Suppositories.
—Sometimes medicines are given through the rectum. For this purpose they are combined with cocoa butter or other material, and made into small cones called suppositories. They melt at a low temperature and should be kept on
ice until needed. A suppository should be lubricated with vaseline, and inserted very gently as far as the finger can be introduced, while the patient is lying on the back or left side.
Enemata.
—An injection of a fluid into the rectum is called an enema. (Plural, enemas, or enemata.) Enemas are generally used to cause evacuation of the bowels.
For a simple purgative enema one of the following is generally used: plain water; or a solution of common salt in the proportion of one teaspoonful of salt to one pint of water; or soap suds made with a white soap such as castile or ivory. Unless otherwise ordered the temperature of the enema should be between 105° and 110° F.
To give an enema, one should proceed as follows: First protect the bed by placing under the patient's hips a rubber sheet, covered by a draw sheet or large towel. Let the patient lie on the back, with the knees flexed and head low. Bring to the bedside a commode or bedpan, and lastly the solution contained in a fountain syringe having a long rubber tube, stopcock and short hard rubber nozzle. The bag of the syringe may be hung on the bed post or elsewhere, but it should not be more than three feet at most above the patient's head. Lubricate the nozzle with vaseline either from a tube, or removed from a jar by means of a
piece of toilet paper; never dip the nozzle itself into a vaseline jar. Let the solution flow into the bedpan until it runs warm and smoothly; a jerky flow means presence of air bubbles which cause pain if injected into the bowels. Unless the patient is able to do it herself, gently insert the nozzle, and at the same time start the flow. Force must not be used in inserting the nozzle, and the flow should be gentle; if the solution goes in rapidly the patient may be unable to retain it. If there is a desire to expel the enema as soon as the injection has begun, shut off the current and wait a minute, meanwhile making gentle pressure upon the patient's abdomen with one hand; then lower the bag a little and begin again. A grown person should take from two to four pints, and a child from one to two pints. After the enema is finished give the bedpan immediately; the enema will, however, be more effective if retained a few minutes. The bedpan should be given and removed according to the directions on [page 176]. Sometimes an enema is expelled with such violence that it soils the upper sheet; to protect the covers a rubber sheet may be spread over the patient's knees and legs. Since an enema sometimes causes nausea or faintness, a patient should be watched constantly during the process.
To give an enema to a baby one may use a small syringe having a soft rubber bulb with a nozzle directly attached, or the ordinary fountain syringe with the small, hard rubber tip designed for infants. The enema should be given in a warm room free from draughts, and the baby must be warmly covered throughout the process. First cover the lap with a pad or folded blanket. Upon the blanket place a warmed rubber sheet, and over the rubber a warm diaper. Hold the baby on your lap, so that he lies on his back with his knees drawn up. Hold his feet or legs firmly in your left hand. Lubricate the nozzle thoroughly with vaseline. Be sure that all the air is expelled from the syringe, and then proceed as already directed. A baby will take from two or three ounces up to half a pint or even more, according to the size of the child. After the injection is finished place a small vessel under the baby's hips, and hold it until the fluid has been expelled, keeping the child well covered all the time.
After being used, the nozzle of a fountain syringe should be washed with soap and water, boiled, dried and put away in a clean place. Inserting the nozzle into the bag of the syringe immediately after withdrawing it from the rectum is a filthy but not uncommon practice. The syringe should be kept clean inside and out; it