COLONIC THERAPY IN THE TREATMENT OF DISEASE BY O. BOTO SCHELLBERG NEW YORK American Institute of Medicine, Inc, 1923 126046 Copyright, 1923, by O. BOTO SCHELLBERG Press of J. J. Little & Ives Company y/'z/l'f Jlfi 73 To quote Dr. Stokes’ own words: “The patients are given a general overhauling, their hygiene is investigated and corrected, if possible. . . . Many show evidence of endocrine imbalance, others are mildly toxic, and frequently the colon is at fault. These cases are referred to Schellberg for cecal irrigation and the establishment of proper drain- age in the digestive tract.” 22 Since 1918, Dr. Stokes has given special atten- tion to endocrine depletion due to influenza as affecting the suprarenal and pituitary glands. By thoroughly cleansing the entire length of the colon with large quantities of medicated fluid which are quickly absorbed into the blood stream, the secretory organs, the liver in particular, are flooded, and the kidneys thoroughly washed out, the entire blood stream being in this way freed of its impurities. No matter what form of medica- tion or other therapy be employed with the inten- tion of combating the conditions which have arisen because of the infection due to colonic stasis, until the local conditions in the intestines have been cor- rected, all such efforts can be, at best, but partially effective, and usually they will fail completely. In many instances the removal of the infective focus will be followed by immediate disappearance of the remote symptoms, making any future treat- ment wholly unnecessary. Not only is the estab- lishment of proper systemic drainage valuable in 74 COLONIC THEBAPY cases of manifest disease, but careful attention to this matter will always greatly raise the health standard, even of those who do not look upon themselves as sick, and in considering preventive medicine, it is certainly fully as important to make a careful study of colonic conditions as it is to ex- amine the state of the teeth. Upon proper elimi- nation of waste and toxic products depend the health and correct function of every gland and organ in the body. Of the many methods employed to restore nor- mal intestinal activity and function, none has proved so satisfactory and effectual as colonic irri- gation. The introduction of a warm (50° C.) so- lution into the bowel “hastens the rate of rhythmic contraction,” as has been shown by Magnus, Tay- lor and Alvarez ; 23 and it has been my experience that it not only stimulates active downward peri- stalsis in the entire colon, but that in some patients even the waves of the ileum are made stronger. Concerning this peristaltic action Alvarez says: “The gastrointestinal tract is largely autonomous, that is, it carries within itself the mechanism essen- tial to peristalsis. This point cannot be emphasized too strongly, because it seems to me that the fail- ure to grasp it is the greatest stumbling-block to further advance in our understanding of the sub- ject. It is undoubtedly true that the extrinsic nerves have much to do with peristalsis, but it is COLONIC PATHOLOGY AND SYSTEMIC INFECTION 75 very helpful in simplifying our problems to recog- nize that the tract can get along without any outside help or interference. This should make us the more willing and eager to study the all- important local mechanisms.” 15 To put this “local mechanism” in proper work- ing order and to keep it so, without the interfer- ence of outside agents in the form of drugs, is the aim of proper colonic irrigation. Heretofore it was commonly supposed that a sufficiently heavy catharsis would effectually clear out the intestinal canal, but I have repeatedly demonstrated the fallacy of such a conception. After the adminis- tration of four ounces of castor oil — the patient being on “starvation diet” during these experi- ments — and the administration of a compound cathartic pill nightly, large quantities of residue have been removed daily by successive, colonic irrigations ; and even after the lapse of eight days, when the patient had taken one and a half ounces of castor oil, with three compound cathartic pills, followed by six ounces of citrate of magnesia, colonic irrigation brought away more residue than had been evacuated following the initial dose of castor oil. Where colonic stasis exists it is evident that catharsis is wholly inadequate to establish or maintain efficient drainage. The idea that the taking of cathartics or enemas is likely to induce the formation of a habit is not 76 COLONIC THERAPY consistent but it is well established that they may be injurious, depending upon the drug ingested, or the method of taking the enema. The steady use of Epsom salts, or related substances, produces inflammatory conditions. The action begins in the stomach, causing a violent stimulation of the ileum whereby a large amount of fluid is hastened through the colon by an active functioning of the cecum. No active peristaltic action of the colon is produced, however, and the liquid is quickly ex- pelled by the rectum because of its active disten- tion by the fluid. But when it is desired to produce this action, as in certain acute conditions, the use of Epsom salts may be justified. Any interference with colonic drainage will lead to intestinal disturbances of some kind, so that it is obvious that the maintenance of proper drainage is a matter of the very first importance. As bac- teria colonize in the colon much as they do on an agar plate, any putrefactive focus of bacterial in- fection may be a determining factor in the produc- tion of systemic ailments. The belief that cathartics drain the system is wholly erroneous. The fluid is hastened through the alimentary canal before absorption can take place and the body is thus robbed of necessaiy fluids. Therefore, following the use of cathartics we find urine of high specific gravity, and voided in reduced quantity. This condition may be offset Fig. !). — Membrane and feces removed from a large pocket in the transverse colon after antiseptic treatment and the application of ichthyol. COLONIC PATHOLOGY AND SYSTEMIC INFECTION 77 by irrigations of the colon in connection with ca- thartics, as following irrigations a great amount of fluid is absorbed by this organ. This augments the volume of the urine, and immediately after irrigation the fulness of the pulse will indicate the increase of fluid in the circulation. There is probably no part of the body which re- quires more care and attention than the colon; and it is equally probable that no other part of the body has been so uniformly neglected. More than that, very eminent authorities, the most con- spicuous perhaps being Sir Arbuthnot Lane, have declared that the colon is superfluous, an outgrown organ existing only to give trouble; the utter ex- tirpation of which can only result in benefit to him who loses it. There remain, however, some who, having given considerable attention to the matter, still believe that the colon may be “reformed,” and with proper care and treatment returned to its original condi- tion of harmlessness and efficiency. Although many diseases undoubtedly have their origin in the colon, this does not argue that it is a superfluous organ, but rather that we have misused and neg- lected it, overlooking entirely its great importance in the human economy. The generation of bac- terial poisons in the digestive tract, and their absorption into the blood stream or the genito- urinary system give rise to a long train of ills. 78 COLONIC THERAPY If we can devise a means of emptying out this bacterial incubator, and keeping it thereafter free from infection, we shall have gone a long way toward “reforming” the colon. Certain putrefactive microorganisms cause an exudate upon the intestinal wall, forming what I have termed intestinal interlining adhesions. The matrix of some of these adhesions is made up of fibrin, in which numerous small round cells can be observed together with a few polynuclears, which, when stained, are frequently found to contain streptococci and staphylococci in almost pure cul- ture. These adhesions can also be produced by other infectious bacteria in a great variety of com- binations, displaying a more or less pronounced matrix; in the more pronounced forms strips of fibrin enmeshing red blood-cells and desquamated epithelium are to be seen. In the formation of abdominal adhesions the peritoneal and intestinal fluids consist of both exudate and transudate, solidifying as a protective element, on the inner, as well as on the outer wall of the lumen, an in- flammatory process being the causative factor. This fluid is rich in proteins which invite the growth of cells and fibrin. Thus, living elements are produced out of parts previously destitute of shape. Descriptions of these bowel casts are not com- monly found in literature, so the following excerpt COLONIC PATHOLOGY AND SYSTEMIC INFECTION 79 from P. J. Cammidge’s Faeces of