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diff --git a/old/53836-0.txt b/old/53836-0.txt deleted file mode 100644 index f1552ea..0000000 --- a/old/53836-0.txt +++ /dev/null @@ -1,5788 +0,0 @@ -The Project Gutenberg EBook of Intestinal Irrigation, by Alcinous B. Jamison - -This eBook is for the use of anyone anywhere in the United States and most -other parts of the world at no cost and with almost no restrictions -whatsoever. You may copy it, give it away or re-use it under the terms of -the Project Gutenberg License included with this eBook or online at -www.gutenberg.org. If you are not located in the United States, you'll have -to check the laws of the country where you are located before using this ebook. - -Title: Intestinal Irrigation - Why, How and When to Flush the Colon - -Author: Alcinous B. Jamison - -Release Date: December 30, 2016 [EBook #53836] - -Language: English - -Character set encoding: UTF-8 - -*** START OF THIS PROJECT GUTENBERG EBOOK INTESTINAL IRRIGATION *** - - - - -Produced by Thiers Halliwell, deaurider and the Online -Distributed Proofreading Team at http://www.pgdp.net (This -file was produced from images generously made available -by The Internet Archive) - - - - - -Transcriber’s notes: - -The text of this book has been preserved in its original form -apart from correction of two typographic errors: incidently → -incidentally, flouroscopic → fluoroscopic. Inconsistent hyphenation -has not been altered. - -In this transcription italic text is denoted by _underscores_. A -caret (^) indicates that the following bracketed characters are -superscripted. Footnotes have been numbered and positioned below the -relevant paragraphs, and some illustration captions have been moved -closer to the relevant text. - -Numbering and labelling of illustrations is somewhat flawed, although -it is hardly noticeable in this plain text version. Figure 20 does not -exist and figures 18–24 are not in correct numerical sequence. The text -has several references to figures 25, 26, 27 and 29 but these do not -exist as figures in their own right – the numbers actually identify -labelled items in figure 18. - - - - -[Illustration: _Hargrave_ - - _5^{th} Ave. & 37^{th} St._, - New York.] - - - - - INTESTINAL - IRRIGATION - - OR - - WHY, HOW, AND WHEN TO - FLUSH THE COLON - - TREATED IN CONNECTION WITH OTHER MATTERS - OF PHYSIOLOGICAL INTEREST AND - IMPORTANCE - - BY - - ALCINOUS B. JAMISON, M.D. - - AUTHOR OF “INTESTINAL ILLS,” “HOW TO BECOME - STRONG,” ETC. - - _Published by the Author_ - - THIRD EDITION - - NEW YORK CITY - - 43 West Forty-fifth Street - - 1914 - - - - - COPYRIGHT, 1914 - - BY - - ALCINOUS B. JAMISON - - - - - “Even from the Body’s Purity, the Mind - Receives a secret sympathetic aid.” - - --_Thomson._ - - - - -PREFACE. - - -Within the last three decades the diagnosis and treatment of bowel -troubles have been greatly changed through improved instruments, -technique, hygienic measures, and various remedial agents. - -The domain of surgery of the anus, rectum, etc., has been surprisingly -limited, and that of gastro-intestinal hygiene enlarged, together with -knowledge of man’s assimilative and eliminative organs. Systemic and -local hygiene has supplanted drugs and surgery in the treatment of -diseases of the anus, rectum, sigmoid flexure, and vermiform appendix. -Indeed, the domain of surgery will be restricted to what are still -considered incurable diseases if the suggestions of this volume are -widely adopted. From a clinical experience extending over a period of -thirty-three years, however,--as a specialist in diseases of the anus, -rectum, and intestinal machinery generally,--the author feels warranted -in maintaining that, if hygio-therapic measures were taken by both -physicians and laymen, surgical clinics and hospitals for “operating” -on anal and rectal diseases and the administering of countless -medicinal remedies would enter the stage of therapeutic oblivion. - -The present work is more comprehensive in its scope than its title, -_Intestinal Irrigation_, would at first thought seem to indicate. It -is a practical book on home relief for all the symptoms of that form -of internal inflammation known as proctitis and colitis. The measures -that may safely be taken by the victim himself, without consulting a -physician, are minutely explained; and, that he may understand his own -case, every chapter goes more or less extensively into anatomical, -physiological, and pathological details. - -The author has kept abreast of the advancement of science in relation -to his special branch of the healing art, and as the outcome of his -large daily experience in this line he feels qualified to speak with -authority. Victims of any of the symptoms described in this book may -therefore have confidence in its statements. It conveys a message of -common sense to the world at large and to the victims of intestinal -ills in particular. It is a compilation of clinical talks to the -author’s patients, making plain a variety of symptoms arising from a -single primary cause. - -As the purpose of the book is pre-eminently practical, the author -felt warranted in describing minutely his own clinics, so far as -any patient could apply the results to his individual needs. This, -therefore, is the author’s excuse for introducing his own appliances -and describing their features and uses. Certain work must be done by -the sufferer himself, and no other invention in the market will aid him -so materially in doing this work scientifically and efficiently. - -Furthermore, it was found impossible for the author to describe what -he himself was doing as a rectal specialist, or to direct sufferers on -the road to relief, unless he stated how certain appliances should be -employed. In the following pages, consequently, the reader will learn -just what to do, for the work is above all things simple and direct, -and in the writer’s judgment has the sterling quality of common sense. - -Some of the chapters have already appeared, in abridged form, in -the magazine _Health_, as contributed essays; but the text has been -elaborated in the following pages and much new matter added, in order -that the work should present the most mature information concerning the -subjects discussed. - - A. B. J. - - New York, March 2, 1914. - - - - -CONTENTS. - - - CHAPTER I. PAGE - - Efforts to Overcome Constipation without Seeking its Cause 1 - - CHAPTER II. - - Pathology of the Anus and Rectum; or, The Genesis - of Constipation 8 - - CHAPTER III. - - The Formation of Channels, Piles, and Fistulas 19 - - CHAPTER IV. - - Undue Retention of Gas and Feces in the Sigmoid Flexure 28 - - CHAPTER V. - - Rebellion of our Outraged Internal Economy 35 - - CHAPTER VI. - - Gaseous Obesity and our Roly-polies 46 - - CHAPTER VII. - - Irrigation of the Assimilative and Eliminative Organs 57 - - CHAPTER VIII. - - Methods of Stomach Cleansing 65 - - CHAPTER IX. - - When Enemas should be Taken 72 - - CHAPTER X. - - How Enemas should be Taken 84 - - CHAPTER XI. - - The Internal Fountain Bath 90 - - CHAPTER XII. - - Benefits of the Inner Bath 101 - - CHAPTER XIII. - - Objections to the Use of the Enema Answered 108 - - CHAPTER XIV. - - Lame Back 121 - - CHAPTER XV. - - Uric Acid 126 - - CHAPTER XVI. - - Rational Sanitation and Hygiene 136 - - CHAPTER XVII. - - Personal Cleanliness 145 - - CHAPTER XVIII. - - Hot Water in the Treatment of Proctitis and Colitis 152 - - CHAPTER XIX. - - Hot Water in the Treatment of External Symptoms 162 - - CHAPTER XX. - - The Health of School Children 165 - - CHAPTER XXI. - - Internal Hemorrhoids or Piles versus Mucous Sac, Recto-Anal - Mucous Sac 171 - - CHAPTER XXII. - - External and Thrombotic Piles versus Muco-Cutaneous Sac and - Thrombus 181 - - CHAPTER XXIII. - - Abscess and Fistula Involving Anus, Rectum and Neighboring - Regions 190 - - CHAPTER XXIV. - - Nine Radiograph Illustrations Showing Mucus Channels and - Cavities 200 - - CHAPTER XXV. - - Chronic Mucous Proctitis and Sigmoiditis--Usually Diagnosed - as Chronic Mucous Colitis 202 - - CHAPTER XXVI. - - Antiseptic Employment of Powders and Oils 208 - - - - -INTESTINAL IRRIGATION. - - - - -CHAPTER I. - -EFFORTS TO OVERCOME CONSTIPATION WITHOUT SEEKING ITS CAUSE. - - -In the year 1496 an Italian, Gatenaria, invented an appliance for -taking an enema; since that time depuratory instruments have had more -or less vogue in all civilized countries. Of late years inventive -powers have been taxed to construct more convenient and effective -appliances, and now perfection has been almost reached, and the poor -civilizee, whose habits are really very bad from the savage point of -view, may enjoy the delicious privilege of an internal bath whenever he -feels the need of it. By any other name this bath is just as purifying: -call it irrigation, injection, lavement, clyster, enema--its many names -and what they mean testify to the fact that it is for the disease of -civilization. - -The medical profession is really behind the layman in -genuine therapeutic measures. It still cares more for the -pill-and-powder-prescription-earning fee than for the real health of -the patient. When it shall wean itself from its sordid commercialism, -it will make the use of the enema a fundamental factor in most forms of -therapeutic treatment, and then the enema will become universal. - -From the origin of the enema to the present day, the layman has not -been unmindful of this valuable resource for removing morbid matter -from his physiological sewer. The great relief he thus obtained, and -the invariably good results that followed its use, established as a -necessary toilet article some form of depuratory apparatus in many -homes for all time to come. - -But of the nature of the disease that had occasioned its use, both -layman and physician were, and for the most part are, ignorant. Local -obstruction and discomfort were sufficient to suggest this mode of -relief; yet no truly scientific inquiry seems to have been instituted -to discover the cause of the obstruction. The author, during an -experience of over twenty-three years as a specialist in diseases -of the bowels, rectum, and anus, has found the true cause, namely, -PROCTITIS; that is, the chronic inflammation (dating often from infancy -and childhood) of the anus, rectum, and frequently of a portion of -the sigmoid flexure and colon. Proctitis is practically the universal -cause of chronic constipation. Victims of constipation have more or -less haphazardly resorted to the enema as a ready means of relief--a -recourse that was often, nay generally, against the advice of their -medical counselor: a professional opposition that indicates either -ignorance, mistaken judgment, or fear of losing a profitable patient. -But the layman has not been uniformly wise. He is an experimenter on -his own hook--encouraged in his experiments by the most promising -and seductive of advertisements in the whole gamut of advertising. -He experimented on his organism, tinkering it now with cathartics or -purgatives of multiform nature, and again with digestive and other -agents. This tinkering habit seems to have become all but universal -with civilized man. Constipation--which is caused by proctitis--will, -of course, bring indigestion and biliousness and diarrhea and -nervousness and headache and a host of other maladies in its train; all -of these induce the civilizee to increase his tinkering with his divine -abode until it eventually falls in ruins. The tinkerer loses sight of -the fact that his abode is not a body like the bodies of wood, stone, -and iron that he handles and putters with daily; he forgets or ignores -the fact that it is a vital organic machine, which, when tinkered too -much, will stop, “never to go again.” It is poor consolation when you -have reached your last gasp, after a chronic invalidism, to feel that -you have done the best you knew how. You have not sought the cause, -nor, having learned it somehow, sought to remove or avoid it. For the -last four hundred years this tinkering, this futile medication, has -been kept up at a furious pace without even a hope of permanent cure. -Poor, outraged human nature dimly knew that it was simply doctoring a -symptom, a _consequence_ of something or other--for that is all that -constipation and its host of symptoms really are. - -The writer is of the opinion that constipation is the fundamental -disease that afflicts mankind; that, at all events, there are more -cases of proctitis than of any other disease; that very few “civilized” -persons are free from it; that so prevalent a disease must have a -common origin, which he traces right back to babyhood, to the wearing -of soiled diapers, a practice that cannot but result in inflammation of -the buttocks and mucous membrane of the anus and rectum; and that this -inflammation continues and finally becomes deepened and established, -producing in after years chronic constipation and its train of evils. -Of course, there are other causes that bring on proctitis among -children and adults; but careful examination shows that the severity -of the malady with its train indicates long duration in the tissues -comprising the wall of the anal and rectal canals and the adjoining -tissues of the bowels. - -Proctitis, with its extension, colitis, is by no means a slight -disease, as it is supposed to be by a few members of the medical -fraternity who are beginning to apprehend its existence; on the -contrary, it is so serious that its gravity cannot be impressed too -forcibly upon both laymen and physicians. During the many years of -special attention the writer has given to diseases of the anus, rectum, -colon, etc., he has not ceased to wonder how it was possible that the -victim of deep-seated proctitis could have so dreadful a disease -and not be greatly alarmed at its ravages and dangers. The anatomy, -physiology, and hygiene of the parts involved in this inflammation -continue in some manner to permit the passage of excrement along the -diseased canal; and the victim continues to swallow drugs and tinker -with these--his irreplaceable “inards.”[1] - - [1] For numerous illustrations of the various morbid conditions of - the anus and rectum, see the author’s 64-page booklet, entitled _How - to Become Strong_. - -It is not my purpose at present to go into a detailed description of -the organs involved in this inflammatory process, but to make plain why -the enema is superior to all other means of securing cleanliness. When -we know why we do a thing, the task is not so difficult and annoying -as when we go it blind or simply obey the behest of a physician. -Ignorance has no business bothering with anything; experience, however, -is usually a painful if not a fatal instructor. The human race at -large is ignorant concerning the normal and abnormal processes of its -internal organs. “Out of sight, out of mind” seems to be the maxim of -almost every one as to our vital organs and the conditions for their -hygienic functioning. The purpose of the writer will be achieved if he -succeed in sounding a note of warning that will be heard and heeded by -those whose influence will extend the echoes till the world listens and -learns the claims of the inner physiological economy. - -Those that possess even a modicum of sense will easily understand how -a muscular tube like the anus, rectum, sigmoid flexure, etc., when -invaded and traversed for eight to ten or more inches by disease, will -offer obstruction to the descent and escape of gases and feces. All -are familiar with the contraction that occurs when a finger, hand, or -limb is inflamed; how little we can then use the diseased part until -all of the inflammation has left the muscular tissue. Why do we give -so much attention to an inflamed external part and none at all to the -all-important internal organ for the expulsion of the sewage of the -body? The parts are not “weak” when contracted with inflammation: -weakness is not what is the matter with them. The trouble is that -the muscular fiber is then too active, made so by the excessive -irritation of the local disorder. Irritation of muscular tissue always -causes contraction of its fiber. Such contraction well accounts for -constipation. - -We are a nation of constipated people, so constipated indeed that we -have developed dyspepsia and neurasthenia. As I have already stated, -the chief ill of “civilized” people is proctitis; the chief symptom -of proctitis is constipation; the chief symptom of constipation is -dyspepsia; and the chief symptom of dyspepsia is neurasthenia, and so -on and on--all of them the outcome of imperfect elimination of morbid -matter from the intestinal canal. - -The common sense learned in the treatment of external parts should be -applied to such diseased portions of the body as the anus, rectum, -etc. Common sense declares that an enema ought to be used on all -occasions of undue retention of the contents of the bowels. It is the -only sensible thing under the circumstances. Yet, for the last four -hundred years, only independent men and women have had the courage to -proclaim its merits, since the subject was under the ban of both laymen -and physicians. Now that we have learned the absolute necessity of such -a device, it is to be hoped that the taboo will be removed, and that -the numerous victims of proctitis will be instructed in the wisdom of -availing themselves of the valuable aid of the enema in either curing -proctitis or preventing it from growing worse, while they are at the -same time securing relief through its use by the removal of feces and -gases several times daily, thus preventing the absorption of poison, -which the retention of waste invariably facilitates. - - - - -CHAPTER II. - -PATHOLOGY OF THE ANUS AND RECTUM; OR, THE GENESIS OF CONSTIPATION. - - -When an affliction is seemingly universal it is reasonable to conclude -that it springs from universal conditions. Proctitis, the most -widespread disease of civilized man, originates very early in life, and -develops in after years numerous painful symptoms--such as piles or -hemorrhoids, constipation, etc. - -Now, what is the most common exciter of proctitis, which, as has been -said, is an inflammation of the mucous membrane of the anus and rectum? -In my earlier work, _Intestinal Ills_, I have shown that inattention to -the soiled diaper is generally the original cause of this most grievous -of ills, with its train of malign consequences continuing throughout -the victim’s life on earth. Unnoticed by nurse or mother, the -inflammation of the anus and rectum makes headway with each subsequent -soiling; and thereafter, when the use of the diaper is dispensed with, -inattention to the normal action of the bowels, improper food, the -resort to purgatives, stimulants, and opiates, play no small part in -aggravating the existing malady. - -[Illustration: Fig. 1. - -A portion of the wall of the rectum has been removed exposing various -layers: 1, serous layer; 2, muscular layers; 3, 3, submucous layers; 4, -4, mucous membrane; 5, internal sphincter muscle; 6, external sphincter -muscle; 7, circular muscular bands forming the rectum; 8, rectum; -9, sigmoid flexure. (See Fig. 7, showing the longitudinal muscular -bands.)] - -The first care-taker of the infant is therefore responsible for the -initial process, which progresses to a chronic condition by subsequent -inattention. She is indeed solicitous over the inflamed buttocks of her -charge, but overlooks the far more dangerous inflammation of the mucous -membrane of the anus and rectum, or she does not realize its insidious -and subtly progressive character. Candidates for motherhood should be -instructed on this momentous subject. - -[Illustration: Fig. 2. - -_a_, Ulcer on sphincter ani. _b_, Filaments of two nerves are exposed -on the ulcer, the one a nerve of sensation, the other of motion, both -attached to the spinal marrow, thus constituting an excito-motory -apparatus. _c_, Levator ani. _d_, Transversus perinei. (Hilton.)] - -There are other exciting causes of proctitis, but, since they are -exceptional when compared with the neglected diaper, we need not -concern ourselves with them at present. - -The muscular coat of the rectum consists of two layers: an inner -circular and an outer longitudinal band. The inner circular layer of -muscular tissue of the rectum forms the internal sphincter muscle; -and the outer longitudinal bands merge with those of the external -sphincter. The anal orifice is closed or guarded by two strong -sphincter muscles, as shown in Figs. 1, 2, and 3. These muscles are -abundantly supplied with nerves, of which branches are distributed to -the bladder and other adjacent organs, which accounts for the sympathy -of these organs and their grave disturbance when disease inheres in the -anus and rectum. - -[Illustration: Fig. 3. - -_a_, Sacrum. _b_, Coccyx. _c_, Tuberosity of ischium. _d_, Posterior -or larger sacro-sciatic ligament. _e_, Anterior or small sacro-sciatic -ligament, with the pudic nerve passing over its posterior aspect, and -proceeding to the rectum and penis. _f_, Sphincter ani receiving its -nervous supply from the pudic nerve. Portions of the muscles have -been cut away, in order to show nerve filaments going to the mucous -membrane, through the muscular fibers. _g_, Levator ani. _h_, Fat -and areolar tissue occupying the ischiorectal fossa and covering the -levator ani. _i_, Transverse muscles of perineum. _k_, Erector penis. -_l_, Accelerator urinæ. 1, Pudic nerve. 2, Posterior sacral nerves -proceeding to posterior part of the coccyx and to the sphincter ani. 3, -Anterior sacral nerve (4th) supplying the sphincter ani. (Hilton.)] - -The orifice used for the elimination of undigested food and waste -matter plays quite as important a part in the organic economy as the -orifice that is employed for receiving food. Normal elimination, -physiological and psychological, is the correlative process to -prehension (seizure or appropriation), and the concord of the two forms -the key-note of the organism. - -The muscles and tissues constituting the anal vent should be as -flexible and responsive to the will or desire of the rectum for relief -of its contents as the lips are in permitting the saliva to escape. -In like manner the upper portion of the rectum (Figs. 6 and 8) should -respond with instant readiness to the effort of the sigmoid flexure to -expel its contents. But an abnormal condition like inflammation rooted -in the anus and lower part of the rectum (Fig. 1, 4–4) will inhibit the -passage of the pressing burden above them, which inhibition will cause -the inflammation to extend to the sigmoid flexure, and thence on to the -colon proper; and sooner or later the inflammation will penetrate the -submucous coat (Fig. 1, 3–3), which is composed of fatty or areolar -connective tissue in which trunks of nerves and blood-vessels are -imbedded. - -The first symptom of inflammation is undue redness, followed by -slight puffiness of the anal and rectal mucous membrane (Fig. 1, -4–4), with more or less sensitiveness of the tissues involved; and -as its irritability increases there is more or less contraction of -the muscular tissue forming the anus and rectum, which lessens the -diameter of their bore. And the consequence of this contraction -is of physiological concern to the victim, for in proportion to -the contraction the normal demand of the victim for relief of the -impending feces and gas is modified and lessened. - -In health, the anal canal is from two to three inches in length, and -it will distend about two inches--an elasticity quite equal to that -of any other orifice of the body. As the anal tissues are usually the -first to be invaded by disease, it is but natural that the obstipation -or constipation should occur right above it--namely, in the rectum. The -average length of the rectum is about six inches, and when the disease -invades its whole length the constipation occurs in the sigmoid flexure -and may thence extend to the colon. - -The filling of the intestine with feces and gases usually occurs just -above the diseased portion of the gut; but at the same time the walls -of the affected part of the canal are more or less coated with feces, -and its abnormal pouches here and there contain more or less liquefied -or dried feces. A diseased canal cannot expel all of its contents, -since its normal expulsive power is gone. Some of the feces somehow or -other gets down and out, but a larger portion inevitably remains. It -is for this reason that a diseased intestine always reminds one of the -Augean stable. It is simply marvelous that the human body continues as -a living organism with so much filth and bacterial poison stored in its -alimentary canal, and the vaults that result from abnormal pressure -during periods of fecal impaction (Fig. 4). - -When the inflammatory process extends up the rectum and at the same -time into the spongy, fatty, or areolar tissue under the mucous -membrane (Fig. 1, 3–3), thence to the muscular and serous layers -(Fig. 1, 2–1), or through the four layers of tissue comprising its -wall, we have a more marked and serious occlusion (closing) of the -organ than when only the mucous membrane was affected. When muscular -tissue is inflamed, its tendency is to contract and become solidified -by an adhesive inflammatory product secreted between the circular -and longitudinal muscular fibres (Fig. 1, 7, and Fig. 7). Often the -circular or sphincter muscles forming the anal canal have to be -distended to bring about a more normal vent. The same pathological -conditions that occasion contraction of the anal bore or caliber occur, -more or less, as far up the gut as the disease has advanced. - -In a normal state of the lower bowel the sigmoid flexure passes its -contents into the rectum, and the desire to defecate is reported--that -is, the impulse to stool becomes more or less urgent until it is -performed. But when all four coats of the anus and rectum are diseased, -with perhaps a portion of the sigmoid flexure also, it is very -difficult for the healthy portion of the sigmoid flexure and the colon -to discharge their contents into the rectum; consequently no call, -impulse, or desire reaches the mind. Constipation will then ensue, for -the stool, not being called for, is not performed. Every demand of a -healthy portion of the intestine is answered by increased contraction -of the muscles of the diseased portion of the rectum. While the war -between the healthy and the diseased sections of the bowels goes on, -the victim naturally concludes that there is no occasion or demand for -defecation, and he attends to other affairs, ignorant of the fact that -he is thus making a fatal mistake. - -The first condition that ensues is the tendency of the rectum to fill -unduly with feces and gases, impelling the victim to “strain” in -order to force the feces through the constricted anal canal. After a -while the sigmoid flexure and colon will fill unduly, and then the -victim will form the habit of waiting for the feces to descend, and of -straining to expel what little manages to escape through the diseased -gut. - -A portion of the imprisoned feces in the healthy section of the -intestine sometimes, at an unguarded moment, manages to distribute -itself along the length of the diseased and constricted canal, where -it is retained indefinitely, increasing the local irritation. And when -the fecal mass accumulates sufficiently in both the healthy and the -diseased portions of the intestines to set up a vigorous excitement, -the victim may, by the aid of his waiting and straining habit -(which habit, by the way, only torments and bruises the chronically -diseased organs), bring on some sort of evacuation. In the early -history of the disease this habit may serve for a time; but, as the -disease progresses, the “laxative” habit is formed, which, in turn, -settles into a chronic “drug” habit for all sorts and conditions of -gastro-intestinal and other ills, which inevitably ensue. As the -ravages of chronic inflammation of the anus and rectum increase, the -symptoms rapidly multiply, till finally the victim, in desperation, -feels that he must find additional sources of relief--and, among other -habits, he forms the “diet” habit. - -The order of abnormal habits brought into existence by ulcerative -inflammation of the anus, rectum, and colon is about as follows: (1) -the habit of unduly retaining the feces in the rectum; (2) the habit of -straining at stool; (3) the habit of unduly retaining the feces in the -sigmoid flexure; (4) the habit of resorting to the use of purgatives, -pepsin, and other drugs; (5) the chronic “physic” habit; (6) the -foolish “diet” habit; (7) the gastro-intestinal neurasthenic habit; (8) -the health-resort habit; (9) the habit of trying desperately to appear -agreeable while feeling really ill; (10) the habit of blaming the liver -for all direful feelings, physical and mental. - -It is but natural that the lower portion of the rectal and anal -structures should be affected more severely than any other portion of -the intestines by the ulcerative, inflammatory process. The sphincter -muscles are very strong, as a rule, and fill their office only too -well when the anal and rectal canals are in a diseased state, for -they effectually prevent the contents from escaping. Often their -contraction or stricture is so great that their expansion is limited to -from one-fourth to one-half an inch. This virtually permanent closure -of the anal vent naturally results in an accumulation of feces just -above it, or in the lower portion of the rectum, which accounts for the -dilatation, stretching, or ballooning of the anal and rectal tissues -immediately above these muscles, as shown in Fig. 4. - -[Illustration: Fig. 4. - -1, The dotted lines indicate the normal direction of the anus and -rectum; 2, 4, the cavities or pouch formed by dilatation or ballooning -from the storage of impacted feces; 3, a probe bent at right angles, -and introduced through a speculum, to ascertain the depth of the pouch, -which is frequently found to be two and a half inches.] - -In not a few cases where dilatation of the rectum exists, the upper -half or more of the anal canal is also dilated, leaving an anal canal -only an eighth of an inch in length in some cases; in other cases, -perhaps half an inch to an inch. - -Similar dilatation of the sigmoid flexure occurs as the result of the -severe contraction of the upper half of the rectum, and especially at -the bend shown by Fig. 6 and Fig. 12. This bend forms quite a sphincter -for the normal receptacle--the sigmoid flexure. Here also prolapse, -distention, and dislocation of the sigmoid flexure may occur, somewhat -similar to the anal prolapse from disease and abuse. - -Piles and itching of the anus are symptoms of proctitis, or -inflammation of the anus and rectum. Why should we find such dissimilar -symptoms proceeding from the same cause? The reason is plain when we -consider the results following chronic inflammation of the mucous -membrane of the anus and rectum and the deeper tissues. Those who -suffer from catarrh of this membrane are familiar with the discharge -of mucus that appears from time to time during the progress of the -inflammation. But, as the inflammation penetrates the mucous membrane -and the underlying tissues of the anus and rectum, the escape of the -inflammatory product is prevented; and this imprisoned fluid must -either be absorbed by the system or retained in reservoirs or in -channels wherever the least resistance is offered to its invasion. - -The mucous membrane of the anus and rectum is loosely attached to the -subjacent parts by areolar tissue (Fig. 1, 3–3), which is sufficiently -lax to allow an expansion of two inches; and in a puckered or -contracted state the membrane is thrown into folds, or into shallow -or deep wrinkles. The loose areolar attachment and folds of various -depths afford space for lodgment of the inflammatory discharge, which -channels its way down along the folds through the areolar tissue under -the mucous membrane to that of the integument, and so on for a distance -of a foot or more from the anus in some cases. - - - - -CHAPTER III. - -THE FORMATION OF CHANNELS, PILES, AND FISTULAS. - - -Should channels, of varying length and numbers, form early in the -development of proctitis, the sufferer is usually found to be free from -piles, or hemorrhoids, for the reason that the channels have afforded -an outlet to the inflammatory product. The formation of lengthy -channels also prevents to a great extent the development of skinny tabs -round about the integument of the anus. This is some compensation to -the sufferer for the labor of scratching and for enduring the painful -itching so often present. Some suffer only from pain along the channels -themselves, while others experience a slight disturbance of the nervous -system; yet all must be more or less poisoned from the absorption of so -large an amount of the contents of the channels and cavities. - -In the cavities and along the channels the areolar tissue is of a -mahogany color, and no channel is traced to its end so long as the -tissues present a bruised, inflamed appearance. In some cases the -inflammatory product has destroyed the areolar tissue attached to the -integument at and near the anus, frequently to the extent of leaving a -hollow space or cavity of surprising dimensions. I have met only a few -cases in which the channels were opened by pus forming in them. Those -that are very shallow, the walls being friable, may break and form a -fissure of the anus; or a little anal fistula may arise from a slight -suppuration at its end in the integument near the anus. - -In cases where the channels are few and short, whether itching be -present or not, the pile tumors are likewise few and of moderate size, -demonstrating the intimate relation of the aggravation of either of the -symptoms or the moderation of both in the same case. Very frequently -pile tumors have channels extending from them to the junction of -the mucous membrane and integument of the anus, or even under the -integument about the anus, forming rugæ, or tabs. - -The number and size of pile tumors would seem to depend on how -completely the inflammatory product is imprisoned in the tissues in -what is termed the “pile-bearing” region. Often the treatment of piles, -or hemorrhoids, aids very much in the cure of itching at the anus--by -destroying a part of the channels involved in the pile structures in -the mucous membrane of the lower end of the rectum and extending along -under the anal membrane and the integument of the anus. - -The meshes and layers of the mucous membrane, as well as the space -occupied by the areolar tissue, are stretched or pouched by the -inflammatory product. - -My observation forces me to conclude that the inflammatory product -imprisoned in the areolar meshes, between the mucous membrane and the -muscular layers, is the principal factor in forming piles and the -channels so often found in the same region. Of course, obstructed -circulation, congested veins, capillaries, and arterioles, and a more -or less apparent varicose condition, increase the size of the pile -tumors and the general thickness of the mucous membrane over the region -affected by the disease. - -The process occasioning the separation of the mucous membrane from its -areolar attachment or bed often extends the whole length of the rectum, -giving the mucous membrane the loose and raised appearance that a piece -of thin silk would have if laid on over that surface. The fatty or -areolar tissue under the skin about the anus suffers likewise by being -destroyed, leaving a hollow cavity or a large channel of great length -under the skin. The separation of the mucous membrane and integument -about the anus from their areolar attachment permits of prolapse of the -mucous membrane and integument that form the anal canal and skin around -the orifice. - -It would seem that the channels, pile sacs, and cavities serve as -temporary reservoirs for the inflammatory product, a portion of which -the system absorbs and another portion of which escapes through the -mucous membrane and integument. In escaping in this way it occasions -itching and pain. The itching or soreness does not in all cases extend -throughout the whole length of the channel. A few inches of the channel -farthest from its origin may be the seat of the greatest disturbance, -and the sufferer and physician alike are usually unaware that the -source of the trouble is in the tissues of the anus and rectum. - -The marked improvement in the health of those that have been cured of -both the morbid condition produced by the inflammatory product and the -cause of that condition is evidence that the general vitality of the -system had been greatly lowered, even though the most annoying of the -symptoms, such as piles, itching, or acute pain, had not been present. -The lack of annoyance along the channel for a certain period may be due -to a limited production, or to a rapid absorption of the inflammatory -product by the system. - -Proctitis and the attendant symptoms just described have been -overlooked by the medical profession. Physicians have confined their -attention to two symptoms--piles and fistula. After undergoing a -surgical operation for these, the patient is considered cured. What -ignorance, or rather short-sightedness, to remove only the annoying -symptom, and then to pronounce the patient healed! Let me ask my -professional brethren why they do not concern themselves with the -underlying _cause_ of the symptom or symptoms, and whether they suppose -this cause is going out of business. Surely it is a grave mistake to -concern one’s self with the leading symptom merely--to remove that, -and to leave its cause intact. When the disease-producing cause remains -to generate its poisonous effects in the system, opportunities exist -for further symptoms to develop. - -The system may be already depleted of vitality, and the harsh treatment -for the purpose of removing a mere symptom may only make the sufferer’s -condition more deplorable--if it does not indeed cause death. - -There are other symptoms of proctitis than piles and fistula, which -remain after the conventional surgical operation for their removal. -Obstipation and constipation are usually symptoms of proctitis, and -will persist until the inflammation in the upper half of the rectum and -sometimes in a portion of the sigmoid flexure is cured. - -The victim of proctitis has two marked sources of poisoning of the -system: one proceeding from the absorption of the inflammatory product, -and the other from undue retention of the waste matter of the body that -should pass out by the lower bowel. - -Inflammation of a mucous membrane causes structural changes in the -tissues involved in the morbid process, and not infrequently it becomes -the seat of a malignant disease. - -The reader may be familiar with the white, loose, alveolar -(honeycomb-like) network of elastic tissue (called fat) just under the -skin and mucous membrane. Consult in this connection the cut on page 24. - -[Illustration: Fig. 5. - -Male pelvic organs viewed from the right side (the right ilium and a -portion of the ischium and the pubic bone, together with their soft -parts, have been removed). 