THE ENEMA AS A PERMANENT PRACTICE.
In the effort to restore the long-abused bowel to its normal functioning by the use of the enema and massage, there may be, in the beginning of such treatment, an exceptional case in which a mild laxative is indicated as the desirable thing, rather than that a furred tongue and base bodily feelings shall evidence too much foulness all the way up to the mouth.
The enema, of course, constitutes the chief means and mainstay of relief from obstipation of the bowels, and one by one the other aids are to be omitted. Moreover, when the time comes that the bowel is freed from the disease that occasioned the occlusion and obstipation,—that is to say, when the bowels evacuate themselves naturally three times a day,—then the enema itself may be omitted, or it may be continued without harm by those whose sense of cleanliness would induce them to keep up the practice in preference to the uncleanly habit of using toilet paper as a partial means toward cleanliness. Surely there is no harm in substituting a better habit for a worse one—one, moreover, that we should be ashamed to continue! As no one would think of cleaning his soiled fingers with toilet paper, as already said, so no one with any real sense of decency will continue the attempt to clean his anal orifice with such material when he has learned a better and more effective way. Likewise, after having learned the rational mode of relieving the surcharged bowels, no wise person will continue the use of physic, coarse food, gymnastic exercises, and other futile and foolish practices as remedial measures for intestinal ailments.
No one suffering from proctitis and colitis can have a clean and healthy sigmoid flexure and rectum unless these be kept clean by the regular use, three times a day, of the enema. From the day when the disease invades these parts there is and will continue to be a clogged, plastered, or incrusted passage for more or less of the entire length of the colon. This must be so in the nature of things, since these organs are unable to perform their functions while the disease is present. Just think of possessing a filthy, congested intestinal canal, without one day of real cleanliness for twenty, forty, sixty, or more years! It is not the easiest thing in the world to cleanse this channel even by the use of the enema; for the ancient contents refuse dislodgment even after repeated flushings, and it is only after many days of persistent and patient irrigation that the intestines are freed.
Some persons are apprehensive as to the quantity of water the large intestine will hold with safety. Let me reassure them. It is capable of holding about three gallons without too great distention. One-third of this amount, however, is quite sufficient to bring away the accumulated fecal mass, and in many cases a much smaller amount will answer the purpose—especially when, as advised, it is used two or three times within twenty-four hours. After a thorough evacuation, water should be injected one or more times until it returns clear and free from fragments of feces.
If I were asked to name the greatest curse parents could inflict upon their helpless offspring, I would say fecal auto-intoxication. A large volume could be written on the subject, and I trust the hints here given will lead to discussion of this grave matter.
CHAPTER XIII.
Objections to the Use of the Enema Answered.
The privilege of raising objections belongs to the ignorant as well as to the intelligent. But the objector is under as great obligations to state his reasons as the advocate.
The first plausible objection to the use of the enema is that it is not natural.
Admitting this charge, I would say that, inasmuch as proctitis, colitis, and constipation are unnatural, the use of a preternatural or, in other words, a rational means to overcome the consequences of these diseases is imperative. The enema is such a means.
Can any one that suffers from proctitis, etc., have a natural stool? Unnatural conditions require preternatural aids, as we all know. The injected water dilates the constricted portion of the gut and arouses a revulsive impulse to expel the invading water. In obeying this impulse, the imprisoned feces, gases, etc., are ejected with the water.
It may be unnatural to put water into the rectum, etc., but once there its expulsion from healthy bowels would be quite natural. No natural action can be expected from unhealthy bowels; they do the best they can under the circumstances. Eyeglasses, false teeth, crutches, etc., are unnatural but invaluable aids, but no more so than is the enema as a means of relief from overloaded bowels. The enema, moreover, be it noted, not only aids the system by relieving it of its load: it cleanses and soothes an organ that must keep at work and perform its function even when invaded by disease.
Surely it is unhygienic and irrational to ignore the valuable service of the enema in cases in which the bowels are in an unnatural condition.
The second objection is that the water will wash away the mucus from the mucous membrane of the bowels and leave them dry and parched and thus apt to crack and break in two. I would remind the objector that, since about seventy-five per cent. of the normal feces is water, it seems strange that so great a quantity of water in contact with the mucous surface of the bowels should not also cause dryness.
The integument of the body and that of the mucous membrane are similar in structure, yet who ever had a fear of producing dryness of the skin by much application of water? The mucous membrane is simply the skin turned inward; and since it is much more vascular it is less apt to become dry—if, indeed, its dryness were at all possible. The objector should also remember that the body is composed of over eighty per cent. of water—an organism not to be made dry or parched by the application of water to the skin or to the mucous membrane two or three times a day.
The mucous membrane of the lower bowel is not unlike that of the mouth, throat, or stomach. Do you realize how often the upper end of the intestinal canal is washed or bathed daily with liquids,—soft and hard drinks, hot and cold,—especially by those who have formed the drink habit instead of the enema habit? They have no fear of drying the mucous membrane thereby; but, if you can instill this fear, they will increase the quantity with pleasure!
This second objection, being the result of too vivid an imagination and too little reflection, is a very nonsensical objection indeed.
A third objection is that if you begin the use of the enema you will have to continue its use; you can’t stop, and, lo and behold! the enema habit is formed,—a new habit in addition to the many habits civilized man is already carrying: the constipated habit, the physic habit, the sand, bran, sawdust-food habit, the muscular peristaltic habit, etc.,—and with all these habits the poor victim of proctitis and intestinal foulness wonders that he is alive.
Usually the first symptom of proctitis is constipation, and for relief the enema habit should be formed and continued while the constipation remains. When the proper means are found to remove the intestinal inflammation—proctitis and colitis—then the constipation will disappear, and with its disappearance the enema habit can be discontinued. But let it be well noted that the enema is itself an aid in curing the cause, an aid superior to any other at our command. A cleanly habit ought not to be an objectionable one, especially in cases in which it is most needed to prevent toxic substances from entering the system.
A fourth objection is that after taking the first enema the constipation is worse.
With many persons a certain amount of undue accumulation of feces will excite a sufficient muscular effort of the gut to force the dried mass through the proctitis- and colitis-strictured bowels. This unnatural effort may occur once a day or once in two or three days, and has doubtless been a habit of many years’ duration.
To introduce a new order of conduct on the part of the bowels requires time. If the bowels have been in the habit of expelling feces in the morning, and an enema were taken the night before, there might be no desire to stool the next morning because of the fact that the bulk or accumulated mass of excrement was no longer there to create a vigorous call or impulse for defecation.
But we have found the extent of local damage and reflex injury to the organs, and more especially we have found the constant absorption of poisons into the system, due to the presence of feces. It is for this reason that the elimination of feces twice or thrice in twenty-four hours is advised. The condition for which an enema is used is disturbing and poisoning to the system. It is, therefore, a most unnatural condition. What is more rational, then, than to employ an “unnatural” yet not harmful means to bring about a more normal condition, one free from poisoning and irritating consequences?
A fifth objection is made by those who have as a symptom of proctitis a large development of pile tumors or hemorrhoids (distended mucous membrane). The objection is that at times these tumors or sacs prolapse very freely during the act of expelling the injected water. But this prolapse occurs in many cases whether water is used or not.
A certain amount of anal irritation caused by the passage of feces occurs, causing contraction of the circular muscular tissue that forms the anal and rectal canal, also of the longitudinal muscular bands and the levator muscles of the organs. The enema lessens or entirely diminishes the irritation of passing feces, and the natural result is that the serum-filled sacs called piles and the tissue loosened by the inflammatory product would more readily prolapse during the act of defecating. It is simply a choice between irritation of the stool keeping the tissue up and no irritation permitting a prolapse.
Of course, if there be no expulsion of feces and water the stretched or dilated sacs may keep their places in the rectum. And then again the enema may be used for quite a period, when all at once a large prolapse of sacculated mucous membrane occurs, and the enema is thought to be the cause of it. That this is not the cause, let it be remembered that in all cases of proctitis the chronic inflammation is apt to become subacute or acute, and that this intense engorgement and enlargement of the tissue with blood and the increased fever in the parts often result in prolapse at any time, especially at times of convulsive effort at evacuation.
Whatever follows the proper use of an enema, even though what follows be annoying, should not be blamed on the enema, for its action is most kindly, lessening, as it does, the irritation that otherwise would be more severe when the feces pass through a disease-constricted canal.
The sixth objection is that the use of the enema will weaken the bowels, which are already too “weak” to expel their contents. “Atony, paralysis, fatty degeneration of the gut, are bad enough,” say these objectors, “without having an enema increase their uselessness.” Diagnosis wrong and objection groundless!
Distend and contract an organ for a short time two or three times a day, and it will gain in strength from the exercise. Every one knows that this is the case. What more gentle means of exercising the large intestine than by the enema?
But the truth of the matter is, that in all cases of proctitis and constipation the diseased portion of the gut is too active in its muscular movements, contracting spasmodically, as it does, at even the suggestion or suspicion of feces near it. Every impulse of the bowels above the constricted section to force the feces down through the closed bore only intensifies the spasmodic action and increases the muscular obstruction, compelling the victim to resort to some one of the many drastic means of relief.
The enema does no more than kindly to dilate the constricted region, which, when dilated, evokes a harmonious concerted action of all the nerves and muscles to pass along and down the burden of feces, which, without the aid of a flood of water, they had been incapable of moving, and would have had to leave to poison the system.
The seventh objection is quite naïve: “Inasmuch as the Indians of this country had no use for the enema, why should we resort to it?”
The all-sufficient answer to this objection is that the Indians lived a natural life, while ours is artificial. Much can be said on this point, but the reader is surely rational enough to follow out the distinction suggested. Our lives are much more important than were the lives of the aborigines of this country, and our “demands of Nature” are more exigent. If your life is of no greater value than theirs, for leisure’s sake don’t use the enema! You will be taking too much trouble. It really should seem that the cleanliness of the skin and mucous membrane, the care we take of our bodies, is an indication and measure of our sense of refinement. An ancient Scripture hath it: “Let those that are filthy, be filthy still.” It all depends upon how you wish to be classed—with the filthy or the cleanly.
The eighth objection to be noted is the fear of “poking things” (points of instruments) “into the rectum.”
This looks like a real objection. No healthy, nor even unhealthy, organ, for that matter, should be “abused.” And what seems more likely to cause it trouble than to poke a hard- or soft-rubber point or tube through its vent in opposition to its bent or inclination? Still, the muscles of the vent are strong, and they soon accommodate themselves to the practice. Their slight disinclination is not to be considered alongside of the relief and cure you effectuate by the use of the enema.
Have no fear that the point will occasion disease when intelligently used. Always see to it that the point is scrupulously clean. Those made of hard rubber or metal can be kept so without effort. Soft-rubber points are always foul and dangerous, especially after they are used a few times. A good rule is never to put a point higher in the bowel than is absolutely necessary.
The ninth objection seems serious. It is that in taking an enema the water escaping from the syringe point will injure the mucous membrane where the jet strikes. But on examination this objection falls to the ground; for it stands to reason the jet cannot directly hit the surface for more than a moment. Immediately thereafter the accumulation of water will force the jet to spend its energy on the increasing volume, to lift it out of the way so that the continuous inflow may find room.
But even were it possible for the jet to strike a definite section of the mucous membrane during the taking of the enema, it could do no harm provided the water be at the proper temperature. And this is true even if a hydrant pressure be used. Not a few persons use the hydrant pressure of their houses in taking an enema. For a really successful flushing of the colon a considerable pressure is requisite to force the volume up and along a distance of five feet, especially when sitting upright. But it is folly to use a long syringe point, since it is like introducing one canal into another for the purpose of cleansing it. Therefore, have no fear from the use of proper syringe points; the jet of water will not hurt the mucous membrane. My professional brethren at least ought to know that the idea of such harm is sheer nonsense.
The tenth objection to using an enema is in being obliged to use it from the fact of having such a disease as chronic inflammation of the rectum and colon. Every victim hates to be compelled to do a thing; and the victim of proctitis and colitis is no exception to the rule. In fact, he is beginning to realize that unless he uses it his system will be poisoned by the absorption of the sewage waste. Let the victim object to the disease that necessitates the use of the enema, and all will shortly be well. Then this objection to the use of the enema will indeed be the most important of all.
The eleventh objection, and the most ridiculous of all, is that it requires too much time to take the enema twice or thrice daily.
I lose all patience with persons urging this objection. Those that have little or no system with their daily duties seldom have time to do anything of importance. They suffer from “haphazarditis,” a very difficult disease to cure, and they are in many cases hopeless. Usually they are an uncleanly lot of people, full of good intentions, but their intentions, though taken often, seldom operate as an antidote to foulness. Their one sigh the livelong day is: “Oh, could we be like birds that can stool while on the wing or on foot!” This feat of time-saving being hardly possible in the present incarnation and order of society, they content themselves with making a storehouse out of the intestinal canal for an indefinite length of time as they concern themselves with external affairs of work or sport. A sorry lot they are, indeed, when they are laid up for repairs! Many doctors, I am sorry to say, encourage, with a chuckle, this foolish practice. “Any time to stool you can manage to get, so that you stool at least once a day, or once in every two or three days; stool when it is normal for you to do so.” This criminal advice just suits the sleepy, the lazy, or the “awfully busy.”
The American habit of doing things en masse, of handling things in large quantities or in bulk, has something to do with their don’t-care constipated habit. Small evacuations two or three times a day seem too much like small business, which of course is a waste of precious time. Wholesaling, laziness, lack of system, hurry, are the cause of good-for-nothingness of body and mind. It should never be too much trouble to restore the lost impulse for stooling twice or thrice daily.
