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DIETETICS FOB NURSES
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j!^^
THE MACMILLAN COMPANY
NBW YOKK • BOSTON • CHICAGO • DALLAS
ATLANTA • SAN FRANCISCO
MACMILLAN & CO.. Limitbd
LONDON • BOMBAY • CALCUTTA
MELBOURNE
THE MACMILLAN CO. OP CANADA, Lm
TORONTO
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DIETETICS FOR
NURSES
BY
FAIRFAX T. PROUDFIT
INSTRUCTOR AND CLINICAL DIETITIAN, MBMPHI8 QENSRAL
HOSPITAL, AND ST. JOSEPH'S HOSPITAL, CONSULTING
DIETITIAN, BflBlfPHIS ASSOCIATED CHARITIES, AND
PUBUC HEALTH NURSING ASSOCIATION,
MEMPHIS, TENNESSEE
SECOND EDITION
Completely Bevised
THE MACMILLAN COMPANY
1922
AU fighU rtwrved
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'\. > ^ I *,' rkctsmjb)' in *tiie united states or ameeiga.
COPTUOHT, 1918 AHD 1922,
bt the macmillan company.
Set up and electrotyped. Published November, 1918
Second Edition completely revised and reset
Published, July, 1922
of
J. J. Little k Ives Company
New York. U. S. A.
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to tbc
0reat Btmi? ot nurses
in tbe Service
493385
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PREFACE TO SECOND REVISED EDITION
The old order of things is passing. The keynote of to-
day's work is prevention, rather than cure, children are
tau^t to eat correctly that they may grow into the strong,
healthy men and women which are needed to make any na-
tion great. This instilling of good health habits must rest
upon the nurse, the nutrition worker, the physician and
the home-maker. Close cooperation is necessary among
these workers and a definite understanding of the way to
accomplish the best results, in this respect, must come
from the training of those who are undertaking this all im-
portant work.
The present revision of this text is the outgrowth of sev-
eral years of close attention to the progress, changes and
adjustments which are being made daily in this important
subject of nutrition. The changes made in this revised edi-
tion are all in the line of constructive teaching. The ma-
terial has been reorganized that no time may be lost in a
search for the proper word to illustrate a definite point.
The method of project teaching used in this edition, is
not a new one, although the name may possibly be un-
familiar to some. Every good teacher recognizes the value
of motivation as a means of getting an idea "across.'' The
revision of this text was undertaken with the idea of lead-
ing the student to think for herself and to put into practice
tiie scientific facts learned in class room and ward.
The author is indebted to many of her colleagues for
the encouragement and constructive criticism which en-
abled her to make the changes which will, it is hoped and
b^li^ved, materially aid the student nurse in the study of
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viii PREFACE
Dietetics. She also wishes to express her appreciation for
the many helpful suggestions made by her co-workers in
this respect, especially to Misses L. H. Gillett and L. Willson
for valuable criticism and to Miss H. Buquo for assistance
in the preparation of the manuscript.
F. T. P.
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PREFACE TO FIRST EDITION
No other science has so much to do with the general
welfare of mankind as the study of food and its effects in
the human body. When we use the term "dietetics" as
representing "the effect of the food in the human body,"
we do so in a very broad sense, for the subject is a big one,
requiring comprehensive terms to express it.
The problems of nutrition are many. Food alone is no
small subject and a still greater one is the utilization of food
materials in such a way that the body may gain the greatest
value with the least expenditure of vital forces. These
problems are discussed in this text and the methods of over-
coming them are given in the simplest possible language.
For this purpose the subject of nutrition has been divided
into groups: (1) a comprehensive study of the sources of
food, its composition and nutritive value; (2) the effect of
food in the body under normal conditions, as in health ; and
(3) its behavior and effect when conditions in the body
become abnormal, as in disease. In this way much of the
non-essential material is eliminated from the course of
study and only that included which it is necessary for the
nurse to understand and which she will constantly use both
in the hospital and later on in the practice of her profession.
