2. If solids are given they should be finely cut up and thoroughly mixed and chewed in the mouth. In the case of a solid meal, liquid, water or a little soda water, might be given an hour before the meal, but neither with it nor for 3 hours after.
3. A considerable interval should occur be tween meals, 3 hours elapsing after a meal of bread and milk, or such soft food, before the next, and 4i or 5 hours after a more solid meal.
4. Spices and condiments should be avoided.
There are, of course, exceptions to these rules, but they must be noted in discussing special diseases.
If the stomach will not bear even a tea-cupful of milk, then a less quantity must be given, but it must be repeated oftener. If even small quantities of ordinary milk cannot be borne, then the milk must be peptonized, or pre digested. Directions for this are given on p. 380, Vol. II.
The Bowels must be attended to also, at the very outset. They should be cleared out, to begin with, by means of a full dose of castor oil, a dessert or table-spoonful. If this does not act soon, an injection should be thrown into the bowel, made of 3 ounces of olive-oil, 1 ounce of glycerine, and 7 or 8 ounces of warm water, sufficiently soapy to make an emulsion vith the oil when thoroughly shaken. After he bowels have once been effectually cleared, L good daily motion must be obtained, by ad ninistering at the same hour, the last thing at light, as much castor-oil as is necessary. If ;his is given with perfect regularity, a tea spoonful will probably be found sufficient. If t has not acted by early morning, another tea spoonful should then be given. But all that s wanted is one good movement daily, and if he oil be given absolutely regularly it will ?robably be found that smaller and smaller loses will suffice. The smallest amount is to w found which will secure the result.
In the event of insuperable objection being ?ersistently maintained to the castor-oil, a tea of Epsom salts in a tumbler of hot water, on the empty stomach, in the morning, will probably be sufficient, or a wine-glassful of A penta, Hunyadi Janos, or similar mineral water. But it also must be given with perfect regularity, and only that amount that is found necessary.
Pain in most cases will speedily be relieved if these measures as to diet and clearing the bowel are properly carried out. Once the pain has ceased, its return must be held to indicate an error in the diet, too rapid addition to its amount or variety.
For the first day or so, however, it may be necessary to do something more to relieve the pain. The most useful would be a large warm poultice, or hot fomentation all over the stomach region, repeated as necessary. At the same time the milk may be iced, by putting a piece of ice as large as a hen's egg into the tumbler and pouring over it a cup of milk. Iced milk must, however, be sipped slowly, the cupful taking an hour for its consumption.
Pain still persisting severely, the effect of 5 grains bicarbonate of soda and 5 grains car bonate of bismuth given in water may be tried, repeated every two hours till relief is got. If relief is still delayed, after several doses of the bismuth and soda, 10 drops of the liquor muriato of morphia may be added and repeated for 2 or 3 doses only. The use of morphia, however, is to be withheld as long as possible, and if it must be resorted to, it is to be given up again as soon as relief permits.
Vomiting will, like pain, probably speedily cease, as soon as the reduced milk diet is com menced and the bowels cleared. If it persists, all food, including milk, should be withheld for 6 or 8 hours, chips of ice only being given, or tea-spoonfuls of hot water, the warm poultice or fomentation over the stomach region also being applied. If the relief is not complete in the time mentioned, the same steps may be taken as advised for pain. The dilute hydrocyanic acid is very useful for vomiting, and it may be given in combination with bismuth-3 drops to each dose of 5 grains of bismuth—before morphia is tried.
These are the general lines on which treatment should proceed. What further remedies may be later employed, or what other steps may be necessary, must depend on the particular nature of the stomach disorder, and will be indicated in the short statement that will now be given of a few of the chief diseases of the stomach.
In many cases, a great many cases, indeed, of stomach disease, the steps already detailed will suffice to rid the patient of all discomfort and symptoms. But these will certainly return if careless habits of eating are again followed. The patient should persist in the line of diet and the regulation of the bowels stated above for a long time, many months, to permit of a return of the stomach to a normal tone.