The Starvation Treatment Of Diabetes

Views:
 
Category: Others/ Misc
     
 

Presentation Description

Man cures his diabetes in 11 days with 'starvation diet'. A MAN has told ... Cure for MS? Pioneering stem cell treatment could 'reverse disability'.

Comments

Presentation Transcript

slide 1:

1/1/2016 THE STARVATI ON TREATME NT OF DIABETES LEWIS WEBB

slide 2:

2/173 THE STARVATION TREATMENT OF DIABETES WITH A SERIES OF GRADUATED DIETS USED AT THE MASSACHUSETTS GENERAL HOSPITAL by

slide 3:

3/173 LEWIS WEBB HILL M.D. Childrens Hospital Boston AND

slide 4:

4/173 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

slide 5:

5/173 Second Edition Printed January 1916 Second Edition Reprinted April 1916

slide 6:

6/173 INTRODUCTION. Although Dr. Allens modifications of the classical treatment of sac- charine 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.

slide 7:

7/173 One of the difficulties which is likely to prevent the wide adoption of his treatment is the detailed knowledge of food composition and cal- orie value which it requires. Dr. Hills and Miss Eckmans 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 Hos- pital 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 admir- ably well. To all who wish to give their patients the benefit of this treatment I can heartily recommend this book. RICHARD C. CABOT.

slide 8:

7/173

slide 9:

8/173 PREFACE TO FIRST EDITION. Want to Cure Diabetes Click Here 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 Hospit- al is undoubtedly a most valuable treatment. At the Mas- sachusetts 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 pro- teid and carbohydrate intake is of the utmost importance if the treatment is to be successful. In carrying out the Al- len treatment the physician must think in grams of carbo- hydrate 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 get-

slide 10:

9/173 ting each day. It is not easy for a busy practitioner to fig- ure out these dietary values and for this reason the calcu- lated series of diets given here may be of service. The vari- ous 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

slide 11:

10/173 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.

slide 12:

11/173 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.

slide 13:

12/173 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 cal- ories. The whiskey is not an essential part of the treatment it merely furnishes a few calories and keeps the patient more comfort- able 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. Al- len 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

slide 14:

13/173 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 re- markably 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 pa- tient 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 be- haves 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 estima- tion 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 determina- tion of the ratio between the total urinary nitrogen and the ammo- nia 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

slide 15:

14/173 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 inconsider- able 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 veget- able 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 caus- ing 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 in- take 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 reas- ons 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 val- ues 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

slide 16:

15/173 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 glyc- osuria it is not desirable to raise the diet any further. The caloric in- take 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 ve- getables 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.

slide 17:

16/173 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 reas- on 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 Allens 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.

slide 18:

17/173 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 Gen- eral Hospital the children at the Childrens 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 meth- od 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 acet- one 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

slide 19:

18/173 day. Allens treatment was then started and after one day of starva- tion 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 sug- ar. 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.

slide 20:

19/173 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 fol- lowing 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 ve- getable 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 en- trance he was putting out 2.5 of sugar 135 grams per day with

slide 21:

20/173 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 veget- ables 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 al- lowing too many vegetables on the vegetable day or raising the pro- tein 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 reac- tion. There was no diacetic reaction present at entrance. After one

slide 22:

21/173 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.

slide 23:

22/173 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 reac- tions 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.

slide 24:

23/173 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 contin- ued 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 ap- peared 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 ap- peared 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

slide 25:

24/173 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.

slide 26:

25/173 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 star- vation treatment at the Childrens Hospital the results have been very satisfactory as far as rendering the patient sugar-free is con- cerned. 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 Childrens 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 cof- fee 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

slide 27:

26/173 she was sugar-free with a moderate acetone reaction. No soda bi- carbonate 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:

slide 28:

27/173 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 dis- appeared. 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.

slide 29:

28/173 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 report- ing 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 ques- tion 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 dia- betic old or young goes into coma he rarely comes out of it no matter what the treatment is.

slide 30:

29/173 CASE 10. H. S. male 6 years entered April 29 1915. Duration of his diabetes uncertain not discovered until day of entrance. An emaci- ated 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 gradu- ally raised until on May 7 he was taking 32 grams protein 33 grams carbohydrate and 75 grams fat and was sugar-free with absent di- acetic 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 re- mained so until June 8 when he was discharged taking the follow- ing 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.

slide 31:

30/173 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 en- trance 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 ur- ine 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 boys 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 Childrens Hos- pital 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

slide 32:

31/173 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 mak- ing the carbohydrate intake about 30 grams. This day she showed .6 sugar. She was starved for half a day and became sugar-free again.

slide 33:

32/173 On Nov. 16 she was taking protein 40 carbohydrate 20 fat 90 cal- ories 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 contin- ued 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 car- bohydrate 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 hold- ing 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: CASE 8.

slide 34:

33/173 .2 ... • I • - A .. .. .. - .. . 1- " AlRIL 1 3 j S 6 .. 8 i 10 II u: 13 . 15 // 17 IB 17 ° soo 1-. .. ¢ le • -.. .. fl. - - i 1600 1000 - r - r. - - " Cl . - Ii . I It:\ ..ld eaUrl nelnO.C. April I I t 10 11 11 11 U U 11 lT 11 Jt 10 11 U II f- n :. " sa .. ... - .. -· ul " " " ..... .... I\ .... 0 ... ... ... 1•1. " \. : - - -- .... I -

slide 35:

34/173 _ s

slide 36:

35/173 • I I -: - - - - - - - - - la \ l I 1 - - - - - - la. - - _ la._la .- ..U I • t 10 11 11 11 u 11 tt 11 11 u to 11 n u 10 8 I f- l. 0 _ Ptt Cent. at 8\apr . .u I • 10 11 11 11 u 15 11 n u u to 11 11 u so 70 .O so f-0 30 a.o o 0 - -

slide 37:

36/173 April I I 6 e T I t 10 11 11 11 U 11 lt 1f 11 H 111 11 H U 1111111111111111111111 A11uao111 I• Oruna. Aprill I 6 e T ltlOllllllUUHlTlllttollHU I I 6 f 7 ltl01111111Ult17111tl011DII EXAMINATION OF THE URINE. Directions for Collecting Twenty-four Hour Urine.

slide 38:

37/173 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 Fehlings Test: —Boil about 4 c.c. of Fehlings 1 solution in a test tube and add to the hot Fehlings 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 diabetics daily urine this is a valuable test and the one which we always use. 2 Benedicts Test: —To 5 c.c. of Benedicts 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 per- fectly clear or be slightly turbid due to precipitated urates. This is a more delicate test than Fehlings. 1 Fehlings 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 hydrox- ide and 178 gm. of Rochelle salt dissolved in water and made up to 500 c.c.

slide 39:

38/173 These solutions are kept in separate bottles and mixed in equal volumes when ready for use. 2 Benedicts 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° 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 sug- ar. 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 Benedicts Test: —The best quantitative test for dextrose except- ing polariscopic examination which is too complicated for ordinary work is Benedicts test. It is performed as follows: Measure with a pipette 25 c.c. of Benedicts solution into a porcelain dish add 5 or 10 gm. approx- imately of solid sodic carbonate heat to boiling and while boiling run in the urine until a white precipitate forms.

slide 40:

39/173 Then add the urine more slowly until the last trace of blue disap- pears. 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. Benedicts 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. anhyd- rous 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 dex- trose 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 so- dium nitro prusside. Acidify with glacial acetic acid shake a mo- ment 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 ox- alate and 2 to 3 drops of phenolphthalein.

slide 41:

40/173 Run in from a burette decinormal sodic hydrate to a faint pink col- or. 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 neut- ral to phenolphthalein.

slide 42:

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. To Cure Diabetes Click Here 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 diabet- ics 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 re- strict 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

slide 43:

analyses of food products for diabetics. We have found some use for soya meal casoid flour and Lysters flour "akoll" biscuits and

slide 44:

40/173 "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 incid- entally 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 wa- ter 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 cal- ories 58. 3 Lysters Diabetic Flour prepared by Lyster Brothers An- dover Mass.

slide 45:

41/173 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 sacchar- ine 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

slide 46:

42/173 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.

slide 47:

43/173 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 spe- cial 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 Lysters Diabetic Flour prepared by Lyster Brothers. An- dover Mass. Barkers 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

slide 48:

44/173 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 but- ter 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 dur- ing 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 dur- ing 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 À 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 un- til 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.

slide 49:

45/173 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 sau- cer 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 PURÉE. Serve a dropped egg with one tablespoon tomato purée. For tomato purée 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 chickens liver finely chop and sauté 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 purée. EGG FARCI II.

slide 50:

46/173 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 pep- per 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.

slide 51:

47/173 CHICKEN SOUP WITH EGG CUSTARD. Serve Chicken Soup with Egg Custard. Egg Custard. —Beat yolk of one egg slightly add one-half table- spoon 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 sea- son 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 re- move 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

slide 52:

48/173 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

slide 53:

49/173 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 purée 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

slide 54:

50/173 purée strainer add egg yolk slightly beaten cream remaining but- ter 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 purée strain- er 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

slide 55:

51/173 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 sev- eral 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 À 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 thor- oughly and separate into flakes there should be two tablespoons. Reheat over hot water with one hard boiled egg thinly sliced in two

slide 56:

52/173 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 bak- ing 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 sauté 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 À LA MAÎTRE DHOTEL. Prepare smelts same as for smelts with cream and serve with maître dhotel 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.

slide 57:

53/173 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 purée. To prepare tomato purée 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 tea- spoon vinegar. Season with salt and pepper then fold in one-half ta- blespoon 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.

slide 58:

54/173 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 sautéd 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 table- spoons stewed and strained tomatoes. SPINACH. Chop one cup cooked spinach drained as dry as possible. Season with salt and pepper press through a purée strainer reheat in but- ter 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 tea- spoon salt and a few grains paprika. Add yolk of one egg slightly beaten one tablespoon olive oil one and one-half tablespoons vin- egar and a few drops of onion juice. Cook over hot water stirring constantly until mixture thickens. Add one-fourth teaspoon curry

slide 59:

55/173 powder one teaspoon melted butter and one-eighth teaspoon chopped parsley. FRIED CAULIFLOWER. Steam or boil a small cauliflower. Cool and separate into pieces. Sauté 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 À 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. Sauté 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

slide 60:

56/173 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 Neufchâtel 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 Gruyère cheese cut as thin as possible.

slide 61:

57/173 CHEESE CUSTARD. Beat one egg slightly add one-fourth cup cold water two table- spoons 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 cab- bage 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.

slide 62:

58/173 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 ta- blespoon grated cheese season with salt cayenne and a few grains

slide 63:

59/173 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 over- lap each other. Fill in center with chicory or watercress. Serve with salad dressing. CHEESE SALAD. Mash one-sixth of a Neufchâtel cheese and moisten with cream. Shape in forms the size of a robins 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 cay- enne. 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 por- tion of the pulp. Mix equal quantities of Roquefort and Neufchâtel cheese and mash then moisten with French dressing. Fill cavity

slide 64:

60/173 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 sep- arate in flakes there should be one-fourth cup. Mix one-eighth tea- spoon 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 wa- ter 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.

slide 65:

61/173 Season stewed and strained tomato with salt and cayenne. Fill a small tin box with mixture cover with buttered paper then tight-fit- ting cover pack in salt and ice equal parts and let stand two hours. Remove from mould place on lettuce leaf and serve with mayon- naise 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. Re- move 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 vineg- ar. Line an individual mould with cucumber cut in fancy shapes and string beans then pour in mixture. Chill remove from mould ar- range 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.

slide 66:

62/173 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 Neufchâtel 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.

slide 67:

63/173 Drain and finely chop one-fourth cup cooked spinach. Season with salt pepper lemon juice and melted butter. Pack solidly in an indi- vidual 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 ta- blespoon 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 Eng- lish walnut meats browned in oven with one-eighth teaspoon butter and a few grains salt then broken in pieces. Moisten with mayon- naise dressing. Mound and garnish with curled celery tips of celery and whole nut meats. PRINCESS PUDDING

slide 68:

64/173 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.

slide 69:

65/173 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 ingredi- ents and freeze to a mush. Serve in sections of grapefruit. FROZEN PUNCH.

slide 70:

66/173 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 in- gredients and freeze.

slide 71:

67/173 DIET LISTS. To Cure Diabetes Naturally Click Here Attention is called to the fact that the protein allowance in the fol- lowing 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 substi- tuted 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 de- sirable to give so much fat that the weight will increase. Protein 10 grams Carbohydrate 15 grams Fat 7 grams C a l o r i e s 200 BREAKFAST. String beans

slide 72:

68/173 TABLE I. 2-1/2 h. canned. 120 grams tbsp.

slide 73:

69/173 Asparagus canned. 150 grams Tea or coffee. DINNER. Celery. 100 grams Spinach 3 h. tbsp. or 13-1/2 stalks 4 in. long. 6 pieces 4-1/2 in. long. cooked. 135 grams 3 h. tbsp. Tea or coffee. SUPPER. Asparagus. 100 grams Celery. 100 grams Tea or coffee. 2 h. tbsp. or 9 stalks 4 in. long. 6 pieces 4-1/2 in. long. Protein 7 grams Carbohydrate 15 grams Fat 6 grams Calories 150 TABLE II.

slide 74:

70/173 BREAKFAST. Asparagus canned. 75 grams 1-3/4 h. tb- sp. chopped. Cabbage. 65 grams 1 very h. tbsp. Tea or coffee. DINNER. Onions cooked. 100 grams 2 h. tbsp. 3 pieces Celery. 50 grams Tea or coffee. SUPPER. about 4-1/2 in. long. Spinach. 100 grams 2 h. tbsp. 3 pieces Celery. 50 grams Tea or coffee. 4-1/2 in. long. Protein 24 grams Carbohydrate 8 grams Fat 22 grams Calories 340

slide 75:

71/173 TABLE III.

slide 76:

72/173 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. Protein 31 grams Fat 14 grams Carbohydrate 17 grams Calories 327 BREAKFAST. TABLE IV. Egg. 1 Asparagus. 100 grams 2 h. tbsp. Tomatoes. 100 grams 2 h. tbsp. Coffee.

slide 77:

73/173 DINNER. Chicken. String beans. 35 grams 200 grams 1 small serving. 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. Protein 43 grams Carbohydrate 15 grams Fat 19 grams Calories 414 BREAKFAST. TABLE V. Egg. 1 Asparagus. 200 grams 4 h. tbsp. Coffee. DINNER. Chicken. 70 grams 1 mod. serving. Cauliflower. 120 grams 2 h. tbsp.

slide 78:

74/173 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. Protein 38 grams Fat 31 grams Carbohydrate 19 grams Calories 520 BREAKFAST. TABLE VI. 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.

slide 79:

75/173 Egg. 1 Lettuce. 20 grams 2 medium leaves. Cucumbers. 100 grams 2 h. tbsp. String beans. 50 grams 1 h. tbsp. Tea. Protein 35 grams TABLE VII. Carbohydrate 17 grams Fat 100 grams Calories 1143 BREAKFAST. Bacon. 50 grams Asparagus. 100 grams 2 slices about 6 in. long. 2 h. tbsp. or 9 stalks 4 in. long canned. Spinach. 100 grams 2 h. tbsp. Butter. Cream. Coffee. DINNER.

slide 80:

76/173 Steak. Turnips. 100 grams 140 grams 1 small serving. 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 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 5 tbsp. ounces cooked. Protein 40 grams TABLE VIII.

slide 81:

77/173 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.

slide 82:

78/173 Cauliflower. 100 grams 2 h. tbsp. Butter. Cream. Tea. Allow during day: Butter. 20 grams 2 squares. Cream 40. 3 ounces 6 tbsp. Protein 50 grams Carbohydrate 15 grams Fat 125 grams Calories 1500 BREAKFAST. TABLE IX. Eggs. 2 String beanscanned. 100 grams 3 h. tbsp. Butter. Cream. Coffee. DINNER. Chop. 100 grams 1 chop. Cabbage cooked. 100 grams 2 h. tbsp.

slide 83:

79/173 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. Protein 61 grams Carbohydrate 16 grams Fat 160 grams Calories 1795 BREAKFAST. TABLE X.

slide 84:

80/173 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. 6 stalks Celery. 100 grams Butter. Cream. Tea. Allow during day: 4-1/2 in. long.

slide 85:

81/173 Butter. 50 grams 5 squares. Cream 40. 5 ounces 10 tbsp.

slide 86:

82/173 Bacon. Egg. 30 grams 1 1-1/2 slice 6 in. long. Spinach. Coffee. Butter. Cream. DINNER. 100 grams 2 h. tbsp. Steak. 50 grams 1 very sm serving. Cabbage. Onions. Butter. Cream. Tea. SUPPER. 100 grams 100 grams 2 h. tbsp. 2 h. tbsp. Protein 38 grams Carbohydrate 20 grams TABLE XI. Fat 100 grams Calories 1168 BREAKFAST. s all Scraped beef balls. Chopped cel- 40 grams 1-1/3 oz. ery salad. 100 grams 2 h. tbsp. Tomatoes. 100 grams 2 tbsp.

slide 87:

83/173 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. Allow during day: Butter. 25 grams 2-1/2 squares. Cream 40. 4 ounces 8 tbsp. TABLE XII.

slide 88:

84/173 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. Protein 40 grams TABLE XIII. Fat 110 grams Carbohydrate 21 grams Calories 1187 BREAKFAST. Bacon. 50 grams 2 slices 6 in. long.

slide 89:

85/173 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.

slide 90:

86/173 TABLE XIV.

slide 91:

87/173 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 Tomatoes. 100 grams Onions. 100 grams 2 h. tbsp. 2 h. tbsp. 2 h. tbsp. Butter. Cream. Tea. SUPPER. Scraped beef

slide 92:

88/173 balls 40 grams 1-1/3 oz. Celery. 100 grams 6 stalks 4-1/2 in. long.

slide 93:

89/173 Cream. Butter. Tea. Allow during day: Butter. 20 grams 2 squares. Cream 40. 5 ounces 10 tbsp. Protein 40 grams Carbohydrate 22 grams TABLE XV. 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. 6 stalks Celery. 50 grams 4-1/2 in. long.

slide 94:

90/173 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. Protein 40 grams TABLE XVI. Fat 100 grams Carbohydrate 30 grams Calories 1200 BREAKFAST. Bacon. 50 grams 2 slices 6 in. long. Peas canned. 75 grams Butter. 1-3/4 h. tbsp.

slide 95:

91/173 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. 3 pieces Celery. 50 grams 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. 6 stalks Celery. 100 grams Allow during day: 4-1/2 in. long.

slide 96:

92/173 Butter. 50 grams 5 squares. Cream 40. 4 ounces 8 tbsp.

slide 97:

93/173 chopped. Butter. Cream. Coffee. DINNER. 100 grams 2 h. tbsp. 1 small serving. Chicken. 50 grams Cabbage. Cauliflower. Cucumbers. Butter. Cream. Tea. SUPPER. Turnips. String beans. 100 grams 120 grams 100 grams 140 grams 100 grams 2 h. tbsp. 2 h. tbsp. + 2 h. tbsp. 2 h. tbsp. 2 h. tbsp. Protein 40 grams TABLE XVII. Carbohydrate 30 grams Fat 100 grams Calories 1200 BREAKFAST. Bacon. 50 grams Egg. 1 Asparagus 2 slices about 6 in. long.

slide 98:

94/173 Bread. 25 grams Butter. Cream. Tea. Allow during day: 1 thin slice bakers loaf. Butter. 25 grams 2-1/2 squares. Cream 40. 4 ounces 8 tbsp. Protein 40 grams TABLE XVIII. 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.

slide 99:

95/173 Cream.

slide 100:

96/173 Coffee. DINNER. Broth —chicken lamb or beef. 6 ounces Steak. 100 grams 1 small serving. Turnips. 200 grams 4 h. tbsp. 9 stalks Celery. 150 grams 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.

slide 101:

97/173 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 Butter. Cream. Coffee. DINNER. Broth. 6 ounces Squab. 1 1 very small one. Cabbage. 100 grams 2 h. tbsp. 6 stalks Celery. 100 grams Butter. Cream. Tea. SUPPER. about 4-1/2 in. long.

slide 102:

98/173 String beans. 140 grams 3 h. tbsp. Cucumbers. 100 grams 2 h. tbsp. Parsnips. 100 grams 2 h. tbsp.

slide 103:

99/173 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. Protein 50 grams TABLE XX. 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.

slide 104:

100/17 3 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. Protein 50 grams TABLE XXI. Carbohydrate

slide 105:

101/17 3 40 grams

slide 106:

102/17 3 Bread. Spinach. Butter. Cream. Coffee. DINNER. 20 grams 100 grams 3 x 1/2 in. 2 h. tbsp. 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. Fat 158 grams Calories 1830 BREAKFAST. Bacon. 50 grams 2 slices 6 in. long. 1 slice 3 x

slide 107:

103/17 3 Butter. Cream. Tea. Allow during day: Butter. 50 grams 5 squares. Cream 40. 5 ounces 10 tbsp. Protein 60 grams TABLE XXII. 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. +

slide 108:

104/17 3 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. 6 stalks Celery. 100 grams 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. Protein 62 grams TABLE XXIII.

slide 109:

105/17 3 Carbohydrate 31 grams Fat 153 grams Calories 1800 BREAKFAST. Bacon. 50 grams 2 slices. Peas. 75 grams 1-1/2 h. tbsp. Butter. 7 tbsp. Cream. Coffee. DINNER. Broth —100 c.c. with veget- ables: 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.

slide 110:

106/17 3 Tea. SUPPER.

slide 111:

107/17 3 Chicken. 75 grams 1 small serving. Turnips. 175 grams 2-3/4 h. tbsp. 6 stalks Celery. 100 grams Allow during day: 4-1/2 in. long. Butter. 50 grams 5 squares. Cream 40. 5 ounces 10 tbsp. Olive oil. 7 grams 1/2 tbsp. +

slide 112:

Protein 60 grams TABLE XXIV. 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. 6 stalks Celery. 100 grams 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. +

slide 113:

Butter. Cream.

slide 114:

99/173 Chicken. Turnips. 50 grams 280 grams 1 very sma serving. 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. Tea. SUPPER. ll + Protein 60 grams TABLE XXV. Carbohydrate 30 grams Fat 154 grams Calories 1800 BREAKFAST. Bacon. 60 grams Eggs. 2 2-1/2 slices 6 in. long.

