The tobacco smoke enema, an insufflation

Insufflation (medicine)

Insufflation is the practice of inhaling a substance. Insufflation has limited medical use, but is a common route of administration with many respiratory drugs used to treat conditions in the lungs and paranasal sinus .The technique is common for many recreational drugs and is also used for some...

 of tobacco smoke into the rectum

Rectum

The rectum is the final straight portion of the large intestine in some mammals, and the gut in others, terminating in the anus. The human rectum is about 12 cm long...

 by enema

Enema

An enema is the procedure of introducing liquids into the rectum and colon via the anus. The increasing volume of the liquid causes rapid expansion of the lower intestinal tract, often resulting in very uncomfortable bloating, cramping, powerful peristalsis, a feeling of extreme urgency and...

, was a medical treatment employed by European physicians for a range of ailments.

Tobacco

Tobacco

Tobacco is an agricultural product processed from the leaves of plants in the genus Nicotiana. It can be consumed, used as a pesticide and, in the form of nicotine tartrate, used in some medicines...

 was recognised as a medicine soon after it was first imported from the New World

New World

The New World is one of the names used for the Western Hemisphere, specifically America and sometimes Oceania . The term originated in the late 15th century, when America had been recently discovered by European explorers, expanding the geographical horizon of the people of the European middle...

, and tobacco smoke was used by western medical practitioners as a tool against cold and drowsiness, but applying it by enema was a technique appropriated from the North American Indians. The procedure was used to treat gut pain, and attempts were often made to resuscitate victims of near drowning. Liquid tobacco enemas were often given to ease the symptoms of a hernia

Hernia

A hernia is the protrusion of an organ or the fascia of an organ through the wall of the cavity that normally contains it. A hiatal hernia occurs when the stomach protrudes into the mediastinum through the esophageal opening in the diaphragm....

.

During the early 19th century the practice fell into decline, when it was discovered that the principal active agent in tobacco smoke, nicotine

Nicotine

Nicotine is an alkaloid found in the nightshade family of plants that constitutes approximately 0.6–3.0% of the dry weight of tobacco, with biosynthesis taking place in the roots and accumulation occurring in the leaves...

, is poisonous.

Tobacco in medicine

Until its discovery and importation from the New World

New World

The New World is one of the names used for the Western Hemisphere, specifically America and sometimes Oceania . The term originated in the late 15th century, when America had been recently discovered by European explorers, expanding the geographical horizon of the people of the European middle...

, tobacco was unknown to western medicine. Europeans were not ignorant of the effects of smoke; incense

Incense

Incense is composed of aromatic biotic materials, which release fragrant smoke when burned. The term "incense" refers to the substance itself, rather than to the odor that it produces. It is used in religious ceremonies, ritual purification, aromatherapy, meditation, for creating a mood, and for...

 has been used since antiquity, and the narcotic effects of burning hemp seed was well known by the Scythians and Thracians

Thracians

The ancient Thracians were a group of Indo-European tribes inhabiting areas including Thrace in Southeastern Europe. They spoke the Thracian language – a scarcely attested branch of the Indo-European language family...

. The ancient Greek

Greeks

The Greeks, also known as the Hellenes , are a nation and ethnic group native to Greece, Cyprus and neighboring regions. They also form a significant diaspora, with Greek communities established around the world....

 physician Hippocrates

Hippocrates

Hippocrates of Cos or Hippokrates of Kos was an ancient Greek physician of the Age of Pericles , and is considered one of the most outstanding figures in the history of medicine...

 recommended the inhalation of smoke for "female diseases" as did Pliny the Elder

Pliny the Elder

Gaius Plinius Secundus , better known as Pliny the Elder, was a Roman author, naturalist, and natural philosopher, as well as naval and army commander of the early Roman Empire, and personal friend of the emperor Vespasian...

