*** START OF THE PROJECT GUTENBERG EBOOK 49833 ***

DIRECTIONS

FOR

COOKING BY TROOPS,

IN

CAMP AND HOSPITAL,

PREPARED FOR THE ARMY OF VIRGINIA, AND PUBLISHED
BY ORDER OF THE SURGEON GENERAL:

WITH ESSAYS ON

"TAKING FOOD," AND "WHAT FOOD,"

BY FLORENCE NIGHTINGALE.


 J. W. RANDOLPH:
 121 MAIN STREET, RICHMOND, VA.
 1861.




Directions for Cooking in Camp.


No. 1.

COFFEE FOR ONE HUNDRED MEN, ONE PINT EACH.

Put 12 gallons water into a suitable vessel (or divide if necessary),
on the fire; when boiling, add 3 lbs. ground coffee, mix well with a
spoon; leave on the fire a few minutes longer; take it off, and pour in
½ a gallon cold water; let it stand till the dregs subside, say from 5
to 10 minutes; then pour off and add 6 lbs. sugar. If milk is used, put
in 12 pints, and diminish the water by that amount.


No. 2.

FRESH BEEF SOUP FOR ONE HUNDRED MEN.

Take 75 lbs. beef; cut into pieces of about ¼ lb. each; 15 gallons
water; 8 lbs. mixed vegetables; 10 small tablespoonfuls salt; 2 small
tablespoonfuls ground pepper; some cold bread, crackers, or 3 lbs.
rice, to thicken; place on the fire; let it come to a boil; then simmer
for 3 hours. Skim off the fat and serve.


No. 3.

SOYER'S STEW FOR ONE HUNDRED MEN.

Cut 50 lbs. fresh beef in pieces of about ¼ lb. each, and with 18
quarts of water put into the boiler; add 10 tablespoonfuls of salt, two
of pepper, 7 lbs. onions, cut in slices, and 20 lbs. potatoes peeled
and sliced; stir well, and let it boil for 20 or 30 minutes; then add
1½ lbs. flour previously mixed with water; mix well together, and with
a moderate heat simmer for about two hours. Mutton, veal or pork can be
stewed in a similar manner, but will take half an hour less cooking. A
pound of rice or plain dumplings may be added with great advantage.


No. 4.

SUET DUMPLINGS.

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 (fat from salt meat
is preferable); then add the meat you are going to cook; turn it
several times, to have it equally done; season to each pound a small
teaspoonful of salt and a quarter of pepper. A few onions in the
remaining fat, with the addition of a little flour, a quarter pint of
water, two tablespoonfuls of vinegar, or a few chopped pickles, will be
very relishing.


No. 6.

TO COOK SALT BEEF OR PORK.

Put the meat, cut in pieces of from 3 to 4 lbs., to soak the night
before; in the morning wash in fresh water, and squeeze well with the
hands to extract the salt; after which, put in your kettle with a pint
of water to each pound, and boil from 2 to 3 hours.


No. 7.

SALT BEEF OR PORK, WITH MASHED BEANS, FOR ONE HUNDRED MEN.

Put in two vessels 37½ 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.

[NOTE.—In cooking all kinds of meat, be careful to preserve the grease,
which can be easily done by putting the liquor in which it is boiled,
by till it cools; then skim off and place in a clean covered vessel. It
is an excellent substitute for butter; is useful for cooking purposes,
and will burn in a common lamp or tin plate with a piece of old cotton
twisted up for a wick.]




Directions for Cooking in Hospital.


No. 1.

MUTTON STEWED AND SOUP FOR ONE HUNDRED MEN.

Put in a convenient sized vessel 16 gallons water, 60 lbs. meat,
12 lbs. plain mixed vegetables, 9 lbs. pearl barley or rice (or 4½
lbs. each), 1½ lbs. salt, 1¼ lbs. flour, 1 oz. pepper. Put all the
ingredients, except the flour, into the pan; set it on the fire, and
when beginning to boil, diminish the heat, and simmer gently for two
hours and a half; take the meat out and keep warm; add to the soup your
flour, which you have mixed with enough water to form a light batter;
stir well together with a large spoon; boil another half hour; skim
off the fat, and serve the meat and soup separate. The soup should be
stirred occasionally while making, to prevent burning or sticking.


