,transcriber's notes3 ,the text of this book has been preserved in its original form apart from correction of two typographic errors3 incidently incidentally1 flouroscopic fluoroscopic4 ,inconsistent hyphenation has not been altered4 ,in this transcription italic text is denoted by underscores4 ,a caret 77 indicates that the following bracketed characters are superscripted4 ,footnotes have been numbered and positioned below the relevant paragraphs1 and some illustration captions have been moved closer to the relevant text4 ,numbering and labelling of illustrations is somewhat flawed1 although it is hardly noticeable in this plain text version4 ,figure #bj does not exist and figures #ah-bd are not in correct numerical sequence4 ,the text has several references to figures #be1 #bf1 #bg and #bi but these do not exist as figures in their own right - the numbers actually identify labelled items in figure #ah4 ,illustration3 ,hargrave #eth ,ave4 #cgth ,st41 ,new ,york4 ,,intestinal ,,irrigation ,,or ,,why1 ,,how1 ,,and ,,when ,,to ,,flush ,,the ,,colon ,,treated ,,in ,,connection ,,with ,,other ,,matters ,,of ,,physiological ,,interest ,,and ,,importance ,,by ,,alcinous ,b4 ,,jamison1 ,m4,d4 ,,author ,,of 8,,intestinal ,,ills10 8,,how ,,to ,,become ,,strong10 ,,etc4 ,published by the ,author ,,third ,,edition ,,new ,,york ,,city #dc ,west ,forty-fifth ,street #aiad ,,copyright1 #aiad ,,by ,,alcinous ,b4 ,,jamison 8,even from the ,body's ,purity1 the ,mind ,receives a secret sympathetic aid40 --,thomson4 ,,preface4 ,within the last three decades the diagnosis and treatment of bowel troubles have been greatly changed through improved instruments1 technique1 hygienic measures1 and various remedial agents4 ,the domain of surgery of the anus1 rectum1 etc41 has been surprisingly limited1 and that of gastro-intestinal hygiene enlarged1 together with knowledge of man's assimilative and eliminative organs4 ,systemic and local hygiene has supplanted drugs and surgery in the treatment of diseases of the anus1 rectum1 sigmoid flexure1 and vermiform appendix4 ,indeed1 the domain of surgery will be restricted to what are still considered incurable diseases if the suggestions of this volume are widely adopted4 ,from a clinical experience extending over a period of thirty-three years1 however1--as a specialist in diseases of the anus1 rectum1 and intestinal machinery generally1--the author feels warranted in maintaining that1 if hygio-therapic measures were taken by both physicians and laymen1 surgical clinics and hospitals for 8operating0 on anal and rectal diseases and the administering of countless medicinal remedies would enter the stage of therapeutic oblivion4 ,the present work is more comprehensive in its scope than its title1 ,intestinal ,irrigation1 would at first thought seem to indicate4 ,it is a practical book on home relief for all the symptoms of that form of internal inflammation known as proctitis and colitis4 ,the measures that may safely be taken by the victim himself1 without consulting a physician1 are minutely explained2 and1 that he may understand his own case1 every chapter goes more or less extensively into anatomical1 physiological1 and pathological details4 ,the author has kept abreast of the advancement of science in relation to his special branch of the healing art1 and as the outcome of his large daily experience in this line he feels qualified to speak with authority4 ,victims of any of the symptoms described in this book may therefore have confidence in its statements4 ,it conveys a message of common sense to the world at large and to the victims of intestinal ills in particular4 ,it is a compilation of clinical talks to the author's patients1 making plain a variety of symptoms arising from a single primary cause4 ,as the purpose of the book is pre-eminently practical1 the author felt warranted in describing minutely his own clinics1 so far as any patient could apply the results to his individual needs4 ,this1 therefore1 is the author's excuse for introducing his own appliances and describing their features and uses4 ,certain work must be done by the sufferer himself1 and no other invention in the market will aid him so materially in doing this work scientifically and efficiently4 ,furthermore1 it was found impossible for the author to describe what he himself was doing as a rectal specialist1 or to direct sufferers on the road to relief1 unless he stated how certain appliances should be employed4 ,in the following pages1 consequently1 the reader will learn just what to do1 for the work is above all things simple and direct1 and in the writer's judgment has the sterling quality of common sense4 ,some of the chapters have already appeared1 in abridged form1 in the magazine ,health1 as contributed essays2 but the text has been elaborated in the following pages and much new matter added1 in order that the work should present the most mature information concerning the subjects discussed4 ,a4 ,b4 ,j4 ,new ,york1 ,march #b1 #aiad4 ,,contents4 ,,chapter ,i4 ,,page ,efforts to ,overcome ,constipation without ,seeking its ,cause #a ,,chapter ,,ii4 ,pathology of the ,anus and ,rectum2 or1 ,the ,genesis of ,constipation #h ,,chapter ,,iii4 ,the ,formation of ,channels1 ,piles1 and ,fistulas #ai ,,chapter ,,iv4 ,undue ,retention of ,gas and ,feces in the ,sigmoid ,flexure #bh ,,chapter ,v4 ,rebellion of our ,outraged ,internal ,economy #ce ,,chapter ,,vi4 ,gaseous ,obesity and our ,roly-polies #df ,,chapter ,,vii4 ,irrigation of the ,assimilative and ,eliminative ,organs #eg ,,chapter ,,viii4 ,methods of ,stomach ,cleansing #fe ,,chapter ,,ix4 ,when ,enemas should be ,taken #gb ,,chapter ,x4 ,how ,enemas should be ,taken #hd ,,chapter ,,xi4 ,the ,internal ,fountain ,bath #ij ,,chapter ,,xii4 ,benefits of the ,inner ,bath #aja ,,chapter ,,xiii4 ,objections to the ,use of the ,enema ,answered #ajh ,,chapter ,,xiv4 ,lame ,back #aba ,,chapter ,,xv4 ,uric ,acid #abf ,,chapter ,,xvi4 ,rational ,sanitation and ,hygiene #acf ,,chapter ,,xvii4 ,personal ,cleanliness #ade ,,chapter ,,xviii4 ,hot ,water in the ,treatment of ,proctitis and ,colitis #aeb ,,chapter ,,xix4 ,hot ,water in the ,treatment of ,external ,symptoms #afb ,,chapter ,,xx4 ,the ,health of ,school ,children #afe ,,chapter ,,xxi4 ,internal ,hemorrhoids or ,piles versus ,mucous ,sac1 ,recto-,anal ,mucous ,sac #aga ,,chapter ,,xxii4 ,external and ,thrombotic ,piles versus ,muco-,cutaneous ,sac and ,thrombus #aha ,,chapter ,,xxiii4 ,abscess and ,fistula ,involving ,anus1 ,rectum and ,neighboring ,regions #aij ,,chapter ,,xxiv4 ,nine ,radiograph ,illustrations ,showing ,mucus ,channels and ,cavities #bjj ,,chapter ,,xxv4 ,chronic ,mucous ,proctitis and ,sigmoiditis--,usually ,diagnosed as ,chronic ,mucous ,colitis #bjb ,,chapter ,,xxvi4 ,antiseptic ,employment of ,powders and ,oils #bjh ,,intestinal ,,irrigation4 ,,chapter ,i4 ,,efforts ,,to ,,overcome ,,constipation ,,without ,,seeking ,,its ,,cause4 ,in the year #adif an ,italian1 ,gatenaria1 invented an appliance for taking an enema2 since that time depuratory instruments have had more or less vogue in all civilized countries4 ,of late years inventive powers have been taxed to construct more convenient and effective appliances1 and now perfection has been almost reached1 and the poor civilizee1 whose habits are really very bad from the savage point of view1 may enjoy the delicious privilege of an internal bath whenever he feels the need of it4 ,by any other name this bath is just as purifying3 call it irrigation1 injection1 lavement1 clyster1 enema--its many names and what they mean testify to the fact that it is for the disease of civilization4 ,the medical profession is really behind the layman in genuine therapeutic measures4 ,it still cares more for the pill-and-powder-prescription-earning fee than for the real health of the patient4 ,when it shall wean itself from its sordid commercialism1 it will make the use of the enema a fundamental factor in most forms of therapeutic treatment1 and then the enema will become universal4 ,from the origin of the enema to the present day1 the layman has not been unmindful of this valuable resource for removing morbid matter from his physiological sewer4 ,the great relief he thus obtained1 and the invariably good results that followed its use1 established as a necessary toilet article some form of depuratory apparatus in many homes for all time to come4 ,but of the nature of the disease that had occasioned its use1 both layman and physician were1 and for the most part are1 ignorant4 ,local obstruction and discomfort were sufficient to suggest this mode of relief2 yet no truly scientific inquiry seems to have been instituted to discover the cause of the obstruction4 ,the author1 during an experience of over twenty-three years as a specialist in diseases of the bowels1 rectum1 and anus1 has found the true cause1 namely1 ,,proctitis2 that is1 the chronic inflammation 7dating often from infancy and childhood7 of the anus1 rectum1 and frequently of a portion of the sigmoid flexure and colon4 ,proctitis is practically the universal cause of chronic constipation4 ,victims of constipation have more or less haphazardly resorted to the enema as a ready means of relief--a recourse that was often1 nay generally1 against the advice of their medical counselor3 a professional opposition that indicates either ignorance1 mistaken judgment1 or fear of losing a profitable patient4 ,but the layman has not been uniformly wise4 ,he is an experimenter on his own hook--encouraged in his experiments by the most promising and seductive of advertisements in the whole gamut of advertising4 ,he experimented on his organism1 tinkering it now with cathartics or purgatives of multiform nature1 and again with digestive and other agents4 ,this tinkering habit seems to have become all but universal with civilized man4 ,constipation--which is caused by proctitis--will1 of course1 bring indigestion and biliousness and diarrhea and nervousness and headache and a host of other maladies in its train2 all of these induce the civilizee to increase his tinkering with his divine abode until it eventually falls in ruins4 ,the tinkerer loses sight of the fact that his abode is not a body like the bodies of wood1 stone1 and iron that he handles and putters with daily2 he forgets or ignores the fact that it is a vital organic machine1 which1 when tinkered too much1 will stop1 8never to go again40 ,it is poor consolation when you have reached your last gasp1 after a chronic invalidism1 to feel that you have done the best you knew how4 ,you have not sought the cause1 nor1 having learned it somehow1 sought to remove or avoid it4 ,for the last four hundred years this tinkering1 this futile medication1 has been kept up at a furious pace without even a hope of permanent cure4 ,poor1 outraged human nature dimly knew that it was simply doctoring a symptom1 a consequence of something or other--for that is all that constipation and its host of symptoms really are4 ,the writer is of the opinion that constipation is the fundamental disease that afflicts mankind2 that1 at all events1 there are more cases of proctitis than of any other disease2 that very few 8civilized0 persons are free from it2 that so prevalent a disease must have a common origin1 which he traces right back to babyhood1 to the wearing of soiled diapers1 a practice that cannot but result in inflammation of the buttocks and mucous membrane of the anus and rectum2 and that this inflammation continues and finally becomes deepened and established1 producing in after years chronic constipation and its train of evils4 ,of course1 there are other causes that bring on proctitis among children and adults2 but careful examination shows that the severity of the malady with its train indicates long duration in the tissues comprising the wall of the anal and rectal canals and the adjoining tissues of the bowels4 ,proctitis1 with its extension1 colitis1 is by no means a slight disease1 as it is supposed to be by a few members of the medical fraternity who are beginning to apprehend its existence2 on the contrary1 it is so serious that its gravity cannot be impressed too forcibly upon both laymen and physicians4 ,during the many years of special attention the writer has given to diseases of the anus1 rectum1 colon1 etc41 he has not ceased to wonder how it was possible that the victim of deep-seated proctitis could have so dreadful a disease and not be greatly alarmed at its ravages and dangers4 ,the anatomy1 physiology1 and hygiene of the parts involved in this inflammation continue in some manner to permit the passage of excrement along the diseased canal2 and the victim continues to swallow drugs and tinker with these--his irreplaceable 8inards40#a #a ,for numerous illustrations of the various morbid conditions of the anus and rectum1 see the author's #fd-page booklet1 entitled ,how to ,become ,strong4 ,it is not my purpose at present to go into a detailed description of the organs involved in this inflammatory process1 but to make plain why the enema is superior to all other means of securing cleanliness4 ,when we know why we do a thing1 the task is not so difficult and annoying as when we go it blind or simply obey the behest of a physician4 ,ignorance has no business bothering with anything2 experience1 however1 is usually a painful if not a fatal instructor4 ,the human race at large is ignorant concerning the normal and abnormal processes of its internal organs4 8,out of sight1 out of mind0 seems to be the maxim of almost every one as to our vital organs and the conditions for their hygienic functioning4 ,the purpose of the writer will be achieved if he succeed in sounding a note of warning that will be heard and heeded by those whose influence will extend the echoes till the world listens and learns the claims of the inner physiological economy4 ,those that possess even a modicum of sense will easily understand how a muscular tube like the anus1 rectum1 sigmoid flexure1 etc41 when invaded and traversed for eight to ten or more inches by disease1 will offer obstruction to the descent and escape of gases and feces4 ,all are familiar with the contraction that occurs when a finger1 hand1 or limb is inflamed2 how little we can then use the diseased part until all of the inflammation has left the muscular tissue4 ,why do we give so much attention to an inflamed external part and none at all to the all-important internal organ for the expulsion of the sewage of the body8 ,the parts are not 8weak0 when contracted with inflammation3 weakness is not what is the matter with them4 ,the trouble is that the muscular fiber is then too active1 made so by the excessive irritation of the local disorder4 ,irritation of muscular tissue always causes contraction of its fiber4 ,such contraction well accounts for constipation4 ,we are a nation of constipated people1 so constipated indeed that we have developed dyspepsia and neurasthenia4 ,as ,i have already stated1 the chief ill of 8civilized0 people is proctitis2 the chief symptom of proctitis is constipation2 the chief symptom of constipation is dyspepsia2 and the chief symptom of dyspepsia is neurasthenia1 and so on and on--all of them the outcome of imperfect elimination of morbid matter from the intestinal canal4 ,the common sense learned in the treatment of external parts should be applied to such diseased portions of the body as the anus1 rectum1 etc4 ,common sense declares that an enema ought to be used on all occasions of undue retention of the contents of the bowels4 ,it is the only sensible thing under the circumstances4 ,yet1 for the last four hundred years1 only independent men and women have had the courage to proclaim its merits1 since the subject was under the ban of both laymen and physicians4 ,now that we have learned the absolute necessity of such a device1 it is to be hoped that the taboo will be removed1 and that the numerous victims of proctitis will be instructed in the wisdom of availing themselves of the valuable aid of the enema in either curing proctitis or preventing it from growing worse1 while they are at the same time securing relief through its use by the removal of feces and gases several times daily1 thus preventing the absorption of poison1 which the retention of waste invariably facilitates4 ,,chapter ,,ii4 ,,pathology ,,of ,,the ,,anus ,,and ,,rectum2 ,,or1 ,,the ,,genesis ,,of ,,constipation4 ,when an affliction is seemingly universal it is reasonable to conclude that it springs from universal conditions4 ,proctitis1 the most widespread disease of civilized man1 originates very early in life1 and develops in after years numerous painful symptoms--such as piles or hemorrhoids1 constipation1 etc4 ,now1 what is the most common exciter of proctitis1 which1 as has been said1 is an inflammation of the mucous membrane of the anus and rectum8 ,in my earlier work1 ,intestinal ,ills1 ,i have shown that inattention to the soiled diaper is generally the original cause of this most grievous of ills1 with its train of malign consequences continuing throughout the victim's life on earth4 ,unnoticed by nurse or mother1 the inflammation of the anus and rectum makes headway with each subsequent soiling2 and thereafter1 when the use of the diaper is dispensed with1 inattention to the normal action of the bowels1 improper food1 the resort to purgatives1 stimulants1 and opiates1 play no small part in aggravating the existing malady4 ,illustration3 ,fig4 #a4 ,a portion of the wall of the rectum has been removed exposing various layers3 #a1 serous layer2 #b1 muscular layers2 #c1 #c1 submucous layers2 #d1 #d1 mucous membrane2 #e1 internal sphincter muscle2 #f1 external sphincter muscle2 #g1 circular muscular bands forming the rectum2 #h1 rectum2 #i1 sigmoid flexure4 7,see ,fig4 #g1 showing the longitudinal muscular bands47 ,the first care-taker of the infant is therefore responsible for the initial process1 which progresses to a chronic condition by subsequent inattention4 ,she is indeed solicitous over the inflamed buttocks of her charge1 but overlooks the far more dangerous inflammation of the mucous membrane of the anus and rectum1 or she does not realize its insidious and subtly progressive character4 ,candidates for motherhood should be instructed on this momentous subject4 ,illustration3 ,fig4 #b4 a1 ,ulcer on sphincter ani4 b1 ,filaments of two nerves are exposed on the ulcer1 the one a nerve of sensation1 the other of motion1 both attached to the spinal marrow1 thus constituting an excito-motory apparatus4 c1 ,levator ani4 d1 ,transversus perinei4 7,hilton47 ,there are other exciting causes of proctitis1 but1 since they are exceptional when compared with the neglected diaper1 we need not concern ourselves with them at present4 ,the muscular coat of the rectum consists of two layers3 an inner circular and an outer longitudinal band4 ,the inner circular layer of muscular tissue of the rectum forms the internal sphincter muscle2 and the outer longitudinal bands merge with those of the external sphincter4 ,the anal orifice is closed or guarded by two strong sphincter muscles1 as shown in ,figs4 #a1 #b1 and #c4 ,these muscles are abundantly supplied with nerves1 of which branches are distributed to the bladder and other adjacent organs1 which accounts for the sympathy of these organs and their grave disturbance when disease inheres in the anus and rectum4 ,illustration3 ,fig4 #c4 a1 ,sacrum4 b1 ,coccyx4 c1 ,tuberosity of ischium4 d1 ,posterior or larger sacro-sciatic ligament4 e1 ,anterior or small sacro-sciatic ligament1 with the pudic nerve passing over its posterior aspect1 and proceeding to the rectum and penis4 f1 ,sphincter ani receiving its nervous supply from the pudic nerve4 ,portions of the muscles have been cut away1 in order to show nerve filaments going to the mucous membrane1 through the muscular fibers4 g1 ,levator ani4 h1 ,fat and areolar tissue occupying the ischiorectal fossa and covering the levator ani4 i1 ,transverse muscles of perineum4 k1 ,erector penis4 l1 ,accelerator urin4 #a1 ,pudic nerve4 #b1 ,posterior sacral nerves proceeding to posterior part of the coccyx and to the sphincter ani4 #c1 ,anterior sacral nerve 7#dth7 supplying the sphincter ani4 7,hilton47 ,the orifice used for the elimination of undigested food and waste matter plays quite as important a part in the organic economy as the orifice that is employed for receiving food4 ,normal elimination1 physiological and psychological1 is the correlative process to prehension 7seizure or appropriation71 and the concord of the two forms the key-note of the organism4 ,the muscles and tissues constituting the anal vent should be as flexible and responsive to the will or desire of the rectum for relief of its contents as the lips are in permitting the saliva to escape4 ,in like manner the upper portion of the rectum 7,figs4 #f and #h7 should respond with instant readiness to the effort of the sigmoid flexure to expel its contents4 ,but an abnormal condition like inflammation rooted in the anus and lower part of the rectum 7,fig4 #a1 #d-d7 will inhibit the passage of the pressing burden above them1 which inhibition will cause the inflammation to extend to the sigmoid flexure1 and thence on to the colon proper2 and sooner or later the inflammation will penetrate the submucous coat 7,fig4 #a1 #c-c71 which is composed of fatty or areolar connective tissue in which trunks of nerves and blood-vessels are imbedded4 ,the first symptom of inflammation is undue redness1 followed by slight puffiness of the anal and rectal mucous membrane 7,fig4 #a1 #d-d71 with more or less sensitiveness of the tissues involved2 and as its irritability increases there is more or less contraction of the muscular tissue forming the anus and rectum1 which lessens the diameter of their bore4 ,and the consequence of this contraction is of physiological concern to the victim1 for in proportion to the contraction the normal demand of the victim for relief of the impending feces and gas is modified and lessened4 ,in health1 the anal canal is from two to three inches in length1 and it will distend about two inches--an elasticity quite equal to that of any other orifice of the body4 ,as the anal tissues are usually the first to be invaded by disease1 it is but natural that the obstipation or constipation should occur right above it--namely1 in the rectum4 ,the average length of the rectum is about six inches1 and when the disease invades its whole length the constipation occurs in the sigmoid flexure and may thence extend to the colon4 ,the filling of the intestine with feces and gases usually occurs just above the diseased portion of the gut2 but at the same time the walls of the affected part of the canal are more or less coated with feces1 and its abnormal pouches here and there contain more or less liquefied or dried feces4 ,a diseased canal cannot expel all of its contents1 since its normal expulsive power is gone4 ,some of the feces somehow or other gets down and out1 but a larger portion inevitably remains4 ,it is for this reason that a diseased intestine always reminds one of the ,augean stable4 ,it is simply marvelous that the human body continues as a living organism with so much filth and bacterial poison stored in its alimentary canal1 and the vaults that result from abnormal pressure during periods of fecal impaction 7,fig4 #d74 ,when the inflammatory process extends up the rectum and at the same time into the spongy1 fatty1 or areolar tissue under the mucous membrane 7,fig4 #a1 #c-c71 thence to the muscular and serous layers 7,fig4 #a1 #b-a71 or through the four layers of tissue comprising its wall1 we have a more marked and serious occlusion 7closing7 of the organ than when only the mucous membrane was affected4 ,when muscular tissue is inflamed1 its tendency is to contract and become solidified by an adhesive inflammatory product secreted between the circular and longitudinal muscular fibres 7,fig4 #a1 #g1 and ,fig4 #g74 ,often the circular or sphincter muscles forming the anal canal have to be distended to bring about a more normal vent4 ,the same pathological conditions that occasion contraction of the anal bore or caliber occur1 more or less1 as far up the gut as the disease has advanced4 ,in a normal state of the lower bowel the sigmoid flexure passes its contents into the rectum1 and the desire to defecate is reported--that is1 the impulse to stool becomes more or less urgent until it is performed4 ,but when all four coats of the anus and rectum are diseased1 with perhaps a portion of the sigmoid flexure also1 it is very difficult for the healthy portion of the sigmoid flexure and the colon to discharge their contents into the rectum2 consequently no call1 impulse1 or desire reaches the mind4 ,constipation will then ensue1 for the stool1 not being called for1 is not performed4 ,every demand of a healthy portion of the intestine is answered by increased contraction of the muscles of the diseased portion of the rectum4 ,while the war between the healthy and the diseased sections of the bowels goes on1 the victim naturally concludes that there is no occasion or demand for defecation1 and he attends to other affairs1 ignorant of the fact that he is thus making a fatal mistake4 ,the first condition that ensues is the tendency of the rectum to fill unduly with feces and gases1 impelling the victim to 8strain0 in order to force the feces through the constricted anal canal4 ,after a while the sigmoid flexure and colon will fill unduly1 and then the victim will form the habit of waiting for the feces to descend1 and of straining to expel what little manages to escape through the diseased gut4 ,a portion of the imprisoned feces in the healthy section of the intestine sometimes1 at an unguarded moment1 manages to distribute itself along the length of the diseased and constricted canal1 where it is retained indefinitely1 increasing the local irritation4 ,and when the fecal mass accumulates sufficiently in both the healthy and the diseased portions of the intestines to set up a vigorous excitement1 the victim may1 by the aid of his waiting and straining habit 7which habit1 by the way1 only torments and bruises the chronically diseased organs71 bring on some sort of evacuation4 ,in the early history of the disease this habit may serve for a time2 but1 as the disease progresses1 the 8laxative0 habit is formed1 which1 in turn1 settles into a chronic 8drug0 habit for all sorts and conditions of gastro-intestinal and other ills1 which inevitably ensue4 ,as the ravages of chronic inflammation of the anus and rectum increase1 the symptoms rapidly multiply1 till finally the victim1 in desperation1 feels that he must find additional sources of relief--and1 among other habits1 he forms the 8diet0 habit4 ,the order of abnormal habits brought into existence by ulcerative inflammation of the anus1 rectum1 and colon is about as follows3 7#a7 the habit of unduly retaining the feces in the rectum2 7#b7 the habit of straining at stool2 7#c7 the habit of unduly retaining the feces in the sigmoid flexure2 7#d7 the habit of resorting to the use of purgatives1 pepsin1 and other drugs2 7#e7 the chronic 8physic0 habit2 7#f7 the foolish 8diet0 habit2 7#g7 the gastro-intestinal neurasthenic habit2 7#h7 the health-resort habit2 7#i7 the habit of trying desperately to appear agreeable while feeling really ill2 7#aj7 the habit of blaming the liver for all direful feelings1 physical and mental4 ,it is but natural that the lower portion of the rectal and anal structures should be affected more severely than any other portion of the intestines by the ulcerative1 inflammatory process4 ,the sphincter muscles are very strong1 as a rule1 and fill their office only too well when the anal and rectal canals are in a diseased state1 for they effectually prevent the contents from escaping4 ,often their contraction or stricture is so great that their expansion is limited to from one-fourth to one-half an inch4 ,this virtually permanent closure of the anal vent naturally results in an accumulation of feces just above it1 or in the lower portion of the rectum1 which accounts for the dilatation1 stretching1 or ballooning of the anal and rectal tissues immediately above these muscles1 as shown in ,fig4 #d4 ,illustration3 ,fig4 #d4 #a1 ,the dotted lines indicate the normal direction of the anus and rectum2 #b1 #d1 the cavities or pouch formed by dilatation or ballooning from the storage of impacted feces2 #c1 a probe bent at right angles1 and introduced through a speculum1 to ascertain the depth of the pouch1 which is frequently found to be two and a half inches4 ,in not a few cases where dilatation of the rectum exists1 the upper half or more of the anal canal is also dilated1 leaving an anal canal only an eighth of an inch in length in some cases2 in other cases1 perhaps half an inch to an inch4 ,similar dilatation of the sigmoid flexure occurs as the result of the severe contraction of the upper half of the rectum1 and especially at the bend shown by ,fig4 #f and ,fig4 #ab4 ,this bend forms quite a sphincter for the normal receptacle--the sigmoid flexure4 ,here also prolapse1 distention1 and dislocation of the sigmoid flexure may occur1 somewhat similar to the anal prolapse from disease and abuse4 ,piles and itching of the anus are symptoms of proctitis1 or inflammation of the anus and rectum4 ,why should we find such dissimilar symptoms proceeding from the same cause8 ,the reason is plain when we consider the results following chronic inflammation of the mucous membrane of the anus and rectum and the deeper tissues4 ,those who suffer from catarrh of this membrane are familiar with the discharge of mucus that appears from time to time during the progress of the inflammation4 ,but1 as the inflammation penetrates the mucous membrane and the underlying tissues of the anus and rectum1 the escape of the inflammatory product is prevented2 and this imprisoned fluid must either be absorbed by the system or retained in reservoirs or in channels wherever the least resistance is offered to its invasion4 ,the mucous membrane of the anus and rectum is loosely attached to the subjacent parts by areolar tissue 7,fig4 #a1 #c-c71 which is sufficiently lax to allow an expansion of two inches2 and in a puckered or contracted state the membrane is thrown into folds1 or into shallow or deep wrinkles4 ,the loose areolar attachment and folds of various depths afford space for lodgment of the inflammatory discharge1 which channels its way down along the folds through the areolar tissue under the mucous membrane to that of the integument1 and so on for a distance of a foot or more from the anus in some cases4 ,,chapter ,,iii4 ,,the ,,formation ,,of ,,channels1 ,,piles1 ,,and ,,fistulas4 ,should channels1 of varying length and numbers1 form early in the development of proctitis1 the sufferer is usually found to be free from piles1 or hemorrhoids1 for the reason that the channels have afforded an outlet to the inflammatory product4 ,the formation of lengthy channels also prevents to a great extent the development of skinny tabs round about the integument of the anus4 ,this is some compensation to the sufferer for the labor of scratching and for enduring the painful itching so often present4 ,some suffer only from pain along the channels themselves1 while others experience a slight disturbance of the nervous system2 yet all must be more or less poisoned from the absorption of so large an amount of the contents of the channels and cavities4 ,in the cavities and along the channels the areolar tissue is of a mahogany color1 and no channel is traced to its end so long as the tissues present a bruised1 inflamed appearance4 ,in some cases the inflammatory product has destroyed the areolar tissue attached to the integument at and near the anus1 frequently to the extent of leaving a hollow space or cavity of surprising dimensions4 ,i have met only a few cases in which the channels were opened by pus forming in them4 ,those that are very shallow1 the walls being friable1 may break and form a fissure of the anus2 or a little anal fistula may arise from a slight suppuration at its end in the integument near the anus4 ,in cases where the channels are few and short1 whether itching be present or not1 the pile tumors are likewise few and of moderate size1 demonstrating the intimate relation of the aggravation of either of the symptoms or the moderation of both in the same case4 ,very frequently pile tumors have channels extending from them to the junction of the mucous membrane and integument of the anus1 or even under the integument about the anus1 forming rug1 or tabs4 ,the number and size of pile tumors would seem to depend on how completely the inflammatory product is imprisoned in the tissues in what is termed the 8pile-bearing0 region4 ,often the treatment of piles1 or hemorrhoids1 aids very much in the cure of itching at the anus--by destroying a part of the channels involved in the pile structures in the mucous membrane of the lower end of the rectum and extending along under the anal membrane and the integument of the anus4 ,the meshes and layers of the mucous membrane1 as well as the space occupied by the areolar tissue1 are stretched or pouched by the inflammatory product4 ,my observation forces me to conclude that the inflammatory product imprisoned in the areolar meshes1 between the mucous membrane and the muscular layers1 is the principal factor in forming piles and the channels so often found in the same region4 ,of course1 obstructed circulation1 congested veins1 capillaries1 and arterioles1 and a more or less apparent varicose condition1 increase the size of the pile tumors and the general thickness of the mucous membrane over the region affected by the disease4 ,the process occasioning the separation of the mucous membrane from its areolar attachment or bed often extends the whole length of the rectum1 giving the mucous membrane the loose and raised appearance that a piece of thin silk would have if laid on over that surface4 ,the fatty or areolar tissue under the skin about the anus suffers likewise by being destroyed1 leaving a hollow cavity or a large channel of great length under the skin4 ,the separation of the mucous membrane and integument about the anus from their areolar attachment permits of prolapse of the mucous membrane and integument that form the anal canal and skin around the orifice4 ,it would seem that the channels1 pile sacs1 and cavities serve as temporary reservoirs for the inflammatory product1 a portion of which the system absorbs and another portion of which escapes through the mucous membrane and integument4 ,in escaping in this way it occasions itching and pain4 ,the itching or soreness does not in