There are various methods used for injecting fluids into the body. When they are introduced into the intestines, we speak of giving enemata (enema is the singular). They are named according to their purpose.
1. Simple laxative or purgative enemata.
2. Nutritive enemata for the purpose of nourishment.
3. Sedative enemata for local or systemic quieting effects.
4. Astringent enemata to check bleeding and diarrhea, like hot water, ice water, solution of alum or nitrate of silver.
5. Emollient (soothing) enemata for soothing irritated and painful mucous membrane; starch and drugs are also used.
6. Antispasmodic enemata to relieve flatulence such as the turpentine enemata.
7. Anthelmintic (against worms) for destroying worms; salt, turpentine and quassia are used.
8. Antiseptic or germicidal enemata used in dysentery.
9. Stimulating enemata, like hot water, hot strong coffee, hot whisky and water, salt water.
10. To relieve thirst, water one pint or normal salt solution (one dram to a pint of water) and injected high up.
ENEMATA are given either high or low. A high enemas thrown high up into the bowel. A low enema is injected into the rectum only, through a hard rubber tip to a syringe.
There are many ways of giving a simple enema.
A good way is to place an adult patient on his left side, with the knees bent up close. Protect the bed with a rubber sheet and towel under the patient. The basin of water can be placed on the rubber sheet and the enema given under cover.
An adult person will take one to four pints. A child one-half to one pint. For an infant about two ounces will do.
A simple enema can be made with good castile soap or good brown soap and water, temperature about 95 degrees F. When ready for use make into a good suds.
Use a bulb syringe, see that the syringe is filled full to the nozzle before the nozzle is put into the bowel. Any air left in the syringe will pass into the bowel and cause pain. Oil the nozzle with vaselin or sweet oil and then gently put the nozzle into the rectum. It is better to introduce an oiled finger through the sphincter muscle and pass the nozzle along the finger and gently into the bowel. It should be in the bowel two or three inches. Do not attempt to force the nozzle through any obstruction. Introduce the water slowly in a gentle and steady stream.
The main object is to distend the rectum by means of the water, thereby producing reflex stimulation. The worm-like movement of the bowels results, thus bringing about an evacuation. The patient should retain it for ten or fifteen minutes to get the best results. A folded towel placed against the anus will assist the patient in resisting the desire to expel the water. A large amount should be given in one-half hour if the first one does not produce the desired result.
Sometimes a laxative enema is necessary.—Olive oil or glycerin or castor oil may be used. For olive oil, six ounces may be given in a hard rubber syringe; this is seldom successful unless followed by a soap suds enema in one-half hour.
Glycerin enema, one-half ounce with equal quantity of warm water 95 degrees F., and give with a hard rubber syringe. This generally proves successful, without an additional soap suds enema. For infants and children the contents of a straight medicine dropper will be sufficient. Glycerin irritates the mucous membrane, and it is best that we add an equal amount of olive oil.
If these enemata fail it will be necessary to use purgative enemata. These are made by adding drugs, such as turpentine, rochelle or epsom salts or castor oil in certain proportions to the simple enema. In giving castor oil and water it is necessary first to mix the oil with the yolk of an egg and then add the warm soap suds.
Castor Oil 2 ounces
Turpentine 1/2 ounce
Mix thoroughly and inject with hard rubber syringe, followed in one-half hour by a quart of soap-suds.
Turpentine 1/2 ounce
Rochelle Salts 1 ounce
Mix with warm soap-suds, one pint.
The buttocks and anus should be washed off with warm water after turpentine has been used in the enema.
3. Molasses and Laxative Enema.
Mix from two to ten ounces, according to age, with one pint of soap suds and inject slowly.
Food is given by the bowel when the stomach cannot retain it. It is then called Nutritive Enemata.
They should be given only from four to six times in twenty-four hours and the quantity given at one time should not exceed four ounces.
It must be introduced high up in the bowel, about ten inches, and therefore they should be given through a rectal tube made of heavy rubber one-quarter inch in diameter and at least eight inches of it should be inserted in the bowel.
After it has been oiled the tube is gently inserted in a backward, upward, direction and a glass funnel is attached to the outer end.
The enema has been already mixed in a small pitcher and gently poured (very slowly) into the funnel, which is then raised so that the contents will go slowly through the tube into the bowel.
The patient is protected from drops by a folded towel underneath him. Then the tube is slowly withdrawn. The tube should then be cleansed by allowing warm water to run through it, and then kept in a one per cent solution of boric acid. Food given by enemata should be very nourishing and concentrated.
The following are excellent formulas:
One whole Egg Table Salt 15 grains
Peptonized Milk 3 ounces or 3/8 of a cup
Brandy 1/2 ounce
White of two Eggs Peptonized Milk 2 ounces or 1/4 of a cup
The whole amount should never exceed four ounces.
The addition of salt aids the absorption of the egg. Brandy, and whisky are very irritating and should be given only every other time. The fresh raw milk can be used, if it is impossible to have it peptonized. After a nutritive enemata the patient should lie quietly on his back for twenty or thirty minutes.
Turpentine enemata for distention may be given according to the following formula:
Mucilage of Acacia 1/2 ounce
Spirits of Turpentine 10 drops
This should be administered high up in the bowel.
Astringent Enemata. To check diarrhea.
They should be given slowly and injected high up, and they should be retained as long as possible.
Starch and Laudanum.
Boil the starch as if to be used in the laundry and dilute with luke-warm water, until it is thin enough to pass through a tube. Take of this three ounces. This can be given alone in mild cases; but if there is much pain and straining add ten to fifteen drops of laudanum to the starch water or thirty to forty drops of paregoric. This dose is for an adult.
1. Black coffee.
One-half to one pint of strong coffee, injected as hot as possible. It should be strained before using. This is frequently given in poison cases.
2. Salt Enemata.
Two teaspoonfuls to one quart of hot water is mildly stimulating; one-half to one ounce of brandy or whisky may be added.
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