Doctor's Review: Medicine on the Move

January 22, 2022
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Royal Flush

From ancient pharaohs to the kings of France,
the upper crust loved their enemas

Ah, the enema. Shooting warm liquid into the rectum through the anus as a quick fix for what ails you has a history as long as the human colon itself. Like bleeding and cupping, the enema has been touted as a cure-all ever since doctors were penning their prescriptions on papyrus. Used by folk-healers and physicians alike, this particular form of therapy reached an art form in pre-revolutionary France, where more people probably had daily enemas than brushed their teeth.

The first mention of the enema in medical literature comes from Ancient Egypt. No surprise there. What is unusual, however, is that the enema was considered such an essential component of good health that every pharaoh had his own so-called "Guardian of the Anus." Both the Edwin Smith Papyrus (c.1600 BC) and the Ebers Papyrus (c. 1550 BC) -- two of the earliest known medical documents -- mention enemas in detail. Ancient Greek writings corroborate the Egyptian preoccupation with colonic cleanliness. In 500 BC, Hippocrates and his followers began to advocate health by enema as well, as did the eternally popular Galen, some 650 years later.

Back in ancient times, enemas were believed to cure a wide range of physical ailments and not just those related to digestion and excretion. Headaches, sexual dysfunction, allergies, asthma, childbirth, fevers, even the common cold -- all were supposedly helped by a good rectal purging. The enema's powers were so revered that the procedure itself bordered on the sacred. As such, it was an essential part of many religious rituals in Egypt and elsewhere.

The cleansing ritual became a critical part of many spiritual ceremonies across an astounding variety of cultures. The people of ancient Babylonia, India, China and Africa all believed in the bag. Actually, the common delivery systems back then differed greatly from the comfortable and flexible rubber tubing and bulbs of today. The most common enema devices consisted of hollowed-out animal bones attached to liquid-filled gourds or animal bladders. Sometimes, instead of just letting the time-tested scientific principle of gravity do its work, designated blowers were recruited to help the process along.

In the Americas, dating from around the beginning of the Common Era, the Aguaruna Indians of Peru and many Mayan tribes were also known to use ritual and therapeutic enemas to empty their bowels, as evidenced by the many explicit yet artistically rendered scenes on their art and pottery. Unlike the straight-laced Egyptians, who generally employed a traditional warm-water solution, the Mayans got a little playful with their enemas. The alcoholic and hallucinogenic ingredients mixed into their concoctions must have led to more than a few wild evenings.

Around the same time, Native Indian cultures were using tobacco enemas as part of their religious worship as well as in rite-of-passage rituals. Pubic and anal areas were shaved, prayers were recited, the requisite solutions or smokes were injected, and then the families celebrated. Of course, many tribes employed tobacco enemas for purely recreational purposes, too. We can only pray that today's ever-scheming tobacco industry will leave that little marketing strategy in the vault.

Though enemas never really went away, it was the pre-revolutionary French, taking a cue from their much-adored monarch, who carried an enthusiasm for enemas to the extreme. To say Louis XIV (1638-1715) was fond of enemas would be a vast understatement. The Sun King was such a fervent advocate of the procedure that he reportedly had thousands and thousands of them in his lifetime. Though the idea of the enema was much the same as in ancient times, the delivery system had evolved quite a bit. Instead of a simple bone and bottle, the clyster syringe, with its specially designed rectal nozzle and plunger, helped propel the solution into the rectum with gusto.


Enemas proved addictive to the charismatic monarch. In the beginning, every night after dinner, Louis would briefly excuse himself to indulge in a little postprandial flush. But after a few years, derriere douching became so popular that the stigma attached to it fell by the wayside. People would enjoy some three or four lavements a day. It wasn't long before Louis would actually confer with his advisors and hang out with his buddies while receiving his enemas.

And the trend wasn't reserved for royalty alone. Any fashionable lady who desired a beautiful complexion had to have enemas administered on a regular basis by servants who were experts in the task. Those slightly embarrassed by the prospect, but still desiring its beneficial effects, might purchase one of the special, bent clyster syringes, designed for self-application. Alternatively, there was an optional buttocks-cover attachment, for those modest ladies too squeamish to attend to their lavements all by themselves. Most women, however, were not modest about enemas at all. A famous account in the memoirs of the Duc de Saint-Simon (1675 -1755) had the Duchess of Bourgogne chatting with the king during a crowded party while her loyal maid crawled beneath her bejewelled evening gown to administer an enema.

As for the king and his own beloved bottom boosts, he credited them as the reason behind his health and longevity. Perhaps there was something to his cleansing clysters: Louis XIV ruled France for 72 years, the longest reign in modern European history. Or maybe he was just a garden-variety klismaphiliac, deriving sexual pleasure from the procedure.

Up until about 100 years ago, anything less than one bowel movement a day was considered abnormal, so virtually every household had an enema bag hanging on the back of the bathroom door. While they were once routinely prescribed for irregularity and before childbirth, the idea of therapeutic enemas has now pretty much been flushed down the drain. With the development of more effective drugs, suppositories and laxatives, most modern MDs pooh-pooh the procedure as outdated and unnecessary except in such diagnostic treatments as barium enemas, or, occasionally, pre- or post-surgery.

But mainstream medical opinion may not necessarily spell the end for society's rear-door fixations. We need only look to the popularity of the latest pseudo-medical craze -- colonic irrigation. Unlike enemas, which flush out only the sigmoid portion of the colon, colonic irrigation goes the whole nine yards -- or two yards, rather -- from rectum to cecum. Many proponents of alternative medicine have held the enema up as the be-all and end-all for a variety of ailments; the best way to cleanse your body and system of notorious "toxins." Janet Jackson herself has claimed that coffee enemas cured her of a two-year bout with depression by washing away her "sad cells." Doctors may scoff, but with British royalty (Princess Diana) and American royalty (Hollywood starlets) praising its virtues, the constipated, toxic masses have been quick to take up the tube.

A few more reputable sources have also been wondering whether or not this old-fashioned remedy might be helpful even by today's medical standards. The fuss focuses on the potential cancer-fighting qualities of the coffee enema. Long heralded as the ideal colonic cleanser by proponents of alternative medicine, it was even included in the well-respected Merck Manual of Diagnosis and Therapy until 1972. The National Institutes of Health recently jumped on the java-injection bandwagon by funding a $1.4 million clinical trial at Columbia University, which hopes to determine whether or not coffee enemas, in conjunction with pancreatic enzymes and supplements, might help fight pancreatic cancer by helping the liver more efficiently dispose of dead cancer cells. The results are not yet in, but patients in the pilot study lived 17.5 months, nearly triple the average survival period. It seems this particular caffeinated clyster might actually live up to all the buzz.

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