all cases extend throughout the whole length of the channel4 ,a few inches of the channel farthest from its origin may be the seat of the greatest disturbance1 and the sufferer and physician alike are usually unaware that the source of the trouble is in the tissues of the anus and rectum4 ,the marked improvement in the health of those that have been cured of both the morbid condition produced by the inflammatory product and the cause of that condition is evidence that the general vitality of the system had been greatly lowered1 even though the most annoying of the symptoms1 such as piles1 itching1 or acute pain1 had not been present4 ,the lack of annoyance along the channel for a certain period may be due to a limited production1 or to a rapid absorption of the inflammatory product by the system4 ,proctitis and the attendant symptoms just described have been overlooked by the medical profession4 ,physicians have confined their attention to two symptoms--piles and fistula4 ,after undergoing a surgical operation for these1 the patient is considered cured4 ,what ignorance1 or rather short-sightedness1 to remove only the annoying symptom1 and then to pronounce the patient healed6 ,let me ask my professional brethren why they do not concern themselves with the underlying cause of the symptom or symptoms1 and whether they suppose this cause is going out of business4 ,surely it is a grave mistake to concern one's self with the leading symptom merely--to remove that1 and to leave its cause intact4 ,when the disease-producing cause remains to generate its poisonous effects in the system1 opportunities exist for further symptoms to develop4 ,the system may be already depleted of vitality1 and the harsh treatment for the purpose of removing a mere symptom may only make the sufferer's condition more deplorable--if it does not indeed cause death4 ,there are other symptoms of proctitis than piles and fistula1 which remain after the conventional surgical operation for their removal4 ,obstipation and constipation are usually symptoms of proctitis1 and will persist until the inflammation in the upper half of the rectum and sometimes in a portion of the sigmoid flexure is cured4 ,the victim of proctitis has two marked sources of poisoning of the system3 one proceeding from the absorption of the inflammatory product1 and the other from undue retention of the waste matter of the body that should pass out by the lower bowel4 ,inflammation of a mucous membrane causes structural changes in the tissues involved in the morbid process1 and not infrequently it becomes the seat of a malignant disease4 ,the reader may be familiar with the white1 loose1 alveolar 7honeycomb-like7 network of elastic tissue 7called fat7 just under the skin and mucous membrane4 ,consult in this connection the cut on page #bd4 ,illustration3 ,fig4 #e4 ,male pelvic organs viewed from the right side 7the right ilium and a portion of the ischium and the pubic bone1 together with their soft parts1 have been removed74 #a1 auricular surface of the sacrum2 #b1 tuberosity of the sacrum2 #c1 ischium2 #d1 pubic bone2 #e1 psoas muscle2 #f1 erector spinal muscle2 #g1 glutei muscles2 #h1 obdurator muscles2 #i1 external sphincter of anus2 #aj1 rectum2 #aa1 sigmoid flexure2 #ab1 bladder2 #ac1 ureter2 #ad1 vas deferens2 #ae1 seminal vesicles2 #af1 prostate2 #bj1 lateral vesicle ligaments2 #ba1 hypo-gastric artery2 #bb1 hypo-gastric vein2 #bc1 external iliac artery2 #bd1 abdominal aorta4 7,boas47 ,the abdominal and pelvic organs are cushioned or held in place somewhat by the network of fatty tissue that surrounds them1 and the rectum is no exception to the rule4 ,the outer or serous wall is surrounded by an abundance of loose areolar tissue1 which is divided into cellular spaces4 ,when this tissue also is invaded by inflammation1 the condition is spoken of as periproctitis2 and we have a result somewhat similar to that which occurs in the areolar tissue just under the mucous membrane and integument1 as previously described4 ,as the inflammatory product is discharged into this spongy or fatty connective tissue it is slowly forced in some direction1 which is naturally downward1 if not too much obstructed by firm tissue2 at all events1 it follows the line of least resistance and forms usually quite a large channel and several cavities along its course4 ,the channel may begin at an elevation of four or more inches on the outside of the rectum 7,fig4 #e74 ,should it form in front of the rectum1 the seminal vesicles 7#ae7 and the prostate gland 7#af7 would suffer greatly by its presence4 ,as the inflammatory process burrows its way downward1 it finally reaches the soft fatty connective tissue under the skin4 ,it then continues along this in one or more directions for a distance of two or more inches4 ,several of these long1 large pus-less channels may exist for many years1 or for a lifetime1 without sufficient evidence of their existence along their route accurately to locate them4 ,itching1 pain1 and color of the skin often indicate the presence of such a channel under the integument4 ,the author has frequently found large channels extending up along the outer rectal wall for four inches1 and extending out into the deep tissues of the buttocks in various directions1 without making their presence and ravages known to the victim4 ,such numerous pathological conditions have led the author to conclude that an abscess just under the skin and the discharge of pus are merely incidents in the history of such maladies4 ,think of it3 your body may be bored with channels or holes of varying diameters and lengths1 while you yourself may be ignorant of what is occurring6 ,the mucous membrane may be lifted from the connective tissue for the whole length of the rectum1 and the skin about the anus may also be in this condition4 ,you know that your health is not good1 but you are ignorant of the cause4 ,the formation of pus at some period of the channel's inroads1 or of an abscess1 would seem a kindly act of ,nature1 for the presence of so serious a disturber to health would thus become known4 ,i have not overdrawn this picture of periproctitis and of submucous tissue channels4 ,the victims could scarcely be worse off than they are4 ,i want boys and girls1 young men and young women1 to learn the facts concerning the local dangers of proctitis2 for1 when they once realize the seriousness of this disease because of its many grave symptoms1 they will give it proper attention before these effects manifest themselves4 ,you cannot neglect so important a portion of your body as the anus and rectum and not seriously endanger the organs that lie close to them4 ,no wonder so many men are troubled with inflammation and induration of the prostate gland4 ,the percentage of such cases would be greatly reduced were proctitis and periproctitis denied the existence they now enjoy for years1 and often for a lifetime4 ,in view of all that has been advanced concerning these local pathological conditions1 is it strange that almost everybody is constipated1 and that we need some simple sovereign aid to further the scientific treatment of the physician--an aid such as the enema has proved to be8 ,,chapter ,,iv4 ,,undue ,,retention ,,of ,,gas ,,and ,,feces ,,in ,,the ,,sigmoid ,,flexure4 ,in the previous chapters attention was called especially to the lower portion of the rectum and the anus4 ,in this chapter we will consider the sigmoid flexure1 which1 when diseased1 is often dilated1 dislocated1 and depressed1 a pathological condition somewhat similar to that found in the lower portion of the rectum and the anus4 ,the illustration on page #bi shows the normal relations of the rectum and the sigmoid flexure2 also the whole colon4 #g marks the beginning of the sigmoid flexure1 and #f its upper end4 ,the reader will note the four sharp curves or flexures of this organ1--from #f to #g1--which forms in health a normal and most convenient receptacle for feces1 and which1 like the bladder1 can be emptied at regular intervals4 ,unless the system were able in some way to eliminate the waste and poisonous matter it had generated within six hours1 it would fatally poison itself4 ,those internal ventilators1 the lungs1 and those external ducts1 the pores1 are constantly at work purifying the body2 and they are actively assisted by the kidneys and the bladder4 ,observation extending over many years of practice induces me to believe that among those who suffer from chronic constipation two-thirds to three-fourths of the fecal mass is taken into the system and eliminated by the kidneys1 mucous membrane1 and skin4 ,diseases of the above organs are numerous and seemingly incurable from the fact that their common cause has not been discovered and treated properly4 ,were it not for these organs steadily at work1 the labor of the bowels would be of little avail4 ,but while the importance of the former cannot be ignored1 it must be conceded that the most important of all the eliminating organs are the bowels1 for their function is to discharge not only the waste solids but also a great amount of waste liquids and gases as well4 ,illustration3 ,fig4 #f4 #i4 ,the anus4 ,levator ani muscle seen on each side4 #h1 #h4 ,the rectum4 #g4 ,beginning of the rectum4 #f4 ,the sigmoid flexure4 #e4 ,the descending colon4 #d4 ,the transverse colon4 #c4 ,the ccum1 or caput coli4 #b4 ,appendicula vermiformis4 #a4 ,the end of the ileum4 ,undue fermentation of the ingesta 7the aliment taken into the system7 generates poisons of more or less virulence2 it must therefore be obvious that a clean intestinal canal is necessary after every meal to further the normal digestive process4 ,very often the outlet of the sigmoid flexure is obstructed4 ,figures #f and #g are shown to make the cause of this obstruction more clear4 ,in ,figure #g we see the longitudinal and transverse fibers that form the wall of the rectum4 ,in all cases of chronic obstipation1 the muscular structure of the anus1 rectum1 and frequently of a portion of the sigmoid flexure is invaded with chronic inflammation of a very severe and serious character4 ,illustration3 ,fig4 #g4 ,a view of the longitudinal muscular fibers of a section of the rectum3 #b1 upper portion of the rectum2 #c1 #d1 #e1 the three bands of longitudinal fibers of the colon continued upon the rectum2 #f1 the longitudinal muscular fibers of the rectum formed by the expansion of those of the colon4 ,a view of the muscular coat of the colon3 #a1 #a1 one of the bands of longitudinal muscular fibers2 #b1b1 the circular fibers of the muscular coat4 ,what is the result of this inflammation8 ,self-evidently contraction of the muscular structure1 as you would quickly enough discover were one of your hands or arms inflamed4 ,though constant attention should be given to the much more important organ1 the rectum1 practically none is given it4 8,out of sight1 out of mind40 ,again1 no doctor would diagnose an inflamed limb as paralysis1 atony1 etc41 and dose the victim with nux vomica1 tonics1 physic1 etc41 in the hope of thereby healing it4 ,yet1 with singular fatuity1 this absurd diagnosis and treatment is given when the lower bowel is invaded with chronic inflammation4 ,let the common-sense reader inform himself concerning his organism4 ,let him remember that he has within muscular organs that demand exactly the same attention when diseased as those without4 ,this fact is especially important for the sufferer from constipation or semi-constipation to know4 ,were the anus1 rectum1 and sigmoid flexure one continuous straight tube1 the muscular action in the process of defecation would not be as complex as it is1 since then the feces would drop right down and out4 ,but these parts have so many curves and angles that when disease invades their interior they accentuate their folds and valves by contracting and do not readily respond to the nerve demand for complex1 muscular1 snakelike movements1 when evacuation is desired4 ,in this unreadiness to respond they cast into confusion all the functions of the whole complicated organism1 all parts of which are necessarily interdependent4 ,a wise provision of ,mother ,nature are these curves1 angles1 and valves1 for they prevent the sudden dropping of the contents of the colon down to the anal orifice--a possibility that would greatly embarrass us during social and business hours4 ,the accompanying figure shows the rectum dissected at its upper end from the sigmoid flexure4 ,this portion of the rectum is smaller than the lower two-thirds of the organ4 ,now1 it is this lessened diameter of the gut that is an aid to the sigmoid flexure in its capacity as a receptacle1 but a most decided hindrance when it is diseased--since it will positively inhibit the passage of feces and gases1 thereby occasioning a distention of the sigmoid flexure 7obstipation7 because of a detention of the contents1 which then weights the flexure down upon the rectum4 ,thus we see exemplified how an aid may turn into a hindrance1 as we already have observed1 in an unduly contracted anal vent4 ,the rectum is not straight1 as the word itself would indicate1 but curves to the right1 then back well on to the spine1 and then forward to the anus1 which turns slightly backward from the lower anterior portion of the rectum4 ,illustration3 ,fig4 #h4 ,when these muscular-tube organs are invaded by disease1 these very curves1 valves1 and bends of anus1 rectum1 and sigmoid flexure are responsible for at least nine-tenths of the ills that affect humanity from the cradle to the grave--ills directly due to self-poisoning1 technically known as auto-infection and auto-intoxication1 the fashionable name of which is neurasthenia3 a weakening of involuntary and voluntary nervous systems through lack of vent from irritating poisons1 flatulency1 and of course defective metabolism or nutrition4 ,a better name would be vaso-motor neurasthenia4 ,after these anatomical and physiological points have been noted1 it is to be hoped that the reader has grasped the idea of how easily this portion of the bowels1 when diseased1 can prevent the normal descent of the feces and gases accumulated just above the diseased portion of the gut4 ,it should also be easy to understand how a portion of the unduly retained feces may pass out1 but in so doing be the cause of increased irritation and consequent contraction of the muscular tube1 preventing thus any further passage of feces from its receptacle4 ,usually a portion of the escaping feces is caught and held in the rectum itself1 converting the rectum into a receptacle4 ,it is just here that the practical application of the principles deduced must come in4 ,let my professional brethren as well as all victims of bowel disease consider the following question1 and then all will be clear3 ,since normal feces contain about #ge per cent4 water1 is there any harm1 nay1 is there not decided benefit1 in suddenly liquefying the imprisoned mass to1 say1 #ii per cent4--whether disease exist or not8 ,when disease exists we simply desire to open the contracted or obstructed canal4 ,what can be better1 in a therapeutic line1 than the kindly distending influence of warm water to overcome the spasmodic closure of the diseased tube8 ,in addition to the gentle dilatation the injected water occasions1 the water creates or calls into activity the lost nervous impulse to evacuate1 which impulse is a step toward the restoration of the lost normality4 ,under the benignant influence of the water injected in the large intestine there comes a desire to expel it1 which1 when responded to1 carries with it the feces so long imprisoned1 and at the same time divests the walls of the intestine of the inevitable incrustations4 ,thus1 with purifying water1 the foul pool is emptied1 and the parts are cleansed so thoroughly that nothing is left to vex the inflamed tissue4 ,is there any sane person that can offer one valid objection to the use of depuratory enemas in cases in which the normal function of the bowels is lost through abnormal changes brought about by chronic disease8 ,,chapter ,v4 ,,rebellion ,,of ,,our ,,outraged ,,internal ,,economy4 ,the small intestine is that portion of the alimentary canal which begins at the stomach and ends at the large intestine4 ,its usual length is twenty feet4 ,the diameter1 which at the upper portion 7duodenum7 is two inches1 gradually becomes less1 until at the lower end it is but one inch4 ,now1 the length of the inner coat of this small intestine--the mucous membrane--is about double that of the intestine itself4 ,think of wearing a coat twice as long as yourself6 ,how do you think this is accomplished in the case of the muscular tube under consideration8 ,well1 ,nature1 having a most peculiar function to perform1 has thrown this mucous coat or tube into a thousand folds 7valvul conniventes1 or 8winking valves074 ,these folds form valves1 occupying from one-third to one-half the circumference of the bowel4 ,the greatest width of each fold is at the center1 where it measures from a quarter to half an inch4 ,over this great expanse of mucous membrane we find studded ten million five hundred thousand intestinal villi1 whose office it is to absorb the food substances in their passage through the canal4 ,illustration3 ,fig4 #i4 ,stomach1 liver1 small intestine1 etc4 7,flint47 #a1 inferior surface of the liver2 #b1 round ligament of the liver2 #c1 gall-bladder2 #d1 superior surface of the right lobe of the liver2 #e1 diaphragm2 #f1 lower portion of the sophagus2 #g1 stomach2 #h1 gastro-hepatic omentum2 #i1 spleen2 #aj1 gastro-splenic omentum2 #aa1 duodenum2 #ab1 #ab1 small intestine2 #ac1 ccum2 #ad1 appendix vermiformis2 #ae1 #ae1 transverse colon2 #af1 sigmoid flexure of the colon2 #ag1 urinary bladder4 ,those that have observed the anatomical illustrations of the small intestines must have been struck by their apparently inextricably tangled convolutions4 ,in life1 these convolutions are constantly changing their locations1 as though they were a mass of worms4 ,the large intestine begins at the ccum and extends to the anus1 or vent of the intestinal sewer4 ,it is called the colon--the ascending1 transverse1 and descending colon4 ,it is about five feet in length4 ,its diameter is the greatest at the ccum1 where it measures1 when moderately distended1 two and a half to three and a half inches4 ,beyond the ccum the diameter is one and two-thirds to two and two-thirds inches1 the smallest part being at the upper end of the rectum4 ,the muscular movements of the large intestine are much more limited in number and range than those of the small intestines4 ,the area of its mucous membrane is also much less1 notwithstanding the fact that it is thrown into sacculated pouches1 or sacculi1 by the contraction of the longitudinal muscular bands of the bowel4 ,illustration3 ,fig4 #aj4 ,the ccum1 dorso-mesial view1 showing the ileum-side of the ileo-ccal valve1 and the beginning of the three muscular ribbons4 7,gerrish47 ,consider this tube1 for it is really unique4 ,note the longitudinal muscular bands 7,figs4 #ab and #ac74 ,we find this tube to be five feet long when the surface made by the circular bands is measured1 and four feet long when that made by the longitudinal bands is measured4 ,now1 the four feet of surface must of course contract the five feet4 ,well1 in the tube under consideration1 the musculo-areolo mucous tube is thrown into circular puckerings in short sections1 between which are deep transverse creases1 each bounded by prominent bulges4 7,fig4 #ac47 ,an inspection of the bore of the tube shows a sharp ridge corresponding to each depression of the outer surface1 and a large recess collocated with each external protrusion4 ,this external and internal appearance of the large intestine reminds one somewhat of the flexible hard-rubber tubing used as a conduit for electric wire in houses4 ,illustration3 ,fig4 #aa4 ,cavity of the ccum1 its front wall having been cut away4 ,the ileoccal valve and the opening of the appendix are shown4 7,gerrish47 ,illustration3 ,fig4 #ab4 ,a view of the position and curvatures of the large intestine4 #cb1 end of the ileum2 #ca1 appendix vermiformis2 #d1 ccum2 #c1 ascending1 #b1 transverse1 #h1 descending colon2 #i1 #i1 #i1 sigmoid flexure2 #aj1 #aj1 rectum2 #ab1 anus2 #ac1 #ac1 bladder2 #aa1 #aa1 #aa1 peritoneum--length from #d to #f feet1 and a mean diameter of about #a-b_/c to #b-b_/c inches4 ,the sigmoid flexure is a receptacle for the feces1 and each end is the highest and bent on itself2 this arrangement spares the rectum and sphincters of pressure and weight until the proper time to stool4 ,the sacculated pouches thus formed by the shortening of the bowel may become abnormally distended1 and resemble the proper receptacle for feces--the sigmoid flexure4 ,even the rectum1 in cases of chronic constipation1 is usually enormously distended1 owing to the overloading or filling up of the bowel with feces4 ,i have given this somewhat lengthy rsum in order to enable the reader to appreciate a most pertinent question4 ,let us see what we have found3 ,the small intestine1 with its manifold folds and its numerous pockets1 made by the forty feet of mucous membrane2 the bends and curves in the five feet of the large intestine1 with its numerous dams and pools2 and1 lastly1 the abnormal reservoirs for feces1 liquids1 and gases4 ,illustration3 ,fig4 #ac4 ,segment of large intestine1 showing the characteristic features of its structure4 7,gerrish47 ,finding this1 the question inevitably is1 ,what is the best agent for cleansing this marvelously sensitive canal1 twenty-five feet long1 whose mucous membrane extends forty-five feet8 ,no one would think of taking1 if he could1 the foul sewer in his hands1 and shaking it1 fold upon fold1 with the faint yet fond hope of sterilizing it4 ,how can any mode of physical culture meet the requirements for effecting a cure of ulcerative proctitis and colitis1 to say nothing about keeping the bowels sweet and clean8 ,chronic1 subacute1 and acute inflammation1 accompanied with ulceration1 located in any part of the body1 requires rest to overcome the fever and congestion4 ,muscular exercise irritates and inflames the diseased parts4 ,another form of 8physical culture0 would put into the bowels all sorts of stuff that cannot be digested1 such as bran1 crushed seeds1 shells1 raw food1 etc41 that set up excessive muscular action and secretion of mucus as the improper stuff passes down and out4 ,in the sacred name of hygiene1 this new cathartic remedy is prescribed and taken4 ,seeking relief from the painful effects1 the patient finds that these 8remedies0 make the disease and its symptoms worse4 ,hygienic fool-killers are1 like the poor1 always with us4 ,illustration3 ,fig4 #ad4 ,a longitudinal section of the end of the small intestines1 or ileum1 and of the beginning of the large intestines1 or colon4 #a1 #a1 a portion of the ascending colon2 #b1 #b1 the ccum1 or caput coli2 #c1 #c1 lower portion of the ileum2 #d1 #d1 the muscular coat1 covered by the peritoneum2 #e1 #e1 the cellular and mucous coats2 #f1 #f1 folds of the mucous coat at this end of the colon2 #g1 #g1 prolongations of the cellular coat into these folds2 #h1 #h1 ileo colic valve2 #i1 #i1 the union of the coats of the ileum and colon4 ,you are aware of the irritation that a grain of sand will set up when it comes in contact with the mucous membrane of the eye4 ,then can you not realize that you will torment the forty-five feet of intestinal mucous membrane with like indigestible stuff8 ,it is estimated that ten per cent4 of the really suitable food is residue matter with which the digestive tract has to deal and get rid of with as much economy and as little friction as possible4 ,then why increase this residue twenty or fifty per cent48 ,more than nine-tenths of the human race have been content to depend on comparatively violent excitants1 such as drugs1 coarse food1 and muscular exercise1 etc41 to relieve the bowels of the feces1 liquids1 and gases of a most foul character--the foulness due to putrid fermentation and undue retention4 ,when will these prescribers and partakers ever learn that bile bouncers and peristaltic persuaders have an immense journey before them when they start to remove the foul accumulation of feces from the sigmoid flexure and ballooned rectum8 ,for1 be it remembered1 the normal receptacle for feces is twenty-four feet four inches from the stomach1 and the abnormal receptacle twenty-four feet eleven inches--within two inches of the vent of the body6 ,surely quite a degree of mental constipation must have existed in both the prescribers and the partakers to think such thick and dense thoughts as are represented by these bouncers and persuaders4 ,so you would cleanse the bowels with such unclean1 poisonous1 and irritating things6 ,what amazing hope born of ignorance6 ,outraged ,nature cries3 8,how long6 how long6 how long will my #8inards' be so abused in the name of cleanliness and yet remain so unclean8 ,ye benighted mortals1 if ye would listen to me1 your ,mother1 ,i would give ye a pure and wholesome prescription1 for ,i would prescribe equal parts of enlightenment and water well mixed1 and advise ye to take a portion of it fore and a portion of it aft1 per os 7mouth7 and per anus4 ,thus and thus alone would ,i prescribe for ye2 such and such alone is the way for ye to do2 purify to cure1 or cure by purifying40 ,constipation must not continue1 for it means not only the clogging up of the large intestine with the foul sewage of the system1 but also the drying of that sewage1 which latter process implies the absorption of poison4 ,now that you are in this condition1 ,medicus steps up and prescribes a cathartic mixed with belladonna or opium1 or both4 ,these latter are meant to quiet the mournful cry of outraged ,nature when the cathartic invades its sacred precincts4 ,and it may be noted1 by the way1 that though belladonna1 atropine1 morphia1 etc41 tend to dry up the secretions of the mucous membrane and make matters worse by making them still more arid1 still the action of the cathartic is usually so powerful that after the free fight with the pain soothers it triumphs1 and produces a free flow of watery secretion into the dried1 impacted mass of the bowel4 ,does it not stand to reason that the greater portion of the liquid in which the feces were dissolved and had fermented is re-absorbed into the system8 ,why should the poor victim of proctitis and cathartics wonder why he has gout1 rheumatism1 and disease of the kidneys1 bladder1 lungs1 liver1 stomach1 nerves2 why he has neurasthenia1 debility1 feebleness1 loss of memory1 inability to fix and hold the attention upon a single line of thought1 apprehensions1 etc48 ,his wonder is childish1 for deep in his heart he knows that he poisoned himself4 ,he knows this1 but it seems that he must be reminded of the fact that there is a better way to remove the accumulated mass from the large intestine1 and to prevent in future the undue retention of feces1 liquids1 and gases in abnormal sacs or pouches4 ,the way that ,nature prescribes is the resort daily1 two or three times1 to the enema4 ,when the injected water reaches the imprisoned and dried feces1 the crust is loosened from its holdings and the mass is moved toward the exit by the expulsive effort of the bowels4 ,previously the bowels were helpless with their load4 ,as the sudden flood of water is expelled it carries with it the inspissated feces2 whereupon the subconscious personal ,ego1 who is the superintendent of the digestive apparatus and functions1 congratulates himself on the delightfully refreshing manner in which the local disturber has been ousted4 ,such is the satisfactory decision of the arbitrator--,enlightened ,nature4 ,no longer need we bow to ,medicus or to any other kind of 8cuss10 whether styled hygiene or physical culture4 ,arbitration of this sort makes life worth living4 ,now for ,nature's benediction3 8,may that feeling of freedom from uncleanliness1 internal and external1 be with you constantly1 and this double blessing make your joys flow so fast that in their rapidity they blend into a sun and radiate from your rejuvenated physical being40 ,,chapter ,,vi4 ,,gaseous ,,obesity ,,and ,,our ,,roly-,,polies4 ,is there any human being so ignorant that he cannot understand that when food stuffs in the gastro-intestinal canal ferment and putrefy they thereby generate toxic 7poisonous7 gaseous matter1 volatile fatty acids1 and putrid feces2 that such matter1 acids1 and feces are rapidly absorbed by the system1 and that1 if the system does not readily eliminate them by way of the bowels1 kidneys1 and mucous membrane1 they will tend to bring on one or more forms of acute or chronic disease8 ,gas is matter in its most rarefied state--a state that permits its easy entrance into all the tissues of the body1 where it perverts by its presence and toxic effect the normal function of all the organs4 ,besides its poisonous infection1 it distends or bloats the stomach1 bowels1 and tissues--a fact especially noticeable in the abdominal region1 giving the appearance of corpulency or obesity to many1 when really it is only abdominal ballooning or gaseous obeseness4 ,roly-polies--and there are a great many of them--will have their pride greatly hurt by accounting for their condition in this way1 but the truth must be told and they might as well face the facts first as last4 ,gaseous obesity1 or borborygmus1 is spoken of popularly as wind in the stomach and bowels4 ,no wonder the roly-poly is sensitive on the subject1 for this 8wind0 occasions rumbling sounds1 eructations1 and offensive odors--all of which are a great annoyance to the sufferer from dilated1 displaced1 and unclean digestive apparatus4 ,besides being generated in the system1 gases may be swallowed during the act of eating1 in the form of air 7oxygen and nitrogen71 and in liquids containing carbonic acid1 sulphuretted hydrogen1 etc4 ,micro-organisms swallowed with the food will occasion fermentation of the contents of the stomach and bowels1 which if unduly retained become excessive1 foul1 and toxic--therefore extremely harmful to the system4 ,the gases generated in the stomach are the following3 carbonic acid1 hydrogen1 hydrochloric1 ammonia1 sulphuretted hydrogen1 marsh gas1 etc4 ,they are partly absorbed or thrown off by eructations1 or they pass into the duodenum or small intestine4 ,gases are found throughout the small and the large intestine4 ,these are the result of both the normal and the abnormal digestive fermentation and bacterial decomposition of the ingesta or food stuffs4 ,some of the gases are passed into the intestines from the blood by diffusion4 ,the production of gas is more copious in the upper portion of the small intestine and becomes less rapid and abundant as the large intestine is reached4 ,as formed or found in the intestines1 the gases are3 carbonic acid1 hydrogen1 marsh1 ammonia1 nitrogen1 sulphuretted hydrogen1 and sulphate of ammonia4 ,considering the large amount of abnormal gases generated in the bowels and which abnormally distend the abdominal walls for several inches and press upon the heart and lungs1 and considering the small amount passed out as flatus1 their entrance into the tissues of the body must be very rapid and harmful4 ,stop the habitual putrefaction and mal-digestion1 and then the formation of toxic feces1 gases1 and volatile acid will speedily cease4 ,then the erstwhile roly-polies will shrink in circumference four or more inches1 necessitating the refitting of their garments to the new and better order of things4 ,much has been written about the distention of the rectum1 sigmoid flexure1 and colon from the undue accumulation of feces4 ,the fecal distention of the gut may extend along the intestine for from three to nine inches or more1 which is a very grave matter indeed4 ,but why is so much attention given to a few inches of impacted feces dilating a portion of the bowel1 and none whatever to the prevention or elimination of gaseous matter that distends the whole gastro-intestinal canal to such an extent that the body is tightly inflated and the median parts of the belly bulge out like a balloon8 ,cattle raisers are conversant with the gaseous inflation of their animals1 and have to resort to the knife to puncture the stomach to permit the gas to escape2 otherwise fatal results would soon follow4 ,some animals1 even1 like most human beings1 are intemperate in eating4 ,when they consume too much grass they suffer from flatulency and colic1 and require drastic treatment4 ,rather than let some worthy men and women die1 ought we not at times to adopt the ranchman's treatment for flatus8 ,this harsh means1 however1 might be avoided by inventive science4 ,overfed1 constipated1 inflated man1 victim of habitual flatulency1 could easily have small gas valves inserted here and there along his gastro-intestinal canal--one1 say1 to relieve the stomach of toxic gas1 another for the appendix region1 and still another in the hernial region of the abdomen4 ,suppose overfeeders were to adopt the gas-valve fad1 and discontinue the habit of using cathartics1 soda1 charcoal1 peppermint1 pepsin1 whiskey1 etc41 as means of relief6 ,how in the world can a drug aid digestion when taken into a foul1 gaseous1 and feces-clogged canal8 ,a chemist cannot get the definite results he seeks unless he have the right chemicals and proper vessels4 ,just so with the spiritual ,ego and his systemic chemistry of food3 he needs a clean and healthy digestive apparatus for proper assimilation and elimination4 ,but he gets careless1 allows it to get foul1 and then insincerely expresses astonishment that the chemical combinations are not such as one could wish or expect4 ,other chemists1 called doctors or druggists1 come along and dose the poor victim of his own carelessness until they have ruined his apparatus completely4 ,they have got to live1 of course2 and it is their business to see that he does not escape so long as they can help it4 ,sometimes there is a reassertion of common sense2 the poor victim becomes disgusted with himself and his credulous acceptance of the doctor's dictation and his fatuous swilling of the druggist's decoctions4 ,he gets tired of chronic ill-health and bowel troubles1 and1 lo and behold6 he does the simplest and most sensible thing in the world--a thing he ought to have done at the very start1 or before he ever had the least trouble3 ,he thoroughly washes out his alimentary canal with pure or antiseptic water4 ,he drinks a lot of pure spring water1 and he flushes his bowels with two or three enemas4 ,doctors and drugs are henceforth banished2 he gets well6 ,what a blessing to lose one's faith in the magic of drugs and the majesty of doctors6 ,few