The Project Gutenberg eBook of Intestinal Ills, by Alcinous Burton Jamison

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.

"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.

"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."

"The morbid conditions that constipation may occasion are of various kinds. Under an undue retention of fecal matters within the colon noxious products may be formed there, and act as irritants upon the mucous coat, setting up inflammation, followed by ulceration. It is to be here remarked that fecal matters are sometimes retained in the sacculi or pouches of the colon, and may give rise to the circumstances referred to, whilst a passage exists along the centre of the canal that shall permit a daily evacuation to occur. The dejections, even, may be loose in character, and still the same sequence of events ensue. From the irritating influence of preternaturally retained feces, colicky pains are, as a rule, induced, and the ultimate effects may be such as to lead to the production of fatal inflammation.

"The effect of constipation upon the muscular coat of the bowel is, through distention to which it is subjected, to weaken or deteriorate its evacuating power. As the result of a great amount of distention, like as happens in the case of the urinary bladder, more or less complete paralysis is induced. From the prolonged retention of fecal matter accompanying constipation, excrementitious products that ought to be eliminated become absorbed and thereby contaminate the contents of the circulatory system. As the result of this contamination, the secretions become vitiated, and a general disturbance of the conditions of life is produced. The action of the liver becoming deranged, its eliminative office is imperfectly discharged, and thus sallowness of the face and a bilious-tinged conjunctiva are produced. A coated tongue, foul mouth, loss of appetite, and other dyspeptic manifestations, accompany the general disorder of the digestive organs that prevails. The accumulation existing in the colon leads to a sense of distention and uneasiness in the abdomen. The kidneys vicariously discharge products that ought to have been eliminated by the alimentary canal. In this manner the urine becomes preternaturally loaded. From the contaminated state of the blood the functions of animal life also become disturbed; and hence the lassitude, debility, headache, giddiness and dejected spirits, that form such frequent accompaniments of constipation.... A distended cæcum, colon, and rectum may also, by the pressure exerted upon the nerves and vessels of the lower extremities, be the cause of numbness, cramps, pains and edema of the legs. The edema occasioned by constipation, if not exclusively confined to one side, will in all probability be decidedly greater in one leg than in the other."

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.

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.

"In certain persons there is a state of mind distinguished by a concurrence of the following circumstances: a languor, a listlessness, or want of resolution and activity with respect to all undertakings; a disposition to seriousness, sadness and timidity as to all future events; an apprehension of the worst or most unhappy state of them; and therefore, often upon slight grounds, an apprehension of great evil. Such persons are particularly attentive to the state of their own health, to every smallest change of feeling in their bodies; and from any unusual feeling, perhaps of the slightest kind, they apprehend great danger and even death itself. In respect to all these feelings and apprehensions, there is commonly the most obstinate belief and persuasion." (Quoted in Leared, On Imperfect Digestion, p. 106.)

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:

"The consequence of this development of acid in the whole length of the digestive tube is an inflammatory condition. We notice catarrh of the stomach, ulcerative gastritis, to which patients often succumb after twenty-five years of bad stomach; these are the false cancers, as they are called, or malignant gastritis without tumor. The large intestine is inflamed; around the fecal matter are seen glairy secretions and sometimes blood (membranous enteritis)." (Op. cit., p. 159.)

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.

"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.

"If thou well observe

In what thou eat'st and drink'st, seek from thence

Due nourishment, not gluttonous delight,

Till many years over thy head return:

So may'st thou live, till like ripe fruit thou drop

Into thy mother's lap, or be with ease

Gathered, not harshly plucked, for death mature."

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.

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.

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."

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.