IT IE EE I E PE P E V DIETIT LA S E H S IT CL ST IS D R SPITA P I S I C PA

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2 MODERN DIETETICS FEEDING THE SICK IN HOSPITAL AND HOME WITH SOME S TUDIES ON FEEDING WELL PEOPLE B" LULU G R A V ES DIETITIAN LAKESIDE HOSPITAL CLEVELAN D ST LOUIS THE MOD ERN HOSPITAL PUBLISHING COMPAN" 1917

3 COPYRIGHT 1917 B" THE MODERN HOSPITAL PUBLISHING COMPANY

4 But we ha e meat and we c an e at Sme ha e meat and canna eat And sme wad e at that want it ; And sae the Lrd be thankit Burns

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6 P R EFA C E With the mdest intentin t help the hspitals this cuntry slve sme the intricate prblems feeding the a mnthly jurnal de vted The Mdern Hspital sick t the interests and allied prevailed Miss Lulu hspitals sanatriums tian Lakeside n dieti institutins Graves t prepare a series papers under the general title Feeding the Hspital Cleveland Ohi dividing the tpics s that a paper culd be Hspital published each mnth until the series was cmpleted There were eight these After the publicatin a few the papers it became papers evident that they were attracting mre than rdinary number dmestic science schls adpted in te them rest in their A teachers in sme the better medical schls curriculums used them in their class and mre than ne in the apprpriate wrk cluded them in university as part the wrk in physilgy department and physi lgical chemistry great became the call fr cpies Of the papers that all S back numbers cntaining The Mdern Hspital them were sn and it was then decided t republish them in exhausted vlume making such additins and crrectins as were necessary have them serve the frm greatest pssible This t t which has been given the purpse title Mdern mngraph is the result the decisin t publish these Dietetics papers in vlume Mst frtunately the interest Pressr Lafayette frm Mendel was by sme his valuable he giving B attracted has been gd and enugh t the matter making such alteratins as were read necessary t time critically adjust sme the and cntrversial scientific statements

7 J uly VIII Prefa c e Pressr Mendel s suggestin sme pages have A added t the chemical cnstituents the chief fds been plyed n in institutinal and Miss Graves has been em persuaded t append sme feeding the special recipes by herself t meet the requirements the medical designed pr fessin in her wn hspital It is believed that the little bk will prve value t medical hspital physicians and students if this value shall administratrs be thse dietitians wh have nurses been respnsible and the publicatin realized the vlume will be abundantly f r repaid PREFAC E ADD ENDUM Since the cmpletin the material fr this bk the United States has becme engaged in a war that will materially affect cnditins pertaining t the fd is deemed advisable t revise the text supply the It bk Of nt n hwever that as these cnditins will change accunt frm time t time until the situatin again becmes nr in the meantime a questin relative t this changed If state affairs shuld ccur t the the mal authr will be pleased t discuss the matter either reader thrugh the Department Dietetics in HOSPITAL r by persnal THE MODERN crrespndence

8 C O N TE N T S C HAPTER I MANAGING INSTITUTION THE COMMISSARY Frmer Methds Buying Necessity J udicius Buying as t Quantity Quality and Price Prper Strage and Care S c ientific Preparatin D efinitin a Gd Ck Methdical Distributin CHAPTER II FOOD VALUE OF CERTAIN PRODUCTS General Principles Crrect Diet De finiti n Fd Functin in th e Bdy Cmpsitin and Utilizatin Surces Fd 12 CHAPTER III MILK AND ITS MODIFICATIONS Cmplete Fd fr Children but nt fr Adults Value Cream and Skimmed Milk Effect Pasteurizatin and Sterilizatin Use Eiweissmil ch Kumiss and Cheese CHAPTER IV 2 0 BUTTER ITS USES AND ITS SUBSTITUTES Fd Value Availability and Physical Prperties Prcess Renvatin Animal and Vegetable Fats Olemargarine r Butterine Sue t and Lard Olive Oil and Cttnseed Oil 2 7 CHAPTER V VEGETABLES IN THE DIETARY Physical and Physilgic Prperties Differentiatin Of Raw and Cked Vegetables Chacteri stic s Ptates Beets Carrts Onins Cabbage Cauliflwer Artichkes Tmates Aspara gus Lettuce Cress Celery Chicry and Alligatr Pears 32 CHAPTER VI CEREALS LEGUM ES AND BREAKFAST FOODS Crn Oats Wheat and Rice Principal Grains Used Ta i the p ca Sag and tr The Place Le A rrwr g umes in th e Dietary Sme th e Preparatins and their Fd Values 3 7 IX

9 CHAPTER VIII EGGS A S A STAPLE ARTICLE OF DIET X C ntents C HAPTE R VII FRUITS COOKED RAW CANNED AND DRIED Apples Grapes Plums Cranberries Prunes Figs Lemns Orange Pineapples Bananas Pears Melns s A dva n tage Canned Fruits The Place Fruits in th e Hs pital Dietary 43 COFFEE TEA COCOA AND C HOCOLATE Cfee and Tea have Practically n Nutritive Value and are Merely Stimulants Cca and Chclate are E xcellent Fds but sme Adulterants are Harmful Cereal C fees and their Use 48 CHA PTER IX POULTRY A s A HOSPITAL FOOD All Fwls have the same Fd Values thugh Geese and Ducks have t much F a t fr Impaired Digestin Little Difference between White and Dark Meat Value Prper Cking CHAPTE R X 53 Value Due t Large Amunt Nutritin Mildness Of Flavr Facilitates their Use in Cmbinatin with ther Fds Fresh Eggs Causes and Cure Rancidity Egg Dishes CHAPTER XI 56 MEATS THEIR STORAGE AND PREPARATION Feeding Values and Relative Availability Beef Veal Mut t n Prk Liver and Sweetbreads Chice Cuts and Meth Ods Preparatin Curing Prcesses Meats Beef J uice and Beef Tea 61 CHAPTER XII FISH AND OYSTERS IN THE DIETARY Oysters are Similar t Milk in Fd Value Oily Fishes Mre Nutritius than O thers Sme Superstitins E xplded Freshness Great Imprtance Hw Flavr Oysters is Affected 67

