6. The Form Of Instrument Used Does Not Much Signify

If used with proper caution, an enema is perfectly safe, and a valuable resource in many forms of disease, in children as well as in adults.

3130. Therapeutic Uses

In Constipation, from whatever cause arising, enemas may be used with advantage; but it must be remembered that they are only temporary measures, removing an existing overcharged state of the bowels, but incapable of establishing that healthy condition of the peristaltic action, upon which a natural daily discharge of the faeces depends. This must be done by tonics, alteratives, and other remedies. In the Constipation of Hysterical Women, Assaftida may be advantageously added to the enema. In that depending upon Spasm of the Rectum, tepid-water enemas, with soap, &c, are very useful, temporarily relaxing the spasm, and bringing away the accumulated faeces.

3131. In Diarrhoea, enemas often prove most serviceable; they may be either simply mucilaginous, or containing opiates, Ipecacuanha, &c. In a case which recently came under my care, the Diarrhoea had continued several weeks, and had resisted the employment of almost every other means; but, by the use of enemas, a cure was effected in a very short period. The first enema, consisting of about two pints of demulcent fluid, brought away a large number of small and very hardened scybala. Immediate relief followed their expulsion; and the remaining irritation, which had been caused by the presence of these hardened bodies, yielded entirely to small glysters, containing Opium and Ipecacuanha

3132. In Dysentery, the employment of large enemas (four or six pints thrown into the transverse colon, by means of a long flexible tube introduced per rectum) was first proposed by Dr. O'Beirne.* The rationale of this treatment, its mode of application, together with some obstacles to its employment, are fully considered when speaking of Dr. Hare's treatment in the article Argenti Nitras (which see). They may doubtless prove highly useful in removing accumulated fAeces and irritant matters from the colon, and have proved successful in the hands of Dr. Irving, Dr.? M'Pherson, &c. Small enemas (fiss. - fij.). containing opiates, Ipecacuanha, &c, often prove useful in allaying the tenesmus and tormina. In other Abdominal Inflammations, in Peritonitis, Peri-hepatitis, Nephritis, Abdominal Typhus, &c., Dr. Eisenmann § speaks highly of the value of enemas of three or four quarts of water at blood-heat. The first injection generally returns in a short time, bringing with it much fAecal matter. The second, which is given immediately after the return of the first, is generally retained without difficulty. He considers that he has often seen cases of the above inflammation cut short by the use of these enemas.

3133. In Intussusception of the Bowels, Cullen proposed the employment of large warm-water enemas. The flexible tube of a stomach-pump introduced per rectum, is to be passed up six or seven inches, in the manner advised in Dysentery (see sect. 319); and several pints of water, as hot as the patient can bear it without pain, are to be injected. The warmth, the moisture, and the pressure of the fluid, sometimes cause relaxation of the surrounding tissues, and a reduction of the affected part is effected. It, however, often fails. In Colica Pictonum, hot-water enemas have also been found serviceable. (See Hot Bath.)

3134. In Cholera, enemas offer an effectual means of introducing medicines into the system. They may contain salines or Turpentine, and should be repeated every hour or half-hour. However frequently repeated, or in whatever quantity, the fluid becomes absorbed into the system; as in those who die after their employment, although the fluid has not been returned per anum, none of it is to be found in the intestines. They should only be regarded as auxiliary to other treatment.

* New Views of DefAecation, &c. Edin. Med. Surg. Journ., Jan. 1849.

On Bengal Dysentery, Calcutta, 1850. § Bull. de Therap., lv. p. 542.

3135. Against Worms, Martinet advises the employment of enemas in the following manner, to be repeated at short intervals. The first is a common aperient one, to unload the intestines of faecal matter; the second, a strong solution of common salt, or vinegar and water, which should be retained as long as possible; the third should consist of three or four large tablespoonfuls of Olive Oil or thick mucilaginous decoction of Marsh Mallow or Rice, to mitigate any uneasiness of the rectum. This treatment is stated to be very effectual, but can be chiefly useful only when A. Vermiculares are present.

3136. In Acute Peritonitis, Enteritis, and Inflammatory states of the Intestinal Canal, warm, mucilaginous enemas are in all cases preferable to strong or irritating purgatives.

3137. In Cerebral Affections, Apoplexy, Insanity, &c., tere-binthinate and other enemas prove highly serviceable. They not only remove the scybala which so often accumulate in the intestines of maniacal patients, but operate as powerful revulsives. In Fevers attended with Cerebral Complication, Prof. Graves found Tartar Emetic, administered in this manner, very serviceable.

3138. In Affections of the Genito-urinary Organs, enemas containing opiates prove in the highest degree beneficial. In Subacute Ovaritis, warm-water enemas, simple or medicated, are strongly recommended by Dr. Tilt. The enema should be retained as long as possible. In Rigidity of the Os Uteri, warm-water enemas, and in Uterine HAemorrhage, enemas containing iced water, may be used with advantage. (See Water.)

3139. In Hysteria, connected with worms, terebinthinate enemas may be employed with the best results. A cold-water enema has been found to check a violent paroxysm of hysteria.