, as a cure for coughs. The Native Americans from whom the first western explorers learnt about tobacco used the leaf for a variety of purposes, including religious worship, but Europeans soon became aware that the Americans also used tobacco for medicinal purposes. The French diplomat Jean Nicot

Jean Nicot

Jean Nicot was a French diplomat and scholar.Born in Nîmes, in the south of France, he was French ambassador in Lisbon, Portugal from 1559 to 1561....

 used a tobacco poultice

Poultice

A poultice, also called cataplasm, is a soft moist mass, often heated and medicated, that is spread on cloth over the skin to treat an aching, inflamed, or painful part of the body. It can be used on wounds such as cuts...

 as an analgesic

Analgesic

An analgesic is any member of the group of drugs used to relieve pain . The word analgesic derives from Greek an- and algos ....

, and Nicolás Monardes

Nicolás Monardes

Nicolás Bautista Monardes was a Spanish physician and botanist.The genus Monarda was named for him.Monardes published several books of varying importance. In Diálogo llamado pharmacodilosis , he examines humanism and suggests studying several classical authors, principally Pedanius Dioscorides...

 advocated tobacco as a treatment for a long list of diseases, such as cancer, headaches, respiratory problems, stomach cramps, gout, intestinal worms and female diseases. Contemporaneous medical science placed much weight on humorism

Humorism

Humorism, or humoralism, is a now discredited theory of the makeup and workings of the human body, adopted by Greek and Roman physicians and philosophers, positing that an excess or deficiency of any of four distinct bodily fluids in a person directly influences their temperament and health...

, and for a short period tobacco became a panacea

Panacea (medicine)

The panacea , named after the Greek goddess of healing, Panacea, also known as panchrest, was supposed to be a remedy that would cure all diseases and prolong life indefinitely...

. Its use was mentioned in pharmacopoeia

Pharmacopoeia

Pharmacopoeia, pharmacopeia, or pharmacopoea, , in its modern technical sense, is a book containing directions for the identification of samples and the preparation of compound medicines, and published by the authority of a government or a medical or pharmaceutical society.In a broader sense it is...

 as a tool against cold and somnolence brought on by particular medical afflictions, its effectiveness explained by its ability to soak up moisture, to warm parts of the body, and to therefore maintain the equilibrium so important to a healthy person. In an attempt to discourage disease tobacco was also used to fumigate buildings.

The stimulation of respiration through the introduction of tobacco smoke by a rectal tube was first practiced by the North American Indians. An early example of the use of this procedure was described in 1809 by Thomas Sydenham

Thomas Sydenham

Thomas Sydenham was an English physician. He was born at Wynford Eagle in Dorset, where his father was a gentleman of property. His brother was Colonel William Sydenham. Thomas fought for the Parliament throughout the English Civil War, and, at its end, resumed his medical studies at Oxford...

, who to cure iliac passion prescribed first bleeding

Bloodletting

Bloodletting is the withdrawal of often little quantities of blood from a patient to cure or prevent illness and disease. Bloodletting was based on an ancient system of medicine in which blood and other bodily fluid were considered to be "humors" the proper balance of which maintained health...

, followed by a tobacco smoke enema:
Tobacco smoke enemas were also reportedly used by 19th-century Danish farmers, for horses that needed laxatives, and the US anthropologist Frank Speck

Frank Speck

Frank Gouldsmith Speck was an American anthropologist and professor at the University of Pennsylvania, specializing in the Algonquian and Iroquoian peoples among the Eastern Woodland Native Americans of the United States and First Nations peoples of eastern boreal Canada.-Early life and...

 reported that contemporary Catawba Native Americans

Catawba (tribe)

The Catawba are a federally recognized tribe of Native Americans, known as the Catawba Indian Nation. They live in the Southeast United States, along the border between North and South Carolina near the city of Rock Hill...

 also treated their horses using the technique.

