until we establish tolerance on the part of the colon. Once the bowel is educated up to taking food at regular intervals, then we can feed the patient for at least ten days or two weeks, until the more aggravated stomach symptoms have subsided, when we can gradually resume regular feeding by mouth. In all cases the rectum must be cleansed with one pint or more of warm salt water about an hour before each enema. We can then determine to what extent the food has been absorbed. If we find that it has not been well taken up by the bowel, it will be advisable to change to a more simple form of nourishment. The anemic condition must be remedied by iron in some form. The ideal nutrient, then, to sustain strength and renew the impoverished blood would seem to be blood itself. We know from experiment that defibrinated blood is wholly absorbed by the bowel when given in small amounts, five or six ounces at a time. There may be some difficulty in obtaining blood, since it is not so readily accessible as the other foods. Stewart's formula is one that should meet the condition; viz., a heaping teaspoonful of somatose is dissolved in as little water as possible; two eggs are thoroughly whipped with it; and four ounces of peptonized milk gruel added to it; the whole not to exceed eight ounces. Papain is given for the digestion of the egg. If the enema is well borne, he adds some form of the albuminate of iron (preferably Dree's), one-half to one ounce. To combat anemia and improve the general condition, Ewald used 3 j of a three per cent. solution of ferri chlorid in a wineglassful of egg water (one part white of egg, two parts of water), taken through a glass tube to protect the teeth. He maintains that chloride of iron is one of the best and most easily assimilable preparations that there are. With the iron he gives arsenious acid gr. 1–30 in pill form; this treatment he continues for months. Since rectal feeding is not sufficient to sustain strength very long, we should try feeding by mouth as soon as we think it safe to do so. After two or three days' rest the stomach will admit of gradual resumption of food. Begin with very small doses of milk and lime water, a teaspoonful at a time; liquids in a predigested form; peptonized milk gruel; matzoon; and milk thickened with partially digested starchy foods, such as Nestle's, Mellin's, Malted Milk or Imperial Granum, to prevent the coagulation of the milk. If foods prepared with milk disagree, give beef juice in teaspoonful doses, either peptonized or pancreatized, or egg albumin beaten and prepared with sherry wine. If a bland diet is tolerated, we gradually add to it broths, eggs, light puddings, sweetbreads, minced chicken and finely scraped beef, being careful to eliminate all foods likely to irritate the stomach, such as brown bread, oatmeal, coarse vegetables and fruit. As the gastric symptoms disappear we may give toast, rusks, rare roast beef and beefsteak. Any serious departure from a strict diet carefully laid down may bring about a return of the old symptoms. Hemorrhage occurs in about fifty per cent. of all cases. In repeated and profuse hemorrhage Dreschfeld advises turpentine and considers it to give great relief. He administers it in capsules, or in emulsion 3 ii thoroughly beaten up with the white of one egg. The dose is m.xx or xxx of the mixture. He cites several cases of hematemesis in which the patient was pulseless and blanched to an extreme degree, in which ice, gallic acid, ergotin injections, and other styptics were tried in vain, and in which the first dose of turpentine completely stopped the hemorrhage. It is well borne by the stomach. In case of hemorrhage with symptoms of collapse, flood the colon with hot salt solution, one drachm to the pint, and give digitalin gr. 1-30 and strychnia gr. 1-30 subcutaneously. In case of perforation radical surgical interference is at once demanded. If the surgeon is not at hand, give morphia subcutaneously to quiet peristalsis and relieve pain, and brandy and coffee by enema to sustain the heart. BIBLIOGRAPHY. Welch-Pepper System of Medicine, Vol. ii. Wilson-Journal American Medical Association, Sept. 20, 1902. Boas-Deutsche Med. Woch. May 16, 1901. Strumpell-Practice of Medicine. Ewald-Diseases of Stomach. Barker-British Med. Jourual, Feb. 8, 1902. Millet-St. Paul Med. Journal, March, 1903. Kenner-St. Louis Med. and Surg. Journal, May, 1902. Max Einhorn-Diseases of Stomach. Dreschfeld-Allbut's System of Medicine. Hammeter-Diseases of Stomach. Hare-System of Practical Therapeutics, Vol. ii. International Medical Annuals from 1894 to 1902. |