CHAPTER VIII
THE ENEMA
"I keep as delicate around the bowels as around the head and heart;
Divine am I inside and out."
Walt Whitman.
CHAPTER VIII
THE ENEMA
In fasting for the cure of disease, the enema is a necessary daily adjunct, and, while the fast is in progress, it should be taken on rising and before retiring. In health its use is advised at least bi-weekly, when it will be found a most relieving as well as cleansing operation, at once preventing accumulation and subsequent absorption of waste. In the event that it is administered directly after a movement of the bowels, convincing proof invariabty follows that complete evacuation of the intestinal contents has not occurred ; that there is a residue which, if not removed, will remain to ferment and putrefy. The necessity of this artificial aid to natural bowel movement is thus apparent. At the beginning of the fast, peristaltic action, in the absence of fresh supplies of food, becomes sluggish, and absorption proceeds through the walls of the intestines irrespective of the material present. The fluid state of the waste thrown into the bowels when the process of digestion is suspended, permits of easy absorption and of consequent septic poisoning. During the fast, from the first day of abstinence until indications point to the fact that the cleansing process is complete, large amounts of brownish foul-smelling discharges are evacuated, mixed with lumps of hardened fecal matter, dislodged from the walls of the intestines or impacted from particles excreted in the process of elimination. In long fasts another feature more or less noticeable is the quantity of stringy white or yellowish mucus that is evacuated. The latter is catarrhal in nature and is evidence of the complete renewal that is accomplished when the fast is carried to its logical conclusion.
The necessity for the use of the enema would cease to exist were all food ingested perfectly transformed and entirely consumed in tissue-building. But continued excess in supply creates imperfect functioning of the digestive organs. Natural bowel movements depend upon food perfectly digested or chemically changed, and the waste products from this process are always fully eliminated. Imperfect digestion causes imperfect elimination, which is the one source of septic poisoning and of subsequent disease; but so long as food ingested is cooked food and soft food, and so long as it is not properly masticated, just so long will assistance be required to evacuate the contents of the bowels. Inferentially this fact has been recognized for ages, since drug statistics show that ninety per cent, of all medication is aimed at the intestines.
Objections are made to the use of the enema on the grounds that it is not natural; that it tends to dilate permanently the bowel ; and that its constant employment will ultimately destroy the functioning of the colon. In answer to the first difference it is found that drugs taken into the system for the purpose of causing a movement of the bowels pass through a process similar to that to which ingested food is subjected. They are acted upon by the digestive juices in the stomach and small intestine, and are absorbed into the circulation. The liver, in its capacity of separator, objects to their introduction as harmful to the system and casts out with increased secretion of bile that portion which reaches it. The nerves governing the absorptive and secretive functions of the stomach and intestines, irritated by the presence of a substance foreign and noxious to the digestive process, are stimulated into action and cause an augmented quantity of secretion to be poured forth, and the folds of the colon are filled with fluid fouled by dissolved fecal matter, which is partially absorbed ere evacuation can occur.
Purgatives in medicine are drugs which act as described, and they are divided according to their supposed peculiar properties. Thus there are cholagogues, that increase the flow of bile, and intestinal purgatives, that act on the intestinal secretion, e. g., calomel ; or that increase peristaltic action, e. g., aloes and cascara. Again there are drastic purgatives or cathartics, e. g., croton oil ; and mild aperients, e. g., compound licorice powder and senna.
Each application of the remedy finds the alimentary tract less able to contend against its presence, and, in order to obtain the desired effect in future, larger doses are necessary, more of the digestive fluids of the body are wasted, and the cathartic habit becomes as dangerous as continued indulgence in morphine. By it digestive juices are drawn upon to excess, digestion is rendered difficult, if not impossible, and constipation, with danger of septic poisoning, is aggravated. If the taking of purgatives were confined solely to adult life, the tale to be told would be utterly different in character, since functional derangement would be the principal harm effected. But cathartics are prescribed in infancy, and their indiscriminate use at this period of life is one of the great causes of intestinal mechanical defect, such as is described in detail in the chapter dealing with death in the fast. By their employment in childhood nutrition is lowered through resulting digestive disturbance; inflammation thus engendered is soothed with opiates; feeding and fermentation continue; development of the intestinal tract is arrested, or the tract in portions is functionally paralyzed—an organic condition that cannot be corrected, even by nature itself, in a lifetime of later natural existence. How different the outcome were the enema administered in infancy when functional digestive disturbance and constipation occur! The results are immediate and are attained with no tax upon digestion. The delicate nervous fabric of the child suffers no disastrous reaction when bowel accumulation is thus naturally removed, and internal purity, the condition of health, is reached and thereafter assured.