Medical opinion

To physicians of the time, the appropriate treatment for "apparent death" was warmth and stimulation. Anne Greene

Anne Greene

Anne Greene , was an English domestic servant who was accused of committing infanticide in 1650.Greene was born in 1628, in Steeple Barton, Oxfordshire. She entered the household of Sir Thomas Read of the manor house at nearby Duns Tew as a domestic servant...

, a woman sentenced to death and hanged in 1650 for the supposed murder of her stillborn child, was found by anatomists to be still alive. They revived her by pouring hot cordial

Cordial (medicine)

A cordial is any invigorating and stimulating preparation that is intended for a medicinal purpose. The term derives from an obsolete usage. Various concoctions were formerly created that were believed to be beneficial to one's health, especially for the heart .Some cordials, with their flecks of...

 down her throat, rubbing her limbs and extremities, bleeding her, applying heating plasters and a "heating odoriferous Clyster to be cast up in her body, to give heat and warmth to her bowels." After placing her in a warm bed with another woman, to keep her warm, she recovered fully and was pardoned. Artificial respiration

Artificial respiration

Artificial respiration is the act of assisting or stimulating respiration, a metabolic process referring to the overall exchange of gases in the body by pulmonary ventilation, external respiration, and internal respiration...

 and the blowing of smoke into the lungs or the rectum were thought to be interchangeably useful, however, the smoke enema was considered the most potent method, due to its supposed warming and stimulating properties. The Dutch experimented with methods of inflating the lungs, as a treatment for those who had fallen into their canals and apparently drowned. Patients were also given rectal infusions of tobacco smoke, as a respiratory stimulant. Richard Mead

Richard Mead

Richard Mead was an English physician. His work, A Short Discourse concerning Pestilential Contagion, and the Method to be used to prevent it , was of historic importance in the understanding of transmissible diseases.-Life:The eleventh child of Matthew Mead , Independent divine, Richard was born...

 was among the first Western scholars to recommend tobacco smoke enemas to resuscitate victims of drowning, when in 1745 he recommended tobacco glysters

Enema

An enema is the procedure of introducing liquids into the rectum and colon via the anus. The increasing volume of the liquid causes rapid expansion of the lower intestinal tract, often resulting in very uncomfortable bloating, cramping, powerful peristalsis, a feeling of extreme urgency and...

 to treat iatrogenic

Iatrogenesis

Iatrogenesis, or an iatrogenic artifact is an inadvertent adverse effect or complication resulting from medical treatment or advice, including that of psychologists, therapists, pharmacists, nurses, physicians and dentists...

 drowning caused by immersion therapy

Immersion Therapy

Immersion therapy is a psychological technique which allows a patient to overcome fears .First a fear-hierarchy is created: the patient is asked a series of questions to determine the level of discomfort the fear causes in various conditions...

. His name was cited in one of the earliest documented cases of resuscitation by rectally applied tobacco smoke, from 1746, when a seemingly drowned woman was treated. On the advice of a passing sailor, the woman's husband inserted the stem of the sailor's pipe into her rectum, covered the bowl with a piece of perforated paper, and "blew hard". The woman was apparently revived. In the 1780s the Royal Humane Society

Royal Humane Society

The Royal Humane Society is a British charity which promotes lifesaving intervention. It was founded in England in 1774 as the Society for the Recovery of Persons Apparently Drowned, for the purpose of rendering first aid in cases of near drowning....

 installed resuscitation kits, including smoke enemas, at various points along the River Thames

River Thames

The River Thames flows through southern England. It is the longest river entirely in England and the second longest in the United Kingdom. While it is best known because its lower reaches flow through central London, the river flows alongside several other towns and cities, including Oxford,...

, and by the turn of the 19th century, tobacco smoke enemas had become an established practice in Western medicine, considered by Humane Societies to be as important as artificial respiration

Artificial respiration

Artificial respiration is the act of assisting or stimulating respiration, a metabolic process referring to the overall exchange of gases in the body by pulmonary ventilation, external respiration, and internal respiration...

