Mrs. Beeton's Book of Household Management/Chapter XLIV
GENERAL OBSERVATIONS ON INVALID COOKERY
CHAPTER XLIVDiet of the Sick.—It is not possible to lay down universal laws on the diet of sick persons. Given any two persons suffering from disease, the temperament, the disease, and the needs of the one may be entirely different from those of the other. One may be in danger of collapse from weakness; another may be in a high fever. One may need to make blood and regain strength, the other may be suffering from a lifetime of overfeeding and underwork. It is evident that to feed all these people alike would be ridiculous. What suits some patients might injure others. There are besides many persons hopelessly ill, for whom food and physic can do no more than keep them alive with the least possible discomfort. One can only make the food pleasant to the eye and taste, and easily digestible, remembering always, that in the course of any long illness the human machine is so worn that the least extra strain may stop its working altogether. It is with such cases as these that the art of sick-room cookery is of most avail.
Roughly speaking, the fundamental idea of sick-room diet is (1) to select food that will provide the necessary nourishment, and will not strain any digestive organs that may be affected; (2) to compensate for any waste or drain upon the system. Untrained persons often have a superstitious faith in the cravings of the sick, and will disobey the doctor to gratify the patient. If a doctor knows his business, he ought to be trusted and obeyed. But it is well known that even in health people crave for and obtain things to eat and drink that do them harm. Why should a diseased appetite be more dependable than a healthy one?
In some cases (notably after fever) the patient develops a surprising appetite, which, in the state of his digestive organs, it would be dangerous to gratify, while other patients will actually sink from exhaustion while refusing all food.
Overfeeding gives no Strength.—Nothing is more common than to find some such reasoning as this: " All invalids are more or less weak; weakness is to be cured by food; all persons in poor health should be persuaded or coerced into taking as much food as possible." It is INVALID COOKERY.
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1.—Scrambled Egg and Chicken Cream. 3.—Quenelles of Chicken, with Peas and Fruit Jelly.
2.—Fillets of Sole and Lemon Cream. 4.—Plain Omelet, Mutton Cutlets, and Cauliflower.
forgotten that not what a man swallows feeds him, but what he is able to digest and assimilate out of what he swallows. To overload feeble digestive organs is the surest way of preventing them from doing even as much work as they could do if they were allowed to work quietly. Again, a little wise starvation is Nature's cure, and the best for many complaints.
Diet as a Cure.—There are not a few diseases where the only hope of cure or alleviation lies in rigid abstention from some sorts of food. Diet can often cure where drugs are useless or worse.
Food or Physic?—Many well known remedies are thought to be physic because they are prescribed by the doctor and sold by the chemist, but they are, in reality, foods. The best example is cod-liver oil, the most digestible of all fats, given often to consumptive and other persons, who either cannot take other fats, or who do not like any fat, and will not force themselves to swallow fat food as they do to take fat physic. Cream, or any other fat, if it is digested, answers the same purpose as oil.
Certain Rules apply to all sick-room feeding. Give little food and often. It is a mistake to persuade a patient to swallow large quantities at once. What is eaten willingly and with relish does more good than double the amount swallowed with disgust. At the same time, it must be remembered that when people are very ill they will often refuse to swallow anything, though they are actually sinking for want of food.
Let the food come at stated times, and punctually. A very weak patient faints and flags if the hour is stretched to an hour and a quarter. A convalescent looks forward to meals as the great event of the day, and frets and worries if they do not come to time. As a rule, a patient should not be awakened to be fed, though it may sometimes be necessary. Amateur nurses often forget to feed in the small hours of the morning, when the patient's strength is always at the lowest ebb. If obliged to wait a long time the patient loses the desire to eat, and often turns against the food when brought.
When there is no appetite, give such food as affords most nourishment for the least work, either to the digestive organs or to the teeth. If the patient is very weak the exertion of eating, even without mastication, is already very severe. Put the greatest amount of nourishment into the smallest space, and let the food be already divided.
Let such work of digestion as there must be fall on the part of the patient that is best able to bear it, as to which the doctor should be the best judge.
Only just so much as the patient is likely to eat should be taken into the sick-room, and what remains should be at once removed. Never keep any food standing by the bedside. Never leave food about a sick-room; if the patient cannot eat it when brought to him, take it away, and bring it to him in an hour or two's time. Miss Nightingale says: "To leave the patient's untasted food by his side from meal to meal, in hopes that he will eat it in the interval, is simply to prevent him from taking food at all. I have known patients literally incapacitated from taking one article of food after another by this piece of ignorance. Let the food come at the right time and be taken away, eaten or uneaten, at the right time; but never let the patient have 'something always standing' by him, if you don't wish to disgust him with everything."
