Surgery : its theory and practice / by William Johnson Walsham.

  • William Walsham
Date:
1889
Catalogue details

Licence: Public Domain Mark

Credit: Surgery : its theory and practice / by William Johnson Walsham. Source: Wellcome Collection.

    147/864 page 131
    the teeth, and coated -svitli a creamy fur, and in severe cases becomes dry and brown. The bowels are usually confined. The patient cannot sleep, and will not of his own accord take food, but will, as a rule, ibiuk anything. The jivof/itosis is good when the patient is young and can be induced to take food; but when he is broken- down in health or the subject of visceral disease he iisually sinks into a state of asthenia, and dies of exhaus- tion, or it may be of heart-failure dm-ing a paroxysm of violence. Treatment.—The chief indications arc to make the patient take food and to procure sleep, and so restore power to the exhausted nerve-centres. Thus, the diges- tiye functions should be regulated by clearing the bowels with a purgative or an enema, and by the subsequent administration of tonics, such as quinine. The difficulty :n getting the patient to take food may generally be over- come by a judicious mixture of firmness and coaxing, otherwise he must be fed by an oesoiAageal tube. The diet should consist of fluid noiu'ishment given in small and repeated quantities by night as well as by day, provided the patient is awake. To procm-e sleep subcutaneous mjections of morp]ua(gT. -L to or bromide of potassium and chloral in doses of twenty grains of the former to fifteen of the latter, should be given every two hours, carefully watching their effect. When these fail, success may sometimes be obtained by first inducing insensibility by chlorofoi-m, and following up its effects by the subcu- taneous injection of morphia. The administration of chloroform to patients with delirium tremens is however by no moans free from danger, since three deaths have occurred at f^t. Bartholomew's alone in seven years. If there is kidney disease, morphia and opium should not be given at all, or with great caution. The question of the adiniuistration of stinuilants is one on which siu'geons differ. Perhaps the best rule is—where the patient is young and of good constitution, to Avithhold them entirely; but where he is old, broken down in health, or the subject of visceral disease, to give them in moderate quantities, regulating the dose according to the amount of dciwession and the effects produced. If ho is violent or noisy ho must be placed in an isolation-ward, and prevented frominjuriii- himself or his attendants, eitlier by the use of tho strait- .lackot or by inanual restraint. Seclusion itself has often a good effect in producing sleep. The managoment of a K 2
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