10 CHAPTE R XIV C HAPTER XV C ntents XI CHAPTER XIII SPECIAL DIETS IN DISEASE Certain Diseases th e Result Faulty Use Fd by the System Treatment Mstly Dietetic - Special Diets N ece s sary but must be used with Intelligence Lists Diets 69 CLASSES OF PEOPLE T BE FED Surgical Patients Maternity Ca ses Private Patients Feed ing Interns and Nurses Hspital Hel p Making Menus Fd Carts and Cntainers Pantries Diet Training fr Nurses The Cmmissary 87 FEEDING VARIOUS INSTITUTIONS Catering t the Tuberculus Feeding the Children The In sane have their wn Prblem Buying fr and Feeding Eleemsynary Institutins Feeding Private Sanatriums Help in the Kitchen Dietetics th e Future 100 CHAPTER XVI TRAINING SCHOOL WORK IN DIETETICS Preliminary Lessns Theretical and Practical Methds Instructin Teaching Basic Principles C l a ssific atin Sub j ects fr Cnvenient Teaching Cmparisn Thery and Practice 131 CHAPTER XVII SPECIAL DIETS AND PRINCIPAL FOODS Special Diets Designed fr Use in the Hspital r the Hme Sme th e Principal Articles F d fr the Sick and their Fd Values in Calries 140 CHAPTER XVIII COMPOSITION OF Atwater Tables Prepared fr the COMMON FOODS United States Department Agriculture Average Cmpsitin Cmmn American Fd Prducts 150

11 C HAPTE R XIX XII Cntents SOME SELECTED RECIPES FOR THE HOSPITAL Sups Fish and Pultry Meats Vegetables Egg s S al ads Salad Dressings Sauces Desserts Breads Cakes Beverages 155

12 MODERN DIETETICS INTRODUCTION B" PROFESSOR LAFAYETTE B MENDEL SHEFFIELD SCIENTIFIC SCHOOL YALE UNIVERSITY N EW HAVEN CONN It I be generally admitted that an accurate acquaintance will think with the quantity and quality fd sary t the maintenance human health and nece under s different is a matter great interest life t everyne but it ismre especially s t Of magis circumstances naval ; and military physicians statesmen and sur trates ficers gvernrs hspitals and ther public institu gens and the guardians the T them are tins intrusted the care and supervisin the inhabitants pr and pr prisns ships and garrisns their armies knwledge asylums ignrance de hspitals pends the health n disease the life r death r a cn huses prtin r the O f side This rable qutatin frm the American cmmunity Treatise Pereira s n Fd and deserves editin almst the same Diet emphasis tday as at the time its first publicatin in Recent decades have dubtless witnessed impr tant 1843 advances in the methds institutinal manage Efficient hspital rganizatin is recg as an essential factr in the prgress becming practical ment nized Of medicine the newest cntributins science are drawn n ; t furnish nv l nt nly in the being the mdern e but especially adminis in their helps trati applicatin n t therapy hspital mechanical devices the latest ; new remedial and aids t diagnsis are type stalled as prmptly as in agents they are intrduced and smetimes befre they have been adequately This is investigated

13 2 Mdern Dietetics as it shuld every hspital ught t f r hwever in a brad a labratry fr testing the latest be be cme suggestins the inventr r the research sense liberal attitude in this respect is in harmny with the A wrker public welfare and the greatest gd t the institutin s patients as well T the student nutritin it seems as if feature hspital service has been unduly ne that it lags behind the prgress in this branch s neglected Die physilgy in the as in ther has nt tetics the recgnitin which it deserves re hspital institutins bth as an essen tial c eived t the management the patients and as scheme in the field twenty years the a mvement fr the ppularizing current F r knwledge the elements treatment nutritin has received widespread attentin in the United This cuntry need nt be ashamed the cntributins its institutes and investigatrs in States this field wn Newspapers and ppular magazines are prmptly translating the findings the labrat ry science int the language the intelligent nnpressinal the newer cntributins the energy fac the But calrie the specific features diet and its reader culinary the relatin dietary cmpnents trs idea the alimentary have been slw in finding t aspects their way int the rigid rutine the average American respnses etc The reasn fr this underestimatin hspital diettherapy may be I in the neglect fund believe dietetics and these subjects as a part the educatin students Where ignrance indifference is likely t The situatin is prevails reflected further in the medicine inadequate instructin the trained nurse in the science fllw dietetics and the refinements the culinary arts which can find an applicatin at the Where prblems bedside ecnmy and cst must be cnsidered n a large scale

14 Intrducti n 3 it has nt been easy t enfrce the prescriptin diet t the Neither the average the the hspital superintendent has individual physician been educated nurse up t n the r highest There are signs the grwth a prgressive spirit standard mre in harmny with the advanced suggestins the physilgy and pathlgy The cur will inevitably be frced t respnd medical t the de nutritin mands ric ulum ratinal dietetics the physi n lnger the sle arbiter ; and in furthermre matters The c trained ian is dietitian has cme t This mngraph by diet Miss Lulu Graves is ne the timely attempts t pint stay the pssibilities prgress and t encurage a mre tlerant ut attitude diettherapy and a ratinal scheme nutritin tward applied in the hspital