comprehend the baneful effects of flatulency on the system1 the most usual of which are fatigue1 depression1 headache1 buzzing in the ears1 deafness1 vertigo1 loss of memory1 inability to fix the attention1 disturbance of sight1 drowsiness1 etc4 ,a continuous stream of carbonic acid or of hydrogen directed against muscular tissue will cause paralysis of the part4 ,physicians admit that in certain portions of the alimentary canal extensive dilatation may occur1 independent of any permanent obstruction1 in the lumen1 or bore1 of the gut4 ,as a rule1 however1 victims of proctitis and colitis suffer from more or less occlusion of the lumen in the region invaded by the ulcerative inflammatory process4 ,considering that the wall of the abdomen is often greatly extended by gas within the digestive apparatus1 it is not amiss to assume that this gas may cause local distention of segments of the gastro-intestinal canal1 sufficient to paralyze or render inoperative the parts4 ,suppose we make a rubber duplicate of the abdominal walls of the average man1 and place therein rubber duplicates of all the internal vital organs--pelvic and abdominal4 ,to hold the stomach1 bowels1 and other organs in place1 we fasten them with elastic bands here and there1 and make a generous use of cotton to support the various parts1 which are all connected with many little circulating tubes1 with strings for the greater nerves1 etc4 ,now let us distend our thin artificial digestive apparatus with air or gas--snugly filling the abdominal space of our model1 without tension1 however1 or slackness of the various parts1 which are happily adjusted and at rest4 ,now1 be it remembered1 persons suffering from flatulency are more or less in the predicament of the gluttonous animal referred to above3 the gas will not escape at either end1 however much of an effort it makes1 or the victim may make to help it4 ,illustration3 ,fig4 #ae4 ,the stomach and intestines1 front view1 the great omentum having been removed and the liver turned up and to the right4 ,the dotted line shows the normal position of the anterior border of the liver4 ,the arrow points to the foramen of ,winslow4 7,gerrish47 ,in filling very slowly our thin artificial alimentary canal1 note the distention along the canal as the gas accumulates4 ,then note that the elastic bands stretch as the various segments of the canal change location1 especially the stomach and portions of the small intestine and of the colon1 etc4 ,the stomach1 small intestine1 and colon1 as they dilate1 shift about for room4 ,the abdomen is seen to bulge out some four or more inches while the turmoil is heard going on inside4 ,continue this inflation and our rubber intestinal tract will display here and there a displacement and permanent abnormal enlargement of the lumen or bore4 ,suppose1 further1 that our complete model of the abdominal viscera and wall had tightly around its outer surface unelastic corsets1 skirt bands1 trouser bands1 vests1 etc41 all or any of which held in or compressed its bulging wall--what would happen8 ,why1 something inside would slip out of place or burst and let all the wind escape1 relegating our creation to the rubbish heap4 ,now1 when a man loses his wind by the rupture of a tube1 he is said to have expired1 and his body is sent to the crematory--or ought to be sent there for sanitary reasons4 ,it would be much more satisfactory1 by the way1 to our friends1 after our demise1 were our bodies sterilized while they 8live40 ,i hope ,i have made it clear that it is a most serious pathological condition--inasmuch as it prevents the normal onward progress of ingesta and feces--to permit of the continued existence of an excessively dilated gastro-intestinal canal1 with one or more of its segments permanently enlarged--segments like the stomach1 duodenum1 ccum1 transverse colon1 sigmoid flexure1 rectum1 etc4--and with pendulous abdomen1 sallow and muddy complexion1 etc4 ,when to this condition is added a general displacement of the abdominal viscera1 or of one or more of the organs of the abdominal and pelvic cavities1 you have an objective picture of chronic ill health in all its severity4 ,are you sincerely desirous to know how your friends feel when you greet them8 ,don't ask them the stereotyped question1 8,how do you do80 or1 if you are a ,german1 8,how do you go it80 or1 if you are a ,frenchman1 8,how do you carry yourself80 ,but ask them the specific and sensible question appropriate to our civilized habits3 8,how are you and your bowels to-day80 ,and at parting it were well to say3 8,may peace be with you both--you and your bowels60 ,the spirit of man can torment his personality1 and his personality in turn can vex his spirit4 ,few people are aware of the fact that the stomach and intestines can undergo alteration in position4 ,many are familiar with the fact that the kidneys may be displaced1 and are then called 8floating kidneys02 that the liver1 pancreas1 spleen1 and uterus occasionally go on excursions1 causing thereby considerable and numerous disturbances4 ,and it is not at all strange that they should1 since there is so much pressure from within1 so much pressure downward1 and so much pressure from without--all through the requirements of fashion1 indulgence1 and ignorance4 ,but the stomach1 upper portion of the duodenum1 and small intestine1 ccum1 the ascending colon1 and especially the transverse colon and sigmoid flexure1 are susceptible to various forms of displacement1 inhibiting the ready flow or passage of food stuffs1 gases1 and feces from one segment of the digestive apparatus to another1 until the vent is reached4 ,reviewing the ground already gone over1 we have found that proctitis1 as a rule1 is the primary cause of sigmoiditis and colitis2 that these combined are the cause of constipation2 that this is the cause of indigestion1 flatulency1 and distended alimentary canal1 and1 as matters go from bad to worse1 of permanent distentions and displacement4 ,is it any wonder then that there are so many that suffer from gastro-intestinal neurasthenia8 ,surely our digestive apparatus ought to have as much attention as a well-regulated house furnace4 ,in the morning the ashes are dumped and fresh coal is put on4 ,a similar process is gone through with at noon and night4 ,some may run their furnaces on two meals a day and two dumpings of the waste material4 ,when a boy puts a penny into a slot machine he gets what he expects and is pleased4 ,the machine has done its work in delivering the goods4 ,why should he give a thought where his penny lodged8 ,in like manner man is always ready to put food stuff1 and other stuff as well1 into the upper slot of his machine1 for he gets immediately satisfaction thereby4 ,but he is like the boy2 he doesn't care a fig what becomes of the stuff so long as it doesn't annoy him too much4 ,eventually the machine refuses to work1 and seems unable to deliver the goods at the other end2 something has become clogged or out of gear4 ,let me advise the reader at least to keep the passage clear by dumping the systemic furnace twice or thrice daily--using the enema to effect the result4 ,,chapter ,,vii4 ,,irrigation ,,of ,,the ,,assimilative ,,and ,,eliminative ,,organs4 ,the habits of people in general do not seem so bad when one considers the average individual's limitations as to knowledge and thought4 ,the fact is that most people don't know1 don't think1 and hence don't care4 ,let them read more science1 think more sensibly1 and act more seriously2 then their habits will be more satisfactory4 ,the alimentary receptacle--the stomach or vat in which foods and liquids are received and mixed--is habitually converted by many persons into a chemical retort for all sorts of drugs and remedies1 with the view of reaching and relieving the ills of the various organs of the body1 from dandruff to corns4 ,the writer believes that he can give more and better reasons for his confidence in the therapeutic value of remedies than most other physicians1 but he wishes to emphasize here the transcendent importance of common sense in their administration4 ,before and above all else1 however1 what is wanted is a clean gastro-intestinal canal2 and his claim is that water1 properly used1 is the best agent to effect that cleansing4 ,on a par with this canal in importance are the eliminative tissues and organs of the system3 the kidneys1 mucous membrane1 and skin4 ,what therapeutic agent1 properly used1 is better than water8 ,after all the assimilative and eliminative organs and tissues have been thoroughly rinsed with pure1 soft water1 then1 if it be still necessary to administer a chemical agent1 one may be selected that will1 with these organs and tissues in better condition1 work wonders4 ,if you are so foolish as to allow yourself to become foul from head to foot1 cleanse yourself with water before resorting to chemical aids4 ,somehow or other the mass of even intelligent people1 not to speak of the great mass of the ignorant1 and ,i may add even my co-workers in the healing art1 are not aware of the supreme want and worth of water for internal and external therapeutic purposes2 they do not realize how the stomach1 the bowels1 and the kidneys cry for it in their neglected and infected condition4 ,the stomach serves as a convenient receptacle to dump things into after the palate has been entertained and pleased--and about everything is swallowed but pure1 soft water4 ,as a rule the stomach takes very kindly to water4 ,it is1 moreover1 not so piggish as to absorb it all and leave its surface in a foul condition1 covered with ropy1 slimy products of imperfect digestion4 ,immediately after deglutition of water1 the stomach does just what it ought to do3 its muscles contract and dump the contents of the stomach into the duodenum1 where the principal act of digestion is accomplished4 ,as its name implies1 the stomach 7stow-make7 is a receptacle made for the purpose of storing stuffs for nutrition4 ,here they are mixed and broken up somewhat1 and then deposited in the second or real digestive apparatus--the duodenum4 ,this latter organ requires water and organic fluids in liberal quantities for its digestive operations4 ,both organs need cleansing after they have finished their work1 and the digestive and assimilative vessels require water1 not only to convey the building material to their harbors1 but also to eliminate effectually the worn-out tissues and the residuals of the digestive process4 ,it has been said that were man to discover heaven 7a clean and healthy locality7 he would at once convert it into a hell 7a vile and filthy one74 ,man is possessed of an organism of whose constituent elements water forms over eighty per cent4 ,the alvine discharges ought to contain the same percentage of water1 if not more4 ,the mucous membrane and skin1 to be kept clean1 soft1 fresh1 plump1 moist1 and free from odors1 require their appropriate irrigation4 ,man may keep himself clean1 both inside and out1 by irrigating himself before each meal daily4 ,the well-watered and well-washed body and brain constitute a heaven on earth for the indwelling spirit that needs these for its manifestation4 ,it does seem sometimes that man in his ignorance gets nothing right except to walk forward instead of backward4 ,even so1 most likely he walked on all fours for ages1 judging from his progress to date1 before he learned to walk on his hind legs4 ,to-day we find him self-poisoned1 auto-intoxicated1 a gastro-intestinal neurasthenic4 ,his bowels are filled and stretched with ancient feces and gases1 and his stomach is burdened with undigested food and tenacious mucus4 ,the average man's scanty excreta from the bowels are dry1 hard1 lumpy1 and foul1 exhaling a noxious odor2 and these excretions may be passed once a day1 or once in two or three days1 or with some persons too often1 should diarrhea supervene4 ,two-thirds to three-fourths of the fecal mass is absorbed by the system every day2 and this absorption is accompanied more or less constantly by symptoms of indigestion1 biliousness1 uric acid1 and many other distressful conditions4 ,his breath and the exhalations of a garbage-can are much alike2 in fact they are twins1 the only difference between the human and metallic receptacles being that one is capable of walking and the other is not4 ,both manifest the same conditions4 ,his mucous membrane is covered more or less with catarrhal discharges1 which result in granulated deposits1 especially near the orifices4 ,the skin is often sallow1 dry1 yellow1 scaly1 flabby4 ,the hair is dry1 non-oily1 with a scaly scalp1 and often there is a loss or total lack of hair4 ,the teeth are decayed1 the gums are found to recede1 and the eyes1 muscles1 joints1 etc41 are more or less affected by calcareous deposits4 ,man is seldom or never in a normal physiological condition4 ,he is either obese or emaciated and lean4 ,most bodies are anemic and ill-conditioned1 a prey to several ailments4 ,of course1 civilized man uses drugs2 he would not be civilized were he not to use on occasion a stimulant1 tonic1 sedative1 narcotic1 etc41 and he has to keep in continual touch with a doctor1 to take care of him by prescribing special diet1 fasts1 exercise1 and what not for his numerous bodily infirmities4 ,generally these prescriptions are ineffective and leave him physically weaker and financially poorer1 with the barren consolation that he has really tried everything under heaven that the wisest knew or that money could buy4 ,yes1 indeed1 he tries everything3 everything but water--pure1 soft1 spring or distilled water4 ,he never--like the flirt--8thought of such a thing06 ,very few 8humanals0 think it worth while to irrigate themselves inside and out4 ,victims of semi-ignorance1 too1 get things most abominably mixed4 ,they are often half wrong and half right2 hence they never enjoy good1 sound1 robust health and its blessings4 ,physiologically1 these people are what old-time pastors used to describe as lukewarm--neither hot nor cold1 neither good nor bad1 neither dirty nor clean1 neither fish nor fowl1 neither one thing nor another4 ,so we find them also complaining and looking for the fountain of health and strength1 but not looking very anxiously--they are not interested enough in the matter4 ,whenever they possess an equal mixture of ignorance and laziness1 there is not much hope for them4 ,illustration3 ,fig4 #af4 sophagus and stomach in their natural relation to the vertebral column and aorta4 7,gerrish47 ,note the position of the stomach in health1 and how1 by slight muscular action1 it can free itself of its contents4 ,when dilatation or displacement1 or both1 occur1 the power of rapidly expelling its contents is diminished to the extent in which the change from the normal position and size takes place4 ,i have found that1 if there is a normal passing down of the ingesta and also of the feces1 the stomach will perform its functions perfectly4 ,fear of 8stomach trouble0 is groundless if you keep the digestive and eliminative apparatus in good working order4 ,but this requires that you must keep them clean1 and to do so you must drink plenty of water before each meal4 ,illustration3 ,fig4 #ag4 ,stomach and duodenum--the liver and most of the intestines having been removed4 7,gerrish47 ,shows the anatomical relation of the stomach1 duodenum1 kidneys1 diaphragm1 and the large artery and vein4 ,the organs are held in position by a ligamentous attachment and abundant fatty tissue1 which serve as a connective cushion that furnishes aid in supporting the organs in their proper place4 ,in chronic cases of self-poisoning1 the victim1 as a rule1 becomes anemic and emaciated1 and loses thereby the fatty support required by the organs4 ,they are consequently apt to become displaced and the muscular tissue weakened1 with the consequent pendulous condition of the abdomen often observed in both children and adults4 ,the clay-colored1 flabby1 obese1 anemic victims may retain their worthless adipose tissue2 but they suffer quite as keenly as if they had lost it--from the fact that this tissue is impregnated with poison and filled with gas1 and from the further fact that this abnormal tissue presses on the vital organs here and there as the victim wheezes or puffs along on his road through existence4 ,there is not the slightest doubt that nine-tenths of gastro-intestinal ills and their effects can be prevented or cured by thorough irrigation of the canal1 from mouth to anus1 if it does not itself perform the cleansing process three times in twenty-four hours4 ,,chapter ,,viii4 ,,methods ,,of ,,stomach ,,cleansing4 ,lavage is a term restricted to irrigation of the stomach--a term that has become more or less popular of late with physicians1 but is not so popular with those who have to swallow a rubber stomach tube1 or with the anxious mother or friends who are usually not permitted to be present on such occasions because of the disturbed and cyanotic appearance of the patient--an appearance produced by the introduction of the catheter4 ,much can be said1 however1 of the good results following irrigation of the stomach by the employment of the stomach rubber tube1 and in a special class of cases its use is imperative4 ,but my purpose in this chapter is to advocate the drinking of water as the means par excellence for effective irrigation of the assimilative and eliminative organs1 and to make it plain that this form of irrigation is essential for the preservation of health and the relief and cure of chronic inactivity of the principal organs of the system4 ,usually the drinking of water at regular intervals is sufficient2 but in exceptional cases a generous drinking will result in a complete unloading1 which can be accomplished with ease and with little loss of time4 ,should your stomach be actually performing its office1 the suggestions ,i am about to give will1 if followed1 keep it sweet1 clean1 and in good condition1 and will also flush all the tissues of the body as well4 ,the first duty on rising in the morning should be that of flushing the colon1 as previously recommended1 and flushing the stomach1 as now recommended4 ,take one or two goblets of water 7about eight ounces each7 at a temperature most agreeable1 which1 however1 should not be ice cold4 ,an hour or half an hour later1 during the breakfast1 take one goblet of milk and water or two of water alone1 when the mouth is free from food4 ,about eleven o'clock in the forenoon1 one or two goblets of spring or distilled water1 at its natural temperature1 should be drunk to cleanse the stomach1 duodenum1 kidneys1 etc41 and to flush the tissues of the body4 ,at the noon meal one or two goblets1 and at four or five in the afternoon a similar amount1 should be drunk--the latter as a cleanser before the evening meal1 at which about a pint or more is drunk to aid in emulsifying the food1 as at the breakfast and noon repasts4 ,as a rule1 besides the amounts drunk at meal-time1 there should be consumed as much as two quarts daily1 and the best time for this is when the stomach is empty1 or when it ought to be empty4 ,at bedtime1 one or more glasses may be drunk if one does not suffer from inconvenience from a full bladder during the sleeping hours4 ,one should make water-drinking a habit1 like eating1 sleeping1 defecating1 etc4 ,water-drinking should be performed at regular periods during the day4 ,system is as essential for the harmonious working of the organs as it is for the relations of the departments in a business1 or of the details of any particular department4 ,the guide to the order and temperature to be adopted is agreeableness4 ,find out by experiment what is most agreeable and beneficial to you1 and continue the practice with slight variations adapted to the changes of the seasons and the conditions of the system4 ,there must1 however1 be some training done in most cases1 and what is not agreeable at first may become so4 ,all persons suffering from proctitis and colitis and their symptoms1 as described in the previous chapters of this work and in ,intestinal ,ills1 will require1 now and then1 if not under treatment1 special irrigation of the stomach to remove fermentative matter1 particles of undigested food1 and tenacious1 ropy mucus before the next meal is taken4 ,otherwise the condition will be made doubly bad1 for the fresh material is piled on top of the unduly retained contents of the stomach4 ,as evidence of our civilization1 we clean pots and kettles before the next meal4 ,we even clean our fingers before1 during1 and after the meal4 ,teeth1 mouth1 and face get their proper cleansing4 ,why should we suppose that stomach1 duodenum1 and kidneys1 which receive all sorts of stuff1 should remain clean without an occasional flushing8 ,they need rinsing out after brewing the wine of life4 ,the water drunk between meals not only cleanses the organs through which it passes but irrigates the whole system1 keeping a normal amount of water in all the tissues1 which is as necessary for the maintenance of health as is the due supply of water to the plant in your conservatory4 ,observe the large percentage of human beings that are anemic1 sallow1 clay-colored1 or white--a few obese1 but the many spare1 lean1 gaunt--all of them expressing the disgust of the soul in having such an abiding-place4 ,if all the organs and tissues of the body were kept flushed1 what a fresh and inviting spot the soul would have for the cultivation here on earth of the arts of life6 ,water is the wholesomest of all drinks4 ,it quickens the appetite and strengthens the digestion4 ,it is the most effective agent in the work of elimination--in ridding the system of waste material4 ,properly taken1 it prevents the undue clogging of the organs and tissues1 and tends to cure or relieve those that had become clogged1 and it does this by washing away the substances for which the system has no further use1 and which if they remained would poison it4 ,it is said that if water be drunk freely during a meal the gastric juice will become diluted or washed away4 ,a similar objection is offered concerning the use of the enema4 ,the horse1 it is alleged1 should have more sense than to drink from three to six gallons of water and almost immediately thereafter eat a peck or more of oats and a quantity of hay1 for it ought to know that there is no room for food with such an amount of water in the stomach4 ,if such objectors could but see the horse smile at such arguments--for it secretly knows that the water does not remain in its stomach1 and that its gastric juice is naturally strong and needs dilution--they would stand aghast4 ,would we not be better off if we were not influenced by fool talk like the above advice to the horse1 especially as regards our internal economy8 ,the stomach1 like the freight station1 can accommodate only a limited amount4 ,its contents must be rapidly dispersed1 and every muscular contraction and every respiration gives it an impulse4 ,disease and lack of irrigation will occasion an accumulation or congestion of the contents in the gastro-intestinal canal1 and then the victim of slow transit complains of indigestion1 biliousness1 flatulency1 uric acid1 and of many other ills4 ,your foul1 furred tongue is a very good indication of the trouble below1 so it is wise to examine it in the morning to learn your interior condition4 ,many persons scrape their tongue with a knife because of heavy coating and offensive odor and taste4 ,dyspeptics of this order need a thorough internal bath from above 7per os7 and from below 7per anus74 ,some that suffer from undue gastric retention and indigestion will find relief by flushing the colon and the stomach1 as herein specifically directed4 ,others may find it desirable to start with a mild laxative and an intestinal wash-out with hot water in which some antiseptic or stimulant has been dissolved4 ,the special stomach cleansing is accomplished by the rapid drinking of one tumbler of hot water after another1 until a pint or more is taken into the stomach1 or until a sensation of vomiting is felt1 which may be encouraged by putting the end of the finger down the throat as far as possible or the end of a long lead-pencil wrapped in a little muslin4 ,after as much of the contents of the stomach as is desired is thus cast forth1 drink freely of water again1 as much as you may think proper1 which will be discharged into the duodenum4 ,if this gastro-cleansing has occurred near meal-time omit the meal altogether1 and in an hour or two drink as much water as is agreeable1 to make sure of a thorough washing out of the erstwhile neglected receptacle--the stomach4 ,this special washing out of the stomach may be repeated as often as occasion demands it4 ,it frequently happens with some persons that an hour after a meal there is a hint that all is not well4 ,this may be concealed or corrected by drinking a goblet or two of water1 which practice will permit the brew to go on without further attention to the vat4 ,water may be taken at all times of the day or night if occasion arises for its therapeutic effect in addition to its regular period of use4 ,usually physic1 pepsin1 soda1 charcoal1 whiskey1 etc41 are kept within reach1 and are resorted to on such occasions with the thought that one or more of them will do the work4 ,they will not1 however1 any more than red paint will act as an antidote to poor health by painting the cheeks with it4 ,water1 hot water1 especially when used plentifully1 is the only solvent of dirt4 ,very few realize how essential water is to digestion and to the digestive canal after the process of digestion is completed2 and that it has physiological effects on the system generally is less widely known4 ,there exists a great natural demand for water to carry on the normal functions of the system2 for both atmosphere and heat draw moisture from the body1 and a considerable amount is utilized in the processes of our daily work and in unexpected efforts4 ,an organism composed of almost eighty per cent4 of water requires a generous supply for subsistence--a supply equal to the expenditure of vitality involved in carrying on the numerous functions of body and brain4 ,some day it will be discovered that water is mainly the element employed in psycho-physiological processes4 ,water is easily changed to air1 and atmospheric air to water1 in the system4 ,the generous consumer of air and water will have a good stock of vital or of psychical force on which to draw for the process of thinking4 ,a thinker is a creator1 and he must be successful if his thoughts be rightly directed and he have an ample supply of liquid food--water4 ,,chapter ,,ix4 ,,when ,,enemas ,,should ,,be ,,taken4 ,method is imperative in this strenuous life of ours4 ,nature in her universal operations seems to sanction a uniform system in our daily conduct4 ,had we a regular time for doing things1 periodicity would be established in our sleeping1 eating1 bathing1 defecating1 work1 recreation1 etc4 ,unfortunately1 we are prone to ignorance1 self-indulgence1 procrastination1 which render us careless and reckless in regard to the common-sense conditions of normal living2 and before we are fairly out of our 'teens we begin to bear a crop of proctitis1 colitis1 constipation1 etc4 ,it is in this way that periodicity as to stooling is lost1 and whim1 convenience1 or necessity takes its place4 ,as a result1 we dribble or strain under the fecal and gaseous burden4 ,this happy-go-lucky method accounts for much of the gastro-intestinal disorder complained of by so many1 who 8want to die0 when the painful neurasthenic blues hover around and pervade their bodies like a dense fog4 ,the insidious manner in which proctitis1 colitis1 constipation1 and self-poisoning progress from mild through medium to severe stages does not1 generally1 alarm the victim of intestinal neurasthenia until many years have elapsed1 and one or more of the vital organs have become diseased1 and the whole system is thoroughly under its toxic effects4 ,thus1 slowly1 are the various segments of the gastro-intestinal canal changed to an abnormal condition4 ,suppose the tissues of one of your arms and hands were inflamed1 constricted1 or swollen1 and that the nerves of motion were uncertain1 shaky1 and 8kinky10--all of which conditions we often find in the digestive apparatus1--and that finally recovery takes place under persevering and patient treatment2 how soon1 think you1 could a sensible person expect the limb thus affected to become as useful as its companion that had never been disturbed by disease8 ,unfortunately1 we have not two sets of bowels4 ,ocean steamers are equipped with two sets of motion-producing engines1 so that the disability of one will result in no loss of speed4 ,when man places as much commercial value on himself as he does on his machines or on a boat1 he will either induce ,nature to furnish him with an extra set of energy-producing organs1 or he will take the best possible care of the only one she vouchsafes to him--a care that extends from os to anus4 ,civilized man does1 indeed1 take a little notice of a sore mouth 7although indifferent about an unclean one71 and will even try hard to have it heal1 because a sore mouth may be seen1 and is likely to disfigure him4 ,but a sore anus and rectum may1 for all he seriously cares1 play their painful and poisonous pranks until he is put to bed disabled or is sent to an asylum--or to the final inn where all diseases of the body cease from troubling and the weary organs are at rest4 ,to re-establish that normal rgime of physiological relations called health1 after many years of perverse relations and disorderly practices1 obviously requires time and intelligent1 faithful attention to prescribed conditions4 ,the factors or causes that militate against the removal of curable diseases are3 7#a7 ,the neglect of a local disorder until it has had time to exhaust the general vitality of the system4 7#b7 ,inattention on the part of the patient after he has obtained temporary or partial relief4 7#c7 ,the victim arbitrarily setting his own time limit for the cure of the disease4 7#d7 ,his wilful disobedience of prescribed rules4 7#e7 ,inability to realize the importance of having the cause removed1 as well as the local symptoms4 ,confining attention for the present to proctitis and colitis1 ,i wish to impress the patient1 as well as the physician1 with the fact that no better measure for relieving or removing these undermining disorders can be adopted than the regular practice1 twice or thrice daily1 of intestinal irrigation by means of enemas4 ,the persistent use of the enema is directly influential in relieving and removing the symptoms of such disorders4 ,these symptoms may be piles1 prolapse1 skinny tabs1 fissure1 dull pains1 soreness1 itching channels1 stricture of the anus and rectum1 ulceration1 abscess1 fistula1 cancer1 etc4 ,in the early history of ulcerative proctitis and colitis1 the local symptoms at the anal vent may not be noticeable2 yet the disease may be quite well developed for six or nine inches along the bowels4 ,the early or more obscure symptoms are mild and unnoticeable2 then they progress into notice1 sometimes most sharply2 finally we have severe and chronic constipation1 indigestion1 flatulency1 diarrhea1 etc41 and1 keeping pace with these1 we have the stages of self-poisoning1 which is known as auto-infection or auto-intoxication4 ,with other measures1 the most effective for relieving and removing these symptoms of proctitis and colitis is the enema night and morning4 ,during the long period of relaxation at night1 the functions of elimination and repair are1 with the great majority of us1 going on under abnormal conditions--such1 for instance1 as excessive fermentation and bacterial putrefaction1 which generate poisonous gases that are absorbed by the nerves and bring about the condition of malaise we complain of when we rise in the morning4 ,we then find our bowels distended and ready for relief--and also1 strangely1 8not ready06 ,before dressing1 therefore1 is the time to relieve the excessive pressure from gases and feces1 and a slight enema is accordingly advisable1 say from half a pint to a pint of water1 which should be expelled at once4 ,this removal of the contents of the rectum and perhaps of the sigmoid flexure will permit the contents of the ascending and transverse colon to pass more readily toward and into the sigmoid flexure1 as though they had been invited to come2 and1 indeed1 such passage is rendered inevitable by the removal of the local gas and feces in their path4 ,when half an hour or more has passed and breakfast is over1 it is time for the regular and complete evacuation of the bowels1 by the aid of the internal bath1 or1 as some describe it1 by a full flushing of the colon4 ,in our early efforts to establish harmony and periodicity with the enema1 it is advisable to resort to a mild vegetal laxative1 in some cases1 rather than to let the tongue indicate so much foulness and allow the feelings to become so intensely blue that they cannot be hidden by even the utmost effort at pleasantry4 ,extreme cases may call for different aids toward relief1 until1 one by one1 these aids may be dropped--the last one to be discontinued being the enema4 ,for a short time at the start it is1 perhaps1 best to confine one's self to two enemas1 especially if fairly successful with the attempt at a thorough cleansing after breakfast and before retiring at night4 ,the sleep will be sounder and the patient will be more apt to rise refreshed with a clean tongue and cheerful spirits4 ,so much will this before-bed enema do for him that he may soon find it unnecessary to take the preliminary injection on rising1 inasmuch as fermentation and gas will no longer trouble him4 ,but individual experience and intelligence must dictate the course in this respect4 ,let the patient study himself and note the demands of his system4 ,it may even be1 indeed it is frequently the case1 that a patient requires several enemas during the day4 ,when abnormality has set in1 it gives rise to all sorts of freak requirements1 and the victim must1 for a time1 accede to its whims4 ,quite frequently1 owing to various causes1 the feces will descend into the rectum1 which is properly a conduit1 not a receptacle4 ,while there it occasions much nervous irritation of the whole system and makes its victim desperate4 ,it is wise1 under such a condition1 to take slight injections for relief4 ,never allow any foulness to accumulate4 ,establish the habit of internal cleanliness4 ,the new sense of bodily purity will be so great that it can never be outgrown4 ,nature easily accommodates herself to habits1 whatever they be--normal or abnormal1 wholesome or unwholesome1 cleanly