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INTESTINAL ILLS

Chronic Constipation
Indigestion
Autogenetic Poisons
Diarrhea, Piles, Etc.

Also

Auto-Infection, Auto-Intoxication,
Anemia, Emaciation, Etc.

Due to
Proctitis and Colitis







Published by Chas. A. Tyrrell, M.D.
134 West 65th Street, New York City
1915

Copyright, 1901
by
Alcinous B. Jamison, M.D.
43 W. 45th Street, New York
U. S. A.




TO
THE UNFORTUNATE SUFFERER
FROM ILLS DESCRIBED IN THIS VOLUME
AND TO THOSE WHOM I HAVE HAD
THE PLEASURE OF CURING
THIS BOOK
IS RESPECTFULLY
DEDICATED




    BEAUTY'S FALL.


    It was an image good to see,
    With spirits high and full of glee,
        And robust health endowed;
    Its face was loveliness untold,
    Its lines were cast in beauty's mold;
        At its own shrine it bowed.

    With perfect form in each respect,
    It proudly stood with head erect
        And skin surpassing fair;
    Surveyed itself from foot to head,
    And then complacently it said:
        "Naught can with me compare."

    When lo the face began to pale,
    The body looked too thin and frail,
        The cheek had lost its glow;
    The tongue a tale of woe did tell,
    With nerves impaired its spirits fell;
        The fire of life burned low.

    In the intestinal canal
    Waste matter lay, and sad to tell,
        Was left from day to day;
    And while it was neglected there
    It undermined that structure fair,
        And caused it to decay.

    The doctor's words I would recall
    Who said: "Neglect precedes a fall,"
        And verily 'tis true;
    For ye who disregard your health,
    And value not that precious wealth,
        Will surely live to rue.




PREFACE.


The following chapters were contributions to _Health_--a monthly
magazine published in New York City. Certain peculiarities of form and
considerable repetition of statement--both of which the reader cannot
fail to notice--are owing to the fact that about two-thirds of the
chapters were written under the caption "Auto-genetic Poisons in
the Intestinal Canal and their Auto-infection." In revising these
contributions for book form I have given to each chapter a caption of
its leading thought; but I am convinced that repetition of some of
the matters treated, especially if the repetition be in a somewhat
different connection, is not such a very bad thing. I have used my blue
pencil sparingly, and as a consequence the consecutive reader will find
that constipation, diarrhea, biliousness, indigestion, auto-infection
and proctitis are treated in nearly all the chapters--but with varying
applications. Therefore anyone suffering from one of these complaints
would better read the whole book instead of only the chapter with the
corresponding title.

These pages were written for intelligent laymen by a specialist, during
a busy, assiduous practice. I take such radical ground, however, going
to the very root of the matter, that the general practitioner will do
well to give my thesis his careful consideration; he should at least
glance at the following Introduction for the gist of my claim.




CONTENTS.


CHAPTER I.                                                       PAGE

MAN, COMPOSED ALMOST WHOLLY OF WATER, IS CONSTIPATED. WHY?          1

CHAPTER II.

THE PHYSICS OF DIGESTION AND EGESTION                              12

CHAPTER III.

THE INTERDEPENDENCE OF ANUS, RECTUM, SIGMOID FLEXURE AND COLON     24

CHAPTER IV.

INDIGESTION, INTESTINAL GAS AND OTHER MATTERS                      29

CHAPTER V.

KEY TO AUTO-INFECTION                                              36

CHAPTER VI.

HOW AUTO-INFECTION AFFECTS THE GASTRIC DIGESTION, AND VICE VERSA   46

CHAPTER VII.

HOW AUTO-INFECTION AFFECTS INTESTINAL DIGESTION, AND VICE VERSA    56

CHAPTER VIII.

THE CAUSE OF CONSTIPATION AND HOW WE IGNORANTLY TREAT IT           64

CHAPTER IX.

CURES FOR CONSTIPATION: "FEARFULLY AND WONDERFULLY MADE"           71

CHAPTER X.

BILIOUSNESS AND BILIOUS ATTACKS                                    78

CHAPTER XI.

KING LIVER AND BILE-BOUNCERS                                       83

CHAPTER XII.

SEMI-CONSTIPATION AND ITS DANGERS                                  89

CHAPTER XIII.

THE ETIOLOGY OF THE MOST COMMON FORM OF DIARRHEA, i.e.,
EXCESSIVE INTESTINAL PERISTALSIS                                   98

CHAPTER XIV.

BALLOONING OF THE RECTUM                                          107

CHAPTER XV.

BALLOONING OF THE RECTUM--_continued_                             117

CHAPTER XVI.

THE USUAL DIAGNOSIS AND TREATMENT OF BOWEL TROUBLES WRONG         126

CHAPTER XVII.

COSTIVENESS                                                       132

CHAPTER XVIII.

INFLAMMATION                                                      137

CHAPTER XIX.

PROCTITIS AND PILES                                               148

CHAPTER XX.

PRURITUS OR ITCHING OF THE ANUS                                   156

CHAPTER XXI.

ABSCESS AND FISTULA                                               164

CHAPTER XXII.

THE ORIGIN AND USE OF THE ENEMA                                   173

CHAPTER XXIII.

HOW OFTEN SHOULD AN ENEMA BE TAKEN?                               180

CHAPTER XXIV.

MAN'S BEST FRIEND                                                 190

CHAPTER XXV.

PHYSIOLOGICAL IRRIGATION                                          191

CHAPTER XXVI.

PROPER TREATMENT FOR DISEASES OF ANUS AND RECTUM ESSENTIAL        202

CHAPTER XXVII.

THE BODY'S BOOK-KEEPING                                           215

CHAPTER XXVIII.

SELECTION AND PREPARATION OF FOOD                                 220

CHAPTER XXIX.

DIET FOR INDIGESTION                                              227

CHAPTER XXX.

DIET FOR CONSTIPATION AND OBSTIPATION                             231

CHAPTER XXXI.

COSTIVENESS, DIET, ETC.                                           235

CHAPTER XXXII.

DIET FOR DIARRHEA                                                 237

A FINAL WORD                                                      240

NO. 1.

CHRONIC CONSTIPATION AND THE USE OF THE ENEMA                     245

NO. 2.

OBJECTIONS TO THE USE OF ENEMA ANSWERED                           257




INTRODUCTION.


The keynote of this book is Proctitis, inflammation of the anal and
rectal canals. Hardly a civilized man escapes proctitis from the day of
the diaper to that of death. The diaper is in truth chiefly responsible
for proctitis, and proctitis is in turn chiefly responsible for chronic
constipation, chronic diarrhea, auto-infection; and hence for
mal-assimilation, mal-nutrition, anemia; and for a thousand and one
reflex functional derangements of the system as well. The inflamed
surface of the intestinal canal (proctitis) inhibits the passage of
feces. Absorbent glands begin to act on the retained sewage, and the
whole system becomes more or less infected with poisonous bacteria.
Various organs (especially the feeblest) endeavor to perform vicarious
defecation, and the patient, the friends, and even the physician are
deceived by such vicarious performance into thinking and treating it as
a local ailment. I cannot, accordingly, insist too emphatically that
proctitis, the exciting cause, must be treated primarily if we would
cure chronic constipation. Millions of human beings are sent to
untimely graves by these ailments. Indeed, the body of nearly every
human being is a pest-house of absorbed poison instead of being the
worthy temple of a wondrous soul. All due to Proctitis!




INTESTINAL ILLS




CHAPTER I.

MAN, COMPOSED ALMOST WHOLLY OF WATER, IS CONSTIPATED. WHY?


Naturally the mind of man was first educated to observe external
objects and forces in their effects upon himself, and the external
still continues to engross his attention as if he were a child in a
kindergarten. Fascinated by the Without, he ignores the Within. But,
marvel of marvels, Disease (which when looked at with discerning eyes
is seen to be an angel in disguise) comes to enlighten him concerning
the world within. Disease gradually acquaints him with the fact that
there are within him organs and functions corresponding to the objects
and forces in the world without,--servitors in fact which must not be
ignored under penalty of transforming them into foes to his well-being.
Disease makes him aware that by ignoring the claims of his inner
relations he has been converting his very food, juices and gases into
insidious and formidable poisons, which perforce he absorbs into his
blood and tissues and circulates throughout his entire system. Thus
does the disguised angel admonish the ignorant that the rights of the
inner world must not be ignored--that one's duties thereto cannot be
neglected without disastrous consequences.

Thus does Pathology, which is really Physiology reversed, become the
self-revealer _par excellence_. Through digestion and assimilation the
physiological process takes up the food, juices and gases, to support
and augment the life of man. The pathological process, on the contrary,
because the conditions for nutrition are ignored, reverses the
upbuilding processes; and the organs of life wither, waste and weaken,
until life goes out like fire unfed.

Man has been slowly learning to take sanitary measures in reference to
everything that contributes to comfort in his surroundings, and
hygienic measures in reference to everything conducive to stability in
his health.

Through ages he has learned, by experience and experiment, of the
changes that inevitably occur in such perishable nutritive substances
as water, milk, meats, vegetables, fruits, etc., if they be left
uncared for; and he has been led thus to the inference of the law of
decomposition--or putrefactive and fermentative changes. Idle
substances, like idle minds, have decomposition and the devil for
companions. Substances confined in containers open to the air--ponds,
cesspools, etc.--are every-day object lessons to man of the fact that
the chemical changes they undergo furnish the conditions for breeding
bacterial poisons, and that these poisons are a dread menace to animal
life.

If the reader will observe the analogy between the decomposition of
substances in vessels or pools, and the decomposition of food in the
reservoir called the stomach; and its further decomposition in a long
canal (the small intestine), connecting the stomach with other
receptacles called the colon and sigmoid flexure; and then the
decomposition of _their_ contents; he will readily comprehend the
chemical putrefactive or fermentative changes or bacterial action that
take place in the organism, if for any reason the contents be confined.

Of the four chief elements that enter into the composition of living
bodies three are gaseous, or convertible into gas. In the physical man
water constitutes three-fourths of the weight of the body. This being
so we realize why, notwithstanding our sense of solidity and weight,
chemical changes occur quite as readily in our organism as in the
substances we see about us. There are no waterproof walls in the body
of man to impede the percolation of liquids freighted with promiscuous
Passengers from the alimentary canal; Passengers designed to nourish
the organs for which they have an affinity. But there are those that
have no organic affinity, and these are tramps, vagabonds, and even
murderers, disturbing and destroying the normal functions of the
system. Through extravasation, that is, through fluid infiltration of
tissues, these Passengers come to be one with us, and we make them part
of our tissue; but some of the Passengers are the demolishers of the
living temple.

Water is universally present in all the tissues of the body, and it is
indispensable for introducing new substances into the system and for
eliminating the worn-out tissues and foreign substances. It is indeed
important to emphasize the fact that properly to eliminate the foreign
and waste products from the system requires, in a healthy person, at
least five pints of water during twenty-four hours.

The amount of gastric juice secreted in twenty-four hours is from six
to fourteen pints; of pancreatic juice, one pint; of bile there are two
to three pints, and of saliva one to three pints. It is estimated that
the juices secreted during digestion in a man weighing 140 pounds
amount to twenty-three pounds in twenty-four hours. These fluids are
poured back and forth in the process of transforming food into flesh
and eliminating waste material.

In the alimentary canal there are vessels for holding fluid, semi-fluid
and moist masses of substance, in all of which decomposition occurs if
the substances be retained beyond the normal length of time. These
vessels or reservoirs are the stomach, duodenum, small intestines,
colon, sigmoid flexure, and too often the rectum. Through the
harmonious action of this intestinal retinue of servitors man is well
equipped and qualified for health, and he in whom this harmonious
subservience prevails is among the blessed and elect of mankind. But
alas! the great majority of human beings are sufferers from the
inharmonious and insubordinate action of these servitors. How many a
human being suffers from _chronic constipation and indigestion_, the
exciting causes of which are insidious, and the consequences a protean
enemy to his happiness! Medical writers on the subject of chronic
constipation have assigned numerous causes, and likewise prescribed
multitudinous remedies to the patient; but as a general rule this
patient, after suffering various woes, if still surviving the many
years of medication, rebels against taking further remedies and resigns
himself to the chronic enemy on the best terms he can make with diet.

For this large class of chronic sufferers we have good news; and for
the class that have suffered five or ten years we have better news; and
for the class of infants and children that have started on the road of
ill-health we have real glad tidings. To know that there is only one
chief cause for chronic constipation and its train of disorders, and
that that cause overshadows all other causes combined, and is easily
diagnosed and treated, is news long hoped and prayed for by a multitude
of sufferers the world over.

Twenty years as a specialist in diseases of the lower bowels have
demonstrated to the writer that chronic inflammation, and often
ulceration, of the rectum and sigmoid flexure, in ninety-nine cases out
of a hundred, is the cause of chronic constipation and the long army of
ills resulting from it. And yet, as the reader is well aware,
constipation has had many "causes," since the days of Hippocrates,
especially the abnormal condition of the liver.

The etiology, that is, the exciting cause, of the inflammation of the
anus, rectum, colon, etc., may date from the time a diaper was placed
on the new-born infant. Excoriations of the integument about the anus
by the excretions of bowels and bladder indicate that the mucous
membrane of anus and rectum demands local remedies, as well as the
integument of the buttocks, and that it is not the liver which is at
fault. The many applications of the diaper during the period of its
use, and the frequently delayed removal at night or during long rides
in baby wagons, railway trains or carriages, and during long social
visits of the nurse; constipating foods, lack of drinking water,
constipating medicines, followed by all sorts of purgatives, etc., are
among a few of the direct causes of diseases of the rectum. A child at
the age of eighteen months with a healthy rectum is most rare.

The ten thousand and one chances for contracting disease of the anus
and rectum do not cease with the period of infancy. The child is left
pretty much to shift for itself as to regularity of eating and the
evacuation of the contents of its bowels, wherein disease has already
obtained a foothold. All kinds of foodstuffs, at all hours, with seeds,
stones, etc., are poked into its stomach, followed by constipating
remedies to quiet inevitable troubles, or brisk purgatives given with
the hope of expelling the arrested contents of the bowels. Is it any
wonder that ninety-eight persons of adult age out of every hundred
suffer more or less from chronic inflammation and ulceration of anus,
rectum, sigmoid flexure, colon, or appendix?

Traumatic (externally produced) injuries to the mucous membrane of the
rectum frequently cause inflammation, and hard pieces of bone, wood,
seeds, imbedded in the feces, scratch, cut and bruise the tissues
before and during the act of defecation. Cold boards, stones, earth and
other substances used as seats may produce inflammation of the rectum.
There are many and various causes which may be the means of exciting
inflammation of the anus and rectum later in life; but it is the
writer's opinion that the cause can be traced back to infancy or early
childhood, and that accidents or imprudence in after years merely
excite an already-existing chronic inflammation. Piles, fissure,
itching pockets, tabs, prolapse, abscesses, fistulæ, etc., are only the
outcome and symptoms of a chronic disease which has incubated for
fifteen, twenty or more years. None of this list of troubles produces
constipation. It is the inflammation located at the middle portion of
the rectum and extending into the sigmoid flexure that causes
constipation; that protean monster which deranges more lives with
nervousness than any other pathological condition to which the flesh of
man is heir!




CHAPTER II.

THE PHYSICS OF DIGESTION AND EGESTION.


A tree is simply an extension from its roots; and, in an analogous
manner, man's body may be said to be an extension from the alimentary
canal. Does it not follow, consequently, that the digestive apparatus,
from a physiological point of view, is the most important organ of the
human body? It must be prime and paramount because all other organs
depend upon it: it provides them with nourishment for preservation and
improvement, and it punishes them--if they do not mind the laws of
normality--by withholding its gifts, or by presenting these gifts in
the form of poisons that impoverish, hinder and degenerate the system
of organs. Uncleanliness is surely one of the chief ways in which
physiological thoughtlessness is exhibited, and due punishment will
inevitably follow disobedience.

Foodstuffs are prepared for assimilation in the alimentary laboratory
through the process of normal fermentation. Is it not essential,
therefore, that the connecting canals and receptacles be cleansed of
the fermented debris that may remain unused and unexpelled, before more
food be taken by the digestive apparatus? The all-important question
is:--How soon and how well have the residuary part of the food (for
some part will always be undigested or unassimilated), and the waste
resulting from worn-out tissues of the various organs, been eliminated
from the system? Wisdom declares that it is not so much what we eat,
but what and how well we eliminate, that decides the issues of health
and disease. Do the egesta pass out in the form of normal feces? Three
times in twenty-four hours foodstuffs are taken, and as many times the
bowels should be freed of accumulated excrement and gases. Does Nature
have her way, or do neglect and bad habits rule the assimilative and
eliminative functions of the bowels?

The habit of storing feces for twenty-four hours ought to concur and
keep pace with a habit of eating one meal in the same period. Household
and laboratory receptacles in which fermentation has occurred are
emptied and cleaned before fresh material is put into them. Is not the
same precaution more essential with the receptacles for digestion and
egestion? They constitute our chief physiological economy; they are
precious household and laboratory utensils; exceedingly precious, as we
can purchase no other set when these are worn and wasted beyond repair.
What marvelous possessions, and how reckless most of us are with them!
Neither love nor money will bring another "body"-house to us when this
decays; when poisons or parasites infest it as the result of a
pernicious diathesis, of debasing, destructive tendencies; in short, of
unmindfulness!

Too often criminal negligence or the lack of proper convenience has
brought on the habit of using the intestinal canal as a storehouse for
dried feces, and the glands and blood-vessels as reservoirs for the
absorbed fluid poisons from the feces that have been stored and thus
dried. This baneful habit is general throughout civilized communities.
It is this habit that has made the words "constipation," "indigestion,"
"diarrhea," etc., familiar and household subjects of complaint. Medical
writers agree that "constipation" is the most common malady that
afflicts mankind; but they are also unanimous in preposterously
attributing the cause to the abnormal action of the liver and the
secondary symptoms of constipation.

Chronic constipation is the result of proctitis and colitis. Proctitis,
the inflammation of the rectal and anal canals, is the most common
disease that afflicts the human creature from infancy to old age; and
colitis is only the extension of proctitis to the colon.

The scientific diagnosis of constipation predicates proctitis and
sometimes colitis. It is declared that constipation is its primary
symptom; and that diarrhea is one of its secondary symptoms, resulting
from constipation. There is a legion of secondary symptoms of
proctitis, all of which medical empiricism considers and denominates
causes. As constipation is such an every-day complaint of almost
everybody one meets, it will not tax our imagination unduly to conceive
how it may be a frequent cause of diarrhea, which is only Nature's
effort to get rid of its useless and excessive burden of retained feces
and gases. Constipation, semi-constipation, and irregular action of the
bowels, excessive fermentation, putrefaction, self-generated or
auto-infection, are the factors to be considered. It is to be noted
that in many cases diarrhea is simply an increased peristalsis of the
bowels, often due to local and diffused irritation and often to
inflammation of the mucous membrane (not infrequently with ulceration);
all of these may be the outcome of fecal impaction.

To make intelligible the physics of the digestive and egestive
processes, we must understand the apparatus. One would naturally think
that were the bends or curves of the large intestine undone, it would
be found to be a long, straight, smooth canal or bore like a rubber
tube. But such is not the case. The outer muscular longitudinal bands
are much shorter than the musculo-areolo-mucous tube, an arrangement
which brings about a transverse puckering of the gut and mucous
membrane, thus forming valves, folds, sacs or pouches at short
intervals along the canal. These transverse folds or valves inhibit the
too hasty passage of the feces along the bowels by checking and
retaining the egested product in the large recesses or pools between
the folds; they thus serve as so many dams in the passage of feces
toward elimination. This wise provision of Nature to moderate the
steady motion of the feces as they proceed toward the sigmoid flexure
or receptacle, to wait there till there is a proper stimulus for
expulsion, is wofully abused by man. He is quite willing to take
foodstuffs three or four times a day, to fill the long row of
intestinal pools between the dams with feces and gases in all stages of
decomposition, not dreaming of the danger from developing bacteria and
their absorption into the system.

Really he is inclined to eat at all times, yet begrudges a few minutes
spent in a hurried effort to perform the act of defecation once in
twenty-four hours. Some of us even have our minds absorbed in reading
while awaiting an "automatic action" of the bowels. What a contrast
between the gusto and time spent in taking foodstuffs and the
indifference and indolence regarding the action of the bowels, unless
indeed severe biliousness or diarrhea reminds us strongly of our sewer
of waste products.

An attack of acute or chronic diarrhea is the penalty some pay for long
inattention to the demands nature makes for intestinal cleanliness
three times in twenty-four hours. Constipated people, semi-constipated
people, irregular people and twenty-four-hour people, are not healthy.
They are constantly being poisoned by the abnormal products of
indigestion and putrefaction resulting from fecal stagnation, which
products enter the blood and circulate through every tissue of the
body.

All cases of proctitis are more or less accompanied by constipation and
diarrhea. In all cases of chronic constipation I have found proctitis,
and often colitis, and am forced to believe it is the most common and
proximate cause of chronic constipation of the bowels. Constipation
being a primary symptom, there must of necessity follow numerous
secondary symptoms, of which diarrhea well marks the progress of septic
infection. Some of the symptoms of infection are headache, megrim,
vertigo, dyspepsia, foul tongue and mouth, back-aches, stiff neck,
gnawing pain or numb feeling at the lower end of the spine,
biliousness, bad odor from breath and skin, muddy complexion, cold
hands and feet, jaundice, neurasthenia, loss of memory, drowsy feeling,
pernicious anemia, emaciation, flabby obesity with pallor, capricious
appetite, fits of great mental depression, palpitation of the heart,
bloating of the stomach and bowels, disturbance of the kidneys, liver,
lungs and mucous membrane in general, and especially chronic rhinitis
and pharyngitis, which latter are among the first symptoms of imperfect
alimentary excretion.

As auto-intoxication (that condition of the system when it is
continually poisoned, usually by one's own excretions) gains the
mastery of the vital forces at any period of life, the mucous membranes
are likely to be first affected by inflammation of catarrhal character;
then the serous membranes of the body. Mal-assimilation, mal-nutrition,
cell-atrophy, are symptoms of the giving way of the vital energies to
the invasion of the filth and bacterial poisons absorbed from the
intestinal canal.

On the inner surface of the alimentary canal, from the stomach to the
colon, there are, it is estimated, over 20,000,000 rootlets (called
glands, lacteals, follicles, villi), which take up intestinal juices as
roots of a plant take sap from the soil. These millions of rootlets
give a velvety appearance to the alimentary canal, like a nap or downy
surface. Intestinal rootlets of the small intestines, like vegetal
rootlets, demand a certain amount of normal fluid and solid substance,
free from noxious gas. It is the down or nap of fabrics, and not their
body, that shows damage first. So it is with the frail structure of
vegetal and animal life if not properly supplied with nourishment from
day to day. There is probably in the vegetal bodies a continuous
circulation of sap corresponding to the digestive circulating fluids of
the alimentary canal. This circulation from the alimentary canal to the
blood-vessels, and from the blood-vessels to the alimentary canal,
involves a wonderful mechanism, facilitating the flow of several
gallons daily from each to the other during the process of
metamorphosis of food into flesh. You can thus see how inevitable it is
that the functions of these millions of secreting and excreting
rootlets will be disturbed by the clogging of the system with filth and
bacterial poisons as a consequence of chronic constipation, biliousness
and general foulness of the alimentary canal. Through such disturbance
nutrition is diminished, cell-atrophy progresses, and emaciation
becomes more marked. The progressive destruction of these rootlets,
involving the pathological change indicated, will be manifest in one of
its results, either costiveness or diarrhea.

Often the power of properly digesting and absorbing the foodstuffs is
so greatly diminished that the alimentary canal is about as useless as
a soft rubber tube. Millions on millions of these glands, lacteals and
follicles in the stomach and small intestines, are destroyed like the
rootlets of a plant or tree in unwholesome soil. The active circulation
of the digestive fluids ceases, and the sufferer is said to be costive
or to have chronic diarrhea. Both symptoms are the outgrowth of many
years of intestinal foulness, and indicate the degree and character of
intestinal irritability and semi-starvation of the body, as a
consequence of either the absorption of poisons or the excessive
elimination of the vital substance of the body through diarrhea.




CHAPTER III.

THE INTER-DEPENDENCE OF ANUS, RECTUM, SIGMOID FLEXURE, AND COLON.


Physiologically, or in a normal state, the rectum is not a receptacle
for liquids and feces but a conduit during the act of defecation.
Should, therefore, the feces have passed into the rectum and the desire
to stool be not responded to--though the desire continue urgent--the
feces will be returned to the sigmoid cavity by physiological action.
When, however, the functions of the anus and rectum are disturbed by
chronic inflammation, etc., the lower portion of the rectum becomes a
more or less roomy pouch, a receptacle for feces and liquids; and
instead of being physiologically empty it becomes pathologically
distended, the result of spasmodic action or of more or less permanent
stricture of the sphincter ani. See illustration in my book entitled
_How to Become Strong_ (page 14).

The putrid fecal mass of solid and liquid contents accumulated in the
artificial reservoir at the end of the intestinal sewer, is one of the
most common and serious pathogenic (disease-producing) and pyogenic
(pus-producing) sources, which, by auto-infection, afflict man from
infancy to old age. Here--in the dilated and obstructed sewer--the
ptomain and leucomain class of poisons, and many of the poisonous
germs, led by the king of morbid disturbers, the bacillus coli
communis, find another and last chance to be taken up by the absorbing
cells of the mucous membrane and returned to the blood; with which they
are carried to all parts of the body, clogging the glands, choking up
the pores and obstructing the circulation, thereby causing congestion
and inflammation of the various organs. The action of cathartics,
laxatives, etc., fills the ano-rectal cavity with a watery solution of
foul substances; this solution is readily absorbed into the
circulation, aggravating the auto-intoxication (the established
self-poisoned condition) already existing. Danger does not end with the
absorption of bacterial poisons, as we have to reckon with the
deleterious effects of the various intestinal gases, resulting, with
rapid augmentation of volume, from the putrefactive changes in the
imprisoned feculent matter.

