Medicines Ethics and Practice MEP 43rd Edition

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Medicines,
Ethics and
Practice
Edition 43
July 2019
 About
R O YA L P H A R M A C E U T I C A L S O C I E T Y

We are the dedicated professional body for

the Royal
pharmacists and pharmacy in England, Scotland
and Wales. We are the only body which represents

Pharmaceutical
all sectors of pharmacy in Great Britain. We lead
and support the development of the pharmacy

Society
profession including the advancement of science,
practice, education and knowledge in pharmacy.

We ensure the voice of the profession is heard

and actively promoted in the development and
delivery of healthcare policy and work to raise the
profile of the profession.

We put pharmacy at the forefront of healthcare

and are the world leader in the safe and
effective use of medicines. We are committed
to supporting and empowering our members
to make a real difference to improving health
outcomes for patients.

Our office details are: Details of how we are governed can be viewed at:

HEAD OFFICE www.rpharms.com/about-us/who-we-are/

66-68 East Smithfield how-we-are-run
London E1W 1AW
Details of the current national pharmacy board
Tel 0845 257 2570 or 0207 572 2737
members are:
Email [email protected]
English Pharmacy Board members
SCOT TISH OFFICE www.rpharms.com/about-us/how-we-are-run/
Holyrood Park House english-pharmacy-board
106 Holyrood Road
Scottish Pharmacy Board members
Edinburgh EH8 8AS
www.rpharms.com/about-us/who-we-are/
Tel 0131 556 4386
national-boards/scottish-national-pharmacy-board
Fax 0131 558 8850
Email [email protected] Welsh Pharmacy Board members
www.rpharms.com/about-us/who-we-are/
WELSH OFFICE national-boards/welsh-national-pharmacy-board
Unit 2, Ashtree Court
Woodsy Close
Cardiff Gate Business Park
Cardiff CF23 8RW
Tel 0292 073 0310
Fax 0292 073 0311
Email [email protected]

C O P Y R I G H T © T H E R OYA L P H A R M A C E U T I C A L S O C I E T Y
2 0 1 9 . A L L R I G H T S R E S E R V E D . T H I S P U B L I C AT I O N M AY N OT
B E R E D I S T R I B U T E D O R R E P R O D U C E D I N W H O L E O R I N PA R T
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I N W H O L E O R I N PA R T

MEP 2019
 Foreword

Welcome to edition 43 of Medicines, Ethics develop MEP and also appreciate comments
and Practice (MEP). and feedback; these can be sent to the RPS
Professional Support service on 0845 257 2570 or
The MEP is a professional guide for pharmacists
0207 572 2737, or by email: [email protected]
and aspires to support pharmacists to practise
confidently and professionally; to use professional Copies of MEP are available for general
judgement and to develop as a professional. It can purchase at a cost of £55.00 and are available
be used to support practice, learning and CPD. from the Pharmaceutical Press website
Please note: the MEP will not always provide a at www.pharmpress.com or from Pharmaceutical
definitive solution to a problem however it can Press c/o Macmillan on tel: 01256 302 699.
be used to help you identify steps to resolve a
Please note: Details of any corrections to the printed
problem/issue in practice.
and pdf of the MEP after publication can be found
MEP evolves and develops with the support and on the RPS website www.rpharms.com.
collaboration of members through the advice
Disclaimer
and expertise of the MEP advisory group and
This publication is intended as a guide and may
through feedback received from members
not always include all information relating to its
between editions.
subject matter. You should interpret all information
The advisory group is composed of pharmacists and advice in light of your own professional
and aspiring pharmacists from different sectors, knowledge and all relevant pharmacy and
different stages of practice and across Great healthcare literature and guidelines. Nothing in
Britain who have volunteered their time to provide this publication constitutes legal advice and
advice to the RPS on the development of the MEP. cannot be relied upon as such. Whilst care has
been taken to ensure the accuracy of content,
This edition of MEP has been edited by Rakhee Amin,
the Royal Pharmaceutical Society excludes to
Senior Professional Standards Pharmacist.
the fullest extent permissible by law any liability
We welcome volunteers from all sectors and stages whether in contract, tort or otherwise arising
of practice willing to commit time to help us from your reliance on any information or advice.

MEP 2019 1
 Contents
CONTENTS

2.4 P R O F E S S I O N A L E M P O W E R M E N T 19

2.5 CLINICAL CHECK 20

CLICK ON 2.5.1 Patient characteristics 21

CONTENT HEADERS 2.5.2 Medication regimen factors 21

T O N AV I G AT E 2.5.3 Administration and monitoring 22

2.5.4 Record keeping 22

2.6 TH E PHAR MACI ST 23

C O N S U LTAT I O N I N P R A C T I C E

2.6.1 Medicines reconciliation 23

2.6.2 Helping patients to understand 25

their medicines

2.7 G E T T I N G T H E C U LT U R E R I G H T 26

2 . 7. 1 A just culture 27

2.8 PROFESS I ONAL D E VE LOPM E NT 31

2.8.1 Revalidation 31

2.8.2 RPS Faculty 31

2.8.3 RPS Foundation programme 31

2.8.4 Developing leadership 31

FOREWORD 1 2.9 R E S E A R C H I N V O LV E M E N T 32

1 CHANGES FOR THIS EDITION 6 3 UNDERPINNING KNOWLEDGE 36

– L E G I S L AT I O N A N D
2 CORE CONCEPTS AND SKILLS 10 PROFESSIONAL ISSUES

2.1 P AT I E N T O R P E R S O N - C E N T R E D 11 3.1 C L A S S I F I C AT I O N O F 37
H E A LT H C A R E MEDICINES

2.2 M E D I C I N E S O P T I M I S AT I O N 11 3.1.1 General Sale List (GSL) medicines 37

AN D PHAR MACEUTICAL CAR E
3.1.2 Pharmacy (P) medicines 38
2.2.1 Medicines optimisation (England) 12
3.1.3 Prescription-Only Medicines (POM) 38
2.2.2 Pharmaceutical care (Scotland) 13
3.2 P R O F E S S I O N A L A N D L E G A L
39
2 . 2 . 3 
P harmaceutical care and 14 I SSU ES : PHAR MACY M E D I C I N ES
prudent pharmacy (Wales)
3.2.1 Pseudoephedrine and ephedrine 39
2 . 2 . 4 
Polypharmacy 15
3.2.2 Oral emergency contraceptives 40
2.3 P R O F E S S I O N A L I S M A N D 16 as pharmacy medicines
PROFESSIONAL JUDGEMENT
3.2.3 Paracetamol and aspirin 41
2.3.1 Professionalism 16
3.2.4 Codeine and dihydrocodeine 42
2.3.2 Professional judgement 17
3.2.5 Reclassified medicines 42
2.3.3 Social media 18

