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Transcriber’s notes:

The text of this book has been preserved in its original form
apart from correction of two typographic errors: incidently →
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caret (^) indicates that the following bracketed characters are
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labelled items in figure 18.




[Illustration: _Hargrave_

  _5^{th} Ave. & 37^{th} St._,
  New York.]




                              INTESTINAL
                              IRRIGATION

                                  OR

                         WHY, HOW, AND WHEN TO
                            FLUSH THE COLON

               TREATED IN CONNECTION WITH OTHER MATTERS
                     OF PHYSIOLOGICAL INTEREST AND
                              IMPORTANCE

                                  BY

                       ALCINOUS B. JAMISON, M.D.

              AUTHOR OF “INTESTINAL ILLS,” “HOW TO BECOME
                             STRONG,” ETC.

                       _Published by the Author_

                             THIRD EDITION

                             NEW YORK CITY

                      43 West Forty-fifth Street

                                 1914




                            COPYRIGHT, 1914

                                  BY

                          ALCINOUS B. JAMISON




                 “Even from the Body’s Purity, the Mind
                 Receives a secret sympathetic aid.”

                                           --_Thomson._




PREFACE.


Within the last three decades the diagnosis and treatment of bowel
troubles have been greatly changed through improved instruments,
technique, hygienic measures, and various remedial agents.

The domain of surgery of the anus, rectum, etc., has been surprisingly
limited, and that of gastro-intestinal hygiene enlarged, together with
knowledge of man’s assimilative and eliminative organs. Systemic and
local hygiene has supplanted drugs and surgery in the treatment of
diseases of the anus, rectum, sigmoid flexure, and vermiform appendix.
Indeed, the domain of surgery will be restricted to what are still
considered incurable diseases if the suggestions of this volume are
widely adopted. From a clinical experience extending over a period of
thirty-three years, however,--as a specialist in diseases of the anus,
rectum, and intestinal machinery generally,--the author feels warranted
in maintaining that, if hygio-therapic measures were taken by both
physicians and laymen, surgical clinics and hospitals for “operating”
on anal and rectal diseases and the administering of countless
medicinal remedies would enter the stage of therapeutic oblivion.

The present work is more comprehensive in its scope than its title,
_Intestinal Irrigation_, would at first thought seem to indicate. It
is a practical book on home relief for all the symptoms of that form
of internal inflammation known as proctitis and colitis. The measures
that may safely be taken by the victim himself, without consulting a
physician, are minutely explained; and, that he may understand his own
case, every chapter goes more or less extensively into anatomical,
physiological, and pathological details.

The author has kept abreast of the advancement of science in relation
to his special branch of the healing art, and as the outcome of his
large daily experience in this line he feels qualified to speak with
authority. Victims of any of the symptoms described in this book may
therefore have confidence in its statements. It conveys a message of
common sense to the world at large and to the victims of intestinal
ills in particular. It is a compilation of clinical talks to the
author’s patients, making plain a variety of symptoms arising from a
single primary cause.

As the purpose of the book is pre-eminently practical, the author
felt warranted in describing minutely his own clinics, so far as
any patient could apply the results to his individual needs. This,
therefore, is the author’s excuse for introducing his own appliances
and describing their features and uses. Certain work must be done by
the sufferer himself, and no other invention in the market will aid him
so materially in doing this work scientifically and efficiently.

Furthermore, it was found impossible for the author to describe what
he himself was doing as a rectal specialist, or to direct sufferers on
the road to relief, unless he stated how certain appliances should be
employed. In the following pages, consequently, the reader will learn
just what to do, for the work is above all things simple and direct,
and in the writer’s judgment has the sterling quality of common sense.

Some of the chapters have already appeared, in abridged form, in
the magazine _Health_, as contributed essays; but the text has been
elaborated in the following pages and much new matter added, in order
that the work should present the most mature information concerning the
subjects discussed.

  A. B. J.

  New York, March 2, 1914.




CONTENTS.


  CHAPTER I.                                                      PAGE

    Efforts to Overcome Constipation without Seeking its Cause       1

  CHAPTER II.

    Pathology of the Anus and Rectum; or, The Genesis
      of Constipation                                                8

  CHAPTER III.

    The Formation of Channels, Piles, and Fistulas                  19

  CHAPTER IV.

    Undue Retention of Gas and Feces in the Sigmoid Flexure         28

  CHAPTER V.

    Rebellion of our Outraged Internal Economy                      35

  CHAPTER VI.

    Gaseous Obesity and our Roly-polies                             46

  CHAPTER VII.

    Irrigation of the Assimilative and Eliminative Organs           57

  CHAPTER VIII.

    Methods of Stomach Cleansing                                    65

  CHAPTER IX.

    When Enemas should be Taken                                     72

  CHAPTER X.

    How Enemas should be Taken                                      84

  CHAPTER XI.

    The Internal Fountain Bath                                      90

  CHAPTER XII.

    Benefits of the Inner Bath                                     101

  CHAPTER XIII.

    Objections to the Use of the Enema Answered                    108

  CHAPTER XIV.

    Lame Back                                                      121

  CHAPTER XV.

    Uric Acid                                                      126

  CHAPTER XVI.

    Rational Sanitation and Hygiene                                136

  CHAPTER XVII.

    Personal Cleanliness                                           145

  CHAPTER XVIII.

    Hot Water in the Treatment of Proctitis and Colitis            152

  CHAPTER XIX.

    Hot Water in the Treatment of External Symptoms                162

  CHAPTER XX.

    The Health of School Children                                  165

  CHAPTER XXI.

    Internal Hemorrhoids or Piles versus Mucous Sac, Recto-Anal
      Mucous Sac                                                   171

  CHAPTER XXII.

    External and Thrombotic Piles versus Muco-Cutaneous Sac and
      Thrombus                                                     181

  CHAPTER XXIII.

    Abscess and Fistula Involving Anus, Rectum and Neighboring
      Regions                                                      190

  CHAPTER XXIV.

    Nine Radiograph Illustrations Showing Mucus Channels and
      Cavities                                                     200

  CHAPTER XXV.

    Chronic Mucous Proctitis and Sigmoiditis--Usually Diagnosed
      as Chronic Mucous Colitis                                    202

  CHAPTER XXVI.

    Antiseptic Employment of Powders and Oils                      208




INTESTINAL IRRIGATION.




CHAPTER I.

EFFORTS TO OVERCOME CONSTIPATION WITHOUT SEEKING ITS CAUSE.


In the year 1496 an Italian, Gatenaria, invented an appliance for
taking an enema; since that time depuratory instruments have had more
or less vogue in all civilized countries. Of late years inventive
powers have been taxed to construct more convenient and effective
appliances, and now perfection has been almost reached, and the poor
civilizee, whose habits are really very bad from the savage point of
view, may enjoy the delicious privilege of an internal bath whenever he
feels the need of it. By any other name this bath is just as purifying:
call it irrigation, injection, lavement, clyster, enema--its many names
and what they mean testify to the fact that it is for the disease of
civilization.

The medical profession is really behind the layman in
genuine therapeutic measures. It still cares more for the
pill-and-powder-prescription-earning fee than for the real health of
the patient. When it shall wean itself from its sordid commercialism,
it will make the use of the enema a fundamental factor in most forms of
therapeutic treatment, and then the enema will become universal.

From the origin of the enema to the present day, the layman has not
been unmindful of this valuable resource for removing morbid matter
from his physiological sewer. The great relief he thus obtained, and
the invariably good results that followed its use, established as a
necessary toilet article some form of depuratory apparatus in many
homes for all time to come.

But of the nature of the disease that had occasioned its use, both
layman and physician were, and for the most part are, ignorant. Local
obstruction and discomfort were sufficient to suggest this mode of
relief; yet no truly scientific inquiry seems to have been instituted
to discover the cause of the obstruction. The author, during an
experience of over twenty-three years as a specialist in diseases
of the bowels, rectum, and anus, has found the true cause, namely,
PROCTITIS; that is, the chronic inflammation (dating often from infancy
and childhood) of the anus, rectum, and frequently of a portion of
the sigmoid flexure and colon. Proctitis is practically the universal
cause of chronic constipation. Victims of constipation have more or
less haphazardly resorted to the enema as a ready means of relief--a
recourse that was often, nay generally, against the advice of their
medical counselor: a professional opposition that indicates either
ignorance, mistaken judgment, or fear of losing a profitable patient.
But the layman has not been uniformly wise. He is an experimenter on
his own hook--encouraged in his experiments by the most promising
and seductive of advertisements in the whole gamut of advertising.
He experimented on his organism, tinkering it now with cathartics or
purgatives of multiform nature, and again with digestive and other
agents. This tinkering habit seems to have become all but universal
with civilized man. Constipation--which is caused by proctitis--will,
of course, bring indigestion and biliousness and diarrhea and
nervousness and headache and a host of other maladies in its train; all
of these induce the civilizee to increase his tinkering with his divine
abode until it eventually falls in ruins. The tinkerer loses sight of
the fact that his abode is not a body like the bodies of wood, stone,
and iron that he handles and putters with daily; he forgets or ignores
the fact that it is a vital organic machine, which, when tinkered too
much, will stop, “never to go again.” It is poor consolation when you
have reached your last gasp, after a chronic invalidism, to feel that
you have done the best you knew how. You have not sought the cause,
nor, having learned it somehow, sought to remove or avoid it. For the
last four hundred years this tinkering, this futile medication, has
been kept up at a furious pace without even a hope of permanent cure.
Poor, outraged human nature dimly knew that it was simply doctoring a
symptom, a _consequence_ of something or other--for that is all that
constipation and its host of symptoms really are.

The writer is of the opinion that constipation is the fundamental
disease that afflicts mankind; that, at all events, there are more
cases of proctitis than of any other disease; that very few “civilized”
persons are free from it; that so prevalent a disease must have a
common origin, which he traces right back to babyhood, to the wearing
of soiled diapers, a practice that cannot but result in inflammation of
the buttocks and mucous membrane of the anus and rectum; and that this
inflammation continues and finally becomes deepened and established,
producing in after years chronic constipation and its train of evils.
Of course, there are other causes that bring on proctitis among
children and adults; but careful examination shows that the severity
of the malady with its train indicates long duration in the tissues
comprising the wall of the anal and rectal canals and the adjoining
tissues of the bowels.

Proctitis, with its extension, colitis, is by no means a slight
disease, as it is supposed to be by a few members of the medical
fraternity who are beginning to apprehend its existence; on the
contrary, it is so serious that its gravity cannot be impressed too
forcibly upon both laymen and physicians. During the many years of
special attention the writer has given to diseases of the anus, rectum,
colon, etc., he has not ceased to wonder how it was possible that the
victim of deep-seated proctitis could have so dreadful a disease
and not be greatly alarmed at its ravages and dangers. The anatomy,
physiology, and hygiene of the parts involved in this inflammation
continue in some manner to permit the passage of excrement along the
diseased canal; and the victim continues to swallow drugs and tinker
with these--his irreplaceable “inards.”[1]

  [1] For numerous illustrations of the various morbid conditions of
  the anus and rectum, see the author’s 64-page booklet, entitled _How
  to Become Strong_.

It is not my purpose at present to go into a detailed description of
the organs involved in this inflammatory process, but to make plain why
the enema is superior to all other means of securing cleanliness. When
we know why we do a thing, the task is not so difficult and annoying
as when we go it blind or simply obey the behest of a physician.
Ignorance has no business bothering with anything; experience, however,
is usually a painful if not a fatal instructor. The human race at
large is ignorant concerning the normal and abnormal processes of its
internal organs. “Out of sight, out of mind” seems to be the maxim of
almost every one as to our vital organs and the conditions for their
hygienic functioning. The purpose of the writer will be achieved if he
succeed in sounding a note of warning that will be heard and heeded by
those whose influence will extend the echoes till the world listens and
learns the claims of the inner physiological economy.

Those that possess even a modicum of sense will easily understand how
a muscular tube like the anus, rectum, sigmoid flexure, etc., when
invaded and traversed for eight to ten or more inches by disease, will
offer obstruction to the descent and escape of gases and feces. All
are familiar with the contraction that occurs when a finger, hand, or
limb is inflamed; how little we can then use the diseased part until
all of the inflammation has left the muscular tissue. Why do we give
so much attention to an inflamed external part and none at all to the
all-important internal organ for the expulsion of the sewage of the
body? The parts are not “weak” when contracted with inflammation:
weakness is not what is the matter with them. The trouble is that
the muscular fiber is then too active, made so by the excessive
irritation of the local disorder. Irritation of muscular tissue always
causes contraction of its fiber. Such contraction well accounts for
constipation.

We are a nation of constipated people, so constipated indeed that we
have developed dyspepsia and neurasthenia. As I have already stated,
the chief ill of “civilized” people is proctitis; the chief symptom
of proctitis is constipation; the chief symptom of constipation is
dyspepsia; and the chief symptom of dyspepsia is neurasthenia, and so
on and on--all of them the outcome of imperfect elimination of morbid
matter from the intestinal canal.

The common sense learned in the treatment of external parts should be
applied to such diseased portions of the body as the anus, rectum,
etc. Common sense declares that an enema ought to be used on all
occasions of undue retention of the contents of the bowels. It is the
only sensible thing under the circumstances. Yet, for the last four
hundred years, only independent men and women have had the courage to
proclaim its merits, since the subject was under the ban of both laymen
and physicians. Now that we have learned the absolute necessity of such
a device, it is to be hoped that the taboo will be removed, and that
the numerous victims of proctitis will be instructed in the wisdom of
availing themselves of the valuable aid of the enema in either curing
proctitis or preventing it from growing worse, while they are at the
same time securing relief through its use by the removal of feces and
gases several times daily, thus preventing the absorption of poison,
which the retention of waste invariably facilitates.




CHAPTER II.

PATHOLOGY OF THE ANUS AND RECTUM; OR, THE GENESIS OF CONSTIPATION.


When an affliction is seemingly universal it is reasonable to conclude
that it springs from universal conditions. Proctitis, the most
widespread disease of civilized man, originates very early in life, and
develops in after years numerous painful symptoms--such as piles or
hemorrhoids, constipation, etc.

Now, what is the most common exciter of proctitis, which, as has been
said, is an inflammation of the mucous membrane of the anus and rectum?
In my earlier work, _Intestinal Ills_, I have shown that inattention to
the soiled diaper is generally the original cause of this most grievous
of ills, with its train of malign consequences continuing throughout
the victim’s life on earth. Unnoticed by nurse or mother, the
inflammation of the anus and rectum makes headway with each subsequent
soiling; and thereafter, when the use of the diaper is dispensed with,
inattention to the normal action of the bowels, improper food, the
resort to purgatives, stimulants, and opiates, play no small part in
aggravating the existing malady.

[Illustration: Fig. 1.

A portion of the wall of the rectum has been removed exposing various
layers: 1, serous layer; 2, muscular layers; 3, 3, submucous layers; 4,
4, mucous membrane; 5, internal sphincter muscle; 6, external sphincter
muscle; 7, circular muscular bands forming the rectum; 8, rectum;
9, sigmoid flexure. (See Fig. 7, showing the longitudinal muscular
bands.)]

The first care-taker of the infant is therefore responsible for the
initial process, which progresses to a chronic condition by subsequent
inattention. She is indeed solicitous over the inflamed buttocks of her
charge, but overlooks the far more dangerous inflammation of the mucous
membrane of the anus and rectum, or she does not realize its insidious
and subtly progressive character. Candidates for motherhood should be
instructed on this momentous subject.

[Illustration: Fig. 2.

_a_, Ulcer on sphincter ani. _b_, Filaments of two nerves are exposed
on the ulcer, the one a nerve of sensation, the other of motion, both
attached to the spinal marrow, thus constituting an excito-motory
apparatus. _c_, Levator ani. _d_, Transversus perinei. (Hilton.)]

There are other exciting causes of proctitis, but, since they are
exceptional when compared with the neglected diaper, we need not
concern ourselves with them at present.

The muscular coat of the rectum consists of two layers: an inner
circular and an outer longitudinal band. The inner circular layer of
muscular tissue of the rectum forms the internal sphincter muscle;
and the outer longitudinal bands merge with those of the external
sphincter. The anal orifice is closed or guarded by two strong
sphincter muscles, as shown in Figs. 1, 2, and 3. These muscles are
abundantly supplied with nerves, of which branches are distributed to
the bladder and other adjacent organs, which accounts for the sympathy
of these organs and their grave disturbance when disease inheres in the
anus and rectum.

[Illustration: Fig. 3.

_a_, Sacrum. _b_, Coccyx. _c_, Tuberosity of ischium. _d_, Posterior
or larger sacro-sciatic ligament. _e_, Anterior or small sacro-sciatic
ligament, with the pudic nerve passing over its posterior aspect, and
proceeding to the rectum and penis. _f_, Sphincter ani receiving its
nervous supply from the pudic nerve. Portions of the muscles have
been cut away, in order to show nerve filaments going to the mucous
membrane, through the muscular fibers. _g_, Levator ani. _h_, Fat
and areolar tissue occupying the ischiorectal fossa and covering the
levator ani. _i_, Transverse muscles of perineum. _k_, Erector penis.
_l_, Accelerator urinæ. 1, Pudic nerve. 2, Posterior sacral nerves
proceeding to posterior part of the coccyx and to the sphincter ani. 3,
Anterior sacral nerve (4th) supplying the sphincter ani. (Hilton.)]

The orifice used for the elimination of undigested food and waste
matter plays quite as important a part in the organic economy as the
orifice that is employed for receiving food. Normal elimination,
physiological and psychological, is the correlative process to
prehension (seizure or appropriation), and the concord of the two forms
the key-note of the organism.

The muscles and tissues constituting the anal vent should be as
flexible and responsive to the will or desire of the rectum for relief
of its contents as the lips are in permitting the saliva to escape.
In like manner the upper portion of the rectum (Figs. 6 and 8) should
respond with instant readiness to the effort of the sigmoid flexure to
expel its contents. But an abnormal condition like inflammation rooted
in the anus and lower part of the rectum (Fig. 1, 4–4) will inhibit the
passage of the pressing burden above them, which inhibition will cause
the inflammation to extend to the sigmoid flexure, and thence on to the
colon proper; and sooner or later the inflammation will penetrate the
submucous coat (Fig. 1, 3–3), which is composed of fatty or areolar
connective tissue in which trunks of nerves and blood-vessels are
imbedded.

The first symptom of inflammation is undue redness, followed by
slight puffiness of the anal and rectal mucous membrane (Fig. 1,
4–4), with more or less sensitiveness of the tissues involved; and
as its irritability increases there is more or less contraction of
the muscular tissue forming the anus and rectum, which lessens the
diameter of their bore. And the consequence of this contraction
is of physiological concern to the victim, for in proportion to
the contraction the normal demand of the victim for relief of the
impending feces and gas is modified and lessened.

In health, the anal canal is from two to three inches in length, and
it will distend about two inches--an elasticity quite equal to that
of any other orifice of the body. As the anal tissues are usually the
first to be invaded by disease, it is but natural that the obstipation
or constipation should occur right above it--namely, in the rectum. The
average length of the rectum is about six inches, and when the disease
invades its whole length the constipation occurs in the sigmoid flexure
and may thence extend to the colon.

The filling of the intestine with feces and gases usually occurs just
above the diseased portion of the gut; but at the same time the walls
of the affected part of the canal are more or less coated with feces,
and its abnormal pouches here and there contain more or less liquefied
or dried feces. A diseased canal cannot expel all of its contents,
since its normal expulsive power is gone. Some of the feces somehow or
other gets down and out, but a larger portion inevitably remains. It
is for this reason that a diseased intestine always reminds one of the
Augean stable. It is simply marvelous that the human body continues as
a living organism with so much filth and bacterial poison stored in its
alimentary canal, and the vaults that result from abnormal pressure
during periods of fecal impaction (Fig. 4).

When the inflammatory process extends up the rectum and at the same
time into the spongy, fatty, or areolar tissue under the mucous
membrane (Fig. 1, 3–3), thence to the muscular and serous layers
(Fig. 1, 2–1), or through the four layers of tissue comprising its
wall, we have a more marked and serious occlusion (closing) of the
organ than when only the mucous membrane was affected. When muscular
tissue is inflamed, its tendency is to contract and become solidified
by an adhesive inflammatory product secreted between the circular
and longitudinal muscular fibres (Fig. 1, 7, and Fig. 7). Often the
circular or sphincter muscles forming the anal canal have to be
distended to bring about a more normal vent. The same pathological
conditions that occasion contraction of the anal bore or caliber occur,
more or less, as far up the gut as the disease has advanced.

In a normal state of the lower bowel the sigmoid flexure passes its
contents into the rectum, and the desire to defecate is reported--that
is, the impulse to stool becomes more or less urgent until it is
performed. But when all four coats of the anus and rectum are diseased,
with perhaps a portion of the sigmoid flexure also, it is very
difficult for the healthy portion of the sigmoid flexure and the colon
to discharge their contents into the rectum; consequently no call,
impulse, or desire reaches the mind. Constipation will then ensue, for
the stool, not being called for, is not performed. Every demand of a
healthy portion of the intestine is answered by increased contraction
of the muscles of the diseased portion of the rectum. While the war
between the healthy and the diseased sections of the bowels goes on,
the victim naturally concludes that there is no occasion or demand for
defecation, and he attends to other affairs, ignorant of the fact that
he is thus making a fatal mistake.

The first condition that ensues is the tendency of the rectum to fill
unduly with feces and gases, impelling the victim to “strain” in
order to force the feces through the constricted anal canal. After a
while the sigmoid flexure and colon will fill unduly, and then the
victim will form the habit of waiting for the feces to descend, and of
straining to expel what little manages to escape through the diseased
gut.

A portion of the imprisoned feces in the healthy section of the
intestine sometimes, at an unguarded moment, manages to distribute
itself along the length of the diseased and constricted canal, where
it is retained indefinitely, increasing the local irritation. And when
the fecal mass accumulates sufficiently in both the healthy and the
diseased portions of the intestines to set up a vigorous excitement,
the victim may, by the aid of his waiting and straining habit
(which habit, by the way, only torments and bruises the chronically
diseased organs), bring on some sort of evacuation. In the early
history of the disease this habit may serve for a time; but, as the
disease progresses, the “laxative” habit is formed, which, in turn,
settles into a chronic “drug” habit for all sorts and conditions of
gastro-intestinal and other ills, which inevitably ensue. As the
ravages of chronic inflammation of the anus and rectum increase, the
symptoms rapidly multiply, till finally the victim, in desperation,
feels that he must find additional sources of relief--and, among other
habits, he forms the “diet” habit.

The order of abnormal habits brought into existence by ulcerative
inflammation of the anus, rectum, and colon is about as follows: (1)
the habit of unduly retaining the feces in the rectum; (2) the habit of
straining at stool; (3) the habit of unduly retaining the feces in the
sigmoid flexure; (4) the habit of resorting to the use of purgatives,
pepsin, and other drugs; (5) the chronic “physic” habit; (6) the
foolish “diet” habit; (7) the gastro-intestinal neurasthenic habit; (8)
the health-resort habit; (9) the habit of trying desperately to appear
agreeable while feeling really ill; (10) the habit of blaming the liver
for all direful feelings, physical and mental.

It is but natural that the lower portion of the rectal and anal
structures should be affected more severely than any other portion of
the intestines by the ulcerative, inflammatory process. The sphincter
muscles are very strong, as a rule, and fill their office only too
well when the anal and rectal canals are in a diseased state, for
they effectually prevent the contents from escaping. Often their
contraction or stricture is so great that their expansion is limited to
from one-fourth to one-half an inch. This virtually permanent closure
of the anal vent naturally results in an accumulation of feces just
above it, or in the lower portion of the rectum, which accounts for the
dilatation, stretching, or ballooning of the anal and rectal tissues
immediately above these muscles, as shown in Fig. 4.

[Illustration: Fig. 4.

1, The dotted lines indicate the normal direction of the anus and
rectum; 2, 4, the cavities or pouch formed by dilatation or ballooning
from the storage of impacted feces; 3, a probe bent at right angles,
and introduced through a speculum, to ascertain the depth of the pouch,
which is frequently found to be two and a half inches.]

In not a few cases where dilatation of the rectum exists, the upper
half or more of the anal canal is also dilated, leaving an anal canal
only an eighth of an inch in length in some cases; in other cases,
perhaps half an inch to an inch.

Similar dilatation of the sigmoid flexure occurs as the result of the
severe contraction of the upper half of the rectum, and especially at
the bend shown by Fig. 6 and Fig. 12. This bend forms quite a sphincter
for the normal receptacle--the sigmoid flexure. Here also prolapse,
distention, and dislocation of the sigmoid flexure may occur, somewhat
similar to the anal prolapse from disease and abuse.

Piles and itching of the anus are symptoms of proctitis, or
inflammation of the anus and rectum. Why should we find such dissimilar
symptoms proceeding from the same cause? The reason is plain when we
consider the results following chronic inflammation of the mucous
membrane of the anus and rectum and the deeper tissues. Those who
suffer from catarrh of this membrane are familiar with the discharge
of mucus that appears from time to time during the progress of the
inflammation. But, as the inflammation penetrates the mucous membrane
and the underlying tissues of the anus and rectum, the escape of the
inflammatory product is prevented; and this imprisoned fluid must
either be absorbed by the system or retained in reservoirs or in
channels wherever the least resistance is offered to its invasion.

The mucous membrane of the anus and rectum is loosely attached to the
subjacent parts by areolar tissue (Fig. 1, 3–3), which is sufficiently
lax to allow an expansion of two inches; and in a puckered or
contracted state the membrane is thrown into folds, or into shallow
or deep wrinkles. The loose areolar attachment and folds of various
depths afford space for lodgment of the inflammatory discharge, which
channels its way down along the folds through the areolar tissue under
the mucous membrane to that of the integument, and so on for a distance
of a foot or more from the anus in some cases.




CHAPTER III.

THE FORMATION OF CHANNELS, PILES, AND FISTULAS.


Should channels, of varying length and numbers, form early in the
development of proctitis, the sufferer is usually found to be free from
piles, or hemorrhoids, for the reason that the channels have afforded
an outlet to the inflammatory product. The formation of lengthy
channels also prevents to a great extent the development of skinny tabs
round about the integument of the anus. This is some compensation to
the sufferer for the labor of scratching and for enduring the painful
itching so often present. Some suffer only from pain along the channels
themselves, while others experience a slight disturbance of the nervous
system; yet all must be more or less poisoned from the absorption of so
large an amount of the contents of the channels and cavities.

In the cavities and along the channels the areolar tissue is of a
mahogany color, and no channel is traced to its end so long as the
tissues present a bruised, inflamed appearance. In some cases the
inflammatory product has destroyed the areolar tissue attached to the
integument at and near the anus, frequently to the extent of leaving a
hollow space or cavity of surprising dimensions. I have met only a few
cases in which the channels were opened by pus forming in them. Those
that are very shallow, the walls being friable, may break and form a
fissure of the anus; or a little anal fistula may arise from a slight
suppuration at its end in the integument near the anus.

In cases where the channels are few and short, whether itching be
present or not, the pile tumors are likewise few and of moderate size,
demonstrating the intimate relation of the aggravation of either of the
symptoms or the moderation of both in the same case. Very frequently
pile tumors have channels extending from them to the junction of
the mucous membrane and integument of the anus, or even under the
integument about the anus, forming rugæ, or tabs.

The number and size of pile tumors would seem to depend on how
completely the inflammatory product is imprisoned in the tissues in
what is termed the “pile-bearing” region. Often the treatment of piles,
or hemorrhoids, aids very much in the cure of itching at the anus--by
destroying a part of the channels involved in the pile structures in
the mucous membrane of the lower end of the rectum and extending along
under the anal membrane and the integument of the anus.

The meshes and layers of the mucous membrane, as well as the space
occupied by the areolar tissue, are stretched or pouched by the
inflammatory product.

My observation forces me to conclude that the inflammatory product
imprisoned in the areolar meshes, between the mucous membrane and the
muscular layers, is the principal factor in forming piles and the
channels so often found in the same region. Of course, obstructed
circulation, congested veins, capillaries, and arterioles, and a more
or less apparent varicose condition, increase the size of the pile
tumors and the general thickness of the mucous membrane over the region
affected by the disease.

The process occasioning the separation of the mucous membrane from its
areolar attachment or bed often extends the whole length of the rectum,
giving the mucous membrane the loose and raised appearance that a piece
of thin silk would have if laid on over that surface. The fatty or
areolar tissue under the skin about the anus suffers likewise by being
destroyed, leaving a hollow cavity or a large channel of great length
under the skin. The separation of the mucous membrane and integument
about the anus from their areolar attachment permits of prolapse of the
mucous membrane and integument that form the anal canal and skin around
the orifice.

It would seem that the channels, pile sacs, and cavities serve as
temporary reservoirs for the inflammatory product, a portion of which
the system absorbs and another portion of which escapes through the
mucous membrane and integument. In escaping in this way it occasions
itching and pain. The itching or soreness does not in all cases extend
throughout the whole length of the channel. A few inches of the channel
farthest from its origin may be the seat of the greatest disturbance,
and the sufferer and physician alike are usually unaware that the
source of the trouble is in the tissues of the anus and rectum.

The marked improvement in the health of those that have been cured of
both the morbid condition produced by the inflammatory product and the
cause of that condition is evidence that the general vitality of the
system had been greatly lowered, even though the most annoying of the
symptoms, such as piles, itching, or acute pain, had not been present.
The lack of annoyance along the channel for a certain period may be due
to a limited production, or to a rapid absorption of the inflammatory
product by the system.