A sphincter ani permanently constricted or irritable owing to disease
results in an _abnormal_ receptacle just above the anal orifice (as
shown in the illustration referred to); and a constricted and irritable
rectum results in the impaction and dilatation of the sigmoid cavity,
which is normally a receptacle, closed at its lower end by circular
fibres separating it (the cavity) from the rectum and performing the
function of a sphincter muscle. The rectal muscular fibres perform the
office of a sphincter for the sigmoid cavity. The pathological changes
that result in rectal impaction of feces usually extend to the sigmoid
cavity. This cavity is 17-1/2 inches in length, shaped in a double
curve like an italic _S_. Civilized man should consider the disturbance
to the functional action of body and brain, and the danger to health
and longevity involved in the storage of effete and fetid matter. The
disturbance and danger are enhanced when the tissues of the sigmoid
flexure and the rectum are invaded by inflammation. A healthy action of
the sigmoid receptacle depends on the rectum (a conduit six to eight
inches in length); and as it is the universal verdict that disease of
the rectum is one of the most common maladies that afflict the human
race, it must inevitably follow that the feces will be abnormally
stored in the sigmoid cavity, occasioning thereby habitual constipation
which in turn brings on a host of functional disturbances throughout
the system.

The colon is a receptacle and a conduit some three feet in length (see
ib. p. 13) and its action depends upon the ability of the sigmoid
flexure to perform its function as a final normal receptacle; and this
in turn upon the rectum, which depends on the sphincter ani. The colon
does not appear to possess any digestive powers, though it is capable
of absorbing substances. Its function is not only to receive and
forward the trifling residue of food which escapes digestion and
absorption, but chiefly to excrete, through its own minute glands, the
waste of the system coming from the blood.

The excretion from these glands of the colon into the colon, plus the
effete portion of the food received by the colon from the small
intestine, approximate in weight from four to six ounces in an adult
person in twenty-four hours; and of this amount passed 75 per cent is
water; so that were the excreta dried the solid matter thus evacuated
would not be found to weigh more than one ounce, or one and a half
ounces.




CHAPTER IV.

INDIGESTION, INTESTINAL GAS, AND OTHER MATTERS.


We noted the fact that the "digestive secretions" in a man weighing 140
pounds amount to twenty-three pounds in twenty-four hours; now add to
these the food and liquids taken in that period, and you will form some
estimate of the work done in the human chemical laboratory in its
normal and abnormal states.

We noted further that substances confined too long in receptacles
decompose and generate pathogenic poisons, that is, poisons productive
of disease; and that the intestinal reservoirs are no exception to this
law of putrefactive changes. How could we avoid drawing the inference,
therefore, that disease-breeding germs, (generated in the organism and
hence called "autogenetic"), and their auto-infection, _i.e._,
absorption by the system, are an inevitable consequence of the undue
retention and fermentation of the contents of these reservoirs: a
consequence, in other words, of that intestinal uncleanliness commonly
called biliousness, constipation, indigestion.

By far the most common and immediate source of autogenetic
(self-produced) poisons and their auto-infection, is some degree of
chronic constipation and the deadening, smothering effects of
constipation on digestion; an effect analogous to what takes place when
we allow waste material or ashes to bank up against a fire, shutting
off its draft. Does the fire then continue to digest the coal? Clog up
the receptacle for ashes and the coal grows cold. Dam up the colon or
sigmoid and digestion is disturbed, diminished and debased, as
evidenced by the local and general discomfort, and later by the train
of inevitable disorders.

Indigestion is a household word. It has the widest range of all the
diseases, because it forms a part of almost every other; and some
diseases, such as chronic catarrh and pulmonary consumption, are in
many cases produced by indigestion; which in turn had its source in
chronic constipation caused by injury or inflammation of the lower
bowel, as explained in our first chapter.

Diminished nutrition, impoverished blood, and loss of weight of from
ten to twenty-five pounds, are the signs that indicate the coming
disaster to the sufferer from auto-intoxication: the thoroughly
poisoned state of the system resulting from auto-infection.

Vessels used by the dairyman and by those who furnish us with food
products and liquids are kept scrupulously clean. Why? Because it is a
question of loss of trade--of money. Should these vessels be used when
foul from fermentation or putrefaction of their contents, Wealth would
flee from the coffers of our purveyors, and the Boards of Health would,
or rather should, take a hand in the matter. And these same purveyors,
by the way, why do they care more for Wealth than for Health, their own
and ours? But why are we all of us so neglectful of Inner cleanliness
and so careful of Outer? The receptacles of the inner man reek with
augean filth, and we cleanse them not. The immortal fountains of Health
and Happiness are dammed, blasted and degraded by just this neglect of
our imperative duty; the duty of furnishing full opportunity for the
functions of replenishment and life, _by keeping the sewer passages
clear_.

Are a sour stomach and foul intestinal canal fit receptacles for food
and liquids? When our receptacles are in this condition, why do we add
more material for the generation of poisons of the ptomain and
leucomain classes, and morbid gaseous elements? It has been
demonstrated that during fermentation an apple will evolve a volume of
gas six hundred times its own size. What folly then to add to the
fermenting mass! Food taken under such conditions will produce results
not hard to imagine.

The gases that are commonly found in the stomach and small intestines
are carbonic acid, nitrogen, oxygen and hydrogen; while, besides all
these, sulphureted and carbureted hydrogen are found in the large
intestine, causing in a normal state the necessary and useful
distention of the alimentary canal. The writer has long regarded the
abnormal production of gaseous substances in the intestinal canal from
putrefactive changes as of itself not only a grave menace to health,
but as a condition productive of morbific results of which we have
still much to learn. The more or less constant and excessive distention
of the whole or even of a part of the intestinal canal by gases is a
serious condition, affecting as it does the various organs of the body,
not only through the absorption of these gases into the general
circulation but also through the reflex nervous reaction of these
organs. It is astonishing what amount of mechanical force is exerted by
the gases in the intestinal canal. They distend not only the muscular
walls of the intestines and stomach but the strong abdominal walls as
well, until the clothing worn has to be loosened for ease and comfort.
This more or less extreme mechanical pressure may account for many
cases of hernia, prolapse of the uterus, dislocation of various organs,
disturbance of the circulation of the blood, and interference with the
function of the nervous system, as indicated by its many protests in
the way of aches and pains. Naval-constructor Hobson has lately
demonstrated the dynamic power of gas confined in bags or receptacles
in raising battleships; and it still remains for some physiologist or
pathologist to demonstrate the morbid dynamic results of gases confined
in the alimentary apparatus. The deleterious effect of the abnormal
quantity of gases on all the organs of the body is imperfectly
understood at present, but will be better apprehended when we are able
to study more minutely the pathogenic poisons of the human system. It
is known, however, that a stream of carbonic acid gas, or even of
hydrogen, will paralyze a muscle against which it is directed.




CHAPTER V.

KEY TO AUTO-INFECTION.


In a previous chapter we stated that the average quantity of fecal
discharge daily, by an adult, is from four to six ounces, and that of
this weight 75 per cent is water. We referred of course to the daily
passage from the bowels alone, not including that from the bladder.

Our studies have thus furnished us with the key wherewith to unlock the
secret chambers of auto-infection. What is that key? It is the
discovery that the system may possibly absorb as high as three-fourths
of this feculent substance in the colon; that this absorption is made
possible by an obstructed or sluggish intestinal canal where disease
germs are propagated and lodged; that these germs, along with a certain
amount of excrement, invade the tissues by absorption; and that we thus
have the system constantly saturated with poisonous germs and filth,
re-excreted, re-absorbed and re-secreted--no one knows how many
times--by the various organs of the body.

That the importance of intestinal cleanliness may be better
appreciated, I will quote from the following authors on the subjects of
excretion, absorption and circulation of the intestinal fluids.

Dr. Murchison states that:

"From what is now known of the diffusibility of fluids through animal
membranes, it is impossible to conceive bile long in contact with the
lining membrane of the gall-bladder, bile-ducts, and intestine, without
a portion of it (including the dissolved pigment) passing into the
blood. A circulation is constantly taking place between the fluid
contents of the bowel and the blood, the existence of which, till
within the last few years, was quite unknown, and which even now is too
little heeded. It is now known, says Dr. Parker, that in varying
degrees there is a constant transit of fluid from the blood into the
alimentary canal, and as rapid absorption. The amount thus poured out
and absorbed in twenty-four hours is almost incredible, and of itself
constitutes a secondary or intermediate circulation never dreamt of by
Harvey. The amount of gastric juice alone passing into the stomach in a
day, and then re-absorbed, amounted in the case lately examined by
Grunewald to nearly 23 imperial pints. If we put it at 12 pints we
shall certainly be within the mark. The pancreas, according to Kröger,
furnishes 12-1/2 pints in twenty-four hours, while the salivary glands
pour out at least 3 pints in the same time. The amount of the bile is
probably over 2 pints. The amount given out by the intestinal mucous
membrane cannot be guessed at, but must be enormous. Altogether the
amount of fluid effused into the alimentary canal in twenty-four hours
amounts to much more than the whole amount of blood in the body (which
is 18 pounds in a man weighing 143 pounds); in other words, _every
portion of the blood may, and possibly does, pass several times into
the alimentary canal in twenty-four hours_. The effect of this
continual out-pouring is supposed to be to aid metamorphosis; the same
substance more or less changed seems to be thrown out and re-absorbed
until it be adapted for the repair of tissues, or become effete."

The reader will readily perceive how the system may become so charged
that other organs of the body will vicariously attempt to play the part
of a receptacle and conduit for the bowel, in order to excrete and
eliminate ancient and offensive filth and bacterial poisons. The
phenomenon of vicarious excretion may occur through the kidneys, lungs,
skin, throat, nose, vagina, or uterus, thus keeping up chronic diseases
and discharges that would not exist but for the chronic constipation or
even for _incomplete action of the bowels each day_. Over-distention
of the rectum, sigmoid and colon, due to the pressure of gases and the
impaction of feces, results in inflammation, ulceration, stricture,
appendicitis, abscess, strangulation, intussusception, and abnormal
ballooning or roominess in certain portions of these intestines or
conduits. This roominess, though it becomes filled with feces, and
often with liquids, permits of sufficient space for even the daily
passage of feces without dislodging the stored contents. The fact that
there is a passage daily deceives both sufferer and medical adviser as
to the source of the poisonous condition of the system, and masks the
origin of such disorders as chronic inflammation and ulceration of the
nose, throat, lungs, stomach, duodenum, colon, appendix vermiformis,
uterus, bladder, kidneys and edema of the legs. But these evidences of
auto-infection are generally preceded and accompanied by a general loss
of vitality and weight, by anemia, by a lowering of the resisting power
of the organism--all of which produce a fit soil for the various
diseases to which flesh is heir. As soon as the system becomes
saturated with bacteria and effete matter, auto-intoxication results,
in which condition there is but little or no store of vitality for
resistance, reaction and recuperation.

Dr. Bright has recorded several instances of fecal accumulation in the
colon mistaken for enlargement of the liver and for malignant tumors.
In one of the cases there was jaundice which disappeared after free
evacuation of the bowels. Frerichs also relates a case where
enlargement from fecal accumulation was at first ascribed to a pregnant
uterus, and subsequently, on the supervention of deep jaundice, to an
enlarged liver, but in which purgatives dispelled the patient's anxiety
about a diseased liver and at the same time her hopes for a child.

Dr. N. Chapman, in his _Clinical Lectures_ (p. 304), says:

    "The feces sometimes accumulate in distinct indurated scybala or in
    enormous masses, solid and compact. Taunton, a surgeon of London,
    has a preparation of the colon and rectum of more than twenty
    inches in circumference containing three gallons of feces, taken
    from a woman, whose abdomen was as much distended as in the
    maturity of pregnancy. By Lemazurier, another case is reported of a
    pregnant woman, who was constipated for two months, from whom,
    after death, thirteen and one-half pounds of solid feces were taken
    away, though a short time before between two and three pounds had
    been scraped out of the rectum. Cases are reported by Dr. Graves of
    Dublin, which he saw in women, where from the great distentions in
    certain directions of the abdomen, the one was considered to be
    owing to a prodigious hypertrophy of the liver, and the other of
    the ovary; in the latter of which he removed a bucket-full of feces
    in two days. Mr. Wilmot of London has recently given a case where a
    gallon of matter was lodged in the cæcum, and the intestines
    perforated by ulceration."

Dr. Pavy, in his treatise on _The Functions of Digestion_ (p. 232),
writes:

    "The morbid conditions that constipation may occasion are of
    various kinds. Under an undue retention of fecal matters within the
    colon noxious products may be formed there, and act as irritants
    upon the mucous coat, setting up inflammation, followed by
    ulceration. It is to be here remarked that fecal matters are
    sometimes retained in the sacculi or pouches of the colon, and may
    give rise to the circumstances referred to, whilst a passage exists
    along the centre of the canal that shall permit a daily evacuation
    to occur. The dejections, even, may be loose in character, and
    still the same sequence of events ensue. From the irritating
    influence of preternaturally retained feces, colicky pains are, as
    a rule, induced, and the ultimate effects may be such as to lead to
    the production of fatal inflammation.

    "The effect of constipation upon the muscular coat of the bowel is,
    through distention to which it is subjected, to weaken or
    deteriorate its evacuating power. As the result of a great amount
    of distention, like as happens in the case of the urinary bladder,
    more or less complete paralysis is induced. From the prolonged
    retention of fecal matter accompanying constipation,
    excrementitious products that ought to be eliminated become
    absorbed and thereby contaminate the contents of the circulatory
    system. As the result of this contamination, the secretions become
    vitiated, and a general disturbance of the conditions of life is
    produced. The action of the liver becoming deranged, its
    eliminative office is imperfectly discharged, and thus sallowness
    of the face and a bilious-tinged conjunctiva are produced. A coated
    tongue, foul mouth, loss of appetite, and other dyspeptic
    manifestations, accompany the general disorder of the digestive
    organs that prevails. The accumulation existing in the colon leads
    to a sense of distention and uneasiness in the abdomen. The kidneys
    vicariously discharge products that ought to have been eliminated
    by the alimentary canal. In this manner the urine becomes
    preternaturally loaded. From the contaminated state of the blood
    the functions of animal life also become disturbed; and hence the
    lassitude, debility, headache, giddiness and dejected spirits, that
    form such frequent accompaniments of constipation.... A distended
    cæcum, colon, and rectum may also, by the pressure exerted upon the
    nerves and vessels of the lower extremities, be the cause of
    numbness, cramps, pains and edema of the legs. The edema occasioned
    by constipation, if not exclusively confined to one side, will in
    all probability be decidedly greater in one leg than in the other."

Case (from _Gaz. Méd. de Paris_, July 20, 1839): A woman of fifty was
troubled with habitual diarrhea and frequent calls to urinate, in which
urine could be discharged only by drops. After six years of suffering
and unsuccessful use of remedies, she was examined for the first time
per anum, and an accumulation of fecal matter discovered, forming a
mass the size of an infant's head. This was removed and found to weigh
four pounds. She then got well.




CHAPTER VI.

HOW AUTO-INFECTION AFFECTS THE GASTRIC DIGESTION, AND VICE VERSA.


Frederick the Great said that all culture comes through the stomach.
This saying emphasizes pithily the dependence of psychology upon
physiology. The stomach with the intestines is certainly the source
from which every portion of the body receives its nourishment and most
of its diseases. The physiological _plus_ and _minus_ processes leave
their reflex on the mind.

Prof. Ch. Bouchard, in his lectures on Auto-Intoxication (Oliver's
trans., p. 14), says: "The organism in its normal, as in its
pathological state, is a receptacle and a laboratory of poisons.
Amongst these some are formed by the organism itself, others by
microbes, which either are the guests, the normal inhabitants of the
intestinal tube, or are parasites at second-hand, and disease
producing."

In the preceding chapters we have mentioned some of the most common
cases of retention of excreta in the rectum, sigmoid cavity, colon,
cecum, duodenum and stomach, and how the consequent foul conditions
often resulted in diarrhea. Auto-infection impairs the functions of
every organ in the body, by clogging the pores with poisons and filth.
By the transfer of disease germs from one infected, that is, tainted,
contaminated part of the body to parts that were free from infection,
the kidneys, mucous membrane and skin receive these unnatural products,
and their functions are disturbed thereby. The disturbance of the
various organs throughout the system sets up such a multiplicity of
symptoms that one gets the impression of a pandemonium--a veritable
council-hall of evil spirits. The visitation is omnipresent.
Infliction, misery, are everywhere. The taint of auto-generated
intestinal morbific products, carried and communicated to the remotest
parts, manifests itself now here now there as if it were a local
trouble, and it is difficult therefore, nay, impossible, to classify
scientifically the symptoms of auto-infection. A classification, though
necessarily imperfect, will aid in the diagnosis and treatment of the
various abnormal conditions of the stomach and intestines, that is, of
mal-digestion. The sympathy, good understanding and responsiveness
between the brain and the digestive apparatus are so close and intimate
that the physician must take into consideration the inter-relationship
of these organs before deciding which one is reporting reflex nervous
symptoms, and which direct symptoms. Plutarch says in one of his
essays: "Should the body sue the mind before a court judicature for
damages, it would be found that the mind had been a ruinous tenant to
its landlord." The digestive apparatus is, or should be, a farm for the
mind, but unfortunately it usually has to wait twenty or more years
before the tenant understands how to cultivate it for the uses of his
intellectual and esthetical life.

I have referred to the fact that the most common causes of
constipation, indigestion and other foul conditions of the alimentary
canal favorable to the production of autogenetic poisons and their
auto-infection, are such common and every-day matters, so familiar to
almost every one that the victim, the parents and the physician feel no
alarm of the coming danger for years. During these ignorant and
innocent years the poison and filth were being absorbed, infecting the
system with their morbific taint and lowering the quality of the blood
and lessening its quantity, producing the state known as anemia.
Associated with progressive anemia is mal-assimilation, improper
nutrition, ebbing of the nervous and vital forces and the lessening of
the secretory, excretory and digestive powers. By the time the poor
victim is weighing fifteen to twenty-five pounds less than he ought to
the symptoms of ill-health are sufficiently alarming to compel the
sufferer to seek medical aid for disease of the stomach, bowels, liver,
kidneys, lungs, etc.

_Slow digestion_ is perhaps the most common form of functional
disturbance of the stomach, due to an insidious auto-infection for
years. The eyes and the skin begin to show the effect of the poisonous
infection. The skin becomes dry, pale and muddy in color; has more or
less annoying eruptions, and exhibits a jaundiced appearance. The body
is ill nourished, the nervous system depressed, the blood impoverished,
the memory failing, the general appearance languid, irritable, anxious.
What a household picture this is to every one of the human family! But
let us fill it out somewhat more fully. Note how the undue delay of
food in the stomach occasions a sense of weight and oppression, the
feeling beginning about an hour after a meal and continuing for hours,
sometimes attended with fermentation and sometimes without it. At times
there is a feeling of drowsiness due to the absorption of an excessive
amount of the gases which distend the stomach and bowels, and this
absorption is accompanied by pains in the stomach, head, between the
shoulders and in the region of the heart. Sleep is disturbed by dreams,
or one is awakened with a feeling of numbness and palpitation of the
heart. At times the urine is scanty, strongly acid or high-colored. The
tongue is more or less foul, with white or creamy coating. Now and then
tasteless or saltish eructations occur. The appetite may be too good,
or there is no appetite at all. Note the careworn expression, the
wondering what to eat, what to drink or what remedy to take. So between
much worse and some better, the trouble continues--both of body and
mind.

_Indigestion_, however, with undue formation of acids proper, or acids
unnatural, to the stomach, is a much more annoying affliction than slow
digestion. The sufferer from indigestion may be debilitated, anemic,
may have a general want of tone; or he may be a more or less vigorous
and plethoric person. In some cases flatulence is very troublesome. But
the most usual symptoms are heartburn, acid eructations that produce
burning sensations, sour taste at intervals or constantly in the mouth,
setting the teeth on edge. In the more vigorous or plethoric sufferers
a gouty diathesis may exist, which may result in a tendency to
inflammation, bringing on neuralgia, rheumatism, gout, etc. Tongue more
or less foul; uric acid in the system; confusion in the mind;
headaches; pains in the loins, legs and feet; in fact, more or less
shifting pains everywhere: these are the common exhibits of
indigestion. On the whole, the sufferer is a victim to an irritable
body and a fretful mind, necessitating the cultivation by him of
patience and the effort to be agreeable.

Besides the symptoms mentioned, indigestion may also be accompanied by
gastric pain or by uneasiness at the pit of the stomach. It may be a
sense of fulness or tightness, or a feeling of distention or weight, or
again, a feeling of emptiness, goneness or sinking. Now and then there
are burning, tearing, gnawing, dragging sensations under the
breast-bone; and there is a general complaint of a capricious appetite,
heartburn, vomiting, nervous headache, neuralgia and cold extremities.
Other symptoms are pain from lack of food at the proper hour, or from
food taken at the improper time; both of which practices may be
followed by flatulency, occasioning a swollen, drum-like condition of
the stomach and abdomen; the body of the tongue will be coated white,
while the edges will present a redder appearance than in health.

_Impaired digestion_ with nervous symptoms--in which the morbid
sensibility of the mind is apparently the greatest--is called
_hypochondria_. This class of sufferers, whose bodily and mental ills
and morbid fears are so chaotically interwoven, are deserving of much
consideration. So numerous are their fears and so fertile are their
reasons for the many changes they arbitrarily make in their efforts to
get well or keep from getting worse, so obstinately sure are they of
being always right--that we can but give them our sincerest pity.

In some cases the functional troubles of the stomach and mind are
aggravated by disease of the pelvic organs, which adds to the
depression of the mind through nervous sympathy with the abdominal
organs.

Dr. Cullen says on this point:--

    "In certain persons there is a state of mind distinguished by a
    concurrence of the following circumstances: a languor, a
    listlessness, or want of resolution and activity with respect to
    all undertakings; a disposition to seriousness, sadness and
    timidity as to all future events; an apprehension of the worst or
    most unhappy state of them; and therefore, often upon slight
    grounds, an apprehension of great evil. Such persons are
    particularly attentive to the state of their own health, to every
    smallest change of feeling in their bodies; and from any unusual
    feeling, perhaps of the slightest kind, they apprehend great danger
    and even death itself. In respect to all these feelings and
    apprehensions, there is commonly the most obstinate belief and
    persuasion." (Quoted in Leared, _On Imperfect Digestion_, p. 106.)




CHAPTER VII.

HOW AUTO-INFECTION AFFECTS INTESTINAL DIGESTION, AND VICE VERSA.


Intestinal indigestion is a more common form of functional disturbance
than is gastric indigestion. It is a well established fact that the
greater portion of the digestive work is done beyond the stomach, in
the duodenum, by the hepatic and pancreatic fluids. The duodenum--very
properly called the _second stomach_--has none of the peculiar
characteristics of a receptacle that receives crude substances--the
office of the stomach. Much greater sensitiveness characterizes the
digestive canal than the stomach; which is accounted for by the fact
that a network of nerves, forming the sympathetic system, surrounds the
bowels. The symptoms of intestinal indigestion are not always clearly
defined and distinguishable from gastric indigestion, especially as the
two are frequently associated.

The cecum, more than any other portion of the digestive canal,
resembles the stomach, and it secretes an acid, albuminous fluid having
considerable solvent properties. It is to be observed that as the cecum
is only three inches in length and two and a half in diameter, and as
its contents are necessarily propelled in opposition to gravity, a
slight casualty will hinder or obstruct the upward movement of the
pultaceous mass of the effete ingesta. The turning point in the
ascending colon affords another ready hindrance to the upward and
onward movement of this mass; and the gases and ancient feces beyond
the turn conduce to further sluggish peristalsis, bringing about more
or less obstruction and reflex irritation of the remaining length of
intestinal canal. Undue retention of the contents of the cecum, and the
disturbance and obstruction of the duodenum by the pressure incident to
the distention of the colon with feces and gases, lead to congestion,
inflammation and occasionally to ulceration of the mucous membrane in
various parts of the intestinal tube.

This condition of affairs increases the occlusion (closing) of the
bowels, but makes very easy indeed the entrance and propagation of
micro-organisms in the sub-mucous coat of the intestine. The conditions
are now ripe and rife for auto-infection. Which of the following
microbes are the most active agents of progressive auto-infection: the
streptococcus lanceolatus, the bacterium pyogenes, the bacillus
subtilis, the staphylococci, the bacterium coli commune? They all play
a part in the game, reducing the body in time to a charnel-house. Or
are such substances as putrescein, cadaverin, skatol or indol--which
are derived through chemical change in the putrescent mass--contributors
to the spread of the poisonous taint throughout the system? Any single
one or a group of the fifty or more bacterial poisons may be the
responsible agents in the ensuing auto-infection. Chemical analysis of
the gases resulting from decomposition reveals oxygen, nitrogen,
hydrogen, carbonic acid, protocarbonated hydrogen and sulphureted
hydrogen, ammonia, and sulphate of ammonia. Leucin, tyrosin, lithic
acid, lithates, xanthin, cystin, keratin, sulphureted hydrogen, etc.,
are deposits in the urine and are signs of the derangement of the
intestinal canal and liver. The external symptoms observed are the
following: the tongue is large, pale, flabby and indented by the teeth
at the edge of the anterior third, while its surface is white and the
papillæ often enlarged; the appetite may be excellent, though there is
great functional derangement of the liver with lithemia, so that the
sufferer is tempted to eat what he knows from experience will disagree
with him; a bitter coppery taste in the mouth, due to taurocholic
acid--a common symptom of lithemia or of imperfect oxidation of
albumen; emaciation, fatigue, depression, headache, buzzing in the ears
and deafness, disturbance of sight, loss of memory, faintness and
vertigo, very marked in some cases; sometimes tenderness and pain under
the cartilages of the right ribs; the fretting of the sensitive surface
of the bowels by imperfectly digested, semi-putrescent food, resulting
sometimes in convulsions, coma, paralysis, or in fetid diarrhea of an
acid character producing a burning sensation or pain of the anus when
the discharges are being passed; rumbling and twisting sensations in
the region of the navel occurring with flatulency, and occasionally
colicky pains which at times are so severe as to simulate poisoning.