In a case of infectious fever, all remains of food should at once be burnt, and on no account eaten by another person. The nurse should not take her meals in the sick-room.
For a convalescent the food should be as varied as possible. In the monotonous existence of the sick-room small events appear great.
For invalids, never make a large quantity of one thing, as they seldom require much at a time. Because a patient once likes a food, do not repeat it till he is tired of its very name.
If the food may not be varied, the mode of serving may. A stray flower, or a new patterned plate, is better than no variety at all. Let everything look as tempting as possible. Have a clean tray-cloth laid smoothly over the tray; let the spoons, tumblers, cups and saucers, etc., be very clean and bright. Gruel served in a tumbler is more appetising than when served in a basin, or cup and saucer. Do not put a very little broth in the bottom of a very large basin. Let all kitchen utensils used in the preparation of invalid's cookery be scrupulously clean; if this is not the case, a disagreeable flavour may be imparted to the preparation, which flavour may disgust and prevent the patient from partaking of the refreshment when brought to him or her. Invalids notice flavour more than people in health. It is generally better to cook in earthenware, glass or china, than in metal.
In Miss Nightingale's admirable "Notes on Nursing," she says: "You cannot be too careful as to quality in sick diet. A nurse should never put before a patient milk that is sour, meat or soup that is turned, an egg that is bad, or vegetables underdone." Yet often, she says, she has seen these things brought in to the sick, in a state perfectly perceptible to every nose or eye except the nurse's. It is here that the clever nurse appears—she will not bring the peccant article; but, not to disappoint the patient, she will whip up something else in a few minutes. Remember that sick cookery should half do the work of your poor patient's weak digestion. She goes on to caution nurses by saying: "Take care not to spill into your patient's saucer; in other words, take care that the outside bottom rim of his cup shall be quite dry and clean. If every time he lifts his cup to his lips he has to carry the saucer with it, or else to drop the liquid upon and to soil his sheet, or bedgown or pillow, or, if he is sitting up, his dress, you have no idea what a difference this minute want of care on your part makes to his comfort, and even to his willingness for food."
Crumbs are great enemies to the patient's comfort, and even with the greatest care they are difficult to keep out of the bed. Tuck a tablenapkin carefully round the patient's shoulders before each time of feeding.
If a feeding cup is used, scald it carefully and keep it quite clean. Warm it before using it for any hot food. Keep one for milk, and lay that in water. Have a separate cup for beef tea or broth.
No cooking may be done in the sick-room.
In Acute Disease, the diet is often limited to milk and beef tea. Inexperienced persons imagine that every liquid food is insufficient nourishment, and that the patient should be persuaded to take some solid. So far from this being true, milk is the best of all foods, the only food we could live on for a length of time without admixture of anything else. A patient who can take milk has at once a greater chance of prolonging life or recovering health.
But there are some persons who cannot take milk, in health or sickness. They will often find it agrees with them better mixed with limewater, a third or half of water to two-thirds or half of milk. Sodawater and milk is agreeable to some patients, and to some boiled milk is more digestible, especially boiled milk hot. Only in rare cases should the cream be removed. Whey has been found useful when every preparaton of fresh milk has been tried in vain. Koumiss or fermented milk is also sold in considerable quantities for the use of invalids.
Sickness and Nausea.—If the patient suffers from sickness and nausea, every food should be given iced, or as cold as possible, and in the smallest quantities, and it is a good plan to slip a tiny piece of ice into the patient's mouth immediately after taking food. Milk may be kept on ice for a long time, or, if no ice is at hand, set the jug in a tub of salt and water, or wrap a wet cloth round the jug and stand it in a draught outside the door. The slightest souring is enough to make milk disagree with a patient.
Cooking Apparatus.—In keeping anything hot in the sick-room a specially-constructed cooking apparatus is very useful. It is a box thickly padded with non-conducting material, and containing a double tin receptacle, the outer for hot water, and the inner for beef tea, or whatever has to be cooked or kept hot. The tin is filled with hot water, and retains the heat for many hours without evaporation, or giving out any smell.
Beef Tea.—Formerly, beef tea was regarded as the patient's greatest support, but now many doctors have ceased to attach much importance to it, largely owing to the difficulty of getting it properly prepared. This difficulty ought not to exist, for it is quite easy to make if the few simple rules set forth in the following recipes are strictly adhered to.
