ON THE HYGIENE AND CUISINE OF THE SICK-ROOM

Seções: Índice Geral Seção Atual: Índice Obra: Índice Anterior: 27. Sobre a Higiene e a Cozinha do Quarto de Doentes – III Seguinte: 29. Sobre a Higiene e a Cozinha do Quarto de Doentes – V

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28. SOBRE A HIGIENE E A COZINHA

DO QUARTO DE DOENTES – IV

DEAR LADY POMEROY, – In a former letter I pointed out to you that in preparing food for invalids it is necessary to pay special attention, not only to the condition of their digestive organs and powers of assimilation, but to their particular tastes and fancies. Your patient will not thrive on food which he does not like. For the living organism is a wilful creature; its juices refuse to flow at the call of aliments repugnant to it; it must be catered for, not as a mechanical apparatus for the consumption of fuel, but as a complex and finely-endowed being, whom, if need be, you must wheedle and propitiate with all manner of subtle devices. Therefore you will understand that in the application of what I am about to say regarding sick-room cookery, you must bear in mind always the special partialities and aversions of individual patients, and, within due limits, provide accordingly. Thus, some invalids have an unconquerable repugnance to jelly, and recoil from it with disgust; others sicken at the sight of arrowroot, gruel, or milk puddings. Sometimes this dislike is due to the form in which such foods have been habitually presented to them, to the insipid manner of preparation adopted, or to some neglect easily remediable. You must take pains to ascertain the facts in respect to these details before accepting as final the emphatic declaration, “Oh, I

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can’t bear this or that; it never agrees with me. I hate the taste of it.” For it often happens that the addition of some savoury condiment, a sprig or two of pot-herbs, a little mace, a few cloves, a scrap of lemon-peel or cinnamon, may make a world of difference in the character of the broth or the gruel which you are anxious your patient should take. Sick-room cooks ought, however, to be specially chary of one particular form of condiment, the proportion of which employed is often greatly in excess of the requisite quantity. I speak of salt, an ingredient which should be administered very sparingly to invalids, because it is liable to hinder and impede digestion, to irritate the mucous surfaces, and to excite unnatural thirst. Salted meats are, as is well known, very indigestible, the reason being that salt is, in its nature, a preservative agent, preventing disintegration, and hardening and consolidating organic substances. When it is wished to preserve butter, fish, flesh, or other perishable matters, it is customary to salt them, because by this means they are rendered refractory to decomposition and alteration. But, by this very action, they become equally refractory to the process of assimilation and dissolution in the stomach, and their presence in a delicate or enfeebled organ is apt therefore to set up a state of grave irritation and of subsequent fever.

Salt ought to be viewed rather as a medicine than as a condiment, for it differs widely, both in its operation, and in its nature from all other condiments in common use, being, unlike these, a mineral inorganic product, and needing to undergo in the living economy a more complex evolution than principles immediately derived from vegetable or animal sources. In its crystallized state, moreover, salt exhibits an extraordinary avidity

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for water, and thus causes thirst, which should especially be avoided in cases of debility, tendency to fever and invalid conditions generally. Use, therefore, in your sick-room cookery, only just sufficient salt to make your dishes palatable, depending rather for their savouriness on such organic substances as ginger, pepper, spices, thyme, bay-leaves, vanilla, parsley, mint, celery, chives, eschalot, horseradish, and other aromatic or pungent stimulants of the digestive functions.

Before serving a meal of any kind to an invalid, see that his hands and face have been washed, and his mouth well rinsed with tepid water to which a few drops of myrrh have been added; if he is able to clean his teeth, so much the better. You will find that when these little attentions have been observed he will relish his food far more than when they are omitted. Take care, also, that the tray on which any viands brought to him are served, be covered with a clean white napkin, the glass and silver bright, the dishes prettily garnished, and the general aspect of the meal as inviting and appetising as possible. With a sick person such small details often carry great weight, and strongly influence the imagination.

Before I enter into particulars in regard to special recipes and preparations, it will, I think, be well to give you some general ideas in regard to the relative digestibility of the various articles of food in common use, in so far as it has yet been possible to ascertain their properties in this respect. By the word “digestibility,” we must understand the quality any given aliment possesses of yielding promptly to the digestive juices the sum of its nutritive elements. The proportion of nutriment which it may contain is independent of its digestibility, since, as will presently be seen, fruit is more

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digestible than poultry, though the latter is certainly richer in alimentary principles. Again, certain conditions of the constitution and preparation of different viands modify both their digestibility and their nutritive properties; for example, highly concentrated foods, such as pure albumen, are far less nutritive than aliments containing an admixture of various principles; and a process of cooking which disintegrates and dissociates tissue in such a manner as to render it easily soluble in the stomach greatly enhances its value as food.

