09 February 2025
Soap and water enemas and sennakot. On geriatric wards sennakot was dispensed quite liberally along with the night medication. At least a quarter of patients were routinely given the tablets.
If an elderly gent reported constipation, or, more likely, had not been either observed to have a bowel action and/or been incontinent of loose faeces (or by-pass constipation) in a space of 7 (sometimes 10) days, then they would be given a soap and water enema. This procedure on most male geriatric wards would be undertaken on the pm shift between 2pm and 4pm when baths and nail cuttings were done. It was generally allocated to a senior student or competent nursing assistant. The patient would be taken to his bed in the dormitory (sometimes locked against the day room) and placed on a rubberised sheet on top of the counterpane. Rarely were screens provided, but on one ward screens were placed against the dorm door which had glass panels, so that people couldn’t view in. A commode would be wheeled alongside the bed. A stand containing a stainless-steel container high up, would be filled with warm water and a soap solution from a jug. To the containing receptacle attached to a spout was an evil-smelling red rubber hose several feet long. The proximal tip of this hose would be lubricated (KY jelly) and inserted into the anus of the patient lying supine on his left side on the bed. Gravity was allowed to do its work and the patient ordered to remain still for as long as he could hold the fluid in his rectum.
At the patient’s signal he would be transferred to the commode. Frequently this signal would arrive too late, or more frequently the attendant nurse would not allow the patient to transfer because he (the nurse) was not satisfied that significant time had elapsed for the treatment to work. This, invariably, was a messy business. Shoes and trouser bottoms might be splashed with faecal liquid. Neither pleasant for the patient or nurse. But reputed to be effective! Even when disposable enemas became available, the older charge nurses would insist on the old-style soap and water on the grounds that these were more efficacious. I was never convinced that that red/brown rubber hose was ever properly cleaned by most members of staff, I once witnessed it just given a wipe down with a flannel after use, before the next recipient was unbunged. Ironically there were some patients who welcomed this procedure and one man, I recall, an elderly gent with, I would guess, learning disabilities, who would positively demand this every Tuesday afternoon!
09 February 2025