[Sidenote: The Hospital Kitchen]
With the advance in science, and a better knowledge of things desirable
and things avoidable in hospital construction, a gradual change is
taking place in institutions designed for the care of the sick.
Perhaps in no department have greater changes taken place than in the
construction of the modern hospital kitchen. Instead of being located
in the basement, where odors from cooking were diffused throughout the
whole building, and where absence of light invited the accumulation of
dirt, the kitchen is now located in the top story, or, if the hospital
be built on the cottage plan, in a separate building. In deciding
on the location, one thought should be prominent—the possibility of
conveying cooked food without delay to those for whom it is prepared.
With proper facilities for keeping food hot, this important point is
not difficult of accomplishment.
[Sidenote: General Construction]
Wherever the kitchen is located, it should be large, light and
thoroughly ventilated. Proper care in planning and construction will
insure the installation of vent flues and ducts to carry off smoke and
odors, as soon as generated. As far as possible, the interior of the
kitchen and its furnishings should be constructed of non-absorbent
material. Those who have had experience with cement floors claim
for them that they are splendidly absorbent of grease, exceedingly
difficult to cleanse, and liable to crack, thereby furnishing crevices
for the deposit of dirt of all kinds. Therefore, in a hospital designed
to be thoroughly sanitary, cement floors will have no place. Tile seems
to be the material that gives the most general satisfaction for kitchen
floors and walls. A white vitrified tile, laid on a heavy foundation,
having the joints between the tiles carefully sealed with cement, gives
perhaps the nearest to the ideal kitchen floor yet attained. If the
floor is constructed so as to slope gently toward a drain properly
trapped and protected, the cleaning will be facilitated. The side walls
and ceiling of glass tile, with the corners well rounded, gives a
surface that is not only bright and beautiful, but thoroughly sanitary.
Such a finish will endure the most severe cleaning without injury. Wood
mouldings, that invite the deposit of dust, will of course be avoided.
The sinks in the hospital should be placed at sufficient distance from
the walls, so as to be accessible on all sides.
[Sidenote: Kitchen Cabinet]
A hygienic outfit for the hygienic kitchen is of course essential, but
sometimes more difficult to secure than is the sanitary room. Dressers
and drawers for the accommodation of the kitchen utensils must be
provided, and in these things crevices and angles and dark corners
and all sorts of complications of this character seem unavoidable. If
these cabinets could be of metal, all angles and corners done away with
by the finishing with curves, the shelves loose fitting and easily
removable, it would be a decided advance in kitchen arrangements. The
drawers could be made in the same way, the emphasis being on the point
“easily removable.” Thus constructed, the person in charge would find
it easier to remove them than to undertake to clean them while in
position.
Architects say, that in hospitals where steam boilers and engines for
supplying power for elevators, electric lights, laundries, etc., are
in use, arrangements should be made to utilize for cooking the large
amount of exhaust steam, that ordinarily goes to waste. When this
is done, ashes, smoke and their attendant ills can be avoided. The
hospital may then be not only “a thing of beauty,” but “a joy forever,”
and the drudgery of that department greatly reduced.
Through the courtesy of Mr. W. J. Palmer, architect, of Washington, D.
C., we are able to present drawings for a hospital kitchen embodying
most of the features above mentioned. The drawings were designed for
a kitchen located on the ground floor in a separate building, but
with a few changes could be easily adapted to a kitchen located on
the top floor. The range is located in the center of the room, with
steam tables on each side to keep the cooked food hot. A gas range
is provided and a chopping block, tables and dressers are arranged
conveniently for work. On one side is a small pantry, which leads
to the vegetable cellar beneath, and adjoining it is the main diet
kitchen. At one end is the serving room, where the food is divided
and dispatched to the wards. Leading from the serving room is a hall,
off which on one side are the cooling rooms, and on the other side
storerooms for staple supplies. If the kitchen be on the top floor, a
cooling room on that floor, sufficient at least to care for one day’s
provisions, will be necessary, having the main cooling rooms located on
the main floor or in the basement.
[Sidenote: Cold Storage]
A good cooling room, in which can be stored large quantities of the
perishable supplies, has now come to be regarded as essential to
economical housekeeping. The size of the cooling room will depend on
the size of the hospital, but there are special features which should
always be kept in view, and which can be had in cooling rooms of any
size. One important point is to have it so constructed that the ice can
be put in from the outside, if it is not manufactured on the premises.
