For instance, to the large majority of very weak patients it is quite impossible to take any solid food before 11 A.M., nor then, if their strength is still further exhausted by fasting till that hour.  For weak patients have generally feverish nights and, in the morning, dry mouths; and, if they could eat with those dry mouths, it would be the worse for them.  A spoonful of beef-tea, of arrowroot and wine, of egg flip, every hour, will give them the requisite nourishment, and prevent them from being too much exhausted to take at a later hour the solid food, which is necessary for their recovery.  And every patient who can swallow at all can swallow these liquid things, if he chooses.  But how often do we hear a mutton-chop, an egg, a bit of bacon, ordered to a patient for breakfast, to whom (as a moment’s consideration would show us) it must be quite impossible to masticate such things at that hour.

Again, a nurse is ordered to give a patient a tea-cup full of some article of food every three hours.  The patient’s stomach rejects it.  If so, try a table-spoon full every hour; if this will not do, a tea-spoon full every quarter of an hour.

I am bound to say, that I think more patients are lost by want of care and ingenuity in these momentous minutiae in private nursing than in public hospitals.  And I think there is more of the entente cordiale to assist one another’s hands between the doctor and his head nurse in the latter institutions, than between the doctor and the patient’s friends in the private house.

[Sidenote:  Life often hangs upon minutes in taking food.]

If we did but know the consequences which may ensue, in very weak patients, from ten minutes’ fasting or repletion (I call it repletion when they are obliged to let too small an interval elapse between taking food and some other exertion, owing to the nurse’s unpunctuality), we should be more careful never to let this occur.  In very weak patients there is often a nervous difficulty of swallowing, which is so much increased by any other call upon their strength that, unless they have their food punctually at the minute, which minute again must be arranged so as to fall in with no other minute’s occupation, they can take nothing till the next respite occurs—­so that an unpunctuality or delay of ten minutes may very well turn out to be one of two or three hours.  And why is it not as easy to be punctual to a minute?  Life often literally hangs upon these minutes.

In acute cases, where life or death is to be determined in a few hours, these matters are very generally attended to, especially in Hospitals; and the number of cases is large where the patient is, as it were, brought back to life by exceeding care on the part of the Doctor or Nurse, or both, in ordering and giving nourishment with minute selection and punctuality.

[Sidenote:  Patients often starved to death in chronic cases.]