15 CHA PTER I MANAGING THE INSTITUTION COMMIS SARY FORMER NECESSITY METHODS BUYING OF OF J UDICIOUS PROPER BU"ING PRICE STORAGE AS AND TO A ND QUANTITY QUALITY CARE SCIENTIFIC PREPARATION DEFINI TION OF A GOOD COOK METHODICAL DISTRIBUTION Frmerly it was a cmmn custm amng whlesale dealers t dispse their less desirable prducts insti usually a safe as there t was n ne in authrity wa s wh tk either prcedure time truble t pass judgment the fd materials when r r see that they received n the prper treatment t delivered after This gave t the whlesale dealer the same Opprtunity t delivery dispse much stck that might therwise mean a lss as is given t his the retail dealer by the family which rders the day s supplies by telephne sends a child t the stre t d the These r methds are n lnger prevalent either hmes r institutins cnducted purchasing n a business in with standards efficiency and As every basis sick cnnected with an institutin in any capacity r persn must it is a self-evident ecnmy well fact that the cmmissary department eat is the mst and it must be given the same ne Of intelligent imprtant thught that is given t any department 'the whle Of tuti ns It The fundatin a well-rdered cmmissary depart rganizatin ment judicius Of j udiciusly means nt nly buying is fd materials Buying a desirable and buying which cntain the prper nutritive values fr quality the needs the peple be at reasnable but qualities t strage facilities a must be als keeping as well fed price as discunts and Offered cash r prmpt cnsidered payment fr bills

16 Managing the Institutin C mmissary 5 As the keeping qualities depend much n the strage the tw cannt well be s In the ma facilities hspitals and ther public institutins the stre separated j rm rit y is apt be space in the basement which cannt be utilized fr any t ther r which remains after all ther rms are If there hap ens t be venti purpse latin in this well and gd if prvided p it will d very well a stre rm rm anyway is ; the nt general This fr in itself is very pr We are all well aware decisin that a damp rm is cnducive t the grwth ecnmy mlds and dark ther frms micrrganisms which may cause the rapid deteriratin fruits and vegetables either fresh r dried and als that it is very difficult t keep such a rm free frm Fruits and vegetables shuld be kept in a rm that is vermin but thrugh which currents nt nly well ventilated air a fairly even temperature are In the Of larger hspitals in the East sme attentin has ne been Of passing given t finding the best temperatures stragethe cn elusin having been reached that mst fr vegetables keep best at a temperature but that ptates are bet ter kept at a tem erature 42 and sweet ptates at F prper p cnditins 6 0 are F in the 70 stre F If fruits and vegetables must nt be maintained clsely and the verripe defective be frequently srted rm watched and thus thrugh much r handling is added mre cause ut fr rapid t mentin the extra ne labr Cereals nt decay are very difficult t keep in gd cnditin in a invlved warm rm unless in sealed and this makes them cnsiderably mre The packages prepared expensive cereals are apt becme even in wrmy t sealed particularly and thers may becme Flur will keep better in clth than in Dried may packages rancid becme r fruits barrels t wrmy In there are if musty staple articles which are cmmnly fact kept in the few supply any

17 6 M dern Dieteti cs rm which d nt keep better in a well-ventilated even thugh they may clean dry well-lighted nt actually spil rm we are all and nt withut t Mrever assciate a damp inclined rm with elsewhere reasn and ther s dark that naturally we dislike mice t raches assciate urfd materials vermin with that kind a place Besides and anther prtant feature im temperature a stre rm is If the cnditins ventilatin light are favrable fr Of keeping it is great advantage space be able t buy in large supplies quantities particularly is this t true and all vegetables ; that can be bught fr apples a much ptates lwer price at the time they are being gathered and stred fr use during If enugh business is given t them t warrant their winter ding sme the larger firms will their buyers when infrm s the prbable lwest price fr the seasn a par article has been advise them n as t when tic ular it is a prpitius time t r This is knwn as reached the We are apt t buy prtecting make mistakes at and ccasinally it happens that all hwever custmer the buyer is nt times but at any rate he is n an equal fting with prtected the and the Odds are in his favr the reater number On the ther merchant g hand times giving rders t mre than firm creates a and n the whle is a better ne prvided there be mre cmpetitin than ne firm available furnishing desirable plan The -priced article is nt always the mst ec prducts lwest there is mre ecnmy nmic in buying al select apples F r at per barrel than in buying example purchase an inferir quality at which and prb ably cntain enugh wrmy r decayed apples may r t des make the price really equal that the better in which the flavr thse that are grade specked r much less agreeable that they shuld be classed as in may be s ferir

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19 8 Mdern Dietetics grwn in and sme them unnatural transprted lng ripened cnditins artificially Mst ur fd material in the cities is handled by many different distances peple befre it reaches the All these things may affect its cnditin its mre r cnsumer and mean much t the persn r wh desirability is ill r has an impaired less appetite Unripe fruits vegetables have a large percent r starch in a state which r makes it difficult digestin On the ther if verripe because the sugars and misture they hand cntain they furnish a digestin medium fr the grwth mlds and which may gd frm Objectinable bacteria Meats may be kept in very gd cnditin fr a reasn prducts able length time in cld if kept lng at a higher temperature when taken strage int but the retail they deterirate very This especially true market is rapidly and the same can be said fish Thugh and a buyer knws all these essential things abut pultry eggs his and fd he is nt yet cmpletely equipped institutin markets until he knws materials what can and will happen t these fd materials when cked and served The very best that the market affrds may be and thrugh imprper cking s much the purchased flavr and nutritive value be lst that it will be served Of as a unattractive frm which the human bdy is able tasteless t assimilate dish very and which palls the appetite and upsets the n little Experience has shwn that many the peple em digestin plyed in the kitchens hspitals are inclined t give very little thught t this imprtant matter using fresh r green fd materials while still in their best cnditin nr are many them trained ck things in such a way ; that the flavrs are prperly t develped that their greatest fd value and digestibility r r retained are Ob tained

