Directions for Cooking by Troops, in Camp and Hospital, by Nightingale, Florence

"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." — FOOTNOTES — Transcriber's Notes

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.

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 confined to ordinary drills and parades. What is now wanted, is a treatise going to show when the various movements of Artillery, Cavalry, Infantry and Rifle, as taught in their respective drills, should be used in presence of an enemy,—what grounds should be selected for battle and encampment—what precautions to be taken when advancing or retreating—when to act in column—when in line, how to post the different arms to act most favorably—information most essential to success, and without which, no matter how personally brave troops may be, they are exposed to almost certain disaster in presence of an equal 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.

SOUTHERN

BOOK PUBLISHING HOUSE,

Established 1833.

J. W. RANDOLPH,

Bookseller, Publisher, Stationer

AND

MUSIC DEALER,

Offers on the best terms for cash or approved credit, the largest assortment of goods in his line to be found south of Philadelphia.

THE STOCK EMBRACES

LAW, MEDICINE, THEOLOGY, HISTORY, BIOGRAPHY, POLITICS, SCHOOL, CLASSICS, JUVENILE, NOVELS, POETRY, and MISCELLANEOUS BOOKS, in English and other languages.

Particular attention given to the collection of Rare Works. Books imported to order.

AMERICAN, ENGLISH and FRENCH STATIONERY
Of the best quality.

A large stock of STANDARD MUSIC, and all the New Popular Pieces are for sale soon as published.

BLANK BOOKS made to order, and all kinds of BOOK-BINDING executed in good style.

Catalogues will be mailed to all who send a stamp to pay the postage.

OLD BOOKS

Taken in Exchange for New Works.

J. W. RANDOLPH,

121 MAIN STREET, Richmond, Va.

NEW MILITARY WORK

ON

INFANTRY CAMP DUTY, FIELD FORTIFICATION, AND COAST DEFENSE.

Prepared and arranged by Capt. L. v. Buckholtz, with plates, 16mo. muslin. Price 50 cts. by mail, post paid.

RECOMMENDATIONS.

"This is a mere pocket-book in size, but it is crowded with instruction for military men—instruction gathered and condensed from the great bulk of works on military science. It encloses grains of wheat, threshed, as it were, out of the great stack—is simple, convenient and comprehensive. It is from the pen of Captain Buckholtz, of this city, a gentleman who has seen service on the continent of Europe, and who is an accomplished officer."—Richmond Dispatch.

"We are always pleased to meet with a Southern book, one written, printed and bound in our own section by our own people, and we therefore greet with pleasure two military works now before us, by Captain Buckholtz, and published by J. W. Randolph, Richmond.

The first is "On Infantry Camp Duty, Field Fortification, and Coast Defense." Under the head of Infantry Camp Duty we are instructed in out guards, patrols, vanguard, side-guard, rear guard, ambuscade, surprise, and transports. In Field Fortification we have instructions on fortifications, regularly constructed forts, attack and defense, fortresses, and a description of the principal parts of fortified works.

The chapter on Coast Defense is most excellent.

As an elementary work on the subjects treated, this book has no superior, and we commend it to our military.

The second book is, "Tactics for Officers of Infantry, Cavalry and Artillery." This is a most complete military work, comprising instruction in the three departments of the army, and contains much information which we have never met with in the popular military works of the day."—Norfolk Southern Argus.

Published and for sale by

J. W. RANDOLPH, Richmond, Va.

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 management of plantation and farm business in many particulars. By a Southern Planter. "Order is Heaven's first law."

New and improved edition, cap folio, half calf, price $1.50. Also a larger edition, for Cotton Plantations, price $2.00. Either sent by mail, post paid.

The author of this book is one of the most successful farmers in the Southern States, and the systematic use of it has added tens of thousands of dollars to his estate.

"We consider it as indispensable to the farmer as the ledger to the merchant."—N. C. Planter.

"This book supplies a real want on every plantation."—Southern Planter.

"This is a most admirable work, and one which every farmer should possess."—American Farmer.

"Every farmer who will get one of these books, and regulate all his movements by its suggestions, cannot fail to realize great benefits from it. We cannot too highly commend it to the consideration of agriculturists."—Richmond Whig.

"It will prove a most valuable assistant to the planter, manager or overseer, and a work that will facilitate them greatly in the transaction of business."—Richmond Dispatch.

"We hope many farmers will buy the work and make an effort to keep things straight."—Southern Planter.

"The form is concise and methodical, while it embraces everything appropriate to such records."—Plough, Loom and Anvil.

"It is the result of mature experience and observation"—Methodist Quarterly Review.

"It is full of useful information."—Richmond Enquirer.

"A friend, in whose judgment we have great confidence, and who is one of the best farmers in Virginia, assures us that this publication is one of real value to Southern agriculturalists."—Southern Literary Messenger.

Published and for sale by

J. W. RANDOLPH, Richmond, Va.

Also for sale by Booksellers generally.