Children and Adults is of interest in this connection: “Casts of the Bowel. — More or less complete casts of the bowel are sometimes passed. These usually consist of mucus, but occasionally are ‘diphtheritic’ membranes. The former may be mere shreds of mucin-like material or cylindrical masses, varying in length from 1 or 2 in. up to 8 or 10 ft. and of different degrees of density. Even in children, casts 18 or 20 in. long are some- times met with. Such casts usually have a con- stant diameter throughout their entire length. They are generally grey in color, but may be translucent or even transparent. On their free surface they are seen to be studded with fine white granules, and when associated with an acute in- flammatory process, may be studded with blood. They are frequently passed with severe tenesmus, without any associated faecal material. Mucus casts are met with in both acute and chronic in- flammations of the mucosa of the large intestine, the intensity of the lesion being indicated by the number of entangled epithelial cells. The long, thin tubular, or tape-like membranes passed in muco-membranous colitis have been ascribed to absorption of water and the astringent action of the faeces on the mucus which accumulates round them when they are retained for several days; but more probably they arise from the action of a spe- 80 COLONIC THERAPY cial mucus-coagulating ferment secreted by the mucous membrane. Casts which do not present a membranous formation until they have been carefully suspended in water may also be passed with a good deal of tensemus and the absence of faecal material in mucous colitis, and are not un- common in gastroptosis and in enteroptosis.” 21 Generally, in slight intestinal perforations where there is a focus of infection within the in- testine, adhesions are likely to be produced. Nat- urally, we should assume that the production of intestinal and peritoneal fluids is a part of nature’s process of checking general leakage from the lumen, acting in a manner similar to clot -forma- tions in leakage of the blood-vessels. Extensive intestinal adhesions are found in cases of perico- litis. Ordinarily, we encounter extensive adhesions in the vicinity of the cecum, the hepatic and splenic flexures and the pelvic loop. It is also at these points that drainage is most likely to be obstructed. However, to attempt to classify the nondrain- able points of the colon would be a difficult task, as adhesions in one part of the colon, aided by angulations or chronic spasms due to foci of infec- tion, may distort this organ into all sorts of shapes, producing pockets of various dimensions, as well as constrictions which may cause serious strangula- tions. Case , 24 who has done extensive x-ray work Pig. 10.— Specimen from the same case as rig. 0, following t bulgaricus. Note the breaking down of the membrane. COLONIC PATHOLOGY AND SYSTEMIC INFECTION 81 on colon abnormalities and diseases, is authority for the statement that one may deduce from the work of Eastman, Hertzler and Jackson— in par- ticular the latter — the fact, that even when we are able to elicit no history pointing to the existence of any previous intestinal inflammation it is pos- sible for extensive colonic adhesions to exist as a result of chronic intestinal stasis. He adds also that “patients with colonic adhesions are much to be pitied because the adhesions are often not recognized.” Any increase of pressure within the bowel, any weakening of the muscular tone of the wall as a whole, in fact, whatever causes may act to weaken the wall at any point, will offer opportunity for hernial protrusion, and give rise to diverticula or sacculi. Given a series of pockets resulting from relative weakness of the bowel wall and containing fecal material and possibly foreign bodies, we can quite easily predict the various lines of pathologic development which these diverticula will be likely to follow. There are two aspects to be reckoned with, the mechanical factor and the pathologic or toxic element. Any fecal mass not periodically expelled will tend to inspissate, and will likewise become a nidus for bacterial flora of varying sepsis and virulence, and this, combined with the me- chanical rotation of the concretions, will almost invariably bring about some sort of inflammatory 82 COLONIC THERAPY reaction. So we might expect to find fibrous hyperplasia with the usual result, contraction of newly formed tissue. If the organisms present are very virulent we are likely to get an acute inflam- mation, or ulcerations, and even gangrene may occur. In milder cases we should be likely to find ulcerations resulting in chronic local abscess formation, a process of which adhesions are an invariable sequel . 25 Incomplete and infrequent evacuations of the bowel may be caused by diverticula or an increase in the size of the normal sacculi of the colon. If these sacs are deep enough, feces may accumulate in them and their passage be seriously delayed or altogether prevented. A state of chronic costive- ness may result from the collection of a large amount of residue in such a cul-de-sac, for peri- stalsis will be very greatly impeded, and even obstruction produced, while the entire bowel maj^ be dragged downward, resulting in enteroptosis and angulations, or even producing enterospasms. All this will increase obstacles in the passage of the fecal current through the affected part of the bowel. If these pockets are large and narrow the action is much like that of adhesions in the form of bands so that they may cause obstruction by direct pressure upon the intestine, or a greater or less degree of strangulation. Hernia of the mu- cosa may form in different parts of the bowel by COLONIC PATHOLOGY AND SYSTEMIC INFECTION 83 the giving way of the mucosa coat, thus diminish- ing the walls’ propulsive power and favoring im- pactions, until a decided bulging will take place at the affected spot. These sacculi are most often found in the sections of the colon where there is likely to be sagging, as in the cecum, the transverse colon and the sigmoid flexure . 26 The victims of diverticula are often — in fact usually — obese, because in such patients there is apt to be excessive development of the appendices epiploicae, and also of fat under the serous coat of the intestine which diminishes the resistance of the wall to any extra pressure which may happen to be exerted. These pockets are for the same rea- son much less frequent in young subjects . 27 According to Pfahler , 28 constrictions of the colon are most likely to be found at the hepatic, splenic and sigmoid flexures, but they may occur anywhere. Carcinoma is especially apt to be lo- cated at the sigmoid flexure, in the cecum and in the rectum, and when present is usually limited in the early stage to a comparatively small area. The initial symptoms of carcinoma are often over- looked. In the absence of hemorrhoids or benign rectal lesions the passage of a slight amount of bloody mucus should always be regarded as a danger signal. When there is any suspicion of malignancy, all measures to clean the bowel should be pursued with the utmost caution, and the exact 84 COLONIC THERAPY condition be previously made as clear as possible by x-ray examination. While I do not wish to deprecate the value of roentgenographs of the colon, they not infre- quently remind me of the silhouettes which ante- dated the era of photography. While an x-ray of the colon filled by a barium meal gives the outline and anatomical position of the organ, it shows none of the defects due to the presence of gas and feces, so that such an outline is less exact than the clear- cut delineation of the old-time silhouette. Disease may exist in the colon and yet remain unrevealed by fluoroscope or roentgenograph. The x-ray photograph of the colon filled with a barium meal does not give a comprehensive picture of the state of the colon, for it is possible for a diverticulum to exist on the side opposite to that facing the roentgenographer, though all that would appear in the roentgenograph would be a smooth black surface like the silhouette. A sil- houette profile gives no intimation that its subject possesses ears. CHAPTER V THE FUTILE ENEMA Establishment of free colonic drainage necessary to health — Effects of intra-abdominal pressure — Futility of the enema as usually administered — Hot solutions wholly ineffective without preliminary emptying of the colon — Effect of method of irrigation without special apparatus — Proper irrigative treatment does not produce shock, but stimulation — Consist- ent, continued irrigation only is effective — Roentgenologic diagnosis of diseased conditions that have been effectually relieved by properly applied irrigation. CHAPTER V THE FUTILE ENEMA Establishment of free colonic drainage necessary to health — Effects of intra-abdominal pressure — Futility of the enema as usually administered — Hot solutions