Is it a small matter to have the main sewer of a city partly or entirely closed, or the main sewer pipe of a dwelling stopped up? Think of the dire results, notwithstanding that the windows and doors remain wide open! The Board of Health would soon deal with the negligent official or landlord. With very few exceptions, “civilized” men, women, and children are negligent and niggardly caretakers of the human dwelling-place—the marvelous body of man. “Lack of time,” “haven’t the time,” or “no time,” is the excuse they give themselves and others.
Notwithstanding the numberless victims around them, none of these negligent and niggardly ones seem to get alarmed until the secondary symptoms—such as indigestion, gout, rheumatism, or disease of some vital organ—are sufficiently annoying to demand attention. But I have full faith in humanity. Man does the best he knows how—as a general rule. But often he doesn’t know how; he needs enlightening.
The hints I have given will, I am confident, be considered and acted upon by all to whose attention they are brought, for, by acting upon them, normal bodies and minds will result, and blessings attained heretofore considered impossible. Normal health depends on right doing and being. Eternal vigilance is the price to be paid for the attainment and maintenance of the goal of normal life and progress. Eliminate all waste material from the body and all shifty vermin from the mind, and the millennium for all things in the universe will soon dawn.
Fig. 24.
NIAGARA FOUNTAIN SYRINGE.
(Patented Nov. 14, 1905.)
The above illustration represents the Niagara Fountain Syringe, to which can be attached the enema handle, Fig. [22], Fig. [23], or the combined enema and recurrent douche handle, Fig. [21], page 91. The Niagara Fountain Syringe is made of soft rubber and holds about two gallons of water, and is very handy when traveling or in need of a hot-water bottle.
CHAPTER XIV.
Lame Back.
The manufacturers of various compounds advertised in our daily newspapers and on the billboards usually select very common ailments or symptoms on which to exploit the merits of their product. They make no distinction between a disease and its symptoms; and why should they, when their sole object is to sell their goods?
Lame back is a common weakness of that portion of the spine usually spoken of as the “small of the back.” As a general rule, it is an indication of some pelvic disease involving the anus, rectum, colon, bladder, or uterus. Those who suffer from disease of one or more of the pelvic organs will have at times reminders that they have a lame, weak, or “dead” spot at the “small of the back” or a little lower down on the spine.
As an illustration, a current advertisement reads as follows: “Weak Backs! If you happen to be one of those unfortunate people with a weak, lame, tired, aching back, it is time you were finding out about ——.” Then the advertisement proceeds to tell how to put on a plaster or a liniment, or rub the back for a week or two with the hands. Another enterprising wonder-worker asks: “Do you get up with a lame back? Thousands of women have kidney trouble and never suspect it.” “Lifted from the depths of despair by ——” etc. Now, this may be seriously alarming to actual sufferers from lame back.
Fig. 19.
Showing the distribution of the sympathetic nerve about the rectum. 22, the rectum; 23, the bladder; 26, the kidney; 20, the rectal plexus; 19, the vesicle plexus; 18, the sacral ganglia; 21, the lumbar plexus; the lumbar ganglia; 16, the mesenteric plexus; 15, the solar plexus; 27, the aorta.
The kidneys are located several inches above the region called the “small of the back”; therefore, a difficulty in this region does not necessarily indicate disease of the kidneys. Those who suffer from the symptoms described—lame, weak, hot, dead spots, lumbago, rheumatism, etc.—at this portion of the spine may suspect that some of the organs in what is called the pelvic cavity are causing them. The spinal nerves (lumbar nerves) on leaving the “small of the back” and proceeding lower down are distributed to the anus, rectum, bladder, uterus, etc., and when one or more of these organs are diseased the victim will have some of the symptoms in the portion of the back mentioned above. The earlier indications of a disease are usually localized, but, as the malady itself persists indefinitely, both the sufferer and his physician are often deceived as to the producing cause of the varying symptoms manifesting throughout the body.
In this brief chapter I will confine myself to the diseases of the anus, rectum, and colon, as causing so much annoyance from the symptoms enumerated at or below the “small of the back.” The most common ailment that afflicts mankind is chronic catarrhal inflammation of the anus, rectum, and colon. The disease invades not only the mucous membrane but the whole bowel structure, and the nerves report from the seat of the trouble up to where they enter the spinal column—a region that should be called the porous-plaster region rather than the “small of the back.”
The chronic inflammation involving eight to ten inches of the lower portion of the intestinal canal, like all other diseases, has its alternating periods of quietude and excitement; and the negligent sufferer must count on having “stitches in the back,”—cold in the back, lumbago, rheumatism, sciatica, etc., as they are usually called for want of a definite idea as to the cause of the annoying symptoms. The physician consulted usually agrees with the sufferer’s diagnosis, and coincides with the application of bands, porous plasters, liniments, etc.—which may allay the neuralgic symptoms to some extent.
The reader is so familiar with illustrations in the newspapers and on bill-boards of a man with a weak or lame back that it is unnecessary here to take up space with a pen picture descriptive of the symptoms and attitudes of a sufferer.
Those who have had occasion to acquire the warm-band, the rubbing with liniment, and the plaster habits, had better direct their attention and remedies to the cause of the symptoms. One frequent source of all these back symptoms is chronic inflammation of the anus, rectum, and colon, with more or less ulceration accompanying it. In the female, disease of the uterus complicates the painful symptoms. Usually among the first indications of this disease is some degree of constipation, which in time is followed by local symptoms known as piles, fissure, itching tabs, clot of blood in a vein, abscess, etc. Constipation is a prolific cause of indigestion, biliousness, flatulency, loss of appetite, self-poisoning, anemia, emaciation, uric acid, neuralgia in various parts of the system, catarrhal inflammation of the mucous membrane of one or more organs, and many other symptoms.
A diseased organ is a constant source of unconscious and conscious irritation to the sufferer. If the victim can tolerate the trouble he seldom seeks treatment. “I will not bother with it as long as it is no worse,” he says. At times, however, the symptoms become very annoying, and measures are taken to allay them. During the long interval of “better and worse” effects the malady is becoming more deeply seated, and the symptoms eventually appear in all parts of the body.
As a rule, the majority of victims put off treatment until a protracted period of extreme suffering or the fear of a fatal ending compels them to consult a physician—who labors at a great disadvantage in seeking to effect a cure on account of the long neglect.
Severe symptoms located at the porous-plaster region of the spine, when brought on by disease of the lower bowel, usually indicate an acute stage of chronic inflammation and retention of feces and gases in the sigmoid flexure and colon. Acute or subacute inflammation and fever and pressure of the feces are more than the long-abused nerves can endure, and severe pain is the result.
Then the sufferer has something to say about his back, and what is best to do for it.
The logical course is to unload the bowels of feces and gases by a generous use of the enema and to treat the diseased tissues kindly. The symptoms will soon disappear when the cause is removed.
CHAPTER XV.
Uric Acid.
A society leader, in speaking of her ills to a woman friend, said: “I am ‘lousy’ with uric acid.” From infancy to old age, mankind is more or less filled with uric acid and other poisons—the result of a foul intestinal canal. Poisoned blood is a common symptom, and it arises from an almost universal cause—chronic constipation. So universal is constipation of the bowels in illness that it is the first duty of a physician to prescribe some remedy to unload them.
It is said that a Boston doctor, whose practice was largely among the wealthy classes, used to say: “There is no use in physicians pretending to be anything else—they always smell of rhubarb.” And in an address to a class of medical students an old doctor once said that he and his associate practitioners had found that calomel and opium filled every want in the ills they were called upon to treat.
For ages all mankind has striven to find a remedy effectively to clean the intestinal tract. Pills, powders, tablets, wafers, suppositories, salts, teas, candies, and syrups have been administered—all with that sole purpose. Efforts have been made to accomplish this object by utilizing every possible device and contrivance known to human ingenuity. Calisthenics, massage, physical-culture exercise, mental therapy, horseback riding, “dieting,” fasting—these are some of the many means resorted to in order to “sterilize” the foul, constipated intestinal canal.
Albeit that the cleaning of the digestive apparatus in the case of a sick person is regarded as a necessary first help the world over, few persons realize that it is of equal importance in the case of a seemingly healthy person. Is it not a fair inference, therefore, that where a purgative—such as calomel, or one of the innumerable similarly-acting medicines—temporarily relieves a patient’s symptoms, the timely precaution of keeping the intestinal canal and system clean would prevent a person from getting ill?
The reader may think that, in these observations, I have wandered away from my text, but, as uric acid is the symptom of a combination and complication of disorders of which constipation is the secondary cause, the connection and sequence of my remarks are evident. It is safe for a layman to assume that, where so many diverse schemes are employed to relieve symptoms, the diagnosis is wrong—also the treatment.
A few of the many primary symptoms of proctitis and colitis are constipation, diarrhea, indigestion, biliousness, flatulency, putrefaction, and gaseous and bacterial poisons—a foul gastro-intestinal canal, through which there are daily absorbed from the bowels two-thirds to three-fourths of the excrementitious matter into the system. With these facts before us we need not be astonished at the statement that nine-tenths of human ills have their origin in the digestive apparatus.
Among the secondary symptoms of proctitis and colitis is poisoned blood—anemia, which is usually followed by impaired nutrition and emaciation or obesity. Along with the changes in the blood and nutrition there occurs lodgment or deposit of salts, acids, etc., in the various organs and tissues of the body. Almost every one is familiar with gouty deposits in the finger joints and other joints of the body. If the deposits occur in the muscular tissue it is called rheumatism. If in the urinary organs we have gravel, Bright’s disease, diabetes, cystitis, irritation of the neck of the bladder, frequent calls to urinate; and the urine, scanty and high-colored, on cooling reveals a crystalline deposit. The principal mineral substances of the urine are as follows—of which one or more may become poisonous: chloride of potassium, chloride of calcium, chloride of magnesium, chloride of sodium, sulphate of potassium, sulphate of soda, sulphate of magnesia, phosphate of soda, and phosphate of potassium.
The liver gets its share of the foul substances generated in the intestinal canal, which cause congestion of the organ. Toxic biliary salts and acids are present. The deposit may form gall-stones, and jaundice and many other annoying symptoms may occur. The system is simply a filter, or blotter, that lets the poisonous contents of the intestinal canal pass through and out; but all the organs and tissues, during the process, retain many of the foreign toxic substances, which overtax (and frequently destroy) their functions with work that Nature never intended they should do. Think of it—all the organs and tissues around the intestinal canal serving as fecal vents! Deposits cause irritation of nerve centers and nerve cells precisely as in fibrous and cartilaginous tissues; and we speak of the symptoms as spinal irritation, hysteria, chorea, lumbago, sciatica, nervous tension, headache, irritability, despondency, melancholia, insomnia, dementia, etc. From the disturbance of the voluntary and involuntary nerves we have irregular circulation of the blood from disturbed heart action, cold hands and feet, and flushing of the face alternating with pallor, vertigo, and dizziness. The capillary circulation becomes obstructed with crystallized bodies, as chunks of ice obstruct a stream of water.
Catarrhal inflammation of the mucous membrane is set up in various parts of the body by the deposits in the membrane and the abnormal means of their elimination through it. The skin of the body, which is the mucous membrane turned outward, suffers likewise from diseases having numerous names.
Doctors have always expressed a poor opinion of the liver because it did not keep the bowels sweet and clean, and they mistakenly though honestly called it “the lazy liver,” “the torpid liver,” “hepatic insufficiency,” “atony of the liver,” “sluggish liver,” “hepatic torpor,” “fatty liver,” etc.; and the poor victim of proctitis and colitis was glad he had consulted the doctor and learned “just the cause” of his internal troubles—and could suffer on more reconciled to his malady since he knew its exact name and could continue to take with regularity one or more of the many powerful liver exciters, to stimulate activity in the liver and bowels once every day or two, if possible. By some strange psychological or other influence of late years, however, physicians have turned their attention to the “lazy kidneys,” and now it is difficult to decide which they are purging the most—the liver or the kidneys. At any rate, they both must be violently excited at the same time, and we hear “lithia” mentioned, or “laxative salts of lithia,” every time uric acid is thought of. Stimulate the lazy liver and kidneys, and with abundant salts dissolve out of the tissues and blood the precipitated deposits; this is the fashion of the times.
Diagnosis wrong and treatment harmful! Water is by far the best agent to dissolve salt compounds, to dilute acids, or to remove filth. It is also the best means of soothing and relieving the long irritated and inflamed tissues and organs, that have had from two-thirds to three-fourths of the daily fecal mass thrust upon them and collected in them, when they are called torpid, lazy, and whipped up unmercifully by bile and urine bouncers. We ourselves would be very torpid, sluggish, or “lazy” if called upon to do the work of two persons under such embarrassing physiological circumstances as being filled with toxic substances, or thoroughly auto-intoxicated.
When will common sense take the place of theories founded on guesswork, and some thorough washing out by plain or distilled water be done, internally as well as externally? After such an operation some specific remedy may be taken, if demanded, with the certainty of permanent good resulting. But remember, your aqueous body, held in its form by the skin and mucous membrane, needs a well-nigh constant stream of pure water flowing through it to keep it fresh and clean.
The diagnostic error of mistaking effect for cause, however, is frequently made. Patients are treated for one of the secondary symptoms—say uric acid—with a view to abate that disorder and restore health, when treatment for the specific cause of constipation—proctitis (inflammation of the anus and rectum)—would restore the patient to his normal vigor. Pale, anemic sufferers from constipation are often told that the restoration of their blood to its normal state will effect a complete cure. No idea could be further amiss, for if the poisoned victims take coal oil, fish oil, malt compounds, iron, etc., as tonics, into a disordered stomach and unclean bowels, how can anything more than imaginary relief be obtained? Is it not evident that the chief disorder, proctitis, the main cause of the trouble, has in no way been reached?
