CHAPTER XVIII.

HOT WATER IN THE TREATMENT OF PROCTITIS AND COLITIS.

In treating chronic ulcerative inflammation of the anus, rectum, sigmoid flexure, etc., it is well to take advantage of every really practical device to which one may have access, so that valuable time may be saved in obtaining relief and effecting a cure.

The capillaries, veins, arteries, and arterioles in an inflamed organ become distended and the tissues swollen, indurated, and tense by the excess of blood and the inflammatory serum deposited in the tissues. The vasomotor nerves in the diseased part have lost their contractile power, which fact increases the stasis, or congestion, of the blood. Circulation in diseased tissue depends very much on the general tone of the system, and if the circulation is below the normal the ravage of the malady is increased proportionally.

Have you ever observed a little stream of water enter a large pond in which were grass, shrubbery, logs, decaying vegetation, and débris of all sorts--the accumulation of years? And have you noticed that here and there there were stagnant pools, without a perceptible motion from where you stood, but that as you reached the side opposite to the entrance some faint traces of motion became visible, and that as you followed the line it soon formed into a stream quite equal to the inflow? The pure water, on entering and mingling with the stagnant water and old deposits, soon becomes corrupted and foul. Somewhat similar unhygienic and toxic results take place in ponds of stagnant blood and abnormal deposits such as proctitis and colitis involve, and where, for six or eight inches or more of the large intestine, inflammation is deeply seated, and blood stasis is of course in full swing. As the débris in a stagnant pond decays, making the water impure, so in an inflamed organ the tissues decay, making the blood impure. Ulceration is an exhibition of this process of congestion, induration, and decay.

The rectum and sigmoid flexure are loosely hung in the pelvic space and are surrounded by fatty cushions of connective tissue on all sides, which fact allows the organ considerable dilatation and motion (Fig. 5). Owing to the anatomical structure and the location of the lower bowel, it becomes a serious matter when it is invaded by an ulcerative inflammatory process--especially when all the layers of tissue forming its wall are invaded, and still more so when the connective tissue around the organ is in the same condition.

Far better were it for the victim of proctitis and periproctitis--filled as he is with channels and reservoirs--if pus were to form in abundance at once and thus betray the destructive action in the spongy areolar or connective tissue, under the mucous membrane, around the rectum, and in the tissue forming the anus and buttocks.

The pathological condition brought about by inflammation, etc., requires a remedy that will empty the over-dilated vessels and remove the serum deposit in the tissues, which is analogous to the rubbish of a pond.

Our grandmothers were familiar with the therapeutic effects of heat and moisture when they applied hot poultices constantly to an inflamed organ or limb for one or more hours until the tissues presented a blanched, shriveled, and white appearance; if there were signs of the inflammation returning, the poulticing was continued or repeated. They knew very well what the parboiled condition of a washerwoman’s hands indicated after a day’s work in hot water. They were bloodless, notwithstanding their incessant muscular exercise. In case of inflammation, they reasoned, heat and moisture would make the congestion and fever leave if applied long enough. On beginning the use of the hot poultice, the tissues to which its heat and moisture were applied became relaxed, and the parts for the time more congested than before; but our grandmothers did not mind that, as the final result would justify their hydriatic procedure. They well knew that after ten minutes or more a reverse action would take place, and if the treatment were continued long enough the blood-vessels and tissues would show little or no evidence of fever or inflammation.

Where chronic inflammation exists, the blood-vessels and tissues lose their normal tone or vitality; consequently, they will require repeated application of hot water as well as other aids until a cure shall have been effected.

Another great advantage in the use of hot water is that its application can be interrupted and resumed without detriment to the diseased tissues or organs. Cold water, on the contrary, causes the vessels quickly to contract and expel the blood, but, on reaction taking place, the tissues become more congested than before.

In the use of water at a temperature of 120 to 135 degrees, or even more, we have one of the most valuable adjuvants in all stages of proctitis and colitis, and, if a properly regulated plan be pursued in connection with the requisite local treatment, more good can thus be accomplished than by all other means combined.

The layman is more or less familiar with the condition of a sore or ulcer in which soft, spongy, or fungous tissues appear, called “proud flesh,” which, on an inflamed mucous membrane, is called granular tissue. Were it not for the usual presence of granular tissue on a chronically inflamed mucous membrane and for ulcerated sections or patches, channels, and stretched or pouched mucous membrane called piles, the proper use of hot water alone would in time effect a total cure in almost every case of proctitis.

Many well-meaning persons conceive the idea that, if hot water is so beneficial, they may use it as hot as possible for the purpose of an enema likewise, since they will thereby not only relieve the bowels of their stored feces but simultaneously do the inflamed tissues “a whole lot of good.” Their spirit is admirable, for not all patients are prompted to such thoughtful attempts to do everything in their power to get well--even though they err with the best intentions at heart. Let them remember, however, that the first effect of hot water is to increase the blood supply in the tissues if it be applied for a short time only. In the majority of cases, the enema does not require more than from five to ten minutes; hence, only harm can result if really hot water be used. Now and then a person will become possessed with the notion that a hot enema should be followed by a cold one, to bring “tone” to the lower bowels. But in all these misdirected efforts matters are made doubly worse.

Cold water will allay fever and inflammation, but when its use is once begun it should be continued without intermission until a cure is effected. For this reason it is _not_ suitable where chronic inflammation exists--especially on the mucous membrane of the bowels. It is, however, excellent for acute inflammation of the external parts of the body, such as the hands, arms, legs, etc., where it can be continued without interruption for one, two, or three days if necessary.

