Pap and Gruel and Invalid Foods

I read a lot of old novels during lockdown when I was on furlough, and they have reminded me that there are a lot of traditional sickbed foods designed to help you recover from illness which you don’t hear much about any more.

I’m not talking about the really nutty stuff like using salted owls flesh to treat gout or mixing ox gall and urine to relieve sciatica, or even treacle, which I have covered previously to now – I mean just classic invalid nourishments which have been used for centuries.

Can they still do us good today and help us get through this pandemic, which will be going on for a while despite what people say?

Lets check in with some medical doctors, and see what they think.

Boiled onions

The recipe for this is too simple, and still very popular in Asia today. You place chopped onions in water, adding garlic cloves if you want to be a bit extra, simmer for half an hour then strain the liquid off and drink. Onion water is used mainly as a home remedy for coughs and colds, and you should drink it very hot, with a little honey if you find it easier to take that way.

Dr Nathan Curran: Healing benefits from onion water are likely conferred through inulin – a prebiotic fibre which is preferentially metabolised by beneficial gut flora into short chain fatty acids. These help calm down inflammation and promote healing. 


Onions are also a rich source of the flavonoid Quercetin. Quercetin is a plant pigment so red onions contain higher levels and it’s mainly found in the layers closest to the skin. Quercetin is an antioxidant and protects tissues against free radical damage. It’s also a zinc ionophore and helps to shuttle zinc into cells where it exerts potent antiviral activity by interfering  with the assembly of viral proteins within cells.

Most broths support recovery as they are nutrient dense (high nutrient: calorie ratio) so they provide a rich source of raw materials (minerals and amino acids) required for tissue repair and healing. The low calorie aspect can be beneficial as the body doesn’t have to divert energy and immune resources from healing to digesting (which is why we repair when we sleep). 

I make a version of this which consists of boiled onion and garlic in bone broth – ideally made with chicken feet, which sounds disgusting, but chicken foot broth is especially high in collagen — the most abundant protein in your body.

This collagen content can help relieve joint pain and skin health. I add honey and lemon juice before serving, and I really think it’s great when you feel ill. Plus, it’s delicious! I call it my Magic Soup.

Toast water

The recipe featured in ‘Household Cookery & Laundry Work’ (published in 1898) seems typical: “Toast the quarter of a slice of bread till it is quite brown in every part without being in the least burned.
Have a jug, with three breakfast-cupfuls of cold water in it in which put the bread, and allow it to stand for a few hours.
Hot water is frequently used instead of cold, but the water is scarcely so clear and nice. In this case it must cool before being used.
The water is put in the jug first and the bread put in, otherwise the bread gets crumbled.
It is a most refreshing drink.”

Is it, though? I’ve tried it, and it’s… fine. I think fresh lemonade is a better option – at least that has Vitamin C. Toast water was a huge deal in Victorian times, but maybe the Victorians didn’t know everything, although I’m a big fan of their architecture.

Dr Teresa Tatton: This has no nutritional value.

 

Chicken soup

Of all the folk remedies for fighting a cold, a hot bowl of chicken soup has to be the hands-down winner. So pervasive is the belief in the healing power of chicken soup – aka “Jewish penicillin” – that scientists have actually taken it into the lab for testing. An easily digested form of protein, it seems as if you can’t go wrong with this absolute classic.

There are a million different recipes for this online. I favour the version where you simmer a whole chicken up to make stock, then use the stock with carrots, leek and chopped meat from the boiled chicken for the final soup.

Dr Teresa Tatton: this is the main one with real potential healing benefit.

Dr Salma Haque: chicken soup makes everything better.

Pap & gruel

Pap is a type of thin porridge still commonly made in Africa, where maize flour is cooked in boiling water or milk until it reaches the required consistency.

In the past, invalids were fed a mixture of diluted milk and flour called pap – invalid foods generally tended to be runny and bland. An “invalid feeder” or “pap boat”was ideal for giving liquid meals to bedridden patients. You can still buy pap boats on eBay.

The food was cooked into mush, spooned into the feeder, and the patient was propped up to drink from the spout, holding the handle with one frail, shaking hand.

If they were very weak, a nurse or helper sat next to them and fed them. In the old days and in rural areas, doctors couldn’t easily put you on an intravenous drip to keep you hydrated and nourished, so you would be kept alive with delicious pap instead, lucky you!

Dr Teresa Tatton: We eat pap in Africa , known as mieliepap in Afrikaans – either as a good porridge in the morning with milk, sugar, and a blob of salted butter, or as a savoury accompaniment with tomato relish and sausage (boerewors). A good cheap way to fill hungry tummies though nutritionally speaking, these are fast release carbs (high glycaemic index) and don’t sustain energy for long.

Oat porridge would really be more nourishing. Traditionally, Africans eat maize pap solid and dry with anything- breakfast, lunch and supper. From an invalid perspective, maybe getting some energy in fast with some pap is a good idea, maybe adding some peanut butter for additional calories.

