Part 1

+Transcriber's Notes+

1. Typographical errors have been silently corrected.

2. Variations of spelling and hyphenation are as in the original.

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RULES AND DIRECTIONS

FOR THE

EMPLOYMENT OF INJECTIONS

IN VARIOUS DISEASES;

WITH QUOTATIONS FROM DISTINGUISHED MEDICAL AUTHORS.

PRINTED TO ACCOMPANY

LEWIS'S IMPROVED PORTABLE SYRINGES,

OR DOMESTIC INJECTING APPARATUS.

BOSTON 1857.

Entered according to Act of Congress in the year 1856,

BY THOMAS LEWIS,

In the Clerk's Office of the District Court of Massachusetts.

PRINTED BY ALFRED MUDGE & SON, 21 SCHOOL ST.

INJECTIONS.

PREFACE.

Heretofore one of the greatest objections to the free use of Injections, as a domestic remedy, has been the inconvenience and clumsy size of the instruments employed for the purpose, and the manner of their construction, such as to render them liable in a short time to get out of repair, and become worthless. It had therefore become a matter of necessity that a new instrument should be introduced, that could be used with ease either for injecting the bowels of children, for female uses, or for self-administration. The new instrument which is herewith offered to the public, termed the Improved Portable Syringe, or Domestic Injecting Apparatus, we have taken great pains with to perfect, so as to overcome the many serious objections entertained against the old ones, and which we flatter ourselves we have succeeded in doing, by constructing it in such a manner as to render it impossible for it to get out of repair, unless by the abuse of the user. Its size makes it extremely portable, so much so that it can be carried in the pocket without the least inconvenience; and being made on the principle of the pump, is capable of injecting any given quantity of fluid without being taken to pieces, or altered in the least, and with any degree of force or rapidity that may be necessary; and in connection with the crooked or angular tube, can be used by an invalid without any assistance or difficulty, therefore making it a very superior and convenient instrument for self use. Also, in connection with the vaginal tube, as a female syringe, and with the small tube for injecting the bowels of children, which is a very difficult matter with the common instruments formerly used for the purpose. One very important feature in this instrument is, that an injection of which gruel forms a part will be found to be as easily administered as one more fluid, therefore rendering it invaluable to physicians and others who have frequently to resort to such an Instrument, and are annoyed to find the instruments with which most families are supplied will not answer the purpose.

This little book of rules and directions, which has been carefully prepared by an experienced physician, and which is herewith presented to our readers as an accompaniment to the Improved Portable Syringe, is not intended as a _medical work or treatise on the human system_, which are often printed to accompany instruments of the kind, and which few people ever read or care about, but is intended merely as a guide in the administration of the more simple remedies in the form of injections, well knowing that the majority of the people had rather rely on the advice of an experienced physician in all critical cases than their own judgment, formed from reading books of the kind.

BOSTON, January, 1856.

The Uses of Injections.

Injections, or Clysters, are liquid substances or medicines injected into the lower intestines by mechanical means, for the purpose of promoting alvine discharges, relieving costiveness and cleansing the bowels. They are also sometimes administered to nourish and support patients who cannot swallow aliment, to evacuate the bowels without purging, to affect the system through the intestines, to remove worms from the rectum, to cure other disorders of the rectum, to lessen diarrhœa or dysentery, to alleviate spasms in the stomach and intestines, to produce other medicinal effects in the stomach, when all other curative means are too irritating. Prompt in operation, they are very useful in inflammatory affections of the bladder, womb, liver, kidneys, and lungs; and for the relief of hysterics, croup, determination of blood to the head, and convulsions; also in urethral strictures, urinal retention, flooding after child-birth, and in removing the after-birth, when nature fails to do so. When warm, they are of the greatest service in cases of suspended animation; and for the purpose of nutrition they alone have prolonged life for over ten weeks. Carefully administered, they are always safe.

Authorities upon Injections.

It is not necessary to accumulate the evidence of physicians concerning their utility. Every practitioner of medicine can recall the cases, in which a perfect syringe would have saved hours of pain, and in which he could find only the most inefficient aid from a leaky barrel and a loose piston.

Dr. Pereira, of London, author of one of the best treatises on Therapeutics, says: "Warm water is injected into the rectum to excite alvine discharges, to promote the hæmorrhoidal flux, to diminish irritation in the large intestine, or in some neighboring organ, as the uterus, bladder, prostate gland, &c.; and to bring on the menstrual action. Thrown into the vagina, it is used to allay uterine irritation and pain, and to promote the uterine discharge." And again:

"Cold water is thrown into the rectum to check hæmorrhage, to expel worms, to allay local pain, to rouse the patient in poisoning by opium."