No. 2.

BEEF SOUP.

Proceed the same as for mutton, only leave the meat in till serving, as
it takes longer to cook than mutton. The pieces are not to be above 4
or 5 lbs. weight each.


No. 3.

BEEF TEA, SIX PINTS.

Cut three pounds lean beef into pieces the size of walnuts, and break
up the bones (if any); put it into a convenient sized kettle, with ½
lb. mixed vegetables (onions, celery, turnips, carrots, or one or two
of these, if all are not to be obtained), 1 oz. salt, a little pepper,
2 oz. butter, ½ pint of water. Set it on a sharp fire for 15 minutes,
stirring occasionally, till it forms a rather thick gravy at the
bottom, but not brown; then add 7 pints of hot water; simmer gently for
an hour. Skim off all the fat, strain through a sieve and serve.


No. 4.

THICK BEEF TEA.

Dissolve a teaspoonful of arrow-root in a gill of water, and pour it
into the beef tea twenty minutes before passing through the seive, or
add ¼ oz. gelatine to the above quantity of beef tea, when cooking.

Mutton and veal will make good tea, by proceeding the same as above.


No. 5.

ESSENCE OF BEEF.

Take 1 lb. lean beef, cut fine; put it into a porter bottle with a tea
cup of water, ½ teaspoonful of salt, a little pepper, and 6 grains
allspice; cork loosely, and place in a saucepan of cold water; then
with a gentle heat let it simmer till sufficient quantity of the
essence is obtained. Serve either warm or cold.


No. 6.

CHICKEN BROTH.

Put in a stew-pan a fowl, 3 pints water, 2 teaspoonfuls of rice, 1
of salt, a little pepper and a small onion, or two ounces of mixed
vegetables; boil the whole gently for one hour (if an old fowl, simmer
for two hours, adding one pint more water.) Skim off the fat and serve.

A light mutton broth may be made in the same way, taking 1½ pounds
mutton—neck if convenient.


No. 7.

PLAIN BOILED RICE.

Put 2 quarts water in a stew pan with a teaspoonful of salt; when
boiling, add to it ½ pound rice, well washed; boil for ten minutes;
drain off the water and slightly grease the pan with butter; put the
rice back, and let it swell slowly for about twenty minutes, near the
fire. Each grain will then swell up, and be well separated. Flavor with
nutmeg or cinnamon, and sweeten to taste.


No. 8.

SAGO JELLY.

Put in a pan with 3 pints water, 3 oz. sago, 1½ oz. sugar, half a lemon
peel, cut very thin, ¼ teaspoonful of ground cinnamon, or a small
stick of the same, and a little salt; boil about 15 minutes, stirring
constantly, then add a little port, sherry or madeira wine, as the case
will admit.


No. 9.

ARROW-ROOT MILK.

Put in a pan 4 oz. arrow-root, 3 oz. sugar, the peel of half a lemon, ¼
teaspoonful of salt, 2½ pints of milk; set it on the fire; stir gently;
boil for ten minutes, and serve.

If no lemons at hand, a little essence of any kind will do.

When short of milk, use half water—half an ounce of butter is an
improvement.


No. 10.

ARROW-ROOT WATER.

Put in a pan 3 oz. arrow-root, 2 oz. white sugar, the peel of a lemon,
¼ teaspoonful of salt, and 4 pints water; mix well, set on the fire,
and boil for ten minutes. Serve hot or cold.


No. 11.

RICE WATER.

Put 7 pints water to boil; add 2 oz. rice, washed, 2 oz. sugar, the
peel of two-thirds of a lemon, boil gently for three quarters of an
hour, or till reduced to 5 pints. Strain and serve—use as a beverage.


No. 12.

BARLEY WATER.

Put in a saucepan 7 pints water, 2 oz. pearl barley; stir now and then
when boiling; add 2 oz. white sugar, the rind of half a lemon, thinly
peeled; boil gently for two hours, and serve, either strained or with
the barley left in.


No. 13.

CRIMEAN LEMONADE.

Put in a basin 2 tablespoonfuls of white or brown sugar, ½ a
tablespoonful of lime juice, mix well together, and add one pint of
water.


No. 14.

CITRIC ACID LEMONADE.

