Dix-Huit

Who needs Enemas?

Why The French Are The World’s Largest “Consumers” of Suppositories.

According to European medical lore, the English and the Dutch prefer to take their medication in pill form, the Germans go for an injection and the French, it seems, like to shove it up their butts.

Medical treatment varies from country to country not just by disease but by culture. In 2003, the Vanderbilt Institute for Medicine, Health and Society noted “that the preference for different dosage forms – more pills in America, more parenterals (for injection) in Germany, more suppositories in France – is fraught with cultural significance”.

Basically, the French take their medicine by the path less travelled by, either as a solid capsule (a rectal suppository or vaginal pessary) or in liquid form as an enema. 

These are not only prescribed when the patient is unable to receive oral medication, they are administered for almost any ailment “and that means everything”, as novelist Lawrence Durrell learnt to his consternation, “from coated tongue to tertiary gangrene”.

According to their health ministry, four out of five French people shoved something pharmaceutical up one or other of their orifices in 2003. Doliprane is the French version of paracetemol and it outsells its pill form by a factor of 60 to 1. Aventis, France’s largest manufacturer of suppositories, sold 300 million of them in 2004, and they all have to end up somewhere. 

There is no real reason for administering a drug rectally unless there is a specific need to avoid liver metabolisation (which occurs with pills taken orally). The French just seem to like it and they are encouraged to get used it to at an early age. The website of the French Health Ministry provides pages of advice to young mothers on the best way of stuffing baby like a turkey “so you can get on with your busy, happy life”. 

The suppository has always been deeply embedded in French history. As a child, Louis XIII was regularly given clysters (a kind of rectal wash-out administered with a syringe the size of a bazooka) in the presence of numerous lookers-on, by his mother. This may or may not explain how he matured into a flamboyant homosexual but he certainly passed on his tastes to his son, Louis XIV who, according to memoirist the Marquis de Saint-Simon, became a “clystéromane”, an enema maniac. 

Louis XIV himself had many thousands of clysters and had his hunting dogs regularly douched. According to Saint-Simon, clysters were so popular at Versailles “that the duchess of Burgundy had her servant give her a clyster in front of the King (her modesty being preserved by an adequate posture) before going to the theatre”. Possibly she was on her way to see Molière’s Le Malade Imaginaire. (The Hypochondriac) whose hero, Argan is always on the verge of impalement by some syringe-wielding quack. Louis XIV was eventually to die of an anal fistula the size of a boot which historians suspect was brought about by an over-enthusiastic clystering.

It was not only the French royals that enjoyed this back alley work. Voltaire, the father of French philosophy, had a strong preference for soap enemas. He wrote eloquent passages about a small English enema device that he used. The painter Matisse believed that coffee enemas would cure his increasing blindness but being, well, rather short-sighted, once had to be prevented by his wife from douching himself with bleach. In the early 1920s, the elderly and housebound writer Anatole France found the best way to meet women was to invite warm-fingered nurses over to his house to administer smoke enemas. 

Today France’s strange predilection for blocking the main exit has, if anything, intensified. Maybe even over-intensified. In 2004, ANAES (Agence Nationale d'Accréditation et d'Evaluation en Santé, the National French Agency for Accreditation and Health) issued a stern warning to modern day French clystéromanes, citing the case of the two Orly women who died following excessive enema use. Their deaths were attributed to fluid and electrolyte abnormalities. One took ten to twelve coffee enemas in a single night and then continued at a rate of one per hour. The other took four daily. As ANAES points out, "in both cases, the enemas were taken much more frequently than was necessary for healthy and sociable use".

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The Enema of My Enemy... The French appetite for enemas and their like has often been cause for ridicule by their neighbours and, at times, for overt propaganda. “One particularly explicit political cartoon by Dutch artist Romeyn de Hooghe shows Louis XIV, identified by a sun-burst on his head, sitting atop a terrestrial globe, impaled upon a large clyster syringe. Lacking the necessary commode, the contents of the royal bowel, successfully loosened by the procedure, spill over the world. Holland seems to get the worst of it, with various German cities (Heidelberg, Offenburg, etc.) also receiving the exalted anal effluvia... In the eyes of a Dutch satirist, the military, religious, and territorial policies of Louis XIV, embodied in the enema syringe and the incontinence resulting from its use, have befouled the earth.” Laurinda S. Dixon, Art Journal, 1993.

Was Napoleon His Own Worst Enema? According to a new study conducted by the San Francisco medical examiner's department, Napoleon Bonaparte was killed by too many uncomfortably large enemas. An autopsy performed straight after Napoleon's death, by his personal physician, revealed that he had died from stomach cancer. But over the decades historians have disputed this explanation, suggesting either that the exiled leader might have died from toxic ingredients in his hair ointment, or was poisoned by his confidant Charles de Montholon. But after a detailed study of the medical records, forensic pathologists in California have focused on the daily enema he had to relieve the pain caused by the cancer. "They used really big, nasty syringe-shaped things," Steven Karch, head of the researchers, told New Scientist magazine. In the final crisis of Napoleon's illness, the doctors' decision to administer a purgative of 600mg of mercuric chloride (five times the usual amount) on 3 May 1821 would have further reduced his potassium levels – and may have been fatal. He died two days later, aged 51.