The lower bowel in health and disease

Front matter

Lower Bowel in Health and Disease

LIBRARY OR CONGRESS.

s&r —

Index

Introduction, - - - - . - 6

The Digestive Tract, - - - - 13

The Rectum, - - - - - - 19

Disorders of the Rectum, 22

Constipation, - - - - - -31

Hemorrhoids or Piles, 61

Prolapsus, - - - - -71

Polypus and Tumors, 74

Ulceration Within the Rectum, - - 77

Stricture, - - - - - 83

Fistula, 86

Fissure and Painful Irritable Ulcer of the Anus, - 91

Itching at the Anus, 96

Catarrh of the Rectum, - - - no

Palliative Treatment, - - - 118

Hygiene of the Lower Bowel, ... 123

Influence of the Mind, 129

Preface

A notion has somehow possessed a great many persons that almost any disorder of the lower bowel may easily be removed, or at least made bearable from time to time ; that so long as one is not brought to bed by acute suffering, these disorders are like a cold in the head and can as easily be endured, by getting accustomed to them.

Common ignorance of physical self, supplemented by the literature and vulgar boastings of the Quack professional pile curer and the manufacturers of ready-made pile medicines, have gone far to sustain the idea that rectal disorders are only passing events, common to the ordinary life, and were probably meant not to be cured, but to be endured.

No greater mistake in the economy of human life was ever made than this neglect of a grave and serious disorder.

These disorders are undoubtedly the underlying cause oi many serious ill-conditions of the body, which seem strange to the sufferer, because of ignorance of the cause.

The enormity and serious influence of disorders of the lower bowel is fully appreciated by the intelligent physician, and there is hardly a case of illness in their practice, either in the office or at the bedside, but that

4 PREFACE.

the first question asked is " What is the condition of your bowels ? ' '

With the hope of creating a more general intelligence and correcting many ignorant ideas relative to the subjects of which this book treats, this compilation has been made. In its preparation great indebtedness is due to the writings of the late Dr. W. H. Van Buren and Dr. Charles B. Kelsey of New York ; Dr. Allingham, Dr. Lionel S. Beal and Dr. Benj. W. Richardson of England and Dr. Joseph F. Edwards of Philadelphia; Dr. George H. Taylor, Dr. Felix Oswald and Dr. L. B. Sperry, and that admirable Journal, ''Medical Classics" of New York.

This indebtedness is not acknowledged in every instance by the medium of inverted commas and attaching the names of the authors, for the reason that the exact text has not always been followed, and technical language has been changed into common place phrase.

The doctrines of compensation, action and reaction, and dependency, enter very minutely into the economy of the human body. As early as 550 years before the Christian era the following piece of wisdom was written down from the lips of iEssop.

*' The Members of the body found fault with the Belly, for spending an idle luxurious life, while they were wholly occupied in laboring for its support and ministering to its wants and pleasures ; so they entered into a conspiracy to cut off its supplies for the future.

The Hands were no longer to carry food to the Mouth, nor the Mouth to receive the food, nor the Teeth to chew it.

PREFACE. 5

They had not long persisted in this course of starving the Belly into subjection, ere they all began one by one, to fall and flag, and the whole body to pine away. Then the members were convinced that the Belly also, cumbersome and useless as it seemed, had an important function of its own; that they could no more do without it, than it could without them ; and that if they would have the constitution of the body in a healthy state, they must work together, each in his proper sphere for the common good of all."

The truth which this old fable teaches, may with equal force be applied to the Rectum or lower bowel as well.

Throughout this little book there will be found language, phrase and ideas, which have a marked similarity and which may truly be said, to be repetitions. But we claim to offer these pages as an educational influence against the misfortunes of ignorance, and have therefore kept before us the fact, that true and successful education demands iteration, and reiteration to drive home to the mind the lasting impression.

Introduction

Health is that condition which comprises " a sound state of the body, in which the parts perform their natural functions, and there is mental vigor, moral purit}^ a vigorous body, beauty of face and form, with graceful carriage."

In this advanced state of civilization, it is strange how much ignorance exists among all classes, as to the human body and its functions.

It is a fact that human beings know something of almost all that goes to make up the sum total of our daily lives, in association with the world.

Most men and women know something of the laws which govern countries and communities ; they are acquainted with commerce ; they know how to build ; how to co-operate for common safety and defence ; in a word there is hardly an external condition of human life that is not known to the masses, but when we ask ourselves, what do we know of our human body and its functions f we become aware of our ignorance, and discover

8 INTRODUCTION.

that we are utterly dependent upon a select class, known as ' • Doctors of Medicine, ' ' and into their hands we surrender ourselves for life or death. There are notable exceptions, but they only prove the rule.

