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Impaired Health Its Cause And Cure by J. H Tilden, M.D.

G. DISEASES OF THE INTESTINE
I. DIARRHEA (Catarrhal Enteritis)

   It is purely arbitrary to diagnose an intestinal derangement as duodenitis, jejunitis, typhlitis, ileitis, colitis, or proctitis; for diarrhea--or, rather, its cause or causes--will not be confined to one particular section of the intestinal tract. Indeed, when there is a serious derangement of this organ, the entire tract is more or less involved. The derangement oftenest met with in civilized life is colitis. Yet this derangement is not absolutely confined to the colon; for, as a rule, the rectum is more or less involved, and, either directly or sympathetically, the small intestine plays its part. In established derangements of the large bowel there is almost invariably sympathetic derangement of the stomach; hence, to my mind, it is exceedingly foolish to separate the intestinal tract into special locations for the development of the derangement known as catarrhal diarrhea.

   Etiology.--First, last, and all the time, the most important cause of all diarrheacal derangements of the intestine is improper feeding or improper eating. Foods vary in their influence on the stomach and bowels. A persistent use of the laxative foods--such as prunes, figs, spinach, onions, mutton, lamb, and others which I might mention--will keep the bowels of those in normal health quite regular, while in those who have a sensitive state of the mucous membrane it develops a diarrheacal condition. Strange to say, there are more people who are inclined to constipation than to diarrhea, and foods that prove laxative to some will appear to produce constipation in others. Young children will be forced into a diarrheacal state by being overfed on milk. At first they are severely constipated, but the constipation eventually creates inflammation of the mucous membrane, and from this time on diarrhea supplants constipation, This is very largely true with grown people. Those who eat excessively will be troubled with constipation and bloating of the bowels. Constipation grows more confirmed from year to year, until a catarrhal state is set up in the large intestine. This we call colitis; when it extends to the rectum it is called proctitis. As the disease advances, the patient becomes more and more toxin-poisoned, and the catarrh becomes more intense. Local inflammations start up, on the order of appendicitis or typhlitis, with periodic diarrhea and constipation.

   If the patient is not carried off by a typhlitic abscess or an appendiceal abscess, it will be because the abscess opens into the bowel. The real cause of this diarrhea is toxin poisoning and the irritation produced by the hardened fecal accumulations from constipation. The influence of polyuria in causing constipation must not be overlooked.

   The exanthematous skin diseases, when there is a retrocession of the rash from the surface to the mucous membrane, may set up a diarrhea that is very intractable.

   Such diseases as dysentery, cholera, typhoid fever, pyemia, septicemia, tuberculosis, etc., are often accompanied or followed by a state of catarrh of the intestine--colitis. This is according to the leading authorities. I should like, however, to put in a few words of explanation. When those diseases leave in their wake a catarrhal diarrhea, it is more often due to the treatment than to the natural evolution of the disease. In the first place, dysentery cannot end in anything but health, unless it is maltreated. This is true of all the other diseases named above; hence all the causes that are listed as inclined to produce catarrhal diarrhea will fall short of any such effect if they are treated in the most simple, but the most effective manner-namely, by removing their causes.

   Treatment.--When a diarrhea begins, what is the probable cause? Indigestion. What causes indigestion? Improper combinations of food, on the one hand; on the other hand, nerve exhaustion. Those who eat when tired--when pronouncedly enervated--do not have the power to take care of food; but if they eat heartily under such circumstances, fermentation is set up instead of digestion. In other words, the system, on account of being enervated, does not furnish enough digestive fluid to finish physiological fermentation; hence, as germs are always present, pathological fermentation is set up, resulting in diarrhea.

   If the condition is understood and properly treated, the attack will end as soon as the gastro-intestinal canal is emptied of its contents. The diarrhea washes the offending material out of the bowels. If no food is taken, and the efforts of nature are seconded by copious enemas of hot water within twenty-four to forty-eight hours the intestinal canal will be cleaned out; and if proper rest--bodily rest and rest from food--is given, after all symptoms have passed away--say twenty-four hours with no nourishment except hot water--the disease will end, never to return unless some imprudence in eating is practiced. If, however, this disease is met with opiates to relieve pain, locking up the decomposition in the intestine, producing a sluggish state of the liver, locking up secretions and excretions, and the patient is fed for the purpose of keeping up. his strength, instead of the case being entirely free of disease within seventy-two hours, those hours will be spent in laying the foundation for chronic diarrhea; for be it known that, if eating is continued before there has been a reestablishment of normal secretions and excretions, digestion will be imperfect and diarrhea will continue.

(1) Chronic Diarrhea

   In tubercular subjects, maltreatment will often transform an acute case of diarrhea into one of so-called chronic diarrhea, or intestinal tuberculosis. In these cases there is a glandular involvement, and there will be general symptoms pointing to the tubercular character of the disease. An increase in temperature of the body, with high pulse-rate and diarrhea, will cause a breaking down that will be very much on the order of the breaking-down of patients who suffer from pulmonary tuberculosis. The disease, when once thoroughly established, will be as difficult to relieve and cure as pulmonary tuberculosis. It will have to be treated on general principles. The eating must be watched, and the digestive power consulted regarding the kinds of food administered. Fats, oils, sweets, and starches will not be taken care of well in such cases. Only foods that are well taken care of in the stomach will agree. These are the cases in which animal foods and products act best. They are truly types of disease that can be handled best by using meat and milk, with fruit and vegetable juices.

(2) Dysentery

   This is a disease that is strictly a type of constipation.

   Symptoms.--The patient has frequent desire to evacuate the bowels. The first symptoms are those of a slight diarrhea, with a great deal of bearing-down. The patient leaves the stool unsatisfied, feeling that there must be more to pass; but this will be the sensation almost continually, no matter how frequent the attempts to evacuate the bowels. In the acute state the disease is really a proctitis--an acute inflammation of the rectum. The cause is constipation of the large intestine.

   Treatment.--No food should be eaten. Copious enemas--two quarts of hot water--should be given at first to cleanse the bowels. If the first enema does not bring good results, a second should be tried immediately. The patient should lie on the left side, with the hips well elevated on a pillow, and then introduce as much water into the bowels as possible. On account of the sensitive state of the rectum, it may be impossible to get a very large enema into the bowels. In that case the bowels must be moved from above by using two or three tablespoonfuls of castor oil, with the juice of half a lemon, every three hours until the bowels are thoroughly cleared out. Between the doses the patient should have lemon juice and water once or twice--the juice of half a lemon in a glass of water. If ideal treatment is desired, and the patient will accept it; perfect quiet, hot cloths bound on the abdomen, changed every three hours, and no food, no oil, but enough hot water in the bowels to supply thirst, will in a reasonable time bring about a perfect cure.

