Diet (assembly)

“ If we attended more to this point, our digestions would have sufficiently varied exercise to keep them in healthy working order, and we should hear less about what does or does not agree with people. It is of more consequence that our digestions should be permitted to work at regular hours, than that they should have an over-easy diet. ”

“ All excretions from the patient should be buried, and not committed to privies to communicate disease to those who frequent them.
The Diet contains a very important relation to health. During the process of acute disease, the appetite is generally much impaired, if not entirely absent. It should then be the study of the nurse to devise such articles of nourishment as will [pg 381] be acceptable to the patient and suitable to the condition. The food should be light, nutritious, and easy of digestion.
Each individual disease requires a diet adapted to its peculiarities. ”

“ In general it may be said that the needs of no two individuals can be satisfied with exactly the same diet. In sickness it is the province of the physician to adjust the food to the condition of the patient. In convalescence the taste of the individual and the judgment of the nurse or attendant combined will usually not fail of good results. If an individual craves a certain dish, and there is no good reason why he should not have it, by all means procure it. ”

“ Its principles are of great practical importance to the commissary of an army or to the purveyor of an institution which provides for large numbers of people; but it is neither necessary nor advisable that the diet of any healthy individual be regulated solely with a view to satisfying the actual requirements of his or her body. Food should possess other qualities than fuel value: first of all it must be appetizing, for appetizing food receives the most thorough digestion. ”

“ To be able to judge whether the food one eats daily is giving the best possible value from a physiological and economic standpoint, requires a definite knowledge of food, its source, composition and nutrient value, as well as its relation to the body in health and disease.
No one is capable of giving constructive advice upon matters pertaining to diet, unless he has acquired this knowledge through training. A nurse should obtain this training during her course in the hospital, through the class room, the wards and the diet kitchen. ”

“ It is interesting to note that hygiene and physiology classes are doing much to inculcate sound notions of diet, which, taken in conjunction with increased wages and easy accessibility of food in canteens, are doing much to prevent gastric disorders. ”

“ Chief Points to be remembered in formulating a diet and instituting an obesity treatment are the necessity for small meals and dry meals, no fluid given at all during the meal except perhaps one or two small cups of coffee per day, without sugar or cream, the avoidance of fat-forming foods, sugars and starches in all forms, milk, cream, butter and oil, potatoes, bananas, fat meats of all descriptions, especially pork, soups of every description and alcoholic or malted beverages. ”

“ Nevertheless, I have seen cases in which, after failure of the most carefully carried- out milk or meat diets, a mixed diet proved successful for a time. In such mixed diets, in fact in all diets in sprue, restriction in the amount is as important, perhaps, as the quality of the food consumed. Food should never be given unless the patient is hungry. It is a great mistake to try to make these patients fat rapidly, or to stimulate the desire for food by encouraging active exercise. The bowel is not in a condition to deal with large meals. ”

“ Granted, then, that the general health of the nation is far from what it should be, and looking from effects to causes, may we not pertinently enquire whether our diet is not largely responsible for this state of things? May it not be that wrong feeding and mal-nutrition are at the root of most disease? It needs no demonstrating that man's health is directly dependent upon what he eats, yet how few possess even the most elementary conception of the principles of nutrition in relation to health? ”

“ The number of physicians, and surgeons, and medical men, whose testimony is brought to bear on the subject of diet, in the chapter which follows, is by no means as great as it might have been. There are few writers on anatomy, physiology, materia medica, or disease, who have not, either directly or indirectly, given their testimony in favor of a mild and vegetable diet for persons affected with certain chronic diseases. And there is scarcely a writer on hygiene, or even on diet, who has not done much more than this, and at times hinted at the safety of such a diet for those who are in health ”

“ Unfortunately, many of the simplest rules relating to the development and care of the human body are as yet enveloped in mystery, or, to speak more exactly, no two authorities seem to agree upon them. The investigation of the régime in vogue in a number of sanatoria by Professor Fisher has demonstrated that scarcely any two of them agree in the diet prescribed for consumptive patients. The calorific value of the prescribed food for each person ranges, in the different institutions, between 2,000 and 5,500 calories per diem, or a difference of 250 per cent. ”

“ The patient must be urged to thoroughly masticate the food, so that it will be properly salivated and thus facilitate digestion. Patients seriously ill, should receive their food mashed or minced, so that they can partake of it more easily. All waste parts, such as skin, fat, sinews, bones, must be removed from the food, even for convalescents. Warmed up food and fibrous vegetables must be banished from the patient's diet. It must not be a question as to what the patient wants; the prescription of the physician only must govern. ”

“ The medical officer is alone competent to judge what food should be issued to patients. Visitors who criticise the diet of the patient are assuming a function which they are obviously unable to discharge. Diet sheets are provided for each ward, and on these is entered the number of different diets prescribed by the medical officer. These diet sheets should be the only and the final authority of what should be issued to the patient in the way of eatables. As it happened, ladies sometimes brought into the different wards of the hospital foods which constituted an added danger to the patient. ”

“ The patient's food habits, his tastes, inherited or acquired, are often vital considerations because the practical question in securing results is often not what diet the person needs, but what diet he can get or will take. Knowing the technique of adapting diets to individual needs in terms of food elements, calories, mineral content, vitamines, etc., is essential knowing the technique of adapting the diet in terms of the patient's food habits and financial circumstances is no less so. ”