1, auricular surface of the sacrum; 2, -tuberosity of the sacrum; 3, ischium; 4, pubic bone; 5, psoas muscle; -6, erector spinal muscle; 7, glutei muscles; 8, obdurator muscles; -9, external sphincter of anus; 10, rectum; 11, sigmoid flexure; 12, -bladder; 13, ureter; 14, vas deferens; 15, seminal vesicles; 16, -prostate; 20, lateral vesicle ligaments; 21, hypo-gastric artery; 22, -hypo-gastric vein; 23, external iliac artery; 24, abdominal aorta. -(Boas.)] - -The abdominal and pelvic organs are cushioned or held in place -somewhat by the network of fatty tissue that surrounds them, and -the rectum is no exception to the rule. The outer or serous wall is -surrounded by an abundance of loose areolar tissue, which is divided -into cellular spaces. When this tissue also is invaded by inflammation, -the condition is spoken of as periproctitis; and we have a result -somewhat similar to that which occurs in the areolar tissue just under -the mucous membrane and integument, as previously described. - -As the inflammatory product is discharged into this spongy or fatty -connective tissue it is slowly forced in some direction, which is -naturally downward, if not too much obstructed by firm tissue; at all -events, it follows the line of least resistance and forms usually quite -a large channel and several cavities along its course. The channel may -begin at an elevation of four or more inches on the outside of the -rectum (Fig. 5). Should it form in front of the rectum, the seminal -vesicles (15) and the prostate gland (16) would suffer greatly by its -presence. - -As the inflammatory process burrows its way downward, it finally -reaches the soft fatty connective tissue under the skin. It then -continues along this in one or more directions for a distance of two or -more inches. Several of these long, large pus-less channels may exist -for many years, or for a lifetime, without sufficient evidence of their -existence along their route accurately to locate them. Itching, pain, -and color of the skin often indicate the presence of such a channel -under the integument. The author has frequently found large channels -extending up along the outer rectal wall for four inches, and extending -out into the deep tissues of the buttocks in various directions, -without making their presence and ravages known to the victim. - -Such numerous pathological conditions have led the author to conclude -that an abscess just under the skin and the discharge of pus are merely -incidents in the history of such maladies. Think of it: your body may -be bored with channels or holes of varying diameters and lengths, while -you yourself may be ignorant of what is occurring! The mucous membrane -may be lifted from the connective tissue for the whole length of the -rectum, and the skin about the anus may also be in this condition. You -know that your health is not good, but you are ignorant of the cause. -The formation of pus at some period of the channel’s inroads, or of -an abscess, would seem a kindly act of Nature, for the presence of so -serious a disturber to health would thus become known. - -I have not overdrawn this picture of periproctitis and of submucous -tissue channels. The victims could scarcely be worse off than they are. -I want boys and girls, young men and young women, to learn the facts -concerning the local dangers of proctitis; for, when they once realize -the seriousness of this disease because of its many grave symptoms, -they will give it proper attention before these effects manifest -themselves. You cannot neglect so important a portion of your body as -the anus and rectum and not seriously endanger the organs that lie -close to them. No wonder so many men are troubled with inflammation -and induration of the prostate gland. The percentage of such cases -would be greatly reduced were proctitis and periproctitis denied the -existence they now enjoy for years, and often for a lifetime. - -In view of all that has been advanced concerning these local -pathological conditions, is it strange that almost everybody is -constipated, and that we need some simple sovereign aid to further the -scientific treatment of the physician--an aid such as the enema has -proved to be? - - - - -CHAPTER IV. - -UNDUE RETENTION OF GAS AND FECES IN THE SIGMOID FLEXURE. - - -In the previous chapters attention was called especially to the -lower portion of the rectum and the anus. In this chapter we will -consider the sigmoid flexure, which, when diseased, is often dilated, -dislocated, and depressed, a pathological condition somewhat similar to -that found in the lower portion of the rectum and the anus. - -The illustration on page 29 shows the normal relations of the rectum -and the sigmoid flexure; also the whole colon. 7 marks the beginning of -the sigmoid flexure, and 6 its upper end. The reader will note the four -sharp curves or flexures of this organ,--from 6 to 7,--which forms in -health a normal and most convenient receptacle for feces, and which, -like the bladder, can be emptied at regular intervals. - -Unless the system were able in some way to eliminate the waste and -poisonous matter it had generated within six hours, it would fatally -poison itself. - -Those internal ventilators, the lungs, and those external ducts, -the pores, are constantly at work purifying the body; and they are -actively assisted by the kidneys and the bladder. Observation extending -over many years of practice induces me to believe that among those who -suffer from chronic constipation two-thirds to three-fourths of the -fecal mass is taken into the system and eliminated by the kidneys, -mucous membrane, and skin. Diseases of the above organs are numerous -and seemingly incurable from the fact that their common cause has not -been discovered and treated properly. Were it not for these organs -steadily at work, the labor of the bowels would be of little avail. -But while the importance of the former cannot be ignored, it must be -conceded that the most important of all the eliminating organs are the -bowels, for their function is to discharge not only the waste solids -but also a great amount of waste liquids and gases as well. - -[Illustration: Fig. 6. - -9. The anus. Levator ani muscle seen on each side. 8, 8. The rectum. -7. Beginning of the rectum. 6. The sigmoid flexure. 5. The descending -colon. 4. The transverse colon. 3. The cæcum, or _caput coli_. 2. -Appendicula vermiformis. 1. The end of the ileum.] - -Undue fermentation of the ingesta (the aliment taken into the system) -generates poisons of more or less virulence; it must therefore be -obvious that a clean intestinal canal is necessary after every meal to -further the normal digestive process. - -Very often the outlet of the sigmoid flexure is obstructed. Figures 6 -and 7 are shown to make the cause of this obstruction more clear. In -Figure 7 we see the longitudinal and transverse fibers that form the -wall of the rectum. In all cases of chronic obstipation, the muscular -structure of the anus, rectum, and frequently of a portion of the -sigmoid flexure is invaded with chronic inflammation of a very severe -and serious character. - -[Illustration: Fig. 7. - -A view of the longitudinal muscular fibers of a section of the -rectum: 2, upper portion of the rectum; 3, 4, 5, the three bands of -longitudinal fibers of the colon continued upon the rectum; 6, the -longitudinal muscular fibers of the rectum formed by the expansion of -those of the colon. A view of the muscular coat of the colon: 1, 1, one -of the bands of longitudinal muscular fibers; 2,2, the circular fibers -of the muscular coat.] - -What is the result of this inflammation? Self-evidently contraction of -the muscular structure, as you would quickly enough discover were one -of your hands or arms inflamed. - -Though constant attention should be given to the much more important -organ, the rectum, practically none is given it. “Out of sight, out of -mind.” - -Again, no doctor would diagnose an inflamed limb as paralysis, atony, -etc., and dose the victim with nux vomica, tonics, physic, etc., in the -hope of thereby healing it. Yet, with singular fatuity, this absurd -diagnosis and treatment is given when the lower bowel is invaded with -chronic inflammation. - -Let the common-sense reader inform himself concerning his organism. Let -him remember that he has within muscular organs that demand exactly the -same attention when diseased as those without. This fact is especially -important for the sufferer from constipation or semi-constipation to -know. - -Were the anus, rectum, and sigmoid flexure one continuous straight -tube, the muscular action in the process of defecation would not be -as complex as it is, since then the feces would drop right down and -out. But these parts have so many curves and angles that when disease -invades their interior they accentuate their folds and valves by -contracting and do not readily respond to the nerve demand for complex, -muscular, snakelike movements, when evacuation is desired. In this -unreadiness to respond they cast into confusion all the functions of -the whole complicated organism, all parts of which are necessarily -interdependent. A wise provision of Mother Nature are these curves, -angles, and valves, for they prevent the sudden dropping of the -contents of the colon down to the anal orifice--a possibility that -would greatly embarrass us during social and business hours. - -The accompanying figure shows the rectum dissected at its upper end -from the sigmoid flexure. This portion of the rectum is smaller than -the lower two-thirds of the organ. Now, it is this lessened diameter -of the gut that is an aid to the sigmoid flexure in its capacity as a -receptacle, but a most decided hindrance when it is diseased--since -it will positively inhibit the passage of feces and gases, thereby -occasioning a distention of the sigmoid flexure (obstipation) because -of a detention of the contents, which then weights the flexure down -upon the rectum. Thus we see exemplified how an aid may turn into a -hindrance, as we already have observed, in an unduly contracted anal -vent. - -The _rectum_ is not straight, as the word itself would indicate, but -curves to the right, then back well on to the spine, and then forward -to the anus, which turns slightly backward from the lower anterior -portion of the rectum. - -[Illustration: Fig. 8.] - -When these muscular-tube organs are invaded by disease, these very -curves, valves, and bends of anus, rectum, and sigmoid flexure are -responsible for at least nine-tenths of the ills that affect humanity -from the cradle to the grave--ills directly due to self-poisoning, -technically known as auto-infection and auto-intoxication, the -fashionable name of which is neurasthenia: a weakening of involuntary -and voluntary nervous systems through lack of vent from irritating -poisons, flatulency, and of course defective metabolism or nutrition. A -better name would be _vaso-motor neurasthenia_. - -After these anatomical and physiological points have been noted, it is -to be hoped that the reader has grasped the idea of how easily this -portion of the bowels, when diseased, can prevent the normal descent of -the feces and gases accumulated just above the diseased portion of the -gut. It should also be easy to understand how a portion of the unduly -retained feces may pass out, but in so doing be the cause of increased -irritation and consequent contraction of the muscular tube, preventing -thus any further passage of feces from its receptacle. Usually a -portion of the escaping feces is caught and held in the rectum itself, -converting the rectum into a receptacle. - -It is just here that the practical application of the principles -deduced must come in. Let my professional brethren as well as all -victims of bowel disease consider the following question, and then all -will be clear: Since normal feces contain about 75 per cent. water, -is there any harm, nay, is there not decided benefit, in suddenly -liquefying the imprisoned mass to, say, 99 per cent.--whether disease -exist or not? - -When disease exists we simply desire to open the contracted or -obstructed canal. What can be better, in a therapeutic line, than the -kindly distending influence of warm water to overcome the spasmodic -closure of the diseased tube? In addition to the gentle dilatation the -injected water occasions, the water creates or calls into activity the -lost nervous impulse to evacuate, which impulse is a step toward the -restoration of the lost normality. - -Under the benignant influence of the water injected in the large -intestine there comes a desire to expel it, which, when responded to, -carries with it the feces so long imprisoned, and at the same time -divests the walls of the intestine of the inevitable incrustations. - -Thus, with purifying water, the foul pool is emptied, and the parts are -cleansed so thoroughly that nothing is left to vex the inflamed tissue. - -Is there any sane person that can offer one valid objection to the -use of depuratory enemas in cases in which the normal function of -the bowels is lost through abnormal changes brought about by chronic -disease? - - - - -CHAPTER V. - -REBELLION OF OUR OUTRAGED INTERNAL ECONOMY. - - -The small intestine is that portion of the alimentary canal which -begins at the stomach and ends at the large intestine. Its usual length -is twenty feet. The diameter, which at the upper portion (duodenum) is -two inches, gradually becomes less, until at the lower end it is but -one inch. - -Now, the length of the inner coat of this small intestine--the mucous -membrane--is about _double_ that of the intestine itself. Think of -wearing a coat twice as long as yourself! How do you think this is -accomplished in the case of the muscular tube under consideration? -Well, Nature, having a most peculiar function to perform, has thrown -this mucous coat or tube into a thousand folds (valvulæ conniventes, or -“winking valves”). These folds form valves, occupying from one-third -to one-half the circumference of the bowel. The greatest width of each -fold is at the center, where it measures from a quarter to half an -inch. Over this great expanse of mucous membrane we find studded ten -million five hundred thousand intestinal villi, whose office it is to -absorb the food substances in their passage through the canal. - -[Illustration: Fig. 9. - -Stomach, liver, small intestine, etc. (Flint.) 1, inferior surface of -the liver; 2, round ligament of the liver; 3, gall-bladder; 4, superior -surface of the right lobe of the liver; 5, diaphragm; 6, lower portion -of the œsophagus; 7, stomach; 8, gastro-hepatic omentum; 9, spleen; -10, gastro-splenic omentum; 11, duodenum; 12, 12, small intestine; 13, -cæcum; 14, appendix vermiformis; 15, 15, transverse colon; 16, sigmoid -flexure of the colon; 17, urinary bladder.] - -Those that have observed the anatomical illustrations of the small -intestines must have been struck by their apparently inextricably -tangled convolutions. In life, these convolutions are constantly -changing their locations, as though they were a mass of worms. - -The large intestine begins at the cæcum and extends to the anus, or -vent of the intestinal sewer. It is called the colon--the ascending, -transverse, and descending colon. It is about five feet in length. -Its diameter is the greatest at the cæcum, where it measures, when -moderately distended, two and a half to three and a half inches. Beyond -the cæcum the diameter is one and two-thirds to two and two-thirds -inches, the smallest part being at the upper end of the rectum. - -The muscular movements of the large intestine are much more limited in -number and range than those of the small intestines. The area of its -mucous membrane is also much less, notwithstanding the fact that it is -thrown into sacculated pouches, or sacculi, by the contraction of the -longitudinal muscular bands of the bowel. - -[Illustration: Fig. 10. - -The cæcum, dorso-mesial view, showing the ileum-side of the ileo-cæcal -valve, and the beginning of the three muscular ribbons. (Gerrish.)] - -Consider this tube, for it is really unique. Note the longitudinal -muscular bands (Figs. 12 and 13). We find this tube to be five feet -long when the surface made by the circular bands is measured, and four -feet long when that made by the longitudinal bands is measured. Now, -the four feet of surface must of course contract the five feet. Well, -in the tube under consideration, the musculo-areolo mucous tube is -thrown into circular puckerings in short sections, between which are -deep transverse creases, each bounded by prominent bulges. (Fig. 13.) -An inspection of the bore of the tube shows a sharp ridge corresponding -to each depression of the outer surface, and a large recess collocated -with each external protrusion. This external and internal appearance of -the large intestine reminds one somewhat of the flexible hard-rubber -tubing used as a conduit for electric wire in houses. - -[Illustration: Fig. 11. - -Cavity of the cæcum, its front wall having been cut away. The ileocæcal -valve and the opening of the appendix are shown. (Gerrish.)] - -[Illustration: Fig. 12. - -A view of the position and curvatures of the large intestine. 32, end -of the ileum; 31, appendix vermiformis; 4, cæcum; 3, ascending, 2, -transverse, 8, descending colon; 9, 9, 9, sigmoid flexure; 10, 10, -rectum; 12, anus; 13, 13, bladder; 11, 11, 11, peritoneum--length from -4 to 6 feet, and a mean diameter of about 1-2/3 to 2-2/3 inches. The -sigmoid flexure is a receptacle for the feces, and each end is the -highest and bent on itself; this arrangement spares the rectum and -sphincters of pressure and weight until the proper time to stool.] - -The sacculated pouches thus formed by the shortening of the bowel may -become abnormally distended, and resemble the proper receptacle for -feces--the sigmoid flexure. Even the rectum, in cases of chronic -constipation, is usually enormously distended, owing to the overloading -or filling up of the bowel with feces. - -I have given this somewhat lengthy _résumé_ in order to enable the -reader to appreciate a most pertinent question. - -Let us see what we have found: The small intestine, with its manifold -folds and its numerous pockets, made by the forty feet of mucous -membrane; the bends and curves in the five feet of the large intestine, -with its numerous dams and pools; and, lastly, the abnormal reservoirs -for feces, liquids, and gases. - -[Illustration: Fig. 13. - -Segment of large intestine, showing the characteristic features of its -structure. (Gerrish.)] - -Finding this, the question inevitably is, What is the best agent for -cleansing this marvelously sensitive canal, twenty-five feet long, -whose mucous membrane extends forty-five feet? No one would think of -taking, if he could, the foul sewer in his hands, and shaking it, fold -upon fold, with the faint yet fond hope of sterilizing it. How can any -mode of physical culture meet the requirements for effecting a cure of -ulcerative proctitis and colitis, to say nothing about keeping the -bowels sweet and clean? Chronic, subacute, and acute inflammation, -accompanied with ulceration, located in any part of the body, requires -rest to overcome the fever and congestion. Muscular exercise irritates -and inflames the diseased parts. - -Another form of “physical culture” would put into the bowels all -sorts of stuff that cannot be digested, such as bran, crushed seeds, -shells, raw food, etc., that set up excessive muscular action and -secretion of mucus as the improper stuff passes down and out. In the -sacred name of hygiene, this new cathartic remedy is prescribed and -taken. Seeking relief from the painful effects, the patient finds that -these “remedies” make the disease and its symptoms worse. Hygienic -fool-killers are, like the poor, always with us. - -[Illustration: Fig. 14. - -A longitudinal section of the end of the small intestines, or ileum, -and of the beginning of the large intestines, or colon. 1, 1, a -portion of the ascending colon; 2, 2, the cæcum, or caput coli; 3, -3, lower portion of the ileum; 4, 4, the muscular coat, covered by -the peritoneum; 5, 5, the cellular and mucous coats; 6, 6, folds of -the mucous coat at this end of the colon; 7, 7, prolongations of the -cellular coat into these folds; 8, 8, ileo colic valve; 9, 9, the union -of the coats of the ileum and colon.] - -You are aware of the irritation that a grain of sand will set up when -it comes in contact with the mucous membrane of the eye. Then can you -not realize that you will torment the forty-five feet of intestinal -mucous membrane with like indigestible stuff? It is estimated that ten -per cent. of the really suitable food is residue matter with which the -digestive tract has to deal and get rid of with as much economy and as -little friction as possible. Then why increase this residue twenty or -fifty per cent.? - -More than nine-tenths of the human race have been content to depend -on comparatively violent excitants, such as drugs, coarse food, and -muscular exercise, etc., to relieve the bowels of the feces, liquids, -and gases of a most foul character--the foulness due to putrid -fermentation and undue retention. - -When will these prescribers and partakers ever learn that bile bouncers -and peristaltic persuaders have an immense journey before them when -they start to remove the foul accumulation of feces from the sigmoid -flexure and ballooned rectum? For, be it remembered, the normal -receptacle for feces is twenty-four feet four inches from the stomach, -and the abnormal receptacle twenty-four feet eleven inches--within two -inches of the vent of the body! - -Surely quite a degree of mental constipation must have existed in -both the prescribers and the partakers to think such thick and dense -thoughts as are represented by these bouncers and persuaders. So -you would _cleanse_ the bowels with such unclean, poisonous, and -irritating things! What amazing hope born of ignorance! Outraged Nature -cries: “How long! how long! how long will my ‘inards’ be so abused -in the name of cleanliness and yet remain so unclean? Ye benighted -mortals, if ye would listen to me, your Mother, I would give ye a -pure and wholesome prescription, for I would prescribe equal parts of -enlightenment and water well mixed, and advise ye to take a portion of -it fore and a portion of it aft, per os (mouth) and per anus. Thus and -thus alone would I prescribe for ye; such and such alone is the way for -ye to do; purify to cure, or cure by purifying.” - -Constipation must not continue, for it means not only the clogging up -of the large intestine with the foul sewage of the system, but also -the drying of that sewage, which latter process implies the absorption -of poison. Now that you are in this condition, Medicus steps up and -prescribes a cathartic mixed with belladonna or opium, or both. These -latter are meant to quiet the mournful cry of outraged Nature when the -cathartic invades its sacred precincts. And it may be noted, by the -way, that though belladonna, atropine, morphia, etc., tend to dry up -the secretions of the mucous membrane and make matters worse by making -them still more arid, still the action of the cathartic is usually so -powerful that after the free fight with the pain soothers it triumphs, -and produces a free flow of watery secretion into the dried, impacted -mass of the bowel. - -Does it not stand to reason that the greater portion of the liquid in -which the feces were dissolved and had fermented is re-absorbed into -the system? Why should the poor victim of proctitis and cathartics -wonder why he has gout, rheumatism, and disease of the kidneys, -bladder, lungs, liver, stomach, nerves; why he has neurasthenia, -debility, feebleness, loss of memory, inability to fix and hold the -attention upon a single line of thought, apprehensions, etc.? His -wonder is childish, for deep in his heart he knows that he poisoned -himself. He knows this, but it seems that he must be reminded of the -fact that there is a better way to remove the accumulated mass from the -large intestine, and to prevent in future the undue retention of feces, -liquids, and gases in abnormal sacs or pouches. The way that Nature -prescribes is the resort daily, two or three times, to the enema. - -When the injected water reaches the imprisoned and dried feces, the -crust is loosened from its holdings and the mass is moved toward the -exit by the expulsive effort of the bowels. Previously the bowels were -helpless with their load. As the sudden flood of water is expelled -it carries with it the inspissated feces; whereupon the subconscious -personal Ego, who is the superintendent of the digestive apparatus and -functions, congratulates himself on the delightfully refreshing manner -in which the local disturber has been ousted. - -Such is the satisfactory decision of the arbitrator--Enlightened -Nature. No longer need we bow to Medicus or to any other kind of -“cuss,” whether styled hygiene or physical culture. Arbitration of this -sort makes life worth living. - -Now for Nature’s benediction: “May that feeling of freedom from -uncleanliness, internal and external, be with you constantly, and this -double blessing make your joys flow so fast that in their rapidity they -blend into a sun and radiate from your rejuvenated physical being.” - - - - -CHAPTER VI. - -GASEOUS OBESITY AND OUR ROLY-POLIES. - - -Is there any human being so ignorant that he cannot understand that -when food stuffs in the gastro-intestinal canal ferment and putrefy -they thereby generate toxic (poisonous) gaseous matter, volatile fatty -acids, and putrid feces; that such matter, acids, and feces are rapidly -absorbed by the system, and that, if the system does not readily -eliminate them by way of the bowels, kidneys, and mucous membrane, they -will tend to bring on one or more forms of acute or chronic disease? - -Gas is matter in its most rarefied state--a state that permits its -easy entrance into all the tissues of the body, where it perverts by -its presence and toxic effect the normal function of all the organs. -Besides its poisonous infection, it distends or bloats the stomach, -bowels, and tissues--a fact especially noticeable in the abdominal -region, giving the appearance of corpulency or obesity to many, -when really it is only abdominal ballooning or gaseous obeseness. -Roly-polies--and there are a great many of them--will have their pride -greatly hurt by accounting for their condition in this way, but the -truth must be told and they might as well face the facts first as -last. Gaseous obesity, or borborygmus, is spoken of popularly as wind -in the stomach and bowels. No wonder the roly-poly is sensitive on the -subject, for this “wind” occasions rumbling sounds, eructations, and -offensive odors--all of which are a great annoyance to the sufferer -from dilated, displaced, and unclean digestive apparatus. - -Besides being generated in the system, gases may be swallowed during -the act of eating, in the form of air (oxygen and nitrogen), and in -liquids containing carbonic acid, sulphuretted hydrogen, etc. - -Micro-organisms swallowed with the food will occasion fermentation of -the contents of the stomach and bowels, which if unduly retained become -excessive, foul, and toxic--therefore extremely harmful to the system. - -The gases generated in the stomach are the following: carbonic acid, -hydrogen, hydrochloric, ammonia, sulphuretted hydrogen, marsh gas, etc. -They are partly absorbed or thrown off by eructations, or they pass -into the duodenum or small intestine. - -Gases are found throughout the small and the large intestine. These are -the result of both the normal and the abnormal digestive fermentation -and bacterial decomposition of the ingesta or food stuffs. Some of the -gases are passed into the intestines from the blood by diffusion. - -The production of gas is more copious in the upper portion of the -small intestine and becomes less rapid and abundant as the large -intestine is reached. As formed or found in the intestines, the gases -are: carbonic acid, hydrogen, marsh, ammonia, nitrogen, sulphuretted -hydrogen, and sulphate of ammonia. - -Considering the large amount of abnormal gases generated in the bowels -and which abnormally distend the abdominal walls for several inches and -press upon the heart and lungs, and considering the small amount passed -out as flatus, their entrance into the tissues of the body must be very -rapid and harmful. - -Stop the habitual putrefaction and mal-digestion, and then the -formation of toxic feces, gases, and volatile acid will speedily cease. -Then the erstwhile roly-polies will shrink in circumference four or -more inches, necessitating the refitting of their garments to the new -and better order of things. - -Much has been written about the distention of the rectum, sigmoid -flexure, and colon from the undue accumulation of feces. The fecal -distention of the gut may extend along the intestine for from three -to nine inches or more, which is a very grave matter indeed. But why -is so much attention given to a few inches of impacted feces dilating -a portion of the bowel, and none whatever to the prevention or -elimination of gaseous matter that distends the whole gastro-intestinal -canal to such an extent that the body is tightly inflated and the -median parts of the belly bulge out like a balloon? - -Cattle raisers are conversant with the gaseous inflation of their -animals, and have to resort to the knife to puncture the stomach to -permit the gas to escape; otherwise fatal results would soon follow. -Some animals, even, like most human beings, are intemperate in eating. -When they consume too much grass they suffer from flatulency and colic, -and require drastic treatment. - -Rather than let some worthy men and women die, ought we not at times to -adopt the ranchman’s treatment for flatus? This harsh means, however, -might be avoided by inventive science. Overfed, constipated, inflated -man, victim of habitual flatulency, could easily have small gas valves -inserted here and there along his gastro-intestinal canal--one, say, to -relieve the stomach of toxic gas, another for the appendix region, and -still another in the hernial region of the abdomen. Suppose overfeeders -were to adopt the gas-valve fad, and discontinue the habit of using -cathartics, soda, charcoal, peppermint, pepsin, whiskey, etc., as means -of relief! How in the world can a _drug_ aid digestion when taken into -a foul, gaseous, and feces-clogged canal? - -A chemist cannot get the definite results he seeks unless he have -the right chemicals and proper vessels. Just so with the spiritual -Ego and his systemic chemistry of food: he needs a clean and healthy -digestive apparatus for proper assimilation and elimination. But he -gets careless, allows it to get foul, and then insincerely expresses -astonishment that the chemical combinations are not such as one could -wish or expect. Other chemists, called doctors or druggists, come along -and dose the poor victim of his own carelessness until they have ruined -his apparatus completely. They have got to live, of course; and it is -their business to see that he does not escape so long as they can help -it. - -Sometimes there is a reassertion of common sense; the poor victim -becomes disgusted with himself and his credulous acceptance of -the doctor’s dictation and his fatuous swilling of the druggist’s -decoctions. He gets tired of chronic ill-health and bowel troubles, -and, lo and behold! he does the simplest and most sensible thing in -the world--a thing he ought to have done at the very start, or before -he ever had the least trouble: He thoroughly washes out his alimentary -canal with pure or antiseptic water. He drinks a lot of pure spring -water, and he flushes his bowels with two or three enemas. Doctors and -drugs are henceforth banished; he gets well! What a blessing to lose -one’s faith in the magic of drugs and the majesty of doctors! - -Few comprehend the baneful effects of flatulency on the system, the -most usual of which are fatigue, depression, headache, buzzing in -the ears, deafness, vertigo, loss of memory, inability to fix the -attention, disturbance of sight, drowsiness, etc. A continuous stream -of carbonic acid or of hydrogen directed against muscular tissue will -cause paralysis of the part. - -Physicians admit that in certain portions of the alimentary canal -extensive dilatation may occur, independent of any permanent -obstruction, in the lumen, or bore, of the gut. As a rule, however, -victims of proctitis and colitis suffer from more or less occlusion of -the lumen in the region invaded by the ulcerative inflammatory process. - -Considering that the wall of the abdomen is often greatly extended by -gas within the digestive apparatus, it is not amiss to assume that this -gas may cause local distention of segments of the gastro-intestinal -canal, sufficient to paralyze or render inoperative the parts. - -Suppose we make a rubber duplicate of the abdominal walls of the -average man, and place therein rubber duplicates of all the internal -vital organs--pelvic and abdominal. To hold the stomach, bowels, -and other organs in place, we fasten them with elastic bands here -and there, and make a generous use of cotton to support the various -parts, which are all connected with many little circulating tubes, -with strings for the greater nerves, etc. Now let us distend our thin -artificial digestive apparatus with air or gas--snugly filling the -abdominal space of our model, without tension, however, or slackness of -the various parts, which are happily adjusted and at rest. Now, be it -remembered, persons suffering from flatulency are more or less in the -predicament of the gluttonous animal referred to above: the gas will -not escape at either end, however much of an effort it makes, or the -victim may make to help it. - -[Illustration: Fig. 15. - -The stomach and intestines, front view, the great omentum having been -removed and the liver turned up and to the right. The dotted line shows -the normal position of the anterior border of the liver. The arrow -points to the foramen of Winslow. (Gerrish.)] - -In filling very slowly our thin artificial alimentary canal, note -the distention along the canal as the gas accumulates. Then note that -the elastic bands stretch as the various segments of the canal change -location, especially the stomach and portions of the small intestine -and of the colon, etc. The stomach, small intestine, and colon, as they -dilate, shift about for room. The abdomen is seen to bulge out some -four or more inches while the turmoil is heard going on inside. - -Continue this inflation and our rubber intestinal tract will display -here and there a displacement and permanent abnormal enlargement -of the lumen or bore. Suppose, further, that our complete model of -the abdominal viscera and wall had tightly around its outer surface -unelastic corsets, skirt bands, trouser bands, vests, etc., all or any -of which held in or compressed its bulging wall--what would happen? -Why, something inside would slip out of place or burst and let all the -wind escape, relegating our creation to the rubbish heap. - -Now, when a man loses his wind by the rupture of a tube, he is said to -have expired, and his body is sent to the crematory--or ought to be -sent there for sanitary reasons. It would be much more satisfactory, by -the way, to our friends, after our demise, were our bodies sterilized -while they “live.” - -I hope I have made it clear that it is a most serious pathological -condition--inasmuch as it prevents the normal onward progress of -ingesta and feces--to permit of the continued existence of an -excessively dilated gastro-intestinal canal, with one or more of its -segments permanently enlarged--segments like the stomach, duodenum, -cæcum, transverse colon, sigmoid flexure, rectum, etc.