The origins of colon hydrotherapy date back to ancient times. As far back as the Ebers Papyrus of 1552 BC (the document from which we learned about the main medical practices of the ancient Egyptians) we find information about the use of enemas as a remedy for more than 20 intestinal and gastric symptoms. Drugs, herbs and juices were administered using pumpkins as reservoirs, through pipes and blowpipes made with dry papyrus leaves.

According to William Liebermann, confirmation of the frequent use of enemas by the Egyptians comes from Herodotus, who in the 5th century wrote: "The Egyptians purify themselves for 3 consecutive days each month, keeping themselves healthy with emetics and enemas because they believe that all diseases comes to man from the food which he eats"

Even the ancient Greeks and Romans made a contribution to the history of colon hydrotherapy. Hippocrates (4th and 5th century BC) used enemas in the treatment of fevers and other bodily ailments. The Roman physician Asclepiades of Bithynia (2nd century BC), considered one of the fathers of the Roman medicine, preferred to use enemas rather than laxatives for the treatment of intestinal worms and fevers. Proceeding in a chronological order, the next written quotation on the use of the enema is in the "De Medicina" of Celsus (25 BC - 50 AD): "This remedy should not be too often repeated, nor should it be too hot or too cold." The Greek physician Galen (129-199 AD) was also a supporter of the enema: unlike Aetius, a Greek doctor of the sixth century who suggested enemas of water alone, Galen prescribed enemas of various types, including those with oil and honey.

The first documented device for colon hydrotherapy was in fact the enema syringe. However, who invented it, is not known for certain. The use of a hollow cylinder with a mobile plunger to draw up and inject liquids was known in ancient times. Heron of Alexandria, who lived about 100 years before Christ, described a device which drew up fluids by means of a vacuum effect, and in a sixteenth-century Latin translation of his work a depiction of a syringe was added to illustrate the original text. Lieberman attributed the first description of the syringe to Avicenna (980-1036 AD). Although we cannot be sure that some objects found in Roman archaeological excavations worked on the same principle, it is known that the great surgeon and Arab physician Albucasis of Cordoba (1013- 1106) described one in the surgery section of his work Al Tasrif (handbook). This was written towards the end of the tenth century and it remained the basic textbook for many centuries to follow. Spink and Lewis reproduced this work of Albucasis in a publication in the Wellcome Institute of the History of Medicine using two Arab manuscripts and giving an English translation on the opposite page. It seems probable that this concerns a small syringe with a plunger. In fact, the description given by Albucasis leaves no doubt. The device " is made of silver or ivory, is hollow with a long fine tube like a probe; it is entirely hollow except for the end. [...] The hollow part containing the plunger is of such a size that the plunger seals it; thus liquid is drawn up when it is pulled out and is issued in a jet when it is pushed down". This demonstrates that small syringes did exist at the time of Albucasis. However, he claimed to use this invention for cleaning ears and for injecting a fluid into the patient's bladder through the urethra, not for colonic irrigation. He did not suggest the use of the syringe described above for enemas, perhaps because it was too small and delicate, but presented a completely different device instead. This was a rigid shaped tube with two adjacent protuberances between which the edge of an animal membrane could be tightly bound. This served as a container for the liquid and was compressed by hand. This is basically a bag connected to a rigid cannula, i.e. a type of device which was common up until the sixteenth century. After describing the two parts and the entire device, Albucasis explained in detail how to use it when administering an enema.

During the Middle Ages knowledge about enemas continued to spread and their use became fashionable among the affluent sections of the population, reaching as high as the royal families. Naturally, this growth in popularity was followed by the evolution of the related instruments.

One of the first apparatus described is that developed by Fabrizio Hildano. In addition to the now popular concept of the bladder, he introduced clamps to control the flow of fluid from the bag. These had the added benefit that other liquids could be added during treatment without removing the irrigation cannula.

The use of enemas continued to rise and by the time of the famous English surgeon John Ardene (1307-1390) they were used "extensively by Englishwomen of that day...". Ardene wrote a treatise entitled "Treatise of Fistula-in-ano, Haemorrhoids and Clysters"" in which he advised that the use of enemas with complicated formulas, composed of various ingredients, should be abandoned because, he maintained, they left the patient more constipated than before. Ardene recommended that everyone, constipated or not, should purge themselves at least three or four times a year to maintain good health.

In 1480, the King of France, Louis XI, suffered a stroke which was cured by an enema administered under the direction of his doctor, Angelo Catho, who wrote: "The King became such a strong supporter of enemas that he had them administered to his dogs when he felt they needed it."

The first reliable illustrations regarding the use of a syringe to administer enemas in fact date back to the fifteenth century. One, perhaps the first, appears in the 1497 book Das Buch der Cirurgia by Hieronymus Brunschwig, almost hidden amongst countless other surgical devices. A syringe of the same type, this time in use, is clearly seen in a wooden bas-relief of the same century preserved in the Gruuthuse museum in Bruges. It was probably an apothecary's sign and the rather odd scene shows the home administration of an enema to a woman through a window.

