The a.n.a.l and rectal ca.n.a.ls are made up of circular and longitudinal muscular bands, which, when invaded by disease, lose their proper or normal sensibility and cooperative voluntary action. The excessive contraction of the circular muscles closes the calibre or bore of the gut, and the excessive contraction of the longitudinal muscles shortens the length of the gut, thus throwing the mucous membrane into abnormal folds which increase the depth of the sacculi, or cavities, between the fibrous folds. In the normal gut the sacculi and bands act as valves to control the descent of the feces. This valvular arrangement and the curvatures of the lower bowels conserve the energy of the involuntary and voluntary nerve force until there is a sufficient acc.u.mulation of feces to excite a normal desire for stool; otherwise the feces would rush upon the a.n.u.s at once and occasion much inconvenience.

Catarrhal inflammation of the mucous membrane of the a.n.a.l ca.n.a.l will sooner or later penetrate the muscular structure of that ca.n.a.l, causing an abnormal irritability and contraction of the sphincter ani and the other tissues composing its structure. The contraction of the a.n.a.l tissues becomes more permanent as the muscular tissues of the structure become cohered or bound together by the process of inflammation.

The normal stimulus and sensation that should precede the act of defecation are perverted or destroyed by the excessively irritable contraction of the sphincter ani, which contraction is occasioned by the presence of feces and gases just above the seat of inflammation, that is, above the a.n.a.l ca.n.a.l or at the lower end of the r.e.c.t.u.m. As the bulk of feces and gases lodged at this point increases, the a.n.a.l contraction becomes firmer in grip, and as a consequence permits no hint of the imprisoned contents until the acc.u.mulating bulk is beyond the power of toleration by the organ. Daily a portion of the lodged feces, or some new addition to the ma.s.s, pa.s.ses the a.n.a.l ca.n.a.l, but the attending irritation or contraction of the muscles prevents any further exit of the imprisoned rectal contents.

CHAPTER XIII.

THE ETIOLOGY OF THE MOST COMMON FORM OF DIARRHEA, i.e., EXCESSIVE INTESTINAL PERISTALSIS.

If you are interested to know why a certain plant does not flourish in the temperature and light to which it has been accustomed, you investigate the soil--the source of nourishment--and thus determine why the downy or velvety appearance has left the flower; why the leaves are yellow, dry or falling; why the stems are withering. Even the most ignorant person knows that the symptoms the plant presents did not bring about the unsuitableness of the soil; that, on the contrary, the condition of the soil is responsible for the plant's present state.

Would it not be unwisdom, therefore, to treat directly the symptoms of decay, instead of treating the soil, or changing it? Just so misguided is the judgment of the physician who prescribes physic or tonics in the case of a person having a foul intestinal ca.n.a.l, a condition destructive of the absorbent and the excretory glands. But members of county medical societies do just such foolish things. Notwithstanding their prescriptions, a point will be reached by the patient where the restoration of his millions of small rootlets, or organic feeders, will be impossible, and like a decaying plant in unfavorable soil he gradually decays or withers, here and there, until finally he topples over before he knows it, probably long before maturity has been reached.

It is not generally known among laymen, nor sufficiently appreciated among physicians, that the ma.s.s of fecal matter normally evacuated from the bowels comes mainly from the blood; and that this ma.s.s is not, as it is usually supposed to be, the residue of the food that has been left una.s.similated. Embedded in the mucous membrane of the colon are tubular glands under the control of the nervous system. When these glands become unduly excited through local inflammation and irritation, the normal flow from them is increased to such an extent that a rapid waste of precious tissue occurs throughout the system, and the vital force--which had taken perhaps years to store--is depleted to the point of exhaustion, sometimes even in a few hours. Almost every one has had some experience of exhaustion following diarrhea.

The increased flow of blood to the mucous membrane of the colon furthers this extraordinary secretion by the glands. As has been pointed out, inflammation, septic poisoning, intestinal foulness, or retained feces, act as irritants on the mucous membranes, thereby drawing the blood to the colon where it is excreted and exhaustion follows. The great danger in diarrhea, therefore, is the rapid depletion of the vital force. But when the small intestines are affected the consequences may be still more deplorable. Then the una.s.similated food is hurried along too quickly for absorption and the body receives but little nourishment to restore its powers. Thus another draught is made upon the sufferer's reservoir of vitality, and hence additional exhaustion. But this waste of tissue, loss of vital force, non-a.s.similation and non-supply, are not so grave as the positive danger of the permanent destruction of the millions of small absorbing vessels (villi) of the small intestine by a continuance of this abnormal irritation. Of course the secretory and excretory glands of the colon also suffer, and we then have costiveness resulting from lack of absorption and excretion.

