A physician who prescribes for a case of chronic constipation or diarrhea without first examining the sufferer for proctitis and colitis, is either ignorant or does wilful harm to his patient and injury to his practice. The abominable, aboriginal and almost universal custom at the present time of giving some physic to "cleanse" the gastro-intestinal canal is in every respect a deplorable mistake for a conscientious doctor to make.
Many persons suffering from chronic constipation drink very little or no water. As a consequence, they are a sort of dirty, dried-up plant, with but little juice of life in them.
Others, again, equally unclean, or more so, take a moderate amount of fluid every day, and present a more or less roly-poly appearance, with considerable abdominal distention, due to malnutrition and gases. Of course, their eyes, skin, tongue, breath, and lack of vim and vigor tell the story of a long process of self-poisoning, with every now and then the eventuation of a storm of foulness, called a bilious attack—meaning an overflow of filth. Death often brings about a radical change in such poisoned bodies.
Now, what can a prescriber of a gastro-intestinal ejector expect to accomplish by disturbing the maleconomy of this apparatus? Usually he expects that considerable trouble will ensue; consequently, he will add belladonna or some other soothing drug to mitigate the act of expulsion. The ejector (called laxative, purgative, cathartic) occasions irritation, which sets up twisting, writhing, rumbling of the bowels, accompanied with a shower of liquid into the canal (as tears fill the eyes from the effects of sand or a blow), which liquid mingles again with the putrid refuse materials, from which it had been recently absorbed, and, mingling, proceeds to fill up the normal and abnormal spaces just described, to be again reabsorbed into the system. Oh, the foulness of it all! The spirits of the departed, as well as the still incarnate patients, demand of the healing art safe and sane hygienic methods of cure. The enema, regularly and properly used, is the remedy par excellence.
Those that suffer from chronic constipation are usually deficient in the quantity and quality of intestinal secretions. Physic increases the depletion of the intestinal juices. Of the watery secretion forced into the bowels, four-fifths are reabsorbed into the system, plus poisons and filth. The system soon becomes accustomed to the irritation of drugs, and requires an ever-increasing amount. These irritate and increase the chronic inflammation of the lower bowel, often to the extent of a discharge of blood.
Straining effort to induce defecation is injurious. The use of massage, of vibratory exercises, of electricity; the spraying of cold water on the abdomen, etc.,—none of them are calculated to remove or even to relieve the proctitis and colitis.
The temperature of the water used for an enema should be about one hundred degrees. It should be taken at least twice daily, preferably on retiring at night and soon after breakfast, at regular times, if possible. Such practice obviates the need of large injections.
In beginning the use of the enema it is well to inject from a half to a pint of water, and expel it. This constitutes a preliminary injection. Frequently it is desirable to take another preliminary injection before taking the large one, which latter is variously called "flushing the colon," "taking an enema," "taking an internal bath" or "a washout," etc. It is essential first to get rid of the feces and gases in the rectum, so that they be not sent back when you proceed to flush the colon.
NO. 2.