VERCO, W. A. _The Australian Med. Gazette_, 1908, 681. WALLA, A. VON. Ruptura uteri completa, abdominale Totalextirpation. Heilung. _Centralb. für Gynäk._, 1900, xxiv. 497. CHAPTER XI THE AFTER-TREATMENT. RISKS AND SEQUELÆ OF ABDOMINAL GYNÆCOLOGICAL OPERATIONS The performance of ovariotomy, hysterectomy, and allied procedures is attended by several risks, immediate and remote, which may spoil the best-planned and most carefully executed operation. Some of these may be avoided by careful attention to the details embraced by the phrase ‘after-treatment’. THE AFTER-TREATMENT OF ABDOMINAL OPERATIONS The patient is returned to the bed with gentleness and usually lies on her back, but many anæsthetists prefer to turn the patient on one or other side for an hour, until there is a fair return to consciousness. The patient then lies on her back and a pillow is placed under the knees. Hot-water bottles should not be placed in the bed with the patient until she is completely conscious, and they are rarely needed. The healing of blisters caused by hot-water bottles is a slow process. During the first twelve hours the patient complains of pain, thirst, and vomiting. The thirst is in a measure relieved by administering six or eight ounces of normal saline solution by the rectum an hour after the patient returns to bed, and repeating it in three or four hours. The patient may wash her mouth out frequently with water, hot or cold, according to her fancy, and if there is no vomiting she may swallow a little hot water from time to time. As a rule, it is better for her to abstain from swallowing anything for the first eighteen hours; the best way to avoid vomiting after an anæsthetic is to keep the stomach empty. There is always some pain after an abdominal operation, partly due to tension on the sutures, and colic. The injection of normal saline solution (a teaspoonful of salt to a pint of water) by the rectum often controls this, but occasionally the pain is so severe that it is necessary to give a quarter of a grain of morphine hypodermically, or in a suppository, about twelve hours after the operation, in order to procure sleep. The routine use of morphine after these operations is injudicious and rarely necessary. At the end of twenty-four hours small quantities of barley-water, tea, or milk and water are given, and if retained they may be taken in increasing quantities. On the fourth day an enema is given to clear the bowel, and then the patient will take fish, chicken, &c., and soon get on to convalescent diet. When vomiting is very troublesome, it is sometimes necessary to keep a patient on rectal feeding two or three days. When there is abdominal distension, this may be relieved by the passage of a rectal tube at intervals of three hours, and if this fails a turpentine enema should be given.