At times, even in those who have been accustomed to the use of the enema, difficulty is experienced in causing the water to penetrate beyond the sigmoid flexure. There may be slight griping pains when this occurs. Hindrance of the kind may be due to gas in the bowel or to nervous contraction of the muscles of rectum and flexure. If the difficulty persists, small amounts of water should be injected and discharged, this procedure to be repeated until the contraction ceases or the gas is discharged. Manipulation of the abdomen over the region occupied by the parts of the bowel involved usually affords prompt assistance, but, should the trouble prove obstinate, repeating itself at each attempt at injection, there is reason to believe that structural defect of some sort is present in the bowel.

In certain cases, when the enema is being employed daily under treatment, if there be in the subject a tendency to the formation of hemorrhoids or piles, these blood tumors may appear in and about the rectum and anus. In this contingency local application of some soothing emollient should be made to relieve irritation, and a properly constructed rectal dilator should be used to mitigate congestion. The symptom will not persist at length, and the enemas should continue notwithstanding slight inconvenience. But, while the hemorrhoids are in evidence, the dilator should be worn. It is to be borne in mind that in health the use of the internal bath twice weekly, as suggested herein, will preclude congestion of the rectum, and that hemorrhoids are unknown to one who employs this simple cleanly measure.

To revert to the condemnation visited upon the internal bath. Two cogent arguments lie behind this censure, of which one is commercial in character, for purgatives are sold at a price, and prescriptions also bring fees; the other is discovered in that an enema administered under medical direction is not correctly given either in posture or in quantity of fluid, and advice is usually proffered that the latter be retained for a time in the bowel. Hence these injections merely succeed in stirring up a filthy mass, putting it into condition to be easily absorbed, with increased auto-intoxication and subsequent depression as results. If a feeling of weakness occurs in a patient after an enema administered as described in the text, it is due to the removal of poisonous stimulation, the consequence of absorption from the contents of the colon. Once the accumulation is discharged and the bowel cleansed, recuperation is almost instant.

Physicians have also claimed that no appreciable absorption of fecal matter in solution or of its products can take place from the large intestine. But medical science long since stultified itself in this respect when it recommended the employment of nutrient enemata in cases where feeding by way of mouth and stomach was refused. Denying that the contents of the bowel may be returned in part to the circulation through the walls of the gut, it nevertheless affirms that sustenance may in this manner be absorbed. It assumed and it still assumes that tissue may be nourished and that strength may be maintained by matter that does not undergo the process of normal digestion, introduced into the system by way of the colon. What occurs in this instance is stimulation, and poisonous stimulation at that, for material absorbed through the walls of the large intestine is received, not by the portal or nourishing portion of the circulation but directly by the venous blood, which already is laden with impurity awaiting oxygenation. Food substances introduced into the organism in this manner putrefy and poison. To deliver household water to the faucets through the sewers of a city would be deemed an act of insanity, yet analogy is plainly apparent when this method of transmission is compared with that of food injected into the body by way of the rectum.

In most cases during the development of disease the intestines are filled with food variously changed by the digestive processes but then in a state of fermentation; and the blood is laden with poison largely the product of morbific decomposition. The retention of excrement or waste in the alimentary canal, coupled with its disease-producing putrefaction, gives rise to bowel stoppage or constipation, and it may also cause the reverse condition, excessive liquid movements or diarrhea. Both of these phenomena are indicative of an unnatural, abnormal condition, are the immediate consequences of indigestion, and their toxic sequelae still further vitiate the entire organism.

Man in his natural state lived as nature dictated, and living naturally he was free from the harmful effects that arise from the retention of excrement in the colon, since fecal matter was not retained in the bowel long enough to be injurious. But man in his civilized state lives in many ways not naturally, and suffers in consequence. In natural conditions the human intestines are unobstructed by accumulation of refuse, and, as is the case with the lower animals, they are evacuated by frequent passages. This observation may be extended by stating the actuality that fecal matter in natural evacuations, refuse from the natural food of man, which was non-flesh in character, is almost without odor. That this is not true in the usual present-day instance needs no comment.

During a period of fasting the function of elimination is paramount, and waste from body tissue is cast into the intestines in profuse amount. The fluid state of this refuse permits of easy absorption, and its prompt discharge is imperative. From the beginning of abstinence until indications point to approaching completion of systemic cleansing, brownish, foul-smelling discharges are evacuated, and, in the earlier stages, hardened feces dislodged from the walls of the bowel are cast out in the enema. As purification progresses a feature more or less noticeable is the appearance of quantities of stringy white or yellowish mucus. This phenomenon is elsewhere commented upon, but the discharge is catarrhal in origin, although no inflammation of intestinal mucus membrane now exists. It consists of the remnants of impurity remaining in tissue structure, and is evidence of the complete purification that is accomplished by permitting the function of elimination full scope. Depending upon the responsiveness of the individual organism, this symptom is sometimes present from the beginning of a fast, and it is always noted in greater or less degree at some point during prolonged abstinence from food.