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diff --git a/26058.txt b/26058.txt new file mode 100644 index 0000000..95e620a --- /dev/null +++ b/26058.txt @@ -0,0 +1,4574 @@ +The Project Gutenberg EBook of The Starvation Treatment of Diabetes, by +Lewis Webb Hill and Rena S. Eckman + +This eBook is for the use of anyone anywhere at no cost and with +almost no restrictions whatsoever. You may copy it, give it away or +re-use it under the terms of the Project Gutenberg License included +with this eBook or online at www.gutenberg.org + + +Title: The Starvation Treatment of Diabetes + +Author: Lewis Webb Hill + Rena S. Eckman + +Release Date: July 14, 2008 [EBook #26058] + +Language: English + +Character set encoding: ASCII + +*** START OF THIS PROJECT GUTENBERG EBOOK STARVATION TREATMENT OF DIABETES *** + + + + +Produced by Stacy Brown, Bryan Ness and the Online +Distributed Proofreading Team at https://www.pgdp.net (This +book was produced from scanned images of public domain +material from the Google Print project.) + + + + + + + + + +THE +STARVATION TREATMENT +OF DIABETES + +With a Series of Graduated Diets used at the + +MASSACHUSETTS GENERAL HOSPITAL + +by + + LEWIS WEBB HILL, M.D. + _Children's Hospital, Boston_ + +and + + RENA S. ECKMAN + _Dietitian, Massachusetts General Hospital, Boston_ + + With an Introduction + by + RICHARD C. CABOT, M.D. + +_Second Edition_ + + Boston, Mass. + W. M. LEONARD + 1916 + + + + + Copyrighted 1915 + by + W. M. Leonard + + Second Edition + First Edition Printed August, 1915 + Second Edition Printed January, 1916 + Second Edition Reprinted April, 1916 + + + + +INTRODUCTION. + + +Although Dr. Allen's modifications of the classical treatment of +saccharine diabetes have been in use only for about two years in the +hands of their author, and for a much shorter time in those of other +physicians, it seems to me already clearly proven that Dr. Allen has +notably advanced our ability to combat the disease. + +One of the difficulties which is likely to prevent the wide adoption +of his treatment is the detailed knowledge of food composition and +calorie value which it requires. Dr. Hill's and Miss Eckman's little +book should afford substantial aid to all who have not had opportunity +of working out in detail the progressive series of diets which should +be used after the starvation period. These diets, worked out by Miss +Eckman, head of the diet kitchen at the Massachusetts General +Hospital, have seemed to me to work admirably with the patients who +have taken them, both in hospital and private practice. The use of +thrice boiled vegetables, as recommended by Dr. Allen, seems to be a +substantial step in advance, giving, as it does, a considerable bulk +of food without any considerable carbohydrate portion, and with the +semblance of some of the forbidden vegetables. + +It is, of course, too early to say how far reaching and how permanent +the effects of such a diet will be in the severe and in the milder +cases of diabetes. All we can say is that thus far it appears to work +admirably well. To all who wish to give their patients the benefit of +this treatment I can heartily recommend this book. + +Richard C. Cabot. + + + + +PREFACE TO FIRST EDITION. + + +The purpose of this little book is to furnish to the general +practitioner in compact form the details of the latest and most +successful treatment of diabetes mellitus. + +The "starvation treatment" of diabetes, as advanced by Dr. Frederick +M. Allen of the Rockefeller Institute Hospital, is undoubtedly a most +valuable treatment. At the Massachusetts General Hospital it has been +used for several months with great success, and it is thought worth +while to publish some of the diets, and details of treatment that have +been used there, as a very careful control of the proteid and +carbohydrate intake is of the utmost importance if the treatment is to +be successful. In carrying out the Allen treatment the physician must +think in grams of carbohydrate and proteid--it is not enough simply to +cut down the supply of starchy foods; _he must know approximately how +much carbohydrate and proteid his patient is getting each day_. It is +not easy for a busy practitioner to figure out these dietary values, +and for this reason the calculated series of diets given here may be +of service. The various tests for sugar, acetone, etc., can, of +course, be found in any good text-book of chemistry, but it is thought +worth while to include them here for the sake of completeness and +ready reference. The food table covers most of the ordinary foods. + +We wish to thank Dr. Roger I. Lee and Dr. William H. Smith, visiting +physicians, for many helpful suggestions. + + + + +PREFACE TO SECOND EDITION. + + +The Authors beg to thank the Profession for the cordial reception +given the first edition of this book. The present edition has been +revised and enlarged, with the addition of considerable new material +which we hope will be of use. + +January, 1916. + + + + +DETAILS OF TREATMENT + + + + +DETAILS OF TREATMENT. + + +For forty-eight hours after admission to the hospital the patient is +kept on ordinary diet, to determine the severity of his diabetes. Then +he is starved, and no food allowed save whiskey and black coffee. The +whiskey is given in the coffee: 1 ounce of whiskey every two hours, +from 7 A.M. until 7 P.M. This furnishes roughly about 800 calories. +The whiskey is not an essential part of the treatment; it merely +furnishes a few calories and keeps the patient more comfortable while +he is being starved. If it is not desired to give whiskey, bouillon or +any clear soup may be given instead. The water intake need not be +restricted. Soda bicarbonate may be given, two drachms every three +hours, if there is much evidence of acidosis, as indicated by strong +acetone and diacetic acid reactions in the urine, or a strong acetone +odor to the breath. In most cases, however, this is not at all +necessary, and there is no danger of producing coma by the starvation. +This is indeed the most important point that Dr. Allen has brought out +in his treatment. At first it was thought best to keep patients in bed +during the fast, but it is undoubtedly true that most patients do +better and become sugar-free more quickly if they are up and around, +taking a moderate amount of exercise for at least a part of the day. +Starvation is continued until the urine shows no sugar. (The daily +weight and daily urine examinations are, of course, recorded.) The +disappearance of the sugar is rapid: if there has been 5 or 6 per +cent., after the first starvation day it goes down to perhaps 2 per +cent., and the next day the patient may be entirely sugar-free or +perhaps have .2 or .3 per cent. of sugar. Occasionally it may take +longer; the longest we have starved any patient is four days, but we +know of obstinate cases that have been starved for as long as ten or +eleven days without bad results. The patients tolerate starvation +remarkably well; in no cases have we seen any ill effects from it. +There may be a slight loss of weight, perhaps three or four pounds, +but this is of no moment, and indeed, Allen says that a moderate loss +of weight in most diabetics is to be desired. A moderately obese +patient, weighing say 180 pounds, may continue to excrete a small +amount of sugar for a considerable period if he holds this weight, +even if he is taking very little carbohydrate; whereas, if his weight +can be reduced to 170 or 160, he can be kept sugar-free, with ease, on +the same diet. _This is very important: reduce the weight of a fat +diabetic, and keep it reduced._ + +We have not found that the acetone and diacetic acid output behaves in +any constant manner during starvation; in some cases we have seen the +acetone bodies disappear, in others we have seen them appear when they +were not present before. + +Their appearance is not necessarily a cause for alarm. The estimation +of the ammonia in the urine is of some value in determining the amount +of acidosis present, and this can readily be done by the simple +chemical method given below. If the 24-hourly ammonia output reaches +over 3 or 4 grams, it means that there is a good deal of +acidosis--anything below this is not remarkable. More exact methods of +determining the amount of acidosis are the determination of the ratio +between the total urinary nitrogen and the ammonia, the quantitation +of the acetone, diacetic acid and oxy-butyric acid excreted, and the +carbon dioxide tension of the alveolar air. These are rather +complicated for average clinical use, however. + +When the patient is sugar-free he is put upon a diet of so-called "5% +vegetables," _i.e._ vegetables containing approximately 5% +carbohydrate. It is best to boil these vegetables three times, with +changes of water. In this way their carbohydrate content is reduced, +probably about one-half. A moderate amount of fat, in the form of +butter, can be given with this vegetable diet if desired. The amount +of carbohydrate in these green vegetables is not at all +inconsiderable, and if the patient eats as much as he desires, it is +possible for him to have an intake of 25 or 30 grams, which is +altogether too much; the first day after starvation the carbohydrate +intake should not be over 15 grams. Tables No. 1 and No. 2 represent +these vegetable diets. The patient is usually kept on diet 1 or 2 for +one day, or if the case is a particularly severe one, for two days. +The day after the vegetable day, the protein and fat are raised, the +carbohydrate being left at the same figure (diets 2, 3 and 4). No +absolute rule can be laid down for the length of time for a patient to +remain on one diet, but in general we do not give the very low diets +such as 2, 3 and 4, for more than a day or two at a time. _The diet +should be raised very gradually_, and it is not well to raise the +protein and carbohydrate at the same time, for it is important to know +which of the two is causing the more trouble. The protein intake may +perhaps be raised more rapidly than the carbohydrate, but an excess of +protein is very important in causing glycosuria, and for this reason +the protein intake must be watched as carefully as the carbohydrate. +With adults, it is advisable to give about 1 gram of protein per +kilogram of body weight, if possible; with children 1.5 to 2 grams. It +will be noticed that the diets which follow contain rather small +amounts of fat, a good deal less than is usually given to diabetics. +There are two reasons for this: In the first place, _we do not want +our diabetics, our adults, at any rate, to gain weight; and in the +second place acidosis is much easier to get rid of if the fat intake +is kept low_. If the fat values given in the diets are found too low +for any individual case, fat can very easily be added in the form of +butter, cream or bacon. Most adults do well on about 30 calories per +kilogram of body weight; children of four years need 75 calories per +kilogram, children of eight years need 60, and children of twelve +years need 50. + +If sugar appears in the urine during the process of raising the diet, +we drop back to a lower diet, and if this is unavailing, start another +starvation day, and raise the diet more slowly. But it will be found, +if the diet is raised very slowly, sugar will not appear. It is not +well to push the average case; if the patient is taking a fair diet, +say protein 50, carbohydrate 50 and fat 150, and is doing well, +without any glycosuria, it is not desirable to raise the diet any +further. The caloric intake may seem rather low in some of these +diets, but it is surprising to see how well most patients do on 1500 +or 2000 calories. + +It will be seen that the treatment can be divided into three stages: + +(1) The stage of starvation, when the patient is becoming sugar-free. + +(2) The stage of gradually working up the diet to the limit of +tolerance. + +During the first two stages a daily weight record should be kept, and +the urine should be examined every day. The patient should, of course, +be under the immediate supervision of the physician during these two +stages. It is always well to discharge a patient on a diet somewhat +under his tolerance, if possible. + +(3) The stationary stage, when the diet is kept at a constant level. +The patient is at home and going about his business. Most patients may +be taught to test their own urine, and they should do this every other +day. If there is sugar in the urine, the patient should go back to a +lower diet, and if he cannot be made sugar-free this way, he should be +starved again. A semi-starvation day of 150 grams of vegetables, once +a week, whether or no the urine contains sugar, is of value for the +purpose of keeping well within the margin of safety and of reminding +the patient that he is on a strict diet. + +_It is very important for a diabetic to take a considerable amount of +exercise: he can utilize his carbohydrate better, if he does._ + +If this treatment is to be successful, it is absolutely necessary for +the patient to adhere very strictly to the diets, and to measure out +everything very carefully; the meat especially should be weighed. + +It will be noticed that in some cases the calories in the diets do not +tally exactly with the protein, fat and carbohydrate values. The +reason for this is that for the sake of convenience the calories have +been given in round numbers--5 or ten calories one way or the other +makes no difference. + +The essential points brought out by Allen's treatment are as follows: + +(1) It is not dangerous to starve a diabetic, and two or three days of +starvation almost always make a patient sugar-free, thus saving a good +deal of time, as contrasted with the old treatment of gradually +cutting down the carbohydrate. + +(2) It is not desirable for all diabetics to hold their weight. Some +cases may do much better if their weight is reduced ten, fifteen, or +even twenty pounds. + +(3) After starvation, the diet must be raised very slowly, to prevent +recurrence of glycosuria. + +(4) An excess of protein must be regarded as producing glycosuria and +an excess of fat ketonuria, and the protein and fat intake must be +restricted a good deal more than has usually been the custom in +treating diabetes. + + + + +Case Reports. + + +It is thought worth while, for the sake of illustration, to include a +few case reports. The adults were treated at the Massachusetts General +Hospital, the children at the Children's Hospital. + +Two charts are kept for each case: one a food chart, with the amounts +of the different articles of food taken each day, and the