Proctitis and the attendant symptoms just described have been
overlooked by the medical profession. Physicians have confined their
attention to two symptoms--piles and fistula. After undergoing a
surgical operation for these, the patient is considered cured. What
ignorance, or rather short-sightedness, to remove only the annoying
symptom, and then to pronounce the patient healed! Let me ask my
professional brethren why they do not concern themselves with the
underlying _cause_ of the symptom or symptoms, and whether they suppose
this cause is going out of business. Surely it is a grave mistake to
concern one’s self with the leading symptom merely--to remove that,
and to leave its cause intact. When the disease-producing cause remains
to generate its poisonous effects in the system, opportunities exist
for further symptoms to develop.

The system may be already depleted of vitality, and the harsh treatment
for the purpose of removing a mere symptom may only make the sufferer’s
condition more deplorable--if it does not indeed cause death.

There are other symptoms of proctitis than piles and fistula, which
remain after the conventional surgical operation for their removal.
Obstipation and constipation are usually symptoms of proctitis, and
will persist until the inflammation in the upper half of the rectum and
sometimes in a portion of the sigmoid flexure is cured.

The victim of proctitis has two marked sources of poisoning of the
system: one proceeding from the absorption of the inflammatory product,
and the other from undue retention of the waste matter of the body that
should pass out by the lower bowel.

Inflammation of a mucous membrane causes structural changes in the
tissues involved in the morbid process, and not infrequently it becomes
the seat of a malignant disease.

The reader may be familiar with the white, loose, alveolar
(honeycomb-like) network of elastic tissue (called fat) just under the
skin and mucous membrane. Consult in this connection the cut on page 24.

[Illustration: Fig. 5.

Male pelvic organs viewed from the right side (the right ilium and a
portion of the ischium and the pubic bone, together with their soft
parts, have been removed). 1, auricular surface of the sacrum; 2,
tuberosity of the sacrum; 3, ischium; 4, pubic bone; 5, psoas muscle;
6, erector spinal muscle; 7, glutei muscles; 8, obdurator muscles;
9, external sphincter of anus; 10, rectum; 11, sigmoid flexure; 12,
bladder; 13, ureter; 14, vas deferens; 15, seminal vesicles; 16,
prostate; 20, lateral vesicle ligaments; 21, hypo-gastric artery; 22,
hypo-gastric vein; 23, external iliac artery; 24, abdominal aorta.
(Boas.)]

The abdominal and pelvic organs are cushioned or held in place
somewhat by the network of fatty tissue that surrounds them, and
the rectum is no exception to the rule. The outer or serous wall is
surrounded by an abundance of loose areolar tissue, which is divided
into cellular spaces. When this tissue also is invaded by inflammation,
the condition is spoken of as periproctitis; and we have a result
somewhat similar to that which occurs in the areolar tissue just under
the mucous membrane and integument, as previously described.

As the inflammatory product is discharged into this spongy or fatty
connective tissue it is slowly forced in some direction, which is
naturally downward, if not too much obstructed by firm tissue; at all
events, it follows the line of least resistance and forms usually quite
a large channel and several cavities along its course. The channel may
begin at an elevation of four or more inches on the outside of the
rectum (Fig. 5). Should it form in front of the rectum, the seminal
vesicles (15) and the prostate gland (16) would suffer greatly by its
presence.

As the inflammatory process burrows its way downward, it finally
reaches the soft fatty connective tissue under the skin. It then
continues along this in one or more directions for a distance of two or
more inches. Several of these long, large pus-less channels may exist
for many years, or for a lifetime, without sufficient evidence of their
existence along their route accurately to locate them. Itching, pain,
and color of the skin often indicate the presence of such a channel
under the integument. The author has frequently found large channels
extending up along the outer rectal wall for four inches, and extending
out into the deep tissues of the buttocks in various directions,
without making their presence and ravages known to the victim.

Such numerous pathological conditions have led the author to conclude
that an abscess just under the skin and the discharge of pus are merely
incidents in the history of such maladies. Think of it: your body may
be bored with channels or holes of varying diameters and lengths, while
you yourself may be ignorant of what is occurring! The mucous membrane
may be lifted from the connective tissue for the whole length of the
rectum, and the skin about the anus may also be in this condition. You
know that your health is not good, but you are ignorant of the cause.
The formation of pus at some period of the channel’s inroads, or of
an abscess, would seem a kindly act of Nature, for the presence of so
serious a disturber to health would thus become known.

I have not overdrawn this picture of periproctitis and of submucous
tissue channels. The victims could scarcely be worse off than they are.
I want boys and girls, young men and young women, to learn the facts
concerning the local dangers of proctitis; for, when they once realize
the seriousness of this disease because of its many grave symptoms,
they will give it proper attention before these effects manifest
themselves. You cannot neglect so important a portion of your body as
the anus and rectum and not seriously endanger the organs that lie
close to them. No wonder so many men are troubled with inflammation
and induration of the prostate gland. The percentage of such cases
would be greatly reduced were proctitis and periproctitis denied the
existence they now enjoy for years, and often for a lifetime.

In view of all that has been advanced concerning these local
pathological conditions, is it strange that almost everybody is
constipated, and that we need some simple sovereign aid to further the
scientific treatment of the physician--an aid such as the enema has
proved to be?




CHAPTER IV.

UNDUE RETENTION OF GAS AND FECES IN THE SIGMOID FLEXURE.


In the previous chapters attention was called especially to the
lower portion of the rectum and the anus. In this chapter we will
consider the sigmoid flexure, which, when diseased, is often dilated,
dislocated, and depressed, a pathological condition somewhat similar to
that found in the lower portion of the rectum and the anus.

The illustration on page 29 shows the normal relations of the rectum
and the sigmoid flexure; also the whole colon. 7 marks the beginning of
the sigmoid flexure, and 6 its upper end. The reader will note the four
sharp curves or flexures of this organ,--from 6 to 7,--which forms in
health a normal and most convenient receptacle for feces, and which,
like the bladder, can be emptied at regular intervals.

Unless the system were able in some way to eliminate the waste and
poisonous matter it had generated within six hours, it would fatally
poison itself.

Those internal ventilators, the lungs, and those external ducts,
the pores, are constantly at work purifying the body; and they are
actively assisted by the kidneys and the bladder. Observation extending
over many years of practice induces me to believe that among those who
suffer from chronic constipation two-thirds to three-fourths of the
fecal mass is taken into the system and eliminated by the kidneys,
mucous membrane, and skin. Diseases of the above organs are numerous
and seemingly incurable from the fact that their common cause has not
been discovered and treated properly. Were it not for these organs
steadily at work, the labor of the bowels would be of little avail.
But while the importance of the former cannot be ignored, it must be
conceded that the most important of all the eliminating organs are the
bowels, for their function is to discharge not only the waste solids
but also a great amount of waste liquids and gases as well.

[Illustration: Fig. 6.

9. The anus. Levator ani muscle seen on each side. 8, 8. The rectum.
7. Beginning of the rectum. 6. The sigmoid flexure. 5. The descending
colon. 4. The transverse colon. 3. The cæcum, or _caput coli_. 2.
Appendicula vermiformis. 1. The end of the ileum.]

Undue fermentation of the ingesta (the aliment taken into the system)
generates poisons of more or less virulence; it must therefore be
obvious that a clean intestinal canal is necessary after every meal to
further the normal digestive process.

Very often the outlet of the sigmoid flexure is obstructed. Figures 6
and 7 are shown to make the cause of this obstruction more clear. In
Figure 7 we see the longitudinal and transverse fibers that form the
wall of the rectum. In all cases of chronic obstipation, the muscular
structure of the anus, rectum, and frequently of a portion of the
sigmoid flexure is invaded with chronic inflammation of a very severe
and serious character.

[Illustration: Fig. 7.

A view of the longitudinal muscular fibers of a section of the
rectum: 2, upper portion of the rectum; 3, 4, 5, the three bands of
longitudinal fibers of the colon continued upon the rectum; 6, the
longitudinal muscular fibers of the rectum formed by the expansion of
those of the colon. A view of the muscular coat of the colon: 1, 1, one
of the bands of longitudinal muscular fibers; 2,2, the circular fibers
of the muscular coat.]

What is the result of this inflammation? Self-evidently contraction of
the muscular structure, as you would quickly enough discover were one
of your hands or arms inflamed.

Though constant attention should be given to the much more important
organ, the rectum, practically none is given it. “Out of sight, out of
mind.”

Again, no doctor would diagnose an inflamed limb as paralysis, atony,
etc., and dose the victim with nux vomica, tonics, physic, etc., in the
hope of thereby healing it. Yet, with singular fatuity, this absurd
diagnosis and treatment is given when the lower bowel is invaded with
chronic inflammation.

Let the common-sense reader inform himself concerning his organism. Let
him remember that he has within muscular organs that demand exactly the
same attention when diseased as those without. This fact is especially
important for the sufferer from constipation or semi-constipation to
know.

Were the anus, rectum, and sigmoid flexure one continuous straight
tube, the muscular action in the process of defecation would not be
as complex as it is, since then the feces would drop right down and
out. But these parts have so many curves and angles that when disease
invades their interior they accentuate their folds and valves by
contracting and do not readily respond to the nerve demand for complex,
muscular, snakelike movements, when evacuation is desired. In this
unreadiness to respond they cast into confusion all the functions of
the whole complicated organism, all parts of which are necessarily
interdependent. A wise provision of Mother Nature are these curves,
angles, and valves, for they prevent the sudden dropping of the
contents of the colon down to the anal orifice--a possibility that
would greatly embarrass us during social and business hours.

The accompanying figure shows the rectum dissected at its upper end
from the sigmoid flexure. This portion of the rectum is smaller than
the lower two-thirds of the organ. Now, it is this lessened diameter
of the gut that is an aid to the sigmoid flexure in its capacity as a
receptacle, but a most decided hindrance when it is diseased--since
it will positively inhibit the passage of feces and gases, thereby
occasioning a distention of the sigmoid flexure (obstipation) because
of a detention of the contents, which then weights the flexure down
upon the rectum. Thus we see exemplified how an aid may turn into a
hindrance, as we already have observed, in an unduly contracted anal
vent.

The _rectum_ is not straight, as the word itself would indicate, but
curves to the right, then back well on to the spine, and then forward
to the anus, which turns slightly backward from the lower anterior
portion of the rectum.

[Illustration: Fig. 8.]

When these muscular-tube organs are invaded by disease, these very
curves, valves, and bends of anus, rectum, and sigmoid flexure are
responsible for at least nine-tenths of the ills that affect humanity
from the cradle to the grave--ills directly due to self-poisoning,
technically known as auto-infection and auto-intoxication, the
fashionable name of which is neurasthenia: a weakening of involuntary
and voluntary nervous systems through lack of vent from irritating
poisons, flatulency, and of course defective metabolism or nutrition. A
better name would be _vaso-motor neurasthenia_.

After these anatomical and physiological points have been noted, it is
to be hoped that the reader has grasped the idea of how easily this
portion of the bowels, when diseased, can prevent the normal descent of
the feces and gases accumulated just above the diseased portion of the
gut. It should also be easy to understand how a portion of the unduly
retained feces may pass out, but in so doing be the cause of increased
irritation and consequent contraction of the muscular tube, preventing
thus any further passage of feces from its receptacle. Usually a
portion of the escaping feces is caught and held in the rectum itself,
converting the rectum into a receptacle.

It is just here that the practical application of the principles
deduced must come in. Let my professional brethren as well as all
victims of bowel disease consider the following question, and then all
will be clear: Since normal feces contain about 75 per cent. water,
is there any harm, nay, is there not decided benefit, in suddenly
liquefying the imprisoned mass to, say, 99 per cent.--whether disease
exist or not?

When disease exists we simply desire to open the contracted or
obstructed canal. What can be better, in a therapeutic line, than the
kindly distending influence of warm water to overcome the spasmodic
closure of the diseased tube? In addition to the gentle dilatation the
injected water occasions, the water creates or calls into activity the
lost nervous impulse to evacuate, which impulse is a step toward the
restoration of the lost normality.

Under the benignant influence of the water injected in the large
intestine there comes a desire to expel it, which, when responded to,
carries with it the feces so long imprisoned, and at the same time
divests the walls of the intestine of the inevitable incrustations.

Thus, with purifying water, the foul pool is emptied, and the parts are
cleansed so thoroughly that nothing is left to vex the inflamed tissue.

Is there any sane person that can offer one valid objection to the
use of depuratory enemas in cases in which the normal function of
the bowels is lost through abnormal changes brought about by chronic
disease?




CHAPTER V.

REBELLION OF OUR OUTRAGED INTERNAL ECONOMY.


The small intestine is that portion of the alimentary canal which
begins at the stomach and ends at the large intestine. Its usual length
is twenty feet. The diameter, which at the upper portion (duodenum) is
two inches, gradually becomes less, until at the lower end it is but
one inch.

Now, the length of the inner coat of this small intestine--the mucous
membrane--is about _double_ that of the intestine itself. Think of
wearing a coat twice as long as yourself! How do you think this is
accomplished in the case of the muscular tube under consideration?
Well, Nature, having a most peculiar function to perform, has thrown
this mucous coat or tube into a thousand folds (valvulæ conniventes, or
“winking valves”). These folds form valves, occupying from one-third
to one-half the circumference of the bowel. The greatest width of each
fold is at the center, where it measures from a quarter to half an
inch. Over this great expanse of mucous membrane we find studded ten
million five hundred thousand intestinal villi, whose office it is to
absorb the food substances in their passage through the canal.

[Illustration: Fig. 9.

Stomach, liver, small intestine, etc. (Flint.) 1, inferior surface of
the liver; 2, round ligament of the liver; 3, gall-bladder; 4, superior
surface of the right lobe of the liver; 5, diaphragm; 6, lower portion
of the œsophagus; 7, stomach; 8, gastro-hepatic omentum; 9, spleen;
10, gastro-splenic omentum; 11, duodenum; 12, 12, small intestine; 13,
cæcum; 14, appendix vermiformis; 15, 15, transverse colon; 16, sigmoid
flexure of the colon; 17, urinary bladder.]

Those that have observed the anatomical illustrations of the small
intestines must have been struck by their apparently inextricably
tangled convolutions. In life, these convolutions are constantly
changing their locations, as though they were a mass of worms.

The large intestine begins at the cæcum and extends to the anus, or
vent of the intestinal sewer. It is called the colon--the ascending,
transverse, and descending colon. It is about five feet in length.
Its diameter is the greatest at the cæcum, where it measures, when
moderately distended, two and a half to three and a half inches. Beyond
the cæcum the diameter is one and two-thirds to two and two-thirds
inches, the smallest part being at the upper end of the rectum.

The muscular movements of the large intestine are much more limited in
number and range than those of the small intestines. The area of its
mucous membrane is also much less, notwithstanding the fact that it is
thrown into sacculated pouches, or sacculi, by the contraction of the
longitudinal muscular bands of the bowel.

[Illustration: Fig. 10.

The cæcum, dorso-mesial view, showing the ileum-side of the ileo-cæcal
valve, and the beginning of the three muscular ribbons. (Gerrish.)]

Consider this tube, for it is really unique. Note the longitudinal
muscular bands (Figs. 12 and 13). We find this tube to be five feet
long when the surface made by the circular bands is measured, and four
feet long when that made by the longitudinal bands is measured. Now,
the four feet of surface must of course contract the five feet. Well,
in the tube under consideration, the musculo-areolo mucous tube is
thrown into circular puckerings in short sections, between which are
deep transverse creases, each bounded by prominent bulges. (Fig. 13.)
An inspection of the bore of the tube shows a sharp ridge corresponding
to each depression of the outer surface, and a large recess collocated
with each external protrusion. This external and internal appearance of
the large intestine reminds one somewhat of the flexible hard-rubber
tubing used as a conduit for electric wire in houses.

[Illustration: Fig. 11.

Cavity of the cæcum, its front wall having been cut away. The ileocæcal
valve and the opening of the appendix are shown. (Gerrish.)]

[Illustration: Fig. 12.

A view of the position and curvatures of the large intestine. 32, end
of the ileum; 31, appendix vermiformis; 4, cæcum; 3, ascending, 2,
transverse, 8, descending colon; 9, 9, 9, sigmoid flexure; 10, 10,
rectum; 12, anus; 13, 13, bladder; 11, 11, 11, peritoneum--length from
4 to 6 feet, and a mean diameter of about 1-2/3 to 2-2/3 inches. The
sigmoid flexure is a receptacle for the feces, and each end is the
highest and bent on itself; this arrangement spares the rectum and
sphincters of pressure and weight until the proper time to stool.]

The sacculated pouches thus formed by the shortening of the bowel may
become abnormally distended, and resemble the proper receptacle for
feces--the sigmoid flexure. Even the rectum, in cases of chronic
constipation, is usually enormously distended, owing to the overloading
or filling up of the bowel with feces.

I have given this somewhat lengthy _résumé_ in order to enable the
reader to appreciate a most pertinent question.

Let us see what we have found: The small intestine, with its manifold
folds and its numerous pockets, made by the forty feet of mucous
membrane; the bends and curves in the five feet of the large intestine,
with its numerous dams and pools; and, lastly, the abnormal reservoirs
for feces, liquids, and gases.

[Illustration: Fig. 13.

Segment of large intestine, showing the characteristic features of its
structure. (Gerrish.)]

Finding this, the question inevitably is, What is the best agent for
cleansing this marvelously sensitive canal, twenty-five feet long,
whose mucous membrane extends forty-five feet? No one would think of
taking, if he could, the foul sewer in his hands, and shaking it, fold
upon fold, with the faint yet fond hope of sterilizing it. How can any
mode of physical culture meet the requirements for effecting a cure of
ulcerative proctitis and colitis, to say nothing about keeping the
bowels sweet and clean? Chronic, subacute, and acute inflammation,
accompanied with ulceration, located in any part of the body, requires
rest to overcome the fever and congestion. Muscular exercise irritates
and inflames the diseased parts.

Another form of “physical culture” would put into the bowels all
sorts of stuff that cannot be digested, such as bran, crushed seeds,
shells, raw food, etc., that set up excessive muscular action and
secretion of mucus as the improper stuff passes down and out. In the
sacred name of hygiene, this new cathartic remedy is prescribed and
taken. Seeking relief from the painful effects, the patient finds that
these “remedies” make the disease and its symptoms worse. Hygienic
fool-killers are, like the poor, always with us.

[Illustration: Fig. 14.

A longitudinal section of the end of the small intestines, or ileum,
and of the beginning of the large intestines, or colon. 1, 1, a
portion of the ascending colon; 2, 2, the cæcum, or caput coli; 3,
3, lower portion of the ileum; 4, 4, the muscular coat, covered by
the peritoneum; 5, 5, the cellular and mucous coats; 6, 6, folds of
the mucous coat at this end of the colon; 7, 7, prolongations of the
cellular coat into these folds; 8, 8, ileo colic valve; 9, 9, the union
of the coats of the ileum and colon.]

You are aware of the irritation that a grain of sand will set up when
it comes in contact with the mucous membrane of the eye. Then can you
not realize that you will torment the forty-five feet of intestinal
mucous membrane with like indigestible stuff? It is estimated that ten
per cent. of the really suitable food is residue matter with which the
digestive tract has to deal and get rid of with as much economy and as
little friction as possible. Then why increase this residue twenty or
fifty per cent.?

More than nine-tenths of the human race have been content to depend
on comparatively violent excitants, such as drugs, coarse food, and
muscular exercise, etc., to relieve the bowels of the feces, liquids,
and gases of a most foul character--the foulness due to putrid
fermentation and undue retention.

When will these prescribers and partakers ever learn that bile bouncers
and peristaltic persuaders have an immense journey before them when
they start to remove the foul accumulation of feces from the sigmoid
flexure and ballooned rectum? For, be it remembered, the normal
receptacle for feces is twenty-four feet four inches from the stomach,
and the abnormal receptacle twenty-four feet eleven inches--within two
inches of the vent of the body!

Surely quite a degree of mental constipation must have existed in
both the prescribers and the partakers to think such thick and dense
thoughts as are represented by these bouncers and persuaders. So
you would _cleanse_ the bowels with such unclean, poisonous, and
irritating things! What amazing hope born of ignorance! Outraged Nature
cries: “How long! how long! how long will my ‘inards’ be so abused
in the name of cleanliness and yet remain so unclean? Ye benighted
mortals, if ye would listen to me, your Mother, I would give ye a
pure and wholesome prescription, for I would prescribe equal parts of
enlightenment and water well mixed, and advise ye to take a portion of
it fore and a portion of it aft, per os (mouth) and per anus. Thus and
thus alone would I prescribe for ye; such and such alone is the way for
ye to do; purify to cure, or cure by purifying.”

Constipation must not continue, for it means not only the clogging up
of the large intestine with the foul sewage of the system, but also
the drying of that sewage, which latter process implies the absorption
of poison. Now that you are in this condition, Medicus steps up and
prescribes a cathartic mixed with belladonna or opium, or both. These
latter are meant to quiet the mournful cry of outraged Nature when the
cathartic invades its sacred precincts. And it may be noted, by the
way, that though belladonna, atropine, morphia, etc., tend to dry up
the secretions of the mucous membrane and make matters worse by making
them still more arid, still the action of the cathartic is usually so
powerful that after the free fight with the pain soothers it triumphs,
and produces a free flow of watery secretion into the dried, impacted
mass of the bowel.

Does it not stand to reason that the greater portion of the liquid in
which the feces were dissolved and had fermented is re-absorbed into
the system? Why should the poor victim of proctitis and cathartics
wonder why he has gout, rheumatism, and disease of the kidneys,
bladder, lungs, liver, stomach, nerves; why he has neurasthenia,
debility, feebleness, loss of memory, inability to fix and hold the
attention upon a single line of thought, apprehensions, etc.? His
wonder is childish, for deep in his heart he knows that he poisoned
himself. He knows this, but it seems that he must be reminded of the
fact that there is a better way to remove the accumulated mass from the
large intestine, and to prevent in future the undue retention of feces,
liquids, and gases in abnormal sacs or pouches. The way that Nature
prescribes is the resort daily, two or three times, to the enema.

When the injected water reaches the imprisoned and dried feces, the
crust is loosened from its holdings and the mass is moved toward the
exit by the expulsive effort of the bowels. Previously the bowels were
helpless with their load. As the sudden flood of water is expelled
it carries with it the inspissated feces; whereupon the subconscious
personal Ego, who is the superintendent of the digestive apparatus and
functions, congratulates himself on the delightfully refreshing manner
in which the local disturber has been ousted.

Such is the satisfactory decision of the arbitrator--Enlightened
Nature. No longer need we bow to Medicus or to any other kind of
“cuss,” whether styled hygiene or physical culture. Arbitration of this
sort makes life worth living.

Now for Nature’s benediction: “May that feeling of freedom from
uncleanliness, internal and external, be with you constantly, and this
double blessing make your joys flow so fast that in their rapidity they
blend into a sun and radiate from your rejuvenated physical being.”




CHAPTER VI.

GASEOUS OBESITY AND OUR ROLY-POLIES.


Is there any human being so ignorant that he cannot understand that
when food stuffs in the gastro-intestinal canal ferment and putrefy
they thereby generate toxic (poisonous) gaseous matter, volatile fatty
acids, and putrid feces; that such matter, acids, and feces are rapidly
absorbed by the system, and that, if the system does not readily
eliminate them by way of the bowels, kidneys, and mucous membrane, they
will tend to bring on one or more forms of acute or chronic disease?

Gas is matter in its most rarefied state--a state that permits its
easy entrance into all the tissues of the body, where it perverts by
its presence and toxic effect the normal function of all the organs.
Besides its poisonous infection, it distends or bloats the stomach,
bowels, and tissues--a fact especially noticeable in the abdominal
region, giving the appearance of corpulency or obesity to many,
when really it is only abdominal ballooning or gaseous obeseness.
Roly-polies--and there are a great many of them--will have their pride
greatly hurt by accounting for their condition in this way, but the
truth must be told and they might as well face the facts first as
last. Gaseous obesity, or borborygmus, is spoken of popularly as wind
in the stomach and bowels. No wonder the roly-poly is sensitive on the
subject, for this “wind” occasions rumbling sounds, eructations, and
offensive odors--all of which are a great annoyance to the sufferer
from dilated, displaced, and unclean digestive apparatus.

Besides being generated in the system, gases may be swallowed during
the act of eating, in the form of air (oxygen and nitrogen), and in
liquids containing carbonic acid, sulphuretted hydrogen, etc.

Micro-organisms swallowed with the food will occasion fermentation of
the contents of the stomach and bowels, which if unduly retained become
excessive, foul, and toxic--therefore extremely harmful to the system.

The gases generated in the stomach are the following: carbonic acid,
hydrogen, hydrochloric, ammonia, sulphuretted hydrogen, marsh gas, etc.
They are partly absorbed or thrown off by eructations, or they pass
into the duodenum or small intestine.

Gases are found throughout the small and the large intestine. These are
the result of both the normal and the abnormal digestive fermentation
and bacterial decomposition of the ingesta or food stuffs. Some of the
gases are passed into the intestines from the blood by diffusion.

The production of gas is more copious in the upper portion of the
small intestine and becomes less rapid and abundant as the large
intestine is reached. As formed or found in the intestines, the gases
are: carbonic acid, hydrogen, marsh, ammonia, nitrogen, sulphuretted
hydrogen, and sulphate of ammonia.

Considering the large amount of abnormal gases generated in the bowels
and which abnormally distend the abdominal walls for several inches and
press upon the heart and lungs, and considering the small amount passed
out as flatus, their entrance into the tissues of the body must be very
rapid and harmful.

Stop the habitual putrefaction and mal-digestion, and then the
formation of toxic feces, gases, and volatile acid will speedily cease.
Then the erstwhile roly-polies will shrink in circumference four or
more inches, necessitating the refitting of their garments to the new
and better order of things.

Much has been written about the distention of the rectum, sigmoid
flexure, and colon from the undue accumulation of feces. The fecal
distention of the gut may extend along the intestine for from three
to nine inches or more, which is a very grave matter indeed. But why
is so much attention given to a few inches of impacted feces dilating
a portion of the bowel, and none whatever to the prevention or
elimination of gaseous matter that distends the whole gastro-intestinal
canal to such an extent that the body is tightly inflated and the
median parts of the belly bulge out like a balloon?

Cattle raisers are conversant with the gaseous inflation of their
animals, and have to resort to the knife to puncture the stomach to
permit the gas to escape; otherwise fatal results would soon follow.
Some animals, even, like most human beings, are intemperate in eating.
When they consume too much grass they suffer from flatulency and colic,
and require drastic treatment.

Rather than let some worthy men and women die, ought we not at times to
adopt the ranchman’s treatment for flatus? This harsh means, however,
might be avoided by inventive science. Overfed, constipated, inflated
man, victim of habitual flatulency, could easily have small gas valves
inserted here and there along his gastro-intestinal canal--one, say, to
relieve the stomach of toxic gas, another for the appendix region, and
still another in the hernial region of the abdomen. Suppose overfeeders
were to adopt the gas-valve fad, and discontinue the habit of using
cathartics, soda, charcoal, peppermint, pepsin, whiskey, etc., as means
of relief! How in the world can a _drug_ aid digestion when taken into
a foul, gaseous, and feces-clogged canal?

A chemist cannot get the definite results he seeks unless he have
the right chemicals and proper vessels. Just so with the spiritual
Ego and his systemic chemistry of food: he needs a clean and healthy
digestive apparatus for proper assimilation and elimination. But he
gets careless, allows it to get foul, and then insincerely expresses
astonishment that the chemical combinations are not such as one could
wish or expect. Other chemists, called doctors or druggists, come along
and dose the poor victim of his own carelessness until they have ruined
his apparatus completely. They have got to live, of course; and it is
their business to see that he does not escape so long as they can help
it.

Sometimes there is a reassertion of common sense; the poor victim
becomes disgusted with himself and his credulous acceptance of
the doctor’s dictation and his fatuous swilling of the druggist’s
decoctions. He gets tired of chronic ill-health and bowel troubles,
and, lo and behold! he does the simplest and most sensible thing in
the world--a thing he ought to have done at the very start, or before
he ever had the least trouble: He thoroughly washes out his alimentary
canal with pure or antiseptic water. He drinks a lot of pure spring
water, and he flushes his bowels with two or three enemas. Doctors and
drugs are henceforth banished; he gets well! What a blessing to lose
one’s faith in the magic of drugs and the majesty of doctors!

Few comprehend the baneful effects of flatulency on the system, the
most usual of which are fatigue, depression, headache, buzzing in
the ears, deafness, vertigo, loss of memory, inability to fix the
attention, disturbance of sight, drowsiness, etc. A continuous stream
of carbonic acid or of hydrogen directed against muscular tissue will
cause paralysis of the part.

Physicians admit that in certain portions of the alimentary canal
extensive dilatation may occur, independent of any permanent
obstruction, in the lumen, or bore, of the gut. As a rule, however,
victims of proctitis and colitis suffer from more or less occlusion of
the lumen in the region invaded by the ulcerative inflammatory process.

Considering that the wall of the abdomen is often greatly extended by
gas within the digestive apparatus, it is not amiss to assume that this
gas may cause local distention of segments of the gastro-intestinal
canal, sufficient to paralyze or render inoperative the parts.