Abnormal irritability of the bowels is necessarily involved in the inflammatory process known as proct.i.tis and colitis. Increase this irritability to a certain point and diarrhea takes the place of constipation--a much more alarming symptom. Diarrhea is more alarming because the intensified local activity of the excretory glands of the bowels brings on, as has been said, a general exhaustion of the vital powers.

The severity of diarrheal symptoms is much increased by the character and abundance of bacterial poisons. Bacteria find a ready medium in fetid feces, and are absorbed by the excited glands to the degree in which these glands have time and power for absorption. Of course the extent and character of the intestinal irritation have a good deal to do with the severity of the diarrheal symptoms. This irritation is not infrequently intensified by a catarrhal process, or by a lesion of an ulcerative nature. All these forms of irritation bring on "excessive intestinal peristalsis"--which, accordingly, is our definition of diarrhea. The normal peristaltic action of the intestines propels the nutritive as well as the effete material through the ca.n.a.l at a rate that allows of both proper absorption and timely elimination. But when excessive peristalsis occurs, neither absorption nor elimination will be normal or suited to the requirements of the system.

Undigested foodstuffs may become an irritant, or increase, as is usually the case, the established irritation, and thus bring on an acute attack of diarrhea. The immediate consequence of the acute attack may indeed be, and often is, comparatively beneficial, inasmuch as the diarrhea removes the undigested material that occasioned the irritation. When this removal is accomplished, the diarrhea usually subsides without treatment. This is the case, however, only when the patient has committed an infrequent error in diet. When such errors are habitual the burden on the glands of the intestinal mucous membrane becomes intolerable, and the chronic inflammation once established has a tendency to proceed from bad to worse. It will then be observed that digestion becomes more and more impaired. In such a case diarrhea will no longer serve a good end, but will on the contrary debilitate the system. A change to better dietetic habits will then aid, but will not suffice for cure. Only treatment and time will restore the inflamed parts to a healthy tone. When, however, the digestive tract is invaded by any of the many forms of bacteria, treatment will avail little and serious consequences follow rapidly.

Too much cannot be said or done to secure intestinal cleanliness in infancy, childhood and maturity. Mothers and nurses cannot give this subject too much thought and care, since the welfare of future generations depends largely upon intestinal cleanliness, in view of the rich and racy life of our hothouse civilization. We are a people poisoned through constipation and diarrhea: two affections that derange more lives than all other pathological conditions together. Banish alimentary uncleanliness and you take most of the poisons from the human race--poisons that stunt the body and blunt the mind.

The soul of man should dwell in a palace, not in a pest-house; in a human temple, velvety, lined with down, inside and out; in which there are hundreds of millions of lilliputian trappings, fittings and articles of furniture, to carry on the minute and finer functions and chemistry of the soul. The very mult.i.tude of the fine equipments that decorate the temple give it that beautiful blending of color and form which its coating has when in normal condition. They adorn this body-house with health, and supply it with the rich red wine of joy.

The blood is dependent for its richness not only on the digestive fluids, but also on the proper eliminating powers of the system. If you would avoid premature decay you must not neglect the reservoir of vitality, the alimentary ca.n.a.l, but see to it that it be kept clean and pure. Then will the elixir of life spring from an almost inexhaustible fountain. To recur to our plant a.n.a.logy. Keep the soil in your own vegetable garden sweet, for intestinal cleanliness corresponds to soil fitness. Purity of the stomach and bowels is more important than quant.i.ty or quality of food. That defecation should occur normally two or three times in twenty-four hours is more important than that three meals should be eaten within that time. The conveniences for eating and drinking are on every hand, but oh, how few, inaccessible, miserably constructed, and poorly cared for, are the toilet cabinets for the accommodation of the gourmand! Suspenders and silk hats mark the progress of our outer refinement; toilet cabinets and flushing appliances, of our inner. When the _inner_ refinement comes we shall live longer and be healthier.

CHAPTER XIV.

BALLOONING OF THE r.e.c.t.u.m.

To make plainer what has been said of the rectal and a.n.a.l tubes or ca.n.a.ls, consider the sleeve of an infant's gown. This sleeve well represents the rectal tube, the wrist-band the a.n.a.l orifice and tube--an inch or more long. Think of the sleeve or rectal tube as being made up of four layers of material or membranes; and counting from the inside of the sleeve or r.e.c.t.u.m there are (1) the mucous layer; (2) the areolar layer; (3) the muscular layer; (4) the serous layer.

