ENTEROCLYSIS OF ICE-WATER 
IN THE 
TREATMENT 
OF 
INTESTINAL DISEASES OF CHILDREN. 
BY 
JULIUS L. SALINGER, M.D., 
Lecturer on Renal Diseases in the Jefferson Medical College. 
REPRINTED FROM THE THERAPEUTIC GAZETTE, NOVEMBER is, i8q2. 
DETROIT, MICH. : 
GEORGE S. DAVIS, PUBLISHER. 
1892. Enteroclysis of Ice*Water in the Treat- 
ment of Intestinal Diseases, 
of Children. 
THE object of this paper is to call attention 
to a mode of treatment of diseases of the 
intestines not generally known or practised. 
The treatment of diseases of the bowel by 
water is by no means of recent origin. G. 
Simon (Archiv fur Klinische Chirurgie, von 
Langenbeck, xv., Heft I., pp. 122, 123) was, 
however, the first to prove that water injected 
through the rectum, rapidly diffused itself 
through the bowel even to the small intestines, 
without harm to the patient. The method in 
which this can best be accomplished is to place 
the patient on the left side and elevate the hips. 
The knee-elbow position is also a very good 
one to accomplish the same object. Mader 
(Allgem. Med. Centralzeitung, Berlin, 1887, 
No. 27) proved upon the cadaver that by in- 
jections of even less than two quarts of water, 
the ileo-csecal valve was reached, and that 
by a forced injection of the same quantity of 
water, even the bowel beyond the valve has 
been reached. The method which, however, 
is to be preferred is that in which the water is 
allowed to slowly flow into the bowel, and at- 
tempts made to retain the water in the bowel 2 
for some little time. A simple rectal syringe 
is all that is required and not the elaborate 
irrigator which has been patented in Ger- 
many by Komp. Forced injections should 
never be used, nor should the water be al- 
lowed to flow quickly into the bowel, as un- 
pleasant and even dangerous symptoms have 
been seen to follow this procedure, such as 
headache, abdominal cramp (principally in 
the region of the umbilicus), vomiting, and 
severe symptoms of shock. No death has 
ever followed this method, as far as I have 
been able to learn. It is, however, a proce- 
dure which should always be carried out with 
care, and it should always be remembered 
that harm can ensue in the hands of an inex- 
perienced and ignorant operator. 
Various substances, antiseptic and other- 
wise, have been injected into the bowel. My 
plan has been to use ice-water. With its use 
I have observed the most beneficial effects in 
the treatment of intestinal diseases of chil- 
dren. My experience has been largely with 
children, and I have made an effort to treat 
only cases by this method which have proved 
very obstinate, and where other remedies 
usually useful have failed. A fair illustration 
is the following : 
Baby S. L., aged 2, has been troubled with 
vomiting and diarrhoea for two weeks. 
Vomiting took place immediately after taking 
food, and was accompanied by considerable 
retching. The stools varied from seven to 
twelve daily, and were at first tarry and 
offensive, later turning to yellow and a light 
clay color. The patient rapidly lost flesh and 
strength, and refused to take food. Fever 3 
was constantly present, ranging from ioo° to 
io2° F., but very irregular. The patient was 
given the ordinary chalk mixture, bismuth, 
tannic acid, opium, and salol, without the 
slightest effect. The only remedy that re- 
lieved the symptoms at all was salol. Under 
the use of this remedy the stools were re- 
duced to five, and even four, daily. It had, 
however, not the slightest effect on the tem- 
perature. Taking into consideration that the 
ordinary remedies had proven ineffective, 
the unwillingness and perhaps inability of 
the child to swallow, and the amount of fever 
present, I ordered injections of ice-water, 
beginning at first with a pint and increasing 
to a quart every four hours. This treatment 
was not at all painful, and the child offered 
no opposition. An ordinary fountain-syringe 
was used, the nozzle introduced into the 
rectum and the ice-water allowed to slowly 
trickle into the bowel. As the water came 
away, solid particles of faeces about the size 
and shape of a split pea were seen in the 
evacuation. The water had a slimy look and 
was quite offensive. The temperature taken 
before and after the injection showed a fall of 
3°,—from io2° to 990. The child seemed re- 
lieved and soon fell asleep. This treatment 
was repeated every four hours, until the child 
had five injections. On the second day the 
patient had three stools, which had lost their 
offensiveness and were becoming more solid. 
