 
work. Lombard, professor of physiology of the University of 
Michigan, demonstrated the same toxic influence of nicotine upon 
the muscles. He demonstrated that a single cigar lessens muscular 
power for many hours. 
The tobacco habit leads to serious impairment of the move- 
ments and secretions of the stomach and intestines and gives 
rise to dyspepsia, gastric catarrh, and impaired nutrition. Under 
the influence of this drug the body cells act with less vigor, meta- 
bolism is reduced, and all the life processes are slowed. 
Tobacco a Heart Poison, 
The first effect of a cigar is to raise the blood pressure and 
slow the pulse, but this effect is later followed by a quickening of 
the pulse. The pulse of the old smoker becomes irregular, and 
myocarditis and other changes in the heart are produced. Ac- 
cording to Tibbies, “the juice from 22 pounds of tobacco yielded 
497 498 
THE NEW DIETETICS 
2.2 pounds of nicotine, two-thirds of an ounce of nicoteine, one- 
sixth of an ounce of nicotinine and 15 grains of nicotelline,” all 
deadly poisons. 
Angina abdominis, a form of angina affecting the vessels of 
the abdominal organs which is characterized by crises of very 
severe abdominal pain, has been shown to be one of the conse- 
quences of smoking. 
French tobacco contains 7 or 8 per cent, of nicotine, which is 
the principal poison of tobacco. In Kentucky and Virginia 
tobacco 6 to 7 per cent, of nicotine is found: In smoking the nico- 
tine is partially destroyed, 50 per cent, of it remaining. The smoke 
contains besides nicotine, pyridine, hydrocyanic acid, ammonia, 
carbon monoxide and numerous other poisons, some twenty or 
more. 
The highly poisonous effects of carbon monoxide are well 
known. Carbon dioxide, or carbonic acid gas, is a comparatively 
harmless poison. It is, of course, irrespirable, and in pure or 
rather concentrated form will produce asphyxia; but carbon 
monoxide is deadly in minute doses. It is found in considerable 
quantity in cigarette smoke, as shown by Hartridge (Journal of 
Physiology, 53). This investigator has shown that heavy smokers 
are in a state of chronic carbon monoxide poisoning. 
We are glad to be able to quote the following keen and thor- 
oughly just criticism of the tobacco habit from so competent a 
medical authority as the New York Medical Journal (Feb. 2, 
1918): 
Psychical Pharmacology of Nicotinism.—Of the three principal 
narcotics used in this country, nicotine for several reasons leads in 
popularity. One of the reasons is that nicotine most quickly satis- 
fies the longing of the storm tossed “mental” and of the inept neuron. 
Tolstoi said that after the first whiff from his pipe he no longer felt 
the prick of conscience. To be able to banish care is, to a jaded 
mentality, the one supreme requirement of a narcotic. Nicotine 
exalts the ego. The nicotine-enthused and flattered ego feels like 
advertising its way of taking a narcotic. The user actually feels that 
everybody likes, or at least ought to like, everything that goes with 
his use of nicotine. To him it is entirely unbelievable that a sane 
person can object to any feature of its use. The grandeur intoxication 
prompts the customary good-natured obtrusion of the practices of 
nicotinism into the presence of others. As care flees away in the 
intoxication, there comes in its stead a feeling of being at peace with 
the world. The narcosis grants the peace, but the condition of peace 
always is that the use of nicotine is not to be interfered with Because TOBACCO 
499 
the narcotic effect is upon the ego itself, inflated ideas as to personal 
estimation of the meaning of the intoxication and resentment to any 
and all criticism of nicotine are very acute. 
The reactions of public opinion to these features of the narcosis 
are favorable to the public use of nicotine. This accords with the 
psychological law, that the mind is likely to be captivated by that 
which presents a bold front of assumed sincerity. Public opinion 
does not give ‘the matter study before it sanctions the public use of 
nicotine, but the use forces itself upon the public, and as non endorse- 
ment of the narcotic act means a fight, the peace-loving instinct in 
man surrenders to nicotine. The medical matter involved is that the 
end results of nicotine narcosis are never as good as the non-narco- 
tized man would have been capable of. Besides its use violates every 
principle of scientific medicine. 
The tobacco habit has obtained almost a strangle hold upon 
society in every civilized land and is rapidly invading the coun- 
tries just emerging from a less sophisticated and possibly less cul- 
pable heathenism. Sometime the hold will be broken and this 
pernicious drug habit, a gigantic curse of modern civilization, will 
be cast off as a handicap which a degenerating race can no longer 
tolerate. Already, forces are at work which within a quarter of 
a century, if not sooner, will so discredit the delusive drug that its 
condemnation by sane and intelligent men and women will be uni- 
versal, One of the most important of these agencies by which this 
good work will be accomplished we believe to be “The Committee 
of Fifty to Study the Tobacco Problem,” which has initiated and 
is carrying forward important researches on all phases of the to- 
bacco question as related to human welfare, physical, mental and 
moral, by the aid of scientific experts of such national and inter- 
national standing that their findings, when published, and the 
ultimate verdict when rendered, will be above and beyond dispute 
or refutation. A similar authoritative scientific inquiry on the 
alcohol question laid the foundation for prohibition and the over- 
throw of the saloon; and a like inquisition followed by a nation- 
wide educational campaign will in due time abolish the smoke 
nuisance, a thing too impudent and offensive, to say nothing of its 
insidious destructiveness, to be tolerated by a decent and rational 
society. Ptomains—Poisoned Foods 
Ptomains are poisons produced by the decomposition of pro- 
tein. They are particularly encountered in decomposing animal 
foodstuffs, and especially in flesh that has been too long kept 
after the slaughter of the animal. Some of the ptomains are 
highly virulent poisons. The most deadly are likely to be found 
in sausage, hamburger steak, game, and chickens, turkeys, ducks 
and geese which have been long in cold storage. 
Ptomains are produced in the early stages of decay and so 
may he present before there is any taint of decomposition per- 
ceptible to the senses. On this account it is, in the writer’s 
opinion, important that all meats, including fish, should be exam- 
ined bacteriologically before using as food. Meat may be swarm- 
ing with putrefactive, ptomain-producing bacteria when only re- 
cently killed—within a few days—and when apparently perfectly 
fresh. Such meat should be condemned. 
Oysters and mussels may contain deadly ptomains when 
fresh, doubtless because they are scavengers and subsist upon the 
affal which they find in the water, especially about river mouths. 
There are more than 60 different ptomains known, of which 
may be named, cadaver'me, putrescin, butylamin, amylamin, 
nenridine, saprin, sperium, mydalein, cholin, neurin, muscarin, 
betain, gadinin, mytilotoxin, callidin, parvolin, corrindin, mor- 
rhuin, asellin, typhotoxin, tetanin, spasmotoxin, telanotoxin, 
pyocyanin, tyrotoxicon. 
Among the most deadly of these are cadaverin, putrescin, 
neurin, neuridin, and cholin, found in stale meat and fish; mytilo- 
toxin, occurring in oysters and other shell-fish; muscarin, found 
in meat and mushrooms; and tyrotoxicon, the deadly cheese 
poison, sometimes found in milk and ice cream. 
This is certainly a formidable array of deadly agents, nearly 
all of which may be escaped by avoiding flesh foods, which under 
all ordinary circumstances must be regarded as wholly unneces- 
sary additions to the bill of fare. 
500 Food Toxins. 
PTOMAINS—POISONED FOODS 
501 
Besides' ptomains, there may occur in food other deadly 
poisons known as toxins. These are the result of the growth in 
animal tissues, either before or after slaughter, of germs which 
cause specific infections. One source of food toxins is a germ 
which gives rise to botulism. This germ grows readily in fish 
and meats which have not been properly processed in canning. 
It has also been found in spoiled canned beans, spinach, and ripe 
olives canned in glass. 
Animal foods are especially liable to contamination with 
poisons which may be produced by the action of either specific 
germs or the ordinary organisms which produce putrefaction. 
Sausages, potted meats, fish, oysters, lobsters, eels and canned 
meats which have spoiled in the can or been allowed to stand 
after opening, often contain poisons which produce very severe 
and often fatal illness. 
Meat poisoning often results from the ingestion of Gartner’s 
bacillus in cold storage meats. It most frequently occurs as the 
result of eating pork, veal, fowl, beef or ham. 
Fish poisoning may result from the use of fish that are partly 
decomposed or diseased, or which have spoiled in the can, either 
before or after opening, or it may result from the use of fish of 
certain species which are always poisonous. Fish sometimes be- 
come poisonous through feeding on decomposing corals and other 
poisonous substances. 
Poisoning often occurs as the result of eating shellfish which 
contain a special poison, mytilotoxin. Shellfish are scavengers 
and thrive in the vicinity of the outlets of rivers which receive 
the sewage in large cities. Typhoid fever and other germs are 
found in the intestines of shellfish. Oysters strain the water 
through their gills and capture great numbers of bacteria and 
other organisms as well as particles of decomposing matter. The 
poison found in these creatures is chiefly concentrated in their 
livers. 
Oysters and shellfish of all sorts are always swarming with 
bacteria. Oyster juice is fairly alive with the wriggling bacilli. 
Raw shell fish are too unclean to be given a place in any stomach 
except that of a scavenger. 
Other virulent poisons have been found in the flesh of 
animals which when slaughtered were suffering from pyemia, 
septicemia or specific enteritis. 502 
THE NEW DIETETICS 
The flesh, milk, and dairy products from cows infected with 
foot and mouth disease, particularly cheese, butter, and milk, may 
give rise to the same disease in human beings. 
Acute poisonings from animal foods are frequently seen in 
the sickness which follows the use of herring, pickled fish ad- 
vanced in decay, particularly stale oysters, salted sturgeon and 
tainted horse flesh. 
The flesh of hunted animals often becomes poisonous through 
the entrance of the B. coli into the blood before death. 
Cold storage meats sometimes become poisonous from the 
slow decomposition which takes place even at temperatures only 
a little above freezing. 
Rouennaise ducks are rendered poisonous by the peculiar way 
in which they are killed. They are killed by a puncture of the 
medulla, which causes death without loss of blood. They are 
afterwards beaten, causing absorption of intestinal bacteria and 
poisons which are diffused throughout the body. 
Hamburger Steak* 
Hamburger steak is usually prepared from odds and ends, 
trimmings of meats which have often been accumulating for sev- 
eral days. The retail butcher keeps under his counter a receptacle 
into which these scraps are thrown. When a sufficient amount 
has been collected, the mass is worked over and served up in a 
form which offers no suggestion of its miscellaneous origin. Meat 
inspectors report that not infrequently the butcher neglects to 
scour and disinfect his collecting receptacle and in consequence 
it is often found with fragments of putrid meat clinging to its 
interior, and in hot weather are found swarming with maggots. 
In view of these facts it is evident that Hamburger steak can- 
not be too strongly condemned as an article of food for human 
consumption; According to Weinzrl and Newton who some 
years ago (1914) made an extensive study of Hamburger steak 
and other meats with reference to their bacterial content, steak 
practically always contains 1,000,000 bacteria to the gram, or 
30,000,000 to the ounce even “when showing no taint or other 
evidence of putrefaction,” and half the samples contained 10 
times as many bacteria, or 300,000,000 to the ounce. 
According to these authors, fully half of all the Hamburger 
steak offered for sale “is potentially rotten.” As a matter of fact 
it is evident from the above statements that all Hamburger steak PTOMAINS—POISONED FOODS 
503 
is potentially rotten since the difference between the best and 
worst samples is only one of degree. Putrefactive bacteria grow 
so rapidly that their numbers may easily multiply 10 fold or 
even more within 24 hours under favorable conditions. 
Moldy Meat* 
The average meat-eater is probably not aware that the meat 
he consumes at the breakfast table often belongs to the long- 
neglected-to-be-buried type. The fact is that meat kept long in 
cold storage grows such a prodigious crop of mold, bright green, 
black and other colors, that it has the appearance of being covered 
with a flourishing beard. 
The Food Investigation Board of Great Britain has been 
making a study of the fungi of frozen meat. Special Report No. 6 
contains information concerning “the black spot and other types 
of fungi found on chilled and frozen meat. Black spots on the 
surface of beef and mutton brought from the Argentine and New 
Zealand and some other countries are commonly found upon 
arrival.” 
These black spots are produced by molds of fungi and indi- 
cate that the meat has been stored for a long period before ship- 
ping. The spots are frequently so numerous that they overlap 
one another and the fungus threads penetrate below the surface 
of the meat. Experiments have shown that these fungi grow at 
temperatures 10 or 12 degrees below freezing. 
The writer was recently informed by a Boston meat dealer 
that hotel chefs preferred meats that were covered with slime, 
doubtless because such meats are much more tender, being far- 
ther advanced in putrefaction. 
Edelmann, Mohler and Eichhorn, in their Text-Book of Meat 
Hygiene, quote Marxer as authority that “meat should be consid- 
ered as putrefactive if one gram contains over a million organ- 
isms of any kind, or proteus bacteria in large numbers.” 
According to Weinzrl and Newton, a standard of 1,000,000 
bacteria per gram (30,000,000 per ounce) “would, condemn nearly 
all samples of hamburger, when showing no taint or other evi- 
dences of putrefaction. Samples of other market meats, all of 
which would otherwise pass inspection, often exceed this limit.” 
It is evident that whether the standard be 1,000,000 or 
10,000,000, it is a question of degree of rottenness, since the 
lower standard named means not less than 30,000,000 bacteria 504 
THE NEW DIETETICS 
per ounce, and bacteria of the most objectionable class, including 
B. Welchii, the terrible organism of gas gangrene. Hamburger 
steak is carrion, and quite unfit for food except by a turkey buz- 
zard, a hyena, or some other scavenger. 
Poisons in the Flesh or Milk of 
Sick or Overworked Animals. 
The flesh of a horse which was killed in the effort to break 
him was fed to hogs. The hogs sickened and died. (Kahnert). 
The flesh of a deer caught in a trap and killed by its efforts 
to escape was the cause of sickness in a large number of persons 
who ate of it. The infant of an overworked mother showed 
marked symptoms of poisoning which disappeared when the child 
was nursed by another woman. 
It has long been known that.the flesh of overworked animals 
undergoes putrefaction very rapidly after death. It is even pos- 
sible that in such cases the tissues of the animal may be pervaded 
by bacteria during life on account of the greatly lowered resist- 
ance which results from overwork. It should be generally known 
that the flesh of an animal subjected to violent exertion or over- 
work before killing is absolutely unfit to eat.' Without doubt, 
many such animals find their way to the market. 
Some years ago the people of Boston were very much dis- 
turbed by the discovery that animals which had been condemned 
by the State Board of Health because of infection with tubercu- 
losis were sold in their markets. Investigation showed that such 
animals were regularly disposed of for food purposes. The de- 
fense of the board was that the same practice prevailed in other 
states and was recognized as legitimate by the United States De- 
partment of Agriculture. This repulsive practice seems to he 
general. 
A case was reported by Bollinger in which sixteen persons 
were made sick by eating sausage made from the body of a pig 
which had received arsenic as a remedy. 
It should always be recollected that fish are scavengers, and 
when caught in waters near the mouths of sewers are very likely 
to be infected by the sewage which they greedily consume as food. 
Poisonous substances are found in the flesh of animals which 
have suffered from apoplexy, especially hogs, animals which have 
died of indigestion and which have been affected with dropsy or 
infectious disorders. Poisons of this sort are not destroyed by PTOMAINS—POISONED FOODS 
505 
cooking and have given rise to symptoms in human beings re- 
sembling cholera or typhoid fever. Of more than one hundred 
people who ate of a cow that had died of puerperal fever half 
were made very sick. 
The flesh of animals which have suffered from disease of the 
lungs, from enteritis, peritonitis, nephritis, and hepatic affections, 
always contain poisonous substances and are wholly unfit for 
food. 
Dr. Weseberg reported some time ago an epidemic of meat 
poisoning in which sixty-three persons became seriously ill as the 
result of eating the flesh of a cow which had been killed because 
of pericarditis resulting from an accident. The persons who be- 
came ill had eaten of minced meat prepared from the animal and 
also portions of the cooked liver. The symptoms resulting were 
violent headache, severe abdominal pain, dizziness, muscular 
weakness, diarrhea and vomiting. Bowel discharges were highly 
offensive. Mice inoculated with portions of the meat died within 
one to three days, with symptoms similar to those shown by the 
persons who had eaten of the same flesh. 
When the fact is recalled that all the flesh sold in the market, 
and practically all that is eaten, is swarming with the bacteria of 
putrefaction, the wonder is that the number of persons who 
suffer from acute symptoms of poisoning after eating flesh is so 
small. 
Milk from Tuberculous Cows Poisonous. 
When it is recalled that in the most favored portions of the 
United States 5 to 10 per cent, of all the milch cows are tuber- 
culous, while in many states the proportion of infected animals 
reaches 25 per cent., some idea may be formed of the enormous 
mischief done by the use of the milk of tuberculous cows. Milk 
should be regarded as unsafe for use as food unless known to 
be produced by cows proven by federal inspection to be free 
from tuberculous disease. 
Roger insists that too much precaution cannot be taken 
against the use of the milk of tuberculous animals, since the 
cooking of milk does not render it harmless. The researches of 
Calmette and Breton demonstrate that the ingestion of dead 
germs may produce a fatal cachexia. Even though it contains no 
bacilli, the milk of tuberculous cows should be rejected. When 
such milk is given to young rabbits or injected under the skin of 506 
THE NEW DIETETICS 
guinea pigs, the animal falls promptly into a state of cachexia 
and marasmus. The experiments of Pasq. de Michele show that 
such milk contains poisons which are not destroyed by boiling or 
by digestion. 
Poison in Clams. 
Soper says: “It is not unusual to see persons digging hard 
clams close to the mouths of sewers. After a very short period in 
market this form of shellfish is often eaten raw. Hard clams are 
particularly in favor during those warm months when oysters 
are out of season and diarrheal diseases are most common. It 
would not be at all surprising if many outbreaks of diarrheal 
disease at seaside summer resorts were traceable to hard clams 
taken from nearby polluted sources. 
“Heavily polluted shores are among the most prolific sources 
of soft clams, and large quantities are annually taken from situa- 
tions of this kind.” 
Typhoid from Oysters. 
An investigation made by Klein and Boyce of typhoid fever 
epidemics in Brighton, England, traced the disease to the use of 
oysters. Sewage bacteria were found both in the oysters and in 
the mud. The proportion of cases definitely traced to the use of 
oysters was in 1894, 38 per cent.; in 1895, 34 per cent.; in 1896, 
32 per cent.; in 1897, 31 per cent. Certainly proportions suffici- 
ently large to condemn the oyster as a food under any condition 
except the absence of any more wholesome sustenance. 
Poisonous Ice Cream* 
The unwholesomeness of ice cream, on account of its low 
temperature and depressing influence upon the activities of the 
stomach, has long been appreciated, but the great danger of infec- 
tion from this source has within the last few years been made 
clear by bacteriological studies conducted in the biological labora- 
tory of the city of Philadelphia by Drs. Pennington and Walter. 
Physicians constantly meet cases of disease of the stomach, both 
acute and chronic, which are directly traceable to the use of ice 
cream. This matter is especially important in view of the large 
amount of ice cream consumed by young children and invalids 
and its extensive use in connection with soda water. 
It was found by Drs. Pennington and Walter that the strep- 
tococcus, a pus-forming organism which is always found in ice PTOMAINS—POISONED FOODS 
507 
cream, is the principal cause of the acute disorders directly trace- 
able to its use. Escherich, Kaiser, Petroschky and others have 
called special attention to the dangerous character of the strepto- 
coccus found in milk, and attributed to this microorganism a 
large part of the infant mortality which occurs in the summer 
time. Heynemann found that the streptococci of milk readily 
take on the highest degree of virulence, especially in persons 
whose resistance is low. There are many such persons who show 
signs of bacterial infection whenever they eat ice cream. In the 
special research above referred to streptococci were found in 
80 per cent, of the samples examined. Of 50 per cent, of the 
samples examined, all but three contained more than 500,000 
microorganisms per cubic centimeter (15,000,000 per ounce). 
Ice cream is usually made from stale cream. It is cheaper, 
and it is claimed makes better ice cream than fresh cream, because 
it is near the souring stage. The pasteurization which ice cream 
makers give the cream rather encourages the growth of bacteria 
by the increased temperature, as the presence of fats protects the 
microorganisms from the heat, so that a higher temperature is 
required than that used in pasteurization to kill the bacteria of 
milk. It is more than probable that the cheap ice cream which is 
sold in the summer time is largely responsible for the wide pre- 
valence of diarrheal disorders at this season. 
Cheese Bacteria. 
Professor Adametz made some years ago an interesting study 
of cheese, in which he identified nineteen varieties of bacteria 
which are ordinarily active in the ripening of various sorts of 
cheese. Some of these bacteria are furnished by the milk, others 
are derived from the vessels in which the milk is kept, still others 
from the air and from the rennet ferment added to the milk in 
the process of cheese-making. In certain cases molds or other 
fungi are added, as in the case of camembert cheese. Adametz 
estimated the number of bacteria in cheese to be about 25,000,000 
germs to the ounce. Roquefort cheese is made by adding to the 
curd of milk, mold from a dough made from barley flour, with 
which yeast and sometimes vinegar have been mixed. The mold 
which forms on this dough when allowed to stand, is rubbed into 
a powder and added to the milk. Gorgonzola and Stilton cheese 
are made by the same process. The mold consists of several 
varieties of fungi, one being the common green mould frequently 508 
THE NEW DIETETICS 
found in bread and other food kept in warm moist places. Ein- 
horn has shown that molds sometimes take up their abode in the 
stomach, form colonies on the mucous membrane, and thus be- 
come a cause of grave disease. 
Cheese Poisoning. 
Cheese poisoning is due to tyrotoxicon. This was discovered 
hy Vaughan forty years ago (1883). A large number of cases 
of cheese poisoning, some three or four hundred in all, had 
then been reported to the Michigan State Board of Health. At 
the suggestion of the writer, at that time a member of the Board, 
Dr. V. C. Vaughan, of the University of Michigan, was asked to 
make a special research for the purpose of ascertaining if pos- 
sible the cause of the poisoning. After some months of careful 
study of the subject, Dr. Vaughan announced the discovery of 
tyrotoxicon, a ptomain which in minute doses produces vomit- 
ing and purging, pain in the region of the stomach, feeble heart 
action, cyanosis, and in larger doses speedy death. Cheese con- 
taining this poison does not differ in appearance from ordinary 
cheese, and to the taste and smell of human beings gives no indi- 
cation of being unwholesome, the distressing symptoms appearing 
some hours after it has been eaten. But cats and dogs, which 
readily eat ordinary cheese, at once recognize the poisoned cheese 
and refuse to eat it. Cats die quickly in convulsions when in- 
jected with small doses of tyrotoxicon. 
Poisons in Plant Foods. 
Plants sometimes absorb poisons from the earth. Paul Bert 
watered radishes with water containing strychnia. The radishes 
accumulated so much strychnia that they killed the animals to 
which they were fed. 
Poisonous mushrooms may cause death from the muscarin 
which they contain. The poisonous mushroom is much used in 
Siberia for preparing an intoxicating drink. This form of in- 
toxication is so pleasing to those addicted to it that, according to 
Roger, “The poor do not hesitate, it appears, to drink the urine 
of the rich in order to enjoy the same pleasures.” 
The Poisons of Molds. 
Certain molds, particularly black and orange molds, produce 
poisons which cause vertigo, colic, sweating and even coma, symp- PTOMAINS—POISONED FOODS 
509 
toms similar to those produced by the poisons of the mushroom. 
These poisons are destroyed, however, by oven heat. 
M. Pietro, an Italian investigator, in the study of pellagra 
made the discovery that the common green mold known as pen- 
nicilium glaucum, produces a highly toxic substance in its spores. 
This toxin is active when introduced into the stomach or under 
the skin. Dogs, rabbits and guinea pigs are sensitive to its effects 
as well as human beings. The poison of green mold produces 
muscular trembling, paralysis, spasms and other symptoms which 
in many respects resemble those present in pellagra. 
Moldy grain and flours prepared from such grain may give 
rise to poisoning from the specific poisons developed by molds. 
Lathyrism. 
This is a form of poisoning produced by the chick-pea. It 
has sometimes occurred as the result of eating flour adulterated 
with the chick-pea. The disease is also known as lupinosis. 
Ergotism. 
This is a form of poisoning due to the eating of grain, par- 
ticularly rye, infected with “smut.” In the Middle Ages severe 
epidemics of this disease, then known as St. Anthony’s, occurred 
at various points in Europe. In recent times epidemics have 
occurred in Russia. 
Actinomycosis. 
This is a parasitic disease which sometimes rather resembles 
cancer in its gross appearance. It may give rise to abscesses in 
bones, in the brain, or in the liver. Its origin is not well known, 
but probably comes from contact with cattle. 
Infected Vegetables. 
Melee has shown that radishes grown in contaminated soil 
showed infection after 28 to 37 days; lettuce, after 21 days. The 
bacteria were found only on the outside of the plants, and were 
not removed by ordinary washing. This shows the necessity for 
disinfection with peroxide of hydrogen or hydrochloric acid or 
chlorine. (See index.) 
The Germs of Fruit Skins* 
Professor Ellen H. Richards, of the Massachusetts Institute 
of Technology, made some years ago a study of the condition of 510 
THE NEW DIETETICS 
fruit found on open air fruit stands. A pint of various fruits 
taken at random from a stand were washed and a bacteriological 
examination made of the washings. 140,000,000 germs were 
obtained from this single pint of fruit. Fruit thus exposed to 
street dust is certain to collect a great number of germs derived 
from the excreta of animals and other dangerous sources, and is 
quite unfit for food. Market fruit should be disinfected by wash- 
ing and soaking five minutes in a solution of fresh chloride of 
lime, an ounce to the gallon. 
Infection from Flies. 
Fruits and other foods may become a source of infection 
through the medium of flies. Flies are in the summer always 
liable to be carriers of infection. Epidemics of typhoid fever 
have not infrequently developed through the medium of flies. 
Hence, these pests should be carefully excluded from kitchens, 
pantries and dining rooms, and should never under any circum- 
stances be allowed to come in contact with food. 
Ladd reports the results of an examination of grapes in 
which “the grapes from the outside of the cluster were found to 
bear colon bacilli, approximately 100 colon bacilli per grape. 
Botulism. 
The increasing prevalence of this disease, outbreaks of which 
are now frequently appearing in different parts of the country, 
renders it necessary to be sharply on the lookout to prevent seri- 
ous or even fatal poisoning. This duty is especially incumbent 
upon proprietors, dietitians and chefs of hotels, restaurants, 
boarding houses and other eating places, and especially hospitals, 
and other institutions where canned vegetables are much used. 
Botulism is a disease due to poisons produced by spore- 
forming organisms of which there are two types, A and B. The 
germs themselves do not grow in the human body; hence the 
effects are produced by the poisons already developed in the 
spoiled food, the eating of which is the cause of the disease. In 
former times attacks were usually the result of eating spoiled 
salmon, sardines or some other sort of canned fish or meats. More 
recently, attacks have resulted from the use of canned beans, 
beets, olives or spinach. The cans are usually bulged and the 
contents have an unpleasant flavor and offensive odor. An 
offensive odor is not always present, however. PTOMA1NS—POISONED FOODS 
511 
The cause of botulism appears to be lack of cleanliness, the 
use of decomposing materials, and insufficient processing. If the 
goods are processed at a sufficiently high temperature (240° F.) 
the spores as well as the germs which produce them will be de- 
stroyed. When the cans are not heated at a sufficiently high 
temperature, the spores are left viable and later develop, produc- 
ing the highly virulent poison characteristic of B. botulinns. For- 
tunately, thorough heating at the boiling point will destroy the 
poison. In the outbreaks which have occurred, the foods have 
been eaten cold or have been insufficiently heated. When cans 
are bulged or “flip,” the goods should be promptly rejected no 
matter whether an offensive odor is present or not. The slightest 
taint should always lead to the rejection of canned goods; but 
even when no evidence of spoiling is present it is necessary for 
entire safety to subject canned vegetables of all sorts to thorough 
boiling before serving. 
Dr. Robert Graham has recently shown that B. botulinus is 
often present in flour, though fortunately not in a state dangerous 
to human life. 
When an attack of botulism occurs, one of the first symptoms 
is double vision. Headache, more or less gastric disturbance and 
a peculiar feeling in the throat with difficulty in swallowing 
are characteristic symptoms. Drooping of the eyelids is another 
prominent symptom, and great prostration in severe cases. Some- 
times there is a disappearance of the symptoms shortly after the 
beginning of an attack. The patient may feel well enough to 
resume his usual duties; but after twenty-four hours a relapse 
may occur. Fever is usually absent. 
The symptoms of botulism may be so mild as to be hardly 
noticeable. In other cases the attack may prove rapidly fatal. 
At the present time more can be accomplished by prevention 
than by curative measures after an attack has developed. 
The disease is very frequent among fowls, cattle and horses, 
among which it is known under various names, such as “limber 
rock,” “blind staggers,” “corn stalk disease,” “forage poisoning,” 
etc. 
Parasitic Infection of Foods. 
Certain foods, particularly animal foods, are liable to become 
injurious to health through the presence of parasites. Among the 
parasites which may be present in foods, either in the form of 
ova or in the young or adult state, are the following: 512 
THE NEW DIETETICS 
Ameba coli, which gives rise to dysentery. 
Coccidium oviforme, derived from the eating of infected 
green vegetables or contaminated drinking water and the hand- 
ling of domestic pets, which are likely to carry this parasite. 
Liver fluke, {distoma hepaticum), derived from aquatic 
plants. The infection occurs through drinking water. The para- 
site is found in the gall-duct and the gall-bladder. 
The blood fluke, (bilharzia), found in the urine. Probably 
derived from drinking water. It occurs especially in Egypt and 
is often fatal. 
Whip worm, (ascaris), a common parasite in the tropics, 
derived from water or infected raw vegetables. 
Pin or thread worm, (oxyuris), infects the lower extremity 
of the small intestine. Descends to the colon and rectum. Enters 
the body with raw fruit or other uncooked foods. 
Pork tapeworm, {tenia solium), a parasite derived from raw 
or uncooked pork (measly pork). 
Beef tapeworm, {tenia saginata), a parasite derived from the 
eating of raw or undone beef (measly beef). 
Tenia echinococcus, a parasite which is found in the intes- 
tines of dogs. It is communicated to human beings by the hand- 
ling of dogs or the eating of infected raw, green vegetables. 
Bothriocephalus lotus, a tapeworm derived from fish, com- 
mon in northern Europe but rare in the United States. 
Hookworm, derived from infected water or through abrasion 
of the skin, especially of the feet. 
Filaria sanguinis, a parasite which gives rise to elephantiasis. 
It is derived from impure water. 
Trichina spiralis, a parasite derived from pork which de- 
velops in the muscles. The hogs in this country are so generally 
infected that the United States government has issued repeated 
warnings against the eating of pork which has not been thor- 
oughly cooked. The disease has become so widespread that no 
attempt is being made to control it, and there is no inspection of 
pork sold for consumption in the United States. 
Adulterated Foods. 
In general, wholesome foods are little adulterated. The pure 
food law has, in fact, almost wholly suppressed the adulteration 
of foods of any sort in this country. The articles most likely to 
be adulterated are mustard and spices, pickles, coffee, tea and PTOMAINS—POISONED FOODS 
513 
cocoa. Butter is sometimes adulterated with oleomargarine, lard, 
beef tallow, fats, and oils. Olive oil is frequently adulterated 
with cottonseed oil, and strained honey is sometimes adulterated 
with glucose. None of these adulterations, however, are particu- 
larly harmful. The most harmful adulterations are those which 
consist of the use of preservatives, such as sulphurous acid, sul- 
phites, sulphates, salicylic acid, benzoic acid and formaldehyde 
in foodstuffs. These preservatives are often added to canned 
foods. All of them are harmful. Boric acid and borax, which 
are frequently used, have been shown to be injurious to digestion. 
Copper, iron and nickel are sometimes used to improve the color 
of pickles, green peas and other vegetables. Zinc occurs in dried 
apples as the result of using galvanized iron pans in drying. 
Jams and jellies are adulterated with aniline colors and with agar, 
turnips, apple or gooseberry pulp. 
Benzoate of Soda. 
Benzoic acid is much more toxic than benzoate of soda, just 
as hydrochloric acid is more poisonous than sodium chlorid or 
common salt. It should be noted, however, that the experiments 
on animals which seemed to show the benzoate of soda to be 
harmless cannot be taken as evidence of the effects in man, who 
is much more susceptible to these poisons than are lower animals. 
The facts now known concerning the poisonous properties of 
benzoic acid and benzoate of soda are certainly sufficient to con- 
demn its use as a preservative. It is to be hoped that the federal 
pure food department will soon see its duty to prohibit the 
use of this drug in foodstuffs, especially as it is so often used to 
conceal the inferior character of the raw material used; and 
further, in view of the fact that it is almost exclusively used in 
the preservation of hot sauces which are an unnecessary and often 
highly injurious addition to foods. 
Toxicity of Certain Foodstuffs, 
Recent experiments by Cook on the toxicity of foodstuffs 
have given some most interesting results. Frogs and gold fish 
were the subjects used. Cane sugar, the acetic acid of vinegar, 
the potassium oxalate of rhubarb, alcohol and Rochelle salts, the 
residue of baking powder, all were found to be toxic. Sodium 
benzoate was found to be much more toxic than oxalic acid or 
potassium oxalate of rhubarb. Cane sugar was found to be three 
times as toxic as grape sugar. 514 
THE NEW DIETETICS 
Keeping the Soil Clean, 
One of the advantages of cookery is the fact that it lessens 
the danger from infection with disease-producing bacteria. For- 
tunately, cooking at ordinary temperatures will destroy most of 
the bacteria which produce disease and in some cases cookery de- 
stroys the poison produced by the germ as well as the germ itself. 
Consequently, the cooking of food is in no small measure a pro- 
tection against infection by disease-producing germs, such as 
those of typhoid fever, tuberculosis, cholera and various water- 
born diseases. There are a few germs, however, which are not de- 
stroyed by ordinary cooking for the reason that they produce 
spores which are highly resistant to heat. Some of these spores 
resist a temperature as high as 240" F. for a few minutes without 
being destroyed and for their destruction require heating for 40 
minutes at the high temperature named. Of germs of this class 
which are dangerous to human life, the bacteriologists especially 
mention four—the bacillus which produces tetanus, or lockjaw ; 
Welch’s bacillus, which causes gas and putrefaction and gives 
rise to gas gangrene in infected tissues; the B. botulinus, which 
causes botulism, and the anthrax bacillus, which causes malignant 
postule. 
The tetanus bacillus usually finds access to the body through 
wounds. The bacillus of gas gangrene is likewise due to infec- 
tion of the tissues with Welch’s bacillus through a wound of some 
sort, usually either the bite of animals or a wound received in 
battle. Welch’s bacillus, however, finds its entrance to the body 
through the mouth with certain foods. It is always present in 
meats, which as obtained from the butcher shop are infested 
with putrefactive bacteria of various sorts, among which is the 
gangrene bacillus. These bacteria, when introduced with the 
food, find in the colon a favorable opportunity for develop- 
ment and are the chief cause of the putrefactive changes which 
occur in the colon and which give rise to gas-forming and the 
development of ofifensive odors. This bacillus is thus largely 
responsible for the intestinal toxemia or autointoxication which is 
always present in cases of chronic constipation, although the char- 
acteristic symptoms which will result from various kinds of dam- 
age to the body are sometimes slow in developing. 
These most pernicious organisms, some of which are the most 
deadly with which the human organism comes in contact, find PTOMAINS—POISONED FOODS 
515 
in the colon of animals the most favorable place for their de- 
velopment. The bacillus of lockjaw apparently grows with a 
special luxuriance in the colon of the horse. It is thus evident 
that the use of manure as a means of fertilizing the soil is also 
a source of infection of the soil. It is for this reason that step- 
ping on a nail is a common cause of tetanus. Either the nail or 
the unprotected foot is very likely to be more or less soiled with 
dirt, and if the earth has been infected, through fertilizing with 
animal manure, the tetanus germs are very likely to be present. 
A recent experience shows that soil may become infected with 
B. botulinus, the cause of botulism, in a similar manner. The 
owner of a small garden for eight years canned string beans 
grown in his own garden, with excellent success. There was no 
spoilage and no sickness due to the use of the beans. In 1918 
animal manure was used as a fertilizer. The beans raised were 
canned by the same process employed before, but instead of 
keeping as before they spoiled and some of the cans were found 
to contain the deadly poison produced by the B. botulinus. 
Since the scores of cases of botulinus poisoning from ripe 
olives canned in glass and from spinach, an investigation has 
been made of the soil in the vicinity of the canning factories in 
California from which the infected products came and it has 
been found to be infected with the botulinus bacillus. The real 
source of infection is thus clearly seen. 
All agricultural authorities warmly advocate animal manure 
as fertilizer. Doubtless, this method of fertilizing the soil has dis- 
tinct advantages. However, the dangers which arise from in- 
fection of the soil with the pernicious bacteria found in animal 
manure must be given consideration. It is, indeed, not unrea- 
sonable to suggest the advisability of discouraging the use of 
animal manures for use in vegetable gardening; or at least if 
such manures are used should they not be first subjected to a 
process of sterilization which will insure the destruction of the 
dangerous germs which are always present? That manure is 
not necessary for the enrichment of the soil is clearly shown by 
the fact that natural soils are found which are as rich as could 
possibly be desired in plant food of the finest sort. 
When we are taking such precautions to avoid contamination 
through drinking water, insisting not only that the water should 
be pure but also that the individual drinking cup shall be used 
so as to make certain that the vehicle as well as the water itself 516 
THE NEW DIETETICS 
is clean; when we are taking care to see that food is protected 
from flies, that our bread is wrapped in paraffin paper, that 
milk is pasteurized or certified and delivered in aseptic contain- 
ers ; and while we are even taking the precaution to inspect the 
people who handle foodstuffs in any way, such as grocers, bakers, 
cooks or waiters; when we take such great pains in so many 
ways to make sure that our food is kept clean after it is produced, 
why should we permit it to be produced under conditions which 
almost absolutely insure contamination with the dirtiest kind of 
dirt and infection with the most deadly of known germs? 
There are many excellent fertilizers besides animal manure 
and there are well-known methods of improving the fertility of 
the soil without the addition of either manure or artificial fer- 
tilizers of any sort. It seems more than likely that the sanitarian 
of the future will extend his inspection to the soil in which food 
is grown, thus cutting off at its source one of the most common, 
most certain and most deadly sources of food contamination. \*7ater Drinking 
Claude Bernard, the eminent French physiologist, many years 
ago pointed out the fact that all life is under water. The work 
of the brain, heart, liver and every other vital organ is performed 
in a water medium. The blood cells float in a liquid stream, and 
the muscle cells and gland cells—all the living elements of the 
body—are submerged in water as truly as the fishes which swim 
in the sea. 
So it is literally true, as pointed out by Bernard, that the dif- 
ference between water breathing animals and air breathing animals 
is more in appearance than in fact. These animals differ really 
only in their method of obtaining air. Warm blooded animals 
obtain air directly from the atmosphere, whereas cold blooded or 
water breathing animals, requiring much smaller quantities of air, 
are able to satisfy their needs with the small quantities of air 
obtainable from the water in which they are submerged. 
We are often reminded of the importance of taking food and 
of taking just the proper amount of protein, fats, carbohydrates 
and mineral salts, but we too often forget that water is really a 
food also and that it is equally as essential as the solid constituents 
of foodstuffs. Roger, the successor of Bouchard and the leading 
living French physiologist, in his recent remarkable book, “Phy- 
siologic du Foie” (Physiology of the Liver), remarks, “It is a 
general law that the younger a tissue is the more active it is, and 
the more active a tissue is the larger is the amount of water which 
it contains.” 
The amount of water in the body gradually diminishes with 
age and with lessened activity. The water content of the body 
of a new-born babe is higher than at any later period of life, being 
82.5 per cent., more than four-fifths the body weight. So tenacious 
is the body of its water content even temporary starvation and 
deprivation of water does not greatly diminish the proportion of 
water present in the tissues. The tissues actually produce 
water out of their own substance. 
There is an important relation between food and the water 
content of the body. The amount of water in the tissues is in- 
517 518 
THE NEW DIETETICS 
creased to a marked degree by carbohydrates, that is, starch, sugar 
and dextrin, and to a much greater extent than by a nitrogenous 
diet or a diet rich in fats. Zuntz showed that for every ounce of 
carbohydrates retained in the body in the form of glycogen four 
ounces of water are retained in combination with the carbohydrate. 
Roger observed that the larger the amount of fat contained in an 
organ the less is its activity. 
These facts emphasize the importance of giving the same 
attention to supplying the tissues with water as with solid food- 
stuffs. Many people suffer from headaches, malaise and other 
discomforts because of their neglect to supply the body with 
water with which to wash away the waste elements through the 
kidneys. 
A simple experiment will show the important relation of water 
drinking to the kidney function. If a quart of water (five tumb- 
lerfuls) is swallowed within a short period, say 15 or 20 minutes, 
within an hour or two almost the entire quantity (four-fifths) 
will be passed out through the kidneys. While this large quantity 
of urine is less concentrated than usual, it will nevertheless contain 
a larger amount of waste matter than would have been excreted 
by the kidney in the same length of time if the water had not 
been taken. It is evident, then, that copious water drinking is a 
means by which the body may be given an internal bath. The 
internal bath is far more important than scrupulous grooming of 
the skin. 
The daily loss of water from the body is about four and 
one-half pints. Ordinary food, as eaten at the table, contains 
water to the extent of about one-half its weight. About 12 ounces 
of water are produced in the body by the reactions which occur in 
the processes of digestion, assimilation and dissimilation. To 
supply the daily loss, at least two to four pints of water should be 
taken daily in addition to that contained in the food. When food 
is not eaten, more water is needed. When water is taken in 
insufficient amount, one result is to diminish the volume of the 
blood. The effect of this is to lower the blood pressure. Water- 
drinking is important as a means of raising the blood pressure in 
persons in whom the blood-pressure is too low. 
Hunt (Cambridge) has shown that in a hot atmosphere as 
much as six liters (quarts) of water may be needed to neutralize 
and carry off the enormous amount of heat produced and ab- 
sorbed. The body’s store of water is mostly in the muscles, WATER DRINKING 
519 
which give it up when needed but replace it slowly. This stored 
water should never be drawn upon more than is absolutely neces- 
sary. 
Certain animals, as the camel, are able to go long periods 
without drink, but only because they are able to store up large 
quantities of water. Camels often travel 200 or 300 miles with 
heavy loads, going as long as 15 days without water, and in- 
stances are on record in which waterless stretches of more than 
600 miles have been covered. After having been deprived of 
water for several days, the camel readily swallows 40 gallons of 
water, and its ordinary drink is 7 or 8 gallons. The sheep of the 
Nebo national forests in Utah pass the four and one-half months 
of summer without water, and thrive on the small quantity of 
moisture found in the scanty herbage which grows in that dry, 
rocky region. The American prong horned antelope lives con- 
tentedly in the desert of the southwest notwithstanding the ab- 
sence of water. (Hornaday). 
Human beings differ from these desert bred animals in that 
they require a large amount of water. The water content and 
daily need of the body depends upon age as well as weight. An 
infant needs four times as much water as an adult in proportion 
to its weight. That is, a child weighing .35 pounds needs as 
much water, daily, as an adult weighing 140 pounds. Restric- 
tion of water hinders growth and development. Great care should 
be taken to supply infants and school children with water at 
frequent intervals. 
Many people never drink except at meals, a time when copious 
drinking is not advisable. Two or three hours after eating is the 
best time for water drinking, although it is perfectly proper for a 
person to drink whenever he feels thirsty, since thirst is an ex- 
pression of the need of the tissues for water. 
It is wise to form the habit of taking water at regular times. 
A very good plan is to drink a glass of water on rising in the 
morning, on going to bed at night and every time the bladder is 
evacuated. A sense of dullness or weariness is .often at once re- 
lieved by drinking a glass of cool water. Ice water is not ob- 
jectionable if it is sipped slowly, but ice cold water should never 
be swallowed rapidly. A large quantity of ice water taken into 
the stomach suddenly may stop digestion for an hour or two. 
Every person should take daily two or three pints of water 
in addition to the water contained in ordinary foodstuffs, which 
has been estimated to be about one pint. 520 
THE NEW DIETETICS 
In some up-to-date business houses the excellent practice has 
been established of supplying water to each employee six times a 
day, a capital means of increasing efficiency. 
Tests for the Purity of Water, 
A critical examination of water with reference to its purity 
and fitness for use as a beverage or for culinary purposes requires 
the services of expert chemists and bacteriologists. There are a 
few tests, however, which are of considerable value and may be 
employed by a person who has such a knowledge of chemistry as 
may be obtained in the high school department of the public 
schools. 
The following table (Notter and Firth) gives the method of 
testing for some of the most common chemical impurities likely 
to be found in drinking water. 
Reagents Necessary for Qualitative Examination of Water. 
Substance 
sought for 
Reagents to be used, 
and effects 
Remarks 
Reaction 
Litmus and tumeric 
powders; usual red or 
brown reactions. 
Usually neutral. If acid, and 
acidity disappears on boil- 
ing, it is due to carbonic 
acid. If alkaline, and al- 
kalinity disappears on boil- 
ing, to ammonia (rare); if 
permanently alkaline, to 
sodium carbonate. 
Lime 
Oxalate of ammoniun\; 
white precipitate. 
Six grains per gallon (9 per 
100,000) give turbidity; six- 
teen grains (23 per 100,000) 
considerable precipitate. 
Ammonia 
Nessler’s solution; a 
yellow color or a yel- 
low brown precipi- 
tate. 
If in small quantity, several 
inches in depth of water 
should be looked down 
through on a white ground. 
Iron 
Red' and yellow prus- 
siates of potash and 
dilute HC1; blue 
color. 
The red for ferrous and the 
yellow for ferric salts. 
Hydrogen 
sulphid 
A salt of lead; black 
precipitate. 
When the water is heated the 
smell of hydrogen sulphid 
may be perceptible. 
Lead or 
copper 
Ammonium sulphid; 
dark color, not clear- 
ed up by HC1. 
Place some water (100 c. c.) 
in a white dish, and stir up 
with a rod dipped in am- 
monium sulphid; wait till 
color produced, then add a 
drop or two of hydrochloric 
acid. If the color disap- 
pears, it is due to iron; if 
not, to lead or copper. 
Lead 
11V L, IV/ 1VUU V/ » a 
One-tenth grain per gallon 
gives an immediate tur- 
Small crystals of potas- 
sium bichromate give WATER DRINKING 
521 
a turbidity 
bidity; one-twentieth grain 
per gallon after one min- 
ute; one-fiftieth grain per 
gallon after half an hour. 
Zinc 
Render water slightly 
ammoniacal; boil; fil- 
ter; a few drops of 
potassium ferrocy- 
anid give a haze to 
white precipitate; hy- 
drogen sulphid gives 
a white precipitate. 
The filtrate must be quite 
clear before the ferro- 
cyanid is added. 
This reaction is not available 
if iron be present or if the 
water be acid or alkaline. 
Water obtained from uncertain sources should always be 
boiled; indeed, this precaution is a wise one under nearly all 
circumstances when traveling. 
Very hard water should be. boiled for a long time to elim- 
inate, so far as possible, the lime which it contains. 
Mineral Waters. 
Mineral waters are unwholesome. Their use should be 
avoided. Saline waters, which are usually taken for their laxa- 
tive effect, when long used cause colitis. This was pointed out 
by Von Noorden and other clinicians some years ago. These 
waters also disorder the stomach. So-called calybeate waters, 
supposed to be beneficial to the blood, often contain so little iron 
that they can produce no appreciable effect unless taken in 
quantities amounting to some gallons daily. The same is true 
of waters supposed to be beneficial in certain maladies because 
of the presence of lithia. The amount of lithia in these waters 
is so small that one would need to drink a barrelful to get a 
single medicinal dose. More than this, it has been shown that 
lithia is absolutely worthless as a remedy for gout and other uric 
acid disorders for which these waters are recommended; and it 
is doubtful if mineral iron can replace the organic iron of the 
blood. 
Some bottled waters are valuable and highly to be recom- 
mended because of their unusual purity and freedom from min- 
erals. These are not to be classed with mineral waters. 
Distilled Water. 
Water which has been purified by double distillation and 
rendered palatable by aeration is a perfect beverage. Such water 
is in no respect inferior to water from any natural source and is 
absolutely pure and not liable to contamination. 
The idea set afloat by an impractical English physician some 522 
THE NEW DIETETICS 
years ago that distilled water is not only unwholesome but actu- 
ally dangerous, is wholly without scientific foundation. It is 
true that the body cells are adapted to a saline medium. The 
fluids of the body which bathe the cells and tissues contain about 
four-fifths of one per cent, of salt and other mineral substances. 
When these cells are exposed to distilled water they swell up and 
break into fragments. But Nature has provided against any 
such catastrophe. When water is taken into the stomach, it 
always finds there a sufficient amount of saline liquid to give to 
it a degree of salinity sufficient to protect the body cells from 
any possible harm. 
The use of distilled water or absolutely soft water is not 
essential to health. No evidence has been offered that moderately 
hard water, that is, water containing a few grains of lime salts to 
the gallon, is in any way prejudicial to health. It is barely pos- 
sible, in fact, that the lime of hard water may under some circum- 
stances render the body service by supplementing a deficiency of 
lime in the food. 
It has been noted, however, that stones in the bladder and 
kidney stones are much more common in districts where only very 
hard water is obtainable than in regions where an abundant 
supply of soft water is available. 
Purification of Water With Chlorin. 
Freshly prepared chlorid of lime is added to the water and 
thoroughly mixed with it in proportion of 5 to 8 pounds of 
chlorid of lime, or “bleach,” to 1,000,000 gallons of water. When 
liquid chlorin is used, which is the best practice, only one or two 
parts per 1,000,000 are used. The residues left in the water 
when hypochlorite of lime or liquid chlorin is employed are 
harmless. The chlorid of lime gives to the water a very slight 
degree of hardness. This is a very practical emergency method 
which may be applied at once to water known or suspected to 
he contaminated. Either chlorid of lime or chlorinated soda 
may be used. The preparation must be fresh. 
This method is now used in treating the water supply of 
many cities, and has in some cases quickly reduced the death rate 
from typhoid fever to one-fifth the original rate. 
I he old methods of filtration cannot be relied on as a means 
of rendering water safe for drinking except as regards animal 
parasites. Modernly constructed filter beds greatly reduce the WATER DRINKING 
523 
number of bacteria, but do not destroy them all. Chlorination is 
the only safe method, and fortunately is so easily available and so 
thoroughly efficient and practical that it may be utilized on short 
notice and under almost any conditions. By the installation of 
automatic machinery for chlorination, many dangerously polluted 
public water supplies have been rendered safe, and many typhoid 
epidemics have been promptly arrested. 
It is well for travelers to carry with them a supply of freshly 
made chlorid of lime (not calcium chlorid) for use when water 
is not known to be pure. One grain in a quart of water will in a 
few minutes destroy all bacteria that may be present. This quan- 
tity is, in fact, sufficient to sterilize three gallons of water in half 
an hour. It is a good plan to put a grain of the chlorin salt into 
the water bottle whenever it is filled so as to make sure of a 
supply of pure water whenever needed. 
A stronger solution, say a teaspoonful to the. quart may be 
used for disinfecting fruits and other raw foods. 
A convenient method of rendering suspicious water safe is 
by the addition of a drop or two of ordinary tincture of iodine to 
a quart of water in a glass pitcher or a thermos bottle. After 
half an hour the water may be used with perfect safety. The 
amount of iodine is too small to do any harm, or to produce any 
unpleasant flavor. MEDICAL DIETETICS 
Regulation of the diet is perhaps the most important of any 
single measure in the treatment of chronic disease. As Professor 
Chittenden, the eminent head of the Sheffield Scientific School, 
has well said: “It is one of the axioms of physiology that the 
majority of the diseases of mankind are due to, or connected with, 
perversions of nutrition.” Food supplies the materials neces- 
sary for the repair of the body cells; food furnishes the materials 
upon which the body cells work in their various activities, and 
food also acts as a vital stimulus to the cells. By regulating the 
food supply in kind and in arhount, and by modifying its form, 
every tissue and function may be profoundly influenced. 
It is important to remember that a large part of our daily 
diet is comparatively new to the human stomach. The develop- 
ment of the art of cookery has led to the use of many substances 
with which the primitive stomach was wholly unacquainted and 
has introduced into the dietary a great number of artificial foods, 
many of which are by the processes of preparation more or less 
modified. Man no longer takes his sustenance from the hand of 
Nature, gathering it, often at the cost of much physical exertion, 
from forest and plain, hillside and valley, but receives it at his 
door from the hands of the grocer, the butcher, the miller, the 
baker and a hundred other purveyors of food and culinary acces- 
sories. Instead of taking our food supply in the natural state in 
which it is furnished to us by Mother Earth, or made more ac- 
ceptable by simple cooking processes, we require it to be sophisti- 
cated and in a multitude of ways denatured and even poisoned by 
an army of caterers, cooks, confectioners and food adulterators, 
thus exposing our bodies to an indefinite number of damaging 
influences which our primitive ancestors escaped. 
Clinical experience has demonstrated that a large share of all 
chronic disorders to which civilized man is subject are the result 
of erroneous habits of life, and there can be no question that 
wrong eating habits are, of all our habitual errors, most active in 
the production of the disorders of nutrition which characterize 
all forms of chronic disease. It is evident, then, that in dealing 
524 MEDICAL DIETETICS 
525 
with these disorders the first thing to be done is to correct errors 
in nutrition by so regulating the dietary as to eliminate faulty 
habits, cultivate normal or biologic appetites and train the diges- 
tive organs to normal activity. 
Among the illustrious examples of the benefits arising from 
such a correction of faulty dietetic habits may be mentioned the 
case of Professor Huxley, who, after describing himself as suffer- 
ing from want of energy and “life-long depression,” by renounc- 
ing the use of alcohol and tobacco and greatly lessening his intake 
of food, freeing himself, as he said, “from gross intemperance,” 
recovered his former vigor and enjoyed as good health as ever 
in his life. 
Until very recent years, almost nothing was known about 
the therapeutics of diet. The whole subject, like most other medi- 
cal matters, was based on empiricism. Today, thanks to the labors 
of Pavlov, Rubner, Yoit and Pettenkofer, Bayliss, Atwater, Bene- 
dict, Chittenden, Osborne, Mendel, Cannon, McCollum, and 
scores of other modern investigators, we have a really scientific 
basis for dietetics; and as a result such wonderful victories in 
the battle against disease are daily being won as a century ago 
would have been regarded as truly miraculous. Indeed, the old 
materia medica of the last generation is rapidly falling into innoc- 
uous desuetude, having been supplanted by a rational and efficient 
system of materia alimentaria. 
The purpose of this section of this work is to make practical 
application to individual diseases and diseased conditions of the 
scientific facts which have been presented in the foregoing pages. 
If the reader misses many of the familiar formulas usually found 
in works on medical dietetics, let him not be disconcerted and 
imagine himself on untried ground; but rather, let him be assured 
that every suggestion or recommendation has behind it not only a 
sound physiological fact, but also long and thorough practical 
tests at the Battle Creek Sanitarium, where many thousands of 
intelligent men and women are annually fed in harmony with the 
principles herein set forth and in numerous other medical insti- 
tutions as well as by hundreds of physicians engaged in private 
practice. The same methods are likewise in extensive use in a 
more or less complete form in many other sanitariums and hos- 
pitals which are served by dietitians trained in the Battle Creek 
Sanitarium School of Home Economics, from which hundreds of 526 
THE NEW DIETETICS 
expert dietitians have gone out to teach and practice the prin- 
ciples of biologic living and scientific dietetics. 
COMMON DIETETIC ERRORS 
Before considering the dietetic treatment of individual dis- 
eases we shall first give attention to some general considerations 
which apply to nearly all disorders, especially the question of 
intestinal toxemia or autointoxication, common errors in diet, and 
some of the more important tests for the functions of digestion, 
nutrition, metabolism and excretion, by means of which the regu- 
lation of the dietary may be scientifically directed. 
The many forms of indigestion, as well as most of the dis- 
orders of nutrition, are due to errors in diet. Attention has 
already been called in the preceding chapters to numerous com- 
mon faults and erroneous notions in relation to human feeding, 
but it will perhaps be profitable again to briefly summarize those 
errors in diet which are most common and the correction of which 
is highly essential in the treatment of nutritive disorders. 
Overeating. 
An excessive intake of food is much more common than a 
deficiency. The average person has little appreciation of the fact 
that there is no definite relation between the bulk and weight of 
food and its nutritive value. For example, a pound of almonds 
has more food value than 20 pounds of cabbage, cauliflower or 
eggplant, or 15 pounds of beets, carrots or string beans. 
So it is possible for one to overeat by unduly distending the 
stomach with bulky food, such as coarse vegetables or juicy 
fruits, while the quantity of nutriment absorbed may really be 
insufficient to nourish the body. On the other hand, one may 
easily take a great excess of nourishment, although the actual 
weight and bulk of the food consumed be small. 
On this account it is highly important that every one should 
learn how to estimate the actual values of foodstuffs as expressed 
in calories. This may be easily done by a careful study of the 
extensive tables presented elsewhere in this work. 
The general bad efifects of overeating are an excessive gain 
in weight, dullness after meals, drowsiness, insomnia, indiges- 
tion. It is to be noted, also, that overfed people are more likely 
to suffer from cancer than the underfed. According to Williams. MEDICAL DIETETICS 
527 
cancer is almost unknown among the poorly-fed Hebrews of East 
London, but is very common among the wealthy Jewish bankers 
of Hyde Park. Bright’s disease, arteriosclerosis, high blood 
pressure, and apoplexy are also among the consequences of over- 
feeding. In time, the stomach breaks down from overwork; 
flatulence, hyperacidity, disorders of the liver and gall bladder 
and hemorrhoids are among the common results. 
It is always to be remembered that what would be oidy a 
sufficiency or even not enough for a hard working laborer might 
easily be a great excess for a man of sedentary habits. The daily 
ration for persons of different occupations has been considered 
in a previous chapter. 
The method of serving the food in successive courses, and 
especially the plan of arranging the bill of fare in such a way as 
to encourage eating to excess by presenting the most highly 
palatable dishes last, is productive of great mischief. Desserts 
consisting of rich dishes, such as ice cream, pastry and confec- 
tionery, are on this account to be condemned. Persons who are 
addicted to overeating should adopt the plan of eating at the 
beginning of the meal a considerable quantity of bulky food, such 
as spinach, cabbage, turnips, carrots, lettuce, etc. By this means, 
the sense of satiety may be induced before an excess of nourish- 
ment has been swallowed. 
Special injuries may result from an excess of particular food 
principles: for example, an excess of fat leads rapidly to obesity 
and induces so-called “biliousness” by causing too long retention 
of foodstuffs in the stomach and of food residues in the colon, 
thus promoting intestinal putrefactions. Intestinal toxemia in- 
duced in this way is the explanation of the injury suffered from 
eating an excess of fat, rather than “clogging” of the liver, the 
popular explanation. 
Persons whose stomachs do not produce a sufficient quantity 
of gastric juice and those suffering from intestinal toxemia, the 
result of chronic constipation, should especially avoid an excess 
of fat. The oil enema, sometimes employed for the relief of con- 
stipation, may do harm by promoting intestinal putrefaction and 
by interfering with gastric digestion. On this account, paraffin 
oil should be used -for this purpose rather than olive or linseed 
oil, for the reason that it is non-absorbable, has no effect upon the 
digestive processes, and does not undergo either fermentation or 
putrefaction. 528 
THE NEW DIETETICS 
Less injury, perhaps, is likely to follow from an excessive 
intake of starch than from any other quantitative error in diet, 
as it taxes the digestive process less than any other food principle 
and produces less disturbance of metabolism. This cannot be 
said, however, of the carbohydrate, sugar, the reverse being true; 
especially in relation to cane sugar, the excessive use of which 
not only induces disorders of digestion, particularly hyperacidity, 
but is very probably one of the chief causes of diabetes as well 
as of chronic gastric catarrh. The free use of cane sugar also 
leads to lime starvation, as elsewhere explained. Malt sugar is 
much less likely to produce gastric or nutritive disturbances; 
and the free use of milk sugar, because of its slow absorption, 
may become a valuable means of changing the flora by promoting 
the growth of acid-forming organisms in the colon. 
Eating an excess of protein is one of the most grievous of all 
dietary faults. It may be rightfully regarded as one of the lead- 
ing causes of chronic disease, through the intestinal toxemia 
which results from the putrefaction of undigested residues of 
meat and other proteins in the colon and the absorption of indol, 
phenol and other putrefaction products. Bright’s disease, rheu- 
matism, cancer, gastric ulcer, skin disorders, neurasthenia, in- 
somnia and a long list of chronic disorders directly or indirectly 
due to intestinal toxemia are among the evil results of a high 
protein diet. 
The researches of Rubner, Chittenden, Sherman, Folin and 
others supply a scientific basis for the view that one calorie of 
protein for each pound of normal body weight is sufficient to 
supply all the nutritive needs of the average individual. This 
amount of protein will be well supplied by a pint or even by 
half a pint of milk, according to the size of the individual, even 
though eggs as well as meat are excluded from the dietary. A 
few ounces daily of soy beans, almonds or other nuts will also 
fully meet the demand. If meats are discarded from the bill of 
fare, and eggs and milk are used in moderation, the ordinary 
mixed diet will usually furnish a proper balance of protein. 
Injury may result, as shown by Bunge and as pointed out 
elsewhere in this work, by making the bill of fare consist too 
largely of cereals, such as are supplied by ordinary breakfast 
foods. Cereals introduce into the body an excess of mineral 
acids, and when used in excess may lead to a preponderance of 
acids in the body, inducing a mild form of acidosis, with lowered MEDICAL DIETETICS 
529 
vital resistance and impaired nutrition. If the cereal intake of 
the average individual were reduced one-half by substituting an 
equivalent amount of farinaceous material in the form of pota- 
toes and other vegetables, the results would be a great improve- 
ment in our national health. Potatoes are rich in alkaline salts, 
which neutralize the excess of acid found in cereals as well as 
those produced by the cell activity of the body. These useful 
salts are also found in fruits. The preponderance of acids found 
in meats is four times as great as that found in cereals, hence the 
injury from a heavy meat diet is so much the greater. 
Underfeeding. 
Underfeeding is most frequently observed among the women 
and children of the poorer classes. Invalids, also, through lack 
of appetite or ignorance of food values, frequently suffer from 
lack of nourishment. An adult person of average size who is 
taking less than 1,800 calories daily is almost certain to be under- 
fed, unless confined to bed. 
Underfeeding is naturally accompanied by a loss in weight, 
the degree of which is a fairly accurate means of determining 
the measure of the food deficiency. The underfed individual also 
suffers, often to a very extreme degree, from a deficiency of 
vitamins. Famine is almost universally accompanied by scurvy 
and other deficiency disorders. 
Modern studies of metabolism have shown that at least two 
or three ounces of carbohydrates (starch and sugar) must be 
taken daily to insure the proper utilization of other foodstuffs 
and to prevent acidosis. A normal dietary contains six or eight 
times this amount of carbohydrates. 
The amount of protein eaten is rarely too small, although 
a dietary of exclusively vegetable origin may easily be deficient 
in complete proteins unless very carefully selected. The addi- 
tion to a dietary of ordinary cereals or other vegetable foodstuffs 
of four to eight ounces of milk will insure an ample amount of 
complete proteins to meet the needs of the body. 
Deficiency Diet. 
Bills of fare notably lacking in vitamins are very commonly 
found in prisons, almshouses, hospitals for the insane and feeble- 
minded, college dormitories and boarding-houses, also in many 
private homes. A breakfast consisting of toast and coffee, bacon, 530 
THE NEW DIETETICS 
griddle cakes and syrup, a very common menu, is almost alto- 
gether lacking not only in vitamins but in iron, lime and cellu- 
lose—elements highly essential to a complete dietary. Canned 
foods, particularly canned meats and vegetables, as well as dried 
fruits, are likely to be deficient in vitamins. Canned tomatoes 
and canned fruits are processed at a sufficiently low temperature 
largely to prevent the destruction of the vitamins, which are also 
preserved to a notable extent by fruit acids. 
Reducing diets, such as are recommended for combating 
obesity, are almost always deficient in vitamins. Reduction in 
the amount of food eaten necessarily reduces the vitamins along 
with the other food constituents; and because of it, many persons 
on a special fat-reducing regimen have been greatly injured by 
the lack of these food essentials. A reducing diet should always 
comprise an abundance of foods rich in vitamins. The lack of 
this important food principle in the so-called light diet of hospital 
wards and the ordinary fever diets in common use has no doubt 
been responsible for delayed convalescence and various untoward 
symptoms and disappointing failures in thousands of cases in 
hospital and private medical practice. 
Irregular Meals. 
Irregularity in the times of eating is highly injurious for 
numerous reasons which become at once apparent when one 
recalls some of the simple facts relating to the physiology of 
gastric digestion. The stomach empties itself normally in about 
four hours. Whenjm interval of five hours is allowed between 
meals, it has an hour in which to completely empty and disinfect 
itself, as well as to recruit the energies of its gland cells in 
preparation for the work of digesting the next meal. This is 
essential for good digestion. 
There is a close relation between the taking of food and the 
normal rhythmic activity of the colon. During the taking of a 
meal the food residues are moved forward in the colon four times 
as far as during the hour preceding the meal. When a meal is 
omitted, this physiologic stimulation of the colon is lacking, and 
the result may be the failure of the colon to evacuate its contents 
at the normal time, leading to distention of the colon and stasis 
or stagnation, which may become the starting point for chronic 
constipation. Thus regularity of meals is necessary in order to 
secure normal rhythmical action of the colon in the evacuation of 
food residues and other body wastes. MEDICAL DIETETICS 
531 
When the interval between meals is shortened, which is likely 
to occur when meals are taken at irregular hours, the result will 
be the reception of fresh food into the stomach before the diges- 
tion of the previous meal is completed. This deprives the stomach 
of rest and so prolongs the stay of the digesting foodstuffs in the 
stomach as to produce not only exhaustion of the organ but undue 
congestion of the gastric mucous membrane from too long contact 
with the gastric juice and digesting foodstuffs. The ultimate 
result will be gastric catarrh, slow digestion, together with other 
disorders affecting the later stages of digestion. 
Late suppers are particularly injurious. They not only lead 
to impaired sleep, but take away the appetite for breakfast the 
next morning because the stomach is exhausted. Thus it is very 
common for the late diner to suffer from heaviness, headache 
and a feeling of malaise and inefficiency the next morning. 
The heavy meal usually eaten at night by city dwellers is, 
in the writer’s opinion, chiefly responsible for the obstinate in- 
somnia so frequently encountered, especially among persons ac- 
tive in business or society. 
Hasty Eating. 
Insufficient mastication is a fault which has become almost 
universal because of the general use by civilized people of foods 
which by cooking have been rendered soft or semi-liquid, and 
hence receive little or no chewing to prepare them for swallowing. 
All foods, whether solid or liquid, should be chewed, and it 
is important to take at each meal a sufficient amount of dry, hard 
food, not only to exercise the teeth but to stimulate the salivary 
glands to produce an adequate amount of saliva, which when 
thoroughly mixed with the food by mastication renders material 
aid in its digestion. 
Crato adviseth his patient to eat but twice a day, and that at his 
set meals . . . and to put seven hours’ difference between dinner and 
supper. Which rule, if we did observe in our colleges, it would be 
much better for our healths, but custom, that tyrant, so prevails that, 
contrary to all good order and rules of physic, we scarce admit of five. 
Moreover, that which he doth eat must be well chewed, and not has- 
tily gobbled, and by all means to eat no more than he can well digest. 
Burton says in his “Anatomy of Melancholy”: 
Crato’s advice to put seven hours between the meals may be 
advantageously followed by many sufferers from gastric disor- 
ders. Some stomachs need even more time for rest and clearance. 532 
THE NEW DIETETICS 
Drinking at Meals. 
The general custom of drinking several glasses of water or 
several cups of tea or coffee or other beverages with meals is a 
common cause of indigestion. One glassful of water or other 
liquid at a meal is quite sufficient to supply all dietary needs. 
Water-drinking does not interfere with digestion by diluting the 
gastric juice, but by overstimulating the glands of the stomach, 
causing them to produce an excess of gastric acid. 
Bad Food Combinations. 
Much stress was formerly laid upon the making of proper 
combinations of foods. The mixing of fruits with vegetables and 
of acids with milk were particularly considered to be highly pro- 
ductive of indigestion. Later experience, however, has shown 
that while some attention should be given to food combinations 
there is comparatively little ground for anxiety upon this point, 
provided the foodstuffs eaten are wholesome in character and are 
thoroughly masticated. Wholesome foods harmonize with one 
another in the liquid state or when reduced to a smooth pulp by 
thorough chewing. It is, of course, essential that the foodstuffs 
which enter into a menu should be so selected as to secure a 
balanced bill of fare; that is, one would not combine eggs with 
beans because both are rich in protein, or olive oil with nuts for 
the reason that nuts are rich in fat. Neither is there any occasion 
for the addition of sugar to oatmeal and other breakfast cereals 
or syrup to griddle cakes, because these foodstuffs consist chiefly 
of starch, which by the process of digestion is all converted into 
sugar. Cream or milk and fats are the proper accessories for cereal 
foodstuffs rather than sugar, the free use of which with breakfast 
foods is a very common cause of indigestion. 
There are, however, certain unphysiologic combinations 
which should be noted, such as drinking freely with liquid foods, 
the addition of cream to pastry. Meat and milk is an objection- 
able combination, because both are highly nitrogenous foods and 
because the highly acid gastric juice evoked by meats produces 
hard, indigestible curds which remain long in the stomach. 
Highly Seasoned Foods. 
Foods which are highly seasoned are overstimulating to the 
appetite and lead not only to overeating but to overstimulation 
of the digestive organs, the result of which is hyperacidity, which MEDICAL DIETETICS 
533 
is later followed by degeneration of the secreting glands and a 
deficiency of gastric acid. Gourmands are certain to suffer sooner 
or later from their gastronomic abuses, being especially subject 
to gastric ulcer and cancer. 
The Use of Condiments* 
Mustard, pepper, pepper-sauce, horse-radish, cayenne, capsi- 
cum and other hot and irritating substances have no proper place 
in the bill of fare. These substances all owe their properties to 
highly poisonous essential oils which in the pure state readily 
raise blisters upon the skin, and when taken internally produce 
irritation of the delicate structures with which they come in 
contact. Though certain condiments may at first stimulate the 
stomach to increased activity, the ultimate result of their use is 
lessened gastric activity and irreparable injury to the stomach, 
liver, kidneys and other vital organs, including the heart and 
blood vessels. 
Insipid Foods, 
Foods which are lacking in flavor, while much less positively 
injurious to the body than those which are highly seasoned, are 
nevertheless objectionable for the reason that they are deficient 
in the flavoring substances which Nature places in normal foods 
to render them attractive to the palate, and which through the 
nerves of taste call forth the glandular and other activities con- 
cerned in the process of digestion. To be well digested, food 
must be attractive. It should please not only the sense of taste 
but the sense of smell and the sense of sight. This has been 
clearly shown by the classical experiments of Pavlov. 
A Monotonous Diet* 
A monotonous diet is objectionable, not simply because it 
fails to gratify the sense of taste but because it is likely to be 
deficient in some of the elements essential to good nutrition. To 
make sure that the body is abundantly supplied with all the 
subtle principles which it needs to repair its tissues and sustain 
its varied activities, a considerable variety in the bill of fare is 
required. The number of kinds taken at any one meal should not 
be too great, but they should be varied from day to day. 534 
THE NEW DIETETICS 
Indigestible Foods. 
Such indigestibles as pickles, green olives, rich pastry, pre- 
serves and fried foods present to the digestive organs a difficult 
or even impossible task, since they remain long in the stomach, 
irritating its walls and exhausting its secreting glands and some- 
times causing injury through mechanical irritation. 
Cold Foods. 
Very cold foods, such as ices, ice cream, and ice water, are 
questionable as elements of a meal. If taken at all, they should 
be in limited quantity and so slowly swallowed that before reach- 
ing the stomach they will acquire a temperature near that of the 
body. 
Hot Foods. 
Very hot foods are objectionable for the reason that exces- 
sive heat produces the same injurious effects upon the mucous 
membrane of the stomach as upon the skin. The mucous mem- 
brane, in fact, appears to be less able to endure high temperatures 
than the skin, being more delicate in structure and less accus- 
tomed to such contacts. The use of hot food is an unnatural habit 
and one which is without doubt more or less detrimental to the 
health. Dr. William Mayo, the eminent surgeon, has for years 
maintained that the taking of’ hot foods and liquids into the 
stomach is a cause of gastric cancer. 
Eating When Exhausted* 
When the nerves or muscles are in a state of exhaustion 
as the result of effort, all the bodily activities are slowed down. 
The taking of a hearty meal under such conditions is often 
attended by bad results. Digestion fails for lack of a sufficient 
amount of active gastric juice, and acute indigestion is a frequent 
consequence. Rest, especially sleep, is indicated rather than food, 
unless the exhausted person has been fasting for some time. In 
such cases the most suitable nourishment will be found in a solu- 
tion of honey or malt sugar in water or diluted fruit juice. 
Nutriment of this sort is quickly absorbed and immediately 
appropriated, requiring little or no action of the digestive organs. 
An exhausted person, after resting for an hour or two, may take 
simple food in liberal quantity. Eating heartily when one is tired 
out by either mental or muscular effort is likely to be followed 
by indigestion, malaise and incapacity for work. MEDICAL DIETETICS 
535 
Misinformation and Pseudo-scientific Teaching* 
The popular newspaper and magazine literature of the day 
is filled with dangerous misinformation about diet and other 
matters pertaining to health. Articles by a chemist of Philadel- 
phia, claiming to be based upon scientific experiments, have been 
particularly misleading. This writer would have us believe that 
he has demonstrated that bolting meat is harmless, that drinking 
freely of water at meals aids digestion instead of hindering it, 
and that drinking large quantities of ice water at meals does not 
involve risk of indigestion. 
The experimenter draws his conclusions from the fact that he 
was able to subject the stomachs of healthy men to these various 
abuses without immediate apparent injury. This is the same old 
argument with which we are so familiar. It has been brought 
forward in support of liquor drinking and tobacco using, the tea 
and coffee habit, the breathing of bad air, neglect of exercise, 
neglect to breathe properly, neglect of the bowels, and any num- 
ber of other unhygienic practices that might be mentioned. With- 
in a week of this writing the writer received a letter from a man 
who maintained that infrequent movement of the bowels is con- 
ducive to health, and offered as proof the fact that he enjoys 
good health though moving his bowels but once in two weeks. 
These experiments simply demonstrate how much abuse a 
healthy stomach is able to endure before it surrenders to disease. 
Fortunately, we are all born with a certain margin of safety. The 
first violations of biologic law may not give rise to any tangible ill 
effects; the bodily functions are performed as usual. The indi- 
vidual therefore thinks himself invulnerable, perhaps priding 
himself upon the fact that he can do with impunity things which 
are considered harmful. He is unaware of the fact that a hidden 
damage is being done, the effects of which may be irreparable. 
His margin of safety is being consumed and when it is wholly 
exhausted he will begin to realize the harm which has been done; 
but it will then probably be too late to repair the injury. 
Because it seems to make very little difference to a healthy 
stomach whether bread is stale, and hence quickly digested, or 
new and slowly digested, it cannot be assumed that it makes no 
difference to any stomach. The new bread, which only causes 
the healthy stomach to empty a little more slowly, when taken 
into a stomach which always empties slowly, even when supplied 536 
THE NEW DIETETICS 
with the very best of food, may upset the stomach altogether and 
enormously lengthen the time required for digestion. This prin- 
ciple applies to all sorts of unhygienic practices. Infractions of 
the laws of good digestion which are apparently followed by no ill 
effects whatever in healthy persons make the difference between 
comfort and discomfort, good digestion and no digestion at all in 
persons whose digestive powers are impaired. 
It is true that husky lumberjacks “bolt their three square 
meals each day,” along with (until very recently) a lot of bad 
whiskey, besides doing many other equally unwholesome things. 
But it must not be imagined that even the lumberjack can go on 
doing this forever with immunity from stomach and other 
troubles. Some of the worst cases of gastric disorder the writer 
has ever encountered were those of men who had spent a few 
years of their lives in lumber camps and whose stomachs had 
been subjected to the sort of treatment described above as inno- 
cent. Cancer, gastritis, ulcer of the stomach, and other gastric 
disorders are common among these men, notwithstanding the great 
advantages which they derive from their out-of-door life and 
vigorous bodily exercise, which should give them supreme health 
and high resistance. 
Professor Pavlov showed that taking a quantity of water into 
the stomach gives rise to the production of an increased amount 
of gastric acid. The increase is not so great as to cause any 
serious disturbance in a healthy stomach, but in the case of a 
stomach which is already making an excess of gastric acid the 
drinking of a quantity of water may be the means of greatly in- 
creasing the difficulty. Thus it is an easy inference that the 
habitual use of liberal quantities of water in connection with 
meals, like other gastric stimulants, will in time produce pro- 
nounced hyperacidity. 
A glass of water at meal times is not at all harmful for the 
ordinary person, but the practice of drinking water to wash the 
food down is very injurious. Those whose stomachs are already 
producing an excess of acid, however, should avoid all water 
drinking at meals as well as the use of broths and thin soups. 
In the feeding of milk to many hundreds of patients sub- 
jected to the milk regimen experience has shown the taking of 
milk slowly to be so important that the patient is invariably 
required to draw it through a straw or a small glass tube. In 
this way a person may take as much as six quarts of milk a day 
without difficulty. MEDICAL DIETETICS 
537 
A unity of function characterizes the whole alimentary tract. 
All the various processes of digestion are linked together. When 
food is taken into the mouth and the muscles of mastication begin 
to work, activity begins all along the alimentary canal. While the 
food is being sipped or chewed, the food residues in the colon 
move forward toward the exit four times as rapidly as at other 
times. Consequently, sipping, chewing and tasting the food are 
most important natural means of encouraging efficient bowel 
action. An infant or young animal always sips its food with a 
sucking action. This is important for the reason that the suction 
force exerted on the salivary glands increases the flow of saliva. 
This is easily demonstrated by experiment. Intestinal Toxemia—Auto- 
intoxication 
Miller, of Berlin, made an exhaustive study of the microbes 
of the mouth and showed the dominant role which they play in 
caries of the teeth and various other diseases of the teeth and 
gums. When the author, some thirty years ago (1893), estab- 
lished a laboratory for the study of the bacteria of the stomach, 
with the expert assistance of Professor Novy, of the University 
of Michigan, it was generally believed that bacteria were always 
present in the stomach since it was known that they existed in 
the mouth and were swallowed in great numbers with the food. 
These studies were begun by giving a sterile test meal to healthy 
persons, great care being taken to avoid accidental contamination 
by thorough cleansing of the mouth and the use of sterilized 
stomach tubes. The expectation was that many bacteria would be 
found and it was intended to make a study of these, which might 
he termed the normal bacteria, for subsequent comparison with 
the bacteria in pathological cases. After ten days’ work, during 
which time a considerable number of cultures were made, no 
bacteria at all had been .found. Various culture mediums had 
been employed and the conditions essential for encouraging the 
growth of anaerobic as well as aerobic species had been supplied, 
but without result. The character of the test meal was then 
changed. It was no longer made sterile as before, and the result 
was that some of the cultures showed growths, although the 
majority of them still remained sterile. 
So far as the writer knows, this was the first demonstration 
of the fact that the healthy stomach carries on its work without 
the aid of bacteria, and that it is even capable of sterilizing noil- 
sterile food substances which may be introduced into it. Since 
then, more than twenty thousand bacteriological examinations of 
stomach fluids have been made in the clinical laboratory of which 
the writer has charge. Of these, the great majority have been 
found sterile. Numerous other investigators have obtained simi- 
lar results, and it may be considered as now thoroughly established 
538 INTESTINAL TOXEMIA 
539 
that the healthy stomach carries on its work without the aid of 
bacteria, and that their presence in the stomach fluid obtained 
after a test meal is an evidence of the presence of a pathological 
state. Normal gastric juice destroys bacteria, or at least inhibits 
their growth, so that the process of gastric digestion is carried on 
without the aid of microbic activity. When the gastric secretion 
becomes deteriorated in character so that it no longer destroys 
bacteria or inhibits their growth, various pathologic processes are 
set up in the stomach, which extend to the intestine and to the 
liver and other adjacent organs, resulting in serious derangement 
not only of the digestive functions but of the system at large. 
Later the study of the bacteria of the small intestine occupied 
the attention of bacteriologists. Roux, a pupil of Pasteur, showed 
the fallacy of his master’s contention that microbic intervention 
is necessary for the maintenance of plant life by causing beans to 
grow in a thoroughly sterile medium. Nuttall and Thierfelder 
showed that guinea pigs brought into the world aseptically by 
Caesarian operation lived when fed upon sterilized food, although 
they did not grow so rapidly as the control animals. Experiments 
made upon chickens and other animals indicated that animals fed 
upon sterilized food did not thrive so well as those fed upon 
ordinary food. Subsequent researches have made it clear that the 
reason animals fed upon sterilized diet do not thrive is not on ac- 
count of their being deprived of the beneficent influence of mi- 
crobes but because the vitamins of the food have been impaired 
or destroyed. 
Dr. Levin, of Stockholm, accompanied the Natthorst expedi- 
tion to the Arctic regions in the summer of 1898 for the purpose 
of studying the bacteria of that region. In obtaining each speci- 
men he passed through his apparatus 20,000 liters (more than 
5,000 gallons) of air. He found practically no bacteria in the 
air. In sea water, snow, and melted ice he found on an average 
one organism in a little more than one-third of an ounce. In 12 
samples of brown mud he found only a single microbe. The intes- 
tinal contents of the polar bears, seals, eider ducks and other 
birds, as well as sharks, sea urchins, sea anemones and crabs, were 
nearly always sterile. His examinations were made both by cul- 
ture and by staining, so as to exclude the presence of dead bac- 
teria. These results agree with those of Nencki and also Nuttall 
and Thierfelder, whose experiments showed that animals are able 
to live without the presence of bacteria in their intestines. 540 
THE NEW DIETETICS 
The fact that only a minority of these animals show bac- 
teria in the intestines clearly indicates that their presence in any 
part of the alimentary canal is due to accidental infection and 
is not essential to the well-being of the animal organism. 
Conclusive as are the observations of Levin in the Arctic 
regions as indicating beyond the shadow of a doubt that microbes 
are not essential to the most vigorous animal life, we may still 
call attention to the exhaustive researches of Adami, who studied 
the contents of different parts of the intestinal tract from the 
stomach to the rectum, and found the contents of the duodenum 
and the upper part of the small intestine to be practically sterile. 
In fact, in healthy conditions the entire small intestine was found 
free from bacterial development, with the exception of harmless 
lactic-acid-forming organisms. Bacteria capable of producing 
putrefaction were found only in the large intestine or at the ex- 
treme lower part of the small intestine. In pathological condi- 
tions, however, the putrefactive bacteria which ordinarily exist 
only in the large intestine are found higher up, in the small intes- 
tine, in some cases occupying the entire intestine and even the 
stomach and biliary passages. This general infection of the 
intestine exists in both acute and chronic gastro-enteritis and in 
various other pathological conditions of the stomach and intestine. 
Escherich made an interesting study of the bacteria of the 
intestine in infants. His observations showed the intestinal con- 
tents of an unborn child to be absolutely sterile. Within eight 
or ten hours after birth the B. bifidns and other lactic-acid-form- 
ing bacteria make their appearance. So long as the nourishment 
of the child consists exclusively of mother’s milk the intestine is 
dominated by acid-forming bacteria, the stools are free from 
putrescence, no indol is found in the urine, and there is no evi- 
dence of the slightest putrefaction in any part of the intestine. 
When fed upon cow’s milk, however, the intestine often becomes 
infected and the stools offensive, and bacteriological examination 
shows the presence of the putrefactive organisms which are 
always found in market milk. Tissier, of the Pasteur Institute, 
has confirmed and extended these observations. He found that 
while Welch’s bacillus, B. putrificus and other organisms make 
their appearance their increase is prevented by B. bifidus and other 
acid-formers which constitute about seventy-five per cent, of the 
total bacterial inhabitants of the intestine. 
Later studies have shown that while in early infancy the INTESTINAL TOXEMIA 
541 
B. bifidus is the dominant organism and protects the colon from 
the invasion of putrefactive bacteria, another, stronger-growing 
acid-forming bacillus, the B. acidophilus, makes its appearance as 
the child advances in age. And this organism, if encouraged by a 
biologic or non-putrefactive diet and proper care of the colon, is 
capable of preventing the putrefaction of the body wastes and 
food residues in the colon, thus protecting the body against the 
numberless evils which result from the absorption of putrefactive 
products from the colon, the chief cause of intestinal toxemia or 
autointoxication. The loss of this most important defense against 
disease is one of the greatest misfortunes a human being can 
suffer, and yet there are few among civilized people who do not 
undergo life-long injury from this cause. The maintenance of 
normal intestinal flora is one of the chief essentials of a biologic 
life; and the restoration of the normal flora by securing the domi- 
nance of the B. acidophilus in the colon is one of the chief objec- 
tives in the rational dietetics the principles of which we have 
undertaken to set forth in this work. 
Bouchard was one of the first to call attention to the role 
played by bacteria in the production of toxins in the colon, re- 
sulting in a condition which he termed autointoxication. He 
showed by experiments on rabbits that solutions of fecal matter 
were highly toxic in character and that the toxicity was increased 
in proportion to the degree of putrefaction. Thus, the fecal 
matters of a meat-eating animal or a meat-eating man were shown 
to be twice or more as toxic as the feces of a non-flesh-eating man 
or animal. Bouchard estimated that in some cases half the en- 
tire bulk of the feces consisted of bacteria. 
Charrin of Paris, Combe of Lausanne, Tissier, Escherich and 
numerous other European bacteriologists, as well as Herter in 
this country, have made exhaustive studies of the different species 
of bacteria which are produced in the intestine and of the toxins 
which they generate and the effects they produce upon animal 
organisms. An enormous number of facts of the highest import- 
ance has been developed by these indefatigable investigators, 
which leaves no shadow of doubt that the putrefactive bacteria 
and anaerobic organisms of various sorts which thrive in the colon 
and the lower part of the small intestine are a constant and 
almost universal source of mischief to the human race, and that 
many chronic and acute maladies and various degenerations owe 
their origin to this cause. 542 
THE NEW DIETETICS 
Physiologists are agreed that normally there is no putrefaction 
of foods or food residues in the alimentary tract. Nature has 
apparently taken great pains to prevent putrefactive changes. The 
gastric juice is a powerful disinfectant and destroys most forms 
of bacteria; the bile inhibits the growth of many species of bac- 
teria, and at the beginning of life Nature supplies the young of 
all mammals with acidophile organisms capable of maintaining a 
vigorous growth in the aerobic conditions of the lower intestine 
and colon, and which produce only harmless acids and no toxic 
substances whatever. So long as those acid-forming organisms 
are dominant in the intestine putrefaction is prevented and a 
normal state of activity of the intestine is maintained. 
The whole alimentary canal is highly sensitive to acids, which 
raise the tone of the muscular walls of the intestine and produce 
active peristalsis, whereas the alkaline products of putrefaction 
have the opposite effect, producing paralysis. The highly acid 
gastric juice produces strong peristaltic waves in the stomach and 
high tone or gradient of its muscular walls. The gastric acids are 
neutralized in the duodenum so as to lower the gradient and per- 
mit the food to pass onward from the stomach into the intestine. 
The interesting gradient theory which has been put forward 
hv Alvarez and his associates helps to a clearer understanding of 
the physiology of the intestine, although Alvarez seems to have 
overlooked the significance of the opposing relation of acids and 
alkalines to the muscular tone of the intestine. The gradient is 
lowered in the small intestine by the alkaline bile, pancreatic and 
intestinal juices; but when the colon is reached, it is necessary 
that the gradient should be raised again in order to secure ex- 
pulsion of the food residues and wastes. Nature has made provis- 
ion for this by supplying the B. acidophilus, which by the fermen- 
tation of carbohydrates produces lactic acid which, as long ago 
pointed out by Adolph Schmidt, is the normal intestinal stimulant. 
When lactic acid is present in sufficient amount, the food residues 
in the colon are rapidly moved forward toward the exit and the 
colon is emptied so frequently that there is not time for the de- 
velopment of putrefactive changes even if this were possible in 
the presence of an aciduric flora. The gradient rises so high in 
the colon that peristaltic waves starting at the middle of the 
transverse colon travel backward toward the cecum. 
Herter, as well as others, has shown that the number of these 
pernicious, toxin-producing organisms present depend largely INTESTINAL TOXEMIA 
543 
upon the character of the food—the larger the amount of protein 
food, the larger the number of organisms. The feces of the lion, 
tiger, wolf and cat show enormous numbers of these pathogenic 
organisms, while the fecal matters of the buffalo, goat, camel and 
elephant were found practically free from virulent organisms. 
In other words, Herter showed that there is a distinct herbivor- 
ous type of bacterial flora. When the feces were inoculated into 
broth, he found mercaptan was produced by the feces of car- 
nivorous animals but that none resulted from the feces of herbiv- 
orous animals. Emulsions of carnivorous feces inoculated into 
guinea-pigs gave rise to edema, hemorrhages and destruction of 
tissue. Gas and butyric acid were formed. None of these patho- 
logical effects were produced by the feces of herbivora. 
An interesting clinical fact in harmony with the above obser- 
vation was mentioned by'Herter; namely, that carnivorous ani- 
mals frequently suffer from pernicious anemia and other forms of 
anemia, while these diseases very rarely occur in herbivorous ani- 
mals unless associated with intestinal parasites. 
Langer has shown that in breast-fed infants the colon bacil- 
lus develops feebly, while in older persons it grows with vigor. 
This would seem to indicate that the bacillus becomes more viru- 
lent in time or that the infant intestine is a less favorable habitat 
than that of the adult. By means of a biologic diet, the adult 
colon may be rendered as inhospitable a place for the mischievous 
colon bacillus as is that of the normal nursing infant. 
Another interesting fact to which Herter calls attention is 
that in the feces of healthy young persons disease-producing 
bacteria are comparatively few in number, and that there is a 
close relationship between the decrease of vital resistance incident 
to advanced age and the increase of putrefactive bacteria and 
their products found in aged people. 
Of the three great food principles which constitute the 
digestible portions of our foods, carbohydrates are chief in im- 
portance in relation to the bacteriology of the intestine. No matter 
how favorable other conditions may be, bacterial growth cannot 
take place without a food supply. Carbohydrates, that is, starch, 
sugar and dextrin, constitute the natural and necessary food 
supply for acid-forming bacteria, the harmless character of which 
has already been referred to. The lactose, or milk sugar, of the 
nursing infant’s food supply thus encourages the growth of the 
acid-forming organisms which are found present within a few 544 
THE NEW DIETETICS 
hours after birth and which, as Escherich has shown, are a pro- 
tection against the harmful putrefactive organisms which appear 
later. The proteins, on the other hand, are the natural and 
necessary food supply of the putrefactive and pathogenic poison- 
forming organisms which grow in the lower part of the intestine, 
where the absence of air and the presence of retained and un- 
digested and unabsorbed protein substances furnish conditions in 
the highest degree favorable for the development of this class of 
organisms. 
The classical experiments of Fischer have shown us that the 
process of digestion of proteins reduces these complex compounds 
to simple crystalline bodies (amino acids) which, when absorbed 
by the intestinal mucous membrane, are reconstructed into a new 
albumin molecule—human albumin, as it has been called. Putre- 
factive bacteria are likewise capable of breaking up the albumin 
molecule, and produce the very same amino acids, fatty bodies 
and other substances as do the digestive fluids of the stomach and 
the intestines. But the putrefactive bacteria do not stop with the 
formation of these useful products, which at least resemble those 
formed in animal digestion, but go farther, breaking up the crys- 
talline substances which the body uses in building up its own kind 
of albumin, converting them into substances of a highly toxic 
character. 
Poisons Produced by Putrefactions in the Colon. 
According to Nencki, MacFayden and other investigators, 
not less than one-seventh of the total amount of protein eaten is 
ordinarily destroyed by putrefaction, thus occasioning a very 
considerable loss to the body. But this loss is a matter of small 
consequence compared with the mischiefs which result from the 
poisons into which this one-seventh of the nitrogenous food supply 
is converted instead of being transformed into human albumin 
adapted to the nourishment and repair of the tissues. Among the 
first substances produced by bacteriological action through the 
breaking up of the crystalline products of normal digestion are 
the so-called aromatic bodies. From the normal tyrosin is formed 
cresol and phenol, while from tryptophan are formed the well- 
known malodorous skatol, indol and pyrrhol, to which the char- 
acteristic odors of putrid feces are due. 
Of the various ptomains which are formed the best known 
are putrescin, cadaverin, parolin, puridin and collidin. These INTESTINAL TOXEMIA 
545 
ptomains have been found in the stools of persons subsisting upon 
an ordinary mixed diet by Roos, Garcia, Baumann and others. 
Bouchard, more than thirty years ago, showed the enormous 
difference which may exist in the character of the fecal matters. 
In one case he found a sufficient amount of toxic material in the 
extract obtained from 17 grams (less than two-thirds of an ounce) 
of fecal matters to kill a rabbit weighing one kilogram (two and 
one-fifth pounds). After changing the intestinal flora, the ex- 
tract of 200 grams, or twelve times as much of fecal matters, was 
required to kill an animal weighing one kilogram. 
That these ptomains are not only present in the intestinal 
contents but that they are absorbed and circulated throughout the 
body and thus brought into contact with all the tissues is clearly 
shown by the fact that they have been recovered from the urine. 
Numerous observers have found cadaverin, putrescin and other 
ptomains in the urine of subjects in various forms of disease. 
Salkowski found indol and phenol in the urine of starving dogs. 
Observations made by Muller on the faster, Cetti, found both 
indol and phenol. It was observed that the phenol increased after 
the fifth day. Indol was also found in the urine of the faster, 
Succi, and the professional faster, Breithaupt. Ernst and others 
have shown that in these cases phenol, indol and skatol are 
formed by the putrefaction of bile, the pancreatic juice and the 
intestinal juice. According to Muller, the putrefactive activity of 
bacteria is increased during starvation because of the absence of 
lactic acid in the intestinal contents and the frequent occurrence 
of hemorrhages. The stools of new-born infants contain none of 
these poisons, for the reason that putrefaction has not as yet 
begun in the sterile intestine of the new-born, although it is true 
that they may be found in small amount in the urine of a new-born 
infant, having been derived from the blood of the mother through 
the placenta. The pancreatic juice seems to be particularly prone 
to putrefaction. The intestinal mucus also putrifies readily, and 
the coloring matters of the bile are decomposed by bacteria, by 
which they are converted into toxic substances. 
Phenol (carbolic acid) appears to be formed only in the large 
intestine. At least this is the opinion held by the majority of 
authorities. It appears in the urine whenever stasis of the colon 
occurs, sometimes in cases of obstruction increasing to as much as 
seventy times the ordinary amount. Brenzcatechin, hydrochinon 
and alcapton are three curious coloring matters of a toxic charac- 546 
THE NEW DIETETICS 
ter which are formed by the putrefaction of protein, and which 
sometimes are found in the urine in such quantities as to give it a 
brownish or even a blackish color. 
But by no means all the poisons produced by putrefaction 
processes in the intestine appear in the urine. Through the action 
of the intestinal mucous membrane, the liver and various anti- 
toxic glands, a considerable portion of the toxic substances is 
either destroyed or so changed that their toxicity is very consid- 
erably decreased. 
Animal parasites are nearly always present in dogs and other 
carnivorous animals, and are not infrequent in the intestine in 
man; but the parasites found in the human intestine rarely do 
much injury, though they sometimes encourage infection by 
typhoid bacteria by wounding the intestine, and occasionally give 
rise to appendicitis. 
Intestinal Antiseptics Harmful. 
An investigation conducted by Nicate and Schulz (Berlin 
Klin. JVoch., June, 1900) shows that intestinal antiseptics dimin- 
ish the ability of the intestine to destroy bacteria. After a dose 
of castor oil and calomel, cholera germs were found in abundance 
in the stools of dogs to whom cultures of this micro-organism had 
been given, while before the calomel was given no bacteria were 
found, although cholera germs in quantity had been introduced 
into the intestine in such a way as to avoid action by the gastric 
juice. This experiment indicated that the intestine has in some 
way the power to destroy bacteria, probably, as suggested by 
Buchler, by means of a special ferment, and that the action of 
calomel interferes with the action of this protective process. 
The observation that disease germs are destroyed in the nor- 
mal intestine has been confirmed by Eiskamp and Park (Jour, of 
Infectious Diseases, Jan., 1921), who noted that the pathogenic 
organisms disappeared in the intestine in two to seven hours. 
Thyroid Extract in Intestinal Toxemia, 
Borsch recommends the use of thyroid extract for neutraliz- 
ing or distoxicating the poisons absorbed from the colon. This 
practice would seem to be justified by the facts known respecting 
the function of the thyroid gland. It is well known that dogs 
from which the thyroid gland has been removed die when fed on 
a meat diet, but live and prosper when fed on a diet from which INTESTINAL TOXEMIA 
547 
meat is excluded, doubtless because of the lessened production of 
putrefactive poisons in the colon. 
Gastric Toxicity, 
It was long ago discovered that the secretions of the stomach 
are more or less toxic. Among the observations made was the 
fact that a hypodermic injection of a solution of morphia or 
similar poisons is quickly followed by the excretion of the poison 
into the stomach. For example, half an hour after the injection 
of a quarter of a grain of morphia one-half of the quantity has 
been obtained from the gastric contents withdrawn by a stomach 
tube. 
Roger found in experiments upon dogs and rabbits that when 
intestinal putrefaction is active the toxins absorbed are excreted 
into the stomach in large quantities. M. Borri conducted a series 
of experiments for the purpose of determining the degree of 
toxicity of the gastric contents obtained after a test breakfast in 
normal and diseased conditions. The results showed that in hyper- 
acidity toxicity is very much increased. That this is not due to 
the acid was proven by the fact that the toxicity was increased 
even when the acid was neutralized. Toxins were also increased 
when motility of the stomach was diminished. The toxicity is 
also increased in gastritis. 
The toxicity was found to be increased also to an extraordi- 
nary degree in cases of hysterical vomiting accompanied by head- 
ache, disturbance of vision, general depression, and various nerv- 
ous disturbances. In these cases even water passed through the 
stomach by means of a tube was found to be very toxic. This 
hypertoxicity disappears as soon as the attack ceases. 
These observations furnish a rational explanation for the 
headache, sense of weight and pressure in the head, mental 
inertia, general feebleness and other symptoms which accompany 
disturbance of gastric motility and other forms of indigestion; 
they also show why gastric lavage usually gives such great relief 
in cases of gastric disorders accompanied by slow emptying of 
the stomach. Tests of the Nutritive 
Functions 
The purpose of this short chapter is not to present the tech- 
nical details of medical examinations in relation to digestion, but 
briefly to describe the several physical examinations and labo- 
ratory tests which may be utilized in the investigation of gastric 
and intestinal disorders. 
Examination of the Mouth. 
Every examination of the digestive functions should begin 
with the mouth. It should include, to be complete, an inspection 
of the tongue, examination of the teeth by a competent dentist, 
an X-ray examination of the teeth and a bacteriological and chem- 
ical examination of the saliva. The mouth has formerly received 
much less attention than it deserves, and we still lack much of 
knowing all that needs to be known concerning the various con- 
ditions found in the mouth. 
Significance of the Coated Tongue, 
The tongue naturally received first attention in the examina- 
tion of the mouth. Old medical writers attached great significance 
to the various coatings and other appearances presented by the 
tongue, but modern medical researches have shown most of these 
views to be erroneous. Many years of observations have con- 
vinced the writer of the truth of the suggestion of the eminent 
French physician, Lasegue; “La langue ne denonce pas la 
maladie, mais I’etat du malade qui en est atteint” (The tongue 
does not indicate the disease, but the state of the patient). 
To understand the significance of the coating of the tongue, 
it is necessary to remember that the mouth, next to the nasal 
cavity, is of all parts of the body most exposed to contact with 
germs and micro-organisms of all sorts. The warm, moist cavity 
of the mouth afifords an ideal incubating chamber, in which the 
numerous bacteria swept in with each incoming breath may grow 
and develop luxuriantly unless prevented from doing so by some 
special provision. The only reason why the tongue and all the 
548 TESTS OF NUTRITIVE FUNCTIONS 
549 
mucous surfaces of the mouth are not always thickly coated is 
because the saliva, under normal conditions, prevents the growth 
of the various yeasts, molds and other organisms, which a micro- 
scopic examination shows to be present in countless numbers in 
the material scraped from a coated tongue. 
The studies of Metchnikoff, Wright, and others have shown 
that the blood contains alexins, opsonins and other suble agents 
which hinder the growth and development of bacteria. Under 
normal conditions, the white cells of the blood, or leukocytes, of 
which the blood of a person of ordinary size contains more than 
30,000,000,000, are constantly active in destroying the bacteria 
which are continually finding their way into the blood stream; 
and thus, so long as an individual remains in perfect health, the 
blood is kept free from these invading enemies of the body. 
Although countless millions of these organisms daily find their 
way into the blood from the intestine, especially the colon, they 
are destroyed as rapidly as they enter, and so do not obtain a 
foothold within the body. 
The saliva is formed from the blood and for a time after 
being freshly secreted it possesses the same germ-resisting prop- 
erties exhibited by the blood. The same is true of milk when 
freshly produced and still warm from the body of the cow. Small 
numbers of typhoid fever germs introduced into such milk rap- 
idly disappear. The freshly secreted saliva contains not only the 
same opsonins and alexins found in the blood but also great num- 
bers of white blood cells. As it pours into the mouth from the 
salivary ducts, it floods the tongue and teeth and other mouth 
surfaces, coming in contact with any bacteria which may have 
been lodged in the mouth and so preventing their development; 
and the white cells, though outside the blood vessels, may continue 
their work of capturing bacteria. And thus the mouth under 
normal conditions is kept clean. 
When the mouth is dry, as in fever, when the salivary glands 
are paralyzed and produce very little saliva, the tongue becomes 
thickly coated by the growth of bacteria, molds, yeasts and other 
fungi. Persons who sleep with the mouth open have the tongue 
coated in the morning because the surfaces are dried and no 
longer bathed with the germ-resisting saliva. 
But there is still another and much more common cause of 
coating of the tongue. The power of the blood to deal with germs 
and germ toxins is necessarily limited; hence, in autointoxication, 550 
THE NEW DIETETICS 
when the body is flooded with putrefaction products, and viru- 
lent bacteria swarming in countless myriads in the alimentary 
canal find their way into the blood in unusual numbers, the germ- 
destroying properties of the blood and saliva are exhausted. The 
same condition of the blood may result from germs and germ 
poisons derived from other sources than the alimentary canal; 
thus a coated tongue is practically always found present in fever, 
no matter what the cause of infection. A coated tongue may be 
regarded as practically always an indication of a toxic condition 
and lowered resistance to bacteria, as the result of which the 
saliva has been rendered incapable of affording the mouth the 
natural protection which it gives in conditions of health. 
When the tongue is thickly coated, the breath has a bad odor 
and not infrequently a characteristic fecal odor. In such cases, 
there will always be found very pronounced intestinal stasis, the 
food residues and other body wastes being retained in the colon 
for days, instead of being promptly dismissed from the body. 
When the colon functions in a normal manner, that is, empties 
itself of its contents three times a day, or after each meal, there is 
no time for putrefaction and the absorption of toxic materials. 
Under normal conditions, the colon will not contain the residues 
and wastes of more than three meals; but when the bowels move 
but once daily, perhaps then imperfectly, the residues of six to 
ten meals or even more accumulate in the colon, and by their 
long retention in this excellent incubating chamber in contact with 
various species of putrefactive bacteria they reach a highly ad- 
vanced state of putrefaction; and this may be true even though 
the amount of meat or other highly nitrogenous products eaten is 
small, for the reason that the mucus produced in all parts of the 
alimentary tract and the residues of most of the digestive juices 
are all highly putrescible substances and supply abundant food 
material to promote the growth of putrefactive organisms in the 
colon. 
To make things worse, the overstretching of the colon with 
accumulated residues breaks down the ileocecal valve, an admir- 
ably constructed and most efficient check valve provided by Nature 
to prevent the return of the feces into the small intestine when 
they have once been disposed of by being pushed out of the small 
intestine into the waste receptacle of the body. 
A chronically coated tongue, with a fecal odor of the breath, TESTS OF NUTRITIVE FUNCTIONS 
551 
is an almost certain indication of incompetency of the ileocecal 
valve and the need of a change of the intestinal flora. 
Under the writer’s direction many hundreds of examinations 
of the saliva of persons with coated tongues have been made in 
the laboratories of the Battle Creek Sanitarium. Colon bacteria 
are always found in the mouths of persons with badly coated 
tongues. The saliva of such persons when allowed to remain for 
some days in a closely corked bottle acquires a very pronounced 
fecal odor. 
Fluid obtained from the duodenum by means of an Einhorn 
tube likewise shows in many cases colon germs in great numbers. 
These facts, taken together, clearly indicate that in persons suffer- 
ing from so-called autointoxication the whole alimentary canal 
from mouth to rectum is swarming with poison-forming bacteria 
which are continually polluting the body with their offensive and 
highly toxic excretions, through the absorption of which an enor- 
mous burden is imposed upon the liver, the kidneys and other 
poison-destroying organs, which in time become exhausted by the 
excessive work required of them and permit the inflowing stream 
of multitudinous poisons to accumulate in the tissues, giving rise 
to the various functional and organic disturbances which mani- 
fest themselves in the various forms of chronic disease either as 
the direct or indirect results of chronic autointoxication. 
The explanation of this wide dispersal of bacteria through 
the alimentary tract appears to be found in some recent remark- 
able observations made by Grutzner, Bernheim and others who 
have shown that bacteria, lycopodium, and fine particles of various 
sorts introduced into the rectum may be carried to the mouth 
within a few hours either by reverse peristalsis or possibly through 
the activity of the villi, or by both these means (Alvarez). 
The Teeth. 
As a result of bacteria in the mouth the teeth undergo decay 
and the gums become the seat of bacterial growth. These perni- 
cious organisms even penetrate to the roots of the teeth, produc- 
ing abscesses and infections which may insidiously attack almost 
every organ and structure in the body. Rheumatism, neuritis, 
disease of the eyes, even gastric ulcer, duodenal ulcer, gall bladder 
disease and appendicitis, may find their origin in these infections 
of the mouth. 
A thorough examination of the teeth should include not 552 
THE NEW DIETETICS 
simply inspection by a dentist but also a careful X-ray examina- 
tion. | 
In a special study of the teeth as related to digestion, made 
more than twenty years ago, the writer found that there exists a 
definite correlation between the state of the teeth and the function 
of the stomach, showing very conclusively a close relation between 
certain gastric disorders and the condition of the teeth. Some of 
the facts noted may be of interest. Of the one hundred cases 
examined, only two had perfectly sound teeth. Of persons suf- 
fering from a deficiency of gastric acid (about one-half the total 
number of cases studied) the average number of sound teeth was 
ten, whereas in the less advanced cases of digestive disorder the 
average number of sound teeth was twenty. Of the persons suf- 
fering from simple dyspepsia, none had been compelled to resort 
to the use of artificial teeth, whereas among the fifty-one persons 
suffering from a deficiency of gastric acid twelve were dependent 
upon artificial teeth, five having upper sets only and seven having 
both upper and lower sets. Among the persons suffering from 
infection of the stomach or gastric catarrh, the number of sound 
teeth was only about one-half as many as in persons not so 
affected. 
The Saliva* 
The saliva should be included in a thoroughgoing examina- 
tion of the mouth. ' A bacterial examination will give some idea 
of the state of the alimentary canal as regards bacterial infection. 
If the mouth is badly infected with putrefactive germs and 
disease-producing organisms, especially if the colon bacillus is 
found present, it may be taken for granted that the whole ali- 
mentary canal, with the possible exception of the stomach, is in- 
fected with pernicious bacteria. 
More important still is a test of the digestive properties of 
the saliva. Some years ago (1890) the writer began the systematic 
study of the digestive power of the saliva, and soon discovered 
that wide differences existed in the digestive activity of the saliva 
produced by different persons. The plan of examination adopted 
was that devised by Sir William Roberts in his study of the effects 
of acids upon salivary digestion, the technic of which need not be 
given here. This method was employed in testing more than fifty 
thousand salivas. Very great differences were found in the 
digestive power of the saliva. In a few cases it was found to be TESTS OF NUTRITIVE FUNCTIONS 
553 
almost inactive. Gum chewing rapidly depreciates the activity 
of the saliva. 
While the great physiologist, Magendi, certainly was wrong 
in his supposition that the saliva is “the principal solvent of ali- 
mentary matter,” it has recently been shown that cooked starch 
which has not been acted upon by the saliva interferes with gastric 
digestion by absorbing the pepsin, leaving hydrochloric acid in 
excess and so giving rise to hyperacidity. 
The action of the saliva in liquifying the starch of the food 
is a necessary aid to its disintegration, thus preparing it for the 
action of the gastric juice and succeeding digestive fluids. 
Tests for Gastric Digestion, 
A third of a century ago, gastric disorders held a much 
more prominent place in the minds of clinicians than at the 
present time. The teachings of Glenard, Dujardin-Beaumetz, 
Ewald and other clinicians focused attention upon the stomach 
as chief offender in the physical economy. But modern physiology 
has shown that the stomach holds a secondary place in the work 
of digestion, since it may be dispensed with when rendered useless 
by disease and apparently without serious interference with nutri- 
tion or the major vital functions. Many disorders once charged 
to the stomach are now believed to be properly chargeable to the 
colon, a veritable Pandora’s box of ills and miseries. Neverthe- 
less, the stomach still holds a large place in clinical medicine, and 
is the understood seat of a considerable number of painful and 
crippling maladies and subject to numerous functional disturb- 
ances which may be remedied by judicious treatment and espe- 
cially by careful and rational feeding. 
For success in dealing with gastric disorders by dietetic 
means, it is of first importance that the exact nature of the de- 
rangement should be understood. Thirty years ago this was 
rarely possible. The meager means of investigation then avail- 
able left the physician to depend largely upon shrewd guessing for 
his diagnosis in a very large proportion of cases. But this is no 
longer necessary. Modern methods of studying gastric disorders 
are sufficiently exact to enable the up-to-date physician by a 
searching examination to ascertain with a reasonable degree of 
certainty the real conditions present in any individual case. Such 
an examination is not only desirable but essential in every case 
as a foundation for the scientific application of modern, rational 
dietetics. 554 
THE NEW DIETETICS 
The Test Breakfast, 
The test breakfast of Ewald introduced a new era in the 
treatment of diseases of the stomach. This breakfast consists of 
two ounces of bread with eight ounces of water. At the end of 
an hour from the beginning of the breakfast a stomach tube is 
passed into the stomach and its contents evacuated, filtered, and 
examined for total acidity, the amount of free hydrochloric acid 
present, the amount of combined and fixed acid, the digestive 
activity, as shown by the digestion of egg albumin in Mett’s 
tubes. Tests are also made for the rennet ferment, for lactic and 
other organic acids. A bacteriological examination is also made. 
The Fractional Test Meal, 
A fractional examination of the gastric fluid has been shown 
to be of special value. This test is made by the aid of a small tube, 
which is swallowed and allowed to remain in the stomach during 
the entire test. The gastric fluid is withdrawn at intervals of 
fifteen to thirty minutes and tests are made for free hydrochloric 
acid and total acidity. Hayem and Winter, who made the first 
thoroughgoing studies of the gastric fluid, were also the first to 
make these fractional tests, which have only recently been fully 
appreciated, since their value has been demonstrated by Rehfuss 
and others. 
In some cases the secretion of acid, though ample at the start, 
soon fails. Cases are also found in which there is only a little 
acid in the stomach at the end of an hour, but half an hour later 
a large amount. These cases of hyperacidity were quite frequently 
overlooked when the examination was confined to the Ewald 
method. The fullest information concerning the work of the 
stomach is to be obtained only by a combination of the Ewald and 
the fractional methods. To the ordinary methods devised by 
Ewald, Toepfer, Hayem and Winter, which are found most 
efficient when used in combination, the writer added many years 
ago (1892) a method for determining the amount of work done 
by the saliva in the stomach as shown by the degree to which the 
starch is digested. 
A number of other test meals have been proposed, some of 
which render essential service in appropriate cases. In the author’s 
practice, protose, a nitrogenous food prepared from vegetable 
protein, having essentially the same chemical composition as beef, 
is used in place of meat. TESTS OF NUTRITIVE FUNCTIONS 
555 
EwalcPs Test Dinner. 
Stale bread, one rather thick slice (1 oz.) with butter and 
chopped meat 6 oz. Withdraw with stomach tube at the end of 
three hours. 
Reigel's Test Dinner, 
Beefsteak (protose), 6 oz.; potato puree, 2 oz.; meat (sa- 
vita) broth, three-quarters pints; one roll or a slice of bread. 
Klemperer’s Test Meal. 
Bread and milk. One pint of milk and two rolls or two thick 
slices of bread. Remove after two hours. 
Von Leube's Gastric Motor Meal, 
Potato soup, three-fourths pint; two slices of bread; beef 
(protose), 6 oz. Wash out stomach with tube at end of six 
hours. If the stomach is normal, no residue will be found. 
The Water Meal, 
A pint of warm water is introduced into the stomach before 
breakfast and small quantities withdrawn for testing at intervals 
of fifteen or twenty minutes. 
Pavlov showed many years ago that water in sufficient quan- 
tity stimulates the acid secreting glands. The degree of acidity 
found may equal that of the normal juice. 
The water meal also gives information about the presence of 
mucus or regurgitated duodenal contents. 
Tests for the Chemical Secretion, 
The small gastric tube having been introduced into the 
stomach, a test meal is introduced through the tube, care being 
taken that no food comes in contact with the mouth. Various 
meals may be used, as simple water, animal or vegetable extracts, 
milk, purees of cereals or vegetables, oil, or combinations. Fluid 
is withdrawn at intervals for examination. 
Test for the Psychic Secretion, 
A small tube is introduced into the empty stomach and the 
subject is then allowed to see, smell, and taste food, but to swal- 
low none. Samples of the gastric secretion are withdrawn at 
intervals of fifteen minutes for examination. 556 
THE NEW DIETETICS 
Test for the Condition of the Gastric Glands. 
Taylor calls attention to the fact that if acid protein is given 
in cases of achylia ferments are very often formed. If ferments 
are not formed, it is concluded that the glands are degenerated; 
hence this test should be applied in every case in which ferments 
are absent, by the giving of acid protein (protein HCL). In 
cases in which acid protein causes the ferments to appear in the 
gastric fluid when previously absent it should be used with each 
meal as an aid to the glands until the ferment-forming function 
is restored. The continuous use of acid protein (acidone) is 
necessary when no hydrochloric acid is formed. 
Capsule Test for Gastric Activity. 
A simple test of much value as a means of determining 
whether the stomach retains or has lost its power to digest pro- 
tein is based upon the fact that the gastric juice alone, of all the 
digestive fluids, is able to digest raw connective tissue. The test 
is carried out by the use of three beads connected by thread and 
also by a bit of raw catgut. These are placed in a perforated 
capsule, which the patient swallows at meal time. The following 
day examination of the stools is made to find the beads. If the 
catgut has disappeared, the gastric juice is known to be active. 
If not, achylia is probably present; that is, the stomach glands 
have ceased to make an active gastric juice. In such cases it is 
necessary to repeat the test, giving a quantity of acid protein 
(acidone). If the catgut does not then appear, the gastric glands 
are still capable of producing pepsin, but for some reason are not 
active. The regular administration of acidone is necessary. But 
if the catgut is present, it is evident that the gastric glands have 
undergone degeneration. 
The Barium Meah 
Soon after the discovery of the X-ray it became evident that 
valuable information might be obtained by the use of a test meal 
containing substances opaque to the X-rays. First, nitrate or 
carbonate of bismuth was employed for this purpose. Later, 
barium was substituted. For the efficiency of this plan of exam- 
ination, the world is largely indebted to Dr. James T. Case, of the 
Battle Creek Sanitarium, who has contributed much to the per- 
fecting of the technic of this valuable method. TESTS OF NUTRITIVE FUNCTIONS 
557 
The digestive apparatus has two distinct classes of functions. 
One of these is concerned with the transformation of the food 
from insoluble or non-absorbable substances into soluble and 
absorbable products which may be utilized by the body in build- 
ing and repairing the vital machinery and in replenishing the 
vital energies of the body. This work is done chiefly by the aid 
of the digestive juices, which are formed by glands placed at 
various points along the digestive canal, chiefly in its upper part. 
A second class of functions consists of mechanical treatment 
of the foodstuffs by which they are: (1) reduced to a soluble or 
pultaceous state; then (2) mixed with the digestive juices; (3) 
spread out upon the intestinal wall so as to aid in absorption; (4) 
moved from one part of the alimentary canal to another, con- 
stantly in the same direction; and (5) when reduced to the un- 
usable residues discharged from the body. 
The Ewald meal and chemical examination of the stomach 
fluid give us information concerning the first class of functions 
—the action of the digestive 'juices upon the food. The barium 
meal gives information concerning the second class of functions, 
which are executed by the muscular walls of the intestine. The 
information obtained by the aid of the barium meal is of even 
greater value than that secured by the test breakfast; but for 
complete information it is necessary that both methods be em- 
ployed. It is further to be noted that the barium meal not only 
advises us concerning the stomach, but visualizes the entire ali- 
mentary canal from mouth to anus, giving information concern- 
ing the conditions of the small intestine, the colon, the gall bladder 
and the liver, which facts are of even greater importance than 
those elicited concerning the stomach by the Ewald meal. The 
following is a brief resume furnished by Dr. J. T. Case of the 
principal conditions concerning which information may be ob- 
tained by the opaque (bismuth or barium) meal: 
Ulcer, cancer or tumor of the stomach, cardio-spasm, spasm 
of the esophagus, spasm of the pylorus, distortions of the stom- 
ach, cysts and tumors of the pancreas, adhesions of the pylorus, 
ulcer of the duodenum, distortions, obstructions and adhesions 
of the duodenum, gall stones, adhesions of the gall bladder, loca- 
tion and changes in the liver, abscess in or about the liver, tumors, 
cancer, ulcers and other changes in the small intestine, incom- 
petency of the ileocecal valve, adhesions of the intestine, 
adhesions of the colon, disease of the appendix, dilatation and 558 
THE NEW DIETETICS 
adhesions of the cecum, cancer of the colon, tuberculosis, syphilis, 
atony, colitis and spasm of the colon. 
The Motility Test* 
The rate at which the undigested foodstuffs are moved along 
the alimentary canal is termed its motility. The barium meal 
affords an exact and scientific method of studying the motility 
of the alimentary tract. Another very simple and high prac- 
ical method, affording final results which agree very exactly with 
those obtained by the barium meal, is the following: 
Two capsules, containing together about 75 grains of carmine, 
are swallowed with the breakfast. In place of carmine a tea- 
spoonful of bone black or finely pulverized charcoal may be used. 
The carmine or the charcoal mingle with the food, giving it a 
characteristic color which can readily be recognized in the stools. 
After the administration of the carmine or charcoal the stools are 
carefully watched and the exact time noted when the color first 
appears. Further observations are made until the color disap- 
pears, the time of which is also recorded. The time of the first 
appearance of the color has long been in use as a means of determ- 
ining motility, but the writer’s experience has been that this is not 
the true measure of the motility rate, but that the motility time 
is marked by the disappearance of the color. This time is found 
to correspond very accurately with the results obtained by the 
use of the barium meal. Some thousands of observations made 
under the writer’s supervision indicate that the motility period 
may vary from eight or nine hours to several days. 
It is found that persons whose bowels move once a day 
usually have a motility period of 50 hours or more. When the 
bowels move thoroughly three times a day, the motility period is 
reduced to 16 to 24 hours. 
The normal motility rhythm is in the writer’s opinion , the 
following: 
The breakfast residue is discharged some time between sup- 
per and bedtime; the dinner residue before breakfast the next 
morning or not later than soon after breakfast; the supper 
residue after breakfast or not later than soon after dinner the 
following day. When this normal motility rate is maintained, the 
time which the food residues remain in the body will be; for 
breakfast, 13 to 15 hours; for dinner, 17 to 20 hours; for supper, 
15 to 20 hours. 559 
TESTS OF NUTRITIVE FUNCTIONS 
When the body wastes are dismissed in this prompt and 
regular manner, there is no time for putrefaction; wild bacteria 
cannot obtain a foothold, the normal acid-forming flora of the 
intestine is dominant, and the vital machinery is not crippled by 
the absorption of the enormous quantities of high toxic sub- 
stances which are constantly pouring into the blood when the 
food residues and body wastes are retained so long in the colon 
that they become putrid. 
This is the normal or ideal alimentary cycle, but it is by no 
means realized in actual experience. The colon of the average 
man is in the condition of a congested railway system. The right 
of way is choked, and if bowel movements occur, they are belated, 
—two or three days in arrears; the residues of half a dozen or 
more meals being packed away in the colon undergoing putrefac- 
tion and poisoning the body. 
The motility test is invaluable in connection with diet and 
treatment for changing the intestinal flora, and should always 
be used in connection with this method as a means of checking 
the results obtained, in addition to careful bacteriological studies. 
Examination of the Gall Bladder. 
The X-ray examination of the gall bladder region often gives 
information of great value concerning the condition of the gall 
bladder. Gallstones are sometimes seen. A certain proportion 
of cases, however, remain obscure, and in these some help may 
be gotten by the use of the Metzer-Lyon method of obtaining 
specimens of bile, which is as follows: 
The test is made before breakfast, 12 hours after the last 
meal. A duodenal feeding tube is introduced while the patient is 
in a sitting position. The patient is then placed on the right side, 
with the left limb drawn up over the right, so as to get the gall 
bladder region as low down as possible. The position aids the 
tube in entering the duodenum so as to bring the bulbous end of 
the tube near the mouth of the bile duct. The tube will usually 
reach the duodenum in 10 to 60 minutes. When it is certain that 
the bulb is in the duodenum some of the duodenal fluid should be 
collected. The first fluid obtained should be a “pearly fluid” with 
little mucus and alkaline in reaction. If the duodenum is diseased, 
many germs will be present and the fluid will be turbid. 
The next step is to inject with a small syringe through a tube 
one and two-thirds ounces of a 25 per cent, solution of magnesium THE NEW DIETETICS 
560 
sulphate. This will cause relaxation of the bile ducts and opening 
of the common duct, with discharge of bile from the gall bladder. 
By gentle suction on the syringe, some of the fluid may then be 
withdrawn, after which the tube is disconnected and hung over 
the side of the couch to drain. The first liquid will be clear 
duodenal fluid, bile and sulphate solution mixed. In 10 to 30 
minutes the bile will become darker and more viscid. This is gall 
bladder bile. If the quantity is large,—more than two and two- 
thirds ounces—there is probably stasis in the gall bladder. After 
a time the bile again becomes thinner and lighter in color, coming 
direct from the liver. 
Normal bile is free from germs unless contaminated by duo- 
denal contents. Cultures prove sterile. If no bile can be obtained, 
the common duct may be obstructed. If only clear, light-colored 
bile is obtained, there may be obstruction of the cystic or gall 
bladder duct. 
A 2 per cent, solution of citric acid may be used instead of 
magnesium sulphate solution. 
The benefit which sometimes results from this mode of gall 
bladder drainage is probably due to the getting rid of a quantity 
of stale and concentrated and hence highly poisonous bile. 
Examination of the Stools* 
The chemical and microscopic study of the stools is of great 
importance, not only as a means of investigating the residual 
products of digestion but also for the purpose of detecting the 
presence of animal parasites, tapeworms, the amoeba of tropical 
dysentery, etc. 
Chemical and macroscopic as well as microscopic examina- 
tions are also made for undigested food, parasites, blood, mucus, 
and other evidences of pathological conditions. 
The examinations are repeated until the flora is changed and 
the stools lose their putrid character and become in other respects 
normal. 
Some of the most significant indications in relation to the 
stools are the following: 
The Color. Very light or clay-colored stools signify the 
absence of bile. Pancreatic digestion may be deficient also. Such 
stools are usually very foul smelling. 
Dark-colored stools denote putrefaction. The stools of a 
healthy breast-fed infant are light yellow in color and nearly TESTS OF NUTRITIVE FUNCTIONS 
561 
odorless. When they become brown or dark, the child is sick 
and toxic. Black stools may indicate blood from hemorrhage. 
The normal stool is of a yellowish color and soft consistency. 
The so-called “well-formed stool” is an indication of chronic 
constipation. It occurs when the bowels move but once daily, a 
form of constipation usually mistaken for an indication of health. 
The Odor. This is most important. Normal stools have a 
slightly sour odor or a very faint fecal odor, but no suggestion of 
putridity. A putrid, strong, ammoniacal or rancid (butyric) odor 
is a certain sign of putrefaction; and when putrefaction is present, 
there are also infection, colitis and autointoxication. 
Lumpy stools indicate a spastic state of the colon, probably 
due to colitis. 
The presence of mucus is a certain sign of colitis. 
Frothy stools with a sour odor indicate very active fermenta- 
tion. 
Gas or flatulence accompanying the stool indicates the pres- 
ence of the pernicious Welch’s bacillus and other gas-forming 
organisms, especially the colon bacillus. 
Bacteriological Examination of the Stools. 
Most important of all is the bacteriological examination of 
the stools by modern methods. Examination of the stools with 
reference to typhoid and other intestinal infections is of course 
important, but of far greater importance is examination to de- 
termine the character of the dominant flora present in the in- 
testine, particularly in the colon. The normal flora of the colon 
is fermentative, or acid-forming. The dominant organism pres- 
ent is B. acidophilus, a germ which produces lactic acid and does 
not produce gas. This germ appears as the dominant flora in 
very young healthy children. It is also found in the colons of 
chickens, monkeys, rats and other animals when fed on food rich 
in carbohydrates and given no meat. 
In adults on a mixed diet the B. acidophilus is found in the 
stools only in very small numbers if at all. The dominant flora 
is putrefactive. That is, the food residues are of such a sort that 
they undergo putrefaction in the colon. Putrefaction is encour- 
aged by the constipation generally present in the average Ameri- 
can. A bacteriological examination shows the presence of 
Welch’s bacillus, a common putrefactive germ and the organism 
which causes gas gangrene. The colon bacillus is also present in 562 
THE NEW DIETETICS 
large numbers with various other putrefactive and poison-form- 
ing germs. 
By means of bacteriological cultures, the character of the 
flora may be readily determined. The presence of large quanti- 
ties of gas shows the presence of Welch’s germ. Small gas bub- 
bles in the Veillon tube indicate the colon bacillus. The absence 
of gas and characteristic colonies show the presence of B. acid- 
ophilus, the normal acid-forming flora. As the flora improves un- 
der proper feeding, the gas gradually diminishes until it disap- 
pears when the flora is changed, and the B. acidophilus becomes 
dominant. 
The accompanying cuts show the appearance of the Veillon 
culture tubes before and after changing the flora. Litmus milk 
and plate cultures are also made. 
The Blood. 
The normal blood count per cubic millimeter is 5,000,000 red 
cells and about 7,000 white cells. The total number of red cells 
in the body of a man of average size is about 25,000,000,000. The 
absorbing surface presented by the red cells is about 82 square 
rods, more than one-half acre. It is the function of the red cells 
to absorb oxygen, which is taken up and concentrated by the 
hemoglobin, an organic iron compound to which the red corpuscles 
owe their color. The blood of a well-developed man contains 
about 40 grains of iron. 
In the words of the old prophet, “The blood is the life.” The 
blood was held as sacred by the ancients because it was believed 
to be the seat of the life principle of the body. The modern 
physiologist recognizes the fact that the blood is the vitalizing 
element of the body, that it creates and maintains the body; in 
other words, that it is in a literal sense the life of the body. 
It has long been known that oxygen is carried by the red 
blood cells. It has been supposed, however, that the transport 
of the carbon dioxide was chiefly accomplished by the serum or 
plasma of the blood. Recent observations by Joffe have shown 
that at least two-thirds of the carbon dioxide is carried by the 
red blood cells. It is now known that the red blood cells carry 
oxygen from the lungs to the tissues and carbon dioxide from the 
tissues back to the lungs. The little burden bearers are always 
loaded. 
In anemia the blood iron is reduced and the blood cells may A 
B 
Veillon Tube Cultures Showing, A. Flora Changed, No Gas; B. Putrefactive Flora, 
Welch’s Bacillus, Much Gas Colon Bacteria 
The red color indicates species which produce putrefaction and give rise to toxins; the blue color, 
acid-forming organisms which are friendly. A. Stool from a child suffering from intestinal toxemia. 
B. Same case ten days later after flora was changed by a change of diet and other measures. 
B 
A TESTS OF NUTRITIVE FUNCTIONS 
563 
also be reduced in either greater or lesser proportion than the 
coloring matter of the blood. In a person whose hemoglobin is 
50 per cent., for example, the blood contains only half the normal 
amount of iron, which means that the vital resistance, endurance, 
and ability to cope with disease are proportionately reduced. His 
stream of life is at a low ebb. When the white cells are reduced, 
the ability to resist the invasion of bacteria is depreciated, since it 
is upon the white cells that we depend for defense against these 
invisible enemies. Whenever infection occurs, that is, whenever 
disease-producing germs find entrance to the body, the white cells 
usually increase in number very rapidly. This is simply the rally; 
ing of the defenders of the body to combat the invading enemy. 
For example, when an attack of appendicitis is developing, the 
white blood cells may within a few hours increase from 7,000 
per cubic millimeter to 20,000 or even more. At the beginning of 
an attack of pneumonia the increase may reach 100,000, many 
times the original number. In general, an increase of the white 
cells in the blood indicates bacterial infection. 
The white cells are usually increased after meals, doubtless 
because the number of bacteria entering the blood from the intes- 
tine is also increased after eating, requiring a greater number of 
white cells to deal with them. 
Chemical Examination of the Blood* 
Chemical examination of the blood is of the highest import- 
ance. Though not as yet in general use, this method, thanks to 
the new and exact technic of Folin, is now thoroughly practical 
and its use is most desirable, almost indispensable, in certain 
classes of disorders. This is, indeed, the most exact means of 
determining the degree of efficiency of the kidneys. It is the 
function of the kidneys to remove waste matters from the blood. 
These toxic substances taken collectively are termed non-protein 
nitrogen. By drawing a few drams of blood from a vein by the 
aid of a suitable syringe and a fine needle the exact amount of 
non-protein nitrogen present in a given quantity of blood may be 
readily determined. By this means it is possible to ascertain the 
amount of waste matters left in the blood by inefficient kidneys. 
The normal amount of this substance is 28 to 32 milligrams (one- 
half grain) per 100 cubic centimeters (three and one-third 
ounces) of blood. When the amount of non-protein nitrogen is 
much greater than this, there is reason to suspect a considerable 564 
THE NEW DIETETICS 
degree of renal inefficiency; that is, the kidneys are not able to 
remove from the blood the waste matters which it is their duty to 
extract from it. 
The determination of an increase in the amount of uric acid 
present in the blood is the best means of detecting the earliest 
indications of failure of the kidneys to perform their work effici- 
ently. An increased amount of creatinin in the blood indicates 
that disease of the kidneys is far advanced. 
A knowledge of these conditions is of the utmost conse- 
quence, as it shows a necessity for the establishment of a rigor- 
ously low protein diet, which might not otherwise be considered 
justifiable, but is absolutely required for the prolongation of the 
individual’s life. 
Sugar is normally found in the blood in the proportion of 
about one part in one thousand. When the sugar is increased 
considerably beyond this amount it appears in the urine and the 
patient is said to have diabetes. Examination of the blood, how- 
ever, often shows a marked increase of blood sugar when it has 
not yet appeared in the urine; hence, an increase of blood sugar 
is a most important symptom of the approach of diabetes. 
Waste Constituents of Normal Blood. 
Mgms. per 100 ccm. 
Non-protein nitrogen (nrea, uric acid, etc.) 25- 32 
Urea i 8-15 
Uric acid 2- 4.5 
Creatinin 1- 2.5 
Sugar 80-120 
The so-called Wasserinann test and various other serological 
tests are important as means of indicating the presence of syphilitic 
and other infections, which may be recognized by changes in the 
blood. 
The Urine. 
The urine is an extract of the tissues. It represents to a 
large extent the acid wastes of the body, while the bile represents 
the alkaline wastes. The quantity of the urine, its specific grav- 
ity, the amount of urea, uric acid and other substances, are all 
highly important in measuring the tissue changes which are taking 
place. The amount of ammonia, indol and other putrefaction 
products, also the presence or absence of albumin, casts and other 565 
TESTS OF NUTRITIVE FUNCTIONS 
abnormal elements, are most important means of judging of the 
kind and extent of morbid changes which may be taking place in 
the body. 
A high protein diet is necessarily accompanied by a great 
increase in the amount of urea and uric acid. Folin has shown, 
in fact, that urea represents the excess of protein which has been 
eaten, the only use for protein being to make good the wear and 
tear of the living tissues. Any amount beyond the small quantity 
required to accomplish this, instead of being built into tissue, is 
directly carried out of the body as so much waste matter. It will 
thus be readily seen how great a burden is imposed upon the 
kidneys by the extra work required of them in the elimination of 
surplus protein eaten in the form of steaks and chops. 
Still another extra burden thrust upon the generally over- 
worked kidneys when an excess of protein is eaten is the necessity 
for the elimination of the indol, skatol, and other poisonous 
products resulting from the putrefaction in the colon of the 
undigested residues of meat and other food substances rich in 
protein. These putrefaction products are probably the source of 
the ammonia which is found in the urine in quantities closely 
proportional to the amount of meat eaten. 
Tests of the Urine. 
Diabetic patients, when possible, should be instructed in the 
methods of examining the urine, so that they may be able to note 
the effects of diet and to detect at once the appearance of threat- 
ening symptoms in their own cases. The following directions for 
testing the urine are borrowed from the author’s work on 
diabetes*: 
Collection of the Specimen* 
Use for the purpose only glass jars or bottles which have 
been thoroughly cleaned and scalded with boiling water. During 
the collection keep the jar well covered and in a cool place. The 
specimen to be analyzed should cover a period of twenty-four 
hours, and should be obtained in the following manner: 
Empty the bladder at the usual time of rising in the morn- 
ing, say 7 A. M. This is to mark the beginning of the collecting 
period; hence this passage is not to be saved. Then carefully 
* “The New Method in Diabetes,” John Harvey Kellogg-, M. D. Modern 
Medicine Publishing Company, Battle Creek, Mich. 566 
THE NEW DIETETICS 
save all the urine passed until 7 A. M. the next day, taking care 
to completely empty the bladder at this time. If the quantity is 
so large as to require several containers to hold it, the whole of 
the twenty-four-hour collection should be poured into one vessel 
large enough to hold it all, so as to secure thorough mixing. Note 
the total quantity, being careful to measure very accurately. If it 
is desired to send to the laboratory a specimen for complete 
analysis, fill a perfectly clean bottle or jar, holding at least one 
pint, with the mixed urine, seal properly and label with the 
name and the total quantity of urine passed during the 24 hours. 
A half dram of toluol may be added to preserve. 
The following tests should be made: 
1. The specific gravity. Place enough urine in the cylinder 
to float the urinometer. Take the reading just below the surface 
of the urine. The urine tested should be at the ordinary room 
temperature, which will be the case if the specimen has been 
standing in a room of ordinary temperature for some hours. The 
normal specific gravity is 1016 to 1020. A high specific gravity 
gives ground for suspecting sugar. As the sugar of the urine 
diminishes, the specific gravity will fall. 
2. Diacetic acid. Five cubic centimeters of the urine (a 
large teaspoonful) are placed in the test tube. Add, drop by drop, 
the ferric chlorid solution as long as a precipitate forms. Filter, 
and to the filtrate add a few drops more of ferric chlorid. If 
diacetic acid is present, a violet-red color will result, which be- 
comes lighter when heated. 
This test can be made without filtering, as follows: 
To four cubic centimeters of urine (a small teaspoonful) in 
the test tube, add an equal amount of ferric chlorid solution. If 
diacetic acid is present, the violet-red color will appear. This 
color may be due to other substances; but if on heating the mix- 
ture the color fades it is an indication that the color was due to 
diacetic acid. 
3. Test for sugar in the urine. To test for sugar, five cubic 
centimeters (a large teaspoonful) of the test solution are placed 
in a test tube. Add eight to ten drops, not more, of the urine to be 
tested. While shaking, the mixture is heated to boiling and kept 
at this temperature for two minutes, or the tube may be held in 
boiling water for five minutes. It is then allowed to stand until 
cool. In the presence of sugar, the entire body of the solution 
will be filled with a precipitate, which may be red, yellow, or TESTS OF NUTRITIVE FUNCTIONS 
567 
greenish in tinge. If the quantity of sugar is low (under 0.3 per 
cent.) th« precipitate forms only on cooling. If no sugar is pres- 
ent, the solution either remains perfectly clear or shows a faint 
turbidity that is blue in color. 
If the above tests show even a trace of sugar or diacetic acid, 
the diet must be changed at once. A fast day, or even a green 
vegetable day, will usually suffice to cause the sugar to disappear. 
If a trace of sugar still persists, a second or even a third day of 
fasting may be necessary. Then the diet must begin at a lower 
level, say one-half the former amount of carbohydrate; and if the 
acid test is very pronounced, reduce the fat to two-thirds the 
former amount. Then gradually increase the amount of starch or 
fat from day to day, stopping a little short of the amount of 
carbohydrate or fat which caused the sugar or acid to appear. 
After some time, a week or two, another attempt may be made to 
increase the amount of carbohydrate or fat. This increase should 
follow a green diet day. 
Many other tests of the urine, qualitative and quantitative, 
are necessary for a complete study of this most important excre- 
tion, which normally carries off two-thirds of all the poisonous 
wastes of the body. The rapid increase in the mortality rate 
from Bright’s disease and other renal disorders points to the 
importance of giving greater attention to the prevention of this 
class of maladies. In the lessened consumption of meat, tea and 
coffee, and the restriction of the tobacco habit, will be found the 
most efficient means of prophylaxis against this grave disease. 
Every adult should have a careful examination of his urine made 
at least once a year. Too often, disease of the kidneys becomes 
far advanced toward a fatal termination before it is discovered. 
Scanty and high colored urine or an unusually large amount of 
it, painful urination, frequent urination, sediments in the urine, 
are symptoms which should lead at once to a complete chemical 
examination by a competent chemist. 
Metabolism Tests. 
In the term metabolism is summarized the total vital activi- 
ties of the body. All these activities depend upon the consump- 
tion of oxygen, just as does the combustion taking place in a 
furnace. The amount of steam produced, and thus the amount 
of energy set free from the coal in a boiler plant or a locomotive, 
is determined by the amount of oxygen admitted to the boiler 568 
THE NEW DIETETICS 
furnaces. In like manner, the amount of oxygen consumed in 
the body is an accurate measure of the amount of energy pro- 
duced. Each cubic foot of oxygen burned means the liberation 
in the body of energy equivalent to 160 foot tons. Exposure to 
cold and muscular activity increase the rate of oxygen consump- 
tion and of energy expenditure. 
By means of recently devised apparatus, it is now possible 
to make very exact measurements of the amount of oxygen con- 
sumed and hence to determine accurately the rate of energy 
production in the body. The application of these tests has shown 
that the rate of metabolism is increased in certain diseases and 
sometimes to a very high degree. This is particularly true of 
hyperthyroidism, or toxic thyroid, commonly known as exoph- 
thalmic goiter. There is also increase of metabolism in various 
other serious disorders, as in advanced cases of heart disease, 
pernicious anemia, in fevers, in hysteria, in arteriosclerosis and 
in nervous diseases accompanied by extreme nervous tension. 
The metabolism rate is commonly diminished in aged persons, 
and in certain diseases, as chlorosis, anemia, cachexia, Bright’s 
disease, myxoedema and certain cases of malnutrition and malig- 
nant diseases. 
Tests for Acidosis. 
A condition of the body in which there is a disturbance of 
metabolism which gives rise to an increase of acid substances in 
the blood and tissue fluids is known as acidosis. The importance 
of acidosis has not been appreciated until recent times and is as 
yet not so well recognized as it should be. Acidosis is most com- 
monly the result of an excessive use of fats; that is, more fats 
are eaten than can be completely burned and the imperfectly 
oxidized fatty acids found in the blood and tissue fluids give rise 
to various toxic symptoms. An illustration of the character of 
these compounds resulting from the imperfect combustion of fat 
is to be found in the smoke which arises from a partially extin- 
guished taper or a smoking candle wick. The highly irritating 
products of this imperfect combustion, if present in considerable 
amount, are likely to give rise to very dangerous symptoms, 
and, indeed, may even cause death through coma. Acidosis aris- 
ing in this way is the cause of the so-called diabetic coma. 
General anesthesia always produces acidosis. Fasting and a 
heavy meat diet may also cause acidosis. TESTS OF NUTRITIVE FUNCTIONS 
569 
The condition of acidosis is often indicated by a sweetish or 
sweetish-sour odor of the breath, due to the presence of acetone. 
Acetone may also be found in the urine. The most accurate 
means of' measuring the amount of acidosis present is by de- 
termination of the CO2 tension of the residual air of the lungs. 
This is done by the use of a special apparatus, into which the 
patient breathes. The carbon dioxide is carried in the blood in 
loose combination with soda salts, which normally abound in the 
blood. When abnormal acids are present in the blood, they com- 
bine with the soda and thus prevent the taking up of the carbon 
dioxide from the tissues, where it is produced by the vital com- 
bustion continually taking place, in which oxygen combines with 
carbon in connection with muscular work and other vital changes. 
The minimum normal CO2 tension is 34. When the tension falls 
below this it is evidence that the supply of oxygen to the tissues is 
insufficient, and acids are accumulating. In high health the ten- 
sion is 40 to 45. Inability to hold the breath thirty seconds or 
more suggests acidosis. 
The Body Weight. 
The body weight is a simple and very practical metabolism 
test which should have more attention than it commonly receives. 
Rapid loss of weight may be due to excessive metabolism. This 
condition is often the result of worry, suspense, or anything which 
increases nerve tension. The increased expenditure of energy is 
not due to increased activity of the nerves, but to an increase of 
the so-called muscle tonus, which in health and with the body 
in a state of rest, accounts for 30 to 50 per cent, of the total 
energy expenditure, but which may be increased 100 per cent, or 
even more as the result of tension from exciting emotions, as 
well as exercise of the muscles. 
Strength Tests. 
Tests of strength are, when properly interpreted, a valuable 
means of determining general neuro-muscular conditions. Mus- 
cular effort is the result of the combined activity of nerves, nerve 
centers and muscles—the so-called neuro-muscular mechanism. 
Weakness may be the result of an impaired condition of either 
one of the three sources named—an exhausted nerve center, an 
impaired nerve conductor, or a muscle exhausted because satu- 
rated with fatigue poisons. Exhaustion of the muscle may be 570 
THE NEW DIETETICS 
quickly removed by the application to it of simple massage while 
an exhausted nerve center may be restored only by the renewed 
accumulation of energy in its cells and a damaged nerve con- 
ductor must be repaired. A muscle which has become perma- 
nently weakened by disuse can be strengthened only by carefully 
graduated exercise, the exact amount of which may be deter- 
mined by dynamometric tests. 
More than thirty-five years ago (1884-5), the writer began 
experiments for the purpose of devising means for measuring the 
individual groups of muscles of the body. After ten years’ effort 
an apparatus was constructed, known as the universal dyna- 
mometer, which has now been in extensive use for more than 
twenty-five years. By means of this device the strength of each 
of the large groups of muscles in the body may be accurately 
determined. The results are then placed on a percentile chart 
and a graph made, showing the relation of the strength of each 
group of muscles in the body to the strength of corresponding 
groups in a normal man of the same height. By this means one 
obtains a definite expression of the nutritive condition of the 
muscular system, which constitutes one-half of the weight and 
bulk of the entire body. By repeating the tests from time to 
time, a very accurate account of the general nutritive state of the 
body may be maintained. With increasing nerve tone and im- 
proving nutrition, strength increases notably, sometimes at the 
rate of four or five hundred pounds weekly. Such an increase of 
strength is of much greater significance than an increase of sev- 
eral pounds in body weight. Indeed, it is a positive indication of 
improvement, whereas increase of body weight might have the 
very opposite significance. In not a few cases improvement is 
measured by decrease in weight, but under no circumstances is a 
decrease of bodily strength to be counted as a gain. 
Tests of Heart and Circulation. 
The heart muscle expends in its activities about 10 per cent, 
of the total energy output of the body when in a state of rest. 
The strength of the heart and its powers of endurance vary 
within almost as wide limits as does the strength of other muscles, 
though of course complete paralysis of the heart muscle cannot 
exist without immediate death. No dynamometer has yet been 
devised by which the strength of the heart can be measured, but 
useful information concerning its strength may be obtained by the TESTS OF NUTRITIVE FUNCTIONS 
571 
use of the sphygmomanometer, an instrument for obtaining the 
blood pressure. 
The method is simple. The blood pressure is taken, both 
systolic and diastolic, first with the patient lying, and then stand- 
ing, and finally standing after gentle exercise for ten minutes. 
The pulse rate is also noted in both the lying and standing posi- 
tions and in the standing position after exercise. The difference 
between the diastolic pressure and the systolic pressure is known 
as the pulse pressure. Both the diastolic and the systolic pressure 
normally rises when a person changes from the horizontal to 
the vertical position, the diastolic pressure rising more than the 
systolic. 
The pulse is usually quickened on rising and still more after 
exercise. The pulse pressure really represents the efficiency with 
which the work of the heart is done, and is in a certain sense a 
measure of the blood moved from the heart into the arteries at 
each beat. If, then, the pulse pressure is multiplied by the pulse 
rate, the figures resulting will indicate the amount of blood 
movement per minute. 
This method of testing the strength of the heart has recently 
been greatly improved by Dr. M. A. Mortensen, of the Battle 
Creek Sanitarium, who has devised a tilting table by the use of 
which the patient’s position may be changed from horizontal to 
vertical without any movement on the part of the patient. By this 
means, the effect upon the circulation by the change is determined 
without being complicated by muscular effort on the part of the 
patient. This improved method has been shown by Dr. Morten- 
sen to be a very delicate test of the condition of the heart muscle. 
* Blood-Pressure Reaction to Passive Postural Changes an Index to Myocardial 
Efficiency by M. A Mortensen, M.D., American Journal of Medical Science, May 
23, 1923. Regimens and Dietaries 
While there are many special feeding indications for indi- 
vidual diseases, most of the hundreds of different maladies and 
morbid conditions which are encountered by the physician and 
the nurse may be grouped as regards dietetic requirements into a 
small number of classes; and most of the requirements may be 
met by some one of the following dietaries or regimens or a com- 
bination of two or more. Some of the dietaries described, for 
example, the laxative and the antitoxic dietaries, are applicable, 
with modifications, in most cases. 
All Dietaries Must Supply- 
Lime, Iron and Vitamins. 
In arranging bills of fare, it is important to remember that 
certain elements must be found in every dietary which is to be 
followed for more than a few days. This is especially true as 
regards vitamins, lime, iron, and the alkaline salts. Hence, no 
matter what other food constituents may be reduced, the supply 
of iron, lime and vitamins must be kept up to the normal. It is 
especially important to bear this in mind in the treatment of 
cases of fever, obesity, peptic ulcer, and surgical cases. 
THE FRUIT REGIMEN 
(See also page 980) 
The fruit cure has been practiced in various ways. The 
most familiar is the so-called “grape cure.” The patient takes 
ten to fourteen pounds of grapes a day and a few pieces of 
zwieback. The seeds and skins are excluded. 
Linnaeus tells us of the cherry cure, which he himself em- 
ployed with advantage. 
During the Civil War the diarrhea and dysentery from 
which soldiers suffered were relieved during the peach season 
when the soldiers had access to peach orchards. 
How Fruits Differ. 
Fruits do not stimulate the bowel by irritation, but by the 
bulk that they furnish because of the cellulose which they contain 
572 REGIMENS AND DIETARIES 
573 
and through their acids and sugars. Fruits differ in these proper- 
ties. Apples and pears contain almost no cellulose, bananas con- 
tain practically none and are little laxative. Cherries, grapes, 
apricots and peaches contain more cellulose and are therefore 
more laxative. Prunes contain a considerable amount of cellu- 
lose and are highly laxative. Raisins are also laxative, as are 
figs. Dates are less laxative, but when freely used (one-quarter 
pound three times a day) greatly aid the change of flora. Huckle- 
berries contain the largest amount of cellulose of any food, and 
are very highly laxative. Raspberries and blackberries are laxa- 
tive, but less so than huckleberries. 
Fruits that contain much acid are prohibited in cases of 
hyperacidity, and sometimes in chronic gastric catarrh without 
hyperacidity, and also in achylia when the gastric mucous mem- 
brane has become hypersensitive to organic acids. In such cases 
fruits free from acids should be taken, such as bananas, pears, 
white cherries, very sweet peaches, cantaloupe, watermelon and 
casava melon. 
The Daily Routine. 
At the start, the patient should take a carmine capsule 
and note the time when the color appears and disappears. The 
character of the stools should also be noticed, especially the color 
and the odor. Putrescent stools are generally dark in color, either 
black or brown, and have an ammoniacal, rancid or putrescent 
odor. 
With the fruit regimen the patient takes four meals a day. 
