Dishwashing, that bugbear of every household, is not less a task in a hospital than elsewhere. In fact, it forms a very large part of the work of the institutional kitchens. The use of mechanical dishwashers has not yet become general, and it is doubtful if any but the largest institutions will deem it necessary to adopt them. Those who have had experience with them as a rule find them satisfactory, and comment especially on the saving in breakage and time. Provision ought to be in every hospital kitchen for handling dishes in large quantities and the adoption of a routine method of dishwashing will do much to prevent confusion and simplify the task. If each floor has its own kitchen and diet kitchen where the ward dishes can be washed and kept, the labor in the kitchen will be greatly reduced and fewer servants in that department will be necessary; and this is perhaps the better way. The frequent handling of dishes that is necessary, when the supply for the whole household has to be sent to and from the main kitchen three times a day, adds greatly to the breakage, and results in increased labor and loss of time. But in this matter, as in many other lines of hospital work, the housekeeper’s methods are modified by the construction of the hospital. If no facilities are provided on each floor for washing the dishes, there is no alternative but to send them to the main kitchen to be handled there. The real work there may be greatly facilitated if in cleaning and packing the trays, care has been exercised in separating the different articles. The silver should be collected on one tray, the fragments placed by themselves on another, the dishes carefully scraped and packed, the tray-cloths shaken and folded together. The maid in the kitchen receives them from the dumb waiter as they are sent from the different wards. The silver and glass and delicate china should be placed together to be washed first, the heavier china and greasy dishes on a separate table, and when all are collected the washing begins. The water for the glass and fine china should not be too hot, and these should be finished and put away before the washing of the silver is begun. But few servants can be trusted to properly handle delicate china and glassware without supervision, and the all too prevalent custom of piling a large draining dish full of delicate articles is the cause of constant breakage. A draining rack, constructed with grooves, and fitting on one edge of the sink, is a much appreciated convenience in many hospital kitchens. Every housekeeper has her own theories of proper dishwashing, and all are good if the result is clean dishes. The main point is to have a system of preparing the dishes for washing and adhering to it; without system the disorder and confusion in the kitchen when all the trays are sent in will disturb the most saintly individual. A limit to the time when dishes may be sent from the wards is also essential to methodical work. Much unnecessary delay and unpleasant feeling is often caused by the late arrival of a consignment of dirty dishes which should have reached the kitchen an hour or two before. The carelessness of those in charge of the ward dishes results in upsetting the arrangements of the other work of the kitchen, the maids who had finished their task having to gather together their dishwashing utensils and begin over again. To require that the delinquents assume the responsibility of washing all dishes not sent to the kitchen at the proper time will do much to prevent the repetition of this unpleasant occurrence.
Dishcloths and Towels
Much care needs to be used in the handling of dishcloths and towels. Plenty of towels should be provided, and dishcloths should be washed and scalded after each meal. It is impossible to have clean, shining dishes if these are not kept thoroughly clean. The tendency for kitchen towels to disappear may be overcome by the housekeeper requiring each maid to state the number necessary for her work, supplying them, insisting that each put her special mark on her own towels, and requiring that the old towels be produced before new ones will be given out.
The Chief Kitchen employee
In selecting a chief employee who will be responsible for the direction of the details of the work, and for the care of the kitchen and the other rooms in her department, several points need to be considered. She should not only be familiar with methods of preparation and cooking, proper carving and serving of food, but she should know how to keep herself neat during the process. Neatness and cleanliness about the person of the workers in the kitchen is fully as essential as neatness in the care of the room and utensils. In fact, one who is not neat in person cannot be trusted to observe the rules of cleanliness anywhere. “Doing” is dependent on “being,” here as elsewhere.
Training Needed
The secret of success in the kitchen is the same as in other departments of the institution, and, indeed, of life in general. It can be spelled in one word—s-y-s-t-e-m; and be it understood here and now, that system and red tape are not synonymous terms. Just as in a large department store, every yard of ribbon sold has its relation to the whole establishment, or in a great railway system every train dispatched influences the running of every other train, and system is necessary to insure the success of the business or the safety of human lives, so in a hospital every part is vitally related to the great whole. Some mind must plan the details, first of the whole and then the minutæ of the different parts as they contribute to its harmony and success. And yet, while this truth is generally admitted, and its importance is evident, how little training does the average nurse of the present day receive to fit her for the responsibilities of hospital housekeeping—that on which much of the comfort and well-being of the whole institution depends. Most graduate nurses can nurse, they can care for a patient afflicted with an ordinary disease in a satisfactory manner, but how much have they learned regarding the management of the household? How much have they been taught regarding the purchase of supplies, the care of food, the management of the linen room, the laundry and kitchen, the supervision of servants, and other matters of vital importance to every hospital? Is there not much still lacking in our present system of training? If a railway company sent an engineer to conduct a train to its destination as ignorant of, and inexperienced in, the working of the whole train system as some graduate nurses are, who have the responsibility of a hospital, small or large, placed upon them, the public would raise its hands in horror, and brand the railway officials with criminal carelessness. While present methods continue, the success or failure of the nurse as an executive officer and housekeeper depends largely on the thoroughness of the domestic training she received from her mother, her own native ability, and her intuitions as to how things should be done—not on the training received in the average hospital. When the nurses’ course includes practical instruction in the management of every department of the hospital, the purchase of supplies of all kinds and simple accounting, the public, with the nurses, will reap the benefit. In large institutions stewards may be employed, or it may be possible to secure a trained housekeeper from some institute of domestic science. But in the small hospital the superintendent must be her own housekeeper; such superintendents must almost of necessity be nurses, and there ought to be time in a three years’ course to give them some insight into, and experience in, the details of hospital housekeeping.
The Diet Kitchen
An advance step has been taken, however, in the introduction of cooking into the nurse’s course of study. The nurse’s work in the diet kitchen ought to mean a lightening of some of the burden in the main kitchen. The custom of management of this department varies and each institution must work out its own problems. Where there is a regular dietitian in charge, with the diet kitchen work as her exclusive business, the matter is easier of adjustment. Where this is not possible two nurses may be assigned for this special duty, making the term of service two months. The junior nurse may thus be initiated by the senior diet nurse, the housekeeper having general supervision of the entire work. The value of this practical experience in cooking can scarcely be overestimated, for unfortunately a great many young women enter a hospital with no more definite idea of how to prepare food for invalids than they have of medicine or surgery. In order that this course in practical work be productive of the most good to the nurses, previous instruction in the principles of nutrition, food values, and in the processes of digestion, should be given. Valuable, however, as the diet kitchen work is in the nurse’s education, unless it is arranged that that department assume a certain responsibility for preparing a part of the hospital dietary, its introduction is hardly justifiable. In most cases the diet kitchen should furnish at least the special diets and desserts, all broths, jellies, etc. If the diet kitchen facilities are adequate, it may be wise to have all the cooking for private patients done in this special department. In this way it is possible to devote more attention to attractive arrangement of food, as well as more care to its preparation. Where the housekeeper has a real interest in the people for whom the food is prepared, and has cultivated the fine art of cookery, or has a degree of native ingenuity, many delightful dishes may be constructed even of odds and ends, and a variety secured out of very little. The very first essential to proper feeding is good cooking, and this, like most other expert service, is an economy rather than a waste. For this reason many institutions that have tried both methods claim that the employment of a trained chef at a good salary was really a saving to the institution when the total cost of the culinary department was reckoned. This is in comparison with the old method of having the cooking done by women who had received no previous training, and had no special desire to study the art of cooking or to become more proficient in it.