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

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

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

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

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

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

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

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



CHAPTER XIV.

BALLOONING OF THE RECTUM.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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



CHAPTER XV.

BALLOONING OF THE RECTUM—Continued.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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



CHAPTER XVI.

THE USUAL DIAGNOSIS AND TREATMENT OF BOWEL TROUBLES WRONG.

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

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

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

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

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

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

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



CHAPTER XVII.

COSTIVENESS.

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

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

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

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

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

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

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



CHAPTER XVIII.

INFLAMMATION.

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

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

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

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

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

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

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

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

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

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

Various chemical changes are by no means uncommon.

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

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

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

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

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

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

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



CHAPTER XIX.

PROCTITIS AND PILES.

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

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

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

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

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

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

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

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

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



CHAPTER XX.

PRURITUS OR ITCHING OF THE ANUS.

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

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

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

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

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

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

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

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

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

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



CHAPTER XXI.

ABSCESS AND FISTULA.

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

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

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

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

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

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

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



CHAPTER XXII.

THE ORIGIN AND USE OF THE ENEMA.

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

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

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

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

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

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

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

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



CHAPTER XXIII.

HOW OFTEN SHOULD AN ENEMA BE TAKEN?

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

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

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

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

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

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

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

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

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

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

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

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

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

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



CHAPTER XXIV.

MAN'S BEST FRIEND.

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



CHAPTER XXV.

PHYSIOLOGICAL IRRIGATION.

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

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

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

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