Each meal consists of fruit—any kind of fruit which agrees with 
the patient—one-half ounce of bran and one ounce of paraffin 
oil. If desired, one ounce of brose (a mixture of equal parts by 
measure of oatmeal, cornmeal and sterilized bran) made into a 
porridge may be added twice a day. Roughage may be taken in 
the form of sterilized bran. For persons who cannot take bran, or 
think they cannot, agar-agar may be used instead. The bran or 
agar-agar should be divided into six or eight equal parts and dis- 
tributed through the meal, so that it may be well mixed with the 
other foodstuffs. Two or three ounces of milk sugar or lacto- 
dextrin should be taken three times a day for speedy results. The 
sugar may be taken before meals or three hours after eating. The 
l itter plan is best for persons who need to gain in flesh as it does 
not lessen appetite. 574 
THE NEW DIETETICS 
After three or four days of the fruit regimen the stool gen- 
erally becomes nearly odorless and consists chiefly of bran. The 
fruit regimen should be continued until this change occurs, unless 
the patient is very feeble, in which case the diet may be changed 
and the patient allowed to take a more liberal bill of fare for a 
few days, when the regimen may be repeated. 
In exceptional cases the diet must be continued for ten days 
or two weeks. When this is necessary, no serious inconvenience 
will be experienced by the patient, provided he is kept at rest. 
In the case of very feeble or emaciated patients the fruit 
regimen may be used for three or four days, and then followed 
by the milk regimen, which not only serves to perfect and estab- 
lish the change in the intestinal flora but secures a very desirable 
gain in flesh, often at the rate of half a pound a day or even twice 
as much. 
Thin persons should rest while taking the fruit regimen, so 
as to avoid undue loss of flesh. It is not necessary to remain in 
bed, but the horizontal posture should be maintained; if not in 
bed, on a cot or a sofa, and always in the fresh air. 
By the addition of lettuce, celery, and in some cases salads of 
carrots, turnips, cabbage, and palm cabbage when available, valu- 
able vitamins are supplied as well as nutrient material—elements 
of the greatest value in rebuilding the diseased and deteriorated 
organism. 
An especial advantage of the fruit regimen is that it is so 
simple that it may be employed by anyone, at almost any time 
and in almost any place. For good results it is only necessary 
that the rules here laid down should be carefully followed. 
By this regimen all the good effects claimed by the advo- 
cates of fasting may be obtained, without the dangers and incon- 
veniences of total abstinence from food. 
Evidence that the Intestinal Flora is Changed: When the 
flora is changed, intestinal gas disappears, the stools are no longer 
foul or strong smelling, they are lighter in color unless colored 
by spinach or other food, they usually have a slightly acid odor, 
chemical tests show acids dominant, and a bacteriological exami- 
nation shows absence of Welch’s bacillus and other putrefactive 
and gas-forming bacteria, very few colon bacilli, and an abun- 
dant growth of acid-forming bacteria, especially the B. acido- 
philus. 
Keeping the Flora Changed. After the flora has been changed, REGIMENS AND DIETARIES 
575 
it may be easily kept in a nearly normal condition by close ad- 
herence to an antitoxic diet and once in three or four weeks taking 
2 or 3 ounces of milk sugar or lacto-dextrin three times a day for 
two or three days. This should be done whenever the stools be- 
come foul smelling or when intestinal gas is troublesome. The 
continuous use of acidophilus buttermilk is an excellent means of 
keeping the flora changed. Half a pint to a pint at each meal is 
required for best results. 
The Green Regimen. 
In certain cases of hyperhydrochloria the stomach is exceed- 
ingly sensitive to fruit acids, so that the fruit regimen gives rise 
to pain even when bicarbonate of soda and small quantities of 
olive oil are employed, as elsewhere suggested. In such cases 
fruits may be eliminated altogether and the dietary may be made 
to consist exclusively of green vegetables, such as lettuce, celery, 
cucumbers, green corn, cabbage, carrots, turnips, and cooked 
greens of all sorts, spinach (parboiled), dandelion, beet tops, en- 
dive, etc. Brose (equal parts by measure of oatmeal, cornmeal 
and cooked bran) cooked for five to ten minutes may be used 
twice a day. Otherwise the regimen is managed exactly like the 
fruit regimen. 
In many cases purees of sweet fruits such as bananas, dates, 
soaked figs or raisins, and sweet apples, pears or white cherries 
may be carefully added to the regimen; and later, acid fruits. 
Carrots, both raw and cooked, are of special service. Metch- 
nikoff found the stools of rabbits nearly sterile when the animals 
were fed on carrots. 
When the Tongue Remains Coated* 
In certain cases the tongue remains coated after the fruit 
regimen or the green regimen has been closely followed for sev- 
eral days. This is an indication that the normal state of the 
blood has not been restored. This may be due to an excessive 
accumulation of toxic matters in the body, or the cause may be 
an adherent or pouched cecum in which food residues accumulate 
and putrefy because the crippled cecum is not able to empty itself. 
In such cases the systematic use of the enema is very necessary. 
An enema consisting of three pints of water at a temperature of 
about 90° F. should be slowly introduced into the colon at bed- 
time. In cases of spastic constipation the temperature should be 576 
THE NEW DIETETICS 
102° to 105° F. Five minutes should be occupied in getting the 
water in the colon, so as to give time for it to reach the cecum 
and thoroughly flush the head of the colon. There are some- 
times adhesions of the pelvic colon which prevent efficient bowel 
action. In such cases a simple surgical procedure may be needed. 
If necessary, repeat the enema so as to make sure that the 
colon is thoroughly emptied. After the warm enema, introduce 
a pint of cool water to restore the tone of the bowel. This pre- 
vents any possible injury from the long use of the enema. Con- 
tinue this practice as long as necessary. 
Disorders in Which the Fruit 
Regimen is Indicated. 
In high blood pressure, whether due to degeneration of the 
arteries, to renal disease or to fully developed cardio-vascular- 
renal disease with or without dropsy, the fruit regimen is capable 
of rendering valuable service. The urinary acidity is high and 
the diminished activity of oxidation leads to a continued tend- 
ency in the direction of acidosis. 
The large amount of acid salts contained in fruits in which 
an organic acid (citric, malic or tartaric) is combined with potash 
and soda to alkalinize the tissues, or at least to neutralize the acid 
products present, renders this class of foods, especially juicy 
fruits, most useful. 
Another advantage afforded by the fruit regimen in these 
cases is the small amount of protein present, the fruit regimen 
being practically a carbohydrate diet. The amount of protein 
present in fruits is on an average a little more than one-half of 
one per cent. The fruit regimen is thus practically a protein fast. 
If the fruit feeding is sufficiently abundant, a considerable quan- 
tity of carbohydrate will find its way into the colon and thus 
encourage the growth of acid-forming organisms; and even the 
colon bacillus and allied species, which ordinarily produce toxins, 
may become acid-formers, thus being transformed into protective 
instead of disease-producing organisms, especially with lactose 
feeding. 
By this change of flora the production of poisons in the intes- 
tine is checked. The blood stream is no longer charged with toxic 
substances that irritate the delicate lining of the vessels and cause 
degenerative changes by which the vessels are narrowed and 
finally obliterated. The liver and kidneys are relieved of the REGIMENS AND DIETARIES 
577 
great burden of distoxicating and eliminating the enormous quan- 
tities of highly active poisons which have so overtaxed their 
capacity that they have finally become seriously crippled. The 
fruit regimen, by thus eliminating the most common and active 
causes of vascular and renal disease, will accomplish for persons 
suffering from arteriosclerosis, with or without high blood pres- 
sure, more than can be accomplished by any known drug. 
The fruit regimen is of special service in cases of paren- 
chymatous nephritis. 
The fruit regimen is often highly successful in cases of 
dropsy. In dropsy there is an accumulation in the tissues of 
fluid charged with salt and urea. A diet free from salt has been 
found to be one of the most efficient means of relieving dropsy 
and edema. The fruit regimen is salt-free and almost nitrogen- 
free and so rapidly clears the tissues of salt and urea. 
The fruit regimen is especially adapted to the treatment of 
obesity. Notwithstanding the fact that a sufficient bulk of food 
is taken to afford the patient a sense of satiety, or to satisfy the 
appetite, the actual amount of nourishment is not more than half 
or two-thirds the maintenance ration. 
In intestinal toxemia, which is commonly indicated by a 
coated tongue, bad breath and dingy or pigmented skin, very 
foul stools, and the other well-known symptoms of this condition, 
the fruit regimen is almost a panacea. In all cases in which there 
is no serious mechanical obstruction to bowel action present, such 
as adhesions of the pelvic colon, the fruit regimen may be ex- 
pected to accomplish the result desired—cases being very rare 
indeed in which the most sanguine expectations are not realized. 
Almost invariably within three or four days after the beginning 
of the regimen the stools will lose their foul odor, the tongue will 
be found very much less coated, the breath less offensive, and in 
a few days more the symptoms will be very greatly ameliorated. 
If the regimen is followed by a rational antitoxic diet, the patient 
will make very rapid and satisfactory progress toward recovery. 
It is only necessary to manage the dietary in such a way as to 
keep the tongue clean and the stools free from foul odor. The 
bowels should move three or four times a day. So long as con- 
stipation exists, the good effects of the regimen will be mani- 
fested only in a partial way. It is wise to take daily an enema at 
bed-time, to insure complete clearance of putrescible residues. 578 
THE NEW DIETETICS 
Roderick has demonstrated that the fruit regimen may produce a 
marked change in the intestinal flora within a week. 
If the patient still continues to suffer from headache, if the 
tongue does not clear off, and if the foul odor of the breath and 
stools does not disappear after three or four days, the fruit 
regimen may be continued longer—if necessary, for a couple of 
weeks. It must be remembered, however, that the fruit regimen 
is partial starvation and so cannot be continued indefinitely. In 
cases in which the full results of this diet are not obtained by 
the first trial, the patient may return to a more liberal diet for a 
few days, a week or two perhaps, when the fruit regimen may be 
resumed. In extreme cases the regimen may be repeated many 
times. 
It must be remembered that the coating of the tongue is due 
to the growth of bacteria in the mouth which is the result of the 
lowered vital resistance of the whole body. This cannot be com- 
pletely recovered at once; but if the stools are becoming less foul 
progress is certainly being made and the complete result will 
appear later. 
In most cases of chronic disease definite indications of intes- 
tinal toxemia will be found present. While the fruit regimen 
will not accomplish all that needs to be done, yet it is a very good 
means for starting the therapeutic campaign. When there is 
much emaciation the ration should not be continued for more 
than two or three days, after which the milk or some other fatten- 
ing regimen should be employed. In cases of obesity, in myxed- 
ema with obesity, and especially in dropsical cases, the fruit regi- 
men may be continued seven to eight days, or even two weeks. 
The absence of appetite is an extremely common symptom in 
many cases of chronic disorders and cachexias. A patient whose 
tongue is coated very often has no desire for food and the flavors 
of food are unattractive. After two or three days of the fruit 
regimen an excellent appetite is often developed. This is a 
highly favorable omen, for according to Pavlov’s dictum “appe- 
tite means juice”; that is, when the patient has a good appetite 
and a keen relish for food it is highly probable that the stomach 
is prepared to digest the food and the tissues to assimilate it. 
When the tongue is coated, the. fruit regimen reinforced by 
a liberal supply of milk sugar or lacto-dextrin is a most excel- 
lent preparation for an abdominal operation of any sort. The 
same regimen may be resumed soon after the operation, usually REGIMENS AND DIETARIES 
579 
in three or four days, and aids greatly in regulating the bowels, 
obviating almost altogether the use of salines, castor oil, and 
other laxative drugs, with the exception of paraffin oil. 
The fruit regimen so greatly facilitates the attainment of the 
results expected of the milk regimen that it serves a highly useful 
purpose as an introductory measure. In many cases in which the 
milk regimen is indicated the patient has a coated tongue, a foul 
breath and is obstinately constipated. It is the writer’s custom in 
dealing with such cases to employ the fruit regimen for three or 
four days before beginning with the milk. The tongue clears off, 
the appetite is improved, the bowels become more active, and thus 
the patient is prepared to take the milk with relish and to digest 
and utilize it. 
THE MILK REGIMEN 
The value of milk as a food remedy has been recognized from 
the most ancient times. Hippocrates especially commended it as 
a remedy for phthisis and for gout. He was perhaps the first to 
recommend the addition of water to milk (hydrogala) as a means 
of increasing its digestibility. 
Aretoeus, a Greek physician who wrote an extended treatise 
on acute and chronic diseases in the second century of our era, 
recommended as a remedy for phthisis the free use of milk, direct- 
ing that it be prepared by adding a fourth part of water and then 
boiling it until the mixture was reduced to one-half its original 
bulk. ■ 1 
Galen made use of cow’s milk, milk of the goat and sheep, 
and even woman’s milk. He very highly commended milk as a 
remedy for various diseases, and refined the method by requiring 
that the cow producing the milk should be fed upon certain 
special herbs. 
The ancients evidently attributed to milk specific healing 
properties which their keen powers of observation had enabled 
them to discover. 
Hoffman especially recommended the milk of cows fed in 
pastures which abounded with lotus and polygonum. As the 
patient improved in health, he was allowed to sail down the Tiber 
and use milk from the cows of Strabioe. 
Health resorts in which the milk cure was practiced existed 
even in those days. Each invalid was given a goat, an ass or a 
cow as his source of milk supply, and it was part of the duty of 
the patient to lead his animals to graze in pastures supposed to be 580 
THE NEW DIETETICS 
best adapted to his particular case and to take the milk warm, 
direct from its source. 
The ancients often made use of woman’s milk as a remedy, 
and it is still used in some parts of Africa in feeding fever 
patients. Mr. Poultney Bigelow relates a personal experience of 
this sort when sick with a fever on the pest-ridden Gold Coast. 
This is very interesting evidence of the appreciation of the special 
curative properties of milk by primitive people. 
Sir John Sinclair, in his “Code of Health and Longevity,” 
mentions the use of sour milk as common in Scotland and Ireland. 
The milk was prepared by permitting it to sour in a vessel placed 
in warm water, after which the whey was turned off and the 
curds placed in a “plunge churn,” where they were churned for 
some time. 
Sydenham and other eminent physicians of his time made 
large use of milk as a remedy. 
Van Swieten especially recommended milk as a remedy for 
gout, declaring that the victims of this disease would find them- 
selves wholly free from pain so long as they lived upon an exclu- 
sive diet of milk. 
In modern times the use of milk as an exclusive diet was 
brought to the attention of the profession by Philip Karell, of 
Petrograd, physician to the Emperor of Russia. A paper written 
by this sagacious physician was translated by Carrick, at that time 
physician to the British Embassy at Petrograd, and was pub- 
lished in this country in 1870. 
Karell was perhaps the first to systematize the use of milk 
and to insist upon its use in small doses. He made use of the 
remedy especially in the treatment of obesity and dropsy, though 
he commended it in many other chronic diseases. On this account 
he employed small quantities, generally not exceeding two to 
four pints daily, the object being to reduce flesh or to promote 
the absorption of dropsical fluids. He said: 
1 have, after fruitlessly trying all sorts of remedies in many 
chronic and obstinate diseases, at last succeeded in thoroughly bring- 
ing the alimentary canal, that seat of so many diseases, under my 
control. I did this by administering milk according to a new method. 
Karell’s method consisted in giving one glassful (7 ounces) 
of milk four times a day at intervals of four hours. After a few 
days the amount of milk was slightly increased, but always re- 
mained much below the normal requirement of liquids and solids REGIMENS AND DIETARIES 
581 
until the end desired, the reduction of fat or dropsy, had been 
attained. 
Among the specific virtues of milk are: 
1. Its‘richness in lime salts ; an ounce of milk contains more 
food lime than a pound of beefsteak and nearly as much as a 
pound loaf of bread. 
2. Richness in vitamins, supplying every sort needed by 
the growing animal, anti-rachitic, anti-beriberi, and anti-scorbutic. 
3. Protein of exceptional quality which is not only capable 
of supplying all the elements needed for repair of living cells, 
but is capable of supplementing the deficiencies of the incomplete 
proteins of vegetable origin. 
4. A considerable proportion of lactose, a milk sugar which 
by its slow absorption is able to reach the colon, where it serves a 
most useful purpose in encouraging the growth of B. acidophilus, 
the protective intestinal flora, thus suppressing the putrefactive 
processes which give rise to autointoxication. 
5. The fats of milk are in a state of fine emulsion and thus 
well prepared for the action of the digestive juices. 
Technic of the Milk Regimen. 
First of all, it must be emphasized that simply feeding milk 
is not what is meant by the milk regimen. The difference is a 
vital one. Milk feeding is often a failure in cases where the milk 
regimen succeeds admirably. 
The first essential is that the milk should be taken in large 
amount, so large as greatly to exceed the needs of the body, and 
thus fill the alimentary canal with material which will promote 
the growth of friendly bacteria. 
A second essential is that the milk shall be taken often. A 
half pint every half hour is the usual plan. This makes it pos- 
sible to take into the stomach the five or six quarts of fluid for 
one day’s ration. It is also important to maintain a constant 
stream of fresh material passing along the alimentary canal, so 
that a considerable portion may reach the colon undigested and 
unabsorbed. It is especially desirable that a sufficient amount of 
milk sugar should reach the colon unabsorbed to maintain in the 
colon a state of acid fermentation, thereby preventing putrefac- 
tion and changing the intestinal flora. This is, indeed, in many 
cases the chief benefit derived from the milk diet. An important 
fact pointed out by Magnus-Levy is that “the absorption of the 582 
THE NEW DIETETICS 
various forms of sugar in the intestine proceeds with unequal 
velocity. This observation, which has been made repeatedly on 
animals, Weinland has found to hold good for man (Nagano) ; 
maltose and dextrose disappeared completely in one hour, whereas 
only 26 per cent, of milk sugar, present originally in equal quan- 
tity and in the same concentration as the maltose and dextrose, 
was absorbed during the same period.” 
To encourage the acid fermentation in the colon it is well to 
give at each alternate feeding acidophilus buttermilk in place of 
sweet milk; or equal parts of sweet milk and milk soured by the 
B. acidophilus may be taken at each feeding. 
Milk ferments but does not putrefy. This fact has been 
established by Hirschler, Rovighi, Schmitz, Eisenstadt and many 
other observers. The fact that milk also “arrests or diminishes 
intestinal putrefaction accounts for its absence in milk diet” 
(Czerny). As a matter of fact, however, milk may encourage 
putrefaction if constipation coexists. This is due to the fact that 
undigested curds remain in the colon after the sugar of milk has 
been wholly absorbed, so that its protective influence in support- 
ing acid fermentation is lost. This makes bran or agar and 
paraffin oil an essential part of the milk regimen to insure fre- 
quent and efficient action of the colon. 
Feedings begin at 7 :00 A. M. and end at 7 :30 P. M.—twenty- 
six feedings in all. At 10:00 A. M. and 4:00 P. M. the milk is 
omitted and a meal of fruits is taken instead. The purpose of 
this is to encourage bowel activity, since very free and frequent 
bowel movement is essential to success. The disappointing results 
often encountered in the use of the milk diet are chiefly due to 
the constipation which is likely to be produced in many persons, 
the natural result of which is intestinal toxemia and an aggrava- 
tion of the very symptoms for which relief is sought. 
Two ounces of sterilized wheat bran or an ounce and a half 
of agar-agar should be taken in half ounce doses, in connection 
with several of the milk feedings, preferably at 7 :00 A. M., 11 :00 
A. M., 3:00 P. M. and 7:00 P. M. 
In cases in which the colon is badly crippled—that is, when 
there is obstinate constipation—the use of the Russian paraffin oil 
in doses of one to three tablespoonfuls four times a day is neces- 
sary to secure the activity required for a rapid and efficient change 
of the flora. REGIMENS AND DIETARIES 
583 
When the period of exclusive milk feeding is ended, a laxa- 
tive and strictly antitoxic diet must be adopted. 
It should be remembered that the chief advantages of the 
milk regimen as a means of changing the intestinal flora lie 
(1) in the large amount of milk sugar that by this means is car- 
ried into the colon and there, fermenting, produces lactic acid 
and so prevents the growth of the putrefactive bacteria; (2) in 
the frequent bowel actions induced. The soft curds, undigested 
and unabsorbed, by their bulk as well as by their acidity, stimu- 
late peristalsis and cause several bowel movements daily. 
The bowels should move four or five times a day, the enema 
being used if necessary. No laxatives other than bran or agar 
and paraffin should be used. If proper bowel action cannot be 
secured by these means, the milk regimen must be suspended at 
once. 
If the patient is emaciated, so that a gain in flesh is one of 
the objects of treatment, complete rest should be maintained dur- 
ing the first week—not necessarily in bed, but on a cot, or in a 
wheel-chair a part of the time if more agreeable. 
During the resting period the patient should take a few deep 
breaths four or five times every hour when awake, to counteract 
the ill effects of lying in bed. The position should be changed 
occasionally. When lying on the back, a cushion should be placed 
at the small of the back. Sand bags are useful as props. 
The patient must spend every possible moment out of doors, 
day and night. 
Amount of Milk to be Taken. 
The amount of milk taken daily must depend upon the capac- 
ity of the patient. Much more is necessary than actually needed 
for nourishment. The ratio to body weight is about one and one- 
half ounces of milk to each pound of body weight. The following 
table shows the aggregate amounts for different sized feedings: 
At each feeding 
Total 
4 ounces 6 pints 
4>4 “ 6y4 “ 
5 “ 7y2 “ 
5/2 “ 8J4 “ 
6 9 584 
THE NEW DIETETICS 
6*4 ounces pints 
7 1034 “ 
7y2 “ 1154 “ 
8 “ 12 
The total food value in calories of the full regimen (6 quarts) 
is not far from 4,000 calories, of which one-half is fat, one-fourth 
casein and one-fourth milk sugar; that is, 2,000 calories of fat, 
1,000 of protein and 1,000 of carbohydrates. 
The fat and milk sugar are more completely utilized than the 
casein. The body can store up almost any amount of sugar and 
fat in the form of adipose tissue and glycogen, but only a very 
limited amount of protein. This is especially true while the patient 
remains in a state of rest. Protein cannot be retained unless it is 
utilized by entering into the composition of the living tissues of 
the body—the glands, nerves, blood, and muscles. Not more than 
200 or 300 calories per day can be used for this purpose, so that 
several hundred calories of casein must be lost in the stools. The 
loss is not complete, however, for the soft, slightly acid curds 
have a highly beneficial effect upon the diseased surfaces of the 
colon, suppressing the growth of pernicious bacteria and gather- 
ing them up and sweeping them away by stimulating intestinal 
activity. 
In the exceptional cases in which a larger amount of milk is 
needed, an extra quart may be added by giving feedings at 8 :00, 
8:30, 9:00 and 9:30 P. M. These extra feeding hours may also 
be utilized to make up the full amount needed in cases in which 
the patient is not able to take so much as 8 ounces at each 
feeding. 
In vefy exceptional cases feedings may be given at midnight, 
2:00 A. M., 4:00 A. M. and 6:00 A. M. It is better, however, in 
general to allow the stomach an opportunity to rest during the 
night. Within about eight hours after the last feeding the 
stomach and small intestine should be empty of food, thus giving 
the digestive tube and its secreting glands an opportunity for 
complete rest during five or six hours. Glands, like muscles, need 
rest to enable them to replenish their stores of energy. 
One of the chief benefits derived from the milk regimen is 
the change of flora which is produced by it. This requires the 
ingestion of 8 to 10 ounces of milk sugar. When the full six 
quarts of milk are taken this amount of lactose will be assured. REGIMENS AND DIETARIES 
585 
In many cases the addition of 3 or 4 ounces of milk sugar or lacto- 
dextrin is an advantage, and may be added in proportion as the 
amount of milk is diminished. 
How the Milk Regimen Differs 
from the Milk Diet, 
There are several important particulars in which the milk 
regimen differs from the milk diet, or ordinary milk feeding, and 
these points are so important that we shall give brief attention to 
each one, and endeavor to make clear why the milk regimen may 
be expected to succeed in cases where the so-called milk diet has 
failed. 
Cases are, indeed, very rare in which the milk regimen can 
not be employed with success, even though the patient’s former 
experience may have been such as to justify the expectation of 
failure. About the only cases, in fact, in which the milk regimen 
is positively contra-indicated are those in which the individual has 
been sensitized to milk protein. 
The milk regimen differs from ordinary milk feeding, especi- 
ally in the following particulars : 
1. It is a systematised method. In ordinary milk feeding, 
it is a common practice with physicians to say to the patient: 
“Take all the milk you can at meals and between meals.” That 
is, the milk is simply added to the ordinary bill of fare. This 
method occasionally succeeds fairly well in securing a gain in 
weight when this is the chief object sought, but not infrequently, 
perhaps in a majority of cases, the patient soon finds his diges- 
tion upset. The appetite disappears, the bowels become inactive, 
the tongue coated, and pronounced symptoms of intestinal toxemia 
appear. 
When taken in this desultory manner, milk is likely to pro- 
mote rather than combat putrefaction in the colon. In cases in 
which a normal or excessive amount of free hydrochloric acid 
is produced by the stomach, large tough curds are likely to be 
formed which, finding their way into the colon, furnish a favor- 
able medium for the development of the putrefactive organisms 
that abound in this part of the alimentary canal. This is par- 
ticularly apt to occur if the milk is taken between meals, for 
then it enters the stomach at a time when a large amount of 
highly acid gastric juice is present, a condition favorable to the 
production of large indigestible curds. 586 
THE NEW DIETETICS 
Intestinal putrefaction increases the constipation and result- 
ing toxemia that destroy the appetite and give rise to malaise, 
headache, and other distressing symptoms. Thousands of per- 
sons have learned from experience that milk, when taken in con- 
nection with other foods, produces the disagreeable symptoms 
here mentioned; but when taken in sufficient quantity and as an 
exclusive article of diet, these symptoms do not appear, for the 
following reasons: 
(a) The quantity of milk taken is so great that the lime and 
casein present neutralize the acid of the gastric juice and dimin- 
ish the intensity of the action of the rennin, so that the curds 
formed are soft and friable and easily broken up. 
(b) When milk is taken in connection with an ordinary 
diet, the quantity is so small and its movements along the intes- 
tine so slow that the milk sugar present is all absorbed before it 
reaches the colon. Thus the undigested curds present are not 
protected from the action of putrefactive bacteria, but are left to 
undergo decomposition. When taken in the quantity prescribed 
by the milk regimen, the whole alimentary canal is flushed with 
milk, in which the lactic acid fermentation begins before the colon 
is reached; and the movement toward the colon is so rapid that a 
considerable portion of the milk sugar taken reaches the colon. 
The twelve pounds of milk usually taken by the patient on a 
milk regimen contain about half a pound of milk sugar. A suffi- 
cient amount of this will reach the colon to maintain acid fer- 
mentation by which tne growth of the putrefactive organisms is 
prevented. 
Bienstock, Tissier, and Martelly have shown that when sugar 
is present to the extent of 1 per cent, putrefaction and toxemia 
are prevented. Careful chemical analysis of the stools of patients 
taking the milk regimen shows the presence of sugar to the extent 
of 1 per cent. In a case in which a fistulous opening existed in 
the intestine just above the ileocecal valve the amount of lactose 
found present in the intestinal contents while the patient was 
taking the milk regimen was more than 2 per cent. That is, the 
food residues of the small intestine which were just ready to enter 
the colon contained an amount of sugar amply sufficient to pro- 
tect the contents of the colon against the action of putrefactive 
bacteria. 
2. The frequency with which the milk is administered plays 
a highly important part in the success of the milk regimen. Each REGIMENS AND DIETARIES 
587 
time the milk is taken a new impetus is given to the peristaltic 
activity of the stomach and the intestine. Fresh food entering 
the stomach sets up active peristalsis the whole length of the 
alimentary canal. This serves an important purpose in getting a 
sufficient quantity of lactose into the colon to support the active 
growth of acid-forming bacteria. Carmine given at the seven 
o’clock feeding to a patient on the milk regimen will usually make 
its appearance in the stool within 14 hours, and may disappear 
within 25 hours. 
3. Peristaltic activity is increased with the milk regimen 
and decreased with the ordinary milk diet. When used in the 
ordinary way, milk is generally found to be constipating. Some 
persons note laxative effects from the use of buttermilk, although 
this is not uniformly the case. Boiled milk is almost universally 
regarded as constipating. There are two reasons for this : 
(1) When milk is well digested, no residue is left behind 
to stimulate peristaltic activity. 
(2) If it is not well digested, the putrefaction of the curds 
that pass into the colon will cause the production of ammonia and 
other putrefaction products, the effect of which is to paralyze the 
colon and produce constipation. 
The older writers on the milk diet call attention to the fact 
that patients taking the milk cure are constipated, and even refer 
to the constipation as a good indication. Some modern advocates 
of the milk diet have expressed the same view. One writer even 
goes so far as to recommend that the “call” for evacuation of the 
bowels should be resisted and postponed so as to secure a large 
movement the next day! Nothing could be more absurd. The 
bowels should always move three times a day, and a person on 
the milk regimen should have at least four bowel movements 
daily. A steady stream of sour milk must pour along the intesti- 
nal canal. In this way the old flora or meat bacilli (Herter) and 
other “wild” bacteria, may be driven out and the new protective, 
acid-forming flora may be established. 
The employment of special means for increasing intestinal 
activity has been found to be highly advantageous. It is for this 
reason that bran or agar-agar, with white refined paraffin oil in 
some form, should be employed in sufficient quantity to insure 
vigorous peristaltic activity. In the exceptional cases in which 
the bowels move too frequently the quantity of milk must be 
lessened. 588 
THE NEW DIETETICS 
4. It has been found decidedly advantageous to allow the 
patient two meals of fresh fruit, one in the forenoon, the other in 
the afternoon—at 10:00 A. M. and 4:00 P. M. The usual glass of 
milk is omitted and the patient is allowed to take, instead, fruit 
of any kind for which he may have a fancy. Fresh fruits or 
dates are, however, preferable, particularly strawberries and juicy 
fruits of all sorts. Great care must be taken to masticate the fruit 
very thoroughly. Lettuce and spinach may be added to the fruit 
meal without any disadvantage in most cases and with very great 
advantage in some. These foods require almost no digestive ac- 
tivity, while they supply vegetable acids together with carbohy- 
drates, which aid in establishing the acid-forming bacteria in the 
colon, as well as vitamins, iron and various salts that promote 
nutrition. The alkaline salts furnished by fruits are particularly 
valuable to combat the slight tendency of the milk regimen to dis- 
turb the equilibrium of the body fluids as regards the exact bal- 
ance of acids and bases. 
In cases of anemia, the addition of purees of spinach or 
other greens is important to supply food iron for the blood. 
Practical Suggestions. 
When a gain in flesh is one of the chief objects desired to be 
obtained by the use of the milk regimen, the patient should take 
very little or no exercise during the first week. It is not neces- 
sary, however, that he stay in bed, as some have insisted, but he 
must avoid active exercise. Even moderate exercise may increase 
metabolism from 25 to 50 per cent. The energy thus consumed 
in muscular activity diverts a definite amount of nutritive ma- 
terial which has been digested and absorbed, and consumes instead 
of storing it. Generally, the patient may read, chat and entertain 
himself, and may be entertained with music and in other ways, 
but should avoid violent excitement of all sorts and should sleep 
as much as possible. 
Care should be taken to see that while the patient lies in bed 
the trunk is properly supported by a firm cushion placed at the 
small of the back. When this precaution is neglected, patients 
lying long in bed often suffer from backache due to lack of back 
support, and sometimes sublaxation, or strain, of the sacro-iliac 
synchrondrosis, the joint formed by the junction of the sacrum 
and the lateral bones of the pelvis. 
It is also wise to lie with the body inclined toward the right REGIMENS AND DIETARIES 
589 
side. This position facilitates emptying of the stomach, especi- 
ally when it is dilated or prolapsed; but if nausea is present, the 
patient should lie upon the left side, to prevent drag upon the 
cardiac orifice (Brunton). 
Sand bags weighing ten to twenty pounds are of great service 
in supporting the patient in a position of complete relaxation and 
rest. More than half the internal work of the body is due to 
muscle tension. Lying in bed is often far from being the com- 
plete rest that one naturally conceives it to be. The evidence of 
this is seen in the fact that the patient often becomes uncomfort- 
able and requires frequent change of position. The chief cause 
of discomfort is undue muscle tension, due to unconscious muscu- 
lar effort in mantaining the body in position. That this is con- 
siderable is shown by the instant relief and sense of comfort ex- 
perienced when sand bags or other suitable props are properly 
applied. 
The tendency to slip down in bed, if the head and shoulders 
are raised even a little, is unconsciously antagonized by involun- 
tary muscular action involving waste of energy. This may be 
easily prevented by a twenty pound sand bag placed against the 
buttocks. 
Absorption of the digested food material from the intestine 
may be promoted by application of pressure upon the abdomen. 
In the majority of cases in which the milk regimen is employed 
the patient will be found to have very relaxed abdominal muscles, 
and in consequence the intra-abdominal pressure is much dimin- 
ished if not altogether absent. This greatly hinders the absorp- 
tion of the digested foodstuffs. By the application of a sand bag 
or a shot compress to the abdomen the necessary pressure may be 
secured and absorption thus greatly facilitated. Or, instead of 
applying weight to the abdomen the patient may obtain essentially 
the same result by lying upon the face, so that the abdomen will 
be compressed by the weight of the body. By lying over a 
cushion or a pillow the effect of the prone position may be greatly 
increased. 
The care of the mouth is important. It should be well 
cleansed by rinsing with water after each feeding, and the teeth 
brushed and polished, preferably with the paper polisher (Hygos). 590 
THE NEW DIETETICS 
Results of the Milk Regimen. 
The tongue becomes clean, the breath sweet, the stools are no 
longer offensive, and usually have a yellow color and little odor 
or a slightly sour odor. This change is generally observed within 
a week or ten days, and even sooner when the bowels move very 
freely. The skin clears, the blood improves, the patient gains in 
flesh, often a pound a day, and the old depression, headache, 
mental dullness and other miseries are replaced by a sense of 
energy and well-being. The transformation of the patient from 
a poor, emaciated, despairing invalid to a plump, rosy cheeked, 
bright, forceful person is often so rapid as to seem almost miracu- 
lous. 
This rejuvenating process sometimes continues for two or 
three months, if the regimen is faithfully carried out and modi- 
fied to meet the patients changing needs. A gain of 25 to 30 
pounds in six or eight weeks is not uncommon. Sometimes a 
gain of 40 pounds is made in as many days. This is easily 
accounted for by the large amount of lactose in the ration. One 
ounce of sugar absorbed in addition to a full ration may cause 
an increase of flesh amounting to four ounces. Fats only add 
their own weight. 
SUPPLEMENTARY FEEDING 
While, in general, eating between meals is to be discredited 
and condemned, supplementary feedings at stated times between 
regular meals are sometimes useful, particularly in cases in which 
the amount of food which can be taken at meals is so small that 
the required number of calories cannot be taken at three meals, 
and in cases in which it is desirable to increase the food intake to 
the maximum limit. Supplementary feeding is also found advan- 
tageous in cases in which the patient’s stomach empties too rapidly, 
giving occasion for the development of annoying hunger pains. 
In all cases when supplementary feedings are employed, care 
should be taken to make sure that the food taken both at the 
regular meals and the supplementary meals is of such a character 
that it will pass out of the stomach quickly—say within an hour 
or two. To insure this it must be taken in the form of purees. 
It should be well chewed, whether mastication seems necessary 
or not, and should contain little fat. Fats pass from the stomach 
very slowly and on this account are not suited to supplementary 
feeding. REGIMENS AND DIETARIES 
591 
Among the foodstuffs best adapted to supplementary feeding 
are juicy fruits and fruit juices. The list of fruits should not 
include, however, such substantial foods as dates, figs, raisins or 
bananas. Peaches, apricots, plums, apples, pears, melons of all 
sorts (rejecting the pulp) may be taken at any time when the 
stomach is not already filled with food. Such foodstuffs require 
practically no work on the part of the digestive organs. Almost 
their sole nutritive constituents are acids and sugars. These are 
ready for immediate absorption and furnish to the heart and 
other muscular structures material ready to be utilized at once. 
Malt sugar also requires little digestive work to prepare it for 
immediate assimilation. 
Milk sugar may also be employed for supplementary feeding 
with advantage in cases in which it is desirable to change the 
intestinal flora. 
Whey is another supplementary food of value. Rice jelly and 
agar jelly prepared with fruit juices, also fruit ices, may be em- 
ployed in this way. Ices and all cool foods should be eaten very 
slowly, so as to avoid disturbing digestion by the chilling of the 
stomach. 
It is useful to bear in mind that the food value of an ounce 
of sugar is about 100 calories. An ounce of dry starch or flour 
has practically the same value. An ounce of grape juice has a 
caloric value of one-fourth as much, an ounce of whey 8 calories, 
an ounce of tomato broth 3 calories. 
By means of supplementary feedings, especially by the use of 
malt sugar and milk sugar, it is easy to introduce 800 or even 
1,000 calories of food in addition to the regular meals, thus secur- 
ing a rapid gain in flesh. 
Vegetable broths, such as savita broth, bean broth, tomato 
broth and a broth prepared from the unripe soy bean (Hahto or 
Easy Cook), are excellent for supplementary feedings when the 
desire is to increase the supply of vitamins and organic salts. 
When taken with the regular meals these bulky liquid foods fill 
up the stomach and prevent the patient from taking the needed 
quantity of proteins, fats and carbohydrates. Eggnog, beef juice, 
beef tea, animal broths, bread and milk, bread and butter, sand- 
wiches, cake, pie, and similar foods, and all solid foodstuffs are 
wholly unsuited for supplementary feedings. 592 
THE NEW DIETETICS 
METHOD OF CHANGING THE INTESTINAL FLORA 
The intestinal flora is the bacterial vegetation of the intestine, 
just as the flora of a country consists of the plants—trees, shrubs, 
weeds, flowers, mosses and other growths which its soil pro- 
duces. 
Why the Intestinal Flora Needs to be Changed. 
When a physician is called to attend a young infant, one of 
his first inquiries is respecting the character of the stools. The 
well-trained nurse always has the infant’s napkin ready for ex- 
hibition when the doctor is expected. 
A normal infant’s stool is yellow in color, soft in consistency, 
and nearly odorless or perhaps of a slightly sour odor. 
If the stool is dark in color and putrid, ammonical, rancid, 
or otherwise foul smelling, no other evidence is needed that the 
child is ill and suffering from the absorption from the colon of 
putrefactive products, the result of intestinal stasis. 
Careful examination of the stools is as important in the 
treatment of adults as of infants. The significance of a dark 
colored, putrid, strong-smelling stool is essentially the same 
whether the patient is an adult or an infant. Such a stool means 
colonic stasis or delay in the colon and the putrefaction of the 
colon contents, with the absorption of the products of putrefac- 
tion and resulting toxemia. All physiologists agree that, normally, 
there is no putrefaction in the human intestine. Only when delay 
occurs is there opportunity for putrefaction. Putrefaction is, for 
the most part, due to the development of spore-forming organ- 
isms which require an incubation period, so that twenty-four 
hours or more are required for the development of active putre- 
faction in a freshly inoculated medium. 
The food leaves the stomach in about four hours after it is 
eaten, and in four hours more the food residues have completely 
passed out of the small intestine and have reached the transverse 
colon; the process of digestion is completed and the utilizable 
portions have been absorbed. There is nothing left but unusable 
residues and excretory products and body wastes which ought to 
be dismissed from the body in six or eight hours more, or in less 
than twenty-four hours from the time the food was eaten. This 
is what takes place when the normal intestinal rhythm is main- 
tained ; that is, when three complete bowel movements occur daily. REGIMENS AND DIETARIES 
593 
When the bowels move but once a day, the motility period of 
the alimentary canal is fifty to fifty-four hours, often longer. In 
quite a large percentage of cases the stasis is not confined to the 
colon. Because of incompetency of the ileocecal valve, the stasis 
may extend to the small intestine and even the stomach. 
Savages and the big apes move their bowels three times a 
day and escape intestinal toxemia; but among civilized people a 
faulty diet, lack of exercise, bad postures, neglect to attend 
promptly and regularly to the evacuation of the bowels, the use 
of laxative drugs, mineral waters and other disturbing influences 
and conditions connected with modern life, have made constipa- 
tion almost universal, and as a result chronic intestinal toxemia 
and a host of chronic ills growing out of this condition including 
premature senility, have likewise become nearly universal. 
As a natural consequence of chronic stasis, the flora of the 
adult colon is entirely different from that of the infant. The 
flora of the healthy nursing infant consists mostly of acid-forming 
organisms, especially the B. bifidus and the B. acidophilus as 
pointed out by Dr. Tissier of the Pasteur Institute many years 
ago. 
The flora of the average adult living on a mixed diet is largely 
made up of putrefactive organisms, the B. Welchii, B. putrificus, 
with B. coli and streptococci. The same sort of flora, as Torrey 
and Distaso have pointed out, is found in the dog and for the 
reason that the diets of the dog and of the average man are muchi 
alike. 
The suppression of intestinal putrefactions by means of anti- 
septic drugs was offered as the solution of the problem of in- 
testinal asepsis soon after Bouchard’s .great work appeared and 
various agents, chiefly coal tar products, were for some years 
widely used; but the results were most disappointing. Labora- 
tory tests showed the utter futility of this method. The admin- 
istration of B-napthol for several days failed to lessen the number 
of bacteria (Stern). 
It was Quincke who first suggested the rational method of 
supplanting “the injurious bacteria by beneficent ones, just as 
weeds are suppressed by the growth of useful crops.” 
Poehl, of Petrograd, was the first to call attention to the 
remarkable influence of diet upon the intestinal flora. He noted 
that a diet of buttermilk quickly caused the disappearance of 
putrid stools in children, 594 
THE NEW DIETETICS 
Tissier later called attention to the antagonism between lactic- 
acid-forming organisms and bacteria which produce putrefaction. 
Bienstock showed that the B. coli produces harmless acids 
instead of toxins when abundantly supplied with carbohydrates. 
Sittler showed some years ago that when infants were fed 
maltose and dextrin in the form of malt soup B. acidophilus ap- 
peared in the stools in abundance. 
The notable work of Herter and Kendall, published in 1910, 
and the more recent work of Torrey, Rettger and others, have 
clearly demonstrated the readiness with which the intestinal flora 
may be changed by controlling the diet. Indeed, experiments by 
Metchnikoff and extensive clinical observations by Combe had 
previously established the same fact. 
The writer became interested in the question of suppressing 
intestinal putrefactions nearly thirty years ago, when Metchni- 
koff first called attention to the pernicious influence of colon bac- 
teria upon health and longevity. Beginning some twenty-eight 
years ago, the author employed with a considerable measure of 
success, cultures prepared from sterilized milk with various lactic- 
acid-forming organisms obtained for the purpose from Professor 
Conn, of the Connecticut Agricultural Experiment Station. 
Some twenty years ago, the idea occurred to the writer that 
if buttermilk rendered service when taken in at the upper end of 
the alimentary canal it ought to render still greater service if 
applied directly to the colon, where its services are most required. 
The method was found somewhat inconvenient, however, on ac- 
count of the enormous quantities of gas sometimes produced in 
the colon, which gave the patient much distress. 
Some twelve years ago (1911), opportunity arose to spend a 
few weeks in the laboratory of Dr. Distaso, at the Royal Institute 
of Public Health, London. Dr. Distaso was at this time making a 
study of the intestinal flora in persons upon whom Sir Arbuthnot 
Lane had operated for short-circuiting or removing the colon. 
At the same time there was an opportunity to observe the opera- 
tive work of Lane and the immediate and remote results, as seen 
in his clinic. The writer became convinced that for a thorough- 
going change of the intestinal flora, it was necessary not only to 
implant protective cultures in large quantities, but to make a 
radical and permanent change in the dietary, eliminating food- 
stuffs calculated to promote putrefaction; and lastly, perhaps 
most important of all, to increase the motility of the intestinal REGIMENS AND DIETARIES 
595 
tract so as to dispose of the food residues and body wastes so 
rapidly as to leave no time for the development of putrefactive 
changes. 
This led to the establishment of a plan of treatment in which 
these three factors were combined, namely: 
1. A radical change of diet, eliminating putrescible material 
and supplying carbohydrates in a form suitable to reach the colon 
(raw starch, dextrin and later lactose). 
2. Increased intestinal activity, so as to secure three bowel 
movements a day by the combined use of bran or agar and 
mineral oil. 
3. Flushing the alimentary canal with an active whey cul- 
ture of acid-forming organisms (B. bifidus and later acidophilus), 
by the administration by mouth of a half pint to a pint of whey 
culture, and the injection of a similar amount of culture into the 
colon after administering a warm enema. 
At once more definite and reliable results were obtained 
than before. This method has now been extensively used at the 
Battle Creek Sanitarium for ten years, and has been employed in 
thousands of cases with excellent success. 
The intestinal flora may be favorably influenced by any one 
of these three measures, but for definite and rapid change of the 
flora all three of the methods must be employed simultaneously. 
We will consider each of the three distinct methods. 
I. The Low Protein Diet. 
It is a matter of common observation that carbohydrates 
(starches and sugars) ferment, while proteins putrefy. Although 
both changes are due to bacterial action, there is a most important 
difference between the classes of microorganisms involved in the 
two processes. The organisms that give rise to fermentation pro- 
duce acids—chiefly lactic or acetic—that are harmful only in 
very large quantities. In the minute quantities in which they can 
be produced in the intestine they are usually entirely harmless. 
On the other hand, the microbes that give rise to putrefaction 
produce deadly poisons and toxins which are highly injurious in 
very minute quantities. 
Bacteria, like other plants, require soils favorable for their 
development. It is evident that the most effective way of sup- 
pressing the growth of poison-forming organisms in the intestine 
is to reduce to a minimum the amount of protein in the diet. 596 
THE NEW DIETETICS 
The marked difference in the character of the stools of a 
vegetable-eating animal like the sheep and those of a carnivorous 
animal like the dog is clear evidence of the influence of a high 
protein diet in promoting putrefactive changes in the intestine. 
The same difference is observed between the stools of a flesh- 
eating man and those of a flesh-abstainer. When meat and eggs 
are eaten freely, considerable of the proteins escape digestion, 
find their way into the colon and there undergo putrefactive 
changes. If, on the other hand, the protein of the diet is reduced 
to a minimum, so that the protein residues that reach the colon 
are small in quantity, the putrefactive changes are slight and the 
number of bacteria, with their toxins and endotoxins, is notably 
lessened. 
By a change of diet it is not only possible to change the bac- 
terial vegetation of the intestine, but also to change the action 
and the nature and influence of the colon bacillus and its con- 
geners so that they no longer produce pernicious effects, but 
actually become a means of protection and defense. In other 
words, the wild bacteria that in various ways, as already pointed 
out, find their way into the human intestine and give rise to 
putrefaction and other bacterial changes whereby poisons in large 
quantities are produced may be either eliminated or changed to 
harmless acid formers. The researches of Bienstock and Kendall 
have shown beyond question that these poison-forming bacteria 
cease to produce poisons when they are adequately supplied with 
carbohydrates of a kind that they can utilize. Kendall found 
that even most virulent disease-producing bacteria, like the diph- 
theria bacillus, in the presence of sugar cease to produce toxins. 
The same is found to be true of the colon bacillus and of other 
pernicious organisms that grow in the human intestines. 
How to get the required amount of carbohydrates into the 
colon is the problem. Cane or malt sugar and cooked starch are 
so quickly digested and so completely absorbed in the small intes- 
tine that it is by no means easy to get any amount of them into 
the colon. Raw starch digests less quickly, and milk sugar is 
much more slowly absorbed than other sugars. Practically only 
three carbohydrates can be made to reach the colon without un- 
dergoing digestion and absorption—raw starch, dextrin and milk 
sugar. Raw starch digests so slowly that when taken freely con- 
siderable quantities will reach the colon and there be acted upon 
by amylolytic bacteria which are always present; sugar is thus REGIMENS AND DIETARIES 
597 
produced, supplying to the colon bacillus and other harmful bac- 
teria the material necessary for changing the action of these 
organisms, so that they become protective instead of destructive, 
through the harmless acids which they produce. 
Sugar of milk in considerable quantities (3 ounces three 
times a day) in connection with means for stimulating intestinal 
activity may also be made to reach the colon because of the great 
slowness with which it is digested and absorbed in adults. Milk 
sugar remains four times as long in the alimentary canal as does 
malt sugar. By means of the milk regimen, it is possible to 
introduce lactose or milk sugar into the colon in almost any de- 
sired quantity. Milk sugar and dextrin may be injected directly 
into the colon. 
When the colon is thus supplied with carbohydrates, fermen- 
tation takes the place of putrefaction and the acids produced act 
as normal stimulants to the colon, encouraging its frequent and 
normal emptying. 
The milk regimen always changes the intestinal flora, which 
is, in many cases, no doubt, the chief benefit derived from its use. 
Combe, a recognized authority in the treatment of auto- 
intoxication, more than twenty years ago laid down the following 
among other rules in relation to diet. 
Nitrogenous foods: 1. Diminish as much as possible the nitro- 
genous foods from which the intestinal bacteria derive their nourish- 
ment. 2. Absolutely prohibit those nitrogenous foods (meats) that 
are favorable media for the development of bacteria and form veritable 
culture bouillons. 3. Select eggs as being less putrefactive in the 
intestine. 
Fatty foods: 1. Avoid the fats of meat for they increase putre- 
faction. 2. Give fresh butter in preference to meat fat, for its action 
is much less harmful. 
Farinaceous foods: 1. Introduce into the diet as large a propor- 
tion of farinaceous substances as possible. But to obtain a result 
it is necessary to saturate the intestine with carbohydrates. The 
word “saturate” is used because it is not sufficient simply to add a few 
farinaceous substances to the diet. The patient must be filled with 
farinaceous aliments. 2. In autointoxication from acute enteritis, or in 
the acute recurrences, an exclusive farinaceous diet must be maintained for 
several days, for it plays the same part in acute enteritis that a liquid diet 
does in acute catarrh. 
Chalmers Watson requires that meat shall be excluded from 
the diet in cases of autointoxication, as do most present day 
writers on dietetics. If this counsel were followed by all suffer- 598 
THE NEW DIETETICS 
ing from autointoxication in any degree, it would lead to the 
disuse of meat, for autointoxication is an almost universal disease 
in civilized communities. It is for this reason, perhaps, that its 
full significance as a cause of disease is so often overlooked. 
Wegele places first among the list of causes of autointoxica- 
tion the use of meat; that is, a diet which encourages putrefaction 
in the intestine, both by the introduction of material which readily 
undergoes putrefaction and with it B. IVclchii and other germs 
which give rise to putrefaction. 
Tissier of the Pasteur Institute requires his patients to 
adhere closely to a strict non-flesh dietary. Writing the author 
in 1911, Professor Tissier said: 
You know that all our efforts have been in the direction of pre- 
venting intestinal putrefaction, the predisposing cause of intestinal 
infection, and sometimes the determining cause of digestive and nerv- 
ous disorders. To prevent intestinal putrefaction, we introduce as 
much sugar as possible into the intestine, and certain microbes fer- 
ment these sugars and thus produce acids. The acid produces arrest 
of the bacteria of putrefaction. But sugar is rapidly absorbed by the 
mucous membrane of the stomach and intestines. It does not reach 
the large intestine. The sugar that goes the farthest is that of the 
date, which can be recovered in the cecum. Of all the hydro-carbons, 
starch alone arrives in the large intestine, where it is decomposed and 
absorbed by the mucous membrane. We may increase the quantity of 
the sugar produced, and thanks to the ferments which produce acids 
from sugar, for instance the bifidus and lactic-forming bacilli, putre- 
faction may be arrested more quickly. 
These views have been abundantly verified by clinical experi- 
ence, and are fully sustained by recent researches, conducted by 
Drs. Torrey, Rettger and others, as well as by the writer. 
In an extended series of bacteriological studies of the stools 
of dogs under various conditions by Torrey, the results of which 
were published in the Journal of Medical Research, it was shown 
that lactose and dextrin have a very marked effect in modifying 
the character of the intestinal flora. When lactose or dextrin 
were given in sufficient amount, putrefactive bacteria almost en- 
tirely disappeared, the lactic acid-forming bacteria, particularly 
the B. acidophilus, taking their place. Similar but less marked 
results were obtained by the use of cane sugar. 
Better results were obtained with boiled milk than with un- 
boiled. With the latter the B. coli predominated. Potatoes, bread, 
and beans, when freely used, tended to lessen the putrefactive REGIMENS AND DIETARIES 
599 
bacteria, while meats “markedly encouraged the growth and 
activity of putrefactive bacteria.” The casein of milk produced 
less tendency to putrefaction than did meat. Vegetable proteins 
“did not offer the slightest encouragement to the growth of intes- 
tinal putrefactive types of bacteria.” 
According to Rettger, 
Lactose, milk and mixed grains (wheat, oats, etc.) are specific articles 
of diet which exert an influence on the intestinal bacteria. Lactose, when 
fed in sufficient quantities (2 or 3 grams daily), brings about complete 
transformation of the flora of white rats within three or four days: milk 
requires a longer time, and does not bring about a complete change. Milk 
and lactose together form the most practical and effective diet, at least for 
man. Grain feeds tend to increase the number of aciduric bacteria, but 
their influence is comparatively small. 
Meat or other high protein diet increases the indol-producing 
bacteria and other organisms of the so-called “putrefactive” type, like 
B. coli and B. Welchii. 
The marked influence of a high lactose diet upon the intestinal 
flora of man, which was demonstrated in these experiments, has been 
confirmed by other investigators (Lowey) working with typhoid 
patients, who found that eating milk sugar (250 to 300 grams, 8 to 10 
ounces, daily) brought about a marked change in the intestinal flora 
where the initial flora had been of a distinctly putrefactive type. 
The above observations show beyond room for doubt the im- 
portance of supplying to the colon the carbohydrate necessary for 
promoting the growth of acid-forming bacteria. The only way 
in which this can be done is by proper regulation of the diet and 
increasing peristaltic activity. The regimen must supply forms 
of carbohydrate which will be slowly absorbed so that some of it 
may have a chance to reach the colon. 
With the fruit regimen, 4 to 8 ozs. of lactose, or lacto-dex- 
trin, are given daily, the amount found necessary for producing the 
change of the colon flora. The milk sugar is given dissolved in 
plain water, lemonade or fruit juice of some sort, in doses of 
three ounces, three times a day. A specially prepared laco-dextrin 
is preferable for this purpose as the ordinary dextrin of the drug 
stores has a very unpleasant flavor and is difficult to take. Milk 
sugar in large amount causes nausea in some cases, while lacto- 
dextrin may be taken as easily as any breakfast food. 
With the fruit regimen, also, the action of the intestine is 
hastened, and a sufficient amount of starch and fruit sugar 600 
THE NEW DIETETICS 
reaches the colon to encourage the needed acid fermentation. In the 
after-diet, brose, or half-cooked cereals, supplies the raw starch 
needed to feed the sugar-forming and acid-forming bacteria and 
to secure normal bowel action and arrest of putrefaction in the 
colon and of chronic intestinal toxemia which results therefrom 
2. Increased Intestinal Activity. 
The multiplication of bacteria in the intestine is more actively 
encouraged by stasis or stagnation of the intestinal contents than 
by any other factor aside from an excessive amount of protein in 
the dietary. A most important means of lessening the multipli- 
cation of bacteria in the intestine is acceleration of the movement 
of the food residues along the intestinal tract. Delay of the intes- 
tinal contents at any point along the twenty-seven feet of small 
and large intestine is quickly followed by the development of 
active bacterial changes. While active digestion is taking place, 
putrefaction and fermentation are restrained. When the several 
digestive cycles have been completed, fermentation or putrefaction 
becomes active—the nature of the process being determined by 
the dominant character of the food residues. If these are chiefly 
carbohydrates, fermentation results; if protein, putrefaction. 
Normally, the stomach becomes empty in about four hours 
after the beginning of a meal and the small intestine discharges 
the last remainders of the meal into the large intestine four hours 
later. In other words, the process of digesting and absorbing a 
meal normally occupies about eight hours. Three or four hours 
later, in the case of a perfectly normal person, the undigested 
residues of foodstuffs, mixed with excretory substances derived 
from the liver and mucous membrane, may be discharged from 
the body. Under such circumstances, the opportunity for putre- 
factive changes is so slight that the bacteria developed are com- 
paratively few, and the amount of poisons produced is accord- 
ingly small. In carnivorous animals, the time required for the 
transit of foodstuffs through the alimentary canal is much shorter. 
Results of experimental researches published by the United States 
Government show that the time elapsing between the taking of 
food and the discharge of the unused residues is, in the barnyard 
fowl, only three and one-half hours. In the fruit-eating bat of 
South America the time is only one hour, and the feces have the 
odor of bananas, upon which these bats feed. The alimentary 
tube of the sheep is twenty-six times the length of the animal’s REGIMENS AND DIETARIES 
601 
body and the time of transit is necessarily considerably longer. 
Metchnikoff many years ago showed by extended researches that 
those animals live longest that have the shortest colons. Some 
animals, such as the eagle, which live on an exclusively flesh diet 
live to a great age because of the extreme shortness of their 
colons, which affords no opportunity for stasis and hence little 
chance for putrefactive changes. 
It must be clearly understood, however, that by increased 
frequency of bowel movement is meant not simply one bowel 
movement a day, but at least three full bowel evacuations. In 
many cases, it is desirable that as many as four evacuations 
should be secured. Briefly stated, the reasons for this belief are 
UIC3C . 
In healthy infants, the bowels usually move soon after feed- 
ing. The same is true of healthy animals and active, healthy boys 
and girls who are fed upon a natural diet that is sufficiently 
bulky to produce normal peristalsis. 
The savage moves his bowels three times a day, as does also 
the Turk. Said a Bushman to a missionary doctor whom he con- 
sulted for relief : “Doctor, I am horribly constipated; my bowels 
move only once a day.” 
The chimpanzees and other big apes in zoological gardens 
move their bowels four to six times a day. 
It is usually quite easy by the methodical use of simple means 
to acquire the habit of three bowel movements daily and the 
results of this practice have always been found to be beneficial 
and in no way harmful. The method is quite simple. It is only 
necessary to supply the proper amount of bulk and lubrication 
required in each individual case. 
3. The Displacement of Harmful, Putrefactive Bacteria by 
Harmless Acid-Forming Organisms* 
According to Burnet, the idea of supplanting the putrefactive 
bacteria present in intestinal toxemia by beneficent acid-formers 
originated with Quincke. 
By extensive experiments conducted under the supervision 
of the writer in the bacteriological laboratory of the Battle Creek 
Sanitarium, it has been demonstrated that when boiled or even 
slightly cooked starch is present to the extent of two per cent, 
the growth and activity of putrefactive organisms in the feces 
are controlled; acids are produced in place of ammonia, and fer- 602 
THE NEW DIETETICS 
mentation predominates over putrefaction. The same is true 
when milk sugar, dextrin or lacto-dextrin, is taken in sufficient 
amount; that is, three ounces three times a day (Torrey). 
The principal battle waged between beneficent and pernicious 
bacteria in tbe intestine is, according to Burnet, between B. 
Welchii on the one hand and B. acidophilus and B. bifidus on the 
other. 
Those bacteria that produce the largest amount of acids are 
most active in resisting the growth of putrefactive organisms. 
The B. bifidus and the B. acidophilus cease to grow only in solu- 
tions containing five per cent, of acid, while B. Welchii is inhib- 
ited by an acid solution of the strength of one-sixth of one per 
cent. 
Some 16 years ago (1907), the writer began an experiment 
for the purpose of testing the ability of lactic acid-forming or- 
ganisms to suppress putrefaction. A pound of beefsteak was 
immersed in a two-quart jar of buttermilk. Although the flesh 
was slightly tainted when purchased, after a few days in the but- 
termilk it was found to be entirely free from taint. This experi- 
ment is still in progress, the buttermilk being regularly changed 
every week. The beefsteak remains absolutely free from any 
putrefactive change. Bacteriological examination shows no pu- 
trefactive bacteria present. The flesh has the appearance of fresh 
meat made a little paler than usual by the long continued macera- 
tion to which it has been subjected. 
This method of preserving meat was practiced by the pioneer 
women of our western frontier, who often kept fresh meat for 
several weeks by immersing it in pans of sour milk. A gentle- 
man who has traveled extensively in the East reports that a 
similar practice is also in vogue among the Arabs, who preserve 
their fresh meat in camel’s milk. 
The philosophy of this method is exceedingly simple. The 
B. acidophilus, introduced with the food, finds its way into the 
colon and there produces lactic acid and so develops a condition 
unfavorable to the growth of putrefactive bacteria, which do not 
thrive in an acid medium. Bienstock, Tissier and Martilly showed 
that in a medium containing one per cent of sugar, a putrefactive 
flora does not flourish, an aciduric flora taking its place. The B 
bulgaricus, a buttermilk germ, so closely resembles the B. acid- 
ophilus of the intestine that it was for a long time mistaken for 
it and was recommended by MetchnikofY to change the flora, which REGIMENS AND DIETARIES 
603 
we now know it will not do for it does not thrive in the intestine. 
Two conditions are necessary for the success of this method: 
1. The B. acidophilus must reach the colon in sufficient 
numbers to be able to produce enough lactic acid to acidify the 
colon’s contents. 
2. It is necessary that the B. acidophilus shall find in the 
colon the food necessary for its sustenance and by the aid of 
which alone it is able to produce lactic acid, viz., carbohydrate. 
Unfortunately, both these conditions are somewhat difficult 
to secure. The B. acidophilus is likely to be destroyed by the 
digestive fluids on its way to the colon, while the sugar which is 
essential for its development is almost certain to be absorbed in 
the small intestine, so that the acid-forming bacilli speedily starve 
to death after reaching the colon, for lack of suitable nourish- 
ment. 
It is necessary that large quantities of very active cultures 
should be taken and special measures must be adopted to supply 
to the B. acidophilus when in the colon the carbohydrate which it 
requires for efficient growth. 
One way of accomplishing this is by the administration of 
freshly prepared acidophilus buttermilk in connection with the 
milk regimen. It may also be accomplished by giving fresh whey 
cultures of the B. acidophilus in massive quantities, a glassful 
three times a day. 
The B. acidophilus is probably always present in the intes- 
tine, but generally in such small numbers that it is overwhelmed 
by the putrefactive bacteria. 
By the administration of three ounces of milk sugar or 
dextrin three times daily, the B. acidophilus will increase in 
numbers, and by the end of a week or ten days may be obtained 
from the stools in almost pure culture. The Welch’s bacillus and 
other putrefactive and injurious organisms will be found to have 
disappeared. By adherence to an antitoxic dietary, an occasional 
return to the milk sugar feeding, or the constant use of a moderate 
amount (2-4 ounces) of lacto-dextrin daily, the putrefactive flora 
of the intestine may be held in abeyance and the colon kept free 
from putrefaction. 
Fuld (Dent. Med. Woch) mentions a method which has 
been tried for changing the intestinal flora by injecting into the 
colon cultures of the colon bacillus. This method has been ex- 
tensively exploited in this country, but cannot be regarded as other 604 
THE NEW DIETETICS 
than irrational and utterly incapable of securing any definitely 
beneficial results. 
The writer has for some years made use of colon injections 
of whey cultures of B. acidophilus as a means of changing the 
flora in connection with a special dietary, such as the fruit or milk 
regimen, and with very great success. Many hundreds of cases of 
colitis have been cured. 
In a recent work by Rettger and Cheplin it is held that the 
flora may be changed by the use of lactose or dextrin or by the 
use of acidophilus milk in liberal quantities without any other 
change in diet. The writer is convinced that this method alone 
will fail to make a satisfactory change of the flora in cases in 
which the colon is badly crippled and especially when there is 
marked stasis in the small intestine. The delay in the intestine 
permits absorption of the lactose before it reaches the colon, where 
its services are especially needed. 
Rettger and Cheplin also note that after the flora has been 
changed by means of lactose or acidophilus milk, the objectionable 
mixed flora reappears in less than a week after the lactose or cul- 
ture is discontinued. Obviously there is little use in changing the 
flora unless the change is maintained. By combining the use of 
lactose and dextrin or cultures with the fruit regimen or the milk 
regimen, the change may be accomplished more quickly and cer- 
tainly than by either plan alone. To prevent return of the flora 
to the mixed type, meats of all sorts must be discarded from the 
dietary and the colon must be evacuated three times a day. 
When the cecum is adherent, the descending colon spastic, 
the pelvic colon prolapsed and adherent or impacted, the change 
of flora is more difficult of accomplishment because of the delay 
of residues whereby opportunity is given for the absorption of 
the lactose, permitting the development of the putrefactive or- 
ganisms. In such cases, the colon must be emptied thoroughly by 
an enema daily, or even twice a day. By a persevering effort and 
the use of larger quantities of lactose or dextrin (4 ounces three 
times daily) the change will finally be accomplished, although the 
time required may be sometimes so long as two or three weeks. 
After the flora is changed, continue the same measures moder- 
ated to keep the stools frequent and free from putrid odor. An 
occasional laboratory test should be made when possible. 
With lactose feeding, as with the milk regimen, there is not 
infrequently at first a very marked looseness of the bowels, due, REGIMENS AND DIETARIES 
605 
possibly, to the temporary increased development of the Welch’s 
bacillus. A lessening of the dose to one ounce three times a day 
will usually correct the looseness at once; then the smaller dose 
may be taken and as the flora is changed the tendency to diarrhea 
will disappear. 
The first effect of large doses of dextrin or lactose is greatly 
to increase gas production. This inconvenience will disappear in 
a few days, as soon as the Welch’s bacillus and the colon bacillus 
have been greatly reduced in numbers. The disappearance of 
putridity of the stools and of gas are an indication that the change 
of flora has taken place, and with this change the production of 
colon poisons and the mischiefs which they produced will have 
ceased. 
Change of the Intestinal Flora Without the Use of Cultures* 
At the present time much interest is being manifested by the 
laity as well as by the profession in the change of the intestinal 
flora by means of cultures, numerous brands of which are being 
put upon the market and extensively sold. By far the great 
majority of people who have made use of these cultures have 
found the results very disappointing. It could not be otherwise, 
for it is as irrational to suppose that a spoonful or two of any 
culture administered two or three times a day could effect a 
change of the condition of an infected alimentary canal as to 
undertake to produce a grass covered front lawn with a teaspoon- 
ful of seed, or to disinfect a whole back yard with a teaspoonful 
of chloride of lime. Whatever the agent employed for changing 
the intestinal flora, it is necessary that the whole alimentary canal 
should be flooded with it, and this flooding must be continued for 
many days in succession if any degree of success is to be attained 
in ousting the pernicious parasitic bacteria which have for years 
held undisputed possession of the territory. 
The parasitic bacteria are found not only upon the surface 
of the mucous membrane, but in its deeper layers. The bacteria 
sometimes even pass through the whole thickness of the intestinal 
wall and find their way into the bladder, kidneys and other organs 
and are hidden in innumerable folds and pockets of the bowel, in 
the appendix, the gall bladder, the bile passages and the ducts of 
the intestinal glands. 
After long and thorough study of the subject and observa- 
tions in many hundreds of cases, the writer has found that cul- 606 
THE NEW DIETETICS 
tures are not only not indispensable for changing the intestinal 
flora, but that the change may be more certainly, definitely and 
permanently accomplished without cultures than by the use of 
cultures alone. 
The bacillus acidophilus and other protective acid-forming 
organisms are implanted by Nature in the intestine not only of 
human infants but of the young of all mammals within a few days 
after birth without the administration of cultures. The protec- 
tive organisms are evidently very widely dispersed for they never 
fail to make their appearance in the stools of the nursing infant, 
the suckling calf or the milk-fed chicken. The droppings of milk- 
fed chickens are, in fact, almost pure cultures of the B. acido- 
philus. Once introduced into the intestinal tract these organisms 
are never wholly lost although their numbers may be very greatly 
reduced, and even if they were lost Nature has an abundant 
supply ready at hand for adults as well as for infants when con- 
ditions are made favorable for their growth. It is evident, then, 
that all that is necessary to secure a change of the intestinal flora 
is an abundant supply of such nutrients as will encourage the 
growth in the colon of the protective flora and discourage the 
growth of the pernicious bacteria. 
It is also to be noted that if we encourage the growth of the 
protective organisms present by proper feeding we shall be cer- 
tain that the results secured may be easily made permanent by 
continuing the proper feeding. If, on the other hand, we admin- 
ister quantities of the organism which have been grown outside of 
the body, the good results secured would only last so long as the 
cultures are being given in large quantities, for they will not grow 
and develop in the body unless encouraged by special feeding with 
lactose or dextrin. 
Lactose and dextrin are the only carbohydrates that can be 
relied upon to encourage a luxuriant growth of B. acidophilus in 
the colon. These carbohydrates are absorbed much more slowly 
than others and are thus able to reach the colon before complete 
absorption. To make certain that a sufficient amount of lacto- 
dextrin reaches the colon to change the flora, that is, to encourage 
the growth of the B. acidophilus sufficiently to make it dominant 
and discourage the growth of the putrefactive organisms, it is 
necessary that large doses should be taken. Lactose alone has in 
practice been found to be objectionable for several reasons. First, 
it sometimes gives rise to nausea; second, it becomes after a few REGIMENS AND DIETARIES 
607 
days repugnant to most persons; third, it is difficult to dissolve; 
fourth, and perhaps the most important of all, the use of such 
large quantities of sugar for a considerable period sometimes 
causes the appearance of sugar in the urine. This might prove to 
be highly injurious to a person already having a tendency to 
diabetes. Dextrin is equally as valuable as lactose for changing 
the flora, but its use for human beings is impracticable because its 
laste is so disagreeable it is practically impossible to swallow the 
quantity required. The objectionable features of both lactose and 
dextrin have been overcome by combining the two, not by simple 
mechanical mixture but by adding lactose to a specially prepared 
dextrin in such proportions as to produce a readily soluble, highly 
agreeable product which may be used without difficulty for an 
indefinite period of time. The combination of a keloid with the 
crystalloid lactose serves to protect the stomach from the well- 
known irritating effects of sugars of all sorts in concentrated 
form, This product, known as lacto-dextrin, not only changes 
the intestinal flora but is a highly concentrated food, each ounce 
of it having a food value of about 120 calories. 
The Quantity of Lacto-Dextrin Required. 
For rapidly changing the intestinal flora it is necessary to ad- 
minister large doses, sufficient to fill the alimentary tract, or other- 
wise the total amount taken may be absorbed before reaching the 
colon where its presence is necessary to encourage the growth of 
the B. acidophilus. This amount varies in different persons. On 
the average the required dose is about three ounces. This quan- 
tity must be taken three times a day. In exceptional cases four 
or five ounces may be required for a few days. These are cases in 
which the intestine is badly crippled and a long time is required 
for the lacto-dextrin to reach the colon so that nearly all is ab- 
sorbed. In these cases large doses must be taken until the flora 
is changed, and afterwards doses half as large will generally suf- 
fice to maintain the change, that is, to prevent the return of the 
intestinal putrefaction and consequent autointoxication. 
The Best Time for Taking Lacto-Dextrin. 
Lacto-dextrin may be used advantageously at any time, with 
meals as an addition to fruits, or between meals as a drink—it 
makes a very agreeable beverage. An excellent time for taking 
lacto-dextrin in ordinary cases is about one hour before each 608 
THE NEW DIETETICS 
meal. It should be taken with a liberal quantity of water. A full 
dose requires about 12 to 16 ounces or two large tumblerfuls of 
water. The product is much more soluble in hot water than in 
cold, hence hot water is decidedly preferable. A convenient way 
for taking is to put about one-half the dose, three heaping dessert 
spoonfuls, in a tumbler, add an equal quantity of hot water, stir 
quickly with a fork till smooth, then add hot water to fill the 
tumbler. After swallowing this, prepare and take another similar 
dose. Repeat this before each meal. 
Not infrequently the taking of a large dose of this concen- 
trated food a short time before a meal lessens the appetite. This 
need not give alarm, for it is to be remembered that lacto-dextrin 
is a highly concentrated food. A heaping dessert spoonful repre- 
sents about 100 calories, and the full day’s dose represents fully 
half the amount of food required by the average individual 
engaged in light employment. Persons who are overfat or of 
average weight and hence do not desire to add to their weight 
must necessarily reduce the amount of food eaten while taking 
lacto-dextrin. Such persons should make the diet consist chiefly 
of coarse vegetables such as cabbage, cauliflower, green peas, 
string beans, lettuce, celery, brussel sprouts, asparagus and fresh 
fruits of all sorts with a moderate allowance of bread, potatoes, 
cereals, milk, buttermilk, etc. Persons who are thin in flesh and 
desire to add to their weight should take the lacto-dextrin about 
three hours after meals. When taken at this time lacto-dextrin 
does not lessen the appetite for other food and so may be taken 
in addition to the regular full diet and will thus insure a decided 
and usually a rapid gain in flesh. 
To Keep the Flora Changed. 
This is not a case in which the good Methodist doctrine of 
“Once in grace always in grace” is applicable. Even when the 
flora has been completely changed, if the measures employed to 
effect a change are completely withdrawn, the old putrefactive 
flora will be found back in full force within a week or ten days. 
To keep the flora changed requires a constant battle. 
The things which must be done without fail and systematic- 
ally are the following: 
1. The bowels must be thoroughly emptied every day. To 
insure this, the bowels should be trained to move three times a 
day or after each meal. In many cases an additional movement REGIMENS AND DIETARIES 
609 
occurs before breakfast and this is advantageous. To secure 
this efficient action of the bowels the use of large quantities of 
bulky foods is necessary together with proper lubrication. An 
ounce to an ounce and a half of bran is required in obstinate cases 
and paraffin oil in liberal quantities is also needed. Fresh fruit, 
greens and such vegetables as lettuce, celery, cabbage, beets, pars- 
nips, etc., should be freely used. Bulky or laxative foods must 
be used in liberal quantities, not once a day only, but at every 
meal. If one of the daily meals is taken away from home at a 
lunch counter, hotel or restaurant, a quantity of “ballast” may be 
taken along in the pocket. Laxa is especially excellent for this 
purpose. This is a combination of bran and agar, which is the 
most efficient form of roughage with which the writer is ac- 
quainted. It is prepared in the form of a biscuit which may be 
carried in the pocket and is quite palatable and easily eaten either 
with or without other food. If the ordinary meal is omitted, one 
or two laxa biscuit may be taken with a little fruit so as to avoid 
interrupting the normal intestinal rhythm. 
2. An antitoxic diet must be closely followed, that is, meats 
of all sorts, including fowl, fish, etc., must be rigorously excluded 
from the diet. This is necessary not only for rapidly changing the 
intestinal flora, but after the flora has been changed to prevent re- 
infection of the intestine. A single chop or serving of fish or 
chicken may suffice to re-inoculate the intestine with the putrefac- 
tive flora and render necessary a new campaign to change the 
flora by means of large doses of lacto-dextrin. In some cases 
even eggs must be used very sparingly, the yolk of the egg in 
preference to the white, being less putrescible and less likely to 
encourage putrefaction in the colon. When eggs are eaten the 
greatest care should be taken to insure perfect freshness. In hot 
weather an egg will not remain fresh for more than two or three 
days, and ordinary commercial eggs are quite liable to contain 
bacteria even when perfectly fresh. Bacteriological examinations 
of eggs have shown that about one egg in seven is infected when 
laid. It is necessary that the food and surroundings of chickens 
should be thoroughly clean in order to insure that the eggs are 
wholly free from bacteria even when fresh. Eggs from milk-fed 
chickens are of the best sort. 
3. Three or four ounces of lacto-dextrin should be used 
daily. In many cases a single morning dose of two to four heap- 
ing dessert spoonfuls is found to be efficient. This dose in many 610 
THE NEW DIETETICS 
acts as a decided laxative. Changing the flora always increases 
the efficiency of the colon. If acidophilus buttermilk is used, 
about two pints should be taken daily to maintain a good intestinal 
flora. Perhaps the best plan of all is to combine the buttermilk 
and lacto-dextrin. When this is done only a half dose of each 
will be required, say two or three tablespoonfuls of lacto-dextrin 
daily and one or two glasses of buttermilk. 
Change of the intestinal flora is one of the most efficient of 
all means to be employed for combating constipation. This is 
true for the reason that putrefaction gives rise to ammonia and 
other alkaline products which paralyze the colon. That all alkalies 
have this effect is a well established physiologic fact, while it is 
equally well established that acids excite the colon to normal 
activity. The addition of the juice of one or two lemons to the 
water employed as an enema is one of the most efficient of all 
known means of stimulating the bowel to action when stimula- 
tion is required. When the flora has been changed, the normal 
acid-forming organisms, B. acidophilus and B. bifidus being domi- 
nant, acids are constantly formed in the colon which excite it to 
normal activity and tend to restore it to a normal condition. 
When Is the Intestinal Flora Changed? 
The intestinal flora is changed when the stools are soft, fre- 
quent (three times a day), and free from putrid or rancid odor. 
Examination by a bacteriologist should show a luxuriant growth 
of B. acidophilus and the gram stain should give positive 80 and 
negative 20 (80-20), which means 80 per cent of the acid-formers 
and 20 per cent of other bacteria. In a bad flora, the percentage 
will be the reverse, 20-80. In some cases, a percentage of 5-95 is 
found. In healthy, nursing infants, the flora shows gram 80-20. 
The feces of milk-fed chickens give the same. Of course, a change 
from 20-80 or worse to 40-60 or 50-50, is a decided improvement, 
but this should not be considered at all satisfactory. Old troubles 
may still continue, perhaps somewhat modified. But when the 
change reaches 75-25, marked improvement will be evident, and 
the more complete the change of flora, the more decided will be 
the change for the better in the patient’s symptoms. 
While the change is taking place, it is most desirable to have 
made, when possible, frequent bacteriological examinations so as 
to be able to note the progress being made. However, it is en- 
tirely possible to make a thorough-going change of the flora with- REGIMENS AND DIETARIES 
611 
out the aid of the bacteriologist by carefully following the sug- 
gestions above made. By continuing the use of a laxative and 
antitoxic diet with daily use of lacto-dextrin, the flora may be kept 
changed and with such great profit as will amply repay all the ex- 
pense and trouble involved. In considering the matter of expense, 
it should be remembered that the special carbohydrates used pos- 
sess high food value, equaling in calories about twice their weight 
of ordinary beefsteak. 
Persons who have long suffered from constipation and intes- 
tinal toxemia may with great profit make constant use of lacto- 
dextrin in doses of one or two ounces once or twice daily, or one 
or two pints of acidophilus buttermilk daily. In very pronounced 
cases of toxemia, lacto-dextrin and buttermilk may be used to- 
gether with great advantage. 
Diseases in Which the Intestinal Flora must be Changed. 
Among the maladies in which the defensive mechanisms of 
the body are crippled may be mentioned especially the following: 
Achylia, gastric ulcer, cancer of the stomach, duodenal ulcer, 
inflammation of the gall bladder, gallstones, abscess of the liver, 
cirrhosis of the liver, pancreatitis, diabetes, exophthalmic goiter, 
toxic goiter, cystic goiter, myxedema, Addison’s disease, Bright’s 
disease, pyonephrosis, arteriosclerosis, jaundice, syphilis, multiple 
neuritis, intestinal toxemia, dementia praecox, manic depressive, 
toxic neurasthenia, eczema, acne, degenerative disorders of the 
nervous system, pernicious anemia, splenic anemia, cancer in any 
part, of the body, chronic appendicitis, chronic bronchitis, bron- 
chial asthma, cardiac asthma, migraine, or so-called sick head- 
ache, so-called biliousness or torpid liver, acidosis, apoplexy, 
osteo-arthritis or chronic rheumatism, chorea, colitis, chronic 
diarrhea, premature old age, sprue, pellagra, fever. 
Sir Arbuthnot Lane enumerates the following symptoms and 
conditions as due to intestinal toxemia, in all of which the anti- 
toxic diet is necessary: 
Wrinkles, atrophy of the skin, pigmentation of the skin, brown- 
ing of the eyelids, also the skin about the eyes, the axillae, the abdo- 
men, cyanosis, coldness of the hands and feet, sweating of the hands 
and feet, livid skin, roughness and dryness of the skin, wasting of the 
muscles, general muscular weakness, curvature of the spine, wasting 
of the abdominal muscles, prolapse of the viscera, weakness of the 
heart, degeneration of the aorta, dilated heart, melancholia, imbecility, 612 
THE NEW DIETETICS 
headache, symptoms resembling brain tumor, epilepsy, diseased condi- 
tions of the mammary gland—a nodulated condition, induration, cystic 
degeneration and later cancer—goiter, adenoids, enlarged tonsils—the re- 
sult of lowered vital resistance—pyorrhea, endometritis, uterine cancer, 
various diseases of the eye and baldness. In certain persons increased 
growth of the fine hairs covering the general surface of the body, 
tuberculosis, rheumatoid arthritis. 
In all the above conditions a change of flora is most posi- 
tively indicated. It is not always possible to accomplish this 
easily, although in the majority of cases a well directed effort will 
show definite results within three or four days. The best means 
is the fruit regimen already described in preceding pages. This 
should be used for three to five days, after which the antitoxic 
regimen should be definitely and permanently adopted and scrup- 
ulously followed. A departure from a strict antitoxic diet may 
often be followed by relapse within a short time. It must be con- 
stantly borne in mind that disorders and symptoms such as above 
described do not appear until after some essential part of the 
defensive mechanism of the body has been broken down, so that 
dietetic digressions which produced no apparent effect when the 
body defenses were intact, even when indulged to an immoderate 
degree, become disastrous even when the departure from a strict 
antitoxic regimen is comparatively slight. It must be remembered, 
also, that when the results of intestinal toxemia have become 
well developed and have existed for a considerable length of time 
the damage to the defensive mechanism has become so serious 
that it is probably to a considerable degree irreparable, and for 
this reason relief from the existing disorders can only be secured 
by a thorough change of flora and the most exemplary following 
of a carefully arranged antitoxic regimen with no digressions. 
When the kidneys have been badly damaged, as shown by the 
presence in the blood of an abnormal amount of non-protein 
nitrogen, the protein of the diet must be kept down to the very 
lowest limit and should never exceed one calorie per pound of 
body weight. In many cases the protein may be with benefit 
reduced to half this amount for periods of a few days at intervals, 
and in extreme cases it is desirable to eliminate the protein from 
the bill of fare entirely for short periods so as to make the work 
of the kidneys as light as possible. 
In chronic cases of intestinal toxemia it is often necessary to 
repeat the special regimen for changing the flora (fruit regimen) REGIMENS AND DIETARIES 
613 
at intervals of a week or two for some time in order to secure a 
radical change in the intestinal flora, and the fruit regimen with 
lactose and acidophilus cultures should be returned to whenever 
the putrid odor of the stools reappears. 
THE ANTITOXIC DIET 
(See also page 975) 
According to Herodotus, who wrote in the fifth century, 
B. C., being one of the earliest of all historians, the early Egypt- 
ians recognized the importance of maintaining the activity of the 
colon. He says: “For three successive days in each month they 
purge, hunting after health with emetics and clysters (enemas), 
and they think that all the diseases which exist are produced in 
men by the food on which they live; for the Egyptians are from 
other causes also the most healthy of all men next after the 
Libyans.” 
The fact that the Egyptians recognized, as shown by the 
above paragraph, the pernicious influence of constipation as a 
cause of disease indicates the great advancement they had made in 
the knowledge of hygiene, as shown also by their numerous sani- 
tary regulations, many of which were incorporated into the code 
of laws formulated by Moses for the Israelites while they were 
wandering in the wilderness. 
Bouchard taught us that the body is a factory of poisons. 
Besides those which it normally produces, the colon when in- 
fected produces a long list of disgusting putrefaction products 
which are absorbed and often overwhelm the poison-destroying 
and poison-eliminating mechanisms of the body to such a degree 
as to interfere seriously with the ordinary life processes. This 
condition is termed autointoxication or intestinal toxemia, or 
alimentary toxemia, and is the predisposing or exciting cause of 
most chronic and many acute maladies. 
1. It must be laxative so as to prevent stagnation in the 
colon, thus giving the residues and wastes no opportunity for 
putrefaction. 
2. It must be free from putrefaction products and from the 
bacteria which produce putrefaction and the resulting poisonous 
products. 
The antitoxic dietary has five essential characteristics. 614 
THE NEW DIETETICS 
3. It should be poor in substances capable of undergoing 
putrefaction; that is, it must be low in protein. 
4. It should be rich in carbohydrates which encourage the 
growth of protective bacteria in the intestine. 
5. For the greatest efficiency it must include considerable 
raw starch or other carbohydrates such as lactose or dextrin which 
are absorbed with sufficient slowness to permit them to reach the 
colon and thus furnish food for the protective bacteria which, 
by encouraging fermentation in the colon, prevent putrefactive 
changes, thus cutting off the source of the toxins which give rise 
to intestinal toxemia. 
In arranging an antitoxic bill of fare: 
1. Meats of all kinds, including fish, flesh, fowl, and shell- 
fish, together with many varieties of cheese, as limburger and 
roquefort, must be wholly discarded. 
2. Eggs must be used sparingly. The yolks of eggs may be 
eaten more freely than the whites. Raw whites must be wholly 
discarded. It has been demonstrated that the raw white of egg 
is not well digested in the human intestine. The yolks of eggs, 
even when hard boiled, are quickly and very completely digested. 
Hard boiled whites of eggs often pass through the alimentary 
canal without digestion. The greatest care must be taken to avoid 
the use of eggs which are not perfectly fresh. Eggs are likely to 
be infected even under most favorable conditions. The bacteria 
found in eggs will escape destruction unless they are well cooked. 
When freely used, eggs, even when free from germs, promote 
intestinal putrefaction. 
3. In some persons milk produces such decidedly toxic 
effects it must be avoided. The ill effects are shown by coating 
of the tongue, loss of appetite, headache and often constipation. 
The symptoms may be due to a special sensitivity against milk. 
They may also result from toxemia arising from the putrefaction 
of undigested curds in the colon. It should be noted, however, 
that milk, as shown by Tissier, Torrey and others, is much less 
likely to encourage putrefactive changes in the colon than is 
either meat or eggs. Buttermilk has some merit as an antitoxic 
diet if properly prepared and used in sufficient quantity. Three 
or four pints of acidophilus buttermilk taken daily will produce 
within a week a very marked change in the character of the 
intestinal flora. REGIMENS AND DIETARIES 
615 
4. Greens and such coarse vegetables as turnips, carrots, 
parsnips, celery, lettuce, cabbage, etc., should be freely used to- 
gether with bran and coarse cereals. Fine flour bread and other 
superfine cereal products should be avoided. Polished rice may 
be used, but only in connection with the coarser foods mentioned. 
A liberal supply of roughage should constitute a portion of every 
meal. 
5. Certain vegetables, such as carrots, seem to possess a 
special antitoxic value, discouraging the growth of bacteria prob- 
ably by carrying a considerable amount of undigested starch into 
the colon. Metchnikoff found that the stools of animals fed upon 
carrots were sometimes nearly sterile. Salads prepared from 
uncooked materials, edible raw fruits and vegetables of all sorts 
are valuable as antitoxic foods. 
6. Milk sugar, because of its slow absorption, affords an 
excellent means of getting carbohydrate into the colon where it 
is needed to suppress putrefactions. Milk sugar has the addi- 
tional advantage that it encourages the lactic acid fermentation. 
On this account a few ounces of lactose or milk sugar is always 
a valuable addition to the antitoxic bill of fare. The best effect 
is obtained by taking the sugar before eating. It should be mixed 
with a little water and swallowed quickly. 
7. Dextrin seems to possess the same power to encourage 
the growth of the B. acidophilus in the colon shown by milk sugar 
and is better suited to many cases. 
8. Raw, or imperfectly cooked starch is digested more slowly 
than well cooked starch, and hence has a better chance to reach 
the colon and encourage the growth of a non-putrefactive flora. 
This may be provided by the use of fresh fruit and such fresh 
vegetables as lettuce, cucumbers, radishes and salads of various 
sorts, and especially by the use of scalded oatmeal; that is, steel- 
cut oats cooked six to ten minutes like the brose of the Scotch 
Highlands. 
9. Fats, especially animal fats, must be used in moderation 
as an excess of fats encourages intestinal putrefaction. 
10. In order to secure promptly the maximum amount of 
benefit from the antitoxic diet it is important to initiate the effort 
with a few days’ special regimen to change the intestinal flora. 
The fruit regimen is best for this purpose. After the flora has 
been changed, then the antitoxic diet should be followed syste- 
matically for an indefinite length of time. 616 
THE NEW DIETETICS 
Says Tibbies, an eminent English authority on dietetics: “A 
course of lacto-vegetarian dietary is exceedingly useful in the 
state of high arterial tension which precedes arteriosclerosis, in 
some forms of renal disease,—e. g., Bright’s disease, in Grave’s 
disease, gout, gravel, chronic rheumatism, liver trouble, constipa- 
tion, intestinal fermentations, autointoxication, skin diseases— 
e. g., chronic urticaria and psoriasis—in neurasthenia, neuralgia, 
sciatica, cardiac and gastric neuroses, etc. A pure vegetarian diet 
is good for some of the patients; for others a lacto-vegetarian diet 
is better.” 
Torrey found that a diet of bread and milk produces a good 
or acid-dominant flora. 
It was long ago shown by Bachman (Zeitschrif for Klin. 
Med., 1902) that while intestinal putrefaction is increased by fat 
and albumin, it is decidedly decreased by a farinaceous diet as 
well as by milk. 
The diet should be made very simple and laxative. Fresh 
green vegetables and fruits should constitute a large bulk of the 
diet. Protein should never constitute more than 10 per cent, of 
the day’s ration. Cottage cheese, buttermilk or egg yolk may be 
used once a day in most cases. Greens should be used daily. 
When buttermilk disagrees, Malted Nuts may be substituted for 
milk with great advantage. 
Nearly all modern writers on dietetics recognize the import- 
ance of suppressing intestinal putrefactions. Taylor well says: 
“In normal bacterial disintegration of foodstuffs in the alimen- 
tary tract no known toxic substance is found.” This is perfectly 
true since normal bacterial disintegration which takes place in the 
alimentary canal is fermentative and not putrefactive. Conse- 
quently, when Taylor further says: “Although protein putrefac- 
tion yields phenol, skatol, indol and cresol from aminoacids and 
hexone bases, none of these are toxic,” he is certainly in error. 
For example, Lee, of Columbia University, found that the skatol 
and indol submitted to him by Herter for physiologic tests were 
powerful fatigue poisons, and a long series of observations car- 
ried oh by Metchnikoff and his students in the Pasteur Institute, 
of Paris, showed that indol given to small animals produced 
marked changes in the blood vessels in the course of a few months. 
Bois, of Paris, showed by experiments upon animals that fecal 
matters mixed with their ordinary diet, even in small quantities, 
produced cirrhosis of the liver and other degenerative changes. REGIMENS AND DIETARIES 
617 
Taylor himself in directing the treatment of autointoxication, both 
acute and chronic, gives the following wise advice. 
“Absolutely prohibit those form of nitrogenous foods that 
favor the development of putrefactive bacteria, particularly ani- 
mal protein except milk, e. g., meat, fish and eggs,” and names 
among additional foods to be especially avoided, bouillon, meat 
soups, meat juices and jellies, meat extracts, white of egg or dishes 
which are made of it, and further directs that “in autointoxication 
from acute enteritis an exclusive farinaceous diet must be given 
for several days.” 
THE LOW PROTEIN DIET 
The value of the low protein regimen is no longer questioned. 
Since the epoch-making experiments of Chittenden, supplemented 
by those of Folin of Harvard, Hindhede of Copenhagen and 
other investigators, the sufficiency of a low protein diet to support 
life and health can no longer be questioned. Folin, in fact, states 
that ordinary foodstuffs contain a sufficient amount of protein 
to supply the needs of the body, so that a person taking a variety 
of fruits, grains and vegetables in his daily bill of fare need have 
no apprehension of injury because of the restriction of the 
amount of protein eaten, although flesh foods and even eggs may 
be excluded. Combe and many others have shown by many 
observations that by eliminating from the diet foods rich in pro- 
tein, putrefaction may be controlled. When milk as well as meat 
and eggs is excluded, nuts must be eaten. 
This fact has also been very clearly established by the ex- 
perience of the writer and his colleagues in the Battle Creek Sani-i 
tarium, where for more than forty years a low protein dietary 
has been employed as a prominent feature in the general thera- 
peutic program employed in the treatment of more than one hun- 
dred and thirty thousand patients. The great benefit derived from 
the reduction of the amount of protein has in most cases been so 
pronounced that the patient, as well as the physician, has been 
thoroughly convinced of the value of this regimen. 
It is not necessary at this place to enter more fully into the 
discussion of the low protein ration, this subject having been 
considered at length elsewhere in this work. 1 his diet is indi- 
cated for all persons suffering from intestinal toxemia, which 
(See also page 974) 618 
THE NEW DIETETICS 
includes nearly all chronic invalids, and is especially indicated in 
cases of acute or chronic Bright’s disease, arteriosclerosis, myo- 
carditis, and mental and nervous disorders. In detail, the low 
protein diet is much the same as the antitoxic diet. The same 
foods may be eaten, care being taken to keep the protein intake 
at a low level, not exceeding one calorie per pound of body weight. 
Green vegetables, greens and fruits should make up the bulk of 
the dietary. In most cases eggs as well as meats should be dis- 
carded, and milk should be used in moderation, not to exceed a 
pint a day. Even milk may be eliminated with advantage in 
many cases, four to six ounces of nuts or Malted Nuts being sub- 
stituted for a time at least. 
PROTEIN-FREE DIET 
(See also page 977) 
A protein-free diet is of special service as a means of chang- 
ing the intestinal flora, and in certain cases of nephritis in which 
uric acid and other nitrogenous wastes are retained in the blood 
and tissue fluids. It affords the most efficient means of eliminat- 
ing from the body surplus and toxic nitrogenous compounds and 
combating uremia and acidosis. 
The amount of nitrogen excreted daily during a period of 
starvation is about seven grams, representing thirty times as much 
muscle tissue, or seven ounces. The loss of muscular tissue does 
not begin, however, until about the fourth day when the “floating” 
nitrogen, chiefly waste matters, has been eliminated. During this 
four days the intake of protein may be reduced to nothing with- 
out doing any damage to the vital machinery. This fact opens the 
way for a vital housecleaning which may be repeated at intervals 
as frequent as may be necessary, provided the period of complete 
abstinence from protein is not at any time prolonged beyond four 
or five days. 
Meat and meat products, eggs, milk and other dairy products 
are all excluded from this dietary, together with nuts, legumes 
and all cereals with the exception of rice. 
In the strictest form, the protein-free dietary will consist 
exclusively of juicy fruits, fruit juices and sugar water (malt 
sugar or milk sugar). Honey water may be used in moderation. 
The juices of sweet fruits, such as raisins and especially orange REGIMENS AND DIETARIES 
619 
juice and the freshly expressed juice of sweet apples, are most 
valuable. All fruit juices are suitable, also dates. 
The nutritive value of fruit juices varies from about 10 to 20 
calories per ounce. Sweet grape juice, as found in the market, 
has a somewhat higher calorie value, about 24 calories to the 
ounce. The most highly nutritive fruit juices have a calorie value 
equal to that of full milk, while the more dilute juices equal 
skimmed milk and buttermilk in value. 
At 20 calories to the ounce, a pint of fruit juice supplies 
320 calories, and hence four or five pints daily, supplying 1,300 
to 1,600 calories, would suffice for a person of average size while 
confined to the bed. This amount of liquid can be easily taken in 
divided doses. 
A good plan is to administer half a glassful (4 ounces) of 
juice every half or three-quarters of an hour. Fruit juice should 
be substituted for other fluids. In case the full amount of fluid 
indicated is more than the patient can easily take, its nutritive 
value may be increased by the addition of malt sugar or milk 
sugar. Two ounces of malt sugar added to a pint of apple juice 
will supply approximately 400 calories. Three to three and one- 
half pints of the mixture will furnish a fair day’s ration. 
It is well to supply the patient with as large a variety of fruit 
juices as possible. A good substitute for fruit juice, which is 
better liked by some patients, may be prepared by adding to a 
pint of water four ounces of malt sugar or milk sugar and the 
juice of one lemon. Purees of ripe fruits may be used instead of 
fruit juices, or even the ripe fruits themselves. Watermelon, 
canteloupe, peaches, apricots, strawberries, huckleberries, rasp- 
berries and other small fruits may be served with malt sugar. 
Rice flakes, boiled rice, rice jelly and other preparations of rice 
may be used in most cases and help to relieve the monotony of 
this regimen when necessary to do so. 
Other foods which may be used are the following: agar 
jellies, green vegetables of all kinds, particularly tomatoes, cu- 
cumbers, turnips, cauliflower, cabbage, celery, squash, artichokes, 
lettuce and greens. When anemia is pronounced, purees of 
spinach and other greens should be freely used twice a day. 
Within four or five days any surplus or “floating” nitrogen 
which has existed in the tissues will be removed and hence it will 
not be necessary to continue this dietary for more than five days. 
The regimen may be repeated at intervals as required. 620 
THE NEW DIETETICS 
The protein-free regimen may be used advantageously in the 
following conditions: in acute nephritis, temporarily in chronic 
Bright’s disease with low renal efficiency, very pronounced cases 
of autointoxication, in fever accompanied by a very high tem- 
perature in which there is reason to apprehend kidney involve- 
ment, etc.; in all cases in which the blood nitrogen is high, that is, 
above 40; in acute severe eruptive fevers and in eczema. 
One or two ounces of agar or an ounce of sterilized bran and 
three to six ounces of paraffin oil should be used daily to pro- 
mote intestinal activity. In addition, an enema should be used 
twice a day to insure thorough evacuation of the colon. These 
measures are highly important, and should always be employed 
when the patient is placed upon a liquid diet or other regimen 
which does not supply the necessary bulk to secure sufficient 
bowel action. 
FEVER DIET 
(See also page 976) 
Hippocrates fed his fever patients ptisan or barley gruel. 
Niemeyer was an enthusiastic advocate of fruit soups in fever 
cases. We are just beginning to learn how to feed fever patients, 
after having for years first starved and then stuffed them with 
milk and whiskey. When the writer was walking the wards of 
Bellevue Hospital more than forty years ago whiskey and milk 
constituted the universal diet in typhoid, and this practice still 
continues in certain regions, although whiskey was long ago dis- 
credited and milk affords the best possible medium for the cul- 
ture of the typhoid germ and has been shown to be responsible 
for the tympanites, putrid stools, and even perforations which 
were common occurrences in typhoid cases under the old regime. 
A better understanding of the metabolism of the body and of 
the significance of fever has led to radical changes in the dietetic 
management of fevers of all sorts, especially typhoid and other 
fevers of severe type. It is now known that under the influence 
of a high temperature vital combustions are incomplete. This is 
especially true of fats and nitrogenous substances. A natural 
consequence of this is the production of acidosis, which is respon- 
sible for the so-called typhoid state. Starvation only increases the 
tendency to acidosis, while abundant carbohydrate feeding has 
the opposite effect. Carbohydrates afford, in fact, the only REGIMENS AND DIETARIES 
621 
efficient means of combating acidosis. Another very pronounced 
advantage in the use of carbohydrates is the fact that by their free 
use the character of the intestinal flora may be profoundly in- 
fluenced, putrefactions may be largely suppressed, and thus the 
absorption of toxins from the colon may be lessened. 
It is evident, then, that the dietary for fever patients should 
consist chiefly of carbohydrates. The imperfect oxidation of fats 
precludes the free use of this class of foods, but carbohydrates, 
being well utilized, may be freely employed. 
The old adage, “Stuff a cold and starve a fever” has long 
been discredited, and yet there are still many who do not recog- 
nize the fact that there is no essential difference between a cold 
and a fever. As a matter of fact, a cold is a fever, a mild infec- 
tion. A generation ago fever patients often became very greatly 
reduced by the starvation regimens to which they were subjected. 
A bill of fare consisting chiefly of meat extracts, broths, thin 
gruels, etc., is a starvation regimen. On such a dietary the 
patient is not only starved but poisoned by the large quantities 
of meat extractives taken, which afford no nourishment and 
greatly tax the already overworked liver and kidneys. 
Dr. Austin Flint many years ago called attention to the fact 
that the chemical analysis of beef tea very closely tallies with 
that of urine. Meat preparations of all sorts should be sup- 
pressed in fevers. Since fever is generally due to toxins developed 
in the body by infectious organisms it is manifestly unwise to 
increase the burden by the addition of toxic foods. Consequently, 
an antitoxic diet is especially indicated in fever, no matter what 
the particular infection or condition to which it may be due. 
A low protein diet is certainly indicated for the evident reason 
that a high protein diet encourages putrefactive changes in the 
colon and resulting toxemia. The amount of protein should cer- 
tainly not be greater than that required for repair of the tissues, 
which is probably about one calorie per pound of body weight. 
Rubner, Lusk and others have shown, also, that proteins 
stimulate metabolism and otherwise excite the body cells to abnor- 
mal activity. This effect is certainly not needed in fever; hence 
particular pains should be taken to keep the protein content of 
the food low. Eggs as well as meat may well be discarded, though 
occasionally an egg yolk may be permitted. Milk must also be 
used in moderation. Buttermilk may be used more freely and 
whey may be employed liberally. 622 
THE NEW DIETETICS 
In fever there is increased production of heat; the combus- 
tion of the vital processes in the body are accelerated. If fuel is 
not supplied from outside sources, the body itself will be con- 
sumed. This is the cause of the great emaciation occurring in 
prolonged fevers. Carbohydrates are evidently needed to furnish 
fuel to supply the loss occasioned by the fever process and to 
prevent the destruction of the tissues. When food is supplied in 
proper amount the great emaciation seen in badly managed cases 
does not occur. Carbohydrates should be supplied in liberal 
quantities in all febrile cases. The best forms of carbohydrates 
are gruels sweetened with malt sugar, fruit juices to which malt 
sugar or milk sugar has been added, purees of fruits and vege- 
tables and fruit soups. 
The loss of lime and iron is greatly exaggerated during 
febrile conditions, and there is a special need for vitamins to aid 
in repairing the damage done to the tissues. 
Great care should be taken to see that these important ele- 
ments are supplied in abundance, as they are necessary to aid 
Nature in the healing process. The importance of this cannot be 
overestimated. An examination of the fever diet and the so-called 
liquid diet in ordinary use in hospitals and prescribed in text- 
books on dietetics will show that both lime and iron are often 
almost wholly lacking. When milk is used, lime is supplied in 
sufficient quantity; but iron is almost universally lacking, and 
the patient becomes anemic not only as the result of the disease 
from which he is suffering but because of the iron and vitamin 
starvation to which he is subjected by a deficient dietary. 
Purees of spinach and other greens are of special value be- 
cause of the large amount of lime and iron which they contain. 
By the free use of greens the pronounced anemia and the heart 
weakness which results from the depreciation of the blood and 
from the deficiency of food lime is prevented. Not infrequently, 
fever patients are fed continuously on water gruel or some other 
monotonous diet which is lacking not only in lime and iron but 
also in vitamins, so that to the damage done by the fever is added 
the injury resulting from a dietary lacking in these three great 
food essentials. Fever patients often present symptoms of in- 
cipient scurvy or beri-beri which are without doubt due to un- 
scientific feeding. 
Bran or agar in various combinations should be freely used 
in all cases of fever except in cases of marked gastrointestinal REGIMENS AND DIETARIES 
623 
disease. This is necessary to combat the constipation to which 
there is usually a decided tendency in febrile conditions. Bran 
may be mixed with oatmeal, rice and other cereals in liberal pro- 
portions. The average fever patient needs two-thirds of an ounce 
of bran or agar daily. Even in typhoid fever, agar and mineral 
oil may be used when the bowels do not move freely. There is 
no evidence that cooked bran is irritating or otherwise harmful 
in typhoid cases. 
Malt sugar and Malted Nuts, also purees of dates, are very 
useful in typhoid because of their richness in food iron and lime. 
(See Tables XII, XIV, and XV for food rich in lime and iron.) 
In general the antitoxic dietary should be followed in fevers. 
The following is a list of foodstuffs that have been found especi- 
ally valuable in the feed of fever patients: 
Gruels, especially oatmeal, barley and rice gruel 
Purees of vegetables 
Purees of fruits 
Fruit juices 
Whey 
Malt sugar 
Meltose (Malt Floney) 
Puree of potato 
Puree of banana 
Milk sugar 
Agar jellies 
Fruit ices 
Malted Nuts 
The amount of food given the fever patient should be equal 
at least to that required by an individual of the same size and 
weight when leading a moderately active life. It is especially 
important to insure a large intake of water in these cases. Water 
is the best means of washing the tissues free from the fever toxins 
and securing their elimination through the kidneys. The amount 
of water taken daily should be three to six quarts, a glassful of 
water being given the patient every half hour when he is awake. 
The water may be flavored with fruit juice, lemon juice or any 
other fruit juice, or malt sugar or milk sugar. Water should be 
administered by enema when a sufficient amount is not taken by 
mouth. 
Tibbies gives the following list of diseases in which a fever 
diet is indicated: 
Abscess of various parts 
Anthrax, or splenic fever 
Appendicitis 
Boils, furunculosis 
Breast, inflammation of 
Bronchitis, acute 624 
THE NEW DIETETICS 
Bronchial catarrh 
Broncho-pneumonia 
Burns and scalds, extensive 
Bursitis, acute 
Cancrum oris 
Carbuncle 
Catarrh, acute 
Cellulitis 
Cerebro-spinal fever 
Chicken-pox 
Cystitis 
Delirium tremens 
Diphtheria 
Eczema, acute 
Empyema 
Endocarditis 
Epididymitis 
Erysipelas 
Erythema, acute 
Fevers 
Gangrene 
Gastritis, acute 
Glossitis, acute 
Hepatic abscess 
Hepatic congestion, acute 
Herpes zoster 
Inflammations 
Influenza 
Intermittent fever 
Laryngitis, acute 
Lichen, acute 
Lymphangitis 
Malarial fever 
Mastoiditis 
Measles 
Meningitis, acute 
Meningitis, tubercular 
Meningitis, cerebro-spinal 
Metritis, acute 
Mumps 
Nephritis 
Oophoritis, acute 
Operations 
Orchitis, acute 
Osteo-myelitis 
Otitis media 
Pancreatitis, acute 
Pemphigus, acute 
Pericarditis 
Peritonitis, acute 
Perityphilitis 
Pharyngitis 
Phlebitis 
Plague 
Pleurisy 
Pneumonia 
Poliomyelitis 
Prostatitis, acute 
Psoriasis, acute 
Puerperal fever 
Pyaemia 
Pyelitis 
Pyonephrosis 
Relapsing fever 
Rheumatism, acute 
Rotheln, rubella 
Salpingitis 
Scarlet fever 
Septicaemia 
Stomatitis 
Surgical fever 
Synovitis, acute 
Tetanus 
Thrombosis 
Tonsilitis 
Typhoid fever 
Typhus fever 
Urticaria, acute REGIMENS AND DIETARIES 
625 
In all these maladies meats of all sorts should be discarded 
together with beef tea, bouillon and meat extracts of all kinds. 
Fruit juices should be freely used. Fruit soups, fruit and veg- 
etable purees, especially potato soup or puree, cereals of all sorts 
in the form of mushes and gruels and purees of greens are the 
proper foods. The use of malt sugar and dates in place of cane 
sugar because of their richness in iron is important in febrile and 
many other acute conditions. 
In mild fever cases, after convalescence begins in typhoid, 
and in most cases in which the fever accompanies some localized 
infection or inflammation, the antitoxic diet may be followed. In 
all cases attention must be given to the stools. Milk sugar or lacto- 
dextrin should be used in sufficient quantity to change the flora. 
The amount required is usually two or three ounces three times 
a day. To prevent nausea the sugar should be well diluted. 
Twelve to sixteen ounces of water or fruit juice is not too much. 
Take slowly in the course of ten or fifteen minutes, especially if 
there is a tendency to nausea. Lemon or other fruit juice or 
syphon water may be added to overcome repugnance or prevent 
nausea. 
THE LAXATIVE DIET 
(See also page 979) 
This dietary is chiefly addressed to the colon, although its 
beneficial effects are participated in by the whole body; and not 
only indirectly through improved elimination, but directly through 
the rich supplies of vitamins, lime, iron and other essential food 
minerals which it affords. 
Most important of all as a means of increasing intestinal 
activity is change of the intestinal flora. The products of putre- 
faction are alkaline, often strongly ammoniacal, and paralyze the 
colon. The normal acids produced by an aciduric flora are the 
natural stimulants of the colon. Increased frequency of bowel 
movement as the result of change of the intestinal flora was noted 
by the author some years ago (1915) and has been a matter of 
constant observation since. Kopeloff and other investigators have 
recently demonstrated the importance and efficiency of suppres- 
sion of putrefaction in the colon as a means of overcoming con- 
stipation in the most obstinate cases. 
The most laxative foods are those which contain the largest 
amount of cellulose. The amount of cellulose found in each one 626 
THE NEW DIETETICS 
of the ordinary foodstuffs is shown in tables given elsewhere in 
this work. (See Tables XXI, XXII, XXIII.) 
The foods in the following list are especially rich in cellulose 
and have precedence in the order named: 
Wheat bran 
Huckleberries 
Oatmeal 
Green peas 
String beans 
Cabbage 
Parsnips 
Beans 
Brussels sprouts 
Kohl-rabi 
Red raspberries 
Celery 
Turnip 
Pumpkin 
Peas 
Beets 
Asparagus 
Blackberries 
Cranberries 
Carrots 
Spinach 
Currants 
Cauliflower 
Figs 
Tomatoes 
Lentils 
Barley 
Lettuce 
Onions 
Gooseberries 
Bran. 
When it is necessary to combat obstinate constipation, it is 
usually essential that wheat bran be used in liberal quantities. 
The laxative virtues of bran have long been known and utilized 
by stock raisers, but it is only within the last twenty years that 
the value of this article as a food laxative has begun to receive 
the recognition which it deserves. When the writer first began 
the advocacy of bran as a laxative food some forty-five years ago, 
it was very hard to convince the average man that in taking bran 
he was not running great risk of doing violence to his stomach 
and intestines, perhaps creating ulceration, inflammation, hemorr- 
hoids or some other distressing disorder. On purely theoretical 
grounds and perhaps with a commercial purpose, some one years 
ago launched the notion that bran irritates the gastric and intesti- 
nal mucous membrane. The patent flour manufacturers have 
industriously cultivated this false notion until it has come to be 
widely held and deeply rooted in the popular mind. The millers 
can well afford to spend a considerable amount of money in per- 
suading people to eat fine flour bread, for this will make them con- 
stipated so that they will later be obliged to resort to the use of 
the same miller’s bran, for which they will be asked to pay fifteen 
to twenty-five cents a pound after having paid one or two cents 
extra per pound for the superfine flour which has made them ill. 
Thus the miller by his shrewd scheme not only makes an extra 
profit on his superfine flour, but gets triple price for the precious REGIMENS AND DIETARIES 
627 
bran which should never have been separated from the other 
components of the wheat berry. 
It should be remembered that bran does not irritate; it titil- 
lates. It passes through the mouth without inflicting injury and 
likewise passes along over the mucous membrane of the whole 
alimentary tract, stimulating the intestine to action but doing it 
no damage. 
The amount of bran required to produce decided laxative 
effects is considerable. A quarter ounce at each meal is often 
needed, and it must be taken at every meal without exception. 
The quantity should be increased until the desired effect, three 
bowel movements daily, is produced. 
There are many convenient methods of using bran. Here 
are a few. Bran brose may be prepared by mixing together equal 
measures of bran, cornmeal and steel-cut oats. Stir into boiling 
water and cook three to ten minutes, never longer. This is an 
excellent breakfast dish. Dry bran may be served upon the table 
and eaten with corn flakes or rice flakes, oatmeal, cream of wheat 
or other breakfast foods. One or two heaping tablespoonfuls is 
not too large a dose for the average individual. Some require 
more. At dinner bran may be added to the soup or mixed with 
mashed potatoes or purees of some sort. 
Bran bread, bran gems and other similar combinations will 
be found efficient and satisfactory. The important thing is to use 
a liberal quantity of bran and to take it at every meal without ex- 
ception. Agar, another form of cellulose, is equally efficient in 
many cases and occasionally produces more satisfactory results 
than does bran. 
It is to be remembered, also, that bran is rich in lime, iron 
and vitamins and so has a real food value aside from its laxative 
properties. 
When the Laxative Diet is Indicated* 
The laxative diet is indicated in almost every case of chronic 
disease, either alone or in combination with some other specific 
dietary as may be required in any individual case. It is always 
indicated when the bowels move less than twice a day and when 
fecal residue is found in the colon after the last daily movement. 
Normally, the colon empties itself at least three times a day. 
Many persons, even some physicians, take alarm at this sugges- 
tion ; but a short experience of the benefits of prompt and thor- 628 
THE NEW DIETETICS 
ough clearance of the body refuse will convince the most skeptical 
of the necessity for frequent and complete bowel movement. 
In every case of obstinate constipation the motility test 
should be employed. If the delay is two days or more, an X-ray 
examination should be made and the possibility of mechanical 
hindrance should be considered. 
The laxative regimen is indicated especially in colitis, a very 
common malady which is due to infection, the result of chronic 
constipation. Even in cases in which there are frequent bowel 
movements, the laxative regimen is needed so long as the stools 
are putrid. There is no danger of irritation from the use of bran 
and laxative foods. The frequent movements are due to the fact 
that the colon is never properly emptied, and to the irritation 
caused by putrefaction products. A clean colon is the first essen- 
tial for recovery. A daily enema or even two enemas daily, if 
not always essential, will be found helpful in many cases, in addi- 
tion to a very laxative regimen. 
In chronic tuberculosis, so-called neurasthenia, insomnia, 
skin diseases, arteriosclerosis, Bright’s disease, hyperchlorhydria, 
duodenal ulcer, and the whole long category of digestive, nervous 
and nutritional disorders, a laxative regimen is of first import- 
ance. 
TISSUE-BUILDING OR FATTENING REGIMEN 
(See also page 978) 
Fluctuations in the weight of the body are chiefly due to 
changes in the amount of adipose tissue. After maturity has 
been attained the number of body cells does not materially change 
although the muscle fibers may increase in volume. A muscle 
does not increase in size, however, as the result of feeding alone. 
Exercise must be combined with feeding to stimulate muscular 
development. The tissue-building or fattening diet, then, relates 
chiefly to increase of adipose tissue. It is, however, important 
that means should be adopted also for increasing the blood cells 
and the volume of blood in the body since the increase of .adipose 
tissue results practically in a dilution of the blood which is spread 
out through an increased area of tissue. This fact is shown by 
the fall in the percentage of hemoglobin which usually accompan- 
ies an increase of weight. This decrease in hemoglobin may be 
prevented, however, by the adoption of a diet which will increase 
the hemoglobin along with the increase of weight. REGIMENS AND DIETARIES 
629 
Thinness of flesh may be due to any one of many causes, such 
as fever or other wasting diseases, excess of work, loss of sleep, 
or high tension due to worry, anxiety, suspense, apprehension or 
other cause. Whenever the energy intake through eating is less 
than the expenditure through internal or external work, there 
will necessarily be a loss of weight. An increase of weight can 
only be induced by reversing the balance. To accomplish this, 
the causes of excessive energy expenditure must be removed or 
reduced as much as possible. When a rapid gain of flesh is 
desired, it is usually best to keep the patient in bed or at least to 
keep him horizontal and as quiet mentally and physically as pos- 
sible, by this means reducing tension as well as muscular work. 
In arranging a fattening bill of fare, the relation of the 
several food principles to adipose tissue must be kept in mind. 
For fattening purposes it is evidently useless to increase the pro- 
tein intake, at least so long as the patient is at rest, for the reason 
that protein cannot be stored in the body. It can be used only 
for repair and growth. If the growth of the muscles is not being 
stimulated by exercise, there is not only no demand for an extra 
intake of protein, but there is no way in which the body can be 
made to store a surplus of it beyond what is absolutely necessary 
for repair, which amounts to less than one calorie per pound of 
body weight. 
The case is quite different with carbohydrates and fat. These 
food principles, when taken into the body in larger quantity than 
is needed for fuel purposes, are retained and build up the adipose 
or residual tissue. Fats are absorbed and carried direct to the fat 
depositories of the body. Carbohydrates, after conversion into 
dextrose, the sugar of the body,- are converted into fat if not 
needed for immediate use as fuel. Each ounce of surplus fat 
taken in the food becomes an ounce of fat in the body. In the 
case of carbohydrates, starch and sugar, however, the case is 
different, each ounce adding to the body weight three or four 
ounces instead of one. It is evident, then, that of the several food 
principles, carbohydrates are best adapted to increase body 
weight. Carbohydrates have the further advantage, also, that 
they are much more quickly and easily digested and assimilated 
than are the fats. 
It is possible, also, to greatly increase the intake of carbo- 
hydrates without producing disturbance of digestion or of any 
other function. An increase of protein, through the use of meat, 630 
THE NEW DIETETICS 
eggs, oysters, etc., increases the intestinal putrefactions and so 
tends to create toxemia. Fats, when freely taken, are likely to 
impair the appetite by delaying the movement of food through 
the stomach and intestines and also by increasing the putrefactive 
changes in the colon. A moderate increase of fat and a very con- 
siderable increase of carbohydrates is the physiologic formula for 
securing a rapid increase of weight. The free use of meats offers 
no advantage whatever and is indeed a positive disadvantage, 
since protein does not make fat and consumes energy in exces- 
sive heat production and by overworking the liver and kidneys 
in the elimination of surplus waste. 
The amount to which the food intake is increased will depend 
upon the rate of increase in weight required or expected and the 
appetite and digestive powers of the patient. Not infrequently 
the emaciated patient will be found to be greatly underfed, the 
daily intake of food often being not more than two-thirds the 
amount required for full nutrition, sometimes even less. In such 
a case the amount of food habitually taken must be doubled. In 
general, the calorie value of the daily ration must be made 25 to 
50 per cent, more than the amount required for bare mainten- 
ance. By reference to the table (see Table II), the number of 
calories required for maintenance may be found, and this should 
be increased by one-fourth to one-half. If the patient is put to 
bed and all exercise prohibited, the base ration may be made the 
foundation for the feeding and should be increased 50 to 100 
per cent. The maximum increase should not be made at once, but 
the amount of food should be increased from day to day, the 
maximum being reached by the end of the first week and main- 
tained until a satisfactory increase of weight has been secured. 
Whenever possible, the patient’s metabolism should be tested. 
By this means, much time may often be saved. If the metabolism 
rate is much increased, this will at once explain the loss of flesh 
and will show the necessity for complete rest in bed as the most 
efficient means of reducing metabolic activity. The systematic 
use of clinical metabolism tests, first employed at the Battle Creek 
Sanitarium, is now in use in several of the progressive clinics of 
this country. 
As a preliminary to the fattening regimen, the employment 
of the fruit regimen for three or four days has the advantage in 
most cases of greatly promoting appetite and facilitating the gain 
in flesh when the fattening regimen is established. REGIMENS AND DIETARIES 
631 
The dietary must include foods rich in lime, iron and vita- 
mins as well as carbohydrates and fats. This is important for 
the reason that in many cases of emaciation the cause is in large 
part a lack of the essential growth-promoting vitamins which 
are abundant in fresh milk and greens but are found only in very 
small quantity in most other foodstuffs, being almost wholly lack- 
ing in meats and in cereals as commonly used. Foods rich in 
vitamins also serve to increase appetite for food and ability to 
utilize it. 
In connection with the fattening diet it is important to adopt 
efficient measures for increasing appetite; that is, moderate cold 
bathing, particularly such measures as the cold mitten friction, 
cold towel rub, and for persons of average strength the cold wet 
sheet rub or cold shower bath. Out-of-door sleeping and almost 
continuous life out of doors are other measures of highest value 
and should not be forgotten. Abundant sleep should be secured. 
Ten to twelve hours daily is none too much. 
Among the foods of special value for fattening purposes may 
be mentioned malt sugar, milk sugar, malted nuts and fresh 
cream. A food par excellence is fresh cream or butter combined 
with malt syrup, malt honey or meltose. 
In many cases it is of very great advantage to give the 
patient, in addition to the three regular meals, two or three minor 
meals consisting of malt sugar or milk sugar dissolved in water, 
either with or without fruit juices of some sort. (See Supple- 
mentary Feeding.) Carbonated water may often be used with 
advantage, as the gas set free in the stomach has the effect of 
stimulating gastric activity and hastening the emptying of the 
stomach. In order that the intake should be as large as possible, 
it is best that it should be simple in character so that the tax 
upon the digestive organs may be as little as possible. Compli- 
cated dishes should be avoided and only a few different dishes 
served at each meal. When eggs are eaten, the white should be 
discarded. The yolk of an egg possesses twice the food value of 
the white and is much more easily digested, while supplying also 
a rich store of lime, iron and vitamins which are deficient in egg 
white. 
In connection with the rest cure, it is unwise to allow patients 
to stay in bed too long. A week or two is usually sufficient. At 
the end of this time systematic exercises should be begun, gradu- 
ally increasing in vigor from day to day. With the increase of 632 
THE NEW DIETETICS 
exercise the appetite will also increase, and when things are man- 
aged well the patient’s gain in weight will continue without inter- 
ruption and may be substantially increased because of the im- 
provement in appetite. 
The fattening regimen is indicated especially for persons 
who have been reduced in weight by acute or chronic disease or 
by malnutrition resulting from any cause. Persons who are con- 
valescent from an acute illness and consumptives are excellent 
subjects for the fattening regimen. 
The milk regimen is one of the most efficient of all methods 
of creating a rapid gain in flesh. When it can be made accept- 
able to the patient, and is not contraindicated, this regimen may 
be adopted with advantage. There are, however, many cases in 
which/the patient is sensitized to milk or in which for some 
other reason it cannot be tolerated. 
Cane sugar should never be employed as a means of increas- 
ing the intake of carbohydrates because of its irritating proper- 
ties. Malt sugar and the sugars of sweet fruits and fruit juices 
may be used to any extent which may be desirable without injury. 
Milk sugar is sometimes useful in doses of three ounces three 
times a day as a means of changing the intestinal flora. Large 
doses of milk sugar sometimes give rise to nausea. In such cases 
lacto-dextrin may be used or acidophilus buttermilk. 
Malt sugar may be used in divided doses to the extent of ten 
or twelve ounces daily. When carbohydrates are used in large 
quantities for some time it is a wise precaution to apply the 
Bergel test to the urine, for the purpose of detecting any elimina- 
tion of imperfectly utilized carbohydrates. When possible, it is 
also well to make a determination of the blood sugar. 
One of the most important indications for the carbohydrate 
diet is the preparation of patients for severe surgical procedures, 
instead of fasting the patient. In cases in which it is desirable 
that the intestinal tract shall be free from residues the result 
desired may be secured by feeding the patient on carbohydrates 
exclusively for a few hours before the operation. Malt sugar is 
best adapted to this purpose. The commercial product consists 
of approximately equal parts of maltose and dextrin, which are 
quickly digested and absorbed and produce no disturbance. 
The old teaching respecting carbohydrate indigestion has 
literally no scientific foundation. When such flatulence appears 
after the free use of carbohydrates it is not to be attributed to REGIMENS AND DIETARIES 
633 
the carbohydrates themselves, but rather to the presence in the 
intestine of gas-producing micro-organisms which do not belong 
there, and which disappear when the dietary is managed in such 
a way as to produce a transformation of the intestinal flora, re- 
storing the normal and beneficent B. acidophilus. This change 
may usually be effected in a week or ten days by feeding two 
to three ounces of milk sugar or lacto-dextrin three times a day. 
Gas in the intestine is the result of the action upon carbo- 
hydrates of Welch’s bacillus, an organism which causes gas 
gangrene and is also the cause of putrefaction in the intestine 
and elsewhere. The colon bacillus is also to a less extent pro- 
ductive of gas. These organisms produce little gas on a flesh diet; 
but when they are present in large numbers in the colon, the addi- 
tion of considerable carbohydrate to the diet will give rise to much 
gas. The acid-forming organisms do not produce gas; hence, as 
soon as the flora is completely changed or nearly so the gas dis- 
appears. So while it is true that a carbohydrate diet gives rise to 
gas in many cases, the remedy is to be found not in less carbohy- 
drate but more. 
Fattening Diet* 
Carbohydrates are best. One ounce of carbohydrates repre- 
sents about 100 calories. This amount is found in each of the 
following foods in the quantities named: 
Ounces 
Apples, fresh 6.0 
Apricots, fresh 7.0 
Bananas 4.0 
Barley gruel 8.0 
Bread, corn 2.0 
“ graham 1.3 
“ white 2.0 
“ whole wheat 2.0 
Chestnuts, fresh 1.5 
Cornstarch pudding 5.0 
Dates, dried 1.0 
Figs, dried 1.1 
Gems, whole wheat 2.0 
Granose biscuit 1.0 
Health chocolates 1.1 
Ounces 
Hoe cake 2.0 
Hominy 1.1 
Johnny cake 1.3 
Macaroni 1.2 
Malted Nuts 2.0 
Meltose 1.2 
Muskmelon 10.0 
Oatmeal porridge 8.0 
Oranges ; 8.0 
Peaches 9.0 
Pears 6.0 
Popcorn 1.1 
Potatoes, baked 4.0 
sweet, baked 3.3 
Tapioca custard 4.0 634 
THE NEW DIETETICS 
THE RESTORATIVE REGIMEN 
(See also page 981) 
The discovery of vitamins has in recent times brought into 
clear view the cause of a great number of cases of chronic mal- 
nutrition which were formerly highly obscure and were often 
subjected to treatment during long periods without satisfactory 
results. Extended researches by Bunge of Switzerland, and Sher- 
man of this country, together with Mendel, Osborne, McCollum 
and others, have also thrown much light upon these cases. It is 
now known that in a large proportion of instances in which indi- 
viduals suffer from general feebleness, lack of vigor, endurance, 
efficiency, and sense of well-being; a state of semi-invalidism or 
valetudinarianism without evidence of any clearly defined malady; 
their troubles are due to malnutrition, the result of a deficiency of 
vitamins, lime, iron, and other salts in the food. There is no doubt 
that in this country alone there are many tens of thousands of 
persons suffering from a deficiency of these highly essential food 
principles in their daily food. Such persons often derive great 
benefit from short vacations, partly perhaps because of a change 
from their accustomed inadequate bill of fare to one which sup- 
plies some of the lacking elements. On returning home they find 
themselves quickly relapsing into the old conditions. When such 
individuals are placed upon a dietary which supplies the needed 
diet factors, they often make surprisingly rapid gains in weight, 
strength, mental and physical vigor, and in general physical well- 
being ; the blood corpuscles increase in number, the blood becomes 
richer in hemoglobin, the appetite improves and a notable physical 
uplift is experienced. 
Not infrequently patients of this class are recommended to 
adopt a heavy meat diet, but the hoped for results do not appear 
for the excellent reason that meat is itself notably lacking in both 
vitamins and lime. In the animal body 99 per cent, of all the 
lime present is found in the bones, the flesh being almost wholly 
lacking in this element, and the vitamins are likewise concen- 
trated in special structures, being found almost exclusively in the 
liver, spleen, kidneys and other glands. 
The idea that the protein of meat is better suited to the 
building and repair of the human tissues has been shown to be 
an error. 
Caspari, of Berlin, found that casein is superior to flesh as REGIMENS AND DIETARIES 
635 
a source of protein. This was observed to be true in both the 
human subject and the dog. 
Among restorative foods will be found those foodstuffs which 
are particularly rich in the elements that are needed for refur- 
nishing the blood, bones, nerve and tissue fluids with the elements 
needed for complete nutrition. Greens of all sorts, milk, butter, 
cottage cheese and other dairy products; all grains, particularly 
oatmeal and millet; fruits, especially the orange, the tomato and 
the apple and fruit juices of all sorts; potatoes, artichokes, tur- 
nips and other roots and tubers ; the onion, properly cooked ; these 
are all highly valuable, also salads prepared from fresh, uncooked 
materials. (See Raw Diet.) The lentil should not be forgotten 
because of its richness in lime and iron. Bran should be freely 
used at every meal because of its rich store of lime, iron and 
other salts as well as vitamins. 
A vegetable puree or consomme prepared from a variety of 
vegetables may be used with great advantage for both adults and 
infants whose tissues are poor in mineral constituents in conse- 
quence of long feeding on a diet deficient in food minerals. The 
mixture may consist of string beans, shell beans, especially the 
Hahto bean, green peas, young beets with the tops, radishes, tur- 
nips, young turnip tops, celery, artichokes, spinach, tomatoes, 
mustard greens, and almost any other green or fresh vegetables. 
Add cold water enough to cover, bring to a boil and simmer five 
or ten minutes. Put into a fireless cooker over night. Pass 
through a colander, taking care to save all the water. Serve as a 
consomme, or add Japanese isinglass and allow to jelly. 
Greens, fresh vegetables and fresh fruits should be taken in 
liberal quantities at two meals daily. Better results still will be 
obtained by taking greens at every meal in quantities of four to 
six ounces. Most surprising results in blood building may often 
be obtained by the very abundant use of greenstuffs. 
Tomato juice, either fresh or canned, potato soup, oranges, 
lemons, grape fruit and tamarinds are rich in the antiscorbutic 
vitamin which is often needed in these cases. Wheat germs, 
sprouted soy beans, or better Savita, an extract of yeast, are also 
to be highly recommended. 
All edible green things, such as lettuce, celery, cucumbers, 
cabbage, green corn (uncooked), carrots, turnips, salads, and 
melons should be conspicuous in the bill of fare. 
The daily use of a pint and a half or two pints of certified 636 
THE NEW DIETETICS 
milk, a quart of yogurt buttermilk and liberal quantities of cream 
and butter is conducive to rapid improvement. Cottage cheese 
is especially valuable for the lime and vitamins which it furnishes. 
Elsewhere in this volume will be found lists of foods which 
are rich respectively in vitamins, lime and iron (see Tables XVII, 
XVIII, XIX, XIV, XII), which should receive careful study. 
Foods which contain an abundant supply of lime and iron are 
certain to contain a sufficient amount of the other mineral salts 
required by the body. 
THE FASTING REGIMEN 
In recent times numerous attempts have been made to exploit 
the idea of fasting as a panacea for human ills. However, there 
is no danger that this drastic method will ever become a popular 
fad. Only heroic souls and fanatics are likely to become enthusi- 
astic devotees of a method which requires the amount of self- 
control and endurance incident to the withholding of food during 
periods of one to six weeks. 
Voluntary fasting probably originated as a religious rite. It 
was prescribed as a penance, or was undertaken for the purpose 
of encouraging a state of spiritual elevation. 
That a person may live without eating for a considerable 
period has been clearly demonstrated by the experience of Cetti 
and Succi, the Italian fasters, Doctor Tanner, and others. Pro- 
fessor Luciana, who observed the faster, Succi, during a thirty 
days’ fast, found him a demented person (formerly insane) who 
believed himself to be “the son of God,” and who fasted for the 
purpose of demonstrating the indestructibility of his divine body. 
Various professional fasters as well as fasting animals have 
since that time been studied by physiologists in different parts of 
the world. The uniform testimony of these expert observers has 
been that the withholding of food does not exercise the prompt 
control over intestinal putrefactions that might be expected. 
Food is not the only source of putrescible material in the colon. 
The bile, intestinal mucus and other intestinal secretions that are 
constantly poured into the alimentary canal furnish a sufficient 
amount of putrescible material to maintain a luxuriant putrefac- 
tive flora. When these materials are promptly discharged from 
the body there is not, however, sufficient time for the development 
of the putrefactive process, which requires much more time than REGIMENS AND DIETARIES 
637 
is needed for the development of the fermentative changes to 
which carbohydrates are subject. In fasting, however, there is 
almost complete inactivity of the intestine. Food is the natural 
excitant of peristaltic activity. Whenever food is taken into the 
stomach, active contraction waves begin at once, traversing the 
stomach at the rate of three to five a minute, and passing along 
down the whole alimentary tract. When food is withheld, these 
movements cease, the biliary and other excretions accumulate and 
undergo putrefaction; the poisons are absorbed, the tongue be- 
comes coated, the breath foul, the urine loaded with the products 
of putrefaction and all the evidences of intestinal autointoxica- 
tion become intensified. 
In the case of the faster, Cetti, observed by Lehmann, the 
first stool after the beginning of the fast occurred on the ninth 
day. The amount of phenol, a putrefaction product, found in 
the urine had increased in the meantime to nearly five times the 
amount present at the beginning of the fast. The condition of 
the urine was the same as that which is usually observed in cases 
of obstruction from peritonitis or other causes, the result of the 
paralyzed condition of the bowel due to complete abstinence from 
food. Examinations of the urine of Succi, the famous Italian 
faster, made by Apollo and Solard by Bouchard’s method, showed 
its toxicity to be greatly increased. These facts show most con- 
clusively that fasting is not, as claimed, an efficient means of 
cleansing the body from poisons. 
Starvation suspends the secretion of the digestive juices. 
“The secretion of saliva diminished in acute starvation even when 
water was taken ad libitum. Thus Succi, on the seventh day of 
his fast, only produced as much saliva by the movements of his 
jaws in three hours as under ordinary circumstances is secreted 
in five minutes” (Von Noorden). 
In fasting, the stools were highly putrid and “similar in ap- 
pearance to the feces passed when the diet is mainly composed 
of meat” (Von Noorden). 
Says the same author: “The blood atrophies.” 
Statkewitsch studied the effects of fasting in a large number 
of animals—cats, dogs, rabbits, pigeons, frogs, lizards and other 
animals—and found that after prolonged fasting the cells of the 
heart, liver, muscles, kidneys, pancreas and other glands were 
the seat of degenerative processes. These processes were most 
marked in the muscles and the glands. 638 
THE NEW DIETETICS 
Zander found evidences of degeneration of the heart muscles 
in pigeons after fasting eight to twelve days. 
Gaglio found cloudy swelling of the muscles, granular and 
fatty degeneration of the liver in fasting frogs. 
The Fasting Body Feeds Upon Itself. 
So long as life continues, the fasting animal body continues 
to consume energy although at a reduced rate. The energy output 
of the body during fasting is three-fifths to three-fourths the 
ordinary output. In the absence of the usual source of energy 
food, the body feeds upon itself and is consumed at the rate of 
about one-eightieth of its weight each day. The stores of fat are 
first drawn upon, then the muscles, glands and other structures are 
consumed to keep the fires of the body burning. The heart mus- 
cles and some other organs may lose as much as one-half their 
weight. This process of degeneration may be carried so far that 
the body cannot recuperate itself. According to the London 
Lancet., the professional faster, Sued, although only thirty-eight 
years of age, had the appearance of a very aged person; not only 
his face but his entire body was covered with deep wrinkles. His 
muscles were so atrophied and degenerated that he looked like a 
skeleton and had the appearance of a person suffering from incip- 
ient marasmus. 
Loss of Weight During Fasting. 
A man of average size when at rest and fasting, burns up 
daily about 75 grams (2/£ oz.) of protein (muscle and gland 
tissue), 25 grams (5/6 oz.) of glycogen (animal starch stored in 
the liver and muscles), and 200 grams (6/5 oz.) of fat (adipose 
tissue), amounting in all to 10 ounces of tissue consumed. But 
this does not represent the total loss of weight for the reason that 
with each ounce of carbohydrate or protein (glycogen or muscle) 
consumed, three times the same weight of water is lost, so that 
the actual loss in weight for the muscle and glycogen burned is 
100 grams X 4 = 400 grams or ounces. Adding the 6/5 
ounces of fat, the total loss in weight is 20 ounces, or double the 
weight of the actual solid matter consumed by the body processes. 
If the fasting patient exercises, the loss of weight will be 
much greater. It may be easily doubled by a sufficient amount of 
exercise. 
The following table (Von Noorden) shows the percentage of REGIMENS AND DIETARIES 
639 
loss sustained by some of the principal organs and tissues of the 
body during fasting: 
Fatty tissue 95 per cent. 
Muscles 40-46 “ “ 
Heart 40-45 “ 
Glands 40-45 “ “ 
Blood 40-45 “ “ 
Bones 10-15 “ “ 
Many persons have passed through the ordeal of a long fast 
and have survived, and in some instances there has been evidence 
of a notable improvement in health following a long fast. There 
are, in fact, certain advantages in fasting which may be briefly 
stated as follows: 
1. By fasting, surplus body fat may be disposed of. During 
a fast the body feeds upon its reserves. 
2. Any accumulation of surplus or “floating” nitrogen or 
wastes which may be present will rapidly disappear during a fast. 
It is true that the amount of surplus protein and tissue wastes 
which may accumulate in the body can never exceed a very small 
amount, certainly never more than a few pounds; but that these 
objectionable substances may be present cannot be denied, and by 
a fast they are gotten rid of. 
3. Fasting creates an appetite by producing an imperious 
demand for food and perhaps at the same time increases the 
ability of the tissues to assimilate food. This effect of fasting 
may be an advantage in certain cases, particularly when it is 
desirable to produce a rapid gain in flesh by subsequent overfeed- 
ing- 
4. There is some evidence that a prolonged fast may in some 
cases produce a sort of rejuvenescence of the tissues. It has been 
shown by experiments upon animals that in certain lower or- 
ganisms, particularly in certain mites, a remarkable rejuvenes- 
cence results from a fast prolonged to such a degree as to reduce 
the creature to a fraction of its original proportions. These ex- 
periments, however, have been made only upon animals of the 
lowest orders, and there is so far no evidence that a similar 
change can be effected in human beings. However, the observa- 
tion has been made that after a prolonged fast, when the body 
has been built up by proper feeding, there is apparently present 640 
THE NEW DIETETICS 
an unusual degree of vigor and an enhanced sense of well-being. 
It is to be noted, however, that a similar observation is often made 
following recovery from typhoid fever or some other acute wast- 
ing disease in which the patient has been greatly reduced. It is 
to be further noted, also, that notwithstanding this apparent 
rejuvenation accompanying convalescence from fevers the life 
expectancy of such persons is only one-half that of the avefage 
person of the same age. Hence, there is ground for believing that, 
notwithstanding the apparent improvement resulting from the 
fast as well as from the fever, a certain constitutional damage is 
done, the effects of which become apparent later. It is certainly 
irrational to suppose that great benefit can come from prolonged 
and painful resistance of a natural instinct with which the body 
is endowed by Nature for its protection by securing the prompt 
and regular meeting of its essential requirements. Hunger is a 
sensation through which Nature serves notice upon the conscious- 
ness that the energy resources of the body are running low and 
need to be re-enforced; in other words, that food is needed. 
Thirst is a sensation which notifies the intelligence of the need of 
water. On purely a priori grounds it would seem to be highly 
unreasonable that man should use his intelligence to thwart this 
means of automatic defense of the body against injury. 
Arguments could be offered in favor of water fasting as well 
as of food fasting. Indeed, why should not one restrain himself 
from gratifying the sense of air hunger which prompts constant 
rhythmic action of the lungs? Air hunger, water hunger, and 
ordinary hunger are simply Nature’s demands for supplies of 
different kinds of foods which the body needs for its protection 
and the maintenance of its functions. 
When foocfr fasts were practiced by the empiric Priessnitz at 
Grafenburg in Germany more than a century ago, a neighbor set 
up on the opposite side of the mountain a rival establishment at 
which water fasting was the method employed, and Dr. Schrott, 
the founder of this absurd method, claimed as wonderful cures 
as those which have been exploited by the fasting faddists of 
recent years. Furthermore, notwithstanding the apparent advan- 
tages which have been mentioned above as possible results from 
fasting, it is evident that there must be certain disadvantages; 
and when these have been considered, it will be found that the 
disadvantages of prolonged fasting very far outweigh any advan- 
tages which may be derived therefrom. And not only this, it will REGIMENS AND DIETARIES 
641 
also be found that all the advantages derived from complete 
abstinence from food, the “absolute diet” of the French, may 
be more easily and more comfortably obtained by a scientific 
regulation of the diet and without any of the dangers and dis- 
advantages which attach to the fasting method. 
Objections to Fasting. 
Here are some of the serious disadvantages which are prop- 
erly attributable to fasting, and the force of which cannot be 
denied. 
1. Fasting produces a harmful destruction of the “noble” 
tissues of the body; that is, while a prolonged fast rids the body 
of surplus fat and of accumulated wastes, it at the same time 
involves a notable wasting of the muscles, including the heart, 
and shrinking of the liver, kidneys and other tissues, a marked 
reduction of the blood volume and destruction of the blood cor- 
puscles and a great loss of the essential salts, lime, iron and other 
materials of which the bones, brain and blood are robbed. 
2. The body contains, almost wholly in the blood, about 
forty-five grains of iron. More than a fifth of a grain of iron is 
lost daily. The life of the blood cells is about six weeks. When 
the cell dies it gives up its iron, which is eliminated in the bile by 
the liver and becomes a waste product. Experiments upon ani- 
mals have shown that the body loses 40 per cent, of its store of 
iron within three weeks when the daily intake of iron is wholly 
suspended. In a fast of four or five weeks the body would lose 
more than half of its blood iron, and must necessarily likewise 
lose a proportionate amount of its oxygen-carrying capacity. In 
like manner the body, when fasting, daily loses a certain amount 
of lime, which in the course of several weeks amounts to a quan- 
tity sufficient to rob the bones and the blood of an element essen- 
tial to their integrity. 
3. The body is also continually losing vitamins which are 
essential for the promotion of the processes of repair and the 
maintenance of the various vital functions. The daily supply of 
vitamins is as necessary as the daily supply of air and water. 
Vitamins cannot be produced by the animal body. They are an 
exclusive product of plant life. The liver hoards a small store of 
vitamins sufficient to serve in emergency', but the supply is not 
sufficient to last indefinitely and, as shown by the experience of 
sailors who contract scurvy and those who become the victims of 642 
THE NEW DIETETICS 
beri-beri through living upon polished rice, the vitamin store of 
the liver soon becomes exhausted and the body then falls into 
serious disorder. Fasting deprives the body of vitamins and thus 
involves the risk of serious injury for which no adequate com- 
pensation is offered. The total loss of all vitamins must certainly 
involve greater damage than the loss of one only, yet the absence 
of but one of the three known vitamins for even a short period 
produces noticeable injury. Certainly the body can be in no way 
benefited by the deprivation of food iron, food lime, and other 
food salts, and of the precious vitamins, the activators of the vital 
processes. 
4. A fasting person is starved only in a conventional sense. 
As a matter of fact, his body feeds as usual, but instead of obtain- 
ing his food supply from outside sources, it feeds in part upon 
reserve fat which has been laid up in store for the purpose, and 
in part upon the living machinery of the body, muscles, nerves, 
brain, glands, etc., as already noted. In other words, a fasting 
person feeds upon himself, upon animal flesh, a strictly carnivor- 
ous diet. He is not only a flesh eater but a cannibal and even 
worse, he is autophagic. The effect of a strictly flesh diet is 
always unwholesome. Even the dog suffers physical impairment 
when fed exclusively upon flesh. So must the flesh-feeding faster. 
5. Examination of the blood of a fasting person shows that 
there are present poisonous acids, particularly beta-oxybutyric 
acid and diacetic acid, two highly poisonous substances which 
seriously impair the power of the blood to carry CO2. The 
cause of these poisons is the imperfect oxidation of the body fats 
which is always the result of a deficiency of carbohydrates. It 
has been shown by Naunyn and others that the body requires 
daily 200 or 300 calories of starch or sugar (2 or 3 ounces) to 
enable it to burn up the fats of the ordinary diet and when the 
body is compelled to subsist largely upon its own fats, acidosis 
quickly develops. It thus appears that long fasting, instead of 
clearing the body of poisons, produces new and dangerous poisons 
which grow out of the fact that the fasting body is compelled to 
feed upon itself. The free use of fruit juices and a moderate use 
of unsalted mashed potatoes, greens, juicy fruits, with perhaps 
the addition of a few ounces of malt sugar or milk sugar, will 
prevent the evil effects of fasting, while at the same time secur- 
ing all the results desired from underfeeding. 
6. It is true, as above admitted, that during a prolonged REGIMENS AND DIETARIES 
643 
fast any surplus of protein which may be present in the body may 
be used up and accumulated tissue wastes may be lessened in 
amount. But the amount of such accumulations is too small to 
justify the expensive method adopted by the faster for their 
elimination. For example, Gautier has shown that the total tissue 
wastes or soluble salts of the tissues amount to only about 10 
per cent, of the total solids. In a man weighing 150 pounds, the 
soft parts and viscera have a weight of about 125 pounds. Three- 
fourths of this is water, giving less than 32 pounds as the total 
solids of the soft parts. Of this, 10 per cent., or 3.2 pounds, 
represents the maximum of excretory products and stored protein 
which fasting is supposed to be able to eliminate. In a prolonged 
fast, losses of weight of 25 to 30 or even 40 or more pounds fre- 
quently occur. It is at once apparent that the faster, in order to 
free himself of 3 pounds of waste or undesirable material, sacri- 
fices an amount of healthy and useful tissue ten times as great. 
Why should one throw away 30 pounds of good muscle, brain, 
nerve, heart, blood and other useful, vital machinery in order to 
get rid of 3 pounds of waste material which can be easily gotten 
rid of by simply restricting the diet and increasing the intake of 
water ? 
The surplus protein and tissue wastes are derived exclusively 
from the protein of the food. Fats and carbohydrates leave no 
poisonous residues behind but are converted into harmless water 
and carbon dioxide which quickly escapes from the lungs. 
It is evident, then, that all that is necessary to secure all that 
can be accomplished by a long fast in freeing the body from 
tissue poisons may also be secured by the adoption of a protein- 
free dietary which will compel the body to use up its surplus 
protein and give it an opportunity to eliminate any surplus tissue 
poisons, while at the same time keeping the body supplied with 
fuel to furnish animal heat and muscular energy and thus pre- 
venting the necessity for the tearing down of its vital machinery 
and the loss of blood, vitamins and other essential elements. 
Fasting is certainly the most wasteful and ineffectual method 
of body purification that could possibly be conceived. The daily 
drinking of two or three extra quarts of water, with proper exer- 
cise, and a reasonable limitation of the intake of protein and fats 
will accomplish even more than the fast and without incurring 
any of its risks. 
7. But the eminent absurdity of the fast as a method of 644 
THE NEW DIETETICS 
depuration becomes apparent when some of the conditions present 
in fasting are considered. Food is the natural laxative. Under 
the influence of food the stomach and the entire alimentary canal 
are stimulated to rhythmic activity through which the food is 
mixed with the digestive juices, spread out over the mouths of 
the absorbents, and when reduced to a small remnant of indi- 
gestible and unusable residues is dumped into the colon and 
finally dismissed from the body. When food is not taken, these 
rhythmic movements disappear, and no indigestible and non- 
absorbable material is passed along into the colon. Consequently, 
the colon remains inactive. The faster argues: “I am eating 
nothing, hence there is nothing for my bowels to remove and no 
occasion for bowel movements.” The argument seems conclusive 
but it is not. The colon has another function than that of remov- 
ing food residues. A highly important and essential part of its 
function is the removal of the body wastes which are excreted by 
the liver in the bile and also extracted from the blood by the intes- 
tine itself; in other words, the colon is an excretory organ as well 
as a garbage disposal plant. This excretory function has been 
quite overlooked by the exploiters of the fasting method. They 
have thought only of the food residues. 
The writer was once consulted by a faster who asked him to 
look at his tongue. It was very thickly coated and his breath was 
highly offensive. He stated that he had been fasting for three 
weeks and had hoped constantly that his tongue would clear, but 
instead it had steadily become worse. On saying to him, “You 
are highly toxic; I think you should have a movement of the 
bowels,” he replied: 
“But there is nothing in my bowels to move. I have eaten 
nothing in more than three weeks and took care to thoroughly 
move my bowels by enema the day I began my fast. Of course 
there is no occasion for bowel movement.” 
He was urged to secure a thorough bowel movement, which 
he did by taking a dose of salts. A day or two later he reported 
that the result of his purgation was a surprising amount (several 
quarts), of the most offensive material that he had ever come in 
contact with. 
Every person who takes a prolonged fast becomes highly 
toxic. The bile, mucus and other secretions are constantly pour- 
ing into the intestine, which, lying quiet because there is no intake 
of food, permits an accumulation of these poisonous and highly REGIMENS AND DIETARIES 
645 
putrescent materials. The liver produces daily from 16 to 20 
ounces of bile. The watery portion of the bile is re-absorbed, 
leaving the solids behind to undergo putrefaction, along with 
mucus and other secretions of the various glands which line the 
intestines. The constant swallowing of saliva supplies the bac- 
teria necessary to transform this accumulated refuse into a seeth- 
ing mass of horrible corruption such as is practically impossible 
except during a complete fast, for the reason that the digestive 
process calls forth the disinfecting gastric juice by which the 
intestine is protected from the action of.bacteria, at least to a 
large degree—a protection which is lost during fasting. It is 
evident, then, that in his attempt to free himself from poisons 
the fasting man actually increases the number and virulence of 
the poisons which his body must combat, and it is no wonder that 
now and then a faster succumbs to the terrible toxemia produced 
by the conditions created by the fast. 
The late Horace Fletcher was at one time a believer in the 
fasting theory and himself tried the experiment of fasting. At 
the end of two weeks he found himself so highly toxic, his tongue 
so badly coated, and his breath so horribly fetid that he did not 
dare pursue the experiment further and though he had no appe- 
tite he broke his fast by a small taste of baked beans, of which he 
was usually very fond. Though he had no desire for food before 
placing the beans in his mouth, the moment his palate recognized 
the familiar taste a very robust appetite developed and he found 
difficulty in restraining himself from eating more than was pru- 
dent. 
This experiment cured Mr. Fletcher of his interest in fast- 
ing. But a more enthusiastic devotee might possibly have been 
satisfied with the explanation that if the fast had been continued 
two or three weeks longer his tongue would have cleared and the 
toxemia disappeared. That such a change sometimes occurs, 
seems to be well attested by a number of fairly reliable witnesses. 
The explanation is to be sought in the same direction as that of a 
similar phenomena which occurs in connection with typhoid fever. 
After being heavily coated for several weeks the tongue suddenly 
begins to clear off and convalescence sets in with a return of 
appetite and improvement in other symptoms. This change in the 
typhoid patient is the result of the establishment of immunity 
due to a defensive effort of the tissues, which alone makes re- 
covery from an infectious disease possible. In prolonged fasting 646 
THE NEW DIETETICS 
there is often observed a toxemia as intense as that which occurs 
in typhoid fever. It appears to the writer that in cases in which 
the tongue clears spontaneously after prolonged fasting the 
change is due to a temporary immunity developed through the 
absorption of the endo-toxins derived from the enormous quan- 
tities of bacteria which die in the colon. 
