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Lewis Webb Hill and Rena S. Eckman

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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

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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





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