The Enema

THE ENEMA

DESCRIPTION OF' THE STOMACH AND INTESTINES:
THE FALLACY OF "PURGATIVES":
THE PRINCIPLES AND USE OF THE EDEMA:
NOTES ON GIVING THE ENEMA TO CHILDREN
AND ON AN ENEMA TACTIC

Extreme weakness results in many instances both from an unnatural drain upon these secretions and from poisoning of the circulation by absorption.

An apparently normal movement of the bowels may take place without clearing away impacted fecal matter. One may have a daily passage and yet be constipated. It is equally true that one may just have undergone a severe purge through the administration of a drug and still may have accumulation in the bowel. Nature at all times makes extreme effort to rid the colon of refuse, and in her striving a small channel is necessarily always open through the gut, else death would shortly occur.

If the taking of purgatives were confilled to adult life, the tale here told would be different in character, since functional derangement would be the principal harm effected. But cathartics are prescribed for infants and children in their growing years, and their indiscriminate use at this time of life is one of the great causes of intestinal non-development. Nutrition is lowered through digestive disturbance; inflammation caused by congestion is soothed by opiates; feeding and fermentation continue; development of the intestinal tract is arrested, or the tract in portions is paralyzed, thus affecting function. These conditions, if permitted to continue through adolescence, cannot be corrected by a lifetime of later natural existence.

It is evident that clean bowels are essential to perfect digestion, hence to pure blood, hence to health. The purgative fails in cleansing the colon. What, then, is the means to be employed when conditions such as have been described exist. When a conduit is badly incrusted with an accumulation of soluble matter, the course pursued to remove the coating is that of flushing repeatedly with clean water, and this is the process here advised when the colon is obstructed with body waste.

The enema, the internal bath, properly administered, will flush and cleanse the large intestine, will promote peristaltic action throughout the alimentary canal, and will fully suffuse the abdominal circulation with the most soothing and healthful of all fluids--pure water. And from its use there will result no depressing, no deleterious effects, either immediate or subsequent.

The enema or clyster has been known and used by man for centuries. Herodotus, who lived and wrote five hundred years before the birth of Christ, says of the Egyptians: "For three successive days in each month they purge the body by means of emetics and clysters, which is done out of a regard for their health, since they have a persuasion that every disease to which men are liable is occasioned by the substances whereon they feed." However, the manner of administration of the enema then and thereafter was such as not to be as efficacious in result as we have later discovered it may be. The idea was held that an accumulation of feces had gathered in the rectum and in the folds of the sigmoid flexure. For the evacuation of this material a small amount of water injected into the rectum in a sitting posture was found to be easy and effective. This portion of the intestine may be cleansed by the injection of from one pint to one quart of water--in fact this is about its capacity, a larger quantity rising above the curve of the bend. It was also formerly doubted whether water could be forced above the flexure unless pressure was employed, and for a long time those who used the rectal bath made no attempt to cause the fluid to reach the descending colon for fear of injury. It has been demonstrated that the entire bowel can and often does become clogged and incrusted with refuse, and that larger amounts of water may easily and safely be injected into the organ flushing it throughout its length.

For the administration of the enema the sole equipment necessary is that of a fountain syringe with its rectal-tube attachment. The syringe should be suspended about five feet above the floor of the bath or lavatory, thus insuring sufficient fall for the water. Examination of the preceding diagram of the intestines will show that there are three positions in which the body may be placed in order that the colon may receive the water injected in such manner as to reach its entire surface, soften its contents, and wash them from its walls. These are the right-side, the knee-chest, and the flat-on-the-back postures. The last, excepting for children and for bedridden cases, is inconvenient to assume, but the two former positions are found to be comfortable and are easily taken.

When the subject in taking the injection lies on the left side, gravity assists the flow of the water only as far as the transverse colon, which in this position is perpendicular to the descending colon and forbids further passage of the fluid. Hence only the lower third of the bowel is affected. The right-side posture allows the water to flow along the descending colon, thence down the transverse colon and through the ascending gut to the cecum, thus completely flushing the organ. The knee-chest and the flat-on-the-back positions, obviously and with even greater ease, insure similar cleansing of the bowel. If, as is usual with those who are ignorant of the advantages of the postures described, the injection is administered while seated, gravity and the contents of the descending colon prevent the rise of the water unless some special device embodying force is utilized; and then again only the lower third of the bowel receives the benefit of the flow, and dilatation of the rectum and flexure is almost certain to occur with possible structural injury.

When a patient is bedridden or is extremely weakened, the knee-chest posture or the right-side position may prove too difficult or too exhausting to assume. In either of these contingencies, when no specially constructed table is at hand, a canvas stretcher upon which the subject may lie can be placed over the bath tub. If this apparatus cannot be procured, a triangular platform of three foot-wide boards covered with oiled cloth and a blanket, its base arranged so as to cross the top of the tub beneath the buttocks, may be used as a substitute. By the means indicated all effort in maintaining position is removed, a matter of importance in states of excessive weakness.

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