20 Managing the Instituti n C mmissary 9 T digress just a are nt altgether t blame little frthis it may be said that the cks In emplying a ck the hspital will almst invariably fr experience ability rather than knwledge ask cking r perhaps t fr ck it is better t say t ask fr the r knwledge as well as the neglecting ck has had many experience began his A career wh befre fd experience years values fd cmpsitin were subjects fr because and r he has dne a thing twenty study and it has passed him it is the fr prper way years d his ability t t and muster ck is prprtinate t the quantities it these things he t has prepared during the twenty The larger htels and restaurants are paying their cks years mre than are hspitals crrespnding and them chiefly that they serve fd highly seasned asking size Of usually at the sacrifice natural by rich sauces elabrately flavr accmpanied in which these htels and restaurants can get a But ptat which is garnished well r yet dry and ne a egg that is biled evenly and r cked mealy a vegetable that is nt swim in r a salad that r is really crisp It is true tender that ming this? fat very feature htels restaurants des much t furnish patrnage fr the and but it is the busi ness the hspital t remedy hspitals it far as What Shall we as Offer in rder t make pssible it wrth inducement the while then cks t hw fd shuld be prepared in rder t ur btain the learn mst its nutritive value and at the same time nt interfere with digesti One step is t raise the status the its bilit and y that? wuld be a lng and Slw prcess anther pressin and greater inducement will be t pay higher ; salary and thereby get cmpetent At present it seems t be the part the trained dietitian t accmplish what she peple can in the way prper preparatin and serving fd in many nly incnvenient wrking nt with instances

21 10 Mdern Dieteti cs quarters and inadequate but Often with an utter difference lng in help if nt pen nt nly in the Of but standing frm ther departments ppsitin as In additin kitchen t the prblems and well cking fd materials cmes the buying questin string prperly utilizing distributing If meat is bught by the where r shall the mre nurishing cuts be used and them where thse cuts which have mre delicate flavr What carcass shall be dne with the cuts frm parts the animal? mst cnsequently with harder and exercised yet with a gd percent c n muscle fiber nurishment nective Fruits and? tissue vegetables are always delivered in the mst desirable What nt shall be dne with that which is verripe green fr the purpse planned cnditin are the r t left-vers t be utilized s as be? really ecnmical Hw Often there is a small amunt t vegetablefruitr? pudding thugh enugh meat t serve all wh eat in ne nt remaining dining rm Shall we have such a rutine established that these r cannt be ward served t the peple fr whm they were riginally Or shall they be eaten by the emplyees in the kitchen perhaps planned? in additin t their regular meal Shall they be kept very religiusly a few days and then? dis psed in sme wasteful manner fr small quantity material Of wasted a small? amunt A nt may in a Shrt utilized here time aggregate quite a large there Where shall we make gd slid the first thught sum fd and ecnmize and where shall we give mre time t making daintiness n time and attractiveness the greater cnsideratin The tendency n the part the peple emplyed in kitchens been t have a Of menus r dishes with ur which they has were thrughly set and cntinue t use them thus familiar institutinal fd its pres ent reputatin rsameness giving Peple indefinitely and f unattractiveness

22 Managing the Institutin Cmmissary 1 1 g int an institutin hlding this prej udice and with their minds made up be and in mst hspitals they are nt t critical disappinted One wh attempts t intrduce variety int the diet instill int the emplyees in the kitchen the prper atti and tude tward a judicius use all fd at the same time instilling int the peple being materials fed an attitude respect rather than has a mst prdigius ne that will require criticism much time and but it task patience is ne wrth while

23 CHA PTER II FOOD VALUE OF CERTAIN PRODUCTS GENERAL PRINCIPLES OF CORRECT DIET DEFINITION OF FOOD FUNCTION IN THE BODY COMPOSITION AND UTILIZATION SOURCES OF FOOD Nt nly des fd play a very imprtant part in physical and mental but it als furnishes ne the largest items in efficiency the expense this wuld make it ne the first cnsideratins Lgically in the accunt business as a matter it is all t frequently ne living the but if it is given any fact cnsideratin last at Nature has wisely the human nt all nly in supplying prvided fds adapted fr t its varius bdy but in prviding facilities fr utilizing the needs The tent which we abuse this prvisin nature ex fd has much t t d with use the r lasting qualities the physical Amng thse us wh are well and and wish t remain as well as amng thse wh strng are mechanism handicapped by physical s there is mre wide spread interest in the quality a weakness and quantity dubt this partly due t the emphasis many ur NO fd leading medical is men are placing n the dietetic treatment the reasn that it is nly in recent years that this F has r been given much there are disease cmparatively few facts even well-established attentin theries n its several and r we find almst as many pin ins as we find advcates scientific phases phase all are agreed that Of mre attentin But be n dietaries shuld given ne t the nurishment and care the it fit all the rather than relying n drugs keeping bdy r ther means furnishing temprary time stimulatin 12

24 F d Value f C ertain Prducts 13 much is being written the subject fd S and diets that n need have n difficulty fd in acquiring ne materials The bulletins issued by the United States Gvernment at by the state infrmatin experiment and by the Washingtn agricultural clleges are and statins may usually be fr the Obtained asking authentic The terminlgy may hwever be cnfusing t ne familiar with the usage the different nt as it is nt The terms mst frequently publicatins in use are fd and fd gener unifrm ally A fd accepted definitin material fd is anything when cnstituents taken int the is capable building which repairing r furnishing r bdy material frm which energy may tissue be in rder t be a real it must be palatable if the best results are t be liberated thugh fd ; and Obtained it must be easily All fds cntain and xygen pr digestible carbn hydrgen ; teins in additin t nitrgen cntain these sulphur and smetimes phsphrus and ther this their distinctin frm ther fd elements being Thus we have the nitrgenus and nnnitrgenus principles fds the nnnitrgenus include the carbhydrates classificatin and ; Carbhydrates include the sugars and as fats the name are made up and starches and the implies latter tw being in the same carbn hydrgen prprtin as xygen tw atms hydrgen t xygen water with the exceptin ne lactse and ( H 0 2 gly is btained chiefly frm vegetables and Carbhydrate cgen the mst cmplex is fund in all green fruits plants and is manufactured frm by Starch chlrphyl and sunlight frm the carbn dixid in the air and frm water in the The starch grain is inclsed within a cell wall (cel Often as in rice and ther When sil l ul se ) in this frm it shuld be cked lng enugh and at high tugh cereals )

