For this purpose a tube similar in type to the two-way eatheter is made of soft rubber, but for ordinary use the plain stomach tube answers all purposes. This may be connected by a two-way cock to the reservoir and an over-flow, allowing first the stomach to fill from the reservoir, then turning the cock and permitting it to empty through the over-flow Or simply a funnel and a pitcher may complete the equipincur. There may be purchased a stomach tube (also known as an oesophageal tube), which terminates in a rub-ber funnel and has upon it a permanent mark to indicate how far it should be passed in adult. This is the most serviceable form for practical work.
The first introduction of the stomach tube, and sometimes the second, will often cause nausea and retching, but these effects will immediately pass off, and as a rule subsequent introductions are well tolerated. The tube should be first wet, either in hot water or in milk, and then the operator, standing in front of the patient, passes it rapidly over the base of the tongue into the oesophagus, the patient being told to swallow. It may then be rapidly pushed on into the stomach, but for the first few times there is usually less discomfort to the patient if he is told to swallow repeatedly, and the tube advanced as he makes the effort. The mark referred to on the tube will show when it has been introduced far enough.
The funnel <*ml is then elevated and from a pint to a quart, or even more, of the solution to be used poured in. The symptoms of nausea usually disappear as soon as the fluid enters the stomach, and the patient's sensa tions generally indicate when a sufficient quantity of fluid has been introduced. As the last portion is about to disappear from the funnel compress the tube at its junction with the funnel and invert the same over some receptacle, taking care that it be lower than the level of the end which is in the stomach. The stomach contents will now How out by syphonage.
Sometimes during the process some solid matter may obstruct the flow before the stomach is emptied, in which case a little fluid poured into the funnel in the original position will usually wash it out, and again pinching the tube and inverting it the emptying may be continued. The process should he repeated till the washings come away clear. This will usually require from four to six quarts of solution. 10
Ordinarily physiologic saline is used for stomach washing, at a temperature of about 100° F., although plain boiled water answers every purpose.
The best time for stomach washing is when it is empty. consequently immediately after arising is the time usually selected, when the patient has gotten so he can do the lavage himself. Otherwise, late in the afternoon is more convenient.