Suppose we make a rubber duplicate of the abdominal walls of the
average man, and place therein rubber duplicates of all the internal
vital organs--pelvic and abdominal. To hold the stomach, bowels,
and other organs in place, we fasten them with elastic bands here
and there, and make a generous use of cotton to support the various
parts, which are all connected with many little circulating tubes,
with strings for the greater nerves, etc. Now let us distend our thin
artificial digestive apparatus with air or gas--snugly filling the
abdominal space of our model, without tension, however, or slackness of
the various parts, which are happily adjusted and at rest. Now, be it
remembered, persons suffering from flatulency are more or less in the
predicament of the gluttonous animal referred to above: the gas will
not escape at either end, however much of an effort it makes, or the
victim may make to help it.

[Illustration: Fig. 15.

The stomach and intestines, front view, the great omentum having been
removed and the liver turned up and to the right. The dotted line shows
the normal position of the anterior border of the liver. The arrow
points to the foramen of Winslow. (Gerrish.)]

In filling very slowly our thin artificial alimentary canal, note
the distention along the canal as the gas accumulates. Then note that
the elastic bands stretch as the various segments of the canal change
location, especially the stomach and portions of the small intestine
and of the colon, etc. The stomach, small intestine, and colon, as they
dilate, shift about for room. The abdomen is seen to bulge out some
four or more inches while the turmoil is heard going on inside.

Continue this inflation and our rubber intestinal tract will display
here and there a displacement and permanent abnormal enlargement
of the lumen or bore. Suppose, further, that our complete model of
the abdominal viscera and wall had tightly around its outer surface
unelastic corsets, skirt bands, trouser bands, vests, etc., all or any
of which held in or compressed its bulging wall--what would happen?
Why, something inside would slip out of place or burst and let all the
wind escape, relegating our creation to the rubbish heap.

Now, when a man loses his wind by the rupture of a tube, he is said to
have expired, and his body is sent to the crematory--or ought to be
sent there for sanitary reasons. It would be much more satisfactory, by
the way, to our friends, after our demise, were our bodies sterilized
while they “live.”

I hope I have made it clear that it is a most serious pathological
condition--inasmuch as it prevents the normal onward progress of
ingesta and feces--to permit of the continued existence of an
excessively dilated gastro-intestinal canal, with one or more of its
segments permanently enlarged--segments like the stomach, duodenum,
cæcum, transverse colon, sigmoid flexure, rectum, etc.--and with
pendulous abdomen, sallow and muddy complexion, etc.

When to this condition is added a general displacement of the abdominal
viscera, or of one or more of the organs of the abdominal and pelvic
cavities, you have an objective picture of chronic ill health in all
its severity.

Are you sincerely desirous to know how your friends feel when you greet
them? Don’t ask them the stereotyped question, “How do you do?” or, if
you are a German, “How do you go it?” or, if you are a Frenchman, “How
do you carry yourself?” But ask them the specific and sensible question
appropriate to our civilized habits: “How are you and your bowels
to-day?” And at parting it were well to say: “May peace be with you
both--you and your bowels!”

The spirit of man can torment his personality, and his personality in
turn can vex his spirit.

Few people are aware of the fact that the stomach and intestines can
undergo alteration in position. Many are familiar with the fact that
the kidneys may be displaced, and are then called “floating kidneys”;
that the liver, pancreas, spleen, and uterus occasionally go on
excursions, causing thereby considerable and numerous disturbances.
And it is not at all strange that they should, since there is so much
pressure from within, so much pressure downward, and so much pressure
from without--all through the requirements of fashion, indulgence,
and ignorance. But the stomach, upper portion of the duodenum, and
small intestine, cæcum, the ascending colon, and especially the
transverse colon and sigmoid flexure, are susceptible to various
forms of displacement, inhibiting the ready flow or passage of food
stuffs, gases, and feces from one segment of the digestive apparatus to
another, until the vent is reached.

Reviewing the ground already gone over, we have found that proctitis,
as a rule, is the primary cause of sigmoiditis and colitis; that
these combined are the cause of constipation; that this is the
cause of indigestion, flatulency, and distended alimentary canal,
and, as matters go from bad to worse, of permanent distentions and
displacement. Is it any wonder then that there are so many that suffer
from _gastro-intestinal neurasthenia_?

Surely our digestive apparatus ought to have as much attention as a
well-regulated house furnace. In the morning the ashes are dumped and
fresh coal is put on. A similar process is gone through with at noon
and night. Some may run their furnaces on two meals a day and two
dumpings of the waste material.

When a boy puts a penny into a slot machine he gets what he expects
and is pleased. The machine has done its work in delivering the goods.
Why should he give a thought where his penny lodged? In like manner
man is always ready to put food stuff, and other stuff as well, into
the upper slot of his machine, for he gets immediately satisfaction
thereby. But he is like the boy; he doesn’t care a fig what becomes
of the stuff so long as it doesn’t annoy him too much. Eventually the
machine refuses to work, and seems unable to deliver the goods at the
other end; something has become clogged or out of gear. Let me advise
the reader at least to keep the passage clear by dumping the systemic
furnace twice or thrice daily--using the enema to effect the result.




CHAPTER VII.

IRRIGATION OF THE ASSIMILATIVE AND ELIMINATIVE ORGANS.


The habits of people in general do not seem so bad when one considers
the average individual’s limitations as to knowledge and thought. The
fact is that most people don’t know, don’t think, and hence don’t
care. Let them read more science, think more sensibly, and act more
seriously; then their habits will be more satisfactory.

The alimentary receptacle--the stomach or vat in which foods and
liquids are received and mixed--is habitually converted by many persons
into a chemical retort for all sorts of drugs and remedies, with the
view of reaching and relieving the ills of the various organs of the
body, from dandruff to corns. The writer believes that he can give
more and better reasons for his confidence in the therapeutic value of
remedies than most other physicians, but he wishes to emphasize here
the transcendent importance of common sense in their administration.
Before and above all else, however, what is wanted is a clean
gastro-intestinal canal; and his claim is that water, properly used, is
the best agent to effect that cleansing. On a par with this canal in
importance are the eliminative tissues and organs of the system: the
kidneys, mucous membrane, and skin. What therapeutic agent, properly
used, is better than water? After all the assimilative and eliminative
organs and tissues have been thoroughly rinsed with pure, soft water,
then, if it be still necessary to administer a chemical agent, one
may be selected that will, with these organs and tissues in better
condition, work wonders. If you are so foolish as to allow yourself
to become foul from head to foot, cleanse yourself with water before
resorting to chemical aids.

Somehow or other the mass of even intelligent people, not to speak of
the great mass of the ignorant, and I may add even my co-workers in the
healing art, are not aware of the supreme want and worth of water for
internal and external therapeutic purposes; they do not realize how the
stomach, the bowels, and the kidneys cry for it in their neglected and
infected condition.

The stomach serves as a convenient receptacle to dump things into after
the palate has been entertained and pleased--and about everything is
swallowed but pure, soft water. As a rule the stomach takes very kindly
to water. It is, moreover, not so piggish as to absorb it all and leave
its surface in a foul condition, covered with ropy, slimy products
of imperfect digestion. Immediately after deglutition of water, the
stomach does just what it ought to do: its muscles contract and dump
the contents of the stomach into the duodenum, where the principal act
of digestion is accomplished.

As its name implies, the stomach (stow-make) is a receptacle made for
the purpose of storing stuffs for nutrition. Here they are mixed and
broken up somewhat, and then deposited in the second or real digestive
apparatus--the duodenum. This latter organ requires water and organic
fluids in liberal quantities for its digestive operations. Both organs
need cleansing after they have finished their work, and the digestive
and assimilative vessels require water, not only to convey the building
material to their harbors, but also to eliminate effectually the
worn-out tissues and the residuals of the digestive process.

It has been said that were man to discover heaven (a clean and healthy
locality) he would at once convert it into a hell (a vile and filthy
one). Man is possessed of an organism of whose constituent elements
water forms over eighty per cent. The alvine discharges ought to
contain the same percentage of water, if not more. The mucous membrane
and skin, to be kept clean, soft, fresh, plump, moist, and free from
odors, require their appropriate irrigation. Man may keep himself
clean, both inside and out, by irrigating himself before each meal
daily. The well-watered and well-washed body and brain constitute a
heaven on earth for the indwelling spirit that needs these for its
manifestation.

It does seem sometimes that man in his ignorance gets nothing right
except to walk forward instead of backward. Even so, most likely he
walked on all fours for ages, judging from his progress to date,
before he learned to walk on his hind legs. To-day we find him
self-poisoned, auto-intoxicated, a gastro-intestinal neurasthenic. His
bowels are filled and stretched with ancient feces and gases, and his
stomach is burdened with undigested food and tenacious mucus.

The average man’s scanty excreta from the bowels are dry, hard, lumpy,
and foul, exhaling a noxious odor; and these excretions may be passed
once a day, or once in two or three days, or with some persons too
often, should diarrhea supervene. Two-thirds to three-fourths of the
fecal mass is absorbed by the system every day; and this absorption
is accompanied more or less constantly by symptoms of indigestion,
biliousness, uric acid, and many other distressful conditions.

His breath and the exhalations of a garbage-can are much alike; in fact
they are twins, the only difference between the human and metallic
receptacles being that one is capable of walking and the other is not.
Both manifest the same conditions.

His mucous membrane is covered more or less with catarrhal discharges,
which result in granulated deposits, especially near the orifices. The
skin is often sallow, dry, yellow, scaly, flabby. The hair is dry,
non-oily, with a scaly scalp, and often there is a loss or total lack
of hair. The teeth are decayed, the gums are found to recede, and the
eyes, muscles, joints, etc., are more or less affected by calcareous
deposits.

Man is seldom or never in a normal physiological condition. He is
either obese or emaciated and lean. Most bodies are anemic and
ill-conditioned, a prey to several ailments. Of course, civilized man
uses drugs; he would not be civilized were he not to use on occasion
a stimulant, tonic, sedative, narcotic, etc., and he has to keep in
continual touch with a doctor, to take care of him by prescribing
special diet, fasts, exercise, and what not for his numerous bodily
infirmities. Generally these prescriptions are ineffective and
leave him physically weaker and financially poorer, with the barren
consolation that he has really tried everything under heaven that the
wisest knew or that money could buy. Yes, indeed, he tries everything:
everything but _water_--pure, soft, spring or distilled water. He
never--like the flirt--“thought of such a thing”! Very few “humanals”
think it worth while to irrigate themselves inside and out.

Victims of semi-ignorance, too, get things most abominably mixed. They
are often half wrong and half right; hence they never enjoy good,
sound, robust health and its blessings. Physiologically, these people
are what old-time pastors used to describe as lukewarm--neither hot nor
cold, neither good nor bad, neither dirty nor clean, neither fish nor
fowl, neither one thing nor another. So we find them also complaining
and looking for the fountain of health and strength, but not looking
very anxiously--they are not interested enough in the matter. Whenever
they possess an equal mixture of ignorance and laziness, there is not
much hope for them.

[Illustration: Fig. 16.

Œsophagus and stomach in their natural relation to the vertebral column
and aorta. (Gerrish.)]

Note the position of the stomach in health, and how, by slight
muscular action, it can free itself of its contents. When dilatation
or displacement, or both, occur, the power of rapidly expelling its
contents is diminished to the extent in which the change from the
normal position and size takes place. I have found that, if there is a
normal passing down of the ingesta and also of the feces, the stomach
will perform its functions perfectly. Fear of “stomach trouble” is
groundless if you keep the digestive and eliminative apparatus in good
working order. But this requires that you must keep them clean, and to
do so you must drink plenty of water before each meal.

[Illustration: Fig. 17.

Stomach and duodenum--the liver and most of the intestines having been
removed. (Gerrish.) Shows the anatomical relation of the stomach,
duodenum, kidneys, diaphragm, and the large artery and vein.]

The organs are held in position by a ligamentous attachment and
abundant fatty tissue, which serve as a connective cushion that
furnishes aid in supporting the organs in their proper place. In
chronic cases of self-poisoning, the victim, as a rule, becomes anemic
and emaciated, and loses thereby the fatty support required by the
organs. They are consequently apt to become displaced and the muscular
tissue weakened, with the consequent pendulous condition of the abdomen
often observed in both children and adults.

The clay-colored, flabby, obese, anemic victims may retain their
worthless adipose tissue; but they suffer quite as keenly as if they
had lost it--from the fact that this tissue is impregnated with poison
and filled with gas, and from the further fact that this abnormal
tissue presses on the vital organs here and there as the victim wheezes
or puffs along on his road through existence.

There is not the slightest doubt that nine-tenths of gastro-intestinal
ills and their effects can be prevented or cured by thorough irrigation
of the canal, from mouth to anus, if it does not itself perform the
cleansing process three times in twenty-four hours.




CHAPTER VIII.

METHODS OF STOMACH CLEANSING.


Lavage is a term restricted to irrigation of the stomach--a term that
has become more or less popular of late with physicians, but is not
so popular with those who have to swallow a rubber stomach tube, or
with the anxious mother or friends who are usually not permitted to
be present on such occasions because of the disturbed and cyanotic
appearance of the patient--an appearance produced by the introduction
of the catheter. Much can be said, however, of the good results
following irrigation of the stomach by the employment of the stomach
rubber tube, and in a special class of cases its use is imperative.

But my purpose in this chapter is to advocate the drinking of water as
the means _par excellence_ for effective irrigation of the assimilative
and eliminative organs, and to make it plain that this form of
irrigation is essential for the preservation of health and the relief
and cure of chronic inactivity of the principal organs of the system.
Usually the drinking of water at regular intervals is sufficient; but
in exceptional cases a generous drinking will result in a complete
unloading, which can be accomplished with ease and with little loss of
time.

Should your stomach be actually performing its office, the suggestions
I am about to give will, if followed, keep it sweet, clean, and in good
condition, and will also flush all the tissues of the body as well.

The first duty on rising in the morning should be that of flushing
the colon, as previously recommended, and flushing the stomach, as
now recommended. Take one or two goblets of water (about eight ounces
each) at a temperature most agreeable, which, however, should not be
ice cold. An hour or half an hour later, during the breakfast, take one
goblet of milk and water or two of water alone, when the mouth is free
from food. About eleven o’clock in the forenoon, one or two goblets
of spring or distilled water, at its natural temperature, should be
drunk to cleanse the stomach, duodenum, kidneys, etc., and to flush
the tissues of the body. At the noon meal one or two goblets, and at
four or five in the afternoon a similar amount, should be drunk--the
latter as a cleanser before the evening meal, at which about a pint or
more is drunk to aid in emulsifying the food, as at the breakfast and
noon repasts. As a rule, besides the amounts drunk at meal-time, there
should be consumed as much as two quarts daily, and the best time for
this is when the stomach is empty, or when it ought to be empty. At
bedtime, one or more glasses may be drunk if one does not suffer from
inconvenience from a full bladder during the sleeping hours.

One should make water-drinking a habit, like eating, sleeping,
defecating, etc. Water-drinking should be performed at regular periods
during the day. System is as essential for the harmonious working of
the organs as it is for the relations of the departments in a business,
or of the details of any particular department. The guide to the
order and temperature to be adopted is _agreeableness_. Find out by
experiment what is most agreeable and beneficial to you, and continue
the practice with slight variations adapted to the changes of the
seasons and the conditions of the system. There must, however, be some
training done in most cases, and what is not agreeable at first may
become so.

All persons suffering from proctitis and colitis and their symptoms,
as described in the previous chapters of this work and in _Intestinal
Ills_, will require, now and then, if not under treatment, special
irrigation of the stomach to remove fermentative matter, particles
of undigested food, and tenacious, ropy mucus before the next meal
is taken. Otherwise the condition will be made doubly bad, for the
fresh material is piled on top of the unduly retained contents of the
stomach. As evidence of our civilization, we clean pots and kettles
before the next meal. We even clean our fingers before, during, and
after the meal. Teeth, mouth, and face get their proper cleansing. Why
should we suppose that stomach, duodenum, and kidneys, which receive
all sorts of stuff, should remain clean without an occasional flushing?
They need rinsing out after brewing the wine of life. The water drunk
between meals not only cleanses the organs through which it passes but
irrigates the whole system, keeping a normal amount of water in all the
tissues, which is as necessary for the maintenance of health as is the
due supply of water to the plant in your conservatory.

Observe the large percentage of human beings that are anemic, sallow,
clay-colored, or white--a few obese, but the many spare, lean,
gaunt--all of them expressing the disgust of the soul in having such
an abiding-place. If all the organs and tissues of the body were kept
flushed, what a fresh and inviting spot the soul would have for the
cultivation here on earth of the arts of life!

Water is the wholesomest of all drinks. It quickens the appetite and
strengthens the digestion. It is the most effective agent in the work
of elimination--in ridding the system of waste material. Properly
taken, it prevents the undue clogging of the organs and tissues, and
tends to cure or relieve those that had become clogged, and it does
this by washing away the substances for which the system has no further
use, and which if they remained would poison it.

It is said that if water be drunk freely during a meal the gastric
juice will become diluted or washed away. A similar objection is
offered concerning the use of the enema. The horse, it is alleged,
should have more sense than to drink from three to six gallons of water
and almost immediately thereafter eat a peck or more of oats and a
quantity of hay, for it ought to know that there is no room for food
with such an amount of water in the stomach. If such objectors could
but see the horse smile at such arguments--for it secretly knows that
the water does not _remain_ in its stomach, and that its gastric juice
is naturally strong and needs dilution--they would stand aghast. Would
we not be better off if we were not influenced by fool talk like the
above advice to the horse, especially as regards our internal economy?

The stomach, like the freight station, can accommodate only a limited
amount. Its contents must be rapidly dispersed, and every muscular
contraction and every respiration gives it an impulse. Disease and
lack of irrigation will occasion an accumulation or congestion of
the contents in the gastro-intestinal canal, and then the victim of
slow transit complains of indigestion, biliousness, flatulency, uric
acid, and of many other ills. Your foul, furred tongue is a very good
indication of the trouble below, so it is wise to examine it in the
morning to learn your interior condition. Many persons scrape their
tongue with a knife because of heavy coating and offensive odor and
taste. Dyspeptics of this order need a thorough internal bath from
above (per os) and from below (per anus).

Some that suffer from undue gastric retention and indigestion
will find relief by flushing the colon and the stomach, as herein
specifically directed. Others may find it desirable to start with
a mild laxative and an intestinal wash-out with hot water in which
some antiseptic or stimulant has been dissolved. The special stomach
cleansing is accomplished by the rapid drinking of one tumbler of hot
water after another, until a pint or more is taken into the stomach,
or until a sensation of vomiting is felt, which may be encouraged by
putting the end of the finger down the throat as far as possible or the
end of a long lead-pencil wrapped in a little muslin. After as much of
the contents of the stomach as is desired is thus cast forth, drink
freely of water again, as much as you may think proper, which will be
discharged into the duodenum. If this gastro-cleansing has occurred
near meal-time omit the meal altogether, and in an hour or two drink as
much water as is agreeable, to make sure of a thorough washing out of
the erstwhile neglected receptacle--the stomach. This special washing
out of the stomach may be repeated as often as occasion demands it. It
frequently happens with some persons that an hour after a meal there
is a hint that all is not well. This may be concealed or corrected by
drinking a goblet or two of water, which practice will permit the brew
to go on without further attention to the vat.

Water may be taken at all times of the day or night if occasion arises
for its therapeutic effect in addition to its regular period of use.
Usually physic, pepsin, soda, charcoal, whiskey, etc., are kept within
reach, and are resorted to on such occasions with the thought that one
or more of them will do the work. They will not, however, any more than
red paint will act as an antidote to poor health by painting the cheeks
with it. Water, hot water, especially when used plentifully, is the
only solvent of dirt.

Very few realize how essential water is to digestion and to the
digestive canal after the process of digestion is completed; and that
it has physiological effects on the system generally is less widely
known. There exists a great natural demand for water to carry on the
normal functions of the system; for both atmosphere and heat draw
moisture from the body, and a considerable amount is utilized in the
processes of our daily work and in unexpected efforts. An organism
composed of almost eighty per cent. of water requires a generous supply
for subsistence--a supply equal to the expenditure of vitality involved
in carrying on the numerous functions of body and brain.

Some day it will be discovered that water is mainly the element
employed in psycho-physiological processes. Water is easily changed to
air, and atmospheric air to water, in the system. The generous consumer
of air and water will have a good stock of vital or of psychical force
on which to draw for the process of thinking. A thinker is a creator,
and he must be successful if his thoughts be rightly directed and he
have an ample supply of liquid food--water.




CHAPTER IX.

WHEN ENEMAS SHOULD BE TAKEN.


Method is imperative in this strenuous life of ours. Nature in her
universal operations seems to sanction a uniform system in our
daily conduct. Had we a regular time for doing things, periodicity
would be established in our sleeping, eating, bathing, defecating,
work, recreation, etc. Unfortunately, we are prone to ignorance,
self-indulgence, procrastination, which render us careless and reckless
in regard to the common-sense conditions of normal living; and before
we are fairly out of our ’teens we begin to bear a crop of proctitis,
colitis, constipation, etc.

It is in this way that periodicity as to stooling is lost, and whim,
convenience, or necessity takes its place. As a result, we dribble or
strain under the fecal and gaseous burden. This happy-go-lucky method
accounts for much of the gastro-intestinal disorder complained of by
so many, who “want to die” when the painful neurasthenic blues hover
around and pervade their bodies like a dense fog.

The insidious manner in which proctitis, colitis, constipation, and
self-poisoning progress from mild through medium to severe stages does
not, generally, alarm the victim of intestinal neurasthenia until many
years have elapsed, and one or more of the vital organs have become
diseased, and the whole system is thoroughly under its toxic effects.
Thus, slowly, are the various segments of the gastro-intestinal canal
changed to an abnormal condition.

Suppose the tissues of one of your arms and hands were inflamed,
constricted, or swollen, and that the nerves of motion were uncertain,
shaky, and “kinky,”--all of which conditions we often find in the
digestive apparatus,--and that finally recovery takes place under
persevering and patient treatment; how soon, think you, could a
sensible person expect the limb thus affected to become as useful as
its companion that had never been disturbed by disease?

Unfortunately, we have not two sets of bowels. Ocean steamers are
equipped with two sets of motion-producing engines, so that the
disability of one will result in no loss of speed. When man places as
much commercial value on himself as he does on his machines or on a
boat, he will either induce Nature to furnish him with an extra set of
energy-producing organs, or he will take the best possible care of the
only one she vouchsafes to him--a care that extends from os to anus.

Civilized man does, indeed, take a little notice of a sore mouth
(although indifferent about an unclean one), and will even try hard
to have it heal, because a sore mouth may be _seen_, and is likely to
disfigure him. But a sore anus and rectum may, for all he seriously
cares, play their painful and poisonous pranks until he is put to
bed disabled or is sent to an asylum--or to the final inn where all
diseases of the body cease from troubling and the weary organs are at
rest.

To re-establish that normal régime of physiological relations called
health, after many years of perverse relations and disorderly
practices, obviously requires time and intelligent, faithful attention
to prescribed conditions.

The factors or causes that militate against the removal of curable
diseases are:

(1) The neglect of a local disorder until it has had time to exhaust
the general vitality of the system.

(2) Inattention on the part of the patient after he has obtained
temporary or partial relief.

(3) The victim arbitrarily setting his own time limit for the cure of
the disease.

(4) His wilful disobedience of prescribed rules.

(5) Inability to realize the importance of having the cause removed, as
well as the local symptoms.

Confining attention for the present to proctitis and colitis, I wish to
impress the patient, as well as the physician, with the fact that no
better measure for relieving or removing these undermining disorders
can be adopted than the regular practice, twice or thrice daily, of
intestinal irrigation by means of enemas. The persistent use of the
enema is directly influential in relieving and removing the symptoms of
such disorders. These symptoms may be piles, prolapse, skinny tabs,
fissure, dull pains, soreness, itching channels, stricture of the anus
and rectum, ulceration, abscess, fistula, cancer, etc.

In the early history of ulcerative proctitis and colitis, the local
symptoms at the anal vent may not be noticeable; yet the disease may be
quite well developed for six or nine inches along the bowels. The early
or more obscure symptoms are mild and unnoticeable; then they progress
into notice, sometimes most sharply; finally we have severe and chronic
constipation, indigestion, flatulency, diarrhea, etc., and, keeping
pace with these, we have the stages of self-poisoning, which is known
as auto-infection or auto-intoxication.

With other measures, the most effective for relieving and removing
these symptoms of proctitis and colitis is the enema night and
morning. During the long period of relaxation at night, the functions
of elimination and repair are, with the great majority of us, going
on under abnormal conditions--such, for instance, as excessive
fermentation and bacterial putrefaction, which generate poisonous
gases that are absorbed by the nerves and bring about the condition of
_malaise_ we complain of when we rise in the morning. We then find our
bowels distended and ready for relief--and also, strangely, “not ready”!

Before dressing, therefore, is the time to relieve the excessive
pressure from gases and feces, and a slight enema is accordingly
advisable, say from half a pint to a pint of water, which should
be expelled at once. This removal of the contents of the rectum
and perhaps of the sigmoid flexure will permit the contents of the
ascending and transverse colon to pass more readily toward and into the
sigmoid flexure, as though they had been invited to come; and, indeed,
such passage is rendered inevitable by the removal of the local gas and
feces in their path. When half an hour or more has passed and breakfast
is over, it is time for the regular and complete evacuation of the
bowels, by the aid of the internal bath, or, as some describe it, by a
full flushing of the colon.

In our early efforts to establish harmony and periodicity with the
enema, it is advisable to resort to a mild vegetal laxative, in some
cases, rather than to let the tongue indicate so much foulness and
allow the feelings to become so intensely blue that they cannot be
hidden by even the utmost effort at pleasantry. Extreme cases may call
for different aids toward relief, until, one by one, these aids may be
dropped--the last one to be discontinued being the enema.

For a short time at the start it is, perhaps, best to confine one’s
self to two enemas, especially if fairly successful with the attempt
at a thorough cleansing after breakfast and before retiring at night.
The sleep will be sounder and the patient will be more apt to rise
refreshed with a clean tongue and cheerful spirits. So much will this
before-bed enema do for him that he may soon find it unnecessary to
take the preliminary injection on rising, inasmuch as fermentation
and gas will no longer trouble him. But individual experience and
intelligence must dictate the course in this respect. Let the patient
study himself and note the demands of his system. It may even be,
indeed it is frequently the case, that a patient requires several
enemas during the day. When abnormality has set in, it gives rise to
all sorts of freak requirements, and the victim must, for a time,
accede to its whims.

Quite frequently, owing to various causes, the feces will descend into
the rectum, which is properly a conduit, not a receptacle. While there
it occasions much nervous irritation of the whole system and makes
its victim desperate. It is wise, under such a condition, to take
slight injections for relief. Never allow any foulness to accumulate.
Establish the _habit_ of internal cleanliness. The new sense of bodily
purity will be so great that it can never be outgrown.

Nature easily accommodates herself to habits, whatever they be--normal
or abnormal, wholesome or unwholesome, cleanly or uncleanly; and the
train of consequences will be accordingly good or evil. My point may
be easily illustrated by the habits of “civilized” man in regard
to bathing. Many persons never take an external bath, and are not
conscious of any bodily discomfort arising from the omission of this
presumably necessary practice. As the summer approaches, another batch
of “civilizees,” so fortunate as to be within convenient distance of a
pond, lake, river, or ocean, begin to feel the real need of a “dip,”
and are uncomfortable until they get it. This is surely a sign that the
spirit of cleanliness is beginning to stir in the breast of humanity.
Then there is another contingent that bathe once a week, and should
their regular routine in this respect be interfered with they would at
once feel unclean--nay, even dirty, and, sometimes, “nasty.” Others,
again, bathe twice or thrice weekly, and this quota of the human
race feels very uncomfortable and foul when hindered for a week from
following this routine; indeed, such bathers often imagine that a dire
illness is impending. Finally, the “salt of the earth” take an external
bath once or twice a day, and, should _their_ routine be suspended for
twenty-four hours, visions of madness or suicide begin to haunt them
until relieved by soap and hot water, or the cold plunge, as their
habits require.

Of course, the same rule applies to the routine concerning the teeth,
facial ablutions, etc. Nature is stored habit, and she feels outraged
when her proprieties are disregarded. Let us pray, therefore, that the
habit of cleanliness may become contagious!

Now, the parallel between external and internal cleanliness is quite
obvious. Those whose bowels move but once in two or three days do not
realize how foul they are. Others have a scant evacuation once in
twenty-four hours, and they imagine that they are as clean as those
that take an external bath once a week think themselves to be. Still
others have two stools daily, and they feel as clean internally as
those that take three external baths weekly. And, finally, there are a
few who, defecating thrice daily, feel quite as clean as does the most
persistent external bather. Thus we see that cleanliness, external and
internal, is a habit, a new nature, attended with exquisite comfort
and pleasure--a quality that may lead to the goal of divine purity in
realizing the joys of hydropathy.

The wild woodland flower grew and blossomed without attention,
attracting but little interest. After, however, the florist has
cultivated it to the high stage of development in which we find it
to-day, with its stalk, stem, leaf, and fragrant petals displaying
their marvelous symmetry and beauty, we begin to appreciate the value
of labor, pains, cultivation. In like manner, it is our imperative duty
to give proper care to every requisite detail in the transformation of
our body into a human flower of health, grace, joy, and harmony.

