[Sidenote: Want of attention to hours of taking food.]
Every careful observer of the sick will agree in this that thousands of
patients are annually starved in the midst of plenty, from want of
attention to the ways which alone make it possible for them to take
food. This want of attention is as remarkable in those who urge upon the
sick to do what is quite impossible to them, as in the sick themselves
who will not make the effort to do what is perfectly possible to them.
For instance, to the large majority of very weak patients it is quite
impossible to take any solid food before 11 A.M., nor then, if
their strength is still further exhausted by fasting till that hour. For
weak patients have generally feverish nights and, in the morning, dry
mouths; and, if they could eat with those dry mouths, it would be the
worse for them. A spoonful of beef-tea, of arrowroot and wine, of egg
flip, every hour, will give them the requisite nourishment, and prevent
them from being too much exhausted to take at a later hour the solid
food, which is necessary for their recovery. And every patient who can
swallow at all can swallow these liquid things, if he chooses. But how
often do we hear a mutton-chop, an egg, a bit of bacon, ordered to a
patient for breakfast, to whom (as a moment's consideration would show
us) it must be quite impossible to masticate such things at that hour.
Again, a nurse is ordered to give a patient a tea-cup full of some
article of food every three hours. The patient's stomach rejects it. If
so, try a table-spoon full every hour; if this will not do, a tea-spoon
full every quarter of an hour.
I am bound to say, that I think more patients are lost by want of care
and ingenuity in these momentous minutiæ in private nursing than in
public hospitals. And I think there is more of the _entente cordiale_ to
assist one another's hands between the doctor and his head nurse in the
latter institutions, than between the doctor and the patient's friends
in the private house.
[Sidenote: Life often hangs upon minutes in taking food.]
If we did but know the consequences which may ensue, in very weak
patients, from ten minutes' fasting or repletion, (I call it repletion
when they are obliged to let too small an interval elapse between
taking food and some other exertion, owing to the nurse's
unpunctuality), we should be more careful never to let this occur. In
very weak patients there is often a nervous difficulty of swallowing,
which is so much increased by any other call upon their strength that,
unless they have their food punctually at the minute, which minute again
must be arranged so as to fall in with no other minute's occupation,
they can take nothing till the next respite occurs--so that an
unpunctuality or delay of ten minutes may very well turn out to be one
of two or three hours. And why is it not as easy to be punctual to a
minute? Life often literally hangs upon these minutes.
In acute cases, where life or death is to be determined in a few hours,
these matters are very generally attended to, especially in Hospitals;
and the number of cases is large where the patient is, as it were,
brought back to life by exceeding care on the part of the Doctor or
Nurse, or both, in ordering and giving nourishment with minute selection
and punctuality.
[Sidenote: Patients often starved to death in chronic cases.]
But, in chronic cases, lasting over months and years, where the fatal
issue is often determined at last by mere protracted starvation, I had
rather not enumerate the instances which I have known where a little
ingenuity, and a great deal of perseverance, might, in all probability,
have averted the result. The consulting the hours when the patient can
take food, the observation of the times, often varying, when he is most
faint, the altering seasons of taking food, in order to anticipate and
prevent such times--all this, which requires observation, ingenuity, and
perseverance (and these really constitute the good Nurse), might save
more lives than we wot of.
[Sidenote: Food never to be left by the patient's side.]
To leave the patient's untasted food by his side, from meal to meal, in
hopes that he will eat it in the interval, is simply to prevent him from
taking any food at all. I have known patients literally incapacitated
from taking one article of food after another, by this piece of
ignorance. Let the food come at the right time, and be taken away, eaten
or uneaten, at the right time; but never let a patient have "something
always standing" by him, if you don't wish to disgust him of everything.
On the other hand, I have known a patient's life saved (he was sinking
for want of food) by the simple question, put to him by the doctor, "But
is there no hour when you feel you could eat?" "Oh, yes," he said, "I
could always take something at -- o'clock and -- o'clock." The thing was
tried and succeeded. Patients very seldom, however, can tell this; it is
for you to watch and find it out.
[Sidenote: Patient had better not see more food than his own.]
A patient should, if possible, not see or smell either the food of
others, or a greater amount of food than he himself can consume at one
time, or even hear food talked about or see it in the raw state. I know
of no exception to the above rule. The breaking of it always induces a
greater or less incapacity of taking food.