or uncleanly2 and the train of consequences will be accordingly good or evil4 ,my point may be easily illustrated by the habits of 8civilized0 man in regard to bathing4 ,many persons never take an external bath1 and are not conscious of any bodily discomfort arising from the omission of this presumably necessary practice4 ,as the summer approaches1 another batch of 8civilizees10 so fortunate as to be within convenient distance of a pond1 lake1 river1 or ocean1 begin to feel the real need of a 8dip10 and are uncomfortable until they get it4 ,this is surely a sign that the spirit of cleanliness is beginning to stir in the breast of humanity4 ,then there is another contingent that bathe once a week1 and should their regular routine in this respect be interfered with they would at once feel unclean--nay1 even dirty1 and1 sometimes1 8nasty40 ,others1 again1 bathe twice or thrice weekly1 and this quota of the human race feels very uncomfortable and foul when hindered for a week from following this routine2 indeed1 such bathers often imagine that a dire illness is impending4 ,finally1 the 8salt of the earth0 take an external bath once or twice a day1 and1 should their routine be suspended for twenty-four hours1 visions of madness or suicide begin to haunt them until relieved by soap and hot water1 or the cold plunge1 as their habits require4 ,of course1 the same rule applies to the routine concerning the teeth1 facial ablutions1 etc4 ,nature is stored habit1 and she feels outraged when her proprieties are disregarded4 ,let us pray1 therefore1 that the habit of cleanliness may become contagious6 ,now1 the parallel between external and internal cleanliness is quite obvious4 ,those whose bowels move but once in two or three days do not realize how foul they are4 ,others have a scant evacuation once in twenty-four hours1 and they imagine that they are as clean as those that take an external bath once a week think themselves to be4 ,still others have two stools daily1 and they feel as clean internally as those that take three external baths weekly4 ,and1 finally1 there are a few who1 defecating thrice daily1 feel quite as clean as does the most persistent external bather4 ,thus we see that cleanliness1 external and internal1 is a habit1 a new nature1 attended with exquisite comfort and pleasure--a quality that may lead to the goal of divine purity in realizing the joys of hydropathy4 ,the wild woodland flower grew and blossomed without attention1 attracting but little interest4 ,after1 however1 the florist has cultivated it to the high stage of development in which we find it to-day1 with its stalk1 stem1 leaf1 and fragrant petals displaying their marvelous symmetry and beauty1 we begin to appreciate the value of labor1 pains1 cultivation4 ,in like manner1 it is our imperative duty to give proper care to every requisite detail in the transformation of our body into a human flower of health1 grace1 joy1 and harmony4 ,the great majority of those that do me the honor to read what ,i have to say on internal and external cleanliness will1 doubtless1 not agree with me as to the frequency of the ablutions in twenty-four hours4 ,yet ,i have a suspicion that if my objectors were to try an external and an internal bath1 on both rising and retiring1 they would soon consider the practice too delightful to be foregone2 they would soon develop more sweetness of character and be more particular as to the purity of their nether garments1 and1 finally1 would seem ensphered by an atmosphere peopled with angels4 ,my proposition is this3 ,first make a man clean1 internally and externally1 and thus you may make him good2 after you have made him good you can make him healthy in both body and mind2 after you have made him healthy you can make him full of joy4 ,to recapitulate3 ,a good time to take your internal bath is about half an hour after each meal4 ,cultivate regularity in this1 and ,nature will second your efforts and establish a periodicity for you by her suggestive impulse and call4 ,our internal economy should not be slighted as it has been4 ,the intestines are good1 faithful1 patient servitors1 ready to perform their lowly office even when we are inattentive and heedless4 ,sometimes1 however1 they become rebellious1 after they have stood more abuse than one would think them capable of standing4 ,let us reform our bad habits2 our servitors are willing to enter with us into better habits1 and co-operate with us in a truly human life4 ,can you not spare a few minutes1 three times a day1 at regular periods1 for inner purification8 ,you will find it very easy when once you make it a matter of routine4 ,now note this point3 ,the work of your brain depends on the power sent to it by the gastro-intestinal canal4 ,a motor car goes no faster than the power furnished enables it to go4 ,so your brain activity is ever on a par with the energy supplied from this usually despised intestinal source2 that is1 it can never rise higher than the supply of this energy warrants1 and it always falls to the level of this supply1 for it depends on it absolutely for sustaining power4 ,it would seem1 therefore1 that common sense would be sufficient to shame us into keeping clean1 scrupulously clean1 the canal that supplies us with working force--the canal that extends without a break from mouth to anus4 ,yet my experience shows that almost everybody cares more for his outsides than for his insides--more for squandering his stored energy than for looking out for its constant renewal--and that most patients are foul all the way down4 ,well-fed animals that have the range of ,nature are plump1 and have healthy hair1 skin1 teeth1 etc41 because their intestinal organs perform their functions frequently and fully4 ,when animals become domesticated and 8civilized10 they become constipated and catch various human illnesses or grow a crop of their own4 ,well-fed 8humanals0 grow thin and puny1 or bloated with gas1 looking like corpulent clay men1 without natural teeth1 without natural hair1 their skin dry and of a sickly hue1 bloodless1 fading away because of an early blight before they have completed their early growth4 ,heredity is blamed for the bloodless1 nerveless1 brainless body1 when1 as a matter of fact1 its degeneration is due to foulness within4 ,birds1 beasts1 and savages 7more fortunate than civilized man7 have the wide earth on which to stool when ,nature calls4 ,their handy water-closet enables them to enjoy good health4 ,as civilization advances1 and business and social customs become more complex1 water-closets get fewer and less accessible4 ,as a consequence1 man has to use his large intestine for a storehouse4 ,he has done this so long that it seems impossible to break him of the foul habit4 ,but he is paying the penalty4 ,many have abused the bladder in the same way1 and had this been a large organ like its brother1 the colon1 we would long ago have heard the stereotyped excuse in regard to this function1 8,oh1 any time to urinate that ,i can find will do40 ,those who object to the new order of bowel relief should1 on the same principle1 object to frequent bladder relief4 ,i submit this proposition to the judgment of unprejudiced minds3 ,is it not reasonable that so harmless and efficient a remedy as the internal bath should be adopted by all intelligent persons8 ,inasmuch as neglect--due to social1 business1 and other customs1 and to lack of conveniences for ready relief--has brought upon us so much fecal poisoning and local disorders and so many abnormal and pernicious systemic results1 it should not be considered too great a task to take an internal bath three times a day to amend our outrage on ,nature--an outrage that involves our health and general well-being1 here and hereafter4 ,we owe it1 not only to our possibilities1 but also to posterity1 that fecal poisoning be banished4 ,we have no right to communicate such a taint to our children4 ,they have a right to be free from such poison4 ,do we ever think of their claims in this regard8 ,let us leave them a better legacy1 by adopting the thrice-a-day use of the enema for the purification of the alimentary canal6 ,,chapter ,x4 ,,how ,,enemas ,,should ,,be ,,taken4 ,,methods ,,of ,,intestinal ,,irrigation4 ,a satisfactory appliance for taking an enema should possess the following features3 capacity1 adaptability1 convenience1 cleanliness1 durability1 and sufficient external anal and water pressure to effect a thorough flushing or an agreeable vaginal injection while one is in a sitting position over a water-closet bowl4 ,there are several postures in which an enema may be taken4 ,for those physically able1 the most convenient1 cleanly1 and comfortable manner in which the thrice-daily inner bath may be had is the usual upright position on a water-closet seat4 ,for those not physically able to sit upright1 or for those that are not up-to-date and still adhere to the use of the fountain or the bulb syringe1 the best method is not the usual sitting position1 but the recumbent one4 ,they are advised to lie on the right side1 or on the back with hips raised4 ,as a rule1 a water-closet room is too small for reclining purposes1 and1 besides1 the necessary rubber sheet and toweling convenience may be absent4 ,another drawback to lying full length for the purpose of flushing the colon is that with short arms and the lack of external anal pressure there is apt to be an escape of water and feces around the anal point1 necessitating much cleansing1 considerable annoyance from nasty odors1 and an irritating waste of time4 ,various devices1 advertised as great inventions1 have been resorted to for the purpose of overcoming such malodorous and uncleanly incidents4 ,among them is one that may be described as a colon tube1 ranging from nine to eighteen inches in length1 which can be attached to a fountain or a bulb syringe4 ,the tube is usually of flexible rubber1 colored red to hide as much as possible the cumulative evidence of saturated filth and bacterial poison1 the presence of which a white tube would betray too readily4 ,i fail to see the necessity of introducing a rubber canal of such length into an intestinal channel five feet long for the purpose of 8cleansing0 the latter4 ,the project lacks common sense4 ,what a ridiculous practice--to worm or bore a hole through the impacted feces as you work your tube upward1 then to squirt a little water into the middle of things1 or as near to the middle as you have managed to get with a tube that will persist in bending on itself1 and then to withdraw it covered with liquid filth6 ,what folly to put a canal into a canal--the one inserted being one-fifth the length of the one to be cleansed6 ,is not the original physiological channel good enough to convey the antiseptic water or oil1 or both8 ,why not have the rubber canal five or six feet long if one foot is so essential8 ,we should remember that ulcerative proctitis and colitis have made the use of the enema a necessity2 that1 accordingly1 the diseased1 constricted gut or canal must be treated very gently and not irritated in any avoidable way4 ,the least irritation will result in still greater muscular contraction4 ,it stands to reason that the effort to reach the healthy portion of the bowel with a slightly flexible colon tube frustrates its own purpose1 and that it is besides a source of serious and unnecessary irritation4 ,while this rubber tube is being forced up one's bowels it often becomes lodged here and there in the valves and folds of the mucous membrane4 ,it has been found that the effort used to dislodge it sometimes results in a doubling of the tube on itself in the form of a knot1 and that the end first introduced comes back to the anus waiting to escape with the next push6 ,we need not argue that this forced looping and knotting of the tube is very injurious to the diseased intestinal region1 and that no one would care to introduce it two or three times a day4 ,does not common sense suggest that the rational way is to open the bore of the alimentary canal by beginning at its end2 that liquid should be applied directly to the first feces encountered1 and that as this impacted mass is removed the progress should be successfully upward8 ,the liquid as it enters dilates the channel1 and as it passes on and up it eventually gets beyond the diseased section of the bowels4 ,here1 by a gentle and soothing dilatation1 we create at once an impulse in the imprisoned feces and gases to descend and escape4 ,what other method is so kindly1 and yet so effectual8 ,we avoid1 by this means1 irritating the diseased and constricted muscular canal2 whereas by the tube method we occasion still greater contraction1 the inflamed surface having a tendency to contract and close tightly over the tube4 ,the flood of liquid dilates the canal2 whereas the forced rubber tube1 by irritation1 contracts it4 ,besides1 as has been pointed out1 the conduct of the tube working in the dark is most uncertain4 ,suppose the rubber tube does finally reach the section of the colon free from inflammation2 that its passage thither has greatly increased the spasmodic contraction of the diseased portion of the gut1 and that1 of course1 it had great difficulty in circumventing the resistance offered by the valves1 curves1 and short bends--suppose all this1 and an idea of how the contents of the bowel above the diseased zone are imprisoned will dawn upon you4 ,for1 after the tube has reached this point of impaction1 the distention there is most unduly increased by the sudden gush of water1 and1 what is of still graver import1 the presence of the tube prevents its return flow4 ,then as the object is being removed the watery feces following closely after are impeded by the increased irritative contraction set up by the tube4 ,in short1 this greatly extolled colon tube subjects the region of proctitis and colitis1 as well as the healthy section1 to just such objectionable procedure until the amount of water injected becomes so extremely large that a means of escape is irresistibly produced by the great pressure above4 ,is it wise treatment to irritate the diseased portion of the bowels1 and to distend still further the healthy portion above1 in order to get rid of distention due to feces and gases8 ,without increasing the danger by injecting water into the already unduly distended colon by the use of the tube1 the imprisoned feces and gases of themselves alone have been known to exert sufficient pressure to occasion prolapse of the sigmoid flexure into the rectum or undue displacement of the organ4 ,surely it were better to get rid of the imprisoned contents by removing them from near the vent and working one's way gradually upward than to add more to the store and burden1 which only causes unendurable excitement and fierce demands for relief4 ,the rectal enema1 taken in the rational way1 simply dilates the portion of the gut that is morbidly contracted--a procedure that is very beneficial and should be continued just so long as any remnant of the inflammation remains in the tissues4 ,kindly treatment is essential1 because ulcerative inflammation is an irritable condition and tends to contract the muscular tissue at the slightest touch of a foreign substance4 ,what1 ,i repeat1 is more kind and soothing than antiseptic water mixed with oil8 ,advocates of the colon tube assert that water entering the lower portion of the rectum will occasion ballooning of this portion of the gut4 ,after an experience covering twenty or more years1 ,i am in a position to say that there is absolutely nothing in this objection--that water used in this way cannot produce such a pathological condition4 ,ballooning of the lower portion of the rectum is occasioned by impaction of feces1 which remain lodged often for weeks or months at a time in this locality4 ,whatever dilatation the use of the enema may transiently produce would be only healthy exercise for the diseased organ4 ,an instrument is frequently used properly to dilate the more or less contracted canal above and below the distended pouch for a distance of from six to ten or more inches4 ,nothing but good results can follow the proper use of the enema two or three times a day in all forms of local disease of the anus1 rectum1 and colon4 ,,chapter ,,xi4 ,,the ,,internal ,,fountain ,,bath4 ,,the ,,author',s ,,unique ,,invention4 ,the author has searched the markets of the world for suitable apparatus for intestinal irrigation1 so that he1 as a specialist in this line and in anal and rectal diseases1 could recommend it to his patients4 ,none of the appliances to be had1 however1 quite answered the purpose he had in view4 ,all of them had some drawbacks4 ,owing to this fact1 after much experimentation he has invented an instrument that is herein fully described to show its serviceableness4 ,were this volume to be issued without this description1 the author would be inundated with interrogatories concerning the best instrument to be employed by its readers1 or whether the appliances they have on hand would answer the purpose4 ,as the object of this book is practical1 not literary1 it is not out of place1 the author thinks1 to describe the invention and its unique serviceableness1 as well as its special adaptability for the tri-daily employment of enemas4 ,the instrument is known as 8,the ,internal ,fountain ,bath for ,home ,treatment40 ,the following illustration gives a very good idea of its construction and merits3 ,illustration3 ,patented ,dec4 #ca1 #aija2 ,nov4 #ad1 #aije4 ,figures #ah1 #ba1 #bb1 and #bc4 #ah1 ,reservoir2 #ba1 hard rubber handle2 #bb1 metal handle2 #bc1 metal handle1 hard rubber cone1 and enema point2 #ai1 lamp support2 #bj1 lamp2 #cc1 rubber tube and shut-off2 #bd1 glass bottle2 #bg1 hard rubber anal cone2 #bi1 valve2 #bh1 enema point2 #be and #bf1 recurrent douche points2 #cj1 glass bottle2 #ca1 hard rubber cone2 #cb1 enema point4 ,figure #bd1 ,page #abj1 illustrates the author's rubber enema appliance1 ,the ,niagara ,fountain ,syringe1 holding about two gallons of water4 ,the ,internal and ,external ,fountain ,bath is an appliance that ,i have devised and supplied to my patients for many years with most satisfactory results in every particular4 ,several other enemata and recurrent douche instruments which ,i have used did not wholly meet the requirements in capacity or aseptic features2 but long use of this apparatus in all the various bowel troubles has demonstrated1 to me as well as to my students and patients1 that the instrument is the best that can be made1 perfectly meeting all the requirements essential for scientific results4 ,features and ,uses4 ,the ,fountain ,bath is the product of necessity1 effort1 and long experience in accomplishing a definite purpose fully and properly4 ,figure #ah illustrates a large enamelled metal reservoir for water4 ,figure #ba shows a hard rubber combined enema and recurrent douche appliance for the application of water to the mucous membrane of the large intestine1 the temperature of which should range from ninety to one hundred and thirty-five degrees or more4 ,to one end of the handle is attached a hard rubber anal cone 7,figure #bg71 inside of which is a valve 7,figure #bi71 which is opened and closed by turning the handle1 permitting the water to pass through the rectal point 7,figure #be71 or 7,figure #bf7 into the bowels and return into the toilet basin without removing the point4 ,at the other end of the handle is attached a glass reservoir for the use of oils4 ,figure #bb is a metal handle with a glass reservoir and a hard rubber anal cone4 ,figure #bc is a metal handle without glass reservoir1 and both are intended for the use of water at a temperature of from ninety to one hundred and five or one hundred and ten degrees4 ,a thermometer is absolutely necessary to determine the temperature of the water during its use as a depurent and antiphlogistic remedy4 ,the heating appliance will keep the water at a desired temperature during its application1 which is a very essential feature indeed4 ,water ,capacity4 ,the ,fountain ,bath reservoir holds three gallons of water1 which is quite sufficient to meet all requirements of the various complicated cases of bowel and uterine troubles which require a generous supply of tepid or very hot water4 ,this obviates any interruption in the use of the enema or the recurrent douche treatment until one or both are satisfactorily completed1 and without changing one's position on the toilet seat4 ,it requires a quantity of water to irrigate the large intestine1 which is some five feet long and two and a half inches in diameter4 ,it is foolish to attempt to irrigate one end of a long1 tortuous1 foul sewer with one or two quarts of water and hope for good results4 ,water is cheap1 then why not clean out and keep clean8 ,adaptability4 ,for the first time in the history of enemata appliances can an enema1 recurrent douche1 or vaginal injection be taken with water at any desired temperature and at the same time be medicated with any remedy desired4 ,external pressure against the anal orifice is regulated at will2 also the flushing of the integument about the anus and buttocks is easily accomplished before leaving the toilet seat4 ,convenience4 ,this scientific device can be used without assistance4 ,it has one feature moreover1 that renders it unique among rectal appliances1 namely that you may take a number of rapid injections without changing your seat4 ,you may inject a small quantity of water 7from eight to twelve ounces71 and expel it immediately2 then you may follow with a larger amount 7from one to three pints71 and expel that also1 then in the same manner flush the colon4 ,a complete internal bath may be effected in the same way by using three1 four or more quarts of water4 ,in this way1 thorough depurating results may be obtained4 ,the several preliminary injections of gradually increasing quantities of water free the lower bowel of feces1 germs1 and gases which otherwise might be forced by the flushing process backward into and along the colon4 ,with the ,internal ,fountain ,bath1 unlike other syringes1 it is not inconvenient to take preliminary injections before flushing the bowels4 ,after the flushing the rectal and anal canals the bowels can be easily cleaned their entire length1 as can also the integument about the anus and buttocks by letting the jet of water play on these parts to wash away any germs and other poisonous discharges4 ,all the necessary movements of the anal point are easily made with the handle which projects between the limbs in front of the toilet seat4 ,cleanliness4 ,the water reservoir is enameled white1 both inside and out and free from poisonous substances4 ,the enamel is not injured by the use of any germicidal remedies that may be placed in the water1 or by the water being brought to a very high temperature to destroy bacterial poisons4 ,furthermore this enameled surface is easily cleaned1 thus avoiding foulness of the reservoir from continued use4 ,the glass medicine case and anal cone attached to the handle1 as well as the anal point1 are all detachable and easily cleaned1 and the handle is of sufficient length to obviate soiling the hands and impregnating them with odors4 ,to bring away a quantity of feces does not exhaust the purpose of the enema4 ,the intestinal sewer requires further cleaning from end to end1 and the external parts around the anus as well4 ,by playing a jet of water on the external anal region you finish the enema and avoid the very uncleanly practice of using 8toilet paper0 as a means of external cleansing4 ,it is strange that otherwise cleanly people are content with such uncleanly treatment of these parts4 ,they imagine that 8toilet paper0 will effectually remove the excrement and its attending odors4 ,they would not think it sufficient thus to clean their hands if soiled by excrementitious matter4 ,it is the old story1 8out of sight1 out of mind10 and of letting any make-shift in such cases answer2 but the spirit of cleanliness is abroad in the land1 and the ,silent ,club of the ,cleanly is being formed through just such agencies as the ,internal ,fountain ,bath4 ,many have doubtless longed for a better practice but did not know what to do4 ,the 8toilet paper0 habit will pass with the once-a-day habit of stooling1 the constipation habit1 and the physic habit1 for all four are uncleanly in the extreme4 ,durability4 ,the enameled metal reservoir and the metal and hard-rubber parts of the handle ought1 with care1 to last a lifetime2 the soft-rubber tube1 if properly cared for1 will be of service for a long time4 ,external ,anal ,pressure4 ,this is of very important assistance in flushing the colon1 as it aids in preventing the return of the injected water1 and thereby promotes its conveyance along the colon until it arrives at the surgically famous vermiform appendix4 ,it is not strange that both ends of the large intestine--the anus and rectum and the appendix region--have kept the surgeons busy1 and ,i may add the undertaker likewise4 ,these two ends are of extraordinary concern1 because they manifest intense symptoms and pathological consequences4 ,modern medical practice is the heroic treatment of symptoms and consequences and not patient search for causes of disease and sensible treatment of it1 as explained in my treatise dealing with 8,intestinal ,ills10 as well as in the present volume4 ,water ,pressure4 ,two or three gallons of water1 suspended at the usual height of enemata appliance1 affords quite enough pressure1 especially when the outlet and tubing are amply large4 ,the shut-off on the rubber tube enables the user to gauge the flow of water to a nicety4 ,time ,required4 ,the time required for taking an internal bath--that is1 for a complete flushing of the bowels--will vary in individual cases4 ,after removing the local deposits in and near the rectum by one or two rapid injections of very small quantities of water1 two to four quarts are taken into the intestinal canal at one time1 and this constitutes the enema proper4 ,now1 many persons will find it advantageous to let the flushing water enter very slowly1 taking from two to five minutes1 or even more4 ,with some1 if the water is allowed to flow in very rapidly1 the various segments of the rectum and colon may not readily accommodate themselves to the inflow1 and will too soon make an expulsive effort1 returning the water before it has dissolved the feces or united with them1 thus defeating the object sought through the enema4 ,with other persons1 however1 the flow may be as rapid as desired4 ,the speed must be left to individual judgment and experience4 ,temperature of ,water for an ,enema4 ,the chief purpose of an enema is to produce depuratory results2 that is1 to remove morbid matter from the bowels and then to cleanse them4 ,to accomplish this effectively and at the same time to avoid exciting an increased flow of blood to the diseased gut1 the water should be about the normal temperature of the body1 which is about #ih-a_/b degrees4 ,water too hot or too cold will aggravate the sensitive1 inflamed surface2 and1 as it is this very inflammation that causes the abnormal action of the bowels for the relief of which the enema is taken1 the temperature of the water is most important4 ,if it range between #ij and #aje degrees it will do1 for within those extremes it will not be likely to increase the existing chronic engorgement of the tissues4 ,under no circumstances should very hot or very cold water be used for the removal of fecal accumulation4 ,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 water4 ,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 symptoms4 ,when water is applied to the mucous membrane anywhere throughout the body1 ,i use it hot exclusively1 as that temperature has then certain advantages over cold4 ,in the chapters treating upon the different uses of hot water1 ,i give the hydro-therapeutic action of such liquid on the tissues of the body4 ,quantity of ,water to be ,used4 ,the quantity of water to be injected into the colon at one time must vary in each case and also on each occasion4 ,in the beginning of its use and for some time following1 a greater amount may be required than will be necessary when1 with its continued use1 a better action of the bowels becomes established4 ,in cases of chronic constipation and semi-constipation1 the kidneys1 lungs1 mucous membrane1 and skin eliminate a daily accumulation of feces from the system equal to two-thirds or three-fourths of the amount of normal feces4 ,this accounts for the frequency of chronic disease of these organs4 ,to establish a new rgime in the mode of fecal and gaseous elimination requires much time and patience in the use of the enema4 ,nearly all persons can take the enema with comfort and satisfaction4 ,now and then1 however1 there is a person who finds it a little troublesome to inject over a quart of water at one time1 while most persons can inject over four quarts without inconvenience4 ,i would advise patience and perseverance on the part of those who find it irksome to inject a sufficient amount thoroughly to cleanse the colon1 or the portion thereof involved in undue accumulation4 ,enough water should be injected to bring away what would constitute the normal amount of feces to be passed at a regular stool4 ,gradually1 as the practice is established by the use of the enema twice or thrice daily1 it will be easy to determine the proper amount of feces to pass4 ,and note this fact3 it is just as easy to establish the habit of three evacuations in twenty-four hours as of two or one4 ,whenever the amount of water injected proves sufficient at any time to bring away all the feces that should pass1 it is not necessary at that sitting to repeat the dose1 except it be for subsequent cleansing1 as a sort of gargle4 ,no possible harm can come from the generous use of the enema during a lifetime2 indeed1 its constant use will prolong life and make it more comfortable4 ,,chapter ,,xii4 ,,benefits ,,of ,,the ,,inner ,,bath4 ,i speak from clinical observation with the use of various rectal and colon specula1 of which ,i have over fifty4 ,i have watched the progress of cases that were using the enema twice or thrice daily1 and of cases that were also using the intestinal recurrent douche1 which latter required an hour's continuous application of hot water1 and ,i know1 therefore1 whereof ,i speak when ,i affirm its salutary effect both on the local organs and on the general system4 ,many that write about the use or abuse of the enema have never seen the mucous membrane of the rectum and colon4 ,most of what is written on the subject is worthless4 ,the author of this book writes from the accumulated experience of daily examinations with specula for a period of over twenty-three years4 ,had he merely used his fingers or hand for making rectal examinations1 or had he contented himself with prescribing for symptoms reported by the sufferer1 his views and opinions as to the use and benefits of the internal bath would have been on a par with those that1 by the old methods1 make futile efforts in diagnosis and treatment4 ,some good souls now and then become oversolicitous as to the matter they should pass when their bowels are already empty1 and they feel alarmed if the enema fails to produce an evacuation4 ,such timid ones should remember that what they cannot accomplish at one time and with one attempt they may at the next1 and that thus slowly the new order of fecal elimination will become established4 ,it takes time and patience2 but is this cause for apprehension when diagnosis1 treatment1 and means of relief are right8 ,i claim that flushing of the colon is the best means for removal of the consequences of proctitis and colitis1 and that it should be employed by all that have these chronic ailments4 ,let them get relief for the symptoms at once and in this rational way1 after which let them seek scientific treatment for the ailments themselves2 for1 sooner or later1 they will be compelled to seek it by the severe complications that will inevitably set in4 ,,try ,,scientific ,,and ,,practical ,,measures4 ,some persons find difficulty in estimating--or think they do1 which in most cases is nearer the truth--the amount of water they can inject at one time1 when it would work a great relief to their bowels were they able to inject from two to four quarts4 ,it is half the battle to know your efforts are rightly directed2 for1 when you are defeated1 you will try a thousand and one changes--an experiment first with one element of the difficulty and then with another4 ,you will experiment with the temperature1 with the speed of flow into the rectum and colon1 with intermittent flow1 etc4 ,be a little scientific and original in this matter1 ,i pray you1 and know no defeat6 ,as to the intermittent flow1 the following way may be found judicious in some cases3 ,take in just sufficient water--a few ounces perhaps--to provoke an evacuation1 and proceed till you have taken half a dozen or more4 ,after this you can take a greater quantity for a washout4 ,but this is not exactly what is meant by the term 8intermittent flow40 ,it means that you may make the experiment--if you find it difficult to fill up after ridding yourself of the local accumulation--of turning off the stop-cock for a moment1 thus giving your bowels a slight rest1 and then turning it on again1 alternating in this way for some minutes4 ,many little devices of similar utility will suggest themselves to those who know no defeat4 ,remember that1 now that you are in serious trouble1 it is not the easiest thing in the world to get out of it4 ,should your stomach raise objections to the enema1 change the time4 ,if abdominal pains are severe1 change the temperature of the water and the time and manner of injecting it4 ,in other words1 do something different1 but be determined to conquer and take the internal bath at proper periods every day4 ,,liberating ,,the ,,water4 ,some persons who find no trouble at all in taking a large quantity of water have much difficulty in expelling it1 or rather in expelling all of it at once4 ,various methods may be resorted to to liberate the retained water4 ,one is to inject a little more1 as a provoker1 when all will escape without further difficulty4 ,another method is to resort to various motions of the arms and body4 ,some find relief by raising and projecting both arms together slowly1 and then stretching and holding them aloft for a few moments4 ,other methods are3 to twist the trunk a few times1 to walk up and down a little1 to bend forward and backward1 etc4 ,still another method is to massage the abdominal walls1 beginning at the ascending colon 7see ,fig4 #ab71 passing upward to the left along the transverse