Before any operation is undertaken the question arises whether the body is in a fit condition to stand the operation. In high degrees of subnutrition and inanition it is sometimes better to delay the operation, if feasible, until a better state of general nutrition can be accomplished. If the nature of the disease excludes such a possibility then filling up of the system with water, will be of great assistance.

Any kind of general anesthesia (chloroform or ether) requires some preparatory dietetic regime. Usually it is best to have the patient on a light diet (milk, cereals and light vegetables, a few eggs, very little meat, bread and butter, soups, stewed fruits) the day before the operation. A mild cathartic the night previous to operation is, likewise, appropriate, although not absolutely essential. If the operation is done in the early morning it is best to have the patient in the fasting condition. If later in the day, a light breakfast consisting of tea and toast, is advisable.

When the operation is in the afternoon, then an early luncheon of a cup of bouillon and crackers may also be given.

The reason why no bigger meal is allowed is the. tendency to vomit on account of the anesthesia.

Following the anesthesia no food is given until the following day. For thirst small pieces of ice can be kept in mouth, or the latter may be frequently washed with cool plain water or with mineral water. A Murphy drip per rectum of saline or saline with coffee will also be of help.

A day after the operation the diet will depend upon (1) the state of the stomach as influenced by the anesthesia and (2) upon the nature of and the organ on which, the operation was performed.

The Diet As Influenced By The Anesthesia

The effect of the anesthetic remedy upon the stomach varies in different individuals. Some awake and show no ill effects. In such patients the anesthesia as such will hardly influence the dietary regime. In others there is nausea and vomiting extending for a number of days. Here very little of the finest nourishment (egg albumin water, barley water, mutton broth, clam broth, kumyss) will be given every two to three hours until there is a decided amelioration of the gastric irritability, when more substantial foods can be given. The diet should always be gradually and cautiously changed and never increased too abruptly.

The Diet As Influenced By The Nature Of The Operation, And The Organ The Latter Involves

A small operation like the removal of a dermoid cyst or lipoma of the skin will require no dietetic change and patient will be able to eat as usual. A major operation, however, no matter on what organ influences the state of the whole organism inclusive of the digestive tract. There is usually some suffering present, while at times a rise of temperature exists. A light liquid diet will be appropriate for the first 2-4 days. Thereafter semiliquid and solid food can be added.

We will also have to differentiate between operations of organs outside the sphere of the digestive apparatus and those of the alimentary tract.

The operations outside of the digestive tract influence the diet merely in a general way, depending upon the condition of the stomach and the general state of the organism as mentioned above.

The operations on the alimentary tract require special attention with regard to diet. For here the food or its products have to pass over the operated area. The dietary regime will pay attention to favor the healing process as much as possible and to introduce sufficient food when feasible.

In operations upon the esophagus and also the stomach, rectal alimentation and still better duodenal alimentation can be resorted to, if necessary. Provided the patient is in good nutritive condition, he can be left for 2-3 days without food. Small amounts, 1-2 table-spoonfuls, of egg albumen water, alternating with the same quantity of barley or oatmeal or rice water, are given every hour or two during the day, while 1-2 quarts of saline or of a 5 per cent glucose solution are injected daily into the rectum by the Murphy drip.

On the 3rd day of the operation milk and barley water mixed (half and half) is added to the above in the same quantities. On the fourth day instead of one ounce, two ounces are given of the same nutritive material. On the 5th day milk and mutton broth and gruels with milk are given every two hours in three ounce quantities. On the sixth day 4-5 ounces of the above with the addition of one raw egg in bouillon are given every two hours. Thereafter the diet is further increased by giving every day an addition of one ounce more every two hours and likewise one egg more every day, so that on the 7th day 7 ounces and two eggs, on the 8th day 8 ounces and three eggs, on the 9th day 9 ounces and 4 eggs, and the 10th day 10 ounces and 5 eggs are employed. During these four days the diet is also increased step by step in consistency. Thus, first strained gruels, and strictly raw eggs, beaten up in milk or bouillon are administered; later on farina in the milk, coddled eggs, still later crackers and butter, mashed potatoes are added. On the 11th day, poached eggs on toast are added and chicken with baked potatoes are given at luncheon. Soup with vermicelli, mashed vegetables and stewed fruits are then also employed. From the 12th day on it is well to arrange for three larger meals and two additional smaller meals, the latter to consist of milk or egg nogg and crackers and butter or toast and butter, while the larger meals resemble more the ordinary meals.

Coarse foods (like salads, raw apples, sausages) will be avoided for a long time, especially after operations upon the'gastro-intestinal canal proper.

It is self understood that the increase in the bill of fare will take place, as stated above, merely when the patient shows no ill effect from the diet, otherwise the nutrition can not be increased, and in some instances may have to be decreased for a period of time. As soon as the patient's digestion improves the increase in the diet is again resumed.

In operations upon the colon and the rectum it will be necessary to arrange a diet which contains very little undigestible residue. This serves to diminish the amount of fecal matter, and in this way favor the healing process in the colon. The diet consists of eggs beaten up in bouillon, tender meat, cream, tea with sugar, ice cream; in plastic operations between vagina and the rectum, it is sometimes necessary to keep up artificial constipation for a week or so by instituting the above diet and administering opiates, at the same time. As soon as the healing has taken place, there should be a gradual return to the customary foods.