The Lettsomian Lectures on Peritonitis: Delivered before the Medical Society of London, January, 1894
Authors: F. Treves
Journal: BMJ (1894)

ANlsoluteb re st in xtte re cumbenllt, positioii.lippears to be tlle firs-t obviouls iidiclitionl.TlleX knlees iiiay bez flexedl over a¢ ziloi to lf ssenltllt ttlision o lie ti'tbds(oiiiiial walls, andl to tvoIltir li patienlt's iistiilt't to assuiiie thast posttire.Tlle up)per part o!tlieceliest .alltliee.aXr --r(-,stless upptbrliiibs sllould be protee-te(I by a woollenljacekt, ati(i no reasoiiab)le resti-aint offered to t lez patient's hielina.tiol.to liold tlle liaiids above tlit-liezad.Iilis favourite posturt-, by actiiig upon tll(' lower p)art of t}le thlora,eit walll, assists al1so in diniiiiiisliing tlle ten.sion writliin thie abjdoiieii.It is cruel to iiisist tllat tlle lian]ds sliould be? kepl) bezneathl tle? btideblotlies.The Stflte of 11nisery in peritonitis is acuteb enlouall.witliout becing inerease?dby purposelessaiid rigid forniluke.Coldt liands do iiot cause deatli, but as on exposure thley tenid to becoiine c-old tlley sliould be covered tip.Trlle wre^teliedlezss of restlessnless h1as a niatural i-elicef in little inovtements.II.-FEED>ING;.Thle oldl rule of eiglity vears a(ro of givinlg as little foodl as possible by tlle moutli' caniiot be imprloved upon.Tlle stomaCi is not in a condition to receive iiourisll¢ment, and wliat is taken usually remaiins unutilised, andz is r'eturned unclianged.Tlle practice somebtimes met witli of laboriously plying tlle patient witll teaspooiif uls of tllis meat extract or of tliat, recalls the legend of tlle Danafides, wlio spent tlleir energies in pourinig water into piteliers wit}lout b)ottoms.Two extremes are,to be-avoided.T}le first is the rigidl,uinreason'ing, and oftens needlessly cruel problibition of food of ally kind by tlle moutli; and tlle secondL is the reckless andl intemperate use of ice or iced fluids.Tliirst is often a most terrible syiiiptoin ill peritonitis.It is not always qu'ite relieved-at first at least-by rectal in- jetions.The patient is ready to give Iiis life^for a drop of odwater.If he takes it ie is siek, but lie is iiiucli relieved.This little indulgenlce does iiot introduce anewv tlle symptom of vomitinlg; it is thiere, but it is latent, aiid tlle droD of cold water only makes it evidebnt.Thle atienlt will not die of vomiting, and simply because a rigi eXxclusion of all fluid by tlle mouth does iiot render tlle symptom apparent it does not render it non-existing.T}le man would sooner vomit tllan endure his tliirst.Very often great relief is given by allowing a fairly copious drauglit of fluid, wliicli is soon rejected, and wliicll as it were, by wasIhing-out tlice stoiiacli -le.aves tlle patienlt for awliile infinlitely comforted.On the otlier liand, the perpetual sucking of ice is Cas bad as tlle per- petual teaspoonlful of useless jelly or of decomposible meat juice.The filling of tlle stomach witli iced water does un- doubtedly add to the general depression of tlle patient, especially wlien vrom'iting lias beenl brouglit illtO abeyance by morphline.Tlle right course appears to lie b)etwreen these two extremes.Thlere shlould be no rigid formula except tliis-let t ie patient take as little food aas possible by the moutli.If t iere be a raging tbirst, let Ilim liave a little ice-and very little suffices -or alittle iced milk and soda water; or if, as is common, the inclination lies towards sometliing warm, let himn take a