Americans in general suffer from dyspepsia, biliousness, constipation,

uric acid, etc.--all of which disorders are symptoms of that world-wide

disease, proctitis: inflammation of the anus, rectum, and often the

colon. Nor is it any wonder that unwashed humanity suffers from

proctitis and its consequences. The unwashed have no bath-tubs and

practically no water-closets. This lack is due to the tax on water

facilities, to expensive plumbing, and to too much “science” and

not enough common sense among our city fathers. As a consequence

of ignorance and inconvenience, most people defecate but once in

twenty-four hours; and very many but once in two or three days or a

week. The once-a-day stool is frequently scanty, and as a consequence

the kidneys, lungs, and skin are called upon to perform the vicarious

function of eliminating a portion of the daily excrement; and the colon

and sigmoid flexure have to hold the stored contents unduly--until

the feces be expelled by purgatives or by the irritation that the

accumulated mass occasions. Could the members of the Board of Health

and the people at large be brought to a realizing sense of the value

of personal cleanliness,--internal as well as external,--bath-tubs and

water-closets would abound in our homes.

Man’s habits as to eating, drinking, dressing, bathing, and especially

as to defecating, are clues to his growth in refinement. But we must

beware of judging a person by one or two good or bad habits; he should

be estimated by the sum of his habits and their peculiar combination.

Refined habits are not all of them acquired at once; they develop

slowly, one after another, when opportunities are favorable, especially

the habits as to bathing and defecating. Opportunities for these

latter are wofully lacking at present--the cause and consequences of

which lack are pointed out in the last chapter. A child will derive

far more good from a ready access to bath-tub and water-closet than

from a lifelong attendance at Sunday-school and church with the temple

of the human soul permanently unclean. Only one that has learned to

respect and care for the abode of the soul--the body--is worthy of

being classed among the refined. It is truly deplorable that the great

majority of the human race are creatures of the moment or the hour,

tolerators of abnormal functioning, slow suicides of vital capacities.

Claims of the permanent are constantly ignored; most of us are blind

to the joy involved in the harmonious functioning of all the organs--a

functioning that always ensues upon hygienic care.

Our organs will for a time bear neglect or unhygienic conditions

without protesting their annoyance. Many persons never use hot water

or soap; others find one bath, in river or sea, quite sufficient for

the year; others, again, feel the need of a bath once or even twice a

month, or even once a week. But there are very few of us that seem to

require a bath daily. Many, alas! have grown accustomed to a bathless

existence.

Have you ever stood near an Italian or Greek street vender, or have

you ever been within five feet of a low-class Polish Jew? If so, the

stench arising from his unwashed body must have nauseated you. It is no

secret that such persons never wash--especially the latter, who live

in rooms reeking with filth. Contemplating such conditions, I feel

impelled to propose a great, nay, the greatest reform--one suggested

years ago by Samuel Butler in _Erewhon_. Let us make Health the great

civic virtue, and Disease, as well as unsanitary and unhygienic

conditions, the crime. Our so-called crimes of theft, murder, forgery,

etc., should be treated as weaknesses and faults to be corrected by

Moral Rectifiers--by the preachers, priests, rabbis, and ethical

culturists. Consider how much is implied in developing and breeding a

race of healthy men and women. All relations of life would feel the

vital change at once, and moral weaknesses would disappear. Any human

cesspool entering a public conveyance, or in any way mingling with

cleanly people, should be arrested, thoroughly cleansed, internally

and externally, and sequestered for a time sufficient to teach him

better. There is a local rule of the Board of Health against spitting,

but it is rarely enforced. There are millions of public expectorations

to one arrest. For the appearance in public of consumptives, and

their offensive hawking, coughing, and spitting, no one seems to have

suggested a remedy. All diseases should be classified as to grades of

punishment; and all moral weaknesses, such as defalcations, adultery,

burglary, should be treated at the various hospitals, which latter

should be conducted solely by Moral Rectifiers.

In closing, I shall direct attention to a few other points in personal

cleanliness--the mouth, ear, nose, and throat.

It is important on hygienic grounds that the mouth receive proper care

two or three times daily.

The ear is commonly kept clean; still there are many instances of

non-refinement of this organ, and from its non-hygienic treatment

deafness often occurs.

The prevalent nasty, ill-bred habit of hawking and spitting in public,

or in company, even by genteel persons, can be cured best by early

training in correct habits. This habit, as well as the evidences of

throat troubles, is usually to be ascribed to inattention to the nose.

When catarrhal conditions are avoided or properly treated the throat

will not be so affected as to necessitate this reprehensible practice.

Trouble is invited for the tonsils and soft palate by our constant

hawking; certainly the tender sensibility of the throat is destroyed

thereby. Inasmuch as the tobacco habit is so general, and spitting is a

necessary accompaniment of that habit, stringent laws against hawking

and spitting would be unpopular among the masculine half of the race.

But should public opinion ever become educated up to the point in which

disease becomes a crime, opposition would cease. This consummation

is devoutly to be wished, for then we will have adopted and followed

Ingersoll’s injunction to “make health catching, not disease.”

CHAPTER XVIII.

HOT WATER IN THE TREATMENT OF PROCTITIS AND COLITIS.

In treating chronic ulcerative inflammation of the anus, rectum,

sigmoid flexure, etc., it is well to take advantage of every really

practical device to which one may have access, so that valuable time

may be saved in obtaining relief and effecting a cure.

The capillaries, veins, arteries, and arterioles in an inflamed organ

become distended and the tissues swollen, indurated, and tense by the

excess of blood and the inflammatory serum deposited in the tissues.

The vasomotor nerves in the diseased part have lost their contractile

power, which fact increases the stasis, or congestion, of the blood.

Circulation in diseased tissue depends very much on the general tone of

the system, and if the circulation is below the normal the ravage of

the malady is increased proportionally.

Have you ever observed a little stream of water enter a large pond in

which were grass, shrubbery, logs, decaying vegetation, and débris of

all sorts--the accumulation of years? And have you noticed that here

and there there were stagnant pools, without a perceptible motion

from where you stood, but that as you reached the side opposite to

the entrance some faint traces of motion became visible, and that as

you followed the line it soon formed into a stream quite equal to the

inflow? The pure water, on entering and mingling with the stagnant

water and old deposits, soon becomes corrupted and foul. Somewhat

similar unhygienic and toxic results take place in ponds of stagnant

blood and abnormal deposits such as proctitis and colitis involve,

and where, for six or eight inches or more of the large intestine,

inflammation is deeply seated, and blood stasis is of course in full

swing. As the débris in a stagnant pond decays, making the water

impure, so in an inflamed organ the tissues decay, making the blood

impure. Ulceration is an exhibition of this process of congestion,

induration, and decay.

The rectum and sigmoid flexure are loosely hung in the pelvic space

and are surrounded by fatty cushions of connective tissue on all

sides, which fact allows the organ considerable dilatation and motion

(Fig. 5). Owing to the anatomical structure and the location of

the lower bowel, it becomes a serious matter when it is invaded by

an ulcerative inflammatory process--especially when all the layers

of tissue forming its wall are invaded, and still more so when the

connective tissue around the organ is in the same condition.

Far better were it for the victim of proctitis and

periproctitis--filled as he is with channels and reservoirs--if pus

were to form in abundance at once and thus betray the destructive

action in the spongy areolar or connective tissue, under the mucous

membrane, around the rectum, and in the tissue forming the anus and

buttocks.

The pathological condition brought about by inflammation, etc.,

requires a remedy that will empty the over-dilated vessels and remove

the serum deposit in the tissues, which is analogous to the rubbish of

a pond.

Our grandmothers were familiar with the therapeutic effects of

heat and moisture when they applied hot poultices constantly to

an inflamed organ or limb for one or more hours until the tissues

presented a blanched, shriveled, and white appearance; if there were

signs of the inflammation returning, the poulticing was continued

or repeated. They knew very well what the parboiled condition of a

washerwoman’s hands indicated after a day’s work in hot water. They

were bloodless, notwithstanding their incessant muscular exercise. In

case of inflammation, they reasoned, heat and moisture would make the

congestion and fever leave if applied long enough. On beginning the use

of the hot poultice, the tissues to which its heat and moisture were

applied became relaxed, and the parts for the time more congested than

before; but our grandmothers did not mind that, as the final result

would justify their hydriatic procedure. They well knew that after

ten minutes or more a reverse action would take place, and if the

treatment were continued long enough the blood-vessels and tissues

would show little or no evidence of fever or inflammation.

Where chronic inflammation exists, the blood-vessels and tissues lose

their normal tone or vitality; consequently, they will require repeated

application of hot water as well as other aids until a cure shall have

been effected.

Another great advantage in the use of hot water is that its application

can be interrupted and resumed without detriment to the diseased

tissues or organs. Cold water, on the contrary, causes the vessels

quickly to contract and expel the blood, but, on reaction taking place,

the tissues become more congested than before.

In the use of water at a temperature of 120 to 135 degrees, or even

more, we have one of the most valuable adjuvants in all stages of

proctitis and colitis, and, if a properly regulated plan be pursued in

connection with the requisite local treatment, more good can thus be

accomplished than by all other means combined.

The layman is more or less familiar with the condition of a sore or

ulcer in which soft, spongy, or fungous tissues appear, called “proud

flesh,” which, on an inflamed mucous membrane, is called granular

tissue. Were it not for the usual presence of granular tissue on a

chronically inflamed mucous membrane and for ulcerated sections or

patches, channels, and stretched or pouched mucous membrane called

piles, the proper use of hot water alone would in time effect a total

cure in almost every case of proctitis.

