FOOD and COOKERY
for the SICK and
CONVALESCENT
Fannie M.
Farmer
MICHIGAN
STATE AGRICULTURAL COLLEGE LIBRARY
No.
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HOME ECONOMICS DIVISION
MICHIGAN AGRICULTURAL COLLEGE
EAST LANSING MICH.
MICHIGAN STATE UNIVERSITY LIBRARY
FOOD AND COOKERY
FOR THE SICK
AND
CONVALESCENT
FOOD AND COOKERY
FOR THE SICK
AND
CONVALESCENT
BY
FANNIE MERRITT FARMER
PRINCIPAL OF MISS FARMER'S SCHOOL OF COOKERY
AND AUTHOR OF
"THE BOSTON COOKING-SCHOOL COOK BOOK" AND
"CHAFING-DISH POSSIBILITIES"
BOSTON
LITTLE, BROWN, AND COMPANY
1905
BY FANNIE MERRITT FARMER.
Published February, 1904
Transferred in library,
8/12-21
UNIVERSITY PRESS. JOHN WILSON AND SON. CAMBRIDGE, U.S.A.
TO
MY MOTHER
WHOSE DEVOTION TO DUTY HAS INSPIRED ME TO
MY BEST WORK
This Book is Lovingly Dedicated
FLORENCE NIGHTINGALE
HELENA V. SACHSE
"Food is the only source of human power to work or to think"
THIS work is designed to meet the demands made upon me by the numberless classes of trained nurses whom it has been my pleasure and privilege to instruct during my thirteen years of service as a teacher of cookery.
It is earnestly hoped that, besides meeting this long felt need, it will do a still broader work in thousands of homes throughout the land, where it will be of inestimable help to the mothers upon whom so much of the welfare of the family depends.
The opening chapters are equally valuable to those who care for the sick and those who see in correct feeding the way of preventing much of the illness about us.
Emphasis has been laid on the importance of diet from infancy to old age. The classification, composition, nutritive value, and digestibility of foods have been carefully considered with the same constant purpose of being a help to those who arrange dietaries. The chapter on infant feeding is an authoritative
The hundreds of thoroughly tested recipes cover the whole range of the subject of cookery for the sick and convalescent. They are, for the most part, individual, thus requiring but a minimum of time for their preparation, while many have their caloric value given.
I wish to express my sincere thanks for the sympathy, encouragement, and help I have received from pupils, superintendents of nurses, professors, and physicians, which have made this work possible.
F.M.F
FOOD is that which builds and repairs the body, and furnishes heat and energy for its activities. Metabolism includes the processes by which food is assimilated and becomes part of the tissues, and the excretion of broken-down tissues as waste products. The body, by the analysis of its different organs and tissues, is found to contain from fifteen to twenty chemical elements, of which the principals are: carbon (C), 21 1/2%; hydrogen, (H), 10%; oxygen (O), 62 1/2%; and nitrogen (N), 8%. Phosphorus (P), sulphur (S), iron (Fe), chlorine (CI), fluorine (FI), calcium (Ca), potassium (K), sodium (Na), magnesium (Mg), and silicon (Si) are some of the others present. The elements found in the body must be supplied by the oxidation and utilization of the food stuffs, and the health of the individual will suffer if these are not properly maintained.
Food adjuncts are such substances as stimulate the appetite without fulfilling the requirements of food. Examples: tea, coffee, spices, flavoring extracts, condiments, etc., etc.
While air is not classified as a food, it is essential to life. Combustion cannot take place without it, and all food must be oxidized (which is a process of slow combustion) before it can be utilized by the body.
PROF. W. O. ATWATER.
The chief office of proteids is to build and repair tissues, and they only can do this work. They also furnish heat and energy, and in cases of emergency are capable of supplying fat. The chemical elements found in proteid foods are carbon, hydrogen, oxygen, nitrogen, sulphur, and generally phosphorus and iron. They differ from the other food principles inasmuch as they contain nitrogen, and nitrogen is essential to life.
The principal animal proteids are meat, fish, eggs, and cheese; the principal vegetable proteids are cereals, peas, beans, and lentils. The proteids obtained from animal foods are more easily digested and more completely absorbed than those obtained from vegetable foods. This is due in part to the presence of the large quantity of cellulose in vegetables. During the oxidation of proteids ammonia is set free, which neutralizes the acids constantly being formed.
The waste products of proteids are excreted by the urine in the form of urea. While a well-balanced dietary
Proteids are the most expensive foods, and there is often found to be an insufficient quantity in dietaries, especially among the poorer classes. it is conceded to be true, that in the United States with those of large incomes there is a tendency to an excess of proteids, but this does not apply to the average American family. Our people eat more than any other people, and do correspondingly more work. The growing child suffers more from the lack of proteid than the adult, as much material is required for building as well as repair. Until recently it was supposed that metabolism went on much faster in young cells, but now the greater activity of the child is held responsible for these rapid changes.
The chief office of carbohydrates is to furnish heat and energy and store fat. They contain carbon, hydrogen, and oxygen, the hydrogen and oxygen always being in the proportion to form water (H2O).
Starch, the chief source of carbohydrates, abounds throughout the vegetable kingdom, being obtained from seeds, roots, tubers, stems, and pith of many plants. Examples: cereals, potatoes, sago, tapioca, etc.
Sugars, the other source from which carbohydrates are obtained, are classified as follows:--
HUTCHINSON.
Carbohydrates include the cheapest kinds of foods and are apt to be taken in excess. In institutions where large numbers are fed there is a tendency in this direction.
Carbohydrates in the form of starch furnish a bulky food; and while a certain amount of bulk is necessary, an excess causes gastric disorders. Sugar is oxidized and abosorbed more readily than starch. The monosaccharids are ready for absorption, dextrose being the sugar found in the blood. Some sugar is absorbed through the walls of the stomach, and this holds true of no other foods except alcohol and a very small per cent of peptones (proteids). No water is absorbed through the walls of the stomach.
Sugar (sucrose), on account of its cheapness and complete absorption when taken in combination and moderation, makes a desirable quick-fuel food. Milk sugar (lactose) is equal in nutritive value to cane sugar. Being less sweet to the taste and more slowly absorbed it is often used to advantage for infant feeding and sick-room cookery, where expense is not considered. The usual retail price of milk sugar is about thirty cents per pound. Milk sugar, under ordinary conditions, does not ferment and give rise to an excess of acids.
