THE AUTHOR’S UNIQUE INVENTION.
The author has searched the markets of the world for suitable apparatus for intestinal irrigation, so that he, as a specialist in this line and in anal and rectal diseases, could recommend it to his patients. None of the appliances to be had, however, quite answered the purpose he had in view. All of them had some drawbacks. Owing to this fact, after much experimentation he has invented an instrument that is herein fully described to show its serviceableness. Were this volume to be issued without this description, the author would be inundated with interrogatories concerning the best instrument to be employed by its readers, or whether the appliances they have on hand would answer the purpose. As the object of this book is practical, not literary, it is not out of place, the author thinks, to describe the invention and its unique serviceableness, as well as its special adaptability for the tri-daily employment of enemas.
The instrument is known as “The Internal Fountain Bath for Home Treatment.” The following illustration gives a very good idea of its construction and merits:
[Patented Dec. 31, 1901; Nov. 14, 1905.]
Figures 18, 21, 22, and 23.
18, Reservoir; 21, hard rubber handle; 22, metal handle; 23, metal handle, hard rubber cone, and enema point; 19, lamp support; 20, lamp; 33, rubber tube and shut-off; 24, glass bottle; 27, hard rubber anal cone; 29, valve; 28, enema point; 25 and 26, recurrent douche points; 30, glass bottle; 31, hard rubber cone; 32, enema point.
Figure [24], Page 120, illustrates the author’s rubber enema appliance, The Niagara Fountain Syringe, holding about two gallons of water.
The Internal and External Fountain Bath is an appliance that I have devised and supplied to my patients for many years with most satisfactory results in every particular. Several other enemata and recurrent douche instruments which I have used did not wholly meet the requirements in capacity or aseptic features; but long use of this apparatus in all the various bowel troubles has demonstrated, to me as well as to my students and patients, that the instrument is the best that can be made, perfectly meeting all the requirements essential for scientific results.
Features and Uses.
The Fountain Bath is the product of necessity, effort, and long experience in accomplishing a definite purpose fully and properly. Figure 18 illustrates a large enamelled metal reservoir for water. Figure 21 shows a hard rubber combined enema and recurrent douche appliance for the application of water to the mucous membrane of the large intestine, the temperature of which should range from ninety to one hundred and thirty-five degrees or more. To one end of the handle is attached a hard rubber anal cone (Figure 27), inside of which is a valve (Figure 29), which is opened and closed by turning the handle, permitting the water to pass through the rectal point (Figure 25), or (Figure 26) into the bowels and return into the toilet basin without removing the point. At the other end of the handle is attached a glass reservoir for the use of oils. Figure 22 is a metal handle with a glass reservoir and a hard rubber anal cone. Figure 23 is a metal handle without glass reservoir, and both are intended for the use of water at a temperature of from ninety to one hundred and five or one hundred and ten degrees. A thermometer is absolutely necessary to determine the temperature of the water during its use as a depurent and antiphlogistic remedy. The heating appliance will keep the water at a desired temperature during its application, which is a very essential feature indeed.
Water Capacity.
The Fountain Bath reservoir holds three gallons of water, which is quite sufficient to meet all requirements of the various complicated cases of bowel and uterine troubles which require a generous supply of tepid or very hot water. This obviates any interruption in the use of the enema or the recurrent douche treatment until one or both are satisfactorily completed, and without changing one’s position on the toilet seat. It requires a quantity of water to irrigate the large intestine, which is some five feet long and two and a half inches in diameter. It is foolish to attempt to irrigate one end of a long, tortuous, foul sewer with one or two quarts of water and hope for good results. Water is cheap, then why not clean out and keep clean?
Adaptability.
For the first time in the history of enemata appliances can an enema, recurrent douche, or vaginal injection be taken with water at any desired temperature and at the same time be medicated with any remedy desired. External pressure against the anal orifice is regulated at will; also the flushing of the integument about the anus and buttocks is easily accomplished before leaving the toilet seat.
Convenience.
