Doses for Enemata.

The following simple rules should guide the practitioner in the employment of enemata :

1. Unless the remedy thus applied is excessively potent, three times as much of it should be injected per anum as would otherwise be administered by the mouth.

2. When it is desirable to retain the injection, the total amount of fluid should be small, not more than two or three fluidounces, and slowly injected, so that the bowel will not be excited to reject it. On the other hand, a large quantity should be used, as will be presently observed, when the object is to produce an evacuation of the bowels. A mucilaginous menstruum may sometimes be necessary, such as starch, barley-water, etc., to cover irritating qualities of the drug or to shield the bowel.

3. The appropriate quantity of fluid, at different ages, to be injected for purposes of evacuation, may be briefly stated as follows:

For a very young infant, f3j.

For a young child (1 to 6 years of age), for each year an additional f3j.

For a child 6 to 15 years of age, varying with age, from f3vj-x.

After 16 years of age, from f3x-xvj or more.

The quantity mentioned for each article is intended for a pint of water, only when the object of the enema is to produce an evacuation; otherwise, the rule of injecting a very much smaller quantity of fluid must be adhered to. The therapeutic action of each substance, in the form of enema, is appended :

A class of ENEMATA is officinal in the last edition of the British Pharmacopoeia, including the following:Enema aloës.-B. Aloës, gr. xl; potassii carbonatis, gr. XV; mucilaginis amyli, f3v.

Enema assafoetida.-B. Assafoetidæ, gr. xxx; aquæ destillatæ, fiv.

Enema magnesiæ sulphatis.—B. Magnesiæ sulphatis, 3j (avoir.); olei olivæ, f3j; mucilaginis amyli, fzxv.

Enema opii.-B. Tincturæ opii, mxxx; mucilaginis amyli, fžij.

Enema tabaci.-B. Tabaci foliorum, gr. xx; aquæ bullientis, f3viij.

Enema terebinthina.-B. Olei terebinthinæ, f3j; mucilaginis amyli, f3xv.

In addition to the articles just enumerated, quite a number of domestic remedies are similarly employed. No definite directions are necessary in regard to proportion or the quantity of these to be injected, other than the general rules already laid down. Among these may be mentioned the following:

Alcoholic liquors, barley, beef-tea, chocolate, coffee, flaxseed, gum Arabic, lard, molasses, mutton suet, oatmeal, slippery elm, starch, sugar, tapioca, tea, wines, yelk

of egg, and yeast. Their therapeutic action needs no further allusion.

When the object of the administration of an enema is its nutritive effect only, in cases in which, for some pathological cause, it is impossible for the stomach to receive. nourishment, one of the following formulæ will be found. serviceable:1

Beef-tea and Cream Enema.-Mix together from four to eight ounces of strong beef-tea, an ounce of cream, and half an ounce of brandy or an ounce and a half of port wine, and administer two or three times in the twentyfour hours.

Or, mix four or six ounces of beef-tea or restorative soup (see Dietetic Precepts), prepared without acid, one ounce of cream, two teaspoonfuls of brandy, and ten grains of citrate of iron and quinia.

If brandy is not indicated, take beef-tea, soup, or milk and eggs beaten together, and thicken with corn flour.

Cod-liver Oil and Bark Enema.-Mix four ounces of milk, one ounce of port wine, half an ounce of cod-liver oil, two drachms of tincture of yellow bark, and twenty minims of liquid extract of opium. Administer every twelve hours.

Quinine and Solution of Beef Enema.-Take one tablespoonful of brandy, five grains of sulphate of quinia, one teaspoonful of glycerine, two tablespoonfuls of cream, and from four to eight ounces of restorative soup or beeftea. Administer every six or eight hours. If the rectum. should be irritable, add fifteen to twenty minims of liquid extract of opium.

Baths and how to Medicate them.

The baths recommended by the practitioner vary in kind and the quantity of the material employed to mediTanner, Practice of Medicine, 5th Amer. edit., 1872, p. 1053.

cate them, as they vary also in temperature. The simplest forms of unmedicated baths, classified chiefly according to temperature (Fahr.), are the following:

of practical

The following formule will be found value in a variety of cutaneous, hepatic, and other affections.'

Arsenical Bath.-B. Sodii carbonatis, iv; sodii arseniatis, gr. xx-xxxv; aquæ calidæ, Cong. xxx.

Or, R. Sodii chloridi, 3j; sodii sulphatis, 3j; sodii carbonatis, 3ij; sodii arseniatis, gr. lii; aquæ calidæ, Cong.

XXX.

Or, B. Potassi sulphureti, 3iv; sodii arseniatis, gr. xxx -xl; aquæ calidæ, Cong. xxx.

Borax Bath.-B. Sodii boratis, 3iv; glycerinæ, f3iij; aquæ calidæ, Cong. xxx.

Conium and Starch Bath.-B. Extracti conii, 3j; amyli pulv. Hj; aquæ ferventis, Cong. xxx.

Or, the conium may be omitted, and a simple starch bath be employed.

Creasote Bath.-B. Creasoti, f3iij; glycerinæ, fživ; aquæ ferventis, Cong. xxx.

Gelatine Bath.-Dissolve bj of gelatine or common glue in a little boiling water, and add twenty gallons of hot water. To make it more efficacious, soak in it Ħbj-ij of bran confined in a muslin bag.

1 For several important suggestions in this place, the author is indebted to Tanner's Practice of Medicine, 5th Am. ed., Appendix, p. 1070.