protein, +carbohydrate, fat and caloric value figured out for each foodstuff; +the second (see below) a more general chart, which shows graphically +the progress of the case. + +The first three are cases which were treated first with the old method +of _gradually_ reducing the carbohydrate intake and could never be +made sugar-free, running from 0.1% to 0.2% of sugar. On the new +treatment they responded promptly and were discharged sugar-free. + + * * * * * + +Case 1. A woman of 64, diabetic for two years. She was sent in from +the out-patient department, where she had been receiving a diet of 50 +grams of carbohydrate and 50 grams of protein. On this diet she was +putting out 8 grams of sugar a day with moderately strong acetone and +diacetic acid reactions in her urine. When the carbohydrate was cut in +the ward to 30 grams, she put out 3 grams of sugar a day. She +complained of severe pruritus vulvae. After sixteen days of this +treatment she continued to put out from 0.1% to 0.2% of sugar a day. +Allen's treatment was then started, and after one day of starvation +she was sugar-free and remained so for four days on a diet of +carbohydrate, 20 grams; protein, 30 grams; fat, 150 grams. The +itching had gone. Then the protein was raised to 80 grams, with the +carbohydrate at 20 grams, and she immediately showed 1.5% of sugar. +This is very important; the protein should not be raised too quickly. +This we did not realize in our earlier cases. + +A second starvation day, followed by two vegetable days, and a more +careful raising of the diet--as follows--kept her sugar-free, and she +was discharged so. Her diets were: + +Dec. 12. + Carbohydrate, 20 grams. + Protein, 30 grams. + Fat, 150 grams--1500 calories. No glycosuria. + +Dec. 15. + Carbohydrate, 30 grams. + Protein, 30 grams. + Fat, 200 grams--2000 calories. No glycosuria. + +Dec. 20. + Carbohydrate, 30 grams. + Protein, 40 grams. + Fat, 180 grams--2000 calories. No glycosuria. + +Dec. 26. + Carbohydrate, 40 grams. + Protein, 40 grams. + Fat, 180 grams--2000 calories. No glycosuria. + +Dec. 30. + Carbohydrates, 50 grams. + Protein, 50 grams. + Fat, 180 grams--2000 calories. No glycosuria. + Weight on entrance, 119 pounds. + Weight at discharge, 116 pounds. + + * * * * * + +Case 2. A Jew of 49, at entrance had 175 grams of sugar (5.5%), +acetone slight, diacetic acid absent. Treated for three weeks with the +old method, he got down to a diet containing carbohydrate, 15 grams; +protein, 50 grams,--but still put out from 3 to 8 grams of sugar a +day. By the old method we could not do away with the last traces of +sugar. + +The Allen treatment was started with two starvation days. On the +second he was sugar-free--but showed 2.6 grams of sugar the following +day on 12 grams of carbohydrate and 40 grams of protein. (This was one +of the earlier cases when the diet was raised too quickly after +starvation.) After one more starvation day and two vegetable days he +stayed sugar-free while the diet was raised slowly to 30 grams of +carbohydrate and 45 grams of protein, calories about 2000. Discharged +sugar-free on this diet. + + Weight at entrance, 109 pounds. + Weight at discharge, 110 pounds. + + * * * * * + +Case 3. A man of 35, a severe diabetic, entered Dec. 28, 1914. He had +been in the hospital the previous July for a month and could never be +made sugar-free with the old method of treatment. At entrance he was +putting out 2.5% of sugar (135 grams) per day with strongly positive +acetone and diacetic acid tests. Two starvation days made him +sugar-free, but we made the mistake of not using twice boiled +vegetables for his vegetable day after starvation. So on this day he +got about 30 grams of carbohydrates, and for a few days he showed from +0.2% to 1% of sugar. Another starvation day was given him and he +became sugar-free. This time his vegetables were closely restricted +and he was given only enough twice-boiled vegetables to provide about +15 grams of carbohydrates. After this the diet was raised very slowly. +He remained sugar-free for three weeks and was discharged so on, + + Carbohydrate, 20 grams. + Protein, 40 grams. + Fat, 200 grams. + At no time did he receive more than 2200 calories. + Weight at entrance, 139 pounds. + Weight at discharge, 138 pounds. + + * * * * * + +These three cases were the first ones we tried, and in each one of +them we made the mistake of raising the diet too quickly--either +allowing too many vegetables on the vegetable day, or raising the +protein too quickly afterwards. With the later cases, after we had +more experience, there was no more trouble. + + * * * * * + +Case 4. A Greek (male) of 48, diabetic for two months, entered Jan. +14, 1915, with 3.8% (65 grams) of sugar and moderate acetone reaction. +There was no diacetic reaction present at entrance. After one +starvation day he became sugar-free, but was kept on starvation one +day longer and then started on vegetables in the usual way. After the +third day a moderate amount of diacetic acid appeared in the urine and +continued. The ammonia rose from 0.7 grams per day to 2.6 grams per +day, and then varied from 0.3 to 1.5 grams per day. No symptoms of +acidosis. + +Jan. 18. + Carbohydrate, 15 grams. + Protein, 25 grams. + Fat, 150 grams--1360 calories. No glycosuria. + +Jan. 20. + Carbohydrate, 15 grams. + Protein, 25 grams. + Fat, 200 grams--1571 calories. No glycosuria. + +Jan. 24. + Carbohydrate, 25 grams. + Protein, 35 grams. + Fat, 200 grams--1760 calories. No glycosuria. + +Jan. 26. + Carbohydrate, 35 grams. + Protein, 40 grams. + Fat, 200 grams--1838 calories. No glycosuria. + +Jan. 29. + Carbohydrate, 45 grams. + Protein, 50 grams. + Fat, 200 grams--2194 calories. No glycosuria. + +Jan. 31. + Carbohydrate, 50 grams. + Protein, 60 grams. + Fat, 200 grams--2347 calories. No glycosuria. + Discharged Feb. 1 sugar-free on this diet. + Weight at entrance, 160 pounds. + Weight at discharge, 156 pounds. + This was not a severe case and responded very easily to treatment. + + * * * * * + +Case 5. A female of 59, a diabetic of two years' standing, excreted +2.6% of sugar on Jan. 16, 1915, with no acetone or diacetic acid +reactions in the urine. Severe pruritus vulvae. Starved two days; +sugar-free on the second starvation day, with disappearance of the +pruritus. + +Jan. 21. + Carbohydrate, 15 grams. + Protein, 25 grams. + Fat, 150 grams--1595 calories. No glycosuria. + From this time the diet was slowly raised until on + +Jan. 30 she was getting + Carbohydrate, 35 grams. + Protein, 45 grams. + Fat, 200 grams--2156 calories. + She was sugar-free on this and was discharged to the out-patient + department after a two weeks' stay in the wards. + Weight at entrance, 135 pounds. + Weight at discharge, 133 pounds. + + * * * * * + +Case 6. A man of 52, entered Jan. 10, 1915, with 1% of sugar. He +entered for arteriosclerosis and hypertension, and the sugar was found +in the routine examination of the urine. He was kept on house diet for +a few days and his sugar rose to 3.5%. No acetone or diacetic acid. +After two days of starvation he became sugar-free and continued so as +the diet was slowly raised. He was kept sugar-free in the ward +eighteen days and was sugar-free on Feb. 6 with a diet of + + Carbohydrate, 60 grams. + Protein, 60 grams. + Fat, 200 grams--2280 calories. + +On Feb. 7 the protein was raised to 80 grams and 0.2% of sugar +appeared in the urine. The protein was then reduced to 60 grams and he +remained sugar-free on this diet and was discharged so. + +In this case, after starvation, a moderate amount of acetone appeared +and continued. No symptoms of acidosis. The ammonia ran from 0.3 to +1.0 grams per day. + + Weight at entrance, 160 pounds. + Weight after three weeks' treatment, 156. + Maximum caloric intake, 2525. + + * * * * * + +Case 7. A young man of 25, diabetic for eight months, entered Jan. 20, +1915, with 6.6% (112 grams) of sugar and strongly positive tests for +acetone and diacetic acid. After a period of two starvation days he +was sugar-free and actually gained three pounds in the process of +starvation (probably due to water retention). + +His diet was then raised as follows:-- + +Jan. 24. + Carbohydrate, 15 grams. + Protein, 25 grams. + Fat, 150 grams. No glycosuria. + +Jan. 26. + Carbohydrate, 20 grams. + Protein, 35 grams. + Fat, 175 grams. No glycosuria. + +Jan. 29. + Carbohydrate, 20 grams. + Protein, 45 grams. + Fat, 200 grams. No glycosuria. + +Jan. 31. + Carbohydrate, 30 grams. + Protein, 45 grams. + Fat, 200 grams. No glycosuria. + +At entrance his ammonia was 1.7 grams per day; after the starvation +days it ran from 0.9 grams to 0.3 grams per day. The acetone was a +little stronger than at entrance; the diacetic absent except on three +days. + +On Feb. 5 he was still sugar-free having been so since his starvation +days two weeks previously, and weighed 127 pounds, a gain of seven +pounds since entrance. At no time did he receive over 2150 calories. + +This was a very satisfactory case; no doubt the carbohydrate could +have been raised to 50 or 60 grams, but he was doing so well that we +felt it unwise to go any further. + + * * * * * + +Diabetes in children is likely to be a good deal more severe than it +is in adults. Still, in the few cases that have been treated with the +starvation treatment at the Children's Hospital, the results have been +very satisfactory, as far as rendering the patient sugar-free is +concerned. Most diabetic children, however, are thin and frail, and +they have no extra weight to lose, so it does not seem so desirable to +bring about any very great loss of weight, which is quite an essential +part of the treatment for most adults. The few children that have been +treated have borne starvation remarkably well. It is too early, and we +have seen too few children treated by this method, to say what +influence it may have on the course of the disease, but it can +certainly be said that it is very efficacious in rendering them +sugar-free. + + * * * * * + +Case 8. M. M., female, 12 years, entered the Children's Hospital April +1, 1915. She had probably had diabetes for about 6 months, and had +been on a general diet at home. (See charts on pp. 31-36.) + +On the ordinary diet of the ward she showed 8.7% sugar, no acetone or +diacetic acid. Weight, 52-1/4 pounds,--a very thin, frail girl. She +was starved two days, taking about 1-1/2 oz. of whiskey in black +coffee each day. + +The first day of starvation the sugar dropped to 2.3%, and a slight +trace of acetone appeared in the urine. The second day of starvation +she was sugar-free, with a moderate acetone reaction. No soda +bicarbonate was given. She lost 2 pounds during starvation. After she +became sugar-free, her diets were as follows: + +April 5. + Whiskey, 1-1/2 ounces. + Protein, 5 grams. + Carbohydrate, 12 grams. + Fat, 7 grams. No glycosuria. + Calories, 213. + +April 6. + Whiskey, 1-1/2 ounces. + Protein, 26 grams. + Carbohydrate, 18 grams. + Fat, 46 grams. No glycosuria. + Calories, 768. + +April 8. + Whiskey, 1-1/2 ounces. + Protein, 45 grams. + Carbohydrate, 22 grams. + Fat, 72 grams. No glycosuria. + Calories, 1050. + +April 9. + Whiskey, 1-1/2 ounces. + Protein, 58 grams. + Carbohydrate, 36 grams. + Fat, 86 grams. No glycosuria. + Calories, 1309. + +From this her diet was raised gradually until on April 16 she took the +following: + + Bacon, 4 slices. + Oatmeal, 2 tablespoonfuls. + Bread, 2 slices. + Meat, 1 ounce. + Cabbage, 5 tablespoonfuls. + Spinach, 5 tablespoonfuls. + String beans, 5 tablespoonfuls. + Butter, 2 ounces. + +This calculated to, + + Protein, 64 grams. + Carbohydrate, 63 grams. + Fat, 113 grams. + Calories, 1546. + On this diet she excreted .40% sugar. + +The next day the bread was cut down to one slice, and her sugar +disappeared. On April 20 she was taking 4 tablespoonfuls of oatmeal +and one slice of bread with her meat and vegetables, and was +sugar-free. This diet contained: + + Protein, 63 grams. + Carbohydrate, 59 grams. + Fat, 112 grams. + Calories, 1521. + +On April 21, on the same diet, she excreted 1.1% sugar. The next day +her oatmeal was cut to 2 tablespoons, giving her about 10 grams less +carbohydrate. No glycosuria. She was discharged April 24, sugar-free +on + + Protein, 63 grams. + Carbohydrate, 50 grams. + Fat, 112 grams. + Calories, 1510. + +There had never been any diacetic acid in her urine, and only a trace +of acetone. She lost about 2 pounds during starvation, but gained part +of it back again, so that at the discharge she weighed just a pound +less than when she entered the hospital. She has been reporting to the +Out-patient Department every two weeks, and has never had any sugar, +acetone or diacetic acid in the urine, and appears to be in splendid +condition. She is taking just about the same diet as when she left the +hospital. + +A rather mild case, which responded readily to treatment. The question +is, can she grow and develop on a diet which will keep her sugar-free? + + * * * * * + +Case 9. M. D., female, age 3-1/2 years, entered April 7, 1915, with a +history of having progressively lost weight for a month past, and of +having had a tremendous thirst and polyuria. Had been on a general +diet at home. At entrance the child was in semi-coma, with very strong +sugar, diacetic acid and acetone reactions in the urine. For the first +12 hours she was put on a milk diet, with soda bicarbonate gr. xxx +every two hours, and the next day was starved, with whiskey 1 drachm +every 2 hours, and soda bicarbonate, both by mouth and rectum. She +died after one day of starvation. This is hardly a fair test case of +the starvation treatment, as the child was already in coma and almost +moribund when she entered the hospital. When a diabetic, old or young, +goes into coma, he rarely comes out of it, no matter what the +treatment is. + + * * * * * + +Case 10. H. S., male, 6 years, entered April 29, 1915. Duration of his +diabetes uncertain; not discovered until day of entrance. An +emaciated, frail looking boy. He would eat very little at first, and +on ward diet, containing 31 grams of protein, 73 grams of +carbohydrate, and 20 grams of fat, he excreted 5.7% of sugar, with a +moderate amount of acetone, and a very slight trace of diacetic acid. + +May 2 he was starved, taking 1-1/2 ounces of whiskey. One day of +starvation was enough to make him sugar-free. His diet was gradually +raised, until on May 7 he was taking 32 grams protein, 33 grams +carbohydrate, and 75 grams fat, and was sugar-free, with absent +diacetic acid and acetone. May 9 his carbohydrate intake was raised to +45 grams and he excreted .40% sugar. May 10 it was cut to 40 grams, +and he excreted 