From the foregoing considerations it must be apparent to the 
candid reader that prolonged fasting is by no means a harmless 
procedure, and that it is indeed a method fraught with danger 
and liable to produce. irreparable injury. The writer recalls 
several persons in whom through long fasting the heart muscle 
was so weakened from the wasting to which it was subjected that 
many months were required for even partial restoration. All 
these dangers may be avoided by scientific fasting, which consists, 
in a word, of the elimination from the diet of the harmful ele- 
ments, fat and protein, while not depriving the body of the preci- 
ous resources of energy with which it must be constantly sup- 
plied in order that its functions may be maintained. 
Finally, it must be noted that fasting does lessen the work 
required of the stomach, liver, kidneys and pancreas, and reduces 
the work of metabolism. The body establishes a new standard of 
activities adapted to the situation, slowing up all its processes so 
as to economize its resources. The stomach rests from digestive 
activity. The pancreas is no longer required to provide either its 
external or its internal secretion, a rest which seems to increase its 
subsequent efficiency as shown by the benefit derived from periodi- 
cal fasting in diabetes. The liver rests from the several tasks 
required of it in connection with the digestion of food; and the 
kidneys are relieved of the great burden usually carried by them 
in the elimination of the greater part of the protein eaten as urea, 
a purely gratuitous task, since this surplus protein renders the 
body no real service. It is a discredit to the intelligence of civil- 
ized man that in his daily habits, especially in his eating habits, 
he imposes upon his vital organs tasks far greater in magnitude 
than those involved in the natural functioning of the body under 
normal conditions. The superfluous burdens, some of which are 
the intake of tea, coffee, condiments and other poisons, are of 
course temporarily suspended during a fast, and greatly to the 
advantage of the kidneys. But fasting is not necessary to secure 
most of these benefits. A permanent reform in dietetic habits is 
much more rational. REGIMENS AND DIETARIES 
Safe and Scientific Fasting. 
647 
There are several methods of fasting by means of which one 
may secure all the advantages of the prolonged fast without any 
of the dangers and inconveniences which long fasting involves. 
A one-day fast now and then is found by many individuals highly 
beneficial in recovering lost appetite, relieving headache, dullness, 
depression and various other unpleasant symptoms. The fasting 
should be accompanied by copious water drinking. Four to six 
quarts is none too much. A good plan is to take a glassful of 
water every hour. A little fruit juice may be added to the water 
to give it flavor. An ounce of agar or bran should be taken dur- 
ing the day and two to four ounces of paraffin oil. It is also well 
to take, morning and night, an enema consisting of two or three 
pints of water at 80 to 90 degrees. 
A second method of fasting which will yield excellent results 
is to live for a week on greens and fruit. Fresh or canned toma- 
toes should be used liberally with fruit juices of all sorts and 
melons. Twice a day a liberal serving of greens, four to eight 
ounces, should be eaten with large servings of lettuce and celery. 
One to two ounces of bran should be taken during the day or an 
ounce of agar. A couple of ounces of paraffin oil should be 
taken morning and night. 
The chief danger from fasting is the acidosis which develops 
after the first few days. Usually, symptoms of acidosis, nausea, 
headache and lassitude make their appearance by the second or 
third day, due to the fact that the glycogen or carbohydrate of 
the body has been consumed so that the fats and proteins of the 
body are not well burned and the poisonous acid products result- 
ing, are beginning to accumulate in the tissues. Recent metabolism 
studies have shown that by repeated short fasts the body may be 
trained to utilize its own tissues better, so that acidosis is post- 
poned and is less pronounced. By this method, the patient fasts 
first for one or two days, then eats sparingly for two or three 
days, then fasts again for two or three days. After another in- 
terval of low feeding a still longer fast of four or five days may 
be taken without developing unpleasant symptoms. It seems 
probable that the body not only learns by repeated fasts to make 
better use of its own tissues, but also improves in its ability to 
store and utilize carbohydrate in the form of glycogen. This 
method of fasting may be employed for fat reduction in certain 648 
THE NEW DIETETICS 
cases, when fasting is resorted to for clearing the body of toxins 
or to temporarily reduce the work of the liver and kidneys to a 
minimum. The protein fast by means of a protein-free diet 
affords the ideal method rather than absolute fasting. 
REDUCING DIET 
(See also page 982) 
In most cases of obesity and in certain cases of high blood- 
pressure a reduction of body weight is a matter of primary im- 
portance. In obesity especially the only radical means of relief 
is to be found in a diminished intake of food. If food is with- 
drawn altogether, the body is compelled to draw upon its food 
reserves in the form of adipose tissue, and the weight will in 
consequence be diminished at the rate of one to two pounds a 
day, or about one-eightieth of the body weight. If this reduction 
of weight were confined to the loss of fat, fasting would be a most 
practical and efficient method of weight reduction. But careful 
laboratory observations have shown that in complete fasting all 
the tissues of the body are drawn upon to furnish energy with 
which to keep the wheels of life moving. The muscles, including 
the heart and the glandular structures, lose weight as well as the 
adipose tissue. Consequently, the muscles waste and lose strength, 
the heart is weakened and all the bodily machinery is crippled 
and rendered less efficient. On this account, absolute fasting is 
seldom advisable, but a modified fast may render very great 
service. (See Fasting.) 
A good plan is to put the patient on a regimen which will 
furnish him with the calorie requirement of his base ration, which 
is approximately three-fourths the amount of food required by a 
person of a given height doing light work. The base ration for a 
person of any height may be found by reference to Table II. 
When a decided reduction in weight is necessary, the food 
intake should be reduced to one-half the ordinary ration or about 
three-fourths the base ration for a short time. 
This reduced dietary should not be continued indefinitely. 
As the reduction in weight proceeds, the intake of food should be 
gradually increased until nearly the normal amount is eaten, care 
being taken to avoid the slightest excess. 
Having determined the amount of food to be given, the next 
thing is to determine the particular foodstuffs best calculated to REGIMENS AND DIETARIES 
649 
facilitate a reduction in flesh, bearing in mind always, however, 
that it is the amount of food, that is, the number of calories 
eaten rather than the particular kind of food which is of primary 
importance. 
An important point to be borne in mind in the employment 
of the reducing dietary is the fact that when the volume of the 
food intake is diminished there is a tendency to constipation be- 
cause of a lack of the bulk required to stimulate the muscular 
walls of the intestine. On this account, care should be taken to 
avoid reducing the volume of the food; in fact it is highly advan- 
tageous to increase the food volume by the use of liberal quanti- 
ties of celery, lettuce, cucumbers, greens and bran, together with 
other bulky foodstuffs. 
Salt should be used sparingly. A moderate amount of liquids 
(8-12 ounces) may be taken at meals. The variety should be 
small at one meal, but varied from day to day. The appetite 
must be restrained even if necessary to rise from the table a little 
hungry. A pint of water taken one-half hour before meals and 
again at night and on rising in the morning is beneficial and helps 
to quiet hunger pangs. The amount of protein should not exceed 
one calorie per pound of body weight. 
In arranging the bill of fare for reducing weight, bulky 
foods should be served first for the reason that fullness of the 
stomach produces satiety and so satisfies the appetite even though 
the calorie or real food value of the meal may be small. Liberal 
quantities of celery, lettuce, fresh fruits, cucumbers, melons and 
greens may be eaten at each meal without aggregating more than 
a few hundred calories. At least one-fourth ounce of bran or 
a third of an ounce of agar should be taken at every meal. Bran 
supplies lime, iron and vitamins, the amount of which in the daily 
ration should not be reduced. This is a point which has hereto- 
fore been neglected in all diets which have been proposed for 
reducing flesh, a serious oversight which has unquestionably been 
a most prolific cause of failure and has often resulted in produc- 
ing a state of ill health as the result of attempts to reduce weight, 
recovery from which has frequently required many months. It 
is a frequent observation on the part of persons adopting any of 
the usual methods for reducing body weight that while they feel 
lighter from the loss of flesh, they recognize at the same time 
a notable loss of energy, endurance and sense of well-being. This 
experience is often so pronounced as to lead the individual to 650 
THE NEW DIETETICS 
prefer efficient obesity with its inconveniences to a state of more 
comely but inefficient leanness. This may be easily prevented. 
The best method of maintaining the full required intake of 
iron, lime and vitamins is by the free use of vegetable broths, 
greens, yeast extract (Savita, Marmite), oranges, tomatoes, either 
fresh or canned, and such green vegetables as cucumbers, lettuce, 
cabbage (kraut) and celery. 
At the very beginning of a course of diet to reduce weight 
food may be almost wholly withdrawn for the first three or four 
days. Care should be taken, however, not to reduce the intake of 
carbohydrates below 300 calories, the equivalent of 5 ounces of 
bread, 12 ounces of grape juice or 24 ounces of apple juice. On 
such a regimen the weight may be readily reduced by diet alone 
from a pound to a pound and a half a day for three or four days 
in succession. Adding vigorous exercise, the rate of reduction 
may be materially increased; for example, a 300 pound man walk- 
ing for one hour a day at the rate of three miles an hour would in 
so doing utilize energy equivalent to 1,000,000 foot pounds, or 
about 330 calories, which would be represented by an ounce and 
a half of fat. Walking two hours would double the effect, which 
would be shown in a reduction of weight to the extent of prob- 
ably half a pound or more. By thus combining exercise and diet, 
it is possible and sometimes advantageous to reduce the weight 
for a short time at the rate of two or three pounds a day; but it 
is not at all safe to continue reduction of weight at this rate for 
any considerable length of time. It is far better to adjust the 
dietary and the exercise in such a way as to secure the loss of a 
few ounces in weight daily, aggregating one or two pounds a 
week, which in the course of a few months will produce most 
satisfying results. If more rapid reduction of weight is under- 
taken by the use of drastic measures, the effort should be con- 
fined to a short period, ten days or two weeks, at the end of 
which time the regimen should be adjusted for slow, gradual re- 
duction during a long period. 
The effects of diet and exercise may be considerably in- 
creased by means of sweating baths followed by cold baths. The 
sweating bath stimulates metabolism by raising the temperature 
of the body, and the cold bath accelerates metabolism by increas- 
ing muscular tension, which accounts for 40 or 50 per cent, of 
the total energy expenditure of the body. Swimming in at 
a temperature of 75° F. is a most excellent mode of exercise to be REGIMENS AND DIETARIES 
651 
employed in connection with the sweating bath, the best forms of 
which are the incandescent or arc light bath and the sunbath, 
when available. 
It is important to remember that body weight does not al- 
ways follow closely the actual reduction in tissue. There is 
usually a retention of water which masks the actual tissue loss. 
This tendency may be met by greatly reducing the salt (sodium 
chlorid) of the diet, by limiting the amount of water taken, and by 
daily sweating baths. 
In the case of obese persons who are not able to take volun- 
tary exercise, and especially in cases in which the abnormal de- 
posit of fat is largely confined to the abdominal region, automatic 
exercise renders very great service. By a method of automatic 
gymnastics, which the writer devised many years ago (1885) and 
has used successfully in hundreds of cases, the muscles may be 
brought into active operation and made to do actual work through 
the application of a painless electrical current. The rate of meta- 
bolism or tissue work and energy expenditure may be increased 
to eight times the normal or even more. For example, the abdomi- 
nal muscles may be made to lift a weight of 75 to 150 pounds, 
two or three times a second, doing actual mechanical work equiva- 
lent to 10 to 20 foot pounds every second, 36 tons an hour, and 
continue to work at this rate for 30 minutes or such longer period 
as may be considered desirable. 
Underfeeding is indicated in most cases of' obesity and in 
cases of persons suffering from autointoxication from a too high 
protein diet and the excessive use of animal fats. It is the proper 
dietary after an attack of “biliousness” and for a person of full 
weight and active habits who by some accident, as the breaking 
of a leg or a sprain of an ankle, is suddenly confined to bed. Much 
harm results from neglect to reduce the intake of food when the 
habits are suddenly changed from great activity to complete inac- 
tion from any cause. The regimen is contraindicated in cases of 
orthostatic albuminuria; that is, in cases in which albumen ap- 
pears in the urine when the patient is in the upright position but 
disappears when the recumbent position is assumed. Underfeed- 
ing is indicated as an essential feature of the dietetic treatment 
of diabetes and is a very useful measure in many cases of gout. 652 
THE NEW DIETETICS 
THE BLAND OR NON-LAXATIVE DIET 
The bland diet consists of foods which are lacking in the 
qualities which stimulate either secretion or motility; that is, 
foodstuffs which are smooth, emollient, and nearly tasteless. Con- 
diments of all sorts are excluded, with the possible exception of 
salt, which may be allowed in small amount. Cane sugar and 
fruit acids must also be avoided. Rice gruel, oatmeal jelly, barley 
water, and cornstarch or arrow-root gruel, are typical bland foods. 
Such very bland foods are required only in very exceptional cases, 
as acute inflammations or burns of the mouth and throat from 
hot liquids or chemicals, or acute inflammation of the stomach. 
In general, milk may be used in combination with the foods 
named or even by itself. Buttermilk with rice or cornstarch is 
often preferable to fresh milk. 
Purees of potato and other vegetables, mushes, porridge, 
cream toast, panada, and most breakfast cereals are suited to 
cases which do not require the blandest foods. Egg nog (yolk 
only), coddled eggs and custards are also allowable in many 
cases, as well as mildly flavored jellies prepared from agar or 
vegetable gelatine. Malt sugar may be used when cane sugar and 
other sweets are not tolerated. 
There is much less frequent occasion for the use of a bland 
liquid diet than is generally supposed. The mere fact of frequent 
bowel movement is by no means an indication for a bland or 
non-laxative diet. Frequent bowel movement is very often due 
to the fact that the colon is completely filled with putrefying 
residues, the frequent but incomplete evacuations being simply 
the overflow of an overfilled reservoir. In such cases, the feeding 
of bran and various other food laxatives is indicated rather than 
a bland dietary. It seems doubtful, indeed, whether the slightest 
harm ever results from the use of a highly laxative diet except in 
cases of acute diarrhea or dysentery. Food is a natural and 
harmless laxative. Bulky food, even roughage, does not stimulate 
peristalsis by causing irritation, but by titillation. If more bulk 
than necessary is taken, the increased colon activity may cause 
some inconvenience but will do no harm, for there is no infection, 
no inflammation, no production of toxins, and the result will be 
increased sense of well-being rather than malaise and weakness, 
the presence of which in ordinary diarrhea is the result of the 
absorption of the toxins produced by disease-producing bacteria 
and not by the frequent movements. REGIMENS AND DIETARIES 
653 
The bland liquid diet is most clearly indicated in cases of 
feeble patients who cannot chew, in patients who are too ill to 
chew hard or dry food, in certain surgical cases, in cases in which 
tube feeding is required for duodenal or gastric ulcer, sometimes 
in cases of insane persons who refuse to eat and must be nour- 
ished by tube feeding, and in inflammations of the mouth. 
It should be remembered that, in general, a bland diet is 
highly constipating. In infants and in many adults acid fruit 
juices and malt sugar solutions have a laxative tendency. Agar 
jellies are somewhat laxative. Purees of figs, dates, prunes and 
other fruits should be used when possible, though, in general, acid 
and saccharine foods must be avoided. Care must be taken to 
cleanse the colon twice a day by means of a warm enema. When 
colonic irritation exists, a pint of thin warm starch solution should 
be introduced into the colon after each enema. 
All meals should be light, and frequent feedings (four to six 
daily) should be given if necessary. 
A diet of cereal gruels is often of greatest service in cases of 
intestinal infection with looseness of the bowels, especially in 
children, not because of its bland or non—laxative character, but 
because it floods the intestine with carbohydrate, a kind of nutri- 
ment which encourages the growth of beneficent acid-forming 
organisms and discourages the growth of the putrefactive and 
disease-producing bacteria which are the cause of the diarrhea. 
The addition of milk sugar to the diet is advantageous, hastening 
the change of flora and so terminating the bowel disorder. 
In cases of stomatitis or after burns of the mouth and throat 
the rice regimen is most useful. Well-cooked rice gruel or jelly 
will be tolerated when contact of almost any other food is 
painful. 
CARBOHYDRATE-FREE DIET 
The belief held by many, even by some physicians, that the 
free use of farinaceous foods is likely to give rise to certain forms 
of dyspepsia, gout, rheumatism and other disorders, has no scien- 
tific foundation. This doctrine, much more widely current dur- 
ing the latter part of the last century than at the present time, 
was largely due to the teaching of Dr. Salisbury, who held that 
the free use of starch foods led to the development of yeast in the 
intestine and in the blood. These migrating yeast cells he held to 
be the cause of tuberculosis, Bright’s disease and various other 654 
THE NEW DIETETICS 
maladies. He prescribed a starch-free diet, consisting largely of 
lean meat, for the purpose of starving out the dangerous yeast 
cells. 
On one occasion the writer, having been called to Cleveland 
to see in consultation a patient who had for some time been under 
the care of Dr. Salisbury, had an opportunity to see a demonstra- 
tion of the so-called yeast cells in the blood by an assistant to Dr. 
Salisbury, his nephew. The demonstration consisted of the exhi- 
bition of a mass of disintegrated white blood cells collected to- 
gether and crushed by a peculiar method of manipulation, but 
which the demonstrator claimed to be yeast cells. The writer 
suggested that since yeast is a living organism and will grow if 
planted, this biologic test should be applied to the so-called speci- 
men of yeast. The proposition was agreed to but never carried 
out. 
Nothing could be more ridiculous than the theory upon which 
the Salisbury method was based, and it is surprising that this 
pernicious teaching still survives in current treatises on diet. 
Starch is the most easily digestible and the least likely to do 
injury, even when eaten to excess, of any of the several food 
principles. 
An excessive intake of fat causes slow digestion and soon 
gives rise to a condition known as biliousness, which is caused by 
an unusual degree of putrefaction in the colon. In children, an 
excess of fat is likely to give rise to acidosis. 
An excess of protein overtaxes both the liver and the kid- 
neys, and promotes intestinal autointoxication from the putre- 
faction of food residues. An excess of starch, however, leads to 
no greater damage than an undue accumulation of fat. That a 
farinaceous diet can in any way be responsible for gout, rheuma- 
tism or even diabetes is an implication against this highly in- 
offensive foodstuff which has no scientific support. 
A'carbohydrate-free diet is called for in only one class of 
cases, namely, persons suffering from diabetes, and then only as 
a temporary expedient to clear the urine from sugar by reducing 
the blood sugar. The prolonged exclusion of carbohydrates from 
the dietary is not only unnecessary but is highly dangerous, and is 
the most certain method of producing acidosis, a condition which 
is wrongly attributed to the use of carbohydrates. It is impos- 
sible to maintain the body in health without a daily intake of at 
least two or three ounces of carbohydrates. REGIMENS AND DIETARIES 
655 
FAT-FREE DIET 
The researches of Hindhede show conclusively that fats may 
be practically eliminated from the diet without danger. He kept 
a man in good health for twenty-three months on a diet consisting 
of bread, potatoes and greens, all fat being eliminated except that 
naturally found in the three foodstuffs named, certainly a very 
small amount. Dr. Hindhede stated, however, in a letter to the 
writer, that the subject of his experiment found it necessary to 
eat large quantities of greens, doubtless to supply the needed fat 
soluble vitamin, lime and iron, all of which are deficient in bread 
and potatoes. 
Persons who have a tendency to take on fat readily should 
avoid the use of butter and cream and should reduce the fat- 
intake to a minimum. A certain amount of fat seems necessary 
to produce a sense of satisfaction or satiety after meals. 
Those whose stomachs produce a deficiency of hydrochloric 
acid should avoid the free use of fats, since fats tend to discourage 
the production of gastric acid, as shown by Pavlov. 
The free use of fats is also to be avoided by those whose 
stomachs empty slowly because of lack of nerve tone. Fats 
should be used sparingly in cases of achylia because of the ten- 
dency to intestinal putrefaction due to lack of gastric acid, a 
tendency which is increased by the free use of fats. 
DRY DIET 
(See also page 983) 
In this diet, the consumption of fluids is limited to fifteen 
ounces daily. It is recommended by Von Noorden, Oertel and 
others in cases of senile heart, fatty heart, beer drinker’s heart 
and all cases in which there is a very pronounced myocarditis or 
loss of muscular tone with ascites or general dropsy and passive 
congestion of the liver. In the writer’s opinion this severe re- 
striction of fluids is a drastic measure which must be used with 
great caution and never for more than a few days consecutively. 
By careful hydriatic treatment the congestion of the liver and 
kidneys may be in most cases so far overcome as to permit the 
passage through the tissues of a sufficient amount of water to 
allow a daily intake of two or three pints. This may be accom- 
plished by fomentations over the liver and kidneys and by the 
moist abdominal bandage worn continually and changed every 656 
THE NEW DIETETICS 
two or three hours. If the heart is very weak, a cold compress 
(60° F.) should be placed over the heart and chest during the 
application of the fomentation and each alternate hour during 
the day. When fluids are too long restricted, there is likely to be 
an accumulation of waste products in the blood and tissue fluids, 
the result of which is necessarily harmful. 
It is highly important to remember that when the quantity 
of fluids is greatly restricted, salt must be withdrawn entirely (see 
Salt-Free Diet). 
Deep breathing should be practiced hourly for two to five 
minutes, to aid the hepatic circulation. 
The diet should consist of thin slices of well toasted graham 
bread with butter, baked potato, spinach, and other greens, 
blanched almonds, hazelnuts, oatmeal mush, boiled rice and other 
foods of high caloric value, with lettuce and celery. The small 
amount of liquid should be taken in quantities of three ounces at 
intervals during the day. 
THE POTATO REGIMEN 
The potato regimen consists of potatoes served in various 
forms, baked potatoes, steamed potatoes, potato soup or porridge, 
and potato puree. A little salt may be taken with the potatoes 
but not much other seasoning should be added. A little cream or 
savora gravy is most suitable. In addition to potatoes this regi- 
men may include greens of any sort. Among the best are New 
Zealand spinach, narrow or curly leaved dock, chard, beet tops 
and turnip tops. Cantaloups, cucumbers, lettuce, celery and toma- 
toes are also admissible. 
All these garden products are rich in soda and potash, which 
increase the alkalinity of the blood and tissue fluids and so antag- 
onize acidosis and increase the solubility of the uric acid and 
other wastes which are likely to occur in excessive quantity in the 
tissues of sedentary persons and those who have been high livers 
and in all sufferers from chronic constipation and the resulting 
intestinal toxemia. Hindhede believes that by following a potato 
diet for some little time the size of impacted renal calculi or gravel 
may be diminished and that they may thus be gotten rid of. The 
writer has several times observed the passage of renal calculi 
which had lodged in the ureter, after putting the patient on a 
potato diet accompanied by water drinking, water being given to REGIMENS AND DIETARIES 
657 
the extent of three or four quarts daily. This method is cer- 
tainly well worth trying in cases of this sort and may be adopted 
in all cases of so-called uric acid diathesis. 
If necessary, the potato regimen may be followed for a long 
time. This has been shown by Hindhede, who fed a young man 
exclusively on potatoes and fat for several months. In a re- 
search conducted at Columbia University by Miss Lenna Cooper, 
in which the diet consisted exclusively of potatoes and clarified 
butter, the nitrogen balance was maintained on a protein intake 
of only one and one-fourth calories of potato protein a day per 
pound of body weight, from which it is evident both that this 
small amount of protein is sufficient and that the protein of the 
potato is of very good quality. 
Dr. Leipiner recently reported (1919) in the German medical 
press remarkable results from the feeding of dropsical patients 
on a potato diet. 
FRESH OR RAW DIET 
(See also page 984) 
Much nonsense has been talked and written by food charla- 
tans within the last twenty years about the virtues of the raw 
diet. The writer has never been able to endorse the extravagant 
claims made by the promoters of the raw food fad, and there is 
no doubt that considerable harm has been done by the unscientific 
methods and unwarranted claims made by these false prophets 
whose pseudo-dietotherapy has, through the prejudice created, 
hindered greatly the progress of real diet reform. 
It must be remembered, however, that in his original state 
primitive man lived upon the products of the earth as presented 
by the bountiful hand of Nature in forest and field. For long 
ages before the discovery of fire and the art of cookery our 
hardy and vigorous ancestors subsisted upon the natural products 
of the earth. Referring to the Golden Age “that fed on fruit, 
nor durst with bloody meals their mouths pollute 
While earth not only can your needs supply, 
But, lavish of her store, provides for luxury, 
A guiltless feast administers with ease, 
And without blood is prodigal to please. 
There can be no doubt that the natural products of the earth 
afford all the necessary means for the sustenance of human beings 658 
THE NEW DIETETICS 
as well as for other animals. Some years ago Dr. Slonaker, of 
Leland Stanford University, made a feeding experiment with 
rats from which he drew the conclusion that human beings cannot 
subsist upon natural foodstuffs of purely vegetable origin; but 
•the researches of McCollum, of Johns Hopkins, confirmed by 
observations made in the research laboratory of the Battle Creek 
Sanitarium as well as by the personal experience of hundreds of 
persons now living, have fully demonstrated that life can be well 
sustained on a dietary consisting wholly of natural foods un- 
changed by any artificial process. 
Butter, cream, and other dairy products may be easily eaten 
in the raw state. They are, indeed, for the most part habitually 
used in this way. To this list may be added green corn, certain 
varieties of which, particularly the Golden Bantam and a dwarf 
Mexican sweet corn, are more palatable and digestible when raw 
than after cooking. Wheat when in the milk state may also be 
eaten raw, and when properly served is not unpalatable. Tur- 
nips and carrots, when properly prepared, as well as lettuce, 
celery, cucumbers, radishes and even turnips, make very palat- 
able as well as wholesome salads. 
Milk is one of the most important of all available raw foods. 
Unfortunately, most of our commercial milk reaches the con- 
sumer contaminated with such a load of filth that it is scarcely 
safe to eat it without pasteurization or sterilization. Buttermilk, 
sour milk, and cottage cheese are somewhat safer than sweet milk. 
The best of all is certified milk, or milk produced under certified 
conditions. 
The milk regimen owes the good results which it produces in 
large measure to the vitamins and food lime which it supplies. 
Some of the cereals may also be eaten partially cooked. The 
Scotch from time immemorial have made scalded oatmeal their 
staple food. More than two hundred years ago a historian praised 
the Scotch soldiers for their wonderful endurance and military 
prowess, which he attributed to the fact that they subsisted upon 
scalded oatmeal. 
Another excellent method of preparing rolled oats is to stir 
the meal into boiling water and remove from the fire at the end 
of one minute. When prepared in this way the usual pasty 
quality is wholly avoided. The oat grains remain distinct like 
well boiled rice and may be eaten with relish and satisfaction 
The American method of cooking oatmeal until it becomes a REGIMENS AND DIETARIES 
659 
pasty mass is doubtless responsible for much chronic indigestion 
and is particularly promotive of constipation. When cooked in 
the manner above described, oatmeal becomes an excellent laxa- 
tive food as well as an efficient means of promoting the growth 
in the colon of the protective organisms which Nature implants 
in the intestine at birth and which are lost by errors in diet and 
neglect to evacuate the bowels with normal frequency and thor- 
oughness. 
A special virtue of the uncooked dietary which was never 
recognized or even suspected by its advocates, and to which the 
writer first called attention some years ago, is due to the fact that 
uncooked starch is digested less readily than cooked starch and 
hence is less rapidly absorbed. As a result, when cereals are 
eaten in an imperfectly cooked state a certain proportion of the 
raw starch reaches the colon where its presence is greatly needed 
to encourage the growth of the lactic-acid-forming organisms, 
and thus prevent the putrefactive processes likely to be active 
in this part of the intestine. 
Recent experiments by Langworthy and Deuel (1920) show 
that raw potato starch is digested much more slowly than the raw 
starch of wheat, oats and rice. So large an amount as six ounces 
of raw wheat starch or eight ounces of raw corn starch was 
found to be completely digested ; whereas, when six ounces of raw 
potato starch was given with other food nearly one-fourth of it 
was found undigested in the stools. The interesting fact was 
noted that the raw potato stools when burned gave off no fecal 
odor, the odor resembling that of scorched bread. 
The uncooked eggs often included in the raw diet destroy 
the chief advantage of this regimen, since the raw white of egg 
is known to be indigestible in the human alimentary canal, at 
least in large part, and hence must greatly encourage putrefaction 
in the colon. 
A diet consisting wholly of fresh, uncooked fruits, vegetables 
and cereals greatly aids intestinal asepsis. This diet aids the 
change of flora and is most efficient in mantaining the change. 
Acidophilus buttermilk may be advantageously used. 
While not to be recommended as a steady diet, the fresh or 
raw regimen may be resorted to temporarily as an aid in com- 
bating intestinal toxemia, constipation and obesity, for short 
periods as a wholesome change. The adoption of such a diet is 
by no means a hardship to one who does not mind taking the 660 
THE NEW DIETETICS 
trouble to supply himself with the numerous varieties of delicious 
fruits, nuts and fresh vegetables which are now available at 
almost any season of year. 
RECTAL FEEDING 
Rectal feeding renders great service in a variety of conditions, 
particularly in cases of obstruction of the esophagus, inoperable 
cancer of the cardiac orifice or of the pylorus, in cases of ulcer of 
the stomach or duodenum, particularly when hemorrhages are 
present, and in cases in which the patient is unable to swallow 
because of coma, or because of obstruction of the mouth as the 
result of a burn or other injury. In certain cases of great emacia- 
tion with very feeble digestion, but with absence of appetite, rectal 
feeding renders service. 
The use of a long rectal tube is not necessary. It presents no 
advantages. If the food mixture is warm, 100' to 102° F., and 
if it is introduced slowly, not more rapidly than one or two 
ounces a minute, the nutritive material will readily find its way 
from the rectum to the cecum. A long rectal tube offers no 
advantages for the reason that it cannot be passed into the bowel 
for more than a few inches and invariably coils up in the rectum. 
Only by means of the proctoscope can a tube be passed more than 
6 or 8 inches into the bowel. Fortunately this high intubation 
is not necessary. 
There has been much discussion concerning the ability of the 
colon to digest or to absorb nutrient material, and on this account 
it has been the usual fashion to use for nutritive enemata pan- 
creatized milk or fresh pancreas suitably prepared. The writer is 
very doubtful whether the addition of pancreas or pancreatic 
products is likely to be of any material service. In the writer’s 
opinion, nutritive enemas are of little value unless given in suf- 
ficient quantity, not only to fill the colon but to pass the ileocecal 
valve and enter the lower part of the small intestine. It is more 
than probable that this happens in those cases in which the patient 
appears to be well sustained or even to gain in flesh during rectal 
feeding. Incompetency of the ileocecal exists in a large propor- 
tion of chronic invalids and in not a few instances is unquestion- 
ably a factor in the production of chronic disease. 
Rectal feeding is, then, not so very different from ordinary 
feeding. The small intestine is the principal organ of digestion 661 
REGIMENS AND DIETARIES 
and absorption. The stomach and the colon are organs which 
have comparatively little to do with digestive work. The stomach 
absorbs almost none at all and the colon also absorbs compara- 
tively little. The small intestine is the great absorbing as well as 
the great digestive organ. It absorbs liquids daily to the extent of 
six quarts or more, while the colon absorbs only one-twentieth as 
much. The body is fed when food is introduced into the small 
intestine either at its upper or lower end. 
In general, it may be said that malt sugar is about the only 
food the absorption of which through the colon can be depended 
upon. This carbohydrate may be absorbed and utilized without 
undergoing digestion, whereas fats and protein require digestive 
changes which cannot be effected in the colon. Most of the benefits 
which can be derived from the nutritive enema may be secured 
by copious injections of solutions of malt sugar, two ounces to 
the pint. Six or eight pints should be administered daily. The 
solution should be at the temperature of the body, and should be 
introduced slowly, the patient lying down and remaining quiet 
for half an hour after the introduction of the solution so as to 
afford opportunity for absorption. 
It is an excellent plan to make use of vegetable broths, such 
as bean broth, vegetable bouillon and solutions of yeast extract 
(Savita, Marmite). By this means, vitamins and food salts may 
be supplied. 
Nutritive enemas consisting of raw eggs, meat juice and 
animal broths often do more harm than good. They encourage 
the growth of putrefactive organisms, which give rise to noxious 
products, and so increase the burden of toxins with which in a 
large percentage of cases the patient is already overwhelmed. 
Malt sugar solutions encourage the growth of acid-forming organ- 
isms, which discourage putrefaction and thus help to change the 
intestinal flora. 
In the employment of rectal feeding it is necessary, first of 
all, that the colon should be properly prepared. To this end the 
colon should be thoroughly washed out by a cleansing enema half 
an hour before the feeding takes place. Suitably prepared foods 
should be administered at intervals of three or four hours during 
the day. A good plan is to feed at 7:00 A. M., 11 :00 A. M., 3 :00 
P. M., and 7:00 P. M. 
Care must be taken to see that a sufficient amount of liquid 
is taken and retained. The amount required is at least two 662 
THE NEW DIETETICS 
quarts daily. The amount of urine will be a good measure of the 
amount being absorbed. The quantity of urine should not fall 
below one quart. 
Patients sometimes sutler from irritation produced by the 
frequent introduction of the tube into the anal canal. This 
difficulty may be obviated by lubricating the tube with yellow 
carbolated vaseline. Care should also be taken to cleanse the anal 
region thoroughly after each evacuation, using soap and water 
for the purpose. Absolute cleanliness is the best preventive of 
fissure and other anal troubles arising from mechanical irritation. 
The addition of lactose or lacto-dextrin to the nutritive enema 
is a distinct advantage in suppressing putrefaction by encourag- 
ing the growth in the bowel of the B. acidophilus and other acid- 
forming organisms. 
INTRAVENOUS FEEDING 
intravenous feeding is now practiced with great success in 
certain cases. This method consists in the injection into a vein 
of a suitable liquid containing sugar (pure glucose). 
The services of a surgeon are, of course, required and the 
most perfect asepsis is necessary. 
By intravenous feeding, acidosis may be successfully con- 
bated when not amenable to any other measure. It is a precious 
resource when feeding by any other method is impossible. Its 
chief service is rendered in surgical cases when the condition of 
the patient is such as to require quick reinforcement of the vital 
energies by an intake of food. 
WATER DRINKING 
Water drinking as a therapeutic measure is of very ancient 
origin. Hippocrates prescribed water drinking as a remedy in 
fevers, and the drinking of cold water has been practised among 
the Egyptians from the most ancient times in the treatment of 
fevers. Cold water drinking was used by Hahn in the treatment 
of fevers in Germany in the first half of the eighteenth century, 
fully sixty years before Priessnitz prescribed the internal use of 
water in massive doses at Grafenberg. 
Todano, an Italian contemporary of Hahn, made his fever 
patients drink five pints of ice water every three hours. The 
patient was placed in a hammock without covering, and the treat- REGIMENS AND DIETARIES 
663 
ment was continued until perspiration occurred. This extra- 
ordinarily vigorous refrigerative treatment must have sometimes 
produced undesirable results, and it is these excesses in the use of 
an efficient and valuable remedy which are doubtless to a great 
degree responsible for the slowness with which the merit of water 
drinking as a systematic procedure has acquired recognition. 
The importance of water to the vital economy must be recog- 
nized when we remember that the living organisms which com- 
pose the human body, as well as those of all other animals, are 
submerged in water. 
Bernard, the great French physiologist, sagaciously re- 
marked concerning the aquatic life of man: “Life exists only in a 
liquid medium. It is only by certain artifices of construction that 
the organisms of man, as those of other animals, can live in the 
air; but all the active cells upon which their functions depend, 
live, without exception, like the infusoria, in an interior liquid 
medium.” 
Water drinking is an internal bath; it dilutes the fluids of 
the body in which the cells and fibers are bathed; it purifies the 
body by diluting the medium in which it lives. By the free use 
of water the movements of the mass of liquid in which the living 
elements of the human body perform their work are quickened, 
and the stream of life runs clear and pure. It has been shown 
that water is absorbed from the stomach very slowly. Absorption 
takes place chiefly in the intestine. Absorption is stimulated, 
moreover, by the presence of carbon dioxide gas. The presence 
of mineral salts of any kind lessens the rate of absorption. 
Examination of the urine shows not only that the quantity 
is increased by water drinking, but that the urea and other solid 
constituents are also increased. 
Baron Liebig showed long ago (and his observations have 
been many times confirmed) that water drinking powerfully in- 
fluences metabolism, increasing both assimilation and disintegra- 
tion, but especially the former. 
When the amount of water supplied to the body is insuf- 
ficient, the condition of the body becomes in some degree com- 
parable to that of a stagnant pool; while an abundant supply of 
liquid so encourages its activities that it may not inaptly be com- 
pared to the flowing mountain stream. Water is not a mere 
mechanical conveyor of poisons out and of food in ; it is a power- 
ful vital stimulant. 664 
THE NEW DIETETICS 
Priessnitz required very many of his patients to drink 
large quantities of water, many patients taking as high as twenty 
to forty glasses a day. The deluging practice of Priessnitz is 
still recommended by the German water-cure empirics and by 
some hydrotherapists, but cases are certainly very rare in which 
such quantities of cold water can be swallowed with advantage. 
As a measure of treatment, water drinking may be generally 
practiced to the extent of six or eight or even ten glasses a day 
with advantage, but not infrequently three or four glasses are 
sufficient, and there are cases in which it is more important to 
interdict the use of liquids by the stomach than to commend 
their use. In such cases water may be introduced by the enema 
in small quantity, to be retained. 
Water drinking is especially indicated in all the cachexias 
and diatheses. In rheumatism, it is useful as a means of diluting 
the blood so that it can dissolve and carry out of the body a larger 
amount of waste matters. As a means for encouraging activity 
of the skin and kidneys, it is always useful in this disease. 
In diabetes, the free use of water is not injurious but advan- 
tageous. The blood contains an excess of sugar. All the sugar 
that is not oxidized must be removed from the body by the 
kidneys. The specific gravity of the urine in these cases is always 
high, indicating a similarly high specific gravity of the blood. 
It is evident, then, that water is needed in cases of this sort for 
the purpose of maintaining a proper degree of fluidity of the 
blood and of facilitating the removal of the unused sugar, the 
presence of which interferes more or less seriously with the 
various vital functions. 
Free water drinking is also important in diabetes to aid in 
the elimination of acetone and diacetic acid and in preventing 
acidosis. Free water drinking in cases of acidosis and diabetic 
coma is highly important. While the free use of water in diabetes 
will, of course, have the effect'of increasing the quantity of urine 
daily discharged, the amount of sugar, which is a matter of most 
serious importance in this disease, is not increased. Indeed, the 
amount of sugar has appeared to be somewhat decreased, and 
sometimes greatly lessened, doubtless as the result of the in- 
creased oxidation which takes place within the body under the 
influence of free water drinking. 
In diabetes insipidis, the disposition to drink large quanti- REGIMENS AND DIETARIES 
665 
ties of water should be resisted to a moderate extent, water being 
taken only when the thirst becomes very intense. 
In fevers, water drinking is essential as a means of aiding 
the kidneys and the skin in the elimination of the toxins to which 
the rise of temperature is due, of aiding the liver in its work of 
destroying the fever poisons, and promoting the reduction of 
temperature by causing increased evaporation from the skin. 
Water drinking is of the highest importance in the treat- 
ment of acute infectious diseases of all sorts. The paralysis 
which sometimes occurs as a complication of diphtheria and 
typhoid fever and which regularly makes its appearance in 
poliomyelitis, as well as the nephritis which may appear in severe 
acute cases in nearly all of the acute infections, is due to the 
bacterial toxins characteristic of these disorders. The safety of 
the patient depends upon the rapid elimination of these poisons. 
This can best be encouraged by copious water drinking, which 
not only lessens the intensity of the effect of the poisons by 
diluting them, but promotes in the most effective way possible 
their elimination. 
For a small child of two to four years, the rule should be an 
ounce of water every half hour, the total given each twenty-four 
hours amounting to not less than one quart. For a child of five 
to eight years, two ounces should be given every half hour. For a 
child of twelve years and upwards, the amount should be not less 
than four ounces every half hour, or half a pint per hour. In 
addition, an enema should be given twice a day. If the bowels 
move, as they should do, a second enema should be administered 
immediately afterward, a considerable part of which should be 
retained. The size of the first enema should be one to three pints, 
according to the age of the individual, or half a pint for a child of 
three or four years. The quantity of the second enema should be 
about half as much. 
When the proper amount of water is being given, the fact 
will be made evident by a copious flow of urine. If the urine 
remains scanty and high-colored, the fact is almost conclusive 
evidence that the patient is not receiving the proper amount of 
water. 
Fruit juices of various sorts may be added to the water to 
render it more acceptable to the patient. In most cases much less 
difficulty will be experienced in giving a small quantity of water 
frequently than in giving a large quantity at one time. In cer- 666 
THE *MEW DIETETICS 
tain cases the water may be given in teaspoonful or dessert- 
spoonful doses, repeating every few minutes. 
In cases of chronic inactivity of the skin, cold water drinking 
is an exceedingly valuable measure, but it must be employed with 
discretion as inactivity of the skin generally means an inactive 
mucous membrane, so that liquids are absorbed with difficulty. 
In cases of pyloric obstruction, intestinal obstructions or per- 
sistent vomiting, water drinking, while indicated as a means of 
relieving the general condition, is inadmissible, and water must 
be introduced by way of the rectum, using either small enemas 
or the drop method. 
Copious water drinking is one of the most effective means of 
relieving a common cold, by aiding in the elimination of tissue 
poisons, the accumulation of which gives rise to the difficulty 
known as a “cold.” 
One or two glasses of cold water taken half an hour or an 
hour before breakfast prove in many cases an almost perfect 
panacea for chronic inactivity of the bowels. At a meeting of 
the New York Academy of Medicine many years ago, a leading 
physician of New York City stated that he had successfully 
treated more than one hundred cases of constipation by this 
simple means. 
Chronic biliousness, which is nothing more nor less than 
chronic toxemia resulting from the putrefaction of food residues 
in the colon, requires the free use of water. Eight or ten glasses 
a day would be none too much in cases of this sort and the colon 
should be cleared by an enema twice a day. The flora must be 
changed. 
In cases of gall-stones and infectious jaundice, water drink- 
ing is certainly indicated. The amount taken should be ten or 
twelve glasses a day if possible so that the liver shall be thor- 
oughly flushed. The liver is always more or less crippled in these 
cases by extension of the infection and needs assistance. 
In cirrhosis of the liver arising from either indigestion or 
alcohol, water drinking is essential as a means of aiding the liver 
and the kidneys to perform the work required of them in the 
removal of the large quantity of colon poisons in addition to the 
wastes naturally produced within the body by the physiological 
processes of tissue change. 
In the treatment of the opium, alcohol, tobacco and other 
drug habits, water drinking renders important service by hasten- REGIMENS AND DIETARIES 
667 
ing the elimination of the drug and in aiding liver work and 
general oxidation. 
The temperature of the water drunk should ordinarily be 
about 70° F. In special cases water at 60 F. and even 50° F. 
may be employed. Very cold water is indicated only in fevers, in 
constipation, and in small quantities in hypopepsia. 
The quantity of water taken must depend on the effect de- 
sired. In fevers, a good rule is to take a glass of water every 
hour. In hypopepsia, one-third or one-half a glassful of cold 
water may be taken half an hour before eating. For inactivity of 
the bowels, one or two glasses of cold water should be taken on 
retiring at night, and as much more on arising in the morning. 
A thirst for water is almost always an indication that it may be 
taken with advantage, no matter whether such use is in harmony 
with the established canons of hygiene or not. It must be remem- 
bered, however, that when water drinking is indicated it should 
be taken without reference to the sense of thirst. Not infre- 
quently thirst as well as hunger is absent, although both food and 
drink may be greatly needed. It is safer to trust to the natural 
instincts than to pin one’s faith to a theory. Almost the only 
decided contraindication is in connection with meals, when free 
water drinking prevents proper insalivation of the food. 
Whenever water drinking is employed as a therapeutic mea- 
sure, all the urine should be collected daily and carefully 
measured. In general, the amount of urine should be not less 
than half the total amount of water taken, or equal to the amount 
of water taken as such. When a large amount of water is taken, 
the proportion passed as urine will be greater. Aside from 
liquids taken at meals, the food should be reckoned as about 
three-fourths water. Patients often think they drink more than 
they do. The actual measurement of the urine is necessary as a 
check. When the skin is very active as the result of exercise 
or exposure to heat the amount of urine will of course be dimin- 
ished, and the intake of water must be increased, to avoid the 
injury which comes from exposure of the kidney tissues to a 
concentrated solution of tissue wastes and other poisons. 
Minkowski has shown that, in general, the amount of water 
taken daily should be such as to maintain a daily output of 
urine amounting to three or four pints. 
An excess of water in cases in which the kidneys do not 
eliminate water readily may give rise to a marked increase in 668 
THE NEW DIETETICS 
blood pressure and may encourage dropsy. It is important to 
remember this in advanced cases of disease of the heart and 
kidneys. 
When the patient cannot be made to swallow a sufficient 
amount of water, and introduction of water through the colon 
fails, a duodenal feeding tube may be used with advantage. As 
much as ten quarts of water have been introduced daily for a 
week by this method. 
The purest water is universally the best. Whatever beneficial 
effects are obtained from water drinking must be attributed to 
the water itself, and not to any ingredients which it contains. 
Mineral waters are simply diluted drugs. The ingredients may 
be obtained at any drug store, and if diluted to the same extent 
as that in which they are found in the so-called natural waters 
the effects obtained from their use would be the same. Medical 
experience has shown that the best of the so-called mineral waters 
are those which contain the least mineral ingredients. The very 
best water is distilled water which has been well aerated. Water 
obtained from natural sources is generally more or less contam- 
inated, that from lakes, streams and rivers being necessarily 
defiled by the fish and other creatures which live in natural 
bodies of water, and by surface drainage which, after every rain, 
washes in quantities of filth. 
In general water obtained from public supplies should be 
boiled; this precaution is a wise one under nearly all circum- 
stances. 
Hard water should always be boiled for a long time to elim- 
inate, so far as possible, the lime which it contains. 
HOT WATER DRINKING 
Hot water drinking is an excellent means of cleansing the 
stomach. The stomach, like every other cavity of the body which 
is exposed to infection from the exterior, needs constant and 
thorough disinfection. 
The mouth is cleansed by the saliva and buccal mucus which 
not only sweep away the germs which enter the mouth from the 
air and in the food, but when produced from clean, healthy blood 
possess the remarkable property of hindering the growth of germs 
even though not able to actually destroy them. 
In addition to this there is an active destruction of germs by REGIMENS AND DIETARIES 
669 
the white blood cells which enter the mouth in great numbers 
with the several salivary secretions and the secretion poured out 
by the mucous glands of the mouth. 
Those wonderful cells, the phagocytes, are always present in 
the saliva which bathes the gums and the teeth and when exam- 
ined under the microscope may be seen to be filled with germs 
which they have captured and destroyed. 
The stomach is disinfected in a similar manner. Healthy 
gastric juice contains free hydrochloric acid which is a powerful 
disinfectant. The stomach produces daily from one-third to one- 
half ounce of pure hydrochloric acid. 
The hydrochloric acid, aided by pepsin, not only digests the 
food but disinfects it, and after the food leaves the stomach, the 
gastric acid disinfects the stomach itself. This is highly import- 
ant as a preparation for the next meal. 
Two or three glasses of water should be taken four hours 
after each meal, the time when the stomach should be emptied of 
the last remnants of the last meal. The temperature of the water 
may be hot, 105° to 110° F. 
The quantity of water taken should be about a pint, and the 
best time for taking is about an hour before eating. 
Lavage of the Blood and Tissues. 
Flushing and washing of the blood and tissues may be accom- 
plished by means of the duodenal feeding tube. The tube may be 
left in place for several days, and water may be passed in almost 
continuously at the rate of one and one-half pints an hour, or 
two or three gallons daily. The result is very free diuresis and 
often large watery stools. By addition of milk or malt sugar in 
proportion of one or two ounces to the pint, any desired amount 
of carbohydrate food may be introduced. 
GAVAGE 
Feeding by means of the stomach tube or duodenal feeding 
tube sometimes proves to be a highly practical and successful 
measure of treatment. It is especially valuable in cases of gastric 
or duodenal ulcer, as it affords the stomach and upper duodenum 
an opportunity for rest. The amount of food given at each feed- 
ing should be small, not more than 3 to 6 ounces. The feeding 
should be repeated every two hours and the food should be intro- 670 
THE NEW DIETETICS 
duced very slowly. In many cases the quantity should be reduced 
to a half ounce or an ounce and the feeding should be repeated 
every 30 or 40 minutes. The ideal method is almost continuous 
feeding by means of a syphon, which the patient can be taught to 
manage for himself. 
The following formula has been much used by the writer and 
his colleagues in duodenal feeding: 
Malted milk or malted nuts 1% ounce 
Malt sugar % “ 
Cream 1 
Water to make 6 
Calories 221 
To be given six times a day at two hour intervals (6 X 221 
calories = 1326 calories). After one week, increase amount of 
each feeding to nine ounces, which will aggregate approximately 
2000 calories. 
When duodenal feeding is relied upon for more than two or 
three days, care should be taken to include suitable iron-contain- 
ing foods in proper quantity. Yolk of egg hard boiled and 
rubbed smooth and puree of spinach are best for this purpose. 
Four to six ounces of spinach and half a dozen egg yolks are 
required daily to supply the iron and vitamins which are especi- 
ally needed in these cases. Malted nuts may be advantageously 
used when milk does not agree and especially in cases of anemia, 
this preparation containing a good percentage of iron, which is 
deficient in malted milk. Diet in Digestive Disorders 
Most diseases of the digestive organs are the result of errors 
in diet or in eating habits; it is evident, then, that in diet and 
regimens are to be found the most efficient remedies for disorders 
of this class. It must be borne in mind, however, that the modes 
and times of eating and the quantities of food eaten are matters 
equal in importance with the quality of food. In individual 
cases, in fact, any one of the factors named may be the dominant 
influence in causing the particular disturbance present. 
Furthermore, it is important to note the fact that other fac- 
tors besides food profoundly influence the digestive process. The 
woodchopper, or the athlete, is able to manage without difficulty 
a dietary which would paralyze the digestive powers of a judge 
or a college professor. Yet there are sedentary persons who are 
blessed with such extraordinarily vigorous digestive organs that 
for many years they are able to disregard every principle of 
rational dietetics with apparent impunity. But judgment day is 
certain to come at last. These exceptional persons may escape 
the miseries of ordinary digestive disturbances, but Bright’s dis- 
ease, cancer, apoplexy, premature senility or some other degen- 
erative disorder will sooner or later appear as the penalty of 
their unbiologic conduct. 
Exercise, cold bathing and hydrotherapy in other forms, out- 
of-door life and biologic or rational living in all particulars are 
measures which must be faithfully employed in connection with 
regulation of the diet in all cases of gastric or intestinal disease. 
Reverse Peristalsis the New Explanation for 
Many of the Symptoms of Indigestion* 
Much confusion and blundering in the dietetic treatment of 
indigestion has resulted from lack of accurate knowledge of the 
underlying causes of the most common and troublesome symptoms 
of so-called indigestion. Little by little modern studies of the 
alimentary tract, by means of the X-ray and many ingenious 
methods of the physiologic laboratory which have in recent years 
been employed in inquiries relating to this subject, have thrown 
671 672 
THE NEW DIETETICS 
a great flood of new light into one of the darkest corners of prac- 
tical therapeutics. 
The researches of Grutzner, Bernheim, Alvarez and various 
others have afforded ground for the belief that most of the 
symptoms which are included under the general name of indiges- 
tion are the result of reverse peristaltic movements. It is now 
known that the reverse peristaltic movements first observed by 
Cannon are constant not only in animals but in human beings. 
These movements are normally confined to the colon. They begin 
in the middle portion of the transverse colon and pass backward 
to the cecum, their purpose being to retain the liquid material 
which enters the cecum from the small intestine in this part of the 
bowel for a sufficient length of time to permit absorption of the 
larger part of the water content. In constipation, and particularly 
in cases of colitis with spastic contraction of the descending 
colon, these reverse peristaltic movements are greatly exagger- 
ated, and when the ileocecal valve is incompetent, a condition 
which exists in a large proportion of all chronic sufferers from 
indigestion, these reverse movements push the contents of the 
cecum back into the small intestine. 
Case and others have observed movements beginning near 
the lower end of the colon when this part of the bowel was dis- 
tended. Case has reported cases in which the reflux has extended 
even to the duodenum. Treves, the London surgeon, reported 
a case in which castor oil and water colored with an aniline dye 
were vomited within ten minutes after they were introduced by 
enema into the colon. The surgeon thought such rapid movement 
of liquids from the rectum to the stomach must be impossible 
without the existence of a fistula connecting the stomach with 
the colon. He accordingly operated with expectation of finding 
a fistula, but to his surprise found the stomach and intestines to 
all appearance perfectly normal. A number of other similar 
cases have been reported. In these cases the reverse movement 
of the intestine is apparently even more vigorous than the ordi- 
nary peristalsis in the normal direction. Such rapid antiperis- 
taltic movements are, however, very rare. 
There is accumulating evidence, however, that a very slow, 
almost imperceptible reverse peristalsis is an exceedingly common 
phenomena and is the real cause of a majority of the symptoms 
associated with the stomach. These reverse movements may be 
caused by various morbid conditions, especially by chronic appen- DIET IN DIGESTIVE DISORDERS 
673 
dicitis, disease of the gall bladder, duodenal ulcer, pregnancy, 
diseased conditions of the womb and ovaries in women and of 
the bladder and prostate in men; but the most common of all 
causes appears to be the accumulation of food residues in the 
colon. Chronic constipation, or intestinal stasis, is thus being 
shown to be the cause of most of the disorders of the alimentary 
canal as well as the origin, through intestinal toxemia, of a vast 
number of general disorders. Alvarez inclines to the opinion that 
the disturbances caused by fecal accumulations in the colon are 
chiefly of a mechanical nature, while others hold to the view that 
the principal factor is the absorption of poisons resulting from 
the putrefactive changes which are always associated with delay 
of food residues in the colon. The probable truth is that both 
of these factors are active. It is certain that relief of the con- 
stipation and changing the intestinal flora are the most effective 
means of combating many of the most annoying symptoms con- 
nected with the stomach and intestines as well as the various con- 
ditions commonly attributed to intestinal toxemia or autointoxi- 
cation. 
A great mass of facts demonstrated by laboratory research 
and culled from clinical observation has been cited by Alvarez in 
support of the views above advanced. The conclusions reached by 
him with reference to the causes of the various symptoms com- 
monly associated with disorders of the stomach may be briefly 
summarized as follows: 
Vomiting, 
Vomiting is undoubtedly the result of a reverse movement 
of the intestine. During X-ray observations, peristaltic waves 
have been seen to pass from the duodenum to the stomach, and it 
is impossible to account for the vomiting of fecal matters and 
substances introduced experimentally into the rectum except by 
the occurrence of reverse peristalsis. It was even noted by Hip- 
pocrates that purging usually ceases when vomiting begins. Purg- 
ing has even been treated by the administration of emetics, and it 
has been found possible to nourish pregnant women suffering 
from prolonged vomiting by introducing nutritive enemas, which 
were doubtless carried from the colon into the small intestine. 
Feeding in this manner will of course be facilitated by incom- 
petency of the ileocecal valve, which exists in a large proportion 
of patients who have long suffered from constipation. Regurgi- 674 
THE NEW DIETETICS 
tation, as Alvarez suggests, is simply mild vomiting. The reverse 
peristaltic waves are sometimes too slight to produce the violent 
movements of vomiting, in which case only small quantities of 
liquid are raised from the stomach to the mouth. Distention of 
the colon causes it to give rise to reverse waves of sufficient 
intensity to reach the stomach, although with a force barely 
sufficient to lift from the stomach to the mouth small quantities 
of the stomach contents. The material lifted to the mouth may 
be either fresh food in which the process of digestion has not 
yet been begun or highly acid gastric juice from the lower part of 
the stomach, or even duodenal fluids, bile and pancreatic juice 
which, when the pylorus is open, may be carried upward along the 
lesser curvature of the stomach to the esophagus. 
Nausea, 
Nausea without either vomiting or regurgitation is another 
symptom of mild reserve peristalsis. The accumulation of fecal 
residues in the colon is undoubtedly the most common cause of 
nausea, although it is entirely possible that the toxins absorbed 
from putrefying residues in the colon may also give rise to 
nausea. 
A Sense of Fulness, 
Chronic dyspeptics often complain of difficulty in eating be- 
cause of a “sense of fulness,” which appears shortly after a few 
mouthfuls of food have been eaten. Cannon, Carlson and others 
have shown how that the normal stomach gradually enlarges to 
accommodate the increasing volume of contents during the intake 
of food. This appears to be brought about by a reflex action 
which causes gradual relaxation of both the gastric walls and 
the muscular walls of the abdomen. This reflex appears to be 
interfered with by a mild reversal of the normal peristaltic 
movements. Distention of the colon may well give rise to this 
condition. In duodenal feeding the too rapid introduction of 
foods will quickly develop the sense of fulness in the stomach 
although no food whatever has entered the stomach. It is quite 
possible that disease of the gall bladder, ulcer of the duodenum 
or a chronically inflamed appendix may be a cause of these re- 
verse movements; but in the great majority of cases chronic con- 
stipation may be held responsible for this condition. By waiting 
a few moments, especially by diversion of the mind from the DIET IN DIGESTIVE DISORDERS 
675 
condition present, as by pleasant conversation or the reading of 
the morning paper, the symptom will pass off and eating may be 
resumed. Worried mothers and mentally depressed business men 
often complain of this symptom. In these cases the explanation 
may be easily found through the depressing effect of the mind 
upon the activity of the colon and the resulting stasis. 
Lack of Appetite. 
Aversion to food may be the result of many different causes, 
both mental and physical. There is, however, good reason for 
believing that in many cases, perhaps the majority of cases, the 
lack of appetite is but a mild manifestation of the interruption of 
the normal progress of food or food residues along the intestinal 
tract. Cannon demonstrated long ago that when obstruction 
occurs in any portion of the bowel there is at once stoppage of 
movement in the higher lying parts. It has often been noted that 
the stomach ceases to pass its contents into the intestine when the 
intestine lower down is overfilled. A colon overfilled with resi- 
dues thus becomes a cause of gastric disturbance, the emptying 
of the stomach is slowed and the hindrance may be so great as to 
produce not simply a lack of inclination to the taking of food but 
a complete aversion to food of any sort. This aversion may 
extend even to' liquids. The writer has frequently observed that 
persons suffering from extreme intestinal toxemia usually drink 
very little and find it difficult to swallow more than small quanti- 
ties of water. This aversion to food and drink may be in part 
due to the influence of putrefactive toxins upon the hunger center 
and the appetite center, but since Cannon has shown that hunger 
is due to contraction of the stomach it is entirely reasonable to 
believe that the slowing of the gastric movements or reversal of 
these movements may be the principal cause of loss of appetite. 
Belching. 
Alvarez points out there are three kinds of belching. (1) A 
slight gurgling sensation felt in the esophagus; (2) the eructation 
of gas from the stomach; and (3) a movement of air downward 
into the stomach or a voluntary or semi-involuntary swallowing 
of air. Observations made by the writer, Dr. Case and others 
have clearly demonstrated that so-called belching is in the ma- 
jority of cases simply the swallowing of air or the eructation of 
air which has been swallowed. It should be remembered, how- 676 
THE NEW DIETETICS 
ever, that this is not a vicious habit which has been voluntarily 
acquired, but is an effort on the part of the patient to relieve a 
feeling of discomfort experienced in the stomach. The condition 
seems to the writer to be somewhat similar to that which some- 
times gives rise to hiccough. Not infrequently hiccough and 
belching are associated. It is probable that, in many cases at least, 
the gastric discomfort is the result of a reverse peristalsis which 
brings into the stomach gas or liquid which causes distress. Swal- 
lowing of air opens the upper orifice of the stomach and so per- 
mits the air to escape and thus affords momentary relief. Some- 
times a portion of the liquid is ejected from the stomach along 
with the air. It is well known that gas is rarely generated in the 
stomach by fermentation. Gas in the stomach is either swal- 
lowed or brought up from the intestine by reverse peristalsis. It 
is possible that the discomfort may sometimes be due to gas 
found lower down in the intestine. 
Instead of seeking relief by the swallowing of air, persons 
suffering from this inconvenience should obtain temporary relief 
by sipping a glassful of very hot water, perhaps with the addition 
of a little soda. This will open the upper orifice of the stomach 
and allow the escape of disturbing liquid or gas and permit the 
reverse waves to run out as Alvarez suggests, and thus bring 
relief; but at the same time the real cause of the trouble, which 
probably exists lower down in the bowel, must be sought out and 
removed. 
Globus. 
This very unpleasant sensation felt in the esophagus is known 
to be the result of violent contraction of the muscular tube. It 
seems to be the result of the meeting of two peristaltic waves, 
one coming from above and the other from below. Hysterical 
patients suffer from globus more than others because they are 
universally constipated and hence the subjects of pronounced re- 
verse peristalsis. Globus is sometimes a result of an attempt to 
swallow when a wave or regurgitation is passing upward. 
Biliousness. 
There is probably no simple explanation of the condition 
known as biliousness. Many observations made by the writer 
lead him to the conclusion that this condition is, in many cases at 
least, due to an accumulation of toxins in the body fluids. The DIET IN DIGESTIVE DISORDERS 
677 
dingy skin and dull eyes, the general malaise, the mental de- 
pression and confusion, lack of energy and endurance are all 
indications of a toxic state. The great relief which follows the 
removal of a quantity of bile, either by purging or by means of 
the duodenal tube, suggest that one source of the toxemia may 
be a concentrated condition of the bile which, as shown by Lauder 
Brunton and by Schiff, may by re-absorption become abnormally 
concentrated, that is, overcharged with toxic substances. This 
condition naturally is one of the results of intestinal stasis or con- 
stipation. The long delay of the excretions in the colon affords 
an opportunity for excessive re-absorption. Persons who have 
no gastric acid or too little gastric acid are particularly subject 
to biliousness. This may be in part due to the lack of gastric 
acid, one of the important uses of which is to precipitate or 
render insoluble the various toxic substances found in the bile. 
A lack of the disinfecting properties of the gastric juice may also 
be a contributing cause since it permits the entrance of putrefac- 
tive bacteria into the intestine and the consequent excessive pro- 
duction of putrefactive poisons. 
It is entirely possible, also, as suggested by Alvarez, that 
reverse peristalsis may be a strong factor in the production of 
biliousness. There is strong indication of this in the fact that 
nausea, vomiting, and especially vomiting of bile, are common 
symptoms in severe attacks of biliousness. Without reverse peris- 
talsis bile would not be likely to be found in the stomach in any 
considerable quantity. In back of the reverse peristalsis is the 
overfilled condition which causes the reverse of the normal move- 
ments. 
Coated Tongue and Foul Breath. 
These conditions which accompany biliousness are doubtless 
in part due to a general lowering of vital resistance with depre- 
ciation of the germicidal properties of the blood serum, as a result 
of which the saliva loses to a certain extent its power to prevent 
the growth of bacteria in the mouth, which appears to be one of 
the important functions of this secretion. It appears, however, 
from the experiments of Grutzner and others that the coating of 
the tongue, which is known to be due to the growth of bacteria, 
may be the result of reverse peristalsis. Grutzner showed that 
bacteria and lycopodium introduced into the rectum were within a 
few hours carried to the mouth. Examinations of the tongue 678 
1 HE. NEW DIETETICS 
coatings, made in the bacteriological laboratory of the Battle 
Creek Sanitarium several years ago and again recently, show that 
in many cases colon bacilli are found present in large numbers. 
Since it is known that bile frequently enters the stomach during 
sleep, and since it is also known that colon bacilli are frequently 
found in the bile, it will readily be seen that these pernicious 
organisms may easily find their way by regurgitation to the 
mouth, and if the saliva has lost its normal power to inhibit the 
growth of these organisms the natural result will be an unusual 
development and the densely coated tongue and foul smelling 
breath which are found in persons suffering from the condition 
commonly known as biliousness. 
DIET IN CONSTIPATION 
In recent times the colon has been the subject of much con- 
troversy. The question is, shall it be removed or reformed? 
Anatomists have declared the colon to be a useless appendage, 
a vestigial remnant left over from a prehistoric state. Bacterio- 
logists have charged it with being an incubating chamber of 
poison-forming germs, a hold of unclean and hateful ‘parasites, 
a veritable Pandora’s box of disease and degeneracy. Surgeons 
have removed the offending organ, and thus proved that it may 
be dispensed with, and have claimed wonderful advantages from 
this abbreviation of the primae vias. 
Barclay Smith, the great English anatomist, first suggested 
the uselessness of the colon. Metchnikoff proved that animals 
that possess the longest colons have the shortest lives, and an- 
nounced that the colon bacillus is the germ of old age. Sir 
William Arbuthnot Lane, the eminent London surgeon, cites a 
long list of grave maladies, ranging from tuberculosis to rheu- 
matism, cured by removal of this offending organ. 
In the treatment of every chronic disease and most acute 
maladies the colon must be reckoned with. That the average 
colon in civilized communities is in a desperately depraved and 
dangerous condition can no longer be doubted. The colon must 
either be removed or reformed. From the beginning of the colon 
controversy and for many years before, the writer has been a 
very earnest student of the questions involved and has formed 
very definite opinions, the validity of which he together with his 
colleagues of the faculty of the Battle Creek Sanitarium has had DIET IN DIGESTIVE DISORDERS 
679 
opportunity to test in the treatment of many thousands of suffer- 
ers from colon and colon-caused maladies. The writer believes 
that methods have been worked out by means of which the colon 
may be reformed and made to do its work efficiently, not only in 
ordinary cases, but in by far the great majority of those cases 
which are thought by enthusiastic colon surgeons to be suitable 
subjects for surgical treatment. 
Until very recent years almost nothing has been known of 
the physiology of the colon. This part of the body has been 
almost a terra incognita. The physiology of digestion stopped at 
the ileocecal valve. How the colon dealt with its contents, how 
the very necessary act of defecation was performed, nobody knew. 
The discovery of the X-ray enabled Cannon and, later, Hertz to 
study the colon while in action in animals and man. Elliot, Keith 
and other anatomists studied the intestine in dogs, and finally 
Case, by perfecting the X-ray technic of colon examinations, com- 
pleted the physiologic study of this previously neglected organ. 
The combined result of the extensive labors of these investigators 
has been a great flood of light upon one of the most obscure 
questions in physiology. These new facts, not yet known to the 
general public, have rendered the greatest service in the develop- 
ment of rational methods of dealing with that most common and 
most destructive disease of civilized peoples—constipation. 
Forty years’ experience and observation in dealing with 
chronic invalids, and careful study of the results of the modern 
X-ray investigations of the colon, together with observations made 
at the operating table in many hundreds of cases, have convinced 
the writer: 
1. That constipation with its consequences is the result of 
the unnatural habits in relation to diet and colon hygiene which 
prevail among civilized people. 
2. That patients are not constipated on general principles, 
but that there exists in every case of constipation some particular 
condition which is the immediate cause of the delayed intestinal 
movement, and which must be removed before definite relief can 
be obtained, and that in the great majority of cases this cause is 
some real and tangible difficulty which may be removed by chang- 
ing the intestinal flora or by other available means. 
3. That practically every case of constipation is curable, and 
in all but exceptional cases without the air of surgery. It must 
be added, however, that by cure is not meant the working of such 680 
THE NEW DIETETICS 
a miracle that the colon will perform its function normally with- 
out attention to diet or other means which encourage colon ac- 
tivity, but rather that by observing certain rules and the faithful 
and continuous use of safe and simple means the colon may be 
made to perform its functions in a regular and efficient manner 
without the use of irritating laxative drugs. 
Constipation, though aggravated by errors in diet, is by no 
means wholly due to this cause, hence it must not be expected 
that by dietetic means alone all cases of constipation are curable. 
It is certainly true that food is the natural laxative. The act of 
taking foods stimulates peristaltic activity and it is more than 
probable that if from the start an individual adhered closely to 
the proper dietary eaten in a proper manner and took care to 
attend promptly to the call of Nature the normal intestinal rhythm 
would be maintained. These conditions, however, very rarely 
exist, and in consequence constipation is so nearly universal that 
the average individual feels himself the proud possessor of a 
normal colon if his bowels move once in twenty-four hours, 
whereas the savage declares himself to be “horribly constipated” 
when his bowels move but once a day. Normal bowel rhythm 
unquestionably demands at least three evacuations daily. 
The alimentary canal is long in man, ten times the length of 
his body. The colon is also long and sacculated like that of 
herbivorous animals. This fact predisposes him to constipation, 
which becomes inevitable under the ordinary conditions of our 
modern, civilized life. Constipation is universal among civilized 
people. A large proportion of the people of the United States 
are habitual users of laxatives of some sort. Cathartic or laxa- 
tive pills, aperients, liver regulators and mineral waters are manu- 
factured and used in enormous quantities, more extensively than 
any other drugs. Thousands of men and women who congratu- 
late themselves that they are in good health because their bowels 
move regularly once a day are nevertheless suffering from chronic 
intestinal stasis; that is, stagnation of the food residues and body 
wastes in the colon. The colon of a person whose bowels move 
once daily is constantly filled with putrefying residues which are 
retained in the body from two to three days undergoing decom- 
position and flooding the body with putrefaction products instead 
of being dismissed in 15 to 20 hours from the time the food 
was eaten, which is the normal intestinal rhythm. 
Modern studies of the physiology of the colon have demon- DIET IN DIGESTIVE DISORDERS 
681 
strated that the bowels should move at least three times a day, 
or once after each meal. An intake should naturally be followed 
by an output. Normally, no putrefaction occurs in the colon or 
in any part of the alimentary canal. When the food residues 
are dismissed from the body with normal promtpness, there is 
no time for putrefaction, the stools are yellowish in color and 
are free from the putrid and loathsome odor which is the usual 
characteristic of the stools of the average individual. 
Attention must be called to the fact that a person who has 
suffered from chronic constipation for many years has a colon so 
badly crippled that a dietary which would secure normal move- 
ments in a person possessed of a normal colon may be found 
inefficient. Thoroughgoing measures alone will succeed. These 
will include a very liberal supply of roughage, much more than 
a normal colon would require, and in addition copious lubrica- 
tion, which is quite necessary for the reason that in the crippled 
colon, mucus, the normal lubricant, may be largely lacking owing 
to the destructive action of colitis upon the mucus-secreting 
glands. These chronically crippled colons often present a mucous 
surface so dry that fecal matters adhere to it and the food resi- 
dues are pushed along only with the greatest difficulty. 
A person suffering with chronic constipation should first of 
all take the carmine capsule test (see Index) for the purpose of 
determining the motility of his intestine; that is, the time which 
elapses between the taking of a meal and the discharge of the 
unusable residues from the body. 
The next step is to follow faithfully the laxative regimen. 
(See Index.) 
The third step required is a change of the intestinal flora ; 
for it is quite impossible to secure regular and efficient activity 
of the colon without first restoring the normal, protective, acid- 
producing organisms, since the acids developed by these bene- 
ficent bacteria are the natural and necessary stimulants of the 
colon, as pointed out by A. Schmidt, many years ago. (For the 
method of changing the intestinal flora, see Index.) 
Cellulose and the layers of cork cells in bran are the chief 
laxative elements in foodstuffs. Being indigestible, when present 
in sufficient quantity, cellulose gives to the alimentary residues 
the bulk necessary to excite the muscular sense of the intestine 
and so give rise to the peristaltic contractions by which the un- 
usable residues and body wastes are transported through the 682 
THE NEW DIETETIC' 
colon and discharged from the body. Cellulose is found only in 
vegetable foodstuffs; hence animal foods of all sorts, meat, eggs 
and dairy products are constipating. Being wholly digestible and 
absorbable, they leave behind little residue. But the small resi- 
dues of these animal substances which reach the colon readily 
undergo putrefaction, and the products of putrefaction being 
alkaline paralyze the colon, which is rendered inactive by alkalies 
and stimulated to activity by acids. 
In addition to increasing the bulk of the food, lubrication 
is usually required. This may be secured by the use of paraffin 
in some form. The Russian paraffin oil renders the most valu- 
able service in these cases. Examination of the bowels and rec- 
tum generally shows, in cases of chronic constipation, a dryness 
of the mucous membrane. By the use of paraffin oil, which is 
not a food, undergoes no change and acts merely as a mechani- 
cal agent, the mucous surface is so lubricated that the fecal 
matters do not adhere but slip readily along, even when redun- 
dant development may have given rise to folds and kinks which 
are more or less obstructive, or when adhesions exist that offer 
mechanical obstacles to the progress of the alimentary residues 
along the colon. Half an ounce to an ounce of washed white 
Russian paraffin oil should be taken at each meal. Paraffin which 
melts at the body temperature is much more efficient than liquid 
paraffin. 
Much has been claimed for the special advantages of heavy 
mineral oils over the lighter oils. Bastedo, who made a careful 
comparison of the effects of oils of different specific gravity, 
found no difference between them. Experience has shown, how- 
ever, that a paraffin which melts at the body temperature, being 
solid at ordinary temperatures, is much more efficient than min- 
eral oils, and has the further advantage that it does not soil the 
clothing. 
By the application of the two measures above outlined, a low 
protein diet and some simple means for accelerating movement 
along the alimentary canal, putrefactive processes in the intestine 
may be controlled to a wonderful degree and the number of bac- 
teria may be greatly reduced. For best results, either bran or 
agar and the lubricating paraffin should be mixed in the entire 
meal instead of being taken before or after the meal or at some 
other time, as just before retiring at night. It is the meal itself 
which needs the roughage and the lubrication. These physiologi- DIET IN DIGESTIVE DISORDERS 
683 
cal aids to bowel movement do not act by irritation but by pro- 
moting physiologic action. 
This method of taking bran or agar and paraffin has been 
found by experience to be highly important. The method must 
be insisted upon in obstinate cases, for the reason that the food 
is not thoroughly mixed together in the digestive organs, as 
might be imagined but, unless readily soluble like sugar or a 
fruit acid, the foodstuffs pass along down the intestine in prac- 
tically the same order in which they are eaten. If bran and oil 
are taken before the meal, they proceed before it; or, if taken 
after, they follow along behind. For best results, it is essential 
that these helps to colon activity should not only accompany a 
meal, but each part of it. Otherwise efficient bowel action may 
not occur. The oil especially will be likely to be discharged by 
itself, thus giving occasion for unfortunate accidents and often 
much inconvenience; and the food residues, often including the 
bran or agar, are likely to remain behind in the cecum, which is 
frequently crippled badly by overstretching and adhesions, thus 
becoming a sort of cesspool in which putrefying refuse may be 
retained for days in succession. 
In persons whose colons are badly crippled by disease, 
through adhesions of the cecum or pelvic colon, and in cases of 
spastic constipation, the use of paraffin oil in connection with 
bran or agar is essential in addition to the use of laxative foods. 
Agar and paraffin oil should not be regarded as medicines. They 
are not drugs in the ordinary sense. Agar is a form of cellulose 
similar to that found in many foodstuffs. Paraffin oil is simply 
a mechanical lubricant. It has no resemblance to ordinary oils 
and fats except in appearance. It is a mineral product. It un- 
dergoes no change in the alimentary canal and is not absorbed. 
When properly refined and purified it may be used for an indefi- 
nite period without liability of injury, and in most persons who 
have suffered long from obstinate constipation the continued use 
of bran and paraffin or agar and paraffin is as much a necessity 
as the regular and continued use of foods. These substances 
should be regarded as supplementary foods. 
Paraffin should be taken with the meal and not before or 
after. It should be taken in divided doses so as to be distributed 
through the meal and thoroughly mixed with all the food eaten. 
It is the food which needs to be lubricated, not the intestine. If 
the intestine is lubricated, the mucous secretion always forming 684 
THE NEW DIETETICS 
will quickly remove the lubrication. If the food is lubricated, 
the lubrication travels with it and facilitates its movement along 
the intestine. In its ordinary form paraffin cannot be easily 
taken with food; but in emulsion diluted with water or milk it 
may be easily taken. Paraffin tablets, a form of paraffin which 
is solid at ordinary temperatures but melts at the body temper- 
ature, is also easily taken in divided doses with food. In this 
form paraffin is much more efficient than in the liquid form and 
does not “leak,” a property which removes one of the greatest 
objections to the use of paraffin. 
What has been said of paraffin is equally true of agar, bran 
and roughage in general. Bran, agar or greens of some sort, 
must be taken at every meal, and should be taken in divided doses 
so as to be mixed with the whole meal. 
The Use of the Enema* 
In certain cases of constipation the colon is so crippled that 
it cannot he readily made to assume its normal rhythmical action. 
In some such cases surgery may be needed to relieve some 
mechanical obstacle, but in the great majority of these cases 
by the proper use of the enema in connection with proper diet and 
the other measures named the colon may be trained to do its 
work in a fairly normal manner. In these cases the enema must 
be used regularly and daily. The best time is just before retiring 
at night, and the hour should be approximately the same daily. 
About three pints of warm (102° F.) water should be used, never 
more than four pints. The enema may be repeated if necessary 
to completely empty the colon, this being essential. After empty- 
ing the colon a cool or tepid enema, 80° to 70° F., should be used, 
quantity one pint. This will “tone” the bowel and prevent any 
possible injury from the use of this measure. The evening enema 
will not necessarily interfere with the after breakfast movement 
the next day and will prevent the overnight absorption of putre- 
faction products and overdistension of the colon with gas. 
When the ordinary enema does not empty the colon, it is 
useful to add some harmless colon stimulant. A natural stimu- 
lant of the colon is provided by Nature in the acids produced in 
the normal colon by fermentation. These are lost when putrefac- 
tion takes the place of fermentation and the ammonia and other 
putrefaction products produce paralysis of the colon. The effects 
of these constipating poisons may be overcome by an acid enema. DIET IN DIGESTIVE DISORDERS 
685 
This method occurred to the writer many years ago (1899) and 
has been used in hundreds of cases with much satisfaction. Either 
citric or lactic acid may be used. The amount required is the 
juice of a large lemon or one or two drams of lactic acid. 
The introduction into the colon at night of half a pint or 
more of cottonseed or some other vegetable oil is sometimes 
helpful in securing a morning bowel movement, but is likely to do 
harm by causing headache and nausea and lack of appetite, doubt- 
less on account of the large quantity of oil and the depressing 
effects of the oil upon gastric juice formation. When oil is to be 
used for this purpose, a special paraffin which melts at the tem- 
perature of the body should be employed. 
Dr. Winfield, of Brooklyn, New York, has published (1912) 
an account of the successful treatment of psoriasis by irrigation 
of the colon with lactic acid. Of 40 cases treated, 23 were re- 
ported cured, 16 improved. 
In cases in which the measures above indicated do not se- 
cure prompt relief from constipation, an X-ray examination by 
the aid of the barium meal should be made. By this means, a 
minute inspection of every part of the intestine is possible. In 
many cases, contractions, adhesions, displacements, and other 
impediments to normal bowel action are found, which may be 
corrected by the application of special measures. Such an ex- 
amination should be made in all cases of obstinate constipation. 
Food wastes should never be retained more than twenty-five 
or twenty-six hours at the longest, and the normal period is 
probably sixteen hours or less. Longer retention results in putre- 
faction and toxemia. 
Constipation is one of the greatest causes of disease, misery, 
inefficiency and premature senility, and should be most earnestly 
combated. By a persevering effort and the application of known 
and well tested measures, every case of constipation may be 
relieved. 
One of the most obstinate forms of constipation and one of 
the most common is the spastic constipation of chronic colitis. 
This form of constipation derives its name from the fact that 
its cause is a spastic or continuous contraction of the colon, 
usually the descending and pelvic colon. Because this condition 
accompanies colitE, it is often thought by many that br?n and 
other roughage should be avoided. This is entirely an error. 
Roughage is more needed in this form of constipation than any 686 
THE NEW DIETETICS 
other. Bran is of signal benefit in these cases. It is most im- 
portant that the mucous membrane should be kept clean. For 
this reason the colon should be emptied once or twice a day by 
a hot enema, which will not only cleanse the bowel, but will also 
relax it. The diet should contain an abundance of bran or agar 
and other roughage, which is needed to stimulate the dilated 
right portion of the colon to efficient activity. Paraffin oil is 
necessary as a lubricant, as long continued catarrhal inflamma- 
tion causes degeneration of the mucous glands and a loss of the 
normal lubricating mucus. 
In general, the diet should be the same as in ordinary consti- 
pation. 
Rules for Care of the Colon to Combat Constipation. 
First of all, change the flora (see Index) and then: 
1. Never neglect a “call.” Visit a toilet at once even at 
much inconvenience. A lost “call” is not easy to recover. 
2. Train the bowels to move three times a day. After 
breakfast, after dinner or luncheon and before retiring are the 
times when residues are ready for dismissal. If an extra move- 
ment occurs before breakfast, so much the better. 
3. Visit the toilet at regular times even if no “call” is 
present. 
4. Take plenty of time at the toilet. Read the morning 
paper. Crippled colons move slowly. 
5. Place a footstool eight inches high in front of the toilet 
seat. Squatting is the normal position during evacuation. 
6. Deep pressure with the fist just above the left groin 
often aids movement. 
7. The meals must be regular to make the bowels regular. 
Don’t miss a meal. Eat something if only an apple or an orange 
or two. 
8. Take plenty of time to eat. Chewing the food stimu- 
lates the colon to push the residues along. 
9. Eat no white flour bread and avoid condiments, meat 
and other constipating foods. 
10. Eat whole grain breads and cereals. Add an equal 
measure of bran to oatmeal and other cereals. Eat liberally of 
greens, fresh vegetables, dates, figs, prunes and all laxative foods. 
11. An orange or an apple at bedtime aids the morning 
evacuation. DIET IN DIGESTIVE DISORDERS 
687 
12. Drink a glassful of cold water at bedtime, on rising in 
the morning and every time the bladder is emptied. 
13. Every night and morning lie on the back and raise the 
extended legs high as you can ten to forty times. Get a set of 
good exercise records* and use morning and night. Walk 3 or 4 
miles, saw or split wood or work in the garden every day. 
14. Take a cold bath on rising. 
15. Take bran bread or biscuit and mineral or paraffin oil 
in some form at each meal, and in such a way as to mix with the 
whole meal; that is, not only at the beginning and end of the 
meal but during the meal. 
16. Take an enema at night occasionally to make sure that 
the colon empties well, or make the carmine capsule test (see 
Index). 
If necessary, take an enema every night*(three or four pints; 
repeat if necessary; see Index). Keep clean inside. If there is 
pain in the bowels, much gas or mucus in the stools, make the 
enema 105° F. to relax the bowel. After evacuation, take a 
second enema at 80° F. to tone up the bowels. This prevents any 
injury from the enema and helps to train the colon to more effi- 
cient action. 
17. Beware of Drugs. All laxative medicines, including 
mineral waters, are highly injurious. They make constipation 
worse and cause colitis. Agar, bran and mineral or paraffin oil 
are the only harmless laxatives. These are accessory foods rather 
than drugs. They may be used indefinitely without injury. 
19. When there is no “call,” stimulate the rectum with a 
small enema at 80° to 70° F. (half pint to pint). In case the 
enema does not return well, add the juice of a lemon. 
20. When the bowels are once regulated, be careful not to 
interrupt the rhythm. Make no experiments. Keep right on do- 
ing the things which succeed, every day and at every meal. 
THE ELIMINATION OF DISEASE GERMS FROM THE 
ALIMENTARY TRACT 
The elimination of germs from the alimentary tract is one 
of the most important things to be accomplished in dealing with 
most cases of chronic disease. Nature has provided very wonder- 
ful means of protecting the body against the invasion of disease- 
•The “Battle Creek Sanitarium Health Badder” is a good series. Made and 
sold by the Columbia Graphaphone Company. May be obtained of the Modern 
Medicine Publishing Company, Battle Creek, Mich. 688 
THE NEW DIETETICS 
producing germs, but the defense is often broken down, making 
the employment of special measures necessary. 
Stagnation or stasis is one of the conditions which favors 
bacterial development. It is for this reason that the bacteriology 
of the alimentary tract relates especially to the six cavities in 
which fluids or food residues are likely to remain for longer or 
shorter periods—the mouth, the stomach, the duodenum, the gall 
bladder, the cecum, and the lower colon. The methods of dealing 
with these several parts to rid them of disease-producing bacteria 
may be briefly summarized as follows: 
The Mouth. Diseased tonsils must be removed by the sur- 
geon or destroyed by the X-ray. Diseased teeth and gums must 
be dealt with by the dentist and the mouth put in a thoroughly 
sanitary condition by the dental hygienist, and kept sanitary by 
the proper use of the tooth-brush, the orange stick and paper 
polisher (Hygos) and the use of dry food. 
The Stomach. Normally, the stomach keeps itself clean and 
aseptic by its acid secretion, hydrochloric acid, which is produced 
at a strength of one-half of one per cent., equivalent to 1.25 per 
cent, of the C. P. acid of the pharmacy. When the acid-forming 
glands lose their function (achylia), the stomach becomes a dan- 
gerous breeding place for bacteria which rapidly spread to the 
intestine and infect connecting organs. 
The stomach may be cleansed to a degree by lavage, which 
is most useful in cases of pronounced catarrh of the stomach. 
Copious draughts of hot water an hour before meals is 
a crude but more or less efficient mode of cleansing the stomach 
which often renders great service in preparing the stomach for 
the next meal in cases of achylia. The free use of orange juice 
and other acid fruit juices is another highly useful means of com- 
bating the molds and bacteria which thrive in these deteriorated 
stomachs. 
The free use of acidophilus buttermilk is another measure 
of real value. 
Another efficient means is the use of acid protein (Acidone), 
a dram or two at each meal, the best known substitute for the nor- 
mal gastric acid, containing about 5 per cent, of 'HC1 in loose 
combination with protein. 
The employment of chemical antiseptics is useless, even worse 
than useless, because of the extra labor laid upon the liver and 
kidneys to destroy, distoxicate or eliminate them. DIET IN DIGESTIVE DISORDERS 
689 
The liberal use of fresh or uncooked foods and adoption of 
the two-meal-a-day plan with an interval of seven hours between 
meals are measures of great service in keeping the stomach and 
intestine free from bacteria. 
The Duodenum. This expanded, upper part of the small 
intestine receives the food from the stomach sterile, when the 
stomach produces a normal gastric juice, but often swarming with 
bacteria when gastric acid is lacking. Here, also, the bile is 
poured out. The bile may be a source of grave infection when the 
gall bladder has become an incubating chamber for typhoid or 
other disease germs, as is often the case after typhoid fever, in 
cases of infectious jaundice, and probably in many cases of diabe- 
tes. The duodenum is the receptacle of poisons constantly poured 
into it from the blood after absorption from the colon. 
Infection of the duodenum may also occur by the backing 
up of infectious material from the colon, a reflux permitted by an 
incompetent ileocecal valve. The duodenum is one of the great 
storm centers of the body. Bacteria and their poisons concen- 
trate here and initiate troubles which extend to other parts. 
The Gall Bladder. The liver secretes bile more or less con- 
tinuously. The gall bladder stores up the bile and pours it out in 
small portions to neutralize the acid fluids coming in jets through 
the pylorus at frequent intervals during gastric digestion. Most 
of the bile is re-absorbed. It thus becomes concentrated and, 
when infected, the infection inevitably becomes more and more 
intense. The infection may extend into the pancreas and cause 
pancreatitis or diabetes. Ulcer may develop and, in rare cases, 
cancer. Constant exposure of the liver to these concentrated 
poisons after a time results in sclerosis. 
The duodenum and the gall bladder must be dealt with to- 
gether. By means of the duodenal tube, the duodenum may be 
washed out and even disinfected. The disinfection may be chemi- 
cal or biologic. The chemical disinfection is simply an imitation 
of the normal process. A solution of hydrochloric acid (one- 
fifth of one per cent.) is slowly passed into the duodenum during 
one hour three times a day. Biologic disinfection is accomplished 
by passing through the tube a whey culture of B. acidophilus and 
a solution of lactose. 
The gall bladder is drained once a day and the bile examined. 
The draining is repeated daily until the bile is light colored. By 
this means, the concentrated toxin-laden bile is gotten rid of. 690 
THE NEW DIETETICS 
For most thoroughgoing effects, the duodenal tube will be 
kept in situ for some days, a week if need be, and two or three gal- 
lons of water will be passed through daily. The nourishment 
should exclude protein and fats almost wholly. Milk sugar, malt 
sugar and fruit juices should constitute the nourishment. Rice 
gruel, vegetable broths, savora broth and purees of fruits and 
vegetables may be added after the first three or four days. Most 
of the large quantity of water introduced will find exit through 
the kidneys. Some of it may be discharged as watery stools. 
By these thorough-going measures, the duodenum and gall 
bladder may be cleared of mischief-making bacteria, (the bile as 
well as the flora may be changed and the tissues of the body 
cleared of tissue wastes and accumulated poisons. 
The Cecum. The head of the colon normally receives the 
food residue, absorbs two-thirds of its water, and then pushes 
the mass across the transverse colon and so gives it a good start 
toward the exit. But the cecum often becomes a widely dilated, 
adherent, inert pouch, a stagnant reservoir of putrefying food 
residues and a source of almost infinite mischief. This condition 
is very common in cases which have undergone operations for 
appendicitis, and especially in cases of so-called chronic appendi- 
citis. The ileocecal valve is always incompetent and hence there 
is no hindrance to the extension of the infection into the small 
intestine and the development of all the evil results of auto- 
intoxication. Headache and neurasthenia in most pronounced 
forms are frequently associated with this condition. 
The pernicious flora of the cecum may be attacked from both 
directions. By feeding massive doses of lactose or acidophilus 
culture or of the two combined, the colon bacillus, Welch’s bacil- 
lus, B. putrificus and other putrefactive bacteria, may he driven 
out. By flushing the colon with copious enemas twice daily and 
the injection of cultures of B. acidophilus, the change of flora 
may be greatly aided. 
The Lower Colon and Rectum. These parts are more easily 
reached and quite readily yield to the combined attack of lactose 
feeding and colon cleansing followed by freshly prepared cul- 
tures of active strains of B. acidophilus. 
The importance of keeping the lower intestine free from pu- 
trefying residues is emphasized by the recent discovery of the 
facility with which matters are transported upward from the colon 
by reverse peristalsis. Charcoal introduced into the colon at night DIET IN DIGESTIVE DISORDERS 
691 
may often be found in the stomach in the morning. X-ray ex- 
perts (Case and others) have witnessed the return over night to 
the duodenum of opaque meals which had reached the trans- 
verse colon and have seen material almost instantly transported 
from the lower colon to the cecum. That reverse peristalsis is a 
very common cause of general infection of the upper intestine, 
especially in cases of spastic constipation, cannot be doubted. 
When the ileocecal valve is incompetent there is no protection 
against this cause of broadcast infection of the whole intestine 
from colon to stomach, together with the gall bladder and gall 
ducts and even the stomach itself. Both ends of the alimentary 
canal must be safeguarded. The mouth must be closed against 
infectious material in food or drink; the colon must be kept 
freely open for the evacuation of putrescible residues. 
After the use of all these measures, an anti-toxic laxative 
diet must be scrupulously followed for an indefinite period, meats 
of all sorts must be rigorously excluded from the dietary, and 
bran or agar and mineral oil must be freely used to keep the colon 
free from residues. By these means the body may be freed and 
kept free from its most deadly and insidious foes, the bacteria 
which infect the alimentary canal. 
DIET IN CHRONIC COLITIS 
Chronic colitis is an exceedingly common disease which 
seems to be increasing. It is especially prevalent in cities and 
not infrequently affects whole families. 
The cause of colitis is chronic infection of the mucous mem- 
brane of the colon. The disease may involve simply the lower 
part of the bowel or the entire colon. In time, the disease may 
extend to such a degree as to involve the entire intestinal tract 
from the stomach to the rectum. In the majority of cases, the 
disease is most active in the descending colon and the pelvic 
colon. In the rectum, the disease is known as proctitis. The cause 
of the disease is infection of the mucous membrane. The condi- 
tion of the mucous membrance in colitis has been compared to 
the state of the colon in eczema. The two diseases exist simul- 
taneously in many cases. The infection is not known to be due 
to a specific organism but is the result of the contact with the 
mucous membrane of the various putrefactive organisms, com- 
mon pus-forming germs which abound in street dust, in putrefy- 692 
THE NEW DIETETICS 
ing meat, and are found especially in the dejecta of meat-eating 
animals. 
In some chronic cases, the disease is aggravated by the pres- 
ence in the intestine of protozoa—minute animal organisms. This 
form of colitis is very frequent in the tropics. 
Colitis is an infection of the colon. The disease owes its 
origin chiefly to the use of flesh foods, a fact first pointed out by 
Combe years ago. 
Chronic colitis may follow an attack of typhoid fever or of 
paratyphoid, or it may be the result of acute infection, as of 
botulism and of meat poisoning or an attack of dysentery or 
diarrhea. 
First of all, it is necessary for the intestinal flora to be 
changed (see Index), then kept clean by a laxative diet (see 
Index), and, if necessary, by the daily use of the enema. The in- 
troduction into the colon of large quantities of cultures of pro- 
tective ferments such as B. acidophilus is a measure of value. 
It is necessary to lay great emphasis upon the importance of 
roughage in the treatment of this disease, a fact to which Von 
Noorden was one of the first to call attention. The colitis is not 
due to mechanical irritation, but to the chemical irritation of 
bacterial poisons. It should be noted, also, that bran and cellu- 
lose of any sort, in the form in which it reaches the colon, is not 
capable of causing mechanical irritation. Its condition is com- 
parable to that of wet fpaper. Bran does not irritate, but titil- 
lates, a fact which needs to be often reiterated, for the reason 
that the laity, as well as many physicians, have become so thor- 
oughly imbued with the idea that roughage is liable to produce 
harmful irritation—an error which has been productive of an 
enormous deal of harm and is very hard to uproot. 
In cases in which the patient’s apprehension respecting the 
possible harm from the use of bran is so great as to produce a bad 
psychological effect, agar may be substituted. It must be freely 
used and nearly always in connection with paraffin. Lubrication 
is needed for the reason that in many cases the mucous glands 
have become so diseased that they have ceased to produce the 
normal lubricating mucus and the mucous membrane is left in a 
dry condition, which causes the coherence and retention of food 
residues, even when an excess of mucus is present. The mucus 
is often of such a character that it encourages obstruction of the 
bowel rather than clearance. Paraffin, especially a solid form of DIET IN DIGESTIVE DISORDERS 
693 
paraffin, which melts at the temperature of the body, is of great 
service in these cases. Not infrequently, the injection of half a 
pint of warm paraffin with a melting point of 102", is found of 
gieat service in promoting good bowel action the following morn- 
ing. 
The idea that bland foods should be used in these cases is 
wholly erroneous. Whole grain preparations, such as oatmeal, 
graham bread, etc., even bran, greens and other fresh vegetables 
and stewed fruits, may be freely used with advantage. 
Still more important is the use of lactose, or lacto-dextrin, 
in liberal quantities. When taken in sufficient amount to fill the 
alimentary tract, lacto-dextrin is a very efficacious food remedy 
against colitis. It acts by producing in the colon a luxuriant 
growth of acid-forming organisms, discouraging the growth of 
Welch’s bacillus and other putrefactive organisms, the growth 
of which is encouraged by a diet rich in protein, and particularly 
by meat proteins. Lactose, or lacto-dextrin, may be introduced 
directly into the colon with advantage. A good plan is to wash 
the bowel out with a hot enema (105 F.), and after the colon 
is completely emptied, to introduce a half pint or a pint of warm 
starch water containing half an ounce of cornstarch and an ounce 
of lactose. 
A diet which encourages intestinal putrefaction will promote 
colitis. Hence, meats of all sorts must be discarded. All flesb 
foods swarm with the bacteria which give rise to colitis. 
In some cases even eggs must be discarded as they may do 
harm by encouraging the growth in the colon of the germs to 
which the disease is due and by increasing their virulence. 
Kohnstann rightly insists that meat should be excluded from 
the diet of constipated persons because it will intensify the auto- 
intoxication. In colitis the danger of autointoxication is great 
because the filtering power of the intestine is greatly diminished. 
This was demonstrated by Hamburger and Monte, who experi- 
mented with antitoxin. Their observations showed that, although 
taken into the system very readily when injected under the skin, 
antitoxins introduced into the normal rectum are not absorbed to 
any appreciable amount. This is an excellent demonstration of 
the filtering power of the normal intestine by which it offers 
resistance to toxins generated in the alimentary canal. It was 
found also that when colitis exists, this filtering power is largely 
lost. The same loss of filtering power has been shown to be 694 
THE NEW DIETETICS 
produced by the administration of calomel, saline laxatives and 
other cathartic or laxative drugs. 
According to Fuld, colitis is rare in Russia, a fact which he 
attributes to the vegetarian diet of the Russian peasant. 
The so-called mucous colitis does not essentially differ as re- 
gards either the methods of its production or the treatment re- 
quired from other forms of chronic colitis. It is not a nervous 
disease, as has been assumed by many writers, but an infection 
which is accompanied by nervous symptoms, the natural result 
of the poisons which are freely absorbed by the irritated, con- 
gested mucous membrane. In cases in which parasitic infection 
exists, the use of suitable anthelmintics is necessary, in addition 
to dietary regulation. 
Acute Colitis—Dysentery, 
This disease is an acute infection of the colon due to in- 
vasion of either bacteria or minute animal organisms known as 
protozoa. This may be a new infection or simply an exaggeration 
of an old one. The attack may involve the colon only or both 
colon and small intestine. The usual management of acute colitis 
is bad. The first measure generally suggested is a cathartic for 
emptying the bowel, which is much like applying a mustard 
plaster to an inflamed skin surface. It should be remembered 
that only in cases of mechanical obstruction is there likely to be 
an accumulation in the small intestine. This part of the intestinal 
tract is practically always found empty within six to eight hours 
after the last meal. The small intestine always faithfully per- 
forms its part in pushing on into the colon reservoir everything 
which should be disposed of in this way. 
In view of these facts, it is evident that catharsis in colitis is 
a most irrational procedure. The colon is simply a pouch with 
an external opening and it can be emptied of its contents almost 
as easily as a pocket in one’s coat. By means of the enema re- 
peated as often as may be required, the offending contents of the 
colon may be readily removed. The cathartic leaves the whole 
intestine in a state of increased irritation and damages the bowel 
in such a way as to lessen its power of resistance to bacteria and 
bacterial poisons. A simple enema, on the other hand, cleanses 
the diseased surface, and by the use of warm starch water (one- 
half ounce to the pint, boiled for five minutes) for the enema, a 
decided emollient effect is produced. This may be repeated sev- DIET IN DIGESTIVE DISORDERS 
695 
eral times a'day, or often as needed. The addition to the enema 
of half an ounce of lactose to the pint is an exceedingly useful 
means of combating the development of the bacterial causes of 
the condition and promoting a luxuriant growth of non-putrefac- 
tive, acid-forming organisms. 
The diet should be strictly antitoxic. It should first consist 
of cereals only in the form of gruels, to which lactose or dextrin 
should be added in the proportion of two ounces to the pint. 
Three or four pints of gruel may be used in the course of twenty- 
four hours. This will greatly aid in changing the intestinal 
flora. It is better to withhold meats of all sorts, as well as eggs, 
tor several days or until the acute symptoms have wholly sub- 
sided. 
During the first twenty-four hours, the diet may consist of 
sugar water and oatmeal or barley water, with lacto-dextrin, two 
ounces to the pint. As the acute symptoms diminish, which 
usually occurs within twenty-four hours or less, gruels and cereal 
preparations of greater consistency are added. 
Next, vegetable broths and purees of vegetables, sweet and 
sub-acid fruits may be taken. Banana puree and puree of dates 
may be taken quite early, together with puree of spinach. 
The direction given by mosi authors to feed albumin water 
early in the disease and later scraped meat, is quite irrational and 
wholly out of joint with the clear indication of pathology and 
physiology. 
The recommendation of whisky and claret in this disease, 
found even in quite recent works on dietetics, is worthy only of 
most unqualified condemnation as having no sound basis what- 
ever in experimental therapeutics or clinical experience. 
When the patient has recovered from an acute attack of 
colitis, care should be taken to follow a strict anti-toxic diet and 
to keep the flora changed by frequent and liberal use of lactose or 
lacto-dextrin. Great care must be taken to keep the colon empty. 
This may require for some weeks a daily enema at bed-time, since 
acute colitis usually leaves the colon, especially the descending 
colon, in a highly irritated and spastic state, which may continue 
for several weeks after acute symptoms have subsided. 
The tendency of acute colitis to develop into the chronic 
form of the disease is almost inevitable. This result can only be 
prevented by vigilant attention to the diet, avoiding meats of all 
sorts and even using eggs sparingly. High meats and stale eggs 696 
THE NEW DIETETICS 
are especially unwholesome and dangerous. Cold storage eggs, 
chicken, game, oysters, with other “sea food,” are especially to 
be condemned. Constant attention must be given to the intestinal 
flora. The stools must never be allowed to become putrid. The 
bowels should move three times a day. 
DIET IN HYPERCHLORHYDRIA OR HYPERACIDITY 
(See also page 985) 
This, one of the most frequent and important of all func- 
tional disorders of the stomach, was the despair of therapeutists 
until the researches of Pavlov made clear the nature of the diffi- 
culty and pointed out rational methods of cure. The pain of 
hyperhydrochloria usually occurs two or three hours after eat- 
ing, but may occur during the meal or immediately after. In 
many cases there is constantly present in the stomach a larger 
or smaller quantity of intensely acid secretion. The gastric crises 
which occur in locomotor ataxia and certain forms of migraine 
and in connection with certain other maladies are usually asso- 
ciated with hyperhydrochloria. 
The pain experienced is in most cases probably due to spasm 
or violent contraction of the pylorus. 
No better illustration could be found of intelligent defen- 
sive effort on the part of the body than may be noted in con- 
nection with this disease. There are at least three distinct de- 
fensive processes: (1) The increase of saliva, the purpose of 
which is to neutralize the bile by its alkalinity. In some instances 
an exceedingly profuse flow of saliva is observed. (2) A reflux 
of bile into the stomach. This is not an infrequent circumstance 
in connection with hyperhydrochloria and is distinctly pallia- 
tive, since the bile neutralizes the acidity of the gastric juice by 
its alkalinity and also precipitates the pepsin present. (3) Loeb 
has called attention to the fact that in hyperhydrochloria the 
ammonia of the urine is very considerably diminished. This 
accounts for the large amount of neutral chlorin which is found 
in the stomach in these cases. Hayem and Winter long ago called 
attention to the fact that in hyperhydrochloria the acid chlorin 
(coefficient “a”) is often much below normal, sometimes being 
reduced to an extraordinarily low figure. This is due to the fact 
that a large amount of the chlorin has been neutralized by com- 
bination with ammonia which has been diverted from the usual DIET IN DIGESTIVE DISORDERS 
697 
channels of discharge to be used for this defensive purpose. The 
actual amount of ammonia is increased because of the intense 
intestinal putrefaction always present, a fact which has been 
observed by many authors. 
Fuld has called attention to the fact that constipation is 
both a result and a cause of hyperchlorhydria, and Ebstein has 
shown that hyperchlorhydria is improved by relief from consti- 
pation. 
Professor Taylor, of Philadelphia, mentions the fact that cer- 
tain experiments have shown that absorption of poisons frQm the 
colon may excite an excessive production of gastric acid. 
Roger, who made an elaborate study of the toxins produced 
in the alimentary canal under various conditions, demonstrated 
that one of the functions of the stomach is to excrete poisons 
from the blood. He holds that these poisons may be derived from 
intestinal putrefaction. One of the functions of the stomach 
seems to be to eliminate the poisons absorbed from the intestines. 
Roger found the toxicity of the contents of the stomach of the 
vegetable-feeding rabbit to be only one-third as great as that of 
a dog fed on meat. 
It appears to the writer that the evidence is very strong that 
the intestinal toxins excreted by the stomach are a leading factor 
in the production of hyperhydrochloria, and that the excessive 
secretion of hydrochloric acid is a part of the defensive effort of 
the body in combating these toxins. It has been shown that the 
gastric juice destroys a considerable number of the enterotoxins, 
and it may be for this purpose primarily that the excess of acid 
is poured into the stomach. 
In the treatment of hyperhydrochloria it is evident, then, 
that the first and most essential thing to be done is to combat 
intestinal autointoxication. The writer’s experience in the prac- 
tical application of this theory to the treatment of cases of hyper- 
hydrochloria has been most satisfactory. But there are many 
other causes of hyperacidity which must be taken into considera- 
tion. 
While it is probable that the quality of the secretion pro- 
duced by the acid-forming glands of the stomach never varies, 
there is no doubt that the amount of acid produced, or at least 
the amount of acid found in the stomach, varies considerably. 
The normal gastric fluid found in the stomach after a test meal 
contains about one-fifth of one per cent, of hydrochloric acid. 698 
THE NEW DIETETICS 
The amount of free or uncombined acid is about one-fourth or 
one-half this proportion, or one-twentieth to one-tenth of one per 
cent. 
The unpleasant symptoms attributed to hyperacidity or 
hyperhydrochloria are due to the presence of an excess of free 
acid; that is, acid which has not entered into combination with 
the protein of the food in the process of digestion. It may 
happen, then, that hyperacidity is due either to an excessive pro- 
duction of acid in the stomach or to failure of the acid produced 
to enter into combination, thus becoming an irritant. 
The amount of acid formed by the stomach in the digestion 
of a meal depends primarily upon the character of the food. All 
physiologists confirm the observation of Pavlov that animal food- 
stuffs produce a higher degree of acidity than do vegetable foods, 
the average acidity for beef being 120; for eggs 80; and vege- 
tables, 70. Milk produces greater acidity than do eggs. Bread 
and cereals produce the lowest degree of acidity. The degree 
of acidity produced by animal foodstuffs is equal to that which 
is universally regarded as pathological and indicative of disease. 
From this fact the inference may be clearly drawn that the 
habitual use of meats must tend to produce a diseased condition 
of the stomach. Low acidity may be due to severe anemia, to 
gastritis, to a regurgitation of alkaline secretions from the in- 
testine, or may be of purely nervous origin. 
The causes which may give rise to hyperacidity are numer- 
ous. The following may be mentioned as those which are best 
known: 
Meats. Pavlov showed by experiments upon dogs that meats, 
that is, animal flesh, fish, fowl and shellfish as well as ordinary 
meats, when taken into the stomach cause the production of 
highly acid gastric juice. The normal gastric juice produced by 
dogs is for this reason much more acid than that produced by 
human beings. It is interesting to note that when a man eats the 
diet to which a dog’s stomach is naturally adapted rather than his 
own proper bill of fare, his gastric glands are stimulated to meet 
the emergency by producing a gastric juice like that ordinarily 
produced by the dog. Protein requires a highly acid gastric 
juice for its digestion. This is doubtless due to the fact that 
protein absorbs hydrochloric acid, entering into combination 
with it as does soda and other alkalies. For this reason persons 
suffering from hyperacidity are usually made very comfortable DIET IN DIGESTIVE DISORDERS 
699 
by a meal consisting largely of meat. This fact is deceptive and 
led to the practice of feeding patients suffering from hyperacidity 
on a meat diet. Prior to the publication of Pavlov’s epoch-making 
book on the digestive glands, scraped beef, raw beef and meat in 
other forms as an exclusive diet, so-called Salisbury steaks, was 
the universal remedy for hyperacidity. A meat diet gives tem- 
porary comfort in these cases by neutralizing the hydrochloric 
acid but at the same time stimulates the gastric glands more and 
more to the production of an increased quantity of acid. 
Hyperacidity is a disease from which great meat-eaters are 
especially likely to suffer. There are physicians who, not aware 
of Pavlov’s work, prescribe a meat diet in this disease and with 
more or less temporary success, but their patients usually fall 
into the hands of surgeons later for operation for gastric or 
duodenal ulcer. 
Meat Extracts. Pavlov’s observations also demonstrated the 
fact that the extractives of meat stimulate the acid-forming 
glands of the stomach to a very high degree. Hence bouillon and 
animal broths of all sorts must be discarded in the treatment of 
hyperacidity. 
Milk. Next to meat, milk, including cheese and other dairy 
products, stimulates the acid-forming glands of the stomach, this 
action being due to the large amount of protein present in milk 
in the form of casein. 
Cane Sugar excites the acid-forming glands to a very high 
degree. Malt sugar, milk sugar, and honey, a mixture of levu- 
lose and dextrose, differ from cane sugar in this respect and may 
usually be eaten in moderate quantities, often quite freely, in cases 
of hyperacidity. 
Dextrin. Pavlov showed that crude dextrin is a powerful 
excitant of the gastric glands. This fact affords an explanation 
of the frequent occurrence of heartburn as the result of the free 
use of oatmeal in the form of porridge and other cereals eaten 
in the pasty condition resulting from long boiling. New bread is 
objectionable for the same reason, the central or soft portion of 
the loaf being often swallowed in doughy lumps which reach the 
stomach without being acted upon by the saliva. It has recently 
been shown by Marshall that undigested starch in large amount 
in the stomach absorbs the pepsin of the gastric juice and thus 
prevents the acid from entering into combination with the pro- 
tein of the food and so increasing the free hydrochloric acid. 700 
THE NEW DIETETICS 
Highly Flavored Foods. These create an excess of highly 
acid appetite juice by over-stimulation of the gustatory nerves. 
Hot Foods. These over-excite the gastric glands, congest the 
stomach, and when excessively hot may even give rise to injuries 
of the gastric mucous membrane which may ultimately cause 
ulcer and, according to Dr. William Mayo, may become a cause 
of cancer. While over-production of gastric acid under the in- 
fluence of heat has not been demonstrated by laboratory experi- 
ment, there are clinical reasons for believing that excessively hot 
food and drinks do produce this effect. 
Ices. When ices are taken with the food they interrupt the 
process of digestion and delay the exit of the food from the 
stomach, thus giving rise to the production of an excess of free 
acid. 
Water. Pavlov showed that when water is taken in more 
than very small quantities, gastric acid is increased. Hence, free 
water drinking at meals must be forbidden for persons suffering 
from hyperacidity. 
Acids. Acids of all sorts increase the production of gastric 
acid. Mineral acids and acid protein, that is, protein with which 
acid has been combined, produce this effect in a very high degree. 
Pavlov recommended the administration of gastric juice obtained 
from the stomachs of dogs as a means of stimulating the stomach 
to produce an increased amount of acid in cases of hypohydro- 
chloria, or deficient formation of acid. This method has never 
become popular. 
A preparation of acid protein known as Acidone contains 5 
per cent, of hydrochloric acid, equivalent to 12.5 per cent, of the 
C. P. hydrochloric acid of the pharmacy. A quarter of an ounce 
of this preparation is equivalent to 15 minims (30 drops) of 
C. P. hydrochloric acid or half an ounce of the dilute hydro- 
chloric acid of the pharmacy. Acidone or its equivalent should 
be constantly used by persons suffering from extreme hypoacid- 
ity or achylia. 
Fruit Acids. The citric acid, malic acid, and tartaric acid 
found in fruits are much less stimulating to the gastric glands 
than is hydrochloric acid, but are more or less stimulating and in 
most cases of hyperacidity must be on this account forbidden 
until the patient’s condition has been improved. It should be 
noted, however, that in many cases the intolerance of acid fruit 
is due, not to an excess of acid, but to a hypersensitiveness due DIET IN DIGESTIVE DISORDERS 
701 
to a disordered condition of the gastric nerves rather than to 
over-stimulation of the gastric glands. The same is doubtless 
also true as regards the acid of the gastric juice. The distress- 
ing symptoms of which patients complain may be due not to an 
excess of acid but hypersensitiveness resulting from disease. 
Tomatoes. These contain citric acid and, with rhubarb, 
a poisonous plant which contains oxalic acid, are objectionable 
on the same grounds as acid fruits. As patients recover, toma- 
toes are better tolerated, especially moderately acid varieties, but 
rhubarb should be definitely discarded as unwholesome and 
poisonous, irrespective of its injurious effect upon the stomach. 
Butyric Acid. As found in “strong” butter and rancid oils, 
this is highly irritating to the acid-forming glands of the stomach. 
Tannic Acid, found in large amount in tea, is objectionable 
on the same ground; it also precipitates pepsin leaving the gastric 
acid free and so irritating. 
Vinegar. Because of the acetic acid present, vinegar is al- 
ways unwholesome and is particularly injurious in cases of hyper- 
acidity. It interferes with starch digestion. 
Buttermilk. Buttermilk contains lactic acid and so is objec- 
tionable in severe cases of hyperacidity, though ordinarily well 
tolerated. 
Alcohol. It has long been known that alcohol excites the 
activity of the gastric glands. It has been used for this purpose 
by physiologists in experiments upon the stomach. The obser- 
vations made by Chittenden and Sir William Roberts show that 
while alcohol stimulates the stomach to make an increased amount 
of gastric juice, including gastric acid, it destroys the activity of 
the juice by precipitating the pepsin. This action of alcohol, by 
preventing the combination of the free acid with the protein of 
the food, renders it a direct cause of hyperacidity and necessitates 
its total prohibition in any form in persons suffering from hyper- 
acidity. So-called light wines and beer are objectionable just in 
proportion to the amount of alcohol which they contain. 
Tobacco. It is well known that smoking often gives rise to 
the excessive production of acid in the stomach. It has been 
shown experimentally by Gy and others, that digestion is hin- 
dered by smoking. 
Caffein. This active constituent of tea and coffee directly 
excites the acid-forming glands of the stomach. The theobromin 
of cocoa produces the same effect. Tea, coffee, cocoa, and mate 702 
THE NEW DIETETICS 
or Paraguay tea, are objectionable for the same reason. Kaffe< 
Hag, though said to be free from caffein, is nevertheless objec- 
tionable because of the tannic acid and phenolic bodies which it 
contains, which excite the acid-forming glands besides being 
otherwise injurious. Most cereal coffees are harmful for the same 
reason. 
Condiments. Under this head are included mustard, pep- 
per, cayenne, ginger, cloves, spices, horse-radish, Worcestershire 
sauce, and all similar substances, which excite the acid-secreting 
glands of the stomach and thus produce hyperacidity. It is true 
that after being used for some time, the gastric secretion is less- 
ened, but this only occurs when the glands have been destroyed 
by degeneration, the result of chronic irritation and overwork. 
Common Salt. When taken in considerable amount, salt in- 
duces hyperacidity through interfering with digestion (Debove), 
by furnishing an excess of the material from which the gastric 
acid is made. In hyperacidity the use of salt should be restricted 
at least to very minute quantities. 
Carbonated Water. It is objectionable in hyperacidity be- 
cause the gastric glands are stimulated by carbonic acid. 
Errors in the Manner of Eating. These are without doubt in 
a large measure responsible for hyperacidity in many cases. 
Hurried Eating permits the food to enter the stomach in 
large masses which, being retained for a long time, may cause the 
over-accumulation of acid in the stomach. 
It has been shown that cooked starch, which enters the 
stomach without being mixed with a sufficient amount of saliva 
to change it to dextrin, absorbs the pepsin of the gastric juice 
and thus leaves in the stomach contents an excess of free or 
uncombined hydrochloric acid, causing acidity. 
Over-Eating, by over-stimulation of the gastric glands, like- 
wise produces an excess of acid. 
Too frequent eating produces hyperacidity by giving the 
stomach no opportunity for rest. When food is taken into the 
stomach the gastric mucous membrane becomes congested and the 
glands are filled with blood. After the completion of the diges- 
tion of a meal, the stomach should have an opportunity for rest 
and complete clearance before the next meal is taken, so that the 
blood-vessels may be relieved. When a meal is taken before the 
stomach is empty, the stomach has no opportunity for rest or 
clearance and hyperacidity is one of the resulting ill effects. DIET IN DIGESTIVE DISORDERS 
703 
Eating between meals is objectionable for the same reason 
as too frequent meals. It is rare that more than three full meals 
a day can be taken without injury. The only exceptions are cases 
in which the amount of food taken is small and the kind of 
food such as will leave the stomach in an hour or two. In such 
cases, four meals or even more may be necessary to supply the 
body with the proper amount of nutriment. If food is to be 
taken more than three times a day, it is highly important that 
close attention should be given to the kind of food taken and the 
exact spacing of the meals so that they shall not overlap. The 
common practice of recommending patients to take milk or 
other food between meals, while at meal times taking ordinary 
foods which do not usually leave the stomach within less than 
five or six hours, is strongly to be condemned. 
Excessive chewing must be mentioned as another cause of 
hyperacidity. Chewing, as shown by Pavlov, produces appetite 
juice. The stomachs of persons suffering from hyperacidity 
usually contain constantly an excess of acid. Consequently, in 
such persons it is not necessary that the stomach should be pre- 
pared for a new intake of food by prolonged chewing, as urged 
by Mr. Fletcher; in fact, long chewing becomes in hyperacidity a 
means of aggravation of the existing morbid conditions. On this 
account persons suffering from hyperacidity to an extreme degree 
should take all their foods in the form of purees or porridges. 
The food should be swallowed with very little chewing. Thin 
soups should be avoided because they contain an excessive amount 
of water which stimulates acid formation (Pavlov). 
Cereals and other farinaceous foods which have been well 
dextrinized, are best suited for use when much chewing is to be 
avoided. Zwieback softened with hot water or milk and such 
foods as Granola, Zo, Vita-Bits, Grape Nuts and other dextrin- 
ized cereals softened with some hot liquid, are suited to cases of 
this sort. 
Constipation. It is a quite common observation that chronic 
constipation is an almost universal accompaniment of hyperhy- 
drochloria. An explanation is to be found in the fact that in 
constipation the long retention of the foodstuffs in the colon 
affords good opportunity for a considerable amount of putrefac- 
tion in which there is a digestion of proteins by bacteria and the 
production of poisonous peptones. Pavlov showed that peptone 
is one of the most powerful of all stimulants of the gastric glands. 704 
THE NEW DIETETICS 
This is shown to be true even when the peptone is introduced per 
rectum through the absorption of the peptone by the mucous 
membrane of the colon and its excretion into the stomach. The 
same occurs in cases of colitis in which the filtering power of the 
mucous membrane is largely lost. Absorption of the poisonous 
peptones and other products of putrefaction takes place in still 
larger amounts in cases of incompetency of the ileocecal valve, in 
which there is a backing up of putrid materials from the colon 
into the small intestine where absorption takes place with great 
facility. This condition is very common in cases of hyperhydro- 
chloria. 
Mental and nervous influence may give rise to hyperacidit) 
through the gastric nerves. That worry and anxiety cause this 
condition is well known. 
It is also well known that the reflex influence of a diseased 
gall bladder or duodenal ulcer may give rise to a very high degree 
of hyperacidity, which disappears when the exciting cause is re- 
moved. 
Another probable cause of gastric and duodenal ulcer is the 
reverse peristalsis which recent experiments have shown to be of 
much more frequent occurrence than was formerly believed. 
X-ray observation and laboratory experimentation, as well as 
clinical experience, indicate that the contents of the colon are 
often transported upward, reaching not only the duodenum and 
the stomach but even the mouth by a gentle, almost impercept- 
ible, antiperistaltic movement which is especially active in persons 
who. are constipated. It has long been known that duodenal 
liquids are frequently found in the stomach. It is entirely pos- 
sible that this action is not purely local, but that it begins in the 
colon and is simply an extension of the natural, now well recog- 
nized, antiperistalsis of the right half of the colon upward along 
the small intestine. Through this action peptones and other prod- 
ucts of digestion which are known to be highly stimulating to the 
gastric glands, are carried backward, and when brought in con- 
tact with the gastric glands stimulate them to abnormal activity. 
It is entirely possible that this is the cause of the continuous and 
exaggerated gastric secretion which is found in a considerable 
number of cases. DIET IN DIGESTIVE DISORDERS 
705 
Influences Which Lessen the Secretion of Hydrochloric Acid, 
Pavlov showed that fats of all sorts, and particularly olive 
oil, have a powerful influence to check the formation of acid by 
the gastric glands. This is only true, however, when the fats are 
perfectly fresh, that is, free from butyric acid, the presence of 
which is disclosed by a strong or rancid flavor and which excites 
the gastric glands. 
Pavlov also showed that cereals give rise to a gastric secre- 
tion which is low in acid but high in digestive power, that is, 
rich in pepsin. The observations of Pavlov have been confirmed 
by the experimental work of Carlson, of the University of Chi- 
cago, and Boldyreff, Chief of the Pavlov Physiological Institute of 
the Battle Creek Sanitarium. 
By taking the food in the form of puree, so that no chewing 
is required in passing it through the mouth quickly, the gus- 
tatory nerves are only slightly stimulated and less appetite juice 
will be produced. 
The observations of Hemmeter showed in experiments upon 
animals that the withdrawal of salt from the food may cause the 
total disappearance of acid from the gastric secretion. It is 
known that the gastric acid is lessened in cases of fever. It has 
been determined that in fever there is a marked tendency to the 
retention of chlorid of sodium in the tissues. It is quite possible 
that a positive relation may exist between these two facts. It is 
certain that when it is desirable to lessen the secretion of hydro- 
chloric acid by the stomach, the intake of chlorid of sodium 
should be reduced to the lowest limit or at least common salt 
should be taken only in very small amounts. 
In the majority of cases of hyperacidity complete relief may 
be obtained by the following simple measures, which have been 
used with success in the treatment of many hundreds of cases: 
1. The discarding of meats, condiments and all other things 
which are known to excite the secretion of gastric acid. (See 
above.) 
2. All food should be taken in the form of puree or por- 
ridge and should be chewed very little. Dextrinized cereals 
should be the principal foods. 
3. In many cases, milk must be avoided but generally cream 
may be taken in moderation. In some cases butter is preferable 
and, in general, butter should be freely used. 706 
THE NEW DIETETICS 
4. No salt should be added to the food and the amount used 
in seasoning the food should be greatly reduced. By gradual 
diminution its absence will not be missed. The butter used should 
be without salt. If such butter is not obtainable, the butter should 
be washed so as to remove the salt present. 
5. The bowels should be made to move freely three or four 
times a day by the use of a laxative diet (see Index), a quarter of 
an ounce of bran or a third of an ounce of agar at every meal, and 
half an ounce of paraffin oil in some form taken before and after 
every meal. An enema should be taken at bed time two or three 
times a week. If considerable fecal matter is shown by the 
enema to be present, the enema should be used every night until 
the colon has been trained to more efficient action. There is no 
ground for the fear that bran will aggravate the difficulty by 
irritating the stomach. It cannot be too often repeated that bran 
does not irritate; it titillates. 
6. Measures should be adopted to change the intestinal 
flora. 
7. The following foods should be absolutely and perma- 
nently discarded: Cane sugar, tea and coffee, alcoholic drinks of 
all sorts, carbonated waters, condiments of all sorts, meats of 
every description, also meat broths and extracts, much salt and 
salty foods, vinegar and pickles; and water drinking at meals 
must be avoided. 
8. Olive oil must be used freely. The quantity should not 
be less than half an ounce at each meal and twice the amount is 
required in some cases. The amount should be increased to the 
point of tolerance if the acidity is not relieved without. It should 
be remembered, however, that gastric pain, which is usually 
attributed to hyperacidity, may in some cases be due to disease of 
the gall bladder, in which case the use of olive oil may give only 
slight relief or even none at all. If the oil “repeats,” it should be 
taken in teaspoonful doses at first, the quantity being gradually 
increased. 
It is also to be borne in mind that pain accompanying hyper- 
acidity is not always due to an excess of acid but is often due 
to an abnormal sensitiveness of the gastric mucous membrane, 
and this condition may exist even when there is no excess of 
acid, or when acid is absent. 
In all cases in which relief is not obtained by the measures 
herein suggested for hyperhydrochloria, tube feeding, as recom- DIET IN DIGESTIVE DISORDERS 
707 
mended for duodenal ulcer, should be resorted to. In these ob- 
stinate cases, it is quite probable that gastric or duodenal ulcer 
may exist, either with or without disease of the gall bladder. 
Careful investigation should be made to determine whether or 
not disease of the gall bladder is present, by X-ray examination 
and also by drainage of the gall bladder by the non-surgical 
method of Metzger and careful bacteriological examination of the 
bile. 
In extreme cases, it is sometimes necessary to adhere closelv 
for a time to the diet recommended for gastric and duodenal 
ulcer. 
GASTRIC AND DUODENAL ULCER—PEPTIC ULCER 
The cause of gastric and duodenal ulcers is still a subject of 
discussion. The existence of the so-called peptic ulcer has re- 
cently been called in question. To the writer, it seems most 
reasonable to regard the ulcer as due to infection resulting from 
loss of general or local resistance, or both. Recent observations 
showing the probable relation between pyorrhea and a dietary 
lacking in vitamins, suggest the possibility that gastric and duode- 
nal ulcers may be due to the same cause, and may be associated 
with focal infections of the mouth. 
Of all dietetic problems, the feeding of cases of gastric and 
duodenal ulcer is one of the most important, most interesting and 
most difficult of solution. It is now generally recognized that, 
aside from surgical procedures, dietetic measures are practically 
the only ones which afford substantial relief in these cases. Nearly 
all cases may be more or less relieved by proper dietetic treat- 
ment and by far the greater majority of cases, at least nine out 
of ten of the milder class of cases of duodenal ulcer, may be 
temporarily, if not permanently, relieved. 
There is in these cases an inveterate tendency to relapse. 
This tendency is so marked that a well-known surgeon being 
asked the question, “When should surgery be resorted to in cases 
of duodenal ulcer,” replied, “When they have been cured nine 
times.” It is probable that in a large proportion of cases relapse 
might be prevented by very careful adherence to a specific dietary. 
Unfortunately, however, the average ulcer patient does not con- 
sider himself cured of his ulcer unless able to return to his ordi- 
(See also page 986) 708 
THE NEW DIETETICS 
nary diet, which is invariably the dietary well calculated to 
develop ulcer and very likely to lead to a relapse. Relapse is in 
such cases almost inevitable for the reason that the first occur- 
rence of the ulcer is evidence that the resistance of the body to 
the causes which produce ulcer of the stomach and duodenum 
has so broken down that the development of ulcer can in the 
future be prevented only by careful avoidance of all the causes 
known to be provocative of these conditions, particularly those 
foodstuffs which unduly tax the energies of the stomach and 
weaken its defense by prolonging the digestive period with over- 
stimulation of the gastric glands, such as meats. 
The first symptoms of the disease, cancer of the stomach, 
which carried off Napoleon, made their appearance some seven 
years before, after he had eaten a shoulder of mutton cooked with 
garlic. He doubtless had at that time a gastric ulcer, which was 
a prominent factor in his downfall, and on which later developed 
the cancer which caused his death. 
Every case of gastric and duodenal ulcer should be studied 
by an X-ray expert to determine, if possible, the location of the 
ulcer and whether or not it is a so-called penetrating ulcer. This 
examination is also important for the reason that it often throws 
light upon the question of the presence of cancer, always a possi- 
bility in these cases, especially when the seat of disease is the 
stomach. When cancer is present an operation, if the case is 
operable, is the only course which offers any hope for the patient. 
An operation is also imperatively indicated when the ulcer 
involves the pylorus; for the reason that an ulcer in this region is 
certain sooner or later to cause delay in the emptying of the 
stomach, because of mechanical obstruction at the outlet. When 
marked obstruction is actually present, as shown by long reten- 
tion of the food in the stomach, operation is positively indicated. 
Very profuse hemorrhage or repeated hemorrhages, whether from 
the stomach or duodenum, as shown either by the vomiting of 
blood or by bloody stools, is an urgent indication for operation. 
According to Charles H. Mayo, an investigation made in the 
Mayo Clinic of 438 cases of duodenal ulcer which had been 
operated on, showed that, from the standpoint of the patient, 70 
per cent, considered themselves well following gastro-enteros- 
tomy, 25 per cent, were improved and 3 per cent, unimproved. 
The mortality was about 1.6 per cent. 
An analysis of 500 cases of duodenal ulcer treated at the DIET IN DIGESTIVE DISORDERS 
709 
Battle Creek Sanitarium, made by Dr. E. L. Eggleston, (Jour, of 
A. M. A.), showed a cure with no relapse within three years in 
70 per cent, of all cases treated. A course of treatment extend- 
ing over not less than five weeks was found necessary for a cure 
and it was also found to be essential that the patient should fol- 
low permanently a carefully regulated regimen. 
If the X-ray examination shows that the ulcer is penetrating 
in character, that is, if it has formed a deep pocket through 
more or less destruction of the muscular walls of the stomach, an 
operation is clearly indicated for the reason that these ulcers are 
seldom, if ever, permanently cured by other than operative mea- 
sures and are dangerous because likely to penetrate into the 
peritoneal cavity. 
It is now generally conceded by experienced practitioners 
that most well-developed gastric ulcers require surgical attention, 
for radical or permanent relief is not likely to be obtained by any 
other means. Some gastric specialists ,who claim to be able to 
cure practically all cases of gastric and duodenal ulcer are evi- 
dently not thoroughly informed respecting the history of their 
patients after they pass out from under their care. The writer 
remembers some years ago having been informed by a famous 
London gastric specialist that he felt no hesitancy in promising a 
cure in practically all cases that came under his care. A week or 
two later during a visit to Moynihan’s clinic at Leeds, reference 
was made to this statement, when the famous surgeon remarked, 
“Yes, Dr. cures them and then they come to me for 
operation. We generally have some of his patients with us.” 
DIETETIC TREATMENT IN CASES OF GASTRIC AND 
DUODENAL ULCER 
Cases of gastric and duodenal ulcer usually make rapid im- 
provement when the stomach can be permitted to rest from diges- 
tive activity. A most efficient plan of treatment introduced in 
this country by the elder Flint, was starvation. 'More than 40 
years ago, the writer treated cases of this sort with success by a 
fast of one to two weeks. In one case thus treated more than 30 
years ago, in which the patient was nearly exsanguinated by loss 
of blood, the patient remained in good health for more than 10 
years and then suffered a relapse which was cured in the same 
way, after which the patient remained in good health for a num- 
ber of years before she was lost sight of. 710 
THE NEW DIETETICS 
Complete fasting is, however, no longer necessary since the 
duodenal feeding tube has been devised. By duodenal feeding, 
the stomach can be given rest while the body is being supplied 
with needed nourishment. The duodenal feeding tube is so small 
and flexible that it is easily swallowed, and after the first few 
hours it gives practically no inconvenience, so that it may be re- 
tained in place for several days, even two or three weeks, without 
giving rise to either serious discomfort or injury of any sort. 
Thus tube feeding is beneficial in cases of gastric and duo- 
denal ulcer, not only through giving the stomach rest but because 
of the reflux of bile which allays irritation by neutralizing the 
acid gastric contents. The bile also precipitates the pepsin and 
so stops its digestive action on the ulcer. The tube thus secures 
results similar to those of the operation of gastroenterostomy and 
so may sometimes take its place. 
Some excellent gastroenterologists question the value of the 
duodenal feeding tube on the ground that it produces mechanical 
irritation. It is entirely possible that the brilliant success which 
has followed the use of the tube would have been equally or even 
more successful if suitable oral feeding had been employed. The 
writer feels certain that any case of gastric or duodenal ulcer 
which does not require surgery can be cured by gastric rest and 
carefully graduated feeding. 
It is now generally conceded by experienced practitioners 
that most well developed gastric ulcers require surgical attention 
for radical relief. 
It is a common practice to administer through the tube six to 
nine ounces of food every two hours. A better practice is to give 
a small amount at hourly intervals. The food should be very 
slowly introduced. It should be remembered that the duodenum 
normally receives food very slowly, during a period of about four 
hours. Three times a minute, the stomach ejects about half a 
teaspoonful of liquid through the pylorus into the duodenum, or 
one ounce every five minutes. When large quantities are forced 
into the duodenum at one time, the result is a reflux into the 
stomach. This, of course, in part defeats the purpose of this 
special mode of feeding, which is to give the stomach rest, so 
that the diseased surfaces may not be subjected to the irritating 
efifect of contact with food. 
The ideal plan of feeding is to introduce the food at the rate 
of about two ounces every fifteen minutes, omitting the feeding THE STOMACH AFTER GASTROENTEROSTOMY 
THE STOMACH AFTER POLYA OPERATION 
FOR CANCER 
DUODENAL FEEDING DIET IN DIGESTIVE DISORDERS 
711 
the last quarter of each hour. Continue this for four hours, 
then allow a rest for one hour. A good schedule is to start the 
feeding at seven o’clock in the morning; continue until eleven 
o’clock; rest for one hour; resume at twelve o’clock; continue 
until four; rest again from four to five; begin feeding again at 
five o’clock and continue till eight or nine o’clock. 
The food having an energy value of 30 calories to the ounce, 
the hourly intake would be 180 calories, and the amount for each 
feeding period 720 calories. The total intake for the day will 
depend upon the number of hours during which the feeding is 
continued. Eight hours will give 1440 calories; ten hours, 1800 
calories; twelve hours, 2160 calories. 
The food should never be forced into the duodenum by 
means of a syringe. Instead, it should be permitted to run in 
slowly by gravity, as shown in the accompanying cut. The patient 
soon learns to regulate the inflow in such a way as to produce no 
discomfort or other inconvenience. 
The amount of liquid introduced daily should be two or 
three quarts. 
The patient should not only remain quiet but should remain 
as much as possible in the open air. The cure is facilitated by a 
fomentation over the upper abdomen, repeated two or three 
limes a day. In the intervals bettween the fomentations, the heat- 
ing compress should be applied. The cold mitten friction or 
cold towel rub should be employed twice a day, and light mas- 
sage of the arms, legs, back, and lower abdomen should be given 
daily. Sun baths and arc light baths are also exceedingly helpful. 
Care should be taken to empty the colon at least twice a day 
by a thorough enema, which should consist of three or four pints 
of water at 105° F., followed, after evacuation of the bowels, by 
two pints at 80° F. It is well, also, to administer an ounce of 
paraffin three times daily. The patient may take sips of water 
through the mouth, but large quantities of water should not be 
taken for the reason that water in quantity stimulates the pro- 
duction of gastric acid, as shown by Pavlov. Two or three pints 
of water should be introduced into the colon daily to insure an 
adequate water intake. 
As regards gastric ulcer, it must be admitted that there is 
so strong a tendency to relapse that serious cases usually fall into 
the hands of the surgeon at last. The danger of fatal hemor- 
rhage or of the later development of cancer is sufficiently great 712 
THE NEW DIETETICS 
to justify operation in every severe case of ulceration of the 
stomach or duodenum. 
There is little danger of cancer from duodenal ulcer, and the 
results of treatment are usually better than in cases of gastric 
ulcer. It must be remembered, however, that every patient who 
has once suffered from gastric or duodenal ulcer and who has 
been relieved by treatment or by operation must faithfully ad- 
here to a careful, antitoxic regimen, avoiding meats, tea and 
coffee, much salt, condiments and other things that excite the 
gastric glands. 
The foods best adapted to duodenal feeding are gruels re- 
enforced with malt sugar or milk sugar and egg yolks or purees 
of spinach. An emulsion known as malted nuts has proved to 
be an excellent food in these cases, for which it has been very 
extensively employed for more than 20 years at the Battle Creek 
Sanitarium. Milk or buttermilk with yolks of eggs and an addi- 
tion of cereals make an excellent combination. The egg yolk 
should be cooked until thickened, then rubbed smooth with a 
little milk and more milk added until a uniform mixture is 
obtained. Raw white of egg is indigestible, encourages intesti- 
nal putrefaction, and should never be used. 
Sugar Formula. In 15 ounces of hot water, dissolve 9 ounces 
of milk sugar. When completely dissolved, add water sufficient 
to make 20 ounces. Each ounce of the mixture will represent 50 
calories of carbohydrate. The mixture should be boiled to ster- 
ilize it and then kept on ice to prevent fermentation. This sugar 
solution is to be used as an addition to other food mixtures and 
also to water and fruit juices. Twenty ounces is the amount to 
be used daily. Milk sugar is not only a food, but aids greatly 
by encouraging the establishment of a normal intestinal flora. 
Lacto-Dextrin. In many cases, dextrin or lacto-dextrin 
is found superior to milk sugar (lactose). It is equally valuable 
as an aid to growth of the B. acidophilus in the colon (change of 
flora) and does not produce nausea, as lactose does in some cases. 
It should be used in the same quantities. 
As combinations suited for tube feeding, may be mentioned 
egg yolks and buttermilk, egg yolks with fruit juice, sugar water, 
or gruels prepared from rice, oatmeal, millet, soy flour, toasted 
rice gruel, gruel prepared from brown rice. Most excellent are 
malted gruel, potato gruel, banana flour gruel, puree of spinach, DIET IN DIGESTIVE DISORDERS 
713 
bean broth, orange juice, tomato juice, acidophilus buttermilk and 
v/hey cultures of B. Acidophilus. 
It is important to note in duodenal feeding, as in all other 
special dietaries, that the necessity for a daily adequate supply 
of vitamins, lime, and iron must not be overlooked. These ele- 
ments are equally as important as are fats, carbohydrates, and 
proteins. 
Vitamins are found in rich abundance in greens, orange 
juice, tomato juice, milk and yolk of eggs. In many foodstuffs 
vitamins are deficient, especially in cereals. Butter or cream is 
an essential ingredient of duodenal feeding mixtures because of 
the important fat-soluble vitamin which it supplies. Careful 
balancing of the diet is as necessary in duodenal feeding as in 
ordinary feeding. Yeast extract (Savita) is most useful as a 
source of iron and vitamin. Malted nuts ,is rich in iron and in 
this respect is preferable to milk or malted milk. 
Each of the following formulas consists of 9 ounces and is 
sufficient for one hour’s feedings. 
Malted nuts 1 oz. 
Curdled egg yolk one 
Orange or tomato juice 2 oz. 
Water 1 6 oz. 
Protein, 40; fat, 120; carbohydrate, 70; total calories, 230. 
20 per cent, gluten meal 1 oz. 
Cream , 3 oz. 
Tomato juice 2 oz. 
Savita (yeast extract) teaspoonful 
Water 3 oz. 
Protein, 30; fat, 150; carbohydrate, 150; total calories, 330. 
Rice gruel 6 oz. 
Cream 2 oz. 
Egg yolk y2 oz. 
Savita 1 teaspoonful 
Protein, 21 ; fat, 145 ; carbohydrate, 45 ; total calories, 211. 
Potato puree 4 oz. 
Bean broth 2 oz. 
Cream 1 oz. 
Savita *4 teaspoonful 
Water 2 oz. 
Protein, 24; fat, 88; carbohydrate, 112; total calories, 224. 714 
THE NEW DIETETICS 
It is not wise to use the same formula continuously. The 
formula should be changed each day, or two or three of the 
above formulas may be used in alternation on the same day. 
In feeding with the duodenal tube, it is highly important to 
avoid introducing too large a quantity at once. It is to be re- 
membered that the food is passed into the duodenum from the 
stomach in small quantities, about a teaspoonful at a time, and 
at the rate of one teaspoonful a minute. It is evident, then, that 
the introduction of large quantities of food into the duodenum 
would be likely to create disturbance. The more nearly contin- 
uous the feeding can be made the better. Two ounces every 15 
minutes is an ideal plan. In most cases the patient himself can 
learn to manage the feeding with proper instructions. 
The Gluten-Feeding Method. 
It is well known that proteins enter into combination with the 
hydrochloric acid of the gastric juice. This combined acid is far 
less irritating than free acid. This fact is the basis of the gluten- 
feeding method. Forty per cent, cooked gluten meal is used for 
the purpose in the form of gruel with the addition of cream, but- 
ter or olive oil. The butter must be perfectly sweet. The follow- 
ing is a feeding schedule -which will be found highly satisfactory. 
First Day. Feeding formula: gruel prepared with 40 per 
cent, gluten meal. Teaspoonful of Savita. One ounce of gluten 
meal, eight ounces of water. Either no salt or a very little. Two 
ounces of cream. Water to make eight ounces. Calories, 200. 
The mixture supplies 25 calories per ounce. 
Give two tablespoonfuls (one ounce) every hour from 7 
A. M. to 9 P. M., 375 calories. 
Second Day. Feeding formula: the same as the first day. 
Feed one and a half ounces every hour from 7 A. M. to 9 
P. M., 560 calories. 
Third Day. Feeding formula: two ounces 40 per cent, 
gluten; three ounces cream; one and a half ounces milk sugar or 
lacto-dextrin. Water to make one pint. Food value 40 calories 
per ounce. 
Feed one and a half ounces every hour from 7 A. M. to 9 
P. M. Total, 900 calories. 
Fourth Day. Feeding formula: the same as the third day 
with the addition of one egg yolk at the 8, 10, 12 A. M. and 2, 4 
and 6 P. M. feedings. Total calories, 1,272. DIET IN DIGESTIVE DISORDERS 
715 
Fifth Day. Feeding formula: may be exactly the same as 
the fourth day with the addition of another ounce of milk sugar 
to the pint. Total calories, 1,422. 
Sixth to Ninth Day. Feeding formula: 40 per cent, gluten 
mush, cream, rice puree, olive oil, curdled egg, feeding every two 
hours, 7,9, 11 A. M., 1, 3, 5, 7 P. M. Total calories, 2,100. 
Tenth to Fifteenth Day. Feeding formula: the diet con- 
sists of gluten mush, peas puree, cottage cheese, boiled rice, rice 
flakes, granola mush, cream, graham toast, potato puree, brose 
with butter, purees of lentils or spinach and other fresh vege- 
tables, malted nuts, olive oil, butter. Total calories, 2,200 to 
2,500. 
After a course of treatment for gastric or duodenal ulcer, 
the diet for hyperchlorhydria should be adopted permanently. 
The old plan of rectal feeding while giving the stomach rest 
has largely been abandoned. It was found, as a matter of fact, 
that the introduction of foodstuffs into the lower bowel sets up 
at once retroperistaltic movements which create a state of unrest 
of the whole intestinal tract. There is reason to believe, also, that 
rectal injections may excite gastric secretion. This may be 
brought about by reflex action through the absorption of putrid 
substances and perhaps more actively still by the actual transpor- 
tation of some of the injected material from the colon to the 
stomach by antiperistaltic action. 
Lenhartz's Method. 
This method, which has been greatly extolled and widely 
employed, consists in keeping the patient in bed and feeding for 
several days on a mixture consisting of milk, beaten eggs and 
sugar. The first day the diet consists solely of two raw eggs and 
100 c. c. ounces) of milk. The second day three eggs are 
given and the milk increased by 100 c. c. Each day till the sixth 
day the amount of food is increased by one egg and the addition 
of 100 c. c. of milk. Each following day up to the tenth cEv, 
the milk is further increased by the addition of 100 c. c., and the 
patient takes every day in addition four beaten raw eggs and 
four soft cooked eggs with approximately an ounce of sugar. 
Beginning with the seventh day, the patient is given a little more 
than two ounces of scraped beef and three ounces of boiled rice. 
The boiled rice is continued daily and gradually increased to ten 
ounces. On the eighth day an ounce of zwieback is given and 716 
THE NEW DIETETICS 
increased day by day to two ounces by the end of two weeks. 
After the tenth day an ounce or two of chicken is allowed. 
If anybody ever recovered from gastric ulcer by the aid of 
this treatment it must certainly have been because the previous 
diet had been so exceedingly unwholesome that even this absurd 
diet was an improvement. 
The Von Lettbe Diet. 
This diet differs very little from Lenhartz’s method. The 
diet consists during the first days of small and frequent feedings 
of milk, five ounces every hour during five hours, beginning at 
7:00 A. M., nothing being given in the afternoon. After the 
first three days and for a period of eight days, the diet consists of 
ten ounces of milk at 7:00 to 9:00 A. M. At 11 :00 A. M. ten 
ounces of milk with barley or oatmeal water. At 1 :00 P. M. a 
beaten egg with a cup of bouillon. 3: 00 to 5:00 P. M. ten 
ounces of milk. 7: 00 P. M. milk and barley water. 9:00 P. M. 
ten ounces of milk. After the eleventh day the amount of food 
given is increased and crackers added. After the seventeenth day 
chops and mashed potatoes are added to the diet. 
This diet, like that of Lenhartz, is calculated to stimulate 
rather than to restore the stomach and possesses no merit what- 
ever except in the smaller quantity of food which is given during 
the first few days. 
The Alkaline Treatment. 
The alkaline method consists in the administration of a large 
dose (one dram) of subnitrate of bismuth before the first feed- 
ing and between feedings every morning; before the first meal 
and half way between feedings, ten grains each of magnesia and 
bicarbonate of soda, alternating with a powder consisting of 20 
to 30 grains of bismuth and 10 grains of bicarbonate of soda. 
For the first two or three days the food consists of milk and 
cream, equal parts, one to two ounces every hour from 7:00 
A. M. to 7:00 P. M. After two or three days soft boiled eggs 
and well cooked cereals are added. At the end of ten days the 
diet will consist of three ounces of milk and cream every hour 
and one soft boiled egg and three ounces of cereal of some sort, 
each three times a day. Care is taken to avoid giving more than 
six ounces at one time. Frequent tests are made of the acidity 
and care is taken to make sure that no free acid exists in the DIET IN DIGESTIVE DISORDERS 
717 
stomach during the night. This is prevented by giving two or 
three alkaline powders between 7:00 and 10:00 P. M. By the 
third week, the patient is taking a sufficient amount of food to 
secure an actual gain in weight. Irritating foods are avoided for 
many months. Meats are permitted. 
The author of this method claims to be able to cure prac- 
tically all conditions due to gastric ulcer with the exception of 
perforation, abscess, carcinoma, hour-glass stomach, hemorrhage, 
and a high degree of pyloric obstruction. It is conceded that 
these conditions require surgical interference. It is claimed that 
obstructions due to ulcer are in the majority of cases the result 
of spasm and that this will usually disappear under treatment 
within three or four weeks. 
It is objected to this plan of treatment that the administration 
of alkalies, while temporarily neutralizing the free hydrochloric 
acid present, tends to increase the amount of acid secreted by the 
gastric glands. Its advocates have certainly been somewhat over- 
enthusiastic respecting the results obtained. 
Gastric Acidity Due to Organic Acids, 
The stomach is remarkably insensitive to hydrochloric acid, 
tolerating a percentage of this acid which no other tissues in the 
body can endure; but the gastric mucous membrane is often 
highly sensitive to organic acids. This condition may be the re- 
sult of a morbid state developed by the free use of these acids 
in certain foods as, for example, the use of acetic acid in the 
form of vinegar, pickles, hard cider or sour wines. In some 
cases the mild organic acids of sour fruits cannot be tolerated. 
This is particularly true of tartaric acid, the acid of grapes, and 
the oxalic acid of rhubarb. The milder acids of apples (malic) 
and oranges (citric) are better borne, though even these are not 
always well tolerated. Certain stomachs will not even bear the 
mild acidity due to the lactic acid of sour milk. The stomach 
is often highly sensitive to butyric acid as found in butter or oils 
which are not perfectly fresh and in old cheese. Occasionally 
lactic, acetic and even butyric acid may be formed in the stomach 
as the result of fermentation. This usually occurs in cases in 
which there is long delay of the foodstuffs in the stomach either 
from atony or more frequently from organic obstruction of the 
pylorus. 
In these cases the acids which produce discomfort must be 718 
THE NEW DIETETICS 
avoided and the patient must be given a diet as free as possible 
from acidity. Certain fruits, such as very ripe bananas in the 
form of puree, fresh pears, sweet apples, dates and raisins are 
usually acceptable; but even these non-acid fruits must not be 
taken in too concentrated form. Cane sugar must be avoided as 
it usually has the same effect as acids. Candy of all sorts and 
sweet desserts must likewise be prohibited. The diet must be as 
unirritating as possible and must consist largely of purees of 
cereals, potatoes and other vegetables. Bran may be used in 
these cases without ill effects. Care must be taken to keep the 
bowels free from putrefying residues. The daily use of the 
enema is sometimes required for this purpose, but the free use 
of bran and paraffin will usually secure adequate bowel move- 
ments. The colitis which is frequently present in these cases must 
likewise receive attention. 
Gastric Atony* 
Atony of the stomach is rarely, if ever, a purely local disease. 
It is only a part of a general condition of debility and lack of 
tone. Not only the stomach is relaxed but there is generally a 
relaxed condition of all the muscles of the body. There is usually 
a sense of fulness in the stomach and inability to deal with 
liquids, lack of appetite and frequent regurgitation. Splashing 
sounds in the stomach due to the presence of both liquid and air 
are sometimes so loud and frequent as to be a source of em- 
barrassment. A state of atony or debility affects not only the 
stomach but the whole alimentary canal. There is usually obsti- 
nate constipation. There may be colitis with frequent bowel 
movement, but a spastic contraction of the descending colon is 
likely to be found present. The relaxation of the abdominal 
muscles is evidenced by the protruding lower belly. The patient 
usually sits in a completely relaxed or slumped position, and in 
the standing posture the forward carriage of the head and loss 
of the normal contours of the spine are evidence of the relaxed 
condition of the muscles of the trunk and clearly indicate the 
lack of energy characteristic of these cases. Examinations of 
the stomach fluid show either achylia or an excess of gastric 
acid. 
The scraped meat usually prescribed for cases of this sort 
is highly objectionable. A crippled stomach is much less well 
prepared to deal with foods of this sort than is the normal DIET IN DIGESTIVE DISORDERS 
719 
stomach, and the result is to promote to a high degree infection 
of the intestinal tract and the development of the intense toxemia 
which may be the primary cause, a condition which presents an 
insurmountable obstacle to recovery as long as it exists. 
The food should be thoroughly masticated. The meals should 
be small, never more than five or six hundred calories. Even 
smaller meals are better in certain cases. Water should be taken 
at meals only in very small quantities, the less the better. The 
same is true of bouillon and other liquids. Even milk and butter- 
milk are better avoided. It is a good plan for the patient to take 
a couple of glasses of hot water a full hour before each meal. 
The putrid stools which are usually present in these cases indicate 
the importance of changing the intestinal flora. This may be 
best accomplished by the use of lacto-dextrin in liberal doses 
continued over a considerable period of time. The dose should 
be from two to four ounces three times a day, sufficient to flood 
the alimentary canal with the carbohydrates which are best cal- 
culated to promote a luxuriant growth of the B. acidophilus. 
Meats of course must be carefully avoided, particularly fish and 
other “sea food.” Bran and bran preparations should be freely 
used. It is one of the best forms of roughage for cases of this 
sort. Mineral oil should also be used in liberal doses. When 
considerable acid is present, the food should be taken in the 
form of purees and one or two dessert-spoonfuls of olive oil 
should be taken at each meal. A moderate amount of fresh 
butter may be used, but beef and mutton fats should be carefully 
avoided. A moderate amount of sterilized cream may be used. 
