PART FOUR
THE HYGIENE OF THE FAST



CHAPTER XII
HYGIENIC ACCESSORIES OF THE FAST



BREATHING:
BATHING:
SLEEP:
EXERCISE



    BREATHING.--Nature has provided in the air that surrounds the earth a plentiful supply of oxygen, a gas that is essential to the maintenance of human life. Its function within the human body lies in replacing carbonic acid, a poisonous gas developed by the breaking down of tissue, and delivered to the lungs in venous blood. The interchange of carbonic acid and oxygen occurs in the lungs, since in the process of breathing, as carbonic acid is exhaled, oxygen is inhaled. The act of respiration exposes the blood, held within the thin walls of the pulmonary capillaries, to the air, and by mutual diffusion the two operations of oxygenation and of decarbonization are accomplished at one and the same time. The muscular movements made in breathing are not dependent upon the will, as this process goes in in sleep and in other unconscious states. The rate of respiration in health varies from fourteen to eighteen breaths per minute, and, besides carbonic acid, watery vapor and a small amount of organic matter are exhaled.

    In order to furnish oxygen to the system, from three hundred to four hundred cubic feet of air are drawn into the lungs in twenty-four hours. Each hour an adult inhales about five hundred grains of oxygen and emits about six hundred grains of carbonic acid, with a much larger amount of watery vapor. Deprived of air, the body quickly perishes from asphyxiation.

    Not only is a continued supply of pure air essential to life, but constant care is necessary to insure its purity at the moment of intake. The natural passages that carry air to the lungs begin at the nostrils, and these are furnished with short, fine hairs and with mucus secretion, preventives of the inhalation of dust and light material. If obstruction of the nasal tract occurs, it is possible for breathing to take place through the mouth, but so harmful is the latter method to general health that attention is here directed to its results.

    A child that is overfed invariably develops a cold with accompanying nasal discharge and consequent obstruction of the natural air passages. A prolonged cold, or a series of colds, compels the use of the mouth for the act of breathing, a method that, if not corrected, eventually becomes habitual. Constant irritation and inflammation of the mucus membrane of the nostrils and of the vault of the pharynx cause the much discussed adenoid growths to form, and complete or partial obstruction of the air canal is thereafter permanent until removal of the obstacles is accomplished. In the ordinary manner this is done by the knife of the surgeon, but the shock to the organism of the child, both of the anesthetic and of the operation, is often productive of sequelae that persist through life, and this method for the removal of adenoid growth, so prevalent in recent years, is to be disparaged. In infancy and adolescence these annoying gland-like enlargements may not only be prevented in formation but may be removed through natural absorptive means, if proper attention is given to diet, and if short fasts are intermittently performed. In training the child in the care of his body, it is quite important that he be taught to free the nasal passages from gathered mucus at the least sensation of obstructive fullness. This is usually effectively accomplished by blowing the nose.

    Children who are affected with nasal obstruction are more or less stupid and sluggish, and they oftentimes exhibit a facial expression approaching that of imbecility. In fact, when the habit of mouth breathing has been contracted, even when no obstacle is present in the naso-pharyngeal vault, not only do the nasal passages, through lack of exercise, fail of normal development, but the open mouth and dull eyes denote a serious deficiency in intellectual advance and capability.

    We cannot know the exact source whence is received the influx of energy, the expression of which in the human body is life; nor are we yet aware of the manner in which vital force penetrates the organism and governs its movements and its thought. But life is evidently not inherent in the body, and, whatever its source, vital power must reach its vehicle of expression through surrounding atmosphere, through the air that the body breathes. Transference to the brain directly through the bony structure lying immediately above and back of the nasal passages is conceivable; and, while the purity of the atmospheric constituents that furnish the lungs with blood-regenerating matter may well be vitiated by transmission through paths not naturally intended, the lack of intellectuality of most mouth breathers cannot be accounted for on this basis. And yet it exists. Hence the theory here presented--that vital force enters the body from without through the natural air passages, passing to the brain through the bony cavities immediately above and in their rear. Whatever the attitude of the reader in respect to this thought, which holds place only as theory in the mind of the author, there can be no question of the importance to be attached to the cultivation of a nasal breathing habit, a habit that is at once preventive of disease and preservative of health.

    In the fast correct respiratory methods must be pursued, and deep breathing is also recommended. Every portion of the lung surface should be exposed at all times to the general purifying process resultant from oxygenation of the blood, and to insure this contact, in addition to lung exercise, the body should be surrounded by fresh pure air day and night. Well ventilated living and sleeping rooms are important to the highest degree in illness and in health.

    BATHING.--The skin or covering of the human body consists of an outer layer called the cuticle, and of an inner one, the corium. These constitute the true skin, but under them lies a third layer of cellular tissue, which is considered also as part of the skin, when that term is used in its most comprehensive sense. In man the skin is covered more or less with scattered hairs, profuse in some parts and scanty in others. The office of the skin is one of protection to the organs beneath, and it is also a vast excretory or eliminative system, sending out moisture with waste matter in solution through the sudoriferous or sweat glands located in its structure. Each of these glands consists of a long line tube, situated in the cutaneous cellular tissue and coiled into a knot near its closed end. This constitutes the gland proper. Then there is connected with it a straight or spiral duct that traverses the outer layers and ends in a surface opening called a pore. Nearly three thousand of the latter are found upon a square inch of the palm of the hand, and at least five-hundred on an equal space upon other parts of the body.

    Perspiration is the watery matter "breathed out" from the system through the pores described. It is more copious than the exudation from the lungs by respiration, but the amount discharged varies greatly, as it is affected the heat or the dryness of the atmosphere, by liquids consumed, by exercise, and by the relative activity of the kidneys. Sensible perspiration is that which is perceptible in the form of small drops, but by far the larger portion exuded is of the insensible or non-visible kind. Solid matter is carried to the surface of the skin in the sweat, and authorities all agree that a considerable proportion of the total waste of the body is evacuated in this manner.

    Close sympathy exists between the functions of the skin and those of the lungs, the kidneys, the liver, and the bowels, and this is evidenced in that, when one or other of the latter organs is disabled in function, perspiration is sympathetically deranged and vice versa. This does not necessarily mean that the effect produced is that of physical transference of the suppressed exhalation to the internal organ or the reverse, although this may be so; but the chief impression seems to be made upon the nervous system. The importance of the relation existing between the skin and the other excretory organs is such that it cannot be disregarded when disease is to be remedied.

