The question of the origin of tumors or new growths is also an extremely important one; and it is undoubtedly true that many tumors arise where there was a previous inflammation, this being especially the case in tumors of the r.e.c.t.u.m. Why such a growth should arise in some cases and not in others is as yet unknown, though microbes are held by many to play an important role.

When an inflammation has lasted for such a length of time that it has become chronic, a new tissue will sooner or later be produced in varying amount; and this newly formed fibrous connective tissue may entirely replace previous normal structures. Through the exudation and consequent changes in the normal tissue a large amount of mucus is at first secreted, but this secretion becomes less and less marked the more the inflammation causes a desquamation of the epithelia.

p.r.o.nounced desquamation with new formation of connective tissue and no fresh exudation will, sooner or later, occasion dryness--this dryness being sometimes very p.r.o.nounced. The longer the inflammation lasts, the severer it will be; and the greater the amount of tissue it attacks, the more will the normal tissue be destroyed and replaced by a new connective tissue. A partial destruction will cause shrinkage of the organ (so-called "cirrhosis"); while a complete destruction of certain parts will result in what is known as "atrophy" (a wasting away of normal tissue). In atrophy the blood-vessels as well as the original connective and epithelial tissue are destroyed; while the newly formed tissue leads to hypertrophy (excessive over-growth) of other portions of the organ. Such a hypertrophy must not be confounded with an induration that may be present later, or even at the very commencement of an inflammation, due to modification of the blood-vessels and surrounding tissues.

Chronic inflammation, sooner or later, leads to secondary degenerations, that is, new products of the protoplasm, the most common of which is fatty degeneration. In this form fat granules and globules arise, which are at first minute, later on larger; these in certain organs, such as the liver, may become so p.r.o.nounced as to entirely replace the original tissue. Another degeneration--which, however, is found only in chronic systemic disturbances, such as tuberculosis or syphilis--is the waxy or amyloid degeneration, a peculiar chemical change the exact nature of which is unknown.

Various chemical changes are by no means uncommon.

An important question is the decision as to the length of time an inflammation has lasted; and this at best can be determined only approximately and after long experience. The older the inflammation, the more the connective tissue has developed; this connective tissue is at first soft, but soon becomes more and more dense; the result being a varying degree of hardness of the organs.

Again, secondary degenerations are more p.r.o.nounced in long-standing processes. In comparatively fresh cases blood-vessels are still more or less numerous and the tissue appears red, while in older cases these vessels become completely obliterated, and the tissues take on a white, glistening color, becoming harder and denser as the years advance. If a process has lasted twenty or thirty years, the changes to the eye and touch are practically the same as after forty or sixty years.

The changes, as here described, will be the same upon any mucous membrane; and in the large intestine can be easily studied and are perfectly characteristic.

Rarely does an infant escape repeated attacks of inflammation of the integument of the a.n.u.s and the mucous membrane of the a.n.a.l ca.n.a.l. The inflamed integument is treated and healed, but no attention is given to the inflamed mucous membrane so that the inflammation in time becomes chronic, involving the r.e.c.t.u.m also. Should the infant be so fortunate as to escape inflammation (proct.i.tis) of these organs during the wearing of the diaper, there are numerous other exciting causes of inflammation which it will not be likely to escape, hence the almost universal symptom of constipation among civilized people; and hence later in life you hear the familiar expression, "I have a touch of the piles," and many other complaints of bowel ailments that are usually the outcome of that deplorable inflammation.

I have endeavored to make clear the fact that inflammation destroys normal tissues and blood-vessels, and that the newly formed tissue is cicatricial in character, that is poor in cells and vessels, with a tendency to contraction which of course lessens the bore of the gut.

When the hypertrophy or thickening is extensive the appearance of the mucous membrane suggests the addition of one or more thicknesses of a chamois skin added to the inner surface of the a.n.a.l and rectal ca.n.a.ls.

The hypertrophied or newly formed tissue may be limited to the r.e.c.t.u.m, leaving the a.n.a.l tissues comparatively exempt from the superabundant cicatricial formation; or the hypertrophy may involve, to quite a degree, only the a.n.a.l tissues and the integument around the a.n.a.l orifice. The added connective tissue about the a.n.u.s forms the skin into tabs, or into a circle of elongated integument around the orifice, with a mucous lining. These hypertrophied tabs or folds, like pruritus ani, are symptoms of proct.i.tis.