wholly ineffective without preliminary emptying of the colon— Effect of method of irrigation without special apparatus — Proper irrigative treatment does not produce shock, but stimulation — Consist- ent, continued irrigation only is effective— Roentgenologic diagnoses of diseased conditions that have been effectually relieved by properly applied irrigation. Any attempt to clear out the lower part of the digestive canal must presuppose a complete knowl- edge of the anatomy, physiology, and pathology, not only of the parts which are directly involved, but also of the entire abdominal region; and, in addition to this knowledge, one must also be pos- sessed of a thorough comprehension of the chemi- cal reaction of any solution or therapeutic measure to be employed. Even when all this has been fully acquired, it is still necessary to master the opera- tive technic and to become possessed of a skill and manual dexterity which only results from long and varied experience. It is my purpose here to de- 87 88 COLONIC THERAPY scribe a technic for colon irrigation designed to meet the needs I have outlined in the foregoing chapters, and to explain the steps by which the colon — even when badly diseased — may be re- stored to normal function and vigor. For the removal of many abnormalities of the colon this method will be found simpler and safer than surgery . 29 In a diseased excretive organ it is not always the disease that is fatal; often it is the inability of the organ to carry on its function in a normal way, which results in the absorption into the body of those substances which should be expelled. This is well illustrated in the study of urinary metab- olites, where death soon follows the inability of the kidneys to perform their excretory functions. The failure of intestinal excretion is not so imme- diately fatal, because of the existence of the func- tional drainage of the kidneys, skin and lungs, but the accompanying metabolic disturbances are equally disastrous. To combat disease success- fully, the process of tissue change whereby the function of nutrition is effected, must not be over- balanced by the concurrent breaking-down proc- esses — anabolism must not be overwhelmed by catabolism. To preserve this proper balance we must often resort to artificial elimination. It is my experience that many diseases usually considered chronic and fatal can be arrested, THE FUTILE ENEMA 89 if not entirely cured, by artificial drainage. I trust I may be pardoned for inserting here a statement offering confirmation of my point of view, which was published several years ago by one whose experience and standing in the medical pro- fession lend prestige to his opinions : “Schellberg has cured many very obstinate cases of intestinal infection and ailments resulting from the absorption of bacterial toxins. He has demon- strated conclusively the practical value of the long rectal tube for irrigation and cleansing the large intestine. X-ray photographs show clearly that such a tube may be passed through the colon as far as the cecum. We, as medical men, know that a large number of chronic pathological conditions are traceable to the absorption of putrefactive elements from the colon. These putrefactive ele- ments are either bacterial toxins themselves or are formed by the action of bacteria on proteid matter held in the colon.” 30 Not alone can the colon be aided by irrigating its entire length; the effects of such irrigation ex- tend to the ileum, the jejunum, the duodenum, the stomach, and even the throat. We do not need to stop at these; we can include the ductless glands, the heart, the blood-vessels, the lungs and the skin. In other words, we can include the entire body; and, I may add, in successfully combating any dis- ease the alimentary canal is the most effective point 90 COLONIC THERAPY of attack. I do not refer to the use of the soap- suds or saline enema, or to the method of irrigation that is commonly prescribed and followed in homes and institutions by inexperienced persons. Any- one who prescribes such irrigations and expects any satisfactory or effective results is not possessed of a thorough knowledge of the anatomy, physi- ology and pathology of the human intestinal tube. There is no danger in irrigating a colon with a suitable rectal tube and equipment, if the instru- ments are handled with sufficient skill. But there is danger of injury, or even death, if the technic employed is faulty and the proper implements are lacking. Often, in a gastro-enteroptosis or other defect of the canal, the method used is to place the patient in the knee-chest position, thus causing the visceral organs to drop forward, and forcing the feces and gas out of the rectum and sigmoid up into the colon and ileum; then setting the patient upon a commode or having him walk to a toilet, with his abdomen distended with solution and the intestines dropping down, locking the gas and feces within the tube. Such treatment has often caused excruciating pain, collapse and death. Hamburger’s investigations have thoroughly explained the influence of intra-abdominal pres- sure on absorption, and the question of blood pres- sure was also considered. He increased intra- abdominal pressure by injecting physiologic saline THE FUTILE ENEMA 91 solution, and attempted to eliminate the elasticity of the abdominal wall by placing a plaster-of- Paris cast around the abdomen of a rabbit. At the beginning of the increase of intra-abdominal pres- sure he observed a rise of blood pressure, but when intra-abdominal pressure reached a high level there was a sudden fall in blood pressure followed by the death of the animal. It is known also that death may be brought about by an isolated loop in the lumen of the gut; so we can readily understand how injury, suffering, and death may follow from many specific causes. The introduction of a large amount of fluid into the lumen of the intestine when there is malformation of the tube, or even where a spastic condition exists, will form a large tumor with the increase of intestinal exudate and gases which are bound to follow in an isolated sec- tion of the lumen. When pressure is exerted in the abdominal cavity, the circulation, especially that in the veins, labors against increased re- sistance, and if the pressure against the larger veins is severe enough the heart will fail because it contains no more blood upon which to act. This is only one of the fatal injuries which may occur from increased intra-abdominal pressure. Another ineffective method is the use of two rectal tubes. Why try to pass two tubes, when it is so difficult to pass one? This method is no more effective than an enema. The rectum, only, is 92 COLONIC THEEAPY irrigated ; and the patient is caused a great deal of discomfort. The ordinary method of irrigation employed does one of two things or sometimes both. It merely washes the feces out of the rec- tum, or by overdistention from the liquid forces them back into the colon — sometimes as far as the cecum. A very able physician, well versed in the anatomy and pathology 7 of the colon, once inquired of a head nurse in a certain hospital: “What is your technic of a ‘low irrigation,’ and technic of a ‘high irrigation,’ that you mention?” “Why, doctor,” replied the nurse, beaming with confidence, “in a low irrigation, the douche-bag is held fifteen inches above the patient, and in a high irrigation the douche-bag is held three feet above the patient.” Are we to condemn the nurse for her lack of knowledge, or should we condemn those who should have taught her better? We should condemn those who have written text-books, and put themselves on record, without having any more real knowl- edge of the colon, and the proper technic of its treatment than did this nurse. How many times has a “high, hot colon” irrigation been ordered? And how many times has a nurse or an orderly attempted to carry out the physician’s order with a rectal tube about fifteen inches long, that would bend on itself if it met with the slightest resistance, proceeding to put a hot solution into the intestine. THE FUTILE ENEMA 93 without having the slightest knowledge of colon physiology? The results of such treatment are written thousands of times upon hospital charts: “High, hot colon; no result.” The physician’s order to give the enema; the nurse’s attempt to carry out his orders ; the instrument with which she was provided and the hot solution she tried to put into the colon are all utterly futile. Hot solution in quantities amounting to over a few ounces cannot reach the colon, unless it has been cleared beforehand, as the solution will all be expelled by the rectum. The rectum’s normal function is to expel any such solution immediately; and with such a tube as that with which the nurse is supplied it is impossible to reach the pelvic colon. One is amazed to read the assertions of certain investiga- tors armed with x-ray equipment, who