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A new rectal ether analgesia apparatus
A NEW RECTAL ETHER ANALGESIA APPARATUS* BY C. 0. McCoRMICK, M.D.,
INDIANAPOLIS, IND.
(Associate, Obstetrical D!fiJJMtment, Indiana. Unwersity
Sciho(J.~
of Meaicini.B)
TH~S a~_Par~t~s was des.~gn:~ pr~ma:ily .:o simpli:y. th~ r~ctal in~til.lation' of_ t~~ - etner-011 solutiOn prescrwea oy tne uwatnmey tecnmc m tne conuuct of oostetnc analgesia. For the past four months it has been employed in the William H. Coleman Hospital for Women, and is thoroughly endorsed by the nursing staff of that institution. The instrument is cast of the best grade of aluminum. It has a circular base 7 inches in diameter, stands 6lh inches high, and weighs 1 pound and 10 ounces. It is very durably built and except for the rubber parts, will withstand indefinite
Fig. 1.
usage. Fig. 1 shows the instrument assemOJed, ana .ng. 2 represents it in crosssection. The essential features are lettered, and may be enumerated as follows: A, B, C, D, E, F, G, H, I, J,
DeVilbiss bulb. Metal plate, bearing instructions. Stopcock. %" red rubber connecting tubing (machine made). 3" x %" glass connecting tip. 22 Fr. red rubber catheter. 1%," screw-cap. 5-ounce chamber. Fixed stratifying device. 1-ounce chamber.
*Manufactured and sold by the William H. Armstrong Co .. 233 N. Pennsylvania St.. IndianapOlis. Indiana.
411
412
A~IERICAN JOURNAL OP OBSTE'l'RIC~ AND GYNECOLOGY
The direetions for the use of the apparatus are concretely stated on the metal plate (B), and read: (Patient on left side, emptied lower bowel, thighs flexed, buttocks at edge of bed.) 1. Close stopcock, pour in one ounce of mineral or olive oil.
2. Pour in ether-oil mixture, screw on cap. 3. Open cock until oil runs through catheter (22 Fr. red rubber). 4. Spread lubricant freely over and about anus. 5. Insert well lubricated catheter 6 to 8 inches into rpctum. 6. Remove right glove, open cock, hold catheter in place with left hand. 7. With right hand compress bulb, between pains only, not over 20 to 30 times per minute. 8 Just as the bubble passes through the sight-feed, stop compression and close cock. 9. Remove catheter, make pressure over anus with folded towel for t en to fifteen minutes.
Pig:. :!.
SOME HELPS
1. Do not warm either the oil or ether-oil mixture. The absorbabilit.v is suffi· ciently rapid without warming and there is no loss of ether by evaporation. 2. Although vaseline is the popular lubrieaut, either a tragacanth or a seaweed jelly is preferable, as it does not deteriorate the rnhbN, and greatly facilitates cleansing the patient and laundering the linen. 3. Do not add an ounce of oil a ft er th e inRtillation or th e ether-oil solution. Although included in the Gwathmey technic, it has been found unnecessary.1 4. To eleanse, remove catheter and cap, and run ''scalding'' water through the instrument by placing it beneath a running faueet. .May add 1 drachm tincture of green soap. The catheter is the only part requiring sterilization. 1
Sm!th, D. L.: J. A. M. A. 90: 1031, 1928.
