Alcinous B. Jamison

CHAPTER I.

MAN, COMPOSED ALMOST WHOLLY OF WATER, IS CONSTIPATED. WHY?

Naturally the mind of man was first educated to observe external objects and forces in their effects upon himself, and the external still continues to engross his attention as if he were a child in a kindergarten. Fascinated by the Without, he ignores the Within. But, marvel of marvels, Disease (which when looked at with discerning eyes is seen to be an angel in disguise) comes to enlighten him concerning the world within. Disease gradually acquaints him with the fact that there are within him organs and functions corresponding to the objects and forces in the world without,—servitors in fact which must not be ignored under penalty of transforming them into foes to his well-being. Disease makes him aware that by ignoring the claims of his inner relations he has been converting his very food, juices and gases into insidious and formidable poisons, which perforce he absorbs into his blood and tissues and circulates throughout his entire system. Thus does the disguised angel admonish the ignorant that the rights of the inner world must not be ignored—that one's duties thereto cannot be neglected without disastrous consequences.

Thus does Pathology, which is really Physiology reversed, become the self-revealer par excellence. Through digestion and assimilation the physiological process takes up the food, juices and gases, to support and augment the life of man. The pathological process, on the contrary, because the conditions for nutrition are ignored, reverses the upbuilding processes; and the organs of life wither, waste and weaken, until life goes out like fire unfed.

Man has been slowly learning to take sanitary measures in reference to everything that contributes to comfort in his surroundings, and hygienic measures in reference to everything conducive to stability in his health.

Through ages he has learned, by experience and experiment, of the changes that inevitably occur in such perishable nutritive substances as water, milk, meats, vegetables, fruits, etc., if they be left uncared for; and he has been led thus to the inference of the law of decomposition—or putrefactive and fermentative changes. Idle substances, like idle minds, have decomposition and the devil for companions. Substances confined in containers open to the air—ponds, cesspools, etc.—are every-day object lessons to man of the fact that the chemical changes they undergo furnish the conditions for breeding bacterial poisons, and that these poisons are a dread menace to animal life.

If the reader will observe the analogy between the decomposition of substances in vessels or pools, and the decomposition of food in the reservoir called the stomach; and its further decomposition in a long canal (the small intestine), connecting the stomach with other receptacles called the colon and sigmoid flexure; and then the decomposition of their contents; he will readily comprehend the chemical putrefactive or fermentative changes or bacterial action that take place in the organism, if for any reason the contents be confined.

Of the four chief elements that enter into the composition of living bodies three are gaseous, or convertible into gas. In the physical man water constitutes three-fourths of the weight of the body. This being so we realize why, notwithstanding our sense of solidity and weight, chemical changes occur quite as readily in our organism as in the substances we see about us. There are no waterproof walls in the body of man to impede the percolation of liquids freighted with promiscuous Passengers from the alimentary canal; Passengers designed to nourish the organs for which they have an affinity. But there are those that have no organic affinity, and these are tramps, vagabonds, and even murderers, disturbing and destroying the normal functions of the system. Through extravasation, that is, through fluid infiltration of tissues, these Passengers come to be one with us, and we make them part of our tissue; but some of the Passengers are the demolishers of the living temple.

Water is universally present in all the tissues of the body, and it is indispensable for introducing new substances into the system and for eliminating the worn-out tissues and foreign substances. It is indeed important to emphasize the fact that properly to eliminate the foreign and waste products from the system requires, in a healthy person, at least five pints of water during twenty-four hours.

The amount of gastric juice secreted in twenty-four hours is from six to fourteen pints; of pancreatic juice, one pint; of bile there are two to three pints, and of saliva one to three pints. It is estimated that the juices secreted during digestion in a man weighing 140 pounds amount to twenty-three pounds in twenty-four hours. These fluids are poured back and forth in the process of transforming food into flesh and eliminating waste material.

In the alimentary canal there are vessels for holding fluid, semi-fluid and moist masses of substance, in all of which decomposition occurs if the substances be retained beyond the normal length of time. These vessels or reservoirs are the stomach, duodenum, small intestines, colon, sigmoid flexure, and too often the rectum. Through the harmonious action of this intestinal retinue of servitors man is well equipped and qualified for health, and he in whom this harmonious subservience prevails is among the blessed and elect of mankind. But alas! the great majority of human beings are sufferers from the inharmonious and insubordinate action of these servitors. How many a human being suffers from chronic constipation and indigestion, the exciting causes of which are insidious, and the consequences a protean enemy to his happiness! Medical writers on the subject of chronic constipation have assigned numerous causes, and likewise prescribed multitudinous remedies to the patient; but as a general rule this patient, after suffering various woes, if still surviving the many years of medication, rebels against taking further remedies and resigns himself to the chronic enemy on the best terms he can make with diet.

For this large class of chronic sufferers we have good news; and for the class that have suffered five or ten years we have better news; and for the class of infants and children that have started on the road of ill-health we have real glad tidings. To know that there is only one chief cause for chronic constipation and its train of disorders, and that that cause overshadows all other causes combined, and is easily diagnosed and treated, is news long hoped and prayed for by a multitude of sufferers the world over.

Twenty years as a specialist in diseases of the lower bowels have demonstrated to the writer that chronic inflammation, and often ulceration, of the rectum and sigmoid flexure, in ninety-nine cases out of a hundred, is the cause of chronic constipation and the long army of ills resulting from it. And yet, as the reader is well aware, constipation has had many "causes," since the days of Hippocrates, especially the abnormal condition of the liver.

The etiology, that is, the exciting cause, of the inflammation of the anus, rectum, colon, etc., may date from the time a diaper was placed on the new-born infant. Excoriations of the integument about the anus by the excretions of bowels and bladder indicate that the mucous membrane of anus and rectum demands local remedies, as well as the integument of the buttocks, and that it is not the liver which is at fault. The many applications of the diaper during the period of its use, and the frequently delayed removal at night or during long rides in baby wagons, railway trains or carriages, and during long social visits of the nurse; constipating foods, lack of drinking water, constipating medicines, followed by all sorts of purgatives, etc., are among a few of the direct causes of diseases of the rectum. A child at the age of eighteen months with a healthy rectum is most rare.

The ten thousand and one chances for contracting disease of the anus and rectum do not cease with the period of infancy. The child is left pretty much to shift for itself as to regularity of eating and the evacuation of the contents of its bowels, wherein disease has already obtained a foothold. All kinds of foodstuffs, at all hours, with seeds, stones, etc., are poked into its stomach, followed by constipating remedies to quiet inevitable troubles, or brisk purgatives given with the hope of expelling the arrested contents of the bowels. Is it any wonder that ninety-eight persons of adult age out of every hundred suffer more or less from chronic inflammation and ulceration of anus, rectum, sigmoid flexure, colon, or appendix?

Traumatic (externally produced) injuries to the mucous membrane of the rectum frequently cause inflammation, and hard pieces of bone, wood, seeds, imbedded in the feces, scratch, cut and bruise the tissues before and during the act of defecation. Cold boards, stones, earth and other substances used as seats may produce inflammation of the rectum. There are many and various causes which may be the means of exciting inflammation of the anus and rectum later in life; but it is the writer's opinion that the cause can be traced back to infancy or early childhood, and that accidents or imprudence in after years merely excite an already-existing chronic inflammation. Piles, fissure, itching pockets, tabs, prolapse, abscesses, fistulÆ, etc., are only the outcome and symptoms of a chronic disease which has incubated for fifteen, twenty or more years. None of this list of troubles produces constipation. It is the inflammation located at the middle portion of the rectum and extending into the sigmoid flexure that causes constipation; that protean monster which deranges more lives with nervousness than any other pathological condition to which the flesh of man is heir!

CHAPTER II.

THE PHYSICS OF DIGESTION AND EGESTION.

A tree is simply an extension from its roots; and, in an analogous manner, man's body may be said to be an extension from the alimentary canal. Does it not follow, consequently, that the digestive apparatus, from a physiological point of view, is the most important organ of the human body? It must be prime and paramount because all other organs depend upon it: it provides them with nourishment for preservation and improvement, and it punishes them—if they do not mind the laws of normality—by withholding its gifts, or by presenting these gifts in the form of poisons that impoverish, hinder and degenerate the system of organs. Uncleanliness is surely one of the chief ways in which physiological thoughtlessness is exhibited, and due punishment will inevitably follow disobedience.

Foodstuffs are prepared for assimilation in the alimentary laboratory through the process of normal fermentation. Is it not essential, therefore, that the connecting canals and receptacles be cleansed of the fermented debris that may remain unused and unexpelled, before more food be taken by the digestive apparatus? The all-important question is:—How soon and how well have the residuary part of the food (for some part will always be undigested or unassimilated), and the waste resulting from worn-out tissues of the various organs, been eliminated from the system? Wisdom declares that it is not so much what we eat, but what and how well we eliminate, that decides the issues of health and disease. Do the egesta pass out in the form of normal feces? Three times in twenty-four hours foodstuffs are taken, and as many times the bowels should be freed of accumulated excrement and gases. Does Nature have her way, or do neglect and bad habits rule the assimilative and eliminative functions of the bowels?

The habit of storing feces for twenty-four hours ought to concur and keep pace with a habit of eating one meal in the same period. Household and laboratory receptacles in which fermentation has occurred are emptied and cleaned before fresh material is put into them. Is not the same precaution more essential with the receptacles for digestion and egestion? They constitute our chief physiological economy; they are precious household and laboratory utensils; exceedingly precious, as we can purchase no other set when these are worn and wasted beyond repair. What marvelous possessions, and how reckless most of us are with them! Neither love nor money will bring another "body"-house to us when this decays; when poisons or parasites infest it as the result of a pernicious diathesis, of debasing, destructive tendencies; in short, of unmindfulness!

Too often criminal negligence or the lack of proper convenience has brought on the habit of using the intestinal canal as a storehouse for dried feces, and the glands and blood-vessels as reservoirs for the absorbed fluid poisons from the feces that have been stored and thus dried. This baneful habit is general throughout civilized communities. It is this habit that has made the words "constipation," "indigestion," "diarrhea," etc., familiar and household subjects of complaint. Medical writers agree that "constipation" is the most common malady that afflicts mankind; but they are also unanimous in preposterously attributing the cause to the abnormal action of the liver and the secondary symptoms of constipation.

Chronic constipation is the result of proctitis and colitis. Proctitis, the inflammation of the rectal and anal canals, is the most common disease that afflicts the human creature from infancy to old age; and colitis is only the extension of proctitis to the colon.

The scientific diagnosis of constipation predicates proctitis and sometimes colitis. It is declared that constipation is its primary symptom; and that diarrhea is one of its secondary symptoms, resulting from constipation. There is a legion of secondary symptoms of proctitis, all of which medical empiricism considers and denominates causes. As constipation is such an every-day complaint of almost everybody one meets, it will not tax our imagination unduly to conceive how it may be a frequent cause of diarrhea, which is only Nature's effort to get rid of its useless and excessive burden of retained feces and gases. Constipation, semi-constipation, and irregular action of the bowels, excessive fermentation, putrefaction, self-generated or auto-infection, are the factors to be considered. It is to be noted that in many cases diarrhea is simply an increased peristalsis of the bowels, often due to local and diffused irritation and often to inflammation of the mucous membrane (not infrequently with ulceration); all of these may be the outcome of fecal impaction.

To make intelligible the physics of the digestive and egestive processes, we must understand the apparatus. One would naturally think that were the bends or curves of the large intestine undone, it would be found to be a long, straight, smooth canal or bore like a rubber tube. But such is not the case. The outer muscular longitudinal bands are much shorter than the musculo-areolo-mucous tube, an arrangement which brings about a transverse puckering of the gut and mucous membrane, thus forming valves, folds, sacs or pouches at short intervals along the canal. These transverse folds or valves inhibit the too hasty passage of the feces along the bowels by checking and retaining the egested product in the large recesses or pools between the folds; they thus serve as so many dams in the passage of feces toward elimination. This wise provision of Nature to moderate the steady motion of the feces as they proceed toward the sigmoid flexure or receptacle, to wait there till there is a proper stimulus for expulsion, is wofully abused by man. He is quite willing to take foodstuffs three or four times a day, to fill the long row of intestinal pools between the dams with feces and gases in all stages of decomposition, not dreaming of the danger from developing bacteria and their absorption into the system.

Really he is inclined to eat at all times, yet begrudges a few minutes spent in a hurried effort to perform the act of defecation once in twenty-four hours. Some of us even have our minds absorbed in reading while awaiting an "automatic action" of the bowels. What a contrast between the gusto and time spent in taking foodstuffs and the indifference and indolence regarding the action of the bowels, unless indeed severe biliousness or diarrhea reminds us strongly of our sewer of waste products.

An attack of acute or chronic diarrhea is the penalty some pay for long inattention to the demands nature makes for intestinal cleanliness three times in twenty-four hours. Constipated people, semi-constipated people, irregular people and twenty-four-hour people, are not healthy. They are constantly being poisoned by the abnormal products of indigestion and putrefaction resulting from fecal stagnation, which products enter the blood and circulate through every tissue of the body.

All cases of proctitis are more or less accompanied by constipation and diarrhea. In all cases of chronic constipation I have found proctitis, and often colitis, and am forced to believe it is the most common and proximate cause of chronic constipation of the bowels. Constipation being a primary symptom, there must of necessity follow numerous secondary symptoms, of which diarrhea well marks the progress of septic infection. Some of the symptoms of infection are headache, megrim, vertigo, dyspepsia, foul tongue and mouth, back-aches, stiff neck, gnawing pain or numb feeling at the lower end of the spine, biliousness, bad odor from breath and skin, muddy complexion, cold hands and feet, jaundice, neurasthenia, loss of memory, drowsy feeling, pernicious anemia, emaciation, flabby obesity with pallor, capricious appetite, fits of great mental depression, palpitation of the heart, bloating of the stomach and bowels, disturbance of the kidneys, liver, lungs and mucous membrane in general, and especially chronic rhinitis and pharyngitis, which latter are among the first symptoms of imperfect alimentary excretion.

As auto-intoxication (that condition of the system when it is continually poisoned, usually by one's own excretions) gains the mastery of the vital forces at any period of life, the mucous membranes are likely to be first affected by inflammation of catarrhal character; then the serous membranes of the body. Mal-assimilation, mal-nutrition, cell-atrophy, are symptoms of the giving way of the vital energies to the invasion of the filth and bacterial poisons absorbed from the intestinal canal.

On the inner surface of the alimentary canal, from the stomach to the colon, there are, it is estimated, over 20,000,000 rootlets (called glands, lacteals, follicles, villi), which take up intestinal juices as roots of a plant take sap from the soil. These millions of rootlets give a velvety appearance to the alimentary canal, like a nap or downy surface. Intestinal rootlets of the small intestines, like vegetal rootlets, demand a certain amount of normal fluid and solid substance, free from noxious gas. It is the down or nap of fabrics, and not their body, that shows damage first. So it is with the frail structure of vegetal and animal life if not properly supplied with nourishment from day to day. There is probably in the vegetal bodies a continuous circulation of sap corresponding to the digestive circulating fluids of the alimentary canal. This circulation from the alimentary canal to the blood-vessels, and from the blood-vessels to the alimentary canal, involves a wonderful mechanism, facilitating the flow of several gallons daily from each to the other during the process of metamorphosis of food into flesh. You can thus see how inevitable it is that the functions of these millions of secreting and excreting rootlets will be disturbed by the clogging of the system with filth and bacterial poisons as a consequence of chronic constipation, biliousness and general foulness of the alimentary canal. Through such disturbance nutrition is diminished, cell-atrophy progresses, and emaciation becomes more marked. The progressive destruction of these rootlets, involving the pathological change indicated, will be manifest in one of its results, either costiveness or diarrhea.