imagine they have proved to the world that a rectal tube cannot be passed beyond the sigmoid flexure. Truly, we need no x-ray to prove that such a tube coils on itself when introduced into the rectum; it requires but a limited amount of reasoning to realize that such a small, flexible tube cannot be passed. Nevertheless a proper rectal tube can be passed into the colon without difficulty by those who possess the essential skill, and are thoroughly conversant with the anatomy of the parts. When the proper equipment to irrigate a colon is not at hand, instead of using an ineffective colon 94 COLONIC THERAPY tube, the patient should be placed on the left side, and a douche-bag with an ordinary hard-rubber tip pressed into service. Introduce a pint or two of solution at 37° C.; allow the patient to expel im- mediately; and clean the rectum of feces and gas; thereafter allowing the patient to rest for a half hour or an hour. This should be followed with another enema of a larger amount of solution, keeping the patient always on the left side. By this simple process the rectum will be relieved — and no doubt, the sigmoid also — of feces and gas, and the vermiform muscles will be stimulated to exert traction and further empty the bowel. This can be done readily as often as is necessary without causing any ill effects whatever. I have frequently heard it said that a patient was “too weak to be irrigated.” A proper irrigation is not a shock, nor does it have any tendency to weaken. Why should it? On the contrary, it is stimulat- ing; but to use a high-temperature solution in the colon of a patient who is suffering from an eleva- tion of blood pressure or a cardiac defect is a dangerous procedure. In the same case, however, if the proper precautions are taken and a normal temperature solution employed, there is no danger other than that of adding a little more fluid to the blood stream. The soapsuds enema stimulates peristalsis, and also supplies a lubricant, but it has no value as a THE FUTILE ENEMA 95 curative measure. An enema of normal saline solution does not even possess any of these quali- ties, nor is it as efficient in liquefying feces as is soapsuds. Glycerin is an irritant to the mucous membrane. Olive oil is of no value whatsoever; it is given as an emulsifier but actually it does not possess even this action. I have placed a piece of feces in a test-tube containing olive oil, and seen it retain its form for several days; the same feces in sterile water was softened within half an hour; with a solution of sodium carbonate it was dis- solved more thoroughly, as was also the case with a solution of sodium phosphate ; and a 20 per cent, solution of hydrogen peroxid became active at once. What anyone can expect to accomplish by the single saline solution irrigation once a week which is so many times prescribed, I wholly fail to under- stand, for it often requires many successive days of daily irrigation with efficient medicated solu- tions to straighten out and clean a pelvic colon which is impacted with feces and adherent to the pelvic wall. Frequently, even before arriving at the splenic flexure when making the turn into the transverse colon, a large pocket may be found which contains a great quantity of offensive and decomposed feces and is ulcerated from the colon- ization of putrefactive organisms. It can readily 96 COLONIC THERAPY be seen how ineffective would be a saline irrigation applied without a proper rectal tube, when given but once a week, or even if it were given daily. Yet such a condition is only one of thousands which might be used in illustration. It is impossible to classify the multitude of de- fects to which the visceral organs are liable. I will cite a few cases where the pathologic conditions have been adjusted, and the patients restored to perfect health by proper daily irrigations with suitable solutions (elsewhere described in detail), combined with adjustment of diet, and tonic medi- cation prescribed by a competent internist. From one to six years have elapsed since the discharge of these patients. Case I — X-ray Diagnosis. No gastric delay (atony). Duodenum retracted backward; defect on anterior surface; spasm of duodenum; second and third portions dilated. Ulcer of duodenum. Adhesions or bands involving the terminal ileum and cecum, and obstructing the drainage of these structures. Ex- cessive ileac delay. Chronic appendicitis ; inflammatory extension upward to the inner side of the terminal ileum (adhesions). Sigmoid very redundant, consisting of several loops. Bacterial flora of the colon. Bacillus coli (numerous). Bacillus aerogenes capsulatus (numerous). Streptococci. Gram-positive bacilli. THE FUTILE ENEMA 97 Case II. Intestinal toxemia. Indicanuria. Hypothyroidism. Flora. Bacillus coll. Staphylococci (few). Bacillus aerogenes capsulatus (numerous). Gram-positive bacilli. Case III. General splanchnoptosis. Dilated, ptosed myasthenic stomach. Dilated cecum and ascending colon. Transverse colon ptosed to pelvic floor. Ptosed liver. Ptosed right kidney. Dilated, dropped duodenum. General and colonic stasis. Flora. Bacillus coli (numerous) Staphylococci (few). Bacillus aerogenes capsulatus (numerous). Gram-positive bacilli (few). Case IV. Indicanuria three plus. Intestinal toxemia. Cholecystitis. Flora. Streptococci (few). Bacillus aerogenes capsulatus in considerable number. Bacillus coli. Gram-positive bacilli and diplococci. 98 Case V. COLONIC THERAPY Spastic descending colon. Spastic sigmoid. Dilated cecum. Congested liver. Flora. Staphylococci (numerous). Bacillus coli (numerous). Bacillus aerogenes capsulatus. Gram-positive bacilli and diplococci (few). Case VI. Intestinal toxemia. Spastic anus. Atonic constipation. Dilated cecum. Inactive liver (bile insufficiency). Hypotension. Flora. Staphylococci (numerous). Bacillus coli and Bacillus aerogenes capsulatus, in mod- erate number. Gram-positive diplococci and bacilli (few). Case VII. Duodenal regurgitation. Marked indicanuria. Atonic constipation. Dilated hepatic flexure and first third of transverse colon. Infected (pus) tonsil. Beginning arteriosclerosis. Flora. An occasional streptococcus. Bacillus coli. THE FUTILE ENEMA 99 Gram-positive bacilli. Bacillus aerogenes capsulatus. Staphylococci (few). Case VIII. Intestinal toxemia. Nervous indigestion. Gastroenteroptosis. Right nephroptosis. Flora. Bacillus coli (numerous). Staphylococci (few). Bacillus aerogenes capsulatus in considerable number. Gram-positive bacilli and diplococci. Case IX. Gastro-enteroptosis. Lower end of pelvic colon adherent to rectum. Dilated pelvic colon. Angulation of splenic flexure. Transverse colon, ascending colon and cecum dilated. Blood pressure 240 (systolic). Flora. Bacillus coli. Bacillus aerogenes capsulatus. Streptococci. Case X. Spastic rectum. Large dilated colon. Marked meteorism. Flora. A saprophytic organism. Bacillus coli (few). 100 Case XI. COLONIC THEEAPY Epilepsy, grand mal. Large dilated stomach. Retarded gastric motility. Large dilated cecum and terminal ileum. Flora. Bacillus coli (numerous). Staphylococci (few). An occasional streptococcus. Gram-positive bacilli. Bacillus aerogenes capsulatus (numerous). Case XII. Gastro-enteroptosis. Asthenic abdominal wall. Prolapse of uterus. Infected right ovary. Flora. Bacillus coli. Staphylococci. Bacillus aerogenes capsulatus (few). Case XIII. Asthma. Spastic rectum and sigmoid. Angulation of the splenic and hepatic flexures. Pockets in transverse colon. Large, dilated cecum. Feces highly offensive, with odor of sulphur. Flora. Streptococci. Staphylococci. Colon bacilli. THE FUTILE ENEMA 101 Case XIV. Hemorrhoids. Ptosed rectum. Large atonic colon. Abnormally large cecum. Flora. Bacillus colt. Staphylococci (few). Bacillus aerogenes capsulatus. Gram-positive bacilli. Case XV. Marked fecal stasis. Coloptosis. Cecum adherent to pelvic floor. Flora. Streptococci. Staphylococci. Colon bacilli. Case XVI. Distended abdomen. Marked tympanites. Hemorrhoids. Large bleeding ulcer of pelvic colon. Dilated transverse colon, ascending colon, and Flora. Bacillus coli (numerous). Gram-positive bacilli. Bacillus aerogenes capsulatus (numerous). Staphylococci. (Blood positive to benzidin). cecum. 