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Hospital Food
Sketches from The Lancet
Hospital F ood nder the editorship of Robbie Fox, in January, 1945, The Lancet turned its attention to the importance of good diet for hospital patients, and the detrimental effect that poor diet could have on their recove ry : “In many cases the diet, instead of supporting treatment, is in active conflict with it; and the patient only begins to derive full benefit from the care of his doctors after he has gone h o m e ”( Jan 6, 1945, p 19). So serious was this issue taken that the journal ran an editorial setting out the causes and scale of the problems, and suggesting solutions. Not surprisingly, the main problem identified was an economic one: “For those engaged in hospital catering the welfare of the patient is seldom the sole criterion of success. Thus in many municipal hospitals food is entirely in the hands of the steward and his clerks, men so well trained to respect public money that they often see economy as a measure of efficiency”. History also helped to explain the lack of interest on the part of the medical profession to the question of diet: “The earliest hospitals looked to the friends of the patient to bring him food, or else supplied his bare wants out of charity. When convenience made the feeding of the sick a part of hospital care it was still undertaken as a charitable duty, not as a part of treatment. Doctors as a whole never seem to have felt responsible for it”. Thus, stated the journal, the results of poor hospital diet were readily appare n t :“ . . . the flatulent ‘abdominal’ . . . is expected to cope with beans and underboiled potatoes; the young child [is] given strong tea instead of his accustomed milk; the [food of the] patient awaiting admission to a sanatorium . . . is so scanty and unattractive that he
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THE LANCET • Vol 353 • February 27, 1999
steadily loses weight; the [condition of ing. In the wards she is told ‘we haven’t the] men at the spinal centre, many time for all that kind of thing.’ Even if with bedsores . . . deteriorates on a she had the time, she would usually find small, monotonous, and distasteful that the ward had not enough trays to diet. A large proportion of patients, go round, let alone linen and nosegays.” urged to speak frankly, will tell a story The shortage of nosegays continues of this kind from their own experience to this day, and so too does the shortage of hospital”. of time on busy wards. Thankfully, we The journal clearly saw this as a no longer expect our nurses to show crusading issue, and was not going to their talents in quite the same way that be fobbed off by the fact that, with only was suggested in 1945: “She can serve 271 dietitians in the country, there were the helpings neatly and elegantly; she insufficient experts to address the probcan slice [the] corned beef finely and lem: “reforms need not wait for the arrange it in a pattern; she can chop up training centres to turn out enough the lettuce, decorate it with some slices dietitians to go round. MRS BEETON of tomato, serve the salad cream in a took no degree in house-keeping, and small clean jug. Granted she can do all FLORENCE NIGHTINGALE was not an this if she has time, if she has imaginaSRN . . . Probably in every hospital tion, and if she is that increasingly rare there are one or two people with the bird, a born nurse” (Jan 13, 1945, character and initiative to change p 61). the picture. . . What is needed then? Modern equipment, c e rt a i n l y ; and more cooks and dietitians as soon as we can make them: but above all, champions with authority. In every hospital some or all of the medical staff should be backing this essential reform with their might.” (Jan 6, “Not enough trays to go round, let alone linen and nosegays” 1945, p 19). Having pinned its standard to the mast, the journal The final Special Article, entitled then published a series of Special WHAT SHOULD BE DONE, looked to the future. Support from the medical proArticles on hospital diet. The first fession was held to be important in revealed as much about attitudes to achieving any real change: “The seniors women in the home and in the nursing of our own profession should search profession, as about hospital food: their consciences to find out whether “‘Light diet’ in a hospital is apt to be they have harped sufficiently on this monotonous in type and meagre in string in their ward rounds and quantity, especially in war time. We lectures. Has the student been interrohave only to think of the food a good gated as often about the details of diet wife or mother will provide in the home as about mitral stenosis? Can he say for the sick husband or child with equal confidence what went down who ‘fancies something light,’ to realise the patient’s gullet from his plate and that a piece of steamed fish and some from his medicine glass?” rice pudding, bleakly served on chilly The most radical suggestion was the plates, are not what the doctor ordered simplest “Has [the medical student] . . . If [the patient] protests he may tried the food in the wards himself? acquire a reputation for faddiness, A week in bed with some hospital other always punished severely by busy than his own would teach him wondernurses.” (Jan 13, 1945, p 61). fully.” (Jan 27, 1945, p 124) Training of these fierce-sounding Without doubt, there are few doctors nurses seems to have included the today who would welcome such a domestic arts alongside medical sciproposal. Perhaps, 50 years on, these ence: “The student nurse, during her issues remain pertinent. preliminary training, learns invalid cookery and is taught how to make a Peter Kandela tray attractive with clean linen and a 29 Greenlands Road, Staines, nosegay. She rarely uses that technique Middlesex TW18 4LR, UK again, unless she takes up private nurs-