Dr. Thompson, also of London, speaks "favorably of the effects of cold water introduced into the vagina, in uterine hæmorrhage."

Dr. Copland, the editor of the Medical Dictionary, says, that in cases of intestinal spasm or colic, "the spirit of turpentine thus employed is an efficacious remedy, especially when much flatulent distention is associated with spasm."

Dr. Copland also says: "In some cases of lead colic, I have found the colon so enormously distended, from flatus and loss of contractile power, that I could distinguish its form and course, in the different abdominal regions, by the eye, when standing at a considerable distance from the patient; and yet the bowel has been restored to its healthy state by repeated injections containing turpentine, castor oil, &c., aided by stimulating friction on the spine."

In the colic of the young and plethoric, Dr. Charles A. Lee, of New York, says: "A very successful mode of treatment in these cases, is that of gradually forcing up, by injection, a large quantity of some bland fluid until it reaches the seat of obstruction or of spasm, when a speedy evacuation and relief will generally follow. In many instances it will be required to repeat it, before this result takes place; but, in all curable cases, if reasonably applied, more speedy relief may be expected from this means than almost any other."

The following extract from "an oration delivered by Dr. Burne, before the London Medical Society," will show the importance and extensive utility of injections as a means of restoring the alimentary system to its natural state of activity.

"An undue retention of the intestinal excretions is another source of disorder and of disease arising out of civilized life. It is produced by affections of the mind, by indigestion, by inattention to the calls of nature, and mechanical obstruction from organic disease, which last is frequently excited by the retained excretions themselves.

"The undue retention of the excretions takes place in the larger (or lower) intestines, for until the excrementitious matter arrives here, there is no reason to believe that its propulsion is arrested, although it may be less at one time than at another.

"The undue retention of the excrementitious matter allows of the absorption of its more liquid parts, which is a source of great impurity to the blood; and the excretions, thus rendered hard and knotty, act more or less as extraneous substances, and by their irritation induce a determination of blood to the intestines and to the neighboring viscera, which ultimately ends in inflammation and organic change of the bowels.

"It has also a great effect on the whole system; it causes a determination of blood to the head, which oppresses the brain and dejects the mind; it deranges the functions of the stomach, causes flatulency, and produces a general state of discomfort.

"In civilized life, then, the causes which are most generally and continually operating in the production of disorder and of disease are, affections of the mind, improper diet, and retention of intestinal excretions."

Dr. J. G. Gunn, in his interesting medical work, entitled "Gunn's Domestic Medicine," published in 1850, for the benefit of the people, speaking of injections as a domestic remedy, says:

"Language almost fails to express the great value of this innocent and powerful remedy in very many of the diseases to which mankind are daily and even hourly subject; and I most seriously regret to say that it is a remedy not only too little known but too seldom used, both by physicians and in families. This disregard for the great virtues of injections must either arise from the supposition that the operation is too troublesome, or from a false and foolish delicacy, which forbids the use of an instrument by which the lives of thousands have been preserved in extremely critical circumstances, and with which every mistress of a family should be perfectly acquainted, so as to be able to use when required in sickness. And I do here most positively assert, and that, too, from my own experience, that hundreds to whom I have been called in cases of cholic must have died had it not been for the immediate relief given by injections. I will mention one strong instance to prove the correctness of my assertion. While practising in the State of Virginia, I was called on, at midnight, to attend a stranger, who had arrived but a few moments before in the mail stage. This gentleman was one of the judges of the supreme court in the State of New York. He stated to me that the cholic had been coming on him for a considerable time before the stage stopped. By the time I arrived his misery was so extreme that he repeatedly exclaimed, "I must die unless immediate relief is given me." After administering all the remedies which are usually given in such cases, without any relief, I commenced administering injections of water, pleasantly warm. On the first being thrown up the bowels he experienced more relief than had been produced by all the other remedies I had tried. He felt an immediate exemption from pain, and after two or three more had been given, a copious discharge by the stool followed, and he was entirely restored.

