Chapter 34

PROPER TREATMENT FOR DISEASES OF THE ANUS AND RECTUM VERY ESSENTIAL.

No doubt the readers of the preceding chapters on proctitis and its numerous symptoms--noted under separate headings--would like to know something about the home treatment for such an insidious and grave disease. Every sufferer wants to be a self-doctor. This commendable desire it is usually impossible to put into practice. If physicians so often fail to cure the ailments I have described, what can be expected of those who have no knowledge at all of diagnosis and treatment?

A skilful physician is the choicest gem of civilization, and an intelligent patient its worthy setting. Surely it is a moral crime, an inexcusable folly to tolerate a disease with its inevitable train of dire consequences, up to the point when the discomfort compels one to seek treatment. There are patients, of course, who have good and sufficient excuses for their painful predicament; they have, for example, tried persistently for relief and cure, but have failed to find a physician competent to treat their particular case. How many unskilled prescribers there are, and how glaring their shortcomings! Some hold out taking inducements to sufferers; their one object being to transfer their patients' cash to their own pocket. 'Twere charitable to consider these ignorant; but alas! many of them are poisoned by the "fakir" germ. Stuff is sold by the conscienceless, claiming to cure "piles," to "give instant relief," and promising "a complete cure in a few days"; and as to itching piles, why! "only a few applications are necessary for a cure; six boxes for five dollars"! etc.

No remedy that sufferers apply themselves can be more than a temporary relief: it cannot really cure piles, polypus, fistula, tabs, pruritus (itching)--all of them consequences of proctitis. Of course one should be thankful for the little relief to be got temporarily from advertised and drug-store drugs; nothing more than relief can be expected of them. There are indeed times when a palliative treatment will serve to tide the sufferer over a few days until he is able to consult a competent physician. But how strange it is that so many sufferers regard their anatomy and physiology so lightly as to think of using remedies, even for relief, without first undergoing a thorough examination by a competent physician. In troubles of a rectal character it is exceedingly foolhardy to allow any one to prescribe without insisting upon a thorough examination to ascertain whether there be any disease of a cancerous nature present, or what the trouble actually is, and its progress. To expect one remedy or prescription to meet all the requirements for the cure of a chronic disease of the anus and rectum and of the many complications accompanying it is hardly sensible, but that is just what a great many do expect. No one remedy in the market, or any number of them combined can effect a cure, for the simple reason that proper local treatment by a physician is of paramount importance. Unless of a traumatic (externally produced wound) origin, diseases of the anal and rectal canals are usually of fifteen, twenty or more years' incubation before the annoying symptoms become apparent. This accounts for the slight attention to the maturing trouble and for the fact that such attention can afford nothing more than a palliation or postponement. A real cure requires a combination of means, all working harmoniously for the proper length of time. Proper treatment and the proper time are the two prime requisites; and the third and final requisite is, of course, a sensible patient.

Before home treatment is to be thought of it is accordingly advisable to have an examination and a prescription for the specific local treatment necessary for a trouble like piles, fissure, polypus, tabs, itching, fistula, varicose veins, abscess, ulcer, granulation, hypertrophy, or atrophy as the case may be. The local treatment can best be aided by a combination of remedies with suitable instruments for their use between the periods of local attention by the physician. The writer of this has no cure-all to send the sufferers, although it might be to his financial advantage to have one; he is, however, always ready to advise and relieve those who cannot visit him immediately. The relief afforded often facilitates the cure by permitting a more extensive local treatment at the first visit.

_The Use of Instruments for Injecting Water._

To do something at home for one's self for relief from soreness and pain due to anal and rectal diseases, a few suitable instruments are required with which specific remedies may be used, especially that excellent remedy--water.

It is unfortunate that the anal and rectal canals cannot be given rest when invaded by disease. Daily elimination of feces is a very important factor to health and to treatment. To accomplish this the very best means is water in various quantities as the case demands. It does not irritate the diseased canals--as cathartics do--but aids in the escape of imprisoned feces and gases which lodge above the region of the morbid process. Evacuation should be accomplished twice a day, by the injection at first of three or four quarts of water--thus obtaining a good daily flushing of one's sewer--and then, if advisable, gradually lessening the quantity at subsequent injections to one or two pints at a time. The temperature should be 100° to 105° or more. Some people have an idea that water at the temperature named has a remedial effect on an inflamed anus and rectum. It has none whatever; all it does is to wash away the deposits which might irritate the inflamed surface. Water at a temperature of 100° to 105° is not an especially good antiseptic; and its intestinal use should not be continued longer than to bring away the effete and fetid material which may be lodged in the colon, sigmoid flexure and rectum. In the majority of cases its use should be limited to aiding the feces to escape from their normal receptacle--the sigmoid flexure--whenever proctitis does not extend beyond the rectum. But many persons are deceived by the conduct of proctitis and are thus likely to omit the regular irrigation twice a day. They believe themselves to be in pretty good condition and do not realize that their old, implacable enemy may be excited into riot any day; in which case the insurrection may last for months and then slowly settle down to semi-quiet again, reaching finally the point of its best behavior for a short period or until again provoked.