25 14 Mdern Dietetics enugh temperature t sten the intercellular tissue reach the starch making it mre easily and When the starch grains grain are they swell and frm a digested hmgeneus paste if cked cked fr sme starch is mre readily acted upn ; by the digestive juices Bailey time The actin dry heat n starch prduces ( dextrin ) Fa miliar examples this are fund in the tasting brwning flur Of fr Many cereals are bread par and n this grund the manufacturers gravies etc tiall claim y dextrinize fr them d that they are mre easily digested than thers But the bdy cannt use starch even in the frm men it must be changed t simple tined befre ; being r dextrse all frms carbhydrate sugars available must be changed t simple in fact sugars befre being absrbed by the There are many intermediate steps t this which begins in the with the actin bdy the ptyalin prducing the first and is ended in prcess muth the where it is changed change t its simplest Dextrse intestines is fund in natural frm in fruit and plant frm and sweet crn in cmparatively large amunts juices hney and raisins in small amunts in many ther In the dextrse is prduced by the actin veg e sme the digestive juices upn the starch r sugar bdy tables Of In a familiar illustratin the chang ing sucrse t invert sugar is given in the additin cking eaten lemn juice r cream tartar t cane sugar when mak Of ing prevent icing fndants etc crystallizatin t While dextrse is mre easily and quickly it ferments readily and surfeits Carbhydrates assimilated furnish the waste being eliminated in the frm quickly carbn dixid and water thrugh the energy and thugh a breath is very perspiratin little fd Sherman mentins sme studies Of the Cellulse carbhydrate urine utilizatin cellulse which indicate that it may have a value

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27 16 Mdern Dietetics vices cmbining it with ther fd The mst cnvenient f r way ding this is t use a great deal materials butter r il either cked r in in salad dressings n vegetables and sauces t be served with salads meats r Langwrthy and his cwrkers have been r making sme experiments in the use the cheaper vegetables Dr frms They have fund fds and als the marine such as Irish t sea be sme the media fat fr serving algae lard and the cheaper such as mss Oils suet lard and a way that disguises the taste fairly ils Cream may in be used in liberal thugh it is a well cmparatively expensive frm quantities mentined the nitrgenus fds are thse fat which A S cntain nitrgen and sulphur in additin t the abve ther fd The cmmn surces animal pr tein are and meat vegetable elements milk eggs ; prtein legumes and Animal prtein fds are and quite thrughly Meat has an c ncen agree cereals trated able flavr milk and eggs have a mild which digested makes it nt ; nly pssible t use them fr flavr a lng time withut palling the but they may be success fully cmbined with n ther appetite fd These fds in additin the inrganic salts which materials t cntain are On the ther prtein vegetable fds cntain ing prtein are as hand and sme this bulk is valuable desirable fr the Of bulky prcess stated They give variety t the and are a much less expensive frm pr digestin tein fd Of diet Accessry fd recently termed are in substances and material vitamines in the juices Just fund what these cereals substances legumes are is nt thugh they have the pwer t stimulate met meat knwn and seem necessary certain Gela ablism tin is a frm derived prtein t very cmmnly functins Of used Lusk says Gelatin is an artificial derivative an albuminid : largely in the skeletal structure cllagen fund

28 F d Value f C ertain Prducts 1 7 It cntains very nearly the same amunt nitrgen as and breaks up chemical treatment animals int sme n prtein the amin In the gelatin yields the same amunt sugar as des diabetic prtein it des acids nt build up new thugh it may diminish ; tissue It is tissue ur t discuss the numerus prteins nt fund purpse in fd hwever their chemi waste cal their functin materials in the except in a r dissimilarities general way and in cnnectin with bdy the fd in which they are In prteins are cagulated by heat and tugh fund ened by a high this reasn cking and milk shuld be cked at F a r temperature meat belw eggs the temperature biling Recent experiments wuld seem t indi cate that sme the are destryed at higher pint vitamines Prteins play an imprtant part in the chemistry and are acted upn by pepsin in temperatures the gastric nutritin being changed t prteses and pep The pancreatic and intestinal juices change mst juice them still and they are absrbed by the bdy tnes in the frm further amin Their functin is t build tissue thugh they may als furnish energy the acids waste chiefly is in the frm ; and eliminated The casein milk is cagulated urea by rennin sulphates prir t further and this actin will be men phsphates mre fully digestin in the discussin The carb tined and prteins are the fd principles milk hydrates Obtained frm fats rganic fd thse that are chemically changed and xidized materials incidental t their utili by the z atin Fds cntain ther fd principles an inrganic bdy many which are taken int the bdy and assimi lated withut Of further These are mineral salts nature and They liberate d all them change build thugh d nt many them help heat n r t d and water tissue this

29 18 Mdern Dieteti cs sme are essential fr bdy The mineral salts fund in the rdinary diet are sufficient fr rdi develpment nary any are it is mst apt be irn and use If In a vegetable lacking diet sdium chlrid t cmmn salt may be as vegetables cntain little ( sdium calcium salt ) in sluble frm as cmpared with animal lacking fd Many the vegetables cntain large amunts Often sdium chlrid is added fr flavr Sdium alkalies and ptassium help in the cnstructin bld cells and nly Calcium is necessary fr the grwth bne and Milk and eggs are rich in and this muscles calcium teeth is ne reasn why they are gd fds fr Irn is necessary fr the prductin children hemglbin The amunt irn salts present in vegetables depends the sil in which they are and the amunt left in n meats depends the bleeding the animal when grwn Green n especially are relatively rich killed in and sme vegetables spinach and egg ylk are ther irn Phsphrus and magnesium are ther elements cereals beef fund in the bdy in large enugh quantities t be men surces Phsphrus is furnished in the ylk egg and in Under nrmal cnditins the requirements the bdy mineral salts will be met by the use a milk mixed f r diet tined Drinking water usually cntains mineral character thse present is indicated by the hardness salts and the the If these salts are in the frm they may be precipitated by biling and the water made water carbnates st but if they are in the frm it can be made ; nly by the many the sulphates st prcesses metablism use are due t hydrlysis S O that Of water chemicals is necessary in keeping the bdy well even if it cntains n nutritive The average persn nurished requires frm five t pints water depending cnstituents six daily n his habits and the temperature Of the atmsphere sur

