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the human edifice according to its architectural specification, it must be supplied with building stones of a proper pattern. These building stones are the amino-acids contained in all protein foods, whether from the vegetable or animal kingdom, although the kind and proportion are not always the same. Biological experiment has once for all definitely shown that life, growth and health cannot be maintained when certain of these aminoacids are lacking. It is also a well-known physiological axiom that life cannot be supported on foods deficient in inorganic salts. It is recognized at the present time that something more is essential for the maintenance, growth and well-being of man than protein, fat, carbohydrate, mineral salts, etc. Foods must contain a minute proportion of certain accessory substances, which Funk and his followers have described as "vitamines.When these are deficient, or absent from the dietary, the immature body fails to grow, the mature body does not maintain its normal state of health, and in any stage of growth, manifestations of disease soon appear. We know, for instance, that fresh milk prevents scurvy, and that boiled milk will produce this disease; that oatmeal causes more rapid and greater growth than bread made from the patent roller process flour; that whole meal bread causes a greater growth than white bread; and that deficiency of vitamines in the foodstuffs causes beriberi, scurvy and some other diseases. Vitamines are beginning to be regarded as a sine qua non of proper nutrition. The subject is at present little understood, but it is so far-reaching that it involves a large proportion of the foods of civilized

The lipoidal constituents of the diet, and the rôle these substances play in the life and metabolism of the cells, brings into prominence certain groups of disease due to phosphorus deficiency. Enzymes and the striking specificity of the lipoids have been studied of late by eminent physiologists, and the insufficiency of certain proteins has been pointed out by Osborne and Mendel, while the vitamines have been most carefully studied by Funk, Macallum and Vedder during the last few years, all of which investigations have added to the advancement of dietetics. Since these discoveries are so important, and since as much seems to depend upon these accessory bodies—the vitamines, enzymes and lipoids—as on the primary elements of the diet, an attempt has been made in Volume II to give an account of the researches into these subjects, and to place the results in a proper light.

The subject of dietotherapy has not received the attention in medical literature it deserves, neither has it been accorded the prominence in the curriculum of medical schools which its importance demands; therefore, the subject has been and still is sadly neglected by the medical profession.

man,

Indeed, it is one of the most deplorably neglected subjects in the whole domain of medicine. While it is true that the question is more widely appreciated than formerly, yet the average practitioner is unable to tell the exact fuel value of a glass of lemon jelly or the definite amount of the various elements of food substances contained in a pound of beef; he might not be able to recognize the necessity for maintaining a carbohydrate, fat and protein balance, nor how to do it; he might not clearly understand how the metabolism in certain diseases differs from that of a healthy individual, nor appreciate what pathological processes take place in the alimentary canal and other parts of the body, that may render digestion and assimilation of particular foodstuffs difficult or impossible. Functional pathology has supplied the information required in the latter, while the actual, calorimetric study of metabolic processes in disease is illuminating the former.

I have undertaken the preparation of the present work with the purpose of overcoming these shortcomings, and of supplying the needs of the practitioner of medicine, the dietitian, the hospital interne and medical student, as well as of furnishing a reference work for the Domestic Science and Nurses' Training Schools.

This work is the outcome of nearly two decades of laboratory research and clinical investigation of the practical application of the principles of trophotherapy to the science of nutrition in both health and disease. The purpose of the work, from a purely therapeutic standpoint, is to awaken in the mind of the general practitioner the great importance for a biochemic study of nutrition, and to encourage in him a line of inquiry leading to a thorough understanding of the subject of trophology, trophodynamics and trophotherapy.

My aim in presenting a work on this subject in extenso is to produce a book so complete that few questions which may confront the physician or dietitian, pertaining to trophology, trophodynamics and trophotherapy, will remain unanswered. Recently, nutrition and dietetics have been placed upon a scientific basis, and in the future the thoughtful physician will realize that a knowledge of the proper kind and dosage of foods is of as great importance as any knowledge of therapeutics.

