An Address on Medical Education, Examinations, and Degrees
Authors: J. S. Bristowe
Journal: BMJ (1886)

not matter mueb, so long as she gets it.My own preference is to administer it through the stomach-pump, attacbed to a fleXible India- rubber ttibe.The tube should be lubricated with.glycerine.. Food is easily administered in this way, and it is a sure method.Seldom are more than six feedings required for any patient, after which she will usually take food of her own accord.Through the pump, food should be given every four hours.Milk and eggs with wine, beef-tea thick- eoed with corn-flour, but, in cases where the feeding has to be pro- longed over three days, mutton minced fine enough to pass through the tube should be given once a day.'Some malt-extract among them adds to the value of farinaaceonis foods ;. and, no doubt, in such cases, peptonised aand pancreatised foods will be found valuable.Dr.dampbell Clark speaks well of enemata of defibrinated blood.Stimu- 1lits should be given freely, but with caution, and always along with food.'If a patient vomits while the tube is being withdrawn, as she will often do the first once or twice, it cannot be helped; the feeding must be gone on with.Some of the food injected remains each time.the patient should be fed in a recumbent posture, and kept so for some little time after the operation is over.I have added ten, grains of subnitrate of bismuth to each feeding with benefit for this vomiting; and in extreme cases, I have found a subcutaneous injection of one- 'siXtiI of a grain of morphine half an iiour before the feeding do good.During the whole treatment, the diet must be generous.Let the patient have what she likes if wholesome.but, above all, plenty of it.The bowels slhould be carefully attended to, and kept open, for they tend to be confined.The state of the vaginal discharges and' the urine require close attention.Bed-sores are apt to form rapidly in exhausted cases.Rubbing the skin over parts.liable with an alcoholic solution of tannic acil to some extent prevents or retards their formationi.If the breasts are tender and distended with milk, they should be rubbed with b?lladonna extract, dissolved in glycerine, or friction with castor-oil or salt, as Dr. Savage recommends, relieves them.Avoid the use of narcotics if youi wish your patient to do well.In occa- sional cases, where there is' great insomnia, a single dose of chloral given at night, alolng, with some porter or some sherry, with a view of inducing sleep, nlay do no harm, and, if it seems to do good, use it sparingly, and with caution.If the patient can be got to take nourish- ment, sleep will comie.Intercurrent bodily diseases should be looked for, and treated as they may require.Use the thermomneter regularly.If the temperature goes over 990, something is amiss, and must be discovered.As the patient progresses towards convalescence, and the excitement begins to subside, outdoor exercise should be encouraged, on foot, if the strength will allow of it, driving if not.As early as possible, the patient shouild shoul(l spend all the time her mneals and the weather will permit of it in the opein air.Some light wAanual employment *h1le indoors, such as sewing or 'knitting, will be foulnd useful in occupying her mind.When the excitement has passed off, the patienit should be allowed to see her friends, or even sooner if she asks for them.A visit from her husband may do her good, or, if apparently it does harm, the effect will not be lasting, an(d the visit nee(d not be repeated for a time.If friends do see her, advise them not to fuss, or talk foolishly, but to address 'the patielnt as a rational being.During the stage of stupor that so often follows, the excitement, visits and con- verse with husband and relatives are often of great benefit.Tonics and hsematonics are most useful during the convalescence, and, in women who are strong, morning shtwer batbs are beneficial where there is lethargy or stupor.If the case goes badly from the first,- if complicated septiceenia or iinflammatory conditions, or a high temperature persists, -these must be treated on: general medical prin- niples; with due attention to proper support.The foregoing directions apply more particularly to acute cases, but milder cases, and ones where there is less excitement, must be treated