2.3.4 Professional indemnity 19

2 MEP 2019
 CONTENTS
3.3 PROFESSIONAL AND 43 3.4.4 Signed orders and record keeping 80
LEGAL ISSU ES: PR ESCR I PTION
3.4.5 Supply and trade of medicines 80
‑ O N LY M E D I C I N E S
3.4.6 Falsified Medicines Directive (FMD) 80
3.3.1 General prescription requirements 44
3.5 VETERINARY MEDICINES 81
3.3.2 Faxed prescriptions 48
3.5.1 P rescription requirements for POM-V, 82
3.3.3 Dental prescriptions 49
POM-VPS and medicines supplied
3.3.4 Forged prescriptions 49 under the veterinary cascade

3.3.5 Prescriptions from the EEA 50 3.5.2 The veterinary cascade 83

or Switzerland
3.5.3 Labelling 84
3.3.6 Military prescriptions 51
3.5.4 Record keeping 85
3.3.7 Labelling of dispensed 52
3.5.5 Wholesale dealing 85
medicinal products
3.6 CONTROLLED DRUGS 86
3.3.8 Administration 53
3.6.1 Background 88
3.3.9 Patient specific directions and
55
administration, sale and supply 3.6.2 Classification 89
in hospitals and other settings
3.6.3 Possession and supply 92
3 . 3 . 1 0 Exemptions: sale and supply 56
3.6.4 Administration 92
without a prescription
3.6.5 Import, export and travellers 93
3 . 3 . 1 1 D ispensing self-prescribed 64
prescriptions and prescriptions 3 . 6 . 6 
O btaining controlled drugs – 93
for close friends and family requisition requirements for
schedule 1, 2 and 3 controlled drugs
3 . 3 . 1 2 S upplying oral retinoids 65
and pregnancy prevention 3.6.7 Prescription requirements for 96
schedule 2 and 3 controlled drugs
3 . 3 . 1 3 Dispensing valproate 66
for girls and women 3.6.8 Collection of dispensed 101
controlled drugs
3 . 3 . 1 4 Explaining biosimilar medicines 67
3.6.9 Safe custody 102
3 . 3 . 1 5 Summary of prescriber types 69
and prescribing restrictions 3 . 6 . 1 0 Destruction of controlled drugs 103

3 . 3 . 1 6 Checking registration of healthcare

72 3 . 6 . 1 1 Record keeping and controlled 106
professionals and additional drugs registers
information on conditions of supply
3 . 6 . 1 2 Practice issues: disposing 108
3 . 3 . 1 7 Prescribing and dispensing 76 of spent methadone bottles
to the same person
3 . 6 . 1 3 Practice issues: 108
3 . 3 . 1 8 Making things right when there's 76 needle exchange scheme
been a dispensing error
3 . 6 . 1 4 Extemporaneous methadone 109
3.4 WHOLESALE DEALING 77
3 . 6 . 1 5 C annabis-based products 109
3.4.1 MHRA statement 77 for medicinal use in humans

3.4.2 Wholesale dealing of Controlled Drugs 79

3 . 4 . 3 
P ersons and organisations that can 79
receive medicines

MEP 2019 3
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CONTENTS

3.7 A D D I T I O N A L L E G A L A N D
112 9 PHAR MACI ST SU PPORT 147
PROFESSIONAL ISSUES
10 APPENDICES 148
3 . 7. 1 Expiry dates 113

3 . 7. 2 Waste medicines 113 APPENDIX 1 150

GPhC standards for pharmacy
3 . 7. 3 Requests for poisons and chemicals 114
professionals
3 . 7. 4 Delivery and posting of medicines 115
APPENDIX 2 154
to patients (including abroad)
GPhC standards for registered
3 . 7. 5 Secure environments 115 pharmacies

3 . 7. 6 Child-resistant packaging 116 APPENDIX 3 157

GPhC in practice: guidance
3 . 7. 7 Reporting adverse events 116
on confidentiality
3 . 7. 8 Emergency connection to 116
APPENDIX 4 162
ex-directory telephone numbers
GPhC in practice: guidance
3 . 7. 9 Homeopathic and herbal remedies 117 on consent

3 . 7 . 1 0 Charitable donation of medicines 118

APPENDIX 5 168
3 . 7. 1 1 Collection and purchase 119 GPhC in practice: guidance
of medicines by children on raising concerns

3 . 7 . 1 2 Protecting children and young people 120

APPENDIX 6 171
3 . 7 . 1 3 Protecting vulnerable adults 121 GPhC in practice: guidance on
maintaining clear sexual boundaries
3 . 7 . 1 4 Medical devices 124
APPENDIX 7 174
3 . 7 . 1 5 Administration of adrenaline 124
GPhC in practice: guidance on religion,
in an emergency
personal values and beliefs
3 . 7 . 1 6 Multi-compartment compliance aids 125
APPENDIX 8 179
3 . 7 . 1 7 Drugs and driving 126 GPhC guidance on responding
to complaints and concerns
3 . 7 . 1 8 Retention of pharmacy records 129
APPENDIX 9 184
3 . 7 . 1 9 New psychoactive substances 129
GPhC guidance for registered
pharmacies preparing
4 THE RESPONSIBLE 132
unlicensed medicines
PHAR MACI ST
APPENDIX 10 193
5 OTHER RESOURCES 140 GPhC guidance for registered
P U B L I S H E D B Y T H E R O YA L pharmacies providing pharmacy
PHAR MACEUTICAL SOCI E T Y services at a distance, including
on the internet
6 P R O F E S S I O N A L S TA N D A R D S 141
APPENDIX 11 204

