to i oz. of brandy may be added to each injection with benefit. Bicar bonate of soda solution (2 or 3 teaspoonfuls to the pint) is much used, as a condition of acidosis is alleged by some to be a main factor in shock, and though this theory is far from proven, the results of injection of bicar bonate solution are quite equal to those of normal saline.
In combating shock, warmth is most important. The bed to which the patient is removed after operation should be well warmed with hot-water bottles. When he or she has been put into bed a blanket should first be placed over the trunk and limbs; the bottles should then be disposed on both sides so as to supply abundant external heat, and should be re plenished as they cool. Stimulants may be administered in the form of brandy or whiskey, either by the rectum as already mentioned, or by the mouth in small doses very little if at all diluted.
Drugs arc given preferably hypodermically, both on account of the more rapid effect, and because there is no risk of vomiting being excited. The only drugs which should be given in cases of post-operation shock are pituitrin (7 c.c.), which should be injected deeply into the muscles, and morphia (1 gr.), which is very useful when the patient is restless or complaining of great pain.
Vomiting and are two of the most unpleasant sequeke of operation. I am convinced that much of the distress caused by them is aggravated by the practice of restricting fluid by the mouth to an occa sional spoonful of water for the first 24 hours. If a patient is allowed to drink freely of warm saline solution (drachm to the pint) or of bicarbonate of soda solution (2-3 drachms to the pint), the result is in the main very satisfactory. The stomach is, of course, excited to vomit, but the bringing up of a large volume of bland fluid washes out that organ, and so tends to lessen its irritability and the effort required to empty a full stomach is far less trying to the patient than repeated attacks of retching followed by the ejection of small quantities of mucus and bile. If the sickness persists, the patient may be allowed to repeat the procedure. A handkerchief wrung out of toilet or ordinary vinegar and placed so that the fumes can be inhaled often assists in checking nausea. In some cases a mustard poultice over the epigastrium is useful. Some surgeons are in the habit of admin
istering chloretone for some days before operation with a view to lessening the after-sickness.
pain varies enormously in different individuals, even after similar operations. If it is affecting the patient's general condition, inducing restlessness and preventing sleep, it should be met with small doses of morphia. It is better to give gr., repeated, if necessary, in three or four hours, than to give a larger dose at first. In the case of operations on the pelvic organs there seems to be some advantage in giving the morphia in a suppository. Pain in the wound persisting or returning after the first two days should be looked on as suspicious, and demands a redressing of the wound to make certain of the presence or absence of sepsis.
Flatulence and Abdominal complications are especially likely to occur after a prolonged abdominal operation in which there has been much handling or exposure of the intestines. I find nothing more satisfactory than a warm soap-and-water enema containing a drachm of turpentine. This may be given on the evening of the operation, and may be repeated after a few hours if necessary. The hypodermic injection of Pituitrin (r c.c.) is exceedingly useful in cases of persistent meteorism, and may be repeated after an interval of 6-12 hours with good effect. If the condition is very persistent, it is well to administer calomel in grain doses repeated every hour for five doses. This may be followed by a saline aperient should the effect be long delayed.
First of some contra-indication exists, the patient should have the bowels moved 4S hours after operation. The best time to give the aperient is on waking after the second night's sleep. If the patient's stomach will stand it, nothing is so satisfactory as 2 oz. of Black Draught, which gives a single good motion as a rule in from three to six hours without pain or griping. Other satisfactory purgatives are Castor Oil, to r oz., especially useful after rectal operations: Pi1. Colo cynth and Hyoscyamus, so grs.; Vegetable Laxative pill (B.W)., 3 to io grs.; Cascara Sagrada is rather slow, often requiring to be followed by a saline. The action of the aperient may require to be assisted by an enema in from six to eight hours.