CHAPTER X.

[Sidenote: Hospital Dietaries]

The following dietary regulations have been adopted in the New York Hospital:

“All patients shall be furnished the regular house diet, unless otherwise specially directed by the attending physician or surgeon. As a substitute for the house diet there may be furnished, on the order of the attending physician or surgeon only, either of the following:

“1. Restricted diet.

“2. Milk diet.

“The attending physician or surgeon shall specify on the occasion of his first visit to a patient which diet shall be furnished. This duty may not be delegated to the house physician, except that on the admission of a patient to a ward it shall be his duty to give instruction on the subject to the nurse in charge, and such instruction shall be followed until the first visit of the attending physician or surgeon.

“The wards shall be supplied with blanks called diet lists. The head nurse shall carry one of these with her regularly when accompanying the attending physician or surgeon on his visits, and shall note down carefully all his instructions as to diet; he shall sign these lists before leaving the ward.

“Milk diet or restricted diet may not be ordered in addition to the regular house diet, but only as a substitute therefor, but the attending physician or surgeon may order items of special diet in particular cases.

“Lists defining the different classes of diet shall be furnished each attending physician and surgeon.

“Cards appropriately inscribed shall be placed at the head of each bed, which shall designate the class of diet and also the amount of stimulant which is furnished each patient.

“A diet kitchen is established under the direction and control of the directress of nurses, wherein articles of special diet shall be prepared and served as ordered.

DAILY HOUSE DIET.

“_Breakfast._—Oatmeal or hominy; tea or coffee, with milk and sugar; bread and butter.

“_Dinner._—Potatoes; bread and butter; one or more of the following vegetables: Turnips, sweet potatoes, beets, spinach, squash.

“_Supper._—Tea with milk and sugar; bread and butter; stewed or fresh fruit.

“In addition on Sunday: Breakfast—Eggs. Dinner—Roast beef and cornstarch pudding. Monday: Breakfast—Baked potatoes. Dinner—Stock soup, stewed beef or mutton, rice pudding. Tuesday: Breakfast—Mutton chops. Dinner—Pea soup, roast mutton, bread pudding. Wednesday: Breakfast—Fried or stewed potatoes. Dinner—Roast beef, cornstarch pudding. Thursday: Breakfast—Eggs. Dinner—Stock soup, stewed beef or mutton, tapioca pudding. Friday: Breakfast—Salt mackerel or codfish. Dinner—Bean soup, baked fish, beans, rice pudding. Saturday: Breakfast—Beefsteak. Dinner—Corned beef, cabbage, bread pudding.

RESTRICTED DIET.

“_Breakfast._—Tea or coffee (with milk and sugar), farinaceous food (with milk), eggs.

“_Dinner._—Soup; either of the following: Raw oysters, roast beef, steak, chicken with vegetables, pudding (bread, rice, tapioca or cornstarch).

“_Supper._—Tea (with milk and sugar), bread (with butter), fruit, fresh or dried.

MILK DIET.

“Six pints of milk daily.

ARTICLES OF SPECIAL DIET.

“Milk, eggs, beef tea, oysters, cornstarch, chops, steak, chicken, chicken soup, rice, broth, farina, ice creams, as ordered by the attending physician or surgeon.

“Salt fish, jellies, custards, gruels.”

_Dietary of the Roosevelt Hospital, New York._

“The ward diet of the Roosevelt Hospital, New York, is classified as follows:

FULL DIET.

“Daily.—Meat dressed, eight ounces; potatoes, eight ounces; bread, twelve ounces; butter, one ounce; sugar, two ounces and a half; milk, half-pint; coffee, half an ounce; tea, an eighth of an ounce.

“On Sundays, Tuesdays and Thursdays other vegetables in addition to potatoes, two ounces; bread, rice or tapioca pudding.

“On Mondays and Wednesdays, soup, one pint.

“On Fridays, fish.

“_Breakfast._—Coffee with sugar and milk, bread and butter, porridge of oatmeal, wheaten grits or samp.

