CHAPTER VII.
Purchase and Care of Food Supplies
The person to whom is entrusted the purchase of the food supplies, and the direction of the general dietary for the hospital household, occupies a place of no small responsibility. If she is to discharge this duty to the satisfaction of those who have the interests of the institution at heart, she should have a few marks of fitness not found in the average woman.
First, she should have an active, intelligent and sympathetic interest in the welfare of both the sick and healthy members of the household, and be in perfect harmony with the humane designs of the institution.
Judging Values
Second, the purchaser of the food supplies should have sufficient experience and knowledge to detect superior and inferior qualities of the different food stuffs. So far as the food for the sick is concerned, the physician will have the responsibility of deciding the kind of food his patient shall have, but she will have the responsibility of deciding regarding quality and preparation. It does not require an expert to discover that a beef steak is tough when it comes to the table, but that is too late for the discovery to be of any practical value. The toughness should have been detected while it hung in the market. So it is with all varieties of food. To know the desirable and the undesirable qualities before purchasing is to possess one of the chief secrets of successful buying. Clever buying does not mean close buying, though some people think it does. The cheapest article often proves the most expensive, and quality must be paid for. The point is to be able to recognize, and not pay first-grade prices for second-grade goods.
Third, she should keep posted regarding the fluctuations of the markets, and not have to depend entirely on what one dealer may say regarding prices. As she is spending, not her own money, but funds often accumulated by self-denial on the part of givers, she needs to study to spend them wisely.
Fourth, she should make a point of finding out the exact price of most articles before ordering them. Strawberries would be appreciated by her household at any time in the year, but while they sell at thirty or forty cents a box, she is hardly justified in buying them freely, if at all. And this rule holds good in regard to most of the ordinary so-called luxuries—the things that are not absolutely essential as nourishment. There is a time in which she can decide to have them, and also a time to decide to do without.
Fifth, she should have an intelligent conception of the relative nutritive values of different foods, so as to be able to supply a well balanced dietary for the different classes of people who are dependent on her very largely to direct what they shall eat. She ought to bear in mind the fact that the chief value of any food lies in its adaptability to repair the waste of tissue that goes on constantly, and endeavor to supply as far as possible the ideal meal, which is one in which nitrogenous, non-nitrogenous and mineral substances are supplied in the proportion required to repair the waste, and with the minimum tax on the digestive powers.
The first qualification really includes three different qualifications—common sense, conscientiousness and justice, for all of which she will have constant need in discharging the duties of her position. Probably in beginning her work she will make mistakes, as every one who accomplishes anything does, but as she buys she will learn to buy, and in no other way. It cannot be learned from books. However, suggestions may be given and accepted that will save the housekeeper from making all the blunders others have made, and save the hospital from the results of total inexperience and lack of knowledge.
The amount of supplies of any kind to be purchased at one time will depend somewhat on the demand, but chiefly on the facilities for storing and preserving them. The perishable articles are always the most important, and also the most expensive, and whenever possible she will find that a substantial sum may be saved each month by making cash payments for these articles as purchased. With adequate cold storage arrangements, a month’s supply can be purchased at one time. Hand to mouth, or day to day buying is poor policy for any hospital, though lack of facilities for proper preservation of food often gives the buyer no other alternative.
Bread
Among the chief staple foods of any institution is bread. While with many in the hospital it is not exactly the “staff of life,” yet it is perhaps the one thing in demand for every meal of the major portion of the household, and fills no small part in the hospital dietary. Various forms of this important article are on the market, differing in the variety and quality of flour used and in the process of manufacture. Three principal varieties ate in common use in this country—the fine-wheat bread, made from the finest or so-called straight-grade flour, the Graham bread, made from flour containing the entire grain of the wheat ground together, and the whole-wheat bread, made from flour containing the whole substance of the grain except the outer layer of bran. From a chemical analysis of the three different varieties, to ascertain the nutritive value and digestibility, it was found that the fine-wheat bread yielded the highest percentage of digestible nutritive food, the whole-wheat ranking second and the Graham bread the last. In providing bread for the household it is well to supply at least two varieties, the fine-wheat as the staple and the whole-wheat and Graham alternating. Another point worth noting, proven by the same chemical analysis, was that the digestibility depended more on the lightness of the bread than on the quality of flour used.
