Chronic Constipation Indigestion Autogenetic Poisons Diarrhea, Piles, Etc.
Auto-Infection, Auto-Intoxication, Anemia, Emaciation, Etc.
Due to Proctitis and Colitis
Published by Chas. A. Tyrrell, M.D. 134 West 65th Street, New York City 1915
Copyright, 1901 by Alcinous B. Jamison, M.D. 43 W. 45th Street, New York U. S. A.
TO THE UNFORTUNATE SUFFERER FROM ILLS DESCRIBED IN THIS VOLUME AND TO THOSE WHOM I HAVE HAD THE PLEASURE OF CURING THIS BOOK IS RESPECTFULLY DEDICATED
It was an image good to see, With spirits high and full of glee, And robust health endowed; Its face was loveliness untold, Its lines were cast in beauty's mold; At its own shrine it bowed.
With perfect form in each respect, It proudly stood with head erect And skin surpassing fair; Surveyed itself from foot to head, And then complacently it said: "Naught can with me compare."
When lo the face began to pale, The body looked too thin and frail, The cheek had lost its glow; The tongue a tale of woe did tell, With nerves impaired its spirits fell; The fire of life burned low.
In the intestinal canal Waste matter lay, and sad to tell, Was left from day to day; And while it was neglected there It undermined that structure fair, And caused it to decay.
The doctor's words I would recall Who said: "Neglect precedes a fall," And verily 'tis true; For ye who disregard your health, And value not that precious wealth, Will surely live to rue.
The following chapters were contributions to Health—a monthly magazine published in New York City. Certain peculiarities of form and considerable repetition of statement—both of which the reader cannot fail to notice—are owing to the fact that about two-thirds of the chapters were written under the caption "Auto-genetic Poisons in the Intestinal Canal and their Auto-infection." In revising these contributions for book form I have given to each chapter a caption of its leading thought; but I am convinced that repetition of some of the matters treated, especially if the repetition be in a somewhat different connection, is not such a very bad thing. I have used my blue pencil sparingly, and as a consequence the consecutive reader will find that constipation, diarrhea, biliousness, indigestion, auto-infection and proctitis are treated in nearly all the chapters—but with varying applications. Therefore anyone suffering from one of these complaints would better read the whole book instead of only the chapter with the corresponding title.
These pages were written for intelligent laymen by a specialist, during a busy, assiduous practice. I take such radical ground, however, going to the very root of the matter, that the general practitioner will do well to give my thesis his careful consideration; he should at least glance at the following Introduction for the gist of my claim.
CHAPTER I. PAGE
MAN, COMPOSED ALMOST WHOLLY OF WATER, IS CONSTIPATED. WHY? 1
THE PHYSICS OF DIGESTION AND EGESTION 12
THE INTERDEPENDENCE OF ANUS, RECTUM, SIGMOID FLEXURE AND COLON 24
INDIGESTION, INTESTINAL GAS AND OTHER MATTERS 29
KEY TO AUTO-INFECTION 36
HOW AUTO-INFECTION AFFECTS THE GASTRIC DIGESTION, AND VICE VERSA 46
HOW AUTO-INFECTION AFFECTS INTESTINAL DIGESTION, AND VICE VERSA 56
THE CAUSE OF CONSTIPATION AND HOW WE IGNORANTLY TREAT IT 64
CURES FOR CONSTIPATION: "FEARFULLY AND WONDERFULLY MADE" 71
BILIOUSNESS AND BILIOUS ATTACKS 78
KING LIVER AND BILE-BOUNCERS 83
SEMI-CONSTIPATION AND ITS DANGERS 89
THE ETIOLOGY OF THE MOST COMMON FORM OF DIARRHEA, i.e., EXCESSIVE INTESTINAL PERISTALSIS 98
BALLOONING OF THE RECTUM 107
BALLOONING OF THE RECTUM—continued 117
THE USUAL DIAGNOSIS AND TREATMENT OF BOWEL TROUBLES WRONG 126
PROCTITIS AND PILES 148
PRURITUS OR ITCHING OF THE ANUS 156
ABSCESS AND FISTULA 164
THE ORIGIN AND USE OF THE ENEMA 173
HOW OFTEN SHOULD AN ENEMA BE TAKEN? 180
MAN'S BEST FRIEND 190
PHYSIOLOGICAL IRRIGATION 191
PROPER TREATMENT FOR DISEASES OF ANUS AND RECTUM ESSENTIAL 202
THE BODY'S BOOK-KEEPING 215
SELECTION AND PREPARATION OF FOOD 220
DIET FOR INDIGESTION 227
DIET FOR CONSTIPATION AND OBSTIPATION 231
COSTIVENESS, DIET, ETC. 235
DIET FOR DIARRHEA 237
A FINAL WORD 240
CHRONIC CONSTIPATION AND THE USE OF THE ENEMA 245
OBJECTIONS TO THE USE OF ENEMA ANSWERED 257
The keynote of this book is Proctitis, inflammation of the anal and rectal canals. Hardly a civilized man escapes proctitis from the day of the diaper to that of death. The diaper is in truth chiefly responsible for proctitis, and proctitis is in turn chiefly responsible for chronic constipation, chronic diarrhea, auto-infection; and hence for mal-assimilation, mal-nutrition, anemia; and for a thousand and one reflex functional derangements of the system as well. The inflamed surface of the intestinal canal (proctitis) inhibits the passage of feces. Absorbent glands begin to act on the retained sewage, and the whole system becomes more or less infected with poisonous bacteria. Various organs (especially the feeblest) endeavor to perform vicarious defecation, and the patient, the friends, and even the physician are deceived by such vicarious performance into thinking and treating it as a local ailment. I cannot, accordingly, insist too emphatically that proctitis, the exciting cause, must be treated primarily if we would cure chronic constipation. Millions of human beings are sent to untimely graves by these ailments. Indeed, the body of nearly every human being is a pest-house of absorbed poison instead of being the worthy temple of a wondrous soul. All due to Proctitis!
MAN, COMPOSED ALMOST WHOLLY OF WATER, IS CONSTIPATED. WHY?
Naturally the mind of man was first educated to observe external objects and forces in their effects upon himself, and the external still continues to engross his attention as if he were a child in a kindergarten. Fascinated by the Without, he ignores the Within. But, marvel of marvels, Disease (which when looked at with discerning eyes is seen to be an angel in disguise) comes to enlighten him concerning the world within. Disease gradually acquaints him with the fact that there are within him organs and functions corresponding to the objects and forces in the world without,—servitors in fact which must not be ignored under penalty of transforming them into foes to his well-being. Disease makes him aware that by ignoring the claims of his inner relations he has been converting his very food, juices and gases into insidious and formidable poisons, which perforce he absorbs into his blood and tissues and circulates throughout his entire system. Thus does the disguised angel admonish the ignorant that the rights of the inner world must not be ignored—that one's duties thereto cannot be neglected without disastrous consequences.
Thus does Pathology, which is really Physiology reversed, become the self-revealer par excellence. Through digestion and assimilation the physiological process takes up the food, juices and gases, to support and augment the life of man. The pathological process, on the contrary, because the conditions for nutrition are ignored, reverses the upbuilding processes; and the organs of life wither, waste and weaken, until life goes out like fire unfed.
Man has been slowly learning to take sanitary measures in reference to everything that contributes to comfort in his surroundings, and hygienic measures in reference to everything conducive to stability in his health.
Through ages he has learned, by experience and experiment, of the changes that inevitably occur in such perishable nutritive substances as water, milk, meats, vegetables, fruits, etc., if they be left uncared for; and he has been led thus to the inference of the law of decomposition—or putrefactive and fermentative changes. Idle substances, like idle minds, have decomposition and the devil for companions. Substances confined in containers open to the air—ponds, cesspools, etc.—are every-day object lessons to man of the fact that the chemical changes they undergo furnish the conditions for breeding bacterial poisons, and that these poisons are a dread menace to animal life.
If the reader will observe the analogy between the decomposition of substances in vessels or pools, and the decomposition of food in the reservoir called the stomach; and its further decomposition in a long canal (the small intestine), connecting the stomach with other receptacles called the colon and sigmoid flexure; and then the decomposition of their contents; he will readily comprehend the chemical putrefactive or fermentative changes or bacterial action that take place in the organism, if for any reason the contents be confined.
Of the four chief elements that enter into the composition of living bodies three are gaseous, or convertible into gas. In the physical man water constitutes three-fourths of the weight of the body. This being so we realize why, notwithstanding our sense of solidity and weight, chemical changes occur quite as readily in our organism as in the substances we see about us. There are no waterproof walls in the body of man to impede the percolation of liquids freighted with promiscuous Passengers from the alimentary canal; Passengers designed to nourish the organs for which they have an affinity. But there are those that have no organic affinity, and these are tramps, vagabonds, and even murderers, disturbing and destroying the normal functions of the system. Through extravasation, that is, through fluid infiltration of tissues, these Passengers come to be one with us, and we make them part of our tissue; but some of the Passengers are the demolishers of the living temple.
Water is universally present in all the tissues of the body, and it is indispensable for introducing new substances into the system and for eliminating the worn-out tissues and foreign substances. It is indeed important to emphasize the fact that properly to eliminate the foreign and waste products from the system requires, in a healthy person, at least five pints of water during twenty-four hours.