Dissolve 1 oz. citric acid in one pint of cold water; add 1 lb. 9 oz.
white sugar; mix well to form a thick syrup; then put in 19 pints cold
water, slowly mixing well.


No. 15.

TOAST AND WATER.

Cut a piece of crusty bread about ¼ lb.; toast gently and uniformly
to a light yellow color; then place near the fire, and when of a good
brown chocolate, put in a pitcher; pour on it 3 pints boiling water;
cover the pitcher, and when cold, strain—it is then ready for use.
Never leave the toast in, as it causes fermentation in a short time.

A piece of apple, slowly toasted till it gets quite black, and added to
the above, makes a very refreshing drink.




"TAKING FOOD."




"TAKING FOOD."


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.

For instance, to the large majority of very weak patients it is quite
impossible to take any solid food before 11 A. M., nor then, if their
strength is still further exhausted by fasting till that hour. 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. 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.

Again, a nurse is ordered to give a patient a tea-cup full of some
article of food every three hours. The patient's stomach rejects
it. If so, try a table-spoonfull every hour; if this will not do, a
tea-spoonfull every quarter of an hour.

I am bound to say, that I think more patients are lost by want of care
and ingenuity in these momentous minutiæ in private nursing than in
public hospitals. And I think there is more of the _entente cordiale_
to assist one another's hands between the Doctor and his head Nurse
in the latter institutions, than between the doctor and the patient's
friends in the private house.

If we did but know the consequences which may ensue, in very
weak patients, from ten minutes' fasting or repletion (I call it
repletion when they are obliged to let too small an interval elapse
between taking food and some other exertion, owing to the nurse's
unpunctuality), we should be more careful never to let this occur. 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. And why is it not as easy to be punctual to
a minute? Life often literally hangs upon these minutes.

In acute cases, where life or death is to be determined in a few hours,
these matters are very generally attended to, especially in Hospitals;
and the number of cases is large where the patient is, as it were,
brought back to life by exceeding care on the part of the Doctor
or Nurse, or both, in ordering and giving nourishment with minute
selection and punctuality.

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. The consulting the hours when the patient can
take food, the observation of the times, often varying, when he is most
faint, the altering seasons of taking food, in order to anticipate and
prevent such times—all this, which requires observation, ingenuity, and
perseverance (and these really constitute the good Nurse), might save
more lives than we wot of.[1]

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 any 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 a patient have
"something always standing" by him, if you dont wish to disgust him of
everything.

On the other hand, I have known a patient's life saved (he was sinking
for want of food) by the simple question, put to him by the doctor,
"But is there no hour when you feel you could eat?" "Oh, yes," he said,
"I could always take something at — o'clock and — o'clock." The thing
was tried and succeeded. Patients very seldom, however, can tell this;
it is for you to watch and find it out.

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. I know
of no exception to the above rule. The breaking of it always induces a
greater or less incapacity of taking food.

In hospital wards it is of course impossible to observe all this; and
in single wards, where a patient must be continuously and closely
watched, it is frequently impossible to relieve the attendant, so that
his or her own meals can be taken out of the ward. But it is not the
less true that, in such cases, even where the patient is not himself
aware of it, his possibility of taking food is limited by seeing the
attendant eating meals under his observation. In some cases the sick
are aware of it, and complain. A case where the patient was supposed to
be insensible, but complained as soon as able to speak, is now present
to my recollection.

Remember, however, that the extreme punctuality in well-ordered
hospitals, the rule that nothing shall be done in the ward while
the patients are having their meals, go far to counterbalance what
unavoidable evil there is in having patients together. 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.

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 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.

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; she will not bring in 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. But if you further impair
it with your bad articles, I know not what is to become of him or of it.

If the nurse is an intelligent being, and not a mere carrier of diets
to and from the patient, let her exercise her intelligence in these
things. How often we have known a patient eat nothing at all in the
day, because one meal was left untasted (at that time he was incapable
of eating), at another the milk was sour, the third was spoiled by
some other accident. And it never occurred to the nurse to extemporize
some expedient,—it never occurred to her that as he had had no solid
food that day he might eat a bit of toast (say) with his tea in the
evening, or he might have some meal an hour earlier. A patient who
cannot touch his dinner at two, will often accept it gladly, if brought
to him at seven. But some how nurses never "think of these things."
One would imagine they did not consider themselves bound to exercise
their judgment; they leave it to the patient. Now I am quite sure that
it is better for a patient rather to suffer these neglects than to try
to teach his nurse to nurse him, if she does not know how. It ruffles
him, and if he is ill he is in no condition to teach, especially upon
himself. The above remarks apply much more to private nursing than to
hospitals.