The great majority of those that do me the honor to read what I have
to say on internal and external cleanliness will, doubtless, not agree
with me as to the frequency of the ablutions in twenty-four hours. Yet
I have a suspicion that if my objectors were to try an external and an
internal bath, on both rising and retiring, they would soon consider
the practice too delightful to be foregone; they would soon develop
more sweetness of character and be more particular as to the purity
of their nether garments, and, finally, would seem ensphered by an
atmosphere peopled with angels.

My proposition is this: First make a man clean, internally and
externally, and thus you may make him good; after you have made him
good you can make him healthy in both body and mind; after you have
made him healthy you can make him full of joy.

To recapitulate: A good time to take your internal bath is about half
an hour after each meal. Cultivate regularity in this, and Nature
will second your efforts and establish a periodicity for you by her
suggestive impulse and call. Our internal economy should not be
slighted as it has been. The intestines are good, faithful, patient
servitors, ready to perform their lowly office even when we are
inattentive and heedless. Sometimes, however, they become rebellious,
after they have stood more abuse than one would think them capable of
standing. Let us reform our bad habits; our servitors are willing to
enter with us into better habits, and co-operate with us in a truly
human life. Can you not spare a few minutes, three times a day, at
_regular periods_, for inner purification? You will find it very easy
when once you make it a matter of routine.

Now note this point: The work of your brain depends on the power sent
to it by the gastro-intestinal canal. A motor car goes no faster than
the power furnished enables it to go. So your brain activity is ever
on a par with the energy supplied from this usually despised intestinal
source; that is, it can never rise higher than the supply of this
energy warrants, and it always falls to the level of this supply,
for it depends on it absolutely for sustaining power. It would seem,
therefore, that common sense would be sufficient to shame us into
keeping clean, scrupulously clean, the canal that supplies us with
working force--the canal that extends without a break from mouth to
anus. Yet my experience shows that almost everybody cares more for his
outsides than for his insides--more for squandering his stored energy
than for looking out for its constant renewal--and that most patients
are foul all the way down.

Well-fed animals that have the range of Nature are plump, and have
healthy hair, skin, teeth, etc., because their intestinal organs
perform their functions frequently and fully. When animals become
domesticated and “civilized,” they become constipated and catch various
human illnesses or grow a crop of their own. Well-fed “humanals” grow
thin and puny, or bloated with gas, looking like corpulent clay men,
without natural teeth, without natural hair, their skin dry and of a
sickly hue, bloodless, fading away because of an early blight before
they have completed their early growth. Heredity is blamed for the
bloodless, nerveless, brainless body, when, as a matter of fact, its
degeneration is due to foulness within.

Birds, beasts, and savages (more fortunate than civilized man) have
the wide earth on which to stool when Nature calls. Their handy
water-closet enables them to enjoy good health. As civilization
advances, and business and social customs become more complex,
water-closets get fewer and less accessible. As a consequence, man
has to use his large intestine for a storehouse. He has done this so
long that it seems impossible to break him of the foul habit. But he
is paying the penalty. Many have abused the bladder in the same way,
and had this been a large organ like its brother, the colon, we would
long ago have heard the stereotyped excuse in regard to this function,
“Oh, any time to urinate that I can find will do.” Those who object to
the new order of bowel relief should, on the same principle, object to
frequent bladder relief.

I submit this proposition to the judgment of unprejudiced minds: Is
it not reasonable that so harmless and efficient a remedy as the
internal bath should be adopted by all intelligent persons? Inasmuch
as neglect--due to social, business, and other customs, and to lack
of conveniences for ready relief--has brought upon us so much fecal
poisoning and local disorders and so many abnormal and pernicious
systemic results, it should not be considered too great a task to take
an internal bath three times a day to amend our outrage on Nature--an
outrage that involves our health and general well-being, here and
hereafter. We owe it, not only to our possibilities, but also to
posterity, that fecal poisoning be banished. We have no right to
communicate such a taint to our children. They have a right to be free
from such poison. Do we ever think of their claims in this regard? Let
us leave them a better legacy, by adopting the thrice-a-day use of the
enema for the purification of the alimentary canal!




CHAPTER X.

HOW ENEMAS SHOULD BE TAKEN.

METHODS OF INTESTINAL IRRIGATION.


A satisfactory appliance for taking an enema should possess the
following features: capacity, adaptability, convenience, cleanliness,
durability, and sufficient external anal and water pressure to effect a
thorough flushing or an agreeable vaginal injection while one is in a
sitting position over a water-closet bowl.

There are several postures in which an enema may be taken. For those
physically able, the most convenient, cleanly, and comfortable manner
in which the thrice-daily inner bath may be had is the usual upright
position on a water-closet seat. For those not physically able to sit
upright, or for those that are not up-to-date and still adhere to the
use of the fountain or the bulb syringe, the best method is not the
usual sitting position, but the recumbent one. They are advised to
lie on the right side, or on the back with hips raised. As a rule, a
water-closet room is too small for reclining purposes, and, besides,
the necessary rubber sheet and toweling convenience may be absent.
Another drawback to lying full length for the purpose of flushing the
colon is that with short arms and the lack of _external anal pressure_
there is apt to be an escape of water and feces around the anal point,
necessitating much cleansing, considerable annoyance from nasty odors,
and an irritating waste of time.

Various devices, advertised as great inventions, have been resorted to
for the purpose of overcoming such malodorous and uncleanly incidents.
Among them is one that may be described as a colon tube, ranging from
nine to eighteen inches in length, which can be attached to a fountain
or a bulb syringe. The tube is usually of flexible rubber, _colored
red_ to hide as much as possible the cumulative evidence of saturated
filth and bacterial poison, the presence of which a white tube would
betray too readily.

I fail to see the necessity of introducing a rubber canal of such
length into an intestinal channel five feet long for the purpose
of “cleansing” the latter. The project lacks common sense. What a
ridiculous practice--to worm or bore a hole through the impacted feces
as you work your tube upward, then to squirt a little water into the
middle of things, or as near to the middle as you have managed to
get with a tube that will persist in bending on itself, and then to
withdraw it covered with liquid filth! What folly to put a canal _into_
a canal--the one inserted being one-fifth the length of the one to be
cleansed! Is not the original physiological channel good enough to
convey the antiseptic water or oil, or both? Why not have the rubber
canal five or six feet long if _one_ foot is so essential?

We should remember that ulcerative proctitis and colitis have made
the use of the enema a necessity; that, accordingly, the diseased,
constricted gut or canal must be treated very gently and not irritated
in any avoidable way. The least irritation will result in still greater
muscular contraction. It stands to reason that the effort to reach
the healthy portion of the bowel with a slightly flexible colon tube
frustrates its own purpose, and that it is besides a source of serious
and unnecessary irritation. While this rubber tube is being forced up
one’s bowels it often becomes lodged here and there in the valves and
folds of the mucous membrane. It has been found that the effort used
to dislodge it sometimes results in a doubling of the tube on itself
in the form of a knot, and that the end first introduced comes back to
the anus waiting to escape with the next push! We need not argue that
this forced looping and knotting of the tube is very injurious to the
diseased intestinal region, and that no one would care to introduce it
two or three times a day.

Does not common sense suggest that the rational way is to open the bore
of the alimentary canal by beginning at its _end_; that _liquid_ should
be applied directly to the first feces encountered, and that as this
impacted mass is removed the progress should be successfully upward?
The liquid as it enters dilates the channel, and as it passes on and up
it eventually gets beyond the diseased section of the bowels. Here,
by a gentle and soothing dilatation, we create at once an impulse
in the imprisoned feces and gases to descend and escape. What other
method is so kindly, and yet so effectual? We avoid, by this means,
irritating the diseased and constricted muscular canal; whereas by the
tube method we occasion still greater contraction, the inflamed surface
having a tendency to contract and close tightly over the tube. The
flood of liquid dilates the canal; whereas the forced rubber tube, by
irritation, contracts it. Besides, as has been pointed out, the conduct
of the tube working in the dark is most uncertain.

Suppose the rubber tube does finally reach the section of the colon
free from inflammation; that its passage thither has greatly increased
the spasmodic contraction of the diseased portion of the gut, and that,
of course, it had great difficulty in circumventing the resistance
offered by the valves, curves, and short bends--suppose all this, and
an idea of how the contents of the bowel above the diseased zone are
imprisoned will dawn upon you. For, after the tube has reached this
point of impaction, the distention there is most unduly increased by
the sudden gush of water, and, what is of still graver import, the
presence of the tube prevents its return flow. Then as the object is
being removed the watery feces following closely after are impeded by
the increased irritative contraction set up by the tube.

In short, this greatly extolled colon tube subjects the region of
proctitis and colitis, as well as the healthy section, to just such
objectionable procedure until the amount of water injected becomes so
extremely large that a means of escape is irresistibly produced by the
great pressure above. Is it wise treatment to irritate the diseased
portion of the bowels, and to distend still further the healthy portion
above, in order to get rid of distention due to feces and gases?
Without increasing the danger by injecting water into the already
unduly distended colon by the use of the tube, the imprisoned feces and
gases of themselves alone have been known to exert sufficient pressure
to occasion prolapse of the sigmoid flexure into the rectum or undue
displacement of the organ. Surely it were better to get rid of the
imprisoned contents by removing them from near the vent and working
one’s way gradually upward than to add more to the store and burden,
which only causes unendurable excitement and fierce demands for relief.

The rectal enema, taken in the rational way, simply dilates the portion
of the gut that is morbidly contracted--a procedure that is very
beneficial and should be continued just so long as any remnant of the
inflammation remains in the tissues. Kindly treatment is essential,
because ulcerative inflammation is an irritable condition and tends
to contract the muscular tissue at the slightest touch of a foreign
substance. What, I repeat, is more kind and soothing than antiseptic
water mixed with oil?

Advocates of the colon tube assert that water entering the lower
portion of the rectum will occasion ballooning of this portion
of the gut. After an experience covering twenty or more years,
I am in a position to say that there is absolutely nothing in
this objection--that water used in this way cannot produce such a
pathological condition. Ballooning of the lower portion of the rectum
is occasioned by _impaction of feces_, which remain lodged often for
weeks or months at a time in this locality. Whatever dilatation the use
of the enema may transiently produce would be only healthy exercise for
the diseased organ. An instrument is frequently used properly to dilate
the more or less contracted canal above and below the distended pouch
for a distance of from six to ten or more inches. Nothing but good
results can follow the proper use of the enema two or three times a day
in all forms of local disease of the anus, rectum, and colon.




CHAPTER XI.

THE INTERNAL FOUNTAIN BATH.

THE AUTHOR’S UNIQUE INVENTION.


The author has searched the markets of the world for suitable apparatus
for intestinal irrigation, so that he, as a specialist in this line
and in anal and rectal diseases, could recommend it to his patients.
None of the appliances to be had, however, quite answered the purpose
he had in view. All of them had some drawbacks. Owing to this fact,
after much experimentation he has invented an instrument that is herein
fully described to show its serviceableness. Were this volume to be
issued without this description, the author would be inundated with
interrogatories concerning the best instrument to be employed by its
readers, or whether the appliances they have on hand would answer the
purpose. As the object of this book is practical, not literary, it is
not out of place, the author thinks, to describe the invention and its
unique serviceableness, as well as its special adaptability for the
tri-daily employment of enemas.

The instrument is known as “The Internal Fountain Bath for Home
Treatment.” The following illustration gives a very good idea of its
construction and merits:

[Illustration:

[Patented Dec. 31, 1901; Nov. 14, 1905.]

Figures 18, 21, 22, and 23.

18, Reservoir; 21, hard rubber handle; 22, metal handle; 23, metal
handle, hard rubber cone, and enema point; 19, lamp support; 20, lamp;
33, rubber tube and shut-off; 24, glass bottle; 27, hard rubber anal
cone; 29, valve; 28, enema point; 25 and 26, recurrent douche points;
30, glass bottle; 31, hard rubber cone; 32, enema point.

Figure 24, Page 120, illustrates the author’s rubber enema appliance,
The Niagara Fountain Syringe, holding about two gallons of water.]

The Internal and External Fountain Bath is an appliance that I
have devised and supplied to my patients for many years with most
satisfactory results in every particular. Several other enemata and
recurrent douche instruments which I have used did not wholly meet the
requirements in capacity or aseptic features; but long use of this
apparatus in all the various bowel troubles has demonstrated, to me as
well as to my students and patients, that the instrument is the best
that can be made, perfectly meeting all the requirements essential for
scientific results.


_Features and Uses._

The Fountain Bath is the product of necessity, effort, and long
experience in accomplishing a definite purpose fully and properly.
Figure 18 illustrates a large enamelled metal reservoir for water.
Figure 21 shows a hard rubber combined enema and recurrent douche
appliance for the application of water to the mucous membrane of the
large intestine, the temperature of which should range from ninety to
one hundred and thirty-five degrees or more. To one end of the handle
is attached a hard rubber anal cone (Figure 27), inside of which is a
valve (Figure 29), which is opened and closed by turning the handle,
permitting the water to pass through the rectal point (Figure 25), or
(Figure 26) into the bowels and return into the toilet basin without
removing the point. At the other end of the handle is attached a glass
reservoir for the use of oils. Figure 22 is a metal handle with a
glass reservoir and a hard rubber anal cone. Figure 23 is a metal
handle without glass reservoir, and both are intended for the use of
water at a temperature of from ninety to one hundred and five or one
hundred and ten degrees. A thermometer is absolutely necessary to
determine the temperature of the water during its use as a depurent and
antiphlogistic remedy. The heating appliance will keep the water at a
desired temperature during its application, which is a very essential
feature indeed.


_Water Capacity._

The Fountain Bath reservoir holds three gallons of water, which is
quite sufficient to meet all requirements of the various complicated
cases of bowel and uterine troubles which require a generous supply
of tepid or very hot water. This obviates any interruption in the use
of the enema or the recurrent douche treatment until one or both are
satisfactorily completed, and without changing one’s position on the
toilet seat. It requires a quantity of water to irrigate the large
intestine, which is some five feet long and two and a half inches in
diameter. It is foolish to attempt to irrigate one end of a long,
tortuous, foul sewer with one or two quarts of water and hope for good
results. Water is cheap, then why not clean out and keep clean?


_Adaptability._

For the first time in the history of enemata appliances can an enema,
recurrent douche, or vaginal injection be taken with water at any
desired temperature and at the same time be medicated with any remedy
desired. External pressure against the anal orifice is regulated at
will; also the flushing of the integument about the anus and buttocks
is easily accomplished before leaving the toilet seat.


_Convenience._

This scientific device can be used without assistance. It has one
feature moreover, that renders it unique among rectal appliances,
namely that you may take a number of rapid injections without changing
your seat. You may inject a small quantity of water (from eight to
twelve ounces), and expel it immediately; then you may follow with a
larger amount (from one to three pints), and expel that also, then
in the same manner flush the colon. A complete internal bath may be
effected in the same way by using three, four or more quarts of water.
In this way, thorough depurating results may be obtained. The several
preliminary injections of gradually increasing quantities of water
free the lower bowel of feces, germs, and gases which otherwise might
be forced by the flushing process backward into and along the colon.
With the Internal Fountain Bath, unlike other syringes, it is not
inconvenient to take preliminary injections before flushing the bowels.
After the flushing the rectal and anal canals the bowels can be easily
cleaned their entire length, as can also the integument about the
anus and buttocks by letting the jet of water play on these parts to
wash away any germs and other poisonous discharges. All the necessary
movements of the anal point are easily made with the handle which
projects between the limbs in front of the toilet seat.


_Cleanliness._

The water reservoir is enameled white, both inside and out and free
from poisonous substances. The enamel is not injured by the use of any
germicidal remedies that may be placed in the water, or by the water
being brought to a very high temperature to destroy bacterial poisons.
Furthermore this enameled surface is easily cleaned, thus avoiding
foulness of the reservoir from continued use. The glass medicine case
and anal cone attached to the handle, as well as the anal point, are
all detachable and easily cleaned, and the handle is of sufficient
length to obviate soiling the hands and impregnating them with odors.

To bring away a quantity of feces does not exhaust the purpose of the
enema. The intestinal sewer requires further cleaning from end to end,
and the external parts around the anus as well. By playing a jet of
water on the external anal region you finish the enema and avoid the
very uncleanly practice of using “toilet paper” as a means of external
cleansing. It is strange that otherwise cleanly people are content with
such uncleanly treatment of these parts. They imagine that “toilet
paper” will effectually remove the excrement and its attending odors.
They would not think it sufficient thus to clean their hands if soiled
by excrementitious matter. It is the old story, “out of sight, out of
mind,” and of letting any make-shift in such cases answer; but the
spirit of cleanliness is abroad in the land, and the Silent Club of
the Cleanly is being formed through just such agencies as the Internal
Fountain Bath. Many have doubtless longed for a better practice but
did not know what to do. The “toilet paper” habit will pass with the
once-a-day habit of stooling, the constipation habit, and the physic
habit, for all four are uncleanly in the extreme.


_Durability._

The enameled metal reservoir and the metal and hard-rubber parts of the
handle ought, with care, to last a lifetime; the soft-rubber tube, if
properly cared for, will be of service for a long time.


_External Anal Pressure._

This is of very important assistance in flushing the colon, as it aids
in preventing the return of the injected water, and thereby promotes
its conveyance along the colon until it arrives at the surgically
famous vermiform appendix. It is not strange that both ends of the
large intestine--the anus and rectum and the appendix region--have
kept the surgeons busy, and I may add the undertaker likewise. These
two ends are of extraordinary concern, because they manifest intense
symptoms and pathological consequences. Modern medical practice is the
heroic treatment of symptoms and consequences and not patient search
for causes of disease and sensible treatment of it, as explained in
my treatise dealing with “Intestinal Ills,” as well as in the present
volume.


_Water Pressure._

Two or three gallons of water, suspended at the usual height of enemata
appliance, affords quite enough pressure, especially when the outlet
and tubing are amply large. The shut-off on the rubber tube enables the
user to gauge the flow of water to a nicety.


_Time Required._

The time required for taking an internal bath--that is, for a complete
flushing of the bowels--will vary in individual cases. After removing
the local deposits in and near the rectum by one or two rapid
injections of very small quantities of water, two to four quarts are
taken into the intestinal canal at one time, and this constitutes
the enema proper. Now, many persons will find it advantageous to
let the flushing water enter very slowly, taking from two to five
minutes, or even more. With some, if the water is allowed to flow in
very rapidly, the various segments of the rectum and colon may not
readily accommodate themselves to the inflow, and will too soon make
an expulsive effort, returning the water before it has dissolved the
feces or united with them, thus defeating the object sought through
the enema. With other persons, however, the flow may be as rapid as
desired. The speed must be left to individual judgment and experience.


_Temperature of Water for an Enema._

The chief purpose of an enema is to produce depuratory results; that
is, to remove morbid matter from the bowels and then to cleanse them.
To accomplish this effectively and at the same time to avoid exciting
an increased flow of blood to the diseased gut, the water should
be about the normal temperature of the body, which is about 98-1/2
degrees. Water too hot or too cold will aggravate the sensitive,
inflamed surface; and, as it is this very inflammation that causes
the abnormal action of the bowels for the relief of which the enema
is taken, the temperature of the water is most important. If it range
between 90 and 105 degrees it will do, for within those extremes it
will not be likely to increase the existing chronic engorgement of the
tissues. Under no circumstances should very hot or very cold water be
used for the removal of fecal accumulation. Physicians so incompetent
as to make a wrong diagnosis of the cause of chronic constipation
and its numerous symptoms often prescribe a wrong treatment in the
use of water. From two to ten minutes’ use of very hot or very cold
water in cases of proctitis and colitis will only increase the chronic
engorgement of the blood-vessels and tissues and increase the morbid
symptoms. When water is applied to the mucous membrane anywhere
throughout the body, I use it hot exclusively, as that temperature has
then certain advantages over cold. In the chapters treating upon the
different uses of hot water, I give the hydro-therapeutic action of
such liquid on the tissues of the body.


_Quantity of Water to be Used._

The quantity of water to be injected into the colon at one time must
vary in each case and also on each occasion. In the beginning of its
use and for some time following, a greater amount may be required than
will be necessary when, with its continued use, a better action of the
bowels becomes established.

In cases of chronic constipation and semi-constipation, the kidneys,
lungs, mucous membrane, and skin eliminate a daily accumulation of
feces from the system equal to two-thirds or three-fourths of the
amount of normal feces. This accounts for the frequency of chronic
disease of these organs. To establish a new régime in the mode of
fecal and gaseous elimination requires much time and patience in the
use of the enema. Nearly all persons can take the enema with comfort
and satisfaction. Now and then, however, there is a person who finds
it a little troublesome to inject over a quart of water at one time,
while most persons can inject over four quarts without inconvenience. I
would advise patience and perseverance on the part of those who find it
irksome to inject a sufficient amount thoroughly to cleanse the colon,
or the portion thereof involved in undue accumulation.

Enough water should be injected to bring away what would constitute
the normal amount of feces to be passed at a regular stool. Gradually,
as the practice is established by the use of the enema twice or thrice
daily, it will be easy to determine the proper amount of feces to pass.
And note this fact: it is just as easy to establish the habit of three
evacuations in twenty-four hours as of two or one.

Whenever the amount of water injected proves sufficient at any time to
bring away all the feces that should pass, it is not necessary at that
sitting to repeat the dose, except it be for subsequent cleansing, as a
sort of gargle. No possible harm can come from the generous use of the
enema during a lifetime; indeed, its constant use will prolong life and
make it more comfortable.




CHAPTER XII.

BENEFITS OF THE INNER BATH.


I speak from clinical observation with the use of various rectal and
colon specula, of which I have over fifty. I have watched the progress
of cases that were using the enema twice or thrice daily, and of cases
that were also using the intestinal recurrent douche, which latter
required an hour’s continuous application of hot water, and I know,
therefore, whereof I speak when I affirm its salutary effect both on
the local organs and on the general system.

Many that write about the use or abuse of the enema have never seen
the mucous membrane of the rectum and colon. Most of what is written
on the subject is worthless. The author of this book writes from
the accumulated experience of daily examinations with specula for a
period of over twenty-three years. Had he merely used his fingers
or hand for making rectal examinations, or had he contented himself
with prescribing for symptoms reported by the sufferer, his views and
opinions as to the use and benefits of the internal bath would have
been on a par with those that, by the old methods, make futile efforts
in diagnosis and treatment.

Some good souls now and then become oversolicitous as to the matter
they should pass when their bowels are already empty, and they feel
alarmed if the enema fails to produce an evacuation. Such timid ones
should remember that what they cannot accomplish at one time and with
one attempt they may at the next, and that thus slowly the new order of
fecal elimination will become established. It takes time and patience;
but is this cause for apprehension when diagnosis, treatment, and means
of relief are right? I claim that flushing of the colon is the best
means for removal of the consequences of proctitis and colitis, and
that it should be employed by all that have these chronic ailments.
Let them get relief for the _symptoms_ at once and in this rational
way, after which let them seek scientific treatment for the ailments
themselves; for, sooner or later, they will be compelled to seek it by
the severe complications that will inevitably set in.


TRY SCIENTIFIC AND PRACTICAL MEASURES.

Some persons find difficulty in estimating--or think they do, which in
most cases is nearer the truth--the amount of water they can inject at
one time, when it would work a great relief to their bowels were they
able to inject from two to four quarts. It is half the battle to know
your efforts are rightly directed; for, when you are defeated, you will
try a thousand and one changes--an experiment first with one element
of the difficulty and then with another. You will experiment with the
temperature, with the speed of flow into the rectum and colon, with
intermittent flow, etc. Be a little scientific and original in this
matter, I pray you, _and know no defeat_!

As to the intermittent flow, the following way may be found judicious
in some cases: Take in just sufficient water--a few ounces perhaps--to
provoke an evacuation, and proceed till you have taken half a dozen or
more. After this you can take a greater quantity for a washout. But
this is not exactly what is meant by the term “intermittent flow.” It
means that you may make the experiment--if you find it difficult to
fill up after ridding yourself of the local accumulation--of turning
off the stop-cock for a moment, thus giving your bowels a slight rest,
and then turning it on again, alternating in this way for some minutes.
Many little devices of similar utility will suggest themselves to those
who know no defeat. Remember that, now that you are in serious trouble,
it is not the easiest thing in the world to get out of it.

Should your stomach raise objections to the enema, change the time.
If abdominal pains are severe, change the temperature of the water
and the time and manner of injecting it. In other words, do something
different, but be determined to conquer and take the internal bath at
proper periods every day.


LIBERATING THE WATER.

Some persons who find no trouble at all in taking a large quantity of
water have much difficulty in expelling it, or rather in expelling
all of it at once. Various methods may be resorted to to liberate the
retained water. One is to inject a little more, as a provoker, when all
will escape without further difficulty. Another method is to resort to
various motions of the arms and body. Some find relief by raising and
projecting both arms together slowly, and then stretching and holding
them aloft for a few moments. Other methods are: to twist the trunk a
few times, to walk up and down a little, to bend forward and backward,
etc. Still another method is to massage the abdominal walls, beginning
at the ascending colon (see Fig. 12), passing upward to the left along
the transverse colon, and then downward until the lower portion of the
sigmoid flexure is reached. When beginning the massage, one should use
stroking movements from right to left over the entire surface, and then
go over it again with rotary strokes. Some may find it advantageous to
knead the abdominal muscles, gradually reaching the deeper parts as the
air is expelled from the lungs, which expulsion may change the position
of the various segments of the intestine and thus afford an opportunity
for the feces, gases, and water to escape. Before rising in the morning
and retiring at night, it will be found advantageous by some persons
to spend about ten minutes in making the three kinds of manipulations
described. It is an excellent practice for every one to lie flat on the
chest and abdomen and draw in several deep breaths just before rising.
This exercise will strengthen the muscles of those parts and benefit
the internal organs as well.


THE ENEMA AS A PERMANENT PRACTICE.

In the effort to restore the long-abused bowel to its normal
functioning by the use of the enema and massage, there may be, in
the beginning of such treatment, an exceptional case in which a mild
laxative is indicated as the desirable thing, rather than that a furred
tongue and base bodily feelings shall evidence too much foulness all
the way up to the mouth.

The enema, of course, constitutes the chief means and mainstay of
relief from obstipation of the bowels, and one by one the other
aids are to be omitted. Moreover, when the time comes that the
bowel is freed from the disease that occasioned the occlusion and
obstipation,--that is to say, when the bowels evacuate themselves
naturally three times a day,--then the enema itself may be omitted, or
it may be continued without harm by those whose sense of cleanliness
would induce them to keep up the practice in preference to the
uncleanly habit of using toilet paper as a partial means toward
cleanliness. Surely there is no harm in substituting a better habit for
a worse one--one, moreover, that we should be ashamed to continue! As
no one would think of cleaning his soiled fingers with toilet paper, as
already said, so no one with any real sense of decency will continue
the attempt to clean his anal orifice with such material when he has
learned a better and more effective way. Likewise, after having learned
the rational mode of relieving the surcharged bowels, no wise person
will continue the use of physic, coarse food, gymnastic exercises, and
other futile and foolish practices as remedial measures for intestinal
ailments.

No one suffering from proctitis and colitis can have a clean and
healthy sigmoid flexure and rectum unless these be kept clean by
the regular use, three times a day, of the enema. From the day when
the disease invades these parts there is and will continue to be a
clogged, plastered, or incrusted passage for more or less of the entire
length of the colon. This must be so in the nature of things, since
these organs are unable to perform their functions while the disease
is present. Just think of possessing a filthy, congested intestinal
canal, without one day of real cleanliness for twenty, forty, sixty, or
more years! It is not the easiest thing in the world to cleanse this
channel even by the use of the enema; for the ancient contents refuse
dislodgment even after repeated flushings, and it is only after many
days of persistent and patient irrigation that the intestines are freed.

Some persons are apprehensive as to the quantity of water the large
intestine will hold with safety. Let me reassure them. It is capable
of holding about three gallons without too great distention. One-third
of this amount, however, is quite sufficient to bring away the
accumulated fecal mass, and in many cases a much smaller amount will
answer the purpose--especially when, as advised, it is used two or
three times within twenty-four hours. After a thorough evacuation,
water should be injected one or more times until it returns clear and
free from fragments of feces.

If I were asked to name the greatest curse parents could inflict upon
their helpless offspring, I would say _fecal auto-intoxication_. A
large volume could be written on the subject, and I trust the hints
here given will lead to discussion of this grave matter.




CHAPTER XIII.

OBJECTIONS TO THE USE OF THE ENEMA ANSWERED.


The privilege of raising objections belongs to the ignorant as well as
to the intelligent. But the objector is under as great obligations to
state his reasons as the advocate.

The first plausible objection to the use of the enema is that it is not
natural.

Admitting this charge, I would say that, inasmuch as proctitis,
colitis, and constipation are unnatural, the use of a preternatural or,
in other words, a rational means to overcome the consequences of these
diseases is imperative. The enema is such a means.

Can any one that suffers from proctitis, etc., have a natural stool?
Unnatural conditions require preternatural aids, as we all know. The
injected water dilates the constricted portion of the gut and arouses a
revulsive impulse to expel the invading water. In obeying this impulse,
the imprisoned feces, gases, etc., are ejected with the water.

