Just under the mucous membrane of the a.n.u.s and r.e.c.t.u.m there is a layer of loose, fatty, connective tissue, called areolar tissue. When it is invaded by inflammation, abscess and fistula may occur. On the outside of the rectal wall, at the terminal portion, there is also much loose, fatty (areolar) tissue filling the ischio-rectal fossa, which is very p.r.o.ne to suppuration, and inflammation here is called periproct.i.tis.

This is the most common and serious seat and source of the septic process, which process is usually the proximate cause of death after capital surgical operations upon the r.e.c.t.u.m. Beside the abundance of fatty tissue--whose function is to serve as a cushion to the r.e.c.t.u.m at its terminal portion and at the back and sides of the wall--there is a triangular s.p.a.ce in front of the r.e.c.t.u.m containing fatty areolar tissue, which s.p.a.ce is often the location of a pus cavity. Pus, like all fluids, follows the path of least resistance. The progress of imprisoned pus may take weeks, months and years before an abnormal communication between the abscess and the external portion of the body is completed. The imprisoned contents of the abscess cavity and the pus ca.n.a.l or fistula often give rise to much annoyance before finding an outlet. There will be pain in the muscles of the b.u.t.tocks, called myalgia; and pain at the end of the spine, called coccyG.o.dynia. For this latter pain do not, I pray you, as is so often done, have your spine removed by the too ready surgeon. No need of it at all. You might just as sensibly have the muscles cut out for myalgia. Pus in fistulous channels may burrow for several years through the muscular and connective tissue structures before finally forming an external opening through the integument; although its nearness to the surface is frequently marked by a localized puffiness and inflammation, which, however, may disappear for a time without forming an external opening.

This condition of affairs results in periodical attacks of coccyG.o.dynia, myalgia and neuralgia of the b.u.t.tocks and lower extremities.

The important question with the victim of abscess and fistula is, "How did I get it? I don't care for the various and numerous names you give to these fistulas: what I should like to know is, How does it come about that I, an apparently healthy person, have such a nasty disease?"

Simply years of neglect, is my answer. Neglect is due sometimes, and perhaps generally, to ignorance of the thing neglected. The laity can in large measure blame the medical profession for it, and especially those surgeons who have long made a specialty of the treatment of a.n.a.l and rectal diseases.

CHAPTER XXII.

THE ORIGIN AND USE OF THE ENEMA.

Pliny recorded the fact that "the use of clysters or enemata was first taught by the stork, which may be observed to inject water into its bowels by means of its long beak." The _British Medical Journal_, reviewing the newly published _Storia della Farmacia_, says that Frederigo Kernot describes in it the invention of the enema apparatus, which he looks upon as an epoch in pharmacy as important as the discovery of America in the history of human civilization. The glory of the invention of this instrument, so beneficial to suffering mankind, belongs to an Italian, Gatenaria, whose name ought to find a modest place together with Columbus, Galileo, Gioja and other eminent and ill.u.s.trious Italians. He was a compatriot of Columbus and professor at Pavia, where he died in 1496, after having spent several years in perfecting his instrument. The enema apparatus may be justly named the queen of the world, as it has reigned without a rival for three hundred years over the whole continent, besides Brazil and America. The enema came into use soon after the invention of the apparatus itself.

Bouvard, physician to Louis XIII, applied two hundred and twenty enemata to this monarch in the course of six months. In the first years of Louis XIV it became the fashion of the day. Ladies took three or four a day to keep a fresh complexion, and the dandies used as many for a white skin. Enemata were perfumed with orange, angelica, bergamot and roses, and Mr. Kernot exclaims enthusiastically, "_O se torna.s.se questa moda!_" (Oh, that this fashion would return!). The medical profession at first hailed the invention with delight, but soon found the application _infra dig._, and handed it over to the pharmacist; but shameful invectives, sarcasms and epigrams, hurled at those who exercised the humble duty of applying the apparatus, made them at last resign it to barbers and hospital attendants. (_Year Book of Therapeutics_, Wood, 1872.)

"The history of the warm bath," says Dr. Paris, "presents another curious instance of the vicissitudes to which the reputation of our valuable resources is so universally exposed. That which for so many ages was esteemed the greatest luxury in health, and the most efficacious remedy in disease, fell into total disrepute in the reign of Augustus, for no other reason than because Antonius Musa had cured the Emperor of a dangerous malady by the use of the cold bath. The most frigid water that could be procured was in consequence recommended on every occasion.... This practice, however, was doomed but to an ephemeral popularity, for, although it restored the Emperor to health, it shortly afterward killed his nephew and son-in-law Marcellus, an event which at once deprived the remedy of its credit and the physician of his popularity.

"That the _warm_ and not the _cold_ bath was esteemed by the ancient Greeks for its invigorating properties may be inferred from a dialogue of Aristophanes, in which one of the characters says, 'I think none of the sons of the G.o.ds ever exceeded Hercules in bodily and mental force.' Upon which the other asks, 'Where didst thou ever see a cold bath dedicated to Hercules?'

"Thus there exists a fashion in medicine, as in the other affairs of life, regulated by the caprice and supported by the authority of a few leading pract.i.tioners, which has been frequently the occasion of dismissing from practice valuable medicines and of subst.i.tuting others less certain in their effects and more questionable in their nature. As years and fashion revolve, so have these neglected remedies, each in its turn, risen again into favor and notice, whilst old receipts, like old almanacs, are abandoned until the period may arrive that will once more adjust them to the spirit and fashion of the times." (J. A. Paris, _Pharmacologia_, p. 31, New York, 1825.)