The amount of gastric juice secreted in twenty-four hours is from six to fourteen pints; of pancreatic juice, one pint; of bile there are two to three pints, and of saliva one to three pints. It is estimated that the juices secreted during digestion in a man weighing 140 pounds amount to twenty-three pounds in twenty-four hours. These fluids are poured back and forth in the process of transforming food into flesh and eliminating waste material.
In the alimentary canal there are vessels for holding fluid, semi-fluid and moist masses of substance, in all of which decomposition occurs if the substances be retained beyond the normal length of time. These vessels or reservoirs are the stomach, duodenum, small intestines, colon, sigmoid flexure, and too often the rectum. Through the harmonious action of this intestinal retinue of servitors man is well equipped and qualified for health, and he in whom this harmonious subservience prevails is among the blessed and elect of mankind. But alas! the great majority of human beings are sufferers from the inharmonious and insubordinate action of these servitors. How many a human being suffers from chronic constipation and indigestion, the exciting causes of which are insidious, and the consequences a protean enemy to his happiness! Medical writers on the subject of chronic constipation have assigned numerous causes, and likewise prescribed multitudinous remedies to the patient; but as a general rule this patient, after suffering various woes, if still surviving the many years of medication, rebels against taking further remedies and resigns himself to the chronic enemy on the best terms he can make with diet.
For this large class of chronic sufferers we have good news; and for the class that have suffered five or ten years we have better news; and for the class of infants and children that have started on the road of ill-health we have real glad tidings. To know that there is only one chief cause for chronic constipation and its train of disorders, and that that cause overshadows all other causes combined, and is easily diagnosed and treated, is news long hoped and prayed for by a multitude of sufferers the world over.
Twenty years as a specialist in diseases of the lower bowels have demonstrated to the writer that chronic inflammation, and often ulceration, of the rectum and sigmoid flexure, in ninety-nine cases out of a hundred, is the cause of chronic constipation and the long army of ills resulting from it. And yet, as the reader is well aware, constipation has had many "causes," since the days of Hippocrates, especially the abnormal condition of the liver.
The etiology, that is, the exciting cause, of the inflammation of the anus, rectum, colon, etc., may date from the time a diaper was placed on the new-born infant. Excoriations of the integument about the anus by the excretions of bowels and bladder indicate that the mucous membrane of anus and rectum demands local remedies, as well as the integument of the buttocks, and that it is not the liver which is at fault. The many applications of the diaper during the period of its use, and the frequently delayed removal at night or during long rides in baby wagons, railway trains or carriages, and during long social visits of the nurse; constipating foods, lack of drinking water, constipating medicines, followed by all sorts of purgatives, etc., are among a few of the direct causes of diseases of the rectum. A child at the age of eighteen months with a healthy rectum is most rare.
The ten thousand and one chances for contracting disease of the anus and rectum do not cease with the period of infancy. The child is left pretty much to shift for itself as to regularity of eating and the evacuation of the contents of its bowels, wherein disease has already obtained a foothold. All kinds of foodstuffs, at all hours, with seeds, stones, etc., are poked into its stomach, followed by constipating remedies to quiet inevitable troubles, or brisk purgatives given with the hope of expelling the arrested contents of the bowels. Is it any wonder that ninety-eight persons of adult age out of every hundred suffer more or less from chronic inflammation and ulceration of anus, rectum, sigmoid flexure, colon, or appendix?
Traumatic (externally produced) injuries to the mucous membrane of the rectum frequently cause inflammation, and hard pieces of bone, wood, seeds, imbedded in the feces, scratch, cut and bruise the tissues before and during the act of defecation. Cold boards, stones, earth and other substances used as seats may produce inflammation of the rectum. There are many and various causes which may be the means of exciting inflammation of the anus and rectum later in life; but it is the writer's opinion that the cause can be traced back to infancy or early childhood, and that accidents or imprudence in after years merely excite an already-existing chronic inflammation. Piles, fissure, itching pockets, tabs, prolapse, abscesses, fistulae, etc., are only the outcome and symptoms of a chronic disease which has incubated for fifteen, twenty or more years. None of this list of troubles produces constipation. It is the inflammation located at the middle portion of the rectum and extending into the sigmoid flexure that causes constipation; that protean monster which deranges more lives with nervousness than any other pathological condition to which the flesh of man is heir!
THE PHYSICS OF DIGESTION AND EGESTION.
A tree is simply an extension from its roots; and, in an analogous manner, man's body may be said to be an extension from the alimentary canal. Does it not follow, consequently, that the digestive apparatus, from a physiological point of view, is the most important organ of the human body? It must be prime and paramount because all other organs depend upon it: it provides them with nourishment for preservation and improvement, and it punishes them—if they do not mind the laws of normality—by withholding its gifts, or by presenting these gifts in the form of poisons that impoverish, hinder and degenerate the system of organs. Uncleanliness is surely one of the chief ways in which physiological thoughtlessness is exhibited, and due punishment will inevitably follow disobedience.
Foodstuffs are prepared for assimilation in the alimentary laboratory through the process of normal fermentation. Is it not essential, therefore, that the connecting canals and receptacles be cleansed of the fermented debris that may remain unused and unexpelled, before more food be taken by the digestive apparatus? The all-important question is:—How soon and how well have the residuary part of the food (for some part will always be undigested or unassimilated), and the waste resulting from worn-out tissues of the various organs, been eliminated from the system? Wisdom declares that it is not so much what we eat, but what and how well we eliminate, that decides the issues of health and disease. Do the egesta pass out in the form of normal feces? Three times in twenty-four hours foodstuffs are taken, and as many times the bowels should be freed of accumulated excrement and gases. Does Nature have her way, or do neglect and bad habits rule the assimilative and eliminative functions of the bowels?
The habit of storing feces for twenty-four hours ought to concur and keep pace with a habit of eating one meal in the same period. Household and laboratory receptacles in which fermentation has occurred are emptied and cleaned before fresh material is put into them. Is not the same precaution more essential with the receptacles for digestion and egestion? They constitute our chief physiological economy; they are precious household and laboratory utensils; exceedingly precious, as we can purchase no other set when these are worn and wasted beyond repair. What marvelous possessions, and how reckless most of us are with them! Neither love nor money will bring another "body"-house to us when this decays; when poisons or parasites infest it as the result of a pernicious diathesis, of debasing, destructive tendencies; in short, of unmindfulness!
Too often criminal negligence or the lack of proper convenience has brought on the habit of using the intestinal canal as a storehouse for dried feces, and the glands and blood-vessels as reservoirs for the absorbed fluid poisons from the feces that have been stored and thus dried. This baneful habit is general throughout civilized communities. It is this habit that has made the words "constipation," "indigestion," "diarrhea," etc., familiar and household subjects of complaint. Medical writers agree that "constipation" is the most common malady that afflicts mankind; but they are also unanimous in preposterously attributing the cause to the abnormal action of the liver and the secondary symptoms of constipation.
Chronic constipation is the result of proctitis and colitis. Proctitis, the inflammation of the rectal and anal canals, is the most common disease that afflicts the human creature from infancy to old age; and colitis is only the extension of proctitis to the colon.
The scientific diagnosis of constipation predicates proctitis and sometimes colitis. It is declared that constipation is its primary symptom; and that diarrhea is one of its secondary symptoms, resulting from constipation. There is a legion of secondary symptoms of proctitis, all of which medical empiricism considers and denominates causes. As constipation is such an every-day complaint of almost everybody one meets, it will not tax our imagination unduly to conceive how it may be a frequent cause of diarrhea, which is only Nature's effort to get rid of its useless and excessive burden of retained feces and gases. Constipation, semi-constipation, and irregular action of the bowels, excessive fermentation, putrefaction, self-generated or auto-infection, are the factors to be considered. It is to be noted that in many cases diarrhea is simply an increased peristalsis of the bowels, often due to local and diffused irritation and often to inflammation of the mucous membrane (not infrequently with ulceration); all of these may be the outcome of fecal impaction.
To make intelligible the physics of the digestive and egestive processes, we must understand the apparatus. One would naturally think that were the bends or curves of the large intestine undone, it would be found to be a long, straight, smooth canal or bore like a rubber tube. But such is not the case. The outer muscular longitudinal bands are much shorter than the musculo-areolo-mucous tube, an arrangement which brings about a transverse puckering of the gut and mucous membrane, thus forming valves, folds, sacs or pouches at short intervals along the canal. These transverse folds or valves inhibit the too hasty passage of the feces along the bowels by checking and retaining the egested product in the large recesses or pools between the folds; they thus serve as so many dams in the passage of feces toward elimination. This wise provision of Nature to moderate the steady motion of the feces as they proceed toward the sigmoid flexure or receptacle, to wait there till there is a proper stimulus for expulsion, is wofully abused by man. He is quite willing to take foodstuffs three or four times a day, to fill the long row of intestinal pools between the dams with feces and gases in all stages of decomposition, not dreaming of the danger from developing bacteria and their absorption into the system.
Really he is inclined to eat at all times, yet begrudges a few minutes spent in a hurried effort to perform the act of defecation once in twenty-four hours. Some of us even have our minds absorbed in reading while awaiting an "automatic action" of the bowels. What a contrast between the gusto and time spent in taking foodstuffs and the indifference and indolence regarding the action of the bowels, unless indeed severe biliousness or diarrhea reminds us strongly of our sewer of waste products.