Often the power of properly digesting and absorbing the foodstuffs is so greatly diminished that the alimentary canal is about as useless as a soft rubber tube. Millions on millions of these glands, lacteals and follicles in the stomach and small intestines, are destroyed like the rootlets of a plant or tree in unwholesome soil. The active circulation of the digestive fluids ceases, and the sufferer is said to be costive or to have chronic diarrhea. Both symptoms are the outgrowth of many years of intestinal foulness, and indicate the degree and character of intestinal irritability and semi-starvation of the body, as a consequence of either the absorption of poisons or the excessive elimination of the vital substance of the body through diarrhea.

CHAPTER III.

THE INTER-DEPENDENCE OF ANUS, RECTUM, SIGMOID FLEXURE, AND COLON.

Physiologically, or in a normal state, the rectum is not a receptacle for liquids and feces but a conduit during the act of defecation. Should, therefore, the feces have passed into the rectum and the desire to stool be not responded to—though the desire continue urgent—the feces will be returned to the sigmoid cavity by physiological action. When, however, the functions of the anus and rectum are disturbed by chronic inflammation, etc., the lower portion of the rectum becomes a more or less roomy pouch, a receptacle for feces and liquids; and instead of being physiologically empty it becomes pathologically distended, the result of spasmodic action or of more or less permanent stricture of the sphincter ani. See illustration in my book entitled How to Become Strong (page 14).

The putrid fecal mass of solid and liquid contents accumulated in the artificial reservoir at the end of the intestinal sewer, is one of the most common and serious pathogenic (disease-producing) and pyogenic (pus-producing) sources, which, by auto-infection, afflict man from infancy to old age. Here—in the dilated and obstructed sewer—the ptomain and leucomain class of poisons, and many of the poisonous germs, led by the king of morbid disturbers, the bacillus coli communis, find another and last chance to be taken up by the absorbing cells of the mucous membrane and returned to the blood; with which they are carried to all parts of the body, clogging the glands, choking up the pores and obstructing the circulation, thereby causing congestion and inflammation of the various organs. The action of cathartics, laxatives, etc., fills the ano-rectal cavity with a watery solution of foul substances; this solution is readily absorbed into the circulation, aggravating the auto-intoxication (the established self-poisoned condition) already existing. Danger does not end with the absorption of bacterial poisons, as we have to reckon with the deleterious effects of the various intestinal gases, resulting, with rapid augmentation of volume, from the putrefactive changes in the imprisoned feculent matter.

A sphincter ani permanently constricted or irritable owing to disease results in an abnormal receptacle just above the anal orifice (as shown in the illustration referred to); and a constricted and irritable rectum results in the impaction and dilatation of the sigmoid cavity, which is normally a receptacle, closed at its lower end by circular fibres separating it (the cavity) from the rectum and performing the function of a sphincter muscle. The rectal muscular fibres perform the office of a sphincter for the sigmoid cavity. The pathological changes that result in rectal impaction of feces usually extend to the sigmoid cavity. This cavity is 17½ inches in length, shaped in a double curve like an italic S. Civilized man should consider the disturbance to the functional action of body and brain, and the danger to health and longevity involved in the storage of effete and fetid matter. The disturbance and danger are enhanced when the tissues of the sigmoid flexure and the rectum are invaded by inflammation. A healthy action of the sigmoid receptacle depends on the rectum (a conduit six to eight inches in length); and as it is the universal verdict that disease of the rectum is one of the most common maladies that afflict the human race, it must inevitably follow that the feces will be abnormally stored in the sigmoid cavity, occasioning thereby habitual constipation which in turn brings on a host of functional disturbances throughout the system.

The colon is a receptacle and a conduit some three feet in length (see ib. p. 13) and its action depends upon the ability of the sigmoid flexure to perform its function as a final normal receptacle; and this in turn upon the rectum, which depends on the sphincter ani. The colon does not appear to possess any digestive powers, though it is capable of absorbing substances. Its function is not only to receive and forward the trifling residue of food which escapes digestion and absorption, but chiefly to excrete, through its own minute glands, the waste of the system coming from the blood.

The excretion from these glands of the colon into the colon, plus the effete portion of the food received by the colon from the small intestine, approximate in weight from four to six ounces in an adult person in twenty-four hours; and of this amount passed 75 per cent is water; so that were the excreta dried the solid matter thus evacuated would not be found to weigh more than one ounce, or one and a half ounces.

CHAPTER IV.

INDIGESTION, INTESTINAL GAS, AND OTHER MATTERS.

We noted the fact that the "digestive secretions" in a man weighing 140 pounds amount to twenty-three pounds in twenty-four hours; now add to these the food and liquids taken in that period, and you will form some estimate of the work done in the human chemical laboratory in its normal and abnormal states.

We noted further that substances confined too long in receptacles decompose and generate pathogenic poisons, that is, poisons productive of disease; and that the intestinal reservoirs are no exception to this law of putrefactive changes. How could we avoid drawing the inference, therefore, that disease-breeding germs, (generated in the organism and hence called "autogenetic"), and their auto-infection, i.e., absorption by the system, are an inevitable consequence of the undue retention and fermentation of the contents of these reservoirs: a consequence, in other words, of that intestinal uncleanliness commonly called biliousness, constipation, indigestion.

By far the most common and immediate source of autogenetic (self-produced) poisons and their auto-infection, is some degree of chronic constipation and the deadening, smothering effects of constipation on digestion; an effect analogous to what takes place when we allow waste material or ashes to bank up against a fire, shutting off its draft. Does the fire then continue to digest the coal? Clog up the receptacle for ashes and the coal grows cold. Dam up the colon or sigmoid and digestion is disturbed, diminished and debased, as evidenced by the local and general discomfort, and later by the train of inevitable disorders.

Indigestion is a household word. It has the widest range of all the diseases, because it forms a part of almost every other; and some diseases, such as chronic catarrh and pulmonary consumption, are in many cases produced by indigestion; which in turn had its source in chronic constipation caused by injury or inflammation of the lower bowel, as explained in our first chapter.

Diminished nutrition, impoverished blood, and loss of weight of from ten to twenty-five pounds, are the signs that indicate the coming disaster to the sufferer from auto-intoxication: the thoroughly poisoned state of the system resulting from auto-infection.

Vessels used by the dairyman and by those who furnish us with food products and liquids are kept scrupulously clean. Why? Because it is a question of loss of trade—of money. Should these vessels be used when foul from fermentation or putrefaction of their contents, Wealth would flee from the coffers of our purveyors, and the Boards of Health would, or rather should, take a hand in the matter. And these same purveyors, by the way, why do they care more for Wealth than for Health, their own and ours? But why are we all of us so neglectful of Inner cleanliness and so careful of Outer? The receptacles of the inner man reek with augean filth, and we cleanse them not. The immortal fountains of Health and Happiness are dammed, blasted and degraded by just this neglect of our imperative duty; the duty of furnishing full opportunity for the functions of replenishment and life, by keeping the sewer passages clear.

Are a sour stomach and foul intestinal canal fit receptacles for food and liquids? When our receptacles are in this condition, why do we add more material for the generation of poisons of the ptomain and leucomain classes, and morbid gaseous elements? It has been demonstrated that during fermentation an apple will evolve a volume of gas six hundred times its own size. What folly then to add to the fermenting mass! Food taken under such conditions will produce results not hard to imagine.

The gases that are commonly found in the stomach and small intestines are carbonic acid, nitrogen, oxygen and hydrogen; while, besides all these, sulphureted and carbureted hydrogen are found in the large intestine, causing in a normal state the necessary and useful distention of the alimentary canal. The writer has long regarded the abnormal production of gaseous substances in the intestinal canal from putrefactive changes as of itself not only a grave menace to health, but as a condition productive of morbific results of which we have still much to learn. The more or less constant and excessive distention of the whole or even of a part of the intestinal canal by gases is a serious condition, affecting as it does the various organs of the body, not only through the absorption of these gases into the general circulation but also through the reflex nervous reaction of these organs. It is astonishing what amount of mechanical force is exerted by the gases in the intestinal canal. They distend not only the muscular walls of the intestines and stomach but the strong abdominal walls as well, until the clothing worn has to be loosened for ease and comfort. This more or less extreme mechanical pressure may account for many cases of hernia, prolapse of the uterus, dislocation of various organs, disturbance of the circulation of the blood, and interference with the function of the nervous system, as indicated by its many protests in the way of aches and pains. Naval-constructor Hobson has lately demonstrated the dynamic power of gas confined in bags or receptacles in raising battleships; and it still remains for some physiologist or pathologist to demonstrate the morbid dynamic results of gases confined in the alimentary apparatus. The deleterious effect of the abnormal quantity of gases on all the organs of the body is imperfectly understood at present, but will be better apprehended when we are able to study more minutely the pathogenic poisons of the human system. It is known, however, that a stream of carbonic acid gas, or even of hydrogen, will paralyze a muscle against which it is directed.

CHAPTER V.

KEY TO AUTO-INFECTION.

In a previous chapter we stated that the average quantity of fecal discharge daily, by an adult, is from four to six ounces, and that of this weight 75 per cent is water. We referred of course to the daily passage from the bowels alone, not including that from the bladder.

Our studies have thus furnished us with the key wherewith to unlock the secret chambers of auto-infection. What is that key? It is the discovery that the system may possibly absorb as high as three-fourths of this feculent substance in the colon; that this absorption is made possible by an obstructed or sluggish intestinal canal where disease germs are propagated and lodged; that these germs, along with a certain amount of excrement, invade the tissues by absorption; and that we thus have the system constantly saturated with poisonous germs and filth, re-excreted, re-absorbed and re-secreted—no one knows how many times—by the various organs of the body.

That the importance of intestinal cleanliness may be better appreciated, I will quote from the following authors on the subjects of excretion, absorption and circulation of the intestinal fluids.

Dr. Murchison states that:

"From what is now known of the diffusibility of fluids through animal membranes, it is impossible to conceive bile long in contact with the lining membrane of the gall-bladder, bile-ducts, and intestine, without a portion of it (including the dissolved pigment) passing into the blood. A circulation is constantly taking place between the fluid contents of the bowel and the blood, the existence of which, till within the last few years, was quite unknown, and which even now is too little heeded. It is now known, says Dr. Parker, that in varying degrees there is a constant transit of fluid from the blood into the alimentary canal, and as rapid absorption. The amount thus poured out and absorbed in twenty-four hours is almost incredible, and of itself constitutes a secondary or intermediate circulation never dreamt of by Harvey. The amount of gastric juice alone passing into the stomach in a day, and then re-absorbed, amounted in the case lately examined by Grunewald to nearly 23 imperial pints. If we put it at 12 pints we shall certainly be within the mark. The pancreas, according to KrÖger, furnishes 12½ pints in twenty-four hours, while the salivary glands pour out at least 3 pints in the same time. The amount of the bile is probably over 2 pints. The amount given out by the intestinal mucous membrane cannot be guessed at, but must be enormous. Altogether the amount of fluid effused into the alimentary canal in twenty-four hours amounts to much more than the whole amount of blood in the body (which is 18 pounds in a man weighing 143 pounds); in other words, every portion of the blood may, and possibly does, pass several times into the alimentary canal in twenty-four hours. The effect of this continual out-pouring is supposed to be to aid metamorphosis; the same substance more or less changed seems to be thrown out and re-absorbed until it be adapted for the repair of tissues, or become effete."

The reader will readily perceive how the system may become so charged that other organs of the body will vicariously attempt to play the part of a receptacle and conduit for the bowel, in order to excrete and eliminate ancient and offensive filth and bacterial poisons. The phenomenon of vicarious excretion may occur through the kidneys, lungs, skin, throat, nose, vagina, or uterus, thus keeping up chronic diseases and discharges that would not exist but for the chronic constipation or even for incomplete action of the bowels each day. Over-distention of the rectum, sigmoid and colon, due to the pressure of gases and the impaction of feces, results in inflammation, ulceration, stricture, appendicitis, abscess, strangulation, intussusception, and abnormal ballooning or roominess in certain portions of these intestines or conduits. This roominess, though it becomes filled with feces, and often with liquids, permits of sufficient space for even the daily passage of feces without dislodging the stored contents. The fact that there is a passage daily deceives both sufferer and medical adviser as to the source of the poisonous condition of the system, and masks the origin of such disorders as chronic inflammation and ulceration of the nose, throat, lungs, stomach, duodenum, colon, appendix vermiformis, uterus, bladder, kidneys and edema of the legs. But these evidences of auto-infection are generally preceded and accompanied by a general loss of vitality and weight, by anemia, by a lowering of the resisting power of the organism—all of which produce a fit soil for the various diseases to which flesh is heir. As soon as the system becomes saturated with bacteria and effete matter, auto-intoxication results, in which condition there is but little or no store of vitality for resistance, reaction and recuperation.

Dr. Bright has recorded several instances of fecal accumulation in the colon mistaken for enlargement of the liver and for malignant tumors. In one of the cases there was jaundice which disappeared after free evacuation of the bowels. Frerichs also relates a case where enlargement from fecal accumulation was at first ascribed to a pregnant uterus, and subsequently, on the supervention of deep jaundice, to an enlarged liver, but in which purgatives dispelled the patient's anxiety about a diseased liver and at the same time her hopes for a child.

Dr. N. Chapman, in his Clinical Lectures (p. 304), says:

"The feces sometimes accumulate in distinct indurated scybala or in enormous masses, solid and compact. Taunton, a surgeon of London, has a preparation of the colon and rectum of more than twenty inches in circumference containing three gallons of feces, taken from a woman, whose abdomen was as much distended as in the maturity of pregnancy. By Lemazurier, another case is reported of a pregnant woman, who was constipated for two months, from whom, after death, thirteen and one-half pounds of solid feces were taken away, though a short time before between two and three pounds had been scraped out of the rectum. Cases are reported by Dr. Graves of Dublin, which he saw in women, where from the great distentions in certain directions of the abdomen, the one was considered to be owing to a prodigious hypertrophy of the liver, and the other of the ovary; in the latter of which he removed a bucket-full of feces in two days. Mr. Wilmot of London has recently given a case where a gallon of matter was lodged in the cÆcum, and the intestines perforated by ulceration."

Dr. Pavy, in his treatise on The Functions of Digestion (p. 232), writes:

Case (from Gaz. MÉd. de Paris, July 20, 1839): A woman of fifty was troubled with habitual diarrhea and frequent calls to urinate, in which urine could be discharged only by drops. After six years of suffering and unsuccessful use of remedies, she was examined for the first time per anum, and an accumulation of fecal matter discovered, forming a mass the size of an infant's head. This was removed and found to weigh four pounds. She then got well.

CHAPTER VI.

HOW AUTO-INFECTION AFFECTS THE GASTRIC DIGESTION, AND VICE VERSA.

Frederick the Great said that all culture comes through the stomach. This saying emphasizes pithily the dependence of psychology upon physiology. The stomach with the intestines is certainly the source from which every portion of the body receives its nourishment and most of its diseases. The physiological plus and minus processes leave their reflex on the mind.

Prof. Ch. Bouchard, in his lectures on Auto-Intoxication (Oliver's trans., p. 14), says: "The organism in its normal, as in its pathological state, is a receptacle and a laboratory of poisons. Amongst these some are formed by the organism itself, others by microbes, which either are the guests, the normal inhabitants of the intestinal tube, or are parasites at second-hand, and disease producing."