--and with -pendulous abdomen, sallow and muddy complexion, etc. - -When to this condition is added a general displacement of the abdominal -viscera, or of one or more of the organs of the abdominal and pelvic -cavities, you have an objective picture of chronic ill health in all -its severity. - -Are you sincerely desirous to know how your friends feel when you greet -them? Don’t ask them the stereotyped question, “How do you do?” or, if -you are a German, “How do you go it?” or, if you are a Frenchman, “How -do you carry yourself?” But ask them the specific and sensible question -appropriate to our civilized habits: “How are you and your bowels -to-day?” And at parting it were well to say: “May peace be with you -both--you and your bowels!” - -The spirit of man can torment his personality, and his personality in -turn can vex his spirit. - -Few people are aware of the fact that the stomach and intestines can -undergo alteration in position. Many are familiar with the fact that -the kidneys may be displaced, and are then called “floating kidneys”; -that the liver, pancreas, spleen, and uterus occasionally go on -excursions, causing thereby considerable and numerous disturbances. -And it is not at all strange that they should, since there is so much -pressure from within, so much pressure downward, and so much pressure -from without--all through the requirements of fashion, indulgence, -and ignorance. But the stomach, upper portion of the duodenum, and -small intestine, cæcum, the ascending colon, and especially the -transverse colon and sigmoid flexure, are susceptible to various -forms of displacement, inhibiting the ready flow or passage of food -stuffs, gases, and feces from one segment of the digestive apparatus to -another, until the vent is reached. - -Reviewing the ground already gone over, we have found that proctitis, -as a rule, is the primary cause of sigmoiditis and colitis; that -these combined are the cause of constipation; that this is the -cause of indigestion, flatulency, and distended alimentary canal, -and, as matters go from bad to worse, of permanent distentions and -displacement. Is it any wonder then that there are so many that suffer -from _gastro-intestinal neurasthenia_? - -Surely our digestive apparatus ought to have as much attention as a -well-regulated house furnace. In the morning the ashes are dumped and -fresh coal is put on. A similar process is gone through with at noon -and night. Some may run their furnaces on two meals a day and two -dumpings of the waste material. - -When a boy puts a penny into a slot machine he gets what he expects -and is pleased. The machine has done its work in delivering the goods. -Why should he give a thought where his penny lodged? In like manner -man is always ready to put food stuff, and other stuff as well, into -the upper slot of his machine, for he gets immediately satisfaction -thereby. But he is like the boy; he doesn’t care a fig what becomes -of the stuff so long as it doesn’t annoy him too much. Eventually the -machine refuses to work, and seems unable to deliver the goods at the -other end; something has become clogged or out of gear. Let me advise -the reader at least to keep the passage clear by dumping the systemic -furnace twice or thrice daily--using the enema to effect the result. - - - - -CHAPTER VII. - -IRRIGATION OF THE ASSIMILATIVE AND ELIMINATIVE ORGANS. - - -The habits of people in general do not seem so bad when one considers -the average individual’s limitations as to knowledge and thought. The -fact is that most people don’t know, don’t think, and hence don’t -care. Let them read more science, think more sensibly, and act more -seriously; then their habits will be more satisfactory. - -The alimentary receptacle--the stomach or vat in which foods and -liquids are received and mixed--is habitually converted by many persons -into a chemical retort for all sorts of drugs and remedies, with the -view of reaching and relieving the ills of the various organs of the -body, from dandruff to corns. The writer believes that he can give -more and better reasons for his confidence in the therapeutic value of -remedies than most other physicians, but he wishes to emphasize here -the transcendent importance of common sense in their administration. -Before and above all else, however, what is wanted is a clean -gastro-intestinal canal; and his claim is that water, properly used, is -the best agent to effect that cleansing. On a par with this canal in -importance are the eliminative tissues and organs of the system: the -kidneys, mucous membrane, and skin. What therapeutic agent, properly -used, is better than water? After all the assimilative and eliminative -organs and tissues have been thoroughly rinsed with pure, soft water, -then, if it be still necessary to administer a chemical agent, one -may be selected that will, with these organs and tissues in better -condition, work wonders. If you are so foolish as to allow yourself -to become foul from head to foot, cleanse yourself with water before -resorting to chemical aids. - -Somehow or other the mass of even intelligent people, not to speak of -the great mass of the ignorant, and I may add even my co-workers in the -healing art, are not aware of the supreme want and worth of water for -internal and external therapeutic purposes; they do not realize how the -stomach, the bowels, and the kidneys cry for it in their neglected and -infected condition. - -The stomach serves as a convenient receptacle to dump things into after -the palate has been entertained and pleased--and about everything is -swallowed but pure, soft water. As a rule the stomach takes very kindly -to water. It is, moreover, not so piggish as to absorb it all and leave -its surface in a foul condition, covered with ropy, slimy products -of imperfect digestion. Immediately after deglutition of water, the -stomach does just what it ought to do: its muscles contract and dump -the contents of the stomach into the duodenum, where the principal act -of digestion is accomplished. - -As its name implies, the stomach (stow-make) is a receptacle made for -the purpose of storing stuffs for nutrition. Here they are mixed and -broken up somewhat, and then deposited in the second or real digestive -apparatus--the duodenum. This latter organ requires water and organic -fluids in liberal quantities for its digestive operations. Both organs -need cleansing after they have finished their work, and the digestive -and assimilative vessels require water, not only to convey the building -material to their harbors, but also to eliminate effectually the -worn-out tissues and the residuals of the digestive process. - -It has been said that were man to discover heaven (a clean and healthy -locality) he would at once convert it into a hell (a vile and filthy -one). Man is possessed of an organism of whose constituent elements -water forms over eighty per cent. The alvine discharges ought to -contain the same percentage of water, if not more. The mucous membrane -and skin, to be kept clean, soft, fresh, plump, moist, and free from -odors, require their appropriate irrigation. Man may keep himself -clean, both inside and out, by irrigating himself before each meal -daily. The well-watered and well-washed body and brain constitute a -heaven on earth for the indwelling spirit that needs these for its -manifestation. - -It does seem sometimes that man in his ignorance gets nothing right -except to walk forward instead of backward. Even so, most likely he -walked on all fours for ages, judging from his progress to date, -before he learned to walk on his hind legs. To-day we find him -self-poisoned, auto-intoxicated, a gastro-intestinal neurasthenic. His -bowels are filled and stretched with ancient feces and gases, and his -stomach is burdened with undigested food and tenacious mucus. - -The average man’s scanty excreta from the bowels are dry, hard, lumpy, -and foul, exhaling a noxious odor; and these excretions may be passed -once a day, or once in two or three days, or with some persons too -often, should diarrhea supervene. Two-thirds to three-fourths of the -fecal mass is absorbed by the system every day; and this absorption -is accompanied more or less constantly by symptoms of indigestion, -biliousness, uric acid, and many other distressful conditions. - -His breath and the exhalations of a garbage-can are much alike; in fact -they are twins, the only difference between the human and metallic -receptacles being that one is capable of walking and the other is not. -Both manifest the same conditions. - -His mucous membrane is covered more or less with catarrhal discharges, -which result in granulated deposits, especially near the orifices. The -skin is often sallow, dry, yellow, scaly, flabby. The hair is dry, -non-oily, with a scaly scalp, and often there is a loss or total lack -of hair. The teeth are decayed, the gums are found to recede, and the -eyes, muscles, joints, etc., are more or less affected by calcareous -deposits. - -Man is seldom or never in a normal physiological condition. He is -either obese or emaciated and lean. Most bodies are anemic and -ill-conditioned, a prey to several ailments. Of course, civilized man -uses drugs; he would not be civilized were he not to use on occasion -a stimulant, tonic, sedative, narcotic, etc., and he has to keep in -continual touch with a doctor, to take care of him by prescribing -special diet, fasts, exercise, and what not for his numerous bodily -infirmities. Generally these prescriptions are ineffective and -leave him physically weaker and financially poorer, with the barren -consolation that he has really tried everything under heaven that the -wisest knew or that money could buy. Yes, indeed, he tries everything: -everything but _water_--pure, soft, spring or distilled water. He -never--like the flirt--“thought of such a thing”! Very few “humanals” -think it worth while to irrigate themselves inside and out. - -Victims of semi-ignorance, too, get things most abominably mixed. They -are often half wrong and half right; hence they never enjoy good, -sound, robust health and its blessings. Physiologically, these people -are what old-time pastors used to describe as lukewarm--neither hot nor -cold, neither good nor bad, neither dirty nor clean, neither fish nor -fowl, neither one thing nor another. So we find them also complaining -and looking for the fountain of health and strength, but not looking -very anxiously--they are not interested enough in the matter. Whenever -they possess an equal mixture of ignorance and laziness, there is not -much hope for them. - -[Illustration: Fig. 16. - -Œsophagus and stomach in their natural relation to the vertebral column -and aorta. (Gerrish.)] - -Note the position of the stomach in health, and how, by slight -muscular action, it can free itself of its contents. When dilatation -or displacement, or both, occur, the power of rapidly expelling its -contents is diminished to the extent in which the change from the -normal position and size takes place. I have found that, if there is a -normal passing down of the ingesta and also of the feces, the stomach -will perform its functions perfectly. Fear of “stomach trouble” is -groundless if you keep the digestive and eliminative apparatus in good -working order. But this requires that you must keep them clean, and to -do so you must drink plenty of water before each meal. - -[Illustration: Fig. 17. - -Stomach and duodenum--the liver and most of the intestines having been -removed. (Gerrish.) Shows the anatomical relation of the stomach, -duodenum, kidneys, diaphragm, and the large artery and vein.] - -The organs are held in position by a ligamentous attachment and -abundant fatty tissue, which serve as a connective cushion that -furnishes aid in supporting the organs in their proper place. In -chronic cases of self-poisoning, the victim, as a rule, becomes anemic -and emaciated, and loses thereby the fatty support required by the -organs. They are consequently apt to become displaced and the muscular -tissue weakened, with the consequent pendulous condition of the abdomen -often observed in both children and adults. - -The clay-colored, flabby, obese, anemic victims may retain their -worthless adipose tissue; but they suffer quite as keenly as if they -had lost it--from the fact that this tissue is impregnated with poison -and filled with gas, and from the further fact that this abnormal -tissue presses on the vital organs here and there as the victim wheezes -or puffs along on his road through existence. - -There is not the slightest doubt that nine-tenths of gastro-intestinal -ills and their effects can be prevented or cured by thorough irrigation -of the canal, from mouth to anus, if it does not itself perform the -cleansing process three times in twenty-four hours. - - - - -CHAPTER VIII. - -METHODS OF STOMACH CLEANSING. - - -Lavage is a term restricted to irrigation of the stomach--a term that -has become more or less popular of late with physicians, but is not -so popular with those who have to swallow a rubber stomach tube, or -with the anxious mother or friends who are usually not permitted to -be present on such occasions because of the disturbed and cyanotic -appearance of the patient--an appearance produced by the introduction -of the catheter. Much can be said, however, of the good results -following irrigation of the stomach by the employment of the stomach -rubber tube, and in a special class of cases its use is imperative. - -But my purpose in this chapter is to advocate the drinking of water as -the means _par excellence_ for effective irrigation of the assimilative -and eliminative organs, and to make it plain that this form of -irrigation is essential for the preservation of health and the relief -and cure of chronic inactivity of the principal organs of the system. -Usually the drinking of water at regular intervals is sufficient; but -in exceptional cases a generous drinking will result in a complete -unloading, which can be accomplished with ease and with little loss of -time. - -Should your stomach be actually performing its office, the suggestions -I am about to give will, if followed, keep it sweet, clean, and in good -condition, and will also flush all the tissues of the body as well. - -The first duty on rising in the morning should be that of flushing -the colon, as previously recommended, and flushing the stomach, as -now recommended. Take one or two goblets of water (about eight ounces -each) at a temperature most agreeable, which, however, should not be -ice cold. An hour or half an hour later, during the breakfast, take one -goblet of milk and water or two of water alone, when the mouth is free -from food. About eleven o’clock in the forenoon, one or two goblets -of spring or distilled water, at its natural temperature, should be -drunk to cleanse the stomach, duodenum, kidneys, etc., and to flush -the tissues of the body. At the noon meal one or two goblets, and at -four or five in the afternoon a similar amount, should be drunk--the -latter as a cleanser before the evening meal, at which about a pint or -more is drunk to aid in emulsifying the food, as at the breakfast and -noon repasts. As a rule, besides the amounts drunk at meal-time, there -should be consumed as much as two quarts daily, and the best time for -this is when the stomach is empty, or when it ought to be empty. At -bedtime, one or more glasses may be drunk if one does not suffer from -inconvenience from a full bladder during the sleeping hours. - -One should make water-drinking a habit, like eating, sleeping, -defecating, etc. Water-drinking should be performed at regular periods -during the day. System is as essential for the harmonious working of -the organs as it is for the relations of the departments in a business, -or of the details of any particular department. The guide to the -order and temperature to be adopted is _agreeableness_. Find out by -experiment what is most agreeable and beneficial to you, and continue -the practice with slight variations adapted to the changes of the -seasons and the conditions of the system. There must, however, be some -training done in most cases, and what is not agreeable at first may -become so. - -All persons suffering from proctitis and colitis and their symptoms, -as described in the previous chapters of this work and in _Intestinal -Ills_, will require, now and then, if not under treatment, special -irrigation of the stomach to remove fermentative matter, particles -of undigested food, and tenacious, ropy mucus before the next meal -is taken. Otherwise the condition will be made doubly bad, for the -fresh material is piled on top of the unduly retained contents of the -stomach. As evidence of our civilization, we clean pots and kettles -before the next meal. We even clean our fingers before, during, and -after the meal. Teeth, mouth, and face get their proper cleansing. Why -should we suppose that stomach, duodenum, and kidneys, which receive -all sorts of stuff, should remain clean without an occasional flushing? -They need rinsing out after brewing the wine of life. The water drunk -between meals not only cleanses the organs through which it passes but -irrigates the whole system, keeping a normal amount of water in all the -tissues, which is as necessary for the maintenance of health as is the -due supply of water to the plant in your conservatory. - -Observe the large percentage of human beings that are anemic, sallow, -clay-colored, or white--a few obese, but the many spare, lean, -gaunt--all of them expressing the disgust of the soul in having such -an abiding-place. If all the organs and tissues of the body were kept -flushed, what a fresh and inviting spot the soul would have for the -cultivation here on earth of the arts of life! - -Water is the wholesomest of all drinks. It quickens the appetite and -strengthens the digestion. It is the most effective agent in the work -of elimination--in ridding the system of waste material. Properly -taken, it prevents the undue clogging of the organs and tissues, and -tends to cure or relieve those that had become clogged, and it does -this by washing away the substances for which the system has no further -use, and which if they remained would poison it. - -It is said that if water be drunk freely during a meal the gastric -juice will become diluted or washed away. A similar objection is -offered concerning the use of the enema. The horse, it is alleged, -should have more sense than to drink from three to six gallons of water -and almost immediately thereafter eat a peck or more of oats and a -quantity of hay, for it ought to know that there is no room for food -with such an amount of water in the stomach. If such objectors could -but see the horse smile at such arguments--for it secretly knows that -the water does not _remain_ in its stomach, and that its gastric juice -is naturally strong and needs dilution--they would stand aghast. Would -we not be better off if we were not influenced by fool talk like the -above advice to the horse, especially as regards our internal economy? - -The stomach, like the freight station, can accommodate only a limited -amount. Its contents must be rapidly dispersed, and every muscular -contraction and every respiration gives it an impulse. Disease and -lack of irrigation will occasion an accumulation or congestion of -the contents in the gastro-intestinal canal, and then the victim of -slow transit complains of indigestion, biliousness, flatulency, uric -acid, and of many other ills. Your foul, furred tongue is a very good -indication of the trouble below, so it is wise to examine it in the -morning to learn your interior condition. Many persons scrape their -tongue with a knife because of heavy coating and offensive odor and -taste. Dyspeptics of this order need a thorough internal bath from -above (per os) and from below (per anus). - -Some that suffer from undue gastric retention and indigestion -will find relief by flushing the colon and the stomach, as herein -specifically directed. Others may find it desirable to start with -a mild laxative and an intestinal wash-out with hot water in which -some antiseptic or stimulant has been dissolved. The special stomach -cleansing is accomplished by the rapid drinking of one tumbler of hot -water after another, until a pint or more is taken into the stomach, -or until a sensation of vomiting is felt, which may be encouraged by -putting the end of the finger down the throat as far as possible or the -end of a long lead-pencil wrapped in a little muslin. After as much of -the contents of the stomach as is desired is thus cast forth, drink -freely of water again, as much as you may think proper, which will be -discharged into the duodenum. If this gastro-cleansing has occurred -near meal-time omit the meal altogether, and in an hour or two drink as -much water as is agreeable, to make sure of a thorough washing out of -the erstwhile neglected receptacle--the stomach. This special washing -out of the stomach may be repeated as often as occasion demands it. It -frequently happens with some persons that an hour after a meal there -is a hint that all is not well. This may be concealed or corrected by -drinking a goblet or two of water, which practice will permit the brew -to go on without further attention to the vat. - -Water may be taken at all times of the day or night if occasion arises -for its therapeutic effect in addition to its regular period of use. -Usually physic, pepsin, soda, charcoal, whiskey, etc., are kept within -reach, and are resorted to on such occasions with the thought that one -or more of them will do the work. They will not, however, any more than -red paint will act as an antidote to poor health by painting the cheeks -with it. Water, hot water, especially when used plentifully, is the -only solvent of dirt. - -Very few realize how essential water is to digestion and to the -digestive canal after the process of digestion is completed; and that -it has physiological effects on the system generally is less widely -known. There exists a great natural demand for water to carry on the -normal functions of the system; for both atmosphere and heat draw -moisture from the body, and a considerable amount is utilized in the -processes of our daily work and in unexpected efforts. An organism -composed of almost eighty per cent. of water requires a generous supply -for subsistence--a supply equal to the expenditure of vitality involved -in carrying on the numerous functions of body and brain. - -Some day it will be discovered that water is mainly the element -employed in psycho-physiological processes. Water is easily changed to -air, and atmospheric air to water, in the system. The generous consumer -of air and water will have a good stock of vital or of psychical force -on which to draw for the process of thinking. A thinker is a creator, -and he must be successful if his thoughts be rightly directed and he -have an ample supply of liquid food--water. - - - - -CHAPTER IX. - -WHEN ENEMAS SHOULD BE TAKEN. - - -Method is imperative in this strenuous life of ours. Nature in her -universal operations seems to sanction a uniform system in our -daily conduct. Had we a regular time for doing things, periodicity -would be established in our sleeping, eating, bathing, defecating, -work, recreation, etc. Unfortunately, we are prone to ignorance, -self-indulgence, procrastination, which render us careless and reckless -in regard to the common-sense conditions of normal living; and before -we are fairly out of our ’teens we begin to bear a crop of proctitis, -colitis, constipation, etc. - -It is in this way that periodicity as to stooling is lost, and whim, -convenience, or necessity takes its place. As a result, we dribble or -strain under the fecal and gaseous burden. This happy-go-lucky method -accounts for much of the gastro-intestinal disorder complained of by -so many, who “want to die” when the painful neurasthenic blues hover -around and pervade their bodies like a dense fog. - -The insidious manner in which proctitis, colitis, constipation, and -self-poisoning progress from mild through medium to severe stages does -not, generally, alarm the victim of intestinal neurasthenia until many -years have elapsed, and one or more of the vital organs have become -diseased, and the whole system is thoroughly under its toxic effects. -Thus, slowly, are the various segments of the gastro-intestinal canal -changed to an abnormal condition. - -Suppose the tissues of one of your arms and hands were inflamed, -constricted, or swollen, and that the nerves of motion were uncertain, -shaky, and “kinky,”--all of which conditions we often find in the -digestive apparatus,--and that finally recovery takes place under -persevering and patient treatment; how soon, think you, could a -sensible person expect the limb thus affected to become as useful as -its companion that had never been disturbed by disease? - -Unfortunately, we have not two sets of bowels. Ocean steamers are -equipped with two sets of motion-producing engines, so that the -disability of one will result in no loss of speed. When man places as -much commercial value on himself as he does on his machines or on a -boat, he will either induce Nature to furnish him with an extra set of -energy-producing organs, or he will take the best possible care of the -only one she vouchsafes to him--a care that extends from os to anus. - -Civilized man does, indeed, take a little notice of a sore mouth -(although indifferent about an unclean one), and will even try hard -to have it heal, because a sore mouth may be _seen_, and is likely to -disfigure him. But a sore anus and rectum may, for all he seriously -cares, play their painful and poisonous pranks until he is put to -bed disabled or is sent to an asylum--or to the final inn where all -diseases of the body cease from troubling and the weary organs are at -rest. - -To re-establish that normal régime of physiological relations called -health, after many years of perverse relations and disorderly -practices, obviously requires time and intelligent, faithful attention -to prescribed conditions. - -The factors or causes that militate against the removal of curable -diseases are: - -(1) The neglect of a local disorder until it has had time to exhaust -the general vitality of the system. - -(2) Inattention on the part of the patient after he has obtained -temporary or partial relief. - -(3) The victim arbitrarily setting his own time limit for the cure of -the disease. - -(4) His wilful disobedience of prescribed rules. - -(5) Inability to realize the importance of having the cause removed, as -well as the local symptoms. - -Confining attention for the present to proctitis and colitis, I wish to -impress the patient, as well as the physician, with the fact that no -better measure for relieving or removing these undermining disorders -can be adopted than the regular practice, twice or thrice daily, of -intestinal irrigation by means of enemas. The persistent use of the -enema is directly influential in relieving and removing the symptoms of -such disorders. These symptoms may be piles, prolapse, skinny tabs, -fissure, dull pains, soreness, itching channels, stricture of the anus -and rectum, ulceration, abscess, fistula, cancer, etc. - -In the early history of ulcerative proctitis and colitis, the local -symptoms at the anal vent may not be noticeable; yet the disease may be -quite well developed for six or nine inches along the bowels. The early -or more obscure symptoms are mild and unnoticeable; then they progress -into notice, sometimes most sharply; finally we have severe and chronic -constipation, indigestion, flatulency, diarrhea, etc., and, keeping -pace with these, we have the stages of self-poisoning, which is known -as auto-infection or auto-intoxication. - -With other measures, the most effective for relieving and removing -these symptoms of proctitis and colitis is the enema night and -morning. During the long period of relaxation at night, the functions -of elimination and repair are, with the great majority of us, going -on under abnormal conditions--such, for instance, as excessive -fermentation and bacterial putrefaction, which generate poisonous -gases that are absorbed by the nerves and bring about the condition of -_malaise_ we complain of when we rise in the morning. We then find our -bowels distended and ready for relief--and also, strangely, “not ready”! - -Before dressing, therefore, is the time to relieve the excessive -pressure from gases and feces, and a slight enema is accordingly -advisable, say from half a pint to a pint of water, which should -be expelled at once. This removal of the contents of the rectum -and perhaps of the sigmoid flexure will permit the contents of the -ascending and transverse colon to pass more readily toward and into the -sigmoid flexure, as though they had been invited to come; and, indeed, -such passage is rendered inevitable by the removal of the local gas and -feces in their path. When half an hour or more has passed and breakfast -is over, it is time for the regular and complete evacuation of the -bowels, by the aid of the internal bath, or, as some describe it, by a -full flushing of the colon. - -In our early efforts to establish harmony and periodicity with the -enema, it is advisable to resort to a mild vegetal laxative, in some -cases, rather than to let the tongue indicate so much foulness and -allow the feelings to become so intensely blue that they cannot be -hidden by even the utmost effort at pleasantry. Extreme cases may call -for different aids toward relief, until, one by one, these aids may be -dropped--the last one to be discontinued being the enema. - -For a short time at the start it is, perhaps, best to confine one’s -self to two enemas, especially if fairly successful with the attempt -at a thorough cleansing after breakfast and before retiring at night. -The sleep will be sounder and the patient will be more apt to rise -refreshed with a clean tongue and cheerful spirits. So much will this -before-bed enema do for him that he may soon find it unnecessary to -take the preliminary injection on rising, inasmuch as fermentation -and gas will no longer trouble him. But individual experience and -intelligence must dictate the course in this respect. Let the patient -study himself and note the demands of his system. It may even be, -indeed it is frequently the case, that a patient requires several -enemas during the day. When abnormality has set in, it gives rise to -all sorts of freak requirements, and the victim must, for a time, -accede to its whims. - -Quite frequently, owing to various causes, the feces will descend into -the rectum, which is properly a conduit, not a receptacle. While there -it occasions much nervous irritation of the whole system and makes -its victim desperate. It is wise, under such a condition, to take -slight injections for relief. Never allow any foulness to accumulate. -Establish the _habit_ of internal cleanliness. The new sense of bodily -purity will be so great that it can never be outgrown. - -Nature easily accommodates herself to habits, whatever they be--normal -or abnormal, wholesome or unwholesome, cleanly or uncleanly; and the -train of consequences will be accordingly good or evil. My point may -be easily illustrated by the habits of “civilized” man in regard -to bathing. Many persons never take an external bath, and are not -conscious of any bodily discomfort arising from the omission of this -presumably necessary practice. As the summer approaches, another batch -of “civilizees,” so fortunate as to be within convenient distance of a -pond, lake, river, or ocean, begin to feel the real need of a “dip,” -and are uncomfortable until they get it. This is surely a sign that the -spirit of cleanliness is beginning to stir in the breast of humanity. -Then there is another contingent that bathe once a week, and should -their regular routine in this respect be interfered with they would at -once feel unclean--nay, even dirty, and, sometimes, “nasty.” Others, -again, bathe twice or thrice weekly, and this quota of the human -race feels very uncomfortable and foul when hindered for a week from -following this routine; indeed, such bathers often imagine that a dire -illness is impending. Finally, the “salt of the earth” take an external -bath once or twice a day, and, should _their_ routine be suspended for -twenty-four hours, visions of madness or suicide begin to haunt them -until relieved by soap and hot water, or the cold plunge, as their -habits require. - -Of course, the same rule applies to the routine concerning the teeth, -facial ablutions, etc. Nature is stored habit, and she feels outraged -when her proprieties are disregarded. Let us pray, therefore, that the -habit of cleanliness may become contagious! - -Now, the parallel between external and internal cleanliness is quite -obvious. Those whose bowels move but once in two or three days do not -realize how foul they are. Others have a scant evacuation once in -twenty-four hours, and they imagine that they are as clean as those -that take an external bath once a week think themselves to be. Still -others have two stools daily, and they feel as clean internally as -those that take three external baths weekly. And, finally, there are a -few who, defecating thrice daily, feel quite as clean as does the most -persistent external