“_Dinner._—Sunday: Roast beef, tomatoes, potatoes or other vegetables, bread and bread pudding. Monday: Soup, boiled mutton, potatoes and bread. Tuesday: Corned beef, twelve ounces; cabbage or turnips, potatoes and bread. Wednesday: Soup, roast beef, potatoes and bread. Thursday: Soup, boiled beef, potatoes, onions, tapioca, sago, or farina pudding and bread. Friday: Fish, boiled or roast beef, potatoes, bread, boiled rice sweetened with sugar and milk and raisins. Saturday: Stew of mutton, potatoes and bread.

“_Supper._—Tea with sugar and milk, bread and butter, baked apples or stewed pears or prunes or green or dried apple sauce, and on Sundays gingerbread varied alternate weeks with currant buns.

HALF DIET.

“Daily.—Meat dressed, four ounces; potatoes, four ounces; bread, six ounces; of other articles the same as in full diet.

MILK DIET.

“Daily.—Milk, two pints; bread, twelve ounces; rice or samp, two ounces; butter, one ounce.

EXTRAS.

“In addition to the above, the following extras may be ordered by the visiting physicians and surgeons: Beefsteak, chicken soup, gruel, beef tea, oysters or clams, cornstarch, mutton chops, milk, rice, chicken, eggs.

“_Ward Dietary of the New York Infirmary for Women and Children, 1901._

“The following is a sample mid-summer diet from a smaller hospital having about seventy beds, in which attention is economically given to variety in food cookery, which would be impossible in a larger institution without incurring needless expense—Thompson.

SUNDAY.

“_Breakfast._—Full Diets: Hominy with milk, fish balls or creamed fish, brown bread or biscuit, coffee with milk and sugar, fresh fruit. Half Diets: Hominy with milk, toast, coffee, fresh fruit.

“_Dinner._—Full Diets: Soup, bread, roast beef, sweet or white potatoes, spinach or egg plant, pudding. Half Diets: Clam broth, toast, chicken or beef jelly, rice or ice cream.

“_Supper._—Full Diets: Pressed beef or cream salmon, bread and butter, cocoa. Half Diets: Indian meal porridge and milk, toast, cocoa, fruit.

MONDAY.

_“Breakfast._—Full Diets: Oatmeal and milk, bread and butter, poached eggs on toast, coffee with milk and sugar. Half Diets: Oatmeal, eggs on toast, coffee, fresh fruit.

“_Dinner._—Full Diets: Soup, bread, roast lamb, spaghetti, tomatoes or lima beans, rice, prune or cottage pudding. Half Diets: Chicken broth, toast, spaghetti, rice pudding or cottage pudding.

_“Supper._—Full Diets: Baked potatoes and bacon or creamed beef on toast, bread and butter, tea, fruits. Half Diets: Hominy and milk, bread and butter or toast, tea, fruit.

TUESDAY.

“_Breakfast._—Full Diets: Wheat flakes and milk; beef mince or hash, bread and butter, coffee. Half Diets: Wheat flakes, buttered toast, coffee, fresh fish.

“_Dinner._—Full Diets: Soup, bread, steak, cresses, potatoes, beans or carrots or beets, boiled or baked custards or ice cream. Half Diets: Mutton broth, rice, toast, custard or ice cream.

“_Supper._—Full Diets: Brown bread and butter, cream cheese or boiled eggs, or sliced beef, fruit, cocoa. Half Diets: Oatmeal jelly and milk, toast, fruit, cocoa.

WEDNESDAY.

“_Breakfast._—Full Diets: Hominy with milk, lamb mince or lamb with cream sauce, bread, butter, coffee. Half Diets: Hominy with milk, buttered toast, boiled eggs, coffee, fresh fruit.

“_Dinner._—Full Diets: Soup, bread, chicken, potatoes or rice, peas, tapioca or fruit pudding or custard. Half Diets: Broth, rice, toast, tapioca.

“_Supper._—Full Diets: Spaghetti and tomato or sliced tomatoes or baked corn, bread and butter, tea, fruit. Half Diets: Wheat flakes and milk, toast, tea, fruit.