By the strict law of nature a man should die as unconscious of his death as of his birth. ' * In health he should be unconscious of his every day functional life." We often hear people say, "I do not know that I have a stomach, liver, kidneys or bowels. Nature acts with such ease and harmony that I only know I live and move and have a being. " By the hand of Nature death were equally a painless portion."

" When we shall have learned this lesson, this benign process of Nature, by a careful study and loyal regard for her laws, then will death cease to be a dread, it will come as a sleep, without pain, anger or sorrow. The Greeks, true lovers of Nature, and obedient followers of her laws, looked upon death in childhood or youth as so untimely that the body was carried to the pyre at the break of day, lest the sun should behold so sad a sight as the young dead."

In the preservation of life, health and happiness, there is no one portion of the body that bears so important a part in the economy of our physical

INTRODUCTION. 9

nature as the digestive tract, ending with the rectum, or lower bowel as it is called.

We cannot commence too early in life the education of the young person to regard the call of nature, to evacuate refuse matter from the body and thus purify it for the performance of its natural functions.

We ought to ' ' understand that all habits of life which are beneficial to the general health are for the benefit of the rectum ; while those habits that endanger the general health may first show their evil effects on that organ.' ' " It is quite apt to be so if the rectum for any reason is the weakest organ. Most rectal diseases are curable if rightly managed ; but it is far better, easier and safer to prevent them by taking proper precautions/ ' ' ' Prevention is better than cure and far cheaper. ' ' We must learn to deserve health by the practice of such virtue in living that our Mother Nature will smile upon us and by an influence of which we cannot divine the source, w r e shall be lifted up into that better world of daily experience known as perfect health.^

<l By observing the health laws of Nature, a sound constitution can be very easily preserved, but if a violation of those laws has brought on disease, all we can do by way of "curing" is to

IO INTRODUCTION.

remove the cause ; in other words to prevent the continued operation of the predisposing circumstances."

It does no real good to pursue investigation for the purpose of finding the cause of disease and when found to sit down over it and try to guess what will be the best mode of removal. The thing to do is to remove it by the most expeditious plan laid down in the book of experience, and thus remedy the slight put upon Nature and her laws, which are always for the right and for the best.

The history of knowledge is the history of triumphant progress.

" The spell of supernaturalism is broken. The broad minded, free thinking creature of all races and religions, has awakened to a recognition of the fact that this world is not governed by capricious ghosts, but by consistent uniform laws, and that the study of those laws is a path to all the knowledge and happiness our nature is capable of attaining. Great progress and the accomplishment of wonderful results marks the onward march of civilization. Wealth, power and station are the rewards which have been attained by men and women from all walks of life. There is one exception "The science of health is still a barren tree." " Our wealthy minds dwell in poorly

INTRODUCTION. T I

tabernacles; the right method of promoting man's physical welfare seems to be one of the utterly lost arts. ' ' Oswald.

At whose door lies the fault of this ignorance ? Go into the public libraries and ask, — How many of your readers inquire for books on health culture, and they will tell you about one per cent. Go into the public book-stores, and ask, if books on health and physical culture sell, and they will answer, ' ' Yes we dispose of a few during the year, but it is slow work. ' ' L,ook about in our large cities, and you will find a few Gymnasiums and swimming baths, but as a rule they are part of the make up of a Social Club, where food is dispensed at the hands of a French cook, and alcoholic liquors are free to all. Ask the physicians, w T hy we are not better informed, as to our physical natures, and they will tell you, that it is because we wilfully, persistently and premeditatedly avoid the study of first principles of natural living and make our daily lives a hit-or-miss game, — well to day, sick tomorrow, and then the doctor.

A physical and health culture education may be secured by any one of ordinary intelligence, and on through life, it should be a part of the habitual reading to have at hand one or more of the interesting and attractive ' ' Health Journals ' ' that are

12 INTRODUCTION.

now published in every city in this country, 1 ' Seek and ye shall find — knock and it shall be opened unto you/' to experience a foretaste of heaven on earth, by the enjoyment of health.

THE LOWER BOWEL

IN

HEALTH AND DISEASE.

THE DIGESTIVE TRACT,

Before proceeding to a consideration of the disorders peculiar to the rectum, of which we shall speak later, it may interest us to understand the nature and construction of the whole passage through the body, from the mouth where food is taken in, to its end the anus, where the refuse of food and a portion of the waste material of the body is thrown out.