Nut butters and vegetable fats are preferable to animal fats. 
Fried foods, rich pastry, tea and coffee and all other unwhole- 
some foods must of course be strictly avoided. 
DIET FOR HYPOCHLORHYDRIA AND ACHYLIA 
(See also pages 988, 989) 
A deficiency or total absence of hydrochloric acid is encoun- 
tered in about half the cases of gastric disorder. The overwork 
of the acid-forming glands which causes hyperchlorhydria natur- 
ally results in the premature wearing out of the glands so that 
hypochlorhydria is a natural sequence of hyperchlorhydria. In 
the advanced stages of chronic gastritis and in advanced malig- 
nant disease, either of the stomach or of any other part of the 720 
THE NEW DIETETICS 
body, hydrochloric acid is likely to be absent. Pepsin may be 
either absent or present. It is important to determine whether 
or not the pepsin-forming glands have undergone degeneration. 
This may be ascertained by a simple test. If the digestive activity 
of the stomach fluid obtained after a test meal is restored by the 
addition of hydrochloric acid, this means that pepsin is still 
formed. It is possible that pepsin may be absent from the gastric 
juice although the glands which secrete pepsin may not be de- 
generated, lacking only the necessary stimulus to bring them into 
activity. In such cases the administration of acid protein (Aci- 
done) will stimulate the activity of the glands. 
Normally about one-fourth of the hydrochloric acid secreted 
by the stomach is absorbed or neutralized by mucus. In cases of 
gastric catarrh, the enormous excess of mucus may neutralize 
nearly the entire gastric secretion. In such cases, acid protein 
should be freely used if well tolerated. 
The functions of hydrochloric acid in the process of diges- 
tion are so numerous and varied that the loss of this element of 
the gastric juice is necessarily attended by more or less grave 
consequences. This will readily appear when we recall that the 
hydrochloric acid of the gastric juice not only aids the digestion 
of protein but closes the upper or cardiac orifice of the stomach, 
disinfects the food, activates pepsin, opens the pylorus, closes the 
pylorus, stimulates the flow of the bile and of the pancreatic juice, 
activates the pancreatic juice and hence is highly essential to good 
digestion. One of the worst of the consequences of the lack of 
hydrochloric acid is infection of the stomach and intestine 
through the loss of the disinfecting function of the gastric acid. 
Hence it is that bacteriological examination of the stools reveals 
the presence of vast numbers of pernicious bacteria, in conse- 
quence of which the stools are very foul and in many cases 
colitis is present. The ileocecal valve is generally incompetent, 
gastric catarrh and catarrh of the gall bladder are found in a 
very large proportion of cases and the occurrence of gall stones 
is frequent. 
The diet in hypochlorhydria is less restricted than in almost 
any other condition except that of perfect health. Acid fruits 
should be used freely. To a slight extent the acids of fruits are 
a substitute for gastric acid and aid digestion when pepsin is 
present. The intake of fat should be small. An ounce a day is 
sufficient to meet all physiologic needs. Large quantities of fat DIET IN DIGESTIVE DISORDERS 
721 
are objectionable because their presence in the stomach, in some 
way not understood, hinders the secretion of hydrochloric acid 
when this function is not wholly lost. Fat also delays the passage 
of food from the stomach. This action appears to be entirely 
independent of the secretion of acid by the stomach. When fat 
is taken in large amount it is likely to be retained in the stomach 
a long time and, in the absence of gastric acid, fermentative and 
putrefactive changes are likely to take place, with the result that 
the fat becomes rancid and the patient may suffer from heartburn 
and great distress with vomiting of rancid gastric contents. 
Persons suffering from achylia and with very marked hypo- 
chlorhydria should make daily use of acid protein. Acid protein 
(Acidone) is prepared by adding to pure vegetable protein about 
15 per cent, of C. P. hydrochloric acid. This preparation may be 
used freely and without inconvenience by mixing it with other 
foodstuffs, such as thick soup, porridge, mashed potato or other 
vegetable purees. It not only aids the stomach in performing its 
digestive work, but stimulates the gastric glands to produce their 
normal secretion. Hydrochloric acid, as ordinarily used, accom- 
plishes little because of the extreme smallness of the dose com- 
pared with the amount required to do actual digestive work. As 
ordinarily administered, the amount of acid given is less than 
one-twentieth the amount normally produced for the digestion of 
a single meal. The amount is too small to render appreciable 
service. 
It is an error to suppose that flesh foods are to be recom- 
mended when hydrochloric acid is deficient or absent, a con- 
clusion which might be drawn from the fact that meats of all 
sorts are forbidden when acids are present in excess. The con- 
dition of the gastric juice in hypochlorhydria, it is true, is the 
very opposite of the condition found in hyperchlorhydria, but 
the cause is essentially the same. In hyperchlorhydria the glands 
have been over-stimulated by meat eating and other excitants 
of the gastric secretion. The glands are over-worked. Achylia 
is a condition in which the glands have ceased to secrete hydro- 
chloric acid because they are worn out with over-work. Since a 
highly acid gastric juice is necessary for the disinfection as well 
as the digestion of meats of all sorts, it is evident that when this 
condition is present meats should not be eaten, for in the condi- 
tion in which they are eaten practically all meats are greatly in 
need of disinfection before being accorded a place upon the bill 722 
THE NEW DIETETICS 
of fare or at least before or after entering the stomach. Ordinary 
cooking does not destroy the vast numbers of germs present. 
Another fact of importance in relation to this condition is 
the recently discovered association of gall bladder disease with 
diminished gastric acid secretion. Hohlweg found gall bladder 
disease in 71 to 84 per cent, of all cases of hypochlorhydria. 
Hypo-acidity was also found by Oily in nearly all cases of gall 
stone disease. 
It is known that gall stones are due to infection of the gall 
bladder. Diminished gastric acid may be either a cause or a 
consequence of the gall bladder disease. Probably both conditions 
result from the same cause, intestinal toxemia, a condition which 
is responsible for a wide range of disorders of the human body. 
It is evident, then, that a strict antitoxic dietary, change of 
the intestinal flora, and frequent and thorough evacuation of the 
body residues (three times a day) are the dietetic measures likely 
to prove really efficient. 
Pepsin of Little Value* 
For half a century an enormous business has been done in 
the manufacture of pepsin from pigs’ stomachs. Many tons of 
extract prepared from the lining scraped off: the inside of the 
stomachs of hogs in our great slaughtering establishments are 
sold every year in the expectation that the deficiency of human 
pepsin may be made good by digestive ferment borrowed from 
the pig. Scientific research showed long ago that this enormous 
consumption of pepsin is of little or no value. As a matter of 
fact, the stomach rarely fails to make an adequate supply of pep- 
sin. When gastric digestion is deficient, the fault is usually in 
the failure of the gastric glands to manufacture the necessary 
amount of gastric acid, so the thing wanted is not pepsin but 
acid. Notwithstanding the revelations which have been made by 
the exhaustive experiments of Morro and others, the pepsin busi- 
ness still flourishes. Pepsin is always secreted in abundance when 
acid is present. It is true, however, that in cases of extreme 
hyperacidity the pepsin is sometimes destroyed by the gastric acid, 
but this condition will not be remedied by the taking of pepsin. 
If the excess of acid is overcome, no further remedy is needed. 
How this may be done has already been pointed-out. DIET IN DIGESTIVE DISORDERS 
723 
Bitters do not Stimulate the Stomach. 
Another widespread delusion leads to the use of bitters in 
cases of this sort. The observations of Pavlov, Carlson and 
others have clearly demonstrated that bitters do not increase the 
production of gastric juice. Reichmann and Scheffer have shown, 
in fact, that the presence of bitters in the stomach has the effect 
of lessening the secretion of gastric juice. From these experi- 
ments, it is evident that the age-long faith in bitters as a means 
of promoting digestion has no scientific basis. Bitters hinder 
digestion instead of helping it. Scientific experiment does not 
even afford evidence that the use of bitters promotes appetite, or 
at least that any other than a slight psychic effect is produced. 
Special Dangers in Achylia. 
In persons suffering from achylia or extreme hypohydro- 
chloria, the disinfecting action of the gastric juice is lost and 
bacteria and often molds are found present in the stomach and 
small intestine in great numbers. As a result the alimentary canal 
becomes thickly populated with putrefactive and other bacteria. 
A state of pernicious autointoxication is developed. In view of 
this fact, it is evidently important that foods which are likely to 
introduce bacteria into the intestine should be avoided. It is 
equally important to avoid foods which will encourage the growth 
of bacteria in the intestine, for the reason that the natural de- 
fense against these pernicious organisms has been broken down. 
On this account, meats of all sorts must be strictly prohibited. 
As shown elsewhere in this work, meats of all kinds, as supplied 
by the butcher, are swarming with bacteria and are in a state of 
active decomposition. The only exception to this general state- 
ment is found in the case of canned meats, which are necessarily 
made sterile by exposure to high temperatures in processing. 
Game, fish, shell-fish and oysters are especially detrimental and 
likely to give rise to grave and acute symptoms in persons suffer- 
ing from achylia, when they might be eaten with impunity by 
persons possessed with gastric juice strong enough to exercise its 
normal disinfecting function. 
Acute intestinal toxemia, or even ptomain poisoning, is not 
always due to the use of food containing pernicious organisms. 
Such attacks may as well be the result of taking food which 
encourages the unusual development of virulent bacteria already 
present in the intestine. 724 
THE NEW DIETETICS 
Cold storage meats are especially objectionable, as are salted 
and smoked meats of every description. 
For the same reason, certain varieties of cheese, such as lim- 
burger, brie and all forms of cheese which are far advanced in 
the so-called “ripening” process, must be carefully avoided. 
Eggs may be eaten in moderation when they are fresh and 
well cooked. Raw and half-cooked eggs must be avoided. 
Strong butter and rancid foods of all descriptions are ex- 
ceedingly unwholesome, and are certain to increase the intestinal 
toxins by encouraging intestinal putrefactions. 
Ordinary market milk is always unsafe, and is particularly 
dangerous in these cases, as well as for young infants, because of 
the presence of putrefactive organisms of various sorts, includ- 
ing the dangerous Welch’s bacillus. Pasteurizing does not de- 
stroy the spores of these organisms and so does not render un- 
clean milk safe. Only certified or clean milk should be used. 
Malted nuts may be commended as a safe and very satisfactory 
substitute for milk in achylia. 
Lettuce, celery, all forms of salad vegetables and fresh fruits 
must be carefully disinfected before being eaten. 
Persons suffering from achylia are much more exposed than 
are others to danger from infection by the embryos of animal 
parasites which develop in the intestine and with which raw fruits 
or vegetables are likely to become infected, both in the fields and 
when exposed for sale in the markets. 
Such persons must also be continually on their guard against 
the use of bad water. Water containing typhoid germs, and even 
cholera germs, is often taken with impunity by persons whose 
stomachs contain an abundance of gastric juice, but in cases of 
achylia this protection is lost and water-borne bacteria pass 
through the stomach into the intestine and there find conditions 
favorable for their development. If not known to be perfectly 
safe, water should always be boiled. In traveling, it is a good 
plan for persons known to have achylia to carry with them a 
small supply of water known to be pure, or made safe by boiling. 
In emergency, chlorid of lime (bleaching powder) may be used 
to render water safe. Five grains of fresh chlorid of lime added 
to a gallon of water will destroy in a few minutes any dangerous 
germs that may be present. 
Persons suffering from achylia should avoid large meals, for 
the reason that in achylia the stomach empties quickly. This is DIET IN DIGESTIVE DISORDERS 
725 
due to the fact that the pylorus is not closed by the presence of 
the gastric acid in the duodenum, as in the normal stomach. On 
this account, large meals must be avoided, otherwise the small 
intestine is likely to be overcrowded with food material and its 
function thereby disturbed. Meals should be made small and 
frequent. Some persons may take four small meals a day with 
advantage. Care must be taken to select foods which are quickly 
digested and to give preference to foods which are capable of 
being completely digested in the small intestine. Fortunately, this 
is true of most foods with the exception of raw or underdone 
meats, which are digested only by the gastric juice. This is a suf- 
ficient reason for avoiding meats. 
Thorough chewing is necessary not only because the food- 
stuffs remain but a short time in the stomach, but because the 
stomach has, to a large extent, lost its power of breaking up the 
particles of food and reducing them to liquid form, which is a 
necessary preliminary to intestinal digestion. Such liquid or 
semi-liquid foods as buttermilk, fruit juices, gruels, broths, purees 
of fruits and vegetables, especially purees of tomatoes, spinach 
and other greens are to be most highly recommended in this con- 
dition. All fruit juices are valuable, and particularly the juices 
of acid fruits, because fruit acids are capable of replacing to 
some degree the normal acidity of the stomach. Fruits rich in 
vitamins are especially indicated for the reason that achylia is a 
degenerative state and suggests the probable existence of other 
degenerative processes which may very likely have been occa- 
sioned by a diet deficient in vitamins. Orange juice is for this 
reason especially valuable. 
Whole meal preparations should be used instead of fine 
wheat flour, macaroni and polished rice. In addition to whole 
grain meals, bran should be freely used. The laxative diet, else- 
where described (see Index), is especially indicated in cases of 
achylia. Constipation is invariably present, together with chronic 
intestinal autointoxication, hence a change of intestinal flora is 
essential (see Index). 
In every case of achylia, the intestinal motility should be 
determined at the outset of treatment. The stools should be ex- 
amined and the fruit regimen with the other necessary measures 
elsewhere mentioned should be employed until the flora is thor- 
oughly changed, as indicated by the character of the stools, the 
disappearance of intestinal gas and of intestinal putrefaction and 
clearing of the tongue. 726 
THE NEW DIETETICS 
Two or three glasses of hot water may be taken with advan- 
tage half an hour before each meal as a means of cleansing the 
stomach. 
A glass of orange juice or other dilute acid fruit juice half 
an hour before meals is especially valuable as a means of pre- 
paring the stomach for the intake of food. 
ACUTE DILATATION OF THE STOMACH 
Serious gastric dilatation is much less frequent than was for- 
merly supposed. The diagnosis should be based upon a careful 
X-ray examination by a competent roentgenologist. 
Acute dilatation of the stomach may occur after adminis- 
tration of gas, ether or chloroform as an anesthetic, or as the 
result of grave lesions of the central nervous system, but most 
commonly follows serious operations upon the intestinal tract. 
Chronic dilatation rarely exists except in connection with an 
organic obstruction of the pylorus. Of the greatest importance 
are cases of acute dilatation of the stomach following abdominal 
Operation. In these cases an X-ray examination should be made 
for the purpose of determining the exact condition present. Vom- 
iting may be relieved by the use of the duodenal tube, which in 
many cases may be with advantage left in place for a day or 
two. Accumulating fluids may be withdrawn and a few ounces of 
a 10 per cent, solution of lactose or lacto-dextrin may be intro- 
duced. The sugar water has the effect to suppress putrefaction 
while at the same time affording some nourishment. When the 
liquids withdrawn from the stomach are no longer brownish in 
color and offensive in odor small amounts of other foods than 
lactose may be given, such as fruit juices, rice gruel and purees 
of dates, bananas, and a little later even spinach. In cases in 
which the stomach is known to be dilated it is well to prop the 
patient up in bed or to have him lie partially turned to the right 
side so that gravity will favor the movement of liquids from the 
stomach. Great care must be taken to keep the bowels well 
emptied as a clogged state of the colon is often the chief cause 
of trouble through setting up reverse peristaltic movements. DIET IN DIGESTIVE DISORDERS 
727 
This term is applied to the regurgitation of food from the 
stomach, somewhat like rumination in animals. The regurgitated 
liquid may be acid or bitter, or may retain its natural flavor. 
Regurgitation is the result of loss of tone in the cardiac sphincter, 
in consequence of which it does not close the entrance to the 
stomach with sufficient vigor to prevent the contents from being 
forced upward to the mouth by the contraction of the stomach 
which takes place during digestion. 
In certain persons, regurgitation only occurs on stooping or 
coughing violently soon after eating. Merycism is most likely 
to occur in persons who eat hastily, swallowing much air with 
their food, or on drinking too much liquid. 
In some persons the act of swallowing fluids is accompanied 
by a gurgling sound, which indicates that air is being swallowed 
with the liquid. In such cases, rumination is likely to occur 
from distension of the stomach and from the presence of a large 
quantity of air which, accumulating in the upper part of the 
stomach, prevents contact of the gastric juice with the cardiac 
orifice, in consequence of which the sphincter muscle does not 
contract with sufficient vigor to keep the orifice closed. Moderate 
eating, thorough chewing of the food and avoidance of liquids at 
meals are the dietetic measures indicated. The habit of regur- 
gitation of the food when once formed becomes automatic and 
must be firmly and persistently resisted until overcome. 
MERYCISM 
AEROPHAGIA 
This is a condition allied to hiccough, in which air is drawn 
into the stomach in considerable quantities, the diaphragm be- 
ing contracted as in inspiration. While the epiglottis is closed, 
air is sucked into the stomach instead of into the lungs. Its 
causes are similar to those which provoke hiccough. The patient 
should resist the tendency to draw air into the stomach by taking 
ten deep breaths while holding the mouth widely open. It is 
well, also, to drink two or three glassfuls of very hot water. 
The food should be moderate in quantity and rather dry, 
and should be thoroughly chewed. All causes of gastric irrita- 
tion should be avoided, especially the use of condiments, tea, 
coffee or very hot foods or drinks. Special attention should be 
given to thorough mastication. 728 
THE NEW DIETETICS 
CYCLIC VOMITING 
In this distressing ailment, which occurs most frequently in 
children, meat and even eggs and dairy products should be care- 
fully withheld. During the attack, no food should be taken into 
the stomach. The patient should be nourished by means of sugar 
water introduced by the colon. Malt sugar or syrup of raisins 
should be used for the purpose; two or three ounces of malt 
sugar to the pint, or the juice extracted from four ounces of 
stewed raisins, with the addition of water sufficient to make a 
pint. 
The sugar water may be given even before vomiting ceases 
if it does not greatly aggravate the vomiting. Some portion of 
it will be absorbed, and this will help to combat the acidosis to 
which many cases of vomiting are due. In extreme cases in 
which the vomiting has been long continued and large quantities 
of fluids have been lost, a half pint or a pint of normal saline 
solution may be injected subcutaneously. After the vomiting 
has stopped for twelve hours the patient may be given cereals. 
Among the best for this purpose are rice gruel and 20 per cent, 
gluten with the addition of lactose or malt sugar. Orange juice 
and other fruit juices are most excellent. Skimmed or butter- 
milk may be used in small quantities. Fats must be avoided, 
sometimes for a long time. 
HICCOUGH OR SINGULTUS 
Hiccough may be induced by eating too rapidly or swallow- 
ing food in too large masses, or it may be caused by drinking 
carbonated waters or the generation of gas in the stomach. 
It may also result from the reflex irritation originating in 
disease of the gall bladder or in the pelvic viscera. 
Hiccough is also often due to an accumulation of irritating 
liquids in the stomach. Washing out the stomach, drinking co- 
piously of hot water and care to avoid the errors in eating above 
referred to are the measures necessary to secure relief. When 
the hiccough occurs only after taking food, the patient may 
be nourished for a few days by nutritive enemas. DIET IN DIGESTIVE DISORDERS 
729 
ACUTE GASTRO-ENTERIC INFECTION 
This common disease of children requires the immediate and 
complete interdiction of milk and all animal foodstuffs. Thin 
barley or oatmeal gruel, rice jelly or rice gruel sweetened with 
malt sugar or milk sugar or sweet fruit juices and vegetable 
broths should be made the exclusive diet. The patient should 
be fed small quantities of food, the amount being gradually in- 
creased as tolerance is established. After a few days the diet 
may be made more varied. Purees of potato or other vegetables 
seasoned with a little butter may be added. Purees of spinach 
and other greens are especially valuable because of the rich stores 
of iron, lime and vitamins which they supply. 
STOMATITIS 
Rice jelly or a smooth rice gruel should be the exclusive food 
for a few days. Paraffin oil should be given to counteract the 
constipation, and the bowels should be made to move twice a day 
by the enema if necessary. Use Savita for vitamins. 
URTICARIA 
This disease is due in most cases to anaphylaxis. The offend- 
ing substance may usually be determined by the skin test for 
sensitivity. Proper materials for this test are now provided and 
it may be made by any physician who is familiar with the technic. 
In many cases the skin tests do not show sensitivity. In these 
cases, the cause is probably bacterial poisons produced in the 
colon. 
When an offending food can be identified, this article must 
be scrupulously avoided. In other cases, the intestinal flora must 
be changed and a strict antitoxic dietary adopted. The writer 
has seen many cases recover as the result of the persevering use 
of these measures. 
In many cases, the sensitivity to a particular foodstuff may 
be overcome by gradually accustoming the individual to it, be- 
ginning with very minute doses and gradually increasing. For 
example, in a case in which strawberries caused urticaria the 
patient was given one strawberry the first day, two the next, and 
so on, adding one strawberry each day until a full serving could 
be eaten with no inconvenience. The cure accomplished in this 
manner may not be permanent, a fact which should be borne in 
mind. 730 
THE NEW DIETETICS 
Neuroses of the Stomach, 
Comparatively little is known of nervous disorders of the 
stomach. The so-called nervous disorders are probably in many 
cases due to simply the effects of toxins and do not involve any 
actual changes in the nervous system. It must be remembered 
that the nerves act as reporters for the body, and nervous symp- 
toms may not be due to any diseased condition of the nerves 
themselves but to other conditions to which the disordered nervous 
action should direct attention. Eructations and belching are com- 
monly attributed to secretory disturbances. These conditions are 
always associated with chronic constipation and are probably 
caused by a reverse peristalsis. The advice given by most authors 
to avoid roughage in these cases is entirely wrong. Bran and 
greenstuffs and purees of vegetables should be freely used. The 
evidences of irritation present are reflex or chemical and are not 
due to mechanical causes, hence there is no reason for suppress- 
ing roughage. When there is great acidity much chewing should 
be avoided. The food should be taken in the form of purees and 
the diet should be such as is elsewhere directed for hyperacidity. 
So-called sensory disturbances of the stomach, expressed as 
pain, fulness and heaviness, are probably in many cases due to 
gastric ulcer, duodenal ulcer or a diseased condition of the gall 
bladder. X-ray examinations should be made in every case and 
if no evidence of ulcer or other disease of the stomach can be 
discovered, the probability is very strong that the real seat of 
disease is to be found in the gall bladder. 
For temporary relief in these cases heat should be made over 
the stomach and abdomen. A couple of large hot water bags, 
sand bags or hot fomentations, or an electric heating pad applied 
for half an hour after meals will often afford entire relief. 
The diet should consist of bland foods. Vegetables of almost 
any sort may be eaten in the form of a puree, but highly acid 
foodstuffs generally give discomfort. Tea and coffee and condi- 
ments of all sorts must of course be strictly avoided. 
Although the most common form of motor disturbance of 
the stomach is nervous vomiting, there is sometimes observed a 
state of peristaltic unrest which cannot be shown to be due to any 
organic cause. It is important to make sure that pyloric obstruc- 
tion does not exist. To this end careful X-ray examinations 
should be made. This condition is without doubt in the majority DIET IN DIGESTIVE DISORDERS 
731 
of cases due to toxins. The colon is usually found loaded and the 
tongue is coated and the breath is tainted. When the intestinal 
toxemia is relieved, vomiting ceases, but occasionally cases are 
encountered in which the vomiting seems to be wholly due to 
psychic causes. In such cases rest and mental therapeutics are 
essential measures. The application of the moist abdominal 
bandage will often afford relief from nausea and vomiting. A 
towel is wrung quite dry out of cold water. It is applied about 
the trunk covered with mackintosh and the whole covered with a 
thick, tight bandage of flannel. The quick warming up which 
occurs through reaction produces a remarkable quieting effect 
upon the stomach, often affording entire relief. It is highly 
important that the bowels should be kept freely open and the 
general health improved by out-of-door life, tonic baths and gen- 
eral recuperative measures. 
NERVOUS DYSPEPSIA 
The term nervous dyspepsia is usually applied to obscure 
cases of gastro-intestinal disorder in which no clearly defined 
disease can be made out. In the writer’s experience, these cases 
are always highly toxic. Constipation is always present. 
The proper procedure is, first of all, to change the patient’s 
flora by the proper regimen (see Index). When this is accom- 
plished, the patient should adopt a laxative and antitoxic diet 
(see Index), and an outdoor life. If these measures are thor- 
oughly applied and carefully followed, the result will almost 
certainly be rapid progress toward health. 
GASTRIC CATARRH IN CHILDREN 
Jacobson reports that in cases of colitis in children he finds 
that the stomach shares the catarrhal condition of the bowels. 
He has treated these cases successfully as follows: 
The child is restricted to water only for twelve hours, then 
for a few days raw oatmeal soup is administered; then half a 
pint of milk is given during the day, followed the next day by 
half a pint of milk gruel. The next day a pint of milk, a half 
pint of milk gruel and half a pint of water gruel. The diet is 
then made more liberal by the addition of toasted bread, sago 
soup, porridge and mashed potato. Milk sugar may be given 
with advantage, a teaspoonful three or four times a day. 732 
THE NEW DIETETICS 
The bland diet (see Index) and buttermilk (acidophilus) 
should be employed together with treatment for colitis as in 
adults (see Index). 
DIET IN ACUTE GASTRITIS 
This disease is rather rare. Most cases of so-called gastritis 
are simply cases of indigestion, not accompanied by actual in- 
flammation of the gastric mucous membrane. When gastritis is 
actually present, the stomach should be given complete rest for 
one to three days. This does not mean, however, that nothing 
should be given the patient to swallow. Water at the tempera- 
ture of the body should be given frequently in small doses. The 
addition of milk sugar or malt sugar to the water, in proportion 
of an ounce to the pint, is advantageous. Disease-producing 
bacteria will not grow, or at least are not virulent and active in 
producing toxins, in the presence of sugar. Mild fruit juices, as 
the juice of sweet oranges and of raspberries well diluted, may 
also be advantageously used. Sometimes rice water or rice jelly 
is preferable, especially when great irritation i§ present. Whey, 
or still better whey culture of the B. acidophilus, is clearly indi- 
cated. 
When nausea, vomiting and other distressing symptoms have 
ceased and water or rice water is well borne, well-boiled rice or 
rice gruel may be added, with buttermilk {acidophilus). As im- 
provement progresses, the bland diet (see Index), may be added. 
Perfectly sweet butter and cream may be taken a little later. 
Strong acids, spices, as well as tea and cofifee, animal broths 
and animal fats, must likewise be avoided. 
Meat especially must be carefully avoided, as most harmful. 
Care must be taken to avoid a relapse, which is very liable 
to occur. Great precaution must be exercised to avoid overeat- 
ing and to masticate the food very thoroughly. 
Special attention must be given to the bowels. If the stools 
are putrid, as is likely to be the case, the flora must be changed 
by the use of lactose or lacto-dextrin and special cultures of B. 
acidophilus, which must be taken in doses of a half pint three 
times a day. Milk sugar should be taken freely; three ounces 
three times a day well diluted for several days. DIET IN DIGESTIVE DISORDERS 
733 
DIET IN CHRONIC GASTRITIS 
This disease is usually the result of frequently repeated at- 
tacks of acute gastritis occasioned by abuse of the stomach; 
alcohol, tea and coffee, overeating, the free use of meat, condi- 
ments—mustard, cayenne pepper, capsicum, horse-radish, hot 
sauces, vinegar, spices, pickles and smoking. Gastritis often ac- 
companies cirrhosis of the liver, due to the same causes, and pre- 
cedes and accompanies cancer of the stomach. It is usually 
present in pernicious anemia, and often accompanies chronic 
Bright’s disease. 
When vomiting is present, the same diet as in acute gas- 
tritis is indicated until the vomiting ceases; then farinaceous 
foods, with buttermilk, potato puree, rice pudding, bread pud- 
ding, cereal flakes, toast zwieback, bran bread, rolls. Enemas 
must be given twice a day while the bland diet is used. 
When free hydrochloric acid is present in the stomach, butter 
may be used sparingly, also cream, olive oil, egg yolk and egg 
yolk nog. As the stomach becomes less irritable, fruit juices and 
purees of fruits may be added. In all cases, purees of greens, 
spinach, lamb’s quarters, red root, and other greens should be 
freely used as soon as the stomach will tolerate them. Herschell 
recommends fresh fruit alone for one meal daily in chronic gas- 
tritis, attributing special virtue to the fruit acids, which are doubt- 
less highly beneficial. Cane sugar must be avoided. Malt sugar 
only should be used as sweetening. 
Things to Avoid: Meats of all sorts, broths, meat extracts, 
fish, oysters, pickles, vinegar, condiments, new bread, tea and 
coffee, much liquids at meals, pastry, cane sugar, preserves, con- 
fectionery, ice cream, ices. 
AMYLACEOUS DYSPEPSIA 
A general characteristic of so-called amylaceous dyspepsia 
is inconvenience from the presence of gas in either the colon or 
small intestine or both. When the small intestine is involved, the 
central portion of the abdomen, in the region of the umbilicus, is 
the chief seat of discomfort. The presence of much gas in the 
small intestine is due to two causes; excessive formation of gas in 
the colon and incompetency of the ileocecal valve, permitting the 
gas to pass from the colon into the small bowel. 
Intestinal gas is chiefly produced by two organisms, the 734 
THE NEW DIETETICS 
colon bacillus and Welch’s bacillus. The last named organism, 
also known as the gas bacillus, is the great gas producer of the 
intestine. These organisms give rise to both fermentation and 
putrefaction. From protein they produce highly ofifensive gases; 
from starch or sugar they produce enormous quantities of car- 
bonic acid gas. 
The normal flora or bacterial vegetation of the human intes- 
tine produces harmless acids and little or no gas. In the presence 
of the “wild” (Herter) putrefactive bacteria, saccharine or fari- 
naceous foodstuffs give rise to much gas; but when the flora is 
changed, the gas at once disappears. This is a constant obser- 
vation in the use of the fruit regimen or the milk sugar or dextrin 
method of changing the flora. At first, the gas is much increased ; 
in a few days, however, the gas disappears although the amount 
of carbohydrates is not diminished or even is increased. So the 
cure for so-called carbohydrate or amylaceous or farinaceous 
dyspepsia is more carbohydrate! 
In many cases, a cause of gas formation is the accumulation 
of food residues in the colon, especially the cecum. In such 
cases relief is readily obtained by means of a copious warm 
enema (three pints). The diet should be decidedly laxative, with 
bran or agar and paraffin. When adhesions of the cecum exist, 
the enema should be regularly used at night to insure complete 
emptying of the colon. Adhesions usually exist in cases of chronic 
appendicitis and in cases in which the appendix has been removed. 
Distension of the bowels with gas is also a common symptom 
in colitis because of the spastic or contracted condition of the 
lower colon almost always present, causing retention of food 
residues and consequent fermentation and putrefaction with gas 
production in the cecum and ascending colon. A change of flora 
followed by a laxative and antitoxic diet will afford definite relief. 
DIET FOR DECAY OF THE TEETH 
One of the first to study the bacteria of the mouth was Miller, 
an American dentist practising in Berlin. He held that the cause 
of decay of the teeth was the fermentation of sugar and starch in 
the mouth. Miller experimented by placing teeth in fermenting 
mixtures of bread and saliva. He thought that he saw evidence 
of decay after several months. 
Howe, of Harvard University, repeated the experiments, DIET IN DIGESTIVE DISORDERS 
735 
using saliva from persons with badly decayed teeth in mixtures 
of grape sugar, malt sugar, cane sugar, milk sugar, dextrin, and 
white flour bread. It was only after six months that he noticed 
etching of some of the teeth. 
Many years ago (1895), the writer became convinced that 
decay of the teeth is not due to the formation of lactic acid by 
the fermentation of sugar or starch in the mouth as has been 
generally believed, a doctrine which has been held by dentists for 
half a century or more and is still believed and taught by the 
majority of dental practitioners. Observations on numerous 
patients convinced the writer that the cause of decay of the teeth 
is a general nutritive disturbance affecting the whole body, par- 
ticularly a lowered vital resistance from some cause. 
One recognized cause was intestinal toxemia; that is, a pol- 
lution of the blood through the absorption of the products of 
putrefaction from the colon. Dr. Percy R. Howe has recently 
demonstrated another cause. He has shown a lack of vitamins, 
particularly of the water-soluble B and water-soluble C, or anti- 
scorbutic vitamins, produce a disturbance of the calcium meta- 
bolism, that is, interfere with the assimilation of lime so that the 
teeth are robbed of their lime and are thus softened and made 
subject to decay as well as other injuries. 
It is a notable fact that the teeth of primitive people are 
almost invariably free from decay. Dr. Ottofy, who examined 
the teeth of many Igorot children in the Philippine Islands, found 
more than two-thirds with perfect teeth, and the defects in the 
remainder were so slight as to be almost undiscoverable. 
In one of his interesting papers, Dr. Howe remarks as fol- 
lows : 
It is evident to any practitioner of dentistry that t)he people of many 
different nationalities have excellent teeth when they live on their natural 
food products. The Esquimau is practically free from caries. He does not 
live on muscle meat alone, but he eats practically the whole carcass of the 
animals which form his food. He gets his calcium from the bones and 
some of the tissues. He gets his vitamins from many of the glandular 
organs, but with a change of diet, his teeth decay. Stefansson has written 
me that concomitant with the influx of our refined foods, caries has crept 
into the camps of the Esquimaux and Icelanders. The natives upon the 
Labrador coast, now subsisting on bread and tea in a great measure, have 
extensive decay, while formerly they were exempt from it. 
Wells has shown that the Scotch Highlanders have excellent teeth, 
but that as they obtain city foods their teeth decay badly. We might 736 
THE NEW DIETETICS 
mention any number of such cases. We know that many immigrants have 
excellent teeth upon arrival in this country, but in a short time after living 
on our foods their teeth decay. 
Modern diets are deficient in calcium and in vitamins, both of which 
are needed for sound teeth, and if we desire to practice preventive dentistry 
we need to begin here. The other many effects described indicate the need 
of a similar diet for sound bodily development and for vigor. For the 
fullest bodily development, every effort should be made to restore the 
teeth to their usefulness and to retain them. 
Soft foods, foods poor in lime and vitamins, and meats of all 
sorts encourage dental decay and pyorrhea. The fibers of meat 
caught between the teeth encourage the growth of the sort of 
germs which cause decay of the teeth. 
The use of hard, dry foods which require vigorous use of 
the jaw muscles and promote the flow of saliva is essential for 
good development of the teeth. Greens, coarse vegetables, bran 
and acid fruits which stimulate the flow of saliva are all import- 
ant means of promoting the health of the teeth. Cane sugar, fine 
flour bread, very hot foods and drinks and meats are most ob- 
jectionable from the standpoint of dental hygiene. 
Mellanby showed that the fat-soluble vitamin A is necessary 
for the proper development of the teeth. Marked difference was 
found between the teeth of animals fed on linseed oil and those 
fed butter fat. Butter fat contains the fat-soluble A in abun- 
dance, whereas linseed oil contains little or none. 
At the suggestion of Dr. Vida A. Latham, the Indians con- 
fined in government jails have been required to give special at- 
tention to cleansing the teeth in accordance with the rules of oral 
hygiene. The result has been that the sickness from dysentery, 
which had formerly been very prevalent in the jails, has been de- 
creased more than 50 per cent. There is a growing mass of facts 
which clearly indicate that a foul condition of the mouth may 
lead to infection not only of structures immediately connected 
with the mouth but of the stomach and intestines as well. Infec- 
tion of the mouth and decay of the teeth are encouraged by the 
use of flesh foods more than by any other means. 
The substitution of milk for meat in the dietary, the free use 
of greenstuffs which abound in food lime, avoidance of confec- 
tionery, the use of malt sugar, dates, figs or raisins in place of 
cane sugar, and especially the use of dry, hard food that will give 
the teeth and jaws exercise are the most important dietetic pre- DIET IN DIGESTIVE DISORDERS 
737 
cepts relating to dental dietetics. Every child should have at 
least one quart of good clean milk daily. 
The intestinal flora must be changed (see Index) and kept in 
a normal state. The bowels must be kept free by the use of bran 
or agar and mineral oil and a laxative diet. 
DIET IN INTESTINAL OBSTRUCTION 
In cases of intestinal obstruction, surgical measures are indi- 
cated and should be resorted to at the earliest possible moment. 
In the meantime, while preparation for more radical measures 
are being made, several things of importance may be done. 
Half a pint of warm water with an ounce of malt or milk 
sugar should be given by enema hourly. When possible, the 
duodenal feeding tube should be used. By this means, the putrid 
and highly toxic duodenal contents may be pumped out and 
sugar water introduced, greatly to the patient’s advantage. Some 
portion of the sugar will be absorbed, giving valuable re-enforce- 
ment to the patient’s flagging energies, especially sustaining the 
heart much more effectually than caffein or any other drug can 
do. The sugar also has the effect of modifying bacterial changes, 
preventing the development of putrefactive products and other 
bacterial toxins. Sugar water is prepared by dissolving in warm 
water two ounces of malt sugar or milk sugar. 
In the writer’s hands this plan of feeding a patient suffering 
with intestinal obstruction has proved invaluable and in several 
instances has been the means of saving the patient’s life. 
After an operation for enterostomy has been performed for 
intestinal obstruction, lactose or malt sugar, two ounces to the 
pint, should be used for irrigation of the intestine, the effect 
being both to nourish the patient and to suppress putrefactive 
changes which are always actively present. 
The observation by Case that intestinal obstruction may be 
discovered by examination with the X-ray, which reveals the 
abnormal distension of the intestine, is highly important as a 
means of early diagnosis. 
DIET FOR ULCERATION OF THE COLON 
The diet in ulceration of the colon is the same as that for 
colitis (see Index). It is not necessary to suppress bran and 
other roughage. This element of the food is necessary to pro- 738 
THE NEW DIETETICS 
mote bowel movement. The thing necessary for recovery in 
these cases is not a bland diet but cleanliness of the colon. Noth- 
ing is so irritating to the diseased surfaces as the presence of 
putrefying residues. The irritation of the colon is caused, not 
mechanically but chemically, by the products of putrefaction. 
Agar may be used freely, and paraffin oil should be taken 
with each and every meal. Large enemas of starch water with 
milk sugar (an ounce to the pint), and, if possible, several ounces 
of whey cultures of the B. acidophilus should be used daily. Lac- 
tose or lacto-dextrin one to three ounces three times a day for 
one or two weeks should be given to change the intestinal flora. 
This is always necessary. 
Ulcer of the colon is usually the result of chronic colitis. In 
some cases protozoa are present as an active cause of the ulcera- 
tion. This is particularly true in the case of persons who have 
lived in the tropics. In such cases suitable antiparasitic remedies 
should be employed. Ulceration sometimes follows typhoid fever. 
In the great majority of cases this condition accompanies chronic 
colitis and is most frequently located in the upper part of the 
rectum or in the pelvic colon. Bad cases require rest in bed and 
occasionally surgery is required. Remarkably rapid results have 
often been obtained by the aid of appendicostomy, an operation 
which consists in the establishment of a fistulous opening into 
the head of the colon through the appendix. By irrigating the 
colon several times a day, thus keeping it free from putrefying 
residues, ulcerations, even though quite extensive, may often be 
rapidly healed. The colon should be irrigated with cultures of 
B. acidophilus and sugar water. Whey cultures of B. acidophilus 
are the best for this purpose. Flushing with starch water is also 
useful. 
Diet in Hirschsprung's Disease. 
In this, fortunately, rather rare disease, the colon is enor- 
mously enlarged. The condition generally makes its appearance 
in infancy and is commonly regarded as congenital, at least in 
most cases. Removal, or abbreviation of the colon, is recom- 
mended by many surgeons, and has been practised in some cases, 
but in the writer’s opinion is rarely required, provided the sub- 
ject is willing to submit to the necessary restrictions in diet. 
The essentials of the dietetic treatment are: 1. The careful 
exclusion from the diet of meats of all sorts and careful adher- DIET IN DIGESTIVE DISORDERS 
739 
ence to a strictly antitoxic diet, with no digressions. The dietary 
must be low in protein, all the surplus being avoided. Even eggs 
must be used sparingly. It is better to avoid the whites of eggs 
entirely. It is even necessary to use some care with reference to 
the use of milk. When milk is not well digested, the curds which 
reach the colon are likely to undergo decomposition and may give 
rise to an intense toxemia. It is well to remember that vege- 
table proteins are far less likely to undergo putrefactive changes 
than animal proteins. On this account, nuts are to be highly 
recommended as a source of protein in place of meat, milk or 
eggs. Walnuts, almonds, filberts, and even peanuts, may be made 
a part of the regular bill of fare with advantage. An emulsion 
of nuts known as malted nuts is a convenient and very acceptable 
nut preparation. The intestinal flora should be changed and kept 
changed by the use of lactose or lacto-dextrin. 
The diet should be bulky, consisting very largely of coarse, 
green vegetables. Bran or agar should be used at every meal. 
Paraffin in some form should also be used at every meal. All the 
measures recommended for the relief of constipation should be 
systematically and continuously employed. The colon should be 
emptied daily by a copious enema to which the juice of one or two 
lemons or one or two teaspoonfuls of lactic acid should be added. 
If necessary, several enemas may be employed to make sure that 
the colon is thoroughly emptied. 
DIET FOR HEMORRHOIDS 
The diet to be employed in a case of hemorrhoids is essen- 
tially an antitoxic and laxative dietary. Bran should be freely 
used to the extent of one-half to an ounce daily. The bowels 
should be kept loose; should be moved three times daily. Patients 
sometimes complain of increased irritation due to frequent bowel 
movements, particularly when the enema is used. This difficulty 
can be usually obviated by taking care to cleanse the parts thor- 
oughly after the bowel movement, and to apply to the anal canal 
a little carbolated vaseline. 
Large hemorrhoids may often be made to disappear by the 
daily application of a powder consisting of equal parts of starch 
and calomel, after first carefully cleansing the parts. 
The idea that the use of bran and coarse vegetables may 
produce or aggravate hemorrhoids by mechanical irritation is 
wholly an error. Bran does not irritate, it titillates. 740 
THE NEW DIETETICS 
DIET IN APPENDICITIS 
Appendicitis is the result of an extension of infection from 
the colon to the appendix. Nothing can be done by diet for an 
acute attack of appendicitis since all food should be suppressed 
until after the patient gives marked indications of recovery or 
has been subjected to the operation indicated. It is highly prob- 
able, however, that appendicitis may be prevented by a proper 
regimen, or at least that it is much less likely to occur when a 
special regimen is followed, and so-called chronic appendicitis is 
usually curable by changing the intestinal flora. 
Many years ago, Dr. Lucas-Champonniere, the surgeon- 
general of the French army, discovered that appendicitis is a 
disease to which meat-eaters are especially liable. During a 
military campaign in Africa he noted that appendicitis was very 
common among the French soldiers who were fed canned meats, 
but almost unknown among the Arabs, who lived upon a diet of 
wheat cakes, camel’s milk and vegetables. 
He later observed that appendicitis, except in the case of 
newly admitted inmates, was practically unknown in the prisons 
and insane asylums of France, where meat is not used. 
Senn, of Chicago, observed that appendicitis was unknown 
among the vegetarian natives of the east African coast. 
Dr. McCord, who has practised for more than thirty years 
among the natives of Natal, states that appendicitis is the rarest 
of maladies among these people, by whom meat is rarely eaten. 
Crichlow reports that appendicitis is unknown among the 
natives of the Solomon Islands so long as they adhere to their 
native diet, which is almost wholly of vegetable origin. 
Dr. Snyder, for ten years physician to the Shah of Persia, 
met only ten cases during that time in Teheran, three of whom 
were Europeans and one a native student just back from Paris. 
Dr. Magnon, physician to the French Embassy at Pekin, 
met among the Chinese only one case of appendicitis in five years. 
The staples of the Chinese diet are millet, rice, sweet potatoes, 
turnips, cabbage, soy beans, greens, cornmeal and wheat meal. 
Flesh-eating encourages the development of appendicitis for 
the reason that all meats, as ordinarily eaten, including fish and 
fowl, contain in a state of luxuriant growth virulent forms of 
bacteria which are capable of producing infection of the colon 
and of the appendix. For this reason, game, cold storage meats DIET IN DIGESTIVE DISORDERS 
741 
and meat that has been hung until tender are particularly likely 
to give rise to this disease. 
Persons who have been subject to attacks of appendicitis 
and have recovered should discard meats of all sorts, especially 
fish, including oysters, and should take care to keep the colon 
empty by three regular movements daily. 
Efficient measures should be taken for changing the intestinal 
flora (see Index). The stools are always putrid in persons sub- 
ject to attacks of appendicitis. Such persons should not rest 
until they have made such modifications of their diet as to cause 
a decided change in the stools, including the disappearance of 
the putrid odor and of the mucus which is nearly always present 
on account of the coexistence of colitis. 
After an operation for appendicitis, the antitoxic diet (see 
Index) should be permanently adopted and should be faithfully 
adhered to as a permanent regimen. There is no danger of the 
recurrence of inflammation of the appendix, since this organ has 
been removed, but the same sort of infection which produced the 
appendicitis still exists in the colon and will be perpetuated by the 
continuance of the diet which induced it in the first place. The 
danger from infection of the colon is less acute and immediate 
than that from infection of the appendix, but the autointoxication 
which it induces may later produce equally calamitous results. 
DIET IN DISORDERS OF THE LIVER 
There is probably no other organ of the body whose functions 
are so often overtaxed either temporarily or permanently as 
those of the liver. The liver suffers even more than does the 
stomach from dietetic errors. The stomach may summarily dis- 
pose of its offending contents; but the liver acts as a strainer or 
filter. It must secrete and retain in its cells substances found in 
the portal blood likely to do the body harm, and must then, little 
by little, destroy or detoxicate the offending matters. The great 
multiplicity of its functions and the enormous overwork we re- 
quire of this faithful body servant, the monstrous abuses we sub- 
ject it to by our poison habits—the use of tea and coffee, the 
tobacco habit, the use of alcoholics, the high protein diet of meat- 
eaters, and probably worst of all, the great flood of toxins ab- 
sorbed from the intestines and poured through the liver as the 
result of constipation and the use of cathartics and other drugs— 742 
THE NEW DIETETICS 
prematurely wear out the liver cells and cripple this most import- 
ant of all the body defenses against extraneous poisons as well as 
those generated within the body. 
Tests for the Liver Function. 
The great number of vitally important duties performed by 
the liver render highly important the determination of the state 
of its function. Although the great desirability of this informa- 
tion has long been appreciated, it has only been within recent 
years that tests have been devised by means of which the condi- 
tion of the liver function could be determined with any degree of 
exactness. Within a few years numerous methods have been 
brought forward so that at the present time it is possible to apply 
fairly accurate tests to the liver functions by means of which any 
considerable degree of insufficiency may be readily discovered. 
Because of the many different functions of the liver, the tests 
which may be applied to it are now more numerous than those 
which are employed in the functional examination of any other 
vital organ. 
One of the simplest and most practical methods is that known 
as the hemoclastic crisis of Widal. This test is based upon the 
fact that at the beginning of the process of digestion some of the 
products of protein digestion are absorbed before their transfor- 
mation is entirely completed. Normally these substances, which 
in this crude form cannot be utilized by the body, and act as 
poisons, are distributed by the circulation, retained and destroyed 
or detoxicated by the liver. When the liver is diseased, this pro- 
tective function is impaired, so that the imperfectly digested pro- 
teins are permitted to pass into the general blood stream. The 
result is a more or less distinct anaphylactic reaction, the first 
indication of which is an increase in the number of white blood 
cells. This increase of white cells is a part of the defensive re- 
action of the body against the foreign proteins. When the liver 
is the seat of organic disease or its cells functionally crippled, the 
increase of white blood cells does not occur. Instead the white 
cell count decreases, and the more, the greater the deficiency. 
This decrease may occur as the result of taking milk even in 
so small amount as one or two ounces in cases in which the liver 
is very considerably diseased. A larger amount is usually em- 
ployed, however, so that the smaller degrees of hepatic impair- 
ment may be discovered. DIET IN DIGESTIVE DISORDERS 
743 
The method of applying Widal’s test is as follows: The ex- 
amination is made in the morning before breakfast, care being 
taken that the patient has eaten nothing since the night before. 
The blood is examined and the number of white blood cells 
determined. The subject is then made to swallow seven ounces 
of milk and at the end of 20 minutes another specimen of blood 
is obtained and examined. Each 20 minutes the examination is 
repeated. When the liver is diseased the blood cells instead of 
increasing as in health are found to diminish. This change may 
appear at the end of the first 20 minutes. In the majority of cases 
the most marked difiference is observed at the end of 40 minutes. 
The decrease in the number of white blood cells may amount to 
50 or even 75 per cent. This is a very delicate test for impair- 
ment of the function of the liver, and it sometimes gives positive 
results when no other indication of liver disease is observable. By 
means of this test, disturbance of the liver function may be clearly 
demonstrated after the administration of chloroform or treat- 
ment by salvarsan or other arsenical preparations. It is highly 
useful, also, in detecting cases of sensitivity to special proteins 
and is employed by Widal and his associates in all cases of urti- 
caria and asthma. When in a case of this sort a positive reaction 
occurs, a further search is made for the purpose of determining 
the individual protein to which the subject is sensitized. 
Temporary inefficiency of the liver exists in most cases of 
acute infectious disease. It is marked in pneumonia. Whether 
death or recovery occurs will depend in many cases upon the de- 
gree of permanent inefficiency which existed before the develop- 
ment of the acute disease. In general, when marked renal in- 
efficiency exists, inefficiency of the liver is also present. 
Hepatic inefficiency may involve all the liver cells and hence 
all the functions of the liver, or it may concern only a single 
function. It is possible that a considerable degree of organic 
disease of the liver may exist without noticeable functional defici- 
ency. 
It is thus apparent that tests for hepatic efficiency are highly 
important and should be employed in all cases in which there is 
reason to suspect impairment of the functions of this great vital 
organ. To judge of the conditions of the liver only by the color 
of the skin or of the stools, is not sufficient. The inquiry must 
look into other of the less obvious but equally important phases of 
liver work. As many tests as possible should be employed. In 744 
THE NEW DIETETICS 
addition to the test of Widal, the conjugation test of Roger is 
most important. Unfortunately, the color reagents necessary for 
making this test have not been obtainable since the World War, 
but it is believed that they will soon be again available. 
The use of tests for hepatic efficiency is especially important 
in connection with diet regulation, for in no way can the liver 
functions be so greatly influenced as by the food intake. Bennett 
of Edinburg long ago, and Rutherford more recently have shown 
the uselessness of drugs to increase the activity of the liver; but 
foods profoundly affect the liver, exciting it to activity when 
properly employed, and overwhelming it with unnecessary work 
when unsuitable in quality or quantity. It has even been shown* 
that certain foods (carbohydrates) may render invaluable service 
by enabling the liver to repair its damaged cells after they have 
been injured by poisons. Since the time of Claude Bernard it 
has been known that carbohydrates stored in the liver in the form 
of glycogen are an essential aid to the liver in the performance 
of its poison-destroying function. 
DIET FOR “BILIOUSNESS” 
“Biliousness,” an unscientific term, is generally used to desig- 
nate a condition of general malaise, loss of appetite, dullness, 
constipation, and general unfitness. This condition is usually 
attributed to torpidity or inactivity of the liver and calomel is the 
usual prescription, especially in the South, one of its chief prop- 
erties being supposed to be to increase the activity of the liver. 
As a matter of fact, calomel does not increase the activity of 
the liver. This was shown by Bennett, of Edinburg, more than 
a hundred years ago by experiments upon dogs. Bennett found, 
in fact, that calomel lessens the amount of bile produced by the 
liver instead of increasing it. Modern investigators have con- 
firmed these findings; but the use of calomel still continues and 
the users testify that they find relief by its use, at least tempor- 
arily. This is not to be disputed. It is this immediate relief 
which maintains confidence in this antiquated drug. 
The explanation is to be found in the fact that “biliousness” 
is not due to deficient secretion of bile or to sluggishness of the 
liver, but to autointoxication, arising from retention of putrefy- 
ing food residues and body wastes in the colon. Calomel acts 
♦Foie et Pancreas. M. J. Castaigne, Paris, 1920. DIET IN DIGESTIVE DISORDERS 
745 
as a laxative and a disinfectant. Its use causes the discharge 
of a quantity of bile which has become concentrated and toxic by 
re-absorption. Getting rid of these poisons affords relief from 
the symptoms commonly called “biliousness” and other evidences 
of toxemia. 
Unfortunately, the relief is only temporary; and still more 
unfortunately, the relief is not the only result. Some of the 
calomel is converted into corrosive sublimate and is absorbed as 
such, and poisonous effects are produced. The liver is damaged, 
and other evil effects result, among which is colitis. 
It is thus most desirable to avoid the use of calomel, and to 
combat the evil conditions for which it is employed in some other 
way. Fortunately, this may be done and by very simple means. 
Here are the measures which may be adopted with the certainty 
of good results. 
Omit from the diet meats of all sorts and for a time, also, 
eggs. Buttermilk may be used freely and all sorts of fresh vege- 
tables, particularly turnips, greens, celery, cabbage and lettuce, 
with fruits and fruit juices. Two large tablespoonfuls of bran 
should be taken at each meal. 
The flora must be changed by the fruit regimen with three 
ounces of lactose or lacto-dextrin three times daily for a week or 
ten days. A cleansing enema should be taken every night to 
thoroughly empty the colon. 
After recovery from a “bilious attack,” the antitoxic and 
laxative dietaries should be definitely and permanently adopted. 
Care must be taken to move the bowels three times a day, using 
an enema at bedtime if necessary to secure complete emptying 
of the colon. 
DIET FOR GALL BLADDER DISEASE 
Infection of the gall bladder, either with or without gall 
stones, as is the case with other cavities of the body is chiefly 
due to stasis or stagnation of its contents. When the gall bladder 
is not fully and frequently emptied, it becomes an incubating 
chamber. The bile is not a real antiseptic and when charged 
with mucus, as it always is when diseased, it becomes a most 
excellent medium for the growth of putrefactive bacteria and 
other disease-producing organisms. On this account, it is highly 
important in cases of this sort to secure as complete and frequent 
emptying of the gall bladder as possible, thus lessening the op- 746 
THE NEW DIETETICS 
portunity for the growth of bacteria and the development of 
virulent strains of bacteria. 
Something may be done toward the emptying of the gall 
bladder by the cool enema (85° to 75 F.), which stimulates con- 
traction and thus empties the bile reservoir. Free water drink- 
ing (5 to 6 pints daily) thins the bile and encourages its passage 
into the intestine. But the most effective means of exciting con- 
tractions in the gall bladder is the taking of food. When food is 
taken into the stomach and begins to pass out into the duodenum 
through the pylorus, the contact of the acid mixture of gastric 
juice and food with the lining membrane of the duodenum, ex- 
cites powerful contractions in the gall bladder. On this account, 
it is better for these patients to take small quantities of food at 
frequent intervals, preferably four times a day. Two major 
meals may be eaten and two minor fruit meals, the latter two 
hours before meal-time, so as to secure complete emptying of the 
stomach before the next meal. The late Professor Dujardin- 
Beaumetz called attention to this fact so long as thirty years ago. 
A point which the professor overlooked is the need of making a 
careful selection of foodstuffs when four meals are taken. First 
of all, the food should be easily digestible, and of a sort which 
leaves the stomach quickly. Fruit fills the indications exactly, 
and should constitute the sole food taken at the minor meals. 
Rice gruel or plain potato puree may be used when fruit does 
not agree. 
Persons who suffer from gall stones should avoid foods rich 
in cholesterol-containing foods. They should particularly avoid 
much cream or butter and yolk of eggs, which are rich in chol- 
esterol. 
Test for liver efficiency should be made in all cases when gall 
bladder disease is believed to be present. In operating for drain- 
age or removal of the gall bladder the writer has had an oppor- 
tunity to inspect the liver during life in some hundreds of cases. 
In practically all cases there has been observed some evidence of 
disease of the liver itself, after marked cirrhosis has been found 
present and not infrequently enlargement. In view of these facts 
it is evidently necessary that in all cases of gall bladder disease 
great care should be taken to maintain a normal intestinal flora 
by a strict antitoxic diet. The flora should be changed in every 
case and the stools should never be permitted to become putrid 
nor the patient constipated. The bowels should be made to DIET IN DIGESTIVE DISORDERS 
747 
move three times a day and care must be taken to see that the 
colon is well emptied. It is well to empty the colon by means of 
an enema every night at bedtime whenever there is ground to 
suspect that there is retention of residues in the colon. 
The presence of gall stones or pronounced disease of the 
gall bladder is always an indication for operation, and in general 
the gall bladder should be removed because it is a focus of in- 
fection not only for the liver, but for the pancreas, and for the 
whole body. A diseased gall bladder is a far more serious men- 
ace than a diseased tooth or tonsil. 
CIRRHOSIS AND OTHER DEGENERATIONS 
OF THE LIVER 
The liver is crippled in all its functions. It has been required 
to deal with such enormous quantities of toxins that it has been 
prematurely worn out. Its work must be made as light as possible 
by changing the intestinal flora with lactose or lecto-dextrin or 
other of the means pointed out in other chapters, so as to sup- 
press the formation of putrefaction products in the colon, and 
also by avoiding all excess in the use of sweets, since it is a part 
of the duty of the liver to metabolize sugars. Meats of all sorts, 
condiments, all excess of food and especially of protein and fat 
must be carefully avoided. Copious water-drinking and attention 
to personal hygiene in all particulars are necessary measures. 
M. T. V. Tallqvist (La Semaine Medicate) in extended 
dietetic experiments made upon persons suffering from catarrhal 
jaundice, inflammation of the gall bladder, gall stones, and hepatic 
sclerosis due to cardiac diseases and other forms of disease of the 
liver due to intestinal autointoxication, observed that in order to 
produce nitrogenous equilibrium it was necessary to employ much 
larger proportions of carbohydrates than in the normal state. 
This is doubtless due to the disturbance of the hepatic functions 
set up by the toxins absorbed from the alimentary canal. The 
fruit regimen is of great service in these cases. Ewald’s test for 
liver efficiency should be employed. 
DIET IN DISEASE OF THE PANCREAS 
This disease, formerly considered rare, is now known to be 
of comparatively frequent occurrence. The pancreas is especially 
exposed to disease because of its connection with the gall duct. 
The outlet duct of the pancreas and the bile duct generally enter 748 
THE NEW DIETETICS 
the intestine through the same opening, the two ducts usually 
joining just back of the opening into the intestines. When infec- 
tion with chronic inflammation of the gall bladder and gall ducts 
occurs, a common result is a partial obstruction of the outlet, 
which causes a backing up of bile in the pancreatic duct. The 
bile, reaching the pancreas, probably activates the pancreatic juice 
and causes autodigestion of the pancreas, which in turn gives rise 
to infection and inflammation, either acute or chronic. In many 
cases this process goes on for years without producing any con- 
siderable amount of pain, although a common result is diabetes, 
which accounts for the observation made by several eminent 
authorities that meat eating is an active cause of diabetes. Some- 
times, through the formation of cysts, the development of calculi 
or other causes of obstruction, pancreatitis may be accompanied 
by paroxysms of severe pain. 
It is evident that in all cases of pancreatitis a strictly anti- 
toxic dietary should be followed. The diet should be essentially 
the same as that recommended for gall stones and cases in which 
operations have been performed upon the gall bladder. It is 
especially important that meats of all kinds should be discarded 
and that the colon should be kept free from putrefying residues. 
The diet should be such as to secure three full movements daily, 
the enema being used daily, if necessary, to accomplish this. 
The flora must be changed. 
While surgical drainage of the gall bladder affords the only 
radical means of relief, regulation of the diet is of the highest 
importance. 
In cases in which sugar has not appeared in the urine and 
the blood sugar has not increased, as well as in cases of diabetes, 
the antitoxic dietary is especially indicated (see Index). 
Copious water drinking and the use of acid fruit juices are 
highly beneficial. Condiments of all kinds must be excluded from 
the bill of fare, together with tea and coffee. 
DIET IN DIARRHEA 
Diarrheas are generally due to infection, the increased activity 
of the bowels being a remedial effort to eliminate poisons of bac- 
terial origin. There are many micro-organisms which are capable 
of giving rise to diarrhea. Those which are most active are 
found in impure drinking water, usually being derived from the DIET IN DIGESTIVE DISORDERS 
749 
stools of human beings through contamination of the water with 
sewage, in milk, eggs, meat and stale fruits. 
Certain articles of diet, particularly cheese, oysters, contami- 
nated milk, cold storage meats and game, are frequent causes of 
diarrhea not only in individuals but in whole families, sometimes 
affecting entire communities. Pork eaters should remember that 
diarrhea is one of the symptoms of infection with the hog para- 
site trichina. 
Chronic diarrhea is often a symptom of inactivity of the 
colon. It is not infrequently found in cases in which eight or ten 
bowel movements occur daily that the colon, especially the right 
half of it, is filled with fecal matters, never being perfectly 
emptied; and this retention of irritating, putrefying material is 
the real cause of the diarrhea. In such cases, it is necessary to 
increase the efficiency of the colon in order to unload it before 
any progress can be made toward the control of the disease. The 
colon should be thoroughly emptied by the administration of 
copious warm enemas. The enema should be repeated until the 
water is no longer colored with fecal matter. 
The use of cathartics, though frequently employed in the 
treatment of enteritis, is most irrational. The small intestine is 
always found empty six or eight hours after the last meal, the 
food residues and wastes being pushed on into the colon from 
which it may be removed by a simple mechanical means, the 
enema. Cleansing the colon by means of the enema, which may 
be repeated several times if necessary, is all that is required. The 
hot enema (temperature 105 to 108 degrees) has a remarkably 
quieting effect upon the colon, relieves pain, relaxes spasm, and 
in conjunction with hot applications to the abdomen affords the 
patient very great comfort. 
Bran or agar and paraffin oil are indicated in connection 
with the laxative diet. The intestinal flora must be changed and 
the antitoxic diet closely followed. Boil drinking water and dis- 
infect fruits, lettuce and celery. 
Diet in Acute Diarrhea. 
When the diarrhea is due to acute infection, the condition is 
usually accompanied by rise of temperature. 
First of all, in case of acute diarrhea, the patient should be 
put to bed and the diet should consist of water only, or water 
containing two or three ounces of milk sugar to the pint, or of 750 
THE NEW DIETETICS 
thin oatmeal or rice gruel. Eight or nine ounces of milk sugar 
should be taken daily by an adult. Whey cultures of the B. 
acidophilus, in doses of half a pint by mouth three or four times 
a day, are most useful. Lacto-dextrin is still more efficient. 
Milk, eggs, animal broths, all foodstuffs rich in protein, 
should be avoided. The colon should be washed out two or three 
times a day by a hot enema, and a fomentation followed by a 
moist abdominal bandage should be applied to relieve the intes- 
tinal congestion. Repeat the fomentation two or three times a 
day, not only to relieve pain, but to relax the contracted colon 
and thus aid in completely emptying it of its irritating contents. 
In children, milk should be avoided altogether. Instead, for 
seasoning, a little almond cream or nut meal may be added to the 
gruel. Buttermilk, prepared with the B. bulgaricus or B. acid- 
ophilus, is an excellent diet for a few days after convalescence 
begins and helps to complete the change of flora. One to two 
quarts of buttermilk should be used daily. 
Loeper has shown that the loss of calcium through the stools 
in diarrhea may be so great as to give rise to puerpural hem- 
orrhages, tetany, epilepsy, urticaria, itching of the skin, erythema, 
neurasthenia and loss of weight. 
It is evident that these serious effects of the loss of calcium 
may easily be aggravated by the long use of a diet consisting 
only of bland gruels prepared from cornstarch, fine flour and sim- 
ilar preparations which are known to be lacking in lime and 
calcium as well as vitamins, to the absence of which some of the 
symptoms noted may be due. 
No attempt should be made to correct the diarrhea by means 
of a constipating diet. The looseness is not due to mechanical 
causes but to infection. It is necessary that the flora should be 
changed as promptly as possible. In most cases this is accom- 
plished by the free use of dextrin or milk sugar, which should 
be given in quantities of two and a half to three and a half ounces, 
or two ounces of lacto-dextrin, three times a day. 
As soon as the diarrhea is checked, foods rich in lime should 
be administered. Cottage cheese, whey, buttermilk, purees of 
spinach and other greens are the best foods for rapidly making 
good a deficiency of lime. 
The diet should also include sweet or mildly acid fruits, 
purees of vegetables, cereal, gruels and porridges. A day or two 
later, oatmeal porridge, bran brose, graham bread and stewed DIET IN DIGESTIVE DISORDERS 
751 
fruits may be added, and within a day or two more the regular 
antitoxic and laxative diet may be adopted, and should be adhered 
to as a regular regimen. 
If the stools again become very foul or strong smelling, the 
intestinal flora certainly needs to be changed. It is well to apply 
the motility test (see Index). 
DYSENTERY 
In dysentery, the plan of feeding should be essentially the 
same as that for diarrhea in the acute form. In addition, a warm 
starch enema should be administered three or four times a day. 
The addition of half an ounce of milk sugar to a pint of starch 
solution is a most excellent means of combating the colonic in- 
fection. 
In chronic dysentery the diet should not exclude roughage, 
but care should be taken that the roughage is of the right sort. 
Agar may be used safely in quantity from one ounce to one and 
a half ounces daily. Even bran, when well cooked, may also be 
used in connection with other cereals. Greens should be used 
freely in form of puree as roughage and for their iron content and 
vitamins. 
Meats of all sorts must be strictly excluded, of course, as 
they will only aggravate the disease by promoting the growth of 
the bacteria to which the infection is due. Rice, buttermilk, brose, 
potato soup, vegetable broths and purees of greens are particu- 
larly suitable for cases of this sort. 
The intestinal toxemia which often follows diarrhea or dysen- 
tery requires a special regimen to change the intestinal flora. 
DIET IN TROPICAL DYSENTERY 
The diet in tropical dysentery does not differ from that of 
ordinary dysentery, and should be employed in connection with 
proper medication and other measures necessary for the eradica- 
tion of the infection. 
DIET IN PARASITIC DISEASE OF THE INTESTINE 
Most of the parasites which infest the intestine are scaven- 
gers and thrive best in a medium rich in protein residues. Consti- 
pated children are the ones that suffer from worms. While chang- 
ing the intestinal flora and increasing the activity of the intestine 
by natural means cannot be offered as wholly efficient means of 752 
THE NEW DIETETICS 
cure, these measures are of great value in all forms of parasitic 
disease of the intestine in connection with the use of emetin, thy- 
mol, phenyl salicylate and other appropriate specific remedies. An 
antitoxic diet, strictly excluding meats of all sorts, and the main- 
tenance of an acidophile flora are efficient means of lessening the 
liability to relapse. 
An intestinal parasite, Balantidium Coli, a unicellular flagel- 
late organism, a native of the tropics, has been observed in this 
country with increasing frequency during the last thirty years, es- 
pecially in the Southern States, but more frequently in all parts 
of the country. This parasite penetrates the intestinal mucous 
membrane and becomes encysted and resists the emetin and thymol 
and other remedies which destroy most other intestinal parasites. 
Scully and Greene report uniform success in the treatment of 
these cases with a milk and fruit diet. The patients were given 
two and a half quarts of milk a day in small doses at frequent in- 
tervals. Stewed fruits were given to aid bowel action. After 
some days one or two soft boiled eggs were added to the diet. 
It seems probable that the improvement in these cases may 
be due to the presence of the lactose of the milk or the lactic acid 
produced by the acidophile flora, the growth of which is encour- 
aged by a milk regimen. It seems probable that the regular milk 
regimen, with the use of lactose dextrin to change the flora, would 
expedite the cure of these cases. 
DIET IN INCOMPETENCY OF THE ILEOCECAL VALVE 
Although the ileocecal valve has been known as an anatomi- 
cal structure since 1579, or nearly 350 years, its significance has 
not been fully appreciated until very recent times. The small 
intestine is the chief digestive and absorbing organ of the body. 
Within eight hours after the eating of a meal, the digestible and 
useful portions of the food have been digested and absorbed and 
the unusable residue has been pushed through the ileocecal valve 
into the colon. When intact, the valve closes after the food resi- 
dues have passed through it and prevents their return to the small 
intestine. This is highly necessary for the reason that in the 
colon the food residues, if long retained, undergo putrefactive 
changes through which highly toxic substances are produced. 
The structure of the colon is such that these poisons are 
absorbed only to a small extent and are mostly filtered out, while in 
the small intestine absorption is very rapid. DIET IN DIGESTIVE DISORDERS 
753 
Another and very important reason why the ileocecal valve is 
essential is a curious function which was first discovered by 
Cannon in animals and demonstrated by Case in human beings. 
While digestion is taking place in the stomach and small 
intestine and strong peristaltic waves are forcing the food resi- 
dues into the colon through the ileocecal valve, reverse or anti- 
peristaltic waves, starting at the middle of the colon, travel back- 
wards for the purpose of holding the liquid materials for a brief 
period in the cecum, where they have been deposited from the 
small intestine. This action in cases of incompetency of the ileo- 
cecal valve is sometimes so strong, especially after the work of 
digestion in the stomach and intestines has been completed, that 
several feet of the small intestine may be filled with fecal matters 
forced back from the colon. 
In this way the putrid materials with which the colon is 
often filled, may find their way into the intestine and the in- 
fection traveling upward may reach the gall bladder, the pan- 
creas, even the stomach, giving rise to catarrhal inflammation, 
gall stones, pancreatitis, probably also duodenal and gastric ulcers 
and other disorders. According to A. Schmidt, putrefaction should 
never occur anywhere in the intestine except the colon and in 
perfectly normal conditions with a proper dietary, which must 
necessarily exclude meats, putrefaction does not occur even in the 
colon. Says Schmidt: “The ileocecal valve forms a sharp line 
of demarcation above which putrefaction never occurs except 
under pathological conditions. If protein decomposition extends 
up into the small intestine, far greater quantities of indican ap- 
pear in the urine than ever occur through the absorption in the 
colon.” 
From the above it will readily appear that a rigid antitoxic 
diet is of the highest importance in cases of this sort. The food 
should be of such a character that the residues will not encourage 
putrefaction even if delayed for some time in the colon. If 
putrefaction in the colon is suppressed, the injuries resulting from 
a backing up of the colon contents into the small intestine will be 
largely obviated. In such cases the diet must be not only anti- 
toxic, excluding flesh meats of all sorts, but also highly laxative 
so as to encourage frequent bowel action. The bowels should be 
made to move three times daily, by diet if possible, ordinary 
foods being supplemented by the free use of bran or agar and 
paraffin oil. If the bowels do not move freely three times a day, 754 
THE NEW DIETETICS 
the colon should be emptied at night by means of a warm or tepid 
enema. Quantity, three or four pints. Temperature, 90° to 80° 
F. The intestinal flora must be changed. 
ATONIC CONSTIPATION 
Constipation is often attributed to an atonic condition of 
the colon. In this state the colon is widely dilated, as shown by 
X-ray examination, and constantly contains large quantities of 
gas. The walls of the colon seem paralyzed, the gut appearing to 
have lost its power to expel its contents. This condition is 
usually regarded as a disorder of the nerves which supply the 
colon. In the writer’s opinion, the condition is due rather to the 
effect upon the colon of the putrefying materials with which it 
is filled. In such cases the stools are always highly putrid and 
have a most repulsive odor because of their long retention and 
the very advanced stage of putrefaction. In such a condition 
a large amount of ammonia and other alkaline substances is 
present in the colon. It is well known that alkaline substances 
paralyze the colon while acid substances stimulate the muscu- 
lar structures of the colon and cause contraction. That the colon 
is not paralyzed even in these cases is shown by the fact that by 
the introduction of an enema containing citric or lactic acid vigor- 
ous bowel movements may be secured. The addition to the enema 
of the juice of a lemon or a half tablespoonful of lactic acid rarely 
fails to secure prompt expulsion of the colon contents. This may 
be expected, in fact, in all cases in which there is no serious me- 
chanical obstacle to bowel movement. 
It is of the highest importance, then, in these cases to change 
the intestinal flora, so that the colon contents will become acid 
instead of alkaline. This must be done to secure permanent im- 
provement. This may be accomplished by means of the fruit 
regimen. Much more rapid progress may be made in changing 
the flora by introducing into the colon, daily, cultures of the B. 
acidophilus or B. bulgaricus or a mixture of the two. The intro- 
duction of a half pint of an active whey culture of the B. acido- 
philus into the colon after cleansing it by a warm lemon juice or 
malt sugar enema (Index) greatly facilitates the change of the 
intestinal flora. Lacto-dextrin by mouth and rectum is most ef- 
ficient. 
The diet should be made permanently laxative and antitoxic 
(see Index). It should contain sufficient quantities of bran or DIET IN DIGESTIVE DISORDERS 
755 
agar, fresh fruits, fresh vegetables, especially greens, to secure 
three full bowel movements daily. A warm enema should be 
used daily, if necessary, to secure complete clearance of the bowel. 
TAPEWORM 
There is no dietetic treatment by which the tapeworm may 
be expelled from the alimentary canal. Suitable vermifuge treat- 
ment is necessary. It is important, however, to impress upon the 
patient the fact that this disease can be contracted in no other 
way than by the use of flesh food, either beef, pork or fish. 
The fish tapeworm produces more serious injury to health 
than does either the beef or pork tapeworm, often giving rise to 
a very pernicious anemia. This parasite is fortunately rare. 
In the treatment of tapeworm, it is very important that the 
patient should eat very sparingly for several days before the 
treatment is undertaken, and to prevent a recurrence of the 
disease it is equally important that flesh foods, which are likely to 
harbor the parasite, should be entirely discarded. 
DIET IN ESOPHAGEAL STRICTURE 
In this condition, the diet must be fluid. It is a mistake to 
use meat broths, bouillon, albumin water, etc. These prepara- 
tions have little food value and encourage acidosis, which on 
account of the restricted amount of food which can be taken is 
likely to supervene. 
Malt sugar is in these cases of great value. From 1200 to 
1600 calories may be given daily. When malt sugar is not avail- 
able, the sugar of raisins may be utilized. Raisin juice may be 
obtained by boiling four ounces of raisins in a pint of water for 
half an hour. This amount contains about 300 calories of sugar. 
Rice jelly, or rice puree, egg yolk nog, vegetable broths, 
potato puree, spinach puree, sweet corn pulp and similar prep- 
arations are indicated. Farinaceous foods of all sorts should be 
well mixed with saliva before being swallowed. These dietetic 
measures are of course not curative. They are to be used simply 
to keep the patient alive until radical means of relief can be ap- 
plied. Diet in Disorders of Nu- 
trition 
While food is by no means the only agent by which the 
nutrition of the body may be influenced, it is certainly the most 
powerful. By suitable feeding, the weight may be increased or 
decreased, the iron, lime and other saline constituents of the tis- 
sues may be augmented or diminished, cell activity may be ex- 
cited, the activities of the kidney and other glands may be pro- 
moted or lessened and the work of various parts of the digestive 
organs may be increased, facilitated or lessened. 
The significance of body weight as an indication of disease 
has been greatly emphasized by modern studies in metabolism. 
The popular idea that rotundity is an evidence of health and 
vigor has been shown by the statistics of insurance companies, as 
well as by laboratory studies, to be a grievous error. The insur- 
ance companies have shown that the lowest mortality at ages 
under 30 is to be found among persons whose weight is about 10 
pounds above the average, whereas after the age of 30 the lowest 
mortality is found among persons whose weight is below the 
average, and at the age of 50 years and after the minimum mor- 
tality is found in persons whose weight is as much as 30 or 40 
pounds below the average. It is thus apparent that excessive 
weight, especially in persons advanced in years, is highly unde- 
sirable. 
Joslin has called attention to the fact that every over-fat 
person is a potential diabetic. The overfeeding which results in 
an excessive accumulation of fat overworks the pancreas and 
ultimately leads to a failure of its function, which is to produce 
a hormone that enables the body to burn sugar. It is evident, 
then, that every obese patient should make haste to divest himself 
of his burden of excessive fat. It has been wisely suggested that 
every over-fat person should have made on every birthday an 
examination of the urine for the presence of sugar. For greater 
safety, a chemical examination of the blood should also be made, 
for the appearance of sugar in the urine is often preceded for a 
considerable period by an increase of the blood sugar. The slight- 
756 DIET IN DISORDERS OF NUTRITION 
757 
est indication of the loss of the ability to utilize carbohydrates 
should lead to an immediate restriction of the intake of carbo- 
hydrates so as to prevent further damage to the pancreas. 
DIET IN OBESITY 
Before beginning a course of diet to reduce weight, it should 
be determined how much the weight is to be reduced. Suppose, 
for example, a person whose original and normal weight was 120 
pounds now weighs 200 pounds; it would be most unwise to 
reduce such an individual to his original proportions. Ordinarily, 
in a case of this sort it is wiser to be content with reduction of 
the weight to 160 or 165 pounds; that is, not more than half or 
two-thirds of the surplus weight should be removed. In the case 
of persons who have become exceedingly obese, the weight being 
increased from two and one-half to three times the original 
weight, it is not best to undertake to remove more than one-third 
of the surplus. After this has been accomplished, some further 
progress may be made by very slow reduction so as to permit 
the tissues to accommodate themselves to the changed relations 
which result from the removal of a large amount of accumulated 
internal fat. 
When should the weight be reduced? 
In persons over thirty years, a weight 10 to 15 per cent, 
above the average for a person of the same height is an indica- 
tion for weight reduction. 
Weight reduction is advantageous (1) in all cases of diabetes 
when the weight is above the average, (2) in cases of high blood 
pressure even when the overweight is slight, and (3) in cases of 
disease of the heart and (4) in Bright’s disease. 
Persons advanced in years even though 10 or 12 per cent, 
over weight should not undertake a reduction in weight but 
should carefully avoid taking on more weight. 
It is important to notice before beginning a course of diet 
for fat reduction just where the largest masses of fat are de- 
posited, especially whether the surplus abdominal fat is outside 
or inside. In many cases, the excessive accumulation is almost 
wholly within the cavity of the trunk, the fat being deposited in 
the omentum, the mesentery, about the kidneys, around the 
heart and in other parts of the chest and abdomen. In other 
cases, the fat accumulation is almost wholly external, large 758 
THE NEW DIETETICS 
masses being heaped about the abdomen, the hips, sometimes 
about the shoulders, upper arms and thighs. In women, the 
breasts are not infrequently the seat of overfat accumulation. 
A simple method of detecting the location of the abdominal 
fat consists of having the patient lie down and raise the extended 
legs. If the fat accumulation is within the abdomen, the play of 
the abdominal muscles may be easily seen as they are made tense 
when the legs are raised; and if the skin and underlying fat is 
grasped between the hands at the lower abdomen when the legs 
are raised, it will be noticed that the contracted muscles are 
readily felt and the mass which may be gathered between the 
hands when the muscles are lax is snatched away as soon as the 
muscles are tensed by the raising of the legs. On the other hand, 
if the fat is external, a large mass remains between the hands 
when the legs are raised. When the chief accumulation of fat 
is internal, the patient usually suffers greatly from shortness of 
breath because of the great deposit of fat about the heart, and 
fatty degeneration as well as fatty infiltration of the heart muscle 
may exist. This condition often presents an insuperable obstacle 
in the way of taking a sufficient amount of exercise to accelerate 
the fat reduction to any considerable degree. 
Having decided how much fat reduction is required, the next 
question is the determination of the amount of the daily ration; 
that is how many calories shall the patient eat for breakfast, din- 
ner and supper. First of all, we must know what would be the 
normal ration for the individual. If he weighs 210 pounds, and 
we determine to reduce his weight to 170 pounds, then by refer- 
ence to Table II we may ascertain what is the basal ration for a 
person weighing 170 pounds. We find this to be about 1,900 
calories. This makes no allowance for exercise, which would 
probably increase the patient’s ration about 50 per cent., making 
it 2,800 calories. Halving this will give us 1,400 calories for the 
daily intake of the first week. 
The amount of food taken should be determined by careful 
measuring and weighing and should not be guessed at. The 
average person eats a great deal more than he thinks he does. 
The next question is what kind of food shall the patient be 
allowed to eat ? First of all, it is important that the patient should 
be instructed concerning foods which are highly fattening and 
which on this account must be avoided. These are, particularly, 
fats of all sorts, sugar, including candy, rich gravies, pastry and DIET IN DISORDERS OF NUTRITION 
759 
potatoes. Breads and breakfast foods must also be greatly re- 
stricted. On the other hand, there are certain foods which the 
patient may eat freely, almost without restriction. These are, 
especially, fresh vegetables of all kinds, with the exception of 
potatoes, and juicy fruits, green things, particularly cabbage, 
lettuce and fresh cucumbers. Lettuce and greens should consti- 
tute a large part of each meal, so as to supply an abundance of 
vitamins and of food iron and lime. 
Many over-fed persons hesitate to undertake a course of diet 
for losing weight because of the dread of hunger. Such persons 
will be encouraged by learning that when a patient is willing to 
restrict the kind of food which he eats, there is no necessity 
whatever for suffering any inconvenience from hunger. 
The sense of satiety, or the satisfaction of hunger, is largely 
the result of distension of the stomach, and hence bulky foods 
will satisfy the patient and make him feel that he has enough 
to eat even though the intake of food as reckoned in calories is 
very small. It is well, also, to allow butter in very small amounts 
as this greatly aids in producing the sense of satiety. The amount 
should not exceed a half ounce daily. 
Persons who suffer much from hunger may generally find 
relief by taking a small amount of food at frequent intervals. 
Yon Noorden feeds his obese patients five times a day. Hunger 
is simply an indication that the stomach is empty and disappears 
when even a small amount of food is taken. A small apple or 
some other juicy fruit or a few spoonfuls of gruel will tempor- 
arily afford relief of hunger as well as a larger amount of food 
and may be taken whenever discomfort from hunger is experi- 
enced. 
Greens and greenstuffs, especially uncooked foods, are par- 
ticularly valuable and should he made the major part of the 
diet because of the large amount of vitamins which they contain. 
In reducing the diet, the intake of vitamins is proportionately 
reduced, but there is no possible benefit from such a reduction. 
On the other hand, the diet of the average person is very deficient 
in vitamins, so in the obese patient more rather than less vitamins 
should be given and this can only be accomplished by the free use 
of greens and fresh foods. The reduction of food also tends to 
produce anemia. This danger is also obviated by the free use of 
greens, which supply an abundance of food iron. 
The amount of protein required is not increased and should 760 
THE NEW DIETETICS 
never be more than one calorie per pound of body weight. An 
excess of protein is the grievous fault in all the many regimens 
heretofore recommended for fat reduction. It is true that lean 
meats do not contribute largely to the production of fat, hut it is 
equally true that the large intake of protein imposes an enormous 
and onerous burden upon the liver and kidneys while serving no 
useful purpose to the patient. Surplus protein, as shown by 
Folin, is simply eliminated as urea and contributes nothing to the 
welfare of the body. A meat diet greatly increases the liability 
to acidosis. 
The necessary bulk can he easily secured by the free use of 
greens, fresh fruits, fresh vegetables, and bran or agar. A half 
ounce of bran should he taken at each meal or a third of an 
ounce of agar. Paraffin oil should also be taken to secure active 
movements of the bowels, which are likely to become constipated 
when the intake of food is cut down. A tablespoonful of paraffin 
oil should be taken before and after each meal and also, if neces- 
sary, at bedtime. Buttermilk, whey, skimmed milk, and cottage 
cheese may be freely used and are a good source of food lime 
and vitamins. 
The fat reduction is to be secured by reducing the intake of 
fats and carbohydrates. Fats may, in fact, be wholly eliminated 
from the dietary for long periods without injury, as shown by 
the observations of Hindhede referred to elsewhere in this work. 
(For further suggestions see “The Reducing Diet.”) 
It is sometimes advantageous to put the patient upon a 
“mono” diet. For example, he may be allowed one day to eat 
apples, another day peaches, still another day pears, another day 
lettuce, celery and salads of various sorts, either alone or com- 
bined with fruits. Even nuts may be allowed in moderation. A 
very acceptable diet may be arranged on a menu consisting of 
apples, bananas, almonds or Brazil nuts. It is only necessary 
to take care always to keep the total intake of calories within 
the limits, that is, not exceeding half or two-thirds the normal 
ration. 
After the first week or ten days the intake of food should be 
increased 50 per cent., and this reduced dietary, which furnishes 
about three-fourths of the total energy requirement of the in- 
dividual, may be continued for several weeks or even months. 
After a few weeks, the amount of food should be increased a 
little more, to four-fifths the normal requirement, and later to DIET IN DISORDERS OF NUTRITION 
761 
five-sixths. Care must be taken to supply each day all the protein, 
vitamins, lime and iron the individual can possibly need, and 
when this is done no possible harm can come from the dietetic re- 
strictions. The injury which many persons suffer when trying 
to reduce the weight by dieting results from some one of the 
following causes: 
1. Too long fasting, producing injury from acidosis and 
loss of muscular tissue, weakening of the heart, etc. 
2. Excessive intake of protein, overworking the liver and 
kidneys and increasing intestinal putrefactions. 
3. Deficiency of vitamins, leading to general malnutrition 
and sometimes symptoms of scurvy or polyneuritis. 
4. Deficiency of food lime, leading to a condition of lassi- 
tude, loss of muscular tone and a state of general asthenia. 
5. Deficiency of iron, leading to anemia and general loss of 
vigor and vitality. 
6. Constipation and intestinal toxemia, resulting from re- 
duction in the volume of the food and deficiency of roughage. 
Intermittent Fasting* 
Observations made at the Carnegie Nutrition Laboratory of 
Boston, (Folin and Denis), showed that the calorie value of a 
pound of human flesh is 1500, consequently a reduction of the 
maintenance ration of an individual, that is, the number of cal- 
ories required to prevent the loss of weight to the extent of 1500 
calories, will result in the loss of one pound of weight. 
If a person whose maintenance ration is 2500 calories 
undergoes an absolute fast, the result would be a daily loss of \2/$ 
pounds. By means of vigorous exercise, in addition to fasting, 
the energy output may be increased to 3000 or 4000 calories, 
which would cause a loss of weight of two pounds or more. 
Fasting is undoubtedly the most expeditious mode of reducing 
weight, but this method is open to the objection that it produces 
acidosis, a condition in which there is an accumulation in the blood 
and tissue fluids of imperfectly burned fats, which give rise to 
headache, weakness, sometimes nausea and great depression. This 
objection may be overcome by intermittent instead of continuous 
fasting. 
The patient is asked to make a series of short fasts, follow- 
ing each fast by a day or two of feeding, limiting the intake of 
food, however, to the bare maintenance ration. 762 
THE NEW DIETETICS 
Folin and Denis observed that when a series of such fasts 
is undertaken, acidosis becomes less and less severe with each fast 
and appears later. 
A very good plan is the following: Fast one day, drinking 
freely. An ounce and a half of bran or agar should be taken 
with Savita broth, weak lemonade, with little or no sugar, or 
cereal coffee, or some other beverage with a very low nutritive 
value. Two or three ounces of paraffin oil should also be taken 
several times a day to insure bowel movements. After one day 
fasting, take a small amount of bulky food not exceeding the 
maintenance ration, that is, 1500 or 1600 calories. After a couple 
of days, renew the fasting for two days. Follow this by three 
feeding days, making the ration consist chiefly of bulky foods not 
exceeding 1500 or 1600 calories a day. 
After three days of this ration, renew the fasting for a couple 
of days and so continue fasting one or two days after three days 
of light diet, until the weight has been reduced to the proportions 
desired. 
Reduction of Weight by Exercise. 
The comparative inefficiency of exercise as a means of re- 
ducing weight will be clearly shown by a little computation: 
According to the observations of Zuntz, the amount of work 
done by a man walking 13.4 feet, at the rate of three miles an 
hour, is the same that would be required in the lifting of his body, 
vertically, one foot. In walking a mile at this rate, one would 
do work equivalent to lifting his body 400 feet vertically. 
The amount of mechanical work done by a 200 pound man, 
then, walking a mile at the rate of three miles an hour, would be 
80,000 foot pounds (400 x 200), equal to 80 calories. 
At this rate, a man weighing 200 pounds would have to walk 
8 or 9 hours, and to travel 25 to 30 miles in order to reduce his 
fat half a pound. The actual reduction in weight might be four 
times this because of the water associated with solids in the tis- 
sues, although the water loss often follows a little later. 
Automatic exercise, first employed by the author by means 
of the sinusoidal electrical current some thirty years ago, has 
proved itself to be efficient as a means of reducing weight. When 
vigorously applied, this exercise may increase the energy output 
of the body to eight times the ordinary rate. The actual loss of 
weight in a half hour by automatic exercise sometimes amounts DIET IN DISORDERS OF NUTRITION 
763 
to as much as two pounds, but of course this great loss in weight 
is chiefly due to excessive perspiration, and does not represent 
actual fat reduction. 
The rational method of dealing with cases of obesity re- 
quires the combination of exercise and diet restriction, the last 
being most efficient. 
Obesity Due to Endocrine Disturbance, 
In cases of obesity due to disturbance of the internal secre- 
tions, an entirely different course must be pursued. The patient’s 
increase of weight is not due to an excessive intake of food or 
fuel, but to diminished vital combustions. The fuel-food is not 
consumed as rapidly as it should be and hence accumulates, pro- 
ducing much the same effect as would result from an excessive 
intake of food. A metabolism test will probably reveal this con- 
dition when present. 'The metabolism rate is diminished. 
The obesity resulting from disturbed metabolism is likely to 
be regional in character. The principal seats of accumulation 
are the abdomen, the hips, shoulders or breasts. Obesity from 
disturbed internal secretions is the most common form of over- 
fatness encountered in boys and girls. It makes its appearance 
before puberty, and in well pronounced cases there is marked 
delay in the development of the genital organs. 
By proper tests, it may be shown that in these cases there is 
a diminished metabolism. The treatment consists not in greatly 
restricted diet and exercise but in the administration of prep- 
arations of the thyroid, pituitary or other internal glands. 
Still another form of obesity may be mentioned which is 
sometimes termed anemic obesity. The patient is pale, the tis- 
sues are soft and flabby and contain an excess of water. The 
patient may be said to be “water-logged.” Metabolism is de- 
ficient. These cases recover rapidly under the influence of tonic 
baths combined with light baths and massage. The diet should 
be rich in food iron. This means that the patient should eat a 
liberal serving of greens of some sort twice a day and should se- 
lect for his bill of fare foods rich in iron. 
In the dietetic management of obesity a few important points 
to be remembered are these: The protein intake should be not 
more than normal in amount. Fat may be almost wholly excluded 
from the dietary and the proteins and carbohydrates considerably 
reduced. If too great a reduction in the total food intake is made, 764 
THE NEW DIETETICS 
the result will be loss of body protein, which is not desirable. 
Carbohydrates protect the body proteins more than do fats, hence 
they must not be too greatly reduced. 
Greens should be used in abundance at every meal. A little 
butter taken at the beginning of the meal helps to cause a com- 
fortable feeling of satiety. 
Broths, such as bean broth, vegetable bouillon, and broths 
prepared from yeast extract (savita), should be freely used to 
supply vitamins. 
The Water Intake. 
A person undergoing treatment for the cure of obesity re- 
quires less water than a normal person under the same conditions 
for the reason that in the state in which they exist in the human 
body the solids are in biologic combination with a considerable 
amount of water. This water content of fhe tissues does not 
always leave the body as rapidly as do the solids in cases under- 
going fat reduction. It is on this account that patients do not 
always lose in weight as rapidly as they are naturally expected 
to do, judging from the amount of the food intake and the elim- 
ination of solids taking place. When the elimination of water 
is slow it is only necessary to persevere in the application of the 
measures employed with the certainty that the effects desired will 
in due time make their appearance. Such cases are greatly bene- 
fited by the use of sweating baths, and also by the disuse of salt. 
In the preparation of foods for obese patients, little or no 
salt should be used. The importance of this will be recognized 
when it is remembered that for every ounce of salt in the tissues, 
more than one hundred ounces of water must be retained to hold 
it in solution; that is, for every ounce of salt which the tissues re- 
tain, over six pounds of water will be retained with it. A certain 
amount of salt is eliminated daily in the urine and the perspira- 
tion. If the salt thus lost is not replaced by salt in the food, the 
result will necessarily be a proportionate loss of weight. The daily 
salt requirement of the body is not more than one dram (four 
grams) but the majority of people take with their food three or 
four times this amount. If the intake be reduced even so much 
as one dram, the result would be the reduction of the body salt 
to an equal extent and with it the loss of more than one hundred 
times as much water and reduction of weight to the extent of 
one pound. DIET IN DISORDERS OF NUTRITION 
765 
Karell's Method. 
Weight Reduction. This method, originated by Dr. Phillip 
Karell, of St. Petersburg, physician to the emperor of Russia, 
more than fifty yeafs ago, was the first systematic plan for the 
reduction of weight. The method consists in restricting the food 
intake to three or four pints of milk daily. The milk is divided 
into four portions and taken at intervals of about four hours. 
This method has been much used in Germany, especially in the 
treatment of cases of diseases of the heart or kidneys with 
dropsy and obesity. 
Oertel's Method* 
The patient is given daily five to six ounces of protein, two 
and a half to four ounces of carbohydrates and an ounce and a 
half of fat, or 1150-1600 calories. The intake of fluids was re- 
stricted to three pints. Tea and coffee and wine were allowed. 
Patients were required to exercise vigorously, especially in hill- 
climbing. This method is certainly not to be recommended. 
Von Noor den's Method* 
This author divides his patients into three classes, which he 
distinguishes as “slight, moderate and pronounced.” The main- 
tenance ration for the first class of patients is diminished one- 
fifth ; for the second, two-fifths; and for the third, three-fifths. 
The objectionable features are the free allowance of beef broth, 
wine and an excess of protein, of which the patient is given 
480-720 calories, fully three times the required amount. 
Banting's Method* 
This once famous method required the patient to subsist upon 
a diet consisting largely of meat and wine. Three ounces of 
toasted bread were allowed, with green vegetables. Fluids were 
restricted to one quart. As these consisted chiefly of wine, the 
amount of water supplied to the tissues was not sufficient to 
insure the proper elimination of the tissue wastes, enormously 
increased by the great excess of protein. The patient was allowed 
four meals a day, all but one of which consisted chiefly of meat 
and wine. 766 
THE NEW DIETETICS 
The Salisbury Method, 
This method, considerably in vogue forty years ago, is still 
mentioned by writers of dietetics, although it should have been 
long ago forgotten, as it had no scientific basis whatever. Dr. 
Salisbury conceived the idea that most human ailments are due 
to the development of yeast in the alimentary canal and in the 
blood. He maintained that by excluding carbohydrates from the 
diet, the yeast cells might be starved out. He employed this 
method in the treatment of tuberculosis, Bright’s disease and 
nearly all chronic maladies, including obesity. The diet consisted 
almost exclusively of chopped or scraped beef, hot water, weak 
tea and broths. The patient was given one pound of meat three 
times a day. The weight may be reduced, without doubt, by a 
diet of this sort, but the remedy will be found worse than the 
disease and will produce disorders far more serious than obesity. 
DIET IN EMACIATION 
A person may be under weight, that is, below the average 
weight for a person of his height and yet enjoy excellent health; 
indeed, in persons 50 years of age or over, as shown by the 
statistics of the Metropolitan Life Insurance Company, the life 
expectancy of persons who are under weight, even to the extent 
of 30 or 40 pounds, is greater than that of persons of average 
weight. In persons under 30 years of age, however, the opposite 
is true. Young persons weighing slightly above the average show 
the lowest mortality. Rotundity is a mark of high health in 
youth. In persons below the age of 30 under weight is significant 
of malnutrition. This is the age when tuberculosis claims the 
greatest number of its victims and loss of fat is one of the early 
symptoms of this disease. Persons who are threatened with 
tuberculosis or in whom a formerly active tubercular process has 
become latent, should take care to maintain their body weight a 
little above the normal. Persons suffering from Bright’s disease 
and diabetics should carefully avoid overweight. Neurasthenics 
generally are improved with the taking on of weight. 
Fat, or residual tissue, is like a bank account. The amount 
depends upon the balance between income and expenditure. When 
the intake of foods is greater than the amount consumed, the sur- 
plus is normally deposited as fat, held in reserve for some future 
time when the intake may not be equal to the outgo. DIET IN DISORDERS OF NUTRITION 
767 
The problem, then, when a gain of weight is desired, is to 
adjust the relation between the intake of food and the expendi- 
ture of energy so that there will be a balance left for deposit as 
fat. Ordinarily the solution of the problem is not difficult, but 
there are certain cases in which an abnormal expenditure of 
energy in a manner not easy to control becomes a serious ob- 
stacle. With reference to these cases it is especially important to 
bear in mind that the largest expenditure of energy, and hence 
the largest draft upon the food supply, is made by what is known 
as muscular tension or tonus. 
The muscles are constantly in a state of rhythmic automatic 
activity. When a living muscle is cut the ends instantly separate 
because of tonus. This tension is maintained by a continuous 
series of nerve impulses which reach the muscles from the con- 
trolling centers at the rate of 16 to 20 impulses per second. Evi- 
dence of this continuous muscular activity may be obtained by 
pressing the tip of the finger into each ear while contracting the 
muscles of the arms. The pulsating tone heard corresponds to 
the low notes of a great pipe organ. This muscle tonus is the 
chief means by which the normal temperature of the body is 
maintained, heat being the by-product of the muscular action. 
According to the physiologists from 30 to 50 per cent, of the 
entire intake of energy in the form of food is consumed by muscle 
tension. This continuous automatic form of muscular work is 
exceedingly variable. In a person who is in a highly nervous 
state, through worry, fear or for any other cause, the tension is 
high and hence the consumption of energy very much greater. 
Such persons often make no gain in weight even though eating 
much more than the normal requirement. They do not gain for 
the reason that the expenditure is greater than the normal rate. 
It is to be remembered, also, that the body, like a growing 
plant, makes its chief gains during sleep; hence it is essential for 
a person who desires to gain in weight to eliminate all sources of 
nervousness and worry so that tension may be reduced to a mini- 
mum and that abundant sleep should be secured. For a very 
rapid gain rest, even to the extent of confinement to bed or to the 
horizontal position, is essential. The patient should be kept as 
quiet as possible and should sleep as much as possible. In general 
it is not necessary that the patient should remain in bed. It is 
only important that active exercise should be avoided. It is to be 
remembered, however, that even what might be called moderate 768 
THE NEW DIETETICS 
exercise may increase the expenditure of energy 25 to 50 per 
cent. So slight an exercise as sitting increases energy expendi- 
ture 5 per cent., while standing causes an increase of 10 per 
cent. Sewing causes an extra loss of 13 per cent., and moderate 
walking increases the energy expenditure to the extent of 250 
per cent. 
Generally, the patient may read, chat, and entertain himself, 
and may be entertained with music and in other ways, but should 
avoid violent excitement of all sorts. 
Care should be taken to see that while the patient lies in bed 
the trunk is properly supported by a firm cushion placed at the 
small of the back. When this precaution is neglected patients who 
lie long in bed often suffer from subluxation, or strain, of the 
sacro-iliac synchrondrosis, the joint formed by the junction of 
the sacrum and the lateral bones of the pelvis. Many patients 
when lying in bed suffer from backache due to lack of back sup- 
port. 
It is also wise for the patient to lie with the body inclined 
forward toward the right side. This position facilitates emptying 
of the stomach, especially in cases in which the stomach is dilated 
or prolapsed. If nausea is present, the patient should lie upon 
the left side to prevent strain upon the cardiac orifice (Brunton). 
Absorption of the digested food material from the intestine 
may be greatly promoted by application of pressure upon the abdo- 
men. In the majority of cases in which the milk regimen is em- 
ployed, the patient will be found to have very relaxed abdominal 
muscles and in consequence the intra-abdominal pressure is greatly 
diminished if not altogether absent. This greatly hinders the 
absorption of the digested foodstuffs. By the application of a 
sand bag or a shot compress to the abdomen the necessary pres- 
sure may be secured and absorption greatly facilitated. 
Instead of applying weight to the abdomen the patient may 
obtain essentially the same result by lying upon the face so that 
the abdomen will be compressed by the weight of the body. By 
lying over a cushion or a pillow the effect of the prone position 
may be greatly increased. 
Sand bags weighing ten to twenty pounds are of great service 
in supporting the patient in a position of complete relaxation and 
rest. More than half the internal work of the body is due to 
muscle tension. Lying in bed is often far from being the com- 
plete rest that one naturally conceives it to be. The evidence of DIET IN DISORDERS OF NUTRITION 
769 
this is seen in the fact that the patient gets tired and most uncom- 
fortable and requires frequent change of position. 
The chief cause is undue muscle tension, due to unconscious 
muscular effort in maintaining the body in position. That this is 
considerable is shown by the instant relief and sense of comfort 
experienced when sand bags or other suitable “props” are prop- 
erly applied. 
The tendency to slip down in bed if the head and shoulders 
are raised even a little is unconsciously antagonized by involun- 
tary muscular action involving waste of energy. This may be 
easily prevented by a twenty-pound sand bag placed against the 
buttocks. When the patient lies upon the side the addition of a 
couple of ten-pound bags placed against the small of the back 
and the shoulders give the patient a feeling of support and secur- 
ity that is most agreeable and restful. In many cases an addi- 
tional bag placed in front against the lower abdomen is highly ad- 
vantageous. If pain is present, or if colitis and a spastic con- 
dition of the colon exist, a warm or hot bag in front (especially 
the lower left side) is most useful, relieving pain and relaxing 
the contracted bowel at the same time that it gives support and 
compresses the relaxed and distended abdomen. 
Surrounded by these supports, the sense of tension that 
makes patients restless in bed and keeps them turning from side 
to side or otherwise changing position is soon lost and the patient 
feels at perfect rest, cradled in a comfortable nest in which he may 
relax completely and thus save a useless waste of energy that will 
not only hinder the accumulation of fat, but will also interfere 
with the storing up of energy in the cells of the brain and spinal 
cord, one of the essential aims of the “rest cure” in these cases. 
Observations by Benedict and others have shown that a con- 
siderable restriction in the diet for two or three days is likely to 
be followed by a more active assimilation of food, and hence 
facilitates fattening. It is well on this account to employ the 
fruit regimen for three or four days before beginning the surplus 
feeding. Lactose or lacto-dextrin should be used in liberal doses 
for changing the flora and care should be taken to empty the 
bowels thoroughly as an aid to elimination of toxic products. 
In arranging a fattening bill of fare special care should be 
taken to place the protein of the diet at a low level since it is well 
known that protein in excess of the actual needs of the body 
increases nerve and muscle tension and thus wastes energy. 770 
THE NEW DIETETICS 
For a rapid gain in flesh the milk regimen is one of the most 
efficient means. By the milk regimen is not meant milk diet, but 
systematic feeding of milk in connection with other foodstuffs 
necessary to make good the deficiencies as explained elsewhere in 
this work. The free use of lactose and lacto-dextrin with the 
use of milk is of great value. Either lactose or malt sugar may be 
used in doses of one or two ounces well dissolved in two-thirds 
of a pint of water between meals. By repeating doses of sugar 
water several times a day the total intake of food may be con- 
siderably increased. In general, the increase should be about 25 
per cent, above the maintenance ration. 
Further directions concerning the technic of feeding to secure 
a gain in weight will be found under the headings “Fattening 
Regimen” and “Fattening Diet.” 
DIABETES 
In this disease, the patient has lost his power to burn the 
sugar which the blood takes up from the liver and so the kid- 
neys must eliminate it to prevent the mischiefs which would 
necessarily arise from an accumulation of sugar in the blood. 
The primary fault is believed to be in nearly all cases in the 
pancreas, which normally creates and sends into the blood sub- 
stances which enable the muscles and other tissues to burn the 
blood sugar, but in diabetes fails to produce the necessary amount 
of these hormones. 
Sugar appears in the blood in excessive proportion before it 
can be detected in the urine by the ordinary tests. 
By modern laboratory tests the sugar content of the blood 
may be easily determined and watched from day to day. Nor- 
mally, the amount of sugar is about one part in one thousand of 
blood, or 0.08 to 0.12 per cent. In diabetics, the sugar of the 
blood is usually much higher than normal, rising to 0.30 per cent, 
or even more. 
Experiments with insulin show that the sugar content of the 
blood is nicely regulated to body needs, and when it is much re- 
duced, the results are more serious than when it is raised. A very 
low blood sugar may give rise to stupor and even convulsions and 
death. Fatal effects are easily produced in animals, although an 
injection of glucose, if made soon enough, will cause the men- 
acing symptoms quickly to disappear. DIET IN DISORDERS OF NUTRITION 
771 
An excess of blood sugar may result from (a) an excessive 
intake of sugar (6 to 8 ounces) ; (b) lessened use of sugar by the 
muscles; (c) failure of the liver to store sugar or glycogen or 
increased production of sugar by the liver; (d) increased pro- 
duction of sugar or diminished storage by the muscles; (e) les- 
sened fat production at the expense of sugar. 
The blood sugar is usually higher in persons of advanced 
age than in young persons. It is also higher in advanced cases of 
diabetes. In such cases, it .should not be too much reduced. 
In occasional cases, sugar is found in the urine even though 
the blood sugar is not raised. All these facts must be taken into 
consideration in dealing with diabetics. 
In recent years, a new test known as the Bergel test has been 
developed by means of which the pre-diabetic state may be de- 
tected by examination of the urine; that is, a condition in which 
a moderate excess of sugar is found in the blood and in which 
carbohydrates are not well utilized. The writer has found this test 
very useful in detecting cases of potential diabetes. In one in- 
stance a father brought to the Battle Creek Sanitarium his daugh- 
ter—a young girl of 12 years, a very severe case of diabetes. He 
had lost two children with the disease at about the same age. Her 
urine showed no sugar, but responded to the Bergel test. Ex- 
amination of the blood showed it to contain a large excess of 
sugar. 
The failure of the pancreas to produce the sugar-burning hor- 
mone is probably due, in most cases, to chronic pancreatitis, one 
cause of which is associated with infection of the gall bladder and 
biliary passages. 
Conroy, who examined the pancreas of a considerable num- 
ber of patients who died of diabetes, found quantitative or quali- 
tative changes in every case. Diabetes as a cause of death is 
becoming increasingly prominent in the mortality statistics. While 
the death rate from this cause varies in different parts of the coun- 
try from 6 to 22 per hundred thousand, the average is now 17. 
The deaths from this cause in the United States have reached the 
great total of nearly 19,000 annually in 1922, an increase of 10 
per cent, over the preceding year. It is estimated that there are 
in this country more than one million diabetics, nearly all of 
whom will be dead within five or six years and their places will 
be filled by a still larger number with the same dismal prospect. 
The new methods of treatment have increased the diabetic’s 772 
THE NEW DIETETICS 
life duration more than a year, but the life expectancy of patients 
under 20 years of age is still less than three years and that of 
older patients less than six years. There is hope, however, that 
hy the very recent great advances which have been made, not only 
in feeding methods but through the use of the pancreatic hormone 
first isolated by Banting, much more may be accomplished in pro- 
longing the lives of these unfortunates than has heretofore been 
done. It is evident, however, that the most important of all the 
many problems remaining unsolved with reference to this disease 
is that of causation and prevention. Some progress has been 
made in this direction. 
It is the writer’s belief that diabetes has its origin chiefly in 
three common, almost universal, dietetic errors: 
1. The excessive use of carbohydrates in the form of cane 
sugar and candy and other sweets. 
2. The use of an excessive amount of protein, particularly 
in the form of meats, by which intestinal putrefaction is encour- 
aged, resulting in infection of the bowel through which the body 
is flooded with toxins and pernicious organisms which induce de- 
generative and destructive changes in the pancreas, by which this 
organ finally becomes so crippled that it is no longer able to per- 
form its part in the metabolism of sugar by the production of 
the necessary quantity of the hormone insulin, or “iletin.” 
3. Neglect to provide in the daily bill of fare the necessary 
amount of bulk in the form of bran and other roughage to secure 
the prompt and thorough evacuation of the food remnants and 
body wastes which is necessary to prevent putrefaction of these 
residues. This results in intestinal toxemia by which the glands 
which destroy are overworked and damaged, together with other 
glandular structures, especially the pancreas, the liver, the kid- 
neys and other great glandular,organs. 
Another cause of degenerative changes in the islands of 
Langerhans is no doubt the circulation of poisons in the blood, 
the sources of which may be as various as in the case of similar 
degenerations in the liver and other glandular structures. Doubt- 
less the most common source of these poisons is putrefactive 
processes resulting from stasis in the colon and lower small 
intestine. 
In cases in which a hereditary predisposition to diabetes 
exists, it is possible that careful avoidance of these dietetic errors 
would prevent the appearance of the disease. DIET IN DISORDERS OF NUTRITION 
773 
These several causes co-operate together in a remarkably effi- 
cient manner for the destruction of the pancreas by increasing 
the work required of it, while at the same time lessening its func- 
tional capacity. When it is borne in mind that the average Ameri- 
can consumes not less than 102 pounds of cane sugar annually, or 
four and one-third ounces every day, together with one hundred 
and seventy pounds of meat, or half a pound daily, a quantity of 
protein which Chittenden has shown to be more than double the 
amount which the body can utilize—it is no wonder that diabetes 
is rapidly increasing in this country. 
Gall stones are frequently present in cases of diabetes, and 
in many cases recovery from diabetes has occurred when gall 
stones have been removed. In other cases, a cure has been 
effected by draining of the gall bladder. 
R. T. Williamson (British Medical Journal, February 2, 
1918) lays great emphasis upon three general factors which seem 
to play an important role, at least as predisposing causes, in the 
production of diabetes mellitus. These are: habitual consump- 
tion of sugar and sweets; prolonged and intense mental anxiety, 
worry, overstrain or sudden shock; a family history of diabetics. 
Dr. Magnus-Levy, who has made a study of conditions in 
Germany since the war, reports that diabetes has practically dis- 
appeared, doubtless one of the many beneficent results following 
from the food restriction made necessary by the war. 
The X-ray study of a number of diabetic cases made by 
Dr. James T. Case showed that ileac stasis, that is, stagnation 
of the contents of the small intestine, exists in nearly all cases 
of this disease. This condition is produced in most cases, at 
least, by incompetency of the ileocecal valve, which is, in turn, 
due to dilatation of the cecum, a result of obstruction to normal 
bowel movement usually existing in the descending or pelvic colon. 
Infection gradually travels up from the lower bowel until it 
reaches the pancreas. Diabetes is only one of the disorders which 
may be due to this chronic intestinal toxemia. 
The Dietetic Treatment of Diabetes. 
In the dietetic treatment of this disorder, it is important to 
give consideration to the cause of the disease as well as to its 
results. The moderate suppression of sugar in the urine is by 
no means sufficient. The urinary sugar is merely a symptom of 
the disease. The most important thing of all is to check the pro- 774 
THE NEW DIETETICS 
gressive disease of the pancreas; in other words, to suppress the 
intestinal infection. This requires first of all relief of the intes- 
tinal stasis, which usually begins in the lower part of the bowel 
and gradually ascends until the small intestine becomes involved. 
Chronic colitis, a spastic condition of the colon, stasis in the 
cecum, and any other conditions found present by careful exami- 
nation must be removed so far as possible by proper treatment. 
The colon must be kept emptied by securing three full evac- 
uations of the bowels daily. Agar-agar, specially prepared bran 
from which the starch has been removed, and paraffin oil are of 
essential service in accomplishing this end. If necessary, the 
warm water enema should be used once or twice daily, to secure 
thorough evacuation of the colon. 
A strictly antitoxic diet must be adopted. This of course 
requires the elimination of meats of all sorts. If milk is used, 
only certified milk should be employed and it should be free from 
contamination with Welch’s bacillus. Eggs must be perfectly 
fresh and when possible should be obtained from milk-fed hens. 
Mouth asepsis must be carefully maintained. In some cases gall 
bladder drainage may be practised with great advantage. 
The next step is to arrange for the patient a bill of fare 
which will cause the disappearance of sugar from the urine and 
reduce the blood sugar. The amount of sugar normally found 
present in the blood is 9 to 12 parts in 1000. This may be in- 
creased in diabetes to two or three times the normal amount. 
The determination of urinary sugar is much more easily accom- 
plished than that of the blood and it is a convenient means of 
watching the daily progress of the case. From time to time the 
urinary examinations should be supplemented by an examination 
of the blood. 
The treatment of diabetes is chiefly dietetic, although without 
doubt other accessory measures are important and have been quite 
too much neglected, particularly exercise and the employment of 
means to combat intestinal toxemia. Within the last ten years 
there have been wonderful advances in our knowledge of this 
malady and revolutionary progress in the methods of treatment. 
Formerly a diet consisting almost wholly of meats was a routine 
prescription, and it was thought necessary to increase very con- 
siderably the intake of food in order to make good the losses 
which the diabetic suffers through the escape of sugar in the DIET IN DISORDERS OF NUTRITION 
775 
urine. It is now known, however, that not infrequently these 
overfed patients were actually starving because of their inability 
to utilize the food eaten. It has been learned, also, that an excess 
of protein produces even worse effects than an excess of carbo- 
hydrates by increasing acidosis as well as the loss of sugar since 
sugar may be derived from protein as well as from carbohy- 
drates. 
One of the first suggestions which led to the development of 
modern methods was perhaps the observation by the eminent 
Bouchardat, who noted during the siege of Paris that many dia- 
betics lost their sugar. This led Bouchardat to require his dia- 
betic patients to fast occasionally for the purpose of clearing the 
urine of sugar. Some years ago Guelpa of Paris adopted fasting 
as a routine method in diabetes and read several papers on the 
subject before the faculties of Paris and also presented a paper 
before the profession of Great Britain and wrote a book on the 
subject. But the fasting method was made known to the people 
of this country chiefly through the work of Allen and Joslin. 
Woodyatt, Newburgh and numerous others in this country as 
well as in France and England have within recent years made 
extended experimental and clinical researches which have re- 
sulted in the development of new methods which promise to 
improve very greatly the outlook for this class of sufferers. Hun- 
dreds of cases have been treated at the Battle Creek Sanitarium 
by modifications of the new methods proposed and with results 
which justify the belief that still farther progress may be made 
in dealing with this hitherto intractable malady. 
In mild cases of diabetes the urine may be made free of sugar 
by fasting two or three days, and by proper regulation of the 
diet may be kept free. Cases are rare, in fact, in which by suffici- 
ently careful dietetic management the urine cannot be kept free 
from sugar. 
Complete fasting should be resorted to only when the urine 
cannot be cleared of sugar by less drastic restrictions in the diet. 
It needs to be remembered that a fasting patient loses very nearly 
one per cent, of his tissues daily. To make up this loss may 
require several days or even several weeks in one whose powers 
of assimilation are considerably depreciated. A year might be 
required to recover the loss of weight resulting from a complete 
fast of five or six days. For each pound of body weight, a person 
loses about sixty grams of protein, one hundred and twenty-two 776 
THE NEW DIETETICS 
grams of fat and seven grams of carbohydrates, or 1366 calories. 
Joslyn estimates the value of a pound of human flesh at 1500 
calories. 
Sakaguchi, who has made an extended research in relation 
to the effects of food on sugar elimination in diabetes, has shown 
that tolerance for carbohydrates is least at breakfast and the 
elimination of sugar highest after the first meal of the day. He 
thinks this is due to the lessened production of glycogen in con- 
nection with the breakfast. He finds that the elimination of sugar 
following breakfast may be reduced by giving a small amount of 
carbohydrate an hour or two before breakfast. 
He also noted that carbohydrates are best burned if taken 
four or five hours after the preceding meal. If the interval be- 
tween meals is prolonged to six hours or more, sugar elimination 
is increased. 
The same investigator observed that the maximum increase 
of blood sugar occurs two to four hours after the meal it eaten. 
The normal sugar tolerance differs considerably for the dif- 
ferent sugars. According to the best authorities, a normal indi- 
vidual should be able to utilize completely the several sugars in 
the quantities named, as follows : 
Lactose 120 grams 
Cane sugar 150-200 “ 
Levulose 200 “ 
Glucose or malt sugar 200-250 “ 
The above quantities of sugar taken at a single dose should 
not be followed by the appearance of sugar in the urine. If sugar 
appears, the patient is probably diabetic. 
The discovery by Banting of a method by which the pan- 
creatic hormone, insulin or iletin, may he obtained from the pan- 
creas of slaughtered animals, has provided a new and invaluable 
remedy for use in the treatment of this disease. By the proper 
use of insulin, it is indeed possible to dispense with the complete 
and prolonged fasting first employed by Guelpa and systematized 
by Allen and Joslin. 
By careful administration of insulin the urine may he freed 
from sugar and the blood sugar may be quickly reduced to nor- 
mal or nearly normal limits. Insulin does not effect a cure but 
simply supplies the lacking hormone which is necessary to enable 
the body to utilize carbohydrate. Insulin should always he em- DIET IN DISORDERS OF NUTRITION 
777 
ployed under the supervision of a physician who has been prop- 
erly instructed in its use. While invaluable as an aid in the treat- 
ment of diabetes, its use does not obviate the necessity for careful 
regulation of the diet; neither does it restore the pancreas to 
its normal condition. It simply supplies to the body a lacking 
element which is essential. Its use must be continued indefinitely 
in cases in which a moderate restriction in diet is not sufficient to 
keep the blood sugar within safe limits. Neither does the use of 
insulin remove or combat the original causes of diabetes, whatever 
they may be. It does, however, afford a means of giving the 
pancreas rest and so encourages repair. Recently, also, cases have 
been reported in which by the judicious use of insulin the carbo- 
hydrate tolerance has been increased to such a degree that by 
careful dieting its further use appeared to he, for the time at 
least, unnecessary. 
The readiness with which absolute fasting usually clears the 
urine of sugar, together with the enthusiastic reports made by the 
promoters of this method, led to its rapid adoption by physicians 
throughout the country, but the results were on the whole disap- 
pointing. The fasting method has its dangers as well as its ad- 
vantages and there is at present a decided reaction against the 
extreme, drastic measures first employed. At the present time, 
in fact, some of those most successful in the treatment of this 
disease have eliminated the fast altogether. In cases in which 
the urine contains a large amount of sugar, however, there is an 
undoubted advantage in restricting the diet for one to three days 
to such a degree as to amount to almost an absolute fast. During 
this period the patient should remain quiet in bed or lying on a 
couch in the open air. He should drink three or four quarts of 
water daily. The water may be slightly flavored with some acid 
fruit, or a dilute broth (yeast extract) may be used instead of 
water. It is well, also, to have the patient take three or four 
times a day a half ounce of agar agar or diabetic bran, that is, 
bran from which all the starch has been removed, not by wash- 
ing, but by actual digestion. 
In arranging the dietary of the diabetic patient, each of the 
following points must receive consideration 
1. The amount of protein, which should he sufficient to 
meet the patient’s requirements without excess. 
2. The total carbohydrate should be as great as the patient 
can utilize, that is, should he equal to the patient’s sugar tolerance. 778 
THE NEW DIETETICS 
3. The total number of calories should approach as nearly 
as possible to the patient’s actual requirement, and should not be 
permitted to fall below the patient’s basal requirement for any 
considerable length of time. 
4. The supply of vitamins and mineral salts should be suf- 
ficient. 
5. An adequate amount of roughage should be added to 
secure normal bowel action. 
The Fat Allowance in Diabetes. 
Newburgh and Marsh maintain that fats may be used in 
much larger quantities than have heretofore been regarded safe 
provided the protein is kept low (.66 gram per kilogram of body 
weight, or 1.2 calories per pound). They also dispense with fast- 
ing, maintaining that undernutrition is not desirable. They also 
keep the carbohydrate very low, never allowing more than 35 
grams (1 1/6 ounces) daily. They begin the diet with very low 
protein and very little carbohydrate and a considerable amount of 
fat and rapidly increase the fat until the requisite number of 
calories required by the patient is provided, always keeping the 
carbohydrate and protein within the limits stated. They claim 
that the results found in the treatment of 200 cases fully justify 
their conclusion that the danger of acidosis from the free use of 
fats is much less than has been supposed and that the urine may 
be kept free from sugar more easily by this method. The results 
of Newburgh and Marsh seem to agree with those of Labbe and 
Leclerq with reference to the pernicious influence of a high pro- 
tein regimen in diabetes. 
The Low Protein Ration Established. 
It seems at last to be clearly established that a low protein 
diet is highly important in a disease which for many years has 
been supposed to require a very highly nitrogenous regimen. 
These observations also give color to the view already expressed 
that excessive use of protein may be one of the fundamental 
causes of diabetes. 
Carbohydrate tolerance is found to be greatly increased by 
the disuse of meats. Von Noorden found that without meat five 
times as much starch could be taken without increasing the sugar 
of the urine as when meat was used with the starch. 
After Sydenham and Rollo discovered, something more than 
a hundred years ago, that the urine of the diabetic patient could DIET IN DISORDERS OF NUTRITION 
779 
be made sugar free by a diet consisting exclusively of lean meat 
and fat, a fat and protein diet consisting almost wholly of flesh 
foods came into general use and has been practically the routine 
method until very recent years. A few years ago it was pointed 
out by Mosse, of France, and others that a flesh diet greatly 
increases the danger of diabetic coma. Von Noorden announced 
several years ago that “much meat is not good for diabetics.” 
Straub and other eminent authorities have shown that “meat is 
especially harmful as compared with vegetable albumin,” such 
as gluten and the protein of peas and beans. Reach believes that 
“raw (rare cooked) meat has a toxic action which paralyzes the 
function of the pancreas,” and in this way exercises an injurious 
effect in diabetes. 
Practically all authorities on diabetes now agree that vege- 
table albumin or protein is much to be preferred to meat or 
animal protein in the treatment of this disease. That vegetable 
proteins are entirely sufficient to maintain health and strength 
is now conceded by the ablest physiologists. 
The advantages of a non-flesh dietary for diabetics are: 
1. Vegetable proteins may be used in larger quantity than 
animal proteins without increasing the urinary sugar. 
2. Vegetable proteins permit a larger carbohydrate intake. 
3. Vegetable proteins, being less putrescible than animal 
proteins, as pointed out by Tissier, do not encourage intestinal 
putrefaction as do animal proteins, and hence are useful in com- 
bating the intestinal toxemia which is probably a leading factor 
in the causation of diabetes. 
4. All sorts of fresh, smoked or salted meats, fish, flesh, fowl 
and “sea foods,” are usually in a state of decomposition when 
eaten, containing millions of undesirable colon germs per gram 
(1,000,000 to 95,000,000, according to Roderick). Vegetable pro- 
teins are free from bacteria. If animal proteins are required, eggs 
or casein may be used. 
5. Avoidance of meats lessens the danger from acidosis and 
diabetic coma. 
The Best Food for Diabetics* 
Nuts. The high fat and protein content and the very small 
proportion of carbohydrates present in most nuts render them 
almost ideal food for diabetics. Butternuts, for example, contain 780 
THE NEW DIETETICS 
only 2 per cent, of carbohydrate, estimated on total energy value, 
and Brazil nuts only 4 per cent. Nuts of almost any sort may be 
freely eaten by the average diabetic patient. They are not, of 
course, suited for an exclusive dietary as they are much too con- 
centrated, being almost wholly lacking in the cellulose essential 
for bulk. The one thing essential for the thorough digestibility 
of nuts is complete mastication. Each particle must be chewed 
until of a smooth, creamy consistency. 
Legumes. These highly nitrogenous vegetables find a useful 
place in the dietary of the diabetic when combined with a proper 
amount of fat. Peas, beans and lentils have a high food content 
of which nearly one-third is protein. 
The soy bean is a remarkable legume, the carbohydrates of 
which are lactans and not digestible, and so may be disregarded. 
This bean is nearly free from starch and is very rich in protein 
of high quality. 
Green Vegetables. Green vegetables must always constitute 
the bulk of the bill of fare of a diabetic patient. Green vege- 
tables furnish a liberal supply of alkaline salts which help to neu- 
tralize the acids which form in the tissues in excess in this dis- 
ease. Green vegetables are also of special service because they 
supply bulk with practically no starch and very little food value 
and are rich in food lime and iron and also vitamins. 
Foods to Be Wholly Avoided by Diabetics, 
Sugar 
Sweet desserts 
Sweet fruits 
Honey 
Tea and coffee 
Potatoes (unless prescribed) 
Aleoholic drinks 
Meats (fish, flesh, fowl) 
Pickles, vinegar, condiments 
The introduction of insulin has practically rendered thrice- 
boiled vegetables unnecessary so that further details about their 
use is unnecessary. This is fortunate, as these thoroughly de- 
natured products were a very poor substitute for food, being 
nearly devoid of flavor and lacking almost wholly the salts and 
vitamins essential for nutrition. 
To Remove Starch from Vegetables. 
Green vegetables contain very little starch and only a small 
amount of dextrin and sugar. By repeated boiling or soaking DIET IN DISORDERS OF NUTRITION 
781 
in warm water nearly all the carbohydrates present may be re- 
moved. When thus treated, the vegetables are said to be “ex- 
tracted.” It is very difficult, however, to remove the last trace 
of carbohydrates, although O’Reilly and McCabe have shown that 
lettuce, celery, and vegetable marrow may be made completely 
free from carbohydrates by thrice boiling. For best results it is 
necessary that the vegetables be boiled in twenty times their vol- 
ume of water. Canned spinach, canned asparagus, beets, onions, 
and turnips may be made nearly free from carbohydrate, while 
thrice-boiled cauliflower, pumpkin, cabbage, carrots, and string 
beans contain about one-half of one per cent, of carbohydrate. 
The addition of one-twentieth of one per cent, of bicarbonate of 
soda greatly favors the removal of the carbohydrate, especially 
in the case of cauliflower. 
Since the introduction of insulin, thrice-cooked vegetables, 
formerly almost essential in the feeding of diabetics of severe 
type, have become of comparatively little importance. However, 
instances may occasionally develop a necessity for the use of car- 
bohydrate-free vegetables. 
The following vegetables prepared by thrice-boiling contain 
about one calorie of carbohydrate per ounce, a quantity so small 
that it may be ignored except in the gravest cases: 
Turnips 
Parsnips 
Palm cabbage 
Beets 
Summer squash 
Carrots 
Vegetable oysters 
French artichokes 
Rutabagas 
Onions 
Eggplant 
Cabbage 782 
THE NEW DIETETICS 
List of Foods Showing the Quantities of Each in Which Are Found 
Five Grams of Carbohydrates.* 
Ounces 
Fruits 
Almonds 1 
Apples, fresh 1*4 
“ baked y3 
“ juice 1)4 
“ sauce y 
Apricots, fresh 1)4 
canned y 
stewed y 
Avocado (Alligator pear) 4 
Banana % 
Blackberries 1 y 
Blackberry juice— 
iy tablespoonfuls 
Blueberry juice— 
1 y2 tablespoonfuls 
Cataloup 2 
Cherries 1 
canned y2 
Cucumbers 6 
Currants 1 y2 
Dates y4 
Figs, dried J4 
“ fresh 1 
Grapes 1)4 
Grapefruit— 
Four tablespoonfuls 
Lemon juice— 
Four tablespoonfuls 
Orange juice— 
Three tablespoonfuls 
Peach juice 1 
Pears 1)4 
Pear juice 24 
Pineapple, fresh 2 
juice 1 
Plums, fresh 1 
Ounces 
Fruits 
Prunes, fresh 1 
“ stewed y3 
Raisins )4 
Raspberries 1)4 
Raspberry juice, black 1 
“ “ red y3 
Raspberries, red, stewed- 
\l/2 tablespoonfuls 
Strawberries, fresh 2y2 
“ canned )4 
Strawberry juice 24 
Watermelon 2)4 
Vegetables 
Artichokes 1)4 
Asparagus 6 
Beans, baked 1 
“ string iy2 
Beets, buttered 2 
Beet greens 6)4 
Brussels sprouts 6 
Cabbage 3 
Carrots 2 y2 
Cauliflower, buttered 4 
Celery 6 
Dandelion greens 2 
Eggplant 1 
Lentils, baked 1 
Lima beans, green 1 
Onions, fresh iy 
“ boiled 2y 
“ stewed 2 
Parsnips, browned..... 1)4 
Peas, green 1 
Potato, baked 24 
“ boiled 1 
* One ounce avoirdupois equals 28.4 grams. DIET IN DISORDERS OF NUTRITION 
783 
Ounces 
Vegetables 
Potatoes, browned 1 
“ creamed 1 
“ hashed brown 1 
“ mashed 1y 
“ sweet, baked 
“ creamed .. 1 
Radish 3 
Spinach, creamed 4 
Squash, Hubbard 1 y2 
“ summer 5 
Tomatoes, fresh 5 
stewed 2 
Turnips, mashed 2 
Turnip puree 2y 
Cereals 
Bran Biscuit y2 
Bran mush 3 
Bran, sterilized 1 
Bread, gluten y$ 
Bread, graham x/3 
Bread, white Vs 
Bread, whole wheat y$ 
Breakfast toast y 
Corn bread F3 
Gluten bread (40%) y$ 
Gluten mush 2 
Oatmeal, boiled 1 y2 
Pop corn 
Rice, boiled 1 
Oats, boiled 2 
Shredded wheat 
Nuts 
Almonds 1 
Beechnuts 1% 
Brazil nuts 2y2 
Butternuts 5 
Ounces 
Cocoanuts 2/z 
Filberts \y2 
Hazelnuts \y2 
Hickory nuts \y2 
Nuttolene 3 
baked 3 
Peanuts Y\ 
Pecans .... 1 y 
Pignolias 2 y2 
Pine nuts (pinon) 1 
Protose 3 
Walnuts 1 y2 
Soups 
Bean iy 
Bean, lima 2y2 
Lentil 2y2 
Pea 2 
Potato, cream of 2 
“ savory, y2 cupful 
Vegetable 3^2 
Bouillons 
Tomato, 4 tablespoonfuls 
“ y2 cupful 
Vegetable 2 
Broths 
Bean, 1 y2 tablespoonfuls 
Protose, y2 cupful 
Gruels 
Barley, 2 tablespoonfuls 
Cornmeal 5 
Farina 3 
Gluten 5 
“ cream of 2 
Oatmeal, Y\ cupful 
Rice 3 784 
THE NEW DIETETICS 
Foods Grouped According to Carbohydrate Content 
3 Per Cent 
Vegetables 
Per cent 
Chinese Cabbage 1.4 
Lettuce , 2.9 
Endive 3.0 
Cucumbers 3.1 
Spinach 3.2 
Beet greens 3.2 
Celery 3.3 
Per cent 
Asparagus 3.3 
Brussels sprouts 3.4 
Sauer kraut 3.8 
String Beans 3.8 
Sea kale 3.8 
Tomatoes 3.9 
5 Per Cent 
V EGETABLES 
Cabbage sprouts 4.3 
Cauliflower 4.7 
Chard 5.0 
Eggplant 5.1 
Pumpkin 5.1 
Kohl-rabi 5.5 
Cabbage 5.6 
Leeks 5.8 
Radishes 5.8 
Collards 6.3 
Mushrooms 6.8 
Fruits 
Ripe olives (fat 21) 3.5 
Avocado (fat 17.3) 4.4 
Watermelon 6.7 
Butternuts 3.5 
Pignolias 6.9 
Nuts 
Brazil nuts 7.0 
Nuttolene 6.1 
1 0 Per Cent 
Beets 7.4 
Okra 7.4 
Turnips 8.1 
Rutabaga - 8.5 
Vegetables 
Onions 8.9 
Squash 9.0 
Carrots 9.3 
Fruits 
Strawberries .. 7.4 
Lemons 8.5 
Cantaloup 9.3 
Peaches 9.4 
Pineapple 9.7 
Cranberries 9.9 
Mango ... .10,0 
Blackberries 10.9' 
Oranges 8.7 
Orange juice 10.8 
Grapefruit ;.:.:.M0.4 
Paradise nuts 10.2 
Hickory nuts 11.4 
Nuts 
Black walnuts 11.7 DIET IN DISORDERS OF NUTRITION 
785 
1 5 Per Cent 
Vegetables 
Parsnips 13.5 
Lima beans (canned) 14.6 
Macaroni 15.8 
Per cent 
Artichokes 16.7 
Green peas 16.9 
Per cent 
Fruits 
Raspberries 12.6 
Currants 12.8 
Blueberries 12.8 
Apricots 13.4 
Pears 14.1 
Apples 14.2 
Huckleberries 16.6 
Cherries 16.7 
Filberts 13.0 
Walnuts (English) 13.0 
Beechnuts 13.2 
Peanut butter ...14.0 
Nuts 
Pecans 15.3 
Pistachios 16.3 
Pine nuts 17.3 
Almonds 17.3 
20 Per Cent 
Vegetables 
Baked beans 19.6 
Green corn 19.7 
Potatoes 20.9 
Rice (boiled) 24.4 
Fruits 
Plums 20.1 
Bananas 22.0 
Almonds 17.3 
Almond butter 18.0 
N UTS 
Peanut 24.4 
Peanut butter .25.0 
Insulin—The Pancreatic Hormone, 
The recent discovery of insulin has begun a new era in the 
treatment of diabetes, the developments of which are already 
wonderful although the experimental stage is as yet not finished. 
The theory that the pancreas produces an internal secretion 
which somehow enables the body to burn sugar and fats long 
regarded as most probable, was definitely proven by Banting of 
Toronto, who was the first to succeed in obtaining a product from 
the pancreas, the injection of which lowers the blood sugar and,, 
in dogs whose pancreas has been removed, causes the disappear- 
ance of sugar from the urine. 
Insulin has proved to be a reliable help in cases of diabetic 
coma, a condition heretofore justly regarded as most formidable 
and almost certainly fatal. In a recent case a patient in a state 
of coma was in one hour relieved and the next morning was 
feeling as well as usual. 786 
THE NEW DIETETICS 
Properly used, insulin can be relied upon to lower the blood 
sugar and to lessen the urinary sugar to such an extent as to 
render unnecessary the drastic dietetic measures. 
As would naturally be expected, the use of so powerful a 
remedy as insulin is not wholly without danger. It is safe only in 
the hands of skilled experts and must be used in connection with 
the greatest observation of the blood sugar. 
Winter and Smith, of Cambridge, England, have recently 
discovered the presence in yeast of a substance which seems to be 
possessed of the same qualities as insulin, and which, in rabbits, 
reduces the blood sugar with the same degree of certainty as 
does insulin. 
These later discoveries may prove to be of greater value 
than that of Banting, as it should result in greatly lessening the 
cost of the remedy which, at the present time, is so great as to be 
a serious handicap to its use except for the well-to-do. Fortunately 
this disease is much less common among the poor than among 
the well-to-do. The hard-working laboring man is little liable to 
suffer from diabetes or obesity. These are the favorite diseases 
of over-fed persons who lead inactive lives. 
Collip has discovered in various vegetable products a sub- 
stance which hie calls glucokinin, which much resembles insulin 
and which produces more lasting effects than does insulin. 
The Use of Insulin (Iletin) 
The injection of insulin is a simple matter; but the proper 
dosage of insulin and especially the management of the diet of a 
patient ujider treatment by insulin are matters which require 
scientific knowledge and technical skill. 
It is important that every patient for whom insulin is to be 
used should be clearly informed at the very outset that insulin 
does not take the place of dieting. Most misleading are the an- 
nouncements made by sensational newspapers and by some igno- 
rant or unprincipled medical practitioners that by the aid of 
insulin the diabetic may disregard all restrictions of diet and “eat 
anything he likes.” 
Two important results may be justly attributed to insulin. 
By its use the necessity for complete and prolonged fasting with 
the great reduction in weight and loss of strength resulting is 
eliminated. And further, experience has already shown that by 
the intelligent and continuous use of insulin the restriction of 
carbohydrates may be very greatly lessened. DIET IN DISORDERS OF NUTRITION 
787 
It is highly important, moreover, that every patient should be 
impressed with the fact that, to secure the best possible results, 
which are almost never all that could be desired, it is necessary 
that every means by which experience has shown that recovery 
may be promoted should be applied with persevering thorough- 
ness. 
In the practical application of insulin the services of a com- 
petent trained physician or dietitian, or both, is indispensable. 
Insulin is a powerful drug. It reduces the blood sugar rapidly. 
Curiously, a small deficiency of blood sugar is far more dangerous 
than a much greater excess. When the blood sugar is lowered 
to 3 parts in 10,000 of blood, unconsciousness occurs and death 
may follow. A small overdose causes nervousness or tension which 
with a larger dose will increase to trembling. Hunger and sweat- 
ing are other symptoms following an overdose. Fortunately, these 
symptoms, if given prompt attention, may be relieved within a 
few minutes by a glassful of orange juice or two or three tea- 
spoonfuls of sugar dissolved in a glassful of hot water. Adrenalin 
solution (1: 1000 in dose of 1 cc. or 15 minims) injected hypo- 
dermatically is a most valuable antidote and should be given, also, 
when possible. 
Insulin is quantitatively designated as units. One unit is an 
amount sufficient to reduce the blood sugar of a small fasting 
rabbit (on£ kilo) to 4.5 parts in 10,000 or .045 per cent. 
In giving insulin, it is safest to start with one unit. This is 
given a short time before the meal (15 minutes to an hour and a 
half). After the meal the urine is tested and if sugar is found 
two units are used before the next meal, and before the next, 
three units, and so on up to three units three times a day (Joslyn). 
But the increase should not be continued indefinitely. The average, 
total daily dose, in the hands of such experienced practitioners as 
Joslyn, is about 10 to 12 units. Very few patients require so much 
as 40 or 50 units daily and a few get on well with 2 units before 
each meal. In general, 1 unit will secure the utilization of 2 grams 
of carbohydrate. Patients differ in this regard, however, so that 
caution is needed. 
A Simple Method of Approximating the Proper Ration 
for a Diabetic Patient. 
The difficulty in arranging the ration, or bill of fare, for a 
new case of diabetes is to know where to begin. The ordinary 788 
THE NEW DIETETICS 
“cut and try” method often involves a great waste of time and 
may work to the serious disadvantage of the patient. This method 
is clumsy and unscientific and is about as reasonable as would he 
the action of a tailor if, instead of measuring his customer for a 
coat, he should make a guess as to the dimension of the garment, 
make and try it on, and if he found it a misfit, make another, 
and if he found this a misfit, proceed to make still another, and 
so on continuing until by gradual approximations a proper fit 
might in time be attained, then charging up to the patient the total 
cost of the time and material employed in wasteful experimenta- 
tion. 
All competent internists who have had much to do with the 
treatment of diabetic patients by modern methods have aban- 
doned the routine, drastic starvation of the Guelpa-Allen method. 
It seems to be a general practice, however, to begin with the 
average patient by putting him upon a very low ration and then 
working up until the limit of carbohydrate tolerance is reached. 
In addition to loss of time, this method may involve unnecessary 
loss of flesh and sometimes of strength and vital resistance, which 
it may be difficult, if not impossible to regain, and so should be 
limited in use to cases in which the carbohydrate tolerance is so 
low as to make it necessary. 
By the use of mathematical formulae (Woodvatt) or com- 
putations by the aid of tables (Holmes), a suitable ration may be 
arrived at when the carbohydrate tolerance is known, this de- 
termining factor being ascertained by simply subtracting the 
urinary sugar from the total carbohydrate of the diet, taking ac- 
count of the carbohydrate content of the protein and the fat, 
together with the starch, sugar and dextrin. While accurate and 
scientific and an immense advantage over the “cut and try” 
methods in common vogue, this method involves so much figuring 
and reference to tables, that a very busy internist having to deal 
with a considerable number of diabetic patients, will be tempted 
when crowded for time to lapse into the old empirical way of 
guessing at the patient’s requirement instead of making a close 
approximation to his needs by the application of a more exact 
and scientific method. 
The author has prepared a table by the use of which: the 
laborious calculations referred to may be saved. The table pre- 
sents several hundred daily rations which have been calculated 
for different degrees of sugar tolerance, from 200 grams to 10 DIET IN DISORDERS OF NUTRITION 
789 
grams and for different quantities of protein varying from 80 
grams to 10 grams. 
The basis of the calculations by which the figures given in 
the table have been arrived at is to be found in the following well- 
known facts which have been established by modern metabolism 
studies:— 
1. One gram of carbohydrate will suffice for the burning of 
1% to 3 or 4 grams of fat. The lower figure is very conservative. 
2. Protein is ketogenic to the extent of 46 per cent, of its 
weight, the equivalent of 51 per cent, uf fat. 
3. Protein when metabolized yields 58 per cent, of its 
weight of carbohydrate. 
4. Fat when metabolized yields 10 per cent, of its weight of 
carbohydrate (glycerol). 
In arranging a diet for a diabetic patient, first consideration 
must be given to the amount of protein, which should be sufficient 
to meet the needs of the body without loading it with an excess. 
Sherman has shown that half a gram of protein per kilogram of 
body weight (1 calorie per pound) is sufficient to meet all physio- 
logic needs. Newburgh finds that 0.66 grams per kilogram of body 
weight (1.2 calories per pound) is ample. Woodyatt employs 1 
gram per kilogram of body weight and some practitioners recom- 
mend a still higher intake of protein. All are agreed, however, that 
excess of protein is injurious in diabetes, a fact pointed out by 
Von Noorclen many years ago. Since Folin has shown that all 
surplus protein is directly eliminated by the kidneys after having 
been converted into urea by the liver without making any useful 
contribution to the body needs, the writer considers it wise to 
keep the protein intake as low as compatible with the satisfaction 
of physiologic requirements; and hence accepts as a good basis 
two-thirds of a gram of protein for each kilogram of body weight 
or approximately one-third of a gram of protein for each pound 
of body weight. This amount is found ample provided the proteins 
employed are of high quality. 
By the aid of the above data, with the patient’s sugar tolerance 
known, it is easy to calculate at once a diet which will supply such 
quantities of protein, carbohydrate and fat as the patient should 
be able to utilize without the appearance of sugar in the urine and 
without the production of acidosis. 
We first ascertain the patient’s sugar tolerance. To do this 
it is only necessary to know exactly what he eats during 24 hours 790 
THE NEW DIETETICS 
and how much, and the amount of sugar in the urine of 24 hours. 
Let us suppose, for example, that the patient’s diet contains the 
following: 
Protein grams 70 (2.3 ounces) 280 
Fats “ 165 (5.5 “ ) 1485 
Carbohydrates “ 62 (2.0 “ ) 248 
Calories 2013 
Examination of the urine shows 70 grams of sugar. 
To find the carbohydrate tolerance we first find the total 
amount of carbohydrate in his diet. This is not fully represented 
by the amount of starch and sugar eaten. When metabolized in 
the body, the protein yields 58 per cent, protein and the fats 10 
per cent. The total sugar of the diet, then, will be approximately 
41 grams from the proteifi (70X.58=40.6), 16.5 grams from the 
fat and 62 carbohydrate,—in all, in round 
numbers, 120 grams (41 16.5-f-62=l 19.5). If from this we 
subtract the 70 grams of urinary sugar, we have left 50 grams as 
the sugar tolerance of the patient. 
Knowing the sugar tolerance, we can now proceed to formu- 
late at once a dietary which the patient should be able to utilize 
without the appearance of sugar in the urine. First, we will fix 
the protein at such a point as will be just sufficient to meet the 
patient’s actual requirements, or two-thirds of a gram per kilo- 
gram of body weight. Supposing, then, that the patient weighs 
60 kilos or 132 pounds, we will fix the protein at 40 grams per 
diem. 
Next we will determine the fats. The amount of fat the 
patient can burn is determined by his carbohydrate tolerance. As- 
suming that one gram of carbohydrate will insure the complete 
oxidation of one and two-thirds grams of fat, and the patient’s 
sugar tolerance being 50 grams, he can easily burn one and two- 
thirds as much fat, or 83 grams. However, we cannot add this 
amount of fat in substance to his bill of fare, since it must be 
remembered that protein contains a molecular group which in 
metabolism behaves like fat. This amounts to 51 per cent, of the 
protein, practically one-half its weight. The protein being 40 
grams, we must subtract half of this from 83, leaving 63 grams 
as the fat of the ration. 
Now we may find the carbohydrate constituent of the diet. 
For this, it is only necessary to subtract from the carbohydrate TABLE OF RATIONS FOR DIABETIC PATIENTS 
Carbo. Tolerance 
10 
20 
30 
40 
50 
60 
70 
80 
90 
100 
no 
120 
130 
140 
150 
160 
170 
180 
190 
200 
Protein 
Fats 
60 
77 
94 
110 
127 
144 
160 
177 
194 
210 
227 
244 
260 
277 
293 
80 
Carbo. 
8 
16 
25 
33 
41 
50 
58 
66 
75 
83 
91 
100 
108 
116 
125 
Cal. 
892 
1077 
1266 
1442 
1627 
1816 
1992 
2177 
2366 
2542 
2727 
2916 
3092 
3277 
3457 
Protein 
Fats 
47 
63 
80 
97 
113 
130 
147 
163 
180 
197 
213 
230 
247 
263 
280 
296 
75 
Carbo. 
2 
10 
18 
27 
35 
43 
52 
60 
68 
77 
85 
93 
102 
110 
118 
127 
Cal. 
731 
907 
1092 
1281 
1457 
1642 
1831 
2007 
2192 
2381 
2557 
2742 
2931 
3107 
3292 
3472 
Protein 
Fats 
49 
65 
82 
99 
115 
132 
149 
165 
182 
199 
215 
232 
249 
265 
282 
298 
70 
Carbo. 
4 
12 
20 
29 
37 
45 
54 
62 
70 
79 
87 
95 
104 
112 
120 
129 
Cal. 
737 
913 
1098 
1287 
1463 
1648 
1837 
2013 
2198 
2387 
2563 
2748 
2937 
3113 
3298 
3478 
Protein 
Fats 
52 
68 
85 
102 
118 
135 
152 
168 
185 
201 
217 
234 
251 
268 
285 
301 
65 
Carbo. 
7 
15 
23 
32 
40 
48 
57 
65 
73 
82 
90 
98 
107 
115 
123 
132 
Cal. 
756 
932 
1117 
1306 
1482 
1667 
1852 
2028 
2213 
2393 
2569 
2754 
2943 
3132 
3317 
3497 
Protein 
Fats 
37 
54 
70 
87 
104 
120 
136 
154 
170 
187 
203 
219 
236 
253 
270 
287 
60 
Carbo. 
1 
10 
18 
26 
35 
43 
51 
60 
68 
76 
85 
93 
101 
109 
118 
126 
Cal. 
577 
758 
938 
1123 
1312 
1488 
1668 
1866 
2042 
2227 
2407 
2583 
2768 
2953 
3142 
3327 
Protein 
Fats 
39 
56 
73 
90 
106 
123 
139 
156 
172 
189 
205 
221 
238 
255 
272 
55 
Carbo. 
4 
12 
21 
29 
37 
45 
53 
62 
70 
79 
88 
96 
104 
112 
221 
Cal. 
587 
772 
961 
1146 
1322 
1507 
1683 
1872 
2048 
2237 
2417 
2593 
2778 
2963 
3152 
Protein 
Fats 
42 
59 
76 
92 
108 
124 
141 
158 
175 
192 
208 
224 
241 
258 
50 
Carbo. 
7 
15 
23 
31 
40 
48 
56 
64 
73 
81 
90 
98 
107 
115 
Cal. 
606 
791 
976 
1152 
1332 
1508 
1689 
1878 
2067 
2252 
2432 
2608 
2797 
2982 
Protein 
Fats 
28 
44 
61 
78 
94 
111 
127 
144 
160 
177 
193 
210 
226 
243 
45 
Carbo. 
1 
10 
18 
26 
34 
42 
50 
58 
66 
75 
84 
93 
101 
110 
Pol 
136 
616 
ftOI 
OOA 
1 1 AO 
1347 
1708 
1884 
2073 
2253 
2442 
2618 
Protein 
F ats 
30 
47 
63 
81 
97 
113 
130 
146 
163 
180 
196 
213 
229 
40 
Carbo. 
4 
12 
21 
28 
36 
45 
53 
61 
69 
78 
86 
96 
104 
Cal. 
446 
631 
811 
1001 
1177 
1357 
1542 
1718 
1903 
2092 
2268 
2461 
2637 
Protein 
Fats 
33 
49 
66 
83 
99 
116 
133 
149 
166 
183 
199 
215 
35 
Carbo. 
7 
15 
23 
31 
39 
48 
56 
64 
72 
81 
89 
99 
Cal. 
465 
641 
826 
1011 
1187 
1372 
1557 
1733 
1922 
2111 
2287 
2471 
Protein 
Fats 
18 
35 
52 
69 
85 
101 
118 
135 
152 
168 
185 
202 
30 
Carbo. 
1 
9 
18 
26 
34 
42 
51 
59 
67 
75 
84 
92 
Cal. 
286 
471 
660 
845 
1021 
1197 
1386 
1571 
1756 
1932 
2121 
2306 
Protein 
Fats 
20 
37 
54 
71 
87 
103 
120 
137 
154 
171 
187 
25 
Carbo. 
4 
12 
21 
29 
37 
45 
53 
61 
70 
78 
86 
Cal. 
296 
481 
670 
855 
1031 
1207 
1392 
1577 
1766 
1951 
2127 
Protein 
Fats 
23 
40 
57 
73 
90 
106 
123 
140 
156 
174 
20 
Carbo. 
6 
14 
23 
31 
39 
47 
56 
64 
73 
81 
Cal. 
311 
496 
685 
861 
1046 
1222 
1411 
1596 
1776 
1970 
Protein 
Fats 
8 
25 
42 
59 
76 
92 
108 
125 
142 
159 
15 
Carbo. 
0 
8 
16 
25 
33 
41 
49 
58 
66 
75 
Cal. 
132 
317 
502 
691 
876 
1052 
1228 
1417 
1602 
1791 
Protein 
Fats 
11 
28 
45 
62 
79 
95 
111 
128 
145 
10 
Carbo. 
3 
11 
19 
28 
36 
44 
52 
61 
69 
Cal. 
151 
336 
521 
710 
895 
1071 
1247 
1436 
1621 
Balanced for Sugar Tolerance and Acidosis DIET IN DISORDERS OF NUTRITION 
791 
tolerance (50) the carbohydrate of the protein which is 23 
(40X-58=23.2) and that of the fat which is 6 (63-f-10=6.3). 
