By the gastric douche is meant a sprinkling of the stomach with water under high pressure. This can be done by raising the funnel of the washing apparatus to a considerable height. Ewald's tube, which has several small openings and one large one, is most suitable for this purpose. Rosenheim 2 likewise makes use of a similar tube. Boas employs a tube with many small openings of pinhead size. The latter, however, has the disadvantage that the water cannot return quickly. The gastric douche was applied by Malbranc and afterward by the above-named writers in order to combat severe gastralgias.

1 Malbranc: Berl. klin. Woohenschr,, 1878, No. 4. 2Th. Rosenheim: "Ueber die Magendouche." Therapeutische Monatehefte, 1892.

According to my experience there is but little difference between lavage and douching of the stomach. In fact, every form of lavage has almost the same effect as the gastric douche. Of late M. Gross,1 of New York, has devised a double-current gastric douche.

The double-current tube has the disadvantage that its size is quite considerable, and its introduction into the stomach of the patient is not very convenient.

In order to have an apparatus which could be introduced without any inconvenience, and which would at the same time allow a thorough douching of the stomach, I' have constructed a new gastric douche. Its principle is based upon a valve arrangement. The apparatus consists of a rubber tube, not too flexible (thickness three-eighths of an inch, length twenty-six inches), at the end of which a hard-rubber capsule is attached (Fig. 43). The latter contains numerous very small openings all around, and one very large opening at its lower extremity. Within the capsule, which can be screwed apart, lies a small aluminum ball. This moves easily and freely within the capsule, and when it lies above the lower opening it entirely occludes the same. Two cross bars in the capsule prevent the entrance of the small ball into the tube (Fig. 44). If the tube described is attached to an irrigator provided with a waste pipe, the apparatus is complete. If the waste pipe is closed, and the water made to run through the douche, the liquid will press the hall downward, thus closing up the large opening.

The water will then come out through the small side openings like a very fine shower, sprinkling over quite a large area (Fig. 4.1). The inflowing tube being closed, and the waste pipe opened while the capsule is inserted into the liquid, the latter will push the ball upward, and thus the large opening will be free, and the water will easily return through it. The liquid will certainly return not only through the large opening, but also through the numerous small side openings. While these, however, do not admit the return of coarse particles, the latter will easily be able to pass through the large hole.

1 M. Gross: Medical Record. 1895.

2Max Einhorn: "A New Gastric Douche." Medical Record. December 2d. 1899.

Figs. 43. 44.45.-Einhorn's Gastric Douche.

Method of using: The douche end of the apparatus is dipped into warm water, and then inserted into the stomach. It is necessary to pay attention that the capsule lies immediately below the cardia, and is not situated deeply in the stomach. The length of tubing from the mouth should be sixteen and one-half to seventeen inches. It may be useful to make a mark at this point of the tube. The tube is now attached to the irrigator, the outflowing pipe closed, the inflowing one opened, and the stomach sprinkled with about a quart of water. In order to make the water return from the stomach, the tube is inserted a little farther into the stomach, about four to six inches, the outflowing pipe opened, and the inflowing one closed. The liquid from within the stomach now returns. This procedure may be repeated three to four times. The temperature of the water should be regulated according to the therapeutic indications. The douche may also be connected with two irrigators, one containing cold, the other warm water; the stomach may thus be sprinkled alternately with cold and warm water.

Both lavage and the gastric douche have been made use of for the application of medicaments directly to the mucous membrane of the stomach. Thus, for instance, various antiseptic solutions have been applied (boracic acid, salicylic acid, sodium salicylate, thymol, creolin, lysol, etc.). Again, chloride of sodium on the one band, and nitrate of silver on the other (the one to increase, the other to diminish gastric secretion) have been used by Boas and Rosenheim.1

The solution introduced into the stomach by means of the apparatus is left there for a few minutes (two to five) and then withdrawn. This procedure has the great disadvantage that in order to apply a solution in the right concentration, covering the whole inside of the stomach, a considerable quantity of the medicament is absolutely necessary. The quantity of the agent has to exceed the normal dose, and reach the poisonous limit. Although by emptying we certainly remove the greatest part of the solution and in this way the danger of intoxication is greatly diminished, nevertheless a considerable quantity of the injected fluid may pass through the pylorus into the intestines beyond our control and at times may do harm. That is the reason why nitrate of silver and similar poisonous substances should not be introduced into the stomach by these means.