Many persons suffering from chronic constipation drink very little or no water. As a consequence, they are a sort of dirty, dried-up plant, with but little juice of life in them.

Others, again, equally unclean, or more so, take a moderate amount of fluid every day, and present a more or less roly-poly appearance, with considerable abdominal distention, due to malnutrition and gases. Of course, their eyes, skin, tongue, breath, and lack of vim and vigor tell the story of a long process of self-poisoning, with every now and then the eventuation of a storm of foulness, called a bilious attack--meaning an overflow of filth. Death often brings about a radical change in such poisoned bodies.

Now, what can a prescriber of a gastro-intestinal ejector expect to accomplish by disturbing the maleconomy of this apparatus? Usually he expects that considerable trouble will ensue; consequently, he will add belladonna or some other soothing drug to mitigate the act of expulsion.

The ejector (called laxative, purgative, cathartic) occasions irritation, which sets up twisting, writhing, rumbling of the bowels, accompanied with a shower of liquid into the ca.n.a.l (as tears fill the eyes from the effects of sand or a blow), which liquid mingles again with the putrid refuse materials, from which it had been recently absorbed, and, mingling, proceeds to fill up the normal and abnormal s.p.a.ces just described, _to be again reabsorbed into the system_. Oh, the foulness of it all! The spirits of the departed, as well as the still incarnate patients, demand of the healing art safe and sane hygienic methods of cure. _The enema, regularly and properly used, is the remedy par excellence._

Those that suffer from chronic constipation are usually deficient in the quant.i.ty and quality of intestinal secretions. Physic increases the depletion of the intestinal juices. Of the watery secretion forced into the bowels, four-fifths are reabsorbed into the system, plus poisons and filth. The system soon becomes accustomed to the irritation of drugs, and requires an ever-increasing amount. These irritate and increase the chronic inflammation of the lower bowel, often to the extent of a discharge of blood.

Straining effort to induce defecation is injurious. The use of ma.s.sage, of vibratory exercises, of electricity; the spraying of cold water on the abdomen, etc.,--none of them are calculated to remove or even to relieve the proct.i.tis and colitis.

The temperature of the water used for an enema should be about one hundred degrees. It should be taken at least twice daily, preferably on retiring at night and soon after breakfast, at regular times, if possible. Such practice obviates the need of large injections.

In beginning the use of the enema it is well to inject from a half to a pint of water, and expel it. This const.i.tutes a preliminary injection.

Frequently it is desirable to take another preliminary injection before taking the large one, which latter is variously called "flushing the colon," "taking an enema," "taking an internal bath" or "a washout,"

etc. It is essential first to get rid of the feces and gases in the r.e.c.t.u.m, so that they be not sent back when you proceed to flush the colon.

NO. 2.

OBJECTIONS TO THE USE OF ENEMA ANSWERED.

The privilege of raising objections belongs to the ignorant as well as to the intelligent. But the objector is under as great obligations to state his reasons as the advocate.

The _first_ plausible objection to the use of the enema is that it is not natural.

Admitting this charge, I should say that, inasmuch as proct.i.tis, colitis, and constipation are unnatural, the use of a preternatural or, in other words, a rational means to overcome the consequences of these diseases is imperative. The enema is such a means.

Can any one that suffers from proct.i.tis, etc., have a natural stool?

Unnatural conditions require preternatural aids, as we all know. The injected water dilates the constricted portion of the gut and arouses a revulsive impulse to expel the invading water. In obeying this impulse the imprisoned feces, gases, etc., are ejected with the water.

It may be unnatural to put water into the r.e.c.t.u.m, etc., but once there its expulsion from healthy bowels would be quite natural. No natural action can be expected from unhealthy bowels; they do the best they can under the circ.u.mstances. Eye-gla.s.ses, false teeth, crutches, etc., are unnatural but invaluable aids, but no more so than is the enema as a means of relief from overloaded bowels. The enema, moreover, be it noted, not only aids the system by relieving it of its loads; it cleanses and soothes an organ that must be kept at work and perform its functions even when invaded by disease.

Surely it is unhygienic and irrational to ignore the valuable service of the enema in cases in which the bowels are in an unnatural condition.

The _second_ objection is that the water will wash away the mucus from the mucous membrane of the bowels and leave them dry and parched, and thus apt to crack and break in two. I would remind the objector that, since about 75 per cent. of the normal feces is water, it seems strange that so great a quant.i.ty of water in contact with the mucous surface of the bowels should not also cause dryness.