"Injections principally act by exciting the lower portion of the intestinal tube, and sometimes from the effects of sympathy. In the latter case the discharges are generally copious, or in other words, of large quantity; and to produce these full discharges by stool, the injections of warm water, tempered so as to be pleasant to the feelings of the patient, may be frequently administered, and in such quantities as the bowels will bear. I have continued to give these injections of warm water for an hour or more, in many instances, before I could overcome or subdue spasm or cholic, and in cases of great constipation. In fevers and inflammations, injections made of slippery elm bark, which I have frequently directed and administered, tend to cool the whole system, allay the heat and irritation of the bowels, and gently assist the operation of the medicine which has been given. They will also produce a determination to the skin, which means a gentle moisture or sweat. Tepid or warm water always opens the bowels, but the very reverse of this practice is sometimes resorted to in desperate circumstances and with great advantages by some of the most distinguished physicians. In cases of very obstinate constipation relief has frequently been obtained when all other remedies had failed, by an injection of the coldest water, even of iced water. There are many persons who are constitutionally subject to costiveness. This costiveness arises from a variety of causes, such as diseased liver, indigestion, torpor of the bowels, and from improper food being taken into the stomach and bowels, which will generally produce spasms or cholic pains, depression of spirits, &c. All these can be easily remedied by a simple injection of water thrown up the bowels, which relieves them of their load, and the mind and feelings soon experience an agreeable change. You who are always taking medicines to keep your bowels open and whose stomachs are becoming exhausted and worn out by medical drugs, let me entreat you, as a friend and physician, who has witnessed throughout France the great and surprising benefits arising from this simple operation, to abandon the idea of constantly taking medicines for the purpose. In France there is scarcely a family unprovided with an injecting apparatus, which is always used when there is the slightest obstruction or costiveness of the bowels. These people mostly use a simple clyster of milk and water, and sometimes water alone; in summer they use cold water, and in winter, water pleasantly warm. It is to the warm bath and the common use of injections that are to be attributed, in a great degree, the cheerful dispositions, the uniform health, and the practical philosophy with which these people bear the hardships and misfortunes of life. In fact, if you take from a French physician the warm bath and the injecting pipe, he cannot practise medicine with any kind of success. The importance of injections, both in the hands of physicians and families, has become so well known, and is now so highly valued, as to call forth the commendations of the most eminent physicians of both Europe and America. Injections constitute one of the most powerful, innocent, mild, and beneficial remedies known in the science and practice of medicine."

DESCRIPTION.

A--_Base of Instrument_, connected by a screw, containing a cavity and valve, through which the fluid is drawn into the Barrel.

B--_Barrel_, containing the Piston or Plunger.

C--_Cap_, connected with the Barrel by a screw.

D--_Piston Rod_, surmounted by a metallic handle, terminating within the Barrel by the Piston or Plunger.

E--_Metallic Chamber_, containing a valve, to which is connected, by a screw, the flexible Tube.

F--_Flexible Tube_, to the end of which are attached, as they may be needed, the different pipes.

G--_Straight Pipe_, for injecting the bowels of adults, to be attached to the flexible Tube, when used with an assistant.

H--_Crooked or Angular Tube_, to be used for self-administration.

I--_Small Pipe_, for injecting the bowels of children.

J--_Female_ or _Vaginal Tube_.

DIRECTIONS FOR USE.

For Self-administration.

Attach the crooked or angular tube, H, to the end of the flexible tube, F; place the fluid intended for use in a basin opposite you; introduce the pipe, and sit down upon it, holding the instrument upright in the basin with one hand, and working the piston with the other.

For use with an Assistant.

If the instrument is to be used by an assistant, (as is often the case in sickness by a nurse,) the straight pipe, G, should be used instead of the crooked or angular one.

For Children.

For injecting the bowels of children, use the small pipe, I.

For Female or Vaginal Uses.

Attach the long pipe, J. (See Vaginal Injections.)

The Piston, or Plunger, and the Care of the same.

If the instrument has stood some time without use, or has been kept in a dry or warm place, the leather of which it is composed may have become dry; it should therefore be withdrawn from the barrel and immersed in warm water, (not hot.) It should then, after remaining a short time, be saturated with melted tallow or sweet oil, which will restore the suppleness to the leather and cause it to work easily within the barrel. If the instrument has stood in a very cold place, the leather of course would become chilled. This can be easily set right by merely immersing the barrel of the syringe in a basin of warm water. The interior of the barrel may sometimes become rough by means of matter adhering to it that has been used in the instrument, such as gruel, or other thick injections, and may cause an obstruction to the working of the plunger. The barrel should, therefore, in such cases, be thoroughly washed out with warm soapsuds before returning the plunger to its place. _The leather with which this is constructed is prepared in a peculiar manner, expressly for the proprietor, so that it will_ _not dry hard, and can be used for a long time without parting with its oily matter._

N. B.--Extra leathers for the plunger can be obtained of the proprietor, or his agents, and sent to any place by mail. _Price 12½ cents._

The Valves.

These consist of small mineral balls, and are operated in an improved chamber or cavity, which allows them to always work well, and are not liable to stick or become wedged, as has been the case with instruments formerly made with this kind of a valve. They are greatly superior to India-rubber valves, which soon, by the action of the fluid, become unfit for use. Should the valves by any means be lost, a common marble, if round, will answer the purpose. ☞ After the instrument has been used for administering any thick injection, it should be thoroughly cleansed by pumping some clear water through it, and all sediment which may remain in the valve chambers, A and E, should be removed, or it may cause an obstruction to the working of the valves.