Many well-meaning persons conceive the idea that, if hot water is so

beneficial, they may use it as hot as possible for the purpose of an

enema likewise, since they will thereby not only relieve the bowels

of their stored feces but simultaneously do the inflamed tissues “a

whole lot of good.” Their spirit is admirable, for not all patients

are prompted to such thoughtful attempts to do everything in their

power to get well--even though they err with the best intentions at

heart. Let them remember, however, that the first effect of hot water

is to increase the blood supply in the tissues if it be applied for a

short time only. In the majority of cases, the enema does not require

more than from five to ten minutes; hence, only harm can result if

really hot water be used. Now and then a person will become possessed

with the notion that a hot enema should be followed by a cold one, to

bring “tone” to the lower bowels. But in all these misdirected efforts

matters are made doubly worse.

Cold water will allay fever and inflammation, but when its use is

once begun it should be continued without intermission until a cure

is effected. For this reason it is _not_ suitable where chronic

inflammation exists--especially on the mucous membrane of the bowels.

It is, however, excellent for acute inflammation of the external parts

of the body, such as the hands, arms, legs, etc., where it can be

continued without interruption for one, two, or three days if necessary.

In beginning the treatment for constipation, there are a few cases

in which the patient has to fuss for an hour or more with the enema

before he can obtain any sort of a proper fecal evacuation; or there

may be inability to expel the water from the bowels when once injected.

This stoppage is most likely to occur at the recto-sigmoid juncture

(O’Beirne’s sphincter). A strictured condition of the bowels causes

retention of feces and gases and why not water as well? In such cases

time would be saved, perhaps, by combining the procedure for an

enema with that of a recurrent douche, which involves a continuous

application of water at a temperature of from one hundred and twenty

to one hundred and thirty-five degrees for an hour or more. Figure 21

illustrates a successful device for applying medicated water at a high

temperature to the anus, rectum, and colon. This apparatus can be used

while sitting on a water-closet seat and the treatment can be completed

without changing position or removing the instrument.

The instrument is attached to the reservoir (Figure 18) by a

soft-rubber tube. In the cone-shaped piece of hard rubber (Figure

27) is a hard-rubber stop-cock or valve (Figure 29), and by turning

the handle sidewise the valve is opened to let the water escape from

the bowels into the toilet basin. When sufficient water, at from one

hundred and twenty to one hundred and thirty-five degrees temperature,

has entered the bowels, allow it to remain for ten minutes, then permit

it to escape by opening the valve; then close it and allow more hot

water to flow in and remain for five or ten minutes and again allow it

to escape through the rectal point, repeating the inflow and outflow

every five or ten minutes for an hour or more without removing the

anal point from the rectum during the whole time of treatment. After

a few trials it will be found that the hot-water treatment can be

accomplished without withdrawing the point.

Rectal Points for recurrent douche are of two sizes (Nos. 25 and 26).

The larger one (No. 25) requires a plug to be introduced through

the cone-shaped external anal support and rectal point, to make its

introduction into the rectum easy, after which the plug is withdrawn

and the hot-water treatment begun. The bore of the rectal points cannot

become clogged by the presence of feces, mucus or membranous shreds

or casts, which are usually brought away by the hot-water treatment.

At no time during the treatment can the point become stopped up, the

size being sufficient to insure a proper inflow and outflow. And the

instrument can be easily cleaned.

Near the attachment of the soft-rubber tube is a glass reservoir

(Figure 24), for the use of oils with the enema or the hot-water

treatment; it is detachable. A valve regulates the outflow of oil from

the pressure of water in the reservoir, as it passes into the bowels.

We are enabled thus to treat by double medication as it were, a

chronic disease of the intestines and its symptoms--that is, intestines

that have been long neglected or maltreated through lack of proper

diagnosis, or by all sorts of chemical compounds from above, through

mouth and stomach.

The author and inventor naturally enjoys not a little satisfaction in

being able to present to sufferers as nearly perfect an instrument as

can be devised; one that, in conjunction with other aids, meets all

requirements involved in the proper treatment of proctitis and colitis.

Lavage or irrigation of the large intestine with water at a temperature

at from one hundred and twenty to one hundred and forty or one

hundred and fifty degrees, not only accomplishes rapid and wonderful

cleaning and curative results, but overcomes, when properly applied,

contracted, congested, engorged, and inflamed tissues of the bowels.

Therapeutically, it has a marked effect on the whole system, being

beneficial beyond words to describe; it relaxes nervous and muscular

tension of the body, producing restfulness and sleep; it stimulates

and equalizes the circulation, promotes perspiration, absorption, and

active elimination of all deleterious substances from all the organs

of the body. Medicinally, it is really a combined internal Russian

and Turkish bath, removing abdominal corpulency and gaseous obesity,

resulting from chronic auto-intoxication. The external Russian and

Turkish baths afford a satisfaction skin deep to the bather, but the

combined internal Russian and Turkish bath is most agreeably relaxing

and restful to mind and body, bringing peace, since all the organs of

the system are performing their functions. Some of my patients resort

to internal hot-water lavage for all aches and ills that mar their

happiness. After an external bath the bather may desire an application

of oil, alcohol, or cocoanut butter rubbed on the skin, and in the

same way the bather’s internal mucous membrane is not neglected; for,

with the author’s appliance, medicated and perfumed oils, extracts,

and powders for remedial purposes are carried to every part of the

intestines that the water reaches, thus exerting a cleansing, healing,

and soothing effect where most needed.

A few sufferers will object to the time required for an enema twice a

day, although they find time to eat three, or even four times a day,

without any objection whatever; there is plenty of time for filling

up the digestive apparatus, but no time for its normal elimination.

And these miserable, go-lucky, haphazard people are always sick and

unfortunate. The internal Russian and Turkish bath is demanded only by

those who truly desire to be free from their bowel troubles, and from

the numerous symptoms resulting from mucus absorption, constipation,

and auto-intoxication.

A sufferer’s efforts to be well depend largely on how much he or she

estimates the worth or value of mind and body. A noble purpose in life

is priceless; are not one’s spirit and body worth the time required

for two enemata each day and an hour for the internal bath, if needed?

I think so, and you should likewise.

The author trusts the reader will not infer that all sufferers from

piles, anal fissure, pruritus ani and vulvæ, mucus channels and

reservoirs, abscess, fistula, and all similar troubles, require the

enema and recurrent douche appliance; the character of the disease and

its symptoms must determine the requirement of the treatment. Many of

my patients receive office treatment only, omitting home attentions,

although this is not always advisable. The reader might conclude that

the recurrent douche treatment was simply for the cure of a chronic

inflammatory invasion of the bowels and fecal auto-intoxication, and

not be aware of another great source of auto-intoxication--that is,

from the absorption of large quantities of serous, fibrinous, or

albuminous exudation from a large area of tissues invaded by the very

insidious inflammatory process, a condition which, in time, may reach

the pus-forming stage. Thus we have three very grave pathological

conditions to meet and remove before the pus-formation stage is

made manifest through the development of abscesses. I have found

five aids--perhaps more--to accomplish a cure in which I have been

exceptionally successful, as my students and patients will verify;

these are: local treatment, local medication, the proper use of the

enema, the use of the recurrent douche, and the determination of the

sufferer to get well.

CHAPTER XIX.

HOT WATER IN THE TREATMENT OF EXTERNAL SYMPTOMS.

After proctitis has continued for many years it will give rise to

painful inflammatory and ulcerative processes at the external anal

vent and in the adjoining tissues. The anal mucous membrane and the

integument about the anus become brittle, loosened, and detached from

the areolar connective tissue by the retention of inflammatory serum.

The engorged, indurated, and swollen mucous membrane and integument

serve as reservoirs, especially when the chronic inflammation is

excited to an acute stage, which stage is often accompanied by a

fissure, abscess, or anal ulcer. Soreness and pain in the parts may

then be so severe that the sufferer is compelled to stay indoors

or in bed. Whatever the symptoms may be--piles, fissure, pruritus,

abscess, or fistula--the sufferer desires to reduce the local fever

and the acute inflammation, as well as to find relief from the pain.

The customary treatment is to use poultices, which are troublesome and

ineffective.

In the following illustration I give a good idea of a perfect device

for relieving quickly the soreness, pain, acute inflammation, and

induration, all of which are so very prostrating; and, situated as

they are physiologically, they are exceedingly inconvenient to treat

properly by the ordinary methods in use:

[Illustration: (Patented November 8, 1892.)

Fig. 23.]

The Sitz-bath pan, though small, is yet of sufficient depth and

diameter for all practical purposes, and can be placed wherever is

most convenient--on a low chair or a box. The bather should sit on the

instrument with the limbs on either side of the funnel through which

the hot water enters the pan. Just below the funnel is an overflow

tube, under which a vessel should be placed to catch the water as

it flows out. While sitting on the pan the elbows may rest on any

convenient support, so as not to tire the invalid too much during the

bath, which should consume from half an hour to an hour, or longer if

agreeable. Hot water may be added every few minutes as the bather finds

that the tissues will tolerate it. Depurant powder may also be added to

the water in the Sitz-bath pan.

What has been said in a previous chapter on the therapeutic effects of

hot water in the treatment of proctitis need not be repeated here.

The three indispensable appliances for combating and effectually

overcoming the pathological conditions to which this book and my two

previous books--_Intestinal Ills_ and _How to Become Strong_--are

devoted, are _The Internal Fountain Bath_, _The Intestinal Recurrent

Douche_, and _The Shallow Sitz-bath Pan_. These appliances are

well-nigh perfect for the uses to which they are adapted.

CHAPTER XX.

THE HEALTH OF SCHOOL CHILDREN.