Proct.i.tis (the inflammation of the a.n.a.l and rectal ca.n.a.ls) is the most common and serious disease that afflicts man. The system is not only poisoned by bacteria and filth through proct.i.tis, but proct.i.tis is also the cause of the many annoying and painful local symptoms, such as hypertrophy, piles, abscess, fistula, cancer, polypus, fissure, pruritus, etc.

When the subject of proct.i.tis is better understood by laymen they will see to it that the r.e.c.t.u.ms of children receive an examination before the children are six years old, and thus obviate the necessity of dosing them with all sorts of medicine that follow improper diagnosis.

CHAPTER XIX.

PROCt.i.tIS AND PILES.

Piles (hemorrhoids) are not the result of either the normal or abnormal growth of the tissues of the a.n.a.l and rectal mucous membrane. They are developed by the combination of pathological and physiological conditions: (1) chronic inflammation or proct.i.tis; (2) stricture of the a.n.a.l ca.n.a.l and lower portion of the r.e.c.t.u.m, which may be spasmodic, or more or less permanent, which stricture pinches or constricts the ca.n.a.l, thereby inhibiting the circulation of the blood; (3) the pressure or straining effort during the act of defecation, occasioned by the constricted ca.n.a.l, which effort brings on greater local congestion and constriction of the tissues.

Pile formations are a symptom of chronic proct.i.tis of fifteen, twenty or more years duration. Proct.i.tis (inflammation of the a.n.u.s or r.e.c.t.u.m) and periproct.i.tis (inflammation of the connective tissue about the r.e.c.t.u.m) are by no means uncommon inflammatory processes. The mucous membrane like the skin is liable to injury or poisons and especially so at the orifices of the body. Let inflammation set in: if it be not cured at once, it will invade the ca.n.a.l, especially a ca.n.a.l like the r.e.c.t.u.m; in which case it will establish itself throughout from six to ten inches of its length, sometimes taking in the sigmoid flexure and even the colon. Just how long chronic inflammation confines itself to the mucous membrane before invading the areolar or lace-like connective tissue and the muscular tissue of the organ, I am unable to state.

The first symptom or indication that all the tissues are involved in the inflammatory process will most naturally be constipation. You have observed that inflammation of a portion of the skin on the arm, trunk or leg does not disturb the muscular movements of the region involved, except when the muscles underneath the skin are affected also, as in the case of deep burns where the movements are very much disturbed by the irritability, soreness and contraction of the diseased muscles.

There is also an adhesive product excreted from the inflamed tissue that binds the muscular fibres of an organ together, and you have contraction of the organ and its usefulness impaired. Now, as this is precisely the pathological or diseased condition which chronic cases of proct.i.tis and periproct.i.tis present, you will readily understand how spasmodic and partial stricture or contraction occurs in the sore muscles (circular and longitudinal) of the a.n.u.s and r.e.c.t.u.m. The length and the bore of the ca.n.a.l are diminished, and thus the circulation of the blood arrested by the pressure or gripping of the contracted muscles. This congestion of the blood brings about an anatomical change in the structure of the mucous membrane, which we call piles: a mere symptom of inflammation.

Medical authors have defined inflammation as follows: "(1) A series of changes const.i.tuting the local reaction to injury; (2) a series of changes that const.i.tute the local attempt at repair of actual or referred injury of a part; (3) a series of local phenomena that are developed in consequence of primary lesion of the tissues and that tend to heal these lesions; (4) the method by which an organism attempts to render inert the noxious elements introduced from without or arising within it; (5) a disturbance of the mechanism of nutrition of an organ or tissue, affecting the structures concerned in its function."

These effects or changes give rise to the five cardinal symptoms of inflammation: pain, heat, redness, swelling and impaired function (dolor, calor, rubor, tumor, functio laesa).