bather. Thus we see that cleanliness, external and -internal, is a habit, a new nature, attended with exquisite comfort -and pleasure--a quality that may lead to the goal of divine purity in -realizing the joys of hydropathy. - -The wild woodland flower grew and blossomed without attention, -attracting but little interest. After, however, the florist has -cultivated it to the high stage of development in which we find it -to-day, with its stalk, stem, leaf, and fragrant petals displaying -their marvelous symmetry and beauty, we begin to appreciate the value -of labor, pains, cultivation. In like manner, it is our imperative duty -to give proper care to every requisite detail in the transformation of -our body into a human flower of health, grace, joy, and harmony. - -The great majority of those that do me the honor to read what I have -to say on internal and external cleanliness will, doubtless, not agree -with me as to the frequency of the ablutions in twenty-four hours. Yet -I have a suspicion that if my objectors were to try an external and an -internal bath, on both rising and retiring, they would soon consider -the practice too delightful to be foregone; they would soon develop -more sweetness of character and be more particular as to the purity -of their nether garments, and, finally, would seem ensphered by an -atmosphere peopled with angels. - -My proposition is this: First make a man clean, internally and -externally, and thus you may make him good; after you have made him -good you can make him healthy in both body and mind; after you have -made him healthy you can make him full of joy. - -To recapitulate: A good time to take your internal bath is about half -an hour after each meal. Cultivate regularity in this, and Nature -will second your efforts and establish a periodicity for you by her -suggestive impulse and call. Our internal economy should not be -slighted as it has been. The intestines are good, faithful, patient -servitors, ready to perform their lowly office even when we are -inattentive and heedless. Sometimes, however, they become rebellious, -after they have stood more abuse than one would think them capable of -standing. Let us reform our bad habits; our servitors are willing to -enter with us into better habits, and co-operate with us in a truly -human life. Can you not spare a few minutes, three times a day, at -_regular periods_, for inner purification? You will find it very easy -when once you make it a matter of routine. - -Now note this point: The work of your brain depends on the power sent -to it by the gastro-intestinal canal. A motor car goes no faster than -the power furnished enables it to go. So your brain activity is ever -on a par with the energy supplied from this usually despised intestinal -source; that is, it can never rise higher than the supply of this -energy warrants, and it always falls to the level of this supply, -for it depends on it absolutely for sustaining power. It would seem, -therefore, that common sense would be sufficient to shame us into -keeping clean, scrupulously clean, the canal that supplies us with -working force--the canal that extends without a break from mouth to -anus. Yet my experience shows that almost everybody cares more for his -outsides than for his insides--more for squandering his stored energy -than for looking out for its constant renewal--and that most patients -are foul all the way down. - -Well-fed animals that have the range of Nature are plump, and have -healthy hair, skin, teeth, etc., because their intestinal organs -perform their functions frequently and fully. When animals become -domesticated and “civilized,” they become constipated and catch various -human illnesses or grow a crop of their own. Well-fed “humanals” grow -thin and puny, or bloated with gas, looking like corpulent clay men, -without natural teeth, without natural hair, their skin dry and of a -sickly hue, bloodless, fading away because of an early blight before -they have completed their early growth. Heredity is blamed for the -bloodless, nerveless, brainless body, when, as a matter of fact, its -degeneration is due to foulness within. - -Birds, beasts, and savages (more fortunate than civilized man) have -the wide earth on which to stool when Nature calls. Their handy -water-closet enables them to enjoy good health. As civilization -advances, and business and social customs become more complex, -water-closets get fewer and less accessible. As a consequence, man -has to use his large intestine for a storehouse. He has done this so -long that it seems impossible to break him of the foul habit. But he -is paying the penalty. Many have abused the bladder in the same way, -and had this been a large organ like its brother, the colon, we would -long ago have heard the stereotyped excuse in regard to this function, -“Oh, any time to urinate that I can find will do.” Those who object to -the new order of bowel relief should, on the same principle, object to -frequent bladder relief. - -I submit this proposition to the judgment of unprejudiced minds: Is -it not reasonable that so harmless and efficient a remedy as the -internal bath should be adopted by all intelligent persons? Inasmuch -as neglect--due to social, business, and other customs, and to lack -of conveniences for ready relief--has brought upon us so much fecal -poisoning and local disorders and so many abnormal and pernicious -systemic results, it should not be considered too great a task to take -an internal bath three times a day to amend our outrage on Nature--an -outrage that involves our health and general well-being, here and -hereafter. We owe it, not only to our possibilities, but also to -posterity, that fecal poisoning be banished. We have no right to -communicate such a taint to our children. They have a right to be free -from such poison. Do we ever think of their claims in this regard? Let -us leave them a better legacy, by adopting the thrice-a-day use of the -enema for the purification of the alimentary canal! - - - - -CHAPTER X. - -HOW ENEMAS SHOULD BE TAKEN. - -METHODS OF INTESTINAL IRRIGATION. - - -A satisfactory appliance for taking an enema should possess the -following features: capacity, adaptability, convenience, cleanliness, -durability, and sufficient external anal and water pressure to effect a -thorough flushing or an agreeable vaginal injection while one is in a -sitting position over a water-closet bowl. - -There are several postures in which an enema may be taken. For those -physically able, the most convenient, cleanly, and comfortable manner -in which the thrice-daily inner bath may be had is the usual upright -position on a water-closet seat. For those not physically able to sit -upright, or for those that are not up-to-date and still adhere to the -use of the fountain or the bulb syringe, the best method is not the -usual sitting position, but the recumbent one. They are advised to -lie on the right side, or on the back with hips raised. As a rule, a -water-closet room is too small for reclining purposes, and, besides, -the necessary rubber sheet and toweling convenience may be absent. -Another drawback to lying full length for the purpose of flushing the -colon is that with short arms and the lack of _external anal pressure_ -there is apt to be an escape of water and feces around the anal point, -necessitating much cleansing, considerable annoyance from nasty odors, -and an irritating waste of time. - -Various devices, advertised as great inventions, have been resorted to -for the purpose of overcoming such malodorous and uncleanly incidents. -Among them is one that may be described as a colon tube, ranging from -nine to eighteen inches in length, which can be attached to a fountain -or a bulb syringe. The tube is usually of flexible rubber, _colored -red_ to hide as much as possible the cumulative evidence of saturated -filth and bacterial poison, the presence of which a white tube would -betray too readily. - -I fail to see the necessity of introducing a rubber canal of such -length into an intestinal channel five feet long for the purpose -of “cleansing” the latter. The project lacks common sense. What a -ridiculous practice--to worm or bore a hole through the impacted feces -as you work your tube upward, then to squirt a little water into the -middle of things, or as near to the middle as you have managed to -get with a tube that will persist in bending on itself, and then to -withdraw it covered with liquid filth! What folly to put a canal _into_ -a canal--the one inserted being one-fifth the length of the one to be -cleansed! Is not the original physiological channel good enough to -convey the antiseptic water or oil, or both? Why not have the rubber -canal five or six feet long if _one_ foot is so essential? - -We should remember that ulcerative proctitis and colitis have made -the use of the enema a necessity; that, accordingly, the diseased, -constricted gut or canal must be treated very gently and not irritated -in any avoidable way. The least irritation will result in still greater -muscular contraction. It stands to reason that the effort to reach -the healthy portion of the bowel with a slightly flexible colon tube -frustrates its own purpose, and that it is besides a source of serious -and unnecessary irritation. While this rubber tube is being forced up -one’s bowels it often becomes lodged here and there in the valves and -folds of the mucous membrane. It has been found that the effort used -to dislodge it sometimes results in a doubling of the tube on itself -in the form of a knot, and that the end first introduced comes back to -the anus waiting to escape with the next push! We need not argue that -this forced looping and knotting of the tube is very injurious to the -diseased intestinal region, and that no one would care to introduce it -two or three times a day. - -Does not common sense suggest that the rational way is to open the bore -of the alimentary canal by beginning at its _end_; that _liquid_ should -be applied directly to the first feces encountered, and that as this -impacted mass is removed the progress should be successfully upward? -The liquid as it enters dilates the channel, and as it passes on and up -it eventually gets beyond the diseased section of the bowels. Here, -by a gentle and soothing dilatation, we create at once an impulse -in the imprisoned feces and gases to descend and escape. What other -method is so kindly, and yet so effectual? We avoid, by this means, -irritating the diseased and constricted muscular canal; whereas by the -tube method we occasion still greater contraction, the inflamed surface -having a tendency to contract and close tightly over the tube. The -flood of liquid dilates the canal; whereas the forced rubber tube, by -irritation, contracts it. Besides, as has been pointed out, the conduct -of the tube working in the dark is most uncertain. - -Suppose the rubber tube does finally reach the section of the colon -free from inflammation; that its passage thither has greatly increased -the spasmodic contraction of the diseased portion of the gut, and that, -of course, it had great difficulty in circumventing the resistance -offered by the valves, curves, and short bends--suppose all this, and -an idea of how the contents of the bowel above the diseased zone are -imprisoned will dawn upon you. For, after the tube has reached this -point of impaction, the distention there is most unduly increased by -the sudden gush of water, and, what is of still graver import, the -presence of the tube prevents its return flow. Then as the object is -being removed the watery feces following closely after are impeded by -the increased irritative contraction set up by the tube. - -In short, this greatly extolled colon tube subjects the region of -proctitis and colitis, as well as the healthy section, to just such -objectionable procedure until the amount of water injected becomes so -extremely large that a means of escape is irresistibly produced by the -great pressure above. Is it wise treatment to irritate the diseased -portion of the bowels, and to distend still further the healthy portion -above, in order to get rid of distention due to feces and gases? -Without increasing the danger by injecting water into the already -unduly distended colon by the use of the tube, the imprisoned feces and -gases of themselves alone have been known to exert sufficient pressure -to occasion prolapse of the sigmoid flexure into the rectum or undue -displacement of the organ. Surely it were better to get rid of the -imprisoned contents by removing them from near the vent and working -one’s way gradually upward than to add more to the store and burden, -which only causes unendurable excitement and fierce demands for relief. - -The rectal enema, taken in the rational way, simply dilates the portion -of the gut that is morbidly contracted--a procedure that is very -beneficial and should be continued just so long as any remnant of the -inflammation remains in the tissues. Kindly treatment is essential, -because ulcerative inflammation is an irritable condition and tends -to contract the muscular tissue at the slightest touch of a foreign -substance. What, I repeat, is more kind and soothing than antiseptic -water mixed with oil? - -Advocates of the colon tube assert that water entering the lower -portion of the rectum will occasion ballooning of this portion -of the gut. After an experience covering twenty or more years, -I am in a position to say that there is absolutely nothing in -this objection--that water used in this way cannot produce such a -pathological condition. Ballooning of the lower portion of the rectum -is occasioned by _impaction of feces_, which remain lodged often for -weeks or months at a time in this locality. Whatever dilatation the use -of the enema may transiently produce would be only healthy exercise for -the diseased organ. An instrument is frequently used properly to dilate -the more or less contracted canal above and below the distended pouch -for a distance of from six to ten or more inches. Nothing but good -results can follow the proper use of the enema two or three times a day -in all forms of local disease of the anus, rectum, and colon. - - - - -CHAPTER XI. - -THE INTERNAL FOUNTAIN BATH. - -THE AUTHOR’S UNIQUE INVENTION. - - -The author has searched the markets of the world for suitable apparatus -for intestinal irrigation, so that he, as a specialist in this line -and in anal and rectal diseases, could recommend it to his patients. -None of the appliances to be had, however, quite answered the purpose -he had in view. All of them had some drawbacks. Owing to this fact, -after much experimentation he has invented an instrument that is herein -fully described to show its serviceableness. Were this volume to be -issued without this description, the author would be inundated with -interrogatories concerning the best instrument to be employed by its -readers, or whether the appliances they have on hand would answer the -purpose. As the object of this book is practical, not literary, it is -not out of place, the author thinks, to describe the invention and its -unique serviceableness, as well as its special adaptability for the -tri-daily employment of enemas. - -The instrument is known as “The Internal Fountain Bath for Home -Treatment.” The following illustration gives a very good idea of its -construction and merits: - -[Illustration: - -[Patented Dec. 31, 1901; Nov. 14, 1905.] - -Figures 18, 21, 22, and 23. - -18, Reservoir; 21, hard rubber handle; 22, metal handle; 23, metal -handle, hard rubber cone, and enema point; 19, lamp support; 20, lamp; -33, rubber tube and shut-off; 24, glass bottle; 27, hard rubber anal -cone; 29, valve; 28, enema point; 25 and 26, recurrent douche points; -30, glass bottle; 31, hard rubber cone; 32, enema point. - -Figure 24, Page 120, illustrates the author’s rubber enema appliance, -The Niagara Fountain Syringe, holding about two gallons of water.] - -The Internal and External Fountain Bath is an appliance that I -have devised and supplied to my patients for many years with most -satisfactory results in every particular. Several other enemata and -recurrent douche instruments which I have used did not wholly meet the -requirements in capacity or aseptic features; but long use of this -apparatus in all the various bowel troubles has demonstrated, to me as -well as to my students and patients, that the instrument is the best -that can be made, perfectly meeting all the requirements essential for -scientific results. - - -_Features and Uses._ - -The Fountain Bath is the product of necessity, effort, and long -experience in accomplishing a definite purpose fully and properly. -Figure 18 illustrates a large enamelled metal reservoir for water. -Figure 21 shows a hard rubber combined enema and recurrent douche -appliance for the application of water to the mucous membrane of the -large intestine, the temperature of which should range from ninety to -one hundred and thirty-five degrees or more. To one end of the handle -is attached a hard rubber anal cone (Figure 27), inside of which is a -valve (Figure 29), which is opened and closed by turning the handle, -permitting the water to pass through the rectal point (Figure 25), or -(Figure 26) into the bowels and return into the toilet basin without -removing the point. At the other end of the handle is attached a glass -reservoir for the use of oils. Figure 22 is a metal handle with a -glass reservoir and a hard rubber anal cone. Figure 23 is a metal -handle without glass reservoir, and both are intended for the use of -water at a temperature of from ninety to one hundred and five or one -hundred and ten degrees. A thermometer is absolutely necessary to -determine the temperature of the water during its use as a depurent and -antiphlogistic remedy. The heating appliance will keep the water at a -desired temperature during its application, which is a very essential -feature indeed. - - -_Water Capacity._ - -The Fountain Bath reservoir holds three gallons of water, which is -quite sufficient to meet all requirements of the various complicated -cases of bowel and uterine troubles which require a generous supply -of tepid or very hot water. This obviates any interruption in the use -of the enema or the recurrent douche treatment until one or both are -satisfactorily completed, and without changing one’s position on the -toilet seat. It requires a quantity of water to irrigate the large -intestine, which is some five feet long and two and a half inches in -diameter. It is foolish to attempt to irrigate one end of a long, -tortuous, foul sewer with one or two quarts of water and hope for good -results. Water is cheap, then why not clean out and keep clean? - - -_Adaptability._ - -For the first time in the history of enemata appliances can an enema, -recurrent douche, or vaginal injection be taken with water at any -desired temperature and at the same time be medicated with any remedy -desired. External pressure against the anal orifice is regulated at -will; also the flushing of the integument about the anus and buttocks -is easily accomplished before leaving the toilet seat. - - -_Convenience._ - -This scientific device can be used without assistance. It has one -feature moreover, that renders it unique among rectal appliances, -namely that you may take a number of rapid injections without changing -your seat. You may inject a small quantity of water (from eight to -twelve ounces), and expel it immediately; then you may follow with a -larger amount (from one to three pints), and expel that also, then -in the same manner flush the colon. A complete internal bath may be -effected in the same way by using three, four or more quarts of water. -In this way, thorough depurating results may be obtained. The several -preliminary injections of gradually increasing quantities of water -free the lower bowel of feces, germs, and gases which otherwise might -be forced by the flushing process backward into and along the colon. -With the Internal Fountain Bath, unlike other syringes, it is not -inconvenient to take preliminary injections before flushing the bowels. -After the flushing the rectal and anal canals the bowels can be easily -cleaned their entire length, as can also the integument about the -anus and buttocks by letting the jet of water play on these parts to -wash away any germs and other poisonous discharges. All the necessary -movements of the anal point are easily made with the handle which -projects between the limbs in front of the toilet seat. - - -_Cleanliness._ - -The water reservoir is enameled white, both inside and out and free -from poisonous substances. The enamel is not injured by the use of any -germicidal remedies that may be placed in the water, or by the water -being brought to a very high temperature to destroy bacterial poisons. -Furthermore this enameled surface is easily cleaned, thus avoiding -foulness of the reservoir from continued use. The glass medicine case -and anal cone attached to the handle, as well as the anal point, are -all detachable and easily cleaned, and the handle is of sufficient -length to obviate soiling the hands and impregnating them with odors. - -To bring away a quantity of feces does not exhaust the purpose of the -enema. The intestinal sewer requires further cleaning from end to end, -and the external parts around the anus as well. By playing a jet of -water on the external anal region you finish the enema and avoid the -very uncleanly practice of using “toilet paper” as a means of external -cleansing. It is strange that otherwise cleanly people are content with -such uncleanly treatment of these parts. They imagine that “toilet -paper” will effectually remove the excrement and its attending odors. -They would not think it sufficient thus to clean their hands if soiled -by excrementitious matter. It is the old story, “out of sight, out of -mind,” and of letting any make-shift in such cases answer; but the -spirit of cleanliness is abroad in the land, and the Silent Club of -the Cleanly is being formed through just such agencies as the Internal -Fountain Bath. Many have doubtless longed for a better practice but -did not know what to do. The “toilet paper” habit will pass with the -once-a-day habit of stooling, the constipation habit, and the physic -habit, for all four are uncleanly in the extreme. - - -_Durability._ - -The enameled metal reservoir and the metal and hard-rubber parts of the -handle ought, with care, to last a lifetime; the soft-rubber tube, if -properly cared for, will be of service for a long time. - - -_External Anal Pressure._ - -This is of very important assistance in flushing the colon, as it aids -in preventing the return of the injected water, and thereby promotes -its conveyance along the colon until it arrives at the surgically -famous vermiform appendix. It is not strange that both ends of the -large intestine--the anus and rectum and the appendix region--have -kept the surgeons busy, and I may add the undertaker likewise. These -two ends are of extraordinary concern, because they manifest intense -symptoms and pathological consequences. Modern medical practice is the -heroic treatment of symptoms and consequences and not patient search -for causes of disease and sensible treatment of it, as explained in -my treatise dealing with “Intestinal Ills,” as well as in the present -volume. - - -_Water Pressure._ - -Two or three gallons of water, suspended at the usual height of enemata -appliance, affords quite enough pressure, especially when the outlet -and tubing are amply large. The shut-off on the rubber tube enables the -user to gauge the flow of water to a nicety. - - -_Time Required._ - -The time required for taking an internal bath--that is, for a complete -flushing of the bowels--will vary in individual cases. After removing -the local deposits in and near the rectum by one or two rapid -injections of very small quantities of water, two to four quarts are -taken into the intestinal canal at one time, and this constitutes -the enema proper. Now, many persons will find it advantageous to -let the flushing water enter very slowly, taking from two to five -minutes, or even more. With some, if the water is allowed to flow in -very rapidly, the various segments of the rectum and colon may not -readily accommodate themselves to the inflow, and will too soon make -an expulsive effort, returning the water before it has dissolved the -feces or united with them, thus defeating the object sought through -the enema. With other persons, however, the flow may be as rapid as -desired. The speed must be left to individual judgment and experience. - - -_Temperature of Water for an Enema._ - -The chief purpose of an enema is to produce depuratory results; that -is, to remove morbid matter from the bowels and then to cleanse them. -To accomplish this effectively and at the same time to avoid exciting -an increased flow of blood to the diseased gut, the water should -be about the normal temperature of the body, which is about 98-1/2 -degrees. Water too hot or too cold will aggravate the sensitive, -inflamed surface; and, as it is this very inflammation that causes -the abnormal action of the bowels for the relief of which the enema -is taken, the temperature of the water is most important. If it range -between 90 and 105 degrees it will do, for within those extremes it -will not be likely to increase the existing chronic engorgement of the -tissues. Under no circumstances should very hot or very cold water be -used for the removal of fecal accumulation. Physicians so incompetent -as to make a wrong diagnosis of the cause of chronic constipation -and its numerous symptoms often prescribe a wrong treatment in the -use of water. From two to ten minutes’ use of very hot or very cold -water in cases of proctitis and colitis will only increase the chronic -engorgement of the blood-vessels and tissues and increase the morbid -symptoms. When water is applied to the mucous membrane anywhere -throughout the body, I use it hot exclusively, as that temperature has -then certain advantages over cold. In the chapters treating upon the -different uses of hot water, I give the hydro-therapeutic action of -such liquid on the tissues of the body. - - -_Quantity of Water to be Used._ - -The quantity of water to be injected into the colon at one time must -vary in each case and also on each occasion. In the beginning of its -use and for some time following, a greater amount may be required than -will be necessary when, with its continued use, a better action of the -bowels becomes established. - -In cases of chronic constipation and semi-constipation, the kidneys, -lungs, mucous membrane, and skin eliminate a daily accumulation of -feces from the system equal to two-thirds or three-fourths of the -amount of normal feces. This accounts for the frequency of chronic -disease of these organs. To establish a new régime in the mode of -fecal and gaseous elimination requires much time and patience in the -use of the enema. Nearly all persons can take the enema with comfort -and satisfaction. Now and then, however, there is a person who finds -it a little troublesome to inject over a quart of water at one time, -while most persons can inject over four quarts without inconvenience. I -would advise patience and perseverance on the part of those who find it -irksome to inject a sufficient amount thoroughly to cleanse the colon, -or the portion thereof involved in undue accumulation. - -Enough water should be injected to bring away what would constitute -the normal amount of feces to be passed at a regular stool. Gradually, -as the practice is established by the use of the enema twice or thrice -daily, it will be easy to determine the proper amount of feces to pass. -And note this fact: it is just as easy to establish the habit of three -evacuations in twenty-four hours as of two or one. - -Whenever the amount of water injected proves sufficient at any time to -bring away all the feces that should pass, it is not necessary at that -sitting to repeat the dose, except it be for subsequent cleansing, as a -sort of gargle. No possible harm can come from the generous use of the -enema during a lifetime; indeed, its constant use will prolong life and -make it more comfortable. - - - - -CHAPTER XII. - -BENEFITS OF THE INNER BATH. - - -I speak from clinical observation with the use of various rectal and -colon specula, of which I have over fifty. I have watched the progress -of cases that were using the enema twice or thrice daily, and of cases -that were also using the intestinal recurrent douche, which latter -required an hour’s continuous application of hot water, and I know, -therefore, whereof I speak when I affirm its salutary effect both on -the local organs and on the general system. - -Many that write about the use or abuse of the enema have never seen -the mucous membrane of the rectum and colon. Most of what is written -on the subject is worthless. The author of this book writes from -the accumulated experience of daily examinations with specula for a -period of over twenty-three years. Had he merely used his fingers -or hand for making rectal examinations, or had he contented himself -with prescribing for symptoms reported by the sufferer, his views and -opinions as to the use and benefits of the internal bath would have -been on a par with those that, by the old methods, make futile efforts -in diagnosis and treatment. - -Some good souls now and then become oversolicitous as to the matter -they should pass when their bowels are already empty, and they feel -alarmed if the enema fails to produce an evacuation. Such timid ones -should remember that what they cannot accomplish at one time and with -one attempt they may at the next, and that thus slowly the new order of -fecal elimination will become established. It takes time and patience; -but is this cause for apprehension when diagnosis, treatment, and means -of relief are right? I claim that flushing of the colon is the best -means for removal of the consequences of proctitis and colitis, and -that it should be employed by all that have these chronic ailments. -Let them get relief for the _symptoms_ at once and in this rational -way, after which let them seek scientific treatment for the ailments -themselves; for, sooner or later, they will be compelled to seek it by -the severe complications that will inevitably set in. - - -TRY SCIENTIFIC AND PRACTICAL MEASURES. - -Some persons find difficulty in estimating--or think they do, which in -most cases is nearer the truth--the amount of water they can inject at -one time, when it would work a great relief to their bowels were they -able to inject from two to four quarts. It is half the battle to know -your efforts are rightly directed; for, when you are defeated, you will -try a thousand and one changes--an experiment first with one element -of the difficulty and then with another. You will experiment with the -temperature, with the speed of flow into the rectum and colon, with -intermittent flow, etc. Be a little scientific and original in this -matter, I pray you, _and know no defeat_! - -As to the intermittent flow, the following way may be found judicious -in some cases: Take in just sufficient water--a few ounces perhaps--to -provoke an evacuation, and proceed till you have taken half a dozen or -more. After this you can take a greater quantity for a washout. But -this is not exactly what is meant by the term “intermittent flow.” It -means that you may make the experiment--if you find it difficult to -fill up after ridding yourself of the local accumulation--of turning -off the stop-cock for a moment, thus giving your bowels a slight rest, -and then turning it on again, alternating in this way for some minutes. -Many little devices of similar utility will suggest themselves to those -who know no defeat. Remember that, now that you are in serious trouble, -it is not the easiest thing in the world to get out of it. - -Should your stomach raise objections to the enema, change the time. -If abdominal pains are severe, change the temperature of the water -and the time and manner of injecting it. In other words, do something -different, but be determined to conquer and take the internal bath at -proper periods every day. - - -LIBERATING THE WATER. - -Some persons who find no trouble at all in taking a large quantity of -water have much difficulty in expelling it, or rather in expelling -all of it at once. Various methods may be resorted to to liberate the -retained water. One is to inject a little more, as a provoker, when all -will escape without further difficulty. Another method is to resort to -various motions of the arms and body. Some find relief by raising and -projecting both arms together slowly, and then stretching and holding -them aloft for a few moments. Other methods are: to twist the trunk a -few times, to walk up and down a little, to bend forward and backward, -etc. Still another method is to massage the abdominal walls, beginning -at the ascending colon (see Fig. 12), passing upward to the left along -the transverse colon, and then downward until the lower portion of the -sigmoid flexure is reached. When beginning the massage, one should use -stroking movements from right to left over the entire surface, and then -go over it again with rotary strokes. Some may find it advantageous to -knead the abdominal muscles, gradually reaching the deeper parts as the -air is expelled from the lungs, which expulsion may change the position -of the various segments of the intestine and thus afford an opportunity -for the feces, gases, and water to escape. Before rising in the morning -and retiring at night, it will be found advantageous by some persons -to spend about ten minutes in making the three kinds of manipulations -described. It is an excellent practice for every one to lie flat on the -chest and abdomen and draw in several deep breaths just before rising. -This exercise will strengthen the muscles of those parts and benefit -the internal organs as well. - - -THE ENEMA AS A PERMANENT PRACTICE. - -In the effort to restore the long-abused bowel to its normal -functioning by the use of the enema and massage, there may be, in -the beginning of such treatment, an exceptional case in which a mild -laxative is indicated as the desirable thing, rather than that a furred -tongue and base bodily feelings shall evidence too much foulness all -the way up to the mouth. - -The enema, of course, constitutes the chief means and mainstay of -relief from obstipation of the bowels, and one by one the other -aids are to be omitted. Moreover, when the time comes that the -bowel is freed from the disease that occasioned the occlusion and -obstipation,--that is to say, when the bowels evacuate themselves -naturally three times a day,--then the enema itself may be omitted, or -it may be continued without harm by those whose sense of cleanliness -would induce them to keep up the practice in preference to the -uncleanly habit of using toilet paper as a partial means toward -cleanliness. Surely there is no harm in substituting a better habit for -a worse one--one, moreover, that we should be ashamed to continue! As -no one would think of cleaning his soiled fingers with toilet paper, as -already said, so no one with any real sense of decency will continue -the attempt to clean his anal orifice with such material when he has -learned a better and more effective way. Likewise, after having learned -the rational mode of relieving the surcharged bowels, no wise person -will continue the use of physic, coarse food, gymnastic exercises, and -other futile and foolish practices as remedial measures for intestinal -ailments. - -No one suffering from proctitis and colitis can have a clean and -healthy sigmoid flexure and rectum unless these be kept clean by -the regular use, three times a day, of the enema. From the day when -the disease invades these parts there is and will continue to be a -clogged, plastered, or incrusted passage for more or less of the entire -length of the colon. This must be so in the nature of things, since -these organs are unable to perform their functions while the disease -is present. Just think of possessing a