ON THE HYGIENE AND CUISINE OF THE SICK-ROOM

Seções: Índice Geral Seção Atual: Índice Obra: Índice Anterior: 25. Sobre a Higiene e a Cozinha do Quarto de Doentes – I Seguinte: 27. Sobre a Higiene e a Cozinha do Quarto de Doentes – III

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26. SOBRE A HIGIENE E A COZINHA

DO QUARTO DE DOENTES – II

DEAR LADY POMEROY, – In fulfilment of my promise, this letter shall be devoted to invalid dietaries, with a few simple suggestions concerning various regimens and their appropriate uses.

Alimentary regimens are usually divided by authorities on hygiene into seven classes, which are, – tonic, stimulant, analeptic, emollient, laxative, astringent, and temperate or watery. This classification is, of course, somewhat arbitrary, and in practice it is customary to combine the characteristics of two or more groups. The advantages of a cleverly and scientifically composed regimen cannot be too highly estimated, for diet plays the leading part in the art of healing, and the ancients wisely attributed to it an importance which has since been unhappily usurped by drugs. Hippocrates did not hesitate to affirm that the most learned and skilful physician was he who cured the sick by means of an appropriate regimen.

The first class of regimen above enumerated – thetonic – consists of aliments selected for their richness in nutritive qualities, and comprises all albuminous, mucilaginous, and feculent substances, whether animal or vegetable, plants and herbs containing bitter principles, tonic beverages, Bordeaux and Burgundy wines, and in general all the more solid and generous foods and drinks. This regimen is appropriate to cachectic conditions of ill-health – that is to say, chronic states of exhaustion and feebleness following

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prolonged maladies by which the system of the patient has been depleted and shattered; it is suitable also to cases of brain fatigue after severe mental strain, and should be permanently adopted by lymphatic, scrofulous, and weakly persons, especially those suffering habitually from fluxions of the intestine, loss of blood, and other similar excesses in the function of internal organs.

The stimulant regimen comprises the greater number of the aliments named in the preceding class, with the addition of herbs, spices, and condiments possessing aromatic and pungent qualities. Mustard, ginger, pepper, curry-powder, garlic, capsicum, – all these things, and others of analogous kind, are stimulants. Among meats, game in particular belongs to this class, and among beverages, coffee, tea, and liqueurs. Such a regimen is useful in cases of long-continued loss of appetite, nervous nausea, convalescence after infectious fevers or other epidemic diseases, and in certain types of illness characterised by prostration of the physical forces, sluggish circulation, faintness, and feeble digestive power. On the contrary, a diet of this kind must be studiously avoided wherever heart disease is present, aneurism of the blood-vessels, liver complaint, or tendency to apoplexy, gout, or gravel.

The analeptic regimen is sometimes described as a milk diet. It is one of the most important and useful. Its component aliments are at once nutritious and emollient in a high degree, and include milk and all milky products, light puddings, farinaceous gruels and soups, custards, and beverages prepared from pearl barley and other fine meals and grains. This regimen is especially suited to acute stages of illness, in fevers, diseases of the chest or throat, dyspepsia, cancer, complaints of the kidneys, hysteria, rheumatism, and inflammation of the intestinal canal.

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Next in order comes the emollient regimen, the model “light diet” of the doctors, often apostrophised by discontented nurses and recalcitrant patients as “lowering.” The aliments which compose it are chiefly vegetables, fruits, jellies, thin soups, and watery broths. It is the appropriate diet of severe cases of illness, hemorrhage, dysentery, pneumonia, pleurisy, gastritis, typhoid fever, and during the first day or two after serious surgical operations.

Laxative and astringent dietaries consist, of course, in the usage of foods and drinks possessing these characteristics, the first comprising a liberal allowance of fruits, stewed, baked, or raw, salads, oils, green vegetables, and so forth. This kind of regimen is particularly appropriate to cases of scorbutic disease. Astringent qualities are useful in the treatment of chronic diarrhea, hemorrhage, and fluxions of various kinds. A milk diet is frequently associated with the employment of astringent herbs and grains. Rice possesses this quality in a high degree, and when boiled in milk or water is often successfully employed to arrest persistent diarrhea or English cholera.

