The purgative, or as it is also called, cleansing enema, is given as its name indicates for the purpose of washing out the intestines. It is generally resorted to when cathartic medicine fails to act, when immediate catharsis is necessary, or when for any reason the patient is unable to take a cathartic by mouth.

The long rubber rectal tube is the best appliance for the giving of such enemata; the water is injected higher into the bowel and there is a steadier flow than when any of the bulb syringes are used. This can be attached by means of a connecting tube to the tube of the ordinary fountain syringe bag. See that the stop cock is on the tube.

The cleansing enema generally consists of a soap suds made with "ivory" or castile soap; the froth of which should be removed as it contains too much air; the temperature should be about 98°F. Make the soap suds in a pitcher, pour it into the bag, let some run through the tube to warm it and expel the air, shut the stop cock, grease the rectal tube. Hang or hold the bag not more than three feet higher than the patient.

The bed should always be protected with a rubber sheet and large towel, the patient lies on her left side with the knees well flexed. The tube should be inserted very gently, never use force, let the water run in slowly. If much pain is given shut the water off occasionally, for a minute or two. When a sufficient quantity has been given (two to three pints for an adult, one for a child) remove the tube quickly, but gently, and press a folded towel to the anus. The fluid to do much good should be retained from fifteen to twenty minutes.

After use the tube must be carefully cleansed, wash it in warm soap suds and water, afterward let a quantity of hot water run through it, hang it up lengthwise to drip till perfectly dry.

When used for more than one person the tube should always be boiled for five minutes after use.

Vaginal Douches

Douches are given, as a rule, either for cleanliness or to relieve inflammation. When used for the former purpose the solution should be of a temperature ranging from 100° F. to 110° F. When given to relieve inflammation it is generally required very hot even 118° or 120° F, and great care must then be taken not to burn the patient by having it any hotter; mix the water well before you test it. Some disinfectant is often added, carbolic or bichloride being the ones most frequently used; they should, however, never be used without a doctor's order. In giving, the patient lies on her back, have the douche pan placed under her properly so that the return flow of the water will run into it. Put a pillow under the small of the back. Before inserting the nozzle let the water flow through the tube, to expel the air. Insert gently and move it around while in.

The douche nozzle should always be boiled or washed in boric acid, or other disinfectant, after use. Glass douche nozzles are preferable to any other. They can be attached to the ordinary fountain syringe.

Catheterization improperly performed is fraught with so much danger to the patient that it must not be attempted till further instruction than can be given in writing is obtained.

Catheterization is necessary when the patient is unable to void urine naturally, but there are many simple devices which should all be tried before this is resorted to; for instance, put hot water in the bed pan, allow water to run from a faucet within hearing (if this is impossible pour water from one vessel to another), squeeze a sponge dipped in warm water over the lower part of the abdomen, or hot stupes can be applied, and, this failing, the stupes can be alternated with ice.

Glass Douche Nozzles

Glass Douche Nozzles

Catheterization

In preparing to catheterize it is necessary to exercise not only the greatest cleanliness but asepsis. The catheter (glass ones are preferable for women) should be boiled for five minutes. Have at hand some small sterile swabs (see chapter on asepsis) in a solution of boric acid. Put the patient on the bed pan (leaving it further in front than for ordinary use), have the patient's knees flexed and separated, drape a sheet around her legs, leaving the vulva exposed. Then wash the hands well with soap and hot water, soaking them afterwards in a solution of bichloride of mercury, 1-1ooo. With the left hand separate the labia, and carefully wash all around the meatus (the opening to the urethra, the tube leading to the bladder) ; into this opening the catheter is then carefully introduced, it must not be forced forward if any obstruction is met with, but withdrawn slightly and the course changed.

When the bladder is very much distended it should not be emptied entirely at one time; when a pint or a pint and a half has been withdrawn remove the catheter and insert it again four or five hours later.

Before removing the catheter, the index finger is placed over the end; this prevents drops of urine falling upon the bed.

Care to be Taken

Glass Catheter

Glass Catheter