In the preceding chapters we have mentioned some of the most common cases of retention of excreta in the rectum, sigmoid cavity, colon, cecum, duodenum and stomach, and how the consequent foul conditions often resulted in diarrhea. Auto-infection impairs the functions of every organ in the body, by clogging the pores with poisons and filth. By the transfer of disease germs from one infected, that is, tainted, contaminated part of the body to parts that were free from infection, the kidneys, mucous membrane and skin receive these unnatural products, and their functions are disturbed thereby. The disturbance of the various organs throughout the system sets up such a multiplicity of symptoms that one gets the impression of a pandemonium—a veritable council-hall of evil spirits. The visitation is omnipresent. Infliction, misery, are everywhere. The taint of auto-generated intestinal morbific products, carried and communicated to the remotest parts, manifests itself now here now there as if it were a local trouble, and it is difficult therefore, nay, impossible, to classify scientifically the symptoms of auto-infection. A classification, though necessarily imperfect, will aid in the diagnosis and treatment of the various abnormal conditions of the stomach and intestines, that is, of mal-digestion. The sympathy, good understanding and responsiveness between the brain and the digestive apparatus are so close and intimate that the physician must take into consideration the inter-relationship of these organs before deciding which one is reporting reflex nervous symptoms, and which direct symptoms. Plutarch says in one of his essays: "Should the body sue the mind before a court judicature for damages, it would be found that the mind had been a ruinous tenant to its landlord." The digestive apparatus is, or should be, a farm for the mind, but unfortunately it usually has to wait twenty or more years before the tenant understands how to cultivate it for the uses of his intellectual and esthetical life.

I have referred to the fact that the most common causes of constipation, indigestion and other foul conditions of the alimentary canal favorable to the production of autogenetic poisons and their auto-infection, are such common and every-day matters, so familiar to almost every one that the victim, the parents and the physician feel no alarm of the coming danger for years. During these ignorant and innocent years the poison and filth were being absorbed, infecting the system with their morbific taint and lowering the quality of the blood and lessening its quantity, producing the state known as anemia. Associated with progressive anemia is mal-assimilation, improper nutrition, ebbing of the nervous and vital forces and the lessening of the secretory, excretory and digestive powers. By the time the poor victim is weighing fifteen to twenty-five pounds less than he ought to the symptoms of ill-health are sufficiently alarming to compel the sufferer to seek medical aid for disease of the stomach, bowels, liver, kidneys, lungs, etc.

Slow digestion is perhaps the most common form of functional disturbance of the stomach, due to an insidious auto-infection for years. The eyes and the skin begin to show the effect of the poisonous infection. The skin becomes dry, pale and muddy in color; has more or less annoying eruptions, and exhibits a jaundiced appearance. The body is ill nourished, the nervous system depressed, the blood impoverished, the memory failing, the general appearance languid, irritable, anxious. What a household picture this is to every one of the human family! But let us fill it out somewhat more fully. Note how the undue delay of food in the stomach occasions a sense of weight and oppression, the feeling beginning about an hour after a meal and continuing for hours, sometimes attended with fermentation and sometimes without it. At times there is a feeling of drowsiness due to the absorption of an excessive amount of the gases which distend the stomach and bowels, and this absorption is accompanied by pains in the stomach, head, between the shoulders and in the region of the heart. Sleep is disturbed by dreams, or one is awakened with a feeling of numbness and palpitation of the heart. At times the urine is scanty, strongly acid or high-colored. The tongue is more or less foul, with white or creamy coating. Now and then tasteless or saltish eructations occur. The appetite may be too good, or there is no appetite at all. Note the careworn expression, the wondering what to eat, what to drink or what remedy to take. So between much worse and some better, the trouble continues—both of body and mind.

Indigestion, however, with undue formation of acids proper, or acids unnatural, to the stomach, is a much more annoying affliction than slow digestion. The sufferer from indigestion may be debilitated, anemic, may have a general want of tone; or he may be a more or less vigorous and plethoric person. In some cases flatulence is very troublesome. But the most usual symptoms are heartburn, acid eructations that produce burning sensations, sour taste at intervals or constantly in the mouth, setting the teeth on edge. In the more vigorous or plethoric sufferers a gouty diathesis may exist, which may result in a tendency to inflammation, bringing on neuralgia, rheumatism, gout, etc. Tongue more or less foul; uric acid in the system; confusion in the mind; headaches; pains in the loins, legs and feet; in fact, more or less shifting pains everywhere: these are the common exhibits of indigestion. On the whole, the sufferer is a victim to an irritable body and a fretful mind, necessitating the cultivation by him of patience and the effort to be agreeable.

Besides the symptoms mentioned, indigestion may also be accompanied by gastric pain or by uneasiness at the pit of the stomach. It may be a sense of fulness or tightness, or a feeling of distention or weight, or again, a feeling of emptiness, goneness or sinking. Now and then there are burning, tearing, gnawing, dragging sensations under the breast-bone; and there is a general complaint of a capricious appetite, heartburn, vomiting, nervous headache, neuralgia and cold extremities. Other symptoms are pain from lack of food at the proper hour, or from food taken at the improper time; both of which practices may be followed by flatulency, occasioning a swollen, drum-like condition of the stomach and abdomen; the body of the tongue will be coated white, while the edges will present a redder appearance than in health.

Impaired digestion with nervous symptoms—in which the morbid sensibility of the mind is apparently the greatest—is called hypochondria. This class of sufferers, whose bodily and mental ills and morbid fears are so chaotically interwoven, are deserving of much consideration. So numerous are their fears and so fertile are their reasons for the many changes they arbitrarily make in their efforts to get well or keep from getting worse, so obstinately sure are they of being always right—that we can but give them our sincerest pity.

In some cases the functional troubles of the stomach and mind are aggravated by disease of the pelvic organs, which adds to the depression of the mind through nervous sympathy with the abdominal organs.

Dr. Cullen says on this point:—

CHAPTER VII.

HOW AUTO-INFECTION AFFECTS INTESTINAL DIGESTION, AND VICE VERSA.

Intestinal indigestion is a more common form of functional disturbance than is gastric indigestion. It is a well established fact that the greater portion of the digestive work is done beyond the stomach, in the duodenum, by the hepatic and pancreatic fluids. The duodenum—very properly called the second stomach—has none of the peculiar characteristics of a receptacle that receives crude substances—the office of the stomach. Much greater sensitiveness characterizes the digestive canal than the stomach; which is accounted for by the fact that a network of nerves, forming the sympathetic system, surrounds the bowels. The symptoms of intestinal indigestion are not always clearly defined and distinguishable from gastric indigestion, especially as the two are frequently associated.

The cecum, more than any other portion of the digestive canal, resembles the stomach, and it secretes an acid, albuminous fluid having considerable solvent properties. It is to be observed that as the cecum is only three inches in length and two and a half in diameter, and as its contents are necessarily propelled in opposition to gravity, a slight casualty will hinder or obstruct the upward movement of the pultaceous mass of the effete ingesta. The turning point in the ascending colon affords another ready hindrance to the upward and onward movement of this mass; and the gases and ancient feces beyond the turn conduce to further sluggish peristalsis, bringing about more or less obstruction and reflex irritation of the remaining length of intestinal canal. Undue retention of the contents of the cecum, and the disturbance and obstruction of the duodenum by the pressure incident to the distention of the colon with feces and gases, lead to congestion, inflammation and occasionally to ulceration of the mucous membrane in various parts of the intestinal tube.

This condition of affairs increases the occlusion (closing) of the bowels, but makes very easy indeed the entrance and propagation of micro-organisms in the sub-mucous coat of the intestine. The conditions are now ripe and rife for auto-infection. Which of the following microbes are the most active agents of progressive auto-infection: the streptococcus lanceolatus, the bacterium pyogenes, the bacillus subtilis, the staphylococci, the bacterium coli commune? They all play a part in the game, reducing the body in time to a charnel-house. Or are such substances as putrescein, cadaverin, skatol or indol—which are derived through chemical change in the putrescent mass—contributors to the spread of the poisonous taint throughout the system? Any single one or a group of the fifty or more bacterial poisons may be the responsible agents in the ensuing auto-infection. Chemical analysis of the gases resulting from decomposition reveals oxygen, nitrogen, hydrogen, carbonic acid, protocarbonated hydrogen and sulphureted hydrogen, ammonia, and sulphate of ammonia. Leucin, tyrosin, lithic acid, lithates, xanthin, cystin, keratin, sulphureted hydrogen, etc., are deposits in the urine and are signs of the derangement of the intestinal canal and liver. The external symptoms observed are the following: the tongue is large, pale, flabby and indented by the teeth at the edge of the anterior third, while its surface is white and the papillÆ often enlarged; the appetite may be excellent, though there is great functional derangement of the liver with lithemia, so that the sufferer is tempted to eat what he knows from experience will disagree with him; a bitter coppery taste in the mouth, due to taurocholic acid—a common symptom of lithemia or of imperfect oxidation of albumen; emaciation, fatigue, depression, headache, buzzing in the ears and deafness, disturbance of sight, loss of memory, faintness and vertigo, very marked in some cases; sometimes tenderness and pain under the cartilages of the right ribs; the fretting of the sensitive surface of the bowels by imperfectly digested, semi-putrescent food, resulting sometimes in convulsions, coma, paralysis, or in fetid diarrhea of an acid character producing a burning sensation or pain of the anus when the discharges are being passed; rumbling and twisting sensations in the region of the navel occurring with flatulency, and occasionally colicky pains which at times are so severe as to simulate poisoning.

In some people certain articles of food, without being either toxic or putrid, induce indigestion and the production of microbes in quantity amounting to one third of fecal dejections. Prof. Ch. Bouchard says:

In chronic inflammation of the rectum and colon there is more or less discharge of mucous, and in some cases of membranous, desquamation, with yellow or bloody mucus. The shreds, cords or complete tubular casts are discharged constantly or at varying intervals. The quantity and character often alarm the sufferer. The discharge is nothing less than a thick, tenacious mucus that had formed a thin coating on the inflamed mucous membrane, and become exfoliated in casts or thin shreds—the result of many years of morbid intestinal exaggerated action.

Microscopical examination of the desquamated intestinal membrane and mucus from a man forty years of age, revealed the following products: crystals, mostly complete; incomplete phosphates, very numerous; mucous shreds in abundance; fat globules and granules, numerous; anal epithelia; red blood globules, few; connective tissue, scanty; pus corpuscles, very few; margaric acid and detritus (substances resulting from the destruction or wearing away of the part); undigested material, mostly cellulose; leptothrix threads, micrococci; and the bacillus coli communis. Diagnosis: foul, undigested material, due to a chronic inflammation of the lower intestinal tract. The microscopical examination of mucus and desquamated membrane from a woman sixty-five years of age, disclosed that she was suffering from proctitis and colitis. She wrote: "Please tell me how long this mucous discharge must continue. I am alarmed at the quantity of membrane, cords, casts, etc., in my excreta, and I think that if this process goes on much longer there will soon be no bowels left to purify." This letter was written some weeks after contracting a severe cold, which accounts for the unusual amount of exfoliation and mucus. The sample she sent contained a large quantity of mucus, both threads and corpuscles; with a moderate number of epithelial scales, partly anal and partly intestinal. Pus corpuscles were present in small numbers; also vegetable fibres, fat, starch, muscle fibres and cellulose—the remains of undigested material. In the membranes themselves no micro-organisms were found; in the pieces containing undigested material the bacillus coli communis was found as well as micrococci, and the bacilli of putrefaction (secondary formation) were seen.

CHAPTER VIII.

THE CAUSE OF CONSTIPATION AND HOW WE IGNORANTLY TREAT IT.

One of the best preparations for active life is a first-class intestinal canal.

"An old Scotch physician," says Sir Astley Cooper, "for whom I had a great respect and whom I frequently met in consultation, used to say to me as we were about to enter our patient's room together, 'Weel, Misther Cooper, we ha' only twa things to keep in meend, and they'll serve us for here and herea'ter; one is au'ways to hae the fear o' the Laird before our e'es, that'll do for herea'ter; and th' t'other is to keep our boo'els au'ways open, and that'll do for here.'"

A person whose mind is devoted to the realization of ideals, and whose body has a set of bowels that perform the act of defecation twice every twenty-four hours is doubly prepared for a useful life.

Milton's advice in poetic lines is all very well for those who have escaped chronic inflammation of the lower bowels, an ailment common and troublesome even under the very best dietetic regulations.

Inflammation having once penetrated the circular and longitudinal muscular fibres or bands of a section of the intestine, all hope of a comfortable existence is at an end, for such inflammation will bring on constipation and constipation nervous misery. It is inevitable that inflammation should determine this outcome since it induces spasmodic contraction of the muscular walls of the tube, lessening the bore or closing the portion of the canal invaded. Plastic infiltration takes place in the walls of the gut, thickening and binding them together; or, if the inflammation be of a simple catarrhal or atrophic nature, the plastic infiltration will more or less bind the circular muscular bands of the gut together in their abnormally contracted state! The presence of feces and gases above the zone of the disease will increase the irritation and contraction of the affected portion of the intestine. Consequent upon these changes wrought by inflammation, gases and excrementitious material are perforce imprisoned in the intestine, inducing constipation, foul fermentation, flatulency, diarrhea, indigestion, nausea, loss of appetite, sick headache and, in fine, autogenetic poisons, the source of auto-infection, ending in auto-intoxication, the chronic poisoned condition of the system.

Since the most common cause of chronic constipation, internal sluggishness and uncleanliness, is known, too much cannot be said in condemnation of the wide-spread abuse of "liver and atony persuaders" and the use of irritating suppositories and dilating bougies, candles, etc. The numerous and various drastic purgative nostrums—which literally fill our medical literature—and the universal demand for them, are evidence of this very common disease, which disease is rendered worse by the drugs taken for the relief of a foul intestinal alveus. An abnormal amount of watery secretion is forced by the drug into the foul canal, to mix there with its contents, of which the major portion is retained and re-absorbed into the system. And to make the bad condition and treatment worse, all such sufferers, as a rule, drink very little water, some scarcely any.

The demand for an irritating stimulus to "open the bowels" (the exciters contribute to close them) is largely due to the popular error in thinking, "I can treat my own bowels quite as well as the doctor, if not better." No intelligent person would think of stimulating and irritating daily an inflamed region of tissue on the outer portion of the body; yet this is precisely what intelligent persons do when they habitually use liver and peristaltic persuaders. The primary disease in the lower bowels and the consequent symptoms are gradually aggravated as the "physic" habit is formed.

As in the case of opium fiends and drunkards, so with habitual cathartic drug-users, should they be suddenly deprived of the accustomed artificial stimulus and irritant they become absolutely miserable, mentally and physically. It is a well-known physiological fact that every artificial stimulation of the intestines is followed by a corresponding loss of vitality and reaction. Now that the almost universal cause of undue retention of foul, effete matter has been ascertained, it is important to communicate to the world at large the best means of cleansing the bowels without increasing the local primary disease and its annoying symptoms.

That external physical cleanliness is next to godliness is an apt proverb. That internal physical cleanliness is nearer to godliness no one will deny.

Water is a universal solvent and therapeutic agent and is therefore indispensable in the cleansing and purifying of the integument and mucous membrane of the body. A large quantity of water is necessary to carry on the functions of the animal economy. Water enters every cell and fibre of the living organism, aiding in nutrition and in the elimination of worn-out tissues which if retained turn into poisons.

It is really not an intelligent but rather a barbarous practice to prescribe liver and intestinal exciters for the purpose of throwing into the alimentary tract a sufficient quantity of watery excretions to "cleanse itself"; to succeed they must first soften and liquefy the dry, hardened feces and scybalous masses (little ancient, bullet-like formations) imprisoned above an inflamed and fevered lower bowel, even colon.

Normal feces consist of 75 per cent water; and when unduly retained in the colon much of this fetid percentage is absorbed into the system. Then drugs are prescribed to liquefy the hardened putrid remnant and absorption begins again: a fact very shocking to a sensitive, even sensible, person.

CHAPTER IX.

CURES FOR CONSTIPATION: "FEARFULLY AND WONDERFULLY MADE."

Diseases of the anus and rectum are very common, very numerous and of very critical consequences. This is especially true of the disease of chronic inflammation, one of whose symptoms is piles or hemorrhoids. In the writings of the early Greek and Roman physicians will be found minute descriptions of the latter disorder. But on the whole, the most important symptom of chronic inflammation of the lower bowel, and the most far-reaching in its morbific results, is that protean monster, chronic constipation. It deranges more lives, from infancy to old age, than any other pathological condition that can be named.

