As the extreme sensitiveness of the inflamed upper half of the r.e.c.t.u.m offers resistance to the pa.s.sage of the fecal contents of the sigmoid flexure; so, in a somewhat similar manner, the inflamed a.n.a.l tube, in its more or less constricted state, prevents the pa.s.sage of feces and gases as they approach the terminal part of the r.e.c.t.u.m. As a consequence, the feces and gas deposit and lodge at this latter location, producing in so doing the abnormal cavity called ballooning of the r.e.c.t.u.m, so often found just above the a.n.a.l tube.

The greatest depth of the dilated pouch is on the posterior wall of the r.e.c.t.u.m, or just in front of the tip of the coccyx. In some cases the pouch measures two and a half inches in depth at the back and gradually diminishes in depth on each side as you near the anterior wall of the r.e.c.t.u.m. Often the upper end of the a.n.a.l ca.n.a.l is higher than the depressed circ.u.mference of the s.p.a.cious cavity that almost surrounds it. The irritable orifice of the cavity will invariably compel a quant.i.ty of liquids and feces to lodge in the cavity as a permanent cesspool, allowing the absorbent vessels to absorb as much as they can by incessant work. The height or length of this abnormal cone-shaped rectal cavity is from two to three inches, involving usually the lower half of the r.e.c.t.u.m. The a.n.a.l ca.n.a.l frequently becomes shortened by the dilating process to a quarter of an inch, leaving two frail, irritable muscles at the vent, to guard the rectal cavity. And fortunate are these two thin, sore, contracted muscles, and the possessor of them, if they escape the surgeon's barbarous notion of operating on them.

If the medical butcher has operated on them, you will find an a.n.a.l ca.n.a.l open to such an extent that two fingers can be inserted without distending the tissues in the least. And when the victim of ballooning of the r.e.c.t.u.m and ignorant operation makes further complaint to the surgeon of the aches and pains, he is consoled by being informed that the end of the spine will have to be removed. Irreparable damage done and no aid at all received! It is a pity such ignorance on the subject should exist in the medical profession in this city.

The abnormal cavity, so difficult to empty properly owing to its depth and diseased outlet, is seldom free from gases, feces and liquids.

Daily evacuations will not empty this cavity, nor will cathartics or diarrhea. A permanent cesspool of poisons is this, where all forms of poisonous germs are propagated, and infect the system by absorption. No use to take medicines for your _poor blood, bad complexion and horrid feelings_, as they will not cleanse the augean stable so long neglected. No use to journey to other localities for health so long as you carry so formidable a foe to health with you.

The mucous membrane in the chronic state of the disease presents a rather dry, indolent and bluish appearance, except that here and there the tissues show more activity of the disease, more especially so over the a.n.a.l region, due to harsher disturbance during the act of stooling.

In the subacute or acute stage of the inflammatory process there is more general redness and puffiness of the mucous membrane, or a swollen condition with increased discharge of mucus and perhaps some blood.

There is a heavy, uncomfortable feeling, with more or less soreness and pain, especially after evacuation of the feces. If a fissure or a.n.a.l ulcer is present the pain is in proportion to its size and the general aggravation of all the diseased parts. Itching or pruritus about the a.n.u.s may accompany the trouble to a very annoying extent, being an evidence that the a.n.a.l pockets are becoming much diseased. The partially constricted and irritable sphincter muscles become excited during the act of stooling and react on the a.n.a.l grip or contraction, making it more intense. This latter condition may shut off the flow of blood in a local vein; and the blood becoming coagulated forms a painful bluish grape-like tumor at the external opening of the a.n.u.s.

Abscesses may form at some portion of the diseased gut and result in an external fistula.

Piles may co-exist in some cases of ballooning, but are usually not annoying.

It is the local a.n.a.l or external annoyances that compel the sufferer to seek medical advice and aid, and he learns that the troubles complained of are only symptoms of a chronic disease, therefore easily removed without harsh treatment while the cause is being properly cured.

