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The Enema within


Mention the word enema to anyone and they would probably be put in mind of some of the more off-putting aspects of hospital life. They might remember the childhood discovery of a mysterious black snake curled up among old family belongings, grandmother’s embarrassed explanation at once frightening and comical.

The vogue for collecting old medical instruments has brought to light the close interest, even obsession, our forebears had with their bowels. Syringes used for enemas date back to Roman days. Early methods consisted of using a cow horn or hollow reed. In the 17th century the brass or pewter piston syringe came along. Cumbersome at first, more refined and elaborately decorated examples were soon being turned out to meet demand.

The enema was used for all sorts of intestinal complaints, real or fancied. Louis XIV’s courtiers used to speculate on how he managed to consume such vast quantities of food. Some suggested he might be host to a gigantic tapeworm. The answer was more mundane: the Sun King made room for each new onslaught by having his overworked bowels cleared out by up to four enemas a day.

But it was in the 19th century that the enema reached a peak of frenzied popularity. Part of its appeal was that it could be resorted to domestically, on a personal whim, as often as desired.

The Victorians, with their restless interest in order, proper regulation and efficient functioning they brought to all aspects of life could choose from no fewer than 39 varieties of enema apparatus in Maw’s Medical Catalogue of 1868.

They came in all shapes and sizes but were packed into discreetly anonymous cases for transport to the farthest reaches of Empire. One rare example of the time was a brass telescope which operated by slowly collapsing when sat upon.

This period saw the advent of the most famous enema of them all. Higginson’s Syringe of 1850 had a bulb inserted into a length of rubber tubing which allowed the liquid to run in one direction only when the bulb was squeezed. Light, compact and simple it was the acme of pumps for decades.

The variety of equipment was matched only by the range of solutions employed: castor oil as a purgative; treacle as a carminative; turpentine, olive oil and salt solution as evacuants and coffee as a stimulant, were among the more bizarre substances in use.

There was even an instrument which consisted of a pair of wood and leather bellows and pumped in tobacco smoke, apparently as a laxative.

It would, however, be a mistake to attribute the demand for such apparatus solely to a Victorian fixation with the bowels. Many items came supplied with an ivory plug for rectal use and a brass mounted rubber tube for vaginal irrigation. From the 1860s onward, the contraceptive function this provided was an immeasurable but certain factor in the demand for enema equipment.

The most elaborate development in colonic lavage did not arrive until 1895. The two-tube high colonic enema allowed a continuous washing out that was considered more thorough, by its devotees. It was not surprising that this method reached its modish peak in the angst-ridden 1920s and newly health-conscious 30s, before the undesirable habit-forming nature of prolonged use was understood.

The playwright Moliere in La Malade Imaginaire described the hypochondriacal patient obsessed with the state of his bowels, pandered to by quack doctors whose cure-all advice was ‘give an enema, then bleed, finally purge’.

The neurotic’s belief in the efficacy of the enema is understandable. There are not many self-administered treatments that possess the ability to deal simultaneously with deep and complex psychological notions of cleanliness, purging ‘poisons’, keeping regular, even punishment. It enables vague, disturbing anxieties to be attacked in a uniquely private way complete with the comforting trappings of ritual.

The occasional use of enemas to wash out the rectum does not have a significant effect on the natural fermentation of bacteria which forms a vital part of the food breakdown process. However, regular use of enemas further up could cause difficulty in salvaging carbohydrates, so dependence is inadvisable. This is why giving enemas to treat faecal impaction in the elderly is a rare expedient done under medical supervision. Old people can least afford to have their bowel flora washed away.

However, medicines’ oldest nostrum is not entirely a quaint curiosity from a bygone age. Thanks in part to TV’s Absolutely Fabulous, the enema gained new fans among the ladies who lunch of the 1990s.

The procedure became one of the commonest offered at beauty spas. ‘Is there a better way to improve muscle tone, reduce stagnation and bacterial build-up in the colon and generally promote colon health?’ asks one spa website.

Although they still have their medical uses it is likely that the high noon of the high colonic has passed, never to return.

With the present-day blitz of plant-based and high-fibre diets, gym exercise and numerous other self-help alternatives, its connotations of fussiness and absurdity do not always fit in with the modern idea of the busy, successful lifestyle. ■

Twitter: @KenWilson

An enema device that could equally do service at a Japanese tea ceremony


The Victorians, with their restless interest in order in all aspects of life had no fewer than 39 varieties to choose from


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