.
By 1805, the use of rectally applied tobacco smoke was so established as a way to treat obstinate constrictions of the alimentary canal that doctors began experimenting with other delivery mechanisms. In one experiment, a decoction

Decoction

Decoction is a method of extraction, by boiling, of dissolved chemicals, or herbal or plant material, which may include stems, roots, bark and rhizomes. Decoction involves first mashing, and then boiling in water to extract oils, volatile organic compounds, and other chemical substances...

 of half a drachm of tobacco in four ounces of water was used as an enema in a patient suffering from general convulsion

Convulsion

A convulsion is a medical condition where body muscles contract and relax rapidly and repeatedly, resulting in an uncontrolled shaking of the body. Because a convulsion is often a symptom of an epileptic seizure, the term convulsion is sometimes used as a synonym for seizure...

 where there was no expected recovery. The decoction worked as a powerful agent to penetrate and "roused the sensibility" of the patient to end the convulsions, although the decoction

Decoction

Decoction is a method of extraction, by boiling, of dissolved chemicals, or herbal or plant material, which may include stems, roots, bark and rhizomes. Decoction involves first mashing, and then boiling in water to extract oils, volatile organic compounds, and other chemical substances...

 resulted in excited sickness, vomiting, and profuse perspiration. Such enemas were often used to treat hernias. A middle-aged man was reported in 1843 to have died following an application, performed to treat a strangulated hernia, and in a similar case in 1847 a woman was given a liquid tobacco enema, supplemented with a chicken broth enema, and pills of opium

Opium

Opium is the dried latex obtained from the opium poppy . Opium contains up to 12% morphine, an alkaloid, which is frequently processed chemically to produce heroin for the illegal drug trade. The latex also includes codeine and non-narcotic alkaloids such as papaverine, thebaine and noscapine...

 and calomel (taken orally). The woman later recovered.

In 1811, a medical writer noted that "[t]he powers of the Tobacco Enema are so remarkable, that they have arrested the attention of practitioners in a remarkable manner. Of the effects and the method of exhibiting the smoke of Tobacco per anum, much has been written", providing a list of European publications on the subject. Smoke enemas were also used to treat various other afflictions. An 1827 report in a medical journal tells of a woman treated for constipation

Constipation

Constipation refers to bowel movements that are infrequent or hard to pass. Constipation is a common cause of painful defecation...

 with repeated smoke enemas, with little apparent success. According to a report of 1835, tobacco enemas were used successfully to treat cholera

Cholera

Cholera is an infection of the small intestine that is caused by the bacterium Vibrio cholerae. The main symptoms are profuse watery diarrhea and vomiting. Transmission occurs primarily by drinking or eating water or food that has been contaminated by the diarrhea of an infected person or the feces...

 "in the stage of collapse".

Decline

Attacks on the theories surrounding the ability of tobacco to cure diseases had begun early in the 17th century. King James I

James I of England

James VI and I was King of Scots as James VI from 24 July 1567 and King of England and Ireland as James I from the union of the English and Scottish crowns on 24 March 1603...

 was scathing of its effectiveness, writing "[it] will not deigne to cure heere any other than cleanly and gentlemanly diseases." Others claimed that smoking dried out the humours, that snuff made the brain sooty, and that old people should not smoke as they were naturally dried up anyway.

While certain beliefs regarding the effectiveness of tobacco smoke to protect against disease persisted until well into the 20th century, the use of smoke enemas in Western medicine declined after 1811, when through animal experimentation Benjamin Brodie demonstrated that nicotine

Nicotine

Nicotine is an alkaloid found in the nightshade family of plants that constitutes approximately 0.6–3.0% of the dry weight of tobacco, with biosynthesis taking place in the roots and accumulation occurring in the leaves...

—the principal active agent in tobacco smoke—is a cardiac poison that can stop the circulation of blood.