It is very fortunate for the sufferer from ballooning of the r.e.c.t.u.m to have in or near the a.n.a.l ca.n.a.l those painful hints or symptoms of a very grave and long existing disease whose const.i.tutional symptoms were well marked but attributed to other causes, especially to disease of the liver--an organ of _so much solicitude_ that the poor liver-worshipping patient ought to receive more gracious response from it.

In every case of chronic proct.i.tis, or inflammation of the a.n.u.s and r.e.c.t.u.m, the sigmoid flexure must be more or less dilated, as the upper part of the r.e.c.t.u.m is very irritable and contracted and inhibits the feces from pa.s.sing beyond the sigmoid; but this irritability and contraction of the r.e.c.t.u.m, as a rule, is not nearly so severe as that of the a.n.a.l ca.n.a.l, whose orifice is closed by very strong sphincter muscles.

Such being the pathological change in the sigmoid flexure and especially in the lower portion of the r.e.c.t.u.m, as described in these two chapters, who, with ordinary intelligence and an idea of cleanliness, would take or prescribe remedies to move the bowels, if it were possible to cleanse the foul capacious cavities with water? We know that they can be thus cleansed, and that it can be easily accomplished with benefit to the diseased ca.n.a.ls.

After the system has absorbed 75 per cent of the fecal ma.s.s, a "remedy"

is taken to excite a flow of watery excretions into the bowels, of which a portion will be retained in the colon, and especially the ballooned cavities, and reabsorbed; and every day the objectionable practice is repeated without any thought of the harm being done.

The flushing of the r.e.c.t.u.m, sigmoid flexure and colon with water is not a _cure-all_, but it is one of the means of treating a grave chronic disease, a disease insidious and far-reaching in its poisonous effects on the human organism.

CHAPTER XVI.

THE USUAL DIAGNOSIS AND TREATMENT OF BOWEL TROUBLES WRONG.

Herodotus tells us that among certain tribes when a man fell sick his next-door neighbor did not wait for him to become thin but killed him at once, lest by the loss of his adipose his flesh might be rendered less appetizing.

But alas! in this age of constipation and piles, of self-generated poisons and self-infection, how changed is the custom! Our next-door neighbor, the doctor, waits till we are really thin, and then begins to feed and grow fat on our ills! In our day, through the continuous process of self-poisoning we take on no flesh from puny, peaked childhood, or we insidiously lose what little flesh we had, and when our bones are well exposed, become alarmed, realize that we are sick, rush for the doctor, and dispossess ourselves of our spare cash.

Very frequently, as stated in the first chapter, auto-infection begins in infancy and slowly but steadily progresses, but it may not be before adult age is reached and one or more organs are seriously diseased that it becomes apparent to all. The vital round of the alternate building-up and breaking-down of the system has been going on unceasingly during these years of increasing infection, but prematurely the balance between up and down is lost in favor of down; the building-up process becoming feebler, slower, and the breaking-down process quicker, easier. What can the inevitable outcome be but _emaciation_ and _anemia_, and all their attendant suffering and consequences? It is the superabundance of vitality in the growing child that r.e.t.a.r.ds (inhibits) the morbid changes going on in the blood and tissues of the system; but the process is all the more insidious by being thus restrained, and its very subtlety and stealth beguile us all into fancied security: parents, friends, physicians--all are deceived.

As stated in a previous chapter, the first unwelcome visitor, in infancy, is inflammation of the integument and mucous membrane of the a.n.a.l orifice, invited by the uncleanliness involved in the use of diapers; and this visitor takes up its residence slowly along several inches of the lower bowel. Its first symptoms are likely to be constipation, flatulency, colic, indigestion, bacterial and other poisons, occasionally diarrhea, and the usual general disturbance of the system as above detailed. It is admitted by all authors that inflammation of the a.n.u.s, r.e.c.t.u.m, etc., is by far the most common disease that afflicts mankind at all ages; and I maintain that the natural result of such inflammation is a more or less extensive occlusion of the lower bowel, which in turn involves an undue retention of the feces, and thus we have the foul intestinal ca.n.a.l and stomach called gastric and intestinal indigestion.