This gives 21 grams (50—29=21) as the amount of carbohydrate 
in substance which may be included in the day’s ration. The 
ration which should free the patient’s urine from sugar will 
thus be, 
Protein grams 40 calories 160 
Fats “ 63 “ 567 
Carbohydrates “ 21 “ 84 
Total calories 811 
This diet is, of course, not sufficient for a maintenance ration, 
affording little more than half the energy required by the basal 
metabolism of a man weighing 60 kilograms. It will free the urine 
of sugar, however, and will give the pancreas relief from the 
overwork to which it has been subjected and without the reducing 
fast required by the Guelpa-Allen method, and may be increased 
by the addition of fat and carbohydrate by the use of insulin, 
adding about 2 grams of carbohydrate for each unit of insulin 
given. 
As a labor-saving device, the writer has prepared a table (see 
Appendix) which gives a series of two hundred rations based 
upon the protein intake and the carbohydrate tolerance. By the 
use of this table, a suitable ration may be selected without making 
the calculations above detailed, thus saving considerable time, a 
matter of serious moment when many cases are awaiting attention. 
Another table indicates suitable foods and quantities. 
First of all, the patient’s sugar tolerance must be found. This 
is easily done thus: Select from the table a ration which will 
supply about the number of calories required by the basal metab- 
olism of the patient. For a patient not working and weighing 60 
kilos (132 pounds), this will be about 1500 calories (Dubois). 
Taking the patient’s protein requirement as 40 grams (two-thirds 
of his weight in kilograms), we locate on the chart ration 40-90 
as furnishing the requisite number of calories. This ration sup- 
plies 
Protein 40 grams 
Fat 130 “ 
Carbohydrate 53 “ 
Calories 1542 792 
THE NEW DIETETICS 
It is only necessary to put the patient on this ration for 24 
hours and subtract this from the known carbohydrate content of 
the ration. Supposing the urinary sugar for 24 hours to be 40 
grams, subtracting this from 90 we have 50 grams as the patient’s 
sugar tolerance. 
Referring again to this table, we find in the column under 
50, ration 40-50, as follows: 
Protein 40 
Fat 63 
Carbohydrate 21 
Calories -. . . 811 
On this ration the patient will he sugar free. Thus, by the 
use of the table, the necessity for time-consuming calculations 
is wholly avoided and the appropriate initial ration for any degree 
of sugar tolerance may be quickly arrived at. 
Having found the ration on which the patient is sugar free, 
the next thing to be done is to raise the energy value of the diet 
to the actual body requirement as rapidly as possible. Here is 
where insulin (iletin) comes in as a time-saving and life-saving 
remedy of priceless value. By giving the patient 5 units of insulin, 
his sugar tolerance will be increased 10 or 11 grams. Following 
the table, we will find the appropriate ration in the 60 column on 
the 40 protein line, ration 40-60. This raises the calorie intake to 
1001, an increase of 190 calories. The addition of another 5 units 
of insulin raises the ration to 40-70, with 1177 calories. Thus 
within a few days the ration may be brought up to the patient’s 
full basal requirement, say 1542 calories which is provided by 
ration 40-90 with 20 units of insulin. From this point on the 
fats need not be increased. The protein remains fixed at 40 grams. 
We have now found a solid scientific basis on which to build 
the patient’s daily ration and bills of fare. It is now only neces- 
sary to increase the carbohydrate intake by the further daily in- 
crease of the dose of insulin. For every 5 units of insulin, 10 or 
11 grams of carbohydrate may be added to the ration. With 40 
units of insulin, the ration would become, 
Protein 40 
Fats 130 
Carbohydrate 93 
Calories , . . 1702 DIET IN DISORDERS OF NUTRITION 
793 
After some days or weeks the insulin should be lessened a 
little for a day and if sugar does not appear, an equivalent amount 
of carbohydrate may be added to the ration, and this may be 
repeated until a full ration is supplied that is sufficient for the 
full requirements of the patient’s basal metabolism 'plus his energy 
expenditure in work. This will be about one-third more than his 
basal metabolism. 
As there is often a marked gain in sugar tolerance under the 
use of insulin with a scientifically adjusted dietary, it is wise to 
omit half the insulin for a day, after some weeks, and de- 
termine anew the sugar tolerance. This determination may be 
used as a basis for a new ration-building process, which will be 
carried out as already detailed. 
In very bad cases, with a sugar tolerance as low as 10 or 20 
grams, for example, the protein must necessarily be very low, 
not more than 20 or 25 grams, and sometimes as low as 10 or 15 
grams for a few days at the start. The lower the protein intake, 
the more fat and carbohydrate may be given. 
In these cases the table renders especially valuable service as 
will be shown by an example. Supposing the carbohydrate toler- 
ance to be found to be 10. The initial ration selected will be 10-10, 
Protein 10 
Fats 11 
Carbohydrate 3 
Calories 151 
This is a starvation ration and must be increased as rapidly 
as possible. It is first of all important to increase the protein to 
the fundamental requirement as quickly as possible. Giving 5 
units of insulin will raise the tolerance, to 20 which will enable the 
patient to take ration 30-20. 
Protein 30 
Fat 18 
Carbohydrate 1 
Calories 286 
This ration affords nearly twice as many calories as the 
former, and gives 30 grams of protein. Adding another 5 units to 
the dose of insulin will raise the tolerance to 30 and give the 60- 794 
THE NEW DIETETICS 
kilo patient 40 grams of protein, which is sufficient, the complete 
ration (40-30) being 
Protein . 40 
Fats 30 
Carbohydrate 4 
Calories 446 
The protein of the ration is now fixed and we may begin at 
once to build up the ration by daily additions of insulin as before 
until the basal requirement is reached, then gradually adding 
carbohydrate until the normal diet is approached as nearly as the 
patient’s carbohydrate tolerance will permit. 
If at any time sugar appears in the urine, a new determina- 
tion of the sugar tolerance should be made. 
The rations shown in the chart being in physiological bal- 
ance under the given conditions of protein intake and carbohy- 
drate tolerance, they may be used as a check upon the daily bills 
of fare and will quickly show in what direction modification is 
required. 
Suppose, for example, the patient’s carbohydrate tolerance 
is found to be 50 and the protein intake 60. Reference to the 
table will show that such a patient should be sugar free with 
ration 60-50 consisting of 
Protein grams 60 
Fat “ 54 
Carbohydrate “ 10 
Calories 758 
If, instead of the above ration the patient is receiving, say, 
Protein grams 60 
Fat “ 70 
Carbohydrate “ 20 
by comparison, it will be seen at once where the trouble is (excess 
of both fat and carbohydrate), and by putting the patient on the 
diet indicated in the table, he will almost certainly at once be- 
come sugar free. Thus by the use of the table, it may be seen 
at once whether the pancreas is being subjected to a strain likely 
to injure it or whether, on the other hand, there is a wider margin 
between the sugar tolerance and the actual intake of carbohy- 
drate than is necessary. DIET IN DISORDERS OF NUTRITION 
795 
By a little practice, the table may be used in such a way as 
to greatly facilitate the fixing of the initial diet and also in the 
daily adjustment of the diet that changes in the patient’s carbo- 
hydrate tolerance may necessitate. The table will be found use- 
ful, also, in checking up the patient. When his tolerance is known 
and a ration has been selected for him from the table, the ap- 
pearance of sugar in the urine will probably mean a surreptitious 
intake of carbohydrate in some form; or, the failure of the ra- 
tion selected from the table to make the urine sugar free may 
indicate that the patient failed to save the whole amount of urine 
passed. 
In the normal diet the proportion of total carbohydrate to 
fat is about five to one. It is not to be expected that the diabetic 
will be able to utilize this amount of carbohydrate even with the 
aid of insulin; but while it is possible for a diabetic to live on a 
diet in which the proportion of carbohydrate is 1 to 2 of fat, or 
ten times the usual amount of fat, it is most desirable to increase 
the amount of total carbohydrate. The amount of carbohydrate 
in the daily ration (starch, sugar, dextrin) should when possible 
at least equal the fat in weight. By the proper use of insulin this 
may be accomplished in most cases and in some cases the pro- 
portion of carbohydrate may be made much greater. 
As an aid to the use of the table, the writer has had ar- 
ranged a series of corresponding daily rations, by the use of which 
the adjustment of the diet for any case may be very quickly ac- 
complished without the calculation of calories. 
Diabetes and Renal Disease. 
In cases of diabetes which show evidence of disease of the 
kidneys—casts, albumin or a high non-protein nitrogen, especially 
when analysis of the blood shows an excess of uric acid or crea- 
tinin, the protein of the diet must be kept as low as possible and 
meats of all sorts must be rigorously excluded from the bill of 
fare. Eggs must be used very sparingly if at all and only “ster- 
ile” eggs should be eaten. Casein, casein gluten preparations, soy- 
gluten biscuit, nuts and to-fu (See Index) are the best sources of 
protein. There is special danger of acidosis in these cases. 
Diabetes in the Aged. 
In the treatment of diabetes in aged persons great care must 
be taken to prevent gangrene, which is very common and often 
fatal in these cases. By keeping the urine quite free from sugar 796 
THE NEW DIETETICS 
by a judicious dietary with the use of iletin, healing may often 
be secured in cases in which the disease has not advanced too far. 
Pregnancy with Diabetes, 
Pregnancy is less likely to occur in a woman who is diabetic 
than in a normal woman, but does occur and is a complication 
which menaces both the mother and the fetus. An experienced 
obstetrician reports ten cases with death of the fetus in every case. 
Later experience has shown, however, that by careful dietetic 
management, much better results may be obtained. The dietetic 
management of a case of this sort does not differ from that of 
others. The same general rules should be followed. At confine- 
ment, gas should be used rather than ether or chloroform if an 
anesthetic is required. 
In cases in which sugar appears in the urine at the beginning 
of lactation, the condition appears to be due to a temporary dis- 
turbance of metabolism which may be made to disappear in a few 
weeks by careful dieting. 
Diet in Diabetic Coma, 
Perhaps the greatest boon conferred by insulin is its effici- 
ency in combating coma, for which it is so nearly a specific that 
when it is available, death from diabetic coma should not occur. 
Coma should be avoided by proper feeding and treatment. If by 
accident, symptoms of coma develop, prompt action is needed. The 
patient should go to bed at once, and should drink copiously of 
hot water and take a glassful of orange juice every hour. In the 
absence of orange juice, thin oatmeal gruel or better, a dessert- 
spoonful of malt sugar dissolved in a glassful of hot water. 
Every three hours an enema should be given consisting of three 
pints of water at a temperature of 105° F. and containing the 
juice of two lemons and two ounces of malt sugar. 
Ten units of insulin should be given every hour in coma 
until, if needed, three or four doses have been given, then every 
other hour; but more than 60 units should seldom be given in 
twelve hours, although as much as 100 units have been required 
in some cases (Joslvn). When the patient is in a state of pro- 
found coma, carbohydrate may be given intravenously if neces- 
sary in the form of glucose. DIET IN DISORDERS OF NUTRITION 
797 
Examination of the Urine (see Index). 
Diabetic patients should learn to examine the urine for sugar 
and dangerous acids. If the tests show sugar or acids, even a 
trace, the diet must be changed at once. 
A twenty-four hour specimen of urine should be obtained 
and a quantitative examination of sugar made and the carbohy- 
drate tolerance determined. The proper dietary is selected from 
the chart and the ration increased from day to day by the use of 
insulin, as previously indicated. 
Saccharine. 
The use of saccharine by diabetics should be discouraged. 
The diabetic should be educated to forget sweets and to be con- 
tented without them. A few weeks of discipline will accomplish 
this. Heitler, of Vienna, claims to have shown that saccharine is 
a heart poison. Under its influence, the heart’s action is les- 
sened in vigor and its continued use may give rise to serious 
injury. 
Recipe for Gluten Bread* 
Make a rather stiff dough by adding to the best quality of 
spring wheat flour the proper amount of water. Allow to stand 
for two or three hours, then knead until a strong, elastic, ten- 
acious dough is formed. Now place on a sieve or coarse cloth 
under a spigot and knead under a small stream of water until 
no more starch can be washed away; that is, until the water 
runs away clear. The rubber-like mass left is almost pure gluten. 
This may be molded and cut into small masses and baked in a 
quick oven. Surprisingly large rolls may be made from very 
small pieces of this wet gluten. If 40 per cent, gluten is desired 
instead of merely pure gluten biscuit, flour may be added to the 
gluten in right proportion to produce the desired percentage. In 
general, about one pound and a quarter of spring wheat flour will 
be required for each pound of wet gluten. Gluten bread is more 
easily made by the use of 40 per cent, gluten flour. 
Gluten Products. 
In the summer of 1889 the writer devised a method for 
preparing standardized gluten preparations. Prior to that time 
the only gluten products known were gluten biscuit, prepared 
by washing the starch out of wheat flour, and the so-called 798 
THE NEW DIETETICS 
“gluten flours” which contained little if any more gluten than 
good whole wheat flour. The writer had made for use at the 
Battle Creek Sanitarium gluten flours containing 40 per cent, of 
gluten and meals containing 20, 40, 60, 80, and 90 per cent, of 
gluten. For many years these products were the only glutens 
produced in this country of known value, as noted by the late 
Dr. Osier in his writings on diabetes. Many years later the 
U. S. Government under the Pure Food Law established 35 per 
cent, as the legal standard for gluten flour and other products to 
which the term gluten is applied. Most manufacturers have 
adopted our original standard of 40 per cent., but it would seem 
to be desirable to make the proportion of gluten 50 per cent, for 
convenience in prescribing. 
Gluten biscuit are especially useful in the feeding of dia- 
betic patients. Gluten contains more lime and iron than any other 
food product. A pure gluten biscuit weighing one-half ounce 
contains as much protein as a small beefsteak weighing two 
ounces, besides more iron and lime. 
Eighty per cent, and 40 per cent, biscuit are exceedingly use- 
ful, almost indispensable in arranging a bill of fare for the dia- 
betic. As prepared by the Battle Creek Food Company, these 
gluten products are presented in biscuit of nearly uniform size 
weighing about 3.5 grams each. The 80 per cent, biscuit contain 
each 3 grams of protein and .5 grams of carbohydrate. The 40 
per cent, biscuit contain 1.5 grams of protein and 2 grams of car- 
bohydrate. These biscuit are much more palatable than gluten 
bread and, when freshly toasted, are exceedingly crisp and tooth- 
some. Their bulk is so large that they aid greatly in utilizing the 
large amount of fat which is required in patients whose carbo- 
hydrate tolerance is very low. 
Two recent improvements have been made in gluten products 
at the writer’s suggestion, in the addition to wheat gluten of a 
certain proportion of casein and a concentrated vegetable extract 
(prepared from yeast) rich in vitamin B. The purpose of add- 
ing casein to gluten is to supplement its incomplete proteins by 
means of the trytophan of milk, an amino acid which is deficient 
in the proteins of all cereals. This is known as “aminized” 
Gluten. By the addition of vitamin B. to gluten its dietetic 
properties are notably improved. This “vitamized” and 
“aminized” gluten more than replaces the proteins of meat in 
nutrient value. DIET IN DISORDERS OF NUTRITION 
799 
Soy bean products are highly valuable not only because of 
the small amount of carbohydrate which this legume contains but 
because of the superior quality of its proteins which, like the pro- 
teins of milk and nuts, are of the “complete” class. 
Acidophilus Buttermilk.—A good culture of B. acidophilus in 
skim milk or whey is of great value in diabetes as a means of com- 
bating the intense intestinal toxemia which is at least one of the 
potential factors to which this disease must be attributed. The 
carbohydrate content of acidophilus buttermilk and whey is small, 
only 4 per cent., so that a half pint will supply less than 10 grams 
of lactose along with the highly beneficent protective organism, B. 
acidophilus, of which a first-class whey or buttermilk culture con- 
tains about 200,000,000 to the c. cm. (Kopenoff), or 6,000,000,000 
to the ounce. 
Sugar-Free Milk. 
Foodstuffs wholly free from carbohydrates are of little im- 
p rtance since the discovery of insulin; but in cases in which the 
free use of milk would be desirable except for the considerable 
amount of lactose which it contains, a formula for preparing a 
sugar-free milk may be found useful. 
First it is necessary to prepare a one per cent, solution of the 
salts of milk. These are said to consist of the following, com- 
bined in the proportion indicated:— 
Potass, chloride 9.9 grams 
Sodium chloride 11.5 “ 
Mono potass, phosphate 13.8 “ 
Di-potass, phosphate 10.0 “ 
Dimagnesium phosphate 4.0 “ 
Dicalcium phosphate 8.0 “ 
Tricalcium phosphate 9.6 “ 
Potassium citrate 5.9 “ 
Magnesium citrate 4.4 “ 
Calcium citrate 25.5 “ 
Calcium oxide 5.5 “ 
Sodium carbonate 40.0 “ 
148.1 
MILK SALT 
For a quart of sugar-free milk prepare one quart of one per 
cent, solution of milk salts by dissolving in a quart of hot water 800 
THE NEW DIETETICS 
two and one-half drams of the above mixed salts. Put the solu- 
tion on ice to cool. Now precipitate the curd of three pints of full 
milk by adding one dram and a quarter of glacial acetic acid mixed 
with one quart of water. Drain off the whey on a thick cloth filter. 
Wash with water until free from acid then dissolve the curd in 
the solution of milk salts. 
DIET IN SIMPLE GOITER 
In simple goiter there is diminished activity of the thyroid 
gland. The development of this disease appears, in some cases 
at least, to be connected with a deficiency of iodine. The disease 
especially affects girls, and sometimes appears in young animals. 
It is related that in the pioneer days of Michigan sheep raising 
was almost impossible on account of the death of the animals from 
goiter. The use of salt containing a small amount of iodine was 
found to be a cure for the disease. 
The great mortality of young pigs in many parts of the 
country, from the same cause, has been checked by the adminis- 
tration of small quantities of iodine. The normal thyroid gland 
contains about one-seventh of one grain of iodine. The normal 
daily intake of iodine is about one two-hundredth of a grain. 
The diseased thyroid often contains less than one-twentieth the 
normal amount of iodine. 
The diet should be made antitoxic, including liberal quan- 
tities of greens, and particularly the following foods, which an- 
alysis has shown to contain iodine in appreciable quantities: 
Turnips, melons, lettuce, beets, tomatoes, French beans, green 
peas, radishes. The carrot, parsley and potato also contain con- 
siderable quantities of iodine, while the cucumber, pumpkin, spin- 
ach and kidney beans contain only very small quantities. 
Agar and Irish moss are very rich in iodine and for this 
reason should be freely, used by persons suffering from the simple 
form of goiter. 
It is quite possible that concentrated extracts prepared from 
such vegetables as the turnip, radish, French beans and beets, 
used daily in proper quantities, might be of substantial service 
in these cases. 
Observations of Chalmers Watson suggest the special value 
of oatmeal in the feeding of persons suffering from simple goiter. 
The feeding of iodine in common table salt has been sug- DIET IN DISORDERS OF NUTRITION 
801 
gested as a simple means of supplying iodine in localities in which 
this element seems to be deficient. Iodized salt may be prepared 
as follows: Dissolve 75 grains of iodide of potash in two ounces 
of sixty per cent, alcohol. Sprinkle over a pound of salt, mix 
well, dry thoroughly and grind fine. Add half a tumblerful of this 
one per cent, iodized salt to five pounds of table salt and mix 
well. Employ for cooking and table use when iodine is needed. 
DIET IN HYPERTHYROIDISM—EXOPHTHALMIC 
GOITER 
In this disease there is an excessive activity of the thyroid 
gland, a condition which is believed to be brought about by the 
influence of poisons circulating in the blood. There are several 
interesting experimental facts which have a strong bearing upon 
dietetic indications in this condition. In the early experiments 
for the purpose of studying the function of the thyroid gland the 
gland was removed from dogs. It was noticed that these dogs 
soon became subject to convulsions and other grave disorders 
and after a few weeks died. It was later learned, however, that 
if the dogs were fed on bread and milk instead of meat, death 
did not occur. This led to the theory that a function of the 
thyroid gland is to destroy the poisons which develop in the 
body as a result of flesh eating. 
That such poisons do develop has been well known since the 
classical experiments of Bouchard, who found that solutions pre- 
pared from the stools of meat-eaters were twice as toxic as those 
prepared from the stools of non-flesh eaters. Herter, of New 
York, observed that animals were quickly killed by solutions pre- 
pared from the stools of carnivorous animals, but did not suc- 
cumb to similar solutions prepared from the stools of herbivorous 
animals. 
Numerous highly virulent poisons have been isolated from 
the stools of flesh-eating men and carnivorous animals. The pu- 
trid character of the stools of carnivorous animals and meat- 
eating men is a clear indication of the abundance of poisonous 
putrefaction products found in such stools. 
Extensive laboratory research has shown that the thyroid 
gland is actively concerned in the destruction of poisons circulat- 
ing in the blood. The first line of defense against poisons is the 
intestinal mucous membrane. Next, the liver offers an important 
barrier against toxic invasion. The third line of defense is the 802 
THE NEW DIETETICS 
thyroid gland and other glands of internal secretion which are 
associated with it. 
In typical cases of hyperthyroidism the thyroid gland is en- 
larged and its activity enormously increased. A general disturb- 
ance of the body results from the abnormal increase of thyro- 
toxin or thyroidin, which increases greatly the activity of the body 
cells, producing hypermetabolism, sometimes to the extent of even 
doubling the normal cell activity of the body. According to 
Plummer this increase affects especially the protein metabolism, 
which is also known to be increased in febrile conditions generally. 
It may be said, then, that in exophthalmic goiter the body 
is suffering from an intense toxemia in which, in addition to 
poisons produced in the alimentary canal and perhaps elsewhere, 
the body is also disturbed by thyrotoxin produced by the thyroid 
gland itself. 
It is evident, then, that in the dietetic treatment of exoph- 
thalmic goiter, or hyperthyroidism, it is of primary importance 
to suppress all foodstuffs calculated to increase the production 
of poisons in the body or which will tend to in any way stimulate 
the activity of the gland. That meats, meat extracts, bouillon, 
and broths are active stimulants of the thyroid gland is now gen- 
erally recognized. Says Plummer, of the Mayo Clinic: “Un- 
questionably the diet should be one that will reduce metabolism 
to the lowest point. This indication is best met by a diet low in 
proteins.” Fish, shellfish, meats, tea, coffee, alcohol and tobacco 
are all well known to be stimulants of the thyroid gland and their 
use must be positively prohibited. This practice the writer has 
followed for more than forty years, and by this method he suc- 
ceeded in curing a considerable number of severe cases of exoph- 
thalmic goiter long before relief of this condition by operation 
was even suggested. 
Tsuji, a Japanese investigator, has found that when rats are 
fed on large quantities of egg yolk or milk their thyroids enlarge. 
There was also enlargement of other organs such as takes place 
when animals are fed on thyroid. This observation agrees with 
the clinical fact that persons suffering from hyperthyroidism, the 
so-called exophthalmic goiter, are also practically always found 
to be suffering at the same time from intestinal toxemia or auto- 
intoxication, the result of putrefaction of the food residues in the 
colon. It is doubtless for this reason that meat feeding is found 
so highly detrimental in cases of thyroid disease. Dr. Crile has DIET IN DISORDERS OF NUTRITION 
803 
frequently called attention to the importance of excluding meats 
from the diets of patients who have undergone operations upon 
the thyroid. He insists upon the exclusion of meats for at least a 
month after the operation, and when asked, “Would it be better 
to exclude meats from the dietary permanently ?” at once replied, 
“Of course, of course.” Every physiologist is familiar with the 
facts upon which this recommendation is based. The surgeons 
are rapidly becoming informed. It is important that the informa- 
tion should be passed along to the patients as rapidly as possible. 
Curschmann, in an article in Riforma Medica, reports that in 
Italy during the war as meat became scarce exophthalmic goiter 
steadily decreased in frequency. Twenty-two prominent physi- 
cians and surgeons who were questioned with reference to the 
frequency with which this disease was observed during the war 
reported, without exception, a notable decrease in the disease. 
Deneky, of Hamburg, Germany, who observed in the five years 
preceding the war 217 cases, in the five years from 1915 to 1920 
observed but 42 cases. 
While there are still a few authors who recommend the use 
of meat in this disease, the ablest authorities, both English and 
American, recommend that meat should be wholly discarded and 
that the diet should consist of milk and farinaceous foods with 
fresh vegetables and fruits. 
Thompson forbids the use of meats of all kinds, including 
sea food and discourages the use of tea and coffee. 
Chalmers Watson claims to have demonstrated that oatmeal 
also stimulates the thyroid and on this account this cereal is 
usually excluded from the dietary of patients suffering from 
Graves’ disease. It is difficult to understand how a simple cereal 
should behave in this manner, and the writer has never observed 
any injurious effect from the use of oatmeal. Nevertheless, until 
further light is obtained upon the subject, it will be well to avoid 
the use of oatmeal in more than small amounts in feeding these 
patients. Foodstuffs known to be rich in iodine should be used 
very sparingly or altogether discarded in this disease. 
McCarrison finds that a deficiency of vitamins in the food, 
particularly of the antiscorbutic vitamin, lessens the resistance of 
the thyroid gland and renders it “susceptible to the harmful action 
of intestinal bacteria, with resulting atrophic changes.” 
McCarrison has also called attention to the fact that the 
feeding of onions to animals suffering from intestinal toxemia 804 
THE NEW DIETETICS 
because of an excess of fat and protein, restrains the growth of 
putrefactive bacteria in the intestinal tract and retards the ab- 
sorption of their products and, to a marked degree, delays the 
development of the thyroid enlargement which usually develops 
rapidly in pronounced intestinal toxemia. McCarrison was led by 
this observation to recommend onion juice as a remedy for re- 
straining the over-development of the gland in exophthalmic 
goiter, or Graves’ disease. Evidently, a still better measure is to 
be found in a change of the intestinal flora, thus eliminating the 
putrefaction altogether. 
The excessive activity of the body cells results in a rapid 
wasting of the tissues, a loss which must be met by an increase 
in the food intake. The basal metabolism of a person suffering 
from hyperthyroidism may, in extreme cases, be double the nor- 
mal basal metabolism so that in addition to keeping the patient 
very quiet, an essential factor in treatment, there must be an 
increase in the total number of calories eaten. The proteins 
should not be increased, as this will still further increase the 
abnormal activity. The increase should be confined to the fats 
and carbohydrates, chiefly the latter. 
In all cases operated upon for relief of exophthalmic goiter, 
the dietary above described should be strictly followed, not simply 
as a temporary measure but permanently. Otherwise the disorder 
is almost certain to recur, making another operation necessary. 
In cases of exophthalmic goiter with diabetes the patient must 
be put upon a diabetic diet. In cases of this sort the newly dis- 
covered insulin is a very precious resource indeed. 
HYPOTHYROIDISM 
It is now generally conceded that the thyroid gland is the 
seat of iodine metabolism. This gland removes from the blood 
minute quantities of iodine and therewith produces its special 
secretion, thyroidin, which is in excess in hyperthyroidism but 
deficient in hypothyroidism, giving rise to certain well-marked 
morbid conditions. Well marked hypothyroidism in children is 
known as cretinism and in adults or adolescents as myxedema. 
In this condition there is a diminished activity of the body cells 
due to the lack of the stimulating influence of the thyroid secre- 
tion. The body cells are overburdened with waste products. This 
is clearly shown in the skin, which becomes puffy, dry and in- 
active. The whole body becomes sluggish, including the brain, DIET IN DISORDERS OF NUTRITION 
805 
and in young children cretinism, a condition bordering on idiocy, 
is developed. 
The myxedematous patient usually has a cachectic appear- 
ance suggesting Bright’s disease. The speech is slow and slug- 
gish, as though the tongue were swollen. The patient moves slowly 
and clumsily. There appears to be a mental as well as a physical 
slowness. 
These patients generally have a tendency to increase in 
weight and are often large eaters. Care must be taken to restrict 
the amount of food to actual needs. A reducing diet for a week 
or two is advantageous at the outset of treatment. 
Mild forms of hypothyroidism occur much more frequently 
than is generally recognized. This condition almost universally 
develops in advanced age and is indicated by dryness of the 
hair and skin and the development of a depression just above the 
sternum, the result of atrophy of the thyroid. 
In this condition, the natural conclusion would be that a 
radically different dietary would be indicated and perhaps flesh 
meats might be admissible on account of their iodine content and 
their stimulating influence upon the thyroid. 
But this is not the case. While oatmeal and vegetable foods 
containing iodine are especially indicated, meats of all kinds are 
certainly contraindicated for the reason that putrefaction of un- 
digested remnants of flesh foods in the colon gives rise to toxic 
products with which the crippled thyroid is not prepared to deal, 
it being remembered that dogs whose thyroid glands have been 
removed, died when fed meat but lived with a diet of bread and 
milk. It is a well-known fact that in cases of myxedema a meat 
diet will “sometimes induce tetanic attacks or convulsions.” Flesh 
foods of all sorts must be wholly and permanently avoided. 
Rosenbloom recommends a diet containing a minimum 
amount of protein. The low protein diet is necessary to lessen 
the intestinal putrefaction which enormously increases the work 
of the thyroid. Foods rich in iodine are useful because iodine is 
necessary to enable the thyroid to do its work. 
Another point of essential importance in these cases is the 
feeding of thyroidin, thyroid extract or dried thyroid gland. This 
feature of the diet, however, should rather be classed as medica- 
tion and should be carried on under the supervision of a com- 
petent physician, since it is quite possible to do harm as well as 
good. The good effects of thyroid feeding in most cases quickly 806 
THE NEW DIETETICS 
become apparent. Much harm may result from excessive thyroid 
feeding, which should be carefully avoided. It is a grave error, 
however, to depend exclusively upon thyroid feeding. 
Regulation of the diet in such a way as to lessen the amount 
of poisons circulating in the blood, thus diminishing the work 
required of the thyroid, is of first importance. This with rest in 
bed and changing the intestinal flora will secure radical improve- 
ment even in grave cases of myxedema, although much more 
rapid progress is made when thyroid feeding is added. 
Murray reported in 1920 the death of the first patient treated 
for myxedema by thyroid extract. The patient began treatment 
by this remedy in 1891 at the age of 46 years. She continued 
the treatment until her death in 1919 at the age of 74. Her life 
was doubtless greatly prolonged by the use of thyroid extract. 
The great number of operations now-a-days being done for 
relief of exophthalmic goiter will, in the writer’s opinion, pro- 
duce an epidemic of surgical hypothyroidism a few years in the 
future. Operators not infrequently remove so much of the gland 
that not more than a fifth, or even a tenth of the original gland 
structure is left. When an operation of this sort is performed 
and no change is made in the patient’s dietetic habits, over-stimu- 
lation of the gland will continue and the small fraction of gland 
left will be overworked to a greater extent even than the whole 
gland would have been, although the unpleasant effects arising 
from the excessive production of thyroidin may not appear. Over- 
work of a gland always results sooner or later in degeneration 
and diminished functional activity. It is inevitable that these 
abbreviated thyroids should suffer a very great shortening of the 
duration of their functional activity. 
To say that a man is as old as his thyroid is equally as true 
as to say that a man is as old as his arteries, for the thyroid func- 
tion is an important link in the chain of vital activities which 
are essential to the prolongation of life. 
Deficient functioning of the thyroid, or hypothyroidism, is 
one of the active factors in inducing the changes characteristic 
of senility, particularly the changes in the hair and the skin. 
When the skin becomes thin, dry, parchment-like, inelastic and 
covered with brown patches, the function of the thyroid gland 
is impaired. These external evidences of old age degeneration 
are only the outward sign of similar degenerative changes taking 
place all through the body, which are in part at least the result DIET IN DISORDERS OF NUTRITION 
807 
of the loss of the thyroid function. To live long and well, one 
must take good care of his thyroid and must keep it intact. To 
accomplish this it is necessary that the thyroid should not be 
overworked by the use of flesh meats and other toxin-containing 
foodstuffs and by such neglect of the colon as will permit it to 
become an incubator of noxious germs and a veritable reservoir 
of virulent poisons. 
In many forms of skin diseases, as well as in premature old 
age, hypothyroidism is found to be the dominant factor. In all 
these conditions the dietary suggestions made above may be fol- 
lowed with marked advantage. 
Another of the consequences of thyroid inefficiency is an 
irritation of the skin which results from the chapping due to 
excessive dryness. This occurs especially in winter and in old 
people. 1 i 
These conditions indicate the necessity for increased activity 
of the thyroid, which may be encouraged by the use of foods rich 
in iodine, and if necessary, by thyroid feeding. 
In conclusion, attention must be called to the importance of 
maintaining a sanitary condition of the colon. This requires 
three bowel movements daily, or an emptying of the colon after 
each meal. To accomplish this, it is necessary that a much larger 
amount of roughage than that found in the ordinary bill of fare 
should be made a regular part of the dietary (see laxative diet, 
Index). Bran to the extent of a quarter ounce at each meal and 
an abundance of greens are probably the best forms of roughage 
for regular use. Agar-agar may sometimes be employed advan- 
tageously, and the continuous use of mineral oil both before and 
after each meal is necessary to serve as a lubricant in cases in 
which constipation has existed so long that the natural lubricat- 
ing function of the colon has been impaired. 
The amount of thyroid needed is much less when a strict 
antitoxic diet is followed and the intestinal flora changed and 
kept free from putrefactive bacteria. 
DYSPITUITARISM 
In this disorder there is a remarkable tolerance for carbo- 
hydrates. This is not a morbid symptom but simply an instinc- 
tive or automatic indication of a special need. The craving for 
carbohydrates should be curbed only to such a degree as to pre- 
vent undue indulgence in confectionery and other sweets. If the 808 
THE NEW DIETETICS 
patient is asked to avoid the use of candy and sugar, confining 
the indulgence in sweet things to sweet fruits and fruit juices, 
malt sugar and malted preparations, no harm will be likely to 
result from the gratification of the appetite for saccharine and 
farinaceous foods. Proteins should be kept at a low level. The 
appetite must be curbed in cases in which there is a marked 
tendency to accumulation of fat, and the intake of butter and 
other oleaginous foods may be reduced to a minimum. Potatoes 
should be largely used instead of cereal foods. This is advan- 
tageous, first, because they are more bulky and hence will dimin- 
ish the tendency to overeating; and second, because potatoes, like 
other farinaceous roots, are rich in organic bases which are needed 
to neutralize the acid wastes with which the body is likely to be 
overcharged. Potatoes are also richer in iodine than are cereals. 
Special attention must be given to the colon and to the intes- 
tinal flora, which always needs to be changed, so as to lighten so 
far as possible the burden upon the thyroid, which is also usually 
crippled to a marked degree in these cases. 
The bowels must be kept active, at least three movements a 
day, by a laxative diet (see Index) and the use of bran, agar, and 
mineral oil. The flora must be changed. 
The same principles of treatment apply as in disease of the 
thyroid. Evidence of pituitary deficiency requires the adminis- 
tration of the dried gland in connection with proper diet. Thy- 
roid deficiency may exist at the same time, in which case feeding 
of thyroid may also be found necessary. The regulation of the 
dose of thyroid or pituitary gland substances requires the atten- 
tion of a physician skilled in this particular class of ailments. 
ADDISON'S DISEASE 
While little in the direction of a cure can be accomplished 
either by diet or other means in this disease, much can be done 
to better the patient’s condition and prolong life by careful regu- 
lation of the diet. The essential things to be done are to change 
the intestinal flora and then to suppress intestinal putrefactions by 
an antitoxic diet. Meats of all sorts must be excluded. The 
bowels must be kept active by a laxative diet, supplemented by 
daily enemas. Carbohydrates may be freely used with advan- 
tage. In some cases, benefit has seemed to follow the use of 
liberal doses of dried adrenal gland. DIET IN DISORDERS OF NUTRITION 
809 
The patient is always toxic, and hence the flora should be 
changed by the fruit regimen with lactose or lacto-dextrin. 
UREMIA 
The diet in uremia should be the same as indicated for 
acidosis (see Index). It should consist exclusively of fruit juices 
and such carbohydrates as malt sugar and raisin water (see 
Index). Malt sugar is superior to the juice of raisins in these 
cases, for the reason that the latter contains some tartaric 
acid, which is less perfectly oxidized in the body than is citric acid 
and may tend to increase the acidosis. Orange juice is of great 
value and may be freely used with advantage in cases of renal 
acidosis as well as in acidosis due to defective metabolism, the 
so-called ketonic acidosis. Protein should be wholly excluded 
from the diet for a few days. Potato in various forms should 
largely replace cereals on account of the alkaline salts, which it 
supplies, which lessen the tendency to acidosis. 
Enemas containing two ounces of malt sugar to the pint may 
be given in quantities of half a pint to a pint every hour, to be 
retained. The colon should be emptied by a large enema every 
four or five hours. 
THE ANEMIAS 
In anemia there is a notable lack of iron and of blood cells. 
The problem is to supply the body with the iron needed for the 
production of new red blood cells, and to encourage the blood- 
making process. It is now generally recognized that this can be 
best accomplished only through the means of appropriate food- 
stuffs and the application of other natural curative measures and 
not by the use of drugs. Neither is feeding alone sufficient. 
Out-of-door air, exercise in proper cases, sunlight, cold bathing, 
and attention to all health-promoting measures, are almost equally 
important. 
The diet, in addition to a sufficient amount of food iron, 
must also present to the body an abundance of vitamins, lime, 
complete proteins and other essential tissue-building elements. 
Hence, the restorative regimen is required (see Index), especial 
care being taken to include foods rich in iron in sufficient quan- 
tity to double the ordinary normal intake of iron. The ordinary 
amount of iron excreted by the body daily is about one-sixth of 
one grain. Since the total amount eaten is never assimilated, it 810 
THE NEW DIETETICS 
is necessary that the daily intake or the food iron ration should 
be about one-fourth of a grain. The amount of each one of the 
ordinary foodstuffs which contains this quantity of iron is given 
in the table shown elsewhere in this work (see Table XI). 
Anemia is coming to be very widespread in this country be- 
cause of the neglect of the use of green stuffs, which in every 
other country are extensively employed. 
An explorer for the United States Bureau of Plant Introduc- 
tion informed the writer that the average Chinaman eats four 
times as much greens as does the average American. When it is 
realized that it is from greens that our supply of iron is chiefly 
derived it becomes apparent that the national anemia must be 
the consequence of this serious dietetic neglect. Every effort 
should be made to instruct the public with reference to this grave 
error, almost universal in this country. 
The one-fifth to one-fourth of a grain of iron necessary to 
make good the daily loss represents about one two-hundredth part 
of the total iron content of the body. 
Each drop of 1 per cent, in the hemoglobin content of the 
blood means a loss of 0.43 grains of iron. A loss of 20 per cent., 
as in a case showing a hemoglobin content of 80 per cent., means 
a deficiency of 8.6 grains, the amount of iron found in 34 pounds 
of spinach. 
By eating half a pound of spinach a day, this amount of iron 
might be absorbed in sixty-eight days or a little more than two 
months. It must be remembered, also, that the bill of fare must 
be so constructed as to supply the patient in addition his full 
normal daily ration of iron, which may be easily done by the aid 
of the table above referred to. 
In cases in which anemia is due to loss of blood, the iron of 
the body may be quickly restored by proper feeding, provided 
there is no recurrence of hemorrhage. The same is true of all 
secondary forms of anemia. When the cause is removed, proper 
feeding will quickly restore the patient. 
An important point to which attention should be especially 
called is the fact that flesh foods are not particularly valuable for 
building up the blood. The popular idea that red meat of some 
sort is indicated in anemia has no sound scientific basis. Red 
meats often have been prescribed as a remedy for anemia with 
most unsatisfactory results. Although red meats and blood are 
rich in hemoglobin, it appears that the iron of hemoglobin is not DIET IN DISORDERS OF NUTRITION 
811 
so readily assimilated as is iron in the form in which it is fur- 
nished in plants, particularly green leaves (Sherman). 
Grigoriew has shown that rabbits rendered anemic by bleed- 
ing improve much more rapidly when given chlorophyll, or 
organic iron found in green leaves, than when given iron in a 
metallic state. 
Abderhalden and others have shown that the iron found in 
foods is necessary for supplying the iron requirements of the 
body. Even the so-called organic compounds were found to be 
not so readily assimilated as the iron supplied in foods. 
Attention should also be called to the fact that there are 
many vegetable foodstuffs which are far richer in iron than is 
lean beef, while the fat of meat contains no iron at all. For ex- 
ample the following common foodstuffs (20 in number) are all 
richer in iron than is beefsteak, namely: almonds, barley, beans, 
egg yolk, hazel nuts, molasses, malted nuts, malt sugar, peas, pro- 
tose, 40 per cent, gluten flour, rye, entire wheat, wheat bran, figs, 
dates, prunes, mustard greens and many other green stuffs. A 
few vegetable foods contain nearly double the amount of iron 
contained in beefsteak, among which may be mentioned lima 
beans, lentils and wheat bran. And it must not be forgotten that 
the iron found in these vegetable products is more easily assim- 
ilated than that found in meats. 
Even that humble vegetable, the onion, contains a notable 
amount of iron which is said to be of particularly fine quality; 
while the yolk of egg contains as much iron as more than twice 
its weight of the best beefsteak. 
A person suffering from chronic anemia must make radical 
changes in his bill of fare. Meats must be discarded. Nuts, nut 
meats, and glutens should take the place of meats. Foods rich in 
iron should be the staples of each meal. Cane sugar should be 
replaced by malt sugar, dates, figs and raisins. Malted nuts (vege- 
table milk) is rich in iron and may well in part replace milk, 
which is very poor in iron. Lentil soup and greens of all sorts 
must enter largely into the dietary. The restorative regimen is 
indicated (see Index). 
A cup of savita (yeast extract) broth contains as much iron as 
half a pound of beefsteak besides food lime and vitamins and 
highly palatable osmazome. 
Much more interesting and useful data respecting the iron 812 
THE NEW DIETETICS 
content of foods may be obtained by a careful study of the 
Table XI. 
Pernicious Anemia. 
In pernicious anemia, leukemia, Addison’s disease, and other 
of the grave forms of anemia, the problem is by no means so 
simple as in ordinary anemia. In these cases, there is undoubt- 
edly a profound toxemia, the seat of which in many cases at 
least is the intestinal canal, as shown by the highly putrid char- 
acter of the stools. 
On this account, it is of the utmost importance to give at- 
tention to the alimentary canal and to suppress foodstuffs cal- 
culated to promote intestinal putrefactions. 
The failure of the gastric glands to produce hydrochloric 
acid, a condition present in most cases of pernicious anemia, 
deprives the intestinal tract of the normal disinfectant action of 
the gastric juice. In such cases, putrefactive bacteria taken with 
the food are not destroyed in the stomach but are left to grow 
and thrive in the intestine, especially in the colon, exposing the 
body to the pernicious influence of a great variety of putrefac- 
tion products. Some of these products destroy the red blood 
cells when brought into contact with them, a fact which was be- 
lieved by Herter to explain the disappearance of the red blood 
cells in pernicious anemia. 
Fortunately greens, which are absolutely essential in the 
feeding of anemic patients, are among the most laxative of food- 
stuffs. These must be freely used and also bran, which should be 
eaten to the extent of one ounce daily or at least a large table- 
spoonful at each meal. 
When taken by itself, bran is rejected by the nerves of the 
throat, which recognize it as foreign material rather than food; 
hence the bran must be mixed with other suitable quantity of food 
to conceal its innutritious character and provoke the normal swal- 
lowing reflex. A couple of tablespoonfuls of bran may be easily 
concealed in an ordinary dish of breakfast cereal. With the 
addition of malt sugar or malt syrup and a little cream such a 
mixture is not at all unpalatable. 
Bran may also be added to potato and other purees and 
thick soups of all sorts or it may be eaten with bread and milk. 
It is necessary to insist that it should be taken at every meal. 
Fortunately, bran is also rich in iron. An ounce of bran DIET IN DISORDERS OF NUTRITION 
813 
contains 0.034 grains of iron, and the daily dose of one ounce of 
bran would thus contribute a sufficient amount of iron to lessen 
the required intake of spinach by two ounces. 
By reference to Table XXIX it will be seen that some other 
greens, particularly the narrow leaved dock and red root, con- 
tain double the amount of iron found in spinach. 
As before remarked, it is idle to rely upon drugs—iron, 
arsenic or other drugs for the cure of anemia. Blood corpuscles 
cannot be made without food iron. Arsenic and iron combined 
may sometimes render some service in the treatment of anemia 
by stimulating the blood-making processes, but such stimulation is 
unnatural and the results are altogether disappointing when these 
methods are relied upon, for no substantial progress toward actual 
cure can be accomplished without supplying the body with the 
normal material required for the construction of blood cells; that 
is, hematogen, or food iron, which is alone produced by the vege- 
table kingdom. 
The apparent benefit often secured by the use of arsenical 
preparations, such as cacodylate of soda, has led to the widespread 
use of these remedies to the neglect of proper feeding. That 
this practice is a great error, however, has been pointed out by 
Chaippori (Riforma Medica), who found that in the administra- 
tion of arsenic in cases of anemia there is an increase of red cor- 
puscles, but no increase of white cells. In one case the red cells 
were found to be increased one million within an hour after 
injection. The increase in the red cells was found to be due to 
the throwing into the circulation of a great number of young and 
immature red cells. These young cells possessed so little resist- 
ance that they were quickly destroyed and eliminated, as shown 
by an increase of urobilin in the urine. Poggi confirmed these 
observations, which clearly show the futility of depending upon 
arsenic to cure anemia. The taking of more food iron in the 
food, relief of autointoxication and the proper use of exercise, 
phototherapy, and cold frictions with other forms of hydro- 
therapy, are the most efficient means of combating anemia. 
Drugs cannot be relied upon to restore the blood or any other 
wasted tissue. The use of ox blood and preparations of blood in 
severe anemia, once so common, has no scientific foundation. 
If blood iron were readily available for replenishing the wast- 
ing iron losses of the body, carnivorous animals would never suffer 
from anemia and vegetable-eating animals would be especially sub- 814 
THE NEW DIETETICS 
ject to blood impoverishment; but the very opposite is the case. 
Carnivorous animals are far more subject to anemia than are 
herbivorous or grass-eating animals (Sherman). And where does 
the ox find iron for making his rich red blood if not in the green 
grass on which he feeds? It seems that original sources are of as 
much consequence in the matter of iron supply as in so many 
other of our every day affairs. 
If the iron of blood and flesh were a superior source of iron 
for replenishing the iron losses of the body, such losses would 
not occur except as the result of hemorrhage from accident or 
other cause. This is evident from the fact that the waste iron is 
excreted through the intestine. If such iron as is supplied by 
beefsteaks or by the chemist could be advantageously utilized by 
the body, the intestine would absorb the waste iron already pres- 
ent, which could not be less available than iron from the sources 
named. 
There can be no doubt that the iron of plants is the natural 
and the best source of iron for blood making. Hence, in anemia, 
such vegetable foods should be selected as will supply the largest 
amount of iron. Fortunately, the number of such foods is ample 
for needed variety. More than a score of different vegetable foods 
supply more iron than does average beefsteak, as will be seen by 
reference to Table XII. 
Yeast extract (savita, marmite), contains very many times 
as much iron as does average beefsteak; pure gluten fourteen 
times as much; 40 per cent, gluten six times as much; egg yolk and 
lentils nearly four times, and molasses, wheat bran, yellow dock 
greens and 20 per cent, gluten, an average of three times as much. 
A long list of foods furnish twice as much or more iron than does 
moderately fat beefsteak, of which may be mentioned soy beans, 
peas, protose, whole wheat, malt sugar, malted nuts, mustard 
greens, brose and hazelnuts. The iron content of beefsteak is 
exceeded by that of all the whole grain cereals, dates, figs, prune ~ 
and olives, and by nearly all the nuts and nut products. 
Keeping these facts in mind, it is easy to arrange a bill of 
fare containing an abundance of food iron in most available form. 
In general, the plan for the bill of fare must be as follows. For 
cane sugar, which contains no iron, substitute malt sugar and 
such sweet fruits as dates, figs, Zante currants and raisins, 
molasses and maple syrup. Discard white bread, polished rice, 
rice flakes, hominy, corn flour and all bolted cereals, and use only DIET IN DISORDERS OF NUTRITION 
815 
such whole grain products as oatmeal, cracked, shredded, or 
puffed wheat, wheat flakes, brown rice, graham bread, Boston 
brown bread, rye bread, bran and bran preparations. Make a 
liberal use of lentils, dried peas, navy and lima beans, and soy 
beans. Make greens a staple article of food, serving at least 
twice a day a liberal portion. Substitute nuts or nut products 
for meats of all sorts. Use egg yolks in moderation. Malted nuts 
may be in part substituted for milk because milk is deficient in 
iron, or altogether in cases in which the patient is sensitized to 
dairy products. 
Fresh fruits, especially citrus fruits, and fresh vegetables, 
particularly tomatoes and carrots should be freely used to insure 
an ample supply of vitamins, a deficiency of which is known to be 
a cause of anemia. It is well to use tomatoes in some form every 
day. 
Says the eminent Von Noorden respecting the feeding of 
children, and the same principles apply with equal force to the 
feeding of adults: 
The necessity of a generous supply of vegetables and fruits must 
be particularly emphasized. They are of the greatest importance for 
the normal development of the body and of all its functions. As far 
as children are concerned, we believe we could do better by following 
the dietary of the most rigid vegetarians than by feeding the children 
as though they were carnivora, according to the bad custom which is 
still quite prevalent. 
Transfusion with animal blood was once much in vogue, but 
was soon abandoned. Good results follow the transfusion of hu- 
man blood of the right type. This method is now much more often 
used than formerly and often with results which seem little short 
of miraculous. Too often the effect is more or less transient, but 
the o[>eration is a comparatively simple one and may be repeated 
many times if necessary. 
Recent observations by Wearn, Warren and Ames (Arch. 
Int. Med., April, 1922) show that the life of blood cells when in- 
troduced by transfusion is much longer than has been supposed. 
By ingenious methods they were able to prove that transfused cells 
survive from 59 to 113 days, an average of 86 days or more than 
12 weeks. These observations confirm the increasing confidence in 
transfusion supported by clinical experience and suggest its use 
earlier and more frequently. In the case of a patient treated at 
the Battle Creek Sanitarium the blood was brought from 30 per 816 
THE NEW DIETETICS 
cent, of the normal to 80 per cent, and at the time of this writing, 
a year and a half since the patient returned home, the improve- 
ment is still maintained. Of course the benefit received could not 
be entirely attributed to the transfusions. The patient was placed 
upon a diet rich in iron and thoroughly antitoxic, and the intestinal 
flora was changed by the method above pointed out. In another 
case in which the hemoglobin had reached the unusually low point 
of 14 per cent., the blood was restored by diet and physiotherapy 
to 90 per cent., and the patient after fourteen years is still in ex- 
cellent health and active in business as a travelling salesman. No 
transfusions were employed in this case, but the patient has ad- 
hered very closely to an antitoxic (no meat) regimen. 
DIET FOR ACIDOSIS 
The blood and tissue fluids are slightly alkaline in reaction. 
This slight degree of alkalinity is essential to the maintenance of 
health. When, through disordered metabolism, the body becomes 
charged with an excess of acids, so that the alkalinity of the blood 
and tissues is diminished, the result is a condition known as 
acidosis. Among the symptoms due to acidosis may be mentioned 
nervousness, mental depression, mental confusion, drowsiness, 
convulsions and coma. Air hunger with shortness of breath is 
one of the early symptoms of acidosis. This condition is most 
pronounced in advanced cases of diabetes and is encouraged by 
a meat diet, particularly by the use of an excess of fats. Fasting 
persons always show a condition of acidosis after fasting for a 
day or two. Professor Fischer believes that this preponderance 
of acids, or chronic acidosis, is the exciting cause of Bright’s 
disease. It is believed that acidosis favors the development of 
disease of the skin. A slight degree of acidosis is manifested in 
loss of endurance, physical and mental inefficiency and slight 
shortness of breath. 
When the increase of acids in the blood and tissue fluids 
is due to imperfect oxidation or disturbed metabolism, the con- 
dition is termed ketonic acidosis. When the condition is due to 
deficient elimination of acid wastes by the kidneys, as in uremia, 
it is known as renal acidosis. 
A simple test for acidosis, suggested by Flenderson, is hold- 
ing the breath. One of the first symptoms of acidosis is shortness 
of breath and a sensation of air hunger. A normal person at rest DIET IN DISORDERS OF NUTRITION 
817 
after taking a full breath can hold the breath for 40 seconds 
or longer. When acidosis is present, the time for which the breath 
can be held is reduced to 20 seconds, one-half the normal or even 
less. When the breath cannot be held more than 20 seconds, the 
degree of acidosis is sufficient to render general anesthesia a 
highly dangerous procedure (Stange). 
The opposite condition, known as alkalinosis, is believed to 
be associated with a condition known as tetany. 
It is evidently important that attention should be given to 
the acid and alkaline constituents of the food. When food con- 
taining an excess of acids other than malic and citric acid is 
taken in considerable quantity and for some time the result is 
likely to be an over-accumulation of acids. This does not occur 
in the case of citric and malic acids for the reason that these 
acids are combined with soda and potash and in the body the 
acids are burned, leaving the alkalies behind, so that the effect 
of taking these acids in the combinations in which they are found 
in foodstuffs is to increase the alkalinity of the body fluids rather 
than to diminish it. Tartaric acid is probably burned to some 
extent in the body, but less readily than malic and citric acid; 
while acetic, butyric, oxalic and benzoic acids, which are also 
frequently found in foods, often in considerable quantity, are 
not burned in the body and hence are not utilized. 
When food is burned, the ashes are found to contain sul- 
phuric acid, phosphoric acid and hydrochloric acid in combina- 
tion with lime, magnesia, soda and potash. In some foods these 
acids are preponderant. This is particularly true of meats. Milk, 
fruits and vegetables of all sorts contain a preponderance of the 
alkalies or bases. A meat diet necessarily tends to acidify the 
tissue fluids because of the large amount of sulphur, chlorin 
and phosphorous which meats contain. A diet of cereals has the 
same tendency although to a less degree. 
Carnivorous animals appear to be equipped by Nature for 
dealing with these acids in a way in which non-flesh eating ani- 
mals are not prepared to do. From the lean meat of their diet, 
they are able to produce abundantly the alkali ammonia, thus 
neutralizing the excess of acids derived from their diet. Human 
beings and other animals are not prepared to do this except to a 
limited extent, and hence are likely to suffer from the use of 
foods containing an excess of acids. 
Another source of acidosis is imperfect combustion of fats. 818 
THE NEW DIETETICS 
Although sugar is the current fuel of the body, more or less fat 
is burned daily. The chief consumption of fat occurs some hours 
after a meal has been taken. More fat is consumed in the early 
morning hours than at any other time because at this time the 
starch and sugar taken in the previous day’s meals have been 
largely consumed. Exercise before breakfast or when fasting is 
on this account more efficient in burning up the body fat than 
when taken soon after eating. 
That fats are less easily utilized by the body than are starches 
and sugars is shown by the observation that while a person may 
for some days without injury subsist upon a diet consisting ex- 
clusively of carbohydrates this is not true in relation to fats. On 
a diet consisting exclusively of fats, a state of acidosis of the 
tissue fluids very rapidly develops. In this condition CO2 is 
accumulating in the tissues because the blood is unable to carry 
it off with sufficient rapidity. As a natural consequence, the 
amount of carbon dioxid exhaled in the expired breath will be 
diminished. The state of acidosis is thus most readily shown by 
an examination of the expired air and a determination of the 
so-called carbon dioxid tension. The normal tension is about 40. 
When the tension falls lower than 34, the condition of acidosis 
is present. 
Hasselbalch has shown that the carbon dioxid tension of a 
meat-eater is only 37.8; that of a person living on a mixed diet is 
but little higher, 38.3; while the tension of a non-flesh eater is 
43.3. These figures are highly significant. The non-flesh eater’s 
tension is nearly ten points above the danger line, while that of 
the meat-eater is less than four points; that is, the hearty meat- 
eater lives continuously in a condition bordering on acidosis, and 
the mixed feeder is only a little better off, whereas the flesh- 
abstainer enjoys a wide safety margin. 
Here we find the explanation of the greater endurance of the 
flesh-abstainer as compared with the meat-eater. Hunters have 
long noted that dogs do not run well when fed meat. When rid- 
ing on the top of a touring coach through the Highlands of Scot- 
land many years ago the writer, in chatting with the driver, 
levrned that he was a shepherd and kept a number of dogs. When 
asked the question: “What do you feed your dogs ?” the Scotch- 
man replied: “The same as I eat meself, sir—brose, bannocks 
and potatoes.” 
“And why do you not give meat to your dogs ?” DIET IN DISORDERS OF NUTRITION 
819 
The instant reply was : “Because they hae nae so guid wind; 
they canna’ riff.” 
Vegetable-eating animals are notable for their powers of 
endurance, whereas the strict carnivora, lions, leopards and other 
members of the cat tribe, even though possessed of powerful mus- 
cles, become quickly exhausted when pursued. 
Acidosis develops on a diet of fat because of the incomplete 
burning or oxidation of the fat. 
Naunyn has shown that it is necessary for a person to eat 
daily at least two or three ounces of carbohydrates (200 to 300 
calories), starch or sugar, to prevent acidosis. Carbohydrates in 
some mysterious way not fully understood seem to enable the 
tissues to utilize fats more perfectly than is possible without 
them. As Naunyn remarks: “Fats burn in a fire of carbohy- 
drates.” The normal diet contains 1,600 to 2,000 calories of car- 
bohydrates or even more, while the proportion of fats is normally 
not more than 30 per cent, of the total food intake, although in 
the case of diabetics this proportion must often be considerably 
increased. 
The amount of fat actually required by the body has been 
a matter of much discussion among physiologists and no definite 
figures have been given. Within recent years, Hindhede has 
shown that the absolute requirement must be very small since he 
was able to keep a man in perfect physical condition for nearly 
two years on a diet consisting exclusively of bread, potatoes and 
greens, without the addition of fat of any sort. 
While reducing the protein to a minimum and eliminating 
fats from the diet, persons suffering from a chronic tendency to 
acidosis should also avoid meats and should greatly reduce the 
use of cereals and other foods known to have a tendency to 
acidify the tissue fluids. In addition, they should select for their 
bill of fare foodstuffs which are known to be rich in base-forming, 
or alkaline, elements. By this means, a normal reaction balance 
of the tissue fluids may be maintained. (See Index.) 
When the stools are foul, which is generally the case, the 
flora must be changed at once. Protein must be reduced to a low 
level, not to exceed one calorie per pound of body weight, and 
fats must be used sparingly. 
In acute acidosis, orange juice and malt sugar should be 
freely used. The juice of a dozen large oranges and half a pound 820 
THE NEW DIETETICS 
of malt sugar may be given every twenty-four hours, or even 
more. 
The relative excess of acid or of base-forming elements 
found in some common foodstuffs is given in the following table 
which shows this estimated excess of acid-forming elements equiv- 
alent to one cubic centimeter ()4 dram) normal acid solution per 
100 calories. 
Beef, free from visible fat 10 
Eggs 9 
Round steak 6.7 
Oatmeal 3.2 
Wheat flour 2.7 
Wheat, entire grain 2.6 
Rice 2.4 
Corn, entire grain 0.1 
Because the tissues are constantly forming acid products 
which must be removed by the kidneys, lungs and skin, there is 
always a tendency to acidosis. Vegetable foods generally tend 
to combat acidosis. The urine of carnivorous animals is highly 
acid while that of herbivorous animals is alkaline. 
Infantile Acidosis. 
The acidosis of infants usually results from overfeeding. 
The condition is indicated in young infants by convulsions and 
symptoms of rickets; in other children, by cyclic vomiting, head- 
aches and “biliousness.” 
In the case of a young child, purees of vegetables, especially 
potato, tomato juice and orange juice, should be added to the 
diet and the amount of food should be diminished, particularly 
fats. Change the intestinal flora (see index). 
In the case of older children, cane sugar should be avoided 
in all forms, including candy. Malt sugar may be allowed in 
moderate quantities. Butter and fats should be used sparingly. 
Meats should be avoided entirely, also animal broths. Potatoes 
should be largely used in place of bread. Greens should be made 
a part of the daily diet. A liberal serving of spinach should be 
eaten at least once a day. In young infants give spinach in 
puree. Spinach should always be parboiled. 
The colon should be kept empty by the free use of bran or 
agar and paraffin oil. It is well to empty the colon by an enema 
at 80° F. at least once a day for several days. DIET IN DISORDERS OF NUTRITION 
821 
Post-Operative Acidosis. 
Acidosis always occurs in general anesthesia no matter how 
induced. Dangerous acidosis is most common after chloroform 
anesthesia, but may occur after ether or nitrous oxide. Pro- 
phylaxis is most important in these cases. Instead of being de- 
prived of all food, as is usual, the patient should be given malt 
sugar freely during the twelve hours just before the operation. 
Eight to sixteen ounces of sugar, well diluted, should be taken 
during this time. A little lemon or other fruit juice may be 
added, to suit the patient’s taste. Immediately following the 
operation, malt sugar should be administered per rectum. Half 
a pint of water containing an ounce of malt sugar should be in- 
troduced into the rectum every hour. The introduction should 
be made slowly, if necessary employing the drop method to insure 
absorption. As soon as the nausea has disappeared, malt sugar 
may be administered by mouth, dissolved in water or diluted 
fruit juice. In severe cases, duodenal feeding (see index) with 
sugar water should be resorted to. 
Surgical acidosis is now preventable by the intravenous in- 
jection of dextrose during the operation. This method is in 
regular use in the surgical department of the Battle Creek Sani- 
tarium and has given excellent satisfaction. 
SPRUE 
This form of intestinal toxemia is apparently simply an ad- 
vanced stage of tropical diarrhea. The disease generally origi- 
nates in tropical countries, but after it has once become well 
developed may continue in spite of removal to a different climate. 
The first dietetic indication is to secure a change of the 
intestinal flora. In addition, it is highly important to include in 
the dietary an abundant supply of vitamins and iron and lime 
with the other organic salts associated with them. These indica- 
tions are best met by a diet consisting of milk and fruit. 
At the beginning, milk should be given warm and in small 
quantities, not more than half a pint, at intervals of two hours. 
The first day the quantity should be not more than two or three 
pints. The amount should be gradually increased to seven or 
eight pints, when the patient will usually begin to show a gain 
in weight. 
Strawberries have been the most highly recommended of 822 
THE NEW DIETETICS 
any fruit, but in cases under the writer’s observation other fruits 
have appeared to be quite satisfactory. One or two pints of 
strawberries should be eaten daily, or three to six bananas, or 
bananas and strawberries may be used together. The fruit 
should be thoroughly ripe. 
When fit for use, the skin of the banana is brown. Bananas 
should be eaten only in the form of puree, produced by removing 
the coarse fiber and mashing or putting through a colander. It 
is a good plan to mix the banana with a portion of milk or cream 
and beat with an egg beater. 
Lacto-dextrin may be used with advantage both by mouth 
as well as by enema. Two or three ounces (smaller doses at first) 
should be administered three or four times a day. It should be 
dissolved in a glassful of hot water to which a glassful of milk 
should be added. The use of lacto-dextrin in large doses should 
be continued until the stools lose their putrid odor. The dose may 
then be reduced to one or two ounces three times a day and con- 
tinued indefinitely. 
According to Thim, sprue is due to a poison which develops 
in certain media, particularly in such a medium as is supplied 
by flesh foods, but appears to be unable to develop in milk or the 
juices of fruits. He explains in this way the great benefit derived 
from a diet of milk and strawberries or other fruit. 
Yogurt buttermilk, and particularly milk soured with B. 
acidophilus, greatly facilitates the process of changing the intes- 
tinal flora. Purees of spinach and other greens to the extent 
of six to eight ounces daily may be used with advantage for the 
purpose of furnishing iron, which is deficient in milk and is found 
in only comparative small proportions in most fruits. The 
superior value of the strawberry in these cases may be in part 
due to the fact that it is richer than other fruits in iron. 
Hot cornstarch enemas should be used twice daily to thor- 
oughly cleanse the colon and hasten the change of flora. An 
ounce or two of milk sugar or lacto-dextrin may be added to the 
enema with advantage to still further encourage the development 
of B. acidophilus in the colon. Enemas of whey cultures of B. 
acidophilus or lacto-dextrin are also highly useful. 
Brown {Am. Jour. Med. Sci.) reports a number of cases of 
sprue treated successfully with five to ten grains of pancreatic 
extract three times a day. The extract is given two hours after 
meals in connection with 20 grains of bicarbonate of soda. This DIET IN DISORDERS OF NUTRITION 
method of treatment was adopted because of the finding of the 
complete absence of pancreatic ferments in the duodenal contents. 
Patients remained well so long as they continued the use of the 
pancreatic extract. The diet consisted of buttermilk, bread and 
milk, fruit purees and fruit juices, an excellent antitoxic diet. 
Canned fruft may be used in place of fresh fruit if the latter 
is not obtainable. Apples may be used instead of strawberries. 
Pellagra. 
This disease in some respects resembles sprue. Its nature is 
not yet fully understood, but the many researches which have 
been made indicate that it is a general failure of nutrition with 
lowered vital resistance, associated with intense intestinal toxemia. 
The dietetic management of this disease should be essentially the 
same as that indicated for sprue. 
Dr. Joseph Goldberger, who has for many years given special 
attention to the study of the causes of pellagra, in a recent re- 
search conducted by himself and Dr. Tanner under the auspices 
of the U. S. Public Health Service, has apparently demonstrated 
that pellagra is the result of the long-continued use of a food 
deficient in protein of high quality. They found, for example, 
that in one case in which the patient was supplied with an abun- 
dance of vitamins, salts and every other necessary food element 
and food accessory, including milk, pellagra appeared when the 
milk was reduced in quantity and disappeared when the milk was 
increased to one and one-half pints, the amount formerly used. 
Ilindhede maintains that this view is erroneous and offers plaus- 
ible evidence of the correctness of his contention. 
It is noteworthy that in Dr. Goldberger’s experiments there 
was no evidence whatever that meat was essential to prevent the 
development of pellagra. An increase in the amount of milk 
taken was the only thing found necessary to cause a disappearance 
of the symptoms characteristic of this disease. Milk protein is of 
the highest quality. The protein of nuts is of equal value. 
The writer has observed recently several cases of pronounced 
pellagra which have been apparently cured by the use of “606,” in 
connection with a fruit and milk regimen and change of the in- 
testinal flora. At present, this method seems to offer to pellagra 
patients the best hope for a cure. 824 
THE NEW DIETETICS 
HODGKIN'S DISEASE 
The patient is subjected to the influence of toxins contin- 
ually absorbed from the seat of the disease, and hence the greatest 
care should be taken to reduce the alimentary toxins to a mini- 
mum. This may be accomplished by first changing the intestinal 
Bora, by methods elsewhere described (see Index), and then ad- 
hering closely to the antitoxic and laxative diet. 
Anemia and demineralization should be combated by the 
free use of greens and other foodstuffs rich in iron. 
HEMOPHILIA 
The diet should aim to enrich the blood in lime. A milk reg- 
imen is especially indicated. Three or four quarts of milk a day, 
half a pound of spinach, and an ounce and a half of bran may 
with benefit constitute the regimen for one to three weeks. The 
most efficient remedy is a transfusion of blood, the effect of which 
is immediate but, unfortunately, not permanent. 
DIET IN SCURVY 
Scurvy has been long recognized, and an efficient mode of 
treatment has been known, but only recently has the disease 
come to be well understood. It is now known that natural foods 
contain a subtle element, the antiscorbutic vitamin (p. 186), the 
absence of which leads to the terrible consequences sometimes 
seen in persons deprived of foods containing this vitamin in 
sufficient amount. This vitamin is, of all the vitamins, the most 
easily destroyed. Ordinary cooking destroys it, as does also dry- 
ing and other means of preservation. It has recently been shown 
that quick drying and drying m the absence of air, prevents the 
destruction of the antiscorbutic vitamin by preventing oxidation. 
Observations by Plimmer (Biochemical Journal) have re- 
cently demonstrated that pigs are much subject to scurvy, which 
is shown by stoppage of growth, lack of appetite, swollen joints 
and other symptoms observed in scorbutic animals. This disease 
is the result of using cooked food, which in the winter time is 
the common food of pigs. Cooking destroys the antiscorbutic 
vitamin. This disease is sometimes called “pigs gout, rickets, or 
rheumatism.” 
Thousands of human beings are unwittingly suffering to a DIET IN DISORDERS OF NUTRITION 
825 
greater or less extent in a similar way as the result of the too 
exclusive use of cooked foods. 
Preserved foods cannot be made an exclusive diet without 
the development of scurvy. The body stores up vitamins in the 
liver and other tissues, sometimes more and sometimes less. The 
length of time one can live on a diet lacking the scurvy-prevent- 
ing vitamins without contracting the disease will depend upon 
how much of this particular vitamin he happens to have in store. 
A few weeks at the most will ex'* mst the reserve, and then the 
disease makes its appearance and nothing but a new supply will 
cause the distressing symptoms to disappear. 
Umber, of Berlin, recently reported to the Berlin Medical So- 
ciety several cases of scurvy, some of which had developed in a 
hospital as a result of feeding on long cooked porridge, the regu- 
lation hospital diet. Among the symptoms noted in these patients 
was the so-called jumping-jack sign, which consists in the jerking 
upward of the shoulder and arm when the calf of the leg is 
suddenly pressed upon. 
The scurvy was speedily cured by the use of fresh vegetables 
or fresh fruits, or by a cup of pine needle tea given three times 
a day. 
Fresh foods are the only emedy for scurvy. The fresh 
juices of oranges and lemons ai , particularly rich in the antiscor- 
butic vitamin. The lime has little value, as has been shown by 
the failure of lime juice to prevent the disease. The juice of 
tomatoes, even of canned tomatoes, is perhaps as good as orange 
juice. Several ounces a day of these juices or their equivalent 
are required to prevent or cure scurvy. 
Turnip juice, cabbage, lettuce, all green and uncooked vege- 
tables, are of proven value. The potato is strongly antiscorbutic, 
even when cooked, as well as the tomato. 
Skimmed milk (unboiled), whey, cottage cheese and butter- 
milk, are good antiscorbutics. Pasteurized milk is better than 
boiled milk but is inferior to fresh, raw milk. Almost any sort of 
green stuff will serve in emergency, as alfalfa or clover leaves or 
even grass. The fact that gardens were little cultivated in the 
Middle Ages and green vegetables on this account little used 
doubtless explains in large part at least the great prevalence of 
scurvy during that period. 
The idea that meat is essential as a preventive of scurvy 
is an error. In the famous siege of Kut-el-amara in Mesopo- 826 
THE NEW DIETETICS 
tamia, during the World War, scurvy was very prevalent among 
the British soldiers, whose rations consisted of white bread or 
biscuit and tinned meats, but long unknown among the Indian 
soldiers, who ate no meat but added to their wheat bread a le- 
gume known as dhal. The East Indians finally succumbed to 
scurvy through starvation, but were cured by three ounces daily, 
per man, of green herbs collected from the plains. The use of 
yeast extract was found of great value in preventing and curing 
beri-beri {Brit. Med. Jour.). 
Recent studies of the antiscorbutic properties of various 
foodstuffs have shown that cows’ milk, even when fresh and 
neither pasteurized nor sterilized, possesses rather feeble anti- 
scorbutic properties, notably less than mothers’ milk. This is 
probably due to the fact that the calf, being born with teeth, when 
a few days old begins nibbling at tender green shoots of grass 
and herbs and thus begins to supply itself with the important 
antiscorbutic vitamin which is found in all green leaves as well as 
in the juices of most acid fruits and fresh vegetables. 
Another fact of recent discovery is that the antiscorbutic 
properties of cows’ milk vary greatly with the food of the cow. 
In winter when the cows are fed chiefly upon hay, oil cake and 
other dry foodstuffs the antiscorbutic properties of the milk are 
very greatly diminished, and bottle-fed infants using the milk of 
such cows are likely to develop scurvy even though perfectly 
fresh, certified milk may be used. Orange juice or tomato juice 
is just as necessary in such cases as when sterilized milk is em- 
ployed. When .cows are fed on swede turnips the milk is richer in 
the antiscorbutic vitamin, which is found in abundance in swede 
turnips although not in the rutabaga. Silage is lacking in the 
antiscorbutic vitamin, which is destroyed by fermentation. As a 
means of safety, all infants fed on cow’s milk should be given an 
ounce or two of orange or tomato juice, daily, so long as cow’s 
milk or milk and cereals remain their chief diet. 
Scurvy in partially developed forms generally known as mal- 
nutrition is one of the most common of diseases. Thousands of 
puny, weazened and short-lived infants and perhaps millions of 
ailing and inefficient adults are victims of this nutritional dis- 
order, to correct which is one of the great and worth-while tasks 
set before the rising generations of dietitians. 
Greens and salads are of great use in the prevention of 
scurvy as well as other deficiency diseases. The following culti- DIET IN DISORDERS OF NUTRITION 
827 
vated plants make good greens : radish tops, turnip tops, beet tops, 
Swiss chard, kale, Chinese cabbage leaves, upland cress, French 
endive, cabbage sprouts, asparagus, New Zealand spinach, dan- 
delion, native mustard and horse radish leaves, Russian mustard, 
collards, rape, tender tips of alfalfa, lettuce. In addition to the 
above cultivated greens the following uncultivated ones are good 
to eat and some of them are superior to most of the cultivated 
varieties of greens; wild dandelion, wild lettuce, sour dock, lamb’s 
quarter or pig weed, wild mustard, pepper cress, smartweed 
sprouts, purslane, marsh marigold, tender sprouts and young 
leaves of milkweed, young thistles. 
It was shown by Furst that the antiscorbutic, or scurvy- 
preventing vitamin, is produced in the germination of plants. 
Fortunately, this vitamin is not destroyed by heating to a tem- 
perature of 158’ F., which is necessary to gelatinize starch. For 
this reason non-alcoholic malt extracts are useful in the scurvy 
of infants. Sprouted grain or soy beans may be used as salads. 
PURPURA 
The diet should be the same as in pernicious anemia, with 
special attention to antiscorbutic foods. 
A pint to a pint and a half of orange juice daily, one or 
two pounds of fresh tomatoes, the juice of half a dozen turnips, 
potato soup, sprouted barley or sprouted soy beans with lettuce 
and other salads are especially helpful food remedies. 
SEPTICEMIA 
The patient should take an abundant supply of water, at 
least three to four quarts daily. Malt sugar or raisin water should 
be freely used. A good plan is to add to each pint of water 
administered two ounces of malt sugar or the juice of four ounces 
of raisins. A glassful of water should be given at intervals of 
every half hour during the day. If the patient cannot take the 
full amount of water by the stomach, it should be given per rec- 
tum in such a manner as to secure absorption. 
Purees of greens should be used liberally to maintain the 
blood in a condition to combat the invading germs. Meats of all 
sorts should be discarded. The fever diet should be carefully fol- 
lowed until convalescence, after which the antitoxic and laxative 
diet will be indicated. 828 
THE NEW DIETETICS 
OSTEOMALACIA 
This disease requires a reconstructive regimen. Milk, whey, 
buttermilk, greens of all sorts and other foodstuffs rich in lime 
are especially indicated. Feeding alone will not effect a cure in 
this disease but it will help to make good the deficiency resulting 
from the extraordinary loss of minerals which usually continues 
in spite of all measures of treatment. The administration of 
adrenalin seems to have a favorable influence upon the course of 
the disease and castration has been suggested as a remedy. As 
the stools are usually putrid, change of the intestinal flora by the 
use of lactose or lacto-dextrin is important. Care should be taken 
that the carbohydrate feeding does not lessen the intake of food- 
stuffs rich in lime. 
ANOREXIA 
The absence of appetite is one of the most constant effects 
of profound toxemia. When the intestine is loaded with putre- 
fying material, the products of putrefaction are absorbed into 
the blood in great quantities and produce profound disturbance 
of all the nutritive functions. The thirst center as well as the 
hunger center is often depressed to such an extent by the bac- 
terial toxins circulating in the blood that the appetite for water 
as well as for solid food is almost wholly lacking. The tongue is 
coated, there is a bad taste in the mouth, and the very thought 
of food is often nauseating. There is complete perversion of the 
gustatory sense in certain cases, and lack of appetite even when 
the tongue is clean; but in these cases, also, stasis in either the 
large or small intestine is rarely absent. 
McCarrison has shown that lack of vitamins may be a cause 
of loss of appetite and that appetite may be greatly stimulated by 
the free use of vitamin B. 
In the majority of cases, the X-ray will show incompetency 
of the ileocecal valve, as the result of which there is a reflux of 
putrid material into the small intestine and absorption of toxins 
into the general circulation. 
The first thing to be done, of course, is to remove the cause 
by changing the intestinal flora. In the meantime, even though 
the patient may be weak and emaciated and greatly in need of 
food, it would be useless and even highly detrimental to urge the 
taking of rich or hearty foodstuffs. Even milk often aggravates DIET IN DISORDERS OF NUTRITION 
829 
the situation rather than relieving it. Foods rich in protein or 
fats are least suitable, and are often most objectionable to the 
patient. Fruits and fruit juices (especially orange juice) with 
liberal amounts of malt sugar or gruels mixed with fruit juices, 
with lettuce and other fresh, raw vegetables are especially useful. 
Fruit jellies prepared with vegetable gelatin are usually very ac- 
ceptable to the patient. These foods should be given in liberal 
amounts and at intervals of two or three hours. The fruit regimen 
may be employed for two or three days with great advantage 
(Index). A large enema (three or four pints) should be-admin- 
istered twice a day, care being taken to empty the colon completely. 
To accomplish this the juice of one or two lemons should be added 
to the enema or in place one or two drams of citric or lactic acid. 
Liberal amounts of bran should be given if possible. It may be 
added to the vegetable jellies. Paraffin oil in some form also is 
needed in liberal amounts. 
In the majority of cases, the patient will by the second or 
third day under this dietetic regimen acquire a natural appetite. 
Not infrequently the appetite becomes so keen that the simplest 
food is taken with zest. If the patient is much emaciated, it is 
well to administer in the intervals between meals eight to ten 
ounces of milk sugar daily. The sugar should be taken dissolved 
in water or fruit juice. Three ounces of milk sugar or lacto-dex- 
trin three times a day with the fruit regimen is the most effective 
means of changing the intestinal flora. 
When the tongue clears off readily after two to four days 
of the fruit regimen the patient, if very thin in flesh, should be 
put upon the milk regimen for two to four weeks (see index). 
In the application of the milk regimen and the fruit regimen, 
the greatest care must be exercised to observe every detail indi- 
cated elsewhere (see index). 
In cases in which the appetite still remains deficient and 
fickle after the application of the above measures, the patient 
must be encouraged to eat liberal quantities of food, even though 
appetite is lacking. This may best be accomplished by admin- 
istering the food in very simple, rather concentrated form, in 
small quantities at frequent intervals. Fats and proteins should 
be eaten sparingly, the diet consisting at first chiefly of carbo- 
hydrates. 
Carbohydrates, especially in the form of fruit juices, with or 
without the addition of malt sugar, are readily taken when foods 830 
THE NEW DIETETICS 
rich in fats and proteins are not relished. It is highly necessary 
that the protein constituent of the food should be reduced to a 
minimum. By so doing, the production of toxins in the intestine 
is lessened and the liver and other excretory organs are relieved 
of the task of eliminating unnecessary and unusable protein. 
Fats should be taken in the form of emulsion as cream or 
butter or cream mixed with an equal or greater amount of Malt 
Honey. This combination is very readily accepted by stomachs 
unable to take fat in any other form and is highly palatable. 
By reference to the table of food values, it will be noticed 
that many fruits have a caloric value considerable in amount; 
and by the addition of malt sugar, with or without cream, the 
caloric value can be greatly increased, more than doubled in most 
cases. 
The application of an ice bag over the stomach for half an 
hour before eating will often induce an appetite. Continuous 
living out-of-doors day and night, a cold bath morning and night, 
and a moist abdominal bandage, are other measures which greatly 
encourage appetite. Care must be taken to keep the colon empty 
by employing the enema twice a day if necessary, and by the free 
use of laxative foods and other laxative means, and the intestinal 
flora must be changed and a good flora maintained. Diet in Joint Diseases 
CHRONIC RHEUMATISM 
Within the last few years, since it has become known that 
infections of the teeth and tonsils are often associated with 
chronic inflammation of the joints, so-called chronic rheumatism, 
it has become a fashion to attribute all cases of this disease to 
mouth infections. This is an error. There are many rheumatics 
who still sufifer from painful joints after having not only their 
tonsils but all their teeth removed. It is becoming more and 
more evident that in a considerable proportion of cases the real 
seat of the disease is in the colon. Infections of the colon such as 
are always present in colitis, at least in incipient form, when- 
ever the stools are putrid or foul-smelling, may be found to be 
the chief source of chronic rheumatic afifections of various forms. 
In the treatment of this disease, the colon should always 
receive attention, even when the teeth and tonsils are found dis- 
eased. The diet should be so regulated that the stools lose their 
foul odor and the bowels move three or four times daily. It is 
generally necessary to empty the colon by means of the enema 
at least once a day, even when using agar or bran, paraffin oil, 
fresh fruits and vegetables and various other dietetic means by 
which peristalsis may be encouraged. 
It is clear that the indications in rheumatism are for a strictly 
antitoxic diet and the free use of laxative foods after the intestinal 
flora has been changed by the use of lactose or lacto-dextrin. 
The popular notion that acid fruits should be avoided in 
rheumatism is wholly an error, for the reason that fruit acids are 
oxidizable in the body like sugar and behave like carbohydrates, 
not as mineral acids. In all foods in which they occur they are 
found in combination with the organic bases, soda and potash. 
When eaten the acids are burned or oxidized, setting free the 
bases, so while the acid has a sour flavor and produces acid effects 
in the mouth and stomach, when absorbed into the blood the acid 
disappears, leaving behind the soda and potash which serve a 
useful purpose in rheumatism by neutralizing the acid products 
of tissue wastes which have a tendency to accumulate in this 
831 832 
THE NEW DIETETICS 
disease. Melons, and especially the muskmelon, are especially 
valuable in rheumatism because they tend strongly to alkalinize 
the blood and tissue fluids. The cataloup is in this respect more 
efficient than any other fruit. Potato soup or puree should appear 
often on the bill of fare of the rheumatic patient on account of 
its rich store of bases which alkalinize the tissue fluids, and pota- 
toes and root vegetables should largely take the place of bread 
and cereals. 
Pemberton has shown that a temporary reduction in the food 
intake produces brilliant results in the treatment of this disease. 
The food should be reduced to the base ration, or about two-thirds 
the usual amount of food eaten. In some cases a still further 
reduction is necessary. Pemberton has also shown that in this 
disease there is a marked increase of creatinin, which is a clear 
indication for the elimination of meats of all sorts. It is, of 
course, to be understood that these dietary restrictions are not to 
be relied upon as the only therapeutic measure but are to be used 
in connection with hydrotherapy, especially local applications and 
sweating baths, sun baths, the arc light, hot applications to the 
afifected joints and other rational measures. 
Recently cases of chronic rheumatism have been reported in 
which the disease had resisted treatment by the most approved 
methods without benefit and which were either cured or greatly 
relieved by injections of milk. The milk is sterilized by boiling. 
The amount used is from a gram to a gram and a half the first 
dose. The dose is increased from one-fourth to one-third at each 
successive treatment. The treatment is repeated once in three to 
seven days. A reaction consisting of chill, fever, headache, nausea 
and vomiting is present in about half the cases. The more severe 
the reaction the better the results are said to be. 
OSTEOARTHRITIS—RHEUMATOID ARTHRITIS 
Dr. Helen Baldwin, who made in Herter’s laboratory in 1904 
a study of 21 cases of rheumatoid arthritis, found excessive intes- 
tinal putrefaction constantly present in cases in which the disease 
was active. There were also found in the urine abnormal organic 
acids which had evidently escaped oxidation in the body. 
This disease is without doubt, in many cases, the result of 
intestinal toxemia and other forms of autointoxication. On this 
account, the diet should be strictly antitoxic. The bowels should 
be made to move very freely and in bad cases should be completely DIET IN JOINT DISEASES 
833 
emptied by enema once a day. Changing the intestinal flora by 
means of the fruit regimen and by the introduction of the B. 
acidophilus into the colon, as well as taking the culture by mouth 
are measures which have shown themselves to be of value in 
dealing with many cases of this disease. 
ACUTE POLYARTHRITIS 
This disease is now generally thought to be due to focal in- 
fection. The source of infection may be diseased tonsils, the 
teeth, an infected appendix or gallbladder, a chronic infection 
of the cervix uteri, gonorrheal infection, or an infection of the 
colon (colitis). The last named is probably the most common 
source of infections of this sort. 
The modern treatment of this condition consists of rest in 
bed, the application of plaster casts to secure complete rest of 
the joints, fomentations and heating compresses to the joints. 
After the most acute stage has passed, the application of the arc 
light, the hot and cold pour to the joints, and the general electric 
light bath are highly useful. 
Most important of all is regulation of the diet, which in gen- 
eral should be like that of other febrile conditions (see Fever). 
The flora should be changed by the fruit regimen combined with 
lactose or dextrin feeding, three ounces three times a day for a 
week or two, until the stools show B. acidophilus dominant. 
Greens, fresh fruit, and fresh vegetables should be freely used to 
supply lime, iron and vitamins. Cereals should be used spar- 
ingly. Potatoes should largely replace bread. The bowels should 
be emptied at night by enema, even though there may be one or 
two natural movements. 
Diet in Acute Rheumatism. 
Acute rheumatism has in recent years been proved to be due 
to bacterial infection. In general, it may be regarded as a strep- 
tococcic infection with which the serous membranes are partic- 
ularly affected. A peculiar characteristic of this disease which 
must receive special consideration in the arrangement of the die- 
tary is the highly acid state of the excretions due to the produc- 
tion of an extraordinary amount of acids which are eliminated by 
the kidneys and the skin. During the first stage of this disease in 
addition to giving water in liberal quantities, fruit juices and thin 834 
THE NEW DIETETICS 
gruels should be very freely used. Potato soup made with very 
little seasoning, flavored with yeast extract, is very acceptable. 
Potato and other vegetable purees should be used largely in pref- 
erence to cereals because of their large content of alkaline salts 
which are useful in neutralizing the excess of acids present. 
Purees of fruits and vegetables with a moderate amount of cream 
may be given in large amounts as the fever diminishes. 
Care must be taken to keep the colon free from putrefying 
residues. An enema should be given twice daily and when the 
temperature is high more frequent enemas are useful. Irritation 
of the rectum may be avoided by taking care to lubricate the 
enema tube with carbolated vaseline. Lactose or lacto-dextrin 
should be used in quantities of 4 to 8 ounces daily as a concen- 
trated form of carbohydrate which furnishes a liberal supply of 
calories while at the same time promoting the development of a 
normal flora. 
DIET IN SO-CALLED URIC ACID DISORDERS 
The modern refined methods of chemical examination of 
the blood has led to the discovery of the fact that uric acid is not 
infrequently present in the blood in excessive amount. It has 
also been established that this excess is one of the earliest indica- 
tions of renal failure. This fact is now recognized as of great 
diagnostic value. It is equally important as a dietetic indication. 
When the kidneys are no longer able to keep the blood normally 
free of uric acid, the fact shows that the process of renal degen- 
eracy has reached a pretty advanced stage. The margin of safety 
which Nature provides for emergencies and to draw upon in 
advancing age has been used up. The kidneys are old, in other 
words, and Father Time is preparing to execute judgment. 
In the condition commonly known as gout there seems to 
be in addition to an increased production or diminished elimina- 
tion of uric acid, or a combination of these two factors, another 
element which leads to the deposit of uric acid at certain points. 
It was observed by Ebstein that the deposits of uric acid were 
always preceded by a destructive process which prepared the way 
by changes in the circulation. Other authors regard the deposit 
of uric acid to be the result of obscure nervous disturbances. 
Guelpa, of Paris, has recently insisted that the acute attacks to 
which gouty patients are subject are a remedial effort set up by the DIET IN JOINT DISEASES 
835 
body for the purpose of eliminating the poison. Haig many years 
ago put forward the same idea. It must be admitted that the real 
cause of the characteristic features of gout aside from the accu- 
mulation of uric acid are at present only imperfectly understood. 
There may be a marked retention of uric acid even when the 
non-protein nitrogen is not in excess. 
While it is more than probable that many disorders for 
which uric acid is not responsible have been erroneously charged 
to its account, it nevertheless cannot be denied that uric acid is a 
highly toxic excretory product and that it is certainly associated 
with gout. Since it is now known that the human liver is not 
able to convert uric acid into urea or some allied non-toxic sub- 
stance, it is clearly evident that one who wishes to live long and 
preserve his liver and kidneys intact to a good old age must 
eliminate uric acid from his dietary as fully as possible. There 
is no doubt of the truth of the statement by Tibbies that “The 
persistent consumption of foods containing a large percentage of 
purin bodies is apt [certain] to lead to their accumulation in the 
organism.” 
Gout, 
Much less importance is in recent years attached to uric 
acid as a cause of specific disease than in former times. However, 
it is perfectly well known that the output of uric acid in the 
urine is diminished in gout, while uric acid is found in the blood 
in increased amount. The association of uric acid with gout is 
unquestionable; hence it is clear that foods rich in uric acid 
should be avoided in this disease. This requires exclusion of 
meats of all kinds and animal extracts and broths of every de- 
scription. Foods rich in oxalates or oxalate of lime should like- 
wise be forbidden. Cereals should also be restricted because they 
leave behind in the tissues a preponderance of acids which lessen 
the alkalinity of the blood and tissue fluids and so diminish the 
solubility of uric acid and encourage its accumulation in the tis- 
sues. The free use of potatoes and other root vegetables is 
indicated because of the fact, demonstrated by Hindhede, that 
the rich store of sodium and potash salts found in these vege- 
tables increases the solubility of uric acid and helps to remove 
it from the body. With an ordinary mixed diet, including meat, 
the urine was found to be completely saturated with uric acid 
and would not take up even a small additional quantity, whereas 836 
THE NEW DIETETICS 
when potatoes were freely used the urine was able to dissolve 
considerable additional quantities of uric acid. 
It is generally recognized that gout is little known among 
people who live chiefly on vegetable foodstuffs. It is essentially 
a meat-eater’s disease. For this reason gout, while common among 
city dwellers in England is little known among the Scotch and is 
also uncommon among the people of southern Europe. Gout is 
unquestionably one of the consequences of chronic intestinal tox- 
emia. The kidneys become worn out by the demand made upon 
them for the elimination of toxins, and the result is accumulation 
of uric acid in the blood and tissues. The toxins produced by the 
putrefaction of meat residues in the colon excite cell activity, 
especially in the endocrine glands and so increase the production 
of uric acid. One of the first things to be done in this disease is 
the suppression of colonic putrefaction by the exclusion of meats 
(fish, flesh, fowl) and change of the intestinal flora (Index). It 
is the writer’s belief that the putrefaction of meat residues is a 
much larger factor in the production of gout than the uric acid 
found in meats. 
To avoid uric acid, it is practically necessary to do nothing 
more than to exclude meats from the dietary, for the amount of 
uric acid found in beans and other vegetable foods is too small to 
be of any significance. For example, beans contain 4 grains of 
uric acid to the pound. A pound of baked beans containing one 
grain of uric acid is practically equivalent in food value to a full 
pound of meat containing 14 grains of uric acid in the case of 
beefsteak, or 70 grains in the case of sweetbreads. 
Meat extracts, bouillon and animal broths of all sorts must 
be rigorously excluded from the dietary. We are glad to find in 
a recent work on dietetics* the following lucid statement, which 
is thoroughly in accord with the known facts of physiologic chem- 
istry : 
Soups made with meat stock may be labeled “poison” for gouty people, 
containing as they do such a high percentage of extractives, almost a solu- 
tion of purines. In fact these patients might much better eat meat 
from which the soup is made than the soup itself and a safe rule for them 
is to forget that such a thing as a clear or meat soup exists. 
If meat soups and broths are “poisons” for the gouty, as they 
are justly called by the authority quoted, they are “near” poisons 
‘Nutrition and Clinical Dietetics by Carter, Howe and Mason; Lea & Febiger. DIET IN JOINT DISEASES 
837 
for everybody, since the human organism cannot destroy uric 
acid, and the first symptom of renal disease is increase of uric 
acid in the blood through failure of the kidneys to eliminate it. 
If meats, meat extracts, broths and soups prepared from meat 
stock are excluded from the dietary, little further restriction is 
required for the reason that the so-called purin bodies are found 
in vegetable foods in such minute quantities that they are not 
likely to do harm. Tea and coffee must of course be strictly 
avoided. The use of salt should be reduced to a minimum. 
Achard and others have shown in recent years that the food nor- 
mally contains a sufficient amount of sodium chlorid, so that salt 
is needed to satisfy only a cultivated taste. It may be dispensed 
with entirely without harm. By gradually reducing the amount 
of salt in the food it may finally be omitted entirely and will be 
scarcely missed. 
An excellent soup stock may be prepared from vegetables. 
Fruit juices, greens and milk with a great variety of green vege- 
tables, of which our markets now have a supply at all seasons of 
the year, leave no excuse for the use of meat or meat flavors to 
satisfy a reasonable appetite. 
It is highly necessary in cases in which uric acid elimina- 
tion is deficient to combat intestinal toxemia by a laxative and 
antitoxic diet and by changing the intestinal flora (Index). The 
ability of the kidneys to eliminate other poisons as well as uric 
acid is lowered. These essential organs are seriously crippled, 
and their task must be made as easy as possible. (See Bright’s 
disease.) 
All foods which lessen the alkalinity of the fluids will cer- 
tainly increase the predisposition to gout. Hence, besides elimi- 
nating meats and to a large extent eggs from the diet, care must 
be taken to give special prominence in the bill of fare to such 
foods as potatoes, turnips, beets, cabbage, cauliflower, spinach, 
greens of all kinds, Brussels sprouts and other fresh vegetables. 
The influence of diet upon the nervous system must also be 
considered in this disease, as illustrated by the case of the famous 
surgeon, John Hunter, of whom it is related that “when not yet 
fifty years of age he suffered an attack of gout, accompanied with 
cardiac symptoms. At fifty-five he had an attack of angina and 
was never quite well afterward. . . The attacks were easily 
induced by anger, and he used to say that his life was at the 
mercy of any knave who should chance to worry him.” The 838 
THE NEW DIETETICS 
irritating effects of a flesh diet are well known, as shown in the 
influence of meat feeding upon dogs and other animals. 
A fruit diet aids in the elimination of uric acid by increas- 
ing the alkalinity of the blood and thus its solubility. This state- 
ment does not rest on purely theoretical grounds but may be 
demonstrated by anyone who will take the trouble to make the 
simple experiment of placing himself for a few days upon a fruit 
diet and making careful comparative examinations of the urine. 
Some years ago the writer made a study of the effects of 
fruit upon the elimination of uric acid in a number of medical 
students who were placed upon a diet consisting almost exclu- 
sively of fruit, the only addition being a small amount of dry 
toast. The urea was, of course, diminished as the nitrogen intake 
was greatly reduced, but the output of uric acid was very con- 
siderably increased, on the average doubled and in some cases 
more than doubled. A variety of fruits was given, chiefly grapes, 
bananas, apples, oranges and peaches. The source of the increased 
output of uric acid was doubtless the quantity of this waste ele- 
ment which had been stored up in the tissues. By the increased 
alkalinity of the blood, its ability to dissolve the uric acid from 
the tissues and transport it to the kidneys was increased and thus 
the output was increased. In a later experiment, in which the 
fruit diet was continued for more than a week, it was observed 
that the increased output of uric acid continued only for a few 
days. After the first three or four days, the acidity of the urine 
decreased rapidly, and at the end of the week the urine was 
nearly neutral. 
In every case of gout the condition of the colon must receive 
careful attention. The bowels should be made to move thor- 
oughly three times every day by means of a laxative diet and 
necessary accessory measures. An enema at bedtime for a few 
weeks to make certain that the colon is completely evacuated will 
be found of great service. The flora should be changed by the 
use of lactose or lacto-dextrin or large doses of whey cultures of 
B. acidophilus. If at any time the stools show a putrid character 
greater diligence to keep the colon free of putrefying residues 
should be exercised. It is not only necessary to change the intesti- 
nal flora but to keep it changed. Diet in Disease of the 
Heart and Blood 
V essels 
In these disorders degenerative changes take place in the 
heart and blood vessels in various parts of the body. Sometimes 
there is a progressive rise in the blood pressure as the disease 
advances. In many, perhaps the majority of cases, the blooci 
pressure is only slightly or not at all raised. 
As regards the cause of the disease, Huchard says arterio- 
sclerosis “begins by intoxication, continues by intoxication and 
ends by intoxication.” This intoxication may have various 
sources, but in the opinion of Huchard and other equally emi- 
nent authorities, the most common origin is the intestine through 
the putrefaction of undigested remnants of food proteins, espe- 
cially flesh meats, and the absorption of the putrefaction products 
in quantities greater than the liver is able to destroy or the kid- 
neys to eliminate. 
Another remark by Huchard is well worth quoting: “The 
origin of the disease is alimentary, the lesion vascular, but the 
danger is renal. As the disease advances, the kidneys become 
less and less efficient and the final catastrophe is in a large per- 
centage of cases due to renal failure.” 
Professor Huchard also held that the great frequency with 
which arteriosclerosis is encountered in modern times is the re- 
sult of the increase in flesh eating which in recent years has been 
very marked in all civilized countries. 
Boix, of Paris, produced arteriosclerosis by feeding rabbits 
extracts of feces and cultures of colon bacteria. 
Dr. Herbert Fox, director of the laboratory of Comparative 
Pathology, Philadelphia Zoological Garden, has shown that ar- 
teriosclerosis occurs in certain wild animals when subjected to the 
conditions of captivity. 
Among the interesting observations made by Dr. Fox is the 
fact that the glands of internal secretion, the pituitary, adrenal 
839 840 
THE NEW DIETETICS 
and thyroid glands, are larger in cats, dogs and eagles—flesh- 
eating animals—than in lemurs, rodents and rabbits—animals 
which live on fruits, nuts and tender shoots. 
Dr. Fox also observed that arteriosclerosis is found most 
definitely developed in animals living upon a meat diet and hence 
subject to autointoxication. 
On the whole, arteriosclerosis is found much less frequently 
in lower animals than in human beings, doubtless for the reason 
that in general animals live more physiologically than do human 
beings. 
An interesting contrast was found between horses and dogs 
in the fact that it is doubtful whether arteriosclerosis ever occurs 
in horses, although they often attain very great age. On the 
other hand, in the case of dogs arteriosclerosis is comparatively 
frequent. A sufficient cause for this difference is found in the 
difference in diet. Horses are herbivorous, while dogs are car- 
nivorous. Meat-eating man exposes himself to the same causes 
of arteriosclerosis as those to which the meat-eating dog is sub- 
jected. This fact is so well known it has become the universal 
custom among practical physicians to exclude meats, meat ex- 
tracts and broths of all sorts from the diet of patients suffering 
from arteriosclerosis, as the most efficient means of checking the 
degeneration of the arteries to which the disease of the blood 
vessels is due. It is evident that the same dietetic restrictions 
which will arrest degeneration of the blood vessels when this pro- 
cess has begun must be an effective means of preventing this de- 
structive change, or at least of delaying its appearance. Dr. Har- 
vey, who examined the body of Old Parr, who was much more 
than a centenarian (reputed age at death 152 years), found no 
evidence of arteriosclerosis in his body. Parr’s diet consisted of 
potatoes, greens, coarse bread and buttermilk. He rarely ate meat. 
The observations of Dr. Fox have been strikingly confirmed 
by those of Newburgh, of Ann Arbor, whose experiments on 
rabbits have shown that rabbits very quickly develop arterioscler- 
osis when a moderate proportion of meat powder is added to the 
bread with which they are fed. To the objections brought in 
reference to the significance of his observations that rabbits are 
not accustomed to a meat diet and hence more likely to be affected 
injuriously by it, Dr. Newburgh very properly cited the observa- 
tions of Fox above referred to. 
These observations are highly important for they show that DISEASE OF HEART AND BLOOD-VESSELS 
841 
notwithstanding the fact that carnivorous animals are supplied 
with superior means of defense against the poisons of flesh 
meats, they still suffer from arteriosclerosis, which seldom occurs 
in non-flesh eating animals. 
If dogs and other carnivorous animals, which for an unknown 
period of time have been accustomed to a meat diet, have not 
become immune to its injurious effects, we need not be surprised 
to find no immunity existing in the case of human beings, who are 
admittedly less carnivorous in their habits than are dogs and 
lions and less well equipped for defense against the putrefactive 
poisons which naturally result from a meat diet. 
The first thing to be done in arranging the regimen of a 
person suffering from arteriosclerosis is to change the intestinal 
flora. The flora of this class of patients always needs changing. 
In a very large proportion of cases, Barger and Walpole 
demonstrated the production of pressure-raising poisons by 
putrefaction. According to Dixon, of King’s College, London, 
pressure-raising poisons are produced in the intestine, and Bain 
demonstrated the presence of these poisons in the blood and urine 
of persons having high blood pressure. Experiments have shown 
that a non-flesh diet reduces the amount of these poisons found in 
the urine. A biologic diet must be closely adhered to, not merely 
for a few weeks or months, but so long as the individual lives. 
Cornwall insists that in hypertension the diet should be kept 
low in protein, avoiding soups and meats, but still allows 60-65 
grams, or more than 2 ounces of protein—quite too much. Two- 
thirds this amount is ample. Cornwall also very properly insists 
that the diet should be antiputrefactive and laxative, but also 
requires that it should exclude fermentable carbohydrates. The 
last suggestion is surprising. In what way can the diet be made 
antiputrefactive except by the use of carbohydrate foods? And 
if carbohydrates are excluded (they are all fermentable) and the 
protein held low, the patient’s diet would consist chiefly of fats, 
which would be decidedly objectionable. 
The diet to be followed in arteriosclerosis is a strictly anti- 
toxic and laxative one. All foods containing uric acid in appre- 
ciable amount must be discarded. This naturally excludes meats 
of all sorts, fish, flesh, fowl and shellfish, together with meat 
extracts, broths, bouillons. Reference to the table showing the 
uric acid content of foodstuffs will show at once the necessity for 
the elimination of the articles named. 842 
THE NEW DIETETICS 
Tea and coffee must be discarded for the same reason. A 
cup of coffee contains more than double the amount of purin (uric 
acid) found in normal urine. Uric acid is chemically a xanthin 
compound. Caffein is also a xanthin compound, tri-methylxan- 
thin. Mendel and Warded have shown that an intake of caffein 
is followed by an increase of uric acid in the urine. 
Foods rich in oxalic acid, such as sorrel and rhubarb, must 
be discarded. 
Eggs must be used sparingly. The yolks are preferable to 
the whites. Raw eggs should not be eaten. 
Potatoes and other farinaceous roots should be largely used 
in place of cereals, breads and breakfast foods, because of the 
rich supply of organic bases which they afford and which neu- 
tralize the acids arising from tissue wastes always present in 
excessive quantity in persons subject to arteriosclerosis or high 
blood pressure. Fruits should be freely used and greens in suffi- 
cient amount to furnish an adequate supply of lime and iron. 
Bran, agar and paraffin oil should be used freely enough to 
secure three bowel movements daily and the enema should be 
used at night, in addition, two or three times a week, when a con- 
siderable amount of residue is found to be still present after the 
last bowel movement as ascertained by administering an enema. 
In every case of arteriosclerosis the carmine test (see Index), 
should be applied to determine how long the food residues remain 
in the colon. If more than 24 hours elapse before the red color 
disappears from the stools, further stimulation of intestinal ac- 
tivity is necessary and the amount of bran and paraffin oil should 
be increased. The daily use of the enema of moderate size (2 to 
4 pints) is in no way harmful, while drug laxatives of any sort 
are higl ly injurious when frequently resorted to. 
DIET IN HIGH BLOOD PRESSURE 
The diet in high blood pressure should be the same as that 
suggested for arteriosclerosis (see above). Tea, coffee, tobacco, 
condiments and flesh foods of all kinds must be discarded. The 
bowels must be made to move freely (three times a day), by the 
use of laxative foods, bran, agar and paraffin oil. Vigorous mea- 
sures for changing the intestinal flora should be adopted and 
continued or repeated until the stools cease to be putrid. In 
many cases the colon is so crippled that the fruit regimen for DISEASE OF HEART AND BLOOD-VESSELS 
843 
changing the flora (see Index), must be repeated every few weeks 
in order to maintain a normal flora; that is, to prevent the recur- 
rence of putrid stools. The adoption of an antitoxic and laxative 
regimen after changing of the flora in these cases generally results 
in a pronounced lowering of the blood pressure within a few days, 
at most within a month. In the case of young persons, or when 
the high pressure has existed only for a short time in older per- 
sons, the pressure can often be brought back nearly to normal. 
It is not an uncommon experience to see the pressure drop from 
200 to 150 or even lower within a few weeks, and by a careful 
regimen it may be kept down for years and useful life and 
activity may thus be prolonged. Dr. M. A. Mortensen, of the 
Battle Creek Sanitarium medical staff, recently reported the case 
of a patient, a man past middle age, whose blood pressure was re- 
duced from 260 to 160 and still remained at this point after seven 
years, with the disappearance of other symptoms of ill health. 
Equally good results have been obtained in hundreds of like cases. 
Dale showed that para-hydroxylphenyl-ethylamine,a poison found 
in decaying meat, acts like suprarenal extract, and raises the 
blood pressure at once from 110 to 260. Hence, the great im- 
portance of a low protein and fleshless diet in these cases. 
Reduction in weight is one of the most important means of 
reducing blood pressure. In over-fat persons the pressure often 
falls one point for each pound reduction of weight. 
DIET IN APOPLEXY 
The diet in apoplexy should be the same as that for arterio- 
sclerosis. Special care must be given to the regulation of the 
bowels, on which account a large amount of roughage, together 
with paraffin oil in liberal doses, may be needed because of the 
patient’s inactivity. For the same reason, the intake of food 
should be considerably diminished. If the patient is obese, the 
diet may be reduced to two-thirds of the standard dietary for 
the individual until there is an appreciable diminution in weight. 
The flora must be changed and the antitoxic and laxative diets 
must be closely adhered to. The stools should never be allowed to 
become hard or putrid. The bowels must be moved thoroughly 
three times daily. The enema should be used at night once or 
twice a week or more often, to insure complete emptying of tbe 
colon. It is well, once a month, to resort for a few days to the 
fruit regimen to keep the flora in good condition. 844 
THE NEW DIETETICS 
Overeating and late suppers should be especially avoided. In 
many cases of apoplexy the history shows that the attack has fol- 
lowed a large meal. Persons with high blood pressure, especially 
when the cerebral blood vessels are known to be involved to a 
marked degree, should be carefully cautioned against hearty eat- 
ing. The diet should be rather meager. The weight should be 
reduced to the average and if possible a few pounds below. Two 
meals a day are better than three in these cases for the reason 
that less food is likely to be taken in two meals than in three. If 
supper is eaten it should consist exclusively of fruits. Ice cream, 
pastry, rich desserts and other hearty foods should be strictly 
excluded from the last meal. Six o’clock dinners are perilous for 
the apoplectic. 
DIET IN ANEURISM 
The diet to be followed in aneurism is the same as that in 
arteriosclerosis and high blood pressure. Care should be taken 
to avoid overeating and drinking too freely, also to avoid con- 
stipation. The bowels must be kept very free, and the stools as 
nearly odorless as possible. The colon should be fully evacuated 
three times a day. An enema (2 or 3 pints, at 90 degrees F.), 
should he used at night to insure complete emptying of the colon 
when the bowels do not move freely. The flora must be changed 
and kept changed by applications of the fruit regimen as often 
as may he necessary for the purpose. 
DIET IN ANGINA PECTORIS 
The proper dietary is the same as that for arteriosclerosis 
and high blood pressure. Great care should be taken to avoid 
overdistention of the stomach and foods which are known to 
“disagree.” Hot drinks, ices, pickles, and indigestibles of all 
sorts must be carefully avoided. Flesh meats should be dis- 
carded wholly and eggs should be eaten sparingly. The diet indi- 
cated for arteriosclerosis (see Index) should he carefully fol- 
lowed. 
DIET IN MYOCARDITIS 
This disease is not an inflammation of the heart, as the name 
would naturally indicate, but a degeneration of the muscle fibers 
of the heart, which become more or less fibrous in character, thus 
lessening the efficiency of the heart as a muscular organ. The DISEASE OF HEART AND BLOOD-VESSELS 
845 
causes of this disease are essentially the same as those of the senile 
heart, but the disease often develops in persons who are not suf- 
ficiently advanced in years to justify a diagnosis of senile heart. 
The excessive use of tobacco is one of the most common causes 
of this early deterioration of the heart muscle; alcohol acts in a 
similar manner. Probably the most common of all causes is to 
be found in the numerous poisons of alimentary origin with which 
the blood stream is constantly contaminated in cases of chronic 
intestinal toxemia. Heavy meat eaters are very prone to suffer 
from this disease. Men suffer much more frequently than do 
women, the number of males affected being more than double the 
number of females. A probable cause for this is to be found in 
the fact that men are much more addicted to tobacco than are 
women and are much larger consumers of meat. 
In the dietetic management of myocarditis, the first attention 
must be given to changing the intestinal flora by the means which 
have already been pointed out (see Index). Great care must be 
taken to secure prompt discharge of food residues and body 
wastes. The bowels should be trained to move regularly three 
times a day, and if there is any ground for suspicion that the 
colon is not thoroughly emptied, an enema should be taken at 
bed-time so as to insure complete clearance of the colon. Free 
use should be made of fruits and root vegetables. Potatoes should 
be used largely in place of cereals. A potato diet increases the 
alkalinity of the blood and the tissue fluids and thus aids in the 
oxidation of body wastes, which have a tendency to accumulate 
in the blood stream in cases of this sort. Copious water-drinking 
should be encouraged. Of the highest importance is the complete 
change of the intestinal flora. The gram stain count should be 
brought to 120 and maintained at this point. By this means, the 
intake of colon toxins will be reduced to a minimum. The con- 
stipation with putrid stools, commonly encountered in cases of 
this sort, have undoubtedly a causative relation to the degenera- 
tive changes- in the heart muscle, and hence great care must be 
taken to see that the stools are kept free from odor and that the 
bowels are made to move freely. An enema should be taken at 
bed-time if necessary. The daily use of lacto-dextrin, paraffin 
oil and agar or bran are important means which should be com- 
bined with a strict antitoxic diet. 
In ordinary mild cases of cardiac disease, an antitoxic and 
laxative dietary is indicated. If the patient is anemic or ema- 846 
THE NEW DIETETICS 
dated, a reconstructive diet is indicated (see Index). In 
cases of obesity with myocarditis, or other grave heart lesion, 
very careful dieting is of greatest importance. Vigorous exercise 
must be avoided in these cases because of the cardiac weakness; 
hence, the reduction of weight must be accomplished by restric- 
tion of the diet. A low protein regimen, such as is afforded by 
the antitoxic diet (see Index), with a proper diminution of the 
amount of food eaten, is usually sufficient. Meats are, of course, 
contraindicated for the reason that they encourage the degenera- 
tive process, which is the essential factor in the case. Fats must 
also be restricted and need not constitute more than 10 per cent, 
(calories) of the dietary. The protein should not exceed one 
calorie per pound of body weight. The total ration may be re- 
duced from one-third to two-fifths the normal amount for an 
individual of a given height. The Karell method of milk feeding 
has been highly recommended in cases of this sort and has often 
been used with success. It is doubtful, however, if it has any 
specific virtue other than the reduction of the amount of food in- 
gested and the elimination of meats. 
In cases of marked heart weakness coupled with dropsy and 
inability of the kidneys to eliminate the normal amount of water, 
a saltless diet is essential, together with great restriction of the 
fluid intake. The amount of fluids taken should not exceed two 
or three pints for a few days. In some cases the amount may 
be still further reduced for one or two days (salt-free diet and 
dry diet, (see Index). But the low fluid intake must not be con- 
tinued too long. The fluid food should consist of malt sugar in 
water or fruit juices. A moderate intake of food secures better 
results than complete fasting for the reason that it promotes the 
elimination of the sodium chlorid, which is responsible for the 
accumulation ot water in the tissues. Care must be taken to 
keep the bowels open by means of the enema and the free use of 
bran or agar and paraffin oil. 
By the adoption of these measures and close adherence to a 
non-toxic diet, so great improvement may often be secured that 
the patient may be safely assured of a very considerable increase 
of his life expectancy. The writer has seen many cases in which 
the life expectancy was doubled and even tripled by close ad- 
herence to this regimen. DISEASE OF HEART AND BLOOD-VESSELS 
847 
DIET FOR THE SENILE HEART 
The heart grows old with the rest of the body. The parch- 
ment-like, senile skin, marked by brown spots, is an outward sign 
of the general senile changes which have taken place throughout 
the body. The heart muscle, cells and other tissues have deter- 
iorated because of the continuous contact of a blood stream con- 
taining poisons which the liver has failed to destroy or the kid- 
neys to eliminate. 
The most important thing to be done is to lessen the absorp- 
tion of poisons from the alimentary canal. Tea, coffee, and of 
course tobacco, must be excluded and the dietary must be made 
such as will not encourage the putrefaction in the colon and lower 
small intestine. In other words, meats, including fish and fowl, 
oysters, as well as red meats, must be wholly excluded from the 
dietary, together with cheese, with the exception of cream cheese 
and cottage cheese. 
The patient’s flora should be changed by the free use of lac- 
tose or lacto-dextrin or acidophilus buttermilk and by enemas of 
lactose or lacto-dextrin. In general, the dietary should be the 
same as that for arteriosclerosis. Diet in Nervous Disorders 
HEADACHE 
Most headaches are toxic. Many are no doubt the result of 
the breakdown of the liver defense. As the late Professor Lauder 
Brunton wisely remarked: “The liver is the porter which stands 
at the gate of the organism to prevent all deleterious substances 
which enter the blood vessels from the intestine from reaching 
the general circulation. These substances are caught up by the 
liver and destroyed, or excreted unchanged into the intestine, 
where they may pass away with other feces. But many of these 
substances may be re-absorbed, and so they form a constant round 
from bowel to liver and liver to bowel, until at last they amount 
to so- much that the liver cannot deal with them, and they pass 
into the general circulation. A period of time is required for 
this accumulation, which varies even in the same person, and oc- 
curs in less time with a highly nitrogenous diet. Absorption from 
the liver is influenced by the emotions, so that after emotion a 
person may become jaundiced; therefore we may expect anything 
which is circulating with the bile would be rapidly absorbed. 
Anxiety, grief or sorrow is apt to bring on a headache, and there 
are good reasons for attributing the headache to the presence of 
abnormal constituents circulating in the hlood. Why do the 
toxins fasten on the head and cause a headache instead of causing 
a pain in the intestines or big toe? It is because there is some 
factor, perhaps a local lesion, which determines the pain to the 
head. The most common determining causes are decayed teeth, 
astigmatism, myopia, hypermetropia, presbyopia, nasal or pharyn- 
geal trouble, disease of the antrum of Highmore, or of the frontal 
or ethmoidal sinuses, glaucoma, periostitis, or neuritis. 
There are now few authorities who question the toxic origin 
of migrain. Starr, one of the leading neurologists of this country, 
holds that migrain is due to an unidentified toxin and that herni- 
crania, a somewhat similar disorder, is due to the same cause. 
Other investigators attribute the disorder to uric acid and other 
toxic bodies derived from protein. 
Dr. F. Hare some years ago, and more recently Mercier, have 
848 DIET IN NERVOUS DISORDERS 
849 
called attention to the fact that an excess of fat in the diet is 
often the cause of headache. Headaches due to this cause are 
usually worse in the morning. Fats may easily become a cause 
of headache. When present in excess they increase intestinal 
putrefaction and autointoxication. 
With this explanation of the cause of headache, it is evident 
that the most promising outlook for relief is in the direction of 
dietetic control. 
Most persons subject to headache are found to present coated 
tongues and foul breath, an indication of saturation of the tissues 
with putrefaction products derived from the colon. 
The first step is to change the flora of the colon (Index). 
This must be done thoroughly. Often two or three attempts will 
be needed for complete success. After four to six days on the 
fruit regimen a more liberal diet may be allowed for three or 
four days, and then the fruit regimen should be resumed for 
another period of four to six days. As the tongue clears and 
the colon becomes more active, the headaches will grow less fre- 
quent and finally disappear. The writer has seen this occur in 
many hundreds of cases. 
In occasional cases, a crippled state of the colon will com- 
plicate the situation and delay success. The incompetent ileocecal 
valve, adherent pelvic colon, adherent appendix or cecum and 
spastic colon, are serious hindrances which must be reckoned with. 
A diseased gall bladder is another troublesome complication. 
Sometimes surgery is necessary. 
Removal of a few ounces of bile by means of the duodenal 
feeding tube two or three times a week is a measure which may be 
worth trying. Four to six ounces may be removed at each pas- 
sage of the tube until a total of a pint and a half or two pints 
have been removed. Lemon juice (one to three of water) or a 
solution of citric acid (two per cent.) may be used to excite 
contraction of the gall bladder instead of magnesia sulphate. Still 
better is the use of hydrochloric acid, the normal stimulant of 
the gall bladder and disinfectant of the stomach and the duode- 
num. ' i 
Many persons subject to headaches notice the beneficial 
effects of acid fruits, for which they often have a craving, per- 
haps due to the fact that the gall bladder and liver are made to 
discharge more freely while peristalsis is hastened, so that less is 
absorbed and thus some of the stock of stale bile is gotten rid of. 850 
THE NEW DIETETICS 
Many persons have experienced relief from headache after 
vomiting a quantity of very bitter, evidently highly concentrated 
bile. The relief experienced from purgation by salts or calomel 
is doubtless due to the same cause—the getting rid of a quantity 
of concentrated and highly poisonous bile. Bouchard showed 
that bile is six times as toxic as urine. 
After the flora is changed, the laxative and antitoxic diets 
must be consistently followed. 
Tea and coffee must be avoided. This is imperative. While a 
cup of tea or coffee is often resorted to as a means of relief from 
headache, the benefit is only apparent and is delusive. The cause 
is not removed, and the disorder is definitely aggravated. Not a 
few persons are so sensitized to coffee that very small amounts 
produce almost immediate ill effects. An eminent New York 
physician recently stated to the writer that a teaspoonful of 
coffee would in his case produce a severe headache in half an 
hour or less. Many thousands of persons have gotten rid of per- 
sistent headaches by discarding coffee and tea. The headache 
which coffee relieves temporarily is one of the results of the 
coffee habit and disappears when the drug is definitely discarded. 
Copious water drinking (3 to 4 pints daily) is highly import- 
ant to aid in elimination of toxins. 
MENTAL DISEASE 
We quote from a competent medical author as follows: 
“Intestinal toxemia is a common complication of mental 
diseases as seen at the Philadelphia Hospital, and occasionally it 
is the cause or complication of certain cases of epileptiform con- 
vulsions.” 
Modern studies of the causes of mental disease have made 
clear the fact that in not a small proportion of cases mental 
alienation is the result of intestinal toxins acting upon a peculiarly 
susceptible nervous system. Constipation and toxemia lead to 
insomnia and depression and in time the mental equilibrium is 
broken down. Change of flora and the laxative and antitoxic 
diets are potent means for loosing the shackles of mental disease; 
and it is hoped that at no distant day, tens of thousands of mental 
sufferers who are now immured behind asylum bars may be set 
free by the application of enlightened physiologic measures which 
at present the state fails to supply. DIET IN NERVOUS DISORDERS 
851 
In some cases insanity has been traced to the coffee habit. 
Williams, of Edinburgh, reports a case of mental disease in which 
a woman suffered from frequent attacks of angoissc. The attacks 
stopped entirely when she ceased taking three grains of caffein 
daily, which she had continued for several months. When it is 
recalled that a single cup of good coffee contains four grains of 
caffein, according to Dr. Wiley, it will not appear surprising that 
mental disturbance sometimes results from the long continued 
use of tea and coffee, or its use in immoderate quantities. 
Dementia praecox has been definitely shown to be, in cer- 
tain cases, at least, the result of chronic intestinal toxemia. Foul 
stools and constipation are always present. The writer has seen 
very marked improvement in numerous cases of this disease as 
the result of a change of flora followed by strict adherence to an 
antitoxic dietary, with hydrotherapy and other physiologic mea- 
sures. Better results have been obtained at the Battle Creek 
Sanitarium in the treatment of many cases of manic-depressive 
neurosis. The loss of appetite, insomnia, depression, and men- 
tal inefficiency are all directly traceable to the disordering influence 
of intestinal toxins, the suppression of which by changing the 
intestinal flora and accustoming the patient to an antitoxic and 
laxative diet of such character as to secure three or four bowel 
movements daily, has been attended by the happiest results. If 
these simple measures could be introduced into all our state hos- 
pitals for the insane, the result would be a notable and rapid les- 
sening of the insane population of the country and such a setting 
free of minds in bondage to disease as would remind the world 
of the days when miracles were wrought and demons cast out by 
the performance of mystic rites. 
In certain forms of paresis, intestinal toxemia plays an active 
part and hence the fruit regimen and other methods for changing 
the flora and the antitoxic and laxative diet are measures of essen- 
tial importance. Even in paresis due to syphilitic infection the 
added burden of intestinal toxins is a decided handicap to the 
curative efforts of the body forces and an obstacle to therapeutic 
success in the use of salvarsan and other specific remedies that 
may be readily and advantageously removed by the use of the 
proper dietetic measures. 
In cases in which food is refused, tube feeding, especially 
feeding by means of the nasal tube, becomes a most valuable and 
necessary means of keeping up and improving the patient’s nutri- 852 
THE NEW DIETETICS 
tion. The liquid foods prescribed for duodenal ulcer are appro- 
priate. Malt sugar and milk sugar are especially useful and should 
be freely used. Malt sugar is the most readily assimilable of 
foods and milk sugar or lacto-dextrin is a most valuable 
means of combating intestinal toxemia, as has been elsewhere) 
shown. Cultures of B. acidophilus should be freely used to 
aid in restoring the normal intestinal flora and suppress putre- 
factions. Acidophilus buttermilk is most useful. 
Water drinking should have especial attention. The per- 
version of the natural instincts frequently met in the insane leads 
often to the neglect by the patient to take water in anything like 
the proper amount. Often the sense of thirst appears to be lost. 
Water should be given systematically. A glassful every hour is not 
too much for the average patient suffering from mental aliena- 
tion. Fruit juices of any sort may be advantageously added. 
EPILEPSY 
The most important points in the feeding of epileptics are 
the elimination of meats, meat extracts and broths, and the dis- 
use of salt. 
The late Doctor Combe, of Switzerland, was one of the first 
to call attention to the injurious efifects of salt in epilepsy. He 
reported very remarkable results from the saltless regimen. 
Another French physician, Dr. Mirallie, has more recently 
made a study of this method and claims it to be highly valuable. 
This author insists that: 
Salt should be discarded absolutely, as also tea, coffee and alcohol. 
Then the doses of bromides can be materially reduced, and such im- 
provement may then be realized that it amounts to an actual cure. 
He gives a moderate dose of bromide every day, without interruption. 
When his patients go thus two or three years without a seizure, he 
reduces the dose of bromide, but emphasizes that absolute abstention 
from salt is the main thing. In his first series of 181 cases, only 83 
followed his instructions. At that time he ordered merely restriction 
of salt. In 12 cases the results were negative; in 18 there was im- 
provement and 53 had no further seizures. Since 1912, 52 of the 
later series of 133 cases followed instructions, and 31 have had no 
further seizures and 18 have been much improved; more or less benefit 
has been realized in all but 3 cases. Of 10 men in one institution, all 
were improved and 5 apparently cured, as also 9 of the 12 women, all 
showing marked improvement. The youngest of the clinically cured 
was 7, the oldest 63 years of age. The seizures in one case had been 
frequent from the age of 7 to 37, but there has been none since this DIET IN NERVOUS DISORDERS 
853 
treatment was instituted. The best results were realized in families in 
which the mother did the cooking, and she was able thus to keep all 
salt out of the bread, the butter, etc. When this was left to servants, 
the salt was not banished so rigorously. Full success was realized 
only in the cases with absolute abstention from salt, tea, coffee and 
alcohol. ***** The benefit was prompter and more pronounced 
in persons who had previously used much salt. The other symptoms 
of epilepsy were not modified so early as the actual seizures. The diet, 
except for salt and stimulants, can be varied and liberal, but must be 
served entirely without salt. The failures were always in wealthy 
homes. 
Epileptics nearly always have an inveterate tendency to over- 
eat. In many cases, they are also very fond of meats and have a 
craving for salt. All of these faults must be corrected. Meats 
must be discarded entirely. In cases in which convulsions occur 
frequently, the patient should be placed upon a strict saltless diet 
(see Index). Special attention should be given to changing the 
intestinal flora (see Index) and keeping the bowels freely open 
by the liberal use of bran, greens and paraffin oil. Washing the 
colon thoroughly with the enema daily should be practiced as a 
routine measure in cases in which other methods fail to eliminate 
the putrid character of the stools. The epileptic should be taught 
to chew well and to eat sparingly. The food should be simple 
and rather bland to avoid temptation to overeating. Vegetables 
like potatoes, turnips, carrots and beets, properly cooked, should 
largely take the place of breadstuffs. 
It is now generally recognized that a strict antitoxic diet or 
lacto-vegetarian diet is one of the most efficient means of con- 
trolling this disease. The attacks gradually become less and less 
frequent until they finally disappear. So long as the kidneys 
continue to act efficiently, there is little danger of an attack. It 
has been noted that just before an attack the proportion of urea 
diminishes to half or two-thirds the normal. The reduction of 
proteins to the lowest practical level is unquestionably one of the 
most efficient means of controlling this malady. 
That toxins in the body fluids play a leading part in this 
disease has been clearly shown by several observers. Some years 
ago the writer had under observation the case of a young woman 
who had frequent epileptic attacks, sometimes remaining in a 
status epilepticus for two or three days. A study of the toxicity 
of the urine by Bouchard’s method of determining the urotoxic 
coefficient showed a notable lessening of toxicity during the height 854 
THE NEW DIETETICS 
of the attack and a remarkable increase as it was passing off. 
Evidently a highly antitoxic diet and copious water drinking are 
clearly indicated in this disease, together with the elimination of 
salt from the dietary and conscientious following of the biologic 
life. The patient referred to was greatly helped by these measures 
though not wholly cured. 
Great claims have been made for fasting as a cure of epilepsy. 
All the benefits derived from fasting may be secured by a protein 
fast; that is, by reducing the protein to a minimum or even ex- 
cluding it from the dietary for a few days. It is indeed much 
safer and more rational to put the patient on a carbohydrate 
dietary (see Index) for a week or two than to require an absolute 
fast. 
Good results have followed the operations of appendicostomy 
and removal of a part of the colon; but there is good reason to be- 
lieve that the benefit following these operations was the result of 
a lessening of the toxemia from putrefactive processes in the colon 
and that the same relief of symptoms may be secured by a thor- 
ough change of the intestinal flora (see Index) and persistent 
adherence to the antitoxic regimen. The writer has seen many 
epileptics greatly benefited by these dietetic measures and not a 
few cures. In the epileptic ward of a large insane asylum, the 
adoption of a fleshless diet diminished the number of “attacks” 
fully one-half. 
HYSTERIA 
This condition requires no specific dietary other than to avoid 
the use of nerve-irritating and stimulating foods and condiments 
and to increase the activity of the colon by a highly laxative diet 
(see Index). Tea, coffee, mustard, pepper, pepper-sauce, vinegar, 
pickles, much salt, broths and meat extracts, as well as meats of 
all kinds must be discarded. For emaciated patients, the milk 
regimen for two or three weeks often secures good results. The 
milk regimen should be introduced by three or four days of fruit 
regimen to get the bowels active, eliminate the fetor of the stools, 
and to create an appetite. A laxative diet is especially indicated. 
The amount of roughage, bran, greens, and fresh vegetables 
should be increased until the bowels are made to move three times 
daily. The enema should be employed in cases in which diet 
alone is insufficient. Change of the intestinal flora is of first 
importance. DIET IN NERVOUS DISORDERS 
855 
Neurasthenia is not in itself a disease but is rather a symp- 
tom of disease. It may have for its foundation various morbid 
conditions, but the most common of all is intestinal toxemia. The 
writer has maintained this view of the nature of this disease 
for many years. It is also held by many eminent French physi- 
cians. M. Lepine, of Paris, holds that neurasthenia is usually 
due to autointoxication. The source of the toxins, according to 
Lepine, is intestinal putrefactions. He finds that the symptoms of 
exhaustion and neurasthenia disappear quickly when the elimina- 
tive organs are made active, and especially when the patient is 
placed upon an antitoxic dietary by the elimination of flesh foods 
or the so-called lacto-vegetarian regimen. Consequently, the 
proper dietetic measures are the fruit regimen to clear the 
tongue and render the stools non-putrid, followed by the milk 
regimen for two or three weeks if the patient is emaciated. This 
course should be repeated until the flora is thoroughly changed, 
the tongue clean, and breath and stools no longer foul. 
After a sufficient gain of flesh has been secured, the patient 
should follow permanently the antitoxic dietary, taking care to 
Ihclude in the bill of fare for every meal a sufficient amount of 
roughage to secure three bowel movements daily. This method 
the writer has followed with much success in the treatment of 
many hundreds of neurasthenics. 
The diet must also include a considerable amount of green- 
stuffs or uncooked food to supply daily an adequate amount of 
vitamins, a lack of which is often a cause of the neurasthenic 
symptoms. 
NEURASTHENIA 
SITOPHOBIA 
Sitophobia is the term applied to a condition in which there 
is a morbid fear or aversion of food. The patient fancies that 
some particular food, ordinarily perfectly innocuous, is certain to 
do him harm, and as a result the food, when eaten, through the 
patient’s perverse mental attitude apparently does disagree, pro- 
ducing various digestive and other disturbances. A person who 
has been made sick by some particular article, even though it may 
be something of which he has previously been very fond, is very 
likely to develop a sitophobia for the article in question. 
The gravity of this condition depends upon the extent of the 
list of foodstuffs which are tabooed by the disease. If the patient 856 
THE NEW DIETETICS 
has an aversion to all food, the situation may be very serious. The 
use of the nasal or duodenal feeding tube may be necessary to 
prevent starvation. When only one or two articles are involved, 
wholesome, agreeable equivalents may be substituted. Not infre- 
quently the patient may be cajoled out of his morbid mental state. 
In other cases suggestion or other careful psychic treatment is 
required. 
These patients are usually neurasthenic. Indeed, sitophobia 
is really a neurasthenic symptom. There are nearly always pres- 
ent marked symptoms of intestinal toxemia and colitis. The flora 
must be changed, and the bowels made to move three times a 
day. In some cases, the patient’s aversion is due to sensitivity 
rather than to a morbid psychology. 
NEURALGIA—NEURITIS 
Pains to which the terms neuralgia, neuritis, sciatica, etc., 
are commonly applied are in general due to toxins. The patient 
requires an antitoxic and laxative dietary. Frequent bowel move- 
ments, at least three times a day, are necessary to keep the body 
free from the toxins with which it has long been flooded. In 
many cases there is incompetency of the ileocecal valve, which 
permits the reflux of putrefying material into the small intestine, 
where it is rapidly absorbed. Change of the intestinal flora is 
essential. 
Genuine neuritis, or inflammation of a nerve, is usually the 
result of traumatism or of a specific infection. The dietary re- 
quired is the same as that indicated when fever is present; that is, 
antitoxic and laxative. 
VAGATONIA 
This is a condition in which the autonomic nervous system 
is abnormally irritable, as indicated by a tendency to excessive 
contraction of the pylorus, spastic contraction of the colon and 
sometimes of the anal muscle. Diet alone is not sufficient in these 
cases. Rest, sedative baths, changing the intestinal flora, out-of- 
door life, quiet surroundings, relief from worry, and general re- 
constructive measures are essential. The diet should be unstim- 
ulating. Meats must be discarded. Fruits and green vegetables 
should be given in great abundance to alkalinize and enrich the 
blood and farinaceous foods to increase adipose tissue, which is 857 
DIET IN NERVOUS DISORDERS 
nearly always deficient. The antitoxic and laxative diets are 
indicated. 
This rather vaguely defined condition is supposed to be 
present in cases of hyperacidity, spasm of the pylorus and gastric 
hypersecretion, conditions which may be complicated with gastric 
or duodenal ulcer, or disease of the gall bladder or other lesions. 
The diet must then be modified to suit the conditions known to be 
present, as shown by the X-ray or other means. In general, it 
should be bland and unstimulating and yet should include a suit- 
able amount of roughage to stimulate intestinal activity, for con- 
stipation is practically always present in these conditions. The 
colon is often spastic and there is generally dilation of the cecum 
and incompetency of the ileocecal valve as a result of the long- 
continued over-distension of the large intestine. 
Copious drinking of hot water is highly beneficial in most 
cases of this sort. As soon as the first symptoms of pain appear 
a tumblerful of hot water should be swallowed. The temperature 
of the water should not be more than 105° F. The hot water 
drinking may be repeated if the pain recurs. In cases in which 
the pain appears three or four hours after eating, a copious 
draught of hot water, two to three glasses, will often afford com- 
plete relief by diluting the gastric contents and relaxing the 
pyloric spasm. The good effects of the hot water drinking are 
encouraged by lying upon the right side for a' few minutes after 
the water has been swallowed. A hot bag over the stomach, 
either with or without the abdominal bandage, is helpful in these 
cases, as is also a large hot enema (3 or 4 pints), in cases in 
which the pain is accompanied by distention of the colon. In 
cases in which hot water drinking does not afford relief, bland 
food may be taken in small quantity. The best food for this pur- 
pose is rice jelly or a smooth rice gruel, taken warm, with the 
addition of a little unsalted butter or sweet cream. A tablespoon- 
ful to a cupful of bland food will often cause complete relief from 
pain by stopping the violent contractions of the stomach which 
accompany and cause the so-called hunger pain. In cases in 
which the pain occurs in the night, it is well for the patient to 
have a little food by his bed to take at once when the pain occurs, 
as it is much more easily relieved if food or hot water is taken 
at once when the distress first makes its appearance, instead of 
waiting until it becomes unbearable. 858 
THE NEW DIETETICS 
Since this condition is generally associated with intestinal 
toxemia and colitis, a change of intestinal flora and treatment 
for colitis are essential. 
DIET IN SEASICKNESS—CARSICKNESS 
The writer once asked an intelligent steward on a big ocean 
liner what he thought was the cause of seasickness. He replied at 
once: “It is because they all eats too much. They just goes 
down into the saloon and stuffs themselves with all sorts of vittles 
and then when the ship rolls a little they heaves it all up. Why, 
there’s the captain. He’s been to sea more than twenty years, 
and yet he gets seasick every time the water is a little rough. 
He eats plum puddin’ and all sorts of rich things so of course 
he is sick. I don’t eat them fixin’s and I am never sick; but I 
would get sick mighty quick if I ate like the captain does.” 
While diet may not be the dominating factor in seasickness 
and carsickness, it nevertheless is important. Constipation, over- 
eating, and especially the eating of rich food, meats and fats, 
greatly increase the liability to seasickness. If one is about to 
take a voyage he should take care to have his bowels in thoroughly 
good condition before embarking; the tongue should be clean and 
the breath sweet. He should be free from any symptom of intes- 
tinal toxemia. Such a person, by the exercise of a little care, is 
not likely to suffer from seasickness. A highly susceptible person 
may find it necessary at first to remain quiet in his berth during 
very stormy weather, but he may not suffer from nausea, and by 
keeping his cabin well ventilated and maintaining a horizontal 
position he will have no serious discomfort. The diet in the mean- 
time- should be spare, consisting of plainly cooked vegetables, 
cereals and fruits, with an abundance of bran and other roughage. 
Meats of all kinds and even eggs must be avoided. Buttermilk 
is preferable to sweet milk. Take fats sparingly. 
MYASTHENIA 
The dietary of myasthenia is the same as that suggested for 
neurasthenia (Index). 
The inability of these patients to take much exercise renders 
a liberal use of bran or agar and paraffin oil essential to promote 
intestinal activity. The protein intake should be small and fat 
should be used rather sparingly. A liberal quantity of perfectly DIET IN NERVOUS DISORDERS 
859 
sweet butter and yeast extract (Savita) should be used to insure 
a good supply of vitamins. 
Greens in abundant quantity should constitute a part of each 
day’s bill of fare. 
Water should be taken to the extent of two to three quarts 
daily. The intestinal flora should be changed and kept changed 
by the antitoxic and laxative diet (see Index). 
In cases with marked emaciation, the milk regimen for two 
or three weeks is indicated. Care should be taken to make the 
diet supply an adequate amount of vitamins of all sorts and also 
food lime and iron. 
HERPES ZOSTER 
In severe cases, especially when the disease is accompanied 
by fever and infection involving the central nervous system, a 
fever diet should be taken for several days (Index). Agar or 
bran with paraffin oil should be administered to move the bowels. 
If the tongue is foul, the intestinal flora should be changed by 
means of the fruit regimen with milk sugar and cultures of B. 
acidophilus. After the fever has disappeared, the antitoxic and 
laxative diet should be employed (see Index). 
MYELITIS 
In this disease the body is laboring under the influence of a 
toxicant, the seat of the attack being the spinal cord. This fact 
has led some authorities to suppose that special attention to diet 
is a matter of no consequence. It is evident, however, that any 
measure which tends to decrease or diminish the amount of toxins 
with which the body has to deal must be important in its rela- 
tion to this condition. Hence, the dietary should be such as to 
lighten the burden of the liver, kidneys and other poison-elimi- 
nating organs, and thus raise the vital resistance and so aid the 
body in its battle with disease. 
A foul breath and coated tongue are a clear indication for 
a change of the intestinal flora by means of the fruit regimen 
and milk sugar feeding. 
If there is a continuous rise of temperature, the fever diet is 
indicated. When the febrile action ceases, the antitoxic and 
laxative diet must be employed. 860 
THE NEW DIETETICS 
The necessity for copious water drinking to the extent of 
three or four quarts daily should not be overlooked. 
The diet in this disease should be the same as indicated for 
neuralgia and neuritis. 
Many cases are greatly benefited by changing the intestinal 
flora and the adoption of an antitoxic regimen, but in quite a large 
proportion of cases, other than dietary measures are essential for 
the accomplishment of the results desired. 
TIC-DOULOUREUX 
A state of high nervous tension and an unusual degree of 
nervous and mental irritability, a certain mental instability—in 
short, the nervous condition generally known as nervousness is, 
to a remarkable degree, amenable to dietetic treatment. In the 
great majority of these cases, the real cause is not nervousness 
due to a weak or diseased nervous system, but a toxic state which 
may be more or less readily relieved by changing the intestinal 
flora and the adoption of an antitoxic dietary. Of course, fresh 
eir sleeping, out-of-door life, sun-baths, proper exercise, proper 
clothing, mental hygiene,—everything, in short, that relates to bi- 
ologic living may render service in promoting recovery in cases 
of this sort; but, in the writer’s experience, the greatest benefit 
is realized from the employment of measures for cleansing the 
blood stream from the toxins which disturb the central nervous 
system. This can only be accomplished by careful regulation of 
the dietary and by promoting intestinal activity. 
Many sufferers from nervousness are constantly being vic- 
timized by psychoanalysts, Christian Scientists and the promoters 
of various pseudo-healing cults. It is a mistake to suppose that 
these patients are to be cured by psychic measures alone. Coue- 
ism, or suggestion in some other form, unquestionably produces 
temporary benefit in many cases, but the benefit received is neces- 
sarily only temporary for the reason that the remedy does not 
strike at the root of the disease. The real cause of the condition 
is physical rather than psychic and can be removed only by the 
use of such measures as will suppress morbid influences and re- 
store normal conditions. Coueism, suggestion, faith-healing and 
allied measures may promote recovery through removing some 
grave obstacle in the way, such as fear or worry, but the cure 
must be accomplished by the establishment of normal physical 
conditions, one of the most important of which is a biologic diet. 
NERVOUSNESS Diet in Disorders of the 
Genito-Urinary Organs 
DIET IN DISEASES OF THE KIDNEYS 
The kidneys eliminate two-thirds of the tissue wastes. Each 
one of the four million renal cells produces about one-fourth of 
an ounce of urine in a life-time of sixty years, or four drops in 
one year. This delicate machinery is easily damaged when com- 
pelled to eliminate poisons unusual in character or amount; 
hence, the injury done by typhoid, scarlet fever and other in- 
fectious diseases, and by smoking and other drug habits, the use 
of tea and coffee and of irritating condiments. 
Disease of the kidneys may be regarded as due to two 
causes: 
1. Injury from acute infections. Tuberculosis, scarlet 
fever, measles, typhoid fever, smallpox, even chicken-pox and 
other acute infections may injure the kidney structures to such 
a degree as to greatly cripple it, so instead of being able to bear 
the wear and tear of life for 60 or 70 years, they are worn out at 
40 or 50. 
2. Overwork. The normal kidney is without doubt able 
to do the natural work of the body not only for an average life- 
time but for 100 or 120 years or more. But if the work required 
daily and hourly of the kidneys is two or three or ten times as 
much as is required of these organs under normal conditions, the 
delicate filtering structures of these wonderful organs become 
prematurely old and unable longer to perform their function. Of 
course a breakdown due to overwork will occur sooner in a per- 
son whose kidneys have been damaged in early life by an infec- 
tious disease than in those who have • fortunately escaped such 
injury. 
The cause of overwork of the kidneys is of course the circu- 
lation in the blood of an excessive amount of toxins. The normal 
work required of the kidney is comparatively small, but various 
causes may increase the burden to an enormous extent. 
861 862 
THE NEW DIETETICS 
One of the most common sources of excessive kidney work 
is a high protein diet. Folin has shown that all of the protein 
eaten beyond that which the body can use in the repair of its 
tissues is directly transformed by the liver into urea to be elimi- 
nated at once by the kidney; that is, surplus protein never be- 
comes a part of the living structures of the body and does not 
enter into its useful work. It is simply excreted like so much 
waste matter. Comparative analyses of the urine of low protein 
feeders and those who take an ordinary mixed diet show that 
even moderate meat eaters require of their kidneys three times 
the amount of work in the elimination of nitrogenous wastes that 
is demanded of the kidneys of flesh abstainers. While the kid- 
neys are young they are usually able to bear this extra burden 
so that no evidence of injury appears; but as they become worn 
with advancing age they become unable to do their work effici- 
ently. Poisonous products begin to accumulate in the blood. 
Then the blood vessels begin to suffer from contact with a con- 
taminated blood stream and degenerations begin in the heart, liver 
and various other vital organs. 
Another prolific source of overwork of the kidneys connected 
with the high protein diet -is the production in the colon through 
putrefaction of the food residues of large quantities of bacterial 
poisons. At first these toxins are very largely destroyed and 
detoxicated by the liver so that their effect upon the kidneys is 
less pronounced, but later the liver begins to fail in its efficiency 
and then the injury to the kidneys as well as other structures 
becomes greater. 
Another source of poisons which leads to overwork of the 
kidneys is to be found in tea and coffee which contain a dozen or 
more poisons, some of which, like caffein and tannic acid, are 
found naturally in the coffee berry while others are produced by 
the roasting process. 
Tobacco smoking introduces a long series of highly potent 
kidney poisons, more than 20 in all, of which nicotine is perhaps 
chief although exceeded in virulence by several of the poisons 
associated with it. 
Metallic poisons of all sorts are extremely damaging to the 
kidneys. This is well shown in the nephritis which follows the 
taking of corrosive sublimate either by accident or intent. The 
long-continued use of mineral drugs even in small quantities may 
also result in great damage to the kidneys. There can be no DISEASES OF GENITO-URINARY ORGANS 
863 
doubt that the use of arsenical preparations in the treatment of 
syphilis and skin diseases does more or less damage to the kidneys. 
The elimination of the excess of protein eaten, of chlorid of 
sodium, mustard, pepper and other condiments, of the alkaloids 
of tea and coffee and of other unusable materials taken with our 
food, together with the poisonous products of putrefactive pro- 
cesses in the colon, constitute by far the greatest part of the work 
required of the kidneys of modern man. This fact is made to 
appear in a very strong light by the examination of the urine of 
a fasting person. Although the ordinary life processes, including 
muscular activity, may be going on as usual, the amount of solids 
eliminated in the urine is reduced to a small fraction of that 
ordinarily found. 
The chief aim of diet should be to lessen the intake of toxins 
and the production of toxins in the body. The first object may 
be accomplished by suppressing drug habits of all sorts, includ- 
ing the use of laxative drugs, patent medicines, tonics, and sopori- 
fics or sleep-producing drugs as well as irritating condiments, 
alcohol, tea, coffee, tobacco, meat, meat extracts, broths and vege- 
tables containing considerable quantities of oxalic acid, such as 
pieplant and sorrel. 
Meats of all kinds and meat products should be avoided be- 
cause meat eating almost inevitably leads to an excessively high 
protein intake, which necessarily imposes extra and more or less 
damaging overwork upon the kidneys. Folin has shown that all 
the protein eaten beyond a small amount required for repair of 
the tissues, which is never more than two ounces per diem, gen- 
erally less, is at once converted into urea and eliminated through 
the kidneys as soon as possible; that is, surplus protein is treated 
like tissue waste, rendering the body no service, but laying an 
extra burden on the kidneys. 
Squier and Newburgh have also studied the effects of a high 
protein diet on the human kidney. Two groups of subjects were 
employed. One group consisted of five healthy young men, who 
were carefully examined and found to possess healthy kidneys and 
to be normal in every way. They were then given a pound of 
beefsteak at each of two successive meals. In each case, exami- 
nation of the urine showed the presence of blood cells, indicating 
so intense a degree of congestion produced by the meat that 
blood had escaped from the blood-vessels into the urinary ducts. 
Examination of the urine before the meat was given showed not 864 
THE NEW DIETETICS 
the slightest trace of blood cells or any other evidence of disease. 
A second group consisted of persons suffering from high 
blood pressure. The urine in each of these cases showed some 
evidence of disease of the kidneys. When given a high protein 
diet, red blood cells and albumin appeared in the urine, if not be- 
fore present, and increased if previously present. There was a 
like increase in all the other symptoms of Bright’s disease present. 
There can be no doubt that the excessive use of flesh foods 
is one of the chief causes of the very rapid increase of deaths 
from Bright’s disease in this country and other civilized lands. 
This has been noted particularly during the last 20 or 30 years, 
during which time the consumption of meat has greatly increased. 
Modern methods of examination of the blood have attained 
such a degree of accuracy that the influence of diet can now be 
very definitely determined. Myers has recently shown that in 
cases of Bright’s disease in which the amount of urea in the blood 
is greatly increased the urea content may be notably decreased 
by a low protein diet. The retention of urea in the blood also 
occurs in pneumonia, in cases of intestinal obstruction, in syphilis 
and other diseases. 
The use of so small an amount as a single small beefsteak 
which would double the work normally required of the kidneys, 
might be a matter of serious moment when these organs are crip- 
pled by disease. Certainly, the constant aim should not be to tax 
the kidneys to the limit of tolerance but to diminish the work re- 
quired of them to the lowest minimum. 
Game, cold storage meats and such putrid foodstuffs as lim- 
burger cheese are so highly injurious in renal disease that in cases 
in which the renal efficiency is considerably reduced a single meal 
of such food may be sufficient to overwhelm the crippled organs 
completely and produce a fatal uremia. Many a Christmas, New 
Year’s or Thanksgiving feast has been the introduction to a trag- 
edy of this sort. 
Meat extracts, animal broths and bouillon are especially 
harmful. In an interesting paper on the treatment of Bright’s 
disease, (Bulletin General de Therapeutique), Sapelier, an emi- 
nent French physician of Nanterre, in prescribing the dietetic 
regimen suited to patients suffering from this disease absolutely 
prohibits the use of bouillon and all juices and extracts of meat, 
remarking of bouillon that it is a “veritable solution of pto- 
maines.” DISEASES OF GENITO-URINARY ORGANS 
865 
Smoking is particularly injurious to the kidneys, nicotine 
acting as an irritant to these organs. Gy, of Paris, has shown by 
experiments upon animals that the effect of the poisons of to- 
bacco smoke is to cause degeneration of the kidney cells. Doctors 
who permit their patients to smoke moderately simply say to 
them: “You may damage yourself a little but do not do yourself 
as much harm as you might.” The late eminent Professor 
Lauder Brunton maintained that in order to be benefited by re- 
nouncing the use of tobacco the smoker must abandon the habit 
in toto, so that the last trace of nicotine may be eliminated from 
the body in order to give the recuperative forces an opportunity 
to rally and so far as possible repair the damage done. This 
agrees with the writer’s experience. 
Doctors who prohibit smoking to their nephritic patients 
in so doing do not expect to effect a cure of the disease but only 
to postpone the patient’s funeral. A longer and more certain 
postponement would certainly have been possible if the smoking 
had been prohibited earlier, before the appearance of the kidney 
disease; in other words, prevention by the avoidance of the poison 
habits is a far more effective means of combating disease of the 
kidneys and other grave maladies than abstaining after the mis- 
chief has been done. 
Condiments of all sorts contain essential oils which are 
chiefly eliminated through the kidneys, and are objectionable 
because of their irritating properties. Chlorid of sodium should 
be used very sparingly and in cases in which a dropsical condi- 
tion exists a salt-free diet should be employed. Tea and coffee, 
cocoa and chocolate are objectionable for the same reason as meat 
and meat broths. A single cup of coffee contains on an average 
three grains of caffein, which is practically identical with uric 
acid. When coffee is taken, the uric acid of the urine is increased 
(Mendel). Three cups of coffee daily more than double the 
amount of work normally required of the kidneys in the elimina- 
tion of uric acid. The toxic element of cocoa and chocolate is 
theobromine, an alkaloid very closely related to caffein, which 
produces when taken into the body essentially the same effects 
as would be produced by an intake of uric acid. 
