Part 11

Some physicians hold that chronic inflammation of the rectum is a disease of more frequent occurrence than all other rectal diseases combined. And equally as pernicious, causing many functional and even organic troubles through reflex action.

FLUSHING THE COLON.

I have always been loath to admit the value of a thing which did not come from an authoritative source. A little retrospective medicine, however, is sufficient to teach any of us that many important discoveries have been made without the free-will and full consent of “acknowledged authorities;” and that it is not positively necessary for progressive physicians to first obtain their permission before being allowed to think and act for themselves.

Flushing the colon is a discovery of intrinsic worth, brought to notice in an irregular way, and has its place as a remedial agent with which every physician should become familiar. If you doubt its efficacy, and want a free evacuation of the bowels without taking physic, lie on the back and inject into the rectum slowly with a bulb-syringe one-half gallon or more of hot water, and you will get it inside of fifteen minutes.

I do not see that Dr. A. W. Hall, who claims in his health pamphlet to be the father of the process, and whose name bears the titles of Ph.D. and LL.D., and consequently deserving of the respect of an educated man, makes out a clear case in defense of his “New Hygienic Treatment” as a life-giving principle, either in health or disease.

His argument is certainly unphysiological, and we are left to infer that nature has been derelict in the construction of man, which he has been instrumental in supplementing. If he were to confine himself to disease alone, his reasoning would appear more plausible; but he claims that people enjoying good health, with no physical ailment whatever, should wash out the colon.

No doubt Dr. Hall has been greatly benefited by flushings of the colon, as also have many others, which offers some apology for the enthusiasm and interest he manifests in the “new revelation;” but we shall be compelled to look to others for the pathological conditions in which it will be found of greatest service.

Respecting the colon itself, there are two very diverse conditions, with their concomitant symptoms, in which flushing will be found of great benefit. The one a diseased condition of the mucous membrane, of a chronic dysenteric or an ulcerative character. The other, a sluggishness or torpidity of the bowel belonging to a constipated habit.

The most easy, simple and efficient manner of practicing the flushings, according to my experience, is by assuming the position shown in the cut. A piece of oil-cloth, rubber-cloth, or a newspaper may be used to protect the carpet. One or both feet are allowed to rest on the floor, and the hips can be raised by the slightest exertion for a few moments, any time it is desirable to hold and hasten the water down the incline.

Beginners should use a common bulb syringe, with water rather hot, varying in quantity as they become accustomed to the process, from a quart to a gallon or more, and a bulb-full squeezed out slowly, with intervals between, giving it time to pass out of the rectum into the colon. On regaining the erect posture, if the rectum be loaded with feces or distended with water, the desire to expel its contents may be irresistible, especially if air has passed through the syringe; although a little practice will enable any one to exert great control over his or herself in this respect.

Dr. F. H. Etheridge (Trans. Chicago Med. Soc.) gives a number of cases of impacted colon, where daily flushings, extending over a period of from one to three months in each case, were followed by the most grateful results. This, too, after the persistent use of drugs had almost hopelessly failed to even afford temporary relief.

Without segregating the cases, some of the diseased conditions mentioned in connection with his patients were dyspepsia, characterized by anorexia, acid and bitter eructations, bad taste in the mouth, gaseous distention, gastric weight and pain. Also cephalalgia, chills, vertigo, chloasmic spots, muddy sclerotics and complexion, insomnia, ennui, eczema, psoriasis, dysuria, etc.

He says: “Daily movements of the bowels are no sort of a sign that the colon is not impacted; in fact, the worst cases of costiveness that we ever see are those in which daily movements of the bowels occur. The diagnosis of fecal accumulations is facilitated by inquiring as to the color of the daily discharges. A black or a very dark green color almost always indicates that the feces are ancient. Prompt discharge of food refuse is indicated by more or less yellow color. It would be interesting to inquire why fresh feces are yellow and ancient feces are dark.

“Absorption of the feces from the colon leads to a great many different symptoms; amongst others, anæmia, with its results, sallow or yellow complexion, with its chloasmic spots, furred tongue, foul breath, and muddy sclerotics. Such patients have digestive fermentations to torment them, resulting in flatulent distention, which encroaches on the cavity of the chest, which in excessive cases may cause short and rapid breathing, irregular heart action, disturbed circulation in the brain, with vertigo and headache. An over-distended cæcum, or sigmoid flexure, from pressure, may produce dropsy, numbness or cramps in the right or left lower extremity.

“I have often questioned whether chloasmic spots were not due to fecal absorption. These spots are pigmentary matter deposited under the skin. It is a physiological fact that all pigments originate in the liver. In a condition of health their abnormal deposit we never see. It is only when the patient is not well, in some way, that these spots are noticed. They are infinitely more common in women than in men. It is easy to see that their sedentary life is more apt to lead in them to the filling of the colon. Absorption from the colon produces a poisoned blood, which in turn deranges every organ of the body, among others the liver. It is possible that the action of light, as in photographs, contributes in some way to precipitate the deposits of these chloasmic spots, because we see them chiefly upon the parts of the body exposed to light....