   As soon as the bowels are cleared out, the tendency for going to stool should be relieved. If, however, the bearing-down continues, and the patient is not contented except when sitting on stool, the indications are that the bowels are still loaded with material and the constipation has not been overcome. Under those conditions, perhaps it would be well to take copious doses of olive oil--half a teacupful with a little lemon juice, using olive oil in place of the castor oil. The patient may be sure that he will get full relief as soon as the bowels are cleared out. No food should be taken, except a little orange juice or some other fruit juice, for at least two days after the disease is controlled, and certainly no starch is to be used for at least a week. Lamb broth may be used in a day or two after the symptoms have passed away, with a little grapefruit or orange juice, or any other fruit juice.

(3) Chronic Dysentery

   'This is the remains of a badly treated case of acute dysentery,

   'Treatment.--The treatment should not be very different. Copious enemas must be given to unload the bowels. No food should be given until. the symptoms are entirely overcome, which may be a week or ten days. Then the feeding must be very carefully done for several months. Foods that irritate the large intestine should not be eaten--those containing seeds, such as strawberries, blackberries, grapes, etc. All starchy foods must be thoroughly masticated, and prepared for eating by the second baking. Bread should always be baked twice, or thoroughly toasted. The animal albuminoids, with grapefruit or vegetable salads, can be depended upon as the best food for such patients, Rest in bed and fasting are the best remedies until the disease is controlled.

(4) Amebic Dysentery

   Etiology.--Colitis, acute or chronic, caused by amebic dysentery, is not very frequently met with, yet often enough to be noticed in this place. It is said that in these cases there is a strong tendency for abscesses to form in the liver. This is a disease that prevails in the eastern countries, Egypt, and Europe. It is in reality a tropical disease; yet we do occasionally run across cases of it in this country. I believe I have not seen more than two. It is very intractable, and when it is once thoroughly established, and the patient highly enervated, the prognosis is doubtful. I have been favorably located for the practice of my profession, so far as not having many cases of this disease to treat is concerned. It belongs to the warmer countries, and is more inclined to develop in the southern states of this country than in the northern and western.

   Morbid Anatomy.--These cases present lesions on the order of ulcerations. The mucous membrane is very edematous, and there is more or less sloughing. This may even be seen in the mucous stools which the patient passes. It is said that the disease is inclined to be wholly confined to the large intestine, and to the cecum more than any other part of the intestinal canal except the sigmoid flexure of the colon.

   Symptoms.--In mild cases the disease may exist for several months before a patient is aware of it. There are vague symptoms of headache, tired feeling, weakness, slight pain in the intestines, occasionally diarrhea. There is but one way to be absolutely sure of the existence of this disease, and that is by having the stools examined with the microscope, when the ameba will be found. Patients suffer very greatly and become very much emaciated. They will spend hours out of each twenty-four on the stool. They know that they can have very little action from the bowels, notwithstanding a great desire; yet they are compelled to prepare and get into position for soliciting a stool, and try to have a movement, even if the trying is injurious. Where the bearing down is very great, a pint of hot water should be introduced into the rectum before attempting to have the bowels move, and always bear down as little as possible.

   In all such cases it would be well, if possible, to induce the patient not to wear out the nervous system by going to the closet seat. Use either a bed-pan or cloths; for there will seldom be an amount beyond a tablespoonful of mucous. Of course, occasionally there will be a movement of the bowels; but in the majority of instances when the patient is called upon to have a movement there will be nothing to pass, except a small amount of mucous and the necrosed tissue.

   Treatment--Patients should be kept in bed. When a person finds he has this disease--it matters not how much strength he has left, it matters not if he has strength to go and attend to his business--he should make his business that of getting rid of this disease; for, when it is once established and the constitution is broken, the chances for recovery are very slight, as stated before.

   The feeding should be fruit juices, vegetable juices, lamb or chicken broth, or coddled eggs; fruit juices for breakfast, lamb or chicken broth, with fruit juices, for dinner, and buttermilk for the evening meal. But if the patient is in good flesh, he should fast for one or more weeks, depending upon the severity of the symptoms. THERE IS NOTHING THAT DRUGS CAN DO. It would be well to use copious enemas. The object of treatment should be to restore the patient's health to the normal standard--to the point of being able to furnish enough of the digestive secretions--enzymes--to digest the ameba.

   It should not be forgotten that parasites will not find lodgment in the intestinal tract of normally healthy people. To find anyone troubled with any kind of parasitic disease is proof positive that his nerve energies have been broken down, and, as a consequence, his digestive power is below normal; hence everything must be done to restore his resistance. While he should be kept in bed, he should go through a course of exercise daily. Everything should be done for him that is done to restore people suffering from any other disease. Exhaustion from exercise must be avoided.

 

II. CONSTIPATION; OBSTIPATION; FECAL IMPACTION

   Definition of Peristalsis.--Peristalsis means rolling. It is a vermicular motion or movement of the bowels--a contraction of the transverse or circular muscular fibers of the muscular coat of the intestine. When the contraction takes place, the movement starts at the head of a section of intestine with a circular contraction--perhaps constriction would be a better term. No sooner does the constriction begin than it starts, wave-like, to descend, rapidly passing to the end of that particular section of the bowel. If it starts at the head of the small intestine, the wave-like contraction ends at the ileo-cecal valve (a valve that guards the passage between the ileum and cecum). This contraction may be likened in effect to stopping a rubber tube with the thumb and finger; whatever the content of the tube, it is forced ahead of the stripping. The peristaltic movement produces the same effect; it forces the contents of the intestine onward.

   Definition of Constipation.--Constipation is the opposite of diarrhea. In constipation there is a lack of normal secretion into the bowels; in diarrhea there is an abnormal amount secreted into the bowels, Anatomical malformation, stricture, adhesions, obstructions from tumors, and malposition of organs, or telescoping or twisting of the intestine, are forms of constipation that come under the head of mechanical obstruction, and are not to be considered under the head of constipation proper. There are many causes for constipation due to functional derangement.

   Etiology of Constipation.--The commonest predisposing causes for constipation are neglect in answering nature's calls, and the unnatural position at stool that custom and modem bathroom equipment enforce. The position deprives the bowels of the thigh support and pressure that squatting gives. Postponing a desire tends to blunt sensation and educate a toleration for rectal accumulation. It is no uncommon thing to find, in obstinately constipated people , very large, pouchy rectums, which have become enlarged and made senseless from being allowed to pack with waste matter. It is not uncommon for physicians to be called to see patients with fecal impaction of the rectum requiring mechanical measures for unloading.

   One of the causes of this state is spasmodic stricture of the anus. Spasmodic stricture is not a real stricture; hence it can be overcome very readily. Organized stricture means a thickening up, due to such derangements as fissure. and ulceration of the lower part of the rectum and unnecessary operations for piles.