In some people certain articles of food, without being either toxic or
putrid, induce indigestion and the production of microbes in quantity
amounting to one third of fecal dejections. Prof. Ch. Bouchard says:

    "The consequence of this development of acid in the whole length of
    the digestive tube is an inflammatory condition. We notice catarrh
    of the stomach, ulcerative gastritis, to which patients often
    succumb after twenty-five years of _bad stomach_; these are the
    _false cancers_, as they are called, or malignant gastritis
    without tumor. The large intestine is inflamed; around the fecal
    matter are seen glairy secretions and sometimes blood (membranous
    enteritis)." (Op. cit., p. 159.)

In chronic inflammation of the rectum and colon there is more or less
discharge of mucous, and in some cases of membranous, desquamation,
with yellow or bloody mucus. The shreds, cords or complete tubular
casts are discharged constantly or at varying intervals. The quantity
and character often alarm the sufferer. The discharge is nothing less
than a thick, tenacious mucus that had formed a thin coating on the
inflamed mucous membrane, and become exfoliated in casts or thin
shreds--the result of many years of morbid intestinal exaggerated
action.

Microscopical examination of the desquamated intestinal membrane and
mucus from a man forty years of age, revealed the following products:
crystals, mostly complete; incomplete phosphates, very numerous; mucous
shreds in abundance; fat globules and granules, numerous; anal
epithelia; red blood globules, few; connective tissue, scanty; pus
corpuscles, very few; margaric acid and detritus (substances resulting
from the destruction or wearing away of the part); undigested material,
mostly cellulose; leptothrix threads, micrococci; and the bacillus coli
communis. Diagnosis: foul, undigested material, due to a chronic
inflammation of the lower intestinal tract. The microscopical
examination of mucus and desquamated membrane from a woman sixty-five
years of age, disclosed that she was suffering from proctitis and
colitis. She wrote: "Please tell me how long this mucous discharge must
continue. I am alarmed at the quantity of membrane, cords, casts, etc.,
in my excreta, and I think that if this process goes on much longer
there will soon be no bowels left to purify." This letter was written
some weeks after contracting a severe cold, which accounts for the
unusual amount of exfoliation and mucus. The sample she sent contained
a large quantity of mucus, both threads and corpuscles; with a moderate
number of epithelial scales, partly anal and partly intestinal. Pus
corpuscles were present in small numbers; also vegetable fibres, fat,
starch, muscle fibres and cellulose--the remains of undigested
material. In the membranes themselves no micro-organisms were found; in
the pieces containing undigested material the bacillus coli communis
was found as well as micrococci, and the bacilli of putrefaction
(secondary formation) were seen.




CHAPTER VIII.

THE CAUSE OF CONSTIPATION AND HOW WE IGNORANTLY TREAT IT.


One of the best preparations for active life is a first-class
intestinal canal.

"An old Scotch physician," says Sir Astley Cooper, "for whom I had a
great respect and whom I frequently met in consultation, used to say to
me as we were about to enter our patient's room together, 'Weel,
Misther Cooper, we ha' only twa things to keep in meend, and they'll
serve us for here and herea'ter; one is au'ways to hae the fear o' the
Laird before our e'es, that'll do for herea'ter; and th' t'other is to
keep our boo'els au'ways open, and that'll do for here.'"

A person whose mind is devoted to the realization of ideals, and whose
body has a set of bowels that perform the act of defecation twice every
twenty-four hours is doubly prepared for a useful life.

    "If thou well observe
    In what thou eat'st and drink'st, seek from thence
    Due nourishment, not gluttonous delight,
    Till many years over thy head return:
    So may'st thou live, till like ripe fruit thou drop
    Into thy mother's lap, or be with ease
    Gathered, not harshly plucked, for death mature."

Milton's advice in poetic lines is all very well for those who have
escaped chronic inflammation of the lower bowels, an ailment common and
troublesome even under the very best dietetic regulations.

Inflammation having once penetrated the circular and longitudinal
muscular fibres or bands of a section of the intestine, all hope of a
comfortable existence is at an end, for such inflammation will bring on
constipation and constipation nervous misery. It is inevitable that
inflammation should determine this outcome since it induces spasmodic
contraction of the muscular walls of the tube, lessening the bore or
closing the portion of the canal invaded. Plastic infiltration takes
place in the walls of the gut, thickening and binding them together;
or, if the inflammation be of a simple catarrhal or atrophic nature,
the plastic infiltration will more or less bind the circular muscular
bands of the gut together in their abnormally contracted state! The
presence of feces and gases above the zone of the disease will increase
the irritation and contraction of the affected portion of the
intestine. Consequent upon these changes wrought by inflammation, gases
and excrementitious material are perforce imprisoned in the intestine,
inducing constipation, foul fermentation, flatulency, diarrhea,
indigestion, nausea, loss of appetite, sick headache and, in fine,
autogenetic poisons, the source of auto-infection, ending in
auto-intoxication, the chronic poisoned condition of the system.

Since the most common cause of chronic constipation, internal
sluggishness and uncleanliness, is known, too much cannot be said in
condemnation of the wide-spread abuse of "liver and atony persuaders"
and the use of irritating suppositories and dilating bougies, candles,
etc. The numerous and various drastic purgative nostrums--which
literally fill our medical literature--and the universal demand for
them, are evidence of this very common disease, which disease is
rendered worse by the drugs taken for the relief of a foul intestinal
alveus. An abnormal amount of watery secretion is forced by the drug
into the foul canal, to mix there with its contents, of which the major
portion is retained and re-absorbed into the system. And to make the
bad condition and treatment worse, all such sufferers, as a rule, drink
very little water, some scarcely any.

The demand for an irritating stimulus to "open the bowels" (the
exciters contribute to close them) is largely due to the popular error
in thinking, "I can treat my own bowels quite as well as the doctor, if
not better." No intelligent person would think of stimulating and
irritating daily an inflamed region of tissue on the outer portion of
the body; yet this is precisely what intelligent persons do when they
habitually use liver and peristaltic persuaders. The primary disease in
the lower bowels and the consequent symptoms are gradually aggravated
as the "physic" habit is formed.

As in the case of opium fiends and drunkards, so with habitual
cathartic drug-users, should they be suddenly deprived of the
accustomed artificial stimulus and irritant they become absolutely
miserable, mentally and physically. It is a well-known physiological
fact that every artificial stimulation of the intestines is followed by
a corresponding loss of vitality and reaction. Now that the almost
universal cause of undue retention of foul, effete matter has been
ascertained, it is important to communicate to the world at large the
best means of cleansing the bowels without increasing the local primary
disease and its annoying symptoms.

That external physical cleanliness is next to godliness is an apt
proverb. That internal physical cleanliness is nearer to godliness no
one will deny.

Water is a universal solvent and therapeutic agent and is therefore
indispensable in the cleansing and purifying of the integument and
mucous membrane of the body. A large quantity of water is necessary to
carry on the functions of the animal economy. Water enters every cell
and fibre of the living organism, aiding in nutrition and in the
elimination of worn-out tissues which if retained turn into poisons.

It is really not an intelligent but rather a barbarous practice to
prescribe liver and intestinal exciters for the purpose of throwing
into the alimentary tract a sufficient quantity of watery excretions to
"cleanse itself"; to succeed they must first soften and liquefy the
dry, hardened feces and scybalous masses (little ancient, bullet-like
formations) imprisoned above an inflamed and fevered lower bowel, even
colon.

Normal feces consist of 75 per cent water; and when unduly retained in
the colon much of this fetid percentage is absorbed into the system.
Then drugs are prescribed to liquefy the hardened putrid remnant and
absorption begins again: a fact very shocking to a sensitive, even
sensible, person.




CHAPTER IX.

CURES FOR CONSTIPATION: "FEARFULLY AND WONDERFULLY MADE."


Diseases of the anus and rectum are very common, very numerous and of
very critical consequences. This is especially true of the disease of
chronic inflammation, one of whose symptoms is piles or hemorrhoids. In
the writings of the early Greek and Roman physicians will be found
minute descriptions of the latter disorder. But on the whole, the most
important symptom of chronic inflammation of the lower bowel, and the
most far-reaching in its morbific results, is that protean monster,
chronic constipation. It deranges more lives, from infancy to old age,
than any other pathological condition that can be named.

For the cause and cure of that mere symptom of a disease, constipation,
the so-called scientific physicians, from the early history of
medication to the present time, have had one immutable theory as to the
leading cause, and one grand motto as to the "safe and sure" cure. They
have always prescribed remedies for this malady on the theory of portal
congestion and hepatic derangement, and hence their supreme motto:
"_Physic! Physic!! Physic!!!_"

The layman naturally adopted the theory and the motto of his medical
advisers; hence in his self-medication and also under advice he
consumes such vast quantities of purgative nostrums.

I have just received some medical literature beginning with the usual
salutation--"Dear Doctor"--setting forth a new and remarkable theory of
the cause, and an original motto for the cure, of constipation. Its
authors have discovered that the "rectal nerve-tissues" are hungry,
torpid, anemic, and to overcome the "atony" they must be "_Fed! Fed!!
Fed!!!_"

"The greatest of physical ills in America," we are informed, "is
digestive torpor or semi-paralysis, originally induced by a kind of
starvation of the intestinal nerve-tissues. One of its most prevalent
forms is constipation," caused by "local torpor or semi-paralysis,
dependent upon an anemic condition of the nerve-tissues of the rectal
region." By "feeding directly" the limpid, bedraggled rectum and colon,
they receive their "appropriate nutriment, by which comes added
vigor,"--the nutriment the stomach and the rest of the system had
failed to furnish on account of constipation, excessive fermentation,
indigestion and auto-infection.

To overcome this "atony" of two or more feet of the lower bowel, a
little "nutritious" suppository, weighing twenty grains, is a
"specific." It is claimed to cure chronic auto-infection and the
spasmodic occlusion of the lower bowel! The excessive activity of all
the region invaded by the chronic inflammation and the local irritation
are perpetuated by such "feeding" instead of allayed! Does it not stand
to reason that there is already too much activity, and that when the
irritability reaches a certain stage diarrhea or looseness of the
bowels must result? Twenty grains prescribed once a day to nourish an
organ (the rectum) six to eight inches in length, and from one and a
half to two and a half inches in diameter! When for two to three feet
the lower bowel requires nourishment, a suppository night and morning
is prescribed! However, the new treatment has the merit of some
consistency between the diagnosis and the treatment, notwithstanding
both are wrong.

Chronic inflammation of the lower bowel causes, as I have pointed out,
excessive activity and thereby excessive nutrition of the tissues
involved in the morbid process. But sphincter ani gymnastics have been
suggested by some one who thinks chronic constipation is owing to a
lack of muscular activity of the lower bowels; and the following reason
is given:

"Physiological experiments have shown that rapid voluntary movements of
the external sphincter ani and the levator ani produce very active
peristaltic movements of the large intestine. This effect is produced
by the mechanical excitement of the plexus myentericus of Auerbach.
This curious automatic center lies between the two muscular coats of
the intestine and controls the peristaltic movements. A person
suffering from constipation should make powerful movements of the
sphincter ani, and of the levator ani, in as rapid succession as
possible, continuing the exercise for three or four minutes or until
the muscles are fatigued. The time chosen for this exercise should be
either before breakfast or an hour after breakfast, according to the
natural habit of the individual in respect to the evacuation of the
large intestines."

There are surgeons who recommend stretching and paralyzing the external
sphincter muscle; and if they are correct in their diagnosis and
treatment, those who prescribe _bile-bouncers_, and those who prescribe
"_nutrient suppositories_," and those who prescribe the use of _rubber
bougies_ and _candles_, should call a convention (to meet in, say, New
York City) to discuss the subject and see if they cannot agree to
inform the people that constipation is a sign of, or a factor in, the
evolution of the human race. Those who believe in the gymnastics of
man's ears and of his sphincter ani and the therapeutic merits of this
and of that could readily assent to the same glorious conclusion.

Strange to say, there are in New York physicians who are in the habit
of inserting a rubber bougie up their patients' rectums two or three
times a week for the cure of constipation. Some, more bold, intrust the
bougie performance to the patient in order that a daily dilatation and
stimulation may be kept up until "recovery from the disease is
effected." Others, more original, order the patient to insert a candle
some six inches in length up the rectum and allow it to remain ten
minutes, with the hope of a "rapid cure."

A Mrs. P----, who had used the candle treatment for a great length of
time by order of her distinguished physician, once consulted me. On
examination, I found her afflicted with atrophic catarrh, chronic
constipation and anal ulceration, from which she had suffered for seven
years, with but little intermission from pain during each day of that
entire period.




CHAPTER X.

BILIOUSNESS AND BILIOUS ATTACKS.


Commonly the source of chronic gastro-intestinal uncleanliness, of
dyspepsia, of autogenetic poisons and auto-infection is inflammatory
occlusion--more or less permanent or spasmodic--of some part of the
lower bowel. Many years of auto-infection will exhibit such diseased
symptoms as poor appetite, bad digestion, impoverished blood,
emaciation, etc., accompanied by increased virulence of the catarrhal
discharge of mucus, shreds, etc., and a mind and body sinking down to
the morbid plane of hysteria, hypochondriasis (fear of illness) and
neurasthenia (debility of the nervous system).

Biliousness and bilious attacks are evidence that there is a more or
less constipated condition, that there has been an occasional
imprudence in diet, and that the dreadful sense of fulness up to the
end of the tongue is a faithful report of the state of affairs. What is
it but a full foul condition of the digestive canal, a complete
blockade of the canal from the rectum or colon to the stomach, making
the victim feel that there must be something done in the way of
cleaning out? He fears that the condition will be followed by
fever--not infrequently this is the case. Biliousness is usually
supposed to be occasioned by hindrance to the flow of bile, and the
conclusion is drawn that the liver requires stimulating. This
supposition is erroneous and very far from pathological veritude, as
the liver, like the other organs, is merely _a secondary sufferer from
the over-eating and the closed sewer_.

    "The _bowels_ with sullen vapours cloud the brain,
    And bind the spirits in _their_ heavy chain;
    Howe'er the cause fantastick may appear,
    The effect is real, and the pain severe."

The bilious attack is usually noticed in the morning before food has
been taken. The tongue is heavily coated and often so foul that it is
necessary to scrape it and cleanse the mouth of disagreeable taste.
Eructations, nausea followed by vomiting of undigested foul-smelling
food, and if the vomiting be long-continued, mucus from the stomach and
bile that had accumulated in the duodenum, are sufficient evidence that
there was no torpidity of the liver. There is likewise more or less
headache, neuralgia, giddiness, hebetude (state of mild stupidity),
dejection, confusion of the senses, skin disease, acne rosacea (scarlet
redness of the nose and cheeks), eczema, etc. The headache may be
seated in the centre of the brain and extend to one or both eyeballs
and be increased by stooping. Should diarrhea occur many of the
annoying symptoms are likely not to be present.

In this form of indigestion the bowels are often much constipated,
which is usually only a more marked symptom of chronic constipation.
The system now and then vigorously rebels against this chronic
condition and an acute bilious attack is the evidence of such
rebellion. The whole digestive canal is involved in the rebellion,
resulting in the symptoms described and also in a morose, petulant
and querulous temper, accompanied by a peculiar, despairing
expression,--partly due, perhaps, to regrets of having only _one_
digestive apparatus,--or in some cases, perhaps, of having _any_.

That the character and disposition may be materially influenced by such
a state of the bowels is well established. Plato believed that "an
infirm constitution is an obstacle to virtue, because such persons
think of nothing but their own wretched carcasses"; for which reason he
contended that Æsculapius should not undertake to patch up persons
habitually complaining, lest they beget children as useless as
themselves, being persuaded that it was an injury both to the community
and to the infirm person himself that he continue in the world, even
though he were richer than Midas.

Acting on this well-known fact, the celebrated Voltaire, in one of the
articles in his _Philosophical Dictionary_, has very humorously
ascribed half the evils of Europe to the intestinal irritations of the
public men of the age.

"Let the person," he adds, "who may wish to ask a favor of a minister,
or a minister's secretary, or kept mistress, endeavor previously, by
all means, to ascertain whether they go to stool regularly; and, if
possible, to approach them after a comfortable evacuation, that being a
most propitious moment, one of the _mollia tempora fandi_, when the
individual is good-humored and pleased with all around him."




CHAPTER XI.

KING LIVER AND BILE-BOUNCERS.


The "house not made with hands"--the human body--has, like the house
made with hands, _its_ sewer system, which is over twenty-five feet in
length. To cleanse (?) this wonderfully delicate, tortuous and extended
passage-way of waste material, civilized man knows no better than to
put in at the top of the house, purgatives, cathartics, bile-bouncers,
etc., with one hope and purpose in view, namely, that these policemen
go searching, scouring and hustling the intestines in the greatest
possible haste, in order to remove an obstruction about three hundred
inches distant from where these "forcers" had entered the intestinal
sewer. With mercury as a scavenger the work is pretty thoroughly done,
though extra care has to be taken that some of the teeth may remain
after the victim survives the additional intestinal inflammation
occasioned by its drastic measures.

Traits acquired by the father are inherited by the children;
present-day doctors follow early practitioners; they still pour in many
and various decoctions at the top of the obstructed sewer of the human
house to dislodge accumulated gases and feces at the bottom. The
plumber treats the sewer of the house of brick and stone more wisely.

Our fathers partook of laxatives, cathartics, purgatives, and in
consequence we start in life with teeth, intestines, appendices, out of
gear and nervous systems on edge. With unconscious stupidity we
continue the fatuous practice. The monarch selected to preside over the
functions of human life was the Liver; and it is only with bated breath
that any doctor dares question the legitimacy of that monarch's claim.
The loyal subjects of King Liver are ever ready to call out "quack,"
"charlatan," etc., to those who dare repudiate the sovereignty of the
Liver.

So much attention and flirtation does the liver receive from the
_liver-persuaders_ that the pancreas ought to be very jealous. The
pancreas excretes quite as much fluid into the duodenum as its larger
neighbor, and is, therefore, no mean organ. And we need not wonder
should we find the intestinal glands piqued at our over-attention to
the liver, as they, in their work at the metamorphosis of digested food
into blood, excrete two or three gallons of fluid in a day to the
liver's two or three pints; yet witness our medieval solicitude for the
liver, for one among many organs. The liver is located near the upper
portion of the intestinal canal and connected by a tube (the bile duct)
to the rest of the excursion route. The following liver-persuading
knights-errant are prescribed and ordered by disciples of Hippocrates,
Galen, Herodicus, and Iccus, to treat with that digestive and
eliminative monarch, the Liver--usually at night-time, that the family
may not be disturbed. After making as good terms as possible they
journey on, riotously churning and swashing the long, tortuous canal
and its contents in search of ancient toxic gases and feces lodged in
the lower bowel. It is believed by the prescribers that the length of
the journey adds dignity to the drastic, dredging knights-errant. The
reader needs no introduction to the podophyllins, the aloes, the
jalaps, the rhubarbs, the mercurys, the croton oils, the sennas, the
salines, the seltzers, the Carters, the Beechams, the Websters, the
Pierces, the Ayers, the Ripans, the Warners, and others belonging to
"The Four Hundred" fashionable grenadiers, with their credentials and
stamp!

After these knights-errant have paid their respects to King Liver, and
ended their long, tortuous and eventful journey, they depart and leave
behind them burning and painful abdominal and anal regrets, and then
some soothing, stimulating and tonic remedies are in order, so that the
dredged though chronically constipated sufferer and his friends may
still hope that life will be spared to repeat the same nauseating and
often painful process in a few days or weeks, taking, in the meanwhile,
milder bile-bouncers daily as a reminder to King Liver that the time
for the knights-errant is coming again.

Sufferers from chronic constipation receive assurances that by the use
of these "remedies" the anemia will be corrected, nutrition and
digestion restored, atony of the liver and intestines overcome, yellow
complexion and morbid feeling disappear. In short, remove the numerous
symptoms and "causes" of toxicity of the body and of chronic
constipation, and proclaim the victory of Powder and Pill!

All of us would believe Medicus, the son who so abjectly follows in the
footsteps of his father, if we could really feel the possibility of
such a victory; but the protests of our bowels are living witnesses
against the validity of the medieval practice as here described; and we
ask for a modern scientific solution of the fulness and foulness within
and the fatuity without.

I must now apologize to the large class of sufferers from chronic
constipation for hurting their feelings. I know very well how seriously
they have been compelled to regard their trouble, and out of respect
for their protracted suffering and efforts to get relief I should
instead have sympathized and condoled with them in their dire
misfortune. But we all know and realize that there are occasions when
we get into awful and painful predicaments, and, when the whole
situation is taken in, it becomes comical and ridiculous, so that for a
time we cannot treat it seriously, even when old Chronic Biliousness
and the mighty knights-errant are having a deadly combat at our
internal and external (and possibly infernal) expense.




CHAPTER XII.

SEMI-CONSTIPATION AND ITS DANGERS.

    "At least six times in every fleeting day
    Some tribute to the renal functions pay,
    And twice or thrice all alvine calls obey."


What has been said thus far has been based on chronic constipation
mainly, and the accompanying intestinal foulness, which condition was
shown to be so annoying that it compelled the sufferer to resort
frequently to some more or less direct and artificial means for the
relief of the bowels and the incidental indigestion. It has been
further shown that many of the chronic cases fail to take on the normal
amount of flesh or lose what flesh they have because of self-poisoning
(auto-infection), which in turn is the outcome of mal-assimilation and
mal-nutrition, and that this consequence must occur wherever there is
an absorption of waste through a checking or disturbance of systemic
functions. Emaciation and anemia are inevitable in such cases. On the
other hand, there are cases that have such great powers of assimilation
and elimination that they are able to stand the invasion of destructive
material, may maintain the normal amount of flesh, or even take on an
abnormal amount, but with the invariable accompaniment of more or less
impoverishment of blood, disturbed circulation, indigestion, and the
usual nervous derangements. The harmful practice of the lean and the
fleshy sufferers of resorting to daily medicines--cathartics,
digestives and tonics--has been commented upon. Willingly do they
squander their money to get relief from an ever-present ailment. Cases
are these of hope deferred that maketh the heart sick.

The primary cause of chronic constipation, namely, proctitis, has been
explained, and its many symptoms, as indicated by the functional
disturbances of many or all of the organs of the body, enumerated.

But beside the cases of chronic constipation--both lean and fat--there
are many sufferers from auto-infection who have only semi-constipation,
or partial evacuation of the feces daily. Though they suffer from the
effects of self-poisoning, yet they have no such well-defined symptoms
of local disease and functional disturbance as are always found in
those who have chronic constipation. Nevertheless, they have
disturbances of practically all the functions of the system. Believing
as they do that the evacuation of their bowels is complete, they are at
a loss to find a cause for the toxemia (blood-poisoning),
mal-nutrition, debility and general atony. The symptoms of
auto-infection with the semi-constipated are as complex as with the
severer cases, but not so well defined. The most prominent symptoms are
those connected with the process of katabolism, that is, of
degeneration of the tissues, as indicated by their color and texture.
The liver, however, is usually held responsible for the bad complexion,
impaired nutrition, constipation and diminished vitality, when really
the liver is only indirectly concerned, as made manifest in the
previous articles. The seat and source are found to be the diseased
colon and rectum.

    Dr. Treves says: "The colon being the part of the bowel involved in
    obstruction due to fecal accumulation, it may be further assumed
    that the blocking of the gut will most usually concern its lower or
    terminal parts. Accumulation of feces is most common in the rectum
    and sigmoid flexure, and then in the cecum. Masses of feces may
    block the colon at any point, and more particularly at the flexures
    of the bowel. Still, the three common sites of the accumulation are
    those just named. The accumulation in the colon may assume the form
    of a more or less isolated nodule or mass. Thus a considerable lump
    may be found in the cecum or sigmoid flexure and the rest of the
    colon be comparatively clear of any gross accumulation. An isolated
    lump may even persist after free purgation. On the other hand, the
    accumulation may assume the form of several isolated fecal masses.
    One of them may occupy the cecum, another the transverse colon, and
    possibly a third the sigmoid flexure. The bowel between these
    masses may appear to be fairly clear."

A number of the exciting causes of inflammation of the lower or
terminal portion of the large intestine have been mentioned. It cannot,
however, be too strongly emphasized that chronic inflammation of the
colon and rectum results in hyperkinesis (excessive muscular
irritability) and contraction of the diseased portion invaded, thereby
retarding or preventing the passage of feces and gases. A portion of
the daily accumulation of feces in the sigmoid may pass through the
diseased rectum every day, but not without increasing the inflammation
and the spasmodic contraction; this in time inhibits the elimination of
the accumulating feces, which by undue retention become condensed and
hardened. Each day will then be a repetition of the abnormal and
partial effort of the organ to accomplish the act of defecation, and
there will be no thought of the cumulative and chronic intoxication
(poisoning) of the system from the imprisoned feces and gases.

It may be stated without reservation that the rectal canal cannot be
involved in chronic inflammation without involving the anal canal, and
_vice versa_. One half of civilized people are suffering from chronic
constipation, and very nearly the remainder from semi-constipation. The
semi-constipated are now under consideration. The chronic cases are
those that have a _complete_ impaction of feces in the terminal portion
of the sigmoid and rectum; the semi-constipated have the usual daily
_partial_ impaction, that is, an incomplete or partially successful
evacuation of the contents of the bowels: the incompleteness is due to
disease of the anal and rectal canals.