filthy, congested intestinal -canal, without one day of real cleanliness for twenty, forty, sixty, or -more years! It is not the easiest thing in the world to cleanse this -channel even by the use of the enema; for the ancient contents refuse -dislodgment even after repeated flushings, and it is only after many -days of persistent and patient irrigation that the intestines are freed. - -Some persons are apprehensive as to the quantity of water the large -intestine will hold with safety. Let me reassure them. It is capable -of holding about three gallons without too great distention. One-third -of this amount, however, is quite sufficient to bring away the -accumulated fecal mass, and in many cases a much smaller amount will -answer the purpose--especially when, as advised, it is used two or -three times within twenty-four hours. After a thorough evacuation, -water should be injected one or more times until it returns clear and -free from fragments of feces. - -If I were asked to name the greatest curse parents could inflict upon -their helpless offspring, I would say _fecal auto-intoxication_. A -large volume could be written on the subject, and I trust the hints -here given will lead to discussion of this grave matter. - - - - -CHAPTER XIII. - -OBJECTIONS TO THE USE OF THE ENEMA ANSWERED. - - -The privilege of raising objections belongs to the ignorant as well as -to the intelligent. But the objector is under as great obligations to -state his reasons as the advocate. - -The first plausible objection to the use of the enema is that it is not -natural. - -Admitting this charge, I would say that, inasmuch as proctitis, -colitis, and constipation are unnatural, the use of a preternatural or, -in other words, a rational means to overcome the consequences of these -diseases is imperative. The enema is such a means. - -Can any one that suffers from proctitis, etc., have a natural stool? -Unnatural conditions require preternatural aids, as we all know. The -injected water dilates the constricted portion of the gut and arouses a -revulsive impulse to expel the invading water. In obeying this impulse, -the imprisoned feces, gases, etc., are ejected with the water. - -It may be unnatural to put water into the rectum, etc., but once there -its expulsion from healthy bowels would be quite natural. No natural -action can be expected from unhealthy bowels; they do the best they -can under the circumstances. Eyeglasses, false teeth, crutches, etc., -are unnatural but invaluable aids, but no more so than is the enema -as a means of relief from overloaded bowels. The enema, moreover, be -it noted, not only aids the system by relieving it of its load: it -cleanses and soothes an organ that must keep at work and perform its -function even when invaded by disease. - -Surely it is unhygienic and irrational to ignore the valuable service -of the enema in cases in which the bowels are in an unnatural condition. - -The second objection is that the water will wash away the mucus from -the mucous membrane of the bowels and leave them dry and parched and -thus apt to crack and break in two. I would remind the objector that, -since about seventy-five per cent. of the normal feces is water, it -seems strange that so great a quantity of water in contact with the -mucous surface of the bowels should not also cause dryness. - -The integument of the body and that of the mucous membrane are similar -in structure, yet who ever had a fear of producing dryness of the skin -by much application of water? The mucous membrane is simply the skin -turned inward; and since it is much more vascular it is less apt to -become dry--if, indeed, its dryness were at all possible. The objector -should also remember that the body is composed of over eighty per cent. -of water--an organism not to be made dry or parched by the application -of water to the skin or to the mucous membrane two or three times a day. - -The mucous membrane of the lower bowel is not unlike that of the -mouth, throat, or stomach. Do you realize how often the upper end of -the intestinal canal is washed or bathed daily with liquids,--soft and -hard drinks, hot and cold,--especially by those who have formed the -drink habit instead of the enema habit? They have no fear of drying the -mucous membrane thereby; but, if you can instill this fear, they will -increase the quantity with pleasure! - -This second objection, being the result of too vivid an imagination and -too little reflection, is a very nonsensical objection indeed. - -A third objection is that if you begin the use of the enema you will -have to continue its use; you can’t stop, and, lo and behold! the enema -habit is formed,--a new habit in addition to the many habits civilized -man is already carrying: the constipated habit, the physic habit, -the sand, bran, sawdust-food habit, the muscular peristaltic habit, -etc.,--and with all these habits the poor victim of proctitis and -intestinal foulness wonders that he is alive. - -Usually the first symptom of proctitis is constipation, and for -relief the enema habit should be formed and continued while the -constipation remains. When the proper means are found to remove the -intestinal inflammation--proctitis and colitis--then the constipation -will disappear, and with its disappearance the enema habit can be -discontinued. But let it be well noted that the enema is itself an aid -in curing the cause, an aid superior to any other at our command. A -cleanly habit ought not to be an objectionable one, especially in cases -in which it is most needed to prevent toxic substances from entering -the system. - -A fourth objection is that after taking the first enema the -constipation is worse. - -With many persons a certain amount of undue accumulation of feces will -excite a sufficient muscular effort of the gut to force the dried mass -through the proctitis- and colitis-strictured bowels. This unnatural -effort may occur once a day or once in two or three days, and has -doubtless been a habit of many years’ duration. - -To introduce a new order of conduct on the part of the bowels requires -time. If the bowels have been in the habit of expelling feces in the -morning, and an enema were taken the night before, there might be no -desire to stool the next morning because of the fact that the bulk or -accumulated mass of excrement was no longer there to create a vigorous -call or impulse for defecation. - -But we have found the extent of local damage and reflex injury to the -organs, and more especially we have found the constant absorption -of poisons into the system, due to the presence of feces. It is -for this reason that the elimination of feces twice or thrice in -twenty-four hours is advised. The condition for which an enema is -used is disturbing and poisoning to the system. It is, therefore, a -most unnatural condition. What is more rational, then, than to employ -an “unnatural” yet not harmful means to bring about a more normal -condition, one free from poisoning and irritating consequences? - -A fifth objection is made by those who have as a symptom of proctitis -a large development of pile tumors or hemorrhoids (distended mucous -membrane). The objection is that at times these tumors or sacs prolapse -very freely during the act of expelling the injected water. But this -prolapse occurs in many cases whether water is used or not. - -A certain amount of anal irritation caused by the passage of feces -occurs, causing contraction of the circular muscular tissue that forms -the anal and rectal canal, also of the longitudinal muscular bands -and the levator muscles of the organs. The enema lessens or entirely -diminishes the irritation of passing feces, and the natural result is -that the serum-filled sacs called piles and the tissue loosened by -the inflammatory product would more readily prolapse during the act -of defecating. It is simply a choice between irritation of the stool -keeping the tissue up and no irritation permitting a prolapse. - -Of course, if there be no expulsion of feces and water the stretched or -dilated sacs may keep their places in the rectum. And then again the -enema may be used for quite a period, when all at once a large prolapse -of sacculated mucous membrane occurs, and the enema is thought to be -the cause of it. That this is not the cause, let it be remembered that -in all cases of proctitis the chronic inflammation is apt to become -subacute or acute, and that this intense engorgement and enlargement of -the tissue with blood and the increased fever in the parts often result -in prolapse at any time, especially at times of convulsive effort at -evacuation. - -Whatever follows the proper use of an enema, even though what follows -be annoying, should not be blamed on the enema, for its action is most -kindly, lessening, as it does, the irritation that otherwise would be -more severe when the feces pass through a disease-constricted canal. - -The sixth objection is that the use of the enema will weaken the -bowels, which are already too “weak” to expel their contents. “Atony, -paralysis, fatty degeneration of the gut, are bad enough,” say these -objectors, “without having an enema increase their uselessness.” -Diagnosis wrong and objection groundless! - -Distend and contract an organ for a short time two or three times a -day, and it will gain in strength from the exercise. Every one knows -that this is the case. What more gentle means of exercising the large -intestine than by the enema? - -But the truth of the matter is, that in all cases of proctitis and -constipation the diseased portion of the gut is too active in its -muscular movements, contracting spasmodically, as it does, at even the -suggestion or suspicion of feces near it. Every impulse of the bowels -above the constricted section to force the feces down through the -closed bore only intensifies the spasmodic action and increases the -muscular obstruction, compelling the victim to resort to some one of -the many drastic means of relief. - -The enema does no more than kindly to dilate the constricted region, -which, when dilated, evokes a harmonious concerted action of all the -nerves and muscles to pass along and down the burden of feces, which, -without the aid of a flood of water, they had been incapable of moving, -and would have had to leave to poison the system. - -The seventh objection is quite _naïve_: “Inasmuch as the Indians of -this country had no use for the enema, why should we resort to it?” - -The all-sufficient answer to this objection is that the Indians lived -a natural life, while ours is artificial. Much can be said on this -point, but the reader is surely rational enough to follow out the -distinction suggested. Our lives are much more important than were the -lives of the aborigines of this country, and our “demands of Nature” -are more exigent. If your life is of no greater value than theirs, -for leisure’s sake don’t use the enema! You will be taking too much -trouble. It really should seem that the cleanliness of the skin and -mucous membrane, the care we take of our bodies, is an indication and -measure of our sense of refinement. An ancient Scripture hath it: “Let -those that are filthy, be filthy still.” It all depends upon how you -wish to be classed--with the filthy or the cleanly. - -The eighth objection to be noted is the fear of “poking things” (points -of instruments) “into the rectum.” - -This looks like a real objection. No healthy, nor even unhealthy, -organ, for that matter, should be “abused.” And what seems more likely -to cause it trouble than to poke a hard- or soft-rubber point or tube -through its vent in opposition to its bent or inclination? Still, the -muscles of the vent are strong, and they soon accommodate themselves -to the practice. Their slight disinclination is not to be considered -alongside of the relief and cure you effectuate by the use of the enema. - -Have no fear that the point will occasion disease when intelligently -used. Always see to it that the point is scrupulously clean. Those made -of hard rubber or metal can be kept so without effort. Soft-rubber -points are always foul and dangerous, especially after they are used a -few times. A good rule is never to put a point higher in the bowel than -is absolutely necessary. - -The ninth objection seems serious. It is that in taking an enema the -water escaping from the syringe point will injure the mucous membrane -where the jet strikes. But on examination this objection falls to the -ground; for it stands to reason the jet cannot directly hit the surface -for more than a moment. Immediately thereafter the accumulation of -water will force the jet to spend its energy on the increasing volume, -to lift it out of the way so that the continuous inflow may find room. - -But even were it possible for the jet to strike a definite section of -the mucous membrane during the taking of the enema, it could do no -harm provided the water be at the proper temperature. And this is true -even if a hydrant pressure be used. Not a few persons use the hydrant -pressure of their houses in taking an enema. For a really successful -flushing of the colon a considerable pressure is requisite to force the -volume up and along a distance of five feet, especially when sitting -upright. But it is folly to use a long syringe point, since it is like -introducing one canal into another for the purpose of cleansing it. -Therefore, have no fear from the use of proper syringe points; the jet -of water will _not_ hurt the mucous membrane. My professional brethren -at least ought to know that the idea of such harm is sheer nonsense. - -The tenth objection to using an enema is in _being obliged to use it_ -from the fact of having such a disease as chronic inflammation of the -rectum and colon. Every victim hates to be compelled to do a thing; -and the victim of proctitis and colitis is no exception to the rule. -In fact, he is beginning to realize that unless he uses it his system -will be poisoned by the absorption of the sewage waste. Let the victim -object to the disease that necessitates the use of the enema, and all -will shortly be well. Then this objection to the use of the enema will -indeed be the most important of all. - -The eleventh objection, and the most ridiculous of all, is that it -requires too much time to take the enema twice or thrice daily. - -I lose all patience with persons urging this objection. Those that -have little or no system with their daily duties seldom have time to -do anything of importance. They suffer from “haphazarditis,” a very -difficult disease to cure, and they are in many cases hopeless. Usually -they are an uncleanly lot of people, full of good intentions, but -their intentions, though taken often, seldom operate as an antidote -to foulness. Their one sigh the livelong day is: “Oh, could we be -like birds that can stool while on the wing or on foot!” This feat of -time-saving being hardly possible in the present incarnation and order -of society, they content themselves with making a storehouse out of -the intestinal canal for an indefinite length of time as they concern -themselves with external affairs of work or sport. A sorry lot they -are, indeed, when they are laid up for repairs! Many doctors, I am -sorry to say, encourage, with a chuckle, this foolish practice. “Any -time to stool you can manage to get, so that you stool at least once a -day, or once in every two or three days; stool when it is normal for -you to do so.” This criminal advice just suits the sleepy, the lazy, or -the “awfully busy.” - -The American habit of doing things _en masse_, of handling things in -large quantities or in bulk, has something to do with their don’t-care -constipated habit. Small evacuations two or three times a day seem -too much like small business, which of course is a waste of precious -time. Wholesaling, laziness, lack of system, hurry, are the cause of -good-for-nothingness of body and mind. It should never be too much -trouble to restore the lost impulse for stooling twice or thrice daily. - -Is it a small matter to have the main sewer of a city partly or -entirely closed, or the main sewer pipe of a dwelling stopped up? Think -of the dire results, notwithstanding that the windows and doors remain -wide open! The Board of Health would soon deal with the negligent -official or landlord. With very few exceptions, “civilized” men, women, -and children are negligent and niggardly caretakers of the human -dwelling-place--the marvelous body of man. “Lack of time,” “haven’t the -time,” or “no time,” is the excuse they give themselves and others. - -Notwithstanding the numberless victims around them, none of these -negligent and niggardly ones seem to get alarmed until the secondary -symptoms--such as indigestion, gout, rheumatism, or disease of some -vital organ--are sufficiently annoying to demand attention. But I have -full faith in humanity. Man does the best he knows how--as a general -rule. But often he doesn’t know how; he needs enlightening. - -The hints I have given will, I am confident, be considered and acted -upon by all to whose attention they are brought, for, by acting upon -them, normal bodies and minds will result, and blessings attained -heretofore considered impossible. Normal health depends on right doing -and being. Eternal vigilance is the price to be paid for the attainment -and maintenance of the goal of normal life and progress. Eliminate all -waste material from the body and all shifty vermin from the mind, and -the millennium for all things in the universe will soon dawn. - -[Illustration: Fig. 24. - -NIAGARA FOUNTAIN SYRINGE. - -(Patented Nov. 14, 1905.) - -The above illustration represents the Niagara Fountain Syringe, to -which can be attached the enema handle, Fig. 22, Fig. 23, or the -combined enema and recurrent douche handle, Fig. 21, page 91. The -Niagara Fountain Syringe is made of soft rubber and holds about two -gallons of water, and is very handy when traveling or in need of a -hot-water bottle.] - - - - -CHAPTER XIV. - -LAME BACK. - - -The manufacturers of various compounds advertised in our daily -newspapers and on the billboards usually select very common ailments or -symptoms on which to exploit the merits of their product. They make no -distinction between a disease and its symptoms; and why should they, -when their sole object is to sell their goods? - -Lame back is a common weakness of that portion of the spine usually -spoken of as the “small of the back.” As a general rule, it is an -indication of some pelvic disease involving the anus, rectum, colon, -bladder, or uterus. Those who suffer from disease of one or more of the -pelvic organs will have at times reminders that they have a lame, weak, -or “dead” spot at the “small of the back” or a little lower down on the -spine. - -As an illustration, a current advertisement reads as follows: “Weak -Backs! If you happen to be one of those unfortunate people with a weak, -lame, tired, aching back, it is time you were finding out about ----.” -Then the advertisement proceeds to tell how to put on a plaster or a -liniment, or rub the back for a week or two with the hands. Another -enterprising wonder-worker asks: “Do you get up with a lame back? -Thousands of women have kidney trouble and never suspect it.” “Lifted -from the depths of despair by----” etc. Now, this may be seriously -alarming to actual sufferers from lame back. - -[Illustration: Fig. 19. - -Showing the distribution of the sympathetic nerve about the rectum. 22, -the rectum; 23, the bladder; 26, the kidney; 20, the rectal plexus; 19, -the vesicle plexus; 18, the sacral ganglia; 21, the lumbar plexus; the -lumbar ganglia; 16, the mesenteric plexus; 15, the solar plexus; 27, -the aorta.] - -The kidneys are located several inches above the region called the -“small of the back”; therefore, a difficulty in this region does not -necessarily indicate disease of the kidneys. Those who suffer from the -symptoms described--lame, weak, hot, dead spots, lumbago, rheumatism, -etc.--at this portion of the spine may suspect that some of the organs -in what is called the pelvic cavity are causing them. The spinal nerves -(lumbar nerves) on leaving the “small of the back” and proceeding lower -down are distributed to the anus, rectum, bladder, uterus, etc., and -when one or more of these organs are diseased the victim will have some -of the symptoms in the portion of the back mentioned above. The earlier -indications of a disease are usually localized, but, as the malady -itself persists indefinitely, both the sufferer and his physician -are often deceived as to the producing cause of the varying symptoms -manifesting throughout the body. - -In this brief chapter I will confine myself to the diseases of the -anus, rectum, and colon, as causing so much annoyance from the symptoms -enumerated at or below the “small of the back.” The most common ailment -that afflicts mankind is chronic catarrhal inflammation of the anus, -rectum, and colon. The disease invades not only the mucous membrane but -the whole bowel structure, and the nerves report from the seat of the -trouble up to where they enter the spinal column--a region that should -be called the porous-plaster region rather than the “small of the back.” - -The chronic inflammation involving eight to ten inches of the lower -portion of the intestinal canal, like all other diseases, has its -alternating periods of quietude and excitement; and the negligent -sufferer must count on having “stitches in the back,”--cold in the -back, lumbago, rheumatism, sciatica, etc., as they are usually called -for want of a definite idea as to the _cause_ of the annoying symptoms. -The physician consulted usually agrees with the sufferer’s diagnosis, -and coincides with the application of bands, porous plasters, -liniments, etc.--which may allay the neuralgic symptoms to some extent. - -The reader is so familiar with illustrations in the newspapers and on -bill-boards of a man with a weak or lame back that it is unnecessary -here to take up space with a pen picture descriptive of the symptoms -and attitudes of a sufferer. - -Those who have had occasion to acquire the warm-band, the rubbing with -liniment, and the plaster habits, had better direct their attention and -remedies to the _cause_ of the symptoms. One frequent source of all -these back symptoms is chronic inflammation of the anus, rectum, and -colon, with more or less ulceration accompanying it. In the female, -disease of the uterus complicates the painful symptoms. Usually among -the first indications of this disease is some degree of constipation, -which in time is followed by local symptoms known as piles, fissure, -itching tabs, clot of blood in a vein, abscess, etc. Constipation is -a prolific cause of indigestion, biliousness, flatulency, loss of -appetite, self-poisoning, anemia, emaciation, uric acid, neuralgia -in various parts of the system, catarrhal inflammation of the mucous -membrane of one or more organs, and many other symptoms. - -A diseased organ is a constant source of unconscious and conscious -irritation to the sufferer. If the victim can tolerate the trouble he -seldom seeks treatment. “I will not bother with it as long as it is no -worse,” he says. At times, however, the symptoms become very annoying, -and measures are taken to allay them. During the long interval of -“better and worse” effects the malady is becoming more deeply seated, -and the symptoms eventually appear in all parts of the body. - -As a rule, the majority of victims put off treatment until a protracted -period of extreme suffering or the fear of a fatal ending compels them -to consult a physician--who labors at a great disadvantage in seeking -to effect a cure on account of the long neglect. - -Severe symptoms located at the porous-plaster region of the spine, when -brought on by disease of the lower bowel, usually indicate an acute -stage of chronic inflammation and retention of feces and gases in the -sigmoid flexure and colon. Acute or subacute inflammation and fever and -pressure of the feces are more than the long-abused nerves can endure, -and severe pain is the result. - -Then the sufferer has something to say about his back, and what is best -to do for it. - -The logical course is to unload the bowels of feces and gases by a -generous use of the enema and to treat the diseased tissues kindly. The -symptoms will soon disappear when the cause is removed. - - - - -CHAPTER XV. - -URIC ACID. - - -A society leader, in speaking of her ills to a woman friend, said: “I -am ‘lousy’ with uric acid.” From infancy to old age, mankind is more -or less filled with uric acid and other poisons--the result of a foul -intestinal canal. Poisoned blood is a common symptom, and it arises -from an almost universal cause--chronic constipation. So universal is -constipation of the bowels in illness that it is the first duty of a -physician to prescribe some remedy to unload them. - -It is said that a Boston doctor, whose practice was largely among the -wealthy classes, used to say: “There is no use in physicians pretending -to be anything else--they always smell of rhubarb.” And in an address -to a class of medical students an old doctor once said that he and his -associate practitioners had found that calomel and opium filled every -want in the ills they were called upon to treat. - -For ages all mankind has striven to find a remedy effectively to clean -the intestinal tract. Pills, powders, tablets, wafers, suppositories, -salts, teas, candies, and syrups have been administered--all with -that sole purpose. Efforts have been made to accomplish this object -by utilizing every possible device and contrivance known to human -ingenuity. Calisthenics, massage, physical-culture exercise, mental -therapy, horseback riding, “dieting,” fasting--these are some of the -many means resorted to in order to “sterilize” the foul, constipated -intestinal canal. - -Albeit that the cleaning of the digestive apparatus in the case of -a sick person is regarded as a necessary first help the world over, -few persons realize that it is of equal importance in the case of -a seemingly healthy person. Is it not a fair inference, therefore, -that where a purgative--such as calomel, or one of the innumerable -similarly-acting medicines--temporarily relieves a patient’s symptoms, -the timely precaution of keeping the intestinal canal and system clean -would prevent a person from getting ill? - -The reader may think that, in these observations, I have wandered away -from my text, but, as uric acid is the _symptom_ of a combination and -complication of disorders of which constipation is the secondary cause, -the connection and sequence of my remarks are evident. It is safe for -a layman to assume that, where so many diverse schemes are employed to -relieve symptoms, the diagnosis is wrong--also the treatment. - -A few of the many primary symptoms of proctitis and colitis are -constipation, diarrhea, indigestion, biliousness, flatulency, -putrefaction, and gaseous and bacterial poisons--a foul -gastro-intestinal canal, through which there are daily absorbed from -the bowels two-thirds to three-fourths of the excrementitious matter -into the system. With these facts before us we need not be astonished -at the statement that nine-tenths of human ills have their origin in -the digestive apparatus. - -Among the secondary symptoms of proctitis and colitis is poisoned -blood--anemia, which is usually followed by impaired nutrition and -emaciation or obesity. Along with the changes in the blood and -nutrition there occurs lodgment or deposit of salts, acids, etc., -in the various organs and tissues of the body. Almost every one is -familiar with gouty deposits in the finger joints and other joints of -the body. If the deposits occur in the muscular tissue it is called -rheumatism. If in the urinary organs we have gravel, Bright’s disease, -diabetes, cystitis, irritation of the neck of the bladder, frequent -calls to urinate; and the urine, scanty and high-colored, on cooling -reveals a crystalline deposit. The principal mineral substances of -the urine are as follows--of which one or more may become poisonous: -chloride of potassium, chloride of calcium, chloride of magnesium, -chloride of sodium, sulphate of potassium, sulphate of soda, sulphate -of magnesia, phosphate of soda, and phosphate of potassium. - -The liver gets its share of the foul substances generated in the -intestinal canal, which cause congestion of the organ. Toxic biliary -salts and acids are present. The deposit may form gall-stones, and -jaundice and many other annoying symptoms may occur. The system is -simply a filter, or blotter, that lets the poisonous contents of the -intestinal canal pass through and out; but all the organs and tissues, -during the process, retain many of the foreign toxic substances, which -overtax (and frequently destroy) their functions with work that Nature -never intended they should do. Think of it--all the organs and tissues -around the intestinal canal serving as _fecal vents_! Deposits cause -irritation of nerve centers and nerve cells precisely as in fibrous -and cartilaginous tissues; and we speak of the symptoms as spinal -irritation, hysteria, chorea, lumbago, sciatica, nervous tension, -headache, irritability, despondency, melancholia, insomnia, dementia, -etc. From the disturbance of the voluntary and involuntary nerves we -have irregular circulation of the blood from disturbed heart action, -cold hands and feet, and flushing of the face alternating with pallor, -vertigo, and dizziness. The capillary circulation becomes obstructed -with crystallized bodies, as chunks of ice obstruct a stream of water. - -Catarrhal inflammation of the mucous membrane is set up in various -parts of the body by the deposits in the membrane and the abnormal -means of their elimination through it. The skin of the body, which is -the mucous membrane turned outward, suffers likewise from diseases -having numerous names. - -Doctors have always expressed a poor opinion of the liver because it -did not keep the bowels sweet and clean, and they mistakenly though -honestly called it “the lazy liver,” “the torpid liver,” “hepatic -insufficiency,” “atony of the liver,” “sluggish liver,” “hepatic -torpor,” “fatty liver,” etc.; and the poor victim of proctitis and -colitis was glad he had consulted the doctor and learned “just the -cause” of his internal troubles--and could suffer on more reconciled -to his malady since he knew its exact name and could continue to take -with regularity one or more of the many powerful liver exciters, to -stimulate activity in the liver and bowels once every day or two, if -possible. By some strange psychological or other influence of late -years, however, physicians have turned their attention to the “lazy -kidneys,” and now it is difficult to decide which they are purging -the most--the liver or the kidneys. At any rate, they both must be -violently excited at the same time, and we hear “lithia” mentioned, -or “laxative salts of lithia,” every time uric acid is thought of. -Stimulate the lazy liver and kidneys, and with abundant salts dissolve -out of the tissues and blood the precipitated deposits; this is the -fashion of the times. - -Diagnosis wrong and treatment harmful! Water is by far the best agent -to dissolve salt compounds, to dilute acids, or to remove filth. It -is also the best means of soothing and relieving the long irritated -and inflamed tissues and organs, that have had from two-thirds to -three-fourths of the daily fecal mass thrust upon them and collected -in them, when they are called torpid, lazy, and whipped up unmercifully -by bile and urine bouncers. We ourselves would be very torpid, -sluggish, or “lazy” if called upon to do the work of two persons under -such embarrassing physiological circumstances as being filled with -toxic substances, or thoroughly auto-intoxicated. - -When will common sense take the place of theories founded on guesswork, -and some thorough washing out by plain or distilled water be done, -internally as well as externally? After such an operation some specific -remedy may be taken, if demanded, with the certainty of permanent good -resulting. But remember, your aqueous body, held in its form by the -skin and mucous membrane, needs a well-nigh constant stream of pure -water flowing through it to keep it fresh and clean. - -The diagnostic error of mistaking effect for cause, however, is -frequently made. Patients are treated for one of the secondary -symptoms--say uric acid--with a view to abate that disorder -and restore health, when treatment for the specific cause of -constipation--proctitis (inflammation of the anus and rectum)--would -restore the patient to his normal vigor. Pale, anemic sufferers from -constipation are often told that the restoration of their blood -to its normal state will effect a complete cure. No idea could be -further amiss, for if the poisoned victims take coal oil, fish oil, -malt compounds, iron, etc., as tonics, into a disordered stomach -and unclean bowels, how can anything more than imaginary relief be -obtained? Is it not evident that the chief disorder, _proctitis_, the -main cause of the trouble, has in no way been reached? - -In other complications arising from constipation, a favorite diagnosis -is one of the secondary symptoms--“atony” of the bowels, liver, or -kidneys. In these cases nux vomica and various poisonous compounds -are given, but here also it stands to reason that the administering -of remedies for symptoms cannot effect a cure of a chronic local -disease of the anus, rectum, or colon. Then, again, by way of variety, -a diagnosis of “uric acid” is made for which irritant drugs are -administered to increase the eliminating or excretory action of the -bowels and kidneys. It is utter folly and absurdity to attempt the -cleansing of the intestinal tract by laxatives, cathartics, purgatives, -exercise, etc., and to make the kidneys and liver, overtaxed from foul -bowel products, do still more work by giving medicines to increase the -urinal and biliary secretions. - -It does not require a knowledge of the principles of physiology and -pathology to know that no sufferer from chronic constipation can be -permanently benefited if any or all of the secondary symptoms already -noted be treated with the usual list of drugs and the cause ignored. - -Much stress is laid upon the quantity and quality of food consumed by -most people, and many generalizers attribute chronic constipation, uric -acid, etc., to this very thing. Surely the average person knows that -too much or too little food taken at regular intervals is not conducive -to good health--a view that I have found borne out by a large majority -of my patients, who rarely overstepped the limits and knew when a -diminution in the supply of nourishment was advisable. - -In the last analysis, the principal cause of ill health is lack of -elimination of the excretory organs. When the bowels fail to do their -proper work, the functions of the other organs of the body become -correspondingly affected and impaired, and general debility ensues. - -In previous chapters, also in my book, _Intestinal Ills_, I have made -plain the causes contributing to chronic constipation and the use -of enemas and their origin. _Prehension_ and _elimination_ are two -subjects that are vital to the welfare of man. If the eliminating -power of the intestinal canal is normally active, the fortunate -individual may eat abundantly, or really in excess of the requirements -of the system, and still escape any ill effects, such as indigestion, -biliousness, acid in the urine, etc. The hearty consumer of food whose -bowels eliminate properly may suffer a loss of appetite, but it will -not be accompanied with foulness of the digestive apparatus. - -When all the organs of the body perform their functions in a normal -manner, no part of the structure is in immediate need of repair. Every -organ whose function consists in building tissues, muscles, or some -other part of the body, having a sufficient supply of reserve nutriment -on hand, makes known this state throughout the organism; hence there -is no craving for food, no appetite, although the tongue, stomach, -and intestines are in a normal