2.2% sugar. + +May 11 it was cut to 20 grams, and he became sugar-free and remained +so until June 8, when he was discharged, taking the following diet: + + String beans, 3 tablespoonfuls. + Spinach, 4 tablespoonfuls. + Bacon, 4 slices. + Butter, 2 ounces. + Eggs, 3. + Bread, 1/2 slice. + Cereal, 2 tablespoonfuls. + Meat, 3 ounces. + Protein, 63 grams. + Carbohydrate, 31 grams. + Fat, 113 grams. + Calories, 1402. + +For the first few days after entrance he showed a moderate amount of +acetone and a slight amount of diacetic acid in the urine; for the +rest of his stay in the hospital these were absent. His weight at +entrance was 31-1/2 pounds; he lost no weight during starvation, and +weighed 32-1/2 pounds on discharge. + +He was kept on approximately the same diet, and was followed in the +Out-patient Department, and on two occasions only did his urine +contain a small trace of sugar and of acetone (July 31 and Oct. 16, +1915). Nov. 9 his mother brought him in, saying he had lost his +appetite, which had previously been good. The appearance of the boy +was not greatly different than it had been all along, but his mother +was advised to have him enter the wards immediately, so that he could +be watched carefully for a few days. She refused to leave him, but +said she would bring him in to stay the next day. She took him home, +and he suddenly went into coma and died that night. This was a most +unfortunate ending to what seemed to be a very satisfactory case. The +boy's mother was an extremely careful and intelligent woman, and it is +certain that all directions as to diet were carried out faithfully. + +He had never shown any evidence of a severe acidosis, but he must have +developed one very suddenly. + + * * * * * + +Case 11. V. D., 11 years, female, was admitted to the Children's +Hospital Nov. 3, 1915. She had had diabetes for at least a year. On +house diet, containing about 90 grams of carbohydrate, she excreted +6.9% of sugar, with moderate acetone and diacetic acid reactions in +the urine. + +Starting Nov. 5, she was starved 3 days. The first day of starvation +the sugar dropped to 3.5%, the second day to 1.1%, and the third day +she was sugar-free with a little more acetone in the urine than had +been present before, but not quite so much diacetic acid. From then +her diet was raised as follows: + +Nov. 8. + Protein, 9 grams. + Carbohydrate, 20 grams. + Fat, 9 grams. No glycosuria. + Calories, 200. + +Nov. 9. + Protein, 7 grams. + Carbohydrate, 15 grams. + Fat, 35 grams. No glycosuria. + Calories, 415. + +Nov. 10. + Protein, 17 grams. + Carbohydrate, 15 grams. + Fat, 55 grams. No glycosuria. + Calories, 625. + +Nov. 11. + Protein, 38 grams. + Carbohydrate, 20 grams. No glycosuria. + Fat, 88 grams. + Calories, 1055. + +Nov. 13 two tablespoonfuls of oatmeal were added to her diet, making +the carbohydrate intake about 30 grams. This day she showed .6% sugar. +She was starved for half a day and became sugar-free again. + +On Nov. 16 she was taking protein 40, carbohydrate 20, fat 90, +calories 1080, and had no glycosuria. + +Nov. 17 her diet was protein 43, carbohydrate 25, fat 140, calories +1538, and on this diet she showed .5% sugar. The carbohydrate was cut +to 15 grams, and kept at this level for 3 days, but she still +continued to excrete a trace of sugar, and so on Nov. 21 she was +starved again, immediately becoming sugar-free. From this her diet was +raised, until on discharge, Nov. 30, she was taking: protein 48, +carbohydrate 15, fat 110, calories 1280, and was sugar-free, having +been so for 9 days. + +At entrance she weighed 56 pounds, at discharge 54, and lost 4 pounds +during starvation, part of which she gained back again. On the diet +which she was taking at discharge, she was just about holding her +weight. She never excreted much acetone or diacetic acid, and when she +was discharged there was merely the faintest traces of these in the +urine. + +It is not well to raise the diet quite so rapidly as was done in this +case, but for special reasons she had to leave the hospital as soon as +possible, and so her diets were pushed up a little faster than would +ordinarily be the case. + +Below is a graphic chart, such as we use in recording our cases. It +has been split up into several pieces here on account of its size: + +[Illustration: Case 8. A chart tracking Urine and Calorie Intake for +the month of April.] + +[Illustration: A chart tracking Carbohydrate and Protein Intake for +the month of April.] + +[Illustration: A chart tracking per cent. of sugar for the month of +April.] + +[Illustration: A chart tracking sugar output for the month of April.] + +[Illustration: A chart tracking ammonia for the month of April.] + +[Illustration: A chart tracking acetone and diacetic acid for the month +of April.] + +[Illustration: A chart tracking weight in pounds for the month of +April.] + + +EXAMINATION OF THE URINE. + +_Directions for Collecting Twenty-four Hour Urine._ + +Pass the urine at 7 a.m. and throw it away. + +Save all the urine passed after this up to 7 a.m. the next day. Pass +the urine exactly at 7 a.m., and add it to what has previously been +passed. + + +_Qualitative Sugar Tests._ + +(1) Fehling's Test:--Boil about 4 c.c. of Fehling's[1] solution in a +test tube, and add to the hot Fehling's an equal amount of urine, a +few drops at a time, boiling after each addition. + +A yellow or red precipitate indicates sugar. + +For practical purposes in the following of a diabetic's daily urine, +this is a valuable test, and the one which we always use. + +(2) Benedict's Test:--To 5 c.c. of Benedict's[2] reagent add 8 drops +of the urine to be examined. The fluid is boiled from 1 to 2 minutes +and then allowed to cool of itself. If dextrose is present there +results a red, yellow, or green precipitate, depending upon the +amount of sugar present. If no sugar is present the solution may +remain perfectly clear or be slightly turbid, due to precipitated +urates. + +This is a more delicate test than Fehling's. + + [1] Fehling's solution is prepared as follows: + + (a) Copper sulphate solution: 84.65 gm. of copper sulphate + dissolved in water and made up to 500 c.c. + + (b) Alkaline tartrate solution: 125 gm. of potassium hydroxide + and 178 gm. of Rochelle salt dissolved in water and made up to + 500 c.c. + + These solutions are kept in separate bottles and mixed in equal + volumes when ready for use. + + [2] Benedict's solution has the following composition: + + Copper sulphate, 17.8 gm. + Sodium citrate, 178.0 gm. + Sodium carbonate (anhydrous), 100 gm. + Distilled water to 1000 c.c. + + +_Quantitative Sugar Tests._ + +(1) The Fermentation Test:--The fermentation test is the simplest +quantitative test for sugar, and is quite accurate enough for clinical +work. It is performed as follows: The specific gravity of the 24 deg. +urine is taken, and 100 c.c. of it put into a flask, and a quarter of +a yeast cake crumbled up and added to it. The flask is then put in a +warm place (at about body temperature) and allowed to remain over +night. The next morning a sample of the fermented urine is tested for +sugar. If no sugar is present the urine is made up to 100 c.c. (to +allow for the water that has evaporated) and the specific gravity +taken again. The number of points loss in specific gravity is +multiplied by .23, and this gives the percentage of sugar in the +urine. + +(2) Benedict's Test:--The best quantitative test for dextrose +(excepting polariscopic examination, which is too complicated for +ordinary work) is Benedict's test. + +It is performed as follows: Measure with a pipette 25 c.c. of +Benedict's solution into a porcelain dish, add 5 or 10 gm. +(approximately) of solid sodic carbonate, heat to boiling, and while +boiling, run in the urine until a white precipitate forms. + +Then add the urine more slowly until the last trace of blue +disappears. The urine should be diluted so that not less than 10 c.c. +will be required to give the amount of sugar which the 25 c.c. of +reagent is capable of oxidizing. + +Calculation: 5, divided by the number of c.c. of urine run in, equals +the per cent. of sugar. + +Benedict's quantitative solution is prepared as follows: Dissolve 9.0 +gm. of copper sulphate in 100 c.c. distilled water. (The copper +sulphate must be weighed very accurately.) Dissolve 50 gm. anhydrous +sodic carbonate, 100 gm. sodic citrate, and 65 gm. of potassium sulpho +cyanate in 250 c.c. of distilled water. + +Pour the copper solution slowly into the alkaline citrate solution. +Then pour the mixed solution into the flask without loss, and make up +to 500 c.c.; 25 c.c. of this solution is reduced by 50 mgm. of +dextrose, 52 mgm. of levulose or 67 mgm. of lactose. + +(3) Acetone Test:--To 5 c.c. of urine in a test tube add a crystal of +sodium nitro prusside. Acidify with glacial acetic acid, shake a +moment, and then make alkaline with ammonium hydrate. A purple color +indicates acetone. + +(4) Diacetic Acid Test:--To 5 c.c. of urine in a test tube add an +excess of a 10% solution of Ferric chloride. A Burgundy red color +indicates diacetic acid. + + +_Quantitative Test for Ammonia._ + +To 25 c.c. of urine add 5 c.c. of a saturated solution of potassium +oxalate and 2 to 3 drops of phenolphthalein. + +Run in from a burette decinormal sodic hydrate, to a faint pink color. +Then add 5 c.c. of formalin (40% commercial) and again titrate to the +same color. + +Each c.c. of the decinormal alkali used in this last titration equals +1 c.c. of n/10 ammonia, or .0017 gm. of ammonia. Multiply this by the +number of c.c. n/10 sodic hydrate used in the last titration; this +gives the number of grams of ammonia in 25 c.c. urine. + +Note:--The potassium oxalate and the formalin must both be neutral to +phenolphthalein. + + 1 kilogram = 2.2 pounds. + 1 calorie = The amount of heat necessary to raise the temperature + of 1 kilogram of water 1 degree Centigrade. + 1 gram fat = 9.3 calories. + 1 gram protein = 4.1 calories. + 1 gram carbohydrate = 4.1 calories. + + + + +DIETS. + + +In the diet tables following, the vegetables listed, excepting +lettuce, cucumbers, celery, and raw tomatoes, are boiled. In the very +low carbohydrate diets they are thrice boiled. When possible to obtain +the figures, the analyses for boiled vegetables have been used. It has +been estimated that four-tenths of the carbohydrate will go into +solution when such vegetables as carrots and cabbage are cut into +small pieces, and thoroughly boiled, with changes of water. It must be +remembered that bacon loses about half its fat content when moderately +cooked. + +A number of more or less palatable breads may be made for diabetics, +but the majority of the so-called "gluten" and "diabetic flours" are +gross frauds, often containing as much as fifty or sixty per cent. +carbohydrate. Gluten flour is made by washing away the starch from +wheat flour, leaving a residue which is rich in the vegetable protein +gluten, so it must be remembered that if it is desired to greatly +restrict the protein intake, any gluten flour, even if it contains +only a small percentage of carbohydrate, must be used with caution. +The report of 1913, Connecticut Agricultural Experiment Station, Part +I, Section 1, "Diabetic Foods", gives a most valuable compilation of +analyses of food products for diabetics. We have found some use for +soya meal, casoid flour and Lyster's flour, "akoll" biscuits, and +"proto-puffs," but generally the high protein content of all of these +foods interferes with giving any large quantity of them to a severe +diabetic over a long period of time. The flours mentioned below we +know to be reliable. + +Some recipes which we have found useful are given below. The use of +bran is meant to dilute the protein, increase the bulk, and +incidentally to aid in preventing or correcting constipation. + + +BRAN AND LYSTER FLOUR MUFFINS.[3] + + 2 level tablespoons lard + 2 eggs + 4 tablespoons heavy cream, 40% fat + 2 cups washed bran + 1 package Lyster flour + 1/2 cup water or less + +Tie dry bran in cheesecloth and soak 1 hour. Wash, by squeezing water +through and through, change water several times. Wring dry. + +Separate eggs and beat thoroughly. Add to the egg yolks the melted +lard, cream and 2 beaten egg whites. Add the Lyster flour, washed bran +and water. + +Make eighteen muffins. + +Total food value: Protein 99 grams, fat 68 grams, carbohydrate 2 +grams, calories 1049. + +One muffin = protein 5 grams, fat 4 grams, carbohydrate, trace, +calories 58. + + [3] Lyster's Diabetic Flour prepared by Lyster Brothers, + Andover, Mass. + + +BRAN CAKES. + + 2 cups wheat bran + 2 tablespoons melted butter + 2 whole eggs + 1 egg white + 1/2 teaspoon salt + 1/2 grain saccharine + +Tie bran in a piece of cheesecloth and soak for one hour. Wash by +squeezing water through and through. Change water several times. Wring +dry. Dissolve saccharine in one-half teaspoon water. Beat the whole +eggs. Mix the bran, beaten eggs, melted butter, and saccharine +together. Whip the remaining egg white and fold in at the last. Form +into small cakes, using a knife and a tablespoon. Bake on a greased +baking sheet until golden brown. + +This mixture will make about 25 small cakes. One cake represents 16 +calories. A sample cake made by this recipe was analyzed and found to +contain neither starch nor sugar. + + +SOYA MEAL AND BRAN MUFFINS.[4] + + 1 ounce (30 grams) soya meal + 1 level tablespoon (15 grams) butter + 1 ounce (30 c.c.) 40% cream + 1 cup of washed bran (see method given elsewhere) + 1 egg white + 1 whole egg may be substituted for 1 egg white + 1/4 teaspoon salt + 1-1/2 teaspoons baking powder + +Mix soya meal, salt and baking powder. Add to the washed bran. Add +melted butter and cream. Beat egg white and fold into mixture. Add +enough water to make a very thick drop batter. Bake in six +well-greased muffin tins until golden brown--from fifteen to +twenty-five minutes. + +Total food value: + + Protein, 11 grams, Fat, 27 grams. + Carbohydrate, 2 grams. Calories, 304. + One muffin = protein, 2 grams; fat, 4.5 grams. + Carbohydrate, trace. Calories, 50. + + [4] Soya Bean Meal, Theodore Metcalf Co., Boston, Mass. + + +CASOID FLOUR AND BRAN MUFFINS.