A Text-book of Diseases of Women

by Charles B. Penrose

The after-treatment of celiotomy is usually very simple. A special nurse is required for the first three days. The patient should lie upon her back for the first two or three days; after this she may be moved partly upon either side, and a pillow may be placed behind her for support.

The head may be supported by one or two pillows. Much comfort is experienced by raising the knees over pillows. The patient often complains bitterly of backache, which may be relieved by slipping a folded sheet or towel under the small of the back.

Thirst is always present after celiotomy, and is usually the symptom of which the patient complains the most. There is much diversity of practice in regard to the administration of water after celiotomy. The writer allows no water during the first twenty-four hours. During this time the lips and mouth are frequently moistened with a cloth wet in cold water or wrapped about a piece of ice. At the end of twenty-four hours small quantities of hot water or cold soda-water (1 dram) are given every fifteen minutes or half hour, and gradually increased as it is found to be retained by the stomach. Hot water relieves thirst as well, and is not so likely to cause vomiting, as cold water.

The chief objection to the early administration of water after celiotomy is that it may cause vomiting. Some operators avoid this by administering the water by the rectum.

Another reason, more or less theoretical, for withholding water is that the absorbing power of the peritoneum is greatest when the tissues of the body contain a deficient amount of water.

Pain after celiotomy seems to bear no relation whatever to the amount of traumatism that has been inflicted. More discomfort may be experienced after ventro-suspension of the uterus than after a hysterectomy. In operations upon the generative organs the chief seat of pain is in the region of the sacrum. Pain is also felt in the ovarian region and in the abdominal incision. The pain begins to abate after the first fifteen or twenty hours. Opium should not be administered unless it is absolutely necessary to allay nervous excitement in a cowardly woman. In such a case a small dose (gr. ⅙) of morphine may be administered hypodermically.

The writer rarely finds it necessary to administer an anodyne. Most patients are able to endure the pain if they are properly encouraged by the physician and the nurse.

There are several objections to the administration of opium. It increases the thirst and it diminishes the functional activity of the gastro-intestinal tract. It retards the passage of flatus by the rectum and causes tympanites, and it increases the difficulty of moving the bowels. It obscures and delays the recognition of symptoms that may demand immediate treatment. The patient who has had no opium is more comfortable at the end of three or four days after celiotomy than one to whom it has been given.

The patient should be encouraged to pass water voluntarily. The application of hot moist cloths to the external genitals sometimes facilitates urination. In many cases the use of the catheter is never necessary. If the urine is not voided about every eight hours, it should be drawn with the catheter. Catheterization should be done with strict attention to asepsis. The former frequency of cystitis from the improper use of the catheter has already been referred to. Catheterization should never be performed under any circumstances by the aid of the tactile sense alone. The nurse should always see what she is doing. The catheter—metal, glass, or preferably soft rubber—should be sterilized by boiling, and should be preserved in a 1:20 solution of carbolic acid.

The catheter may be lubricated with sterilized oil or glycerin. The labia should be separated, and the vestibule and the external meatus should be wiped off with a solution of bichloride of mercury (1:2000).