An attack of acute or chronic diarrhea is the penalty some pay for long inattention to the demands nature makes for intestinal cleanliness three times in twenty-four hours. Constipated people, semi-constipated people, irregular people and twenty-four-hour people, are not healthy. They are constantly being poisoned by the abnormal products of indigestion and putrefaction resulting from fecal stagnation, which products enter the blood and circulate through every tissue of the body.
All cases of proctitis are more or less accompanied by constipation and diarrhea. In all cases of chronic constipation I have found proctitis, and often colitis, and am forced to believe it is the most common and proximate cause of chronic constipation of the bowels. Constipation being a primary symptom, there must of necessity follow numerous secondary symptoms, of which diarrhea well marks the progress of septic infection. Some of the symptoms of infection are headache, megrim, vertigo, dyspepsia, foul tongue and mouth, back-aches, stiff neck, gnawing pain or numb feeling at the lower end of the spine, biliousness, bad odor from breath and skin, muddy complexion, cold hands and feet, jaundice, neurasthenia, loss of memory, drowsy feeling, pernicious anemia, emaciation, flabby obesity with pallor, capricious appetite, fits of great mental depression, palpitation of the heart, bloating of the stomach and bowels, disturbance of the kidneys, liver, lungs and mucous membrane in general, and especially chronic rhinitis and pharyngitis, which latter are among the first symptoms of imperfect alimentary excretion.
As auto-intoxication (that condition of the system when it is continually poisoned, usually by one's own excretions) gains the mastery of the vital forces at any period of life, the mucous membranes are likely to be first affected by inflammation of catarrhal character; then the serous membranes of the body. Mal-assimilation, mal-nutrition, cell-atrophy, are symptoms of the giving way of the vital energies to the invasion of the filth and bacterial poisons absorbed from the intestinal canal.
On the inner surface of the alimentary canal, from the stomach to the colon, there are, it is estimated, over 20,000,000 rootlets (called glands, lacteals, follicles, villi), which take up intestinal juices as roots of a plant take sap from the soil. These millions of rootlets give a velvety appearance to the alimentary canal, like a nap or downy surface. Intestinal rootlets of the small intestines, like vegetal rootlets, demand a certain amount of normal fluid and solid substance, free from noxious gas. It is the down or nap of fabrics, and not their body, that shows damage first. So it is with the frail structure of vegetal and animal life if not properly supplied with nourishment from day to day. There is probably in the vegetal bodies a continuous circulation of sap corresponding to the digestive circulating fluids of the alimentary canal. This circulation from the alimentary canal to the blood-vessels, and from the blood-vessels to the alimentary canal, involves a wonderful mechanism, facilitating the flow of several gallons daily from each to the other during the process of metamorphosis of food into flesh. You can thus see how inevitable it is that the functions of these millions of secreting and excreting rootlets will be disturbed by the clogging of the system with filth and bacterial poisons as a consequence of chronic constipation, biliousness and general foulness of the alimentary canal. Through such disturbance nutrition is diminished, cell-atrophy progresses, and emaciation becomes more marked. The progressive destruction of these rootlets, involving the pathological change indicated, will be manifest in one of its results, either costiveness or diarrhea.
Often the power of properly digesting and absorbing the foodstuffs is so greatly diminished that the alimentary canal is about as useless as a soft rubber tube. Millions on millions of these glands, lacteals and follicles in the stomach and small intestines, are destroyed like the rootlets of a plant or tree in unwholesome soil. The active circulation of the digestive fluids ceases, and the sufferer is said to be costive or to have chronic diarrhea. Both symptoms are the outgrowth of many years of intestinal foulness, and indicate the degree and character of intestinal irritability and semi-starvation of the body, as a consequence of either the absorption of poisons or the excessive elimination of the vital substance of the body through diarrhea.
THE INTER-DEPENDENCE OF ANUS, RECTUM, SIGMOID FLEXURE, AND COLON.
Physiologically, or in a normal state, the rectum is not a receptacle for liquids and feces but a conduit during the act of defecation. Should, therefore, the feces have passed into the rectum and the desire to stool be not responded to—though the desire continue urgent—the feces will be returned to the sigmoid cavity by physiological action. When, however, the functions of the anus and rectum are disturbed by chronic inflammation, etc., the lower portion of the rectum becomes a more or less roomy pouch, a receptacle for feces and liquids; and instead of being physiologically empty it becomes pathologically distended, the result of spasmodic action or of more or less permanent stricture of the sphincter ani. See illustration in my book entitled How to Become Strong (page 14).
The putrid fecal mass of solid and liquid contents accumulated in the artificial reservoir at the end of the intestinal sewer, is one of the most common and serious pathogenic (disease-producing) and pyogenic (pus-producing) sources, which, by auto-infection, afflict man from infancy to old age. Here—in the dilated and obstructed sewer—the ptomain and leucomain class of poisons, and many of the poisonous germs, led by the king of morbid disturbers, the bacillus coli communis, find another and last chance to be taken up by the absorbing cells of the mucous membrane and returned to the blood; with which they are carried to all parts of the body, clogging the glands, choking up the pores and obstructing the circulation, thereby causing congestion and inflammation of the various organs. The action of cathartics, laxatives, etc., fills the ano-rectal cavity with a watery solution of foul substances; this solution is readily absorbed into the circulation, aggravating the auto-intoxication (the established self-poisoned condition) already existing. Danger does not end with the absorption of bacterial poisons, as we have to reckon with the deleterious effects of the various intestinal gases, resulting, with rapid augmentation of volume, from the putrefactive changes in the imprisoned feculent matter.
A sphincter ani permanently constricted or irritable owing to disease results in an abnormal receptacle just above the anal orifice (as shown in the illustration referred to); and a constricted and irritable rectum results in the impaction and dilatation of the sigmoid cavity, which is normally a receptacle, closed at its lower end by circular fibres separating it (the cavity) from the rectum and performing the function of a sphincter muscle. The rectal muscular fibres perform the office of a sphincter for the sigmoid cavity. The pathological changes that result in rectal impaction of feces usually extend to the sigmoid cavity. This cavity is 17-1/2 inches in length, shaped in a double curve like an italic S. Civilized man should consider the disturbance to the functional action of body and brain, and the danger to health and longevity involved in the storage of effete and fetid matter. The disturbance and danger are enhanced when the tissues of the sigmoid flexure and the rectum are invaded by inflammation. A healthy action of the sigmoid receptacle depends on the rectum (a conduit six to eight inches in length); and as it is the universal verdict that disease of the rectum is one of the most common maladies that afflict the human race, it must inevitably follow that the feces will be abnormally stored in the sigmoid cavity, occasioning thereby habitual constipation which in turn brings on a host of functional disturbances throughout the system.
The colon is a receptacle and a conduit some three feet in length (see ib. p. 13) and its action depends upon the ability of the sigmoid flexure to perform its function as a final normal receptacle; and this in turn upon the rectum, which depends on the sphincter ani. The colon does not appear to possess any digestive powers, though it is capable of absorbing substances. Its function is not only to receive and forward the trifling residue of food which escapes digestion and absorption, but chiefly to excrete, through its own minute glands, the waste of the system coming from the blood.
The excretion from these glands of the colon into the colon, plus the effete portion of the food received by the colon from the small intestine, approximate in weight from four to six ounces in an adult person in twenty-four hours; and of this amount passed 75 per cent is water; so that were the excreta dried the solid matter thus evacuated would not be found to weigh more than one ounce, or one and a half ounces.
INDIGESTION, INTESTINAL GAS, AND OTHER MATTERS.
We noted the fact that the "digestive secretions" in a man weighing 140 pounds amount to twenty-three pounds in twenty-four hours; now add to these the food and liquids taken in that period, and you will form some estimate of the work done in the human chemical laboratory in its normal and abnormal states.
We noted further that substances confined too long in receptacles decompose and generate pathogenic poisons, that is, poisons productive of disease; and that the intestinal reservoirs are no exception to this law of putrefactive changes. How could we avoid drawing the inference, therefore, that disease-breeding germs, (generated in the organism and hence called "autogenetic"), and their auto-infection, i.e., absorption by the system, are an inevitable consequence of the undue retention and fermentation of the contents of these reservoirs: a consequence, in other words, of that intestinal uncleanliness commonly called biliousness, constipation, indigestion.
By far the most common and immediate source of autogenetic (self-produced) poisons and their auto-infection, is some degree of chronic constipation and the deadening, smothering effects of constipation on digestion; an effect analogous to what takes place when we allow waste material or ashes to bank up against a fire, shutting off its draft. Does the fire then continue to digest the coal? Clog up the receptacle for ashes and the coal grows cold. Dam up the colon or sigmoid and digestion is disturbed, diminished and debased, as evidenced by the local and general discomfort, and later by the train of inevitable disorders.
Indigestion is a household word. It has the widest range of all the diseases, because it forms a part of almost every other; and some diseases, such as chronic catarrh and pulmonary consumption, are in many cases produced by indigestion; which in turn had its source in chronic constipation caused by injury or inflammation of the lower bowel, as explained in our first chapter.
Diminished nutrition, impoverished blood, and loss of weight of from ten to twenty-five pounds, are the signs that indicate the coming disaster to the sufferer from auto-intoxication: the thoroughly poisoned state of the system resulting from auto-infection.