102 Case XVII. COLONIC THERAPY Marked gastro-enteroptosis. Ptosed liver. Spastic rectum, marked atony of colon with pockets. Hemoglobin — 40-50 per cent. Flora. Bacillus coli. Staphylococci (few). An occasional streptococcus. Bacillus aerogenes capsulatus (few). Gram-positive bacilli. CHAPTER VI TECHNIC OF COLONIC IRRIGATION Local medication most effective in the colon — Necessity of clearing the gut before applying local treatment — Description of cecum tube — Apparatus for irrigation — Formulas for irri- gating solutions — Purpose of the different solutions — Control of intestinal hemorrhage — Absorption of fluid — Coloptosis — Method of relief — Peristalsis as an aid in emptying the im- pacted cecum — Position of patient for irrigation — Method of advancing the tube. CHAPTER VI TECHNIC OF COLONIC IRRIGATION Local medication most effective in the colon — Necessity of clearing the gut before applying local treatment— Description of cecum tube — Apparatus for irrigation — Formulas for irri- gating solutions — Purpose of the different solutions — Control of intestinal hemorrhage — Absorption of fluid — Coloptosis — Method of relief— Peristalsis as an aid in emptying the im- pacted cecum — Position of patient for irrigation — Method of advancing the tube. In treating the defects of the colon, we must bring our efforts to bear directly, using both me- chanical appliances and medicinal agents. This can be successfully accomplished through the rec- tum as, when the solutions are applied there, they do not undergo the changes that take place in sub- stances given by mouth. Neither do they disturb the stomach or other organs. Actually but very few chemicals, when administered orally, ever reach the colon in a curative form. I find that antiseptics and other medicaments can be most effectively applied to the colon through the rectum, thus insuring their physiologic action without gen- eral systemic disturbance. An effective treatment 105 106 COLONIC THEHAPY of acidosis, or of duodenal and gastric ulcers, etc., is by the use of antiseptics followed by four to eight ounces of sodium phosphate and an ounce of sodium salicylate in a quart solution (which pro- duces a soft, lubricating, emulsifying solution) applied in the cecum. This can be given daily without any disturbance to the patient, and is a most useful method for producing general stimula- tion of the excretory tract. The only way to clean an intestinal pocket, or to straighten an adherent loop in the colon, is by mechanical and antiseptic measures. For such conditions, my most important instrument is a 54-inch cecum tube (50-French), fitted with a pointed tip, shaped somewhat like a gunnery shell. This tapering point, when passed slowly into the colon, will slip off such folds as it may encounter, and the end being flexible, it is enabled to bend around sharp angles, while the body of the tube, being more rigid, makes it possible to lift the colon. Other tubes are required, as we must have both small and large, and these must also be soft and flexible so as to prepare the way for the stiff cecum tube. The cecum tube is rigid when new, but it becomes soft from sterilization, and, where a great number are used, runs a large scale in flexibility. The irrigator consists of a swinging crane, a frame constructed to hold three glass tanks — one TECHNIC OF COLONIC IRRIGATION 107 three-gallon, and two two-quart — a small tank for antiseptic solution, and another for bacterial cul- tures. Each tank is equipped with a cover and with electric bulbs to keep the solution at a fixed temperature. Thermometers are hung from the cover to register the temperature of the solution at the bottoms of the tanks; while a four-prong glass tube is connected by rubber tubing with stop- cocks which are attached to the three tanks. A long rubber tube communicates with the lower glass prong, which in turn is attached to a three- way valve. One prong of the three-way valve is perpendicular, having two feet of rubber tubing for suction, conveying the outflow into a large bottle. The other prong, which points parallel to the patient, is provided with a tube-turner joined by means of rubber tubing to a straight glass tube used to connect the rectal tube. There is also an observation point where one may watch the return. The three-way valve rests on a folding arm, fas- tened to a special operating table provided with a flush and a glass bowl, with an electric light to facilitate the inspection and measurement of the discharge from the bowels. After an experience extending over more than ten years I have found to be most satisfactory the alternate use of solutions made up by the follow- ing formulas : 108 COLONIC THERAPY First Day: Solution in three-gallon tank: Solution of chlorinated soda (dilute)*; temperature, 37° C. Solution in small tank: Colloidal silver,** . . . 1:8000; temperature, 50° C. Second Day: Solution in three-gallon tank: Solution of chlorinated soda (dilute).* Solution in small tank: Two teaspoonfuls of the following solution to a quart of water; temperature 50° C. 85% phosphoric acid 3 drams. Hydrochloric acid (C.P.) 6 drams. Potassium permanganate 1 dram. Distilled water enough to make one gallon. Third Day: Solution in three-gallon tank: Mix: Solution of chlorinated soda (dilute).* Sodium carbonate, 1 dram to the quart. Solution in small tank: Mix: Sodium salicylate % ounce. Sodium phosphate 4 ounces. Temperature 50° C. * Chlorinated soda is a solution of chlorid of lime (1 gm.) and carbonate of soda (2 gm.) in water. As Javelle water, it was first in use as a clothes bleach, but in the 40 years since its introduction it has also been known as Labarraque’s disinfecting solution, chlora- zene, Dakin’s solution, and zonite. There is some slight variation in these different solutions. The solution was used 30 years ago in St. Luke’s Hospital, New York, for cure of varicose ulcers. Dr. Frank Markoe used it in Bellevue Hospital, New York, 28 years ago as a hand solution and to scrub the skin before operating. I have used it in my work for the last 15 years for scrubbing operating tables, and as a hand solution and general deodorizer. The solutions listed in this work are based on the use of zonite (1:100 in water), a stabilized solution of chlorinated soda not in U. S. P. strength. In other forms the solution has a tendency to deteriorate rapidly. ** I have been employing the “collene” brand of colloidal silver. TECHNIC OF COLONIC IRRIGATION 109 When using turpentine, kerosene, or any oily substance, mix with an ounce of ichthyol to eight ounces of water, which will form an emulsion. By uncoupling the rectal tube — the tube remaining in the bowel — this solution can be applied with a large, hard-rubber syringe through the rectal tube. Solution of emetin, three grains to a quart, should be used on alternate days with quinin, gr. 100 to the quart, when it is desired to destroy parasites, including ameba. The solution in the large tank serves three pur- poses: First, as an antiseptic to wash the intestine; second, to clean the intestine of feces and gas ; and third, to place and advance the tube. Therefore, its normal temperature should be such as to pre- vent unnecessary peristalsis. When the tube is placed, the high-temperature solution in the small tank is applied, if indications warrant a high- temperature solution. If in doubt, a normal tem- perature should be used, depending upon the ex- isting conditions. These solutions may be modified and changed as the conditions warrant. Where bleeding is pres- ent, the solution of colloidal silver in the small tank is used in the proportions of 1 : 4000. This solution is very effective in stopping hemorrhages and may be used daily. Bleeding from the colon is most commonly the result of ulcerations, but these ulcerations when properly treated will readily sub- 110 COLONIC THERAPY side. When the hemorrhage is from the pelvic colon, it is more apt to be bright red; farther up the intestine it is generally found in dark, almost black clots, but not necessarily so, since it depends upon the action of the chemicals and the placement of the tube, whether or not it comes in direct con- tact with the point of hemorrhage. When mixed with feces, the blood is dark brown, and its amount can be approximately estimated by the depth of the positive color reaction of the benzidin test. But in applying these tests, one must be mindful of the amount of meat in the patient’s diet. The digestive juices must always be taken into con- sideration, as I have seen cases, where the patient was on a red meat diet, in which no positive blood reaction was found. On the other hand, I have removed quantities of solution colored red by the blood from a duodenal ulcer. I have also removed feces from the cecum which were bright yellow and showed marked blood reaction, likewise due to the bleeding from a duodenal ulcer. The rectum, sigmoid and cecum are the most common points of hemorrhage, but we can find it in many locations in the colon, depending upon the anatomical defects which follow ptosis. The cecum is more often distended than any other part of the colon, angulation of the flexures being fre- quently the cause. When this distention exists, we may expect to find ulcerations in many forms, and TECHNIC OF COLONIC IRRIGATION 111 such phenomena as sharp pains in the vicinity of the hepatic flexure extending to the back on the right side, falsely suggesting gall-bladder dis- turbance, or pains and symptoms identical with those of an inflamed appendix. Though this con- dition can be easily detected, caution must be used in unloading a distended cecum, as