Proct.i.tis may exist many years before the pain and heat become noticeable or are complained of by the victim of this insidious disease, the bodily symptoms of which are well expressed before the local trouble demands attention and treatment. The sufferer from proct.i.tis is unable to detect the change from a normal color of the mucous membrane (a light, muddy gray) to an extremely abnormal one (a fiery redness). The swelling or puffiness of the mucous membrane becomes more marked as repeated attacks of subacute and acute inflammation occur, from year to year, over a period of twenty or more years. During all this time impairment of the function and structure of the a.n.a.l and rectal ca.n.a.ls is incessantly going on. The nervous and muscular spasmodic contraction of the diseased a.n.u.s and r.e.c.t.u.m, which in time become more or less permanently constricted, steadily increases the stagnation and engorgement of blood in the dilated arteries, veins, arterioles, venous rootlets and capillaries. All of the circulatory vessels, especially the smaller ones, become enlarged, varicose; and an aggregation of varicosed vessels forms a tumor called a pile or hemorrhoid. Inflammation interferes with nutrition of the a.n.a.l and rectal tissues, rendering them friable or weak and easily broken; whence the bleeding and painful fissure or the a.n.a.l ulcer, which so often are the outcome of proct.i.tis and an accompaniment of piles.

As already stated, piles are one of the symptoms of proct.i.tis, and all cases of piles involve more or less irritability and contraction of the a.n.a.l ca.n.a.l and the terminal portion of the r.e.c.t.u.m through which the fecal matter is forced. All the muscular ability of the r.e.c.t.u.m, a.s.sisted by straining effort of the abdominal muscles, is concentrated upon the feces to force it through the constricted portion of the lower bowel. The force exerted not only develops pile tumors, but carries out with the feces those tumors that had reached considerable proportions; thus the frail diseased mucous membrane is torn, and another symptom added to a chronic disease. Observation for over twenty years has convinced me that chronic proct.i.tis usually exists fifteen, twenty or more years before piles are developed (if developed at all), from daily pressure on the inflamed, congested, dilated, varicose, friable blood-vessels and surrounding tissue.

Piles are easily and quickly cured without any annoyance to the sufferer. Chronic proct.i.tis may be cured, but not quickly, as time is required to undo damage to tissues so long invaded by inflammatory process. Any one that allows a continuance of "a touch of the piles,"

as the expression is, and omits to take proper treatment as soon as this "touch" is felt, simply invites or takes chances of some form of cancer of the lower bowel later in life.

All other forms of disease of the lower bowel will yield to treatment satisfactory to physician and patient, but I am sorry to say cancer cases are numerous, and up to the present time we have no cure for this dreadful disease. If you value health, if you desire to avoid future suffering and disease, be sure that the lower bowel is free from inflammation, for with such freedom you will escape the many symptoms of proct.i.tis described in my treatise on diseases of the a.n.u.s and r.e.c.t.u.m.

CHAPTER XX.

PRURITUS OR ITCHING OF THE a.n.u.s.

One of the many symptoms of proct.i.tis is the existence of a.n.a.l channels from which an inflammatory product exudes through the skin, causing painful itching of the skin around the a.n.a.l margin and not infrequently around the b.u.t.tocks to the distance of three, six or even more inches from the a.n.a.l orifice. An aggravated form of pruritus ani is much more trying to physical endurance than severe pain. Sometimes the torture is so great that a portion of the body will be covered with cold perspiration.

The natural color of the integument about the a.n.u.s slowly changes to a dull whitish appearance. As the pathological process goes on, the skin becomes thickened and parchment-like. In exceptional cases the mucous membrane of the a.n.a.l ca.n.a.l becomes toughened and hardened like cardboard. As a consequence there is a degree of inertia in the muscular action of the parts affected.

The inflamed, thickened and indurated integument near the a.n.u.s takes on the form of folds, wrinkles or rugae, of more or less prominence; but as these extend out over the b.u.t.tocks they become more and more obliterated, leaving no clue to the direction of the channel which leads from the site of inflammation; which latter, however, may be learned from the itching, or from the burning sensation with some soreness, over portions of their length.

During a practice extending over twenty years, I have found only two cases in which one of these channels was the seat of a slight abscess.

