Editing Enema (section)

== History ==

=== Etymology ===

''Enema'' entered the English language c. 1675 from Latin in which, in the 15th century,<ref name=Free_Dictionary_Enema/> it was first used in the sense of a rectal injection,<ref name=Merriam-Webster_Enema/> from Greek ἔνεμα (énema), "injection", itself from ἐνιέναι (enienai) "to send in, inject", from ἐν (en), "in" + ἱέναι (hienai), "to send, throw".<ref>{{cite web |url=https://www.etymonline.com/search?q=enema |title=enema (n.) |work=[[Online Etymology Dictionary]] |publisher=Douglas Harper of the [[LNP Media Group]] |access-date=2019-04-15 }}</ref>

''Clyster'' entered the English language in the late 14th century from Old French or Latin, from Greek κλυστήρ (klyster), "syringe", itself from κλύζειν (klyzein), "to wash out",<ref>{{cite web |url=https://www.etymonline.com/search?q=clyster |title=clyster (n.) |work=[[Online Etymology Dictionary]] |publisher=Douglas Harper of the [[LNP Media Group]] |access-date=2019-12-29 }}</ref> also spelled ''glister'' in the 18th century.<ref>{{cite book |author=[[Benjamin Rush]] |title=Medical observations and inquiries |volume=3 |year=1769 |pages=250, 251, 252 |work=By a Society of Physicians in London |location=[[London]] |url=https://archive.org/details/s9id13413710/ |access-date=2022-01-22 |edition=The Second }}</ref> It is a generally archaic word used more particularly for enemas administered using a ''clyster syringe''.

=== Ancient and medieval ===
==== Africa ====

The first mention of the enema in medical literature is in the Ancient Egyptian [[Ebers Papyrus]] ({{circa|1550}} BCE). One of the many types of medical specialists was a Nery-Pehuyt, the Shepherd of the Anus. Enemas administered many medications.<ref>Magner, ''A History of Medicine'':31</ref> There was a Keeper of the Royal Rectum<ref>Magner, ''A History of Medicine'':30</ref> who may have primarily been the pharaoh's enema maker. According to Egyptian mythology, the god [[Thoth]] invented the enema.<ref>Magner, ''A History of Medicine'':26</ref>

[[File:Afrikanische Holzplastik.jpg|thumb|Pressure enema from an animal bladder (African wooden sculpture, 19th century)]]

In parts of Africa, the [[calabash]] gourd is used traditionally to administer enemas. On the Ivory Coast the narrow neck of the gourd filled with water is inserted the patient's rectum and the contents are then injected by means of an attendant's forcible oral inflation, or a patient may self-administer the enema by using suction to create a negative pressure in the gourd, placing a finger at the opening, and then upon anal insertion, removing the finger to allow atmospheric pressure to effect the flow. In South Africa, [[Bhaca]] people used an ox horn to administer enemas.<ref>Annals of the South African Museum, page 18</ref> Along the upper Congo River an enema apparatus is made by making a hole in one end of the gourd for filling it, and using a resin to attach a hollow cane to the gourd's neck. The cane is inserted into the anus of the patient who is in a posture that allows gravity to effect infusion of the fluid.<ref>Friedenwald & Morrison, 'Part I:75-76</ref>

==== Americas ====

The [[Olmec]] used trance-inducing substances ceremonially from their middle preclassic period (10th through 7th centuries BCE) through the Spanish Conquest. These were ingested via enemas administered using jars, among other routes.

As further described below in [[#Religious rituals|religious rituals]], the [[Maya civilization|Maya]] in their late classic age (7th through 10th centuries CE) used enemas for, at least, ritual purposes, Mayan sculpture and ceramics from that period depicting scenes in which, injected by syringes made of gourd and clay, ritual hallucinogenic enemas were taken.<ref name=Hallucinogenic_pre-Columbian>{{cite journal |title=Hallucinogenic drugs in pre-Columbian Mesoamerican cultures |volume=30 |issue=1 |pages=42–49 |author=F. J. Carod-Artal |date=2011-07-01 |journal=Neurología |doi=10.1016/j.nrleng.2011.07.010 |pmid=21893367 |doi-access= }}</ref> In the Xibalban court of the God D, whose worship included ritual cult paraphernal, the Maya illustrated the use of a characteristic enema bulb syringe by female attendants administering clysters ritually.<ref>Parsons and Carlson:92</ref><ref name="pmid3528674">{{cite journal |vauthors = de Smet PA, Hellmuth NM |title = A multidisciplinary approach to ritual enema scenes on ancient Maya pottery |journal = J Ethnopharmacol |volume = 16 |issue = 2–3 |pages = 213–62 |year = 1986 |pmid = 3528674 |doi = 10.1016/0378-8741(86)90091-7 }}</ref>

