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82
Method of
quantitative
measurement
of diet.
Meticulous accuracy in the weighing of the diabetic diet has been criticized by
several authorities on the treatment of this disease.4,7,11 Such accuracy is not
justified owing to the variations in the carbohydrate, protein and fat content of
food materials, which in different samples of the same material may vary by as
much as 25 per cent.10 The use of scales, and the accurate weighing of every article
of diet, also requires a degree of intelligence and perseverance not found in the
majority of hospital patients. A means must be found which will combine a rough
degree of accuracy with simplicity of execution.
A method of visual estimation of portions of food by means of wood and cardboard
models, and ordinary household utensils, has been evolved by Rabinowitch.
This was described in 1930,11 and fully elaborated in his text book on diabetes
mellitus published in 1933.14 The method has been used in the large clinic for diabetes
at the Montreal general hospital for several years with considerable success. The
combination of simplicity of execution and graphic demonstration of food quantities
which it provides commends itself particularly to the patient of low intelligence.
The patient is supplied with the following models, representing unit quantities of
various foods which, with some modification, are described by Rabinowitch, and
full details of the method may be found in this reference:—
Model No. 1.—A block of wood, 3½ ins. square by ½ in. thick, representing
one portion of bread weighing 1 oz.
Model No. 2.—A half portion of bread, weighing ½ oz.
Models Nos. 3 and 4.—A portion and a half portion of butter weighing
½ oz. and ¼ oz., respectively.
Model No. 5.—A portion of lean meat, chicken or fish of any kind weighing
1½ oz.
Models Nos. 6 and 7.—Discs of cardboard, no. 6 representing a potato
weighing 3 oz., and no. 7 an apple or orange weighing 5 oz.
The models are labelled "No. 1: One portion of bread," "No. 6:
One potato," etc.
Vegetables, rice and oatmeal are measured in ordinary household tablespoons,
and a cheap glass measure is obtained graduated in fluid ounces. The diet sheet
supplied to the patient is "translated" from ounces into terms of portions and
tablespoons, and diet A (prescribed in ounces) will appear in the form of diet B
(prescribed in portions).
Patients are instructed in the wards in the use of this method. To the patient
of limited intelligence, the visual picture of food quantities given by the models
forms a standard of guidance more graphic and comprehensible than does a diet
prescribed in weights. In my experience the method has proved cheaper, simpler
and more efficient than the use of scales in the measurement of the diabetic diet.
References.
1 Easton, J., and Lyon, D. M. Lancet, 1933, 1, 743.
2 Gottschalk, Klin. Wchnschr., 1931, 10, No. 26, 1208.
3 Graham, G., Clark, A., and Robertson, H. E. N. Lancet, Nov. 5th, 1932, 990.
4 Himsworth, H. P. University College Hosp. Mag., Jan. 1934.
5 Joslyn, E. P. New Eng. Jour. Med., 1933, 209, 519.
6 Joslyn, E. P., Med. Clin. N. Amer., 1933, 16, 793.
7 Lawrence, R. D. B.M.J., 1933, 2, 517.
8 Leyton, 0. "Diagnosis and treatment of Diabetes Mellitus." Adlard & Son, Ltd., London, 1933.
9 Pryll. Sociale Medizin, 1928, 1. 152.
10 Rabinowitch, I. M. Canadian Med. Assoc. Journ., 1925, 15, 1106.
11 Rabinowitch. Ibid, 1930, 23, 489.
12 Rabinowitch. Ibid, 1932, 26, 141.
13 Rabinowitch. Ibid, 1933, 28, 162.
14 Rabinowitch. "Diabetes Mellitus," Macmillan Co. of Canada, Ltd., Toronto, 1933.
15 Wislicki, L. Lancet 1934, 2, 717.