It's a tobacco smoke enema (1750s-1810s), used to infuse tobacco smoke into patient’s rectum for various medical purposes, primarily the resuscitation of drowning victims. A rectal tube inserted into the anus was connected to a fumigator and bellows that forced the smoke towards the rectum.
The warmth of the smoke was thought to promote respiration, but doubts about the credibility of tobacco enemas led to the popular phrase "blowin'smoke up your ass".
It has been reintroduced by the Obama Administration as an integral part of the Affordable Care Act (ObamaCare).
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