“Cleanliness of body was ever esteemed to proceed from a due reverence

to God, to society, and to ourselves.”--_Bacon._

The International Congress on School Hygiene ended its fourth meeting

at Buffalo recently to meet two years hence in Brussels. In the interim

the Board of Education in this city, the Department of Health, and the

New York School Luncheon Committee will continue their investigations

as vigorously as in the past, and the information thus gained will be

an important contribution to the next Congress.

Too much attention cannot be given to the question of hygiene, diet,

and excretion to meet the psycho-physical requirements of the mind

and body in normal health. As a rule, diet is prescribed for the

purpose of relieving the various annoying and painful symptoms caused

by chronic impairment of the functions of the stomach and bowels,

but when we find the cause of these various symptoms arising from a

disturbed gastro-intestinal tract, the question of diet will receive

less attention. Why has not the subject of normal intestinal excretion

received as much attention as diet in health or ill-health? As our

knowledge of the human psycho-chemical laboratory increases, we are

able definitely to locate a diseased organ and account for the symptoms

caused by the pathological condition of that organ; and when the

diagnosis is properly made these symptoms become a secondary matter of

treatment.

The chief enemy of health among school children (and older persons as

well) is the accumulation and retention of waste matter and gases in

the intestinal canal, where are generated ptomaine, toxic, and other

poisons which enter into the system, resulting in self-poisoning or

auto-intoxication.

What do we mean by school hygiene? Is it only the school building, or

the external appearance of the children, their eyes, teeth, mouth,

nose, hands? What about the coated tongue, foul breath, fouler

stomach, and putrefaction of the contents of their intestines? A human

being is only an extension of his gastro-intestinal apparatus, hence

it is very essential that such apparatus should be in a hygienic

state to ensure his physical and mental resistance and efficiency

being at their normal strength. There is one symptom that causes

more sickness and suffering from infancy to old age than all others

combined--that is, constipation with its attending putrefaction and

foulness of digestive organs. Only a small percentage of people escape

its baneful effects or the secondary diseases induced by fecal and

mucus auto-intoxication. Such a common primary symptom must have,

necessarily, a common exciting cause or origin. Through many years

of clinical experience as a gastro-enterologist and proctologist, we

have found that inflammation of the anus, rectum, and sigmoid flexure

is the frequent or common cause of constipation. Observation has

demonstrated that a soiled diaper is the exciting cause of Proctitis

and Sigmoiditis in the beginning. Examination of one hundred children

of the “defective class” would show most of them suffering from

chronic Proctitis and Sigmoiditis, with some degree of constipation

and auto-intoxication, and even of those classed as “healthy school

children” a large percentage would show the same conditions. The

continuous invasion of the neighboring tissues by the disease,

the increasing auto-intoxication and constipation, the on-coming

malnutrition, and anemia, the gradual emaciation, are all the while

lessening the vitality and power of bodily resistance of their victims.

The early inception of the malady and its insidious progress, with the

symptoms and diseases resulting, easily deceives the victim as well

as the parents and medical advisers, until the long-pent-up virulence

breaks forth, showing itself in every part of the tabernacle of the

spirit of man, when the removal of the primary cause does little or no

good.

The Department of Health, in examining the sanitary or hygienic

condition of a school building, would not devote all its attention to

the top story to overcome unhygienic conditions; it would probably

direct its attention to the trap and vent of the sewer of the building

to see that there was no retention and filling up of the pipe to befoul

the atmosphere of the structure. Why then so much attention to the head

or top story of the human temple, and so little to the trap and vent of

its sewer? Are modesty and ignorance to defeat the progress of hygienic

measures dealing with the stomach and bowels of our school children?

How long will those abdominal incubators of poisonous microbes and

gases be allowed to infect not only a school building but all its

occupants as well?

The absorption into the system of serous, fibrinous or albuminous

mucus exudations from the invasion of chronic inflammation through all

the layers of the tissues of the anus (Figure 1), rectum, and sigmoid

flexure, as well as through the adjoining fatty tissue in the pelvic

space around the organs (Figure 5), under the skin and between the

muscles of the buttocks, goes on continuously, creating an extensive

inflammable area and source of exudation of broken-down tissues. (See

Chapter III.) It is a grave pathological condition and the source of

mucus auto-intoxication, and its symptoms ought to be differentiated

from those of fecal auto-intoxication. This mucus exudate has an

intensely irritating effect on the nervous system, especially when

an acute intestinal mucus storm has developed, torturing its victims

and unfitting them mentally to attend to the ordinary duties of the

day. Very often this is accompanied by more or less pain or muscular

soreness. These annoying symptoms occur very early in the history of

Proctitis and Sigmoiditis, and clinical experience has demonstrated

to me and to my students the necessity for infants and children being

examined in order to determine whether inflammation exists in the anus

and rectum, and thus early cut short the progress of the disease and

its numerous and familiar symptoms, which I may here enumerate, to

wit: indigestion, flatulency, coated tongue, foul breath, bad taste

in the mouth, capricious appetite, nausea, intestinal colic, cramps

and pains, diarrhea, headache or band of pain encircling the head with

sense of constriction, neuralgia, pain about the heart, cold hands and

feet, malnutrition, anemia, emaciation, dry skin, seborrhea sicca,

carbonic acid toxemia, sallow complexion, liver spots, jaundice, acute

bilious attacks, drowsy states, mental torpor, bad temper, night

terrors, irritability, melancholia, vertigo, dizziness, loss of memory,

insomnia, drawn face, tired feeling, unrestful sleep, easily fatigued,

subject to colds, catarrhal affections of the ears, eyes, nose, throat,

etc., decay of teeth, dry cough, loss of hair, impaired vision,

sterility, impotency, mucus and membranous cords and casts from the

bowels, sediment in the urine, irritability of the bladder, premature

age, reduced physical and mental efficiency, inability to concentrate

the mind, morbidity, suicidal notions with a view to ending mental and

physical suffering.

I am pleased to inform such sufferers that their ills can be properly

diagnosed and treated; and the earlier in life they seek treatment, the

sooner they will escape the accumulative ills that make existence so

painful to endure.

We have mentioned Proctitis and Sigmoiditis as the primary cause of

intestinal stasis in the majority of cases; later, other sections of

the intestinal canal may be invaded by inflammatory process, causing

a more serious intestinal stasis, not infrequently bringing about

dislocation of the stomach, intestines, and other abdominal organs. We

have enumerated the symptoms and maladies that are now, in the light

of latest medical science, traceable directly or indirectly, to this

primary cause; in short, it may be said that, with the exception of a

few diseases caused by toxic agents, most of the illnesses that cause

so much invalidism, cutting short our lives, can be traced to mucus and

fecal auto-intoxication.

The purpose of this book and others I have published is to educate

my fellow beings as to how to prevent or avoid the many diseases and

symptoms that afflict them from the cradle to the grave; already I feel

that I have accomplished something in helping humanity, and I trust

others will do their part to lessen the ills that flesh is heir to

through neglect and ignorance.

CHAPTER XXI.[2]

INTERNAL HEMORRHOIDS OR PILES VERSUS RECTAL MUCOUS SAC, RECTO-ANAL

MUCOUS SAC.

[2] Chapters XXII, XXIII, and XXIV have been revised from Papers

contributed to _Albright’s Office Practitioner, in 1908_.

Before the history of medicine and surgery began, man suffered at

his hinder parts as well as at other parts of his organism. Bodily

ills are as old as the human race, and the flowing of blood from

the “terhinder” was a signal of distress or of physical anarchy, of

which the references to “emeroids” in the Bible and in other ancient

writings bear witness. The “emeroid” doctors of Egypt, in the time of

Moses, unquestionably regarded the distress caused by the “emeroids”

as a disease. And it came to pass that every subsequent Moses that

has written on the subject of hemorrhoids up to the present time has

regarded piles as a disease. And they likewise, all of them without

exception, believe the “disease” to be hereditary, as is certainly

their information on the subject. This mental obsequiousness of the

proctologists of our day is indeed quite a long-drawn-out compliment to

the pile doctors of Egypt, since our proctologists still continue to

diagnose piles as a disease and “to smite the smitten of emeroids.”

I have always respected the idea of ancestral worship and of reverence

for the dead past, but at the same time I have felt that one should not

be wholly oblivious to their egregious mistakes.

If Moses, Samuel, Herodotus, Hippocrates, Galen, and other illustrious

men had said that “emeroids” is a symptom of a disease, what a blessing

they would have conferred upon suffering humanity. The simple use of

that one word would have been illuminating, and would have set the

tide of attention for the proper diagnosis and treatment in the right

direction. Possibly some one more bold than the servile brotherhood

did see and say that it was a mere symptom, but, if so, his temerity

was treated by “the wise ones” of that day as similar innovations

are treated to-day, with a “Tut, tut, tut; pugh, pugh, pugh. We know

better, and we refer you to the following chapters in Holy Writ and to

the classical work of the great Medi Cusus on ‘Pilus Diseasicus.’ And

besides, have you no respect for the superior clinical advantages we

enjoy?”

Notwithstanding the bad odor in which I shall be held, I will nerve

myself to claim that, when the ancients considered and called piles or

hemorrhoids a disease, they made a very grave and palpable mistake, and

that, having made this mistake, it was inevitable that numerous errors

should follow logically in its train when they attempted to account for

the etiology, character, and means of cure of this “disease.”

Pruritus ani is also called a disease, and a similar bedlam of reasons

is offered as causes and means of cure, all of which accounts for the

many, many pages of a book filled to overflowing by a “classical”

author, with compilations of the redeeming gospel truths on this

subject from prehistoric times till the present day, including his

own commentary, guesses, interpretations, and surmises. Ignorant as

he is of the nature of this symptom, the conjectures of his perfervid

imagination are “to laugh.” The errors of one or more authors, endorsed

by the mistakes of others, seemingly make a truth to minds that are

vassals to authority, which accounts for much of the useless medical

literature of to-day and for the mistakes of those that are misguided

by it.