I long since realized that, to produce a work of this kind, comprising all that is known or worth knowing, I must invite the coöperation of specialists in the science of nutrition. The authors who have honored me by collaborating and by writing certain chapters were selected because I considered them thoroughly equipped and able to write authoritatively upon the subjects assigned them. Their names, their reputations,

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and their literary productions are a guarantee for the quality of their contributions. My best thanks are due to all of these men for their ready coöperation, for the manner in which they have carried out the plan of the work, and for the time and labor they so cheerfully gave, often at great personal inconvenience. The readiness with which they complied with my request for assistance has rendered my own task an easy and pleasant

one.

It is with grateful appreciation that I extend thanks to Prof. W. B. Cannon for reading the chapters, “The Mechanical Processes of Digestion" and "The Hygiene of Eating,” and to Professor Donald D. Van Slyke for reading the chapters, “Protein and Nutrition” and “General Sitologic and Mineral Metabolism." I acknowledge special obligations to Prof. Carl Voegtlin for many valuable suggestions concerning the vitamine content of foodstuffs and its bearing on pellagra. Moreover, I also desire to express my obligations to Dr. Harvey W. Wiley for care fully reading and improving the chapter on Vegetable Foods.

The citation of authorities for facts that are universally established is not considered necessary. It may seem to appear, in some instances, that scant credit is accorded to many workers from whose writings I have borrowed thoughts, results, sometimes words or even sentences to bridge

in my own knowledge, but at the end of each chapter will be found a numbered list of references in loco; this is followed by a bibliography for the convenience of those who may wish to go deeper into the subject. In every case I have endeavored to make suitable acknowledgment to the proper source, and if this has not been done in any instance, it is a lapsus calami, and not intentional.

the gap

W. E. FITCH.

New York City.

LIST OF CONTRIBUTORS

J. W. AMESSE, M.D.

Denver

A. EVERETT AUSTIN, A.B., A.M., M.D.

Boston

E. H. S. BAILEY, Ph.B., Ph.D.

U. S. Dept. Agriculture

ELIAS H. BARTLEY, B.S., M.D., A.M., F.A.C.P.

Brooklyn, N. Y.

A. L. BENEDICT, A.M., M.D., F.A.C.P.

Buffalo, N. Y.

GEORGE FRANK BUTLER, Ph.G., A.M., M.D.

Mudlavia, Ind.

JOHN H. CARROLL, M.D.

New York City

GEORGE W. CRILE, A.M., M.D., F.A.C.S.

Cleveland, Ohio

ALFRED C. CROFTAN, Ph.G., M.D.

Chicago

WILLIAM P. CUNNINGHAM, A.M., M.D.

New York City

W. A. NEWMAN DORLAND, A.M., M.D., F.A.C.S.

Chicago

WILLIAM EDWARD FITCH, M.D.

New York City

CASIMIR FUNK, D.Sc., Ph.D.

New York City

DAVID GEIRINGER, M.D.

New York City

H. S. GRINDLEY, B.S., Sc.D.

Urbana, ili.

WINFIELD S. HALL, B.S., M.S., M.D., Ph.D.

Chicago

GRAEME M. HAMMOND, A.M., M.D.

New York City

HENRY R. HARROWER, M.D., F.R.S.M. (Lond.)

California

JOHN C. HEMMETER, M.D., Ph.D., Sc.D., LL.D.

Baltimore

J. ALLISON HODGES, A.M., M.D., F.A.C.P.

Richmond, Va.

WILLIAM C. HOLLOPETER, A.M., M.D., LL.D.

Philadelphia

H. LYONS HUNT, M.D., L.R.C.P. (Edin.)

New York City

M. E. JAFFA, M.D.
Agri. Exp. Station, Berkeley, Cal.

RICHARD A. KEARNY, M.Ph., M.D.

Surg. U.S.P.H. Service

ROBERT COLEMAN KEMP, A.B., M.D.

New York City

ARTHUR I. KENDALL, B.Sc., Ph.D., Dr.P.H.

Chicago

LE GRAND KERR, M.D., F.A.C.P.

Brooklyn, N. Y.

GEORGE N. KREIDER, A.M., M.D., F.A.C.S.

Springfield, III.

CLAUDE H. LAVINDER, M.D.

Surg. U.S.P.H. Service

H. EDWIN LEWIS, M.D.

New York City

A. BRUCE MACALLUM, A.B., M.D.

Toronto, Ont., Can.

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