perforation due to ulceration has occurred and has at times even caused death. The solution in the large tank should contain solution of chlorinated soda (dilute), at 37° C., and in the small tank six to eight ounces of sodium phosphate and an ounce of sodium salicylate to a quart of solution at 50° C., the patient being kept on the left side. When irrigating, never allow more than a few ounces of solution to remain in the intestine at a time. The object is to open the flexures; and the feces and gases may be removed from the rectum and sigmoid, the splenic flexure opened up, and the transverse colon cleansed by siphoning. I have often given relief in this way, and have removed quantities of feces from the transverse colon, relieving the cecum, after reach- ing the splenic flexure. When the transverse colon is sufficiently empty, fill it with the solution from the small tank, remove the tube, and raise the patient to a sitting position with instruction to relax the muscles but not to force a bowel movement. A quantity of fluid will 112 COLONIC THERAPY remain in the colon, and the following day great quantities of feces can be removed, as it generally requires from eight to twenty-four hours for a physiologic action to result from sodium phosphate and sodium salicylate. Following a violent dis- tention of the cecum, some hemorrhage is likely to take place. When this occurs, a hot solution of colloidal silver should be employed . 31 Absorption of solutions from the intestines is not merely a simple, physical phenomenon which can be sufficiently explained by the process of filtration or osmosis; it depends upon the vital activity of the intestinal epithelium. When the intestine is unable to expel the solution because of physical defects, the solution may be absorbed rapidly or, again, it may remain in the colon for hours. W 7 e know that when stasis exists, absorption is less rapid, but we also know that more solution is ab- sorbed in the presence of stasis. When irrigating, it is well to bear in mind that intestinal distention increases absorption, and that in the colon some chemicals are more easily absorbed than others. A mixture of sodium salicylate and sodium phos- phate is a powerful stimulant to fluid secretion by the villi fistulae of the colon and ileum, a compara- tively small quantity of these chemicals being absorbed into the blood stream; but potassium iodid applied in the colon is absorbed into the blood stream within a few minutes after its administra- Fig. 13. — Operating table and irrigator, showing the three-way valve. When the treatment is concluded, the patient may be raised into the sitting position while still upon the table. ' • ■: TECHNIC OF COLONIC IRRIGATION 113 tion, producing iodism of the mouth. Solution of chlorinated soda (dilute) is practically a local anti- septic on the intestinal wall, as is also colloidal silver solution. Quinin administered in the colon in 100 grain doses can rarely be detected by the patient. It is only when atony is present that the colon becomes ptosed, this ptosis being due to the relaxa- tion of the muscles. In many cases of marked redundancy of the left colon I have found the cecum distended with residue very low in the right iliac fossa. The redundancy of the sigmoid is due to the continuous pulling of the physically de- teriorated muscles in an effort to raise the impacted cecum. As these patients suffer from gas disten- tion, regurgitation, vomiting and other distressing symptoms, relief can be given by passing the tube into the cecum. Very little tone is found in a colon thus afflicted, and the tube is more readily passed, due to the fact that the weakened waves and con- traction of the intestine and transient sphincters of the colon are very easy to overcome with water- pressure, and when a portion of the gut is dilated it is very slow to contract. Caution must be used in this condition, however, since, if one is not care- ful, a great deal of solution is apt to be forced into the cecal region and cause distention at the wrong time. Where this condition exists, we find that a high-temperature solution of 50° C. applied in the 114 COLONIC THERAPY cecum or ascending colon will stimulate constrict- ing colon waves, which cause the patient to expel huge masses of feces, otherwise irremovable. To produce peristalsis sufficient to empty the cecum, this solution must be applied in the cecal region. In beginning an irrigation, place the patient on the left side provided the colon is not transposed. Wash off the rectum with a solution of carbonate of soda and chlorid of lime; then clamp the end of the rectal tube, sterilized and full of solution, with a sponge forceps; and lubricate the rectum with sterile white vaseline or, if it is spastic or if hemorrhoids are present, with adrenalin ointment. In any condition of the rectum insert the tube very slowly. Remove the sponge forceps and allow three or four ounces of solution to flow into the rectum. Reverse the three-way valve allowing the gas and solution to escape. Repeat, using the same amount of solution, or increasing it if neces- sary. Irrigate the rectum until the returned solu- tion becomes practically clear. With the water flowing, advance the tube a short distance into the intestine; then reverse the valve and allow the solution to escape. Repeat this maneuver until the solution comes away practically clear. In this way progress can be made into the pelvic colon. Distending the colon and forcing the folds of the intestine forward while the water is flowing is but one method of advancing. Sometimes the TECHNIC OF COLONIC IRRIGATION 115 condition of the intestine is not amenable to this technic. It may be necessary to distend the intes- tine, after which the reverse valve is thrown open allowing the water to escape, and passing the tube at the same time. In this way the intestinal wave will be encountered and the gut will slip over the tube as it meets the wave or contraction. In like manner, where a great quantity of feces and gas lies beyond the colon sphincter, when the tube has been advanced and has come in contact with the contracted portion of the intestine, it will be pos- sible to distend the intestine, and then draw back the tube with the valve opened. By this method a transient sphincter of the colon may be induced to relax, and a wave will follow the tube which will allow the gas and feces to escape. When this is accomplished, the colon should be dilated and the tube passed simultaneously, before the gut has time to contract further. The amount of solution put into the intestine should be carefully gauged, as often in certain con- ditions control may be lost; for example, perhaps a turn cannot be made at the splenic flexure, and the solution will flow over into a large redundancy in the transverse colon, and cannot be removed, and the resulting distention of the redundancy may cause a contraction and force the water still further over into the cecum, or — if the ileocecal valve is incompetent — even into the ileum. When 116 COLONIC THERAPY confronted with this condition, the tube must be drawn back a few inches and the flexure dilated. It will then be possible to siphon. If not, the tube must still be retracted. The patient being on the left side, gravity is in the operator’s favor. Again perhaps there may be a floating and stretched transverse colon, persistently ptosed to the left, which is weighted with feces and solution ; this is likely to press against the tube and cause it to kink. If this or similar conditions occur, turn the patient on his back, carefully regulating the amount of solution allowed to flow into the intes- tine. Under these conditions, the tube must be passed with only a small amount of solution, fre- quently throwing open the outflow, until it is pos- sible to siphon out the feces and solution locked in the intestine. In a large atonic intestine dis- tended with feces and gas, the tube will often hug the upper surface of the gut where only gas is present. The solution when flowing into the colon will go to the bottom, and when the valve is re- versed it will be found that the tube is filled with gas. The only way to overcome this is to remove the tube slowly, with the valve open (which per- mits the gas to rush out) ; then refill the tube with solution, reinsert it into the rectum; and continue as before. Allow but a few ounces of solution to flow; then reverse the valve. The gas may have followed the tube down to the rectum and here TECHNIC OF COLONIC IRRIGATION 117 it can be removed. When the sigmoid is reached, change the position of the patient, as by so doing any remaining gas will be more apt to be removed. A gas pocket in the intestine is generally coinci- dent with the presence of feces, and is very difficult to remove. It may sometimes be necessary to withdraw the tube wholly under these conditions. If so, distend the colon with hot solution, remove the