Sugars are more rapidly oxidized than starches. The former may be compared to the quick flash of heat from pine wood, the latter to the longer-continued heat from hard wood.
The starches furnish the necessary bulk to our foods and are also proteid sparers. Proteids give such an intense heat that but for the starches much of their energy would be wasted.
The waste products of carbohydrates are carbon dioxid (CO2) and water (H20), which leave the body through the lungs, skin, and urine.
The fats and oils also furnish heat and energy, and constitute the adipose tissue of the body. Examples: Fats of meat, butter, cream, olive oil, etc. They are an expensive concentrated fuel food, yielding two and one-fourth times as much energy as an equal weight of carbohydrates. To those who do not consider expense in feeding, there is a strong tendency to increase the use of fats and oils and decrease the carbohydrates, while
Water constitutes about two-thirds of the weight of the body, and enters into the composition of all the tissues and fluids. To keep the necessary proportion, a large quantity needs to be ingested. One of the great dietetic errors is the neglect to take a sufficient quantity. The amount found in foods is insufficient, and about five cupfuls should be taken daily in beverages. A vegetable diet diminishes the need of water, while one composed largely of animal food increases this need.
Mineral matter is necessary for the building of tissues, being found, principally, in the bones and teeth. It aids in the digestion of foods, and also assists in the diffusion of the fluids of the body. Phosphate of lime, or calcium phosphate, is the mineral basis of bones. Potassium, magnesium, sodium, and iron are minerals, all of which are essential to life. They usually enter the body in
THE familiar comparison between the body and the locomotive engine serves as a most forcible Illustration for studying the fuel value of foods.
Food furnishes fuel to supply heat and energy for the body as wood and coal do for the locomotive. The food not only does this work, but it must also build and repair the human structure, while the locomotive is not capable of making its own repairs.
Latent beat is just as surely found in meat or bread as in wood or coal. They are both waiting to be oxidized, that they may be converted into heat and energy. As different kinds of wood and coal are capable of giving off different degrees of heat, and also giving off that heat in longer or shorter periods of time, so different food stuffs work in comparatively the same way.
The subject of the fuel value of food is of such great importance that within the last few years much time has been devoted to experiments along this line, and the results have furnished much valuable knowledge to aid us in correct feeding.
The latent energy in different foods has been determined by their oxidation, outside the body, in the apparatus known as the bomb calorimeter. Still further experiments have been made with the respiration calorimeter. By this apparatus not only is the fuel value of all the food taken into the body determined, but the excreta, products of respiration, and heat given off by the body are measured. From this statement it can be seen that man himself is used in making the experiments.
"The amount of heat given off in the oxidation of a given quantity of any material is called its 'heat of combustion,' and is taken as a measure of its latent or potential energy" The calorie is the unit measure of heat used to denote the energy-giving power of food, and is equivalent to the amount of heat necessary to raise one kilogram of water 1° C. or about one pound of water 4° F.
While proteids are capable of furnishing heat and energy as well as building and repairing tissues, it must always be remembered that their chief office is for the latter work. It is impossible for metabolism to go on without the production of some heat. The proteids are the only foods that contain nitrogen.
To determine the amount of nitrogen in a given food stuff, divide its grammes of proteid by 6.25. One gramme nitrogen equals 6.25 grammes proteid. The excretion of nitrogen for a man of average weight is about twenty grammes daily, the same amount being consumed. When the quantity of nitrogen is increased, there is a corresponding increase of its excretion, thus establishing nitrogenous equilibrium.
128.3 grammes equal 1 oz.
1 In ordinary computations entire wheat bread can be reckoned as having the same nutritive value as white bread.
1 lb. white bread furnishes 1215 calories; 1 lb. entire wheat bread, 1140 calories. The same statement applies to many of the flours, thus:--
A man of average weight (one hundred and fifty-four pounds, or seventy kilos), at moderate work, requires about three thousand calories daily. The standard dietaries include one hundred and twenty-five grammes proteid, fifty grammes fat, and five hundred grammes carbohydrates.
A woman needs eight-tenths as much food as a man.
The quantity of food required in a temperate and warm climate is about the same; the kinds, however, vary. Mother Nature, always wise and unerring, produces different crops to meet different needs. In our own country oats is grown in the northern part, rice in the southern.
In a cold climate more food is needed,--a fact not due to the temperature, but to the greater activity of the inhabitants,--and fat forms a larger proportion of the diet, as it is oxidized slowly in the body.
A tall, thin person consumes more food than a short, stout person, for the reason that the larger surface exposed is the cause of a greater loss of heat.
Age has a marked effect upon the rations needed. A child from three to five years old requires four-tenths as much food as a man at moderate work; from six to nine years, one-half as much; while a boy of fifteen years requires as large a quantity as a man of sedentary habits.
The abuses of diet in youth are responsible for much suffering which develops later in life. The laws of retributive justice may be slow, but are, nevertheless, sure. Again, many of the diseases which occur after middle life are due to the habit of eating and drinking such foods as were indulged in during the early years of vigorous manhood.
In advancing years, when growth has ceased and activity has lessened, food is oxidized more slowly; therefore, a smaller quantity is required, and that in a form to be easily digested.
In arranging menus for individuals or families, personal idiosyncrasies must be considered. It is a homely saying, but true, that, " One man's meat is another man's poison."
The "Dietary Computer," by Mrs. Ellen H. Richards, is of great value to one whose desire it is to make out bills of fare according to food values. By its use money spent for foods could be used to better advantage, families would be better nourished, and disease would be less frequent.
FOOD, before it can be utilized by the body, must undergo many mechanical and chemical changes to render it capable of digestion, absorption, and assimilation.
Digestion is carried on principally by ferments, and these act by contact. Food is taken into the mouth, masticated by the teeth, moistened by the saliva, and coated by the mucin in the saliva, which makes it easy to swallow. The
Thorough mastication is very important, that the food may be finely divided before passing on into the alimentary canal. If not well masticated it is retained in the stomach for too long a time, thus favoring the development of bacteria, which give rise to acid fermentation.
Food is forced by peristaltic action through the œsophagus into the cardiac portion of the stomach, where it comes in contact with the gastric juice. The gastric juice is a fluid which contains hydrochloric acid (HCl) and two ferments, pepsin and rennin. The flow of gastric juice is intermittent, but about the same quantity is secreted, daily, as of saliva.
Cut showing the division of the stomach into two portions.
