the first 24. hours the patient is better if allowed to fast from all solids including milk. If appetite has returned, a cup of tea or beef tea may be given, or some Valentine's meat juice or Brands essence. In the second 24 hours, a slice of dry toast or of thin bread and butter may be added. Alter the bowels have been moved mare latitude may be allowed, and the patient's appetite may be followed as a guide which will seldom lead the physician astray. Care should be taken that fresh fruit, either raw or cooked, is given. I have often found great benefit result from the giving of the flesh of ripe grapes or the juice of ripe oranges in cases of persistent nausea.
Treatment of Iround.—In an aseptic case the first dressing need not take place till three days after the operation, unless pain in the wound or a rise of temperature leads to a suspicion of sepsis. The patient will he more comfortable, however, when the soiled and hardened dressings are removed and fresh ones substituted. This should be done under strict antiseptic precautions, and the wound should be sponged free of serum or blood-clot with an antiseptic solution and painted with Tr. Iodi before the fresh antiseptic dressings are put on. Should everything be in order, the next dressing need not take place till the twelfth or four teenth day, when the sutures may be removed.
I f a drainage-tube has been left in the wound, it should be removed at the end of 24 to 36 hours, and if its reinsertion is required it should be washed and sterilised by boiling. If drainage by gauze was instituted, the gauze must be withdrawn, and the cavity or sinus may be packed with fresh gauze if necessary. This is easily done when a suppurating area has been drained, but if the gauze has been introduced into an abdominal wound in contact with a fairly healthy peritoneum and bowel, it will be firmly held in place for from 7 to 14 days by coagulated lymph, and could only be removed by unjustifiable force and at some risk before the expiry of that period. It will do no harm if left till it loosens.
Should suppuration have occurred in the wound, the best plan is to remove as many stitches as will give free exit to the pus and allow of the inflamed parts being thoroughly cleansed and dressed. A boracic or perchloride poultice, which should be changed every four to six hours, will clean up the wound, and may be applied for the first two or three days. As soon as the sloughing surfaces begin to show healthy granula tions, the cavity may be loosely packed with iodoform or cyanide gauze changed twice a day until the amount of pus has become minimal and healing has begun, and afterwards once a day. Each time the wound is dressed it should be sluiced with i in r,000 perchloride lotion to wash away the discharges, the lotion dried out with sterile wipes, and a drachm or two of zo vols. solution of Hydrogen Peroxide should be poured into
it and allowed to remain. The same treatment may be adopted with abscess cavities which have been opened.
Treatment of. Rectal Wounds.—Each time the bowels are opened, the anus and surrounding parts should be first carefully cleansed with mops of cotton soaked in boracic acid solution, and then dried with cotton or gauze. If irritation is complained of, an ointment consisting of . Hydrarg. Subchlor.
Bismuth. Oxychlor. Morphite lid 0'. j. Lanolin 5j.
may be used with good effect.
Treatment of Vaginal and Perineal TVounds.—When an operation has been performed on the uterus through the vagina, a douche should be administered once or twice daily, consisting of r in 4,000 perchloride or drachm to the pint Lysol or cyllin. A perineal wound should be bathed with a similar antiseptic solution every four hours for the first two days, and afterwards night and morning. It should also be bathed each time the bladder or bowels act. The sutures may be removed at the end of ten to fourteen days.
Convalescence.—After an abdominal operation the patient should keep to bed for at least two or three weeks if all goes well. This time must be extended if any complications have set in such as suppuration, cystitis or the like. The patient may get up first for an hour or two after the midday meal, and the time should be gradually extended. It is a good plan to allow the patient to get up for a few hours in the morning, then to lie down in bed for two hours after dinner and to get up for a few hours in the evening. After a serious operation the patient should be warned that some months will elapse before normal health is restored, and that full recovery will be hastened by a due amount of rest not only at night, but in the middle of the day, by careful attention to the bowels, which are often constipated, by exercise in the open air and by plain nourishing food. A tonic containing strychnine is often most valuable, and when the patient is anaemic iron should be administered. The motto, Festina lente, should be dinned into the ears of such a convalescent.
The use of an abdominal belt is often prescribed as a routine after abdominal section. In my opinion it is merely a costly and useless en cumbrance. Ventral hernia grows rarer as technique is improved, and it can certainly not be prevented by wearing a belt. Women find, how ever, much comfort in the wearing of a belt-corset after an abdominal section.—R. J. J.