Pap and some other carbs like potato salad can be high GI ( fast release carbs, not good for diabetes) if eaten hot, but change to low GI if eaten cold.

The GI is essentially a way of ‘ranking’ carbohydrate foods according to the speed at which they cause our blood glucose levels to rise and fall. High GI foods are those which are more quickly digested and absorbed while low GI foods break down more slowly, gradually releasing glucose into the bloodstream.

Dr Salma Haque: This has little nutritional content, although it was popular in times gone by and still is used in some countries. My favourite home remedy is honey and lemon for sore throats and ginger tea for sickness.

A relatively modern form of gruel is the hot drink Ovaltine. Historically, gruel has been a staple of the Western diet, especially for the sick bed. Although its actual medical use is not proven, gruel has historically been considered an important form of sustenance for invalids, and recently weaned children. Ovaltine is technically a gruel, but the manufacturers avoid calling it that due to negative connotations. I think myself that they should lean into it, and advertise it as a SUPER GRUEL FOR KIDS.

Calves Foot Jelly

Put a Gang of Calf’s Feet well cleaned into a Pan, with fix Quarts of Water, and let them boil gently ’till reduced to two quarts, then take out the Feet, scum off the Fat clean, and clear your Jelly from the Sediment, beat the whites of five Eggs to a Froth, then add one Pint of Lisbon, Madeira, or any pale made Wine, if you chuse it, then squeeze in the Juice of three Lemons; when your Stock is boiling, take three Spoonfuls of it, and keep stirring it with your Wine and Eggs to keep it from curdling, then add a little more Stock, and still keep stirring it, and then put it in the Pan, and sweeten it with Loaf Sugar to your Taste, a Glass of French Brandy will keep the Jelly from turning blue in frosty Air, put in the outer Rind of two Lemons, and let it boil one Minute all together, and pour it into a Flannel Bag, and let it run into a Bason, and keep pouring it back gently into the Bag ’till it runs clear and bright, then set your Glasses under the Bag, and cover it lest Dust gets in. – Raffald, Elizabeth.  “The Experienced English House-keeper”  1769

This is essentially a recipe for meat gelatin with added fortified wine or sherry, lemon juice and sugar.

Calf’s foot jellies remained in cookbooks well into the twentieth century, generally as invalid foods as the resulting jelly is almost pure protein, fat free and was seen as nutritious and easy to digest. Fruit jellies remain a staple of hospital foods today, as anyone who has spent any recent time in a ward knows.

Beef tea

  • 8 ounces steak, cut into 1/2-inch cubes
  • 1/4 teaspoon salt
  • 3 cups water
  • Preparation
  1. 1. Combine the beef, salt, and water in a saucepan and bring to a boil over high heat. Let the mixture boil for 1 minute. Reduce the heat to low and let the water barely simmer for 20 minutes more, skimming off any scum that forms on the surface. Remove the pan from the heat and let cool.
  2. 2. Pour the liquid and the pieces of beef into the jar or container, cover it tightly, and let the liquid steep (like tea, of course) in the refrigerator for at least 24 hours.
  3. 3. Strain the liquid either through cheesecloth or a fine-mesh strainer and discard the beef. You’ll be left with the tea. Serve hot.

Dr Teresa Tatton: beef extract may actually be beneficial for someone with anaemia, and provide a little increase in iron and energy in the absence of iron tablets and transfusions.

Dr Salma Haque: This has a good amount of nutrients in it.

Bovril was a packaged beef tea which was popular in the first part of this century. Ask your grandparents about it. Those guys LOVED Bovril.

It holds the unusual distinction of having been advertised with a Pope. An advertising campaign of the early 20th century in Britain depicted Pope Leo XIII seated on his throne, bearing a mug of Bovril. The campaign slogan read: The Two Infallible Powers – The Pope & Bovril.

It is not recorded whether there is any religious healing power attached to Bovril.

Dr Nathan Curran: A potential issue with some of these traditional sickbed foods is that the chemical makeup of all these today is very different from what they may have been a century or more ago, due to several factors – topsoil depletion, synthetic nutrition fortification, pesticides, crop rotation, and so on. What they all have in common is that they are low calorie. Fasting CAN be immune enhancing under certain circumstances.

This is why broths and gelatins have traditionally been seen as healing foods. They are nutrient dense but calorifically sparse. This means your immune system doesn’t have to divert significant resources to policing these foods as they pass through your digestive tract.

The low calorie aspect means mitochondrial capacity is reserved for healing/repair, and not metabolising calories. Having said that, certain nutrients are vital for healing – and toast water or pap are not nutrient dense at all. They contain few amino acids, vitamins and antioxidants. Fresh fruit or vegetable juices are more to be recommended.

Another general consideration with meat jelly or broth is that nutritional requirements change over the different stages of healing, so low calorie foods may be both of benefit or harmful, depending on the nature of the illness and the duration of the recovery.

Chronic disease is very catabolic, which is why muscle wasting can be an issue in recovery. This muscle wasting could be exacerbated by low calorie foods.

