HOW OFTEN SHOULD AN ENEMA BE TAKEN?
The following lines will show you how advertising is done in medical
journals. "Dear Doctor: The spring being the time for cathartics, I beg
to call your attention to R. L. (yellow label),..."
Why is spring a special time for cathartics? Has the intestinal canal
been obstructed like the Erie Canal during the winter months? With as
much propriety they might advertise: "Dear Doctor: The spring being the
time for bathing, I beg to call your attention to antiseptic bath
soap,..."
I suppose that a sort of annual cleansing of the alimentary canal is
suggested so that the summer heat may be less objectionable, as it
warms up foul bodies. However, attention once a year is better than
none at all, as said of the Augean stables.
Not long ago I had a conversation with the proprietor of a bath cabinet
company, who had given some thought to hygienic measures, and he
considered it essential to flush the bowels with water once a month to
secure "proper cleanliness." This opinion is quite in advance of the
annual cathartic cleansing. Some people may have acquired the habit of
a monthly cathartic "cleansing"; others wash out once a week, and a few
once a day: all of them act from their idea of cleanliness, as they
would perform the ablution of their hands, face and body. There are
some hygienic students who have adopted the idea of "cleansing" the
bowels with warm water once or twice a week, which practice is quite in
advance of the annual or monthly attention. All have reasons for the
manner and time they adopt to "cleanse" the bowels; and yet they find
that they are not cleansed properly, as they still have spells of
biliousness and misery. They wonder at themselves for being so rash and
bold as to take an enema twice a week, and begin to feel that they have
reached a point of positive danger.
One anxiety is that they will weaken the bowels by the use of a pint or
a quart of water once a month, or once or twice a week. Another is that
they will wash away the mucus, leaving the membrane of the bowels as
dry as an oven. Another is that they will form the dreadful habit of
using the enemata. What a pity to form such a cleanly habit! Sorry for
them!
Another stubborn objection is, that flushing of the bowels is not
natural. These foolish objections and fears can be attributed to
medical authors who belong to medical societies. It is very strange how
these authors adopt so many wrong notions about the physiology and
pathology of the bowels. What an erroneous and absurd idea that the
enema should weaken the bowels! Why should it? Exercise ought to
strengthen muscular tissue; and what could give the bowels more gentle
muscular exercise than the proper use of them? Has the reader any idea
of the amount of water requisite for the distention of an elastic
muscular tube, about five feet in length and two and a half inches in
diameter in the widest part? The large intestine is capable of great
distention, as is frequently demonstrated in fecal impaction described
in previous chapters. The quantity is named in gallons. The amount of
water usually injected at one time--from one pint to two quarts--can
hardly be said to distend the bowels at all. I wish the enemata did
have power to weaken that part of the bowel involved in disease. I am
very sorry it does not weaken it. For twenty years it has been
demonstrated to my mind that almost every case of chronic constipation,
biliousness, intestinal foulness, diarrhea, indigestion, self-poisoning
(auto-infection or auto-intoxication) was due to too much activity and
vigor of the lower bowels, this excessive activity and vigor being the
result of chronic proctitis, colitis, etc. To lessen this muscular
irritability, and to devise means to relieve and cure quickly, has cost
me more studious hours than the aggregate of all the other diseases and
symptoms of the lower bowels.
If liquids washed away the mucus from the mucous membrane, the throats
of many individuals ought to be very harsh and dry, inasmuch as six to
eight glasses of liquids pass through their mouths and throats during
every day of twenty-four hours. Even after the "dry feeling in the
throat and stomach" has been bountifully attended to by the owner, the
conversation usually becomes more loquacious and hilarious, and there
is no suggestion that the intemperate person had spent many hours in a
hot desert without water. The frequent flushings they give their
throats and stomachs really do not seem to wash the mucus away.
When a person consults an oculist about an affection of the eyes and
glasses are prescribed, good sense will inform him that the glasses
must be worn while the imperfect functioning of the eyes requires them.
If a limb be fractured and splints be applied, would you worry lest you
form the habit of wearing them? Certainly not; you expect in due time
to recover the proper use of the limb. So if you are compelled to use
crutches you do not worry about forming the crutch habit, for you will
use them as long as needed and discard them at the proper time.
As to its being unnatural to flush the bowels with water, I would say
that it is very unnatural to suffer from proctitis accompanied with its
annoying symptoms, such as constipation, indigestion, diarrhea,
auto-intoxication, emaciation, anemia, muddy complexion, foul breath,
blotches and pimples on the face, each and all of which indicate a
physical debasement.
It is unnatural to wear glasses, crutches, splints, wigs, artificial
teeth, artificial eyes, but many people do such unnatural things. Many
of our habits are not exactly "natural," but they are rational, none
the less; such, for example, as bathing the body night and morning;
cleansing the mouth and teeth after each meal; and the nostrils and
ears several times a day. The frequency of these practices may, with
some people, be unnecessary and useless, but no real harm is done by
their scrupulous cleanliness--physical and mental.
Proctitis is usually worse than it seems to be. This is because of the
insidious progress of the inflammation during the fifteen, twenty or
more years before the local symptoms at the anus or in the anal canal
are sufficiently annoying to compel the sufferer to seek treatment.
Such sufferers are, as a rule, born with the idea that the liver
regulates the whole alimentary canal; and if the sufferer has not this
hereditary notion, his physician will soon impart it to him with his
diagnosis and treatment. The disciple of cathartics, whether the
cathartics be in the form of pills, powders, or solutions, or contain
belladonna and opium to overcome the cramping pain the dose would
otherwise occasion, has no legitimate reason to indulge in the hope of
a cure or of even moderate relief of the real source of trouble--the
proctitis. It is proceeding on the liver theory, when the key is, as
has been shown in these articles, _Proctitis_, inflammation of the
anus and rectum. Physicians ignorant of the key to all bowel troubles
even prescribe strychnine in order to stimulate bowels which have
already an excessive amount of stimulation due to the presence of the
proctitis, which, as has been said, over-stimulates the lower bowels
because of the inflammation.
The chronic character of proctitis of many years' duration, improperly
diagnosed and treated, must necessarily compel a rather long and
continued use of the enema, especially so if not accompanied by proper
local treatment of all the inflamed surface. I should not care to treat
patients suffering from proctitis, constipation, etc., unless they used
the enema twice a day. The feces and gases should escape the bowels at
least twice in twenty-four hours. Any less than two stools a days is
abnormal and will result in infection and disease. You may not always
succeed in having two stools when first treating the local disease, but
what you properly start out to accomplish will be attained in due time.
Free evacuation of the contents of the bowels should occur at least
twice in twenty-four hours. This can be accomplished by injecting into
the colon from one to four quarts of warm water. Before taking the
large injection, relieve the bowels of any gas seeking liberation, and
of course, also, of whatever feces may come readily. Then take a small
injection, using very little water: just enough to bring on a relief of
as much feces and gas as possible. It is not well to drive the gas back
and up into the colon; hence the precaution to suggest a further
passage with a small quantity of water before taking the large
injection.
Enemata, and also the use of the recurrent douche, can in no way be
harmful--if the water be of a proper temperature--to a normal or even
to a diseased bowel; therefore the fear of habit is absurd and should
not receive a moment's consideration. The length of time during which
the enemata and the douche are to be used, whether months or years,
will depend on the character of the disease that made its use
necessary.