In hospital wards it is of course impossible to observe all this; and in
single wards, where a patient must be continuously and closely watched,
it is frequently impossible to relieve the attendant, so that his or
her own meals can be taken out of the ward. But it is not the less true
that, in such cases, even where the patient is not himself aware of it,
his possibility of taking food is limited by seeing the attendant eating
meals under his observation. In some cases the sick are aware of it, and
complain. A case where the patient was supposed to be insensible, but
complained as soon as able to speak, is now present to my recollection.
Remember, however, that the extreme punctuality in well-ordered
hospitals, the rule that nothing shall be done in the ward while the
patients are having their meals, go far to counterbalance what
unavoidable evil there is in having patients together. I have often seen
the private nurse go on dusting or fidgeting about in a sick room all
the while the patient is eating, or trying to eat.
That the more alone an invalid can be when taking food, the better, is
unquestionable; and, even if he must be fed, the nurse should not allow
him to talk, or talk to him, especially about food, while eating.
When a person is compelled, by the pressure of occupation, to continue
his business while sick, it ought to be a rule WITHOUT ANY EXCEPTION
WHATEVER, that no one shall bring business to him or talk to him while
he is taking food, nor go on talking to him on interesting subjects up
to the last moment before his meals, nor make an engagement with him
immediately after, so that there be any hurry of mind while taking them.
Upon the observance of these rules, especially the first, often depends
the patient's capability of taking food at all, or, if he is amiable and
forces himself to take food, of deriving any nourishment from it.
[Sidenote: You cannot be too careful as to quality in sick diet.]
A nurse should never put before a patient milk that is sour, meat or
soup that is turned, an egg that is bad, or vegetables underdone. Yet
often I have seen these things brought in to the sick in a state
perfectly perceptible to every nose or eye except the nurse's. It is
here that the clever nurse appears; she will not bring in the peccant
article, but, not to disappoint the patient, she will whip up something
else in a few minutes. Remember that sick cookery should half do the
work of your poor patient's weak digestion. But if you further impair it
with your bad articles, I know not what is to become of him or of it.
If the nurse is an intelligent being, and not a mere carrier of diets to
and from the patient, let her exercise her intelligence in these things.
How often we have known a patient eat nothing at all in the day, because
one meal was left untasted (at that time he was incapable of eating), at
another the milk was sour, the third was spoiled by some other accident.
And it never occurred to the nurse to extemporize some expedient,--it
never occurred to her that as he had had no solid food that day, he
might eat a bit of toast (say) with his tea in the evening, or he might
have some meal an hour earlier. A patient who cannot touch his dinner at
two, will often accept it gladly, if brought to him at seven. But
somehow nurses never "think of these things." One would imagine they did
not consider themselves bound to exercise their judgment; they leave it
to the patient. Now I am quite sure that it is better for a patient
rather to suffer these neglects than to try to teach his nurse to nurse
him, if she does not know how. It ruffles him, and if he is ill he is in
no condition to teach, especially upon himself. The above remarks apply
much more to private nursing than to hospitals.
[Sidenote: Nurse must have some rule of thought about her patients
diet.]
I would say to the nurse, have a rule of thought about your patient's
diet; consider, remember how much he has had, and how much he ought to
have to-day. Generally, the only rule of the private patient's diet is
what the nurse has to give. It is true she cannot give him what she has
not got; but his stomach does not wait for her convenience, or even her
necessity.[22] If it is used to having its stimulus at one hour to-day,
and to-morrow it does not have it, because she has failed in getting it,
he will suffer. She must be always exercising her ingenuity to supply
defects, and to remedy accidents which will happen among the best
contrivers, but from which the patient does not suffer the less, because
"they cannot be helped."
[Sidenote: Keep your patient's cup dry underneath.]
One very minute caution,--take care not to spill into your patient's
saucer, in other words, take care that the outside bottom rim of his cup
shall be quite dry and clean; if, every time he lifts his cup to his
lips, he has to carry the saucer with it, or else to drop the liquid
upon, and to soil his sheet, or his bed-gown, or pillow, or if he is
sitting up, his dress, you have no idea what a difference this minute
want of care on your part makes to his comfort and even to his
willingness for food.