It may be unnatural to put water into the rectum, etc., but once there
its expulsion from healthy bowels would be quite natural. No natural
action can be expected from unhealthy bowels; they do the best they
can under the circumstances. Eyeglasses, false teeth, crutches, etc.,
are unnatural but invaluable aids, but no more so than is the enema
as a means of relief from overloaded bowels. The enema, moreover, be
it noted, not only aids the system by relieving it of its load: it
cleanses and soothes an organ that must keep at work and perform its
function even when invaded by disease.

Surely it is unhygienic and irrational to ignore the valuable service
of the enema in cases in which the bowels are in an unnatural condition.

The second objection is that the water will wash away the mucus from
the mucous membrane of the bowels and leave them dry and parched and
thus apt to crack and break in two. I would remind the objector that,
since about seventy-five per cent. of the normal feces is water, it
seems strange that so great a quantity of water in contact with the
mucous surface of the bowels should not also cause dryness.

The integument of the body and that of the mucous membrane are similar
in structure, yet who ever had a fear of producing dryness of the skin
by much application of water? The mucous membrane is simply the skin
turned inward; and since it is much more vascular it is less apt to
become dry--if, indeed, its dryness were at all possible. The objector
should also remember that the body is composed of over eighty per cent.
of water--an organism not to be made dry or parched by the application
of water to the skin or to the mucous membrane two or three times a day.

The mucous membrane of the lower bowel is not unlike that of the
mouth, throat, or stomach. Do you realize how often the upper end of
the intestinal canal is washed or bathed daily with liquids,--soft and
hard drinks, hot and cold,--especially by those who have formed the
drink habit instead of the enema habit? They have no fear of drying the
mucous membrane thereby; but, if you can instill this fear, they will
increase the quantity with pleasure!

This second objection, being the result of too vivid an imagination and
too little reflection, is a very nonsensical objection indeed.

A third objection is that if you begin the use of the enema you will
have to continue its use; you can’t stop, and, lo and behold! the enema
habit is formed,--a new habit in addition to the many habits civilized
man is already carrying: the constipated habit, the physic habit,
the sand, bran, sawdust-food habit, the muscular peristaltic habit,
etc.,--and with all these habits the poor victim of proctitis and
intestinal foulness wonders that he is alive.

Usually the first symptom of proctitis is constipation, and for
relief the enema habit should be formed and continued while the
constipation remains. When the proper means are found to remove the
intestinal inflammation--proctitis and colitis--then the constipation
will disappear, and with its disappearance the enema habit can be
discontinued. But let it be well noted that the enema is itself an aid
in curing the cause, an aid superior to any other at our command. A
cleanly habit ought not to be an objectionable one, especially in cases
in which it is most needed to prevent toxic substances from entering
the system.

A fourth objection is that after taking the first enema the
constipation is worse.

With many persons a certain amount of undue accumulation of feces will
excite a sufficient muscular effort of the gut to force the dried mass
through the proctitis- and colitis-strictured bowels. This unnatural
effort may occur once a day or once in two or three days, and has
doubtless been a habit of many years’ duration.

To introduce a new order of conduct on the part of the bowels requires
time. If the bowels have been in the habit of expelling feces in the
morning, and an enema were taken the night before, there might be no
desire to stool the next morning because of the fact that the bulk or
accumulated mass of excrement was no longer there to create a vigorous
call or impulse for defecation.

But we have found the extent of local damage and reflex injury to the
organs, and more especially we have found the constant absorption
of poisons into the system, due to the presence of feces. It is
for this reason that the elimination of feces twice or thrice in
twenty-four hours is advised. The condition for which an enema is
used is disturbing and poisoning to the system. It is, therefore, a
most unnatural condition. What is more rational, then, than to employ
an “unnatural” yet not harmful means to bring about a more normal
condition, one free from poisoning and irritating consequences?

A fifth objection is made by those who have as a symptom of proctitis
a large development of pile tumors or hemorrhoids (distended mucous
membrane). The objection is that at times these tumors or sacs prolapse
very freely during the act of expelling the injected water. But this
prolapse occurs in many cases whether water is used or not.

A certain amount of anal irritation caused by the passage of feces
occurs, causing contraction of the circular muscular tissue that forms
the anal and rectal canal, also of the longitudinal muscular bands
and the levator muscles of the organs. The enema lessens or entirely
diminishes the irritation of passing feces, and the natural result is
that the serum-filled sacs called piles and the tissue loosened by
the inflammatory product would more readily prolapse during the act
of defecating. It is simply a choice between irritation of the stool
keeping the tissue up and no irritation permitting a prolapse.

Of course, if there be no expulsion of feces and water the stretched or
dilated sacs may keep their places in the rectum. And then again the
enema may be used for quite a period, when all at once a large prolapse
of sacculated mucous membrane occurs, and the enema is thought to be
the cause of it. That this is not the cause, let it be remembered that
in all cases of proctitis the chronic inflammation is apt to become
subacute or acute, and that this intense engorgement and enlargement of
the tissue with blood and the increased fever in the parts often result
in prolapse at any time, especially at times of convulsive effort at
evacuation.

Whatever follows the proper use of an enema, even though what follows
be annoying, should not be blamed on the enema, for its action is most
kindly, lessening, as it does, the irritation that otherwise would be
more severe when the feces pass through a disease-constricted canal.

The sixth objection is that the use of the enema will weaken the
bowels, which are already too “weak” to expel their contents. “Atony,
paralysis, fatty degeneration of the gut, are bad enough,” say these
objectors, “without having an enema increase their uselessness.”
Diagnosis wrong and objection groundless!

Distend and contract an organ for a short time two or three times a
day, and it will gain in strength from the exercise. Every one knows
that this is the case. What more gentle means of exercising the large
intestine than by the enema?

But the truth of the matter is, that in all cases of proctitis and
constipation the diseased portion of the gut is too active in its
muscular movements, contracting spasmodically, as it does, at even the
suggestion or suspicion of feces near it. Every impulse of the bowels
above the constricted section to force the feces down through the
closed bore only intensifies the spasmodic action and increases the
muscular obstruction, compelling the victim to resort to some one of
the many drastic means of relief.

The enema does no more than kindly to dilate the constricted region,
which, when dilated, evokes a harmonious concerted action of all the
nerves and muscles to pass along and down the burden of feces, which,
without the aid of a flood of water, they had been incapable of moving,
and would have had to leave to poison the system.

The seventh objection is quite _naïve_: “Inasmuch as the Indians of
this country had no use for the enema, why should we resort to it?”

The all-sufficient answer to this objection is that the Indians lived
a natural life, while ours is artificial. Much can be said on this
point, but the reader is surely rational enough to follow out the
distinction suggested. Our lives are much more important than were the
lives of the aborigines of this country, and our “demands of Nature”
are more exigent. If your life is of no greater value than theirs,
for leisure’s sake don’t use the enema! You will be taking too much
trouble. It really should seem that the cleanliness of the skin and
mucous membrane, the care we take of our bodies, is an indication and
measure of our sense of refinement. An ancient Scripture hath it: “Let
those that are filthy, be filthy still.” It all depends upon how you
wish to be classed--with the filthy or the cleanly.

The eighth objection to be noted is the fear of “poking things” (points
of instruments) “into the rectum.”

This looks like a real objection. No healthy, nor even unhealthy,
organ, for that matter, should be “abused.” And what seems more likely
to cause it trouble than to poke a hard- or soft-rubber point or tube
through its vent in opposition to its bent or inclination? Still, the
muscles of the vent are strong, and they soon accommodate themselves
to the practice. Their slight disinclination is not to be considered
alongside of the relief and cure you effectuate by the use of the enema.

Have no fear that the point will occasion disease when intelligently
used. Always see to it that the point is scrupulously clean. Those made
of hard rubber or metal can be kept so without effort. Soft-rubber
points are always foul and dangerous, especially after they are used a
few times. A good rule is never to put a point higher in the bowel than
is absolutely necessary.

The ninth objection seems serious. It is that in taking an enema the
water escaping from the syringe point will injure the mucous membrane
where the jet strikes. But on examination this objection falls to the
ground; for it stands to reason the jet cannot directly hit the surface
for more than a moment. Immediately thereafter the accumulation of
water will force the jet to spend its energy on the increasing volume,
to lift it out of the way so that the continuous inflow may find room.

But even were it possible for the jet to strike a definite section of
the mucous membrane during the taking of the enema, it could do no
harm provided the water be at the proper temperature. And this is true
even if a hydrant pressure be used. Not a few persons use the hydrant
pressure of their houses in taking an enema. For a really successful
flushing of the colon a considerable pressure is requisite to force the
volume up and along a distance of five feet, especially when sitting
upright. But it is folly to use a long syringe point, since it is like
introducing one canal into another for the purpose of cleansing it.
Therefore, have no fear from the use of proper syringe points; the jet
of water will _not_ hurt the mucous membrane. My professional brethren
at least ought to know that the idea of such harm is sheer nonsense.

The tenth objection to using an enema is in _being obliged to use it_
from the fact of having such a disease as chronic inflammation of the
rectum and colon. Every victim hates to be compelled to do a thing;
and the victim of proctitis and colitis is no exception to the rule.
In fact, he is beginning to realize that unless he uses it his system
will be poisoned by the absorption of the sewage waste. Let the victim
object to the disease that necessitates the use of the enema, and all
will shortly be well. Then this objection to the use of the enema will
indeed be the most important of all.

The eleventh objection, and the most ridiculous of all, is that it
requires too much time to take the enema twice or thrice daily.

I lose all patience with persons urging this objection. Those that
have little or no system with their daily duties seldom have time to
do anything of importance. They suffer from “haphazarditis,” a very
difficult disease to cure, and they are in many cases hopeless. Usually
they are an uncleanly lot of people, full of good intentions, but
their intentions, though taken often, seldom operate as an antidote
to foulness. Their one sigh the livelong day is: “Oh, could we be
like birds that can stool while on the wing or on foot!” This feat of
time-saving being hardly possible in the present incarnation and order
of society, they content themselves with making a storehouse out of
the intestinal canal for an indefinite length of time as they concern
themselves with external affairs of work or sport. A sorry lot they
are, indeed, when they are laid up for repairs! Many doctors, I am
sorry to say, encourage, with a chuckle, this foolish practice. “Any
time to stool you can manage to get, so that you stool at least once a
day, or once in every two or three days; stool when it is normal for
you to do so.” This criminal advice just suits the sleepy, the lazy, or
the “awfully busy.”

The American habit of doing things _en masse_, of handling things in
large quantities or in bulk, has something to do with their don’t-care
constipated habit. Small evacuations two or three times a day seem
too much like small business, which of course is a waste of precious
time. Wholesaling, laziness, lack of system, hurry, are the cause of
good-for-nothingness of body and mind. It should never be too much
trouble to restore the lost impulse for stooling twice or thrice daily.

Is it a small matter to have the main sewer of a city partly or
entirely closed, or the main sewer pipe of a dwelling stopped up? Think
of the dire results, notwithstanding that the windows and doors remain
wide open! The Board of Health would soon deal with the negligent
official or landlord. With very few exceptions, “civilized” men, women,
and children are negligent and niggardly caretakers of the human
dwelling-place--the marvelous body of man. “Lack of time,” “haven’t the
time,” or “no time,” is the excuse they give themselves and others.

Notwithstanding the numberless victims around them, none of these
negligent and niggardly ones seem to get alarmed until the secondary
symptoms--such as indigestion, gout, rheumatism, or disease of some
vital organ--are sufficiently annoying to demand attention. But I have
full faith in humanity. Man does the best he knows how--as a general
rule. But often he doesn’t know how; he needs enlightening.

The hints I have given will, I am confident, be considered and acted
upon by all to whose attention they are brought, for, by acting upon
them, normal bodies and minds will result, and blessings attained
heretofore considered impossible. Normal health depends on right doing
and being. Eternal vigilance is the price to be paid for the attainment
and maintenance of the goal of normal life and progress. Eliminate all
waste material from the body and all shifty vermin from the mind, and
the millennium for all things in the universe will soon dawn.

[Illustration: Fig. 24.

NIAGARA FOUNTAIN SYRINGE.

(Patented Nov. 14, 1905.)

The above illustration represents the Niagara Fountain Syringe, to
which can be attached the enema handle, Fig. 22, Fig. 23, or the
combined enema and recurrent douche handle, Fig. 21, page 91. The
Niagara Fountain Syringe is made of soft rubber and holds about two
gallons of water, and is very handy when traveling or in need of a
hot-water bottle.]




CHAPTER XIV.

LAME BACK.


The manufacturers of various compounds advertised in our daily
newspapers and on the billboards usually select very common ailments or
symptoms on which to exploit the merits of their product. They make no
distinction between a disease and its symptoms; and why should they,
when their sole object is to sell their goods?

Lame back is a common weakness of that portion of the spine usually
spoken of as the “small of the back.” As a general rule, it is an
indication of some pelvic disease involving the anus, rectum, colon,
bladder, or uterus. Those who suffer from disease of one or more of the
pelvic organs will have at times reminders that they have a lame, weak,
or “dead” spot at the “small of the back” or a little lower down on the
spine.

As an illustration, a current advertisement reads as follows: “Weak
Backs! If you happen to be one of those unfortunate people with a weak,
lame, tired, aching back, it is time you were finding out about ----.”
Then the advertisement proceeds to tell how to put on a plaster or a
liniment, or rub the back for a week or two with the hands. Another
enterprising wonder-worker asks: “Do you get up with a lame back?
Thousands of women have kidney trouble and never suspect it.” “Lifted
from the depths of despair by----” etc. Now, this may be seriously
alarming to actual sufferers from lame back.

[Illustration: Fig. 19.

Showing the distribution of the sympathetic nerve about the rectum. 22,
the rectum; 23, the bladder; 26, the kidney; 20, the rectal plexus; 19,
the vesicle plexus; 18, the sacral ganglia; 21, the lumbar plexus; the
lumbar ganglia; 16, the mesenteric plexus; 15, the solar plexus; 27,
the aorta.]

The kidneys are located several inches above the region called the
“small of the back”; therefore, a difficulty in this region does not
necessarily indicate disease of the kidneys. Those who suffer from the
symptoms described--lame, weak, hot, dead spots, lumbago, rheumatism,
etc.--at this portion of the spine may suspect that some of the organs
in what is called the pelvic cavity are causing them. The spinal nerves
(lumbar nerves) on leaving the “small of the back” and proceeding lower
down are distributed to the anus, rectum, bladder, uterus, etc., and
when one or more of these organs are diseased the victim will have some
of the symptoms in the portion of the back mentioned above. The earlier
indications of a disease are usually localized, but, as the malady
itself persists indefinitely, both the sufferer and his physician
are often deceived as to the producing cause of the varying symptoms
manifesting throughout the body.

In this brief chapter I will confine myself to the diseases of the
anus, rectum, and colon, as causing so much annoyance from the symptoms
enumerated at or below the “small of the back.” The most common ailment
that afflicts mankind is chronic catarrhal inflammation of the anus,
rectum, and colon. The disease invades not only the mucous membrane but
the whole bowel structure, and the nerves report from the seat of the
trouble up to where they enter the spinal column--a region that should
be called the porous-plaster region rather than the “small of the back.”

The chronic inflammation involving eight to ten inches of the lower
portion of the intestinal canal, like all other diseases, has its
alternating periods of quietude and excitement; and the negligent
sufferer must count on having “stitches in the back,”--cold in the
back, lumbago, rheumatism, sciatica, etc., as they are usually called
for want of a definite idea as to the _cause_ of the annoying symptoms.
The physician consulted usually agrees with the sufferer’s diagnosis,
and coincides with the application of bands, porous plasters,
liniments, etc.--which may allay the neuralgic symptoms to some extent.

The reader is so familiar with illustrations in the newspapers and on
bill-boards of a man with a weak or lame back that it is unnecessary
here to take up space with a pen picture descriptive of the symptoms
and attitudes of a sufferer.

Those who have had occasion to acquire the warm-band, the rubbing with
liniment, and the plaster habits, had better direct their attention and
remedies to the _cause_ of the symptoms. One frequent source of all
these back symptoms is chronic inflammation of the anus, rectum, and
colon, with more or less ulceration accompanying it. In the female,
disease of the uterus complicates the painful symptoms. Usually among
the first indications of this disease is some degree of constipation,
which in time is followed by local symptoms known as piles, fissure,
itching tabs, clot of blood in a vein, abscess, etc. Constipation is
a prolific cause of indigestion, biliousness, flatulency, loss of
appetite, self-poisoning, anemia, emaciation, uric acid, neuralgia
in various parts of the system, catarrhal inflammation of the mucous
membrane of one or more organs, and many other symptoms.

A diseased organ is a constant source of unconscious and conscious
irritation to the sufferer. If the victim can tolerate the trouble he
seldom seeks treatment. “I will not bother with it as long as it is no
worse,” he says. At times, however, the symptoms become very annoying,
and measures are taken to allay them. During the long interval of
“better and worse” effects the malady is becoming more deeply seated,
and the symptoms eventually appear in all parts of the body.

As a rule, the majority of victims put off treatment until a protracted
period of extreme suffering or the fear of a fatal ending compels them
to consult a physician--who labors at a great disadvantage in seeking
to effect a cure on account of the long neglect.

Severe symptoms located at the porous-plaster region of the spine, when
brought on by disease of the lower bowel, usually indicate an acute
stage of chronic inflammation and retention of feces and gases in the
sigmoid flexure and colon. Acute or subacute inflammation and fever and
pressure of the feces are more than the long-abused nerves can endure,
and severe pain is the result.

Then the sufferer has something to say about his back, and what is best
to do for it.

The logical course is to unload the bowels of feces and gases by a
generous use of the enema and to treat the diseased tissues kindly. The
symptoms will soon disappear when the cause is removed.




CHAPTER XV.

URIC ACID.


A society leader, in speaking of her ills to a woman friend, said: “I
am ‘lousy’ with uric acid.” From infancy to old age, mankind is more
or less filled with uric acid and other poisons--the result of a foul
intestinal canal. Poisoned blood is a common symptom, and it arises
from an almost universal cause--chronic constipation. So universal is
constipation of the bowels in illness that it is the first duty of a
physician to prescribe some remedy to unload them.

It is said that a Boston doctor, whose practice was largely among the
wealthy classes, used to say: “There is no use in physicians pretending
to be anything else--they always smell of rhubarb.” And in an address
to a class of medical students an old doctor once said that he and his
associate practitioners had found that calomel and opium filled every
want in the ills they were called upon to treat.

For ages all mankind has striven to find a remedy effectively to clean
the intestinal tract. Pills, powders, tablets, wafers, suppositories,
salts, teas, candies, and syrups have been administered--all with
that sole purpose. Efforts have been made to accomplish this object
by utilizing every possible device and contrivance known to human
ingenuity. Calisthenics, massage, physical-culture exercise, mental
therapy, horseback riding, “dieting,” fasting--these are some of the
many means resorted to in order to “sterilize” the foul, constipated
intestinal canal.

Albeit that the cleaning of the digestive apparatus in the case of
a sick person is regarded as a necessary first help the world over,
few persons realize that it is of equal importance in the case of
a seemingly healthy person. Is it not a fair inference, therefore,
that where a purgative--such as calomel, or one of the innumerable
similarly-acting medicines--temporarily relieves a patient’s symptoms,
the timely precaution of keeping the intestinal canal and system clean
would prevent a person from getting ill?

The reader may think that, in these observations, I have wandered away
from my text, but, as uric acid is the _symptom_ of a combination and
complication of disorders of which constipation is the secondary cause,
the connection and sequence of my remarks are evident. It is safe for
a layman to assume that, where so many diverse schemes are employed to
relieve symptoms, the diagnosis is wrong--also the treatment.

A few of the many primary symptoms of proctitis and colitis are
constipation, diarrhea, indigestion, biliousness, flatulency,
putrefaction, and gaseous and bacterial poisons--a foul
gastro-intestinal canal, through which there are daily absorbed from
the bowels two-thirds to three-fourths of the excrementitious matter
into the system. With these facts before us we need not be astonished
at the statement that nine-tenths of human ills have their origin in
the digestive apparatus.

Among the secondary symptoms of proctitis and colitis is poisoned
blood--anemia, which is usually followed by impaired nutrition and
emaciation or obesity. Along with the changes in the blood and
nutrition there occurs lodgment or deposit of salts, acids, etc.,
in the various organs and tissues of the body. Almost every one is
familiar with gouty deposits in the finger joints and other joints of
the body. If the deposits occur in the muscular tissue it is called
rheumatism. If in the urinary organs we have gravel, Bright’s disease,
diabetes, cystitis, irritation of the neck of the bladder, frequent
calls to urinate; and the urine, scanty and high-colored, on cooling
reveals a crystalline deposit. The principal mineral substances of
the urine are as follows--of which one or more may become poisonous:
chloride of potassium, chloride of calcium, chloride of magnesium,
chloride of sodium, sulphate of potassium, sulphate of soda, sulphate
of magnesia, phosphate of soda, and phosphate of potassium.

The liver gets its share of the foul substances generated in the
intestinal canal, which cause congestion of the organ. Toxic biliary
salts and acids are present. The deposit may form gall-stones, and
jaundice and many other annoying symptoms may occur. The system is
simply a filter, or blotter, that lets the poisonous contents of the
intestinal canal pass through and out; but all the organs and tissues,
during the process, retain many of the foreign toxic substances, which
overtax (and frequently destroy) their functions with work that Nature
never intended they should do. Think of it--all the organs and tissues
around the intestinal canal serving as _fecal vents_! Deposits cause
irritation of nerve centers and nerve cells precisely as in fibrous
and cartilaginous tissues; and we speak of the symptoms as spinal
irritation, hysteria, chorea, lumbago, sciatica, nervous tension,
headache, irritability, despondency, melancholia, insomnia, dementia,
etc. From the disturbance of the voluntary and involuntary nerves we
have irregular circulation of the blood from disturbed heart action,
cold hands and feet, and flushing of the face alternating with pallor,
vertigo, and dizziness. The capillary circulation becomes obstructed
with crystallized bodies, as chunks of ice obstruct a stream of water.

Catarrhal inflammation of the mucous membrane is set up in various
parts of the body by the deposits in the membrane and the abnormal
means of their elimination through it. The skin of the body, which is
the mucous membrane turned outward, suffers likewise from diseases
having numerous names.

Doctors have always expressed a poor opinion of the liver because it
did not keep the bowels sweet and clean, and they mistakenly though
honestly called it “the lazy liver,” “the torpid liver,” “hepatic
insufficiency,” “atony of the liver,” “sluggish liver,” “hepatic
torpor,” “fatty liver,” etc.; and the poor victim of proctitis and
colitis was glad he had consulted the doctor and learned “just the
cause” of his internal troubles--and could suffer on more reconciled
to his malady since he knew its exact name and could continue to take
with regularity one or more of the many powerful liver exciters, to
stimulate activity in the liver and bowels once every day or two, if
possible. By some strange psychological or other influence of late
years, however, physicians have turned their attention to the “lazy
kidneys,” and now it is difficult to decide which they are purging
the most--the liver or the kidneys. At any rate, they both must be
violently excited at the same time, and we hear “lithia” mentioned,
or “laxative salts of lithia,” every time uric acid is thought of.
Stimulate the lazy liver and kidneys, and with abundant salts dissolve
out of the tissues and blood the precipitated deposits; this is the
fashion of the times.

Diagnosis wrong and treatment harmful! Water is by far the best agent
to dissolve salt compounds, to dilute acids, or to remove filth. It
is also the best means of soothing and relieving the long irritated
and inflamed tissues and organs, that have had from two-thirds to
three-fourths of the daily fecal mass thrust upon them and collected
in them, when they are called torpid, lazy, and whipped up unmercifully
by bile and urine bouncers. We ourselves would be very torpid,
sluggish, or “lazy” if called upon to do the work of two persons under
such embarrassing physiological circumstances as being filled with
toxic substances, or thoroughly auto-intoxicated.

When will common sense take the place of theories founded on guesswork,
and some thorough washing out by plain or distilled water be done,
internally as well as externally? After such an operation some specific
remedy may be taken, if demanded, with the certainty of permanent good
resulting. But remember, your aqueous body, held in its form by the
skin and mucous membrane, needs a well-nigh constant stream of pure
water flowing through it to keep it fresh and clean.

The diagnostic error of mistaking effect for cause, however, is
frequently made. Patients are treated for one of the secondary
symptoms--say uric acid--with a view to abate that disorder
and restore health, when treatment for the specific cause of
constipation--proctitis (inflammation of the anus and rectum)--would
restore the patient to his normal vigor. Pale, anemic sufferers from
constipation are often told that the restoration of their blood
to its normal state will effect a complete cure. No idea could be
further amiss, for if the poisoned victims take coal oil, fish oil,
malt compounds, iron, etc., as tonics, into a disordered stomach
and unclean bowels, how can anything more than imaginary relief be
obtained? Is it not evident that the chief disorder, _proctitis_, the
main cause of the trouble, has in no way been reached?

In other complications arising from constipation, a favorite diagnosis
is one of the secondary symptoms--“atony” of the bowels, liver, or
kidneys. In these cases nux vomica and various poisonous compounds
are given, but here also it stands to reason that the administering
of remedies for symptoms cannot effect a cure of a chronic local
disease of the anus, rectum, or colon. Then, again, by way of variety,
a diagnosis of “uric acid” is made for which irritant drugs are
administered to increase the eliminating or excretory action of the
bowels and kidneys. It is utter folly and absurdity to attempt the
cleansing of the intestinal tract by laxatives, cathartics, purgatives,
exercise, etc., and to make the kidneys and liver, overtaxed from foul
bowel products, do still more work by giving medicines to increase the
urinal and biliary secretions.

It does not require a knowledge of the principles of physiology and
pathology to know that no sufferer from chronic constipation can be
permanently benefited if any or all of the secondary symptoms already
noted be treated with the usual list of drugs and the cause ignored.

Much stress is laid upon the quantity and quality of food consumed by
most people, and many generalizers attribute chronic constipation, uric
acid, etc., to this very thing. Surely the average person knows that
too much or too little food taken at regular intervals is not conducive
to good health--a view that I have found borne out by a large majority
of my patients, who rarely overstepped the limits and knew when a
diminution in the supply of nourishment was advisable.

In the last analysis, the principal cause of ill health is lack of
elimination of the excretory organs. When the bowels fail to do their
proper work, the functions of the other organs of the body become
correspondingly affected and impaired, and general debility ensues.

In previous chapters, also in my book, _Intestinal Ills_, I have made
plain the causes contributing to chronic constipation and the use
of enemas and their origin. _Prehension_ and _elimination_ are two
subjects that are vital to the welfare of man. If the eliminating
power of the intestinal canal is normally active, the fortunate
individual may eat abundantly, or really in excess of the requirements
of the system, and still escape any ill effects, such as indigestion,
biliousness, acid in the urine, etc. The hearty consumer of food whose
bowels eliminate properly may suffer a loss of appetite, but it will
not be accompanied with foulness of the digestive apparatus.

When all the organs of the body perform their functions in a normal
manner, no part of the structure is in immediate need of repair. Every
organ whose function consists in building tissues, muscles, or some
other part of the body, having a sufficient supply of reserve nutriment
on hand, makes known this state throughout the organism; hence there
is no craving for food, no appetite, although the tongue, stomach,
and intestines are in a normal condition. In this state of surplus
of nourishment the person may omit a few meals or partake sparingly
until the expenditure is equal to the income. But such physiological
happiness is not for the person whose intestinal canal and system are
clogged and foul from undue retention of excrementitious material,
causing no desire for food, while all the atomic builders of the body
are wanting nourishment and protesting through the nervous system
against their impoverished condition.

Sufferers from self-poisoning, as described in this chapter, should
irrigate the system thoroughly by frequent drinking and by copious
injections of water into the bowels. The action of the enema if
properly given and the drinking of water that is pure or distilled
increase the quantity of urine and diminish the renal congestion, while
increasing the eliminative action of the skin.

Irrigation of the bowels for fifty minutes or more with hot water (120
to 125 degrees) increases the action of the kidneys. Hot irrigation
(125 to 135 degrees) is especially recommended to increase the
discharge of urine and the action of the skin, and should be continued
for sixty minutes or more. The Intestinal Recurrent Douche, described
in a subsequent chapter, is an excellent instrument for the employment
of hot water to produce diuresis and diaphoresis.

The Chemung Spring Water and Clynta Double-Distilled Water, sold in New
York, are excellent drinking waters and can be obtained at a moderate
price.




CHAPTER XVI.

RATIONAL SANITATION AND HYGIENE.


We, all of us, like to use things; indulgence is enjoyable, but it
generally ends with the day. Few of us “take thought of the morrow.”
Neglecting, as we do, the _instruments_ of use, their availability
for permanent subservience to our wants steadily diminishes, becoming
finally lost. Is it that we do not know any better, or is it that we
are really so intoxicated with the Present that we simply ignore the
well-known claims of the Permanent? Whatever the explanation may be,
it is nevertheless passing strange that little or no care is bestowed
on either our external or internal servitors, instruments, or organs,
which otherwise are ever ready to keep us well filled with the pure
wine of joy. Perhaps it is that many of us find Nature so lavish in
supplying us with the means of joy that we are naturally equally lavish
in wasting them. True economy--that is, the conserving of means for
their effective use--is yet to be learned by man. Especially is this
the case with our interior means, our flesh, blood, nerves, vital
force, etc. Nature seems so ready to recoup and renew the organic loss
incurred by our use or indulgence--recuperation seems so easy--that
we simply grow careless, reckless, prodigal, and before we are fairly
aware of it the disintegrative process gains an ascendency over the
restorative, and thenceforward our time will be spent in endeavoring to
cure what might have been kept whole or well.