   Next to neglect--not answering the demands of the bowels to evacuate--is overeating. More food is eaten than can be digested, and it must decompose. As a result of this decomposition, the gastro-intestinal tract is overstimulated from the toxins. The irritation from toxin stimulation brings on enervation and catarrhal inflammation. The catarrhal secretions interfere with perfect digestion. The stomach derangements resulting are many. The diseases that develop because of the influence of fermentation on the stomach, small intestine, and auxiliary organs are many; namely: irritation, inflammation, and ulceration of the stomach and duodenum; catarrh of the gall-bladder and eventually gall-stones, pancreatitis, diabetes, albuminuria, etc. The irritation caused by decomposition in the large bowels becomes the exciting cause of constipation, colitis, ulceration, typhlitic ulceration, appendicitis, and, directly and indirectly, other affections of the colon, rectum, bladder, and the abdominal and pelvic organs.

   The decomposition causes gas to form, and the distention from gas is a mechanical cause of pain and constipation. The distention causes pain, because the inflamed and ulcerated mucous membrane is put on the stretch. The distention and pain tend to fix the parts by putting the muscles. on guard to keep the inflamed and sensitive. parts quiet. This, of course, means inactivity--constipation.

   When putrefaction is an established habit, toxin poisoning keeps the abdominal and pelvic viscera in a sensitive state, The sensitive state is made up of irritation and catarrhal inflammation. There is catarrh of the bowels and uterus, and an irritable state of the abdominal arid pelvic lymphatic glands; for these are worked overtime in keeping the blood from being overwhelmed with toxins.

   This sensitive state favors fixation, because any movement is uncomfortable--even the moving of gas. The peristaltic motion necessary to pass the intestinal contents on to the outlet is painful. The consequence is that stasis--which means a standing still--is cultivated. Because of this stasis and gas distention, fecal matter and debris accumulate and cause ptosis (dragging down). The affections appearing as a consequence are dilation of the stomach, with retarded digestion, irritation, inflammation, ulceration, cancer; duodenitis with ulceration--perforating ulcer of the duodenum--gall-bladder diseases, pancreatic diseases, diseases of the cecum, colon, and rectum, diseases of the pelvic organs and bladder. These are a few of the affections of the alimentary tract and auxiliary organs caused by constipation, and are amenable to a plan of treatment that will cure gastro-intestinal fermentation and decomposition.

   To be able to correct a disease, it is necessary to know its causes. Attention has been worked overtime in finding remedies which cause the bowels to move. It is an error to apply the name "remedy" to the thousand-and-one inventions and contrivances made to force the bowels to move. All so-called remedies are causes of constipation.

   We have seen that overeating leads to decomposition, that decomposition (putrefaction) evolves toxins, and that toxins poison the entire organism. Certainly one of the most important things to do in overcoming constipation is to stop overeating and improper eating. Unless this is done, all arrangements, devices, drugs, waters, enemas, peculiar foods, etc., must continue to fail as they have done in the past.

The So-Called Remedies and Why They Must Fail.--Cellulose. Rough food containing much cellulose is the first thing thought of when the physician's mind turns from cathartics and all kinds of drug stimulation, enemas, suppositories, rectal dilators, etc.

   Bran bread, graham bread, whole-wheat bread, bread with flax-seed in it, oils, agar-agar, water-drinking, and many other bowel persuaders, are in daily use by the people and prescribed by the profession.

   The use of bran in constipation marks the early stages of dietetic evolution. When a physician begins to talk bran, eat bran, prescribe bran, insist on bran, and can expatiate for hours on the virtues of bran, it is safe to say that he is in the prehistoric age of dietetics. His next evolution will bring him to the calories and protein age, where he will spend his idle hours figuring out menus with an eye single to the correct number of calories (heat units) and protein contained therein. If heat units and protein were all that is necessary for a correct dietetic blend, then butter, oil, or sugar, and eggs or cheese, would be the only food required. One may know, or think he knows how many heat units, and how much protein, are required by a man of so many pounds' weight; and he may know how to figure out and properly blend menus which will contain just the required heat units, and the proper weight of protein; yet he is many years removed from a successful dietetic physician. Indeed, any layman may have all this knowledge, but it takes the dexterity of a physician to apply the knowledge successfully.

   All dieticians must go through these stages of development; and they all go through them in the same way--namely, with the mental horizons fastened down tight, so as to prevent the knowledge they think they have from slipping away. But they do not know that when the horizon fits too tight, it keeps knowledge out as well as keeps ignorance in.

   It is not necessary to take up bran and other rough foods for a separate study, for all can come under one head, The object of rough foods is to prick and prod the bowels into activity. The effect is the same as prodding a jaded horse, or giving strychnine to a flaggering heart; namely, it hastens to prostration.

   It is only a question of time when bowels that are forced to act will cease to act, except by the use of more and more powerful stimulation.

   No one has ever been cured of constipation by the use of rough food--by bran or whole-wheat or graham bread. These breads, like laxatives, will keep the bowels regular for a time; but the end of their laxative effect comes, and then a change in bowel stimulants must be had.

   A very serious objection to eating rough bread to keep the bowels moving is that too much is used-more bread is eaten than should be, and starch poisoning is developed. Those who are most constipated are often the very people who have the least power to digest starch in this from; and, as a consequence, they are often injured more than benefited by the use of bran.

   It should not be forgotten that the gastro-intestinal tract is a pleasure resort for bacteria. The food eaten serves to feed them. But the reason why they are there in great abundance is because they are needed. They are a conservative necessity. They are as necessary as enzymes (unorganized ferments); for when enzymic power is unavailing for liquefying ingested aliments, the microbes (organized ferments) lend a hand and bring the refractory ingesta to a liquid form for expulsion. It is not so much for refractory aliments that microbes are needed as for liquefying the superabundance of the supply taken in beyond the enzymic power.

   Enzymes are limited, and the power of the organism to manufacture the unorganized ferments is limited; hence, when the food intake is beyond the enzymic power, organized ferments, the germs--bacteria or microbes--start up fermentation in carbohydrate foods, and decomposition--putrefaction--in the proteins. The bacterial fermentation cannot be exhausted; for the bacteria are organized as needed. The organized ferments are dispersed when they are no longer necessary.

   So much more food is taken than is required by the average person that it is not strange that the alimentary canal becomes the mecca for germs.

   The estimated number of microbes in the digestive tract is 411,000, 000,000; a few billions more or less cannot matter. It is obvious that the number must vary from millions to billions. Large numbers are not necessary, if we admit overeating is not necessary. A hibernating animal will have few, and perhaps none, unless the slight distintegration calls for a few. In hibernation enzymes are not needed and are not secreted. Where the least food is taken there will be fewer bacteria, and obviously less enzymic secretion.