This scientific device can be used without assistance. It has one feature moreover, that renders it unique among rectal appliances, namely that you may take a number of rapid injections without changing your seat. You may inject a small quantity of water (from eight to twelve ounces), and expel it immediately; then you may follow with a larger amount (from one to three pints), and expel that also, then in the same manner flush the colon. A complete internal bath may be effected in the same way by using three, four or more quarts of water. In this way, thorough depurating results may be obtained. The several preliminary injections of gradually increasing quantities of water free the lower bowel of feces, germs, and gases which otherwise might be forced by the flushing process backward into and along the colon. With the Internal Fountain Bath, unlike other syringes, it is not inconvenient to take preliminary injections before flushing the bowels. After the flushing the rectal and anal canals the bowels can be easily cleaned their entire length, as can also the integument about the anus and buttocks by letting the jet of water play on these parts to wash away any germs and other poisonous discharges. All the necessary movements of the anal point are easily made with the handle which projects between the limbs in front of the toilet seat.
Cleanliness.
The water reservoir is enameled white, both inside and out and free from poisonous substances. The enamel is not injured by the use of any germicidal remedies that may be placed in the water, or by the water being brought to a very high temperature to destroy bacterial poisons. Furthermore this enameled surface is easily cleaned, thus avoiding foulness of the reservoir from continued use. The glass medicine case and anal cone attached to the handle, as well as the anal point, are all detachable and easily cleaned, and the handle is of sufficient length to obviate soiling the hands and impregnating them with odors.
To bring away a quantity of feces does not exhaust the purpose of the enema. The intestinal sewer requires further cleaning from end to end, and the external parts around the anus as well. By playing a jet of water on the external anal region you finish the enema and avoid the very uncleanly practice of using “toilet paper” as a means of external cleansing. It is strange that otherwise cleanly people are content with such uncleanly treatment of these parts. They imagine that “toilet paper” will effectually remove the excrement and its attending odors. They would not think it sufficient thus to clean their hands if soiled by excrementitious matter. It is the old story, “out of sight, out of mind,” and of letting any make-shift in such cases answer; but the spirit of cleanliness is abroad in the land, and the Silent Club of the Cleanly is being formed through just such agencies as the Internal Fountain Bath. Many have doubtless longed for a better practice but did not know what to do. The “toilet paper” habit will pass with the once-a-day habit of stooling, the constipation habit, and the physic habit, for all four are uncleanly in the extreme.
Durability.
The enameled metal reservoir and the metal and hard-rubber parts of the handle ought, with care, to last a lifetime; the soft-rubber tube, if properly cared for, will be of service for a long time.
External Anal Pressure.
This is of very important assistance in flushing the colon, as it aids in preventing the return of the injected water, and thereby promotes its conveyance along the colon until it arrives at the surgically famous vermiform appendix. It is not strange that both ends of the large intestine—the anus and rectum and the appendix region—have kept the surgeons busy, and I may add the undertaker likewise. These two ends are of extraordinary concern, because they manifest intense symptoms and pathological consequences. Modern medical practice is the heroic treatment of symptoms and consequences and not patient search for causes of disease and sensible treatment of it, as explained in my treatise dealing with “Intestinal Ills,” as well as in the present volume.
Water Pressure.
Two or three gallons of water, suspended at the usual height of enemata appliance, affords quite enough pressure, especially when the outlet and tubing are amply large. The shut-off on the rubber tube enables the user to gauge the flow of water to a nicety.
Time Required.
The time required for taking an internal bath—that is, for a complete flushing of the bowels—will vary in individual cases. After removing the local deposits in and near the rectum by one or two rapid injections of very small quantities of water, two to four quarts are taken into the intestinal canal at one time, and this constitutes the enema proper. Now, many persons will find it advantageous to let the flushing water enter very slowly, taking from two to five minutes, or even more. With some, if the water is allowed to flow in very rapidly, the various segments of the rectum and colon may not readily accommodate themselves to the inflow, and will too soon make an expulsive effort, returning the water before it has dissolved the feces or united with them, thus defeating the object sought through the enema. With other persons, however, the flow may be as rapid as desired. The speed must be left to individual judgment and experience.
Temperature of Water for an Enema.