"A story told of Voltaire," says Dr. Arthur Leared, "well ill.u.s.trates both the evil effects of constipation and the advantage of using the enema. The great philosopher was one day so miserable and dejected that he told a friend he had resolved to hang himself.

His friend called the next morning to ascertain whether the resolve had been or was intended to be carried out. But Voltaire only replied, with a smile, 'I have been well washed out this morning.'"

(Op. cit., p. 200.)

For those suffering from chronic intestinal uncleanliness or constipation, an occasional intestinal wash-out, or bath, is quite as satisfactory as an "occasional" external bath or the "occasional" use of a cathartic medicine. If there is a necessity for cleansing and purifying the bowels at all, why not do it properly and systematically until the condition that made the artificial cleansing necessary is removed? Who would tolerate the cleaning of dining-room, kitchen, dairy and other utensils in domestic use only when they became so foul that they could not be endured any longer without great annoyance? Away with the "occasional" cleansing habit for either external or internal bodily cleanliness! There are persistent causes for internal uncleanliness, for the tardy action of the bowels, which require regular periods for cleansing until cure is effected.

It is estimated that food taken into the stomach will reach the colon in five hours. For nineteen hours the sewage waste of the body is gradually becoming a fetid pool before an outlet is furnished it by the one-movement-a-day people; and O ye G.o.ds of health! how many of us there are that haven't even one movement a day! For a few hours the absorbent cells of the colon will try to extract as much of the nutritious residue as the system calls for, but along with it a lot of poisonous filth will be absorbed. The call of the system for nourishment should be fully answered by the small intestines. Savages have four or five movements a day, and we certainly should not have less than three. People of refined sentiments will, at such a disclosure, bestir themselves to better things.

Water, when properly applied, is the only remedy that meets the physiological and pathological requirements of the chronically constipated. By its use the diseased, spasmodically contracted muscular tube is simply dilated, and the imprisoned feces and gases above are permitted to pa.s.s down and through the temporarily occluded section of the diseased bowels, the patient will have the consciousness of neatly accomplishing an imperative requirement, and the satisfaction which cleanliness entails.

CHAPTER XXIII.

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 ca.n.a.l been obstructed like the Erie Ca.n.a.l 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 ca.n.a.l 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 quant.i.ty 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 proct.i.tis, 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 gla.s.ses of liquids pa.s.s 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 gla.s.ses are prescribed, good sense will inform him that the gla.s.ses 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 proct.i.tis 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 debas.e.m.e.nt.

It is unnatural to wear gla.s.ses, 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.

Proct.i.tis 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 a.n.u.s or in the a.n.a.l ca.n.a.l 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 ca.n.a.l; 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 proct.i.tis. It is proceeding on the liver theory, when the key is, as has been shown in these articles, _Proct.i.tis_, inflammation of the a.n.u.s and r.e.c.t.u.m. 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 proct.i.tis, which, as has been said, over-stimulates the lower bowels because of the inflammation.

The chronic character of proct.i.tis 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 proct.i.tis, 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 pa.s.sage with a small quant.i.ty 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.

CHAPTER XXIV.

MAN'S BEST FRIEND.

Travel the world from end to end You ne'er will find a better friend Than sparkling water, pure and free, Most precious boon to you and me.

It cheers the faint, it crowns the feast, Makes food to grow for man and beast; In sickness soothes the fevered frame, There's healing in its very name.

And what can more life-giving be Than cooling breezes from the sea, Whose bosom bears upon their way The stately ships from day to day?

A treasure trove of priceless worth; A jewelled belt for mother Earth, Encircling with its silvery bands, She binds together many lands.

To cure disease dame Nature brings Her remedy in mineral springs; Water without, water within, Equally good for stout or thin; And more than man can e'er devise Invigorates and purifies.

Travel the world from end to end, You ne'er will find a better friend.

CHAPTER XXV.

PHYSIOLOGICAL IRRIGATION.

The scientific irrigation of land is pretty well understood by those who have financial interest in soil requiring it. The wonderful beauty and freshness of flower and fruit give evidence of what scientific irrigation can do. So from a commercial and esthetic point of view the proper amount of daily moisture for land, tree or vine, is of such importance that it receives the consideration of those interested. How many persons, however, in the course of a lifetime have given ten minutes to serious consideration of the question: _How much water should be imbibed daily under the varying conditions of the body's garden?_ Those who give no consideration to the problem of how to attain and maintain a healthy and vigorous physical basis are persons who usually drift into habits for which they will, sooner or later, have to pay the penalty.

For the first twenty or more years the body is, as a rule, unfortunate in not having an intelligent tenant. For man misuses his physiological estate, and lets things go to rack and ruin ere he wakes to realize how it might have been as to length of days and strength of body and mind.

Enlighten him, after he has reached adult years, on the values and needs of physiological and psychological functions; you will find that however eager he may be to follow the light he is handicapped by vicious habits and by confirmed, destructive changes which had seized on him when he was quite too young and incompetent to care for his body. What a topsy-turvy world this is, to be sure!