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.

CHAPTER XXV.

PHYSIOLOGICAL IRRIGATION.

The scientific irrigation of land is pretty well understood by those who have financial interest in soil requiring it. The wonderful beauty and freshness of flower and fruit give evidence of what scientific irrigation can do. So from a commercial and esthetic point of view the proper amount of daily moisture for land, tree or vine, is of such importance that it receives the consideration of those interested. How many persons, however, in the course of a lifetime have given ten minutes to serious consideration of the question: How much water should be imbibed daily under the varying conditions of the body's garden? Those who give no consideration to the problem of how to attain and maintain a healthy and vigorous physical basis are persons who usually drift into habits for which they will, sooner or later, have to pay the penalty.

For the first twenty or more years the body is, as a rule, unfortunate in not having an intelligent tenant. For man misuses his physiological estate, and lets things go to rack and ruin ere he wakes to realize how it might have been as to length of days and strength of body and mind. Enlighten him, after he has reached adult years, on the values and needs of physiological and psychological functions; you will find that however eager he may be to follow the light he is handicapped by vicious habits and by confirmed, destructive changes which had seized on him when he was quite too young and incompetent to care for his body. What a topsy-turvy world this is, to be sure!

It is astonishing what a number of people there are who drink little or nothing, and especially amazing is it to find this lack of sense in people suffering from constipation. One would suppose that they above all others would see the wisdom of irrigating their bowels. But it is seldom that there is one who thinks of such a thing. A cup of coffee or tea at meal-time, in addition to the liquid contained in the food, is the extent of water consumption by ever so many teetotalers and other "totalers," especially women, until they reach, say, thirty years of age. Such persons as a rule are not long-lived, inasmuch as their power of resistance is small, owing to their lack of blood, a lack in quality as well as in quantity. The blood pressure in their arteries and veins is light, as evidenced by their pale, sallow complexion, and the dry, scaly, feverish skin, which seldom or never perspires. The body garden has not been properly irrigated and is slowly drying up as age advances. Did you ever notice how like death such persons appear when they are asleep? Their dull, pasty complexions alarm us then. When I see them a desire to soak these dried specimens of humanity possesses me. Is it not unfortunate that we were not born with an automatic irrigator? We even lack a tube on our boiler to indicate the danger point! Deficient by nature in these little conveniences, and unaided by science, man is compelled to give some attention to the irrigation of his physiological soil, however indifferent or careless he may be.

Planters and gardeners have treatises on irrigation. Have mothers or nurses any similar guides? Such books are unknown to modern civilization. Infants, boys and girls, and adults are brought up haphazard, and their garden of life becomes choked with weeds. The drought soon makes itself felt, and a little graveyard mound is their usual fate. Before some of us wither and fade, to what a pest-weed is our adipose changed for want of life-giving water.

Man's most serious physiological fault is the toleration of constipation; or even of semi-constipation induced by the twenty-four-hour habit of stooling. In other words, his fault is the toleration of intestinal uncleanliness. And next to this foolhardiness is his negligence in the matter of drinking daily a quantity of pure soft water sufficient to aid in the proper stimulation and circulation of the blood, in the proper elimination of the waste material from the body, and in the proper assimilation of nutriment by the system.

If parents would encourage their children to become bibbers of pure spring water daily it would not be easy to make them bibbers of intoxicants in after years. I would give a child all the liquid it desires, I would even encourage it to take more rather than less, and the best liquid of all for this purpose is pure soft water. Man's body is 70 per cent water. It is therefore a good-sized water cask with a ramification of countless canals or pipes imbedded in soft connective tissues, nerves and muscles, all of which are supported by a bony framework; through the centre of this runs the alimentary canal, down which waters may flow and disappear like unto a stream lost in the sand, to reappear and ooze from skin, lungs, kidneys and intestinal canal. Every organ and tissue luxuriates in water; they lave and live in and by it. With all kinds of food it is introduced into the body. Water acts as a solvent for the nutritious elements and as a sponsor for the elimination of foreign substances and worn-out tissues of the system. It also serves to maintain a proper degree of tension in the tissues, which tension is essential to the proper circulation of the lymphatic fluids.

