Dietary Tables

Dietary Tables serve patients who require special (corresponding to the disease) therapeutic nutrition; therefore, it is more correct to call them therapeutic nutrition canteens. Dietary tables should essentially also be called canteens for rational nutrition of healthy people; consequently, any public canteen must be a dietary one. The significance and role of dietary tables in the health improvement of the broad masses of the people is extremely great. Their therapeutic role lies in providing patients, by a physician's prescription, with all types of therapeutic nutrition; such nutrition for a large number of patients is the strongest therapeutic agent, especially in chronic diseases of the digestive organs, metabolic disorders, kidneys, in tuberculosis, and in various forms of anemia and nutritional disorders. The prophylactic significance of dietary tables as canteens for rational nutrition for healthy people lies in providing a hygienic table without sharp food irritants and substitutes, and in acquiring correct habits in the dietary regimen (in the sense of the qualitative and quantitative composition of food). Finally, the sanitary-propaganda role of dietary tables is extremely important due to the presence of constant medical guidance and the possibility of conducting wide propaganda of the principles of proper nutrition (lectures, conversations, question-and-answer evenings, posters, instructions, and brochures). Before the revolution, dietary tables almost did not exist, with the exception of individual dietary tables organized by medical societies at resorts (for example, the canteen of the Medical Society in Essentuki). In Western Europe, dietary tables exist mainly at large resorts, where they are under the jurisdiction of resort administrations or private individuals. With the development of public nutrition organization in the USSR, a new type of state institution for therapeutic nutrition, arising on the initiative of health authorities, first began to emerge. A special form of dietary tables is the milk kitchen (see) for feeding young children, where, according to a physician's prescription, the child receives food, individually prepared for him with an exact calculation of the components, from laboratory-tested products. In close general work with consultations, these milk kitchens play a huge role in the fight against infant mortality and in sanitary-propaganda work among the population. Modern dietary tables are therapeutic institutions of an outpatient type; they are organized according to a strict medical plan and conduct treatment according to developed nutrition schemes. The main categories of dietary tables are as follows: 1. Dietary tables organized by health departments at large hospitals to serve the contingent of outpatient patients. 2. Dietary tables in factory districts. Both these types of dietary tables are particularly important: a) for those patients who do not have the opportunity to undergo therapeutic nutrition at home but do not require inpatient treatment, and who, under conditions of proper nutrition, are sufficiently capable of work; b) for convalescents after inpatient treatment. Such a contingent of patients can receive in a dietary table either a full "pension," i.e., breakfast, lunch, and dinner, or (more often) only lunch, which is especially important for factory and plant workers who are at work for most of the day. 3. The network of state dietary tables at resorts, which has developed since 1925 on the initiative of the Resort Administration of the NKZdrav for serving outpatient (ambulatory) patients and their families. These canteens are increasingly displacing the obsolete and imperfect type of private canteens, where under the guise of "dietary" nutrition is offered mainly a milk-vegetarian table without any system and without any medical control. Resort dietary tables are organized in two types. A. Closed canteens with a definite contingent of pensioners from resort dormitories and rest homes. At some resorts (Staraya Russa, partly Pyatigorsk), dietary tables even serve an entire group of sanatoriums that do not have separate canteens. The advantages of the closed type are: 1) a strictly defined contingent of diners receiving a full therapeutic pension throughout the course of treatment; 2) the possibility of constant medical accounting and medical observation. B. Mixed-type canteens serve, alongside pensioners-subscribers, one-time casual visitors. The disadvantage of this type is the forced semi-restaurant nature of their service and the difficulty of systematic medical control and observation of visitors. However, canteens of this type are still very valuable due to their demonstrative significance for the broad masses of patients. The selection of patients for dietary tables is carried out by the dispensary method and through outpatient departments. At resorts, selection is made through polyclinics, where patients, in addition to other therapeutic regimen, also receive a "prescription" for therapeutic nutrition indicating the main diagnosis and the corresponding diet number according to the therapeutic canteen schedules available in the polyclinic. In open canteens, there is a possibility of independent influx of visitors who receive a therapeutic table according to the nature of their disease, in accordance with the prescription of the attending physician. With the further development of public nutrition organization, the most important problem is: 1) the rationalization of all public catering places (at factories, plants, institutions, educational establishments, etc.) in order to ensure the broad masses of workers with truly rational nutrition corresponding to the needs of the organism and the nature of work, and thereby raising the intensity of labor; and 2) the development of the network of district therapeutic canteens in connection with the general dispensarization of the working population. The system of therapeutic nutrition is built on the principle of grouping according to individual types of diseases. There are several analogous schemes of therapeutic canteens. In the USSR resorts, the scheme introduced in the dietary kitchen of the Central Institute of Balneology in Moscow is universally adopted. The basic principles and advantages of this scheme are as follows. A. Schematization of diets in accordance with the main groups of diseases, for example, with increased gastric acidity, liver diseases, obesity, etc. B. Combination of the diversity of individual tables with the simplicity of their preparation (for example, a menu for the whole day for 12 different diets requires no more than 20–25 different dishes). C. The scheme, in spite of its universality, is so simple that it is easily mastered not only by physicians but also by the middle and junior staff of the canteen and kitchen. Equipment of dietary tables does not present special difficulties. All sanitary-hygienic requirements developed for public canteens must be fulfilled. Under appropriate conditions, the throughput of therapeutic nutrition canteens can be brought up to 1,000 persons per day. Individual tables in the canteen are grouped by the numbers of the corresponding diets. Kitchen equipment must contain the entire necessary stock of utensils for special cooking: steam pots, water baths (marmites), portion forms, calibrated portioners for soup, butter, porridge, etc. It is desirable to have a physician's office and a rest room at a dietary table, which also serves for organizing lectures. Management and personnel of dietary tables. A physician with special training in dietetics should head the dietary table; he compiles the weekly and daily menu (together with the sister-housekeeper and head cook), monitors the quality of products and the correctness of dish preparation, instructs all personnel, and conducts sanitary-propaganda work among the canteen visitors. The main assistants to the physician are the sister-housekeeper and the head cook; the latter must possess great culinary experience and interest in therapeutic nutrition tasks, as well as special knowledge in the field of therapeutic cookery. Special courses in dietetics and therapeutic cookery prepare cadres of dietetic physicians, sister-housekeepers, and cook-culinary specialists for dietary tables.