In an 1893 address, Jane Addams told an audience that "It is part of the new philanthropy to recognize that the social question is largely a question of the stomach." This was an age in which scientific information coupled with social science research suggested cures for a myriad of social ills. The discovery of the composition of foods in the mid-19th century came as an exciting revelation with the promise of ameliorating a myriad of social problems. Poverty and its attendant ills were visible on a daily basis to settlement workers, visiting nurses, and charity workers and many worked hard to improve housing and employment conditions, improve wages, and secure better support systems. As they explored the conditions in immigrant neighborhoods, they were appalled, not only by the special cases of epidemic disease, but by the general ill health of immigrants. [164]

Although many reformers were dismayed at the percentage of income Italians spent on food, they concurred that the dollar amount should still have been adequate to provide a healthy diet. Settlement house resident Jane Addams felt that the lack of educated restraint and knowledge of foods rather than an actual lack of food itself was often at fault. In a 1903 speech she suggested,

It is not going too far to say that many families continue poor largely because of over-eating. The cost of the food is not the only consideration, nor the most important. The gorging with unwholesome stuffs dulls the mind and deadens the energies. And gluttonous eating often goes hand in hand with gluttonous drinking. The undisciplined stomach causes more poverty, drunkenness and other ill health and misery than can be readily estimated. [165]

Health was a primary concern for an era which saw high infant mortality rates and danger from epidemic disease which crossed all class lines. As they examined immigrant diets, reformers combined an interest in how income was spent with a concern with whether the expenditure produced a diet conducive to good health. While city officials focused on the impact of Italian food habits on public health and workers worried about their effect on wages, private agencies and concerned individuals set out to examine the role of food in intemperance and personal health and make suggestions for improved diets.

A new group of professionals led the way. In the late nineteenth century, as industrialization and the wage economy affected changes in both public and private life, some middle class women believed their role should also change to reflect the needs of a modern society. Convinced that the predominantly male public sphere would benefit from the special sensitivity of women and their knowledge of issues affecting home and family, they opened settlement houses, joined women's clubs, organized charity efforts, and pressured city officials and politicians for social reforms.

While many women sought to effect change within the public sphere, others chose to affect public life through modernizing the traditional home. They created a new academic discipline, home economics, which sought to transform the home into a modern bastion of rationality, efficiency, and scientific method.

Middle class, college trained women attempted to replace the informal networks of family and friends in housewifery training. Their advice was based in experimentation, research, and the application of scientific knowledge to the home. Food, one of the central elements of home life was no longer to be about arbitrary taste but about planning, cleanliness, uniformity, and nutrients.

Inspired by the work of chemist A.O. Atwater and by Ellen Swallow Richards, the first woman chemist trained at MIT and one of the founders of home economics, home economists and nutritionists developed hierarchies of foods they considered nutritious based on chemical analysis of individual ingredients. Advice was refined and altered as new information emerged and as new interpretations were made, although Atwater's recommendations were initially the most influential. After the turn-of-the-century, however, nutritionists revised Atwater's caloric recommendations downward and placed less emphasis on meat. They promoted grains and cereals and turned away form recommending white flour as an inexpensive source of carbohydrates. Yet, until the discovery of vitamins, vegetables and fruits received scant attention and were believed to offer little nutritional value for their cost. [166]

Nutritionists worried constantly about the digestibility of foods. Preparation was seen to be a key factor in this and they advocated broiling and baking over frying and were suspicious of fresh fruits and vegetables. Fannie Farmer's 1906 cookbook recommended boiling string beans for one to three hours. Reformers taught that foods should be separated on the plate, since mixtures of food used too much energy to digest. Food mixtures were also believed to be unappetizing to the eye and, therefore, an impediment to proper appetite stimulation and digestion. The appearance of food gained increasing importance for home economists in the twentieth century and was sometimes valued above taste and eventually above nutrition. [167]

Most of all, nutritionists promoted the idea of diet--the orderly and systematic selection of foods for rational reasons. The concept of diet had appeal for middle class reformers since it emphasized planning over impulse, long-term goals over short-term gratification, and rationality over tradition and habit. These were all qualities the middle class valued and believed the working class lacked. Some believed that good planning and educated spending would wipe out the need for wage increases and stem future social unrest. Others acknowledged the necessity of better wages but realized that families needed to adequately feed their families in the interim. All focused, not just on ingredients, but on the idea that a systematic alteration of consumption could result in long term benefits.