“ Diseases of many different organs, a run-down nervous condition, too much hard work and too little rest, improper food, and disorders of the digestive tract are among the causes that may produce malnutrition, and the first measure adopted by the painfully thin person should be a frank talk with her family physician, as the diet required may not be that intended especially for increasing weight, but one that shall improve nutrition by remedying the defective working of some organ or system of the body. ”

“ Too great a variety of alimentary substances is always injurious when it becomes a temptation to excess. Thus, a much larger amount of food is taken than the wants of the body require, and more than the digestive organs have the capacity to dispose of.
It is impossible to point out to each individual the kind of diet which will suit best. This, to some extent, must be a matter of personal observation and experience. Peculiarities of constitution, habits of life, age, sex, etc., require modifications of diet in accordance with the natural wants of each individual. ”

“ In dealing with each and all of these conditions, including obesity, which is often the result of sedentary habits, the first thing to be done is to limit the quantity of food to the normal requirements of the body, and in extreme cases a diet below the normal should be observed; no one was ever made ill by underfeeding. Then, with proper care as to the selection, combination, and proportions of food, and an increased [1199] amount of exercise and deep breathing, the person of sedentary habits should be made as healthy and strong as the outdoor worker in the fields of manual labor. ”

“ In towns we often observe the bad effects of over feeding in young female servants recently arrived from the country. From being accustomed to constant exercise in the open air, and to the comparatively innutritious diet on which the labouring classes subsist, they pass all at once, with appetite, digestion, and health in their fullest vigour, to the confinement of a house, to the impure atmosphere of a crowded city, and to a rich and stimulating diet. Appetite, still keen, is freely indulged ”

“ The proper conclusion to be drawn from it is, that the permanent and exclusive use of concentrated food is not in harmony with the structure and functions of our digestive and assimilating organs, and that, therefore, instead of continuing their use, and merely resorting to purgatives to excite an action for the removal of a residue which does not exist, reason requires that we should select a diet better adapted to the constitution and laws of the organization by which it is to be acted upon. ”

“ When the above conditions become chronic, the patient loses weight and strength rapidly, becomes anemic and emaciated. The treatment, like that used in the acute disease, consists of rest and liquid diet. The medicinal treatment is left entirely in the hands of the physician. ”

“ When the blood is thus directed, nutrition is more vigorous and the activity of all the functions is augmented.
Not only should there be regularity in eating, but sound discretion should be exercised in selecting a plain, wholesome diet, consisting of such articles of food as best favor a daily and free evacuation of the bowels. Avoid the use of those articles of food which produce excessive acidity of the stomach. Hearty or late suppers are not allowable. [pg 783] The patient should use no alcoholic beverages, and should abstain from such stimulants as tea, coffee, beer, wine, and tobacco. ”

“ Such is the dose for a bottle of water Paris measure; but as the patient ought to drink two pints a day, you may make several pints at a time in the above proportion.
In these two distempers the patients must be supported with good nourishment, and made to sweat copiously. It would be a mistake to think that they ought to be kept to a spare diet; you must give them nourishing food, but a little at a time. ”

“ We need a far more complete knowledge than we possess at present of the laws governing nutrition; we need fuller knowledge of the methods by which the most complete, satisfactory, and economical utilisation of the diet can be obtained; we need to know more concerning the minimum diet and the minimum amount of proteid or albuminous foods on which health, mental and physical vigour can be permanently maintained ”

“ Many famous systems of reduction by restricted diet have been given to the world, but most of them are so severe that they should only be used under the direction of a physician. All of these systems require a reduction of the total amount of food taken, a restriction of the quantity of fluid allowed, and a more or less strict avoidance of those food substances which are most readily turned into fat in the body. ”

“ These people also regained their health, but it took them a year at minimum, and once well they had to remain on a diet tailor-made to their digestive capacity for the rest of their life, usually along with food supplements. ”

“ Each patient on a semi-solid diet usually requires nourishment between meals, and as milk enters largely into the composition of the semi-solid diet, about the same amount will be necessary as for liquid diets. ”

“ The elementary textures being thus differently proportioned in different individuals, it follows that the aliment best suited for the support and repair of one is not always so for the others; in other words, a distinct modification of diet ought to be adopted for every marked variety of constitution, because a direct relation ought always to subsist between the qualities of the food and the nature of the system which it is intended to nourish. ”

“ That the dietary errors arising in this country are largely due to disturbance of the balance in the diet because of change of environment, new scales of prices, etc.; and that the problem before the dietitian is not so much to introduce a complete "American" dietary, as it is to restore the former dietary balance by supplying lost elements. ”

“ One of the greatest difficulties attending the administering of the high calorie diet is persuading the patient to take sufficient food for his needs. The fluids are often more difficult to give in quantity than the more solid foods, and it requires much tact on the part of the nurse to prevent a refusal of the necessary fluids. However, if the patient is possessed of even ordinary intelligence, an explanation of the reasons for the large amount of food will as a rule be all that is necessary. ”

“ The habitual foods of the nationality or race dealt with must be in the mind of the person who prepares the diet list, if it is to be of much real service. This means that the dietary problems of patients need to be handled by dietitians, visiting nurses, or social workers who have some knowledge of foreign as well as of the characteristic American diet. The average visiting nurse or medical-social service worker cannot become an expert in dietetics, and must depend upon the advisory dietitian or the visiting housekeeper. ”