G PhC guidance to ensure a safe
7 R O YA L P H A R M A C E U T I C A L
143
and effective pharmacy team
SOCIETY CODE OF CONDUCT

8 W O R K I N G W I T H P A R T N E R S ,
146
A F F I L I AT E S A N D O T H E R
O R G A N I S AT I O N S

4 MEP 2019
MEP 2019 5
 and additions have been
made for edition 43
1
Changes
for this edition

The following amendments NEW SECTIONS

2.2.4
P O LY P H A R M A C Y

2.3.4
PROFESSIONAL INDEMNITY

2.8.1
R E V A L I D AT I O N

3.3.1
GENERAL PRESCRIPTION REQUIREMENTS
Falsified Medicines Directive (which came
into force on 9th February 2019)

3.3.1
GENERAL PRESCRIPTION REQUIREMENTS
Prescriptions from the Crown Dependencies
(Jersey, Guernsey and Isle of Man)

3.6.1
C O N T R O L L E D D R U G S B AC KG R O U N D
Added a section on Gosport report

6 MEP 2019
 CHANGES FOR THIS EDITION
3.6.7 2.9
PRESCRIPTION REQUIREMENTS FOR R E S E A R C H I N V O LV E M E N T
SCHEDULE 2 AND 3 CONTROLLED DRUGS Changes to examples of how the GPhC
Added guidance on the rescheduling standards apply to research
of gabapentin and pregabalin
3.2.2
3.6.15 O R AL E M E RG E N CY CO NTR ACE P TIVES
CANNABIS -BASED PRODUCTS AS PHAR MACY M E D I C I N ES
FOR MEDICINAL USE IN HUMANS Included further guidance on religious and
moral beliefs impacting on the supply of EHC
APPENDIX 11
GPHC GU I DANCE TO EN SU R E A SAFE 3.2.3
AN D E FFECTIVE PHAR MACY TE AM P A R A C E TA M O L A N D A S P I R I N
Updates to Table 1 (OTC legal restrictions)
R E MOVE D S ECTION S
3.2.5
RECLASSIFIED MEDICINES
2 . 8 . 1 (E D I T I O N 42)
Updated further reading box to include signposting
CONTINUING PROFESSIONAL
to RPS guidance on the following:
D E V E L O P M E N T ( C P D) R E P L A C E D W I T H
I N F O R M AT I O N O N R E V A L I D AT I O N • Anti-malarials as Pharmacy medicines

3 . 2 . 5 (E D I T I O N 42) • Mometasone 0.05% nasal spray

COUGH AND COLD MEDICINES
• O ral lidocaine-containing products
FOR CHILDREN
for teething in children
3 . 7. 3 (E D I T I O N 4 2)
3.3.1
C O S M E T I C C O N TA C T L E N S E S
GENERAL PRESCRIPTION REQUIREMENTS
( Z E R O P O W E R E D)
Added signposting to information on EPS and CDs
in the ‘Electronic Prescriptions’ box in this section
U P D AT E D S E C T I O N S
3.3.1
Updated references and further reading GENERAL PRESCRIPTION REQUIREMENTS
signposting in all sections Repeatable prescriptions: added reference
to use in hospitals and homecare settings,
2.2.2
and updated guidance on prisons
PHAR MACEUTICAL CAR E , SCOTL AN D
At time of writing, the Chronic Medication 3.3.6
service had a name change to the Medicines M I L I TA R Y P R E S C R I P T I O N S
Care and Review Service Updated in line with current practice

2.3.1 3.3.8
PROFESSIONALISM A D M I N I S T R AT I O N
Added more examples of pharmacy Updated to current guidance as published
professionalism in RPS Professional guidance on the administration
of medicines in healthcare settings 2019 and
2.3.3
RPS Professional guidance on the safe and secure
SOCIAL MEDIA
handling of medicines 2018 www.rpharms.com
Included reference to the use of Whatsapp
instead of bleeping colleagues 3.3.12
S U P P LY I N G I S O T R E T I N O I N A N D
2.4
PR EG NAN CY PR E VE NTI O N
PROFESSIONAL EMPOWERMENT
Updated this section to include information
Moved section on Professional Empowerment
on all oral retinoids. Title changed to ‘SUPPLYING
from 2.7 to 2.4 , to follow on from Professionalism
ORAL RETINOIDS AND PREGNANCY PREVENTION’
and Professional Judgement

MEP 2019 7
CHANGES FOR THIS EDITION

3.3.15 Home Office wording for instalment prescribing

SUMMARY OF PRESCRIBER TYPES of CDs during periods when pharmacy is closed
AND PRESCRIBING RESTRICTIONS
• Updated printing errors in table 13 CONTROLLED
Updated table 4: Different types of prescriber
DRUGS PRIVATE PRESCRIPTION FORMS on the type
and restrictions on what can be prescribed –
of form used in England and Wales
to include information on the following prescribers:
3 . 7. 8
• Physiotherapist and Podiatrist independent
E M E RG E N CY CO N N ECTI O N TO
prescriber – added signposting to Health
E X-DI R ECTORY TELEPHON E N U M B ERS
and Care Professionals Council (HCPC) and
Updated in line with advice from BT
NHS England have issued a joint statement
(www.hcpc-uk.org/registrants/updates/2019/ 3 . 7. 1 1
reclassification-of-gabapentin-and-pregabalin) COLLECTION AND PURCHASE
on the reclassification of gabapentin and OF MEDICINES BY CHILDREN
pregabalin giving details of which prescribers Updated to consider additional factors
can issue prescriptions for CDs on whether supply of dispensed medicines
is appropriate or not
• Paramedic independent prescriber
3 . 7. 1 7
3.3.16
DRUGS AND DRIVING
C H E C K I N G R E G I S T R AT I O N O F
Included signposting to information on new
H E A LT H C A R E P R O F E S S I O N A L S A N D
safety laws being introduced in Scotland during
A D D I T I O N A L I N F O R M AT I O N O N
October 2019
C O N D I T I O N S O F S U P P LY
Updated table 5 to include information on 3 . 7. 2 0
advanced paramedics prescribing medicines N E W P S Y C H O A C T I V E S U B S TA N C E S
Removed detailed information on what NPS
3.4
are – signposted to the RPS website for information
WHOLESALE DEALING
in the quick reference guide and factsheet
Added section 3.4.6 on Falsified
Medicines Directive (FMD) 6
P R O F E S S I O N A L S TA N D A R D S
3.6.2
Added to the list – professional standards
C O N T R O L L E D D R U G S C L A S S I F I C AT I O N
and framework currently under development
Added reference to new the section on cannabis
based products for medicinal use in humans 7
(3.6.15) and the rescheduling of gabapentin RPS CODE OF CODUCT
and pregabalin to Schedule 3 CD Updated RPS Code of Conduct reproduced