In beginning the treatment for constipation, there are a few cases in which the patient has to fuss for an hour or more with the enema before he can obtain any sort of a proper fecal evacuation; or there may be inability to expel the water from the bowels when once injected. This stoppage is most likely to occur at the recto-sigmoid juncture (O’Beirne’s sphincter). A strictured condition of the bowels causes retention of feces and gases and why not water as well? In such cases time would be saved, perhaps, by combining the procedure for an enema with that of a recurrent douche, which involves a continuous application of water at a temperature of from one hundred and twenty to one hundred and thirty-five degrees for an hour or more. Figure 21 illustrates a successful device for applying medicated water at a high temperature to the anus, rectum, and colon. This apparatus can be used while sitting on a water-closet seat and the treatment can be completed without changing position or removing the instrument.

The instrument is attached to the reservoir (Figure 18) by a soft-rubber tube. In the cone-shaped piece of hard rubber (Figure 27) is a hard-rubber stop-cock or valve (Figure 29), and by turning the handle sidewise the valve is opened to let the water escape from the bowels into the toilet basin. When sufficient water, at from one hundred and twenty to one hundred and thirty-five degrees temperature, has entered the bowels, allow it to remain for ten minutes, then permit it to escape by opening the valve; then close it and allow more hot water to flow in and remain for five or ten minutes and again allow it to escape through the rectal point, repeating the inflow and outflow every five or ten minutes for an hour or more without removing the anal point from the rectum during the whole time of treatment. After a few trials it will be found that the hot-water treatment can be accomplished without withdrawing the point.

Rectal Points for recurrent douche are of two sizes (Nos. 25 and 26). The larger one (No. 25) requires a plug to be introduced through the cone-shaped external anal support and rectal point, to make its introduction into the rectum easy, after which the plug is withdrawn and the hot-water treatment begun. The bore of the rectal points cannot become clogged by the presence of feces, mucus or membranous shreds or casts, which are usually brought away by the hot-water treatment. At no time during the treatment can the point become stopped up, the size being sufficient to insure a proper inflow and outflow. And the instrument can be easily cleaned.

Near the attachment of the soft-rubber tube is a glass reservoir (Figure 24), for the use of oils with the enema or the hot-water treatment; it is detachable. A valve regulates the outflow of oil from the pressure of water in the reservoir, as it passes into the bowels. We are enabled thus to treat by double medication as it were, a chronic disease of the intestines and its symptoms--that is, intestines that have been long neglected or maltreated through lack of proper diagnosis, or by all sorts of chemical compounds from above, through mouth and stomach.

The author and inventor naturally enjoys not a little satisfaction in being able to present to sufferers as nearly perfect an instrument as can be devised; one that, in conjunction with other aids, meets all requirements involved in the proper treatment of proctitis and colitis. Lavage or irrigation of the large intestine with water at a temperature at from one hundred and twenty to one hundred and forty or one hundred and fifty degrees, not only accomplishes rapid and wonderful cleaning and curative results, but overcomes, when properly applied, contracted, congested, engorged, and inflamed tissues of the bowels. Therapeutically, it has a marked effect on the whole system, being beneficial beyond words to describe; it relaxes nervous and muscular tension of the body, producing restfulness and sleep; it stimulates and equalizes the circulation, promotes perspiration, absorption, and active elimination of all deleterious substances from all the organs of the body. Medicinally, it is really a combined internal Russian and Turkish bath, removing abdominal corpulency and gaseous obesity, resulting from chronic auto-intoxication. The external Russian and Turkish baths afford a satisfaction skin deep to the bather, but the combined internal Russian and Turkish bath is most agreeably relaxing and restful to mind and body, bringing peace, since all the organs of the system are performing their functions. Some of my patients resort to internal hot-water lavage for all aches and ills that mar their happiness. After an external bath the bather may desire an application of oil, alcohol, or cocoanut butter rubbed on the skin, and in the same way the bather’s internal mucous membrane is not neglected; for, with the author’s appliance, medicated and perfumed oils, extracts, and powders for remedial purposes are carried to every part of the intestines that the water reaches, thus exerting a cleansing, healing, and soothing effect where most needed.

A few sufferers will object to the time required for an enema twice a day, although they find time to eat three, or even four times a day, without any objection whatever; there is plenty of time for filling up the digestive apparatus, but no time for its normal elimination. And these miserable, go-lucky, haphazard people are always sick and unfortunate. The internal Russian and Turkish bath is demanded only by those who truly desire to be free from their bowel troubles, and from the numerous symptoms resulting from mucus absorption, constipation, and auto-intoxication.

A sufferer’s efforts to be well depend largely on how much he or she estimates the worth or value of mind and body. A noble purpose in life is priceless; are not one’s spirit and body worth the time required for two enemata each day and an hour for the internal bath, if needed? I think so, and you should likewise.

The author trusts the reader will not infer that all sufferers from piles, anal fissure, pruritus ani and vulvæ, mucus channels and reservoirs, abscess, fistula, and all similar troubles, require the enema and recurrent douche appliance; the character of the disease and its symptoms must determine the requirement of the treatment. Many of my patients receive office treatment only, omitting home attentions, although this is not always advisable. The reader might conclude that the recurrent douche treatment was simply for the cure of a chronic inflammatory invasion of the bowels and fecal auto-intoxication, and not be aware of another great source of auto-intoxication--that is, from the absorption of large quantities of serous, fibrinous, or albuminous exudation from a large area of tissues invaded by the very insidious inflammatory process, a condition which, in time, may reach the pus-forming stage. Thus we have three very grave pathological conditions to meet and remove before the pus-formation stage is made manifest through the development of abscesses. I have found five aids--perhaps more--to accomplish a cure in which I have been exceptionally successful, as my students and patients will verify; these are: local treatment, local medication, the proper use of the enema, the use of the recurrent douche, and the determination of the sufferer to get well.