The amateur nurse should at this stage once more carefully read the articles on Digestion which appeared in Volume I. (pages 360 and 505) of Every Woman's Encyclopaedia. The nurse who wishes to know her business must understand the simple physiology of digestion and have a practical grasp of dietetics. At the same time, she must know how to prepare food properly, for the art of cookery is a very important part of sick nursing. Any nurse worthy of the name knows how to make beef-tea, how to cook fish in a nourishing, appetising fashion, how to prepare gruel, custards, and all the attendant light, and yet simple, dishes of the sick-room.
Food is especially necessary in illness to repair tissue waste. After fever, for example, the body is markedly wasted, the reserve store of fat has been exhausted, the muscles are flabby, the skin loose and poorly nourished. The nurse, by proper diet, has to make good all these waste tissues.
Food provides heat for the body, and it is common knowledge how much more readily people feel cold after illness.
Now, the intelligent nurse must study the following facts, and impress them on her brain for all time.
It has already been said that there are five classes of food:
1. The nitrogenous foods, or protcids, which are the flesh-formers, and repair tissue waste. Examples of these are white of egg, lean meat, fish, rabbit, fowl, game-so-called animal pro-teid. Lentils and such leguminous vegetables as peas and beans are typical vegetable pro-teids, or nitrogenous foods.
2. Hydro-carbons, or fats and oils. Fat is necessary for body nourishment and for the production of heat. Fat of meat, dripping, lard, suet, etc., certain oily fish are examples of animal fats. Most of the " cereals " and such vegetables as peas and beans contain some fat. For invalid purposes the best fat is rich fresh milk, which is, indeed, a perfect food, as it contains nitrogenous food, fat, and carbo-hydrate. Butter and cream are also easily digestible forms of fat, whilst olive oil and other vegetable oils are important fats. '
4. Mineral constituents of the food are necessary for the production of bone and for purifying the blood. Table salt, phosphorus, lime, iron, and potash are found in many of the fruits and vegetables.
5. Water is an essential part of food. Its chief function is to dissolve the food-stuffs and aid their absorption into the blood, also it washes out waste matters from the system.
Now, the best foods for invalids of the nourishing and easily digested order are milk and eggs. All the five elements essential to diet are contained in milk. The nitrogenous constituents are egg albumen, or white of egg, and casein, which forms cheese. The hydro-carbon, or fat food, is the cream; the carbo-hydrate is the sugar of milk, whilst the milk also contains water and mineral constituents, lime, potash, iron, etc.
During acute illness food must be given as a digestible liquid, in order to save the body the prolonged work of digestion which the eating of solid foods entails. The nurse who has studied carefully the articles on digestion knows what a complicated process it is, and that several hours are required for the stomach and intestines to reduce solid animal and vegetable food to a liquid, soluble condition so that it can be absorbed by the blood. In certain illnesses, when the digestive tract, for example, is inflamed, fatal results may follow upon giving solid food such as cutlets or steak. No food, apart from the routine ordered by the doctor, must ever be given to a patient unless the doctor's permission has first been obtained. The safest plan is to give only liquids when the temperature is elevated. During the acute stage of fevers milk-and-water or milk-and-soda-water are prescribed.
Preparing Milk-and-soda-water The following is an excellent way of preparing milk-and-soda-water for an invalid, and it forms a useful stimulant and food at the beginning of a chill. Heat half a tumblerful of milk until it is nearly boiling, pour it into a tumbler, which must then be filled with soda-water. It should be sipped whilst effervescing.
The first foods generally given to a patient when the temperature is lowered are gruel, beef-tea, liquid arrowroot. In cases of severe illness it may be necessary to give the patient peptonised milk, which is made by adding pep-tonising powders and bicarbonate of soda to the milk. Peptpnisation brings about a partial digestion, which is of great help in sickness where the digestion is enfeebled. It is accomplished by means of peptonising powders, or pancreaticus, which are prepared from the pancreatic gland, or the sweetbread, a very important digestive gland. Peptonisation must be ordered by the doctor, who will decide whether or not the patient is to have ordinary milk, or whether he must be given milk partially digested.
Take half a pint of fresh cow's milk and half a pint of cold water and put them, with half a peptonising powder, into a clean jug. These peptonising powders are sold ready for use in glass tubes by the chemist. Place the jug in a basin of hot water, so hot that the hand can just bear it, for twenty minutes. The mixture should be shaken occasionally, and is then ready to be taken. If only half this quantity is to be given at once, and the other half reserved for a later meal, that which is to be kept must either be boiled or placed on ice to prevent digestion or peptonisation continuing. Sir William Roberts gives the following recipe for peptonising cold milk in the sick-room.
A pint of milk (at about 6o° F., which is the ordinary temperature in the sick- room) is diluted by half a pint of lime-water, and to this are added three teaspoonfuls of liquor pancreaticus. The mixture is then set aside in a covered jug in the sick-room for three or four hours, and is thus advanced in the process of digestion, and has developed a slightly bitter taste. It is now ready for use, and may be warmed, sweetened, or used cold, either alone or with soda-water. If it is to be kept it must be boiled.
The following rules must be observed in administering milk:
1. Absolute cleanliness of utensils.
2. Protect the milk from contamination of dust, etc., by covering it.
3. Boil milk unless absolutely sure of the source from which it comes.
5. Milk which is drunk undiluted in large mouthfuls is very indigestible.
6. As milk readily absorbs impurities, it should not be kept in an ill - ventilated larder or near a leaking drain, sink, or closet, but in a clean, well-ventilated place, adequately protected from dust and flies.
7. The nurse must understand that milk is very nutritious, and that patients suffering from kidney affections and digestive diseases can be kept on it for several months if necessary.
It has been said that the real difference between a trained and an amateur nurse is most apparent in the matter of feeding patients. The trained nurse is careful in every detail with regard to the patient's diet. The untrained nurse is too often a poor cook, slipshod in serving and