“The use of a long rectal tube is unnecessary. The patient should be placed in a genu-pectoral position, the shoulders thus being lower than the hips. The water will be made to descend while anatomically ascending the intestines. Patients can be made to receive from one to six pints of water in this position without the slightest trouble. One of the effects of the water is to distend the colon, and in that way pressing away the walls of the loculi from the accumulations that fall into the current of water and are passed out while the water is leaving the intestine. The patient will oftentimes complain of severe tormina, checking the current of water for a few seconds, and will be followed by complete relief. The presence of such a strange foreign body in the intestine as hot water in many cases excites prodigious peristaltic activity, thus producing the tormina. Plain hot water is all that is necessary to use; the water should be hot; cold water, or tepid water, will not do. It will produce great suffering. One patient took the flushings for a fortnight, returning vowed she would never use any more because they produced such terrific cramps. Upon inquiry it was found that she was using tepid water. The subsequent use of hot water by her was never followed by a cramp. Upon many patients this large amount of water acts as a vigorous diuretic. Where patients suffer as well from renal insufficiency, I am in the habit of telling them to use a pint or a pint and a half of hot water after the flushing has passed away, and to lie upon the back with hips elevated for half an hour. Thus retaining the water, it will act as a powerful diuretic. Some patients can administer this flushing with greatest ease, while others will develop a most phenomenal awkwardness. I am in the habit of telling patients to kneel in the bath-tub, who are at all awkward about using these flushings.”

REFLEXES.

The lower end of the rectum is richly supplied with both sensory and sympathetic nerves. The sensory greatly predominating at the verge, making it one of the most acutely sensitive surfaces of the body. In ascending upwards the sensory gradually give place to the sympathetic, until little sensibility is imparted by the touch three inches from the entrance in a normal condition.

This accounts for the hidden cause of so many reflexes, having their seat of origin from lesions an inch or more above the anus, where the sensibility is not always sufficiently great to attract attention.

It has been claimed that obscure rectal disorders may so undermine the nervous system by reflex irritation, allowing the inroad of general systemic disease, that many die yearly from this as the primary cause, without ever knowing the source and origin of the fatal malady.

That migratory pain, headaches, dyspepsia, sleeplessness, palpitations, sexual weakness, nervousness, despondency, irritability, and a general breaking down of the system, may all be caused by a small ulcer or other irritation of the rectum, which has passed unnoticed by either physician or patient.

Nearly every physician is familiar with the white ring around the mouth extending up the sides of the nose, produced by the presence of pin worms in the rectum, or a fatal lock-jaw caused by a broken off needle or rusty nail in the foot. Such illustrations alone, are sufficient to demonstrate conclusively the power of this dynamical disturbance called reflex action.

While there is doubtless unwarrantable exaggeration concerning rectal reflexes by some, there are many unpardonable oversights by others. A case was reported in the Medical Record where all preparations were made to operate for organic stricture of the urethra, which, perchance, proved to be a reflex from a small rectal fissure. When the fissure was cured the spasm ceased. A case of roaring in the right ear was relieved by the cure of a fistula, says Dr. Rorick, who also speaks of two other similar cases.

A very remarkable case occurred in my own practice, where the right testicle had been enlarged to the ordinary size of a well developed case of orchitis for some years, and had resisted all manner of treatment, completely disappeared after the removal of hemorrhoids. The case of hemorrhoids, which was one of the worst I ever saw, is represented in Fig. 2.

Another case was that of a merchant, who suffered frequently from a sensation of drawing and weight in the back of the head and neck. When these attacks came on, his memory became so badly impaired that he was rendered unfit for the transaction of business. He noticed during the attacks that there was a feeling of heaviness in the rectum, swelling and tightness of the sphincters, and a lack of expulsive power at stool.

Examination revealed several pockets and papillæ of the variety shown in Fig. 23, which was taken from this case. Have not been apprised of any return of the trouble since an operation for the removal of these abnormalities.

As evidence that physicians should be a little more vigilant in the observation and study of rectal reflexes, the case of a very talented and influential lady of this State might be appropriately instanced. Her general health had been greatly impaired for a long time, with unexplained and repeated outbursts of sickness. Several prominent physicians were consulted, to whom she called attention to a little uneasiness, at times, in the rectum with an irritable bladder. They all examined the rectum, in their way, and ridiculed the idea of local disease, but went on treating the reflex symptoms, with nothing more than temporary relief.

The successes of a local specialist in the treatment of hemorrhoids by the Brinkerhoff system, whose ignorance of anatomy was such that he denominated the sphincters “dispenser” muscles, induced her to pay him a visit. He found a well defined superficial rectal ulcer, and exhibited it to one of the previously named doubting physicians. The ulcer was quickly healed and the lady restored to health.