Various forms of pre-digested and concentrated foods are in use that are of great value in such cases, but they belong to the drug room, rather than the kitchen, and need not be mentioned here.
Broths
Next in value to milk and its preparations, on the liquid diet sheet, come broths. When broths are required for patients suffering from acute or febrile diseases, the housekeeper should see that a rich and nutritious article is provided—not water flavored. In the preparation of these broths, the object should be to extract as much as possible of the soluble elements of the meat into the water. The meat should be cut in small pieces and put in cold water, the temperature being gradually raised to about 160° F. The remainder of the cooking should be a gentle simmering process. For these broths the cheaper part of meat may be utilized, and it is hardly necessary to add that when a cheaper grade article can be used with equal satisfaction it should always be done. In the preparation of soups, care must be exercised regarding the flavor. All strong and decided odors, such as onion, should be avoided. In fact it is usually better to have a carefully combined flavor than one special flavor that may be disagreeable to some tastes.
Soups
As a general rule it is well to have soup of some kind on all the dietaries of the hospital once a day, except in the very hot weather. The body, even in health, requires a large proportion of water, and in most diseases water has a real therapeutic value. It is needed as a solvent agent during digestion and assists in the various processes of absorption, secretion and excretion. When, therefore, it can be combined with certain food substances to form an acceptable article of diet, it should be done. The value of broths and soups is not sufficiently appreciated by the poorer classes, and the hospital dietary should form a practical lesson on sensible diet. The bones of meat can be utilized in the making of soups, a nutritious extract consisting chiefly of gelatin being obtained by boiling them. It is said that three pounds of bone contains as much carbon as one pound of meat, and as much nitrogen as seven pounds of meat. In serving broths to patients care must be taken to remove all floating grease. When there is time, it is always better to allow the soup or broth to become thoroughly cold, and then have it carefully skimmed. A few drops of oil or grease on the broth may be sufficient to destroy the appetite for food that is such an important factor in tiding a patient over the critical period.
Cooking Meats
When the object of boiling meat is simply to cook it, retaining as much as possible of its soluble constituents, the meat should be in one large piece and plunged into water already boiling. Brisk boiling should be continued for ten minutes till the albuminous matter on the exterior is coagulated. This forms a protective layer which helps in preventing the escape of the nutritious juices into the water. The cooking should be completed more slowly. Too great heat causes the meat to be hard and shrunken. Roasting meat retains the nutritious juices better than boiling. But, as in the boiling, the meat should be first exposed to a strong heat, the cooking being completed more slowly.
Cooking Vegetables
Green vegetables are valuable as food, not so much because of their nutritious elements, but because of the salts they supply which are demanded by the system. Their digestibility depends greatly on their being well and carefully cooked. In most of them there is a large proportion of indigestible residue, which acts as a stimulant to peristalsis. It must not be forgotten that a relish for certain vegetables is an acquired taste, and unless an article has real nutritive value it is unwise to try to cultivate the taste while in the hospital, even for variety. Celery, for instance, is rarely relished by poor people, and for this reason it is a needless expense to serve it in the free wards. Other exceptions will readily suggest themselves. Potatoes are rich in starch and when cooked in quantity are best served mashed. This method of serving prevents them reaching the stomach in hard, indigestible masses, as is often the case when served whole.
The profusion of books, giving definite culinary rules for the preparation of all the various articles of diet, both for the sick and healthy family, makes unnecessary more than a passing mention of these few general principles to be observed in preparing a hospital dietary. One general aim should be kept in view in preparing food in general; the method of preparation should conserve the nutritive elements of the food and cause it to make as little tax on the digestive functions as possible.