    In order to insure full functional activity of the surface of the body, frequent bathing is necessary. For this purpose one daily cleansing bath is essential in health. By it, dead, scaly particles of skin, dirt, and the products of perspiration are removed, the pores are cleared of surface obstruction, and the other eliminative organs are relieved of the performance of extra labor. When, as in the fast, the process of elimination is active in the extreme, cleansing baths may never be neglected.

    A cleansing bath is a hot bath. One at temperature of about 105 degrees Fahrenheit is cleansing in the highest degree if pure vegetable oil soap be freely-used and the brush or cloth be vigorously plied. During a fast the temperature of the water in the daily bath or baths should upon entrance be approximately 100 degrees, and it should be gradually increased to as high as 107 or 110 degrees, with about twenty minutes submergence as the time limit. Baths such as this are not only cleansing, but are relaxing and tonic in effect. In cases of lowered temperature, habitual or temporary, the latter as in fasters' chilliness, correction to normal register, with systemic equalization of circulation, is rapidly effected by resorting to this therapeutic agency. Its very apparent benefits are due not only to the artificial raising of body heat, but to the process of osmosis, or interchange of fluids, that takes place in the capillary tubes constituting the pores of the skin. Cold baths should never be employed during a fast. They have but slight cleansing properties, but in health they exert a powerful stimulating action on the circulation and the nervous system.

    Because of the oily nature of the waste brought by perspiration through the pores to the surface of the body, the skin can never be rendered perfectly clean with water alone. Hence the recommendation concerning the use of pure vegetable oil soap.

    While the ancients made use of and elaborated the bath for purposes not only of cleanliness but also of social and intellectual objects, after the advent of Christianity and its domination of the civilized world, the bath fell into disrepute. Departure from the cleanly habit of body characteristic of early civilization was due directly to the rise and growth of the religion of Christ. The church frowned upon the care of the body, deeming it as negligible in comparison with the soul. And the early fathers in instances went so far as to impose penance upon those who gazed at the nakedness of their own bodies. Cultivated modesty, prudishness, thus had its part in the reversion that took place from the bathing habits of the Greeks and the Romans. Centuries later John Wesley uttered the aphorism, "Cleanliness is next to Godliness," but whether his reference was to the mind rather than to the body, it is impossible now to know.

    Not so long ago the bathtub was generally condemned by medical authority in the United States, and about the time this was happening the cultured city of Boston by ordinance made bathing unlawful, save on the advice of a physician. However, be it said in extenuation of the hygienic condition of the Bostonese, the ordinance was characterized by slack enforcement and was finally repealed, but not until 1862. The good doctors of that generation averred that bathing, especially in winter, led to phthisis, rheumatic fevers, inflammation of the lungs, and to the whole category of zymotic disease. In the public prints bathing was inveighed against as subversive of democratic simplicity and of pioneer hardihood. And even today the medical profession is chary of advice regarding the hot cleansing bath, as, they say, it is weakening in its effects.

    It is said that the first bathtub to be built and used in the Republic was that of one Adam Thompson, a citizen of Cincinnati, who installed his lead-lined, mahogany-covered receptacle in the year 1842. Water was supplied from the kitchen stove by way of the tea-kettle. His temerity appeared as a gross misdemeanor in the eyes of the press, the public, the medical profession, and the legislatures of those days. Later, in 1851, President Fillmore braved public opinion and placed the first bathtub in the White House.

    There is no doubt that today in the mechanical conveniences connected with the bath, America surpasses the bathing arrangements of other ages and other races, but socially and sanitarily we have yet some distance to go before reaching the bathing standards and facilities of ancient Persia, of Rome, and of present-day Japan. The ages-old warm bath habit of the Japanese causes them to look with the scorn of the elect upon those who are so uncivilized as to omit a daily hot cleansing bath. Yet it is this habit that is one of the great factors in that over-crowded land that makes for the remarkable health and vigor of the Japanese as a race.

    The skin is the natural clothing of the body. Its protection to the parts beneath is aided by sub-cutaneous deposits of fat, a non-conductor of heat, distributed more or less uniformly over the body. When heated, evaporation of perspiration cools; when chilled, closed pores retain the.body warmth. Like the lungs the skin permits of blood oxygenation through the walls of the capillaries, those small veins that ramify its substance, and, as has been stated, it is an organ of elimination as well. In the conservation of body heat, the skin is thermostat of the organism. It regulates temperature, and acts as a governor of internal function. If its work be interfered with by the interposition of substances between it and outer air, evaporation from its surface cannot take place freely, and elimination of the products of the pores is impeded if not arrested. In the latter case temperature is heightened artificially and abnormally, for prevention of skin activity causes retention of heat developed internally, and health suffers.

    A striking exemplification of the close sympathy noted as existing between the functions of the skin and those of the other eliminative organs is given in cases of cutaneous burns where large areas are affected. Respiration is increased to exhaustion, and kidney discharges are heavily laden with waste that in the ordinary instance is eliminated through the pores. If an extreme proportion of skin area is seared, virtual suffocation ensues. Fatal results accompanied with symptoms similar to those in asphyxiation also follow when the body is covered with a substance, such as gold-leaf, that is impervious to air.

    In this connection it is not generally known that burns or scalds upon the skin may be sucessfully treated by submergence of the part affected in water. The exquisite pain of such injury is at once relieved by this procedure, and continuing the latter for hours or even days permits natural healing processes to act with despatch and surety. If the skin area seared is extensive, placing the sufferer in a full bath and keeping him there for the time necessary will often serve to save life. The water in the tub should be at constant temperature and must be frequently changed, while water in quantity should be given the patient to drink.

    The customs entailed by civilization are responsible for a number of physiological evils. While modesty is, in its origin, independent of clothing, for nakedness of body by no means involves the absence of this quality, nevertheless in civilized communities the world over modesty compels body concealment, and, because of conventional covering, the skin has for ages been permitted but partial function. Since clothing is deemed essential to decency, in order to reduce its effects upon the skin to a minimum, it should be fashioned of material as light and as pervious to air as is possible, while the skin itself should be cleansed and cared for with constancy and diligence.