For the cause and cure of that mere symptom of a disease, constipation, the so-called scientific physicians, from the early history of medication to the present time, have had one immutable theory as to the leading cause, and one grand motto as to the "safe and sure" cure. They have always prescribed remedies for this malady on the theory of portal congestion and hepatic derangement, and hence their supreme motto: "Physic! Physic!! Physic!!!"

The layman naturally adopted the theory and the motto of his medical advisers; hence in his self-medication and also under advice he consumes such vast quantities of purgative nostrums.

I have just received some medical literature beginning with the usual salutation—"Dear Doctor"—setting forth a new and remarkable theory of the cause, and an original motto for the cure, of constipation. Its authors have discovered that the "rectal nerve-tissues" are hungry, torpid, anemic, and to overcome the "atony" they must be "Fed! Fed!! Fed!!!"

"The greatest of physical ills in America," we are informed, "is digestive torpor or semi-paralysis, originally induced by a kind of starvation of the intestinal nerve-tissues. One of its most prevalent forms is constipation," caused by "local torpor or semi-paralysis, dependent upon an anemic condition of the nerve-tissues of the rectal region." By "feeding directly" the limpid, bedraggled rectum and colon, they receive their "appropriate nutriment, by which comes added vigor,"—the nutriment the stomach and the rest of the system had failed to furnish on account of constipation, excessive fermentation, indigestion and auto-infection.

To overcome this "atony" of two or more feet of the lower bowel, a little "nutritious" suppository, weighing twenty grains, is a "specific." It is claimed to cure chronic auto-infection and the spasmodic occlusion of the lower bowel! The excessive activity of all the region invaded by the chronic inflammation and the local irritation are perpetuated by such "feeding" instead of allayed! Does it not stand to reason that there is already too much activity, and that when the irritability reaches a certain stage diarrhea or looseness of the bowels must result? Twenty grains prescribed once a day to nourish an organ (the rectum) six to eight inches in length, and from one and a half to two and a half inches in diameter! When for two to three feet the lower bowel requires nourishment, a suppository night and morning is prescribed! However, the new treatment has the merit of some consistency between the diagnosis and the treatment, notwithstanding both are wrong.

Chronic inflammation of the lower bowel causes, as I have pointed out, excessive activity and thereby excessive nutrition of the tissues involved in the morbid process. But sphincter ani gymnastics have been suggested by some one who thinks chronic constipation is owing to a lack of muscular activity of the lower bowels; and the following reason is given:

"Physiological experiments have shown that rapid voluntary movements of the external sphincter ani and the levator ani produce very active peristaltic movements of the large intestine. This effect is produced by the mechanical excitement of the plexus myentericus of Auerbach. This curious automatic center lies between the two muscular coats of the intestine and controls the peristaltic movements. A person suffering from constipation should make powerful movements of the sphincter ani, and of the levator ani, in as rapid succession as possible, continuing the exercise for three or four minutes or until the muscles are fatigued. The time chosen for this exercise should be either before breakfast or an hour after breakfast, according to the natural habit of the individual in respect to the evacuation of the large intestines."

There are surgeons who recommend stretching and paralyzing the external sphincter muscle; and if they are correct in their diagnosis and treatment, those who prescribe bile-bouncers, and those who prescribe "nutrient suppositories," and those who prescribe the use of rubber bougies and candles, should call a convention (to meet in, say, New York City) to discuss the subject and see if they cannot agree to inform the people that constipation is a sign of, or a factor in, the evolution of the human race. Those who believe in the gymnastics of man's ears and of his sphincter ani and the therapeutic merits of this and of that could readily assent to the same glorious conclusion.

Strange to say, there are in New York physicians who are in the habit of inserting a rubber bougie up their patients' rectums two or three times a week for the cure of constipation. Some, more bold, intrust the bougie performance to the patient in order that a daily dilatation and stimulation may be kept up until "recovery from the disease is effected." Others, more original, order the patient to insert a candle some six inches in length up the rectum and allow it to remain ten minutes, with the hope of a "rapid cure."

A Mrs. P——, who had used the candle treatment for a great length of time by order of her distinguished physician, once consulted me. On examination, I found her afflicted with atrophic catarrh, chronic constipation and anal ulceration, from which she had suffered for seven years, with but little intermission from pain during each day of that entire period.

CHAPTER X.

BILIOUSNESS AND BILIOUS ATTACKS.

Commonly the source of chronic gastro-intestinal uncleanliness, of dyspepsia, of autogenetic poisons and auto-infection is inflammatory occlusion—more or less permanent or spasmodic—of some part of the lower bowel. Many years of auto-infection will exhibit such diseased symptoms as poor appetite, bad digestion, impoverished blood, emaciation, etc., accompanied by increased virulence of the catarrhal discharge of mucus, shreds, etc., and a mind and body sinking down to the morbid plane of hysteria, hypochondriasis (fear of illness) and neurasthenia (debility of the nervous system).

Biliousness and bilious attacks are evidence that there is a more or less constipated condition, that there has been an occasional imprudence in diet, and that the dreadful sense of fulness up to the end of the tongue is a faithful report of the state of affairs. What is it but a full foul condition of the digestive canal, a complete blockade of the canal from the rectum or colon to the stomach, making the victim feel that there must be something done in the way of cleaning out? He fears that the condition will be followed by fever—not infrequently this is the case. Biliousness is usually supposed to be occasioned by hindrance to the flow of bile, and the conclusion is drawn that the liver requires stimulating. This supposition is erroneous and very far from pathological veritude, as the liver, like the other organs, is merely a secondary sufferer from the over-eating and the closed sewer.

The bilious attack is usually noticed in the morning before food has been taken. The tongue is heavily coated and often so foul that it is necessary to scrape it and cleanse the mouth of disagreeable taste. Eructations, nausea followed by vomiting of undigested foul-smelling food, and if the vomiting be long-continued, mucus from the stomach and bile that had accumulated in the duodenum, are sufficient evidence that there was no torpidity of the liver. There is likewise more or less headache, neuralgia, giddiness, hebetude (state of mild stupidity), dejection, confusion of the senses, skin disease, acne rosacea (scarlet redness of the nose and cheeks), eczema, etc. The headache may be seated in the centre of the brain and extend to one or both eyeballs and be increased by stooping. Should diarrhea occur many of the annoying symptoms are likely not to be present.

In this form of indigestion the bowels are often much constipated, which is usually only a more marked symptom of chronic constipation. The system now and then vigorously rebels against this chronic condition and an acute bilious attack is the evidence of such rebellion. The whole digestive canal is involved in the rebellion, resulting in the symptoms described and also in a morose, petulant and querulous temper, accompanied by a peculiar, despairing expression,—partly due, perhaps, to regrets of having only one digestive apparatus,—or in some cases, perhaps, of having any.

That the character and disposition may be materially influenced by such a state of the bowels is well established. Plato believed that "an infirm constitution is an obstacle to virtue, because such persons think of nothing but their own wretched carcasses"; for which reason he contended that Æsculapius should not undertake to patch up persons habitually complaining, lest they beget children as useless as themselves, being persuaded that it was an injury both to the community and to the infirm person himself that he continue in the world, even though he were richer than Midas.

Acting on this well-known fact, the celebrated Voltaire, in one of the articles in his Philosophical Dictionary, has very humorously ascribed half the evils of Europe to the intestinal irritations of the public men of the age.

"Let the person," he adds, "who may wish to ask a favor of a minister, or a minister's secretary, or kept mistress, endeavor previously, by all means, to ascertain whether they go to stool regularly; and, if possible, to approach them after a comfortable evacuation, that being a most propitious moment, one of the mollia tempora fandi, when the individual is good-humored and pleased with all around him."

CHAPTER XI.

KING LIVER AND BILE-BOUNCERS.

The "house not made with hands"—the human body—has, like the house made with hands, its sewer system, which is over twenty-five feet in length. To cleanse (?) this wonderfully delicate, tortuous and extended passage-way of waste material, civilized man knows no better than to put in at the top of the house, purgatives, cathartics, bile-bouncers, etc., with one hope and purpose in view, namely, that these policemen go searching, scouring and hustling the intestines in the greatest possible haste, in order to remove an obstruction about three hundred inches distant from where these "forcers" had entered the intestinal sewer. With mercury as a scavenger the work is pretty thoroughly done, though extra care has to be taken that some of the teeth may remain after the victim survives the additional intestinal inflammation occasioned by its drastic measures.

Traits acquired by the father are inherited by the children; present-day doctors follow early practitioners; they still pour in many and various decoctions at the top of the obstructed sewer of the human house to dislodge accumulated gases and feces at the bottom. The plumber treats the sewer of the house of brick and stone more wisely.

Our fathers partook of laxatives, cathartics, purgatives, and in consequence we start in life with teeth, intestines, appendices, out of gear and nervous systems on edge. With unconscious stupidity we continue the fatuous practice. The monarch selected to preside over the functions of human life was the Liver; and it is only with bated breath that any doctor dares question the legitimacy of that monarch's claim. The loyal subjects of King Liver are ever ready to call out "quack," "charlatan," etc., to those who dare repudiate the sovereignty of the Liver.

So much attention and flirtation does the liver receive from the liver-persuaders that the pancreas ought to be very jealous. The pancreas excretes quite as much fluid into the duodenum as its larger neighbor, and is, therefore, no mean organ. And we need not wonder should we find the intestinal glands piqued at our over-attention to the liver, as they, in their work at the metamorphosis of digested food into blood, excrete two or three gallons of fluid in a day to the liver's two or three pints; yet witness our medieval solicitude for the liver, for one among many organs. The liver is located near the upper portion of the intestinal canal and connected by a tube (the bile duct) to the rest of the excursion route. The following liver-persuading knights-errant are prescribed and ordered by disciples of Hippocrates, Galen, Herodicus, and Iccus, to treat with that digestive and eliminative monarch, the Liver—usually at night-time, that the family may not be disturbed. After making as good terms as possible they journey on, riotously churning and swashing the long, tortuous canal and its contents in search of ancient toxic gases and feces lodged in the lower bowel. It is believed by the prescribers that the length of the journey adds dignity to the drastic, dredging knights-errant. The reader needs no introduction to the podophyllins, the aloes, the jalaps, the rhubarbs, the mercurys, the croton oils, the sennas, the salines, the seltzers, the Carters, the Beechams, the Websters, the Pierces, the Ayers, the Ripans, the Warners, and others belonging to "The Four Hundred" fashionable grenadiers, with their credentials and stamp!

After these knights-errant have paid their respects to King Liver, and ended their long, tortuous and eventful journey, they depart and leave behind them burning and painful abdominal and anal regrets, and then some soothing, stimulating and tonic remedies are in order, so that the dredged though chronically constipated sufferer and his friends may still hope that life will be spared to repeat the same nauseating and often painful process in a few days or weeks, taking, in the meanwhile, milder bile-bouncers daily as a reminder to King Liver that the time for the knights-errant is coming again.

Sufferers from chronic constipation receive assurances that by the use of these "remedies" the anemia will be corrected, nutrition and digestion restored, atony of the liver and intestines overcome, yellow complexion and morbid feeling disappear. In short, remove the numerous symptoms and "causes" of toxicity of the body and of chronic constipation, and proclaim the victory of Powder and Pill!

All of us would believe Medicus, the son who so abjectly follows in the footsteps of his father, if we could really feel the possibility of such a victory; but the protests of our bowels are living witnesses against the validity of the medieval practice as here described; and we ask for a modern scientific solution of the fulness and foulness within and the fatuity without.

I must now apologize to the large class of sufferers from chronic constipation for hurting their feelings. I know very well how seriously they have been compelled to regard their trouble, and out of respect for their protracted suffering and efforts to get relief I should instead have sympathized and condoled with them in their dire misfortune. But we all know and realize that there are occasions when we get into awful and painful predicaments, and, when the whole situation is taken in, it becomes comical and ridiculous, so that for a time we cannot treat it seriously, even when old Chronic Biliousness and the mighty knights-errant are having a deadly combat at our internal and external (and possibly infernal) expense.

CHAPTER XII.

SEMI-CONSTIPATION AND ITS DANGERS.

What has been said thus far has been based on chronic constipation mainly, and the accompanying intestinal foulness, which condition was shown to be so annoying that it compelled the sufferer to resort frequently to some more or less direct and artificial means for the relief of the bowels and the incidental indigestion. It has been further shown that many of the chronic cases fail to take on the normal amount of flesh or lose what flesh they have because of self-poisoning (auto-infection), which in turn is the outcome of mal-assimilation and mal-nutrition, and that this consequence must occur wherever there is an absorption of waste through a checking or disturbance of systemic functions. Emaciation and anemia are inevitable in such cases. On the other hand, there are cases that have such great powers of assimilation and elimination that they are able to stand the invasion of destructive material, may maintain the normal amount of flesh, or even take on an abnormal amount, but with the invariable accompaniment of more or less impoverishment of blood, disturbed circulation, indigestion, and the usual nervous derangements. The harmful practice of the lean and the fleshy sufferers of resorting to daily medicines—cathartics, digestives and tonics—has been commented upon. Willingly do they squander their money to get relief from an ever-present ailment. Cases are these of hope deferred that maketh the heart sick.

The primary cause of chronic constipation, namely, proctitis, has been explained, and its many symptoms, as indicated by the functional disturbances of many or all of the organs of the body, enumerated.

But beside the cases of chronic constipation—both lean and fat—there are many sufferers from auto-infection who have only semi-constipation, or partial evacuation of the feces daily. Though they suffer from the effects of self-poisoning, yet they have no such well-defined symptoms of local disease and functional disturbance as are always found in those who have chronic constipation. Nevertheless, they have disturbances of practically all the functions of the system. Believing as they do that the evacuation of their bowels is complete, they are at a loss to find a cause for the toxemia (blood-poisoning), mal-nutrition, debility and general atony. The symptoms of auto-infection with the semi-constipated are as complex as with the severer cases, but not so well defined. The most prominent symptoms are those connected with the process of katabolism, that is, of degeneration of the tissues, as indicated by their color and texture. The liver, however, is usually held responsible for the bad complexion, impaired nutrition, constipation and diminished vitality, when really the liver is only indirectly concerned, as made manifest in the previous articles. The seat and source are found to be the diseased colon and rectum.

A number of the exciting causes of inflammation of the lower or terminal portion of the large intestine have been mentioned. It cannot, however, be too strongly emphasized that chronic inflammation of the colon and rectum results in hyperkinesis (excessive muscular irritability) and contraction of the diseased portion invaded, thereby retarding or preventing the passage of feces and gases. A portion of the daily accumulation of feces in the sigmoid may pass through the diseased rectum every day, but not without increasing the inflammation and the spasmodic contraction; this in time inhibits the elimination of the accumulating feces, which by undue retention become condensed and hardened. Each day will then be a repetition of the abnormal and partial effort of the organ to accomplish the act of defecation, and there will be no thought of the cumulative and chronic intoxication (poisoning) of the system from the imprisoned feces and gases.

It may be stated without reservation that the rectal canal cannot be involved in chronic inflammation without involving the anal canal, and vice versa. One half of civilized people are suffering from chronic constipation, and very nearly the remainder from semi-constipation. The semi-constipated are now under consideration. The chronic cases are those that have a complete impaction of feces in the terminal portion of the sigmoid and rectum; the semi-constipated have the usual daily partial impaction, that is, an incomplete or partially successful evacuation of the contents of the bowels: the incompleteness is due to disease of the anal and rectal canals.

