Florence Nightingale

“ I have often seen the private nurse go on dusting or fidgeting about in a sick room all the while the patient is eating or trying to eat.
That the more alone an invalid can be when taking food, the better, is unquestionable; and, even if he must be fed, the nurse should not allow him to talk, or talk to him, especially about food, while eating. ”

“ Upon the observance of these rules, especially the first, often depends the patient's capability of taking food at all, or, if he is amiable and forces himself to take food, of deriving any nourishment from it.
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 undone. Yet often I have 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 ”

“ Generally, the only rule of the private patient's diet is what the nurse has to give. It is true she cannot give him what she has not got; but his stomach does not wait for her convenience, or even her necessity. [2] If it is used to having its stimulus at one hour to-day, and to-morrow it does not have it, because she has failed in getting it, he will suffer. She must be always exercising her ingenuity to supply defects, and to remedy accidents which will happen among the best contrivers, but from which the patient does not suffer the less, because "they cannot be helped." ”

“ The main question is what the patient's stomach can assimilate or derive nourishment from, and of this the patient's stomach is the sole judge. Chemistry cannot tell this. The patients stomach must be its own chemist. The diet which will keep the healthy man healthy, will kill the sick one. The same beef which is the most nutritive of all meat and which nourishes the healthy man, is the least nourishing of all food to the sick man, whose half-dead stomach can assimilate no part of it, that is, make no food out of it. ”

“ Every careful observer of the sick will agree in this, that thousands of patients are annually starved in the midst of plenty, from want of attention to the ways which alone make it possible for them to take food. This want of attention is as remarkable in those who urge upon the sick to do what is quite impossible to them, as in the sick themselves who will not make the effort to do what is perfectly possible to them. ”

“ I wish the recommenders would themselves try the experiment of substituting a piece of bread for a cup of tea or coffee, or beef tea, as a refresher. They would find it a very poor comfort. When soldiers have to set out fasting on fatiguing duty, when nurses have to go fasting in to their patients, it is a hot restorative they want, and ought to have, before they go, not a cold bit of bread. And dreadful have been the consequences of neglecting this. If they can take a bit of bread with the hot cup of tea, so much the better, but not instead of it. ”

“ Arrow-root is another grand dependence of the nurse. As a vehicle for wine, and as a restorative quickly prepared, it is all very well. But it is nothing but starch and water. Flour is both more nutritive, and less liable to ferment, and is preferable wherever it can be used.
Again, milk, and the preparations from milk, are a most important article of food for the sick. Butter is the lightest kind of animal fat, and though it wants the sugar and some of the other elements which there are in milk, yet it is most valuable both in itself and in enabling the patient to eat more bread. ”

“ But how often do we hear a mutton-chop, an egg, a bit of bacon, ordered to a patient for breakfast, to whom (as a moment's consideration would show us) it must be quite impossible to masticate such things at that hour. ”

“ In the great majority of cases, the stomach of the patient is guided by other principles of selection than merely the amount of carbon or nitrogen in the diet. No doubt, in this as in other things, nature has very definite rules for her guidance, but these rules can only be ascertained by the most careful observation at the bed-side. She there teaches us that living chemistry, the chemistry of reparation, is something different from the chemistry of the laboratory. Organic chemistry is useful, as all knowledge is, when we come face to face with nature ”

“ For weak patients have generally feverish nights, and, in the morning, dry mouths; and, if they could eat with those dry mouths, it would be the worse for them. A spoonful of beef-tea, of arrowroot and wine, of egg flip, every hour, will give them the requisite nourishment, and prevent them from being too much exhausted to take at a later hour the solid food, which is necessary for their recovery. And every patient who can swallow at all can swallow these liquid things, if he chooses. ”

“ Sleeplessness in the early night is from excitement generally, and is increased by tea or coffee; sleeplessness which continues to the early morning is from exhaustion often, and is relieved by tea. The only English patients I have ever known refuse tea, have been typhus cases, and the first sign of their getting better was their craving again for tea. In general, the dry and dirty tongue always prefers tea to coffee, and will quite decline milk, unless with tea. Coffee is a better restorative than tea, but a greater impairer of the digestion. Let the patient's taste decide. ”

“ That it is a fatal mistake there is no doubt. It seems, though very little is known on the subject, that what "assimilates" itself directly, and with the least trouble of digestion with the human body, is the best for the above circumstances. Bread requires two or three processes of assimilation, before it becomes like the human body.
The almost universal testimony of English men and women who have undergone great fatigue, such as riding long journeys without stopping or sitting up for several nights in succession, is that they could do it best upon an occasional cup of tea—and nothing else. ”

“ A patient should, if possible, not see or smell either the food of others, or a greater amount of food than he himself can consume at one time, or even hear food talked about or see it in the raw state. ”

“ But, if fresh milk is so valuable a food for the sick, the least change or sourness in it, makes it of all articles, perhaps, the most injurious; diarrhœa is a common result of fresh milk allowed to become at all sour. The nurse therefore ought to exercise her utmost care in this. ”

“ Cream, in many long chronic diseases, is quite irreplaceable by any other article whatever. It seems to act in the same manner as beef tea, and to most it is much easier of digestion than milk. In fact, it seldom disagrees. Cheese is not usually digestible by the sick, but it is pure nourishment for repairing waste ”