    Because of clothing the two great mediums through which energy is delivered to the human organism, pure air and sunshine, are in large part denied contact with its outer covering Clothing prevents full elimination of perspiration and its products, the latter remaining to clog the pores. This condition may be relieved to a degree by daily exposing the naked body to the air and to the light of the sun, and air-baths and sunbaths will be found valuable agents in compelling the skin to functional activity. During a fast, weather permitting, these baths should be taken with the subject upon the ground in open air.

    In health a cold bath should never be undertaken immediately after a meal, but, with regard to a hot bath this caution is unnecessary. When the menstrual flow in woman is in progress, medical dicta to the contrary, a hot body bath and vaginal douche are daily essential for cleanliness and for relief and ease in function. The relaxing effect of a hot tub bath, together with resulting equalization of circulation, alleviates congestion and pain, if present, and in conjunction with other natural agencies cited herein, leads ultimately to permanent relief.

    During a fast or while on restricted diet, the patient frequently experiences a sensation of chilliness with or without change in pulse and temperature. The source of this phenomenon, "fasters' chilliness," lies in nervous reaction following the absence of food stimulation, and, at times, in the absorption of liquid waste from the intestines. The enema will correct the latter condition, and a therapeutic bath taken as soon as the sensation of chill occurs will serve at once to equalize the circulation and to restore temperature and pulse to normal, if the latter are in any degree deranged. Baths for this purpose may and should be repeated as often as needful, if proper precaution is observed. In cases of greatly lowered vitality, when temperature is habitually below register, hot therapeutic baths should frequently be given, three or four daily usually proving not too many. Cold therapeutic baths for assistance in reducing fever should be more cautiously used. In any contingency, the therapeutic bath, hot or cold, should be administered only under competent direction.

    SLEEP.--Sleep has its analogue in death; and it is an accepted scientific truth that the continuance of life in any living thing depends upon death. Through life to death; through death to life again. One manner of expressing this truth regards merely the outward fact, as when we say that animal tissue is renewed through decay; another regards the action and reaction proper to life itself, whereby it forever springs freshly from its source. And because of this inter-relation, this inter-dependency, between the two states of life and death, we.apply to all manifest existence the term, Nature, which in derivation means "forever being born."

    In the regularly recurring periods of unconsciousness, in the hours we spend in sleep, we find exemplification of the relation that exists between our working, active moments, and those that are devoted to the renewal of our physical and mental equipment. It is during sleep that the human instrument of thought and of motive government, the brain, obtains its repose; it is then that the cells of the human battery are recharged, that the working principle receives its potential for transformation during conscious intervals. It is then, too, that the greater portion of tissue impaired by wear in bodily activity is rebuilt and prepared for use in further exertion when consciousness recurs. Sleep is both a physiological and psychological necessity, and literal death will follow within short time if it be denied.

    In the fast inability to sleep sometimes occurs, due in instances to lessened wear upon body tissue because of diminished call on muscles and organs, since muscular labor is more or less curtailed during abstinence from food, and digestion is entirely in abeyance. It may also happen that in the earlier stages of abstinence waste is excreted in amount incapable of being promptly and fully evacuated, and slight brain congestion with accompanying wakefulness results. The hot bath and the enema here again find their mission, and their use before retiring will go far towards remedying any tendency to insomnia.

    But no natural process may be compelled if conditions be such that its function in the organism is not at the moment essential. Demand dependent upon necessity governs every natural desire. Upon it wait hunger, thirst, and sleep; without it, these constructive processes cannot be evoked. Hence frenzied attempts to induce sleep are futile, not to say foolish. The cultivation of an equable frame of mind in health, the ability to cast aside the cares of the day when one lies down to rest, add to disease-resistive qualities, and, if illness does occur, prove valuable aids to the efforts nature then proceeds to put into operation for relief. Here also reading plays its part; not that which necessitates extreme concentration of mind, but that which diverts the mentality, leading it along cheerful, wholesome lines of thought. The expedients suggested are natural abetters of healthful slumber, and find fitting time for their exercise after the activities of the day are done.

    EXERCISE.--The maintenance of every muscle of the body in proportionate development is regulated by its work as well as by its supply of pabulum, although the latter is determined in large part by the necessity for repair or upbuilding occasioned by the exercise given the particular muscle. Constant use of one portion of the muscular fabric tends to add to its substance at the expense of that of neighboring parts not equally exercised. Hence the aim of all physical labor should be that of uniformity. Trunk and legs, arms and neck, all should receive proportioned attention. Normal muscular development also depends upon an unimpeded circulation of the blood and upon healthful cell-forming constituents uninterruptedly supplied for the replacement of used tissue. Constriction of the body in any region restricts free circulation, and only loose garments permit of full growth and proper development. The tight collar, the round garter, and the corset, make flabby muscles inevitable, and only a body unrestrained by the bonds so often prescribed by conventional usage can hope for muscular perfection. The possibilities of hygienic living, coupled with judicious exercise, are surely worth consideration, if merely for the satisfaction resulting from their effects upon personal appearance; but their more important consequences in respect to general health and longevity make neglect of these desiderata most deplorable.

    Exercise that is self-imposed is wholesome; but exercise to which one is naturally attracted is the ideal form of labor. Combined with enthusiasm, physical work is doubly healthful, for enthusiasm in itself is a source of health. And that form of exercise that serves a productive purpose and is enthusiastically performed is best of all, whether the effort be physical or mental. Make your avocation the complement of your vocation. Gladstone and Horace Greeley chopped wood in their moments of relief from mental tasks. Conversely he who works with his hands should divert himself by exercising his brain.

    During a fast moderate exercise in keeping with daily access of strength is advised, and, after the completion of the period of abstinence, constant comprehensive muscular activity is essential to tissue rebuilding and to form-development and maintenance. BR>



CHAPTER XIII
THE ENEMA



DESCRIPTION OF' THE STOMACH AND INTESTINES:
THE FALLACY OF "PURGATIVES":
THE PRINCIPLES AND USE OF THE EDEMA:
NOTES ON GIVING THE ENEMA TO CHILDREN
AND ON AN ENEMA TACTIC


    THE ACCOMPANYING diagram of the human stomach and intestines is essential to a proper understanding of the digestive and eliminative functions of the body. It should be carefully studied in connection with the following description of the organs displayed.