_The Use of the Recurrent Douche._

Water at a temperature of 120° to 130° properly applied is a good therapeutic agent in the treatment of proctitis. At that temperature it is an excellent antiseptic and astringent. Its continuous use for half to one hour applied with a recurrent douche brings about a contraction of the engorged and dilated blood-vessels; and accompanied by local treatment and by other remedies is the best means known for restoring the nerves to their normal function of controlling the proper circulation of blood in the diseased organ. Treatment with the recurrent douche is of course to follow, not to precede, the evacuation of the bowels; but at any time when there is a tendency toward additional evacuation on the admission of the hot water, the new douche is easily adjustable to the contingency without removal from the anal canal; it will facilitate the escape of the feces with the return flow of the water. The new recurrent douche has therefore the great advantage of promoting simultaneously both the thorough evacuation of the bowels, and the therapeutic effect of hot water.

_Sitz-Bath._

There are patients who, because of years of neglect of their local ailments, are taken with severe attacks of inflammation of the anus and rectum, involving considerable prolapse, much swelling around the anus, and general local soreness and pain; all of which is often accompanied by a general disrelish of life. For this condition nothing is so good as a very hot sitz-bath, if properly adjusted to the parts and continued for about an hour at a sitting. The alleviation afforded is so decided and the local and prolonged application of hot water so restorative that it may be left to the sufferer to determine how often this bath is to be repeated. It may be taken as often as there is an inclination to do so. The sitz-bath apparatus should be scientifically adapted to the parts so that the bather will not sit lower than ten or twelve inches, thereby avoiding a straining position. During the bath there should be more or less pressure against the anal tissues, which assists the hot water in expelling the blood from the inflamed parts. From the beginning to the end of the bath the water must be as hot as the tissues will tolerate. Only a small portion of the buttocks need be immersed in the hot water.

_Spring Water the Ideal Beverage._

Those who suffer from disease of the rectum, with rare exceptions, are constipated or semi-constipated, which condition in turn aggravates or disturbs the inflamed parts. To overcome this constipated condition all sorts of laxatives are taken, which will in the end do grave harm not only to the whole system, but especially to the inflamed parts, irritating them still more. There is a valuable therapeutic agent seldom taken by the constipated; in fact, it is never thought of; unfortunately the remedy is not easily to be had in its pure state by most of us, boxed as we are in cities. Sold under various names as mineral water, it is too often adulterated. 'Tis a simple remedy, and yet it has a wider range of healing power than any other; a universal solvent, applicable to all diseases and all states of health. I would write it at the head of all remedial agents: pure spring water! We do not drink enough water. If we were to imbibe at least two quarts of pure water daily we would be healthier and have better movements of our bowels. Water may be taken freely during mealtime; not, however, for the purpose of washing down half-masticated food. Alcoholic drinks, coffee and tea would better be dispensed with, also tobacco. The nervous system has enough to bear without the use of avoidable irritants.

_Other Hygienic Agencies._

Too much cannot be urged as to the advisability of a proper amount of exercise, sleep, rest, food, breathing, cleanliness (internal and external), as well as and above all, pure, high-minded thoughts and serene temper--the outcome of the habit of viewing life philosophically. Care should be taken to protect the feet and body from sudden climatic changes, thus avoiding catarrhal troubles, especially of the lower bowels.

As to the wise and proper use of nature's pharmacopoeia, nothing need be said here. However, I may be within my limits when I advise patients to use a little sense and not neglect disease of the lower bowel any more than they would neglect that of the eye, ear and throat. In the latter case they submit at once to an examination. Why not in the former? Let them bear in mind that the cure of chronic proctitis is no holiday job; that it is, on the contrary, a task which requires constant attention. To merely relieve the annoying symptoms that accompany it cannot be called a cure. But on the other hand relief may be the commencement of a cure. Of course the true way of looking at the subject of this disease is to regard the cure of proctitis as necessarily leading to the disappearance in time of all the other troubles that were the outcome of that ailment. Through the harmonious efforts of patient and physician, marvellous results are often obtainable.