Food when taken into the mouth should be torn apart and ground to a pulp by the teeth, and moistened by the saliva, so that it may be more easily swallowed. The saliva contains chemical agents which aid in turning starchy foods into nutriment for bodily tissue. From the mouth the food passes into the stomach ; here it is mixed with the gastric juice, another chemical, which

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acts upon the food as a solvent, and still further reduces solids into a semi-liquid pulpy mass ; this is further accomplished by a motion which is given to the stomach, by its muscular tissue, which causes the food to be stirred up and around, until it is small enough to pass out through an opening at the lower right hand end of the stomach called the pylorus or gate of the stomach into the bowels.

As the food passes into the bowels, it is first received in the duodenum (a twelve inch long space) which is the beginning of the small bowels and in circumference, somewhat larger. In the duodenum, the food comes in contact with the bile and the pancreatic juice ; by these two chemical agents the process called digestion is about completed, although further on and throughout the whole extent of the small bowels digestive influence is being exerted, and the nutrient value of the food is taken up and absorbed into the blood circulation by which it is carried to the liver, heart, and lungs where it is purified, and then serves to rebuild tissue, repair bone, muscle and nervous waste. In the separation of the food nutrients in the bowels, the waste portions of the food are pushed forward to the lower end of the small bowels, and, at the lower right hand side of the

*5

abdominal cavity they are passed through another gate (called the caecum or ilio-csecal valve) into the large bowel, called the ascending colon, which takes an upward direction on the right side of the abdominal cavity, then turning passes to the left side, below the stomach and liver, and then descends on the left side, terminating in the rectum.

The purpose of the colon in the economy of the body seems to be to receive from the small bowels the waste particles of food, and a portion of the waste of the bodily tissue gather this into a mass and urge it forward into the rectum, whence it is ejected from the body. The removal of waste from the body is also accomplished by the action of the kidneys and the sweat glands acting on the pores of the skin, and the common act of washing with soap and water.

In the passage through the body from the mouth to the anus, there exists a lining of soft mucous membrane, of delicate formation, at all points crowded with blood vessels and nerves. In the pouch-like rectum the location of the bloodvessels is peculiar and somewhat different from other portions of the surface of the digestive tract. The blood vessels terminate in separate ends almost like a sac ; the blood is forced into them by the portal circulatory system and, at times, it is dull in i6

its reaction or recirculation. These pouch-ending blood Vessels, and this dull circulation are the seat of many of the disorders of the rectum.

When the act of defecation is normal and no extraneous causes are produced to interfere with nature, the healthful condition of the rectum is assured and no attention is called to the parts, that requires either the service of the physician or the layman. Nature is at her best, and health is in possession.

Disorders of the rectum are largely caused by others of the digestive tract. Indigestion is not so frequently a disorder of the stomach as it is of the intestines, and the disorder in either case is not by reason of some functional change in the stomach or intestines, but the cause must be looked for beyond the circumscribed space of the abdominal cavity. The character of the food, the liquids drunk, the habits of life, the occupations, either business or professional, the clothing, the hours of sleep, all have a bearing on the digestive . act, and make or mar it, for health. The German physician, Dr. L,ustig, thus speaks of "Chronic Abdominal Ailments."

"The fact that a sedentary habit of living is the cause of abdominal ailments in strong, wellbuilt and otherwise healthy individuals, is well born out by experience."

As to the cause of this, there are many differences of opinion among physicians.

" We know as a positive fact that the proper normal oxidation of the blood is a much more important factor in the preservation of health and life than the most bountiful table."

' ■ Compare the physical daily laborers working in the open air, with those who work in closed rooms. The former present a robust appearance, and are less subject to disease than the in-door workers, and yet the latter are better served with food than the former, they earn more compensation, and therefore can afford better living."

1 ' With those who only exercise occasionally to the point of perspiration, there is imperfect oxidation of the blood."

" It therefore follows, that when the blood is imperfectly oxidized, it must become vitiated and undergo change." This change as a rule consists of more or less thickening and is apt to stagnate in the portal system." (The blood vessels of the rectum are a part of the portal system) . When the blood becomes thus thickened, the glandular organs become engorged with blood, especially the liver, which as we know stands in the most intimate relation with the portal system, conducting the blood from the entire digestive tract to it.-"

"When once the veins and venous plexus of the abdomen become engorged, this condition spreads to the large venous trunks, and as they possess an appreciable elasticity they become overfilled with blood, become tortuous in their course, causing larger or smaller nodules to form, which, when they make their appearance in the rectum are called hemorrhoids ox piles.