Studies of immigrant diets made special note of the consumption of alcohol, which was viewed as a factor in wasted income, personal ill health, and family instability. Reformers interested in temperance were convinced of a connection between bad food and drunkenness, although they differed in whether they believed wasteful expenditure of money on alcohol led to poor food or the consumption of poor food led to a craving for alcohol. "Temperance workers are coming to feel that they cannot make headway if they ignore the importance of proper nutrition for the body, for with monotonous food is apt to go whisky to whip up the digestion," Jane Addams once said. Another reformer, in a letter read to open a meeting at the headquarters of Industrial Education for Women insisted that:

Intemperance has ruined many homes. I shouldn't be a bit surprised if bad cooking had ruined just as many more. We all ought to realize that bad cooking actually causes intemperance. It's the man whose food is poor and poorly cooked, so that it's hard to digest, and doesn't nourish him, who's going to be the very first to turn to alcohol, to give him the heat, and comfort, and strength that he ought to have got out of his food. [168]

In their study of Italian diets, the Department of Labor made special note of the amount of money spent on alcohol as opposed to the amount spent on milk, suggesting that money wasted on alcohol should have gone towards food. Although most reformers acknowledged that Italians could seldom be accused of public drunkenness, they were concerned with the rise of beer drinking among Italian immigrants whom they were convinced had begun to substitute it for Italian wine. The Italian diet was particularly suspect since spicy foods were believed by some to stimulate alcohol consumption. [169]

Many reformers recognized that inadequate diets were a factor in susceptibility to disease and prevention. A flyer from the Hull-House Women's Club suggested that a component in the prevention of cholera was the avoidance of over-ripe fruits and vegetables and recommended that all foods should be thoroughly cooked. A Visiting Nurse Association flyer advised: "To maintain good health, or to overcome a consuming disease like tuberculosis, good digestible food, in sufficient quantity is absolutely necessary. ... Milk, bread, butter, meat, and vegetables are the most important ones in the order in which they are named." [170]

Food was viewed as a particular impediment to the recovery of infirm Italians, whose attachment to ethnic food was blamed for their unwillingness to seek out adequate medical care. In its study of Italians in Chicago, the Department of Labor asserted that Italians declined to go to hospitals when ill because they refused to submit to the "plain, nutritious and well-prepared food". The study suggested sensitivity to this behavior and recommended: "Perhaps the treatment of an Italian during this period of change should be studied much as the treatment of an inebriate being won from his strong drink is studied." Catering to familiar tastes for a few days could ward off the inevitable shock to the digestive system that healthy foods would give, and the patient could then be slowly weaned away. Feeding actual Italian foods to an Italian in hospital, however, was inconceivable to reformer Phyllis Williams since "an actual South Italian dish would be too strong smelling for the modern hospital ward." Porridge, gruels, and milk based puddings were the soothing recommendations given for sick room cookery by the Hull-House Dietary Kitchen, suggesting that spicy or highly flavored foods might inhibit recovery. [171]

Rosa Casettari offered a far different explanation for Italian avoidance of American medicine:

The American doctors they ruin the people. I say, 'People, don't go to the doctors! Let them alone!' Here in America everybody runs to the doctor. And those doctors when you get a pain down there in your leg, they look in your mouth and say, 'You have to pull out her teeth, that's all.'

You get a pain in your stomach, and they say, 'Take off the tonsils.

They tell you to take off all those things and they won't cure you till you do. They won't. In Italia we don't take off nothing--we keep everything, and we are not sick. God gave us all those little things; what for the doctors take them off? It's not right. And then they tell you to open the window to sleep and let in all the germs from the night air. The American people ruin themselves by running all the time to those crazy doctors. [172]

Most dietary studies and the advice they led to tended to be male centered. They claimed to analyze the entire family, despite the fact that the actual consumption by individual family members was seldom tracked. Instead, the amount of food consumed by the entire family was recorded and divided among the number of people in the family. Men were assumed to be eating the largest proportion of the family's food. Women were assumed to eat a smaller percentage of that amount and children an even lesser one. The percentages were not based on actual observation but were arbitrarily assigned based on assumptions about the structures of families and the lesser needs of women and children. No account was taken of the needs of pregnant or nursing mothers, and most women were assumed to be at leisure or involved in non-strenuous work. While studies tended to ignore any special needs of women, however, most critics of the Italian diet found much cause for concern in the diets of children. [173]