The wrong treatment of constipation, diarrhea, indigestion and auto-intoxication up to the present time has been due to improper diagnosis. Writers on these subjects speak of them as causes when they are merely symptoms. And the remedies for these "causes" are even more numerous. _Mistaken diagnosis on the one hand, measured doses on the other, and there you have the scientific doctor!_ The primary cause, inflammation, like the original spark applied to dry shavings, sets up morbid changes in the various parts of the digestive ca.n.a.l and the other organs of the body, and these "set up" or established changes are properly secondary or derivative causes accompanied by their own symptoms. The primary disease and symptoms may exist for five, ten, twenty or more years before any p.r.o.nounced secondary or derivative diseases and their symptoms occur or are noticeable to a sufficiently marked degree.

The chronic character of the malady, and the complication of primary with secondary diseases and their symptoms, have thoroughly disconcerted the doctors. Hence the many "causes" a.s.signed for indigestion, constipation, etc., and the many kinds of remedies prescribed with the one sure result, FAILURE; and hence, also, not a few of the self- and drug-intoxicated ones dubbed, or actually developed into, hypochondriacs. Diagnosis wrong, treatment wrong, failure certain, and the foulness of the intestinal ca.n.a.l continued!

This is the experience and testimony of the many, many sufferers from the most common malady that afflicts humanity from infancy to old age, and which will continue to afflict the great majority until it is properly understood and treated.

When a sewer of a town is obstructed, the most sensible plan is to begin the investigation at the outlet and then proceed up, section after section, to trace the obstacle that had occasioned the acc.u.mulation of debris. When the waste-pipes of a house are clogged, we do not expect the plumber to go to the top of the building and poke substances down the pipe to dislodge the unduly retained material some twenty-five feet or more away. Nor would we believe him if he informed us that the sewer-gas and overflow of waste in the house were the _cause_ of the constipated condition of the drain. But just this is what the doctor declares concerning our sewer; just this is what he does when he doses it with laxatives, cathartics, purgatives. Such is the treatment we receive when we rush to the doctor, or such the treatment we give ourselves. The poor, sensitive, inflamed ca.n.a.l is desecrated on all hands, though part of a house not made with hands--a house that should be a home for the soul of man.

CHAPTER XVII.

COSTIVENESS.

The words constipation, obstipation and costiveness are often employed as if of exactly similar meaning, but it is well to let each stand for a particular condition. Obstipation implies that the ca.n.a.l of the intestine is stopped up or closed. Constipation carries the idea that the ca.n.a.l is completely filled up with refuse matter. In the normal condition the intestine is divided by transverse bulges or valves or dams into a number of separate segments, the entire arrangement having the effect of preventing too rapid descent of the feces. These folds within the ca.n.a.l may become too much narrowed by disease and thus prevent the movement of the matters inside; this is obstipation.

Constipation, stuffing of the gut, may be the result of neglecting the call of nature, and after a time the ability to recognize and answer it is lost; or it may result from inflammation which itself comes from the bad habit mentioned.

The author prefers to use the term costiveness for the general debased condition of the system from auto-intoxication depending upon proct.i.tis and similar conditions of the intestinal tract. And it must be remembered that the same patient may have two or more of these conditions at the same time. Constipation, obstipation and diarrhea may alternate through the progress of the case.

We would expect people suffering from constipation or obstipation to pa.s.s as fairly well people for a time, but the same is not true of patients having the other condition, costiveness. As we may speak of the stages of a disease like consumption, so we may speak of these three conditions as different stages of one affliction, the worst being costiveness with its progressive self-poisoning by the products of intestinal decomposition. Early in the case the system may pa.s.s these poisons out of the body with comparative ease, by way of the lungs, skin and kidneys. In time the second stage begins to make itself apparent, vitality becomes less and less, calling for a greater variety of medicines to correct the condition, as in the second stage of consumption, and also to arrest the progress of emaciation and anemia or anemic obesity.

The third stage of auto-intoxication is a most unhappy one. The impoverished tissues offer a most favorable soil for the development of diseased conditions. These three stages which are clear to the experienced eye of the physician may to the patient seem to be indistinguishable, the one from the other; and it must not be forgotten that the three conditions do not mean simply that a smaller or larger part of the intestine is clogged by its contents, but that the whole system is involved as well.