N. B.--_Be careful not to put the instrument away wet, or it will injure the box._

The Flexible Tube.

The reader will observe that the couplings to which the flexible tube is attached are made with a neck, which is inserted into the orifice of the tube, the compression of which, when on, holds it firmly in its place. ☞ If at any time the flexible tube should be injured so as to be unfit for use, a new one can be forwarded by mail to any place, on application to either of the proprietor's agents, and it can be readily attached without the least trouble by any person. _Price of Flexible Tube, 25 cents._

Withdrawal of the Piston.

Persons may sometimes withdraw the piston or plunger from the barrel, and on account of its peculiar construction be unable to return it again. Therefore, please observe that it is composed of two round pieces of leather, which are turned in opposite directions over the metallic plates--_the upper one turning up, the lower one turning down_. With the leathers thus arranged, it is to be introduced sideways into the barrel, and the portion of the lower leather which remains outside of the barrel gradually and carefully pressed in with the thumb nail. ☞ But in so doing be very careful not to cut or injure the leather. N. B.--Silver Plated Syringes, suitable for using nitrate of silver, furnished to order at short notice. (See _Nitrate of Silver Injections_.)

Peculiarities of the Improved Portable Syringe.

The peculiarity of this instrument, which renders it superior to others heretofore used, consists in the mode of constructing the valves and valve chambers. Many of the celebrated instruments with which the market has been heretofore supplied have been constructed with cylindrical valve chambers, having a flat seat for the valve to rest upon, through which is an orifice for the passage of the fluid. The valve itself consists of a circular piece of India-rubber, the diameter of which is somewhat less than that of the chamber, in order to allow the fluid to flow by it when the valve is raised. There are several serious objections to these valves. The India-rubber in a short time enlarges when in use so as entirely to obstruct the passage of the fluid, especially when a warm injection is used, which quickly softens and moistens the rubber. The valve, too, in such cases, if made so small and light as to avoid this evil, is liable to double or fold up, and is drawn through the orifice in the valve neck into the barrel of the instrument, and thereby entirely stops its working.

In the instrument now offered to the public, these objections are entirely obviated by using for a valve a small mineral ball, which rests upon a concave seat, to which it is nicely adjusted. The ball, being of a material which does not absorb water, never becomes enlarged by use; and it is obvious that it can never be drawn through the orifice into the body of the instrument. It is also a self-adjusting valve, the friction of the ball on its seat having a constant tendency to make them fit together more accurately. The mineral balls are acknowledged to be much more durable than the India-rubber disks; and as an instrument is serviceable only while all its parts are fit for use, it is apparent that the new instrument will last much longer than those which have been constructed in the manner described.

Care and Preservation of the Instrument.

In all cases, after the instrument has been used for injecting any medicinal preparation, gruel, or in fact anything except clear water, care should be taken to thoroughly cleanse it before laying it aside, or it will become foul. This can be easily effected by pumping through it some pure water, which will generally remove all sediment that may be left in the instrument. If an injection containing oil has been used, strong soapsuds will be required to remove the oily matter. If in cleansing the syringe the plunger is withdrawn from the barrel, great care should be taken that the leather is not injured in returning it again. (_See Directions for Use._)

As this instrument is composed wholly of the best of Britannia, and not of part lead, like most of the instruments of the kind, it can be easily kept clean and bright as when new, by rubbing it smartly for a moment with a piece of soft flannel or wash-leather. The little trouble occasioned by this process will be amply repaid by the handsome appearance of the apparatus.

Common Injections.

Take of cold or warm water about three quarters of a pint. These are the most simple injections for costiveness, and are generally very effective in their action. Cold water is highly recommended by Dr. Jackson, of Boston, in cases of habitual costiveness, and may be used daily for many years, without injury.

Laxative Injections.

FORM I.

Take one half pint of strong soapsuds, made from the yellow bar; or common soft soap is often used, in two gills of warm water. This will be found very active, and is much used in bad cases of constipation, or to hasten the operation of cathartics taken by the mouth.

FORM II.

Take of common salt, molasses, and lard, one table spoonful each, to which add one pint of warm water. If this do not operate as effectually as may be desired, the effect may be increased by the addition of a table spoonful of olive oil, or infusion of senna.

Purgative Injections.

FORM I.

Take of soft soap one table spoonful, of olive oil one half a pint, to which add a pint and a half of warm water. This is recommended by Dr. Jackson in cases of obstinate constipation.

FORM II.