The simple methods of study presented in this text are given
with the idea of avoiding confusion in the mind of the aver-
age pupil nurse by fitting in the course with her other
studies rather than by making it stand out as a separate
subject. In this way she will be able to see at a glance the
connection between the body processes and the materials
which are used to carry them on. Thus her study of physi-
ology, anatomy and bacteriology go hand in hand with that
of dietetics, each bearing a distinct relationship to the others.
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CONTENTS
SECTION I
FOOD AND ITS SIGNIFICANCE
I Food 1
II Fuel Value op Food 36
in Food Rbquibements of the Body 42
SECTION II
LABORATORY OR DIET KITCHEN WORK
IV Methods op Feeding in Ncsmal and Abnormal Conditionb 59
V Food MATERUiis and Their Preparation 81
VI Infant Foods and Formulas Used in Abnormal Conditions 140
SECTION III
THE HUMAN MACHINE
VII The Human Body 165
SECTION IV
DIETO-THERAPY
VlU Pregnancy and Lactation 191
IX Infant Feeding 199
X Care and Feeding of Children in Normal and Abnormal
Conditions 231
XI Feeding op Adults in Diseases op the Gastro-intestinal
Tract 245
Xn Diseases of the Intestinal Tract 263
Xni Fevers in General 281
XIV Typhoid Fever 288
XV Diseases of the Respiratory Tract 301
XVI Dietetic Treatment Before and After Operation .... 312
xi
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xii CONTENTS
CHAPTER PAGS
XVII Urinalysis 323
XVIII Acute and Chronic Nephritis 336
XIX Diseases of the Heart 365
XX Diabetes Melutus 372
XXI Diseases of the Liver 404
XXII Gout, Obesity and Emaciation 418
XXIII Other Conditions Affected by Diin* 451
APPENDIX
T^ble I. Edible Organic Nutrients and Fuel Values of Foods . . 461
Table II. Ash Constituents of Foods in Percentage of the Edible
Portion 472
Table III. Showing 100-Calorie Portions of some Common Foods,
Together with Their Protein, Nitrogen, and Mineral Content . 478
Table IV. Composition and Fuel Value of most of the Foods used
m the Invalid Dietary 484
Table V. Vitamines in Foods 496
Heights and Weights for Children under Five Years of Age . . . 409
Height and Weight Table for Boys 500
Height and Weight Table for Girls 601
Pelidisi Chart 502
The Nutritional Index— The "Pelidisi" 503
Index 505
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SECTION I
POOD AND ITS SIGNIFICANCE
PrEUMINABY CotJBSE OF LECTURES AND LABORATORY WoRK
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CHAPTER I
FOOD
The value of a knowledge of food and its effect in the
human body cannot be overestimated. In health, this
knowledge leiads to higher standards, since by pointing out
the errors in one's mode of living, good health habits may
be established, which will, undoubtedly assure the indi-
vidual of a better nourished and a more vigorous body.
There is no question as to the value of health either from
the standpoint of comfort or of economy. And the knowl-
edge which will enable one to spread the good work intelli-
gently cannot but raise the standards of living throughout
the entire community.
In taking up the study of dietetics, the student is intro-
duced to some of the fundamental principles governing the
health and well-being of a people, since dietetics includes a
study of food and its relation to the body.
The relationship between right food and good health is
very close; how close is being demonstrated constantly in
experimental fields of scientific research.
To be able to judge whether the food one eats daily is
giving the best possible value from a physiological and
economic standpoint, requires a definite knowledge of food,
its source, composition and nutrient value, as well as its
relation to the body in health and disease.
No one is capable of giving constructive advice upon
matters pertaining to diet, unless he has acquired this
knowledge through training. A nurse should obtain this
training during her course in the hospital, through the class
room, the wards and the diet kitchen.
1 .
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2 -•'•'•••:•. DIETETICS FOR NURSES
The dividing line between health and disease is fre-
quently almost imperceptible, and without a knowledge
of the normal body, it is, at times, impossible to tell where
the normal leaves ofiF fuid the abnormal begins. For this
reason a nurse must understand normal nutrition, that is,
the behavior of food in the healthy body, before under-
taking the task of ministering to the body attacked by
disease.
