When it is desired to medicate by putting fluids into the bowel we adopt the colon infusion.
Every diseased condition of the bowel does not, however, indicate irrigation. If a child is having frequent loose movements every half-hour it is safe to assume that the bowel is being cleaned out sufficiently without any artificial aid. To irrigate in these cases would only irritate and would not accomplish anything. The cases which are benefited are those in which we have a fever with four or five green stools in the twenty-four hours, or where we have a high fever with no movement at all. To irrigate in these cases we not only get rid of the products of decomposition, but we prevent further decomposition and we reduce the fever, thereby contributing to the general welfare of the child.
When the child is convalescing and when there is only mucus in the stools, with no fever—as in cases of chronic ileo-colitis—the colon irrigations should be stopped, as they tend to keep up the discharge of mucus in these cases. If, however, there is a relapse with fever, which would indicate a fresh infection with more discharging mucus and possibly green stools, the irrigation must be used until the fever subsides.
Colon irrigations should always be given in every case of convulsions in infancy, first to clean out the bowel to prevent putrefaction, and second to empty the bowel on general principles because an overloaded bowel is very frequently the cause of convulsions in children.
When irrigation of the bowel is given at all it must be given thoroughly. Enough water must pass into the bowel to wash it all out. For this reason it is essential that the catheter should be all in and in the bowel—not doubled on itself two or three inches in the bowel. If it is a serious case and the mother nervous, someone else should give the washing—preferably the physician himself. If the child objects strenuously, as often happens, it must be done with greater care to be successful. Remember that a colon irrigation is never given unless it is absolutely necessary and as a consequence it is given to accomplish a certain purpose; it must, therefore, be done thoroughly. If it is not, your child may miss the chance it has of getting over some immediate difficulty and if the moment of the "chance" is wasted or lost, that moment will not return. Be thorough, therefore.
Enema.—Some physicians talk about a high enema and a low enema. A high enema is really an irrigation as described above. The following remarks apply to low enemas only.
A so-called low enema is given to clean out the rectum of constipated matter, or for the introduction of food or medicine by rectum, when for various reasons it is necessary to spare the stomach.
It may be given with the fountain syringe or with the ordinary bulb (baby) syringe. A catheter may be put on the tip of the syringe if it is thought best to inject higher up than in the rectum.
When an enema is used in infants or older children for the relief of constipation, the best medium to use is glycerine. For an infant, one teaspoonful to an ounce of water is sufficient; for older children, one tablespoonful to two ounces of water, given with the bulb syringe, will give prompt results. If the constipation is pronounced, the fecal mass very hard, an enema of sweet oil, allowed to remain in for ten minutes, will soften it and permit a movement.
Soap suds are often used. They are good but not as reliable as the glycerine or oil; if, however, neither of these two are at hand the soap suds may be given.