The anal and rectal canals are made up of circular and longitudinal
muscular bands, which, when invaded by disease, lose their proper or
normal sensibility and coöperative voluntary action. The excessive
contraction of the circular muscles closes the calibre or bore of the
gut, and the excessive contraction of the longitudinal muscles shortens
the length of the gut, thus throwing the mucous membrane into abnormal
folds which increase the depth of the sacculi, or cavities, between the
fibrous folds. In the normal gut the sacculi and bands act as valves to
control the descent of the feces. This valvular arrangement and the
curvatures of the lower bowels conserve the energy of the involuntary
and voluntary nerve force until there is a sufficient accumulation of
feces to excite a normal desire for stool; otherwise the feces would
rush upon the anus at once and occasion much inconvenience.

Catarrhal inflammation of the mucous membrane of the anal canal will
sooner or later penetrate the muscular structure of that canal, causing
an abnormal irritability and contraction of the sphincter ani and the
other tissues composing its structure. The contraction of the anal
tissues becomes more permanent as the muscular tissues of the structure
become cohered or bound together by the process of inflammation.

The normal stimulus and sensation that should precede the act of
defecation are perverted or destroyed by the excessively irritable
contraction of the sphincter ani, which contraction is occasioned by
the presence of feces and gases just above the seat of inflammation,
that is, above the anal canal or at the lower end of the rectum. As the
bulk of feces and gases lodged at this point increases, the anal
contraction becomes firmer in grip, and as a consequence permits no
hint of the imprisoned contents until the accumulating bulk is beyond
the power of toleration by the organ. Daily a portion of the lodged
feces, or some new addition to the mass, passes the anal canal, but the
attending irritation or contraction of the muscles prevents any further
exit of the imprisoned rectal contents.




CHAPTER XIII.

THE ETIOLOGY OF THE MOST COMMON FORM OF DIARRHEA, i.e., EXCESSIVE
INTESTINAL PERISTALSIS.


If you are interested to know why a certain plant does not flourish in
the temperature and light to which it has been accustomed, you
investigate the soil--the source of nourishment--and thus determine why
the downy or velvety appearance has left the flower; why the leaves are
yellow, dry or falling; why the stems are withering. Even the most
ignorant person knows that the symptoms the plant presents did not
bring about the unsuitableness of the soil; that, on the contrary, the
condition of the soil is responsible for the plant's present state.
Would it not be unwisdom, therefore, to treat directly the symptoms of
decay, instead of treating the soil, or changing it? Just so misguided
is the judgment of the physician who prescribes physic or tonics in the
case of a person having a foul intestinal canal, a condition
destructive of the absorbent and the excretory glands. But members of
county medical societies do just such foolish things. Notwithstanding
their prescriptions, a point will be reached by the patient where the
restoration of his millions of small rootlets, or organic feeders, will
be impossible, and like a decaying plant in unfavorable soil he
gradually decays or withers, here and there, until finally he topples
over before he knows it, probably long before maturity has been
reached.

It is not generally known among laymen, nor sufficiently appreciated
among physicians, that the mass of fecal matter normally evacuated from
the bowels comes mainly from the blood; and that this mass is not, as
it is usually supposed to be, the residue of the food that has been
left unassimilated. Embedded in the mucous membrane of the colon are
tubular glands under the control of the nervous system. When these
glands become unduly excited through local inflammation and irritation,
the normal flow from them is increased to such an extent that a rapid
waste of precious tissue occurs throughout the system, and the vital
force--which had taken perhaps years to store--is depleted to the point
of exhaustion, sometimes even in a few hours. Almost every one has had
some experience of exhaustion following diarrhea.

The increased flow of blood to the mucous membrane of the colon
furthers this extraordinary secretion by the glands. As has been
pointed out, inflammation, septic poisoning, intestinal foulness, or
retained feces, act as irritants on the mucous membranes, thereby
drawing the blood to the colon where it is excreted and exhaustion
follows. The great danger in diarrhea, therefore, is the rapid
depletion of the vital force. But when the small intestines are
affected the consequences may be still more deplorable. Then the
unassimilated food is hurried along too quickly for absorption and the
body receives but little nourishment to restore its powers. Thus
another draught is made upon the sufferer's reservoir of vitality, and
hence additional exhaustion. But this waste of tissue, loss of vital
force, non-assimilation and non-supply, are not so grave as the
positive danger of the permanent destruction of the millions of small
absorbing vessels (villi) of the small intestine by a continuance of
this abnormal irritation. Of course the secretory and excretory glands
of the colon also suffer, and we then have costiveness resulting from
lack of absorption and excretion.

Abnormal irritability of the bowels is necessarily involved in the
inflammatory process known as proctitis and colitis. Increase this
irritability to a certain point and diarrhea takes the place of
constipation--a much more alarming symptom. Diarrhea is more alarming
because the intensified local activity of the excretory glands of the
bowels brings on, as has been said, a general exhaustion of the vital
powers.

The severity of diarrheal symptoms is much increased by the character
and abundance of bacterial poisons. Bacteria find a ready medium in
fetid feces, and are absorbed by the excited glands to the degree in
which these glands have time and power for absorption. Of course the
extent and character of the intestinal irritation have a good deal to
do with the severity of the diarrheal symptoms. This irritation is not
infrequently intensified by a catarrhal process, or by a lesion of an
ulcerative nature. All these forms of irritation bring on "excessive
intestinal peristalsis"--which, accordingly, is our definition of
diarrhea. The normal peristaltic action of the intestines propels the
nutritive as well as the effete material through the canal at a rate
that allows of both proper absorption and timely elimination. But when
excessive peristalsis occurs, neither absorption nor elimination will
be normal or suited to the requirements of the system.

Undigested foodstuffs may become an irritant, or increase, as is
usually the case, the established irritation, and thus bring on an
acute attack of diarrhea. The immediate consequence of the acute attack
may indeed be, and often is, comparatively beneficial, inasmuch as the
diarrhea removes the undigested material that occasioned the
irritation. When this removal is accomplished, the diarrhea usually
subsides without treatment. This is the case, however, only when the
patient has committed an infrequent error in diet. When such errors are
habitual the burden on the glands of the intestinal mucous membrane
becomes intolerable, and the chronic inflammation once established has
a tendency to proceed from bad to worse. It will then be observed that
digestion becomes more and more impaired. In such a case diarrhea will
no longer serve a good end, but will on the contrary debilitate the
system. A change to better dietetic habits will then aid, but will not
suffice for cure. Only treatment and time will restore the inflamed
parts to a healthy tone. When, however, the digestive tract is invaded
by any of the many forms of bacteria, treatment will avail little and
serious consequences follow rapidly.

Too much cannot be said or done to secure intestinal cleanliness in
infancy, childhood and maturity. Mothers and nurses cannot give this
subject too much thought and care, since the welfare of future
generations depends largely upon intestinal cleanliness, in view of the
rich and racy life of our hothouse civilization. We are a people
poisoned through constipation and diarrhea: two affections that derange
more lives than all other pathological conditions together. Banish
alimentary uncleanliness and you take most of the poisons from the
human race--poisons that stunt the body and blunt the mind.

The soul of man should dwell in a palace, not in a pest-house; in a
human temple, velvety, lined with down, inside and out; in which there
are hundreds of millions of lilliputian trappings, fittings and
articles of furniture, to carry on the minute and finer functions and
chemistry of the soul. The very multitude of the fine equipments that
decorate the temple give it that beautiful blending of color and form
which its coating has when in normal condition. They adorn this
body-house with health, and supply it with the rich red wine of joy.

The blood is dependent for its richness not only on the digestive
fluids, but also on the proper eliminating powers of the system. If you
would avoid premature decay you must not neglect the reservoir of
vitality, the alimentary canal, but see to it that it be kept clean and
pure. Then will the elixir of life spring from an almost inexhaustible
fountain. To recur to our plant analogy. Keep the soil in your own
vegetable garden sweet, for intestinal cleanliness corresponds to soil
fitness. Purity of the stomach and bowels is more important than
quantity or quality of food. That defecation should occur normally two
or three times in twenty-four hours is more important than that three
meals should be eaten within that time. The conveniences for eating and
drinking are on every hand, but oh, how few, inaccessible, miserably
constructed, and poorly cared for, are the toilet cabinets for the
accommodation of the gourmand! Suspenders and silk hats mark the
progress of our outer refinement; toilet cabinets and flushing
appliances, of our inner. When the _inner_ refinement comes we shall
live longer and be healthier.




CHAPTER XIV.

BALLOONING OF THE RECTUM.


To make plainer what has been said of the rectal and anal tubes or
canals, consider the sleeve of an infant's gown. This sleeve well
represents the rectal tube, the wrist-band the anal orifice and
tube--an inch or more long. Think of the sleeve or rectal tube as being
made up of four layers of material or membranes; and counting from the
inside of the sleeve or rectum there are (1) the mucous layer; (2) the
areolar layer; (3) the muscular layer; (4) the serous layer.

The muscular membrane is itself composed of two layers, and may be said
to form the framework of the rectum. One layer is composed of circular
muscular fibres, and the other of longitudinal muscular fibres. In a
similar manner you could make a sleeve out of fine circular rubber
bands; then bind them together by rubber strings extending lengthwise
of the sleeve. With the circular bands the bore of the sleeve may be
contracted or widened; and with the longitudinal bands the length may
be shortened or extended. Just so with the corresponding muscular
membranes of the rectum, in their normal and abnormal conditions.
Outside of the longitudinal muscular bands are the serous and areolar
layers, the latter covering the lower half of the rectum.

As you look inside the incomplete model of the rectum, or rather
sleeve, you observe circular muscular bands or fibres which it is
necessary to cover with soft spongy or fatty substance in whose meshes
are nerves, blood-vessels, etc. This is called the areolar layer or
coat. One more layer or coat upon this--the mucous coat--completes the
structure. This latter possesses the power of accommodating itself to
the distention and contraction of the muscular tube. The mucous
membrane is thrown into folds and columns which serve as valves to
inhibit the undue descent of the feces, thus assisting the mucous
membrane in performing its office.

The length of the rectum varies in different persons, six inches is the
average length. It is divided into two parts. The upper part is a
little more than three inches long; beginning in front of the third
sacral vertebra and extending down to the end or tip of the coccyx. In
shape this part conforms to the curve of the sacrum and the coccyx, to
which it is attached behind. The lower part of the rectum is a little
shorter than the upper part, and begins at the tip of the coccyx and
extends down with the same curve as the upper part, terminating at the
upper portion of the anal canal.

Returning to the sleeve again; the portion of it from the shoulder to
the elbow illustrates the upper part of the rectum when partially
covered with a serous coat on the side opposite the bore (the outside).
From the elbow to the wrist-band illustrates the lower part of the
rectum, when covered on the outside with an areolar coat.

The wrist-band of the sleeve will represent the anal tube if drawn into
a pucker and turned slightly backward from the direction of the sleeve
of which it is a continuation.

The muscular fibres described above likewise enter into the formation
of the anal canal or orifice. This orifice is closed by two strong
muscles that lie close together and are called internal and external
sphincters, which are abundantly supplied with nerves and blood-vessels
whose branches extend to the neighboring organs.

Nine persons in every ten have more or less chronic inflammation of the
mucous membrane of the anus and rectum. In time the areolar and
muscular coats become invaded by the morbid process, and this increases
the irritability of the tissues of the organ.

The change from the normal functions of the anal membranes is slow, and
the symptoms are not well marked and are consequently ignored for years
owing to inexpertness in detecting an invading serious disease, until
the time comes when the suffering can no longer be tolerated by the
victim of the neglect.

The result of disease to muscular tissue is contraction of its fibres,
and the contractions become more painful as the disease increases.
Accompanying the inflammation, there is a more or less inflammatory
product secreted between muscular fibres that "glues" them together in
their contracted state. And as the anal and rectal tubes are made up of
round muscular fibres, it is not hard to see how the bore of the canal
can be lessened by the slow binding together of its fibres in the
contracted state. The fact is that when the anal structure is invaded
by inflammation, there is more or less stricture of the canal and of
the orifice.

Recalling the sleeve illustration, and how the wrist-band was puckered
and bent back a trifle so that the contents of the sleeve would not
pass out so easily, suppose you now pucker the wrist-band rather
tightly, and suppose there is a forcible descent of sand in the sleeve,
the natural result would be a bulging out of the lower portion of the
sleeve just above the wrist-band, or place of undue constriction. If
the abnormally constricted condition of the anal orifice has been
growing from bad to worse for years, the locality immediately above the
anal canal will become dilated or cavernous (caused by retained feces
or gases), which cavity is called ballooning of the rectum. When a
speculum is introduced into the rectum (as shown on page 14 of pamphlet
_How to Become Strong_), and through it a bent probe is inserted to
determine the depth of the dilatation or abnormal cavity, it is as if
one were poking inside of an inflated balloon: hence the name.

Anatomists describe the rectum as terminating in a forward pouch, which
is close to the prostate gland in the male and the lower part of the
vagina in the female. In some cases there may be such a slight pouch,
due to the anal canal not following the direction of the rectum, and
slightly turning backward; but in most cases such a normal pouch is not
perceptible or observed through the speculum. The small pouch sometimes
found on the anterior wall of the rectum I have thought due to a very
acute inflammation on the verge of forming abscess, which often occurs
in the triangular space. (See 4 in diagram in pamphlet cited above.)

Immediately above the sphincter muscles on the posterior wall of the
rectum the greatest dilatation is found (as shown by the bent probe),
and extends on each side with less depth about the anterior wall of the
rectum.

The greater portion of the lower part of the rectum, which part is
about three inches long, is usually involved in the dilatation or
ballooning. Often the upper half or more of the anal canal is also
dilated with the rectum, leaving the sphincter muscles quite bare of
fatty tissue, with anal length of a quarter of an inch or less.

Your attention was called to a sleeve containing sand, and the bulging
or dilatation above the puckered wrist-band that was an inch or more
broad. Now suppose there were two strong rubber rings at the lower end
of the wrist-band, whose power of resistance to pressure is much
greater than the tissues above them forming the wrist-band. Naturally,
the tissues which form the upper part of the wrist-band would dilate
the same as the terminal portion of the sleeve just above the
wrist-band.

Similar changes in structure or formation take place in diseases of the
anal and rectal canals which result in ballooning of the rectum; and
two frail constricted sphincter muscles are left to guard this balloon,
filled, as it so often is, with feces and gas.

Chronic inflammation, that results in contraction of the circular
muscular fibres, will sooner or later constrict the gut so that it will
lose its normal power to expand without causing pain. The anal canal
may be said to be strictured to the degree in which it is unable to
dilate normally, and this strictured condition usually grows from bad
to worse.

The first symptom of rectal disease is usually an affection of the
anus, which affection occasions an inhibition, that is, a reluctant
permission for the passage of the feces; and this inhibition results,
consequently, in some degree of constipation. And this constipation
reacts more or less on the peristaltic action of the bowels and in time
defeats the function of peristalsis. All this will react on the
inflammatory processes at the anus, which originally engendered the
constipation. The narrow and contracted strait or canal through which
the feces must pass, gives a tape-like shape to the stools.

The anal and rectal mucous membrane is of a firm and tough structure,
similar to the integument at the bottom of a boy's heel. After many
years' observation of diseases of the anus and rectum I am forced to
conclude that as a rule inflammation exists in the tissues twenty or
more years before the severe symptoms, such as piles, fissure, anal
pockets, pruritus, hypertrophy, atrophy, tabs, abscesses, and fistula,
are sufficiently annoying to compel the sufferer to seek medical aid. I
believe it to be of as much importance to give early attention to
disease of the anus and rectum as to teeth and eyes, or even more.




CHAPTER XV.

BALLOONING OF THE RECTUM--Continued.


In the last chapter a description was given of the anatomy of the anus
and rectum; and it was shown how a chronic inflammatory process
involving these organs develops stricture in the parts invaded; and it
was shown how a partial stricture of the anal canal results in
ballooning or dilatation of the lower part of the rectum. The primary
cause of all the symptoms of rectal disease is chronic inflammation
(proctitis) involving the whole structure of the anal tubes and in a
few cases the sigmoid flexure as well.

Perhaps the first marked symptom of disease of the rectum is
constipation, semi-constipation or of chronic character. The function
of the anus and rectum being disturbed by the inflammation, the fecal
mass is unduly retained and its moisture is absorbed by the system.
This accounts for the condensed and hardened fecal mass in isolated
lumps of various proportions. A hard-formed stool is abnormal, and is
evidence of auto-infection. When three-fourths of the normal fecal mass
has been re-absorbed by the system, does it not stand to reason that
the blood and tissues have been poisoned by their own waste products
(auto-intoxication) and that anemia, emaciation and local disturbances
of other organs of the body are symptoms of such intoxication?

The loading and blocking of the sigmoid flexure come from _too much
activity or irritability, due to inflammation, of the upper half of the
rectal tube_. A consequence of this excessive sensitiveness is a
diminished or perverted normal stimulus, notice or desire, that the act
of defecation should take place.

The victim of proctitis simply forms a habit of daily soliciting an
evacuation, though the normal invitation or desire to stool may be
entirely absent, and the evacuation in such cases is attended with more
or less delay and straining effort to accomplish partially or wholly
the expulsion of the more or less inspissated feces.

As the extreme sensitiveness of the inflamed upper half of the rectum
offers resistance to the passage of the fecal contents of the sigmoid
flexure; so, in a somewhat similar manner, the inflamed anal tube, in
its more or less constricted state, prevents the passage of feces and
gases as they approach the terminal part of the rectum. As a
consequence, the feces and gas deposit and lodge at this latter
location, producing in so doing the abnormal cavity called ballooning
of the rectum, so often found just above the anal tube.

The greatest depth of the dilated pouch is on the posterior wall of the
rectum, or just in front of the tip of the coccyx. In some cases the
pouch measures two and a half inches in depth at the back and gradually
diminishes in depth on each side as you near the anterior wall of the
rectum. Often the upper end of the anal canal is higher than the
depressed circumference of the spacious cavity that almost surrounds
it. The irritable orifice of the cavity will invariably compel a
quantity of liquids and feces to lodge in the cavity as a permanent
cesspool, allowing the absorbent vessels to absorb as much as they can
by incessant work. The height or length of this abnormal cone-shaped
rectal cavity is from two to three inches, involving usually the lower
half of the rectum. The anal canal frequently becomes shortened by the
dilating process to a quarter of an inch, leaving two frail, irritable
muscles at the vent, to guard the rectal cavity. And fortunate are
these two thin, sore, contracted muscles, and the possessor of them, if
they escape the surgeon's barbarous notion of operating on them.

If the medical butcher has operated on them, you will find an anal
canal open to such an extent that two fingers can be inserted without
distending the tissues in the least. And when the victim of ballooning
of the rectum and ignorant operation makes further complaint to the
surgeon of the aches and pains, he is consoled by being informed that
the end of the spine will have to be removed. Irreparable damage done
and no aid at all received! It is a pity such ignorance on the subject
should exist in the medical profession in this city.

The abnormal cavity, so difficult to empty properly owing to its depth
and diseased outlet, is seldom free from gases, feces and liquids.
Daily evacuations will not empty this cavity, nor will cathartics or
diarrhea. A permanent cesspool of poisons is this, where all forms of
poisonous germs are propagated, and infect the system by absorption. No
use to take medicines for your _poor blood, bad complexion and horrid
feelings_, as they will not cleanse the augean stable so long
neglected. No use to journey to other localities for health so long as
you carry so formidable a foe to health with you.

The mucous membrane in the chronic state of the disease presents a
rather dry, indolent and bluish appearance, except that here and there
the tissues show more activity of the disease, more especially so over
the anal region, due to harsher disturbance during the act of stooling.
In the subacute or acute stage of the inflammatory process there is
more general redness and puffiness of the mucous membrane, or a swollen
condition with increased discharge of mucus and perhaps some blood.

There is a heavy, uncomfortable feeling, with more or less soreness and
pain, especially after evacuation of the feces. If a fissure or anal
ulcer is present the pain is in proportion to its size and the general
aggravation of all the diseased parts. Itching or pruritus about the
anus may accompany the trouble to a very annoying extent, being an
evidence that the anal pockets are becoming much diseased. The
partially constricted and irritable sphincter muscles become excited
during the act of stooling and react on the anal grip or contraction,
making it more intense. This latter condition may shut off the flow of
blood in a local vein; and the blood becoming coagulated forms a
painful bluish grape-like tumor at the external opening of the anus.

Abscesses may form at some portion of the diseased gut and result in an
external fistula.

Piles may co-exist in some cases of ballooning, but are usually not
annoying.

It is the local anal or external annoyances that compel the sufferer to
seek medical advice and aid, and he learns that the troubles complained
of are only symptoms of a chronic disease, therefore easily removed
without harsh treatment while the cause is being properly cured.

It is very fortunate for the sufferer from ballooning of the rectum to
have in or near the anal canal those painful hints or symptoms of a
very grave and long existing disease whose constitutional symptoms were
well marked but attributed to other causes, especially to disease of the
liver--an organ of _so much solicitude_ that the poor liver-worshipping
patient ought to receive more gracious response from it.

In every case of chronic proctitis, or inflammation of the anus and
rectum, the sigmoid flexure must be more or less dilated, as the upper
part of the rectum is very irritable and contracted and inhibits the
feces from passing beyond the sigmoid; but this irritability and
contraction of the rectum, as a rule, is not nearly so severe as that
of the anal canal, whose orifice is closed by very strong sphincter
muscles.

Such being the pathological change in the sigmoid flexure and
especially in the lower portion of the rectum, as described in these
two chapters, who, with ordinary intelligence and an idea of
cleanliness, would take or prescribe remedies to move the bowels, if it
were possible to cleanse the foul capacious cavities with water? We
know that they can be thus cleansed, and that it can be easily
accomplished with benefit to the diseased canals.

After the system has absorbed 75 per cent of the fecal mass, a "remedy"
is taken to excite a flow of watery excretions into the bowels, of
which a portion will be retained in the colon, and especially the
ballooned cavities, and reabsorbed; and every day the objectionable
practice is repeated without any thought of the harm being done.

The flushing of the rectum, sigmoid flexure and colon with water is not
a _cure-all_, but it is one of the means of treating a grave chronic
disease, a disease insidious and far-reaching in its poisonous effects
on the human organism.




CHAPTER XVI.

THE USUAL DIAGNOSIS AND TREATMENT OF BOWEL TROUBLES WRONG.


Herodotus tells us that among certain tribes when a man fell sick his
next-door neighbor did not wait for him to become thin but killed him
at once, lest by the loss of his adipose his flesh might be rendered
less appetizing.

But alas! in this age of constipation and piles, of self-generated
poisons and self-infection, how changed is the custom! Our next-door
neighbor, the doctor, waits till we are really thin, and then begins to
feed and grow fat on our ills! In our day, through the continuous
process of self-poisoning we take on no flesh from puny, peaked
childhood, or we insidiously lose what little flesh we had, and when
our bones are well exposed, become alarmed, realize that we are sick,
rush for the doctor, and dispossess ourselves of our spare cash.

Very frequently, as stated in the first chapter, auto-infection begins
in infancy and slowly but steadily progresses, but it may not be before
adult age is reached and one or more organs are seriously diseased that
it becomes apparent to all. The vital round of the alternate
building-up and breaking-down of the system has been going on
unceasingly during these years of increasing infection, but prematurely
the balance between up and down is lost in favor of down; the
building-up process becoming feebler, slower, and the breaking-down
process quicker, easier. What can the inevitable outcome be but
_emaciation_ and _anemia_, and all their attendant suffering and
consequences? It is the superabundance of vitality in the growing child
that retards (inhibits) the morbid changes going on in the blood and
tissues of the system; but the process is all the more insidious by
being thus restrained, and its very subtlety and stealth beguile us all
into fancied security: parents, friends, physicians--all are deceived.

As stated in a previous chapter, the first unwelcome visitor, in
infancy, is inflammation of the integument and mucous membrane of the
anal orifice, invited by the uncleanliness involved in the use of
diapers; and this visitor takes up its residence slowly along several
inches of the lower bowel. Its first symptoms are likely to be
constipation, flatulency, colic, indigestion, bacterial and other
poisons, occasionally diarrhea, and the usual general disturbance of
the system as above detailed. It is admitted by all authors that
inflammation of the anus, rectum, etc., is by far the most common
disease that afflicts mankind at all ages; and I maintain that the
natural result of such inflammation is a more or less extensive
occlusion of the lower bowel, which in turn involves an undue retention
of the feces, and thus we have the foul intestinal canal and stomach
called gastric and intestinal indigestion.

The wrong treatment of constipation, diarrhea, indigestion and
auto-intoxication up to the present time has been due to improper
diagnosis. Writers on these subjects speak of them as causes when they
are merely symptoms. And the remedies for these "causes" are even more
numerous. _Mistaken diagnosis on the one hand, measured doses on the
other, and there you have the scientific doctor!_ The primary cause,
inflammation, like the original spark applied to dry shavings, sets up
morbid changes in the various parts of the digestive canal and the
other organs of the body, and these "set up" or established changes are
properly secondary or derivative causes accompanied by their own
symptoms. The primary disease and symptoms may exist for five, ten,
twenty or more years before any pronounced secondary or derivative
diseases and their symptoms occur or are noticeable to a sufficiently
marked degree.

The chronic character of the malady, and the complication of primary
with secondary diseases and their symptoms, have thoroughly
disconcerted the doctors. Hence the many "causes" assigned for
indigestion, constipation, etc., and the many kinds of remedies
prescribed with the one sure result, FAILURE; and hence, also, not a
few of the self- and drug-intoxicated ones dubbed, or actually
developed into, hypochondriacs. Diagnosis wrong, treatment wrong,
failure certain, and the foulness of the intestinal canal continued!
This is the experience and testimony of the many, many sufferers from
the most common malady that afflicts humanity from infancy to old age,
and which will continue to afflict the great majority until it is
properly understood and treated.

