After the catheter has been used once it should be thoroughly cleansed, inside and out, and sterilized by boiling before being replaced in the carbolic solution.
The secretion of urine is always diminished for a few days after celiotomy, probably on account of the restricted ingestion of fluids. The writer has found the average secretion in 111 cases of celiotomy on women to be, during the first twenty-four hours, 13.4 ounces; during the second twenty-four hours, 14.6 ounces; during the third twenty-four hours, 19.6 ounces. In considering these numbers it should be remembered that the gynecological patient passes, before operation, a daily amount of urine much less than that passed by the average healthy woman.
Food is usually first administered at the end of forty-eight hours. If the patient be feeble, nutriment may be given by the mouth or the rectum before this time. The patient may have any easily digested food that she wishes, such as buttermilk, soup, beef-tea, milk or milk and lime-water, soft-boiled egg, etc. The food should be given frequently in small quantities. Buttermilk is one of the best foods with which to begin. It gratifies thirst and is more readily digested than milk. Half an ounce to an ounce may be given every hour until the retentive power of the stomach is determined.
The bowels should be moved at the end of forty-eight or seventy-two hours. If the patient is uncomfortable and is unable to pass flatus freely, or if there is any abdominal distention, the purgative should be administered at the earlier time (forty-eight hours). If she is comfortable and passes flatus easily, she may wait for three days. Purgation is most readily produced with Rochelle salts, given, in doses of ½ dram in about 3 or 4 ounces of water or soda-water, every hour. After the patient has taken five or six doses she usually feels the inclination to have a movement. If she is unable to accomplish this, she may be assisted with a rectal injection of 1 pint of soap and water and 2 drams of turpentine. The bowels should be moved at least once in every forty-eight hours during the remainder of the convalescence.
Sometimes the bowels are more difficult to move, and it is necessary to repeat the rectal injection at intervals of two or three hours until a good movement is produced. A compound enema composed of Epsom salts ℥j, glycerin ℥j, turpentine ℥iss, water ℥viij, injected high in the bowel through a rectal tube, may be effective. If the Rochelle salts are not retained, or if they fail to act, 1 grain of calomel may be administered every hour for five or six hours.
If the patient does well, vomiting does not often occur after the first twenty-four hours, when the effects of the ether have passed off. When vomiting occurs later than this, it is usually accompanied by abdominal distention and general abdominal pain. It is then an alarming symptom, and may indicate the onset of intestinal paralysis and general peritonitis.
This group of symptoms (vomiting, general abdominal pain, and distention) demands immediate treatment. A hot mustard plaster or a turpentine stupe should be placed over the epigastrium, and an enema of 1 pint of water and ½ ounce of turpentine should be administered, and should be repeated every three or four hours until a fecal movement occurs and flatus is freely discharged. At the same time Rochelle salts should be administered, or, if there is persistent vomiting, 1-grain doses of calomel. The escape of flatus may be assisted by inserting a rectal tube. In case of moderate distention or of intestinal pain from inability to pass flatus, the insertion in the anus of the ordinary rectal nozzle of the syringe will usually give relief. If this is not sufficient, the long rectal tube or a large rubber catheter should be introduced. It should be well greased and passed slowly into the rectum for a distance of 10 or 12 inches.
The patient is sometimes able to pass flatus when upon her side, though she may not be able to do so upon her back. Inability to pass flatus is not necessarily a sign of peritonitis or intestinal paralysis. It may be caused by the unaccustomed position, or pain or nervousness may prevent the woman relaxing the sphincter ani.
If the vomiting persists and becomes bilious, relief is sometimes obtained by thoroughly washing out the stomach through the stomach-tube.
The internal administration of medicines—except the purgatives already mentioned—is of little use in vomiting of this character.