    "P. C.".--The Stomach.

    This organ is a pear-shaped muscular bag, which receives the food after it has been masticated in the mouth. In mastication food is moistened and softened by the saliva, which also acts chemically upon certain elements, notably starch. Masticated food reaches the stomach through its upper or cardiac opening by means of a tube called the esophagus. Gastric juice, the normal secretion of the stomach, then begins its work of further transformation. While stomach digestion is proceeding, the liquid portion of the mass and the fluids drunk are in great part separated from the solids, and are at once absorbed into the circulation. The residue, called chyme, then passes through the lower or pylorio opening of the stomach into the small intestine.

    "D. J. I."--The Small Intestine.

    This portion of the digestive apparatus consists of a long tube, varying between twenty and thirty feet in length, which is ingeniously coiled upon itself. It is lined with what appears to be a soft velvety covering, an appearance that is caused by numerous minute elevations, the villi, which act as absorbents and secretents. In the upper part of the small intestine, chyme is subjected to the action of bile, the secretion of the liver, and to that of the pancreatic juice, the secretion of the pancreas, as well as to that of the secretion of the walls of the intestine itself. All of these juices still further soften and dissolve the food mass, and chemically transform the chyme into substances that permit of absorption through the villi into the blood. After the tissue-building portion is absorbed, the remainder--the refuse matter, the excrement--passes through a small opening known as the ileo-cecal valve into the large intestine or colon. This valve is constructed in such manner as to permit the waste to pass freely into the colon, but it prevents any backward movement or return to the small intestine.

    "CC."--The Cecum.

    The cecum is the large end of the colon situated just beyond the point at which the waste enters from the small intestine.

    The Vermiform Appendix.

    This is the small worm-like appendage to the cecum, which when inflamed gives rise to the trouble known as appendicitis. It is from one to five inches in length, and, despite the assumption that it is an organ that performs no necessary function in the economy of digestion, it finds its purpose and its use in adding stimulus, through its own motion and secretion, to the involuntary contractions and expansions of the colon, those vermicular movements called peristalsis.

    "AC-R."--The Colon.

    This organ, also known as the large intestine, consists of a tube about five feet in length, designated in the illustration as "AC", the ascending colon, "TC", the transverse colon, "DC", the descending colon, "SF", the sigmoid flexure, "R", the rectum at the extremity of which is the anus.

    The colon is the main organ of elimination of the body, and through it the greater part of solid refuse is carried to the rectum to be discharged. When the colon is permitted to become clogged with food waste, the resulting condition is known as constipation, in which state fecal matter accumulates and renders the normally clean bowel a receptacle and retainer of foul, rotting refuse. The sigmoid flexure, "SF", is a device that prevents excessive pressure by the contents of the organ upon the muscles of the rectum, "R". Lying between the descending colon and the rectum it interrupts the straight fall from the transverse colon and it acts as a retaining pouch. The lower opening of the rectum, the anus, is guarded by a strong circular muscle which is under voluntary control.

    The intestines as a whole are thus seen to consist of that part of the alimentary canal, which, commencing at the pyloric opening of the stomach, is coiled in the abdominal cavity and which ends at the anus. The several portions of the small intestine are known as the duodenum, the upper section, the jejunum, the middle section, and the ileum, the lower section. The lumen or tubular cavity of the small intestine is larger at its upper end, gradually narrowing as it goes downward.

    The muscular coats of the intestines are circular and longitudinal in structure. In the colon the longitudinal fibres are proportionately longer than in the small intestine. Their greater length here permits of the formation of enlargements that often become the seats of fecal accumulation, and it is undoubtedly true that these cavities may contain fecal material that has been in process of gathering for weeks, months, or even years. Its presence and its products cause symptoms of disease to appear that vary from catarrhal inflammation to serious reflex disturbances. Excepting in extreme conditions, while quantities of waste may be held in these enlargements, a passage is necessarily maintained, and the main channel of the bowel still carries off feces. Occasionally a cavity becomes greatly distended with fecal matter, which hardens as its moisture is absorbed, and accumulations such as this have been mistaken for tumors or for malignant growths upon some abdominal organ. Impacted feces may occur in any part of the bowel, but chronic accumulations are discovered more often in the region of the cecum, in the ascending colon, and at or about the point of juncture of the ascending and transverse portions of the bowel, a condition that is to be expected, since in this part of the organ peristalsis works against gravity during the waking moments of the day.

    Accumulations in the colon at times become so great that their weight tends to displace portions of the bowel, and several instances have been observed in whom the transverse colon from this cause had descended to the pelvis. In other cases the portion of the organ referred to, thus weighted for long periods, no longer lay normally just beneath the stomach, but occupied a position varying from slight downward displacement to a situation approximately in rear of the umbilicus. Fecal accumulations also vary in density, and they at times are so hard as to be mistaken for gall-stones. And again their mass may be so great as to press upon one or other of the abdominal organs, thus interfering with its functions. In this manner the liver is often compressed and its flow of bile obstructed, while the urinary organs may suffer likewise. In one observed instance, after thorough cleansing of the colon by means of an enema, a loss in weight of ten pounds was noted; and in another fecal matter sufficient to fill a bedroom vessel of common size was taken from the bowel.

    When feces are impacted in the colon it is difficult for the small intestine to perform its functions, for, not being able to discharge its waste freely, this organ in turn becomes clogged. Fermentation results, and the stomach is involved, while always the kidneys, the liver, the lungs, and the skin are forced to tasks beyond their capabilities, the two organs last named, in addition to their normal labor, being called upon to assist in the elimination of poisonous products not discharged, as they should be, through the bowels.

    Fermentation and putrefaction of gathered waste in the colon at first occasion flatulent or gaseous distention, and the gas formed often encroaches upon the cavity of the chest, causing short and rapid breathing, and, when it invades the bend between the transverse and descending portions of the bowel, irregular heart action. As the result of pressure thus put upon the heart, death has often occurred, its cause being diagnosed as heart failure or organic heart disease. In other cases symptoms that have developed because of the formation of gas in the cecum and ascending colon have been diagnosed as appendicitis, and the patient has been operated upon surgically.