The anal and rectal canals are made up of circular and longitudinal muscular bands, which, when invaded by disease, lose their proper or normal sensibility and coÖperative voluntary action. The excessive contraction of the circular muscles closes the calibre or bore of the gut, and the excessive contraction of the longitudinal muscles shortens the length of the gut, thus throwing the mucous membrane into abnormal folds which increase the depth of the sacculi, or cavities, between the fibrous folds. In the normal gut the sacculi and bands act as valves to control the descent of the feces. This valvular arrangement and the curvatures of the lower bowels conserve the energy of the involuntary and voluntary nerve force until there is a sufficient accumulation of feces to excite a normal desire for stool; otherwise the feces would rush upon the anus at once and occasion much inconvenience.

Catarrhal inflammation of the mucous membrane of the anal canal will sooner or later penetrate the muscular structure of that canal, causing an abnormal irritability and contraction of the sphincter ani and the other tissues composing its structure. The contraction of the anal tissues becomes more permanent as the muscular tissues of the structure become cohered or bound together by the process of inflammation.

The normal stimulus and sensation that should precede the act of defecation are perverted or destroyed by the excessively irritable contraction of the sphincter ani, which contraction is occasioned by the presence of feces and gases just above the seat of inflammation, that is, above the anal canal or at the lower end of the rectum. As the bulk of feces and gases lodged at this point increases, the anal contraction becomes firmer in grip, and as a consequence permits no hint of the imprisoned contents until the accumulating bulk is beyond the power of toleration by the organ. Daily a portion of the lodged feces, or some new addition to the mass, passes the anal canal, but the attending irritation or contraction of the muscles prevents any further exit of the imprisoned rectal contents.

CHAPTER XIII.

THE ETIOLOGY OF THE MOST COMMON FORM OF DIARRHEA, I.E., EXCESSIVE INTESTINAL PERISTALSIS.

If you are interested to know why a certain plant does not flourish in the temperature and light to which it has been accustomed, you investigate the soil—the source of nourishment—and thus determine why the downy or velvety appearance has left the flower; why the leaves are yellow, dry or falling; why the stems are withering. Even the most ignorant person knows that the symptoms the plant presents did not bring about the unsuitableness of the soil; that, on the contrary, the condition of the soil is responsible for the plant's present state. Would it not be unwisdom, therefore, to treat directly the symptoms of decay, instead of treating the soil, or changing it? Just so misguided is the judgment of the physician who prescribes physic or tonics in the case of a person having a foul intestinal canal, a condition destructive of the absorbent and the excretory glands. But members of county medical societies do just such foolish things. Notwithstanding their prescriptions, a point will be reached by the patient where the restoration of his millions of small rootlets, or organic feeders, will be impossible, and like a decaying plant in unfavorable soil he gradually decays or withers, here and there, until finally he topples over before he knows it, probably long before maturity has been reached.

It is not generally known among laymen, nor sufficiently appreciated among physicians, that the mass of fecal matter normally evacuated from the bowels comes mainly from the blood; and that this mass is not, as it is usually supposed to be, the residue of the food that has been left unassimilated. Embedded in the mucous membrane of the colon are tubular glands under the control of the nervous system. When these glands become unduly excited through local inflammation and irritation, the normal flow from them is increased to such an extent that a rapid waste of precious tissue occurs throughout the system, and the vital force—which had taken perhaps years to store—is depleted to the point of exhaustion, sometimes even in a few hours. Almost every one has had some experience of exhaustion following diarrhea.

The increased flow of blood to the mucous membrane of the colon furthers this extraordinary secretion by the glands. As has been pointed out, inflammation, septic poisoning, intestinal foulness, or retained feces, act as irritants on the mucous membranes, thereby drawing the blood to the colon where it is excreted and exhaustion follows. The great danger in diarrhea, therefore, is the rapid depletion of the vital force. But when the small intestines are affected the consequences may be still more deplorable. Then the unassimilated food is hurried along too quickly for absorption and the body receives but little nourishment to restore its powers. Thus another draught is made upon the sufferer's reservoir of vitality, and hence additional exhaustion. But this waste of tissue, loss of vital force, non-assimilation and non-supply, are not so grave as the positive danger of the permanent destruction of the millions of small absorbing vessels (villi) of the small intestine by a continuance of this abnormal irritation. Of course the secretory and excretory glands of the colon also suffer, and we then have costiveness resulting from lack of absorption and excretion.

Abnormal irritability of the bowels is necessarily involved in the inflammatory process known as proctitis and colitis. Increase this irritability to a certain point and diarrhea takes the place of constipation—a much more alarming symptom. Diarrhea is more alarming because the intensified local activity of the excretory glands of the bowels brings on, as has been said, a general exhaustion of the vital powers.

The severity of diarrheal symptoms is much increased by the character and abundance of bacterial poisons. Bacteria find a ready medium in fetid feces, and are absorbed by the excited glands to the degree in which these glands have time and power for absorption. Of course the extent and character of the intestinal irritation have a good deal to do with the severity of the diarrheal symptoms. This irritation is not infrequently intensified by a catarrhal process, or by a lesion of an ulcerative nature. All these forms of irritation bring on "excessive intestinal peristalsis"—which, accordingly, is our definition of diarrhea. The normal peristaltic action of the intestines propels the nutritive as well as the effete material through the canal at a rate that allows of both proper absorption and timely elimination. But when excessive peristalsis occurs, neither absorption nor elimination will be normal or suited to the requirements of the system.

Undigested foodstuffs may become an irritant, or increase, as is usually the case, the established irritation, and thus bring on an acute attack of diarrhea. The immediate consequence of the acute attack may indeed be, and often is, comparatively beneficial, inasmuch as the diarrhea removes the undigested material that occasioned the irritation. When this removal is accomplished, the diarrhea usually subsides without treatment. This is the case, however, only when the patient has committed an infrequent error in diet. When such errors are habitual the burden on the glands of the intestinal mucous membrane becomes intolerable, and the chronic inflammation once established has a tendency to proceed from bad to worse. It will then be observed that digestion becomes more and more impaired. In such a case diarrhea will no longer serve a good end, but will on the contrary debilitate the system. A change to better dietetic habits will then aid, but will not suffice for cure. Only treatment and time will restore the inflamed parts to a healthy tone. When, however, the digestive tract is invaded by any of the many forms of bacteria, treatment will avail little and serious consequences follow rapidly.

Too much cannot be said or done to secure intestinal cleanliness in infancy, childhood and maturity. Mothers and nurses cannot give this subject too much thought and care, since the welfare of future generations depends largely upon intestinal cleanliness, in view of the rich and racy life of our hothouse civilization. We are a people poisoned through constipation and diarrhea: two affections that derange more lives than all other pathological conditions together. Banish alimentary uncleanliness and you take most of the poisons from the human race—poisons that stunt the body and blunt the mind.

The soul of man should dwell in a palace, not in a pest-house; in a human temple, velvety, lined with down, inside and out; in which there are hundreds of millions of lilliputian trappings, fittings and articles of furniture, to carry on the minute and finer functions and chemistry of the soul. The very multitude of the fine equipments that decorate the temple give it that beautiful blending of color and form which its coating has when in normal condition. They adorn this body-house with health, and supply it with the rich red wine of joy.

The blood is dependent for its richness not only on the digestive fluids, but also on the proper eliminating powers of the system. If you would avoid premature decay you must not neglect the reservoir of vitality, the alimentary canal, but see to it that it be kept clean and pure. Then will the elixir of life spring from an almost inexhaustible fountain. To recur to our plant analogy. Keep the soil in your own vegetable garden sweet, for intestinal cleanliness corresponds to soil fitness. Purity of the stomach and bowels is more important than quantity or quality of food. That defecation should occur normally two or three times in twenty-four hours is more important than that three meals should be eaten within that time. The conveniences for eating and drinking are on every hand, but oh, how few, inaccessible, miserably constructed, and poorly cared for, are the toilet cabinets for the accommodation of the gourmand! Suspenders and silk hats mark the progress of our outer refinement; toilet cabinets and flushing appliances, of our inner. When the inner refinement comes we shall live longer and be healthier.

CHAPTER XIV.

BALLOONING OF THE RECTUM.

To make plainer what has been said of the rectal and anal tubes or canals, consider the sleeve of an infant's gown. This sleeve well represents the rectal tube, the wrist-band the anal orifice and tube—an inch or more long. Think of the sleeve or rectal tube as being made up of four layers of material or membranes; and counting from the inside of the sleeve or rectum there are (1) the mucous layer; (2) the areolar layer; (3) the muscular layer; (4) the serous layer.

The muscular membrane is itself composed of two layers, and may be said to form the framework of the rectum. One layer is composed of circular muscular fibres, and the other of longitudinal muscular fibres. In a similar manner you could make a sleeve out of fine circular rubber bands; then bind them together by rubber strings extending lengthwise of the sleeve. With the circular bands the bore of the sleeve may be contracted or widened; and with the longitudinal bands the length may be shortened or extended. Just so with the corresponding muscular membranes of the rectum, in their normal and abnormal conditions. Outside of the longitudinal muscular bands are the serous and areolar layers, the latter covering the lower half of the rectum.

As you look inside the incomplete model of the rectum, or rather sleeve, you observe circular muscular bands or fibres which it is necessary to cover with soft spongy or fatty substance in whose meshes are nerves, blood-vessels, etc. This is called the areolar layer or coat. One more layer or coat upon this—the mucous coat—completes the structure. This latter possesses the power of accommodating itself to the distention and contraction of the muscular tube. The mucous membrane is thrown into folds and columns which serve as valves to inhibit the undue descent of the feces, thus assisting the mucous membrane in performing its office.

The length of the rectum varies in different persons, six inches is the average length. It is divided into two parts. The upper part is a little more than three inches long; beginning in front of the third sacral vertebra and extending down to the end or tip of the coccyx. In shape this part conforms to the curve of the sacrum and the coccyx, to which it is attached behind. The lower part of the rectum is a little shorter than the upper part, and begins at the tip of the coccyx and extends down with the same curve as the upper part, terminating at the upper portion of the anal canal.

Returning to the sleeve again; the portion of it from the shoulder to the elbow illustrates the upper part of the rectum when partially covered with a serous coat on the side opposite the bore (the outside). From the elbow to the wrist-band illustrates the lower part of the rectum, when covered on the outside with an areolar coat.

The wrist-band of the sleeve will represent the anal tube if drawn into a pucker and turned slightly backward from the direction of the sleeve of which it is a continuation.

The muscular fibres described above likewise enter into the formation of the anal canal or orifice. This orifice is closed by two strong muscles that lie close together and are called internal and external sphincters, which are abundantly supplied with nerves and blood-vessels whose branches extend to the neighboring organs.

Nine persons in every ten have more or less chronic inflammation of the mucous membrane of the anus and rectum. In time the areolar and muscular coats become invaded by the morbid process, and this increases the irritability of the tissues of the organ.

The change from the normal functions of the anal membranes is slow, and the symptoms are not well marked and are consequently ignored for years owing to inexpertness in detecting an invading serious disease, until the time comes when the suffering can no longer be tolerated by the victim of the neglect.

The result of disease to muscular tissue is contraction of its fibres, and the contractions become more painful as the disease increases. Accompanying the inflammation, there is a more or less inflammatory product secreted between muscular fibres that "glues" them together in their contracted state. And as the anal and rectal tubes are made up of round muscular fibres, it is not hard to see how the bore of the canal can be lessened by the slow binding together of its fibres in the contracted state. The fact is that when the anal structure is invaded by inflammation, there is more or less stricture of the canal and of the orifice.

Recalling the sleeve illustration, and how the wrist-band was puckered and bent back a trifle so that the contents of the sleeve would not pass out so easily, suppose you now pucker the wrist-band rather tightly, and suppose there is a forcible descent of sand in the sleeve, the natural result would be a bulging out of the lower portion of the sleeve just above the wrist-band, or place of undue constriction. If the abnormally constricted condition of the anal orifice has been growing from bad to worse for years, the locality immediately above the anal canal will become dilated or cavernous (caused by retained feces or gases), which cavity is called ballooning of the rectum. When a speculum is introduced into the rectum (as shown on page 14 of pamphlet How to Become Strong), and through it a bent probe is inserted to determine the depth of the dilatation or abnormal cavity, it is as if one were poking inside of an inflated balloon: hence the name.

Anatomists describe the rectum as terminating in a forward pouch, which is close to the prostate gland in the male and the lower part of the vagina in the female. In some cases there may be such a slight pouch, due to the anal canal not following the direction of the rectum, and slightly turning backward; but in most cases such a normal pouch is not perceptible or observed through the speculum. The small pouch sometimes found on the anterior wall of the rectum I have thought due to a very acute inflammation on the verge of forming abscess, which often occurs in the triangular space. (See 4 in diagram in pamphlet cited above.)

Immediately above the sphincter muscles on the posterior wall of the rectum the greatest dilatation is found (as shown by the bent probe), and extends on each side with less depth about the anterior wall of the rectum.

The greater portion of the lower part of the rectum, which part is about three inches long, is usually involved in the dilatation or ballooning. Often the upper half or more of the anal canal is also dilated with the rectum, leaving the sphincter muscles quite bare of fatty tissue, with anal length of a quarter of an inch or less.

Your attention was called to a sleeve containing sand, and the bulging or dilatation above the puckered wrist-band that was an inch or more broad. Now suppose there were two strong rubber rings at the lower end of the wrist-band, whose power of resistance to pressure is much greater than the tissues above them forming the wrist-band. Naturally, the tissues which form the upper part of the wrist-band would dilate the same as the terminal portion of the sleeve just above the wrist-band.

Similar changes in structure or formation take place in diseases of the anal and rectal canals which result in ballooning of the rectum; and two frail constricted sphincter muscles are left to guard this balloon, filled, as it so often is, with feces and gas.

Chronic inflammation, that results in contraction of the circular muscular fibres, will sooner or later constrict the gut so that it will lose its normal power to expand without causing pain. The anal canal may be said to be strictured to the degree in which it is unable to dilate normally, and this strictured condition usually grows from bad to worse.

The first symptom of rectal disease is usually an affection of the anus, which affection occasions an inhibition, that is, a reluctant permission for the passage of the feces; and this inhibition results, consequently, in some degree of constipation. And this constipation reacts more or less on the peristaltic action of the bowels and in time defeats the function of peristalsis. All this will react on the inflammatory processes at the anus, which originally engendered the constipation. The narrow and contracted strait or canal through which the feces must pass, gives a tape-like shape to the stools.

The anal and rectal mucous membrane is of a firm and tough structure, similar to the integument at the bottom of a boy's heel. After many years' observation of diseases of the anus and rectum I am forced to conclude that as a rule inflammation exists in the tissues twenty or more years before the severe symptoms, such as piles, fissure, anal pockets, pruritus, hypertrophy, atrophy, tabs, abscesses, and fistula, are sufficiently annoying to compel the sufferer to seek medical aid. I believe it to be of as much importance to give early attention to disease of the anus and rectum as to teeth and eyes, or even more.

CHAPTER XV.

BALLOONING OF THE RECTUM—CONTINUED.

In the last chapter a description was given of the anatomy of the anus and rectum; and it was shown how a chronic inflammatory process involving these organs develops stricture in the parts invaded; and it was shown how a partial stricture of the anal canal results in ballooning or dilatation of the lower part of the rectum. The primary cause of all the symptoms of rectal disease is chronic inflammation (proctitis) involving the whole structure of the anal tubes and in a few cases the sigmoid flexure as well.

Perhaps the first marked symptom of disease of the rectum is constipation, semi-constipation or of chronic character. The function of the anus and rectum being disturbed by the inflammation, the fecal mass is unduly retained and its moisture is absorbed by the system. This accounts for the condensed and hardened fecal mass in isolated lumps of various proportions. A hard-formed stool is abnormal, and is evidence of auto-infection. When three-fourths of the normal fecal mass has been re-absorbed by the system, does it not stand to reason that the blood and tissues have been poisoned by their own waste products (auto-intoxication) and that anemia, emaciation and local disturbances of other organs of the body are symptoms of such intoxication?

