Thursday, 7 July 2016

25 September 1880 - 'Food for Invalids'

Miss S.F.A. Caulfield, one of our most valued contributors, has just published a handbook on "Home Nursing,"* which we recommend our readers to procure for themselves, n order that they may be able, upon any sudden emergency, to undertake with proficiency the important duty of nursing any member of their own household. This is a noble and most humanising occupation for a girl, and is a work which, above all others, is calculated to bring down upon the worker feelings of respect, admiration, and love.

Writing on food for invalids, Miss Caulfield says: - Food must be made to look as attractive as possible, and also cooked so as to please the taste of the invalid. The question of "well-done" and "under-done" meat is a vexed one; but it matters not which may be the prescription of the doctor for ordinary cases if, in any particular one, there be a natural loathing for either mode of dressing. What is eaten with appetite and relish is likely to nourish far more than what is crammed down as a loathsome duty at which the stomach revolts. And as such is the case with some people in reference to slightly cooked meat, on no account should any be presented to them that they will regard with abhorrence and heaving of the stomach. I have known an invalid turn from even a fairly-cooked slice of meat, and say he "was not hungry," but when I stuck a little scrap on a toasting fork, and held it in the fire till scorched, and, while almost too hot to eat, I put a scrap of fresh butter on it, and a sprinkle of pepper, he ate it at once, and asked for more, and thus got a light meal that he not only enjoyed, but that did him good. We do not make light of the rules prescribed by science - very far from it - but we cannot for their sake dare to set aside the laws of kindness and common sense, which have their own time for supremacy, if only the nurse have the judgment to decide on the when.

Much discretion must be observed in allowing the patient to have his own way. Never thwart his trifling fancies if at all permissible to indulge them. He will mind you the more when you must have submission. For instance, let him choose his own position, however awkward it may look; e must know which muscles are mot weary, and how to give them relief, and he wants variety. Lying on the back is often the most distressing of all positions, and should not be insisted upon. Remember how often an infant's crying is stopped by turning on its stomach; it brings relief to internal pain, and new rest to the tired frame; and where there is a cough, or difficulty in breathing, to turn over on the stomach and rest on the elbows, or lie down and lay the face just at the edge of the pillow, will usually put the patient to sleep.

Sick people do not like their soup, tea, or other drinks spilt into the saucer, nor to return to an old piece of jelly or pudding which they have not been able to finish. All that they have tasted should be at once removed, and fresh brought in when required, a rule which holds good as regards lemonade or such-like beverages, which should be poured fresh from the jug into a clean glass. But never leave even the untouched supply in the jug or dish in the sick chamber. Germs grow quickly in organic matter, and in all liquids. Milk and soup, and any description of food, may receive and spread infection. Vessels employed for milk, or any such drinks, the feeding cup included, must be scalded out with boiling water.

It may be desirable  for the patient to take warm "slops" and milk puddings. Take care not to nauseate the poor creature with more than really must be taken, in change with other things. I have heard a patient say, "How sickly those tasteless sops are!" Why destroy the little inclination for food which he has by loading him with what he dislikes? The importance of cultivating any little returning fancy for food - while under the influence of confinement to one room, loss of exercise, of sleep, of permission to eat a variety of things, all combined with depression of spirits, bodily pain, and a stomach oppressed with drugs - cannot be too strongly insisted upon. Unless attractive, it will not stimulate the flow of that secretion of the mouth which is absolutely requisite to promote digestion.

In cases where there is a strong tendency to sickness, endangering the loss both of food and medicine, the nurse must have recourse to ice. A small scrap that can be swallowed entire, should be given immediately before the dose, and a similar piece immediately after it. In the same way, when giving cold chicken broth in strong jelly (which a sick person can retain better than any other kind of food), or in giving a spoonful of consommé, administered in dessert, or even teaspoons, at considerable intervals one from another, ice should be given both before and after it Should the nausea be obstinate, a mustard plaster on the pit of the stomach is likely to relieve it; and, in still more serious cases of disposition to vomit, as for instance, when at sea, and where haemorrhage is feared, the use of an indiarubber ice bag will reduce the symptoms when nothing else will. It is a sort of long belt with a brass clasp, divided into three or four pocket inside. The ice should be broken into very small pieces, and when secured by the clasp, the bag should be laid down the spine from the nape of the neck. The result will probably be demonstrated at once. The spinal cord being connected with the brain, the brain powerfully influenced by the stomach, and the latter by the brain, relief is almost immediate, and sleep will probably supervene. But it should be a golden rule never to attempt strong remedies unless simple ones have failed, and no medical man can be obtained to give advice.

While on the subject of food, there is one rule to which I attach much importance. In cases of extreme weakness let no word be uttered by the patient for a full hour after his dinner, nor at least for half an hour after breakfast and tea. It would be expedient for the nurse to retire into the ante-room for that time, leaving the door ajar, and telling him the reason of her so doing. There is more exhaustion produced by conversation than is generally imagined, and in cases of pulmonary disease, bronchitis, and sore throat, this is felt by the sick. But the fact that the brain and stomach, so closely connected as they are, should not be simultaneously set at work is quite sufficient argument, apart from all physical fatigue entailed.

* SICK NURSING AT HOME. By S.F.A. Caulfield. Published at 170, Strand.

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