ENE′MA

Syn. Clyster ; En′ema (pl. Enem′ata ), L. A medicine, usually liquid (sometimes gaseous), thrown into the rectum or lower bowels. Clysters usually consist of some weak glutinous or mucilaginous fluid, to which the active ingredients are added; or a decoction or infusion is made of the medicaments, which is then used, either alone, or after the addition of a little gum, starch, or sugar. The proper vehicle for astringent vegetable matter, metallic salts, and the mineral acids, is pure water. Oleaginous and resinous substances are made into emulsions before being employed for enemas. In all cases the fluid is administered warm. The quantity of fluid forming a clyster, for an adult, may vary from 1 ⁄ 2 to 3 ⁄ 4 pint; that for an infant within a month old, should be about 1 fl. oz.; for a child of one year, about 2 1 ⁄ 2 fl. oz.; from one to seven years, from 3 or 4 fl. oz.; and from seven to twelve or fourteen, 6 or 7 fl. oz.; after that age to puberty, 1 ⁄ 2 pint may be employed. The quantity or dose of the active ingredients in a clyster should be 4 or 5 times as great as that of the same medicines when taken by the mouth; as it is generally regarded that the susceptibility of the rectum is only 1 ⁄ 5 th that of the stomach, and that to exert a like absorbent action it occupies 5 times as long as the latter viscus. The dose, and the interval between its repetition, should, therefore, be proportionately increased. Narcotics, as opium, tobacco, ., should, however, be given in only twice or thrice the quantity that would be exhibited in the usual manner. Enemata are usually administered by means of a syringe, bladder, or elastic bag, furnished with a rectum tube; but many ingenious and elegant pieces of mechanism, adapted for self-administration, are made by the instrument makers. Great care should be taken to avoid injuring the coats of the rectum by the use of a rough or improperly shaped pipe, or one that is too long. The extremity of the pipe or tube should also be perfectly smooth and well rounded (rather spherical than pointed), and in using it no force should be employed. A neglect of this point often produces very serious consequences, especially in young children. Tobacco smoke may be administered by means of a double pair of bellows, supplied with air from a small funnel under which the herb is burning,—and gaseous matter, by connecting the rectum tube with a small gasometer, exerting a trifling pre ure on the confined gas. The number of substances employed in the preparation of enemata is very great. The following are some of them, arranged according to their effects:— 1. (Anodyne and Narcotic.) Opium, henbane, ., are employed to allay spasms of the bowels, stomach, uterus, bladder, . 2. (Aperient or Cathartic.) Aloes, colocynth, senna, various purging salts, gruel, decoction of marshmallows, decoction of linseed, warm water, ., are commonly employed to promote the peristaltic action of the bowels, or to destroy worms. 3. (Demulcent and Emollient.) Decoction of starch, gum, isingla , glue, ., either alone or combined with opium, are used to protect the coats of the intestines, and to allay irritation; and also to restrain diarrhœa, especially when combined with astringents, as logwood, catechu, or oak bark. 4. (Nutrient.) Animal jelly, soups, broths, milks, ., are frequently used as injections to convey nourishment to the body. 5. (Sedative.) Tobacco infusion or smoke, and tartar emetic (in solution), are employed to relax the powers of the body, to remove spasms, depre the circulation, and to produce syncope. Enemata or clysters are now very frequently employed in our large towns, especially among the higher cla es; but a great prejudice exists among many persons against their use, arising from a fastidious and mistaken delicacy. The introduction of improved apparatus of late years, by which the administration of these remedies is attended with le difficulty and exposure than formerly, has removed much of the repugnance which previously existed. Clysters are invaluable when it is nece ary to evacuate the bowels as speedily as po ible, and when the stomach will not bear the administration of a purgative by the mouth, as well as in cases requiring a direct medication of the lower bowels, as in dysentery, colic, . As a mere laxative, an injection of tepid water, milk-and-water, or water gruel, will generally be found sufficient. By the addition of 1 or 2 table-spoonfuls of common salt, Epsom salts, salad oil, or mola es, to this laxative enema, it will form an excellent purgative one, which will, in most cases, induce a full discharge. In all cases, the patient should be directed to retain the injection for as long a time as po ible, and not to attempt to empty his bowels immediately after the reception of the medicine. “In irritation of the bladder, rectum, or uterus, an anodyne injection or enema often affords much relief. In diseases of the lower bowels, clysters are also of almost indispensable utility, as also in the dislodgment of ascarides seated in the rectum; nor are they le beneficial in those cases of sudden sinking of the powers of life where deglutition is impo ible, and yet a prompt stimulating impre ion is requisite to save the patient; under such circumstances, clysters of some of the diffusible stimuli have proved of the greatest benefit.” The injection of large quantities of liquid matter into the bowels, as well as the constant use of clysters (even of warm water only), is deemed by the highest medical authorities to be injurious, and occasionally dangerous. The practice should not, therefore, be allowed to grow into a habit. The bowels continually accustomed to a stimulant cease to act without one. The same remarks apply to aperients taken by the mouth. The following formulæ embrace the whole of the enemas ( ENEMATA ) of the ‘British Pharma copœia,’ as well as a few others in common use:—