   Bowels that are abused by converting them into veritable gehennas require rapid developing of microbes to meet the demand for organized ferment. If an unusual meal be eaten of fish, meat, or sausage, and the enzymes are unequal to the task, in from twelve to fifteen hours, or less time, vomiting may occur, and a fetid diarrhea starts up and relieves the system of the poisoning.

   Imported sausage is liable to start up botulism or allantiasis--sausage poisoning. Ptomain (cadaver poisoning) brings on great enervation. Besides vomiting and diarrhea, there may be skin and kidney enervation, great nervousness, dizziness, and double vision; the temperature drops, cold sweat appears, and the patient dies in a collapse. This is the severest type of food poisoning.

   Chronic subacute food poisoning, ending in constipation, is what concerns us most. As time runs on, the intensity of food-poisoning symptoms grows less and less, until there are scarcely any symptoms of decomposition, except gas in the bowels, which is ill-smelling, a chronic tired feeling, constipation, with catarrhal mucus passing with most bowel movements, which are scybalous (hard and lumpy in character) and often coated with catarrhal matters, giving them a grayish, glazed appearance. This state of the bowels. is called colitis, and proctitis often accompanies it. This condition is brought on from years of abuse in over-eating, and the catarrh is a conservative measure.

   The symptom complex may be stated as follows: decomposition, intestinal irritation, diarrhea, alternating with constipation, inflammation, ulceration, confirmed constipation. The systemic symptoms are chronic toxin poisoning, lymphatic involvement, pelvic diseases, appendicitis, ovaritis, sexual neurosis, liver and kidney diseases, tuberculosis, arteritis, arteriosclerosis, cancer, and others.

   Those with chronic constipation and its accompanying toxin poisoning must necessarily grow old rapidly and develop old-age diseases, such as cirrhosis, sclerosis, or cancer.

   Constipation is a conservative measure. Nature is always marshaling her forces in such a way as to strengthen all weak points, and, when necessary, the various organs of the body are made to do vicarious work--work for others.

   In constipation of this character the kidneys eliminate for the bowels. At first the fluid intake is diverted to the kidneys to prevent dilution and ready absorption of toxins; and, secondly, the toxin irritation of the nucous membrane of the bowels causes an exudation of mucus which coats the membrane and renders absorption slow and difficult. In confirmed constipation almost the entire fluid intake is diverted kidneyward, leaving the bowels with a Saharian dryness. This vicarious habit becomes so firmly established that a cure for constipation means a cure for polyuria (excessive urination). A true etiology of all affections of the body must give, as the leading factor, confirmed, chronic constipation, with more or less colitis, and more or less malnutrition, with greater or less poverty of flesh, or more or less waterlogging of the tissues of the body, which is a form of obesity.

   Excessive weight, with anemic complexion, often means polyuria diverted into the tissues of the body--in common language, urinating in one's body. The subject may be young, and the average person may mistake rotundity for robust health; but the true physician will not be mistaken.

   Nature works and schemes in various ways to save us. The fecal waste is made to dry up by diverting the fluid to the kidneys. If the kidneys are failing, the water will be retained in the tissued of the body--the cellular tissues become waterlogged, or a diarrhea may relieve the waterlogged tissues. This is the true explanation of many intractable diarrheas.

   The leading etiological factor, then, in constipation is toxin infection, which first stimulates, then irritates, then inflames, then ulcerates, then hardens and strictures, and finally degenerates into cancer. Add to this all the vicarious and auxiliary affections, including every constitutional derangement that is caused by toxemia, and we have, as a leading etiological factor in all the diseases of the body, constipation. Toxin causes constipation, bacterial fermentation causes toxins, and eating beyond enzymic power leaves no alternative but to get rid of the surplus intake of food by decomposition.

   Intestinal fermentation and gas distention, with intestinal putrefaction and excruciating colics, diarrhea and nauseous evacuations, bad breath, malodorous skin, lassitude, dizziness, headache, are the first developments, which recur, or come and go with irregularity, until constipation is established; then come reabsorption, chronic, systemic toxin poisoning, and the development of conservative affections--namely, any intercurrent affection, fevers, etc. --which should be looked upon as crises in chronic toxemia from constipation. The lighter affections that come and go are periodic attacks of dizziness, headache, fatigue, coated tongue, fetid breath, insomnia, eczemas, acne, and other skin diseases, as well as night sweats. Add to this state intercurrent affections from unusual causes, and we have a picture of chronic constipation.

   The latter half of the nineteenth century built many fortunes out of pills. Pills, squills, and opium have built a financial nobility unequaled by that of beer and whisky. The financial world may boast of the colossal fortunes which it has built on trafficking in human health and life, but esthetism and ethics certainly cannot be proud of the mutilation and wrecked lives which represent the graduates from our sanatoria, hospitals, and "surgical plants."

   As a result of medical wisdom (?), constipation is universal; and the McLeans and Beachams have taken the lion's share of glory and filthy lucre for the benefaction. But it is the elite of the medical profession that popularizes quackery by making drugs popular.

   Treatment of Constipation.--Constipation is an affection--it is not a disease; hence, whatever the cause is, it must be sought out and removed. To use anything--any one remedy or any hundred remedies--is equivalent to limiting cause, and that shows a fallacious understanding of what constipation is. No cure can come from a treatment based on a false conception of cause.

   Constipation is one prominent symptom in a syndrome represented as follows: indigestion; catarrhal inflammation of the throat, nasal passages, stomach and intestine; diarrhea, alternating with constipation; intestinal indigestion; gas distention; headaches; heart palpitation; chilliness; cold hands and feet; dizziness; fermentation of starches; decomposition of proteins; constitutional toxemia; colitis; and ending in obstinate constipation and many collateral affections.

   As to cause, it is as impossible to find a single cause as it is to find a single effect or a single remedy. The causes and effects become a tangled web, as we see causes becoming effects and effects becoming causes; but order comes out of chaos when we think of fermentation standing at the head of organization and disorganization--when we think of ferment, enzyme, and bacteria as cause and effect in every process of being. Causes that pervert the normal action of the ferments may be enumerated as follows: excessive eating; imprudent eating; eating wrong combinations, causing indigestion, fermentation, and decomposition, acidosis and toxin poisoning, which totals catarrhal inflammations of vulnerable parts; water-drinking, causing polyuria, diabetes, or Bright's disease; eating foods that are artificially prepared, or which are changed in their chemical constituents in preparing them for the table; overwork; worry; anything that uses up nerve energy; overworked emotions; lack of discipline; the use of stimulants of all kinds; neglect in the care of the skin; carelessness in looking after the functions of the body; in fact, any influences that will produce overstimulation, intoxication, enervation, imperfect elimination, etc., may be looked upon as so many causes making up the syndrome above mentioned. But without fermentation the named causes become meaningless.