Solid foods, of whatever kind, are always more readily converted into chyme – that is, into the state necessary for assimilation by the blood – when eaten roasted than when prepared in any other manner. Boiling deprives the material subjected to the process of a large proportion of its nutritive substances which escape by evaporation from the water in which it is cooked. Thus is lost a great part of its flavouring matter, called by chemists osmazome, its fatty and gelatinous elements; while its whole mass is rendered tougher and more fibrous. Part of its albumen is dissolved, and, with its hematosine, coagulates and floats on the surface of the boiling water in the shape of froth and scum. The meat which has undergone this process is largely deprived of its most nutritious principles. It is the more difficult of digestion, also, in proportion to the quantity of water used and the length of time the boiling process has been continued. Roast meats are more savoury, more stimulating, and more nutritive; but the heat applied to them should be uniform and gentle; hence slow fires cook better than fierce ones, the object being to expand and rupture the fibres of the viands, so as to render them susceptible of easy division and mastication, and not to char or harden them. In the process known as baking,

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the comestibles are penetrated and softened by the vapour of their own juices, and although the nutritive principles are thus largely retained, the food is less easily digestible than when exposed before an open fire. Fricassee, frying, and similar methods of culinary preparation, in the course of which considerable quantities of grease are used – this grease being usually of a most objectionable nature, such as pork fat and dripping – should be avoided, especially in catering for invalids or persons in delicate health. These methods of cooking give rise to certain chemical changes in the ingredients used, the effect of which is to deteriorate the meats and to cause thirst and severe indigestion.

Of all processes of cooking applied to fish and flesh-meat, that of grilling or broiling is the best; while of all modes of preparation to which vegetables can be subjected, that of steaming is to be infinitely preferred. In fact, all vegetables, of whatever description, are perfectly cooked only when they are steamed. A boiled potato is tasteless, watery, poor in soluble salts and nutriment; a potato steamed in its skin in a covered receptacle made for the purpose, is both delicious in flavour and valuable as food. Nor is the potato the only vegetable that is habitually spoilt by unscientific preparation. One of the most delicate and precious foods for invalids – asparagus – which, when cooked with due art and served on toast might tempt the appetite of an ascetic, is generally ruined, and deprived of its subtlest and most sapid qualities by the ordinary treatment which it undergoes in English kitchens. Asparagus, of whatever variety, should, before cooking, be loosely tied in a bundle with a wisp of long grass, and the ends cut exactly even. The bundle should then be placed, standing endwise, in a deep covered saucepan, not three parts full of water.

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The heads should be out of the water, the steam sufficing to cook them, as they form the tenderest part of the plant; while the hard stalky part is rendered soft and succulent by the longer boiling which this plan permits. Instead of the orthodox twenty minutes allotted to average asparagus boiling in the usual manner, a period of thirty or forty minutes on the plan recommended will render quite a third part of the stalk delicious, while the head will retain its full flavour and consistency, being cooked by the steam alone. Sir Henry Thompson, in his little treatise of Food and Feeding advocates this method of preparing table vegetables. The same plan is, of course, applicable to seakale, celery, vegetable marrow, tomatoes, cauliflower, and all similar comestibles; remembering, however, that the process of steaming requires, always, twice the time at least, needed for boiling them in the usual manner.

Upon farinaceous, oily and fatty matters, the effect of cooking is somewhat more complex than in the case of the foods we have just enumerated. Starch – the feculent matter constituting so large a proportion of the various meals and grains in common use, as well as of certain edible roots and stems, such as sago, tapioca, and arrowroot – consists of minute cells or granules which, under the influence of heat and moisture, whether derived from steam or boiling water, swell and burst, thus becoming soft, and loosening the texture of the substance they compose. A considerable portion of the fecula becomes transformed into dextrine, which substance is the connecting link between starch and sugar. Although by this process such foods as tubers and the farinacea are rendered lighter and more digestible, these beneficial results are, in the case of some preparations, in which fat or oil is largely used, more than counterbalanced by

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the nature of the change which cooking produces in these latter substances. Fat, whether animal or vegetable, when subjected to prolonged heat, undergoes decomposition, attended by the formation of fatty acids and of a pungent volatile product called acrolein, liable to cause dyspepsia. These acrid matters are the source of the gastric disorder known as “heart-burn.” Baked fat undergoes greater decomposition than boiled fat, and for this reason, pie-crust, and pastry generally, are compounds of a more indigestible order than boiled puddings.

Having thus resumed the chief modifications caused by cookery in the digestibility and nutritive value of various foods, I will briefly sum up for you the conclusions arrived at by Dr. William Beaumont in regard to the relative solubility in the human stomach of the comestibles most commonly used in this country.

He found that beef, mutton, pork, and veal are less easily digestible than game and poultry, and these, again, much less readily than fish. Fish are, as a rule, a great deal more easily digestible than any other kind of animal viands. Roast meats of whatever description are more easily digestible than meats boiled or fried. Mutton and beef are both more digestible than pork. White fowl is more easily soluble than game, and fresh fish than fish salted. Milk and milky products are more digestible than any of the preceding articles, fish only excepted; and milk boiled is more digestible than it is raw. Cream is more readily disposed of than butter or cheese. Eggs, when lightly cooked, are as easily digested as boiled milk. Beef tea and meat broths are very refractory, and quite as difficult of digestion as pork. Feculent vegetables are as digestible as milk, eggs, and fish; bread is less so than potatoes; starchy foods when unmixed with grease

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are very readily soluble. Fresh green vegetables are digestible in the same degree as poultry. Lastly, the most digestible of all foods in the human stomach are fruits.

Of course, you will remember that individual peculiarities and idiosyncrasies may modify considerably the special application of these data, as also may an unnatural or diseased state of the stomach itself. Experience and personal observation must qualify all scientific deductions, for no general rule is without its exceptions and variations.