THE American authors, Fricdenwald and Ruhrah, in their text-book on Dietetics, point out that in many hospitals the diet for patients is selected by the nurses, with the exception of a few of the more important diseases such as typhoid fever, diabetes, and the like.

There is some reason for thinking that the same remark may also be applied to some hospitals in this country. An efficient remedy for this state of affairs will not perhaps be found until instruction in dietetics is made an essential part of the medical student's curriculum.

At the present time it is found that in many institutions where the official dietary leaves little or nothing to be desired, the actual dietary is in a manner faulty. Use and wont has led to the establishment of an increased number of feeding hours with a proportionate increase in the total amount of food, some of which there is good reason to believe is injurious rather than beneficial.

A concrete example of this is given in the table on p. 546, which gives the official dietary of a large infirmary, and, for comparison, the actual dietary in vogue in the same institution.

This official dietary allows for three good meals a day, which is ample for the majority of patients. Use and wont, however, has led to the following dietary being adopted as the average one for ordinary and convalescent diets in that institution: -

Hospital Diet

Full or Ordinary Diet.

Convalescent Diet

Beef-tea Diet.

Milk Diet.

Breakfast

Coffee or tea.

As ordinary.

Milk. 1 pint

Butter, 1/2 oz. ; bread, 6 oz.

Bread, 4 oz.

Bread, 4 oz.

Porridge and 1/2 pint milk, if desired.

Butter, 1/2 oz

Dinner .

Meat, boiled or roast, 8 oz.

Fish, 8 oz., or chicken, 6 oz.

(roast, boiled, or stewed); or Minced collops, 6 oz.; or Mutton cutlets; or Tripe, if desired.

Beef-tea, or Chicken broth.

Milk, I pint.

Vegetables, 12 oz.

Rice, sago, arrowroot.

Bread, 4 oz.

Farinaceous pudding (custard occasionally).

Cornflour, etc , 2 oz.

Soup.

(Farinaceous or suet pudding once a week in lieu of soup).

Bread, 6 oz.

Bread, 6 oz.

Vegetables. 8 oz.

Bread, 4 oz.

Soup.

Tea

Tea.

As ordinary.

As breakfast.

As breakfast.

Bread. 6 oz.

Sago or arrowroot, 1 oz. in addition,if desired.

Butter, 1/2 oz.

-When meat is boiled, a portion of the vegetables to be used for the soup; no extras to be given with the two first diets, except stimulants. Half a pint of sweet milk, with a slice of bread, for Lunch, to every patient requiting it.

For the purpose of comparison, the official and actual dietaries are here given side by side: -

Official Dietary.

Actual Dietary.

5 A.M. : Morning Snack, consisting of milk, 8 ounces ; or beef-tea, 8 ounces. Bread and butter, 2 to 3 ounces.

8 a.m. : Breakfast -

8 A.M. : Breakfast-

Coffee or tea.

As laid down on the chart.

Butter, 1/2 ounce ; bread, 6 ounces.

Porridge and 1/2 pint of milk, if desired.

10 to 11 A.M. : Lunch -

Milk, 8 to 10 ounces.

Bread and butter, 2 to 3 ounces.

1.30 P.M. : Dinner -

1.30 p.m. : Dinner -

Meat, boiled or roast, 8 ounces.

Consisting of soup, meat, and pudding. (Patients on convalescent diet get white meat).

Vegetables, 12 ounces.

Bread, 4 ounces.

Soup.

(Farinaceous or suet pudding once a week in lieu of soup).

4.30 P.M. : Tea -

4.30 p.m. : Tea -

Tea.

Tea.

Bread, 6 ounces.

Bread and butter, 3 to 6 ounces.

Butter, 1/2 ounce.

An egg.

7 P.M. : Supper -

Milk, 6 to 10 ounces.

Bread and butter, 1 1/2 to 2 ounces.

In this actual dietary there is no restriction to the amount of bread, the amount being regulated solely by the patient's desires. It will be observed that the nutritive value of this dietary is considerably greater than the official dietary. This regime is one which is for many patients undoubtedly excessive. It is true that there are some patients who thrive on it, and increase in weight in a favourable manner. These are, however, in a minority, and are usually patients who have been under-fed prior to admission to hospital. For the majority of patients this diet is excessive. It gives little rest to the digestive organs, and such a diet is certainly not one to be adopted as a regular routine.

There is no doubt that too much food is often given to hospital patients by over-zealous nurses who are anxious to hasten convalescence. The desire to feed is a kindly feminine instinct which should be carefully regulated by the practitioner. The medical man should always explicitly indicate the nature and the amount of food, and the frequency of administration which he considers advisable for each patient. A useful way of classifying hospital dietaries is the following: -

1. A Milk Diet

A Milk Diet, consisting of 4 to 6 pints of milk daily, and nothing else. This may be given in the form of diluted milk, whey, skimmed milk, or koumiss. It is best administered in six meals in the 24 hours.

2. A Fluid Diet

A Fluid Diet, consisting of milk, beef-tea, chicken broth, mutton broth, egg albumin. The milk or beef-tea may be thickened with one of the pre-digested invalid foods (p. 185), six meals daily being given.

3. A Light Or Convalescent Diet

A Light Or Convalescent Diet, consisting of the light, nutritive, and more-easily digested foodstuffs - e.g., milk, fish, chicken, tripe, bread, invalid foods, milk puddings, and stewed fruit; green vegetables, red meats, pastry, rich sauces, etc., are withheld. An illustrative dietary is here given: -

Breakfast

Milk, flavoured with tea or coffee.

Bread and butter, or toast and butter.

Gruel, or Hominy, or Farina; or lightly-cooked egg or steamed fish.

Dinner

Soup; meat- or chicken-tea or broth, thickened with barley or rice (see p. 302). Dry bread or toast. Fish or chicken. Pudding made from invalid food, p. 185; or well-made milk pudding, p. 297; or stewed fruit - apples, prunes, rhubarb, or gooseberries or plums passed through a sieve.

Tea

Milk, flavoured with tea. Rusk, or sponge biscuit.

Supper

A cupful of gruel, p. 296; or malted gruel, p. 18l; or invalid food, p. 184; or beef- or chicken-tea thickened, p. 176, with a slice of toast.

4. Lacto-Vegetarian Or Farinaceous Diet

Lacto-Vegetarian Or Farinaceous Diet, from which animal food, with the exception of milk and butter, are excluded (see p. 526).

5. Protein Or Nitrogenous Diet

Protein Or Nitrogenous Diet, from which starchy and saccharine foods are very largely excluded, consisting mainly of meats, fish, eggs, with a specified small amount of starchy foods in the form of dried bread, toast, or rusks, arranged as follows: -

Breakfast

Tea or coffee.

One slice of toast with butter, and Kalari biscuit (p. 476).

Eygs, bacon, ham, tongue, or fish.

Dinner

Soup from meat stock (pp. 73, 271), crisp toast or rusk.

Fish, fowl, game, meat, with cauliflower, spinach, lettuce, celery, or tomato. Curds, custard, jelly, souffle, or stewed fruit.

Supper

Repetition of dinner, two courses being taken.

6. Ordinary Or House Diet

Ordinary Or House Diet, as in Hospital Diet, p. 546.