colon1 and then downward until the lower portion of the sigmoid flexure is reached4 ,when beginning the massage1 one should use stroking movements from right to left over the entire surface1 and then go over it again with rotary strokes4 ,some may find it advantageous to knead the abdominal muscles1 gradually reaching the deeper parts as the air is expelled from the lungs1 which expulsion may change the position of the various segments of the intestine and thus afford an opportunity for the feces1 gases1 and water to escape4 ,before rising in the morning and retiring at night1 it will be found advantageous by some persons to spend about ten minutes in making the three kinds of manipulations described4 ,it is an excellent practice for every one to lie flat on the chest and abdomen and draw in several deep breaths just before rising4 ,this exercise will strengthen the muscles of those parts and benefit the internal organs as well4 ,,the ,,enema ,,as ,a ,,permanent ,,practice4 ,in the effort to restore the long-abused bowel to its normal functioning by the use of the enema and massage1 there may be1 in the beginning of such treatment1 an exceptional case in which a mild laxative is indicated as the desirable thing1 rather than that a furred tongue and base bodily feelings shall evidence too much foulness all the way up to the mouth4 ,the enema1 of course1 constitutes the chief means and mainstay of relief from obstipation of the bowels1 and one by one the other aids are to be omitted4 ,moreover1 when the time comes that the bowel is freed from the disease that occasioned the occlusion and obstipation1--that is to say1 when the bowels evacuate themselves naturally three times a day1--then the enema itself may be omitted1 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 cleanliness4 ,surely there is no harm in substituting a better habit for a worse one--one1 moreover1 that we should be ashamed to continue6 ,as no one would think of cleaning his soiled fingers with toilet paper1 as already said1 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 way4 ,likewise1 after having learned the rational mode of relieving the surcharged bowels1 no wise person will continue the use of physic1 coarse food1 gymnastic exercises1 and other futile and foolish practices as remedial measures for intestinal ailments4 ,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 use1 three times a day1 of the enema4 ,from the day when the disease invades these parts there is and will continue to be a clogged1 plastered1 or incrusted passage for more or less of the entire length of the colon4 ,this must be so in the nature of things1 since these organs are unable to perform their functions while the disease is present4 ,just think of possessing a filthy1 congested intestinal canal1 without one day of real cleanliness for twenty1 forty1 sixty1 or more years6 ,it is not the easiest thing in the world to cleanse this channel even by the use of the enema2 for the ancient contents refuse dislodgment even after repeated flushings1 and it is only after many days of persistent and patient irrigation that the intestines are freed4 ,some persons are apprehensive as to the quantity of water the large intestine will hold with safety4 ,let me reassure them4 ,it is capable of holding about three gallons without too great distention4 ,one-third of this amount1 however1 is quite sufficient to bring away the accumulated fecal mass1 and in many cases a much smaller amount will answer the purpose--especially when1 as advised1 it is used two or three times within twenty-four hours4 ,after a thorough evacuation1 water should be injected one or more times until it returns clear and free from fragments of feces4 ,if ,i were asked to name the greatest curse parents could inflict upon their helpless offspring1 ,i would say fecal auto-intoxication4 ,a large volume could be written on the subject1 and ,i trust the hints here given will lead to discussion of this grave matter4 ,,chapter ,,xiii4 ,,objections ,,to ,,the ,,use ,,of ,,the ,,enema ,,answered4 ,the privilege of raising objections belongs to the ignorant as well as to the intelligent4 ,but the objector is under as great obligations to state his reasons as the advocate4 ,the first plausible objection to the use of the enema is that it is not natural4 ,admitting this charge1 ,i would say that1 inasmuch as proctitis1 colitis1 and constipation are unnatural1 the use of a preternatural or1 in other words1 a rational means to overcome the consequences of these diseases is imperative4 ,the enema is such a means4 ,can any one that suffers from proctitis1 etc41 have a natural stool8 ,unnatural conditions require preternatural aids1 as we all know4 ,the injected water dilates the constricted portion of the gut and arouses a revulsive impulse to expel the invading water4 ,in obeying this impulse1 the imprisoned feces1 gases1 etc41 are ejected with the water4 ,it may be unnatural to put water into the rectum1 etc41 but once there its expulsion from healthy bowels would be quite natural4 ,no natural action can be expected from unhealthy bowels2 they do the best they can under the circumstances4 ,eyeglasses1 false teeth1 crutches1 etc41 are unnatural but invaluable aids1 but no more so than is the enema as a means of relief from overloaded bowels4 ,the enema1 moreover1 be it noted1 not only aids the system by relieving it of its load3 it cleanses and soothes an organ that must keep at work and perform its function even when invaded by disease4 ,surely it is unhygienic and irrational to ignore the valuable service of the enema in cases in which the bowels are in an unnatural condition4 ,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 two4 ,i would remind the objector that1 since about seventy-five per cent4 of the normal feces is water1 it seems strange that so great a quantity of water in contact with the mucous surface of the bowels should not also cause dryness4 ,the integument of the body and that of the mucous membrane are similar in structure1 yet who ever had a fear of producing dryness of the skin by much application of water8 ,the mucous membrane is simply the skin turned inward2 and since it is much more vascular it is less apt to become dry--if1 indeed1 its dryness were at all possible4 ,the objector should also remember that the body is composed of over eighty per cent4 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 day4 ,the mucous membrane of the lower bowel is not unlike that of the mouth1 throat1 or stomach4 ,do you realize how often the upper end of the intestinal canal is washed or bathed daily with liquids1--soft and hard drinks1 hot and cold1--especially by those who have formed the drink habit instead of the enema habit8 ,they have no fear of drying the mucous membrane thereby2 but1 if you can instill this fear1 they will increase the quantity with pleasure6 ,this second objection1 being the result of too vivid an imagination and too little reflection1 is a very nonsensical objection indeed4 ,a third objection is that if you begin the use of the enema you will have to continue its use2 you can't stop1 and1 lo and behold6 the enema habit is formed1--a new habit in addition to the many habits civilized man is already carrying3 the constipated habit1 the physic habit1 the sand1 bran1 sawdust-food habit1 the muscular peristaltic habit1 etc41--and with all these habits the poor victim of proctitis and intestinal foulness wonders that he is alive4 ,usually the first symptom of proctitis is constipation1 and for relief the enema habit should be formed and continued while the constipation remains4 ,when the proper means are found to remove the intestinal inflammation--proctitis and colitis--then the constipation will disappear1 and with its disappearance the enema habit can be discontinued4 ,but let it be well noted that the enema is itself an aid in curing the cause1 an aid superior to any other at our command4 ,a cleanly habit ought not to be an objectionable one1 especially in cases in which it is most needed to prevent toxic substances from entering the system4 ,a fourth objection is that after taking the first enema the constipation is worse4 ,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 bowels4 ,this unnatural effort may occur once a day or once in two or three days1 and has doubtless been a habit of many years' duration4 ,to introduce a new order of conduct on the part of the bowels requires time4 ,if the bowels have been in the habit of expelling feces in the morning1 and an enema were taken the night before1 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 defecation4 ,but we have found the extent of local damage and reflex injury to the organs1 and more especially we have found the constant absorption of poisons into the system1 due to the presence of feces4 ,it is for this reason that the elimination of feces twice or thrice in twenty-four hours is advised4 ,the condition for which an enema is used is disturbing and poisoning to the system4 ,it is1 therefore1 a most unnatural condition4 ,what is more rational1 then1 than to employ an 8unnatural0 yet not harmful means to bring about a more normal condition1 one free from poisoning and irritating consequences8 ,a fifth objection is made by those who have as a symptom of proctitis a large development of pile tumors or hemorrhoids 7distended mucous membrane74 ,the objection is that at times these tumors or sacs prolapse very freely during the act of expelling the injected water4 ,but this prolapse occurs in many cases whether water is used or not4 ,a certain amount of anal irritation caused by the passage of feces occurs1 causing contraction of the circular muscular tissue that forms the anal and rectal canal1 also of the longitudinal muscular bands and the levator muscles of the organs4 ,the enema lessens or entirely diminishes the irritation of passing feces1 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 defecating4 ,it is simply a choice between irritation of the stool keeping the tissue up and no irritation permitting a prolapse4 ,of course1 if there be no expulsion of feces and water the stretched or dilated sacs may keep their places in the rectum4 ,and then again the enema may be used for quite a period1 when all at once a large prolapse of sacculated mucous membrane occurs1 and the enema is thought to be the cause of it4 ,that this is not the cause1 let it be remembered that in all cases of proctitis the chronic inflammation is apt to become subacute or acute1 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 time1 especially at times of convulsive effort at evacuation4 ,whatever follows the proper use of an enema1 even though what follows be annoying1 should not be blamed on the enema1 for its action is most kindly1 lessening1 as it does1 the irritation that otherwise would be more severe when the feces pass through a disease-constricted canal4 ,the sixth objection is that the use of the enema will weaken the bowels1 which are already too 8weak0 to expel their contents4 8,atony1 paralysis1 fatty degeneration of the gut1 are bad enough10 say these objectors1 8without having an enema increase their uselessness40 ,diagnosis wrong and objection groundless6 ,distend and contract an organ for a short time two or three times a day1 and it will gain in strength from the exercise4 ,every one knows that this is the case4 ,what more gentle means of exercising the large intestine than by the enema8 ,but the truth of the matter is1 that in all cases of proctitis and constipation the diseased portion of the gut is too active in its muscular movements1 contracting spasmodically1 as it does1 at even the suggestion or suspicion of feces near it4 ,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 obstruction1 compelling the victim to resort to some one of the many drastic means of relief4 ,the enema does no more than kindly to dilate the constricted region1 which1 when dilated1 evokes a harmonious concerted action of all the nerves and muscles to pass along and down the burden of feces1 which1 without the aid of a flood of water1 they had been incapable of moving1 and would have had to leave to poison the system4 ,the seventh objection is quite nave3 8,inasmuch as the ,indians of this country had no use for the enema1 why should we resort to it80 ,the all-sufficient answer to this objection is that the ,indians lived a natural life1 while ours is artificial4 ,much can be said on this point1 but the reader is surely rational enough to follow out the distinction suggested4 ,our lives are much more important than were the lives of the aborigines of this country1 and our 8demands of ,nature0 are more exigent4 ,if your life is of no greater value than theirs1 for leisure's sake don't use the enema6 ,you will be taking too much trouble4 ,it really should seem that the cleanliness of the skin and mucous membrane1 the care we take of our bodies1 is an indication and measure of our sense of refinement4 ,an ancient ,scripture hath it3 8,let those that are filthy1 be filthy still40 ,it all depends upon how you wish to be classed--with the filthy or the cleanly4 ,the eighth objection to be noted is the fear of 8poking things0 7points of instruments7 8into the rectum40 ,this looks like a real objection4 ,no healthy1 nor even unhealthy1 organ1 for that matter1 should be 8abused40 ,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 inclination8 ,still1 the muscles of the vent are strong1 and they soon accommodate themselves to the practice4 ,their slight disinclination is not to be considered alongside of the relief and cure you effectuate by the use of the enema4 ,have no fear that the point will occasion disease when intelligently used4 ,always see to it that the point is scrupulously clean4 ,those made of hard rubber or metal can be kept so without effort4 ,soft-rubber points are always foul and dangerous1 especially after they are used a few times4 ,a good rule is never to put a point higher in the bowel than is absolutely necessary4 ,the ninth objection seems serious4 ,it is that in taking an enema the water escaping from the syringe point will injure the mucous membrane where the jet strikes4 ,but on examination this objection falls to the ground2 for it stands to reason the jet cannot directly hit the surface for more than a moment4 ,immediately thereafter the accumulation of water will force the jet to spend its energy on the increasing volume1 to lift it out of the way so that the continuous inflow may find room4 ,but even were it possible for the jet to strike a definite section of the mucous membrane during the taking of the enema1 it could do no harm provided the water be at the proper temperature4 ,and this is true even if a hydrant pressure be used4 ,not a few persons use the hydrant pressure of their houses in taking an enema4 ,for a really successful flushing of the colon a considerable pressure is requisite to force the volume up and along a distance of five feet1 especially when sitting upright4 ,but it is folly to use a long syringe point1 since it is like introducing one canal into another for the purpose of cleansing it4 ,therefore1 have no fear from the use of proper syringe points2 the jet of water will not hurt the mucous membrane4 ,my professional brethren at least ought to know that the idea of such harm is sheer nonsense4 ,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 colon4 ,every victim hates to be compelled to do a thing2 and the victim of proctitis and colitis is no exception to the rule4 ,in fact1 he is beginning to realize that unless he uses it his system will be poisoned by the absorption of the sewage waste4 ,let the victim object to the disease that necessitates the use of the enema1 and all will shortly be well4 ,then this objection to the use of the enema will indeed be the most important of all4 ,the eleventh objection1 and the most ridiculous of all1 is that it requires too much time to take the enema twice or thrice daily4 ,i lose all patience with persons urging this objection4 ,those that have little or no system with their daily duties seldom have time to do anything of importance4 ,they suffer from 8haphazarditis10 a very difficult disease to cure1 and they are in many cases hopeless4 ,usually they are an uncleanly lot of people1 full of good intentions1 but their intentions1 though taken often1 seldom operate as an antidote to foulness4 ,their one sigh the livelong day is3 8,oh1 could we be like birds that can stool while on the wing or on foot60 ,this feat of time-saving being hardly possible in the present incarnation and order of society1 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 sport4 ,a sorry lot they are1 indeed1 when they are laid up for repairs6 ,many doctors1 ,i am sorry to say1 encourage1 with a chuckle1 this foolish practice4 8,any time to stool you can manage to get1 so that you stool at least once a day1 or once in every two or three days2 stool when it is normal for you to do so40 ,this criminal advice just suits the sleepy1 the lazy1 or the 8awfully busy40 ,the ,american habit of doing things en masse1 of handling things in large quantities or in bulk1 has something to do with their don't-care constipated habit4 ,small evacuations two or three times a day seem too much like small business1 which of course is a waste of precious time4 ,wholesaling1 laziness1 lack of system1 hurry1 are the cause of good-for-nothingness of body and mind4 ,it should never be too much trouble to restore the lost impulse for stooling twice or thrice daily4 ,is it a small matter to have the main sewer of a city partly or entirely closed1 or the main sewer pipe of a dwelling stopped up8 ,think of the dire results1 notwithstanding that the windows and doors remain wide open6 ,the ,board of ,health would soon deal with the negligent official or landlord4 ,with very few exceptions1 8civilized0 men1 women1 and children are negligent and niggardly caretakers of the human dwelling-place--the marvelous body of man4 8,lack of time10 8haven't the time10 or 8no time10 is the excuse they give themselves and others4 ,notwithstanding the numberless victims around them1 none of these negligent and niggardly ones seem to get alarmed until the secondary symptoms--such as indigestion1 gout1 rheumatism1 or disease of some vital organ--are sufficiently annoying to demand attention4 ,but ,i have full faith in humanity4 ,man does the best he knows how--as a general rule4 ,but often he doesn't know how2 he needs enlightening4 ,the hints ,i have given will1 ,i am confident1 be considered and acted upon by all to whose attention they are brought1 for1 by acting upon them1 normal bodies and minds will result1 and blessings attained heretofore considered impossible4 ,normal health depends on right doing and being4 ,eternal vigilance is the price to be paid for the attainment and maintenance of the goal of normal life and progress4 ,eliminate all waste material from the body and all shifty vermin from the mind1 and the millennium for all things in the universe will soon dawn4 ,illustration3 ,fig4 #bd4 ,,niagara ,,fountain ,,syringe4 7,patented ,nov4 #ad1 #aije47 ,the above illustration represents the ,niagara ,fountain ,syringe1 to which can be attached the enema handle1 ,fig4 #bb1 ,fig4 #bc1 or the combined enema and recurrent douche handle1 ,fig4 #ba1 page #ia4 ,the ,niagara ,fountain ,syringe is made of soft rubber and holds about two gallons of water1 and is very handy when traveling or in need of a hot-water bottle4 ,,chapter ,,xiv4 ,,lame ,,back4 ,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 product4 ,they make no distinction between a disease and its symptoms2 and why should they1 when their sole object is to sell their goods8 ,lame back is a common weakness of that portion of the spine usually spoken of as the 8small of the back40 ,as a general rule1 it is an indication of some pelvic disease involving the anus1 rectum1 colon1 bladder1 or uterus4 ,those who suffer from disease of one or more of the pelvic organs will have at times reminders that they have a lame1 weak1 or 8dead0 spot at the 8small of the back0 or a little lower down on the spine4 ,as an illustration1 a current advertisement reads as follows3 8,weak ,backs6 ,if you happen to be one of those unfortunate people with a weak1 lame1 tired1 aching back1 it is time you were finding out about ----40 ,then the advertisement proceeds to tell how to put on a plaster or a liniment1 or rub the back for a week or two with the hands4 ,another enterprising wonder-worker asks3 8,do you get up with a lame back8 ,thousands of women have kidney trouble and never suspect it40 8,lifted from the depths of despair by----0 etc4 ,now1 this may be seriously alarming to actual sufferers from lame back4 ,illustration3 ,fig4 #ai4 ,showing the distribution of the sympathetic nerve about the rectum4 #bb1 the rectum2 #bc1 the bladder2 #bf1 the kidney2 #bj1 the rectal plexus2 #ai1 the vesicle plexus2 #ah1 the sacral ganglia2 #ba1 the lumbar plexus2 the lumbar ganglia2 #af1 the mesenteric plexus2 #ae1 the solar plexus2 #bg1 the aorta4 ,the kidneys are located several inches above the region called the 8small of the back02 therefore1 a difficulty in this region does not necessarily indicate disease of the kidneys4 ,those who suffer from the symptoms described--lame1 weak1 hot1 dead spots1 lumbago1 rheumatism1 etc4--at this portion of the spine may suspect that some of the organs in what is called the pelvic cavity are causing them4 ,the spinal nerves 7lumbar nerves7 on leaving the 8small of the back0 and proceeding lower down are distributed to the anus1 rectum1 bladder1 uterus1 etc41 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 above4 ,the earlier indications of a disease are usually localized1 but1 as the malady itself persists indefinitely1 both the sufferer and his physician are often deceived as to the producing cause of the varying symptoms manifesting throughout the body4 ,in this brief chapter ,i will confine myself to the diseases of the anus1 rectum1 and colon1 as causing so much annoyance from the symptoms enumerated at or below the 8small of the back40 ,the most common ailment that afflicts mankind is chronic catarrhal inflammation of the anus1 rectum1 and colon4 ,the disease invades not only the mucous membrane but the whole bowel structure1 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 8small of the back40 ,the chronic inflammation involving eight to ten inches of the lower portion of the intestinal canal1 like all other diseases1 has its alternating periods of quietude and excitement2 and the negligent sufferer must count on having 8stitches in the back10--cold in the back1 lumbago1 rheumatism1 sciatica1 etc41 as they are usually called for want of a definite idea as to the cause of the annoying symptoms4 ,the physician consulted usually agrees with the sufferer's diagnosis1 and coincides with the application of bands1 porous plasters1 liniments1 etc4--which may allay the neuralgic symptoms to some extent4 ,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 sufferer4 ,those who have had occasion to acquire the warm-band1 the rubbing with liniment1 and the plaster habits1 had better direct their attention and remedies to the cause of the symptoms4 ,one frequent source of all these back symptoms is chronic inflammation of the anus1 rectum1 and colon1 with more or less ulceration accompanying it4 ,in the female1 disease of the uterus complicates the painful symptoms4 ,usually among the first indications of this disease is some degree of constipation1 which in time is followed by local symptoms known as piles1 fissure1 itching tabs1 clot of blood in a vein1 abscess1 etc4 ,constipation is a prolific cause of indigestion1 biliousness1 flatulency1 loss of appetite1 self-poisoning1 anemia1 emaciation1 uric acid1 neuralgia in various parts of the system1 catarrhal inflammation of the mucous membrane of one or more organs1 and many other symptoms4 ,a diseased organ is a constant source of unconscious and conscious irritation to the sufferer4 ,if the victim can tolerate the trouble he seldom seeks treatment4 8,i will not bother with it as long as it is no worse10 he says4 ,at times1 however1 the symptoms become very annoying1 and measures are taken to allay them4 ,during the long interval of 8better and worse0 effects the malady is becoming more deeply seated1 and the symptoms eventually appear in all parts of the body4 ,as a rule1 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 neglect4 ,severe symptoms located at the porous-plaster region of the spine1 when brought on by disease of the lower bowel1 usually indicate an acute stage of chronic inflammation and retention of feces and gases in the sigmoid flexure and colon4 ,acute or subacute inflammation and fever and pressure of the feces are more than the long-abused nerves can endure1 and severe pain is the result4 ,then the sufferer has something to say about his back1 and what is best to do for it4 ,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 kindly4 ,the symptoms will soon disappear when the cause is removed4 ,,chapter ,,xv4 ,,uric ,,acid4 ,a society leader1 in speaking of her ills to a woman friend1 said3 8,i am #8lousy' with uric acid40 ,from infancy to old age1 mankind is more or less filled with uric acid and other poisons--the result of a foul intestinal canal4 ,poisoned blood is a common symptom1 and it arises from an almost universal cause--chronic constipation4 ,so universal is constipation of the bowels in illness that it is the first duty of a physician to prescribe some remedy to unload them4 ,it is said that a ,boston doctor1 whose practice was largely among the wealthy classes1 used to say3 8,there is no use in physicians pretending to be anything else--they always smell of rhubarb40 ,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 treat4 ,for ages all mankind has striven to find a remedy effectively to clean the intestinal tract4 ,pills1 powders1 tablets1 wafers1 suppositories1 salts1 teas1 candies1 and syrups have been administered--all with that sole purpose4 ,efforts have been made to accomplish this object by utilizing every possible device and contrivance known to human ingenuity4 ,calisthenics1 massage1 physical-culture exercise1 mental therapy1 horseback riding1 8dieting10 fasting--these are some of the many means resorted to in order to 8sterilize0 the foul1 constipated intestinal canal4 ,albeit that the cleaning of the digestive apparatus in the case of a sick person is regarded as a necessary first help the world over1 few persons realize that it is of equal importance in the case of a seemingly healthy person4 ,is it not a fair inference1 therefore1 that where a purgative--such as calomel1 or one of the innumerable similarly-acting medicines--temporarily relieves a patient's symptoms1 the timely precaution of keeping the intestinal canal and system clean would prevent a person from getting ill8 ,the reader may think that1 in these observations1 ,i have wandered away from my text1 but1 as uric acid is the symptom of a combination and complication of disorders of which constipation is the secondary cause1 the connection and sequence of my remarks are evident4 ,it is safe for a layman to assume that1 where so many diverse schemes are employed to relieve symptoms1 the diagnosis is wrong--also the treatment4 ,a few of the many primary symptoms of proctitis and colitis are constipation1 diarrhea1 indigestion1 biliousness1 flatulency1 putrefaction1 and gaseous and bacterial poisons--a foul gastro-intestinal canal1 through which there are daily absorbed from the bowels two-thirds to three-fourths of the excrementitious matter into the system4 ,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 apparatus4 ,among the secondary symptoms of proctitis and colitis is poisoned blood--anemia1 which is usually followed by impaired nutrition and emaciation or obesity4 ,along with the changes in the blood and nutrition there occurs lodgment or deposit of salts1 acids1 etc41 in the various organs and tissues of the body4 ,almost every one is familiar with gouty deposits in the finger joints and other joints of the body4 ,if the deposits occur in the muscular tissue it is called rheumatism4 ,if in the urinary organs we have gravel1 ,bright's disease1 diabetes1 cystitis1 irritation of the neck of the bladder1 frequent calls to urinate2 and the urine1 scanty and high-colored1 on cooling reveals a crystalline deposit4 ,the principal mineral substances of the urine are as follows--of which one or more may become poisonous3 chloride of potassium1 chloride of calcium1 chloride of magnesium1 chloride of sodium1 sulphate of potassium1 sulphate of soda1 sulphate of magnesia1 phosphate of soda1 and phosphate of potassium4 ,the liver gets its share of the foul substances generated in the intestinal canal1 which cause congestion of the organ4 ,toxic biliary salts and acids are present4 ,the deposit may form gall-stones1 and jaundice and many other annoying symptoms may occur4 ,the system is simply a filter1 or blotter1 that lets the poisonous contents of the intestinal canal pass through and out2 but all the organs and tissues1 during the process1 retain many of the foreign toxic substances1 which overtax 7and frequently destroy7 their functions with work that ,nature never intended they should do4 ,think of it--all the organs and tissues around the intestinal canal serving as fecal vents6 ,deposits cause irritation of nerve centers and nerve cells precisely as in fibrous and cartilaginous tissues2 and we speak of the symptoms as spinal irritation1 hysteria1 chorea1 lumbago1 sciatica1 nervous tension1 headache1 irritability1 despondency1 melancholia1 insomnia1 dementia1 etc4 ,from the disturbance of the voluntary and involuntary nerves we have irregular circulation of the blood from disturbed heart action1 cold hands and feet1 and flushing of the face alternating with pallor1 vertigo1 and dizziness4 ,the capillary circulation becomes obstructed with crystallized bodies1 as chunks of ice obstruct a stream of water4 ,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 it4 ,the skin of the body1 which is the mucous membrane turned outward1 suffers likewise from diseases having numerous names4 ,doctors have always expressed a poor opinion of the liver because it did not keep the bowels sweet and clean1 and they mistakenly though honestly called it 8the lazy liver10 8the torpid liver10 8hepatic insufficiency10 8atony of the liver10 8sluggish liver10 8hepatic torpor10 8fatty liver10 etc42 and the poor victim of proctitis and colitis was glad he had consulted the doctor and learned 8just the cause0 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 exciters1 to stimulate activity in the liver and bowels once every day or two1 if possible4 ,by some strange psychological or other influence of late years1 however1 physicians have turned their attention to the 8lazy kidneys10 and now it is difficult to decide which they are purging the most--the liver or the kidneys4 ,at any rate1 they both must be violently excited at the same time1 and we hear 8lithia0 mentioned1 or 8laxative salts of lithia10 every time uric acid is thought of4 ,stimulate the lazy liver and kidneys1 and with abundant salts dissolve out of the tissues and blood the precipitated deposits2 this is the fashion of the times4 ,diagnosis wrong and treatment harmful6 ,water is by far the best agent to dissolve salt compounds1 to dilute acids1 or to remove filth4 ,it is also the best means of soothing and relieving the long irritated and inflamed tissues and organs1 that have had from two-thirds to three-fourths of the daily fecal mass thrust upon them and collected in them1 when they are called torpid1 lazy1 and whipped up unmercifully by bile and urine bouncers4 ,we ourselves would be very torpid1 sluggish1 or 8lazy0 if called upon to do the work of two persons under such embarrassing physiological circumstances as being filled with toxic substances1 or thoroughly auto-intoxicated4 ,when will common sense take the place of theories founded on guesswork1 and some thorough washing out by plain or distilled water be done1 internally as well as externally8 ,after such an operation some specific remedy may be taken1 if demanded1 with the certainty of permanent good resulting4 ,but remember1 your aqueous body1 held in its form by the skin and mucous membrane1 needs a well-nigh constant stream of pure water flowing through it to keep it fresh and clean4 ,the diagnostic error of mistaking effect for cause1 however1 is frequently made4 ,patients are treated for one of the secondary symptoms--say uric acid--with a view to abate that disorder and restore health1 when treatment for the specific cause of constipation--proctitis 7inflammation of the anus and rectum7--would restore the patient to his normal vigor4 ,pale1 anemic sufferers from constipation are often told that the restoration of their blood to its normal state will effect a complete cure4 ,no idea could be further amiss1 for if the poisoned victims take coal oil1 fish oil1 malt compounds1 iron1 etc41 as tonics1 into a disordered stomach and unclean bowels1 how can anything more than imaginary relief be obtained8 ,is it not evident that the chief disorder1 proctitis1 the main cause of the trouble1 has in no way been reached8 ,in other complications arising from constipation1 a favorite diagnosis is one of the secondary symptoms--8atony0 of the bowels1 liver1 or kidneys4 ,in these cases nux vomica and various poisonous compounds are given1 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 anus1 rectum1 or colon4 ,then1 again1 by way of variety1 a diagnosis of 8uric acid0 is made for which irritant drugs are administered to increase the eliminating or excretory action of the bowels and kidneys4 ,it is utter folly and absurdity to attempt the cleansing of the intestinal tract by laxatives1 cathartics1 purgatives1 exercise1 etc41 and to make the kidneys and liver1 overtaxed from foul bowel products1 do still more work by giving medicines to increase the urinal and biliary secretions4 ,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 ignored4 ,much stress is laid upon the quantity and quality of food consumed by most people1 and many generalizers attribute chronic constipation1 uric acid1 etc41 to this very thing4 ,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 patients1 who rarely overstepped the limits and knew when a diminution in the supply of nourishment was advisable4 ,in the last analysis1 the principal cause of ill health is lack of elimination of the excretory organs4 ,when the bowels fail to do their proper work1 the functions of the other organs of the body become correspondingly affected and impaired1 