It is important to remember in the treatment of chronic 
Bright’s disease that every patient suffering from this malady 
has not only a diseased condition of the kidneys but also of the 
heart and blood vessels. The affection of the heart is in many 866 
THE NEW DIETETICS 
cases even more immediately dangerous than the changes in the 
kidney. In these cases care must be taken to avoid administer- 
ing too large quantities of fluids, since the weakened heart may 
be overloaded and dilation may occur. When the heart affection 
is serious and there is a tendency to dropsical accumulation the 
amount of fluids should be limited to about three and one-half 
pints in persons of average size. The food taken may contain a. 
pint and a half of water in addition to that taken as'fluid. The 
amount of urine should be about equal to that of the fluid taken 
as such. Once a week the tissues should be flushed by doubling 
the intake of fluid. This is important to prevent accumulation 
of tissue wastes. 
The writer is quite in accord with the dictum of Doctor 
Vaughan, of the University of Michigan, who holds that in 
Bright’s disease the blood stream carries to the kidneys toxins 
which give rise to degenerative changes. To suppress these toxins, 
Vaughan forbids all flesh food and commends a diet consisting 
largely of potatoes, green vegetables, fresh fruits, cream and 
butter, and cereals in moderation. 
It is perfectly true, as Vaughan suggests, that after a few 
weeks patients lose all desire for meat and eggs. This is quite 
natural because of the fact that the appetite for a high protein 
diet is an artificial one. The appetite for meat quickly falls 
away for the reason that man is not naturally a meat eater. 
Vaughan affirms that even a hard-working man can easily live 
on a diet from which both eggs and meat are excluded. 
As Vaughan observes: “The chief value of vegetarian food 
is that it is a low protein diet, containing less extractives and 
purin bases than the ordinary mixed diet.” It is for this reason 
that it is to be recommended not only for persons who suffer 
from Bright’s disease but for those who do not wish to become the 
victims of Bright’s disease and wish to keep their kidneys intact 
to a ripe old age. Sooner or later these delicate and essential 
mechanisms fail through the development of senile changes. Why 
wait until the catastrophe comes? Wise forethought well sug- 
gests that prophylaxis is better than cure, but in the case of 
Bright’s disease the damage is irreparable and cure impossible. 
Prevention is the proper thing. Hence the advantage of the 
biologic diet. 
Special care should be taken to avoid the eating of raw or 
insufficiently cooked white of egg. Egg albumen in this form DISEASES OF GENITO-URINARY ORGANS 
867 
is almost wholly indigestible and greatly promotes putrefactive 
changes in the colon. If eggs are eaten, it is best to reject the 
whites for the reason that in cases of nephritis egg albumin seems 
to be less readily appropriated than most other forms of protein. 
The intake of protein by a person suffering from Bright’s 
disease should not be more than one calorie per pound of body 
weight. 
Care should be taken in making up the bill of fare of a 
nephritic to see that the base or alkaline elements of the food are 
strongly predominant (see Index). This will not only require the 
elimination of all flesh foods but also decided restriction of 
cereals, which should never be made the staple dietary in cases of 
nephritic disease for the reason that their exclusive or dominant 
use tends to diminish the alkalinity of the blood and tissue fluids. 
Potatoes and other vegetables should largely take the place of 
cereals. 
The use of mineral waters is to be avoided in nephritis for 
the same reason that medication of all sorts is interdicted. The 
ingredients of mineral waters, like other drugs, only add to the 
burden required of the kidneys and thus hasten the time when 
their margin of safety will be wholly consumed and they will no 
longer be able to keep the blood free from toxins and these 
noxious elements will be permitted to accumulate to such a degree 
that uremia will supervene and death occur. 
In cases of renal sclerosis which accompanies arteriosclerosis 
or cardiovascular-renal disease it is sometimes necessary to limit 
the amount of water for periods of one to three days. This 
measure is especially necessary in cases of general dropsy with 
dilated heart (see Dry Diet). In nephritis with dropsy, salt 
should be wholly excluded from the dietary until the dropsy dis- 
appears. It may then be used in very great moderation. The 
“buttermilk cure” and the “skimmed milk cure” for renal dropsy, 
first suggested by Karell, are chiefly valuable because of the 
small amount of liquid and very small amount of salt which they 
supply. This method really seems to present no advantage which 
cannot be as well secured by a diet consisting chiefly of fruit 
juices and fruit purees (the Fruit Regimen), which has advan- 
tages over the Karell method in the small amount of protein 
supplied and the laxative effects secured. 
In acute nephritis, the diet of the patient for several days 
may be largely, or even wholly, confined to fruit juices or sugar 868 
THE NEW DIETETICS 
water prepared by the addition of two ounces of malt sugar to a 
pint of water, or in place of malt sugar the sugar of raisins may 
he used. Soak four ounces of raisins in a pint of water, stew for 
20 minutes, pour off the juice and increase to one pint. A pint 
of raisin juice prepared in this way contains 200 calories of sugar 
which is ready for immediate absorption. Lactose or milk sugar 
may also be used. 
Von Noorden is a very strong advocate of fruit in renal dis- 
ease, as is well known by all who have visited his clinics. He 
says in his “Metabolism”: 
It is the theory of many physicians that nephritic patients should 
be given a diet poor in proteins (Senator, F. Hirschfelt, Albu, and 
others.) It is said that such a diet puts less strain on the diseased 
organs. No doubt this is true, for acute nephritis and for the acute 
relapses of chronic nephritis, as I have emphasized elsewhere. For 
two years I have been of the opinion that in acute and dangerous 
cases no nitrogen should be given in the food. I have given nothing 
but sugar water and fruit juice for from three to eight days at a 
stretch (often 200 to 300 grams of sugar daily). It was my impression 
that this form of treatment was very useful, and that uremic symptoms 
were obviated, or if already present, were removed. 
In acute nephritis on the one hand, and in acute inflammatory 
exacerbations of chronic renal disease, a large protein intake un- 
doubtedly exercises an injurious effect on the albuminuria. Even a 
milk diet is too rich in protein for this form of kidney trouble. When 
the inflammation is at its worst I give nothing but sugar-water (about 
150 to 200 grams daily) and strained rice broth, with cream or butter 
added. This regimen reduces the work done by the kidneys to the 
lowest limit. I.add milk to the diet only when the patient begins to be 
convalescent. 
The fruit regimen is still more efficient in cases of renal 
disease than the fruit diet of Von Noorden, because of the 
increased intestinal activity and change of the intestinal flora, 
which lesserfs the absorption of toxins and the work of the crip- 
pled kidneys. 
In the employment of the fruit regimen it is important to 
remember that prunes, cranberries and plums must be avoided 
because they contain a considerable amount of benzoic acid which 
the body is not able to utilize but must be eliminated through the 
kidneys. Frothingham and Smillie urge the importance of a low 
protein diet in chronic nephritis to prevent an increase of nitro- 
genous wastes in the blood. Goodall observed that in nephritic 
patients on a low protein diet the nitrogenous wastes, the so- DISEASES OF GENITO-URINARY ORGANS 
869 
called non-protein nitrogen of the blood, was diminished. He 
also observed a simultaneous fall in blood pressure. 
In cases of poisoning by corrosive sublimate the stomach 
should be washed out, and after the washing an ounce of lactose 
should be dissolved in a pint of milk and water, equal parts, and 
introduced into the stomach. 
Bichlorid Nephritis* 
The almost complete urinary suppression induced by this 
toxic nephritis quickly leads to an accumulation of nitrogen- 
ous wastes in the blood. The indication is to place the patient for 
a few days upon a strictly carbohydrate diet of rice or potato 
gruel with sugar water by mouth, by enema, and if necessary, by 
intravenous injection of glucose. It should be given in such 
quantities as will give the patient 1,200 to 1,500 calories daily. 
By this means, the patient’s strength may be maintained and the 
heart action sustained, while the mercury is being eliminated. The 
patient should receive 3 to 4 pints of water or liquid in twenty- 
four hours. 
Water-Drinking. 
Modern clinical experience has shown that the old practice 
of indiscriminately recommending the sufferer from Bright’s dis- 
ease to drink large quantities of water is not altogether safe, 
since in numerous cases the liver loses its ability to eliminate 
water even while still able to deal efficiently with the waste sub- 
stances brought to it by the blood stream. The water intake of 
the average person for each twenty-four hours is about four 
pints, of which from a pint to a pint and a half will be taken as 
food, which, in general, is about three-fourths water. From one- 
fourth to one-fifth of the fluid intake is eliminated by the lungs 
and the skin; the balance, or about three-fourths, should appear 
in the urine. When the kidneys are unable to eliminate this 
amount of water, it is not only useless but harmful to increase 
the water intake. In such cases, edema is likely to appear and 
the water intake must be eliminated. , 
The exclusion of salt from the dietary and a very low pro- 
tein diet will greatly lessen the water requirement, as it will 
greatly reduce the amount of solids which the kidneys have to 
eliminate. If the amount of salt consumed is reduced by one 
gram, the intake of water may be reduced one pint and the 870 
THE NEW DIETETICS 
kidneys will htive this much less work to do. Before a patient is 
encouraged to drink an increased amount of water, care should be 
taken to make sure that he is able to eliminate the amount of 
water which he is already taking. 
Diet in Cases in Which One Kidney Has Been Removed, 
In cases in which one kidney has been removed, a strict 
antitoxic (see Index) and laxative diet (see Index) should be 
carefully adhered to. On a high protein diet the amount of urea 
excreted by the kidneys is 33 to 37 grams, or an ounce and a 
quarter. On a heavy meat diet the amount may rise to 100 
grams, or three and one-third ounces. On a meat-free diet the 
urea output falls to 9 grams, less than one-third of an ounce. 
From these facts it is evident that the kidneys of the meat 
eater are compelled to do from two to five times as much work in 
the elimination of urea as is required of the kidneys of a low 
protein feeder. Since Folin has shown that all the urea excreted 
by the kidneys represents surplus protein, that is, food protein 
which has never been assimilated and hence has not been utilized 
for tissue building, it will readily appear that a high protein diet 
is one of the most efficient methods by which the kidneys may be 
prematurely worn out and life thus abbreviated. By means of 
careful dieting, the work of the kidneys may be reduced to one- 
half or even one-third that required by the ordinary dietary and 
thus, when one kidney has been removed, life and useful activity 
may be prolonged for many years; whereas, without the relief 
afforded by careful dieting, the single kidney would soon be 
worn out and the patient’s career brought to an untimely end. 
ALBUMINURIA 
When albuminuria occurs in connection with a nervous dis- 
order of some sort, such as epilepsy or apoplexy, the patient 
should he placed at once upon a low protein and salt-free die- 
tary. When albumin appears in acute Bright’s disease, all food 
except fruit juices apd malt sugar should be withheld for a short 
time. In acute nephritis occurring as a complication of scarlet 
fever and in the acute albuminuria of pregnancy, the same dietary 
should be adopted for a few days until the intensity of the disease 
is controlled. 
The statistics of life insurance companies show that the life DISEASES OF GENITO-URINARY ORGANS 
871 
expectancy of persons who have suffered from typhoid fever or 
other severe infectious maladies is diminished to a marked degree. 
In a very large number of cases of chronic nephritis a history of 
some acute infection such as scarlet fever, measles, typhoid or 
smallpox is obtainable. Evidently the kidney is injured in these 
cases and so a rational preventive procedure would be to place 
every such person, even in youth, on a strictly antitoxic diet, 
excluding meats of all sorts, with tea, coffee and excess of salts, 
and to take care to change the intestinal flora and to keep it 
changed. These precautionary measures, if adopted in early life, 
would doubtless prevent the later development of nephritis in 
many cases. 
OXALURIA 
Besides eliminating from the diet foods rich in oxalic acid, 
meats of all sorts should be discarded and special care should be 
taken to avoid the use of hard water. An antitoxic laxative diet 
should be permanently adopted. Pieplant, tea and coffee must 
be scrupulously avoided and greens, especially spinach, must be 
parboiled. 
DIET IN ABSCESS OF THE KIDNEY 
When the kidney is the seat of abscess or of infection with 
rise of temperature, the dietetic indications are the same as in 
fever. It is especially important to keep the bowels active by a 
laxative diet and to change the flora so as to lessen the work of 
the kidneys as much as possible. 
GRAVEL AND STONE 
This condition is most often due to faulty metabolism. The 
alkalinity of the body fluids is diminished and there is excessive 
formation of oxalic acid and other organic acids which, when 
present in concentrated urine, lead to the deposit of insoluble 
salts in the kidney or bladder. A diet consisting chiefly of cereals 
and meats with a small intake of water strongly predisposes to 
this condition. It only requires the absorption of a small quan- 
tity of water from such concentrated urine to cause the deposit 
of a minute amount of solids in the urinary tract, and when this 
is done the formation of a calculus has begun. It has been 
noticed that calculi do -not form in domestic animals when they 872 
THE NEW DIETETICS 
are allowed to graze at pasture in the summer or are fed liber- 
ally on potatoes, ensilage, turnips, pumpkins and other foods rich 
in alkaline salts and containing an abundance of water. Hard 
water tends to increase the concentration of the urine and so 
encourages the formation of calculi, which accounts for the fre- 
quent occurrence of these concretions in both men and animals 
in limestone regions. 
Many eminent authorities, including Klemperer, insist 
strongly that all foods containing uric acid or oxalic acid must be 
strictly prohibited. This interdiction includes not only meats of 
all kinds but tea, coffee and cocoa as well, also sorrel, rhubarb, 
and even spinach and beans, although beans and spinach may he 
rendered wholesome by parboiling. 
Cereals should be eaten sparingly and potatoes should be 
used largely instead of bread because of the alkaline salts which 
they supply. Fruits should be freely used for the same reason. 
Vluskmelons are particularly beneficial. 
When magnesia is present in water in considerable quantity, 
the tendency to formation of calculi is increased because of the 
readiness with which magnesia is precipitated in the presence of 
ammonia, which is developed in the bladder in cases of catarrhal 
inflammation of the mucous membrane, and is likely to occur as 
the result of infection with the colon bacillus and other germs. 
Roberts, an authority of high standing, holds that urinary 
calculus, that is, stone in the bladder or kidney, is due to a de- 
ficiency of the diet in the alkaline salts, soda and potash, found 
in potatoes and other vegetables. He notes that these alkalies 
are deficient in the blood and the urine in all cases of gravel, and 
also observes that calculus rarely affects children in well-to-do 
families but is quite common among the poor, who suffer most 
from the lack of the alkaline salts supplied by green vegetables. 
It is not at all likely that stones once formed in either the kidney 
or the bladder can be entirely dissolved in this way, hut in case 
of renal calculi in the ureter the free use of potatoes with copious 
water drinking may diminish the size of the stone sufficiently to 
dislodge it and thus lead to its expulsion. The writer has seen 
this result in several cases. It is clearly evident, then, that per- 
sons who live in a hard water district should avoid the too free 
use of cereals and by the free use of potatoes and other fresh 
vegetables and fruits seek to alkalinize the tissues and to maintain 
a high content of soda and potash in the tissue fluids. DISEASES OF GENITO-URINARY ORGANS 
873 
Intestinal asepsis is important in these cases because of the 
more or less crippled condition of the kidneys. The flora should 
be changed and the colon kept free from putrefaction by a laxa- 
tive and antitoxic diet. 
PYELITIS 
In this disease there is an infection with an excessive pro- 
duction of mucus and other matters in the pelvis or vestibule of 
the kidney with the consequent tendency to accumulation of ma- 
terial which is likely to become more or less obstructive. On this 
account it is important that the volume of urine should be very 
considerably increased so that the secretions may be diluted and 
washed away. By increasing the volume of urine the toxic mat- 
ters which it contains will be diluted and hence less irritating to 
the hypersensitive structures of the kidney. Irritants of every 
sort should be eliminated from the diet, as well as everything 
which will tend to increase the work of the kidneys; hence tea 
and coffee, condiments, as well as meats of every description, 
cheese and more than minute quantities of salt, should be avoided. 
The more completely salt is eliminated from the diet the better. 
The dietary in general should be the same as that for nephritis. 
It is well to substitute potatoes largely for cereals because of the 
large amount of alkaline salts which may thus be introduced into 
the circulation. 
In a large number of cases, the cause of the infection is the 
colon bacillus, and the reason for the infection is a lowering of 
ihe vital resistance of the body and the entrance into the blood 
stream of an excessive number of bacteria absorbed from a colon 
filled with highly virulent organisms. Cases of this sort require 
the services of a specially trained expert who, besides administer- 
ing the special treatment required, should see that the patient’s 
diet is such as to change the intestinal flora (see Index) and sup- 
press the production of virulent bacteria in the colon. 
The diet should consist of gruels, purees, fresh vegetables, 
fruit juices and fresh fruits, with bran and other food laxatives. 
The patient should take a half glass of water every hour so as 
to keep a steady stream of liquids passing through the kidneys. 874 
THE NEW DIETETICS 
INFLAMMATION OF THE PROSTATE GLAND 
The indications are the same as for disease of the kidneys 
and cystitis. Meats and condiments tend to increase the irrita- 
tion of the prostate. Constipation greatly aggravates this disease 
and on this account the dietary should be highly laxative, contain- 
ing large amounts of bran, at least half an ounce to an ounce a 
day, with greens and . other roughage and a sufficient amount of 
paraffin oil to secure three full and soft bowel movements daily. 
The enema should be used daily if necessary. Laxative drugs 
should be avoided. 
DIET IN URETHRITIS—GONORRHEA 
Condiments of every description, and especially asparagus, 
rhubarb and other foodstuffs which contain irritating substances 
which find their way out of the body through the kidneys must 
be avoided. Water should be taken very freely, at least a glass- 
ful every hour, to render the urine neutral. Beer, ale and other 
alcoholic liquors and tea and coffee should be avoided, also meat 
dishes, pickles and other unwholesome foodstuffs of all sorts. 
The diet should be essentially the same as in cases of calculus. 
CYSTITIS 
In cystitis the indications are the same as in urethritis. By 
copious water drinking the urine may be diluted so that the 
irritation produced by contact of this excretion with the inflamed 
mucous membrane of the bladder will be lessened. When urina- 
tion is frequent and painful, copious water drinking is especially 
important. A glassful every hour is not too great a quantity. 
The diet should be laxative and antitoxic (see Index). When 
the urine is slightly acid, fruits and fruit juices should be freely 
used, with the exception of prunes, plums, grapes and cranber- 
ries. Potatoes should be used instead of cereals. Diet in Diseases of Women 
While there is no specific diet indicated for the disorders 
peculiar to women in general, it is to be noted that women are, 
on account of their sedentary life, much more subject to consti- 
pation than are men. It may be said, also, that many of the 
distresses from which women suffer should be attributed to the 
intestinal toxemia, colitis and other colonic infections which are 
the result of constipation rather than to disease of the sex or- 
gans, This is especially true of the headaches, backaches, lack 
of appetite, lassitude and general lowered vitality which are most 
often charged to disease of the pelvic organs and various local 
affections, such as leucorrhoea, cervicitis (erosion), menstrual 
pains and irregularities and urinary affections, which are in 
many cases either a direct or indirect result of constipation. 
In general it may be said that practically all civilized women 
need to adopt more biologic habits in diet. Tea and coffee must 
be given up. The confections and pastries should be replaced 
by coarser and simpler dishes. Bran should be made a part of 
every meal. Greens and fresh fruits and vegetables should figure 
largely in every day’s bill of fare. The laxative and antitoxic 
and blood building dietaries (see Index), may be safely recom- 
mended in nearly all cases. The average American woman is 
anemic. Milk and greens should take the place of beefsteak. 
Coarse graham or bran bread should replace white bread and 
soda biscuits. More and better blood acquired by eating and 
assimilating appropriate food in ample quantity will do more to 
restore an invalid woman to health than all the drug tonics and 
widely exploited nostrums to be found in the drug shops. 
DIET DURING PREGNANCY 
The expectant mother needs to be well fed for the sake of 
her unborn child as well as for her own welfare. The intake of 
food must be increased, and Nature has provided for this by giv- 
ing to woman a stomach, liver, and other digestive and elimina- 
tive organs notably larger than in man. The dietary of the ex- 
pectant mother should include especially foods rich in lime, iron, 
875 876 
THE NEW DIETETICS 
vitamins and roughage. The body of an infant weighing 6 pounds 
contains more than an ounce of lime, all of which must be stored 
up during the months of gestation and most of it within the last 
three months. This would require an average daily addition of 
five grains of lime, or one-third the ordinary ration of 15 grains. 
This extra amount of lime will be furnished by three ounces of 
spinach and 6 ounces of milk. 
Again, the infant’s body contains about 10 grains of iron, 
nearly half of which is stored in its liver for use in blood-making 
during the nursing period, necessary because of the fact that 
milk contains only a very small percentage of iron. It is thus 
evident that the pregnant mother should take care to make her 
daily menus rich in food iron. The deficiency cannot be made up 
by swallowing iron pills or tonics or drugs of any sort. The 
iron must be furnished by suitable foodstuffs. Fortunately, 
Nature supplies an abundance of iron in greens of many sorts 
(Table XXIX). Six ounces of spinach added to a varied diet 
of fruits, whole grain products and fresh vegetables will supply 
the full amount of iron required. Numerous other foodstuffs are 
also rich in iron, even richer than is beefsteak, while affording a 
superior kind of food iron (Table XII). Malt sugar, molasses, 
dates, figs and raisins should be substituted for cane sugar. 
Malted nuts may be substituted for milk. Lentils and nuts should 
be freely used. 
Vitamins are needed to promote growth. The ordinary diet 
of tea, toast, bacon, rice, white bread, potatoes, pastry and sweets 
is almost wholly lacking in all three of the food essentials men- 
tioned. 
The expectant mother should take at least a full quart of 
milk daily. The diet should be substantial. Pastry and tidbits 
as well as tea, coffee and condiments must be strictly avoided. 
Flesh foods are not needed, and are likely to do much harm. 
The same is true of meat extracts and bouillons. The flora should 
he changed and kept changed, so as to lighten the work of the 
kidneys as much as possible. Especial attention should be given 
to this during the last weeks of pregnancy as a preparation for 
the final ordeal. By this means some of the greatest perils of 
childbearing may be almost certainly avoided. 
The intake of food by the expectant mother near time for 
confinement should be at least 10 per cent, greater than that of DIET IN WOMAN’S DISEASES 
877 
the non-pregnant woman under like conditions. A tendency to 
overfatness will demand restriction to actual' requirements. 
Free water drinking is likewise important as an aid to free 
elimination. The water intake, aside from the water of the food, 
should be at least three or four pints daily. 
Especial attention must be given to the bowels. By three 
daily bowel movements and care to thoroughly empty the colon 
every day, intestinal putrefactions may be suppressed and the 
danger of serious complications greatly lessened. The expectant 
mother should adhere closely to an antitoxic and laxative diet 
(see Index), should make free use of bran and paraffin oil and 
if necessary should resort to the use of the daily enema. 
Nuts and nut preparations may be used quite freely with 
advantage, especially during the last weeks of pregnancy, to en- 
courage a liberal production of milk (Hoobler). 
DIET OF THE LYING-IN WOMAN 
The lying-in period is one of the most critical in a woman’s 
life experience. By proper feeding, serious dangers may be 
warded off. In general, the directions already given for the feed- 
ing of the expectant mother should be followed by the lying-in 
woman. During the first two days, the diet should be light, con- 
sisting chiefly of ripe fruits, fruit juices, purees of vegetables, 
oatmeal porridge with bran, buttermilk and baked or mashed 
potatoes. Spinach is especially indicated. Meats must be wholly 
excluded and eggs may be omitted with advantage for a few days. 
Three ounces of milk sugar three times a day for the first four or 
five days aid in keeping the intestinal flora in good condition. 
The aim should be to make the diet sufficiently laxative to insure 
three bowel movements a day without the use of laxative drugs 
other than paraffin oil with bran or agar. Buttermilk prepared 
with the B, acidophilus ferment and whey cultures of the same 
are especially to be recommended. Copious water drinking, two 
or three quarts in twenty-four hours, greatly protects the kidneys 
by encouraging elimination of toxins. 
Some authors forbid the use of fruits for lying-in or nursing 
mothers, particularly very acid fruits, because they are likely 
to produce colic in the infant. It is doubtful whether this notion 
is well founded; but when any fruits are found to disagree with 
the mother or the infant they should naturally be excluded from 
the diet. 878 
THE NEW DIETETICS 
DIET IN ECLAMPSIA 
The colon should be thoroughly emptied by repeated enemas. 
Milk sugar should be given in doses of three ounces three times 
a day for a few days to change the intestinal flora. It is well 
also to administer enemas containing two or three ounces of milk 
sugar or malt sugar to the pint of water to suppress intestinal 
putrefactions. Fasting is a measure of value. It is especially 
important to suppress proteins, particularly animal proteins. Eggs 
and meats of all kinds should be carefully suppressed. Fruit 
juices and purees and sugar water are the only foods permissible. 
A hot blanket pack followed by vigorous cold towel rubbing is a 
measure of great importance. It may be repeated two or three 
times a day. 
DIET IN LEUCORRHEA 
The most common of all female disorders is unquestionably 
influenced by diet. Thousands of women suffer constantly from 
vaginal discharges without seeking relief, because of the wide 
prevalence of the notion that such discharges are so common as 
to be of little consequence except from the inconvenience they oc- 
casion. The fact is, all discharges of this sort are due to infec- 
tion. The source is, in many cases, germs derived from the colon. 
On inquiry, it is found almost invariably that very obstinate con- 
stipation exists. 
Local applications for the cure of the leucorrhea will achieve 
only temporary success, so long as the constipation resulting in 
intestinal toxemia continues. By changing the intestinal flora 
and training the bowels to move in a natural three-a-day manner 
and topical application of appropriate measures, the discharge can 
be made to disappear very quickly in many cases. In some cases, 
however, the infection has penetrated so deeply as to involve the 
neck of the womb, and in these cases, when the infection of the 
cervix uteri has reached an advanced stage, some simple surgical 
measure may be necessary in addition to proper feeding. 
The anemia which exists in quite a large proportion of these 
cases demands a dietary rich in iron, hence grains should be very 
freely used. White bread and other denatured cereal foodstuffs 
should be discarded. Dietetic Management of 
Fevers 
The recognition of the fact that in fevers a state of general 
acidosis exists, has led to a radical change in the general method 
of dietetic management of this class of maladies. The old plan of 
starving fever patients was most unwise as it encouraged to a 
high degree the development of acidosis. Equally objectionable 
was the gross feeding with meats and miscellaneous foodstuffs 
advocated forty or fifty years ago when Brand was demonstrating 
the value of the hydriatic method of treating fevers, especially 
typhoid fever. Incomplete oxidation and acidosis may result 
either from excess of food or from starvation. 
Probably no other measure can do more for the ameliora- 
tion of the patient’s sufferings and his safeguarding against com- 
plications than appropriate regulation of the dietary. The nor- 
mal functions of food are to supply the body with fuel and with 
material for tissue repair. Certain foodstuffs, particularly pro- 
teins, when supplied in more than the amount needed for re- 
pairs act as stimulants or excitants and cause an enormous and 
most unprofitable loss of energy, far exceeding in amount that 
actually devoted to useful work. Carbohydrates are the most 
economical of foodstuffs, as they require the least expenditure 
of energy, and give most in return for the energy expended. 
Malt sugar and the sugars of fruits and fruit juices are the foods 
par excellence for fever cases because of the ease with which 
they are appropriated and because they are least stimulating and 
also supply alkaline residues which neutralize the disturbing acids 
always present and leave behind no toxic residues. 
Milk sugar and dextrin or lacto-dextrin are the best carbo- 
hydrates for combating the intestinal infection and putrefactions, 
for the reason that they are slowly absorbed and pass quickly 
through the small intestine, and so are certain to reach the colon 
and to arrive there more quickly than other sugars. Lactose and 
dextrin are the best foods to encourage the growth in the colon 
of the protective organism B. acidophilus, the natural guardian 
879 880 
THE NEW DIETETICS 
of the colon against the dangerous putrefactive organisms always 
present in the colons of adult human beings. 
Lactose, or lacto-dextrin, may be used in liberal quantities; 
that is, six to ten ounces a day, with marked benefit. Torrey 
showed that by feeding these carbohydrates the flora may be 
changed in typhoid fever, greatly to the benefit of the patient. 
Either lactose or lacto-dextrin may be used with advantage in 
place of ordinary sugar for sweetening lemonade and other dilute 
fruit juices. 
In the feeding of fever patients, one of the first considera- 
tions is an abundance of water to dilute and carry away the 
toxins through the kidneys. From four to six quarts of fluid 
are needed daily, by mouth or per rectum or both. This is a mat- 
ter of the highest importance. A glassful of water should be 
given every half hour when the patient is awake. The patient 
often objects, but must be induced to take the amount required. 
Weak lemonade or diluted fruit juices, of any agreeable sort, are 
ideal fever beverages. Lacto-dextrin, two ounces to the pint, is 
a pleasant and i>erhaps the best of all food beverages for a fever 
patient. 
Another indication is to combat the tendency to emaciation. 
This is accomplished by rest, control of the temperature, and the 
liberal feeding of carbohydrates in the form of cereals, fruits 
and fruit juices and malt sugar. 
On account of the tendency to retention of chlorids in the 
tissues, salt should be as far as possible eliminated from the diet. 
Loss of lime, iron and vitamins should be made up by the use of 
fresh vegetables, greens and vegetable broths. The liver and 
kidneys are compelled to do an enormous amount of overwork 
in fever, in the destruction and elimination of poisons produced 
by the fever. On this account the greatest care must be taken 
to avoid adding burdens to these overworked organs, and to 
lessen their work as much as possible by supplying an abundance 
of water and by withholding from the patient anything likely to 
increase renal work. Condiments of all kinds—mustard, pepper 
and vinegar—must be strictly prohibited. Alcoholic liquors and 
tea and coffee are especially damaging because of the poisons 
which they contain. For this reason, also, meat broths, extracts, 
beef tea, chicken broth, etc., must be strictly avoided, as well as 
meats themselves. Because of the special tendency to intestinal 
putrefaction in cases of fever, all foods which have a tendency DIETETIC MANAGEMENT OF FEVER 
881 
to putrefy must be prohibited. This is the reason why not only 
meats of all kinds but eggs must be discarded. 
The substitution of malt sugar for cane is important for the 
reason that this sugar contains much iron, lime and vitamins, not 
found in cane sugar. Purees and other dishes prepared from 
dates, figs and raisins should take the place of dishes sweetened 
with ordinary sugar because of the richness of these fruits in 
iron (see Table XII). Change the intestinal flora with milk 
sugar or lacto-dextrin. 
Special attention should be given to the colon in all cases of 
fever. Even when the bowels are loose, the colon should be 
emptied by an enema twice a day in order to insure against fecal 
accumulation. Except in enteric fevers, bran, agar, mineral oil 
and laxative foodstuffs should be used in quantities sufficient to 
insure efficient action of the colon. Even in typhoid there seems 
to be no good reason why agar and mineral oil may not be used, 
and even cooked bran when constipation is present. 
The amount of food given in fevers should be sufficient to 
prevent great wasting. There is perhaps at the present time a 
tendency to overfeeding. This should be avoided for the reason 
that the liver, the kidneys and associated organs are so greatly 
overtaxed that all rational means should be employed to lessen the 
work required of these poison-destroying and eliminating oragns. 
No harm will be done if the patient loses a few pounds in weight. 
The loss will consist only of adipose tissue and will be readily 
made up when convalescence is established. It is only when the 
loss of flesh is carried to such a degree that the muscles and 
other living tissues are attacked that harm is done. 
Special care should be taken to avoid an excess of protein 
as protein more than any other food element increases the work 
of the liver and kidneys, since any excess of protein must be 
treated like so much waste matter and is passed directly out of 
the body without rendering any service. It also encourages in- 
testinal putrefaction, which has a tendency to increase during 
fever and which enormously increases the burden of the liver and 
kidneys. The free use of lactose or lacto-dextrin will greatly aid 
in suppressing intestinal putrefactions. 
In the selection of food great care must be taken to see that 
there is no deficiency of vitamins, which are notably lacking in 
the ordinary fever diet of gruels, broths, etc. Purees of green 
vegetables and fruit juices, especially orange juice, fresh or 882 
THE NEW DIETETICS 
stewed tomatoes and yeast extracts (Savita), should be freely 
used not only occasionally but several times a day. On account 
of the diminished secretion of hydrochloric acid in the stomach, 
acid fruits are particularly advantageous and may be freely used 
without injury. 
The amount of food eaten should be fully equal to that of 
the base ration of the patient; that is, the amount required for a 
person lying in bed taking no exercise. This would be about 12 
calories per pound of body weight. As the temperature falls, 
the amount of food may be increased. When perspiration occurs 
feeding should be temporarily discontinued or greatly reduced. 
After hemorrhage the feeding should be discontinued for 10 
or 12 hours, after which the first food given should be rice gruel. 
As little salt as possible should be added to the food of fever 
patients. This is important for the reason that the kidneys are 
already overtaxed with the elimination of the enormously in- 
creased body wastes together with the specific poisons which are 
produced by the bacterial cause of the fever. 
Foods Which May be Used in Fevers. 
All fruit juices, fresh if possible 
Apple juice 
Orange juice 
Lemonade with malt sugar 
Watermelon juice 
Cantaloup 
Raspberry juice 
Pear juice 
Grape juice 
Fruit soups 
Fruit purees 
Fresh, ripe fruits 
Banana puree 
Soaked prunes 
Malt sugar 
Cereals: 
Rice 
Wheat flakes 
Gruels of oatmeal, cornmeal, 
granola, 20 per cent, gluten, 
rice meal 
Vegetables: 
Cucumbers 
Lettuce 
Purees 
Vegetable broths 
Vegetable purees 
Buttermilk 
Nuts: 
Blanched almonds 
Nuttolene 
Malted nuts 
Almond cream 
Acidophilus buttermilk, lacto-dextrin. DIETETIC MANAGEMENT OF FEVER 
883 
Foods to be Avoided in Fevers. 
Foods which must be strictly prohibited in fevers are meats 
of all sorts—fish, flesh, fowls, oysters, etc.—eggs, mushrooms, 
pickles, cheese, condiments, much salt. 
Acute Infectious Fevers. 
The dietetic indications in the several infectious fevers are 
essentially identical. Fever diet is indicated in all. In scarlet 
fever and diphtheria, bland foods must be employed when the 
throat is sore. Rice gruel is especially indicated. In cases of 
post-diphtheritic paralysis in which the patient is unable to swal- 
low, the food must be administered with a small feeding tube. 
A laxative and reconstructive diet is indicated as soon as the 
fever patient is able to eat. If for some days during the height 
of the disease the patient refuses gruels and similar foods, 
strength may be maintained by the free use of sugar water. The 
latter is prepared by adding two ounces of malt sugar or milk to 
a pint of water. The sugar water may be taken by the stomach 
or by enema, or both. 
In scarlet fever the amount of protein in the diet should be 
very greatly reduced. Eggs must be wholly excluded and milk 
should be used very sparingly if at all. No harm will be done if 
the patient’s diet consists almost exclusively of fruit juices and 
lactose or malt sugar for a few days. 
Whooping Cough. While the diet in this disease is essen- 
tially the same as in other fevers, a special difficulty arises in the 
fact that the violent coughing often induces vomiting and loss of 
a large part of a meal which may have just been eaten. Any dis- 
turbance of the stomach likewise has a tendency to increase the 
coughing, so a sort of vicious circle is formed. The food must 
be appetizing, but bland and lukewarm. If either hot or cold, 
violent coughing may be induced with vomiting. Gluten gruel, 
vegetable broths, rice, rice gruel, oatmeal gruel, cream toast, 
brose and breakfast cereals with bran are foods especially suit- 
able to this condition. When the coughing is violent, the child 
should be kept in bed for two or three days if necessary until 
the paroxysms are less intense. The patient should be kept in 
the open air practically all the time. 
Poliomyelitis. The dietetic indications are the same as in 
typhoid and other fevers. 
Other Fevers. The regular fever diet is also indicated in 884 
THE NEW DIETETICS 
yellow fever, malarial fever, relapsing fever, sleeping sickness, 
and plague. In malarial fevers care should be taken to avoid 
giving food just before the time of an expected chill. 
In smallpox, as in scarlet fever, the protein should be re- 
duced very low because of the great tendency to nephritis. 
In foot and mouth disease, rice will be especially grateful 
to the patient as it is bland and absolutely unirritating and can 
be swallowed with less distress than almost any other food. 
Cholera. During the acute stage of the disease, the patient 
should take nothing but water or water containing a small pro- 
portion of sugar, say an ounce of malt sugar or lactose to the 
pint. Notwithstanding the persistent vomiting the patient should 
drink copiously. The effect will be to dilute the poisons of the 
stomach and to wash out infectious material. At the same time 
large enemas should be administered. Cold rubbing combats 
shock and promotes the skin circulation. If vomiting and purg- 
ing continue to an extreme degree, liquids may be introduced by 
intravenous injection of glucose in Ringer’s solution, and it is 
possible in an extreme case that life may be saved by transfusion 
of blood, an operation which has now become quite common 
since the dangers and inconveniences have been practically elimi- 
nated by the discovery of a method by which a suitable donor 
may be selected. The intravenous injection of dextrose is the 
most efficient method of combating acidosis. Milk sugar with 
B. acidophilus in larger doses should be tried. 
Typhoid Fever. This disease presents typical indications 
for the fever diet. Alcohol, eggs and animal broths, as well as 
meat and fish should be prohibited in this disease. Rice, strained 
oatmeal, granola, toasted flakes of various sorts, zwieback, stewed 
fruit, fruit juices, and especially purees of greens, potatoes and 
other vegetables should be given the patient in such quantities as 
to furnish about 2,000 to 2,500 calories daily. When this is done, 
the great loss of flesh which often occurs in this disease will not 
take place, the disease will run a shorter course and convales- 
cence will be more rapid. 
Torrey has shown (1915) that by the feeding of 8 to 10 
ounces of milk sugar (900-1100 calories) the intestinal flora of 
typhoid fever patients may be changed from the ordinary, mixed 
type with putrefactive flora dominant to an acidophile flora with 
B. acidophilus dominant. Such a change is exceedingly advan- 
tageous to the typhoid fever patient by the suppression and ab- DIETETIC MANAGEMENT OF FEVER 
885 
sorption of putrefaction products which increase the labor of the 
kidneys, already enormously overtaxed in dealing with the 
typhoid toxin, the specific product of the typhoid bacillus. Excel- 
lent results may be obtained by administering large doses of 
milk sugar or lacto-dextrin. The latter is preferable to lactose 
for the reason that it is more agreeable to the patient, less liable 
to cause disturbance of the stomach and presents, besides the 
carbohydrates, lactose and dextrine, the antiscorbutic vitamin C. 
This method not only changes the intestinal flora but supplies 
the patient with a considerable amount of nutritive material of 
exactly the sort needed as has been shown by Coleman. 
Milk is not a good routine diet for use in typhoid fever. It 
often promotes intestinal autointoxication through the retention 
in the colon of considerable quantities of undigested curds. Whey 
cultures of B. acidophilus are especially valuable in typhoid feed- 
ing. Cautley commends whey as a substitute for milk. Milk 
sugar may be added with advantage, two ounces to the pint. 
Four to six pints may be taken daily. Malted nuts, lentil soup, 
the fruit soups of the Germans, and savita are of special value. 
Typhus Fever. The dietetic requirements of this disease are 
the same as those indicated in typhoid. Fruit juices, sugar 
water, malt or milk sugar, boiled rice and oatmeal gruel are the 
most appropriate foods. 
The great loss of water through vomiting must be made 
good by the regular introduction of water into the colon at fre- 
quent intervals. Lactose or malt sugar should be added to the 
water in proportion of one ounce of sugar to the pint. This sugar 
water should be taken by mouth in the intervals between the 
vomiting spells. 
Erysipelas. The dietetic indications are the same as in 
typhoid and other fevers. 
Influenza. The diet requirements are the same as in pneu- 
monia and typhoid. Alcohol should be avoided as also meat 
extracts and broths. 
Mumps. The diet should be the same as in other infectious 
fevers. Food is best taken in liquid form and by the aid of a 
large feeding tube, which minimizes the use of the jaws. The 
necessary intake of bran or roughage and paraffin oil for lubri- 
cation should not be neglected. 
Pyemia. The diet should be strictly antitoxic. Fruit juices 
and sugar water should be used in sufficient quantity to give the 886 
THE NEW DIETETICS 
patient 16 to 18 ounces of carbohydrate daily. A carbohydrate 
diet greatly aids in promoting resistance. 
Tetanus. The diet in lockjaw should be the same as that 
in other febrile diseases. On account of the difficulty in moving 
the jaws, liquid diet is especially indicated as in mumps. Milk 
sugar and malt sugar should be freely taken in solution in water 
or in whey. When swallowing is seriously interfered with, food 
and drink may be introduced into the stomach by means of a 
small tube passing through the nose or the duodenal feeding 
tube. 
PNEUMONIA AND PLEURISY 
In lobar pneumonia, bronchial pneumonia and other forms 
of inflammation of the lung tissue as well as in pleurisy, the 
fever diet should be employed (see index). 
There seems to be at present a decided tendency to overfeed- 
ing in pneumonia. Nothing could be more absurd than the advice 
of some authors to feed pneumonia patients every two hours 
night and day, giving in the aggregate an amount of food suffi- 
cient to support an able-bodied laboring man. Pneumonia is a 
disease of short duration and on this account the withholding of 
food almost entirely for two or three days would do no par- 
ticular harm. It is most of all important to withhold proteins. 
Carbohydrates may be used freely in the form of fruit juices, 
malt sugar or, better, lactose or lacto-dextrin. This will furnish 
just the sort of material the body needs to support the heart 
action and to combat putrefactive changes with toxin production 
in the intestine. Gastric acid is low in amount in pneumonia as 
well as in other fevers, hence fats should be used very sparingly 
and preferably in the form of cream. 
In addition, it should be noted that in inflammation of the 
lungs, especially in lobar pneumonia, there is a marked tendency 
to retention of sodium chlorid. Hence, common salt should be 
omitted from the food until it re-appears in the urine. Meat, meat 
broths and extracts as well as eggs should be rigorously excluded 
in this disease. Copious water drinking to the extent of three or 
four quarts daily is most important. 
After the attack is over, the restorative regimen should be em- 
ployed to aid in the building of blood and tissues and to restore 
the tissue salts. 
In empyema, hay fever and other chronic febrile conditions DIETETIC MANAGEMENT OF FEVER 
887 
of the lungs and air passages, the fever diet should be followed 
closely during periods when there is a rise of temperature, and 
in the intervals the reconstructive diet should be employed. Milk, 
cottage cheese, buttermilk, butter, greens, potatoes, rice, fresh 
fruits and vegetables of all sorts, especially in the form of purees 
and soups, constitute a suitable diet for cases of this sort. 
The bill of fare should be varied from day to day so as to 
promote appetite, but too many different kinds should not be 
taken at the same meal. The quantity of food should be 25 to 50 
per cent, more than the amount needed for a maintenance ration, 
so as to secure a gain in flesh until the normal weight has been 
attained or slightly exceeded. 
Malt sugar and malted nuts and other malted preparations 
are especially useful in promoting flesh-building. 
Pleurisy with Effusion. 
The diet should be very low in protein, not more than one 
calorie per pound of body weight. Salt should be wholly ex- 
cluded from the diet. Suppression of intestinal putrefactions 
by the use of lactose or lacto-dextrin will greatly facilitate re- 
covery. The bill of fare should be so arranged as fo give the 
patient an abundant supply of vitamins and food salts. 
DIET IN ASTHMA 
There are various forms of asthma, all of which are charac- 
terized by obstructed breathing and all are unquestionably in- 
fluenced more or less by diet. A person who is subject to asthma 
from any cause whatever is liable to experience an attack, espe- 
cially after overeating. Eating heartily at night is likely to bring 
on an attack during the night. This is true of persons in whom 
the real cause of the attacks is reflex, as from adenoids or other 
diseased conditions of the nasal cavity and in cases of so-called 
cardiac asthma, as well as in cases in which the disease is primar- 
ily due to errors in diet. 
In the writer’s experience, fully nine-tenths of all cases of 
asthma may be attributed to intestinal toxemia, or autointoxica- 
tion. Constipation, with the coated tongue, foul breath, sallow 
complexion and highly colored urine, which accompany intense 
toxemia, is a prominent feature in nearly all cases of chronic 
asthma. Changing the intestinal flora and normal colon activity 888 
THE NEW DIETETICS 
will secure prompt and permanent relief in a great majority of 
cases of chronic asthma of adults. The bowels must move three 
times a day and the colon must be kept so thoroughly free from 
decomposing residues that the stools will be free from putrid 
residue or ammoniacal odors. 
A laxative, antitoxic diet (see Index) and the continued use 
of lacto-dextrin will suppress intestinal putrefactions and thus 
relieve the lungs of the irritation produced in the pulmonary 
mucous membrane by the effort to remove from the blood through 
this channel offensive gaseous poisons developed in the breath. 
The fecal odor of the breath in many asthmatics is very pro- 
nounced. The attacks become less frequent and appear only 
when the stools become putrid through errors in diet or neglect 
to keep the colon free from putrefying residues. 
Meats must, of course, be discarded. Eggs, if eaten at all, 
must be eaten sparingly and great care must be taken to make 
sure that they are perfectly fresh. It is difficult and requires as 
assiduous attention to keep the colon free from pernicious organ- 
isms as to keep a garden free from weeds. 
A warm enema should be taken at night to make sure that 
the colon is completely evacuated, until constipation has been 
fully corrected and the colon kept free from debris by three free 
bowel movements daily. The enema at night does not interfere 
with the morning evacuation, but, rather, aids by preventing 
constant over-distension of the colon, by which its walls are weak- 
ened by the production of ammonia and other poisonous products 
which paralyze the bowel, and by leaving in the colon more or 
less water, which prevents the excessive drying out of the fecal 
residues. When the lower part of the colon is filled, the contents 
often become so dried out and hardened over night as to render 
the morning movement difficult or impossible. Any possible ill 
effect of the repeated use of the warm enema may be wholly 
obviated by introducing into the colon a half-pint of cooler 
water (80° F.), at least a portion of which may be retained with- 
out inconvenience. 
In many cases, asthmatic attacks are in the form of anaphy- 
laxis (see Index). Hay fever is a notable example of this sort. 
Asthmatic attacks may be induced by the inhalation of various 
substances to which the body has been sensitized, as dust from 
horses, cats or other animals, the odor from feathers, etc. It is 
probable that many poisons of this sort are produced in the colon. DIETETIC MANAGEMENT OF FEVER 
889 
In many cases, the asthmatic is found to be sensitized to 
certain foods. 
In all cases of asthma Ewald’s test for liver efficiency should 
be employed (see Index). A positive reaction is regarded by 
Ewald as proof that the patient is sensitized to protein. This fact 
having been ascertained, such sensitivity tests should be applied. 
Fish, milk, strawberries and many other foods, have been 
shown to be the cause of the attacks in individual cases. The 
writer is very confident, also, that in not a few instances the 
poisons produced in the colon act in a similar manner. By the 
application of special tests which are now available, the particular 
kind of foods which give rise to the attacks may be discovered. 
These foods should be avoided and by carefully graduated train- 
ing, the sensitivity should be overcome. Persons who suffer 
from Bright’s disease are frequently subject to asthma, which is 
also, in the writer’s opinion, often associated with impairment of 
the liver function. In these cases, especial attention must be 
given to changing the intestinal flora and avoiding toxic foods of 
all sorts. 
Strong coffee and alcohol are recommended by many writers 
on dietetics for temporary relief in case of asthmatic attacks. The 
writer is thoroughly convinced that these drugs are highly detri- 
mental and should be carefully avoided in all cases of asthma. 
When temporary relief is afforded, which is by no means often 
the case, it may easily lead to the formation of a drug habit the 
result of which will be to make matters only worse rather than 
better. Diet in Chronic Infections 
PULMONARY TUBERCULOSIS 
It must be frankly conceded that there is no specific dietary 
adapted to tuberculosis as in diabetes and in certain other mala- 
dies. The important thing is to build up the patient’s nutrition 
to the highest level possible. 
The general indications are for a diet rich in fats and carbo- 
hydrates, vitamins, iron and lime, and sufficiently bulky to secure 
three or four bowel movements daily. When necessary, agar as 
well as bran should be added to the dietary and mineral oil 
should be taken before and after each meal. 
Malt sugar in the form of syrup, combined with olive oil or 
butter or cream, is perhaps the most efficient of all food combi- 
nations in promoting the development of fat. Malt sugar is 
much better tolerated and more readily absorbed and utilized 
than any other form of sugar, and it is tolerated in much larger 
quantities than is cane sugar. Fats when combined with malt 
sugar, are much more readily tolerated and do not cloy the appe- 
tite as they are otherwise likely to do. In equal quantities, malt 
sugar syrup (Meltose) and butter make a very palatable combi- 
nation and one which can be taken at every meal and in consider- 
able quantities, and which will rapidly secure a substantial gain in 
weight. 
On a dietary such as is here suggested, a gain of a pound 
a day is frequently secured, and the weekly gain for a short time 
may be as much as eight or ten pounds. 
It is more than probable that a deficiency of vitamins in 
the diet encourages the development of pulmonary tuberculosis 
and other diseases which result from low vital resistance . 
In many cases the milk regimen (see Index) is advantageous. 
When the tongue is coated and the breath foul, indicating auto- 
intoxication, the fruit regimen (see Index), should be employed 
for a few days to change the intestinal flora before starting the 
milk regimen. 
Buttermilk prepared with the B. acidophilus may be freely 
used with great advantage. About three pints of buttermilk a 
890 DIET IN CHRONIC INFECTIONS 
891 
day is required to influence the intestinal flora to a marked ex- 
tent. Practically every tuberculous patient may be substantially 
benefited by a change of the intestinal flora. There is no way in 
which the curative functions of the body can be more efficiently 
reinforced than by eliminating the poisons arising from the 
putrefaction of food residues in the colon. By the methods pre- 
sented elsewhere in this work this may be easily and quickly 
accomplished. 
It is now well known that milk proteins are equal if not 
superior to meat proteins and are more easily assimilable. One 
quart of milk daily will certainly supply to any consumptive all 
the real value he can possibly receive from the usual daily intake 
of meat, and in better form. Several quarts may be taken if 
needed. 
The tendency of tuberculous patients to renal disease (86 
per cent.) is a most weighty reason for lessening intestinal toxins 
by withholding meats. 
Says an authoritative writer in the Journal of the American 
Medical Association: “The favorable course of many cases of 
pulmonary tuberculosis is interrupted by attacks of intestinal 
toxemia. The diagnosis of this complication is absolutely neces- 
sary for success in the treatment of tuberculosis.” 
There has been a marked tendency on the part of the ma- 
jority of those who have given special attention to the treatment 
of this class of patients to insist upon overfeeding as the most 
efficient method of combating the wasting disease. 
This is certainly a serious error. No patient can be benefited 
by an amount of food in excess of his needs, that is, an amount 
sufficient to maintain his weight at the normal average. An excess 
of food throws an enormous amount of extra work upon the 
organism. Not only the liver and kidneys are overburdened, but 
the lungs also are required to do an extra amount of work in the 
elimination of the oxidized products of the surplus food. Sur- 
plus food increases the tendency to a rise in body temperature. 
This is particularly true of protein, which produces wasteful 
metabolism to the amount of 30 per cent. 
Certain specialists have demanded a very high protein diet, 
which in a few instances comprised not less than 1,000 calories of 
protein per diem, or more than five times as much as the normal 
requirement according to the standards of Chittenden, Sherman 
and Folin. Some years ago an institution was started in Ger- 892 
THE NEW DIETETICS 
many which undertook to feed the tuberculosis patient on an 
exclusively flesh diet, and in this instance the diet was not only 
wholly made up of meat but of raw meat. It is hardly necessary 
to add that the enterprise was a complete failure, in fact col- 
lapsed within six months of the opening. 
For many years the writer has urged the employment of a 
low protein regimen as best adapted to tuberculosis cases. Some 
of the dangers of the high protein regimen are pointed out in 
the following paragraphs. 
The marked tendency of the tuberculosis patient to loss of 
flesh and to the development of anemia has naturally directed 
special attention to the importance of encouraging the fat-build- 
ing and blood-making processes of the body. But there are 
other indications which are equally deserving of attention and 
which should be permitted to influence the dietetic management 
of these cases. The materials ingested must be metabolized and 
eliminated as well as digested and absorbed. Incidentally, while 
undergoing digestion, they may also undergo fermentations and 
putrefactions which may so change their nature as to render 
them not only useless as nutrients but toxic and in the highest 
degree damaging. Hence the welfare of the liver and other 
toxin-destroying glands and of the kidneys, poison-eliminating 
glands, must be considered as well as the need of the organism 
for an increase of adipose tissue. 
A simple increase in the thickness of the panniculus adi- 
posus cannot be of any very great advantage to a man whose 
body has been invaded by a vast army of tubercle bacilli. Be- 
fore the infection took place there had been a depreciation in 
vital resistance, a deterioration of tissue and function which made 
the invasion possible, and with each advance of the disease this 
weakening of the ability of the organism to battle against its foes 
is increased. Recovery can be secured only by improving the 
integrity of tissue and function to such a degree that the ability 
of the organism to combat its assailants will be raised higher 
than before the invasion occurred. 
The average subject of tuberculous infection presents a 
number of special pathological conditions which must be consid- 
ered in preparing a therapeutic regimen. Among these may be 
especially enumerated the following: 
1. Diminished Alkalinity of the Blood (Lawrason Brown). 
—This signifies diminished vital resistance, diminished efficiency DIET IN CHRONIC INFECTIONS 
893 
of the blood as a germicide, diminished power to develop im- 
munity, diminished power to repair damaged tissues, diminished 
power to oxidize wastes. Anything which tends still further to 
diminish the alkalinity of the blood must be to that degree a 
hindrance, rather than a help, in the battle of the organism 
against the tubercle bacillus. One of the notable and constant 
efifects of a high protein dietary is to diminish the alkalinity of 
the blood. 
2. Diminished Hepatic Efficiency—In consumption the liver 
is nearly always seriously crippled. Ulldom declares that passive 
congestion of the liver is found in nearly every case of pulmonary 
tuberculosis. This is the natural result of diminished respiratory 
activity, since the venous circulation of the liver is largely in- 
fluenced by the movements of the chest in respiration. To the 
evidences of chronic passive congestion of the liver are added, 
according to Ulldom, many other evidences of a lowered vital 
state in this organ, among which are amyloid and fatty degenera- 
tion, tuberculous infection, and fibrosis or cirrhosis. Ulldom 
expresses the opinion that fibrosis of the liver is not due to the 
tubercle bacillus, but to other etiological factors. Boix and others 
have shown what these factors may be. xA.ccording to Boix the 
toxins formed as a result of putrefactive processes in the intestine 
are the chief cause of hepatic fibrosis. He was able to produce 
cirrhosis of the liver in rabbits by mixing with their food cultures 
of colon bacilli and also by feeding them extracts of feces. 
That a high protein ration, that is, a dietary consisting largely 
of flesh foods, favors hepatic congestion is a fact long known 
to physicians. A diet which encourages intestinal putrefaction 
and an abundant anaerobic flora in the intestine must in the 
highest degree encourage hepatic congestion and various func- 
tional and organic changes in the liver, and thereby break down 
this important defensive barrier and prepare the way for invasion 
by the tubercle bacilli. It need not, then, be a matter of surprise 
that Ulldom found in thirty-seven autopsies in cases of pulmonary 
tuberculosis a tuberculous condition of the liver in 81 per cent, 
of the cases. Fatty degeneration of the liver was found in 24 
per cent, of the cases, and in only two cases (5.4 per cent.) was 
the liver found approximately normal; that is, the liver was 
found diseased in 94.6 per cent, of the cases. Arnold reported 
tuberculosis of the liver as an almost constant finding in pul- 
monary tuberculosis. Simmons found 78 per cent. 894 
THE NEW DIETETICS 
The passive congestion of the liver which naturally results 
from the overwork of the right heart and the diminished mobility 
of the chest, together with the special exposure of the liver to 
infection through the portal circulation and the extra work re- 
quired of it in metabolizing the excessive nitrogenous waste 
which accompanies the febrile stage of pulmonary tuberculosis, 
certainly suggest the importance of guarding the integrity of this 
vitally important organ in every possible way, and contraindi- 
cate a high protein dietary which imposes exaggerated and un- 
necessary hepatic work. 
3. Degeneration of the Thyroid Gland.—Entirely in har- 
mony with the considerations presented above is the interesting 
fact to which Roger, Gamier, De Quervain, Sarbuch, and others 
have recently called attention, viz., the occurrence of general 
sclerosis of the thyroid gland without tuberculous lesions of the 
gland itself in cases of tuberculosis affecting other parts of the 
body. 
In a case of tuberculosis of the lungs reported by Carnot and 
Delion, death occurred from tetany, and post-mortem examina- 
tion showed caseous degeneration of the parathyroids. This con- 
dition of the thyroid and parathyroid is attributed to “the effect 
of the action of the diffusible toxins produced by the tubercle 
bacilli.” It is well known that other toxins, especially those 
produced by putrefactive changes in the intestine, are capable 
of producing diseased conditions of the thyroid, the natural re- 
sult of the overwork of the glands occasioned by excessive sat- 
uration of the blood with these toxic substances. 
The enormous burden added to the labor of the defensive 
organs of the body by a high protein diet, and the great injury 
which must result when these organs are weakened, is illustrated 
by what happens when certain toxin-destroying glands are re- 
moved from the body or rendered functionally inactive. It is 
well known, for example, that the removal of the thyroid gland 
(Breisacher, 1890) of a dog is quickly followed by the death of 
the animal if it is fed upon a meat diet, while life is prolonged 
indefinitely and the animal enjoys good health when fed upon a 
diet of bread and milk. When such a dog is fed upon meat which 
has been well boiled, it suffers less and lives much longer than 
when fed upon raw meat, evidently because of the removal of 
poisonous meat extractives in the boiling. Blum holds that the 
function of the thyroid gland is to neutralize poisons derived DIET IN CHRONIC INFECTIONS 
895 
from the putrefaction of albumin in the intestine. Kishi holds 
that the thyroid destroys a poisonous substance, a nucleo-protein 
which is formed in the intestine after the ingestion of meat. 
These facts are alone sufficient to condemn a high protein or 
flesh diet in a disease in which the thyroid gland is already over- 
worked, and in which it is likely to be seriously crippled. Is it 
not possible, indeed, that the effect of such a diet in a case of 
pulmonary tuberculosis with degenerated thyroids may be almost 
as pernicious as in dogs deprived of their thyroids? 
In the ingenious Eck fistula experiment an anastomosis is 
made between the portal vein and the vena cava, a ligature being 
applied to the portal vein close to the liver, thus cutting out the 
liver from the portal circuit. A dog thus prepared and fed upon 
meat dies in three days; when fed upon a diet of bread and milk, 
the animal lives in excellent health for an indefinite length of 
time. The urotoxic coefficient of such a dog was found to be 
increased to nearly three times the normal after the tying of the 
portal vein, from which the conclusion may be drawn that with 
a high protein meat diet the poison-destroying work of the liver 
and of the body is three times as great as on a low protein or 
non-flesh dietary. 
4. Disease of the Adrenals.—Authorities agree in regard to 
the great frequency with which the adrenals are involved in con- 
nection with tuberculous affections of the lungs. The relation 
of these glands to oxidation, to general vital resistance, and to 
the toxin-destroying functions of the body gives great signifi- 
cance to this fact. Behring showed that blood serum (sheep’s) 
possessed sterilizing properties far superior to those even of the 
stronger solutions of carbolic acid and corrosive sublimate, which 
were formerly employed in surgical operations. This property of 
the blood being, very probably, largely due to the adrenals as well 
as the ability of the blood and tissues to oxidize or destroy toxins. 
It needs no argument to indicate the importance of promoting 
intestinal asepsis in all possible ways in pulmonary tuberculosis, 
and especially by avoiding a dietary which must flood the blood 
and the tissues with toxic products to an extraordinary degree, 
thus weakening or destroying its bactericide properties. 
5. Concurrent Disease of the Kidneys.—Drs. Flick and 
Walsh state that “nephritis occurs very frequently in tubercu- 
losis.” Among the causes they mention the effects of “the toxin 
excreted through the kidneys from lesions elsewhere.” Grancher THE NEW DIETETICS 
896 
and Martin produced nephritis in dogs by attempts to establish 
immunity with increasing doses of tubercle bacilli. “The longer 
the animal lived and the higher the resistance it attained, the 
greater were the chances of nephritis.” Drs. Flick and Walsh 
regard nephritis as “one of the complications in tuberculosis 
most to be dreaded”; especially “because it is a complication 
which comes through the very process which leads to recovery, 
namely, immunization.” These eminent observers assert that 
“many patients with tuberculosis die by way of nephritis as the 
real cause of death,” and indicate as the symptoms pointing to- 
ward nephritis “a pasty skin, unusual fatigue upon slight exer- 
tion, shortness of breath, high specific gravity of urine, hyalin and 
granular casts, albumin, etc.” 
The above observations are certainly impressive. They sug- 
gest most emphatically that the tuberculous patient should be 
treated and fed not simply with reference to disease of the lungs, 
but with reference to the possible complications involving other 
vital organs which may occur, especially disorders of the kidneys 
and also of the liver because of its close association with the kid- 
neys in protecting the body against toxins. 
The Third Annual Report of the Phipps Institute 1905, con- 
tains an exceedingly interesting resume by Joseph Walsh of the 
autopsy findings, from which it appears that 84 per cent, of the 
cases showed chronic changes in the kidneys. Tuberculosis of the 
kidneys was observed in 58 per cent., or about two-thirds of the 
cases in which the kidneys were afifected. In the other one-third, 
the changes were wholly due to the excessive amount of toxins 
which the kidneys were compelled to eliminate. 
In the face of such facts it would seem to be quite unneces- 
sary to urge the necessity of exercising every possible care to 
avoid excessively taxing the kidneys, not only by suppressing 
irritating condiments, the importance of which is recognized, but 
by avoiding any unnecessary increase of the nitrogenous wastes, 
of which the kidney is the chief outlet. 
It seems proper then to raise the question whether the feed- 
ing of large quantities of protein in tuberculosis may not aggra- 
vate one of the most grave and incurable of the lesions incident 
to this malady. Indeed, we may even inquire whether a high 
protein dietary may not be very largely responsible for the great 
number of cases of renal disease observed as a complication of DIET IN CHRONIC INFECTIONS 
897 
pulmonary tuberculosis. Certainly it cannot be denied that the 
kidneys must be considered when arranging the bill of fare of 
the patient suffering from phthisis pulmonalis. 
Every modern author on the dietetic treatment of renal 
disease insists that the amount of work required of the kidneys 
must be diminished as much as possible, and that hence the pro- 
portion of protein should be reduced, that the extractive matters 
of meats should be especially avoided, and even that the amount 
of sodium chlorid should be reduced to the minimum. Hutchi- 
son urges that flesh foods should be allowed only in very small 
quantity in renal disease, and advises that the proteins should 
be “derived largely from vegetable sources.” Freidenwald and 
Ruhrah entirely prohibit strong meat broths and beef teas, and 
reduce the protein to 30 or 40 grams. They also limit the chlorid 
of sodium and state that “meat should be used cautiously.” 
This is good advice as far as it goes, but there is certainly 
no justification for permitting meat to be used even “cautiously.” 
The reasons given for prohibiting meat broths, beef tea, and re- 
ducing the protein, are good and sufficient reasons for excluding 
meats altogether. 
Hirschfeld emphasized the inability of the diseased kidney 
to eliminate nitrogen. The diseased kidney is like an obstructed 
filter. With a diet of 70 grams of albumin a healthy kidney elim- 
inates 10.1 grams of nitrogen, the diseased kidney 9.3 grams. 
When the albumin ration is increased to 130 grams, the healthy 
kidney eliminates 14.5 grams, and the diseased kidney only 11.7 
grams. When the ration of 130 grams is continued for a few 
days, the disproportion increases, the diseased kidney eliminat- 
ing only 12.7 grams, while the healthy kidney eliminates 18.6 
grams. Thus the diseased kidney under a ration furnishing 533 
calories of protein — considerably less than the amount often 
given consumptives—is able to eliminate only two-thirds of the 
nitrogen intake. 
It is evident, then, that the consumptive patient who is fed 
on a high protein diet is thereby not only rendered more liable 
to fatal hepatic and renal complications, but through the ac- 
cumulation of the retained products of protein metabolism all 
his functions are hindered and all his tissues are exposed to a 
damaging influence. 
Gautier emphasizes the necessity of reducing, in renal dis- 
ease, “the toxins and other offensive products to the minimum 898 
THE NEW DIETETICS 
by diminishing the consumption of the food principle from which 
they originate (protein.)” He permits meat in small quantities, 
20 grams of protein, but recommends especially bread and cer- 
eals, cereal soups, purees of vegetables, potatoes, rice, and all 
fruits, giving as the reason that “these foods do not produce, or 
only in very small quantity, urinary toxins.” W. Gilman Thomp- 
son says: “Whatever views may be entertained in regard to the 
causation of albuminuria, it is agreed by all that cooked meats, 
eggs, and highly seasoned foods in general are injurious in all 
cases.” Senator, of Berlin, in cases of serious renal disease 
prefers to prescribe only vegetables, salads, fruits, or an exclu- 
sive milk diet of two liters per diem. It seems a just conclusion 
from the facts presented that the recommendations made in 
relation to diet in renal diseases are equally applicable to cases 
of pulmonary tuberculosis. 
If a high protein ration in general is open to suspicion in 
tuberculosis, a flesh diet is particularly questionable for several 
reasons: 
1. Flesh proteins more readily undergo putrefactive de- 
composition than do vegetable proteins. 
2. Flesh foods as eaten always contain, ready formed, a 
considerable amount of toxins which have resulted from putre- 
factive processes which take place in the flesh after killing, while 
being “ripened” in preparation for the market. 
3. Flesh foods always contain multitudes of putrefactive 
bacteria in active growth, and hence introduce into the intestine 
an agent in the highest degree calculated to encourage intestinal 
autointoxication and to aggravate some of the gravest features 
of the disease. 
4. Lusk, Rubner and various other physiologists have 
shown that protein causes a waste of energy by overstimulation 
of cell activity. With a high protein ration the body cells are so 
overstimulated that they expend more energy than the protein 
supplies. In a tuberculous patient the cells are already suffering 
from overstimulation due to toxins produced by the tubercle 
germ. This is the cause of the fever, weakness, emaciation and 
wasting of the tuberculous patient. It is evident that a diet 
which increases this destructive tendency cannot be otherwise 
than harmful; and that a diet rich in flesh proteins produces this 
effect cannot be questioned in the light of modern physiologic 
research. DIET IN CHRONIC INFECTIONS 
899 
While the writer is not a specialist in the treatment of pul- 
monary tuberculosis, he has during more than forty years had 
cases of this sort constantly under his care and has had consid- 
erable opportunity to observe the effects of both a low protein 
and a high protein dietary. A very considerable number of 
patients have been seen to make good recoveries from well pro- 
nounced tuberculous disease of the lungs on a dietary which fur- 
nished not more than 200 calories of protein in the form of eggs, 
milk and vegetable protein, and often less. On the other hand, 
there has frequently been a rise of temperature and an aggra- 
vation of other symptoms when a digression was made to a diet 
of flesh foods such as beefsteak, etc. Several times patients have 
come under our care who had been subjected to forced feeding 
with disastrous results. The enthusiastic advocacy of forced 
feeding by Debove, Broca and Dujardin-Beaumetz and the slav- 
ish way in which for a time the example of these clinicians was 
followed, have led in not a few instances to most untoward re- 
sults. The chief evils of these large dietaries doubtless result 
from the excess of protein and fats. 
Bardswell and Chapman found that “patients make much 
less satisfactory progress on the very large diets than on diets of 
considerably smaller nutritive value.” The same investigators 
observed that “any considerable increase in the protein of the 
diet produced a disproportionate excretion of nitrogen, an in- 
crease in the amount of imperfectly oxidized proteins in the 
urine, a decrease in the percentage of nitrogen absorbed, and an 
increase in the amount of aromatic sulphates excreted, indicat- 
ing increased intestinal putrefaction.” These authors conclude 
that the most satisfactory diet for the consumptive “is one which 
represents only a moderate increase of a diet suitable for him in 
ordinary health 
Dr. Lawrason Brown notes that the method of forced ali- 
mentation rarely yields permanent success, and also warns against 
the use of foods which are likely “to give rise to toxic action of 
the liver and kidneys.” 
Of all foodstuffs flesh meats are the ones which “encourage 
toxic action of the liver and kidneys,” or rather toxic effects due 
to excessive demands upon the liver and kidneys for the destruc- 
tion and elimination of poisons. If used too freely, eggs may 
give rise to similar symptoms, particularly the whites of eggs 
and especially when eaten raw as in the form of eggnog, as 900 
THE NFAV DIETETICS 
elsewhere pointed out. Milk proteins and particularly milk in 
the form of acidophilus buttermilk present this necessary ele- 
ment in a form in which it is in the highest degree digestible and 
assimilable. And it should be remembered that Sherman has 
shown that the addition of a few ounces of milk to a diet other- 
wise made up of cereals, affords a supply of complete proteins 
sufficient to wholly meet the needs of the body. 
The facts relating to the feeding of tuberculous cases may 
be summarized as follows : 
1. A low protein dietary, 0.80 to 1.00 gram of protein per 
kilogram of body weight per diem (one calorie per pound of body 
weight) is entirely consistent with health, vigor, and a high 
degree of efficiency and endurance in health. 
2. While a patient suffering from pulmonary tuberculosis 
doubtless requires a small increase in the intake of nitrogen, an 
excessive increase involves grave dangers to the patient, both (a) 
by decreasing his general vital resistance and (b) by imposing 
unnecessary and dangerous burdens upon the liver, kidneys, 
thyroid, and other organs which are already overburdened and 
often seriously crippled in this disease. 
3. There is no evidence that a larger proportion of con- 
sumptives recover under a high protein diet than under a pro-* 
tein ration sufficiently above the Chittenden standard to replace 
the nitrogen loss due to febrile conditions in certain states of 
the disease. 
4. In consumption the organism is required to deal with 
various highly virulent poisons which overstimulate and ulti- 
mately cripple or destroy the thyroid, adrenals, liver, and other 
antitoxic organs. A high protein diet produces similar effects in 
healthy animals and persons, and destroys life in animals whose 
poison-destroying functions are seriously impaired. 
5. A high protein diet is recognized as an important factor 
in the causation of renal disease and is universally condemned 
in grave affections of the liver and kidneys. Vegetable proteins 
are much less objectionable than flesh proteins for the reason that 
they are entirely free from toxins and very much less readily 
undergo putrefactive changes in the intestine. 
A copy of the above statements was sent to a number of 
physicians specializing in the treatment of pulmonary tubercu- 
losis, including superintendents of tuberculosis sanitariums. In DIET IN CHRONIC INFECTIONS 
901 
the considerable number of letters received there was a general 
consensus of opinion against the overfeeding of tuberculous 
patients, then and still in great vogue, and especially against the 
very high protein diet. The late Dr. Sternberg, who after retir- 
ing from service as surgeon general of the United States Army 
for some years conducted a sanitorium for tuberculous patients, 
in a letter to the writer endorsed most heartily the views above 
expressed and stated that he had demonstrated to his entire 
satisfaction by his own experience that tuberculous patients are 
injured by a free use of meat. 
Numerous papers have appeared in the medical press calling 
attention to the dangers of a high protein diet in tuberculosis. 
Dr. F. J. Walter, in the Journal of the American Medical Asso- 
ciation, 1919, calls attention to the danger of a too heavy nitro- 
genous diet in this disease, showing that a patient by this means 
may become the subject of nephritis and renal tuberculosis. 
The report of observations made by McCann and Barr, of 
the Russell Sage Foundation at Bellevue Medical College of New 
York City, on the metabolism of consumptives has placed the 
question of the amount of the food intake in these cases on a 
sound scientific basis. According to these observers, the total 
amount of food taken by the tuberculous patient need not be 
more than 20 or 25 per cent, greater than that required by a pa- 
tient at rest, or 500 calories more than required by the basal 
metabolism of the individual; and the amount of protein is not 
more than half that required by the old standard of Voit and 
only two-thirds of that demanded by the standard of Atwater. 
In a dietary balanced on this basis there is naturally no room 
for steaks, chops and similar meats, for in a dietary including a 
moderate amount of milk, eggs, cereals and such other foods as 
ordinarily compose a lacto-vegetarian dietary, with the exclusion 
o! meats, there will be as much protein as the body can make use 
of and more than this must be clearly recognized as a detriment. 
Malt sugar contains more iron than the same amount of beef- 
steak and much more than cow’s milk. Change of the intestinal 
flora is of the greatest importance in all cases of pulmonary dis- 
ease. Patients always give a history of chronic intestinal stasis. 
The intestinal autointoxication resulting from constipation in- 
evitably lowers vital resistance and prepares the way for the de- 
velopment of tubercular disease. By the use of milk sugar or 902 
THE NEW DIETETICS 
lacto-dextrin the change may be readily made within a few days 
and should be repeated whenever the stools become foul smell- 
ing. Meat feeding will of course at once restore the putrefac- 
tive flora, an excellent reason for its disuse. An antitoxic and 
restorative regimen should he faithfully adhered to. The 
fattening regimen is needed when the patient is under weight. 
Special care should he taken to secure a large intake of 
food lime, at least double the normal requirement or 200 per cent. 
Milk, greens, cottage cheese, legumes, certain nuts (almonds, 
filberts), bran, oatmeal, and malt sugar are the best sources of 
lime (Table XIV). Meats of all sorts are highly deficient in 
lime. Protose, gluten bread (40 per cent), and gluten biscuit are 
rich in lime, iron and protein and on this account most valuable 
foods for a consumptive. Yeast extract (Savita, Marmite), 
should be used daily to insure a full supply of vitamins. 
Hindhede, who has recently made a study of the dietaries of 
various institutions for the treatment of tuberculosis, correlates 
his observations with the results obtained in the several institu- 
tions studied. He reaches the conclusion that the richer the 
dietary the poorer the results, and recommends as most suitable 
for the tuberculous, as well as for healthy persons, the lacto- 
vegetarian regimen. He found that the average daily consump- 
tion of food at Rollier’s, which was the most successful of all 
the European institutions, was only 2,742 calories, and “the con- 
sumption of meat was exceedingly small.” The average consump- 
tion at eight public sanitoriums was 3,725 calories, and at Saug- 
man’s sanitorium the average was 4,738 calories. 
It is to be hoped that the application to the treatment of the 
tuberculous of the new facts relating to human nutrition which 
have been developed in recent years will soon lead to a reform 
of the dietaries in public sanitoriums. 
THE DIET IN INTESTINAL TUBERCULOSIS 
In general, the diet should be the same as in pulmonary 
tuberculosis. Carbohydrates (starchy foods and malt sugar) are 
especially needed to combat emaciation. The intestinal flora must 
be changed and kept non-putrefactive. 
When the patient suffers from diarrhea, milk, milk porridge, 
rice, milk toast, purees of potato, greens and sweet fruits should 
constitute the dietary. Use also milk sugar or lacto-dextrin. DIET IN CHRONIC INFECTIONS 
903 
THE DIET IN SYPHILIS 
In syphilis the liver and kidneys suffer because of the toxins 
with which they have to deal, even when they may not be the 
seat of specific lesions. It is important to note that the huge 
doses of drugs which are necessary to destroy the parasite of 
syphilis are by no means without deleterious effect upon the liver 
and kidneys. It is, in fact, simply a question of the choice of 
evils. The powerful arsenical preparations used to destroy the 
syphilitic parasite inevitably injure the liver and kidneys, not 
merely temporarily but doubtless more or less permanently, just 
as does a severe attack of typhoid fever, small-pox or any other 
grave infectious malady. For example, it has been shown by 
life insurance statisticians that an attack of typhoid fever dimin- 
ishes life expectancy 50 per cent. Certainly a person who has 
had syphilitic infection cannot expect to become a centenarian 
even though he may have undergone most thorough antisyphilitic 
treatment, since the treatment itself involves no small amount of 
damage to vital organs, although far less than would have been 
produced by the syphilitic parasite and the poisons produced by 
it if the treatment had not been applied. 
Bailey and Mackay have called attention to the toxic effects 
which frequently appear in patients under antisyphilitic treat- 
ment, causing among other tissue damage changes resembling 
those of yellow atrophy of the liver; while Davis and Whipple 
have shown the importance of reducing protein and fats to a 
minimum in cases in which the liver has been damaged by chloro- 
form given for anesthesia or by other drugs. The increase of 
urea and cholesterol in the blood following the use of salvarsan 
point to injury to the kidney as well as the liver. The observa- 
tions made by these investigators, together with facts long known 
concerning the function of the liver in defending the body against 
metallic and organic poisons, show clearly the importance of pro- 
tecting this vital organ by reducing the protein and fat of the diet 
to a minimum while supplying it by means of a diet rich in carbo- 
hydrates with the glycogen necessary to assist it in its work of 
destroying and detoxicating not only the syphilitic poisons but 
the toxic substances used to destroy the parasite. An eminent 
authority, writing upon this subject, remarks: “A diet of cooked 
skeletal muscle is not favorable for rapid liver repair.” “Cooked 
skeletal muscle” is a fine scientific euphemism for beefsteak, 904 
THE NEW DIETETICS 
roast beef, mutton chops and other forms of meat, all of which 
are unfriendly to the liver and kidneys because of the increase 
of intestinal putrefactions to which they give rise. 
It has long been known to those familiar with the advantages 
of a non-flesh dietary that the disuse of flesh foods of all sorts is 
of very great importance in the treatment of syphilitic patients. 
The diet in syphilis should be a combination of the anti- 
toxic, laxative and reconstructive dietaries. It is important to 
reduce the alimentary toxins to the lowest point possible and by 
all means available to raise the patient’s vital resistance and 
recuperative powers. 
An eminent French physiologist* has recently called atten- 
tion to the interesting and most useful fact that by a liberal use 
of carbohydrates the liver may be enabled to repair the damaged 
cells when the injury is recent and the changes not too far ad- 
vanced. Lactose, lecto-dextrin and carbohydrate foods of all 
sorts should enter largely into the dietary in all syphilitic cases. 
In cases of syphilitic stomatitis, rice gruel with the addition 
of a little butter or cream should be the almost exclusive diet for 
a few days on account of the bland character of this preparation. 
In syphilitic cirrhosis the diet which has been recommended 
for ordinary hepatic cirrhosis should be followed. 
Patients preparing to undergo treatment with salvarsan 
should first have a change of flora and then faithfully follow the 
antitoxic diet. Numerous observers have noted that the incon- 
veniences and dangers of the treatment may be avoided by the 
disuse of meats of all sorts. In the treatment of a very large 
number of cases in which this regimen has been employed at the 
Battle Creek Sanitarium, most strikingly favorable results have 
been obtained. Says Dr. W. F. Martin, specialist of the Battle 
Creek Sanitarium staff, “I consider a low protein antitoxic die- 
tary of essential importance in the treatment of cases of syphilitic 
disease.” 
It is highly important that the condition of the liver should 
be determined by means of Widal’s test for hepatic insufficiency 
(see Index), both before beginning treatment and at frequent 
intervals during a course of treatment. It is generally agreed 
that in cases of visceral syphilis, arsenical preparations should 
* Foie et Pancreas, Paris, 1920. 905 
DIET IN CHRONIC INFECTIONS 
not be employed. It is also equally important that the liver 
should be permitted to recover from the injurious effects of one 
dose of salvarsan before another dose is administered. 
CHRONIC PARASITIC INFECTIONS 
Actinomycosis. In this disease the indication is for an anti- 
toxic and reconstructive diet. On account of the restricted ac- 
tivities of the patient special care should be taken to keep the 
bowels active by the free use of bran or agar and paraffin oil. 
Trichinosis. In this disease, which is due to the invading of 
the body by trichinae, the pork parasite, the fever diet is indi- 
cated during the acute febrile period. If the patient should have 
the good fortune to recover, he should forever after abjure pork 
in every form, the ordinary source from which this dreadful in- 
fection is derived. Many persons give a history indicating re- 
peated infections by the parasite. Unfortunately this disease is 
incurable. There is no known method for destroying the para- 
site after it has entered the tissues. The permanently crippled 
organism requires scrupulous adherence to an antitoxic dietary. 
DIET IN DISEASES OF THE SKIN 
During more than forty years the writer and his colleagues 
have successfully treated various forms of skin disease, chiefly 
by regulation of the diet. Nearly forty-five years ago the writer 
had under his care a prominent educator, a professor in a state 
college, who suffered from eczema of such a severe type that 
his entire body was covered. With a strict non-flesh dietary and 
without other applications to the skin than simple warm baths 
and soda lotions he was soon wholly free from the disease. Hun- 
dreds of similar cases might be cited. 
Many years ago Dr. L. D. Bulkley, of New York, began the 
advocacy of a rice diet in psoriasis and eczema. At first he only 
required his patients to avoid beef and mutton. Of late years 
he has made the diet more strict, excluding entirely all flesh foods, 
even meat soups, poultry, eggs and fish. He has had a number 
of patients for years on an absolutely vegetarian diet, allowing 
only butter and restricting the use of milk. 
Bulkley thus describes the result of this dietary: 
The effect of this cutting off of the supply of animal nitrogenous 
foods has been very remarkable and striking in many instances (a 906 
THE NEW DIETETICS 
considerable amount of nitrogen is still supplied by certain vegetables, 
as the legumes and oatmeal). Patients continually notice the change 
in the color and character of the eruption, it paling and becoming 
less scaly, and even entirely disappearing in some wCeks, with abso- 
lutely no local treatment. 
Note has been made repeatedly that when there has been a 
neglect of the dietary element there has been a recurrence of the 
eruption, which again yielded rapidly when stringent measures were 
enforced. 
On the other hand, there has been a number of patients who 
have faithfully pursued this plan of treatment, in whom a long- 
existing psoriasis has remained absent, and who, having become accus- 
tomed to the diet, say that they have lost the desire for flesh food and 
will not touch it again. 
Little need be said in regard to the general subject of a vegetarian 
diet, for abundant experience has shown its value under many condi- 
tions of health and disease. The opinion is, I believe, gaining ground 
both among the medical profession and the laity that far too much 
meat is eaten by those who can get it. . . . In my experience patients 
have felt remarkably well when this was rightly directed and carried 
out, and in numerous instances I have found distinct and steady gain 
in weight in the spare, and loss of weight in the obese, when tested 
repeatedly on the same scales. 
The results of Dr. Bulkley’s tests were so successful that 
he called upon the writer for a dietitian trained in the School of 
Home Economics of the Battle Creek Sanitarium and established 
the meatless regimen in the Skin and Cancer Hospital of New 
York City, where it has been employed now for many years and 
in the successful treatment of many hundreds of cases. 
Eczema. Eczema and most other forms of skin diseases are 
greatly influenced by diet. Various skin maladies are commonly 
associated with chronic intestinal toxemia and are apparently due 
to the lowered vital resistance resulting from the absorption into 
the blood of large quantities of putrefaction products developed 
in the intestine. In some cases the skin eruption may be due to 
anaphylaxis. These eruptions may occur in persons who are sen- 
sitized to some particular foodstuff. The food substances most 
often incriminated are oysters or other shellfish, pork, mutton, 
veal, strawberries, buckwheat, eggs, sometimes milk and even 
tomatoes. In all cases of eczema and other forms of skin eruption 
a strict antitoxic diet should be adopted. Meats of all sorts 
should be eliminated and a search should be made for the par- 
ticular substances to which the body may be sensitized by means 
of tests with the various allergens which are now prepared for DIET IN CHRONIC INFECTIONS 
907 
this purpose. These tests must be conducted by a physician who 
is acquainted with this line of research. 
In beginning a course of treatment, the intestinal flora must 
be changed; any existing colitis must be cured by diet and treat- 
ment of the colon and the antitoxic dietary must be faithfully fol- 
lowed. 
The dietetic treatment of acne and other chronic skin dis- 
orders is essentially the same as that required for eczema. Acne 
often requires a very considerable restriction of the use of ani- 
mal fats, and special attention must be given to the colon. 
Eczema in Infants. M. Langstein (La Semaine Medicate, 
September, 1908) confirms the observations of M. Finkelstein 
in relation to the beneficial results obtained by withdrawing 
chlorid of sodium from the food in eczema of infants. In four 
children suffering from eczema the disease disappeared entirely 
in four weeks on a diet from which four-fifths of the amount of 
salt ordinarily present had been withdrawn. 
Gershun (Vratch) calls attention to the fact that skin dis- 
eases in infants are frequently due to poisons in the mother’s 
food. Psoriasis and eczema have been shown to be due to this 
cause, the disease disappearing when the mother discards meats. 
Special attention should be .given to the bowels, which should 
be made to move three times daily by the use of bran, paraffin oil 
and spinach. The flora should be changed by use of B. acidophilus 
and milk sugar or lacto-dextrin. 
Certain infants are sensitized to cow’s milk. In such cases, 
Malted Nuts or almond milk may be substituted for milk. Butter 
should be given in potato soup, and a soup of malted barley may 
be advantageously used. The cure will be facilitated by the use 
of lanolin cream, of which the following is the formula: lanolin, 
2 drams; boroglyceride, 1 dram; cold cream made with white 
vaselin, 6 drams. Apply freely several times a day. 
DIET IN CANCER 
Dr. William Mayo has for some years maintained that the 
eating of hot food is the cause of the great frequency of cancer 
of the stomach. It is known that burns give rise to cancer. For 
example, cancer of the skin of the abdomen is common among the 
natives of Kashmir as the result of burns due to the kangri, a 
basket of coals which these mountaineers carry under their cloth- 908 
THE NEW DIETETICS 
ing as a sort of “warming pan.” Cancer in this region is almost 
unknown among other people. 
Cancer of the gullet is rather frequently observed among the 
men in China, but is rarely met among the women. The men in 
China eat their rice very hot while the women eat it cold, at the 
second table. 
Dr. Mayo finds a similar explanation of the greater fre- 
quency of cancer of the stomach in men in the fact that the wives 
pour the cofifee and serve their husbands first and themselves last, 
and hence take their coffee at a lower temperature. 
Dr. Carl Petersen, the eminent statistician, in a recent article 
confirms the observation of Professor Maynard that there is a 
close relation between diabetes and cancer, the coefficient of 
correlation being according to Petersen 71 per cent. 
Careful study of the statistics of these two diseases shows 
that whenever there is an increase in the mortality from cancer 
there is a like increase in the number of deaths from diabetes, 
and the reverse. Williams has shown that the mortality from 
cancer increases in proportion to the amount of meat eaten. He 
has accumulated an enormous mass of evidence which seems to 
demonstrate the close relation between flesh-eating and cancer. 
Hoffman, the noted statistician of the Prudential Life In- 
surance Company, has fully confirmed the observations of Wil- 
liams in a world-wide study of mortality statistics, the results of 
which he exhibited at the Panama-Pacific Exposition. 
Ross, by observations made in the Lister Institute of Experi- 
mental Medicine, showed that putrescin, cadaverin, cholin and 
perhaps other products of putrefaction of meat, together with 
caffein and uric acid, increase cell proliferation to an extraordi- 
nary degree. 
So long ago as 1880, Beneke called attention to the greater 
frequency of cancer in meat-eating animals and men. 
Dr. Charles H. Mayo finds that cancer is extremely frequent 
in dogs, being found in 25 per cent of all dogs eight years of 
age, increasing to 50 per cent in dogs twelve to fourteen years of 
age. 
Recent observations have shown that the suppression of 
vitamins, particularly of vitamin C, tends to check the growth of 
cancer. This is the basis of the diet of Centanni. 
The writer saw in the laboratory of Ehrlich, who made ex- 
tensive studies of the effect of diet upon cancer, rats in whom DIET IN CHRONIC INFECTIONS 
909 
well-developed cancerous growths had very largely disappeared 
under special feeding. Professor Ehrlich remarked that “While 
the development of cancer could be to a large degree controlled 
by feeding, it was found necessary to starve the animals nearly 
to death to secure a pronounced effect.” 
Gastric Cancer. A bland reconstructive diet is indicated. 
Rice is in many cases more acceptable than any other food. Sugar 
water, prepared by the addition of two ounces of malt sugar or 
milk sugar to a pint of water, may be used to advantage when 
more solid food is rejected. The introduction of sugar water by 
enema is also of great service in sustaining the patient’s energies 
and especially in preparing him for a radical operation when 
this is deemed advisable. 
Sugar feeding not only supplies the patient with the sort 
of nourishment he most needs, but at the same time serves as a 
biologic disinfectant and antiseptic for the stomach, preventing 
the growth of the putrefactive organisms which swarm in the 
cancerous stomach in these cases, because of the absence of hydro- 
chloric acid. 
An antitoxic diet, that is, a diet which discourages the de- 
velopment of putrefactive poisons in the intestine, is specially 
to be commended as a means of combating cancer. Such a diet- 
ary should be adopted by all persons suffering from cancer, and 
also by those who are so unfortunate as to have a cancer heredity. 
During the last forty-five years the writer has had unusual op- 
portunities for observation in relation to the influence of a non- 
flesh dietary upon the occurrence of cancer. Of many thousands 
of flesh-abstainers with whom he has been acquainted, he has 
known during this period of only four cases of cancer in persons 
who had been for a long time flesh abstainers, and in one case 
recovery occurred without removal of the cancerous growth. 
I here can be no doubt that among the thousands of persons under 
observation who escaped the disease, as the writer believes through 
flesh abstaining, there must have been a considerable number who 
were especially susceptible to cancer because of heredity and who 
were able to overcome this special susceptibility by a non-flesh 
dietary. This conclusion seems inescapable when it is remem- 
bered that ten to fifteen per thousand of all persons past middle- 
age die of cancer. 
An antitoxic dietary excludes not only flesh foods but tea, 910 
THE NEW DIETETICS 
coffee, alcohol, tobacco, vinegar, mustard, pepper, peppersauce 
and other condiments, as well as all other toxic substances. 
A liberal use should be made of fresh fruits and vegetables 
because of the large amount of potash which they contain. Po- 
tatoes, carrots, raw cabbage, lettuce and cucumbers are especially 
to be commended. 
Cancer of the Colon. 
This disease, like cancer of the stomach, is more frequent in 
men than in women; and, like cancer of the stomach, its fre- 
quency is increasing steadily from year to year. Unquestionably, 
one of the great causes of cancer of the colon is the unusual ex- 
posure to injury and contact with putrefactive bacteria and the 
poisons which they produce. This idea is suggested by the fact 
that the cecum and the pelvic colon, the two portions of the colon 
in which foodstuffs remain the longest, are the chief points at 
which cancer attacks the colon. 
Regular and frequent, at least tri-daily, evacuation of the 
colon is the most important preventive measure which can be 
brought to bear in cases of this sort, if the colon is kept in a 
healthy condition by changing the flora at frequent intervals and 
maintaining a non-putrefactive condition of the seat of cancerous 
disease. Diet in Surgical and Hos- 
pital Cases 
The ordinary hospital dietaries are open to severe criticism, 
especially in the light of modern discoveries in human nutrition. 
1 here is almost a total lack of lime, iron or vitamins in the 
regular hospital “light diet,” and the various gruels and other 
liquid preparations are well calculated to encourage constipation 
and intestinal toxemia. Milk contains lime, but is lacking in 
iron. Bouillon and broth are the chief stock in trade of the 
hospital cook. These time-honored preparations fill such a large 
place in the current hospital bill of fare that it may seem almost 
equal to sacrilege to denounce them; but in the light of modern 
knowledge they must go. They are too pernicious to be allowed 
a place in a bill of fare from which everything toxic or germ- 
breeding should be excluded. For more than forty years the 
writer has conducted a surgical service through which many 
hundreds of cases have passed every year and from which all 
meats and meat broths and bouillons have been excluded. The 
advantages of this regimen was early demonstrated. More than 
twenty-five years ago unusually good results were obtained by the 
author in several series of abdominal operations, which were 
attributed to the special system of feeding employed. In a series 
of 395 abdominal sections within six years (1889-1895) the mor- 
tality was 2.3 per cent. The above figures include a series of 233 
cases of non-septic ovarian cysts with one death, and 165 succes- 
sive cases of ovarian tumors or diseased appendages with no 
deaths. I he significance of these figures will be appreciated when 
it is remembered that at the period named our modern surgical 
technic had not yet been developed. Rubber gloves were not 
worn, and the usual mortality rate in abdominal cases was 15 to 
20 per cent, or more. 
The usual hospital regimen greatly needs reformation. The 
bill of fare should be enlarged by the addition of many foods 
rich in vitamins, lime and especially iron. Bran is needed for 
roughage, with agar and other forms of cellulose. Bran is also a 
911 912 
THE NEW DIETETICS 
good source of food lime and iron. Vegetable broths, rich in 
vitamins and salts, should take the place of the animal extracts 
and bouillons, which are nothing less than solutions of uric acid 
and other poisons, as pointed out long ago by the elder Flint 
and eminent French physicians. Meats of all sorts may well be 
dismissed from the hospital larder. All, without exception, are 
septic, putrescent, swarming with the terrible bacillus of gas 
gangrene, B. Welchii, and other highly virulent mischief makers. 
Put into the intestine of a feeble patient who has barely survived 
a grave operation, nothing could be devised in the shape of food 
more likely to become a cause of disaster. 
Lucas-Champonniere, of Paris, surgeon-general of the 
French Army, observed that a high proportion of urea in the 
urine, a necessary result of meat eating, was unfavorable to re- 
covery after an important operation or injury. 
Diet before Operation. After the flora has been changed by 
a few days of fruit regimen, a non-toxic dietary should be adopted 
before the operation, as well as after the operation, and until 
convalescence is fully established. This requires a reduction of 
the protein to as low a level as safety will permit, certainly not 
exceeding 10 per cent, of the total calorie value of the ration. 
Bouillon and meat extracts of all sorts must be discarded. 
Meats must necessarily be discarded because of the readiness 
with which the undigested residues undergo putrefaction in the 
colon, besides introducing myriads of putrefactive bacteria which 
are always present in fresh, salted and smoked meats of all kinds. 
The famous surgeon, Paget, in his lessons on surgery many 
years ago asserted that “the high death rate from operations in 
cities, as compared with rural districts, is due to the fact that 
city dwellers eat large quantities of meat, while country dwellers 
in Europe taste meat only on occasions.” 
More than a dozen years ago Tissier called attention to the 
fact that vegetable proteins are only about “half as prone to 
putrefy as animal proteins,” and Torrey has recently demon- 
strated the same fact. Neither bouillon nor meat broths are 
ever served to the writer’s surgical patients. Tea and coffee as 
well as wines are also scrupulously excluded from the bill of 
fare. 
Storing up Glycogen. It is most desirable that that won- 
derful poison-destroying organ, the liver, and the poison-elimi- 
nating kidneys should be gotten into as efficient a condition as DIET IN SURGICAL AND HOSPITAL CASES 
913 
possible before the operation, so as to be prepared to deal with 
the anesthetic, itself an active poison, as well as the great influx 
of poisons naturally following the operation. For accomplishing 
this, it is especially important that the patient’s diet should be 
rich in carbohydrates so that the patient’s liver, muscles and 
body cells may be well stocked with glycogen. 
It is current practice in abdominal cases to give the patient 
no food on the day of the operation. This plan has the disad- 
vantage of bringing the patient to the operating table fasting and 
necessarily with his store of precious glycogen greatly reduced. 
Glycogen is necessary not only to support the heart in its activity, 
but to aid the liver in dealing with the great flood of toxins thrown 
into the blood by the anesthetic and the traumatism of the oper- 
ation and which are the principal cause of shock, as shown by 
Cannon. An abundant store of glycogen in the liver and the body 
cells is the best possible means of protection against shock. In 
order to enrich the patient’s store of glycogen, the writer has for 
years adopted the practice of giving the patient eight or ten 
ounces of malt sugar between the last meal the night before the 
operation and the hour of the operation. Four to six ounces of 
malt sugar dissolved in water may be given in divided doses the 
morning of the day of the operation. 
The value of this ready-to-use nutriment is very great, not 
only as a means of replenishing the liver’s store of glycogen but 
to sustain the heart, which consumes a fraction of a calorie of 
sugar at every beat, and especially to combat the acidosis in- 
variably produced by the anesthetic. 
Renal Efficiency. If a high non-protein nitrogen content 
is shown by the blood test, or the urinary test ration shows renal 
inefficiency, the operative hazard may be enormously lessened 
by a few weeks’ careful treatment with an atoxic diet, changing 
the intestinal flora and improving elimination. 
Prophylaxis against Acidosis. If the carbon dioxide ten- 
sion is found to be less than 34, which is not infrequently the 
case in meat eaters and in persons whose nutrition has been 
seriously interfered with by fever, low diet or other cause, the 
body’s store of glycogen must be replenished and the carbon 
dioxide tension raised to normal by carbohydrate feeding, par- 
ticularly by the use of malt sugar and milk sugar, of which a 
half ounce may be given in a glass of water every hour for a day 
or two before the operation, or even every half hour if the 914 
THE NEW DIETETICS 
patient is able to absorb so much fluid. If necessary, retaining 
enemas of malt or milk sugar, two ounces to the pint, are given. 
Post-Operative Feeding. 
The post-operative feeding of surgical cases is a matter 
which has received far less attention than its importance de- 
mands. In many cases, the patient’s nutrition has been seriously 
interfered with for some time before the operation by the condi- 
tions which make the operation necessary. The starvation of 
patients, either before or after operation, is not only unnecessary 
but is highly prejudicial to the patient’s interests, lessening the 
chance of recovery and increasing the danger of serious compli- 
cations. Food is a most important regulator of metabolism. 
Assimilated food furnishes the material upon which the cell 
works, both in the performance of its functions and in the repair 
of its structure. If material is not supplied in the form of food 
the body must draw upon its own tissues. 
Food, likewise, is the only source of energy for the body. 
The heart alone consumes approximately two ounces of sugar 
every twenty-four hours. 
Furthermore, food furnishes a physiological stimulus to the 
living cells. The rapid loss of strength and endurance as the 
result of fasting and the marvelously rapid restoration of energy 
by appropriate nourishment afford ample evidence of the helpful 
stimulus which may be secured through proper feeding. This 
stimulation is doubtless due in large measure to the presence of 
vitamins which abound in certain foods and in which vegetable 
broths are rich. These vegetable broths differ from bouillon 
and animal broths in the fact that, while rich in vitamins, they 
contain no urea and other waste matters of which animal broths 
are largely made up while lacking vitamins almost altogether. 
Yeast extracts (Savita, Marmite) are especially valuable. 
The eating habits of most patients lead to an accumulation 
of protein wastes in the tissues. Since all excess of protein must 
be eliminated as urea and other nitrogenous wastes, both the liver 
and kidneys are overtaxed by this excessive protein metabolism, 
causing a predisposition to acidosis and uremia. In addition to 
these waste products from excessive protein metabolism, the 
blood and other body fluids are likely to be saturated with toxins 
of bacterial origin originating from the putrefactive changes in 
food residues in the colon. On this account it is most unwise to DIET IN SURGICAL AND HOSPITAL CASES 
915 
feed a prospective surgical patient meats of various sorts as a 
means of preparing him for the operation, or to advise such a diet 
for promoting convalescence after operation. On the other hand, 
a low protein diet for a few days before the operation as well as 
immediately following the operation is most advantageous. The 
blood may be more rapidly built up by a lacto-cereal diet, with 
the addition of liberal quantities of greens than by heavy meat 
feeding. 
There is usually a sufficient amount of fats stored up in the 
tissues to supply the needs of the body for a few days, and the 
fat intake in post-operative cases may be advantageously dimin- 
ished because of the inhibitory effect of the operation upon the 
secretion of gastric juice. Gastric juice is important in stomach 
cases to prevent the putrefaction of stagnant gastric fluids and 
so maintain a condition favorable to healing. It is well to remem- 
ber, also, that the body is able to manufacture fat from carbo- 
hydrates and that starch and sugar are, under normal conditions, 
the chief sources of body fat. 
Abundant carbohydrate feeding is hence of great interest 
in relation to surgical cases. Farinaceous foods of all sorts, 
fruit juices and malt or milk sugar are the most appropriate 
materials for feeding a patient on the days before operation and 
two to five days succeeding. 
Feeding After Gastro-Enterostomy, Pylorectomy 
and the Polya Operations* 
The feeding should begin early—as soon as vomiting is con- 
trolled—for several reasons: The sooner feeding can be begun 
the less will be the danger of exhaustion, since the food supply 
rather than the tissues of the patient will thus be the source of 
the energy. 
Another benefit to be derived from early feeding, which is 
especially noticeable in operations upon the stomach and gall 
bladder, is the suppression of “hunger pains” which Carlson has 
shown to be due to violent contractions of the stomach. Bland 
food introduced into the stomach is often more effective than 
morphia or any other anodyne in controlling the pain following 
operations on the gall bladder or the stomach. 
It is well to remember, also, that food is a natural laxative. 
Taking food into the stomach sets up peristaltic waves which 
travel over the entire intestinal tract, thus encouraging evacua- 916 
THE NEW DIETETICS 
tion and the elimination of waste matters from the colon. This 
early peristalsis has the effect of straightening out kinks in the 
intestine and breaking up newly-formed adhesions which have 
not yet become organized. It is even advantageous in many 
cases to make use of moderate quantities of agar-agar or gruels 
containing bran. By supplying these colon stimulants, the early 
restoration of normal bowel action may be greatly encouraged. 
Careful early feeding is especially advantageous in cases of 
gastric surgery, even in gastrojejunostomy, pylorectomy and the 
polya operations, as well as in other cases. 
The objection that foods may be irritating does not hold 
good for the reason that bland foods of the sort mentioned are 
by far less irritating than the acrid matters invariably present. 
Such foods certainly will be as well tolerated by the stomach as 
the stagnant, germ-infected, often foul-smelling and irritating 
material usually found in the stomach after operations on this 
organ. The effect of taking food in such cases is to dilute or 
wash away the stagnant fluids resulting from oozing, involuntary 
swallowing of the saliva, etc. Displacing the putrefying gastric 
contents by a small quantity of bland and sterile rice gruel 
often produces a most favorable effect, relieving nausea, hunger 
pains and other distressing symptoms. 
The fact that taking fluid into the stomach may give rise 
to gastric secretion cannot be regarded as an objection to early 
feeding for the reason that the gastric juice is the normal dis- 
infectant of the stomach, its presence will help to suppress putre- 
factive changes in the gastric fluids, and will hence promote the 
healing process rather than prevent it. 
When the patient does not vomit, malt sugar water contain- 
ing two ounces of malt sugar to the pint or fruit juice of some 
sort containing the same proportion of sugar is given in spoonful 
doses hourly, and affords the patient exactly the kind of nourish- 
ment required. Pathogenic organisms do not grow in sugar water, 
fruit juice or gruel, while they thrive in blood serum, bouillon 
and broths. Of course, it is important to avoid overfeeding. A 
half ounce of rice gruel every two hours while the patient is 
awake, the first day, increased by half an ounce on the second 
day, causes no disturbance in the average case. After the first 
few days, spinach puree may be added to promote blood building 
and thorough evacuation of the colon. 
Bouillon, beef juice, broths and similar preparations are DIET IN SURGICAL AND HOSPITAL CASES 
917 
carefully avoided, and, in fact, are never admitted to the writer’s 
ward. Vegetable broths, which are quite as appetizing as any of 
the preparations mentioned and wholly free from unwholesome 
properties, are freely used. A bouillon prepared from yeast ex- 
tract (Savita, Marmite) so closely resembles bouillon that it is 
readily accepted in place of it and is, in fact, more palatable. 
Gruel diet is relied upon only for a very short time, a few 
days at the most. Simple purees of vegetables and fruits are 
allowed after the first two or three days, and these are accom- 
panied by agar jellies or special bran preparations to encourage 
bowel action. Purees of spinach or other greens should appear 
daily on the menu in some form. These lime and iron contain- 
ing foods are essential to rapid blood building and tissue repair 
and help to sustain the heart in its arduous work. Green foods 
are also rich in the vitamins which are as essential for the rapid 
repair and rebuilding of the tissues as for the normal growth of 
young animals. 
Every meal should be carefully balanced, not only for pro- 
teins, fats and carbohydrates, but for cellulose, food lime and 
iron and other salts and vitamins. 
In cases in which a great portion of the stomach has been 
removed, great care must be taken in the mastication of the food 
or else it should be taken in the form of purees. Food must be 
taken in moderate quantities, and on this account it is necessary 
in some cases that the time between meals should be shortened, 
the patient taking four meals a day instead of three. This is 
especially necessary during the first few weeks following the 
operation. In several cases in which the writer has found it 
necessary to remove the stomach, X-ray examinations made by 
Dr. Case after the operation have shown that Nature has devel- 
oped a new pylorus which behaves in a remarkably normal man- 
ner, holding the food back in the duodenum and the stump of the 
stomach for three or four hours as in the healthy stomach. 
After the polya operation, intense and constant hunger is 
often experienced for some months. In such cases frequent small 
meals may be necessary for comfort when the hunger pain is 
severe. 918 
THE NEW DIETETICS 
Diet in Post-Operative Peritonitis. 
In peritonitis the chief indication is to maintain the strength 
of the patient by such food as will supply energy without en- 
couraging the development of toxins. The patient’s liver and 
kidneys are already overwhelmed with toxins which are being 
absorbed from the peritoneal cavity, and there is likely to be 
pronounced intestinal stasis; hence, foods rich in protein should 
be withheld, also foods rich in fat, which when present in large 
amount tends to increase stasis. Carbohydrates encourage peri- 
stalsis, combat acidosis and at the same time supply the body 
with the most readily available source of energy. Malt sugar is 
exceedingly valuable for use in this class of cases, a fact which 
seems to have been largely overlooked by writers on dietetics. 
The writer has made use of this valuable nutrient in the feeding 
of many thousands of surgical cases within the last 25 years and 
has found increasing reason for confidence in its value. Sugar 
water may be used by enema and also by mouth. When vomiting 
is persistent, a Rehfuss tube should be introduced into the stom- 
ach or duodenum and through this the accumulating fluids may 
be pumped out and sugar water introduced in their place, with 
great benefit to the patient. By this plan the amount of toxins 
absorbed into the blood may be greatly reduced and at the same 
time much needed nutriment may be introduced. 
When there is stagnation of fluids in the stomach, as indi- 
cated by vomiting, the stomach should be frequently emptied by 
means of the duodenal tube, which may be left in position and 
liquids withdrawn every hour or two, as may be required. After 
the withdrawal of liquid, two ounces of sugar water (one ounce 
of malt sugar or milk sugar to the pint) should be passed in 
through the tube. This is especially important in cases in which 
the fluids have an offensive odor. The sugar water answers a 
double purpose. It feeds the patient and prevents the putrefac- 
tion of stagnant fluids. 
Jejunal Feeding. When an intestinal fistula is established 
for the relief of obstruction, sugar water, preferably milk sugar 
or malt sugar, two ounces to the pint, should be introduced in- 
stead of plain water. Three or four quarts may be introduced 
in fractional doses in 24 hours. By this means the patient’s 
energy is sustained and acidosis is prevented. DIET IN SURGICAL AND HOSPITAL CASES 
919 
Diet After Operation on the Gall Bladder. 
In cases of gall bladder operation, very careful regulation 
of the diet is essential to insure the results sought by the opera- 
tion. During the first four or five days the diet should be the 
same as after operations on the stomach. Later, a strictly atoxic 
or antitoxic diet should be adhered to without deviation. Meats 
of all kinds must he carefully discarded. Raw eggs should never 
be eaten. Meats and raw eggs greatly encourage intestinal putre- 
factions and continually reinoculate the intestine with the very 
bacteria which has made necessary the operation. 
The diet should be very “loosening,” and hence should in- 
clude a liberal quantity of wheat bran. A quarter of an ounce 
three times a day is generally none too much, or two-thirds the 
quantity of agar, with an abundance of fruits, fresh vegetables, 
greens and other laxative foods, not as frequent items on the bill 
of fare but as a part of every meal. The regular use of paraffin 
oil is needed in most cases for the purpose of lubrication, so as to 
secure three full evacuations daily. 
Especial care must be taken to masticate the food thoroughly. 
Prolonged mastication prevents too rapid swallowing of the food 
and hence too rapid discharge of food from the stomach into the 
duodenum, which is important when the gall bladder has been 
removed, because of the loss of the storage reservoir for bile. 
Taking the food at frequent intervals is advantageous by 
causing the liver to contract and expel the bile from its ducts, 
thus helping to combat the infection in which the liver is always 
involved when the gall-bladder is diseased. High carbohydrate 
feeding is especially indicated for the reason that this is a means 
by which the liver may be enabled to repair its damaged cells. 
Diet in Accidents and Emergency Cases. 
When the accident or emergency is of such a character that 
the patient must be confined to bed, especial attention to the 
dietary is of great importance. First of all, the food intake 
should be diminished in quantity. The food requirement of a 
person in bed is not more than half or two-thirds that of the 
same person engaged in ordinary activities. A hard working man 
requires while he is resting in bed less than half the amount of 
food usually eaten by a man engaged in hard work. An exces- 
sive intake of food under such conditions is certain to aggravate 
the evils which are naturally the result of inactivity in a person 920 
THE NEW DIETETICS 
who has been accustomed to an active life. Indigestion, so-called 
biliousness and other inconveniences in many cases very quickly 
make their appearance. Inactivity produces a tendency to con- 
stipation, which will be increased by the lessened volume of food 
unless care is taken to avoid this by increasing the amount of 
roughage. On this account, bran should be used in liberal quan- 
tities—three or four heaping dessertspoonfuls at each meal, or 
half as much agar. 
Greens should be largely used also. In cases in which there 
has been a considerable loss of blood, the use of greens, lentils and 
other foods rich in lime and iron is especially important (see 
Table XV). 
Dates, figs, raisins or malt sugar should take the place of 
cane sugar and other sweets. Fruits should be very freely used, 
especially acid fruits and tomatoes, and such coarse vegetables 
as cabbage, cauliflower, turnips, lettuce and celery. 
In cases of bone injury, care should be taken to make the 
dietary rich in lime. It should be remembered that the cereals are 
poor in lime, also potatoes and most vegetables. Legumes pro- 
vide lime in abundance. An ounce of peas, beans or lentils con- 
tains several times as much as an ounce of beefsteak. Buttermilk 
and skimmed milk are also good sources of lime, as are gluten 
preparations, almonds and hazelnuts. 
Gluten preparations such as bread made from 40 per cent, 
gluten flour or gluten biscuit should be more freely used by surgi- 
cal patients. Forty per cent, gluten biscuit supply six times as 
much food iron as does ordinary beefsteak. 
DIET IN COMA 
In coma or unconsciousness from any cause, the two nutrients 
of which the body stands most in need are water and carbohy- 
drate (dextrose). 
Water is needed to dilute and carry away through the kid- 
neys and other emunctories the poisons which are the cause of 
the condition. If the patient can be made to swallow readily 
without choking, a glassful (8 ounces) of water should be given 
hourly by the mouth. The colon must be thoroughly washed 
out by enema twice a day, and water may be given by enema by 
the drop method or by introducing into the rectum half a pint of 
warm water every two or three hours to be retained. DIET IN SURGICAL AND HOSPITAL CASES 
921 
A most efficient method of introducing water is by means of 
the duodenal tube. When necessary a tube may be introduced 
through the nose. The tube may be introduced and retained for 
several days. Water should be introduced at the rate of two 
ounces every fifteen minutes or eight ounces every hour. Not 
more than four ounces should be introduced at one time. The 
amount of water given in twenty-four hours should be not less 
than five or six quarts. The effect should be to produce a profuse 
flow of urine. It is important to save and measure the amount 
of urine as a check upon the water intake. The amount of urine 
should be not less than three or four quarts. 
Carbohydrate must be given in the form of sugar—not cane 
sugar, but dextrose, levulose or malt sugar. Malt sugar is usually 
available. It is readily tolerated, is quickly utilized, and is non- 
irritating, which is not true of cane sugar. Starch is not a suit- 
able form of nourishment in these cases for the reason that it 
requires digestion and so will be utilized but slowly if at all, while 
malt sugar is quickly changed to dextrose and absorbed. 
Pure dextrose is now available and may be used in place of 
malt sugar. 
Sugar should always be given in very dilute solution. The 
best plan is to add malt sugar or dextrose to the water in pro- 
portion of one ounce to one and a quarter ounces for each pint of 
water given. 
Lacto-dextrin is perhaps the best of all forms of carbohy- 
drate for use in these cases for the reason that it not only supplies 
carbohydrate but also suppresses putrefaction by inhibiting the 
growth of pernicious organisms such as B. Welchii, B. proteus 
and the colon bacillus. In addition, lacto-dextrin affords in abun- 
dance the valuable vitamin C which prevents scurvy, which is 
not present in cane sugar. 
An excellent source of carbohydrate for use in coma is fruit 
juice. The pure juice of any sweet fruit is suitable. Orange 
juice especially is excellent. Apple juice, grape or loganberry 
juice, the juice of raspberries, cherries, huckleberries and black- 
berries are all suitable for carbohydrate feeding. The amount of 
sugar present in each variety of fruit juice will be found in the 
tables given elsewhere in this work (Table XXXV). The amount 
of sugar varies greatly in different varieties of fruit. Orange 
juice, apple juice and blueberry juice afford about two and a half 
ounces of sugar to the pint. If any one of these juices were sub- 922 
THE NEW DIETETICS 
stituted for one-half the water given, the proper amount of carbo- 
hydrate would be administered. Blackberry and raspberry juice 
contain about twice as much sugar as does the orange; and grape, 
strawberry and pear juice about one-half more. 
Another excellent source of sugar is the raisin. Soaked and 
then stewed for an hour, the raisin surrenders to water its fruit 
sugars which are ready for immediate absorption and assimilation. 
In extreme cases intravenous injections of dextrose in sterile 
normal saline solution must be given by a competent specialist. 
It is to be understood, of course, that this water carbohydrate 
regimen is not to be continued indefinitely. Coma is an emer- 
gency and tbe method of feeding is an emergency diet to be fol- 
lowed for a day or two or possibly a week in an extreme case. 
As the patient rallies, gruels and purees containing a minimum 
amount of protein are added to the sugar feeding. 
In diabetic coma, orange juice should be given with water 
as above directed. Other carbohydrates may be given carefully. 
Chief reliance must be put upon the newly discovered pancreatic 
extract, Insulin, the pancreatic hormone, by the proper adminis- 
tration of which diabetic coma may be almost certainly controlled. 
In case of shock, intravenous feeding with glucose in normal 
saline solution renders great service. Intravenous feeding may 
also be employed in cases of great cardiac weakness in preparing 
a patient for operation. Woodyatt thinks that the tissues may 
assimilate as much as four-tenths of a gram (six grains) of glu- 
cose, per pound of body weight, per hour. Two pints, or even 
more, of a 5 per cent, solution of glucose, may be employed when 
necessary and the feeding may be repeated several times in 
twenty-four hours. Care must be taken that the solution is thor- 
oughly sterile. 
The usual formula is one part of chemically pure glucose, or 
dextrose, to nineteen parts of Ringer’s solution. 
A Meatless Hospital Dietary. 
That dispensing with meat and meat extracts in the treat- 
ment of hospital cases is entirely practicable, as well as advanta- 
geous, is clearly shown by the recent action of the management of 
the great Beth Israel Hospital of New York City. After making 
a careful study of the results of the elimination of meats by a 
personal visit to the Battle Creek Sanitarium, the physician-in- 
chief and superintendent of the hospital recommended to the DIET IN SURGICAL AND HOSPITAL CASES 
923 
board of trustees that, in opening their new three million dollar 
building which had been several years under construction, meats 
should be excluded from the bill of fare. The trustees unani- 
mously decided to pursue this course, first having fortified their 
position by sending out a questionnaire to leading physiologists 
and other authorities in nutrition in this country, the replies to 
which were published, together with the proposed meatless regi- 
men in “The Modern Hospital.” The replies received to this 
questionnaire were unanimous in the endorsement of the plan 
proposed. 
Said Dr. Francis G. Benedict, director of the Carnegie Nu- 
trition Laboratory, Boston: 
My good friends at the Battle Creek sanitarium would, I am sure, 
assure you that your project is hygienically and physiologically sound. 
Looking out for the food accessory substances (vitamins) I should be quite 
inclined to feel that your plan was a safe one. 
Prof. Russel H. Chittenden, Sheffield Scientific School of 
Yale University, expressed the opinion that 
It is quite possible, and indeed a desirable thing, for many reasons, to 
establish a lacto-vegetarian dietary in the wards of your hospital. 
Said Prof. Graham Lusk, Department of Physiology, Cornell 
University Medical College, New York: 
I believe that the lacto-vegetarian diet could be established in any 
hospital without detriment to the health of the patients. 
Said Prof. E. V. McCollum, the Johns Hopkins University 
School of Hygiene and Public Health, Baltimore: 
I have not the slightest hesitation in saying that a vegetarian diet sup- 
plemented with fairly liberal amounts of milk, is the most satisfactory 
type of diet that man can take. 
Said Prof. Lafayette B. Mendel, Sheffield Laboratory of 
Physiological Chemistry, Yale University: 
Inasmuch as I myself lived upon a diet devoid of meat, fowl, and fish 
for nearly a year,for purely experimental purposes, and remained in ex- 
cellent health and vigor during that period, I have no fears regarding the 
wholesomeness of such a procedure. 
If you have ever visited the Battle Creek Sanitarium, you will have 
noted that life is possible and good health is maintained without the use 
of meat. Diet in Diseases of the Eye, 
Ear, Nose and Throat 
Dr. J. A. Stuckey, of Lexington, Kentucky, (Medical Revieiv 
of Revieivs, July, 1909) holds that diseases of the ear, nose, and 
throat are generally the result of intestinal autointoxication. In 
several hundred cases of disease of the nose and accessory si- 
nuses, and diseases of the middle and internal ear, the doctor has 
found in all marked evidences of intestinal autointoxication. Ex- 
amination of the urine has shown in nearly every case quantities 
of indican and other poisons formed in the intestine. It was also 
found that by treating the patient with the proper measures to 
combat intestinal autointoxication great relief was obtained from 
the ear, nose and throat disorders. The effect of various drugs 
such as quinine, for example, upon the ear is well known. It is 
evident that poisons generated within the body may similarly 
irritate the nerves and other tissues of the ear, nose and throat, 
as shown in asthmatic attacks, rheumatic pains, and various pain- 
ful affections of the eye, ear, nose and throat. Changing the 
flora and adherence to a strict antitoxic regimen are essential 
for the most successful treatment of affections of the nose, ear 
and throat. It is especially important to secure efficient bowel 
movements three or four times a day. This may be accomplished 
by the methods elsewhere detailed. 
DIET IN DISEASES OF THE EYE 
The supreme importance of diet in the treatment of certain 
forms of eye disease has not been appreciated until very recent 
years. Dr. Ernest Clarke, an eminent English oculist, tells us 
that the eye registers in a very delicate manner the effects of 
intestinal toxemia. The mode of registration he thus explains: 
In quite early youth the crystalline lens is practically a small bag 
of semi-fluid jelly, and accommodation takes place by its being 
squeezed by the action of the ciliary muscle in such a manner that its 
anteroposterior diameter is enlarged. So great is the squeezability 
(if I may use the term) of the lens in the very young, that an accom- 
924 EYE, EAR, NOSE AND THROAT DISEASES 
925 
modation power of 20 D. can often be recorded. As age advances, a 
hardening process, or sclerosis, goes on in the lens as in all the other 
tissues of the body, and so its elasticity becomes less and less, until 
a point is reached when the near point of accommodation, which rep- 
resents the fullest accommodative power, has so far receded that the 
normal eye requires assistance in the shape of a convex lens in order 
to see near objects distinctly. This hardening of the lens may be 
delayed by the absence of, and accelerated by the presence of, certain 
poisons in the system, and intestinal toxemia takes a very high place 
in the list. 
One individual has only an accommodative power of 2.5 D., while 
another has 8.5 D. What is the difference between these two individ- 
uals? In the one aged forty with 2.5 D. accommodative power the 
lens has hardened prematurely and become equal to the lens of a. man 
aged fifty-five. That is, he is suffering from premature senility, and 
in the great majority of cases, in physical appearance, habits and 
powers, he is aged fifty-five. There are many causes which help to- 
wards this premature senility, but the factor common to a very large 
majority of them is intestinal stasis. On the other hand, those whose 
accommodative power is higher than normal look much younger than 
their years, and are in every way younger, and on going into their 
history it will be found invariably that they have taken the greatest 
care to avoid the least suspicion of intestinal stasis. 
These facts, in connection with the premature senility of the lens, 
are another proof of the correctness of the old saying that “a man is 
as old as his arteries”; the premature sclerosing of the vessels often 
taking place at the same time as the process in the lens. 
I think I have said enough to prove that premature hardening of 
the lens is a very constant sequela of intestinal stasis, and this is a 
very useful and easily ascertained index. 
Here are three cases which have come under the writer’s ob- 
servation and which fully confirm the observations by Prof. 
Clarke: 
A young woman of eighteen years found her sight failing. 
Examination by an eye specialist showed that the young woman’s 
eye accommodation was so much impaired that she needed glasses 
such as are usually worn by a person of fifty years. By a change 
of regimen and improvement of bowel action, as recommended 
in this work, the abnormality in a few weeks disappeared and 
her eyes were young again. 
A college professor of fifty years, wearing glasses adapted 
to a presbyopic person of his age, after following for a few 
months the regimen recommended in these pages found his eyes 
improved to such a degree that he had the same range of ac- 
commodation as a normal person of thirty-five years. 926 
THE NEW DIETETICS 
A physician sixty years of age, who had for some time 
adopted a highly laxative, antitoxic regimen and who had taken 
care to change his flora, found his glasses uncomfortable, and 
on examination by an oculist discovered that these glasses, which 
had been very carefully fitted some years before, were more than 
ten years too old for him. A change was made to “younger” 
glasses, and he is still wearing them at the age of seventy, with 
entire comfort, although they are adapted to a person of forty- 
seven years. 
In the above cases the rejuvenation of the eyes was accom- 
panied by the disappearance of numerous symptoms of senility, 
and a great increase in physical and mental vigor and endurance. 
Dr. Hugh Blake Williams, of Chicago, professor of ophthal- 
mology in the Illinois Medical School, reports a case of inter- 
stitial keratitis which proved to be caused by intestinal autointoxi- 
cation. The patient had been sufifering with attacks of vomiting 
and diarrhea alternating with constipation prior to the appear- 
ance of eye symptoms. Local applications of atropine and dionin 
gave only temporary relief, but after the patient had been put 
upon a non-flesh dietary the cornmeal opacity cleared thoroughly 
and the ocular inflammation completely subsided. 
A number of cases of neuroretinitis have been reported 
which were evidently associated with intestinal toxemia, the pa- 
tients showing large quantities of indican in the urine. Pains in 
the eye as well as in other parts of the body attributed to neu- 
ritis, rheumatism and gout, are without doubt in many cases due 
to toxins of intestinal origin. 
In view of the above facts, it is evident that the eye is very 
sensitive to conditions which may result from errors in diet, par- 
ticularly intestinal toxemia. In both acute and chronic eye af- 
fections, thorough attention should be given to elimination of 
food residues by the aid of a laxative diet and the diet should 
be strictly antitoxic. The intestinal flora should be changed by 
an efficient application of the fruit regimen with lactose or lacto- 
dextrin and this should be from time to time repeated whenever 
the stools show any trace of putridity. Infant Feeding 
The very best possible food for a very young infant is its 
own mother’s milk, unless the mother is ill. The mortality of 
bottle-fed infants is several times that of those who are breast- 
fed. Mother’s milk differs from cow’s milk. The milk of ani- 
mals differs as does their blood. Mother’s milk contains subtle 
elements designed by nature for the human infant, which are not 
found in cow’s milk and is richer in the things a human infant 
needs. Mother’s milk is so important for the infant that a very 
little, even so little as a spoonful or two daily, is of value to a 
bottle-fed infant as a supplement to its artificial diet. 
Woman’s milk contains only one-third as much casein as does 
cow’s milk, and two-thirds as much total protein; but it contains 
nearly twice as much milk sugar (seven per cent.) and about the 
same amount of fat as is found in Holstein milk, so that its total 
calorie value is slightly greater, 19 for woman’s milk and 18 for 
cow’s milk. The iron content of woman’s milk is about three 
times that of cow’s milk, an important fact which makes possible 
a long period of nursing. 
The mother should never forget that her own milk, even if 
deficient in quality and quantity, is better than any kind of 
artificial food. Only under the pressure of urgent necessity and 
positive orders of a competent physician should she give up 
nursing her baby. 
If the child does not thrive on its mother’s milk the physi- 
cian should be consulted and the mother’s diet should be care- 
fully regulated. 
If the mother eats carelessly for a single day or even a 
single meal, the milk may be affected and the child may suffer. 
After the mother leaves her bed there frequently follows a 
period of depression, due to her physical weakness, and she is 
likely to feel discouraged and want to give up nursing. She fears 
that she is not going to be strong enough to furnish the necessary 
food and to stand the drain upon her own strength. She should, 
however, not allow herself to yield to this fear. If necessary, 
artificial feeding may be used to supplement the mother’s milk 
for a short time, if the supply is deficient. In such a case, the 
927 928 
THE NEW DIETETICS 
directions given elsewhere for milk modification should be care- 
fully followed. 
The quantity of milk furnished by nursing mothers differs 
greatly. The amount may be only sufficient to supply the infant 
with a few ounces two or three times a day, making supplemen- 
tary feeding necessary, or there may be much more than any 
child can take. 
Certain foods increase the flow of milk. This is especially 
true of nuts. Malted nuts has a well deserved reputation for 
greatly increasing the flow of milk and improving its quality 
(Hoobler). It is extensively used for this purpose in lying-in 
hospitals. 
In their excellent work, “Nutrition and Clinical Dietetics,” 
Carter, Howe and Mason call attention to this remarkable prop- 
erty of nuts. “A diet of nuts and cereals and vegetables has 
recently been shown to be a satisfactory diet for the production 
of milk by women.” 
The nursing mother should take daily not less than three 
pints of water in addition to the water taken at meals and in 
food. 
The bowels must be kept well open, that is, moving three 
times a day by the use of bran and paraffin. Greens and fresh 
vegetables should be used daily and freely and fruits should be 
made a part of every meal. 
Mother’s milk is clean, whereas cow’s milk is always more or 
less contaminated with stable filth. The danger is only partly 
obviated by pasteurizing, for while the process of pasteurization 
destroys the germs of tuberculosis, typhoid fever, scarlet fever, 
diphtheria and septic sore throat, infectious diseases which are 
likely to be borne by milk, the putrefaction germs derived from 
the cow’s colon which are produced from spores are not de- 
stroyed. It is for this reason that sterilized milk undergoes putre- 
faction, while raw milk sours. This is especially true in the 
intestine of the child, since the sugar of milk which tends to 
prevent putrefaction is absorbed in the small intestine of the 
child, leaving undigested curds to undergo putrefactive changes 
in the colon. 
The stools of a child fed on pasteurized or sterilized milk 
usually become dark colored and putrid, with a very offensive 
odor, while those of a breast-fed child remain yellowish in color 
and slightly acid in odor because of the presence of acid fermen- INFANT FEEDING 
929 
tation instead of putrefaction, one of the remarkable means 
adopted by Nature for the protection of the child against auto- 
intoxication. Intestinal toxemia in a child is a much more ser- 
ious matter than in an adult, for the reason that an adult has ac- 
quired a certain resistance to the action of intestinal toxins. 
Chapin has called attention to the fact that the character 
of the food of a young infant has much to do with the develop- 
ment of its alimentary canal. He points out that the hard, tough 
curds formed by cow’s milk are adapted to a digestive apparatus 
in which a large part of the work of digestion is done in the 
stomach. In the case of the cow, goat and sheep, the stomach 
constitutes more than half of the digestive tract. In animals like 
the horse and donkey, which do not ruminate, the stomach forms 
only 10 per cent, of the digestive tract, nearly all the work of 
digestion being done in the small intestine. 
The digestive apparatus in man is much like that of the 
horse, the stomach forming about 20 per cent, of the whole diges- 
tive tract. The milk of the mare and the ass, like human milk, 
differs from that of ruminating animals in the fact that it does not 
form large tough curds destined to be retained in the stomach for 
a long time, but small flocculent masses which pass quickly into 
the intestine, where the principal work of digestion is done. 
It is a great advantage to an infant to have the benefit of 
breast feeding for the first few weeks of its life, even though 
artificial feeding must be adopted later, not only for the reason 
that the character of its food has a remarkable influence in the 
development of its digestive apparatus, as shown by Chapin, but 
because of a fact pointed out by Langer, who discovered that so 
long as the child is breast fed the colon bacilli develop slowly 
in the colon, and apparently do little or no harm; whereas, later, 
when cow’s milk is fed, the colon bacilli develop rapidly and 
acquire a high degree of virulence, which shows itself in indi- 
gestion, arrested growth and in various other ways. Langer does 
not assign any reason for the interesting fact which he records, 
but the writer would suggest that a sufficient reason may be 
found in the fact that breast milk contains 50 per cent, more 
lactose than does cow’s milk. It is well known that lactose dis- 
courages the growth of the colon bacillus and encourages the 
development of B. acidophilus and other beneficent acid-forming 
organisms. It is also to be noted that in the presence of lactose 
the colon germs cease to develop toxins, thus losing their power 
for mischief. 930 
THE NEW DIETETICS 
A further and important reason why a mother should nurse 
her infant is found in the fact pointed out by Fannileuer and 
others some years ago, that the milk contains, especially during 
the first weeks, immune bodies by means of which at least a 
certain amount of immunity against communicable diseases which 
the mother has had may be transmitted to the infant. The colos- 
trum is especially rich in immune bodies. An opportunity to 
employ an immune wet nurse might sometimes be advantageously 
improved. 
The number of feedings daily and the quantity for different 
ages is shown in the following table: 
FEEDING SCHEDULE 
3rd day to 
3rd month to 
8th month to 
3rd month 
8th month 
12th month 
6 A.M. 
6 A.M. 
6 A.M. 
9 A.M. 
9:30 A. M. 
10 A. M. 
12 noon 
1 P. M. 
2 P. M. 
3 P. M. 
4:30 P. M. 
6 P. M. 
6 P. M. 
8 P. M. 
10 P. M. 
9 P. M. 
12 midnight 
12 midnight 
During the day the infant may be awakened from sleep to 
nurse. The habit of regularity is quickly established. It is not 
necessary to disturb the child at night, provided he is healthy 
and seems to be thriving. In fact, when he is normal and grow- 
ing it will be better for the infant and for the mother to miss the 
midnight feeding. If in the interval he is restless, give a half 
feeding of warm boiled water from a bottle. This can be done 
without thoroughly awakening the baby. 
Perfect regularity in nursing is especially to be emphasized. 
The child should be fed at exactly the same hours each day. This 
is quite as important in breast feeding as in bottle feeding. 
The child must not be kept at the breast for more than 
twenty minutes. Overfeeding is more likely to occur than under- 
feeding. Sometimes the mother’s milk is too rich and the baby 
must not be allowed to nurse so long. A little water should be 
then given to supply the amount of fluid needed. INFANT FEEDING 
931 
A Simple Plan for Artificial Feeding of Infants* 
In beginning the use of cow’s milk, the quantity given should 
at first be very small, as in some infants there exists an idiosyn- 
crasy against cow’s milk so great that symptoms of poisoning 
appear when milk is given and a large feeding might even produce 
fatal results. At first the cow’s milk mixture should be given 
only once a day. If there are no signs of disturbance, a second 
feeding may be added after a few days. 
The amount of food required by a child depends upon its age 
and size. Children require much more food in proportion to 
their size than do adults. For example, a child one week old may 
require one-sixth as much food as an adult weighing twenty 
times as much; while a child one year old may require one-third 
as much food as an adult weighing seven times as much. 
Milk Mixtures. Pure cow’s milk is too highly concentrated 
a food for an infant which has been breast fed. The stomach of 
the child must be gradually accustomed to the milk by feeding 
at first milk mixtures to which considerable water has been added. 
As the child grows older, less water is added. It is also necessary 
to add malt sugar or milk sugar as mother’s milk contains much 
more sugar than does cow’s milk. Cane sugar should never be 
used. 
Many complicated methods and formulas for artificial in- 
fant feeding have been proposed and recommended by various 
authorities. Numberless special foods have been prepared and 
offered for sale at high prices. But extended experience has 
conclusively demonstrated that complex and troublesome methods 
of food preparation and expensive foods possess no real advan- 
tages ; the best results may be attained by very simple and inex- 
pensive means. 
The first feeding of cow’s milk should be very dilute. A 
good formula is two tablespoonfuls of milk, one level tablespoon- 
ful of milk sugar and ten ounces of boiled water. Every two or 
three days the milk and lactose may be increased a little until the 
proportions are seven to eight ounces of milk, an ounce and a 
half of lactose and twelve ounces of water. 
The complicated formulas which have been much used in 
recent times have no advantage over the following simple for- 
mulas which have been well tested in the feeding of hundreds 
of babies, and which may be easily prepared in any home by an 
intelligent mother: 932 
THE NEW DIETETICS 
First month: One-third milk, two-thirds water, with two 
ounces malt sugar to the quart. One ounce gives thirteen calories. 
Second to sixth months: Half water, half milk, with two 
ounces of malt sugar to the quart. One ounce gives seventeen 
calories. 
Seventh to ninth months: Two-thirds milk, one-third water, 
two ounces of malt sugar to the quart. One ounce gives twenty- 
one calories. 
Tenth to twelfth months: Use full milk, adding two ounces 
of malt sugar to the quart. One ounce gives twenty-eight calories. 
Infant Feeding Program. 
Age 
Weight 
Quantity in 
24 Hrs. 
Feeding 
No. of 
Feedings 
Amt. of 
Feedings 
Calories 
Daily 
Birth 
7 
pounds 
20 ounces 
8 
ounces 
350 
1 
mo. 
9 
pounds 
24 ounces 
6 
4 ounces 
400 
2 
mo. 
10*4 pounds 
28 ounces 
5 
5 *4 ounces 
475 
3 
mo. 
12 
pounds 
30 ounces 
5 
6 ounces 
510 
4 
mo. 
13 
pounds 
32 ounces 
5 
6y2 ounces 
545 
5 
mo. 
14 
pounds 
34 ounces 
5 
7 ounces 
575 
6 
mo. 
15 
pounds 
36 ounces 
5 
7*/a ounces 
612 
7 
mo. 
16 
pounds 
32 ounces 
5 
6y2 ounces 
640 
8 
mo. 
17 
pounds 
33 ounces 
5 
yy2 ounces 
660 
9 
mo. 
18 
pounds 
34 ounces 
5 
8 ounces 
680 
10 
mo. 
19 
pounds 
28 ounces 
5 
SyA ounces 
700 
11 
mo. 
20 
pounds 
29 ounces 
5 
5yA ounces 
725 
12 
mo. 
21 
pounds 
30 ounces 
5 
6 ounces 
750 
Infants under one year should not take more than thirty- 
two to thirty-six ounces of food daily. In changing to a stronger 
diet, that is, from half milk to two-thirds milk or two-thirds 
milk to full milk, the quantity should be reduced at first. After 
the child weighs eight pounds, the amount may be increased one 
ounce of the milk mixture for every six ounces that he gains in 
weight. 
The Infant Ration. A simple method of determining the 
number of calories a child should eat has been proposed by 
Lassabliere. It is this: multiply the height measure in inches by 
35; or multiply the chest measure by 58; or multiply the sum of 
the height and the chest measure by 22y2. 
An excellent and simple method of determining the amount 
of milk to be given when full milk feeding is begun has been INFANT FEEDING 
933 
proposed by Bartlett. To determine the calorie value of the day’s 
ration, multiply the child’s weight in pounds by forty-five. From 
this subtract 120 calories, the value of the ounce of milk sugar 
required to supplement the sugar of cow’s milk. The remainder 
divided by 20, the calorie value of an ounce of milk, will give the 
number of ounces for a day’s feedings. If the weight of the 
child is 15 pounds, the calculation will be made as follows: 
15X45=675; 675—120=555; This will give 
Sy2 ounces for each of the five daily feedings. For each ounce 
increase in weight one small teaspoonful of milk should be added 
to the total of the daily feedings. 
Supplementary Feeding. One of the most important of all 
foodstuffs which may be usefully added to milk in infant feed- 
ing is malt sugar. This is the only sugar which is native to the 
body, as it is produced in the body by digestion of starch. 
The free use of lactose sometimes produces digestive disor- 
ders, and an infant will assimilate more maltose. But lactose is 
often useful to change the intestinal flora. 
Cane sugar is irritating to the stomach and should never be 
used in infant feeding. Candy should never be given to infants 
or young children. The use of this unwholesome sugar is the 
cause of much disease and suffering in both children and adults. 
Orange Juice. The juice of sweet oranges is a most im- 
portant, almost essential aid in the artificial feeding of infants. 
Orange juice is rich in vitamins. When sterilized milk is used, 
orange juice is necessary to supply the vitamins which boiling 
destroys in the milk and which are absolutely essential for the 
healthy development of the infant. The observations of Holt 
and others show that every bottle-fed child requires daily at 
least one ounce of orange juice when cow’s milk is used. The 
orange juice should be given in doses of two or three teaspoon- 
fuls at intervals during the day. When malt sugar and cereals 
are used, the amount of orange juice must be increased in pro- 
portion to the amount of sugar or cereals added to the milk. The 
more sugar or starch, the more orange juice is needed. In chil- 
dren who show evidences of scurvy, four or five ounces of orange 
juice must be given daily to supply the needed vitamins. It is 
now known that in cases in which it was formerly supposed that 
infants were suffering from an excess of cereals in the food the 
real fault was the absence of vitamins in the carbohydrate given. 
Fine wheat flour and prepared infant foods are lacking in vita- 934 
THE NEW DIETETICS 
mins. This discovery has already been the means of saving 
thousands of infant lives. Every mother should know that 
orange juice or tomato juice is indispensable in the artificial 
feeding of infants of all ages. These highly valuable juices 
should be used in all cases of artificial feeding. All “baby foods” 
are deficient in vitamins. The same is true of all cereal prep- 
arations, and even certified milk is often rather deficient in these 
essential food principles. It is now known that tomato juice, 
either fresh or canned, is fully equal to orange juice. 
Tomato or orange juice should be given to all infants whether 
nursing or bottle-fed after the fourth month. All bottle-fed in- 
fants should be fed either tomato juice or orange juice daily. 
Infants four months old may take a teaspoonful of orange juice 
or tomato juice two or three times a day. If the infant is nurs- 
ing, the juice should be given half or three-quarters of an hour 
before feeding; if bottle-fed, give between the feedings. 
Purees of Fruits. Purees of ripe fruit such as sweet apples, 
pears, and bananas, prepared by pressing the fresh pulp through 
a fine colander, are exceedingly wholesome and useful additions 
to the dietary of the bottle-fed infant. Modern physiological 
experiments have shown the necessity for variety in foodstuffs to 
insure a full supply of vitamins and salts. 
Vegetable Broths. 
While meat extracts, bouillon and animal broths of all sorts 
should never be given under any circumstances to infants, vege- 
table broths are very useful. The following is a good formula. 
Savita Vegetable Broth. 
2y2 quarts water 
cup diced carrots 
1 cup shredded cabbage 
1 cup diced potatoes 
1 cup diced celery 
1 cup diced onion 
y2 cup strained tomato 
\y2 tablespoonfuls Savita 
3 tablespoonfuls butter 
Prepare the carrots first and allow them to cook while pre- 
paring the other vegetables. Add these and cook slowly one and 
one-half hours. Pour through a collander and add to the clear 
liquor the butter and savita, and boil for five minutes. Should 
make one quart of broth. INFANT FEEDING 
935 
Vegetable Broth for Babies. 
To one cup of Savita vegetable broth, add one-half cup of 
water. 
Two or three ounces of vegetable broth may be given daily 
with great advantage. Vegetable bouillon supplies nutritive 
salts which are needed to promote growth and tissue building. 
Malt Sugar. 
Malt sugar in place of cane sugar. Cane sugar is a pure 
carbohydrate product. It contains nothing but sugar and is in- 
tensely sweet. Malt sugar is less sweet—an advantage, because 
in this respect it more nearly resembles lactose, the natural sugar 
of milk. 
Malt sugar has the great advantage of containing water-sol- 
uble B vitamin in considerable amount, as well as iron, lime and 
other things essential to nutrition. Malt sugar, in other words, 
is something more than sugar. Purees of dates, prunes and 
raisins may also be given to infants with great benefit in many 
cases because of the richness of these fruits in lime and iron. 
Malt sugar has also another important advantage which has 
only recently come to be appreciated; namely, the considerable 
amount of dextrin which it contains. Pavlov showed the great 
value of dextrin as a peptogen, that is, a substance which actively 
promotes the digestive processes. This makes malt sugar of 
great importance as an aid to the feeble digestive powers of the 
average infant. 
Torrey, Rettger and others have recently shown dextrin to 
be one of the best of all substances for promoting the growth of 
the protective germs. 
Certain acid-forming germs, the B. bifidus and B. acidophilus 
make their appearance in the colon of the breast-fed infant with- 
in a few hours after birth. 
When cow’s milk is fed, these essential protective germs 
tend to disappear, their place being taken by putrefactive germs 
which produce poisons causing dark, foul-smelling stools, fretful- 
ness, restless sleep, lack of appetite, delayed growth and other 
symptoms of the chronic poisoning induced by dangerous germs 
which, unfortunately, are always found in great numbers in 
commercial cow’s milk. 
Torrey, experimenting with white rats, found that by feed- 
ing dextrin the protective germs could be restored within three 936 
THE NEW DIETETICS 
or four days, the putrefactive and colon germs disappearing al- 
most wholly. This is a discovery of very great importance and 
helps to explain the benefits derived from the feeding of barley 
gruel, malt soup, potato soup, and other preparations containing 
more or less dextrin. In malt sugar, dextrin is found in greater 
abundance than in any other food suitable for young children, a 
fact which in part doubtless explains the great benefits following 
the substitution of malt sugar for cane sugar in the diet of 
bottle-fed infants, an observation which has led modern special- 
ists in the care of children to recommend malt sugar as greatly 
superior to either cane sugar or milk sugar in infant feeding. 
The malt sugar should be added to the milk or milk and 
water mixture in the proportion of one ounce to the pint. Malt 
sugar is now obtainable at most drug stores. 
Vitamins, 
Gruels prepared with wheat germs are very rich in vitamins 
and are advantageously used in supplementing the dietaries of 
artificially fed children. 
Wheat germs may be combined with oatmeal, barley or any 
other cereal suitable for gruels in proportion of one part of the 
germs to nine or ten parts of cereal meal. Boil half an hour and 
strain. 
Recent observations show that mother’s milk as well as cow’s 
milk is often deficient in vitamins because the food of the mother 
or of the cow is lacking in these food accessories. The food of 
cows in winter, when they eat much dry feed, is certain to be 
deficient in growth-stimulating elements. The winter food of 
mothers is likely to be deficient for a similar reason, unless pains 
are taken to supplement the usual dietary with liberal quantities 
of greens, fresh vegetables, tomatoes, and fresh fruits. 
Fats Often a Source of Disturbance, 
An excess of fat in cow’s milk is one of the most serious 
causes of trouble in the artificial feeding of infants. Many 
infants are able to digest fats only in small amounts and when 
the food contains an excess, the undigested portion undergoes 
decomposition in the intestines, forming irritating and poisonous 
substances. An excess of fat is one of the most common causes 
of indigestion and bowel troubles. This difficulty is overcome 
by diluting the milk with skimmed milk or with water, or by 
removing a part of the cream. INFANT FEEDING 
937 
The fat of cow’s milk consists of globules much larger than 
those of human milk, which is one of the reasons given for the 
inferior digestibility of cow’s milk. The milk fat of Holstein 
and Guernsey cattle occurs in smaller globules than that of other 
breeds of dairy animals. 
The common practice of taking the baby to the table and 
permitting him to “nibble” all sorts of foods is most pernicious. 
The infant’s stomach is able to digest only simple foods. 
Dangerous Foods. 
Beef tea, meat juice, and meat broths are in the highest 
degree unwholesome for infants. These preparations have prac- 
tically no food value. They represent the excretory products in 
the meat and encourage putrefaction in the intestines. 
Eggs are also a dangerous food for young infants. Many 
infants are “sensitized” to eggs so that a single feeding may pro- 
duce highly poisonous, even fatal effects. 
Anemic Infants. 
Many infants become anemic soon after the sixth month 
because of the small amount of iron in cow’s milk. This may 
even occur in the case of breast-fed infants, for mother’s milk 
contains little iron. The liver of the child born at full term con- 
tains iron enough to last it for eight or nine months, but it is 
reasonable to suppose that a premature infant born from three 
to eight weeks before full term must be launched into the world 
with a deficient store of iron in its liver. Such infants will need 
a supplementary supply of food iron earlier. Test the blood of 
the infant for hemoglobin whenever there is any ground for 
suspicions that its supply of iron may be insufficient. Malted nuts 
may be used in alternate feedings with much advantage. 
One teaspoonful of puree of steamed spinach, or steamed 
carrots may be given daily after the sixth month. Three ounces 
of malt sugar daily will insure the infant an adequate supply of 
food iron. Cane sugar and milk sugar supply no food iron. 
Cereals for Infants. Oatmeal is a specially wholesome food 
for all young children who have attained the age of six months, 
and may often be used earlier with advantage. According to 
Chalmers Watson, oatmeal and milk constitute a better food than 
bread and milk because of the stimulating action of oatmeal on 
the thyroid gland, which tends to accelerate growth. 938 
THE NEW DIETETICS 
It is better that the oatmeal should not be too long boiled. 
Just sufficient boiling to render it liquid enough to feed con- 
veniently is quite sufficient. Long boiling impairs the precious 
vitamins. An eminent specialist in the diseases of children 
records that he found bottle-fed babies did well on a diet con- 
sisting of milk with the addition of fifty grams daily of raw 
starch, which ignorant mothers had administered through failing 
to follow directions. All the cereal starches are digestible in 
small amounts in the raw state and aid bowel action and combat 
intestinal toxemia. 
Vita Wheat contains the wheat germ and when well boiled 
and strained, is a most excellent cereal for infants. Cream of 
wheat and cornmeal may be used if a rounded teaspoonful of 
wheat germ meal is added for each ounce of the cereal. The 
wheat germ meal is a necessary addition when degerminated 
cereals are used. In place of wheat germ meal, Savita or Mar- 
mite, an extract of yeast, may be employed. 
“Zo” is an excellent cereal for infant feeding because of its 
richness in vitamins and iron. 
Dry toast is another form of cereal food which may be 
given to infants in small amounts after the teeth make their ap- 
pearance. Graham or whole wheat bread should be cut in thin 
slices and placed in a moderately hot oven until brown through 
the whole thickness of the slice. This toast is much superior to 
ordinary commercial zwieback. 
Vegetable Soup. 
Potato soup prepared without meat or other seasoning than 
a little butter or cream, may be given once a day at nine or ten 
months. Soup or purees prepared from potatoes and spinach 
mixed has the advantage that it supplies iron, which is deficient 
in potato. 
Butter Soup for Infants. Czerny and Kleinschmidt suggest 
for the feeding of very young infants, especially premature in- 
fants, butter soup combined with milk. Butter soup consists of 
7)4 level teaspoonfuls of melted butter, 5)4 level teaspoonfuls of 
sugar (preferably malt sugar), 14 J4 level teaspoonfuls of wheat 
flour and 17)4 ounces of water. The food value of soup pre- 
pared in this way is about 28 calories to the ounce. For an in- 
fant weighing 7 pounds, 14 ounces of this soup should be given 
daily mixed with 7 ounces of whole milk. The food should be INFANT FEEDING 
939 
given at 7 feedings. The food value of the mixture will be 
about 24 calories to the ounce. This diet is particularly rich in 
vitamin A, which is needed by the young infant to promote 
growth. 
Buttermilk for Infants. Marfan, an eminent specialist in 
diseases of children, gives the following directions for the prep- 
ration of buttermilk for infants suffering from diarrhea, claim- 
ing it to be an almost infallible remedy: 
A little sour milk is added to the milk to be prepared. This 
is set aside for 24 hours and allowed to sour. At the end of this 
time it is skimmed, then churned for 40 minutes and passed 
through a fine sieve. An ounce of malt sugar and a tablespoonful 
of rice gruel are then added with a little salt and the whole is 
very slowly heated to boiling while constantly stirred with a cream 
whip. This preparation should be made the sole food of the 
child until the diarrhea disappears. Buttermilk prepared with 
B. acidophilus is doubtless the best of all buttermilks for the 
reason that the B. acidophilus is the normal protective organism 
of the intestine. Acidophilus buttermilk should be taken without 
cooking, as heat will quickly destroy the bacilli which it is desired 
to plant in the colon. 
Water for Infants. Infants often suffer from lack of water. 
The crying of young children is often due to thirst rather than 
hunger. A child under one year of age should receive for each 
pound of body weight two ounces of liquid, either in the form 
of water or liquid food. Children over a year old require not 
less than one quart of water daily. 
Lime Water. The extensive use of lime water as an in- 
gredient of modified milk used for bottle-fed children renders 
important a brief reference to this widely used mineral solution. 
Lime water differs little from hard water except in the fact that 
it contains more lime. Tibbies says that the value of lime water 
is disputable. Bunge declares that inorganic lime is not assimi- 
lated. As a matter of fact, the amount of lime in lime water is 
less than that found in cow’s milk. A pint of cow’s milk contains 
26 grains of lime (CaO) while a pint of lime water contains 
only 20 grains or less than four-fifths as much. In milk and 
other foodstuffs the lime is in organic combination with the 
casein and so is prepared to be utilized by the body, whereas in 
lime water it is in its native mineral form and needs to be acted 
upon by the cells of the living plant before it is suitable for 940 
THE NEW DIETETICS 
human food. It is believed by Tibbies and Bunge that to insure 
utilization, lime “must be organically united to the proteins of 
the food.” 
The addition of lime water or soda to milk is an objection- 
able practice for the reason that these alkalies injure and may 
destroy the vitamins upon which the development, health and 
even the life of the infant depend. 
Cane Sugar Poisoning. According to Fischl, cane sugar, in 
excess, may in young infants give rise to fever, with rapid breath- 
ing, stupor, tendency to collapse, and the occurrence of sugar in 
the urine. This is especially likely to occur from the use of milk 
preparations containing much sugar, such as the Swiss con- 
densed milk and similar preparations. 