The muscular membrane is itself composed of two layers, and may be said to form the framework of the r.e.c.t.u.m. One layer is composed of circular muscular fibres, and the other of longitudinal muscular fibres. In a similar manner you could make a sleeve out of fine circular rubber bands; then bind them together by rubber strings extending lengthwise of the sleeve. With the circular bands the bore of the sleeve may be contracted or widened; and with the longitudinal bands the length may be shortened or extended. Just so with the corresponding muscular membranes of the r.e.c.t.u.m, in their normal and abnormal conditions.

Outside of the longitudinal muscular bands are the serous and areolar layers, the latter covering the lower half of the r.e.c.t.u.m.

As you look inside the incomplete model of the r.e.c.t.u.m, or rather sleeve, you observe circular muscular bands or fibres which it is necessary to cover with soft spongy or fatty substance in whose meshes are nerves, blood-vessels, etc. This is called the areolar layer or coat. One more layer or coat upon this--the mucous coat--completes the structure. This latter possesses the power of accommodating itself to the distention and contraction of the muscular tube. The mucous membrane is thrown into folds and columns which serve as valves to inhibit the undue descent of the feces, thus a.s.sisting the mucous membrane in performing its office.

The length of the r.e.c.t.u.m varies in different persons, six inches is the average length. It is divided into two parts. The upper part is a little more than three inches long; beginning in front of the third sacral vertebra and extending down to the end or tip of the coccyx. In shape this part conforms to the curve of the sacrum and the coccyx, to which it is attached behind. The lower part of the r.e.c.t.u.m is a little shorter than the upper part, and begins at the tip of the coccyx and extends down with the same curve as the upper part, terminating at the upper portion of the a.n.a.l ca.n.a.l.

Returning to the sleeve again; the portion of it from the shoulder to the elbow ill.u.s.trates the upper part of the r.e.c.t.u.m when partially covered with a serous coat on the side opposite the bore (the outside).

From the elbow to the wrist-band ill.u.s.trates the lower part of the r.e.c.t.u.m, when covered on the outside with an areolar coat.

The wrist-band of the sleeve will represent the a.n.a.l tube if drawn into a pucker and turned slightly backward from the direction of the sleeve of which it is a continuation.

The muscular fibres described above likewise enter into the formation of the a.n.a.l ca.n.a.l or orifice. This orifice is closed by two strong muscles that lie close together and are called internal and external sphincters, which are abundantly supplied with nerves and blood-vessels whose branches extend to the neighboring organs.

Nine persons in every ten have more or less chronic inflammation of the mucous membrane of the a.n.u.s and r.e.c.t.u.m. In time the areolar and muscular coats become invaded by the morbid process, and this increases the irritability of the tissues of the organ.

The change from the normal functions of the a.n.a.l membranes is slow, and the symptoms are not well marked and are consequently ignored for years owing to inexpertness in detecting an invading serious disease, until the time comes when the suffering can no longer be tolerated by the victim of the neglect.

The result of disease to muscular tissue is contraction of its fibres, and the contractions become more painful as the disease increases.

Accompanying the inflammation, there is a more or less inflammatory product secreted between muscular fibres that "glues" them together in their contracted state. And as the a.n.a.l and rectal tubes are made up of round muscular fibres, it is not hard to see how the bore of the ca.n.a.l can be lessened by the slow binding together of its fibres in the contracted state. The fact is that when the a.n.a.l structure is invaded by inflammation, there is more or less stricture of the ca.n.a.l and of the orifice.

Recalling the sleeve ill.u.s.tration, and how the wrist-band was puckered and bent back a trifle so that the contents of the sleeve would not pa.s.s out so easily, suppose you now pucker the wrist-band rather tightly, and suppose there is a forcible descent of sand in the sleeve, the natural result would be a bulging out of the lower portion of the sleeve just above the wrist-band, or place of undue constriction. If the abnormally constricted condition of the a.n.a.l orifice has been growing from bad to worse for years, the locality immediately above the a.n.a.l ca.n.a.l will become dilated or cavernous (caused by retained feces or gases), which cavity is called ballooning of the r.e.c.t.u.m. When a speculum is introduced into the r.e.c.t.u.m (as shown on page 14 of pamphlet _How to Become Strong_), and through it a bent probe is inserted to determine the depth of the dilatation or abnormal cavity, it is as if one were poking inside of an inflated balloon: hence the name.

Anatomists describe the r.e.c.t.u.m as terminating in a forward pouch, which is close to the prostate gland in the male and the lower part of the v.a.g.i.n.a in the female. In some cases there may be such a slight pouch, due to the a.n.a.l ca.n.a.l not following the direction of the r.e.c.t.u.m, and slightly turning backward; but in most cases such a normal pouch is not perceptible or observed through the speculum. The small pouch sometimes found on the anterior wall of the r.e.c.t.u.m I have thought due to a very acute inflammation on the verge of forming abscess, which often occurs in the triangular s.p.a.ce. (See 4 in diagram in pamphlet cited above.)