In other complications arising from constipation, a favorite diagnosis is one of the secondary symptoms—“atony” of the bowels, liver, or kidneys. In these cases nux vomica and various poisonous compounds are given, but here also it stands to reason that the administering of remedies for symptoms cannot effect a cure of a chronic local disease of the anus, rectum, or colon. Then, again, by way of variety, a diagnosis of “uric acid” is made for which irritant drugs are administered to increase the eliminating or excretory action of the bowels and kidneys. It is utter folly and absurdity to attempt the cleansing of the intestinal tract by laxatives, cathartics, purgatives, exercise, etc., and to make the kidneys and liver, overtaxed from foul bowel products, do still more work by giving medicines to increase the urinal and biliary secretions.
It does not require a knowledge of the principles of physiology and pathology to know that no sufferer from chronic constipation can be permanently benefited if any or all of the secondary symptoms already noted be treated with the usual list of drugs and the cause ignored.
Much stress is laid upon the quantity and quality of food consumed by most people, and many generalizers attribute chronic constipation, uric acid, etc., to this very thing. Surely the average person knows that too much or too little food taken at regular intervals is not conducive to good health—a view that I have found borne out by a large majority of my patients, who rarely overstepped the limits and knew when a diminution in the supply of nourishment was advisable.
In the last analysis, the principal cause of ill health is lack of elimination of the excretory organs. When the bowels fail to do their proper work, the functions of the other organs of the body become correspondingly affected and impaired, and general debility ensues.
In previous chapters, also in my book, Intestinal Ills, I have made plain the causes contributing to chronic constipation and the use of enemas and their origin. Prehension and elimination are two subjects that are vital to the welfare of man. If the eliminating power of the intestinal canal is normally active, the fortunate individual may eat abundantly, or really in excess of the requirements of the system, and still escape any ill effects, such as indigestion, biliousness, acid in the urine, etc. The hearty consumer of food whose bowels eliminate properly may suffer a loss of appetite, but it will not be accompanied with foulness of the digestive apparatus.
When all the organs of the body perform their functions in a normal manner, no part of the structure is in immediate need of repair. Every organ whose function consists in building tissues, muscles, or some other part of the body, having a sufficient supply of reserve nutriment on hand, makes known this state throughout the organism; hence there is no craving for food, no appetite, although the tongue, stomach, and intestines are in a normal condition. In this state of surplus of nourishment the person may omit a few meals or partake sparingly until the expenditure is equal to the income. But such physiological happiness is not for the person whose intestinal canal and system are clogged and foul from undue retention of excrementitious material, causing no desire for food, while all the atomic builders of the body are wanting nourishment and protesting through the nervous system against their impoverished condition.
Sufferers from self-poisoning, as described in this chapter, should irrigate the system thoroughly by frequent drinking and by copious injections of water into the bowels. The action of the enema if properly given and the drinking of water that is pure or distilled increase the quantity of urine and diminish the renal congestion, while increasing the eliminative action of the skin.
Irrigation of the bowels for fifty minutes or more with hot water (120 to 125 degrees) increases the action of the kidneys. Hot irrigation (125 to 135 degrees) is especially recommended to increase the discharge of urine and the action of the skin, and should be continued for sixty minutes or more. The Intestinal Recurrent Douche, described in a subsequent chapter, is an excellent instrument for the employment of hot water to produce diuresis and diaphoresis.
The Chemung Spring Water and Clynta Double-Distilled Water, sold in New York, are excellent drinking waters and can be obtained at a moderate price.
CHAPTER XVI.
Rational Sanitation and Hygiene.
We, all of us, like to use things; indulgence is enjoyable, but it generally ends with the day. Few of us “take thought of the morrow.” Neglecting, as we do, the instruments of use, their availability for permanent subservience to our wants steadily diminishes, becoming finally lost. Is it that we do not know any better, or is it that we are really so intoxicated with the Present that we simply ignore the well-known claims of the Permanent? Whatever the explanation may be, it is nevertheless passing strange that little or no care is bestowed on either our external or internal servitors, instruments, or organs, which otherwise are ever ready to keep us well filled with the pure wine of joy. Perhaps it is that many of us find Nature so lavish in supplying us with the means of joy that we are naturally equally lavish in wasting them. True economy—that is, the conserving of means for their effective use—is yet to be learned by man. Especially is this the case with our interior means, our flesh, blood, nerves, vital force, etc. Nature seems so ready to recoup and renew the organic loss incurred by our use or indulgence—recuperation seems so easy—that we simply grow careless, reckless, prodigal, and before we are fairly aware of it the disintegrative process gains an ascendency over the restorative, and thenceforward our time will be spent in endeavoring to cure what might have been kept whole or well.
Nor is it an organ of the body here and there that we neglect or abuse; it is more especially the entire system of organs called “the body.” The body is the organ of man’s spirit. We give no heed to its tones; perhaps we have never caught its rhythm; certain it is that when but a short time in our perverted hands its chords are more or less jangled, and a minor part is played in the grand symphony of life.
The organ of man’s spirit! How rational, nay, how necessary, it would seem to be to keep that instrument keyed to its perfect work!
But the ordinary denizen of civilization has a most ridiculous ideal of physical capability, namely, that the savage—a being altogether “physical”—was able to retain a healthy body till ripe old age without attention either to sanitary surroundings or to the hygienic functioning of his system of organs. The “civilizee’s” fancy picture of the noble savage is not based upon verifiable fact. It is true that we have a few attractive myths concerning savages that had survived appalling hardship; but we are just learning of the innumerable host that have perished periodically of various contagious diseases, and of the countless number (infants, youths, and adults) that have suffered from all sorts of ailments. Alas! how little we know—or, for that matter, how little we seem to care—of the great multitude of “civilized” fellow-creatures whose lives are all jangled and out of tune through subjection to the many ills that flesh seems heir to; ills that have arisen through either ignorance or the voluntary ignoring of the light of accessible knowledge!
In another aspect the human race is like an army that concerns itself with its immediate and imperative duties and has no time or thought to bestow on those that fall out of the ranks. But slaves to stern duty offend against Nature’s normality as do slaves to desire; and the former little suspect that their retirement also is near at hand. In health we seldom or never think of the conditions for the maintenance of health. That these conditions should receive our prime attention is obvious when we contemplate for a moment (1) our race of invalids, and (2) the growing unsanitary condition of modern industrialism, involving, as industrialism perforce must, the unsanitary life of the factory, workshop, office, and hothouse home.
Again, with the advance of high-pressure civilization and culture human beings are developing a more highly sensitive physical organism, pitched to finer issues. How urgent the necessity for a greater safeguarding of that organism!
If it be claimed that many of us do live up to our knowledge of health conditions, and that we are notwithstanding unwell, I would answer that our knowledge now is very disconnected, and that when the time shall come that our itemistic information shall have coalesced and formed a system of principles, we will then have trustworthy rules for the acquisition of health habits and become completely normal physical beings. At present most of us are intemperate in one or more ways. We eat too much or too little—too rich or too poor food. So it is with our drinking, our sleeping, our sporting, our enjoyment of this or that excitement—the quantity or the quality of each of these is not well adapted or proportioned to the conditions of normality.
Let me offer the health-seeker a few indications of the sanitary and hygienic requirements demanded by Nature’s normality. In our family and household life, to carry into execution daily hygienic measures, it is essential that we have ample, accessible conveniences for the necessary ablution of the body, externally and internally. How extremely rare it is, however, that bath-tubs and water-closets are found in sufficient quantity and suitable quality in our apartments. As household fixtures they are usually about as scarce as hens’ teeth.
In New York City a house with from eight to sixteen persons is restricted to the use of one water-closet and one bath-tub. On these (and a laundry and servants’ privy in the basement) there is the tax of ten dollars a year. Now, should that rare human product, an enlightened and humane owner, put in eight more bath-tubs and water-closets for the proper accommodation of his sixteen guests, so that each suite of sleeping apartments should have its appropriate conveniences, he would have to pay an additional tax of forty dollars a year. Is this tax levied with the connivance of the Board of Health? It would seem so, since no protest from that august body has ever been heard within the memory of the oldest inhabitant. Indeed, the suspicion is not at all unwarranted that if the masses were less constipated and better washed they would have less use for the doctors, and that, therefore, it is not well to encourage undue sanitation and hygiene.
It must be, too, that the Department of Water Supply has figured it out quite beautifully that a saving will be insured in the amount of water consumed by sixteen persons if they be restricted to one bath-tub and one water-closet; otherwise forty dollars a year would not be charged for eight additional tubs and closets for the use of the same number of persons. Listen to a sample of their logic: “Sixteen persons with eight additional bath-tubs and water-closets would use more water than if they were restricted to one of each—hence the additional tax. We don’t care a continental whether these human beings are clean externally or internally; that’s not our lookout. But we do care that they shouldn’t use more water than just so much, see!”
And does the august Board of Health raise the least objection to this sort of logic? None whatever.
Professor C. S. Smith states that, out of 255,000 families in tenement-houses in the city of New York, only 306 had access to bath-tubs in their own homes in 1894. In 1897 one city block containing 904 families did not have a single bath-tub.
Paradoxical as it may seem, there is, notwithstanding the appropriation every year for the New York City Board of Health of over one million dollars, a prohibitive tax on bath-tubs and water-closets—that is, on cleanliness—prohibitive on all homes except those of the wealthy. Is it to be wondered at that contagious diseases are prevalent, especially during the winter months, and that we have so many acute and chronic maladies?
Let me make a suggestion here for the serious consideration of our city fathers: Reduce the appropriation for the Board of Health to two hundred thousand and give the other eight hundred thousand to the Department of Water Supply, so as to abolish the tax on water-closets and bath-tubs. If every citizen of New York could have all the water he needed for cleanliness and comfort, there would be little excuse for the existence of such a body as the Board of Health; its existence would then be more honorable than onerous. Furthermore, the city, as a corporate body, should manufacture bath-tubs and water-closets, and furnish them at cost. Thus would it insure a great stride toward the health of its own citizens. When the disease-producing microbe becomes scarce, the occupation of the Health Board pathologist will be gone. Hold! Could he not devote his time profitably to studying the habits of health-producing microbes—for there are such? Microbes are absolutely necessary for higher forms of existence, it being now well known that some microbes are destructive or pathological and that others are constructive or physiological. Is it not much wiser to spend our millions of dollars for the prevention of disease than for quarantining it? Inducing, and even compelling, people to be clean is a far better policy than to compel them to be vaccinated.
Now, we pay the Board of Health many thousands of dollars a year simply for making cultures of disease-producing bacteria so that antidotes may be found. The pictures and history of these bacteria are published in many large volumes, costing the city several hundred thousand dollars a year. Scientific as this practice undoubtedly is, it is very expensive—and needless.
Every year thousands of children and invalids of New York receive improper nourishment, or are made positively sick, on milk that is either foul, stale, or ready to sour; and every summer thousands of children die from complaints traceable to this source. Swill milk is one of the great generators of disease-producing germs to which all sorts of “complaints” are due. Does the Board of Health care a fig for the generator? No; the Board is absorbed in watching the antics of the germs! Mighty intellects are searching for malignant, multitudinous mites. Yet there are just a few mites of common sense in existence, which if encouraged will breed quite as fast as the sinister ones. Indeed, there must be one or two at work in myself, for I seem to be urged to say that if our City and State Boards of Health should see to it that our cows are kept clean and healthy, our milk clean and pure, our cans clean and well scoured, and our shops and ice-boxes clean and free from odor, there would be no occasion for germ cultures of diseases brought on by swill milk.
Our milk example will illustrate what germs of common sense would do to ward off all kinds of disease-producing micro-organisms. Rigorous regulations, well enforced, as indicated above, would work in other lines as well. And when the source is gone sinister microbes will not come into existence, and diseases that have resulted from such microbes will have gone into innocuous desuetude.
There should be a bath-tub and a water-closet in every suite of sleeping apartments. When this is the case, there will be a larger number of persons clean internally and externally, and the doctors will be on a hunt for health-producing germs instead of disease-producing ones. Let us start an organized movement in this direction.
Last summer Medical Science went about killing mosquitoes on Staten Island with a little spraying apparatus, and managed to disturb the pest for a day or two from its customary bivouac. Christian Science stood aloof and smiled superciliously, claiming that “there aren’t any such things as mosquitoes; but if they should prove to exist, there isn’t any malaria anyhow.” Good sense might have suggested to Medicus the draining of the ponds for gardening purposes; and, if that were not possible, the filling in of the edges and the making of deep-water lakes for the sport-loving youth, who might be depended on to keep the water stirred up by boating, etc., free of charge, and thus convert a pest pond into a pleasure lake. Pleasure and cleanliness are taxed to-day for disease and pests. Oh, human imbecility!
As to public baths, there are so many objections to them that I cannot touch on the subject in this chapter. But let me impress upon the health-seeker, the public-spirited citizen, and our city officials that what we urgently need are ample conveniences in our homes for internal and external cleanliness—conveniences easily accessible several times a day, every day of the year.
CHAPTER XVII.
Personal Cleanliness.