I would say to the nurse, have a rule of thought about your patient's
diet; consider, remember how much he has had, and how much he ought to
have to-day. 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."

One very minute caution,—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 his bed-gown, or pillow, or if
he is siting 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.




"WHAT FOOD."




"WHAT FOOD."


I will mention one or two of the most common errors among women in
charge of sick respecting sick diet.—One is the belief that beef tea is
the most nutritive of all articles. Now, just try and boil down a lb.
of beef into beef tea, evaporate your beef tea and see what is left of
your beef. You will find that there is barely a teaspoonful of solid
nourishment to half a pint of water in beef tea; nevertheless there is
a certain reparative quality in it, we do not know what, as there is in
tea;—but it may safely be given in almost any inflammatory disease, and
is as little to be depended upon with the healthy or convalescent where
much nourishment is required. Again, it is an ever ready saw that an
egg is equivalent to a lb. of meat,—whereas it is not at all so. Also,
it is seldom noticed with how many patients, particularly of nervous or
bilious temperament, eggs disagree. All puddings made with eggs, are
distasteful to them in consequence. 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; whereas
scorbutic sores have been actually known to appear among sick persons
living in the midst of plenty in England, which could be traced to no
other source than this, viz.: that the nurse, depending on meat alone,
had allowed the patient to be without vegetables for a considerable
time, these latter being so badly cooked that he always left them
untouched. 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. Flour, oats, groats,[3]
barley, and their kind, are, as we have already said; preferable in
all their preparations to all the preparations of arrowroot, sago,
tapioca, and their kind. 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;
and I have seen sick, and not a few either, whose craving for cheese
showed how much it was needed by them.[4]

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. In large institutions for the sick, even the poorest, the utmost
care is exercised. Wenham Lake ice is used for this express purpose
every summer, while the private patient, perhaps, never tastes a drop
of milk that is not sour, all through the hot weather, so little does
the private nurse understand the necessity of such care. Yet, if you
consider that the only drop of real nourishment in your patient's tea
is the drop of milk, and how much almost all English patients depend
upon their tea, you will see the great importance of not depriving your
patient of this drop of milk. Buttermilk, a totally different thing, is
often very useful, especially in fevers.

In laying down rules of diet, by the amounts of "solid nutriment"
in different kinds of food, it is constantly lost sight of what the
patient requires to repair his waste, what he can take and what he
can't. You cannot diet a patient from a book, you cannot make up
the human body as you would make up a prescription,—so many parts
"carboniferous," so many parts "nitrogeneous" will constitute a perfect
diet for the patient. The nurse's observation here will materially
assist the Doctor—the patient's "fancies" will materially assist
the nurse. For instance, sugar is one of the most nutritive of all
articles, being pure carbon, and is particularly recommended in some
books. But the vast majority of all patients in England, young and old,
male and female, rich and poor, hospital and private, dislike sweet
things,—and while I have never known a person take to sweets when he
was ill who disliked them when he was well, I have known many fond of
them when in health who in sickness would leave off anything sweet,
even to sugar in tea,—sweet puddings, sweet drinks, are their aversion;
the furred tongue almost always likes what is sharp or pungent.
Scorbutic patients are an exception. 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 ⅛ 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. If 100 spoonfuls of jelly were given in the course of the day,
you would have given one spoonful of gelatine, which spoonful has no
nutritive power whatever.

And, nevertheless, gelatine contains a large quantity of nitrogen,
which is one of the most powerful elements in nutrition; on the other
hand, beef tea may be chosen as an illustration of great nutrient power
in sickness, co-existing with a very small amount of solid nitrogenous
matter.