The question as to whether home-baked or baker’s bread is most expensive is often asked, and the answer almost invariably is that bread can be baked in the institution at much less cost than to purchase the ready-made article. The U. S. Department of Agriculture in 1900 published the result of investigation regarding the market value of bread. Their investigation showed that in some places the baker’s price was set by the trade name of the bread, and in others by the size of the loaf, and that the prices varied greatly in different cities.[1] “In New Jersey it appeared that the larger the loaf, the higher the cost per pound tended to rise. In New Brunswick, where fifty analyses were made, the bread containing the highest amount of nutriment, and that containing the lowest, were sold at exactly the same price per pound, 4.1 cents. When the selling price of bread and the cost of its ingredients are compared, the results are still more striking. In two experiments made in New Jersey it was found that two lots of bread made from materials costing respectively $2.28 and $2.56, were sold for $5.68 and $6.08. This represents a profit of 116.5 per cent over the cost of the materials, or to put it in dollars and cents, the baker received $216.50 for bread whose materials cost him $100. In Pittsburg, the average increase in price over the original cost was 110 per cent.”
[1] U. S. Dept. of Agriculture, Office of Experiment Stations, Bulletin 112.
From these experiments it will be seen that a great saving of money can be effected by home baking, even allowing for the extra cost of labor and fuel.
Milk
Another of the important articles of diet, and one that has special value in a hospital, is milk. It is the one article of diet that contains all the essentials for nourishment and because of its perishable character it is the food that usually causes the greatest anxiety to the housekeeper. In order to determine the amount required for each day’s consumption it will be necessary to decide, before ordering, the demands of the bills of fare for the different departments for the coming day. This is essential for even approximate calculation. The constant changing of patients and diets that goes on in a hospital makes a close calculation scarcely possible. The evening of the day before the supply is to be ordered, the head nurse in each section should submit her diet list, showing the number of patients on liquid, semi-solid, light and regular diets. For a patient on an exclusive milk diet, from two to three quarts per day will be needed, the amount being modified by the age, sex and general condition of the patient. Where the liquid diet includes broth and other fluids alternating with milk, two to four pints will be needed. Each patient on a semi-solid diet usually requires nourishment between meals, and as milk enters largely into the composition of the semi-solid diet, about the same amount will be necessary as for liquid diets. For patients on light diet who must have nourishment in some form between meals, a quart is a fair daily allowance, and a pint for those on regular diet and for the household staff.
The quality of milk is a matter of paramount importance. The proportion of fat or cream in milk from the same cow will vary somewhat from day to day, but there is no doubt that the most frequent cause of variation is found in the unscrupulous methods of some dairymen. Three principal methods of adulteration are used: water is added, cream is removed, and certain chemicals are added as preservatives. Whatever form of adulteration is used, the results are bad. Whether water is added or the cream removed, the nutritive value of the milk is lessened. The injurious effects of chemically preserved milk depend, of course, on the amount consumed by one person. The drugs most frequently used as preservatives are boracic acid, borax, salicylic acid and formaldehyde. Where a life is in the balance, and milk diet is depended on to maintain the vitality, these adulterations are of tremendous importance. No housekeeper can afford to patronize a dairyman where there is a suspicion of these methods being practiced. Laws regarding adulteration exist in many places, but are not always enforced. But pure milk can be produced, and if the consumer insists on having it, and takes pains to find out at intervals the facts regarding its purity, the milk dealer will arrange to supply the genuine article. In purchasing from any dealer it is a safeguard to have the milk examined periodically by an expert chemist. Then the housekeeper may know for a certainty what she is getting. Milk which contains sediment is always suspicious. In preparing a specimen for analysis care should be taken that it is a fair sample. Milk from the top or bottom of a bottle should not be used. If the milk to be tested is poured several times from one vessel to another until no particles of cream appear on the surface, the sample may be considered to be a fair specimen of the composition of the whole.