Considering the pathological condition, it would be better if we were

to give a more definitive characterization to it than “piles” or

“hemorrhoids.” In accordance with the distinctive exhibit contemplated,

we should describe it as a rectal mucous sac, an ano-rectal mucous sac,

or an ano-muco-cutaneous sac. These are more distinctive and suitable

designations for these symptoms of chronic proctitis, inasmuch, by

such designations, we call attention to the fact that they are simply

constricted mucus[3] channels and sacs, with engorged arteries and

veins, formed by the serous exudation that accompanies inflammation.

[3] I found it more convenient to use the words mucus channel, mucus

fistula, etc., in preference to sinus, as they better convey my ideas

to the average reader.

If a recto-anal mucus channel, under one or more layers of the mucous

membrane, becomes constricted or obstructed (they usually do), its

epithelial wall will become sacculated, and then we have a rectal

mucous sac, or an ano-rectal mucous sac, or an ano-muco-cutaneous

sac, all of which may be present in the same case. The inflammatory

exudation called serum distends and destroys fatty tissue, which makes

space for its lodgment under the tissue that imprisons it, and at the

same time there occurs more or less proliferation of the cells of the

tissue involved in the severe inflammation. The internal sphincter

muscle, by its contraction, aids in the undue retention of the mucus

and blood above it, hence the so-called pile-bearing region--that

is, the sacculated mucosa region. The serous exudation meets with

obstruction along the anal canal and the mucosa is sacculated. When the

integument around the anus offers obstruction to the flow of serum and

blood, we find that muco-cutaneous sacs are formed around the anus. If

the exudation occurs in the areolar space under the ano-rectal mucosa,

it readily passes down into the areolar space under the integument

around the anus, and thence to parts deep, devious, and far away, as

described in Chapter III.

Channels, reservoirs, sacs, that would hold from one to eight or

more ounces of fluid, no longer excite my wonder and amazement at

the extensive and serious pathological condition of which they

are exhibits, a pathological condition that occasions symptoms

often diagnosed as sciatica, rheumatism, myalgia, caries of the

coccyx, coxitis, prostatitis, pruritus ani, scroti, and vulvæ,

auto-intoxication, anemia, invalidism, etc.

Inasmuch as we have learned the cause of sacculated mucosa at the

lower end of the rectum and over the anal canal and of the integument

around it, we had better in future omit the following designations and

distinctions, which are merely a ridiculous display of sciolism. Surely

we can do without them, and ought to do so for the sake of truth and

simplicity. With a sigh of relief let us in future ignore: Safety-valve

piles, organized piles, itching piles, blind piles, bleeding piles,

moon piles, cutaneous piles, thrombotic piles, external and internal

pile tumors, venous piles, ulcerated piles, capillary piles,

mixed hemorrhoids, arterial hemorrhoids, white hemorrhoids, acute

hemorrhoids, chestnut hemorrhoids, chronic hemorrhoids, inflammatory

hemorrhoids, hypertrophic hemorrhoids, atrophic hemorrhoids, Egyptian

piles, Philistine itching hemorrhoids, etc.

Quite naturally such a variety of “diseases” called forth many sorts of

surgical operations for their removal, of which the following are the

ones most in vogue: Clamp and cautery, ligature, crushing electrolysis,

excision, submucous ligation, the Whitehead operation, the Earle

operation, the American operation, etc.

Forget them all, forget all of the senseless terms that are employed

to describe a supposed variety of “disease” and all of the barbarous

procedures for their banishment, and the banishment, alas! too

frequently, of the wretched sufferer likewise.

Study carefully the varieties of chronic inflammation and the character

and extent of the exudation in each case. By so doing you will

ascertain the nature of the many varied symptoms of proctitis, of which

the following are the most common: Sacculated mucosa and integument,

submucous and subtegumentary channels, reservoirs, pockets, fistula,

pruritus ani, fissure- or ulcer-in-ano, constipation, diarrhea, etc.

Proctitis may present a chronic, a subacute, or an acute stage, with an

atrophic or hypertrophic condition, or a less marked structural change

in the tissue. If proctitis were treated early in its inception, none

of the above-mentioned symptoms would have occasion to develop. When

mankind becomes properly enlightened on the subject of proctitis, due

attention will be given to it long before so many annoying symptoms

occur.

Ano-rectal mucous sacs, formed by the serous exudation into the

connective tissue and stasis of the blood, are the slightest symptoms

of proctitis, and by far the most easily removed.

Since we have found out what are the symptoms and what is the disease,

it naturally follows that in treating a sacculated mucosa we should be

governed by the character of the proctitis, whether it be in a chronic,

subacute, or acute stage. If the inflammation be acute, no matter

whether or not there is a general prolapse of the sacculated tissue, it

may be well to delay the treatment for removal of one or more mucous

sacs until we have in a degree overcome the acute inflammation by the

use of a shallow sitz bath, Fig. 23, and by the use of a soothing

ointment and liquid remedy, to meet the depurant requirements of the

case.

The removal of the chronic inflammation, in whatever state it may be

found, should be a paramount feature of the treatment from the time a

case comes under one’s care. The cure of the disease ought to be of

more importance than the removal of a symptom or symptoms. Should there

be bleeding from a mucous sac, or should there be prolapse of it, or

both, immediate treatment will give relief at once, and the sufferer

will think you have performed a miracle, especially if the annoyance

has existed for many years.

After the immediately annoying mucous sacs are removed by the

hypodermic method, a physician can doubly guard his reputation in

the painless treatment of mucous sacs by delaying further treatment

of those remaining sacs, which, if treated, might occasion special

annoyance, till such a time as the general inflammatory condition is

much improved; but in the interim he may treat the mucous sacs that are

located above the sphincter muscles, and the granular and ulcerated

regions.

For the almost universal success in the painless removal of mucous

sacs, the operator should be in possession of all of his normal wits

and senses, so that his judgment will be at its best when the following

points present themselves:

What to treat.

When to treat it.

Where to treat it.

How much to treat of it.

The quantity of remedy to be injected--all of which require discretion

and good technique.

By the hypodermic method of treating mucous sacs some escharotic is

employed with the object of causing the absorption of the sacculated

mucosa. The object to be accomplished ought to determine the proper

strength of any escharotic used. Whatever will absorb the mucous

membrane involved in the sac in the slowest and mildest manner is the

best remedy or the best way to employ any of the tissue absorbers

you might select. And another fact: the lower the per cent. employed

the larger the quantity that may be used at a time, and this is

desirable if the area of a sac be large and you wish to absorb the

greater portion of it. A skillful operator will make sure to have the

escharotic used cover just the amount of the mucous sac desired, and

no more. Physicians that are not aware of the channeled and sacculated

character of the mucosa in the case of “piles” or “hemorrhoids” are

liable to introduce the escharotic into the base or the center of

the mucous sac with the hypodermic needle; and in such an event the

remedy often enters a cavity or a channel, or both, and naturally

it finds its way along the channel to the integument at the anus,

whence, as a consequence, a deep, ugly fissure-in-ano is in a short

time to be reckoned with by the patient and the physician, because

of the destruction of the epithelial wall of the channel. The patient

thereupon is far from being in a good humor, and the physician wonders

how the thing happened, and he feels like quitting practice altogether,

and doubtless many have done so; and certainly every one should do so

if such an error were to occur a second time.

The object we wish to accomplish is to absorb the wall of the

sacculated mucosa. Therefore the remedy should be injected at the

apex of the sac, in the epithelial layer, or slightly deeper, if the

occasion demands it. The area of the sac and the thickness of its walls

must be taken into consideration, and will suggest the amount of the

escharotic to be used.

A proper speculum is very essential to the successful treatment of

sacculated mucosa, and I know of none equal to that devised some thirty

years ago by Dr. A. W. Brinkerhoff. The speculum is easy to introduce,

and by drawing a slide the tissue is properly exposed or shut out to

a nicety, exhibiting just the amount you wish to treat. In some cases

there is a rather lengthy sacculated mucosa on the side, or on the

anterior wall of the anorectal tube, and it is advisable to treat only

the upper third or half, and at a subsequent visit or visits to treat

the remainder, thus avoiding annoyance to the patient.

The paramount concern should be to avoid causing pain both during the

treatment of a sacculated mucosa or its possible occurrence a few

hours or days later. I have often remarked that when pain or soreness

follows the treatment of a mucous sac the fault is in the application

of the remedy, and not in the remedy itself. Now and then there may

be conditions in which you will expect pain or soreness to follow

the treatment, and you will prepare your patient with the necessary

appliances and remedies to overcome it promptly. Where there are no

possible means for avoiding the pain consequent upon a treatment, leave

nothing undone to make it as slight as possible. All mucous sacs ought

to be treated without any after-annoyance to the patient, and they can

be if we only wait for the proper time to treat them.

I have not thus far considered the muco-cutaneous sacs around the anus,

which are neither useful nor ornamental, and which often indicate the

volcanic action of inflammation and the amount of mucous lava thrown

out around the vent.

CHAPTER XXII.

EXTERNAL AND THROMBOTIC PILES VERSUS MUCO-CUTANEOUS SACS AND THROMBUS.

The vent of a crater indicates the convulsive and destructive changes

that have taken place within; and, very often, the vent of the

gastro-enteric sewer gives like evidence of long, great, and severe

destructive changes. The fire of inflammation has burned fiercely

for many, many years, and serous lava has, from time to time, poured

forth, leaving a searing, inflammatory path. As it was forced from the

recto-anal crater, the acrid, burning mucus, that had been imprisoned,

made subcutaneous streams, cavities, channels, sacs, etc. Its course

is marked around the anus by peaks, crags, muco-skinny tabs, small and

large bulging muco-cutaneous sacs, dilated anal veins in which clots

of blood often form; light gray, brittle, shiny skin with small and

large red and sore oases, thickly studded over the itching area, which

the sufferer has scratched in the vain hope of appeasing the torture

of pruritus ani, scroti, vulvæ; while cold drops of perspiration stand

over his or her face and body, serving to indicate the physical and

mental anguish inexpressible in words.

