Injections into the bowel in the form of clysters were used for curative purposes even in old times. The regular syringe with its stiff end may, if forcibly inserted, give rise to damage of the rectum. For this reason nowadays a soft-rubber rectal tube is employed, to which a fountain or Davidson syringe or any form of syringe can be attached. The tube being flexible cannot injure the intestinal walls. It can also be introduced higher up than the ordinary hard-rubber end pieces of the fountain syringe. Instead of the fountain syringe a funnel apparatus similar to the one used in gastric lavage may be employed. For washing out the bowel Leube-Kosenthal's appliance for washing out the stomach can be used to advantage. For irrigation of the bowel Kemp's hard-rubber rectal double-current irrigator can be conveniently employed (Fig. 26).

These injections into the bowel are made for various purposes:

1. To Produce An Evacuation

About a quart of lukewarm water to which a teaspoonful of salt is added can be employed, or a piece of soap dissolved in the same amount of water. As a rule, it is not advisable to introduce larger quantities of water than these as they distend the bowel too much. In greatly atonic conditions, however, in which a quart of water may be inefficient, an injection of from two to three quarts will be required. Injections of oil (olive oil or sesame oil) in quantities varying from half a pint to one joint have been recommended by Fleiner.1 According to this writer the oil should be injected at blood temperature into the rectum when retiring and be retained over night. While olive oil was used as a laxative injection long ago by Habershon2 and others, we owe its methodical use to Fleiner, to whom is also due the credit for having promulgated the method. Small injections of glycerin (one or two drachms) in about an ounce of water can also be advantageously employed for producing an evacuation of the bowels.

Dr. R. C. Kemp's Rectal Irrigator (New Model). Outer tube of hard rubber; central tube of metal

Fig. 26. - Dr. R. C. Kemp's Rectal Irrigator (New Model). Outer tube of hard-rubber; central tube of metal. Hard-rubber flange, protecting sphincter from transmission of heat through the metal parts.

1 Fleiner: "Ueber die Behandlung der Constipation." Berl. klin. Wochenschr., 1893, Nos. 3 and 4. 2 Habershon "Diseases of the Abdomen," London, 1862.

2. Injections may be resorted to either to strengthen the tonicity of the bowel, in which case plain very cold water in amounts of from one to two quarts can be employed, or for medicinal purposes, i.e., for applying certain medicaments directly to the intestinal mucosa. The drugs most frequently used for this purpose are nitrate of silver, tannic acid, subnitrate of bismuth, as astringents; thymol, hydrogen peroxide, boracic acid, essence of peppermint, as disinfectants.