Cane sugar should be excluded from the diet of infants. 
Malt Soup and Scurvy. Experience has shown that malt 
soup or malt soup extract, when fed to young children, is likely 
to lead to the development of scurvy. When malt soup or any 
other artificial food is used in infant feeding, orange juice or 
tomato juice should be added in proper quantity. 
The Deleterious Effects of Meat Diet for Children. Pro- 
fessor Sherman of Columbia University, an able physiologist, 
several years ago called the attention of the profession to the 
fact that meat is lacking in lime salts. This fact alone renders it 
an unsuitable food for children. 
Dr. Winters maintains that one of the many evil conse- 
quences of the early use of meat by children “is the loss of relish 
it creates for the physiological foods of children—milk, cereals 
and vegetables.” Says Dr. Winters, “A child that is allowed a 
generous meat diet is certain to refuse cereals and vegetables. 
Meat, by its stimulating effect, produces a habit as surely as does 
alcohol, tea, or coffee, and a distaste for less satisfying foods. 
The foods which the meat-eating child dislikes contain in large 
proportions certain mineral constituents which are essential to 
bodily nutrition and health, and without which the processes of 
growth and development are stunted.” 
Dr. Winters attributes to the use of meat many of the dis- 
orders to which children are subject, particularly incontinence 
of urine, rheumatism, chorea, rheumatic inflammation of the 
tonsils and torticollis, night terrors, urticaria, angio-neurotic 
edema, anemia, convulsions and petit mal. 
According to this author, “there is more so-called nervous- INFANT FEEDING 
941 
ness, anemia, rheumatism, valvular disease of the heart, and 
chorea at the present time in children from an excess of meat 
and its preparations in the diet than from all other causes com- 
bined.” No doubt these observations are well founded. A meat 
diet is as unnatural for a young infant as for a young gorilla. 
The Infant's Stools. 
In the feeding of children of all ages, careful observation 
of the character of the flora is of the utmost importance. This 
may be done in a crude but practical way by simple examination 
of the stools. If the stools are dark in color and of putrid am- 
moniacal odor, putrefactive germs or flora may be known to be 
dominant. The flora needs to be changed by regulation of the 
diet in a manner elsewhere recommended for this purpose. Por- 
ter, Morris and Meyer {Am. Jour. Dis. of Ckil., 1919), who have 
made a special study of the intestinal bacteria in children, tell us: 
In children who suffer from certain types of alimentary intoxica- 
tion with malnutrition, the intestinal flora departs in a uniform man- 
ner from the normal, and this departure is always characterized by the 
establishment of bacterial types predominantly putrefactive. The re- 
turn of these children to normal health is coincident with a regression 
of the intestinal flora toward predominantly fermentative types and a 
later swing to balance between the two types. Such changes in the 
intestinal flora can be brought about in the intestine of the human 
infant by withdrawing of animal protein and persistently feeding 
large amounts of lactose (from 2 to 4 ounces daily), and other carbo- 
hydrates (the period which may be necessary to produce this variation 
being from 10 to 40 days). . . The progressive cessation of the 
symptoms of intoxication and a return of toxemic patients to nutri- 
tional health coincides with the recognizable dominance of a fermen- 
tative flora (B. acidophilus). Lactose and dextrins are the carbohy- 
drates most effective in encouraging the rapid establishment of a fer- 
mentative flora in the intestines of infants and children. 
Nursing. 
Observation of the habits of primitive people and lower 
animals indicates that the nursing period naturally continues until 
some time after the eruption of the first teeth is complete. Garner 
noted that apes, our nearest kin in the animal world, nurse their 
infants from five to seven months. Their first teeth are complete 
by the third month. Young camels nurse for a year although 
they begin to eat with their mothers a few weeks after they are 
born. 942 
THE NEW DIETETICS 
Among primitive people nursing continues until the first 
teeth are complete, or for three years, although considerable 
other food is eaten. Pictures of young children standing at the 
breast of savage mothers are common. Referring to this fact, 
Dr. Vander Bogert well says: “But we must remember that these 
are primitive people in their natural state and that because of 
natural conditions they are able to produce a better milk supply 
and for a longer time.” This simple statement contains much 
food for thought. In how many other ways is the tame or civil- 
ized human being inferior to his wild or savage brothers and 
sisters because of unnatural conditions of life! 
It is a matter of general observation that the modern civil- 
ized woman is unable to produce a good quality of milk for a 
longer time than one year. Babies that are breast-fed for a 
longer time do not develop well and in later life develop physical 
defects and digestive disorders which are attributed to too long 
breast-feeding. 
Weaning. 
Artificial feeding is by no means a full substitute for breast- 
feeding, hence a child should never be weaned before the age of 
nine months except for unavoidable reasons. No food can be so 
well adapted to the young infant’s needs as its mother’s milk. 
Mother’s milk contains three times as much iron as does cow’s 
milk, which explains the fact that artificially-fed infants are 
usually pale, anemic and far more subject to illnesses of various 
sorts than are breast-fed children because of their low resistance. 
Breast milk contains, in addition to the food principles necessary 
for nourishing the infant, subtle substances derived from the 
mother’s blood known as immune bodies, by means of which at 
least some degree of the immunity acquired by the mother against 
disease is transmitted to the infant. 
It is well to prepare the infant for weaning by beginning 
bottle feeding early and increasing the amount gradually as the 
infant advances in age. Bottle feeding may be substituted for 
breast feeding once a day, after three months, with great advan- 
tage. At this age, infants accept the bottle much more readily 
than later. When bottle feeding is begun as early as three 
months, the proportion of milk employed should be about six 
ounces of milk to fourteen of water. When bottle feeding is 
begun at the age of six or seven months, a larger proportion of INFANT FEEDING 
943 
milk may be employed, say eight ounces of milk to twelve of 
water. For feeding program, see Table XXX. 
Malted nuts or lacto-dextrin may be added to the mixture in 
proportion of two ounces to the quart. This will supply prac- 
tically the same amount of carbohydrate (7 per cent) found in 
breast milk. Lacto-dextrin is superior to either lactose or malt 
sugar for the reason that it supplies vitamin, which is never in 
excess in cow’s milk and is always deficient in milk mixtures. 
Mixed Feeding, 
Infants do far better when breast milk is very gradually 
withdrawn. Even though the mixed feeding may cover a very 
considerable period, a small amount of breast milk is a great 
advantage to the infant, not only because it is richer in iron but 
because of other elements which it supplies which are not found 
in cow’s milk. 
When the infant has reached the age of five or six months, 
two or even three bottles may be given daily in place of breast 
feeding and the child may be given small quantities of purees of 
vegetables and fruits of various sorts so as to accustom it to the 
flavors of these foodstuffs. Well boiled oatmeal gruel may also 
be given in moderate amounts, slightly sweetened with lactose or 
malt sugar. 
The proper rule seems to be to begin feeding wholesome 
simple food in small quantities as soon as the first teeth appear, 
especially purees of greens and of fresh vegetables, fruit juices 
and gruels. From week to week the quantity and the variety of 
foods may be increased. Orange juice and tomato juice may be 
given almost from the outset, and encourage growth, appetite and 
bowel action. 
Children should be taught from a very early age to make use 
of sweet fruits instead of cane sugar. Dates, figs and raisins, 
first in the form of purees, then in their natural state, should be 
made a regular part of the child’s bill of fare. 
Vomiting of Infants, 
Vomiting in bottle-fed infants may be due to swallowing air 
while feeding. To prevent, hold the bottle so as to keep the 
neck wholly filled with milk. 
If large curds are present, the milk mixture is probably too 
strong. More water should be added. 944 
THE NEW DIETETICS 
If the vomit has a rancid odor, the stomach must be washed 
out. Less fat should be given and more malt or milk sugar. 
If vomiting is very persistent, there may be obstruction of 
the pylorus requiring operation. In such cases, operation should 
not be delayed. An X-ray examination should be made. 
Simple regurgitation of the food after .eating, without the 
presence of tough curds, has no significance other than that the 
child may have eaten a little too much. 
Hot applications over the stomach before and after feeding 
will often control troublesome vomiting. 
Diarrhea in Infants and Cholera Infantum, 
In cases of intestinal irritation with diarrhea or cholera in- 
fantum, the child should be fed on a thin barley or oatmeal 
gruel until the bowel looseness is checked, and then malt soup 
should be employed. 
Pyloric Obstruction, 
Congenital obstruction of the pylorus is by no means a rare 
condition in infants. If the obstruction is complete, as shown 
by the vomiting of everything eaten and rapid emaciation, an 
operation should be performed at once. If the obstruction is 
not complete, as shown by the fact that only a portion of the 
food is vomited, and even a slight gain in weight, an attempt 
should be made to build the patient up by breast-feeding and by 
the feeding of lactose or malt sugar by enema. One ounce of 
sugar should be dissolved in a pint of water, and 3 or 4 ounces 
of this sugar solution, at body temperature, should be introduced 
by enema three or four times a day. Breast milk may be given, 
together with an equal quantity of sugar water. Time should not 
be lost in ineffectual efforts to build the child up. The case should 
be placed in the hands of a competent surgeon for operation. 
An hour after the operation, half an ounce of sugar solution 
or equal parts of sugar solution and breast milk may be given. 
During the first twenty-four hours the sugar water should be 
given every hour and a half. After the second day an equal 
quantity of mother’s milk may be mixed with the sugar water. 
If mother’s milk is not obtainable, cow’s milk may be given— 
at first, one part to nine of sugar water; the next day, one to 
eight; third day, one to seven, gradually increasing the milk 
until the proportion is one to three of sugar water. INFANT FEEDING 
945 
After the first day, the amount of food given at each feed- 
ing is gradually increased from half an ounce to one ounce at 
the end of the fifth or sixth day. Orange juice may be given as 
to any other infant. Vegetable broths are needed to supply food 
salts. 
Feeding During Fever, 
During an attack of fever from any cause, less fat and 
protein are required, but the amount of sugar should be in- 
creased. On this account, the feeding mixture should be diluted 
by the addition of an equal quantity of water. The added water 
should contain an ounce of sugar to the pint. Cane sugar should 
not be used because of its irritating effects. Lactose, malt sugar 
or maltose dextrin are best suited to the infant’s needs. Orange 
juice should be given in proportion to the age of the child. An 
infant too feeble to take its food in the usual way, or unconscious, 
may be fed by means of a soft catheter passing into the stomach. 
Water as well as food should be given. In addition to a quart of 
food, a pint or a pint and a half of water will be required to aid 
elimination. 
Hypersensitiveness of Infants to Certain 
Foodstuffs—Anaphylaxis, 
For many years it has been known that children, as well as 
adults, may be made very ill by small quantities- of foods and 
other substances which are ordinarily harmless. So long ago as 
1831 Elliotson noted the connection between the pollen of plants 
and hay fever. Hutchinson, in 1884, reported the observation 
that certain patients suffered from nausea, vomiting, and abdomi- 
nal pain after eating eggs. Within recent years a large number 
of similar cases have been reported. It is now known that both 
children and adults are frequently sensitized to cow’s milk, shell- 
fish, meat and other substances. The following case, reported 
by Dr. Black fan, of Baltimore, will be found interesting as an 
example of the effects of food upon a sensitized person: 
An infant that had been exclusively breast-fed was given, when 
six weeks old, a small amount of cow’s milk. This was immediately 
vomited. One month later one-half teaspoonful of milk caused a 
severe general reaction. The baby vomited and had diarrhea. He 
became cyanosed and so prostrated that the physician considered 
him dangerously ill. Bread prepared with cow’s milk brought on a 
similar reaction, as did the administration of three drops of one in 946 
THE NEW DIETETICS 
32 dilution of condensed milk. Cow’s milk in any form and in infini- 
tesimal amounts always caused vomiting, loose stools, cyanosis, ir- 
regular respirations and prostration. He was able to take goat’s milk 
without any symptons. In order to determine that the symptons were 
due to cow’s milk the protein of cow’s milk was applied to the skin. 
This was followed by an area of edema and erythema after four hours. 
When introduced in this manner cow’s milk caused the same general 
symptons as when taken by mouth. Protein from beef, egg, horse 
serum, barley, human milk and goat’s milk caused no reaction when 
applied to the skin. The baby was nursed at the breast and given 
supplemental feedings of goat’s milk until ten months old, after which 
minute amounts of cow’s milk were given by mouth. Gradually the 
amount was increased until the hypersensitiveness to cow’s milk was 
overcome. The paternal aunt had an idiosyncrasy to shellfish and the 
paternal grandfather and great-grandfather had asthma. 
An infant aged two years was breast-fed for two months, after 
which he was given a formula of cow’s milk. Cereals, broths and 
vegetables were added subsequently. Eczema appeared when he was 
given a soft-boiled egg. This was immediately vomited and he was 
sick for several hours. Six months later egg was given and he again 
vomited. The protein of egg, cow’s milk, barley, horse serum and beef 
gave a marked reaction when applied to the skin. By omitting 
eggs, meats and milk from the diet the eczema improved, and by giving 
them in small amounts and gradually increasing them he was finally 
able to take these foods without a return of the eczema. The mother 
had eczema when she was an infant. 
A girl of ten suffered from fever, vomiting, diarrhea, great 
prostration, edema and intense general itching whenever she ate 
meat. This child showed no intolerance for milk. 
Methods now exist by which a person may be tested for 
hypersensitiveness by simple means which may be employed by 
any physician familiar with the technic. No child should be 
given cow’s milk without first being tested for hypersensitive- 
ness ; in other words, in changing from breast milk to cow’s milk, 
the cow’s milk should be given first in very small quantities. 
The amount at first should be not more than a teaspoonful and 
should be well diluted with water, and after it is given several 
hours should elapse before another dose is administered, to give 
opportunity for the development of any possible unfavorable 
reaction. 
By means of allergens, prepared from various foodstuffs, 
sensitivity tests may be made for more than a hundred different 
articles which have been incriminated clinically of causing ana- 
phylaxis. The test is usually made after the method of vaccina- 
tion. A slight abrasion of the skin is made and the substance to INFANT FEEDING 
947 
be tested is rubbed upon it. The appearance of a macula within 
a few minutes shows sensitivity. 
Hypersensitiveness may be inherited. In some instances 
every member of a family of children are found to be sensitized 
to the same foodstuff. Sensitivity may appear in very young 
infants or develop a few months later. Very marked sensitivity 
may disappear in a manner wholly unaccountable. 
The foods to which infants and young children are most 
often sensitized are cow’s milk, oatmeal, potato, eggs, peas, beef 
juice, chicken, fish and strawberries. 
A new and apparently valuable method for discovering cases 
of this sort has been recently brought forward by Ewald. This 
sagacious observer has discovered that the application of his 
simple milk test for hepatic insufficiency is one of the best means 
of discovering sensitivity. The test is a simple one, as elsewhere 
described (see Index). It owes its value to the fact that when 
sensitivity exists a slight anaphylactic effect is observed, the evi- 
dence of this reaction being a more or less considerable fall in 
the white blood count. According to Ewald, when this reaction 
is found, the patient is sensitized to something, and the particular 
form of protein to which he is sensitized may be worked out by 
the application of the appropriate tests. Diet of Young Children 
One to Five Years of Age 
The diet of the growing child is a matter of first importance 
not only in relation to its present welfare but in relation to its 
whole after-life. Food is to the growing child just what soil is to 
the growing plant. Certain essential elements which enter into the 
structure of the plant are derived only from the soil. The mus- 
cles, bones, brains—every bodily structure—are formed from the 
food which, after digestion, is taken up by the villi and other 
absorbents from the intestines, which perform for the body the 
same functions as do the rootlets of the plant. The child is made 
of what it eats. The farmer, the gardener, the horticulturist, the 
lady who cultivates a flower garden, each takes great pains to 
see that the soil in which his plants, trees, shrubs, flowers, etc., 
grow, contains the right sort of plant food, and will expect only 
disappointment in the results of his labors unless this matter of 
primal importance receives attention. It is most surprising, 
indeed, that the average housewife feeds her family almost wholly 
with reference to individual likes and dislikes and with little con- 
sideration for actual body needs. 
The physiological needs of a child are practically the same 
as those of adults with this exception, however, which must be 
constantly kept in mind, that the child is a developing organism, 
that its body is not yet formed, but is growing rapidly and hence 
requires not only special attention to the kinds and quality of 
food eaten but also special consideration as to quantity. A child 
requires a much larger intake of food in proportion to its weight 
than does an adult. Between the ages of two months and five 
years, a child requires, in fact, practically double as much food 
in proportion to its weight as does an adult; that is, a boy of 
seven weighing fifty pounds requires as much food as an adult 
weighing one hundred pounds; and after the ages of ten or 
twelve, active children require practically as much food as do 
adults who are not engaged in hard, muscular work. The stom- 
ach of a child of ten years is scarcely half the size of the 
948 DIET OF YOUNG CHILDREN 
949 
average adult, and having practically the same amount of work 
to do as has the adult stomach, it may easily be overtaxed, either 
by overeating or by the use of foods difficult of digestion. 
It is thus highly important that the food of the child shall 
be simple and of the highest quality so that it may not fail to 
supply the body with all the nutritive material necessary for build- 
ing its various structures. Tens of thousands of children are 
dwarfed for life by improper feeding during the years of early 
childhood. A marked arrest of growth at this period is not likely 
to be fully recovered from in later years. The loss of 2y2 inches 
in the stature of the American people within the last sixty years, 
pointed out by Professor Osborn, President of the American 
Museum of Natural History, New York City, is without doubt, 
in part at least, the result of the improper feeding of children. 
In general, it may be said as regards the kind of food suit- 
able for children of three years of age and afterwards, that the 
child may be permitted to eat anything that is really suitable for 
its parents. The presence of teeth indicates the suitability of 
foods requiring mastication, and if only such foods are eaten as 
are perfectly adapted to meeting the biologic or physiologic re- 
quirements of the human body, there is no reason why a child 
may not eat anything which his parents eat, although, as will be 
noted later, there are certain important particulars in which the 
dietetic requirements of the child are essentially different from 
those of the adult, to which careful attention must be given in 
the preparation of bills of fare for growing children, especially 
as regards the need of greater quantities of lime and iron. 
While it is true that a biologic diet is safe and wholesome 
for children that have acquired teeth, it is important that atten- 
tion should be called to the fact that many articles which usually 
enter into the daily bill of fare of adults, but which are better 
excluded because of their unwholesomeness, are particularly un- 
wholesome for children, and hence must be rigorously excluded 
from their dietaries. Among articles of this sort may be men- 
tioned particularly condiments of all sorts. Mustard, pepper, 
peppersauce, cayenne, horseradish, cloves, even nutmeg, and 
vinegar and pickles of every sort, while unwholesome for adults, 
are pernicious and even positively dangerous for young children. 
None of the substances named have any food value whatever. 
They supply no body need. They are instead poisons which in- 
jure the stomach and work various mischiefs in the body. 950 
THE NEW DIETETICS 
A properly trained child has no relish for any of the articles 
mentioned above. They are unnatural substances, an appetite for 
which is cultivated and must be regarded as a perverted taste. 
Hot condiments of all sorts over-excite the stomach, wear out the 
glands which secrete the gastric juice and do other mischiefs to 
which attention has been called elsewhere in this work (see Con- 
diments). Even salt should be used sparingly. There is no 
necessity for adding salt to any of our ordinary food as all nat- 
ural food contains a sufficient amount of salt to satisfy the needs 
of the body. If salt is used at all, it should be in very minute 
quantities. Children should never be permitted to acquire the 
habit of eating large quantities of salt as it is injurious not only 
to the stomach but to the kidneys and other vital organs as well. 
The use of tea and coffee is another practice which works 
great injury to the growing child. The caffein of tea and coffee, 
as every one knows, tends to wakefulness. The child needs a 
great amount of sleep. Ten or twelve hours out of every twenty- 
four, or even more, in the case of very young children, are re- 
quired to afford the body the needed opportunity for building 
bones, muscles, nerves and other tissues, a process which proceeds 
rapidly only during sleep. Plants grow much faster at night than 
in the daytime and the same is true of children. The use of tea 
or coffee tends to lessen the hours of sleep through its effect 
upon the nervous system and thus lessens the rate of growth and 
dwarfs the child. 
Coca Cola has precisely the same effect as coffee owing to 
the caffein which it contains. Many parents being unaware of 
this fact, permit children to use Coca Cola ad libitum, a practice 
which cannot be too strongly condemned. The Coca Cola habit 
is easily formed and will naturally lead later in life to other drug 
habits. 
The idea that meat is highly essential for children has been 
in recent years widely propagated by various unreliable syndi- 
cate writers and, unfortunately, has sometimes been counten- 
anced by physicians who have not given special study to dietetics 
to qualify them to give expert advice upon the subject. The 
studies of Professor Sherman, of Columbia University, McCol- 
lum, of Johns Hopkins, and of numerous other authorities who 
have conducted nutrition researches in laboratories especially 
equipped for the purpose, have shown most conclusively that meat 
is not essential for the feeding of children. In fact, the very DIET OF YOUNG CHILDREN 
951 
opposite is the truth. Every food essential which can be secured 
by the use of meat is supplied by milk and in a form far better 
adapted for the use of the child than in meat. Meat, on the 
other hand, is highly lacking in certain elements which are abso- 
lutely essential for children. This is particularly true of the salts 
essential for building up not only the bones but other of the 
bodily tissues. But the greatest objection to the use of meat for 
children is to be found in the fact that it is practically always 
swarming with bacteria of the most pernicious sort. Fresh meat, 
fish, chicken, fresh oysters, meats in all forms, in fact, are fairly 
swarming with putrefactive bacteria. 
In the process of slaughtering animals, their tissues become 
thoroughly infected with the manure germs which are found upon 
their bodies. These bacteria rapidly penetrate the tissues and 
within a few hours after death the carcass of the animal is every- 
where swarming with these filthy intestinal bacteria, which are 
not destroyed by cooking. When flesh is eaten, these parasites 
infect the intestine, particularly the colon, and cause diarrhea, 
appendicitis and various other infections. 
Feeding meat to young children is not only absolutely un- 
necessary but is one of the most certain methods of laying the 
foundation for life-long misery from constipation, autointoxica- 
tion and various disorders which grow out of these conditions. 
Every mother should know that in order to supply a child 
with the things essential for its nutrition, foods must be taken as 
nearly as possible in their natural state. Unfortunately many 
foods which come to our tables are denatured by the manufactur- 
ers of breakfast foods and other staples. A child fed upon bread 
and milk, a dish which is perhaps more generally used than any 
other in the feeding of children, is certain to be poorly developed, 
to suffer from poverty of blood, constipation and possibly more 
serious maladies. A bread and milk diet, as well as a bread and 
meat diet, is a most incomplete bill of fare. Food to be suited to 
the needs of children must be particularly rich in vitamins, lime 
and iron. It is unnecessary to repeat here the facts in relation 
to vitamins, lime and iron which have been fully presented else- 
where in this work (see index). We wish only to emphasize the 
fact that children require at least double as much of these food 
essentials as do adults because of the fact that they are develop- 
ing organisms and require not simply a sufficient amount of new 
material to replace that which has been worn out and lost from 952 
THE NEW DIETETICS 
the body, so-called “repair material,” but a large amount of 
building material out of which to construct the framework of the 
body, the bones and various soft parts attached thereto. 
There are few foods which are richly supplied with all three 
of the food essentials mentioned, lime, iron and vitamins. It is 
only by a proper combination of foodstuffs that the necessary 
supply of these elements can be insured to the child. Many com- 
mon foods are greatly deficient in all three of these essentials. 
This is especially true of many breakfast foods, which are woe- 
fully lacking in lime, iron and vitamins. Of the various cereals, 
oatmeal is one of the best. It contains a considerable amount of 
lime and some iron, though deficient in vitamins. By the addi- 
tion of milk, oatmeal becomes very nearly a perfect food, for 
milk is rich in lime, although deficient in iron. On a diet of 
white bread and milk, or of rice, rice flakes, or corn flakes, the 
diet would be deficient because of the almost entire absence of 
iron. A breakfast food ought to supply, with the addition of 
milk, all of the elements required for complete nutrition and in 
such abundance as to make good the deficiency of other food- 
stuffs. Such a breakfast food has within the last year or two 
been put upon the market and is sold under the name of “ZO.” 
A very excellent breakfast food for children may be pre- 
pared by the addition of sterilized, cooked bran to oatmeal. The 
two may be combined in equal parts by measure. Cooking should 
not be continued longer than ten or fifteen minutes. Longer 
cooking lessens the food value. 
Ordinary cornmeal is deficient in lime and iron, but may be 
improved by the addition of wheat bran. The coarser the bran 
the better. Bran not only adds lime and iron, but also supplies 
the necessary intestinal stimulant. It should be remembered that 
bran is not irritating, but is simply titillating; that is, it stimu- 
lates the intestine by its presence, but not by irritation. It may 
be used by the youngest children without injury and in liberal 
quantities. A law prohibiting the manufacture and sale of fine 
flour bread and similar denatured products would be of great 
service as a health-promoting measure. 
Fresh vegetables are of great service as a source of vitamins 
and salts, and should be used freely in the feeding of children. 
The Irish potato, in particular, is a food of great value for chil- 
dren, tending to prevent acidosis, which is likely to develop from 
a too exclusive diet of cereals and milk. When meats are given DIET OF YOUNG CHILDREN 
953 
to children, acidosis is still more likely to develop, with constipa- 
tion and autointoxication. The potato is of almost equal value 
with bread as a nutrient, though of course it must be used in 
larger quantity. Baked potatoes are easily digestible and, com- 
bined with milk or buttermilk, they supply all the elements re- 
quired for good nutrition, with the exception of food iron and 
roughage. These should be supplied through the free use of bran 
and greens. 
For very young children, vegetables should be used in the 
form of purees of carrots, turnips, spinach and other fresh vege- 
tables, and greens. 
Dates, raisins and figs should be largely used instead of cane 
sugar and cakes. Candies might well be excluded altogether. 
Children are as well satisfied with raisins or dates, which are in 
every way preferable to candy, not only because they are less 
intensely sweet but because they contain vitamins, lime and iron, 
all of which are lacking in candies. Raisins contain more iron 
than do ordinary meats, and dates are richer in iron than the 
average beefsteak. 
Cane sugar could be banished from our tables with ad- 
vantage. The practice of eating sugar freely on cereals is highly 
objectionable. For all table purposes it is better to use molasses, 
maple sirup, maple sugar or sorghum than the fine crystalline 
product usually used, for the reason that these sweet products 
contain the lime and iron which are excluded in the process of 
crystallization and purification to which fine sugars are subjected. 
In recent years, malt sugars have been produced which may be 
substituted with great benefit for cane sugar and corn sirups which 
are now in general use. Malt sugar is not only rich in lime and 
iron, but also vitamin B and is a natural sugar which may be 
taken by children freely without injury. The slightly laxative 
effects of malt sugar are also of service in many cases. 
The quantities of food required by children at different ages 
is shown in the accompanying tables (pp. 954, 955). The following 
menus will be found useful in arranging bills of fare for children 
at different ages. 954 
THE NEW DIETETICS 
BILLS OF FARE FOR CHILDREN 
For Children of Two Years 
Breakfast 
Oz. Calories 
Butter Y 28 
Total 336 
Orange Juice ... 3 45 
Oz. Calories 
Banana puree 2 56 
Branola 3 36 
Malt sugar Ya 25 
Milk 8 157 
Bran Bread Toast ..J4 34 
Dinner 
Tomato Soup 3 37 
Baked Potato 3 89 
Spinach puree 3 41 
Bran Bread Y 34 
Butter Ya 56 
Milk 8 157 
Total 414 
Orange Juice 3 45 
Supper 
Milk 8 157 
Bran Biscuits 1 76 
Prune puree 2 70 
Total 303 
Grand total 1053 
For Children of Six Years 
Breakfast 
Oz. Calories 
Fig Marmalade 2 104 
Brose 3 53 
Bran Bread Toast .. 1 68 
Butter 28 
Oz. Calories 
Milk 8 157 
Total 410 
Dinner 
Lentil Soup 3 87 
Scalloped Potato .... 3 84 
Spinach 3 41 
Stewed Tomatoes ..4 124 
Bran Bread 1 68 
Butter Ya 56 
Milk 8 157 
Dates 1 89 
Total 706 DIET OF YOUNG CHILDREN 
955 
Oz. Calories 
“Zo” 1 102 
Milk 8 157 
Supper 
Oz. Calories 
Baked Apple 5 165 
Total 424 
Grand total 1540 
For Children of Ten Years 
Breakfast 
Oz. Calories 
Orange .f. 5 72 
Stewed Raisins .... 4 261 
Bran Vita Bits 2 180 
Oz. Calories 
Milk 8 157 
Total 670 
Dinner 
Split Pea Soup 5 95 
Mashed Potato 5 116 
Spinach 4 54 
Buttered Carrots ..4 127 
Bran Bread 2 136 
Butter 56 
Milk 8 157 
Strawberry Jelly 
(Veg. Gelatin) .. 3 120 
Total 861 
Supper 
Potato Soup 5 60 
Mashed Turnips .... 4 71 
Celery 2 10 
Whole Wheat Br’d 2 136 
Butter 34 56 
Apple 5 91 
Total 424 
Grand total 1955 The World's Foods 
Edible Foods Growing Wild in the United States. 
The North American Indians, when this country was dis- 
covered by Columbus, were by no means such large consumers of 
flesh as many have supposed. They subsisted very largely upon 
the natural products of the earth. In various parts of New 
England and other localities they had extensive gardens. A 
British officer in describing the results of an expedition against 
the Indians soon after the arrival of the Pilgrims at Plymouth, 
announced among other evidences of his sweeping victory that 
he had destroyed extensive corn fields and several fine orchards 
which the Indians had planted. 
The Indian and other aboriginal Americans gave to the 
world, as the result of centuries of careful cultivation, several of 
our most valuable food plants, among which are all the different 
varieties of Indian corn, including sweet corn and pop corn, 15 
varieties of garden beans, the white potato, the sweet potato, 
watermelons, squashes, pumpkins, tomatoes, the peanut and the 
Jerusalem artichoke. 
Among other plants eaten by the aborigines, and to a con- 
siderable extent still in use by various Indian tribes, may be 
mentioned the roots of the wild parsnip, lily bulbs, camas bulbs, 
roots of the cat-tail, of fern, several grasses, various water plants, 
of clover, eel grass, cinquefoil, the kouse root, the arrowhead 
plant, the carum, bur reed, valerian, balsam root, prairie potato, 
ground nut, milkweed, Jerusalem artichoke, “man of the earth,” 
brake, tule, wild sago; also wild rice, wild oats, wild wheat, wild 
rye, tomatoes, peanuts; besides acorns, walnuts, chestnuts, beech- 
nuts, hickories, pecans, and a great variety of other forest pro- 
ducts. These foods were not only eaten in their season but were 
preserved by drying. Fruits were pulped and dried in the sun 
or in a basket over fire. Roots were stored in the ground. 
The Indians understood various methods of cookery, some 
of which yielded products quite equal to the very latest refine- 
ments of the culinary art. Indeed, their method of steaming 
food for a day and a night by means of heated stones and boiling 
956 THE WORLD’S FOODS 
957 
in water-tight baskets by dropping hot stones into the water 
enabled them to produce from the crude products of the forest 
dishes capable of tempting the palate of a modern gourmand. 
The Indians have known for ages how to produce highly palatable 
and wholesome vegetable dishes, not a few of which have been 
adopted by the civilized people who have supplanted them. Hom- 
iny, hoecake, and succotash, roasting ears, popcorn, and cornmeal 
mush are examples. They used various sorts of greens and knew 
how to prepare delicious and nourishing creams and soups from 
walnuts, hickory nuts, beechnuts, and almost an infinite number 
of mushes or porridges from pinole, a common name used for a 
meal prepared by parching and grinding the seeds of the scores of 
different wild plants with which they were acquainted. Sugar was 
prepared from the sap of the box elder, the willow and the agave, 
as well as the maple tree. It was also prepared by boiling chips 
of the hickory and from watermelons. They made large use of 
honey and gathered sweet products from the sugar pine and 
Douglas fir. In Mexico the fleshy leaves of the agave were 
roasted and eaten together with the fruit. 
Some Indian tribes seem to have appreciated the necessity 
for an ample supply of food lime, since they carefully saved the 
bones of fishes and ground them into a fine powder which they 
added to their food. 
The aboriginal Americans were excellent botanists and were 
thoroughly acquainted with the products of the forest. They 
readily distinguished between poisonous and non-poisonous plants, 
and cultivated in their gardens many of the useful food plants 
which they redeemed from the forest, together with medicinal 
herbs. 
Neither tea and coffee nor any other harmful or intoxi- 
cating drink was indulged by the aborigines of this country, al- 
though they made many agreeable beverages from the pulp of 
fruits of various sorts. These primitive people, like the wild 
animals which shared their forests with them, refrained from 
drinking at meals, as do all primitive people. 
The Eskimos are by no means exclusive meat feeders. They 
eat all the vegetable foods they can get. Certain tribes gather 
masu roots for food, which they eat either raw or cooked, some- 
times fermented. They also make a sort of salad of a species 
of sorrel mixed with seal oil. The cloudberry, barberry and crow- 
berry are eaten by most Eskimo tribes, together with reindeer 958 
THE NEW DIETETICS 
moss and other plants found in the stomachs of caribou and 
other species of reindeer. 
The writer is indebted to Dr. Goddard, of the department 
of anthropology of the American Museum of Natural History, 
for much information concerning the diet of the western In- 
dians. The California Indians make large use of acorns. They 
first grind the acorns, then extract the tannin by leaching with 
warm water. They spread the ground acorns out on a bed of 
sand which is hollowed out like a shallow bowl. They pour 
warm water on this and let it leach out. A squaw sits by, weav- 
ing and pouring on the warm water occasionally. The process 
is completed in about half an hour. The water has just the 
right temperature to dissolve out the tannin quickly but without 
cooking the meal, which would make it pasty. When the leaching 
is done, the squaw very carefully removes the acorn pulp, avoid- 
ing the sand. The layer next to the sand is removed by pressing 
the hand upon it. Both sand and acorn pulp adhere to the hand. 
She dashes a little water gently against the hand, which washes 
away the sand without washing of! the acorn pulp. 
The mush made from the acorn is very wholesome and tasty. 
The Indians thrive on it and prefer it to “white man’s food.” It 
constitutes the principal part of the sustenance of some tribes of 
Indians in northern Mexico. They eat it without salt. They use 
no salt with their food but occasionally eat small quantities of 
kelp, a sort of seaweed which they get from the seashore, to 
which they make occasional visits for the purpose. 
The Indians do not relish beef. It was at first difficult to 
persuade them to eat it. 
WILD FOODS 
The following foods grow wild in the United States, and 
have long been used by the Indians and also to some extent by 
hunters, explorers and early settlers*: 
•‘‘Useful Wild Plants of the United States and Canada,” by Charles Francis 
Saunders, Robert M. McBride, New York. THE WORLD’S FOODS 
959 
Stems or Leaves 
Bisnaga 
Bledo 
Bracken 
Bulrush 
Cabbage palmetto 
Cactus 
Chickory 
Clover 
Dandelion 
Desert trumpet 
Dock 
Lambs’ quarters 
Mescal 
Milkweed (sprouts, buds 
and pods) 
Miner’s lettuce 
Nettle 
Po'keweed 
Purslane 
Red maids 
Red root 
Scurvy grass 
Sotol 
Spanish bayonet 
Watercress 
Wild 
Wintercress 
Roots and Tubers 
Arrowhead 
Biscuit-root 
Bitter-root 
Camas 
Cat-tail 
Chufa 
Conte 
Coontie 
Florida arrowhead 
Groundnut 
Harvest bread-root 
Indian potatoes 
J ack-in-the-pulpit 
Jerusalem artichoke 
Lotus 
Man-of-the-earth 
Pond-lily 
Salt-bush 
Sand-food 
Sego-lily 
Spring beauty 
Tipsin 
Tule 
Virginia tuckaho 
Water chinquapin 
Wild anise 
Wild onion 
Wild potato 
Yamo 
Seeds 
Amaranth 
Brickeye 
Chia 
Goosefoot 
Indian millet 
Islay 
Jojoba 
Juniper 
Salt-bush 
Songwae 
Sunflower 
Tar weed 
Wild flax 
Wild oats 
Wild wheat 
Wild sage THE NEW DIETETICS 
960 
Nuts 
Acorn 
Beechnut 
Chestnut 
Chinquapin 
Groundnut 
Hickory 
Hog peanut 
Walnut 
Pinon 
Fruits 
Barberry 
Blackberry 
Black haw 
Buckthorn 
Buffaloberry 
Cactus 
Cranberry 
Currant 
Elderberry 
Fan-palm 
Gooseberry 
Grape 
Ground cherry 
Hawthorn 
Huckleberry 
Manzanita 
May apple 
May-pop 
Mesquit 
Mulberry 
Oregon grape 
Papaw 
Persimmon 
Pumpkin 
Raspberry 
Salal 
Sahauro 
Screw-bean 
Serviceberry 
Squash 
Strawberry 
Summer haw 
Teaberry 
Tomate del campo 
Tomatillo 
Tomato 
Tuna 
W atermelon 
Yucca 
Plants Cultivated by the Natives of the 
New World Before 1492* 
Agave 
Alligator pear 
Arrowroot 
Bean, kidney 
Bean, lima 
Cashew nut 
Cherimoya 
Corn 
Gourd 
Guava 
Jerusalem artichoke 
Maize 
Manioc 
Potato 
Papaw 
Peanut 
Pineapple 
Prickly pear or Indian fig 
Pumpkin 
Quinoa 
Squash 
Star apple 
Sweet potato 
Tomato 
*The American Indian, by Wissjer. THE WORLD'S FOODS 
961 
EDIBLE PLANTS 
As regards the number of different plants in current use 
as foods by human beings, information was sought from the office 
of Dr. David Fairchild, chief of the Plant Introduction Bureau 
of the U. S. Department of Agriculture. The request brought 
in return the following lists of cereals, vegetables, nuts and 
fruits: 
Cereals 
All plants yielding farinaceous seeds: 
Amaranthus sp.—4 kinds at least 
Bamboo 
Barley 
Brush grass 
Buckwheat 
Carob 
Corn 
Durra 
Emmercorn 
Job’s tears 
Kafir corn 
Lotus 
Manna grits 
Millet (several kinds) 
Oats 
Quinoa 
Ragi 
Rice 
Rye 
Sorghum—6 kinds at least 
Spelt 
Teff 
Teosinte 
Tocusso 
Wheat 
Vegetables 
FI—flowers, R—roots. Unless part eaten is evident from name, 
stem or leaves are eaten if no abbreviation follows: 
Abutilon esculentus—FI. 
Adzuki bean 
Angelica 
Anise 
Arracach 
Arrowhead—R 
Arrowroot 
Artichoke 
Asparagus 
Balm 
Bamboo 
Basil 
Bean, Bonavist 
Bean, common 
Bean, lima 
Bean, mung 
Bean, soy 
Bean, string 
Beet 
Borage 
Brussels sprouts 
Cabbage 
Cabbage palm 
Caper—buds eaten 
Cardoon 
Carosella 
Carrot 
Cassava—R 
Cat-tail—R 
Cauliflower 
Celeriac 
Celery 
Chard 
Chayote- 
Chervil 
Chick pea 962 
THE NEW DIETETICS 
Chicory 
Chinese artichoke 
Chinese cabbage—2 kinds 
Chives 
Clary 
Cornsalad 
Cress—3 or more species 
Crosnes 
Cucumber 
Dandelion 
Dasheen—R 
Egg plant 
Endives 
Fennel 
Fenugreek 
Ferns—5 kinds—R 
Garlic 
Goa bean 
Goosefoot 
Guar bean 
Horehound 
Horseradish 
Ice plant 
Illipi—FI. 
Indian pea 
Jerusalem artichoke—R 
Kafir potato 
Kale 
Kohlrabi 
Leek 
Lentil 
Lettuce 
Licorice—R 
Lotus—R 
Mauritius palm—stem 
Mayna—R 
M itsuba—stems 
Mustard 
New Zealand spinach 
Oca—R 
Okra 
Onion 
Parsley 
Parsnip 
Pea, field 
Pea, garder 
Pea, pigeon 
Pepper 
Phog—FI. 
Pokeberry 
Pomme blanche 
Potato 
Potato bean 
Pumpkin 
Puya 
Queensland arrowroot—R 
Radish 
Raisin tree—stems 
Rape 
Rhubarb 
Rice bean 
Risga—R 
Rocambole—R 
Rocket salad 
Roselle—FI. 
Sago palm—pith 
Salep—R 
Salsify 
Scorzonera 
Scullion 
Seakale 
Shallot—R 
Skirret—R 
Snake gourd 
Sorrels—5 kinds 
Spinach 
Squash 
Sugar cane 
Sweet potato 
Sword bean 
Tahiti arrowroot 
Takka—R 
Tarragon 
Tomato 
Turnip 
Tania—R 
Udo—stems 
Ulluco—R 
Umara—R 
Wax gourd 
Winter purslane 
Yam 
Yam bean—R 
Yautia—R THE WORLD’S FOODS 
963 
Nats 
Acorn 
Almond 
Araucaria nuts 
Avellano 
Beechnut 
Black walnut 
Brazil nut 
Breadnut 
Butternut 
Candlenut 
Caryocar spp. 
Cashew nut 
Catappa nut 
Caucasian walnut 
Chestnut 
Chinquapin 
Chufa 
Earth-chestnut 
Edible acorn, 2 kinds 
(pasania spp.) 
Filbert 
Fox nut 
Ground nut (Voandzeia) 
Ginkgo nut 
Hazel nut 
Hickory nut 
Manketti nuts 
Miriti nut 
Nitta nut 
Peanut 
Pecan 
Pili nut 
Pine nuts—12 species 
Pistachio nut 
Queensland nut 
Sapucaia nut 
Shea nut 
Singhara nut 
Souari nut 
Tabebuia nut 
Torrey nut 
Walnuts—7 species 
Water chestnuts—2 kinds 
Wild almond 
Wild bean 
Yeheb nut 
Fruits 
Abiu 
Akee 
Anchovy pear 
Apple 
Apricot 
Australian carissa 
Avocado 
Bael fruit 
Banana 
Barbardine 
Blackberry 
Blueberry 
Brazilian guava 
Breadfruit 
Buffalo berry 
Caimito 
Canistel 
Carambola 
Caraunda 
Casabanana 
Cashew nut 
Ceriman 
Cherimoya 
Cherry 
Ciruela 
Citron 
Citrus fruits—11 
Cocoa—plum 
Coconut 
Cota Rican guava 
Crabapple 
Cranberry 
Currant—3 species 
Custard apple 
Date 
Diospyros spp.—4 species 
Doum palm 
Eugenia spp.—5 species 
Feijoa 
Fig 
Gooseberry 
Grape 964 
THE NEW DIETETICS 
Papaw 
Papaya 
Pasionaria 
Passion fruit 
Pawpaw 
Peach 
Pear 
Pepino 
Persimmon 
Pineapple 
Pitanga 
Plantain 
Plum 
Pomegranate 
Pond apple 
Prune 
Pulassan 
Quandong-peach 
Queensland pomegranate 
Quince 
Rambutan 
Raspberry 
Rollinia spp.—6 kinds 
Rose apple 
Saguarro 
Sapodilla 
Seaside plum 
Sebesten 
Serviceberry 
Soncoya 
Soursop 
Spanish lime 
Star apple 
Strawberry 
Strawberry guava 
Strychnos fruit 
Sugar apple 
Surinam cherry 
Sweet granadilla 
Tamarind 
Tangerine 
Thimbleberry 
Trebizond date 
Tree tomato 
Tuna 
Watermelon 
White sapote 
Whortleberry 
Yang tao—2 kinds 
Grape fruit 
Guava 
Guisaro 
Gumixameira 
Hagam 
Hog plum 
Huckleberry 
Icaco plum 
llama 
Indian fig 
Jaboticaba 
Jack fruit 
Jambolan plum 
Jujube 
Juneberries—25 species 
eaten 
Kei apple 
Kumquat 
Lamsat 
Lemon vine 
Lemon 
Leichee 
Loganberry 
Longan 
Loquat 
Madagascar plum 
Malay apple 
Mammey apple 
Mang 
Mangosteen 
Marang 
Maracuja melao 
Marmalade plum 
Medlar 
Molucca—apple 
Mombin 
Mountain soursop 
Mulberry 
Muskmelon 
Mytaceae—7 kinds at least 
Nanche 
Natal plum 
Nectarine 
Oleaster 
Olive 
Orange 
Otaheite—apple 
Palmyra palm 
Papachi THE WORLD’S FOODS 
965 
In relation to the above list of food plants, Mr. P. G. Rus- 
sell of the Plant Introduction Bureau, wrote us as follows; 
I have listed about 200 fruits; this I believe would be not more 
than a third of all fruits used for food by native peoples throughout 
the world, or perhaps 600 in all. I have listed 142 vegetables; if we 
count all the plants occasionally used for greens and salads, and the 
many plants whose roots are occasionally eaten, I suspect that the 
number would be at least 500. I have listed 70 kinds of nuts; this might 
easily, in the same manner, be increased to 200, and the 35 kinds of 
cereals, if we take into account the native grasses, amaranths, and 
chenopodiaceous plants used by the tribes of India and Africa, could 
be made 100. Thus we have as the total number of food plants: 
Fruits 600 
Vegetables 300 
Nuts 200 
Cereals 100 
Total 1200 
THE ORIGINS OF FOOD PLANTS 
The following condensed information concerning the origin 
of food plants is chiefly derived from de Candolle’s “Origin of 
Cultivated Plants”: 
Region Where Indigenous 
Almond Mediterranean region 
Apple Anatolia; was known to the ancient lake 
dwellers of Switzerland 
Apricot China 
Arrowroot Tropical America 
Asparagus Europe, Western Asia 
Avocado pear Tropical America 
Banana Southern Asia 
Barley Western Asia 
Bean Region south of Caspian Sea. Also 
America. 
Beetroot Canary Islands 
Bread fruit Sunda Isles 
Buckwheat Manchuria 
Cabbage Europe 
Carob, St. John’s bread Syria 
Carrot Temperate Europe, Asia 
Celery Southern Europe, North Africa 
Cherry Caspian region 
Chestnut Southern Europe, North Africa, Japan, 
North America 
Chick pea Caspian region 966 
THE NEW DIETETICS 
Southern Europe 
Northwest India 
Europe, North India, United States 
Western Asia, Africa 
Italy 
Syria 
Southern Europe, North Africa, Hima- 
layas 
Tropical America 
North America 
South America 
India 
Western Asia, Greece, Italy 
Southern Europe, North Africa 
China 
India 
Brazil 
India, Guinea 
Egypt, Arabia 
Persia 
New Zealand 
North of Caspian Sea 
Guinea 
Tropical Africa 
Syria 
Persia, Palestine 
China 
America 
Tropical America 
China 
Brazil 
Southern Europe, Asia 
Eastern United States 
Tropical America 
Syria 
Persia 
Anatolia 
Peru 
Persia 
New Granada, Peru 
Europe, Asia 
India, China 
Temperate Europe 
Sunda Isles 
Tropical America 
Persia 
Europe, Asia, North America 
China, Japan, Java 
Tropical America 
Corn salad 
Cucumber 
Currant 
Date palm 
Field pea 
Fig 
Gooseberry 
Guava 
Hickory nut 
Indian corn, maize 
Lemon 
Lentil 
Lettuce 
Litchi nut 
Mango 
Manioc 
Melon 
Millet 
Mulberry 
New Zealand spinach 
Oats 
Oil palm 
Okra 
Olive 
Onion 
Orange 
Papaw 
Pawpaw 
Peach 
Peanut 
Pear 
Persimmon 
Pineapple 
Pistachio nut 
Plum 
Pomegranate 
Potato 
Quince 
Quinoa 
Raspberry 
Rice 
Rye 
Sesame 
Sorghum 
Spinach 
Strawberry 
Sugar cane 
Sweet potato THE WORLD’S FOODS 
967 
Tomato 
Turnip 
Walnut, Persian 
Walnut, black 
Wheat 
Yam 
Peru 
Europe, Siberia 
Temperate Europe, Asia 
North America 
Region of Euphrates 
China, Japan Making the Bill of Fare 
The making of the bill of fare is one of the greatest of all 
household responsibilities and should not be left to chance, indi- 
vidual whim or the gross ignorance of the average cook. It is a 
task for the woman who as wife and mother directs the house- 
hold functions. It is never to be forgotten that we are made of 
what we eat. What we eat today will be walking about and talk- 
ing tomorrow. Nature performs wonderful miracles in the trans- 
mutation of humble foodstuffs into sentient, forceful, intelligent 
human beings, a truly marvelous transfiguration ; but even Nature 
must be supplied with raw material. And Nature herself does not 
undertake to make brass rods out of steel ingots, or muscles out 
of fat or starch. Quality is as important in foodstuffs as in 
fabrics. All is not gold that glitters. All is not food that fills 
the mouth or thrills the palate. 
The construction of a bill of fare is a simple problem for an 
ape or a savage. The anthropoid knows instinctively what will 
satisfy his body needs. The savage fills his stomach with what he 
finds, which, fortunately, is usually fairly well suited to his phy- 
siologic requirements, thanks to the fact that he is so close to 
Nature that his primitive tastes are still dominant and are a fairly 
safe guide to his fundamental needs, the means of gratifying 
which have been determined by the accumulated experiences of 
many generations. 
But the civilized man has so completely lost his instinctive 
nutrition guides that he must take careful thought about his eat- 
ing, being guided by the results of the thousands of laboratory 
experiments which have been made in state experiment stations 
and in nutrition laboratories. 
Fortunately, the whole matter of diet has within recent 
years been so simplified by extended clinical experience that it 
is possible, by taking a little care and without the aid of elaborate 
calculations, to arrange a bill of fare for one’s self or for a family 
that may be followed with full assurance of satisfaction and 
safety. It is necessary to give attention to eight items; viz., the 
amount of the food, the protein, the fats, carbohydrates, vitamins, 
968 MAKING THE BILL OF FARE 
969 
salts (lime and iron) cellulose, and variety in the foodstuffs com- 
posing the menus. 
1. Amount of Food. The amount of food must be adapted 
to individual needs. A slight excess is better than a deficiency. 
In general, an average of 2500 calories each will be ample for an 
ordinary family, including two or three small children. This is 
enough for an office man. Hard working men require more. If 
one chews his food thoroughly, the appetite will be a safe guide 
as to quantity. The body weight should be watched. 
2. The Protein. If care is taken to provide for each child 
a quart of full milk daily and for each adult a pint of milk, two 
or three ounces of cottage cheese, or four to six ounces of nuts, 
no further consideration need be given the question of protein, 
provided the diet comprises the usual variety of grains, fruits 
and vegetables. No meat, fish, fowl or shellfish are needed, and 
if eaten will simply burden the body with an excess of protein 
which must be eliminated as urea, throwing this extra burden 
upon the kidneys. Eggs may be eaten sparingly in place of milk, 
but are inferior as a source of protein. Excess of protein is one 
of the most serious of all dietetic faults. Beans, lentils, cottage 
cheese and milk are not needed at meals at which eggs are eaten. 
Eggs must be strictly fresh to be safe and wholesome, and should 
be produced by fowls that are cared for in a cleanly manner and 
given only clean food such as bran, buttermilk, grain and green 
food. Cold storage eggs are a very inferior and rather unsafe 
food. 
One calorie per pound of body weight per diem is all the 
protein needed to meet physiologic requirements (Sherman). 
3. Fats. Little thought need be given to fats except to 
avoid taking too much. One-half, or at most two-thirds of an 
ounce of butter at each meal is quite sufficient in addition to the 
fat usually taken as seasoning in food and in milk or cream. Fat 
is the least essential of the food elements. When taken in excess, 
digestion is delayed and colon putrefaction is increased. Two or 
three calories per pound of body weight per diem will amply meet 
all body needs. More than this may slowly but surely lead to 
obesity. When olive oil is freely used with salads or otherwise, 
the amount of butter eaten should be diminished, especially if 
there is a tendency to take on flesh. 
4. Carbohydrates. Most of the carbohydrates should be 
taken in the form of whole grain preparations and potatoes 970 
THE NEW DIETETICS 
(Irish or sweet). Cane sugar should be used sparingly on ac- 
count of its irritating and somewhat toxic character, and because 
it is wholly lacking in lime, iron and vitamins. These farinaceous 
foodstuffs should constitute the staples of the bill of fare, the 
foods which are relied upon to sustain the body, the fuel to keep 
up steam in the vital engine. It is a mistake to depend too much 
upon breads and breakfast foods, because they lack vitamins and 
salts. Discard white bread for graham or bran bread. Use 
oatmeal or cornmeal with a liberal amount of bran added (an 
equal measure is not too much). The potato should be much more 
largely used than at present. When well cooked, it is the most 
quickly digested of all farinaceous foods. 
The amount of carbohydrate needed is about 12 to 14 cal- 
ories per pound of body weight daily. When the amount of 
work is increased, the carbohydrate ration should be increased in 
proportion. No increase in protein and little, if any, in fat is 
required. 
The use of honey and of dates in place of cane sugar, to some 
extent, at least, is advisable. Malt sugar may well take the place 
of cane sugar for table use. The sugars made from corn by 
chemical processes do not deserve a place in a biologic bill of fare. 
5. Food Salts, Lime and Iron. Care must be taken to pro- 
vide an abundance of these essential blood and bone-building 
elements, for they are woefully deficient in most bills of fare. 
Lime is abundant in milk, greens, wheat bran, beans, lentils, peas 
and some nuts (see Table XIII). Greens, bran, whole grains, 
malt sugar and gluten preparations are rich in iron, richer even 
than average meats. Egg yolks are rich in both lime and iron. 
Milk is very deficient in iron. Malted nuts contain two and a 
half times as much iron as does milk. Some of these iron-and 
lime-rich foods should appear on every bill of fare (see Table 
XV). They are greatly neglected by the makers of menus. Chil- 
dren need more than tdults; and nursing or expectant mothers 
need more than other adults. 
6. Vitamins. To insure an adequate supply of the trio of 
vitamins, fresh, uncooked foods of some sort should be made a 
part of every meal. Unpasteurized milk supplies all the vitamins, 
as do also tomatoes (fresh or canned), raw cabbage, carrots and 
lettuce. On this account, one or more of these foods should ap- 
pear daily on the bill of fare. (See Tables XVII, XVIII, XIX, 
XX). MAKING THE BILL OF FARE 
971 
7. Cellulose. Roughage must be provided for every meal. 
Fresh fruit, greens, fresh vegetables, and especially bran or agar 
in liberal quantities should be used, not daily only, but at every 
meal. Each meal must have its due quantum of indigestible 
material to furnish a residue which will stimulate the colon to 
pass it on to the exit, carrying with it the bile, mucus and other 
secretions which so readily undergo putrefaction in the colon 
when allowed to stagnate. It is well to add bran to the oatmeal, 
cornmeal, or other cereal. Bran may be combined with vegetable 
purees. II , j _ 
8. Balancing the Bill of Fare. A balanced bill of fare must 
contain not only the proper proportion of complete proteins, car- 
bohydrates, and fats but also the essential amounts of food lime, 
iron and other food salts with vitamins and cellulose, or roughage. 
The most important thing, of course, is to make sure of a suffici- 
ency of each one of the six essential food constituents; namely, 
proteins, fats, carbohydrates, food salts, vitamins, and cellulose. 
A little excess of any one of these is really a matter of no par- 
ticular consequence, and indeed no great harm could result from 
a considerable temporary excess of any of the several food con- 
stituents with the exception of protein and fats. As has else- 
where been shown, an excess of protein lays a great and un- 
necessary burden upon the liver and kidneys, which must trans- 
form and eliminate all the excess as so much waste matter, none 
of it being utilizable except in an incomplete way. 
An excess of protein imposes another great burden upon the 
body by flooding the blood and tissue fluids with highly virulent 
toxins which raise blood pressure, irritate and intoxicate the brain 
and nerves, set up degenerative processes in the liver and other 
glands, cause changes in the blood vessels which result in arterio- 
sclerosis, angina pectoris, apoplexy and other grave mischiefs 
and enormously increase the work of the kidneys, through which 
they are eliminated, wearing them out prematurely, thus prepar- 
ing the way for Bright’s disease and general senility and pre- 
mature decay. 
It is thus important to watch the protein content with vigi- 
lance. Fortunately, the danger of an excessive intake of protein 
almost wholly disappears when meats of all sorts (fish, flesh and 
fowl) are eliminated from the bill of fare. It is true that a 
person when on a milk regimen takes a very considerable excess 
of protein. One quart of milk will supply the total amount of 972 
THE NEW DIETETICS 
protein required daily by a person of average size, hence the 
protein intake of a person who is receiving five or six quarts of 
milk a day is five or six times the amount of which his body can 
make use. A considerable amount of the milk protein in such a 
case is lost in the stools. Nevertheless, so great an excess is ab- 
sorbed that the taking of such a large amount of milk continuously 
for a considerable time is inadvisable since both the liver and 
the kidneys would be very decidedly overtaxed. In the case of a 
person whose weight has been considerably reduced by malnutri- 
tion, the excess of protein may he utilized in rebuilding the blood 
and the tissues until such time as the normal weight is regained. 
As has been elsewhere shown, the addition of a pint of milk, or 
even a smaller amount, to a hill of fare made up of fruits, grains, 
and vegetables will fully meet the body requirements for protein. 
An excess of fat may do harm by delaying the movements of 
food along the alimentary canal, particularly prolonging the 
time of gastric digestion. An excess of fats also encourages 
putrefaction in the colon and hence should be avoided. A defici- 
ency can be easily compensated for by carbohydrates, so the only 
real danger is from excess. If the total intake of fats does not 
exceed two and one-half to three ounces there is little possibility 
of excess. 
As regards the food salts and vitamins, there is no evidence 
whatever that any harm can possibly result from an excess; in 
fact, it is wise to make constant use of a superfluity by the free 
use of foods rich in salts so as to make sure of an abundant 
absorption of these essential elements. 
As regards cellulose or roughage, there is a constant danger 
of a deficiency but no danger of an excess, provided always that 
the bulk is not so great as to overtax the capacity of the stomach. 
9. Variety. The staples which furnish the bulk of the food 
value should be varied from day to day, and to these should be 
added as large a variety as can be reasonably secured, so as to 
make certain of securing a full complement of the various subtle 
elements needed for complete nutrition. The variety should not 
be great at a single meal, but the bill of fare should be varied from 
day to day. 
Breakfast. This is too often a makeshift meal, affording 
little support for the day’s labors. The fault does not lie alto- 
gether with the cook. The seven o’clock dinner has spoiled the 
American breakfast. The late diner rises with little or no appe- MAKING THE BILL OF FARE 
973 
tite, because his exhausted stomach is unprepared for a digestive 
task. A cup of coffee with a bit of toast and bacon or griddle 
cakes with corn sirup are the miserable substitutes for a real 
breakfast which are swallowed hurriedly by many thousands of 
business men. Oatmeal with bran and cream, an egg or a glass 
of milk, fresh fruit, lettuce or celery, with bran bread and butter, 
will constitute a breakfast much more in harmony with physiolo- 
gic requirements. For a vigorous man, a total of 800 calories 
will be needed to fortify the body for a good day’s work. 
Dinner. The heartiest meal should be taken at midday or 
at least not later than four or five p. m. The total number of 
calories at the midday meal may be 1000 to 1200. 
Supper. Brain workers do much better to omit supper. 
Better sleep is secured and better digestion. If nourishment is 
needed at night, it is by all means best to confine the menu to 
fresh or stewed fruit with malt sugar, dates or raisins. A few 
nuts may be added if very well chewed and bran with rice, gruel 
or oatmeal porridge may be taken or some dextrinized cereal. 
The evening meal should be light; 500 to 700 calories should be 
sufficient when a substantial breakfast and a hearty dinner have 
been eaten. 
The accompanying diet lists and bills of fare may serve as 
models by the aid of which suitable menus may be readily ar- 
ranged for almost any patient or class of patients. By the ad- 
dition of carbohydrates in the form of malt sugar, cereals or 
potatoes, the energy value or number of calories may be increased 
to meet the needs of practically any case requiring increase of 
flesh or a large output of energy in muscular work. The lime 
and iron content of the menus, as well as the protein, being 
sufficient to meet the needs of almost any possible case. 974 
THE NEW DIETETICS 
BILL OF FARE FOR LOW PROTEIN DIET 
Per cent of 
Calories 
day’s ration 
Breakfast 
Ounces 
Pro. 
Fat 
Carbo. 
Total 
Lime 
Iron 
Orange 
5 
5 
3 
66 
74 
7 
2 
Blueberries 
2 Vt 
2 
3 
42 
47 
1 
4 
Cream of wheat 
4 
6 
1 
42 
49 
7 
8 
Cream 
21/4 
7 
111 
12 
130 
7 
1 
Malt sugar 
1% 
0 
8 
210 
218 
3 
18 
Graham toast 
1 
10 
0 
52 
68 
1 
5 
Butter 
Vt. 
0 
54 
0 
54 
Yogurt buttermilk . . . . 
6 
24 
5 
36 
65 
28 
3 
Bran 
y4 
5 
3 
13 
21 
1 
4 
Total 
59 
194 
473 
726 
55 
45 
Dinner 
Celery soup 
3 
1 
8 
7 
16 
Baked potato 
3 
9 
1 
78 
88 
1 
3 
Spinach 
3 
7 
51 
9 
67 
7 
23 
New beets 
2 
3 
14 
21 
38 
2 
2 
Waldorf salad 
2 V* 
8 
55 
29 
92 
Bran bread 
1 
6 
32 
62 
100 
1 
5 
Butter 
% 
0 
108 
0 
108 
Golden nectar 
3% 
1 
1 
64 
66 
1 
1 
Cantaloup 
6% 
4 
0 
69 
73 
5 
4 
Pecans 
% 
6 
94 
9 
109 
1 
2 
Yogurt buttermilk . . . . 
6 
24 
5 
36 
65 
28 
3 
Bran 
V* 
5 
3 
13 
21 
1 
4 
Total 
74 
372 
397 
843 
47 
52 
Supper 
Potato soup 
4% 
5 
16 
38 
59 
Stuffed tomato 
5 
10 
38 
55 
103 
1 
5 
Lettuce 
1% 
1 
1 
6 
8 
2 
1 
Bran bread toast 
1 
fi 
32 
52 
100 
1 
5 
Butter 
% 
0 
64 
0 
54 
Yogurt buttermilk .... 
6 
24 
5 
36 
66 
28 
3 
Apple 
5% 
2 
7 
88 
97 
2 
3 
Bran 
% 
5 
3 
13 
21 
1 
4 
Total 
53 
156 
288 
507 
35 
21 
Grand total . . . . 
186 
722 
1158 
2076 
137 
118 
LOW PROTEIN DIET LIST 
Fruits: All fruits and fruit juices. Figs, prunes and dates. 
Chestnuts and litchi nuts. (Avoid other nuts and olives.) 
Vegetables: All green vegetables, especially fresh vegetables, 
greens and salads. 
Cereals: Rice, barley and rice flakes. 
Miscellaneous: Butter, olive oil, honey, malt sugar, malt honey, 
malted nuts, buttermilk (one-half pint daily). 
Accessories: Bran, agar, laxa and paraffin preparations. Lacto- 
dextrin. 
When a very low-protein diet is required, as in certain cases 
of nephritis, the diet must be confined to malt sugar and fruit 
juices. BILLS OF FARE 
975 
BILL OF FARE FOR ANTITOXIC DIET 
Per cent of 
Calories 
day’s ration 
Breakfast 
Ounces 
Pro. 
Pat 
Carbo. 
Total 
Lime 
Iron 
Cantaloup 
4 
0 
69 
73 
5 
4 
Stewed raisins 
. . 3 
6 
17 
173 
196 
5 
8 
Brose 
10 
8 
36 
54 
7 
20 
Cream 
7 
111 
12 
130 
7 
1 
Graham gems 
27 
46 
139 
212 
6 
7 
Malt honey 
. 2% 
0 
0 
194 
194 
2 
7 
Cereal coffee 
Bran 
.. % 
5 
3 
13 
21 
1 
4 
Total 
59 
175 
636 
880 
33 
56 
Dinner 
Vegetable soup with noodles 
. 4% 
3 
19 
22 
44 
Baked sweet potato 
12 
10 
188 
210 
4 
5 
Buttered asparagus 
. . 3 
6 
94 
11 
111 
3 
6 
Swiss chard—lemon 
. 3 
7 
51 
9 
67 
19 
15 
Cabbage salad 
. 2 
4 
37 
17 
58 
6 
4 
Bran bread 
.2 
12 
64 
124 
200 
2 
10 
Butter 
. . % 
0 
108 
0 
108 
Yogurt buttermilk 
. 6 
24 
5 
36 
65 
28 
3 
Watermelon 
. . 8 
3 
4 
76 
83 
4 
5 
Bran 
. V* 
5 
3 
13 
21 
1 
4 
Total 
76 
395 
496 
967 
67 
52 
Supper 
Okra soup 
■ 4% 
2 
1 
9 
12 
Baked cornlet 
. 3 
13 
91 
90 
194 
1 
4 
Shredded carrot-—lemon . . . 
. 2 
3 
2 
22 
27 
4 
2 
Whole wheat bread 
. 2 
22 
4 
112 
138 
2 
6 
Butter 
. y2 
0 
108 
0 
108 
Blackberries 
. 3 
5 
8 
38 
51 
2 
3 
Bran 
. y* 
5 
3 
13 
21 
1 
4 
Total 
50 
217 
284 
551 
10 
19 
Grand total 
185 
787 
1416 
2398 
no 
127 
Soups: Vegetable soups without cream and bouillons. 
ANTITOXIC DIET LIST 
Relishes: Tomatoes, celery, lettuce, endive, cucumber, radishes, 
shredded cabbage, shredded carrots and turnips. Ripe olives, 
bromose, meltose, meltose with butter. Vegetable and fruit 
salads without eggs. 
Vegetables: All vegetables, especially fresh vegetables, raw and 
cooked. 
Cereals: Brose (scalded oatmeal), cereal flakes, vita-wheat, 
shredded wheat, granola, macaroni, corn meal, rice, bran. 
Breads: Graham at least 24 hours old. Zwieback, dry toast, 
bran gems, gluten bread. 
Beverages: Fruit juices, cereal coffee, malted nuts, malted milk, 
buttermilk (yogurt, acidophilus). 
Fruits: All fresh and cooked fruits. Tomatoes are particularly 
beneficial. 
Desserts: Fruit tapioca, fruit gelatines, fruit ices, fruit purees, 
fig marmalade, prune marmalade, dates, figs, raisins. 
Miscellaneous: Butter, cream, buttermilk, cottage cheese, to fu, 
nuts, malted nuts, malted milk, protose. 
Accessories: Bran, agar, laxa, paralax, paramels and other par- 
affin preparations, lacto-dextrin. 976 
THE NEW DIETETICS 
BILL OF FARE FOR FEVER 
Per cent of 
Calories 
day’s ration 
Ounces 
Pro. 
Fat 
Carbo. 
Total 
Lime 
Iron 
7 A. M. 
Rice gruel 
4% 
2 
1 
25 
28 
1 
Malt sugar 
1 
0 
0 
109 
100 
2 
9 
Cream 
2% 
7 
111 
12 
130 
7 
1 
Cream toast 
5 
25 
53 
83 
161 
17 
7 
Orange juice 
2% 
0 
0 
39 
39 
3 
4 
Total 
34 
165 
259 
458 
29 
22 
9 A. M. 
Milk 
6 
23 
66 
35 
124 
29 
3 
Lactose 
2 
0 
0 
200 
200 
11 A. M. 
Savora broth 
4% 
1 
32 
0 
33 
2 
39 
Mashed potato 
3% 
9 
15 
61 
85 
1 
9 
Spinach pur6e 
3 
7 
51 
9 
67 
7 
23 
Grape juice 
3% 
0 
0 
83 
83 
1 
' 2 
Baked custard 
17 
45 
51 
113 
14 
9 
Total 
34 
143 
204 
381 
25 
82 
1 P. M. 
Milk 
e 
23 
66 
35 
124 
29 
3 
Lactose or lacto-dextrin 
2 
0 
0 
200 
200 
3 P. M. 
Yogurt buttermilk . . . . 
6 
24 
5 
36 
65 
28 
3 
5 P. M. 
Strained vegetable soup 
4% 
2 
19 
17 
38 
Barley gruel 
4 
4 
2 
31 
37 
1 
5 
Malt sugar 
1 
0 
0 
100 
100 
2 
9 
Lemonade with lactose 
(2 oz.) 6 
0 
0 
200 
200 
Pineapple sherbet .... 
3% 
5 
2 
119 
129 
2 
3 
Total 
11 
23 
467 
504 
5 
17 
Grand total .... 
149 
408 
1436 
2056 
145 
130 
FEVER DIET LIST 
Fruits: Purees and juices of all sorts, especially orange juice, 
fig and prune marmalades (meltose). 
Cereals: Gruel and porridge of all cereals, cereal flakes, granola, 
graham toast, all dextrinized cereals, granose biscuit, rice 
biscuit, shredded wheat. 
Vegetables: Purees of all vegetables, potato soup, vegetable soup, 
cream of corn soup, purees of spinach and other greens, 
vegetable broths. 
Miscellaneous: Buttermilk (acidophilus), whey, malt sugar, 
malt honey, malted nuts, malted milk, savora broth, gluten 
gruel (40% ), cream gluten gruel, lactose, lacto-dextrin. 
Accessories: Bran, (except in typhoid), agar, laxa, paraffin 
(paramels, paralax, petrolatum, etc.) BILLS OF FARE 
977 
BILL OF FARE FOR PROTEIN-FREE DIET 
Per cent of 
Calories 
day’s ration 
Ounces 
Pro. 
Fat 
Carbo. 
Total 
Lime 
Iron 
1 A. M. 
Sliced oranges 
5 
5 
3 
66 
74 
7 
2 
Banana purge 
31/2 
5 
6 
90 
101 
1 
4 
Rice gruel 
3% 
2 
1 
25 
28 
1 
Celery 
1% 
1 
0 
4 
5 
4 
1 
Meltose with butter . . . 
1% 
0 
94 
93 
187 
1 
9 
Cereal coffee 
Cream 
1 
3 
49 
5 
57 
3 
Agar 
• 
Total 
16 
153 
283 
452 
16 
17 
11 A. M. 
Potato broth 
3 
3 
10 
24 
37 
Lettuce—lemon 
1% 
1 
1 
6 
8 
2 
1 
Loganberry juice 
3% 
0 
0 
87 
87 
Fresh peaches 
4 
1 
46 
51 
2 
2 
Malt sugar 
2 
0 
0 
200 
200 
3 
18 
Agar 
Total 
8 
12 
363 
383 
7 
21 
3 P. M. 
Vegetable bouillon 
4% 
12 
1 
1 
14 
String beans 
4 
5 
1 
14 
20 
6 
7 
Stewed tomatoes 
2% 
4 
1 
12 
17 
1 
3 
Mustard greens 
3 
7 
51 
9 
67 
59 
28 
Cantaloup 
61/2 
4 
0 
69 
73 
5 
4 
Apple juice 
6 
0 
0 
102 
102 
1 
2 
Dates 
1% 
4 
13 
160 
177 
4 
11 
Agar 
Total 
36 
67 
367 
470 
76 
55 
7 P. M. 
Savora broth 
4% 
1 
32 
0 
33 
2 
39 
Swiss chard 
3 
7 
51 
9 
67 
14 
15 
Fresh peas 
3 
5 
66 
74 
2 
2 
Blueberry juice 
0 
0 
102 
102 
5 
11 
Malt sugar 
2 
0 
0 
200 
200 
3 
18 
Agar 
Total 
11 
88 
377 
476 
26 
85 
Grand total 
71 
320 
1390 
1781 
125 
178 
PROTEIN-FREE DIET LIST 
All fruit juices, peaches, pears, apples, bananas, honey, malt 
sugar (meltose), malt honey, raisin juice, corn starch, rice gruel, 
oatmeal water, vegetable broths, lactose, lacto-dextrin, whey. 
Greens of all sorts, celery, lettuce, tomatoes, ripe olives, litchi 
nuts. 978 
THE NEW DIETETICS 
BILL OF FARE FOR FATTENING DIET 
Per cent of 
Calories 
day’s ration 
Breakfast 
Ounces 
Pro. 
Fat 
Carbo. 
Total 
Lime 
Iron 
Grapefruit 
..3% 
3 
2 
44 
49 
3 
2 
Steamed rice with raisins 
..4% 
15 
7 
171 
193 
3 
6 
Malt sugar 
. . 2 
0 
0 
200 
200 
3 
18 
Cream 
.. 21/4 
7 
111 
12 
130 
7 
1 
Baked potato 
9 
1 
78 
88 
1 
8 
Celery 
1 
0 
4 
5 
4 
1 
Bran gems toasted 
16 
67 
55 
138 
2 
10 
Butter 
• • % 
0 
108 
0 
108 
Cereal coffee 
Bran 
• • % 
5 
3 
13 
21 
1 
4 
Total 
56 
299 
577 
932 
24 
50 
Dinner 
Cream of pea soup 
• • 4 3/4 
12 
33 
25 
70 
6 
Mashed potato 
• • 3% 
9 
15 
61 
85 
1 
8 
Mustard greens 
. . 3 
7 
51 
9 
67 
89 
28 
Creamed carrots 
. . 3% 
9 
41 
36 
86 
4 
2 
Yogurt buttermilk 
. . 6 
24 
5 
36 
65 
28 
3 
Bran bread 
12 
64 
124 
200 
2 
10 
Butter 
• • % 
0 
108 
0 
108 
Meltose 
• • 2% 
0 
193 
193 
2 
7 
Baked apple 
■ ■ 4% 
1 
3 
82 
86 
1 
2 
Pecans 
• • % 
6 
94 
9 
109 
1 
2 
Bran 
.. y* 
6 
3 
13 
21 
1 
4 
Total 
85 
417 
588 
1090 
135 
66 
Supper 
Savory potato soup 
.. 4% 
2 
27 
20 
49 
1 
35 
Cereal flakes 
11 
1 
92 
104 
0 
0 
Cream 
• • 21/4 
7 
111 
12 
130 
7 
1 
Whole wheat bread 
.. 2 
22 
4 
112 
138 
2 
6 
Butter 
• • % 
0 
108 
0 
108 
Fresh strawberries 
.. 4 
15 
6 
34 
55 
5 
4 
Malt sugar 
0 
4 
120 
124 
2 
9 
Bran 
• • Y* 
5 
3 
13 
21 
1 
4 
Total 
62 
264 
403 
729 
18 
59 
Grand total 
203 
980 
1568 
2751 
177 
175 
FATTENING DIET LIST 
Fruits: All fruits, but especially dates, figs, avocadoes, ripe 
olives. 
Nuts: All nuts, especially almonds, walnuts, pecans and peanuts, 
peanut butter, almond cream, malted nuts. 
Milk: Certified milk, cream, butter, buttermilk, cottage cheese, 
cream cheese, clotted cream, malted milk. 
Cereals: All cereals, especially rice, granola, zo, vita-bits and 
other dextrinized cereals, breads, zwieback, mushes, etc. 
Vegetables: All vegetables. Potatoes, sweet potatoes, greens. 
Miscellaneous: Malt sugar (meltose), lactose, lacto-dextrin. 
Accessories: Laxa, agar, paraffin preparations (paralax, para- 
mels, petrolatum). BILLS OF FARE 
979 
BILL OF FARE FOR LAXATIVE DIET 
Per cent of 
Calories 
day’s ration 
Breakfast 
Ounces 
Pro. 
Fat 
Carbo. 
Total 
Lime 
Iron 
Orange juice 
0 
0 
76 
76 
6 
2 
Stewed prunes 
3% 
3 
1 
99 
103 
2 
6 
Brose 
10 
8 
36 
54 
7 
25 
Cream 
2 XA 
7 
111 
12 
130 
7 
1 
Bran gems 
16 
67 
55 
138 
1 
8 
Butter 
% 
0 
108 
0 
108 
Cereal coffee 
Lettuce 
1 
1 
6 
8 
2 
1 
Total 
37 
296 
284 
617 
25 
43 
Dinner 
Tomato soup 
4% 
6 
22 
29 
57 
1 
Baked potato 
9 
1 
78 
88 
1 
8 
Beet greens 
7 
51 
9 
67 
8 
23 
String beans 
5 
1 
14 
20 
6 
7 
Sliced cucumbers 
.2 
2 
1 
7 
10 
1 
Cottage cheese 
1 
20 
12 
5 
37 
28 
2 
Bran bread 
12 
64 
124 
200 
2 
10 
Butter 
% 
0 
108 
0 
108 
Apple and date salad . 
2% 
4 
8 
94 
106 
2 
5 
Lemon jelly, whipped 
cream 3% 
1 
23 
115 
139 
1 
1 
Bran 
% 
5 
3 
13 
21 
1 
4 
Total 
71 
294 
488 
853 
50 
61 
Supper 
Vegetable consomme . . 
4% 
12 
1 
2 
15 
Asparagus on toast . . 
3 
14 
85 
67 
166 
2 
7 
Shredded carrots .. . . 
2 
3 
2 
22 
27 
5 
2 
Celery 
ly* 
1 
0 
4 
5 
4 
1 
Graham bread 
2 
20 
12 
104 
136 
2 
10 
Butter 
% 
0 
108 
0 
108 
Pecans 
% 
6 
94 
9 
109 
1 
2 
Grapes 
6 
16 
83 
105 
4 
3 
Yogurt buttermilk .... 
24 
5 
36 
65 
28 
3 
Bran 
Y* 
5 
3 
13 
21 
1 
4 
Total 
91 
326 
340 
757 
47 
32 
Grant! total . . . 
199 
916 
1112 
2227 
122 
136 
LAXATIVE DIET LIST 
Fruits: All fruits, especially fresh figs, dried figs, purple figs 
(soaked), figs puree, prunes, prune puree, meltose marma- 
lades, tomatoes, berries and nuts. 
All foods rich in cellulose (See Tables XXI to XXIII). 
Cereals: Oatmeal, brose (cooked only 6 to 10 minutes), cracked 
wheat, whole wheat, cooked bran, bran mush, graham bread, 
bran bread, bran muffins, shredded wheat, wheat flakes. 
Vegetables: Carrots, turnips, rutabagas, parsnips, beets, spin- 
ach, dandelion and other greens, string beans, green peas, 
egg-plant, celery, lettuce, cucumber, radishes, salads, cabbage. 
Miscellaneous: Malt sugar (meltose), malt honey, malted nuts, 
malted milk, buttermilk (acidophilus, yogurt), marmalades. 
Accessories: Agar, laxa, paraffin preparations (paramels, para- 
lax, petrolatum, etc.), lacto-dextrin. 980 
THE NEW DIETETICS 
BILL OF FARE FOR FRUIT REGIMEN 
Breakfast 
Ounces 
Pro. 
Calories 
Fat Carbo. 
Total 
Per cent of 
day’s ration 
Lime Iron 
Tomato broth 
... 4 % 
4 
1 
11 
16 
1 
Grapefruit 
. .. 3% 
3 
2 
44 
49 
3 
2 
Apple sauce 
• •• 3% 
1 
3 
72 
76 
2 
3 
Steamed figs 
... 2 
9 
1 
148 
158 
4 
4 
Lettuce 
... iy4 
1 
1 
6 
8 
2 
1 
Lactose 
... 2 
0 
0 
200 
200 
0 
0 
Bran 
... U 
11 
6 
26 
43 
2 
8 
Total 
29 
14 
507 
550 
13 
19 
Dinner 
Vegetable bouillon 
■ ■■ 4% 
4 
1 
11 
16 
0 
1 
Turnip tops 
. . . 3 
7 
51 
9 
67 
41 
20 
Cauliflower 
. . . 3 
2 
15 
5 
22 
12 
3 
Celery 
• . . IV* 
1 
0 
4 
5 
4 
1 
Strawberry jelly 
. . . 3 
0 
0 
120 
120 
1 
1 
Fruit nectar 
. . . 5 
2 
2 
96 
100 
1 
1 
Dates 
. . . 1 ■% 
4 
13 
160 
177 
4 
11 
Bran 
... % 
11 
6 
26 
43 
2 
8 
Lactose 
0 
0 
200 
200 
0 
0 
Total 
31 
88 
631 
750 
65 
46 
Supper 
Savora broth 
. . . 4% 
1 
32 
0 
33 
1 
39 
New beets 
... 2y* 
6 
1 
19 
26 
2 
2 
String beans 
. . . 4 
5 
1 
14 
20 
6 
7 
Sliced tomato 
4 
4 
18 
26 
1 
3 
Pear sauce 
... 4 
3 
4 
93 
100 
2 
2 
Apple 
... 5 % 
2 
7 
88 
97 
2 
3 
Bran 
• • • % 
11 
6 
26 
43 
2 
8 
Loganberry juice, lactose 
. .. 5% 
0 
0 
287 
287 
3 
4 
Total 
32 
55 
545 
632 
19 
68 
Grand total 
92 
157 
1683 
1932 
97 
133 
DIET LIST FOR FRUIT REGIMEN 
Fruits: Fresh apples, oranges, grapefruit, dates, figs, raisins, all 
berries, plums, peaches, cantaloups, watermelon, honeydew 
melon, osage melon, grapes, apricots, pears, pineapple, cher- 
ries, bananas, fruit sauces, fruit juices—orange, lemon, 
apple, grape, raspberry, blackberry, loganberry, etc. 
Vegetables: (1) Uncooked—Tomatoes, celery, lettuce, endive, 
cabbage, cabbage (shredded), radishes. 
(2) Cooked—Spinach, mustard, turnip tops, dandelion 
greens, red root, Swiss chard, dock, tomatoes, asparagus, 
string beans, potato gruel, vegetable broths, Savita broth. 
Miscellaneous: Malt sugar, malt honey, fig marmalade, prune 
marmalade. 
Accessories: Bran, laxa, agar, paraffin preparations (paralax, 
paramels, etc.). 
Bran: 2 large tablespoonfuls each meal. 
Cereal coffee (unroasted) without cream. 
Lacto-dextrin to change the intestinal flora. BILLS OF FARE 
981 
BILL OF FARE FOR RESTORATIVE OR BLOOD- 
MAKING DIET 
Per cent of 
Calories 
day’s ration 
Breakfast 
Ounces 
Pro. 
Fat 
Carbo. 
Total 
Lime 
Iron 
Orange juice 
0 
0 
76 
76 
6 
2 
Oatmeal with dates 
(1 oz.). . 5 
14 
17 
142 
173 
5 
12 
Cream 
2% 
7 
111 
12 
130 
7 
1 
Bran bread toast . . 
2 
12 
64 
124 
200 
2 
10 
Butter 
% 
0 
108 
0 
108 
Cereal coffee 
Bran 
V* 
5 
3 
13 
21 
1 
4 
TQtal 
38 
303 
367 
708 
21 
29 
Dinner 
' 
Savora rice soup . . . 
4% 
4 
16 
33 
53 
2 
39 
Scalloped potatoes . 
414 
16 
57 
74 
147 
2 
12 
Mustard greens—2 
egg yolks 4 
25 
131 
9 
165 
64 
44 
Sliced tomatoes . .. . 
4 
4 
18 
26 
1 
3 
Yogurt buttermilk . 
6 
24 
5 
36 
65 
28 
3 
Bran bread 
2 
12 
64 
124 
200 
2 
10 
Butter 
Yt 
0 
108 
0 
108 
Fresh strawberries 
4 
5 
6 
34 
45 
7 
7 
Malt sugar 
0 
0 
100 
100 
2 
9 
Bran 
14 
5 
3 
13 
21 
1 
4 
Total 
95 
394 
441 
930 
109 
131 
Supper 
Lentil soup 
4 14 
35 
19 
86 
140 
3 
14 
Baked potato 
3 
9 
1 
78 
88 
1 
8 
Lettuce sandwich . . 
2 
12 
123 
63 
198 
2 
10 
Ripe olives 
114 
2 
92 
7 
101 
7 
9 
Raspberries 
5 
0 
69 
64 
8 
4 
Malt honey 
21/4 
0 
0 
194 
194 
2 
7 
Bran 
Y* 
5 
3 
13 
21 
1 
4 
Total 
68 
238 
500 
806 
24 
56 
Grand total 
201 
935 
1308 
2444 
154 
216 
RESTORATIVE OR BLOOD-MAKING DIET LIST 
This dietary includes most foods rich in lime and iron salts 
(See Tables XII, XIV, XV), especially whole grain preparations, 
graham bread, cracked wheat, oatmeal, browned rice, wheat 
flakes, shredded wheat, zo, gluten biscuit, gluten mush, gluten 
bread (40 per cent), beans, lentils, peas, soy beans, to fu, spinach, 
turnip tops, lettuce, salads, milk, cream, whey, buttermilk, cottage 
cheese, malt sugar (meltose), malt honey, malted nuts, savita, 
vegetable broths, tomatoes, tomato juice, orange juice, lemon 
juice, egg yolks, nuts of all sorts, dates, figs, raisins. 
It is not necessary that the diet should be strictly confined 
to the above foods, but they should constitute the staples of the 
dietary, so as to make sure of an abundant supply of vitamins, 
iron, lime and other food salts. When the hemoglobin is low, 
the iron and lime content of the food should be doubled until the 
deficiency is made good. That is, the percentage of the day’s 
ration of these elements should be 200. 982 
THE NEW DIETETICS 
BILL OF FARE FOR REDUCING DIET 
Per cent of 
Calories 
day’s ration 
Breakfast 
Ounces 
Pro. 
Fat 
Carbo. 
Total 
Lime 
Iron 
Sliced orange 
5 
5 
3 
66 
74 
7 
2 
Banana 
... 3 % 
5 
5 
90 
100 
1 
4 
Bran mush 
... 4 % 
18 
13 
55 
86 
7 
25 
Milk (skimmed) 
6 
24 
5 
36 
65 
28 
3 
Bran bread toast 
1 
6 
32 
62 
100 
1 
5 
Butter 
.... % 
0 
54 
0 
54 
Celery 
• ... 1% 
1 
0 
4 
5 
4 
1 
Total 
69 
112 
313 
484 
48 
40 
Dinner 
Vegetable bouillon 
, ... 4% 
12 
1 
1 
14 
Beet greens 
3 
7 
51 
9 
67 
7 
22 
Jerusalem artichokes . . . . 
3 
8 
94 
50 
152 
Stewed tomatoes 
. • . . 2% 
3 
1 
11 
15 
1 
3 
Sliced cucumbers 
2 
2 
1 
7 
10 
1 
Yogurt buttermilk 
6 
24 
5 
36 
65 
28 
3 
Gluten bread 
1 
28 
12 
32 
72 
Fresh strawberries 
. . . . 4 
5 
6 
34 
45 
7 
7 
Bran 
. .. • % 
5 
3 
13 
21 
1 
4 
Total 
94 
174 
193 
461 
45 
36 
Supper 
Savora broth 
. . . . 4 % 
1 
32 
0 
33 
2 
39 
String beans 
. . . . 4 
14 
58 
32 
104 
7 
9 
Chopped cabbage-lemon . 
2 
6 
2 
21 
29 
4 
4 
Sliced tomato 
. . . . 4 
4 
4 
18 
26 
1 
3 
Graham bread 
1 
10 
6 
52 
68 
1 
5 
Fresh peaches 
. . . . 4 
4 
1 
46 
51 
2 
2 
Bran 
• • • • % 
5 
3 
13 
21 
1 
4 
Total 
44 
106 
182 
332 
18 
66 
Grand total 
197 
392 
638 
1277 
111 
142 
REDUCING DIET LIST 
Fruits: All fresh, juicy fruits, especially acid and sub-acid fruits, 
including tomatoes both cooked and raw. Avoid figs, dates, 
raisins and prunes. Also avoid nuts. 
Cereals: Bran mush (bran three parts by measure, rolled oats 
one part. Cook six minutes). Bran bread toasted, one slice 
at each meal, or rye bread toasted. Gluten bread (40 per 
cent), gluten gems, and gluten biscuit instead of ordinary 
bread. Avoid breakfast foods, flakes and dextrinized cereals. 
Vegetables: Most vegetables, especially the artichoke, the Jeru- 
salem artichoke, greens of all sorts, turnips, cabbage, celery, 
lettuce, cucumber, radish, salsify, Brussels sprouts, and avoid 
the potato, sweet potato and the dasheen. 
Miscellaneous: Whey, cottage cheese, skimmed milk, buttermilk 
(yogurt, acidophilus), butter (one-half ounce daily), cereal 
coffee. 
Accessories: Laxa, agar, paralax, paramels and other paraffin 
preparations. BILLS OF FARE 
983 
BILL OF FARE FOR DRY DIET 
Per cent of 
Calories 
day’s ration 
Breakfast 
Ounces 
Pro. 
Fat 
Carbo. 
Total 
Lime 
Iron 
Cereal flakes 
. . . 1 
11 
1 
92 
104 
Cream 
• ■ • 2% 
7 
111 
12 
130 
7 
1 
Steamed figs 
... 2 
9 
1 
148 
158 
4 
4 
Whole wheat bread toast 
... 2 
22 
4 
112 
138 
2 
6 
Butter 
... % 
0 
108 
0 
108 
Bran 
. . . % 
5 
3 
13 
21 
1 
4 
Total 
54 
228 
377 
659 
14 
15 
Dinner 
Baked potato 
. . . 3 
9 
1 
78 
88 
1 
8 
Spinach 
. . . 3 
7 
51 
9 
67 
7 
23 
Cottage cheese 
. . . 2 
40 
25 
10 
75 
56 
4 
Bran bread toast 
... 2 
12 
64 
124 
200 
2 
10 
Butter 
... y2 
0 
108 
0 
108 
Baked apple 
... 4 Vi 
1 
3 
82 
86 
1 
2 
Bran 
... % 
5 
3 
13 
21 
1 
4 
Total 
74 
255 
316 
645 
68 
51 
riupper 
Bran mush 
... 4 Vi 
18 
13 
55 
86 
7 
25 
Cream 
... 2 y4 
7 
111 
12 
130 
7 
1 
Lettuce 
... i y4 
1 
1 
6 
8 
2 
1 
Popped corn 
... 1 
13 
21 
82 
116 
Dates 
... 2 
5 
15 
183 
203 
5 
11 
Total 
44 
161 
338 
543 
21 
38 
Grand total 
172 
644 
1031 
1847 
103 
104 
DRY DIET LIST 
Toasted cereal flakes, browned rice, parched rice, zwieback, 
breakfast toast, dry toast, toasted whole wheat wafers, granola, 
granuto, corn breads, baked potato, baked sweet potato, spinach 
souffle, baked cornlet, popped corn, steamed figs, bromose, malted 
nuts, meltose (malt honey), protose, nuttolene, yolks of hard 
boiled eggs, baked bananas, baked apples, prune marmalade, 
bananas, raisins, dates, figs, nuts, sterilized butter, cream, cottage 
cheese, fig marmalade. 
Most ordinary foods may be used with the exception of thin 
soups, milk and other beverages and juicy fruits and watery 
vegetables. 984 
THE NEW DIETETICS 
BILL OF FARE FOR FRESH OR RAW DIET 
Breakfast 
Ounces 
Pro. 
Calories 
Fat Carbo. 
Total 
Per cent of 
day’s ration 
Lime Iron 
Grapefruit 
. ... 3% 
3 
2 
44 
49 
3 
2 
Banana 
. ... 3% 
5 
6 
90 
101 
1 
4 
Oatmeal (scalded) 
.. .. 4y* 
13 
11 
53 
77 
3 
7 
Milk 
6 
23 
66 
35 
124 
28 
3 
Pecans 
12 
188 
18 
218 
2 
4 
Celery 
2 
3 
0 
8 
11 
6 
2 
Bran 
... y* 
5 
3 
13 
21 
1 
4 
Total 
64 
276 
261 
601 
44 
26 
Dinner 
Apple juice 
6 
0 
0 
102 
102 
1 
2 
Chopped cabbage-lemon . . 
... 2 
6 
2 
21 
29 
4 
4 
Sliced tomato 
4 
4 
18 
26 
1 
3 
Green corn 
... 5% 
20 
16 
126 
162 
1 
8 
Fresh strawberries 
... 4 
6 
6 
34 
45 
7 
7 
Black figs 
... 2 
1 
16 
173 
190 
11 
13 
Almonds 
... 1 
24 
146 
- 20 
190 
4 
8 
Bran 
... y* 
6 
3 
13 
21 
1 
4 
Total 
66 
193 
507 
765 
30 
49 
Supper 
Milk 
23 
66 
35 
124 
28 
3 
Shredded carrots 
... 2 
3 
2 
22 
27 
2 
2 
Sliced cucumber 
... 2 
2 
1 
7 
10 
1 
Radishes 
... 2 
3 
1 
13 
17 
2 
2 
Lettuce-lemon 
... i y* 
1 
1 
6 
8 
2 
1 
Dates 
... 2 
5 
15 
183 
203 
6 
11 
Walnuts 
21 
164 
15 
200 
4 
4 
Raspberries 
... 4 
5 
0 
59 
64 
8 
4 
Bran 
... % 
5 
3 
13 
21 
1 
4 
Total 
68 
253 
353 
674 
53 
31 
Grand total 
197 
722 
1121 
2040 
127 
106 
FRESH OR RAW DIET LIST 
Fruits of all sorts and fruit juices. 
Lettuce, celery, radish, cucumber, cabbage (uncooked), car- 
rot, turnip, tomato. 
Certified milk, whey, buttermilk (yogurt, acidophilus), egg- 
nog (yolks). 
Brose (oatmeal scalded), bran brose (oatmeal and bran 
equal parts, cooked six minutes), green corn (uncooked). 
Nuts, especially almonds, hazelnuts or filberts, walnuts and 
pecans. Malt sugar may be used with acid fruits. BILLS OF FARE 
985 
BILL OF FARE FOR HYPERCHLORHYDRIA 
Per cent of 
Calories 
day’s ration 
Breakfast 
Ounces 
Pro. 
Fat 
Carbo. 
Total 
Lime 
Iron 
Olive oil 
% 
0 
66 
0 
66 
Cream of wheat 
41/4 
6 
1 
42 
49 
7 
8 
Cream 
2*4 
7 
111 
12 
130 
7 
1 
Malt sugar 
1 
0 
4 
120 
124 
2 
9 
Prune puree 
3% 
3 
1 
99 
103 
2 
6 
Bran bread toast 
2 
12 
64 
124 
200 
2 
10 
Butter 
% 
0 
108 
0 
108 
Agar 
Total 
28 
355 
397 
780 
20 
34 
Dinner 
Olive oil 
% 
0 
66 
0 
66 
Lentil soup 
4% 
35 
19 
86 
140 
3 
14 
Stuffed potato 
3% 
9 
30 
66 
105 
3 
8 
Spinach purfee 
3 
7 
51 
9 
67 
7 
23 
Whole wheat toast . . . . 
2 
22 
4 
112 
138 
2 
6 
Butter 
% 
0 
108 
0 
108 
Yogurt buttermilk 
6 
24 
5 
36 
65 
28 
3 
Blueberries 
2% 
2 
3 
42 
47 
1 
4 
Agar 
Total 
99 
286 
351 
736 
45 
62 
Supper 
Olive oil 
% 
0 
66 
0 
66 
Cream of potato soup . . . 
4% 
12 
38 
53 
103 
1 
3 
Mashed carrots 
3 
4 
4 
33 
41 
7 
3 
Turnip top purfee 
3 
7 
51 
9 
67 
41 
20 
Graham bread toast . . . . 
2 
20 
12 
104 
136 
2 
10 
Butter 
*/2 
0 
108 
0 
108 
Fresh pear 
3 
5 
66 
74 
2 
2 
Total 
46 
284 
265 
595 
63 
38 
Grand total 
173 
925 
1013 
2111 
128 
134 
DIET LIST FOR HYPERCHLORHYDRIA 
Soups: Plain and cream vegetable soups. 
Relishes: Tender celery, lettuce with olive oil, ripe olives. 
Entrees: Macaroni and spaghetti (buttered, creamed or with 
egg sauce), soft cooked eggs (poached or boiled), protose, 
nuttolene. 
Vegetables: Purees of corn, peas, greens, beets, carrots, beans, 
oyster plant, squash, asparagus, soy beans, potatoes. 
Cereals: All flakes, cream of wheat, shredded wheat, oats, corn- 
meal, hominy, gruels of all kinds, especially gluten, bran. 
Breads: Dextrinized breads such as rice biscuit, granose biscuit, 
browned rice, zwieback, granola, thin crisp toast. 
Fruits: Sweet apples, dates, fresh pears, blueberries, very ripe 
bananas, white cherries, cantaloup, malaga or tokay grapes. 
Beverages: Buttermilk with cream, milk and cream, malted milk, 
malted nuts, unsweetened eggnogs (made with yolks only), 
unsweetened cocoa and minute brew. 986 
THE NEW DIETETICS 
Desserts: Custards (slightly sweetened), ices and sherbets, jel- 
lies made with bland fruit juices, ice cream, frozen cream 
and fluffs made with sub-acid fruits. 
Miscellaneous: Pecans, pinenuts, cream, butter, malt honey, 
with butter, olive oil, bromose, malted nuts, cottage cheese 
with cream, yogurt cheese. 
This dietary should consist of foods which require little 
mastication and all irritating and stimulating foods should be 
eliminated. 
Accessories: Bran, laxa, colax, agar, paraffin oil, paralax, para- 
mels. 
BILL OF FARE FOR ULCER DIET 
Per cent of 
Calories 
day’s ration 
Breakfast 
Ounces 
Pro. 
Fat 
Carbo. 
Total 
Lime 
Iron 
Rice gruel 
.... 3 % 
2 
1 
25 
28 
1 
Soft poached egg yolk . . 
. . . . 1 
18 
80 
0 
98 
11 
20 
Oven baked toast (moistened) 1 
10 
6 
52 
68 
1 
5 
Butter 
.... % 
0 
108 
0 
108 
Date purge 
2 
5 
15 
183 
203 
5 
11 
Total 
35 
210 
260 
505 
17 
37 
10 A. M. 
Milk 1/3 cream 
. . . . 6 
21 
143 
34 
198 
26 
3 
Dinner 
Cream of lentil soup . . . . 
. . . 4% 
44 
80 
97 
221 
8 
14 
Spinach soufflg 
25 
78 
146 
249 
10 
10 
Carrot puree 
3 
5 
19 
31 
65 
7 
3 
Oven-baked toast (moistened) 1 
10 
6 
52 
68 
1 
5 
Butter 
.... % 
0 
108 
0 
108 
Malted milk 
.. . . 1% 
20 
14 
132 
166 
2 
2 
Total 
104 
305 
458 
867 
28 
34 
4 P. M. 
Milk 1/3 cream 
6 
21 
143 
34 
198 
26 
3 
Supper 
Potato soup 
.... 4 % 
5 
16 
38 
59 
Pea purge 
3 
19 
24 
52 
95 
4 
11 
Rice biscuit 
.... 1 
9 
1 
97 
107 
Butter 
.... % 
0 
108 
0 
108 
Banana purge 
.. . . 3% 
5 
5 
87 
97 
1 
4 
Malt sugar 
2 
0 
0 
200 
200 
3 
18 
Total 
38 
154 
474 
666 
8 
33 
Grand total 
219 
955 
1260 
2434 
105 
110 
ULCER DIET LIST 
Soups: Strained cream soups of vegetables, such as peas, beans, 
asparagus, potato, corn, rice and oatmeal. 
Vegetables: Purees of vegetables such as spinach, peas, aspara- 
gus, beets, carrots, corn, celery, and egg plant. Mashed or 
baked potato. BILLS OF FARE 
987 
Cereals: Rice flakes, wheat flakes, cream of wheat, granola, soft 
buttered toast, cream gluten mush, rice and gruels of all 
kinds. 
Breads: Toasted bread, granose and rice biscuit. 
Beverages: Malted nuts, malted milk, cream and milk, acidophi- 
lus buttermilk, with cream, unsweetened eggnog (made with 
yolks only). 
Fruits: Banana puree, date puree, baked sweet apple, baked 
banana, avocado. 
Desserts: Frozen cream, unsweetened custards, and jellies made 
from bland fruit juices. 
Miscellaneous: Olive oil, butter, cream, soft cooked eggs, cot- 
tage cheese with cream, yogurt cheese. 
Accessories: Agar, bran, paraffin oil. 
BILL OF FARE FOR MODIFIED ULCER DIET 
Per cent of 
Calories 
day’s ration 
Breakfast 
Ounces 
Pro. 
Fat 
Carbo. 
Total 
Lime 
Iron 
Olive oil 
■ • Vx 
0 
66 
0 
66 
Oatmeal 
. . 5 
11 
9 
50 
70 
2 
6 
Cream 
.. 2% 
7 
111 
12 
130 
7 
1 
Banana pur6e 
• • 3% 
5 
6 
90 
101 
1 
4 
Soft poached egg 
.. 1V4 
23 
40 
0 
63 
4 
12 
Graham toast 
. . 2 
20 
12 
104 
136 
2 
10 
Cereal coffee 
Agar 
Total 
6 
244 
256 
566 
6 
33 
Dinner 
Olive oil 
• - . % 
0 
66 
0 
66 
Cream of rice soup 
• • . 4 % 
11 
40 
16 
67 
23 
2 
Baked potato 
, . . 3 
9 
1 
78 
88 
1 
8 
Carrott pur§e 
. . . 3 
4 
4 
33 
41 
7 
4 
Beet green purfe 
. . . 3 
7 
51 
9 
67 
8 
23 
Yogurt buttermilk, 1/3 cream 6 
22 
102 
35 
159 
28 
3 
Bran bread toast 
... 2 
12 
64 
124 
200 
2 
10 
Butter 
... % 
0 
108 
0 
108 
Baked sweet apple 
... 4% 
1 
3 
82 
86 
1 
3 
Agar 
Total 
66 
439 
377 
882 
70 
53 
Supper 
Olive oil 
• Vx 
0 
66 
0 
66 
Gluten mush 
... 5 % 
18 
2 
81 
100 
1 
13 
Date purSe 
... 2 
5 
15 
183 
203 
5 
11 
Cottage cheese 
... 2 
40 
25 
10 
75 
56 
4 
Blueberries 
... 2% 
2 
3 
42 
47 
1 
4 
Whole wheat bread toast. 
... 2 
22 
4 
112 
138 
2 
6 
Butter 
0 
108 
0 
108 
Total 
87 
223 
428 
738 
65 
38 
Grand total 
219 
906 
1061 
2186 
151 
124 988 
THE NEW DIETETICS 
BILL OF FARE FOR HYPOCHLORHYDRIA 
Per cent of 
Calories 
day’s ration 
Breakfast 
Ounces 
Pro. 
Fat 
Carbo. 
Total 
Lime 
Iron 
Grapefruit 
. . 3% 
3 
2 
44 
49 
3 
2 
Steamed rice 
13 
1 
113 
127 
2 
Tomato sauce 
. . . 3 
6 
54 
20 
80 
1 
3 
Lettuce 
. . . 1 % 
1 
1 
6 
8 
2 
1 
Granose biscuit 
. . . 1 
14 
2 
84 
100 
Butter 
. .. % 
0 
54 
0 
64 
Cereal coffee 
Bran 
■ • • Yx 
5 
3 
13 
21 
1 
4 
Total 
42 
117 
280 
439 
7 
12 
Dinner 
Savora rice soup 
• • . 4% 
4 
16 
33 
53 
2 
39 
Stuffed potato 
. . . 3% 
9 
30 
66 
105 
3 
8 
Carrots 
. . 3 
4 
4 
33 
41 
7 
3 
Green corn 
. . . 2% 
9 
8 
69 
76 
1 
4 
Celery 
. . . i y4 
1 
0 
4 
5 
4 
1 
Yogurt buttermilk 
24 
5 
36 
65 
28 
3 
Bran bread toast 
... 2 
12 
64 
124 
200 
1 
3 
Butter 
... Yx 
0 
54 
0 
54 
Fresh strawberries 
. . . 4 
5 
6 
34 
45 
7 
7 
Malt sugar 
... 2 
0 
0 
200 
200 
3 
18 
Bran 
... % 
5 
3 
13 
21 
1 
4 
Total 
73 
190 
602 
865 
57 
90 
Supper 
Protose broth 
. . . 4% 
12 
1 
1 
14 
Breaded tomatoes 
... 3% 
7 
15 
32 
54 
1 
3 
Wax beans 
. . . 4 
5 
1 
14 
20 
6 
7 
Cottage cheese 
... 2 
49 
25 
10 
75 
66 
4 
Butter 
... Yx 
0 
54 
0 
64 
Whole wheat bread toast. 
...2 
22 
4 
112 
138 
2 
6 
Orange jelly 
... 2 
0 
0 
120 
120 
1 
Bran 
... Yx 
5 
3 
13 
21 
1 
4 
Total 
91 
103 
302 
496 
67 
24 
Grand total 
206 
410 
1184 
1800 
131 
126 
DIET LIST FOR HYPOCHLORHYDRIA 
Soups: Clear vegetable broths and cream vegetable soups. 
Relishes: Ripe olives, celery, lettuce, endive and watercress. 
Entrees: Macaroni, spaghetti and soft cooked eggs. 
Vegetables: Baked, mashed or stuffed potatoes, asparagus tips, 
tender string or wax beans, spinach finely chopped, new 
peas, beets puree, tomatoes, corn, carrots and puree of navy 
and lima beans. 
Cereals: Flakes, zo, granola, cream of wheat, shredded wheat, 
rolled oats, oatmeal with bran, hominy grits, rice and corn- 
meal mush. 
Breads: Dry toast (whole wheat, bran, graham), zwieback, gra- 
ham wafers, soda, butter or water crackers. BILLS OF FARE 
989 
Fruits: All fresh and cooked fruits. Acid fruits are especially 
indicated. 
Beverages: Malted nuts, malted milk, acidophilus buttermilk, 
minute brew and health cocoa. 
Desserts: Custards, tapioca, gelatines, fruit fluffs, simple cakes, 
ices and sherbets. 
Miscellaneous: Avoid pickles, condiments and confectionery, 
also an excess of fat and rich heavy foods and all meats and 
meat broths and extracts. 
Those who have little or no hydrochloric acid should masti- 
cate their food thoroughly. An abundance of fresh fruits should 
be used. Simply prepared and easily digested foods should make 
up the dietary and not too great a variety indulged in at one 
meal. The intestinal flora must be changed and the protective 
flora kept dominant by the frequent or constant use of lactose 
or lacto-dextrin. 
BILL OF FARE FOR ACHYLIA GASTRICA 
Breakfast 
Ounces 
Pro. 
Calories 
Pat Carbo. 
Total 
Per cent of 
day’s ration 
Lime Iron 
Orange juice 
5 
0 
0 
76 
76 
6 
8 
Baked apple 
4% 
1 
3 
82 
86 
1 
2 
Malt sugar 
2 
0 
0 
200 
200 
3 
18 
Brose 
4% 
10 
8 
36 
54 
7 
25 
Cream 
2% 
7 
111 
12 
130 
7 
1 
Graham bread toast . . . 
2 
20 
12 
104 
136 
2 
9 
Lettuce-lemon 
iy4 
1 
1 
6 
8 
2 
1 
Bran 
% 
5 
3 
13 
21 
1 
4 
Total 
44 
138 
529 
711 
29 
68 
Dinner 
Tomato soup 
4% 
6 
22 
29 
57 
1 
Mashed potato 
3y4 
9 
15 
61 
85 
1 
9 
Asparagus tips 
i% 
4 
15 
5 
24 
2 
3 
Yogurt buttermilk 
6 
24 
5 
36 
65 
28 
3 
Celery 
1% 
1 
0 
4 
5 
4 
1 
Bran bread toast 
2 
12 
64 
124 
200 
2 
10 
Pear 
4 
3 
5 
66 
74 
3 
2 
Bran 
% 
5 
3 
13 
21 
1 
4 
Total 
64 
129 
338 
631 
41 
33 
Supper 
Savora broth 
4% 
1 
32 
0 
33 
1 
39 
Cottage cheese 
2 
40 
25 
10 
75 
56 
4 
Sliced tomatoes 
4 
4 
4 
18 
26 
1 
3 
Bran biscuits 
Steamed rice 
4 
20 
13 
23 
1 
56 
113 
99 
127 
2 
Cream 
2% 
7 
111 
12 
130 
7 
1 
Grapes 
6 
16 
83 
105 
4 
3 
Bran 
y4 
5 
3 
13 
21 
1 
4 
Malt sugar 
2 
0 
0 
200 
200 
3 
18 
Total 
96 
215 
505 
816 
73 
74 
Grand total .... 
204 
482 
1372 
2058 
143 
175 990 
THE NEW DIETETICS 
DIET LIST FOR ACHYLIA 
Soups: Plain vegetable soups and purees. 
Relishes: Celery, lettuce, endive and watercress. 
Entrees: Soft cooked eggs, macaroni, spaghetti, protose and 
nuttolene. 
Vegetables: Irish potatoes, peas, navy, lima, kidney, soy, wax 
and green beans, tomatoes, greens of all kinds, egg plant, 
carrots, squash, corn, beets, artichokes and asparagus. 
Cereals: Rice, shredded wheat, brose, farina, rolled oats, cereal 
flakes, bran and other cereal preparations, with breads. 
Fruits: All fresh and cooked fruits. 
Beverages: Fruit juices, malted milk, malted nuts, minute brew, 
cocoa, buttermilk and yogurt buttermilk. 
Desserts: Gelatine custards, ices, sherbets, plain cakes and 
tapioca. 
Miscellaneous: Cottage cheese, yogurt cheese, meltose (malt 
honey), honey, butter and cream in restricted quantities. 
Accessories: Bran, agar, and paraffin preparations should be 
used regularly with each meal, also acid protein (acidone) 
when free acid is wholly absent or nearly so. 
The food must be thoroughly masticated and the dietary 
kept laxative by the use of bulky foods such as fresh fruits, vege- 
tables and greens. Acid fruits should be freely used, also fruit 
juices. The intestinal flora should be changed frequently by the 
use of lactose or lacto-dextrin. COMPOSITION OF FOODSTUFFS 
991 
TABLE XLIV. 
Percentage Composition of Foodstuffs and Energy Value 
(Calories) per Ounce* 
(The letters E. P. stand for edible portion and A. P. for as purchased.) 
Protein 
Fat 
Carbo. 
Total Lime 
Iron 
Cal. 
Cal. 
Cal. 
Cal. 
Per 
Per 
Per 
Per 
Per 
Per 
Per Per 
Per 
cent 
oz. 
cent 
oz. 
cent 
OZ. 
oz. cent 
cent 
Acorns, E. P 
. 8.1 
9.2 
37.4 
95.4 
48.0 
54.4 
159.0 ... 
A. P 
. 5.2 
5.9 
24.1 
61.5 
30.9 
35.0 
102.4 .. . 
Acorn kernel 
. 4.2 
4.8 
.5.4 
13.8 
54.6 
61.9 
80.5 . . . 
Almonds, E. P 
. 21.0 
23.8 
54.9 
139.9 
17.3 
19.6 
183.3 .335 
.0039 
A. P 
. 11.5 
13.0 
30.2 
77.0 
.9.5 
10.8 
100.8 ... 
Apples, E. P 
.4 
.5 
.5 
1.3 
14.2 
16.1 
17.9 .010 
.0003 
A. P 
.3 
.3 
.8 
10.8 
12.2 
13.3 . . . 
dried, A. P 
. 1.6 
1.8 
2.2 
5.6 
66.1 
75.0 
82.4 .045 
.0015 
crab, canned, A. P.. . . 
.3 
.3 
2.4 
6.1 
54.4 
61.7 
68.1 . . . 
juice 
15.0 
17.0 
17.0 .011 
.0002 
sauce, canned, A. P.. . 
.2 
.2 
.8 
2.0 
37.2 
42.2 
44.4 
Apricots, E. P 
1.1 
1.2 
13.4 
15.2 
16.4 .020 
.0003 
A. P 
. 1.0 
1.1 
12.6 
14.3 
15.4 .018 
dried, A. P 
. . 4.7 
5.3 
1.0 
2.6 
62.5 
70.9 
78.8 .092 
.0014 
canned, A. P 
.9 
1.0 
17.3 
19.6 
20.6 . . . 
sauce, canned, A. P,. 
. 1.9 
2.2 
1.3 
3.3 
48.8 
55.55 
60.8 . . . 
Artichokes, A. P 
. 2.6 
2.9 
.2 
.5 
16.7 
18.9 
22.3 .. . 
canned, A. P 
.8 
.9 
5.0 
5.7 
6.6 ... 
Asparagus, fresh, A. P. . . 
. 1.8 
2.0 
.2 
.5 
3.3 
3.7 
6.2 .035 
.0010 
canned, A. P 
. 1.5 
1.7 
.1 
.3 
2.8 
3.2 
5.2 .040 
.0010 
Bouillon, canned, A. P 
. . 2.2 
2.5 
.1 
.3 
.2 
.2 
3.0 .050 
.0012 
cooked, A. P 
. . 2.1 
2.4 
3.3 
8.4 
2.2 
2.5 
13.3 .050 
.0012 
soup, cream of, canned, 
A. P 
. . 2.5 
2.8 
3.2 
8.2 
5.5 
6.2 
17.2 .040 
.0010 
Avocado 
. . 2.2 
2.5 
17.3 
44.1 
4.4 
5.0 
51.6 . . . 
Banana, E. P 
. . 1.3 
1.5 
.6 
1.5 
22.0 
24.9 
27.9 .013 
.0006 
A. P 
.8 
.9 
.4 
1.0 
14.3 
16.2 
18.1 .010 
.0006 
Bacon, smoked, E. P 
. . 10.5 
11.9 
64.8 
165.2 
177.1 .008 
.0016 
A. P 
. . 9.5 
10.8 
59.4 
151.5 
162.3 .007 
.0014 
Barley meal and flour. . . . 
. . 10.5 
11.9 
2.2 
5.6 
72.8 
82.6 
100.1 .060 
.0041 
entire 
. . 9.0 
10.2 
1.6 
4.1 
66.8 
75.8 
90.1 .060 
.0040 
pearled 
. . 8.5 
9.(5 
1.1 
2.8 
77.8 
88.2 
100.6 .028 
.0013 
Bass, black, whole 
. . 20.6 
23.4 
1.7 
4.3 
27.7 .031 
.0008 
Bean, adzuki 
23.8 
.7 
1.8 
56.7 
61.3 
89.9 . . . 
baked, canned, A. P. 
. . 6.9 
7.8 
2.5 
6.4 
19.6 
22.2 
36.4 .067 
.0021 
butter, green 
. . 4.7 
5.3 
.3 
.8 
14.6 
16.6 
22.7 
dried, A. P 
. . 22.5 
25.5 
1.8 
4.6 
59.6 
67.6 
97.7 .224 
.0070 
frijoles, A. P 
. . 21.9 
24.8 
1.3 
3.3 
65.1 
73.8 
101.9 ... 
little green, 
canned, A. P 
. . 1.2 
1.4 
.1 
.3 
3.4 
3.9 
5.6 ... 
haricots, verts, 
canned, A. P 
. . 1.1 
1.2 
.1 
.3 
2.5 
2.8 
4.3 ... 
jack 
.. 23.8 
27.0 
2.6 
6.6 
50.4 
57.2 
90.8 .. . 
red kidney, canned, 
A. P 
. . 7.0 
7.9 
.2 
.5 
18.5 
21.0 
29.4 .. . 
lima, dried 
.. 18.1 
20.5 
1.5 
3.8 
65.9 
74.7 
99.0 .100 
.0070 
lima, fresh, A. P. . . 
. . 3.2 
3.6 
.3 
.8 
9.9 
11.2 
15.6 .039 
.0020 
lima, fresh, E. P. . . 
. . 7.1 
8.1 
.7 
1.8 
22.0 
25.0 
34.9 . . . 
lima, canned, A. P.. 
. . 4.0 
4.5 
.3 
.8 
14.6 
16.6 
21.9 ... 
mesquite, dry, A. P. 
.. 12.2 
13.8 
2.5 
6.4 
77.1 
87.4 
107.6 ... 
and pod, mesquite . 
.. 13.0 
14.7 
3.1 
7.9 
46.7 
53.0 
75.6 . .. 
mung 
.. 23.8 
27.0 
2.0 
5.1 
54.8 
62.1 
94.2 . . . 
soup, homemade, A. 
P. 3.2 
3.6 
1.4 
3.6 
9.4 
10.7 
17.9 . . . 
soy 
44.8 
18.5 
47.2 
17.7 
20.1 
112.1 . . . 
string, cooked, E. P.. 
.8 
.9 
1.1 
2.8 
1.9 
2.2 
5.9 ... 
string, fresh, E. P.. . 
. . 2.3 
2.6 
.3 
.8 
7.4 
8.4 
11.8 .065 
.ooii 
string, fresh, A. P.. . 
. . 2.1 
2.4 
.3 
.8 
6.9 
7.8 
11.0 .065 
.0011 
string, canned, A. P. 
... 1.1 
1.2 
.1 
.3 
3.8 
4.3 
5.8 .035 
.0008 
wax, canned, A. P. . 
. . 1.0 
1.1 
.1 
.3 
3.1 
3.5 
4.9 ... 
* This table is compiled from Bulletin No. 28 of the U. S. Agricultural De- 
partment. Sherman’s Chemistry of Foods and other authoritative sources. 992 
THE NEW DIETETICS 
Protein 
Cal. 
Fat 
Cal. 
Carbo. 
Cal. 
Total 
Cal. 
Lime 
Iron 
Per 
Per 
Per 
Per 
Per 
Per 
Per 
Per 
Per 
cent 
oz. 
cent 
OZ. 
cent 
OZ. 
OZ. 
cent 
cent 
Beechnut, E. P 
21.9 
24.8 
57.4 
146.4 
13.2 
15.3 
186.5 
A. P 
Beef, brisket, med. 
13.0 
14.7 
34.0 
86.7 
7.8 
8.8 
110.2 
fat, E. P 
15.8 
17.9 
28.5 
72.8 
90.7 
.012 
.0024 
A. P 
12.0 
13.6 
22.3 
56.9 
70.5 
.009 
.0018 
chuck, av. E. P 
19.2 
21.8 
15.4 
39.3 
61.1 
.015 
.0029 
A. P 
15.8 
17.9 
12.5 
31.9 
49.8 
.012 
.0024 
corned, av. E. P 
15.6 
17.7 
26.2 
60.8 
84.5 
.012 
.0023 
A. P 
14.8 
16.2 
23.8 
60.7 
76.9 
.011 
.0021 
cross ribs, av. E. P.. . 
15.9 
18.0 
28.2 
71.9 
89.9 
.012 
.0024 
A. P 
dried, salted 
13.8 
15.6 
24.8 
63.2 
78.8 
.011 
.0021 
and smoked, E. P. ... 
30.0 
34.1 
6.5 
16.6 
.4 
.5 
51.2 
.023 
.0045 
smoked, A. P 
26.4 
29.9 
6.9 
17.6 
47.5 
.020 
.0040 
flank, lean E. P 
20.8 
23.6 
11.3 
28.8 
52.4 
.016 
.0031 
A. P 
20.5 
23.2 
11.0 
28.1 
51.3 
.016 
.0031 
forequarter, lean E. P. 
18.9 
21.4 
12.2 
21.1 
52.5 
.014 
.0028 
A. P 
forequarter, 
14.7 
16.7 
9.5 
24.2 
40.9 
.011 
.0022 
med. fat A. P 
14.5 
16.4 
17.5 
44.6 
61.0 
.011 
.0022 
fore shank, E. P 
22.0 
24.9 
6.1 
15.6 
40.5 
.017 
.0033 
A. P 
14.0 
15.9 
3.9 
9.9 
25.8 
.011 
.0021 
heart, E. P 
16.0 
18.1 
20.4 
52.0 
1.0 
i.i 
71.2 
.012 
.0024 
A. P 
hindquarter 
14.8 
16.8 
24.7 
63.0 
.9 
1.0 
80.8 
.011 
.0022 
lean, E. P 
20.0 
22.7 
13.4 
34.2 
56.9 
.016 
.0030 
A. P 
hindquarter, med. 
16.7 
18.9 
11.2 
28.6 
47.5 
.013 
.0025 
fat, A. P 
15.4 
17.5 
18.3 
46.7 
64.2 
.012 
.0023 
hind shank, lean, E. P. 
21.1 
24.8 
5.4 
13.8 
38.6 
.016 
.0032 
A. P 
9.1 
10.3 
2.2 
5.6 
15.9 
.070 
.0014 
hind shank, fat, E. P.. 
20.4 
23.1 
18.8 
47.9 
71.0 
.016 
.0031 
A. P 
9.9 
11.2 
9.1 
23.2 
34.4 
.008 
.0015 
juice, A. P 
4.9 
5.6 
.6 
1.5 
7.1 
kidney, E. P 
16.6 
18.8 
4.8 
12.2 
.4 
.5 
31.5 
.013 
.0025 
liver, E. P 
20.4 
23.1 
4.5 
11.5 
1.7 
1.9 
36.5 
.016 
.0031 
loin, E. P 
19.7 
22.3 
12.7 
32.4 
54.7 
.015 
.0030 
A. P 
17.1 
19.4 
11.1 
28.3 
47.7 
.013 
.0026 
loin steak, cooked, E. P. 
23.5 
26.6 
20.4 
52.0 
78.6 
.018 
.0035 
neck, lean, A. P 
15.1 
17.1 
5.9 
15.0 
32.1 
.012 
.0023 
E. P 
21.4 
24.3 
8.4 
21.4 
45.7 
.016 
.0032 
neck, med. fat E. P. . . 
20.1 
22.8 
16.5 
42.1 
64.9 
.015 
.0030 
A. P 
14.5 
16.4 
11.9 
30.3 
46.7 
.011 
.0022 
plate, lean, E. P 
15.6 
17.7 
18.8 
47.9 
65.6 
.012 
.0023 
A. P 
13.0 
14.7 
15.5 
39.5 
54.2 
.010 
.0020 
porterhouse steak E. P. 
21.9 
24.8 
20.4 
52.0 
76.8 
.017 
.0033 
A. P 
19.1 
21.7 
17.9 
45.6 
67.3 
.015 
.0029 
rib rolls, lean A. P. . . 
20.2 
22.9 
10.5 
26.8 
49.7 
.015 
.0030 
ribs, lean E. P 
19.6 
22.2 
12.0 
30.6 
52.8 
.015 
.0029 
A. P 
15.2 
17.2 
9.3 
23.7 
40.9 
.012 
.0023 
ribs, fat, E. P 
15.0 
17.0 
35.6 
99.8 
107.8 
.012 
.0023 
A. P 
1 2.7 
14.4 
30.6 
78.0 
92.4 
.010 
.0019 
roast, A. P 
22.3 
25.3 
28.6 
72.9 
98.2 
.017 
.0033 
round, lean, E. P 
21.3 
24.2 
7.9 
20.1 
44.3 
.016 
.0032 
A. P 
round, free from 
19.5 
22.1 
7.3 
18.0 
40.7 
.015 
.0029 
visible fat 
23.2 
26.3 
2.5 
6.4 
32.7 
.018 
.0035 
round, med. fat A. P. 
round steak, 
19.0 
21.5 
12.8 
32.6 
54.1 
.015 
.0029 
lean, cooked A. P. ... 
27.6 
31.3 
7.7 
19.6 
50.9 
.021 
.0041 
rump, lean, E. P 
20.9 
23.7 
13.7 
34.9 
58.6 
.016 
.0031 
A. P 
19.1 
21.7 
11.0 
28.1 
49.8 
.015 
.0029 
rump, fat, E. P 
16.8 
19.1 
35.7 
91.0 
110.1 
.013 
.0025 
A. P 
shoulder and clod 
12.9 
14.G 
27.6 
70.4 
85.0 
.010 
.0019 
lean, A. P 
shoulder and clod 
16.4 
18.6 
4.4 
11.2 
29.8 
.013 
.0025 
med. fat A. P 
16.4 
18.6 
9.8 
25.0 
43.6 
.013 
.0025 
side, lean E. P 
19.3 
21.9 
13.2 
33.7 
55.6 
.015 
.0029 
A. P 
15.5 
17.6 
10.6 
27.0 
44.6 
.012 
.0023 
sirloin steak E. P 
18.9 
21.4 
18.5 
47.2 
68.6 
.014 
.0028 
A. P 
16.5 
18.7 
16.1 
41.1 
. • , 
. * . 
75.9 
.013 
.0025 COMPOSITION OF FOODSTUFFS 
993 
Protein 
Cal. 
Fat 
Cal. 
Carbo. 
Cal. 
Total 
Cal. 
Lime 
Iron 
Per 
Per 
Per 
Per 
Per 
Fer 
Per 
Per 
Per 
cent 
oz. 
cent 
OZ. 
cent 
oz. 
OZ. 
cent 
cent 
swet t breads, 
canned A. P 
20.2 
22.9 
9.5 
24.2 
47.1 
.015 
.0030 
sweet breads A. P. ... 
16.8 
19.1 
12.1 
30.9 
50.0 
.013 
.0025 
tenderloin A. P 
16.2 
18.4 
24.4 
62 2 
80.6 
.012 
.0024 
tongue E. P 
18.9 
21.4 
9.2 
23.5 
44.9 
.014 
.0028 
A. P 
14.1 
16.0 
6.7 
17.1 
33.1 
.011 
.0021 
Beets, cooked E. P 
2.3 
2.6 
.1 
.3 
7.4 
8.4 
11.3 
fresh E. P 
1.6 
1.8 
.1 
.3 
9.7 
11.0 
13.1 
.041 
.0006 
Blackberries A. P 
1.3 
1.5 
1.0 
2.6 
10.9 
12.4 
16.5 
.024 
.0006 
canned A. P 
.8 
.9 
2.1 
5.4 
56.4 
64.0 
70.3 
juice (canned) 
26.6 
30.3 
30.3 
Blackfish E. P 
18.7 
21.2 
1.3 
3.3 
24.5 
.028 
.0007 
A. P 
7.4 
8.4 
.7 
1.8 
10 2 
.011 
.0003 
Blueberries, fresh 
.6 
.7 
.6 
1.5 
16.6 
18.8 
21.0 
.028 
.0009 
canned A. P 
.6 
.7 
.6 
1.5 
12.8 
14 5 
16.7 
juice (-canned) 
16.6 
18.9 
18.9 
Bluefish, E. P 
19.4 
22 0 
1.2 
3.1 
25.1 
.029 
.0008 
A. P 
10.0 
11.3 
.6 
1.5 
12 8 
.015 
.0004 
Brano-la 
12.0 
13.6 
2.1 
5.4 
68.0 
77.7 
96.7 
.097 
.0054 
Bran, corn 
9.7 
11.0 
5.7 
14.5 
62.4 
70 8 
96.3 
rye 
12.2 
13.8 
2.8 
7.1 
56.6 
64.2 
85.1 
.250 
.0140 
wheat 
12.5 
14 2 
3.0 
7.7 
41.6 
47.2 
69.1 
.168 
.0078 
wheat, sterilized 
20.0 
22 9 
4.5 
11.6 
46.1 
52.3 
86.8 
.168 
.0078 
Brazil nuts, E. P 
17.0 
19.3 
66.3 
170.3 
7.0 
7.9 
197.5 
A. P 
8.6 
9.8 
33.7 
85.9 
3.5 
4.0 
99.7 
Bread, biscuit, 
homemade, A. P 
8.7 
9.9 
2.6 
6.6 
55.3 
62.7 
79.2 
.130 
.0012 
biscuit, soda, A. P 
9.3 
10.5 
13.7 
34.9 
52.6 
59.6 
94.5 
.150 
.0014 
biscuit, white, A. P. . . 
8.0 
9.1 
1.4 
3.6 
54.3 
61.6 
74.3 
.130 
.0012 
bran 
5.3 
6.0 
12.5 
32.0 
54.6 
62.0 
100.0 
brown, A. P 
5.4 
6.1 
1.8 
4 6 
47.1 
53.4 
64.1 
.180 
.0030 
corn (johnnycake) A.P. 
7.9 
9.0 
4.7 
12.0 
46.3 
52.5 
73.5 
.013 
.0009 
graham, A. P 
8.9 
10.1 
1.8 
4.6 
52.1 
59.1 
73.8 
.070 
.0025 
milk, A. P 
9.6 
10.9 
1.4 
3.6 
51.1 
57.9 
72.4 
pilot, A. P 
11.1 
12.6 
5.0 
12.8 
74.2 
84,1 
109.5 
.036 
.ooii 
rolls, French, A. P. . . 
8.5 
9.6 
2.5 
6.4 
55.7 
63.2 
79.2 
.024 
.0010 
rolls, plain, A. P 
9.7 
11.0 
4.2 
10.7 
59.9 
67.9 
89.6 
.028 
.0010 
rolls, Vienna, A. P. .... 
8.5 
9.6 
2.2 
5.6 
56.5 
64.1 
79.3 
.036 
.0010 
rolls, water, A. P 
9.0 
10.2 
3.0 
7.7 
54.2 
61.5 
79.4 
.036 
.0010 
rye, A. P 
9.0 
10.2 
.6 
1.5 
53.2 
60.3 
72.0 
.034 
.0016 
rye (black) A. P 
9.6 
10.9 
.6 
1.5 
48.9 
55.5 
67.9 
.036 
.0018 
rye (whole) A. P 
11.9 
13.5 
.6 
1.5 
35.9 
40.7 
55.7 
.040 
.0022 
toasted 
11.5 
13.0 
1.6 
4.1 
61.2 
69.4 
86.5 
.036 
.0011 
wholewheat ... 
9.7 
11.0 
.9 
2.3 
49.7 
56.4 
69.7 
.070 
.0016 
white, homemade 
9.1 
10.3 
1.6 
4.0 
53.3 
60.4 
74.7 
.038 
.0009 
white, Vienna 
9.4 
10.7 
1.2 
3.1 
54.1 
61.3 
75.1 
.036 
.0010 
zwieback 
9.8 
11.1 
9.9 
25.2 
73.5 
83.3 
119.6 
.040 
.0011 
Bromose, nut 
18.3 
20.8 
27.5 
70.1 
57.1 
42.1 
133.0 
.038 
.0021 
Brussels sprouts, 
canned, A. P 
1.5 
1.7 
.1 
.3 
3.4 
3.9 
5.9 
.038 
.0011 
Buckwheat 
10.8 
12.2 
2.5 
6.4 
62.2 
70.5 
89.1 
.036 
flour 
6.4 
7.3 
1.2 
3.1 
77.9 
88.3 
98.7 
.055 
.0012 
Buns, hotcross 
7.9 
9.0 
4.8 
12.2 
49.7 
56.4 
77.6 
.024 
.0007 
Butter, A. P 
1.0 
1.1 
85.0 
216.8 
217.9 
.021 
.0002 
Buttermilk, A. P 
3.0 
3.4 
.5 
1.3 
4.8 
5.4 
10.1 
.147 
.0003 
Butternuts, E. P 
27.9 
31.6 
61.2 
156.1 
3.5 
4.0 
191.7 
A. P 
3.8 
4.3 
8.3 
21.2 
.5 
.6 
26.1 
Cabbage, E. P 
1.6 
1.8 
.3 
.8 
5.6 
6.4 
9.0 
.063 
.ooii 
Chinese 
1.2 
1.4 
1.4 
1.6 
3.0 
curly, A. P 
4.1 
4.6 
.6 
1.5 
6.2 
7.0 
13.1 
sprouts, E. P 
4.7 
5.3 
1.1 
2.8 
4.3 
4.9 
18.3 
.148 
.ooi 8 
Cake, chocolate, 
layer, A. P 
6.2 
7.0 
8.1 
20.7 
64.1 
72.7 
110.4 
coffee, A. P 
7.1 
8.1 
7.5 
19.1 
63.2 
71.7 
98.9 
cup cake, A. P 
5.9 
6.7 
9.0 
23.0 
68.5 
77.7 
107.4 
drop, A. P 
7.6 
8.6 
14.7 
37.5 
60.3 
68.4 
114.5 
frosted, A. P 
6.9 
6.7 
9.0 
23.0 
64.8 
73.5 
103.2 
fruit, A. P 
6.9 
6.7 
10.9 
27.8 
64.1 
72.7 
107.2 
gingerbread, A. P 
5.8 
6.6 
9.0 
23.0 
63.5 
72.0 
101.6 
sponge, A. P 
6.3 
7.1 
10.7 
27.3 
65.9 
74.7 
109.1 
cookies, molasses, A. P. 
7.2 
8.2 
8.7 
22,2 
75.7 
85.8 
116.2 
gingersnaps, A. P. . . . 
6.5 
7.4 
8.6 
21.9 
76.0 
86.2 
115.5 
Calf’s foot jelly, A. P 
4.3 
4.9 
17.4 
19.7 
24.6 
Cantaloup, E. P .. 
.6 
• 7 
, . , 
9.3 
10.5 
11.2 
.024 
.0003 994 
THE NEW DIETETICS 
Protein 
Cal. 
Fat 
Cal. 
Carbo. 
Cal. 
Total 
Cal. 
Lime 
Tron 
Per 
Per 
Per 
Per 
Per 
Per 
Per 
Per 
Per 
cent 
oz. 
cent 
oz. 
cent 
OZ. 
OZ. 
cent 
cent 
Capon, cooked, E. P 
27.0 
30.(1 
11.5 
29.3 
59.9 
.020 
.0040 
Carrots, fresh, E. P 
1.1 
1.2 
.4 
1.0 
9.3 
10.5 
12.7 
.078 
.0006 
Cashew nut, E. P 
9.7 
11.0 
47.1 
120.1 
5.9 
6.7 
137.8 
Cassava, dried, A. P 
2.8 
3.2 
.5 
1.3 
84.1 
95.4 
99.9 
sweet, A. P 
1.1 
1.2 
.2 
.5 
30.2 
34.2 
35.9 
Cauliflower, A. P 
1.8 
2.0 
.5 
1.3 
4.7 
5.3 
8.6 
.172 
.0006 
Celery, E. P 
soup,, canned, 
1.1 
1.2 
.1 
.3 
3.3 
3.7 
5.2 
.109 
.0005 
cream of, A P 
2.1 
2.4 
2.8 
7.1 
5.0 
5.7 
15.2 
Cerealine, A. P 
9. G 
10.9 
1.1 
2.8 
78.3 
88.8 
102.5 
.015 
.0011 
Chard, Swiss 
Cheese, American 
3.2 
3.6 
.6 
1.5 
5.0 
5.7 
10.8 
.210 
.0025 
pale, A. P 
28.8 
32.7 
35.9 
91.5 
.3 
.3 
124.5 
1.303 
.0013 
American Red, A, P.. . 
29.6 
33.6 
3 8.3 
97.7 
131.3 
cottage, A. P 
20.9 
23.7 
1.0 
2.6 
4.3 
4.9 
31.2 
.300 
full cream, A. P 
25.9 
29.4 
33.7 
85.9 
2.4 
2.7 
118.0 
Cheddar, A. P 
27.7 
31.4 
36.8 
93.8 
4.1 
4.6 
129.8 
Fromage de Brie, A. P. 
15.9 
18.0 
21.0 
53.6 
1.4 
1.6 
73.2 
limburger, A. P 
23.0 
26.1 
29.4 
75.0 
.4 
.5 
101.6 
Neuchatel, A. P 
18.7 
21.2 
27.4 
69.9 
1.5 
1.7 
92.8 
pineapple, A. P 
29.9 
33.9 
38.9 
99.2 
2.6 
2.9 
136.0 
roquefort, A. P 
partly skimmed milk, 
22.6 
25.6 
29.5 
75.2 
1.8 
2.0 
102.8 
A. P. 
25.4 
28.8 
29.5 
75.2 
3.6 
4.1 
108.1 
skimmed milk, A. P.. . 
31.5 
35.7 
16.4 
41.8 
2.2 
2.5 
80.8 
Swiss, A. P 
27.6 
31.3 
34.9 
89.0 
1.3 
1.5 
121.8 
Cherries, E. P 
1.0 
1.1 
.8 
2.0 
16.7 
18.9 
22.0 
.027 
.0004 
A. P 
.9 
1.0 
.8 
2.0 
15.9 
18.0 
21.0 
canned, A. P 
1.1 
1 2 
.1 
.3 
21.1 
23.9 
25.4 
jelly, A. P 
1.1 
1.2 
77.2 
87.5 
88.7 
juice, A. P 
.3 
.3 
4.6 
5.2 
5.5 
Chestnuts, fresh, E. P 
6.2 
7.0 
5.4 
13.8 
42.1 
47.7 
68.5 
.048 
.0007 
A. P 
5.9 
4.5 
11.5 
35.4 
40.1 
57.5 
dried, E. P 
10.7 
12.1 
7.0 
17.9 
74.2 
84.1 
114.1 
A. P 
8.1 
9.2 
5.3 
13.5 
56.4 
64.0 
86.7 
Chicken, broilers, E. P. ... 
21.5 
24.4 
2.5 
6.4 
30.8 
.016 
.0032 
fricasseed, E. P 
17.6 
20.0 
11.5 
29.3 
2.4 
2.7 
52.0 
.013 
.0026 
gumbo, canned, A.P.. . 
3.8 
4.3 
.9 
2.3 
4.7 
5.3 
11.9 
sandwich, canned, A. P. 
20.8 
23.6 
30.0 
76.5 
100.1 
.016 
.0031 
soup canned, A. P. . . . 
3.6 
4.1 
.1 
.3 
1.5 
1.7 
6.1 
soup, homemade, E. P. 
10.5 
11.9 
.8 
2.0 
2.4 
2.7 
16.6 
Chinese cabbage 
1.2 
1.4 
1.4 
1.6 
3.0 
Chinquapin, E. P 
10.9 
12.4 
.7 
1.8 
73.8 
83.7 
97.9 
Chocolate 
12.9 
14.6 
48.7 
124.2 
30.3 
34.4 
173.2 
.129 
.0027 
Clams, long, fresh, E. P.. . . 
Clam chowder, 
8.6 
9.8 
1.0 
2.6 
2.0 
2.3 
14.7 
.174 
homemade, A. P 
1.8 
2.0 
.8 
2.0 
6.7 
7.6 
11.6 
round, canned, A. P.. . 
10.5 
11.9 
.8 
2.0 
3.0 
3.4 
17.3 
.148 
Cocoanut, E. P 
5.7 
6.5 
50.6 
129.0 
27.9 
31.6 
167.1 
.034 
A. P 
2.9 
3.3 
25.9 
65.9 
14.3 
16.2 
85.4 
prepared, A. P 
6.3 
7.1 
57.4 
146.4 
31.5 
35.7 
189.2 
.083 
Cod, dressed, A. P 
11.1 
12.6 
.2 
.5 
.13.1 
.015 
.0004 
salt, E. P 
25.4 
28.8 
.3 
.8 
29.6 
.038 
.0010 
salt (boneless) E. P. . . 
27.3 
31.0 
.3 
.8 
31.8 
.041 
.0011 
whole, E. P 
16.5 
18.7 
.4 
1.0 
19.7 
.015 
.0004 
Collards, E. P 
4.5 
5.1 
.6 
1.5 
6.3 
7.1 
13.7 
Consomme, canned, A. P.. . . 
2.5 
2.8 
.4 
.5 
3.3 
Corn, green, sweet, E. P.. . . 
3.1 
3.5 
1.1 
2.8 
19.7 
22.3 
28.6 
.008 
.0008 
green, canned, A. P. 
soup, cream of, 
2.8 
3.2 
1.2 
3.1 
19.0 
21.5 
27.8 
canned, A. P 
2.3 
2.8 
1.9 
4.8 
7.8 
8.8 
16.4 
bran 
9.7 
11.0 
5.7 
14.5 
62.4 
70.8 
96.3 
dent 
10.1 
11.5 
5.0 
12.8 
70.9 
80.4 
104.7 
flint 
10.4 
11.8 
5.0 
12.8 
69.4 
78.7 
103.3 
flour 
7.1 
8.1 
1.3 
3.3 
78.4 
88.9 
100.3 
meal, granular 
9.2 
10.4 
1.9 
4.8 
75.4 
85.5 
100.7 
.025 
.0009 
unboited 
8.4 
9.5 
4.7 
12.0 
74.0 
83.9 
105.4 
oil 
100.0 
255.0 
255.0 
parched 
11.5 
13.0 
8.4 
21.4 
72.3 
82.0 
164.0 
soft 
7.4 
8.4 
3.8 
9.7 
66.0 
63.5. 
. .81.6 
sweet, mature 
11.5 
13.0 
7.9 
20.1 
67.2 
76.2 
109.3 
syrup ,,,,,,, t • ? t t•t • t 
t < • 
. , . 
, , . 
83.5 
94.7 
94.7 COMPOSITION OF FOODSTUFFS 
995 
Protein 
Fat 
Carbo. 
Total 
I>ime 
Iron 
Cal. 
Cal. 
Cal. 
Cal. 
Per 
Per 
Per 
Per 
Per 
Per 
Per 
Per 
Per 
cent 
oz. 
cent 
OZ. 
cent 
iZ. 
OZ. 
cent 
cent 
Cornstarch 
90.0 
102.1 
102.1 
Cottolene 
100.0 
255.0 
Cottonseed, A. P 
19.5 
22.1 
19.0 
48.5 
24.9 
28.2 
98.8 
meal, A. P 
44.1 
50.0 
9.1 
23.2 
25.0 
28.4 
101.6 
.371 
Crabs, hardshell 
whole, E. P 
16.6 
18.8 
2.0 
5.1 
1.2 
1.4 
25.3 
canned, A. P 
15.8 
17.9 
1.5 
3.8 
.7 
.8 
22.5 
Crackers, Boston, A. P. ... 
11.0 
12.5 
8.5 
21.7 
71.1 
80.6 
114.8 
butter, A. P 
9.6 
10.9 
10.1 
25.8 
71.6 
81.2 
117.9 
cream, A. P 
9.7 
11.0 
12.1 
30.9 
69.7 
79.0 
120.9 
egg, A. P 
12.6 
14.3 
14.0 
35.7 
66.6 
flatbread, A. P 
14.9 
16.9 
.5 
1.3 
73.6 
83.5 
101.7 
.027 
.0015 
graham, A. P 
10.0 
11.3 
9.4 
24.0 
73.8 
83.7 
119.0 
.055 
.0045 
oatmeal, A. P 
11.8 
13.4 
11.1 
28.3 
69.0 
78.2 
119.9 
.090 
.0027 
oyster. A. P 
11.3 
12.8 
10.5 
26.8 
70.5 
79.9 
119.5 
.032 
.0017 
saltines, A. P 
10.6 
12.0 
12.7 
32.4 
68.5 
77.7 
122.1 
.030 
.0016 
soda, A. P 
9.8 
11.1 
9.1 
23.2 
73.1 
83.9 
117.2 
.028 
.0015 
water, A. P 
10.7 
12.1 
8.8 
22.4 
71.9 
81.5 
116.0 
.030 
.0016 
Cranberries, A. P 
.4 
.5 
.6 
1.5 
9.9 
11.2 
13.2 
.025 
.0006 
Cream 
2.5 
2.8 
18.5 
47.2 
4.5 
5.1 
55.1 
.120 
.0002 
Cucumbers, E. P 
.8 
.9 
.2 
.5 
3.1 
3.5 
4.9 
.022 
.0002 
Currants A. P., fresh 
1.5 
1.7 
12.8 
14.5 
16.2 
.036 
.0005 
Zante, dried, A. P. ... 
2.4 
2.7 
1.7 
4.3 
74.2 
84.1 
91.1 
.115 
.0025 
Dandelion greens 
2.4 
2.7 
1.0 
2.6 
10.6 
12.0 
17.3 
.147 
.0027 
Dasheens 
3.0 
3.4 
.2 
.5 
29.8 
33.8 
37.7 
Dates, dried, A. P 
1.9 
2.2 
2.5 
6.4 
70.6 
80.1 
88.7 
.091 
.0030 
dried, E. P 
2.1 
2.4 
2.8 
7.1 
78.4 
88.9 
98.4 
.100 
.0036 
Doughnuts 
6.7 
7.6 
21.0 
53.6 
53.1 
60.2 
121.4 
Eels, E. P 
18.6 
21.1 
9.1 
23 2 
44.3 
.013 
.0003 
Eggs, uncooked, A. P 
11.9 
13.5 
9.3 
23.7 
37.2 
.094 
.0030 
uncooked, E. P 
13.4 
15.2 
10.5 
26.8 
42.0 
.094 
.0030 
boiled, E. P 
13.2 
15.0 
12.0 
30.6 
45.6 
.093 
.0030 
boiled whites, E. P. . . 
12.3 
13.9 
.2 
.5 
14.4 
.021 
.0001 
boiled yolks, E. P. ... 
15.7 
17.8 
33.3 
84.9 
103.2 
.192 
.Q086 
poached 
13.2 
15.0 
12.0 
30.6 
45.6 
.093 
.0030 
Eggplant, E. P 
1.2 
1.4 
.3 
.8 
5.1 
5.8 
8.0 
.015 
.0005 
Endive 
1.0 
1.1 
.1 
.3 
3.0 
3.4 
4.8 
.146 
Farina 
11.0 
12.5 
1.4 
3.6 
76.3 
86.5 
102.6 
.029 
.0008 
Fig, fresh, E. P 
1.5 
1.7 
18.8 
21.3 
23.0 
.074 
.0008 
dried, A. P 
4.3 
4.9 
.3 
.8 
74.2 
84.1 
89.8 
.227 
.0030 
stewed, A. P 
1.2 
1.4 
.3 
.8 
40.9 
46.4 
48.6 
.080 
.0009 
Filbert, E. P 
15.6 
17.7 
65.3 
166.5 
13.0 
14.7 
198.9 
.0040 
A. P 
7.5 
8.5 
31.3 
79.8 
6.2 
7.0 
95.3 
Flaxseed 
22.6 
25.6 
33.7 
85.9 
23.2 
26.3 
137.8 
.238 
Flounder, A. P 
5.4 
6.1 
.3 
.8 
6.9 
.008 
.0002 
E. P 
14.2 
16.1 
.6 
1.5 
17.6 
.021 
.0006 
Flour, gluten, pure 
81.2 
92.1 
.6 
1.5 
16.6 
18.8 
112.4 
.234 
.0340 
gluten, 40% 
42.5 
48.2 
1.0 
2.6 
42.5 
48.2 
99.0 
.094 
.0136 
buckwheat 
6.4 
7.3 
1.2 
3.1 
77.9 
88.3 
98.7 
.055 
.0012 
rye 
6.8 
7.7 
.9 
2.3 
78.7 
89.2 
99.2 
.025 
.0013 
wheat, entire 
13.8 
15.6 
1.9 
4.8 
71.9 
81.5 
101.9 
.031 
.0025 
wheat, straight, grade 
10.8 
12.2 
1.1 
2.8 
74.8 
84.8 
99.8 
.028 
.0015 
wheat, average. 
high and medium .... 
11.4 
12.9 
1.0 
2.3 
75.1 
85.2 
100.4 
.025 
.0015 
Fowls, E. P 
19.3 
21.9 
16.3 
41.6 
63.5 
.015 
.0029 
A. P 
13.7 
15.5 
12.3 
31.4 
46.9 
.011 
.0021 
Frankforts, sausage, A. P.. 
19.6 
22.2 
18.6 
47.4 
1.1 
1.2 
70.8 
.015 
.0029 
Frog's legs, E. P 
15.5 
17.6 
.2 
.5 
18.1 
.027 
Garlic 
6.8 
7.7 
.1 
.3 
27.9 
31.6 
39.6 
Gelatin 
91.4 
103.6 
.1 
.3 
103.9 
Goose, young, E. P 
16.3 
18.5 
36.2 
92.3 
110.8 
.012 
.0024 
Granola 
13.7 
15.6 
1.0 
2.6 
73.8 
83.8 
102.0 
.054 
.0060 
Grapes, E. P 
1.3 
1.5 
1.6 
4.1 
19.2 
21.8 
27.4 
.024 
.0013 
A. P 
1.0 
1.1 
1.2 
3.1 
14.4 
16.3 
20.5 
butter, A. P 
1.2 
1.4 
.1 
.3 
58.5 
66.3 
68.0 
ground, A. P 
2.8 
3.2 
.6 
1.5 
60.5 
68.6 
73.3 
juice 
20.9 
23.8 
23.8 
.015 
.0003 
Grapefruit 
.6 
.7 
.1 
.3 
12.2 
13.8 
14.8 
.029 
.0003 
Greens, beet, cooked 
2.2 
2.5 
3.4 
8.7 
3.2 
3.6 
14.8 
dandelion, A. P 
2.4 
2.7 
1.0 
2.6 
10.6 
12.0 
17.3 
.147 
.0027 
turnip salad, A. P. . . . 
4.2 
4.8 
.6 
1.5 
6.3 
7.1 
13.4 996 
THE NEW DIETETICS 
Protein 
Cal. 
Fat 
Cal. 
Carbo. 
Cal. 
Total 
Cal. 
Lime 
Iron 
Per 
Per 
Per 
Per 
Per 
Per 
Per 
Per 
Per 
cent 
oz. 
cent 
oz. 
cent 
oz. 
OZ. 
cent 
cent 
Haddock, E. P 
17.2 
19.5 
.3 
.8 
20.3 
.026 
.0007 
A. P 
8.4 
9.5 
.2 
.5 
10.0 
.013 
.0003 
Halibut, A. P 
15.3 
17.4 
4.4 
11.2 
28.6 
.023 
.0006 
steak, E. P 
18.6 
21.1 
5.2 
13.3 
34.4 
.013 
.0003 
Ham, fresh lean, E. P 
25.0 
28.4 
14.4 
36.7 
65.1 
.019 
.0038 
A. P 
24.8 
28.1 
14.2 
36.3 
64.3 
.019 
.0037 
fresh med., E. P 
15.3 
17.4 
28.9 
73.7 
91.1 
.016 
.0023 
A. P 
13.5 
15.3 
25.9 
66.0 
81.3 
.010 
.0020 
smoked, lean, E. P. . . 