When a sewer of a town is obstructed, the most sensible plan is to
begin the investigation at the outlet and then proceed up, section
after section, to trace the obstacle that had occasioned the
accumulation of debris. When the waste-pipes of a house are clogged, we
do not expect the plumber to go to the top of the building and poke
substances down the pipe to dislodge the unduly retained material some
twenty-five feet or more away. Nor would we believe him if he informed
us that the sewer-gas and overflow of waste in the house were the
_cause_ of the constipated condition of the drain. But just this is
what the doctor declares concerning our sewer; just this is what he
does when he doses it with laxatives, cathartics, purgatives. Such is
the treatment we receive when we rush to the doctor, or such the
treatment we give ourselves. The poor, sensitive, inflamed canal is
desecrated on all hands, though part of a house not made with hands--a
house that should be a home for the soul of man.




CHAPTER XVII.

COSTIVENESS.


The words constipation, obstipation and costiveness are often employed
as if of exactly similar meaning, but it is well to let each stand for
a particular condition. Obstipation implies that the canal of the
intestine is stopped up or closed. Constipation carries the idea that
the canal is completely filled up with refuse matter. In the normal
condition the intestine is divided by transverse bulges or valves or
dams into a number of separate segments, the entire arrangement having
the effect of preventing too rapid descent of the feces. These folds
within the canal may become too much narrowed by disease and thus
prevent the movement of the matters inside; this is obstipation.
Constipation, stuffing of the gut, may be the result of neglecting the
call of nature, and after a time the ability to recognize and answer it
is lost; or it may result from inflammation which itself comes from the
bad habit mentioned.

The author prefers to use the term costiveness for the general debased
condition of the system from auto-intoxication depending upon proctitis
and similar conditions of the intestinal tract. And it must be
remembered that the same patient may have two or more of these
conditions at the same time. Constipation, obstipation and diarrhea may
alternate through the progress of the case.

We would expect people suffering from constipation or obstipation to
pass as fairly well people for a time, but the same is not true of
patients having the other condition, costiveness. As we may speak of
the stages of a disease like consumption, so we may speak of these
three conditions as different stages of one affliction, the worst being
costiveness with its progressive self-poisoning by the products of
intestinal decomposition. Early in the case the system may pass these
poisons out of the body with comparative ease, by way of the lungs,
skin and kidneys. In time the second stage begins to make itself
apparent, vitality becomes less and less, calling for a greater variety
of medicines to correct the condition, as in the second stage of
consumption, and also to arrest the progress of emaciation and anemia
or anemic obesity.

The third stage of auto-intoxication is a most unhappy one. The
impoverished tissues offer a most favorable soil for the development of
diseased conditions. These three stages which are clear to the
experienced eye of the physician may to the patient seem to be
indistinguishable, the one from the other; and it must not be forgotten
that the three conditions do not mean simply that a smaller or larger
part of the intestine is clogged by its contents, but that the whole
system is involved as well.

It cannot indeed be otherwise with the rapid circulation of the blood,
nor need it excite wonder that such patients are thin and debilitated
by the deadening of the powers of absorption, assimilation and
elimination.

As a rule the many thin and puny infants and children of either sex,
with bony points well exposed under a tightly drawn skin, which latter
is clay-colored and pimply; children with headache and languor, without
healthy interest in either studies or play;--these are the victims of
intestinal poisoning as described. If they have inherited a spare habit
of body from their parents such bodily ills will manifest themselves
the more quickly. They ought to be fat and hearty as are the young of
animals, but alas many are not! When the young animal is spare, a few
days of rest with good diet will put flesh on it, demonstrating that
the state of the bowels and the powers of assimilation are intact. Why
does not man take on flesh in a similar way?

If the intelligent animals could talk, they would undoubtedly make all
manner of fun of the intestinal canals which they see walking about,
with a little flesh here and there seemingly by accident, and a skin
which is clay-colored or jaundiced, anemic or flabby, the owner of it
all poisoning himself by decomposition in his intestines!




CHAPTER XVIII.

INFLAMMATION.


If we desire to get a general idea of the changes that occur in an
organ when it becomes inflamed, we must first have a knowledge of the
normal structure of that organ, even though that knowledge be but
superficial. Taking the intestines, for example, we see under the
microscope that they are composed of layers of different tissues,
called connective, epithelial, muscle, and nerve tissue; the first two
forming a large part of the structure.

In the connective (and fatty) tissues a great many blood-vessels are
found (varying in different parts of the organ), the existence of which
is necessary for the production of inflammation, since at the very
outset of the process, a discharge (or exudation) takes place from
these blood-vessels, accompanied by changes or degenerations in the
other kinds of tissue.

The process of inflammation is commonly associated with symptoms of
heat, redness, swelling and pain, in greater or less degree, combined
with which a change in the function of the organ is soon noticed.
Micro-organisms are considered the primary cause of inflammation in
many or even in most cases in which mechanical or chemical influences
may undoubtedly be responsible primarily; and then again, each of these
causes may be either external--that is, may originate from the outside
world--or internal, that is, may be produced in and by the body itself.

The first pronounced change occurring in an organ under inflammation is
an increase in the rapidity with which the blood circulates through the
vessels--a so-called hyperemia--which soon gives place to a diminution
(stasis) in the current together with an exudation from the
blood-vessels; the latter is due to changes in the structure of their
walls. This exudation soon occasions a cloudiness of the connective
tissues and at the same time a desquamation (shedding in scales) of the
epithelia (cells of the thin mucous surface). An irritation of the
nerves also takes place.

The varieties of inflammation can be best apprehended by considering
the different characters of the exudation. The exudation may be watery
(called serous) or dense, the latter either fibrinous or albuminous.
With a serous exudation there is swelling of the connective tissue and
a desquamation of epithelia--the latter usually slight in
character--which constitutes what is known as a catarrh; while with a
fibrinous or albuminous exudation there is usually more or less
destruction of the tissue itself, when, for example, we have "croup" or
"diphtheria."

When the changes in the epithelia are only slight and secondary, it is
spoken of as an interstitial (lying between) inflammation, which
strictly speaking denotes confined to connective tissue, and is
therefore a term not entirely correct. When the inflammation of the
epithelia is severe and may lead to their partial destruction, it is
called a parenchymatous inflammation; that is, one involving the soft
cellular substance. There is still another variety, the suppurative,
which is the most intense of all, and indicates the production of an
abscess and the entire destruction of the tissue implicated.

Beside these general grades of inflammation there are special sorts
produced by specific micro-organisms. In all general inflammation we
may expect to find such organisms, which in most cases belong to the
class of micrococci, such as staphylococci and streptococci. In
gonorrhea we have a special organism called the "gonococcus"; while in
tuberculosis--a variety of inflammation in which the blood-vessels are
completely destroyed and a change or degeneration called "cheesy" is
produced, leading to the production of a tubercle--a rod-like bacillus
is invariably found, the well-known and unfortunately too common
tubercle bacillus. In syphilis--another special variety of
inflammation--a specific micro-organism is also surely present, but of
this microbe science has not as yet discovered the exact nature.

The question of the origin of tumors or new growths is also an
extremely important one; and it is undoubtedly true that many tumors
arise where there was a previous inflammation, this being especially
the case in tumors of the rectum. Why such a growth should arise in
some cases and not in others is as yet unknown, though microbes are
held by many to play an important rôle.

When an inflammation has lasted for such a length of time that it has
become chronic, a new tissue will sooner or later be produced in
varying amount; and this newly formed fibrous connective tissue may
entirely replace previous normal structures. Through the exudation and
consequent changes in the normal tissue a large amount of mucus is at
first secreted, but this secretion becomes less and less marked the
more the inflammation causes a desquamation of the epithelia.
Pronounced desquamation with new formation of connective tissue and no
fresh exudation will, sooner or later, occasion dryness--this dryness
being sometimes very pronounced. The longer the inflammation lasts, the
severer it will be; and the greater the amount of tissue it attacks,
the more will the normal tissue be destroyed and replaced by a new
connective tissue. A partial destruction will cause shrinkage of the
organ (so-called "cirrhosis"); while a complete destruction of certain
parts will result in what is known as "atrophy" (a wasting away of
normal tissue). In atrophy the blood-vessels as well as the original
connective and epithelial tissue are destroyed; while the newly formed
tissue leads to hypertrophy (excessive over-growth) of other portions
of the organ. Such a hypertrophy must not be confounded with an
induration that may be present later, or even at the very commencement
of an inflammation, due to modification of the blood-vessels and
surrounding tissues.

Chronic inflammation, sooner or later, leads to secondary
degenerations, that is, new products of the protoplasm, the most common
of which is fatty degeneration. In this form fat granules and globules
arise, which are at first minute, later on larger; these in certain
organs, such as the liver, may become so pronounced as to entirely
replace the original tissue. Another degeneration--which, however, is
found only in chronic systemic disturbances, such as tuberculosis or
syphilis--is the waxy or amyloid degeneration, a peculiar chemical
change the exact nature of which is unknown.

Various chemical changes are by no means uncommon.

An important question is the decision as to the length of time an
inflammation has lasted; and this at best can be determined only
approximately and after long experience. The older the inflammation,
the more the connective tissue has developed; this connective tissue is
at first soft, but soon becomes more and more dense; the result being a
varying degree of hardness of the organs.

Again, secondary degenerations are more pronounced in long-standing
processes. In comparatively fresh cases blood-vessels are still more or
less numerous and the tissue appears red, while in older cases these
vessels become completely obliterated, and the tissues take on a white,
glistening color, becoming harder and denser as the years advance. If a
process has lasted twenty or thirty years, the changes to the eye and
touch are practically the same as after forty or sixty years.

The changes, as here described, will be the same upon any mucous
membrane; and in the large intestine can be easily studied and are
perfectly characteristic.

Rarely does an infant escape repeated attacks of inflammation of the
integument of the anus and the mucous membrane of the anal canal. The
inflamed integument is treated and healed, but no attention is given to
the inflamed mucous membrane so that the inflammation in time becomes
chronic, involving the rectum also. Should the infant be so fortunate
as to escape inflammation (proctitis) of these organs during the
wearing of the diaper, there are numerous other exciting causes of
inflammation which it will not be likely to escape, hence the almost
universal symptom of constipation among civilized people; and hence
later in life you hear the familiar expression, "I have a touch of the
piles," and many other complaints of bowel ailments that are usually
the outcome of that deplorable inflammation.

I have endeavored to make clear the fact that inflammation destroys
normal tissues and blood-vessels, and that the newly formed tissue is
cicatricial in character, that is poor in cells and vessels, with a
tendency to contraction which of course lessens the bore of the gut.
When the hypertrophy or thickening is extensive the appearance of the
mucous membrane suggests the addition of one or more thicknesses of a
chamois skin added to the inner surface of the anal and rectal canals.
The hypertrophied or newly formed tissue may be limited to the rectum,
leaving the anal tissues comparatively exempt from the superabundant
cicatricial formation; or the hypertrophy may involve, to quite a
degree, only the anal tissues and the integument around the anal
orifice. The added connective tissue about the anus forms the skin into
tabs, or into a circle of elongated integument around the orifice, with
a mucous lining. These hypertrophied tabs or folds, like pruritus ani,
are symptoms of proctitis.

Proctitis (the inflammation of the anal and rectal canals) is the most
common and serious disease that afflicts man. The system is not only
poisoned by bacteria and filth through proctitis, but proctitis is also
the cause of the many annoying and painful local symptoms, such as
hypertrophy, piles, abscess, fistula, cancer, polypus, fissure,
pruritus, etc.

When the subject of proctitis is better understood by laymen they will
see to it that the rectums of children receive an examination before
the children are six years old, and thus obviate the necessity of
dosing them with all sorts of medicine that follow improper diagnosis.




CHAPTER XIX.

PROCTITIS AND PILES.


Piles (hemorrhoids) are not the result of either the normal or abnormal
growth of the tissues of the anal and rectal mucous membrane. They are
developed by the combination of pathological and physiological
conditions: (1) chronic inflammation or proctitis; (2) stricture of the
anal canal and lower portion of the rectum, which may be spasmodic, or
more or less permanent, which stricture pinches or constricts the
canal, thereby inhibiting the circulation of the blood; (3) the
pressure or straining effort during the act of defecation, occasioned
by the constricted canal, which effort brings on greater local
congestion and constriction of the tissues.

Pile formations are a symptom of chronic proctitis of fifteen, twenty
or more years duration. Proctitis (inflammation of the anus or rectum)
and periproctitis (inflammation of the connective tissue about the
rectum) are by no means uncommon inflammatory processes. The mucous
membrane like the skin is liable to injury or poisons and especially so
at the orifices of the body. Let inflammation set in: if it be not
cured at once, it will invade the canal, especially a canal like the
rectum; in which case it will establish itself throughout from six to
ten inches of its length, sometimes taking in the sigmoid flexure and
even the colon. Just how long chronic inflammation confines itself to
the mucous membrane before invading the areolar or lace-like connective
tissue and the muscular tissue of the organ, I am unable to state.

The first symptom or indication that all the tissues are involved in
the inflammatory process will most naturally be constipation. You have
observed that inflammation of a portion of the skin on the arm, trunk
or leg does not disturb the muscular movements of the region involved,
except when the muscles underneath the skin are affected also, as in
the case of deep burns where the movements are very much disturbed by
the irritability, soreness and contraction of the diseased muscles.
There is also an adhesive product excreted from the inflamed tissue
that binds the muscular fibres of an organ together, and you have
contraction of the organ and its usefulness impaired. Now, as this is
precisely the pathological or diseased condition which chronic cases of
proctitis and periproctitis present, you will readily understand how
spasmodic and partial stricture or contraction occurs in the sore
muscles (circular and longitudinal) of the anus and rectum. The length
and the bore of the canal are diminished, and thus the circulation of
the blood arrested by the pressure or gripping of the contracted
muscles. This congestion of the blood brings about an anatomical change
in the structure of the mucous membrane, which we call piles: a mere
symptom of inflammation.

Medical authors have defined inflammation as follows: "(1) A series of
changes constituting the local reaction to injury; (2) a series of
changes that constitute the local attempt at repair of actual or
referred injury of a part; (3) a series of local phenomena that are
developed in consequence of primary lesion of the tissues and that tend
to heal these lesions; (4) the method by which an organism attempts to
render inert the noxious elements introduced from without or arising
within it; (5) a disturbance of the mechanism of nutrition of an organ
or tissue, affecting the structures concerned in its function."

These effects or changes give rise to the five cardinal symptoms of
inflammation: pain, heat, redness, swelling and impaired function
(dolor, calor, rubor, tumor, functio læsa).

Proctitis may exist many years before the pain and heat become
noticeable or are complained of by the victim of this insidious
disease, the bodily symptoms of which are well expressed before the
local trouble demands attention and treatment. The sufferer from
proctitis is unable to detect the change from a normal color of the
mucous membrane (a light, muddy gray) to an extremely abnormal one (a
fiery redness). The swelling or puffiness of the mucous membrane
becomes more marked as repeated attacks of subacute and acute
inflammation occur, from year to year, over a period of twenty or more
years. During all this time impairment of the function and structure of
the anal and rectal canals is incessantly going on. The nervous and
muscular spasmodic contraction of the diseased anus and rectum, which
in time become more or less permanently constricted, steadily increases
the stagnation and engorgement of blood in the dilated arteries, veins,
arterioles, venous rootlets and capillaries. All of the circulatory
vessels, especially the smaller ones, become enlarged, varicose; and an
aggregation of varicosed vessels forms a tumor called a pile or
hemorrhoid. Inflammation interferes with nutrition of the anal and
rectal tissues, rendering them friable or weak and easily broken;
whence the bleeding and painful fissure or the anal ulcer, which so
often are the outcome of proctitis and an accompaniment of piles.

As already stated, piles are one of the symptoms of proctitis, and all
cases of piles involve more or less irritability and contraction of the
anal canal and the terminal portion of the rectum through which the
fecal matter is forced. All the muscular ability of the rectum,
assisted by straining effort of the abdominal muscles, is concentrated
upon the feces to force it through the constricted portion of the lower
bowel. The force exerted not only develops pile tumors, but carries out
with the feces those tumors that had reached considerable proportions;
thus the frail diseased mucous membrane is torn, and another symptom
added to a chronic disease. Observation for over twenty years has
convinced me that chronic proctitis usually exists fifteen, twenty or
more years before piles are developed (if developed at all), from daily
pressure on the inflamed, congested, dilated, varicose, friable
blood-vessels and surrounding tissue.

Piles are easily and quickly cured without any annoyance to the
sufferer. Chronic proctitis may be cured, but not quickly, as time is
required to undo damage to tissues so long invaded by inflammatory
process. Any one that allows a continuance of "a touch of the piles,"
as the expression is, and omits to take proper treatment as soon as
this "touch" is felt, simply invites or takes chances of some form of
cancer of the lower bowel later in life.

All other forms of disease of the lower bowel will yield to treatment
satisfactory to physician and patient, but I am sorry to say cancer
cases are numerous, and up to the present time we have no cure for this
dreadful disease. If you value health, if you desire to avoid future
suffering and disease, be sure that the lower bowel is free from
inflammation, for with such freedom you will escape the many symptoms
of proctitis described in my treatise on diseases of the anus and
rectum.




CHAPTER XX.

PRURITUS OR ITCHING OF THE ANUS.


One of the many symptoms of proctitis is the existence of anal channels
from which an inflammatory product exudes through the skin, causing
painful itching of the skin around the anal margin and not infrequently
around the buttocks to the distance of three, six or even more inches
from the anal orifice. An aggravated form of pruritus ani is much more
trying to physical endurance than severe pain. Sometimes the torture is
so great that a portion of the body will be covered with cold
perspiration.

The natural color of the integument about the anus slowly changes to a
dull whitish appearance. As the pathological process goes on, the skin
becomes thickened and parchment-like. In exceptional cases the mucous
membrane of the anal canal becomes toughened and hardened like
cardboard. As a consequence there is a degree of inertia in the
muscular action of the parts affected.

The inflamed, thickened and indurated integument near the anus takes on
the form of folds, wrinkles or rugæ, of more or less prominence; but as
these extend out over the buttocks they become more and more
obliterated, leaving no clue to the direction of the channel which
leads from the site of inflammation; which latter, however, may be
learned from the itching, or from the burning sensation with some
soreness, over portions of their length.

During a practice extending over twenty years, I have found only two
cases in which one of these channels was the seat of a slight abscess.
It is not usual that pus formations occur in these inflammatory
channels. At the margin of the opening from the rectum to the anal tube
are five or six small crescent-shaped loops, semi-lunar valves,
separated by vertical ridges (the anal columns). Naturally in chronic
proctitis the zone of tissue just above the sphincter muscles and
slightly within their grasp at the upper portion of the anal tube,
would suffer greatly from the morbid process, owing to the abnormal
constriction of the tissues and to the incidental pressure and injury,
from time to time, as the stool passes the diseased region. Just under
the mucous membrane covering the anal columns and semilunar valves is
the fatty tissue forming a bed upon which the mucous membrane rests. It
is sufficiently lax to permit considerable movement of the mucous
membrane on the muscular coat beneath it. The frail, fatty, loose
connective tissue in the grasp of the sphincter muscles would be the
first to become impaired by inflammatory process, the product of which
finds its way down and out under the mucous membrane of the anal canal
and integument of the buttocks for quite a distance, occasioning
itching, pain, soreness or burning in the integument covering the
course of the channel.

Here we have the pathological reason why local remedies to the outer
surface of the skin will not cure pruritus ani. Also the reason why
dieting is useless, and why internal remedies are worthless for the
cure of anal itching; for the itching, as shown, is the result of an
inflammatory product in the channels under the skin of the victim,
numbering from five to twenty. Over fifteen years ago I discovered the
cause of the great suffering from painful itching at the anus and
contiguous tissues and have been able to give instant relief, and in a
little time permanent cure, in every case treated since then. It is
well for those who have an occasional attack of pruritus ani to take
treatment at once for proctitis proper, as well as for this symptom,
itching resulting from these channels. The proctitis, if neglected,
will only be the means of increasing the size, length and number of
these channels. In chronic, sub-acute and acute stages of proctitis
there is more or less secretion of inflammatory product; and often the
sufferer is able to discover, in dejections from the bowels, a yellow
syrup-like fluid, of the consistency of glycerine or white of egg, at
times streaked with blood and purulent matter indicating ulceration.

Should the proctitis be cured and these channels remain, there may be
sufficient inflammatory product in the channels to ooze through the
skin to the outer surface, and excite itching; or if a portion of the
channel escapes treatment, the same symptom may be expected at any
time.

The size and length of these channels are best determined by making a
small opening into them through the integument, then inserting a silver
probe in both directions, determining the distance under the mucous
membrane of the anal tube and the distance under the skin of the
buttocks.

In some cases a few of these channels open into the rectum just above
the internal sphincter muscles and become filled with water during the
use of the enema taken to move and cleanse the bowels. As a rule, one
end of the channel is under the mucous membrane of the terminal portion
of the rectum, and the other somewhere under the skin of the anus or of
the buttocks.

I presume that no disease of the human body has been assigned more
reasons for its existence, with the exception of constipation, than
that mere symptom of a disease, anal pruritus; a symptom which
"Regulars" call a "disease," but "Irregulars" know to be only a
symptom. It is very amusing to observe how they fill pages in their
text-books, guessing, wondering and paying their respects to the
imaginary quack doctors, "who are reaping a harvest of ill-gotten
gain." The usual medical writer is a compound of ignorance, egoism and
garrulity, and this may account for the great crop of reasons for
"diseases." However, the writers in question are not so much to blame
after all, even though they do belong to county medical societies; for
how can they well resist the literary itch with which most of them are
afflicted? Let them keep on writing while victims of pruritus ani wear
out their weary lives scratching through weary nights--nights that
extend into years, until permanent invalidism seems to be their destiny
and end. Who, verily, are the medical quacks? I will leave it to a jury
composed of those who have been cured of pruritus ani.

I have yet to meet the first case of pruritus ani that is without the
presence of the channels above described. There may be cases of itching
at the anus and these channels entirely absent, but I have yet to
discover such a case and I very much doubt if it exists. I am happy to
inform the reader that all cases of pruritus ani are cured with ease
and without any restrictions as to diet, and without internal remedies
for the blood, nervous system, etc., given by doctors that guess. The
causes are easily discovered; the symptoms are easily found and
removed; the victim of pruritus ani may therefore escape from the
labyrinth of error of the medical authors and practitioners who ought
to be educators instead of "obstacators"--obstacles and
stumbling-blocks in medical progress.




CHAPTER XXI.

ABSCESS AND FISTULA.


In our daily affairs we take thought for the future and reason from
cause to effect. We observe, anticipate, expect and suspect. This is a
commendable practice, for it is the one that is most likely to lead to
success. Can we not acquire a similar attitude and habit in regard to
our health? Habit is sub-conscious attention. Can we not give
sub-conscious attention to the little details of such bodily functions
as are liable to get out of order? Can we not by a settled habit, that
is, by the formation of a second nature, assure our vital success, on
which the continuance of the enjoyment of life so much depends? If some
part of a complicated machine gets out of order it must be repaired at
once or damage may result to other parts of it. Again, if our business
accounts will not balance, the error must be found and corrected at
once, or the evidence of it will annoy us sooner or later. Why should
not such prompt care and attention be given to the human mechanism, to
the economy of vital functions? It is not often that we neglect disease
of the hands, head, face or neck because the exposure of such disease
to public gaze might embarrass us; but alas for the portion of the body
out of sight, especially for the internal organs, when they fail to
perform their functions normally. Most of us allow the mechanism of the
human body to shift as best it can and as long as it can, should it
happen to become ungeared, ignoring the frequent warnings which the
ever increasing morbid changes and wreckage give us. And then we
surrender and succumb. What else can we do? Our vital creditors file
their claims in the high court of Vital Bankruptcy. What poor business
policy, and what a wretched tenant! For fifteen or more years we may
have had warning "touches of the piles," sometimes accompanied with
indigestion, constipation, diarrhea and insidious auto-infection and
occasionally with local symptoms in and around the anal canal and its
external orifice; these to an intelligent tenant should have been
evidence of proctitis, or worse, of periproctitis--inflammation of the
connective tissue of the rectal tube. What have we done? We have
disregarded the warnings of our ungeared, disordered machine, or else
we have merely tinkered with it. The human factory receives less
attention than does the commercial. Soon, all too soon, the silver cord
is loosed and the golden bowl broken, and just before that event,
frightened, but too late, we do a little more tinkering under a
doctor's direction, and spill the contents--of the golden bowl with
which we were so careless--spill it into another world, to begin our
folly over again!

Do you know that this occasional "touch of the piles" over a period of
many years, and all that it involves, is a precursor and an invitation
to the development of that deadly enemy, Cancer--a worse disaster than
financial ruin? It is my duty to utter a warning here. Only one making
a specialty of the diseases of the alimentary canal is aware of the
frequency of the occurrence of cancer in the lower bowel resulting from
chronic inflammatory process, induration, etc. I have been, again and
again, shocked and alarmed at the reckless neglect that has brought on
this as yet incurable disease--cancer.

These remarks apply well to what I have to say on Abscess and Fistula
at the terminal portion of the intestinal canal. It is the old, old
story of being "touched by the piles for many years," and neglect,
ending in dread and despair at the necessity of being bored full of
holes by pus seeking an outlet. The victim wonders at the spread of the
local trouble, and that an opening for the pus canals has frequently to
be made three to sixteen inches away from the seat of the abscess. In a
former chapter the subject of proctitis and piles was gone into, and
some idea given of the invasion of inflammation in the rectal and anal
tissues.

In exceptional cases the exciting cause of anal and rectal abscess and
fistula, or of abscess and fistula of the buttocks, may be a traumatic
injury or accident, produced, say, by a blow or a fall bruising the
tissues, or by sharp, hard substances--such as pieces of bone or
nutshell--from within the canal, lacerating it. But wounds of this
character are very infrequent compared with chronic inflammation
(proctitis) as the exciting cause. There are several varieties of
proctitis recognized as the exciting cause of abscess and fistula,
namely, traumatic, dysenteric, diphtheritic, gonorrheal, catarrhal,
etc. The reader should not only pardon me, but should be grateful if by
adding another name to the list I point out the most common cause,
namely, _diaper-itic proctitis_. As pointed out in the first chapter or
two, the improper use of the diaper will evidence its deplorable result
when the period of manhood or womanhood is reached, by some of the many
symptoms of proctitis.

