Treatment Of The Second And Third Periods

During the interval of the second period abatement of the fever and of the gastric irritation may admit of a little nourishment being taken by the stomach. Some patients recover without passing into the third period, but because many do not, extreme caution must be observed and food, if taken at all, must be in very minute quantities. The same rules in regard to diet and stimulants apply to the third period which have been prescribed for the first, and the main reliance for nourishment should be through rectal alimentation. When the paroxysm is over and the symptoms have abated, the greatest care must still be exercised in regard to diet even if the patient is hungry, as sometimes happens. In the worst cases no solid food should be permitted for at least ten days or a fortnight, and it must be remembered that fatal relapses have been precipitated by not observing this rule. When the vomiting and epigastric pain have ceased, half-teaspoonful or teaspoonful doses may be given once in fifteen minutes of pancre-atinised milk, koumiss, Liebig's or Valentine's meat extract, iced dry champagne, or good Rhine wine.

If such foods are retained, they may be followed after some hours by a few spoonfuls of pressed beef juice, salted, and later still by warm, nourishing beef broths, chicken broths, gruels, or buttermilk. Stimulating or nutrient ene-mata should still be ordered, because in the early stages of convalescence the stomach will not tolerate all the food which the impoverished tissues require. Any epigastric fulness or distress, or tympanites, should be regarded as a warning, and food should be again withheld until the difficulty is corrected by antacids or antifermen-tatives.

It is to be noted that children usually require rectal feeding and stimulation even earlier than adults. Large doses of opium given to aid the retention of nutrient or stimulating enemata should be avoided on account of the tendency to suppression of urine. In mild cases, after four or five days, and in severe cases after a fortnight, solid food may be occasionally given, commencing with milk-toast, crackers, junket and cream custard, farina and boiled or broiled chicken, soft-cooked eggs, wine jelly, boiled rice, scraped beef, and similar nourishment.

Fruits and vegetables should not be allowed for several weeks.