3127. Observations On Their Use

1. Emmenagogues should be used with great caution, if at all, to bring on the first menstrual discharge. In the majority of cases, when the uterus is properly and fully developed, the catamenia will appear; and the application of stimulants to that organ, before it is capable of performing its functions, may prove highly prejudicial. So long as the general health remains good, the late appearance of the menses does not call for medical aid.

2. They should be given with extreme caution about that time of life when the menses decline naturally. The uterus has completed its functions, and unnaturally stimulating it to more work than nature has allotted to it, will only increase the constitutional disturbance generally present at that period, without delaying the final cessation of the discharge.

3. They should never be given during pregnancy, or when there is malignant disease of the uterus.

4. When one emmenagogue fails, another will frequently succeed; and a combination often proves more effectual than when they are given singly.

5. Emmenagogues operate the most certainly and effectually, if administered at those periods at which the menstrual discharge should naturally appear.

3128. Enema, called also Clyster, Glyster, and Lavement, a liquid thrown by means of a proper instrument (per rectum) into the large intestines.

The objects for which they are employed. 1. To remove from the rectum and lower intestines accumulated faeces, scybala, and other irritating matters. 2. To allay irritation of the pelvic organs, as the bladder, uterus, &c. 3. To remove constipation, particu-

larly when depending upon stricture or intus-susception. 4. To introduce medicinal substances into the system, when from any cause they cannot be administered by mouth.

3129. Observations On Their Use

1. Carefully oil the tube or pipe which is to be introduced into the anus, in order to prevent any injury being done to the soft parts; and care should be taken that the pipe be introduced an inch or two within the sphincter ani.

2. The Quantity Of Fluid Employed Requires Attention

For a child of from one to five years, 3 or 4 ounces is the proper quantity; from ten to fifteen years, 6 or 8 ounces; for an adult, 12 or 16 ounces. These quantities answer well for ordinary enemas; but in some diseases, e.g. dysentery, 4 or even 6 pints may be thrown by means of a long tube into the sigmoid flexure of the colon; and, on the other hand, when the enema is intended to remain any length of time in the rectum, in order to allow the medicinal substances which it may contain to be absorbed into the system, the quantity should not exceed 1 or 2 ounces for an adult, or a drachm or two drachms for children.

3. If the fluid be injected slowly, or with moderate force, it is more likely to be retained than if thrown in with considerable impulse.

4. All medicinal substances, particularly those of an irritating kind, should be well diluted in some mucilaginous fluid, or they may give rise to inflammation of the tissues with which they come in contact.

5. The forcible injection of simple air or medicated vapour, per rectum, was formerly recommended, but is now almost entirely and justly abandoned. The introduction of Tobacco smoke, formerly advised, is a most dangerous remedy.