but not too deeply, straight down into this mass and carefully inject the fluid. After withdrawing the needle put your finger over the point from which it was withdrawn, and rub over the place for a little time to prevent any of the fluid coming back.

or nutrient

When the patient's strength is low, stimulating Stimulating or nutrient enemata are often given. For simple enemata. stimulation a gill of black coffee, strained and carefully injected into the bowel, is excellent. Another stimulating injection is one consisting of 1 tablespoonful of whisky, and I of elixir of the valerianate of ammonia in about 1⁄2 pint of starch or ricewater. This helps to quiet nervous excitement.

As a feeding enema, milk, beef-tea, broth, etc., alone or combined with stimulants, may be employed. All feeding enemata should be peptonized, to render their digestion and assimilation easier, for there is but little digestive power in the lower bowel.

The amount given to an adult at one time should not exceed I gill, and should not be given oftener than once in 3 or 4 hours. It is better to give highly concentrated food, rather than to give these injections too frequently, for the bowel is thus irritated. and will not retain the food given.

A tablespoonful of expressed beef-juice, which represents the nutriment from 14 pound of beef, may be combined with a gill of warm water, to

which whisky or brandy may be added from I teaspoonful to I tablespoonful, according to the surgeon's desire.

This given once in 3 hours will represent considerable nourishment. Medication may be combined with the food thus given, as 15-20 drops tincture of digitalis or aromatic spirits of ammonia.

FIG. 28.

Method of giving injections.

DAVIDSON RUBBER CO.

Davidson Syringe.

The injection should be given at a temperature of 100° Fahr. If too warm or too cold, it will stimulate the action of the bowels.

An ordinary Davidson hand-ball syringe may be used as a siphon for the introduction of this enema from the cup containing it. Care should be taken to inject no air into the bowel. It is well to introduce a vaginal nozzle into the bowel a few minutes.

out bowel.

before the time for giving the enema, to allow of the escape of any gas that may have collected, and thus better insure the retention of the food. A bowel used thus for purposes of nutrition should be washed out at least once daily, to remove any Washing residue that may collect and prevent ready absorption. This may be done by injecting a pint of warm water in which has been dissolved a teaspoonful of salt. If this is not voluntarily evacuated a nozzle may be inserted to draw it off. To administer the stimulating enema itself, all air is first expelled from the syringe by keeping the ends beneath the surface of the mixture and compressing the bulb until no bubbles are produced. A little vaseline may then be used to anoint the nozzle, which is then carefully insinuated into the bowel. If the direction of the lower bowel is remembered by the nurse as first extending for a short distance toward the vagina and then inclining backward, there will be no difficulty experienced in introducing the nozzle without causing any pain. The nozzle must then be held in place. The patient, if strong enough, can do this for herself, and the nurse will raise the vessel containing the mixture to be injected. As soon as the last of the liquid flows into the syringe, the tubing should be compressed while the nozzle is withdrawn. This is to prevent the introduction of air into the bowel. A napkin may then be held insuring re

Method of

tention.

Period in

which danger

from hemorrhage ; from inflamma

firmly applied for a time to the anus, until the irritability of the bowel ceases.

The addition of white of egg beaten into the mixture, or a teaspoonful of starch or arrowroot, will serve to make the liquid injected less irritating to the bowel. When the bowel becomes nonretentive the addition of from 10 to 15 drops of laudanum to the enema may enable it to be retained. Opium in any form should not be used without the express direction of the surgeon. If preferred, a barrel and piston syringe may be used in giving these injections.

The precaution should be taken to inject the fluid very slowly.

The greatest danger in the first twenty-four hours after operation is from hemorrhage; in the first three or four days from inflammation; and the first ten days from blood-poisoning. The nurse blood-poi- should look frequently at the dressings and the clothing under the patient's back to see if there be any bleeding.

tion; from

soning.

Symptoms of internal

rhage.

If there is internal bleeding it will show itself by hemor- the patient being faint, white or blue around the lips, and the pulse becoming very faint and rapid, or else altogether lost. Hemorrhage occurring in the first twenty-four to forty-eight hours after operation is called primary hemorrhage. Secondary hemorrhage comes on generally in the second week.

Primary hemor

rhage.

Secondary hemorrhage.

after opera

Reaction after operation is shown by the patient's Reaction speaking, the pulse getting stronger and the skin tion. becoming moist and warm. When this occurs it is undesirable to keep up too much artificial heat about the patient. The heated bottles, etc., around her may therefore be removed.

tempera

The temperature, pulse, and respiration of the Record of patient should be taken immediately after she is ture, etc. placed in bed, and after that every 3 hours for the first few days. The temperature is best taken in the armpit.

symptoms

For the sake of uniformity it is well to make the Special record of temperature, pulse, etc., come at 12, 3, 6, to be noted. and 9 o'clock.

The nurse should note all symptoms accurately and report them carefully. If the patient is uneasy or complains of pain, note this down in the record. If she is sick or vomits, report the time, quantity, and appearance of the matter vomited.

During any retching or vomiting the nurse should place one hand over the site of the wound, to prevent undue strain upon the stitches or the forcing out of the drainage tube.

The quieter the patient is kept the better, therefore no conversation should go on in the room. Do not let the patient lift her head or move her limbs. Report chills or chilliness. Give just as