   It should be obvious to the discerning that if constipation is a prominent link in the chain of affections above described. it would be foolish to undertake to isolate that particular symptom and give it special treatment. The idea of finding a specific remedy for constipation is as absurd as it would be to discover a single remedy for catarrh, or a single remedy for toxin poisoning. Constipation should be looked upon as a leading symptom of a constitutional derangement for which the blanket term, chronic toxic poisoning, is quite fitting. And when the disease is cured, it will have to be cured by righting the errors of life, so as to bring the general health back to the normal. This we shall endeavor to describe in the following.

   Before making any suggestions regarding cures, it shall be my endeavor to give a frank and honest criticism of the remedies usually resorted to.

   Looking back over medical history for the past hundred years, what do we see regarding the bowels? Drugs and all manner of devices for compelling the bowels to move. What are the results from the various schemes of cure? Failure--always failure--and constipation everywhere , and increasing.

   The fountain syringe, and the thousand-and-one oth er devices for getting water into the alimentary canal, constitute the second of a trinity of illogical plans for overcoming constipation. The first of these is pills, or drugs; the second is the fountain syringe, and other devices for waterlogging the bowels; and the third and last is water-drinking.

   Physic for overcoming constipation should be thrown to the dogs; and, so far as intelligence is concerned, it has been. But there will always be mental slackers and stragglers on the road to reform; and this is true of drugs and physic in the treatment of constipation. As well undertake to cure inebriety without sobriety, as to cure constipation without curing toxin poisoning.

   The plan of washing out the bowels is perhaps one of the most pronounced palliations ever introduced for constipation. How could it be more than palliative, when no causes are removed? Confirmed constipation will be the ultimate reward for a close attention to flushing out the bowels. Of course, there are a few who appear to be benefited; yes, there are a few who boast of breaking every health law and continue to live to tell the story. That fact, however, does not annul the law, nor remove the penalty for breaking it. None but the foolhardy or foolish will be governed by an apparent exception to a rule.

   Enemas wash away natural mucus, and in time paralyze the bowels--leave them dead, so to speak.

   On account of physic and enemas being unsatisfactory, excessive water-drinking has been pretty generally adopted. As in the case of all cure-alls, there has been an unthinking acceptance of the suggestion that water, drunk in sufficient quantities, will overcome constipation. This is one of the great medical mistakes of this century.

   As stated before, nature works out many conservative schemes; and the scheme of routing all water intake out of the body by way of the kidneys is a conservative measure. If the water is allowed to be absorbed by the bowels, it carries toxins with it, and extra intoxication takes place; hence it is railroaded out by way of the kidneys. When these vicarious or auxiliary activities are established, any interference by way of forcing measures will end in failure, and the ending is worse than the beginning. When the bowels are constipated for any length of time, the constipation causes colitis; then the more water drunk, the more the kidneys act, and the drier and more constipated the bowels become, because nature is endeavoring to sidestep being overcome by toxin absorption. It is safe to say that the constipation accompanying colitis cannot be cured--not even relieved--by water-drinking. This constipation is often confirmed by bran-bread eating. Petroleum oil gives a questionable relief, and certainly will do harm when its use is continued over a long period. All :such remedies are miserable failures.

   The capping climax of all medical and surgical inanities is the removing of a part of the colon to cure constipation, epilepsy, or ptosis.

   Those who desire to overcome constipation must first stop overeating, and, when eating begins, eat properly.

   The tensing exercise should be practiced twice daily --about fifteen to twenty minutes before getting up in the morning, and the same length of time after getting ready for bed at night. This is necessary to re-establish the normal tone to the muscular system and help to re-establish peristaltic action of the bowels. At the end of each exercise period the abdomen should be given firm and fairly deep massage. This massage should be clockwise around the navel--in other words, from left to right below the navel and from right to left above the navel. This brings the movement down on the left side and up on the right side of the abdomen.

   In cases of prolapsus of the uterus in women, and in enlarged prostate in men, much time should be spent in the knee shoulder position.

   There should be absolutely no straining at stool--straining brings on piles. If there is a desire for a movement, but the muscular effort amounts to a real strain, always use a little water in the form of a small enema, not more than a pint of water. That will start the movement and prevent development of prolapsus of the rectum or piles.

   If one is eating little in an effort to overcome constipation, there will be much less fecal matter to be thrown out than normal, and under those circumstances a movement every other day should be sufficient to keep the bowels cleared. A person who is taking ordinary meals should find one good movement a day sufficient. If the bowels fail to move, however, don't worry--forget it--in all probability the movement will come the next morning. Don't be in too great a hurry to use artificial means to secure a movement. If it is necessary to use an enema to assist the bowels, it should be a small enema, about a pint of water or less. If a movement is not secured with the first pint of water, repeat, using another pint of water. This is better than using large quantities of water in one enema. One should always avoid large enemas. It washes the mucus out of the colon and is conducive to constipation.

   In any case of sickness where there is reason to believe that the bowels have not been cleared out by enemas, then one should not hesitate to use a laxative. Castor oil is the safest laxative. The tasteless variety may be used with lemon juice to make it more pleasant. In cases of fever, the temperature will not come to normal until the bowels are cleared. This should be the sign that the bowels have not been cleared, and one should not hesitate to continue with the efforts to empty the bowels, because it means the end of whatever disease is threatening.

   In extreme cases there is suffering from sensitiveness to touch over the bowels, caused by gas distention. Toxin infection is marked by tired feeling, headaches, heart palpitation, chilliness, cold hands and feet, dizziness, etc. When these symptoms are pronounced there may be obstinate constipation, and there may be vomiting with diarrhea. Where there is much gas distention the pain is great. These cases are usually operated upon for appendicitis. The proper treatment is: Send the patient to bed to stay; feed an apple, or its equivalent in any fresh fruit , three times a day. He should drink no water, but use an enema, every other night, of a pint of water, hold it in the bowels for ten or fifteen minutes, and then try to have a movement. This is a routine which I follow to stimulate the rectum for a short time at the beginning of treatment, and stop it as soon as possible. If thirst is driving and must be relieved, use a half-pint of water in the rectum with a syringe. Thirst should be endured until secretions are established in the intestines. This is necessary for a cure, and the end cannot be accomplished until polyuria or excessive urination is overcome. Excessive waterdrinking under these circumstances forces excessive flow of water by way of the kidneys, but depuration is not increased; indeed, retention of excretions is favored, and, instead of water-drinking being a benefit, it furthers toxemia.

   Those who have not the will-power to eat carefully, and to go without drinking until cured of constipation, need never expect to be cured of this or any other disease.