The tonic reaction of externally applied water is well known. But the advantages of the internal use of water are hardly known at all because the reactions of the circulation, temperature, respiration, digestion and secretions are less noticed.

Two or three pints of cold water at a temperature of forty to forty-five degrees drunk at intervals of half an hour will reduce the pulse from eight to thirty beats. The copious drinking of cold water will act as a diuretic, removing stagnated secretions, and will at the same time improve the quality of the pulse and the arterial tone. The drinking of warm water will increase the pulse from five to fifteen beats, and at the same time will relax the vessel walls and also increase the cutaneous secretions to a marked degree.

The drinking of a large quantity of water not only increases the secretions of the kidneys—assisting them in the work of carrying off solid constituents, especially urea—it also increases the secretions of the skin, saliva, bile, etc. Under proper conditions the internal use of water acts as a stimulant to the nerves that control the blood-vessels, a stimulant similar to that produced by its external application.

I advise the drinking of a copious quantity of water daily. There need be no fear that this practice will thin the blood too much, as the ready elimination of the water will not permit such a result to ensue. I would further advise the generous use of water (temperature 60°) at meal-times. I pray you do not drink to wash down food: a bad habit of most of us. Drink all you desire; and if you are like many who have no desire for water, cultivate it, even if it takes years. The imbibed water will be in the tissues in about an hour; and the entire quantity will escape in about three and one-half hours. The demand on the part of the system for water is subject to great variation and is somewhat regulated by the quantity discharged from the organism. Physiologists declare that water is formed in the body by a direct union of oxygen and hydrogen, but those who have cultivated the drink-little habit need not hope to find an excuse for themselves in this fact: chronic ill-health betrays them. Water in organic relations with the body never exists uncombined with inorganic salts (especially sodium chloride) in any of the fluids, semi-solids, or solids of the body. It enters into the constitution of the tissues, not as pure water, but always in connection with inorganic salts. In case of great loss of blood by hemorrhage, a saline solution of six parts of sodium chloride with one thousand parts of sterilized water injected into the system will wash free the stranded corpuscles and give the heart something to contract upon.

When water is taken into the stomach, its temperature, its bulk, and its slight absorption react upon the system; but the major part of it is thrown into the intestinal canal. When it is of the temperature of about 60° it gives no very decided sensation either of heat or cold; between 60° and 45° it creates a cool sensation, and below 45° a decidedly cold one. Water at a temperature of about 50° is a generator of appetite. A sufficient quantity should be taken for that end; say, one or two tumblers an hour or so before each meal, followed by some exercise. Those who have acquired the waterless habit, and the many ills resulting from it, will hardly relish cool water as an appetizer; but if they would become robust they must adopt the water habit—a habit that will refresh and rejuvenate nature.

Water of a temperature between 60° and 100° relaxes the muscles of the stomach and is apt to produce nausea, especially if the effect of bulk be added to that of temperature. Lukewarm water seems to excite an upward peristalsis of the intestines and thus produces sickness.

Hot water acts as a stimulant and antiseptic, as a sedative and as a food. Water at a temperature of 110° to 120°, or more, will nearly always relieve a foul stomach and intestines. It should be slowly sipped, so that the stomach may not be uncomfortably distended. After imbibing a pint or a pint and a half, wait for fifteen or thirty minutes to give it time to pass into the bowels, then drink more if thought advisable. Drink it an hour before meal-time. It will excite downward peristalsis, will dilute the foul contents of the stomach, and will thus aid the escape of these contents into the intestines, which latter require the washing process as well. Sometimes it is a good thing to omit one, two or three meals while the washing process is being continued. Commence treatment with pure hot water. To make it appetizing, add a pinch of salt or of bicarbonate of soda; with children add sugar. It will pay you to follow this treatment for the cleansing of the alimentary canal.

The vitality of the body may be sustained for days and weeks on water alone; there is therefore no hurry about food. If human beings would only keep their bowels and stomachs clean they would avoid all the ills that flesh is heir to, except, of course, those due to accident.

My remarks have been confined to irrigation per orem (that is, by way of the mouth), and nothing has been said of irrigation per anum (by injection), since I have treated the latter subject fully in several previous chapters, to which the reader is referred. Be sure to follow the counsel there given, and use the enema two or three times a day in moderate quantities as indicated.