Lastly, a temperate, or, more correctly, a watery regimen, consists of fruit and acid drinks only. It includes grapes, oranges, nectarines, peaches, lemonade, and other substances combining vegetable acids with gummy and sugary principles. Such a dietary, the nearest approach to a fast consistent with eating at all, is most suitable to hot climates, and is resorted to in maladies characterised by plethora, repletion, acute inflammation, brain fever, and some forms of madness. The effect of this regimen is to lower the circulation, and thereby to abate the animal heat and any tendency to fever that may exist, to augment the secretions and facilitate the action of

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the intestine, and, generally, to refresh, cool, and soothe an overheated or irritated system. Aneurism of the arteries, and cases of cancer in the stomach or other parts of the digestive canal, are often advantageously treated by the adoption of a purely fruit diet; but its effects must be carefully watched, and if exhaustion or abnormal lowering of the heart’s action appear, it must be promptly modified by the addition of farinaceous or albuminous foods in small quantities. Absolute abstinence from all aliments – even from fruits – is necessary in the treatment of certain violent disorders, such as apoplexy, cerebral congestion, and concussion of the brain, rupture of blood vessels, capital operations, and dangerous wounds of the bowels, stomach, or other internal organs. In the acute stages of scarlet fever, small-pox, erysipelas, and other diseases characterised by strong febrile symptoms, severe fast is advisable, so that the circulatory and respiratory functions may be favourably modified, and the intensity of the morbid action reduced as much as possible.

To quench the thirst which characterises such diseases, demulcent or acidulated beverages should be administered from time to time throughout the day and night. Barley-water, the most useful and agreeable of such drinks, is prepared in the following manner: – Wash a tablespoonful, or, if required, double the quantity, of pearl barley in cold water; then pour off the water and add to the barley two or three lumps of sugar, the rind of one lemon, and the juice of about half a lemon; pour over the whole a pint of boiling drinking water, and let it stand covered for two or three hours on the hob of the stove or fireplace to keep warm; then strain the mixture, and let it cool. Lemonade is made by slicing into about four or five pieces a good-sized lemon, to which must be added several pieces of loaf

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sugar. A pint of boiling water is added, the mixture is covered, and allowed to cool. If needed in a hurry, lemonade can be made with cold water, but in this case the lemon-juice must be squeezed out of the fruit, and the sugar melted separately in hot water, and added with the juice to the cold water. Whether prepared with hot or cold water, the beverage must be strained in order to remove from it the pips and pulp of the fruit. Toast-water, which is, to some patients, more palatable and acceptable than either of the foregoing drinks, is best made with stale bread, thoroughly browned before a red fire. Immediately after taking it off the toasting-fork, put it into a jug and pour over it a sufficiency of boiling water. Cover it, and let it cool. Tamarind whey, a cooling and slightly laxative drink, is made by adding two tablespoonfuls of the fruit to a pint of milk while boiling, stirring the mixture well, and afterwards straining it. This beverage should be taken cool, and must always be freshly made.

As a general rule, it must be borne in mind that no preparation for the sick-room is fit for use the day after it has been made; nor, if possible to avoid it, should either food or drink be kept standing in the bed-chamber occupied by the patient. The atmosphere and temperature of the sick-room are apt to hasten putrefactive decomposition, especially in milky compounds. A pleasant demulcent drink is made by blanching two ounces of sweet almonds and two bitter almond seeds, pounding these with a little orange-flower water sufficient to make a paste, and then rubbing up the mixture with a pint of boiled milk diluted with an equal quantity of water. The emulsion thus formed must be then strained and sweetened. This liquid is called orgeat. It is nutritive as well as emollient. Rice-water, which I have recommended

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as a useful drink in cases of diarrhea, dysentery, and similar complaints, is prepared in the following manner: – Thoroughly wash an ounce of Carolina rice in cold soft water. Then steep it for three hours in a quart of water kept simmering, and afterwards gradually raised to boiling point; strain and cool the liquid before use. Linseed tea, a useful beverage in acute pulmonary disorders, is thus made: – Take an ounce of bruised linseed and two drachms of bruised liquorice-root, put them into a jug, and pour over them a pint of boiling water. After the tea has been allowed to “draw” for three or four hours on the hob, strain it, sweeten it to taste, and serve it hot. A little lemon peel can be added as flavouring. Iced milk is extremely serviceable in the treatment of maladies involving nausea, or diarrhea, and also in diseases of the throat and stomach. As a rule, ice may be freely used to allay febrile thirst, and remove unpleasant tastes in the mouth; but in administering it to patients in a state of stupor or great weakness, care must be taken that the fragments given are small enough to avoid the possibility of causing choking. Ice may also be conveniently added to gum-water, isinglass-milk, orangeade, or any similar beverage.

In cases of severe collapse or exhaustion the following mixture will be of signed service; it is quickly made, and needs no great skill in the preparation. Take two ounces of first-rate cognac brandy, four ounces of cinnamon water, the yolks of two fresh eggs, and half an ounce of pounded loaf sugar. Beat up the eggs and sugar rapidly, add the cinnamon water and brandy, stir the whole well, and administer in teaspoonful doses. In extremely urgent cases the quantity of brandy may be doubled, age, sex, constitution, and previous habits being taken into due consideration.