Oribasius gives us many interesting particulars about enemas (Collect. VIII. xxiv). The amount necessary is less for men than for women. In any case the largest amount is three heminae (τρεῖς κότυλοι), the smallest one hemina (a small half pint). In dysentery and other cases where the parts would be easily hurt, and where a prompt evacuation was required, cannulae with the opening placed in the side were used. Cannulae with the opening in the end of the instrument were used where a large evacuation was desired to be brought down from the higher parts. To destroy ascarides, cannulae with a circle of small holes placed laterally were used.
From ch. xxxii we learn that the injection pipe varied in length also, for Oribasius says that in making injections into the rectum for affections of the bladder (e. g. to excite expulsion of urine in cases of retention), the tube (τὸ κέρας τοῦ κλυστῆρος) ought to be short.
In the case of nutrient enemas Mnesitheus says the tube ought to be extremely long, and in admitting an injection one ought to keep up compression of the empty part of the clyster because it often happens that the injection returns from the rectum unless this is done (Oribas. viii).
Hippocrates (ii. 276) mentions inflation of the rectum with air by an enema in cases of ileus. A bladder is to be attached to a tube and the air injected with this. It is then to be removed and a clyster injected.
In the excavations of the Roman Hospital at Baden there was found the tube of a clyster in bronze. It is cast in one piece of stout bronze ([Pl. XXXVIII, fig. 2]).
Vaginal and Intrauterine Clysters.
Greek, μητρεγχύτης.
It is difficult to separate ancient descriptions of injections into the vagina from those into the uterus, for the terms for the two parts are frequently interchangeable. It is undoubted, however, that actual intrauterine injections were made. Hippocrates (iii. 17) says:
‘The end of the enema (i. e. the tube) is smooth like a sound. The tube is of silver. A perforation will be made in the side not far from the small tip of the tube (καθετήρ). There will also be other perforations, which will be placed at equal distances on each side of the tube throughout its length. The extremity of the injection tube will be solid, all the rest hollow. To the tube will be attached the bladder of a sow, which has first been well scraped. Place the milk of a mare in the bladder, having taken the precaution to close the perforations in the tube with a linen rag. The bladder is then closed with a cord and given to the woman herself, and she, when the cord shutting off the bladder has been removed, puts it inside the uterus. For she herself will know where it ought to be placed. Then you press the bladder with your hand as long as pus escapes.’
The description quoted already from Heister will help to make clear the description of the manipulation. There is in the Naples Museum (No. 78,235) an injection tube of bronze answering to the description given. It is 13 cm. long, and it has at the end a small opening, while on the side, not far from the tip, eight small holes are arranged in two superposed rings ([Pl. XXXVIII, fig. 1]).