The integument of the body and that of the mucous membrane are similar in structure, yet whoever had a fear of producing dryness of the skin by much application of water? The mucous membrane is simply the skin turned inward; and since it is much more vascular it is less apt to become dry--if, indeed, its dryness were at all possible. The objector should also remember that the body is composed of over 80 per cent. of water--an organism not to be made dry or parched by the application of water to the skin or to the mucous membrane two or three times a day.

The mucous membrane of the lower bowel is not unlike that of the mouth, throat, or stomach. Do you realize how often the upper end of the intestinal ca.n.a.l is washed or bathed daily with liquids, soft and hard drinks, hot and cold, especially by those who have formed the drink habit instead of the enema habit?

They have no fear of drying the mucous membrane thereby; but if you can instil this fear they will increase the quant.i.ty with pleasure.

This second objection, being the result of too vivid an imagination and too little reflection, is a very nonsensical objection indeed.

A _third_ objection is that if you begin the use of the enema you will have to continue its use; you can't stop, and, lo and behold! the enema habit is formed--a new habit in addition to the many habits civilized man is already carrying; the constipated habit, the physic habit, the sand, bran, sawdust-food habit, the muscular peristaltic habit, etc.--and with all these habits the poor victim of proct.i.tis and intestinal foulness wonders that he is alive.

Usually the first symptom of proct.i.tis is constipation, and for relief the enema habit should be formed and continued while the constipation remains. When the proper means are found to remove the intestinal inflammation--proct.i.tis and colitis--then the constipation will disappear, and with its disappearance the enema habit can be discontinued. But let it be well noted that the enema is itself an aid in curing the cause, an aid superior to any other at our command. A cleanly habit ought not to be an objectionable one, especially in cases in which it is most needed to prevent toxic substances from entering the system.

A _fourth_ objection is that after taking the first enema the constipation is worse.

With many persons a certain amount of undue acc.u.mulation of feces will excite a sufficient muscular effort of the gut to force the dried ma.s.s through the proct.i.tis- and colitis-strictured bowels. This unnatural effort may occur once a day or once in two or three days, and has doubtless been a habit of many years' duration.

To introduce a new order of conduct on the part of the bowels requires time. If the bowels have been in the habit of expelling feces in the morning, and an enema were taken the night before, there might be no desire to stool the next morning because of the fact that the bulk or acc.u.mulated ma.s.s of excrement was no longer there to create a vigorous call or impulse for defecation.

But we have found the extent of local damage and reflex to the organs, and more especially the constant absorption of poisons into the system, due to the presence of feces. It is for this reason that the elimination of feces twice or thrice in twenty-four hours is advised.

The condition for which an enema is used is one of disturbance and poison to the system. It is, therefore, a most unnatural condition.

What is more rational, consequently, than to employ an "unnatural" yet not harmful means to bring about a more normal condition, one free from poisoning and irritating consequences?

A _fifth_ objection is made by those who have as a symptom of proct.i.tis a large development of pile tumors or hemorrhoids (distended mucous membrane). The objection is that at times these tumors or sacs prolapse very freely during the act of expelling the injected water. But this prolapse occurs in many cases whether water is used or not.

A certain amount of a.n.a.l irritation caused by the pa.s.sage of feces occurs, causing contraction of the circular muscular tissue that forms the a.n.a.l and rectal ca.n.a.l, also of the longitudinal muscular bands and the levator muscles of the organs. The enema lessens or entirely diminishes the irritation of pa.s.sing feces, and the natural result is that the serum-filled sacs, called piles, and the tissue loosened by the inflammatory product will more readily prolapse during the act of defecating. It is simply a choice between irritation of the stool keeping the tissue up and no irritation permitting a prolapse.

Of course, if there be no expulsion of feces and water the stretched or dilated sacs may keep their places in the r.e.c.t.u.m. And then again, the enema may be used for quite a period, when all at once a large prolapse of sacculated mucous membrane occurs, and the enema is thought to be the cause of it. That this is not the cause, let it be remembered that in all cases of proct.i.tis the chronic inflammation is apt to become subacute or acute, and that this intense engorgement and enlargement of the tissue with blood and the increased fever in the parts often result in prolapse at any time, especially at times of convulsive effort at evacuation.