[5] + + 1 ounce (30 grams) Casoid flour + 1 level tablespoon (15 grams) butter + 1 ounce (30 c.c.) 40% cream + 1 egg white + 1 whole egg may be substituted for 1 egg white + 1/4 teaspoon salt + 1-1/2 teaspoons baking powder + 1 cup washed bran + +Method as in previous rule. Bake in six muffin tins. + +Total food value: + + Protein, 18 grams. Fat, 24 grams. + Carbohydrate, 1 gram. Calories, 300. + One muffin = Protein, 3 grams. Fat, 4 grams. + Carbohydrate + Calories, 50. + + [5] Casoid Diabetic Flour. Thos. Leeming & Co., Importers, + New York City. + + +LYSTER FLOUR AND BRAN MUFFINS[6] + + 1 ounce (30 grams) Lyster flour + 1 level tablespoon (15 grams) butter + 1 ounce (30 c.c.) 40% cream + 1 egg white + 1 whole egg may be substituted for 1 egg white + 1/8 teaspoon salt + 1 teaspoon baking powder + 1 cup washed bran + +Method as in previous recipe. Bake in six muffin tins. + +Total food value: + + Protein, 18 grams. Fat, 25 grams. + Carbohydrate, 1 gram. Calories, 310. + One muffin = Protein, 3 grams. Fat, 4 grams. + Carbohydrate, trace. Calories, 50. + +In order to guard against a monotonous diet, some recipes for special +dishes suitable for diabetics are given, most of which can be used in +the diets of moderate caloric value. They are taken from "Food and +Cookery for the Sick and Convalescent" by Fannie Merritt Farmer. + + [6] Lyster's Diabetic Flour prepared by Lyster Brothers. Andover, + Mass. Barker's Gluten Flour, Herman Barker, Somerville, Mass. + + Note.--In the three preceding recipes one whole egg may be + substituted for one egg white. The food value will be slightly + increased but the texture of the finished article is improved. + + +RECIPES. + +BUTTERED EGG. + +Put one teaspoon butter into a small omelet pan. As soon as the butter +is melted break one egg into a cup and slip into the pan. Sprinkle +with salt and pepper and cook until white is firm, turning once +during the cooking. Care must be taken not to break the yolk. + + +EGGS AU BEURRE NOIR. + +Put one teaspoon butter into a small omelet pan. As soon as butter is +melted, break one egg into a cup and slip into the pan. Sprinkle with +salt and pepper and cook until white is firm, turning once during the +cooking. Care must be taken not to break the yolk. Remove to hot +serving dish. In same pan melt one-half tablespoon butter and cook +until brown, then add one-fourth teaspoon vinegar. Pour over egg. + + +EGG A LA SUISSE. + +Heat a small omelet pan and place in it a buttered muffin ring. Put in +one-fourth teaspoon butter, and when melted add one tablespoon cream. +Break an egg into a cup, slip it into muffin ring, and cook until +white is set, then remove ring and put cream by teaspoonfuls over the +egg until the cooking is accomplished. When nearly done sprinkle with +salt, pepper, and one-half tablespoon grated cheese. Remove egg to hot +serving dish and pour over cream remaining in pan. + + +DROPPED EGG. + +Butter a muffin ring, and put it in an iron frying-pan of hot water to +which one-half tablespoon salt has been added. Break egg into saucer, +then slip into ring allowing water to cover egg. Cover and set on back +of range. Let stand until egg white is of jelly-like consistency. Take +up ring and egg, using a buttered griddle-cake turner, place on +serving dish. Remove ring and garnish egg with parsley. + + +DROPPED EGG WITH TOMATO PUREE. + +Serve a dropped egg with one tablespoon tomato puree. For tomato +puree, stew and strain tomatoes, then let simmer until reduced to a +thick consistency, and season with salt and pepper and a few drops +vinegar. A grating of horseradish root may be added. + + +EGG FARCI I. + +Cut one "hard boiled" egg into halves crosswise. Remove yolk and rub +through a sieve. Clean one-half of a chicken's liver, finely chop and +saute in just enough butter to prevent burning. While cooking add a +few drops of onion juice. Add to egg yolk, season with salt, pepper, +and one-fourth teaspoon finely chopped parsley. Refill whites with +mixture, cover with grated cheese, bake until cheese melts. Serve with +one tablespoon tomato puree. + + +EGG FARCI II. + +Prepare one egg as for Egg Farci I. Add to yolk one-half tablespoon +grated cheese, one-fourth teaspoon vinegar, few grains mustard, and +salt and cayenne to taste; then add enough melted butter to make of +right consistency to shape. Make into balls the size of the original +yolks and refill whites. Arrange on serving-dish, place in a pan of +hot water, cover, and let stand until thoroughly heated. Insert a +small piece of parsley in each yolk. + + +BAKED EGG IN TOMATO. + +Cut a slice from stem end of a medium-sized tomato, and scoop out +pulp. Slip an egg into cavity thus made, sprinkle with salt and +pepper, replace cover, put in a small baking pan, and bake until egg +is firm. + + +STEAMED EGG. + +Spread an individual earthen mould generously with butter. Season two +tablespoons chopped cooked chicken, veal, or lamb, with one-fourth +teaspoon salt and a few grains pepper. Line buttered mould with meat +and slip in one egg. Cook in a moderate oven until egg is firm. Turn +from mould and garnish with parsley. + + +CHICKEN SOUP WITH BEEF EXTRACT. + + 1/2 cup chicken stock + 1/2 teaspoon Sauterne + 1/8 teaspoon beef extract + 1-1/2 tablespoons cream + Salt and pepper + +Heat stock to boiling point and add remaining ingredients. + + +CHICKEN SOUP WITH EGG CUSTARD. + +Serve Chicken Soup with Egg Custard. + +Egg Custard.--Beat yolk of one egg slightly, add one-half tablespoon, +each, cream and water, and season with salt. Pour into a small +buttered tin mould, place in pan of hot water, and bake until firm; +cool, remove from mould, cut into fancy shapes. + + +CHICKEN SOUP WITH EGG BALLS I OR II. + +Egg Balls I.--Rub yolk of one hard boiled egg through a sieve, season +with salt and pepper, and add enough raw egg yolk to make of right +consistency to shape. Form into small balls, and poach in soup. + +Egg Balls II.--Rub one-half yolk of hard boiled egg through a sieve, +add one-half of a hard boiled egg white finely chopped. Season with +salt and moisten with yolk of raw egg until of right consistency to +shape. Form and poach same as Egg Balls I. + + +CHICKEN SOUP WITH ROYAL CUSTARD. + +Serve Chicken Soup with Royal Custard. + +Royal Custard.--Beat yolk of one egg slightly, add two tablespoons +chicken stock, season with salt and pepper, turn into a small buttered +mould, and bake in a pan of hot water until firm. Cool, remove from +mould, and cut into small cubes or fancy shapes. + + +ONION SOUP. + +Cook one-half large onion, thinly sliced, in one tablespoon butter +eight minutes. Add three-fourths cup chicken stock, and let simmer +twenty minutes. Rub through a sieve, add two tablespoons cream, and +yolk one-half egg beaten slightly. Season with salt and pepper. + + +ASPARAGUS SOUP. + + 12 stalks asparagus, or + 1/3 cup canned asparagus tips + 2/3 cup chicken stock + 1/4 slice onion. + Yolk one egg + 1 tablespoon heavy cream + 1/8 teaspoon salt + Few grains pepper + +Cover asparagus with cold water, bring to boiling point, drain, and +add stock and onion; let simmer eight minutes, rub through a sieve, +reheat, add cream, egg and seasonings. Strain and serve. + + +TOMATO BISQUE. + + 2/3 cup canned tomatoes + 1/4 slice onion + Bit of bay leaf + 2 cloves + 1/4 cup boiling water + 1/8 teaspoon soda + 1/2 tablespoon butter + 1/4 teaspoon salt + Few grains pepper + 2 tablespoons heavy cream + +Cook first five ingredients for eight minutes. Rub through sieve, add +soda, butter in small pieces, seasoning, and cream. Serve at once. + + +CAULIFLOWER SOUP. + + 1/3 cup cooked cauliflower + 2/3 cup chicken stock + Small stalk celery + 1/4 slice onion + 1 egg yolk + 1 tablespoon heavy cream + 2 teaspoons butter + Salt and pepper + +Cook cauliflower stalk, celery and onion eight minutes. Rub through +puree strainer, reheat, add egg yolk slightly beaten, cream, butter, +and seasoning. + + +MUSHROOM SOUP. + + 3 mushrooms + 2/3 cup chicken stock + 1/4 slice onion + 2 teaspoons butter + 1 egg yolk + 1 tablespoon heavy cream + 1 teaspoon sauterne + Salt and pepper + +Clean mushrooms, chop, and cook in one teaspoon butter five minutes. +Add stock and let simmer eight minutes. Rub through a puree strainer, +add egg yolk slightly beaten, cream, remaining butter, seasoning and +wine. + + +SPINACH SOUP. + + 1 tablespoon cooked chopped spinach + 2/3 cup chicken stock + 1 egg yolk + 1 tablespoon heavy cream + Salt and pepper + +Cook spinach with stock eight minutes. Rub through a puree strainer, +reheat, add egg yolk slightly beaten, cream, and seasoning. + + +BROILED FISH, CUCUMBER SAUCE. + +Serve a small piece of broiled halibut, salmon, or sword fish, with +cucumber sauce. + +Cucumber Sauce.--Pare one-half cucumber, grate and drain. Season with +salt, pepper and vinegar. + + +BAKED FILLET OF HALIBUT, HOLLANDAISE SAUCE. + +Wipe a small fillet of halibut and fasten with a skewer. Sprinkle with +salt and pepper, place in pan, cover with buttered paper and bake +twelve minutes. Serve with, + +Hollandaise Sauce.--Put yolk of one egg, one tablespoon butter, and +one teaspoon lemon juice in a small sauce-pan. Put sauce-pan in a +larger one containing water, and stir mixture constantly with wooden +spoon until butter is melted. Then add one-half tablespoon butter, and +as the mixture thickens another one-half tablespoon butter; season +with salt and cayenne. This sauce is almost thick enough to hold its +shape. One-eighth teaspoon of beef extract, or one-third teaspoon +grated horseradish added to the first mixture gives variety to this +sauce. + + +BAKED HALIBUT WITH TOMATO SAUCE. + +Wipe a small piece of halibut, and sprinkle with salt and pepper. Put +in a buttered pan, cover with a thin strip of fat salt pork gashed +several times, and bake twelve to fifteen minutes. Remove fish to +serving dish, discarding pork. Cook eight minutes one-third cup of +tomatoes, one-fourth slice onion, one clove, and a few grains salt and +pepper. Remove onion and clove and run through a sieve. Add a few +grains soda and cook until tomato is reduced to two teaspoons. Pour +around fish and garnish with parsley. + + +HALIBUT WITH CHEESE. + +Sprinkle a small fillet of halibut with salt and pepper, brush over +with melted butter, place in pan and bake twelve minutes. Remove to +serving dish and pour over it the following sauce: + +Heat two tablespoons cream, add one-half egg yolk slightly beaten, and +when well mixed one tablespoon grated cheese. Season with salt and +paprika. + + +FINNAN HADDIE A LA DELMONICO. + +Cover a small piece of finnan haddie with cold water, place on back of +range and allow water to heat gradually to boiling point, then keep +below boiling point for twenty minutes. Drain, rinse thoroughly, and +separate into flakes; there should be two tablespoons. Reheat over hot +water with one hard boiled egg thinly sliced in two tablespoons heavy +cream. Season with salt and paprika, add one teaspoon butter and +sprinkle with finely chopped parsley. + + +FILLET OF HADDOCK WITH WINE SAUCE. + +Remove skin from a small piece of haddock, put in a buttered baking +pan, pour over it one teaspoon melted butter, one tablespoon white +wine, and a few drops, each, of lemon juice and onion juice. Cover and +bake. Remove to serving dish, and to liquor in pan add one tablespoon +cream and one egg yolk slightly beaten. Season with salt and pepper. +Strain over fish, and sprinkle with finely chopped parsley. + + +SMELTS WITH CREAM SAUCE. + +Clean two selected smelts and cut five diagonal gashes on sides of +each. Season with salt, pepper, and lemon juice. Cover and let stand +ten minutes. Roll in cream, dip in flour, and saute in butter. Remove +to serving dish, and to fat in pan add two tablespoons cream. Cook +three minutes, season with salt, pepper, and a few drops lemon juice. +Strain sauce around smelts and sprinkle with finely chopped parsley. + + +SMELTS A LA MAITRE D'HOTEL. + +Prepare smelts same as for smelts with cream, and serve with maitre +d'hotel butter. + + +SALT CODFISH WITH CREAM. + +Pick salt codfish into flakes; there should be two tablespoons. Cover +with lukewarm water and let stand on back of range until soft. Drain, +and add three tablespoons cream; as soon as cream is heated add yolk +one small egg slightly beaten. + + +SALT CODFISH WITH CHEESE. + +To salt codfish with cream, add one-half tablespoon grated cheese and +a few grains paprika. + + +BROILED BEEFSTEAK, SAUCE FIGARO. + +Serve a portion of broiled beefsteak with Sauce Figaro. + +Sauce Figaro.--To Hollandaise sauce add one teaspoon tomato puree. To +prepare tomato puree stew tomatoes, force through a strainer and cook +until reduced to a thick pulp. + + +ROAST BEEF, HORSERADISH CREAM SAUCE. + +Serve a slice of rare roast beef with Horseradish Cream Sauce. + +Horseradish Cream Sauce.--Beat one tablespoon heavy cream until stiff. +As cream begins to thicken, add gradually three-fourths teaspoon +vinegar. Season with salt and pepper, then fold in one-half tablespoon +grated horseradish root. + + +FILLET OF BEEF. + +Wipe off a thick slice cut from tenderloin. Put in hot frying pan with +three tablespoons butter. Sear one side, turn and sear other side. +Cook eight minutes, turning frequently, taking care that the entire +surface is seared, thus preventing the escape of the inner juices. + +Remove to hot serving dish, and pour over fat in pan, first strained +through cheesecloth. Garnish with cooked cauliflower, canned string +beans, reheated and seasoned, and sauted mushroom caps. + + +LAMB CHOPS, SAUCE FINESTE. + +Serve lamb chops with Sauce Fineste. + +Sauce Fineste.--Cook one-half tablespoon butter until browned. Add a +few grains, each, mustard and cayenne, one-fourth teaspoon +Worcestershire Sauce, and a few drops lemon juice, and two tablespoons +stewed and strained tomatoes. + + +SPINACH. + +Chop one cup cooked spinach drained as dry as possible. Season with +salt and pepper, press through a puree strainer, reheat in butter, +using as much as desired or as much as the spinach will take up. +Arrange on serving dish and garnish with white of "hard boiled" egg +cut in strips and yolk forced through strainer. + + +BRUSSELS SPROUTS WITH CURRY SAUCE. + +Pick over Brussels sprouts, remove wilted leaves, and soak in cold +salt water fifteen minutes. Cook in boiling salted water twenty +minutes, or until easily pierced with skewer. Drain, and pour over +one-fourth cup curry sauce. + +Curry Sauce.