    Long continued distention of the colon weakens its walls and causes the cavities or pockets already mentioned to form. Food not properly digested, not reduced to a condition adapted to the natural irritability of the intestines, may stimulate the colon to abnormal hasty contractions, as in diarrhoea, or it may prevent normal contraction of the organ. But, whether the fault lie in the quality of the food or in the digestive processes, the result is much the same. This observation applies as well to the ingestion of food in excess of the quantity needed for upbuilding and growth. In either case fecal matter accumulates because the colon is not normally excited to contraction, and cavities are formed because its fibres lose their natural resiliency from inaction and from the distention to which they are subjected.

    It is of course to be understood that an impacted colon may result from a nerve supply insufficient to maintain the walls of the bowel in a state that will respond to the irritative presence of food waste. This constitutes a partial paralysis of the organ, and usually when inactivity of the kind is noted, it may in part be traced to spinal mal-adjustment or subluxation. In these circumstances the nerve fibres that transmit energy to the colon are impinged or pinched, and normal nerve vibration is prevented. In other words, motivating power is shut off at its source, and the sole means by which this deficiency may be corrected is by mechanical adjustment of the vertebrae involved.

    A goodly portion of the information here recorded has been gained from examination of human bodies after death. In a number of these cases death was shown to have occurred because of ultimate organic inability of the intestines to function in that they had suffered in earlier years from lack of development, due either to insufficient nerve supply, the consequence of spinal mal-placement, to bowel inflammation in infancy, or to the paralyzing influence of drugs administered for the suppression of symptoms.

    In other instances of post mortem examination colons were discovered with walls lined to a depth of an inch or more with a viscous mucus-like deposit, portions of which must have been in process of collection for months. In fact, in several cases the entire length of the intestinal canal was thus affected. And, even when deficiency in development existed, impacted refuse was found in amount sufficient to occasion wonder that life in the circumstances could so long have been maintained, since in this condition only a minimum amount of food could have been digested, and the body had been supported mainly by liquids. Here the absorbents of the intestines were completely buried in the deposit and thus were rendered inactive.

    In connection with the subject in hand the germ as a factor in decomposition occurring in the colon must be referred to. The large intestine in a general sense is to be regarded as a receptacle for body waste. It forms a suitable culture medium well supplied with warmth, and in conditions as we find them today, there are microorganisms constantly present that are capable of consuming toxic substances, and in their turn of producing them. When normal discharge of refuse occurs, the time of its retention is so short that the organ is comparatively free from soil in which microbic growth and propagation may proceed. Delay in evacuation gives time sufficient for germ development more or less extreme in character.

    Ninety per cent of all drugs taken into the system under medical direction is aimed to affect the intestines. Evacuation of the colon, where there is constipation, is procured by the administration of a cathartic, a purgative. A purgative is a drug that is reputed to cleanse the bowels by frequent watery evacuations. But does it "cleanse" the bowels? The average conception of a cathartic is that it is a substance which through some power resident in itself removes fecal matter. This is not so. It moves nothing, either by mechanical or by chemical action. All cathartics, all purgatives, contain elements that are repugnant to both stomach and intestines, and that stimulate these organs into resistive action. In other words, they are poisons. When introduced into the system, they cause to be poured forth an augmented flow of intestinal secretion, which, to a degree liquifies the contents of the bowels, and, aided by similarly stimulated peristalsis, forces them to the rectum, thence to evacuation. The effect of the administration of a purgative then is one that results not because of any virtue peculiar to the medicine, but because the organs which it meets, objecting to the presence of a harmful intruder, act upon the drug and make instinctive efforts to cast it from the system. Any material introduced into the human body that cannot be utilized for its maintenance and growth is detrimental, and in a sense is a poison. This is true of all drugs.

    Purgative medicines stimulate stomach and intestines to activities that are not natural, and they eventually bring about a refusal of these organs to perform their functions in a normal way. Once the purgative habit is acquired, the bowels after a time decline to act in the absence of the stimulus supplied by a pill or by some aperient. There is a homely saying that "castor oil loosens once and binds twice," and this is the very truth. Moreover the surfeit of digestive and other intestinal secretions called forth to expel the intruder causes the folds of the bowels to be filled with fluid fouled by dissolved waste, and the latter is partially absorbed ere evacuation can occur.

    Extreme weakness results in many instances both from an unnatural drain upon these secretions and from poisoning of the circulation by absorption.

    An apparently normal movement of the bowels may take place without clearing away impacted fecal matter. One may have a daily passage and yet be constipated. It is equally true that one may just have undergone a severe purge through the administration of a drug and still may have accumulation in the bowel. Nature at all times makes extreme effort to rid the colon of refuse, and in her striving a small channel is necessarily always open through the gut, else death would shortly occur.

    If the taking of purgatives were confilled to adult life, the tale here told would be different in character, since functional derangement would be the principal harm effected. But cathartics are prescribed for infants and children in their growing years, and their indiscriminate use at this time of life is one of the great causes of intestinal non-development. Nutrition is lowered through digestive disturbance; inflammation caused by congestion is soothed by opiates; feeding and fermentation continue; development of the intestinal tract is arrested, or the tract in portions is paralyzed, thus affecting function. These conditions, if permitted to continue through adolescence, cannot be corrected by a lifetime of later natural existence.

    It is evident that clean bowels are essential to perfect digestion, hence to pure blood, hence to health. The purgative fails in cleansing the colon. What, then, is the means to be employed when conditions such as have been described exist. When a conduit is badly incrusted with an accumulation of soluble matter, the course pursued to remove the coating is that of flushing repeatedly with clean water, and this is the process here advised when the colon is obstructed with body waste.

    The enema, the internal bath, properly administered, will flush and cleanse the large intestine, will promote peristaltic action throughout the alimentary canal, and will fully suffuse the abdominal circulation with the most soothing and healthful of all fluids--pure water. And from its use there will result no depressing, no deleterious effects, either immediate or subsequent.