   I have seen obstinate constipation overcome by this plan, so that the patient was getting a movement almost daily within a month or six weeks. Overeating must be given up forever; for as soon as a cured case returns to the old style of eating, the bowel trouble will return.

   These patients complain of gas distention. Fruit does often cause trouble of this kind. There is but one way to correct it--namely, eat less and less, or fast until the gas is gone; then eat; and if the gas or other ill feelings return, fast again.

   It should be understood that there is a price that must be paid, by victims of bad habits, before they can be restored to the normal; namely, stop the bad habits. No one can give up inebriating habits--drunkenness--withouit paying the price of much discomfort, and those of very sensitive natures have great pain and suffering.

   It must be understood that poisoning by alcohol or any other drug, and poisoning by retained excretions, or by the toxin of decomposition of protein (animal or vegetable), or fermentation of carbohydrates (sugar and starch), are all the, same. The nervous system is gradually broken down, and general weakness, or enervation, is brought on to such a degree that when the habit is broken off the victim suffers greatly. The whole organism feels the effect of the suspended stimulation. The whole body cries out its displeasure at being robbed of its stimulation. To stop any habit shocks the nervous system; but it is nonsense to think of curing in any other way.

   People of no self-discipline--those who have been in the habit of indulging every desire, who dance immediate attendance on every impulse and whim--not only have to give up their stimulating habits, but are compelled to cultivate discipline. For the first time in their lives they are compelled to say no to their desire. They suffer fully as much from being forced to say no to a desire--a whim--as their nervous systems suffer from lack of the effect of the poison--stimulation--which they have given up.

   'Those who are self-disciplined--those who have the control that a business training gives, or the self-control that must be developed in filling any responsible position--do not find it so hard to come under rules that are rigid enough to bring about a cure of chronic disease.

   There are many disciplined people who have unwittingly brought upon themselves diseases from overeating and the use of stimulants, because they have been advised by reputable professional men to "eat good, nourishing food," "eat to keep up the strength," and "smoke or drink in moderation"; and they have looked upon medical men, of good standing in medical societies, as oracles of wisdom. When their attention has been called to the probable falsity of their teachings in this matter, they are slow--indeed, reluctant--to believe that the self-professed ethical profession is not more reliable in matters medical than someone who appears to be thinking thoughts that the school-men ignore or reject--someone with "peculiar views."

   It is obvious, then, that the people are divided into two classes. The first class is composed of those of no discipline--those who are self-indulgent, and who are hard to discipline because they have a "right" to self-indulgence. "What are people on earth for? to make ascetics of themselves? I would rather have five years and freedom than ten years with restrictions." Which means five years of license, and enough suffering to kill the body in half the time that might be had with a discipline which gives peace, comfort, and the feeling of well-being that always accompanied self-control and full efficiency.

   The other class are indulgent from advice--from authority. This class pride themselves on discipline to authority. Indeed, they are disciplinarians, and, to serve authority, they do not mind becoming ascetics when required to do so.

   The first class are sensual and self-indulgent. And their reasoning is on a par with their lives. They believe that a system of cure which restricts them is an infringement on their personal rights. It is hard to impart enough knowledge to save them. Such people have knowledge, but no wisdom. Man must live his knowledge; then it becomes his own--it becomes wisdom!

   The second class have the discipline that enables them to follow instructions, if they can be persuaded to give up their: conventional teachings--if they can be convinced that they have been taught wrong.

   To cure colitis (which is another name for chronic constipation) means reforming the life of the patient. No, there can be no cure as long as one continues to smoke, to drink, to eat too much, to live sensually.

   Those with great nervous prostration must go to bed for a few weeks. The eating at first must be as suggested above: nothing but a little fruit until comfort has been secured. If not too weakening, a two- or three-minutes' hot bath may be taken every morning, followed with a quick cold sponge-bath in summer time. The sponging should be followed with dry towel-rubbing. Friction mittins may be used to advantage in these cases.

   When comfort has come, the eating may change a little.

   For Breakfast.--Fruit in summer time, fresh fruits and prunes, in the winter time. Apples for winter may be had by almost anyone. With an apple, or its equivalent in other fresh fruit, 6 or 8 prunes.

   For lunch: Two ounces of thoroughly toasted bread, whole-wheat, and not more than one-fourth ounce of unsalted butter, Each morsel is to be masticated until it turns sweet in the mouth; then take another bite, and treat it the same; and so on until the two ounces have been eaten. Then apples, or any other fresh fruit desired, may be eaten in reasonable amounts. Overeating must end if constipation is to be permanently cured.

   If desired, the food suggested for the morning meal may be taken at noon and the suggestions given for the noon meal may be used for breakfast.

   Those who are opposed to losing weight need not look for a cure. To cure means the complete renovation of the system--the renewal of digestion and assimilation, and the reestablishing and bringing-back to the normal of all secretions and excretions. All idea of eating up to the profession's standard amount must be given up; for a cure means eating properly, but not enough to keep the standard weight.

   The morning and noon meals have been given. For dinner: Meat--lamb, chicken, and fish are the best meats--the lamb and chicken are to be cooked very tender; the fish should be baked and served with salt, lemon, and very little, if any, butter. In cold weather, a roast or a stew of pork may be eaten twice a week. With the meat or fish, one or two of the succulent cooked vegetables, and a combination salad made by combining lettuce, tomatoes, cucumber (or celery), and a very small bit of onion. A large dinner-plate of these vegetables, after they have been cut up, is the quantity required by grown-ups. The salad should be seasoned with salt and olive oil, or a mayonnaise made with lemon--not vinegar.

   During the winter, grapefruit or cabbage slaw may be used in place of the salad.

   On account of its laxative influence, spinach should be used as one of the cooked nonstarchy vegetables as often as possible. Do not overcook the spinach. It should be cooked just enough to thoroughly wilt the leaves.

   Never eat unless comfortable from the preceding mealtime. Then eat deliberately, masticating thoroughly, and eat all desired short of discomfort. If enough is eaten to cause discomfort, the next meal should be omitted, and another, and others, until comfort is secured. Always try to eat in quantities short of enough to bring discomfort. What kind of discomfort? Any discomfort, either of mind or body. When gas is troublesome, stop eating until comfortable, then eat less; when gas reappears, then miss a meal; etc.

   Many will worry about losing flesh and looking haggard. Losing flesh cannot be avoided. It is the price that must be paid to recover health. Looking haggard can be overcome, or rather prevented, by taking exercise. The faint-hearted, the self-indulgent--the babes and boobies of humanity--will make a fuss, stew and fret, and either fail to follow instructions closely enough to get well, or cause themselves a lot more trouble than necessary.

   Hopefulness, and a determination to have health at the sacrifice of any comfort, will soon put any case on the highroad to health.

