LAVAGE ,"i23 



tor stands to the animal's left and an assistant, holding up the horse's 

 head and the distal end of the tube, to the patient's right. 



The tube is placed in warm water and the surface is dusted with 

 powdered slippery elm or smeared with vaseline. The left nostril of the 

 horse is also lubricated in the same way. 



, The operator pushes the tube gently along the floor of the left nasal 

 fossa with the left hand, while guiding its direction with the right hand. 



The first obstruction is likely to be met, when the tube has been 

 entered about a foot, by its contact with the turbinates. The point of the 

 tube should then be held downwards, by the pressure of the right fore- 

 finger pushed as far as possible into the nostril, while the outer part of 

 the tube is lifted upward to force the point down into the pharynx. When 

 the tube enters the pharynx attempts at swallowing are likely to occur 

 and these are just what are needed to close the epiglottis over the larynx 

 and to force the tube into the gullet. If swallowing is not evident it 

 may be brought on by pushing the end of the tube gently backward and 

 forward into the pharynx, and, when an attempt at deglutition occurs, 

 the tube should be thrust forward. If the tube goes into the trachea 

 instead of the esophagus, it will meet with little resistance and expired 

 air may be felt coming from it, while coughing often results. If it is in 

 the gullet, the tube will be held more firmly by its walls and only fetid 

 gas may escape with stomach contents. It should by these means be 

 definitely established then that the tube is in the gullet before introducing 

 it farther. 



The tube may be passed via the mouth by using a speculum or by 

 tying the mouth shut. For the double tube this route is perhaps best. 



The tube should be made with white marks on the rubber to show 

 when it may be expected to have reached the gullet and again the stomach. 



During the course of passing the tube it must be well lubricated. 



When the stomach is reached the gas may have already escaped 

 and fluid contents may be siphoned off by filling the tube with warm 

 water frjm a funnel or .syringe, holding the distal end tiglitly closed 

 and lowering it to the ground so as to permit of the escsiie of stomach 

 contents by .siphonage. It the contents are largely solid, the stomach 

 must he reps.".tedly fiUcd witli 2 to 4 quarts of warm water and 

 allowed to escape again by lowv'ring the outer end of tl c tube to the 

 ground. If the flow stops, owing to choking of the tube, it may be 

 started again by injection of water into the tube with a syringe or 

 pump. 



The latter must not be used to suck out the contents of tlie 

 stomach except so far, if necessary, as to start the siphonage. The 

 stomach should thus be repeatedly washed until the water comes 

 awaj' clear. If the water is injected with a syringe, care must be taken 

 to avoid forcing air into the stomach. 



When passage of the tube becomes impossible through one nos- 

 tril, the other one may be tried. Phillips reported failure to pass the 

 tube in the horse in only 5 per cent, of trials. Many operators experi- 

 ence practically no failures in passing the tube. The tube is best made 

 of red Para rubber and long enough to reach from the stomach to 



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