At the close of my last chapter I referred to the ever-recurring problem of public baths. Annually its agitation is renewed in lectures and newspapers; public bathing is voted without disagreement the thing of things needful to render the laity—i. e., the labor population—physically pure. It is the long-felt want; but, like the longed-for walk of the annual Sunday-school parade, it is soon done and gone. Still, we must have patience with those dear souls, our ethical teachers of the press and platform, for taking such a deep, sentimental, though unscientific, interest in the welfare of the unclean. Owing to the non-existence of home facilities for cleanliness among the working class, the accumulations of soil and exudation during the long fall, winter, and spring months are so great that their bodies become too rank and malodorous for the nostrils of the refined. Consequently, as all animals seek the tepid water of the summer, and as man is no exception to a capacity for laving in the circumambient fluid, to three-fourths of the population of this metropolis it must be a glorious perennial treat to dip in the river, bay, or sea; and it must indeed be a dire necessity to those that have managed to survive contagious and other diseases during their long immurement. Without this summer cleansing few animals, bestial or human, would run half their average careers. It is accordingly not strange that during the summer a bath in open water is a daily hygienic necessity and source of joy to thousands of creatures.
Now, it is just because godliness appears in the wake of cleanliness that I made so strong a plea in my last chapter for ample bath-tubs and water-closets. For I do not approve, nay, I emphatically condemn, the system of public baths along the shores of our rivers and bay. Their waters are contaminated by numerous sewers, and bathers have contracted many contagious diseases that have become epidemic in neighborhoods. Note especially the annoying eye troubles that follow in the wake of such bathing. Of course, the sport and exercise involved in open-water bathing are highly commendable; but the danger of contracting contagious disease, and the outrage of the sense of refinement when contemplating fellow-creatures in the act of stirring up polluted waters, should call a halt to our encouragement of public bathing in and around our metropolitan water fronts. These waters are surely anything but a means of cleanliness.
The water-closet, however, is of far greater importance than the bath-tub, and especially than the public water-gymnasium—which last is so much lauded by some of our misguided philanthropists. Intestinal foulness, as a prolific source of disease, is of far more serious importance than surface foulness. However, both the bath-tub and the water-closet are indispensable to every suite of rooms.
Another need imperatively demanded by the exigencies of city life is the establishment of public water-closets at several thousand convenient centers throughout this great city. At present the male population, when away from their residences, are obliged to make use of a near-by saloon—a most uncertain resort, and one in which courtesy will generally constrain them to imbibe intoxicants nolens volens. The female population have not even the saloon as a resort, and can relieve themselves only when in the vicinity of department stores. American enterprise can improve in many respects on the several European models of public-relief stations. The public is becoming conscious of its needs and rights in this respect; and one of the sanitary evolutions of city life—congested as it is—will be ample and cleanly public accommodations for intestinal relief.
Americans in general suffer from dyspepsia, biliousness, constipation, uric acid, etc.—all of which disorders are symptoms of that world-wide disease, proctitis: inflammation of the anus, rectum, and often the colon. Nor is it any wonder that unwashed humanity suffers from proctitis and its consequences. The unwashed have no bath-tubs and practically no water-closets. This lack is due to the tax on water facilities, to expensive plumbing, and to too much “science” and not enough common sense among our city fathers. As a consequence of ignorance and inconvenience, most people defecate but once in twenty-four hours; and very many but once in two or three days or a week. The once-a-day stool is frequently scanty, and as a consequence the kidneys, lungs, and skin are called upon to perform the vicarious function of eliminating a portion of the daily excrement; and the colon and sigmoid flexure have to hold the stored contents unduly—until the feces be expelled by purgatives or by the irritation that the accumulated mass occasions. Could the members of the Board of Health and the people at large be brought to a realizing sense of the value of personal cleanliness,—internal as well as external,—bath-tubs and water-closets would abound in our homes.
Man’s habits as to eating, drinking, dressing, bathing, and especially as to defecating, are clues to his growth in refinement. But we must beware of judging a person by one or two good or bad habits; he should be estimated by the sum of his habits and their peculiar combination. Refined habits are not all of them acquired at once; they develop slowly, one after another, when opportunities are favorable, especially the habits as to bathing and defecating. Opportunities for these latter are wofully lacking at present—the cause and consequences of which lack are pointed out in the last chapter. A child will derive far more good from a ready access to bath-tub and water-closet than from a lifelong attendance at Sunday-school and church with the temple of the human soul permanently unclean. Only one that has learned to respect and care for the abode of the soul—the body—is worthy of being classed among the refined. It is truly deplorable that the great majority of the human race are creatures of the moment or the hour, tolerators of abnormal functioning, slow suicides of vital capacities. Claims of the permanent are constantly ignored; most of us are blind to the joy involved in the harmonious functioning of all the organs—a functioning that always ensues upon hygienic care.
Our organs will for a time bear neglect or unhygienic conditions without protesting their annoyance. Many persons never use hot water or soap; others find one bath, in river or sea, quite sufficient for the year; others, again, feel the need of a bath once or even twice a month, or even once a week. But there are very few of us that seem to require a bath daily. Many, alas! have grown accustomed to a bathless existence.
Have you ever stood near an Italian or Greek street vender, or have you ever been within five feet of a low-class Polish Jew? If so, the stench arising from his unwashed body must have nauseated you. It is no secret that such persons never wash—especially the latter, who live in rooms reeking with filth. Contemplating such conditions, I feel impelled to propose a great, nay, the greatest reform—one suggested years ago by Samuel Butler in Erewhon. Let us make Health the great civic virtue, and Disease, as well as unsanitary and unhygienic conditions, the crime. Our so-called crimes of theft, murder, forgery, etc., should be treated as weaknesses and faults to be corrected by Moral Rectifiers—by the preachers, priests, rabbis, and ethical culturists. Consider how much is implied in developing and breeding a race of healthy men and women. All relations of life would feel the vital change at once, and moral weaknesses would disappear. Any human cesspool entering a public conveyance, or in any way mingling with cleanly people, should be arrested, thoroughly cleansed, internally and externally, and sequestered for a time sufficient to teach him better. There is a local rule of the Board of Health against spitting, but it is rarely enforced. There are millions of public expectorations to one arrest. For the appearance in public of consumptives, and their offensive hawking, coughing, and spitting, no one seems to have suggested a remedy. All diseases should be classified as to grades of punishment; and all moral weaknesses, such as defalcations, adultery, burglary, should be treated at the various hospitals, which latter should be conducted solely by Moral Rectifiers.
In closing, I shall direct attention to a few other points in personal cleanliness—the mouth, ear, nose, and throat.
It is important on hygienic grounds that the mouth receive proper care two or three times daily.
The ear is commonly kept clean; still there are many instances of non-refinement of this organ, and from its non-hygienic treatment deafness often occurs.
The prevalent nasty, ill-bred habit of hawking and spitting in public, or in company, even by genteel persons, can be cured best by early training in correct habits. This habit, as well as the evidences of throat troubles, is usually to be ascribed to inattention to the nose. When catarrhal conditions are avoided or properly treated the throat will not be so affected as to necessitate this reprehensible practice. Trouble is invited for the tonsils and soft palate by our constant hawking; certainly the tender sensibility of the throat is destroyed thereby. Inasmuch as the tobacco habit is so general, and spitting is a necessary accompaniment of that habit, stringent laws against hawking and spitting would be unpopular among the masculine half of the race. But should public opinion ever become educated up to the point in which disease becomes a crime, opposition would cease. This consummation is devoutly to be wished, for then we will have adopted and followed Ingersoll’s injunction to “make health catching, not disease.”
CHAPTER XVIII.
Hot Water in the Treatment of Proctitis and Colitis.
In treating chronic ulcerative inflammation of the anus, rectum, sigmoid flexure, etc., it is well to take advantage of every really practical device to which one may have access, so that valuable time may be saved in obtaining relief and effecting a cure.
The capillaries, veins, arteries, and arterioles in an inflamed organ become distended and the tissues swollen, indurated, and tense by the excess of blood and the inflammatory serum deposited in the tissues. The vasomotor nerves in the diseased part have lost their contractile power, which fact increases the stasis, or congestion, of the blood. Circulation in diseased tissue depends very much on the general tone of the system, and if the circulation is below the normal the ravage of the malady is increased proportionally.
Have you ever observed a little stream of water enter a large pond in which were grass, shrubbery, logs, decaying vegetation, and débris of all sorts—the accumulation of years? And have you noticed that here and there there were stagnant pools, without a perceptible motion from where you stood, but that as you reached the side opposite to the entrance some faint traces of motion became visible, and that as you followed the line it soon formed into a stream quite equal to the inflow? The pure water, on entering and mingling with the stagnant water and old deposits, soon becomes corrupted and foul. Somewhat similar unhygienic and toxic results take place in ponds of stagnant blood and abnormal deposits such as proctitis and colitis involve, and where, for six or eight inches or more of the large intestine, inflammation is deeply seated, and blood stasis is of course in full swing. As the débris in a stagnant pond decays, making the water impure, so in an inflamed organ the tissues decay, making the blood impure. Ulceration is an exhibition of this process of congestion, induration, and decay.
The rectum and sigmoid flexure are loosely hung in the pelvic space and are surrounded by fatty cushions of connective tissue on all sides, which fact allows the organ considerable dilatation and motion (Fig. [5]). Owing to the anatomical structure and the location of the lower bowel, it becomes a serious matter when it is invaded by an ulcerative inflammatory process—especially when all the layers of tissue forming its wall are invaded, and still more so when the connective tissue around the organ is in the same condition.
Far better were it for the victim of proctitis and periproctitis—filled as he is with channels and reservoirs—if pus were to form in abundance at once and thus betray the destructive action in the spongy areolar or connective tissue, under the mucous membrane, around the rectum, and in the tissue forming the anus and buttocks.
The pathological condition brought about by inflammation, etc., requires a remedy that will empty the over-dilated vessels and remove the serum deposit in the tissues, which is analogous to the rubbish of a pond.
Our grandmothers were familiar with the therapeutic effects of heat and moisture when they applied hot poultices constantly to an inflamed organ or limb for one or more hours until the tissues presented a blanched, shriveled, and white appearance; if there were signs of the inflammation returning, the poulticing was continued or repeated. They knew very well what the parboiled condition of a washerwoman’s hands indicated after a day’s work in hot water. They were bloodless, notwithstanding their incessant muscular exercise. In case of inflammation, they reasoned, heat and moisture would make the congestion and fever leave if applied long enough. On beginning the use of the hot poultice, the tissues to which its heat and moisture were applied became relaxed, and the parts for the time more congested than before; but our grandmothers did not mind that, as the final result would justify their hydriatic procedure. They well knew that after ten minutes or more a reverse action would take place, and if the treatment were continued long enough the blood-vessels and tissues would show little or no evidence of fever or inflammation.
Where chronic inflammation exists, the blood-vessels and tissues lose their normal tone or vitality; consequently, they will require repeated application of hot water as well as other aids until a cure shall have been effected.
Another great advantage in the use of hot water is that its application can be interrupted and resumed without detriment to the diseased tissues or organs. Cold water, on the contrary, causes the vessels quickly to contract and expel the blood, but, on reaction taking place, the tissues become more congested than before.
In the use of water at a temperature of 120 to 135 degrees, or even more, we have one of the most valuable adjuvants in all stages of proctitis and colitis, and, if a properly regulated plan be pursued in connection with the requisite local treatment, more good can thus be accomplished than by all other means combined.
The layman is more or less familiar with the condition of a sore or ulcer in which soft, spongy, or fungous tissues appear, called “proud flesh,” which, on an inflamed mucous membrane, is called granular tissue. Were it not for the usual presence of granular tissue on a chronically inflamed mucous membrane and for ulcerated sections or patches, channels, and stretched or pouched mucous membrane called piles, the proper use of hot water alone would in time effect a total cure in almost every case of proctitis.
Many well-meaning persons conceive the idea that, if hot water is so beneficial, they may use it as hot as possible for the purpose of an enema likewise, since they will thereby not only relieve the bowels of their stored feces but simultaneously do the inflamed tissues “a whole lot of good.” Their spirit is admirable, for not all patients are prompted to such thoughtful attempts to do everything in their power to get well—even though they err with the best intentions at heart. Let them remember, however, that the first effect of hot water is to increase the blood supply in the tissues if it be applied for a short time only. In the majority of cases, the enema does not require more than from five to ten minutes; hence, only harm can result if really hot water be used. Now and then a person will become possessed with the notion that a hot enema should be followed by a cold one, to bring “tone” to the lower bowels. But in all these misdirected efforts matters are made doubly worse.
Cold water will allay fever and inflammation, but when its use is once begun it should be continued without intermission until a cure is effected. For this reason it is not suitable where chronic inflammation exists—especially on the mucous membrane of the bowels. It is, however, excellent for acute inflammation of the external parts of the body, such as the hands, arms, legs, etc., where it can be continued without interruption for one, two, or three days if necessary.
In beginning the treatment for constipation, there are a few cases in which the patient has to fuss for an hour or more with the enema before he can obtain any sort of a proper fecal evacuation; or there may be inability to expel the water from the bowels when once injected. This stoppage is most likely to occur at the recto-sigmoid juncture (O’Beirne’s sphincter). A strictured condition of the bowels causes retention of feces and gases and why not water as well? In such cases time would be saved, perhaps, by combining the procedure for an enema with that of a recurrent douche, which involves a continuous application of water at a temperature of from one hundred and twenty to one hundred and thirty-five degrees for an hour or more. Figure [21] illustrates a successful device for applying medicated water at a high temperature to the anus, rectum, and colon. This apparatus can be used while sitting on a water-closet seat and the treatment can be completed without changing position or removing the instrument.
The instrument is attached to the reservoir (Figure [18]) by a soft-rubber tube. In the cone-shaped piece of hard rubber (Figure 27) is a hard-rubber stop-cock or valve (Figure 29), and by turning the handle sidewise the valve is opened to let the water escape from the bowels into the toilet basin. When sufficient water, at from one hundred and twenty to one hundred and thirty-five degrees temperature, has entered the bowels, allow it to remain for ten minutes, then permit it to escape by opening the valve; then close it and allow more hot water to flow in and remain for five or ten minutes and again allow it to escape through the rectal point, repeating the inflow and outflow every five or ten minutes for an hour or more without removing the anal point from the rectum during the whole time of treatment. After a few trials it will be found that the hot-water treatment can be accomplished without withdrawing the point.
