IV. Nitrogenous Diet

Nitrogenous Diet, or animal food, which is somewhat more used than the preceding diet, and from which sugars and almost all forms of starchy food excepting a little dried bread, toast, or Graham bread, are excluded. This diet is particularly serviceable in cases of flatulent dyspepsia, chronic gastric catarrh, and dilatation of the stomach, in which the starches and sugars invariably undergo acid fermentation, with eructations and flatulence. It also serves for diabetics, with slight modification.

V. House Or Full Diet

House Or Full Diet should be the most economical diet for the hospital upon which patients who have nearly completed their convalescence may be placed, as well as those patients, including certain medical cases and a large number of minor surgical cases, whose digestive organs are in normal condition. It usually includes the coarser articles of food, sometimes corned beef and cabbage, potatoes, codfish, etc., and it is very often the general diet for the servants and attendants in hospitals as well as patients.

VI. Articles Of Special Diet

Under this list are included luxuries and delicacies, such as oysters, jellies, custards, etc., and extra allowances of eggs, chicken, cream, and fruits, which may be desirable to furnish in a few individual cases.

With a system arranged upon this plan, as will be seen by the accompanying sample tables, used in some of the representative hospitals, the ordering of the diet is simplified for the visiting physician or surgeon, and is less likely to be relegated by him to subordinates than it is if he is obliged to spend the time required for 52 selecting a separate menu for each patient in the ward. The limitations of each separate diet should be distinctly understood by all the attendants and nurses, and a printed diet list of articles included under the headings "nitrogenous diet," "farinaceous diet," etc., should be conspicuously posted in the ward dining or service rooms. The daily variations within the limits of these diets should be regulated by the superintendent of the hospital or an assistant, whose special duty it is to provide the food for the institution, and select such articles as will give reasonable variety, due allowance being made for variations in regard to price and season of the year.

In many large hospitals not only is the arrangement of the diet imperfect, but the details of preparing and serving food are so inefficiently supervised that there is great loss from waste and imperfect cooking, and the additional expense of employing one or two specially trained persons to superintend these matters would be more than counterbalanced by the saving in the waste and in the benefit to the patients.

Overfeeding

Too much food is often given hospital patients by overzealous nurses, who are anxious to hasten convalescence. This is particularly true in the treatment of simple surgical cases where there is no special digestive disorder. A man accustomed to doing eight hours of active physical labour when put to bed for six weeks or more with his leg immobilised for a fracture, does not need to be constantly stuffed with large quantities of food, and yet such patients, if the matter is not carefully directed, will be often found to receive full house diet, which in itself is ample for the working attendants of the hospital, and in addition to be given two or three quarts of milk a day as a beverage. The natural result is constipation, indigestion, with a heavily coated tongue and more or less biliousness, which in turn is counteracted by a compound cathartic pill or a dose of calomel. I have known of night nurses going through wards with pitchers of milk, and pouring out tum-blerfuls for any patients who were at all thirsty, quite irrespective of any supervision.

In a large hospital, where the monthly consumption of milk is from ten thousand to fifteen thousand gallons, it may be easily seen that its indiscriminate use as a beverage is an item of very considerable and unnecessary expense to the institution, besides being an actual detriment to many of the patients.

Another undesirable tendency among American hospital dietaries is to include too much meat. The ordinary hospital menu compared, for instance, with that of the agricultural labourer, shows this fact very strikingly. Not over four ounces of cooked meat (without bone) need be allowed in the meal for men.

Fish Diet

In some hospitals in addition to the subdivisions of the diet above given, a "fish diet" may be ordered, which is very useful and should be generally adopted. In the London Fever Hospital this diet consists of a ration of bread ten ounces and fish eight ounces (the uncooked measure), such as haddock, cod, or sole, or some similar fish, potatoes eight ounces, cocoa one ounce, with half an ounce of sugar and a sixth of a pint of milk. This is a serviceable and economical form of diet for a considerable class of patients for whom large quantities of meat are not only unnecessary but injurious.

Broth Diet

In children's hospitals a diet is sometimes classified as the "broth diet," i. e., mutton broth flavoured with vegetables, and bread and butter, with milk; or a " beef-tea diet," in which the beef tea replaces the broth; and in the lighter diet of children, gruels, bread and molasses, and simple articles of farinaceous food such as farina, cornstarch, rice, etc., should play an important role. Sometimes such diet goes under the name of "soft food".

In some of the English hospitals, as in the London Fever Hospital, beer is allowed with the full diet, and in this hospital also a discrimination is made in ordering the diet according to sex, females being given from two to four ounces less bread and two to three ounces less meat than males. This discrimination is not usually made in American hospitals.