THURSDAY.

“_Breakfast._—Full Diets: Oatmeal and milk, fresh fish, bread and butter, coffee. Half Diets: Oatmeal and milk, toast, coffee, fresh fruit.

“_Dinner._—Full Diets: Soup, bread, braised beef, macaroni, spinach or string beans, wine jelly or fruit jelly. Half Diets: Chicken broth, macaroni, toast, wine jelly.

“_Supper._—Full Diets: Beef stew or cream toast or pea soup, bread and butter, cake, fruit, cocoa. Half Diets: Cream toast, cocoa, fruit.

FRIDAY.

“_Breakfast._—Full Diets: Wheat flakes and milk, scrambled eggs on toast, bread and butter. Half Diets: Wheat flakes and milk, eggs, toast, coffee, fresh fruit.

“_Dinner._—Full Diets: Soup, bread, fish, potatoes, peas or tomatoes, bread pudding or Indian pudding or ice cream. Half Diets: Lamb broth, rice, bread pudding or ice cream.

“_Supper._—Full Diets: Chowder or boiled eggs, bread and butter, tea, fruit. Half Diets: Oatmeal jelly, toast, tea, fruit.

SATURDAY.

“_Breakfast._—Full Diets: Indian meal porridge and maple syrup or milk, beef ragout, bread and butter, coffee. Half Diets: Indian porridge, toast, coffee.

_“Dinner._—Full Diets: Soup, bread, steak, potatoes, cauliflower or squash. Half Diets: Chicken broth, toast, rice, rennet custard, blanc mange.

“_Supper._—Full Diets: Lamb stew or baked beans, bread and butter, tea, fruit. Half Diets: Wheat flakes and milk, toast, tea, fruit.

“Food which may be ordered by resident or attending physician when daily diet is not adequate or suitable: Beef steak, chops, chicken, beef jelly, chicken jelly, scraped beef balls, raw beef sandwiches, clam broth, crackers, extra eggs and milk, gruels, oatmeal jelly, wine or fruit jelly, cold beef extract, made with hydrochloric acid.”—_Practical Dietetics._—_Thompson._

MENUS FOR NITROGENOUS DIET.

A nitrogenous diet is one in which the use of starchy foods is greatly restricted, if not entirely forbidden. Sugars and acids are also prohibited in many cases. This diet is used chiefly in certain forms of digestive disorder and occasionally in some general diseases. Bread is usually allowed in the form of zwieback, crisp toast, Graham bread or shredded wheat biscuits. Where sugar is prohibited, saccharine or sweetina may be used for sweetening. The latter can be secured either through grocers who handle special food products, or through druggists. Where the ordinary bread is forbidden, the use of gum gluten or gluten flour—a wheaten flour from which the starch has been wholly or partially washed—may be necessary. Many gross adulterations of gluten products are on the market and care should be exercised to see that the product furnished is up to a certain standard and certified. The State Board of Health of New Hampshire has announced that “standard gluten flour must contain at least 30 per cent of proteid and not over 48 per cent of starch.” Recipes for using the gluten flour are easily obtained and a variety of biscuits, wafers and bread may be secured.

_Breakfast._—Omelette, crisp buttered toast, coffee, cream.

_Dinner._—Strained vegetable soup, gluten wafers, lamb chop, lettuce salad, snow pudding with soft egg custard, tea.

_Supper._—Oyster broth, gluten biscuits, celery, cottage cheese, cream, tea.

_Breakfast._—Broiled beefsteak, crisp toast, coffee, cream.

_Dinner._—Pea puree, gluten wafers, whitefish, celery, egg and lettuce salad, Graham bread, coffee jelly with whipped cream.

_Supper._—Cold roast beef; cress; gluten biscuit, baked custard.

_Breakfast._—Broiled fish; zwieback; soft boiled egg; coffee, cream.

_Dinner._—Chicken broth; gluten wafers; beef (steak or roast), string beans, Graham bread, junket.