Rectal Points for recurrent douche are of two sizes (Nos. 25 and 26). The larger one (No. 25) requires a plug to be introduced through the cone-shaped external anal support and rectal point, to make its introduction into the rectum easy, after which the plug is withdrawn and the hot-water treatment begun. The bore of the rectal points cannot become clogged by the presence of feces, mucus or membranous shreds or casts, which are usually brought away by the hot-water treatment. At no time during the treatment can the point become stopped up, the size being sufficient to insure a proper inflow and outflow. And the instrument can be easily cleaned.
Near the attachment of the soft-rubber tube is a glass reservoir (Figure 24), for the use of oils with the enema or the hot-water treatment; it is detachable. A valve regulates the outflow of oil from the pressure of water in the reservoir, as it passes into the bowels. We are enabled thus to treat by double medication as it were, a chronic disease of the intestines and its symptoms—that is, intestines that have been long neglected or maltreated through lack of proper diagnosis, or by all sorts of chemical compounds from above, through mouth and stomach.
The author and inventor naturally enjoys not a little satisfaction in being able to present to sufferers as nearly perfect an instrument as can be devised; one that, in conjunction with other aids, meets all requirements involved in the proper treatment of proctitis and colitis. Lavage or irrigation of the large intestine with water at a temperature at from one hundred and twenty to one hundred and forty or one hundred and fifty degrees, not only accomplishes rapid and wonderful cleaning and curative results, but overcomes, when properly applied, contracted, congested, engorged, and inflamed tissues of the bowels. Therapeutically, it has a marked effect on the whole system, being beneficial beyond words to describe; it relaxes nervous and muscular tension of the body, producing restfulness and sleep; it stimulates and equalizes the circulation, promotes perspiration, absorption, and active elimination of all deleterious substances from all the organs of the body. Medicinally, it is really a combined internal Russian and Turkish bath, removing abdominal corpulency and gaseous obesity, resulting from chronic auto-intoxication. The external Russian and Turkish baths afford a satisfaction skin deep to the bather, but the combined internal Russian and Turkish bath is most agreeably relaxing and restful to mind and body, bringing peace, since all the organs of the system are performing their functions. Some of my patients resort to internal hot-water lavage for all aches and ills that mar their happiness. After an external bath the bather may desire an application of oil, alcohol, or cocoanut butter rubbed on the skin, and in the same way the bather’s internal mucous membrane is not neglected; for, with the author’s appliance, medicated and perfumed oils, extracts, and powders for remedial purposes are carried to every part of the intestines that the water reaches, thus exerting a cleansing, healing, and soothing effect where most needed.
A few sufferers will object to the time required for an enema twice a day, although they find time to eat three, or even four times a day, without any objection whatever; there is plenty of time for filling up the digestive apparatus, but no time for its normal elimination. And these miserable, go-lucky, haphazard people are always sick and unfortunate. The internal Russian and Turkish bath is demanded only by those who truly desire to be free from their bowel troubles, and from the numerous symptoms resulting from mucus absorption, constipation, and auto-intoxication.
A sufferer’s efforts to be well depend largely on how much he or she estimates the worth or value of mind and body. A noble purpose in life is priceless; are not one’s spirit and body worth the time required for two enemata each day and an hour for the internal bath, if needed? I think so, and you should likewise.
The author trusts the reader will not infer that all sufferers from piles, anal fissure, pruritus ani and vulvæ, mucus channels and reservoirs, abscess, fistula, and all similar troubles, require the enema and recurrent douche appliance; the character of the disease and its symptoms must determine the requirement of the treatment. Many of my patients receive office treatment only, omitting home attentions, although this is not always advisable. The reader might conclude that the recurrent douche treatment was simply for the cure of a chronic inflammatory invasion of the bowels and fecal auto-intoxication, and not be aware of another great source of auto-intoxication—that is, from the absorption of large quantities of serous, fibrinous, or albuminous exudation from a large area of tissues invaded by the very insidious inflammatory process, a condition which, in time, may reach the pus-forming stage. Thus we have three very grave pathological conditions to meet and remove before the pus-formation stage is made manifest through the development of abscesses. I have found five aids—perhaps more—to accomplish a cure in which I have been exceptionally successful, as my students and patients will verify; these are: local treatment, local medication, the proper use of the enema, the use of the recurrent douche, and the determination of the sufferer to get well.
CHAPTER XIX.
Hot Water in the Treatment of External Symptoms.
After proctitis has continued for many years it will give rise to painful inflammatory and ulcerative processes at the external anal vent and in the adjoining tissues. The anal mucous membrane and the integument about the anus become brittle, loosened, and detached from the areolar connective tissue by the retention of inflammatory serum. The engorged, indurated, and swollen mucous membrane and integument serve as reservoirs, especially when the chronic inflammation is excited to an acute stage, which stage is often accompanied by a fissure, abscess, or anal ulcer. Soreness and pain in the parts may then be so severe that the sufferer is compelled to stay indoors or in bed. Whatever the symptoms may be—piles, fissure, pruritus, abscess, or fistula—the sufferer desires to reduce the local fever and the acute inflammation, as well as to find relief from the pain. The customary treatment is to use poultices, which are troublesome and ineffective.
In the following illustration I give a good idea of a perfect device for relieving quickly the soreness, pain, acute inflammation, and induration, all of which are so very prostrating; and, situated as they are physiologically, they are exceedingly inconvenient to treat properly by the ordinary methods in use:
(Patented November 8, 1892.)
Fig. 23.
The Sitz-bath pan, though small, is yet of sufficient depth and diameter for all practical purposes, and can be placed wherever is most convenient—on a low chair or a box. The bather should sit on the instrument with the limbs on either side of the funnel through which the hot water enters the pan. Just below the funnel is an overflow tube, under which a vessel should be placed to catch the water as it flows out. While sitting on the pan the elbows may rest on any convenient support, so as not to tire the invalid too much during the bath, which should consume from half an hour to an hour, or longer if agreeable. Hot water may be added every few minutes as the bather finds that the tissues will tolerate it. Depurant powder may also be added to the water in the Sitz-bath pan.
What has been said in a previous chapter on the therapeutic effects of hot water in the treatment of proctitis need not be repeated here.
The three indispensable appliances for combating and effectually overcoming the pathological conditions to which this book and my two previous books—Intestinal Ills and How to Become Strong—are devoted, are The Internal Fountain Bath, The Intestinal Recurrent Douche, and The Shallow Sitz-bath Pan. These appliances are well-nigh perfect for the uses to which they are adapted.
CHAPTER XX.
The Health of School Children.
“Cleanliness of body was ever esteemed to proceed from a due reverence to God, to society, and to ourselves.”—Bacon.
The International Congress on School Hygiene ended its fourth meeting at Buffalo recently to meet two years hence in Brussels. In the interim the Board of Education in this city, the Department of Health, and the New York School Luncheon Committee will continue their investigations as vigorously as in the past, and the information thus gained will be an important contribution to the next Congress.
Too much attention cannot be given to the question of hygiene, diet, and excretion to meet the psycho-physical requirements of the mind and body in normal health. As a rule, diet is prescribed for the purpose of relieving the various annoying and painful symptoms caused by chronic impairment of the functions of the stomach and bowels, but when we find the cause of these various symptoms arising from a disturbed gastro-intestinal tract, the question of diet will receive less attention. Why has not the subject of normal intestinal excretion received as much attention as diet in health or ill-health? As our knowledge of the human psycho-chemical laboratory increases, we are able definitely to locate a diseased organ and account for the symptoms caused by the pathological condition of that organ; and when the diagnosis is properly made these symptoms become a secondary matter of treatment.
The chief enemy of health among school children (and older persons as well) is the accumulation and retention of waste matter and gases in the intestinal canal, where are generated ptomaine, toxic, and other poisons which enter into the system, resulting in self-poisoning or auto-intoxication.
What do we mean by school hygiene? Is it only the school building, or the external appearance of the children, their eyes, teeth, mouth, nose, hands? What about the coated tongue, foul breath, fouler stomach, and putrefaction of the contents of their intestines? A human being is only an extension of his gastro-intestinal apparatus, hence it is very essential that such apparatus should be in a hygienic state to ensure his physical and mental resistance and efficiency being at their normal strength. There is one symptom that causes more sickness and suffering from infancy to old age than all others combined—that is, constipation with its attending putrefaction and foulness of digestive organs. Only a small percentage of people escape its baneful effects or the secondary diseases induced by fecal and mucus auto-intoxication. Such a common primary symptom must have, necessarily, a common exciting cause or origin. Through many years of clinical experience as a gastro-enterologist and proctologist, we have found that inflammation of the anus, rectum, and sigmoid flexure is the frequent or common cause of constipation. Observation has demonstrated that a soiled diaper is the exciting cause of Proctitis and Sigmoiditis in the beginning. Examination of one hundred children of the “defective class” would show most of them suffering from chronic Proctitis and Sigmoiditis, with some degree of constipation and auto-intoxication, and even of those classed as “healthy school children” a large percentage would show the same conditions. The continuous invasion of the neighboring tissues by the disease, the increasing auto-intoxication and constipation, the on-coming malnutrition, and anemia, the gradual emaciation, are all the while lessening the vitality and power of bodily resistance of their victims. The early inception of the malady and its insidious progress, with the symptoms and diseases resulting, easily deceives the victim as well as the parents and medical advisers, until the long-pent-up virulence breaks forth, showing itself in every part of the tabernacle of the spirit of man, when the removal of the primary cause does little or no good.
The Department of Health, in examining the sanitary or hygienic condition of a school building, would not devote all its attention to the top story to overcome unhygienic conditions; it would probably direct its attention to the trap and vent of the sewer of the building to see that there was no retention and filling up of the pipe to befoul the atmosphere of the structure. Why then so much attention to the head or top story of the human temple, and so little to the trap and vent of its sewer? Are modesty and ignorance to defeat the progress of hygienic measures dealing with the stomach and bowels of our school children? How long will those abdominal incubators of poisonous microbes and gases be allowed to infect not only a school building but all its occupants as well?
The absorption into the system of serous, fibrinous or albuminous mucus exudations from the invasion of chronic inflammation through all the layers of the tissues of the anus (Figure [1]), rectum, and sigmoid flexure, as well as through the adjoining fatty tissue in the pelvic space around the organs (Figure [5]), under the skin and between the muscles of the buttocks, goes on continuously, creating an extensive inflammable area and source of exudation of broken-down tissues. (See Chapter III.) It is a grave pathological condition and the source of mucus auto-intoxication, and its symptoms ought to be differentiated from those of fecal auto-intoxication. This mucus exudate has an intensely irritating effect on the nervous system, especially when an acute intestinal mucus storm has developed, torturing its victims and unfitting them mentally to attend to the ordinary duties of the day. Very often this is accompanied by more or less pain or muscular soreness. These annoying symptoms occur very early in the history of Proctitis and Sigmoiditis, and clinical experience has demonstrated to me and to my students the necessity for infants and children being examined in order to determine whether inflammation exists in the anus and rectum, and thus early cut short the progress of the disease and its numerous and familiar symptoms, which I may here enumerate, to wit: indigestion, flatulency, coated tongue, foul breath, bad taste in the mouth, capricious appetite, nausea, intestinal colic, cramps and pains, diarrhea, headache or band of pain encircling the head with sense of constriction, neuralgia, pain about the heart, cold hands and feet, malnutrition, anemia, emaciation, dry skin, seborrhea sicca, carbonic acid toxemia, sallow complexion, liver spots, jaundice, acute bilious attacks, drowsy states, mental torpor, bad temper, night terrors, irritability, melancholia, vertigo, dizziness, loss of memory, insomnia, drawn face, tired feeling, unrestful sleep, easily fatigued, subject to colds, catarrhal affections of the ears, eyes, nose, throat, etc., decay of teeth, dry cough, loss of hair, impaired vision, sterility, impotency, mucus and membranous cords and casts from the bowels, sediment in the urine, irritability of the bladder, premature age, reduced physical and mental efficiency, inability to concentrate the mind, morbidity, suicidal notions with a view to ending mental and physical suffering.
I am pleased to inform such sufferers that their ills can be properly diagnosed and treated; and the earlier in life they seek treatment, the sooner they will escape the accumulative ills that make existence so painful to endure.
We have mentioned Proctitis and Sigmoiditis as the primary cause of intestinal stasis in the majority of cases; later, other sections of the intestinal canal may be invaded by inflammatory process, causing a more serious intestinal stasis, not infrequently bringing about dislocation of the stomach, intestines, and other abdominal organs. We have enumerated the symptoms and maladies that are now, in the light of latest medical science, traceable directly or indirectly, to this primary cause; in short, it may be said that, with the exception of a few diseases caused by toxic agents, most of the illnesses that cause so much invalidism, cutting short our lives, can be traced to mucus and fecal auto-intoxication.
The purpose of this book and others I have published is to educate my fellow beings as to how to prevent or avoid the many diseases and symptoms that afflict them from the cradle to the grave; already I feel that I have accomplished something in helping humanity, and I trust others will do their part to lessen the ills that flesh is heir to through neglect and ignorance.
CHAPTER XXI.[2]
Internal Hemorrhoids or Piles versus Rectal Mucous Sac, Recto-Anal Mucous Sac.