The loading and blocking of the sigmoid flexure come from too much activity or irritability, due to inflammation, of the upper half of the rectal tube. A consequence of this excessive sensitiveness is a diminished or perverted normal stimulus, notice or desire, that the act of defecation should take place.

The victim of proctitis simply forms a habit of daily soliciting an evacuation, though the normal invitation or desire to stool may be entirely absent, and the evacuation in such cases is attended with more or less delay and straining effort to accomplish partially or wholly the expulsion of the more or less inspissated feces.

As the extreme sensitiveness of the inflamed upper half of the rectum offers resistance to the passage of the fecal contents of the sigmoid flexure; so, in a somewhat similar manner, the inflamed anal tube, in its more or less constricted state, prevents the passage of feces and gases as they approach the terminal part of the rectum. As a consequence, the feces and gas deposit and lodge at this latter location, producing in so doing the abnormal cavity called ballooning of the rectum, so often found just above the anal tube.

The greatest depth of the dilated pouch is on the posterior wall of the rectum, or just in front of the tip of the coccyx. In some cases the pouch measures two and a half inches in depth at the back and gradually diminishes in depth on each side as you near the anterior wall of the rectum. Often the upper end of the anal canal is higher than the depressed circumference of the spacious cavity that almost surrounds it. The irritable orifice of the cavity will invariably compel a quantity of liquids and feces to lodge in the cavity as a permanent cesspool, allowing the absorbent vessels to absorb as much as they can by incessant work. The height or length of this abnormal cone-shaped rectal cavity is from two to three inches, involving usually the lower half of the rectum. The anal canal frequently becomes shortened by the dilating process to a quarter of an inch, leaving two frail, irritable muscles at the vent, to guard the rectal cavity. And fortunate are these two thin, sore, contracted muscles, and the possessor of them, if they escape the surgeon's barbarous notion of operating on them.

If the medical butcher has operated on them, you will find an anal canal open to such an extent that two fingers can be inserted without distending the tissues in the least. And when the victim of ballooning of the rectum and ignorant operation makes further complaint to the surgeon of the aches and pains, he is consoled by being informed that the end of the spine will have to be removed. Irreparable damage done and no aid at all received! It is a pity such ignorance on the subject should exist in the medical profession in this city.

The abnormal cavity, so difficult to empty properly owing to its depth and diseased outlet, is seldom free from gases, feces and liquids. Daily evacuations will not empty this cavity, nor will cathartics or diarrhea. A permanent cesspool of poisons is this, where all forms of poisonous germs are propagated, and infect the system by absorption. No use to take medicines for your poor blood, bad complexion and horrid feelings, as they will not cleanse the augean stable so long neglected. No use to journey to other localities for health so long as you carry so formidable a foe to health with you.

The mucous membrane in the chronic state of the disease presents a rather dry, indolent and bluish appearance, except that here and there the tissues show more activity of the disease, more especially so over the anal region, due to harsher disturbance during the act of stooling. In the subacute or acute stage of the inflammatory process there is more general redness and puffiness of the mucous membrane, or a swollen condition with increased discharge of mucus and perhaps some blood.

There is a heavy, uncomfortable feeling, with more or less soreness and pain, especially after evacuation of the feces. If a fissure or anal ulcer is present the pain is in proportion to its size and the general aggravation of all the diseased parts. Itching or pruritus about the anus may accompany the trouble to a very annoying extent, being an evidence that the anal pockets are becoming much diseased. The partially constricted and irritable sphincter muscles become excited during the act of stooling and react on the anal grip or contraction, making it more intense. This latter condition may shut off the flow of blood in a local vein; and the blood becoming coagulated forms a painful bluish grape-like tumor at the external opening of the anus.

Abscesses may form at some portion of the diseased gut and result in an external fistula.

Piles may co-exist in some cases of ballooning, but are usually not annoying.

It is the local anal or external annoyances that compel the sufferer to seek medical advice and aid, and he learns that the troubles complained of are only symptoms of a chronic disease, therefore easily removed without harsh treatment while the cause is being properly cured.

It is very fortunate for the sufferer from ballooning of the rectum to have in or near the anal canal those painful hints or symptoms of a very grave and long existing disease whose constitutional symptoms were well marked but attributed to other causes, especially to disease of the liver—an organ of so much solicitude that the poor liver-worshipping patient ought to receive more gracious response from it.

In every case of chronic proctitis, or inflammation of the anus and rectum, the sigmoid flexure must be more or less dilated, as the upper part of the rectum is very irritable and contracted and inhibits the feces from passing beyond the sigmoid; but this irritability and contraction of the rectum, as a rule, is not nearly so severe as that of the anal canal, whose orifice is closed by very strong sphincter muscles.

Such being the pathological change in the sigmoid flexure and especially in the lower portion of the rectum, as described in these two chapters, who, with ordinary intelligence and an idea of cleanliness, would take or prescribe remedies to move the bowels, if it were possible to cleanse the foul capacious cavities with water? We know that they can be thus cleansed, and that it can be easily accomplished with benefit to the diseased canals.

After the system has absorbed 75 per cent of the fecal mass, a "remedy" is taken to excite a flow of watery excretions into the bowels, of which a portion will be retained in the colon, and especially the ballooned cavities, and reabsorbed; and every day the objectionable practice is repeated without any thought of the harm being done.

The flushing of the rectum, sigmoid flexure and colon with water is not a cure-all, but it is one of the means of treating a grave chronic disease, a disease insidious and far-reaching in its poisonous effects on the human organism.

CHAPTER XVI.

THE USUAL DIAGNOSIS AND TREATMENT OF BOWEL TROUBLES WRONG.

Herodotus tells us that among certain tribes when a man fell sick his next-door neighbor did not wait for him to become thin but killed him at once, lest by the loss of his adipose his flesh might be rendered less appetizing.

But alas! in this age of constipation and piles, of self-generated poisons and self-infection, how changed is the custom! Our next-door neighbor, the doctor, waits till we are really thin, and then begins to feed and grow fat on our ills! In our day, through the continuous process of self-poisoning we take on no flesh from puny, peaked childhood, or we insidiously lose what little flesh we had, and when our bones are well exposed, become alarmed, realize that we are sick, rush for the doctor, and dispossess ourselves of our spare cash.

Very frequently, as stated in the first chapter, auto-infection begins in infancy and slowly but steadily progresses, but it may not be before adult age is reached and one or more organs are seriously diseased that it becomes apparent to all. The vital round of the alternate building-up and breaking-down of the system has been going on unceasingly during these years of increasing infection, but prematurely the balance between up and down is lost in favor of down; the building-up process becoming feebler, slower, and the breaking-down process quicker, easier. What can the inevitable outcome be but emaciation and anemia, and all their attendant suffering and consequences? It is the superabundance of vitality in the growing child that retards (inhibits) the morbid changes going on in the blood and tissues of the system; but the process is all the more insidious by being thus restrained, and its very subtlety and stealth beguile us all into fancied security: parents, friends, physicians—all are deceived.

As stated in a previous chapter, the first unwelcome visitor, in infancy, is inflammation of the integument and mucous membrane of the anal orifice, invited by the uncleanliness involved in the use of diapers; and this visitor takes up its residence slowly along several inches of the lower bowel. Its first symptoms are likely to be constipation, flatulency, colic, indigestion, bacterial and other poisons, occasionally diarrhea, and the usual general disturbance of the system as above detailed. It is admitted by all authors that inflammation of the anus, rectum, etc., is by far the most common disease that afflicts mankind at all ages; and I maintain that the natural result of such inflammation is a more or less extensive occlusion of the lower bowel, which in turn involves an undue retention of the feces, and thus we have the foul intestinal canal and stomach called gastric and intestinal indigestion.

The wrong treatment of constipation, diarrhea, indigestion and auto-intoxication up to the present time has been due to improper diagnosis. Writers on these subjects speak of them as causes when they are merely symptoms. And the remedies for these "causes" are even more numerous. Mistaken diagnosis on the one hand, measured doses on the other, and there you have the scientific doctor! The primary cause, inflammation, like the original spark applied to dry shavings, sets up morbid changes in the various parts of the digestive canal and the other organs of the body, and these "set up" or established changes are properly secondary or derivative causes accompanied by their own symptoms. The primary disease and symptoms may exist for five, ten, twenty or more years before any pronounced secondary or derivative diseases and their symptoms occur or are noticeable to a sufficiently marked degree.

The chronic character of the malady, and the complication of primary with secondary diseases and their symptoms, have thoroughly disconcerted the doctors. Hence the many "causes" assigned for indigestion, constipation, etc., and the many kinds of remedies prescribed with the one sure result, failure; and hence, also, not a few of the self- and drug-intoxicated ones dubbed, or actually developed into, hypochondriacs. Diagnosis wrong, treatment wrong, failure certain, and the foulness of the intestinal canal continued! This is the experience and testimony of the many, many sufferers from the most common malady that afflicts humanity from infancy to old age, and which will continue to afflict the great majority until it is properly understood and treated.

When a sewer of a town is obstructed, the most sensible plan is to begin the investigation at the outlet and then proceed up, section after section, to trace the obstacle that had occasioned the accumulation of debris. When the waste-pipes of a house are clogged, we do not expect the plumber to go to the top of the building and poke substances down the pipe to dislodge the unduly retained material some twenty-five feet or more away. Nor would we believe him if he informed us that the sewer-gas and overflow of waste in the house were the cause of the constipated condition of the drain. But just this is what the doctor declares concerning our sewer; just this is what he does when he doses it with laxatives, cathartics, purgatives. Such is the treatment we receive when we rush to the doctor, or such the treatment we give ourselves. The poor, sensitive, inflamed canal is desecrated on all hands, though part of a house not made with hands—a house that should be a home for the soul of man.

CHAPTER XVII.

COSTIVENESS.

The words constipation, obstipation and costiveness are often employed as if of exactly similar meaning, but it is well to let each stand for a particular condition. Obstipation implies that the canal of the intestine is stopped up or closed. Constipation carries the idea that the canal is completely filled up with refuse matter. In the normal condition the intestine is divided by transverse bulges or valves or dams into a number of separate segments, the entire arrangement having the effect of preventing too rapid descent of the feces. These folds within the canal may become too much narrowed by disease and thus prevent the movement of the matters inside; this is obstipation. Constipation, stuffing of the gut, may be the result of neglecting the call of nature, and after a time the ability to recognize and answer it is lost; or it may result from inflammation which itself comes from the bad habit mentioned.

The author prefers to use the term costiveness for the general debased condition of the system from auto-intoxication depending upon proctitis and similar conditions of the intestinal tract. And it must be remembered that the same patient may have two or more of these conditions at the same time. Constipation, obstipation and diarrhea may alternate through the progress of the case.

We would expect people suffering from constipation or obstipation to pass as fairly well people for a time, but the same is not true of patients having the other condition, costiveness. As we may speak of the stages of a disease like consumption, so we may speak of these three conditions as different stages of one affliction, the worst being costiveness with its progressive self-poisoning by the products of intestinal decomposition. Early in the case the system may pass these poisons out of the body with comparative ease, by way of the lungs, skin and kidneys. In time the second stage begins to make itself apparent, vitality becomes less and less, calling for a greater variety of medicines to correct the condition, as in the second stage of consumption, and also to arrest the progress of emaciation and anemia or anemic obesity.

The third stage of auto-intoxication is a most unhappy one. The impoverished tissues offer a most favorable soil for the development of diseased conditions. These three stages which are clear to the experienced eye of the physician may to the patient seem to be indistinguishable, the one from the other; and it must not be forgotten that the three conditions do not mean simply that a smaller or larger part of the intestine is clogged by its contents, but that the whole system is involved as well.

It cannot indeed be otherwise with the rapid circulation of the blood, nor need it excite wonder that such patients are thin and debilitated by the deadening of the powers of absorption, assimilation and elimination.

As a rule the many thin and puny infants and children of either sex, with bony points well exposed under a tightly drawn skin, which latter is clay-colored and pimply; children with headache and languor, without healthy interest in either studies or play;—these are the victims of intestinal poisoning as described. If they have inherited a spare habit of body from their parents such bodily ills will manifest themselves the more quickly. They ought to be fat and hearty as are the young of animals, but alas many are not! When the young animal is spare, a few days of rest with good diet will put flesh on it, demonstrating that the state of the bowels and the powers of assimilation are intact. Why does not man take on flesh in a similar way?

If the intelligent animals could talk, they would undoubtedly make all manner of fun of the intestinal canals which they see walking about, with a little flesh here and there seemingly by accident, and a skin which is clay-colored or jaundiced, anemic or flabby, the owner of it all poisoning himself by decomposition in his intestines!

CHAPTER XVIII.

INFLAMMATION.

If we desire to get a general idea of the changes that occur in an organ when it becomes inflamed, we must first have a knowledge of the normal structure of that organ, even though that knowledge be but superficial. Taking the intestines, for example, we see under the microscope that they are composed of layers of different tissues, called connective, epithelial, muscle, and nerve tissue; the first two forming a large part of the structure.

In the connective (and fatty) tissues a great many blood-vessels are found (varying in different parts of the organ), the existence of which is necessary for the production of inflammation, since at the very outset of the process, a discharge (or exudation) takes place from these blood-vessels, accompanied by changes or degenerations in the other kinds of tissue.

The process of inflammation is commonly associated with symptoms of heat, redness, swelling and pain, in greater or less degree, combined with which a change in the function of the organ is soon noticed. Micro-organisms are considered the primary cause of inflammation in many or even in most cases in which mechanical or chemical influences may undoubtedly be responsible primarily; and then again, each of these causes may be either external—that is, may originate from the outside world—or internal, that is, may be produced in and by the body itself.

The first pronounced change occurring in an organ under inflammation is an increase in the rapidity with which the blood circulates through the vessels—a so-called hyperemia—which soon gives place to a diminution (stasis) in the current together with an exudation from the blood-vessels; the latter is due to changes in the structure of their walls. This exudation soon occasions a cloudiness of the connective tissues and at the same time a desquamation (shedding in scales) of the epithelia (cells of the thin mucous surface). An irritation of the nerves also takes place.

The varieties of inflammation can be best apprehended by considering the different characters of the exudation. The exudation may be watery (called serous) or dense, the latter either fibrinous or albuminous. With a serous exudation there is swelling of the connective tissue and a desquamation of epithelia—the latter usually slight in character—which constitutes what is known as a catarrh; while with a fibrinous or albuminous exudation there is usually more or less destruction of the tissue itself, when, for example, we have "croup" or "diphtheria."

When the changes in the epithelia are only slight and secondary, it is spoken of as an interstitial (lying between) inflammation, which strictly speaking denotes confined to connective tissue, and is therefore a term not entirely correct. When the inflammation of the epithelia is severe and may lead to their partial destruction, it is called a parenchymatous inflammation; that is, one involving the soft cellular substance. There is still another variety, the suppurative, which is the most intense of all, and indicates the production of an abscess and the entire destruction of the tissue implicated.

Beside these general grades of inflammation there are special sorts produced by specific micro-organisms. In all general inflammation we may expect to find such organisms, which in most cases belong to the class of micrococci, such as staphylococci and streptococci. In gonorrhea we have a special organism called the "gonococcus"; while in tuberculosis—a variety of inflammation in which the blood-vessels are completely destroyed and a change or degeneration called "cheesy" is produced, leading to the production of a tubercle—a rod-like bacillus is invariably found, the well-known and unfortunately too common tubercle bacillus. In syphilis—another special variety of inflammation—a specific micro-organism is also surely present, but of this microbe science has not as yet discovered the exact nature.

The question of the origin of tumors or new growths is also an extremely important one; and it is undoubtedly true that many tumors arise where there was a previous inflammation, this being especially the case in tumors of the rectum. Why such a growth should arise in some cases and not in others is as yet unknown, though microbes are held by many to play an important rÔle.