_Supper._—Bean soup strained; chicken salad, Graham bread, sherbet, milk.

_Breakfast._—Scrambled eggs with shredded wheat biscuits, cresses, coffee.

_Dinner._—Bouillon, mutton chop, spinach, Graham bread; junket-ice cream; tea.

_Supper._—Pea puree, fish salad, cottage cheese on lettuce; gluten biscuits, tea.

_Breakfast._—Omelette with chopped parsley, cold tongue, crisp toast, coffee.

_Dinner._—Celery broth, gluten wafers, minced chicken, string beans, ice cream.

_Supper._—Raw oysters, gluten wafers, lettuce and egg salad, bran biscuit, Spanish cream.

MENUS FOR A FARINACEOUS DIET.

A farinaceous dietary is not infrequently called for in hospitals. In certain forms of kidney disease it is an important part of the treatment. In this diet all flesh foods are forbidden. Milk and butter are allowed and certain fruits. Eggs, if used at all, must be used very sparingly.

_Breakfast._—Orange, wheat breakfast food, baked potato, rolls, coffee.

_Dinner._—Asparagus soup, riced potato, tomato salad, tapioca cream.

_Supper._—Creamed macaroni, corn muffins, white bread, prune whip.

_Breakfast._—Apple sauce, oatmeal porridge, buttered toast, coffee.

_Dinner._—Barley soup, crackers, baked potato, scalloped corn, blanc mange with apple jelly.

_Supper._—Potato puree, crackers, macaroni with tomatoes, white and brown bread, pears.

_Breakfast._—Baked apple, hominy, corn bread, toast, coffee.

_Dinner._—Tomato soup, crackers, scalloped potatoes, white and brown bread, apple whip.

_Supper._—Potato puree, baked rice, bran biscuits, stewed prunes, cocoa.

MENU FOR A TYPHOID FEVER DIETARY.

6 a. m.—Cup of hot milk, coffee. 8 a. m.—Glass of orange jelly. 10 a. m.—Chicken broth with equal portions of milk. Noon.—Junket, cup of tea. 2 p. m.— Milk with vichy, barley or oatmeal water. 4 p. m.—Chicken or beef broth. 6 p. m.—Glass of buttermilk. 8 p. m.—Cup of cocoa. 10 p. m.—Cup of hot malted milk.

CONVALESCENT DIETARY.

Beginning three or four days after temperature remains normal:

FIRST DAY.

6 a. m.—Equal parts of milk and strained oatmeal gruel. 8 a. m.—Egg-nog. 10 a. m.—Junket. Noon.—Milk toast, cup of tea. 2 p. m.—Cup of cocoa prepared with milk. 4 p. m.—Ice cream. 6 p. m.—Beef broth with well cooked rice.

SECOND DAY.

6 a. m.—Milk toast, cup of coffee. 8 a. m.—Malted milk. 10 a. m.—Buttermilk. Noon.—Chicken broth, crackers, orange sherbet. 2 p. m.—Cup of tea or cocoa. 4 p. m.—Lemon jelly. 6 p. m.—Steak, chewed but not swallowed, junket.

THIRD DAY.

6 a. m.—Farina with cream, coffee. 9 a. m.—Soft boiled egg, cracker. Noon.—Potato puree strained, scraped beef sandwich, tea. 3 p. m.—Ice cream. 6 p. m.—Milk toast, cocoa, orange jelly.

SUPPLIES FOR ONE HUNDRED PERSONS FOR THIRTY DAYS.

Austin Flint gives the following estimate of food supplies for the New York State Hospital:

Meat, with bone, including fresh and salted fish and poultry. Total 2,250 lbs. Flour (may be partly substituted for by corn meal and macaroni) 2,250 lbs. Potatoes 2,250 lbs. Milk 1,500 qts. Eggs 250 doz. Sugar 490 lbs. Butter 430 lbs. Cheese 215 lbs. Rice 108 lbs. Hominy 108 lbs. Oatmeal 108 lbs. Coffee 180 lbs. Tea 26 lbs.