Every cooling room needs to have three departments—one large section,
well arranged with meat hooks and shelving for meats, one with plenty
of shelf space for vegetables and fresh fruits, and one for milk,
butter and eggs. The separation of these articles is highly important.
Vegetables and fruit will taint milk and also meat, and meat alone
will injure milk. The best goods that can be purchased will quickly
deteriorate unless properly cared for, and in a hospital, where the
most capricious appetites have to be catered to, the keeping of the
edibles sweet and fresh is of the utmost importance.
[Illustration]
[Sidenote: The Storeroom]
The storerooms should be light, well ventilated, cool and dry. The
shelving, if arranged in sections in the central part of the room,
similar to the arrangement in libraries, will be much easier of access
and more easily kept clean. Labeled receptacles, with covers for all
the varied commodities used in the domestic department, should be
provided, thus rendering it unnecessary to store supplies of any kind
in paper sacks. A special closet for canned fruit will also be needed.
Provision should be in the kitchen for the care of such supplies as are
needed for each day.
[Sidenote: Dishwashing]
Dishwashing, that bugbear of every household, is not less a task in a
hospital than elsewhere. In fact, it forms a very large part of the
work of the institutional kitchens. The use of mechanical dishwashers
has not yet become general, and it is doubtful if any but the largest
institutions will deem it necessary to adopt them. Those who have had
experience with them as a rule find them satisfactory, and comment
especially on the saving in breakage and time. Provision ought to be
in every hospital kitchen for handling dishes in large quantities and
the adoption of a routine method of dishwashing will do much to prevent
confusion and simplify the task. If each floor has its own kitchen and
diet kitchen where the ward dishes can be washed and kept, the labor
in the kitchen will be greatly reduced and fewer servants in that
department will be necessary; and this is perhaps the better way. The
frequent handling of dishes that is necessary, when the supply for the
whole household has to be sent to and from the main kitchen three times
a day, adds greatly to the breakage, and results in increased labor and
loss of time. But in this matter, as in many other lines of hospital
work, the housekeeper’s methods are modified by the construction of the
hospital. If no facilities are provided on each floor for washing the
dishes, there is no alternative but to send them to the main kitchen to
be handled there. The real work there may be greatly facilitated if in
cleaning and packing the trays, care has been exercised in separating
the different articles. The silver should be collected on one tray, the
fragments placed by themselves on another, the dishes carefully scraped
and packed, the tray-cloths shaken and folded together. The maid in
the kitchen receives them from the dumb waiter as they are sent from
the different wards. The silver and glass and delicate china should be
placed together to be washed first, the heavier china and greasy dishes
on a separate table, and when all are collected the washing begins. The
water for the glass and fine china should not be too hot, and these
should be finished and put away before the washing of the silver is
begun. But few servants can be trusted to properly handle delicate
china and glassware without supervision, and the all too prevalent
custom of piling a large draining dish full of delicate articles is
the cause of constant breakage. A draining rack, constructed with
grooves, and fitting on one edge of the sink, is a much appreciated
convenience in many hospital kitchens. Every housekeeper has her own
theories of proper dishwashing, and all are good if the result is clean
dishes. The main point is to have a system of preparing the dishes for
washing and adhering to it; without system the disorder and confusion
in the kitchen when all the trays are sent in will disturb the most
saintly individual. A limit to the time when dishes may be sent from
the wards is also essential to methodical work. Much unnecessary
delay and unpleasant feeling is often caused by the late arrival of a
consignment of dirty dishes which should have reached the kitchen an
hour or two before. The carelessness of those in charge of the ward
dishes results in upsetting the arrangements of the other work of
the kitchen, the maids who had finished their task having to gather
together their dishwashing utensils and begin over again. To require
that the delinquents assume the responsibility of washing all dishes
not sent to the kitchen at the proper time will do much to prevent the
repetition of this unpleasant occurrence.
[Sidenote: Dishcloths and Towels]
Much care needs to be used in the handling of dishcloths and towels.
Plenty of towels should be provided, and dishcloths should be washed
and scalded after each meal. It is impossible to have clean, shining
dishes if these are not kept thoroughly clean. The tendency for kitchen
towels to disappear may be overcome by the housekeeper requiring each
maid to state the number necessary for her work, supplying them,
insisting that each put her special mark on her own towels, and
requiring that the old towels be produced before new ones will be given
out.
[Sidenote: The Chief Kitchen employee]
In selecting a chief employee who will be responsible for the direction
of the details of the work, and for the care of the kitchen and the
other rooms in her department, several points need to be considered.