   Getting well quickly, or in a reasonable time, depends much upon the mental attitude. Those who have no object in life, who live with nothing higher to hope for, or look for, than the indulging of sensual appetites, are hard, if not impossible to cure; for when their indulgences are cut off to bring health, they have nothing worth while to live for, and they become mentally depressed. They want to be cured, but they do not want to stop self-indulgence--they do not want the cause of their disease removed. Hence those who can reason should see how utterly impossible it is to cure them. They must drift from one palliative to another palliative to secure a little relief; but a cure that means the giving up of any habit will not he looked upon with favor, and will not be adopted,

   Those who are looking for a remedy for constipation--those who wish to have a formula which they can have filled at the corner drug store, and take it, and have their constipation cured--will not appreciate my treatment. But, as stated above, there is no such thing as a specific remedy for this affection, any more than there is for any other affection. There is but on cure, and that is to right the life. Those who are unwilling to go through a routine of treatment that will evolve into full health need never expect to overcome constipation, and its many causes and consequences. If there is one organic change, more constant than another, accompanying confirmed constipation, it is sclerosis. A well-known type is arteriosclerosis.

   Those who are looking for quick cures are doomed to disappointment; for the usual quick remedies are nothing more than palliation.

 

III. APPENDICITIS, COLITIS, AND OBSTRUCTION

   Appendicitis.--There never was a case of appendicitis that was not preceded by constipation and colitis. Indeed, appendicitis is sequential to these two affections. It will be necessary to consider them as different stages of one disease.

   Bowel obstruction in appendicitis is not so complete as in the disease known as complete obstruction, the difference being a lack of intensity, The pain is not so great. Yet, after the first clearing-out of the bowels from drugs, enemas, or perhaps a slight diarrhea, enemas fail to bring anything more than mucus. The same is true of complete obstruction. If food of any kind, even liquid food or milk, is taken, vomiting will take place, and intense pain will follow almost immediately after the ingestion of a very small quantity. This is due to the stimulating effects of the food, creating peristalsis. If food is withheld, these patients become very comfortable. There will be a dullness on percussion in the lower anterior right side of the abdomen, to the right of, and two inches below, the umbilicus. This part will be sensitive on pressure. But, indeed, an experienced physician will use no pressure; he will diagnose his case from what subjective symptoms the patient describes, and the objective symptoms that he himself can see, without submitting his patient to the dangerous procedure of deep bimanual examination. Nearly every case of rupture of the appendiceal abscess has been brought about by the surgeon in his zeal to diagnose the disease and determine if the usual tumor-like development--pus sac--can be found. The obstruction in appendicitis is due more to muscular fixation than to accumulation in the intestine; indeed, most of the obstruction is caused by the inflammatory process--irritation, determination of blood, swelling, and the exudation which is for the purpose of walling in the forming abscess. Muscle fixation guards the intestine and secures quiet. Motion is dangerous; there is danger in using physic, or doing anything that will stimulate peristaltic action, because of a possibility of a rupture or perforation of a necrosed bowel.

   The highly sensitive state of the bowels obtaining in this disease puts the muscles in the region on guard, and the parts are fixed for the very definite purpose of conserving the life of the patient. If nature is not meddled with, the abscess will form and rupture will take place along the line of least resistance, which will be into the bowel. In this way the abscess will empty, and in a very short time after the pus has gained entrance into the bowel, inflammation, swelling, and obstruction will subside, and within twenty-four hours the patient may be given fluid nourishment.

Colitis.--Discomfort in the lower bowels and pelvic region, sometimes amounting to distress. The discomfort of this disease is so great and so constant that thousands have been subjected to operations for appendicitis, ovaritis, and other diseases, without the least suspicion that the real disease was nothing more than gaseous distention of a chronically inflamed colon. Many more have been subjected to ovariotomy--in fact, all the operations peculiar to the pelvic region--because of this discomfort in the lower bowels. Patients frequently complain of pain in the lower right frontal region of the abdomen. At first they are suspicious of appendicitis, and too often the medical man is willing to confirm this suspicion and recommend an unnecessary operation.

   Obstruction.--Distressing pain in the lower bowels, with inability to secure a movement. The taking of laxatives or physic creates great nausea and vomiting, but fails to cause the bowels to move. Large enemas may be used, which return without carrying with them any fecal matter, after the rectum, and perhaps the signioid flexure, are cleared of their contents. If the obstruction is complete, the symptoms become very grave, the stomach will not tolerate anything, not even water, and the distress caused by taking food, or even taking water, is so great that everything by way of the mouth has to be suspended. The pulse increases in frequency, the breathing is hurried, the skin clammy, all the symptoms of collapse gradually set in, and within forty-eight to seventy-two hours death relieves the sufferer.

   Treatment.--In colitis anything that has a tendency to create inflammation of the mucous membrane must be overcome. The bowels must be emptied every day--constipation must be overcome. This can be temporarily relieved by a very light saline laxative, or laxative foods, or small enemas--not more than a pint of water placed in the rectum and left there for five or ten minutes; then solicit a movement. This should be carried out regularly every night. On account of the great tendency for carbohydrate foods to cause gas in the bowels, these foods should be either proscribed entirely or given in very limited quantities. Meat, non-starchy vegetables, and fresh fruits are the proper foods for those who have chronic colitis. For chronic colitis very little starch should be used--none whatever by the obese. Until all the symptoms are under control, no food should be given except fruit three times a day. When the patient is better, the noon meal may be meat, one or two cooked, non-starchy vegetables, and a combination salad. This should be kept up for weeks, if necessary, to overcome the disease. The stools should be watched. If there is much catarrhal discharge, this is evidence that the disease is not yet under control. No starch should be given until the bowels are moving without any mucus in the stools; in fact, the mucous discharge must be overcome before a cure can be accomplished. Then white-flour bread thoroughly toasted, is the best form of starch to be given at first. The coarse bread has a tendency to irritate the bowels, and should not be used until the patient is quite well. During the time when the symptoms are most intense the seeded fruits should not be eaten; or, if they are, they should be run through a sieve or colander that will exclude the seeds.

   For complete obstruction, a surgical operation at once is the only remedy. In this matter there must be no delay. Yet those interested in the case should not lose their head. Unfortunately, surgical insanity is so, general that it is a very difficult matter to find professional men who will not fly off at a tangent and recommend an operation for almost any severe pain in the bowels. But there is a great difference between obstruction caused by appendicitis and complete obstruction, which latter may be due to invagination, or telescoping of the bowels, or to a twist, or to mesenteric, mesocolic, omental, or any visceral hernia.