The method of computing the value of milk used by creamery experts is on the basis of the amount of fat contained. If this basis were the general standard, not only hospitals but all consumers would be the gainers. While the actual food value of milk does not entirely depend on the amount of fat, yet the buyer would have the satisfaction of getting what he paid for, and the dealer the increased return for supplying a better grade article. The milk containing less fat could be secured for cooking and that richer in cream for special purposes, and the whole transaction would be fairer than the present system, where a quart of adulterated and skimmed milk sells for the same money as the genuine product.
Skimmed milk and buttermilk both have their value as nutriment, and experts say that even after cream has been removed the skimmed milk still contains nearly ten per cent of its nutritive properties. Buttermilk is often more acceptable to patients than sweet milk, and, if it can be obtained fresh every day, it can be used occasionally to add variety to a strictly milk or liquid diet. It is said that six ounces of buttermilk has in it the same amount of nutrition as a medium-sized potato.[2] “Actual experiment has demonstrated that a fifteen-cent lunch containing nine different food materials (soup, beef, potatoes, turnips, bread, butter, coffee, milk, sugar), did not have any greater nutritive value than a four-cent lunch consisting of a pint of skimmed milk and ten ounces of bread.”
[2] U. S. Department of Agriculture, Bulletin 74.
In ordering milk it is better to get too much than too little. The excess can always be used in food combinations, and at the prices ordinarily paid it is not an expensive food. Because of the ease with which it is digested by the average person, and its nutritive properties, it can be served in almost a numberless variety of forms to sick people, and often in preference to other foods.
Care of Milk
Assuming that it is possible for dealers to supply pure milk, and that the housekeeper knows whether or not she is getting the genuine article for her sick family, there is still something required, if it is to reach the patients in good condition. Be the article never so pure when delivered, it can quickly become impure by careless handling. The milk delivered at a very early hour may be left at the door where it is exposed to heat, dust and flies, and by the time it is taken into the house impurities may have entered that will account for it becoming sour in a few hours. Another source of contamination can be traced to the practice of putting milk in open vessels into the same refrigerator with meats and vegetables. Old tin or wooden vessels should never be used, and vessels should be thoroughly scalded and scrupulously clean before the milk is put in. If the racks and shelves in the cooling room are scrubbed daily, also the inside of the milk refrigerator, and a temperature of 50 F. or lower maintained, there should be no difficulty in keeping milk sweet twenty-hour hours or longer.
Milk delivered in bottles which have been previously sterilized will be found more satisfactory than that which has been carried in large cans and dipped from vessel to vessel. Each time it is handled the contents of these cans are exposed to floating dust, and the time the milk will remain sweet is shortened. The bottles in which milk is served should be carefully cleaned as soon as emptied, and in warm weather milk should never be left without ice. The careless habit that exists in some kitchens of allowing the milk to stand in a heated room for an hour or more because every one is otherwise employed, should never be tolerated in a hospital.
Another point in handling may be worth mentioning; milk or cream intended for the sick may be consumed by kitchen employees, and in spite of the housekeeper’s plans the supply may become exhausted before the new supply is available. This often occurs at night, when it is impossible to replenish the quantity from any source. All calculations as to the amount per capita required will be valueless if servants are allowed to consume it at will. If milk is to be allowed to them as a beverage, then a much larger amount should be ordered.
Cheese
Cheese, which is a concentrated form of milk, while rich in nutrition, is somewhat difficult of digestion, and if bought at all for hospital patients should be purchased sparingly and served in very small portions. Like milk, it needs to be kept cool and entirely separate from fruits, vegetables and meats.