There is a wide difference in beef tea for invalids and that intended for convalescents, the former being necessarily prepared from juicy meat and at a low temperature, so as to first draw out the juices of the meat and afterwards prevent them coagulating. A more savoury and palatable preparation is the convalescents' beef-tea, usually made by subjecting either shin or neck of beef to a long, slow stewing process. In the preparation of beef-tea for invalids, juicy meat, such as buttock steaks, or top-side alone should be employed, for these parts contain the most albumen and other soluble matters, which are the nourishing constituents of the meat. Beef-tea that sets to a jelly when cold contains a smaller percentage of these constituents; and more gelatine, of which the shin of beef has a comparatively large proportion. Although gelatine possesses neither the stimulating nor nourishing properties of albumen, it has considerable value as a food substance, inasmuch as it replaces albumen in many processes in the human economy, but it is altogether unsuitable when a concentrated, nourishing liquid food is required.
Albumen, which is the life-sustaining element in the meat, is very like white of egg in its properties. White of egg will mix freely with water, as also will the juices of the meat when extracted by means of cold water. This water may be gently heated, and the albumen will still remain in solution, but when heated to about 120º or 130º F. the albumen coagulates and separates into brown particles, which are strained out of the beef-tea, the almost valueless liquid being given to the patient.
Meat Juices and Extracts.—These may be bought ready prepared; some contain little more than the salines and extractives of the meat; others may be regarded as a valuable stimulant and restorative, easily prepared and always at hand, but in serious cases none of them can replace beef-tea containing soluble albumen.
Fluid meat consists of lean meat liquified by artificial digestion, and in a fit state for immediate absorption into the body. In severe illness it is a most valuable food, and is also used for nutrient enemata. Dr. Pavy recommends the following mixture when used for this purpose: 2 ozs. of white sugar, 6 ozs. of mucilage of starch or arrowroot, with 2 tablespoonfuls of fluid meat.
Beef peptonoids and peptonised beef-jelly are also most valuable preparations for the sick-room. Unlike beef-tea and beef extracts, which consist only of the juice of the meat, more or less perfectly extracted, they are the meat itself in a fluid form, fit to be taken at once into the body without any work for the feeble digestion of the invalid.
Variety is an Essential.—In sick-room cookery, except in very serious cases, veal-tea, mutton-tea or broth, or chicken broth, should occasionally replace the beef-tea in order to prevent the patient becoming tired of it. Soups thickened with yolk of egg and cream are very nourishing, but they are also very rich, and should therefore be given sparingly even when the patient is convalescent. Meat teas, soups and broths all offer nourishment in an easily digested form, and their restorative powers are very quickly felt, hence their value in the diet of the sick and convalescent. Savoury jellies are more nourishing when made from veal or calves' feet, for they then contain not only gelatine, but also other extractives of considerable dietetic value. When variety, and not the amount of nourishment afforded, is the chief consideration, jelly may be more easily prepared from isinglass or gelatine, the purest forms of which should alone be used for the purpose.
Milk is undoubtedly a more valuable food for the sick than any kind of beef tea, juice or essence, for it supplies all that is necessary to sustain life during long periods of illness or inactivity. For young children it is also a perfect food, but for adults in health it is necessary to add other foods supplying more solid bulk.
The milk, as soon as possible after it is drawn from the cow, should be boiled and afterwards kept covered until required. For unfortunately, it is extremely susceptible to contamination, and readily absorbs any impure gases or matter.
Eggs are a very valuable food, containing all that is necessary for life in a most concentrated form. The white of an egg is equally nourishing and less rich than the yolk, and consequently may be given to a patient when the yolk would disagree. In a fluid form they are easily digested, also when very lightly cooked; but overcooked insoluble eggs generally tax a healthy digestion, and should therefore be rigidly excluded from the diet of the sick. This applies not only to eggs simply served, but also to eggs forming a part of puddings, soufflés, etc.
Fish, being light and easily digested, plays an important part in invalid diet. Whiting, sole, flounder or plaice should be selected, as these varieties contain a very small percentage of oily matter. Until the first stages of convalescence are passed, the fish should be either steamed or boiled, but afterwards, when butter is allowed, broiled or fried fish generally proves more palatable.
Seasonings and Flavourings should always be added sparingly, for in sickness the organs of taste are often in an abnormally sensitive condition.