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.