    The enema or clyster has been known and used by man for centuries. Herodotus, who lived and wrote five hundred years before the birth of Christ, says of the Egyptians: "For three successive days in each month they purge the body by means of emetics and clysters, which is done out of a regard for their health, since they have a persuasion that every disease to which men are liable is occasioned by the substances whereon they feed." However, the manner of administration of the enema then and thereafter was such as not to be as efficacious in result as we have later discovered it may be. The idea was held that an accumulation of feces had gathered in the rectum and in the folds of the sigmoid flexure. For the evacuation of this material a small amount of water injected into the rectum in a sitting posture was found to be easy and effective. This portion of the intestine may be cleansed by the injection of from one pint to one quart of water--in fact this is about its capacity, a larger quantity rising above the curve of the bend. It was also formerly doubted whether water could be forced above the flexure unless pressure was employed, and for a long time those who used the rectal bath made no attempt to cause the fluid to reach the descending colon for fear of injury. It has been demonstrated that the entire bowel can and often does become clogged and incrusted with refuse, and that larger amounts of water may easily and safely be injected into the organ flushing it throughout its length.

    For the administration of the enema the sole equipment necessary is that of a fountain syringe with its rectal-tube attachment. The syringe should be suspended about five feet above the floor of the bath or lavatory, thus insuring sufficient fall for the water. Examination of the preceding diagram of the intestines will show that there are three positions in which the body may be placed in order that the colon may receive the water injected in such manner as to reach its entire surface, soften its contents, and wash them from its walls. These are the right-side, the knee-chest, and the flat-on-the-back postures. The last, excepting for children and for bedridden cases, is inconvenient to assume, but the two former positions are found to be comfortable and are easily taken.

    When the subject in taking the injection lies on the left side, gravity assists the flow of the water only as far as the transverse colon, which in this position is perpendicular to the descending colon and forbids further passage of the fluid. Hence only the lower third of the bowel is affected. The right-side posture allows the water to flow along the descending colon, thence down the transverse colon and through the ascending gut to the cecum, thus completely flushing the organ. The knee-chest and the flat-on-the-back positions, obviously and with even greater ease, insure similar cleansing of the bowel. If, as is usual with those who are ignorant of the advantages of the postures described, the injection is administered while seated, gravity and the contents of the descending colon prevent the rise of the water unless some special device embodying force is utilized; and then again only the lower third of the bowel receives the benefit of the flow, and dilatation of the rectum and flexure is almost certain to occur with possible structural injury.

    When a patient is bedridden or is extremely weakened, the knee-chest posture or the right-side position may prove too difficult or too exhausting to assume. In either of these contingencies, when no specially constructed table is at hand, a canvas stretcher upon which the subject may lie can be placed over the bath tub. If this apparatus cannot be procured, a triangular platform of three foot-wide boards covered with oiled cloth and a blanket, its base arranged so as to cross the top of the tub beneath the buttocks, may be used as a substitute. By the means indicated all effort in maintaining position is removed, a matter of importance in states of excessive weakness.

    The operator in administering the enema, or the patient himself, in order to insure full benefit, will find it necessary to repeat the injection until the fluid returns comparatively colorless. This may mean that as many as twenty quarts of water may be required to obtain the desired result. Of course this amount of water cannot be introduced into the bowel at one time, but the contents of one bag or can, preferably of three-quart capacity, can be injected in the ordinary case and then evacuated with its accompanying refuse, and this operation may then thereafter be repeated until cleansing of the bowel is assured. Repetition as described is most essential in employing the internal bath, since the injection of only a small quantity of water acts detrimentally in that it serves to render the contents of the bowel readily absorptive, and is not in amount sufficient to be evacuated freely. Because of rapid absorption of the fouled fluid of the injection, retention of the water should be limited only to the time needful for injection and discharge. The latter may be facilitated by kneading the abdomen with the hands over the region traversed by the colon in the abdominal cavity.

    Copious discharge from the bladder immediately after an internal bath is the common indication of the rapidity with which absorption takes place through the walls of the bowel, and it is seen that the process is almost instantaneous. For this reason salt, soap-suds, soda, and like substances should be avoided in preparing the fluid for injection. This caution likewise applies to the use of oil or glycerine. The only flushing agent should be water warmed to body temperature or not higher than one hundred degrees Fahrenheit.

    When the enema is advised in medical practice as at times it is, invariably too small an amount of water is used, the posture is usually that of sitting, and, when what is known as a high enema is given, a colon tube, which is a long soft rubber hose, is attached to the fountain syringe. This accessory is not at any time needed, and its employment may prove harmful to the bowel. The short rectal-tube mentioned answers all purposes if the injection is taken in any one of the indicated effective positions. In any event the colon tube should be used only by an expert or under his direction.

    Ignorance of procedure and erroneous reasoning have occasioned the belief that the use of the enema as recommended in the text will not only cause weakness in the patient, but will also bring about subsequent failure of function of the colon. It is contended that, once the enema is resorted to for any extended period such as is herein advised during a fast, natural movements of the bowels will not again occur, and that thereafter resort to the internal bath for colon evacuation will be compulsory. Natural movements of the bowels are directly dependent upon normal digestion, and in a system organically and functionally correct, peristalsis and subsequent discharge of refuse oecur in sequence. In the course of the long experience of the author in the administration of the enema as described no instance of loss of bowel function nor of colon paralysis has ever occurred. On the contrary, the internal bath has been found to restore natural bowel action and to act as a tonic stimulus upon the muscles of the colon. Objection to the use of the enema advances as its basis the fact that for a day or so after full flushing of the colon no passage from the bowels occur. In the average case all bowel movements are evacuations forced by incoming waste from the small intestines pushing upon the contents of a filled colon, and the boasted daily movement actually consists only of discharge of the fecal matter contained in the rectum, the greater mass being still retained in the bowel. When, however, an enema has been correctly administered, the entire colon is cleansed, is emptied of its contents. The daily habit is consequently broken, and it may not be resumed for one day or several, or until the former condition of fullness has been restored which, if normal peristaltic function is impaired will shortly occur. Natural discharge from the bowels is assured only by attention to diet, to mastication, and to the existence of normal digestive processes, together with normal response of the colon to the irritative stimulus of waste deposited in it from the small intestines. And that man is the exception in whom this healthful sequence of function is the rule.

    At times, even in those who have been accustomed to the use of the enema, difficulty is experienced in causing the water to penetrate beyond the sigmoid flexure. There may be slight griping pains when this occurs. Hindrance of the kind may be due to gas in the bowel or to nervous contraction of the muscles of rectum and flexure. If the difficulty persists, small amounts of water should be injected and discharged, this procedure to be repeated until the contraction ceases or the gas is discharged. Manipulation of the abdomen over the region occupied by the parts of the bowel involved usually affords prompt assistance, but, should the trouble prove obstinate, repeating itself at each attempt at injection, there is reason to believe that structural defect of some sort is present in the bowel.