tube, and allow the patient to expel. After this has been accomplished, the irrigation may be continued. There have been so many inquiries as to the danger of passing cecum tubes in the colon, that I will avail myself of this opportunity to say that 120,000 treatments have been given in my clinic without the slightest injury or mishap, other than occasionally a slight local pain due to spasms or the opening of an angle, and this was felt only during the operation. CHAPTER VII SPECIAL APPLICATIONS OF COLONIC IREIGATION Colonic atony — Treatment of fecal impaction following milk diet — Causal organism in arthritis — Method of irrigating a spastic colon— Bacterial colonization — Irrigating in the presence of putrefactive foci — Stimulating effect of irrigation — Fecal impaction simulating malignancy — Irrigation when malignancy is suspected — Dilatation of colonic angulations and flexures — Preparation for x-ray observation. CHAPTER VII SPECIAL APPLICATIONS OF COLONIC IRRIGATION Colonic atony — Treatment of fecal impaction following milk diet — Causal organism in arthritis — Method of irrigating a spastic colon — Bacterial colonization — ‘Irrigating in the presence of putrefactive foci — Stimulating effect of irrigation — Fecal impaction simulating malignancy — Irrigation when malignancy is suspected — Dilatation of colonic angulations and flexures — Preparation for x-ray observation. In many atonic conditions of the colon a tube can be readily passed into the cecum. An illus- trative case is that of a boy fourteen years of age, who was confined to bed with a distended abdomen (the intestinal waves being apparently dormant), arthritis of eight weeks’ standing, swelling of the joints, and a daily temperature range of from 101° to 102.5° F. The patient, who had been taken off a milk diet two weeks previously and put on a soft diet, was greatly reduced in weight. Though it was difficult to outline the colon so as to locate any fecal mass, dulness over the right iliac fossa was very marked. The simple passing of a tube containing a solution of chlorinated soda (dilute) at 37° C. through the colon caused the 121 122 COLONIC THERAPY expulsion of great quantities of gas with small fragments of feces and mucus. From the cecum, a large amount of variously colored feces was re- moved which included small white balls of milk curds. A quart of solution containing one ounce of sodium salicylate and six ounces of sodium phos- phate at a temperature of 51° C. was applied in the cecum. As soon as the patient was placed on a commode the colon immediately contracted and expelled a large amount of dark-brown, offensive residue, including six hard white chunks as large as golf balls, composed of putrefying milk curds, which had accumulated and lain in the cecum for at least two weeks. These feces upon examination showed a marked streptococcus infection. Follow- ing the treatment the abdomen relaxed, so that it was easy to locate the organs, the dulness over the cecum disappeared, and the temperature dropped to normal that evening. After five similar treat- ments the joints were approaching their normal condition and there was no further rise of tempera- ture. After treatment for two weeks with solu- tions of colloidal silver alternating with acid solu- tions made up according to the formula previously given, with the addition of a nightly compound carthartic pill containing one-half grain of calo- mel, the following mixture was administered at night : One and a half ounces of castor oil; ten minims APPLICATIONS OF COLONIC IRRIGATION 123 of tincture of iodin; and three grains of menthol. This was followed by eight ounces of citrate of magnesia in the morning. A daily implantation of Bacillus acidophilus and Bacillus bulgancus cul- ture was made until eight plants had been given. A solution of sodium phosphate and sodium salicylate was given every fourth day as a cecum douche following an irrigation of sterile water. Implantations of culture were given three times a week for six weeks. Bacillus acidophilus milk was administered orally; at the end of this period, the patient’s condition was normal. The mechanism of the therapy in this particular case is easily understood, as the focus of infection was found in the cecum where curative measures could be applied without difficulty. The medica- ments used were stimulants to the endocrine sys- tem and producers of metabolic drainage rather than direct systemic specifics. The conditions ex- isting here were due to a streptococcus infection, though arthritis is not always produced by the streptococcus as several other putrefactive micro- organisms, including staphylococcus, may be the primary cause of arthritis. The tube could be readily passed, as there was very little ptosis of the colon and the flexures were not angulated. If the same condition had existed in the cecum to- gether with malformation and loops and angula- tion at the flexure and perhaps a spastic condition, 124 COLONIC THERAPY the results would not have been obtained so rapidly. As it is, it very frequently happens in irrigating that spasms of the pelvic colon make it painful to pass a tube beyond this spasm. Under such circumstances, it is advisable to use adrenalin ointment as a lubricant on the tube ; and to employ a very weak solution of chlorinated soda (zonite, 1:500) with a solution of colloidal silver at 35° C., applied in the spastic sigmoid. A small rectal tube, known as a “tracer,” is the best instrument for this purpose. The tube can be passed during the period of relaxation between spasms. During the spasm the outflow must be left open, and when relaxation takes place the water is thrown on, but no attempt made to pass the tube. If the spasm re- occurs, the outflow is again thrown open, careful observation being made as to whether the tube is free. When it is free, the solution may be turned on and the tube passed with as great speed as the feeling of clearance ahead allows. If the tube goes through the sigmoid, no further advance should be made, but the small tank with the solu- tion of colloidal silver turned on and if possible, the contents of the tank emptied in the colon. The object of this is to dilate the constricted area with hot solution which, when expelled, will automati- cally apply itself to the distended wall of the in- testine. In treating a spastic colon, the use of any irritating catharsis as an auxiliary should be Fig. 14.- Roentgenoscopic view of colon, following examination and initial treatment. The figure shows the faint outline of a large fecal impaction in the cecum, which is resting against the redundant sigmoid. In the middle third of the transverse colon a faint shadow is visible. As the colon displays no sacculi, it is evident that the impaction of feces prevented the complete filling by the barium meal. P. B. Hoeber, New York, 1922. 16. Jacobi: Arch. f. exper. Path. u. Pharmakol., 27:147, 1890. 17. Cannon, W. B. : The mechanical factors of diges- tion. Longmans, Green and Co., 1911. 18. Case, James T. : The x-ray investigation of the colon. Surg. Gynec. & Obst. (Internat. Abst. Surg.), 19:581, December, 1914. 19. Kellogg, J. H. : Colon hygiene. Good Health Pub. Co., 1916 (p. 92). 20. Schellberg, O. B.: Systemic disturbances due to colonic infection. Am. Med., 17 : 636, Nov., 1922. 21. Cammidge, P. J. : The faeces of children and adults. Wm. Wood and Co., 1914. 22. Stokes, C. F. : Am. J. Electrol. and Radiol., 41:73, March, 1923. 23. Taylor, F. B., and Alvarez, W. C. : The effect of temperature on the rhythm of excised segments from different parts of the intestine. Am. J. Physiol., 44 : 344, 1917. 24. Case, James T. : Loc. cit. BIBLIOGRAPHY 195 25. Lynch, J. M. : Diseases of the rectum and colon. Lea and Febiger, 1914. 26. Gant, S. G. : Constipation, obstipation and intestinal stasis. 2nd edition, W. B. Saunders, 1916. 27. Hurst, A. H. : Constipation and allied intestinal disorders. 2nd ed., H. Frowde, 1919. 28. Pfahler, G. E. : Adhesions and constrictions of the bowel ; their demonstration and clinical significance. J. A. M. A., 59 : 1770, Nov. 16, 1912. 29. Schellberg, O. B. : The incorrigible colon corrected by medicated irrigation. Internat. J. Surg. 35 : 208, June, 1922. 30. Gael and, Wm. H. : The Schellberg treatment for chronic colonic infections. N. Y. Med. J., 114: 106, July 20, 1921. 31. Schellberg, 0. B.: Technic of colon irrigation. Internat. J. Surg., 36:18, January, 1923. 32. Hutchison, Robert: The chronic abdomen. Brit. M. J., 1 : 667, April 21, 1923. 