In a text of this kind, it is impossible to cover all
phases of the subject, especially since day by day new
discoveries are being made with relation to food and its
uses in the body. But with careful attention to the prin-
ciples set forth, a nurse should be able to carry out the
dietary orders given her by the physician and dietitian in
the hospital. And, when her course of training is finished,
she should find herself equipped to assist in raising the
standard of health through her knowledge of dietetics. With
this brief summary of the aims and object of the study of
dietetics, we will begin the actual work with a study of
Food.
Food Materials. — Food is the name given to any sub-
stance which, taken into the body, is capable of performing
one or more of the following functions:
1. Building and repairing tissue, maintenance, growth,
and development of the muscles, bones, nerves, and the
blood.
2. Furnishing the energy for the internal and external
work of the body.
3. Regulating the body processes, maintaining the
proper alkalinity and acidity of the various fluids through-
out the body, regulating the proper degree of. temperature,
and determining the psmotic pressure, etc. ^^,,,
For the convenience of study scientists hav^ arranged
the foodstuffs in groups:
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FOOD 3
1. According to type;
2. According to their chemical composition;
3. According to the function they perform in the body.
All foods are composed of certain chemical elements;
namely, carbon, oxygen, hydrogen, nitrogen, sulphur, phos-
phorus, iron, magnesium, potassium, chlorine, sodium, cal-
cium, with traces of various others. The manner in which
these elements are combined and the amounts in which
they occur determine the group to which the combination
belongs, and give to the foodstuff its characteristic position
in human nutrition.
COMPOSITION OF THE FOODSTUFFS
The chemical elements are combined in food and in the
body, as: (a) carbohydrates, composed of carbon, oxygen
and hydrogen; (b) fats, composed of carbon, oxygen and
hydrogen; (c) proteins, composed of carbon, oxygen, hy-
drogen, nitrogen and sulphur; (rf) water, composed of
hydrogen and oxygen; (e) mineral salts. The first three
foodstuffs constitute the Organic Food group. The last two
include the remaining chemical elements, calcium, phos-
phorus, sodium, potassium, chlorine, magnesium, iron and
traces of others which make up the Inorganic Food group.
Each of the foodstuffs belonging to the organic group
is capable of being burned in the body to produce heat for:
(a) the maintenance of the body temperature; (6) internal
and external work.
Neither water nor mineral salts alone can be burned to
produce heat; nevertheless, they enter into the composition
and take part in every function performed by the carbo-
hydrates, fats and proteins; therefore one foodstuff cannot
be said to be of greater importance than another, since the
needs of nature are best met by a judicious combination of
all. However, the wear and tear of life can be more effi-
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4 DIETETICS FOR NURSES
ciently accounted for, and the strain upon the organism
reduced more nearly to a minimum when the various food-
stuffs are furnished in amounts which science is proving to
be necessary for the health and wdl-being of the organism.
The sixth essential food substance, the Vitamines, to-
gether with the adjustment of the five foodstuffs just men-
tioned — the amounts and types of each in the dietary
which will assure the body of the best results — has been,
and still is a subject of grave interest. Even on the most
perfect adjustment of these foodstuffs, the diet would fail
to give the desired results without the inclusion of the sixth,
or vitamine factor, which has proved to be essential for the
growth and development of the normal body, as well as for
its protection against certain deficiency diseases.
In order to obtain the best results from food, both from
a health and an economic standpoint, it is necessary to be-
come familiar with the foodstuffs as they are combined to
make up the various common food materials. One foodstuff
may be a producer of heat, but may lack certain chemical
elements which are essential to the building of tissues;
another may be able to accomplish both functions in the
body, but will prove too expensive to use as fuel, except
when it is absolutely necessary to do so. Thus, it is essential
for the nurse to understand where and how both the food-
stuffs and the vitamines occur in natiu-e, in order to make
use of them more advantageously. The following table
gives the sources of the foodstuffs, after which a description
of the individual foodstuffs and vitamine factors will serve
to point the way to their use in the dietary:
Proteins
Milk, cheese (especially skim-milk cheese).