On the following day only two stools. The 
temperature never rose again above and 
the child took nourishment quite freely. 
There has been no return of the diarrhoea. 
This case is not an isolated instance. I have nine other cases to report in which ice- 
water injected into the bowel was the only 
remedy employed. All were speedily relieved 
and cured by this procedure. There is no 
necessity of detailing the cases, as the history 
quoted above is a fair illustration of all the 
rest. All began with vomiting and purging, 
more or less fever, anorexia, insomnia, etc. 
Rapid wasting is also a marked symptom of 
this affection and constitutes one of the chief 
dangers. Naturally there is no difficulty as 
to diagnosis, we are dealing with acute gas- 
trointestinal catarrh or cholera infantum. 
This disease is due to an accumulation of 
faeces in the intestinal tract undergoing de- 
composition, leading to large accumulations 
of bacilli and their ptomaines, which are 
subsequently reabsorbed and taken into the 
system, and produce a fixed set of symptoms 
already enumerated. The principal cause of 
the entire trouble is then in the intestine, and 
the chief aim of the treatment consists in 
removing the cause. It has been demon- 
strated that this cannot be accomplished by 
means of cathartics. It can, however, be 
safely undertaken by copious injections of 
ice-water according to the method already 
described. Very few children will resist or 
offer opposition, and the method is very easy 
of application. The quantity of water that 
should be employed will vary with the age 
of the child. About one pint of water for a 
child six months old will be found to be suffi- 
cient. This amount should be increased to 
a quart for children two years of age. It is 
rarely necessary to give larger quantities than 
this. 
4 5 
This affection is much less frequent in 
breast-fed children than in children that are 
artificially fed. It is, therefore, imperative in 
treating children that are brought up by the 
bottle, and especially in warm weather, to 
give them nothing but sterilized milk. 
That ice-water injections materially reduce 
the temperature I have had occasion to ob- 
serve in other diseases. In a case of scarlet 
fever, in a child 9 years old, this treatment 
was used to reduce the temperature. After 
injecting one quart of ice-water, the tempera- 
ture fell from to iox°, and remained 
so for six hours. Local sponging and bath- 
ing did not cause nearly the same fall of 
temperature, the maximum fall being about 
1 y<2,°. In enteric fever of adults, I have also 
seen the same decrease in temperature fol- 
lowing the injection of ice-water. The Ger- 
mans have been using injections of water by 
the bowel for some time in typhoid fever, and 
it is quite the rule to reduce temperature in 
this way. 
I have used ice-water injections largely, 
and have never seen any ill effects follow. 
On the contrary, the patient seemed to enjoy 
the cooling effects of the ice-water. For the 
treatment of intestinal diseases of children, 
and especially for the midsummer diarrhoeas, 
accompanied by vomiting, loss of flesh, and 
fever, it seems almost a specific. It has, to 
my mind, some very great advantages. The 
digestion of an already enfeebled stomach is 
not interfered with by prescribing remedies 
which are often in themselves difficult to 
digest and assimilate. Besides, the remedy 
may, in itself, be vomited, and so no benefit 6 
obtained. Secondly, the bowel is mechani- 
cally cleansed of masses of irritating, decom- 
posing faeces, containing bacilli and their 
ptomaines, which, by their reabsorption into 
the system, give rise to dangerous, and often 
fatal, consequences. Lastly, the temperature 
is materially reduced by a harmless and cer- 
tain therapeutic agent. JANUARY 15. 1893. 
WHOLE SERIES. VOL. PCVII. No. I. THIRD SERIES. VOL. JX.J 
THE 
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