3.6.7
GPHC APPENDICES
PRESCRIPTION REQUIREMENTS FOR
Updated in line with any changes GPhC has made
SCHEDULE 2 AND 3 CONTROLLED DRUGS
to the contents of their standards and guidance
• Replaced Formulation with Form in line with the and included the following changes:
Misuse of Drugs Regulations 2001
• Title change of Appendix 7 ‘GPhC guidance on
• Updated guidance on the Total Quantity to provide the provision of pharmacy services affected by
clarification on expressing it as the total number religious and moral beliefs’ to ‘GPhC in practice:
of dosage units or the total quantity of the drug. Guidance on religion, personal values and beliefs’
Included reference to Home Office advice on
• Significant changes to Appendix 10 ‘GPhC guidance
expressing the quantity of different strength tablets
for registered pharmacies providing pharmacy
of the same CD on the prescription
services at a distance, including on the internet’
• Added signposting information on CD as revised by GPhC in April 2019
electronic prescriptions

• Added further guidance on the using the approved

8 MEP 2019
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and energy dies. The Food That Counts Is the Pood That Digests
The Woman's World Calendar Cook Book points out plainly the
scientific selection of foods — Gives the careful preparation and
mixing of ingredients— Furnishes the practical knowledge of the
time required and the manner of cooking, preserving or canning —
Brings out the attractive appearance of food for the satisfaction of
the appetite — Shows hundreds of new combinations of nutritious
cookery — But— Its larger purpose is to bring out clearly the
accurate facts on the values of foods and how to retain these values
through proper methods of cooking and to emphasize the Economy
and Nutrition of the Balanced Ration as against the haphazard
choice, in order to prolong life, and to give a greater joy in living.
Woman's World Calendar Cook Book contains Balanced Menus for a
week in every month with variations for every meal — every day in
the year. It has 250 Tested Recipes, made in a home Kitchen — 12
Monthly Messages on good ingredients and their preparation —
Canning and Preserving Charts — Baking, Roasting and Boiling Time
Tables — and practical articles on Child Feeding and other vital
subjects in Home Economics. Mrs. Ida Bailey Allen This Woman's
World Calendar Cogk Book — containing 100 pages — every page
printed in full color to give an appetizing mental meal, has been
prepared by Mrs. Ida Bailey Allen, Director of Domestic Science in
Woman's World. Mrs. Allen has had an honored record in the field of
Home Economics work for the past 20 years — in the Schoolroom, in
the Kitchen, in the Laboratory, in her Cooking School, on the lecture
platform, in the newspapers and in the big national magazines.
Every menu and every recipe, in the book has been tested under her
personal supervision in her own kitchen. Every article, every
suggestion, idea and statement are hers, and upon its Nutrition and
Economy you may confidently depend. This book is for the use of —
Housewives Colleges High Schools Tea Rooms Institutions Cooking
Schools Cooks Churches Fraternal Bodies Cafeterias Restaurants
Woman's Clubs In these days of stress, when everyone is more
vitally concerned than ever before in the purchasing power of the
dollar, the Woman's World Calendar Cook Book will fill a long-felt
need. In conchision. we wish to state that the MoneyBack Guarantee
on advertising which appears every month in Woman's World applies
to all advertisements contained in Woman's World Calendar Cook
Book. Guarantee of Satisfaction We stand hack of every
advertisement in Woman's World. We guarantee these
advertisements to you 'because we believe advertised goods offer
you the fullest protection, quality and service. We ivill refund your
money if you are not satisfied with the value received or treatment
given by any advertiser inWoman's World. if.J^c Preaid cnfi^Wb
mail' a World. Copyrighted, 1922, by Woman'* World Magrazine Co.,
Inc., 107 South Clinton St., Chicago, llllnoi - By MRS. IDA BArLEY
ALLEM
 ?age 2 Fearail Butter BESIDES being an ideal spread for
bread, BeechNut Peanut Butter is just the filler to give flavor and
character to candies, cakes and the like. Truly delicious in itself, it
blends agreeably with many kinds of food. Use it in pastry,
confectionery, fruit puddings, sandwiches and numerous desserts.
You'll be delighted at the really delicious results obtainable from it.
Our booklet, * 'One Hundred and One Recipes," tells you how it can
be used. It is yours for the asking. BEECH-NUT PACKING CO.
Canajoharie, New York BEECH-NUT *'Foods of Finest Flavor" Bacon
Macaroni Spaghetti Pork and Beans Tomato Catsup Chili Sauce
Marmalades and Preserves Peanut Butter Jams and Jellies Ginger Ale
Confections Mints Fruit Drops Chew/ing Gum DELICIOUS! PEANUT
BUTTER FUDGE 1 cup brown sugar 1 cup granulated sugar J^ cup
milk 1 teaspoonful vanilla J^ cup Beech-Nut Peanut Butter Stir milk
and sugar over fire until boiling; cease stirrir.g and allow to boil until
candy forms a soft ball when tested in cold water. Let cool, add
Beech-Nut Peanut Butter and vanilla. Beat until creamy. Turn into
buttered pan and mark in squares. BEECH-NUT PEANUT BUTTER
LAYER CAKE ^ cup butter 2 eggs, beaten separately M cup milk 2
teaspoons baking powder 1 cup sugar 1 teaspoon vanilla 2j^ cups
flour Cream butter and sugar, add yolks of eggs, beat well, add milk,
sifted flour and baking powder, lastly fold in lightly the beaten whites
of eggs. Bake in two layers in rather quick oven, FILLING : Boil 1 J^
cups shaved maple sugar and 3^ cup water, in which has been
dissolved J^ teaspoon cream tartar, until syrup will thread, pour
gradually on the stiffly beaten whites of two eggs, add two