Nor is it an organ of the body here and there that we neglect or abuse;
it is more especially the entire system of organs called “the body.”
The body is the organ of man’s spirit. We give no heed to its tones;
perhaps we have never caught its rhythm; certain it is that when but a
short time in our perverted hands its chords are more or less jangled,
and a minor part is played in the grand symphony of life.

The organ of man’s spirit! How rational, nay, how necessary, it would
seem to be to keep that instrument keyed to its perfect work!

But the ordinary denizen of civilization has a most ridiculous ideal
of physical capability, namely, that the savage--a being altogether
“physical”--was able to retain a healthy body till ripe old age
without attention either to sanitary surroundings or to the hygienic
functioning of his system of organs. The “civilizee’s” fancy picture
of the noble savage is not based upon verifiable fact. It is true that
we have a few attractive myths concerning savages that had survived
appalling hardship; but we are just learning of the innumerable host
that have perished periodically of various contagious diseases, and
of the countless number (infants, youths, and adults) that have
suffered from all sorts of ailments. Alas! how little we know--or, for
that matter, how little we seem to care--of the great multitude of
“civilized” fellow-creatures whose lives are all jangled and out of
tune through subjection to the many ills that flesh seems heir to; ills
that have arisen through either ignorance or the voluntary _ignoring of
the light of accessible knowledge_!

In another aspect the human race is like an army that concerns itself
with its immediate and imperative duties and has no time or thought
to bestow on those that fall out of the ranks. But slaves to stern
duty offend against Nature’s normality as do slaves to desire; and the
former little suspect that their retirement also is near at hand. In
health we seldom or never think of the conditions for the maintenance
of health. That these conditions should receive our prime attention
is obvious when we contemplate for a moment (1) our race of invalids,
and (2) the growing unsanitary condition of modern industrialism,
involving, as industrialism perforce must, the unsanitary life of the
factory, workshop, office, and hothouse home.

Again, with the advance of high-pressure civilization and culture
human beings are developing a more highly sensitive physical organism,
pitched to finer issues. How urgent the necessity for a greater
safeguarding of that organism!

If it be claimed that many of us do live up to our knowledge of health
conditions, and that we are notwithstanding unwell, I would answer
that our knowledge now is very disconnected, and that when the time
shall come that our itemistic information shall have coalesced and
formed a system of principles, we will then have trustworthy rules for
the acquisition of health habits and become completely normal physical
beings. At present most of us are intemperate in one or more ways. We
eat too much or too little--too rich or too poor food. So it is with
our drinking, our sleeping, our sporting, our enjoyment of this or that
excitement--the quantity or the quality of each of these is not well
adapted or proportioned to the conditions of normality.

Let me offer the health-seeker a few indications of the sanitary and
hygienic requirements demanded by Nature’s normality. In our family and
household life, to carry into execution daily hygienic measures, it is
essential that we have ample, accessible conveniences for the necessary
ablution of the body, externally and internally. How extremely rare it
is, however, that bath-tubs and water-closets are found in sufficient
quantity and suitable quality in our apartments. As household fixtures
they are usually about as scarce as hens’ teeth.

In New York City a house with from eight to sixteen persons is
restricted to the use of one water-closet and one bath-tub. On these
(and a laundry and servants’ privy in the basement) there is the tax of
ten dollars a year. Now, should that rare human product, an enlightened
and humane owner, put in eight more bath-tubs and water-closets for
the proper accommodation of his sixteen guests, so that each suite of
sleeping apartments should have its appropriate conveniences, he would
have to pay an additional tax of forty dollars a year. Is this tax
levied with the connivance of the Board of Health? It would seem so,
since no protest from that august body has ever been heard within the
memory of the oldest inhabitant. Indeed, the suspicion is not at all
unwarranted that if the masses were less constipated and better washed
they would have less use for the doctors, and that, therefore, it is
not well to encourage undue sanitation and hygiene.

It must be, too, that the Department of Water Supply has figured it out
quite beautifully that a saving will be insured in the amount of water
consumed by sixteen persons if they be restricted to one bath-tub and
one water-closet; otherwise forty dollars a year would not be charged
for eight additional tubs and closets for the use of the same number of
persons. Listen to a sample of their logic: “Sixteen persons with eight
additional bath-tubs and water-closets would use more water than if
they were restricted to one of each--hence the additional tax. We don’t
care a continental whether these human beings are clean externally or
internally; that’s not our lookout. But we do care that they shouldn’t
use more water than just so much, see!”

And does the august Board of Health raise the least objection to this
sort of logic? None whatever.

Professor C. S. Smith states that, out of 255,000 families in
tenement-houses in the city of New York, only 306 had access to
bath-tubs in their own homes in 1894. In 1897 one city block containing
904 families did not have a single bath-tub.

Paradoxical as it may seem, there is, notwithstanding the appropriation
every year for the New York City Board of Health of over one million
dollars, a prohibitive tax on bath-tubs and water-closets--that is, on
cleanliness--prohibitive on all homes except those of the wealthy. Is
it to be wondered at that contagious diseases are prevalent, especially
during the winter months, and that we have so many acute and chronic
maladies?

Let me make a suggestion here for the serious consideration of our
city fathers: Reduce the appropriation for the Board of Health to two
hundred thousand and give the other eight hundred thousand to the
Department of Water Supply, so as to abolish the tax on water-closets
and bath-tubs. If every citizen of New York could have all the water
he needed for cleanliness and comfort, there would be little excuse
for the existence of such a body as the Board of Health; its existence
would then be more honorable than onerous. Furthermore, the city, as
a corporate body, should manufacture bath-tubs and water-closets,
and furnish them at cost. Thus would it insure a great stride toward
the health of its own citizens. When the disease-producing microbe
becomes scarce, the occupation of the Health Board pathologist will be
gone. Hold! Could he not devote his time profitably to studying the
habits of health-producing microbes--for there _are_ such? Microbes
are absolutely necessary for higher forms of existence, it being now
well known that some microbes are destructive or pathological and that
others are constructive or physiological. Is it not much wiser to
spend our millions of dollars for the prevention of disease than for
quarantining it? Inducing, and even compelling, people to be clean is a
far better policy than to compel them to be vaccinated.

Now, we pay the Board of Health many thousands of dollars a year simply
for making cultures of disease-producing bacteria so that antidotes
may be found. The pictures and history of these bacteria are published
in many large volumes, costing the city several hundred thousand
dollars a year. Scientific as this practice undoubtedly is, it is very
expensive--and needless.

Every year thousands of children and invalids of New York receive
improper nourishment, or are made positively sick, on milk that is
either foul, stale, or ready to sour; and every summer thousands of
children die from complaints traceable to this source. Swill milk is
one of the great generators of disease-producing germs to which all
sorts of “complaints” are due. Does the Board of Health care a fig for
the generator? No; the Board is absorbed in watching the antics of the
germs! Mighty intellects are searching for malignant, multitudinous
mites. Yet there are just a few mites of common sense in existence,
which if encouraged will breed quite as fast as the sinister ones.
Indeed, there must be one or two at work in myself, for I seem to be
urged to say that if our City and State Boards of Health should see to
it that our cows are kept clean and healthy, our milk clean and pure,
our cans clean and well scoured, and our shops and ice-boxes clean
and free from odor, there would be no occasion for germ cultures of
diseases brought on by swill milk.

Our milk example will illustrate what germs of common sense would do
to ward off all kinds of disease-producing micro-organisms. Rigorous
regulations, well enforced, as indicated above, would work in other
lines as well. And when the source is gone sinister microbes will not
come into existence, and diseases that have resulted from such microbes
will have gone into innocuous desuetude.

There should be a bath-tub and a water-closet in every suite of
sleeping apartments. When this is the case, there will be a larger
number of persons clean internally and externally, and the doctors will
be on a hunt for health-producing germs instead of disease-producing
ones. Let us start an organized movement in this direction.

Last summer Medical Science went about killing mosquitoes on Staten
Island with a little spraying apparatus, and managed to disturb the
pest for a day or two from its customary bivouac. Christian Science
stood aloof and smiled superciliously, claiming that “there aren’t any
such things as mosquitoes; but if they should prove to exist, there
isn’t any malaria anyhow.” Good sense might have suggested to Medicus
the draining of the ponds for gardening purposes; and, if that were
not possible, the filling in of the edges and the making of deep-water
lakes for the sport-loving youth, who might be depended on to keep the
water stirred up by boating, etc., free of charge, and thus convert
a pest pond into a pleasure lake. Pleasure and cleanliness are taxed
to-day for disease and pests. Oh, human imbecility!

As to public baths, there are so many objections to them that I cannot
touch on the subject in this chapter. But let me impress upon the
health-seeker, the public-spirited citizen, and our city officials that
what we urgently need are ample conveniences in our homes for internal
and external cleanliness--conveniences easily accessible several times
a day, every day of the year.




CHAPTER XVII.

PERSONAL CLEANLINESS.


At the close of my last chapter I referred to the ever-recurring
problem of public baths. Annually its agitation is renewed in lectures
and newspapers; public bathing is voted without disagreement the
thing of things needful to render the laity--_i. e._, the labor
population--physically pure. It is the long-felt want; but, like the
longed-for walk of the annual Sunday-school parade, it is soon done
and gone. Still, we must have patience with those dear souls, our
ethical teachers of the press and platform, for taking such a deep,
sentimental, though unscientific, interest in the welfare of the
unclean. Owing to the non-existence of home facilities for cleanliness
among the working class, the accumulations of soil and exudation during
the long fall, winter, and spring months are so great that their
bodies become too rank and malodorous for the nostrils of the refined.
Consequently, as all animals seek the tepid water of the summer, and
as man is no exception to a capacity for laving in the circumambient
fluid, to three-fourths of the population of this metropolis it must be
a glorious perennial treat to dip in the river, bay, or sea; and it
must indeed be a dire necessity to those that have managed to survive
contagious and other diseases during their long immurement. Without
this summer cleansing few animals, bestial or human, would run half
their average careers. It is accordingly not strange that during the
summer a bath in open water is a daily hygienic necessity and source of
joy to thousands of creatures.

Now, it is just because godliness appears in the wake of cleanliness
that I made so strong a plea in my last chapter for ample bath-tubs and
water-closets. For I do not approve, nay, I emphatically condemn, the
system of public baths along the shores of our rivers and bay. Their
waters are contaminated by numerous sewers, and bathers have contracted
many contagious diseases that have become epidemic in neighborhoods.
Note especially the annoying eye troubles that follow in the wake of
such bathing. Of course, the sport and exercise involved in open-water
bathing are highly commendable; but the danger of contracting
contagious disease, and the outrage of the sense of refinement when
contemplating fellow-creatures in the act of stirring up polluted
waters, should call a halt to our encouragement of public bathing in
and around our metropolitan water fronts. These waters are surely
anything but a means of cleanliness.

The water-closet, however, is of far greater importance than the
bath-tub, and especially than the public water-gymnasium--which last is
so much lauded by some of our misguided philanthropists. Intestinal
foulness, as a prolific source of disease, is of far more serious
importance than surface foulness. However, both the bath-tub and the
water-closet are indispensable to every suite of rooms.

Another need imperatively demanded by the exigencies of city life
is the establishment of public water-closets at several thousand
convenient centers throughout this great city. At present the male
population, when away from their residences, are obliged to make
use of a near-by saloon--a most uncertain resort, and one in which
courtesy will generally constrain them to imbibe intoxicants _nolens
volens_. The female population have not even the saloon as a resort,
and can relieve themselves only when in the vicinity of department
stores. American enterprise can improve in many respects on the several
European models of public-relief stations. The public is becoming
conscious of its needs and rights in this respect; and one of the
sanitary evolutions of city life--congested as it is--will be ample and
cleanly public accommodations for intestinal relief.

Americans in general suffer from dyspepsia, biliousness, constipation,
uric acid, etc.--all of which disorders are symptoms of that world-wide
disease, proctitis: inflammation of the anus, rectum, and often the
colon. Nor is it any wonder that unwashed humanity suffers from
proctitis and its consequences. The unwashed have no bath-tubs and
practically no water-closets. This lack is due to the tax on water
facilities, to expensive plumbing, and to too much “science” and
not enough common sense among our city fathers. As a consequence
of ignorance and inconvenience, most people defecate but once in
twenty-four hours; and very many but once in two or three days or a
week. The once-a-day stool is frequently scanty, and as a consequence
the kidneys, lungs, and skin are called upon to perform the vicarious
function of eliminating a portion of the daily excrement; and the colon
and sigmoid flexure have to hold the stored contents unduly--until
the feces be expelled by purgatives or by the irritation that the
accumulated mass occasions. Could the members of the Board of Health
and the people at large be brought to a realizing sense of the value
of personal cleanliness,--internal as well as external,--bath-tubs and
water-closets would abound in our homes.

Man’s habits as to eating, drinking, dressing, bathing, and especially
as to defecating, are clues to his growth in refinement. But we must
beware of judging a person by one or two good or bad habits; he should
be estimated by the sum of his habits and their peculiar combination.
Refined habits are not all of them acquired at once; they develop
slowly, one after another, when opportunities are favorable, especially
the habits as to bathing and defecating. Opportunities for these
latter are wofully lacking at present--the cause and consequences of
which lack are pointed out in the last chapter. A child will derive
far more good from a ready access to bath-tub and water-closet than
from a lifelong attendance at Sunday-school and church with the temple
of the human soul permanently unclean. Only one that has learned to
respect and care for the abode of the soul--the body--is worthy of
being classed among the refined. It is truly deplorable that the great
majority of the human race are creatures of the moment or the hour,
tolerators of abnormal functioning, slow suicides of vital capacities.
Claims of the permanent are constantly ignored; most of us are blind
to the joy involved in the harmonious functioning of all the organs--a
functioning that always ensues upon hygienic care.

Our organs will for a time bear neglect or unhygienic conditions
without protesting their annoyance. Many persons never use hot water
or soap; others find one bath, in river or sea, quite sufficient for
the year; others, again, feel the need of a bath once or even twice a
month, or even once a week. But there are very few of us that seem to
require a bath daily. Many, alas! have grown accustomed to a bathless
existence.

Have you ever stood near an Italian or Greek street vender, or have
you ever been within five feet of a low-class Polish Jew? If so, the
stench arising from his unwashed body must have nauseated you. It is no
secret that such persons never wash--especially the latter, who live
in rooms reeking with filth. Contemplating such conditions, I feel
impelled to propose a great, nay, the greatest reform--one suggested
years ago by Samuel Butler in _Erewhon_. Let us make Health the great
civic virtue, and Disease, as well as unsanitary and unhygienic
conditions, the crime. Our so-called crimes of theft, murder, forgery,
etc., should be treated as weaknesses and faults to be corrected by
Moral Rectifiers--by the preachers, priests, rabbis, and ethical
culturists. Consider how much is implied in developing and breeding a
race of healthy men and women. All relations of life would feel the
vital change at once, and moral weaknesses would disappear. Any human
cesspool entering a public conveyance, or in any way mingling with
cleanly people, should be arrested, thoroughly cleansed, internally
and externally, and sequestered for a time sufficient to teach him
better. There is a local rule of the Board of Health against spitting,
but it is rarely enforced. There are millions of public expectorations
to one arrest. For the appearance in public of consumptives, and
their offensive hawking, coughing, and spitting, no one seems to have
suggested a remedy. All diseases should be classified as to grades of
punishment; and all moral weaknesses, such as defalcations, adultery,
burglary, should be treated at the various hospitals, which latter
should be conducted solely by Moral Rectifiers.

In closing, I shall direct attention to a few other points in personal
cleanliness--the mouth, ear, nose, and throat.

It is important on hygienic grounds that the mouth receive proper care
two or three times daily.

The ear is commonly kept clean; still there are many instances of
non-refinement of this organ, and from its non-hygienic treatment
deafness often occurs.

The prevalent nasty, ill-bred habit of hawking and spitting in public,
or in company, even by genteel persons, can be cured best by early
training in correct habits. This habit, as well as the evidences of
throat troubles, is usually to be ascribed to inattention to the nose.
When catarrhal conditions are avoided or properly treated the throat
will not be so affected as to necessitate this reprehensible practice.
Trouble is invited for the tonsils and soft palate by our constant
hawking; certainly the tender sensibility of the throat is destroyed
thereby. Inasmuch as the tobacco habit is so general, and spitting is a
necessary accompaniment of that habit, stringent laws against hawking
and spitting would be unpopular among the masculine half of the race.
But should public opinion ever become educated up to the point in which
disease becomes a crime, opposition would cease. This consummation
is devoutly to be wished, for then we will have adopted and followed
Ingersoll’s injunction to “make health catching, not disease.”




CHAPTER XVIII.

HOT WATER IN THE TREATMENT OF PROCTITIS AND COLITIS.


In treating chronic ulcerative inflammation of the anus, rectum,
sigmoid flexure, etc., it is well to take advantage of every really
practical device to which one may have access, so that valuable time
may be saved in obtaining relief and effecting a cure.

The capillaries, veins, arteries, and arterioles in an inflamed organ
become distended and the tissues swollen, indurated, and tense by the
excess of blood and the inflammatory serum deposited in the tissues.
The vasomotor nerves in the diseased part have lost their contractile
power, which fact increases the stasis, or congestion, of the blood.
Circulation in diseased tissue depends very much on the general tone of
the system, and if the circulation is below the normal the ravage of
the malady is increased proportionally.

Have you ever observed a little stream of water enter a large pond in
which were grass, shrubbery, logs, decaying vegetation, and débris of
all sorts--the accumulation of years? And have you noticed that here
and there there were stagnant pools, without a perceptible motion
from where you stood, but that as you reached the side opposite to
the entrance some faint traces of motion became visible, and that as
you followed the line it soon formed into a stream quite equal to the
inflow? The pure water, on entering and mingling with the stagnant
water and old deposits, soon becomes corrupted and foul. Somewhat
similar unhygienic and toxic results take place in ponds of stagnant
blood and abnormal deposits such as proctitis and colitis involve,
and where, for six or eight inches or more of the large intestine,
inflammation is deeply seated, and blood stasis is of course in full
swing. As the débris in a stagnant pond decays, making the water
impure, so in an inflamed organ the tissues decay, making the blood
impure. Ulceration is an exhibition of this process of congestion,
induration, and decay.

The rectum and sigmoid flexure are loosely hung in the pelvic space
and are surrounded by fatty cushions of connective tissue on all
sides, which fact allows the organ considerable dilatation and motion
(Fig. 5). Owing to the anatomical structure and the location of
the lower bowel, it becomes a serious matter when it is invaded by
an ulcerative inflammatory process--especially when all the layers
of tissue forming its wall are invaded, and still more so when the
connective tissue around the organ is in the same condition.

Far better were it for the victim of proctitis and
periproctitis--filled as he is with channels and reservoirs--if pus
were to form in abundance at once and thus betray the destructive
action in the spongy areolar or connective tissue, under the mucous
membrane, around the rectum, and in the tissue forming the anus and
buttocks.

The pathological condition brought about by inflammation, etc.,
requires a remedy that will empty the over-dilated vessels and remove
the serum deposit in the tissues, which is analogous to the rubbish of
a pond.

Our grandmothers were familiar with the therapeutic effects of
heat and moisture when they applied hot poultices constantly to
an inflamed organ or limb for one or more hours until the tissues
presented a blanched, shriveled, and white appearance; if there were
signs of the inflammation returning, the poulticing was continued
or repeated. They knew very well what the parboiled condition of a
washerwoman’s hands indicated after a day’s work in hot water. They
were bloodless, notwithstanding their incessant muscular exercise. In
case of inflammation, they reasoned, heat and moisture would make the
congestion and fever leave if applied long enough. On beginning the use
of the hot poultice, the tissues to which its heat and moisture were
applied became relaxed, and the parts for the time more congested than
before; but our grandmothers did not mind that, as the final result
would justify their hydriatic procedure. They well knew that after
ten minutes or more a reverse action would take place, and if the
treatment were continued long enough the blood-vessels and tissues
would show little or no evidence of fever or inflammation.

Where chronic inflammation exists, the blood-vessels and tissues lose
their normal tone or vitality; consequently, they will require repeated
application of hot water as well as other aids until a cure shall have
been effected.

Another great advantage in the use of hot water is that its application
can be interrupted and resumed without detriment to the diseased
tissues or organs. Cold water, on the contrary, causes the vessels
quickly to contract and expel the blood, but, on reaction taking place,
the tissues become more congested than before.

In the use of water at a temperature of 120 to 135 degrees, or even
more, we have one of the most valuable adjuvants in all stages of
proctitis and colitis, and, if a properly regulated plan be pursued in
connection with the requisite local treatment, more good can thus be
accomplished than by all other means combined.

The layman is more or less familiar with the condition of a sore or
ulcer in which soft, spongy, or fungous tissues appear, called “proud
flesh,” which, on an inflamed mucous membrane, is called granular
tissue. Were it not for the usual presence of granular tissue on a
chronically inflamed mucous membrane and for ulcerated sections or
patches, channels, and stretched or pouched mucous membrane called
piles, the proper use of hot water alone would in time effect a total
cure in almost every case of proctitis.

Many well-meaning persons conceive the idea that, if hot water is so
beneficial, they may use it as hot as possible for the purpose of an
enema likewise, since they will thereby not only relieve the bowels
of their stored feces but simultaneously do the inflamed tissues “a
whole lot of good.” Their spirit is admirable, for not all patients
are prompted to such thoughtful attempts to do everything in their
power to get well--even though they err with the best intentions at
heart. Let them remember, however, that the first effect of hot water
is to increase the blood supply in the tissues if it be applied for a
short time only. In the majority of cases, the enema does not require
more than from five to ten minutes; hence, only harm can result if
really hot water be used. Now and then a person will become possessed
with the notion that a hot enema should be followed by a cold one, to
bring “tone” to the lower bowels. But in all these misdirected efforts
matters are made doubly worse.

Cold water will allay fever and inflammation, but when its use is
once begun it should be continued without intermission until a cure
is effected. For this reason it is _not_ suitable where chronic
inflammation exists--especially on the mucous membrane of the bowels.
It is, however, excellent for acute inflammation of the external parts
of the body, such as the hands, arms, legs, etc., where it can be
continued without interruption for one, two, or three days if necessary.

In beginning the treatment for constipation, there are a few cases
in which the patient has to fuss for an hour or more with the enema
before he can obtain any sort of a proper fecal evacuation; or there
may be inability to expel the water from the bowels when once injected.
This stoppage is most likely to occur at the recto-sigmoid juncture
(O’Beirne’s sphincter). A strictured condition of the bowels causes
retention of feces and gases and why not water as well? In such cases
time would be saved, perhaps, by combining the procedure for an
enema with that of a recurrent douche, which involves a continuous
application of water at a temperature of from one hundred and twenty
to one hundred and thirty-five degrees for an hour or more. Figure 21
illustrates a successful device for applying medicated water at a high
temperature to the anus, rectum, and colon. This apparatus can be used
while sitting on a water-closet seat and the treatment can be completed
without changing position or removing the instrument.

The instrument is attached to the reservoir (Figure 18) by a
soft-rubber tube. In the cone-shaped piece of hard rubber (Figure
27) is a hard-rubber stop-cock or valve (Figure 29), and by turning
the handle sidewise the valve is opened to let the water escape from
the bowels into the toilet basin. When sufficient water, at from one
hundred and twenty to one hundred and thirty-five degrees temperature,
has entered the bowels, allow it to remain for ten minutes, then permit
it to escape by opening the valve; then close it and allow more hot
water to flow in and remain for five or ten minutes and again allow it
to escape through the rectal point, repeating the inflow and outflow
every five or ten minutes for an hour or more without removing the
anal point from the rectum during the whole time of treatment. After
a few trials it will be found that the hot-water treatment can be
accomplished without withdrawing the point.

Rectal Points for recurrent douche are of two sizes (Nos. 25 and 26).
The larger one (No. 25) requires a plug to be introduced through
the cone-shaped external anal support and rectal point, to make its
introduction into the rectum easy, after which the plug is withdrawn
and the hot-water treatment begun. The bore of the rectal points cannot
become clogged by the presence of feces, mucus or membranous shreds
or casts, which are usually brought away by the hot-water treatment.
At no time during the treatment can the point become stopped up, the
size being sufficient to insure a proper inflow and outflow. And the
instrument can be easily cleaned.

Near the attachment of the soft-rubber tube is a glass reservoir
(Figure 24), for the use of oils with the enema or the hot-water
treatment; it is detachable. A valve regulates the outflow of oil from
the pressure of water in the reservoir, as it passes into the bowels.
We are enabled thus to treat by double medication as it were, a
chronic disease of the intestines and its symptoms--that is, intestines
that have been long neglected or maltreated through lack of proper
diagnosis, or by all sorts of chemical compounds from above, through
mouth and stomach.

The author and inventor naturally enjoys not a little satisfaction in
being able to present to sufferers as nearly perfect an instrument as
can be devised; one that, in conjunction with other aids, meets all
requirements involved in the proper treatment of proctitis and colitis.
Lavage or irrigation of the large intestine with water at a temperature
at from one hundred and twenty to one hundred and forty or one
hundred and fifty degrees, not only accomplishes rapid and wonderful
cleaning and curative results, but overcomes, when properly applied,
contracted, congested, engorged, and inflamed tissues of the bowels.
Therapeutically, it has a marked effect on the whole system, being
beneficial beyond words to describe; it relaxes nervous and muscular
tension of the body, producing restfulness and sleep; it stimulates
and equalizes the circulation, promotes perspiration, absorption, and
active elimination of all deleterious substances from all the organs
of the body. Medicinally, it is really a combined internal Russian
and Turkish bath, removing abdominal corpulency and gaseous obesity,
resulting from chronic auto-intoxication. The external Russian and
Turkish baths afford a satisfaction skin deep to the bather, but the
combined internal Russian and Turkish bath is most agreeably relaxing
and restful to mind and body, bringing peace, since all the organs of
the system are performing their functions. Some of my patients resort
to internal hot-water lavage for all aches and ills that mar their
happiness. After an external bath the bather may desire an application
of oil, alcohol, or cocoanut butter rubbed on the skin, and in the
same way the bather’s internal mucous membrane is not neglected; for,
with the author’s appliance, medicated and perfumed oils, extracts,
and powders for remedial purposes are carried to every part of the
intestines that the water reaches, thus exerting a cleansing, healing,
and soothing effect where most needed.

A few sufferers will object to the time required for an enema twice a
day, although they find time to eat three, or even four times a day,
without any objection whatever; there is plenty of time for filling
up the digestive apparatus, but no time for its normal elimination.
And these miserable, go-lucky, haphazard people are always sick and
unfortunate. The internal Russian and Turkish bath is demanded only by
those who truly desire to be free from their bowel troubles, and from
the numerous symptoms resulting from mucus absorption, constipation,
and auto-intoxication.

A sufferer’s efforts to be well depend largely on how much he or she
estimates the worth or value of mind and body. A noble purpose in life
is priceless; are not one’s spirit and body worth the time required
for two enemata each day and an hour for the internal bath, if needed?
I think so, and you should likewise.

The author trusts the reader will not infer that all sufferers from
piles, anal fissure, pruritus ani and vulvæ, mucus channels and
reservoirs, abscess, fistula, and all similar troubles, require the
enema and recurrent douche appliance; the character of the disease and
its symptoms must determine the requirement of the treatment. Many of
my patients receive office treatment only, omitting home attentions,
although this is not always advisable. The reader might conclude that
the recurrent douche treatment was simply for the cure of a chronic
inflammatory invasion of the bowels and fecal auto-intoxication, and
not be aware of another great source of auto-intoxication--that is,
from the absorption of large quantities of serous, fibrinous, or
albuminous exudation from a large area of tissues invaded by the very
insidious inflammatory process, a condition which, in time, may reach
the pus-forming stage. Thus we have three very grave pathological
conditions to meet and remove before the pus-formation stage is
made manifest through the development of abscesses. I have found
five aids--perhaps more--to accomplish a cure in which I have been
exceptionally successful, as my students and patients will verify;
these are: local treatment, local medication, the proper use of the
enema, the use of the recurrent douche, and the determination of the
sufferer to get well.




CHAPTER XIX.

HOT WATER IN THE TREATMENT OF EXTERNAL SYMPTOMS.


After proctitis has continued for many years it will give rise to
painful inflammatory and ulcerative processes at the external anal
vent and in the adjoining tissues. The anal mucous membrane and the
integument about the anus become brittle, loosened, and detached from
the areolar connective tissue by the retention of inflammatory serum.
The engorged, indurated, and swollen mucous membrane and integument
serve as reservoirs, especially when the chronic inflammation is
excited to an acute stage, which stage is often accompanied by a
fissure, abscess, or anal ulcer. Soreness and pain in the parts may
then be so severe that the sufferer is compelled to stay indoors
or in bed. Whatever the symptoms may be--piles, fissure, pruritus,
abscess, or fistula--the sufferer desires to reduce the local fever
and the acute inflammation, as well as to find relief from the pain.
The customary treatment is to use poultices, which are troublesome and
ineffective.

In the following illustration I give a good idea of a perfect device
for relieving quickly the soreness, pain, acute inflammation, and
induration, all of which are so very prostrating; and, situated as
they are physiologically, they are exceedingly inconvenient to treat
properly by the ordinary methods in use:

[Illustration: (Patented November 8, 1892.)

