The work of the nurse is to care for her patient, to watch, to tend, and to nurture him in such a way that he shall gain and maintain sufficient strength to overcome disease, that he may finally be restored to a state of health. Her greatest allies in this work consist in the proper hygienic surroundings of good air, warmth, cleanliness, and proper nourishment.

The most scrupulous cleanliness in the care and preparation of food is an important point in her work, and practically to appreciate this, some knowledge of bacteriology is necessary, for the various fermentative and putrefactive changes (often unnoticed) which take place in both cooked and uncooked foods are caused by the growth of microscopic forms of life. Most of us realize the necessity for removing all visible impurities, but that is not enough; we should also combat those unseen agents which are everywhere at work, in order that we may prevent their action upon food material or destroy the products of their growth. Often these products are of a poisonous nature, and cause grave physical disturbances when they occur in our foods. When such knowledge is more general, we shall have arrived at a state of progress in the care and preparation of foods not yet universally reached.

The indications at present are that nothing of importance will be done to change for the better the existing methods of housekeeping, until housekeepers are educated in the science of household affairs. They should comprehend (1) that the atmosphere is an actual thing; that it has characteristics and properties like other actual things; that it is a necessity of life, and may be made a medium for the transmission of disease; and that it is as necessary that it should be kept clean as the floor, the table, or the furniture; (2) that food is a subject which may be studied and mastered like any other subject; that the changes it undergoes in its care and preparation are governed by fixed laws; (3) they should have a knowledge of heat in order to appreciate the effects of temperature on different food materials, to regulate the ventilation of their houses, and to control fires wisely and economically; and (4) they should have some knowledge of bacteriology, that milk and water, flesh, fruit, and vegetables may be kept, or rendered, absolutely free from disease-giving properties, and that perfect cleanliness may be exercised in preparing all materials that enter the body as nutrients.

It is not the intention to imply that all micro-organisms produce injurious effects wherever they are found; on the contrary, they are as essential to man's existence as are the higher forms of life; but often they seriously, even fatally, interfere with that existence, and in order to discriminate and to combat the evil a knowledge of their ways and modes of life is essential.

A Harvard professor is credited with saying that no man could be a gentleman without a knowledge of chemistry; and forthwith all the students took to chemistry, for all wanted to be gentlemen. Would that somebody would authoritatively declare that no woman could be a lady without a knowledge of the chemistry of the household—what a glorious prospect would there be opened for the future health of the nation!

We read in history that after a grand medieval repast the bones and refuse of the feast were thrown under the table and left to decay. The scourges which have swept over Europe in past centuries we know, to-day, were not visitations of Providence, but were simply the result of natural causes, due to ignorance of all hygienic laws on the part of the people. Compared with the barbarians of old, in these matters, we are a civilized people; compared with the possibilities of the future, we are still little more than savages.

The ideal life is one in which there shall be no sickness except from accident or natural causes. When we have mastered the laws of hygiene, then will such life be possible. Meanwhile, with sickness always in our midst, we should keep the ideal ever before us, and endeavor by all means to restore suffering human beings to a perfect state of health. A sound body is a material thing, prosaically nourished by material substances, which produce just as exact results in its chemical physiology as if those substances entered into combination in the laboratory of the chemist. The cooking of food should be governed by exact laws which for the most part as yet remain undemonstrated. It is a foregone conclusion that many young women fail in their first attempts at cooking; that they do so is not surprising, for not only are their friends unable to teach them, but the majority of books on the subject furnish no intelligible aid.[1] The science of cookery is still in the empirical stage.

Even among experienced housekeepers there is not enough knowledge of the nature of foods and their proper combinations; the result is a great deal of unwholesome cookery and the consequent injury and waste which must follow. Dislike for the work is usually due to want of success, and failure is attributed to ill luck, poor materials, the fire, or any cause but the true one—which is ignorance of the subject. Of course good dishes cannot be made out of poor materials, but too often poor dishes are made out of good materials.

The systematic teaching of the subject of household affairs cannot fail of good results. Especially is this true in the case of the nurse, who will need at all times to exercise care and wisdom in the choice of food for the sick, to avoid the use of injurious substances, and to select that which is perfectly wholesome and suited to the needs and condition of each individual.

It may be said that most women can prepare a fairly satisfactory meal for those who are well, but very few are able to do the same for the sick.

Count Rumford says: "I constantly found that the richness or quality of a soup depended more upon the proper choice of ingredients than upon the quantity of solid nutrient matter employed; much more upon the art and skill of the cook than upon sums laid out in the market." This is equally true of other dishes than soup. The skill to develop the natural flavors of a food, to render it perfectly and thoroughly digestible, to convert it into a delicate viand, cannot be acquired in a haphazard way. Cooking cannot be done by guesswork. There are right and wrong methods in the kitchen as well as in the laboratory, and there is no doubt that the awakening interest in the subject of domestic science generally is neither an accident nor a whim, but the result of a necessity for better ways of living. We live different lives from those of our grandfathers before the days of the steam-engine, electricity, the telegraph, and the telephone. Now much more energy is needed to meet each day's demand than was required a hundred years ago, and so, much more nutriment is needed to sustain that energy. When the food does not supply the material to meet the demand, the whole being suffers.

A course of study in cooking taken by the nurses of a hospital, while they are still pupils, is valuable for their present and future work. A nurse with the information that such a course should give, will be able to care for the feeding of her patients more wisely,[2] will see the necessity for variety, will learn to avoid suspicious substances, such as fermented meat or fish, canned foods, etc., and will put forth every effort to secure that which is appetizing and wholesome, and suited to the needs of those in her care. She will more easily exercise patience and forbearance with the idiosyncrasies of the sick in regard to articles of diet, knowing that these are usually the symptoms of disease. The proper modes of caring for milk, eggs, oysters, and other perishable foods, the practice of economy in the use of wines, cocoa, and like costly substances, and an appreciation of the value of food materials in general, are some of the points which she will have learned.

She will not forget that cleanliness in the kitchen in the preparation of all food, and in the washing of dishes, towels, waste-pails, sinks, and all receptacles in which easily decomposing substances are kept, means protection against many evils. The little knowledge of bacteriology that it is possible to give in a course in cooking, will enable her to understand that many animal foods, such as oysters, fish, and lobsters, are extremely prone to decay, and, although apparently good, may have been the camping-ground of millions of organisms which have produced such changes in them as to render them suspicious articles of diet. She will, therefore, always endeavor to have such food alive if possible, or at least fresh, and to keep it in such conditions of temperature as shall preserve it in a wholesome state.

The actual practical knowledge of how a certain number of dishes should be made has, of course, its value; but it is not the only consideration which should enter into the teaching of cookery. Perhaps the most important point in all such work is the recognition in certain cases of the necessity for particular dishes, and the reasons for, and the value of, their ingredients. Why one kind of food is better for one person and a different kind for another is, without doubt, an essential point in all such study.

A system depleted by disease, exhausted by long-continued illness, is an exceedingly delicate instrument to handle. It requires the greatest wisdom and good judgment on the part of physician and nurse to restore a patient to health without a lingering convalescence. There is no doubt that the period of convalescence may be much shortened by the wise administration of food, and that the subsequent health of the patient may be either made or marred by the action of the nurse in this respect.

PART I
EXPLANATORY LESSONS