Muco-serous exudations under one or more layers of the recto-anal

mucous membrane finds its way down to the integument around the anus,

and being of a very irritating character, greatly increases the

inflammatory process in the tissues it comes in contact with. Thus

the increased inflammation and blood stasis and the augmented serum

unite in hurrying the development of skinny tabs and the more or less

capacious muco-cutaneous rugæ and sacs.

When the serous exudation takes place entirely under the recto-anal

mucous membrane, there may be formed a large muco-cutaneous anal sac,

especially on the right or left side of the anus, or the serum may pass

under the integument about the anus with little or no anatomical change

in the appearance of the skin at or about the anus. In the latter case,

an experienced eye can detect sufficient evidence to diagnose the

destructive changes wrought by the presence of serum in the connective

tissue under the skin and ano-rectal mucous membrane.

The skin is not, as it should be, held fast by the connective tissue,

but lies loose over the cavity; and a similar pathological condition

exists under the mucous membrane of the anus, rectum, and sigmoid

flexure, which circumstance might lead one, in some instances, to

conclude that there was almost an entire separation of the mucous

membrane from the areolar tissue, by the ridges, folds, large,

pouched, prolapsed, sacculated regions of mucous membrane that has

the appearance of having been simply carelessly laid over the muscular

structure of the organs. When we observe such destructive changes

by the invasion of serous exudation under the mucous membrane, we

have every reason to expect periproctitis and perisigmoiditis, with

the possibility of the formation of pus occurring with the usual

consequences. So remarkable and serious are the excursions of the

mucous currents into healthy neighboring tissue that we find a symptom

of a disease vastly more annoying and serious than the disease itself.

Is it any wonder we find stenosis (narrowing of the passage) of eight,

ten, or more inches of the lower portion of the large intestine, which

is usually diagnosed atony of the bowels? Surely, you must by this

time appreciate the reason I made so strong an appeal for the twice

daily use of the enema as a means of relief. You need the combination

of many aids over a long period of time to effect a cure of proctitis,

etc., and its numerous symptoms. Proctitis and colitis is a serious

affliction, and should have your undivided attention with the hearty

co-operation of the patient in effecting a cure. How foolish is the

practice of removing one or two annoying symptoms (piles and fistula)

and leaving the sufferer untreated, the disease itself and the other

symptoms not so apparent at the time of the operation, and then dismiss

the case as cured! Shame on such practice, in which ignorance and

cupidity dominate! Humanity cries for a correct diagnosis and a humane

treatment!

The profuse serous exudation resulting from proctitis and sigmoiditis

makes its way from the diseased area into the neighboring regions

like lava from an active volcano, carrying with it an intense burning

inflammation, destroying normal fatty tissue as it advances, owing to

its extremely acrid character. Is it any wonder that we find dilated

veins and arteries in the lower rectal and ano-rectal canal and around

the anus where stasis of the blood has existed for a great many years?

The real wonder is that thrombus in the veins around the anus does not

occur more frequently than it does. What is the necessity of calling

such a pathological change in the caliber of a vein and the weakening

of its walls “thrombotic pile”? Thrombus is a clot of blood in a

vein, and there is no use in adding the word “pile.” The aggravated

character of the inflammation accounts for the hypertrophied and the

cicatricial tissue so often found around the anal vent of proctitis

cases. The Biblical suggestion that sacculated mucosa, commonly termed

piles or hemorrhoids, is a disease, accounts for the numerous names

used to designate the particular variety of the disease--whether it be

an internal or an external pile tumor. It is very wrong to so mislead

“scientific” medical men. Had they only known that the numerous sacs,

bags, prolapsed pouches, longitudinal and transverse folds of the

ano-rectal mucous membrane, and the ragged, jagged, prolapsed, pouched

muco-cutaneous tissue around the anus, as well as the fissure-in-ano,

pruritus ani, fistula, are only symptoms of a disease, all of the many

abnormal changes and the other symptoms could have been prevented many

generations ago by simply treating their exciting cause. But it is

never too late to learn things that will benefit mankind.

Don’t for a moment think that all of the structural changes on the

mucous membrane and about the anus mentioned above indicate an

affliction only skin deep, or even the depth of the mucous membrane.

They are far worse than that. You will find all the muscular structure

of the anal organ and that of the rectum sigmoid flexure severely

invaded by the inflammatory process and its fibrinous exudation, and

also the external tissues that surround and support the organs.

We have circular and longitudinal muscular tissue entering into the

structure of the anus and rectum. The sphincter muscles are two large

and strong muscles that close the anal orifice and guard its vent very

effectually if they are not destroyed by a surgeon’s knife.

The acrid burning serum coming in contact with the muscular tissue

excites an aggravated inflammation in its structure as elsewhere. The

constant irritation results in more or less permanent contraction

of the sphincter muscles in which fibrinous exudation takes place,

binding the contracted muscular fibers together. In time their

expansibility is lost in many cases, and in other cases partially so,

necessitating divulsion of the sphincters in order to break up the

adhesions and establish a somewhat normal circulation of the blood in

the diseased parts, also in order to relieve the irritation to the

nerves distributed to the organs and their marked reflex excitement.

In some cases an expansion of the sphincters for one and a half inches

or two inches is quite sufficient; other cases may require a little

more thorough divulsion; but never weaken or paralyze the sphincters,

as your patient needs their normal use, and you need the reputation

of never causing incontinence of feces. Guard the usefulness of the

sphincters as you would a valuable treasure.

As a rule, I treat all of the ano-rectal sacculated mucosa in cases

where divulsion is required before performing the dilatation to break

up the adhesions, and very frequently the muco-cutaneous sacs and

distended veins as well. It may be well to delay the divulsion--with

which there is usually no hurry--until you determine how many U-shaped

(or hairpin shaped) mucus channels and recto-anal mucus fistulas there

may be present that have passed down under the recto-anal mucous

membrane, down to the integument about the anus, and then pressed

immediately upward again along the outer wall of the anus and rectum,

to the extent of six inches or more. There may be three, four, six, or

more of them quite prominent as to length and size.

For the treatment of the recto-anal sacculated mucosa the injection

method is par excellent. For the removal of the muco-cutaneous sac a

double V-shaped incision, the proper depth, length, and width, will

remove the surplus or redundant tissue, after which the edges are

brought together with a catgut suture,--or omit the suture if you think

best,--followed by the home attention as prescribed for fissure-in-ano

in a previous chapter. At the time of removing the sacculated tissue

attention may also be given to the mucus channel; or you may, if

you wish, leave it so that at some future treatment you can give it

the desired attention. A one or two per cent. solution of alypin,

cocain, or beta eucain will produce the necessary local anesthesia

for a painless operation. I remove only one muco-cutaneous sac at a

treatment, which permits the patient to go about as usual without much

inconvenience.

If you have removed all of the ano-rectal sacculated mucosa in a case,

and have omitted to remove the one or more ano-muco-cutaneous sacs

or dilated veins that are so often present around the anus, and have

also neglected to cure the chronic proctitis, then the sacculated

mucosa may, by some hook or crook, become excited again into an acute

inflammatory condition, the sphincter muscles may grip tighter than

usual, and lo, thrombus has taken place in a vein, and the wrinkled,

shriveled, skinny tab or sac looks like a miniature balloon, and your

dismissed patient is in a troubled state of mind to have everything

come back on him so soon!

The cure was all right so far as it went, but there was the disease and

some of the old external symptoms to tell the tale of an incompleted

treatment.

Those muco-cutaneous sacs at the enteric crater’s mouth are just so

many thermometers at its vent to tell the temperature occasioned by the

fire of inflammation within, and they will damage your reputation as

a proctologist if they be not removed. By all means get rid of these

symptoms and indicators of trouble within; and if there should by

chance be a little of the old proctitis remaining that wants to assert

itself by making trouble, in becoming acute, it will be surprisingly

handicapped in its efforts, and the chances are all in your favor; and

you will, moreover, from time to time, hear what So-and-So said about

the very successful treatment of his or her case.

Sacculated mucosa, muco-cutaneous sacs, submucous channels, etc.,

having their source in the rectum and anus, are all of a similar

origin, the result of serous exudation. These symptoms of proctitis

vary in development and number according to the nature and progress

of the disease. In those cases that are quite exempt from sacculated

mucosa (piles) you may expect to find submucous channels largely

developed, and _vice versa_.

Too much stress cannot be placed upon the serious results of

auto-intoxication by the absorption of mucus from channels and cavities

that will hold from three to eight or more ounces of fluid at one time.

They are no doubt rapidly emptied by the process of absorption into the

system.

I have not referred to the fatalities of the hypodermic treatment of

sacculated mucosa (piles or hemorrhoids) because of the fact that none

have ever occurred within my knowledge among those using either this or

a similar method of treatment.

CHAPTER XXIII.

ABSCESS AND FISTULA INVOLVING ANUS, RECTUM, AND NEIGHBORING REGIONS.

Hippocrates, the father of medicine, Celsus, Galen, and other writers

in the early times, described fistula as a disease; and, naturally

enough, through the influence of heredity, contagion, imitation, and

auto-suggestion, every author on the subject to the present day has

chimed in most complaisantly with his “Ditto! ditto! ditto!” “Me

too! me too! me too!” I am sure that the rank and file of my medical

brethren will agree with me that modern authors are hardly justified

in this servility to the ideas of the fathers of medicine in this

recreance to their duties toward suffering humanity. Is it that they do

not know better, or that they are naturally servile and thus too lazy

to do their own thinking?