Fig. 23.]

The Sitz-bath pan, though small, is yet of sufficient depth and
diameter for all practical purposes, and can be placed wherever is
most convenient--on a low chair or a box. The bather should sit on the
instrument with the limbs on either side of the funnel through which
the hot water enters the pan. Just below the funnel is an overflow
tube, under which a vessel should be placed to catch the water as
it flows out. While sitting on the pan the elbows may rest on any
convenient support, so as not to tire the invalid too much during the
bath, which should consume from half an hour to an hour, or longer if
agreeable. Hot water may be added every few minutes as the bather finds
that the tissues will tolerate it. Depurant powder may also be added to
the water in the Sitz-bath pan.

What has been said in a previous chapter on the therapeutic effects of
hot water in the treatment of proctitis need not be repeated here.

The three indispensable appliances for combating and effectually
overcoming the pathological conditions to which this book and my two
previous books--_Intestinal Ills_ and _How to Become Strong_--are
devoted, are _The Internal Fountain Bath_, _The Intestinal Recurrent
Douche_, and _The Shallow Sitz-bath Pan_. These appliances are
well-nigh perfect for the uses to which they are adapted.




CHAPTER XX.

THE HEALTH OF SCHOOL CHILDREN.

“Cleanliness of body was ever esteemed to proceed from a due reverence
to God, to society, and to ourselves.”--_Bacon._


The International Congress on School Hygiene ended its fourth meeting
at Buffalo recently to meet two years hence in Brussels. In the interim
the Board of Education in this city, the Department of Health, and the
New York School Luncheon Committee will continue their investigations
as vigorously as in the past, and the information thus gained will be
an important contribution to the next Congress.

Too much attention cannot be given to the question of hygiene, diet,
and excretion to meet the psycho-physical requirements of the mind
and body in normal health. As a rule, diet is prescribed for the
purpose of relieving the various annoying and painful symptoms caused
by chronic impairment of the functions of the stomach and bowels,
but when we find the cause of these various symptoms arising from a
disturbed gastro-intestinal tract, the question of diet will receive
less attention. Why has not the subject of normal intestinal excretion
received as much attention as diet in health or ill-health? As our
knowledge of the human psycho-chemical laboratory increases, we are
able definitely to locate a diseased organ and account for the symptoms
caused by the pathological condition of that organ; and when the
diagnosis is properly made these symptoms become a secondary matter of
treatment.

The chief enemy of health among school children (and older persons as
well) is the accumulation and retention of waste matter and gases in
the intestinal canal, where are generated ptomaine, toxic, and other
poisons which enter into the system, resulting in self-poisoning or
auto-intoxication.

What do we mean by school hygiene? Is it only the school building, or
the external appearance of the children, their eyes, teeth, mouth,
nose, hands? What about the coated tongue, foul breath, fouler
stomach, and putrefaction of the contents of their intestines? A human
being is only an extension of his gastro-intestinal apparatus, hence
it is very essential that such apparatus should be in a hygienic
state to ensure his physical and mental resistance and efficiency
being at their normal strength. There is one symptom that causes
more sickness and suffering from infancy to old age than all others
combined--that is, constipation with its attending putrefaction and
foulness of digestive organs. Only a small percentage of people escape
its baneful effects or the secondary diseases induced by fecal and
mucus auto-intoxication. Such a common primary symptom must have,
necessarily, a common exciting cause or origin. Through many years
of clinical experience as a gastro-enterologist and proctologist, we
have found that inflammation of the anus, rectum, and sigmoid flexure
is the frequent or common cause of constipation. Observation has
demonstrated that a soiled diaper is the exciting cause of Proctitis
and Sigmoiditis in the beginning. Examination of one hundred children
of the “defective class” would show most of them suffering from
chronic Proctitis and Sigmoiditis, with some degree of constipation
and auto-intoxication, and even of those classed as “healthy school
children” a large percentage would show the same conditions. The
continuous invasion of the neighboring tissues by the disease,
the increasing auto-intoxication and constipation, the on-coming
malnutrition, and anemia, the gradual emaciation, are all the while
lessening the vitality and power of bodily resistance of their victims.
The early inception of the malady and its insidious progress, with the
symptoms and diseases resulting, easily deceives the victim as well
as the parents and medical advisers, until the long-pent-up virulence
breaks forth, showing itself in every part of the tabernacle of the
spirit of man, when the removal of the primary cause does little or no
good.

The Department of Health, in examining the sanitary or hygienic
condition of a school building, would not devote all its attention to
the top story to overcome unhygienic conditions; it would probably
direct its attention to the trap and vent of the sewer of the building
to see that there was no retention and filling up of the pipe to befoul
the atmosphere of the structure. Why then so much attention to the head
or top story of the human temple, and so little to the trap and vent of
its sewer? Are modesty and ignorance to defeat the progress of hygienic
measures dealing with the stomach and bowels of our school children?
How long will those abdominal incubators of poisonous microbes and
gases be allowed to infect not only a school building but all its
occupants as well?

The absorption into the system of serous, fibrinous or albuminous
mucus exudations from the invasion of chronic inflammation through all
the layers of the tissues of the anus (Figure 1), rectum, and sigmoid
flexure, as well as through the adjoining fatty tissue in the pelvic
space around the organs (Figure 5), under the skin and between the
muscles of the buttocks, goes on continuously, creating an extensive
inflammable area and source of exudation of broken-down tissues. (See
Chapter III.) It is a grave pathological condition and the source of
mucus auto-intoxication, and its symptoms ought to be differentiated
from those of fecal auto-intoxication. This mucus exudate has an
intensely irritating effect on the nervous system, especially when
an acute intestinal mucus storm has developed, torturing its victims
and unfitting them mentally to attend to the ordinary duties of the
day. Very often this is accompanied by more or less pain or muscular
soreness. These annoying symptoms occur very early in the history of
Proctitis and Sigmoiditis, and clinical experience has demonstrated
to me and to my students the necessity for infants and children being
examined in order to determine whether inflammation exists in the anus
and rectum, and thus early cut short the progress of the disease and
its numerous and familiar symptoms, which I may here enumerate, to
wit: indigestion, flatulency, coated tongue, foul breath, bad taste
in the mouth, capricious appetite, nausea, intestinal colic, cramps
and pains, diarrhea, headache or band of pain encircling the head with
sense of constriction, neuralgia, pain about the heart, cold hands and
feet, malnutrition, anemia, emaciation, dry skin, seborrhea sicca,
carbonic acid toxemia, sallow complexion, liver spots, jaundice, acute
bilious attacks, drowsy states, mental torpor, bad temper, night
terrors, irritability, melancholia, vertigo, dizziness, loss of memory,
insomnia, drawn face, tired feeling, unrestful sleep, easily fatigued,
subject to colds, catarrhal affections of the ears, eyes, nose, throat,
etc., decay of teeth, dry cough, loss of hair, impaired vision,
sterility, impotency, mucus and membranous cords and casts from the
bowels, sediment in the urine, irritability of the bladder, premature
age, reduced physical and mental efficiency, inability to concentrate
the mind, morbidity, suicidal notions with a view to ending mental and
physical suffering.

I am pleased to inform such sufferers that their ills can be properly
diagnosed and treated; and the earlier in life they seek treatment, the
sooner they will escape the accumulative ills that make existence so
painful to endure.

We have mentioned Proctitis and Sigmoiditis as the primary cause of
intestinal stasis in the majority of cases; later, other sections of
the intestinal canal may be invaded by inflammatory process, causing
a more serious intestinal stasis, not infrequently bringing about
dislocation of the stomach, intestines, and other abdominal organs. We
have enumerated the symptoms and maladies that are now, in the light
of latest medical science, traceable directly or indirectly, to this
primary cause; in short, it may be said that, with the exception of a
few diseases caused by toxic agents, most of the illnesses that cause
so much invalidism, cutting short our lives, can be traced to mucus and
fecal auto-intoxication.

The purpose of this book and others I have published is to educate
my fellow beings as to how to prevent or avoid the many diseases and
symptoms that afflict them from the cradle to the grave; already I feel
that I have accomplished something in helping humanity, and I trust
others will do their part to lessen the ills that flesh is heir to
through neglect and ignorance.




CHAPTER XXI.[2]

INTERNAL HEMORRHOIDS OR PILES VERSUS RECTAL MUCOUS SAC, RECTO-ANAL
MUCOUS SAC.

  [2] Chapters XXII, XXIII, and XXIV have been revised from Papers
  contributed to _Albright’s Office Practitioner, in 1908_.


Before the history of medicine and surgery began, man suffered at
his hinder parts as well as at other parts of his organism. Bodily
ills are as old as the human race, and the flowing of blood from
the “terhinder” was a signal of distress or of physical anarchy, of
which the references to “emeroids” in the Bible and in other ancient
writings bear witness. The “emeroid” doctors of Egypt, in the time of
Moses, unquestionably regarded the distress caused by the “emeroids”
as a disease. And it came to pass that every subsequent Moses that
has written on the subject of hemorrhoids up to the present time has
regarded piles as a disease. And they likewise, all of them without
exception, believe the “disease” to be hereditary, as is certainly
their information on the subject. This mental obsequiousness of the
proctologists of our day is indeed quite a long-drawn-out compliment to
the pile doctors of Egypt, since our proctologists still continue to
diagnose piles as a disease and “to smite the smitten of emeroids.”

I have always respected the idea of ancestral worship and of reverence
for the dead past, but at the same time I have felt that one should not
be wholly oblivious to their egregious mistakes.

If Moses, Samuel, Herodotus, Hippocrates, Galen, and other illustrious
men had said that “emeroids” is a symptom of a disease, what a blessing
they would have conferred upon suffering humanity. The simple use of
that one word would have been illuminating, and would have set the
tide of attention for the proper diagnosis and treatment in the right
direction. Possibly some one more bold than the servile brotherhood
did see and say that it was a mere symptom, but, if so, his temerity
was treated by “the wise ones” of that day as similar innovations
are treated to-day, with a “Tut, tut, tut; pugh, pugh, pugh. We know
better, and we refer you to the following chapters in Holy Writ and to
the classical work of the great Medi Cusus on ‘Pilus Diseasicus.’ And
besides, have you no respect for the superior clinical advantages we
enjoy?”

Notwithstanding the bad odor in which I shall be held, I will nerve
myself to claim that, when the ancients considered and called piles or
hemorrhoids a disease, they made a very grave and palpable mistake, and
that, having made this mistake, it was inevitable that numerous errors
should follow logically in its train when they attempted to account for
the etiology, character, and means of cure of this “disease.”

Pruritus ani is also called a disease, and a similar bedlam of reasons
is offered as causes and means of cure, all of which accounts for the
many, many pages of a book filled to overflowing by a “classical”
author, with compilations of the redeeming gospel truths on this
subject from prehistoric times till the present day, including his
own commentary, guesses, interpretations, and surmises. Ignorant as
he is of the nature of this symptom, the conjectures of his perfervid
imagination are “to laugh.” The errors of one or more authors, endorsed
by the mistakes of others, seemingly make a truth to minds that are
vassals to authority, which accounts for much of the useless medical
literature of to-day and for the mistakes of those that are misguided
by it.

Considering the pathological condition, it would be better if we were
to give a more definitive characterization to it than “piles” or
“hemorrhoids.” In accordance with the distinctive exhibit contemplated,
we should describe it as a rectal mucous sac, an ano-rectal mucous sac,
or an ano-muco-cutaneous sac. These are more distinctive and suitable
designations for these symptoms of chronic proctitis, inasmuch, by
such designations, we call attention to the fact that they are simply
constricted mucus[3] channels and sacs, with engorged arteries and
veins, formed by the serous exudation that accompanies inflammation.

  [3] I found it more convenient to use the words mucus channel, mucus
  fistula, etc., in preference to sinus, as they better convey my ideas
  to the average reader.

If a recto-anal mucus channel, under one or more layers of the mucous
membrane, becomes constricted or obstructed (they usually do), its
epithelial wall will become sacculated, and then we have a rectal
mucous sac, or an ano-rectal mucous sac, or an ano-muco-cutaneous
sac, all of which may be present in the same case. The inflammatory
exudation called serum distends and destroys fatty tissue, which makes
space for its lodgment under the tissue that imprisons it, and at the
same time there occurs more or less proliferation of the cells of the
tissue involved in the severe inflammation. The internal sphincter
muscle, by its contraction, aids in the undue retention of the mucus
and blood above it, hence the so-called pile-bearing region--that
is, the sacculated mucosa region. The serous exudation meets with
obstruction along the anal canal and the mucosa is sacculated. When the
integument around the anus offers obstruction to the flow of serum and
blood, we find that muco-cutaneous sacs are formed around the anus. If
the exudation occurs in the areolar space under the ano-rectal mucosa,
it readily passes down into the areolar space under the integument
around the anus, and thence to parts deep, devious, and far away, as
described in Chapter III.

Channels, reservoirs, sacs, that would hold from one to eight or
more ounces of fluid, no longer excite my wonder and amazement at
the extensive and serious pathological condition of which they
are exhibits, a pathological condition that occasions symptoms
often diagnosed as sciatica, rheumatism, myalgia, caries of the
coccyx, coxitis, prostatitis, pruritus ani, scroti, and vulvæ,
auto-intoxication, anemia, invalidism, etc.

Inasmuch as we have learned the cause of sacculated mucosa at the
lower end of the rectum and over the anal canal and of the integument
around it, we had better in future omit the following designations and
distinctions, which are merely a ridiculous display of sciolism. Surely
we can do without them, and ought to do so for the sake of truth and
simplicity. With a sigh of relief let us in future ignore: Safety-valve
piles, organized piles, itching piles, blind piles, bleeding piles,
moon piles, cutaneous piles, thrombotic piles, external and internal
pile tumors, venous piles, ulcerated piles, capillary piles,
mixed hemorrhoids, arterial hemorrhoids, white hemorrhoids, acute
hemorrhoids, chestnut hemorrhoids, chronic hemorrhoids, inflammatory
hemorrhoids, hypertrophic hemorrhoids, atrophic hemorrhoids, Egyptian
piles, Philistine itching hemorrhoids, etc.

Quite naturally such a variety of “diseases” called forth many sorts of
surgical operations for their removal, of which the following are the
ones most in vogue: Clamp and cautery, ligature, crushing electrolysis,
excision, submucous ligation, the Whitehead operation, the Earle
operation, the American operation, etc.

Forget them all, forget all of the senseless terms that are employed
to describe a supposed variety of “disease” and all of the barbarous
procedures for their banishment, and the banishment, alas! too
frequently, of the wretched sufferer likewise.

Study carefully the varieties of chronic inflammation and the character
and extent of the exudation in each case. By so doing you will
ascertain the nature of the many varied symptoms of proctitis, of which
the following are the most common: Sacculated mucosa and integument,
submucous and subtegumentary channels, reservoirs, pockets, fistula,
pruritus ani, fissure- or ulcer-in-ano, constipation, diarrhea, etc.

Proctitis may present a chronic, a subacute, or an acute stage, with an
atrophic or hypertrophic condition, or a less marked structural change
in the tissue. If proctitis were treated early in its inception, none
of the above-mentioned symptoms would have occasion to develop. When
mankind becomes properly enlightened on the subject of proctitis, due
attention will be given to it long before so many annoying symptoms
occur.

Ano-rectal mucous sacs, formed by the serous exudation into the
connective tissue and stasis of the blood, are the slightest symptoms
of proctitis, and by far the most easily removed.

Since we have found out what are the symptoms and what is the disease,
it naturally follows that in treating a sacculated mucosa we should be
governed by the character of the proctitis, whether it be in a chronic,
subacute, or acute stage. If the inflammation be acute, no matter
whether or not there is a general prolapse of the sacculated tissue, it
may be well to delay the treatment for removal of one or more mucous
sacs until we have in a degree overcome the acute inflammation by the
use of a shallow sitz bath, Fig. 23, and by the use of a soothing
ointment and liquid remedy, to meet the depurant requirements of the
case.

The removal of the chronic inflammation, in whatever state it may be
found, should be a paramount feature of the treatment from the time a
case comes under one’s care. The cure of the disease ought to be of
more importance than the removal of a symptom or symptoms. Should there
be bleeding from a mucous sac, or should there be prolapse of it, or
both, immediate treatment will give relief at once, and the sufferer
will think you have performed a miracle, especially if the annoyance
has existed for many years.

After the immediately annoying mucous sacs are removed by the
hypodermic method, a physician can doubly guard his reputation in
the painless treatment of mucous sacs by delaying further treatment
of those remaining sacs, which, if treated, might occasion special
annoyance, till such a time as the general inflammatory condition is
much improved; but in the interim he may treat the mucous sacs that are
located above the sphincter muscles, and the granular and ulcerated
regions.

For the almost universal success in the painless removal of mucous
sacs, the operator should be in possession of all of his normal wits
and senses, so that his judgment will be at its best when the following
points present themselves:

What to treat.

When to treat it.

Where to treat it.

How much to treat of it.

The quantity of remedy to be injected--all of which require discretion
and good technique.

By the hypodermic method of treating mucous sacs some escharotic is
employed with the object of causing the absorption of the sacculated
mucosa. The object to be accomplished ought to determine the proper
strength of any escharotic used. Whatever will absorb the mucous
membrane involved in the sac in the slowest and mildest manner is the
best remedy or the best way to employ any of the tissue absorbers
you might select. And another fact: the lower the per cent. employed
the larger the quantity that may be used at a time, and this is
desirable if the area of a sac be large and you wish to absorb the
greater portion of it. A skillful operator will make sure to have the
escharotic used cover just the amount of the mucous sac desired, and
no more. Physicians that are not aware of the channeled and sacculated
character of the mucosa in the case of “piles” or “hemorrhoids” are
liable to introduce the escharotic into the base or the center of
the mucous sac with the hypodermic needle; and in such an event the
remedy often enters a cavity or a channel, or both, and naturally
it finds its way along the channel to the integument at the anus,
whence, as a consequence, a deep, ugly fissure-in-ano is in a short
time to be reckoned with by the patient and the physician, because
of the destruction of the epithelial wall of the channel. The patient
thereupon is far from being in a good humor, and the physician wonders
how the thing happened, and he feels like quitting practice altogether,
and doubtless many have done so; and certainly every one should do so
if such an error were to occur a second time.

The object we wish to accomplish is to absorb the wall of the
sacculated mucosa. Therefore the remedy should be injected at the
apex of the sac, in the epithelial layer, or slightly deeper, if the
occasion demands it. The area of the sac and the thickness of its walls
must be taken into consideration, and will suggest the amount of the
escharotic to be used.

A proper speculum is very essential to the successful treatment of
sacculated mucosa, and I know of none equal to that devised some thirty
years ago by Dr. A. W. Brinkerhoff. The speculum is easy to introduce,
and by drawing a slide the tissue is properly exposed or shut out to
a nicety, exhibiting just the amount you wish to treat. In some cases
there is a rather lengthy sacculated mucosa on the side, or on the
anterior wall of the anorectal tube, and it is advisable to treat only
the upper third or half, and at a subsequent visit or visits to treat
the remainder, thus avoiding annoyance to the patient.

The paramount concern should be to avoid causing pain both during the
treatment of a sacculated mucosa or its possible occurrence a few
hours or days later. I have often remarked that when pain or soreness
follows the treatment of a mucous sac the fault is in the application
of the remedy, and not in the remedy itself. Now and then there may
be conditions in which you will expect pain or soreness to follow
the treatment, and you will prepare your patient with the necessary
appliances and remedies to overcome it promptly. Where there are no
possible means for avoiding the pain consequent upon a treatment, leave
nothing undone to make it as slight as possible. All mucous sacs ought
to be treated without any after-annoyance to the patient, and they can
be if we only wait for the proper time to treat them.

I have not thus far considered the muco-cutaneous sacs around the anus,
which are neither useful nor ornamental, and which often indicate the
volcanic action of inflammation and the amount of mucous lava thrown
out around the vent.




CHAPTER XXII.

EXTERNAL AND THROMBOTIC PILES VERSUS MUCO-CUTANEOUS SACS AND THROMBUS.


The vent of a crater indicates the convulsive and destructive changes
that have taken place within; and, very often, the vent of the
gastro-enteric sewer gives like evidence of long, great, and severe
destructive changes. The fire of inflammation has burned fiercely
for many, many years, and serous lava has, from time to time, poured
forth, leaving a searing, inflammatory path. As it was forced from the
recto-anal crater, the acrid, burning mucus, that had been imprisoned,
made subcutaneous streams, cavities, channels, sacs, etc. Its course
is marked around the anus by peaks, crags, muco-skinny tabs, small and
large bulging muco-cutaneous sacs, dilated anal veins in which clots
of blood often form; light gray, brittle, shiny skin with small and
large red and sore oases, thickly studded over the itching area, which
the sufferer has scratched in the vain hope of appeasing the torture
of pruritus ani, scroti, vulvæ; while cold drops of perspiration stand
over his or her face and body, serving to indicate the physical and
mental anguish inexpressible in words.

Muco-serous exudations under one or more layers of the recto-anal
mucous membrane finds its way down to the integument around the anus,
and being of a very irritating character, greatly increases the
inflammatory process in the tissues it comes in contact with. Thus
the increased inflammation and blood stasis and the augmented serum
unite in hurrying the development of skinny tabs and the more or less
capacious muco-cutaneous rugæ and sacs.

When the serous exudation takes place entirely under the recto-anal
mucous membrane, there may be formed a large muco-cutaneous anal sac,
especially on the right or left side of the anus, or the serum may pass
under the integument about the anus with little or no anatomical change
in the appearance of the skin at or about the anus. In the latter case,
an experienced eye can detect sufficient evidence to diagnose the
destructive changes wrought by the presence of serum in the connective
tissue under the skin and ano-rectal mucous membrane.

The skin is not, as it should be, held fast by the connective tissue,
but lies loose over the cavity; and a similar pathological condition
exists under the mucous membrane of the anus, rectum, and sigmoid
flexure, which circumstance might lead one, in some instances, to
conclude that there was almost an entire separation of the mucous
membrane from the areolar tissue, by the ridges, folds, large,
pouched, prolapsed, sacculated regions of mucous membrane that has
the appearance of having been simply carelessly laid over the muscular
structure of the organs. When we observe such destructive changes
by the invasion of serous exudation under the mucous membrane, we
have every reason to expect periproctitis and perisigmoiditis, with
the possibility of the formation of pus occurring with the usual
consequences. So remarkable and serious are the excursions of the
mucous currents into healthy neighboring tissue that we find a symptom
of a disease vastly more annoying and serious than the disease itself.
Is it any wonder we find stenosis (narrowing of the passage) of eight,
ten, or more inches of the lower portion of the large intestine, which
is usually diagnosed atony of the bowels? Surely, you must by this
time appreciate the reason I made so strong an appeal for the twice
daily use of the enema as a means of relief. You need the combination
of many aids over a long period of time to effect a cure of proctitis,
etc., and its numerous symptoms. Proctitis and colitis is a serious
affliction, and should have your undivided attention with the hearty
co-operation of the patient in effecting a cure. How foolish is the
practice of removing one or two annoying symptoms (piles and fistula)
and leaving the sufferer untreated, the disease itself and the other
symptoms not so apparent at the time of the operation, and then dismiss
the case as cured! Shame on such practice, in which ignorance and
cupidity dominate! Humanity cries for a correct diagnosis and a humane
treatment!

The profuse serous exudation resulting from proctitis and sigmoiditis
makes its way from the diseased area into the neighboring regions
like lava from an active volcano, carrying with it an intense burning
inflammation, destroying normal fatty tissue as it advances, owing to
its extremely acrid character. Is it any wonder that we find dilated
veins and arteries in the lower rectal and ano-rectal canal and around
the anus where stasis of the blood has existed for a great many years?
The real wonder is that thrombus in the veins around the anus does not
occur more frequently than it does. What is the necessity of calling
such a pathological change in the caliber of a vein and the weakening
of its walls “thrombotic pile”? Thrombus is a clot of blood in a
vein, and there is no use in adding the word “pile.” The aggravated
character of the inflammation accounts for the hypertrophied and the
cicatricial tissue so often found around the anal vent of proctitis
cases. The Biblical suggestion that sacculated mucosa, commonly termed
piles or hemorrhoids, is a disease, accounts for the numerous names
used to designate the particular variety of the disease--whether it be
an internal or an external pile tumor. It is very wrong to so mislead
“scientific” medical men. Had they only known that the numerous sacs,
bags, prolapsed pouches, longitudinal and transverse folds of the
ano-rectal mucous membrane, and the ragged, jagged, prolapsed, pouched
muco-cutaneous tissue around the anus, as well as the fissure-in-ano,
pruritus ani, fistula, are only symptoms of a disease, all of the many
abnormal changes and the other symptoms could have been prevented many
generations ago by simply treating their exciting cause. But it is
never too late to learn things that will benefit mankind.

Don’t for a moment think that all of the structural changes on the
mucous membrane and about the anus mentioned above indicate an
affliction only skin deep, or even the depth of the mucous membrane.
They are far worse than that. You will find all the muscular structure
of the anal organ and that of the rectum sigmoid flexure severely
invaded by the inflammatory process and its fibrinous exudation, and
also the external tissues that surround and support the organs.

We have circular and longitudinal muscular tissue entering into the
structure of the anus and rectum. The sphincter muscles are two large
and strong muscles that close the anal orifice and guard its vent very
effectually if they are not destroyed by a surgeon’s knife.

The acrid burning serum coming in contact with the muscular tissue
excites an aggravated inflammation in its structure as elsewhere. The
constant irritation results in more or less permanent contraction
of the sphincter muscles in which fibrinous exudation takes place,
binding the contracted muscular fibers together. In time their
expansibility is lost in many cases, and in other cases partially so,
necessitating divulsion of the sphincters in order to break up the
adhesions and establish a somewhat normal circulation of the blood in
the diseased parts, also in order to relieve the irritation to the
nerves distributed to the organs and their marked reflex excitement.
In some cases an expansion of the sphincters for one and a half inches
or two inches is quite sufficient; other cases may require a little
more thorough divulsion; but never weaken or paralyze the sphincters,
as your patient needs their normal use, and you need the reputation
of never causing incontinence of feces. Guard the usefulness of the
sphincters as you would a valuable treasure.

As a rule, I treat all of the ano-rectal sacculated mucosa in cases
where divulsion is required before performing the dilatation to break
up the adhesions, and very frequently the muco-cutaneous sacs and
distended veins as well. It may be well to delay the divulsion--with
which there is usually no hurry--until you determine how many U-shaped
(or hairpin shaped) mucus channels and recto-anal mucus fistulas there
may be present that have passed down under the recto-anal mucous
membrane, down to the integument about the anus, and then pressed
immediately upward again along the outer wall of the anus and rectum,
to the extent of six inches or more. There may be three, four, six, or
more of them quite prominent as to length and size.

For the treatment of the recto-anal sacculated mucosa the injection
method is par excellent. For the removal of the muco-cutaneous sac a
double V-shaped incision, the proper depth, length, and width, will
remove the surplus or redundant tissue, after which the edges are
brought together with a catgut suture,--or omit the suture if you think
best,--followed by the home attention as prescribed for fissure-in-ano
in a previous chapter. At the time of removing the sacculated tissue
attention may also be given to the mucus channel; or you may, if
you wish, leave it so that at some future treatment you can give it
the desired attention. A one or two per cent. solution of alypin,
cocain, or beta eucain will produce the necessary local anesthesia
for a painless operation. I remove only one muco-cutaneous sac at a
treatment, which permits the patient to go about as usual without much
inconvenience.

If you have removed all of the ano-rectal sacculated mucosa in a case,
and have omitted to remove the one or more ano-muco-cutaneous sacs
or dilated veins that are so often present around the anus, and have
also neglected to cure the chronic proctitis, then the sacculated
mucosa may, by some hook or crook, become excited again into an acute
inflammatory condition, the sphincter muscles may grip tighter than
usual, and lo, thrombus has taken place in a vein, and the wrinkled,
shriveled, skinny tab or sac looks like a miniature balloon, and your
dismissed patient is in a troubled state of mind to have everything
come back on him so soon!

The cure was all right so far as it went, but there was the disease and
some of the old external symptoms to tell the tale of an incompleted
treatment.

Those muco-cutaneous sacs at the enteric crater’s mouth are just so
many thermometers at its vent to tell the temperature occasioned by the
fire of inflammation within, and they will damage your reputation as
a proctologist if they be not removed. By all means get rid of these
symptoms and indicators of trouble within; and if there should by
chance be a little of the old proctitis remaining that wants to assert
itself by making trouble, in becoming acute, it will be surprisingly
handicapped in its efforts, and the chances are all in your favor; and
you will, moreover, from time to time, hear what So-and-So said about
the very successful treatment of his or her case.

Sacculated mucosa, muco-cutaneous sacs, submucous channels, etc.,
having their source in the rectum and anus, are all of a similar
origin, the result of serous exudation. These symptoms of proctitis
vary in development and number according to the nature and progress
of the disease. In those cases that are quite exempt from sacculated
mucosa (piles) you may expect to find submucous channels largely
developed, and _vice versa_.

Too much stress cannot be placed upon the serious results of
auto-intoxication by the absorption of mucus from channels and cavities
that will hold from three to eight or more ounces of fluid at one time.
They are no doubt rapidly emptied by the process of absorption into the
system.