The digestion of starch continues for about one-half hour after entering the stomach; by that time the food material is sufficiently mixed with the gastric juice to render the whole acid, thus destroying the alkaline reaction. Fats are set free, and to some extent melted in the stomach. About six per cent of proteids, twenty per cent of sugar, and some salts are absorbed through the walls of the stomach. Water passes on with the partially digested food. If the food is liquid, the water leaves the stomach very quickly, and in drinking water some leaves the stomach before the last swallow is taken.
The stomach has two muscular motions. The first is a turning movement, which takes place in the larger or cardiac portion, mixing the food with the gastric juice, thus bringing the whole to a semi-fluid consistency.
The second is a wave-like movement which takes place in the pyloric end, by means of which the food is allowed to pass by intervals into the duodenum, which is the entrance to the small intestine.
The juice poured out in the pyloric portion contains no hydrochloric acid, but is neutral or slightly alkaline; pepsin is present.
The quantity of gastric juice varies not only in different individuals, but in the same individual according to the diet. Extremes in temperature exert an influence on gastric digestion. Pawlow has made many very interesting experiments along this line, and has discovered that a diet composed chiefly of meat produces a large flow of gastric juice poor in ferments; bread produces a small flow of gastric juice rich in ferments; while milk produces a moderate flow of gastric juice and a moderate amount of ferments. To keep in good normal condition without gain or loss of body weight, a plain, wholesome, mixed diet is the most satisfactory.
There is great danger, especially in the young, of becoming addicted to digestive habits. Each food calls forth a special gastric juice, and if the diet is limited to a few foods the power to assimilate others becomes lessened; therefore if the diet is increased, gastric disturbances are apt to occur. When a patient has been kept for some time on a milk diet, other foods must be introduced gradually, and in small quantities, for the comfort of the individual.
The stomach being capable of great distension, often gives rise to the taking of too much food at a single time. Three meals daily meet the needs of the average person. Dinner should be the heartiest meal, and should be served after the work of the day is over, when sufficient time may be allowed for eating, which may be followed by rest.
In cases of impaired digestion, fifteen or twenty minutes is recommended for rest after each meal. Where a light breakfast is taken, a lunch should be indulged in in the middle of the forenoon. There are frequently found people of small stomach capacity who seem to require food at frequent intervals in small quantities; whereas if a meal is taken which would serve the needs of the average person, gastric disturbances follow.
Appetite has a marked effect on gastric digestion, and it is often necessary to stimulate the appetite. Attractive surroundings (plants, flowers, music, singing birds, etc.) are provided in institutions where money is not the first consideration. The sanitariums and hospitals in Germany are far in advance of ours in this respect. Good cooking plays a far more important part than surroundings, and it is the duty of the cook to stimulate the appetite by appealing to the sense of hearing, smell, sight, and taste.
While the stomach plays but a small part in digestion, the digestibility of foods in calculated by the length of time they remain in this organ. The average meal leaves the stomach in about four or five hours. The following table will be found of value in considering the ease or difficulty with which certain foods are digested.
Digestion principally takes place in the small intestine. The stomach acts as a reservoir for food, playing but a small part in digestion. Many instances are recorded where people have been well nourished after the removal of the stomach. There was, however, a radical change in the diet, the food being taken in a liquid or semi-solid state.
Food in the small intestine comes in contact with two fluids,--the pancreatic juice and the bile (which is poured out from the liver), both of which are alkaline fluids. The flow of pancreatic juice is suspended except during digestion, while the flow of bile is constant but greatest during digestion.
The pancreatic juice contains four ferments,--amylopsin, trypsin, steapsin, and invertin.
Amylopsin acts upon starches and completes their digestion. Trypsin completes the digestion of proteids. Its action is similar to the action of pepsin in the gastric juice, but it is able to act in an alkaline medium. The proteids which were simply swollen in the stomach are now penetrated by this juice and their digestion is completed. Steapsin splits the fats into glycerine and fatty acids. The fatty acids combine with an alkaline solution and form soap. The bile salts also play an important part in the digestion of fats, but affect neither proteids nor carbohydrates. They, too, combine with fatty acids to form soap, and soap forms an emulsion. Fats thus emulsified are rady for absorption. Invertin acts upon cane sugar, changing it to levulose and dextrose.
The liver acts as a storehouse for the body, to be called upon as needed. Some of the carbohydrates which during digestion have been converted into sugar, on reaching the liver are changed into glycogen, and glycogen is reconverted into sugar before entering the general circulation.
The digested food is now ready for absorption, although, as has been stated, the digestion of all foods need not be completed before the absorption of some foods take place. For example, alcohol, sugar, and some proteids and salts are absorbed in the stomach.
Food is moved along from the small to the large intestine by peristaltic muscular contraction. Absorption takes place to a small extent in the small intestine, but to a much larger extent in the large intestine.
Bile salts, on account of their great value, are nearly absorbed before reaching the rectum, and are used over and over again. Salts, bile pigments, connective tissue, and cellulose are not digested (although some authorities affirm that the cellulose in young vegetables is partially digested); these, with the waste products of metabolism, are excreted through the rectum as fæces.
DR. OLIVER WENDELL HOLMES is reported to have said, "I can count on the fingers of one hand the drugs commonly used by the general practitioner." Drugs are used at the present time to a less extent, and administered in smaller doses, than ever before. The physician of to-day knows that the recovery to health from disease is a natural process, and administers drugs to assist nature rather than to effect a cure. The study of foods and their effect on the individual is of equal importance to the study of drugs.
All infectious diseases are due to bacterial action. Germs enter the system in different ways.
Drugs do not kill bacteria; exception must be made, however, to the valuable discovery of anti-toxins, which have done so much for the advancement of medical science.
The healthy person is constantly coming in contact with disease germs, but he is immune from the disease of which they are the cause, as anti-toxins are constantly being formed within the body which neutralize the poisonous effects of the germs.
Health may be defined as a sound mind in a sound body. The necessary conditions for health are:--
It is safe to state that two-thirds of all disease is brought about by errors in diet,--either the food principles have not been properly maintained or the food has been improperly cooked. To one accustomed to visiting children's hospitals, or children's wards in general hospitals, this statement cannot seem an exaggeration, as the results of mal-nutrition are everywhere in evidence. Correct feeding should begin at birth, and continue through childhood, youth, manhood, and old age. Children more readily succumb to disease than older people; herein lies the necessity of paying the strictest attention to their nourishment and care.
