night, instead of tea.  If you give it at 5 or 6 o’clock in the morning, he may even sometimes fall asleep after it, and get perhaps his only two or three hours’ sleep during the twenty-four.  At the same time you never should give tea or coffee to the sick, as a rule, after 5 o’clock in the afternoon.  Sleeplessness in the early night is from excitement generally and is increased by tea or coffee; sleeplessness which continues to the early morning is from exhaustion often, and is relieved by tea.  The only English patients I have ever known refuse tea, have been typhus cases, and the first sign of their getting better was their craving again for tea.  In general, the dry and dirty tongue always prefers tea to coffee, and will quite decline milk, unless with tea.  Coffee is a better restorative than tea, but a greater impairer of the digestion.  Let the patient’s taste decide.  You will say that, in cases of great thirst, the patient’s craving decides that it will drink a great deal of tea, and that you cannot help it.  But in these cases be sure that the patient requires diluents for quite other purposes than quenching the thirst; he wants a great deal of some drink, not only of tea, and the doctor will order what he is to have, barley water or lemonade, or soda water and milk, as the case may be.

Lehmann, quoted by Dr. Christison, says that, among the well and active “the infusion of 1 oz. of roasted coffee daily will diminish the waste” going on in the body “by one-fourth,” and Dr. Christison adds that tea has the same property.  Now this is actual experiment.  Lehmann weighs the man and finds the fact from his weight.  It is not deduced from any “analysis” of food.  All experience among the sick shows the same thing.[25]

[Sidenote:  Cocoa.]

Cocoa is often recommended to the sick in lieu of tea or coffee.  But independently of the fact that English sick very generally dislike cocoa, it has quite a different effect from tea or coffee.  It is an oily starchy nut having no restorative power at all, but simply increasing fat.  It is pure mockery of the sick, therefore, to call it a substitute for tea.  For any renovating stimulus it has, you might just as well offer them chesnuts instead of tea.

[Sidenote:  Bulk.]

An almost universal error among nurses is in the bulk of the food and especially the drinks they offer to their patients.  Suppose a patient ordered 4 oz. brandy during the day, how is he to take this if you make it into four pints with diluting it?  The same with tea and beef tea, with arrowroot, milk, &c.  You have not increased the nourishment, you have not increased the renovating power of these articles, by increasing their bulk,—­you have very likely diminished both by giving the patient’s digestion more to do, and most likely of all, the patient will leave half of what he has been ordered to take, because he cannot swallow the bulk with which you have been pleased to invest it.  It requires very nice observation and care (and meets with hardly any) to determine what will not be too thick or strong for the patient to take, while giving him no more than the bulk which he is able to swallow.