I have not referred to the fatalities of the hypodermic treatment of
sacculated mucosa (piles or hemorrhoids) because of the fact that none
have ever occurred within my knowledge among those using either this or
a similar method of treatment.




CHAPTER XXIII.

ABSCESS AND FISTULA INVOLVING ANUS, RECTUM, AND NEIGHBORING REGIONS.


Hippocrates, the father of medicine, Celsus, Galen, and other writers
in the early times, described fistula as a disease; and, naturally
enough, through the influence of heredity, contagion, imitation, and
auto-suggestion, every author on the subject to the present day has
chimed in most complaisantly with his “Ditto! ditto! ditto!” “Me
too! me too! me too!” I am sure that the rank and file of my medical
brethren will agree with me that modern authors are hardly justified
in this servility to the ideas of the fathers of medicine in this
recreance to their duties toward suffering humanity. Is it that they do
not know better, or that they are naturally servile and thus too lazy
to do their own thinking?

Let me in connection with this point call your attention to a practice
that many of us have been suspicious of for a long time, a suspicion
that has been confirmed for me by one who speaks from positive
knowledge; otherwise I should not refer to it here. The practice I am
about to describe will make it plain why we have so many “Ditto and
Me-too” authors on proctology and other medical subjects.

An eminent surgeon who mentally is as large as the human race, and
has room for all that is good in medicine and surgery, narrated the
following incident of his career to a learned doctor from Georgia
and myself recently. Snatching occasionally a few moments from a
busy practice, he has prepared sufficient material to make a book,
and desired some competent person to edit it before publication. So
he consulted an ethical co-worker concerning such a person. In a few
days a gentleman called at the doctor’s house to inquire about the
contemplated publication. The caller asked the title and size of the
book, and when told volunteered the startling information that he could
have the work ready in a few weeks’ time, but that in the meantime he
would like to hear the doctor lecture once or twice that he might catch
a few peculiar expressions to use in the work, so that the doctor’s
friends, when reading the book, would say, “That sounds just like the
doctor; that is his style of talking.” The would-be scribe never asked
for the author’s manuscript, so accustomed was he to rely upon the
medical literature to be found in the libraries of the city for all the
information needed. It is hardly necessary to add that the professional
bookmaker was summarily dismissed. The doctor’s manuscript is still
unpublished.

There is a third reason for so many “Ditto and Me-too” authors.
Publishers of medical books naturally desire to extend their business,
and in order to do this they must issue new works of medicine in the
same way that lay publishing houses compete for new works of fiction.
Now, doctors usually obtain professorships in some institution by
paying five thousand dollars or more for them, and in due time a
publisher of medical books will tempt the professor to become an
author. They place before him their great facilities for getting
up a book, arguing that consequently but little or no labor on the
professor’s part is required. They point out to him the fame and honor
the publication will bring him, and at the same time estimate how
much money they will make out of it. In due time a “Ditto and Me-too”
medical brief, résumé, or treatise, is published covering the whole
history of the subject, from Biblical mention of it to the present day.
All of us have observed what a great amount of stuffing or padding
it takes to make a book that is to sell for five or seven dollars.
It occurs to me that it might be wise to get up a conference of
enlightened physicians to take some practical steps or to devise some
laws that will prevent such impositions on the too confiding medical
brethren by unscrupulous publishers that rob them of their hard-earned
income through delusive advertising. Still, before any action is taken
that would result in effectively closing the door to this practice, it
may be as well that the eyes of more of us should be opened that we
may not continue to be duped and stung again and again by “Ditto and
Me-too” scrapbooks with hundreds of pictures. When seeking for new and
better information to help suffering humanity, let us be served for a
little while longer with “rehashed rot.”

Pardon this digression. We will now consider, at first hand, the
subject of fistula.

As a rule, pus in a fistula is a secondary symptom of chronic
proctitis, except those fistulæ that occur from traumatic injury to
the region of the rectum, anus, and buttocks. Early in my practice I
entertained the idea that the formation of pus occurred at the point of
dissolution of the tissue, and that, as the volume of pus increased it
made its way in the direction of least resistance through it, if the
abscess had not been opened by an incision. The idea was well founded
when it was applied to the traumatic origin of an abscess and fistula,
but not when their origin was traced to chronic proctitis.

It may seem incredible to all who read this that a mucus channel or a
fistula can be formed for ten, twenty, forty, or more years before the
formation of pus takes place in it; and that the pus exerts no part
in producing the diameter or length of the fistula, which may have a
capacity of six, eight, or more ounces of fluid. As soon as the chronic
inflammatory process has penetrated one or more layers of the mucous
membrane, mucus channel or fistula-formation must take place. If the
sphincter muscles be rather weak or lax I would not expect sacculation
of the rectal mucosa to occur to any extent. In these cases, however,
the muco-cutaneous channels are usually found quite large and numerous.
Of course the extent of the ano-rectal symptoms in each case depend
upon how severe the chronic inflammatory process has been, and is, at
the lower portion of the enteric canal. Often you will find that the
seat of the most active chronic inflammation is in the middle and upper
portion of the rectum, involving also the sigmoid colon. In these cases
the ano-rectal symptoms are not numerous, if there be any at all, on
the mucous membrane, but under it you may expect mucus channels that
serve as outlets for the inflammatory product.

In every case of chronic proctitis and sigmoiditis submucous and
subtegumentary fistulæ can be found, and my experience in tracing
them warrants me in stating that periproctitis and perisigmoiditis
is present also; the latter pathological condition being due to the
invasion of submucous and subtegumentary channels or fistulæ around the
outside of the structure of the anus and rectum, extending far up into
the neighboring tissues of the pelvic space that support the rectum and
sigmoid flexure.

The formation of pus in a submucous or subtegumentary channel that has
existed for many years does not make it a disease; it is only another
incidental phase added to an already existing symptom of chronic
proctitis.

Mucus fistulæ should be diagnosed and treated early in their formation,
or at least before the tissues involved became so deteriorated as
to form pus in quantity sufficient to occasion the usual period of
suffering, fever, loss of rest and sleep before the pus is freed
from its enclosure. The formation of pus in a mucous fistula is only
incidental and marks a stage in the distinctive changes that have
been going on for many, many years in the tissues involved in the
inflammatory exudation.

The numerous small and large submucous and subtegumentary fistulæ
found in every case of chronic proctitis and sigmoiditis was the most
grave and far-reaching of the numerous symptoms, but for three decades
I have fully realized the baneful effects from mucus irritation, and
the self-poisoning by the absorption of large quantities of serum and
fibrinous septic material from the surface of the mucous membrane
involved, as well as that from numerous long, cavernous mucus fistulæ:
a fearful double source of auto-intoxication, for which it is useless
to prescribe diet, tonics, and travel for building up the system and
restoring the health.

Besides the numerous general symptoms, arising from self-poisoning by
fecal and mucus absorption, we have more or less marked local symptoms
in many cases; and if these be not present, the diagnosis can be made
out from the general debility of the system and the character of the
chronic proctitis and sigmoiditis.

The local symptoms of mucus fistulæ, periproctitis, and
perisigmoiditis are, each of them, universally diagnosed as a disease:
Such symptoms as pruritus ani, scroti, vulvæ, lumbago, sciatica,
myalgia, rheumatism, prostatitis, coxitis, disease of the coccyx,
chafing about the anus and along the thigh and scrotum, difficulty in
getting up after sitting for a while, pain in the back of the neck,
lame back, legs feel tired, and sometimes pain is very annoying,
abnormal color of the skin, painful or sore spots at times, confinement
in bed for many weeks from severe continuous pain in and about the
rectum, etc.

Up to the present time proctologists have paid little or no attention
to proctitis and sigmoiditis, which is a grave disease, with a far more
serious symptom, that of mucus fistulæ of great length and diameter,
extending in all directions in the pelvic cavity and tissues of the
buttocks, the large area of tissue found so full of holes, might be
likened to a sponge occupying the same space. They are very numerous in
every case of chronic proctitis and sigmoiditis.

This will explain why an incidental symptom like pus in a fistula is
commonly called a disease by the “Ditto and Me-too” authors, and why it
is so frequently met with in practice. At some hospitals one-half of
the cases treated suffer from fistula in which pus has formed. Why the
per cent. is not much greater I am unable to explain, except to give
credit to the defensive and restorative power of the human body. If the
periproctitis and perisigmoiditis, brought on by the mucus fistulæ,
is not treated at the same time as the cause, the treatment will be
of no consequence in effecting a cure of the chronic inflammation of
the lower bowels. Every mucus fistula should be located and healed at
the time that the disease itself is treated; then the work will be well
done. Every mucus fistula should be diagnosed and treated before the
breaking down of the tissues reaches the pus-forming stage, and thus
obviate all suffering, annoyance, and possible death. Attention to this
course will ensure your treatment of the disease, and its symptoms, to
be taken in time.

The only hindrance to the successful office treatment of a fistula in
which pus has incidentally formed is the fear that you can not cure it,
or that you will fail, or that at a hospital it could be cured quicker,
better, and cheaper. These ideas are born of heredity, timidity,
fear-habit, power of auto-suggestion, and too much caution on your
part. They are all falsehoods and should not be heeded for a moment.
During thirty years of practice in my specialty I have sent seven of my
fistula patients to a hospital for treatment, and four of that number
I afterwards very much regretted sending, as I could have accomplished
the cure in a safer and better way by the usual office method of cure.
In fact every fistula, pus or no pus,--I do not care how bad it may
be,--can be cured by office treatment and at the same time aided by the
home attentions of the patient. There may be periods of a year or more
when your energies are overtaxed with numerous patients, and you feel
like dividing the labor with some fellow-practitioner, and this in a
measure accounts for those I induced to go, or was willing to have go,
to the hospital.

Unless overwork is the excuse, you need never send a fistula patient
to a hospital for treatment. I have everything to say in praise of
the ambulant treatment of ano-rectal fistula and the mucus channels,
since my practice thus far has been devoid of any unfavorable
results,--a fact which should have much weight in favor of the ambulant
office treatment of all of the many symptoms of chronic proctitis,
sigmoiditis, and colitis.

Mucus fistula is very easily healed in all cases, and those cases in
which pus has incidentally formed are likewise not difficult to cure.
All you need to do is to instill intelligence in a stupid patient, if
you haven’t an intelligent one, and induce him to utilize or improvise
a few home conveniences for cleansing the fistula night and morning
between office visits. During the treatment of the fistula patients
will be able to attend to their imperative duties.

To properly explore a fistula and its branches, if any, as to whether
pyogenesis (pus) has taken place or not, it is essential to have the
external opening through the skin of sufficient depth and size to
permit of the application of remedies over all its surface. For a mucus
fistula antiseptic remedies can be applied after a thorough irrigation
by hot water at a temperature of one hundred and twenty degrees, or
more, for half an hour or less time, as the case may demand. Where
pyogenesis (pus) has occurred in a mucus fistula there may be more
or less necrotic tissue formed, which will require the use of an
escharotic remedy as well as very hot water irrigation, followed by an
antiseptic remedy, if not already incorporated in the hot water used.

As a rule I see a fistula case once or twice a week, as the case may
require. There is no packing of the fistula after the morning and
evening home treatment--I have never found it essential. A T-bandage
is worn, with absorbent cotton, over the opening of the fistula,
preventing soiling of the clothes while attending to daily duties.

Never mind what the “Ditto and Me-too” proctologists have copied or
rehashed about the curing of a fistula, which they persist in calling a
disease. Just be resourceful, safe, and sane in all you do, and every
fistula will get well long before you have cured the chronic proctitis
and sigmoiditis, of which the fistula, as a rule, is a symptom.




CHAPTER XXIV.

NINE RADIOGRAPH ILLUSTRATIONS OF MUCUS CHANNELS AND CAVITIES.


I am indebted to Dr. Caldwell, of New York, at whose laboratory my
patients were radiographed for the very excellent illustrations;
and also to Dr. Albright of Philadelphia, for his assistance in the
radiograph work, while attending my clinic, and who, later, with rare
skill and scholarly ability, presented my discoveries in a large
volume, entitled; _A Practical Treatise on Rectal Diseases, Their
Diagnosis and Treatment_.

The following illustrations can only give a hint of the pathological
conditions that existed. Fig. 1 shows seven, and Fig. 2, eight probes
inserted, which by no means indicate the number of channels or size of
the cavities; twenty-five to fifty or more probes inserted would more
accurately indicate the excursions of the inflammatory exudate.

The seven following illustrations, in which Bismuth Paste was injected,
did not meet my expectations in showing the pathological conditions
that existed. The disappointment was largely due to a desire not to
cause annoyance to my patients, who so kindly consented,
in the interest of science, to being radiographed. In all cases the
paste extended over a much greater area than a casual glance at the
illustrations would indicate. The probes and paste were not inserted
with the idea of making a diagnosis, but simply to suggest research on
the subject by proctologists. All the cases radiographed suffered from
proctitis, sigmoiditis, periproctitis, and perisigmoiditis.

[Illustration: Fig. 1.

Radiograph showing tube (1) in the rectum; 2, probe inserted 8-3/4
inches; probes 2 and 4 pass on left side of rectum; 3 and 5 pass on the
right; all pass into perirectal spaces; three probes are seen under the
integument.]

[Illustration: Fig. 2.

Radiograph showing tube (1) in the rectum; probes 2, 4, 6, passed
on the left and front of the rectum; 3 passed forward; 5 under the
integument along the spine; 7, 8, and 9 probes passed to scrotum and
thigh.]

[Illustration: Fig. 3.

Radiograph showing a large region more or less filled with bismuth
from the anal canal forward and upward, as indicated by lines 1
and 2; a severe case of proctitis, sigmoiditis, periproctitis, and
perisigmoiditis.]

[Illustration: Fig. 4.

Radiograph showing a tube in the rectum and probe passed to the left of
the rectum into the space where bismuth was injected; a case of acute
proctitis, sigmoiditis, periproctitis, and perisigmoiditis at time of
treatment.]

[Illustration: Fig. 5.

Radiograph showing bismuth in a perirectal channel on the left side of
the anus and rectum, which caused continuous annoying pain for many
months.]

[Illustration: Fig. 6.

Radiograph showing a long muco-cutaneous sac and perirectal channel
into which bismuth was injected; a case of proctitis and periproctitis,
etc.]

[Illustration: Fig. 7.

Radiograph showing a tube in the rectum, a long probe and bismuth
in perirectal space, also a probe in a submucous channel; a case of
sigmoiditis, proctitis, periproctitis, and perisigmoiditis.]

[Illustration: Fig. 8.

Radiograph showing bismuth injected in the perirectal space; a case of
proctitis, sigmoiditis, periproctitis, and perisigmoiditis with severe
constipation and indigestion.]

[Illustration: Fig. 9.

Radiograph showing tube in the rectum, a probe and bismuth in
perirectal space, and also a probe in a submucous channel; a case of
proctitis, sigmoiditis, periproctitis, and perisigmoiditis.]




CHAPTER XXV.

  CHRONIC MUCOUS PROCTITIS AND SIGMOIDITIS--USUALLY DIAGNOSED AS
  CHRONIC MUCOUS COLITIS.


Chronic mucous colitis ought to mean inflammation of the ascending,
transverse, or descending colon. The length of the rectum varies from
five to eight inches, and the average length of the sigmoid flexure
is about nineteen inches; the length of the two organs is thirty or
more inches. Chronic follicular, ulcerative proctitis and sigmoiditis,
extending half, or even the whole length of the sigmoid flexure, causes
great suffering, and the symptoms are similar to those attributed
to chronic mucous colitis. For about thirty years I have positively
known that many of my patients suffered not only from chronic mucous
proctitis, but from sigmoiditis as well, since I was able to make
positive diagnosis of the diseased condition for at least ten to
fifteen inches up the lower bowels.

If the anal canal is inflamed from any cause and not cured, the chronic
inflammation will gradually extend up the whole length of the rectum
and into the tissues of the sigmoid flexure, invading the organ to a
greater part of its length, if not all of it. The sigmoid flexure is
the normal receptacle for feces, and gases, and physiologically and
hygienically ought to be emptied three times in twenty-four hours to
keep it clean for those who are in the habit of eating food three times
a day. The hygienic condition of the sigmoid receptacle is entirely
dependent upon a healthy condition of the rectum and a sensible tenant
of the body; but when chronic proctitis has taken possession of the
rectum and neighboring tissues, it serves no longer as a normal
passageway for emptying the sigmoid flexure of accumulated feces,
gases, and liquids.

At first inflammation causes spasmodic muscular contraction of the anus
and rectum, which in time becomes more and more permanent stricture
as the progress of disease advances, lessening the bore of the organs
until it becomes very difficult for anything to pass into and through
the rectal and anal canals. Inflammation extending from the rectum
into the sigmoid flexure for perhaps its whole length, interrupts its
functions likewise, thus creating another cause for undue accumulation
of feces and gases in the organ; this accumulation of the waste
material of the body becomes very foul, generating toxic gases, putrid
substances, and poisonous germs which in turn irritate and excite
the diseased organ from their constant contact with the follicular
ulcerated mucous membrane of the sigmoid receptacle. Why should we
not find in these cases all the symptoms attributed by authors to
chronic mucous colitis? Especially so when we have, in addition to
the enumerated symptoms of colitis, those caused by periproctitis and
perisigmoiditis, which are always present and quite severe.

As a rule, the symptoms which have been diagnosed as those of chronic
mucous colitis, membranous colitis, or ulcerative colitis are nothing
more than symptoms of chronic mucous proctitis and sigmoiditis,
accompanied by periproctitis and perisigmoiditis. Proctologists who
have written on the subject of mucous colitis have noted the many
symptoms very accurately, but have missed the usual location of a most
aggravating disease from which mankind suffers early and late in life.
Authors of books on stomach and intestinal troubles are also groping
very much in the dark and are unable to diagnose the cause of a very
common functional disturbance of the whole digestive apparatus, caused
by proctitis and sigmoiditis, bringing numerous and severe primary and
secondary symptoms to which other diseases may be traced.

Chronic proctitis and sigmoiditis and their local symptoms convert the
sigmoid receptacle into an Augean stable, from which foul poisonous
gases and germs are forced up and along the bowels, distending the
descending and transverse colon and finally reaching the ascending
colon and the cæcum, causing undue retention of their contents; hence
so much attention to the cæcum and the vermiform appendix. The ends
of a long rubber tube distended with gas will exhibit more strain and
disturbance than the intermediate parts, and the same is true of the
colon, owing to the intermediate sections of the organ possessing
greater mobility. The great volume of gases confined in the colon
prevents its normal peristaltic action, causing undue retention
of contents, with resulting inflammation of the cæcum, as well as
dislocation of the stomach, colon, etc., and suggesting radiographic
and fluoroscopic examination and surgical operations to discover the
cause of all the trouble, which should have been learned through use of
the speculum before so many complications occurred.

In all cases of chronic mucous proctitis and sigmoiditis where there
is a great amount of secretion of mucus, membranous cords, shreds, and
casts (called mucous colitis), I have found the marked acute symptoms
more or less periodic and accompanied by increased inflammation in
all the tissues involved in the disease, which convinced me that the
colitis we read about had become dislocated and was where I could see
its results without the use of a speculum.

Through often witnessing the phenomena, I have learned what a
“mucous colitis” storm means from a pathological exhibit, a personal
demonstration, and a verbal description of what the sufferer is
enduring. It requires the stuff heroes are made of to endure chronic
mucous proctitis and sigmoiditis for ten, thirty, or forty years
without the disease being accurately diagnosed, and to be told that
all treatment is useless and that the trouble is in the head of the
sufferer, that he is a hypochondriac, and a neurasthenic, terms often
used by doctors who are unable to make a proper diagnosis of a case.

The common symptoms of mucous colitis have been accepted by writers
on the subject, but as to the real cause of them there has been thus
far only mere conjecture, just as the writers have been doing as to
the cause of pruritus ani, scroti, and vulvæ. Dr. George M. Niles,
of Atlanta, Ga., says: “In looking up the literature, one is amazed
at the divergent views as to the etiology and management held by
diligent students and competent observers. It is fairly well agreed
that most cases occur in nervous, neurasthenic, hypochondriac, or
hysteric individuals.” Others blame the liver, hysteria, constipation,
fermentative processes in the intestines. How foolish to name symptoms
of the disease as a probable cause of it! It is not necessary for me to
again enumerate the many primary and secondary symptoms of proctitis
and sigmoiditis, but I will mention briefly a few nervous symptoms
which I think are due to the absorption of mucus into the system.
There is that intense, exasperating, sore, and restless feeling, with
inability to concentrate the mind, with the nerves and muscles of the
body pinched and contracted. Such feelings are at their height during
an acute mucus storm, which is an indication of increased inflammation
in all the inflamed tissues, causing secretion of a great quantity of
mucus or membranous casts. No doubt much of the inflammatory exudate
from the mucous membrane, from the muscular structure of the organs,
and the connective tissue surrounding and supporting the organs, passes
into the sigmoidal and rectal canals, while a portion is absorbed
into the system. In a similar manner, the inflammatory exudate from
a subtegumentary mucus channel and cavity passes through the skin,
causing moisture of the skin, pruritus ani, scroti, and vulvæ. I know
of no non-malignant disease, where the symptoms may truly be said to
be a thousand times worse than the disease that caused them, except in
chronic proctitis and sigmoiditis.

Treatment of such cases has been very successful in my practice,
requiring four principal aids: (1) Local treatment; (2) medicated
enemata; (3) local medication; (4) the recurrent application of
medicated hot water at a temperature of 125 to 135 or more degrees.
A further valuable aid is the determination of the sufferer to get
well by faithfully carrying out the home treatment. The more a patient
studies my diagnosis and treatment of his case, the more he is
encouraged that eventually a cure will be effected. Dr. James Moran of
this city has been a student and assistant at my office for more than
three years, and will bear testimony to the success of my treatment in
all cases observed by him.




CHAPTER XXVI.

ANTISEPTIC EMPLOYMENT OF POWDERS AND OILS.


DEPURANT POWDER.

Water at a temperature of from 120 to 135 or more degrees is an
excellent antiseptic if properly applied to diseased tissue. Its
anti-toxic, soothing, and healing properties, however, can be vastly
increased by the addition of Depurant remedies. Water of this
temperature, if used in the treatment of proctitis or colitis, should
be applied with the aid of an Intestinal Recurrent Douche.

Water at a temperature of from 90 to 105 degrees--which is recommended
for taking an enema--is antiseptic or depuratory only to the extent
to which it washes away morbid matter from the intestinal canal. To
increase its antiseptic and therapeutic value, as well as to meet other
requirements, Depurant remedies are administered with the water during
the flushing of the large intestine.

The Depurant Powder, prepared by the author, readily dissolves in the
warm water and is brought into contact with every part of the mucous
membrane as far as the antiseptic flushing extends along the intestine,
thus leaving the washed and sterilized canal sweet and clean--a fit
and proper channel and receptacle for the on-coming fecal mass. Here it
may remain about four hours without danger of putrefaction, whereas,
were the passage-way and receptacle foul, the feces would putrefy and
form gases and toxic material in briefer time.

This Depurant remedy is not restricted to intestinal uses; it is
equally efficacious when applied to the mucous membrane of any part of
the body or to the skin. It may be used effectively for washing out the
bladder or the vagina; for syringing the ear; for a mouth wash, tooth
wash, gargle, nasal douching or spray; for a throat spray; for bathing
infants; and for internal use where foulness of the stomach and small
intestines exists. It is also a valuable adjuvant in the use of water
for cleansing, or for hygienic purposes, on all the tissues of the body.


DEPURANT OIL.

Next to the use of water on the mucous membrane and skin as a hygienic
and therapeutic agent, I am partial to some of our delightful oils,
which are bland, non-irritating, and of a pleasing, nourishing,
refreshing effect and exquisite odor.

To the oil selected as the base ingredient may be added other oils,
and finally attenuated powdered substances of therapeutic value in
soothing, purifying, healing, or any other purpose the case may call
for. Pure olive oil is an excellent substance in which to incorporate
Depurant remedies, especially when designed to be taken internally,
by way of the mouth, or applied to the integument of the body. Certain
other oils are equally pleasing though rather expensive. However, an
inexpensive oil usually serves as a base in which to embody the proper
medicinal remedies for Depurant purposes in the treatment of proctitis
and colitis.

By a proper instrument the oil is carried into the intestines with the
water used in flushing the colon, or that used with the intestinal
recurrent douche treatment. The oil, being lighter than the water, is
carried ahead or on top as the water passes up the bowels; and, as
the two liquids open the crevices and folds of the mucous membrane
or canal, every part of the latter is completely covered with the
medicated oil, as with a covering of thin salve, ointment, or a
poultice--in every nook and corner, just where it is most needed and
where it should remain for its hygienic and healing effect.

Every kindly aid should be given a diseased organ, mucous membrane, or
the skin, even if one knows it is for relief only; for the very aids
that give relief are often essential when joined with medicinal or
other treatment in effecting a cure.

It is advantageous in treating bowel troubles to use a rather heavy,
tenacious oil for a base--one that may not be so pleasant to swallow
or to use externally as some of the lighter oils. It is therefore
advisable to have two kinds of Depurant Oil: one for internal use (by
the mouth) and for the skin, the other for chronic disease of the lower
bowel.




_INTESTINAL ILLS._

_By Alcinous B. Jamison, M.D._,

SPECIALIST IN RECTAL, ANAL, AND BOWEL DISEASES, AND AUTHOR OF “HOW TO
BECOME STRONG.”

_Cloth, 277 pages_


The above is the title of a work for non-professional readers on the
cause and cure of many forms of bowel and stomach trouble, and their
consequences, and the scientific treatment of piles, fistula, pruritus
ani (itching), etc.

Science is here reduced to common sense; and the intelligent layman,
following the directions of this book, especially as to “physiological
irrigation,” will be able to prevent the usual daily foul state of the
stomach and bowels. Here is set forth in plain language the accumulated
experience of a thoughtful physician, who for over thirty years has
studied the welfare of his patients in the treatment of those diseases
which are peculiar to civilization. During this long practise, patients
from all parts of the United States and other countries have come to
New York City to be under the humane and skilful care of Dr. Jamison,
who has the unique reputation of never employing the barbarous surgical
and hospital methods in vogue throughout the world. No knife, ligature,
clamp, or cautery has ever been employed by him in the treatment
of even the most aggravated case of piles, or hemorrhoids; and no
detention from business is necessary under his treatment for this
symptom of proctitis.

Dr. Jamison’s discoveries in the line of his specialty have added
much to medical knowledge concerning the etiology and pathology of
proctitis, sigmoiditis, and of their symptoms--hemorrhoids, pruritus
ani, constipation, etc. His diagnosis of these afflictions is original,
as well as his treatment of such ailments--hitherto neglected or
improperly cared for.

Physicians and surgeons of conventional schools of medicine are not
aware that the common cause, and indeed the key, of all forms of anal,
rectal, and bowel trouble is proctitis (inflammation of the lower bowel
and sometimes of the colon); that proctitis is the cause of nearly
all cases of constipation, diarrhea, indigestion, and biliousness;
and that, finally, proctitis is the cause of auto-infection
(self-poisoning) and its outcome--anemia, emaciation, etc.

No book to which physicians have access treats this subject so fully as
“Intestinal Ills,” and yet in this volume it is presented in a popular
manner suited to the common understanding.

The following enumeration of the chapter headings will give an idea of
the scope of the treatise:

  1. Man, Composed Almost Wholly of Water, is Constipated. Why?

  2. The Physics of Digestion and Egestion.

  3. The Interdependence of the Anus, Rectum, Sigmoid Flexure, and
       Colon.

  4. Indigestion, Intestinal Gas, and Other Matters.

  5. Key to Auto-infection.

  6. How Auto-infection Affects the Gastric Digestion, and Vice Versa.

  7. How Auto-infection Affects Intestinal Digestion, and Vice Versa.

  8. The Cause of Constipation and How We Ignorantly Treat It.

  9. Cures for Constipation “Fearfully and Wonderfully Made.”

  10. Biliousness and Bilious Attacks.

  11. King Liver and Bile-bouncers.

  12. Semi-constipation and Its Dangers.

  13. The Etiology of the Most Common Form of Diarrhea, i. e.,
        Excessive Intestinal Peristalsis.

  14. Ballooning of the Rectum.

  15. Ballooning of the Rectum (_Continued_).

  16. Erroneous Diagnoses and Treatment of Bowel Troubles.

  17. Costiveness.

  18. Inflammation.

  19. Proctitis and Piles.

  20. Pruritus, or Itching of the Anus.

  21. Abscess and Fistula.

  22. The Origin and Use of the Enema.

  23. How Often Should an Enema be Taken?

  24. Physiological Irrigation.

  25. Proper Treatment for Diseases of the Anus and Rectum Very
        Essential.

  26. The Body’s Book-keeping.

  27. Selection and Preparation of Food.

  28. Diet for Indigestion.

  29. Diet for Constipation.

  30. Costiveness, Diet, etc.

  31. Diet for Diarrhea.

  32. A Final Word.

You need this book for yourself and your friends. By making a present
of it to some one requiring its light you will perform an act of
unselfish kindness.

Price, cloth bound, lettered in gold, $2.00, post-paid to any address.
In sending for the book please write name and address plainly. All
orders should be sent to the author:

  A. B. JAMISON, M.D.,
  43 WEST 45TH STREET, NEW YORK CITY.





End of Project Gutenberg's Intestinal Irrigation, by Alcinous B. Jamison