"I have come to the conclusion that more than half the disease which embitters the middle and latter part of life is due to avoidable errors in diet,...and that more mischief in the form of actual disease, of impaired vigor, and of shortened life accrues to civilized man.....in England and throughout central Europe from erroneous habits of eating than from the habitual use of alcoholic drink, considerable as I know that evil to be."--SIR HENRY THOMPSON.
The effect of foods on metabolism is a subject which has received much attention during the last fifty or sixty years. "Metabolism is the sum of the chemical changes within the body, or within any single cell of the body, by which the protoplasm is either renewed or changed to perform special functions, or else disorganized and prepared for excretion."
As early as the seventeenth centry the idea was advanced that food furnished the necessary fuel for the body, but this theory attracted but little attention and seemed to be of almost no practical value as an aid to better living.
Towards the close of the eighteenth century oxygen was discovered by Priestley, which explained the process of combustion, which he believed to take place in the animal organisma as well as outside the body. Liebig made valuable advances in the study of metabolism, and later investigations have verified the truth of his statements. In 1840 he published a dietary study which, from the standpoint of modern work, on account of its incompleteness, is of but little value. Still it was a pioneer pubication which gave much assistance to many of his followers.
From 1850 to 1870 many experiments were made along these lines with animals, including cattle, dogs, and sheep. In 1865 and 1866 Voigt and Pettenkofer published the results of many experiments which they had made on man. To Voigt and his follows should be given the credit of the most valuable work of recent years.
Thorough work of a very high order has been done in Russia from which much accurate knowledge has been gained. The name of Van Noorden stands out prominently on account of his work on metabolism. Japan, Italy, Sweden, and England have all furnished students who have aided science along this line. As Americans we are especially proud of that which has been done in our own country. Chittenden and Flint have been earnest workers, and more accurate results are being obtained each year at the expense of our own government, under the able directon of Professor Atwater.
In the latest experiments account is taken of all food consumed, the excretory products, and the total energy manifested during the experiment, as heat or muscular work. The ideal has not as yet been reached, as no account has been made of body gain or loss, or the energy stored or transformed during the experiment.
IT would seem that every child's birthright should be a healthy mind in a healthy body, but man is not yet wise enough and science has not opened its doors sufficiently wide to render perfect living possible. Still searching for new truth, each year adds its part towards the complete solution, and "It is a proper or improper nutriment which makes or mars the perfection of the coming generation."
The power of the baby to grow mentally and physically must depend chiefly on its feeding,--although air and sunlight supply, environment, rest, sleep, exercise, bathing, and clothing all play a part not to be overlooked.
A young baby is a young animal, and must eat, sleep, and use some muscular effort in kicking and crying (at least one-half hour each day), to expand the chest and gain strength. A baby should be handled but little, and kept as quiet as possible. Much sleep is necessary, for during sleep the child develops and grows. For the first month a child requires sleep from twenty to twenty-two hours daily; three months, eighteen to twenty hours; six months, sixteen to eighteen hours; one year, fourteen to fifteen hours. A child gets the best sleep in a darkened, well-ventilated, quiet room; for during sleeping hours there is a subconscious activity, and if there is light and noise present the nervous, muscular, and tissue growth are hindered. Avoid the use of too much or too heavy clothing or covering, as either is a hindrance to the best growth and development.
The average weight of a child at birth is seven and one-seventh pounds for a male, while a female weighs about
Nature has provided an animal food for the young of all mammalia, and mother's milk is the typical nourishment for her offspring in the early period of its existence. Statistics show that children among the slums of large cities will survive if fed from the breast, when if artificially fed, death is almost sure to follow.
The baby should be put to her breast six hours after birth; thus the secretion known as colostrum is injected, whose office is to cleanse the alimentary canal, thus preparing it for the milk secretion, which appears usually on the third day. After bathing and dressing, if the child lies quietly, it is left until the time of putting to the breast, but if it cries, one-half tablespoon of sterilized water is given at about 99° F.,--the temperature of the child at birth. Children, like adults, need more water than is found in the food, and the baby should be given one-half tablespoon boiled water every four hours, after the second day,--the quantity being increased in proportion to the increase of the stomach capacity. It is best to have the baby drink it from a spoon, especially if it is to be fed
Regular feeding must be insisted upon as best for mother and child. It tends to keep the quality of the milk uniform, thus enabling the child to sleep better, not be overfed, and lessening the causes for indigestion. Too long intervals between the nursings produce a diluted product; while too short intervals, a condensed product. If regular feeding is observed the milk supply will agree with the capacity of the child's stomach. By more frequent nursing the milk glands are stimulated to secrete a larger quantity, and the little stomach capable of distension is overtaxed. Mothers should be made to realize that upon this care during a few months much of the later health and vigor of their offspring depend.
That the baby may not be overfed, it is necessary to emphasize the stomach capacity at different ages; thus the following table may be of value:--
A mother's first thought should be for the welfare of her child, and she should wisely regulate her exercise and sleep, making an effort to control emotions and avoid nervous disturbances, which so readily affect the composition of the milk. A plain, wholesome diet, including meat, eggs, fish, cereals, fresh vegetables, and fruit, is recommended. Highly seasoned foods, pastry, and an excess of sweet foods should be avoided. Milk, or a beverage of which the principal constituent is milk, should be taken. While tea and coffee are not prohibited, cocoa is much more desirable. Oftentimes the three meals prove insufficient, and a luncheon may be introduced in the forenoon, and milk or gruel before retiring.
If the mother's milk proves inadequate to the child's needs, it often may be made suitable by change of diet and proper exercise. A child will lose on too rich a food as well as one lacking in nutritive value. The proteid and fat in human milk are subject to variations, while the mineral matter and milk sugar are nearly constant.
To increase the supply of milk, increase the liquid in the diet. To decrease the supply (which is seldom necessary), decrease the liquid. To increase the amount of proteid, eat more meat and decrease the exercise; to decrease the quantity, eat less meat, increase the quantity of liquid, and increase the exercise. To increase the fat, increase the meat, and also fats in a readily digested form,
Too much proteid, which is the result of a large amount of meat, in the diet with little exercise, causes constipation and colic. If the fat is increased with the proteid, diarrhœa and vomiting follow.
KöNIG.
NOTE.--While human milk has a slightly alkaline reaction, it is also amphoteric. It will change red litmus paper blue; blue litmus paper red.