For combating illness and discomfort of the digestive tract, the Mayan also employed enemas, as documented during the colonial period, e.g., in the [[Florentine Codex]].<ref name=Hallucinogenic_pre-Columbian/>

The [[indigenous peoples of the Americas#North America|indigenous peoples of North America]] employed [[tobacco smoke enema]]s to stimulate respiration, injecting the smoke using a rectal tube.<ref>{{Citation |last1 = Hurt |first1 = Raymond |last2 = Barry |first2 = J. E. |last3 = Adams |first3 = A. P. |last4 = Fleming |first4 = P. R. |title = The History of Cardiothoracic Surgery from Early Times |publisher = Informa Health Care |page=120 |year = 1996 |isbn = 978-1850706816 |url=https://books.google.com/books?id=ShLvi_kRQtQC}}</ref><ref>{{Citation |doi = 10.2307/2843888 |last = Nordenskiold |first = Erland |title = The American Indian as an Inventor |jstor = 2843888 |journal = Journal of the Royal Anthropological Institute |volume = 59 |page=277 |year = 1929}}</ref>

A rubber bag connected with a conical nozzle, at an early period, was in use among the [[indigenous peoples of the Americas#South America|indigenous peoples of South America]]  as an enema syringe,<ref>Friedenwald & Morrison, Part II:261</ref> and the rubber enema bag with a connecting tube and ivory tip remained in use by them; in contrast, in Europe a syringe was still the usual means for conducting an enema.<ref>Friedenwald & Morrison, Part II:240</ref>

==== Asia ====

In Babylonia, by 600 BCE, enemas were in use. However, it appears that initially they were in use because of a belief that the demon of disease would be driven out of the body by utilizing an enema.<ref name=History_Asia_Misc>Friedenwald & Morrison, Part I:77</ref> Babylonian and Assyrian tablets c. 600 BCE bear cuneiform inscriptions referring to enemas.<ref name=Comparative_Clinical_Study>{{cite journal |last1=Page |first1=Sidney G. |title=A Comparative Clinical Study of Several Enemas |journal=Journal of the American Medical Association |date=2 April 1955 |volume=157 |issue=14 |pages=1208–1210 |doi=10.1001/jama.1955.02950310034008 |pmid=14353661 }}</ref>

In China, c. 200 CE, [[Zhang Zhongjing]]<!--->Redirected from Chang Chung-ching, the name used in the reference---> was the first to employ enemas. "Secure a large pig's bile and mix with a small quantity of vinegar. Insert a bamboo tube three or four inches long into the rectum and inject the mixture" are his directions, according to [[Wu Lien-teh]].<ref>Friedenwald & Morrison, 'Part I:77–80</ref>

In India, in the fifth century BCE, [[Sushruta]] enumerates the enema syringe among 121 surgical instruments described. Early Indian physicians' enema apparatus consisted of a tube of bamboo, ivory, or horn attached to the scrotum of a deer, goat, or ox.<ref name=History_Asia_Misc/>

In Persia, [[Avicenna]] (980–1037 A. D.) is credited with the introduction of the "clyster-purse" or collapsible portion of an enema outfit made from ox skin or silk cloth and emptied by squeezing with the hands.<ref name=Comparative_Clinical_Study/>

==== Europe ====
[[File:The Enema MET DP818226.jpg|thumb|''The Enema'' by [[Abraham Bosse]], ca. 1632–33]]
[[Hippocrates]] (460–370 BCE) frequently mentions enemas, e.g., "if the previous food which the patient has recently eaten should not have gone down, give an enema if the patient be strong and in the prime of life, but if he be weak, a suppository should be administered, should the bowels be not well moved on their own accord."<ref>Friedenwald & Morrison, 'Part I:71</ref>