--Mix one-fourth teaspoon mustard, one-fourth teaspoon +salt, and a few grains paprika. Add yolk of one egg slightly beaten, +one tablespoon olive oil, one and one-half tablespoons vinegar, and a +few drops of onion juice. Cook over hot water, stirring constantly +until mixture thickens. Add one-fourth teaspoon curry powder, one +teaspoon melted butter, and one-eighth teaspoon chopped parsley. + + +FRIED CAULIFLOWER. + +Steam or boil a small cauliflower. Cool and separate into pieces. +Saute enough for one serving in olive oil until thoroughly heated. +Season with salt and pepper, arrange on serving-dish, and pour over +one tablespoon melted butter. + + +CAULIFLOWER A LA HUNTINGTON. + +Separate hot steamed cauliflower into pieces and pour over sauce made +same as sauce for Brussels sprouts with curry sauce. + + +CAULIFLOWER WITH HOLLANDAISE SAUCE. + +Serve boiled cauliflower with Hollandaise sauce, as given with baked +fillet of halibut, Hollandaise sauce. + + +MUSHROOMS IN CREAM. + +Clean, peel and break in pieces six medium-sized mushroom caps. Saute +in one-half tablespoon butter three minutes. Add one and one-half +tablespoons cream and cook until mushrooms are tender. Season with +salt and pepper and a slight grating of nutmeg. + + +BROILED MUSHROOMS. + +Clean mushrooms, remove stems, and place caps on a buttered broiler. +Broil five minutes, having gills nearest flame during first half of +broiling. Arrange on serving dish, put a small piece of butter in each +cap and sprinkle with salt and pepper. + + +SUPREME OF CHICKEN. + +Force breast of uncooked chicken through a meat chopper; there should +be one-fourth cup. Add one egg beaten slightly and one-fourth cup +heavy cream. Season with salt and pepper. Turn into slightly buttered +mould, set in pan of hot water and bake until firm. + + +SARDINE RELISH. + +Melt one tablespoon butter, and add two tablespoons cream. Heat to +boiling point, add three sardines freed from skin and bones, and +separated in small pieces, and one hard-boiled egg finely chopped. +Season with salt and cayenne. + + +DIABETIC RAREBIT. + +Beat two eggs slightly and add one-fourth teaspoon salt, a few grains +cayenne, and two tablespoons, each, cream and water. Cook same as +scrambled eggs, and just before serving add one-fourth Neufchatel +cheese mashed with fork. + + +CHEESE SANDWICHES. + +Cream one-third tablespoon butter and add one-half tablespoon, each, +finely chopped cold boiled ham and cold boiled chicken; then season +with salt and paprika. Spread between slices of Gruyere cheese cut as +thin as possible. + + +CHEESE CUSTARD. + +Beat one egg slightly, add one-fourth cup cold water, two tablespoons +heavy cream, one tablespoon melted butter, one tablespoon grated +cheese and a few grains salt. Turn into an individual mould, set in +pan of hot water, and bake until firm. + + +COLD SLAW. + +Select a small heavy cabbage, remove outside leaves, and cut cabbage +in quarters; with a sharp knife slice very thinly. Soak in cold water +until crisp; drain, dry between towels, and mix with cream salad +dressing. + + +CABBAGE SALAD. + +Finely shred one-fourth of a small firm cabbage. Let stand two hours +in salted cold water, allowing one tablespoon of salt to a pint of +water. Cook slowly thirty minutes one-fourth cup, each, vinegar and +cold water, with a bit of bay leaf, one-fourth teaspoon peppercorns, +one-eighth teaspoon mustard seed and three cloves. Strain and pour +over cabbage drained from salted water. Let stand two hours, again +drain, and serve with or without mayonnaise dressing. + + +CABBAGE AND CELERY SALAD. + +Wash and scrape two stalks of celery, add an equal quantity of +shredded cabbage, and six walnut meats broken in pieces. Serve with +cream dressing. + + +CUCUMBER CUP. + +Pare a cucumber and cut in quarters cross wise. Remove center from one +piece and fill cup thus made with tartare sauce. Serve on lettuce +leaf. + + +CUCUMBER AND LEEK SALAD. + +Cut cucumber in small cubes and leeks in very thin slices. Mix, using +equal parts, and serve with French dressing. + + +CUCUMBER AND WATERCRESS SALAD. + +Cut cucumbers in very thin slices, and with a three-tined fork make +incisions around the edge of each slice. Arrange on a bed of +watercress. + + +EGG SALAD I. + +Cut one hard-boiled egg in halves crosswise, in such a way that tops +of halves may be left in points. Remove yolk, mash, moisten with +cream, French or mayonnaise dressing, shape in balls, refill whites, +and serve on lettuce leaves. Garnish with thin slices of radish, and a +radish so cut as to represent a tulip. + + +EGG SALAD. + +Prepare egg same as for Egg Salad I, adding to yolk an equal amount of +chopped cooked chicken or veal. + + +EGG AND CHEESE SALAD. + +Prepare egg same as for Egg Salad I, adding to yolk three-fourths +tablespoon grated cheese; season with salt, cayenne and a few grains +of mustard; then moisten with vinegar and melted butter. Serve with or +without salad dressing. + + +EGG AND CUCUMBER SALAD. + +Cut one hard boiled egg in thin slices. Cut as many very thin slices +from a chilled cucumber as there are slices of egg. Arrange in the +form of a circle (alternating egg and cucumber), having slices overlap +each other. Fill in center with chicory or watercress. Serve with +salad dressing. + + +CHEESE SALAD. + +Mash one-sixth of a Neufchatel cheese and moisten with cream. Shape in +forms the size of a robin's egg. Arrange on a lettuce leaf and +sprinkle with finely chopped parsley which has been dried. Serve with +salad dressing. + + +CHEESE AND OLIVE SALAD. + +Mash one-eighth of a cream cheese, and season with salt and cayenne. +Add finely chopped olives, two lettuce leaves, finely cut, and a small +piece of canned pimento, to give color. Press in original shape of +cheese and let stand two hours. Cut in slices and serve on lettuce +leaves with mayonnaise dressing. + + +CHEESE AND TOMATO SALAD. + +Peel and chill one medium-sized tomato, and scoop out a small portion +of the pulp. Mix equal quantities of Roquefort and Neufchatel cheese +and mash, then moisten with French dressing. Fill cavity made in +tomato with cheese. Serve on lettuce leaves with French dressing. + + +FISH SALAD I. + +Remove salmon from can, rinse thoroughly with hot water and separate +in flakes; there should be one-fourth cup. Mix one-eighth teaspoon +salt, a few grains, each, mustard and paprika, one teaspoon melted +butter, one-half tablespoon cream, one tablespoon water, one-half +tablespoon vinegar and yolk of one egg; cook over hot water until +mixture thickens; then add one-fourth teaspoon granulated gelatin +soaked in one teaspoon cold water. Add to salmon, mould, chill, and +serve with cucumber sauce. + +Cucumber Sauce.--Pare one-fourth cucumber; chop, drain, and add French +dressing to taste. + + +ASPARAGUS SALAD. + +Drain and rinse four stalks of canned asparagus. Cut a ring one-third +inch wide from a red pepper. Put asparagus stalks through ring, +arrange on lettuce leaves, and pour over French dressing. + + +TOMATO JELLY SALAD. + +Season one-fourth cup hot stewed and strained tomato with salt, and +add one-third teaspoon granulated gelatin soaked in a teaspoon cold +water. Turn into an individual mould, chill, turn from mould, arrange +on lettuce leaves, and garnish with mayonnaise dressing. + + +FROZEN TOMATO SALAD. + +Season stewed and strained tomato with salt and cayenne. Fill a small +tin box with mixture, cover with buttered paper, then tight-fitting +cover, pack in salt and ice, equal parts, and let stand two hours. +Remove from mould, place on lettuce leaf and serve with mayonnaise +dressing. + + +TOMATO JELLY SALAD WITH VEGETABLES. + +Cook one-third cup tomatoes with bay leaf, sprig of parsley, one-sixth +slice onion, four peppercorns, one clove, eight minutes. Remove +vegetables and rub tomato through a sieve; there should be one-fourth +cup. Add one-eighth teaspoon granulated gelatin soaked in one teaspoon +cold water, a few grains salt, and four drops vinegar. Line an +individual mould with cucumber cut in fancy shapes, and string beans, +then pour in mixture. Chill, remove from mould, arrange on lettuce +leaf, and garnish with mayonnaise dressing. + + +TOMATO BASKET OF PLENTY. + +Cut a medium-sized tomato in shape of a basket, leaving stem end on +top of handle. Fill basket with cold cooked string beans cut in small +pieces and two halves of English walnut meats cut in pieces, moistened +with French dressing. Serve on lettuce leaf. + + +TOMATO AND CHIVE SALAD. + +Remove skin from small tomato. Chill and cut in halves crosswise. +Spread with mayonnaise, sprinkle with finely chopped chives, and serve +on lettuce leaf. + + +CANARY SALAD. + +Cut a slice from the stem end of a bright red apple and scoop out +pulp, leaving enough to keep shell in shape. Fill shell thus made with +grapefruit pulp and finely chopped celery, using twice as much +grapefruit as celery. It will be necessary to drain some of the juice +from the grapefruit. Moisten with mayonnaise dressing, replace the +cover and arrange on lettuce leaf, and garnish with a canary made from +Neufchatel cheese, coloring yellow and shaping, designating eyes with +paprika and putting a few grains on the body of the bird. Also garnish +with three eggs made from cheese, colored green and speckled with +paprika. + +Note.--Do not use apple pulp. + + +HARVARD SALAD. + +Cut a selected lemon in the form of a basket with handle, and scoop +out all the pulp. Fill basket thus made with one tablespoon cold +cooked chicken or sweet bread cut in small dice, mixed with one-half +tablespoon small cucumber dice, and one teaspoon finely chopped celery +moistened with cream or mayonnaise dressing. Spread top with dressing +and sprinkle with thin parings cut from round red radishes finely +chopped. Insert a small piece of parsley on top of handle. Arrange on +watercress. + + +CUCUMBER BOATS. + +Cut a small cucumber in halves lengthwise. Scoop out centres and cut +boat-shaped. Cut cucumber cut from boats in small pieces and add one +and one-half olives finely chopped. Moisten with French dressing, fill +boats with mixture and serve on lettuce leaves. + + +SPINACH SALAD. + +Drain and finely chop one-fourth cup cooked spinach. Season with salt, +pepper, lemon juice, and melted butter. Pack solidly in an individual +mould, chill, remove from mould, and arrange on a thin slice of cooked +tongue cut in circular shape. Garnish base of mould with wreath of +parsley and top with sauce tartare. + +Sauce Tartare.--To one tablespoon mayonnaise dressing add +three-fourths teaspoon finely chopped capers, pickles, olives, and +parsley, having equal parts of each. + + +SWEETBREAD AND CUCUMBER SALAD. + +Mix two tablespoons cold cooked sweetbread cut in cubes, one +tablespoon cucumber cubes, and one-half tablespoon finely chopped +celery. Beat one and one-half tablespoons heavy cream until stiff, +then add one-eighth teaspoon granulated gelatin dissolved in one +teaspoon boiling water and three-fourths teaspoon vinegar. Set in a +pan of ice water and as mixture begins to thicken, add sweetbreads and +vegetables. Mould and chill. Remove from mould, arrange on lettuce +leaves, and garnish top with a slice of cucumbers and sprig of +parsley. + + +CHICKEN AND NUT SALAD. + +Mix two tablespoons cold cooked chicken or fowl cut in cubes with one +tablespoon finely chopped celery and one-half tablespoon English +walnut meats browned in oven with one-eighth teaspoon butter and a few +grains salt, then broken in pieces. Moisten with mayonnaise dressing. +Mound and garnish with curled celery, tips of celery, and whole nut +meats. + + +PRINCESS PUDDING + + 1 egg yolk + 3/4 teaspoon granulated gelatin dissolved in + 1 tablespoon boiling water + 2 teaspoons lemon juice + 1/4 grain saccharine dissolved in + 1/4 teaspoon cold water + 1 egg white. + +Beat egg yolk until thick and lemon-colored, add gelatin, continue the +beating. As mixture thickens add gradually the lemon juice and +saccharine. Fold in white of egg beaten until stiff and dry. Turn into +a mould and chill. + + +COFFEE BAVARIAN CREAM. + + 2 tablespoons coffee infusion + 1 tablespoon water + 2 tablespoons heavy cream + 1 egg yolk + Few grains salt + 3/4 teaspoon granulated gelatin soaked in + 1 teaspoon cold water. + 1 grain saccharine dissolved in + 1/2 teaspoon cold water + 1 egg white + 1/4 teaspoon vanilla + +Scald coffee, water and one-half cream. Add egg yolk, slightly beaten, +and cook until mixture thickens; then add gelatin and salt. Remove +from fire, cool, add saccharine, remaining cream beaten stiff, egg +white beaten until stiff, and teaspoon vanilla. Turn into mould and +chill. + + +LEMON CREAM SHERBET. + + 1/4 cup cream + 2 tablespoons cold water + 1/2 grain saccharine dissolved in + 1/2 teaspoon cold water + 4 drops lemon juice + Few grains salt + +Mix ingredients in order given and freeze. + + +ORANGE ICE. + + 1/3 cup orange juice + 1 teaspoon lemon juice + 2 tablespoons cold water + 1/2 grain saccharine dissolved in + 1/2 teaspoon cold water + +Mix ingredients in order given, and freeze. + + +GRAPEFRUIT ICE. + + 1/4 cup grapefruit juice + 1/4 cup water + 1/2 grain saccharine dissolved in + 1/2 teaspoon cold water. + +Remove juice from grapefruit, strain and add remaining ingredients, +and freeze to a mush. Serve in sections of grapefruit. + + +FROZEN PUNCH. + + 1/4 cup cream + 2 tablespoons cold water + 1-1/2 teaspoons rum + 1 egg yolk + 1/2 grain saccharine dissolved in + 1/2 teaspoon cold water + Few grains salt + +Scald one-half cream with water, add egg yolk slightly beaten and cook +over hot water until mixture thickens. Cool, add remaining ingredients +and freeze. + + + + +DIET LISTS. + + +Attention is called to the fact that the protein allowance in the +following diets is not large. The first two tables represent fast +days; the next six are transitional days, in which the nourishment is +gradually increased but does not satisfy the caloric needs. The +remainder may be selected according to the needs of the case or the +weight of the patient. + +To prevent monotony or to give variety, one meat may be substituted +for another, or one "5%" vegetable for another. The fat may be +increased by the addition of butter or olive oil if more calories are +needed to maintain body weight. However, it is not considered +desirable to give so much fat that the weight will increase. + + +TABLE I. + + Protein, 10 grams + Carbohydrate, 15 grams + Fat, 7 grams + Calories, 200 + +BREAKFAST. + String beans (canned). 120 grams 2-1/2 h. tbsp. + Asparagus (canned). 150 grams 3 h. tbsp. or 13-1/2 stalks + 4 in. long. + Tea or coffee. + +DINNER. + Celery. 100 grams 6 pieces 4-1/2 in. long. + Spinach (cooked). 135 grams 3 h. tbsp. + Tea or coffee. + +SUPPER. + Asparagus. 100 grams 2 h. tbsp. or 9 stalks 4 in. long. + Celery. 100 grams 6 pieces 4-1/2 in. long. + Tea or coffee. + + +TABLE II. + + Protein, 7 grams + Carbohydrate, 15 grams + Fat, 6 grams + Calories, 150 + +BREAKFAST. + Asparagus (canned). 75 grams 1-3/4 h. tbsp. (chopped). + Cabbage. 65 grams 1 very h. tbsp. + Tea or coffee. + +DINNER. + Onions (cooked). 100 grams 2 h. tbsp. + Celery. 50 grams 3 pieces about 4-1/2 in. long. + Tea or coffee. + +SUPPER. + Spinach. 100 grams 2 h. tbsp. + Celery. 