In 1861, Surgeon General Dr. Moore had published for the Army of Virginia Florence Nightingale’s “Directions for Cooking by Troops in Camp & Hospital.” In the same publication there were two of Miss Nightingale’s essays: “Taking Food” and “What Food”. These two publications were directed specifically at feeding those in the hospital and are the focus of this article.

“Taking Food” focuses on what and when to feed those in the hospital. She concludes that many patients starve in hospitals in the “midst of plenty.” Many times patients do not eat their food but would eat if only the hospital personnel would pay attention to the sick and observe the patients. Many sick will not make the effort to eat based upon their illness.

She starts off looking at the very weak patients whom she had observed. Many of these patients found it impossible to eat solid foods prior to 11 am. By that time they were exhausted by fasting until that time. Fever patients in the morning have very dry mouths, precluding them from eating many solid foods. Her recommendations were that those who could swallow be served a spoonful of beef tea. Normal breakfast of an egg, a bit of bacon, or a mutton chop would be very difficult to chew at an earlier breakfast hour.

A cup of tea is another potion for the regular breakfast time. If the patient’s stomach rejects the cup, the nurse can try a tablespoon every hour or even a tea spoon every quarter hour until he retains the liquid in his system. Asking the patient to do multiple tasks during eating also disrupts the feeding focus, reducing consumption. An example would be feeding a patient while you were cleaning them up at the same time. The cleaning becomes a distraction which reduces the possibility of increased consumption of their food. A single focus is best when a nurse wants to maintain or increase food consumption.

Maintaining a strict feeding schedule is also critical when the patient is very weak. The possibility of bringing a patient back from the “jaws of death” increases based upon the giving of nourishment on a strict schedule. The flip side of this is observation. This observation is of the times that the patient takes food readily. At the same time, the time that a patient is most faint should be noted and avoided as a feeding time. This requires three things: observation, ingenuity, and perseverance.

Leaving a patient’s food untasted by the side of the bed (in hopes that he will eat it) should be prohibited in the hospital. Her observations were that most of the time, the patient did not eat as a result of left food. Instead, food should be brought and taken away at specific times. Even if uneaten, that data adds to finding the right time to provide food that will be eaten. A patient who cannot touch his dinner at two, would gladly accept that same dinner at seven pm.

Questioning the patient seems like a logical step, but many British doctors did not perform this step. Asking, “is there no hour when you feel you could eat?” helps reestablish the eating habits of the patient. If the patient is unresponsive to this questioning, the nurse and/or doctor will need to watch and take notes on the times that the patient does take food. The patient sometimes need to “teach” the nurse to nurse him.

Miss Nightingale states that she has known a nurse in charge of a set of wards, who not only carried in her head all the little varieties in the diets which each patient was allowed to fix for himself, but also exactly what each patient had taken during each day. She knew another nurse in charge of one single patient, who took away his meals day after day all but untouched, and never knew it.

She felt that if you find it helps you to note down such things on a bit of paper, in pencil, by all means do so. I think it more often lames than strengthens the memory and observation. But if you cannot get the habit of observation one way or other, you had better give up the being a nurse, for it is not your calling, however kind and anxious you may be.

Patients should be provided their food so they can smell only their food. Because of the three types of diets in a hospital: low, medium, and full, there will be patients who will desire something that another patient has based upon the “smell” of the other man’s food. Food should be provided in portions that are appropriate to the condition of the patient. Too much or little can affect the eating habits of the soldier.

While not usually an issue in hospital wards, the concept of the invalid patient eating alone is very questionable. It is recommended that the nurse should not allow him to talk, or talk to him while eating. The focus should be on eating.

The quality of the food is critical to patient consumption. A patient should never be offered milk that is sour, meat or soup that is turned, an egg that is bad, or vegetables that are undercooked. Clever nurses will whip something up in a few minutes that offer a patient delectable foodstuffs. The food offered a patient should do half the work of a patient’s weakened digestion system. If hospital personnel offer to a patient bad food that impairs the digestive system of those sick, nutrition is impaired and the patient will only grow weaker instead of stronger.

Finally, a nurse must take care not to spill into the patient’s saucer during the feeding process. If there is liquid in the saucer, this will spill over the patient, soil the sheets, bed gown, or pillow.

So, what are Miss Nightingale’s recommendations to feed the patients in “What Food”? Her number one go to food is fresh milk. It allows the patient to eat more bread. It can be combined with whey, wine, or other spirits to help revive the patient.

During this time period, nutrition as a food science was just starting to be investigated. There were two food groups known to the public: nitrogeneous and carboniferous. The nitrogeneous foods included meat, dairy, eggs, nuts and legumes, and grains and cereals. The carboniferous foods included fruits, vegetables, beans, and nuts. Scientists felt that a patient needed a balanced diet with foods from both groups. This came from the research being conducted in the new science of Organic Chemistry. This “research” started to conclude that a diet of a healthy person might kill a sick one and the diet of a sick person might make a healthy person sick.

Perhaps the one thing that all could agree on was that jelly was not good for sick people even though they craved it. Jelly was thought to be unnutritious even though it was a chemistry secret yet undiscovered. This concept on jelly was made though observation of patients. Jelly was thought not to nourish but produce diarrhea and simply starve the sick under the guise of feeding them. Many thought that if 100 spoons of jelly were given during a day, that would be the equivalent of one spoon of gelatin, which it was felt had no nutritive power whatever. The problem Miss Nightingale stated was that it was in great favor with nurses and friends of the sick.

In all matters of nutrition, the “opinions” of the patient’s stomach rather that an analysis of foods really should settle what is consumed by the patient. If it does not stay down or is not eaten by the patient, it does not supply the nutrition necessary for the patient to get well.

Until next time….

Your Obt. Servant,

Surgeon Trevor Steinbach

17th Corps Field Hospital