KöNIG.
By comparing the tables showing the composition of human and cow's milk, it will be seen that cow's milk contains more proteid and mineral matter and less sugar of milk, the fat and water varying but little. The calf grows faster than the baby, therefore needs more building material. The baby, having a relatively larger surface exposed, loses more heat.
The proteid of milk is composed of lactalbumin and caseinogen. Lactalbumin is soluble in water; and as there is a larger percentage of this constituent in human than in cow's milk, the former during digestion forms into succulent curds; while the latter, containing more caseinogen, forms into dense cheesy curds.
Cow's milk, to form a typical infant food, needs to be modified. In many large cities throughout the United States, laboratories, with accompanying farms in outlaying districts, have been established to furnish proper infants' food. While human milk is self-modifying, thus meeting the needs of the child in the different stages of its growth and development, its composition varies but little during the period of lactation.
The modification of laboratory milk needs to be changed from time to time according to a physician's formula, lime-water being added to neutralize the acid present in cow's milk. Human milk is sterile, while cow's milk, in the hands of the consumer, contains many varieties of bacteria; therefore it was formerly thought advisable to sterilize the modified product; but sterilization has been largely superseded by pasteurization, and this is not deemed necessary or advisable, where fresh milk can be procured from a reliable source, except in cases of bowel trouble or in extremely hot weather.
A child should not remain at the breast for more than fifteen or twenty minutes at each feeding. Never wake a healthy baby during the night for feeding. It is sometimes necessary during the day, as a young child is quite liable to turn night into day; but persistent effort this may be overcome before it is an established habit.
If for any reason the mother is unable to nurse her child, she must make a decision between a wet nurse and artificial feeding. Cow's milk is best adapted for artificial infant feeding, although in its composition it is not as nearly like human milk as the asses' or the mare's. Cows can be kept more easily under strict control than most animals, and when carefully stabled, fed, watered, and
Among intelligent and care-taking mothers, home modification is being successfully employed, always under the direction of a physician. It has advantages over laboratory modification, namely:--
It is beyond the scope of this work to give formulas for home modifications, as it is plainly the work of the physician. Simply for Illustration a formula corresponding very nearly to human milk has been procured from one who is an authority on infant feeding.
Procure milk, delivered in quart glass jars, that has been reduced to a temperature of 45 ° F. as quickly as possible after milking, and allowed to stand for cream to rise for six or eight hours. Pour off eight ounces of top milk, or take out with a small dipper which comes for the purpose.
A glass tube is sometimes used for syphoning off the lower part of the milk, leaving the top milk in the jar. In order to do this a graduate glass is necessary, to determine the number of ounces drawn off. This later process being more complicated, is less practical for home modification.
This amount is sufficient for ten feedings, allowing two ounces for a feeding. As soon as modified, it should be put in ten sterile nursing-bottles, each being plugged with absorbent cotton, and kept in a cold place until needed, then heated by plunging bottle in cold water and allowing the water to heat, gradually, until the milk is luke warm, about 98° F.
In the home modification of milk, the sugar of the milk (lactose) should be dissolved in boiling water before being added to the remaining ingredients.
Bottles and nipples for infant feeding should be of the simplest construction, that, easily, they may be kept perfectly clean. As soon as baby has finished nursing, the nipple should be removed from bottle, and nipple and bottle thoroughly washed, then the bottle filled with water and the nipple immersed in water. Both should be made sterile each morning, when the number of feedings for twenty-four hours is prepared. The nipples should be allowed to remain in boiling water five minutes, and then immersed in cold water, to stand until needed.
Put milk in sterile, small-mouthed glass bottles, stop with cotton batting or absorbent cotton, place bottles in wire basket, immerse basket in kettle of cold water, and heat water gradually, to a temperature of from 158° to 167°. Keep at same temperature thirty minutes. Remove bottles, cool quickly, and put in a cold place.
By this process almost all of the disease germs are killed; also those germs which produce souring; but the spores, which are not killed, will develop after a few days.
Proceed as in the pasteruization of milk, raising the temperature of the water to the boiling point (212° F.), and keeping at this temperature thirty minutes. Sterilization is an efficient method of destroying all germs, but alters to taste of milk, coagulates the albumen, destroys the flue emulsion of fat, and renders the casein less easy of digestion.
Sterilizers are on the market which simplify the process of sterilization, and their use is recommended where expense need not be considered.
A CHILD fed from the breast is weaned, usually, from the eighth to the twelfth month, the time depending upon the health of both mother and child, as well as the season of the year. Unless compulsory, this change would better not take place during the summer months. Changes in diet should always be gradual ones, which is not the exception with the baby. Healthy children may be taught to drink from a cup or mug before taken from the breast, which will dispense with the use of the bottle. On the other hand, oftentimes ill or delicate children will not take sufficient nourishment in this way, and the bottle becomes a necessity for the welfare of the child. Baby not only eats better, but sleeps better, and keeps happier.
Some children are allowed to use the bottle at nap and bed time until two years of age. While this seems to many an over-indulgence to the child, it is sometimes recommended by physicians as the best course to pursue.
A healthy child of from eight to twelve months may be given a crust of stale bread, educators, rusks, Zwieback, and strained, well-cooked cereal diluted with milk. The necessity for an occasional drink of water, which was emphasized in infant feeding, must not be overlooked in child feeding.
From twelve to sixteen months a child requires four meals daily.
If a child wakes very early, it may be given a crust of bread, a cracker, or a small quantity of milk, but not enough to take away the appetite for breakfast.
For breakfast, serve a cereal sprinkled with sugar (sparingly) and top milk. Well-cooked, strained oatmeal, hominy, or any of the wheat preparations may be used, and it is desirable to offer variety. A glass of milk should accompany this meal.
For luncheon, give strained cereal and milk, allowing three parts milk to one part cereal. In order that the child may have sufficient nourishment, pour off the upper half of quart jars of milk (top milk). In this way the necessary fat is supplied.
For dinner, serve a soft-cooked egg, or beef, chicken, or mutton broth thickened with strained rice or barley; either with a piece of stale bread spread with butter, followed by steamed rice with cream and sugar, steamed or baked custard, junket custard, Irish moss blanc mange, strained stewed prunes, or juice of one-half orange. When eggs are introduced into the diet for the first few times, give but one-half egg. This quantity may be easily digested, while a whole egg might cause gastric disturbance.
