Disinfection Of Utensils

All dishes or utensils used in serving food to patients having syphilis, stomatitis, or diphtheria, or any infectious disease likely to be communicated through such means, should be boiled for at least an hour in water containing a few teaspoonfuls of soda. Syphilitic patients, especially, should have their own set of food receptacles, spoons, forks, etc., properly labelled, to prevent any one else from-using them. 28

Feeding Unconscious Patients

The feeding of unconscious patients demands special care and skill. They should never be given anything but fluid nourishment, and this must be fed with a spoon or through a catheter. Sometimes, if the jaw is set, a medicine dropper may be utilised. Not over a teaspoonful should be given at once, and the nurse must make sure that it is swallowed before she repeats the experiment. It should be remembered that the mechanism of deglutition is not excited by one or two drops of fluid, but usually at least half a drachm is required to start this reflex. In feeding comatose infants or children with tubercular meningitis, apoplexy, etc., fluid may be poured into the nostril with a spoon rather than into the mouth. It disturbs the child less than does the effort to force open the mouth, and if the head is lying back the fluid trickles down the posterior pharyngeal wall. Any excess of fluid is returned through the other nostril. There is no greater danger of choking when fed by this method than by the mouth. It is usually better, however, to use a soft catheter with a funnel attached to the free end. The catheter is oiled or dipped in vaseline or butter, and passed gently through the nostril down into the oesophagus, or, if desired, into the stomach.

Before pouring any fluid into it through the funnel it must be made certain that the patient is breathing easily, and that the tube has not made a false passage into the larynx. Such an accident is very rare. This topic will receive further attention in connection with Lavage.

Gavage, or feeding with the stomach tube, is described under that heading. Nasal feeding is employed sometimes for gavage in young infants, in feeding children with diphtheria, or the insane, who may refuse food or resist the passage of a tube through the mouth by biting, and it may be used when the mouth is sore from ulceration or the effect of corrosive poisons.

When patients are living upon "teacup diet," or broths and gruels, it is a common mistake to give them a diet which is either too low in carbohydrates or deficient in protein. The proper proportions to be prescribed, unless there is some special indication for the contrary, will be appreciated by a comparison of the following table, compiled by Mrs. E. H. Richards, and those previously given on p. 291.

A Common Invalid Ration too Low in Carbohydrates (Mrs. Richards)

Protein.

Fat.

Carbohydrates.

Calories.

Grammes.

Grammes.

Grammes.

1 pint od beef juice, containing 7 per cent

31-5

,.

I29.O

1 pint of whole milk

17.0

18.O

22

325-5

1 quart of flour gruel made with whole milk...

18.2

18.2

38

397.9

2 quarts of liquid. Total

66.7

36.2

60

852.4