50 grams 3 pieces 4-1/2 in. long. + Tea or coffee. + + +TABLE III. + + Protein, 24 grams + Carbohydrate, 8 grams + Fat, 22 grams + Calories, 340 + +BREAKFAST. + String beans. 100 grams 2 h. tbsp. + Egg. 1 + Coffee. + +DINNER. + Egg. 1 + Turnips. 100 grams 2 h. tbsp. + Cabbage. 100 grams 2 h. tbsp. + Tea. + +SUPPER. + Egg. 1 + Turnips. 100 grams 2 h. tbsp. + Spinach. 100 grams 2 h. tbsp. + Tea. + + +TABLE IV. + + Protein, 31 grams + Fat, 14 grams + Carbohydrate, 17 grams + Calories, 327 + +BREAKFAST. + Egg. 1 + Asparagus. 100 grams 2 h. tbsp. + Tomatoes. 100 grams 2 h. tbsp. + Coffee. + +DINNER. + Chicken. 35 grams 1 small serving. + String beans. 200 grams 4 h. tbsp. + Cabbage. 100 grams 2 h. tbsp. + Tea or coffee. + +SUPPER. + Egg. 1 + Cauliflower. 240 grams 5 h. tbsp. + + Spinach. 100 grams 2 h. tbsp. + Tea or coffee. + + +TABLE V. + + Protein, 43 grams + Carbohydrate, 15 grams + Fat, 19 grams + Calories, 414 + +BREAKFAST. + Egg. 1 + Asparagus. 200 grams 4 h. tbsp. + Coffee. + +DINNER. + Chicken. 70 grams 1 mod. serving. + Cauliflower. 120 grams 2 h. tbsp. + Cabbage (cooked). 100 grams 2 h. tbsp. + Tea. + +SUPPER. + Egg. 1 + String beans. 100 grams 2 h. tbsp. + Spinach. 200 grams 4 h. tbsp. + Tea. + + +TABLE VI. + + Protein, 38 grams + Fat, 31 grams + Carbohydrate, 19 grams + Calories, 520 + +BREAKFAST. + Egg. 1 + Asparagus. 200 grams 4 h. tbsp. + Coffee. + +DINNER. + Steak. 100 grams 1 small serving. + Celery (cooked). 200 grams 4 h. tbsp. + Tea. + +SUPPER. + Egg. 1 + Lettuce. 20 grams 2 medium leaves. + Cucumbers. 100 grams 2 h. tbsp. + String beans. 50 grams 1 h. tbsp. + Tea. + + +TABLE VII. + + Protein, 35 grams + Carbohydrate, 17 grams + Fat, 100 grams + Calories, 1143 + +BREAKFAST. + Bacon. 50 grams 2 slices about 6 in. long. + Asparagus. 100 grams 2 h. tbsp. or 9 stalks 4 in. long + (canned). + Spinach. 100 grams 2 h. tbsp. + Butter. + Cream. + Coffee. + +DINNER. + Steak. 100 grams 1 small serving. + Turnips. 140 grams 2 h. tbsp. + + Spinach. 100 grams 2 h. tbsp. + Cabbage. 100 grams 2 h. tbsp. + Butter. + Tea. + Cream. + +SUPPER. + Spinach. 100 grams 2 h. tbsp. + String beans (cooked). 100 grams 2 h. tbsp. + Cauliflower (cooked). 120 grams 2 h. tbsp. + + Butter. + Tea. + Cream. + +_Allow during day:_ + Butter. 20 grams 2 squares. + Cream, 40%. 2-1/2 ounces 5 tbsp. + + +TABLE VIII. + + Protein, 40 grams + Carbohydrate, 16 grams + Fat, 104 grams + Calories, 1196 + +BREAKFAST. + Egg. 1 + Asparagus. 100 grams 2 h. tbsp or 9 stalks 4 in. long + (canned). + Spinach. 100 grams 2 h. tbsp. + Butter. + Coffee. + Cream. + +DINNER. + Steak. 100 grams 1 small serving. + Turnips. 140 grams 2 h. tbsp. + + Celery. 100 grams 2 h. tbsp. + Cabbage. 100 grams 2 h. tbsp. + Butter. + Cream. + Tea. + +SUPPER. + Bacon. 50 grams 2 slices about 6 in. long. + Spinach. 100 grams 2 h. tbsp. + String beans (canned). 100 grams 2 h. tbsp. + Cauliflower. 100 grams 2 h. tbsp. + Butter. + Cream. + Tea. + +_Allow during day:_ + Butter. 20 grams 2 squares. + Cream 40%. 3 ounces 6 tbsp. + + +TABLE IX. + + Protein, 50 grams + Carbohydrate, 15 grams + Fat, 125 grams + Calories, 1500 + +BREAKFAST. + Eggs. 2 + String beans(canned). 100 grams 3 h. tbsp. + Butter. + Cream. + Coffee. + +DINNER. + Chop. 100 grams 1 chop. + Cabbage (cooked). 100 grams 2 h. tbsp. + Cucumbers. 100 grams 2 h. tbsp. + Tea. + Butter. + Cream. + +SUPPER. + Egg. 1 + Asparagus (canned). 100 grams 2 h. tbsp. + Cauliflower (cooked). 100 grams 2 h. tbsp. + Butter. + Cream. + Tea. + +_Allow during day:_ + Butter. 25 grams 2-1/2 square. + Cream, 40%. 5 ounces 10 tbsp. + + +TABLE X. + + Protein, 61 grams + Carbohydrate, 16 grams + Fat, 160 grams + Calories, 1795 + +BREAKFAST. + Bacon. 50 grams 2 slices 6 in. long. + Eggs. 2 + Spinach. 100 grams 2 h. tbsp. + Butter. + Cream. + Coffee. + +DINNER. + Steak. 100 grams 1 small serving. + Tomatoes (canned). 100 grams 2 h. tbsp. + Butter. + Cream. + Tea. + +SUPPER. + Chicken. 50 grams 1 small serving. + Lettuce. 20 grams 2 leaves. + Celery. 100 grams 6 stalks 4-1/2 in. long. + Butter. + Cream. + Tea. + +_Allow during day:_ + Butter. 50 grams 5 squares. + Cream, 40%. 5 ounces 10 tbsp. + + +TABLE XI. + + Protein, 38 grams + Carbohydrate, 20 grams + Fat, 100 grams + Calories 1168 + +BREAKFAST. + Bacon. 30 grams 1-1/2 slices 6 in. long. + Egg. 1 + Spinach. 100 grams 2 h. tbsp. + Coffee. + Butter. + Cream. + +DINNER. + Steak. 50 grams 1 very small serving. + Cabbage. 100 grams 2 h. tbsp. + Onions. 100 grams 2 h. tbsp. + Butter. + Cream. + Tea. + +SUPPER. + Scraped beef balls. 40 grams = 1-1/3 oz. + Chopped celery salad. 100 grams 2 h. tbsp. + Tomatoes. 100 grams 2 tbsp. + +_Allow during day:_ + Butter. 25 grams 2-1/2 squares. + Cream, 40%. 4 ounces 8 tbsp. + + +TABLE XII. + + Protein, 35 grams + Carbohydrate, 16 grams + Fat, 92 grams + Calories, 1064 + +BREAKFAST. + Egg. 1 + Cabbage. 100 grams 2 h. tbsp. + Tomatoes. 100 grams 2 h. tbsp. + Butter. + Coffee. + Cream. + +DINNER. + Steak. 80 grams 1 small serving. + Spinach. 100 grams 2 h. tbsp. + Turnips. 140 grams 2 h. tbsp. + + Egg, white. 1 + Butter. + Cream. + Tea. + +SUPPER. + Cauliflower. 120 grams 2 h. tbsp. + + Onions. 100 grams 2 h. tbsp. + Lettuce. 10 grams 1 leaf. + Olive oil. 5 grams 1 teaspoon. + + Tea. + Butter. + Cream. + +_Allow during day:_ + Butter. 25 grams 2-1/2 squares. + Cream, 40%. 3 ounces 6 tbsp. + + +TABLE XIII. + + Protein, 40 grams + Fat, 110 grams + Carbohydrate, 21 grams + Calories, 1187 + +BREAKFAST. + Bacon. 50 grams 2 slices 6 in. long. + Cauliflower. 120 grams 2 h. tbsp. + Butter. + Cream. + Coffee. + +DINNER. + Squab. 1 + Carrots. 100 grams 2 h. tbsp. + Tomatoes. 100 grams 2 h. tbsp. + Butter. + Cream. + Tea. + +SUPPER. + Turnips. 140 grams 2 h. tbsp. + + Asparagus. 100 grams 2 h. tbsp. + Celery. 100 grams 6 stalks 4-1/2 in. long. + Butter. + Cream. + Tea. + +_Allow during day:_ + Butter. 20 grams 2 squares. + Cream, 40%. 3-1/2 ounces 7 tbsp. + + +TABLE XIV. + + Protein, 40 grams + Carbohydrate, 20 grams + Fat, 103 grams + Calories, 1200 + +BREAKFAST. + Egg. 1 + 1 egg white. + Spinach. 200 grams 4 h. tbsp. + Cream. + Butter. + +DINNER. + Steak. 50 grams 1 very small serving. + Cabbage. 100 grams 2 h. tbsp. + Tomatoes. 100 grams 2 h. tbsp. + Onions. 100 grams 2 h. tbsp. + Butter. + Cream. + Tea. + +SUPPER. + Scraped beef balls 40 grams 1-1/3 oz. + Celery. 100 grams 6 stalks 4-1/2 in. long. + Cream. + Butter. + Tea. + +_Allow during day:_ + Butter. 20 grams 2 squares. + Cream, 40%. 5 ounces 10 tbsp. + + +TABLE XV. + + Protein, 40 grams + Carbohydrate, 22 grams + Fat, 105 grams + Calories, 2100 + +BREAKFAST. + Egg. 1 + Asparagus. 100 grams 2 h. tbsp. + Butter. + Cream. + Coffee. + +DINNER. + Chop. 105 grams 1 medium. + Peas. 50 grams 1 h. tbsp. + Celery. 50 grams 6 stalks 4-1/2 in. long. + Butter. + Cream. + Tea. + +SUPPER. + Cauliflower. 120 grams 2 h. tbsp. + + String beans. 100 grams 2 h. tbsp. + Butter. + Cream. + Tea. + +_Allow during day:_ + Butter. 20 grams 2 squares. + Cream, 40%. 4 ounces 8 tbsp. + + +TABLE XVI. + + Protein 40 grams + Fat, 100 grams + Carbohydrate, 30 grams + Calories, 1200 + +BREAKFAST. + Bacon. 50 grams 2 slices 6 in. long. + Peas (canned). 75 grams 1-3/4 h. tbsp. + Butter. + Cream. + Coffee. + +DINNER. + Broth--6 ounces with + vegetables: + Cabbage. 25 grams 1 level tbsp. + Tomatoes. 25 grams 1 level tbsp. + Turnips. 25 grams 1 level tbsp. + Celery. 50 grams 3 pieces 4-1/2 in. long. + Steak. 100 grams 1 small serving. + Squash. 50 grams 1 h. tbsp. + Tomatoes. 75 grams 1-3/4 tbsp. + Butter. + Cream. + Tea. + +SUPPER. + Spinach. 100 grams 2 h. tbsp. + Turnips. 175 grams 3-3/4 h. tbsp. + Celery. 100 grams 6 stalks 4-1/2 in. long. + +_Allow during day:_ + Butter. 50 grams 5 squares. + Cream, 40%. 4 ounces 8 tbsp. + + +TABLE XVII. + + Protein, 40 grams + Carbohydrate, 30 grams + Fat, 100 grams + Calories, 1200 + +BREAKFAST. + Bacon. 50 grams 2 slices about 6 in. long. + Egg. 1 + Asparagus (chopped). 100 grams 2 h. tbsp. + Butter. + Cream. + Coffee. + +DINNER. + Chicken. 50 grams 1 small serving. + Cabbage. 100 grams 2 h. tbsp. + Cauliflower. 120 grams 2 h. tbsp. + + Cucumbers. 100 grams 2 h. tbsp. + Butter. + Cream. + Tea. + +SUPPER. + Turnips. 140 grams 2 h. tbsp. + String beans. 100 grams 2 h. tbsp. + Bread. 25 grams 1 thin slice, baker's loaf. + Butter. + Cream. + Tea. + +_Allow during day:_ + Butter. 25 grams 2-1/2 squares. + Cream, 40%. 4 ounces 8 tbsp. + + +TABLE XVIII. + + Protein, 40 grams + Carbohydrate, 35 grams + Fat, 110 grams + Calories, 1330 + +BREAKFAST. + Bacon. 50 grams 2 slices about 6 in. long. + Peas. 75 grams 1-3/4 h. tbsp. + Tomatoes. 100 grams 2 h. tbsp. + Butter. + Cream. + Coffee. + +DINNER. + Broth--chicken, lamb + or beef. 6 ounces + Steak. 100 grams 1 small serving. + Turnips. 200 grams 4 h. tbsp. + Celery. 150 grams 9 stalks 4-1/2 in. long. + Butter. + Cream. + Tea. + +SUPPER. + Squash. 50 grams 1 h. tbsp. + Beets. 100 grams 2 h. tbsp. + Cabbage (raw). 25 grams 1 h. tbsp. + Butter. + Cream. + Tea. + +_Allow during day:_ + Butter. 25 grams 2-1/2 squares. + Cream, 40%. 4 ounces 8 tbsp. + + +TABLE XIX. + + Protein, 40 grams + Carbohydrate, 35 grams + Fat, 115 grams + Calories, 1370 + +BREAKFAST. + Bacon. 50 grams 3 slices 6 in. long. + Parsnips. 100 grams 2 h. tbsp. + Potatoes (boiled). 50 grams 1 very small one. + Butter. + Cream. + Coffee. + +DINNER. + Broth. 6 ounces + Squab. 1 + Cabbage. 100 grams 2 h. tbsp. + Celery. 100 grams 6 stalks about 4-1/2 in. long. + Butter. + Cream. + Tea. + +SUPPER. + String beans. 140 grams 3 h. tbsp. + Cucumbers. 100 grams 2 h. tbsp. + Parsnips. 100 grams 2 h. tbsp. + Cauliflower. 120 grams 2 h. tbsp. + + Milk. 4 ounces 1/2 glass. + Butter. + Cream. + Tea. + +_Allow during day:_ + Butter. 20 grams 2 squares. + Cream, 40%. 4 ounces 8 tbsp. + + +TABLE XX. + + Protein, 50 grams + Carbohydrate, 35 grams + Fat, 130 grams + Calories, 1557 + +BREAKFAST. + Orange. 100 grams 1 small. + Bacon. 50 grams 3 slices, 6 in. long. + Egg. 1 + Spinach. 100 grams 2 h. tbsp. + Butter. + Cream. + Coffee. + +DINNER. + Broth. 180 c.c. 1 glass or cup. + Steak. 100 grams 1 small serving. + Boiled onions. 100 grams 2 h. tbsp. + Butter. + Cream. + Tea. + +SUPPER. + Egg. 1 + Lettuce. 25 grams 3 small leaves. + Bread. 20 grams 1 very thin slice. + Cream. + Tea. + Butter. + +_Allow during day:_ + Butter. 25 grams 2-1/2 squares. + Cream, 40%. 4 ounces 8 tbsp. + + +TABLE XXI. + + Protein, 50 grams + Carbohydrate, 40 grams + Fat, 158 grams + Calories, 1830 + +BREAKFAST. + Bacon. 50 grams 2 slices 6 in. long. + Bread. 20 grams 1 slice, 3 x 3 x 1/2 in. + Spinach. 100 grams 2 h. tbsp. + Butter. + Cream. + Coffee. + +DINNER. + Broth. 180 c.c. 1 glass or cup. + Steak. 100 grams 1 small serving. + Cabbage. 100 grams 2 h. tbsp. + Lettuce. 100 grams 10 leaves. + Butter. + Cream. + Tea. + +SUPPER. + Egg. 1 + Onions (boiled). 100 grams 2 h. tbsp. + Bread. 15 grams 1 slice very thin, 3 x 3 x 1/4 + Milk. 4 ounces 8 tbsp. + Butter. + Cream. + Tea. + +_Allow during day:_ + Butter. 50 grams 5 squares. + Cream, 40%. 5 ounces 10 tbsp. + + +TABLE XXII. + + Protein, 60 grams + Carbohydrate, 30 grams + Fat, 158 grams + Calories, 1830 + +BREAKFAST. + Bacon. 50 grams 2 slices 6 in. long. + Egg. 1 + Tomatoes. 100 grams 2 h. tbsp. + Cream. + Butter. + Coffee. + +DINNER. + Steak. 100 grams 1 small serving. + Turnips. 420 grams 4 h. tbsp. + + Cucumbers. 100 grams 2 h. tbsp. + Onions. 100 grams 2 medium sized. + Butter. + Cream. + Tea. + Olive oil. 21 grams 1-1/2 tbsp. + +SUPPER. + Chicken. 50 grams 1 small serving. + Lettuce. 100 grams 10 medium leaves. + Celery. 100 grams 6 stalks 4-1/2 in. long. + Spinach. 100 grams 2 h. tbsp. + Butter. + Tea. + Cream. + +_Allow during day:_ + Butter. 15 grams 1-1/2 squares. + Cream, 40%. 6 ounces 12 tbsp. + + +TABLE XXIII. + + Protein, 62 grams + Carbohydrate, 31 grams + Fat, 153 grams + Calories, 1800 + +BREAKFAST. + Bacon. 50 grams 2 slices. + Peas. 75 grams 1-1/2 h. tbsp. + Butter. + Cream. + Coffee. + +DINNER. + Broth--100 c.c. with + vegetables: = 7 tbsp. + Cabbage. 25 grams 1 level tbsp. + Tomato. 25 grams 1 level tbsp. + Turnip. 25 grams 1 level tbsp. + Celery (chopped). 50 grams 2 level tbsp. + Steak. 100 grams 1 small serving. + Squash. 50 grams 1 h. tbsp. + Tomatoes. 75 grams 1-1/2 h. tbsp. + Butter. + Cream. + Tea. + +SUPPER. + Chicken. 75 grams 1 small serving. + Turnips. 175 grams 2-3/4 h. tbsp. + Celery. 100 grams 6 stalks 4-1/2 in. long. + +_Allow during day:_ + Butter. 50 grams 5 squares. + Cream, 40%. 5 ounces 10 tbsp. + Olive oil. 7 grams 1/2 tbsp. + + + +TABLE XXIV. + + Protein, 60 grams + Carbohydrate, 30 grams + Fat, 158 grams + Calories, 1830 + +BREAKFAST. + Bacon. 50 grams 2 slices 6 in. long. + Egg. 1 + Turnips. 140 grams 3 h. tbsp. -- + Butter. + Cream. + Coffee. + +DINNER. + Steak. 100 grams 1 small serving. + Celery. 100 grams 6 stalks 4-1/2 in. long. + Cucumbers. 100 grams 2 h. tbsp. + Lettuce. 100 grams 10 leaves. + Spinach. 100 grams 2 h. tbsp. + Olive oil. 21 grams 1-1/2 tbsp. + + Butter. + Cream. + Tea. + +SUPPER. + Chicken. 50 grams 1 very small serving. + Turnips. 280 grams 4 h. tbsp. + + Onions. 100 grams 2 h. tbsp. + Tomatoes. 100 grams 2 h. tbsp. + Butter. + Cream. + Tea. + +_Allow during day:_ + Butter. 50 grams 5 squares. + Cream, 40%. 5 ounces 10 tbsp. + + +TABLE XXV. + + Protein, 60 grams + Carbohydrate, 30 grams + Fat, 154 grams + Calories, 1800 + +BREAKFAST. + Bacon. 60 grams 2-1/2 slices, 6 in. long. + Eggs. 2 + Turnips. 140 grams 2-1/2 h. tbsp. + +DINNER. + Steak. 100 grams 1 small serving. + Spinach. 50 grams 1 h. tbsp. + Parsnips. 150 grams 3 h. tbsp. + Onions. 100 grams 2 h. tbsp. + Beets. 50 grams 1 h. tbsp. + Butter. + Cream. + Tea. + +SUPPER. + Ham. 50 grams 1 very small serving. + Lettuce. 100 grams 10 leaves. + String beans. 50 grams 1 h. tbsp. + Celery. 100 grams 6 stalks 4-1/2 in. long. + Asparagus. 50 grams 1 h. tbsp. + +_Allow during day:_ + Butter. 40 grams 4 squares. + Cream, 40%. 4 ounces 8 tbsp. + + +TABLE XXVI. + + Protein, 40 grams + Carbohydrate, 36 grams + Fat, 105 grams + Calories, 1280 + +BREAKFAST. + Bacon. 50 grams 2 slices. + Parsnips. 100 grams 2 h. tbsp. + Potatoes (mashed). 60 grams 1 h. tbsp. + Butter. + Cream. + Coffee. + +DINNER. + Broth. 180 c.c. 1 glass. + Squab. 100 grams 1 squab (small). + Cabbage. 100 grams 2 tbsp. + Celery. 100 grams 6 stalks 4-1/2 in. long. + Butter. + Cream. + Tea. + +SUPPER. + String beans. 100 grams 2 h. tbsp. + Cucumbers. 100 grams 2 h. tbsp. + Parsnips. 100 grams 2 h. tbsp. + Cauliflower. 120 c.c. 2 h. tbsp. + + Milk. 120 c.c. 1/2 glass. + Butter. + Cream. + Tea. + +_Allow during day:_ + Butter. 20 grams 2 squares. + Cream, 40%. 4 ounces 8 tbsp. + + +TABLE XXVII. + + Protein, 50 grams + Carbohydrate, 40 grams + Fat, 131 grams + Calories, 1587 + +BREAKFAST. + Egg. 1 + Parsnips. 100 grams 2 h. tbsp. + Bread. 