It is not usual that pus formations occur in these inflammatory channels. At the margin of the opening from the r.e.c.t.u.m to the a.n.a.l tube are five or six small crescent-shaped loops, semi-lunar valves, separated by vertical ridges (the a.n.a.l columns). Naturally in chronic proct.i.tis the zone of tissue just above the sphincter muscles and slightly within their grasp at the upper portion of the a.n.a.l tube, would suffer greatly from the morbid process, owing to the abnormal constriction of the tissues and to the incidental pressure and injury, from time to time, as the stool pa.s.ses the diseased region. Just under the mucous membrane covering the a.n.a.l columns and semilunar valves is the fatty tissue forming a bed upon which the mucous membrane rests. It is sufficiently lax to permit considerable movement of the mucous membrane on the muscular coat beneath it. The frail, fatty, loose connective tissue in the grasp of the sphincter muscles would be the first to become impaired by inflammatory process, the product of which finds its way down and out under the mucous membrane of the a.n.a.l ca.n.a.l and integument of the b.u.t.tocks for quite a distance, occasioning itching, pain, soreness or burning in the integument covering the course of the channel.

Here we have the pathological reason why local remedies to the outer surface of the skin will not cure pruritus ani. Also the reason why dieting is useless, and why internal remedies are worthless for the cure of a.n.a.l itching; for the itching, as shown, is the result of an inflammatory product in the channels under the skin of the victim, numbering from five to twenty. Over fifteen years ago I discovered the cause of the great suffering from painful itching at the a.n.u.s and contiguous tissues and have been able to give instant relief, and in a little time permanent cure, in every case treated since then. It is well for those who have an occasional attack of pruritus ani to take treatment at once for proct.i.tis proper, as well as for this symptom, itching resulting from these channels. The proct.i.tis, if neglected, will only be the means of increasing the size, length and number of these channels. In chronic, sub-acute and acute stages of proct.i.tis there is more or less secretion of inflammatory product; and often the sufferer is able to discover, in dejections from the bowels, a yellow syrup-like fluid, of the consistency of glycerine or white of egg, at times streaked with blood and purulent matter indicating ulceration.

Should the proct.i.tis be cured and these channels remain, there may be sufficient inflammatory product in the channels to ooze through the skin to the outer surface, and excite itching; or if a portion of the channel escapes treatment, the same symptom may be expected at any time.

The size and length of these channels are best determined by making a small opening into them through the integument, then inserting a silver probe in both directions, determining the distance under the mucous membrane of the a.n.a.l tube and the distance under the skin of the b.u.t.tocks.

In some cases a few of these channels open into the r.e.c.t.u.m just above the internal sphincter muscles and become filled with water during the use of the enema taken to move and cleanse the bowels. As a rule, one end of the channel is under the mucous membrane of the terminal portion of the r.e.c.t.u.m, and the other somewhere under the skin of the a.n.u.s or of the b.u.t.tocks.

I presume that no disease of the human body has been a.s.signed more reasons for its existence, with the exception of constipation, than that mere symptom of a disease, a.n.a.l pruritus; a symptom which "Regulars" call a "disease," but "Irregulars" know to be only a symptom. It is very amusing to observe how they fill pages in their text-books, guessing, wondering and paying their respects to the imaginary quack doctors, "who are reaping a harvest of ill-gotten gain." The usual medical writer is a compound of ignorance, egoism and garrulity, and this may account for the great crop of reasons for "diseases." However, the writers in question are not so much to blame after all, even though they do belong to county medical societies; for how can they well resist the literary itch with which most of them are afflicted? Let them keep on writing while victims of pruritus ani wear out their weary lives scratching through weary nights--nights that extend into years, until permanent invalidism seems to be their destiny and end. Who, verily, are the medical quacks? I will leave it to a jury composed of those who have been cured of pruritus ani.

I have yet to meet the first case of pruritus ani that is without the presence of the channels above described. There may be cases of itching at the a.n.u.s and these channels entirely absent, but I have yet to discover such a case and I very much doubt if it exists. I am happy to inform the reader that all cases of pruritus ani are cured with ease and without any restrictions as to diet, and without internal remedies for the blood, nervous system, etc., given by doctors that guess. The causes are easily discovered; the symptoms are easily found and removed; the victim of pruritus ani may therefore escape from the labyrinth of error of the medical authors and pract.i.tioners who ought to be educators instead of "obstacators"--obstacles and stumbling-blocks in medical progress.

CHAPTER XXI.

ABSCESS AND FISTULA.

