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

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

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

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

Fed!!!_"

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

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

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

"Physiological experiments have shown that rapid voluntary movements of the external sphincter ani and the levator ani produce very active peristaltic movements of the large intestine. This effect is produced by the mechanical excitement of the plexus myentericus of Auerbach.

This curious automatic center lies between the two muscular coats of the intestine and controls the peristaltic movements. A person suffering from constipation should make powerful movements of the sphincter ani, and of the levator ani, in as rapid succession as possible, continuing the exercise for three or four minutes or until the muscles are fatigued. The time chosen for this exercise should be either before breakfast or an hour after breakfast, according to the natural habit of the individual in respect to the evacuation of the large intestines."

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

Strange to say, there are in New York physicians who are in the habit of inserting a rubber bougie up their patients' r.e.c.t.u.ms two or three times a week for the cure of constipation. Some, more bold, intrust the bougie performance to the patient in order that a daily dilatation and stimulation may be kept up until "recovery from the disease is effected." Others, more original, order the patient to insert a candle some six inches in length up the r.e.c.t.u.m and allow it to remain ten minutes, with the hope of a "rapid cure."

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

CHAPTER X.

BILIOUSNESS AND BILIOUS ATTACKS.

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

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

"The _bowels_ with sullen vapours cloud the brain, And bind the spirits in _their_ heavy chain; Howe'er the cause fantastick may appear, The effect is real, and the pain severe."

The bilious attack is usually noticed in the morning before food has been taken. The tongue is heavily coated and often so foul that it is necessary to sc.r.a.pe it and cleanse the mouth of disagreeable taste.

Eructations, nausea followed by vomiting of undigested foul-smelling food, and if the vomiting be long-continued, mucus from the stomach and bile that had acc.u.mulated in the duodenum, are sufficient evidence that there was no torpidity of the liver. There is likewise more or less headache, neuralgia, giddiness, hebetude (state of mild stupidity), dejection, confusion of the senses, skin disease, acne rosacea (scarlet redness of the nose and cheeks), eczema, etc. The headache may be seated in the centre of the brain and extend to one or both eyeb.a.l.l.s and be increased by stooping. Should diarrhea occur many of the annoying symptoms are likely not to be present.

In this form of indigestion the bowels are often much constipated, which is usually only a more marked symptom of chronic constipation.

The system now and then vigorously rebels against this chronic condition and an acute bilious attack is the evidence of such rebellion. The whole digestive ca.n.a.l is involved in the rebellion, resulting in the symptoms described and also in a morose, petulant and querulous temper, accompanied by a peculiar, despairing expression,--partly due, perhaps, to regrets of having only _one_ digestive apparatus,--or in some cases, perhaps, of having _any_.

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

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

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

CHAPTER XI.

KING LIVER AND BILE-BOUNCERS.

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

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

Our fathers partook of laxatives, cathartics, purgatives, and in consequence we start in life with teeth, intestines, appendices, out of gear and nervous systems on edge. With unconscious stupidity we continue the fatuous practice. The monarch selected to preside over the functions of human life was the Liver; and it is only with bated breath that any doctor dares question the legitimacy of that monarch's claim.

The loyal subjects of King Liver are ever ready to call out "quack,"

"charlatan," etc., to those who dare repudiate the sovereignty of the Liver.

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

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

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

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

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

CHAPTER XII.

SEMI-CONSTIPATION AND ITS DANGERS.

"At least six times in every fleeting day Some tribute to the renal functions pay, And twice or thrice all alvine calls obey."

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

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

But beside the cases of chronic constipation--both lean and fat--there are many sufferers from auto-infection who have only semi-constipation, or partial evacuation of the feces daily. Though they suffer from the effects of self-poisoning, yet they have no such well-defined symptoms of local disease and functional disturbance as are always found in those who have chronic constipation. Nevertheless, they have disturbances of practically all the functions of the system. Believing as they do that the evacuation of their bowels is complete, they are at a loss to find a cause for the toxemia (blood-poisoning), mal-nutrition, debility and general atony. The symptoms of auto-infection with the semi-constipated are as complex as with the severer cases, but not so well defined. The most prominent symptoms are those connected with the process of katabolism, that is, of degeneration of the tissues, as indicated by their color and texture.

The liver, however, is usually held responsible for the bad complexion, impaired nutrition, constipation and diminished vitality, when really the liver is only indirectly concerned, as made manifest in the previous articles. The seat and source are found to be the diseased colon and r.e.c.t.u.m.

Dr. Treves says: "The colon being the part of the bowel involved in obstruction due to fecal acc.u.mulation, it may be further a.s.sumed that the blocking of the gut will most usually concern its lower or terminal parts. Acc.u.mulation of feces is most common in the r.e.c.t.u.m and sigmoid flexure, and then in the cec.u.m. Ma.s.ses of feces may block the colon at any point, and more particularly at the flexures of the bowel. Still, the three common sites of the acc.u.mulation are those just named. The acc.u.mulation in the colon may a.s.sume the form of a more or less isolated nodule or ma.s.s. Thus a considerable lump may be found in the cec.u.m or sigmoid flexure and the rest of the colon be comparatively clear of any gross acc.u.mulation. An isolated lump may even persist after free purgation. On the other hand, the acc.u.mulation may a.s.sume the form of several isolated fecal ma.s.ses.

One of them may occupy the cec.u.m, another the transverse colon, and possibly a third the sigmoid flexure. The bowel between these ma.s.ses may appear to be fairly clear."

A number of the exciting causes of inflammation of the lower or terminal portion of the large intestine have been mentioned. It cannot, however, be too strongly emphasized that chronic inflammation of the colon and r.e.c.t.u.m results in hyperkinesis (excessive muscular irritability) and contraction of the diseased portion invaded, thereby r.e.t.a.r.ding or preventing the pa.s.sage of feces and gases. A portion of the daily acc.u.mulation of feces in the sigmoid may pa.s.s through the diseased r.e.c.t.u.m every day, but not without increasing the inflammation and the spasmodic contraction; this in time inhibits the elimination of the acc.u.mulating feces, which by undue retention become condensed and hardened. Each day will then be a repet.i.tion of the abnormal and partial effort of the organ to accomplish the act of defecation, and there will be no thought of the c.u.mulative and chronic intoxication (poisoning) of the system from the imprisoned feces and gases.

It may be stated without reservation that the rectal ca.n.a.l cannot be involved in chronic inflammation without involving the a.n.a.l ca.n.a.l, and _vice versa_. One half of civilized people are suffering from chronic constipation, and very nearly the remainder from semi-constipation. The semi-constipated are now under consideration. The chronic cases are those that have a _complete_ impaction of feces in the terminal portion of the sigmoid and r.e.c.t.u.m; the semi-constipated have the usual daily _partial_ impaction, that is, an incomplete or partially successful evacuation of the contents of the bowels: the incompleteness is due to disease of the a.n.a.l and rectal ca.n.a.ls.