35 grams 1 slice, 3 x 3-1/2 x 1/2 in. + Butter. + Cream. + Coffee. + +DINNER. + Broth. 180 c.c. 1 glass or cup. + Chop. 100 grams 1 + Cauliflower. 120 grams 2 h. tbsp. + + Carrots. 100 grams 2 h. tbsp. + Butter. + Cream. + Tea. + +SUPPER. + Bacon. 50 grams 2 slices. + Lettuce. 25 grams 3 leaves. + String beans. 100 grams 2 h. tbsp. + Peas. 55 grams 1 h. tbsp. + + Spinach. 100 grams 2 h. tbsp. + Butter. + Cream. + Tea. + +_Allow during day:_ + Butter. 25 grams 2-1/2 squares. + Cream, 40%. 3 ounces 6 tbsp. + + +TABLE XXVIII. + + Protein, 50 grams + Carbohydrate, 50 grams + Fat, 124 grams + Calories, 1563 + +BREAKFAST. + Orange. 100 grams 1 small. + Eggs. 2 + Bread. 10 grams 1 slice, 2 x 1 x 1/2 in. + Butter. + Cream. + Coffee. + +DINNER. + Steak. 100 grams 1 small serving. + Lettuce. 100 grams 10 leaves. + Spinach. 100 grams 2 h. tbsp. + Butter. + Cream. + Tea. + +SUPPER. + Egg. 1 + Cold ham. 50 grams 1 small serving. + Asparagus. 50 grams 1 h. tbsp. + String beans. 100 grams 2 h. tbsp. + Bread. 25 grams 1 slice, 3 x 3 x 1/2 in. + Butter. + Cream. + Tea. + +_Allow during day:_ + Butter. 30 grams 3 squares. + Cream, 40%. 4 ounces 8 tbsp. + + +TABLE XXIX. + + Protein, 52 grams + Carbohydrate, 52 grams + Fat, 116 grams + Calories, 1504 + +BREAKFAST. + Orange. 100 grams 1 small. + Bacon. 50 grams 2 slices 6 in. long. + Egg. 1 + Bread. 20 grams 1 slice, 3 x 2 x 1/2 in. + Butter. + Cream. + Coffee. + +DINNER. + Boiled ham. 100 grams 1 large slice (thin). + Brussels sprouts. 100 grams 2 h. tbsp. + Milk. 6 ounces 1 glass. + Butter. + Tea. + Cream. + +SUPPER. + Scotch broth. 6 ounces 12 tbsp. + Lettuce. 50 grams 5 leaves. + Bread. 20 grams 1 slice, 3 x 2 x 1/2 in. + +_Allow during day:_ + Butter. 20 grams 2 squares. + Cream, 40%. 3 ounces 6 tbsp. + + +TABLE XXX. + + Protein, 50 grams + Carbohydrate, 50 grams + Fat, 117 grams + Calories, 1590 + +BREAKFAST. + Orange. 100 grams 1 small. + Bread. 25 grams 1 slice, 3 x 2 x 1/2 in. + Egg. 1 + Bacon. 50 grams 2 slices 6 in. long. + Butter. + Cream. + Coffee. + +DINNER. + Chop. 100 grams 1 medium chop. + Asparagus. 100 grams 2 h. tbsp. + Butter. + Cream. + Tea. + +SUPPER. + Egg. 1 + Cucumbers. 100 grams 2 h. tbsp. + Lettuce. 10 grams 1 leaf. + Bread. 25 grams 1 slice, 3 x 2 x 1/2 in. + +_Allow during day:_ + Butter. 30 grams 3 squares. + Cream, 40%. 3 ounces 6 tbsp. + + +TABLE XXXI. + + Protein, 53 grams + Carbohydrate, 50 grams + Fat, 133 grams + Calories, 1658 + +BREAKFAST. + Orange. 150 grams 1 medium. + Bacon. 60 grams 2-1/2 slices. + Egg. 1 + Bread. 20 grams 1 slice, 3 x 2 x 1/2 in. + Butter. + Cream. + Tea. + +DINNER. + Steak. 50 grams 1 very small serving. + String beans. 50 grams 1 h. tbsp. + Lettuce. 100 grams 10 leaves. + Butter. + Cream. + Tea. + +SUPPER. + Ham. 50 grams 1 small slice. + Asparagus. 50 grams 1 h. tbsp. + Spinach. 50 grams 1 h. tbsp. + Bread. 15 grams 1 slice, 3 x 1 x 1/2 in. + Butter. + Cream. + Tea. + +_Allow during day:_ + Butter. 20 grams 2 squares. + Cream, 40%. 3 ounces 6 tbsp. + + +TABLE XXXII. + + Protein, 101 grams + Carbohydrate, 51 grams + Fat, 255 grams + Calories, 2995 + +BREAKFAST. + Orange. 50 grams 1/2 orange (small). + Steak. 100 grams 1 slice. + Egg. 1 + Bread. 20 grams 1 slice, 3 x 2 x 1/2 in. + Butter. + Cream. + Tea. + +DINNER. + Lamb chop. 180 grams 2 small. + Potato. 50 grams 1 very small. + Turnip. 140 grams 2 h. tbsp + + Lettuce. 10 grams 1 leaf. + Tomato (raw). 100 grams 1 medium. + Custard--made with + one egg and part + of the cream. + Butter. + Tea. + Olive oil. 1-1/2 tbsp. + +SUPPER. + Bacon. 50 grams 2 slices 6 in. long. + Eggs. 2 + Onions. 50 grams 1 h. tbsp. + Cabbage. 100 grams 2 h. tbsp. + Bread. 20 grams 1 slice, 3 x 2 x 1/2 in. + Butter. + Cream. + Tea. + +_Allow during day:_ + Butter. 50 grams 5 squares. + Cream, 40%. 6 ounces 12 tbsp. + + +TABLE XXXIII. + + Protein, 60 grams + Carbohydrate, 55 grams + Fat, 159 grams + Calories, 1950 + +BREAKFAST. + Orange. 100 grams 1 small. + Bacon. 100 grams 4 slices 6 in. long. + Egg. 1 + Spinach. 100 grams 2 h. tbsp. + Bread. 25 grams 1 slice, 3 x 2 x 1/2 in. + Butter. + Cream. + Coffee. + +DINNER. + Broth. 180 c.c. 1 glass or cup. + Steak. 100 grams 1 small serving. + Parsnips. 100 grams 2 h. tbsp. + Carrots. 100 grams 2 h. tbsp. + Butter. + Cream. + Tea. + +SUPPER. + Egg. 1 + Lettuce. 25 grams 3 medium leaves. + String beans. 10 grams 2 h. tbsp. + Bread. 25 grams 1 slice, 3 x 2 x 1/2 in. + Spinach. 60 grams 1 very h. tbsp. + Butter. + Cream. + Tea. + +_Allow during day:_ + Butter. 25 grams 2-1/2 squares. + Cream, 40%. 4 ounces 8 tbsp. + + +TABLE XXXIV. + + Protein, 60 grams + Carbohydrate, 50 grams + Fat, 145 grams + Calories, 1800 + +BREAKFAST. + Egg. 1 + Bacon. 100 grams 4 slices 6 in. long. + Tomatoes. 100 grams 2 h. tbsp. + Bread. 35 grams 1 slice, medium. + Butter. + Cream. + Tea. + +DINNER. + Broth. 180 c.c. 1 glass or cup. + Squab. 100 grams 1 squab (small). + Cabbage. 100 grams 2 h. tbsp. + Onions. 100 grams 2 h. tbsp. + Butter. + Cream. + Tea. + +SUPPER. + Egg. 1 + Lettuce. 25 grams 3 medium leaves. + Celery. 100 grams 6 stalks, 4-1/2 in. long. + Bread. 30 grams 1 slice, med. thin. + +_Allow during day:_ + Butter. 30 grams 3 squares. + Cream, 40%. 3-1/2 ounces 7 tbsp. + + +TABLE XXXV. + + Protein, 63 grams + Carbohydrate, 60 grams + Fat, 140 grams + Calories, 1800 + +BREAKFAST. + Grape fruit. 100 grams 1/2 small grape fruit. + Bacon. 100 grams 4 slices 6 in. long. + Egg. 1 + Cauliflower. 120 grams 2 h. tbsp. + + Bread. 30 grams 1 slice, med. thin. + Butter. + Cream. + Coffee. + +DINNER. + Broth. 180 c.c. 1 glass. + Squab. 100 grams 1 squab. + Carrots. 100 grams 2 h. tbsp. + Lettuce. 100 grams 10 leaves. + Asparagus. 100 grams 2 h. tbsp. + Butter. + Cream. + Tea. + +SUPPER. + Egg. 1 + Asparagus. 100 grams 2 h. tbsp. + Spinach. 100 grams 2 h. tbsp. + Bread. 30 grams 1 slice, med. thin. + Butter. + Cream. + Tea. + +_Allow during day:_ + Butter. 20 grams 2 squares. + Cream, 40%. 3 ounces 6 tbsp. + + +TABLE XXXVI. + + Protein, 60 grams + Carbohydrate, 60 grams + Fat, 140 grams + Calories, 1794 + +BREAKFAST. + Orange. 100 grams 1 small. + Bacon. 100 grams 4 slices 6 in. long. + Egg. 1 + Bread. 35 grams 1 slice medium. + Butter. + Cream. + Tea. + +DINNER. + Broth. 180 c.c. 1 glass or cup. + Steak. 100 grams 1 small serving. + Turnips. 140 grams 2 h. tbsp. + + Parsnips. 200 grams 4 h. tbsp. + String beans. 100 grams 2 h. tbsp. + Butter. + Cream. + Tea. + +SUPPER. + Egg. 1 + Lettuce. 25 grams 3 leaves. + Cucumbers. 100 grams 16 slices (thin). + Bread. 30 grams 1 slice, med. thin. + Butter. + Cream. + Tea. + +_Allow during day:_ + Butter. 20 grams 2 squares. + Cream, 40%. 3 ounces 6 tbsp. + + +TABLE XXXVII. + + Protein, 74 grams + Carbohydrate, 62 grams + Fat, 179 grams + Calories, 2220 + +BREAKFAST. + Bacon. 100 grams 4 slices 6 in. long. + Egg. 1 + Bread. 30 grams 1 slice, 3 x 3 x 1/2 in. medium thin. + Butter. + Cream. + Tea. + +DINNER. + Broth. 180 c.c. 1 glass. + Chicken. 100 grams 1 medium serving. + Baked potato. 100 grams 1 medium. + Tomato. 100 grams 2 h. tbsp. + Lettuce. 25 grams 3 leaves. + Olive oil. 13 grams 1 tbsp. + Butter. + Cream. + Tea. + +SUPPER. + Egg. 1 + Cabbage. 100 grams 2 h. tbsp. + Celery. 100 grams 6 stalks 4-1/2 in. long. + Onions. 100 grams 2 h. tbsp. + Butter. + Tea. + Cream. + +_Allow during day:_ + Butter. 25 grams 2-1/2 squares. + Cream, 40%. 7 ounces 14 tbsp. + + +TABLE XXXVIII. + + Protein, 71 grams + Carbohydrate, 60 grams + Fat, 184 grams + Calories, 2242 + +BREAKFAST. + Bacon. 100 grams 4 slices 6 in. long + Egg. 1 + Asparagus. 100 grams 2 h. tbsp. + Bread. 25 grams 1 slice, 3 x 2 x 1/2 in. + Butter. + Cream. + Coffee. + +DINNER. + Broth. 180 c.c. 1 glass or cup. + Steak. 100 grams 1 small serving. + Spinach. 100 grams 2 h. tbsp. + Carrots. 100 grams 2 h. tbsp. + Butter. + Cream. + Tea. + +SUPPER. + Egg. 1 + Lettuce. 100 grams 10 leaves. + Lima beans. 100 grams 2 h. tbsp. + Cauliflower. 120 grams 2 h. tbsp. + + Beef juice. 4 ounces 8 tbsp. + Bread. 25 grams 1 slice 3 x 3 x 1/2 in. + Butter. + Cream. + Tea. + +_Allow during day:_ + Butter. 25 grams 2-1/2 squares. + Cream, 40%. 7 ounces 14 tbsp. + + +TABLE XXXIX. + + Protein, 72 grams + Carbohydrate, 65 grams + Fat, 174 grams + Calories, 2170 + +BREAKFAST. + Bacon. 100 grams 4 slices 6 in. long. + Eggs. 2 + Bread. 25 grams 1 slice, 3 x 2 x 1/2 in. + Butter. + Cream. + Coffee. + +DINNER. + Broth. 180 c.c. 1 glass or cup. + Squab. 100 grams 1 + Lettuce. 25 grams 3 leaves. + Cucumbers. 100 grams 1 h. tbsp. + Turnips. 140 grams 2 h. tbsp. + Strawberries. 100 grams 2 h. tbsp. + + Bread. 25 grams 1 slice, 3 x 2 x 1/2 in. + Butter. + Cream. + Tea. + +SUPPER. + Fish (Haddock). 1 very small helping. + String beans. 100 grams 2 h. tbsp. + Parsnips. 200 grams 4 h. tbsp. + Bread. 25 grams 1 slice, 3 x 2 x 1/2 in. + Butter. + Cream. + Tea. + +_Allow during day:_ + Butter. 10 grams 1 square. + Cream, 40%. 7 ounces 14 tbsp. + + +TABLE XL. + + Protein, 71 grams + Carbohydrate, 65 grams + Fat, 183 grams + Calories, 2257 + +BREAKFAST. + Bacon. 100 grams 4 slices 6 in. long. + Egg. 1 + Bread. 20 grams 1 very small slice. + Carrots. 100 grams 2 h. tbsp. + Butter. + Cream. + Coffee. + +DINNER. + Broth. 180 c.c. 1 glass or cup. + Roast lamb. 100 grams 1 small serving. + Baked potato. 100 grams 1 medium. + Lettuce. 10 leaves. + Asparagus. 100 grams 2 h. tbsp. + Butter. + Cream. + Tea. + +SUPPER. + Eggs. 2 + Cauliflower. 120 grams 2 h. tbsp. + + Spinach. 100 grams 2 h. tbsp. + Bread. 20 grams 1 very small slice. + Butter. + Cream. + Tea. + +_Allow during day:_ + Butter. 25 grams 2-1/2 squares. + Cream, 40%. 7 ounces 14 tbsp. + + +TABLE XLI. + + Protein, 77 grams + Carbohydrate, 68 grams + Fat, 185 grams + Calories, 2315 + +BREAKFAST. + Bacon. 100 grams 4 slices 6 in. long. + Eggs. 2 + Tomatoes. 100 grams 1 med. tomato. + Butter. + Cream. + Tea. + +DINNER. + Broth. 6 ounces 1 glass. + Haddock. 100 grams 1 small helping. + Cabbage. 100 grams 2 h. tbsp. + Onions. 100 grams 2 h. tbsp. + Baked potato. 100 grams 1 medium. + Tea. + Cream. + Butter. + +SUPPER. + Cold boiled ham. 75 grams 1 slice, large. + Bread. 25 grams 1 slice, 3 x 2 x 1/2 in. + Peas. 100 grams 2 h. tbsp. + Lettuce. 25 grams 3 leaves. + Celery. 100 grams 6 stalks 4-1/2 in. long. + Butter. + Tea. + +_Allow during day:_ + Butter. 35 grams 3-1/2 squares. + Cream, 40%. 7 ounces 14 tbsp. + + +TABLE XLII. + + Protein, 77 grams + Carbohydrate, 69 grams + Fat, 186 grams + Calories, 2328 + +BREAKFAST. + Bacon. 100 grams 4 slices 6 in. long. + Eggs. 2 + Bread. 50 grams 2 slices, 3 x 2 x 1/2 in. + Butter. + Cream. + Coffee. + +DINNER. + Broth. 6 ounces 1 glass or cup. + Steak. 100 grams 1 slice. + Turnips. 140 grams 2 h. tbsp. + + Lettuce. 25 grams 3 leaves. + Bread. 25 grams 1 slice, 3 x 2 x 1/2 in. + Cream. + Tea. + +SUPPER. + Cold veal. 50 grams 1 small slice. + Parsnips. 200 grams 4 h. tbsp. + String beans. 100 grams 2 h. tbsp. + Cucumbers. 100 grams 2 h. tbsp. + Bread. 25 grams 1 slice, 3 x 2 x 1/2 in. + Cream. + Tea. + +_Allow during day:_ + Butter. 30 grams 3 squares. + Cream, 40%. 7 ounces 14 tbsp. + + +TABLE XLIII. + + Protein, 74 grams + Carbohydrate, 71 grams + Fat, 176 grams + Calories, 2220 + +BREAKFAST. + Egg. 1 + Bacon. 100 grams 4 slices 6 in. long. + Parsnips. 100 grams 2 h. tbsp. + Butter. + Cream. + Coffee. + +DINNER. + Broth. 6 ounces 1 glass or cup. + Chicken. 100 grams 1 med. serving. + Squash. 50 grams 1 h. tbsp. + Turnips. 140 grams 2 h. tbsp. + + String beans. 100 grams 2 h. tbsp. + Baked potato. 100 grams 1 medium. + Butter. + Cream. + Tea. + +SUPPER. + Egg. 1 + Parsnips. 100 grams 2 h. tbsp. + Lettuce. 25 grams 3 leaves. + Cucumbers. 100 grams 2 h. tbsp. + Bread. 40 grams 1 slice, 3 x 2 x 1/2 in. + Olive oil. 13 grams 1 tbsp. + Butter. + Cream. + Tea. + +_Allow during day:_ + Butter. 20 grams 2 squares. + Cream, 40%. 7 ounces 14 tbsp. + + +TABLE XLIV. + + Protein, 75 grams + Carbohydrate, 71 grams + Fat, 180 grams + Calories, 2250 + +BREAKFAST. + Bacon. 100 grams 4 slices 6 in. long. + Egg. 1 + Asparagus. 100 grams 2 h. tbsp. + Potato (boiled). 50 grams 1 very small. + Butter. + Cream. + Tea. + +DINNER. + Steak. 100 grams 1 small serving. + Potato (boiled). 100 grams 1 medium. + Spinach. 100 grams 2 h. tbsp. + Cauliflower. 120 grams 2 h. tbsp. + + Butter. + Cream. + Tea. + +SUPPER. + Egg. 1 + Cottage cheese. 50 grams 1-1/2 x 1-1/2 x 1-1/2 in. + Lettuce. 100 grams 10 leaves. + Carrots. 100 grams 2 h. tbsp. + Bread. 35 grams 1 med. thin slice. + Butter. + Cream. + Tea. + +_Allow during day:_ + Butter. 20 grams 2 squares. + Cream, 40%. 7 ounces 14 tbsp. + + +TABLE XLV. + + Protein, 99 grams + Carbohydrate, 101 grams + Fat, 225 grams + Calories, 2880 + +BREAKFAST. + Oranges. 200 grams 2 small. + Bacon. 75 grams 3 slices. + Eggs. 2 + Bread. 35 grams 1 med. slice. + Butter. + Cream. + Coffee. + +DINNER. + Lamb chop. 100 grams 1 chop. + Peas. 100 grams 2 h. tbsp. + Olives. 50 grams 13 small olives. + Almonds. 50 grams 26 small almonds. + Bread. 25 grams 1 slice, 3 x 2 x 1/2 in. + Butter. + Cream. + Tea. + +SUPPER. + Salmon. 100 grams 1 average helping. + Salad: + Lettuce. 25 grams 3 leaves. + Fresh tomato. 100 grams 1 medium. + Mayonnaise. 21 grams 1 tbsp. + American cheese. 25 grams 1-1/2 x 1 x 1 in. + Bread. 40 grams 1 slice, 3 x 3-1/2 x 1/2 in. + +_Allow during day:_ + Butter. 40 grams 4 squares. + Cream, 40%. 6 ounces 12 tbsp. + + +TABLE XLVI. + + Protein, 101 grams + Carbohydrate, 101 grams + Fat, 235 grams + Calories, 3010 + +BREAKFAST. + Grape fruit. 100 grams 1/2 small. + Eggs. 2 + Bread. 50 grams 2 slices, 3 x 2 x 1/2 in. + Butter. + Cream. + Coffee. + +DINNER. + Chops. 200 grams 2 small. + Potato. 75 grams 1 medium or 1-1/2 tbsp. of mashed. + Lettuce. 50 grams 5 leaves. + Bread. 25 grams 1 slice, 3 x 2 x 1/2 in. + Walnuts. 25 grams 5 whole walnut meats. + French dressing: + Oil. 26 grams 2 tbsp. + Vinegar. + +SUPPER. + Cold chicken. 50 grams 1 small slice. + Egg. 1 + Bread. 25 grams 1 slice, 3 x 2 x 1/2 in. + Celery. 50 grams 3 stalks 4-1/2 in. long. + Peach. 100 grams 1 peach. + Butter. + Cream. + Tea. + + _Allow during day:_ + Butter. 50 grams 5 squares. + Cream, 40%. 6 ounces 12 tbsp. + + +TABLE XLVII. + + Protein, 99 grams + Carbohydrate, 126 grams + Fat, 228 grams + Calories, 3043 + +BREAKFAST. + Lamb chop. 100 grams 1 chop. + Eggs. 2 + Bread. 50 grams 2 slices, each 3 x 2 x 1/2 in. + Butter. + Cream. + Coffee. + +DINNER. + Steak. 100 grams 1 small serving. + Potato. 200 grams 2 small ones. + Cabbage. 100 grams 2 h. tbsp. + Bread. 25 grams 1 slice, 3 x 2 x 1/2 in. + Butter. + Tea. + Custard or ice cream, using part of cream, and one-half egg (extra). + +SUPPER. + Bacon. 100 grams 4 slices. + Egg. 1 + Peas. 100 grams 2 h. tbsp. + Beets. 100 grams 2 h. tbsp. + Peach (as purchased). 