When fasting, the enema is an essential daily adjunct, and at this time it should be administered on rising, or shortly thereafter, and before retiring. In health, as a preventive of self-poisoning, an enema is advised at least twice in each week. It will be found a most relieving as well as cleansing operation, and it will obviate all chance of fecal accumulation, which means constipation with subsequent septic poisoning.

In a succeeding chapter mention is made of a procedure recently promulgated by both medicine and osteopathy--that of colonic therapy by means of what is known as cecal injection. This embodies the introduction into the bowel of a specially constructed colon tube of length sufficient to reach with its open tip the cecum. This being accomplished, the bowel discharge obtained, facilitated by injecting a solution of salt, is examined to determine the nature of the bacilli resident in the particular human subject at this point. These bacilli are then classified, and, if certain microbic forms are present, again through the colon tube an implantation by injection of bacillus acidophilus is made. The latter germ is said to have a very salutary effect upon the intestinal mucus membrane, and so to strengthen its powers of resistance as to cause it to withstand the attacks of any deleterious organism which happens to invade its precincts. It may be that the particular microbic infection of the cecal region is a mere amebic infestation--a simpler but more prevalent form of micro-organism than are those requiring to be confronted with a line of battle--and in this instance an antiseptic, consisting of kerosene and ichthyol, the latter a substance prepared from asphaltum, is forced to the domain of the enemy. This is followed by solutions of quinine, of emetine, a drug that has emetic properties, and of plain salt. No doubt the enemy at once retires when this onslaught on his forces occurs, but what of the poor victim whose body he inhabits?

No intelligent reader of these lines can fail to be impressed with the comparison between that method of therapy which insists upon attacking the outposts of disease, its symptoms and the regional abodes of its micro-organisms, and that system of healing which contends for the eradication of the cause underlying the existence of both symptom and bacilli. That the enema, administered as described in this chapter, in conjunction with the eliminative effects of the fast, does all that may be claimed for palliative, temporary agencies, one of whose tedious procedures is here detailed, is patent. And they accomplish much more, even to the ultimate desired result, bodily purification, rendering through their offices every organic secretion physiologic, hence resistive, rather than pathologic, with no power to repel organism inimical to health.

NOTE I

Details of administration of an enema to the infant.

The usual fountain syringe should be used, equipped with convenient length of tubing, with shut-off, and a small-sized rectal tip. An extra unattached tip should be at hand, the use of which is later explained.

There should also be a low chair or stool admitting of holding the recumbent child in the lap at a height slightly above the level of the bowl of the toilet.

Two pieces of rubber sheeting are needed, each one yard in length. One of these should be thrown over the top edge of the raised seat of the toilet, draping it so that it may receive spatterings and forcibly ejected discharges. The other should be placed one-half over the lap of the operator, permitting its free end to cover the front edge of the toilet bowl with sufficient length dropping over the inner edge to convey discharges into this receptacle. A folded Turkish towel should be laid over the end of the sheeting on the lap in such position as to be under the buttocks of the child, thus raising them slightly and preventing contact with the surface of the sheeting.

The operator should sit with right side next the toilet bowl, with the infant lying upon its back across the knees.

Care must be observed in inserting the rectal tip into the anus, and the right hand of the operator should hold it in position after insertion and while the water is flowing. Greasing the tip with olive oil or with an antiseptic lubricant will prevent irritation of the membrane of the orifice. The flow may be regulated by the shut-off or by pinching the soft rubber tubing with the thumb and forefinger of the left hand.

In small children during the administration of the contents of one bag of water, it is usually not necessary to remove the rectal tip from the anus, since the liquid form of the discharge permits ejection around the sides of the tip, and repeated insertion and withdrawal with possible chance of irritation is thus avoided. After the exhaustion of the water in the syringe, the attached tip should be withdrawn, and the unattached one mentioned as part of the equipment should be introduced into the anus. Through it evacuation of that portion of fluid retained in the colon will occur the more easily, since by this means constriction of the muscle of the anus is overcome. Neither pipe should be inserted to greater depth than two inches. At this stage of the procedure manipulation should be made of the abdomen, following the ascending colon on the right side from the cecum to the transverse bowel, thence over the transverse section to the descending colon, thence down the left side to a position corresponding with its extremity and outlet. This is an essential that should not be omitted, since it assists peristaltic action and hastens evacuation. The total quantity of water injected in giving this enema should not be less than six quarts, and, if extreme discoloration in discharge persists, more fluid should be used. It is of course understood that it is not possible to inject this amount of water into the colon at one time, but that repetition in injection and discharge of fluid is here implied.