and general debility ensues4 ,in previous chapters1 also in my book1 ,intestinal ,ills1 ,i have made plain the causes contributing to chronic constipation and the use of enemas and their origin4 ,prehension and elimination are two subjects that are vital to the welfare of man4 ,if the eliminating power of the intestinal canal is normally active1 the fortunate individual may eat abundantly1 or really in excess of the requirements of the system1 and still escape any ill effects1 such as indigestion1 biliousness1 acid in the urine1 etc4 ,the hearty consumer of food whose bowels eliminate properly may suffer a loss of appetite1 but it will not be accompanied with foulness of the digestive apparatus4 ,when all the organs of the body perform their functions in a normal manner1 no part of the structure is in immediate need of repair4 ,every organ whose function consists in building tissues1 muscles1 or some other part of the body1 having a sufficient supply of reserve nutriment on hand1 makes known this state throughout the organism2 hence there is no craving for food1 no appetite1 although the tongue1 stomach1 and intestines are in a normal condition4 ,in this state of surplus of nourishment the person may omit a few meals or partake sparingly until the expenditure is equal to the income4 ,but such physiological happiness is not for the person whose intestinal canal and system are clogged and foul from undue retention of excrementitious material1 causing no desire for food1 while all the atomic builders of the body are wanting nourishment and protesting through the nervous system against their impoverished condition4 ,sufferers from self-poisoning1 as described in this chapter1 should irrigate the system thoroughly by frequent drinking and by copious injections of water into the bowels4 ,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 congestion1 while increasing the eliminative action of the skin4 ,irrigation of the bowels for fifty minutes or more with hot water 7#abj to #abe degrees7 increases the action of the kidneys4 ,hot irrigation 7#abe to #ace degrees7 is especially recommended to increase the discharge of urine and the action of the skin1 and should be continued for sixty minutes or more4 ,the ,intestinal ,recurrent ,douche1 described in a subsequent chapter1 is an excellent instrument for the employment of hot water to produce diuresis and diaphoresis4 ,the ,chemung ,spring ,water and ,clynta ,double-,distilled ,water1 sold in ,new ,york1 are excellent drinking waters and can be obtained at a moderate price4 ,,chapter ,,xvi4 ,,rational ,,sanitation ,,and ,,hygiene4 ,we1 all of us1 like to use things2 indulgence is enjoyable1 but it generally ends with the day4 ,few of us 8take thought of the morrow40 ,neglecting1 as we do1 the instruments of use1 their availability for permanent subservience to our wants steadily diminishes1 becoming finally lost4 ,is it that we do not know any better1 or is it that we are really so intoxicated with the ,present that we simply ignore the well-known claims of the ,permanent8 ,whatever the explanation may be1 it is nevertheless passing strange that little or no care is bestowed on either our external or internal servitors1 instruments1 or organs1 which otherwise are ever ready to keep us well filled with the pure wine of joy4 ,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 them4 ,true economy--that is1 the conserving of means for their effective use--is yet to be learned by man4 ,especially is this the case with our interior means1 our flesh1 blood1 nerves1 vital force1 etc4 ,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 careless1 reckless1 prodigal1 and before we are fairly aware of it the disintegrative process gains an ascendency over the restorative1 and thenceforward our time will be spent in endeavoring to cure what might have been kept whole or well4 ,nor is it an organ of the body here and there that we neglect or abuse2 it is more especially the entire system of organs called 8the body40 ,the body is the organ of man's spirit4 ,we give no heed to its tones2 perhaps we have never caught its rhythm2 certain it is that when but a short time in our perverted hands its chords are more or less jangled1 and a minor part is played in the grand symphony of life4 ,the organ of man's spirit6 ,how rational1 nay1 how necessary1 it would seem to be to keep that instrument keyed to its perfect work6 ,but the ordinary denizen of civilization has a most ridiculous ideal of physical capability1 namely1 that the savage--a being altogether 8physical0--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 organs4 ,the 8civilizee's0 fancy picture of the noble savage is not based upon verifiable fact4 ,it is true that we have a few attractive myths concerning savages that had survived appalling hardship2 but we are just learning of the innumerable host that have perished periodically of various contagious diseases1 and of the countless number 7infants1 youths1 and adults7 that have suffered from all sorts of ailments4 ,alas6 how little we know--or1 for that matter1 how little we seem to care--of the great multitude of 8civilized0 fellow-creatures whose lives are all jangled and out of tune through subjection to the many ills that flesh seems heir to2 ills that have arisen through either ignorance or the voluntary ignoring of the light of accessible knowledge6 ,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 ranks4 ,but slaves to stern duty offend against ,nature's normality as do slaves to desire2 and the former little suspect that their retirement also is near at hand4 ,in health we seldom or never think of the conditions for the maintenance of health4 ,that these conditions should receive our prime attention is obvious when we contemplate for a moment 7#a7 our race of invalids1 and 7#b7 the growing unsanitary condition of modern industrialism1 involving1 as industrialism perforce must1 the unsanitary life of the factory1 workshop1 office1 and hothouse home4 ,again1 with the advance of high-pressure civilization and culture human beings are developing a more highly sensitive physical organism1 pitched to finer issues4 ,how urgent the necessity for a greater safeguarding of that organism6 ,if it be claimed that many of us do live up to our knowledge of health conditions1 and that we are notwithstanding unwell1 ,i would answer that our knowledge now is very disconnected1 and that when the time shall come that our itemistic information shall have coalesced and formed a system of principles1 we will then have trustworthy rules for the acquisition of health habits and become completely normal physical beings4 ,at present most of us are intemperate in one or more ways4 ,we eat too much or too little--too rich or too poor food4 ,so it is with our drinking1 our sleeping1 our sporting1 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 normality4 ,let me offer the health-seeker a few indications of the sanitary and hygienic requirements demanded by ,nature's normality4 ,in our family and household life1 to carry into execution daily hygienic measures1 it is essential that we have ample1 accessible conveniences for the necessary ablution of the body1 externally and internally4 ,how extremely rare it is1 however1 that bath-tubs and water-closets are found in sufficient quantity and suitable quality in our apartments4 ,as household fixtures they are usually about as scarce as hens' teeth4 ,in ,new ,york ,city a house with from eight to sixteen persons is restricted to the use of one water-closet and one bath-tub4 ,on these 7and a laundry and servants' privy in the basement7 there is the tax of ten dollars a year4 ,now1 should that rare human product1 an enlightened and humane owner1 put in eight more bath-tubs and water-closets for the proper accommodation of his sixteen guests1 so that each suite of sleeping apartments should have its appropriate conveniences1 he would have to pay an additional tax of forty dollars a year4 ,is this tax levied with the connivance of the ,board of ,health8 ,it would seem so1 since no protest from that august body has ever been heard within the memory of the oldest inhabitant4 ,indeed1 the suspicion is not at all unwarranted that if the masses were less constipated and better washed they would have less use for the doctors1 and that1 therefore1 it is not well to encourage undue sanitation and hygiene4 ,it must be1 too1 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-closet2 otherwise forty dollars a year would not be charged for eight additional tubs and closets for the use of the same number of persons4 ,listen to a sample of their logic3 8,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 tax4 ,we don't care a continental whether these human beings are clean externally or internally2 that's not our lookout4 ,but we do care that they shouldn't use more water than just so much1 see60 ,and does the august ,board of ,health raise the least objection to this sort of logic8 ,none whatever4 ,professor ,c4 ,s4 ,smith states that1 out of #bee1jjj families in tenement-houses in the city of ,new ,york1 only #cjf had access to bath-tubs in their own homes in #ahid4 ,in #ahig one city block containing #ijd families did not have a single bath-tub4 ,paradoxical as it may seem1 there is1 notwithstanding the appropriation every year for the ,new ,york ,city ,board of ,health of over one million dollars1 a prohibitive tax on bath-tubs and water-closets--that is1 on cleanliness--prohibitive on all homes except those of the wealthy4 ,is it to be wondered at that contagious diseases are prevalent1 especially during the winter months1 and that we have so many acute and chronic maladies8 ,let me make a suggestion here for the serious consideration of our city fathers3 ,reduce the appropriation for the ,board of ,health to two hundred thousand and give the other eight hundred thousand to the ,department of ,water ,supply1 so as to abolish the tax on water-closets and bath-tubs4 ,if every citizen of ,new ,york could have all the water he needed for cleanliness and comfort1 there would be little excuse for the existence of such a body as the ,board of ,health2 its existence would then be more honorable than onerous4 ,furthermore1 the city1 as a corporate body1 should manufacture bath-tubs and water-closets1 and furnish them at cost4 ,thus would it insure a great stride toward the health of its own citizens4 ,when the disease-producing microbe becomes scarce1 the occupation of the ,health ,board pathologist will be gone4 ,hold6 ,could he not devote his time profitably to studying the habits of health-producing microbes--for there are such8 ,microbes are absolutely necessary for higher forms of existence1 it being now well known that some microbes are destructive or pathological and that others are constructive or physiological4 ,is it not much wiser to spend our millions of dollars for the prevention of disease than for quarantining it8 ,inducing1 and even compelling1 people to be clean is a far better policy than to compel them to be vaccinated4 ,now1 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 found4 ,the pictures and history of these bacteria are published in many large volumes1 costing the city several hundred thousand dollars a year4 ,scientific as this practice undoubtedly is1 it is very expensive--and needless4 ,every year thousands of children and invalids of ,new ,york receive improper nourishment1 or are made positively sick1 on milk that is either foul1 stale1 or ready to sour2 and every summer thousands of children die from complaints traceable to this source4 ,swill milk is one of the great generators of disease-producing germs to which all sorts of 8complaints0 are due4 ,does the ,board of ,health care a fig for the generator8 ,no2 the ,board is absorbed in watching the antics of the germs6 ,mighty intellects are searching for malignant1 multitudinous mites4 ,yet there are just a few mites of common sense in existence1 which if encouraged will breed quite as fast as the sinister ones4 ,indeed1 there must be one or two at work in myself1 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 healthy1 our milk clean and pure1 our cans clean and well scoured1 and our shops and ice-boxes clean and free from odor1 there would be no occasion for germ cultures of diseases brought on by swill milk4 ,our milk example will illustrate what germs of common sense would do to ward off all kinds of disease-producing micro-organisms4 ,rigorous regulations1 well enforced1 as indicated above1 would work in other lines as well4 ,and when the source is gone sinister microbes will not come into existence1 and diseases that have resulted from such microbes will have gone into innocuous desuetude4 ,there should be a bath-tub and a water-closet in every suite of sleeping apartments4 ,when this is the case1 there will be a larger number of persons clean internally and externally1 and the doctors will be on a hunt for health-producing germs instead of disease-producing ones4 ,let us start an organized movement in this direction4 ,last summer ,medical ,science went about killing mosquitoes on ,staten ,island with a little spraying apparatus1 and managed to disturb the pest for a day or two from its customary bivouac4 ,christian ,science stood aloof and smiled superciliously1 claiming that 8there aren't any such things as mosquitoes2 but if they should prove to exist1 there isn't any malaria anyhow40 ,good sense might have suggested to ,medicus the draining of the ponds for gardening purposes2 and1 if that were not possible1 the filling in of the edges and the making of deep-water lakes for the sport-loving youth1 who might be depended on to keep the water stirred up by boating1 etc41 free of charge1 and thus convert a pest pond into a pleasure lake4 ,pleasure and cleanliness are taxed to-day for disease and pests4 ,oh1 human imbecility6 ,as to public baths1 there are so many objections to them that ,i cannot touch on the subject in this chapter4 ,but let me impress upon the health-seeker1 the public-spirited citizen1 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 day1 every day of the year4 ,,chapter ,,xvii4 ,,personal ,,cleanliness4 ,at the close of my last chapter ,i referred to the ever-recurring problem of public baths4 ,annually its agitation is renewed in lectures and newspapers2 public bathing is voted without disagreement the thing of things needful to render the laity--i4 e41 the labor population--physically pure4 ,it is the long-felt want2 but1 like the longed-for walk of the annual ,sunday-school parade1 it is soon done and gone4 ,still1 we must have patience with those dear souls1 our ethical teachers of the press and platform1 for taking such a deep1 sentimental1 though unscientific1 interest in the welfare of the unclean4 ,owing to the non-existence of home facilities for cleanliness among the working class1 the accumulations of soil and exudation during the long fall1 winter1 and spring months are so great that their bodies become too rank and malodorous for the nostrils of the refined4 ,consequently1 as all animals seek the tepid water of the summer1 and as man is no exception to a capacity for laving in the circumambient fluid1 to three-fourths of the population of this metropolis it must be a glorious perennial treat to dip in the river1 bay1 or sea2 and it must indeed be a dire necessity to those that have managed to survive contagious and other diseases during their long immurement4 ,without this summer cleansing few animals1 bestial or human1 would run half their average careers4 ,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 creatures4 ,now1 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-closets4 ,for ,i do not approve1 nay1 ,i emphatically condemn1 the system of public baths along the shores of our rivers and bay4 ,their waters are contaminated by numerous sewers1 and bathers have contracted many contagious diseases that have become epidemic in neighborhoods4 ,note especially the annoying eye troubles that follow in the wake of such bathing4 ,of course1 the sport and exercise involved in open-water bathing are highly commendable2 but the danger of contracting contagious disease1 and the outrage of the sense of refinement when contemplating fellow-creatures in the act of stirring up polluted waters1 should call a halt to our encouragement of public bathing in and around our metropolitan water fronts4 ,these waters are surely anything but a means of cleanliness4 ,the water-closet1 however1 is of far greater importance than the bath-tub1 and especially than the public water-gymnasium--which last is so much lauded by some of our misguided philanthropists4 ,intestinal foulness1 as a prolific source of disease1 is of far more serious importance than surface foulness4 ,however1 both the bath-tub and the water-closet are indispensable to every suite of rooms4 ,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 city4 ,at present the male population1 when away from their residences1 are obliged to make use of a near-by saloon--a most uncertain resort1 and one in which courtesy will generally constrain them to imbibe intoxicants nolens volens4 ,the female population have not even the saloon as a resort1 and can relieve themselves only when in the vicinity of department stores4 ,american enterprise can improve in many respects on the several ,european models of public-relief stations4 ,the public is becoming conscious of its needs and rights in this respect2 and one of the sanitary evolutions of city life--congested as it is--will be ample and cleanly public accommodations for intestinal relief4 ,americans in general suffer from dyspepsia1 biliousness1 constipation1 uric acid1 etc4--all of which disorders are symptoms of that world-wide disease1 proctitis3 inflammation of the anus1 rectum1 and often the colon4 ,nor is it any wonder that unwashed humanity suffers from proctitis and its consequences4 ,the unwashed have no bath-tubs and practically no water-closets4 ,this lack is due to the tax on water facilities1 to expensive plumbing1 and to too much 8science0 and not enough common sense among our city fathers4 ,as a consequence of ignorance and inconvenience1 most people defecate but once in twenty-four hours2 and very many but once in two or three days or a week4 ,the once-a-day stool is frequently scanty1 and as a consequence the kidneys1 lungs1 and skin are called upon to perform the vicarious function of eliminating a portion of the daily excrement2 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 occasions4 ,could the members of the ,board of ,health and the people at large be brought to a realizing sense of the value of personal cleanliness1--internal as well as external1--bath-tubs and water-closets would abound in our homes4 ,man's habits as to eating1 drinking1 dressing1 bathing1 and especially as to defecating1 are clues to his growth in refinement4 ,but we must beware of judging a person by one or two good or bad habits2 he should be estimated by the sum of his habits and their peculiar combination4 ,refined habits are not all of them acquired at once2 they develop slowly1 one after another1 when opportunities are favorable1 especially the habits as to bathing and defecating4 ,opportunities for these latter are wofully lacking at present--the cause and consequences of which lack are pointed out in the last chapter4 ,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 unclean4 ,only one that has learned to respect and care for the abode of the soul--the body--is worthy of being classed among the refined4 ,it is truly deplorable that the great majority of the human race are creatures of the moment or the hour1 tolerators of abnormal functioning1 slow suicides of vital capacities4 ,claims of the permanent are constantly ignored2 most of us are blind to the joy involved in the harmonious functioning of all the organs--a functioning that always ensues upon hygienic care4 ,our organs will for a time bear neglect or unhygienic conditions without protesting their annoyance4 ,many persons never use hot water or soap2 others find one bath1 in river or sea1 quite sufficient for the year2 others1 again1 feel the need of a bath once or even twice a month1 or even once a week4 ,but there are very few of us that seem to require a bath daily4 ,many1 alas6 have grown accustomed to a bathless existence4 ,have you ever stood near an ,italian or ,greek street vender1 or have you ever been within five feet of a low-class ,polish ,jew8 ,if so1 the stench arising from his unwashed body must have nauseated you4 ,it is no secret that such persons never wash--especially the latter1 who live in rooms reeking with filth4 ,contemplating such conditions1 ,i feel impelled to propose a great1 nay1 the greatest reform--one suggested years ago by ,samuel ,butler in ,erewhon4 ,let us make ,health the great civic virtue1 and ,disease1 as well as unsanitary and unhygienic conditions1 the crime4 ,our so-called crimes of theft1 murder1 forgery1 etc41 should be treated as weaknesses and faults to be corrected by ,moral ,rectifiers--by the preachers1 priests1 rabbis1 and ethical culturists4 ,consider how much is implied in developing and breeding a race of healthy men and women4 ,all relations of life would feel the vital change at once1 and moral weaknesses would disappear4 ,any human cesspool entering a public conveyance1 or in any way mingling with cleanly people1 should be arrested1 thoroughly cleansed1 internally and externally1 and sequestered for a time sufficient to teach him better4 ,there is a local rule of the ,board of ,health against spitting1 but it is rarely enforced4 ,there are millions of public expectorations to one arrest4 ,for the appearance in public of consumptives1 and their offensive hawking1 coughing1 and spitting1 no one seems to have suggested a remedy4 ,all diseases should be classified as to grades of punishment2 and all moral weaknesses1 such as defalcations1 adultery1 burglary1 should be treated at the various hospitals1 which latter should be conducted solely by ,moral ,rectifiers4 ,in closing1 ,i shall direct attention to a few other points in personal cleanliness--the mouth1 ear1 nose1 and throat4 ,it is important on hygienic grounds that the mouth receive proper care two or three times daily4 ,the ear is commonly kept clean2 still there are many instances of non-refinement of this organ1 and from its non-hygienic treatment deafness often occurs4 ,the prevalent nasty1 ill-bred habit of hawking and spitting in public1 or in company1 even by genteel persons1 can be cured best by early training in correct habits4 ,this habit1 as well as the evidences of throat troubles1 is usually to be ascribed to inattention to the nose4 ,when catarrhal conditions are avoided or properly treated the throat will not be so affected as to necessitate this reprehensible practice4 ,trouble is invited for the tonsils and soft palate by our constant hawking2 certainly the tender sensibility of the throat is destroyed thereby4 ,inasmuch as the tobacco habit is so general1 and spitting is a necessary accompaniment of that habit1 stringent laws against hawking and spitting would be unpopular among the masculine half of the race4 ,but should public opinion ever become educated up to the point in which disease becomes a crime1 opposition would cease4 ,this consummation is devoutly to be wished1 for then we will have adopted and followed ,ingersoll's injunction to 8make health catching1 not disease40 ,,chapter ,,xviii4 ,,hot ,,water ,,in ,,the ,,treatment ,,of ,,proctitis ,,and ,,colitis4 ,in treating chronic ulcerative inflammation of the anus1 rectum1 sigmoid flexure1 etc41 it is well to take advantage of every really practical device to which one may have access1 so that valuable time may be saved in obtaining relief and effecting a cure4 ,the capillaries1 veins1 arteries1 and arterioles in an inflamed organ become distended and the tissues swollen1 indurated1 and tense by the excess of blood and the inflammatory serum deposited in the tissues4 ,the vasomotor nerves in the diseased part have lost their contractile power1 which fact increases the stasis1 or congestion1 of the blood4 ,circulation in diseased tissue depends very much on the general tone of the system1 and if the circulation is below the normal the ravage of the malady is increased proportionally4 ,have you ever observed a little stream of water enter a large pond in which were grass1 shrubbery1 logs1 decaying vegetation1 and dbris of all sorts--the accumulation of years8 ,and have you noticed that here and there there were stagnant pools1 without a perceptible motion from where you stood1 but that as you reached the side opposite to the entrance some faint traces of motion became visible1 and that as you followed the line it soon formed into a stream quite equal to the inflow8 ,the pure water1 on entering and mingling with the stagnant water and old deposits1 soon becomes corrupted and foul4 ,somewhat similar unhygienic and toxic results take place in ponds of stagnant blood and abnormal deposits such as proctitis and colitis involve1 and where1 for six or eight inches or more of the large intestine1 inflammation is deeply seated1 and blood stasis is of course in full swing4 ,as the dbris in a stagnant pond decays1 making the water impure1 so in an inflamed organ the tissues decay1 making the blood impure4 ,ulceration is an exhibition of this process of congestion1 induration1 and decay4 ,the rectum and sigmoid flexure are loosely hung in the pelvic space and are surrounded by fatty cushions of connective tissue on all sides1 which fact allows the organ considerable dilatation and motion 7,fig4 #e74 ,owing to the anatomical structure and the location of the lower bowel1 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 invaded1 and still more so when the connective tissue around the organ is in the same condition4 ,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 tissue1 under the mucous membrane1 around the rectum1 and in the tissue forming the anus and buttocks4 ,the pathological condition brought about by inflammation1 etc41 requires a remedy that will empty the over-dilated vessels and remove the serum deposit in the tissues1 which is analogous to the rubbish of a pond4 ,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 blanched1 shriveled1 and white appearance2 if there were signs of the inflammation returning1 the poulticing was continued or repeated4 ,they knew very well what the parboiled condition of a washerwoman's hands indicated after a day's work in hot water4 ,they were bloodless1 notwithstanding their incessant muscular exercise4 ,in case of inflammation1 they reasoned1 heat and moisture would make the congestion and fever leave if applied long enough4 ,on beginning the use of the hot poultice1 the tissues to which its heat and moisture were applied became relaxed1 and the parts for the time more congested than before2 but our grandmothers did not mind that1 as the final result would justify their hydriatic procedure4 ,they well knew that after ten minutes or more a reverse action would take place1 and if the treatment were continued long enough the blood-vessels and tissues would show little or no evidence of fever or inflammation4 ,where chronic inflammation exists1 the blood-vessels and tissues lose their normal tone or vitality2 consequently1 they will require repeated application of hot water as well as other aids until a cure shall have been effected4 ,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 organs4 ,cold water1 on the contrary1 causes the vessels quickly to contract and expel the blood1 but1 on reaction taking place1 the tissues become more congested than before4 ,in the use of water at a temperature of #abj to #ace degrees1 or even more1 we have one of the most valuable adjuvants in all stages of proctitis and colitis1 and1 if a properly regulated plan be pursued in connection with the requisite local treatment1 more good can thus be accomplished than by all other means combined4 ,the layman is more or less familiar with the condition of a sore or ulcer in which soft1 spongy1 or fungous tissues appear1 called 8proud flesh10 which1 on an inflamed mucous membrane1 is called granular tissue4 ,were it not for the usual presence of granular tissue on a chronically inflamed mucous membrane and for ulcerated sections or patches1 channels1 and stretched or pouched mucous membrane called piles1 the proper use of hot water alone would in time effect a total cure in almost every case of proctitis4 ,many well-meaning persons conceive the idea that1 if hot water is so beneficial1 they may use it as hot as possible for the purpose of an enema likewise1 since they will thereby not only relieve the bowels of their stored feces but simultaneously do the inflamed tissues 8a whole lot of good40 ,their spirit is admirable1 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 heart4 ,let them remember1 however1 that the first effect of hot water is to increase the blood supply in the tissues if it be applied for a short time only4 ,in the majority of cases1 the enema does not require more than from five to ten minutes2 hence1 only harm can result if really hot water be used4 ,now and then a person will become possessed with the notion that a hot enema should be followed by a cold one1 to bring 8tone0 to the lower bowels4 ,but in all these misdirected efforts matters are made doubly worse4 ,cold water will allay fever and inflammation1 but when its use is once begun it should be continued without intermission until a cure is effected4 ,for this reason it is not suitable where chronic inflammation exists--especially on the mucous membrane of the bowels4 ,it is1 however1 excellent for acute inflammation of the external parts of the body1 such as the hands1 arms1 legs1 etc41 where it can be continued without interruption for one1 two1 or three days if necessary4 ,in beginning the treatment for constipation1 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 evacuation2 or there may be inability to expel the water from the bowels when once injected4 ,this stoppage is most likely to occur at the recto-sigmoid juncture 7,o',beirne's sphincter74 ,a strictured condition of the bowels causes retention of feces and gases and why not water as well8 ,in such cases time would be saved1 perhaps1 by combining the procedure for an enema with that of a recurrent douche1 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 more4 ,figure #ba illustrates a successful device for applying medicated water at a high temperature to the anus1 rectum1 and colon4 ,this apparatus can be used while sitting on a water-closet seat and the treatment can be completed without changing position or removing the instrument4 ,the instrument is attached to the reservoir 7,figure #ah7 by a soft-rubber tube4 ,in the cone-shaped piece of hard rubber 7,figure #bg7 is a hard-rubber stop-cock or valve 7,figure #bi71 and by turning the handle sidewise the valve is opened to let the water escape from the bowels into the toilet basin4 ,when sufficient water1 at from one hundred and twenty to one hundred and thirty-five degrees temperature1 has entered the bowels1 allow it to remain for ten minutes1 then permit it to escape by opening the valve2 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 point1 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 treatment4 ,after a few trials it will be found that the hot-water treatment can be accomplished without withdrawing the point4 ,rectal ,points for recurrent douche are of two sizes 7,nos4 #be and #bf74 ,the larger one 7,no4 #be7 requires a plug to be introduced through the cone-shaped external anal support and rectal point1 to make its introduction into the rectum easy1 after which the plug is withdrawn and the hot-water treatment begun4 ,the bore of the rectal points cannot become clogged by the presence of feces1 mucus or membranous shreds or casts1 which are usually brought away by the hot-water treatment4 ,at no time during the treatment can the point become stopped up1 the size being sufficient to insure a proper inflow and outflow4 ,and the instrument can be easily cleaned4 ,near the attachment of the soft-rubber tube is a glass reservoir 7,figure #bd71 for the use of oils with the enema or the hot-water treatment2 it is detachable4 ,a valve regulates the outflow of oil from the pressure of water in the reservoir1 as it passes into the bowels4 ,we are enabled thus to treat by double medication as it were1 a chronic disease of the intestines and its symptoms--that is1 intestines that have been long neglected or maltreated through lack of proper diagnosis1 or by all sorts of chemical compounds from above1 through mouth and stomach4 ,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 devised2 one that1 in conjunction with other aids1 meets all requirements involved in the proper treatment of proctitis and colitis4 ,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 degrees1 not only accomplishes rapid and wonderful cleaning and curative results1 but overcomes1 when properly applied1 contracted1 congested1 engorged1 and inflamed tissues of the bowels4 ,therapeutically1 it has a marked effect on the whole system1 being beneficial beyond words to describe2 it relaxes nervous and muscular tension of the body1 producing restfulness and sleep2 it stimulates and equalizes the circulation1 promotes perspiration1 absorption1 and active elimination of all deleterious substances from all the organs of the body4 ,medicinally1 it is really a combined internal ,russian and ,turkish bath1 removing abdominal corpulency and gaseous obesity1 resulting from chronic auto-intoxication4 ,the external ,russian and ,turkish baths afford a satisfaction skin deep to the bather1 but the combined internal ,russian and ,turkish bath is most agreeably relaxing and restful to mind and body1 bringing peace1 since all the organs of the system are performing their functions4 ,some of my patients resort to internal hot-water lavage for all aches and ills that mar their happiness4 ,after an external bath the bather may desire an application of oil1 alcohol1 or cocoanut butter rubbed on the skin1 and in the same way the bather's internal mucous membrane is not neglected2 for1 with the author's appliance1 medicated and perfumed oils1 extracts1 and powders for remedial purposes are carried to every part of the intestines that the water reaches1 thus exerting a cleansing1 healing1 and soothing effect where most needed4 ,a few sufferers will object to the time required for an enema twice a day1 although they find time to eat three1 or even four times a day1 without any objection whatever2 there is plenty of time for filling up the digestive