OPHTHALMIC SCHOOL CLINICS IN THE COUNTRY
Authors: R. B. Hird
Journal: BMJ (1910)

.1~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ a possible at lunch time, but the stomach is not accustomed to this kind of food at the earlier hour, and it will certainly zesent it on a day of such anxiety.Besides, why should it be concentrated ?A little extra 'water in the stomach can certainly do no harm.As every vaedioal man knows, if a patient be starved all night, and .givennothing whatever by the mouth in the morning, he can still bring up fluid which would be at least as likely to choke him as the extra water would; while, on the other hand, the amount of straining required to bring up this thick viscid mucus is greatly in excess of that required to get -rid of the more liquid substance, and the patient's -discomfort is increased accordingly.Contrary to the usual belief, ether cases generally suffer 4bss discomfort after regaining consciousness than chloro- 'fbrm cases; and this, I think, is partly explained by the act that the secretion in the stomach is more copious and 4lquid when ether is employed.So I have gradually been converted to the opinion that the want of food, and par- 'tioularly of fluids, is an important factor in causing the disagreeable after-effects which are usually falsely ascribed solely to the anaesthetic.It should further be remembered that the stomach -develops a habit of expecting, and demanding in no un--certain manner, a meal at regular definite times; and that, ,if it be disappointed in this expectation, it will cause its -owner to suffer if he takes an anaesthetic, goes on board :ship, or often even if he merely happens to encounter some unpleasant smell.Hence I think it is most important that 1the patient's usual meal-times should never be upset immediately before an operation.The quantity of food -allowed, and to some extent the actual kind of the food, should be carefully regulated, but the hour at which it is -dministered should not be altered.Thus, supposing an operation (in a healthy subject) is to be performed at 9 o'clock in the morning, the patient should be left asleep, unless he awakes of his own accord, until at any rate 7 30, when he may be given his enema.Then, if he be accustomed to breakfast at about 8 o'clock, X may have a thin slice of bread-and-butter, or a small piece of toast, with as much tea to drink as he desires.He will then be able to settle down much more contentedly to -his newspaper until the surgeon arrives.Tea ia, I think, preferable to coffee, as the former is usually taken with -considerably less milk than the latter.If the operation be at 10 or 11 o'clock, he may have a fimilar breakfast, but with (say) two thin slices of bread- and-butter, if he wishes, or. a somewhat larger piece of -toast, provided his usual breakfp&st hour be 8 o'clock.If, 'bowever, he be accastomed to breakfast at 9, the amount -of solid food should be as in the first case, unless the eKcitement of the approaching ordeal has caused him to -wake earlier than usual, under which circumstances he maT also have his small meal a little earlier If the operation be arranged for 12 or 1 o'clock, he may *e given an ordinary light breakfast at the usual time; meat, however, being avoided.A glass of water might, 'in this case, be taken with advantage at about 11 o'clock.For an operation at 2 or 3 o'clock, the ordinary break- Ust should be taken at the usual time, and a cup of hot -clear soup or beef-tea at 1 o'clock, together with a little water to drink.This same arrangement is suitable for a case to be done at 4 o'clock, except that in this instance a little toast, bread, or biscuit may be given with the soup.If 5 o'clock be the appointed hour, the breakfast and lunch should remain the same, but in addition a cup of -tea may be taken at (or a little before) 4 o'clock.If 6 o'clock be chosen, the patient may have his ordinary breakfast, aud then a light luncheon consisting of fish or