Dietetics in the 1940’s

I come from a line of health care professionals. My mum was a physio, her parents doctors, my dads mother and grandmother qualified nurses. My Grandma trained as a nurse in Hartlepool Hospital where she met her friend Margaret who was to become her sister in law. They qualified as nurses in 1946. I have been handed down one of my Grandma’s nursing books that she received on her 20th birthday while she was training.

Here is my Grandma and Great Aunt posing for photos with their friends on the roof of Hartlepool Hospital. The book is the 2nd edition of ‘Aids To Practical Nursing – A Complete Textbook for the Nurse’ which was published in 1940. It is a fascinating read back in time.

The first chapter is entitled ‘History of Nursing, Nursing Ethics and Hospital Etiquette’. It states that the word ‘Nursing’ means nourishing; therefore it has come to mean tending and helping all who need it, especially the sick. It states professional etiquette includes addressing all members of the medical visiting staff as ‘Sir’ and members of the resident or ‘house’ staff usually by Mr___. The nursing staff should be given their proper title of Matron, Sister or Nurse. Trouble should be taken to address patients by their correct names; it is usual to call male patients by their surnames and female patients as Miss____ or Mrs____. It is not good manners, therefore not etiquette, to remain seated when spoken to by one of higher rank, nor to lean against the furniture when so addressed… My Grandfather on my maternal side was a junior ‘House’ doctor in the hospital I now work in now. He recalls how when the consultants were due to visit the ward, the Matron would ensure all the patients and staff looked smart and ready for the consultant and then my grandfather would follow the consultant around with his clip board taking notes!

Some 70 years later and some of these etiquettes have changed slightly, but maybe we should return to others, although I would hope we don’t address our male patients by just their surnames!

But of course my eyes were drawn to Chapter 5 – Ward Diets. Even in the 1940’s they knew that nutrition was very important in recovery. ‘Feeding sick people is a very important part of medical treatment and of nursing care alike. Recently a great deal of attention has been centred on the application of the science of dietetics and nutrition to the preservation of health and the prevention of disease’. The first Dietitian’s started working in hospitals in the 1920’s. They were nurses with an interest in diets and they were called SisterDietitians.

The chapter then goes on to discuss ward diets: The standard diets in a hospital are usually classes as ‘full diet’, ‘light diet’, ‘soft (or spoon) diet’ and ‘fluid diet’.  Daily diets consist of

• Milk – depending on the diet. Fluid diets are allowed 3 pt, soft diet 2 pts, light diets 1 1/2 pts and full diets 1 pts.
• Butter – 1 oz per patient per day.
• Tea – 1/4 oz per patient.
• Sugar – 3 oz per patient (including sugar in cooking).
• Meat – 4 oz for a man, 3 oz for a women.
• Potatoes and Vegetables.
• Pudding – for all excpet those of fluid diet.
• Custard pudding – for patients on light or soft diet.
• Cheese – 1oz for patients on full diets.

Some extra’s such as fruit, meat essence, malted milk, beers, wines and spirits may have to be signed for by the surgeon or physician. Diabetic or other special diets are ordered on special forms and prescribed by the doctor and signed by him.

There are a variety of recipes which include ‘Albumen Water (Egg white and water), milk lemonade (milk, lemon, sugar and sherry) and Barley water (pearl barley, lemon, sugar and water). These drinks were probably the equivalent of the pre made nutritional supplements we have today.

There is also a chapter on artificial feeding. In the 1940’s they didn’t have ready to hang feeds like today, but had to make their own. If feeding with a Oesophagea (Oesophageal) tube or Nasal tube then the feed was usually milk as the base with various added other foods such as eggs beaten up, sugar, malted milk powder or chocolate. For long term feeding a Gastrostomy (tube straight into the stomach) was used. It states care must be taken to ensure the diet meets 2,500-3000kcals and provide all the components to provide a balanced diet. Any food that passes down the tube may be given. Milk forms the basis with the addition of eggs, cream, lactose, Benger’s food* and malted milk. Soup may be given with marmite for B vitamins and orange juice once a day for vitamin C.

It even discusses Rectal feeding!! It does state it is very unusual to have feeds given this route as the powers of absorption of the colon are very limited. Normal saline solution often with 5-10% glucose was often used as a way to introduce fluid.

75 years on and a lot has changed and moved on in Dietetics. There are now 8,598 Dietitians registered to work in the UK (HPCP July 2015). All our supplements and feeds are ready made and often nutritionally complete. Reading a little book like this is a reminder of how far we have come in the world of Dietetics.

If you are interested in learning more about the history of Dietetics then take a look at the BDA’s ‘History of the BDA and Dietetics’.

*Bengers Food

I had a search on the internet to find out what Benger’s food was and this is a description I found: Bengers was first produced in the later part of the 19th Century (Circa 1880/90) in the Strangeways area of Manchester, England. Bengers is a powder supplement drink containing amylase and trypsin, two of the enzymes that the body uses to break down and digest food. Bengers was added to hot milk, the trypsin would then begin to break down the rich milk proteins (often difficult to digest), whilst the amylase would react with the wheaten base, making extra energy instantly available. Bengers was ideal for patients in convalescence or those suffering stress, nervous tension, stomach upsets and sleepnesses as they would benefit from the gentle nourishment of predigested Bengers, even when they fell ‘off’ other food. The original Bengers company was taken over in the 1950s by Fisons Pharmaceuticals.

With thanks to Renée McConnell for sending me this advert she found tucked away in a newspaper in her restaurant in Melbourne, Australia.