Before the history of medicine and surgery began, man suffered at his hinder parts as well as at other parts of his organism. Bodily ills are as old as the human race, and the flowing of blood from the “terhinder” was a signal of distress or of physical anarchy, of which the references to “emeroids” in the Bible and in other ancient writings bear witness. The “emeroid” doctors of Egypt, in the time of Moses, unquestionably regarded the distress caused by the “emeroids” as a disease. And it came to pass that every subsequent Moses that has written on the subject of hemorrhoids up to the present time has regarded piles as a disease. And they likewise, all of them without exception, believe the “disease” to be hereditary, as is certainly their information on the subject. This mental obsequiousness of the proctologists of our day is indeed quite a long-drawn-out compliment to the pile doctors of Egypt, since our proctologists still continue to diagnose piles as a disease and “to smite the smitten of emeroids.”
I have always respected the idea of ancestral worship and of reverence for the dead past, but at the same time I have felt that one should not be wholly oblivious to their egregious mistakes.
If Moses, Samuel, Herodotus, Hippocrates, Galen, and other illustrious men had said that “emeroids” is a symptom of a disease, what a blessing they would have conferred upon suffering humanity. The simple use of that one word would have been illuminating, and would have set the tide of attention for the proper diagnosis and treatment in the right direction. Possibly some one more bold than the servile brotherhood did see and say that it was a mere symptom, but, if so, his temerity was treated by “the wise ones” of that day as similar innovations are treated to-day, with a “Tut, tut, tut; pugh, pugh, pugh. We know better, and we refer you to the following chapters in Holy Writ and to the classical work of the great Medi Cusus on ‘Pilus Diseasicus.’ And besides, have you no respect for the superior clinical advantages we enjoy?”
Notwithstanding the bad odor in which I shall be held, I will nerve myself to claim that, when the ancients considered and called piles or hemorrhoids a disease, they made a very grave and palpable mistake, and that, having made this mistake, it was inevitable that numerous errors should follow logically in its train when they attempted to account for the etiology, character, and means of cure of this “disease.”
Pruritus ani is also called a disease, and a similar bedlam of reasons is offered as causes and means of cure, all of which accounts for the many, many pages of a book filled to overflowing by a “classical” author, with compilations of the redeeming gospel truths on this subject from prehistoric times till the present day, including his own commentary, guesses, interpretations, and surmises. Ignorant as he is of the nature of this symptom, the conjectures of his perfervid imagination are “to laugh.” The errors of one or more authors, endorsed by the mistakes of others, seemingly make a truth to minds that are vassals to authority, which accounts for much of the useless medical literature of to-day and for the mistakes of those that are misguided by it.
Considering the pathological condition, it would be better if we were to give a more definitive characterization to it than “piles” or “hemorrhoids.” In accordance with the distinctive exhibit contemplated, we should describe it as a rectal mucous sac, an ano-rectal mucous sac, or an ano-muco-cutaneous sac. These are more distinctive and suitable designations for these symptoms of chronic proctitis, inasmuch, by such designations, we call attention to the fact that they are simply constricted mucus[3] channels and sacs, with engorged arteries and veins, formed by the serous exudation that accompanies inflammation.
If a recto-anal mucus channel, under one or more layers of the mucous membrane, becomes constricted or obstructed (they usually do), its epithelial wall will become sacculated, and then we have a rectal mucous sac, or an ano-rectal mucous sac, or an ano-muco-cutaneous sac, all of which may be present in the same case. The inflammatory exudation called serum distends and destroys fatty tissue, which makes space for its lodgment under the tissue that imprisons it, and at the same time there occurs more or less proliferation of the cells of the tissue involved in the severe inflammation. The internal sphincter muscle, by its contraction, aids in the undue retention of the mucus and blood above it, hence the so-called pile-bearing region—that is, the sacculated mucosa region. The serous exudation meets with obstruction along the anal canal and the mucosa is sacculated. When the integument around the anus offers obstruction to the flow of serum and blood, we find that muco-cutaneous sacs are formed around the anus. If the exudation occurs in the areolar space under the ano-rectal mucosa, it readily passes down into the areolar space under the integument around the anus, and thence to parts deep, devious, and far away, as described in Chapter III.
Channels, reservoirs, sacs, that would hold from one to eight or more ounces of fluid, no longer excite my wonder and amazement at the extensive and serious pathological condition of which they are exhibits, a pathological condition that occasions symptoms often diagnosed as sciatica, rheumatism, myalgia, caries of the coccyx, coxitis, prostatitis, pruritus ani, scroti, and vulvæ, auto-intoxication, anemia, invalidism, etc.
Inasmuch as we have learned the cause of sacculated mucosa at the lower end of the rectum and over the anal canal and of the integument around it, we had better in future omit the following designations and distinctions, which are merely a ridiculous display of sciolism. Surely we can do without them, and ought to do so for the sake of truth and simplicity. With a sigh of relief let us in future ignore: Safety-valve piles, organized piles, itching piles, blind piles, bleeding piles, moon piles, cutaneous piles, thrombotic piles, external and internal pile tumors, venous piles, ulcerated piles, capillary piles, mixed hemorrhoids, arterial hemorrhoids, white hemorrhoids, acute hemorrhoids, chestnut hemorrhoids, chronic hemorrhoids, inflammatory hemorrhoids, hypertrophic hemorrhoids, atrophic hemorrhoids, Egyptian piles, Philistine itching hemorrhoids, etc.
Quite naturally such a variety of “diseases” called forth many sorts of surgical operations for their removal, of which the following are the ones most in vogue: Clamp and cautery, ligature, crushing electrolysis, excision, submucous ligation, the Whitehead operation, the Earle operation, the American operation, etc.
Forget them all, forget all of the senseless terms that are employed to describe a supposed variety of “disease” and all of the barbarous procedures for their banishment, and the banishment, alas! too frequently, of the wretched sufferer likewise.
Study carefully the varieties of chronic inflammation and the character and extent of the exudation in each case. By so doing you will ascertain the nature of the many varied symptoms of proctitis, of which the following are the most common: Sacculated mucosa and integument, submucous and subtegumentary channels, reservoirs, pockets, fistula, pruritus ani, fissure- or ulcer-in-ano, constipation, diarrhea, etc.
Proctitis may present a chronic, a subacute, or an acute stage, with an atrophic or hypertrophic condition, or a less marked structural change in the tissue. If proctitis were treated early in its inception, none of the above-mentioned symptoms would have occasion to develop. When mankind becomes properly enlightened on the subject of proctitis, due attention will be given to it long before so many annoying symptoms occur.
Ano-rectal mucous sacs, formed by the serous exudation into the connective tissue and stasis of the blood, are the slightest symptoms of proctitis, and by far the most easily removed.
Since we have found out what are the symptoms and what is the disease, it naturally follows that in treating a sacculated mucosa we should be governed by the character of the proctitis, whether it be in a chronic, subacute, or acute stage. If the inflammation be acute, no matter whether or not there is a general prolapse of the sacculated tissue, it may be well to delay the treatment for removal of one or more mucous sacs until we have in a degree overcome the acute inflammation by the use of a shallow sitz bath, Fig. [23], and by the use of a soothing ointment and liquid remedy, to meet the depurant requirements of the case.
The removal of the chronic inflammation, in whatever state it may be found, should be a paramount feature of the treatment from the time a case comes under one’s care. The cure of the disease ought to be of more importance than the removal of a symptom or symptoms. Should there be bleeding from a mucous sac, or should there be prolapse of it, or both, immediate treatment will give relief at once, and the sufferer will think you have performed a miracle, especially if the annoyance has existed for many years.
After the immediately annoying mucous sacs are removed by the hypodermic method, a physician can doubly guard his reputation in the painless treatment of mucous sacs by delaying further treatment of those remaining sacs, which, if treated, might occasion special annoyance, till such a time as the general inflammatory condition is much improved; but in the interim he may treat the mucous sacs that are located above the sphincter muscles, and the granular and ulcerated regions.
For the almost universal success in the painless removal of mucous sacs, the operator should be in possession of all of his normal wits and senses, so that his judgment will be at its best when the following points present themselves:
What to treat.
When to treat it.
Where to treat it.
How much to treat of it.
The quantity of remedy to be injected—all of which require discretion and good technique.
By the hypodermic method of treating mucous sacs some escharotic is employed with the object of causing the absorption of the sacculated mucosa. The object to be accomplished ought to determine the proper strength of any escharotic used. Whatever will absorb the mucous membrane involved in the sac in the slowest and mildest manner is the best remedy or the best way to employ any of the tissue absorbers you might select. And another fact: the lower the per cent. employed the larger the quantity that may be used at a time, and this is desirable if the area of a sac be large and you wish to absorb the greater portion of it. A skillful operator will make sure to have the escharotic used cover just the amount of the mucous sac desired, and no more. Physicians that are not aware of the channeled and sacculated character of the mucosa in the case of “piles” or “hemorrhoids” are liable to introduce the escharotic into the base or the center of the mucous sac with the hypodermic needle; and in such an event the remedy often enters a cavity or a channel, or both, and naturally it finds its way along the channel to the integument at the anus, whence, as a consequence, a deep, ugly fissure-in-ano is in a short time to be reckoned with by the patient and the physician, because of the destruction of the epithelial wall of the channel. The patient thereupon is far from being in a good humor, and the physician wonders how the thing happened, and he feels like quitting practice altogether, and doubtless many have done so; and certainly every one should do so if such an error were to occur a second time.
The object we wish to accomplish is to absorb the wall of the sacculated mucosa. Therefore the remedy should be injected at the apex of the sac, in the epithelial layer, or slightly deeper, if the occasion demands it. The area of the sac and the thickness of its walls must be taken into consideration, and will suggest the amount of the escharotic to be used.
A proper speculum is very essential to the successful treatment of sacculated mucosa, and I know of none equal to that devised some thirty years ago by Dr. A. W. Brinkerhoff. The speculum is easy to introduce, and by drawing a slide the tissue is properly exposed or shut out to a nicety, exhibiting just the amount you wish to treat. In some cases there is a rather lengthy sacculated mucosa on the side, or on the anterior wall of the anorectal tube, and it is advisable to treat only the upper third or half, and at a subsequent visit or visits to treat the remainder, thus avoiding annoyance to the patient.
The paramount concern should be to avoid causing pain both during the treatment of a sacculated mucosa or its possible occurrence a few hours or days later. I have often remarked that when pain or soreness follows the treatment of a mucous sac the fault is in the application of the remedy, and not in the remedy itself. Now and then there may be conditions in which you will expect pain or soreness to follow the treatment, and you will prepare your patient with the necessary appliances and remedies to overcome it promptly. Where there are no possible means for avoiding the pain consequent upon a treatment, leave nothing undone to make it as slight as possible. All mucous sacs ought to be treated without any after-annoyance to the patient, and they can be if we only wait for the proper time to treat them.
I have not thus far considered the muco-cutaneous sacs around the anus, which are neither useful nor ornamental, and which often indicate the volcanic action of inflammation and the amount of mucous lava thrown out around the vent.
CHAPTER XXII.
External and Thrombotic Piles versus Muco-Cutaneous Sacs and Thrombus.
The vent of a crater indicates the convulsive and destructive changes that have taken place within; and, very often, the vent of the gastro-enteric sewer gives like evidence of long, great, and severe destructive changes. The fire of inflammation has burned fiercely for many, many years, and serous lava has, from time to time, poured forth, leaving a searing, inflammatory path. As it was forced from the recto-anal crater, the acrid, burning mucus, that had been imprisoned, made subcutaneous streams, cavities, channels, sacs, etc. Its course is marked around the anus by peaks, crags, muco-skinny tabs, small and large bulging muco-cutaneous sacs, dilated anal veins in which clots of blood often form; light gray, brittle, shiny skin with small and large red and sore oases, thickly studded over the itching area, which the sufferer has scratched in the vain hope of appeasing the torture of pruritus ani, scroti, vulvæ; while cold drops of perspiration stand over his or her face and body, serving to indicate the physical and mental anguish inexpressible in words.
Muco-serous exudations under one or more layers of the recto-anal mucous membrane finds its way down to the integument around the anus, and being of a very irritating character, greatly increases the inflammatory process in the tissues it comes in contact with. Thus the increased inflammation and blood stasis and the augmented serum unite in hurrying the development of skinny tabs and the more or less capacious muco-cutaneous rugæ and sacs.
When the serous exudation takes place entirely under the recto-anal mucous membrane, there may be formed a large muco-cutaneous anal sac, especially on the right or left side of the anus, or the serum may pass under the integument about the anus with little or no anatomical change in the appearance of the skin at or about the anus. In the latter case, an experienced eye can detect sufficient evidence to diagnose the destructive changes wrought by the presence of serum in the connective tissue under the skin and ano-rectal mucous membrane.
The skin is not, as it should be, held fast by the connective tissue, but lies loose over the cavity; and a similar pathological condition exists under the mucous membrane of the anus, rectum, and sigmoid flexure, which circumstance might lead one, in some instances, to conclude that there was almost an entire separation of the mucous membrane from the areolar tissue, by the ridges, folds, large, pouched, prolapsed, sacculated regions of mucous membrane that has the appearance of having been simply carelessly laid over the muscular structure of the organs. When we observe such destructive changes by the invasion of serous exudation under the mucous membrane, we have every reason to expect periproctitis and perisigmoiditis, with the possibility of the formation of pus occurring with the usual consequences. So remarkable and serious are the excursions of the mucous currents into healthy neighboring tissue that we find a symptom of a disease vastly more annoying and serious than the disease itself. Is it any wonder we find stenosis (narrowing of the passage) of eight, ten, or more inches of the lower portion of the large intestine, which is usually diagnosed atony of the bowels? Surely, you must by this time appreciate the reason I made so strong an appeal for the twice daily use of the enema as a means of relief. You need the combination of many aids over a long period of time to effect a cure of proctitis, etc., and its numerous symptoms. Proctitis and colitis is a serious affliction, and should have your undivided attention with the hearty co-operation of the patient in effecting a cure. How foolish is the practice of removing one or two annoying symptoms (piles and fistula) and leaving the sufferer untreated, the disease itself and the other symptoms not so apparent at the time of the operation, and then dismiss the case as cured! Shame on such practice, in which ignorance and cupidity dominate! Humanity cries for a correct diagnosis and a humane treatment!
