ON THE HYGIENE AND CUISINE OF THE SICK-ROOM

Seções: Índice Geral Seção Atual: Índice Obra: Índice Anterior: 26. Sobre a Higiene e a Cozinha do Quarto de Doentes – II Seguinte: 28. Sobre a Higiene e a Cozinha do Quarto de Doentes – IV

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27. SOBRE A HIGIENE E A COZINHA

DO QUARTO DE DOENTES – III

DEAR LADY POMEROY, – I think you are quite right in saying that a savoury and suitable dietary for the use of invalids would be very acceptable to the public, and that difficulty is frequently felt in providing dishes for the sick-room of an appetising, and at the same time of a light and inoffensive nature. I propose to give you a few hints of the kind you desire, with some formulas which are certainly not generally known in this country.

Of course the regimen of any particular invalid must, in great measure, be placed under the direction of the physician. Viands and beverages suited to some forms of malady, or of convalescence, are unsuited to others, and, moreover, due account must be taken of individual idiosyncrasies and tastes. More especially with regard to invalids than to persons in health, it is important to bear in mind that an aliment which is not relished will seldom prove nutritious or beneficial, because the necessary flow of digestive secretions is withheld for want of desire, and eating under such circumstances is likelier to result in indigestion and nausea, than in reparation of vital force and renewal of function.

The first question in your letter refers to the use of beef-tea and bouillon, and asks my opinion of the value of Liebig’sextractum carnis. Medical opinion is still greatly divided respecting the nutritive qualities of beef-tea even

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when made on the most approved plan. Ordinarily the beef used as the basis of the “tea” is subjected to prolonged boiling, and the liquid, on cooling, becomes a jelly, which fact is wrongly supposed by many people to be a guarantee of its nutritive value; while the really nutritious part of the beef – the albuminous matter – becomes condensed and agglomerated in such a manner as to form a part of the subsequently rejected residue, or else to be skimmed off with the so-called “scum” rising to the surface of the boiling mixture. Beef-tea or bouillon thus prepared contains chiefly gelatine, fatty matter, flavouring and odoriferous principles, meaty acids, and certain soluble alkaline salts. It is a mistake to suppose that a concoction of this kind has any high nutritive qualities, for the quantity of albumen contained in it does not exceed an infinitesimal proportion.

Concerning Liebig’s Extract, I prefer to quote the words of Dr. Pavy, an undoubted authority on dietary matters. “The true position of Liebig’s Extract,” he writes in his Treatise on Food, “is scarcely that of an article of nutrition, and this is now beginning to be generally recognised. The fact that from thirty-four pounds of meat only one of extract is obtained shows how completely the substance of the meat which constitutes its real nutritive portion must be excluded. The article, indeed, is free from albumen, gelatine, and fat, and may be said to comprise the salines of the meat, with various extractive principles, a considerable portion of which doubtless consists of products in a state of retrograde metamorphosis, and of no use as nutritive agents. If not truly of alimentary value, the preparation nevertheless appears to possess stimulant and restorative properties which render it useful in exhausted states of the system.”

And, in fact, the value of ordinary bouillon, as well

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as of Liebig’s Extract, may be summed up in the word “stimulant.” These beverages act as excitants of the digestive organs, and, provided they are relished, they may be useful as restoratives of the appetite and digestive powers, this effect being due principally to the potassium salts and flavouring matters contained in them. The old notion that jelly must necessarily be nutritious has been long since exploded by scientific investigation. The chemical composition of jelly, or gelatine, indeed approaches that of albuminous matter, but, physiologically, its action is very different. Gelatine does not undergo in the stomach the same transformation as nutritive substance; – that is to say, the gastric secretion does not convert it into peptone, and it is consequently of little or no value as an alimentary agent. Nay, more, many of the best authorities on hygienic chemistry, both at home and abroad, are of opinion that the addition of gelatine to the food of invalids may often seriously disturb or retard the digestive process.

It is, however, necessary to state that all writers on the food question are not agreed, even on this point. Dr. Edward Smith, F.R.S., for instance, believes jelly to be a valuable form of food, and this view is shared by many practitioners of considerable name and fame. Sir William Roberts places very little faith in beef-tea, as the term is generally intended, but recommends in its place cold-made meat-infusions. As, however, he admits that these infusions have an unpleasant “bloody” appearance, and a “raw” taste, which are difficult to disguise, and as I am emphatically of opinion that one of the chief requisites in sick-room cookery is niceness both in aspect and in flavour, I shall not trouble you with Sir William’s recipe.

