In invalid cookery, cleanliness and good appearance are of great importance. Food and medicine are under the physician's direction, but after the kinds and quantities of food have been designated, the nurse has still much for which she is personally responsible. She must select, prepare, and serve the food.

Invalid's Tray

Invalid's Tray

An educated woman is a thinking woman. The nurse who has a true knowledge of foods thinks when she goes to the market, and endeavors to decide what selection will best subserve the needs of her patient, restricted as she is in the kind of food which he can take. If the physician has ordered fish for his patient, she is careful to select a fish with bright eyes, firm flesh, and stiff fins, for she knows that all fish deteriorate very rapidly, and that unless properly cared for by the fisherman they are unfit for food when first placed on the market. A wise person avoids oysters which have an especially plump appearance, as they have, in all probability, been "floated," which in some cases affects their food value deleteriously, though they sell for a high price.

A piece of meat or a fowl which has been ripened to just the proper degree will not be long in passing beyond that stage, unless carefully protected. A cup of oysters or a piece of fish will spoil in a very short time if left in a warm kitchen. The carefully selected food must not be lost sight of until it is safe in a cool, well-ventilated place. Victuals are often unfit for use when not actually spoiled, and the sick person's taste will decide with great alacrity whether the article has the most perfect flavor. That such food is distasteful is not the only evil effect. Bacteria are constantly at work under favorable circumstances, and their products are often deleterious to health. A change, so slight as not to be noticed by a well person, might be sufficient to materially disturb the digestion of an invalid.

Diets are roughly divided into liquid, light, and dry; convalescent diet may be added also.

Liquid diet is used, of course, in cases in which solid food cannot be taken. Milk is important among the liquids so used. It is given in its pure state, or variously diluted. It is used hot or cold, and may be flavored with ginger, cinnamon, nutmeg, chocolate, coffee, lemon, etc.

Some ways in which milk may be used: (1) by diluting with mineral water; (2) by diluting with alkaline water; (3) by diluting with hot water; (4) acid preparations, as lobbered milk; (5) wheys, as wine whey, vinegar whey, rennet whey, etc.; (6) broths made with milk, as oyster broth and clam broth; (7) prepared milks, as condensed milk, sterilized milk, malted milk, etc.

If the physician orders a diet of milk, the nurse must serve milk alone, but it does not follow that it should always be served in the same cup or glass, or in the same form. Serve it in different dishes, in varied and attractive forms, and with different flavorings, if permitted. Extreme care is necessary to keep milk in such condition that it will be wholesome. The cleanest and purest of milk procurable contains many micro-organisms, and they multiply very rapidly. The vessels in which milk is kept must be thoroughly washed and scalded every time a fresh supply of milk is brought in. If the milk can is a tin one, see that the scalding water reaches every portion of the can, and that it is free from every trace of milk. Pour the boiling water out over the seam, for here is a chance for dirt to cling. Unless the milk has been chilled before it was brought to you, set it in cold water and stir until it is cold; then set where it will be very cold, but not freeze. Mild antiseptics, such as borax, boracic acid, and salicylic acid are sometimes used for preserving milk for domestic purposes, but these should never be used for either sick or well, because they prevent the digestive organs doing their work in the best manner. Disease is sometimes caused by their use.

Milk may be preserved for a time by sterilizing or pasteurizing, and is often so prepared for invalids. Such treatment changes the flavor somewhat, but the taste is not usually objectionable. Condensed milk, diluted with about two parts water, is sometimes substituted for fresh milk.

In some cases, the recovery of health depends, in a great degree, on the ability of the nurse to furnish delicate, delicious, attractive, and, above all, digestible and nourishing, food.

If the smoke on a broiled steak is distasteful to a patient, the difficulty may be removed by broiling the steak in paper, or cooking it in the upper part of a double boiler.

When a varied diet is allowed, the nurse should skillfully and tactfully ascertain the wishes of her patient; then prepare just such a meal as he wants, and serve it at the exact hour that it should be served. The life of a convalescent is not a very eventful one, and the nurse who can serve a well-cooked, dainty meal at just the right time aids in his improvement, both physically and mentally, by putting his mind at rest on this one point, at least. He no longer wonders whether he will have a satisfactory meal today.

There are at least two reasons why it is necessary that the nurse learn as early as possible the amount of food required by the patient: (1) He requires a sufficient amount of nourishment. A thoughtful woman knows practically how much nutritive material the food used contains. If the kinds of food are limited, and the patient cannot take a sufficient amount of food in one form, some means must be devised for preparing it in such form that it will be both palatable and digestible. A food becomes distasteful, no matter how palatable it may be at first, if it is offered too often in the same form. (2) If too large an amount is served, a delicate stomach will sometimes rebel, when the proper amount would be attractive. Better err by serving too little than too much. The practice of overserving is a very wasteful one, for an invalid does not care for made-over dishes, and they are not best for him. Food has its best flavor when fresh cooked and is in general more easily made use of in the body. If the patient insists that a certain tidbit is specially fine, and wishes it reserved, let it be so, but lay it away in a cool, clean place. Do not leave it in the room.

When preparing a meal for the patient, arrange the dishes on the tray before beginning the cooking, that there may be no delay in serving when the food is ready. See that the tray is large enough to admit all that is necessary without crowding, but do not have much vacant space. The perfectly clean tray should be covered with a clean, well-ironed tray cloth. The dishes should be the prettiest the house affords, and if colored, should be such as to present a peaceful, restful effect.

For instance, when you use some blue or yellow dishes, let the rest be white. Orange-colored pieces, if not vivid, are pretty with violet or pale gold dishes. The following, attributed to a famous artist, illustrates the effect of inharmonious combinations on a delicate organism: "I remember once being called upon to paint a portrait of quite a pretty girl. She was dark, and wore a blue waist of an unbecoming shade. I couldn't see that girl's face, for the detestable bodice seemed to shriek and scream at me." Similar emotions might be awakened in an invalid by giving him a tray covered with a red cloth, and furnished with yellow and pink dishes. The tray cloth should always be white, no matter what dishes are used. Green tea is very attractive when served in a Nile green cup, but blue china should not be used on the tray at the same time. Clear coffee is very attractive when served in a yellow cup of just the right shade, and the invalid finds it easier to take beef juice when the unpleasant color is disguised by a red glass; but when both are used at once the one detracts from the other, so far as the person is affected by the colors.

Fashions change in the manner of serving food, the same as in other things, but there are a few things that must not be lost sight of whatever the fashion may be: Serve the coffee or tea in a clean hot metal or earthenware pot of small size. See that the cup is warm also. Serve soup or broth in a hot cup with a hot cover. See that there are warm dishes for the things that are to be served warm, and cold dishes for such as are to be served cold. See that toasts, steaks, etc., go directly from the broiler to the patient, and that cold dishes are served directly after removing from refrigerator. Set the tray before the invalid with the plate in front of him, the cup at the right hand and salt and pepper within reach, and all things in their proper places on the tray. When the patient has finished, remove everything used during the meal from the room. Both food and water absorb impurities very readily.

It is always well to have a few flowers on the tray. It is better to use only dainty blossoms, and very few at a time. Green is always restful, and the slender fern, when procurable, is almost invariably welcomed.

In filling a glass or cup for an invalid, be sure that you do not spill a drop, and do not fill the cup or glass too full. It is not only bad form, but it is hard to prevent spilling, especially in an unsteady hand.

When the patient has so far recovered as to be out of danger, and needs nourishing food to build up the system, care is often necessary still to avoid overserving, and the patient needs a variety of well-cooked food.