Enemata.—Clysters.
SYNONYMS: Injections, Enemas, Lavements, Clysteria, Clysmata.
Injections are medicinal agents in the form of infusion, decoction, or mixture, designed to be passed into the rectum, vagina, urethra, bladder, etc. Sometimes pulverized ingredients are added to those intended for the rectum. They are usually thrown into the rectum to remove constipation, to allay inflammation of the lower intestines, to remove ascarides, to stimulate or nourish the system, to produce an influence upon distant organs by sympathetic action, as to occasion emesis, perspiration, uterine action, etc., and as a revulsive. When, from any cause whatever, medicines or liquid food can not be administered by mouth, they may be used in the form of a rectal injection, in about double the quantity required when taken into the stomach; though some care is necessary in proportioning the dose of powerful medicines. When an evacuation of the bowels is designed, as in bilious colic, apoplexy, convulsions, constipation, etc., the quantity of fluid should be large, 1 or 2 pints for an adult, repeating it every 10, 20, or 30 minutes, until the object is effected. Children will require reduced amounts, according to their ages and susceptibilities. When it is desired to make an impression upon distant or neighboring parts, or upon the rectum itself, or to produce a constitutional influence, the injection should be given in as small an amount of fluid as is consistent with its activity or character, and should be held within the rectum as long as possible; and if the patient can not retain it, a warm compress of linen or muslin may be pressed upon the anus with a moderate degree of firmness, by the nurse, which will prevent the enema from being immediately evacuated.
Injections into the vagina are intended to aid in restoring the normal condition of its walls, to assist in the cure of excoriation or ulceration of the cervix, to remove vaginal leucorrhoea, to produce a sedative influence upon the uterus, to induce premature delivery, etc. Uterine injections are designed to remove a low grade of inflammation of its mucous lining membrane, to cure ulceration in the canal of the cervix, to stimulate the organ to activity, etc. Urethral injections are to relieve inflammation of the urethra or bladder, to check chronic discharges from the urethra, heal ulceration of the bladder, stimulate the mucous lining membrane of the urethra, and the prostate gland, etc. Injections into other parts are usually for the purpose either of removing foreign or unhealthy matters, allaying inflammation, or stimulating the parts to increased action. Very salutary effects are frequently obtained in this way, better than it is possible under certain conditions to procure by administration of remedies by mouth. Many ingenious instruments at present are contrived for the administration of injections.
Injections are a valuable mode of treatment in many diseases; indeed, some affections can not be readily nor permanently cured without them. They are found especially beneficial in bilious colic, in bilious, typhus, yellow, and congestive forms of fever, in dysentery and diarrhoea, etc. In infants, life has often been preserved by their timely application, and the pains and dangers of the parturient woman have frequently been very materially lessened by their use. And yet, notwithstanding their value and importance, there are hundreds of families, especially in country places, who do not supply themselves with the articles necessary for their administration, but who depend entirely upon the physician, or perhaps a neighbor, for the use of a syringe. This is a very reprehensible omission, and, although not exactly within the province of this work, yet, from the evil results which I have seen depending upon a negligence of the above character, I can not refrain from making a few brief advisory remarks. Every individual, and more especially every family, is liable to sickness which may require the use of a syringe, and to depend upon the physician for its supply is certainly bad policy, for very few, especially those practicing in the country, furnish themselves with a quantity sufficient to meet the demands of the various families under their professional care; besides, very few physicians carry an article of this kind, and, in some diseases, the delay occasioned by sending for it may be death to the patient. No doubt, an immense number of patients, and more particularly among those residing in the country, die yearly, solely from the want of an instrument with which to administer an injection. It is, therefore, a matter of duty with the practitioner, both to himself and to his patients, to strongly impress these facts upon those who patronize him professionally, and urge them by all means to make the necessary provisions. A rubber or metallic syringe, capable of holding a pint, and a smaller one of 3 or 4 fluid ounces, and a rubber bulb and tube syringe, or a fountain syringe, should be found in possession of every family, as these can be adapted to meet any emergency requiring their use.
Injections are emollient, stimulant, anodyne, purgative, antispasmodic, etc., and are most generally prescribed by the physician to suit the emergency of the case, without regard to official directions. For purposes of nutrition, as well as to reduce inflammation of the lower intestines, infusions of starch, of elm bark, of flaxseed, and of cornmeal, are usually injected into the rectum, with a portion of laudanum added when inflammation is present; and in cases where the stomach rejects all food and medicine, and when this condition is accompanied with prostration, a proper quantity of wine, brandy, or some similar stimulant, may be added to the nutrient clyster, and repeated as often as the circumstances require (J. King). The following enemata are among the agents of this class in more common use:
ENEMA ALOES, Enema of aloes.—Mix and rub together 40 grains of aloes, 15 grains of potassium carbonate, and 10 fluid ounces of mucilage of starch. This accords with the Br. Pharm. Uses same as for Enema Aloes Composita, which see.