    In certain cases, when the enema is being employed daily under treatment, if there be in the subject a tendency to the formation of hemorrhoids or piles, these blood tumors may appear in and about the rectum and anus. In this contingency local application of some soothing emollient should be made to relieve irritation, and a properly constructed rectal dilator should be used to mitigate congestion. The symptom will not persist at length, and the enemas should continue notwithstanding slight inconvenience. But, while the hemorrhoids are in evidence, the dilator should be worn. It is to be borne in mind that in health the use of the internal bath twice weekly, as suggested herein, will preclude congestion of the rectum, and that hemorrhoids are unknown to one who employs this simple cleanly measure.

    To revert to the condemnation visited upon the internal bath. Two cogent arguments lie behind this censure, of which one is commercial in character, for purgatives are sold at a price, and prescriptions also bring fees; the other is discovered in that an enema administered under medical direction is not correctly given either in posture or in quantity of fluid, and advice is usually proffered that the latter be retained for a time in the bowel. Hence these injections merely succeed in stirring up a filthy mass, putting it into condition to be easily absorbed, with increased auto-intoxication and subsequent depression as results. If a feeling of weakness occurs in a patient after an enema administered as described in the text, it is due to the removal of poisonous stimulation, the consequence of absorption from the contents of the colon. Once the accumulation is discharged and the bowel cleansed, recuperation is almost instant.

    Physicians have also claimed that no appreciable absorption of fecal matter in solution or of its products can take place from the large intestine. But medical science long since stultified itself in this respect when it recommended the employment of nutrient enemata in cases where feeding by way of mouth and stomach was refused. Denying that the contents of the bowel may be returned in part to the circulation through the walls of the gut, it nevertheless affirms that sustenance may in this manner be absorbed. It assumed and it still assumes that tissue may be nourished and that strength may be maintained by matter that does not undergo the process of normal digestion, introduced into the system by way of the colon. What occurs in this instance is stimulation, and poisonous stimulation at that, for material absorbed through the walls of the large intestine is received, not by the portal or nourishing portion of the circulation but directly by the venous blood, which already is laden with impurity awaiting oxygenation. Food substances introduced into the organism in this manner putrefy and poison. To deliver household water to the faucets through the sewers of a city would be deemed an act of insanity, yet analogy is plainly apparent when this method of transmission is compared with that of food injected into the body by way of the rectum.

    In most cases during the development of disease the intestines are filled with food variously changed by the digestive processes but then in a state of fermentation; and the blood is laden with poison largely the product of morbific decomposition. The retention of excrement or waste in the alimentary canal, coupled with its disease-producing putrefaction, gives rise to bowel stoppage or constipation, and it may also cause the reverse condition, excessive liquid movements or diarrhea. Both of these phenomena are indicative of an unnatural, abnormal condition, are the immediate consequences of indigestion, and their toxic sequelae still further vitiate the entire organism.

    Man in his natural state lived as nature dictated, and living naturally he was free from the harmful effects that arise from the retention of excrement in the colon, since fecal matter was not retained in the bowel long enough to be injurious. But man in his civilized state lives in many ways not naturally, and suffers in consequence. In natural conditions the human intestines are unobstructed by accumulation of refuse, and, as is the case with the lower animals, they are evacuated by frequent passages. This observation may be extended by stating the actuality that fecal matter in natural evacuations, refuse from the natural food of man, which was non-flesh in character, is almost without odor. That this is not true in the usual present-day instance needs no comment.

    During a period of fasting the function of elimination is paramount, and waste from body tissue is cast into the intestines in profuse amount. The fluid state of this refuse permits of easy absorption, and its prompt discharge is imperative. From the beginning of abstinence until indications point to approaching completion of systemic cleansing, brownish, foul-smelling discharges are evacuated, and, in the earlier stages, hardened feces dislodged from the walls of the bowel are cast out in the enema. As purification progresses a feature more or less noticeable is the appearance of quantities of stringy white or yellowish mucus. This phenomenon is elsewhere commented upon, but the discharge is catarrhal in origin, although no inflammation of intestinal mucus membrane now exists. It consists of the remnants of impurity remaining in tissue structure, and is evidence of the complete purification that is accomplished by permitting the function of elimination full scope. Depending upon the responsiveness of the individual organism, this symptom is sometimes present from the beginning of a fast, and it is always noted in greater or less degree at some point during prolonged abstinence from food.

    When fasting, the enema is an essential daily adjunct, and at this time it should be administered on rising, or shortly thereafter, and before retiring. In health, as a preventive of self-poisoning, an enema is advised at least twice in each week. It will be found a most relieving as well as cleansing operation, and it will obviate all chance of fecal accumulation, which means constipation with subsequent septic poisoning.

    In a succeeding chapter mention is made of a procedure recently promulgated by both medicine and osteopathy--that of colonic therapy by means of what is known as cecal injection. This embodies the introduction into the bowel of a specially constructed colon tube of length sufficient to reach with its open tip the cecum. This being accomplished, the bowel discharge obtained, facilitated by injecting a solution of salt, is examined to determine the nature of the bacilli resident in the particular human subject at this point. These bacilli are then classified, and, if certain microbic forms are present, again through the colon tube an implantation by injection of bacillus acidophilus is made. The latter germ is said to have a very salutary effect upon the intestinal mucus membrane, and so to strengthen its powers of resistance as to cause it to withstand the attacks of any deleterious organism which happens to invade its precincts. It may be that the particular microbic infection of the cecal region is a mere amebic infestation--a simpler but more prevalent form of micro-organism than are those requiring to be confronted with a line of battle--and in this instance an antiseptic, consisting of kerosene and ichthyol, the latter a substance prepared from asphaltum, is forced to the domain of the enemy. This is followed by solutions of quinine, of emetine, a drug that has emetic properties, and of plain salt. No doubt the enemy at once retires when this onslaught on his forces occurs, but what of the poor victim whose body he inhabits?