When an inflammation has lasted for such a length of time that it has become chronic, a new tissue will sooner or later be produced in varying amount; and this newly formed fibrous connective tissue may entirely replace previous normal structures. Through the exudation and consequent changes in the normal tissue a large amount of mucus is at first secreted, but this secretion becomes less and less marked the more the inflammation causes a desquamation of the epithelia. Pronounced desquamation with new formation of connective tissue and no fresh exudation will, sooner or later, occasion dryness—this dryness being sometimes very pronounced. The longer the inflammation lasts, the severer it will be; and the greater the amount of tissue it attacks, the more will the normal tissue be destroyed and replaced by a new connective tissue. A partial destruction will cause shrinkage of the organ (so-called "cirrhosis"); while a complete destruction of certain parts will result in what is known as "atrophy" (a wasting away of normal tissue). In atrophy the blood-vessels as well as the original connective and epithelial tissue are destroyed; while the newly formed tissue leads to hypertrophy (excessive over-growth) of other portions of the organ. Such a hypertrophy must not be confounded with an induration that may be present later, or even at the very commencement of an inflammation, due to modification of the blood-vessels and surrounding tissues.

Chronic inflammation, sooner or later, leads to secondary degenerations, that is, new products of the protoplasm, the most common of which is fatty degeneration. In this form fat granules and globules arise, which are at first minute, later on larger; these in certain organs, such as the liver, may become so pronounced as to entirely replace the original tissue. Another degeneration—which, however, is found only in chronic systemic disturbances, such as tuberculosis or syphilis—is the waxy or amyloid degeneration, a peculiar chemical change the exact nature of which is unknown.

Various chemical changes are by no means uncommon.

An important question is the decision as to the length of time an inflammation has lasted; and this at best can be determined only approximately and after long experience. The older the inflammation, the more the connective tissue has developed; this connective tissue is at first soft, but soon becomes more and more dense; the result being a varying degree of hardness of the organs.

Again, secondary degenerations are more pronounced in long-standing processes. In comparatively fresh cases blood-vessels are still more or less numerous and the tissue appears red, while in older cases these vessels become completely obliterated, and the tissues take on a white, glistening color, becoming harder and denser as the years advance. If a process has lasted twenty or thirty years, the changes to the eye and touch are practically the same as after forty or sixty years.

The changes, as here described, will be the same upon any mucous membrane; and in the large intestine can be easily studied and are perfectly characteristic.

Rarely does an infant escape repeated attacks of inflammation of the integument of the anus and the mucous membrane of the anal canal. The inflamed integument is treated and healed, but no attention is given to the inflamed mucous membrane so that the inflammation in time becomes chronic, involving the rectum also. Should the infant be so fortunate as to escape inflammation (proctitis) of these organs during the wearing of the diaper, there are numerous other exciting causes of inflammation which it will not be likely to escape, hence the almost universal symptom of constipation among civilized people; and hence later in life you hear the familiar expression, "I have a touch of the piles," and many other complaints of bowel ailments that are usually the outcome of that deplorable inflammation.

I have endeavored to make clear the fact that inflammation destroys normal tissues and blood-vessels, and that the newly formed tissue is cicatricial in character, that is poor in cells and vessels, with a tendency to contraction which of course lessens the bore of the gut. When the hypertrophy or thickening is extensive the appearance of the mucous membrane suggests the addition of one or more thicknesses of a chamois skin added to the inner surface of the anal and rectal canals. The hypertrophied or newly formed tissue may be limited to the rectum, leaving the anal tissues comparatively exempt from the superabundant cicatricial formation; or the hypertrophy may involve, to quite a degree, only the anal tissues and the integument around the anal orifice. The added connective tissue about the anus forms the skin into tabs, or into a circle of elongated integument around the orifice, with a mucous lining. These hypertrophied tabs or folds, like pruritus ani, are symptoms of proctitis.

Proctitis (the inflammation of the anal and rectal canals) is the most common and serious disease that afflicts man. The system is not only poisoned by bacteria and filth through proctitis, but proctitis is also the cause of the many annoying and painful local symptoms, such as hypertrophy, piles, abscess, fistula, cancer, polypus, fissure, pruritus, etc.

When the subject of proctitis is better understood by laymen they will see to it that the rectums of children receive an examination before the children are six years old, and thus obviate the necessity of dosing them with all sorts of medicine that follow improper diagnosis.

CHAPTER XIX.

PROCTITIS AND PILES.

Piles (hemorrhoids) are not the result of either the normal or abnormal growth of the tissues of the anal and rectal mucous membrane. They are developed by the combination of pathological and physiological conditions: (1) chronic inflammation or proctitis; (2) stricture of the anal canal and lower portion of the rectum, which may be spasmodic, or more or less permanent, which stricture pinches or constricts the canal, thereby inhibiting the circulation of the blood; (3) the pressure or straining effort during the act of defecation, occasioned by the constricted canal, which effort brings on greater local congestion and constriction of the tissues.

Pile formations are a symptom of chronic proctitis of fifteen, twenty or more years duration. Proctitis (inflammation of the anus or rectum) and periproctitis (inflammation of the connective tissue about the rectum) are by no means uncommon inflammatory processes. The mucous membrane like the skin is liable to injury or poisons and especially so at the orifices of the body. Let inflammation set in: if it be not cured at once, it will invade the canal, especially a canal like the rectum; in which case it will establish itself throughout from six to ten inches of its length, sometimes taking in the sigmoid flexure and even the colon. Just how long chronic inflammation confines itself to the mucous membrane before invading the areolar or lace-like connective tissue and the muscular tissue of the organ, I am unable to state.

The first symptom or indication that all the tissues are involved in the inflammatory process will most naturally be constipation. You have observed that inflammation of a portion of the skin on the arm, trunk or leg does not disturb the muscular movements of the region involved, except when the muscles underneath the skin are affected also, as in the case of deep burns where the movements are very much disturbed by the irritability, soreness and contraction of the diseased muscles. There is also an adhesive product excreted from the inflamed tissue that binds the muscular fibres of an organ together, and you have contraction of the organ and its usefulness impaired. Now, as this is precisely the pathological or diseased condition which chronic cases of proctitis and periproctitis present, you will readily understand how spasmodic and partial stricture or contraction occurs in the sore muscles (circular and longitudinal) of the anus and rectum. The length and the bore of the canal are diminished, and thus the circulation of the blood arrested by the pressure or gripping of the contracted muscles. This congestion of the blood brings about an anatomical change in the structure of the mucous membrane, which we call piles: a mere symptom of inflammation.

Medical authors have defined inflammation as follows: "(1) A series of changes constituting the local reaction to injury; (2) a series of changes that constitute the local attempt at repair of actual or referred injury of a part; (3) a series of local phenomena that are developed in consequence of primary lesion of the tissues and that tend to heal these lesions; (4) the method by which an organism attempts to render inert the noxious elements introduced from without or arising within it; (5) a disturbance of the mechanism of nutrition of an organ or tissue, affecting the structures concerned in its function."

These effects or changes give rise to the five cardinal symptoms of inflammation: pain, heat, redness, swelling and impaired function (dolor, calor, rubor, tumor, functio lÆsa).

Proctitis may exist many years before the pain and heat become noticeable or are complained of by the victim of this insidious disease, the bodily symptoms of which are well expressed before the local trouble demands attention and treatment. The sufferer from proctitis is unable to detect the change from a normal color of the mucous membrane (a light, muddy gray) to an extremely abnormal one (a fiery redness). The swelling or puffiness of the mucous membrane becomes more marked as repeated attacks of subacute and acute inflammation occur, from year to year, over a period of twenty or more years. During all this time impairment of the function and structure of the anal and rectal canals is incessantly going on. The nervous and muscular spasmodic contraction of the diseased anus and rectum, which in time become more or less permanently constricted, steadily increases the stagnation and engorgement of blood in the dilated arteries, veins, arterioles, venous rootlets and capillaries. All of the circulatory vessels, especially the smaller ones, become enlarged, varicose; and an aggregation of varicosed vessels forms a tumor called a pile or hemorrhoid. Inflammation interferes with nutrition of the anal and rectal tissues, rendering them friable or weak and easily broken; whence the bleeding and painful fissure or the anal ulcer, which so often are the outcome of proctitis and an accompaniment of piles.

As already stated, piles are one of the symptoms of proctitis, and all cases of piles involve more or less irritability and contraction of the anal canal and the terminal portion of the rectum through which the fecal matter is forced. All the muscular ability of the rectum, assisted by straining effort of the abdominal muscles, is concentrated upon the feces to force it through the constricted portion of the lower bowel. The force exerted not only develops pile tumors, but carries out with the feces those tumors that had reached considerable proportions; thus the frail diseased mucous membrane is torn, and another symptom added to a chronic disease. Observation for over twenty years has convinced me that chronic proctitis usually exists fifteen, twenty or more years before piles are developed (if developed at all), from daily pressure on the inflamed, congested, dilated, varicose, friable blood-vessels and surrounding tissue.

Piles are easily and quickly cured without any annoyance to the sufferer. Chronic proctitis may be cured, but not quickly, as time is required to undo damage to tissues so long invaded by inflammatory process. Any one that allows a continuance of "a touch of the piles," as the expression is, and omits to take proper treatment as soon as this "touch" is felt, simply invites or takes chances of some form of cancer of the lower bowel later in life.

All other forms of disease of the lower bowel will yield to treatment satisfactory to physician and patient, but I am sorry to say cancer cases are numerous, and up to the present time we have no cure for this dreadful disease. If you value health, if you desire to avoid future suffering and disease, be sure that the lower bowel is free from inflammation, for with such freedom you will escape the many symptoms of proctitis described in my treatise on diseases of the anus and rectum.

CHAPTER XX.

PRURITUS OR ITCHING OF THE ANUS.

One of the many symptoms of proctitis is the existence of anal channels from which an inflammatory product exudes through the skin, causing painful itching of the skin around the anal margin and not infrequently around the buttocks to the distance of three, six or even more inches from the anal orifice. An aggravated form of pruritus ani is much more trying to physical endurance than severe pain. Sometimes the torture is so great that a portion of the body will be covered with cold perspiration.

The natural color of the integument about the anus slowly changes to a dull whitish appearance. As the pathological process goes on, the skin becomes thickened and parchment-like. In exceptional cases the mucous membrane of the anal canal becomes toughened and hardened like cardboard. As a consequence there is a degree of inertia in the muscular action of the parts affected.

The inflamed, thickened and indurated integument near the anus takes on the form of folds, wrinkles or rugÆ, of more or less prominence; but as these extend out over the buttocks they become more and more obliterated, leaving no clue to the direction of the channel which leads from the site of inflammation; which latter, however, may be learned from the itching, or from the burning sensation with some soreness, over portions of their length.

During a practice extending over twenty years, I have found only two cases in which one of these channels was the seat of a slight abscess. It is not usual that pus formations occur in these inflammatory channels. At the margin of the opening from the rectum to the anal tube are five or six small crescent-shaped loops, semi-lunar valves, separated by vertical ridges (the anal columns). Naturally in chronic proctitis the zone of tissue just above the sphincter muscles and slightly within their grasp at the upper portion of the anal tube, would suffer greatly from the morbid process, owing to the abnormal constriction of the tissues and to the incidental pressure and injury, from time to time, as the stool passes the diseased region. Just under the mucous membrane covering the anal columns and semilunar valves is the fatty tissue forming a bed upon which the mucous membrane rests. It is sufficiently lax to permit considerable movement of the mucous membrane on the muscular coat beneath it. The frail, fatty, loose connective tissue in the grasp of the sphincter muscles would be the first to become impaired by inflammatory process, the product of which finds its way down and out under the mucous membrane of the anal canal and integument of the buttocks for quite a distance, occasioning itching, pain, soreness or burning in the integument covering the course of the channel.

Here we have the pathological reason why local remedies to the outer surface of the skin will not cure pruritus ani. Also the reason why dieting is useless, and why internal remedies are worthless for the cure of anal itching; for the itching, as shown, is the result of an inflammatory product in the channels under the skin of the victim, numbering from five to twenty. Over fifteen years ago I discovered the cause of the great suffering from painful itching at the anus and contiguous tissues and have been able to give instant relief, and in a little time permanent cure, in every case treated since then. It is well for those who have an occasional attack of pruritus ani to take treatment at once for proctitis proper, as well as for this symptom, itching resulting from these channels. The proctitis, if neglected, will only be the means of increasing the size, length and number of these channels. In chronic, sub-acute and acute stages of proctitis there is more or less secretion of inflammatory product; and often the sufferer is able to discover, in dejections from the bowels, a yellow syrup-like fluid, of the consistency of glycerine or white of egg, at times streaked with blood and purulent matter indicating ulceration.

Should the proctitis be cured and these channels remain, there may be sufficient inflammatory product in the channels to ooze through the skin to the outer surface, and excite itching; or if a portion of the channel escapes treatment, the same symptom may be expected at any time.

The size and length of these channels are best determined by making a small opening into them through the integument, then inserting a silver probe in both directions, determining the distance under the mucous membrane of the anal tube and the distance under the skin of the buttocks.

In some cases a few of these channels open into the rectum just above the internal sphincter muscles and become filled with water during the use of the enema taken to move and cleanse the bowels. As a rule, one end of the channel is under the mucous membrane of the terminal portion of the rectum, and the other somewhere under the skin of the anus or of the buttocks.

I presume that no disease of the human body has been assigned more reasons for its existence, with the exception of constipation, than that mere symptom of a disease, anal pruritus; a symptom which "Regulars" call a "disease," but "Irregulars" know to be only a symptom. It is very amusing to observe how they fill pages in their text-books, guessing, wondering and paying their respects to the imaginary quack doctors, "who are reaping a harvest of ill-gotten gain." The usual medical writer is a compound of ignorance, egoism and garrulity, and this may account for the great crop of reasons for "diseases." However, the writers in question are not so much to blame after all, even though they do belong to county medical societies; for how can they well resist the literary itch with which most of them are afflicted? Let them keep on writing while victims of pruritus ani wear out their weary lives scratching through weary nights—nights that extend into years, until permanent invalidism seems to be their destiny and end. Who, verily, are the medical quacks? I will leave it to a jury composed of those who have been cured of pruritus ani.

I have yet to meet the first case of pruritus ani that is without the presence of the channels above described. There may be cases of itching at the anus and these channels entirely absent, but I have yet to discover such a case and I very much doubt if it exists. I am happy to inform the reader that all cases of pruritus ani are cured with ease and without any restrictions as to diet, and without internal remedies for the blood, nervous system, etc., given by doctors that guess. The causes are easily discovered; the symptoms are easily found and removed; the victim of pruritus ani may therefore escape from the labyrinth of error of the medical authors and practitioners who ought to be educators instead of "obstacators"—obstacles and stumbling-blocks in medical progress.

CHAPTER XXI.

ABSCESS AND FISTULA.

In our daily affairs we take thought for the future and reason from cause to effect. We observe, anticipate, expect and suspect. This is a commendable practice, for it is the one that is most likely to lead to success. Can we not acquire a similar attitude and habit in regard to our health? Habit is sub-conscious attention. Can we not give sub-conscious attention to the little details of such bodily functions as are liable to get out of order? Can we not by a settled habit, that is, by the formation of a second nature, assure our vital success, on which the continuance of the enjoyment of life so much depends? If some part of a complicated machine gets out of order it must be repaired at once or damage may result to other parts of it. Again, if our business accounts will not balance, the error must be found and corrected at once, or the evidence of it will annoy us sooner or later. Why should not such prompt care and attention be given to the human mechanism, to the economy of vital functions? It is not often that we neglect disease of the hands, head, face or neck because the exposure of such disease to public gaze might embarrass us; but alas for the portion of the body out of sight, especially for the internal organs, when they fail to perform their functions normally. Most of us allow the mechanism of the human body to shift as best it can and as long as it can, should it happen to become ungeared, ignoring the frequent warnings which the ever increasing morbid changes and wreckage give us. And then we surrender and succumb. What else can we do? Our vital creditors file their claims in the high court of Vital Bankruptcy. What poor business policy, and what a wretched tenant! For fifteen or more years we may have had warning "touches of the piles," sometimes accompanied with indigestion, constipation, diarrhea and insidious auto-infection and occasionally with local symptoms in and around the anal canal and its external orifice; these to an intelligent tenant should have been evidence of proctitis, or worse, of periproctitis—inflammation of the connective tissue of the rectal tube. What have we done? We have disregarded the warnings of our ungeared, disordered machine, or else we have merely tinkered with it. The human factory receives less attention than does the commercial. Soon, all too soon, the silver cord is loosed and the golden bowl broken, and just before that event, frightened, but too late, we do a little more tinkering under a doctor's direction, and spill the contents—of the golden bowl with which we were so careless—spill it into another world, to begin our folly over again!