Let me in connection with this point call your attention to a practice

that many of us have been suspicious of for a long time, a suspicion

that has been confirmed for me by one who speaks from positive

knowledge; otherwise I should not refer to it here. The practice I am

about to describe will make it plain why we have so many “Ditto and

Me-too” authors on proctology and other medical subjects.

An eminent surgeon who mentally is as large as the human race, and

has room for all that is good in medicine and surgery, narrated the

following incident of his career to a learned doctor from Georgia

and myself recently. Snatching occasionally a few moments from a

busy practice, he has prepared sufficient material to make a book,

and desired some competent person to edit it before publication. So

he consulted an ethical co-worker concerning such a person. In a few

days a gentleman called at the doctor’s house to inquire about the

contemplated publication. The caller asked the title and size of the

book, and when told volunteered the startling information that he could

have the work ready in a few weeks’ time, but that in the meantime he

would like to hear the doctor lecture once or twice that he might catch

a few peculiar expressions to use in the work, so that the doctor’s

friends, when reading the book, would say, “That sounds just like the

doctor; that is his style of talking.” The would-be scribe never asked

for the author’s manuscript, so accustomed was he to rely upon the

medical literature to be found in the libraries of the city for all the

information needed. It is hardly necessary to add that the professional

bookmaker was summarily dismissed. The doctor’s manuscript is still

unpublished.

There is a third reason for so many “Ditto and Me-too” authors.

Publishers of medical books naturally desire to extend their business,

and in order to do this they must issue new works of medicine in the

same way that lay publishing houses compete for new works of fiction.

Now, doctors usually obtain professorships in some institution by

paying five thousand dollars or more for them, and in due time a

publisher of medical books will tempt the professor to become an

author. They place before him their great facilities for getting

up a book, arguing that consequently but little or no labor on the

professor’s part is required. They point out to him the fame and honor

the publication will bring him, and at the same time estimate how

much money they will make out of it. In due time a “Ditto and Me-too”

medical brief, résumé, or treatise, is published covering the whole

history of the subject, from Biblical mention of it to the present day.

All of us have observed what a great amount of stuffing or padding

it takes to make a book that is to sell for five or seven dollars.

It occurs to me that it might be wise to get up a conference of

enlightened physicians to take some practical steps or to devise some

laws that will prevent such impositions on the too confiding medical

brethren by unscrupulous publishers that rob them of their hard-earned

income through delusive advertising. Still, before any action is taken

that would result in effectively closing the door to this practice, it

may be as well that the eyes of more of us should be opened that we

may not continue to be duped and stung again and again by “Ditto and

Me-too” scrapbooks with hundreds of pictures. When seeking for new and

better information to help suffering humanity, let us be served for a

little while longer with “rehashed rot.”

Pardon this digression. We will now consider, at first hand, the

subject of fistula.

As a rule, pus in a fistula is a secondary symptom of chronic

proctitis, except those fistulæ that occur from traumatic injury to

the region of the rectum, anus, and buttocks. Early in my practice I

entertained the idea that the formation of pus occurred at the point of

dissolution of the tissue, and that, as the volume of pus increased it

made its way in the direction of least resistance through it, if the

abscess had not been opened by an incision. The idea was well founded

when it was applied to the traumatic origin of an abscess and fistula,

but not when their origin was traced to chronic proctitis.

It may seem incredible to all who read this that a mucus channel or a

fistula can be formed for ten, twenty, forty, or more years before the

formation of pus takes place in it; and that the pus exerts no part

in producing the diameter or length of the fistula, which may have a

capacity of six, eight, or more ounces of fluid. As soon as the chronic

inflammatory process has penetrated one or more layers of the mucous

membrane, mucus channel or fistula-formation must take place. If the

sphincter muscles be rather weak or lax I would not expect sacculation

of the rectal mucosa to occur to any extent. In these cases, however,

the muco-cutaneous channels are usually found quite large and numerous.

Of course the extent of the ano-rectal symptoms in each case depend

upon how severe the chronic inflammatory process has been, and is, at

the lower portion of the enteric canal. Often you will find that the

seat of the most active chronic inflammation is in the middle and upper

portion of the rectum, involving also the sigmoid colon. In these cases

the ano-rectal symptoms are not numerous, if there be any at all, on

the mucous membrane, but under it you may expect mucus channels that

serve as outlets for the inflammatory product.

In every case of chronic proctitis and sigmoiditis submucous and

subtegumentary fistulæ can be found, and my experience in tracing

them warrants me in stating that periproctitis and perisigmoiditis

is present also; the latter pathological condition being due to the

invasion of submucous and subtegumentary channels or fistulæ around the

outside of the structure of the anus and rectum, extending far up into

the neighboring tissues of the pelvic space that support the rectum and

sigmoid flexure.

The formation of pus in a submucous or subtegumentary channel that has

existed for many years does not make it a disease; it is only another

incidental phase added to an already existing symptom of chronic

proctitis.

Mucus fistulæ should be diagnosed and treated early in their formation,

or at least before the tissues involved became so deteriorated as

to form pus in quantity sufficient to occasion the usual period of

suffering, fever, loss of rest and sleep before the pus is freed

from its enclosure. The formation of pus in a mucous fistula is only

incidental and marks a stage in the distinctive changes that have

been going on for many, many years in the tissues involved in the

inflammatory exudation.

The numerous small and large submucous and subtegumentary fistulæ

found in every case of chronic proctitis and sigmoiditis was the most

grave and far-reaching of the numerous symptoms, but for three decades

I have fully realized the baneful effects from mucus irritation, and

the self-poisoning by the absorption of large quantities of serum and

fibrinous septic material from the surface of the mucous membrane

involved, as well as that from numerous long, cavernous mucus fistulæ:

a fearful double source of auto-intoxication, for which it is useless

to prescribe diet, tonics, and travel for building up the system and

restoring the health.

Besides the numerous general symptoms, arising from self-poisoning by

fecal and mucus absorption, we have more or less marked local symptoms

in many cases; and if these be not present, the diagnosis can be made

out from the general debility of the system and the character of the

chronic proctitis and sigmoiditis.

The local symptoms of mucus fistulæ, periproctitis, and

perisigmoiditis are, each of them, universally diagnosed as a disease:

Such symptoms as pruritus ani, scroti, vulvæ, lumbago, sciatica,

myalgia, rheumatism, prostatitis, coxitis, disease of the coccyx,

chafing about the anus and along the thigh and scrotum, difficulty in

getting up after sitting for a while, pain in the back of the neck,

lame back, legs feel tired, and sometimes pain is very annoying,

abnormal color of the skin, painful or sore spots at times, confinement

in bed for many weeks from severe continuous pain in and about the

rectum, etc.

Up to the present time proctologists have paid little or no attention

to proctitis and sigmoiditis, which is a grave disease, with a far more

serious symptom, that of mucus fistulæ of great length and diameter,

extending in all directions in the pelvic cavity and tissues of the

buttocks, the large area of tissue found so full of holes, might be

likened to a sponge occupying the same space. They are very numerous in

every case of chronic proctitis and sigmoiditis.

This will explain why an incidental symptom like pus in a fistula is

commonly called a disease by the “Ditto and Me-too” authors, and why it

is so frequently met with in practice. At some hospitals one-half of

the cases treated suffer from fistula in which pus has formed. Why the

per cent. is not much greater I am unable to explain, except to give

credit to the defensive and restorative power of the human body. If the

periproctitis and perisigmoiditis, brought on by the mucus fistulæ,

is not treated at the same time as the cause, the treatment will be

of no consequence in effecting a cure of the chronic inflammation of

the lower bowels. Every mucus fistula should be located and healed at

the time that the disease itself is treated; then the work will be well

done. Every mucus fistula should be diagnosed and treated before the

breaking down of the tissues reaches the pus-forming stage, and thus

obviate all suffering, annoyance, and possible death. Attention to this

course will ensure your treatment of the disease, and its symptoms, to

be taken in time.

The only hindrance to the successful office treatment of a fistula in

which pus has incidentally formed is the fear that you can not cure it,

or that you will fail, or that at a hospital it could be cured quicker,

better, and cheaper. These ideas are born of heredity, timidity,

fear-habit, power of auto-suggestion, and too much caution on your

part. They are all falsehoods and should not be heeded for a moment.

During thirty years of practice in my specialty I have sent seven of my

fistula patients to a hospital for treatment, and four of that number

I afterwards very much regretted sending, as I could have accomplished

the cure in a safer and better way by the usual office method of cure.

In fact every fistula, pus or no pus,--I do not care how bad it may

be,--can be cured by office treatment and at the same time aided by the

home attentions of the patient. There may be periods of a year or more

when your energies are overtaxed with numerous patients, and you feel

like dividing the labor with some fellow-practitioner, and this in a

measure accounts for those I induced to go, or was willing to have go,

to the hospital.

Unless overwork is the excuse, you need never send a fistula patient

to a hospital for treatment. I have everything to say in praise of

the ambulant treatment of ano-rectal fistula and the mucus channels,

since my practice thus far has been devoid of any unfavorable

results,--a fact which should have much weight in favor of the ambulant

office treatment of all of the many symptoms of chronic proctitis,

sigmoiditis, and colitis.

Mucus fistula is very easily healed in all cases, and those cases in

which pus has incidentally formed are likewise not difficult to cure.

All you need to do is to instill intelligence in a stupid patient, if

you haven’t an intelligent one, and induce him to utilize or improvise

a few home conveniences for cleansing the fistula night and morning

between office visits. During the treatment of the fistula patients

will be able to attend to their imperative duties.

