Page 13 - Pharmacy History 29 July 2006

had immense influence in medical circles after its reappearance in
the Renaissance, gives an exact description when and how to administer an enema. He uses saline or sea-water enemas to remove ‘excreta accumulated near the exit’; for the same purpose he adds oil or honey to the solution. Enemas of barley, decoction of Greek fennel, and mallow serve the removal of intestinal parasites and worms.
The Persian born physician and philosopher, Avicenna (980-1037), was the author of the Canon of Medicine, which consisted of approximately a million words. Victor Robinson calls it ‘the most influential textbook ever written’
– for six centuries it dominated the medical schools of Asia and Europe. Avicenna was an inventor of technical instruments for treatment. He was the first to use catheters made of the skin of animals for treating gonorrhea;
he made injections directly into the urinary bladder by means of a silver syringe, and he invented the clyster syringe.
In the Middle Ages the method of giving an enema was by the use of
a tube about 25cm in length, made of bone or metal, or a reed, with possibly a funnel end; later a bladder of ox-skin or of other animal parts, or of silk cloth (called a clyster-purse) was fastened to the end of the tube and was emptied by squeezing with the hands.
Popularising the
clyster syringe
Marco Gatinaria, Professor of Medicine at Pavia, one of the famous teachers of Arabic medicine in the 15th century, was instrumental in making the clyster syringe popular and simplifying its technique. Somewhat later the French surgeon, Ambroise Pare, who learned medical art as autodidact on the battlefields of his time, constructed a clyster syringe for self-administration, compelled by the ‘foolish shame-fastness’ of some of his patients.
The French ‘Equisier’ (see photo) had a clockwork spring, which when fully wound, forced the fluid in the cylinder through a rectal tube when
the tap at the base was opened. This enema could be self administered.
The Dutch physician, Regnier De Graaf, in the 17th century built a copper silver clyster tube for self treatment, ‘not being unlike the pipes used by the English for introducing tobacco fumes into the bowel.’ His work, De Clysteribus, collected the contemporary knowledge of the use of the enema. In this book De Graaf apologised to the apothecaries for the loss of business entailed to them by his invention of a self-administering enema, but presented them with the consolation that they would sell much more of the ingredients and drugs used in enemas due to their increased popularity.
The enema, together with laxatives and venesection, was the panacea of medical art of that epoch.
The clyster in
literature and art
Gradually the clyster syringe
became the most popular medical instrument, the symbol of medicine and pharmacy. Physicians and apothecaries of those centuries
are frequently painted with this important sign of their professional dignity, the larger the better.
In literature, art and caricature the clyster syringe was an inexhaustible source of more or less rude jokes concerning the doctor-patient relation.
It is of interest that American Indians had discovered the medical value of enemas for the relief of constipation by themselves. Enema syringes, made of rubber, were used early by the South American Indians.
Sometimes very strong solutions
were used, such as clysters of Spanish peppers and antiseptic herbs, to destroy worms before they had settled down too elaborately in the bowels. In the 18th century the use of the clyster decreased remarkably. Today, many physicians are convinced
again of the value of a properly used enema. They want it used only within the limits of considerate medical indication, not as fad or fashion for everybody at any time and for every trouble and ailment.
The French ‘Equisier’
Poisoning by enemas
The enema, at periods of high popularity, was also taken advantage of by criminal people as a well-hidden method of administering poison. Toxicologists are aware that poison
is rather quickly transferred to the blood and lymph-circulation from
the mucous membranes of the lower bowels. In ancient Rome it was commonly believed that. Emperor Claudius was killed by this mysterious method. The poison generally used for such enemas was probably arsenic.
Enemas in our time
The old piston syringes have been substituted by irrigating cans or bags. Still small rubber ball syringes are used for personal administration of the liquid. Cleanliness and avoidance of all pressure in introducing the tube are essential; lubricating the rectal tube will make things easier. For purgative purposes some salt or oil,
Infant’s rectal syringe made of brass
volume 3 ■ no 30 ■ NOVEMBER 2006
Pharmacy History Australia ■ 13