Do you know that this occasional "touch of the piles" over a period of many years, and all that it involves, is a precursor and an invitation to the development of that deadly enemy, Cancer—a worse disaster than financial ruin? It is my duty to utter a warning here. Only one making a specialty of the diseases of the alimentary canal is aware of the frequency of the occurrence of cancer in the lower bowel resulting from chronic inflammatory process, induration, etc. I have been, again and again, shocked and alarmed at the reckless neglect that has brought on this as yet incurable disease—cancer.

These remarks apply well to what I have to say on Abscess and Fistula at the terminal portion of the intestinal canal. It is the old, old story of being "touched by the piles for many years," and neglect, ending in dread and despair at the necessity of being bored full of holes by pus seeking an outlet. The victim wonders at the spread of the local trouble, and that an opening for the pus canals has frequently to be made three to sixteen inches away from the seat of the abscess. In a former chapter the subject of proctitis and piles was gone into, and some idea given of the invasion of inflammation in the rectal and anal tissues.

In exceptional cases the exciting cause of anal and rectal abscess and fistula, or of abscess and fistula of the buttocks, may be a traumatic injury or accident, produced, say, by a blow or a fall bruising the tissues, or by sharp, hard substances—such as pieces of bone or nutshell—from within the canal, lacerating it. But wounds of this character are very infrequent compared with chronic inflammation (proctitis) as the exciting cause. There are several varieties of proctitis recognized as the exciting cause of abscess and fistula, namely, traumatic, dysenteric, diphtheritic, gonorrheal, catarrhal, etc. The reader should not only pardon me, but should be grateful if by adding another name to the list I point out the most common cause, namely, diaper-itic proctitis. As pointed out in the first chapter or two, the improper use of the diaper will evidence its deplorable result when the period of manhood or womanhood is reached, by some of the many symptoms of proctitis.

Proctitis may be considered as acute, subacute or chronic according to the duration of the process; or as atrophic or hypertrophic from the structural changes induced. But no matter about the cause and character of the proctitis, the question is, Have you inflamed anal and rectal canals? If you have, then the very annoying symptom, abscess or fistula, is liable to occur any day. Can you afford to take the chances?

Just under the mucous membrane of the anus and rectum there is a layer of loose, fatty, connective tissue, called areolar tissue. When it is invaded by inflammation, abscess and fistula may occur. On the outside of the rectal wall, at the terminal portion, there is also much loose, fatty (areolar) tissue filling the ischio-rectal fossa, which is very prone to suppuration, and inflammation here is called periproctitis. This is the most common and serious seat and source of the septic process, which process is usually the proximate cause of death after capital surgical operations upon the rectum. Beside the abundance of fatty tissue—whose function is to serve as a cushion to the rectum at its terminal portion and at the back and sides of the wall—there is a triangular space in front of the rectum containing fatty areolar tissue, which space is often the location of a pus cavity. Pus, like all fluids, follows the path of least resistance. The progress of imprisoned pus may take weeks, months and years before an abnormal communication between the abscess and the external portion of the body is completed. The imprisoned contents of the abscess cavity and the pus canal or fistula often give rise to much annoyance before finding an outlet. There will be pain in the muscles of the buttocks, called myalgia; and pain at the end of the spine, called coccygodynia. For this latter pain do not, I pray you, as is so often done, have your spine removed by the too ready surgeon. No need of it at all. You might just as sensibly have the muscles cut out for myalgia. Pus in fistulous channels may burrow for several years through the muscular and connective tissue structures before finally forming an external opening through the integument; although its nearness to the surface is frequently marked by a localized puffiness and inflammation, which, however, may disappear for a time without forming an external opening. This condition of affairs results in periodical attacks of coccygodynia, myalgia and neuralgia of the buttocks and lower extremities.

The important question with the victim of abscess and fistula is, "How did I get it? I don't care for the various and numerous names you give to these fistulas: what I should like to know is, How does it come about that I, an apparently healthy person, have such a nasty disease?" Simply years of neglect, is my answer. Neglect is due sometimes, and perhaps generally, to ignorance of the thing neglected. The laity can in large measure blame the medical profession for it, and especially those surgeons who have long made a specialty of the treatment of anal and rectal diseases.

CHAPTER XXII.

THE ORIGIN AND USE OF THE ENEMA.

Pliny recorded the fact that "the use of clysters or enemata was first taught by the stork, which may be observed to inject water into its bowels by means of its long beak." The British Medical Journal, reviewing the newly published Storia della Farmacia, says that Frederigo Kernot describes in it the invention of the enema apparatus, which he looks upon as an epoch in pharmacy as important as the discovery of America in the history of human civilization. The glory of the invention of this instrument, so beneficial to suffering mankind, belongs to an Italian, Gatenaria, whose name ought to find a modest place together with Columbus, Galileo, Gioja and other eminent and illustrious Italians. He was a compatriot of Columbus and professor at Pavia, where he died in 1496, after having spent several years in perfecting his instrument. The enema apparatus may be justly named the queen of the world, as it has reigned without a rival for three hundred years over the whole continent, besides Brazil and America. The enema came into use soon after the invention of the apparatus itself. Bouvard, physician to Louis XIII, applied two hundred and twenty enemata to this monarch in the course of six months. In the first years of Louis XIV it became the fashion of the day. Ladies took three or four a day to keep a fresh complexion, and the dandies used as many for a white skin. Enemata were perfumed with orange, angelica, bergamot and roses, and Mr. Kernot exclaims enthusiastically, "O se tornasse questa moda!" (Oh, that this fashion would return!). The medical profession at first hailed the invention with delight, but soon found the application infra dig., and handed it over to the pharmacist; but shameful invectives, sarcasms and epigrams, hurled at those who exercised the humble duty of applying the apparatus, made them at last resign it to barbers and hospital attendants. (Year Book of Therapeutics, Wood, 1872.)

For those suffering from chronic intestinal uncleanliness or constipation, an occasional intestinal wash-out, or bath, is quite as satisfactory as an "occasional" external bath or the "occasional" use of a cathartic medicine. If there is a necessity for cleansing and purifying the bowels at all, why not do it properly and systematically until the condition that made the artificial cleansing necessary is removed? Who would tolerate the cleaning of dining-room, kitchen, dairy and other utensils in domestic use only when they became so foul that they could not be endured any longer without great annoyance? Away with the "occasional" cleansing habit for either external or internal bodily cleanliness! There are persistent causes for internal uncleanliness, for the tardy action of the bowels, which require regular periods for cleansing until cure is effected.

It is estimated that food taken into the stomach will reach the colon in five hours. For nineteen hours the sewage waste of the body is gradually becoming a fetid pool before an outlet is furnished it by the one-movement-a-day people; and O ye gods of health! how many of us there are that haven't even one movement a day! For a few hours the absorbent cells of the colon will try to extract as much of the nutritious residue as the system calls for, but along with it a lot of poisonous filth will be absorbed. The call of the system for nourishment should be fully answered by the small intestines. Savages have four or five movements a day, and we certainly should not have less than three. People of refined sentiments will, at such a disclosure, bestir themselves to better things.

Water, when properly applied, is the only remedy that meets the physiological and pathological requirements of the chronically constipated. By its use the diseased, spasmodically contracted muscular tube is simply dilated, and the imprisoned feces and gases above are permitted to pass down and through the temporarily occluded section of the diseased bowels, the patient will have the consciousness of neatly accomplishing an imperative requirement, and the satisfaction which cleanliness entails.

CHAPTER XXIII.

HOW OFTEN SHOULD AN ENEMA BE TAKEN?

The following lines will show you how advertising is done in medical journals. "Dear Doctor: The spring being the time for cathartics, I beg to call your attention to R. L. (yellow label),..."

Why is spring a special time for cathartics? Has the intestinal canal been obstructed like the Erie Canal during the winter months? With as much propriety they might advertise: "Dear Doctor: The spring being the time for bathing, I beg to call your attention to antiseptic bath soap,..."

I suppose that a sort of annual cleansing of the alimentary canal is suggested so that the summer heat may be less objectionable, as it warms up foul bodies. However, attention once a year is better than none at all, as said of the Augean stables.

Not long ago I had a conversation with the proprietor of a bath cabinet company, who had given some thought to hygienic measures, and he considered it essential to flush the bowels with water once a month to secure "proper cleanliness." This opinion is quite in advance of the annual cathartic cleansing. Some people may have acquired the habit of a monthly cathartic "cleansing"; others wash out once a week, and a few once a day: all of them act from their idea of cleanliness, as they would perform the ablution of their hands, face and body. There are some hygienic students who have adopted the idea of "cleansing" the bowels with warm water once or twice a week, which practice is quite in advance of the annual or monthly attention. All have reasons for the manner and time they adopt to "cleanse" the bowels; and yet they find that they are not cleansed properly, as they still have spells of biliousness and misery. They wonder at themselves for being so rash and bold as to take an enema twice a week, and begin to feel that they have reached a point of positive danger.

One anxiety is that they will weaken the bowels by the use of a pint or a quart of water once a month, or once or twice a week. Another is that they will wash away the mucus, leaving the membrane of the bowels as dry as an oven. Another is that they will form the dreadful habit of using the enemata. What a pity to form such a cleanly habit! Sorry for them!

Another stubborn objection is, that flushing of the bowels is not natural. These foolish objections and fears can be attributed to medical authors who belong to medical societies. It is very strange how these authors adopt so many wrong notions about the physiology and pathology of the bowels. What an erroneous and absurd idea that the enema should weaken the bowels! Why should it? Exercise ought to strengthen muscular tissue; and what could give the bowels more gentle muscular exercise than the proper use of them? Has the reader any idea of the amount of water requisite for the distention of an elastic muscular tube, about five feet in length and two and a half inches in diameter in the widest part? The large intestine is capable of great distention, as is frequently demonstrated in fecal impaction described in previous chapters. The quantity is named in gallons. The amount of water usually injected at one time—from one pint to two quarts—can hardly be said to distend the bowels at all. I wish the enemata did have power to weaken that part of the bowel involved in disease. I am very sorry it does not weaken it. For twenty years it has been demonstrated to my mind that almost every case of chronic constipation, biliousness, intestinal foulness, diarrhea, indigestion, self-poisoning (auto-infection or auto-intoxication) was due to too much activity and vigor of the lower bowels, this excessive activity and vigor being the result of chronic proctitis, colitis, etc. To lessen this muscular irritability, and to devise means to relieve and cure quickly, has cost me more studious hours than the aggregate of all the other diseases and symptoms of the lower bowels.

If liquids washed away the mucus from the mucous membrane, the throats of many individuals ought to be very harsh and dry, inasmuch as six to eight glasses of liquids pass through their mouths and throats during every day of twenty-four hours. Even after the "dry feeling in the throat and stomach" has been bountifully attended to by the owner, the conversation usually becomes more loquacious and hilarious, and there is no suggestion that the intemperate person had spent many hours in a hot desert without water. The frequent flushings they give their throats and stomachs really do not seem to wash the mucus away.

When a person consults an oculist about an affection of the eyes and glasses are prescribed, good sense will inform him that the glasses must be worn while the imperfect functioning of the eyes requires them. If a limb be fractured and splints be applied, would you worry lest you form the habit of wearing them? Certainly not; you expect in due time to recover the proper use of the limb. So if you are compelled to use crutches you do not worry about forming the crutch habit, for you will use them as long as needed and discard them at the proper time.

As to its being unnatural to flush the bowels with water, I would say that it is very unnatural to suffer from proctitis accompanied with its annoying symptoms, such as constipation, indigestion, diarrhea, auto-intoxication, emaciation, anemia, muddy complexion, foul breath, blotches and pimples on the face, each and all of which indicate a physical debasement.

It is unnatural to wear glasses, crutches, splints, wigs, artificial teeth, artificial eyes, but many people do such unnatural things. Many of our habits are not exactly "natural," but they are rational, none the less; such, for example, as bathing the body night and morning; cleansing the mouth and teeth after each meal; and the nostrils and ears several times a day. The frequency of these practices may, with some people, be unnecessary and useless, but no real harm is done by their scrupulous cleanliness—physical and mental.

Proctitis is usually worse than it seems to be. This is because of the insidious progress of the inflammation during the fifteen, twenty or more years before the local symptoms at the anus or in the anal canal are sufficiently annoying to compel the sufferer to seek treatment. Such sufferers are, as a rule, born with the idea that the liver regulates the whole alimentary canal; and if the sufferer has not this hereditary notion, his physician will soon impart it to him with his diagnosis and treatment. The disciple of cathartics, whether the cathartics be in the form of pills, powders, or solutions, or contain belladonna and opium to overcome the cramping pain the dose would otherwise occasion, has no legitimate reason to indulge in the hope of a cure or of even moderate relief of the real source of trouble—the proctitis. It is proceeding on the liver theory, when the key is, as has been shown in these articles, Proctitis, inflammation of the anus and rectum. Physicians ignorant of the key to all bowel troubles even prescribe strychnine in order to stimulate bowels which have already an excessive amount of stimulation due to the presence of the proctitis, which, as has been said, over-stimulates the lower bowels because of the inflammation.

The chronic character of proctitis of many years' duration, improperly diagnosed and treated, must necessarily compel a rather long and continued use of the enema, especially so if not accompanied by proper local treatment of all the inflamed surface. I should not care to treat patients suffering from proctitis, constipation, etc., unless they used the enema twice a day. The feces and gases should escape the bowels at least twice in twenty-four hours. Any less than two stools a days is abnormal and will result in infection and disease. You may not always succeed in having two stools when first treating the local disease, but what you properly start out to accomplish will be attained in due time.

Free evacuation of the contents of the bowels should occur at least twice in twenty-four hours. This can be accomplished by injecting into the colon from one to four quarts of warm water. Before taking the large injection, relieve the bowels of any gas seeking liberation, and of course, also, of whatever feces may come readily. Then take a small injection, using very little water: just enough to bring on a relief of as much feces and gas as possible. It is not well to drive the gas back and up into the colon; hence the precaution to suggest a further passage with a small quantity of water before taking the large injection.

Enemata, and also the use of the recurrent douche, can in no way be harmful—if the water be of a proper temperature—to a normal or even to a diseased bowel; therefore the fear of habit is absurd and should not receive a moment's consideration. The length of time during which the enemata and the douche are to be used, whether months or years, will depend on the character of the disease that made its use necessary.

CHAPTER XXIV.

MAN'S BEST FRIEND.

Travel the world from end to end

You ne'er will find a better friend

Than sparkling water, pure and free,

Most precious boon to you and me.

It cheers the faint, it crowns the feast,

Makes food to grow for man and beast;

In sickness soothes the fevered frame,

There's healing in its very name.

And what can more life-giving be

Than cooling breezes from the sea,

Whose bosom bears upon their way

The stately ships from day to day?

A treasure trove of priceless worth;

A jewelled belt for mother Earth,

Encircling with its silvery bands,

She binds together many lands.

To cure disease dame Nature brings

Her remedy in mineral springs;

Water without, water within,

Equally good for stout or thin;

And more than man can e'er devise

Invigorates and purifies.

Travel the world from end to end,

You ne'er will find a better friend.