763
Hospital F ood nder the editorship of Robbie Fox, in January, 1945, The Lancet turned its attention to the importance of good diet for hospital patients, and the detrimental effect that poor diet could have on their recove ry : “In many cases the diet, instead of supporting treatment, is in active conflict with it; and the patient only begins to derive full benefit from the care of his doctors after he has gone h o m e ”( Jan 6, 1945, p 19). So serious was this issue taken that the journal ran an editorial setting out the causes and scale of the problems, and suggesting solutions. Not surprisingly, the main problem identified was an economic one: “For those engaged in hospital catering the welfare of the patient is seldom the sole criterion of success. Thus in many municipal hospitals food is entirely in the hands of the steward and his clerks, men so well trained to respect public money that they often see economy as a measure of efficiency”. History also helped to explain the lack of interest on the part of the medical profession to the question of diet: “The earliest hospitals looked to the friends of the patient to bring him food, or else supplied his bare wants out of charity. When convenience made the feeding of the sick a part of hospital care it was still undertaken as a charitable duty, not as a part of treatment. Doctors as a whole never seem to have felt responsible for it”. Thus, stated the journal, the results of poor hospital diet were readily appare n t :“ . . . the flatulent ‘abdominal’ . . . is expected to cope with beans and underboiled potatoes; the young child [is] given strong tea instead of his accustomed milk; the [food of the] patient awaiting admission to a sanatorium . . . is so scanty and unattractive that he
U
THE LANCET • Vol 353 • February 27, 1999
steadily loses weight; the [condition of ing. In the wards she is told ‘we haven’t the] men at the spinal centre, many time for all that kind of thing.’ Even if with bedsores . . . deteriorates on a she had the time, she would usually find small, monotonous, and distasteful that the ward had not enough trays to diet. A large proportion of patients, go round, let alone linen and nosegays.” urged to speak frankly, will tell a story The shortage of nosegays continues of this kind from their own experience to this day, and so too does the shortage of hospital”. of time on busy wards. Thankfully, we The journal clearly saw this as a no longer expect our nurses to show crusading issue, and was not going to their talents in quite the same way that be fobbed off by the fact that, with only was suggested in 1945: “She can serve 271 dietitians in the country, there were the helpings neatly and elegantly; she insufficient experts to address the probcan slice [the] corned beef finely and lem: “reforms need not wait for the arrange it in a pattern; she can chop up training centres to turn out enough the lettuce, decorate it with some slices dietitians to go round. MRS BEETON of tomato, serve the salad cream in a took no degree in house-keeping, and small clean jug. Granted she can do all FLORENCE NIGHTINGALE was not an this if she has time, if she has imaginaSRN . . . Probably in every hospital tion, and if she is that increasingly rare there are one or two people with the bird, a born nurse” (Jan 13, 1945, character and initiative to change p 61). the picture. . . What is needed then? Modern equipment, c e rt a i n l y ; and more cooks and dietitians as soon as we can make them: but above all, champions with authority. In every hospital some or all of the medical staff should be backing this essential reform with their might.” (Jan 6, “Not enough trays to go round, let alone linen and nosegays” 1945, p 19). Having pinned its standard to the mast, the journal The final Special Article, entitled then published a series of Special WHAT SHOULD BE DONE, looked to the future. Support from the medical proArticles on hospital diet. The first fession was held to be important in revealed as much about attitudes to achieving any real change: “The seniors women in the home and in the nursing of our own profession should search profession, as about hospital food: their consciences to find out whether “‘Light diet’ in a hospital is apt to be they have harped sufficiently on this monotonous in type and meagre in string in their ward rounds and quantity, especially in war time. We lectures. Has the student been interrohave only to think of the food a good gated as often about the details of diet wife or mother will provide in the home as about mitral stenosis? Can he say for the sick husband or child with equal confidence what went down who ‘fancies something light,’ to realise the patient’s gullet from his plate and that a piece of steamed fish and some from his medicine glass?” rice pudding, bleakly served on chilly The most radical suggestion was the plates, are not what the doctor ordered simplest “Has [the medical student] . . . If [the patient] protests he may tried the food in the wards himself? acquire a reputation for faddiness, A week in bed with some hospital other always punished severely by busy than his own would teach him wondernurses.” (Jan 13, 1945, p 61). fully.” (Jan 27, 1945, p 124) Training of these fierce-sounding Without doubt, there are few doctors nurses seems to have included the today who would welcome such a domestic arts alongside medical sciproposal. Perhaps, 50 years on, these ence: “The student nurse, during her issues remain pertinent. preliminary training, learns invalid cookery and is taught how to make a Peter Kandela tray attractive with clean linen and a 29 Greenlands Road, Staines, nosegay. She rarely uses that technique Middlesex TW18 4LR, UK again, unless she takes up private nurs-
763