The profuse serous exudation resulting from proctitis and sigmoiditis makes its way from the diseased area into the neighboring regions like lava from an active volcano, carrying with it an intense burning inflammation, destroying normal fatty tissue as it advances, owing to its extremely acrid character. Is it any wonder that we find dilated veins and arteries in the lower rectal and ano-rectal canal and around the anus where stasis of the blood has existed for a great many years? The real wonder is that thrombus in the veins around the anus does not occur more frequently than it does. What is the necessity of calling such a pathological change in the caliber of a vein and the weakening of its walls “thrombotic pile”? Thrombus is a clot of blood in a vein, and there is no use in adding the word “pile.” The aggravated character of the inflammation accounts for the hypertrophied and the cicatricial tissue so often found around the anal vent of proctitis cases. The Biblical suggestion that sacculated mucosa, commonly termed piles or hemorrhoids, is a disease, accounts for the numerous names used to designate the particular variety of the disease—whether it be an internal or an external pile tumor. It is very wrong to so mislead “scientific” medical men. Had they only known that the numerous sacs, bags, prolapsed pouches, longitudinal and transverse folds of the ano-rectal mucous membrane, and the ragged, jagged, prolapsed, pouched muco-cutaneous tissue around the anus, as well as the fissure-in-ano, pruritus ani, fistula, are only symptoms of a disease, all of the many abnormal changes and the other symptoms could have been prevented many generations ago by simply treating their exciting cause. But it is never too late to learn things that will benefit mankind.
Don’t for a moment think that all of the structural changes on the mucous membrane and about the anus mentioned above indicate an affliction only skin deep, or even the depth of the mucous membrane. They are far worse than that. You will find all the muscular structure of the anal organ and that of the rectum sigmoid flexure severely invaded by the inflammatory process and its fibrinous exudation, and also the external tissues that surround and support the organs.
We have circular and longitudinal muscular tissue entering into the structure of the anus and rectum. The sphincter muscles are two large and strong muscles that close the anal orifice and guard its vent very effectually if they are not destroyed by a surgeon’s knife.
The acrid burning serum coming in contact with the muscular tissue excites an aggravated inflammation in its structure as elsewhere. The constant irritation results in more or less permanent contraction of the sphincter muscles in which fibrinous exudation takes place, binding the contracted muscular fibers together. In time their expansibility is lost in many cases, and in other cases partially so, necessitating divulsion of the sphincters in order to break up the adhesions and establish a somewhat normal circulation of the blood in the diseased parts, also in order to relieve the irritation to the nerves distributed to the organs and their marked reflex excitement. In some cases an expansion of the sphincters for one and a half inches or two inches is quite sufficient; other cases may require a little more thorough divulsion; but never weaken or paralyze the sphincters, as your patient needs their normal use, and you need the reputation of never causing incontinence of feces. Guard the usefulness of the sphincters as you would a valuable treasure.
As a rule, I treat all of the ano-rectal sacculated mucosa in cases where divulsion is required before performing the dilatation to break up the adhesions, and very frequently the muco-cutaneous sacs and distended veins as well. It may be well to delay the divulsion—with which there is usually no hurry—until you determine how many U-shaped (or hairpin shaped) mucus channels and recto-anal mucus fistulas there may be present that have passed down under the recto-anal mucous membrane, down to the integument about the anus, and then pressed immediately upward again along the outer wall of the anus and rectum, to the extent of six inches or more. There may be three, four, six, or more of them quite prominent as to length and size.
For the treatment of the recto-anal sacculated mucosa the injection method is par excellent. For the removal of the muco-cutaneous sac a double V-shaped incision, the proper depth, length, and width, will remove the surplus or redundant tissue, after which the edges are brought together with a catgut suture,—or omit the suture if you think best,—followed by the home attention as prescribed for fissure-in-ano in a previous chapter. At the time of removing the sacculated tissue attention may also be given to the mucus channel; or you may, if you wish, leave it so that at some future treatment you can give it the desired attention. A one or two per cent. solution of alypin, cocain, or beta eucain will produce the necessary local anesthesia for a painless operation. I remove only one muco-cutaneous sac at a treatment, which permits the patient to go about as usual without much inconvenience.
If you have removed all of the ano-rectal sacculated mucosa in a case, and have omitted to remove the one or more ano-muco-cutaneous sacs or dilated veins that are so often present around the anus, and have also neglected to cure the chronic proctitis, then the sacculated mucosa may, by some hook or crook, become excited again into an acute inflammatory condition, the sphincter muscles may grip tighter than usual, and lo, thrombus has taken place in a vein, and the wrinkled, shriveled, skinny tab or sac looks like a miniature balloon, and your dismissed patient is in a troubled state of mind to have everything come back on him so soon!
The cure was all right so far as it went, but there was the disease and some of the old external symptoms to tell the tale of an incompleted treatment.
Those muco-cutaneous sacs at the enteric crater’s mouth are just so many thermometers at its vent to tell the temperature occasioned by the fire of inflammation within, and they will damage your reputation as a proctologist if they be not removed. By all means get rid of these symptoms and indicators of trouble within; and if there should by chance be a little of the old proctitis remaining that wants to assert itself by making trouble, in becoming acute, it will be surprisingly handicapped in its efforts, and the chances are all in your favor; and you will, moreover, from time to time, hear what So-and-So said about the very successful treatment of his or her case.
Sacculated mucosa, muco-cutaneous sacs, submucous channels, etc., having their source in the rectum and anus, are all of a similar origin, the result of serous exudation. These symptoms of proctitis vary in development and number according to the nature and progress of the disease. In those cases that are quite exempt from sacculated mucosa (piles) you may expect to find submucous channels largely developed, and vice versa.
Too much stress cannot be placed upon the serious results of auto-intoxication by the absorption of mucus from channels and cavities that will hold from three to eight or more ounces of fluid at one time. They are no doubt rapidly emptied by the process of absorption into the system.
I have not referred to the fatalities of the hypodermic treatment of sacculated mucosa (piles or hemorrhoids) because of the fact that none have ever occurred within my knowledge among those using either this or a similar method of treatment.
CHAPTER XXIII.
Abscess and Fistula Involving Anus, Rectum, and Neighboring Regions.
Hippocrates, the father of medicine, Celsus, Galen, and other writers in the early times, described fistula as a disease; and, naturally enough, through the influence of heredity, contagion, imitation, and auto-suggestion, every author on the subject to the present day has chimed in most complaisantly with his “Ditto! ditto! ditto!” “Me too! me too! me too!” I am sure that the rank and file of my medical brethren will agree with me that modern authors are hardly justified in this servility to the ideas of the fathers of medicine in this recreance to their duties toward suffering humanity. Is it that they do not know better, or that they are naturally servile and thus too lazy to do their own thinking?
Let me in connection with this point call your attention to a practice that many of us have been suspicious of for a long time, a suspicion that has been confirmed for me by one who speaks from positive knowledge; otherwise I should not refer to it here. The practice I am about to describe will make it plain why we have so many “Ditto and Me-too” authors on proctology and other medical subjects.
An eminent surgeon who mentally is as large as the human race, and has room for all that is good in medicine and surgery, narrated the following incident of his career to a learned doctor from Georgia and myself recently. Snatching occasionally a few moments from a busy practice, he has prepared sufficient material to make a book, and desired some competent person to edit it before publication. So he consulted an ethical co-worker concerning such a person. In a few days a gentleman called at the doctor’s house to inquire about the contemplated publication. The caller asked the title and size of the book, and when told volunteered the startling information that he could have the work ready in a few weeks’ time, but that in the meantime he would like to hear the doctor lecture once or twice that he might catch a few peculiar expressions to use in the work, so that the doctor’s friends, when reading the book, would say, “That sounds just like the doctor; that is his style of talking.” The would-be scribe never asked for the author’s manuscript, so accustomed was he to rely upon the medical literature to be found in the libraries of the city for all the information needed. It is hardly necessary to add that the professional bookmaker was summarily dismissed. The doctor’s manuscript is still unpublished.
There is a third reason for so many “Ditto and Me-too” authors. Publishers of medical books naturally desire to extend their business, and in order to do this they must issue new works of medicine in the same way that lay publishing houses compete for new works of fiction. Now, doctors usually obtain professorships in some institution by paying five thousand dollars or more for them, and in due time a publisher of medical books will tempt the professor to become an author. They place before him their great facilities for getting up a book, arguing that consequently but little or no labor on the professor’s part is required. They point out to him the fame and honor the publication will bring him, and at the same time estimate how much money they will make out of it. In due time a “Ditto and Me-too” medical brief, résumé, or treatise, is published covering the whole history of the subject, from Biblical mention of it to the present day. All of us have observed what a great amount of stuffing or padding it takes to make a book that is to sell for five or seven dollars. It occurs to me that it might be wise to get up a conference of enlightened physicians to take some practical steps or to devise some laws that will prevent such impositions on the too confiding medical brethren by unscrupulous publishers that rob them of their hard-earned income through delusive advertising. Still, before any action is taken that would result in effectively closing the door to this practice, it may be as well that the eyes of more of us should be opened that we may not continue to be duped and stung again and again by “Ditto and Me-too” scrapbooks with hundreds of pictures. When seeking for new and better information to help suffering humanity, let us be served for a little while longer with “rehashed rot.”
Pardon this digression. We will now consider, at first hand, the subject of fistula.
As a rule, pus in a fistula is a secondary symptom of chronic proctitis, except those fistulæ that occur from traumatic injury to the region of the rectum, anus, and buttocks. Early in my practice I entertained the idea that the formation of pus occurred at the point of dissolution of the tissue, and that, as the volume of pus increased it made its way in the direction of least resistance through it, if the abscess had not been opened by an incision. The idea was well founded when it was applied to the traumatic origin of an abscess and fistula, but not when their origin was traced to chronic proctitis.
It may seem incredible to all who read this that a mucus channel or a fistula can be formed for ten, twenty, forty, or more years before the formation of pus takes place in it; and that the pus exerts no part in producing the diameter or length of the fistula, which may have a capacity of six, eight, or more ounces of fluid. As soon as the chronic inflammatory process has penetrated one or more layers of the mucous membrane, mucus channel or fistula-formation must take place. If the sphincter muscles be rather weak or lax I would not expect sacculation of the rectal mucosa to occur to any extent. In these cases, however, the muco-cutaneous channels are usually found quite large and numerous. Of course the extent of the ano-rectal symptoms in each case depend upon how severe the chronic inflammatory process has been, and is, at the lower portion of the enteric canal. Often you will find that the seat of the most active chronic inflammation is in the middle and upper portion of the rectum, involving also the sigmoid colon. In these cases the ano-rectal symptoms are not numerous, if there be any at all, on the mucous membrane, but under it you may expect mucus channels that serve as outlets for the inflammatory product.
In every case of chronic proctitis and sigmoiditis submucous and subtegumentary fistulæ can be found, and my experience in tracing them warrants me in stating that periproctitis and perisigmoiditis is present also; the latter pathological condition being due to the invasion of submucous and subtegumentary channels or fistulæ around the outside of the structure of the anus and rectum, extending far up into the neighboring tissues of the pelvic space that support the rectum and sigmoid flexure.
The formation of pus in a submucous or subtegumentary channel that has existed for many years does not make it a disease; it is only another incidental phase added to an already existing symptom of chronic proctitis.
Mucus fistulæ should be diagnosed and treated early in their formation, or at least before the tissues involved became so deteriorated as to form pus in quantity sufficient to occasion the usual period of suffering, fever, loss of rest and sleep before the pus is freed from its enclosure. The formation of pus in a mucous fistula is only incidental and marks a stage in the distinctive changes that have been going on for many, many years in the tissues involved in the inflammatory exudation.
The numerous small and large submucous and subtegumentary fistulæ found in every case of chronic proctitis and sigmoiditis was the most grave and far-reaching of the numerous symptoms, but for three decades I have fully realized the baneful effects from mucus irritation, and the self-poisoning by the absorption of large quantities of serum and fibrinous septic material from the surface of the mucous membrane involved, as well as that from numerous long, cavernous mucus fistulæ: a fearful double source of auto-intoxication, for which it is useless to prescribe diet, tonics, and travel for building up the system and restoring the health.
Besides the numerous general symptoms, arising from self-poisoning by fecal and mucus absorption, we have more or less marked local symptoms in many cases; and if these be not present, the diagnosis can be made out from the general debility of the system and the character of the chronic proctitis and sigmoiditis.
The local symptoms of mucus fistulæ, periproctitis, and perisigmoiditis are, each of them, universally diagnosed as a disease: Such symptoms as pruritus ani, scroti, vulvæ, lumbago, sciatica, myalgia, rheumatism, prostatitis, coxitis, disease of the coccyx, chafing about the anus and along the thigh and scrotum, difficulty in getting up after sitting for a while, pain in the back of the neck, lame back, legs feel tired, and sometimes pain is very annoying, abnormal color of the skin, painful or sore spots at times, confinement in bed for many weeks from severe continuous pain in and about the rectum, etc.