“ In the diseases produced by bad food, such as scorbutic dysentery and diarrhœa, the patient's stomach often craves for and digests things, some of which certainly would be laid down in no dietary that ever was invented for sick, and especially not for such sick These are fruit, pickles, jams, gingerbread, fat of ham or bacon, suet, cheese, butter, milk. ”

“ It has been observed that a small quantity of beef tea added to other articles of nutrition augments their power out of all proportion to the additional amount of solid matter.
The reason why jelly [6] should be innutritious and beef too nutritious to the sick, is a secret yet undiscovered, but it clearly shows that careful observation of the sick is the only clue to the best dietary.
Chemistry has as yet afforded little insight into the dieting of sick. All that chemistry can tell us is the [30] amount of "carboniferous" or "nitrogenous" elements discoverable in different dietetic articles. ”

“ If she happens to have a fresh jelly, or fresh fruit, she will frequently give it to the patient half an hour after his dinner, or at his dinner, when he cannot possibly eat that and the broth too—or, worse still, leave it by his bed-side till he is so sickened with the sight of it, that he cannot eat it at all. ”

“ It is an oily starchy nut, having no restoritive at all, but simply increasing fat. It is pure mockery of the sick, therefore, to call it a substitute for tea. For any renovating stimulus it has, you might just as well offer them chestnuts instead of tea.
An almost universal error among nurses is in the bulk of the food, and especially the drinks they offer to their patients. Suppose a patient ordered 4 oz. brandy during the day, how is he to take this if you make it into four pints with diluting it? The same with tea and [35] beef tea, with arrowroot, milk, &c. ”

“ When a person is compelled, by the pressure of occupation, to continue his business while sick, it ought to be a rule WITHOUT ANY EXCEPTION WHATEVER, that no one shall bring business to him or talk to him while he is [19] taking food, nor go on talking to him on interesting subjects up to the last moment before his meals, nor make an engagement with him immediately after, so that there be any hurry of mind while taking them. ”

“ An egg, whipped up with wine, is often the only form in which they can take this kind of nourishment. Again, if the patient has attained to eating meat, it is supposed that to give him meat is the only thing needful for his recovery ”

“ They often crave for sweetmeats and jams.
Jelly is another article of diet in great favor with nurses and friends of the sick; even if it could be eaten solid, it would not nourish; but it is simply the height of folly to take 1⁄8 oz. of gelatine and make it into a certain bulk by dissolving it in water and then to give it to the sick, as if the mere bulk represented nourishment. It is now known that jelly does not nourish, that it has a tendency to produce diarrhœa,—and to trust to it to repair the waste of a diseased constitution is simply to starve the sick under the guise of feeding them. ”

“ But in chronic cases, lasting over months and years, where the fatal issue is often determined at last by mere protracted starvation, I had rather not enumerate the instances which I have known where a little ingenuity, and a great deal of perseverance, might, in all probability, have averted the result. ”

“ In very weak patients there is often a nervous difficulty of swallowing, which is so much increased by any other call upon their strength that, unless they have their food punctually at the minute, which minute again must be arranged so as to fall in with no other minute's occupation, they can take nothing till the next respite occurs—so that an unpunctuality or delay of ten minutes may very well turn out to be one of two or three hours. ”

“ You have not increased the nourishment, you have not increased the renovating power of these articles, by increasing their bulk, you have very likely diminished both by giving the patient's digestion more to do, and most likely of all, the patient will leave half of what he has been ordered to take, because he cannot swallow the bulk with which you have been pleased to invest it. ”

“ And the patient's stomach was right and the book was wrong. The articles craved for, in these cases, might have been principally arranged under the two heads of fat and vegetable acids.
There is often a marked difference between men and women in this matter of sick feeling. Women's digestion is generally slower.
[5] Chicken broth, with the fat well skimmed off, is, to most patients, more palatable than beef tea. ”

“ SALT BEEF OR PORK, WITH MASHED BEANS, FOR ONE HUNDRED MEN.
Put in two vessels 371⁄2 lbs. meat each; divide 24 lbs. beans in four pudding cloths, loosely tied; putting to boil at the same time as your meat, in sufficient water; let all boil gently for two hours; take out the meat and beans; put all the meat into one boiler, and remove the liquor from the other; into which turn out the beans; add to them two teaspoonfuls of pepper, a pound of fat, and with the wooden spatular mash the beans, and serve with the meat. Six sliced onions fried and added improves the dish. ”

“ This can be prepared at any country corn mill, is a cheap and valuable article of diet for the sick. It can be boiled or baked. In the latter form, a sauce made with a little sugar, butter and lemon juice, or vinegar, renders it very palatable. When boiled it is usually eaten with a little butter and salt. ”

“ It is made a frequent recommendation to persons about to incur great exhaustion, either from the nature of the service, or from their being not in a state fit for it, to eat a piece of bread before they go. ”

“ Take 10 lbs. flour, 15 teaspoonfuls of salt, 7 of ground pepper, 7 lbs. chopped fat pork or suet, 5 pints water; mix well together; divide into about 150 pieces; which roll in flour, and boil with meat for 20 or 30 minutes.—If no fat or suet can be obtained, take the same ingredients, adding a little more water, and boil about 10 minutes. Serve with the meat.
No. 5.
TO FRY MEAT.
Place your pan on the fire for a minute or so; wipe it clean; when the pan is hot, put in either fat or butter [5] (fat from salt meat is preferable) ; then add the meat you are going to cook ”