Fruit jelly must not be confounded with the jelly

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produced by the coction of bones. The latter is a compound of four elements, – oxygen, hydrogen, carbon, and nitrogen. Fruit or vegetable jelly is a compound of the first three elements only. As an aliment, however, fruit jelly, the basis of which is pectine, is of no greater value than is ordinary stock jelly.

Beef-tea, even when scientifically prepared, is apt to be of but little service, because it is usually distasteful to invalids, on account of its full and unsavoury taste and odour. Prepared unscientifically, it is certainly more toothsome, but is then, as I have pointed out, innutritious. A more agreeable, and a superior alimentary preparation may be made with fish-stock, preferably fresh haddock, flavoured with pot herbs and vegetables. The value of fish is too little appreciated in this country notwithstanding – or, perhaps I should rather say on account of – the fact that as an article of food it is far more economical than butcher’s meat, besides being easier of digestion, and much less liable to disease. Dr. Davy, F.R.S., observes that populations subsisting on fish are found to be particularly strong, healthy, and prolific. “In no other class than in that of fishers,” he says, “do we see larger families, handsomer women, or more robust and active men.”

Moreover, not only do sturdy folks flourish so well on fish, but, as Dr. Pavy points out, it is also a specially suitable food for invalids and persons with weak digestions, and can constantly be employed with advantage when the stomach will not support coarser kinds of animal food. Sea fish, too, contain certain strengthening elements, which, from a therapeutic point of view, are invaluable, and which are far more efficaciously introduced into the system in the form of food than under that of drugs. Every one knows, too, how high a place

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has been accorded by medical men to the oil of the cod’s liver as a fortifying agent in diseases due to mal-nutrition and want of stamina. In this oil are contained three important elements – phosphorus, iodine, and bromine – besides a special constituent peculiar to fish, but not necessarily to the cod, since oil of similar properties is yielded by several other sea-fish. It, is, however, an unpleasant medicine to the taste, and often, therefore, impossible to assimilate; so that the consumption of fish-broth containing its chief ingredients, and prepared in a palatable form, is to be preferred. In order to make such broth scientifically, and to extract from the stock the utmost of its nutritive principles, the fish used should, while uncooked and unboned, be broken up into small pieces and placed in cold water. A pound-and-a-half of ray, skate, cod, haddock, or other fish, will require two pints of water, which should be poured upon it in an earthenware preserve jar. This jar should then be set in a saucepan of hot water, so as to form a bain-marie, and placed upon a moderate fire to boil gently for about an hour. Meanwhile, put into a stew-pan, with a little fresh butter, one or two small carrots and onions; cut the carrots in pieces and the onions across; then cover them with slices of leeks, some sprigs of parsley, mint, thyme, marjoram, a little celery seed, and a bay-leaf, with a few cloves. Moisten with a little hot water, and put the whole to simmer over a slow fire. In an hour add more hot water, and stir until the contents are well mixed and coloured. Then add the fish-stock, and pass through a coarse strainer to preclude the possibility of leaving bones in the broth.

A very savoury and nourishing broth may also be made without fish-stock, using instead of the latter a purée of peas or of lentils. To prepare this, take two or

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three pounds of dried peas or beans, wash, and boil them for some hours, adding water from time to time. Stew half-a-pound of rice for two hours in half-a-gallon of water, with a little butter, a mealy potato, a turnip, carrot, onion, head of celery, a couple of Jerusalem artichokes, and a leek or two, all cut into dice. Then add the peas-broth, with pepper and salt, a little parsley, one or two bay leaves, some thyme or mint, and a few cloves. Boil up, and if thickening be required, add before serving a little cream, well stirred in, and a few button mushrooms.

Or again, an extremely nutritious and valuable soup may be made by soaking four ounces of the best macaroni in cold water for two hours, then throwing it into a pint of boiling milk and water – two parts of milk to one of water – to which must be added salt, pepper, a tablespoonful of stale bread-crumbs and a small onion, with a little spice. Boil the whole gently, pass it through a sieve, then let it simmer, and add before taking it up a gill of cream and a few peppercorns. Vermicelli and sago broth, may be made in the same way.

In the colder season of the year oyster broth is commendable as a nutritious and suitable aliment for convalescent invalids. To make it take a pint of fish-stock and two dozen oysters, a little butter, according to taste, two ounces of flour, a small quantity of grated nutmeg, and a teaspoonful of Chili vinegar. Add to these a quarter of a pint of cream, or good milk, and stir over the fire till it boils gently. Toast should be eaten with all these broths.