slide 115:

100/173 Ham. Lettuce. 50 grams 100 grams 1 very smal serving. 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. 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. l TABLE XXVI.

slide 116:

101/173 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. 6 stalks Celery. 100 grams 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.

slide 117:

102/173 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. Protein 50 grams TABLE XXVII. Carbohydrate 40 grams Fat 131 grams Calories 1587 BREAKFAST. Egg. 1 Parsnips. 100 grams 2 h. tbsp. 1 slice 3 x Bread. 35 grams Butter. Cream. Coffee. DINNER. 3-1/2 x 1/2 in.

slide 118:

103/173 Broth. Chop. 180 c.c. 100 grams 1 glass or cup. 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. Protein 50 grams TABLE XXVIII.

slide 119:

104/173 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. Lettuce. 100 grams 100 grams 1 small serving. 10 leaves. Spinach. Butter. Cream. Tea. SUPPER. Egg. 100 grams 1 2 h. tbsp. Cold ham. 50 grams 1 small serving. Asparagus. String beans. 50 grams 100 grams 1 h. tbsp. 2 h. tbsp. Bread. Butter. 25 grams 1 slice 3 x 3 x 1/2 in.

slide 120:

105/173 Cream. Tea. Allow during day: Butter. 30 grams 3 squares. Cream 40. 4 ounces 8 tbsp. Protein 52 grams TABLE XXIX. 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.

slide 121:

106/173 Brussels sprouts. Milk. 100 grams 6 ounces 2 h. tbsp. 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. Protein 50 grams TABLE XXX. 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.

slide 122:

107/173 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. Protein 53 grams TABLE XXXI.

slide 123:

108/173 Steak. String beans. 50 grams 50 grams 1 very sma serving. 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 x 1/2 in. 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. ll 1

slide 124:

109/173 Butter. Cream. Tea. Allow during day: Butter. 20 grams 2 squares. Cream 40. 3 ounces 6 tbsp. Protein 101 grams TABLE XXXII. 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.

slide 125:

110/173 Olive oil. SUPPER. 1-1/2 tbsp. 2 slices 6 in. long. Bacon. 50 grams 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. 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.

slide 126:

111/173 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. TABLE XXXIII.

slide 127:

112/173 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. Protein 60 grams TABLE XXXIV. Carbohydrate 50 grams Fat 145 grams Calories 1800 BREAKFAST. Egg. 1

slide 128:

113/173 Bacon. 100 grams 4 slices 6 in. long.

slide 129:

114/173 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. 6 stalks Celery. 100 grams 4-1/2 in. long. Bread. 30 grams 1 slice med. thin. Allow during day: Butter. 30 grams 3 squares.

slide 130:

115/173 Cream 40. 3-1/2 ounces 7 tbsp.

slide 131:

116/173 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. TABLE XXXV.

slide 132:

117/173 Egg. Asparagus. Spinach. 1 100 grams 100 grams 2 h. tbsp. 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. Protein 60 grams TABLE XXXVI. 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.

slide 133:

118/173 Butter. Cream. Tea. DINNER. 1 glass or cup. 1 small serving. Broth. 180 c.c. Steak. 100 grams 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. +

slide 134:

119/173 Protein 74 grams TABLE XXXVII. Carbohydrate 62 grams Fat 179 grams Calories 2220 BREAKFAST. Bacon. 100 grams 4 slices 6 in. long. Egg. 1 Bread. 30 grams Butter. Cream. Tea. DINNER. 1 slice 3 x 3 x 1/2 in. medium thin. 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.

slide 135:

120/173 Cream. Tea.

slide 136:

121/173 SUPPER. Egg. 1 Cabbage. 100 grams 2 h. tbsp. 6 stalks Celery. 100 grams 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. Protein 71 grams TABLE XXXVIII. Carbohydrate 60 grams Fat 184 grams Calories 2242 BREAKFAST. Bacon. 100 grams 4 slices 6 in. long Egg. 1

slide 137:

122/173 Bread. Butter. Cream. Coffee. DINNER. 25 grams 2 x 1/2 in. 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: Asparagus. 100 grams 2 h. tbsp. 1 slice 3 x

slide 138:

123/173 Bread. Butter. 25 grams 2 x 1/2 in. Cream. Coffee. DINNER. Broth. 180 c.c. 1 glass or cup. Squab. Lettuce. Cucumbers. Turnips. 100 grams 25 grams 100 grams 140 grams 1 3 leaves. 1 h. tbsp. 2 h. tbsp. Butter. 25 grams 2-1/2 squares. Cream 40. 7 ounces 14 tbsp. Protein 72 grams TABLE XXXIX. Carbohydrate 65 grams Fat 174 grams Calories 2170 BREAKFAST. Bacon. 100 grams 4 slices 6 in. long. Eggs. 2 1 slice 3 x

slide 139:

124/173 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. Protein 71 grams Carbohydrate 65 grams TABLE XL. Fat 183 grams

slide 140:

125/173 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.

slide 141:

126/173 Butter.

slide 142:

127/173 Cream. Tea. Allow during day: Butter. 25 grams 2-1/2 squares. Cream 40. 7 ounces 14 tbsp. Protein 77 grams TABLE XLI. 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.

slide 143:

128/173 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. 6 stalks Celery. 100 grams Butter. Tea. Allow during day: 4-1/2 in. long. Butter. 35 grams 3-1/2 squares. Cream 40. 7 ounces 14 tbsp.

slide 144:

129/173 TABLE XLII.

slide 145:

130/173 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.

slide 146:

131/173 String beans. Cucumbers. 100 grams 100 grams 2 h. tbsp. 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. Protein 74 grams TABLE XLIII. 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.

slide 147:

132/173 Broth. Chicken. 6 ounces 100 grams 1 glass or cup. 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.

slide 148:

133/173 Protein 75 grams TABLE XLIV. 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 Butter. Cream. Tea. DINNER. 1 very small. 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.

slide 149:

134/173 Cream. Tea. SUPPER. Egg. 1

slide 150:

135/173 Bread. Butter. 35 grams 1 med. thi slice. Cream. Tea. Allow during day: Butter. 20 grams 2 squares. Cream 40. 7 ounces 14 tbsp. 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. n Protein 99 grams TABLE XLV. Carbohydrate 101 grams Fat 225 grams Calories 2880 BREAKFAST. Oranges. 200 grams 2 small. Bacon. 75 grams 3 slices. Eggs. 2

slide 151:

136/173 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 Bread. 40 grams 1-1/2 x 1 x 1 in. 1 slice 3 x

slide 152:

137/173 3-1/2 x 1/2 in.

slide 153:

138/173 Allow during day: Butter. 40 grams 4 squares. Cream 40. 6 ounces 12 tbsp. Protein 101 grams TABLE XLVI. 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. 1 medium Potato. 75 grams or 1-1/2 tb- sp. of mashed. Lettuce. 50 grams 5 leaves.

slide 154:

139/173 Bread. 25 grams 2 x 1/2 in. 3 stalks Celery. 50 grams 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. Bread. 25 grams 1 slice 3 x 2 x 1/2 in. 5 whole Walnuts. 25 grams French dressing: walnut meats. Oil. 26 grams 2 tbsp. Vinegar. SUPPER. Cold chicken. 50 grams 1 small slice. Egg. 1 1 slice 3 x

slide 155:

140/173 TABLE XLVII.

slide 156:

141/173 Protein 99 grams Carbohydrate 126 grams Fat 228 grams Calories 3043 BREAKFAST. Lamb chop. 100 grams 1 chop. Eggs. 2 Bread. 50 grams Butter. Cream. Coffee. DINNER. 2 slices each 3 x 2 x 1/2 in. 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

slide 157:

142/173 and one-half egg extra.

slide 158:

143/173 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. Protein 101 grams TABLE XLVIII. Carbohydrate 150 grams Fat 292 grams Calories 3744 BREAKFAST. Grape fruit. 300 grams 1 medium. Bacon. 75 grams 3 slices.

slide 159:

144/173 Eggs. Bread. Butter. 2 35 grams 1 medium slice. 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 Bread. 40 grams B u t t e r .

slide 160:

145/173 1-1/2 x 1-1/2 x 1-1/2 in. 1 slice 3 x 3-1/2 x 1/2 in.

slide 161:

146/173 2 + 5 30 15 12 4 189 23 18 8 294 36 30 11 471 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. Lockes 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 Day 1 Day 2 Day 3 Day 4 Protein Fat Carbohydrate Calories

slide 162:

147/173 18 48 9 560 51 44 17 688 52 51 15 750 46 51 19 740 49 78 20 1008 50 101 21 1230 49 123 19 1422 34 32 10 478 53 100 15 1208 Day 5 Day 6 Day 7 Day 8 Day 9 Day 10 Day 11 Day 12 Starved because sugar came through Day 13 15 12 3 185 Day 14 Day 15 Patient discharged with advice as to diet. The corresponding menus for the above are as follows: FIRST DAY. BREAKFAST. DINNER. SUPPER.

slide 163:

148/173 String beans 25 grams. Lettuce 25 grams. Lettuce 25 grams. Cucumbers 25 grams. Lettuce 25 grams. Tomato 25 grams. Coffee. Tea. Tea. Protein 2 grams Fat trace Carbo- hydrate 5 grams Calories 30. SECOND DAY. BREAKFAST. DINNER. SUPPER. Egg 1. Egg 1. Lettuce 25 grams. Lettuce 25 grams. Cucumbers Lettuce 25 grams. String beans String beans 25 grams. 25 grams. 25 grams. Tea. Coffee. Tea. Protein 15 grams Fat 12 grams Carbo- hydrate 4 grams Calories 189. THIRD DAY. BREAKFAST. DINNER. SUPPER. Egg 1. Egg 1. Egg 1. Asparagus 50 Cauliflower String grams. Lett uce 25 grams.

slide 164:

149/173 50 grams. Lettuce 50 grams. beans 75 g r a m s . C e l e r y 5 0 g r a m s . Protein 28 grams Fat 18 grams Carbo- hydrate 8 grams Calories 294. FOURTH DAY.

slide 165:

150/173 Egg 1. Egg 1. Tea. BREAKFAST. DINNER. SUPPER. Chicken broth 6 oz. Egg 1. String beans 100 grams. Egg 1. Coffee. Celery 100 grams. Egg whites 2. Lettuce 75 grams. Cream 1 oz. Tea. Cucumbers 50 grams. Protein 36 grams Fat 30 grams Carbo- hydrate 11 grams Calories 471. FIFTH DAY. BREAKFAST. DINNER. SUPPER. String beans 75 grams. Egg 1. Cauliflower 100 grams. Lettuce 25 grams. Asparagus. Coffee. Tomatoes 50 grams. Cream 2 tbsp. Butter 1/2 Butter 1 square. Cream 2 tbsp. square. Tea. Cream 2 tbsp. Protein 18 grams Fat 48 grams Carbo- hydrate 10 grams Calories 560.

slide 166:

151/173 SIXTH DAY. BREAKFAST. DINNER. SUPPER. Egg 1. Broth 6 oz. Egg 1.

slide 167:

152/173 Tea. 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. Cream 1 tbsp. Cream 1 tbsp. Butter 1/2 square. Protein 51 grams Fat 44 grams Carbo- hydrate 17 grams Calories 688. SEVENTH DAY. BREAKFAST. DINNER. SUPPER. Eggs 2. Beef broth 6 oz. Asparagus 100 grams. Scraped beef 50 grams. Salmon 50 grams. Coffee. Cauliflower 100 grams. Cream 1 tbsp. Spinach 100 grams. Cabbage 100 grams. Tomatoes raw 75 grams. Lettuce 25 grams. String beans 100 grams. Tea.

slide 168:

153/173 Tea. Cream 1 tbsp. Cream 1 tbsp.

slide 169:

154/173 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 Cream 1 tbsp. Cream 1 Egg 1. Egg 1. Protein 52 grams Fat 51 grams Carbo- hydrate 15 grams Calories 750. EIGHTH DAY. BREAKFAST. DINNER. SUPPER. Chicken 75 grams. Egg 1. String beans 100 grams. Asparagus 100 grams. Cauliflower 100 grams. Olives 25 grams. Spinach 100 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 Carbo- hydrate 19 grams Calories 740. NINTH DAY. BREAKFAST. DINNER. SUPPER. Chicken 75 grams. Egg 1.

slide 170:

155/173 Egg 1. Butter 1 square. Butter 1-1/2 square. Butter 1 square. Protein 49 grams Fat 77 grams Carbo- hydrate 19 grams Calories 1008. TENTH DAY. BREAKFAST. DINNER. SUPPER. Lamb chop 75 grams. Egg 1. Lettuce 50 grams. String beans 100 grams. Cucumbers 100 grams. Spinach 100 grams. Celery 50 grams. Olives 25 grams. Salmon 50 grams. Asparagus 100 grams. Cabbage 100 grams. Coffee. Tea. Tea. Cream 2 Cream 2 tbsp. Cream 2 tbsp. tbsp. Protein 50 grams Fat 101 grams Car- bohydrate 21 grams Calories 1230. ELEVENTH DAY. BREAKFAST. DINNER. SUPPER. Bacon 50 grams. Beef broth 8 oz. Egg 1. Asparagus 100 grams . Spinach 100 grams. Butter 2 squares.

slide 171:

156/173 Chicken 75 grams. Cabbage 100 grams. Cucumbers 50 grams. T o m a t o e s 1 0 0 g r a m s . S p i n a c h 5 0 grams. Butter 2 squares.

slide 172:

157/173 Egg 1. Cream 3 tbsp. Butter 3 squares. Cream made into ice cream 4 tbsp. Cream 1 tbsp. Protein 49 grams Fat 123 grams Car- bohydrate 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 Cabbage grams. 50 grams. Tea. Tea. Protein 15 grams Fat 12 grams Carbo- hydrate 4 grams Calories 185. FOURTEENTH DAY. BREAKFAST. DINNER. SUPPER. Roast chicken 50 grams. Egg 1. String beans 100 grams. Asparagus 100 grams. Cauliflower 100 grams.

slide 173:

158/173 Tea. Coffee. Cabbage 100 grams.

slide 174:

159/173 Egg 1. Cream 1 tbsp. Tea. Cream 1 tbsp. Cream 1 tbsp. Protein 34 grams Fat 32 grams Carbo- hydrate 10 grams Calories 478. FIFTEENTH DAY. BREAKFAST. DINNER. SUPPER. Squab 100 grams. Egg 1. Tomatoes 50 String beans Cold chick- grams. 100 grams. en 25 grams. Coffee. Cauliflower 150 grams. Lettuce 50 grams. Cream 2 tbsp. Butter 1 square. Custard made with 1 egg 4 tbsp. cream and 2 tbsp. water sweetened with saccharine. Tea. Spinach 50 grams. Tea. Cream 2 tbsp.

slide 175:

160/173 Protein 53 grams Fat 100 grams Car- bohydrate 15 grams Calories 1208.