To properly explore a fistula and its branches, if any, as to whether

pyogenesis (pus) has taken place or not, it is essential to have the

external opening through the skin of sufficient depth and size to

permit of the application of remedies over all its surface. For a mucus

fistula antiseptic remedies can be applied after a thorough irrigation

by hot water at a temperature of one hundred and twenty degrees, or

more, for half an hour or less time, as the case may demand. Where

pyogenesis (pus) has occurred in a mucus fistula there may be more

or less necrotic tissue formed, which will require the use of an

escharotic remedy as well as very hot water irrigation, followed by an

antiseptic remedy, if not already incorporated in the hot water used.

As a rule I see a fistula case once or twice a week, as the case may

require. There is no packing of the fistula after the morning and

evening home treatment--I have never found it essential. A T-bandage

is worn, with absorbent cotton, over the opening of the fistula,

preventing soiling of the clothes while attending to daily duties.

Never mind what the “Ditto and Me-too” proctologists have copied or

rehashed about the curing of a fistula, which they persist in calling a

disease. Just be resourceful, safe, and sane in all you do, and every

fistula will get well long before you have cured the chronic proctitis

and sigmoiditis, of which the fistula, as a rule, is a symptom.

CHAPTER XXIV.

NINE RADIOGRAPH ILLUSTRATIONS OF MUCUS CHANNELS AND CAVITIES.

I am indebted to Dr. Caldwell, of New York, at whose laboratory my

patients were radiographed for the very excellent illustrations;

and also to Dr. Albright of Philadelphia, for his assistance in the

radiograph work, while attending my clinic, and who, later, with rare

skill and scholarly ability, presented my discoveries in a large

volume, entitled; _A Practical Treatise on Rectal Diseases, Their

Diagnosis and Treatment_.

The following illustrations can only give a hint of the pathological

conditions that existed. Fig. 1 shows seven, and Fig. 2, eight probes

inserted, which by no means indicate the number of channels or size of

the cavities; twenty-five to fifty or more probes inserted would more

accurately indicate the excursions of the inflammatory exudate.

The seven following illustrations, in which Bismuth Paste was injected,

did not meet my expectations in showing the pathological conditions

that existed. The disappointment was largely due to a desire not to

cause annoyance to my patients, who so kindly consented,

in the interest of science, to being radiographed. In all cases the

paste extended over a much greater area than a casual glance at the

illustrations would indicate. The probes and paste were not inserted

with the idea of making a diagnosis, but simply to suggest research on

the subject by proctologists. All the cases radiographed suffered from

proctitis, sigmoiditis, periproctitis, and perisigmoiditis.

[Illustration: Fig. 1.

Radiograph showing tube (1) in the rectum; 2, probe inserted 8-3/4

inches; probes 2 and 4 pass on left side of rectum; 3 and 5 pass on the

right; all pass into perirectal spaces; three probes are seen under the

integument.]

[Illustration: Fig. 2.

Radiograph showing tube (1) in the rectum; probes 2, 4, 6, passed

on the left and front of the rectum; 3 passed forward; 5 under the

integument along the spine; 7, 8, and 9 probes passed to scrotum and

thigh.]

[Illustration: Fig. 3.

Radiograph showing a large region more or less filled with bismuth

from the anal canal forward and upward, as indicated by lines 1

and 2; a severe case of proctitis, sigmoiditis, periproctitis, and

perisigmoiditis.]

[Illustration: Fig. 4.

Radiograph showing a tube in the rectum and probe passed to the left of

the rectum into the space where bismuth was injected; a case of acute

proctitis, sigmoiditis, periproctitis, and perisigmoiditis at time of

treatment.]

[Illustration: Fig. 5.

Radiograph showing bismuth in a perirectal channel on the left side of

the anus and rectum, which caused continuous annoying pain for many

months.]

[Illustration: Fig. 6.

Radiograph showing a long muco-cutaneous sac and perirectal channel

into which bismuth was injected; a case of proctitis and periproctitis,

etc.]

[Illustration: Fig. 7.

Radiograph showing a tube in the rectum, a long probe and bismuth

in perirectal space, also a probe in a submucous channel; a case of

sigmoiditis, proctitis, periproctitis, and perisigmoiditis.]

[Illustration: Fig. 8.

Radiograph showing bismuth injected in the perirectal space; a case of

proctitis, sigmoiditis, periproctitis, and perisigmoiditis with severe

constipation and indigestion.]

[Illustration: Fig. 9.

Radiograph showing tube in the rectum, a probe and bismuth in

perirectal space, and also a probe in a submucous channel; a case of

proctitis, sigmoiditis, periproctitis, and perisigmoiditis.]

CHAPTER XXV.

CHRONIC MUCOUS PROCTITIS AND SIGMOIDITIS--USUALLY DIAGNOSED AS

CHRONIC MUCOUS COLITIS.

Chronic mucous colitis ought to mean inflammation of the ascending,

transverse, or descending colon. The length of the rectum varies from

five to eight inches, and the average length of the sigmoid flexure

is about nineteen inches; the length of the two organs is thirty or

more inches. Chronic follicular, ulcerative proctitis and sigmoiditis,

extending half, or even the whole length of the sigmoid flexure, causes

great suffering, and the symptoms are similar to those attributed

to chronic mucous colitis. For about thirty years I have positively

known that many of my patients suffered not only from chronic mucous

proctitis, but from sigmoiditis as well, since I was able to make

positive diagnosis of the diseased condition for at least ten to

fifteen inches up the lower bowels.

If the anal canal is inflamed from any cause and not cured, the chronic

inflammation will gradually extend up the whole length of the rectum

and into the tissues of the sigmoid flexure, invading the organ to a

greater part of its length, if not all of it. The sigmoid flexure is

the normal receptacle for feces, and gases, and physiologically and

hygienically ought to be emptied three times in twenty-four hours to

keep it clean for those who are in the habit of eating food three times

a day. The hygienic condition of the sigmoid receptacle is entirely

dependent upon a healthy condition of the rectum and a sensible tenant

of the body; but when chronic proctitis has taken possession of the

rectum and neighboring tissues, it serves no longer as a normal

passageway for emptying the sigmoid flexure of accumulated feces,

gases, and liquids.

At first inflammation causes spasmodic muscular contraction of the anus

and rectum, which in time becomes more and more permanent stricture

as the progress of disease advances, lessening the bore of the organs

until it becomes very difficult for anything to pass into and through

the rectal and anal canals. Inflammation extending from the rectum

into the sigmoid flexure for perhaps its whole length, interrupts its

functions likewise, thus creating another cause for undue accumulation

of feces and gases in the organ; this accumulation of the waste

material of the body becomes very foul, generating toxic gases, putrid

substances, and poisonous germs which in turn irritate and excite

the diseased organ from their constant contact with the follicular

ulcerated mucous membrane of the sigmoid receptacle. Why should we

not find in these cases all the symptoms attributed by authors to

chronic mucous colitis? Especially so when we have, in addition to

the enumerated symptoms of colitis, those caused by periproctitis and

perisigmoiditis, which are always present and quite severe.

As a rule, the symptoms which have been diagnosed as those of chronic

mucous colitis, membranous colitis, or ulcerative colitis are nothing

more than symptoms of chronic mucous proctitis and sigmoiditis,

accompanied by periproctitis and perisigmoiditis. Proctologists who

have written on the subject of mucous colitis have noted the many

symptoms very accurately, but have missed the usual location of a most

aggravating disease from which mankind suffers early and late in life.

Authors of books on stomach and intestinal troubles are also groping

very much in the dark and are unable to diagnose the cause of a very

common functional disturbance of the whole digestive apparatus, caused

by proctitis and sigmoiditis, bringing numerous and severe primary and

secondary symptoms to which other diseases may be traced.

Chronic proctitis and sigmoiditis and their local symptoms convert the

sigmoid receptacle into an Augean stable, from which foul poisonous

gases and germs are forced up and along the bowels, distending the

descending and transverse colon and finally reaching the ascending

colon and the cæcum, causing undue retention of their contents; hence

so much attention to the cæcum and the vermiform appendix. The ends

of a long rubber tube distended with gas will exhibit more strain and

disturbance than the intermediate parts, and the same is true of the

colon, owing to the intermediate sections of the organ possessing

greater mobility. The great volume of gases confined in the colon

prevents its normal peristaltic action, causing undue retention

of contents, with resulting inflammation of the cæcum, as well as

dislocation of the stomach, colon, etc., and suggesting radiographic

and fluoroscopic examination and surgical operations to discover the

cause of all the trouble, which should have been learned through use of

the speculum before so many complications occurred.

In all cases of chronic mucous proctitis and sigmoiditis where there

is a great amount of secretion of mucus, membranous cords, shreds, and

casts (called mucous colitis), I have found the marked acute symptoms

more or less periodic and accompanied by increased inflammation in

all the tissues involved in the disease, which convinced me that the

colitis we read about had become dislocated and was where I could see

its results without the use of a speculum.

Through often witnessing the phenomena, I have learned what a

“mucous colitis” storm means from a pathological exhibit, a personal

demonstration, and a verbal description of what the sufferer is

enduring. It requires the stuff heroes are made of to endure chronic

mucous proctitis and sigmoiditis for ten, thirty, or forty years

without the disease being accurately diagnosed, and to be told that

all treatment is useless and that the trouble is in the head of the

sufferer, that he is a hypochondriac, and a neurasthenic, terms often

used by doctors who are unable to make a proper diagnosis of a case.