1 ' The unnatural pressure which this plethora of the portal system causes on the sympathetic nervous system, produces many sad results of illness. When the overcharged venous system of the rectum presses upon its system of nerves, and this is further complicated, by constipation and pressure of fecal matter, then we may see depressed vital status — hypochondria in men and hysteria in women. This condition is soon reversed by a good cleaning out of the bowels, followed by light diet and plenty of out door exercise. The sad depressed face lights up with a happy smile that rivals the joyous child at Christmas time."

THE RECTUM.

The Rectum is the lower extremity of the large bowel called the descending Colon. It is situated in the lower part of the abdominal cavity, behind the bladder and the womb, and in front and below the lower extremity of the backbone.

It is from four to six inches long and varies in its inside diameter from ij(to 2 inches ; it may be dilated to a much greater size, or contracted by stricture to the fraction of an inch. Its lower portion (just inside its mouth the anus) is surrounded and closed by a band of muscles called the sphincters. This band is about an inch broad, with its upper and lower edges so much thicker than the intervening fibres, as to be called, respectively the internal and the external sphincters. These muscles are well supplied with nerves, are very sensitive and are to quite an extent, under the control of the will.

The chief nerve supply of the walls of the rectum is from the sympathetic nervous system which is not under control of the will and in normal condition is not sensitive.

The walls of the rectum are soft and elastic and capable of holding a surprisingly large mass of excrementitious matter.

There is a net-work of good sized veins surrounding the lower end of the rectum for an inch or two. It is a remarkable fact, that these veins are not provided with valves and consequently whenever the abdominal portal or liver circulation is sluggish or obstructed, as by an overloaded colon from constipation, a congested liver, an abdominal or ovarian tumor, or from pregnancy, there is a strong tendency to stagnation in its lowermost tributaries — the veins of the rectum. Hence they are often found in a state of swollen enlargement, with thickened walls and pouch-like dilations which develop into piles.

When it is also remembered that the course of circulation of the portal system is upwards to the liver, we may understand that those persons whose occupations confine them within doors, and whose work is performed in a standing position or even in a constantly sitting position are likely to be victims of stagnated portal circulation.

Iyiterary and professional men, Dentists, Typesetters, Tailors, Hairdressers, Street car drivers and conductors, are all liable to these distressing disorders. The disorders of stagnated portal circulation seem to be peculiar to civilized humanity; there is no analogous disease in quadrupeds where the body is horizontal and not in the upright position. Monkeys in confinement often show a swollen anus and not infrequently are victims of piles, in some form.

The disease is almost unknown among barbarians and Indians. The active outdoor life seems to keep the circulation under rapid motion, and the pure air oxidizes the impurities of the blood.

DISORDERS OF THE RECTUM:

The disorders most common to the rectum,, are Co?istipation ) Piles, Fistula, Ulceration, Strictures, and prolapsus or falling downwards through the anus of folds of the mucous membrane of the rectum, and in extreme cases the coming down and turning out of the lower end of the large bowel, the colon.

The general and most common causes of disorders of the rectum, arise from constipation, diarrhoea, too good living, especially the consumption of large quantities of meat, very coarse fare, indulgence in alcoholic drinks, excessive smoking, violent and prolonged exertion, sedentary occupation, exposure to wet or cold, discharges from the bowels resulting from internal diseases, pressure by the uterus during pregnancy, uterine displacement, friction from clothing use of printedpaper when the ink rubs off by the slightest friction on the moist mucous membrane of the anus; neglect of bathing the anus, which requires as careful and more frequent washing than almost any other part of the body. Straining at stool, however induced is most injurious. Severe coughing or sneezing will often induce undue straining. The ill effects of straining are more common among children, from weakness of the parts and the undeveloped bone structure which aids to support the lower bowel.

The habit of placing young children over the "chamber," and urging them to strain to produce passage is a most pernicious custom and may result in permanent injury of the parts, or the establishment of such abnormal conditions as to stamp ill health upon a child for a long time, that in all other respects is in the enjoyment of a perfectly healthful action of body and mind.

Infant children should be allowed to perform their act of defecation in a recumbent position, and older children should never be allowed to sit on closet seats where the hole is so small as to have a tendency to drag apart the buttocks, and thus strain open the anus ; this is likely to produce a fissure or crack which may cause much suffering from inflamation. The sitting upon the closet seat for a moment longer than is necessary is injurious at any period of life, and most injurious to children.