    No intelligent reader of these lines can fail to be impressed with the comparison between that method of therapy which insists upon attacking the outposts of disease, its symptoms and the regional abodes of its micro-organisms, and that system of healing which contends for the eradication of the cause underlying the existence of both symptom and bacilli. That the enema, administered as described in this chapter, in conjunction with the eliminative effects of the fast, does all that may be claimed for palliative, temporary agencies, one of whose tedious procedures is here detailed, is patent. And they accomplish much more, even to the ultimate desired result, bodily purification, rendering through their offices every organic secretion physiologic, hence resistive, rather than pathologic, with no power to repel organism inimical to health.


NOTE I

    Details of administration of an enema to the infant.

    The usual fountain syringe should be used, equipped with convenient length of tubing, with shut-off, and a small-sized rectal tip. An extra unattached tip should be at hand, the use of which is later explained.

    There should also be a low chair or stool admitting of holding the recumbent child in the lap at a height slightly above the level of the bowl of the toilet.

    Two pieces of rubber sheeting are needed, each one yard in length. One of these should be thrown over the top edge of the raised seat of the toilet, draping it so that it may receive spatterings and forcibly ejected discharges. The other should be placed one-half over the lap of the operator, permitting its free end to cover the front edge of the toilet bowl with sufficient length dropping over the inner edge to convey discharges into this receptacle. A folded Turkish towel should be laid over the end of the sheeting on the lap in such position as to be under the buttocks of the child, thus raising them slightly and preventing contact with the surface of the sheeting.

    The operator should sit with right side next the toilet bowl, with the infant lying upon its back across the knees.

    Care must be observed in inserting the rectal tip into the anus, and the right hand of the operator should hold it in position after insertion and while the water is flowing. Greasing the tip with olive oil or with an antiseptic lubricant will prevent irritation of the membrane of the orifice. The flow may be regulated by the shut-off or by pinching the soft rubber tubing with the thumb and forefinger of the left hand.

    In small children during the administration of the contents of one bag of water, it is usually not necessary to remove the rectal tip from the anus, since the liquid form of the discharge permits ejection around the sides of the tip, and repeated insertion and withdrawal with possible chance of irritation is thus avoided. After the exhaustion of the water in the syringe, the attached tip should be withdrawn, and the unattached one mentioned as part of the equipment should be introduced into the anus. Through it evacuation of that portion of fluid retained in the colon will occur the more easily, since by this means constriction of the muscle of the anus is overcome. Neither pipe should be inserted to greater depth than two inches. At this stage of the procedure manipulation should be made of the abdomen, following the ascending colon on the right side from the cecum to the transverse bowel, thence over the transverse section to the descending colon, thence down the left side to a position corresponding with its extremity and outlet. This is an essential that should not be omitted, since it assists peristaltic action and hastens evacuation. The total quantity of water injected in giving this enema should not be less than six quarts, and, if extreme discoloration in discharge persists, more fluid should be used. It is of course understood that it is not possible to inject this amount of water into the colon at one time, but that repetition in injection and discharge of fluid is here implied.


NOTE II

    Several positions are indicated as suitable and efficacious when an enema is administered, but perhaps that which will insure both comfort to the subject and complete flushing of the colon is the flat-on-the-back posture. In order that this may be conveniently assumed, a specially constructed table is of great assistance. A table, such as this, now in use at the sanitarium of the author, carries the following measurements:

    Length of top, over all, 44 inches;

    Width of top, over all, 18-1/2 inches;

    Height of rear and higher end, over all, 23-1/2 inches; Height of front and lower end, over all, 16 inches.

    Four sturdy legs, properly braced, support the top.

    Lengthwise from the middle of the top, grooves, such as are carved into drain boards, run to the lower or front end of the table, thus permitting surplus water to be guided to the receiving vessel, usually the bowl of the toilet.

    A semi-circle of four and one-half inches' radius is cut into the center of the lower end of the board that forms the table top.

    This stand should be placed in front of a toilet with its lower or front end projecting partly over the bowl.

    The subject, with head supported by a small pillow lies upon the table on his back, with feet raised so as to rest upon the upper edge of a low toilet tank.

    In order to guard against spatter from discharges, an oil cloth sheet should be draped over the front of the toilet tank, with its lower edges extending below and inside the roll of the bowl. This sheet should be attached to wall and end of table in any convenient manner.

    Instead of the usual fountain syringe, the author employs a tank of galvanized iron, holding approximately four gallons of water. Its measurements and shape are as follows:

    A flat back 10 inches wide by 15 inches high;

    A semi-circular front, 19 inches around from edge to edge of back, to which it is soldered along the 15-inch edges;

    A semi-circular bottom piece soldered to the two pieces already described;

    Two stout metal lugs, holed for screws, are riveted to the top edge of the back for wall supports;

    A substantial and convenient small faucet is soldered into the center of the lowest point of the circular front of the tank. To this faucet are attached five or six feet of rubber tubing with the necessary rectal tube inserted at the extremity.

    By the use of the table described the internal bath may be administered with but small effort or inconvenience either to patient or operator. In case of inability on the part of the patient to perform the acts necessary to the procedure involved, the operator should seat himself on the right side of the subject, in which position he can easily insert and extract the rectal tube, as well as control the flow of water into the colon.

    This auxiliary appliance is of the greatest assistance in administering the enema to children, to the very ill, or to the helpless bedridden sufferer, and it is often preferred by those who are able to assume the various positions and to perform the necessary acts without the help of another.

    The tank, for which measurements are given, is also a convenience, in that it obviates successive refilling of a rubber bag or hospital douche of small capacity. It should be suspended upon the bathroom wall with its bottom about five feet above the floor, this height giving through gravity just about the correct amount of force to the flow of water entering the bowel.

    The author expresses the opinion that her experience in the administration of the internal bath is greater than that of any other known exponent. And out of that experience have evolved the two appliances here described. They have proved invaluable additions to comfort, cleanliness, and ease of performance in what is always an unpleasant but necessary task attached to the practice of natural therapy.


NOTE III

    Those who do not wish to go to the trouble and expense of building their own apparatus, as described in Note II above, may find the J. B. L. Cascade an easy and convenient method of taking an internal bath. This device is distributed by Tyrrell's Hygienic Institute of New York, and it may be found at most good drug stores carrying rubber goods. The author considers that, for taking an internal bath, the J. B. L. Cascade is the most effective and most reliable of the many patented devices that have been put on the market.