In the first century BCE the [[Ancient Greek medicine|Greek physician]] [[Asclepiades of Bithynia]] wrote "Treatment consists merely of three elements: drink, food, and the enema".<ref>Scarborough, ''The Drug Lore of ASCLEPIADES of Bithynia'':44</ref> Also, he contended that indigestion is caused by particles of food that are too big and his prescribed treatment was proper amounts of food and wine followed by an enema which would remove the improper food doing the damage.<ref>Scarborough, ''The Drug Lore of ASCLEPIADES of Bithynia'':46</ref>

In the second century CE the Greek physician [[Soranus (Greek physician)|Soranus]] prescribed, among other [[Surgery in Ancient Rome|techniques]], enemas as a safe [[abortion]] method,<ref>{{cite book|author=Soranus|translator=Owsei Temkin |title=Soranus' Gynecology|date=1956|publisher=JHU Press|pages=62–67|isbn=9780801843204}}</ref> and the Greek philosopher [[Celsus]] recommended an enema of pearl barley in milk or rose oil with butter as a nutrient for those with dysentery and unable to eat,<ref name=Royal_Pharmaceutical>{{cite web |url=http://www.rpharms.com/museum-pdfs/21-enemas.pdf |title = Information Sheet:21 Enemas |website = Information Sheets |publisher = Museum of the Royal Pharmaceutical Society, London |url-status=dead |archive-url=https://web.archive.org/web/20160306155528/https://www.rpharms.com/museum-pdfs/21-enemas.pdf |archive-date=2016-03-06 |access-date=2020-01-03 }}</ref> and also Galen mentions enemas in several contexts.<ref name=Galen>{{Citation |last = Mattern |first = Susan P. |year = 2008 |title = Galen and the Rhetoric of Healing |publisher = [[Johns Hopkins University Press]] |location = Johns Hopkins University Press, Maryland, USA |isbn=978-0-8018-8835-9 |pages = 31, 145, 149 |url = https://books.google.com/books?id=5IXlOC1_liEC }}</ref>

In medieval times appear the first illustrations of enema equipment in the [[Western world]], a clyster syringe consisting of a tube attached to a pump action bulb made of a pig bladder.{{Citation needed|date=July 2020}}
A simple piston [[syringe]] clyster was used from the 15th through 19th centuries. This device had its rectal nozzle connected to a syringe with a plunger rather than to a bulb.{{Citation needed|date=July 2020}}

=== Modern Western ===

[[File:Klistierbank1.JPG|thumb|Portable enema self-administration apparatus by [[Giovanni Alessandro Brambilla]] (18th century; Medical History Museum, University of Zurich)]]

[[File:Clyster syringes.jpg|thumb|A normal clyster syringe ''(front)'' and the nozzle for a syringe designed for self-administration ''(rear)''. The latter avoided the need for a second party to attend an embarrassing procedure.]]

Beginning in the 17th century, enema apparatus was chiefly designed for self-administration at home, and many were French as enemas enjoyed wide usage in France.<ref name=Royal_Pharmaceutical />

In 1694 [[François Mauriceau]] in his early-modern treatise, ''The Diseases of Women with Child,'' records midwives and man-midwives commonly administered clysters to labouring mothers just before their delivery.<ref>{{cite journal |doi=10.1136/adc.66.1_Spec_No.78 |title=Francois Mauriceau (1637-1709) and maternal posture for parturition |year=1991 |last1=Dunn |first1=P. M. |journal=Archives of Disease in Childhood |volume=66 |issue=1 Spec No |pages=78–79 |pmid=1996901 |pmc=1590357 }}</ref>

Clysters were administered for symptoms of constipation and, with more questionable effectiveness, stomach aches and other illnesses.{{when|date=July 2020}}{{Citation needed|date=July 2020}}<ref>{{Cite journal |title= Chronic Constipation: Current Treatment Options|date=2011 |pmc=3206558 |last1=Liu |first1=L. W. |journal=Canadian Journal of Gastroenterology |volume=25 |issue=Suppl B |pages=22B–28B |doi=10.1155/2011/360463 |pmid=22114754 |doi-access=free }}</ref>