Proctitis may be considered as acute, subacute or chronic according to
the duration of the process; or as atrophic or hypertrophic from the
structural changes induced. But no matter about the cause and character
of the proctitis, the question is, Have you inflamed anal and rectal
canals? If you have, then the very annoying symptom, abscess or
fistula, is liable to occur any day. Can you afford to take the
chances?

Just under the mucous membrane of the anus and rectum there is a layer
of loose, fatty, connective tissue, called areolar tissue. When it is
invaded by inflammation, abscess and fistula may occur. On the outside
of the rectal wall, at the terminal portion, there is also much loose,
fatty (areolar) tissue filling the ischio-rectal fossa, which is very
prone to suppuration, and inflammation here is called periproctitis.
This is the most common and serious seat and source of the septic
process, which process is usually the proximate cause of death after
capital surgical operations upon the rectum. Beside the abundance of
fatty tissue--whose function is to serve as a cushion to the rectum at
its terminal portion and at the back and sides of the wall--there is a
triangular space in front of the rectum containing fatty areolar
tissue, which space is often the location of a pus cavity. Pus, like
all fluids, follows the path of least resistance. The progress of
imprisoned pus may take weeks, months and years before an abnormal
communication between the abscess and the external portion of the body
is completed. The imprisoned contents of the abscess cavity and the pus
canal or fistula often give rise to much annoyance before finding an
outlet. There will be pain in the muscles of the buttocks, called
myalgia; and pain at the end of the spine, called coccygodynia. For
this latter pain do not, I pray you, as is so often done, have your
spine removed by the too ready surgeon. No need of it at all. You might
just as sensibly have the muscles cut out for myalgia. Pus in fistulous
channels may burrow for several years through the muscular and
connective tissue structures before finally forming an external opening
through the integument; although its nearness to the surface is
frequently marked by a localized puffiness and inflammation, which,
however, may disappear for a time without forming an external opening.
This condition of affairs results in periodical attacks of
coccygodynia, myalgia and neuralgia of the buttocks and lower
extremities.

The important question with the victim of abscess and fistula is, "How
did I get it? I don't care for the various and numerous names you give
to these fistulas: what I should like to know is, How does it come
about that I, an apparently healthy person, have such a nasty disease?"
Simply years of neglect, is my answer. Neglect is due sometimes, and
perhaps generally, to ignorance of the thing neglected. The laity can
in large measure blame the medical profession for it, and especially
those surgeons who have long made a specialty of the treatment of anal
and rectal diseases.




CHAPTER XXII.

THE ORIGIN AND USE OF THE ENEMA.


Pliny recorded the fact that "the use of clysters or enemata was first
taught by the stork, which may be observed to inject water into its
bowels by means of its long beak." The _British Medical Journal_,
reviewing the newly published _Storia della Farmacia_, says that
Frederigo Kernot describes in it the invention of the enema apparatus,
which he looks upon as an epoch in pharmacy as important as the
discovery of America in the history of human civilization. The glory of
the invention of this instrument, so beneficial to suffering mankind,
belongs to an Italian, Gatenaria, whose name ought to find a modest
place together with Columbus, Galileo, Gioja and other eminent and
illustrious Italians. He was a compatriot of Columbus and professor at
Pavia, where he died in 1496, after having spent several years in
perfecting his instrument. The enema apparatus may be justly named the
queen of the world, as it has reigned without a rival for three hundred
years over the whole continent, besides Brazil and America. The enema
came into use soon after the invention of the apparatus itself.
Bouvard, physician to Louis XIII, applied two hundred and twenty
enemata to this monarch in the course of six months. In the first years
of Louis XIV it became the fashion of the day. Ladies took three or
four a day to keep a fresh complexion, and the dandies used as many for
a white skin. Enemata were perfumed with orange, angelica, bergamot and
roses, and Mr. Kernot exclaims enthusiastically, "_O se tornasse questa
moda!_" (Oh, that this fashion would return!). The medical profession
at first hailed the invention with delight, but soon found the
application _infra dig._, and handed it over to the pharmacist; but
shameful invectives, sarcasms and epigrams, hurled at those who
exercised the humble duty of applying the apparatus, made them at last
resign it to barbers and hospital attendants. (_Year Book of
Therapeutics_, Wood, 1872.)

    "The history of the warm bath," says Dr. Paris, "presents another
    curious instance of the vicissitudes to which the reputation of our
    valuable resources is so universally exposed. That which for so
    many ages was esteemed the greatest luxury in health, and the most
    efficacious remedy in disease, fell into total disrepute in the
    reign of Augustus, for no other reason than because Antonius Musa
    had cured the Emperor of a dangerous malady by the use of the cold
    bath. The most frigid water that could be procured was in
    consequence recommended on every occasion.... This practice,
    however, was doomed but to an ephemeral popularity, for, although
    it restored the Emperor to health, it shortly afterward killed his
    nephew and son-in-law Marcellus, an event which at once deprived
    the remedy of its credit and the physician of his popularity.

    "That the _warm_ and not the _cold_ bath was esteemed by the
    ancient Greeks for its invigorating properties may be inferred from
    a dialogue of Aristophanes, in which one of the characters says, 'I
    think none of the sons of the gods ever exceeded Hercules in bodily
    and mental force.' Upon which the other asks, 'Where didst thou
    ever see a cold bath dedicated to Hercules?'

    "Thus there exists a fashion in medicine, as in the other affairs
    of life, regulated by the caprice and supported by the authority of
    a few leading practitioners, which has been frequently the occasion
    of dismissing from practice valuable medicines and of substituting
    others less certain in their effects and more questionable in their
    nature. As years and fashion revolve, so have these neglected
    remedies, each in its turn, risen again into favor and notice,
    whilst old receipts, like old almanacs, are abandoned until the
    period may arrive that will once more adjust them to the spirit and
    fashion of the times." (J. A. Paris, _Pharmacologia_, p. 31, New
    York, 1825.)

    "A story told of Voltaire," says Dr. Arthur Leared, "well
    illustrates both the evil effects of constipation and the advantage
    of using the enema. The great philosopher was one day so miserable
    and dejected that he told a friend he had resolved to hang himself.
    His friend called the next morning to ascertain whether the resolve
    had been or was intended to be carried out. But Voltaire only
    replied, with a smile, 'I have been well washed out this morning.'"
    (Op. cit., p. 200.)

For those suffering from chronic intestinal uncleanliness or
constipation, an occasional intestinal wash-out, or bath, is quite as
satisfactory as an "occasional" external bath or the "occasional" use
of a cathartic medicine. If there is a necessity for cleansing and
purifying the bowels at all, why not do it properly and systematically
until the condition that made the artificial cleansing necessary is
removed? Who would tolerate the cleaning of dining-room, kitchen, dairy
and other utensils in domestic use only when they became so foul that
they could not be endured any longer without great annoyance? Away with
the "occasional" cleansing habit for either external or internal bodily
cleanliness! There are persistent causes for internal uncleanliness,
for the tardy action of the bowels, which require regular periods for
cleansing until cure is effected.

It is estimated that food taken into the stomach will reach the colon
in five hours. For nineteen hours the sewage waste of the body is
gradually becoming a fetid pool before an outlet is furnished it by the
one-movement-a-day people; and O ye gods of health! how many of us
there are that haven't even one movement a day! For a few hours the
absorbent cells of the colon will try to extract as much of the
nutritious residue as the system calls for, but along with it a lot of
poisonous filth will be absorbed. The call of the system for
nourishment should be fully answered by the small intestines. Savages
have four or five movements a day, and we certainly should not have
less than three. People of refined sentiments will, at such a
disclosure, bestir themselves to better things.

Water, when properly applied, is the only remedy that meets the
physiological and pathological requirements of the chronically
constipated. By its use the diseased, spasmodically contracted muscular
tube is simply dilated, and the imprisoned feces and gases above are
permitted to pass down and through the temporarily occluded section of
the diseased bowels, the patient will have the consciousness of neatly
accomplishing an imperative requirement, and the satisfaction which
cleanliness entails.




CHAPTER XXIII.

HOW OFTEN SHOULD AN ENEMA BE TAKEN?


The following lines will show you how advertising is done in medical
journals. "Dear Doctor: The spring being the time for cathartics, I beg
to call your attention to R. L. (yellow label),..."

Why is spring a special time for cathartics? Has the intestinal canal
been obstructed like the Erie Canal during the winter months? With as
much propriety they might advertise: "Dear Doctor: The spring being the
time for bathing, I beg to call your attention to antiseptic bath
soap,..."

I suppose that a sort of annual cleansing of the alimentary canal is
suggested so that the summer heat may be less objectionable, as it
warms up foul bodies. However, attention once a year is better than
none at all, as said of the Augean stables.

Not long ago I had a conversation with the proprietor of a bath cabinet
company, who had given some thought to hygienic measures, and he
considered it essential to flush the bowels with water once a month to
secure "proper cleanliness." This opinion is quite in advance of the
annual cathartic cleansing. Some people may have acquired the habit of
a monthly cathartic "cleansing"; others wash out once a week, and a few
once a day: all of them act from their idea of cleanliness, as they
would perform the ablution of their hands, face and body. There are
some hygienic students who have adopted the idea of "cleansing" the
bowels with warm water once or twice a week, which practice is quite in
advance of the annual or monthly attention. All have reasons for the
manner and time they adopt to "cleanse" the bowels; and yet they find
that they are not cleansed properly, as they still have spells of
biliousness and misery. They wonder at themselves for being so rash and
bold as to take an enema twice a week, and begin to feel that they have
reached a point of positive danger.

One anxiety is that they will weaken the bowels by the use of a pint or
a quart of water once a month, or once or twice a week. Another is that
they will wash away the mucus, leaving the membrane of the bowels as
dry as an oven. Another is that they will form the dreadful habit of
using the enemata. What a pity to form such a cleanly habit! Sorry for
them!

Another stubborn objection is, that flushing of the bowels is not
natural. These foolish objections and fears can be attributed to
medical authors who belong to medical societies. It is very strange how
these authors adopt so many wrong notions about the physiology and
pathology of the bowels. What an erroneous and absurd idea that the
enema should weaken the bowels! Why should it? Exercise ought to
strengthen muscular tissue; and what could give the bowels more gentle
muscular exercise than the proper use of them? Has the reader any idea
of the amount of water requisite for the distention of an elastic
muscular tube, about five feet in length and two and a half inches in
diameter in the widest part? The large intestine is capable of great
distention, as is frequently demonstrated in fecal impaction described
in previous chapters. The quantity is named in gallons. The amount of
water usually injected at one time--from one pint to two quarts--can
hardly be said to distend the bowels at all. I wish the enemata did
have power to weaken that part of the bowel involved in disease. I am
very sorry it does not weaken it. For twenty years it has been
demonstrated to my mind that almost every case of chronic constipation,
biliousness, intestinal foulness, diarrhea, indigestion, self-poisoning
(auto-infection or auto-intoxication) was due to too much activity and
vigor of the lower bowels, this excessive activity and vigor being the
result of chronic proctitis, colitis, etc. To lessen this muscular
irritability, and to devise means to relieve and cure quickly, has cost
me more studious hours than the aggregate of all the other diseases and
symptoms of the lower bowels.

If liquids washed away the mucus from the mucous membrane, the throats
of many individuals ought to be very harsh and dry, inasmuch as six to
eight glasses of liquids pass through their mouths and throats during
every day of twenty-four hours. Even after the "dry feeling in the
throat and stomach" has been bountifully attended to by the owner, the
conversation usually becomes more loquacious and hilarious, and there
is no suggestion that the intemperate person had spent many hours in a
hot desert without water. The frequent flushings they give their
throats and stomachs really do not seem to wash the mucus away.

When a person consults an oculist about an affection of the eyes and
glasses are prescribed, good sense will inform him that the glasses
must be worn while the imperfect functioning of the eyes requires them.
If a limb be fractured and splints be applied, would you worry lest you
form the habit of wearing them? Certainly not; you expect in due time
to recover the proper use of the limb. So if you are compelled to use
crutches you do not worry about forming the crutch habit, for you will
use them as long as needed and discard them at the proper time.

As to its being unnatural to flush the bowels with water, I would say
that it is very unnatural to suffer from proctitis accompanied with its
annoying symptoms, such as constipation, indigestion, diarrhea,
auto-intoxication, emaciation, anemia, muddy complexion, foul breath,
blotches and pimples on the face, each and all of which indicate a
physical debasement.

It is unnatural to wear glasses, crutches, splints, wigs, artificial
teeth, artificial eyes, but many people do such unnatural things. Many
of our habits are not exactly "natural," but they are rational, none
the less; such, for example, as bathing the body night and morning;
cleansing the mouth and teeth after each meal; and the nostrils and
ears several times a day. The frequency of these practices may, with
some people, be unnecessary and useless, but no real harm is done by
their scrupulous cleanliness--physical and mental.

Proctitis is usually worse than it seems to be. This is because of the
insidious progress of the inflammation during the fifteen, twenty or
more years before the local symptoms at the anus or in the anal canal
are sufficiently annoying to compel the sufferer to seek treatment.
Such sufferers are, as a rule, born with the idea that the liver
regulates the whole alimentary canal; and if the sufferer has not this
hereditary notion, his physician will soon impart it to him with his
diagnosis and treatment. The disciple of cathartics, whether the
cathartics be in the form of pills, powders, or solutions, or contain
belladonna and opium to overcome the cramping pain the dose would
otherwise occasion, has no legitimate reason to indulge in the hope of
a cure or of even moderate relief of the real source of trouble--the
proctitis. It is proceeding on the liver theory, when the key is, as
has been shown in these articles, _Proctitis_, inflammation of the
anus and rectum. Physicians ignorant of the key to all bowel troubles
even prescribe strychnine in order to stimulate bowels which have
already an excessive amount of stimulation due to the presence of the
proctitis, which, as has been said, over-stimulates the lower bowels
because of the inflammation.

The chronic character of proctitis of many years' duration, improperly
diagnosed and treated, must necessarily compel a rather long and
continued use of the enema, especially so if not accompanied by proper
local treatment of all the inflamed surface. I should not care to treat
patients suffering from proctitis, constipation, etc., unless they used
the enema twice a day. The feces and gases should escape the bowels at
least twice in twenty-four hours. Any less than two stools a days is
abnormal and will result in infection and disease. You may not always
succeed in having two stools when first treating the local disease, but
what you properly start out to accomplish will be attained in due time.

Free evacuation of the contents of the bowels should occur at least
twice in twenty-four hours. This can be accomplished by injecting into
the colon from one to four quarts of warm water. Before taking the
large injection, relieve the bowels of any gas seeking liberation, and
of course, also, of whatever feces may come readily. Then take a small
injection, using very little water: just enough to bring on a relief of
as much feces and gas as possible. It is not well to drive the gas back
and up into the colon; hence the precaution to suggest a further
passage with a small quantity of water before taking the large
injection.

Enemata, and also the use of the recurrent douche, can in no way be
harmful--if the water be of a proper temperature--to a normal or even
to a diseased bowel; therefore the fear of habit is absurd and should
not receive a moment's consideration. The length of time during which
the enemata and the douche are to be used, whether months or years,
will depend on the character of the disease that made its use
necessary.




CHAPTER XXIV.

MAN'S BEST FRIEND.


    Travel the world from end to end
    You ne'er will find a better friend
    Than sparkling water, pure and free,
    Most precious boon to you and me.
    It cheers the faint, it crowns the feast,
    Makes food to grow for man and beast;
    In sickness soothes the fevered frame,
    There's healing in its very name.
    And what can more life-giving be
    Than cooling breezes from the sea,
    Whose bosom bears upon their way
    The stately ships from day to day?
    A treasure trove of priceless worth;
    A jewelled belt for mother Earth,
    Encircling with its silvery bands,
    She binds together many lands.
    To cure disease dame Nature brings
    Her remedy in mineral springs;
    Water without, water within,
    Equally good for stout or thin;
    And more than man can e'er devise
    Invigorates and purifies.
    Travel the world from end to end,
    You ne'er will find a better friend.




CHAPTER XXV.

PHYSIOLOGICAL IRRIGATION.


The scientific irrigation of land is pretty well understood by those
who have financial interest in soil requiring it. The wonderful beauty
and freshness of flower and fruit give evidence of what scientific
irrigation can do. So from a commercial and esthetic point of view the
proper amount of daily moisture for land, tree or vine, is of such
importance that it receives the consideration of those interested. How
many persons, however, in the course of a lifetime have given ten
minutes to serious consideration of the question: _How much water
should be imbibed daily under the varying conditions of the body's
garden?_ Those who give no consideration to the problem of how to
attain and maintain a healthy and vigorous physical basis are persons
who usually drift into habits for which they will, sooner or later,
have to pay the penalty.

For the first twenty or more years the body is, as a rule, unfortunate
in not having an intelligent tenant. For man misuses his physiological
estate, and lets things go to rack and ruin ere he wakes to realize how
it might have been as to length of days and strength of body and mind.
Enlighten him, after he has reached adult years, on the values and
needs of physiological and psychological functions; you will find that
however eager he may be to follow the light he is handicapped by
vicious habits and by confirmed, destructive changes which had seized
on him when he was quite too young and incompetent to care for his
body. What a topsy-turvy world this is, to be sure!

It is astonishing what a number of people there are who drink little or
nothing, and especially amazing is it to find this lack of sense in
people suffering from constipation. One would suppose that they above
all others would see the wisdom of irrigating their bowels. But it is
seldom that there is one who thinks of such a thing. A cup of coffee or
tea at meal-time, in addition to the liquid contained in the food, is
the extent of water consumption by ever so many teetotalers and other
"totalers," especially women, until they reach, say, thirty years of
age. Such persons as a rule are not long-lived, inasmuch as their power
of resistance is small, owing to their lack of blood, a lack in quality
as well as in quantity. The blood pressure in their arteries and veins
is light, as evidenced by their pale, sallow complexion, and the dry,
scaly, feverish skin, which seldom or never perspires. The body garden
has not been properly irrigated and is slowly drying up as age
advances. Did you ever notice how like death such persons appear when
they are asleep? Their dull, pasty complexions alarm us then. When I
see them a desire to soak these dried specimens of humanity possesses
me. Is it not unfortunate that we were not born with an automatic
irrigator? We even lack a tube on our boiler to indicate the danger
point! Deficient by nature in these little conveniences, and unaided by
science, man is compelled to give some attention to the irrigation of
his physiological soil, however indifferent or careless he may be.

Planters and gardeners have treatises on irrigation. Have mothers or
nurses any similar guides? Such books are unknown to modern
civilization. Infants, boys and girls, and adults are brought up
haphazard, and their garden of life becomes choked with weeds. The
drought soon makes itself felt, and a little graveyard mound is their
usual fate. Before some of us wither and fade, to what a pest-weed is
our adipose changed for want of life-giving water.

Man's most serious physiological fault is the toleration of
constipation; or even of semi-constipation induced by the
twenty-four-hour habit of stooling. In other words, his fault is the
toleration of intestinal uncleanliness. And next to this foolhardiness
is his negligence in the matter of drinking daily a quantity of pure
soft water sufficient to aid in the proper stimulation and circulation
of the blood, in the proper elimination of the waste material from the
body, and in the proper assimilation of nutriment by the system.

If parents would encourage their children to become bibbers of pure
spring water daily it would not be easy to make them bibbers of
intoxicants in after years. I would give a child all the liquid it
desires, I would even encourage it to take more rather than less, and
the best liquid of all for this purpose is pure soft water. Man's body
is 70 per cent water. It is therefore a good-sized water cask with a
ramification of countless canals or pipes imbedded in soft connective
tissues, nerves and muscles, all of which are supported by a bony
framework; through the centre of this runs the alimentary canal, down
which waters may flow and disappear like unto a stream lost in the
sand, to reappear and ooze from skin, lungs, kidneys and intestinal
canal. Every organ and tissue luxuriates in water; they lave and live
in and by it. With all kinds of food it is introduced into the body.
Water acts as a solvent for the nutritious elements and as a sponsor
for the elimination of foreign substances and worn-out tissues of the
system. It also serves to maintain a proper degree of tension in the
tissues, which tension is essential to the proper circulation of the
lymphatic fluids.

The tonic reaction of externally applied water is well known. But the
advantages of the internal use of water are hardly known at all because
the reactions of the circulation, temperature, respiration, digestion
and secretions are less noticed.

Two or three pints of cold water at a temperature of forty to
forty-five degrees drunk at intervals of half an hour will reduce the
pulse from eight to thirty beats. The copious drinking of cold water
will act as a diuretic, removing stagnated secretions, and will at the
same time improve the quality of the pulse and the arterial tone. The
drinking of warm water will increase the pulse from five to fifteen
beats, and at the same time will relax the vessel walls and also
increase the cutaneous secretions to a marked degree.

The drinking of a large quantity of water not only increases the
secretions of the kidneys--assisting them in the work of carrying off
solid constituents, especially urea--it also increases the secretions
of the skin, saliva, bile, etc. Under proper conditions the internal
use of water acts as a stimulant to the nerves that control the
blood-vessels, a stimulant similar to that produced by its external
application.

I advise the drinking of a copious quantity of water daily. There need
be no fear that this practice will thin the blood too much, as the
ready elimination of the water will not permit such a result to ensue.
I would further advise the generous use of water (temperature 60°) at
meal-times. I pray you do not drink to wash down food: a bad habit of
most of us. Drink all you desire; and if you are like many who have no
desire for water, cultivate it, even if it takes years. The imbibed
water will be in the tissues in about an hour; and the entire quantity
will escape in about three and one-half hours. The demand on the part
of the system for water is subject to great variation and is somewhat
regulated by the quantity discharged from the organism. Physiologists
declare that water is formed in the body by a direct union of oxygen
and hydrogen, but those who have cultivated the drink-little habit need
not hope to find an excuse for themselves in this fact: chronic
ill-health betrays them. Water in organic relations with the body never
exists uncombined with inorganic salts (especially sodium chloride) in
any of the fluids, semi-solids, or solids of the body. It enters into
the constitution of the tissues, not as pure water, but always in
connection with inorganic salts. In case of great loss of blood by
hemorrhage, a saline solution of six parts of sodium chloride with one
thousand parts of sterilized water injected into the system will wash
free the stranded corpuscles and give the heart something to contract
upon.

When water is taken into the stomach, its temperature, its bulk, and
its slight absorption react upon the system; but the major part of it
is thrown into the intestinal canal. When it is of the temperature of
about 60° it gives no very decided sensation either of heat or cold;
between 60° and 45° it creates a cool sensation, and below 45° a
decidedly cold one. Water at a temperature of about 50° is a generator
of appetite. A sufficient quantity should be taken for that end; say,
one or two tumblers an hour or so before each meal, followed by some
exercise. Those who have acquired the waterless habit, and the many
ills resulting from it, will hardly relish cool water as an appetizer;
but if they would become robust they must adopt the water habit--a
habit that will refresh and rejuvenate nature.

Water of a temperature between 60° and 100° relaxes the muscles of the
stomach and is apt to produce nausea, especially if the effect of bulk
be added to that of temperature. Lukewarm water seems to excite an
upward peristalsis of the intestines and thus produces sickness.

Hot water acts as a stimulant and antiseptic, as a sedative and as a
food. Water at a temperature of 110° to 120°, or more, will nearly
always relieve a foul stomach and intestines. It should be slowly
sipped, so that the stomach may not be uncomfortably distended. After
imbibing a pint or a pint and a half, wait for fifteen or thirty
minutes to give it time to pass into the bowels, then drink more if
thought advisable. Drink it an hour before meal-time. It will excite
downward peristalsis, will dilute the foul contents of the stomach, and
will thus aid the escape of these contents into the intestines, which
latter require the washing process as well. Sometimes it is a good
thing to omit one, two or three meals while the washing process is
being continued. Commence treatment with pure hot water. To make it
appetizing, add a pinch of salt or of bicarbonate of soda; with
children add sugar. It will pay you to follow this treatment for the
cleansing of the alimentary canal.

The vitality of the body may be sustained for days and weeks on water
alone; there is therefore no hurry about food. If human beings would
only keep their bowels and stomachs clean they would avoid all the ills
that flesh is heir to, except, of course, those due to accident.

My remarks have been confined to irrigation _per orem_ (that is, by way
of the mouth), and nothing has been said of irrigation _per anum_ (by
injection), since I have treated the latter subject fully in several
previous chapters, to which the reader is referred. Be sure to follow
the counsel there given, and use the enema two or three times a day in
moderate quantities as indicated.




CHAPTER XXVI.

PROPER TREATMENT FOR DISEASES OF THE ANUS AND RECTUM VERY ESSENTIAL.


No doubt the readers of the preceding chapters on proctitis and its
numerous symptoms--noted under separate headings--would like to know
something about the home treatment for such an insidious and grave
disease. Every sufferer wants to be a self-doctor. This commendable
desire it is usually impossible to put into practice. If physicians so
often fail to cure the ailments I have described, what can be expected
of those who have no knowledge at all of diagnosis and treatment?

A skilful physician is the choicest gem of civilization, and an
intelligent patient its worthy setting. Surely it is a moral crime, an
inexcusable folly to tolerate a disease with its inevitable train of
dire consequences, up to the point when the discomfort compels one to
seek treatment. There are patients, of course, who have good and
sufficient excuses for their painful predicament; they have, for
example, tried persistently for relief and cure, but have failed to
find a physician competent to treat their particular case. How many
unskilled prescribers there are, and how glaring their shortcomings!
Some hold out taking inducements to sufferers; their one object being
to transfer their patients' cash to their own pocket. 'Twere charitable
to consider these ignorant; but alas! many of them are poisoned by the
"fakir" germ. Stuff is sold by the conscienceless, claiming to cure
"piles," to "give instant relief," and promising "a complete cure in a
few days"; and as to itching piles, why! "only a few applications are
necessary for a cure; six boxes for five dollars"! etc.