apparatus1 but no time for its normal elimination4 ,and these miserable1 go-lucky1 haphazard people are always sick and unfortunate4 ,the internal ,russian and ,turkish bath is demanded only by those who truly desire to be free from their bowel troubles1 and from the numerous symptoms resulting from mucus absorption1 constipation1 and auto-intoxication4 ,a sufferer's efforts to be well depend largely on how much he or she estimates the worth or value of mind and body4 ,a noble purpose in life is priceless2 are not one's spirit and body worth the time required for two enemata each day and an hour for the internal bath1 if needed8 ,i think so1 and you should likewise4 ,the author trusts the reader will not infer that all sufferers from piles1 anal fissure1 pruritus ani and vulv1 mucus channels and reservoirs1 abscess1 fistula1 and all similar troubles1 require the enema and recurrent douche appliance2 the character of the disease and its symptoms must determine the requirement of the treatment4 ,many of my patients receive office treatment only1 omitting home attentions1 although this is not always advisable4 ,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-intoxication1 and not be aware of another great source of auto-intoxication--that is1 from the absorption of large quantities of serous1 fibrinous1 or albuminous exudation from a large area of tissues invaded by the very insidious inflammatory process1 a condition which1 in time1 may reach the pus-forming stage4 ,thus we have three very grave pathological conditions to meet and remove before the pus-formation stage is made manifest through the development of abscesses4 ,i have found five aids--perhaps more--to accomplish a cure in which ,i have been exceptionally successful1 as my students and patients will verify2 these are3 local treatment1 local medication1 the proper use of the enema1 the use of the recurrent douche1 and the determination of the sufferer to get well4 ,,chapter ,,xix4 ,,hot ,,water ,,in ,,the ,,treatment ,,of ,,external ,,symptoms4 ,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 tissues4 ,the anal mucous membrane and the integument about the anus become brittle1 loosened1 and detached from the areolar connective tissue by the retention of inflammatory serum4 ,the engorged1 indurated1 and swollen mucous membrane and integument serve as reservoirs1 especially when the chronic inflammation is excited to an acute stage1 which stage is often accompanied by a fissure1 abscess1 or anal ulcer4 ,soreness and pain in the parts may then be so severe that the sufferer is compelled to stay indoors or in bed4 ,whatever the symptoms may be--piles1 fissure1 pruritus1 abscess1 or fistula--the sufferer desires to reduce the local fever and the acute inflammation1 as well as to find relief from the pain4 ,the customary treatment is to use poultices1 which are troublesome and ineffective4 ,in the following illustration ,i give a good idea of a perfect device for relieving quickly the soreness1 pain1 acute inflammation1 and induration1 all of which are so very prostrating2 and1 situated as they are physiologically1 they are exceedingly inconvenient to treat properly by the ordinary methods in use3 ,illustration3 7,patented ,november #h1 #ahib47 ,fig4 #bc4 ,the ,sitz-bath pan1 though small1 is yet of sufficient depth and diameter for all practical purposes1 and can be placed wherever is most convenient--on a low chair or a box4 ,the bather should sit on the instrument with the limbs on either side of the funnel through which the hot water enters the pan4 ,just below the funnel is an overflow tube1 under which a vessel should be placed to catch the water as it flows out4 ,while sitting on the pan the elbows may rest on any convenient support1 so as not to tire the invalid too much during the bath1 which should consume from half an hour to an hour1 or longer if agreeable4 ,hot water may be added every few minutes as the bather finds that the tissues will tolerate it4 ,depurant powder may also be added to the water in the ,sitz-bath pan4 ,what has been said in a previous chapter on the therapeutic effects of hot water in the treatment of proctitis need not be repeated here4 ,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 devoted1 are ,the ,internal ,fountain ,bath1 ,the ,intestinal ,recurrent ,douche1 and ,the ,shallow ,sitz-bath ,pan4 ,these appliances are well-nigh perfect for the uses to which they are adapted4 ,,chapter ,,xx4 ,,the ,,health ,,of ,,school ,,children4 8,cleanliness of body was ever esteemed to proceed from a due reverence to ,god1 to society1 and to ourselves40--,bacon4 ,the ,international ,congress on ,school ,hygiene ended its fourth meeting at ,buffalo recently to meet two years hence in ,brussels4 ,in the interim the ,board of ,education in this city1 the ,department of ,health1 and the ,new ,york ,school ,luncheon ,committee will continue their investigations as vigorously as in the past1 and the information thus gained will be an important contribution to the next ,congress4 ,too much attention cannot be given to the question of hygiene1 diet1 and excretion to meet the psycho-physical requirements of the mind and body in normal health4 ,as a rule1 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 bowels1 but when we find the cause of these various symptoms arising from a disturbed gastro-intestinal tract1 the question of diet will receive less attention4 ,why has not the subject of normal intestinal excretion received as much attention as diet in health or ill-health8 ,as our knowledge of the human psycho-chemical laboratory increases1 we are able definitely to locate a diseased organ and account for the symptoms caused by the pathological condition of that organ2 and when the diagnosis is properly made these symptoms become a secondary matter of treatment4 ,the chief enemy of health among school children 7and older persons as well7 is the accumulation and retention of waste matter and gases in the intestinal canal1 where are generated ptomaine1 toxic1 and other poisons which enter into the system1 resulting in self-poisoning or auto-intoxication4 ,what do we mean by school hygiene8 ,is it only the school building1 or the external appearance of the children1 their eyes1 teeth1 mouth1 nose1 hands8 ,what about the coated tongue1 foul breath1 fouler stomach1 and putrefaction of the contents of their intestines8 ,a human being is only an extension of his gastro-intestinal apparatus1 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 strength4 ,there is one symptom that causes more sickness and suffering from infancy to old age than all others combined--that is1 constipation with its attending putrefaction and foulness of digestive organs4 ,only a small percentage of people escape its baneful effects or the secondary diseases induced by fecal and mucus auto-intoxication4 ,such a common primary symptom must have1 necessarily1 a common exciting cause or origin4 ,through many years of clinical experience as a gastro-enterologist and proctologist1 we have found that inflammation of the anus1 rectum1 and sigmoid flexure is the frequent or common cause of constipation4 ,observation has demonstrated that a soiled diaper is the exciting cause of ,proctitis and ,sigmoiditis in the beginning4 ,examination of one hundred children of the 8defective class0 would show most of them suffering from chronic ,proctitis and ,sigmoiditis1 with some degree of constipation and auto-intoxication1 and even of those classed as 8healthy school children0 a large percentage would show the same conditions4 ,the continuous invasion of the neighboring tissues by the disease1 the increasing auto-intoxication and constipation1 the on-coming malnutrition1 and anemia1 the gradual emaciation1 are all the while lessening the vitality and power of bodily resistance of their victims4 ,the early inception of the malady and its insidious progress1 with the symptoms and diseases resulting1 easily deceives the victim as well as the parents and medical advisers1 until the long-pent-up virulence breaks forth1 showing itself in every part of the tabernacle of the spirit of man1 when the removal of the primary cause does little or no good4 ,the ,department of ,health1 in examining the sanitary or hygienic condition of a school building1 would not devote all its attention to the top story to overcome unhygienic conditions2 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 structure4 ,why then so much attention to the head or top story of the human temple1 and so little to the trap and vent of its sewer8 ,are modesty and ignorance to defeat the progress of hygienic measures dealing with the stomach and bowels of our school children8 ,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 well8 ,the absorption into the system of serous1 fibrinous or albuminous mucus exudations from the invasion of chronic inflammation through all the layers of the tissues of the anus 7,figure #a71 rectum1 and sigmoid flexure1 as well as through the adjoining fatty tissue in the pelvic space around the organs 7,figure #e71 under the skin and between the muscles of the buttocks1 goes on continuously1 creating an extensive inflammable area and source of exudation of broken-down tissues4 7,see ,chapter ,,iii47 ,it is a grave pathological condition and the source of mucus auto-intoxication1 and its symptoms ought to be differentiated from those of fecal auto-intoxication4 ,this mucus exudate has an intensely irritating effect on the nervous system1 especially when an acute intestinal mucus storm has developed1 torturing its victims and unfitting them mentally to attend to the ordinary duties of the day4 ,very often this is accompanied by more or less pain or muscular soreness4 ,these annoying symptoms occur very early in the history of ,proctitis and ,sigmoiditis1 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 rectum1 and thus early cut short the progress of the disease and its numerous and familiar symptoms1 which ,i may here enumerate1 to wit3 indigestion1 flatulency1 coated tongue1 foul breath1 bad taste in the mouth1 capricious appetite1 nausea1 intestinal colic1 cramps and pains1 diarrhea1 headache or band of pain encircling the head with sense of constriction1 neuralgia1 pain about the heart1 cold hands and feet1 malnutrition1 anemia1 emaciation1 dry skin1 seborrhea sicca1 carbonic acid toxemia1 sallow complexion1 liver spots1 jaundice1 acute bilious attacks1 drowsy states1 mental torpor1 bad temper1 night terrors1 irritability1 melancholia1 vertigo1 dizziness1 loss of memory1 insomnia1 drawn face1 tired feeling1 unrestful sleep1 easily fatigued1 subject to colds1 catarrhal affections of the ears1 eyes1 nose1 throat1 etc41 decay of teeth1 dry cough1 loss of hair1 impaired vision1 sterility1 impotency1 mucus and membranous cords and casts from the bowels1 sediment in the urine1 irritability of the bladder1 premature age1 reduced physical and mental efficiency1 inability to concentrate the mind1 morbidity1 suicidal notions with a view to ending mental and physical suffering4 ,i am pleased to inform such sufferers that their ills can be properly diagnosed and treated2 and the earlier in life they seek treatment1 the sooner they will escape the accumulative ills that make existence so painful to endure4 ,we have mentioned ,proctitis and ,sigmoiditis as the primary cause of intestinal stasis in the majority of cases2 later1 other sections of the intestinal canal may be invaded by inflammatory process1 causing a more serious intestinal stasis1 not infrequently bringing about dislocation of the stomach1 intestines1 and other abdominal organs4 ,we have enumerated the symptoms and maladies that are now1 in the light of latest medical science1 traceable directly or indirectly1 to this primary cause2 in short1 it may be said that1 with the exception of a few diseases caused by toxic agents1 most of the illnesses that cause so much invalidism1 cutting short our lives1 can be traced to mucus and fecal auto-intoxication4 ,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 grave2 already ,i feel that ,i have accomplished something in helping humanity1 and ,i trust others will do their part to lessen the ills that flesh is heir to through neglect and ignorance4 ,,chapter ,,xxi4#b ,,internal ,,hemorrhoids ,,or ,,piles ,,versus ,,rectal ,,mucous ,,sac1 ,,recto-,,anal ,,mucous ,,sac4 #b ,chapters ,,xxii1 ,,xxiii1 and ,,xxiv have been revised from ,papers contributed to ,albright's ,office ,practitioner1 in #aijh4 ,before the history of medicine and surgery began1 man suffered at his hinder parts as well as at other parts of his organism4 ,bodily ills are as old as the human race1 and the flowing of blood from the 8terhinder0 was a signal of distress or of physical anarchy1 of which the references to 8emeroids0 in the ,bible and in other ancient writings bear witness4 ,the 8emeroid0 doctors of ,egypt1 in the time of ,moses1 unquestionably regarded the distress caused by the 8emeroids0 as a disease4 ,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 disease4 ,and they likewise1 all of them without exception1 believe the 8disease0 to be hereditary1 as is certainly their information on the subject4 ,this mental obsequiousness of the proctologists of our day is indeed quite a long-drawn-out compliment to the pile doctors of ,egypt1 since our proctologists still continue to diagnose piles as a disease and 8to smite the smitten of emeroids40 ,i have always respected the idea of ancestral worship and of reverence for the dead past1 but at the same time ,i have felt that one should not be wholly oblivious to their egregious mistakes4 ,if ,moses1 ,samuel1 ,herodotus1 ,hippocrates1 ,galen1 and other illustrious men had said that 8emeroids0 is a symptom of a disease1 what a blessing they would have conferred upon suffering humanity4 ,the simple use of that one word would have been illuminating1 and would have set the tide of attention for the proper diagnosis and treatment in the right direction4 ,possibly some one more bold than the servile brotherhood did see and say that it was a mere symptom1 but1 if so1 his temerity was treated by 8the wise ones0 of that day as similar innovations are treated to-day1 with a 8,tut1 tut1 tut2 pugh1 pugh1 pugh4 ,we know better1 and we refer you to the following chapters in ,holy ,writ and to the classical work of the great ,medi ,cusus on #8,pilus ,diseasicus4' ,and besides1 have you no respect for the superior clinical advantages we enjoy80 ,notwithstanding the bad odor in which ,i shall be held1 ,i will nerve myself to claim that1 when the ancients considered and called piles or hemorrhoids a disease1 they made a very grave and palpable mistake1 and that1 having made this mistake1 it was inevitable that numerous errors should follow logically in its train when they attempted to account for the etiology1 character1 and means of cure of this 8disease40 ,pruritus ani is also called a disease1 and a similar bedlam of reasons is offered as causes and means of cure1 all of which accounts for the many1 many pages of a book filled to overflowing by a 8classical0 author1 with compilations of the redeeming gospel truths on this subject from prehistoric times till the present day1 including his own commentary1 guesses1 interpretations1 and surmises4 ,ignorant as he is of the nature of this symptom1 the conjectures of his perfervid imagination are 8to laugh40 ,the errors of one or more authors1 endorsed by the mistakes of others1 seemingly make a truth to minds that are vassals to authority1 which accounts for much of the useless medical literature of to-day and for the mistakes of those that are misguided by it4 ,considering the pathological condition1 it would be better if we were to give a more definitive characterization to it than 8piles0 or 8hemorrhoids40 ,in accordance with the distinctive exhibit contemplated1 we should describe it as a rectal mucous sac1 an ano-rectal mucous sac1 or an ano-muco-cutaneous sac4 ,these are more distinctive and suitable designations for these symptoms of chronic proctitis1 inasmuch1 by such designations1 we call attention to the fact that they are simply constricted mucus#c channels and sacs1 with engorged arteries and veins1 formed by the serous exudation that accompanies inflammation4 #c ,i found it more convenient to use the words mucus channel1 mucus fistula1 etc41 in preference to sinus1 as they better convey my ideas to the average reader4 ,if a recto-anal mucus channel1 under one or more layers of the mucous membrane1 becomes constricted or obstructed 7they usually do71 its epithelial wall will become sacculated1 and then we have a rectal mucous sac1 or an ano-rectal mucous sac1 or an ano-muco-cutaneous sac1 all of which may be present in the same case4 ,the inflammatory exudation called serum distends and destroys fatty tissue1 which makes space for its lodgment under the tissue that imprisons it1 and at the same time there occurs more or less proliferation of the cells of the tissue involved in the severe inflammation4 ,the internal sphincter muscle1 by its contraction1 aids in the undue retention of the mucus and blood above it1 hence the so-called pile-bearing region--that is1 the sacculated mucosa region4 ,the serous exudation meets with obstruction along the anal canal and the mucosa is sacculated4 ,when the integument around the anus offers obstruction to the flow of serum and blood1 we find that muco-cutaneous sacs are formed around the anus4 ,if the exudation occurs in the areolar space under the ano-rectal mucosa1 it readily passes down into the areolar space under the integument around the anus1 and thence to parts deep1 devious1 and far away1 as described in ,chapter ,,iii4 ,channels1 reservoirs1 sacs1 that would hold from one to eight or more ounces of fluid1 no longer excite my wonder and amazement at the extensive and serious pathological condition of which they are exhibits1 a pathological condition that occasions symptoms often diagnosed as sciatica1 rheumatism1 myalgia1 caries of the coccyx1 coxitis1 prostatitis1 pruritus ani1 scroti1 and vulv1 auto-intoxication1 anemia1 invalidism1 etc4 ,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 it1 we had better in future omit the following designations and distinctions1 which are merely a ridiculous display of sciolism4 ,surely we can do without them1 and ought to do so for the sake of truth and simplicity4 ,with a sigh of relief let us in future ignore3 ,safety-valve piles1 organized piles1 itching piles1 blind piles1 bleeding piles1 moon piles1 cutaneous piles1 thrombotic piles1 external and internal pile tumors1 venous piles1 ulcerated piles1 capillary piles1 mixed hemorrhoids1 arterial hemorrhoids1 white hemorrhoids1 acute hemorrhoids1 chestnut hemorrhoids1 chronic hemorrhoids1 inflammatory hemorrhoids1 hypertrophic hemorrhoids1 atrophic hemorrhoids1 ,egyptian piles1 ,philistine itching hemorrhoids1 etc4 ,quite naturally such a variety of 8diseases0 called forth many sorts of surgical operations for their removal1 of which the following are the ones most in vogue3 ,clamp and cautery1 ligature1 crushing electrolysis1 excision1 submucous ligation1 the ,whitehead operation1 the ,earle operation1 the ,american operation1 etc4 ,forget them all1 forget all of the senseless terms that are employed to describe a supposed variety of 8disease0 and all of the barbarous procedures for their banishment1 and the banishment1 alas6 too frequently1 of the wretched sufferer likewise4 ,study carefully the varieties of chronic inflammation and the character and extent of the exudation in each case4 ,by so doing you will ascertain the nature of the many varied symptoms of proctitis1 of which the following are the most common3 ,sacculated mucosa and integument1 submucous and subtegumentary channels1 reservoirs1 pockets1 fistula1 pruritus ani1 fissure- or ulcer-in-ano1 constipation1 diarrhea1 etc4 ,proctitis may present a chronic1 a subacute1 or an acute stage1 with an atrophic or hypertrophic condition1 or a less marked structural change in the tissue4 ,if proctitis were treated early in its inception1 none of the above-mentioned symptoms would have occasion to develop4 ,when mankind becomes properly enlightened on the subject of proctitis1 due attention will be given to it long before so many annoying symptoms occur4 ,ano-rectal mucous sacs1 formed by the serous exudation into the connective tissue and stasis of the blood1 are the slightest symptoms of proctitis1 and by far the most easily removed4 ,since we have found out what are the symptoms and what is the disease1 it naturally follows that in treating a sacculated mucosa we should be governed by the character of the proctitis1 whether it be in a chronic1 subacute1 or acute stage4 ,if the inflammation be acute1 no matter whether or not there is a general prolapse of the sacculated tissue1 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 bath1 ,fig4 #bc1 and by the use of a soothing ointment and liquid remedy1 to meet the depurant requirements of the case4 ,the removal of the chronic inflammation1 in whatever state it may be found1 should be a paramount feature of the treatment from the time a case comes under one's care4 ,the cure of the disease ought to be of more importance than the removal of a symptom or symptoms4 ,should there be bleeding from a mucous sac1 or should there be prolapse of it1 or both1 immediate treatment will give relief at once1 and the sufferer will think you have performed a miracle1 especially if the annoyance has existed for many years4 ,after the immediately annoying mucous sacs are removed by the hypodermic method1 a physician can doubly guard his reputation in the painless treatment of mucous sacs by delaying further treatment of those remaining sacs1 which1 if treated1 might occasion special annoyance1 till such a time as the general inflammatory condition is much improved2 but in the interim he may treat the mucous sacs that are located above the sphincter muscles1 and the granular and ulcerated regions4 ,for the almost universal success in the painless removal of mucous sacs1 the operator should be in possession of all of his normal wits and senses1 so that his judgment will be at its best when the following points present themselves3 ,what to treat4 ,when to treat it4 ,where to treat it4 ,how much to treat of it4 ,the quantity of remedy to be injected--all of which require discretion and good technique4 ,by the hypodermic method of treating mucous sacs some escharotic is employed with the object of causing the absorption of the sacculated mucosa4 ,the object to be accomplished ought to determine the proper strength of any escharotic used4 ,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 select4 ,and another fact3 the lower the per cent4 employed the larger the quantity that may be used at a time1 and this is desirable if the area of a sac be large and you wish to absorb the greater portion of it4 ,a skillful operator will make sure to have the escharotic used cover just the amount of the mucous sac desired1 and no more4 ,physicians that are not aware of the channeled and sacculated character of the mucosa in the case of 8piles0 or 8hemorrhoids0 are liable to introduce the escharotic into the base or the center of the mucous sac with the hypodermic needle2 and in such an event the remedy often enters a cavity or a channel1 or both1 and naturally it finds its way along the channel to the integument at the anus1 whence1 as a consequence1 a deep1 ugly fissure-in-ano is in a short time to be reckoned with by the patient and the physician1 because of the destruction of the epithelial wall of the channel4 ,the patient thereupon is far from being in a good humor1 and the physician wonders how the thing happened1 and he feels like quitting practice altogether1 and doubtless many have done so2 and certainly every one should do so if such an error were to occur a second time4 ,the object we wish to accomplish is to absorb the wall of the sacculated mucosa4 ,therefore the remedy should be injected at the apex of the sac1 in the epithelial layer1 or slightly deeper1 if the occasion demands it4 ,the area of the sac and the thickness of its walls must be taken into consideration1 and will suggest the amount of the escharotic to be used4 ,a proper speculum is very essential to the successful treatment of sacculated mucosa1 and ,i know of none equal to that devised some thirty years ago by ,dr4 ,a4 ,w4 ,brinkerhoff4 ,the speculum is easy to introduce1 and by drawing a slide the tissue is properly exposed or shut out to a nicety1 exhibiting just the amount you wish to treat4 ,in some cases there is a rather lengthy sacculated mucosa on the side1 or on the anterior wall of the anorectal tube1 and it is advisable to treat only the upper third or half1 and at a subsequent visit or visits to treat the remainder1 thus avoiding annoyance to the patient4 ,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 later4 ,i have often remarked that when pain or soreness follows the treatment of a mucous sac the fault is in the application of the remedy1 and not in the remedy itself4 ,now and then there may be conditions in which you will expect pain or soreness to follow the treatment1 and you will prepare your patient with the necessary appliances and remedies to overcome it promptly4 ,where there are no possible means for avoiding the pain consequent upon a treatment1 leave nothing undone to make it as slight as possible4 ,all mucous sacs ought to be treated without any after-annoyance to the patient1 and they can be if we only wait for the proper time to treat them4 ,i have not thus far considered the muco-cutaneous sacs around the anus1 which are neither useful nor ornamental1 and which often indicate the volcanic action of inflammation and the amount of mucous lava thrown out around the vent4 ,,chapter ,,xxii4 ,,external ,,and ,,thrombotic ,,piles ,,versus ,,muco-,,cutaneous ,,sacs ,,and ,,thrombus4 ,the vent of a crater indicates the convulsive and destructive changes that have taken place within2 and1 very often1 the vent of the gastro-enteric sewer gives like evidence of long1 great1 and severe destructive changes4 ,the fire of inflammation has burned fiercely for many1 many years1 and serous lava has1 from time to time1 poured forth1 leaving a searing1 inflammatory path4 ,as it was forced from the recto-anal crater1 the acrid1 burning mucus1 that had been imprisoned1 made subcutaneous streams1 cavities1 channels1 sacs1 etc4 ,its course is marked around the anus by peaks1 crags1 muco-skinny tabs1 small and large bulging muco-cutaneous sacs1 dilated anal veins in which clots of blood often form2 light gray1 brittle1 shiny skin with small and large red and sore oases1 thickly studded over the itching area1 which the sufferer has scratched in the vain hope of appeasing the torture of pruritus ani1 scroti1 vulv2 while cold drops of perspiration stand over his or her face and body1 serving to indicate the physical and mental anguish inexpressible in words4 ,muco-serous exudations under one or more layers of the recto-anal mucous membrane finds its way down to the integument around the anus1 and being of a very irritating character1 greatly increases the inflammatory process in the tissues it comes in contact with4 ,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 rug and sacs4 ,when the serous exudation takes place entirely under the recto-anal mucous membrane1 there may be formed a large muco-cutaneous anal sac1 especially on the right or left side of the anus1 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 anus4 ,in the latter case1 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 membrane4 ,the skin is not1 as it should be1 held fast by the connective tissue1 but lies loose over the cavity2 and a similar pathological condition exists under the mucous membrane of the anus1 rectum1 and sigmoid flexure1 which circumstance might lead one1 in some instances1 to conclude that there was almost an entire separation of the mucous membrane from the areolar tissue1 by the ridges1 folds1 large1 pouched1 prolapsed1 sacculated regions of mucous membrane that has the appearance of having been simply carelessly laid over the muscular structure of the organs4 ,when we observe such destructive changes by the invasion of serous exudation under the mucous membrane1 we have every reason to expect periproctitis and perisigmoiditis1 with the possibility of the formation of pus occurring with the usual consequences4 ,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 itself4 ,is it any wonder we find stenosis 7narrowing of the passage7 of eight1 ten1 or more inches of the lower portion of the large intestine1 which is usually diagnosed atony of the bowels8 ,surely1 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 relief4 ,you need the combination of many aids over a long period of time to effect a cure of proctitis1 etc41 and its numerous symptoms4 ,proctitis and colitis is a serious affliction1 and should have your undivided attention with the hearty co-operation of the patient in effecting a cure4 ,how foolish is the practice of removing one or two annoying symptoms 7piles and fistula7 and leaving the sufferer untreated1 the disease itself and the other symptoms not so apparent at the time of the operation1 and then dismiss the case as cured6 ,shame on such practice1 in which ignorance and cupidity dominate6 ,humanity cries for a correct diagnosis and a humane treatment6 ,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 volcano1 carrying with it an intense burning inflammation1 destroying normal fatty tissue as it advances1 owing to its extremely acrid character4 ,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 years8 ,the real wonder is that thrombus in the veins around the anus does not occur more frequently than it does4 ,what is the necessity of calling such a pathological change in the caliber of a vein and the weakening of its walls 8thrombotic pile08 ,thrombus is a clot of blood in a vein1 and there is no use in adding the word 8pile40 ,the aggravated character of the inflammation accounts for the hypertrophied and the cicatricial tissue so often found around the anal vent of proctitis cases4 ,the ,biblical suggestion that sacculated mucosa1 commonly termed piles or hemorrhoids1 is a disease1 accounts for the numerous names used to designate the particular variety of the disease--whether it be an internal or an external pile tumor4 ,it is very wrong to so mislead 8scientific0 medical men4 ,had they only known that the numerous sacs1 bags1 prolapsed pouches1 longitudinal and transverse folds of the ano-rectal mucous membrane1 and the ragged1 jagged1 prolapsed1 pouched muco-cutaneous tissue around the anus1 as well as the fissure-in-ano1 pruritus ani1 fistula1 are only symptoms of a disease1 all of the many abnormal changes and the other symptoms could have been prevented many generations ago by simply treating their exciting cause4 ,but it is never too late to learn things that will benefit mankind4 ,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 deep1 or even the depth of the mucous membrane4 ,they are far worse than that4 ,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 exudation1 and also the external tissues that surround and support the organs4 ,we have circular and longitudinal muscular tissue entering into the structure of the anus and rectum4 ,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 knife4 ,the acrid burning serum coming in contact with the muscular tissue excites an aggravated inflammation in its structure as elsewhere4 ,the constant irritation results in more or less permanent contraction of the sphincter muscles in which fibrinous exudation takes place1 binding the contracted muscular fibers together4 ,in time their expansibility is lost in many cases1 and in other cases partially so1 necessitating divulsion of the sphincters in order to break up the adhesions and establish a somewhat normal circulation of the blood in the diseased parts1 also in order to relieve the irritation to the nerves distributed to the organs and their marked reflex excitement4 ,in some cases an expansion of the sphincters for one and a half inches or two inches is quite sufficient2 other cases may require a little more thorough divulsion2 but never weaken or paralyze the sphincters1 as your patient needs their normal use1 and you need the reputation of never causing incontinence of feces4 ,guard the usefulness of the sphincters as you would a valuable treasure4 ,as a rule1 ,i treat all of the ano-rectal sacculated mucosa in cases where divulsion is required before performing the dilatation to break up the adhesions1 and very frequently the muco-cutaneous sacs and distended veins as well4 ,it may be well to delay the divulsion--with which there is usually no hurry--until you determine how many ,u-shaped 7or hairpin shaped7 mucus channels and recto-anal mucus fistulas there may be present that have passed down under the recto-anal mucous membrane1 down to the integument about the anus1 and then pressed immediately upward again along the outer wall of the anus and rectum1 to the extent of six inches or more4 ,there may be three1 four1 six1 or more of them quite prominent as to length and size4 ,for the treatment of the recto-anal sacculated mucosa the injection method is par excellent4 ,for the removal of the muco-cutaneous sac a double ,v-shaped incision1 the proper depth1 length1 and width1 will remove the surplus or redundant tissue1 after which the edges are brought together with a catgut suture1--or omit the suture if you think best1--followed by the home attention as prescribed for fissure-in-ano in a previous chapter4 ,at the time of removing the sacculated tissue attention may also be given to the mucus channel2 or you may1 if you wish1 leave it so that at some future treatment you can give it the desired attention4 ,a one or two per cent4 solution of alypin1 cocain1 or beta eucain will produce the necessary local anesthesia for a painless operation4 ,i remove only one muco-cutaneous sac at a treatment1 which permits the patient to go about as usual without much inconvenience4 ,if you have removed all of the ano-rectal sacculated mucosa in a case1 and have omitted to remove the one or more ano-muco-cutaneous sacs or dilated veins that are so often present around the anus1 and have also neglected to cure the chronic proctitis1 then the sacculated mucosa may1 by some hook or crook1 become excited again into an acute inflammatory condition1 the sphincter muscles may grip tighter than usual1 and lo1 thrombus has taken place in a vein1 and the wrinkled1 shriveled1 skinny tab or sac looks like a miniature balloon1 and your dismissed patient is in a