Efi»s.
Meat (lean meat in particular).
Poultry, game.
Fish.
Cereals, com, wheat, rye, oats, etc.
Bread and breadstuffs (crackers, pastry, macaroni,
cake).
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FOOD
Proteins .
Beans, peas, lentils.
Cotton seed.
Nuts.
Gelatin. .
Carbohydrates
Wheat products (bread, cake, crackers^ pastry,
macaroni, spaghetti).
Cereal grains, breakfast foods.
Com products, corn meal, green com.
Rice, sago, tapioca, taro.
Potatoes (white and sweet).
Starchy fruits (bananas).
Sweet fruits (oranges, grapes, pineapples).
Dried fruits (prunes, dates, raisins, currants).
Sugar cane, sorghum cane.
Sugar beets, sugar maples.
Products made from sugar (candy, jellies, pre-
serves, marmalade).
Fats •
Butter, cream, cheese.
Olive oil, cotton seed oil, peanut oil, cam oil,
almond oil.
Soy bean.
Com meal, cotton seed meal and flour, oatmeal.
Pork (bacon especially), other fat meat.
Codfish (and other fatty fish).
Eggs (yolk).
Cocoa, chocolate.
Brazil nuts, almonds, pecans, and other nuts rich
in fat.
Water.
t All foodstuffs except those which have been put
'/ through a' drying process.
Mineral salts
(organic form)
Nitrogen (in proteins, meat, eggs, milk, fish,
gluten of wheat, zein of com meal, legumen of
beans, peas, and lentils).
Phosphorus (eggs, yolk especially, cream, vegeta-
bles, whole wheat, cereals, breadstuffs, oatmeal,
dried beans and peas).
Iron (organic and f Eggs, milk, lean meat, cereal products, whole wheat,
inorganic form)< dried beans and peas, vegetables, spinach in par-
y ticular, onions, mushrooms, fruits, port wine.
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DIETETTCg^TOR NURSES
Calcium (organic
and inorganic-
form)
Milk.*
Eggs.
Soft tissues and fluids of all animals, skeleton
and teeth of animals.
Wheat (the entire grain), flour, oatmeal, polished
rice.
Dried beans and peas.
Green vegetables (beets, carrots, parsnips, turnips,
potatoes).
Fruits (apples, bananas, oranges, pineapples, dried
prunes). •
Nuts (almonds, peanuts, walnuts).
Sulphur (organic
and inorganic-
form)
The proteins
Lean beef, eggs, milk.
Wheat flour, entire wheat, crackers,
etc.
Oatmeal.
Beans, i>ea8.
Potatoes.
Sodium, potas-l
sium, magne-|
sium, iodine,!
chlorine
These elements are associated with the other min-
eral salts in foods, and a diet in which they are
adequately supplied furnishes sufficient magne-
sium, potassium, chlorine, sodium, and iodine
for the general needs of the body.
Fat soluble "A,"
Butter, cream, whole-milk.
Whole-milk powder.
Whole-milk cheese.
Cod-liver oil, eggs.
Brains, kidney.
Cabbage (fresh-dried).
Carrots, chard, lettuce.
Spinach, sweet potatoes.
Water soluble "B."
Yeast (brewers').
Yeast cakes, yeast extract.
Whole-milk, whey.
Milk powder (whole and skimmed).
Nuts, cereals (corn-embiyo, wheat-embryo, wheat-
kernel, rice (unpolished).
Beans (kidney, navy, soy).
Cotton seed, peanuts, bread.
* One quart of milk contains more calcium than a quart of clear satu-
rated solution of lime water.
"For complete list, see Eddy's Table, in Appendix.
Vitamines'
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FOOD
YitamineB
Cabbage, carrots, celery.
Cauliflower, onions.
Parsnips, potatoes.
