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]

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.

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.

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.

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.

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.

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.

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.

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.

Fig. 8.

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.

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.

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.

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.)

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.

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.)

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.

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.

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.

Fig. 13.

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

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.

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.

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.

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.

Fig. 16.

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

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.

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.

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.