tablespoons Beech-Nut Peanut Butter and continue beating until
thick and creamy. Spread between layers and on top of cake.
 Page 3 ■ 'CiiU I WOMAN'S WORLD CALENDAR COOK BOOK
THE BALANCED RATION "%ur Meals and Good Healtlv V AKIETY is
the spice of lifethe essence of life. -and it is also Our bodies must
get from the food that we eat the tissue for its cells — energy for
instant use — or storage for the future — mineral salts, vitamines,
water and a certain roughage from vegetables and fruits to aid in
proper elimination. When we do not balance our ration, but leare out
of our diet any food upon which our bodies depend we throw the
machinery out of gear by making it work overtime to secure enough
tissue or energy from other foods to repair the loss. It is of the
greatest importance to strengthen our bodies and brighten our
minds — by a little common sense in the daily selection and
preparation of the food we eat. Living by the balanced ration is
simply giving the body and the brain a chance to do its best as
nature intended, by giving it the right nourishment every day in the
year. We have set forth in the Woman's World Calendar Cook Book
the correct diet with the newest food combinations — with the idea
of providing sufficient nutriment from our food for every one of
every age — with the greatest amount of economy in its selection
and preparation. Our bodies are made up of various parts — there's
fat, bone, muscle, brain and nerve tissue, all of which are being
constantly expended as we think and move, even to repair this
waste ; and food, plus the right amount of water, has to be
regulated. The following foods should be present in every meal :
One protein or muscle-maker, two or three starches or energy foods,
one or two fats or reserve-force foods, one sweet or quick energizer,
one or two roughage or bulky foods, some minerals, at least one
protective food, and a half pint of water. If you have a boy who can't
get "filled up" — a daughter with a blotched skin — a husband who
is always tired — and if you, yourself, are nervous and fretty, just
give this balanced ration a thorough trial. The Balanced Ration In
order to make the proper balancing of meals simple, we have listed
the foods according to the special mission they have in the body.
Muscle-Makers: (One of these for each meal.) Milk, skimmed milk,
eggs, meat, fish, dried peas, dried beans, nuts, peanut butter, all
kinds of cheese. Heat Foods: (Two of these for each meal.) All
cereals, all breads — ^whether made with baking powder, soda or
yeast — crackers, macaroni, spaghetti, and noodles, bananas, all
puddings that include bread crumbs, flour, cornstarch, tapioca,
cereals. Quick Energy Foods: (One of these for each meal.) The
sweets, all kinds of syrups — such as maple syrup, honey molasses,
sorghum and cornsyrup; jellies and preserves, frostings, candies,
sweet puddings, plain sugar as served in coffee, tea and on fresh
fruit. Keserv© Foods, that supply stored-up energy: (Two of these
for each meal.) All the fats — this means butter, nut and animal
margarine: peanut butter, cream, top milk, all sal^ad oils, very fat
ham, pork or bacon, very fat fish, sausages, cream cheese, all salad
dressings, rich gravies, cake and pastry containing a great deal of
shortening, most nuts, chocolate, and all puddings and cakes
containing nauch fat — as suet puddings: also fried foods, such as
fried potatoes, croquettes, etc. Tonic Foods: (One or more of these
for each meal.) All fresh green vegetables, as cabbage, cucumbers,
celery, tomatoes, all salad plants, etc.; rhubarb, peaches,
strawberries, pears, grapes and all fresh and dried fruits, except
bananas: all fruit drinks, canned fruits and fruit ices all whole grain
cereals, such as cracked wheat, brown rice, cornmeal ground at the
mill, etc. The Koughage (or bullcy) Foods: (One or more of these for
each meal.) Includes all of the Tonic Poods, as well as all of the
coarse breads, such as graham, entire wheat and rye — all the gritty
cereals, all the coarse vegetables — as lettuce, onions, asparagus,
cabbage, etc.: all unpared fruits or those which are full of seeds —
as well as all of the bulky green vegetables. The liiquid Foods: (Two
of these tor each meal.) Water, all soups, small amounts of tea or
coffee, skimmed milk, buttermilk, cocoa, all fruit drinks, all o4;her
drinks (not alcoholic) : gelatines, ices, watery fruits and vegetables.
Growing or Protective Foods. (Choose two of these or at least one
for each meal.) Milk, butter, eggs, fresh vegetables, fresh fruits,
whole grains. Let Eacli Play Its Part As we learn to plan and cook
rightly we soon become accustomed to thinking of the different
materials we put into the dishes and find that it is not necessary to
supply eight or ten dishes for each meal, as some may have thought
after reading through the list of foods, but rather to think what goes
into each one separately. In the well-planned meal there' are no
accessories. When sugar, for example, is used in the coffee, tea or
cocoa, or on the cereal, that supplies the necessary sweet for the
meal. Bread acts as one of the heat foods, and the butter or
margarine served on it is one of the foods that supplies stored-up
force. It isn't necessarj' — ^if large amounts of bread and butter are
eaten — to supply any other reserve-force food in the meal. A
balanced meal can be selected by anyone by applying the simple
principles I have mentioned. Properly selected meals mean
efficiency, keener judgment, clear-headedness, a comfortable feeling
after meals— and all it costs is the expenditure of enough time to
understand the list of foods and to select them according to the
simple laws of harmony and body needs. AH Measurements Are
Ijevel. ^^^_^5^ (^U^^-^Ly, ti^€^ , rVAv ' ^iSi^" By MRS. IDA