Eggs
Eggs are another of the valuable tissue-building foods in constant demand in hospitals. For fully eight months of the year they can be bought at moderate prices, and considering their great nutritive value are not an expensive form of food. Because of the ease with which they are digested by most invalids, and the great variety of ways in which they may be served, they fill a very important place in the hospital menu. It is said that there are more than five hundred different ways of preparing eggs. The purchase of them is, however, attended with some uncertainty. Many tests for detecting the quality are in use by experts. The “candling” test consists in holding the egg against a light between the eye and the sun. The perfectly fresh, good egg will appear clear and unclouded and the yolk can be perceived. If decomposition has begun, it will appear dark colored. Changes in the appearance of the shell as shown by comparison of fresh and stale eggs are sometimes helps in detecting the quality.
Where a hospital has an adequate cooling space, undoubtedly the more economical method of buying is by the crate and in sufficient quantity to last several months. Some institutions lay in a year’s stock, buying always in April, which, it is stated, is the only month in which it is wise to buy eggs for storage. In a cooling room in which the atmosphere is sweet and pure, a temperature of 34 F. will preserve eggs for a year with very little appreciable change in quality.
Even when the price of eggs is from twenty-five to thirty cents a dozen, they are not more expensive than many other forms of animal food—notably beefsteak—and when served in the form of omelettes, scrambled or creamed eggs where other substances are added to compose the dish their cost in a meal is less than steak.
Economy and Care
In arranging a hospital dietary the comparative cost of food should always be borne in mind, and where food of cheaper material supplies the place of the more costly, the cheaper should have the preference. If, when eggs are high-priced, the housekeeper could arrange to economize in their use in desserts and cake rather than in their use as meat substances, it will be in the long run the more sensible plan. However, desserts in a hospital and desserts in a home are two different things. The so-called dessert in a hospital often forms the meal for the patient with weakened digestive powers, and in such cases eggs must be used, be the price high or low. For the healthier members of the hospital family, fruits and desserts made without eggs can be depended on to take the place of desserts requiring eggs when the latter are expensive. In storing eggs, the housekeeper should remember that the shell of an egg is not impervious, and if placed long in contact with apples, onions or other substances of decided flavor the odor can be detected in the egg when cooked. Another point to be remembered is that an egg kept in a refrigerator will take longer to boil than if kept in a room at the ordinary temperature. When dealing with impaired appetites and weakened digestive powers these so-called minor points have special importance.
Meat
Meat is the most expensive article of food in a hospital, and for this reason the art of buying requires real study. The flesh of animals seems to be especially adapted to contribute to the building up and maintenance of the organic structure of the human system, but owing to the absence of starch is not to be depended on to produce force or energy. Meats are generally believed to be easier of digestion than vegetable foods. The chemical ingredients are much like the various substances of the human system, and are therefore more quickly acted upon and made ready for absorption. A certain woody fibre often surrounds the nutritive ingredient of the vegetable and renders it more resistive to the action of digestive fluids.
Beef
Beef is believed to be the most nutritious of all animal foods, and that which seems to be most in demand in a hospital. It is a meat in which quality varies greatly, and much care needs to be used in its selection. The age of the animal, the method used in feeding it, the condition when slaughtered, and the length of time since slaughtering took place, all affect the quality and flavor. The flesh of a young animal is more tender, but lacks the flavor found in the flesh of older animals. A larger relative proportion of bone is found also in younger animals. The best beef is usually obtained from animals of from three to six years of age. When the cooling facilities are adequate, at least a side of beef should be purchased at one time. Most meats improve by being kept a reasonable length of time. In a hospital the various parts, even much of the so-called refuse of the butchers, can be utilized where several classes of diets have to be arranged daily, and a great saving of money effected by buying in quantity. This will be clearly shown by comparison if each part has to be bargained for separately. In order to guard against waste and use the meat to the best advantage, some system and skill in cutting will be needed. The accompanying diagram shows the different cuts into which the side may be divided, providing the largest amount of good cuts and with the least refuse. A good quality of beef from an animal three or four years old should show elasticity on being pressed with the finger; it should have a fair sprinkling of creamy-looking fat, the lean portion should be a deep red and of a rather fine fibre. Coarse fibre usually means poor flavor. Tough beef is usually darker in color, the proportion of fat will be less, the fat instead of being a creamy white will be a decided yellow and the fibre coarse.