Vessels used by the dairyman and by those who furnish us with food products and liquids are kept scrupulously clean. Why? Because it is a question of loss of trade—of money. Should these vessels be used when foul from fermentation or putrefaction of their contents, Wealth would flee from the coffers of our purveyors, and the Boards of Health would, or rather should, take a hand in the matter. And these same purveyors, by the way, why do they care more for Wealth than for Health, their own and ours? But why are we all of us so neglectful of Inner cleanliness and so careful of Outer? The receptacles of the inner man reek with augean filth, and we cleanse them not. The immortal fountains of Health and Happiness are dammed, blasted and degraded by just this neglect of our imperative duty; the duty of furnishing full opportunity for the functions of replenishment and life, by keeping the sewer passages clear.
Are a sour stomach and foul intestinal canal fit receptacles for food and liquids? When our receptacles are in this condition, why do we add more material for the generation of poisons of the ptomain and leucomain classes, and morbid gaseous elements? It has been demonstrated that during fermentation an apple will evolve a volume of gas six hundred times its own size. What folly then to add to the fermenting mass! Food taken under such conditions will produce results not hard to imagine.
The gases that are commonly found in the stomach and small intestines are carbonic acid, nitrogen, oxygen and hydrogen; while, besides all these, sulphureted and carbureted hydrogen are found in the large intestine, causing in a normal state the necessary and useful distention of the alimentary canal. The writer has long regarded the abnormal production of gaseous substances in the intestinal canal from putrefactive changes as of itself not only a grave menace to health, but as a condition productive of morbific results of which we have still much to learn. The more or less constant and excessive distention of the whole or even of a part of the intestinal canal by gases is a serious condition, affecting as it does the various organs of the body, not only through the absorption of these gases into the general circulation but also through the reflex nervous reaction of these organs. It is astonishing what amount of mechanical force is exerted by the gases in the intestinal canal. They distend not only the muscular walls of the intestines and stomach but the strong abdominal walls as well, until the clothing worn has to be loosened for ease and comfort. This more or less extreme mechanical pressure may account for many cases of hernia, prolapse of the uterus, dislocation of various organs, disturbance of the circulation of the blood, and interference with the function of the nervous system, as indicated by its many protests in the way of aches and pains. Naval-constructor Hobson has lately demonstrated the dynamic power of gas confined in bags or receptacles in raising battleships; and it still remains for some physiologist or pathologist to demonstrate the morbid dynamic results of gases confined in the alimentary apparatus. The deleterious effect of the abnormal quantity of gases on all the organs of the body is imperfectly understood at present, but will be better apprehended when we are able to study more minutely the pathogenic poisons of the human system. It is known, however, that a stream of carbonic acid gas, or even of hydrogen, will paralyze a muscle against which it is directed.
KEY TO AUTO-INFECTION.
In a previous chapter we stated that the average quantity of fecal discharge daily, by an adult, is from four to six ounces, and that of this weight 75 per cent is water. We referred of course to the daily passage from the bowels alone, not including that from the bladder.
Our studies have thus furnished us with the key wherewith to unlock the secret chambers of auto-infection. What is that key? It is the discovery that the system may possibly absorb as high as three-fourths of this feculent substance in the colon; that this absorption is made possible by an obstructed or sluggish intestinal canal where disease germs are propagated and lodged; that these germs, along with a certain amount of excrement, invade the tissues by absorption; and that we thus have the system constantly saturated with poisonous germs and filth, re-excreted, re-absorbed and re-secreted—no one knows how many times—by the various organs of the body.
That the importance of intestinal cleanliness may be better appreciated, I will quote from the following authors on the subjects of excretion, absorption and circulation of the intestinal fluids.
Dr. Murchison states that:
"From what is now known of the diffusibility of fluids through animal membranes, it is impossible to conceive bile long in contact with the lining membrane of the gall-bladder, bile-ducts, and intestine, without a portion of it (including the dissolved pigment) passing into the blood. A circulation is constantly taking place between the fluid contents of the bowel and the blood, the existence of which, till within the last few years, was quite unknown, and which even now is too little heeded. It is now known, says Dr. Parker, that in varying degrees there is a constant transit of fluid from the blood into the alimentary canal, and as rapid absorption. The amount thus poured out and absorbed in twenty-four hours is almost incredible, and of itself constitutes a secondary or intermediate circulation never dreamt of by Harvey. The amount of gastric juice alone passing into the stomach in a day, and then re-absorbed, amounted in the case lately examined by Grunewald to nearly 23 imperial pints. If we put it at 12 pints we shall certainly be within the mark. The pancreas, according to Kroeger, furnishes 12-1/2 pints in twenty-four hours, while the salivary glands pour out at least 3 pints in the same time. The amount of the bile is probably over 2 pints. The amount given out by the intestinal mucous membrane cannot be guessed at, but must be enormous. Altogether the amount of fluid effused into the alimentary canal in twenty-four hours amounts to much more than the whole amount of blood in the body (which is 18 pounds in a man weighing 143 pounds); in other words, every portion of the blood may, and possibly does, pass several times into the alimentary canal in twenty-four hours. The effect of this continual out-pouring is supposed to be to aid metamorphosis; the same substance more or less changed seems to be thrown out and re-absorbed until it be adapted for the repair of tissues, or become effete."
The reader will readily perceive how the system may become so charged that other organs of the body will vicariously attempt to play the part of a receptacle and conduit for the bowel, in order to excrete and eliminate ancient and offensive filth and bacterial poisons. The phenomenon of vicarious excretion may occur through the kidneys, lungs, skin, throat, nose, vagina, or uterus, thus keeping up chronic diseases and discharges that would not exist but for the chronic constipation or even for incomplete action of the bowels each day. Over-distention of the rectum, sigmoid and colon, due to the pressure of gases and the impaction of feces, results in inflammation, ulceration, stricture, appendicitis, abscess, strangulation, intussusception, and abnormal ballooning or roominess in certain portions of these intestines or conduits. This roominess, though it becomes filled with feces, and often with liquids, permits of sufficient space for even the daily passage of feces without dislodging the stored contents. The fact that there is a passage daily deceives both sufferer and medical adviser as to the source of the poisonous condition of the system, and masks the origin of such disorders as chronic inflammation and ulceration of the nose, throat, lungs, stomach, duodenum, colon, appendix vermiformis, uterus, bladder, kidneys and edema of the legs. But these evidences of auto-infection are generally preceded and accompanied by a general loss of vitality and weight, by anemia, by a lowering of the resisting power of the organism—all of which produce a fit soil for the various diseases to which flesh is heir. As soon as the system becomes saturated with bacteria and effete matter, auto-intoxication results, in which condition there is but little or no store of vitality for resistance, reaction and recuperation.
Dr. Bright has recorded several instances of fecal accumulation in the colon mistaken for enlargement of the liver and for malignant tumors. In one of the cases there was jaundice which disappeared after free evacuation of the bowels. Frerichs also relates a case where enlargement from fecal accumulation was at first ascribed to a pregnant uterus, and subsequently, on the supervention of deep jaundice, to an enlarged liver, but in which purgatives dispelled the patient's anxiety about a diseased liver and at the same time her hopes for a child.
Dr. N. Chapman, in his Clinical Lectures (p. 304), says:
"The feces sometimes accumulate in distinct indurated scybala or in enormous masses, solid and compact. Taunton, a surgeon of London, has a preparation of the colon and rectum of more than twenty inches in circumference containing three gallons of feces, taken from a woman, whose abdomen was as much distended as in the maturity of pregnancy. By Lemazurier, another case is reported of a pregnant woman, who was constipated for two months, from whom, after death, thirteen and one-half pounds of solid feces were taken away, though a short time before between two and three pounds had been scraped out of the rectum. Cases are reported by Dr. Graves of Dublin, which he saw in women, where from the great distentions in certain directions of the abdomen, the one was considered to be owing to a prodigious hypertrophy of the liver, and the other of the ovary; in the latter of which he removed a bucket-full of feces in two days. Mr. Wilmot of London has recently given a case where a gallon of matter was lodged in the caecum, and the intestines perforated by ulceration."
Dr. Pavy, in his treatise on The Functions of Digestion (p. 232), writes:
"The morbid conditions that constipation may occasion are of various kinds. Under an undue retention of fecal matters within the colon noxious products may be formed there, and act as irritants upon the mucous coat, setting up inflammation, followed by ulceration. It is to be here remarked that fecal matters are sometimes retained in the sacculi or pouches of the colon, and may give rise to the circumstances referred to, whilst a passage exists along the centre of the canal that shall permit a daily evacuation to occur. The dejections, even, may be loose in character, and still the same sequence of events ensue. From the irritating influence of preternaturally retained feces, colicky pains are, as a rule, induced, and the ultimate effects may be such as to lead to the production of fatal inflammation.