The chief purpose of an enema is to produce depuratory results; that is, to remove morbid matter from the bowels and then to cleanse them. To accomplish this effectively and at the same time to avoid exciting an increased flow of blood to the diseased gut, the water should be about the normal temperature of the body, which is about 98 1/2 degrees. Water too hot or too cold will aggravate the sensitive, inflamed surface; and, as it is this very inflammation that causes the abnormal action of the bowels for the relief of which the enema is taken, the temperature of the water is most important. If it range between 90 and 105 degrees it will do, for within those extremes it will not be likely to increase the existing chronic engorgement of the tissues. Under no circumstances should very hot or very cold water be used for the removal of fecal accumulation. Physicians so incompetent as to make a wrong diagnosis of the cause of chronic constipation and its numerous symptoms often prescribe a wrong treatment in the use of water. From two to ten minutes’ use of very hot or very cold water in cases of proctitis and colitis will only increase the chronic engorgement of the blood-vessels and tissues and increase the morbid symptoms. When water is applied to the mucous membrane anywhere throughout the body, I use it hot exclusively, as that temperature has then certain advantages over cold. In the chapters treating upon the different uses of hot water, I give the hydro-therapeutic action of such liquid on the tissues of the body.
Quantity of Water to be Used.
The quantity of water to be injected into the colon at one time must vary in each case and also on each occasion. In the beginning of its use and for some time following, a greater amount may be required than will be necessary when, with its continued use, a better action of the bowels becomes established.
In cases of chronic constipation and semi-constipation, the kidneys, lungs, mucous membrane, and skin eliminate a daily accumulation of feces from the system equal to two-thirds or three-fourths of the amount of normal feces. This accounts for the frequency of chronic disease of these organs. To establish a new régime in the mode of fecal and gaseous elimination requires much time and patience in the use of the enema. Nearly all persons can take the enema with comfort and satisfaction. Now and then, however, there is a person who finds it a little troublesome to inject over a quart of water at one time, while most persons can inject over four quarts without inconvenience. I would advise patience and perseverance on the part of those who find it irksome to inject a sufficient amount thoroughly to cleanse the colon, or the portion thereof involved in undue accumulation.
Enough water should be injected to bring away what would constitute the normal amount of feces to be passed at a regular stool. Gradually, as the practice is established by the use of the enema twice or thrice daily, it will be easy to determine the proper amount of feces to pass. And note this fact: it is just as easy to establish the habit of three evacuations in twenty-four hours as of two or one.
Whenever the amount of water injected proves sufficient at any time to bring away all the feces that should pass, it is not necessary at that sitting to repeat the dose, except it be for subsequent cleansing, as a sort of gargle. No possible harm can come from the generous use of the enema during a lifetime; indeed, its constant use will prolong life and make it more comfortable.
CHAPTER XII.
Benefits of the Inner Bath.
I speak from clinical observation with the use of various rectal and colon specula, of which I have over fifty. I have watched the progress of cases that were using the enema twice or thrice daily, and of cases that were also using the intestinal recurrent douche, which latter required an hour’s continuous application of hot water, and I know, therefore, whereof I speak when I affirm its salutary effect both on the local organs and on the general system.
Many that write about the use or abuse of the enema have never seen the mucous membrane of the rectum and colon. Most of what is written on the subject is worthless. The author of this book writes from the accumulated experience of daily examinations with specula for a period of over twenty-three years. Had he merely used his fingers or hand for making rectal examinations, or had he contented himself with prescribing for symptoms reported by the sufferer, his views and opinions as to the use and benefits of the internal bath would have been on a par with those that, by the old methods, make futile efforts in diagnosis and treatment.
Some good souls now and then become oversolicitous as to the matter they should pass when their bowels are already empty, and they feel alarmed if the enema fails to produce an evacuation. Such timid ones should remember that what they cannot accomplish at one time and with one attempt they may at the next, and that thus slowly the new order of fecal elimination will become established. It takes time and patience; but is this cause for apprehension when diagnosis, treatment, and means of relief are right? I claim that flushing of the colon is the best means for removal of the consequences of proctitis and colitis, and that it should be employed by all that have these chronic ailments. Let them get relief for the symptoms at once and in this rational way, after which let them seek scientific treatment for the ailments themselves; for, sooner or later, they will be compelled to seek it by the severe complications that will inevitably set in.