Veal
Veal may be occasionally added to the hospital menu for variety, but because of the excessive proportion of bone it is not considered an economical meat to be used in any quantity. It is also believed to be more difficult of digestion than most other meats.
Mutton will perhaps rank next to beef for hospital uses, and like beef it differs greatly in quality. The fibre is shorter and more tender, and the color of both the lean and fat of mutton somewhat darker than that of beef. Good mutton should have a sprinkling of fat, but excess of fat should be guarded against. An entire carcass should be purchased at one time, cutting it as required.
Chickens
In selecting chickens for the hospital, both young and old fowls will be needed. For broths and jelly an old fowl, not too fat, is preferable. Where the meat of the chicken is the substance wanted, a fowl of from one to two years old should be purchased. The proportion of bone to meat in chickens under that age makes them quite an expensive commodity. To ascertain if the meat is tender try the skin under the wing or leg. If the joint of the wing yields readily or breaks it is tender.
Fish
Fish help to supply the demand for variety in the diet, which is more important in dealing with the capricious appetites of invalids than with those in health. The different varieties vary greatly in nutritive value, in flavor, and also in digestibility, owing largely to the proportion of fat. The amount of bone in proportion to the meat in most ordinary fresh fish makes them a trifle more expensive than most meats, steak and fowl being excepted. Because of their strong odor, which would require for them an entirely separate storage receptacle, it is better to buy them each day as needed. Salmon is considered more rich in nutrition than most other varieties of fish, and the oily or coarser grained species more nutritious than the white or finer grained, although the latter have the more delicate flavor and are easier of digestion. In choosing the fish, if the gills are a bright, clear red, the body firm and stiff, the odor not disagreeable, the fish may be accepted as in good condition.
Pork
Pork will occasionally have to be purchased, even in a hospital. In spite of the fact that it is more difficult of digestion than many other forms of animal food, and of the adverse criticisms heaped upon it, most people in their secret heart (or stomach) are fond of a bit of good ham. Ham and bacon are more suitable for use in a hospital than fresh pork. The lean of ham should be a deep pink, and excess of fat should be avoided. Bacon should be quite thoroughly mottled with both fat and lean. Care should be taken that the ham and bacon have been cured and prepared for market by a reliable firm, and that they are protected from dust and kept in a cool place.
Butter
Butter is perhaps the most digestible of all animal fats, and the most delicately flavored. So many substitutes for the genuine article are now on the market that it needs to be selected with great care. Fat being one of the elements of food depended on for the production of heat and energy in the body, butter has a place of some importance in the average invalid’s diet. For use on the tables and trays, a good quality should be procured and a cheaper grade secured for use in cooking.
Potatoes, the most important of all vegetables for table use, should be purchased in quantity in the fall when the price is lowest and stored in a cool, dark, dry place.
Fresh Vegetables
Green vegetables will, of course, be secured as needed. When fresh there is a crispness about them that is not found in those picked longer. Lack of crispness usually means lack of flavor. All vegetables will be improved by soaking in cold water before being cooked.
Cereals, sugar, and in fact the whole list of dry food products, and canned goods, are a matter of much less anxiety to the hospital housekeeper than the perishable commodities. On general principles, buying in sufficient quantity to secure wholesale rates is the only sensible method. But, as has been previously remarked, the construction of the hospital modifies all plans for housekeeping. Lack of storage facilities make it impossible for many housekeepers to buy wisely or economically. Mistaken ideas of economy in construction often mean increased and unnecessary expense as long as the hospital exists. Where economical housekeeping is expected, arrangements should be made in every hospital for sufficient cold storage facilities, at least for the storing of meats, which usually form the largest item in the monthly accounts.
Approximate Estimate of Quantities of Food for a
25-bed Hospital, a 50-bed Hospital and a
Hospital of 100 Beds.
This is taken from a month’s experience with the average
number of acute cases and convalescents in a hospital
with an active surgical service.
