External Anal Pressure.
This is of very important assistance in flushing the colon, as it aids in preventing the return of the injected water, and thereby promotes its conveyance along the colon until it arrives at the surgically famous vermiform appendix. It is not strange that both ends of the large intestine—the anus and rectum and the appendix region—have kept the surgeons busy, and I may add the undertaker likewise. These two ends are of extraordinary concern, because they manifest intense symptoms and pathological consequences. Modern medical practice is the heroic treatment of symptoms and consequences and not patient search for causes of disease and sensible treatment of it, as explained in my treatise dealing with “Intestinal Ills,” as well as in the present volume.
Water Pressure.
Two or three gallons of water, suspended at the usual height of enemata appliance, affords quite enough pressure, especially when the outlet and tubing are amply large. The shut-off on the rubber tube enables the user to gauge the flow of water to a nicety.
Time Required.
The time required for taking an internal bath—that is, for a complete flushing of the bowels—will vary in individual cases. After removing the local deposits in and near the rectum by one or two rapid injections of very small quantities of water, two to four quarts are taken into the intestinal canal at one time, and this constitutes the enema proper. Now, many persons will find it advantageous to let the flushing water enter very slowly, taking from two to five minutes, or even more. With some, if the water is allowed to flow in very rapidly, the various segments of the rectum and colon may not readily accommodate themselves to the inflow, and will too soon make an expulsive effort, returning the water before it has dissolved the feces or united with them, thus defeating the object sought through the enema. With other persons, however, the flow may be as rapid as desired. The speed must be left to individual judgment and experience.
Temperature of Water for an Enema.
The chief purpose of an enema is to produce depuratory results; that is, to remove morbid matter from the bowels and then to cleanse them. To accomplish this effectively and at the same time to avoid exciting an increased flow of blood to the diseased gut, the water should be about the normal temperature of the body, which is about 98 1/2 degrees. Water too hot or too cold will aggravate the sensitive, inflamed surface; and, as it is this very inflammation that causes the abnormal action of the bowels for the relief of which the enema is taken, the temperature of the water is most important. If it range between 90 and 105 degrees it will do, for within those extremes it will not be likely to increase the existing chronic engorgement of the tissues. Under no circumstances should very hot or very cold water be used for the removal of fecal accumulation. Physicians so incompetent as to make a wrong diagnosis of the cause of chronic constipation and its numerous symptoms often prescribe a wrong treatment in the use of water. From two to ten minutes’ use of very hot or very cold water in cases of proctitis and colitis will only increase the chronic engorgement of the blood-vessels and tissues and increase the morbid symptoms. When water is applied to the mucous membrane anywhere throughout the body, I use it hot exclusively, as that temperature has then certain advantages over cold. In the chapters treating upon the different uses of hot water, I give the hydro-therapeutic action of such liquid on the tissues of the body.
Quantity of Water to be Used.
The quantity of water to be injected into the colon at one time must vary in each case and also on each occasion. In the beginning of its use and for some time following, a greater amount may be required than will be necessary when, with its continued use, a better action of the bowels becomes established.