BAILEY ALLEN
 Page 4 A Page of Special Recipes - by kMts. Knox, 0 But
here I give three special recipes for a dessert, salad and candy with
which readers of my book "Dainty Desserts" have had so much
success that I believe they will be welcomed by N OTHER pages of
this Cook Book will be found a number of very delightful recipes,
which show the unlimited possibilities of Knox Sparkling Gelatine.
'Dainty every user of the Woman's World Cook Book by Rice Parfait
H envelope Knox Sparkling Gelatine 2 cups hot boiled rice VA cups
milk I cup cream 1 cup sugar li teaspoonful salt 1 cup chopped nut
meats \ teaspoonful vanilla Soak gelatine in milk ten minutes and
dissolve in hot rice. Add sugar and salt and when cool fold in cream,
beaten until stifi. Add nut meats and flavoring. Turn into a mold, and
pack in ice and salt. Perfection Salad 1 envelope Knox Sparkling
Gelatine M cup cold water yi cup mild vinegar 2 tablespoonfuls
lemon juice 2 cups boiling water ]/i cup sugar 1 teaspoonful salt 1
cup cabbage, finely shredded 2 cups celery, cut in small pieces 2
pimentoes, cut in small pieces Soak gelatine in cold water five
minutes. Add vinegar, lemon juice, boiling water, sugar, and salt.
Strain, and when mixture begins to stiffen, add remaining
ingredients. . Turn into mold, first dipped in cold water, and chill.
Remove to bed of lettuce or endive. Garnish with mayonnaise
dressing, or cut in cubes, and serve _in cases made of red or green
peppers, or turn into molds lined with canned pimentoes. NOTE —
Use fruits instead of vegetables in the above and yon have a
deliciotis fruit salad. Marshmallows 1 envelope Knox Sparkling
Gelatine Few Grains salt IM cups water 1 teaspoonful vanilla 2 cups
fine granulated sugar Soak gelatine in one-half the water five
minutes. Put remaining water and sugar in saucepan, bring to the
boiling point and let boil until syrup will spin a thread when dropped
from tip of spoon. Add soaked gelatine and let stand until partially
cooled; then add salt and ilavoring. Beat until mixture becomes
white and thick. Pour into granite pans, thickly dusted with
powdered sugar, having mixture one inch in depth. Let stand in a
cool place until thoroughly chilled. Turn on a board, cut in cubes and
roll in powdered sugar. This recipe makes about one hundred
marshmallows. Nuts, chocolate, fruit juices in place of part of the
water, or candied fruits chopped may be added — or the plain ones
rolled in grated cocoanut before being sugared. Send for Free Recipe
Books You will find my books "Dainty Desserts" and "Food Economy"
invaluable in getting up delightfully new dishes, for desserts, meat
and fish molds, relishes, salads and candies. Copies will be sent you
— free — if you will enclose 4c in stamps to cover postage and
mention your grocer's name. PLAJN GtLAfir(£ This is the plain h
Sparkling Package for \ general use. KNOX SPARKLING GELATINE 12
Knox Ave., Johnstown, N. Y. / This package contains Lemon
Flavoring in Separate Envelope, '^Wherever a recipe calls for
gelatine, think of Knox''
 WOMAN'S WORLD CALENDAR COOK BOOK TABLE OF
CONTENTS The Balanced Ration, By MRS. IDA bailey allen Monthly
Messages ■ 3 January — ^About Canned Foods . . 6 February —
Yeast Bread Making . . 12 March — ^The Values in Dried Fruits . iq
April — Cakes and Cake Making . . 29 May— About Gelatine .... • 37
June — Vegetable Oils and Fats ■ 43 July — Milk, Condensed,
Evaporated and Powdered ■ 49 August — Beverages .... ■ 59
September— Seasonings and Flavorings 65 October — Cereals,
Cooked and Uncooked • 71 November— Nuts, Nut Butter and
Margarine • 77 December — About Sweets ■ 8s Balanced Rations —
Variations for Every Meal of the Month January . . .7 July • 52
February . . .13 August , 60 March . . .20 September . 66 April . . .30
October ■ 72 May . . .38 November . 80 June . . .44 December . 86
Tested Recipes Index to Tested Recipes .... . 93 and 95 Special
Articles Feeding the Youngsters . ■ 25 The Proper Kind of Food—
And Why Home-Made Candies .... 26-27 1 Time-Tables in Cookery
.... • 35 { For Cooking Cereals and Vegetables, ) For Broiling,
Roasting and Baking I Measurements ..... • 36 Accuracy Essential to
Good Cookery Canning Suggestions .... • 5° With Time Tables for
Canning Fruits and Vegetables Preserving, Jam and Jelly Making • 57
Refreshments for Little Affairs . .78 The Range and Its Operation . 91
A Discussion of the Diferent Types ■ Setting the Table for an
Informal Dinner . 96 L k. Fuel or Clinkers, By Walter w. manning . I
DD
 WOMAN'S WORLD CALENDAR COOK BOOK Monthly
Message for January About Canned Foods MUCH has been said and
written about canned foods; but, when finally sifted down, the
question really presents the following aspects: How do canned
articles compare in food value with fresh foods? Are they as clean as
foods put up at home? Are they more expensive? The food value of
canned articles is practically the same as when the foods are
prepared at home. However, the process of canning takes away
most of the vitamines, and, because of this, it is not advisable to
plan a dietary based largely upon canned foods. This means that
canned foods should appear in the menu in balanced combination
with fresh foods containing vitamines, as milk, eggs, cheese, etc.
Example: Cream of spinach soup, escalloped brown rice, tomatoes
and cheese. Canned Foocls Are Usually Cheaper Than Fresh Foods
In most cases it is cheaper to buy canned foods than those that are
fresh,, even if the cost of preparation and fuel is not considered.
Standard brands of canned tongue, veal loaf, pressed beef and
corned beef for certain processes of cookery are quite as adaptable
as those that are home prepared. As to canned vegetables, they cost
about the sajne as the home-prepared products, provided the latter