"The effect of constipation upon the muscular coat of the bowel is, through distention to which it is subjected, to weaken or deteriorate its evacuating power. As the result of a great amount of distention, like as happens in the case of the urinary bladder, more or less complete paralysis is induced. From the prolonged retention of fecal matter accompanying constipation, excrementitious products that ought to be eliminated become absorbed and thereby contaminate the contents of the circulatory system. As the result of this contamination, the secretions become vitiated, and a general disturbance of the conditions of life is produced. The action of the liver becoming deranged, its eliminative office is imperfectly discharged, and thus sallowness of the face and a bilious-tinged conjunctiva are produced. A coated tongue, foul mouth, loss of appetite, and other dyspeptic manifestations, accompany the general disorder of the digestive organs that prevails. The accumulation existing in the colon leads to a sense of distention and uneasiness in the abdomen. The kidneys vicariously discharge products that ought to have been eliminated by the alimentary canal. In this manner the urine becomes preternaturally loaded. From the contaminated state of the blood the functions of animal life also become disturbed; and hence the lassitude, debility, headache, giddiness and dejected spirits, that form such frequent accompaniments of constipation.... A distended caecum, colon, and rectum may also, by the pressure exerted upon the nerves and vessels of the lower extremities, be the cause of numbness, cramps, pains and edema of the legs. The edema occasioned by constipation, if not exclusively confined to one side, will in all probability be decidedly greater in one leg than in the other."
Case (from Gaz. Med. de Paris, July 20, 1839): A woman of fifty was troubled with habitual diarrhea and frequent calls to urinate, in which urine could be discharged only by drops. After six years of suffering and unsuccessful use of remedies, she was examined for the first time per anum, and an accumulation of fecal matter discovered, forming a mass the size of an infant's head. This was removed and found to weigh four pounds. She then got well.
HOW AUTO-INFECTION AFFECTS THE GASTRIC DIGESTION, AND VICE VERSA.
Frederick the Great said that all culture comes through the stomach. This saying emphasizes pithily the dependence of psychology upon physiology. The stomach with the intestines is certainly the source from which every portion of the body receives its nourishment and most of its diseases. The physiological plus and minus processes leave their reflex on the mind.
Prof. Ch. Bouchard, in his lectures on Auto-Intoxication (Oliver's trans., p. 14), says: "The organism in its normal, as in its pathological state, is a receptacle and a laboratory of poisons. Amongst these some are formed by the organism itself, others by microbes, which either are the guests, the normal inhabitants of the intestinal tube, or are parasites at second-hand, and disease producing."
In the preceding chapters we have mentioned some of the most common cases of retention of excreta in the rectum, sigmoid cavity, colon, cecum, duodenum and stomach, and how the consequent foul conditions often resulted in diarrhea. Auto-infection impairs the functions of every organ in the body, by clogging the pores with poisons and filth. By the transfer of disease germs from one infected, that is, tainted, contaminated part of the body to parts that were free from infection, the kidneys, mucous membrane and skin receive these unnatural products, and their functions are disturbed thereby. The disturbance of the various organs throughout the system sets up such a multiplicity of symptoms that one gets the impression of a pandemonium—a veritable council-hall of evil spirits. The visitation is omnipresent. Infliction, misery, are everywhere. The taint of auto-generated intestinal morbific products, carried and communicated to the remotest parts, manifests itself now here now there as if it were a local trouble, and it is difficult therefore, nay, impossible, to classify scientifically the symptoms of auto-infection. A classification, though necessarily imperfect, will aid in the diagnosis and treatment of the various abnormal conditions of the stomach and intestines, that is, of mal-digestion. The sympathy, good understanding and responsiveness between the brain and the digestive apparatus are so close and intimate that the physician must take into consideration the inter-relationship of these organs before deciding which one is reporting reflex nervous symptoms, and which direct symptoms. Plutarch says in one of his essays: "Should the body sue the mind before a court judicature for damages, it would be found that the mind had been a ruinous tenant to its landlord." The digestive apparatus is, or should be, a farm for the mind, but unfortunately it usually has to wait twenty or more years before the tenant understands how to cultivate it for the uses of his intellectual and esthetical life.
I have referred to the fact that the most common causes of constipation, indigestion and other foul conditions of the alimentary canal favorable to the production of autogenetic poisons and their auto-infection, are such common and every-day matters, so familiar to almost every one that the victim, the parents and the physician feel no alarm of the coming danger for years. During these ignorant and innocent years the poison and filth were being absorbed, infecting the system with their morbific taint and lowering the quality of the blood and lessening its quantity, producing the state known as anemia. Associated with progressive anemia is mal-assimilation, improper nutrition, ebbing of the nervous and vital forces and the lessening of the secretory, excretory and digestive powers. By the time the poor victim is weighing fifteen to twenty-five pounds less than he ought to the symptoms of ill-health are sufficiently alarming to compel the sufferer to seek medical aid for disease of the stomach, bowels, liver, kidneys, lungs, etc.
Slow digestion is perhaps the most common form of functional disturbance of the stomach, due to an insidious auto-infection for years. The eyes and the skin begin to show the effect of the poisonous infection. The skin becomes dry, pale and muddy in color; has more or less annoying eruptions, and exhibits a jaundiced appearance. The body is ill nourished, the nervous system depressed, the blood impoverished, the memory failing, the general appearance languid, irritable, anxious. What a household picture this is to every one of the human family! But let us fill it out somewhat more fully. Note how the undue delay of food in the stomach occasions a sense of weight and oppression, the feeling beginning about an hour after a meal and continuing for hours, sometimes attended with fermentation and sometimes without it. At times there is a feeling of drowsiness due to the absorption of an excessive amount of the gases which distend the stomach and bowels, and this absorption is accompanied by pains in the stomach, head, between the shoulders and in the region of the heart. Sleep is disturbed by dreams, or one is awakened with a feeling of numbness and palpitation of the heart. At times the urine is scanty, strongly acid or high-colored. The tongue is more or less foul, with white or creamy coating. Now and then tasteless or saltish eructations occur. The appetite may be too good, or there is no appetite at all. Note the careworn expression, the wondering what to eat, what to drink or what remedy to take. So between much worse and some better, the trouble continues—both of body and mind.
Indigestion, however, with undue formation of acids proper, or acids unnatural, to the stomach, is a much more annoying affliction than slow digestion. The sufferer from indigestion may be debilitated, anemic, may have a general want of tone; or he may be a more or less vigorous and plethoric person. In some cases flatulence is very troublesome. But the most usual symptoms are heartburn, acid eructations that produce burning sensations, sour taste at intervals or constantly in the mouth, setting the teeth on edge. In the more vigorous or plethoric sufferers a gouty diathesis may exist, which may result in a tendency to inflammation, bringing on neuralgia, rheumatism, gout, etc. Tongue more or less foul; uric acid in the system; confusion in the mind; headaches; pains in the loins, legs and feet; in fact, more or less shifting pains everywhere: these are the common exhibits of indigestion. On the whole, the sufferer is a victim to an irritable body and a fretful mind, necessitating the cultivation by him of patience and the effort to be agreeable.
Besides the symptoms mentioned, indigestion may also be accompanied by gastric pain or by uneasiness at the pit of the stomach. It may be a sense of fulness or tightness, or a feeling of distention or weight, or again, a feeling of emptiness, goneness or sinking. Now and then there are burning, tearing, gnawing, dragging sensations under the breast-bone; and there is a general complaint of a capricious appetite, heartburn, vomiting, nervous headache, neuralgia and cold extremities. Other symptoms are pain from lack of food at the proper hour, or from food taken at the improper time; both of which practices may be followed by flatulency, occasioning a swollen, drum-like condition of the stomach and abdomen; the body of the tongue will be coated white, while the edges will present a redder appearance than in health.
Impaired digestion with nervous symptoms—in which the morbid sensibility of the mind is apparently the greatest—is called hypochondria. This class of sufferers, whose bodily and mental ills and morbid fears are so chaotically interwoven, are deserving of much consideration. So numerous are their fears and so fertile are their reasons for the many changes they arbitrarily make in their efforts to get well or keep from getting worse, so obstinately sure are they of being always right—that we can but give them our sincerest pity.
In some cases the functional troubles of the stomach and mind are aggravated by disease of the pelvic organs, which adds to the depression of the mind through nervous sympathy with the abdominal organs.
Dr. Cullen says on this point:—
"In certain persons there is a state of mind distinguished by a concurrence of the following circumstances: a languor, a listlessness, or want of resolution and activity with respect to all undertakings; a disposition to seriousness, sadness and timidity as to all future events; an apprehension of the worst or most unhappy state of them; and therefore, often upon slight grounds, an apprehension of great evil. Such persons are particularly attentive to the state of their own health, to every smallest change of feeling in their bodies; and from any unusual feeling, perhaps of the slightest kind, they apprehend great danger and even death itself. In respect to all these feelings and apprehensions, there is commonly the most obstinate belief and persuasion." (Quoted in Leared, On Imperfect Digestion, p. 106.)
HOW AUTO-INFECTION AFFECTS INTESTINAL DIGESTION, AND VICE VERSA.
Intestinal indigestion is a more common form of functional disturbance than is gastric indigestion. It is a well established fact that the greater portion of the digestive work is done beyond the stomach, in the duodenum, by the hepatic and pancreatic fluids. The duodenum—very properly called the second stomach—has none of the peculiar characteristics of a receptacle that receives crude substances—the office of the stomach. Much greater sensitiveness characterizes the digestive canal than the stomach; which is accounted for by the fact that a network of nerves, forming the sympathetic system, surrounds the bowels. The symptoms of intestinal indigestion are not always clearly defined and distinguishable from gastric indigestion, especially as the two are frequently associated.