troubled state of mind to have everything come back on him so soon6 ,the cure was all right so far as it went1 but there was the disease and some of the old external symptoms to tell the tale of an incompleted treatment4 ,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 within1 and they will damage your reputation as a proctologist if they be not removed4 ,by all means get rid of these symptoms and indicators of trouble within2 and if there should by chance be a little of the old proctitis remaining that wants to assert itself by making trouble1 in becoming acute1 it will be surprisingly handicapped in its efforts1 and the chances are all in your favor2 and you will1 moreover1 from time to time1 hear what ,so-and-,so said about the very successful treatment of his or her case4 ,sacculated mucosa1 muco-cutaneous sacs1 submucous channels1 etc41 having their source in the rectum and anus1 are all of a similar origin1 the result of serous exudation4 ,these symptoms of proctitis vary in development and number according to the nature and progress of the disease4 ,in those cases that are quite exempt from sacculated mucosa 7piles7 you may expect to find submucous channels largely developed1 and vice versa4 ,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 time4 ,they are no doubt rapidly emptied by the process of absorption into the system4 ,i have not referred to the fatalities of the hypodermic treatment of sacculated mucosa 7piles or hemorrhoids7 because of the fact that none have ever occurred within my knowledge among those using either this or a similar method of treatment4 ,,chapter ,,xxiii4 ,,abscess ,,and ,,fistula ,,involving ,,anus1 ,,rectum1 ,,and ,,neighboring ,,regions4 ,hippocrates1 the father of medicine1 ,celsus1 ,galen1 and other writers in the early times1 described fistula as a disease2 and1 naturally enough1 through the influence of heredity1 contagion1 imitation1 and auto-suggestion1 every author on the subject to the present day has chimed in most complaisantly with his 8,ditto6 ditto6 ditto60 8,me too6 me too6 me too60 ,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 humanity4 ,is it that they do not know better1 or that they are naturally servile and thus too lazy to do their own thinking8 ,let me in connection with this point call your attention to a practice that many of us have been suspicious of for a long time1 a suspicion that has been confirmed for me by one who speaks from positive knowledge2 otherwise ,i should not refer to it here4 ,the practice ,i am about to describe will make it plain why we have so many 8,ditto and ,me-too0 authors on proctology and other medical subjects4 ,an eminent surgeon who mentally is as large as the human race1 and has room for all that is good in medicine and surgery1 narrated the following incident of his career to a learned doctor from ,georgia and myself recently4 ,snatching occasionally a few moments from a busy practice1 he has prepared sufficient material to make a book1 and desired some competent person to edit it before publication4 ,so he consulted an ethical co-worker concerning such a person4 ,in a few days a gentleman called at the doctor's house to inquire about the contemplated publication4 ,the caller asked the title and size of the book1 and when told volunteered the startling information that he could have the work ready in a few weeks' time1 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 work1 so that the doctor's friends1 when reading the book1 would say1 8,that sounds just like the doctor2 that is his style of talking40 ,the would-be scribe never asked for the author's manuscript1 so accustomed was he to rely upon the medical literature to be found in the libraries of the city for all the information needed4 ,it is hardly necessary to add that the professional bookmaker was summarily dismissed4 ,the doctor's manuscript is still unpublished4 ,there is a third reason for so many 8,ditto and ,me-too0 authors4 ,publishers of medical books naturally desire to extend their business1 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 fiction4 ,now1 doctors usually obtain professorships in some institution by paying five thousand dollars or more for them1 and in due time a publisher of medical books will tempt the professor to become an author4 ,they place before him their great facilities for getting up a book1 arguing that consequently but little or no labor on the professor's part is required4 ,they point out to him the fame and honor the publication will bring him1 and at the same time estimate how much money they will make out of it4 ,in due time a 8,ditto and ,me-too0 medical brief1 rsum1 or treatise1 is published covering the whole history of the subject1 from ,biblical mention of it to the present day4 ,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 dollars4 ,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 advertising4 ,still1 before any action is taken that would result in effectively closing the door to this practice1 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 8,ditto and ,me-too0 scrapbooks with hundreds of pictures4 ,when seeking for new and better information to help suffering humanity1 let us be served for a little while longer with 8rehashed rot40 ,pardon this digression4 ,we will now consider1 at first hand1 the subject of fistula4 ,as a rule1 pus in a fistula is a secondary symptom of chronic proctitis1 except those fistul that occur from traumatic injury to the region of the rectum1 anus1 and buttocks4 ,early in my practice ,i entertained the idea that the formation of pus occurred at the point of dissolution of the tissue1 and that1 as the volume of pus increased it made its way in the direction of least resistance through it1 if the abscess had not been opened by an incision4 ,the idea was well founded when it was applied to the traumatic origin of an abscess and fistula1 but not when their origin was traced to chronic proctitis4 ,it may seem incredible to all who read this that a mucus channel or a fistula can be formed for ten1 twenty1 forty1 or more years before the formation of pus takes place in it2 and that the pus exerts no part in producing the diameter or length of the fistula1 which may have a capacity of six1 eight1 or more ounces of fluid4 ,as soon as the chronic inflammatory process has penetrated one or more layers of the mucous membrane1 mucus channel or fistula-formation must take place4 ,if the sphincter muscles be rather weak or lax ,i would not expect sacculation of the rectal mucosa to occur to any extent4 ,in these cases1 however1 the muco-cutaneous channels are usually found quite large and numerous4 ,of course the extent of the ano-rectal symptoms in each case depend upon how severe the chronic inflammatory process has been1 and is1 at the lower portion of the enteric canal4 ,often you will find that the seat of the most active chronic inflammation is in the middle and upper portion of the rectum1 involving also the sigmoid colon4 ,in these cases the ano-rectal symptoms are not numerous1 if there be any at all1 on the mucous membrane1 but under it you may expect mucus channels that serve as outlets for the inflammatory product4 ,in every case of chronic proctitis and sigmoiditis submucous and subtegumentary fistul can be found1 and my experience in tracing them warrants me in stating that periproctitis and perisigmoiditis is present also2 the latter pathological condition being due to the invasion of submucous and subtegumentary channels or fistul around the outside of the structure of the anus and rectum1 extending far up into the neighboring tissues of the pelvic space that support the rectum and sigmoid flexure4 ,the formation of pus in a submucous or subtegumentary channel that has existed for many years does not make it a disease2 it is only another incidental phase added to an already existing symptom of chronic proctitis4 ,mucus fistul should be diagnosed and treated early in their formation1 or at least before the tissues involved became so deteriorated as to form pus in quantity sufficient to occasion the usual period of suffering1 fever1 loss of rest and sleep before the pus is freed from its enclosure4 ,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 many1 many years in the tissues involved in the inflammatory exudation4 ,the numerous small and large submucous and subtegumentary fistul found in every case of chronic proctitis and sigmoiditis was the most grave and far-reaching of the numerous symptoms1 but for three decades ,i have fully realized the baneful effects from mucus irritation1 and the self-poisoning by the absorption of large quantities of serum and fibrinous septic material from the surface of the mucous membrane involved1 as well as that from numerous long1 cavernous mucus fistul3 a fearful double source of auto-intoxication1 for which it is useless to prescribe diet1 tonics1 and travel for building up the system and restoring the health4 ,besides the numerous general symptoms1 arising from self-poisoning by fecal and mucus absorption1 we have more or less marked local symptoms in many cases2 and if these be not present1 the diagnosis can be made out from the general debility of the system and the character of the chronic proctitis and sigmoiditis4 ,the local symptoms of mucus fistul1 periproctitis1 and perisigmoiditis are1 each of them1 universally diagnosed as a disease3 ,such symptoms as pruritus ani1 scroti1 vulv1 lumbago1 sciatica1 myalgia1 rheumatism1 prostatitis1 coxitis1 disease of the coccyx1 chafing about the anus and along the thigh and scrotum1 difficulty in getting up after sitting for a while1 pain in the back of the neck1 lame back1 legs feel tired1 and sometimes pain is very annoying1 abnormal color of the skin1 painful or sore spots at times1 confinement in bed for many weeks from severe continuous pain in and about the rectum1 etc4 ,up to the present time proctologists have paid little or no attention to proctitis and sigmoiditis1 which is a grave disease1 with a far more serious symptom1 that of mucus fistul of great length and diameter1 extending in all directions in the pelvic cavity and tissues of the buttocks1 the large area of tissue found so full of holes1 might be likened to a sponge occupying the same space4 ,they are very numerous in every case of chronic proctitis and sigmoiditis4 ,this will explain why an incidental symptom like pus in a fistula is commonly called a disease by the 8,ditto and ,me-too0 authors1 and why it is so frequently met with in practice4 ,at some hospitals one-half of the cases treated suffer from fistula in which pus has formed4 ,why the per cent4 is not much greater ,i am unable to explain1 except to give credit to the defensive and restorative power of the human body4 ,if the periproctitis and perisigmoiditis1 brought on by the mucus fistul1 is not treated at the same time as the cause1 the treatment will be of no consequence in effecting a cure of the chronic inflammation of the lower bowels4 ,every mucus fistula should be located and healed at the time that the disease itself is treated2 then the work will be well done4 ,every mucus fistula should be diagnosed and treated before the breaking down of the tissues reaches the pus-forming stage1 and thus obviate all suffering1 annoyance1 and possible death4 ,attention to this course will ensure your treatment of the disease1 and its symptoms1 to be taken in time4 ,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 it1 or that you will fail1 or that at a hospital it could be cured quicker1 better1 and cheaper4 ,these ideas are born of heredity1 timidity1 fear-habit1 power of auto-suggestion1 and too much caution on your part4 ,they are all falsehoods and should not be heeded for a moment4 ,during thirty years of practice in my specialty ,i have sent seven of my fistula patients to a hospital for treatment1 and four of that number ,i afterwards very much regretted sending1 as ,i could have accomplished the cure in a safer and better way by the usual office method of cure4 ,in fact every fistula1 pus or no pus1--,i do not care how bad it may be1--can be cured by office treatment and at the same time aided by the home attentions of the patient4 ,there may be periods of a year or more when your energies are overtaxed with numerous patients1 and you feel like dividing the labor with some fellow-practitioner1 and this in a measure accounts for those ,i induced to go1 or was willing to have go1 to the hospital4 ,unless overwork is the excuse1 you need never send a fistula patient to a hospital for treatment4 ,i have everything to say in praise of the ambulant treatment of ano-rectal fistula and the mucus channels1 since my practice thus far has been devoid of any unfavorable results1--a fact which should have much weight in favor of the ambulant office treatment of all of the many symptoms of chronic proctitis1 sigmoiditis1 and colitis4 ,mucus fistula is very easily healed in all cases1 and those cases in which pus has incidentally formed are likewise not difficult to cure4 ,all you need to do is to instill intelligence in a stupid patient1 if you haven't an intelligent one1 and induce him to utilize or improvise a few home conveniences for cleansing the fistula night and morning between office visits4 ,during the treatment of the fistula patients will be able to attend to their imperative duties4 ,to properly explore a fistula and its branches1 if any1 as to whether pyogenesis 7pus7 has taken place or not1 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 surface4 ,for a mucus fistula antiseptic remedies can be applied after a thorough irrigation by hot water at a temperature of one hundred and twenty degrees1 or more1 for half an hour or less time1 as the case may demand4 ,where pyogenesis 7pus7 has occurred in a mucus fistula there may be more or less necrotic tissue formed1 which will require the use of an escharotic remedy as well as very hot water irrigation1 followed by an antiseptic remedy1 if not already incorporated in the hot water used4 ,as a rule ,i see a fistula case once or twice a week1 as the case may require4 ,there is no packing of the fistula after the morning and evening home treatment--,i have never found it essential4 ,a ,t-bandage is worn1 with absorbent cotton1 over the opening of the fistula1 preventing soiling of the clothes while attending to daily duties4 ,never mind what the 8,ditto and ,me-too0 proctologists have copied or rehashed about the curing of a fistula1 which they persist in calling a disease4 ,just be resourceful1 safe1 and sane in all you do1 and every fistula will get well long before you have cured the chronic proctitis and sigmoiditis1 of which the fistula1 as a rule1 is a symptom4 ,,chapter ,,xxiv4 ,,nine ,,radiograph ,,illustrations ,,of ,,mucus ,,channels ,,and ,,cavities4 ,i am indebted to ,dr4 ,caldwell1 of ,new ,york1 at whose laboratory my patients were radiographed for the very excellent illustrations2 and also to ,dr4 ,albright of ,philadelphia1 for his assistance in the radiograph work1 while attending my clinic1 and who1 later1 with rare skill and scholarly ability1 presented my discoveries in a large volume1 entitled2 ,a ,practical ,treatise on ,rectal ,diseases1 ,their ,diagnosis and ,treatment4 ,the following illustrations can only give a hint of the pathological conditions that existed4 ,fig4 #a shows seven1 and ,fig4 #b1 eight probes inserted1 which by no means indicate the number of channels or size of the cavities2 twenty-five to fifty or more probes inserted would more accurately indicate the excursions of the inflammatory exudate4 ,the seven following illustrations1 in which ,bismuth ,paste was injected1 did not meet my expectations in showing the pathological conditions that existed4 ,the disappointment was largely due to a desire not to cause annoyance to my patients1 who so kindly consented1 in the interest of science1 to being radiographed4 ,in all cases the paste extended over a much greater area than a casual glance at the illustrations would indicate4 ,the probes and paste were not inserted with the idea of making a diagnosis1 but simply to suggest research on the subject by proctologists4 ,all the cases radiographed suffered from proctitis1 sigmoiditis1 periproctitis1 and perisigmoiditis4 ,illustration3 ,fig4 #a4 ,radiograph showing tube 7#a7 in the rectum2 #b1 probe inserted #h-c_/d inches2 probes #b and #d pass on left side of rectum2 #c and #e pass on the right2 all pass into perirectal spaces2 three probes are seen under the integument4 ,illustration3 ,fig4 #b4 ,radiograph showing tube 7#a7 in the rectum2 probes #b1 #d1 #f1 passed on the left and front of the rectum2 #c passed forward2 #e under the integument along the spine2 #g1 #h1 and #i probes passed to scrotum and thigh4 ,illustration3 ,fig4 #c4 ,radiograph showing a large region more or less filled with bismuth from the anal canal forward and upward1 as indicated by lines #a and #b2 a severe case of proctitis1 sigmoiditis1 periproctitis1 and perisigmoiditis4 ,illustration3 ,fig4 #d4 ,radiograph showing a tube in the rectum and probe passed to the left of the rectum into the space where bismuth was injected2 a case of acute proctitis1 sigmoiditis1 periproctitis1 and perisigmoiditis at time of treatment4 ,illustration3 ,fig4 #e4 ,radiograph showing bismuth in a perirectal channel on the left side of the anus and rectum1 which caused continuous annoying pain for many months4 ,illustration3 ,fig4 #f4 ,radiograph showing a long muco-cutaneous sac and perirectal channel into which bismuth was injected2 a case of proctitis and periproctitis1 etc4 ,illustration3 ,fig4 #g4 ,radiograph showing a tube in the rectum1 a long probe and bismuth in perirectal space1 also a probe in a submucous channel2 a case of sigmoiditis1 proctitis1 periproctitis1 and perisigmoiditis4 ,illustration3 ,fig4 #h4 ,radiograph showing bismuth injected in the perirectal space2 a case of proctitis1 sigmoiditis1 periproctitis1 and perisigmoiditis with severe constipation and indigestion4 ,illustration3 ,fig4 #i4 ,radiograph showing tube in the rectum1 a probe and bismuth in perirectal space1 and also a probe in a submucous channel2 a case of proctitis1 sigmoiditis1 periproctitis1 and perisigmoiditis4 ,,chapter ,,xxv4 ,,chronic ,,mucous ,,proctitis ,,and ,,sigmoiditis--,,usually ,,diagnosed ,,as ,,chronic ,,mucous ,,colitis4 ,chronic mucous colitis ought to mean inflammation of the ascending1 transverse1 or descending colon4 ,the length of the rectum varies from five to eight inches1 and the average length of the sigmoid flexure is about nineteen inches2 the length of the two organs is thirty or more inches4 ,chronic follicular1 ulcerative proctitis and sigmoiditis1 extending half1 or even the whole length of the sigmoid flexure1 causes great suffering1 and the symptoms are similar to those attributed to chronic mucous colitis4 ,for about thirty years ,i have positively known that many of my patients suffered not only from chronic mucous proctitis1 but from sigmoiditis as well1 since ,i was able to make positive diagnosis of the diseased condition for at least ten to fifteen inches up the lower bowels4 ,if the anal canal is inflamed from any cause and not cured1 the chronic inflammation will gradually extend up the whole length of the rectum and into the tissues of the sigmoid flexure1 invading the organ to a greater part of its length1 if not all of it4 ,the sigmoid flexure is the normal receptacle for feces1 and gases1 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 day4 ,the hygienic condition of the sigmoid receptacle is entirely dependent upon a healthy condition of the rectum and a sensible tenant of the body2 but when chronic proctitis has taken possession of the rectum and neighboring tissues1 it serves no longer as a normal passageway for emptying the sigmoid flexure of accumulated feces1 gases1 and liquids4 ,at first inflammation causes spasmodic muscular contraction of the anus and rectum1 which in time becomes more and more permanent stricture as the progress of disease advances1 lessening the bore of the organs until it becomes very difficult for anything to pass into and through the rectal and anal canals4 ,inflammation extending from the rectum into the sigmoid flexure for perhaps its whole length1 interrupts its functions likewise1 thus creating another cause for undue accumulation of feces and gases in the organ2 this accumulation of the waste material of the body becomes very foul1 generating toxic gases1 putrid substances1 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 receptacle4 ,why should we not find in these cases all the symptoms attributed by authors to chronic mucous colitis8 ,especially so when we have1 in addition to the enumerated symptoms of colitis1 those caused by periproctitis and perisigmoiditis1 which are always present and quite severe4 ,as a rule1 the symptoms which have been diagnosed as those of chronic mucous colitis1 membranous colitis1 or ulcerative colitis are nothing more than symptoms of chronic mucous proctitis and sigmoiditis1 accompanied by periproctitis and perisigmoiditis4 ,proctologists who have written on the subject of mucous colitis have noted the many symptoms very accurately1 but have missed the usual location of a most aggravating disease from which mankind suffers early and late in life4 ,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 apparatus1 caused by proctitis and sigmoiditis1 bringing numerous and severe primary and secondary symptoms to which other diseases may be traced4 ,chronic proctitis and sigmoiditis and their local symptoms convert the sigmoid receptacle into an ,augean stable1 from which foul poisonous gases and germs are forced up and along the bowels1 distending the descending and transverse colon and finally reaching the ascending colon and the ccum1 causing undue retention of their contents2 hence so much attention to the ccum and the vermiform appendix4 ,the ends of a long rubber tube distended with gas will exhibit more strain and disturbance than the intermediate parts1 and the same is true of the colon1 owing to the intermediate sections of the organ possessing greater mobility4 ,the great volume of gases confined in the colon prevents its normal peristaltic action1 causing undue retention of contents1 with resulting inflammation of the ccum1 as well as dislocation of the stomach1 colon1 etc41 and suggesting radiographic and fluoroscopic examination and surgical operations to discover the cause of all the trouble1 which should have been learned through use of the speculum before so many complications occurred4 ,in all cases of chronic mucous proctitis and sigmoiditis where there is a great amount of secretion of mucus1 membranous cords1 shreds1 and casts 7called mucous colitis71 ,i have found the marked acute symptoms more or less periodic and accompanied by increased inflammation in all the tissues involved in the disease1 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 speculum4 ,through often witnessing the phenomena1 ,i have learned what a 8mucous colitis0 storm means from a pathological exhibit1 a personal demonstration1 and a verbal description of what the sufferer is enduring4 ,it requires the stuff heroes are made of to endure chronic mucous proctitis and sigmoiditis for ten1 thirty1 or forty years without the disease being accurately diagnosed1 and to be told that all treatment is useless and that the trouble is in the head of the sufferer1 that he is a hypochondriac1 and a neurasthenic1 terms often used by doctors who are unable to make a proper diagnosis of a case4 ,the common symptoms of mucous colitis have been accepted by writers on the subject1 but as to the real cause of them there has been thus far only mere conjecture1 just as the writers have been doing as to the cause of pruritus ani1 scroti1 and vulv4 ,dr4 ,george ,m4 ,niles1 of ,atlanta1 ,ga41 says3 8,in looking up the literature1 one is amazed at the divergent views as to the etiology and management held by diligent students and competent observers4 ,it is fairly well agreed that most cases occur in nervous1 neurasthenic1 hypochondriac1 or hysteric individuals40 ,others blame the liver1 hysteria1 constipation1 fermentative processes in the intestines4 ,how foolish to name symptoms of the disease as a probable cause of it6 ,it is not necessary for me to again enumerate the many primary and secondary symptoms of proctitis and sigmoiditis1 but ,i will mention briefly a few nervous symptoms which ,i think are due to the absorption of mucus into the system4 ,there is that intense1 exasperating1 sore1 and restless feeling1 with inability to concentrate the mind1 with the nerves and muscles of the body pinched and contracted4 ,such feelings are at their height during an acute mucus storm1 which is an indication of increased inflammation in all the inflamed tissues1 causing secretion of a great quantity of mucus or membranous casts4 ,no doubt much of the inflammatory exudate from the mucous membrane1 from the muscular structure of the organs1 and the connective tissue surrounding and supporting the organs1 passes into the sigmoidal and rectal canals1 while a portion is absorbed into the system4 ,in a similar manner1 the inflammatory exudate from a subtegumentary mucus channel and cavity passes through the skin1 causing moisture of the skin1 pruritus ani1 scroti1 and vulv4 ,i know of no non-malignant disease1 where the symptoms may truly be said to be a thousand times worse than the disease that caused them1 except in chronic proctitis and sigmoiditis4 ,treatment of such cases has been very successful in my practice1 requiring four principal aids3 7#a7 ,local treatment2 7#b7 medicated enemata2 7#c7 local medication2 7#d7 the recurrent application of medicated hot water at a temperature of #abe to #ace or more degrees4 ,a further valuable aid is the determination of the sufferer to get well by faithfully carrying out the home treatment4 ,the more a patient studies my diagnosis and treatment of his case1 the more he is encouraged that eventually a cure will be effected4 ,dr4 ,james ,moran of this city has been a student and assistant at my office for more than three years1 and will bear testimony to the success of my treatment in all cases observed by him4 ,,chapter ,,xxvi4 ,,antiseptic ,,employment ,,of ,,powders ,,and ,,oils4 ,,depurant ,,powder4 ,water at a temperature of from #abj to #ace or more degrees is an excellent antiseptic if properly applied to diseased tissue4 ,its anti-toxic1 soothing1 and healing properties1 however1 can be vastly increased by the addition of ,depurant remedies4 ,water of this temperature1 if used in the treatment of proctitis or colitis1 should be applied with the aid of an ,intestinal ,recurrent ,douche4 ,water at a temperature of from #ij to #aje degrees--which is recommended for taking an enema--is antiseptic or depuratory only to the extent to which it washes away morbid matter from the intestinal canal4 ,to increase its antiseptic and therapeutic value1 as well as to meet other requirements1 ,depurant remedies are administered with the water during the flushing of the large intestine4 ,the ,depurant ,powder1 prepared by the author1 readily dissolves in the warm water and is brought into contact with every part of the mucous membrane as far as the antiseptic flushing extends along the intestine1 thus leaving the washed and sterilized canal sweet and clean--a fit and proper channel and receptacle for the on-coming fecal mass4 ,here it may remain about four hours without danger of putrefaction1 whereas1 were the passage-way and receptacle foul1 the feces would putrefy and form gases and toxic material in briefer time4 ,this ,depurant remedy is not restricted to intestinal uses2 it is equally efficacious when applied to the mucous membrane of any part of the body or to the skin4 ,it may be used effectively for washing out the bladder or the vagina2 for syringing the ear2 for a mouth wash1 tooth wash1 gargle1 nasal douching or spray2 for a throat spray2 for bathing infants2 and for internal use where foulness of the stomach and small intestines exists4 ,it is also a valuable adjuvant in the use of water for cleansing1 or for hygienic purposes1 on all the tissues of the body4 ,,depurant ,,oil4 ,next to the use of water on the mucous membrane and skin as a hygienic and therapeutic agent1 ,i am partial to some of our delightful oils1 which are bland1 non-irritating1 and of a pleasing1 nourishing1 refreshing effect and exquisite odor4 ,to the oil selected as the base ingredient may be added other oils1 and finally attenuated powdered substances of therapeutic value in soothing1 purifying1 healing1 or any other purpose the case may call for4 ,pure olive oil is an excellent substance in which to incorporate ,depurant remedies1 especially when designed to be taken internally1 by way of the mouth1 or applied to the integument of the body4 ,certain other oils are equally pleasing though rather expensive4 ,however1 an inexpensive oil usually serves as a base in which to embody the proper medicinal remedies for ,depurant purposes in the treatment of proctitis and colitis4 ,by a proper instrument the oil is carried into the intestines with the water used in flushing the colon1 or that used with the intestinal recurrent douche treatment4 ,the oil1 being lighter than the water1 is carried ahead or on top as the water passes up the bowels2 and1 as the two liquids open the crevices and folds of the mucous membrane or canal1 every part of the latter is completely covered with the medicated oil1 as with a covering of thin salve1 ointment1 or a poultice--in every nook and corner1 just where it is most needed and where it should remain for its hygienic and healing effect4 ,every kindly aid should be given a diseased organ1 mucous membrane1 or the skin1 even if one knows it is for relief only2 for the very aids that give relief are often essential when joined with medicinal or other treatment in effecting a cure4 ,it is advantageous in treating bowel troubles to use a rather heavy1 tenacious oil for a base--one that may not be so pleasant to swallow or to use externally as some of the lighter oils4 ,it is therefore advisable to have two kinds of ,depurant ,oil3 one for internal use 7by the mouth7 and for the skin1 the other for chronic disease of the lower bowel4 ,,intestinal ,,ills4 ,by ,alcinous ,b4 ,jamison1 ,m4,d41 ,,specialist ,,in ,,rectal1 ,,anal1 ,,and ,,bowel ,,diseases1 ,,and ,,author ,,of 8,,how ,,to ,,become ,,strong40 ,cloth1 #bgg pages ,the above is the title of a work for non-professional readers on the cause and cure of many forms of bowel and stomach trouble1 and their consequences1 and the scientific treatment of piles1 fistula1 pruritus ani 7itching71 etc4 ,science is here reduced to common sense2 and the intelligent layman1 following the directions of this book1 especially as to 8physiological irrigation10 will be able to prevent the usual daily foul state of the stomach and bowels4 ,here is set forth in plain language the accumulated experience of a thoughtful physician1 who for over thirty years has studied the welfare of his patients in the treatment of those diseases which are peculiar to civilization4 ,during this long practise1 patients from all parts of the ,united ,states and other countries have come to ,new ,york ,city to be under the humane and skilful care of ,dr4 ,jamison1 who has the unique reputation of never employing the barbarous surgical and hospital methods in vogue throughout the world4 ,no knife1 ligature1 clamp1 or cautery has ever been employed by him in the treatment of even the most aggravated case of piles1 or hemorrhoids2 and no detention from business is necessary under his treatment for this symptom of proctitis4 ,dr4 ,jamison's discoveries in the line of his specialty have added much to medical knowledge concerning the etiology and pathology of proctitis1 sigmoiditis1 and of their symptoms--hemorrhoids1 pruritus ani1 constipation1 etc4 ,his diagnosis of these afflictions is original1 as well as his treatment of such ailments--hitherto neglected or improperly cared for4 ,physicians and surgeons of conventional schools of medicine are not aware that the common cause1 and indeed the key1 of all forms of anal1 rectal1 and bowel trouble is proctitis 7inflammation of the lower bowel and sometimes of the colon72 that proctitis is the cause of nearly all cases of constipation1 diarrhea1 indigestion1 and biliousness2 and that1 finally1 proctitis is the cause of auto-infection 7self-poisoning7 and its outcome--anemia1 emaciation1 etc4 ,no book to which physicians have access treats this subject so fully as 8,intestinal ,ills10 and yet in this volume it is presented in a popular manner suited to the common understanding4 ,the following enumeration of the chapter headings will give an idea of the scope of the treatise3 #a4 ,man1 ,composed ,almost ,wholly of ,water1 is ,constipated4 ,why8 #b4 ,the ,physics of ,digestion and ,egestion4 #c4 ,the ,interdependence of the ,anus1 ,rectum1 ,sigmoid ,flexure1 and ,colon4 #d4 ,indigestion1 ,intestinal ,gas1 and ,other ,matters4 #e4 ,key to ,auto-infection4 #f4 ,how ,auto-infection ,affects the ,gastric ,digestion1 and ,vice ,versa4 #g4 ,how ,auto-infection ,affects ,intestinal ,digestion1 and ,vice ,versa4 #h4 ,the ,cause of ,constipation and ,how ,we ,ignorantly ,treat ,it4 #i4 ,cures for ,constipation 8,fearfully and ,wonderfully ,made40 #aj4 ,biliousness and ,bilious ,attacks4 #aa4 ,king ,liver and ,bile-bouncers4 #ab4 ,semi-constipation and ,its ,dangers4 #ac4 ,the ,etiology of the ,most ,common ,form of ,diarrhea1 i4 e41 ,excessive ,intestinal ,peristalsis4 #ad4 ,ballooning of the ,rectum4 #ae4 ,ballooning of the ,rectum 7,continued74 #af4 ,erroneous ,diagnoses and ,treatment of ,bowel ,troubles4 #ag4 ,costiveness4 #ah4 ,inflammation4 #ai4 ,proctitis and ,piles4 #bj4 ,pruritus1 or ,itching of the ,anus4 #ba4 ,abscess and ,fistula4 #bb4 ,the ,origin and ,use of the ,enema4 #bc4 ,how ,often ,should an ,enema be ,taken8 #bd4 ,physiological ,irrigation4 #be4 ,proper ,treatment for ,diseases of the ,anus and ,rectum ,very ,essential4 #bf4 ,the ,body's ,book-keeping4 #bg4 ,selection and ,preparation of ,food4 #bh4 ,diet for ,indigestion4 #bi4 ,diet for ,constipation4 #cj4 ,costiveness1 ,diet1 etc4 #ca4 ,diet for ,diarrhea4 #cb4 ,a ,final ,word4 ,you need this book for yourself and your friends4 ,by making a present of it to some one requiring its light you will perform an act of unselfish kindness4 ,price1 cloth bound1 lettered in gold1 #b4jj1 post-paid to any address4 ,in sending for the book please write name and address plainly4 ,all orders should be sent to the author3 ,a4 ,b4 ,,jamison1 ,m4,d41 #dc ,,west #de,,th ,,street1 ,,new ,,york ,,city4