MCCORMICK:
RECTAL Eii'HER ANALGESIA APPARATUS
413
PRECAUTIONS
1 . .uo not compress the bulb too l~apidly, not over 20 to 30 times per n1inute. Hapid instillation may invoke spasm of the lower bowel, and render retention difficult. ~- A rectal tube allows the solution to flow too freely, and should not be substituted for the 22 Fr. catheter. 3. Be sure to cease compression the instant the bubble passes the sight-feed, thus avoiding forcing air into the bowel, and preventing immediate or subsequent expulsion of the solution. 4. Administer only between contractions and not during, as retention is thus frequently made impossible. 5. Be certain the catheter is not curled in the rectum, and see that it passes the presenting part if the latter is low, using a gloved finger if necessary. Compared with the various known methods of instillations, this apparatus affords the following advantages: 1. It eliminates all necessity for assistants, therefore, the general practitioner or student nurse can perform the instillation alone. ~- It is decidedly neater, as there is no spilling or regurgitation. 3. The actual instillation can be readily performed within thirty to forty seconds, that is, within the interval of any two consecutive pains. (The gravity method usually requires 2 to 4 intervals.) 4. Because of the forced instillation and no ''pain'' pressure interruption, the solution is instilled higher and retention is better. 5. More economical. In addition to dispensing with the ''follow-up'' ounce of oil (as also recommended by the Lilly method), it prevents the loss of oil and the ether solution incurred by slipping and difficult tube connections. Also, if an institution wishes to furnish its own oil and ether mixture, it can do so at a saving of 60 to 75 per cent. 6. By eliminating assistants, and clumsy administration, it perceptibly adds refinement to the technic. 504 MEDICAL ARTS BLDG.
Terruhn:
Leucoplakia and Kraurosis Vulvae.
Arch. f. Gyniik. 138: 318, l!l2!).
According to the author, leucoplakia is not a uisease entity in itself. The con· uition shoulu be really tP1med a lPucodermia rather .than a leucoplakia and considered as a manifestation of the first stage of kraurosis vulvae. The regressive and atrophic ehanges of the ~econd and third stages of kraurosis vulvae make a '' stationm·y'' or permanent leucoplakia an impossibility. It is impossible to have a kraurosis vulvae without a leucodermia, i.e., a loss of pig·ment but a vitiligo vulvae is possible without the presence of a kraurosis. Such a vitiligo is frequently confused with kraurosis vulvHe hut the1·e i~ ahsolutely no pathologic connection Le~ tween the two conditions; they must therefore be sharply differentia teLl. A vitiliginous leucodermia of tlH' vulva is probably due to an irritation of the intnnal pudendal nerw. RALPH A. REIS.
INDIANAPOLIS, IND.
(Associate, Obstetrical D!fiJJMtment, Indiana. Unwersity
Sciho(J.~
of Meaicini.B)
TH~S a~_Par~t~s was des.~gn:~ pr~ma:ily .:o simpli:y. th~ r~ctal in~til.lation' of_ t~~ - etner-011 solutiOn prescrwea oy tne uwatnmey tecnmc m tne conuuct of oostetnc analgesia. For the past four months it has been employed in the William H. Coleman Hospital for Women, and is thoroughly endorsed by the nursing staff of that institution. The instrument is cast of the best grade of aluminum. It has a circular base 7 inches in diameter, stands 6lh inches high, and weighs 1 pound and 10 ounces. It is very durably built and except for the rubber parts, will withstand indefinite
Fig. 1.
usage. Fig. 1 shows the instrument assemOJed, ana .ng. 2 represents it in crosssection. The essential features are lettered, and may be enumerated as follows: A, B, C, D, E, F, G, H, I, J,
DeVilbiss bulb. Metal plate, bearing instructions. Stopcock. %" red rubber connecting tubing (machine made). 3" x %" glass connecting tip. 22 Fr. red rubber catheter. 1%," screw-cap. 5-ounce chamber. Fixed stratifying device. 1-ounce chamber.
*Manufactured and sold by the William H. Armstrong Co .. 233 N. Pennsylvania St.. IndianapOlis. Indiana.
411
412
A~IERICAN JOURNAL OP OBSTE'l'RIC~ AND GYNECOLOGY
The direetions for the use of the apparatus are concretely stated on the metal plate (B), and read: (Patient on left side, emptied lower bowel, thighs flexed, buttocks at edge of bed.) 1. Close stopcock, pour in one ounce of mineral or olive oil.