30 F d Value Certain Prducts 19 runding thugh nt all this is furnished by actu ally drinking Cnsiderable is present in fdstuffs and him sme is the cmbustin fdstuffs in it the prduced frm metablism The fd value any material depends nt alne the percentage fd principles which it n prtant as they may but als n the amunt im cntains pten tial energy it be its and its availability in the yields fd may digestibility yield excellent results in cal ries A and yet be little service the bdy bdy because t energy it difficult Nt the we but the fd is we Of nurishes The fd prtin eat digestin assimilate by the bdy may differ greatly under us fd different assimilated The bdy may be able t utilize mre at time than at and the freshness cnditins the ne its and anther the manner in which it is fd all have appearance their cked effect

31 CHA PTER III MILK AND ITS MODIFICATIONS COMPLETE VALUE FOOD FOR AND BUT NOT FOR ADULTS CHILDREN OF CREAM SKIMMED MILK EFFECT OF PA S TEURIZATION AND STERILIZATION US E OF EIWEIss MILCH KuM Iss AND CHEESE While milk may be a perfect fd fr a it is nt ideal fr the as the needs the yung child are nt the same as thse Of adult an The requirements the yung are mre the grwth tissue and bne than adult fr the fr fat r prductin milk cntains string enugh prtein mineral salts and energy t meet these One quart and milk cntains abut the same amunt nutriment as unces beef r unces requirements Milk cntains all 12 the fd Of principles carb 6 Of hydrates the frm fat in the frm bread prtein in in the casein lactse and and mineral cream salts and frm It is easily and albumin cmpletely water absrbed as there is n indigestible a use milk prlnged Of but may lead t cnstipatin residue Because it is deficient in cnstantly r milk alne may dyspepsia becme ne using irn Bread and when eaten milk tgether anemic make a very gd The cmpsitin milk varies with the different meal breeds cws and in different cws the same Jerseys and Alderneys prduce yellw the breed cream rises rapidly very rich milk and cmpletely and almst all separates frm the leaving it thin and in the milk frm Hlsteins blue-lking milk Durhams the rises ; slwly and nt at and richer cream Cream cntains all leaving a skimmed cmpletely the fd thugh they are in very small amunts all except principles The particles milk fat 2 0

32 Milk and Its M difi c atins 2 1 fat in cream are very finely making it easy Cream des nt prduce divided as much energy as it is a prprtinately mre expensive digestin and butter The cream as an accessry t many ur fd present-day use dishes is due t a r a s cultivated taste fr rich rather than t habit lgical cmbinatin a things Skimmed r separatr cntains the materials nus fd nitrg milk mineral milk and but lacks e fat the principles separatin has been salts sugar The value skimmed if milk is generally and it may effective well be used in cking nt where fat appreciated is needed r is fur in sme ther The suring nt milk des nt nish usually ed affect its fd Sur milk Of is prduced by frm lactic acid-frming when this acid is value bacteria and the which is insluble in an frmed is acid casein which precipitatin cntinues until such medium a percentage acid is frmed that the bacillus acidi precipitated will lnger ther when this de act l gree actici acidity n is in the prcess wrds Other rganisms reached may be suring present and prduce ther ceases thugh the acid medium has a tendency t check the changes grwth putrefactive When casein is precipitated by acid in the frm a the change micrrganisms is a physical the prperties are the curd same as they were in the sweet and ne If an alkali is the will be and sdium bicarbnate curd added (cmmn milk baking sda redisslved is mst Often used fr this purpse in ck ing but if the ) casein is precipitated by a chemical change ; takes and the prperties rennin are nt the as a curd is frmed that cannt readily be redisslved place same by an Rennin is the milk-cagulating enzyme the and rennin prepared frm the stmach Of a calf alkali furnishes stmach the rennet junket tablets the When rennin acts upn r the a clt is n which market frmed casein

33 22 Mdern Dietetics shrinks and squeezes the whey frms mass the density which depends ut n the amunt and a casein and salts present the acidity the The mineral healthy digestive and apparatus is gastric equal t the juice task nrmal this and failure t d s indicates faulty handling This mass difficulty may be vercme by t the milk lime barley r even plain digestin water adding t dilute the milk water and lwer water the percentage Cracker r bread crumbs will separate the par casein and hinder the frmatin a slid casein ticle anther s reasn why bread and milk make a gd cmbina clt and sipping the milk slwly will als Suring tin milk invariably takes place within a few days after help being drawn frm the the length time n the cleanliness the the temperature depending at cw which it is Preventing milk this and actin by means kept \ preservatives is n lnger prevalent t any great nr is the adulteratin milk with water practiced as extent since much Of has been dne by individuals and cmmunities s frmerly t imprve the quality milk sld If is added the milk t preserve there frmaldehyd may nt as has been t enugh present it t d any great harm be t the persn claimed drinking the but we infer that a dealer wh must resrt t this milk means is prducing milk that is nt clean is cntaminated in sme The frmaldehyd r destrys the lactic acid-frming but may inhibit the actin respect nt bacteria sme ther micrrganisms which may be mre Milk is a mst excellent medium fr the grwth micr harmful as it furnishes the required fd and misture fr their this reasn milk shuld always be rganisms kept in clean vessels F and r at a lw temperature it shuld activity nt be expsed in a particularly if there ; are many peple mving abut in the as is likely t be the rm case in kitchens institutins rm nr shuld it be left ;