Here are a couple more tips for sickbed feeding from ‘Notes on Nursing’ by the ultimate nurse Florence Nightingale, published in 1859:

A FEW RULES TO BE OBSERVED IN COOKING FOR INVALIDS.

For invalids, never make a large quantity of one thing, as they seldom require much at a time; and it is desirable that variety be provided for them.
Always have something in readiness; a little beef tea, nicely made and nicely skimmed, a few spoonfuls of jelly, that it may be administered as soon almost as the invalid wishes for it. If obliged to wait a long time, the patient loses the desire to eat, and often turns against the food when brought to him or her.

   
Never leave food about a sick room; if the patient cannot eat it when brought to him, take it away, and bring it to him in an hour or two’s time. To leave the patient’s untasted food by his side, from meal to meal, in hopes that he will eat it in the interval, is simply to prevent him from taking any food at all.

I have known patients literally incapacitated from taking one article of food after another by this piece of ignorance. Let the food come at the right time, and be taken away, eaten or uneaten, at the right time, but never let a patient have ‘something always standing’ by him, if you don’t wish to disgust him of everything.”

God forbid we should disappoint the patient, hey?

Florence Nightingale’s advice reminds me of a great pamphlet I have from the 1930’s about domestic animal care, which states: “Cats love to steal their food. If you wish to tempt a sick cat to eat, leave a whole fresh bloater out on a surface and turn your back – they will quickly pounce upon it” .

FYI a “bloater” is an old fashioned kind of cheap fish, and I have often used this trick with sickly beasts.

   

Cats love to steal their food

To be perfectly honest, all this talk of coddling invalids is beginning to make me think they should just be isolated in a room with an internet connection so they can order their own Deliveroo meals. But then, I’m a bad person.

A perfect cocktail for an invalid to combine the health benefits of bone broth and Vitamin C is the Bloody Bull.

This recipe provides a combination of a Bloody Mary and a Bullshot.

A Bloody Mary is traditionally made with vodka, tomato juice, Worcestershire sauce, horseradish, hot sauce, lemon juice, and freshly ground black pepper.

A Bullshot only calls for only three ingredients – vodka, stock, and Worcestershire sauce.

Bloody Bull

  • 4 ounces homemade bone broth, cooled, potentially jellied. You can use a stock cube if you haven’t made your own bone broth, or you can buy ready made stock in cans.
  • 2 ounces vodka
  • 4 ounces tomato juice (ideally fresh juiced tomatoes, but you can use ready-made tomato juice or V8 juice)
  • juice of 1 lemon
  • 1/4 teaspoon Worcestershire sauce
  • 1/2 teaspoon horseradish
  • pinch of freshly ground black pepper
  • 1 dash hot sauce like Tabasco
  • celery stalk, pickle slices, and lemon wedges for garnishing
  • Mix all ingredients for the glass rim on a plate. Wet the rim of a highball glass with a lemon wedge and dip the rim in the seasonings.
  • Fill the glass with fresh ice cubes.
  • Combine all cocktail ingredients except for the garnish in a cocktail shaker over ice, and shake gently to blend.
  • Strain over ice into the prepared highball glass. Garnish with a celery stalk, a pickle slice, and a lemon wedge.

Drink, and toast to good health!

More about Dr Curran:

Dr Nathan Curran (BMedSc(Hons), MBChB, DOccMed, AFMCP, PGCert Nutr Med) completed his medical training and an intercalated honours degree in Human Genetics at Stellenbosch University in South Africa. Following his studies, he spent a further two years gaining experience in emergency medicine and infectious diseases. Since moving to the UK in 2005 he has spent over a decade working in the private medical sector, which has afforded him a unique insight into the factors affecting the health of people working in competitive and emotionally demanding environments.

You can follow Dr Curran on Instagram as @nutrition_physician

Dr Curran’s collaborative private practice is called Well Works. Their focus is on lifestyle and nutrition driven interventions to help clients take control of their own lives and health. They are currently offering online services and virtual appointments, so you can contact them today for your personal consultation.

More about Dr Teresa Tatton:

Dr Teresa Tatton qualified with MBChB at the University of Stellenbosch in South Africa in 1997. She then worked in Namibia and rural South Africa gaining vast experience. This was followed by attaining the Advanced Cardiac, Paediatric and Trauma Life Support Certificates.

She then worked in private hospitals in the UK whilst also fulfilling her passion for travel. She went back to Cape Town to work at the Red Cross Children’s Hospital, and then A+E. This included stints as a flight doctor and a ship’s doctor. After this it was time to settle down into full-time General Practice in an upmarket private practise in Cape Town, where she practised for 8 years before coming to the UK to continue work in A+E, health screening and General Practice.

More about Dr Salma Haque:

A medical doctor with over 10 years experience, having graduated from the University of Southampton in 2010, Dr Haque is a GMC registered GP and Aesthetics Doctor. She leads a clinic at SAYA Aesthetics which specialises in non-surgical, advanced aesthetic treatments and skincare. She can be contacted on info@sayaaesthetics.co.uk.

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