33. Campbell, Harry: The evolution of man’s diet. Contained in A System of Diet and Dietetics. Edited by G. A. Sutherland, Oxford Med. Pub., 1908. INDEX Abdomen, chronic, 172-181 Abdominal belt, misuse of, 183 Absorption of solutions from in- testine, 112 Adaptive radiation, law of, 20 Adhesions due to intestinal per- foration, 80 intestinal interlining, 78, 133 Adrenalin ointment in colonic spasms, 124 Alcohol less injurious than too much sugar, 186 Alimentary canal, autonomy of, 55, 74 efficient incubator, 39 evolution of, 19-32 focus of infection, 31 variations in different animals, 47 Allbutt, Sir Clifford, 174 Alvarez, W. C., 55, 74 American Electro-Therapeutic Association, 72 Ampulla of rectum, 54 Angina pectoris, vasomotor, 168 Animals, Australian, 23-28 Antiseptics and bacterial implan- tations, 139-148 Apparatus for irrigation, 106-107 cecum tube, 106 irrigator, 106-107 temperature control, 107 three-way valve, 107 Appendices epiploicae, 83 Appendix. See Vermiform ap- pendix Arthritis, cause of, 123 Asthenia due to corset wearing, 184-185 Australia, 23 Autonomy of the gastrointes- tinal tract, 55, 74 Bacillus acidophilus, 123, 129, 139-148 merits of, 142 aerobic liquefying, 37 aerogenes capsulatus, 44, 96, 97, 98, 99, 100, 101, 102, 145 biftdus, 36 bulgaricus, 123, 139-148 merits of, 142 coli, 30, 36, 41, 44, 96, 97, 98, 99, 100, 101, 102 Gram-negative, 36, 44 Gram-positive, 36, 44, 96, 97, 98, 99, 100, 101, 102 lactis aerogenes, 44 Bacteria, predominance of dif- ferent types of, 44 intestinal, 35-44 seasonal variations in, 39 Bacterial implantation, 139-148 results obtained from, 144 technic of, 140-141 Barium meal, 128 Batchelor, M. D., 36 Bauhin’s valve, 49 Biliousness due to milk diet, 61 Blackfan, K. D., 36 Blood stasis, 154-155 Bowel. See Intestine 197 198 INDEX Breath, fecal odor of, 159 Bundy, E. R., 54 Bunge, 60 Cammidge, P. J., 62-63, 79 Campbell, Harry, 186 Cannon, W. B., 58 Case, J. T., 58, 80 Case reports, asthenia due to cor- set wearing, 184-185 fecal accumulation following milk diet, 121-123 illustrating various pathologic conditions, 96-102 mental depression due to colonic stasis, 167 restoration of organs to nor- mal position, 127-130 Casts of the bowel, 78-79 Catharsis does not drain the sys- tem, 76 in conjunction with irrigation, 148 in mucous colitis, 43 produces vomiting, 158 uselessness in colonic stasis, 75 Cecum, lining in man and ani- mals, 53 of horse, 24 of marsupials, 24 passing tube into, 126 treatment, cure for “chronic abdominalism,” 181 unloading a distended, 111 Chemicals seldom reach the colon in curative form, 105 Children, feces of, 36-37, 63 school examination of, 32 Chlorinated soda, solution of, 108, 111, 113 Chronic abdomen, 172-181 Circulation, constriction of, 154 stasis, 154 Colitis, mucous, 43 Colloidal silver solution, 108, 109, 112 Colon, action of gases in, 59 bleeding from, 109 carcinoma of, 83 Case’s x-ray work on, 81 clean-up and catharsis, 139 constrictions of, 83 contracted by vermiform mus- cles, 132 course of, in man, 49-50 diverticula, 81 divisions of human, 27 floating, 116 function of normal, 157 function of sacculations of, 59 grounding point of vermiform muscles, 155 hemorrhage from, 109 hepatic flexure of, 57 high “hot,” 92 knowledge of its anatomy nec- essary, 87 length of, in man, 49 longitudinal fibers of, 50 may be “reformed,” 77 mucus strips in, 158 nerve stimulation of, 164 nerves of, 57 not like an abscess, 131 redundancy of, 113 passing tubes into, 117 ptosis of, 163 refilling of, 161 sigmoid, 54 spasms of, 123, 124 spastic, treatment of, 124-125 splenic flexure of, 132 stretched, 116 subdivisions of, 49 taenia of, 50 traction muscles of, 57 INDEX 199 Colon, transient sphincter of, 126 Colonic irrigation, amount of so- lution carefully gauged, 115 antiseptic, 108 beginning, 114 not a shock, 94 number of treatments, 117 putrefactive elements removed by, 89 restores intestinal activity, 74 simpler and safer than sur- gery, 88 solutions for, 108, 109, 114 special applications of, 118-135 technic of, 105-118 without special apparatus, OS- 94 Colonic stasis responsible for en- docrine dysfunction, 72 Constipation, an inadequate term, 153 Corium of small intestine, 52 Corset-wearing, 185 Crabbe, 178 Crile, G. W., 21-23 Culture medium for B. acidoph- ilus, 147-148 Darwin, Charles, 19, 20 Defects of the visceral organs, 96 adjustment of, 96 Devil, Tasmanian, 24-27 Diet, faults in modern, 189-190 meat less harmful than sugar, 187 milk, 60-62 primitive human, 21, 188-189 refinements of, 29 secondary factor in growth of putrefactive organisms, 40 Divergence, law of, 20 Duodenum, 48 Enema, soap-suds, 94 useless as ordinarily employed, 89-90 Epilepsy, 31, 100 Epsom salts, use of, 76 Experience in passing cecum tube, 126 Fecal impaction, removal of, from colon, 158 residue, 160 stasis, consequence of, 153-168 due to sleeping on right side, 163 variation of effect of in dif- ferent individuals, 154 Feces, appearance of, 160 constituents of human, 62-63 of children, 36-37 yeasts in, 36-37 Flora, intestinal, 35-44 seasonal variations in, 39 Foci of infection, attention re- cently paid to, 70 in cecum, 123 direct cause of disease, 153 not always in the head, 71 Follicles, agminated, 52 solitary, 52 Ford, W. W., 36 Galland, W. H., 89 Gant, S. G., 83 Gas, fecal, expelled by lungs, 159 in colon, difficulty of removing, 116 Glands, agminated, 52 Hepatic flexure, 57 Hernia of the mucosa, 82 High hot colon, 92 High-temperature solution stimu- lates colon waves, 114 200 INDEX Human machine, 171-192 adjustment of, 191 Hutchison, Robert, 171, 181 Hypotonia, 167 Ileocecal valve, 49 backfire of gases through, 66 incompetency of, 126 structure of, 54 Infants, artificially fed, 36 fecal flora of, 35-38 Infection, focal. See Foci of in- fection Intestine, anatomy and physiol- ogy of, 47-65 casts of, 78-79 flora of, 35-44 in cat family, 49 in marsupials, 24 interlining adhesions, 78, 133 large; see Cecum, Colon length in adult man, 48 in cat, 48 in horse, 48 marginal blood-vessel parallel to, 154 secretions, analysis of, 69 ingredients of, 65 small, villi of, 51 stasis, cause of putrefactive processes, 42 subdivisions of large, 49 toxins, 41, 42, 43 x-ray examination, 80-81, 84, 96-102, 130, 136 Intra-abdominal pressure, 90 Irrigation. See Colonic irriga tion Jacobi, 58 Jej uno-ileum, 48 Jejunum, 48 Kangaroo, 24 Kellogg, J. H., 60-62 Kendall, A. I., 38 Koala, 24-27 Lane, Sir Arbuthnot, 77 Lettuce, digestibility of, 60 Locomotion of serpents, 156-157 Longitudinal fibers of colon, 50 Lynch, J. M., 82 MacKenzie, William, 23, 27 Mammals, primitive types of, 20 Marginal blood-vessel parallel to bowel, 154 Marsupials, 24, 26-28 Meconium, 35 Mental disturbance, relation to digestive disease, 163-168 Metabolism, cellular, 30 changes in, during disease, 70 errors in, 71 Microorganisms in internal chem- istry, 30 intestinal, 35-44 types of, 44 Milk, bacillus acidophilus, 123, 145 diet, condition of colon after, 121-122 sugar of, 146 Monotremes, 24 Mucous colitis, 43 Mucus strips in colon, 158 Mushrooms, digestibility of, 60 Natural selection, theory of, 19 Nerves of alimentary canal, 164 Neurotic, definition of, 181 Number of patients treated, 142 Olive oil, 95 Omnivorous adaptation, 21 INDEX Osborn, H. F., 20, 21 Owen, Richard, 156 Pain, difficulty of localizing, lev- ies transferred, 165-166 wrongly attributed to inflamed appendix, 165 Patients, condition of, after bac- terial implantation, 145- 146 Peristalsis, definition of, 55 mechanism of, 56 reverse, 58 waves, course of, 55 Peyer’s patches, 52-53 Pfahler, G. F., 83 Pneumococcus, 30 Position of patient in gastropto- sis and coloptosis, 163 to relieve splenic flexure, 132 when colon is not transposed, 114 with floating and stretched colon, 116 Postoperative conditions, treat- ment of, 182-183 recurrences, 161 Preventive medicine, 190-191 Rami communicantes, 57 Rectum, description of, 54-55 Relative merits of Bacillus acido- philus and Bacillus bul- garicus, 142 Results of general “clean-up,” 147 Russell, E. S., 20 Sacchabides, injurious effects of, 187-190 Serpents, 156-157 Sigmoid, 54 201 Solutions for irrigation, antisep- tic, 109 formulas, 108 high temperature stimulates colon waves, 114 Spasms of colon, adrenalin oint- ment in, 123 Spinach, iron content of, 60 Stapley, William, 23 Stauffer, W. H., 43 Stokes, C. F., 72, 131 Stomach, digestive functions of, 63 of carnivora, 47 ptosis of, 163 variation in different animals, 47 Strassburger, 43 Sugar of milk, 146 Tvenia coli, 50 Tasmanian devil, 24-27 Tomatoes, digestibility of, 60 Toxins, effect of, upon the nerv- ous system, 43 generated by moisture in bowel content, 42 intestinal, 41, 42, 43 produced by anatomic defect in intestinal wall, 41 Treatments, number of, in au- thor’s clinic, 117 Vagotonia, 167 Valvulae conniventes, 51 Vermiform appendix, location of, in man, 49 of wombat, 24 Vermiform muscles, grounding point in pelvic colon, 155 of serpents, 156-157 Villi of small intestine, 51 INDEX 202 Vomiting induced by hot enema, 158 result of stimulating medulla, 162 Wombat, 24-27 X-rays, Case’s work on, 80-81 X-rays, diagnoses, 96-102 of colon, likened to silhouette, 84 preparation of patient for ex- amination, 136 rectal tube in colon, 130 Yeasts in children’s feces, 36-37 i>ate Due JAN 1 7 ’30 m 2 1 L. B. Cat. No. 1137 616.34 S322C ^chellberg . c c. v o rx S w * - \J 126046