Peas (fresh), spinach.
Rutabaga, fruit, grapefruit.
Orange, lemon, tomato, raisins.
Water soluble "C"
Fruits: Orange, lemon, tomatoes (canned).
Tomato (fresh), grapefruit, limes, apples.
Vegetables: Spinach, lettuce, cabbage (raw).
Peas (fresh), onions, carrots, cauliflower.
Potatoes (to a less extent).
Whole-milk (to a less extent).
THE INDIVIDUAL FOODSTUFFS AND VITAMINE FACTORS
A study of the individual foodstuflfs and vitamines will
furnish the first link in the chain which constitutes our
present knowledge of dietetics.
CARBOHYDRATES
In the ordinary mixed diet of man, the carbohydrates
predominate, being not only the most abundant, but also
the most economical source of energy. The term carbo-
hydrate covers all of the simple sugars and those substances
which can be converted into simple sugars by hydrolysis;
the ones of special interest in this study are divided into
three groups, known as. Monosaccharides (CeHigOe); Di-
saccharides (C12H22O11) and Polysaccharides (CcHioOig).
Monosaccharides. — Glucose, Fructose and Galactose
are substances whose monosaccharide molecules contain one
sugar radical; hence they cannot be hydrolized to simpler
sugars (sugars of lower molecular weight). Those consti-
tuting this group of sugars are all soluble, crystallizable and
diffusible substances, which do not undergo changes from
the action of the digestive enzymes, consequently these
sugars will enter the blood stream in their original form,
unless attacked by the bacteria which inhabit the stomach
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8 DIETETICS FOR NURSES
and intestinal tract. The monosaccharides are all suscep-
tible to alcoholic fermentation. Each member of the group
is utilized in the body for the production of glycogen and
for the maintenance of the normal glucose of the blood.
Disaccharides. — Sucrose, Maltose and Lactose are sub-
stances yielding, upon hydrolysis, two molecules of simple
sugar: each of these sugars is crystallizable and diffusible:
all are soluble in water, and to a less degree in alcohol —
sucrose and maltose are more soluble than lactose. When
attacked by the digestive enzymes, these sugars are changed
to monosaccharides.
Polysaccharides. — Starch, Dextrin, Glycogen and Cel-
lulose are substances more complex in character than the
above mentioned groups. They are built up of many sugar
molecules, which yield upon complete hydrolysis many
molecules of simple sugar. The polysaccharides are insol-
uble in alcohol, and only soluble to a certain extent in pure
water. Some members of this group swell and become
gelatinous in the presence of moisture and heat; some be-
come of a colloidal form in water, and will pass through
filter paper; others remain unchanged.
A brief description of the various members of these dif-
ferent groups of carbohydrates will assist the nurse in the
ways and means of utilizing them in the dietary to the best
advantage.
Glucose, which is abundant in the juice of plants and
fruits, and to a more or less degree in the blood of all ani-
mals (usually about 0.1%) occurs free in nature. This
sugar is likewise obtained from many carbohydrates, either
through the action of acids, or as the result of the digestive
enzymes, and as such becomes the principal form in which
the animal body utilizes the carbohydrates ingested. Under
normal conditions the glucose in the blood is constantly
being burned and replaced ; it is only when the body loses
to a greater or less degree the ability to bum the glucose that
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FOOD 9
it accumulates in the blood, from which it must escape by-
way of the urine. There are times, such as when very large
quantities of carbohydrates are eaten at once, when glucose
will also appear in the urine; but under such circumstances
it is generally found to be merely temporary, and for this
reason, the condition is known as temporary glycosuria. As
a rule, however, the surplus of glucose absorbed, whether
it be eaten as such, or is found as the result of enzymic
action upon the other carbohydrates, is converted into gly-
cogen and stored in the liver and to a less extent in the
muscles. Glycogen is readily re-converted into glucose,
which is used by the body for the production of energy. It
has been estimated that over half the energy manifested
in the human body is derived from glucose, and it is in this
form that the tissues of the body will ultimately make use