No remedy that sufferers apply themselves can be more than a temporary
relief: it cannot really cure piles, polypus, fistula, tabs, pruritus
(itching)--all of them consequences of proctitis. Of course one should
be thankful for the little relief to be got temporarily from advertised
and drug-store drugs; nothing more than relief can be expected of them.
There are indeed times when a palliative treatment will serve to tide
the sufferer over a few days until he is able to consult a competent
physician. But how strange it is that so many sufferers regard their
anatomy and physiology so lightly as to think of using remedies, even
for relief, without first undergoing a thorough examination by a
competent physician. In troubles of a rectal character it is
exceedingly foolhardy to allow any one to prescribe without insisting
upon a thorough examination to ascertain whether there be any disease
of a cancerous nature present, or what the trouble actually is, and its
progress. To expect one remedy or prescription to meet all the
requirements for the cure of a chronic disease of the anus and rectum
and of the many complications accompanying it is hardly sensible, but
that is just what a great many do expect. No one remedy in the market,
or any number of them combined can effect a cure, for the simple reason
that proper local treatment by a physician is of paramount importance.
Unless of a traumatic (externally produced wound) origin, diseases of
the anal and rectal canals are usually of fifteen, twenty or more
years' incubation before the annoying symptoms become apparent. This
accounts for the slight attention to the maturing trouble and for the
fact that such attention can afford nothing more than a palliation or
postponement. A real cure requires a combination of means, all working
harmoniously for the proper length of time. Proper treatment and the
proper time are the two prime requisites; and the third and final
requisite is, of course, a sensible patient.

Before home treatment is to be thought of it is accordingly advisable
to have an examination and a prescription for the specific local
treatment necessary for a trouble like piles, fissure, polypus, tabs,
itching, fistula, varicose veins, abscess, ulcer, granulation,
hypertrophy, or atrophy as the case may be. The local treatment can
best be aided by a combination of remedies with suitable instruments
for their use between the periods of local attention by the physician.
The writer of this has no cure-all to send the sufferers, although it
might be to his financial advantage to have one; he is, however, always
ready to advise and relieve those who cannot visit him immediately. The
relief afforded often facilitates the cure by permitting a more
extensive local treatment at the first visit.


_The Use of Instruments for Injecting Water._

To do something at home for one's self for relief from soreness and
pain due to anal and rectal diseases, a few suitable instruments are
required with which specific remedies may be used, especially that
excellent remedy--water.

It is unfortunate that the anal and rectal canals cannot be given rest
when invaded by disease. Daily elimination of feces is a very important
factor to health and to treatment. To accomplish this the very best
means is water in various quantities as the case demands. It does not
irritate the diseased canals--as cathartics do--but aids in the escape
of imprisoned feces and gases which lodge above the region of the
morbid process. Evacuation should be accomplished twice a day, by the
injection at first of three or four quarts of water--thus obtaining a
good daily flushing of one's sewer--and then, if advisable, gradually
lessening the quantity at subsequent injections to one or two pints at
a time. The temperature should be 100° to 105° or more. Some people
have an idea that water at the temperature named has a remedial effect
on an inflamed anus and rectum. It has none whatever; all it does is to
wash away the deposits which might irritate the inflamed surface. Water
at a temperature of 100° to 105° is not an especially good antiseptic;
and its intestinal use should not be continued longer than to bring
away the effete and fetid material which may be lodged in the colon,
sigmoid flexure and rectum. In the majority of cases its use should be
limited to aiding the feces to escape from their normal receptacle--the
sigmoid flexure--whenever proctitis does not extend beyond the rectum.
But many persons are deceived by the conduct of proctitis and are thus
likely to omit the regular irrigation twice a day. They believe
themselves to be in pretty good condition and do not realize that their
old, implacable enemy may be excited into riot any day; in which case
the insurrection may last for months and then slowly settle down to
semi-quiet again, reaching finally the point of its best behavior for a
short period or until again provoked.


_The Use of the Recurrent Douche._

Water at a temperature of 120° to 130° properly applied is a good
therapeutic agent in the treatment of proctitis. At that temperature it
is an excellent antiseptic and astringent. Its continuous use for half
to one hour applied with a recurrent douche brings about a contraction
of the engorged and dilated blood-vessels; and accompanied by local
treatment and by other remedies is the best means known for restoring
the nerves to their normal function of controlling the proper
circulation of blood in the diseased organ. Treatment with the
recurrent douche is of course to follow, not to precede, the evacuation
of the bowels; but at any time when there is a tendency toward
additional evacuation on the admission of the hot water, the new douche
is easily adjustable to the contingency without removal from the anal
canal; it will facilitate the escape of the feces with the return flow
of the water. The new recurrent douche has therefore the great
advantage of promoting simultaneously both the thorough evacuation of
the bowels, and the therapeutic effect of hot water.


_Sitz-Bath._

There are patients who, because of years of neglect of their local
ailments, are taken with severe attacks of inflammation of the anus and
rectum, involving considerable prolapse, much swelling around the anus,
and general local soreness and pain; all of which is often accompanied
by a general disrelish of life. For this condition nothing is so good
as a very hot sitz-bath, if properly adjusted to the parts and
continued for about an hour at a sitting. The alleviation afforded is
so decided and the local and prolonged application of hot water so
restorative that it may be left to the sufferer to determine how often
this bath is to be repeated. It may be taken as often as there is an
inclination to do so. The sitz-bath apparatus should be scientifically
adapted to the parts so that the bather will not sit lower than ten or
twelve inches, thereby avoiding a straining position. During the bath
there should be more or less pressure against the anal tissues, which
assists the hot water in expelling the blood from the inflamed parts.
From the beginning to the end of the bath the water must be as hot as
the tissues will tolerate. Only a small portion of the buttocks need be
immersed in the hot water.


_Spring Water the Ideal Beverage._

Those who suffer from disease of the rectum, with rare exceptions, are
constipated or semi-constipated, which condition in turn aggravates or
disturbs the inflamed parts. To overcome this constipated condition all
sorts of laxatives are taken, which will in the end do grave harm not
only to the whole system, but especially to the inflamed parts,
irritating them still more. There is a valuable therapeutic agent
seldom taken by the constipated; in fact, it is never thought of;
unfortunately the remedy is not easily to be had in its pure state by
most of us, boxed as we are in cities. Sold under various names as
mineral water, it is too often adulterated. 'Tis a simple remedy, and
yet it has a wider range of healing power than any other; a universal
solvent, applicable to all diseases and all states of health. I would
write it at the head of all remedial agents: pure spring water! We do
not drink enough water. If we were to imbibe at least two quarts of
pure water daily we would be healthier and have better movements of our
bowels. Water may be taken freely during mealtime; not, however, for
the purpose of washing down half-masticated food. Alcoholic drinks,
coffee and tea would better be dispensed with, also tobacco. The
nervous system has enough to bear without the use of avoidable
irritants.


_Other Hygienic Agencies._

Too much cannot be urged as to the advisability of a proper amount of
exercise, sleep, rest, food, breathing, cleanliness (internal and
external), as well as and above all, pure, high-minded thoughts and
serene temper--the outcome of the habit of viewing life
philosophically. Care should be taken to protect the feet and body from
sudden climatic changes, thus avoiding catarrhal troubles, especially
of the lower bowels.

As to the wise and proper use of nature's pharmacopoeia, nothing need
be said here. However, I may be within my limits when I advise patients
to use a little sense and not neglect disease of the lower bowel any
more than they would neglect that of the eye, ear and throat. In the
latter case they submit at once to an examination. Why not in the
former? Let them bear in mind that the cure of chronic proctitis is no
holiday job; that it is, on the contrary, a task which requires
constant attention. To merely relieve the annoying symptoms that
accompany it cannot be called a cure. But on the other hand relief may
be the commencement of a cure. Of course the true way of looking at the
subject of this disease is to regard the cure of proctitis as
necessarily leading to the disappearance in time of all the other
troubles that were the outcome of that ailment. Through the harmonious
efforts of patient and physician, marvellous results are often
obtainable.




CHAPTER XXVII.

THE BODY'S BOOK-KEEPING.


Man's food is as varied as his work, more varied than the climate, with
one food for the luxurious and one for the poor. The majority of us
take what we can get, making no complaints; even when we have a cook
and a good one the same is true. The ideal diet prepared by the ideal
cook no one has as yet made fashionable, but one thing is within the
reach of all--cleanliness of the sewers of the body. Keep the contents
of the bowels moving down and out steadily and regularly and you may
eat almost any food and in almost any preparation and still be healthy.

Just as a steam-engine, running at a given rate of speed, must be
supplied with fuel sufficient to maintain that speed, so the human body
must have the requisite food to maintain the speed of civilized society
and business, and replace the waste of the tissues; otherwise decline
sets in and the reserve store of strength is exhausted. How shall we
determine the proper amount and kind of food for the various ages,
sexes, and conditions of life?

A leading authority says that the character and amount of the daily
excreta furnish suggestions as to the required food supply. (Kirk's
_Physiology_, p. 208.) These excreta are found to be carbon, nitrogen,
hydrogen, oxygen in great part, with some sulphur, phosphorus,
chlorine, sodium, etc. A summary is given (_ibid._, p. 432) of the
expenditure for twenty-four hours:

    1. From the lungs:
         Carbonic acid                about  15,000 grains
         Water                           "    5,000   "

    2. From the skin:
         Water                           "   11,500   "
         Solid and gaseous matters       "      250   "

    3. From the kidneys:
         Water                           "   23,000   "
         Organic matter                  "      680   "
         Saline bodies                   "      420   "

    4. From the intestines:
        Water                            "    2,000   "
        Organic and mineral substances   "      800   "

    Total daily expenditure:
        Solid matters                    "   17,150   "
        Water                            "   49,500   "

      Altogether about eight and a half pounds.

    The credit side of the sheet is about as follows:

    Solids (chemically dry foods)        "    8,000 grains
    Water, combined or otherwise   35,000 to 40,000   "
    Oxygen, absorbed by the lungs        "   13,000   "

      Altogether about eight and a half pounds.

With the proper balance between the intake and the outgo, the functions
of the body will be carried on normally, but the balance must be a
proper one; that is, not only must the entire waste be repaired but the
correct proportions of one kind of food and another must be observed.
If all the elements needed are not furnished there can be no true
counterpoise.

How do we expend the energy? By the common wear-and-tear incident upon
all voluntary motion, all work and recreation, carrying on the internal
movements of digestion and respiration, by thinking, by loss of
temperature, by indulgence of any of our functions, and by any wrong
indulgence especially. Excessive use, voluntary or otherwise, will of
course diminish our total capital and cut short our lives. Could we
always maintain the right balance we need never die.

The importance of what has been said must now be clearly apparent. We
ought to be wisely interested in choosing the proper foods for our
daily needs and in having them properly prepared; we ought to know how
much carbohydrates we need, how much proteids, and regulate our diet
accordingly. The foods which contain nitrogen are chiefly the
following: flesh of all animals, milk, eggs, leguminous fruits (peas,
beans, lentils); those which contain carbohydrates chiefly are bread,
starch, vegetables and especially potatoes, rice, etc.; foods supplying
fat are butter, lard, fat of meat, etc. Salts are furnished in almost
all other substances, but especially in green vegetables and fruits.
Liquid food is obtained by water, too often neglected, and tea, coffee,
beer, cider, etc.

Alcohol has no power to form tissue or to repair waste and cannot be
regarded as a true food. Tea and coffee are almost entirely stimulant,
not nutritious, and should be taken sparingly or not at all.

The common mistakes in diet are over-feeding or taking too much of one
kind of food, and of the latter class perhaps an excess of starchy food
is the most mischievous. If taken in excess, especially by the young,
the starchy foods are not digested and what does not digest must
putrefy: the result is a bowel distended with harmful gases. Many
people eat too much nitrogenous food, with resulting plethora or gout.
A great deal of vigorous exercise in the open air is required to use up
such a diet.




CHAPTER XXVIII.

SELECTION AND PREPARATION OF FOOD.


The requirements for normal digestion, assimilation and elimination
are: (1) An intestinal canal clean and sound from mouth to anus; (2)
nutritious food properly prepared; (3) regularity and moderation in
eating; (4) free use of pure water, sufficient to forward the
emulsification and assimilation of the food and the elimination of
waste--whether that waste be of the residual portion of the food or of
detritus of tissue; (5) a seasonably clad body, free from fatigue or
loss of sleep; (6) a cheerful mind.

Every sensible person will grant that a good digestion of vegetable or
animal food furnishes sufficient steam and stimulus for the physical
man; that a good digestion of intellectual food (ideas) furnishes the
corresponding requisites for the mental man; and that exalted
sentiments are the pabulum of the spiritual.

Why over-stimulate the physical, and reflexively degrade the mental and
spiritual, by indulgence in tea, coffee, beer, wine, liquors, opium,
tobacco, etc.? Over-stimulation will bring on indigestion; and
prostration will follow that. Remember that Nature does not carry long
credit accounts.

A suggestion for the selection and preparation of physical foods is
here given; this book being hardly the place for a corresponding list
of mental and spiritual foods.

    FOODS EASY OF DIGESTION.

    ARTICLES OF FOOD     HOW PREPARED        TIME OF DIGESTION

    Venison steak            Broiled         1  hour  30 minutes
    Pig's feet soused        Boiled          1   "    00   "
    Brains                   Boiled          1   "    45   "
    Salmon, tripe or trout
      (fresh)                Boiled or fried 1   "    00   "
    Eggs, fresh              Whipped         1   "    30   "
    Rice                     Boiled          1   "    00   "
    Sago or barley           Boiled          1   "    45   "
    Apples, sweet and mellow Raw             1   "    30   "
    Tomatoes or lettuce      Raw             1   "    30   "
    Melons or watercress     Raw             1   "    20   "
    Peaches, plums or pears  Raw or stewed   1   "    30   "
    Oranges or bananas       Raw             1   "    30   "
    Asparagus or dandelion   Boiled          1   "    30   "
    Onions or apricots       Stewed          1   "    30   "
    Mushrooms                Boiled          1   "    30   "
    Cereal coffee            Boiled          1   "    30   "
    Blackberries                             1   "    30   "
    Grape-nuts                               1   "    00   "
    Lemons                                   1   "    00   "
    Watermelons                              1   "    00   "
    Doxsee's clam juice and
      little neck clams                      1   "    00   "
    Milkine, Horlick's and Mellin's food     1   "    30   "
    Cereal milk                              1   "    00   "
    Armour & Co.'s Vigoral.                  1   "    00   "
    Valentine's or Wyeth's beef juice
      or Wiel's beef jelly                   1   "    00   "


    FOODS NOT SO EASY OF DIGESTION.

    ARTICLES OF FOOD     HOW PREPARED        TIME OF DIGESTION

    Beef                     Boiled          2  hours 00 minutes
    Pig, sucking             Roasted         2   "    30   "
    Liver, beef (fresh)      Broiled         2   "    00   "
    Lamb, fresh              Broiled         2   "    30   "
    Turkey, domestic         Roasted or
                               boiled        2   "    30   "
      "     wild             Roasted         2   "    18   "
    Goose     "              Roasted         2   "    30   "
    Chicken                  Fricasseed      2   "    45   "
    Codfish, cured and dry   Boiled          2   "    00   "
    Oysters, fresh           Raw             2   "    35   "
    Hash (chopped meat and
      vegetables)            Warmed          2   "    30   "
    Eggs, fresh              Roasted         2   "    15   "
      "     "                Raw             2   "    00   "
    Milk                     Boiled          2   "    00   "
     "                       Uncooked        2   "    15   "
    Gelatine                 Boiled          2   "    30   "
    Custard                  Baked           2   "    45   "
    Tapioca or barley        Boiled          2   "    00   "
    Beans, green             Boiled          2   "    30   "
    Sponge cake              Baked           2   "    30   "
    Apples, sour and mellow  Raw             2   "    00   "
      "       "   "  hard    Raw             2   "    50   "
    Parsnips or green corn   Boiled          2   "    30   "
    Potatoes and yams        Roasted or
                               baked         2   "    30   "
    Cabbage, head            Raw             2   "    30   "
      "       " with vinegar Raw             2   "    00   "
    Cauliflower              Boiled          2   "    00   "
    Peas (green) or squash   Boiled          2   "    00   "
    Cranberries or cherries  Stewed          2   "    00   "
    Rhubarb or figs          Stewed          2   "    30   "
    Turnips                  Boiled          2   "    30   "
    Sprouts                  Boiled          2   "    00   "
    Raspberries              Raw             2   "    00   "
    Dates                    Raw             2   "    00   "
    Buttermilk               Raw             2   "    00   "
    Pumpkin                  Cooked          2   "    00   "


    FOODS SOMEWHAT DIFFICULT OF DIGESTION.

    ARTICLES OF FOOD     HOW PREPARED        TIME OF DIGESTION

    Beef, fresh, lean        Broiled         3  hours 00 minutes
      "     "      "         Roasted         3   "    00   "
    Beef, dry                Roasted         3   "    30   "
      "    with salt only    Boiled          3   "    45   "
      "     "  mustard, etc. Boiled          3   "    30   "
    Pork, steak              Broiled         3   "    15   "
      "    recently salted   Broiled         3   "    15   "
      "       "       "      Raw             3   "    00   "
      "       "       "      Stewed          3   "    00   "
    Mutton, fresh            Broiled         3   "    00   "
      "       "              Roasted         3   "    15   "
      "       "              Boiled          3   "    00   "
    Flounder, fresh          Boiled          3   "    30   "
    Oysters, fresh           Roasted         3   "    15   "
      "        "             Stewed          3   "    30   "
    Codfish (salted) or
      whitefish              Boiled          3   "    00   "
    Sausages, fresh          Broiled         3   "    20   "
    Rabbits                  Broiled         3   "    00   "
    Butter or cream                          3   "    00   "
    Eggs, fresh              Hard-boiled
                               or fried      3   "    30   "
     "      "                Soft-boiled     3   "    00   "
    Potatoes, turnips
      or carrots             Boiled          3   "    30   "
    Radishes or lentils      Boiled          3   "    30   "
    Bread (white) fresh      Baked           3   "    15   "
      "   whole wheat        Baked           3   "    30   "
      "   rye                Baked           3   "    30   "
      "   graham             Baked           3   "    30   "
      "   corn               Baked           3   "    15   "
    Corn cake                Baked           3   "    00   "
    Apple dumpling           Boiled          3   "    00   "
    Soup, mutton or oyster   Boiled          3   "    30   "
      "   bean               Boiled          3   "    00   "
      "   chicken            Boiled          3   "    00   "
    Chocolate or cocoa       Boiled          3   "    00   "
    Currants or filberts                     3   "    00   "
    Raisins                                  3   "    00   "
    Hazelnuts                                3   "    30   "
    Peanuts                  Roasted         3   "    00   "
    Potatoes (sweet)         Roasted         3   "    00   "
    Walnuts                                  3   "    30   "
    Chestnuts                Roasted         3   "    15   "
    Beans, lima              Boiled          3   "    00   "
    Zwieback                                 3   "    00   "
    Turkey                   Boiled or
                               roasted       3   to    4 hours
    Eels                     Fried           3   "     4   "
    Oleomargarine                            3   "     4   "
    Cabbage                  Boiled          3   "     4   "
    Buckwheat cakes                          3   "     4   "
    Mutton, lean             Roasted         3   "     4   "
    Herring                  Broiled         3-1/2 "   4-1/2 "
    Cheese                                   3-1/2 "   6   "


    FOODS VERY DIFFICULT OF DIGESTION.

    ARTICLES OF FOOD     HOW PREPARED        TIME OF DIGESTION

    Beef, fresh, lean        Fried           4 hours  00 minutes
      "   old, hard, salted  Boiled          4   "    15   "
      "   recently salted    Boiled          4   "    30   "
      "      "        "      Fried           4   "    15   "
      "   fat or lean        Roasted         5   "    15   "
      "   suet (fresh)       Boiled          5   "    30   "
      "   soup with vegetables
          and bread          Boiled          4   "    00   "
    Beef, soup from marrow
      bones                  Boiled          4   "    15   "
    Pork, fat and lean       Roasted         5   "    15   "
      "   recently salted    Boiled          4   "    00   "
    Pork recently salted     Fried           4   "    15   "
      "   ham                Cured           4   "    30   "
    Veal                     Broiled         4   "    00   "
      "                      Fried           4   "    30   "
    Mutton, suet             Boiled          4   "    30   "
    Fowls                    Boiled or
                               roasted       4   "    00   "
    Heart, animal            Fried           4   "    00   "
    Salmon, salted,
      or mackerel            Boiled          4   "    00   "
    Cabbage, with vinegar    Boiled          4   "    30   "
    Cheese, old, strong      Raw             3-1/2 to 6-1/2 hours
    Duck                     Roasted         4 hours  30   "




CHAPTER XXIX.

DIET FOR INDIGESTION.


Indigestion is a symptom of a functional disturbance or is due to a
local disease in some portion of the digestive apparatus. Therefore
diet must be adapted to the sensibility of the stomach and bowels,
to gastric and intestinal secretions, mobility, absorption and
elimination, to the abnormal increased feeling of hunger or to the
absence of the sensation of hunger.

The food should be of easy solubility and offer slight resistance to
the digestive juices. It should not mechanically or chemically irritate
or impede intestinal peristalsis. It should not increase fermentation
or putrefaction and the greater portion of it should be absorbed.

The object of diet is not to eat less food than usual but to secure
more nourishment until the proper quantity is consumed each day. The
restriction of foods does not mean limitation. Regular hours for meals
should be religiously observed by sufferers from indigestion. The food
should be thoroughly masticated. Good judgment should be used by each
individual in selecting and preparing the foodstuffs; also in the
amount taken at each meal, and the proper length of time to continue
the diet.

You may take:

    _Soup_--in moderate quantity: Doxsee's clam juice, and little neck
    clams; cream of peas, etc.; vermicelli; tapioca; tomato; clear
    soups of chicken, beef, mutton.

    _Fish_: trout; bass; perch; shad; weakfish; whitefish; smelts; raw
    oysters.

    _Meat_: roasted or boiled beef; mutton; venison; calf s head;
    tongue; sweetbread; lamb chops; squab; roasted partridge; pigeon;
    calf's-foot jelly; Armour & Co.'s Vigoral; Valentine's or Wyeth's
    beef juice, or Wiel's beef jelly.

    _Eggs_: raw; soft-boiled; poached; omelette; eggs on toast.

    _Bread_--all over a day old: brown; graham; gluten; rye; zwieback;
    crackers; cracked wheat; corn meal; hominy; wheaten and graham
    grits; rolled rye and oats; granose; cerealin; macaroni with
    toasted bread-crumbs; farina, boiled with milk; Milkine; Horlick's
    or Mellin's food.

    _Vegetables_: spinach; green peas; greens; lettuce; watercress;
    sweet corn; asparagus; celery; artichokes; baked tomatoes;
    cauliflower.

    _Dessert_: baked, roasted or stewed apples; stewed pears or
    peaches; baked bananas; grapes; oranges; and most ripe fruits, if
    fresh.

    _Beverages_: hot, cool or cold water an hour before meals. Drink
    freely of the same during meal-time, but not to wash down food.
    Drink also: cereal coffee; buttermilk; koumiss; fresh cider;
    bouillon.

    _Avoid_: coffee; tea; milk; ice-water; cocoa; chocolate; malt
    liquors; spirituous liquors; sweet and effervescent wines; sugar;
    candies; foods containing much starch; rich soups; sauces and
    chowders; all fried foods; hot or fresh bread; griddle-cakes;
    doughnuts; veal; pork; liver; kidney; hashes; stews; pickled,
    canned, preserved and potted meats; turkey; goose; duck; sausage;
    salmon; salt mackerel; cabbage; radishes; cucumbers; cole-slaw;
    turnips: potatoes; beets; pastry; jellies; jams; nuts.




CHAPTER XXX.

DIET FOR CONSTIPATION AND OBSTIPATION.


Diet is too often a makeshift for ignorance, or it may be an aid until
the cause of indigestion is removed; or if not curable, a compromise
effected on the best possible terms for continued existence. We have
found out the almost universal cause for constipation, obstipation and
costiveness; therefore until you can have the proper local treatment we
suggest the following foodstuffs, trusting to the sufferer's judgment
how much and how often to take the nourishment.

Coarse foods, stimulants and laxatives unduly excite the bowels. Avoid
them if possible. Be regular in your habits as to meal-times; eat three
times daily, and about an equal amount at each meal.

You may take:

    _Soup_: all kinds of meat and vegetable soup; broth; bouillon.
    Reliable preparations of beef juice, jelly, etc.

    _Fish_: all kinds, broiled or baked; raw oysters; Doxsee's clam
    preparations.

    _Meat_: boiled or roasted; poultry; game, etc.

    _Bread_: graham; brown; whole wheat; corn; rye; ginger;
    shredded-wheat biscuit.

    _Cereals_: wheaten grits; wheatena; granose; oatmeal porridge;
    Milkine; Horlick's and Mellin's food.

    _Vegetables_: cauliflower; spinach; beans; asparagus; carrots;
    onions; Brussels sprouts; tomatoes; peas; celery; cabbage.

    Vegetables should be especially well cooked to render them soft and
    easy of digestion.

    _Salads_: may be eaten if dressed with a generous supply of olive
    oil.

    _Dessert_: oranges; melons; prunes; tamarinds; figs; apples (raw or
    baked); pears; plums; peaches; cherries; raisins; stewed fruit;
    honey; blackberries; strawberries; huckleberries; bananas.

    Some may find it advantageous to eat fruit before or between meals.

    _Beverages_: water--pure spring water preferably; if this cannot be
    had, get, if possible, distilled water that has been aërated;
    buttermilk; fresh cider; beer; ale.

Mineral waters like Hunyadi, etc., irritate the cause of constipation
(proctitis) in a way similar to cathartic remedies.

Drink a tumbler or more of hot or cold water an hour before
meals--preferably hot water. If the hot water be distasteful add a
little salt. Drink freely of water about the temperature of 60° during
the meals, but not for the purpose of emptying the mouth of food.