Immediately above the sphincter muscles on the posterior wall of the r.e.c.t.u.m the greatest dilatation is found (as shown by the bent probe), and extends on each side with less depth about the anterior wall of the r.e.c.t.u.m.

The greater portion of the lower part of the r.e.c.t.u.m, which part is about three inches long, is usually involved in the dilatation or ballooning. Often the upper half or more of the a.n.a.l ca.n.a.l is also dilated with the r.e.c.t.u.m, leaving the sphincter muscles quite bare of fatty tissue, with a.n.a.l length of a quarter of an inch or less.

Your attention was called to a sleeve containing sand, and the bulging or dilatation above the puckered wrist-band that was an inch or more broad. Now suppose there were two strong rubber rings at the lower end of the wrist-band, whose power of resistance to pressure is much greater than the tissues above them forming the wrist-band. Naturally, the tissues which form the upper part of the wrist-band would dilate the same as the terminal portion of the sleeve just above the wrist-band.

Similar changes in structure or formation take place in diseases of the a.n.a.l and rectal ca.n.a.ls which result in ballooning of the r.e.c.t.u.m; and two frail constricted sphincter muscles are left to guard this balloon, filled, as it so often is, with feces and gas.

Chronic inflammation, that results in contraction of the circular muscular fibres, will sooner or later constrict the gut so that it will lose its normal power to expand without causing pain. The a.n.a.l ca.n.a.l may be said to be strictured to the degree in which it is unable to dilate normally, and this strictured condition usually grows from bad to worse.

The first symptom of rectal disease is usually an affection of the a.n.u.s, which affection occasions an inhibition, that is, a reluctant permission for the pa.s.sage of the feces; and this inhibition results, consequently, in some degree of constipation. And this constipation reacts more or less on the peristaltic action of the bowels and in time defeats the function of peristalsis. All this will react on the inflammatory processes at the a.n.u.s, which originally engendered the constipation. The narrow and contracted strait or ca.n.a.l through which the feces must pa.s.s, gives a tape-like shape to the stools.

The a.n.a.l and rectal mucous membrane is of a firm and tough structure, similar to the integument at the bottom of a boy's heel. After many years' observation of diseases of the a.n.u.s and r.e.c.t.u.m I am forced to conclude that as a rule inflammation exists in the tissues twenty or more years before the severe symptoms, such as piles, fissure, a.n.a.l pockets, pruritus, hypertrophy, atrophy, tabs, abscesses, and fistula, are sufficiently annoying to compel the sufferer to seek medical aid. I believe it to be of as much importance to give early attention to disease of the a.n.u.s and r.e.c.t.u.m as to teeth and eyes, or even more.

CHAPTER XV.

BALLOONING OF THE r.e.c.t.u.m--Continued.

In the last chapter a description was given of the anatomy of the a.n.u.s and r.e.c.t.u.m; and it was shown how a chronic inflammatory process involving these organs develops stricture in the parts invaded; and it was shown how a partial stricture of the a.n.a.l ca.n.a.l results in ballooning or dilatation of the lower part of the r.e.c.t.u.m. The primary cause of all the symptoms of rectal disease is chronic inflammation (proct.i.tis) involving the whole structure of the a.n.a.l tubes and in a few cases the sigmoid flexure as well.

Perhaps the first marked symptom of disease of the r.e.c.t.u.m is constipation, semi-constipation or of chronic character. The function of the a.n.u.s and r.e.c.t.u.m being disturbed by the inflammation, the fecal ma.s.s is unduly retained and its moisture is absorbed by the system.

This accounts for the condensed and hardened fecal ma.s.s in isolated lumps of various proportions. A hard-formed stool is abnormal, and is evidence of auto-infection. When three-fourths of the normal fecal ma.s.s has been re-absorbed by the system, does it not stand to reason that the blood and tissues have been poisoned by their own waste products (auto-intoxication) and that anemia, emaciation and local disturbances of other organs of the body are symptoms of such intoxication?

The loading and blocking of the sigmoid flexure come from _too much activity or irritability, due to inflammation, of the upper half of the rectal tube_. A consequence of this excessive sensitiveness is a diminished or perverted normal stimulus, notice or desire, that the act of defecation should take place.

The victim of proct.i.tis simply forms a habit of daily soliciting an evacuation, though the normal invitation or desire to stool may be entirely absent, and the evacuation in such cases is attended with more or less delay and straining effort to accomplish partially or wholly the expulsion of the more or less insp.i.s.sated feces.