slide 176:

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 cau- tioned 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.

slide 177:

146/173 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 grams 1 thin slice of bread bakers loaf 25 grams 1 medium sized orange 150 grams 1 peach 125 grams 1 medium sized apple 150 grams 1/2 small grape fruit 150 grams

slide 178:

147/173 1 medium sized lamb chop with bone 1 medium sized 100 grams slice cold tongue 25 grams 1 slice tenderloin steak 1 in. thick 100 grams 1 average helping of fish 100 grams 1 average helping of butter 10 grams 1 average sized egg 50 grams 1 average helping of cooked green ve- getables such as spinach cabbage cauliflower as- paragus etc. 2 ta- blespoons 8 1 average helping 100 grams boiled cereal 100 grams 1 potato size of large egg 100 grams 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.

slide 179:

148/173 The following food values are taken from Lockes Abstract of At- water and Bryants Bulletin No. 28 1906 United States Department of Agriculture.

slide 180:

149/173 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 ac- curate enough for clinical purposes. Food Stuffs. Protein. Fat. Carbohydrate. Total Raw. Quantity. Grams. Grams. MEAT. Grams. Calories. Beef 100 gms. 22 28 350 Chicken 100 gms. 32 4 168 Bacon raw 100 gms. 10 64 636 FISH. Fish average 100 gms. 20 7 147 Oysters 100 gms. 6 1 3 46 EGGS. Eggs 100 gms. 13 12 165 Eggs 1 egg 7 6 84 DAIRY PRODUCTS. Butter 100 gms. 1 85 795 Cheese American 100 gms. 28 35 2 448 Cheese Neufchâtel 100 gms. 19 27 2 337 Milk whole 100 gms. 3 4 5 70 Milk whole 1 qt. 30 36 45 642 Milk skim 100 gms. 3 0.3 5 35

slide 181:

150/173 Milk skim 1 qt. 31 3 46 343

slide 182:

151/173 100 gms. 3 16 5 181 1 pt. 12 73 23 822 100 gms. 3 0.5 12 66 100 gms. 3 0.1 24 112 100 gms. 3 0.1 24 112 100 gms. 9 1 53 264 100 gms. 10 9 73 424 100 gms. 6 9 63 367 100 gms. 2 1 3 30 100 gms. 22 2 59 350 100 gms. 1 1.0 2 22 100 gms. 2 0.1 7 37 100 gms. 2 0.3 6 35 Cream gravity Cream gravity CEREAL PRODUCTS. Oatmeal cooked Rice cooked Macaroni cooked Bread Soda crackers Cake average VEGETABLES. Asparagus canned Beans dried Beans string fresh cooked Beets cooked Cabbage raw

slide 183:

152/173 Carrots raw 100 gms. 1 0.4 9 45 Cauliflower raw 100 gms. 2 0.5 5 33 Celery raw 100 gms. 1 0.1 3 17 Corn green 100 gms. 3 1 20 103 Cucumbers raw 100 gms. 0.8 0.2 3 17 Lettuce raw 100 gms. 1 0.3 3 19 Mushrooms raw 100 gms. 3 0.4 7 45 Onions raw 100 gms. Peas dried 100 gms. 1 24 0.3 1 10 62 48 362 Peas green raw 100 gms. 7 0.5 16 99 Potatoes white 100 gms. 2 0.1 18 83 Potatoes sweet 100 gms. 2 0.7 27 125 Spinach 100 gms. 2 0.3 3 23 Squash 100 gms. 1 0.5 9 46 Tomatoes 100 gms. 0.9 0.4 4 24 Turnips 100 gms. 1 0.2 8 39 The values for all the vegetables are calculated from the raw vegetables. FRUITS.

slide 184:

153/173 Apples edible portion Bananas edible portion 100 gms. 100 gms. Blackberries 100 gms. Cherries 100 gms. Cranberries 100 gms. Currants 100 gms. Figs dried 100 gms. Grapes 100 gms. Huckleberries 100 gms. Lemon juice 100 gms. Muskmelons edible portions Oranges edible portion Peaches edible portion Pears edible portion

slide 185:

154/173 0.4 0.5 14 64 1 0.6 22 100 1 1 11 59 0.1 1 15 71 0.4 0.6 10 48 1 13 57 4 0.3 74 323 1 1 14 71 0.6 0.6 16 74 10 41 0.6 9 39 0.8 0.2 11 50 0.7 0.1 9 41 0.6 0.5 14 65 1 0 0 g m s. 100 gms. 100 gms. 100 gms. Prunes dried 100 gms. 2 73 308

slide 186:

155/173 Raisins dried 100 gms. Pineapples 100 gms. 2 3 76 348 0.4 0.3 10 45 Plums edible portion 100 gms. 1 20 86 Raspberries 100 gms. Strawberries 100 gms. Watermelons 100 gms. 1 12 53 1 0.6 7 38 0.4 0.2 7 32 NUTS. Almonds. 100 gms. Chestnuts 100 gms. 21 54 17 658 6 5 42 243 Peanuts edible portion 100 gms. 25 38 24 554 Walnuts 100 gms. 18 64 13 722 MISCELLANEOUS. Chocolate 100 gms. Whiskey 50 c.c. Lager beer 250 c.c.

slide 187:

156/173 13 48 30 623 43 alcohol 152 4.5 alcohol 130 ADDITIONAL DATA.

slide 188:

157/173 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 Neufchâtel 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 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 table- spoon 50 gms. 1+ 6 33 5 Potato size of large egg 100 gms. 2 18 83 5 "5" vegetables uncooked 1 2.5 10 Bacon raw 4 slices 6 in. long Protein. Fat. Carbohydrate. Calories. 2 in. wide 10 64 636 Bacon cooked 4 slices 6 in. long 2 in. wide 10 32 338 Bread 1 slice 3 x 3-1/2 x 1/2 tablespoon

slide 189:

158/173 1.7 7 1 4 2 30 131 1 13 57 4 12 3 140 2 5 2 63 6 9 6 33 "5" vegetables boiled once 1 tablespoon "5" vegetables boiled thrice 1 tablespoon Grape fruit as purchased 1 small 300 gms. Orange as purchased 1 medi- um 150 gms. English walnuts 6 whole meats 20 gms. Almonds 10 small 10 gms. Peanuts as purchased 15 nuts 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 sor- rel and radishes. As these various vegetables contain from 3 to 7 carbohydrate it will be seen that the value of 2-1/2 grams carbo- hydrate 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. Transcribers Notes: Á has been changed to À throughout

slide 190:

159/173 Removed unnecessary opening parenthesis: On Feb. 5 he was still sugar-free having been so End of the Project Gutenberg EBook of The Starvation Treatment of Diabetes by Lewis Webb Hill and Rena S. Eckman END OF THIS PROJECT GUTENBERG EBOOK STARVATION TREATMENT OF DIABETES This file should be named 26058-h.htm or 26058-h.zip This and all associated files of various formats will be found in: http://www.gutenberg.org/2/6/0/5/26058/ Produced by Stacy Brown Bryan Ness and the Online Distributed Proofreading Team at http://www.pgdp.net This book was produced from scanned images of public domain material from the Google Print project. Updated editions will replace the previous one--the old editions will be renamed. Creating the works from public domain print editions means that no one owns a United States copyright in these works so the Foundation and you can copy and distribute it in the United

slide 191:

160/173 States without permission and without paying copyright royalties. Special rules set forth in the General Terms of Use part of this li- cense apply to copying and distributing Project Gutenberg-tm electron- ic works to protect the PROJECT GUTENBERG-tm concept and trade- mark. Project Gutenberg is a registered trademark and may not be used if you charge for the eBooks unless you receive specific per- mission. If you do not charge anything for copies of this eBook com- plying with the rules is very easy. You may use this eBook for nearly any purpose such as creation of derivative works reports perform- ances and research. They may be modified and printed and given away--you may do practically ANYTHING with public domain eBooks. Redis- tribution is subject to the trademark license especially commercial redistribution. START: FULL LICENSE THE FULL PROJECT GUTENBERG LICENSE PLEASE READ THIS BEFORE YOU DISTRIBUTE OR USE THIS WORK To protect the Project Gutenberg-tm mission of promot- ing the free distribution of electronic works by using or distrib- uting this work

slide 192:

161/173 or any other work associated in any way with the phrase "Project Gutenberg" you agree to comply with all the terms of the Full Project Gutenberg-tm License available with this file or on- line at http://gutenberg.net/license. Section 1. General Terms of Use and Redistributing Project Gutenberg-tm electronic works 1.A. By reading or using any part of this Project Gutenberg-tm electronic work you indicate that you have read un- derstand agree to and accept all the terms of this license and intellec- tual property trademark/copyright agreement. If you do not agree to abide by all the terms of this agreement you must cease using and return or destroy all copies of Project Gutenberg-tm electronic works in your possession. If you paid a fee for obtaining a copy of or access to a Project Gutenberg-tm electronic work and you do not agree to be bound by the terms of this agreement you may obtain a refund from the person or entity to whom you paid the fee as set forth in para- graph 1.E.8. 1.B. "Project Gutenberg" is a registered trademark. It may only be used on or associated in any way with an electronic

slide 193:

162/173 work by people who agree to be bound by the terms of this agreement. There are a few things that you can do with most Project Gutenberg-tm electronic works even without complying with the full terms of this agreement. See paragraph 1.C below. There are a lot of things you can do with Project Gutenberg-tm electronic works if you follow the terms of this agreement and help preserve free future access to Project Gutenberg-tm electronic works. See paragraph 1.E below. 1.C. The Project Gutenberg Literary Archive Foundation "the Foundation" or PGLAF owns a compilation copyright in the collec- tion of Project Gutenberg-tm electronic works. Nearly all the indi- vidual works in the collection are in the public domain in the United States. If an individual work is in the public domain in the United States and you are located in the United States we do not claim a right to prevent you from copying distributing performing displaying or creat- ing derivative works based on the work as long as all references to Project Gutenberg are removed. Of course we hope that you will support the Project Gutenberg-tm mission of promoting free access to elec- tronic works by freely sharing Project Gutenberg-tm works in compliance with the terms of

slide 194:

163/173 this agreement for keeping the Project Gutenberg-tm name associated with the work. You can easily comply with the terms of this agreement by keeping this work in the same format with its attached full Project Gutenberg-tm License when you share it without charge with others. 1.D. The copyright laws of the place where you are located also govern what you can do with this work. Copyright laws in most countries are in a constant state of change. If you are outside the Un- ited States check the laws of your country in addition to the terms of this agreement before downloading copying displaying performing distributing or creating derivative works based on this work or any other Project Gutenberg-tm work. The Foundation makes no representa- tions concerning the copyright status of any work in any country outside the United States. 1.E. Unless you have removed all references to Project Gutenberg: 1.E.1. The following sentence with active links to or other immediate access to the full Project Gutenberg-tm License must appear prominently whenever any copy of a Project Gutenberg-tm work any work on which the phrase "Project Gutenberg" appears or with which the

slide 195:

164/173 phrase "Project Gutenberg" is associated is accessed displayed per- formed viewed copied or distributed: This eBook is for the use of anyone anywhere at no cost and with almost no restrictions whatsoever. You may copy it give it away or re-use it under the terms of the Project Gutenberg Li- cense included with this eBook or online at www.gutenberg.net 1.E.2. If an individual Project Gutenberg-tm electron- ic work is derived from the public domain does not contain a notice in- dicating that it is posted with permission of the copyright holder the work can be copied and distributed to anyone in the United States without paying any fees or charges. If you are redistributing or providing ac- cess to a work with the phrase "Project Gutenberg" associated with or appearing on the work you must comply either with the requirements of paragraphs 1.E.1 through 1.E.7 or obtain permission for the use of the work and the Project Gutenberg-tm trademark as set forth in para- graphs 1.E.8 or 1.E.9. 1.E.3. If an individual Project Gutenberg-tm electron- ic work is posted with the permission of the copyright holder your use and distribution

slide 196:

165/173 must comply with both paragraphs 1.E.1 through 1.E.7 and any additional terms imposed by the copyright holder. Additional terms will be linked to the Project Gutenberg-tm License for all works pos- ted with the permission of the copyright holder found at the begin- ning of this work. 1.E.4. Do not unlink or detach or remove the full Project Gutenberg-tm License terms from this work or any files containing a part of this work or any other work associated with Project Gutenberg-tm. 1.E.5. Do not copy display perform distribute or redistribute this electronic work or any part of this electronic work without prominently displaying the sentence set forth in para- graph 1.E.1 with active links or immediate access to the full terms of the Project Gutenberg-tm License. 1.E.6. You may convert to and distribute this work in any binary compressed marked up nonproprietary or proprietary form including any word processing or hypertext form. However if you provide access to or distribute copies of a Project Gutenberg-tm work in a format other than "Plain Vanilla ASCII" or other format used in the offi- cial version posted on the official Project Gutenberg-tm web site

slide 197:

166/173 www.gutenberg.net you must at no additional cost fee or expense to the user provide a copy a means of exporting a copy or a means of ob- taining a copy upon request of the work in its original "Plain Vanilla ASCII" or other form. Any alternate format must include the full Project Gutenberg-tm License as specified in paragraph 1.E.1. 1.E.7. Do not charge a fee for access to viewing displaying performing copying or distributing any Project Gutenberg-tm works unless you comply with paragraph 1.E.8 or 1.E.9. 1.E.8. You may charge a reasonable fee for copies of or providing access to or distributing Project Gutenberg-tm elec- tronic works provided that - You pay a royalty fee of 20 of the gross profits you derive from the use of Project Gutenberg-tm works calculated using the method you already use to calculate your applicable taxes. The fee is owed to the owner of the Project Gutenberg-tm trademark but he has agreed to donate royalties under this para- graph to the Project Gutenberg Literary Archive Foundation. Royalty payments must be paid within 60 days following each date on which you

slide 198:

167/173 prepare or are legally required to prepare your periodic tax returns. Royalty payments should be clearly marked as such and sent to the Project Gutenberg Literary Archive Foundation at the address specified in Section 4 "Information about donations to the Project Gutenberg Literary Archive Founda- tion." - You provide a full refund of any money paid by a user who notifies you in writing or by e-mail within 30 days of receipt that s/he does not agree to the terms of the full Project Gutenberg-tm License. You must require such a user to return or destroy all copies of the works possessed in a physical medium and discontinue all use of and all access to other copies of Project Gutenberg-tm works. - You provide in accordance with paragraph 1.F.3 a full refund of any money paid for a work or a replacement copy if a defect in the electronic work is discovered and reported to you within 90 days of receipt of the work. - You comply with all other terms of this agreement for free distribution of Project Gutenberg-tm works.

slide 199:

168/173 1.E.9. If you wish to charge a fee or distribute a Project Gutenberg-tm electronic work or group of works on different terms than are set forth in this agreement you must obtain permission in writing from both the Project Gutenberg Literary Archive Foundation and Michael Hart the owner of the Project Gutenberg-tm trademark. Contact the Foundation as set forth in Section 3 below. 1.F. 1.F.1. Project Gutenberg volunteers and employees ex- pend considerable effort to identify do copyright research on tran- scribe and proofread public domain works in creating the Project Gutenberg- tm collection. Despite these efforts Project Gutenberg- tm electronic works and the medium on which they may be stored may contain "Defects" such as but not limited to incomplete in- accurate or corrupt data transcription errors a copyright or oth- er intellectual property infringement a defective or damaged disk or other medium a computer virus or computer codes that damage or cannot be read by your equipment. 1.F.2. LIMITED WARRANTY DISCLAIMER OF DAMAGES - Ex- cept for the "Right of Replacement or Refund" described in paragraph 1.F.3

slide 200:

169/173 the Project Gutenberg Literary Archive Foundation the owner of the Project Gutenberg-tm trademark and any other party distribut- ing a Project Gutenberg-tm electronic work under this agreement dis- claim all liability to you for damages costs and expenses in- cluding legal fees. YOU AGREE THAT YOU HAVE NO REMEDIES FOR NEGLIGENCE STRICT LIABILITY BREACH OF WARRANTY OR BREACH OF CONTRACT EXCEPT THOSE PROVIDED IN PARAGRAPH F3. YOU AGREE THAT THE FOUNDATION THE TRADEMARK OWNER AND ANY DISTRIBUTOR UNDER THIS AGREEMENT WILL NOT BE LIABLE TO YOU FOR ACTUAL DIRECT INDIRECT CONSEQUENTIAL PUNITIVE OR INCIDENTAL DAMAGES EVEN IF YOU GIVE NOTICE OF THE POSSIBILITY OF SUCH DAMAGE. 1.F.3. LIMITED RIGHT OF REPLACEMENT OR REFUND - If you discover a defect in this electronic work within 90 days of re- ceiving it you can receive a refund of the money if any you paid for it by sending a written explanation to the person you received the work from. If you received the work on a physical medium you must return the medium with your written explanation. The person or entity that provided you with the defective work may elect to provide a replacement copy in lieu of a

slide 201:

170/173 refund. If you received the work electronically the person or entity providing it to you may choose to give you a second op- portunity to receive the work electronically in lieu of a refund. If the second copy is also defective you may demand a refund in writing without further opportunities to fix the problem. 1.F.4. Except for the limited right of replacement or refund set forth in paragraph 1.F.3 this work is provided to you AS- IS WITH NO OTHER WARRANTIES OF ANY KIND EXPRESS OR IMPLIED INCLUDING BUT NOT LIMITED TO WARRANTIES OF MERCHANTIBILITY OR FITNESS FOR ANY PURPOSE. 1.F.5. Some states do not allow disclaimers of certain implied warranties or the exclusion or limitation of certain types of damages. If any disclaimer or limitation set forth in this agreement violates the law of the state applicable to this agreement the agreement shall be interpreted to make the maximum disclaimer or limita- tion permitted by the applicable state law. The invalidity or unenforce- ability of any provision of this agreement shall not void the remain- ing provisions. 1.F.6. INDEMNITY - You agree to indemnify and hold the Foundation the trademark owner any agent or employee of the

slide 202:

171/173 Foundation anyone providing copies of Project Gutenberg-tm electronic works in accordance with this agreement and any volunteers associated with the production promotion and distribution of Project Gutenberg-tm electronic works harmless from all liability costs and expenses in- cluding legal fees that arise directly or indirectly from any of the fol- lowing which you do or cause to occur: a distribution of this or any Project Gutenberg-tm work b alteration modification or additions or de- letions to any Project Gutenberg-tm work and c any Defect you cause. Section 2. Information about the Mission of Project Gutenberg-tm Project Gutenberg-tm is synonymous with the free dis- tribution of electronic works in formats readable by the widest variety of computers including obsolete old middle-aged and new com- puters. It exists because of the efforts of hundreds of volunteers and donations from people in all walks of life. Volunteers and financial support to provide volunteers with the assistance they need is critical to reaching Project Gutenberg-tms goals and ensuring that the Project Gutenberg-tm

slide 203:

172/173 collection will remain freely available for generations to come. In 2001 the Project Gutenberg Literary Archive Foundation was created to provide a secure and permanent future for Project Gutenberg-tm and fu- ture generations. To learn more about the Project Gutenberg Literary Archive Foundation and how your efforts and donations can help see Sec- tions 3 and 4 and the Foundation web page at http://www.pglaf.org. Section 3. Information about the Project Gutenberg Literary Archive Foundation The Project Gutenberg Literary Archive Foundation is a non profit 501c3 educational corporation organized under the laws of the state of Mississippi and granted tax exempt status by the Internal Revenue Service. The Foundations EIN or federal tax identification number is 64-6221541. Its 501c3 letter is posted at http://pglaf.org/fundraising. Contributions to the Project Gutenberg Literary Archive Foundation are tax deductible to the full extent permitted by U.S. federal laws and your states laws. The Foundations principal office is located at 4557 Melan Dr. S. Fairbanks AK 99712. but its volunteers and employees

slide 204:

173/173 are scattered throughout numerous locations. Its business office is located at 809 North 1500 West Salt Lake City UT 84116 801 596-1887 email businesspglaf.org. Email contact links and up to date contact information can be found at the Foundations web site and official page at http://pglaf.org For additional contact information: Dr. Gregory B. Newby Chief Executive and Director gbnewbypglaf.org Section 4. Information about Donations to the Project Gutenberg Literary Archive Foundation Project Gutenberg-tm depends upon and cannot survive without wide spread public support and donations to carry out its mission of increasing the number of public domain and licensed works that can be freely distributed in machine readable form accessible by the widest array of equipment including outdated equipment. Many small donations 1 to 5000 are particularly important to maintain- ing tax exempt status with the IRS. The Foundation is committed to complying with the laws regulating

slide 205:

174/173 charities and charitable donations in all 50 states of the United States. Compliance requirements are not uniform and it takes a considerable effort much paperwork and many fees to meet and keep up with these requirements. We do not solicit donations in locations where we have not received written confirmation of com- pliance. To SEND DONATIONS or determine the status of compliance for any particular state visit http://pglaf.org While we cannot and do not solicit contributions from states where we have not met the solicitation requirements we know of no prohibition against accepting unsolicited donations from donors in such states who approach us with offers to donate. International donations are gratefully accepted but we cannot make any statements concerning tax treatment of donations received from outside the United States. U.S. laws alone swamp our small staff. Please check the Project Gutenberg Web pages for cur- rent donation methods and addresses. Donations are accepted in a number of other ways including including checks online payments and credit card donations. To donate please visit: http://pglaf.org/ donate

slide 206:

175/173 Section 5. General Information About Project Gutenberg-tm electronic works. Professor Michael S. Hart is the originator of the Project Gutenberg-tm concept of a library of electronic works that could be freely shared with anyone. For thirty years he produced and dis- tributed Project Gutenberg-tm eBooks with only a loose network of volun- teer support. Project Gutenberg-tm eBooks are often created from sev- eral printed editions all of which are confirmed as Public Domain in the U.S. unless a copyright notice is included. Thus we do not necessarily keep eBooks in compliance with any particular paper edition. Most people start at our Web site which has the main PG search facility: http://www.gutenberg.net This Web site includes information about Project Gutenberg-tm including how to make donations to the Project Guten- berg Literary Archive Foundation how to help produce our new eBooks and how to

slide 207:

176/173 subscribe to our email newsletter to hear about new eBooks.

slide 208:

Created by PDF to ePub

authorStream Live Help