A NOTE ON THE 
USE OF THE BIDET IN SURGERY. 
J. WILLIAM WHITE, M.D., 
DEMONSTRATOR OF SURGERY IN THE UNIVERSITY OF PENNSYLVANIA, 
ASSISTANT SURGEON TO THE UNIVERSITY HOSPITAL. 
BY 
FRqfM 
THE MEDICAL NEWS 
January 12, 1889. [Reprinted from The Medical News, January 12, 1889.J 
A NOTE ON THE USE OF THE BIDET INSURGERY 
J. WILLIAM WHITE, M.D , 
DEMONSTRATOR OF SURGERY IN THE UNIVERSITY OF PENNSYLVANIA, 
ASSISTANT SURGEON TO THE UNIVERSITY HOSPITAL. 
I desire to call the attention of the profession to 
a method of treatment which, although not altogether 
new, is yet not appreciated as, in my judgment, it 
should be. I refer to a moderately forcible stream 
of water of varying temperature in the treatment of 
a number of affections of the rectum, anus, and 
genito-urinary apparatus. The atonic and astringent 
effect of such a stream of water upon any living 
tissue is, of course, a well-understood1 fact, and has 
been employed in the arrest of hemorrhage, in the 
treatment of inflammation, and in various other 
conditions. But it has only been in exceptional 
cases, and usually by the aid of more or less trou- 
blesome apparatus that it has been used in the class 
of cases to which I now refer. 
The bidet, as I have now for a few years prescribed 
i Agnew (Surgery, vol. i. p. 445): “ There is something peculiar 
in the action of a fine stream of water; it produces a much more 
energetic contraction of muscular fibre than that caused by bathing 
or sponging.’’ 2 
WHITE, 
it, should be of the variety which can be attached to 
the water-closet seat habitually used by the patient. 
It should have a nozzle capable of throwing a stream 
ot about the calibre of an ordinary lead pencil or a 
little less. The head of water should be sufficient to 
make it impinge upon the parts exposed to it with 
enough force to excite there a little sensation of 
smarting and tingling. That degree of force will, 
for example, be sufficient to enable the patient to 
take an enema, or, if a female, to take a vaginal 
injection. The bidet pipe should be movable by 
means of a handle, so that the stream can be directed 
against any portion of the external genitals, the peri- 
neum, the anus, or the surrounding parts. It should 
also have connection with the hot and cold water 
supply of the house, so that the water may be used 
of any temperature which the physician may pre- 
scribe, or which the sensations of the patient may 
make desirable. Stopcocks should regulate the size 
and force of the stream, and should be so placed as 
to be easily reached by the hand of the individual 
sitting upon the water-closet seat. Such an apparatus 
can be put in place by an experienced plumber, in 
any ordinary water-closet, at an expense of from 
fifteen to twenty dollars ; and, in this city at least, 
the usual head of water obtainable even in third- 
story rooms is quite sufficient for all therapeutic 
purposes. 
The cases in which it may be desirable to use this 
method of treatment may be divided into two classes: 
first, those affecting the lower end of the bowel and 
its outlet; second, those involving the genito-urinary THE USE OF THE BIDET. 
3 
system. Among the first the most important are 
hemorrhoids, internal and external, prolapsus ani, 
and slight cases of prolapsus recti; pruritus ani and 
eczema of the margin of the anus should also be in- 
cluded in this group of cases in which it has now 
for some time been my habit to prescribe the system- 
atic employment, twice daily, of the bidet, once 
immediately after the daily stool, and for the second 
time, by preference, just before going to bed. As 
a rule, in all but the mid-winter months, the ordinary 
temperature of Schuylkill water is that to be pre- 
ferred, although I am largely governed by the feel- 
ings of the patient in this respect. An enema should 
be taken at each of these times, the lower portion of 
the rectum being thus thoroughly washed out at 
least twice daily, after which the stream of water is 
allowed to play upon the affected region for a period 
of from five to fifteen minutes. The ordinary and 
useful effect of cool sponging or washing immedi- 
ately after stool in cases of hemorrhoids is by this 
means enormously increased; internal hemorrhoids 
will, under this treatment, in many cases almost 
entirely disappear, unless they are exceedingly large 
and have been frequently inflamed or strangulated 
and badly neglected; external hemorrhoids, even 
when fleshy, will shrivel and become scarcely notice- 
able. 