2. Pour in ether-oil mixture, screw on cap. 3. Open cock until oil runs through catheter (22 Fr. red rubber). 4. Spread lubricant freely over and about anus. 5. Insert well lubricated catheter 6 to 8 inches into rpctum. 6. Remove right glove, open cock, hold catheter in place with left hand. 7. With right hand compress bulb, between pains only, not over 20 to 30 times per minute. 8 Just as the bubble passes through the sight-feed, stop compression and close cock. 9. Remove catheter, make pressure over anus with folded towel for t en to fifteen minutes.
Pig:. :!.
SOME HELPS
1. Do not warm either the oil or ether-oil mixture. The absorbabilit.v is suffi· ciently rapid without warming and there is no loss of ether by evaporation. 2. Although vaseline is the popular lubrieaut, either a tragacanth or a seaweed jelly is preferable, as it does not deteriorate the rnhbN, and greatly facilitates cleansing the patient and laundering the linen. 3. Do not add an ounce of oil a ft er th e inRtillation or th e ether-oil solution. Although included in the Gwathmey technic, it has been found unnecessary.1 4. To eleanse, remove catheter and cap, and run ''scalding'' water through the instrument by placing it beneath a running faueet. .May add 1 drachm tincture of green soap. The catheter is the only part requiring sterilization. 1
Sm!th, D. L.: J. A. M. A. 90: 1031, 1928.
MCCORMICK:
RECTAL Eii'HER ANALGESIA APPARATUS
413
PRECAUTIONS
1 . .uo not compress the bulb too l~apidly, not over 20 to 30 times per n1inute. Hapid instillation may invoke spasm of the lower bowel, and render retention difficult. ~- A rectal tube allows the solution to flow too freely, and should not be substituted for the 22 Fr. catheter. 3. Be sure to cease compression the instant the bubble passes the sight-feed, thus avoiding forcing air into the bowel, and preventing immediate or subsequent expulsion of the solution. 4. Administer only between contractions and not during, as retention is thus frequently made impossible. 5. Be certain the catheter is not curled in the rectum, and see that it passes the presenting part if the latter is low, using a gloved finger if necessary. Compared with the various known methods of instillations, this apparatus affords the following advantages: 1. It eliminates all necessity for assistants, therefore, the general practitioner or student nurse can perform the instillation alone. ~- It is decidedly neater, as there is no spilling or regurgitation. 3. The actual instillation can be readily performed within thirty to forty seconds, that is, within the interval of any two consecutive pains. (The gravity method usually requires 2 to 4 intervals.) 4. Because of the forced instillation and no ''pain'' pressure interruption, the solution is instilled higher and retention is better. 5. More economical. In addition to dispensing with the ''follow-up'' ounce of oil (as also recommended by the Lilly method), it prevents the loss of oil and the ether solution incurred by slipping and difficult tube connections. Also, if an institution wishes to furnish its own oil and ether mixture, it can do so at a saving of 60 to 75 per cent. 6. By eliminating assistants, and clumsy administration, it perceptibly adds refinement to the technic. 504 MEDICAL ARTS BLDG.
Terruhn:
Leucoplakia and Kraurosis Vulvae.
Arch. f. Gyniik. 138: 318, l!l2!).
According to the author, leucoplakia is not a uisease entity in itself. The con· uition shoulu be really tP1med a lPucodermia rather .than a leucoplakia and considered as a manifestation of the first stage of kraurosis vulvae. The regressive and atrophic ehanges of the ~econd and third stages of kraurosis vulvae make a '' stationm·y'' or permanent leucoplakia an impossibility. It is impossible to have a kraurosis vulvae without a leucodermia, i.e., a loss of pig·ment but a vitiligo vulvae is possible without the presence of a kraurosis. Such a vitiligo is frequently confused with kraurosis vulvHe hut the1·e i~ ahsolutely no pathologic connection Le~ tween the two conditions; they must therefore be sharply differentia teLl. A vitiliginous leucodermia of tlH' vulva is probably due to an irritation of the intnnal pudendal nerw. RALPH A. REIS.