[[File:A monkey rejects the old style clyster for his new 'clyso-pompe', which he fills with opium and marshmallow Wellcome V0011775.jpg|thumb|19th century satirical cartoon of a monkey rejecting an old style clyster for a new design, filled with marshmallow and opium]]

In 1753, Johann Jacob Woyts described an enema bag prepared from a pig's or beef's bladder attached to a tube as an alternative to a syringe.<ref>Friedenwald & Morrison, Part II:245</ref>

In the 18th century Europeans began emulating the [[indigenous peoples of the Americas#North America|indigenous peoples of North America's]] use of tobacco smoke enemas to resuscitate drowned people.<ref name=BCMJ>{{cite web |url=https://www.bcmj.org/special-feature/special-feature-tobacco-smoke-enemas |title=Special feature: Tobacco smoke enemas |author=Sterling Haynes |date=December 2012 |work=British Columbia Medical Journal |publisher=Doctors of BC |access-date=2019-03-29 }}</ref> Tobacco resuscitation kits consisting of a pair of bellows and a tube were provided by the Royal Humane Society of London and placed at various points along the Thames.<ref name=Royal_Pharmaceutical /> Furthermore, these enemas came to be employed for headaches, respiratory failure, colds, hernias, abdominal cramps, typhoid fever, and cholera outbreaks.<ref name=BCMJ/>

Clysters were a favourite medical treatment in the [[bourgeoisie]] and [[nobility]] of the Western world up to the 19th century. As medical knowledge was fairly limited at the time, purgative clysters were used for a wide variety of [[ailment]]s, the foremost of which were [[stomach ache]]s and constipation.<ref name="Pharmacological treatment">{{cite journal |last1=Clemens |first1=Katri E. |last2=Faust |first2=Markus |last3=Jaspers |first3=Birgit |last4=Mikus |first4=Gerd |title=Pharmacological treatment of constipation in palliative care |journal=Current Opinion in Supportive and Palliative Care |date=June 2013 |volume=7 |issue=2 |pages=183–191 |doi=10.1097/SPC.0b013e32835f1e17 |pmid=23478431 |s2cid=3283246 }}</ref>

According to [[Louis de Rouvroy, duc de Saint-Simon|the duc de Saint-Simon]], clysters were so popular at the court of King [[Louis XIV of France]] that [[Marie Adélaïde of Savoy|the duchess of Burgundy]] had her servant give her a clyster in front of the King (her modesty being preserved by an adequate posture) before going to the [[comedy]]. However, he also mentions the astonishment of the King and Mme de Maintenon that she should take it before them.<ref>Saint-Simon, ''Memoires'', vol. 10, [http://rouvroy.medusis.com/docs/1004.html ch. 4].</ref>

In the 19th century, many new types of enema administration equipment were devised. Devices allowing gravity to infuse the solution, like those mentioned above used by South American indigenous people and like the enema bag described by Johann Jacob Woyts, came into common use. These consist of a nozzle at the end of a hose that connects a reservoir, either a bucket or a rubber bag filled with liquid and held or hung above the recipient.<ref name=Royal_Pharmaceutical />

In the early 20th century the disposable [[#microenema|microenema]], a squeeze bottle, was invented by [[Charles Browne Fleet]].<ref>{{cite web |url=http://www.newsadvance.com/content/tncms/assets/v3/eedition/5/3d/53db44b6-01db-594c-9ed2-a6b4881fb211/537a39dec336e.pdf.pdf |title=Fleet |date=2014-04-27 |work=A Supplement to The News & Advance |publisher=[[The News & Advance]] |access-date=2020-01-03 |archive-date=3 January 2020 |archive-url=https://web.archive.org/web/20200103203637/http://www.newsadvance.com/content/tncms/assets/v3/eedition/5/3d/53db44b6-01db-594c-9ed2-a6b4881fb211/537a39dec336e.pdf.pdf |url-status=dead }}</ref>