For supper, serve strained cereal and milk, same as for lunch. A child from sixteen to twenty-four months takes four meals, with the same hours for serving as the younger child, with some greater variety.
For breakfast, in addition to cereal, give"soft-boiled," dropped, or coddled egg. Scrambled egg, if cooked with a small quantity of butter, may be occasionally served. It is well at this age to introduce one egg daily into the diet.
For luncheon, give bread and butter, cracker, or cereal jelly with sugar and top milk in addition to the luncheon before served.
For dinner, mashed baked potato, beef juice, boiled rice, or macaroni may be added.
For supper, whole wheat or Graham bread spread with butter, stewed prunes, baked apple or apple-sauce, in addition to the supper before served.
Children over two years of age may begin to take fish, meat, vegetables, and fruits. White fish, broiled, steamed, or boiled, may be given in place of egg. Broiled lamb chops, broiled beefsteak, or rare roast beef, broiled or roasted chicken, or boiled fowl, are all suitable food, if introduced occasionally in small quantities. Spinach, asparagus tips, young tender string beans, and peas forced through a strainer, are all allowable. Fresh ripe strawberries, served with sugar, but not cream, may be eaten in the early part of the day, but should never be allowed after dinner. Blueberries and huckleberries had better not be introduced until after the fifth year, as they often act as irritants and give rise to summer complaints.
Some children express a desire for bananas, which may be satisfied if the fruit is scraped to remove the astringent principle which lies close to the surface. Many physicians think they are more easily digested when baked.
Cocoa, as well as milk, may be given as a beverage. The menu at this age is so varied, and the digestive powers of the child so increased, that strained cereals will no longer be necessary. Indian meal mush may now be taken, as well as the oat and wheat preparations; also the cooked cereal products, put up ready for serving.
Always avoid the use, in the dietary of a young child, of salted meats, pork, or veal, coarse vegetables (beets, carrots, turnips, etc.), cheese, fried foods, pastry, rich desserts, condiments, tea, coffee, beer, or any alcoholic stimulant, and iced water.
The child's craving for sweets is a natural one and should be gratified. This is accomplished in part by sugar served with cereal and desserts. Vanilla chocolate is a most desirable food, as well as sweetmeat, and if eaten at the close of a meal is beneficial rather than harmful. Perhaps no food containing albumen, carbohydrate, and fat is as well absorbed as chocolate. All the sugar is taken up, and there is a loss of only two per cent of the albumen, starch, and fat.
The injurious effects of pure chocolate and candy are
See p. 38
See p. 38
MEASURING OF DRY INGREDIENTS
See p.42
When the time arrives that the nap is no longer needed, which time varies with different children, three meals usually suffice. The dietary may be gradually increased, until the child is able to partake of the family menu, avoiding, of course, a night dinner. The wise mother will encourage and continue a resting time until school hours interfere, even though not followed by sleep.
The food of the child at school is of equal importance to the food of the infant. It must not be forgotten that digestive processes go on quickly, and activity is so great in childhood that an abundant supply of well-cooked, nourishing food is essential for both the development of body and mind. The irritability and weak nervous condition of school children, which is often attributed to over-study, is more often the result of excitement, want of sleep, and malnutrition.
Never allow a child to go to school without a proper breakfast, of which a cereal served with sugar and rich milk or cream should form the principal dish.
Many children enter kindergarten at the age of three and one-half or four years, most of whom carry a luncheon, a few minutes being set aside for the purpose of eating the same. This luncheon should be very simple, and limited in quantity, that the appetite may not be destroyed for the hearty dinner. In many cases where a child is fortified with a good breakfast, the luncheon would better be omitted, as the child has a better appetite and enjoyment of the midday meal. In kindergartens attended by the poor, a luncheon is an absolute necessity to the child's welfare, and fortunate is the community where an appropriation is made for the supply of milk, with bread or crackers, or occasionally hot broth in the place of milk.
If the older child attends a one-session school, the luncheon must not be overlooked. Whatever else goes into the luncheon basket, sandwiches must hold first place. If a variety is introduced and pains are taken in
In the high schools of many large towns and cities, lunch counters have been established for furnishing to the pupils well-cooked, nutritious food, at the least possible expense. Hot soups and cocoa may be found each day in addition to rolls, sandwiches, crackers, cookies, cake, fruit, and sometimes ice cream.
A child, relatively to his weight, requires more food than a man or a woman. Three considerations explain this necessity:--
PROF. W. O. ATWATER
HUTCHISON, p. 453. SCHROEDER,
Children must have, for their best mental and physical development, a relatively larger proportion of proteid and fat in the dietary than their elders. The baby receives his proteid and fat from milk and cereals, but the older child needs, in addition to these, eggs, meat, and butter. Much of the pallor and stunted growth of some children is largely attributable to the lack of these very foods.
As carbohydrates furnish the cheapest form of food, they are almost never found wanting, and oftentimes are used to excess. Carbohydrate in the form of sugar, if injudiciously given, may prove harmful, but if used wisely, when it does not interfere with digestive processes, is a most useful fuel food.
The notion that sugar injures the teeth is largely a false one. If children are allowed to eat candy or cookies after the teeth have been brushed for the night, then the sweets which collect between them cause decay.
Milk, eggs, and meat are sources for furnishing mineral matter, but the chief value of fruit and vegetables lies in this food constitutent, upon which tissue growth so much depends.
THE feeding of persons in health is of great importance, but when one succumbs to disease, then feeding becomes a question of supreme moment. The appetite in health is usually a safe guide to follow, but is so perverted by disease conditions that it is unwise to consider its cravings. If these cravings are indulged, the food longed for is almost always a disappointment, as all things taste about the same, until the time of convalescence.
Never consult a patient as to his menu, nor enter into a conversation relating to his diet, within his hearing. The physician in attendance studies the symptoms so closely that he is able to determine what is required to meet the needs of the case. He orders nourishment given regularly, usually in small quantities, at frequent intervals. Appreciating the value of sleep, he never allows his patient to be awakened for feeding, unless the exigencies of the case create this demand.
In acute cases of disease, food plays a very important part towards recovery. The quantity and kind taken must vary greatly, according to the nature of the disease. Sometimes it proves expedient in cases of diarrhœa or dysentery to have the patient abstain for days from all food, except a very thin, starchy gruel, the object being to starve the germ which causes the disease; then, again, a patient, after a surgical operation, where there is a great loss of blood, needs a large supply of food.
