Many well-meaning persons conceive the idea that, if hot water is so beneficial, they may use it as hot as possible for the purpose of an enema likewise, since they will thereby not only relieve the bowels of their stored feces but simultaneously do the inflamed tissues “a whole lot of good.” Their spirit is admirable, for not all patients are prompted to such thoughtful attempts to do everything in their power to get well--even though they err with the best intentions at heart. Let them remember, however, that the first effect of hot water is to increase the blood supply in the tissues if it be applied for a short time only. In the majority of cases, the enema does not require more than from five to ten minutes; hence, only harm can result if really hot water be used. Now and then a person will become possessed with the notion that a hot enema should be followed by a cold one, to bring “tone” to the lower bowels. But in all these misdirected efforts matters are made doubly worse. Cold water will allay fever and inflammation, but when its use is once begun it should be continued without intermission until a cure is effected. For this reason it is _not_ suitable where chronic inflammation exists--especially on the mucous membrane of the bowels. It is, however, excellent for acute inflammation of the external parts of the body, such as the hands, arms, legs, etc., where it can be continued without interruption for one, two, or three days if necessary. In beginning the treatment for constipation, there are a few cases in which the patient has to fuss for an hour or more with the enema before he can obtain any sort of a proper fecal evacuation; or there may be inability to expel the water from the bowels when once injected. This stoppage is most likely to occur at the recto-sigmoid juncture (O’Beirne’s sphincter). A strictured condition of the bowels causes retention of feces and gases and why not water as well? In such cases time would be saved, perhaps, by combining the procedure for an enema with that of a recurrent douche, which involves a continuous application of water at a temperature of from one hundred and twenty to one hundred and thirty-five degrees for an hour or more. Figure 21 illustrates a successful device for applying medicated water at a high temperature to the anus, rectum, and colon. This apparatus can be used while sitting on a water-closet seat and the treatment can be completed without changing position or removing the instrument.