   The treatment for appendicitis amounts to a wise letting-alone. The patient should be put to bed, with hot-water bottles to his feet. If in great pain, and running a temperature above 103 F., ice should be put over the region of the appendix. If the temperature is below 103 F., heat should be put to the abdomen. The mouth must be closed to everything, even water, until comfort is established, which will be within about three days. Then the patient may have all the water desired. A copious enema, or as much as can be introduced into the bowels, should be used every day, either morning or evening; but positively nothing else needs to be done until the bowels move without assistance, except for the enema which is used daily to wash out the lower bowels. There will be a large amount of accumulated fecal matter, blood, and pus above the portion of the bowels involved. The movement will be copious, because it will not take place within seven to twenty-seven days. Of course, the longer the patient lingers before the bowels do move, the greater the accumulation will be above the cut-off. Then, within three or four hours after the first copious evacuation, the patient will have another movement, which will show more or less pus. It will be well to wash out the bowels once or twice with simply warm water. Let the patient alone. He may have fluid nourishment for four or five days; and, to be really safe, he should confine his eating to fluid foods for the first week after the evacuation. Then gradually return to the accustomed style of eating. However, if a permanent cure is desired, such patients should live correctly ever after, having one meal of fruit, one of starch, and one of meat and vegetables.

 

IV. ENTEROPTOSIS

   Definition.--Dropping down of the contents of the abdominal cavity, but particularly a dropping of the stomach and large intestine, transverse colon, kidneys, spleen, and pelvic organs.

   Etiology.--What can cause falling of the organs within the cavity of the abdomen? Weight, causing relaxation of the attachments. Anything that will distend the stomach and intestine has a tendency to cause a dropping-down or a sagging below the normal position. The stomach is distended with food. Those who eat too rapidly will always eat more than they should. After they are through eating, the food swells and distends the stomach beyond its normal capacity. In time this brings on a dilated and a relaxed state of the stomach and intestine. Indigestion will accompany this state, and more or less gas will be evolved, which pulls up or distends the organs. We not only have a dropping-down of the stomach, but we also have a puffed or an enlarged state. This interferes with the mechanism; the muscularity of the organ is put out of commission; the stomach does not empty well; digestion becomes slow, and there is more or less retention of food, This favors the development of still more indigestion and distention with gas, until the entire intestinal canal becomes more or less involved with the stomach, and from the same causes. The individual will have what is called a "high stomach;" that is, a distended, enlarged abdomen. There is always enervation accompanying such a state of the stomach and bowels. Enervation always means relaxation of muscles, and, if the cause is continued, a dropping-down of the entire contents of the abdominal cavity sooner or later follows. Some people are more inclined to take on this state of the stomach than others. Those of a relaxed, flabby habit--those whose muscles are soft and inclined to gravitate--take on the disease sooner than others.

   The attachments of the kidneys partake of this same relaxation; and then, from gas distention and the ordinary affairs of life, the pressure on the loosened kidney has a tendency to pull down and elongate the normal attachments. Those who carry a great deal of fat in the abdomen--who have heavy omentums--will in time cultivate the dropping-down of the entire contents of the abdominal cavity. This intra-abdominal pressure frequently creates more or less bladder trouble, urethral trouble, and, in women, a prolapsus of the womb and ovaries--especially the left ovary, which is often pressed below the uterus into the cul-de-sac of Douglas. Then, if the intra-abdominal pressure is not overcome and constipation follows, the woman will suffer a very great deal from the pressure on the ovary; for it is crowded, so to speak, between a constipated rectum and an intra-abdominal pressure from fat and gas. Many patients will be troubled with prolapsus of the rectum. At each evacuation of the bowels the rectum will prolapse, and, unless replaced, will remain out until a night of rest allows it to resume its proper place within the body. However, when the prolapsus is very extensive it never gets back to the proper location. This same intra-abdominal pressure, and the relaxed state of the muscular system generally, favor the development of all kinds of hernias, especially inguinal and femoral. Those who are of a relaxed habit should take warning and never do any lifting without thinking of the possibility of creating a rupture. If at any time there is a sensitiveness in either flank, one hand should press upon and support it while the other does the lifting. No lifting should be done without the muscles of the abdomen being placed on guard, preventing a rupture. If people generally understood this, and would be mindful of it, they could avoid developing hernia.

   Enteroptosis, then, is a dropping-down of any of the organs in the cavity of the abdomen; but, as a rule, when that word is used it is intended to convey the idea that the patient has a falling of the stomach or transverse colon. I see no reason, however, for dividing these subjects. The treatment for one is the same as for the other.

   Treatment.--The first and most important thing to undertake is to remove all causes that lead to intra-abdominal pressure. The cause of dilation of the stomach was given as improper eating, rapid eating, and overeating; consequently this must be controlled. All cases where there is dropping of the stomach and transverse colon must be treated in such a manner as to get rid of the fermentation. The first week the patient should be put on a fast; the second week, fruit morning and night; and the third week, two meals of fruit, and a dinner consisting of meat, two cooked, non-starchy vegetables, and a combination salad, every other day; the alternate days, potatoes, rice, or any of the decidedly starchy foods, with a cooked, non-starchy vegetable and salad. Every case must be treated according to its special needs. It is very difficult to give an exact treatment for any derangement of the body, because the individual must be treated and not the disease. All bad habits must be stopped. No tobacco, alcoholics, coffee, or tea is to be allowed.

   In cases of floating kidney, the same treatment must be given for correcting the indigestion and getting rid of the gas distention, and also an excessive amount of adipose tissue in the intestine. Those who are quite stout must be fasted long enough to overcome, and cause an absorption of, unnecessary fat deposits in the abdomen. Those who are thin should be fed in such a way as to overcome gaseous distention. All cases must be exercised properly. Lying on the back and going through the movements of bicycle-riding is one of the most important exercises that can be taken for any of the diseases named under the head of enteroptosis. All hernias that have been of long duration can be cured in the same way.

   This disease will require a good deal of exercise to the bowels, also manipulation of the abdomen, and the knee shoulder position should be practiced fifteen minutes twice a day if possible--in the morning and in the evening preceded by the Irish mail movement. Grasping hold of some object in front of one and squatting to almost complete bending of the knees is an excellent exercise. Directions for the different exercise and massage are explained in Toxemia.

   Prolapsus of the rectum can be entirely overcome. The ligaments will shorten under the influence of the exercise recommended. The entire body should be exercised lying down. Patients should be taught to practice the tensing exercise, according to the instructions given elsewhere. Is it ever necessary to shorten the ligaments and cable the kidneys, or operate on the stomach and transverse colon? Never, unless the patient is unwilling to take upon himself the amount of work that will be necessary to restore him to his normal condition. Anyone can be restored to an absolutely normal condition without an operation; but, of course, those who are too shiftless, too indifferent to their best interests, will have to submit to questionable surgical operations. I say "questionable" advisedly; for I have never seen many people derive any great benefit from any of these operations, and, indeed, I have seen many injured by them.

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