are not home-grown, but it is a good rule to introduce the fresh
vegetable in the menu when it is in season, for the vitamine
element, rather than the canned vegetable. When the canned
vegetable is used, let it be in the form of a salad into which a fresh,
raw vegetable, as lettuce, radishes, celery, cabbage or even raw
onions may be featured, or as a milk soup, or with poached eggs.
Commercially-Canned Products More Economical Than Home Canned
Foods Unless there is a large supply of fresh fruits on the home
place, so that it is not necessary to purchase fruit for canning, it is
not an economy to put them up at home, for, with the cost of both
sugar and fruit, home canned fruit is as expensive as the commercial
product. Fresh fruit the year round is the best possible insurance
against autointoxication, sluggish livers and frequent headaches,
although canned fruit is very useful when fresh fruit cannot be had.
With the agitation for pure foods is the necessity for clean products,
for that which is not clean cannot be pure. The Kind to Buy The
housewife should be sure to buy the known brands which stand for
purity in manufacture. The names of reputable firms, whose kitchens
are constantly open for inspection, mean cleanliness. I have seen
hundreds of home kitchens and have also been through many
manufacturing plants producing food products, and in nearly every
case the commercial ingredients were of the best grade, and the
manufacturing kitchens were cleaner than those in the homes.
Comhining Canned Poods with Fresh — For Vitamines Canned foods
should be combined, if possible, with something which will give
either a fresh raw or freshly-cooked taste. Canned pears become
another food if sharpened with a little lemon juice; a fruit cup of
canned pineapple and cherries is more nutritious with a little sliced
orange. Thus fish salad, combined with diced celery or lettuce hearts
and garnished with radish roses, is both appetizing and complete.
The living principles needed by canned foods are thus introduced,
giving the true balance. All canned foods are better if turned from
the can at least a half hour before using and expose to the air to
freshen, or re-oxygenize. This applies also to canned soups. Canned
fish, as tuna and salmon, should be scalded before using. All
vegetables of a firm nature, as asparagus, peas, Lima beans, etc.,
and canned spinach, should be drained, the liquor being used as
sauce or the foundation for a soup. Many housewives seem to think
that because a meat is canned and, therefore cooked, it should be
served plain. This makes it seem expensive and not particularly
attractive. Canned meat is, however, most adaptable to made dishes.
It should never be used entirely in the place of fresh meat. But the
made fish from canned meat or fish, if combined with other
ingredients, will often solve a luncheon or supper problem. All
canned foods should be changed to another container immediately
upon opening. By MRS. IDA BAILEY ALLEN
 Page 7 WOMAN'S WORLD CALENDAR COOK BOOK The
Balanced Ration for Js nuary Tested Menus for One Week ^ Days
Breakfast I^uiicheon or Supper Dinner StJNDAY Sliced Oraages
Creamed Potatoes and Bacon Entire Wheat Toast Butter Coffee
(Adults) Milk (ChUdren) Eacalloped Cheese Muffins and Butter
Stewed Dried Peaches Hermits Tea Broiled Pork Chops Mashed
Potatoes String Beans Bread arid Butter Cole- Slaw Upside-down
Apple Pies Coffee MONDAY SUced Bananas Rice Cooked in Milk
Served with Maple Syrup Corn Bread and Butter Coffee (Adults) Milk
(ChUdren) Lima Bean Chowder Hot Crackers Bread and Butter Baked
Custard Tea Vegetable Bouillon Meat I/oaf Stewed Tomatoes Baked
Potatoes Rye Bread and Butter Warm Gingerbread Coffee TIjESDAY
Stewed Prunes Com Flakes Milk Boiled Eggs Rolls and Butter Coffee
(Adults) Milk (Children) Celerlac or Potato Salad Bread and Butter
Sauash Pic Tea Cream of Corn Soup Nut and Potato Balls Peas Rolls
and Butter Salad Fudge (^ke Coffee WEDNESDAY Grapefruit
Prepared Cereal Milk Frizzled Dried Beef on Toast Coffee (Adults)
Milk (Children) Poached Eggs with Rice and Cream Sauce Celery
Graham Bread and Butter Grape Jelly Cocoa Broiled Halibut or
Mackerel Parsley Sauce Spinach Bread and Butter Cup Cakes Coffee
THTJRSDAY Oatmeal Cooked with Dates MUk Bacon Muffins and
Butter Coffee (Adults) Milk (Children) Boston Baked Beans Steamed
Brown Bread and Butter Picralliili Canned Peaches Tea Chicken or
Veal Fricassee Mashed Potatoes Buttered Beats Sweet Pickles Bread
and Butter Hermits Sliced Oranges Coffee FRIDAY Baked Figs
Swedish Omelet Reheated RoUs Butter Coffee (Adults) MUk
(Children) Chicken or Veal Soup Dumplings Mince Pie Tea Beef
Casserole Buttered Carrots Graham Bread and Butter Lettuce with
Russian Dressing Grape Juice Tapioca Coffee Sliced Oranges Cracked
Wheat Milk Creamed Codfish on Toast Coffee (Adults) Milk (Children)
Baked Bean Soup Hot Toast Orange Shortcake Tea Beef Pie (Made
from Casserole) Mashed Potatoes Diced Turnips Tomato Jelly Salad
Steamed Raisin Pudding Lemon Sauce Coffee Variations of the Basic
Menus for Every Meal of the Month Breakfast As this is the season
when quite a bit of acid should be gradually introduced into the
menu, the citrus fruits and grape fruit can be used plentifully. The
dried fruits may be used interchangeably as they give bulk. If the
family seems to be suffering from colds, try serving a glassfull of
rather sour lemonade, all round, either in the evening, or a half hour
before breakfast. The bread, both yeast and quick, should be made
up — as far as possible — of whole grains. Fried foods should be
avoided as much as possible. Broiled, smoked salmon, or smoked
white fish, can be substituted for bacon. The Swedish omelet may
be supplanted by tomato, or spinach, omelet ; and oven-browned