100 grams 1 peach. + Bread. 25 grams 1 slice, 3 x 2 x 1/2 in. + Butter. + Cream. + Tea. + + _Allow during day:_ + Butter. 50 grams 5 squares. + Cream, 40%. 6 ounces 12 tbsp. + + +TABLE XLVIII. + + Protein, 101 grams + Carbohydrate, 150 grams + Fat, 292 grams + Calories, 3744 + +BREAKFAST. + Grape fruit. 300 grams 1 medium. + Bacon. 75 grams 3 slices. + Eggs. 2 + Bread. 35 grams 1 medium slice. + Butter. + Cream. + Tea. + Sugar. + +DINNER. + Lamb chop. 100 grams 1 chop. + Peas. 100 grams 2 h. tbsp. + Lettuce. 25 grams 3 leaves. + Fresh tomato. 100 grams 1 medium. + Mayonnaise. 21 grams 1 tbsp. + Bread. 25 grams 1 slice, 3 x 2 x 1/2 in. + Butter. + Tea. + +SUPPER. + Cold roast beef. 100 grams 1 slice (large). + Olives. 50 grams 13 small olives. + Almonds. 20 grams + Cream cheese. 50 grams 1-1/2 x 1-1/2 x 1-1/2 in. + Bread. 40 grams 1 slice, 3 x 3-1/2 x 1/2 in. + Butter. + Cream. + Tea. + +_Allow during day:_ + Butter. 50 grams 5 squares. + Cream, 40%. 5 ounces 10 tbsp. + Sugar. 40 grams 4 h. tbsp. + Tea. + Butter. + + + * * * * * + +Dr. Edwin A. Locke's book of food values has been of much value in +making up these diets. + + * * * * * + +The following shows the successive steps in building up a diet for a +patient who starved six days before becoming sugar-free: + + Grams Grams Grams Total + Protein Fat Carbohydrate Calories + + Day 1 2 + 5 30 + " 2 15 12 4 189 + " 3 23 18 8 294 + " 4 36 30 11 471 + " 5 18 48 9 560 + " 6 51 44 17 688 + " 7 52 51 15 750 + " 8 46 51 19 740 + " 9 49 78 20 1008 + " 10 50 101 21 1230 + " 11 49 123 19 1422 + " 12 Starved because sugar came through + " 13 15 12 3 185 + " 14 34 32 10 478 + " 15 53 100 15 1208 + + * * * * * + +Patient discharged with advice as to diet. The corresponding menus for +the above are as follows: + + +FIRST DAY. + + BREAKFAST. DINNER. SUPPER. + + String beans 25 grams. Lettuce 25 grams. Lettuce 25 grams. + Lettuce 25 grams. Cucumbers 25 grams. Tomato 25 grams. + Coffee. Tea. Tea. + + Protein 2 grams, Fat, trace, Carbohydrate 5 grams, Calories 30. + + +SECOND DAY. + + BREAKFAST. DINNER. SUPPER. + + Egg 1. Egg 1. Lettuce 25 grams. + Lettuce 25 grams. Lettuce 25 grams. String beans 25 grams. + Cucumbers 25 grams. String beans 25 grams. Tea. + Coffee. Tea. + + Protein 15 grams, Fat 12 grams, Carbohydrate 4 grams, Calories 189. + + +THIRD DAY. + + BREAKFAST. DINNER. SUPPER. + + Egg 1. Egg 1. Egg 1. + Asparagus 50 grams. Cauliflower 50 grams. String beans 75 grams. + Lettuce 25 grams. Lettuce 50 grams. Celery 50 grams. + + Protein 28 grams, Fat 18 grams, Carbohydrate 8 grams, Calories 294. + + +FOURTH DAY. + + BREAKFAST. DINNER. SUPPER. + + Egg 1. Chicken broth 6 oz. Egg 1. + String beans 100 grams. Egg 1. Egg whites 2. + Coffee. Celery 100 grams. Lettuce 75 grams. + Cream 1 oz. Tea. Cucumbers 50 grams. + + Protein 36 grams, Fat 30 grams, Carbohydrate 11 grams, Calories 471. + + +FIFTH DAY. + + BREAKFAST. DINNER. SUPPER. + + Egg 1. String beans 75 grams. Egg 1. + Cauliflower 100 grams. Lettuce 25 grams. Asparagus. + Coffee. Tomatoes 50 grams. Tea. + Cream 2 tbsp. Butter 1 square. Cream 2 tbsp. + Butter 1/2 square. Tea. + Cream 2 tbsp. + + Protein 18 grams, Fat 48 grams, Carbohydrate 10 grams, Calories 560. + + +SIXTH DAY. + + BREAKFAST. DINNER. SUPPER. + + Egg 1. Broth 6 oz. Egg 1. + Spinach 75 grams. Chicken 50 grams. Egg whites 2. + Butter 1/2 square. Lettuce 50 grams. String beans 75 grams. + Coffee. Tomatoes 75 grams. Cucumbers 75 grams. + Cream 1 tbsp. Asparagus 75 grams. Tea. + Tea. Cream 1 tbsp. + Cream 1 tbsp. Butter 1/2 square. + + Protein 51 grams, Fat 44 grams, Carbohydrate 17 grams, Calories 688. + + +SEVENTH DAY. + + BREAKFAST. DINNER. SUPPER. + + Eggs 2. Beef broth 6 oz. Egg 1. + Asparagus 100 grams. Scraped beef 50 grams. Salmon 50 grams. + Coffee. Cauliflower 100 grams. Cabbage 100 grams. + Cream 1 tbsp. Spinach 100 grams. Tomatoes (raw) 75 grams. + Lettuce 25 grams. String beans 100 grams. Tea. + Tea. Cream 1 tbsp. Cream 1 tbsp. + + Protein 52 grams, Fat 51 grams, Carbohydrate 15 grams, Calories 750. + + +EIGHTH DAY. + + BREAKFAST. DINNER. SUPPER. + + Egg 1. Chicken 75 grams. Egg 1. + String beans 100 grams. Cauliflower 100 grams. Spinach 100 grams. + Asparagus 100 grams. Olives 25 grams. Celery 50 grams. + Coffee. Cucumbers 50 grams. Lettuce 50 grams. + Cream 1 tbsp. Tea. Tea. + Cream 1 tbsp. Cream 1 tbsp. + + Protein 46 grams, Fat 51 grams, Carbohydrate 19 grams, Calories 740. + + +NINTH DAY. + + BREAKFAST. DINNER. SUPPER. + + Egg 1. Chicken 75 grams. Egg 1. + Egg white 1. String beans 100 grams. Cauliflower 100 grams. + Spinach 100 grams. Asparagus 100 grams. Cucumbers 50 grams. + Celery 50 grams. Olives 25 grams. Lettuce 50 grams. + Coffee. Tea. Tea. + Cream 2 tbsp. Cream 1 tbsp. Cream 1 tbsp. + Butter 1 square. Butter 1-1/2 square. Butter 1 square. + + Protein 49 grams, Fat 77 grams, Carbohydrate 19 grams, Calories 1008. + + +TENTH DAY. + + BREAKFAST. DINNER. SUPPER. + + Egg 1. Lamb chop 75 grams. Egg 1. + Lettuce 50 grams. Spinach 100 grams. Salmon 50 grams. + String beans 100 grams. Celery 50 grams. Asparagus 100 grams. + Cucumbers 100 grams. Olives 25 grams. Cabbage 100 grams. + Coffee. Tea. Tea. + Cream 2 tbsp. Cream 2 tbsp. Cream 2 tbsp. + + Protein 50 grams, Fat 101 grams, Carbohydrate 21 grams, Calories 1230. + + +ELEVENTH DAY. + + BREAKFAST. DINNER. SUPPER. + + Bacon 50 grams. Beef broth 8 oz. Egg 1. + Asparagus 100 grams. Chicken 75 grams. Tomatoes 100 grams. + Spinach 100 grams. Cabbage 100 grams. Spinach 50 grams. + Butter 2 squares. Cucumbers 50 grams. Butter 2 squares. + Cream 3 tbsp. Butter 3 squares. Cream 1 tbsp. + Cream (made into ice + cream) 4 tbsp. + + Protein 49 grams, Fat 123 grams, Carbohydrate 19 grams, Calories 1422. + + +TWELFTH DAY. + + BREAKFAST. DINNER. SUPPER. + + Black coffee. Chicken broth 8 oz. Beef broth 8 oz. + + Protein 12 grams, Calories 49. + + +THIRTEENTH DAY. + + BREAKFAST. DINNER. SUPPER. + + String beans 50 grams. Egg 1. Egg 1. + Black coffee. Asparagus 50 grams. Cabbage 50 grams. + Tea. Tea. + + Protein 15 grams, Fat 12 grams, Carbohydrate 4 grams, Calories 185. + + +FOURTEENTH DAY. + + BREAKFAST. DINNER. SUPPER. + + Egg 1. Roast chicken 50 grams. Egg 1. + String beans 100 grams. Asparagus 100 grams. Cauliflower 100 grams. + Coffee. Cabbage 100 grams. Tea. + Cream 1 tbsp. Tea. Cream 1 tbsp. + Cream 1 tbsp. + + Protein 34 grams, Fat 32 grams, Carbohydrate 10 grams, Calories 478. + + +FIFTEENTH DAY. + + BREAKFAST. DINNER. SUPPER. + + Egg 1. Squab 100 grams. Egg 1. + Tomatoes 50 grams. String beans 100 grams. Cold chicken 25 grams. + Coffee. Cauliflower 150 grams. Lettuce 50 grams. + Cream 2 tbsp. Butter 1 square. Spinach 50 grams. + Custard made with 1 Tea. + egg, 4 tbsp. cream Cream 2 tbsp. + and 2 tbsp. water + sweetened with + saccharine. + Tea. + + Protein 53 grams, Fat 100 grams, Carbohydrate 15 grams, Calories 1208. + +Patient discharged with advice as to diet. + + +FOOD VALUES. + +An estimate of the quantity or bulk of food may be of assistance or +interest. There is so much variation in the size of tablespoons or +what may be termed either rounding or heaping tablespoons that it must +be remembered that we can only estimate. Patients who are instructed +how to feed themselves on leaving the hospital are cautioned carefully +to take about the quantity of an article of food they have been served +while in the hospital when the diet is weighed. Any written advice is +always given in quantities known to be _under_ the carbohydrate or +protein tolerance of the patient. However, if they will boil the +vegetables and change the water at least twice, so much carbohydrate +is removed that it is quite possible for them to obtain a comfortable +bulk and still take in very small quantities of carbohydrate. + + +100-Gram Portions. + + Asparagus--8 or 9 stalks 4 inches long. + Beans (string) (cut in small pieces) 3 heaping tablespoons. + Bacon--4 slices 6 inches long, 2 inches wide.[7] + Cabbage (cooked)--3 heaping tablespoons. + Cauliflower--3 rounding tablespoons. + Celery--6 pieces 4-1/2 inches long, medium thickness. + Cheese--a piece 4 inches by 1-1/2 inch by 1 inch. + Cucumbers--12 slices 1/8 inch thick, 1/2 inch in diameter. + Greens (spinach, kale, etc.)--2 heaping tablespoons. + Lettuce--10 to 12 medium-sized leaves. + Onions--2 onions, size of an egg. + Olives--25 small olives. + Peas--3 rounding tablespoons. + Potatoes (baked)--1 small potato, size of egg. + Potatoes (mashed)--2 rounding tablespoons. + Sardines--28 sardines--1 small box. + Salmon--1/4 can (almost). + Tomatoes--2-1/2 heaping tablespoons. + Tomatoes--fresh, one medium sized tomato, 2 inches in diameter. + + [7] Bacon loses about half of its fat content when cooked. + +Other Weights. + + 1 tablespoon olive oil = 13 grams + 1 tablespoon mayonnaise = 21 " + 1 thin slice of bread (baker's loaf) = 25 " + 1 medium sized orange = 150 " + 1 peach = 125 " + 1 medium sized apple = 150 " + 1/2 small grape fruit = 150 " + 1 medium sized lamb chop with bone = 100 " + 1 medium sized slice cold tongue = 25 " + 1 slice tenderloin steak 1 in. thick = 100 " + 1 average helping of fish = 100 " + 1 average helping of butter = 10 " + 1 average sized egg = 50 " + 1 average helping of cooked green vegetables + such as spinach, cabbage, + cauliflower, asparagus, etc. (2 tablespoons)[8] = 100 " + 1 average helping boiled cereal = 100 " + 1 potato, size of large egg = 100 " + + [8] It is not true that all the vegetables weigh the same, + but for the sake of simplicity in most of the diets it has been + reckoned that two heaping tablespoons of any one of the "5%" + vegetables weighs 100 gms. + +The following food values are taken from Locke's Abstract of Atwater +and Bryant's Bulletin No. 28, 1906, United States Department of +Agriculture. + +Fractions of per cents. have been left off in order to make the use of +the table more simple, and the values given will be found quite +accurate enough for clinical purposes. + + Food Stuffs. Quantity. Protein. Fat. Carbohydrate. Total + Raw. Grams. Grams. Grams. Calories. + + MEAT. + + Beef 100 gms. 22 28 350 + Chicken " " 32 4 168 + Bacon (raw) " " 10 64 636 + + FISH. + + Fish (average) " " 20 7 147 + Oysters " " 6 1 3 46 + + EGGS. + + Eggs " " 13 12 165 + Eggs 1 egg 7 6 84 + + DAIRY PRODUCTS. + + Butter 100 gms. 1 85 795 + Cheese (American) " " 28 35 2 448 + Cheese (Neufchatel) " " 19 27 2 337 + Milk (whole) " " 3 4 5 70 + Milk (whole) 1 qt. 30 36 45 642 + Milk (skim) 100 gms. 3 0.3 5 35 + Milk (skim) 1 qt. 31 3 46 343 + Cream (gravity) 100 gms. 3 16 5 181 + Cream (gravity) 1 pt. 12 73 23 822 + + CEREAL PRODUCTS. + + Oatmeal (cooked) 100 gms. 3 0.5 12 66 + Rice (cooked) " " 3 0.1 24 112 + Macaroni (cooked) " " 3 0.1 24 112 + Bread " " 9 1 53 264 + Soda crackers " " 10 9 73 424 + Cake (average) " " 6 9 63 367 + + VEGETABLES. + + Asparagus (canned) 100 gms. 2 1 3 30 + Beans (dried) " " 22 2 59 350 + Beans (string) + fresh cooked " " 1 1.0 2 22 + Beets (cooked) " " 2 0.1 7 37 + Cabbage (raw) " " 2 0.3 6 35 + Carrots (raw) " " 1 0.4 9 45 + Cauliflower (raw) " " 2 0.5 5 33 + Celery (raw) " " 1 0.1 3 17 + Corn (green) " " 3 1 20 103 + Cucumbers (raw) " " 0.8 0.2 3 17 + Lettuce (raw) " " 1 0.3 3 19 + Mushrooms (raw) " " 3 0.4 7 45 + Onions (raw) " " 1 0.3 10 48 + Peas (dried) " " 24 1 62 362 + Peas (green, raw) " " 7 0.5 16 99 + Potatoes (white) " " 2 0.1 18 83 + Potatoes (sweet) " " 2 0.7 27 125 + Spinach " " 2 0.3 3 23 + Squash " " 1 0.5 9 46 + Tomatoes " " 0.9 0.4 4 24 + Turnips " " 1 0.2 8 39 + +The values for all the vegetables are calculated from the _raw_ +vegetables. + + FRUITS. + + Apples (edible portion) 100 gms. 0.4 0.5 14 64 + Bananas (edible portion) " " 1 0.6 22 100 + Blackberries " " 1 1 11 59 + Cherries " " 0.1 1 15 71 + Cranberries 100 gms. 0.4 0.6 10 48 + Currants " " 1 13 57 + Figs (dried) " " 4 0.3 74 323 + Grapes " " 1 1 14 71 + Huckleberries " " 0.6 0.6 16 74 + Lemon juice " " 10 41 + Muskmelons + (edible portions) " " 0.6 9 39 + Oranges (edible portion) " " 0.8 0.2 11 50 + Peaches (edible portion) " " 0.7 0.1 9 41 + Pears (edible portion) " " 0.6 0.5 14 65 + Prunes (dried) " " 2 73 308 + Raisins (dried) " " 2 3 76 348 + Pineapples " " 0.4 0.3 10 45 + Plums (edible portion) " " 1 20 86 + Raspberries " " 1 12 53 + Strawberries " " 1 0.6 7 38 + Watermelons " " 0.4 0.2 7 32 + + NUTS. + + Almonds. 100 gms. 21 54 17 658 + Chestnuts " " 6 5 42 243 + Peanuts (edible portion) " " 25 38 24 554 + Walnuts " " 18 64 13 722 + + MISCELLANEOUS. + + Chocolate 100 gms. 13 48 30 623 + Whiskey 50 c.c. 43% alcohol 152 + Lager beer 250 c.c. 4.5% alcohol 130 + + +ADDITIONAL DATA. + + Protein. Fat. Carbohydrate. Calories. + + Bacon (raw) 4 slices, 6 in. + long 2 in. wide 10 64 636 + Bacon (cooked) 4 slices, 6 in. + long, 2 in. wide 10 32 338 + to 46 to 468 + Beef (roast), 1 slice, 4-1/2 x + 1-1/2 x 1/8 in. 6 7 89 + Egg, 1 medium size, 50 gms. 7 6 84 + Oysters, 6 large 6 1 3 46 + Butter, 1-1/4 in. cube (25 + gms.) 21 195 + Cheese (Neufchatel) 1 cheese + 2-1/4 x 1-1/2 x 1-1/4 in. 16 23 1 284 + Cream (gravity--"16%"), + 1 glass, 7 oz. 5 32 10 359 + Milk (whole), 1 glass, 7 oz. 6 8 9 136 + Bread, 1 slice, 3 x 3-1/2 x + 1/2 in. (30 gms.) 3 0.5 16 81 + Uneeda Biscuit (1) 1 0.5 4 20 + Rice (boiled), 1 tablespoon, + (50 gms.) 1+ 12 56 + Oatmeal (boiled), 1 tablespoon, + (50 gms.) 1+ + 6 33 + Potato (size of large egg), + 100 gms. 2 + 18 83 + "5%" vegetables (uncooked) + 1 tablespoon 2.5 10 + "5%" vegetables (boiled + once) 1 tablespoon 1.7 7 + "5%" vegetables (boiled + thrice) 1 tablespoon 1 4 + Grape fruit as purchased (1 + small) 300 gms. 2 30 131 + Orange as purchased (1 medium) + 150 gms. 1 13 57 + English walnuts (6 whole + meats) 20 gms. 4 12 3 140 + Almonds (10 small) 10 gms. 2 5 2 63 + Peanuts (as purchased) 15 + nuts 6 9 6 33 + +All of these values are approximate. The following vegetables may be +considered as falling into the "5%" group: Lettuce, string beans, +spinach, cabbage, Brussels sprouts, egg plant, cauliflower, tomatoes, +asparagus, cucumbers, beet greens, chard, celery, Sauerkraut, ripe +olives, kale, rhubarb, dandelions, endive, watercress, pumpkin, +sorrel, and radishes. As these various vegetables contain from 3 to 7% +carbohydrate, it will be seen that the value of 2-1/2 grams +carbohydrate for 1 tablespoonful of these vegetables raw, and 1 gram +for the same amount thrice boiled, is not accurate, but it is near +enough for practical purposes. + + +Transcriber's Notes: + +A has been changed to A throughout + +Removed unnecessary opening parenthesis: + On Feb. 5 he was still sugar-free (having been so + + + + + +End of the Project Gutenberg EBook of The Starvation Treatment of Diabetes, by +Lewis Webb Hill and Rena S. 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