The technique is most important. The rectum should first be cleaned by a high injection of decinormal saline solution, after which no attempt should be made to give a nourishing injection for at least an hour. It may be necessary for the physician to treat the rectum if hemorrhoids or great irritability exists. The patient's hips should be raised higher than the head to aid in retaining the enema. A tube specially designed for the purpose should be used, the enema being at body heat and allowed to flow in by gravity from a funnel. The amount injected should never exceed 8 oz. and the enema cannot be repeated oftener than every 6 hours unless the quantity is small. As a rule, the smaller the enema the more frequently it may be used. After an injection the patient should be kept perfectly quiet.

Stimulants like black coffee and whisky are often given by the rectum, the whisky requiring dilution with two parts water. Wine is sometimes used for the purpose. Stimulating and nutritive enemata may be combined.

Injections of normal salt solution, seltzer water, etc., are sometimes used to supply the body with fluids and quench thirst.

Useful additions to enemata comprise a little salt or sodium bicarbonate or a little starch emulsion; at times a few drops of laudanum are of value in aiding retention.

One should not be discouraged by early failure, as it is possible for tolerance to be established.

Formulae For Rectal Feeding

I. Peptone-Milk, Von Leube

250 c. c. milk .............................. =170 Cal.

60 c. c. peptone ...........................=100 Cal.

II. Egg-Milk, Von Leube

250 c. c. milk .............................. =170 Cal.

3 eggs ...............................'.... = 200 Cal.

3 gms. salt.

III. Starch-Milk, Von Leube

250 c. c. milk .............................. =170 Cal.

70 gms. starch ............................ =250 Cal.

IV. Sugar-Milk, Von Leube

250 c. c. milk .............................. =170 Cal.

50 gms. grape sugar ....................... = 250 Cal.

V. Pancreas, Von Leube

75 gm. pancreas substance ................. = 300 Cal.

225 gm. beef ............................... =300 Cal.

35 gms. fat ............................... =350 Cal.

(This enema, in semi-solid condition, is introduced into the rectum and allowed to digest therein. A piston syringe with a wide nozzle is required. )

Nutrient Enema

Peptonised Milk ......................... iv to vi (four Whites of two eggs ..........................to six ounces)

Above used Per Rectum every two to four hours.

'Nutrient Enema

Milk ................................... i (one ounce)

German Seltzer H20 ..................... iv (four ounces)

Used in Icterus, every two hours.

Nutrient Enemata-Malted Milk

Dissolve from three to four heaping teaspoonfuls of Horlick's malted milk powder in one-half pint of water, to which add one-half teaspoonful of salt. Use at body temperature, or two or three degrees higher.

The white of one egg may be incorporated if desired.

Four to six ounces used per rectum every two to four hours.

Stimulating Enema

Black Coffee ............................ iv (four ounces)

Whiskey ............................... ii (two ounces)

Salt Solution

Sodium chloride: ......................... i (one drachm)

Aquae ....................................Oi (one pint)

Use Of Alcohol In The Sick Room

The nurse may be required to exercise her own judgment at times in the emergency use of alcoholics in the sick room. This necessity is most likely to occur with those patients having incurable maladies where the question of harm to the organism or to the morals of the individual does not come into consideration. Consumptives often show a remarkable tolerance to alcohol, and receive a notable stimulating effect from it, and it sometimes happens that an eggnog or milk punch will enable an advanced consumptive to dress and make his toilet in the morning when otherwise he would have to lie in bed. This is true to a less extent of some other incurable diseases. Severe acute or subacute conditions in which an alcoholic stimulant might require to be given in preference to any other for its emergency effect in averting unlooked-for cardiac failure comprise pyemia, septicemia and diphtheria. In the same class belong certain cases of acute poisoning due to mistakes or suicidal intent, such as those due to aconite and similar heart poisons. The propriety of giving alcoholics after simple collapse or syncope when no serious disease is present depends upon the nature of the case and whether other stimulants are available.

Alcohol should perhaps never be given even in emergencies to subjects with neurosis or insanity or to victims of severe disease of the gastrointestinal organs.

Keeping Ice In The Sick Room

The very best plan is to have a small refrigerator or a Japanese ice box, which may be had for a few dollars. If these little luxuries are impossible, put the ice in a deep bowl, cover it with a plate, and place the bowl between two clean feather pillows. Another simple way of keeping ice is to put it in a dish pan, cover with a tin lid, and wrap in flannel cloths and newspapers. It will keep a long time, as feathers, wool and paper are poor conductors of heat.

Disinfecting Utensils

All dishes or utensils used in the sick room should be disinfected before being sent to the kitchen to be washed. A simple method is to scrape them clean and dip them in a basin of borax water (a teaspoonful of borax in a shallow bowl of water). In case of infectious diseases all dishes and utensils should be boiled in water containing 3 per cent. of sodium bicarbonate for one-half an hour to one hour.