condition. In this state of surplus -of nourishment the person may omit a few meals or partake sparingly -until the expenditure is equal to the income. But such physiological -happiness is not for the person whose intestinal canal and system are -clogged and foul from undue retention of excrementitious material, -causing no desire for food, while all the atomic builders of the body -are wanting nourishment and protesting through the nervous system -against their impoverished condition. - -Sufferers from self-poisoning, as described in this chapter, should -irrigate the system thoroughly by frequent drinking and by copious -injections of water into the bowels. The action of the enema if -properly given and the drinking of water that is pure or distilled -increase the quantity of urine and diminish the renal congestion, while -increasing the eliminative action of the skin. - -Irrigation of the bowels for fifty minutes or more with hot water (120 -to 125 degrees) increases the action of the kidneys. Hot irrigation -(125 to 135 degrees) is especially recommended to increase the -discharge of urine and the action of the skin, and should be continued -for sixty minutes or more. The Intestinal Recurrent Douche, described -in a subsequent chapter, is an excellent instrument for the employment -of hot water to produce diuresis and diaphoresis. - -The Chemung Spring Water and Clynta Double-Distilled Water, sold in New -York, are excellent drinking waters and can be obtained at a moderate -price. - - - - -CHAPTER XVI. - -RATIONAL SANITATION AND HYGIENE. - - -We, all of us, like to use things; indulgence is enjoyable, but it -generally ends with the day. Few of us “take thought of the morrow.” -Neglecting, as we do, the _instruments_ of use, their availability -for permanent subservience to our wants steadily diminishes, becoming -finally lost. Is it that we do not know any better, or is it that we -are really so intoxicated with the Present that we simply ignore the -well-known claims of the Permanent? Whatever the explanation may be, -it is nevertheless passing strange that little or no care is bestowed -on either our external or internal servitors, instruments, or organs, -which otherwise are ever ready to keep us well filled with the pure -wine of joy. Perhaps it is that many of us find Nature so lavish in -supplying us with the means of joy that we are naturally equally lavish -in wasting them. True economy--that is, the conserving of means for -their effective use--is yet to be learned by man. Especially is this -the case with our interior means, our flesh, blood, nerves, vital -force, etc. Nature seems so ready to recoup and renew the organic loss -incurred by our use or indulgence--recuperation seems so easy--that -we simply grow careless, reckless, prodigal, and before we are fairly -aware of it the disintegrative process gains an ascendency over the -restorative, and thenceforward our time will be spent in endeavoring to -cure what might have been kept whole or well. - -Nor is it an organ of the body here and there that we neglect or abuse; -it is more especially the entire system of organs called “the body.” -The body is the organ of man’s spirit. We give no heed to its tones; -perhaps we have never caught its rhythm; certain it is that when but a -short time in our perverted hands its chords are more or less jangled, -and a minor part is played in the grand symphony of life. - -The organ of man’s spirit! How rational, nay, how necessary, it would -seem to be to keep that instrument keyed to its perfect work! - -But the ordinary denizen of civilization has a most ridiculous ideal -of physical capability, namely, that the savage--a being altogether -“physical”--was able to retain a healthy body till ripe old age -without attention either to sanitary surroundings or to the hygienic -functioning of his system of organs. The “civilizee’s” fancy picture -of the noble savage is not based upon verifiable fact. It is true that -we have a few attractive myths concerning savages that had survived -appalling hardship; but we are just learning of the innumerable host -that have perished periodically of various contagious diseases, and -of the countless number (infants, youths, and adults) that have -suffered from all sorts of ailments. Alas! how little we know--or, for -that matter, how little we seem to care--of the great multitude of -“civilized” fellow-creatures whose lives are all jangled and out of -tune through subjection to the many ills that flesh seems heir to; ills -that have arisen through either ignorance or the voluntary _ignoring of -the light of accessible knowledge_! - -In another aspect the human race is like an army that concerns itself -with its immediate and imperative duties and has no time or thought -to bestow on those that fall out of the ranks. But slaves to stern -duty offend against Nature’s normality as do slaves to desire; and the -former little suspect that their retirement also is near at hand. In -health we seldom or never think of the conditions for the maintenance -of health. That these conditions should receive our prime attention -is obvious when we contemplate for a moment (1) our race of invalids, -and (2) the growing unsanitary condition of modern industrialism, -involving, as industrialism perforce must, the unsanitary life of the -factory, workshop, office, and hothouse home. - -Again, with the advance of high-pressure civilization and culture -human beings are developing a more highly sensitive physical organism, -pitched to finer issues. How urgent the necessity for a greater -safeguarding of that organism! - -If it be claimed that many of us do live up to our knowledge of health -conditions, and that we are notwithstanding unwell, I would answer -that our knowledge now is very disconnected, and that when the time -shall come that our itemistic information shall have coalesced and -formed a system of principles, we will then have trustworthy rules for -the acquisition of health habits and become completely normal physical -beings. At present most of us are intemperate in one or more ways. We -eat too much or too little--too rich or too poor food. So it is with -our drinking, our sleeping, our sporting, our enjoyment of this or that -excitement--the quantity or the quality of each of these is not well -adapted or proportioned to the conditions of normality. - -Let me offer the health-seeker a few indications of the sanitary and -hygienic requirements demanded by Nature’s normality. In our family and -household life, to carry into execution daily hygienic measures, it is -essential that we have ample, accessible conveniences for the necessary -ablution of the body, externally and internally. How extremely rare it -is, however, that bath-tubs and water-closets are found in sufficient -quantity and suitable quality in our apartments. As household fixtures -they are usually about as scarce as hens’ teeth. - -In New York City a house with from eight to sixteen persons is -restricted to the use of one water-closet and one bath-tub. On these -(and a laundry and servants’ privy in the basement) there is the tax of -ten dollars a year. Now, should that rare human product, an enlightened -and humane owner, put in eight more bath-tubs and water-closets for -the proper accommodation of his sixteen guests, so that each suite of -sleeping apartments should have its appropriate conveniences, he would -have to pay an additional tax of forty dollars a year. Is this tax -levied with the connivance of the Board of Health? It would seem so, -since no protest from that august body has ever been heard within the -memory of the oldest inhabitant. Indeed, the suspicion is not at all -unwarranted that if the masses were less constipated and better washed -they would have less use for the doctors, and that, therefore, it is -not well to encourage undue sanitation and hygiene. - -It must be, too, that the Department of Water Supply has figured it out -quite beautifully that a saving will be insured in the amount of water -consumed by sixteen persons if they be restricted to one bath-tub and -one water-closet; otherwise forty dollars a year would not be charged -for eight additional tubs and closets for the use of the same number of -persons. Listen to a sample of their logic: “Sixteen persons with eight -additional bath-tubs and water-closets would use more water than if -they were restricted to one of each--hence the additional tax. We don’t -care a continental whether these human beings are clean externally or -internally; that’s not our lookout. But we do care that they shouldn’t -use more water than just so much, see!” - -And does the august Board of Health raise the least objection to this -sort of logic? None whatever. - -Professor C. S. Smith states that, out of 255,000 families in -tenement-houses in the city of New York, only 306 had access to -bath-tubs in their own homes in 1894. In 1897 one city block containing -904 families did not have a single bath-tub. - -Paradoxical as it may seem, there is, notwithstanding the appropriation -every year for the New York City Board of Health of over one million -dollars, a prohibitive tax on bath-tubs and water-closets--that is, on -cleanliness--prohibitive on all homes except those of the wealthy. Is -it to be wondered at that contagious diseases are prevalent, especially -during the winter months, and that we have so many acute and chronic -maladies? - -Let me make a suggestion here for the serious consideration of our -city fathers: Reduce the appropriation for the Board of Health to two -hundred thousand and give the other eight hundred thousand to the -Department of Water Supply, so as to abolish the tax on water-closets -and bath-tubs. If every citizen of New York could have all the water -he needed for cleanliness and comfort, there would be little excuse -for the existence of such a body as the Board of Health; its existence -would then be more honorable than onerous. Furthermore, the city, as -a corporate body, should manufacture bath-tubs and water-closets, -and furnish them at cost. Thus would it insure a great stride toward -the health of its own citizens. When the disease-producing microbe -becomes scarce, the occupation of the Health Board pathologist will be -gone. Hold! Could he not devote his time profitably to studying the -habits of health-producing microbes--for there _are_ such? Microbes -are absolutely necessary for higher forms of existence, it being now -well known that some microbes are destructive or pathological and that -others are constructive or physiological. Is it not much wiser to -spend our millions of dollars for the prevention of disease than for -quarantining it? Inducing, and even compelling, people to be clean is a -far better policy than to compel them to be vaccinated. - -Now, we pay the Board of Health many thousands of dollars a year simply -for making cultures of disease-producing bacteria so that antidotes -may be found. The pictures and history of these bacteria are published -in many large volumes, costing the city several hundred thousand -dollars a year. Scientific as this practice undoubtedly is, it is very -expensive--and needless. - -Every year thousands of children and invalids of New York receive -improper nourishment, or are made positively sick, on milk that is -either foul, stale, or ready to sour; and every summer thousands of -children die from complaints traceable to this source. Swill milk is -one of the great generators of disease-producing germs to which all -sorts of “complaints” are due. Does the Board of Health care a fig for -the generator? No; the Board is absorbed in watching the antics of the -germs! Mighty intellects are searching for malignant, multitudinous -mites. Yet there are just a few mites of common sense in existence, -which if encouraged will breed quite as fast as the sinister ones. -Indeed, there must be one or two at work in myself, for I seem to be -urged to say that if our City and State Boards of Health should see to -it that our cows are kept clean and healthy, our milk clean and pure, -our cans clean and well scoured, and our shops and ice-boxes clean -and free from odor, there would be no occasion for germ cultures of -diseases brought on by swill milk. - -Our milk example will illustrate what germs of common sense would do -to ward off all kinds of disease-producing micro-organisms. Rigorous -regulations, well enforced, as indicated above, would work in other -lines as well. And when the source is gone sinister microbes will not -come into existence, and diseases that have resulted from such microbes -will have gone into innocuous desuetude. - -There should be a bath-tub and a water-closet in every suite of -sleeping apartments. When this is the case, there will be a larger -number of persons clean internally and externally, and the doctors will -be on a hunt for health-producing germs instead of disease-producing -ones. Let us start an organized movement in this direction. - -Last summer Medical Science went about killing mosquitoes on Staten -Island with a little spraying apparatus, and managed to disturb the -pest for a day or two from its customary bivouac. Christian Science -stood aloof and smiled superciliously, claiming that “there aren’t any -such things as mosquitoes; but if they should prove to exist, there -isn’t any malaria anyhow.” Good sense might have suggested to Medicus -the draining of the ponds for gardening purposes; and, if that were -not possible, the filling in of the edges and the making of deep-water -lakes for the sport-loving youth, who might be depended on to keep the -water stirred up by boating, etc., free of charge, and thus convert -a pest pond into a pleasure lake. Pleasure and cleanliness are taxed -to-day for disease and pests. Oh, human imbecility! - -As to public baths, there are so many objections to them that I cannot -touch on the subject in this chapter. But let me impress upon the -health-seeker, the public-spirited citizen, and our city officials that -what we urgently need are ample conveniences in our homes for internal -and external cleanliness--conveniences easily accessible several times -a day, every day of the year. - - - - -CHAPTER XVII. - -PERSONAL CLEANLINESS. - - -At the close of my last chapter I referred to the ever-recurring -problem of public baths. Annually its agitation is renewed in lectures -and newspapers; public bathing is voted without disagreement the -thing of things needful to render the laity--_i. e._, the labor -population--physically pure. It is the long-felt want; but, like the -longed-for walk of the annual Sunday-school parade, it is soon done -and gone. Still, we must have patience with those dear souls, our -ethical teachers of the press and platform, for taking such a deep, -sentimental, though unscientific, interest in the welfare of the -unclean. Owing to the non-existence of home facilities for cleanliness -among the working class, the accumulations of soil and exudation during -the long fall, winter, and spring months are so great that their -bodies become too rank and malodorous for the nostrils of the refined. -Consequently, as all animals seek the tepid water of the summer, and -as man is no exception to a capacity for laving in the circumambient -fluid, to three-fourths of the population of this metropolis it must be -a glorious perennial treat to dip in the river, bay, or sea; and it -must indeed be a dire necessity to those that have managed to survive -contagious and other diseases during their long immurement. Without -this summer cleansing few animals, bestial or human, would run half -their average careers. It is accordingly not strange that during the -summer a bath in open water is a daily hygienic necessity and source of -joy to thousands of creatures. - -Now, it is just because godliness appears in the wake of cleanliness -that I made so strong a plea in my last chapter for ample bath-tubs and -water-closets. For I do not approve, nay, I emphatically condemn, the -system of public baths along the shores of our rivers and bay. Their -waters are contaminated by numerous sewers, and bathers have contracted -many contagious diseases that have become epidemic in neighborhoods. -Note especially the annoying eye troubles that follow in the wake of -such bathing. Of course, the sport and exercise involved in open-water -bathing are highly commendable; but the danger of contracting -contagious disease, and the outrage of the sense of refinement when -contemplating fellow-creatures in the act of stirring up polluted -waters, should call a halt to our encouragement of public bathing in -and around our metropolitan water fronts. These waters are surely -anything but a means of cleanliness. - -The water-closet, however, is of far greater importance than the -bath-tub, and especially than the public water-gymnasium--which last is -so much lauded by some of our misguided philanthropists. Intestinal -foulness, as a prolific source of disease, is of far more serious -importance than surface foulness. However, both the bath-tub and the -water-closet are indispensable to every suite of rooms. - -Another need imperatively demanded by the exigencies of city life -is the establishment of public water-closets at several thousand -convenient centers throughout this great city. At present the male -population, when away from their residences, are obliged to make -use of a near-by saloon--a most uncertain resort, and one in which -courtesy will generally constrain them to imbibe intoxicants _nolens -volens_. The female population have not even the saloon as a resort, -and can relieve themselves only when in the vicinity of department -stores. American enterprise can improve in many respects on the several -European models of public-relief stations. The public is becoming -conscious of its needs and rights in this respect; and one of the -sanitary evolutions of city life--congested as it is--will be ample and -cleanly public accommodations for intestinal relief. - -Americans in general suffer from dyspepsia, biliousness, constipation, -uric acid, etc.--all of which disorders are symptoms of that world-wide -disease, proctitis: inflammation of the anus, rectum, and often the -colon. Nor is it any wonder that unwashed humanity suffers from -proctitis and its consequences. The unwashed have no bath-tubs and -practically no water-closets. This lack is due to the tax on water -facilities, to expensive plumbing, and to too much “science” and -not enough common sense among our city fathers. As a consequence -of ignorance and inconvenience, most people defecate but once in -twenty-four hours; and very many but once in two or three days or a -week. The once-a-day stool is frequently scanty, and as a consequence -the kidneys, lungs, and skin are called upon to perform the vicarious -function of eliminating a portion of the daily excrement; and the colon -and sigmoid flexure have to hold the stored contents unduly--until -the feces be expelled by purgatives or by the irritation that the -accumulated mass occasions. Could the members of the Board of Health -and the people at large be brought to a realizing sense of the value -of personal cleanliness,--internal as well as external,--bath-tubs and -water-closets would abound in our homes. - -Man’s habits as to eating, drinking, dressing, bathing, and especially -as to defecating, are clues to his growth in refinement. But we must -beware of judging a person by one or two good or bad habits; he should -be estimated by the sum of his habits and their peculiar combination. -Refined habits are not all of them acquired at once; they develop -slowly, one after another, when opportunities are favorable, especially -the habits as to bathing and defecating. Opportunities for these -latter are wofully lacking at present--the cause and consequences of -which lack are pointed out in the last chapter. A child will derive -far more good from a ready access to bath-tub and water-closet than -from a lifelong attendance at Sunday-school and church with the temple -of the human soul permanently unclean. Only one that has learned to -respect and care for the abode of the soul--the body--is worthy of -being classed among the refined. It is truly deplorable that the great -majority of the human race are creatures of the moment or the hour, -tolerators of abnormal functioning, slow suicides of vital capacities. -Claims of the permanent are constantly ignored; most of us are blind -to the joy involved in the harmonious functioning of all the organs--a -functioning that always ensues upon hygienic care. - -Our organs will for a time bear neglect or unhygienic conditions -without protesting their annoyance. Many persons never use hot water -or soap; others find one bath, in river or sea, quite sufficient for -the year; others, again, feel the need of a bath once or even twice a -month, or even once a week. But there are very few of us that seem to -require a bath daily. Many, alas! have grown accustomed to a bathless -existence. - -Have you ever stood near an Italian or Greek street vender, or have -you ever been within five feet of a low-class Polish Jew? If so, the -stench arising from his unwashed body must have nauseated you. It is no -secret that such persons never wash--especially the latter, who live -in rooms reeking with filth. Contemplating such conditions, I feel -impelled to propose a great, nay, the greatest reform--one suggested -years ago by Samuel Butler in _Erewhon_. Let us make Health the great -civic virtue, and Disease, as well as unsanitary and unhygienic -conditions, the crime. Our so-called crimes of theft, murder, forgery, -etc., should be treated as weaknesses and faults to be corrected by -Moral Rectifiers--by the preachers, priests, rabbis, and ethical -culturists. Consider how much is implied in developing and breeding a -race of healthy men and women. All relations of life would feel the -vital change at once, and moral weaknesses would disappear. Any human -cesspool entering a public conveyance, or in any way mingling with -cleanly people, should be arrested, thoroughly cleansed, internally -and externally, and sequestered for a time sufficient to teach him -better. There is a local rule of the Board of Health against spitting, -but it is rarely enforced. There are millions of public expectorations -to one arrest. For the appearance in public of consumptives, and -their offensive hawking, coughing, and spitting, no one seems to have -suggested a remedy. All diseases should be classified as to grades of -punishment; and all moral weaknesses, such as defalcations, adultery, -burglary, should be treated at the various hospitals, which latter -should be conducted solely by Moral Rectifiers. - -In closing, I shall direct attention to a few other points in personal -cleanliness--the mouth, ear, nose, and throat. - -It is important on hygienic grounds that the mouth receive proper care -two or three times daily. - -The ear is commonly kept clean; still there are many instances of -non-refinement of this organ, and from its non-hygienic treatment -deafness often occurs. - -The prevalent nasty, ill-bred habit of hawking and spitting in public, -or in company, even by genteel persons, can be cured best by early -training in correct habits. This habit, as well as the evidences of -throat troubles, is usually to be ascribed to inattention to the nose. -When catarrhal conditions are avoided or properly treated the throat -will not be so affected as to necessitate this reprehensible practice. -Trouble is invited for the tonsils and soft palate by our constant -hawking; certainly the tender sensibility of the throat is destroyed -thereby. Inasmuch as the tobacco habit is so general, and spitting is a -necessary accompaniment of that habit, stringent laws against hawking -and spitting would be unpopular among the masculine half of the race. -But should public opinion ever become educated up to the point in which -disease becomes a crime, opposition would cease. This consummation -is devoutly to be wished, for then we will have adopted and followed -Ingersoll’s injunction to “make health catching, not disease.” - - - - -CHAPTER XVIII. - -HOT WATER IN THE TREATMENT OF PROCTITIS AND COLITIS. - - -In treating chronic ulcerative inflammation of the anus, rectum, -sigmoid flexure, etc., it is well to take advantage of every really -practical device to which one may have access, so that valuable time -may be saved in obtaining relief and effecting a cure. - -The capillaries, veins, arteries, and arterioles in an inflamed organ -become distended and the tissues swollen, indurated, and tense by the -excess of blood and the inflammatory serum deposited in the tissues. -The vasomotor nerves in the diseased part have lost their contractile -power, which fact increases the stasis, or congestion, of the blood. -Circulation in diseased tissue depends very much on the general tone of -the system, and if the circulation is below the normal the ravage of -the malady is increased proportionally. - -Have you ever observed a little stream of water enter a large pond in -which were grass, shrubbery, logs, decaying vegetation, and débris of -all sorts--the accumulation of years? And have you noticed that here -and there there were stagnant pools, without a perceptible motion -from where you stood, but that as you reached the side opposite to -the entrance some faint traces of motion became visible, and that as -you followed the line it soon formed into a stream quite equal to the -inflow? The pure water, on entering and mingling with the stagnant -water and old deposits, soon becomes corrupted and foul. Somewhat -similar unhygienic and toxic results take place in ponds of stagnant -blood and abnormal deposits such as proctitis and colitis involve, -and where, for six or eight inches or more of the large intestine, -inflammation is deeply seated, and blood stasis is of course in full -swing. As the débris in a stagnant pond decays, making the water -impure, so in an inflamed organ the tissues decay, making the blood -impure. Ulceration is an exhibition of this process of congestion, -induration, and decay. - -The rectum and sigmoid flexure are loosely hung in the pelvic space -and are surrounded by fatty cushions of connective tissue on all -sides, which fact allows the organ considerable dilatation and motion -(Fig. 5). Owing to the anatomical structure and the location of -the lower bowel, it becomes a serious matter when it is invaded by -an ulcerative inflammatory process--especially when all the layers -of tissue forming its wall are invaded, and still more so when the -connective tissue around the organ is in the same condition. - -Far better were it for the victim of proctitis and -periproctitis--filled as he is with channels and reservoirs--if pus -were to form in abundance at once and thus betray the destructive -action in the spongy areolar or connective tissue, under the mucous -membrane, around the rectum, and in the tissue forming the anus and -buttocks. - -The pathological condition brought about by inflammation, etc., -requires a remedy that will empty the over-dilated vessels and remove -the serum deposit in the tissues, which is analogous to the rubbish of -a pond. - -Our grandmothers were familiar with the therapeutic effects of -heat and moisture when they applied hot poultices constantly to -an inflamed organ or limb for one or more hours until the tissues -presented a blanched, shriveled, and white appearance; if there were -signs of the inflammation returning, the poulticing was continued -or repeated. They knew very well what the parboiled condition of a -washerwoman’s hands indicated after a day’s work in hot water. They -were bloodless, notwithstanding their incessant muscular exercise. In -case of inflammation, they reasoned, heat and moisture would make the -congestion and fever leave if applied long enough. On beginning the use -of the hot poultice, the tissues to which its heat and moisture were -applied became relaxed, and the parts for the time more congested than -before; but our grandmothers did not mind that, as the final result -would justify their hydriatic procedure. They well knew that after -ten minutes or more a reverse action would take place, and if the -treatment were continued long enough the blood-vessels and tissues -would show little or no evidence of fever or inflammation. - -Where chronic inflammation exists, the blood-vessels and tissues lose -their normal tone or vitality; consequently, they will require repeated -application of hot water as well as other aids until a cure shall have -been effected. - -Another great advantage in the use of hot water is that its application -can be interrupted and resumed without detriment to the diseased -tissues or organs. Cold water, on the contrary, causes the vessels -quickly to contract and expel the blood, but, on reaction taking place, -the tissues become more congested than before. - -In the use of water at a temperature of 120 to 135 degrees, or even -more, we have one of the most valuable adjuvants in all stages of -proctitis and colitis, and, if a properly regulated plan be pursued in -connection with the requisite local treatment, more good can thus be -accomplished than by all other means combined. - -The layman is more or less familiar with the condition of a sore or -ulcer in which soft, spongy, or fungous tissues appear, called “proud -flesh,” which, on an inflamed mucous membrane, is called granular -tissue. Were it not for the usual presence of granular tissue on a -chronically inflamed mucous membrane and for ulcerated sections or -patches, channels, and stretched or pouched mucous membrane called -piles, the proper use of hot water alone would in time effect a total -cure in almost every case of proctitis. - -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. - -The instrument is attached to the reservoir (Figure 18) by a -soft-rubber tube. In the cone-shaped piece of hard rubber (Figure -27) is a hard-rubber stop-cock or valve (Figure 29), and by turning -the handle sidewise the valve is opened to let the water escape from -the bowels into the toilet basin. When sufficient water, at from one -hundred and twenty to one hundred and thirty-five degrees temperature, -has entered the bowels, allow it to remain for ten minutes, then permit -it to escape by opening the valve; then close it and allow more hot -water to flow in and remain for five or ten minutes and again allow it -to escape through the rectal point, repeating the inflow and outflow -every five or ten minutes for an hour or more without removing the -anal point from the rectum during the whole time of treatment. After -a few trials it will be found that the hot-water treatment can be -accomplished without withdrawing the point. - -Rectal Points for recurrent douche are of two sizes (Nos. 25 and 26). -The larger one (No. 25) requires a plug to be introduced through -the cone-shaped external anal support and rectal point, to make its -introduction into the rectum easy, after which the plug is withdrawn -and the hot-water treatment begun. The bore of the rectal points cannot -become clogged by the presence of feces, mucus or membranous shreds -or casts, which are usually brought away by the hot-water treatment. -At no time during the treatment can the point become stopped up, the -size being sufficient to insure a proper inflow and outflow. And the -instrument can be easily cleaned. - -Near the attachment of the soft-rubber tube is a glass reservoir -(Figure 24), for the use of oils with the enema or the hot-water -treatment; it is detachable. A valve regulates the outflow of oil from -the pressure of water in the reservoir, as it passes into the bowels. -We are enabled thus to treat by double medication as it were, a -chronic disease of the intestines and its symptoms--that is, intestines -that have been long neglected or maltreated through lack of proper -diagnosis, or by all sorts of chemical compounds from above, through -mouth and stomach. - -The author and inventor naturally enjoys not a little satisfaction in -being able to present to sufferers as nearly perfect an instrument as -can be devised; one that, in conjunction with other aids, meets all -requirements involved in the proper treatment of proctitis and colitis. -Lavage or irrigation of the large intestine with water at a temperature -at from one hundred and twenty to one hundred and forty or one -hundred and fifty degrees, not only accomplishes rapid and wonderful -cleaning and curative results, but overcomes, when properly applied, -contracted, congested, engorged, and inflamed tissues of the bowels. -Therapeutically, it has a marked effect on the whole system, being -beneficial beyond words to describe; it relaxes nervous and muscular -tension of the body, producing restfulness and sleep; it stimulates -and equalizes the circulation, promotes perspiration, absorption, and -active elimination of all deleterious substances from all the organs -of the body. Medicinally, it is really a combined internal Russian -and Turkish bath, removing abdominal corpulency and gaseous obesity, -resulting from chronic auto-intoxication. The external Russian and -Turkish baths afford a satisfaction skin deep to the bather, but the -combined internal Russian and Turkish bath is most agreeably relaxing -and restful to mind and body, bringing peace, since all the organs of -the system are performing their functions. Some of my patients resort -to internal hot-water lavage for all aches and ills that mar their -happiness. After an external bath the bather may desire an application -of oil, alcohol, or cocoanut butter rubbed on the skin, and in the -same way the bather’s internal mucous membrane is not neglected; for, -with the author’s appliance, medicated and perfumed oils, extracts, -and powders for remedial purposes are carried to every part of the -intestines that the water reaches, thus exerting a cleansing, healing, -and soothing effect where most needed. - -A few sufferers will object to the time required for an enema twice a -day, although they find time to eat three, or even four times a day, -without any objection whatever; there is plenty of time for filling -up the digestive apparatus, but no time for its normal elimination. -And these miserable, go-lucky, haphazard people are always sick and -unfortunate. The internal Russian and Turkish bath is demanded only by -those who truly desire to be free from their bowel troubles, and from -the numerous symptoms resulting from mucus absorption, constipation, -and auto-intoxication. - -A sufferer’s efforts to be well depend largely on how much he or she -estimates the worth or value of mind and body. A noble purpose in life -is priceless; are not one’s spirit and body worth the time required -for two enemata each day and an hour for the internal bath, if needed? -I think so, and you should likewise. - -The author trusts the reader will not infer that all sufferers from -piles, anal fissure, pruritus ani and vulvæ, mucus channels and -reservoirs, abscess, fistula, and all similar troubles, require the -enema and recurrent douche appliance; the character of the disease and -its symptoms must determine the requirement of the treatment. Many of -my patients receive office treatment only, omitting home attentions, -although this is not always advisable. The reader might conclude that -the recurrent douche treatment was simply for the cure of a chronic -inflammatory invasion of the bowels and fecal auto-intoxication, and -not be aware of another great source of auto-intoxication--that is, -from the absorption of large quantities of serous, fibrinous, or -albuminous exudation from a large area of tissues invaded by the very -insidious inflammatory process, a condition which, in time, may reach -the pus-forming stage. Thus we have three very grave pathological -conditions to meet and remove before the pus-formation stage is -made manifest through the development of abscesses. I have found -five aids--perhaps more--to accomplish a cure in which I have been -exceptionally successful, as my students and patients will verify; -these are: local treatment, local medication, the proper use of the -enema, the use of the recurrent douche, and the determination of the -sufferer to get well. - - - - -CHAPTER XIX. - -HOT WATER IN THE TREATMENT OF EXTERNAL SYMPTOMS. - - -After proctitis has continued for many years it will give rise to -painful inflammatory and ulcerative processes at the external anal -vent and in the adjoining tissues. The anal mucous membrane and the -integument about the anus become brittle, loosened, and detached from -the areolar connective tissue by the retention of inflammatory serum. -The engorged, indurated, and swollen mucous membrane and integument -serve as reservoirs, especially when the chronic inflammation is -excited to an acute stage, which stage is often accompanied by a -fissure, abscess, or anal ulcer. Soreness and pain in the parts may -then be so severe that the sufferer is compelled to stay indoors -or in bed. Whatever the symptoms may be--piles, fissure, pruritus, -abscess, or fistula--the sufferer desires to reduce the local fever -and the acute inflammation, as well as to find relief from the pain. -The customary treatment is to use poultices, which are troublesome and -ineffective. - -In the following illustration I give a good idea of a perfect device -for relieving quickly the soreness, pain, acute inflammation, and -induration, all of which are so very prostrating; and, situated as -they are physiologically, they are exceedingly inconvenient to treat -properly by the ordinary methods in use: - -[Illustration: (Patented November 8, 1892.) - -Fig. 23.] - -The Sitz-bath pan, though small, is yet of sufficient depth and -diameter for all practical purposes, and can be placed wherever is -most convenient--on a low chair or a box. The bather should sit on the -instrument with the limbs on either side of the funnel through which -the hot water enters the pan. Just below the funnel is an overflow -tube, under which a vessel should be placed to catch the water as -it flows out. While sitting on the pan the elbows may rest on any -convenient support, so as not to tire the invalid too much during the -bath, which should consume from half an hour to an hour, or longer if -agreeable. Hot water may be added every few minutes as the bather finds -that the tissues will tolerate it. Depurant powder may also be added to -the water in the Sitz-bath pan. - -What has been said in a previous chapter on the therapeutic effects of -hot water in the treatment of proctitis need not be repeated here. - -The three indispensable appliances for combating and effectually -overcoming the pathological conditions to which this book and my two -previous books--_Intestinal Ills_ and _How to Become Strong_--are -devoted, are _The Internal Fountain Bath_, _The Intestinal Recurrent -Douche_, and _The Shallow Sitz-bath Pan_. These appliances are -well-nigh perfect for the uses to which they are adapted. - - - - -CHAPTER XX. - -THE HEALTH OF SCHOOL CHILDREN. - -“Cleanliness of body was ever esteemed to proceed from a due reverence -to God, to society, and to ourselves.”