Where the temperature is high, metabolism goes on so rapidly there is always a demand for a large quantity of
See p. 44
See p. 62
See p. 62
In chronic cases, by a careful study of the food supply, much can be done to keep up the strength of the patient while endeavoring to overcome the disease. The greater the activity of the patient, the greater the need for food.
Personal idiosyncrasies in disease, as well as in health, play a very important part. Avoid giving food that will overtax the digestion or disagree with any of the conditions of the patient. Food must be assimilated to be of value. The teeth, the mouth, the stomach, and the intestines all must be considered. Some food, if well masticated, might easily pass from the stomach into the intestines, while if not masticated, might prove a stomach irritant. Some food that would not prove irritating to the stomach would cause fermentation in the intestines.
Many patients during the early stages of convalescence have an abnormally large appetite, which must be restricted, as over-feeding would prove dangerous; while with others the appetite needs to be stimulated.
Important things to consider in feeding the sick:
During the gradual return to a normal condition, through the long tedious hours of convalescence, the patient devotes much thought to when and what he shall be allowed to eat, and it is at this time that the taste is gratified as far as is advisable.
The best means of stimulating the appetite is to have good food, well cooked, and attractively served. The
In setting a tray after laying the tray cloth, locate the plate. Place the knife at the right of plate, sharp edge toward plate. Place the spoon at the right of knife, bowl up. Place the fork at the left of plate, tines up. A bread and butter plate or individual butter is placed over fork a little to the left. The napkin is always placed at left of fork; then cup and saucer at right of spoon, with cup so placed that it may be easily raised by handle. The water glass is placed over knife at little to right. Arrange the other dishes to suit the convenience of the patient.
All eating is very much influenced by the taste. Some foods, easy of digestion, if repugnant to a patient, prove indigestible.
The temperature of food has a marked influence upon digestion. As a rule, hot foods should be served hot, cold foods served cold; but this often must be varied according to the case. Under certain conditions very cold or very hot food might retard digestion, thus increasing the amount of energy necessary for absorption.
Coarse foods, like Graham bread, some cereals, and vegetables containing much cellulose, pass through the alimentary canal so quickly that much of their nutritive value is lost, as so large a portion escapes absorption.
The nurse should be a student of the classification of foods, their fuel value and digestibility, thus being able to determine and regulate the needed rations for her patients.
In feeding the sick, strict economy should be considered only when necessary. That which the patient really needs should be furnished always, if possible. Even in homes where the income is limited, there is a general self-denial for the one who is ill. It is too-frequent error to over-indulge a patient, for it weakens rather than strengthens. From this fact, together with lack of knowledge and appliance, those who are treated and cared for in a fine hospital are very apt to recover more quickly than those treated and cared for at home.
In hospitals, where large numbers are to be fed, many of whom are not able to contribute towards the support of the institution and still others who cannot pay their proportionate part, strict economy in food supplies becomes imperative. Many cheap foods are equally nutritious to the more expensive ones, and if well cooked and served are gratifying to all the senses to which one wishes to appeal.
In hospitals the dietaries are classified by the doctors, to assist the nurses in caring for their patients, as house, soft solid, soft diet, and liquid.
A special diet is such as is ordered by a physician for an individual case.
COOKERY is the art of preparing food for the nourishment of the human body. Cookery is the effect produced on food by the application of heat, air, and moisture.
"Uncivilized man takes his nourishment like animals,--as it is offered by nature; civilized man prepares his food before eating, and in ways which are in general the more perfect the higher his culture. The art of cooking, when not allied with a degenerate taste or with gluttony, is one of the criteria of a people's civilization." There are comparatively few foods that are at their best when taken in the raw state; they neither taste so good nor are they so easily digested as when subjected to some kind of cooking.
Disease is oftentimes due to improper feeding. The food rations have not contained the correct proportions of the food principles, or the food stuffs have been improperly cooked. "Food well cooked is partially digested."
The subjects of food and feeding now stand on a scientific basis, and more attention is being paid each year to the subject of cookery. While the fact is to be recognized that there are some born cooks, the large majority need teaching and training. Cookery should form a part of every woman's education, and is especially important for those who have the feeding of the present generation, both in health and in disease.
For the best results in cookery, good materials, accurate measurements, care in combining ingredients, and a knowledge of the object to be attained are essentials. In cooking, the effect of heat at different temperatures and the time of exposure of different foods to such temperatures must be thoroughly understood to reach the best nutritive and economic results.
Measuring cups of glass, granite, or tin ware, divided into thirds or quarters, should be used. Tea and table spoons of regulation sizes, and also a case-knife, are indispensables. To insure uniformly good results, level measurements have been adopted by the leading teachers of cookery, which seem at the present time the best guide that can be given to the average cook. Perhaps the time may come when measurement by weight will be practical, and then accuracy will be assured beyond a doubt.
To measure a cupful of any dry ingredient, fill cup, rounding slightly, using spoon or scoop, and level with a case-knife. Care must be taken not to shake the cup.
To measure a cupful of liquid, pour in all the cup will hold.
To measure butter, pack solidly into cup and level with case-knife.
To measure a tea or table spoon of dry ingredients, dip spoon in same, fill, lift, and level with a case-knife, the sharp edge of knife being towards tip of spoon. Divide with knife lengthwise of spoon for half spoonful; divide halves crosswise for quarters, and quarters crosswise for eighths. Less than an eighth of a teaspoon is considered a few grains.
To measure tea or table spoons of liquid, dip spoon in liquid and take up all the spoon will hold.
To measure tea or table spoons of butter, pack butter solidly into spoon and level with a knife. Divide same as for dry ingredients.
Measure and have at hand all ingredients necessary for the preparation of a dish before attempting to combine.
The application of heat for boiling or steaming is not difficult to understand. Broiling and roasting need more
Vegetable foods abound in starch. Cold water separates starch grains; boiling water causes them to swell and burst.
Dry heat, at a temperature of 320° F., changes starch to dextrine, which is soluble in cold water. Examples: Crust of bread and baked potato.
In cooking vegetables the object is to soften cellulose as well as swell and burst starch grains, and this is best accomplished by keeping the water at the boiling point throughout the entire cooking. By the proper cooking of starch foods their digestibility is greatly increased.
Albumen is the principal constituent of white of egg. It is dissolved in cold water, and coagulated by heat at a temperature of 134° to 160° F.
One of the proteids of meat is albumen, some of which is soluble in cold water and coagulated by heat.