BREAKFAST.
| Hospital of 25 Beds | Hospital of 50 Beds | Hospital of 100 Beds | |
|---|---|---|---|
| Beefsteak, Round | 5 lbs. | 8 lbs. | 15 lbs |
| ”Porterhouse | 8 lbs. | 10 lbs. | 20 lbs. |
| Eggs | 2 doz. | 4¼ doz. | 8 doz. |
| Cereal, Cooked fresh | 5 qts. | 10 qts. | 20 qts. |
| ” Prepared | 1 pkg. | 2 pkgs. | 4 pkgs. |
| Bread for toast, 1 lb. l’ves | 4 loaves | 8 loaves | 2 doz. l. |
| ” (plain) in addition | 2 loaves | 4 loaves | 1 doz. l. |
| Butter | 1½ lbs. | 2½ lbs. | 5 lbs. |
| Cream (for priv’te pat’ts). | 1½ pts. | 3 pts. | 2 qts. |
| Milk (allowing ½ pt. each) | 6 qts. | 12 qts. | 24 qts. |
| Coffee (dry) | 3 to 4 cups | 5 to 7 cups | 2 lbs. |
| Sugar | 3 lbs. | 5 lbs. | 15 lbs. |
| Fruit fresh (oranges, etc.) | 1 doz. | 2½ doz. | 5 doz. |
| Fruit stewed | 2 qts. | 4 qts. | 7 to 9 qts. |
| Cocoa (allow one teaspoon | |||
| for each patient getting | |||
| it and add one cup each | |||
| to quantity of milk) |
DINNER.
| Hospital of 25 Beds | Hospital of 50 Beds | Hospital of 100 Beds | |
|---|---|---|---|
| Soup | 5 qts. | 10 qts | 20 qts. |
| Croutons or Crackers | 2 lbs. | 5 lbs. | 10 lbs. |
| Roast, Rib | 8 lbs. | 12 lbs. | 20 lbs. |
| Lamb, Leg | 10 to 12 lbs. | 15 to 18 lbs. | 25 to 30 lbs. |
| Chops | 2 doz. | 4 doz. | 7½ doz. |
| Potatoes | 1 pk. | ½ bush. | 1 bush. |
| Celery | 1 doz. stalks | 1 large bun. | 2 large bun. |
| Beets | ½ pk. | 1 pk. | ½ bush. |
| Bread, bakers 1 lb. loaves | 3 loaves | 6 loaves | 1 doz. l’ves |
| Tea | ¼ lb. | ½ lb. | 1 lb. |
| Sugar | 2 lbs. | 3 lbs. | 5 lbs. |
| Milk | 3 qts. | 7 qts. | 15 qts. |
| Dessert, Rice pudding | 4 qts. | 6 to 7 qts. | 18 to 20 qts. |
| Ice Cream, in bulk | 4 to 6 qts. | 8 to 10 qts. | 4 to 5 gal. |
| Ice Cream, brick | 2 to 3 br’k | 4 to 8 br’ks | 10 bricks |
SUPPER.
| Hospital of 25 Beds | Hospital of 50 Beds | Hospital of 100 Beds | |
|---|---|---|---|
| Scalloped Potatoes, | |||
| (potatoes, milk, butter) | 3 qts. sliced | 6 qts. | 10 to 12 qts. |
| Bread | 6 loaves | 12 loaves | 2 doz. |
| Butter | 1½ lbs. | 3 lbs. | 6 lbs. |
| Fruit, stewed | 2 qts. | 5 qts. | 10 to 12 qts. |
| Tea | ¼ lb. | ½ lb. | 1 lb. |
| Milk | 4 qts. | 6 to 7 qts. | 10 to 12 qts. |
| Eggs, special diets | 1 doz. | 2 doz. | 4 doz. |
| Cream | 1 pt. | 1 qt. | 1 gal. |
| Oysters, raw | 2 to 3 qts. | 3 to 5 qts. | 6 to 8 qts. |