Wheeler's handbook of medicine / by William R. Jack.

  • Wheeler, Alexander, -1903.
Date:
1920
Catalogue details

Licence: Public Domain Mark

Credit: Wheeler's handbook of medicine / by William R. Jack. Source: Wellcome Collection.

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    dietetic. Give no solid food, or that which would not readily pass through a fine sieve. Milk, if it agrees,albumin-water made from white of egg, beef-tea, and chicken-broth are the principal foods. Milk must not be used to relieve thirst, but must be given as a food only, at regular intervals, and m definite doses. If it disagrees, a 5 per cent, solution of gelatin may be used instead, and has been found of considerable value. Thirst should be met by water, mineral waters, lemonade, or Potus lmperialis (for formula see footnote1). Of late some authorities have ac vo cated a light solid diet throughout, but nothing must be given that would increase the risk of perforation. Such additions as arrowroot, cornflour, custard, mashed potato, and whippe eggs are permissible. The stools should be daily inspected. If undigested curd is found, milk is being given too often, or the gastric function is impaired. The milk may then be given with lime-water or barley-water. Beef-tea should be sparingly used, lest it excite diarrhoea. Alcohol is required mainly in the later stages, when the typhoid state has set in, and the heart is weak. Many cases do well without it altogether. Other stimulants are strychnine, ammonia, ether, etc. Medicinal.—General principles hold good. If the diarrhoea becomes excessive give bismuth and opium, or lead acetate and morphia, or an enema of starch and opium. When the motions are very offensive intestinal antiseptics (calomel in small doses, salol, etc.) may be given. They are also useful in meteorism. If constipation be troublesome, give enemata. No purga¬ tives should be given after the first week. Haemorrhage—opium, lead acetate, or calcium lactate gr.xv (grm. TO) every four hours, hypodermic injections of morphia or ergotin, ice-bag to the caecum. Subcutaneous or intramuscu¬ lar injection of normal serum (10 cc.) is valuable in severe cases. Perforation.—The main chance of recovery lies in early laparotomy and suture of the affected bowel. Every hour lost after the diagnosis is made, and the initial shock has passed off, increases the danger to life. Cases operated on within twenty-four hours may recover ; later, recovery is very rare. In anticipation of the operation, morphia may be given to relieve pain and diminish peristalsis. Bed-sores—water-bed, cleanliness, stimulant and anti¬ septic lotions, dry dressings if the slough is large. 1 Bitartrate of potassium, gi (grm. 4’0); syrup of lemon, 5iss (cc. 45); water to §xx (cc. 600).
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