--_Bacon._ - - -The International Congress on School Hygiene ended its fourth meeting -at Buffalo recently to meet two years hence in Brussels. In the interim -the Board of Education in this city, the Department of Health, and the -New York School Luncheon Committee will continue their investigations -as vigorously as in the past, and the information thus gained will be -an important contribution to the next Congress. - -Too much attention cannot be given to the question of hygiene, diet, -and excretion to meet the psycho-physical requirements of the mind -and body in normal health. As a rule, diet is prescribed for the -purpose of relieving the various annoying and painful symptoms caused -by chronic impairment of the functions of the stomach and bowels, -but when we find the cause of these various symptoms arising from a -disturbed gastro-intestinal tract, the question of diet will receive -less attention. Why has not the subject of normal intestinal excretion -received as much attention as diet in health or ill-health? As our -knowledge of the human psycho-chemical laboratory increases, we are -able definitely to locate a diseased organ and account for the symptoms -caused by the pathological condition of that organ; and when the -diagnosis is properly made these symptoms become a secondary matter of -treatment. - -The chief enemy of health among school children (and older persons as -well) is the accumulation and retention of waste matter and gases in -the intestinal canal, where are generated ptomaine, toxic, and other -poisons which enter into the system, resulting in self-poisoning or -auto-intoxication. - -What do we mean by school hygiene? Is it only the school building, or -the external appearance of the children, their eyes, teeth, mouth, -nose, hands? What about the coated tongue, foul breath, fouler -stomach, and putrefaction of the contents of their intestines? A human -being is only an extension of his gastro-intestinal apparatus, hence -it is very essential that such apparatus should be in a hygienic -state to ensure his physical and mental resistance and efficiency -being at their normal strength. There is one symptom that causes -more sickness and suffering from infancy to old age than all others -combined--that is, constipation with its attending putrefaction and -foulness of digestive organs. Only a small percentage of people escape -its baneful effects or the secondary diseases induced by fecal and -mucus auto-intoxication. Such a common primary symptom must have, -necessarily, a common exciting cause or origin. Through many years -of clinical experience as a gastro-enterologist and proctologist, we -have found that inflammation of the anus, rectum, and sigmoid flexure -is the frequent or common cause of constipation. Observation has -demonstrated that a soiled diaper is the exciting cause of Proctitis -and Sigmoiditis in the beginning. Examination of one hundred children -of the “defective class” would show most of them suffering from -chronic Proctitis and Sigmoiditis, with some degree of constipation -and auto-intoxication, and even of those classed as “healthy school -children” a large percentage would show the same conditions. The -continuous invasion of the neighboring tissues by the disease, -the increasing auto-intoxication and constipation, the on-coming -malnutrition, and anemia, the gradual emaciation, are all the while -lessening the vitality and power of bodily resistance of their victims. -The early inception of the malady and its insidious progress, with the -symptoms and diseases resulting, easily deceives the victim as well -as the parents and medical advisers, until the long-pent-up virulence -breaks forth, showing itself in every part of the tabernacle of the -spirit of man, when the removal of the primary cause does little or no -good. - -The Department of Health, in examining the sanitary or hygienic -condition of a school building, would not devote all its attention to -the top story to overcome unhygienic conditions; it would probably -direct its attention to the trap and vent of the sewer of the building -to see that there was no retention and filling up of the pipe to befoul -the atmosphere of the structure. Why then so much attention to the head -or top story of the human temple, and so little to the trap and vent of -its sewer? Are modesty and ignorance to defeat the progress of hygienic -measures dealing with the stomach and bowels of our school children? -How long will those abdominal incubators of poisonous microbes and -gases be allowed to infect not only a school building but all its -occupants as well? - -The absorption into the system of serous, fibrinous or albuminous -mucus exudations from the invasion of chronic inflammation through all -the layers of the tissues of the anus (Figure 1), rectum, and sigmoid -flexure, as well as through the adjoining fatty tissue in the pelvic -space around the organs (Figure 5), under the skin and between the -muscles of the buttocks, goes on continuously, creating an extensive -inflammable area and source of exudation of broken-down tissues. (See -Chapter III.) It is a grave pathological condition and the source of -mucus auto-intoxication, and its symptoms ought to be differentiated -from those of fecal auto-intoxication. This mucus exudate has an -intensely irritating effect on the nervous system, especially when -an acute intestinal mucus storm has developed, torturing its victims -and unfitting them mentally to attend to the ordinary duties of the -day. Very often this is accompanied by more or less pain or muscular -soreness. These annoying symptoms occur very early in the history of -Proctitis and Sigmoiditis, and clinical experience has demonstrated -to me and to my students the necessity for infants and children being -examined in order to determine whether inflammation exists in the anus -and rectum, and thus early cut short the progress of the disease and -its numerous and familiar symptoms, which I may here enumerate, to -wit: indigestion, flatulency, coated tongue, foul breath, bad taste -in the mouth, capricious appetite, nausea, intestinal colic, cramps -and pains, diarrhea, headache or band of pain encircling the head with -sense of constriction, neuralgia, pain about the heart, cold hands and -feet, malnutrition, anemia, emaciation, dry skin, seborrhea sicca, -carbonic acid toxemia, sallow complexion, liver spots, jaundice, acute -bilious attacks, drowsy states, mental torpor, bad temper, night -terrors, irritability, melancholia, vertigo, dizziness, loss of memory, -insomnia, drawn face, tired feeling, unrestful sleep, easily fatigued, -subject to colds, catarrhal affections of the ears, eyes, nose, throat, -etc., decay of teeth, dry cough, loss of hair, impaired vision, -sterility, impotency, mucus and membranous cords and casts from the -bowels, sediment in the urine, irritability of the bladder, premature -age, reduced physical and mental efficiency, inability to concentrate -the mind, morbidity, suicidal notions with a view to ending mental and -physical suffering. - -I am pleased to inform such sufferers that their ills can be properly -diagnosed and treated; and the earlier in life they seek treatment, the -sooner they will escape the accumulative ills that make existence so -painful to endure. - -We have mentioned Proctitis and Sigmoiditis as the primary cause of -intestinal stasis in the majority of cases; later, other sections of -the intestinal canal may be invaded by inflammatory process, causing -a more serious intestinal stasis, not infrequently bringing about -dislocation of the stomach, intestines, and other abdominal organs. We -have enumerated the symptoms and maladies that are now, in the light -of latest medical science, traceable directly or indirectly, to this -primary cause; in short, it may be said that, with the exception of a -few diseases caused by toxic agents, most of the illnesses that cause -so much invalidism, cutting short our lives, can be traced to mucus and -fecal auto-intoxication. - -The purpose of this book and others I have published is to educate -my fellow beings as to how to prevent or avoid the many diseases and -symptoms that afflict them from the cradle to the grave; already I feel -that I have accomplished something in helping humanity, and I trust -others will do their part to lessen the ills that flesh is heir to -through neglect and ignorance. - - - - -CHAPTER XXI.[2] - -INTERNAL HEMORRHOIDS OR PILES VERSUS RECTAL MUCOUS SAC, RECTO-ANAL -MUCOUS SAC. - - [2] Chapters XXII, XXIII, and XXIV have been revised from Papers - contributed to _Albright’s Office Practitioner, in 1908_. - - -Before the history of medicine and surgery began, man suffered at -his hinder parts as well as at other parts of his organism. Bodily -ills are as old as the human race, and the flowing of blood from -the “terhinder” was a signal of distress or of physical anarchy, of -which the references to “emeroids” in the Bible and in other ancient -writings bear witness. The “emeroid” doctors of Egypt, in the time of -Moses, unquestionably regarded the distress caused by the “emeroids” -as a disease. And it came to pass that every subsequent Moses that -has written on the subject of hemorrhoids up to the present time has -regarded piles as a disease. And they likewise, all of them without -exception, believe the “disease” to be hereditary, as is certainly -their information on the subject. This mental obsequiousness of the -proctologists of our day is indeed quite a long-drawn-out compliment to -the pile doctors of Egypt, since our proctologists still continue to -diagnose piles as a disease and “to smite the smitten of emeroids.” - -I have always respected the idea of ancestral worship and of reverence -for the dead past, but at the same time I have felt that one should not -be wholly oblivious to their egregious mistakes. - -If Moses, Samuel, Herodotus, Hippocrates, Galen, and other illustrious -men had said that “emeroids” is a symptom of a disease, what a blessing -they would have conferred upon suffering humanity. The simple use of -that one word would have been illuminating, and would have set the -tide of attention for the proper diagnosis and treatment in the right -direction. Possibly some one more bold than the servile brotherhood -did see and say that it was a mere symptom, but, if so, his temerity -was treated by “the wise ones” of that day as similar innovations -are treated to-day, with a “Tut, tut, tut; pugh, pugh, pugh. We know -better, and we refer you to the following chapters in Holy Writ and to -the classical work of the great Medi Cusus on ‘Pilus Diseasicus.’ And -besides, have you no respect for the superior clinical advantages we -enjoy?” - -Notwithstanding the bad odor in which I shall be held, I will nerve -myself to claim that, when the ancients considered and called piles or -hemorrhoids a disease, they made a very grave and palpable mistake, and -that, having made this mistake, it was inevitable that numerous errors -should follow logically in its train when they attempted to account for -the etiology, character, and means of cure of this “disease.” - -Pruritus ani is also called a disease, and a similar bedlam of reasons -is offered as causes and means of cure, all of which accounts for the -many, many pages of a book filled to overflowing by a “classical” -author, with compilations of the redeeming gospel truths on this -subject from prehistoric times till the present day, including his -own commentary, guesses, interpretations, and surmises. Ignorant as -he is of the nature of this symptom, the conjectures of his perfervid -imagination are “to laugh.” The errors of one or more authors, endorsed -by the mistakes of others, seemingly make a truth to minds that are -vassals to authority, which accounts for much of the useless medical -literature of to-day and for the mistakes of those that are misguided -by it. - -Considering the pathological condition, it would be better if we were -to give a more definitive characterization to it than “piles” or -“hemorrhoids.” In accordance with the distinctive exhibit contemplated, -we should describe it as a rectal mucous sac, an ano-rectal mucous sac, -or an ano-muco-cutaneous sac. These are more distinctive and suitable -designations for these symptoms of chronic proctitis, inasmuch, by -such designations, we call attention to the fact that they are simply -constricted mucus[3] channels and sacs, with engorged arteries and -veins, formed by the serous exudation that accompanies inflammation. - - [3] I found it more convenient to use the words mucus channel, mucus - fistula, etc., in preference to sinus, as they better convey my ideas - to the average reader. - -If a recto-anal mucus channel, under one or more layers of the mucous -membrane, becomes constricted or obstructed (they usually do), its -epithelial wall will become sacculated, and then we have a rectal -mucous sac, or an ano-rectal mucous sac, or an ano-muco-cutaneous -sac, all of which may be present in the same case. The inflammatory -exudation called serum distends and destroys fatty tissue, which makes -space for its lodgment under the tissue that imprisons it, and at the -same time there occurs more or less proliferation of the cells of the -tissue involved in the severe inflammation. The internal sphincter -muscle, by its contraction, aids in the undue retention of the mucus -and blood above it, hence the so-called pile-bearing region--that -is, the sacculated mucosa region. The serous exudation meets with -obstruction along the anal canal and the mucosa is sacculated. When the -integument around the anus offers obstruction to the flow of serum and -blood, we find that muco-cutaneous sacs are formed around the anus. If -the exudation occurs in the areolar space under the ano-rectal mucosa, -it readily passes down into the areolar space under the integument -around the anus, and thence to parts deep, devious, and far away, as -described in Chapter III. - -Channels, reservoirs, sacs, that would hold from one to eight or -more ounces of fluid, no longer excite my wonder and amazement at -the extensive and serious pathological condition of which they -are exhibits, a pathological condition that occasions symptoms -often diagnosed as sciatica, rheumatism, myalgia, caries of the -coccyx, coxitis, prostatitis, pruritus ani, scroti, and vulvæ, -auto-intoxication, anemia, invalidism, etc. - -Inasmuch as we have learned the cause of sacculated mucosa at the -lower end of the rectum and over the anal canal and of the integument -around it, we had better in future omit the following designations and -distinctions, which are merely a ridiculous display of sciolism. Surely -we can do without them, and ought to do so for the sake of truth and -simplicity. With a sigh of relief let us in future ignore: Safety-valve -piles, organized piles, itching piles, blind piles, bleeding piles, -moon piles, cutaneous piles, thrombotic piles, external and internal -pile tumors, venous piles, ulcerated piles, capillary piles, -mixed hemorrhoids, arterial hemorrhoids, white hemorrhoids, acute -hemorrhoids, chestnut hemorrhoids, chronic hemorrhoids, inflammatory -hemorrhoids, hypertrophic hemorrhoids, atrophic hemorrhoids, Egyptian -piles, Philistine itching hemorrhoids, etc. - -Quite naturally such a variety of “diseases” called forth many sorts of -surgical operations for their removal, of which the following are the -ones most in vogue: Clamp and cautery, ligature, crushing electrolysis, -excision, submucous ligation, the Whitehead operation, the Earle -operation, the American operation, etc. - -Forget them all, forget all of the senseless terms that are employed -to describe a supposed variety of “disease” and all of the barbarous -procedures for their banishment, and the banishment, alas! too -frequently, of the wretched sufferer likewise. - -Study carefully the varieties of chronic inflammation and the character -and extent of the exudation in each case. By so doing you will -ascertain the nature of the many varied symptoms of proctitis, of which -the following are the most common: Sacculated mucosa and integument, -submucous and subtegumentary channels, reservoirs, pockets, fistula, -pruritus ani, fissure- or ulcer-in-ano, constipation, diarrhea, etc. - -Proctitis may present a chronic, a subacute, or an acute stage, with an -atrophic or hypertrophic condition, or a less marked structural change -in the tissue. If proctitis were treated early in its inception, none -of the above-mentioned symptoms would have occasion to develop. When -mankind becomes properly enlightened on the subject of proctitis, due -attention will be given to it long before so many annoying symptoms -occur. - -Ano-rectal mucous sacs, formed by the serous exudation into the -connective tissue and stasis of the blood, are the slightest symptoms -of proctitis, and by far the most easily removed. - -Since we have found out what are the symptoms and what is the disease, -it naturally follows that in treating a sacculated mucosa we should be -governed by the character of the proctitis, whether it be in a chronic, -subacute, or acute stage. If the inflammation be acute, no matter -whether or not there is a general prolapse of the sacculated tissue, it -may be well to delay the treatment for removal of one or more mucous -sacs until we have in a degree overcome the acute inflammation by the -use of a shallow sitz bath, Fig. 23, and by the use of a soothing -ointment and liquid remedy, to meet the depurant requirements of the -case. - -The removal of the chronic inflammation, in whatever state it may be -found, should be a paramount feature of the treatment from the time a -case comes under one’s care. The cure of the disease ought to be of -more importance than the removal of a symptom or symptoms. Should there -be bleeding from a mucous sac, or should there be prolapse of it, or -both, immediate treatment will give relief at once, and the sufferer -will think you have performed a miracle, especially if the annoyance -has existed for many years. - -After the immediately annoying mucous sacs are removed by the -hypodermic method, a physician can doubly guard his reputation in -the painless treatment of mucous sacs by delaying further treatment -of those remaining sacs, which, if treated, might occasion special -annoyance, till such a time as the general inflammatory condition is -much improved; but in the interim he may treat the mucous sacs that are -located above the sphincter muscles, and the granular and ulcerated -regions. - -For the almost universal success in the painless removal of mucous -sacs, the operator should be in possession of all of his normal wits -and senses, so that his judgment will be at its best when the following -points present themselves: - -What to treat. - -When to treat it. - -Where to treat it. - -How much to treat of it. - -The quantity of remedy to be injected--all of which require discretion -and good technique. - -By the hypodermic method of treating mucous sacs some escharotic is -employed with the object of causing the absorption of the sacculated -mucosa. The object to be accomplished ought to determine the proper -strength of any escharotic used. Whatever will absorb the mucous -membrane involved in the sac in the slowest and mildest manner is the -best remedy or the best way to employ any of the tissue absorbers -you might select. And another fact: the lower the per cent. employed -the larger the quantity that may be used at a time, and this is -desirable if the area of a sac be large and you wish to absorb the -greater portion of it. A skillful operator will make sure to have the -escharotic used cover just the amount of the mucous sac desired, and -no more. Physicians that are not aware of the channeled and sacculated -character of the mucosa in the case of “piles” or “hemorrhoids” are -liable to introduce the escharotic into the base or the center of -the mucous sac with the hypodermic needle; and in such an event the -remedy often enters a cavity or a channel, or both, and naturally -it finds its way along the channel to the integument at the anus, -whence, as a consequence, a deep, ugly fissure-in-ano is in a short -time to be reckoned with by the patient and the physician, because -of the destruction of the epithelial wall of the channel. The patient -thereupon is far from being in a good humor, and the physician wonders -how the thing happened, and he feels like quitting practice altogether, -and doubtless many have done so; and certainly every one should do so -if such an error were to occur a second time. - -The object we wish to accomplish is to absorb the wall of the -sacculated mucosa. Therefore the remedy should be injected at the -apex of the sac, in the epithelial layer, or slightly deeper, if the -occasion demands it. The area of the sac and the thickness of its walls -must be taken into consideration, and will suggest the amount of the -escharotic to be used. - -A proper speculum is very essential to the successful treatment of -sacculated mucosa, and I know of none equal to that devised some thirty -years ago by Dr. A. W. Brinkerhoff. The speculum is easy to introduce, -and by drawing a slide the tissue is properly exposed or shut out to -a nicety, exhibiting just the amount you wish to treat. In some cases -there is a rather lengthy sacculated mucosa on the side, or on the -anterior wall of the anorectal tube, and it is advisable to treat only -the upper third or half, and at a subsequent visit or visits to treat -the remainder, thus avoiding annoyance to the patient. - -The paramount concern should be to avoid causing pain both during the -treatment of a sacculated mucosa or its possible occurrence a few -hours or days later. I have often remarked that when pain or soreness -follows the treatment of a mucous sac the fault is in the application -of the remedy, and not in the remedy itself. Now and then there may -be conditions in which you will expect pain or soreness to follow -the treatment, and you will prepare your patient with the necessary -appliances and remedies to overcome it promptly. Where there are no -possible means for avoiding the pain consequent upon a treatment, leave -nothing undone to make it as slight as possible. All mucous sacs ought -to be treated without any after-annoyance to the patient, and they can -be if we only wait for the proper time to treat them. - -I have not thus far considered the muco-cutaneous sacs around the anus, -which are neither useful nor ornamental, and which often indicate the -volcanic action of inflammation and the amount of mucous lava thrown -out around the vent. - - - - -CHAPTER XXII. - -EXTERNAL AND THROMBOTIC PILES VERSUS MUCO-CUTANEOUS SACS AND THROMBUS. - - -The vent of a crater indicates the convulsive and destructive changes -that have taken place within; and, very often, the vent of the -gastro-enteric sewer gives like evidence of long, great, and severe -destructive changes. The fire of inflammation has burned fiercely -for many, many years, and serous lava has, from time to time, poured -forth, leaving a searing, inflammatory path. As it was forced from the -recto-anal crater, the acrid, burning mucus, that had been imprisoned, -made subcutaneous streams, cavities, channels, sacs, etc. Its course -is marked around the anus by peaks, crags, muco-skinny tabs, small and -large bulging muco-cutaneous sacs, dilated anal veins in which clots -of blood often form; light gray, brittle, shiny skin with small and -large red and sore oases, thickly studded over the itching area, which -the sufferer has scratched in the vain hope of appeasing the torture -of pruritus ani, scroti, vulvæ; while cold drops of perspiration stand -over his or her face and body, serving to indicate the physical and -mental anguish inexpressible in words. - -Muco-serous exudations under one or more layers of the recto-anal -mucous membrane finds its way down to the integument around the anus, -and being of a very irritating character, greatly increases the -inflammatory process in the tissues it comes in contact with. Thus -the increased inflammation and blood stasis and the augmented serum -unite in hurrying the development of skinny tabs and the more or less -capacious muco-cutaneous rugæ and sacs. - -When the serous exudation takes place entirely under the recto-anal -mucous membrane, there may be formed a large muco-cutaneous anal sac, -especially on the right or left side of the anus, or the serum may pass -under the integument about the anus with little or no anatomical change -in the appearance of the skin at or about the anus. In the latter case, -an experienced eye can detect sufficient evidence to diagnose the -destructive changes wrought by the presence of serum in the connective -tissue under the skin and ano-rectal mucous membrane. - -The skin is not, as it should be, held fast by the connective tissue, -but lies loose over the cavity; and a similar pathological condition -exists under the mucous membrane of the anus, rectum, and sigmoid -flexure, which circumstance might lead one, in some instances, to -conclude that there was almost an entire separation of the mucous -membrane from the areolar tissue, by the ridges, folds, large, -pouched, prolapsed, sacculated regions of mucous membrane that has -the appearance of having been simply carelessly laid over the muscular -structure of the organs. When we observe such destructive changes -by the invasion of serous exudation under the mucous membrane, we -have every reason to expect periproctitis and perisigmoiditis, with -the possibility of the formation of pus occurring with the usual -consequences. So remarkable and serious are the excursions of the -mucous currents into healthy neighboring tissue that we find a symptom -of a disease vastly more annoying and serious than the disease itself. -Is it any wonder we find stenosis (narrowing of the passage) of eight, -ten, or more inches of the lower portion of the large intestine, which -is usually diagnosed atony of the bowels? Surely, you must by this -time appreciate the reason I made so strong an appeal for the twice -daily use of the enema as a means of relief. You need the combination -of many aids over a long period of time to effect a cure of proctitis, -etc., and its numerous symptoms. Proctitis and colitis is a serious -affliction, and should have your undivided attention with the hearty -co-operation of the patient in effecting a cure. How foolish is the -practice of removing one or two annoying symptoms (piles and fistula) -and leaving the sufferer untreated, the disease itself and the other -symptoms not so apparent at the time of the operation, and then dismiss -the case as cured! Shame on such practice, in which ignorance and -cupidity dominate! Humanity cries for a correct diagnosis and a humane -treatment! - -The profuse serous exudation resulting from proctitis and sigmoiditis -makes its way from the diseased area into the neighboring regions -like lava from an active volcano, carrying with it an intense burning -inflammation, destroying normal fatty tissue as it advances, owing to -its extremely acrid character. Is it any wonder that we find dilated -veins and arteries in the lower rectal and ano-rectal canal and around -the anus where stasis of the blood has existed for a great many years? -The real wonder is that thrombus in the veins around the anus does not -occur more frequently than it does. What is the necessity of calling -such a pathological change in the caliber of a vein and the weakening -of its walls “thrombotic pile”? Thrombus is a clot of blood in a -vein, and there is no use in adding the word “pile.” The aggravated -character of the inflammation accounts for the hypertrophied and the -cicatricial tissue so often found around the anal vent of proctitis -cases. The Biblical suggestion that sacculated mucosa, commonly termed -piles or hemorrhoids, is a disease, accounts for the numerous names -used to designate the particular variety of the disease--whether it be -an internal or an external pile tumor. It is very wrong to so mislead -“scientific” medical men. Had they only known that the numerous sacs, -bags, prolapsed pouches, longitudinal and transverse folds of the -ano-rectal mucous membrane, and the ragged, jagged, prolapsed, pouched -muco-cutaneous tissue around the anus, as well as the fissure-in-ano, -pruritus ani, fistula, are only symptoms of a disease, all of the many -abnormal changes and the other symptoms could have been prevented many -generations ago by simply treating their exciting cause. But it is -never too late to learn things that will benefit mankind. - -Don’t for a moment think that all of the structural changes on the -mucous membrane and about the anus mentioned above indicate an -affliction only skin deep, or even the depth of the mucous membrane. -They are far worse than that. You will find all the muscular structure -of the anal organ and that of the rectum sigmoid flexure severely -invaded by the inflammatory process and its fibrinous exudation, and -also the external tissues that surround and support the organs. - -We have circular and longitudinal muscular tissue entering into the -structure of the anus and rectum. The sphincter muscles are two large -and strong muscles that close the anal orifice and guard its vent very -effectually if they are not destroyed by a surgeon’s knife. - -The acrid burning serum coming in contact with the muscular tissue -excites an aggravated inflammation in its structure as elsewhere. The -constant irritation results in more or less permanent contraction -of the sphincter muscles in which fibrinous exudation takes place, -binding the contracted muscular fibers together. In time their -expansibility is lost in many cases, and in other cases partially so, -necessitating divulsion of the sphincters in order to break up the -adhesions and establish a somewhat normal circulation of the blood in -the diseased parts, also in order to relieve the irritation to the -nerves distributed to the organs and their marked reflex excitement. -In some cases an expansion of the sphincters for one and a half inches -or two inches is quite sufficient; other cases may require a little -more thorough divulsion; but never weaken or paralyze the sphincters, -as your patient needs their normal use, and you need the reputation -of never causing incontinence of feces. Guard the usefulness of the -sphincters as you would a valuable treasure. - -As a rule, I treat all of the ano-rectal sacculated mucosa in cases -where divulsion is required before performing the dilatation to break -up the adhesions, and very frequently the muco-cutaneous sacs and -distended veins as well. It may be well to delay the divulsion--with -which there is usually no hurry--until you determine how many U-shaped -(or hairpin shaped) mucus channels and recto-anal mucus fistulas there -may be present that have passed down under the recto-anal mucous -membrane, down to the integument about the anus, and then pressed -immediately upward again along the outer wall of the anus and rectum, -to the extent of six inches or more. There may be three, four, six, or -more of them quite prominent as to length and size. - -For the treatment of the recto-anal sacculated mucosa the injection -method is par excellent. For the removal of the muco-cutaneous sac a -double V-shaped incision, the proper depth, length, and width, will -remove the surplus or redundant tissue, after which the edges are -brought together with a catgut suture,--or omit the suture if you think -best,--followed by the home attention as prescribed for fissure-in-ano -in a previous chapter. At the time of removing the sacculated tissue -attention may also be given to the mucus channel; or you may, if -you wish, leave it so that at some future treatment you can give it -the desired attention. A one or two per cent. solution of alypin, -cocain, or beta eucain will produce the necessary local anesthesia -for a painless operation. I remove only one muco-cutaneous sac at a -treatment, which permits the patient to go about as usual without much -inconvenience. - -If you have removed all of the ano-rectal sacculated mucosa in a case, -and have omitted to remove the one or more ano-muco-cutaneous sacs -or dilated veins that are so often present around the anus, and have -also neglected to cure the chronic proctitis, then the sacculated -mucosa may, by some hook or crook, become excited again into an acute -inflammatory condition, the sphincter muscles may grip tighter than -usual, and lo, thrombus has taken place in a vein, and the wrinkled, -shriveled, skinny tab or sac looks like a miniature balloon, and your -dismissed patient is in a troubled state of mind to have everything -come back on him so soon! - -The cure was all right so far as it went, but there was the disease and -some of the old external symptoms to tell the tale of an incompleted -treatment. - -Those muco-cutaneous sacs at the enteric crater’s mouth are just so -many thermometers at its vent to tell the temperature occasioned by the -fire of inflammation within, and they will damage your reputation as -a proctologist if they be not removed. By all means get rid of these -symptoms and indicators of trouble within; and if there should by -chance