To the objections that the bowel is permanently dilated, and its functioning lost by continued use of the enema, a detailed reply is necessary. The intestine, as a whole, is that part of the alimentary canal, which, commencing at the pyloric opening of the stomach, is coiled in the abdominal cavity and ends at the anus. For purposes of description it is divided into several portions. Food leaving the stomach passes first into the duodenum, then into the jejunum, and next into the ileum. These three sections form the small intestine, which in man is about twenty feet in length, but is subject to great variations. The lumen of the small intestine is larger at its upper end and gradually narrows as it goes downward. The opening of the ileum into the caecum, the first portion of the colon, is valvular, and this arrangement prevents any passage backward of the intestinal contents. Beyond the ileo-caecal valve the caecum forms a large dilatation, and from it springs an elongated blind process, the vermiform appendix. The caecum is continued upward as the colon, which is described as (1) ascending, (2) transverse, (3) descending. The sigmoid flexure, a device of nature that prevents excessive pressure by the contents of the bowel upon the muscles of the rectum and the anus, lies between the descending colon and the rectum, whose lower opening, the anus, is guarded by a strong circular muscle. The sigmoid flexure thus interrupts the straight fall from the transverse portion of the large intestine to the rectum and acts as a retaining pouch.
From this description it will be seen that there are three positions in which the colon may receive a supply of water sufficient to soften its contents and to wash them away from its walls. These are the right-side, the knee-chest, and the flat-on-the-back. The latter, except in bed-ridden cases and in children, is inconvenient to assume, but the two former postures are found to be comfortable and easily taken.
When the patient in taking the injection lies on the left side, gravity can assist the flow only as far as the transverse colon, which in this position is a perpendicular tube forbidding further passage of the fluid of the enema. Hence only one-third of the bowel is possible of flushing. The right-side posture permits the water to flow along the descending colon, down the transverse bowel, and through the ascending gut to the caecum, completely flushing the organ. The kneechest and the flat-on-the-back positions insure, with even greater ease, full cleansing of the bowel. When the injection is taken in the sitting posture, gravity and the contents of the lower portion of the bowel prevent the rise of the water unless some special device embodying force is utilized; even then only the descending colon receives the benefit of the flow, and dilatation of the rectum and the flexure is certain to occur, with possible mechanical injury.
Soap-suds, salt, soda, and the like are to be avoided in the preparation of the fluid in the injection. Similarly, oils of any kind are forbidden, and water warmed to body temperature, not higher than 100 degrees Fahrenheit, should be the only flushing agent. Absorption of a portion of the contents of each bag is almost instantaneous, so the safer plan lies in using no foreign substance whatever. Copious discharge from the bladder immediately after rectal injection is the common indication of the rapidity with which absorption occurs through the
walls of the colon, and this, in itself, is proof 
View of (1) esophagus, (2) stomach, (3) small intestine, The ascending colon (4a), the transverse colon (4b), and the descending colon (4c), are so constructed that it is impossible to flush the entire large intestine while the body is in an upright position. that there is fallacy in the medical sub-argument against the use of the enema to the effect that no absorption of retained fecal material can take place. But medicine goes even further in the process of self-stultification when it recommends the employment of nutrient enemata. Denying that the contents of the bowels may be returned in part to the circulation through the walls of the. gut, it nevertheless affirms that food material may in this manner be absorbed. It therefore assumes that tissue is nourished by matter that has not undergone the process of digestion. It is also readily seen that food absorbed through the walls of the colon is not received by the portal or nourishing part of the circulation, but enters directly into the venous blood, which is itself loaded with impurity awaiting elimination. To deliver household water to the faucets from the sewers of a city Avould be deemed an act of insanity, yet analogy is plainly evident when this method of transmission is compared with that of food introduced into the human body per rectum. When the patient is bed-ridden or abnormally weakened, the knee-chest posture in taking the enema may prove too exhausting; and, when this condition exists, a canvas stretcher upon which the subject may comfortably lie, can be placed over the bath tub. If this apparatus cannot be procured, a triangular platform of three boards covered with a blanket and oil-cloth, its base arranged so as to cross the top of the tub beneath the buttocks, may be used as a substitute. By this means all effort on the part of the patient in retaining position is removed, a matter of the utmost importance when excessive weakness is present.
The operator in administering the enema, or the patient himself, will often find it needful to repeat its application to the extent of twenty or more quarts, or until the fluid returns comparatively colorless. Observation shows that, even to the twentieth day of a fast and sometimes thereafter, great amounts of bile and mucus appear in the discharges. The necessity is thus apparent of the daily use of the enema. Repetition insuring thorough cleansing of the colon is most essential in employing the internal bath, for the injection of only a small quantity of water acts detrimentally since it serves to render the contents of the bowel easily absorptive, and is not in amount sufficient to be evacuated freely. For this reason also small enemas occasion weakness in the patient, an additional objection advanced against the use of the injection. Less than three quarts should never be administered at any one time. It may be added that in weakened cases the effort of ejecting the water and the contents of the bowel may be lessened by the insertion of a colon-tube to a depth of approximately six inches into the rectum ; through this tube the fluid waste and small particles of fecal matter can pass without difficulty. Hence no matter how weak or depressed the patient may be, the enema is possible of administration without undue physical depletion, while the utmost relief always follows the removal of body filth.
Erroneous teaching is responsible for the assertion that the continual use of the enema during a fast or in health will occasion weakness in a patient and lack of function of the colon, and that natural movements of the bowels will not again occur. In other words, that the patient will thereafter be compelled to resort perforce to the internal bath for bowel evacuation. Natural movements of the bowels, as has been said, are directly dependent upon normal digestion, and in a system organically perfect and naturally correct