She should not only be familiar with methods of preparation and
cooking, proper carving and serving of food, but she should know how to
keep herself neat during the process. Neatness and cleanliness about
the person of the workers in the kitchen is fully as essential as
neatness in the care of the room and utensils. In fact, one who is not
neat in person cannot be trusted to observe the rules of cleanliness
anywhere. “Doing” is dependent on “being,” here as elsewhere.
[Sidenote: Training Needed]
The secret of success in the kitchen is the same as in other
departments of the institution, and, indeed, of life in general. It
can be spelled in one word—s-y-s-t-e-m; and be it understood here and
now, that system and red tape are not synonymous terms. Just as in a
large department store, every yard of ribbon sold has its relation
to the whole establishment, or in a great railway system every train
dispatched influences the running of every other train, and system is
necessary to insure the success of the business or the safety of human
lives, so in a hospital every part is vitally related to the great
whole. Some mind must plan the details, first of the whole and then
the minutæ of the different parts as they contribute to its harmony
and success. And yet, while this truth is generally admitted, and its
importance is evident, how little training does the average nurse of
the present day receive to fit her for the responsibilities of hospital
housekeeping—that on which much of the comfort and well-being of the
whole institution depends. Most graduate nurses can nurse, they can
care for a patient afflicted with an ordinary disease in a satisfactory
manner, but how much have they learned regarding the management of
the household? How much have they been taught regarding the purchase
of supplies, the care of food, the management of the linen room, the
laundry and kitchen, the supervision of servants, and other matters of
vital importance to every hospital? Is there not much still lacking in
our present system of training? If a railway company sent an engineer
to conduct a train to its destination as ignorant of, and inexperienced
in, the working of the whole train system as some graduate nurses are,
who have the responsibility of a hospital, small or large, placed
upon them, the public would raise its hands in horror, and brand the
railway officials with criminal carelessness. While present methods
continue, the success or failure of the nurse as an executive officer
and housekeeper depends largely on the thoroughness of the domestic
training she received from her mother, her own native ability, and her
intuitions as to how things should be done—not on the training received
in the average hospital. When the nurses’ course includes practical
instruction in the management of every department of the hospital, the
purchase of supplies of all kinds and simple accounting, the public,
with the nurses, will reap the benefit. In large institutions stewards
may be employed, or it may be possible to secure a trained housekeeper
from some institute of domestic science. But in the small hospital the
superintendent must be her own housekeeper; such superintendents must
almost of necessity be nurses, and there ought to be time in a three
years’ course to give them some insight into, and experience in, the
details of hospital housekeeping.
[Sidenote: The Diet Kitchen]
An advance step has been taken, however, in the introduction of cooking
into the nurse’s course of study. The nurse’s work in the diet kitchen
ought to mean a lightening of some of the burden in the main kitchen.
The custom of management of this department varies and each institution
must work out its own problems. Where there is a regular dietitian
in charge, with the diet kitchen work as her exclusive business, the
matter is easier of adjustment. Where this is not possible two nurses
may be assigned for this special duty, making the term of service
two months. The junior nurse may thus be initiated by the senior
diet nurse, the housekeeper having general supervision of the entire
work. The value of this practical experience in cooking can scarcely
be overestimated, for unfortunately a great many young women enter a
hospital with no more definite idea of how to prepare food for invalids
than they have of medicine or surgery. In order that this course in
practical work be productive of the most good to the nurses, previous
instruction in the principles of nutrition, food values, and in the
processes of digestion, should be given. Valuable, however, as the diet
kitchen work is in the nurse’s education, unless it is arranged that
that department assume a certain responsibility for preparing a part of
the hospital dietary, its introduction is hardly justifiable. In most
cases the diet kitchen should furnish at least the special diets and
desserts, all broths, jellies, etc. If the diet kitchen facilities are
adequate, it may be wise to have all the cooking for private patients
done in this special department. In this way it is possible to devote
more attention to attractive arrangement of food, as well as more care
to its preparation. Where the housekeeper has a real interest in the
people for whom the food is prepared, and has cultivated the fine art
of cookery, or has a degree of native ingenuity, many delightful dishes
may be constructed even of odds and ends, and a variety secured out
of very little. The very first essential to proper feeding is good
cooking, and this, like most other expert service, is an economy rather
than a waste. For this reason many institutions that have tried both
methods claim that the employment of a trained chef at a good salary
was really a saving to the institution when the total cost of the
culinary department was reckoned. This is in comparison with the old
method of having the cooking done by women who had received no previous
training, and had no special desire to study the art of cooking or to
become more proficient in it.