Up to the present time proctologists have paid little or no attention to proctitis and sigmoiditis, which is a grave disease, with a far more serious symptom, that of mucus fistulæ of great length and diameter, extending in all directions in the pelvic cavity and tissues of the buttocks, the large area of tissue found so full of holes, might be likened to a sponge occupying the same space. They are very numerous in every case of chronic proctitis and sigmoiditis.
This will explain why an incidental symptom like pus in a fistula is commonly called a disease by the “Ditto and Me-too” authors, and why it is so frequently met with in practice. At some hospitals one-half of the cases treated suffer from fistula in which pus has formed. Why the per cent. is not much greater I am unable to explain, except to give credit to the defensive and restorative power of the human body. If the periproctitis and perisigmoiditis, brought on by the mucus fistulæ, is not treated at the same time as the cause, the treatment will be of no consequence in effecting a cure of the chronic inflammation of the lower bowels. Every mucus fistula should be located and healed at the time that the disease itself is treated; then the work will be well done. Every mucus fistula should be diagnosed and treated before the breaking down of the tissues reaches the pus-forming stage, and thus obviate all suffering, annoyance, and possible death. Attention to this course will ensure your treatment of the disease, and its symptoms, to be taken in time.
The only hindrance to the successful office treatment of a fistula in which pus has incidentally formed is the fear that you can not cure it, or that you will fail, or that at a hospital it could be cured quicker, better, and cheaper. These ideas are born of heredity, timidity, fear-habit, power of auto-suggestion, and too much caution on your part. They are all falsehoods and should not be heeded for a moment. During thirty years of practice in my specialty I have sent seven of my fistula patients to a hospital for treatment, and four of that number I afterwards very much regretted sending, as I could have accomplished the cure in a safer and better way by the usual office method of cure. In fact every fistula, pus or no pus,—I do not care how bad it may be,—can be cured by office treatment and at the same time aided by the home attentions of the patient. There may be periods of a year or more when your energies are overtaxed with numerous patients, and you feel like dividing the labor with some fellow-practitioner, and this in a measure accounts for those I induced to go, or was willing to have go, to the hospital.
Unless overwork is the excuse, you need never send a fistula patient to a hospital for treatment. I have everything to say in praise of the ambulant treatment of ano-rectal fistula and the mucus channels, since my practice thus far has been devoid of any unfavorable results,—a fact which should have much weight in favor of the ambulant office treatment of all of the many symptoms of chronic proctitis, sigmoiditis, and colitis.
Mucus fistula is very easily healed in all cases, and those cases in which pus has incidentally formed are likewise not difficult to cure. All you need to do is to instill intelligence in a stupid patient, if you haven’t an intelligent one, and induce him to utilize or improvise a few home conveniences for cleansing the fistula night and morning between office visits. During the treatment of the fistula patients will be able to attend to their imperative duties.
To properly explore a fistula and its branches, if any, as to whether pyogenesis (pus) has taken place or not, it is essential to have the external opening through the skin of sufficient depth and size to permit of the application of remedies over all its surface. For a mucus fistula antiseptic remedies can be applied after a thorough irrigation by hot water at a temperature of one hundred and twenty degrees, or more, for half an hour or less time, as the case may demand. Where pyogenesis (pus) has occurred in a mucus fistula there may be more or less necrotic tissue formed, which will require the use of an escharotic remedy as well as very hot water irrigation, followed by an antiseptic remedy, if not already incorporated in the hot water used.
As a rule I see a fistula case once or twice a week, as the case may require. There is no packing of the fistula after the morning and evening home treatment—I have never found it essential. A T-bandage is worn, with absorbent cotton, over the opening of the fistula, preventing soiling of the clothes while attending to daily duties.
Never mind what the “Ditto and Me-too” proctologists have copied or rehashed about the curing of a fistula, which they persist in calling a disease. Just be resourceful, safe, and sane in all you do, and every fistula will get well long before you have cured the chronic proctitis and sigmoiditis, of which the fistula, as a rule, is a symptom.
CHAPTER XXIV.
Nine Radiograph Illustrations of Mucus Channels and Cavities.
I am indebted to Dr. Caldwell, of New York, at whose laboratory my patients were radiographed for the very excellent illustrations; and also to Dr. Albright of Philadelphia, for his assistance in the radiograph work, while attending my clinic, and who, later, with rare skill and scholarly ability, presented my discoveries in a large volume, entitled; A Practical Treatise on Rectal Diseases, Their Diagnosis and Treatment.
The following illustrations can only give a hint of the pathological conditions that existed. Fig. 1 shows seven, and Fig. 2, eight probes inserted, which by no means indicate the number of channels or size of the cavities; twenty-five to fifty or more probes inserted would more accurately indicate the excursions of the inflammatory exudate.
The seven following illustrations, in which Bismuth Paste was injected, did not meet my expectations in showing the pathological conditions that existed. The disappointment was largely due to a desire not to cause annoyance to my patients, who so kindly consented, in the interest of science, to being radiographed. In all cases the paste extended over a much greater area than a casual glance at the illustrations would indicate. The probes and paste were not inserted with the idea of making a diagnosis, but simply to suggest research on the subject by proctologists. All the cases radiographed suffered from proctitis, sigmoiditis, periproctitis, and perisigmoiditis.
Fig. 1.
Radiograph showing tube (1) in the rectum; 2, probe inserted 83⁄4 inches; probes 2 and 4 pass on left side of rectum; 3 and 5 pass on the right; all pass into perirectal spaces; three probes are seen under the integument.
Fig. 2.
Radiograph showing tube (1) in the rectum; probes 2, 4, 6, passed on the left and front of the rectum; 3 passed forward; 5 under the integument along the spine; 7, 8, and 9 probes passed to scrotum and thigh.
Fig. 3.
Radiograph showing a large region more or less filled with bismuth from the anal canal forward and upward, as indicated by lines 1 and 2; a severe case of proctitis, sigmoiditis, periproctitis, and perisigmoiditis.
Fig. 4.
Radiograph showing a tube in the rectum and probe passed to the left of the rectum into the space where bismuth was injected; a case of acute proctitis, sigmoiditis, periproctitis, and perisigmoiditis at time of treatment.
Fig. 5.
Radiograph showing bismuth in a perirectal channel on the left side of the anus and rectum, which caused continuous annoying pain for many months.
Fig. 6.
Radiograph showing a long muco-cutaneous sac and perirectal channel into which bismuth was injected; a case of proctitis and periproctitis, etc.
Fig. 7.
Radiograph showing a tube in the rectum, a long probe and bismuth in perirectal space, also a probe in a submucous channel; a case of sigmoiditis, proctitis, periproctitis, and perisigmoiditis.
Fig. 8.
Radiograph showing bismuth injected in the perirectal space; a case of proctitis, sigmoiditis, periproctitis, and perisigmoiditis with severe constipation and indigestion.
Fig. 9.
Radiograph showing tube in the rectum, a probe and bismuth in perirectal space, and also a probe in a submucous channel; a case of proctitis, sigmoiditis, periproctitis, and perisigmoiditis.
CHAPTER XXV.
Chronic Mucous Proctitis and Sigmoiditis—Usually Diagnosed as Chronic Mucous Colitis.
Chronic mucous colitis ought to mean inflammation of the ascending, transverse, or descending colon. The length of the rectum varies from five to eight inches, and the average length of the sigmoid flexure is about nineteen inches; the length of the two organs is thirty or more inches. Chronic follicular, ulcerative proctitis and sigmoiditis, extending half, or even the whole length of the sigmoid flexure, causes great suffering, and the symptoms are similar to those attributed to chronic mucous colitis. For about thirty years I have positively known that many of my patients suffered not only from chronic mucous proctitis, but from sigmoiditis as well, since I was able to make positive diagnosis of the diseased condition for at least ten to fifteen inches up the lower bowels.
If the anal canal is inflamed from any cause and not cured, the chronic inflammation will gradually extend up the whole length of the rectum and into the tissues of the sigmoid flexure, invading the organ to a greater part of its length, if not all of it. The sigmoid flexure is the normal receptacle for feces, and gases, and physiologically and hygienically ought to be emptied three times in twenty-four hours to keep it clean for those who are in the habit of eating food three times a day. The hygienic condition of the sigmoid receptacle is entirely dependent upon a healthy condition of the rectum and a sensible tenant of the body; but when chronic proctitis has taken possession of the rectum and neighboring tissues, it serves no longer as a normal passageway for emptying the sigmoid flexure of accumulated feces, gases, and liquids.
At first inflammation causes spasmodic muscular contraction of the anus and rectum, which in time becomes more and more permanent stricture as the progress of disease advances, lessening the bore of the organs until it becomes very difficult for anything to pass into and through the rectal and anal canals. Inflammation extending from the rectum into the sigmoid flexure for perhaps its whole length, interrupts its functions likewise, thus creating another cause for undue accumulation of feces and gases in the organ; this accumulation of the waste material of the body becomes very foul, generating toxic gases, putrid substances, and poisonous germs which in turn irritate and excite the diseased organ from their constant contact with the follicular ulcerated mucous membrane of the sigmoid receptacle. Why should we not find in these cases all the symptoms attributed by authors to chronic mucous colitis? Especially so when we have, in addition to the enumerated symptoms of colitis, those caused by periproctitis and perisigmoiditis, which are always present and quite severe.
As a rule, the symptoms which have been diagnosed as those of chronic mucous colitis, membranous colitis, or ulcerative colitis are nothing more than symptoms of chronic mucous proctitis and sigmoiditis, accompanied by periproctitis and perisigmoiditis. Proctologists who have written on the subject of mucous colitis have noted the many symptoms very accurately, but have missed the usual location of a most aggravating disease from which mankind suffers early and late in life. Authors of books on stomach and intestinal troubles are also groping very much in the dark and are unable to diagnose the cause of a very common functional disturbance of the whole digestive apparatus, caused by proctitis and sigmoiditis, bringing numerous and severe primary and secondary symptoms to which other diseases may be traced.
Chronic proctitis and sigmoiditis and their local symptoms convert the sigmoid receptacle into an Augean stable, from which foul poisonous gases and germs are forced up and along the bowels, distending the descending and transverse colon and finally reaching the ascending colon and the cæcum, causing undue retention of their contents; hence so much attention to the cæcum and the vermiform appendix. The ends of a long rubber tube distended with gas will exhibit more strain and disturbance than the intermediate parts, and the same is true of the colon, owing to the intermediate sections of the organ possessing greater mobility. The great volume of gases confined in the colon prevents its normal peristaltic action, causing undue retention of contents, with resulting inflammation of the cæcum, as well as dislocation of the stomach, colon, etc., and suggesting radiographic and fluoroscopic examination and surgical operations to discover the cause of all the trouble, which should have been learned through use of the speculum before so many complications occurred.
In all cases of chronic mucous proctitis and sigmoiditis where there is a great amount of secretion of mucus, membranous cords, shreds, and casts (called mucous colitis), I have found the marked acute symptoms more or less periodic and accompanied by increased inflammation in all the tissues involved in the disease, which convinced me that the colitis we read about had become dislocated and was where I could see its results without the use of a speculum.
Through often witnessing the phenomena, I have learned what a “mucous colitis” storm means from a pathological exhibit, a personal demonstration, and a verbal description of what the sufferer is enduring. It requires the stuff heroes are made of to endure chronic mucous proctitis and sigmoiditis for ten, thirty, or forty years without the disease being accurately diagnosed, and to be told that all treatment is useless and that the trouble is in the head of the sufferer, that he is a hypochondriac, and a neurasthenic, terms often used by doctors who are unable to make a proper diagnosis of a case.
The common symptoms of mucous colitis have been accepted by writers on the subject, but as to the real cause of them there has been thus far only mere conjecture, just as the writers have been doing as to the cause of pruritus ani, scroti, and vulvæ. Dr. George M. Niles, of Atlanta, Ga., says: “In looking up the literature, one is amazed at the divergent views as to the etiology and management held by diligent students and competent observers. It is fairly well agreed that most cases occur in nervous, neurasthenic, hypochondriac, or hysteric individuals.” Others blame the liver, hysteria, constipation, fermentative processes in the intestines. How foolish to name symptoms of the disease as a probable cause of it! It is not necessary for me to again enumerate the many primary and secondary symptoms of proctitis and sigmoiditis, but I will mention briefly a few nervous symptoms which I think are due to the absorption of mucus into the system. There is that intense, exasperating, sore, and restless feeling, with inability to concentrate the mind, with the nerves and muscles of the body pinched and contracted. Such feelings are at their height during an acute mucus storm, which is an indication of increased inflammation in all the inflamed tissues, causing secretion of a great quantity of mucus or membranous casts. No doubt much of the inflammatory exudate from the mucous membrane, from the muscular structure of the organs, and the connective tissue surrounding and supporting the organs, passes into the sigmoidal and rectal canals, while a portion is absorbed into the system. In a similar manner, the inflammatory exudate from a subtegumentary mucus channel and cavity passes through the skin, causing moisture of the skin, pruritus ani, scroti, and vulvæ. I know of no non-malignant disease, where the symptoms may truly be said to be a thousand times worse than the disease that caused them, except in chronic proctitis and sigmoiditis.
Treatment of such cases has been very successful in my practice, requiring four principal aids: (1) Local treatment; (2) medicated enemata; (3) local medication; (4) the recurrent application of medicated hot water at a temperature of 125 to 135 or more degrees. A further valuable aid is the determination of the sufferer to get well by faithfully carrying out the home treatment. The more a patient studies my diagnosis and treatment of his case, the more he is encouraged that eventually a cure will be effected. Dr. James Moran of this city has been a student and assistant at my office for more than three years, and will bear testimony to the success of my treatment in all cases observed by him.