In using meats for soup-making, the object is to draw out as much of the goodness as possible. This is accomplished by putting the meat on in cold water, and allowing the water to heat gradually to the boiling point, then simmering for several hours, after which time the meat is deprived of its extractives, some mineral water, and soluble albumen, though the greater part of its nutritive value is not extracted; nevertheless, lacking flavor, it is hardly palatable for serving. In the making of stews, when meat and broth are both to be used, the meat should be put on in cold water, brought quickly to the boiling point, and then allowed to simmer until tender.
Experiments have shown that where the water is allowed to boil vigorously during the entire cooking, the connective tissue has been gelatinized, while the fibres are hard and indigestible; quite the reverse is true of the fibres where the meat is cooked for a longer time at a lower temperature, and the connective tissues are partially dissolved. In the latter case the economy of fuel is worthy of consideration.
Cold water dissolves albumen, hot water coagulates it, as does intense heat. Meats, when broiled or roasted, are brought in direct contact with intense heat (coal, gas, or electricity furnishing the fuel), and turned frequently, thus searing the entire surface as quickly as possible. This method is applied to the more expensive cuts of meat. Meat, when baked in a hot oven, is commonly called roasted, as the old method of roasting before live coals has almost passed out of use.
In cooking meats, when the object is to retain as much nutriment as possible, the surface should be subjected to a high temperature to quickly coagulate albuminous juices. When cooked in water, the water must be at the boiling point to accomplish this, allowed to boil vigorously for five minutes, and then allowed to simmer for several hours. This method is applied to the cheaper cuts of meat.
MORE than two-thirds of the weight of the body consists of water. An adult requires five pints daily, and is furnished with this supply from the food he eats and the beverages he drinks. The outgo is even greater than the income, owing to the chemical changes which are constantly taking place in the body.
Pure water is composed of hydrogen and oxygen, there being two parts ofhydrogen to one part of oxygen. The symbol of water is H2O.
Water as found in nature is never chemically pure. It not only contains many mineral substances, but decaying animal and vegetable matter, and often pathogenic germs. From this statement it may be seen that a water supply cannot be too carefully guarded.
The clear, colorless, tasteless fluid furnishes the average person with sufficient evidence of its purity; while if lacking in any of these qualities he seems to be equally assured of its unfitness for consumption. These tests are entirely useless, and scientific investigations are the only safeguards to a proper water supply.
Filters, as used to render drinking water pure, are a delusion and a snare. The bed of a filter furnishes a desirable soil for the growth of bacteria, and while some of the larger organic particles are removed by filtration, the rapidity with which the micro-organisms increase render it less fit for use.
Distilled water, prepared for medicinal purposes, is chemically pure. It is flat and insipid to the taste, having been deprived of its atmospheric gases. When used as a
Water for household consumption is derived from five sources:--
In many large towns and cities a system of reservoirs has been built, fed by springs and streams which have greatly improved water supplies.
Where well water is used, especial attention should be given to the location of the well. It must be of sufficient distance from drains, cesspools, and barnyards to prevent contamination.
Water drawn from large ponds, lakes, or rivers having a bottom of rock, clay, or gravel, usually furnishes a safe supply. The law, nevertheless, requires frequent analyses--thus helping, as far as possible, to make healthful conditions prevail.
Water is frequently spoken of as hard or soft. Hard water contains mineral matter to a greater extent than soft water, the amount varying from eight to seventy grains to the gallon.
The hardness is due principally to salts of lime and magnesia. Soft water is free from an excess of these salts, containing but three to four grains to the gallon. Water is the greatest known solvent, and the softer the water the greater its solvent power.
Many people are accustomed to boil water for drinking purposes. Hard water, due to the presence of carbonates of lime, is rendered soft by boiling with a small quantity of bicarbonate of soda (NaHCO3).
Cold water to a small extent retards gastric digestion, but increases peristalsis. If a glassful is taken before breakfast and upon retiring, it often cures constipation.
Tepid water is successfully used as an emetic, 90° F. being the temperature at which it is administered.
Hot water acts as a stimulant to gastric digestion. It leaves the stomach more quickly and is more quickly absorbed than cold water. Hot water relieves thirst better than cold water. It will also relieve nausea,--a small quantity of crushed ice having the same effect.
Water has many uses of valuable importance to man which ought to be mentioned; namely, for transportation, manufacturing purposes, and the generation of electrical power; but the purpose of this work is to consider it as a cleanser, an antiseptic, and a source of infection. The relation which bathing bears to health need hardly be emphasized, as it has for so long a time been duly recognized. Frequent bathing keeps the pores of the skin open, thus enabling much waste matter to be eliminated. Water is a carrier of disease germs, and too frequent are the cases of typhoid fever caused by drinking water. The only sure way of destroying pathogenic germs
See p. 111
See p. 112
See p. 114
There are many charged, carbonated, and mineral spring waters bottled and put upon the market. Some are used as table beverages, others for medicinal purposes.
Ordinary water, artificially charged with carbon dioxid (CO2), is called soda water, and may be purchased by the glass, usually in combination with fruit syrups or in syphons. Such water, when sold at the druggist's, contains a larger per cent of CO2 than carbonated (naturally charged) waters, which renders it cooler to the taste, as the gas in passing off withdraws heat.
Plain soda water, taken in moderation, assists gastric digestion. It is a bad practice to indulge too freely in soda water with fruit syrups, as it causes a tendency to flatulency and indigestion. Almost all so-called fruit syrups are chemically prepared in the laboratory.
Among the most common carbonated table waters may be mentioned, Poland (uneffervescing), and Vichy, Johannis, Apollinaris, and Seltzer (effervescing). These often tempt people to drink who would otherwise neglect to do so, and in cases of fever they may be freely given. They are useful to dilute alcoholic liquors, and they are quite apt to relieve nausea and vomiting.
The alkaline mineral waters are all carbonated. Their most important ingredient is alkaline carbonates, and sodium chloride, sometimes sodium sulphates being present. Examples: Saratoga, Vichy, White Sulphur Spring, Hot Sulphur Spring, Hunyadi, and Londonderry Lithia Waters. Lithia water is often recommended in cases of rheumatism or gont; Hunyadi for liver troubles and indiscretions in diet.
Where patients are advised by physicians to visit water cures the good results obtained are due as much to change, rest, treatment, and quantity of water ingested, as to any especial value that the water itself contains.
