then albumen water, broth, etc., then milk,
buttermilk, koumiss, etc., after which the semi-solids, etc., until a
normal diet is reached. After a week or more the character of the
operation certainly determines the dietetic treatment. To quote Dr.
Thomas S. Brown,[106] "To give the same diet after pyloroplasty,
gastro-enterostomy, gall bladder operation, or gastric resection as
we would after operations for fracture of the thigh or cancer of the
breast shows a basic ignorance of the pathologic physiology of the
former group of cases." "We should remember that hyperacidity remains
long after the underlying cause has been removed and it is tempting
providence, to say the least, to ply these patients with tomato soup,
salad dressing, and coarse food in the early stages of their
convalescence."

~Character of Diet.~--It must be kept in mind that the character of
the diet is of vital importance, especially in the after-treatment of
operations upon the stomach. In gastro-enterostomy, for example, the
food mass passes from the stomach directly into the upper part of the
small intestine through the new opening. Thus the semi-liquid food
highly acid in character comes in direct contact with the delicate
intestinal walls which are accustomed, not to the acid, but to a
neutral or alkaline medium.

~Adjusting Diet to Disease.~--Thus it is demonstrated that unless care
is used in selecting the diet this portion of the intestinal tract
will be injured; hence the nurse must understand which foods are
liable to stimulate an excess flow of acid in the stomach and avoid
them. She must also keep in mind that the foods given must be in a
semi-liquid or very finely divided condition, since the mechanical
efforts made by the musculature of the gastric organ act as a direct
stimulant to the secretory cells of that organ.

* * * * *

Much of the responsibility thus rests upon the nurse whose business it
is to administer the diet. The efforts of the best surgeon in the
world may be entirely overcome by a careless, thoughtless, or ignorant
nurse.

~Rectal Feeding.~--In some cases it is found necessary to nourish the
patient more than is possible by mouth. This is especially so with
emaciated and very weak patients and for those who have undergone
operations upon the mouth or throat and in some of the above-mentioned
stomach cases when the passage of any food over the newly-operated-upon
surfaces is inadvisa