It cannot indeed be otherwise with the rapid circulation of the blood, nor need it excite wonder that such patients are thin and debilitated by the deadening of the powers of absorption, a.s.similation and elimination.

As a rule the many thin and puny infants and children of either s.e.x, with bony points well exposed under a tightly drawn skin, which latter is clay-colored and pimply; children with headache and languor, without healthy interest in either studies or play;--these are the victims of intestinal poisoning as described. If they have inherited a spare habit of body from their parents such bodily ills will manifest themselves the more quickly. They ought to be fat and hearty as are the young of animals, but alas many are not! When the young animal is spare, a few days of rest with good diet will put flesh on it, demonstrating that the state of the bowels and the powers of a.s.similation are intact. Why does not man take on flesh in a similar way?

If the intelligent animals could talk, they would undoubtedly make all manner of fun of the intestinal ca.n.a.ls which they see walking about, with a little flesh here and there seemingly by accident, and a skin which is clay-colored or jaundiced, anemic or flabby, the owner of it all poisoning himself by decomposition in his intestines!

CHAPTER XVIII.

INFLAMMATION.

If we desire to get a general idea of the changes that occur in an organ when it becomes inflamed, we must first have a knowledge of the normal structure of that organ, even though that knowledge be but superficial. Taking the intestines, for example, we see under the microscope that they are composed of layers of different tissues, called connective, epithelial, muscle, and nerve tissue; the first two forming a large part of the structure.

In the connective (and fatty) tissues a great many blood-vessels are found (varying in different parts of the organ), the existence of which is necessary for the production of inflammation, since at the very outset of the process, a discharge (or exudation) takes place from these blood-vessels, accompanied by changes or degenerations in the other kinds of tissue.

The process of inflammation is commonly a.s.sociated with symptoms of heat, redness, swelling and pain, in greater or less degree, combined with which a change in the function of the organ is soon noticed.

Micro-organisms are considered the primary cause of inflammation in many or even in most cases in which mechanical or chemical influences may undoubtedly be responsible primarily; and then again, each of these causes may be either external--that is, may originate from the outside world--or internal, that is, may be produced in and by the body itself.

The first p.r.o.nounced change occurring in an organ under inflammation is an increase in the rapidity with which the blood circulates through the vessels--a so-called hyperemia--which soon gives place to a diminution (stasis) in the current together with an exudation from the blood-vessels; the latter is due to changes in the structure of their walls. This exudation soon occasions a cloudiness of the connective tissues and at the same time a desquamation (shedding in scales) of the epithelia (cells of the thin mucous surface). An irritation of the nerves also takes place.

The varieties of inflammation can be best apprehended by considering the different characters of the exudation. The exudation may be watery (called serous) or dense, the latter either fibrinous or alb.u.minous.

With a serous exudation there is swelling of the connective tissue and a desquamation of epithelia--the latter usually slight in character--which const.i.tutes what is known as a catarrh; while with a fibrinous or alb.u.minous exudation there is usually more or less destruction of the tissue itself, when, for example, we have "croup" or "diphtheria."

When the changes in the epithelia are only slight and secondary, it is spoken of as an interst.i.tial (lying between) inflammation, which strictly speaking denotes confined to connective tissue, and is therefore a term not entirely correct. When the inflammation of the epithelia is severe and may lead to their partial destruction, it is called a parenchymatous inflammation; that is, one involving the soft cellular substance. There is still another variety, the suppurative, which is the most intense of all, and indicates the production of an abscess and the entire destruction of the tissue implicated.

Beside these general grades of inflammation there are special sorts produced by specific micro-organisms. In all general inflammation we may expect to find such organisms, which in most cases belong to the cla.s.s of micrococci, such as staphylococci and streptococci. In gonorrhea we have a special organism called the "gonococcus"; while in tuberculosis--a variety of inflammation in which the blood-vessels are completely destroyed and a change or degeneration called "cheesy" is produced, leading to the production of a tubercle--a rod-like bacillus is invariably found, the well-known and unfortunately too common tubercle bacillus. In syphilis--another special variety of inflammation--a specific micro-organism is also surely present, but of this microbe science has not as yet discovered the exact nature.