Dr. Christison says that "every one will be struck with the readiness
with which" certain classes of "patients will often take diluted meat
juice or beef tea repeatedly, when they refuse all other kinds of
food." This is particularly remarkable in "cases of gastric fever in
which," he says, "little or nothing else besides beef tea or diluted
meat juice" has been taken for weeks or even months, "and yet a pint
of beef tea contains scarcely ¼ oz. of anything but water,"—the result
is so striking that he asks what is its mode of action? "Not simply
nutrient—¼ oz. of the most nutritive material cannot nearly replace the
daily wear and tear of the tissues in any circumstances. Possibly," he
says, "it belongs to a new denomination of remedies."[5]

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 amount of "carboniferous" or
"nitrogenous" elements discoverable in different dietetic articles. It
has given us lists of dietetic substances, arranged in the order of
their richness in one or other of these principles; but that is all.
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; but it by no means follows that we should learn in the
laboratory any one of the reparative processes going on in disease.

Again, the nutritive power of milk and of the preparations from milk,
is very much undervalued; there is nearly as much nourishment in half
a pint of milk as there is in a quarter of a lb. of meat. But this is
not the whole question or nearly the whole. 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. On a diet of beef tea healthy men on the other hand speedily
lose their strength.

I have known patients live for many months without touching bread,
because they could not eat bakers' bread. These were mostly country
patients, but not all. Homemade bread or brown bread is a most
important article of diet for many patients. The use of aperients may
be entirely superseded by it. Oat cake is another.

To watch for the opinions, then, which the patient's stomach gives,
rather than to read "analyses of foods," is the business of all
those who have to settle what the patient is to eat—perhaps the most
important thing to be provided for him after the air he is to breathe.

Now the medical man who sees the patient only once a day, or even only
once or twice a week, cannot possibly tell this without the assistance
of the patient himself, or of those who are in constant observation on
the patient. The utmost the medical man can tell is whether the patient
is weaker or stronger at this visit than he was at the last visit. I
should, therefore, say that incomparably the most important office of
the nurse after she has taken care of the patient's air, is to take
care to observe the effect of his food, and report it to the medical
attendant.

It is quite incalculable the good that would certainly come from such
_sound_ and close observation in this almost neglected branch of
nursing, or the help it would give to the medical man.

A great deal too much against tea[7] is said by wise people, and a
great deal too much of tea is given to the sick by foolish people. When
you see the natural and almost universal craving in English sick for
their "tea," you cannot but feel that nature knows what she is about.
But a little tea or coffee restores them quite as much as a great deal,
and a great deal of tea, and especially of coffee, impairs the little
power of digestion they have. Yet a nurse, because she sees how one
or two cups of tea or coffee restores her patient, thinks that three
or four cups will do twice as much. This is not the case at all; it
is, however, certain that there is nothing yet discovered which is a
substitute to the English patient for his cup of tea; he can take it
when he can take nothing else, and he often can't take anything else
if he has it not. I should be very glad if any of the abusers of tea
would point out what to give to an English patient after a sleepless
night, instead of tea. If you give it at 5 or 6 o'clock in the
morning, he may even sometimes fall asleep after it, and get perhaps
his only two or three hours' sleep during the twenty-four. At the same
time you never should give tea or coffee to the sick, as a rule, after
5 o'clock in the afternoon. 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. You will say that, in
cases of great thirst, the patient's craving decides that it will drink
_a great deal_ of tea, and that you cannot help it. But in these cases
be sure that the patient requires diluents for quite other purposes
than quenching the thirst; he wants a great deal of some drink, not
only of tea, and the doctor will order what he is to have, barley water
or lemonade, or soda water and milk, as the case may be.

Lehman, quoted by Dr. Christison, says that, among the well and active,
"the infusion of 1 oz. of roasted coffee daily will diminish the waste
going on in the body by one-fourth," and Dr. Christison adds that tea
has the same property. Now this is actual experiment. Lehman weighs
the man and finds the fact from his weight. It is not deduced from
any "analysis" of food. All experience among the sick shows the same
thing.[8]

Cocoa is often recommended to the sick in lieu of tea or coffee. But
independently of the fact that English sick very generally dislike
cocoa, it has quite a different effect from tea or coffee. 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 beef
tea, with arrowroot, milk, &c. 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. It
requires very nice observation and care (and meets with hardly any) to
determine what will not be too thick or strong for the patient to take,
while giving him no more than the bulk which he is able to swallow.