By the sixteenth century, the syringe was favoured by the majority of doctors and apothecaries but there were still some who preferred the old-fashioned enema bag. The usual syringe, however, was not suitable for self-administration by the patient. Thus as early as 1564 the famous French surgeon Ambroise Paré, in his Dix Livres de la Chirurgie, presented a device invented by him for that purpose alongside a normal syringe. However, this device seems to have worked by gravity rather than being a syringe as it was shown with a lid over the cylindrical part but no plunger. Nevertheless, Paré described it, a little strangely, as " another syringe for the modest woman, who will be able to administer the enema herself".

The 17th century became known as "the age of the enema." In Parisian society it was fashionable to use three or four enemas a day, in accordance with the popular belief that internal cleansing was essential for good health. This popular acceptance by the public helped to "remove" enemas from the hands of the apothecaries and druggists, in whose domain they had previously been.

The enema reached its peak in the early years of the reign of Louis XIV (1638-1715) whom, it is said, received more than 2,000 enemas during his lifetime. The King occasionally received visitors and court officials while undergoing an enema.

In this period syringes came in various forms. They could be of copper or porcelain, but the rich had syringes made of mother of pearl and silver. It was considered good practice to have a variety of syringes and some aristocratic families actually owned substantial collections of these devices.

The great Dutch physician and physiologist Reinier de Graaf, who died aged 32 in 1673, noted that although many patients refused to have enemas administered by strangers out of modesty, all the then existing devices which allowed self-administration, such as the old-fashioned bag linked to a cannula or syringes with curved or right-angled cannulae, had serious drawbacks and limitations. So de Graaf decided to develop and present his own device. This was a normal syringe equipped with a flexible, impermeable tube joining the cylinder and the cannula. To this end de Graaf wrote a treatise, which was published in 1668 as the second part of the triptych De Virorum Organis Generationi Inservientibus, de Clysteribus et de Usu Siphonis in Anatomia, and he also displayed an illustration of his flexible tube. According to de Graaf, with his new device patients could manage without an apothecary, or they could protect their modesty by remaining under the covers whilst the apothecary just operated the syringe. Shortly after the publication of his treatise, in which amongst other things, apothecaries were exhorted not to be hostile to the device's spread, de Graaf wrote (in a letter) that he was still having difficulty finding an ideal material for the construction of the flexible tube.

One type of syringe which had a certain success between the eighteenth and nineteenth centuries comprised a tubular metal connector which was attached to the body of the device on the one hand and to the cannula on the other, forming a double right angle. The patient sat down carefully on the cannula and pushed down the plunger of the syringe with both hands. This device was sometimes incorporated into a stool. A variation of this device, with a screw-type plunger, was originally published by Giovanni Alessandro Brambilla in 1781 in Instrumentarium Chirurgicum Viennese.

In the first half of the nineteenth century three English inventors began competing to produce and promote new enema devices, which were (according to them) superior to all the previous ones, and in particular to the traditional syringe. Their names were John Read (who was not a doctor but had a particular talent for mechanics), Edward Jukes (a surgeon and strong proponent of enemas) and James Scott (a medical surgeon who advocated frequent enemas and was probably the most prolific writer on this topic). The devices suggested by these inventors were remarkably similar, and all were small syringes used as pumps with an intermittent suction and pressure action. The first of these devices was patented by Read in 1820 and recommended in his two very similar books in 1824, An Appeal to the Medical Profession and A Vindication of Read's Patent Syringe.

In 1846 the French doctor Éguisier introduced a device he called an " irrigateur". This was also known much later under his name and was particularly useful for self-administering enemas as no pumping action was required by the patient. The device, approved by the Académie Nationale de Médecine, was a large vertical syringe fitted with a tap, a flexible tube connected to a cannula and a spring-actuated mechanism. The irrigator was such a great success, especially in France, that some very elegant models with enamelled decoration were produced. It was also sold in England towards the end of the century and there is an illustration of one in the 1895 Harrod's department store catalogue. They were the most expensive enema devices (approximately 3 times the price of new gravity type irrigators and 6 or 7 times the price of a bulb type) but were nevertheless not abandoned until after 1930.

In France, they appeared even in the illustrations of erotic novels of the time, perhaps because of their stylish looks...

In 1872, another British doctor, W.L. Shepard, presented two small enema devices of his own invention, called Simplex and Facilis, in an article published almost simultaneously in The Lancet and The British Medical Journal. In this article Shepard criticized the shortcomings of the traditional brass syringe, Éguisier's irrigator and the rubber pumps of Higginson and Kennedy, but did not mention the previous devices of Read, Jukes and Scott, which were clearly the predecessors of his own. The Simplex consisted of two small vertical cylinders of which the upper one, which had a smaller diameter and was supported by a spring, was inserted into the lower one like a plunger. The liquid was drawn up through a valve contained in the bottom of the device and was pushed out through another side valve connected to a flexible tube. The entire apparatus was only 4 inches high and could be operated with one hand. The Facilis was very similar but was only 3 inches high and had two side tubes with valves, one for the entrance and one for the exit of the liquid, plus a third for reflux of the liquid.