19.8 
22.5 
20.8 
53.0 
75.5 
.015 
.0030 
A. P 
17.5 
19.8 
18.5 
47.2 
67.0 
.013 
.0026 
Hazelnut 
8.0 
9.1 
28.5 
72.7 
11.5 
13.0 
94.8 
.002 
.0041 
Herring-, E. P 
19.3 
22.1 
7.1 
18.1 
40.2 
.029 
.0008 
A. P 
11.2 
12.7 
3.9 
9.9 
22.6 
.017 
.0004 
smoked, E. P 
36.9 
41.8 
15.8 
40.3 
82.1 
.055 
.0015 
A. P 
20.5 
23.2 
8.8 
22.4 
45.6 
.031 
.0008 
Hickory nuts, E. P 
15.4 
17.5 
67.4 
171.9 
11.4 
12.9 
202.3 
A. P 
5.8 
6.6 
25.5 
65.0 
4.3 
4.9 
76.5 
Hominy 
8.3 
9.4 
.6 
1.5 
79.0 
89.6 
100.5 
.016 
.0009 
cooked 
2.2 
2.5 
.2 
.5 
17.8 
20.2 
23.2 
pearled 
7.8 
8.8 
3.3 
8.4 
76.1 
86.3 
103.5 
Honey, A. P 
.4 
.5 
81.2 
92.1 
92.6 
.006 
.0007 
Huckleberries, fresh, E. P.. 
.6 
.7 
.6 
1.5 
16.6 
18.8 
21.0 
.028 
.0009 
canned 
.6 
.7 
.6 
1.5 
12.8 
14.5 
16.7 
Julienne, canned, A. P 
2.7 
3.1 
.5 
.6 
3.7 
Kaffir corn, A. P 
6.6 
7.5 
3.8 
9.7 
70.6 
80.1 
97.3 
Kaoliang grain, A. P 
10.5 
11.9 
4.3 
11.0 
71.9 
81.5 
104.4 
Kohlrabi, E. P 
2.0 
2.3 
.1 
.3 
5.5 
6.2 
8.8 
.108 
.0006 
Koumiss 
2.8 
3.2 
2.1 
5.4 
5.4 
6.1 
14.7 
Lamb breast, E. P. 
19.1 
21.7 
23.6 
60.2 
81.9 
.015 
.0029 
A. P 
15.4 
17.5 
19.1 
48.7 
66.2 
.012 
.0023 
chops broiled, E. P. ... 
21.7 
24.6 
29.9 
76.2 
100.8 
.017 
.0033 
forequarter, E. P 
18.3 
20.8 
25.8 
65.8 
86.6 
.014 
.0027 
A. P 
14.9 
16.9 
21.0 
53.6 
70.5 
.011 
.0022 
hindquarter, E. P 
19.6 
22.2 
19.1 
48.7 
70.9 
.015 
.0029 
A. P 
16.5 
18.7 
16.1 
41.1 
59.8 
.013 
.0025 
leg roast 
19.7 
22.3 
12.7 
32.4 
54.7 
.016 
.0030 
side, E. P 
17.6 
20.0 
23.1 
58.9 
78.9 
.013 
.0026 
A. P 
14.1 
16.0 
18.7 
47.7 
63.7 
.011 
.0021 
loin, E. P 
18.7 
21.2 
28.3 
72.2 
93.4 
.014 
.0028 
Lard, refined 
100.0 
255.0 
255.0 
Leeks, E. P 
1.2 
1.4 
.5 
1.3 
5.8 
6.6 
9.3 
.081 
Lemons, E. P 
1.0 
1.1 
.7 
1.8 
8.5 
9.6 
12.5 
.050 
.0006 
A. P 
.7 
.8 
.6 
1.3 
5.9 
6.7 
8.8 
juice 
9.8 
11.1 
11.1 
.033 
Lentils, A. P 
25.7 
29.1 
1.0 
2.6 
59.2 
67.1 
98.8 
.150 
.0086 
Lettuce, E. P 
1.2 
1.4 
.3 
.8 
2.9 
3.3 
5.5 
.060 
.0007 
A. P 
1.0 
1.1 
.2 
.5 
2.5 
2.8 
4.4 
.050 
.0010 
Litchi nut, E. P 
2.9 
3.3 
2.1 
5.4 
77.6 
87.9 
91.7 
A. P 
1.7 
1.9 
.1 
.3 
45.2 
51.3 
53.5 
Linseed meal, A. P 
36.9 
41.8 
2.9 
7.4 
36.3 
41.2 
91.4 
.578 
Liver beef, E. P 
20.4 
23.1 
4.5 
11.5 
1.7 
1.9 
36.5 
.016 
.0031 
veal, E. P 
19.0 
21.5 
5.3 
13.5 
35.0 
.015 
.0029 
Lobster, fresh, E. P 
16.4 
18.6 
1.8 
4.6 
.4 
.5 
23.7 
whole, A. P 
6.9 
6.7 
.7 
1.8 
.2 
.2 
8.7 
canned, A. P 
18.1 
20.5 
1.1 
2.8 
.6 
.6 
23.9 
Loganberry juice, com 
.2 
.2 
30.9 
35.0 
35.2 
Macaroni 
13.4 
15.2 
.9 
2.3 
74.1 
84.0 
101.5 
.031 
.0012 
cooked 
3.0 
3.4 
1.5 
3.8 
15.8 
17.9 
25.1 
Macaroons 
6.5 
7.4 
15.2 
38.8 
65.2 
73.9 
120.1 
Mackerel, A. P 
10.2 
11.6 
4.2 
10.7 
22.3 
.015 
.0004 
E. P 
18.7 
21.2 
7.1 
18.1 
39.3 
.028 
.0007 
salt, E. P 
21.1 
23.9 
22.6 
57.6 
81.5 
.032 
.0008 
salt, A. P 
16.3 
18.5 
17.4 
44.4 
62.9 
.025 
.0007 
Malt 
18.0 
20.4 
3.7 
9.4 
60.6 
68.7 
98.5 
.080 
.0040 
Malted nuts 
23.7 
26.9 
27.6 
71.2 
43.9 
49.9 
148.0 
Mango, E. P 
.6 
.7 
10.0 
11.3 
12.0 
.030 
Maple syrup *. ... 
71.7 
81.8 
81.3 
.150 
.0030 
Marmalade (orange peel) . 
,6 
.7 
,i 
.8 
84.5 
95.8 
96.8 
Meat stew, homemade, A.P. 
4.6 
5.2 
4.3 
11.0 
5.5 
6.2 
22.4 
Milk 
3.3 
3.7 
4.0 
10.2 
5.0 
5.7 
19.6 
.168 
.0002 
condensed, sweetened 
8.8 
10.0 
8.3 
21.2 
54.1 
61.3 
92.5 
.420 
.0006 
cond., unsweetened . . . 
9.6 
10.9 
9.3 
23.7 
11.2 
12.7 
47.3 
.604 
.0007 
skimmed 
3.4 
3.9 
.3 
.8 
5.1 
5.8 
10.5 
.171 
.0002 COMPOSITION OF FOODSTUFFS 
997 
Protein 
Cal. 
Fat 
Cal. 
Carbo. 
Cal. 
Total 
Cal. 
Lime 
Iron 
Per 
Per 
Per 
Per 
Per 
Per 
Per 
Per 
Per 
cent 
oz. 
cent 
OZ. 
cent 
oz. 
OZ. 
cent 
cent 
skimmed, dried 
36.6 
41.5 
4.2 
10.7 
25.8 
29.3 
81.5 
1.700 
.0025 
woman’s 
1.5 
1.7 
3.5 
8.9 
7.0 
8.0 
18.6 
.044 
.0005 
ewe’s 
6.5 
7.4 
6.9 
17.6 
4.9 
5.6 
30.6 
.290 
mare's 
2.0 
2.3 
1.1 
3.8 
5.9 
6.7 
11.8 
.116 
sow’s 
5.9 
6.7 
6.7 
17.1 
5.4 
5.1 
29.9 
Millet 
8.3 
9.4 
2.8 
7.1 
44.3 
50.2 
66.7 
.020 
Mincemeat, com 
6.7 
7.6 
1.4 
3.6 
60.2 
68.3 
79.5 
Molasses 
2.4 
2.7 
69.3 
78.6 
81.3 
.295 
.0073 
Mock turtle, canned, E. P.. 
5.2 
5.9 
.9 
2.3 
2.8 
3.2 
14.5 
Mulberry 
.3 
.3 
14.4 
16.3 
16.6 
Mullet, whole, E. P 
19.5 
22.1 
4.6 
11.7 
33.8 
.029 
.0008 
Mulligatawny, canned, A.P. 
3.7 
4.2 
.1 
.3 
5.7 
6.5 
11.0 
Mushrooms, A. P 
3.5 
4.0 
.4 
1.0 
6.8 
7.7 
12.7 
.024 
Muskmelon, E. P 
.6 
.7 
9.3 
10.5 
11.2 
.024 
.0003 
A. P 
.3 
.3 
4.6 
5.2 
5.5 
Mussels, fresh, E. P 
8.7 
9.9 
l.i 
2.8 
4.1 
4.6 
17.3 
Mutton, forequarter, E. P.. . 
15.6 
17.7 
30.9 
78.8 
96.5 
.016 
.0023 
A. P 
12.3 
13.9 
24.5 
62.5 
76.4 
.009 
.0018 
hindquarter, E. P 
16.7 
18.9 
28.1 
71.7 
90.6 
.013 
.0025 
A. P 
13.8 
15.6 
23.2 
59.2 
74.8 
.011 
.0021 
leg, hind, lean, E. P.. . 
19.8 
22.3 
12.4 
31.6 
53.9 
.015 
.0030 
leg, A. P 
16.5 
18.7 
10.3 
26.3 
45.0 
.013 
.0025 
cooked, leg roast 
25.0 
28.3 
22.6 
57.6 
85.9 
.019 
.0038 
loin, E. P 
16.0 
18.1 
33.1 
84.4 
.8 
.9 
103.4 
.012 
.0024 
side, A. P 
13.0 
14.7 
24.0 
61.2 
75.9 
.010 
.0020 
E. P 
16.2 
18.4 
29.8 
76.0 
94.4 
.012 
.0024 
Nectarines, E. P 
.6 
.7 
15.9 
18.6 
18.7 
A. P 
.6 
.7 
14.8 
16.8 
17.5 
Nuttolene 
14.5 
16.5 
25.2 
64.3 
6.1 
6.9 
87.7 
.043 
.0039 
Oats 
12.4 
14.1 
4.4 
11.2 
59.6 
67.6 
92.9 
rolled 
16.7 
18.9 
7.3 
18.6 
66.2 
75.1 
112.6 
.097 
.0038 
Oatmeal 
16.1 
18.3 
7.2 
18.4 
67.5 
76.5 
113.2 
.097 
.0038 
boiled 
2.8 
3.2 
.5 
1.3 
11.5 
13.0 
17.5 
.022 
.0006 
gruel 
1.2 
1.4 
.4 
1.0 
6.3 
7.1 
9.5 
.010 
.0003 
water 
.7 
.8 
.1 
.3 
2.9 
3.3 
4.4 
.006 
.0002 
Okra, E. P 
1.6 
1.8 
.2 
.5 
7.4 
8.4 
10.7 
.099 
A. P 
1.4 
1.6 
.2 
.5 
6.5 
7.4 
9.5 
tomato, canned, A. P.. 
1.1 
1.2 
.3 
.8 
5.2 
5.9 
7.9 
canned, A. P 
.7 
.8 
.1 
.3. 
3.6 
4.1 
5.2 
Oleomargarine, A. P 
1.2 
1.4 
83.0 
211.7 
213.1 
Olives, green, E. P 
1.1 
1.2 
27.6 
70.4 
11.6 
13.2 
84.8 
.171 
.0029 
A. P 
.8 
.9 
20.2 
51.5 
8.5 
9.6 
62.0 
oil 
100.0 
255.0 
255.0 
ripe, A. P 
1.4 
1.6 
21.0 
53.6 
3.5 
4.0 
59.2 
E. P 
1.7 
1.9 
25.9 
66.0 
4.3 
4.9 
72.8 
Onions, A. P 
1.4 
1.6 
.3 
.8 
8.9 
10.1 
12.5 
E. P 
1.6 
1.8 
.3 
.8 
9.9 
11.2 
13.8 
.048 
.0006 
cooked, A. P 
1.2 
1.4 
1.8 
4.6 
4.9 
5.6 
11.6 
.045 
.0004 
green, E. P 
1.0 
1.1 
.1 
.3 
11.2 
12.6 
14.0 
.040 
.0003 
Oranges, E. P 
.8 
.9 
.2 
.5 
11.6 
13.2 
14.6 
.063 
.0002 
A. P 
.6 
.7 
.1 
.3 
8.5 
9.6 
10.6 
juice 
13.3 
15.1 
15.1 
.041 
.0002 
Oxtail soup, canned, A. P.. . 
3.8 
4.3 
.5 
1.3 
4.2 
4.8 
10.4 
Oysters, fresh, E. P 
6.2 
7.0 
1.2 
3.0 
3.7 
4.2 
14.2 
.073 
.0045 
canned, A. P 
8.8 
10.0 
2.4 
6.1 
3.9 
4.4 
20.5 
in shell, A. P 
1.2 
1.4 
.2 
.5 
.7 
.8 
2.7 
Pawpaw 
5.2 
5.9 
.9 
2.3 
6.8 
7.7 
15.9 
Paradise nuts, E. P 
22.2 
25.2 
62.6 
159.6 
10.2 
11.6 
196.4 
Parsnips, E. P 
1.6 
1.8 
.5 
1.3 
13.5 
15.3 
18.4 
.083 
.0006 
A. P 
1.3 
1.5 
.4 
1.0 
10.8 
12.2 
14.7 
Peas, dried, A. P 
24.6 
27.9 
1.0 
2.6 
62.0 
70.3 
100.8 
.118 
.0057 
green, E. P 
7.0 
7.9 
.5 
1.3 
16.9 
19.2 
20.5 
.039 
.0017 
green, cooked, E. P.. . 
6.7 
7.6 
3.4 
8.7 
14.6 
16.6 
32.9 
green, sugar, E. P. ... 
3.4 
3.9 
.4 
1.0 
13.7 
15.5 
20.4 
cowpeas, dry, A. P. ... 
21.4 
24.3 
1.4 
3.6 
60.8 
68.9 
96.8 
.140 
green, canned, A. P. . 
3.6 
4.1 
.2 
.5 
9.8 
11.1 
15.7 
Pea meal 
23.8 
27.0 
1.4 
3.6 
55.7 
63.2 
93.8 
.140 
.0056 
soup, canned, A. P. 
soup, cream of green 
3.6 
4.1 
.7 
1.8 
7.6 
8.6 
14.5 
canned, A. P 
2.6 
2.9 
2.6 
6.9 
5.7 
6.5 
16.3 
Peaches, E. P 
.7 
.8 
.1 
.3 
9.4 
10.7 
11.8 
.022 
.0003 
A. P 
.6 
.6 
.1 
.3 
7.7 
8.7 
9.6 998 
THE NEW DIETETICS 
Protein 
Fat 
Carbo. 
Total 
Lime 
Iron 
Cal. 
Cal. 
Cal. 
Cal. 
Per 
Per 
Per 
Per 
Per 
Per 
Per 
Per 
Per 
cent 
oz. 
cent 
OZ. 
cent 
OZ. 
OZ. 
cent 
cent 
canned, E. P 
.7 
.8 
.1 
.3 
10.8 
12.2 
13.3 
dried 
1.9 
2.2 
.3 
.8 
25.4 
28.9 
31.9 
.048 
.0012 
Peanuts, E. P 
25.8 
29.3 
38.6 
98.4 
24.4 
27.7 
155.4 
.100 
.0020 
A. P 
19.5 
22.1 
29.1 
74.2 
18.5 
21.0 
117.3 
butter 
29.0 
33.0 
45.9 
117.0 
16.7 
19.0 
169.0 
.100 
.0020 
cake (whole nuts) ... 
47.6 
54.0 
8.0 
20.4 
23.7 
26.9 
101.3 
Pears, E. P 
.6 
.7 
.5 
1.3 
14.1 
16.0 
18.0 
.021 
.0003 
A. P 
.5 
.6 
.4 
1.0 
12.7 
14.4 
16.0 
canned, E. P 
.3 
.3 
.3 
.8 
18.0 
20.4 
21.5 
dried, A. P 
2.8 
3.2 
2.2 
5.6 
72.9 
82.7 
91.5 
juice 
22.6 
25.6 
25.6 
.013 
Pecans, unpolished, E. P... 
9.6 
10.9 
70.5 
179.8 
15.3 
17.4 
208.1 
.105 
.0026 
A. P 
5.1 
5.8 
37.9 
96.6 
8.2 
9.3 
111.7 
Persimmons, E. P 
.8 
.9 
.7 
1.8 
31.5 
35.7 
38.4 
.031 
Pickerel, pike (whole) E. P. 
18.7 
21.2 
.5 
1.3 
22.5 
.028 
.0007 
Pickles, cucumber, A. P. . . 
.5 
.6 
.3 
.8 
2.7 
3.1 
4.5 
Pie, apple, A. P 
3.1 
3.5 
9.8 
25.0 
42.8 
48.5 
77.0 
custard, A. P 
4.2 
4.8 
6.3 
16.1 
26.1 
29.6 
50.5 
mince, A. P 
5.8 
6.6 
12.3 
31.5 
38.1 
43.2 
81.3 
.040 
Pineapple, E. P 
.4 
.5 
.3 
.8 
9.7 
11.0 
12.3 
.025 
.0005 
canned, E. P 
.4 
.5 
.7 
1.8 
36.4 
41.3 
43.6 
Pine nuts (Pignolias) E.P.. 
33.9 
38.4 
49.4 
126.0 
6.9 
7.8 
172.2 
(Pignon) E. P. 
14.6 
16.6 
61.9 
157.9 
17.3 
19.6 
194.1 
A. P 
8.7 
9.9 
36.8 
93.8 
10.2 
11.6 
115.3 
Pistachios, E. P 
22.3 
25.3 
54.0 
137.7 
16.3 
18.5 
181.5 
Plums, E. P 
1.0 
1.1 
20.1 
22.8 
23.9 
.028 
.0005 
A. P 
.9 
1.0 
19.1 
21.7 
22.7 
Pomegranates, E. P 
1.5 
1.7 
1.6 
4.1 
19.5 
22.1 
27.9 
.015 
.0004 
Pompano (whole) E. P. ... 
18.8 
21.3 
7.5 
19.1 
40.4 
.028 
.0008 
Pop corn 
10.7 
12.1 
5.0 
12.8 
78.7 
89.2 
114.1 
Pork chops, med. E. P 
16.6 
18.8 
30.1 
76.8 
95.6 
.013 
.0025 
A. P 
13.4 
15.2 
24.2 
61.7 
76.9 
.010 
.0020 
chuck ribs and 
shoulder, E. P 
17.3 
19.6 
31.1 
79.3 
98.9 
.013 
.0026 
A. P 
14.1 
16.0 
25.5 
65.0 
81.0 
.011 
.0021 
fat, salt, A. P 
1.9 
2.2 
86.2 
219.8 
222.0 
.002 
.0003 
loin chops, fat, E. P.. 
14.5 
16.4 
44.4 
113.2 
129.6 
.011 
.0022 
side, E. P 
9.1 
10.3 
55.3 
141.0 
151.3 
.007 
.0014 
A. P 
8.0 
9.1 
49.0 
125.0 
134.1 
.006 
.0012 
tenderloin, A. P 
18.9 
21.4 
13.0 
33.2 
54.6 
.014 
.0028 
salt, lean, ends, E. P.. 
8.4 
9.5 
67.1 
171.1 
180.6 
.007 
.0013 
sausage, bologna, E. F. 
18.7 
21.2 
1 7.6 
44.9 
66.1 
.014 
.0028 
steak, cooked, A. P.. . 
19.9 
22.6 
45.4 
115.8 
138.4 
.015 
.0030 
Potatoes, raw, E. P 
2.2 
2.5 
.1 
.3 
18.4 
20.9 
23.7 
.020 
.0013 
A. P 
1.8 
2.0 
.1 
.3 
14.7 
16.7 
19.0 
evaporated, A. P 
8.5 
9.6 
.4 
1.0 
80.9 
91.7 
102.3 
.064 
.0052 
cooked, chips, A. P. . . 
6.8 
7.7 
39.8 
101.5 
46.7 
53.0 
162.2 
cooked, boiled, A. P. . 
2.5 
2.8 
.1 
.3 
20.9 
23.7 
26.8 
sweet, raw, E. P 
1.8 
2.0 
.7 
1.8 
27.4 
31.1 
34.9 
.027 
.0005 
sweet, canned, A. P. . . 
1.9 
2.2 
.4 
1.0 
41.4 
46.9 
50.1 
sweet, cooked, A. P.. . 
3.0 
3.4 
2.1 
5.4 
42.1 
47.7 
56.5 
chips, A. P 
6.8 
7.7 
39.8 
101.5 
46.7 
53.0 
162.2 
flakes, dried 
7.1 
8.1 
.3 
.8 
73.6 
83.5 
92.4 
flour 
2.7 
3.1 
.8 
2.0 
81.3 
92.2 
97.3 
Protose 
22.5 
25.6 
9.6 
24.5 
8.9 
10.1 
60.2 
.058 
.0057 
Prunes, E. P 
.9 
1.0 
18.9 
21.4 
22.4 
A. P 
..7 
.8 
17.4 
19.7 
20.5 
dried, E. P 
2.1 
2.4 
73.3 
83.1 
85.5 
.076 
.0030 
dried, A. P 
1.8 
2.0 
62.2 
70.5 
72.5 
Pudding, Indian Meal, A. P. 
5.5 
6.2 
4.8 
12.2 
27.5 
31.2 
49.6 
rice custard, A. P. ... 
4.0 
4.5 
4.6 
11.7 
31.4 
35.6 
51.8 
Pumpkins, E. P 
1.0 
1.1 
.1 
.3 
6.2 
5.9 
7.3 
.032 
.0008 
canned, A. P 
.8 
.9 
.2 
.5 
6.7 
7.6 
9.0 
Quail, canned, A. P 
21.8 
24.7 
8.0 
20.4 
1.7 
1.9 
47.0 
.017 
.0033 
Quinoa flour 
19.0 
21.5 
5.0 
12.8 
60.0 
68.0 
102.3 
Radishes, E. P 
1.3 
1.5 
.1 
.3 
6.8 
6.6 
8.4 
.029 
.0006 
Raisins, A. P 
2.3 
2.6 
3.0 
7.7 
68.5 
77.7 
88.0 
Raisins, E. P 
2.6 
2.9 
3.3 
8.4 
76.1 
86.3 
97.6 
.090 
.0021 
Raspberries, black, E. P. .. 
1.7 
1.9 
1.0 
2.6 
12.6 
14.3 
18.8 
.069 
.0006 
red, E. P 
1.0 
1.1 
12.6 
14.3 
15.4 
.069 
.0006 
dried, A. P 
7.3 
8.3 
1.8 
4.6 
80.2 
90.9 
103.8 
juice, sweetened 
.5 
.6 
49.9 
56.6 
57.2 
.030 
Rhubarb, E. P 
.6 
.7 
.7 
1.8 
3.6 
4.1 
6.6 
.062 
.0010 COMPOSITION OF FOODSTUFFS 
999 
Protein 
Cal. 
Fat 
Cal. 
Carbo. 
Cal. 
Total 
Cal. 
Lime 
Iron 
Per 
Per 
Per 
Per 
Per 
Per 
Per 
Per 
Per 
cent 
oz. 
cent 
OZ. 
cent 
oz. 
OZ. 
cent 
cent 
Rice 
8.0 
9.1 
.3 
.8 
79.0 
89.6 
99.5 
.012 
.0009 
boiled 
2.8 
3.2 
.1 
.3 
24.4 
27.7 
31.2 
.004 
.0003 
flaked 
7.9 
9.0 
.4 
1.0 
81.9 
92.9 
102.9 
.012 
.0009 
flour 
8.6 
9.8 
6.1 
15.6 
68.0 
77.1 
102.5 
.013 
.0009 
polish 
11.9 
13.5 
9.1 
23.2 
62.3 
70.6 
107.3 
.012 
.0009 
Rutabagas, E. P 
1.3 
1.5 
.2 
.5 
8.5 
9.6 
11.6 
.104 
Rye 
11.8 
13.4 
1.8 
4.6 
73.2 
83.0 
101.0 
.077 
.0039 
bran 
12.2 
13.8 
2.8 
7.1 
56.6 
64.2 
85.1 
.250 
.0140 
flour 
6.8 
7.7 
.9 
2.3 
78.7 
89.2 
99.2 
.025 
.0013 
meal 
13.6 
15.4 
2.0 
5.1 
71.5 
81.1 
101.6 
.070 
.0040 
Salmon, dressed, A. P 
13.8 
15.6 
8.1 
20.7 
36.3 
.021 
.0006 
whole, A. P 
15.3 
17.4 
8.9 
22.7 
40.1 
.023 
.0006 
whole, E. P 
22.0 
24.9 
12.8 
32.6 
57.5 
.033 
.0009 
Sandwich, egg, A, P 
9.6 
10.9 
12.7 
32.4 
34.5 
39.1 
82.4 
chicken, A. P 
12.3 
13.9 
5.4 
13.8 
32.1 
36.4 
64.1 
Sardines, canned, E. P. . 
23.0 
26.1 
19.7 
50.2 
76.3 
.035 
.0009 
Sauerkraut, A. P 
1.7 
1.9 
.5 
1.3 
3.8 
4.3 
7.5 
Sausage, farmer, E. P 
29.0 
32.9 
42.0 
107.0 
139.9 
.022 
.0044 
A. P 
27.9 
31.6 
40.4 
103.0 
134.6 
.021 
.0042 
Seakale 
1.4 
1.6 
.4 
1.0 
3.8 
4.3 
6.9 
Shad, whole, E. P 
18.8 
21.3 
9.5 
24.2 
45.5 
.028 
.0008 
A. P 
9.4 
10.7 
4.8 
12.2 
22.9 
.014 
.0004 
roe 
20.9 
23.7 
3.8 
9.7 
2.6 
2.9 
36.3 
Shredded wheat, A. P 
10.5 
11.9 
1.4 
3.6 
77.9 
88.3 
103.8 
.057 
.0045 
Shrimp, canned, A. P 
25.4 
28.8 
1.0 
2.6 
.2 
.2 
31.6 
Soy beans, A. P 
39.5 
44.9 
18.5 
47.3 
6.5 
7.4 
99.6 
.320 
.0057 
Soy bean milk, A. P 
4.2 
4.8 
1.9 
4.8 
9.6 
meal (fat extracted) . . 
41.4 
46,9 
7.4 
18.9 
28.7 
32.5 
98.3 
Spaghetti, A. P 
12.1 
13.7 
.4 
1.0 
76.3 
86.5 
101.2 
Spinach, fresh, A. P 
2.1 
2 4 
.3 
.8 
3.2 
3.6 
6.8 
.094 
.0036 
cooked, A. P 
2.1 
2.4 
4.1 
10.5 
2.6 
2.9 
15.8 
.090 
.0032 
Squash, E. P 
1.4 
1.6 
.5 
1.3 
9.0 
10.2 
13.1 
.020 
.0008 
A. P 
.7 
.8 
.2 
.5 
4.5 
5.1 
6.4 
canned, A. P 
.9 
1.0 
.5 
1.3 
10.5 
11.9 
14.2 
Starch, arrowroot 
97.5 
110.6 
110.6 
cornstarch 
90.0 
102.1 
102.1 
manioca, 
.5 
.6 
.1 
.3 
88.8 
100.7 
101.6 
sago 
9.0 
10.2 
.4 
1.0 
78.1 
88.6 
99.8 
tapioca 
.4 
.5 
.1 
.3 
88.0 
99.8 
100.6 
.032 
.0016 
Strawberries, E. P 
1.0 
1.1 
.6 
1.5 
7.4 
8.4 
11.0 
.057 
.0008 
A. P 
.9 
1.0 
.6 
1.5 
7.4 
7.8 
10.4 
stewed 
.7 
.8 
24.0 
27.2 
28.0 
Succotash, canned, A. P.. . . 
3.6 
4.1 
1.0 
2.6 
18.6 
21.1 
27.8 
Sugar, brown, A. P 
95.0 
107.7 
107.7 
granulated, A. P 
100.0 
113.4 
113.4 
maple, A. P 
meltose (maltose- 
82.8 
93.9 
93.9 
dextrin) 
1.8 
2.0 
.1 
.3 
89.9 
101 9 
104.2 
.010 
.0015 
Sunflower seed, hulless, A. P. 
27.7 
31.4 
41.4 
105.6 
16.3 
18.5 
155.5 
seed cake, A. P 
34.8 
39.5 
18.3 
46.7 
21.8 
24.7 
110.9 
Swiss chard 
3.2 
3.6 
.6 
1.5 
5.0 
5.7 
10.8 
.210 
.0025 
Syrup, maple, A. P 
71.4 
81.0 
81.0 
Tallow, refined, A. P 
100.0 
255.0 
255.0 
Tapioca 
.4 
.5 
.1 
.3 
88.0 
99.8 
100.6 
.032 
.0016 
Taro, A. P 
1.8 
2.0 
.2 
.5 
23.2 
26.3 
28.8 
Terrapin, E. P 
21.2 
24.0 
3.5 
8.9 
32.9 
To fu 
10.2 
12.0 
3.7 
9.0 
21.6 
Tomatoes, fresh, A. P 
.9 
1.0 
.4 
1.0 
3.9 
4.4 
6.4 
.015 
.0004 
canned, A. P 
1.2 
1.4 
.2 
.5 
4.0 
4.5 
6.4 
.020 
.0004 
dried, A. P 
12.9 
14.6 
8.1 
20.7 
62.3 
70.6 
105.9 
.286 
.0057 
soup, canned, A. P. .. 
1.8 
2.0 
1.1 
2.8 
5.6 
6.4 
11.2 
Trout, brook, whole, E. P., . 
19.2 
21.8 
2.1 
5.4 
27.2 
.029 
.0008 
salmon, E. P 
17.8 
20.2 
10.3 
26.3 
46.5 
.027 
.0007 
Turkey, E. P 
21.1 
23.9 
22.9 
58.4 
82.3 
.016 
.0032 
A. P 
16.1 
18.3 
18.4 
46.9 
65.2 
.012 
.0024 
sandwich, canned .... 
20.7 
23.5 
29.2 
74.5 
98.0 
.016 
.0031 
roast, stuffed, E. P. . . 
17.1 
19.4 
10.8 
27.5 
5.5 
6.2 
53.1 
.013 
.0026 
Turnips, E. P 
1.3 
1.5 
.2 
.5 
8.1 
9.2 
11.2 
.089 
.0005 
A. P 
.9 
1.0 
.1 
.3 
5.7 
6.5 
7.8 
Turtle, green, canned, A. P. 
6.1 
6.9 
1.9 
4.8 
3.9 
4.4 
27.3 
canned, E. P 
19.8 
22.5 
.5 
1.3 
23.8 
Vegetable soup, canned . . . 
2.9 
3.3 
.5 
.6 
3.9 
.035 
Veal, breast, E. P 
20.3 
23.0 
11.0 
28.1 
51.1 
.015 
.0030 1000 
THE NEW DIETETICS 
Protein 
Fat 
Carbo. 
Total 
I>iine 
Iron 
Cal. 
Cal. 
Cal. 
Cal. 
Per 
Per 
Per 
Per 
Per 
Per 
Per 
Per 
Per 
cent 
©z. 
cent 
oz. 
cent 
oz. 
OZ. 
cent 
cent 
A. P 
15.3 
17.4 
8.6 
21.9 
39.3 
.012 
.0023 
chuck, lean, E. P 
20.6 
23.4 
1.9 
4.8 
28.2 
.016 
.0031 
med. fat, E. P 
19.7 
22.3 
6.5 
10.6 
38.9 
.015 
.0030 
cutlets, E. P 
20.3 
23 0 
7.7 
19.6 
42.6 
.015 
.0030 
A. P 
20.1 
22.8 
7.5 
19.1 
41.9 
.015 
.0030 
forequarter, E. P 
20.0 
22.7 
8.0 
20.4 
43.1 
.015 
.0030 
A. P 
15.1 
17.1 
6.0 
15.3 
32.4 
.012 
.0023 
hindquarter, E. P 
20.7 
23.5 
8.3 
21.2 
44.7 
.016 
.0031 
A. P 
16.2 
18.4 
6.6 
10.8 
35.2 
.016 
.0023 
side, E. P 
20.2 
22.9 
8.1 
20.7 
43.6 
.015 
.0030 
side, A. P 
15.6 
17.7 
6.3 
16.1 
33.8 
.016 
.0023 
loin m-;d. fat, E. P.. . . 
19.9 
22.6 
10.8 
27.5 
50.1 
.015 
.0030 
Vermicelli 
10.9 
12.4 
2.0 
5.1 
72.0 
81.6 
99.1 
Walnuts, California, E. P.. . 
18.4 
20.9 
64.4 
104.2 
13.0 
14.7 
199.3 
.125 
.0021 
A, P 
4.9 
5.6 
17.6 
44.1 
3.5 
4.0 
53.7 
Calif. Black, E. P 
27.6 
31.3 
56.3 
143.6 
11.7 
13.3 
188.2 
A. P 
7.2 
8.2 
14.6 
37.2 
3.0 
3.4 
48.8 
Calif, soft shell, E. P. 
16.6 
18.8 
63.4 
161.7 
16.1 
18.3 
198.8 
A. P 
6.9 
7.8 
26.6 
67.8 
6.8 
7.7 
83.3 
Water chestnut 
1.5 
1.7 
.2 
.4 
15.6 
17.7 
19.8 
.120 
AVatermelon, E. P 
.4 
.5 
.2 
.5 
6.7 
7.6 
8.6 
.015 
A. P 
.2 
.2 
.1 
.3 
2.7 
3.1 
3.6 
Wheat bran 
12.5 
14.2 
3.0 
7.7 
41.6 
47.2 
69.1 
.168 
.0078 
bran, sterilized 
20.0 
22.9 
4.5 
11.6 
46.1 
52.3 
86.8 
.168 
.0078 
flaked 
13.4 
15.2 
1.4 
3.6 
74.3 
84.3 
103.1 
germs 
10.5 
11.9 
2.0 
5.1 
76.0 
86.2 
103.2 
.099 
shredded 
10.5 
11.9 
1.4 
3.6 
77.9 
88.3 
103.8 
.061 
.0053 
winter 
11.7 
13.3 
2.0 
5.1 
71.6 
81.2 
99.6 
.061 
.0053 
spring 
12.5 
14.2 
2.2 
5.6 
70.5 
79 9 
99.7 
durum 
14.1 
16.0 
2.5 
6.4 
68.6 
77.8 
100.2 
polish 
20.3 
23.0 
1.7 
4.3 
64.2 
72.8 
100.1 
middlings, standard 
short 
17.4 
19.7 
4.9 
12.5 
56.8 
64.4 
96 6 
flour, California 
7.9 
9.0 
1.4 
3.6 
76.4 
86.0 
99.2 
.025 
.0015 
gluten 
14.2 
16.1 
1.8 
4.6 
71.1 
80.6 
101.3 
.066 
.0057 
graham 
13.3 
15.1 
2.2 
5.6 
71.4 
81.0 
101.7 
.061 
.0053 
baker’s grade 
13.3 
15.1 
1.5 
3.8 
72.7 
82.4 
101.3 
.040 
.0025 
straight grade, spring. 
10.8 
12.4 
1.1 
2.8 
74.8 
85.7 
100.9 
.018 
.0011 
winter 
12.3 
13.9 
1.1 
2.8 
73.0 
82.8 
99.5 
.020 
.0012 
low grade 
14.0 
15.9 
1.9 
4.8 
71.2 
80.7 
101.4 
.040 
.0012 
cracked and crushed.. 
11.1 
12.6 
1.7 
4.3 
75.5 
85.6 
102.5 
.061 
.0052 
Whey 
.8 
.9 
.3 
.8 
4.8 
5.4 
7.1 
.062 
Whitefish, whole, E. P 
22.9 
26.0 
6.5 
16.6 
42.6 
.034 
.0009 
A. P 
10.6 
12.0 
3.0 
7.7 
19.7 
.016 
.0004 
Whortleberries, A. P 
.7 
.8 
3.0 
7.7 
13.5 
15.3 
23.8 
.043 
Wienerwurst, A. P 
28.0 
31.8 
22.1 
56.4 
1.6 
1.8 
90.0 
.021 
.0042 
Yautia 
2.2 
2.5 
.2 
.5 
26.1 
29.6 
32 6 
ZO 
13.1 
14.9 
1.5 
3.8 
70 8 
80.4 
99.1 
.090 
.0021 Ration 
Carbohydrate 
Protein 
c3 
Ph 
Calories 
80% Gluten 
50% Gluten 
40% Gluten j 
Gluten Bread 
Protose 
a 
hfi 
w 
Cottage Cheese J 
Cream Cheese J 
Butter 
Olive Oil 
Cream 20% 
5% Nuts 
15% Nuts 
20% Nuts 
3% Vegetables 
5% Vegetables J 
10% Vegetables j 
J 
1 
» 
> 
6? 
tO 
20% Vegetables | 
5% Fruits 
10% Fruits 
15% Fruits 
20% Fruits | 
Acidophlus 1 
Buttermilk 
70% Cereals 
75% Cereals 
Bread 
Diabetic Bran j 
j3 
2 
m 
10-10 
3 
10 
ii 
161 1 
2| 
11 
7| 
115 
- 1 
20 
300 
10 20 
1 11 
1 io 
| 28 
| 336 
21 
I 
1 
1 11 
1 
I 
271 
i 
2151 1001 
1 
l 
20 
300 
10 30 
1 19 
1 io 
| 45 
| 521 
1 
1 
151 
1 11 
1 
1 
451 
i 
1 
1001 240| 
1 
1 
1 
1 
! 
20 
300 
10-40 
| 28 | 10 
| 62 
| 710 
1 
3| 
1 
1 11 
1 
1 
671 
100| 220| 
1001 
1 
20| 300 
10 50 
| 36 
1 io 
j 79 
| 895 
1 
151 
1 11 
87] 
100| 140| 100] 
mi 
1 
30| 300 
10^0 
| 44 
1 io 
| 95 
| 1071 | 
1 
1 
1 
1 
1 
1 
871 
i 
1 
3 
200) 100| 
1 
1 90! 
1 100 
30 
301 300 
1C 70 
| 52 
1 io 
1 HI 
| 1247 
1 
1 
1 
1 
1 
106| 
3 
200| 100| 701 
1 1001 
! 
I 100 
1 
30| 30| 300 
10-80 
1 61 
1 io 
| 128 
| 1436 
1 
1 
1 
1 
1 
1 
! 
1261 
i 
1 
3 
2001 100| 1001 
1 160! 
| 100 
30 
301 300 
10-90 
| 69 
1 io 
| 145 
| 1621 
1 
1 
1 
128| 
15 
301 
2001 1001 150| 
190) 
100 
30 
30 
300 
15-10 
1 o 
1 15 
1 8 
| 132 
1 
1 
1 
1 
1 21 
1 
1 
i 
1 
1 
1 
201 300 
15-20 
1 8 
1 15 
| 25 
| 317 
1 3; 
1 
1 
1 11 
101 
221 
1001 1001 
20 
300 
15-30 
1 16 
1 15 
1 42 
j 502 
1 11 
1 
15 
1 
501 
1 
421 
601 1501 
1 
20| 300 
15-40 
| 25 I 15 
| 69 
j 691 
1 
1 
3| 
1 
501 
811 
1 1001 230] 
1 
1001 
1 
1 
20| 300 
15-50 
| 33 
1 15 
| 76 
| 876 
1 2| 
1 
151 
1 11 
1 
1 
711 
501 
1 
| 200| 1001 1001 
110| 
1 
1 
: 
1 
20 
300 
15-60 
1 41 
i 15 
| 92 | 1052 
1 2| 
3| 
1 
1 H 
1 
1 
791 
100| 
i 
1 200| 1901 
1 
1 165| 
1 
1 
20 
300 
15-70 
| 49 
1 15 
| 108 
| 1228 
1 2| 
1 
151 
1 11 
1 
1 
971 
1001 
1 
| 2001 200j 
1 
1 1001 
100| 
! 
20 
300 
15 80 
| 58 
I 15 | 125 
| 1417 
1 
1 
31 
1 
1 
1 
1 
1091 
60) 
1 
301 
| 180| 1001 60| 
1 1001 
1 
100 
! 
30 
30 
300 
15-90 
| 66 
1 15 
| 142 
| 1602 
1 
1 
31 
1 
1 
1 
1 
1291 
601 
180[ 100| 60| 
1 1801 
100 
30 
30| 300 
15-100 
1 75 
1 15 
| 159 
| 1791 
| 
1 
31 
| 
| 
1 
i 
1 
1321 
15 
60| 
; 
30) 
| 180| 100[ 60 
1 120| 
1001 
100 
30 
30 
300 
20 20 
1 6 
| 20 
| 23 
| 311 
1 
1 
1 
1 
2 
1 
10 [ 
1 
201 
1 150! 
i 
I 
1 
20 
300 
2(130 
1 14 
| 20 | 40 
| 496 
1 3| 
1 
1 
1 2| 
1 
1 
331 
i 
| 132| 200| 
1 
1 
20| 300 
20 40 
| 23 
| 20 
1 57 
| 685 
1 2| 
3| 
! 
1 
50) 
i 
671 
i 
| 150| 2301 
1 
151 
t 
20 
300> 
20-50 
1 31 
| 20 
| 73 
j 861 
1 2| 
1 
15| 
1 2| 
1 
i 
711 
i 
! 2151 200| 
t 
100| 
20 
300 
20-60 
| 39 
| 20 
| 90 
| 1046 
! 2| 
31 
1 
• 
1 2| 
1 
1 
921 
1301 1001 1001 
150| 
1 
201 
300; 
20-70 
1 47 
| 20 
| 106 
| 1222 
1 
1 
151 
1 H 
301 
1 
851 
150| 
200j 1001 100! 
140| 
201 
300- 
20-80 
| 56 
1 20 
1 123 
1 1411 
1 
1 
50 j 
981 
100 
30 
1 200 
100 
1001 
80 
1 
1 
301 
301 
300 
20 BO 
64 
20 
140 
1596 
1 
501 
1181 
100/ 
I 
30 
1 
2001 
100 
100 
1 
160, 
1 
1 
I 
301 
301 
300- 
*0-190 
73 
20 
156 
1776 ( 
50j 
1201 
15 
100) 
1 
8) 
1 
200| 
1001 
100 
1 
iooj 
ioo! 
I 
1 
301 
301 
300- 
20-110 
81 
20 
174 
1970 | 
45 
1231 
30 
1001 
| 
30 
1 2001 1001 100| 
1 
1001 1001 
i 
| 
451 
30 j 
300 
.25 23 
4 
25 
20 
296 
31 
2| 
25| 
10 
1 
1 
1 
1101 
1 
1 
I 
1 
1 
201 
300 
25-39 
1 12 
! 25 
| 37 
| 481 
2| 3 
2| 
15! 
25 
115 
100 
1 
1 
201 
300 
26-40 
1 21 
| 25 | 54 
| 670 
31 
15) 
2 
38 
50 j 
1 
130 
2201; 
1 
1 
20j 300 
25-50 
| 29 
| 25 
1 71 
! 855 
3| 
3! 
601 
711 
60| 
1 
130| 
180-1 
60; 
I 
1 
1 
1 
1 
20] 
300 
25-60 
37 
25 | 87 
1031 
4| 
151 
30 
921 
1 
I 
200| 
100| 
100| 
1 
I15( 
1 
I 
1 
1 
20) 
300 
25-70 
j 45 
1 25 
| 103 
| 1207 
4| 
3| 
151 
U 
100 j 
601 
1 
180| 
100| 
1001 
1 
110/ 
1 
50 
I 
1 
1 
20] 
300 
25 SO 
| 53 
1 25 | 120 
| 1392 
41 
3| 
151 
i! 
105 
15 
601 
1 
180| 
160| 
100 
160 
50 
1 
1 
201 
300 
25-M 
61 
25 
| 137 
| 1577 
4! 
3| 
151 
i| 
1241 
15 
601 
1 
180| 
160| 
100 
901 
100| 
50 
1 
1 
1 
201 
300 
25-150 
70 
25 
154 
| 1766 
4| 
151 
109 
15 
601 
1 
50 
100| 2001 
100 
1: 2701 
1 
150 
1 
1 
20| 300 
25-110 
78 
25 
! 171 
| 1951 
1 
3| 
50 
1461 
1 
I 
60 
801 
100 
100 
100 
1001 
100 
30 
301 
300 
25-120 
86 
25 
187 
2127 1 
i| 
140 
30 
60 
100| 
100| 100 
100 
200 
30 
30 
300 
30-20 
1 
30 
18 I 286 
4| 
3! 
1 
1 
401 
20 
300 
30-30 
9 
30 
| 35 | 471 
4! 
31 
201 
1 
1 
300| 
1 
1 
20! 
300 
30-40 
18 
30 
52 
660 
2| 
151 
31 
171 
100 
1151 
1201 
20 
300 
30-60 
26 
30 
69 
845 
3! 
3 
151 
60 
1 
1 
1301 
1001 
110 
100 
20 
300 
38-60 
34 
30 
| 85 
1021 
21 
3| 
151 
74| 
125| 200 
1001 
1001 
20 
300 
30-70 
42 
| 30 
| 101 
| 1197 | 4| 
151 
21 
791 
30 
100 
200 
1001 
100) 
20 
300 
30 80 
51 
30 
| 118 
| 1386 
2| 
31 
3| 
931 
30 
180 
100 
801 
225| 
20 
300 
30-80 
59 
30 I 135 
| 1571 
2| 
15| 
2! 
301 
102 j 
15 
30 
200 
100 
1001 
2751 
20 
300 
30-100 
67 
| 30 
1 152 
1 1756 
31 
11 
15| 
60| 
1281 
15 
30 
200 
100 
1001 
160| 
ioo! 
20| 300 
30-110 
75 
30 
1 168 
| 1932 
2 
11 
451 
136| 
60 
60 
250 
1001 
60 
801 
50 
30| 300 
30-120 
84 
30 1 185 
j 2121 
1 
60] 
138| 
15 
60 
60 
200 
100 
170| 
50 
30 
300 
30-130 
92 
30 
202 
2306 
2 
451 
140 
30 
60 
60 
150 
loot 
1001 
200! 
_ 
50 
30| 300 
35-30 
7 
35 
| 33 
1 465 
61 
t 
3| 
181 
175 
45| 
20 
300 
35-40 
15 
35 
| 49 
I 641 
6 
SI 
361 
250 
120| 
451 
20 
300 
35-50 
23 1 35 
| 66 
| 826 
61 
151 
11 
311 
50 
100 
120| 60| 
351 
20 
300 
35-60 
31 
35 
83 
1011 
4 
31 
151 
2| 
481 
30 
80 
100 
100| 
401 
20 
300 
35-70 
39 
35 
99 
1187 
3i 
31 
15| 
11 
611 
1 
60 
80 
200 
100-1 
50! 
201 
300 
35-80 
48 
35 
116 
1372 
81 
3| 
151 
11 
81! 
1 
60 
80| 200 
401 
190| 
1 
201 
300 
35 90 
56 
35 
133 
1557 
3| 
3 
15| 
30 
2| 
125 
601 
1 
80| 200 
100 
190| 
20 
300 
35 100 1 64 
35 
149 
1733 
11 5 
105| 
100| 
60 
100 
100 
• 
100 
401 
200 
151 
30 
300 
35-110 
72 
35 1 166 
1922 
31 
3| 
151 
30 
1 
130 
601 
i 
50 
1 
801 
200! 
110 
120| 
1001 
I 
1 
1 
301 
300 
35-120 
81 
35 
183 
2111 
3| 
31 
30 
11 
1501 
60 
50 
80| 200 
1001 
110| 
100 
30 
30 
300 
35-130 
| 89 
| 35 
| 199 
| 2287 
31 
1 
30 
1 
1 
1061 
60 
100 
100 
200 
1001 
260| 
90 
30 
30 
300 
35-140 
| 99 
| 35 
| 215 
| 2471 
1 
1 
1 
301 
1551 
15 
100 
60 
100 
100| 
150 
601 
150 
60 
30 
300 
35-150 
1 107 
1 35 
I 231 
| 2647 
1 
2 
| 
1| 
1 
1581 
30 
1001 
60 
751 
1001 
150 
80| 
_ 
601 
20| 300 
40-30 
1 4 1 40 
1 30 
446 
7i 
41 
8 
1 
1 
1 
80) 
1 
1 
1 
1 
20 
300 
40-40 
1 12 
| 40 
1 47 
l 631 
5| 
1 
31 
301 
34 
2001 
60 
40 
1 
1 
1 
20 
300 
40-50 
1 21 
1 40 
1 63 
I 811 
1 5| 
I 
1 
31 
301 
1 
531 
225 
1601 
1001 
20 
300 
40-60 
1 28 1 40 1 81 | 1001 
\ 51 
1 
1 
1 31 
301 
1 
741 
1001 200( 601 
i 
801 
20 
300 
40-70 
\ 36 l 40 V 97 1 1177 
1 
41 
\ 
31 
1 
1 
31 
301 
931 
i 
i 
1 175] 1201 301 
1 
1 
1 1451 
1 
1 
1 
1 
| 291 399 
40-80 
1 45 \ 40 \ 113 \ 1357 \ 
41 
\ 
3\ 
\ 
1 
31 
301 
94 \ 
15\ 
\ 
l 
\ 1001 160\ 601 
\ 205\ 
1 
\ 
1 201 300 
40-00 \ 53 \ 40 \ 430 \ 4542 \ 
\ 
\ 
61 
Vo\ 
\ 
6Q\ 85\ 
\ 
w\ 
\ 150\ 220\ 
\ 120\ 
\ 
\ 
\ 20] 300 
40 100 \ 64 \ 40 \ 446 \ 4748 \ 
\ 
\ 
3\ 
30 \ 
\ 
\ 
\ 
60\ 103 \ 
\ 
\ 
\ 60\ 
\ 150\ 235\ 
\ 
\ 
\ 
\ 195\ 
1 
\ 
\ 
\ 20\ 300 
40110 1 69 1 40 1 163 1 1903 / 
/ 
1 
61 
15/ 
/ 
/ 
1 
601 106/ 
15/ 
/ 
/ 
60/ 
/ 175/ 150/ 
/ 
/ 
1 
1 150/ 100/ 
1 
1 
1 
1 
40-120 1 78 1 40 1 180 / 2092 j 
/ 
1 
31 
301 
60/ 
/ 
30/ 
1 154/ 
1 
/ 
/ 60/ 
/ 100/ 190/ 100/ 
1 
1 
1 110/ 100/ 
1 
1 
/ 20/ 300 
40-130 1 86 1 40 1 196 1 2268 1 
1 
1 
61 151 
601 
301 
156/ 
15/ 
60/ 
1 150/ 150/ 50/ 
1 
1 ioo/ 
/ 
100/ 
1 
1 
1 20/ 300 
40-140 1 96 
1 40 I 213 
/ 2461 I 
1 
1 51 
30/ 
U 
/ 
1351 
301 1001 
/ 
60/ 
1 100/ 100/ 
1 
10 
/ 
70/ 
90/ 
1 
30/ 
1 
1 20/ 300 
40-150 / 104 1 40 I 229 f 2637 
1 
1 
1 51 
151 
i! 
1 
1551 
30/ 1001 
i 
601 
1 1001 tool 
1 
10 
13 0/ 
1 
601 
201 300 
40 160 
1 112 
1 40 
1 246 1 2822 
1 
1 
1 
1 
6 01 n 
1 
1 
14 61 
75 
100| 
30| 1001 100 
1501 
130/ 
100 / 200 
69 
30| 300 
40-170 
| 120 
| 40 
| 263 
| 3007 
1 
51 
| 
2I 
L 
| 
136| 
75 
100| 
60 
100 
100 
601 
10( 
190| 
60| 
30 
399 
45-30 
1 
1 45 
| 28 
| 436 
31 
1 
51 
151 
1 
301 
. 
20! 300 
45-40 
1 10 ! 45 
| 44 
| 616 
31 
1 
51 
301 
1 
161 
180| 
60 
29 
399 
45-50 
18 
45 
1 51 
| 801 
1 
1 3| 
15! 
1 
1 
901 
201 
301 
180| 
29 
300 
45-60 
| 26 
| 45 
1 78 
1 996 
1 5| 
301 
1 
1 
901 
631 
200 
80 
ZU| dUU 
45-70 
I 34 
| 45 
1 94 1 1162 
1 6) 
1 
301 
601 
1 
1 
501 
851 
200| 160 
1 
1 
29 
dUU 
45-80 
I 42 
1 45 
1 111 
| 1347 
i 
1 5) 41 
30| 
1 
601 
1 
901 
i 
501 
| 170| 100 
1 
601 
1 
30 
300 
45-00 
I 60 I 45 
I 127 
1 1523 
1 6| 4! 
301 
2| 
1 
1 
631 
100| 
i 
60 
170| 160 
1 
301 
1 
30 
300 
45.100 i 58 
| 45 
! 144 I 1708 | 61 
1 5| 
301 
11 
1 
1 
mi 
i 
60 
160| 200 
251 
150! 
1 
30 
300 
45-110 
I 66 
1 45 
1 160 
| 1884 
61 
1 5) 
301 
H 
1 
1 
130| 
60 
160 
100| 100| 
200| 
30 
300 
45-120 
I 75 
1 45 1 177 
1 2073 1 6| 
1 5| 
301 
i! 
! 
1 
1321 
15 
i 
i 
60 
1601 100 
1001 
138| 
1001 
30 
300 
45-130 
t 84 
| 45 
| 193 
| 2253 
6| 
1 5| 
301 
i| 
1 
1 
1331 
30 
601 
160| 100 
ioo! 
225| 
1001 
30 
300 
45-140 
| 93 
1 45 
1 210 
| 2442 
! 6| 
1 6| 
301 
i| 
1 
1 
1351 
451 
i 
i 
601 
! 160| 100 
100| 
701 
200! 
30 
300 
45-150 
I 101 
1 45 1 226 
| 2618 
1 61 
1 5| 
301 
i| 
1 
1 
136| 
601 
i 
i 
601 
| 160| 100| 100| 
145| 
1 
200| 
30| 399 
45 160 
1 110 I 45 
! 243 
2807 
21 51 
2| 
130 
60 
ioo| 
1 
60 
1 1001 
100 
140 
1 
180| 
1 
100 
70 
39 
dUU 
50-40 
I 7 
| 50 
I 42 
1 606 
51 
1 
1 4| 
501 
211 
100 
40 
20| 300 
50-50 
| 15 
| 50 
| 59 | 791 
5 
1 
1 4| 
50| 
41! 
200 
100 
201 
zu 
dUU 
50-60 
1 23 
| 50 
1 76 1 976 
51 
1 
1 4 
501 
601 
200 
100 
201 
80 
1 
20 
300 
50-70 
I 31 
| 50 
| 92 
1152 
5| 
1 
4| 
501 
80 
2001 
100 
20 
160| 
1 
1 
1 
1 
20 
300 
50-80 
1 40 
1 50 
1 108 
| 1322 
21 
31 
301 
! 2) 
601 
611 
60 
175 
100 
35 
20 
300 
50-80 
1 48 1 50 1 124 
| 1508 
21 
3| 
30] 
1 2| 
601 
801 
60 
100 
185 
301 
651 
29 
300 
50-100 
| 56 
| 50 
| 141 
| 1693 
2| 
1 3| 
301 
1 2| 
601 
100! 
60 
75 
200 
351 
140 
dU| dUU 
50-110 
1 64 
| 50 
| 158 
| 1878 
1 2| 
1 3| 
301 
1 2| 
601 
1 
1021 
15 
60 
1001 ioo 
100| 
200| 
dU 
dUU 
50-120 
| 73 
| 50 
| 175 
| 2067 
2| 
1 3| 
301 
1 2| 
601 
1041 
30 
60 
100 
200 
1001 
901 
100 
39 
300 
50-130 
1 81 
| 50 
1 192 
1 2252 
2| 
1 3| 
301 
1 21 
601 
124 
30 
60 
1001 100 
2001 
120| 
1001 
30 
300 
sn-140 
I 90 
| 50 
I 208 1 2432 
21 
1 3| 
301 
1 2| 
601 
1 
125| 
45 
60 
100| 100 
2001 
1601 
1001 
30 
300 
50-150 | 98 
| 50 
| 224 
| 2608 
2| 
1 31 
30| 
1 21 
601 
1261 
60 
60 
100 
100 
200 
80 
2001 
301 
390 
50-160 i 107 
| 50 
| 241 
| 2797 
1 7\ 
1 
601 
1 
1421 
45 
150 
60 
100 
100 
100 
110 
200 
60 
30 
300 
50-170 
I 115 
| 50 
I 258 
| 2982 
I 
1 7\ _ 
1 
| 
601 
1 
| 
| 
1441 
60 
150) 
60 
100 
100 
_ 
100 
190| 
_ 
200 
1)0 
30 
300 
55-40 
4 
1 55 
1 39 
| 587 
4| 
1 
1 
1 
1 2| 
1 
100| 
! 
60! 
1 
20 
300 
55-50 
1 12 
1 55 i 56 
| 772 
! 41 
1 
1 
1 
1 21 
1 
1001 
181 
200 
65 
20 
300 
55-69 
1 21 
| 55 
| 73 
| 961 
I 
1 3| 
1 
151 
1 21 
1 
100| 
40| 
1 
200| 100 
1 
1 
1 
2U j dUU 
55-70 
| 29 
| 55 
| 90 
| 1146 
1 
1 2| 
1 
151 
1 21 
1 
1001 
601 
200| 100 
901 
1 
20| 300 
55-80 
| 37 
| 55 
| 106 
| 1322 
1 
1 2| 
1 
151 
1 2| 
1 
1001 
801 
1 
200| 100 
901 
801 
1 
30| 300 
55-90 
| 45 
| 55 
| 123 
| 1507 
1 
1 
1 5| 
15 
1 21 
601 
1 
701 
60 [ 
601 
100j 20 
1 
100| 
1 
1 
1 
1 
1 
30| 300 
55-100 
| 53 
1 55 
| 139 
| 1683 
1 
1 
1 5| 
151 
1 2| 
601 
891 
601 
601 
1001 80| 
1 
iooj 
80 
1 
1 
1 
1 
30| 300 
55-110 
| 62 
| 55 
| 156 
| 1872 
1 
1 
1 5) 
151 
1 2| 
601 
1 
1091 
601 
60 j 
100| 80 
1 
1001 
130] 
1 
30| 300 
55-120 
1 70 
| 55 
| 172 
| 2048 
1 
1 5| 
151 
1 2| 
601 
1 
129| 
601 
601 
100| 100 
401 
100 
160| 
30| 300 
55-130 
| 79 
| 55 
| 189 
| 2237 
1 
1 5| 
151 
1 2| 
601 
1 
1311 
15 
60 
601 
100| 100 
401 
100 
100 
2001 
1 
30| 300 
55-140 
1 88 
| 55 
1 205 
| 2417 
1 
1 61 
15| 
I 2| 
601 
1 
140 J 
30 
601 
60 
100 
70 
100| 
100 
401 
1001 
30| 300 
55-150 
| 96 
| 55 
I 221 
1 2593 
1 
1" of 
151 
1 21 
601 
1 
141| 
45 
601 
60 
100 
70 
100! 100 
1201 
1001 
30| 300 
55-160 
| 104 
| 55 
| 238 
1 2778 I 
1 3 
61 
1 
1 
1 
601 
1 
1381 
30 
150j 
90 
1001 70 
60] 
100 
1001 
| 200 
30 
30| 300 
55-170 
| 112 
| 55 
| 255 
j 2963 
1 3 
61 
1 
1 
1 
601 
1 
1401 
45 
150) 
90 
100| 70 
601 
100 
1801 
| 200 
dU| dU| dUU 
55 180 
; 121 
| 55 
1 272 
1 3152 
1 
1 31 61 
| 
1. 
1 
601 
| 
1421 
60 
150| 
90 
■ 100 
70 
601 
100 
701 
100! 200 
_ 
30 
39 
dUU 
60-40 
i i 
| 60 
j 37 
| 577 
10| 
1 
1 
1 5| 
1 
1 
6| 
1101 
1 
1 
1 
1 
20| 300 
60 50 
1 10 
| 60 
| 54 
| 758 
1 5| 
1 
1 
1 6| 
301 
1 
211 
240| 40 
1 
1 
1 
1 
1 
1 
20| 300 
60-60 
1 18 
1 60 
| 70 
| 938 
41 
31 
1 
1 61 
301 
1 
401 
175| 110 
1 
1 
1 
1 
20| 300 
60-70 
1 26 
1 60 
1 87 
1 1123 
l 4( 
31 
1 
1 6| 
301 
1 
60) 
175| 130 
1 
701 
1 
20| 300 
60-80 
1 35 1 60 
1 104 1 1312 
1 4| 
2| 
1 
1 4| 
601 
1 
451 
i 
1 
6( 
100| r30| 
1 
120| 
1 
30| 300 
60 90 
1 43 
| 60 
| 120 
| 1488 
1 4| 
2| 
1 
1 4| 
60] 
1 
641 
t 
6( 
100| 100 
801 
1351 
1 
30| 300 
60 190 
1 51 
| 60 
| 136 
| 1668 
1 4| 
2| 
1 
1 4) 
601 
1 
831 
60 
100| 100 
100| 
1951 
1 
30| 300 
6C-110 
| 60 
| 60 
| 154 
| 1866 
1 4| 
21 
1 
1 41 
601 
1 
104| 
60 
100| 200 
100| 
851 
1001 
1 
dU 
dUU 
60-129 
| 68 
1 60 
I 170 
| 2042 
1 4| 
2| 
1 
1 4| 
601 
1 
1051 
15 
60 
100| 200 
100) 
1651 
1001 
30 
300 
60-130 
| 76 
1 60 1 187 
| 2227 
1 2| 
1 
1 
1 4| 
601 
1 
1211 
1001 
60 
100 
200 
100| 
. 
68 
60 
39 
300 
fid 140 
1 85 
1 60 
| 203 
| 2407 
1 2) 
1 
1 
1 4! 
601 
1 
1221 
15 
100| 
60 
100 
200 
1001 
158| 
60 
39 
300 
fifi-150 ! 93 1 60 
1 219 
1 2583 
1 21 
1 
1 
1 4| 
601 
1 
123| 
30 
100| 
60 
100| 200 
100| 
851 
1001 
60 
30 
300 
160 
| 101 
| 60 
1 236 1 2768 
I 
1 3 
3| 
1 
601 
1 
601 
1 
138| 
60 
100| 
601 
100 
100 
100 
1501 
30 
30 
30 
300 
60=170 
| 109 
| 60 
| 253 
| 2953 
1 
1 
3| 
1 
60 j 
1 
601 
1 
158| 
60 
100| 
601 
1001 100 
100 
2301 
30 
30 
30 
300 
60 180 
| 118 
| 60 
| 270 
| 3142 
1 
1 
31 
1 
601 
1 
601 
1 
1601 
75 
iooj 
60| 
100! 100 
901 
100 
230| 
1 
301 301 30J 300 
| 60 
I 287 
| 3327 
1 
1 
31 
| 
1 
1 
601 
I 
1521 
75 
1501 
601 
! ioo| ioo 
1 
100 
601 
1001 
1 150 
601 
dU| dU| dUU 
65-50 
1 7 
| 52 
| 756 
51 
1 
1 
1 6| 
601 
1 
191 
i 
1 
1 1001 401 
1 
1 
1 
1 
20 
300 
65 60 
1 15 
1 65 
| 68 
| 932 
51 
1 
1 
1 6| 
601 
1 
381 
| 2001 100 
201 
1 
1 
1 
20| 390 
65 70 
1 23 1 65 
1 85 
1 1117 
1 4| 
31 
1 
601 4| 
601 
1 
651 
i 
1 
| 1001 1201 
1 
1 
1 
201 300 
65-80 
| 32 
| 65 
1 102 1 1306 
1 4| 
31 
1 
601 41 
601 
1 
851 
100| 100 
1001 
1 
201 300 
65 90 
| 40 
| 65 
| 118 
| 1482 
1 4| 
SI 
1 
601 4| 
60) 
1 
105| 
100| 100 
100| 
1991 
1 
30| 300 
65-100 
| 48 
| 65 
| 135 
| 1667 
I 3| 
6| 
1 
601 2| 
601 
1 
106| 
50| 100| 100 
70) 
100 
1 
1 
30| 300 
65-119 
1 57 
1 65 
1 152 
| 1852 
1 3| 
6| 
1 
601 2| 
601 
1 
126| 
501 1001 200 
50) 
100 
601 
1 
30| 300 
fii-IVO 
i 65 
1 65 1 168 
| 2028 
1 31 
6| 
1 
601 2| 
601 
! 
146| 
i 
! 
50| 100| 200 
100| 
1401 
1 
1 
30| 300 
05-130 1 73 1 65 
| 185 
| 2213 
1 3| 
>1 
1 
601 2| 
601 
1 
148| 
15 
i 
1 
50| 100| 200 
100 j 
701 
1001 
1 
30| 300 
65-140 
j 82 
1 65 
1 201 
| 2393 
1 
1 
1 
1 
601 1| 
1 
60 
1421 
601 
I 
60| 1001 200 
1001 
1601 
1 
1 
30I 30| 300 
6j-150 
| 90 
1 65 1 217 
| 2569 
1 
1 5| 
1 
1 
601 1| 
1 
601 
1431 
15 
601 
1 
60| 100| 200 
1001 
901 
1001 
1 
301 301 300 
65 169 
| 98 
| 65 
| 234 
| 2754 
1 
1 1| 61 
301 
601 2| 
1 
135| 
30 
1501 
1 
601 
| 150| 1001 
1 
1001 
1 
1 
1UU| IdU 
1 
dUl dUU 
6 '• 170 
| 107 
| 65 
1 251 
1 2943 
| 
I 
I 
301 
601 2| 
1 
1 
138| 
45 
1501 
1 
601 
| 150| 100| 
1 
1001 
901 
1 
1001 100 
1 
30[ 300 
65-189 
1 115 
1 65 
I 268 1 3132 
1 
1 
61 
301 
601 2) 
1 
1 
140| 
60 
1501 
1 
601 
| 150| 100| 
1 
1001 
170| 
1 
100i 15 
1 
1 
| 301 300 
65 190 
| 123 | 65 
| 285 
| 3317 
1 
1 
3| 
1 
1 21 
1 
60| 118| 
90 
150| 
601 
| 100| 100| 215| 
i inm mni 21.il 
1 
| 
1 
100| 
1451 
0U| 
601 
dU| dpi dUU 
301 301 300 
65-200 
70-50 
1 132 
1 4 
I 05 
| 70 
1 dUl I 
1 49 1 737 
1 1 
1 4| 
3| 
1 
J_ 
1 
1 2| 
1 61 
1 
601 | 
I 
1 
| 100| 301 
1 
1 
20| 300 
70-60 
1 12 
| 70 
| 65 
| 913 
1 4| 
1 
1 
1 6| 
1 
601 
18| 
i 
! 
| 2001 130| 
1 
1 
1 
20| 300 
70-70 
| 20 
| 70 
| 82 
| 1098 
1 31 
3| 
1 
301 6| 
1 
401 
381 
i 
1 
| 200| 180| 
1 
1 
1 
1 
1 
1 
1 20| 300 
70-80 
| 29 
| 70 
| 99 
| 1287 
1 3| 
31 
1 
301 6| 
1 
401 
581 
i 
1 
| 200| 1001 50| 
601 
1 
1 
1 
1 
1 
| 20| 300 
70 90 
1 37 
| 70 
| 115 
| 1463 
1 3| 
31 
1 
301 6| 
1 
401 
771 
200| 100 
100| 
120 
1 
1 
20| 300 
70 100 S 45 
| 70 
| 132 
| 1648 
1 3| 
31 
1 
301 6| 
1 
401 
971 
i 
1 
| 200| 100 
100| 
14U| 
1 
30| 300 
70-110 1 54 
| 70 
| 149 
| 1837 
1 4| 
3| 
1 
1 51 
601 
1 
801 
100| 
1 
601 2001 100| 
1 
291 
1 
1 
| 100 
dU| dU| dUU 
70 120 
| 62 
| 70 
| 165 
| 2013 
1 4| 
31 
1 
1 5| 
601 
1 
1001 
100) 
1 
601 2001 100| 
1 
901 
1 
1 100 
301 301 300 
70 13(1 
1 70 
1 70 
! 182 
1 2198 
I 41 
31 
1 
1 51 
601 
120| 
1001 
1 
601 1001 4°0| 501 
701 
1 
| 199 
1 
| 301 301 300 
70-140 l 79 
1 70 1 199 
1 2387 1 
41 
31 
l 
1 51 
601 
1 
1221 
15 
1001 
1 
601 1001 1001 1001 
1101 
1 1UU 
1 
30| 301 300 
70-150 1 87 
| 70 
| 215 
j 2563 
1 4 j 
31 
1 
1 51 
601 
1231 
30/ 1001 
1 
60| 100| 100| 1001 
190j 
1 
1 
1 
| 30| 30| 300 
70—16C 
| 95 
1 70 
1 232 
| 2748 
1 
1 
1 
1 
1 2| 
1 
601 
138| 
150) 
9( 
1 
100| 10C 
801 
100| 
1 
1 
1251 
1 
| 30 f 301 300 
70-170 
| 104 
1 70 1 249 
1 2937 
1 
1 6| 
1 
1 
1 2| 
1 
601 
1401 
15 
1501 
901 
1001 100 
801 
100] 
1 
1 
1701 
1 
30| 30j 300 
70-180 
| 112 
1 70 
I 265 1 3113 
I 
1 5| 
1 
1 
1 2| 
1 
601 
141| 
30 
150| 
901 
100| 100 
801 
1001 
12U| 
2991 
1 
30| 30j 300 
75-190 
| 120 
1 70 
| 282 
| 3298 
1 
1 5| 
1 
1 
1 11 
1 
601 1331 
601 150| 
901 
Q0| 
1001 100| 1001 
1001 1001 1001 
100 
100 
1001 
100! 
1 
1001 00 
1451 60 
3U| 
301 
30| 30| 300 
301 301 300 
75-200 I 129 
75 50 1 2 
| 70 
j 75 
| 298 
1 47 
| 3478 
| 731 
1 1 0| 
1 101 1 
| 
1 
1 
1 L\ 
1 6| 
1 
301 
1 13| 
1 1 
1 
110| 
1 
1 
1 
1 
1 
20| 300 
75 60 
1 io 
1 75 
| 63 
| 907 
1 5| 
2| 
1 
1 61 
60 j 
1 
8| 
i 
301 
1001 
1 
1 
! 
1 
1 
20| 300 
75-70 
1 18 
1 75 
| 80 
| 1092 
1 51 
2| 
1 
1 6| 
601 
1 
28) 
i 
301 
165| 1201 
1 
1 
1 
1 
1 
1 
20I 300 
75-80 
| 27 
1 75 
| 97 
| 1281 
1 6| 
2| 
1 
1 6| 
601 
1 
481 
i 
301 
100| 2001 
1 
701 
1 
1 
1 
20| 300 
75-90 
| 35 
1 75 
| 113 
| 1457 
1 4| 
3| 
1 
1 6| 
601 
1 
541 
601 
301 
2001 180| 
1 
1551 
1 
1 
1 
1 
1 
| 20| 300 
75-100 
| 43 
1 75 
1 130 
| 1642 
1 41 
31 
1 
1 6| 
601 
1 
741 
601 
301 
200| 180| 
1 
15U| 
1 
1 
20| 300 
75-110 
| 52 
1 75 1 147 
| 1831 
1 4| 
31 
1 
1 6| 
601 
1 
941 
601 
301 
1001 100 
100| 
210| 
1 
1 
1 
20| 300 
75-120 
| 60 
1 75 
| 163 
| 2007 
1 41 
31 
1 
1 61 
601 
1 
113| 
601 
301 
100) 100| 100| 
801 
15U| 
1 
1 
20| 300 
75-130 
| 68 
1 75 
| 180 
j 2192 
1 4| 
51 
1 
601 31 
601 
1 
1341 
i 
1 
601 
200| 1001 
1 
1001 
130| 
1 
1 
30| 300 
75 14(1 
j 77 
1 75 
| 197 
| 2381 
1 41 
5| 
1 
601 3| 
60| 
1 
1541 
i 
1 
601 
100| 100 
100| 
iooj 
1 
1001 
1 
30I 300 
75-150 
1 75 
| 213 
| 2557 
1 41 
51 
1 
601 3[ 
601 
1 
1551 
151 
i 
1 
601 
100| 100 
1001 
100 
801 
1001 
1 
1 
30| 300 
75 ter 
| 93 
1 75 
| 230 
| 2742 
I 
1 
3! 
1 
601 
11 
1 
601 
1351 
1501 
901 
100| 100 
1601 
1001 
1 
301 
30 
30| 300 
75-170 
| 102 
1 75 
| 247 
| 2931 
1 
1 
3| 
1 
601 
u 
1 
601 
1381 
15 
150| 
901 
100| 100 
160| 
190| 
1 
301 
30 
39 
300 
75-180 
| 110 
1 75 
| 263 
| 3107 
1 
1 
3| 
1 
601 1| 
1 
601 
139| 
30 
150| 
901 
1001 100 
2001 
2301 
1 
301 
391 301 309 
75-190 
1 118 
1 75 
1 280 
| 3292 
1 
1 
31 
1 
601 
11 
1 
601 
1411 
45 
150| 
90[ 
100| 100 
210| 
2001 
1 
301 
30| 30| 300 
75 VOO 1 127 
1 75 1 296 
| 3472 
1 
1 
31 
| 
601 1| 
1 
60| 142| 
60 
1501 
90 
1001 100 
2101 
1 19U| 
1UU| 
301 
30| 30| 300 
80-60 
1 8 
| 80 
| 60 
| 892 
1 101 2| 
1 
1 
1 61 
601 
1 
281 
i 
1 
1 1101 
| | 1 | | | | | | | 1 20| 300 
80 70 
1 16 
| 80 
| 77 
| 1077 
1 101 21 
1 
1 
1 
31 
601 
1 
481 
i 
1 
! ioo| 100 
1 
/U 
1 
1 
1 
1 
zu 
dUU 
80-80 
| 25 
| 80 
| 94 
j 1266 
1 101 
1 
1 
1 61 
601 
1 
681 
t 
1 
| 100| 100 
901 
701 
1 
1 
1 
1 
1 
ZU| dUU 
80 90 
1 33 
| 80 
| 110 
| 1442 
1 5| 41 
1 
1 
601 3] 
601 
1 
41 
601 
60) 
100| 100 
1 
1411 
1 
1 
1 
20| 300 
80-100 
1 41 
| 80 
| 127 
| 1627 
1 51 
1 
1 
601 3| 
60 j 
1 
611 
601 
601 
| 100) 100 
501 
200 
1 
301 300 
SO 110 
| 50 
| 80 
| 144 
| 1816 
1 5| 4| 
1 
1 
601 3| 
60 j 
1 
811 
601 
601 
| 100| 100 
100| 
1 1401 
1 
30J 300 
80 120 
j 58 
1 80 
| 160 
| 1992 
1 5| 4| 
1 
1 
601 3| 
601 
1 
1011 
601 
601 
| 100| 100 
1201 
| 2001 
1 
1 
301 300 
80-130 
| 66 
| 80 
| 177 
| 2177 
1 5| 4| 
1 
1 
601 3| 
601 
1 
121 j 
601 
601 
1 100| 100 
120| 
I 1301 
1001 
1 
30| 300 
80-140 
| 75 
80 
| 194 
j 2366 
51 4| 
1 
1 
601 3| 
601 
1 
141 j 
601 
601 
| 100| 100 
120| 
1 170) 
1 
1001 
1 
30| 300 
80 150 
j 83 
| SO 
| 210 
| 2542 
1 5| 
1 
1 
601 31 
601 
1 
1421 
15 
601 
601 
1 100| 100 
120| 
501 
2001 
39 
399 
80-160 
1 O' 
| 80 
| 227 
| 2727 
1 
1 
31 
1 
601 11 
1 
601 
132) 
1501 
901 
100| 100 
1 
100 
I 251 
| 1UU 
0U| dU| dUU 
80 170 
j 100 
| 80 
| 244 
| 2916 
1 
1 
1 
1 
601 1| 
1 
601 
134| 
15 
150| 
901 
1 100| 100 
1 
100 
1 115| 
1 100 
80-180 
| 108 
1 80 
j 260 
| 3092 
1 
1 
3| 
1 
601 1| 
1 
601 
1351 
30 
1501 
90) 
| 100| 100 
1 
100 
1 1951 
1 100 
601 301 300 
80 190 
| 116 
| 80 
1 277 
1 3277 
1 
1 
3| 
1 
601 11 
1 
601 
137| 
45 
150 j 
901 
1 100| 100| 
1 
1001 
1 1251 
100| 
1 16U| 
1 
601 301 300 
80 200 
j 125 
| 80 
1 293 1 3457 
1 
1 
31 
1 
601 11 
1 
601 
1381 
60 
150| 
901 
j 1001 100| 
1 
1001 
1 1551 
1 
1UU| IUU| 
1 
601 30( 309 
105 
St., 
* 
From The New Dietetics, by 
Dr. 
John 
Harvey 
Kellogg 
Modern Medicine 
FubiJLstitngr Company, 
uattie 
New York City. 
Extra copies of this Diet Table mounted 
Co., Dietetic Department. 
on 
heavy cardboard will be supplied at 
Copyrighted, 1923 
75 
cents each. 
Address 
Battle Creek Food 
DIABETIC DIET TABLE' 
Balanced Bills of Fare for Diabetics 
(See back of sheet for tables and lists of foods) Foods Grouped According to Carbohydrate Content 
Nuts 
Ounces 
Blackberries 1)4 
Blackberry juice— 
1)4 tablespoonfuls 
Blueberry juice— 
1)4 tablespoonfuls 
Cantaloup 2 
Cherries 1 
canned )4 
Cucumbers 6 
Currants 1 )4 
Dates )4 
Figs, dried )4 
“ fresh 1 
Grapes 1 )4 
Grapefruit— 
Four tablespoonfuls 
Lemon juice— 
Four tablespoon fills 
Ounces 
Orange juice— 
Three tablespoonfuls 
Peach juice 1 
Pears 1)4 
Pear juice Y\ 
Pineapple, fresh 2 
“ juice 1 
Plums, fresh 1 
Prunes, fresh 1 
stewed Yz 
Raisins )4 
Raspberries 1 )4 
Raspberry juice, black 1 
“ “ red )4 
Raspberries, red, stewed- 
1)4 tablespoonfuls 
Strawberries, fresh 2)4 
“ canned )4 
Strawberry juice Y 
Watermelon 2)4 
Table showing the Number of Calories Required according to Height and Weight When the Body is in a State of 
Complete Rest (Basal Metabolism). 
Height 
Weight 
In. 
Pounds 
55 
66 
77 
88 
99 
110 
121 
132 
143 
154 
165 
176 
187 
198 
209 
220 
231 
80 
1735 
1801 
1858 
1914 
1971 
2027 
2084 
2131 
2178 
2225 
2273 
78 
1631 
1697 
1763 
1820 
1877 
1933 
1990 
2046 
2093 
2141 
2188 
2235 
76 
1471 
1537 
1603 
1669 
1735 
1792 
1848 
1905 
1961 
2009 
2056 
2103 
2150 
2197 
74 
1443 
1509 
1575 
1641 
1697 
1754 
1811 
1867 
1924 
1971 
2018 
2065 
2112 
2159 
72 
1405 
1481 
1547 
1613 
1669 
1726 
1782 
1839 
1886 
1933 
1980 
2027 
2075 
2122 
70 
1122 
1207 
1282 
1377 
1443 
1509 
1575 
1631 
1688 
1745 
1801 
1848 
1895 
1943 
1990 
2037 
2084 
68 
1103 
1188 
1263 
1348 
1414 
1480 
1537 
1594 
1650 
1707 
1754 
1801 
1848 
1895 
1943 
1990 
66 
1075 
1160 
1235 
1320 
1386 
1452 
1509 
1565 
1622 
1679 
1726 
1773 
1820 
1867 
1914 
1952 
64 
1056 
1141 
1216 
1292 
1358 
1414 
1471 
1528 
1584 
1631 
1679 
1726 
1773 
1820 
1867 
62 
1028 
1113 
1188 
1254 
1320 
1377 
1433 
1490 
1547 
1594 
1641 
1688 
1735 
1782 
60 
1000 
1084 
1160 
1226 
1282 
1339 
1396 
1452 
1509 
1556 
1603 
1650 
1697 
58 
971 
1056 
1131 
1198 
1254 
1311 
1367 
1424 
1472 
1518 
1565 
1613 
56 
943 
1028 
1103 
1169 
1226 
1282 
1339 
1386 
1433 
1481 
54 
915 
1000 
1075 
1132 
1188 
1245 
1301 
1348 
1395 
, 
52 
896 
981 
1047 
1103 
1160 
1216 
1273 
1320 
50 
877 
952 
1018 
1075 
1132 
1188 
1235 
1282 
48 
858 
924 
981 
1037 
1094 
1150 
1197 
For intermediate weights the number of required calories may 
be calculated by adding 7 calories for each 
additional pound of body weight, for weights between 55 and 110 lbs.; 5y2 calories for each pound between 11D 
and 154 lbs.; and AlA calories for each pound above 154 lbs. 
Based upon the table of Du Bois and Du Bois. 
3 Per Cent 
Per cent 
Paradise nuts 10.2 
Hickory nuts 11.4 
Per cent 
Black walnuts 11.7 
Vegetables 
FOOD REQUIREMENT OF CHILDREN AND YOUTH 
Per cent 
Chinese Cabbage 1.4 
Lettuce 2.9 
Endive 3.0 
Cucumbers 3.1 
Spinach 3.2 
Beet greens 3.2 
Celery 3.3 
Per cent 
Asparagus 3.3 
Brussels sprouts 3.4 
Sauer kraut 3.8 
String Beans 3.8 
Sea kale 3.8 
Tomatoes 3.9 
1 5 Per Cent 
BOYS 
GIRLS 
Age 
Height 
Weight 
Age 
Height 
Weight 
Yrs. Mos. 
Inches 
Pounds 
Calories 
Yrs. Mos. 
Inches 
Pounds 
Calories 
8-0 
48.8 
54.5 
1700 
8-0 
47 J 
52.5 
1575 
8—6 
49.4 
57.1 
1750 
8-6 
48.7 
55.0 
1600 
9—0 
50.0 
59.6 
1800 
9—0 
49.7 
57.4 
1650 
9—6 
51.0 
62.5 
1850 
9—6 
50.7 
60.2 
1700 
10-0 
51.9 
65.4 
1900 
10-0 
51.7 
62.9 
1750 
10—6 
52.7 
68.0 
1950 
10-6 
52.8 
66.2 
1800 
11—0 
53.6 
70.7 
2000 
11—0 
53.8 
69.5 
1850 
11—6 
54.5 
73.8 
2050 
11—6 
54.9 
74.1 
1900 
12—0 
55.4 
76.9 
2100 
12—0 
56.1 
78.7 
1950 
12—6 
56.5 
80.8 
2150 
12—6 
57.3 
83.7 
2000 
10—0 
57.5 
84.8 
2200 
13—0 
58.5 
88.7 
2050 
13—6 
58.7 . 
90.0 
2250 
13—6 
59.5 
93.5 
2100 
14—0 
60.0 
95.2 
2300 
14—0 
60.4 
98.3 
2150 
14—6 
61.5 
101.3 
2350 
14—6 
61.0 
102.5 
2200 
15—0 
62.9 
107.4 
2400 
15—0 
61.6 
106.7 
2250 
15—6 
63.9 
114.2 
2450 
15—6 
61.9 
109.5 
2275 
16—0 
64.9 
121.0 
2500 
16-0 
62.2 
112.3 
2300 
16-6 
65.7 
125.5 
2550 
16—6 
62.5 
113.8 
2325 
17—0 
66.5 
130.0 
2600 
17—0 
62.7 
115.4 
2350 
17—6 
67.0 
132.6 
2650 
Vegetables 
Parsnips 13.5 
Lima beans (canned) 14.6 
Macaroni 15.8 
Artichokes 16.7 
Green peas 16.9 
Fruits 
5 Per Cent 
Raspberries 12.6 
Currants 12.8 
Blueberries 12.8 
Apricots 13.4 
Pears 14.1 
Apples 14.2 
Huckleberries 16.6 
Cherries 16.7 
Vegetables 
Cabbage sprouts 4.3 
Cauliflower 4.7 
Chard 5.0 
Eggplant 5.1 
Pumpkin 5.1 
Kohl-rabi 5.5 
Cabbage 5.6 
Leeks 5.8 
Radishes 5.8 
Collards 6.3 
Mushrooms 6.8 
Nuts 
Filberts 13.0 
Walnuts (English) 13.0 
Beechnuts 13.2 
Peanut butter 14.0 
Pecans 15.3 
Pistachios 16.3 
Pine nuts 17.3 
Almonds 17.3 
Vegetables 
Fruits 
20 Per Cent 
Artichokes 1)4 
Asparagus 6 
Beans, baked 1.... 
“ string 2 y2 
Beets, buttered 2 
Beet greens 6)4 
Brussels sprouts 6 
Cabbage 3 
Carrots 2)4 
Cauliflower, buttered 3 
Celery 6 
Dandelion greens 2 
Eggplant 1 
Lentils, baked 1 
Lima beans, green 1 
Onions, fresh \2/z 
“ boiled 2)4 
stewed 2y2 
Parsnips, browned 1 )4 
Peas, green 1 
Potato, baked Y 
“ boiled 1 
Radish 3 
Spinach, creamed 4 
Squash, Hubbard 1)4 
“ summer 5 
Tomatoes, fresh 5 
stewed 2 
Turnips, mashed 2 
Turnip puree 2)4 
Ripe olives (fat 21) 3.5 
Avocado (fat 17.3) 4.4 
Watermelon 6.7 
Vegetables 
Baked beans 19.6 
Green corn 19.7 
Potatoes 20.9 
Rice (boiled) 24.4 
FOOD REQUIREMENT OF ADULTS 
Nuts 
Fruits 
MEN 
WOMEN 
Height 
Weight 
Height 
Weight 
Inches 
. Pounds 
Calories 
Inches 
Pounds 
Calories 
60 
120-130 
1900-2000 
59 
111-126 
1775-2000 
61 
122-132 
1950-2100 
60 
113-129 
1800-2050 
62 
124-135 
2000-2150 
61 
115-132 
1850-2100 
63 
127-140 
2050-2200 
62 
117-136 
1875-2175 
64 
131-143 
2100-2250 
63 
120-140 
1900-2250 
65 
134-147 
2150-2350 
64 
123-144 
1950-2300 
66 
138-151 
2200-2400 
65 
125-148 
2000-2350 
67 
142-156 
2250-2500 
66 
128-152 
2050-2400 
68 
146-162 
2300-2550 
67 
132-155 
2100-2450 
69 
150-168 
2400-2650 
68 
136-160 
2150-2500 
70 
154-174 
2450-2750 
69 
140-165 
2200-2600 
71 
159-180 
2500-2850 
70 
144-169 
2300-2700 
72 
165-185 
2600-2900 
73 
170-189 
2700-3000 
74 
176-192 
2800-3050 
75 
181-196 
2900-3100 
Butternuts 3.5 
Pignolias 6.9 
Brazil nuts 7.0 
Nuttolene 6.1 
Plums 20.1 Bananas 22.0 
Nuts 
1 0 Per Cent 
Vegetables 
Almonds 17.3 
Almond butter 18.0 
Peanut 24.4 
Peanut butter 25.0 
Beets 7.4 
Okra 7.4 
Turnips 8.1 
Rutabaga 8.5 
Onions : 8.9 
Squash 9.0 
Carrots 9.3 
List of Foods Showing the Quantities of Each in Which Are 
Found Five Grams of Carbohydrates.* 
Fruits 
Cereals 
Strawberries 7.4 
Lemons 8.5 
Cantaloup 9.3 
Peaches 9.4 
Pineapple 9.7 
Cranberries 9.9 
Fruits 
Mango 10.0 
Blackberries 10.9 
Oranges 8.7 
Orange juice 10.8 
Grapefruit 10.4 
Ounces 
Almonds 1 
Apples, fresh 1% 
baked )4 
juice 1)4 
“ sauce y3 
Ounces 
Apricots, fresh iy3 
canned y 
stewed y2 
Avocado (Alligator pear) 4 
Banana ys 
Bran Biscuit )4 
Bran mush 3 
Bran, sterilized 1 
Bread, Graham )4 
Bread, white Yz 
Bread, whole wheat )4 
Breakfast toast )4 
Corn bread y3 
Oatmeal, boiled 1)4 
Pop corn 14 
Rice, boiled 1 
Oats, boiled 2 
Shredded wheat )4 
zo % 
One ounce avoirdupois equals 28.4 grams. INDEX 
Abderhalden, on white of egg.. 419 
Abscess of kidney, diet in 871 
hepatic 414 
Accidents, diet in 919 
Acetic acid 225 
Achard, use of salt 478 
Achard and Rickett, salt 474 
Achylia 719, 723 
diet for 989, 990 
Acids 700 
Acid, acetic 225 
benzoic 230 
butyric 231, 701 
citric 224 
diacetic 566 
of foods, 190, 223, 235, 820 
fruit 337, 700 
in gastric ulcer 717 
lactic 232 
malic 224 
organic 33, 223 
oxalic 225 
in pears 336 
phytic 224 
tannic 230, 701 
tartaric 223) 
unwholesome 2251 
uric 233 
Acidity, gastric 717 
Acidone 721 
Acidophilus bacillus 602 
Acidophilus buttermilk 799 
Acidosis 401, 414, 662 
diet for 815 
infantile 820 
ketonic 816 
post-operative 821 
prophylaxis against 912 
tests for 568, 816 
Acorns 371 
comp, of 372 
Actinomycosis 5C9, 905 
Acute co’itis 694 
Adametz, bacteria in cheese,440, 507 
Adami, bacteria of intestine .... 540 
Addison’s disease 808 
Adrenalin 69 
Adrenals, disease of 895 
Adsuki bean 314 
Adult body, comp, of 28 
Adult, food requirement... .119, 120 
Adulteration of foods 512 
Aerophagia 727 
Agar 218, 293, 627 
in constipation 683 
Agave 294 
Aged, diabetes in 795 
Air hunger 97 
Albu, on flesh diet 413 
Albuminuria 870 
Alcapton 545 
Alcohol 701 
Alimentary canal, nerves of... 69 
Alkaline treatment of ulcer .... 716 
Alkalinity of the blood 892 
Alkalinosis 817 
Allergins 946 
Alligator pear 353 
Almonds 367 
Almond milk 368 
Alvarez, gradient theory 542 
on reverse peristalsis 551 
Alwens, salt in ascites 481 
Alexins 549 
Ameba coli 512 
Ames, life of blood cells 815 
Amino acids -....31, 136 
Amylaceous dyspepsia 733 
Amylase 56 
Anaphylaxis 33, 729 
in infants 945 
Anemia 162, 415, 442, 562 
568, 588, 809 
pernicious 812 
Anemic infants 937 
Aneurism, diet in 844 
Anger, effects on stomach 71 
Angina abdominis 498 
Angina pectoris, diet in 844 
Animal foods 380 
Animal heat, source of 102 
Anorexia 828 
Antineuritic vitamin 198 
Antiperistalsis 60, 67, 671 
Antiscorbutic vitamin 195 
Antitoxic diet 613, 975 
Apoplexy 414, 527, 870 
diet in 843 
Appendicitis 415, 551, 672 
diet in 740 
Appetite 91 
effects of vitamins on 200 
juice 46 
lack of 675 
Apple 334 
acid in 334 
juice 335 
Arctic animals, bacteria free... 133 
Aretoeus, milk cure 579 
Arsenic in fruit 334 
1001 1002 
INDEX 
Arteriosclerosis 402, 414, 527, 628, 839 
Arthritis, rheumatoid 832 
Artichoke 292 
Jerusalem 306 
Ascites, tuberculous 481 
Asparagus 291 
Asthma 415 
diet in 887 
Atonic constipation 754 
Atony, gastric 718 
Autointoxication 538 
diseases caused by 611 
symptoms of 611 
cause of neurasthenia 855 
Avocado 353 
Bachman, farinaceous diet 616 
Bacillus acidophilus 602 
bifidus 602 
Bulgaricus 602 
putrificus 398, 399 
Welch ii 602 
Bacteria in animal droppings... 401 
of cheese 439, 507 
in children 941 
destroyed in intestine 546 
in eggs 426 
of fruit 328, 509 
in intestine 539 
in meat 398 
on milk bottles 446 
of mouth 538 
of stomach 538 
Biieltz, diet of Japanese 409 
Bailey, danger in meats 394 
Baking powders 255 
Bananas 348 
Banana figs 350 
flour 350 
Bandisch 167 
Bannocks 266 
Banting, discoverer of insulin.. 585 
Banting, treatment of diabetes.. 776 
Banting’s method in obesity 765 
Barberry 343 
Bardswell and Chapman, 
diet in tuberculosis 899 
Barium meal 556 
Barley 268 
pearl 269 
Barr and McCann, 
diet in tuberculosis 901 
Basal metabolism 100 
table 103 
Bases of foods 190 
Bastedo, on oils 682 
Bayliss, on egg white 420 
Beans 313 
adsuki 314 
mung 314 
shelled 315 
string 314 
string, botulism from 515 
soy 315 
Beaumont’s digestion table 464 
experiments 45, 419 
Beaver, on raw rice 244 
Beechnuts 371 
Beef 387 
not antiscorbutic 411 
Beets 303i 
Belching 675 
Benedict 128 
on emaciation 769 
on meat diet 923 
Beneke, cancer and meat eating 908 
Benzoate of soda 513 
Benzoic acid 230 
as preservative 231 
Bergeim 158 
Berberi 201, 414, 442 
Bernard, life in water 663 
Claude, obs 482 
effects of egg on urine 428 
Berries 340, 343 
Bichlorid nephritis 869 
Bienstock, on B. coli 594 
sugar in toxemia 586 
Bifidus bacillus 602 
Bigelow, flesh abstainer 408 
Bile 58, 76 
Biliousness 676 
chronic ... 666 
diet for 744 
Biliousness from eggs 422 
Bill of fare, balancing of 971 
for children 954 
making of 968 
Bills of Fare 974- 990 
Bitters 54, 95, 723 
Blackberries 342 
Blackfan, anaphylaxis in infant 945 
Black spot in meat 503 
Bladder, diseased conditions of. . 673 
Bland diet ; 652 
Blatherwick, on acids in fruits. 337 
Blood .. 562 
alkalinity of 892 
chemical examination 563 
lavage of 669 
pressure 414 
pressure, high 527 
pressure, high, diet in 842 
pressure raised by coffee 486 
useless in anemia 385 
waste constitutents 564 
Blood-making diet list 981 
Blood-vessels, diet in disease of. 839 
Blueberries 342 
Body weight 569 INDEX 
1003 
Boys, weight of Ill 
Boix, arteriosclerosis in rabbits. 839 
butyric acid 231 
pepper 469 
Bolicoh beans 314 
Borax versus salt 481 
Bouchard 76 
poisons in body 613 
recognition of 134 
toxicity of stools 545, 801 
toxins in colon 541 
Bouchardat on diabetes 775 
Botulism 510, 515 
from spinach 301 
Botulinus in olives 338 
Boys, growth of, 112 
Brain of adult 28 
of infant 28 
Bran 211, 626 
how to use 257 
not irritating 216 
Brand, diet in fevers 879 
Brandi 150 
Brazil nuts 372 
Breads, deficient in lime 250 
making 254 
gluten, recipe for 797 
iron in 247 
Breakfast 972 
test 554 
Breath, foul 677 
Brenzcatechin 545 
Bright’s disease, 414, 475, 478, 527 
568, 628, 866 
caused by salt 478 
Brillat-Savarin 80, 492 
Broca, forced feeding 899 
Broccoli 290 
Brose 266 
Brown, Lawrason, forced feed- 
ing 899 
Brunton, Lauder, on bile 848 
observations of bile 677 
tobacco in kidney disease 865 
Brussels sprouts 289 
Bryant, William Cullen, diet of. 408 
Buckner and Martin, lime 181 
Buckwheat 270 
Bulimia 94 
Bulkley, diet in psoriasis 905 
Bullard, tea poisoning 486 
Bunge 167 
lime water in diet 939 
effect of meat diet 411 
salt theory 473 
Burbank, Luther, origin of corn 260 
Burmann, exp. with coffee 488 
Burton on eating 531 
Butter 438 
color 439 
soup for infants 938 
cocoanut 372 
peanut 374 
Buttermilk ...442, 701 
acidophilus 799 
Butternuts 370 
Butyric acid 231, 701 
Cabbage 287 
Chinese 290 
palm 290 
Cachexia 505, 568 
Cacodylate of soda 813 
Cadaver in 500, 544 
Caffein, cause of goiter 495 
poisoning 484 
and uric acid 842 
in Kola drinks 495 
in various products 484 
Cajori, on nuts 361 
Calcium of body 27 
Calculus 871 
Calomel 546 
Calorie 99 
values of foods 237 
Calories in foodstuffs 991 
Cancer 415, 528, 536 
colon 910 
diet in 907 
in dogs 908 
gastric 909 
of colon 910 
of gullet 908 
Candy bill, Nation’s 158 
and acidosis 820 
Cane sugar 632 
poisoning 940 
Cannon 66, 67, 68, 69, 71 
on colon 679 
observations of 212 
on ileocecal valve 753 
reversed peristalsis 672 
on stomach 674 
Capsule test 556 
Carbohydrates 33, 64, 145 
Carbohydrate content of foods. 784 
Carbohydrate-free diet 653 
indigestion 632 
tolerance 776 
Car sickness, diet in 858 
Carbolic acid in cheese 440 
Carbon of body 27 
Carbon monoxide 498 
Cardiac disease 476 
Cardiac orifice of stomach 62 
Carlson 66 
on bitters 723 
obs. on stomach 674 
Carrots 304 
Cartilage, composition of 28 1004 
INDEX 
Cassava 284 
Case 68, 222 
on barium meal 556 
on colon 679 
obs. of ileocecal valve 753 
reversed peristalsis 672 
X-ray study of diabetes 773 
Cashew nut 373 
Casein, superior to meat 634 
Caspari, milk exp 431 
Catarrh, bronchial 415 
gastric 415 
gastric, in children 731 
Catalase, overproduction 411 
Cauliflower 289 
Cecum 66 
Celeriac 306 
Celery 291 
Cellulose 38, 211 
in cereals (Table) 213 
in constipation 681 
foods rich in 626 
in fruits 214 
in vegetables 213 
Cereals 246, 961 
breakfast 271 
cellulose in 213 
flakes 272 
for infants 937 
iron in 247 
lime in 248 
protein of ,...128, 137, 247 
Chaippori, treatment of anemia. 813 
Change of flora in fever 879 
Changing intestinal flora 574 
Changing intestinal flora in 
tuberculosis 890 
Changing intestinal flora in 
typhoid 885 
Chapin, diet and development .. 929 
Chapman and Bardswell, 
diet in tuberculosis 899 
Charrin, toxins in colon 541 
Chayote 309 
Cheese 439 
bacteria 439, 507 
lime content of 433 
molds 578 
poisoning 508 
Chemical juice 49 
secretion, test 555 
tests of blood 563 
Cherries 337 
Cherrie, Dr. George K 260 
Chestnuts 370 
Chestnut, water 286 
Chewing 78 
Cheyne-Stokes 480 
Chick and Delf, scurvy 196 
Chicken 389 
Chicory, white 292 
Children, bacteria of 941 
bills of fare for 954 
diet of 940, 948 
food requirement of..115, 118,119 
water requirement of 519 
Chinquapin 371 
Chittenden 83, 140 
effects of alcohol 701 
meat diet 923 
low protein diet 617 
protein ration of 126 
protein in diet 528 
Chlorosis 568 
Cholera 884 
infantum 944 
Cholin 500 
Cholesterol 428 
Chronic infections, diet in 890 
Chymosin 56 
Circulation and heart, tests of.. 570 
Cirrhosis of liver 414, 475, 666, 747 
Citric acid 224 
Citrus fruits 343 
Clams, poisons in 506 
Gay, laxative effects of 222 
Cloud berries 343 
Cob nuts 371 
Cobez de Baca 179 
Coccidium oviforme 512 
Cocoa 484 
Coca cola 950 
Cocoa drinks 494 
oxalic acid in 226 
tannic acid in 230 
Coconut 372 
Cocks, meat diet in 395 
Coffee 483, 484 
raises blood-pressure 486 
decaffeinated 493 
a drug 483 
heart 487 
cripples the liver 488 
insomnia 492 
poisons 488 
substitutes 496 
and tea, effects of 489 
tannic acid in 230 
increases uric acid .; 865 
Cold, common 666 
Colitis 413, 704 
acute 694 
chronic 774 
diet in 691 
Collidin 544 
Collip, discoverer of glucokinin 786 
Colon, care of 686, 690 
cancer of 910 
movements of 66 
putrefactions in 544 INDEX 
1005 
diet for ulceration of 737 
Coma, diabetic 922 
diabetic diet in 796 
diets 920 
Combe, rules of diet 597 
salt in epilepsy 852 
low protein diet 617 
toxins in colon 541 
Condiments 468, 702 
use of 533 
as preservatives 470 
Constipation 703 
atonic 754 
chronic 673 
diet in 678 
rules for relief of 686 
Conroy, examination of pan- 
creas 771 
Convulsions 480 
Cook, toxicity of foods 513 
Cookery 238 
Cooper 201 
potato diet 280, 657 
Corn 260 
flakes 264 
oil 262, 
popped 263 
products, composition of 261 
syrup 262 
sweet, green 263 
meal 261 
Cornmeal mush and milk 262 
Cornstarch 262 
Cornwall, diet in hypertension.. 841 
Cows, tuberculous 505 
Crab, Roger 217 
Crabs 390 
Cranberries 342 
benzoic acid in 230 
Crato on eating 531 
Cream 438 
Creatin 391 
Cresol 544 
Crichlow, appendicitis and 
vegetarianism 740 
Crile, diet in goiter 803 
Cucumber 308 
Currants 342 
Cyclic vomiting 728 
Cystitis 415, 874 
Dasheen 283 
Dates 155, 351 
Davis and McCollum 199 
Day’s ration 100 
Debove, forced feeding 899 
Delf and Chick, scurvy 196 
Delf and Eddy, effeets of cook- 
ing on vitamins 198 
Dementia praecox 851 
Deneky on goiter 803 
Deuel 149 
Development, influence of food 
on 117 
Dewberries 343 
Dextrin 33, 151, 615 
effects on stomach 699 
Dextrose 152 
Diabetes ... .480, 528, 564, 664, 770 
in the aged 795 
diet in 773 
fat allowance in 778 
protein ration in 778 
and renal disease 795 
insipidus 664 
with pregnancy 796 
Diabetic coma 922 
best food for 779 
ration 787 
Diacetic acid 566 
Diarrhea 480, 652 
diet in 748 
acute, diet in 749 
in infants 944 
Diet, antitoxic 613, 975 
bland or non-laxative 652 
of young children 948 
deficiency 529 
and development 117 
in digestive disorders 671 
dry 655, 981 
errors 526 
fattening 633 
fat-free 655 
fever 62Q, 976 
raw food 243 
fruit 330 
of Grecians 407 
artificial, for infants 931 
mixed, for infants 943 
schedule for infants 930 
for infants, supplementary .. 933 
of Japanese 409 
in kidney diseases 861 
laxative, when indicated .... 627 
laxative 625, 977 
meat, pernicious effects 402 
and metabolism 117 
misinformation about 535 
monotonous 533 
for mothers 928 
protein 595 
list for low protein 974 
low protein 617, 974 
protein-free ........... .617, 977 
raw 657, 984 
reducing 648, 982 
salt-free 479 
in scurvy 824 
of United States army 118 
Dietary, meatless 922 
Dietaries and regimens 572 1006 
INDEX 
Dinner 973 
test 555 
Digestibility of foodstuffs 463 
Digestion aided by liver 74 
time required 66 
gastric, tests of 553 
table 454 
time 463, 466 
Digestive fluids 39 
processes 39 
Diseases requiring antitoxic diet 611 
Disease germs, elimination of.. 687 
requiring change of flora 611 
acute, infectious 665 
of women, diet in 875 
Dixon, poisons in intestine 841 
Drinking at meals 532 
water 482 
Dropsy 414, 475, 480, 655 
Drugs 687 
in anemia 813 
Drug habits 666 
effects of, on peristalsis 69 
tea and coffee 483 
Drummond 199 
Dry diet 655, 981 
Dujardin-Beaumetz, forced 
feeding 899 
on putrefaction in fish ...... 389 
Duodenal feeding 670 
formulas for 713 
gluten 714 
lacto-dextrin 712 
sugar formula 712 
Duodenal ulcer ..416, 551, 628, 673 
704, 707, 986 
diet, Lenhartz’s 715 
Von Leube’s 716 
Duodenum 689 
Dupratz 260 
Dwight, apple cider for head- 
ache 331 
Dysentery 652, 694, 751 
tropical 751 
Dyspepsia, amylaceous 733 
nervous 731 
Dyspeptics, chronic 674 
Dyspituitarism 807 
Dyspnea 480 
Ear disease 924 
Eating, hasty 531, 702 
physiology of 121 
Eclampsia, diet in 878 
Eck fistula 895 
Eczema 415, 480, 620, 905, 906 
in infants 907 
Edelmann, bacteria in meat .... 503 
Edema 475, 480 
caused by salt 480 
Endive—white chicory 292 
Egers 168 
Eggs 416 
bacteria in 426 
bad 425 
biliousness from 422 
candling of 426 
comp, of 417 
cooking of 421 
digestion of 421 
when contraindicated 428 
influence of food on 421 
iron of 422 
lime in 423 
poisoning 427 
preserved 424 
production, lime 181 
protein of 383 
urticaria from 427 
substitutes 424 
whites 419 
yolks 418 
Eggplant 308 
Eggleston on duodenal ulcer .. 709 
Ehrlich, experiment 192 
Eichhorn, bacteria in meat 503 
Einhorn tube 551 
Eiskamp and Park, pathogenic 
organisms in intestine 546 
Elderberries 343 
Emaciation, diet in 766 
Emergency cases, diet in 919 
Emmett and Luros 200 
Endurance, Fisher’s exp 410 
Energy output of body 99 
Enemas 673, 738 
effects of 67 
nutritive 661 
oil 527 
use of 684 
English walnuts 369 
Epilepsy 415, 852, 870 
Ergotism 509 
Erysipelas 475, 885 
Escherich, bacteria of intestine. 540 
germs in milk 507 
toxins in colon 541 
Eskimos, non-use of salt 477 
Esophageal stricture 755 
Evelyn, John, on salads 302 
Ewald’s test breakfast 554 
Ewald’s test dinner 555, 557 
Exercise in obesity 650, 762 
Exophthalmic goiter • 568 
Eye, diet in diseases of 924 
Fasting, intermittent 761 
objections to 641 
regimen 636 
scientific 647 INDEX 
1007 
loss of weight in 638 
Fatigue poisons 616 
Fats ...35, 64, 141, 615 
effect on gastric juice 48 
cause of headache 484 
in infant diet 936 
vegetable 143 
Fat-free diet 655 
Fat-soluble vitamin 202 
Fattening diet 633, 978 
by milk regimen 588 
regimen 628, 978 
Feeding, duodenal 670 
after gastro-enterostomy .... 915 
intravenous 662 
post-operative 914 
rectal 660 
tube, supplementary 590 
Ferments in plants 245 
made by liver 76 
Fever 413, 572 
acute, infectious 883 
feeding in 882 
foods to be avoided 883 
dietetic management of 879 
diet 620, 976 
eruptive 620 
in infants, diet in 945 
malarial 884 
relapsing 884 
scarlet 481 
yellow 884 
water drinking in 665 
Figs 3150 
banana, 350 
Filberts ; 371 
Fischer, exp. with protein 544 
acidosis and Bright’s disease. 815 
Fischl, cane sugar in diet 940 
Fish 389 
Fisher, Irving 84, 410 
Flesh diet cause of acidosis 401 
effects on animals 395 
Flesh foods, characteristics of. 381 
Fletcher’s discoveries 82 
fasting experiment 645 
mistake 88 
Fletcherism 81 
Flick and Walsh, nephritis 
and tuberculosis 895 
Flies, infection from 510 
Flint, beef tea and urine 621 
treatment for ulcer 709 
Flora, changing of 574 
change of, without cultures.. 605 
intestinal, change of 574 
intestinal, when changed 610 
intestinal, to keep changed .. 608 
Flour, banana 350 
peanut 375 
Fluke, blood 512 
liver i 512 
Folin, protein in diet 528, 617, 760 
Food acids 223, 235 
and bases 190 
Foods, adulterated 512 
animal 380 
calorie value of 237 
carbohydrate 784 
rich in cellulose 626 
cold 534 
combinations, bad 532 
cookery 238 
definition of 25 
edible, wild 956, 958 
energy of 99 
hot 534 
indigestible 534 
infant 462 
insipid 533 
transportation by intestine... 59 
rich in iron 175 
poor in iron 190 
iron, where found 167 
lime content of 181 
rich in lime (Table) 189 
poor in lime 190 
deficient in lime 184 
rich in lime and iron (Table) 189 
stored by liver 74 
influence upon milk 432 
parasitic infection's of 511 
plants, origins of 965 
poisoned 500 
poisoning, cheese 508 
principles 30 
raw 243 
requirement 109, 115 
of men and women 119, 120 
salts 36, 160 
highly seasoned 532 
sodium chloride in 479 
source of 29 
hot, effect on stomach 700 
passage of, from stomach... 64 
time for digestion 66, 463 
toxicity of 513 
toxins of ' 501 
uric acid in 234 
values of 991 
vitamin content 206 
water in (Table) 241 
wholesome 236 
work equivalent of 99 
the world’s 956 
Foodstuffs, calories per ounce.. 991 
comp, of 991 
Foot and mouth disease 884 
Fox, arteriosclerosis in animals 839 
disease in animals 403 1008 
INDEX 
Fowls 3S9 
Fractional test meal 554 
Freidenwald and Ruhrah, diet 
in tuberculosis 897 
Frothingham and Smillie, low 
protein diet 868 
Fruits 323, 960, 963 
Fruit acids 700 
arsenic in 334 
canned 356 
canned, comp, of 357 
cellulose in 214 
citrus 343 
comp, of (Table) 326 
diet 330 
dried 355 
digestibility of 464 
how they differ 572 
disinfection of 328 
germicidal properties 331 
iron content of 332 
juices 357 
comp, of 359 
Fruits, pectin in 324 
lime content of 332 
Fruit purees for infants 934 
regimen 572, 980 
when indicated 576 
ripening process in 333 
seeds 329 
skins, germs of 509 
sugar in (Table) 324 
vegetable 307 
Fuld, changing flora 603 
on constipation 697 
Fullness, sense of 674 
Funk, vitamin 210 
Fiirst, vitamin in plants 827 
Gaglio, fasting 638 
Galen, milk cure 579 
Gall-bladder 689 
disease 414, 551, 673, 704, 722, 745 
drainage 746 
examination of 559 
operation, diet after 919 
Gallstones 414, 666 
and diabetes 773 
Garlic 286 
Gas, intestinal 733 
in stomach 676 
Gaspard, putrefying substances 394 
Gastric acid 49 
influences which lessen 705 
how increased 53 
Gastric acidity 717 
activity, capsule test for 556 
atony 718 
cancer 909 
catarrh, chronic 528 
in children 731 
digestion 44 
tests of 553 
time of 466 
dilatation 726 
disorders 536 
glands, test of 556 
juice 45 
effects of salt on 472 
motor meal 555 
spasm, toxicity 547 
ulcer 71, 416, 551, 707, 986 
Gastritis 536 
acute 732 
diet in 733 
Gastro-enteric infection, acute. 729 
Gastroenterostomy, diet 915 
Gautama Buddha 139 
Gautier, analysis of beef tea... 392 
effects of coffee 490 
toxins in renal disease 897 
salt in diet 477 
Gavage 669 
Genito-urinary disorders, diet in 861 
Germs, elimination of 687 
of fruit skins 509 
Germicidal properties of fruits. 331 
Gershun, skin diseases in infants 907 
Ghee 143 
Girls, growth of 113 
weight of Ill 
Givens, effects of temperature 
on tomatoes 308 
Globus 676 
Glucose) 152 
Glucokinin in diabetes 786 
Glutelin 260 
Gluten-feeding for ulcer 714 
Gluten products 797 
Glycogen 34 
storing up 912 
Goat 388 
Gofio 264 
Goiter, simple, diet in 800 
caffein, cause of 495 
Goiter, exophthalmic, diet in... 801 
Goldberger and Tanner, diet 
in pellagra 823 
Gonorrhea, diet in 874 
Goodall, observations of low 
protein diet 868 
Goodrich and Hindman, 
oyster juice 390 
Gooseberries 342 
Gout 414, 579, 835 
Graham, Sylvester, 
whole wheat meal 258 
Graham, Robert, botulinus in 
flour 511 
Grain, average crop 412 INDEX 
1009 
Grapes 339 
juice 339 
comp, of 340 
Gravel 871 
Greens 295, 615 
lime in 298 
lime and iron in (Table) .... 301 
as roughage 297 
Green regimen 575 
Grierson 147 
digestibility of starches 276 
Grigoriew, diet in anemia 811 
Grindley, starches (Table) ... 240 
vegetable'-, (Table) 242 
Grits 262 
Ground nuts 372 
Growth 109 
of boys 112 
of girls 113 
Griitzner, reversed peristalsis.. 677 
Guava 352 
Guelpa, fasting in diabetes 775 
Guerithault, M 160 
Gullet, cancer of 908 
Gum chewing 41, 553 
Haberland, food value of wood. 216 
Hall 167 
uric acid 233 
Hamburger and Monte, autoin- 
toxication in colitis 693 
Hamburger steak 502 
Hamilton, exp. with coffee.... 489 
Hansen, manna 293 
Hart, cellulose exp 215 
Hart and Steenbock, food lime 179 
Hartridge, effects of cigarette 
smoke 498 
Hasselha’ch, CO2 tension 818 
Plazelnuts 371 
Chinese * 378 
Headache 848 
sick 493 
Heat, animal 102 
Heart of adult 29 
and circulation, tests of 570 
disease 475 
diet in disease of 839 
disease caused by coffee 487 
of infant 29 
senile, diet for 847 
tobacco 497 
Height of boys and girls .. .112, 114 
Heit er, Professor 156 
Hematogen 422 
Hemmeter, obs. on stomach.... 705 
Hemophilia 824 
Hemorrhoids 527 
diet for 739 
Henderson, test for acidosis... 816 
Henry, Professor 461 
Hepatic abscess 414 
Hepatic efficiency diminished... 893 
Herbst, food lime 180 
Herpes zoster 859 
Herter, toxin-producing 
organisms 542 
Herter and Kendall, 
change of flora 594 
Hertz 68 
on colon . 679 
Hess, carrots 304 
on scurvy 196 
Heynemann, germs in milk ... 507 
Hiccough 676), 728 
Hickory nuts 368 
Hindhede 148 
on bran 215 
on fat free diet 655 
on greens 298 
on potato diet 279, 656 
on diet in tuberculosis 902 
Hinman and Goodrich, 
bacteria in oyster juice 390 
Hirschfeld 125 
diet in diseased kidneys 897 
Hirschsprung’s disease, diet in. 738 
Hippocrates, cellulose 217 
on diet in fever 620 
milk cure 579 
water drinking 662 
Hodgkin’s disease 824 
Hoffman, cancer and meat eat- 
ing 908 
milk cure 579 
Hohlweg, gall-bladder disease.. 722 
Holcomb, diet of Chinaman ... 407 
Homes, digestibility of soy 
bean 317 
Holst, report of 197 
Holzknecht 68 
Honey 158 
Hoobler, malted nuts 376 
orange juice 196, 198 
Hookworm 512 
Horseradish 305 
Horton, diet of Grecians 407 
Houchard, on arteriosclerosis.. 839 
Housework, energy consumption 
in 108 
Howe, dental disorders 196 
exps. with saliva 735 
Huckleberries 342 
Humboldt, banana yield 349 
Hunger 90 
absence of 93 
increase of 94 
salt 473 
effect of drugs on 95 
in infants .... 92 1010 
INDEX 
pains 94 
Hunt, Dr. Reid 140 
Hunter, John 161 
apples 326 
on diet 837 
Huxley, diet restriction 525 
Hydrochinon 545 
Hydrochloric acid, influences 
which increase 698, 704 
influences which lessen 705 
uses of 52 
acid of stomach 49 
Hydrogen of body 27 
Hyperacidity 50, 527 
diet in 696 
caused by meat 416 
Hyperchlorhydria 628 
diet in 696, 985 
diet list for 985 
caused by meat 416 
Hvpochlorhydria, diet for, 
719, 988, 989 
Hyperthyroidism 413 
diet in 801 
Hypothyroidism 414, 804 
Hysteria 854 
Ice cream 506 
Ices 700 
Iceland moss 292 
Ileocecal valve, function of.... 67 
diet in incompetency of 752 
Iletin, use of 585, 786 
Incompetency of ileocecal valve, 
diet in 752 
Indigestion, tea and coffee in... 493 
Indol 544 
in cheese 440 
with different diets 134 
fatigue poison 616 
Inebriety 394 
Infants, anaphylaxis in 945 
anemic 937 
artificial diet of 931 
body, composition of 28 
buttermilk for 939 
dangerous foods for 937 
diarrhea in 944 
diet schedule for 930 
eczema in 907 
feeding 927 
feeding, oranges in 345 
feeding program 932 
foods 462 
food, comp, of 463 
food requirement of 118 
malt sugar for 835 
nursing of 941 
protein requirement 127 
pyloric obstruction in 944 
ration 932 
stools 941 
vomiting of 943 
Infantile acidosis 820 
Influenza 885 
Inosite 154 
Insanity 415 
Insomnia 415, 493, 528 
caused by coffee 492 
Insulin 585 
Insulin, use of 786 
Intestinal activity 600 
Intestinal antiseptics 546 
Intestinal bacteria in arctic 
region 133 
flora, method of changing ... 592 
gas 733 
juice 59 
obstruction 666, 737 
parasitic disease, diet in 751 
putrefaction 133 
rhythm 71 
toxemia 538, 577 
and thyroid 546 
tuberculosis, diet in 902 
Intestine, absorption in 59 
excretion by 59 
effects of heat and cold 65 
movements of 66 
small, digestion in 55 
Intravenous feeding 662 
Invertase 58 
Iodine in body 27 
in foods 800 
Irish moss 293 
Iron in body 27 
in cereals and bread 247 
daily requirement 164 
in eggs 422 
in diet 572 
in food, where found 167 
foods rich in 175, 176 
foods poor in 190 
in foodstuffs 169, 170 
in fruits 332 
in greens 301 
inorganic, in anemia 716 
in legumes 311 
and lime, foods rich in 189 
in meats 382, 384 
in milk 436 
in nuts 365 
in pregnancy 875 
ration 161 
how to determine 174 
tables 173, 176, 190 
Ishiguro, beri-beri 201 
vegetables 277 INDEX 
1011 
Jacobson, colitis in children.... 731 
Janeway, uric acid 233 
Jansen, exp. with coconut 373 
Jaundice 414, 475 
infectious 666 
Jejunal feeding 918 
Jerusalem artichoke 306 
Johns, nuts 361 
Joint diseases 831 
Joly, Major P 139 
Jordan 222, 239 
June berries 343 
Kaa lee (Paraguay) 157 
Kaffee Hag 493, 702 
Kaiser, germs in milk 507 
Kakowsaki, exp. with mush- 
rooms 294 
Kaoling 270 
Karell, milk diet 580, 765 
Katalases 244 
Kellner 160 
Kennan 221, 470 
Keratitis, diet in 926 
Kidney diseases . .414, 475, 861, 895 
Kitasato, exp. with fruit acids.. 331 
Kishi, function of thyroid 895 
Klemperer 125 
diet in kidney disease 872 
test meal 555 
Knapp, on rice eaters 267 
Kohl-rabi 305 
Kohnstann on meat exclusion.. 693 
Kola 484 
Konig, comp, of meat 391 
Kopeloff, suppression of 
putrefaction 625 
Kronecker, effects of coffee 491 
Kumagawa 124 
Labbe and Leclerq, 
fats in diabetes 778 
Lactans 145 
Lactic acid 232 
Lactose 154, 597 
Lacto-dextrin, quantity required 607 
Lane, diseases due to toxemia.. 611 
Langer, colon bacillus 543 
Langworthy and Hunt, meat... 384 
Langworthy and Deuel, 
potato starch 659 
Lanolin cream 907 
Lasegue, on the tongue 548 
Latham, importance of clean 
teeth 736 
Lathyrism 509 
Lavage of tissues 669 
Laxative diet 625, 627, 977, 979 
Leaves, stems of 959 
Lee, on skatol and indol 616 
Leek 286 
Legendre, poisons in meat 
bouillon 393 
Legumes 310 
for diabetics 780 
digestibility of 310 
iron in 311 
lime in 312 
Lehmann, obs. on caffein 484 
Leipiner, potato diet 657 
JLemoine, exp. with eggs 427 
Lemons 346, 347 
Lenhartz’s duodenal feeding 715 
Lentils 322 
Lepine on neurasthenia 855 
Leszynski, coffee injures 
children ’. 489 
Lettuce 291 
Leucin 130 
Leucorrhea, diet in 878 
Leukemia 812 
Levin 65, 539 
on bacteria of arctic animals. 133 
Levulose 154 
Liebig, diet of bear 409 
water drinking 663 
Lily bulbs ... 286 
Lime in body 27 
in cereals 248 
in cheese 433 
in foodstuffs 181 
(Table) 185 
daily loss of 177 
foods deficient in 184 
deficient in breads 250 
in diet 572 
and egg production 181 
in eggs 423 
foods poor in 190 
foods rich in 189 
content of fruits 332 
in greens 298 
and iron, foods rich in 189 
in legumes 312 
deficient in meats 386 
in milk 433 
in nuts 365 
ration 176 
starvation 177 
in tuberculosis 902 
in vegetables 278 
juices, comp, of 360 
Limes 348 
Lime water for infants 939 
Linnaeus, cherry cure 572 
on strawberries 327 
Linossier, effects of salt 472 
toxalbumin in eggs 421 
Lipase 56 
Lipase of stomach 51 
Litchi nut 378 1012 
INDEX 
Littlejohn, tuberculosis in cattle 397 
Liver 74 
of adult 29 
effects of coffee 488 
congestion of 655 
cirrhosis of 666, 747 
disorders, diet in 741 
degenerations of 747 
fluke 512 
of infant 29 
spots 414 
functions, tests for 742 
Lockjaw 886 
Lobsters 390 
Loganberries 342 
comp, of 343 
Loufer, report on salt 476 
Lucas-Champonniere, appendi- 
citis and meat-eating 740 
Lungs of adult 29 
of infant 29 
Lusk 139 
protein experiments 621 
protein in tuberculosis 898 
on meat diet 923 
milk replaces meat 407 
Luxus protein 130 
Lying-in, diet during 877 
Lyon, diet of hog 404 
Lysin 32 
Mackay and Bailey, 
toxins in syphilis 903 
Magendie on saliva 553 
Magnesium in body 27 
Magnon, appendicitis and diet.. 740 
Magnus Levy on diabetes 773 
milk diet 581 
Malaria 416 
Malarial fever 884 
Malic acid 224 
in apples 334 
Malnutrition 568 
Maltose 58 
Malted nuts 375 
Hoobler’s obs 376 
Maltose 153 
Malt sugar 152, 591 
for infants 935 
Malt soup and scurvy 940 
Mango 352 
Manic depressive neurosis 851 
Manna 154 
Mannite 154 
Manyalla 221 
Martelly, sugar in toxemia 586 
Mastication 78, 86 
Martin, nephritis 896 
Martin, W. F., diet in syphilis. 904 
Mate 484, 494 
Mayer, salt cause of edema 480 
Mayo on duodenal ulcer 708 
cause of cancer 534 
food in cancer 907 
McCann and Barr, 
diet in tuberculosis 901 
McCarrison 200 
on deficiency diseases 193 
diet in goiter 803 
vitamins in diet 828 
McCollum . 37, 148 
on beans 313 
diet for children 950 
flesh foods 384, 923 
importance of milk 431, 432 
value of milk 382 
and Davis 199 
McCord, appendicitis and meat. 740 
McFayden on protein 544 
Meal, barium 556 
Meals, drinking at 532 
Meats 383, 698 
acidosis from 401 
bacteria 398, 400 
black spot in 503 
canned, bacteria in 405 
harmful for children 940 
and CO2 tension 818 
pernicious effects of 402 
effects on animals 401 
versus endurance 818 
not essential 406 
extract, toxicity of 391, 699 
condemned by Roger 391 
fatal to dog 393 
extractives 391 
increases metabolism 117 
moldy 503 
in tuberculosis 890 
source of urinary poisons 135 
contra-indications 413 
and goiter 802 
high 393 
and indol 134 
iron of 384 
in kidney disease 862 
lime deficient in 386 
nut 377 
parasites of 404 
poisons of 391 
putrefaction in 395 
purins in 392 
in syphilis 904 
Meat-fed cocks 395 
Meatless hospital dietary 922 
Meals, irregular 530 
Meals, test 555 
Medical dietetics 524 
Melancholia 850 
Melic, infected vegetables 509 INDEX 
1013 
Mellanby, vitamin A 203, 736 
Melon sapote 352 
Men, food requirement of . .115, 119 
Mendel 148, 259 
on coffee 487, 865 
on meat diet 923 
Mendel and Osborne 199, 215 
Mental disease 850 
Mental work, metabolism in 105 
Merycism 727 
Metabolism 99 
basal 103 
increased by meat 117 
in plants 101 
during sleep 101 
tests 567 
and work 105 
Metc’nnikoff, old age 226 
on the colon 678 
Metzer-Lyon method 559 
Michele, poisons in milk 506 
Migraine 415 
Milk 429 
almond 368 
of various animals, comp. of.. 462 
bitter 446 
bottles, bacteria on 446 
buddized 450 
canned 442 
certified 450 
clean 444 
comp, of 429 
condensed, composition of .... 442 
and cornmeal mush 262 
cost of 461 
effect of diet 826 
dried 437 
hickory milk 369 
feeding 583 
how to eat 458 
iron content of 436 
lime content of 433 
medical uses of 458 
mixtures 931 
modified 444 
pasteurizing 448 
peanut 375 
poisoning 457 
products, comp 429 
protein 431 
regimen 579, 585, 590, 632 
regimen, technic of 581 
salts 433, 799 
sensitization to 457 
skimmed 441 
slimy and colored 446 
souring of 430, 445 
soy bean 318 
sterilized 448 
effect on stomach 699 
sugar 154, 591, 597, 615 
sugar free 799 
sugar in typhoid fever 884 
from tuberculous cows 505 
infections due to 447 
rich in vitamins 432 
Miller, exps. with saliv?. 734 
effects of tea and coffee 490 
microbes in mouth 538 
Millet, vitamins in 270 
Mineral salts 36 
Mineral waters 521 
in nephritis 867 
Minkowski, daily water intake.. 667 
Mohler, bacteria in meat 503 
Molds, poisons of 508 
Morgenroth, on oleomargarine. 447 
Moro 432 
Morrow, pepsin exp 722 
Morse, W. J., soy bean 315 
Mortensen, test for strength 
of heart 571 
Moss, Iceland 292 
Irish 293 
reindeer 292 
Mosse, meat in diabetes 779 
Motility test 558 
Mouth, care of 589, 688 
digestion 39 
examination of 548 
Mucus, putrefaction of 545 
Mulberries 343 
Muller, indol, urine 545 
Muller, effects of meat extract.. 393 
Mumps 885 
Mung bean 314 
Murray, treatment of myxedema 806 
Muscarin 500 
Muscles, comp, of 28 
Muscle tension 104 
Muscular work, metabolism in.. 106 
Mushrooms .' 294 
Muskmelon 309 
Mushrooms, intoxication 508 
Mutton 388 
Myasthenia, diet in 858 
Myelitis, diet in 859 
Myers, diet and urea 864 
Myer and Rose, bananas 249 
Myocarditis 414, 655, 844 
Mytilotoxin 500 
Myxedema 568 
Nansen, effects of tea and coffee 485 
Naunyn, bodily requirement ... 642 
on acidosis 819 
Nausea 92, 674 
Nencki, on protein 544 
Nephritis 229 1014 
INDEX 
acute 620 
bichlorid 869 
from common salt 478 
mineral waters in 867 
mushrooms harmful in 294 
Nerves of alimentary canal 69 
Nervous disorders, diet in 848 
dyspepsia 731 
Nervousness 860 
Neuralgia 856 
Neurasthenia 415, 528, 628, 855 
from tea and coffee 491 
Neuridin 500 
Neurin 500 
Neuritis 551, 856 
Neuroses of stomach 730 
Neurosis, manic depressive .... 851 
Newburgh 83 
arteriosclerosis in animals.... 840 
Newburgh and Marsh, 
fats in diabetes 778 
protein for diabetics 789 
meat exp 402, 403 
Nicate and Schulz, intestinal an- 
tiseptics 546 
Nicotine 69 
injurious to kidneys 865 
Niemeyer, diet in fever 620 
Nitrogen of body 27 
Non-laxative diet 652 
Nose, disease of 923 
Nursing infants 941 
Nutrition, disorders of 756 
Nutritive enemas 661, 673 
functions, tests of 548 
Nuts 361, 960, 963 
composition of 362 
for diabetics 779 
digestibility of 464 
iron in 365 
lime in 365 
malted 375 
meats 377 
meals 379 
milk (Table) 367 
protein 136 
vitamins in 367 
Nuttal and Thierfelder, exp 539 
Nuttolene 377 
Oats 265 
Obesity 572 
diet in 757 
exercise in 762 
Occupations, energy consumed in 108 
Oertel, on dry diet 655 
Oertel’s method 765 
Ogata 151 
Oils, kernel 143 
vegetable 142 
Okda, white of egg 419 
Okra 292 
Old age, changes in 115 
food requirement 116 
Oleomargarine, bacteria in 447 
Olives 338 
botulism from 515 
Onions 285 
Operations, diet before 912 
Opsonins 549 
Oranges 343 
Orange juice for infants 933 
Organs in infants and adults... 29 
Origin of foods, plants 965 
Osborne 139 
and Harris 361 
and Mendel 181, 199, 319 
Osteoarthritis 832 
Osteomalacia 828 
Ovaries, diseased conditions of.. 673 
Overeating 526, 702 
Oxalic acid 225 
in food (Table) 230 
Oxaluria 871 
Oxygen of body 27 
inhalation in pneumonia 98 
Oyster juice, bacteria in 390 
typhoid from 506 
vegetable 305 
Paget, meat eating and death 
rate 912 
Palm cabbage 290 
Pancreas, diet in disease of 747 
Pancreatic hormone 585 
juice 56 
Papaw 352 
Paradise nuts 372 
Paraffin 683 
Paralysis 414, 665 
Parasites in foods 511 
of meat 404 
Parasitic infection 694, 905 
disease of intestine, diet in... 751 
Pare, Ambrose, parasites in meat 404 
Paresis 851 
Parol in 544 
Parsnips 303 
Pasteurizing milk 448 
Pavey, diet of Scotchman.. .408, 409 
Pavlov 45 
on bitters 723 
effects of chewing 703 
experiments with meats 698 
obs. on stomach 705 
Pawpaw 352 INDEX 
1015 
Peaches 336 
Peanuts 373 
butter 374 
flour 375 
milk 375 
oil 374 
Pears 336 
Peas 321 
green 321 
Pecans 369 
Pectin in fruits 324 
Pellagra 209, 414, 509, 823 
Pelvic colon 60 
Pennington, bacteria in eggs ... 426 
Pentosans 145 
Pepper 226 
Pepsin 50 
little value 722 
Peptic ulcer 572, 707, 986 
Peristalsis, reversed 671 
Peristaltic waves 67 
Peritonitis, post-operative, diet 
in 918 
Pernicious anemia 812 
Persimmons 337 
Petersen, Carl, diabetes and 
cancer 908 
Petroschky, germs in milk 507 
Pezard, on flesh-fed cocks..... 395 
Phenol 544 
Phosphorus of body 27 
Phthisis 579 
Physiology of eating 121 
Physique and food requirement. 116 
Phytic acid 224 
Pickles 471 
Pidau 424 
Pietro, study of pellagra 509 
Pin worm 512 
Pineapple 353 
Pinenuts 370 
Plague 884 
Plants, edible 961 
Plant foods, poison in 508 
Plato 139 
Pleurisy 475, 886 
with effusion 887 
Plimer, scurvy in pigs 824 
Plums 336 
benzoic acid in 230 
Plummer, low protein diet 802 
Plutarch 139 
Pneumonia 475, 886 
oxygen in 98 
salt in 481 
Peanut flour 375 
Poehl 593 
Poisons in clams 506 
in coffee 488 
in colon 541, 544 
detoxicated by liver 75 
of foods 500 
of meat 391, 504 
metallic 75 
in milk 504 
of molds 508 
organic 75 
in plant foods 508 
from putrefaction 544 
excreted by stomach 547 
Poisoning, cane sugar 940 
Poliomyelitis 883 
Pollinosis 33 
Polya operations, diet after .... 915 
Polyarthritis, acute 833 
Pomegranate 353 
Popcorn 263 
Pork 388 
tape-worm 512 
Post-operative acidosis 821 
feeding 914 
Potassium of body 27 
Potato cookery 282 
poisoning 281 
regimen 656 
starch, raw 659 
sweet 283 
white 279 
Potter, exp. with coffee 489 
Pregnancy 673 
diet during 875 
with diabetes 796 
Prescott 474 
Preserved foods and scurvy .... 824 
Priessnitz, use of water 662 
Prostate gland, inflammation of 874 
Proteins 30, 64 
complete 31, 136 
of cereals 128, 247 
diet, low 595, 617, 974 
diet and kidney work 129 
effect of on urine 131 
quick elimination of 129 
in fever 621 
and intestinal putrefaction ... 133 
and kidney work 132 
luxus 130 
of milk 431 
cause of nephritis 621 
ration 124 
ration in diabetes 778 
ration, high 118 
ration, low 139 
ration of infants 127 
requirement 138 
effect of on urine 131 
use in body 129 
vegetable 31 1016 
INDEX 
Protein-free diet 617, 977 
Protose 377 
Prunes 336 
benzoic acid in 230 
Psoriasis 415, 685, 905 
Psychic secretions, tests for.... 555 
Ptomaines 500, 544 
Pulmonary tuberculosis 890 
Pumpkin 309 
Purees for infants 934 
Puridin 544 
Purins 27, 392 
Purpura 827 
Putrefaction in colon 544 
in starvation 545 
Putrefactive bacteria 544 
Putrescin 500, 544 
Pyelitis 873 
Pyemia 885 
Pylorectomy, diet 915 
Pyloric obstruction 666 
in infants 944 
Pyorrhea 192 
Pylorus, action of 63 
Pyrrhol 544 
Pythagoras 139 
Quercin 372 
Quince 336 
Quincke, change of bacteria 593, 601 
Quinoa 270 
Rabbits, arteriosclerosis in 402 
Radish 305 
Raspberries 343 
Ration for diabetics 787 
Raw diet 657, 984 
Rectum, care of 690 
Rectal feeding 660 
Reducing diet 648, 982 
Regimens and dietaries 572 
Regimen, fasting 636 
fattening 628, 978 
fruit 572, 980 
green 575 
milk 579 
milk, technic of 581 
potato 656 
restorative 634, 981 
Rehfuss 158 
on tea and coffee 490 
Reichmann and Scheffer on 
bitters 723 
Reid 153 
Reindeer moss 292 
Relapsing fever 884 
Renal disease and diabetes 795 
efficiency 912 
sclerosis 867 
Restorative regimen 634, 981 
Rettger, lactose and milk diet... 599 
bacteria in eggs 425 
changing flora 604 
Rheumatism 414, 551, 528 
acute, diet in 833 
chronic 831 
Rheumatoid arthritis 832 
Rhubarb, oxalic acid in 226 
Rice 266 
eaters, report on 267 
jelly 591 
polish 267 
wild 268 
Richards, germs on fruit 509 
Rickett, salt exp 475 
vitamins in 192 
Roberts, Sir William 225 
effects of alcohol 701 
on salivary digestion 552 
effects of tea 493 
diet in urinary calculus 872 
Robertson, Atchison 150 
Rochelle, salts, toxicity of .... 513 
Roderick, bacteria in meat 400 
bacteria in milk 449 
change of flora 578 
Roger 158 
exp 547 
toxicity of meat extract 391 
tuberculous milk 505 
Roots 276 
and tubers 959 
Root starches 276 
vegetables 303 
Rose, Dr. Mary S., calcium in 
carrots 304 
Rosebloom, low protein diet ... 805 
Rosenau, milk in tuberculosis... 447 
Ross, obs. of meat diet 908 
potash 257 
Roux, exp 539 
Rubner 139 
nutrient value of corn 260 
protein in diet 528 
protein experiments 621 
on protein ration 127 
protein in tuberculosis 898 
Ruhrah and Freidenwald, diet in 
tuberculosis 897 
Rumford, Count 81, 281 
Rusby, caffein as a poison 486 
Rush, Benjamin 471 
Rye 269 
Saccharine 157, 797 
Sago 284 
Sakaguchi on diabetes 776 
Salads 302 INDEX 
1017 
Salant and Wise, citric acid 224 
Salisbury’s method in obesity... 766 
Saliva 40, 552 
effect of acids on 42 
deficient 43 
diminished in starvation 591 
diseased 43 
protective action of 42 
Salivary digestion 41 
Salkowski, indol in urine 545 
Sapelier, diet in Bright’s disease 864 
Salsify 305 
Salt in animal tissues 474 
Bright’s disease 478 
common 471, 702 
exp 474, 475 
food 36, 160 
in foods (Table) 479 
daily loss of 36 
hunger 473 
of milk 433, 799 
poisonous effects 476 
in reducing diet 649 
suicide by 476 
Salt-free diet 479 
Saltless diet in epilepsy 852 
Sanderson, flesh abstainer 416 
Sarcin in meat 392 
Satiety 91 
caused by fats 36 
Sauerkraut 288 
comp, of 289 
Savarin, Brillat, use of coffee... 492 
Sayre, exp. with coffee 488 
Scarlet fever 475 
salt in 481 
Schibkow, acetic acid a poison.. 471 
Schiff, obs. on bile 677 
Schlossman, proteins of milk 
and blood 432 
Schmidt, Adolph 542 
on colon 753 
Schulz and Nicate, intestinal an- 
tiseptics 546 
Scientific fasting 647 
Sclerosis of liver 471 
Scully and Greene, on parasites. 752 
Scurvy in babies 448 
diet in 824 
and malt soup 940 
meat unnecessary in 826 
sprouted grain in 827 
Seakale 290 
Sea foods 390 
Seasickness, diet in 858 
Secretion, psychic 555 
Seeds 959 
Senator, diet in kidney disease.. 898 
Seneca 139 
Senn, obs. of vegetarians 740 
Sensitization 945 
Septicemia 827 
Service berries 343 
Sesame seed meal 274 
Setti, effects of fasting 637 
Sherman 83, 137, 168, 203 
on cereal protein 129 
diet for children 950 
experiments 431 
food iron 386 
lime starvation 177 
iron in meat 382 
value of milk 382 
protein in diet 528 
protein ration of 126 
vitamin A 199 
effect of cooking on vitamins. 198 
Shoemaker, John V., effects of 
caffein 490 
Short, exp. with rats 192 
Sick headache 493 
Silicon in body 27 
Simmons, liver congestion in tu- 
berculosis 893 
Sinclair, sour milk cure 580 
diet 265 
Singultus 728 
Sitophobia 855 
Sittlar, maltose and dextrin in 
diet 594 
Siven 125 
Skatol 544 
fatigue poison 616 
Skin, diet in disease of 905 
diseases 628 
disorders 415 
Sleep, hunger in 92 
Sleeping sickness 884 
Slonaker, exp. on rats 657 
Small intestine, digestion in 55 
Smallpox 475 
Smith, Barclay, on colon 678 
Smith, Edward, caffein as a drug 485 
Smoking injurious to kidneys... 865 
Snyder, appendicitis and diet... 740 
cabbage 242 
Socrates 139 
Soda, benzoate of 513 
cocodylate 813 
Sodium chloride 471, 480, 481 
in body 27 
in foods 479 
Soil, clean 514 
Soper, poisons in clams 506 
Soup, malt, and scurvy 940 
vegetable, for infants 938 
Soy bean 315 
composition of 317 1018 
INDEX 
milk 318 
comp, of 319 
sauce 320 
sprouts, comp, of 321 
Spallanzani 79 
Spinach, botulism from 301 
Springfield experiment 128 
Sprouted grain 827 
Sprue 414, 821 
Squash 309 
Squier and Newburgh, protein in 
kidney disease 863 
Starch 33, 145 
digestibility of 276 
raw, digestibility of 149 
raw, for infants 938 
Starches, root 276 
effect of temperature on 240 
to remove from vegetables ... 780 
Statkewitsch, fasting 637 
Status epilepticus 853 
Starvation, hunger in 92 
Steenbock, vitamins 198 
Steenbock and Gross, exp 303 
Stefansson, salt not used by Es- 
kimos 477 
Steinitz, egg white 419 
Sternberg, meat in tuberculosis. 901 
Stiles, parasites in meat .. .404, 405 
Stomach, acute dilatation of ... 726 
care of 688 
effects of heat and cold 65 
disinfection 669 
gas in 676 
movements of 62 
passage of 64 
normally sterile 538 
neuroses of 730 
work of 44 
Stomatitis 728 
Stone and gravel in kidney 871 
Stools, bacteriological exam. ... 561 
examination of 560 
infants’ 941 
Strawberries 340 
Strength tests 569 
String beans 314 
Stuckey, autointoxication 924 
Succi, effects of fasting 637 
salt exp 474 
Succotash 315 
Suet 387 
Sugars 145, 149, 155, 632 
consumption of 159 
tolerance in diabetes 791 
in fruits 324 
malt 591 
milk 154, 591, 597 
effect on stomach 699 
substitutes for 156 
in urine 566 
odd 159 
Sugar-free milk 799 
Suicide by salt 476 
Sulphur of body 27 
Sun, the source of food 29 
Supper 973 
Supplementary feeding 590 
Surgical cases, diet in 911 
Swallowing 61 
Sydenham, milk cure 580 
and Rollo, meat and fats in 
diabetes :.. 778 
Syphilis 416, 480 
diet in 903 
Tadpoles, effects of feeding on. 118 
Tallqvist, dietetic experiments.. 747 
Tannic acid 230, 701 
in tea and coffee 488 
Tapeworm 755 
pork 512 
Tapioca 285 
Taro 283 
Tartaric acid 223 
Taste 43 
Taylor 255 
on acid protein 556 
exp. with colon poisons 697 
baking powders 256 
on protein ration 128 
vegetarian diet 406 
Tea 483, 484 
and coffee, effects of 489 
and coffee neurasthenia 491 
a drug 483 
oxalic acid in 226 
tannic acid in 230 
Teeth 551 
diet for caries of 734 
Tenia eschinococcus 512 
Tension, muscular 104 
Teosinte 260 
Tests for acidosis 568, 816 
breakfast 554 
for chemical secretion 555 
dinner, Ewald’s 555 
dinner, Reigel’s 555 
of gastric digestion 553 
of heart and circulation 570 
for liver function 742 
meal, fractional 554 
meal, Klemperer 555 
of metabolism 567 
motility 558 
of nutritive functions 548 
for psychic secretion 555 
of stools 560 INDEX 
1019 
of strength 569 
of urine 565 
of water 520 
Tetanin 500 
Tetanus 886 
Tetany 894 
Theobromin 484 
Thirst 95 
Thompson, Gilman, effects of 
coffee 490 
Thompson, diet in goiter 803 
Thread worm 512 
Throat, disease of 923 
Thyroid extract 546 
gland, degeneration of 894 
Tibbies, effect of caffein on the 
liver 488 
cellulose 215, 217 
fever diet 623 
fine flour 253 
lacto-vegetarian dietary 616 
lime water useless in diet 939 
nephritis 229 
salt in diet 477 
effects of tea 491 
effects of uric acid 235 
Tic-douloureux 860 
Tissier, non-flesh dietary 598 
sugar in toxemia 586 
toxins in colon 541 
Tissues, lavage of 669 
Tlascalans deprived of salt 474 
Tobacco 497, 701 
chewing 41 
effects of 497 
a heart poison 497 
Todano, ice water for fever pa- 
tients 662 
To fu 319 
composition of 319 
Tomatoes 307, 701 
juice, vitamins in 308 
Tongue, coated 548, 575, 677 
Torindo, use of salt 478 
Torrey, bread and milk diet 616 
exp. with lactose and with 
dextrin 598, 602 
milk sugar in fever 884 
Toxemia, intestinal 546, 577 
Toxicity, gastric 547 
of certain foodstuffs 513 
Toxins, food 501 
Transfusion 815 
Treves 179 
reversed peristalsis 672 
Trichina, spiralis 512 
Trichinosis 905 
True, food lime 180 
Trypsin 56 
Tryptophan 544 
Tsuji on rats 802 
Tube feeding 710 
feeding formula 713 
Tubers 276 
and roots 959 
Tubercular ascites 481 
Tuberculosis 415, 628 
in cattle 397 
intestinal, diet in 902 
milk 505 
lime in 902 
pulmonary 890 
pulmonary, diet in 899 
Turner, spinach 295 
Turnips 304 
Turnip cabbage 305 
Typhoid fever 475, 481, 884 
caused by oysters 506 
Typhotoxin 500 
Typhus fever 885 
Tyrosin 130 
Tyrotoxicon 500 
Ulcer diet 986 
duodenal 
416, 551, 628, 673, 704, 707 
diet in 709 
gastric 416, 528, 551, 707 
diet in 709 
diet modified 987 
peptic 572, 707, 986 
of the stomach 536 
Ulceration of colon, diet for..... 737 
Ulldom, liver congestion in tu- 
berculosis 893 
Umber, diet in scurvy 825 
Underfeeding 529 
Uremia 809 
Urethritis, diet in 874 
Uric acid 233 
disorders, diet in 834 
in foods (Table) 234 
toxic effects of 234 
in tea and coffee 487 
Urine 564 
collection of 565 
exam, of in diabetes 797 
phenol in 544 
specific gravity of 566 
tests of 565 
test for sugar in 566 
Urticaria 427, 729 
caused by eggs 427 
Vagatonia 856 
Van Ermengen, exp. with fruit 
acids 331 
Van Slyke on protein elimination 129 1020 
INDEX 
nuts 361 
Van Swieten 580 
Vander Bogert, mother’s milk. . 942 
Vaughan, cheese poisoning 508 
toxins in Bright’s disease 866 
Vegetables 275, 961 
broths for infants 934 
cellulose in 213 
disinfection of 328 
dried 322 
fats 143 
fruits 307 
green 287 
green, for diabetics 780 
infected 328, 509 
and indol 135 
iron in 277 
lime in 2/8 
marrow . 309 
oysters 305 
root 303 
soup for infants 938 
starch-free 780 
water in 242 
Venison 388 
Vinegar 225, 701 
Vines, S. H., ferments in plant 
juices 245 
Vinson, on dates 351 
Viscera objectionable 393 
Vitamins 37, 192 
Vitamin A 202, 205 
Vitamin B 198, 205 
Vitamin C 195, 206 
Vitamins, effect on appetite 200 
in diet 572 
how destroyed 210 
and dental decay 735 
infants 209, 936 
lack of 195 
of milk 432 
in millet 270 
of nuts 367 
sources of (Table) 206 
in tomato juice 308 
of yiast extract 202 
Voit, diet standard of 118 
experiment on pigeons 178 
Vomiting 63, 673 
cyclic 728 
of infants 943 
Von Leube diet 716 
gastric motor meal 555 
Von Noorden 155. 168 
on cellulose 217 
on diet for children 815 
on dry diet 655 
on fasting 639 
on fruit in renal disease 868 
on meat in diabetes 778 
method 765 
on mineral waters 521 
on obesity 759 
on uric acid in meats 389 
Wahl 255 
Walking, energy used in 106 
Walnuts 364 
Walter, F. J., diet in tuberculosis 901 
Warren on blood cells 815 
Water . 700 
carbonated 702 
chestnut 286 
in body 28 
distilled 521 
drinking 517, 662, 668 
fasting 640 
purification by chlorin 522 
for infants 939 
intake 764 
meal 555 
mineral 521 
drinking in nephritis 869 
tests for purity 520 
qualitative examination 520 
secreted by stomach 55 
Watermelon 308 
Watson, Chalmers, diet in goiter 803 
diet in autointoxication 597 
Weaning ' 942 
Wearn on blood cells 815 
Weber, Sir Herman, food in old 
age 408 
Wedekind, caffein and goiter ... 495 
Wegele, meat in autointoxication 598 
Weight 569 
of boys and girls Ill 
and height 114 
loss in fasting 638, 639 
reduction by exercise 762 
Weinzirl and Newton, bacteria 
in meat 503 
Welch’s bacillus 602 
Wells and Zilva vitamins 196 
Weseberg, poisons in meat 505 
West, George U 218 
Wheat 252 
comp, of 253 
bran 256 
Whey 443, 591 
in fever 885 
Whip worm 512 
Whooping cough 883 
Whortleberries 343 
Widal’s test 743 
Wiley, Dr. H. W., benzoic acid. 231 
caffein in coffee 851 
caffein in cola drinks 495 INDEX 
1021 
Williams on caffein 851 
on cancer 908 
Williamson on diabetes 773 
Winfield, cure of psoriasis 685 
Winter and Smith, yeast extract 
in diabetes 786 
Winters, meat for children .... 940 
Women, diet in diseases of 875 
food requirement of 115, 119 
Woodyatt, protein for diabetics 789 
Work, mental 105 
Worms 512 
Worm, whip 512 
Wounds, diseased conditions of. 673 
Yautia 285 
Yeast extract in anemia 814 
in diabetes 786 
vitamins 202 
Yellow fever 884 
Yogurt cheese 436 
Youth, food requirement 119 
Zander, fasting 638 
Zein 260 
Zilva and Wells, vitamins 196 
Zinc in body 27