ENEMA ALOES COMPOSITA, Compound enema of aloes, Compound clyster of aloes.—Take of aloes 40 grains, carbonate of potassium 15 grains, tincture of asafetida 3 fluid drachms, infusion of boneset ½ pint. Mix and rub them together. This is a stimulant, cathartic, and vermifuge clyster, and may be used with advantage for the removal of ascarides from the rectum; also in constipation, especially among females laboring under amenorrhoea (J. King). For the purpose of inducing catharsis large amounts should be used; for the destruction of ascarides, and to stimulate local parts, small quantities are preferable.
ENEMA CATHARTICUM, Cathartic enema, Cathartic clyster.—Take of common table salt ½ troy ounce, olive or castor oil 1 fluid ounce, molasses 2 fluid ounces, warm water 2 pints. Mix together. This is a very common laxative clyster, the ingredients of which are generally to be procured readily in every family. The above quantity is intended for an adult; it may be given at once, or be divided into 2 equal parts, to be used within 10 or 15 minutes of each other. It is generally employed in cases of constipation, or where a speedy evacuation of the bowels is desired. An injection is sometimes used for the above purposes, and in diarrhoea and dysentery, and, indeed, in almost every case where an enema is indicated, composed as follows: Take of sweet milk ½ pint, infusion of elm bark ½ pint, olive oil 2 fluid ounces, molasses 4 fluid ounces, bicarbonate of potassium ½ troy ounce. Mix. When there are pains and gripings in the lower intestines, laudanum ½ fluid drachm may be added to each injection (Beach's American Practice).
ENEMA LOBELIAE COMPOSITA, Compound enema of lobelia, Compound clyster lobelia, Antispasmodic clyster.—Take of water ½ fluid ounce, compound tincture of lobelia and capsicum ½ fluid drachm. Mix together. This is a relaxant and antispasmodic clyster, and is used in cases of tetanus, convulsions, rigidity of the os uteri, and whenever its peculiar actions are indicated. The proportions, as given in the above formula are adapted to an infant from several weeks to a year old, laboring under an attack of convulsions; for adults, ½ fluid ounce or even more of the tincture, may be added to a sufficient quantity of water, and so in proportion (J. King).
ENEMA MAGNESII SULPHATIS, Enema of magnesium sulphate, Enema catharticum.—Dissolve 1 ounce (av.) of magnesium sulphate in 15 fluid ounces of mucilage of starch, add 1 fluid ounce of olive oil, and mix. This accords with the Br. Pharm. This enema is of value in cerebral congestion where a derivative effect is desired and as an evacuant in obstinate constipation. Large amounts should be used. A simple solution of magnesium sulphate without the other ingredients would be just as effective.
ENEMA OPII, Enema of opium, Clyster of opium, Enema sedativum, Enema anodynum.—Take of decoction of starch, or infusion of elm bark 1 fluid ounce, tincture of opium 20 minims. Mix them. The Br. Pharm. directs tincture of opium ½ fluid ounce, and mucilage of starch 2 fluid ounces. This clyster is useful in irritation or inflammation of the bladder, uterus, or prostate gland, in obstinate emesis, in the passage of renal calculi, in nephritis, in dysentery, and in painful affections of the large intestines. It may sometimes be necessary to double or treble the quantity of tincture of opium named in the formula. It should be retained in the rectum as long as possible, and may be repeated every 1, 2, or 3 hours, and in severe cases even oftener, according to the urgency of the symptoms. If frequently employed it will produce the constitutional effects of the opium.
ENEMA TABACI, Enema of tobacco.—Infuse in a closed vessel for 30 minutes 20 grains of leaf tobacco in 8 fluid ounces of boiling water (Br. Pharm., 1867). This enema is designed to produce nausea and consequent muscular relaxation in cases of strangulated hernia, ileus, fecal accumulations, and other bowel obstructions, to induce alvine evacuations. It must be carefully used. It has been used in tetanus, and for the destruction of ascarides. Not more than 1 ½ ounces of this preparation should be employed at one injection.
ENEMA TEREBINTHINAE, Enema of turpentine.—Mix 1 fluid ounce of oil of turpentine with 15 fluid ounces of mucilage of starch. This accords with the Br. Pharm. Of value in tympanitic distension of the intestines when confined to the colon. Also used to destroy ascarides, and in hysteria and amenorrhoea, and is said to give marked relief from the pain produced by the presence of vesical calculus.
ENEMA TEREBINTHINAE COMPOSITA, Compound enema of turpentine, Compound clyster of turpentine.—Take of castor oil ½ fluid ounce, oil of turpentine 2 fluid drachms, camphorated tincture of opium 1 fluid drachm. Mix together. This injection is principally employed in flatulency, and tympanitic distension of the abdomen, especially during an attack of peritonitis. It may be repeated 2, 3, or 4 times a day. It may likewise be used in ascarides, obstinate constipation, and amenorrhoea.