In Country Villages and on forms in the Summer time it is not uncommon to see children make a "play house " of the "privy," they frequently sit over the " holes," by reason of the suggestive purpose of the place. Young girls and even more mature women, have a custom of visiting the ' ' out-house ' ' in pairs and there pursuing conversation. It is also not uncommon for persons to carry reading matter with them. All this is most pernicious ; First, by prolonged sitting, straining of the anus and muscular walls of the rectum is produced, a tendency to " bear down " is created and thus the mucous membrane of the rectum is turned out, and likely to be strangulated, causing -piles. Second, the atmosphere of a common " well hole privy ' ' is poisonous, loaded with " Malaria" and therefore must be very injurious to the general health.

The "Out-house privy" in winter time is a most prolific cause of rectal disorders. The subjection of uncovered portions of the body to the cold air produces a chill and as a consequence defecation is hurriedly forced an imperfectly performed.

Defecation should always be performed in a comfortable place, where nature will not be impeded, and where the desire may be most fully accomplished.

That this may be secured, modern sanitary science has perfected the Water, and Earth closets, which should be placed in a comfortable room within the house, and thus contribute to hygienic result. In Summer time the " earth closet" should be used in the " out house." By the use of the earth closet excrementitious matter is deodorized and disinfected, thus preventing disease.

The strain of passing water through a strictuie in the urethra is often attended with serious influence upon the rectum, and this disorder should not be allowed to exist when relief is at hand, as it is now in every civilized community.

Dr. Sperry says "It is a curious and misleading fact that the discomfort arising from rectal diseases are often most marked in other parts of the body. The bladder, the womb, the kidneys, or the lungs often seem to be the seat of disease, whereas these organs are only sympathetically complaining for the rectum, which because of its lack of spinal sensory nerves and its abundance of sympathetic nerves, must remain quite dumb as to its own feelings and must speak through organs that have an abundance of spinal sensory nerves. It is a sad fact that most persons have a silly delicacy or modesty in calling attention to discomforts of the rectum, and yet these diseases are most common, and ignorance both on the part of the patient, and many physicians has caused much suffering, which might have been avoided if the trouble had been given immediate attention."

Rough papers or other substance, when rubbed on the delicate membrane of the anus, may cause irritations which not unlikely will run into fissures, ulcers, or pruritus-itching of the anus.

A proper and safe closet paper is now specially prepared and may be had at the Drug or Dry Goods stores.

The Albany N. Y. Perforated Paper Company have given attention to this matter and prepare special closet papers, and an oiled paper which has proved very satisfactory to those suffering from disorders of the anus.

For some reason that is not well explained, the disorders of the rectum seem to be a subject that must not be spoken about in the family or to ones friends. Quacks and patent medicine vendors advertise, write and talk trash about these diseases as though there was some great mystery attached to the subject, but among intelligent persons and those of refined society a silence exists that is often the cause of much suffering. No mystery is made of the diseases of the kidneys. It is quite common to hear ladies and gentlemen talking of a friend who they say "is suffering or dying or dead from " " Bright' s disease," or that 4 'one is suffering with diabetes (a disease, the indications of which are most prominently observed in the urine). They even speak of friends * ' who have stone in the bladder," or "who have suffered from passing small stones," etc. We do not approve of this general conversation on the subject of diseases — it were better that it were not so common — but the point we wish to make is this, that there is so much ignorance and foolish modesty exhibited by persons generally — both old and young, with regard to disorders in the rectum, or at the anus, that quite frequently the sufferer hides his or her malady until it becomes so severe as to put concealment beyond the question and thus there is presented an aggravated disease which at first might have been cured easily, while in the state of a mild disability.

Dr. Charles B. Kelsey of New York, the specialist, in his book, writen for the members of his profession describes his mode of interview with his patients about as follows.

' ' Generally to one unaccustomed to the examination of patients suffering with disease of the lower bowel, the diagnosis is surrounded by many purely imaginary difficulties ; the idea is well fixed in the minds of patients, who under the false idea that an examination and diagnosis necessarily mean a painful use of instruments, will defer treatment until the disease has made irreparable progress. The surprise of such patients when a diagnosis is made by mere sight or at most by a painless finger examination, is only equalled by that of the young practitioner, when told that only in exceptional cases is it necessary to use any instrument - whatever. At the same time, " a successful diagnosis of these diseases consists in taking nothing for granted. Every affection of the lower four inches of the bowel can be both seen and felt, and a disease which can be felt and looked at is generally easy to understand. He who fails to properly and successfully treat rectal diseases, is the one who has failed to detect the nature of the disease by a neglect of the necessary and yet simple methods by which alone a diagnosis can be reached, he must use his eyes and his fingers, and not deceive himself or his patient by jumping at conclusions in the. dark,"