FOOTNOTES


[1] A patient should never be asked if he will have any particular
article of food; let it be prepared, and brought to him, without any
questioning on the part of the nurse.

[2] Why, because the nurse has not got some food to-day which the
patient takes, can the patient wait four hours for food to-day, who
could not wait two hours yesterday? Yet this is the only logic one
generally hears. On the other hand, the other logic, viz: of the
nurse giving the patient a thing because she _has_ got it, is equally
fatal. 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.

[3] "Groats," or _grits_, a coarse ground corn meal, or _very_ small
hominy, fanned and sifted. 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.

[4] 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. These cases I have seen not by ones, nor by tens, but by
hundreds. 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.

[6] Another most excellent dietetic article is biscuit jelly, made
according to the following formula:

BISCUIT JELLY.—_Biscuit_, crushed, 4 oz.—cold water, 2 quarts; soak
for some hours; boil to one half; strain; evaporate to one pint; then
flavor with sugar, red wine and cinnamon.

_Parched Corn_, powdered and sweetened to suit the taste, is
recommended as a pleasant and nutritious diet for invalids.

In a Southern convalescent, one of the most desirable things that can
be given them is _thin_ corn meal, ground, well boiled, seasoned with
salt, and presented while hot.

[7] 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. 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. The fact that their is more nourishment in bread than
in almost anything else has probably induced the mistake. 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.

Let experience, not theory, decide upon this as upon all other things.

[8] In making coffee, it is absolutely necessary to buy it in the berry
and grind it at home. Otherwise you may reckon upon its containing
a certain amount of chicory, _at least_. This is not a question of
the taste, or of the wholesomeness of chicory. It is that chicory
has nothing at all of the properties for which you give coffee. And
therefore you may as well not give it.

Again, all laundresses, mistresses of dairy-farms, head nurses, (I
speak of the good old sort only—women who unite a good deal of hard
manual labor with the head-work necessary for arranging the day's
business, so that none of it shall tread upon the heels of something
else,) set great value, I have observed, upon having a high-priced
tea. This is called extravagant. But these women are "extravagant"
in nothing else. And they are right in this. Real tea-leaf tea alone
contains the restorative they want; which is not to be found in
sloe-leaf tea.

The mistresses of houses, who cannot even go over their own house once
a day, are incapable of judging for these women. For they are incapable
themselves, to all appearance, of the spirit of arrangement (no small
task) necessary for managing a large ward or dairy.




SCIENCE OF WAR!

TACTICS

FOR

OFFICERS

OF

INFANTRY, CAVALRY AND ARTILLERY.

ARRANGED AND COMPILED BY

L. v. BUCKHOLTZ.

One Volume, 12mo, Price 75 cts. by mail, post paid.


      ARMORY, RICHMOND, VA., Jan'y 8, 1861.

J. W. BANDOLPH—_Dear Sir_:—I have only had time to look over the
Military work of Capt. _Buckholtz_, because of my pressing duties,
yet I am satisfied that, if printed, much valuable information to our
citizen soldiery will be furnished.

The popular works upon military matters, now before the public, are
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different arms to act most favorably—information most essential to
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number of well drilled and well manœuvered troops, and this information
Capt. Buckholtz furnishes in his work.

I have no hesitation in recommending it.

      Very respectfully yours,
      CHARLES DIMMOCK, Capt., &c., &c.


Published and for sale by

J. W. RANDOLPH, Richmond, Va.

Also for sale by Booksellers generally.




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Established 1833.

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NEW MILITARY WORK

ON

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Prepared and arranged by CAPT. L. V. BUCKHOLTZ, with plates, 16mo.
muslin. Price 50 cts. by mail, post paid.


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Published and for sale by

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Also for sale by Booksellers generally.




PLANTATION BOOK.

  PLANTATION and FARM INSTRUCTION,
      REGULATION, RECORD,
          INVENTORY and ACCOUNT BOOK.

For the use of Managers of Estates, and for the better ordering and
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       *       *       *       *       *




Transcriber's Notes


Every effort has been made to replicate this text as faithfully as
possible, including obsolete and variant spellings, missing punctuation
and other inconsistencies.

Italic text is denoted by _underscores_





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Camp and Hospital, by Florence Nightingale

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