The cecum, more than any other portion of the digestive canal, resembles the stomach, and it secretes an acid, albuminous fluid having considerable solvent properties. It is to be observed that as the cecum is only three inches in length and two and a half in diameter, and as its contents are necessarily propelled in opposition to gravity, a slight casualty will hinder or obstruct the upward movement of the pultaceous mass of the effete ingesta. The turning point in the ascending colon affords another ready hindrance to the upward and onward movement of this mass; and the gases and ancient feces beyond the turn conduce to further sluggish peristalsis, bringing about more or less obstruction and reflex irritation of the remaining length of intestinal canal. Undue retention of the contents of the cecum, and the disturbance and obstruction of the duodenum by the pressure incident to the distention of the colon with feces and gases, lead to congestion, inflammation and occasionally to ulceration of the mucous membrane in various parts of the intestinal tube.
This condition of affairs increases the occlusion (closing) of the bowels, but makes very easy indeed the entrance and propagation of micro-organisms in the sub-mucous coat of the intestine. The conditions are now ripe and rife for auto-infection. Which of the following microbes are the most active agents of progressive auto-infection: the streptococcus lanceolatus, the bacterium pyogenes, the bacillus subtilis, the staphylococci, the bacterium coli commune? They all play a part in the game, reducing the body in time to a charnel-house. Or are such substances as putrescein, cadaverin, skatol or indol—which are derived through chemical change in the putrescent mass—contributors to the spread of the poisonous taint throughout the system? Any single one or a group of the fifty or more bacterial poisons may be the responsible agents in the ensuing auto-infection. Chemical analysis of the gases resulting from decomposition reveals oxygen, nitrogen, hydrogen, carbonic acid, protocarbonated hydrogen and sulphureted hydrogen, ammonia, and sulphate of ammonia. Leucin, tyrosin, lithic acid, lithates, xanthin, cystin, keratin, sulphureted hydrogen, etc., are deposits in the urine and are signs of the derangement of the intestinal canal and liver. The external symptoms observed are the following: the tongue is large, pale, flabby and indented by the teeth at the edge of the anterior third, while its surface is white and the papillae often enlarged; the appetite may be excellent, though there is great functional derangement of the liver with lithemia, so that the sufferer is tempted to eat what he knows from experience will disagree with him; a bitter coppery taste in the mouth, due to taurocholic acid—a common symptom of lithemia or of imperfect oxidation of albumen; emaciation, fatigue, depression, headache, buzzing in the ears and deafness, disturbance of sight, loss of memory, faintness and vertigo, very marked in some cases; sometimes tenderness and pain under the cartilages of the right ribs; the fretting of the sensitive surface of the bowels by imperfectly digested, semi-putrescent food, resulting sometimes in convulsions, coma, paralysis, or in fetid diarrhea of an acid character producing a burning sensation or pain of the anus when the discharges are being passed; rumbling and twisting sensations in the region of the navel occurring with flatulency, and occasionally colicky pains which at times are so severe as to simulate poisoning.
In some people certain articles of food, without being either toxic or putrid, induce indigestion and the production of microbes in quantity amounting to one third of fecal dejections. Prof. Ch. Bouchard says:
"The consequence of this development of acid in the whole length of the digestive tube is an inflammatory condition. We notice catarrh of the stomach, ulcerative gastritis, to which patients often succumb after twenty-five years of bad stomach; these are the false cancers, as they are called, or malignant gastritis without tumor. The large intestine is inflamed; around the fecal matter are seen glairy secretions and sometimes blood (membranous enteritis)." (Op. cit., p. 159.)
In chronic inflammation of the rectum and colon there is more or less discharge of mucous, and in some cases of membranous, desquamation, with yellow or bloody mucus. The shreds, cords or complete tubular casts are discharged constantly or at varying intervals. The quantity and character often alarm the sufferer. The discharge is nothing less than a thick, tenacious mucus that had formed a thin coating on the inflamed mucous membrane, and become exfoliated in casts or thin shreds—the result of many years of morbid intestinal exaggerated action.
Microscopical examination of the desquamated intestinal membrane and mucus from a man forty years of age, revealed the following products: crystals, mostly complete; incomplete phosphates, very numerous; mucous shreds in abundance; fat globules and granules, numerous; anal epithelia; red blood globules, few; connective tissue, scanty; pus corpuscles, very few; margaric acid and detritus (substances resulting from the destruction or wearing away of the part); undigested material, mostly cellulose; leptothrix threads, micrococci; and the bacillus coli communis. Diagnosis: foul, undigested material, due to a chronic inflammation of the lower intestinal tract. The microscopical examination of mucus and desquamated membrane from a woman sixty-five years of age, disclosed that she was suffering from proctitis and colitis. She wrote: "Please tell me how long this mucous discharge must continue. I am alarmed at the quantity of membrane, cords, casts, etc., in my excreta, and I think that if this process goes on much longer there will soon be no bowels left to purify." This letter was written some weeks after contracting a severe cold, which accounts for the unusual amount of exfoliation and mucus. The sample she sent contained a large quantity of mucus, both threads and corpuscles; with a moderate number of epithelial scales, partly anal and partly intestinal. Pus corpuscles were present in small numbers; also vegetable fibres, fat, starch, muscle fibres and cellulose—the remains of undigested material. In the membranes themselves no micro-organisms were found; in the pieces containing undigested material the bacillus coli communis was found as well as micrococci, and the bacilli of putrefaction (secondary formation) were seen.
THE CAUSE OF CONSTIPATION AND HOW WE IGNORANTLY TREAT IT.
One of the best preparations for active life is a first-class intestinal canal.
"An old Scotch physician," says Sir Astley Cooper, "for whom I had a great respect and whom I frequently met in consultation, used to say to me as we were about to enter our patient's room together, 'Weel, Misther Cooper, we ha' only twa things to keep in meend, and they'll serve us for here and herea'ter; one is au'ways to hae the fear o' the Laird before our e'es, that'll do for herea'ter; and th' t'other is to keep our boo'els au'ways open, and that'll do for here.'"
A person whose mind is devoted to the realization of ideals, and whose body has a set of bowels that perform the act of defecation twice every twenty-four hours is doubly prepared for a useful life.
"If thou well observe In what thou eat'st and drink'st, seek from thence Due nourishment, not gluttonous delight, Till many years over thy head return: So may'st thou live, till like ripe fruit thou drop Into thy mother's lap, or be with ease Gathered, not harshly plucked, for death mature."
Milton's advice in poetic lines is all very well for those who have escaped chronic inflammation of the lower bowels, an ailment common and troublesome even under the very best dietetic regulations.
Inflammation having once penetrated the circular and longitudinal muscular fibres or bands of a section of the intestine, all hope of a comfortable existence is at an end, for such inflammation will bring on constipation and constipation nervous misery. It is inevitable that inflammation should determine this outcome since it induces spasmodic contraction of the muscular walls of the tube, lessening the bore or closing the portion of the canal invaded. Plastic infiltration takes place in the walls of the gut, thickening and binding them together; or, if the inflammation be of a simple catarrhal or atrophic nature, the plastic infiltration will more or less bind the circular muscular bands of the gut together in their abnormally contracted state! The presence of feces and gases above the zone of the disease will increase the irritation and contraction of the affected portion of the intestine. Consequent upon these changes wrought by inflammation, gases and excrementitious material are perforce imprisoned in the intestine, inducing constipation, foul fermentation, flatulency, diarrhea, indigestion, nausea, loss of appetite, sick headache and, in fine, autogenetic poisons, the source of auto-infection, ending in auto-intoxication, the chronic poisoned condition of the system.
Since the most common cause of chronic constipation, internal sluggishness and uncleanliness, is known, too much cannot be said in condemnation of the wide-spread abuse of "liver and atony persuaders" and the use of irritating suppositories and dilating bougies, candles, etc. The numerous and various drastic purgative nostrums—which literally fill our medical literature—and the universal demand for them, are evidence of this very common disease, which disease is rendered worse by the drugs taken for the relief of a foul intestinal alveus. An abnormal amount of watery secretion is forced by the drug into the foul canal, to mix there with its contents, of which the major portion is retained and re-absorbed into the system. And to make the bad condition and treatment worse, all such sufferers, as a rule, drink very little water, some scarcely any.
The demand for an irritating stimulus to "open the bowels" (the exciters contribute to close them) is largely due to the popular error in thinking, "I can treat my own bowels quite as well as the doctor, if not better." No intelligent person would think of stimulating and irritating daily an inflamed region of tissue on the outer portion of the body; yet this is precisely what intelligent persons do when they habitually use liver and peristaltic persuaders. The primary disease in the lower bowels and the consequent symptoms are gradually aggravated as the "physic" habit is formed.
As in the case of opium fiends and drunkards, so with habitual cathartic drug-users, should they be suddenly deprived of the accustomed artificial stimulus and irritant they become absolutely miserable, mentally and physically. It is a well-known physiological fact that every artificial stimulation of the intestines is followed by a corresponding loss of vitality and reaction. Now that the almost universal cause of undue retention of foul, effete matter has been ascertained, it is important to communicate to the world at large the best means of cleansing the bowels without increasing the local primary disease and its annoying symptoms.
That external physical cleanliness is next to godliness is an apt proverb. That internal physical cleanliness is nearer to godliness no one will deny.
Water is a universal solvent and therapeutic agent and is therefore indispensable in the cleansing and purifying of the integument and mucous membrane of the body. A large quantity of water is necessary to carry on the functions of the animal economy. Water enters every cell and fibre of the living organism, aiding in nutrition and in the elimination of worn-out tissues which if retained turn into poisons.