be a little of the old proctitis remaining that wants to assert -itself by making trouble, in becoming acute, it will be surprisingly -handicapped in its efforts, and the chances are all in your favor; and -you will, moreover, from time to time, hear what So-and-So said about -the very successful treatment of his or her case. - -Sacculated mucosa, muco-cutaneous sacs, submucous channels, etc., -having their source in the rectum and anus, are all of a similar -origin, the result of serous exudation. These symptoms of proctitis -vary in development and number according to the nature and progress -of the disease. In those cases that are quite exempt from sacculated -mucosa (piles) you may expect to find submucous channels largely -developed, and _vice versa_. - -Too much stress cannot be placed upon the serious results of -auto-intoxication by the absorption of mucus from channels and cavities -that will hold from three to eight or more ounces of fluid at one time. -They are no doubt rapidly emptied by the process of absorption into the -system. - -I have not referred to the fatalities of the hypodermic treatment of -sacculated mucosa (piles or hemorrhoids) because of the fact that none -have ever occurred within my knowledge among those using either this or -a similar method of treatment. - - - - -CHAPTER XXIII. - -ABSCESS AND FISTULA INVOLVING ANUS, RECTUM, AND NEIGHBORING REGIONS. - - -Hippocrates, the father of medicine, Celsus, Galen, and other writers -in the early times, described fistula as a disease; and, naturally -enough, through the influence of heredity, contagion, imitation, and -auto-suggestion, every author on the subject to the present day has -chimed in most complaisantly with his “Ditto! ditto! ditto!” “Me -too! me too! me too!” I am sure that the rank and file of my medical -brethren will agree with me that modern authors are hardly justified -in this servility to the ideas of the fathers of medicine in this -recreance to their duties toward suffering humanity. Is it that they do -not know better, or that they are naturally servile and thus too lazy -to do their own thinking? - -Let me in connection with this point call your attention to a practice -that many of us have been suspicious of for a long time, a suspicion -that has been confirmed for me by one who speaks from positive -knowledge; otherwise I should not refer to it here. The practice I am -about to describe will make it plain why we have so many “Ditto and -Me-too” authors on proctology and other medical subjects. - -An eminent surgeon who mentally is as large as the human race, and -has room for all that is good in medicine and surgery, narrated the -following incident of his career to a learned doctor from Georgia -and myself recently. Snatching occasionally a few moments from a -busy practice, he has prepared sufficient material to make a book, -and desired some competent person to edit it before publication. So -he consulted an ethical co-worker concerning such a person. In a few -days a gentleman called at the doctor’s house to inquire about the -contemplated publication. The caller asked the title and size of the -book, and when told volunteered the startling information that he could -have the work ready in a few weeks’ time, but that in the meantime he -would like to hear the doctor lecture once or twice that he might catch -a few peculiar expressions to use in the work, so that the doctor’s -friends, when reading the book, would say, “That sounds just like the -doctor; that is his style of talking.” The would-be scribe never asked -for the author’s manuscript, so accustomed was he to rely upon the -medical literature to be found in the libraries of the city for all the -information needed. It is hardly necessary to add that the professional -bookmaker was summarily dismissed. The doctor’s manuscript is still -unpublished. - -There is a third reason for so many “Ditto and Me-too” authors. -Publishers of medical books naturally desire to extend their business, -and in order to do this they must issue new works of medicine in the -same way that lay publishing houses compete for new works of fiction. -Now, doctors usually obtain professorships in some institution by -paying five thousand dollars or more for them, and in due time a -publisher of medical books will tempt the professor to become an -author. They place before him their great facilities for getting -up a book, arguing that consequently but little or no labor on the -professor’s part is required. They point out to him the fame and honor -the publication will bring him, and at the same time estimate how -much money they will make out of it. In due time a “Ditto and Me-too” -medical brief, résumé, or treatise, is published covering the whole -history of the subject, from Biblical mention of it to the present day. -All of us have observed what a great amount of stuffing or padding -it takes to make a book that is to sell for five or seven dollars. -It occurs to me that it might be wise to get up a conference of -enlightened physicians to take some practical steps or to devise some -laws that will prevent such impositions on the too confiding medical -brethren by unscrupulous publishers that rob them of their hard-earned -income through delusive advertising. Still, before any action is taken -that would result in effectively closing the door to this practice, it -may be as well that the eyes of more of us should be opened that we -may not continue to be duped and stung again and again by “Ditto and -Me-too” scrapbooks with hundreds of pictures. When seeking for new and -better information to help suffering humanity, let us be served for a -little while longer with “rehashed rot.” - -Pardon this digression. We will now consider, at first hand, the -subject of fistula. - -As a rule, pus in a fistula is a secondary symptom of chronic -proctitis, except those fistulæ that occur from traumatic injury to -the region of the rectum, anus, and buttocks. Early in my practice I -entertained the idea that the formation of pus occurred at the point of -dissolution of the tissue, and that, as the volume of pus increased it -made its way in the direction of least resistance through it, if the -abscess had not been opened by an incision. The idea was well founded -when it was applied to the traumatic origin of an abscess and fistula, -but not when their origin was traced to chronic proctitis. - -It may seem incredible to all who read this that a mucus channel or a -fistula can be formed for ten, twenty, forty, or more years before the -formation of pus takes place in it; and that the pus exerts no part -in producing the diameter or length of the fistula, which may have a -capacity of six, eight, or more ounces of fluid. As soon as the chronic -inflammatory process has penetrated one or more layers of the mucous -membrane, mucus channel or fistula-formation must take place. If the -sphincter muscles be rather weak or lax I would not expect sacculation -of the rectal mucosa to occur to any extent. In these cases, however, -the muco-cutaneous channels are usually found quite large and numerous. -Of course the extent of the ano-rectal symptoms in each case depend -upon how severe the chronic inflammatory process has been, and is, at -the lower portion of the enteric canal. Often you will find that the -seat of the most active chronic inflammation is in the middle and upper -portion of the rectum, involving also the sigmoid colon. In these cases -the ano-rectal symptoms are not numerous, if there be any at all, on -the mucous membrane, but under it you may expect mucus channels that -serve as outlets for the inflammatory product. - -In every case of chronic proctitis and sigmoiditis submucous and -subtegumentary fistulæ can be found, and my experience in tracing -them warrants me in stating that periproctitis and perisigmoiditis -is present also; the latter pathological condition being due to the -invasion of submucous and subtegumentary channels or fistulæ around the -outside of the structure of the anus and rectum, extending far up into -the neighboring tissues of the pelvic space that support the rectum and -sigmoid flexure. - -The formation of pus in a submucous or subtegumentary channel that has -existed for many years does not make it a disease; it is only another -incidental phase added to an already existing symptom of chronic -proctitis. - -Mucus fistulæ should be diagnosed and treated early in their formation, -or at least before the tissues involved became so deteriorated as -to form pus in quantity sufficient to occasion the usual period of -suffering, fever, loss of rest and sleep before the pus is freed -from its enclosure. The formation of pus in a mucous fistula is only -incidental and marks a stage in the distinctive changes that have -been going on for many, many years in the tissues involved in the -inflammatory exudation. - -The numerous small and large submucous and subtegumentary fistulæ -found in every case of chronic proctitis and sigmoiditis was the most -grave and far-reaching of the numerous symptoms, but for three decades -I have fully realized the baneful effects from mucus irritation, and -the self-poisoning by the absorption of large quantities of serum and -fibrinous septic material from the surface of the mucous membrane -involved, as well as that from numerous long, cavernous mucus fistulæ: -a fearful double source of auto-intoxication, for which it is useless -to prescribe diet, tonics, and travel for building up the system and -restoring the health. - -Besides the numerous general symptoms, arising from self-poisoning by -fecal and mucus absorption, we have more or less marked local symptoms -in many cases; and if these be not present, the diagnosis can be made -out from the general debility of the system and the character of the -chronic proctitis and sigmoiditis. - -The local symptoms of mucus fistulæ, periproctitis, and -perisigmoiditis are, each of them, universally diagnosed as a disease: -Such symptoms as pruritus ani, scroti, vulvæ, lumbago, sciatica, -myalgia, rheumatism, prostatitis, coxitis, disease of the coccyx, -chafing about the anus and along the thigh and scrotum, difficulty in -getting up after sitting for a while, pain in the back of the neck, -lame back, legs feel tired, and sometimes pain is very annoying, -abnormal color of the skin, painful or sore spots at times, confinement -in bed for many weeks from severe continuous pain in and about the -rectum, etc. - -Up to the present time proctologists have paid little or no attention -to proctitis and sigmoiditis, which is a grave disease, with a far more -serious symptom, that of mucus fistulæ of great length and diameter, -extending in all directions in the pelvic cavity and tissues of the -buttocks, the large area of tissue found so full of holes, might be -likened to a sponge occupying the same space. They are very numerous in -every case of chronic proctitis and sigmoiditis. - -This will explain why an incidental symptom like pus in a fistula is -commonly called a disease by the “Ditto and Me-too” authors, and why it -is so frequently met with in practice. At some hospitals one-half of -the cases treated suffer from fistula in which pus has formed. Why the -per cent. is not much greater I am unable to explain, except to give -credit to the defensive and restorative power of the human body. If the -periproctitis and perisigmoiditis, brought on by the mucus fistulæ, -is not treated at the same time as the cause, the treatment will be -of no consequence in effecting a cure of the chronic inflammation of -the lower bowels. Every mucus fistula should be located and healed at -the time that the disease itself is treated; then the work will be well -done. Every mucus fistula should be diagnosed and treated before the -breaking down of the tissues reaches the pus-forming stage, and thus -obviate all suffering, annoyance, and possible death. Attention to this -course will ensure your treatment of the disease, and its symptoms, to -be taken in time. - -The only hindrance to the successful office treatment of a fistula in -which pus has incidentally formed is the fear that you can not cure it, -or that you will fail, or that at a hospital it could be cured quicker, -better, and cheaper. These ideas are born of heredity, timidity, -fear-habit, power of auto-suggestion, and too much caution on your -part. They are all falsehoods and should not be heeded for a moment. -During thirty years of practice in my specialty I have sent seven of my -fistula patients to a hospital for treatment, and four of that number -I afterwards very much regretted sending, as I could have accomplished -the cure in a safer and better way by the usual office method of cure. -In fact every fistula, pus or no pus,--I do not care how bad it may -be,--can be cured by office treatment and at the same time aided by the -home attentions of the patient. There may be periods of a year or more -when your energies are overtaxed with numerous patients, and you feel -like dividing the labor with some fellow-practitioner, and this in a -measure accounts for those I induced to go, or was willing to have go, -to the hospital. - -Unless overwork is the excuse, you need never send a fistula patient -to a hospital for treatment. I have everything to say in praise of -the ambulant treatment of ano-rectal fistula and the mucus channels, -since my practice thus far has been devoid of any unfavorable -results,--a fact which should have much weight in favor of the ambulant -office treatment of all of the many symptoms of chronic proctitis, -sigmoiditis, and colitis. - -Mucus fistula is very easily healed in all cases, and those cases in -which pus has incidentally formed are likewise not difficult to cure. -All you need to do is to instill intelligence in a stupid patient, if -you haven’t an intelligent one, and induce him to utilize or improvise -a few home conveniences for cleansing the fistula night and morning -between office visits. During the treatment of the fistula patients -will be able to attend to their imperative duties. - -To properly explore a fistula and its branches, if any, as to whether -pyogenesis (pus) has taken place or not, it is essential to have the -external opening through the skin of sufficient depth and size to -permit of the application of remedies over all its surface. For a mucus -fistula antiseptic remedies can be applied after a thorough irrigation -by hot water at a temperature of one hundred and twenty degrees, or -more, for half an hour or less time, as the case may demand. Where -pyogenesis (pus) has occurred in a mucus fistula there may be more -or less necrotic tissue formed, which will require the use of an -escharotic remedy as well as very hot water irrigation, followed by an -antiseptic remedy, if not already incorporated in the hot water used. - -As a rule I see a fistula case once or twice a week, as the case may -require. There is no packing of the fistula after the morning and -evening home treatment--I have never found it essential. A T-bandage -is worn, with absorbent cotton, over the opening of the fistula, -preventing soiling of the clothes while attending to daily duties. - -Never mind what the “Ditto and Me-too” proctologists have copied or -rehashed about the curing of a fistula, which they persist in calling a -disease. Just be resourceful, safe, and sane in all you do, and every -fistula will get well long before you have cured the chronic proctitis -and sigmoiditis, of which the fistula, as a rule, is a symptom. - - - - -CHAPTER XXIV. - -NINE RADIOGRAPH ILLUSTRATIONS OF MUCUS CHANNELS AND CAVITIES. - - -I am indebted to Dr. Caldwell, of New York, at whose laboratory my -patients were radiographed for the very excellent illustrations; -and also to Dr. Albright of Philadelphia, for his assistance in the -radiograph work, while attending my clinic, and who, later, with rare -skill and scholarly ability, presented my discoveries in a large -volume, entitled; _A Practical Treatise on Rectal Diseases, Their -Diagnosis and Treatment_. - -The following illustrations can only give a hint of the pathological -conditions that existed. Fig. 1 shows seven, and Fig. 2, eight probes -inserted, which by no means indicate the number of channels or size of -the cavities; twenty-five to fifty or more probes inserted would more -accurately indicate the excursions of the inflammatory exudate. - -The seven following illustrations, in which Bismuth Paste was injected, -did not meet my expectations in showing the pathological conditions -that existed. The disappointment was largely due to a desire not to -cause annoyance to my patients, who so kindly consented, -in the interest of science, to being radiographed. In all cases the -paste extended over a much greater area than a casual glance at the -illustrations would indicate. The probes and paste were not inserted -with the idea of making a diagnosis, but simply to suggest research on -the subject by proctologists. All the cases radiographed suffered from -proctitis, sigmoiditis, periproctitis, and perisigmoiditis. - -[Illustration: Fig. 1. - -Radiograph showing tube (1) in the rectum; 2, probe inserted 8-3/4 -inches; probes 2 and 4 pass on left side of rectum; 3 and 5 pass on the -right; all pass into perirectal spaces; three probes are seen under the -integument.] - -[Illustration: Fig. 2. - -Radiograph showing tube (1) in the rectum; probes 2, 4, 6, passed -on the left and front of the rectum; 3 passed forward; 5 under the -integument along the spine; 7, 8, and 9 probes passed to scrotum and -thigh.] - -[Illustration: Fig. 3. - -Radiograph showing a large region more or less filled with bismuth -from the anal canal forward and upward, as indicated by lines 1 -and 2; a severe case of proctitis, sigmoiditis, periproctitis, and -perisigmoiditis.] - -[Illustration: Fig. 4. - -Radiograph showing a tube in the rectum and probe passed to the left of -the rectum into the space where bismuth was injected; a case of acute -proctitis, sigmoiditis, periproctitis, and perisigmoiditis at time of -treatment.] - -[Illustration: Fig. 5. - -Radiograph showing bismuth in a perirectal channel on the left side of -the anus and rectum, which caused continuous annoying pain for many -months.] - -[Illustration: Fig. 6. - -Radiograph showing a long muco-cutaneous sac and perirectal channel -into which bismuth was injected; a case of proctitis and periproctitis, -etc.] - -[Illustration: Fig. 7. - -Radiograph showing a tube in the rectum, a long probe and bismuth -in perirectal space, also a probe in a submucous channel; a case of -sigmoiditis, proctitis, periproctitis, and perisigmoiditis.] - -[Illustration: Fig. 8. - -Radiograph showing bismuth injected in the perirectal space; a case of -proctitis, sigmoiditis, periproctitis, and perisigmoiditis with severe -constipation and indigestion.] - -[Illustration: Fig. 9. - -Radiograph showing tube in the rectum, a probe and bismuth in -perirectal space, and also a probe in a submucous channel; a case of -proctitis, sigmoiditis, periproctitis, and perisigmoiditis.] - - - - -CHAPTER XXV. - - CHRONIC MUCOUS PROCTITIS AND SIGMOIDITIS--USUALLY DIAGNOSED AS - CHRONIC MUCOUS COLITIS. - - -Chronic mucous colitis ought to mean inflammation of the ascending, -transverse, or descending colon. The length of the rectum varies from -five to eight inches, and the average length of the sigmoid flexure -is about nineteen inches; the length of the two organs is thirty or -more inches. Chronic follicular, ulcerative proctitis and sigmoiditis, -extending half, or even the whole length of the sigmoid flexure, causes -great suffering, and the symptoms are similar to those attributed -to chronic mucous colitis. For about thirty years I have positively -known that many of my patients suffered not only from chronic mucous -proctitis, but from sigmoiditis as well, since I was able to make -positive diagnosis of the diseased condition for at least ten to -fifteen inches up the lower bowels. - -If the anal canal is inflamed from any cause and not cured, the chronic -inflammation will gradually extend up the whole length of the rectum -and into the tissues of the sigmoid flexure, invading the organ to a -greater part of its length, if not all of it. The sigmoid flexure is -the normal receptacle for feces, and gases, and physiologically and -hygienically ought to be emptied three times in twenty-four hours to -keep it clean for those who are in the habit of eating food three times -a day. The hygienic condition of the sigmoid receptacle is entirely -dependent upon a healthy condition of the rectum and a sensible tenant -of the body; but when chronic proctitis has taken possession of the -rectum and neighboring tissues, it serves no longer as a normal -passageway for emptying the sigmoid flexure of accumulated feces, -gases, and liquids. - -At first inflammation causes spasmodic muscular contraction of the anus -and rectum, which in time becomes more and more permanent stricture -as the progress of disease advances, lessening the bore of the organs -until it becomes very difficult for anything to pass into and through -the rectal and anal canals. Inflammation extending from the rectum -into the sigmoid flexure for perhaps its whole length, interrupts its -functions likewise, thus creating another cause for undue accumulation -of feces and gases in the organ; this accumulation of the waste -material of the body becomes very foul, generating toxic gases, putrid -substances, and poisonous germs which in turn irritate and excite -the diseased organ from their constant contact with the follicular -ulcerated mucous membrane of the sigmoid receptacle. Why should we -not find in these cases all the symptoms attributed by authors to -chronic mucous colitis? Especially so when we have, in addition to -the enumerated symptoms of colitis, those caused by periproctitis and -perisigmoiditis, which are always present and quite severe. - -As a rule, the symptoms which have been diagnosed as those of chronic -mucous colitis, membranous colitis, or ulcerative colitis are nothing -more than symptoms of chronic mucous proctitis and sigmoiditis, -accompanied by periproctitis and perisigmoiditis. Proctologists who -have written on the subject of mucous colitis have noted the many -symptoms very accurately, but have missed the usual location of a most -aggravating disease from which mankind suffers early and late in life. -Authors of books on stomach and intestinal troubles are also groping -very much in the dark and are unable to diagnose the cause of a very -common functional disturbance of the whole digestive apparatus, caused -by proctitis and sigmoiditis, bringing numerous and severe primary and -secondary symptoms to which other diseases may be traced. - -Chronic proctitis and sigmoiditis and their local symptoms convert the -sigmoid receptacle into an Augean stable, from which foul poisonous -gases and germs are forced up and along the bowels, distending the -descending and transverse colon and finally reaching the ascending -colon and the cæcum, causing undue retention of their contents; hence -so much attention to the cæcum and the vermiform appendix. The ends -of a long rubber tube distended with gas will exhibit more strain and -disturbance than the intermediate parts, and the same is true of the -colon, owing to the intermediate sections of the organ possessing -greater mobility. The great volume of gases confined in the colon -prevents its normal peristaltic action, causing undue retention -of contents, with resulting inflammation of the cæcum, as well as -dislocation of the stomach, colon, etc., and suggesting radiographic -and fluoroscopic examination and surgical operations to discover the -cause of all the trouble, which should have been learned through use of -the speculum before so many complications occurred. - -In all cases of chronic mucous proctitis and sigmoiditis where there -is a great amount of secretion of mucus, membranous cords, shreds, and -casts (called mucous colitis), I have found the marked acute symptoms -more or less periodic and accompanied by increased inflammation in -all the tissues involved in the disease, which convinced me that the -colitis we read about had become dislocated and was where I could see -its results without the use of a speculum. - -Through often witnessing the phenomena, I have learned what a -“mucous colitis” storm means from a pathological exhibit, a personal -demonstration, and a verbal description of what the sufferer is -enduring. It requires the stuff heroes are made of to endure chronic -mucous proctitis and sigmoiditis for ten, thirty, or forty years -without the disease being accurately diagnosed, and to be told that -all treatment is useless and that the trouble is in the head of the -sufferer, that he is a hypochondriac, and a neurasthenic, terms often -used by doctors who are unable to make a proper diagnosis of a case. - -The common symptoms of mucous colitis have been accepted by writers -on the subject, but as to the real cause of them there has been thus -far only mere conjecture, just as the writers have been doing as to -the cause of pruritus ani, scroti, and vulvæ. Dr. George M. Niles, -of Atlanta, Ga., says: “In looking up the literature, one is amazed -at the divergent views as to the etiology and management held by -diligent students and competent observers. It is fairly well agreed -that most cases occur in nervous, neurasthenic, hypochondriac, or -hysteric individuals.” Others blame the liver, hysteria, constipation, -fermentative processes in the intestines. How foolish to name symptoms -of the disease as a probable cause of it! It is not necessary for me to -again enumerate the many primary and secondary symptoms of proctitis -and sigmoiditis, but I will mention briefly a few nervous symptoms -which I think are due to the absorption of mucus into the system. -There is that intense, exasperating, sore, and restless feeling, with -inability to concentrate the mind, with the nerves and muscles of the -body pinched and contracted. Such feelings are at their height during -an acute mucus storm, which is an indication of increased inflammation -in all the inflamed tissues, causing secretion of a great quantity of -mucus or membranous casts. No doubt much of the inflammatory exudate -from the mucous membrane, from the muscular structure of the organs, -and the connective tissue surrounding and supporting the organs, passes -into the sigmoidal and rectal canals, while a portion is absorbed -into the system. In a similar manner, the inflammatory exudate from -a subtegumentary mucus channel and cavity passes through the skin, -causing moisture of the skin, pruritus ani, scroti, and vulvæ. I know -of no non-malignant disease, where the symptoms may truly be said to -be a thousand times worse than the disease that caused them, except in -chronic proctitis and sigmoiditis. - -Treatment of such cases has been very successful in my practice, -requiring four principal aids: (1) Local treatment; (2) medicated -enemata; (3) local medication; (4) the recurrent application of -medicated hot water at a temperature of 125 to 135 or more degrees. -A further valuable aid is the determination of the sufferer to get -well by faithfully carrying out the home treatment. The more a patient -studies my diagnosis and treatment of his case, the more he is -encouraged that eventually a cure will be effected. Dr. James Moran of -this city has been a student and assistant at my office for more than -three years, and will bear testimony to the success of my treatment in -all cases observed by him. - - - - -CHAPTER XXVI. - -ANTISEPTIC EMPLOYMENT OF POWDERS AND OILS. - - -DEPURANT POWDER. - -Water at a temperature of from 120 to 135 or more degrees is an -excellent antiseptic if properly applied to diseased tissue. Its -anti-toxic, soothing, and healing properties, however, can be vastly -increased by the addition of Depurant remedies. Water of this -temperature, if used in the treatment of proctitis or colitis, should -be applied with the aid of an Intestinal Recurrent Douche. - -Water at a temperature of from 90 to 105 degrees--which is recommended -for taking an enema--is antiseptic or depuratory only to the extent -to which it washes away morbid matter from the intestinal canal. To -increase its antiseptic and therapeutic value, as well as to meet other -requirements, Depurant remedies are administered with the water during -the flushing of the large intestine. - -The Depurant Powder, prepared by the author, readily dissolves in the -warm water and is brought into contact with every part of the mucous -membrane as far as the antiseptic flushing extends along the intestine, -thus leaving the washed and sterilized canal sweet and clean--a fit -and proper channel and receptacle for the on-coming fecal mass. Here it -may remain about four hours without danger of putrefaction, whereas, -were the passage-way and receptacle foul, the feces would putrefy and -form gases and toxic material in briefer time. - -This Depurant remedy is not restricted to intestinal uses; it is -equally efficacious when applied to the mucous membrane of any part of -the body or to the skin. It may be used effectively for washing out the -bladder or the vagina; for syringing the ear; for a mouth wash, tooth -wash, gargle, nasal douching or spray; for a throat spray; for bathing -infants; and for internal use where foulness of the stomach and small -intestines exists. It is also a valuable adjuvant in the use of water -for cleansing, or for hygienic purposes, on all the tissues of the body. - - -DEPURANT OIL. - -Next to the use of water on the mucous membrane and skin as a hygienic -and therapeutic agent, I am partial to some of our delightful oils, -which are bland, non-irritating, and of a pleasing, nourishing, -refreshing effect and exquisite odor. - -To the oil selected as the base ingredient may be added other oils, -and finally attenuated powdered substances of therapeutic value in -soothing, purifying, healing, or any other purpose the case may call -for. Pure olive oil is an excellent substance in which to incorporate -Depurant remedies, especially when designed to be taken internally, -by way of the mouth, or applied to the integument of the body. Certain -other oils are equally pleasing though rather expensive. However, an -inexpensive oil usually serves as a base in which to embody the proper -medicinal remedies for Depurant purposes in the treatment of proctitis -and colitis. - -By a proper instrument the oil is carried into the intestines with the -water used in flushing the colon, or that used with the intestinal -recurrent douche treatment. The oil, being lighter than the water, is -carried ahead or on top as the water passes up the bowels; and, as -the two liquids open the crevices and folds of the mucous membrane -or canal, every part of the latter is completely covered with the -medicated oil, as with a covering of thin salve, ointment, or a -poultice--in every nook and corner, just where it is most needed and -where it should remain for its hygienic and healing effect. - -Every kindly aid should be given a diseased organ, mucous membrane, or -the skin, even if one knows it is for relief only; for the very aids -that give relief are often essential when joined with medicinal or -other treatment in effecting a cure. - -It is advantageous in treating bowel troubles to use a rather heavy, -tenacious oil for a base--one that may not be so pleasant to swallow -or to use externally as some of the lighter oils. It is therefore -advisable to have two kinds of Depurant Oil: one for internal use (by -the mouth) and for the skin, the other for chronic disease of the lower -bowel. - - - - -_INTESTINAL ILLS._ - -_By Alcinous B. Jamison, M.D._, - -SPECIALIST IN RECTAL, ANAL, AND BOWEL DISEASES, AND AUTHOR OF “HOW TO -BECOME STRONG.” - -_Cloth, 277 pages_ - - -The above is the title of a work for non-professional readers on the -cause and cure of many forms of bowel and stomach trouble, and their -consequences, and the scientific treatment of piles, fistula, pruritus -ani (itching), etc. - -Science is here reduced to common sense; and the intelligent layman, -following the directions of this book, especially as to “physiological -irrigation,” will be able to prevent the usual daily foul state of the -stomach and bowels. Here is set forth in plain language the accumulated -experience of a thoughtful physician, who for over thirty years has -studied the welfare of his patients in the treatment of those diseases -which are peculiar to civilization. During this long practise, patients -from all parts of the United States and other countries have come to -New York City to be under the humane and skilful care of Dr. Jamison, -who has the unique reputation of never employing the barbarous surgical -and hospital methods in vogue throughout the world. No knife, ligature, -clamp, or cautery has ever been employed by him in the treatment -of even the most aggravated case of piles, or hemorrhoids; and no -detention from business is necessary under his treatment for this -symptom of proctitis. - -Dr. Jamison’s discoveries in the line of his specialty have added -much to medical knowledge concerning the etiology and pathology of -proctitis, sigmoiditis, and of their symptoms--hemorrhoids, pruritus -ani, constipation, etc. His diagnosis of these afflictions is original, -as well as his treatment of such ailments--hitherto neglected or -improperly cared for. - -Physicians and surgeons of conventional schools of medicine are not -aware that the common cause, and indeed the key, of all forms of anal, -rectal, and bowel trouble is proctitis (inflammation of the lower bowel -and sometimes of the colon); that proctitis is the cause of nearly -all cases of constipation, diarrhea, indigestion, and biliousness; -and that, finally, proctitis is the cause of auto-infection -(self-poisoning) and its outcome--anemia, emaciation, etc. - -No book to which physicians have access treats this subject so fully as -“Intestinal Ills,” and yet in this volume it is presented in a popular -manner suited to the common understanding. - -The following enumeration of the chapter headings will give an idea of -the scope of the treatise: - - 1. Man, Composed Almost Wholly of Water, is Constipated. Why? - - 2. The Physics of Digestion and Egestion. - - 3. The Interdependence of the Anus, Rectum, Sigmoid Flexure, and - Colon. - - 4. Indigestion, Intestinal Gas, and Other Matters. - - 5. Key to Auto-infection. - - 6. How Auto-infection Affects the Gastric Digestion, and Vice Versa. - - 7. How Auto-infection Affects Intestinal Digestion, and Vice Versa. - - 8. The Cause of Constipation and How We Ignorantly Treat It. - - 9. Cures for Constipation “Fearfully and Wonderfully Made.” - - 10. Biliousness and Bilious Attacks. - - 11. King Liver and Bile-bouncers. - - 12. Semi-constipation and Its Dangers. - - 13. The Etiology of the Most Common Form of Diarrhea, i. e., - Excessive Intestinal Peristalsis. - - 14. Ballooning of the Rectum. - - 15. Ballooning of the Rectum (_Continued_). - - 16. Erroneous Diagnoses and Treatment of Bowel Troubles. - - 17. Costiveness. - - 18. Inflammation. - - 19. Proctitis and Piles. - - 20. Pruritus, or Itching of the Anus. - - 21. Abscess and Fistula. - - 22. The Origin and Use of the Enema. - - 23. How Often Should an Enema be Taken? - - 24. Physiological Irrigation. - - 25. Proper Treatment for Diseases of the Anus and Rectum Very - Essential. - - 26. The Body’s Book-keeping. - - 27. Selection and Preparation of Food. - - 28. Diet for Indigestion. - - 29. Diet for Constipation. - - 30. Costiveness, Diet, etc. - - 31. Diet for Diarrhea. - - 32. A Final Word. - -You need this book for yourself and your friends. By making a present -of it to some one requiring its light you will perform an act of -unselfish kindness. - -Price, cloth bound, lettered in gold, $2.00, post-paid to any address. -In sending for the book please write name and address plainly. All -orders should be sent to the author: - - A. B. JAMISON, M.D., - 43 WEST 45TH STREET, NEW YORK CITY. - - - - - -End of Project Gutenberg's Intestinal Irrigation, by Alcinous B. 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