In our daily affairs we take thought for the future and reason from cause to effect. We observe, antic.i.p.ate, expect and suspect. This is a commendable practice, for it is the one that is most likely to lead to success. Can we not acquire a similar att.i.tude and habit in regard to our health? Habit is sub-conscious attention. Can we not give sub-conscious attention to the little details of such bodily functions as are liable to get out of order? Can we not by a settled habit, that is, by the formation of a second nature, a.s.sure our vital success, on which the continuance of the enjoyment of life so much depends? If some part of a complicated machine gets out of order it must be repaired at once or damage may result to other parts of it. Again, if our business accounts will not balance, the error must be found and corrected at once, or the evidence of it will annoy us sooner or later. Why should not such prompt care and attention be given to the human mechanism, to the economy of vital functions? It is not often that we neglect disease of the hands, head, face or neck because the exposure of such disease to public gaze might embarra.s.s us; but alas for the portion of the body out of sight, especially for the internal organs, when they fail to perform their functions normally. Most of us allow the mechanism of the human body to shift as best it can and as long as it can, should it happen to become ungeared, ignoring the frequent warnings which the ever increasing morbid changes and wreckage give us. And then we surrender and succ.u.mb. What else can we do? Our vital creditors file their claims in the high court of Vital Bankruptcy. What poor business policy, and what a wretched tenant! For fifteen or more years we may have had warning "touches of the piles," sometimes accompanied with indigestion, constipation, diarrhea and insidious auto-infection and occasionally with local symptoms in and around the a.n.a.l ca.n.a.l and its external orifice; these to an intelligent tenant should have been evidence of proct.i.tis, or worse, of periproct.i.tis--inflammation of the connective tissue of the rectal tube. What have we done? We have disregarded the warnings of our ungeared, disordered machine, or else we have merely tinkered with it. The human factory receives less attention than does the commercial. Soon, all too soon, the silver cord is loosed and the golden bowl broken, and just before that event, frightened, but too late, we do a little more tinkering under a doctor's direction, and spill the contents--of the golden bowl with which we were so careless--spill it into another world, to begin our folly over again!

Do you know that this occasional "touch of the piles" over a period of many years, and all that it involves, is a precursor and an invitation to the development of that deadly enemy, Cancer--a worse disaster than financial ruin? It is my duty to utter a warning here. Only one making a specialty of the diseases of the alimentary ca.n.a.l is aware of the frequency of the occurrence of cancer in the lower bowel resulting from chronic inflammatory process, induration, etc. I have been, again and again, shocked and alarmed at the reckless neglect that has brought on this as yet incurable disease--cancer.

These remarks apply well to what I have to say on Abscess and Fistula at the terminal portion of the intestinal ca.n.a.l. It is the old, old story of being "touched by the piles for many years," and neglect, ending in dread and despair at the necessity of being bored full of holes by pus seeking an outlet. The victim wonders at the spread of the local trouble, and that an opening for the pus ca.n.a.ls has frequently to be made three to sixteen inches away from the seat of the abscess. In a former chapter the subject of proct.i.tis and piles was gone into, and some idea given of the invasion of inflammation in the rectal and a.n.a.l tissues.

In exceptional cases the exciting cause of a.n.a.l and rectal abscess and fistula, or of abscess and fistula of the b.u.t.tocks, may be a traumatic injury or accident, produced, say, by a blow or a fall bruising the tissues, or by sharp, hard substances--such as pieces of bone or nutsh.e.l.l--from within the ca.n.a.l, lacerating it. But wounds of this character are very infrequent compared with chronic inflammation (proct.i.tis) as the exciting cause. There are several varieties of proct.i.tis recognized as the exciting cause of abscess and fistula, namely, traumatic, dysenteric, diphtheritic, gonorrheal, catarrhal, etc. The reader should not only pardon me, but should be grateful if by adding another name to the list I point out the most common cause, namely, _diaper-itic proct.i.tis_. As pointed out in the first chapter or two, the improper use of the diaper will evidence its deplorable result when the period of manhood or womanhood is reached, by some of the many symptoms of proct.i.tis.

Proct.i.tis may be considered as acute, subacute or chronic according to the duration of the process; or as atrophic or hypertrophic from the structural changes induced. But no matter about the cause and character of the proct.i.tis, the question is, Have you inflamed a.n.a.l and rectal ca.n.a.ls? If you have, then the very annoying symptom, abscess or fistula, is liable to occur any day. Can you afford to take the chances?