It is really not an intelligent but rather a barbarous practice to prescribe liver and intestinal exciters for the purpose of throwing into the alimentary tract a sufficient quantity of watery excretions to "cleanse itself"; to succeed they must first soften and liquefy the dry, hardened feces and scybalous masses (little ancient, bullet-like formations) imprisoned above an inflamed and fevered lower bowel, even colon.
Normal feces consist of 75 per cent water; and when unduly retained in the colon much of this fetid percentage is absorbed into the system. Then drugs are prescribed to liquefy the hardened putrid remnant and absorption begins again: a fact very shocking to a sensitive, even sensible, person.
CURES FOR CONSTIPATION: "FEARFULLY AND WONDERFULLY MADE."
Diseases of the anus and rectum are very common, very numerous and of very critical consequences. This is especially true of the disease of chronic inflammation, one of whose symptoms is piles or hemorrhoids. In the writings of the early Greek and Roman physicians will be found minute descriptions of the latter disorder. But on the whole, the most important symptom of chronic inflammation of the lower bowel, and the most far-reaching in its morbific results, is that protean monster, chronic constipation. It deranges more lives, from infancy to old age, than any other pathological condition that can be named.
For the cause and cure of that mere symptom of a disease, constipation, the so-called scientific physicians, from the early history of medication to the present time, have had one immutable theory as to the leading cause, and one grand motto as to the "safe and sure" cure. They have always prescribed remedies for this malady on the theory of portal congestion and hepatic derangement, and hence their supreme motto: "Physic! Physic!! Physic!!!"
The layman naturally adopted the theory and the motto of his medical advisers; hence in his self-medication and also under advice he consumes such vast quantities of purgative nostrums.
I have just received some medical literature beginning with the usual salutation—"Dear Doctor"—setting forth a new and remarkable theory of the cause, and an original motto for the cure, of constipation. Its authors have discovered that the "rectal nerve-tissues" are hungry, torpid, anemic, and to overcome the "atony" they must be "Fed! Fed!! Fed!!!"
"The greatest of physical ills in America," we are informed, "is digestive torpor or semi-paralysis, originally induced by a kind of starvation of the intestinal nerve-tissues. One of its most prevalent forms is constipation," caused by "local torpor or semi-paralysis, dependent upon an anemic condition of the nerve-tissues of the rectal region." By "feeding directly" the limpid, bedraggled rectum and colon, they receive their "appropriate nutriment, by which comes added vigor,"—the nutriment the stomach and the rest of the system had failed to furnish on account of constipation, excessive fermentation, indigestion and auto-infection.
To overcome this "atony" of two or more feet of the lower bowel, a little "nutritious" suppository, weighing twenty grains, is a "specific." It is claimed to cure chronic auto-infection and the spasmodic occlusion of the lower bowel! The excessive activity of all the region invaded by the chronic inflammation and the local irritation are perpetuated by such "feeding" instead of allayed! Does it not stand to reason that there is already too much activity, and that when the irritability reaches a certain stage diarrhea or looseness of the bowels must result? Twenty grains prescribed once a day to nourish an organ (the rectum) six to eight inches in length, and from one and a half to two and a half inches in diameter! When for two to three feet the lower bowel requires nourishment, a suppository night and morning is prescribed! However, the new treatment has the merit of some consistency between the diagnosis and the treatment, notwithstanding both are wrong.
Chronic inflammation of the lower bowel causes, as I have pointed out, excessive activity and thereby excessive nutrition of the tissues involved in the morbid process. But sphincter ani gymnastics have been suggested by some one who thinks chronic constipation is owing to a lack of muscular activity of the lower bowels; and the following reason is given:
"Physiological experiments have shown that rapid voluntary movements of the external sphincter ani and the levator ani produce very active peristaltic movements of the large intestine. This effect is produced by the mechanical excitement of the plexus myentericus of Auerbach. This curious automatic center lies between the two muscular coats of the intestine and controls the peristaltic movements. A person suffering from constipation should make powerful movements of the sphincter ani, and of the levator ani, in as rapid succession as possible, continuing the exercise for three or four minutes or until the muscles are fatigued. The time chosen for this exercise should be either before breakfast or an hour after breakfast, according to the natural habit of the individual in respect to the evacuation of the large intestines."
There are surgeons who recommend stretching and paralyzing the external sphincter muscle; and if they are correct in their diagnosis and treatment, those who prescribe bile-bouncers, and those who prescribe "nutrient suppositories," and those who prescribe the use of rubber bougies and candles, should call a convention (to meet in, say, New York City) to discuss the subject and see if they cannot agree to inform the people that constipation is a sign of, or a factor in, the evolution of the human race. Those who believe in the gymnastics of man's ears and of his sphincter ani and the therapeutic merits of this and of that could readily assent to the same glorious conclusion.
Strange to say, there are in New York physicians who are in the habit of inserting a rubber bougie up their patients' rectums two or three times a week for the cure of constipation. Some, more bold, intrust the bougie performance to the patient in order that a daily dilatation and stimulation may be kept up until "recovery from the disease is effected." Others, more original, order the patient to insert a candle some six inches in length up the rectum and allow it to remain ten minutes, with the hope of a "rapid cure."
A Mrs. P——, who had used the candle treatment for a great length of time by order of her distinguished physician, once consulted me. On examination, I found her afflicted with atrophic catarrh, chronic constipation and anal ulceration, from which she had suffered for seven years, with but little intermission from pain during each day of that entire period.
BILIOUSNESS AND BILIOUS ATTACKS.
Commonly the source of chronic gastro-intestinal uncleanliness, of dyspepsia, of autogenetic poisons and auto-infection is inflammatory occlusion—more or less permanent or spasmodic—of some part of the lower bowel. Many years of auto-infection will exhibit such diseased symptoms as poor appetite, bad digestion, impoverished blood, emaciation, etc., accompanied by increased virulence of the catarrhal discharge of mucus, shreds, etc., and a mind and body sinking down to the morbid plane of hysteria, hypochondriasis (fear of illness) and neurasthenia (debility of the nervous system).
Biliousness and bilious attacks are evidence that there is a more or less constipated condition, that there has been an occasional imprudence in diet, and that the dreadful sense of fulness up to the end of the tongue is a faithful report of the state of affairs. What is it but a full foul condition of the digestive canal, a complete blockade of the canal from the rectum or colon to the stomach, making the victim feel that there must be something done in the way of cleaning out? He fears that the condition will be followed by fever—not infrequently this is the case. Biliousness is usually supposed to be occasioned by hindrance to the flow of bile, and the conclusion is drawn that the liver requires stimulating. This supposition is erroneous and very far from pathological veritude, as the liver, like the other organs, is merely a secondary sufferer from the over-eating and the closed sewer.
"The bowels with sullen vapours cloud the brain, And bind the spirits in their heavy chain; Howe'er the cause fantastick may appear, The effect is real, and the pain severe."
The bilious attack is usually noticed in the morning before food has been taken. The tongue is heavily coated and often so foul that it is necessary to scrape it and cleanse the mouth of disagreeable taste. Eructations, nausea followed by vomiting of undigested foul-smelling food, and if the vomiting be long-continued, mucus from the stomach and bile that had accumulated in the duodenum, are sufficient evidence that there was no torpidity of the liver. There is likewise more or less headache, neuralgia, giddiness, hebetude (state of mild stupidity), dejection, confusion of the senses, skin disease, acne rosacea (scarlet redness of the nose and cheeks), eczema, etc. The headache may be seated in the centre of the brain and extend to one or both eyeballs and be increased by stooping. Should diarrhea occur many of the annoying symptoms are likely not to be present.
In this form of indigestion the bowels are often much constipated, which is usually only a more marked symptom of chronic constipation. The system now and then vigorously rebels against this chronic condition and an acute bilious attack is the evidence of such rebellion. The whole digestive canal is involved in the rebellion, resulting in the symptoms described and also in a morose, petulant and querulous temper, accompanied by a peculiar, despairing expression,—partly due, perhaps, to regrets of having only one digestive apparatus,—or in some cases, perhaps, of having any.
That the character and disposition may be materially influenced by such a state of the bowels is well established. Plato believed that "an infirm constitution is an obstacle to virtue, because such persons think of nothing but their own wretched carcasses"; for which reason he contended that AEsculapius should not undertake to patch up persons habitually complaining, lest they beget children as useless as themselves, being persuaded that it was an injury both to the community and to the infirm person himself that he continue in the world, even though he were richer than Midas.
Acting on this well-known fact, the celebrated Voltaire, in one of the articles in his Philosophical Dictionary, has very humorously ascribed half the evils of Europe to the intestinal irritations of the public men of the age.
"Let the person," he adds, "who may wish to ask a favor of a minister, or a minister's secretary, or kept mistress, endeavor previously, by all means, to ascertain whether they go to stool regularly; and, if possible, to approach them after a comfortable evacuation, that being a most propitious moment, one of the mollia tempora fandi, when the individual is good-humored and pleased with all around him."
KING LIVER AND BILE-BOUNCERS.
The "house not made with hands"—the human body—has, like the house made with hands, its sewer system, which is over twenty-five feet in length. To cleanse (?) this wonderfully delicate, tortuous and extended passage-way of waste material, civilized man knows no better than to put in at the top of the house, purgatives, cathartics, bile-bouncers, etc., with one hope and purpose in view, namely, that these policemen go searching, scouring and hustling the intestines in the greatest possible haste, in order to remove an obstruction about three hundred inches distant from where these "forcers" had entered the intestinal sewer. With mercury as a scavenger the work is pretty thoroughly done, though extra care has to be taken that some of the teeth may remain after the victim survives the additional intestinal inflammation occasioned by its drastic measures.