I could detail a number of cases of this character 
taken from my practice of the last two years. In 
some instances in which I had been habitually called 
in, at intervals of a few months, in the cases of old 
people the result has been practically their disap 4 
WHITE, 
pearance from my list of patients; and they speak 
in the warmest manner of the great comfort which 
they have derived from this simple method of treat- 
ment. 
Perhaps nothing is more distressing among minor 
afflictions than the trouble described as pruritus ani, 
and variously attributed to liver disease, constipa- 
tion, gastric troubles, latent gout, uterine disease, 
parasites, neuroses, and a number of other causes, 
varying from the eating of shell-fish, or excessive 
smoking, to alleged hereditary predisposition. There 
are very few practitioners of any experience who 
have not discovered how difficult it is, in any par- 
ticular case of pruritus, to assign distinctly the annoy- 
ing symptoms to any one of these causes. Often the 
whole list may be carefully gone through and elimi- 
nated, or the proper remedies may be applied suc- 
cessively, as different theories are adopted, without 
the slightest benefit resulting. Ointments, lotions, 
ordinary cool bathing will be tried in great variety, 
but without avail; and such patients will often go 
from one physician to another, or will fall into the 
hands of quacks while seeking relief. My list of 
cases of this character which I have now treated by 
means of the “bidet” comprises eight, one of which 
it may be worth while to mention in a little more 
detail. 
Mr. —, aged thirty-five, a lawyer by profession, 
of somewhat sedentary habits, but in good general 
health, applied to me, in January, 1887, on account 
of a long-continued pruritus, which, he said, was 
simply making life miserable to him; he was a 
man of great intelligence, who had secured the best THE USE OF THE BIDET. 
5 
medical advice in this and other cities, and who gave 
a graphic description of his sufferings. Whenever, 
after sitting for a time at his desk, the buttocks and 
perineum became warm, itching would begin, and 
would presently become intolerable, so that he would 
be absolutely obliged to rise, and, if he was not alone, 
to make some excuse to leave the room, in order to 
obtain ease, temporarily, by scratching. At night, 
after he became warm in bed, his trouble—as is usually 
the case with such patients—became much worse, so 
that often a large part of the night was rendered sleep- 
less, and the sleep which he did procure was broken 
and disturbed. He frequently awakened with a start, 
finding himself digging at the parts with his nails. 
He was losing flesh rapidly, was becoming unable to 
attend to the ordinary duties of his profession, was 
annoyed and mortified, even when in court trying 
cases, by the almost irresistible impulse which he felt 
to apply friction to the irritated region, and naturally 
was intensely depressed and despondent. 
He brought me copies of the prescriptions which 
had from time to time been given him, and which 
covered almost the entire ground of the above men- 
tioned list of possible causes. I had —fortunately for 
him and for myself—just been successful in a case of 
much less severity, in procuring relief and apparent 
cure by means of the bidet; I promptly prescribed it 
for him, instructing him, as it was January, to use the 
water at a temperature a little short of tepid, and 
prescribed, in addition, only an ordinary oxide of 
zinc ointment, for the relief of a little eczematous 
irritation produced by his scratching. His improve- 
ment was immediate and marked, and at the end of 
two weeks he said that he had merely a trace of his 
former trouble, which soon after entirely disappeared, 
and he has ever since remained free, although he has 6 
been compelled to take long trips away from home, 
and thus obliged to intermit his treatment. 