The common symptoms of mucous colitis have been accepted by writers

on the subject, but as to the real cause of them there has been thus

far only mere conjecture, just as the writers have been doing as to

the cause of pruritus ani, scroti, and vulvæ. Dr. George M. Niles,

of Atlanta, Ga., says: “In looking up the literature, one is amazed

at the divergent views as to the etiology and management held by

diligent students and competent observers. It is fairly well agreed

that most cases occur in nervous, neurasthenic, hypochondriac, or

hysteric individuals.” Others blame the liver, hysteria, constipation,

fermentative processes in the intestines. How foolish to name symptoms

of the disease as a probable cause of it! It is not necessary for me to

again enumerate the many primary and secondary symptoms of proctitis

and sigmoiditis, but I will mention briefly a few nervous symptoms

which I think are due to the absorption of mucus into the system.

There is that intense, exasperating, sore, and restless feeling, with

inability to concentrate the mind, with the nerves and muscles of the

body pinched and contracted. Such feelings are at their height during

an acute mucus storm, which is an indication of increased inflammation

in all the inflamed tissues, causing secretion of a great quantity of

mucus or membranous casts. No doubt much of the inflammatory exudate

from the mucous membrane, from the muscular structure of the organs,

and the connective tissue surrounding and supporting the organs, passes

into the sigmoidal and rectal canals, while a portion is absorbed

into the system. In a similar manner, the inflammatory exudate from

a subtegumentary mucus channel and cavity passes through the skin,

causing moisture of the skin, pruritus ani, scroti, and vulvæ. I know

of no non-malignant disease, where the symptoms may truly be said to

be a thousand times worse than the disease that caused them, except in

chronic proctitis and sigmoiditis.

Treatment of such cases has been very successful in my practice,

requiring four principal aids: (1) Local treatment; (2) medicated

enemata; (3) local medication; (4) the recurrent application of

medicated hot water at a temperature of 125 to 135 or more degrees.

A further valuable aid is the determination of the sufferer to get

well by faithfully carrying out the home treatment. The more a patient

studies my diagnosis and treatment of his case, the more he is

encouraged that eventually a cure will be effected. Dr. James Moran of

this city has been a student and assistant at my office for more than

three years, and will bear testimony to the success of my treatment in

all cases observed by him.

CHAPTER XXVI.

ANTISEPTIC EMPLOYMENT OF POWDERS AND OILS.

DEPURANT POWDER.

Water at a temperature of from 120 to 135 or more degrees is an

excellent antiseptic if properly applied to diseased tissue. Its

anti-toxic, soothing, and healing properties, however, can be vastly

increased by the addition of Depurant remedies. Water of this

temperature, if used in the treatment of proctitis or colitis, should

be applied with the aid of an Intestinal Recurrent Douche.

Water at a temperature of from 90 to 105 degrees--which is recommended

for taking an enema--is antiseptic or depuratory only to the extent

to which it washes away morbid matter from the intestinal canal. To

increase its antiseptic and therapeutic value, as well as to meet other

requirements, Depurant remedies are administered with the water during

the flushing of the large intestine.

The Depurant Powder, prepared by the author, readily dissolves in the

warm water and is brought into contact with every part of the mucous

membrane as far as the antiseptic flushing extends along the intestine,

thus leaving the washed and sterilized canal sweet and clean--a fit

and proper channel and receptacle for the on-coming fecal mass. Here it

may remain about four hours without danger of putrefaction, whereas,

were the passage-way and receptacle foul, the feces would putrefy and

form gases and toxic material in briefer time.

This Depurant remedy is not restricted to intestinal uses; it is

equally efficacious when applied to the mucous membrane of any part of

the body or to the skin. It may be used effectively for washing out the

bladder or the vagina; for syringing the ear; for a mouth wash, tooth

wash, gargle, nasal douching or spray; for a throat spray; for bathing

infants; and for internal use where foulness of the stomach and small

intestines exists. It is also a valuable adjuvant in the use of water

for cleansing, or for hygienic purposes, on all the tissues of the body.

DEPURANT OIL.

Next to the use of water on the mucous membrane and skin as a hygienic

and therapeutic agent, I am partial to some of our delightful oils,

which are bland, non-irritating, and of a pleasing, nourishing,

refreshing effect and exquisite odor.

To the oil selected as the base ingredient may be added other oils,

and finally attenuated powdered substances of therapeutic value in

soothing, purifying, healing, or any other purpose the case may call

for. Pure olive oil is an excellent substance in which to incorporate

Depurant remedies, especially when designed to be taken internally,

by way of the mouth, or applied to the integument of the body. Certain

other oils are equally pleasing though rather expensive. However, an

inexpensive oil usually serves as a base in which to embody the proper

medicinal remedies for Depurant purposes in the treatment of proctitis

and colitis.

By a proper instrument the oil is carried into the intestines with the

water used in flushing the colon, or that used with the intestinal

recurrent douche treatment. The oil, being lighter than the water, is

carried ahead or on top as the water passes up the bowels; and, as

the two liquids open the crevices and folds of the mucous membrane

or canal, every part of the latter is completely covered with the

medicated oil, as with a covering of thin salve, ointment, or a

poultice--in every nook and corner, just where it is most needed and

where it should remain for its hygienic and healing effect.

Every kindly aid should be given a diseased organ, mucous membrane, or

the skin, even if one knows it is for relief only; for the very aids

that give relief are often essential when joined with medicinal or

other treatment in effecting a cure.

It is advantageous in treating bowel troubles to use a rather heavy,

tenacious oil for a base--one that may not be so pleasant to swallow

or to use externally as some of the lighter oils. It is therefore

advisable to have two kinds of Depurant Oil: one for internal use (by

the mouth) and for the skin, the other for chronic disease of the lower

bowel.

_INTESTINAL ILLS._

_By Alcinous B. Jamison, M.D._,

SPECIALIST IN RECTAL, ANAL, AND BOWEL DISEASES, AND AUTHOR OF “HOW TO

BECOME STRONG.”

_Cloth, 277 pages_

The above is the title of a work for non-professional readers on the

cause and cure of many forms of bowel and stomach trouble, and their

consequences, and the scientific treatment of piles, fistula, pruritus

ani (itching), etc.

Science is here reduced to common sense; and the intelligent layman,

following the directions of this book, especially as to “physiological

irrigation,” will be able to prevent the usual daily foul state of the

stomach and bowels. Here is set forth in plain language the accumulated

experience of a thoughtful physician, who for over thirty years has

studied the welfare of his patients in the treatment of those diseases

which are peculiar to civilization. During this long practise, patients

from all parts of the United States and other countries have come to

New York City to be under the humane and skilful care of Dr. Jamison,

who has the unique reputation of never employing the barbarous surgical

and hospital methods in vogue throughout the world. No knife, ligature,

clamp, or cautery has ever been employed by him in the treatment

of even the most aggravated case of piles, or hemorrhoids; and no

detention from business is necessary under his treatment for this

symptom of proctitis.

Dr. Jamison’s discoveries in the line of his specialty have added

much to medical knowledge concerning the etiology and pathology of

proctitis, sigmoiditis, and of their symptoms--hemorrhoids, pruritus

ani, constipation, etc. His diagnosis of these afflictions is original,

as well as his treatment of such ailments--hitherto neglected or

improperly cared for.

Physicians and surgeons of conventional schools of medicine are not

aware that the common cause, and indeed the key, of all forms of anal,

rectal, and bowel trouble is proctitis (inflammation of the lower bowel

and sometimes of the colon); that proctitis is the cause of nearly

all cases of constipation, diarrhea, indigestion, and biliousness;

and that, finally, proctitis is the cause of auto-infection

(self-poisoning) and its outcome--anemia, emaciation, etc.

No book to which physicians have access treats this subject so fully as

“Intestinal Ills,” and yet in this volume it is presented in a popular

manner suited to the common understanding.

The following enumeration of the chapter headings will give an idea of

the scope of the treatise:

1. Man, Composed Almost Wholly of Water, is Constipated. Why?

2. The Physics of Digestion and Egestion.

3. The Interdependence of the Anus, Rectum, Sigmoid Flexure, and

Colon.

4. Indigestion, Intestinal Gas, and Other Matters.

5. Key to Auto-infection.

6. How Auto-infection Affects the Gastric Digestion, and Vice Versa.

7. How Auto-infection Affects Intestinal Digestion, and Vice Versa.

8. The Cause of Constipation and How We Ignorantly Treat It.

9. Cures for Constipation “Fearfully and Wonderfully Made.”

10. Biliousness and Bilious Attacks.

11. King Liver and Bile-bouncers.

12. Semi-constipation and Its Dangers.

13. The Etiology of the Most Common Form of Diarrhea, i. e.,

Excessive Intestinal Peristalsis.

14. Ballooning of the Rectum.

15. Ballooning of the Rectum (_Continued_).

16. Erroneous Diagnoses and Treatment of Bowel Troubles.

17. Costiveness.

18. Inflammation.

19. Proctitis and Piles.

20. Pruritus, or Itching of the Anus.

21. Abscess and Fistula.

22. The Origin and Use of the Enema.

23. How Often Should an Enema be Taken?

24. Physiological Irrigation.

25. Proper Treatment for Diseases of the Anus and Rectum Very

Essential.

26. The Body’s Book-keeping.

27. Selection and Preparation of Food.

28. Diet for Indigestion.

29. Diet for Constipation.

30. Costiveness, Diet, etc.

31. Diet for Diarrhea.

32. A Final Word.

You need this book for yourself and your friends. By making a present

of it to some one requiring its light you will perform an act of

unselfish kindness.

Price, cloth bound, lettered in gold, $2.00, post-paid to any address.

In sending for the book please write name and address plainly. All

orders should be sent to the author:

A. B. JAMISON, M.D.,

43 WEST 45TH STREET, NEW YORK CITY.

End of Project Gutenberg's Intestinal Irrigation, by Alcinous B. Jamison