34

35 2 4 Mdern Dieteti cs allwed t cntinue lng enugh fr the milk t becme When the prper degree has been the milk be put n Of ice peptnizing t prevent any fur bitter shuld reached ther actin Eiweissmilch is fund t be very beneficial fr chil dren wh have certain types digestive disturbances particularly intestinal This milk is Obtained by p reci p i tating the curd frm milk by temperature abut and adding rennin heating in the t a prprtin 100 tablespnfuls F t quart allwing it t stand 2 1 fif milk teen Or twenty minutes r using less rennin and it t stand keeping the temperature at abut allwing 100 lnger the casein is cagulated ; then it is drained fr F until abut an hur in a sterile muslin T the curd quart milk add pint buttermilk press thrugh a 1 bag fine Sieve tw three 1 times Of and beat ; As it is difficult t get r the fine enugh stay in vigrusly curd t susp en care must be taken in the milk fr warming sin This gives a milk rich in prtein and but pr in use fat Kumiss is anther preparatin milk that is valuable sugar in fevers generally impaired Kumiss was riginally made r frm the milk mares that wild n digestin the steppes In this cuntry cw s ran milk is and fermentatin Of is carried by kephir Russia Lactic ut used acid ther fermentatin take and the grains prduct is readily and Kumiss is place but it has a large amunt nutritive cnstituents digested expensive rendered easy kumiss is made by fer A s - called absrptin milk with a very desirable menting r milk sugar the carbhydrate substitute milk is a yeast particularly fd fr infants and invalids because it Lactse is easily gd It is nt sweet as cane and cnsequently des nt pall s the appetite It sugar digested is readily acted upn by n s int quickly splitting up micrrganisms

36 Milk and Its Mdifi cat ins 2 5 lactic This actin is highly desirable in sme fds fr instance but diarrhea infantile sum acids buttermilk mer trubles may ccasinally be r Lactse is used in making pills and and is frequently fur prduced in the fd typhid tablets in baby nish in many ed ther cases where there and patients is need t increase fds the value the calric Other prducts milk are cheese and Cheese fd cnsists essentially the casein and fat thugh butter the cagulated entangles in its meshes small milk prtins curd and The nature cheese mineral albumin depends lactse the richness the salts and methd n If pure kind milk whle milk milk is almst all the fd value manufacturing used and cltted with rennet the except the is t the This transferred milk is the case in lactse Cheddar cheese as in the cheese the making prprtin fat is ; made r greater making by adding cream Stiltn in ther the cream is remved and a lw percent ; r fat is cases This is smetimes dne in making cttage The flavr depends the left varieties bacteria mlds used the n cheese each species and chemical during changes ripening which prducing prcess give The prcess cn characteristic and in sme cases ripening fr the flavr flavrs tinue slwly s fr grwing weeks strnger and the cheese mnths mre palatable as time The st Stil cheeses shuld be C amembert cnsumed sn prgresses etc tn after cream Neufchatel Neufchatel and cream cheese are Similar cttage and may be eaten after day manufacture t Cream ne cheese cheese has mre fat than the ther but nne them is benefited by the curing ripening Camembert is Of a French cheese which ripens in abut tw prcess thirty kept in a cl and mld develps during is a days place curing Edam is the mst famus the Hlland cheeses It

37 2 6 Mdern Dietetics is made by using a pure culture slimy In Hlland it is marketed in abut a but when we get bacteria it in this cuntry it may be several mnth mnths Rque frt is made frm gat s milk and ripened by green Old a a strngly marked and is very Parmesan has mld and Gruyere and flavr expensive are als made frm its gat s These are the variatins Grgnzla fancy and the high price is paid fr flavr -called s rather milk than fr cheeses fd This is true many Of ur fds value but is particularly likely t be the case with American cheese cntains mre nutriment than Parme cheese and at half the Stiltn is abut the same fd san value but twice as Cheese eaten price fr flavr a s is an expensive if eaten fr fd value American expensive and the prper varieties are fd but it is a decidedly inex chsen pensive frm prtein Well-ripened cheese is nt dif t digest fr the average nrmal fic Because ult the large amunt healthy it may distress deli digestin cate digestive apparatus unless it is very finely fat divided which may be dne by by thrughly by cmbining milk grating bread Eggs chewing and r cheese make a cmbinatin with r prtein and fat in a rather crumbs cncentrated and hence many peple have difficulty in digesting Welsh frm Anther reasn fr culty in digesting diffi rarebit cheese dishes is as a t etc much Fatty acids are frmed in small amunts that rule during is the prcess and these may prve irri eaten tating and prduce disagreeable ripening Cheese shuld enter much mre largely int the diet effects well peple in this as it is ne the mst nutritius Of and satisfying fds we Of and cuntry deed all the rest the appreciates in Eurpe cheese mre have than and uses it as a regular wrld and rutine we fd

38 CHA PTER I V BUTTER IT S USES AND ITS SUBSTITUTES FOOD VALUE AVAILABILITY AND PH"SICAL PROPERTIES PROCESS OF RENOVATION ANIMAL AND VEGETABLE FATS OLEOMARGARINE OR BUTTERINE SUET AND LARD OLIVE OIL AND COTTONSEED OIL While cheese cntains nearly all the nutritive ents that may be btained frm butter c cntains nstitu practically nly the Mst the milk laws rdinances aimed t cver this subject require that milk r Shall cn fat tain less than frm t percent but this varies nt the breed 3 4 the Of her cndi fat accrding t cw care tin The age fat may be separated frm the milk by it etc t stand in a cl place until the cream rises allwing the tp because lwer It is then t skimmed r it may its be remved specific much mre cmpletely by the gravity f use a mechanical The prprtin cream btained depends n the methd and the separatr mechanical separatr can be regulated separating t Obtain any avail able cntent fat the average being pint yields abut t 18 t and 24 desired is a desirable A frm fat be used in the diet the percent calries t Of sick Gd it is very easily Hutchisn says fr cream percent cntains as much fat as a digested Dr : similar quantity ( 45 mst cd ) liver Oil emulsins and is usually much better an expensive frm when brne used by a is Cream hwever healthy persn with a nrmal fat and is quently taken either because a habit demanding fre digestin cream with t gratify a craving fr rich cereals rather desserts than fr nutritive r It is nt etc fd value 2 7