Continuing the evolution in the development of the equipment, one of the most original pieces was the "Plombieres", designed by De Langenhangen. This device was introduced in 1898 and allowed the patient to perform the procedure in a recumbent position. The pressure and the flow of water were adjustable.

The Viennese pathologist Anton Brosch is considered the pioneer of subaquatic intestinal cleaning. He administered the liquid for irrigation through a tube that was inserted into the intestine of the patient before they entered the bath. In the bath itself, hot water carried away all the expelled faeces close to the tube. He later installed a waste pipe right next to the anus so that it would absorb most of the faeces. In 1922 Dr Olpp studied Brosch's method and modified the apparatus as it was unsatisfactory in terms of hygiene. From this moment it became known as subaquatic intestinal cleaning. The intestinal tube and the funnel for the faeces were provided with sealing gaskets, so less faeces were left in water of the bath. A spherical valve was inserted into the intestinal tube to control the pressure, reducing the risk of intestinal perforation.

The Kennison Hydrotone was one of the first "open" systems. It was composed of an all-metal table, with taps for hot and cold water and a basin for drainage, all connected hygienically to the water supply pipes. The operator sat at the side of the table and all the controls were to hand. The irrigation cannula was of hardened steel and allowed both inflow and outflow so that continuous irrigation was possible.

The next development was the Dierker apparatus, one of the first "closed systems" and described by Waddington as "a device promoting physiological peristalsis and working free the contents of the pockets and diverticula...". It was produced in two models, corresponding to the different ways of administering colon hydrotherapy. In "high" colon hydrotherapy, the irrigation tube was inserted for more than a metre into the intestine through the rectum, allowing the water to literally "wash" the intestinal contents out of the anus. In "low" colon hydrotherapy, that which is still performed currently, the rectal tube is replaced by a speculum or anoscope which is inserted into the rectum for 6-10 cm, so allowing the water to soften the faecal contents slowly, starting with the rectum and continuing though the sigmoid colon to the various other parts of the colon.

It was produced in two models, corresponding to the different ways of administering colon hydrotherapy. In "high" colon hydrotherapy, the irrigation tube was inserted for more than a metre into the intestine through the rectum, allowing the water to literally "wash" the intestinal contents out of the anus. 

In 1906, Dr Kellogg, a surgeon in the American state of Michigan, published an extensive treatise on colon hydrotherapy; he recommends it for many medical conditions in his book, including hepato-biliary diseases, surgical shock, colitis and cholera. The importance of colon hydrotherapy was emphasized by many doctors of that period, amongst whom Dr James A. Wiltsie and Dr Joseph E.G. Waddington are particularly remembered. The latter, in a publication entitled " Scientific Intestinal irrigation and Adjuvant Therapy", outlines the position of many of his contemporaries, stating that " abnormal functioning of the intestinal canal is the precursor to much ill-health, especially of chronic disease. Restoration of physiological intestinal elimination is often the important preliminary to eventual restoration of health in general". Dr Wiltsie maintained that " our knowledge of the normal and abnormal physiology of the colon, and of its pathology and management, has not kept pace with that of many organs and systems of the human body. As long as we continue to assume that "the colon will take care of itself, we will remain in complete ignorance of what is perhaps the most important source of ill health in the whole body"". Dr Norman Walker, known throughout the world for having written several books on how to achieve and maintain a balanced state of well-being (being himself the best example of his teachings as he lived peacefully until he was 118 in excellent physical condition) wrote, around half a century ago, in his book dedicated to colon health: "no treatment or healing procedure should ever be started without first giving the patient a series of colon irrigations". At the end of the nineteenth century the Russian biologist Metchnikoff, Director of the Pasteur Institute in Paris and winner of the Nobel Prize for Medicine in 1908 for studies on the biology of intestinal bacterial flora, used to say that " death begins in the colon".

However, the practice of colon cleansing by inadequately trained personnel with no medical experience, together with the consequent lack of professional supervision and appropriate studies, led inevitably to there being resistance to it being accepted by other conventional medicine practitioners during this first " pioneering"phase.

From the 40's onwards, the instruments used in colon hydrotherapy continued to evolve and in the early 50's this type of treatment was flourishing in the United States. The prestigious Beverly Boulevard in Los Angeles used to be known as "colonic row". However, in the mid-60s the use of colonic irrigation and colon hydrotherapy began to decline until the early 70s, when most of the equipment for colon hydrotherapy was removed from hospitals and care homes to be replaced by colostomies, laxatives and single-use enemas.

In conclusion, since the beginning of the last century colon hydrotherapy has known moments of popularity alternating with complete rejection.

Today, the improvements modern technology has made in the instruments used in colon cleansing (in particular as regards safety) and the training of specialized therapists, mean that colon hydrotherapy is becoming established as an effective therapy in the treatment of some diseases and as an aid for correct body homeostasis. Research is currently underway, on a national and international level, to evaluate the benefits of colon hydrotherapy and its various applications. Together with a balanced diet, physical exercise and a positive mental attitude, colon hydrotherapy can play an important role in achieving and maintaining a state of real well-being.


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