On retiring at night and rising in the morning sip slowly from a
quarter to half pint of water (hot or cold). In the morning be sure to
rinse the mouth free of the accumulated mucus before drinking the
water.

The use of tea, chocolate, coffee and alcoholic drinks is so abused by
those even who consider themselves temperate in their habits, that I
recommend these beverages as remedies only in certain conditions of the
system.

About four pints of pure water (_i.e._, free from all salts or other
foreign ingredients) should be imbibed in twenty-four hours.

    _Avoid_: sweets; pastry of all kinds; puddings; rice; milk; cheese;
    new bread; nuts; fried foods; rich gravies; farina and sago
    puddings; salt meats; salt fish; veal; goose; liver; hard-boiled
    eggs; pork; tea; tobacco; spirituous liquors; uncooked strawberries
    and huckleberries. Avoid also tomatoes and peaches when not fresh,
    as the acid generated by keeping them a few days is very irritating
    to an already inflamed bowel.

Avoid substances that would inflame the tissues or cause congestion of
any organ of the body. If the tongue be coated avoid sugar, starchy
foods and fresh milk.




CHAPTER XXXI.

COSTIVENESS, DIET, ETC.


Take anything in the way of food which the unconsciously starved person
can eat without the stomach and intestines protesting too much; any of
the foods recommended for constipation, indigestion, diarrhea; and take
yet more food if by so doing there is a gain in flesh, after exercising
much patience as to time.

Irrigate the system by imbibing freely of hot and cold water at various
periods of the day. Good red wine mixed with the water drunk at
meal-time may serve a good purpose in helping to enrich the blood.

Keep the pores of the skin open by bathing; and all the functions of
the body active by exercise, massage, pure air, sunlight, rest, sleep
and seasonable clothing.

The large intestines should be kept clean by proper amounts of water
injected into them. The local cause of all the trouble should be
treated by a competent physician.

And with all the efforts, continue the treatment long enough to
accomplish some good and then a much longer time to get well. Do not
give up treatment under which you have improved if it requires one, two
or three years to accomplish what you have so well started out to do.




CHAPTER XXXII.

DIET FOR DIARRHEA.


A period marked by constipation, biliousness or poisons generated
within or taken into the intestinal canal is often followed by
diarrhea. Mental excitement will induce it in some persons. More often
man's early and most common malady, proctitis, is the direct or
indirect cause. Some forms of ulceration of the lower bowel induce
diarrhea. Chronic cases of diarrhea usually follow the decline of
vitality marked by the symptom of Costiveness, which means the
interruption of all the functions of nutrition. The intestinal canal is
then like a rubber tube with the contents hurried through it. The whole
system is irritable as the result of an accumulation of secondary
symptoms expressed by the word auto-intoxication.

The food should be nutritious and non-irritating to the intestinal
canal.

Reliance must be placed, in severe cases, on liquid foods and
beverages.

The more solid foods may be taken in limited quantity as the recovery
progresses. In more acute cases it is well to stop all food for twelve
or twenty-four hours.

You may take:

    _Liquid Food and Beverages_: Drink, if possible, pure spring water.
    If this cannot be obtained, sterilize the water, or distil and
    aërate it; it must be pure and soft. Better still: drink toast- or
    rice-water; kefyr, four days old; koumiss; lactic-acid water;
    zoolak; egg lemonade; sterilized milk with one third lime-water;
    whortleberry wine; acorn cocoa; unfermented grape-juice.

    _Soup_: chicken; mutton; clam; oyster broth; Doxsee's clam-juice;
    bouillon; Milkine; Horlick's and Mellin's food.

    _Meat_: minced chicken; scraped beef; roast fowl; beef steak;
    fillet of beef; raw beef; sweetbread; raw oysters.

    _Eggs_: lightly boiled, poached.

    _Cereals and Fruit_: grapes at all hours, eaten without seeds or
    skin; arrowroot; tapioca; sago; barley mush; macaroni; rice boiled
    with milk; milk toast; dry toast; crackers; junket; bread pudding;
    egg pudding, not sweetened; hasty pudding, with flour and milk;
    mashed potatoes.

    _Avoid_: pork; veal; nuts; salt meats; fish; fried foods; sugary
    foods; fruits, cooked or raw; oatmeal; brown and graham bread; new
    bread; vegetables; and most soups.




A FINAL WORD TO THOSE TO WHOM I HAVE DEDICATED THIS BOOK.


It is very evident from the perusal of this work that the symptoms of
proctitis, both general and local, proceed from no trifling disease;
and also that the disease may have existed for a very long time,
perhaps as much as twenty, forty or more years. During the greater part
of its existence all sorts of medication have been tried to allay this
or that annoying prominent symptom with a hope of a cure.

At the congress of physicians that met in Paris in 1900, one of the
subjects discussed was chronic constipation and their "wise" conclusion
was that man needed more grease, therefore they mourned the loss of the
frying-pan.

Symptoms induced by proctitis in various parts of the body are often
accompanied by painful local symptoms, called piles or a "touch of the
piles." Then local medication is added to the general treatment, and as
usual matters go from bad to worse. Physicians consulted have been
honest and kind, but with all their advice the increasing troubles
continue. Your demands grow more pressing on your doctor and as a last
resort he mentions a surgical operation for the removal of one or more
painful local symptoms. The fright is sufficient in most cases to make
the sufferer endure the ills he has rather than flee to others he knows
not, even risking life itself. Others more bold submit to an
examination by the surgeon, which proves so painful at the time and
causes so much subsequent suffering that they are now really content
not to importune any more for help.

A few in desperation make up their minds to have the local anal symptom
removed regardless of the final result.

Thus millions of human beings have suffered and died and countless
numbers are enduring the ills they have, not knowing of a rational and
humane system of treatment; a treatment that not only removes the
numerous annoying symptoms, but _the cause as well_; a system that will
stand the test of time, _of common-sense_, _of constant investigation_
to know the _why_ and _wherefore_ of both disease and treatment.

For over twenty years I have concerned myself with this and allied
ailments, and have treated--without the use of the knife--all cases of
piles, polypus, fissure, stricture, ulcerations, etc. At the present
time physicians are writing me in this wise: "I want to take a course
of instruction from you. I have performed some successful surgical
operations on the rectum, but it is not profitable; the people will not
submit to it." Another writes: "Your treatment of hemorrhoids has been
brought to my notice by my friend and patient, Mr. ----.  The method
you practise is certainly an ideal one and seems to have been most
successful in your hands, and I would like to adopt it."

To physicians and laymen interested, I will send, for twenty-five
cents, my treatise on Diseases of the Anus and Rectum (entitled _How to
Become Strong_). It contains over 100 anatomical illustrations, and 125
testimonials, and forms, therefore, a valuable adjunct to this volume.

All whose testimonials appear in the 64-page book suffered from
proctitis to a greater or less extent and with the exception of a few
all suffered from chronic constipation, indigestion, etc.

Surgeons usually desire strong and vigorous patients. The author asks
merely for an intelligent patient, or for some one to direct the home
attention necessary between treatments.

This book, as well as the one entitled _How to Become Strong_, and the
author's other printed instructions, are the result of his desire to
make his patients intelligent on the subject of the disease and
symptoms for which they seek his assistance. They truly cannot know too
much for their own good in this regard; an ignorant patient can not do
justice either to himself or to his physician. Those who have tried all
the fads and so-called cures in order to relieve their troubles will
certainly appreciate what I have here presented for their study. With
enlightenment comes the desire to set things right. So I have no appeal
to make to the lazy: I shall leave them to their ills and their pills.
And for those who appreciate the beauty of cleanliness, both external
and internal, I shall write another book on that subject, including a
prophecy for coming generations. Eternal vigilance is the price we must
pay if we would enjoy the highest physical, mental and spiritual
expression of our personalities.

Thanking the indulgent reader who has read my description of Intestinal
Ills, I advise him to rewrite it in his own organism, if not in
printer's ink: the world will be better for it!




INTESTINAL ILLS.

NO. 1.

CHRONIC CONSTIPATION AND THE USE OF THE ENEMA.


"Civilized" man is the victim, by inheritance from distant ancestors,
of undesirable characteristics, traits, and tendencies. While, during
the long process of evolution, some of the cruder features of the
physical and mental traits have been refined or eliminated, the modern
man still clings to certain habits inherited from his wholly
animalistic days. Even as the man of that day, so the man of to-day
eats far too much and far too frequently.

To the scientific eye, your capacious digestive apparatus is a
psycho-physical exhibit of the racial proclivity to overeat. Here, in
this exhibit, the race's inordinate craving for food and drink, its
gluttonous thought, have embodied themselves; and this exhibit, this
apparatus, is accordingly not merely physical, but also psychical, for
its sub-conscious outreach for "more and always more" is only too
apparent. Man's stomach and bowels are too much like those of a mere
animal, and are the source of nine-tenths of his ills.

All great consumers of foodstuffs, Nature declares, should walk on all
fours; if you will persist in walking on your hind legs, you will have
to pay the penalty. You will, moreover, contract other habits not
conducive to real animal health. And, as Nature predicted, man's social
customs to-day are out of all accord with gluttonous feeding; he, as
well as his capacious bowels, suffers the consequences of his excessive
feeding, and this suffering leads him to adopt artificial means for
relief or escape. Up-to-date civilization has constrained man to adopt
a cooped-up existence, one that shuts out, to a great extent, sunshine
and air; an existence, moreover, that involves but a limited amount of
exercise. How, then, can it be otherwise than--gormand that he is--that
he should fare ill with this gluttonous, mammoth digestive canal?

Man is not as yet more than half human, and he will not become truly
human until he makes more use of the upper lobes of his brain, nor
until the spiritual part of his nature becomes dominant. When that day
dawns he will have a corresponding evolution of the physical body,
especially of the gastro-intestinal canal. Some one has sagely said
that man's brain is a mere extension of his intestinal canal. Well,
possibly by and by the intestinal canal may become an extension of a
spiritually awakened mind, with all its dominating influence over the
physical body. Surely the evolutional trend from animal to complete
manhood may be aided by intelligent foresight as to bodily care and
hygiene.

Cooped up like a canary bird, or penned up and fattening like a hog,
with his enormous eating capacity and vast intestinal storage space,
poor man has matters made worse by having his several orifices liable
to inflammatory invasions. He does not seem able to escape from his
enemies anywhere.

The mucous membrane lining the orifices of the body is nothing more
than the skin turned in to line canals for air, gases, liquids, and
solids to pass in and out in order to keep up the physio-logical
functions of the body. Very rarely, indeed, do we find, from childhood
to old age, the orifice of the intestinal sewer otherwise than
chronically inflamed, the invasion extending, moreover, the whole
length of the rectum for some distance into the sigmoid colon.

It is no trifling matter to have the function of some thirty feet of
the gastro-intestinal tract disturbed, especially of the large
intestine--some five feet in length, two and a half inches in diameter
in not a few sections.

Almost without exception, we find the lower portion of the intestinal
sewer the seat of chronic inflammation that extends into the sigmoid
colon; and, as an inevitable result of the inflammation, contraction
more or less permanent has taken place in the circular and longitudinal
muscular bands that form its structure. The constriction is especially
severe at the junction of the rectum with the sigmoid colon, where it
flexes upon itself in the region where the bore of the rectum is less.
The comparative shutting up of the caliber of the upper end of the
rectum and lower portion of the sigmoid colon occasions undue retention
of the feces and gases which accumulate, and in accumulating dislocate
various portions of the large intestine, thus forming pouches, sacks,
reservoirs, prolapse, etc., which hold the products of putrefaction as
well as the irritating, poisonous mucus thrown out from the inflamed
tissue.

I regard the occlusion of the upper portion of the rectum, and
especially of the region involved in the flexure of the bowel, as the
most usual seat and source of constipation. Not so very long ago it was
the custom to stretch the sphincter muscles for the "cure" of
constipation; at the present time the "cure" is found in the valves of
the middle lower portion of the rectum. The folly of these "cures"
becomes apparent when we understand that the parts treated were neither
the seat nor the source of constipation. I have always regarded great
retention of feces in the rectum as _impaction_ in a delivery canal,
due to contraction of the anal muscles, not as constipation, which can
only take place in the temporary storage-place--the sigmoid flexure.
The lower two-thirds of the rectum plays no part in constipation of the
bowels.

Form a manikin, made out of very thin, soft rubber tubing, to represent
the stomach and small and large intestine, holding the various parts in
place with elastic bands, and cotton to represent fat. When all
portions are properly and anatomically placed close the lower eight or
ten inches of the manikin, representing the lower portion of the
sigmoid colon, rectum, and anus, just as tightly as we should find it
closed in sufferers from chronically acute proctitis and colitis. Now
insert at the stomach portion of the manikin a generous amount of man's
usual mixture of foodstuffs and liquids, and repeat the supply three or
four times during the day (without any previous attempts at cleansing),
and then note the fermentative and putrefactive changes that take
place; the ensuing bacterial poisons and the great volume of poisonous
gases--all of which occasion squirming, twisting movements of the
manikin as dislocations here and there occur, as pouches and reservoirs
develop, as the walls become distended with gas and putrid substance;
and then, time elapsing, the usual foodstuffs are added to the foul
mass within! Now, if there is any pity in your soul, you medical man,
for the enfouled and deformed human manikin, you will want to wash it
out with cleansing water before its structure comes to an untimely end.
We medical men all know the numerous and grave symptoms exhibited by
one or more organs of the body, or by all of them, from the persistent
work of the deleterious gases and bacterial poisons on the system--a
work going on for years, finally placing the victim beyond medical aid.
All of us are agreed that the capacious gastro-intestinal canal should
be clean. What, I submit, is the best means of keeping clean this long,
large, tortuous, spacious, valved and flexed canal--a canal that
disease has here and there pouched, dislocated, bagged, reservoired; a
canal at whose lower end a great cesspool exists; that, like other
portions of the gut, is never empty and clean--what is the best means
but a flushing with copious amount of water?

Proctitis or colitis is a very serious disease; like a railroad injury,
it is found, on examination, to be much worse than appearances at first
indicated.

A physician who prescribes for a case of chronic constipation or
diarrhea without first examining the sufferer for proctitis and
colitis, is either ignorant or does wilful harm to his patient and
injury to his practice. The abominable, aboriginal and almost universal
custom at the present time of giving some physic to "cleanse" the
gastro-intestinal canal is in every respect a deplorable mistake for a
conscientious doctor to make.

Many persons suffering from chronic constipation drink very little or
no water. As a consequence, they are a sort of dirty, dried-up plant,
with but little juice of life in them.

Others, again, equally unclean, or more so, take a moderate amount of
fluid every day, and present a more or less roly-poly appearance, with
considerable abdominal distention, due to malnutrition and gases. Of
course, their eyes, skin, tongue, breath, and lack of vim and vigor
tell the story of a long process of self-poisoning, with every now and
then the eventuation of a storm of foulness, called a bilious
attack--meaning an overflow of filth. Death often brings about a
radical change in such poisoned bodies.

Now, what can a prescriber of a gastro-intestinal ejector expect to
accomplish by disturbing the maleconomy of this apparatus? Usually he
expects that considerable trouble will ensue; consequently, he will add
belladonna or some other soothing drug to mitigate the act of expulsion.
The ejector (called laxative, purgative, cathartic) occasions
irritation, which sets up twisting, writhing, rumbling of the bowels,
accompanied with a shower of liquid into the canal (as tears fill the
eyes from the effects of sand or a blow), which liquid mingles again
with the putrid refuse materials, from which it had been recently
absorbed, and, mingling, proceeds to fill up the normal and abnormal
spaces just described, _to be again reabsorbed into the system_. Oh,
the foulness of it all! The spirits of the departed, as well as the
still incarnate patients, demand of the healing art safe and sane
hygienic methods of cure. _The enema, regularly and properly used, is
the remedy par excellence._

Those that suffer from chronic constipation are usually deficient in
the quantity and quality of intestinal secretions. Physic increases the
depletion of the intestinal juices. Of the watery secretion forced into
the bowels, four-fifths are reabsorbed into the system, plus poisons
and filth. The system soon becomes accustomed to the irritation of
drugs, and requires an ever-increasing amount. These irritate and
increase the chronic inflammation of the lower bowel, often to the
extent of a discharge of blood.

Straining effort to induce defecation is injurious. The use of massage,
of vibratory exercises, of electricity; the spraying of cold water on
the abdomen, etc.,--none of them are calculated to remove or even to
relieve the proctitis and colitis.

The temperature of the water used for an enema should be about one
hundred degrees. It should be taken at least twice daily, preferably on
retiring at night and soon after breakfast, at regular times, if
possible. Such practice obviates the need of large injections.

In beginning the use of the enema it is well to inject from a half to a
pint of water, and expel it. This constitutes a preliminary injection.
Frequently it is desirable to take another preliminary injection before
taking the large one, which latter is variously called "flushing the
colon," "taking an enema," "taking an internal bath" or "a washout,"
etc. It is essential first to get rid of the feces and gases in the
rectum, so that they be not sent back when you proceed to flush the
colon.




NO. 2.

OBJECTIONS TO THE USE OF 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 should 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. Eye-glasses, 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 loads; it
cleanses and soothes an organ that must be kept at work and perform its
functions 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 75 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 whoever 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 80 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
instil 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 to the organs,
and more especially 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 one of disturbance and
poison to the system. It is, therefore, a most unnatural condition.
What is more rational, consequently, 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 will 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
intestines 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 naive: "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 effect 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 he
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 marvellous 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.




FOURTEEN REASONS

WHY WE SHOULD BATHE INTERNALLY AS WELL AS EXTERNALLY


 1. Because very few persons are free from chronic inflammation of the
anus, rectum, and sigmoid flexure, which causes contraction of the
caliber of the organs.

 2. None escape self-poisoning from the gastro-intestinal canal. Many
are constantly being poisoned from the entrance of bacterial and other
toxic substances into the system.

 3. Nine-tenths of the ills that afflict mankind have their origin in a
foul digestive apparatus and a consequently poisoned body.

 4. Disease of the anus, rectum, and sigmoid flexure results in from
two-thirds to three-fourths of the feces being daily absorbed into the
system.

 5. Feces unduly retained become very foul or malodorous. If the feces
of birds and domestic fowls and animals were as obnoxious as that
usually ejected by man their discharges would require immediate removal
from human neighborhoods.

 6. Man is the only creature that has formed the habit of making a fecal
cesspool of his large intestine; hence his diseases of many varieties.
There is nothing wholesome about him and he is quite destitute of vim,
vigor, and push. The fecal poisoning of his parents is stamped upon
him, and the unhygienic condition of his bowels makes matters worse.

 7. Man needs to form the habit of stooling as frequently as birds,
fowls, and quadrupeds--at least as many times in twenty-four hours as
he partakes of food.

 8. Making a reservoir of the lower bowels is not a time-saving habit,
but, on the contrary, a breeder of many poisons, causing all sorts of
acute and chronic diseases, which demand much time and attention, as
countless numbers know to their sorrow.

 9. You are a factor in the social and business world; then why not
look, feel, and be your best by simply adopting internal hygienic
measures?

10. By the use of the Internal J.B.L. Cascade Bath you can secure two
or three stools a day, as desired; and while you are preventing
self-poisoning you are regaining a normal habit and natural health,
which for so many years and generations have been denied you. Do not
longer perpetuate the dire results of a foul alimentary canal and
consequently diseased body.

11. All desire to be strong and healthy, and many would add beauty of
form and complexion, which is also commendable. This can be attained by
preventing disease through hygienic attention and the proper use of
water.

12. The gastro-intestinal canal is a physiological, moving food supply
for the body, and, like any other vessel that has contained fermenting
substances, it should be emptied and cleaned before a fresh supply is
put into it. This is only a sensible, reasonable, and cleanly duty to
one's self.

13. Who can fear being made sick by adopting cleanly habits? You have
perhaps tried all other means to keep well, and have failed; now try
intestinal cleanliness--a method you should have thought of long ago.

14. Every one desires to avoid surgery, the taking of numerous
medicines, and the spending of money in that way--and they _can_ be
avoided if you keep _clean_, both internally and externally.


                     *      *      *      *      *


You're Not Healthy Unless
You're Clean INSIDE

And the one way to real internal cleanliness--by which you are
protected against ninety per cent of all human ailments--is through
_proper_ internal bathing, with plain antiseptic warm water.

There is nothing unusual about this treatment--no drugs, no
dieting--nothing but the correct application of Nature's own cleanser.
But only since the invention of the J.B.L. Cascade has a means for
_proper_ internal bathing existed.

Only one treatment is known for actually cleansing the colon without
the aid of elaborate surgical apparatus. This is

    THE INTERNAL BATH
    By Means of the
    J.B.L. Cascade

Prof. Metchnikoff, Europe's leading authority on intestinal conditions,
is quoted as saying that, if the colon and its poisonous contents were
removable, people would live in good health to twice the present
average of human life.

Dr. A. Wilfred Hall, Ph.D., L.L.D., and W. E. Forest, B.D., M.D., two
world-famous authorities on internal bathing, are among the thousands
of physicians who have given their hearty and active endorsement and
support to the J.B.L. Cascade treatment.

Fully half a million men and women and children now use this real boon
to humanity--most of them in accordance with their doctor's orders.

    LET DR. TYRRELL ADVISE YOU

Dr. Tyrrell is always very glad of an opportunity to consult freely
with anyone who writes him--and at no expense or obligation whatever.
Describe your case to him and he gives you his promise that you will
learn facts about yourself which you will realize are of vital
importance. You will also receive his book, "The What, the Why, the
Way," which is a most interesting treatise on internal bathing.
Consultation with Dr. Tyrrell involves no obligation.

CHARLES A. TYRRELL, M.D.
134 W. 65th Street,        New York




IF YOU SUFFER FROM ROUGH, SCALY, CRACKED SKIN

If You Value a Good Complexion

Dr. Tyrrell's Health Soap

Effectually Disposes of Troubles. It
Is Refreshing, Purifying, Invigorating

Among the necessities of life there is one to which few people pay the
attention they ought, and that is Soap. Yet it is undoubtedly a most
important matter, for the skin is a very delicate and sensitive organ,
and the constant application of impure or inferior Soaps injures its
texture, and gives rise to numerous cutaneous troubles. Most people are
content, so long as it appeals to the eye and the sense of smell,
without stopping to consider that perfumes may be employed to hide
defects.

Dr. Tyrrell has given this matter long and profound consideration and
now offers to the public a SOAP that leaves nothing to be desired. It
is not only absolutely free from any deleterious substance, but is a
perfect antiseptic and healing soap. Its use thoroughly cleanses and
invigorates the skin, keeps it soft, flexible and healthy, and
effectually prevents rough, cracked and scaly conditions. It is
invaluable for TAN, FRECKLES, SUNBURN, Etc., and is a perfect hygienic
safeguard against cutaneous disorders. It is a positive pleasure to use
it for the toilet or bath, as it leaves such a grateful, refreshing
after-effect.

As a SHAVING SOAP it is unequalled, absolutely preventing those
disagreeable results that frequently follow the use of impure soap.

25 Cents Per Cake

Manufactured solely by
CHARLES A. TYRRELL, M.D.
Formerly President of
Tyrrell Hygienic Institute
134 W. 65th Street, New York City




Sufferers from Catarrh

THERE IS GLORIOUS NEWS FOR YOU.


No matter how much you may suffer from that most distressing and
inconvenient complaint, a speedy and effective release from your
sufferings is now offered to you.

    THE J. B. L. CATARRH REMEDY

Is one of those sterling specifics whose curative effects are quickly
realized on the first trial. It is intended to be used in connection
with the flushing treatment, and the two used in conjunction

    RARELY FAIL TO EFFECT A CURE.

Catarrh is first caused by inflammation of the membrane of the nasal
cavities and air passages, which is followed by ulceration, when
nature, in order to shelter this delicate tissue, and protect the
olfactory nerves, throws a tough membrane over the ulcerated condition.

Flushing the Colon lays the foundation for recovery, but the membrane
must be removed, and for that purpose the J.B.L. Catarrh Remedy IS
WITHOUT AN EQUAL.

It is composed of several kinds of oils, and gently, but effectually,
removes the membrane that nature has built over the inflamed parts,
while its emollient character soothes and allays the inflammation.
These drugs are not absorbed into the system, but act only locally.

    THE MOST OBSTINATE CASE WILL READILY YIELD
    TO THIS TREATMENT.

The price is One Dollar per bottle, which, in view of its marvellous
curative power, is a veritable gift, and with each bottle we furnish an
inhaler specially manufactured for the purpose. Two bottles will
usually effect a cure--though one has been frequently known to do so in
mild cases--but in the event of any one taking six bottles without
being cured, we will forfeit

    ONE HUNDRED DOLLARS,

now deposited in the Lincoln Trust Co. of New York, if they can
honestly make oath that they have faithfully used the remedy according
to the directions, and have received no benefit from it.

    YOU CANNOT AFFORD

to neglect this opportunity of ridding yourself of this most
distressing complaint, which, if neglected too often

    LEADS TO CONSUMPTION.

    _DELAYS ARE DANGEROUS._

CHARLES A. TYRRELL, M.D.
FORMERLY PRESIDENT OF
TYRRELL'S HYGIENIC INSTITUTE,
134 WEST 65TH STREET
NEW YORK




The J.B.L. Antiseptic Tonic

should always be used when introducing water into the intestines. The
use of this preparation renders the water completely sterile unless it
be notoriously impure. Such water should never be used. But the
Antiseptic Tonic possesses another important property which is most
valuable in cases of Constipation, for it acts as an admirable tonic on
the muscular coat of the colon, strengthening it and restoring it to
normal. For these reasons it is invaluable. Owing to the importance of
using the tonic, I have arranged to make it as inexpensive as possible
and am prepared to furnish it (to users of the Cascade only) in one
pound air-proof cans at the price of $1.00; by mail twenty cents extra.
You can buy this at your druggist and save mail charges.

Charles A. Tyrrell, M.D.
134 West 65th Street, New York City