Whatever follows the proper use of an enema, even though what follows be annoying, should not be blamed on the enema, for its action is most kindly, lessening as it does the irritation that otherwise would be more severe when the feces pa.s.s through a disease-constricted ca.n.a.l.

The _sixth_ objection is that the use of the enema will weaken the bowels, which are already too "weak" to expel their contents. "Atony, paralysis, fatty degeneration of the gut, are bad enough," say these objectors, "without having an enema increase their uselessness."

Diagnosis wrong and objection groundless.

Distend and contract an organ for a short time two or three times a day, and it will gain in strength from the exercise. Every one knows that this is the case. What more gentle means of exercising the large intestines than by the enema?

But the truth of the matter is that in all cases of proct.i.tis and constipation the diseased portion of the gut is too active in its muscular movements, contracting spasmodically, as it does, at even the suggestion or suspicion of feces near it. Every impulse of the bowels above the constricted section to force the feces down through the closed bore only intensifies the spasmodic action and increases the muscular obstruction, compelling the victim to resort to some one of the many drastic means of relief.

The enema does no more than kindly to dilate the constricted region, which, when dilated, evokes a harmonious concerted action of all the nerves and muscles to pa.s.s along and down the burden of feces, which, without the aid of a flood of water, they had been incapable of moving, and would have had to leave to poison the system.

The _seventh_ objection is quite naive: "Inasmuch as the Indians of this country had no use for the enema, why should we resort to it?"

The all-sufficient answer to this objection is that the Indians lived a natural life, while ours is artificial. Much can be said on this point, but the reader is surely rational enough to follow out the distinction suggested. Our lives are much more important than were the lives of the aborigines of this country, and our "demands of Nature" are more exigent. If your life is of no greater value than theirs, for leisure's sake don't use the enema! You will be taking too much trouble. It really should seem that the cleanliness of the skin and mucous membrane, the care we take of our bodies, is an indication and measure of our sense of refinement. An ancient Scripture hath it: "Let those that are filthy, be filthy still." It all depends upon how you wish to be cla.s.sed--with the filthy or the cleanly.

The _eighth_ objection to be noted is the fear of "poking things"

(points of instruments) "into the r.e.c.t.u.m."

This looks like a real objection. No healthy nor even unhealthy organ, for that matter, should be "abused." And what seems more likely to cause it trouble than to poke a hard or soft rubber point or tube through its vent in opposition to its bent or inclination? Still, the muscles of the vent are strong, and they soon accommodate themselves to the practice. Their slight disinclination is not to be considered alongside of the relief and cure you effect by the use of the enema.

Have no fear that the point will occasion disease when intelligently used. Always see to it that the point is scrupulously clean. Those made of hard rubber or metal can be kept so without effort.

Soft rubber points are always foul and dangerous, especially after they are used a few times. A good rule is never to put a point higher in the bowel than is absolutely necessary.

The _ninth_ objection seems serious. It is that in taking an enema the water escaping from the syringe point will injure the mucous membrane where the jet strikes. But on examination this objection falls to the ground, for it stands to reason the jet cannot directly hit the surface for more than a moment. Immediately thereafter the acc.u.mulation of water will force the jet to spend its energy on the increasing volume, to lift it out of the way so that the continuous inflow may find room.

But even were it possible for the jet to strike a definite section of the mucous membrane during the taking of the enema, it could do no harm provided the water be at the proper temperature. And this is true even if a hydrant pressure be used. Not a few persons use the hydrant pressure of their houses in taking an enema. For a really successful flushing of the colon a considerable pressure is requisite to force the volume up and along a distance of five feet, especially when sitting upright. But it is folly to use a long syringe point, since it is like introducing one ca.n.a.l into another for the purpose of cleansing it.

Therefore, have no fear from the use of proper syringe points; the jet of water will not hurt the mucous membrane. My professional brethren at least ought to know that the idea of such harm is sheer nonsense.

The _tenth_ objection to using an enema is in being obliged to use it from the fact of having such a disease as chronic inflammation of the r.e.c.t.u.m and colon. Every victim hates to be compelled to do a thing, and the victim of proct.i.tis and colitis is no exception to the rule. In fact, he is beginning to realize that unless he uses it his system will be poisoned by the absorption of the sewage waste. Let the victim object to the disease that necessitates the use of the enema and he will shortly be well. Then this objection to the use of the enema will indeed be the most important of all.

The _eleventh_ objection, and the most ridiculous of all, is that it requires too much time to take the enema twice or thrice daily.