Traits acquired by the father are inherited by the children; present-day doctors follow early practitioners; they still pour in many and various decoctions at the top of the obstructed sewer of the human house to dislodge accumulated gases and feces at the bottom. The plumber treats the sewer of the house of brick and stone more wisely.
Our fathers partook of laxatives, cathartics, purgatives, and in consequence we start in life with teeth, intestines, appendices, out of gear and nervous systems on edge. With unconscious stupidity we continue the fatuous practice. The monarch selected to preside over the functions of human life was the Liver; and it is only with bated breath that any doctor dares question the legitimacy of that monarch's claim. The loyal subjects of King Liver are ever ready to call out "quack," "charlatan," etc., to those who dare repudiate the sovereignty of the Liver.
So much attention and flirtation does the liver receive from the liver-persuaders that the pancreas ought to be very jealous. The pancreas excretes quite as much fluid into the duodenum as its larger neighbor, and is, therefore, no mean organ. And we need not wonder should we find the intestinal glands piqued at our over-attention to the liver, as they, in their work at the metamorphosis of digested food into blood, excrete two or three gallons of fluid in a day to the liver's two or three pints; yet witness our medieval solicitude for the liver, for one among many organs. The liver is located near the upper portion of the intestinal canal and connected by a tube (the bile duct) to the rest of the excursion route. The following liver-persuading knights-errant are prescribed and ordered by disciples of Hippocrates, Galen, Herodicus, and Iccus, to treat with that digestive and eliminative monarch, the Liver—usually at night-time, that the family may not be disturbed. After making as good terms as possible they journey on, riotously churning and swashing the long, tortuous canal and its contents in search of ancient toxic gases and feces lodged in the lower bowel. It is believed by the prescribers that the length of the journey adds dignity to the drastic, dredging knights-errant. The reader needs no introduction to the podophyllins, the aloes, the jalaps, the rhubarbs, the mercurys, the croton oils, the sennas, the salines, the seltzers, the Carters, the Beechams, the Websters, the Pierces, the Ayers, the Ripans, the Warners, and others belonging to "The Four Hundred" fashionable grenadiers, with their credentials and stamp!
After these knights-errant have paid their respects to King Liver, and ended their long, tortuous and eventful journey, they depart and leave behind them burning and painful abdominal and anal regrets, and then some soothing, stimulating and tonic remedies are in order, so that the dredged though chronically constipated sufferer and his friends may still hope that life will be spared to repeat the same nauseating and often painful process in a few days or weeks, taking, in the meanwhile, milder bile-bouncers daily as a reminder to King Liver that the time for the knights-errant is coming again.
Sufferers from chronic constipation receive assurances that by the use of these "remedies" the anemia will be corrected, nutrition and digestion restored, atony of the liver and intestines overcome, yellow complexion and morbid feeling disappear. In short, remove the numerous symptoms and "causes" of toxicity of the body and of chronic constipation, and proclaim the victory of Powder and Pill!
All of us would believe Medicus, the son who so abjectly follows in the footsteps of his father, if we could really feel the possibility of such a victory; but the protests of our bowels are living witnesses against the validity of the medieval practice as here described; and we ask for a modern scientific solution of the fulness and foulness within and the fatuity without.
I must now apologize to the large class of sufferers from chronic constipation for hurting their feelings. I know very well how seriously they have been compelled to regard their trouble, and out of respect for their protracted suffering and efforts to get relief I should instead have sympathized and condoled with them in their dire misfortune. But we all know and realize that there are occasions when we get into awful and painful predicaments, and, when the whole situation is taken in, it becomes comical and ridiculous, so that for a time we cannot treat it seriously, even when old Chronic Biliousness and the mighty knights-errant are having a deadly combat at our internal and external (and possibly infernal) expense.
SEMI-CONSTIPATION AND ITS DANGERS.
"At least six times in every fleeting day Some tribute to the renal functions pay, And twice or thrice all alvine calls obey."
What has been said thus far has been based on chronic constipation mainly, and the accompanying intestinal foulness, which condition was shown to be so annoying that it compelled the sufferer to resort frequently to some more or less direct and artificial means for the relief of the bowels and the incidental indigestion. It has been further shown that many of the chronic cases fail to take on the normal amount of flesh or lose what flesh they have because of self-poisoning (auto-infection), which in turn is the outcome of mal-assimilation and mal-nutrition, and that this consequence must occur wherever there is an absorption of waste through a checking or disturbance of systemic functions. Emaciation and anemia are inevitable in such cases. On the other hand, there are cases that have such great powers of assimilation and elimination that they are able to stand the invasion of destructive material, may maintain the normal amount of flesh, or even take on an abnormal amount, but with the invariable accompaniment of more or less impoverishment of blood, disturbed circulation, indigestion, and the usual nervous derangements. The harmful practice of the lean and the fleshy sufferers of resorting to daily medicines—cathartics, digestives and tonics—has been commented upon. Willingly do they squander their money to get relief from an ever-present ailment. Cases are these of hope deferred that maketh the heart sick.
The primary cause of chronic constipation, namely, proctitis, has been explained, and its many symptoms, as indicated by the functional disturbances of many or all of the organs of the body, enumerated.
But beside the cases of chronic constipation—both lean and fat—there are many sufferers from auto-infection who have only semi-constipation, or partial evacuation of the feces daily. Though they suffer from the effects of self-poisoning, yet they have no such well-defined symptoms of local disease and functional disturbance as are always found in those who have chronic constipation. Nevertheless, they have disturbances of practically all the functions of the system. Believing as they do that the evacuation of their bowels is complete, they are at a loss to find a cause for the toxemia (blood-poisoning), mal-nutrition, debility and general atony. The symptoms of auto-infection with the semi-constipated are as complex as with the severer cases, but not so well defined. The most prominent symptoms are those connected with the process of katabolism, that is, of degeneration of the tissues, as indicated by their color and texture. The liver, however, is usually held responsible for the bad complexion, impaired nutrition, constipation and diminished vitality, when really the liver is only indirectly concerned, as made manifest in the previous articles. The seat and source are found to be the diseased colon and rectum.
Dr. Treves says: "The colon being the part of the bowel involved in obstruction due to fecal accumulation, it may be further assumed that the blocking of the gut will most usually concern its lower or terminal parts. Accumulation of feces is most common in the rectum and sigmoid flexure, and then in the cecum. Masses of feces may block the colon at any point, and more particularly at the flexures of the bowel. Still, the three common sites of the accumulation are those just named. The accumulation in the colon may assume the form of a more or less isolated nodule or mass. Thus a considerable lump may be found in the cecum or sigmoid flexure and the rest of the colon be comparatively clear of any gross accumulation. An isolated lump may even persist after free purgation. On the other hand, the accumulation may assume the form of several isolated fecal masses. One of them may occupy the cecum, another the transverse colon, and possibly a third the sigmoid flexure. The bowel between these masses may appear to be fairly clear."
A number of the exciting causes of inflammation of the lower or terminal portion of the large intestine have been mentioned. It cannot, however, be too strongly emphasized that chronic inflammation of the colon and rectum results in hyperkinesis (excessive muscular irritability) and contraction of the diseased portion invaded, thereby retarding or preventing the passage of feces and gases. A portion of the daily accumulation of feces in the sigmoid may pass through the diseased rectum every day, but not without increasing the inflammation and the spasmodic contraction; this in time inhibits the elimination of the accumulating feces, which by undue retention become condensed and hardened. Each day will then be a repetition of the abnormal and partial effort of the organ to accomplish the act of defecation, and there will be no thought of the cumulative and chronic intoxication (poisoning) of the system from the imprisoned feces and gases.
It may be stated without reservation that the rectal canal cannot be involved in chronic inflammation without involving the anal canal, and vice versa. One half of civilized people are suffering from chronic constipation, and very nearly the remainder from semi-constipation. The semi-constipated are now under consideration. The chronic cases are those that have a complete impaction of feces in the terminal portion of the sigmoid and rectum; the semi-constipated have the usual daily partial impaction, that is, an incomplete or partially successful evacuation of the contents of the bowels: the incompleteness is due to disease of the anal and rectal canals.
The anal and rectal canals are made up of circular and longitudinal muscular bands, which, when invaded by disease, lose their proper or normal sensibility and cooeperative 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 accumulation of feces to excite a normal desire for stool; otherwise the feces would rush upon the anus at once and occasion much inconvenience.
Catarrhal inflammation of the mucous membrane of the anal canal will sooner or later penetrate the muscular structure of that canal, causing an abnormal irritability and contraction of the sphincter ani and the other tissues composing its structure. The contraction of the anal 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 anal canal or at the lower end of the rectum. As the bulk of feces and gases lodged at this point increases, the anal contraction becomes firmer in grip, and as a consequence permits no hint of the imprisoned contents until the accumulating bulk is beyond the power of toleration by the organ. Daily a portion of the lodged feces, or some new addition to the mass, passes the anal canal, but the attending irritation or contraction of the muscles prevents any further exit of the imprisoned rectal contents.
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 canal, 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.