cereal may be served, instead of creamed potatoes. Luncheon or
Supper Escalloped eggs, potatoes, or spinach may be substituted for
the escalloped cheese — ^while canned fruit may be used instead of
stewed, dried fruit. Corn, potato, or tomato chowder will always be
welcomed, and any of the hot desserts will be delicious, especially
on a rather cold day (in this case, a special substitute dish will have
to be provided for the youngsters if the dessert is over-rich ) . As for
general use, bread pudding, any form of cereal puddings, warm
gingerbread, upside-down pies, or baked fruit dumplings are always
acceptable. Dinner Any broiled meat may he substituted for the pork
chops ; instead of meat loaf, Hamburg steak balls may be provided ;
and to vary the meatless menu on Tuesday, nut cutlets, or rice and
nut loaf may be provided. Any broiled fish may replace the broiled
mackerel, or halibut. A fricassee of lamb may be used instead of that
of chicken, and a casserole of chicken, veal, or lamb may be used
instead of beef. As to vegetables, try to put in those which are bulky,
and introduce as many of the fresh vegetables as possible. Serve
fruit freely as dessert, or introduce fruit juices in the form of
tapiocas, gelatine, and so on. Salads should be used frequently, the
French dressing being made with lemon juice, instead of vinegar, to
stimulate the liver. By MRS. IDA BAILEY ALLEN
 1 Page 8 WOMAN'S WORLD CALENDAR COOK BOOK Tested
Recipes for January Niatrition and Economy ^^^^x. ^^. Baked
Beans with Chili Sauce 1% cups dried beans % teaspoon soda 1
teaspoon minced onion 1% cups Chill sauce Baked Beans With Chili
Sauce 1 teaspoon salt % teaspoon pepper 2 slices salt pork 1
tablespoon molasses OOAK beans overnight, drain them, add soda,
"^ cover with fresh water and bring to boiling point. Cook five
minutes, then turn into deep baking dish, add seasonings and
molasses, lay slices of salt pork over top, cut into dice and mix with
beans. Pour Chili Sauce over all, add water to barely cover and bake
in slow oven — 325° to 350° F. — three hours. Add a little water
occasionally should beans appear dry. Oiuons Supreme after it
begins to boil ; then put in cream or top milk, salt, pepper, and
lemon juice, and onions which have been steamed or boiled until
tender in salted water, then thoroughly drained. Add hardcooked
eggs, which have been sliced or cut in quarters, and heat but do not
boil. Serve in deep disli or arrange around mound of mashed
potatoes as the main dish in a meatless meal. Nut and Potato Balls
^A teaspoon pepper Slight grating of nutmeg 2 teaspoons chopped
parsley V2 teaspoon grated onion, if desired 8 medium sized white
onions 3 tablespoons butter % cup flour 1 teaspoon lemon juice ■%
teaspoon salt ■pLEND together butter and flour until smooth, " add
stock or milk a little at a time, stirring while adding. Allow sauce to
cook three minutes. % teaspoon pepper 1% cups hot stock or milk
Vs cup thin cream or top milk 3 hard-cooked eggs 3 cups mashed
potatoes 2 tablespoons butter or vegetable fat 1 cup finely chopped
nutmeats, any kind 1 egg ^/^ teaspoonful salt CEE that potatoes
are entirely free from lumps, •^ add butter, seasonings, nuts, and
moisten with egg, which has been beaten. Spread on plate to cool,
divide into ten equal sized portions, roll into balls, brush over with
beaten egg, coat with bread crumbs, and either fry in deep fat or
bake until golden brown in quick oven — 375° F. Oninnn ftupreme
 1 I WOMAN'S WORLD CALENDAR COOK BOOK Page 9
*::!:SS^^ Tested Recipes for January Air Measurements Are Level
Macai'onl in Cheese Sauce cups cooked macaroni tablespoons butter
or vegetable fat cup grated cheese tablespoons flour 2 cups milk *■
% teaspoon salt % teaspoon pepper or paprika 15 LEND together
flour and butter until smooth, ■^-' add milk, stir until boiling, cook
three minutes after boiling point is reached. Add salt, pepper and
cheese, also macaroni, cut into convenient sized pieces. Let all
become thoroughly hot to melt cheese, but do not let sauce boil,
after cheese has been added. Escalloi)ed Oysters With Spaghetti 1
quart oysters 2 tablespoons flour 1 teaspoon salt % teaspoon
pepper 3 cups cooked spaghetti % cup minced celery 1 cup milk 2
tablespoons butter or vegetable fat % cup dry bread crumbs F\RAIN
oysters and roll each one in flour, salt ■•-^ and pepper which have
been mixed together on a plate. Oil a baking dish and put into it a
thin layer of crumbs, then one of oysters, next a little celery, then a
layer of spaghetti, continuing in this way till all is used. Pour in milk
and sprinkle over top the bread crumbs, moistened with remaining
butter, melted. Bake half hour in moderate oven, 350° F. Chicken,
Salmon or Tuna Croquettes 1 can chicken or two cups cold minced
chicken (or use salmon or tuna fish) 3 tablespoons butter or
vegetable fat 3 tablespoons flour 1 cup milk or stock tions. Roll into
cone or cork shape, brush over with beaten egg, roll in bread
crumbs or cracker crumbs and fry in deep fat, or bake until golden
brown in quick oven — 375° F. Upside-Down Fruit Pies
"pHORODGHLY oil muffin pans and fill with ■•• sliced apples or
fresb^; canned or stfe'weddried peaches, mixed with a half cup
sugar to two and a half cups sliced fruit. Top each section with round
of crust, cut half inch thick, and made of your favorite baking
powder biscuit mixture. Balke for twenty-five minutes in moderate
oven. In the meantime put fruit peelings on to boil in one and a half
cups hot water. Boil twenty minutes, then strain, add half cup sugar,
a few grains of salt, a little nutmeg and thicken with one and a
fourth tablespoons each of flour and butter, or margarine, which
have been creamed together. Serve this sauce with the pies, turned
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