Some of my other cases are of equally striking char- 
acter. They have nearly all resulted in cure; requir- 
ing to attain that end simply different lengths of time 
of the application of the douche, with variations in 
the temperature of the water, and occasionally the 
use of some emollient salve. I have been particu- 
larly struck by the fact that these cases include among 
their supposed causes widely distinct conditions, and 
the uniformity with which they have yielded to this 
simple treatment has led me to regard with suspicion 
the orthodox etiology of the disease. In procidentia 
ani, and in slight cases of prolapsus recti, I have had 
very satisfactory though, of course, less striking 
results. In a few instances the trouble almost en- 
tirely disappeared, and in all of them it was dis- 
tinctly relieved. These cases require for their suc- 
cessful treatment a much longer application of the 
douche, and the water should, in my judgment, be 
at one or the other extremes of temperature, either 
quite cool, or as hot as can comfortably be borne. 
I am quite aware that the use of cold water in 
these affections is not in the least a novel plan of 
treatment; but the method under consideration 
combines the effects of temperature with a sufficient 
force of the stream, and admits of the prolonged 
application of the remedy without effort on the part 
of the patient, who is in the most suitable position 
for this treatment, practical points which induced me 
to make this mention of my results in rectal and anal 
cases. 
WH ITE, THE USE OF THE BIDET. 
7 
Agnew says of pruritus, that among the local 
remedies frequent ablutions with cold water should 
be mentioned ; and of prolapsus ani et recti, that 
“ in all cases where remedies have proved unavailing, 
or where patients have declined an operation, much 
good may be done by douching the parts with cold 
water and applying an oiled compress ; ’ ’ and Ailing- 
ham says of the same class of cases, that “the 
frequent and bountiful application of cold water is 
to be most strongly recommended; ” but few authors, 
so far as I know, have especially alluded to the 
method of application by means of a bidet. 
My second class of cases includes, chiefly, certain 
prostatic troubles, varicocele, atonic impotence in 
the male, and pruritus of the vulva or vaginitis in 
the female. In cases of varicocele, although I have 
not succeeded in effecting a cure in any instance by 
this method, I have certainly seen advancing en- 
largements of the spermatic veins become stationary; 
long, relaxed, and pendulous scrotums become firm 
and much smaller; and the mental condition of the 
patient—which is so important an element in many 
of these cases—share in the improvement. In 
chronic prostatitis, a most intractable and distressing 
ailment in many instances, it has come to be a part 
of my routine treatment to order the use of cold 
perineal douches by means of the bidet, associated 
with frequent cool enemata given in the same 
manner; and I believe to-day that if I had to dis- 
card all therapeutic measures but one in these cases, 
I would retain this one. In a certain number of 
cases of impotence associated with general muscular 8 
THE USE OF THE BIDET. 
weakness, loss of tone, lack of general strength and 
vitality, accompanied by imperfect or rapidly sub- 
siding erections, I have found that the cold douche 
applied with some force and for considerable lengths 
of time to the perineum and testicles has been pro- 
ductive of marked benefit. 
In two cases of pruritus vulvie my results have been 
good, though less striking than in the similar disease 
affecting the region of the anus. In vaginitis, where 
the woman has sufficient intelligence to learn how 
to take an injection by means of the bidet, it 
offers an admirable method of cleansing the vagina, 
of carrying away thoroughly all accumulated secre- 
tions, of reducing heat and swelling, and at the same 
time of avoiding the frequent introduction into the 
inflamed canal of a foreign body in the shape of the 
nozzle of a syringe. My opportunities for observa- 
tion in this class of cases have been limited, owing 
to the disinclination of these patients to procure the 
bidet, and owing to their irregular habits of life and 
their frequent changes of residence ; but I have seen 
enough of its good results to make me feel confident 
that it is a valuable addition to our therapeutic 
agencies. 
After all, in every one of the cases which I have 
mentioned, its use is simply the application of the 
most elementary and common-sense principles to 
everyday practice, but I am satisfied that this par- 
ticular method of applying these principles has not 
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