39 2 8 Mdern Dietetics an uncmmn peple insist either plain thing with fr a dessert t therwise n cream as rich as shuld be r whipped eaten at the end a heavy meal Devnshire cream is prepared by milk in deep pans r cltted in such a way that a rapid heating very cmplete separatin fat is This and cream cntains much as percent fat and nt frm mre btained than half as much as milk sugar 60 as rdinary fr which reasn it is particularly beneficial the cream treatment in Butter may be btained frm either sweet sur diabetes That frm sur cream a due r grwth rganisms during the ripening h as t flavr the which is cream cream butter made frm characteristic sweet cream gd lacks this Naturally but is preferred by butter especially peple suthern flavr and central many Butter withut salt is als liked by these but Eurpe neither the sweet nr the unsalted butter is as peple yet very cmmnly used in this except by the peple wh have cme here frm cuntry Salt is nt rdinarily used in large enugh quantities in butter t act as a preserva Eurpe fact that sweet butter des nt as well may be Th partially keep e by the lack bacterial tive actin during the accunted ripening and fr suring care is necessary t prduce butter with an Cnsid agree prcess erable Mst mdern dairies prduce a very unifrm and excellent flavr ur by intrducing pure cultures flavr the right kind bacteria and cntrlling the ripening While the Of essential cnstituent butter is it als cntains small quantities milk and fat prcess butter is kept any length sugar the casein salt underges If fr certain acids are and casein time the butter fermentatin becmes Thrugh frmed remves much these washing rancid acids Carelessness in handling cream r butter is nt infre

40 Butter Its Uses and Its S ubstitutes 2 9 quently practiced In small dairies r rural cmmunities where a inspectin is nt this is apt rigid As a enfrced a butter is prduced p articu larl which y is t t be put result n the market it is ccur subjected t t a rancid prcess this until renva tin it is melted and the Objectinable drs Fr by renvatin blwing air thrugh r by ther methds remved heat and washing applying it The clear which is nw quite with milk fat and churned it again sweet is drawn f mixed The result this is prduct which is much The degree renvatin a depends n the character the imprved stck frm which it was but butter dif fers smewhat in cmpsitin renvated made frm true butter and shuld nt be sld as Tubs what is claimed t be dairy butter Often renvated such Butter are yields fatty acids which butter fat n decmpsitin are sluble in and thers which are capric water butyric nt sluble in water mst abundant capric and ; the leic being Butter fat cntains percent The fat the human bdy has a large 40 percent lein Olein has a lw melting and is therefre easily lein and Taken pint in cnnectin with ther digested absrbed butter is highly digestible n the ther is mre and apt t Cked fds nutritius hand butter t the fatty acids liberated by wing which disagree are the digestive irritating heat digestin it t shuld be spread n Fr an impaired with sme starchy tract Liquefied bread fats are r cmbined smetimes t cat the stmach interir and prevent the administered actin material The effectiveness this treatment is c apt r r t sive be as the membrane is already mis pisn tened with verestimated and it is difficult t ingest enugh fat t cat the stmach mucus sufficiently r a substitute fr in is Olemargarine which a part r all the butter fat has been replaced butterine butter by

41 3 0 M dern Dietetics ther animal a mixture animal vegetable This cmbinatin r fats has prperties and similar fats natural butter far as the nutritive value is t fats but in making s this substitute the cncerned natu must lk fats and Oils that manufacturer are cheaper than f r rally and that can be readily butter Suet and lard have a higher percentage stearin and btained bth which have a higher melting Of pint than palmitin As stearin slidifies mre quickly than the ther it is mre easily the fats having a lein lwer melting pint are mixed with and Oils and quan fats remved tities butter give the appearance varying the natural t perfectly whlesme and nutritius lemargarine article prduct A has been Obtained which is as easily and almst as cmpletely absrbed as While the best grades butter have a finer flavr and are mre easily assimi butter lated than any substitute yet a gd grade lemargarine is mre whlesme prduced and palatable than a pr grade It is available fr peple wh can affrd the mre ex ensive it lacks the butter nt tw prperties in butter and p befre article mentined which may be the free butyric which is present detrimental namely in butter that is nt fresh and which acid may be irri tating t the digestive and excess which may cause There is n physi tract casein lgical reasn the rather widespread prejudice lgical against decmpsitin the butter fr Olive Oil and cttnseed are largely The pref substitutes erence given t Olive il is il due its It is n mre Olein nutritius than sme ther Oils t is much mre flavr Owing t the high price and Olive it is ex sme p en times adulterated with cheaper and Oil sive percent adulteratin may be used and nt be 20 t 3 0 ils In the States the adulterant is usually cttn distinguished United

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43 CHA PTER V VEGETABLE S IN THE DIETARY PH"SICAL AND PHYSIOLOGIC PROPERTIES DIFFERENTIA TION OF RAW AND COOKED VEGETABLES CHAR ACTERIS TICS OF POTATOES BEETS CARROTS ONIONS CABBAGE CAULIFLOWER ARTICHO KES TOMATOES ASPARAGUS LET TUGE CRESS CELERY CHICORY AND ALLIGATOR PEARs and fruits furnish the necessary The carbhydrate in vegetables cere Vegetables cereals als is chiefly and in fruits it is These and fd carbhydrates materials have starch very little but are relatively rich in sugar mineral with the fat exceptin the have enugh water in their cmpsitin t aid quite materially salts and cereals in supplying the needs the bdy in that respect All these fd materials are Obtained frm largely frm the plants leaves vegetables in frm the seeds and fruits r rt are stem what the name ; cereals ; These are made up innumerable the walls which plants are inclsing the starch cells implies The lder the cellulse the tugher this cellulse and the hardness plant this cellulse fiber is an grains imprtant factr in the palatability Of and digestibility becmes Of If the vegetable is yung and it is at its best vegetables when cked nly fr a shrt time tender and in a small amunt this a minimum the salts is dis B methd water y slved the sgginess vercked fd is and in ut green vegetables the natural clr is avided If the vegetable is it requires a lnger cking in a retained larger quantity lder water in rder t break up the inter cellular tissue and allw the starch grains t be Older vegetables are apt t have lst sme their rigi reached 3 2