Part 19

Ascites caused by an Ovarian Tumor.--The tumor must be removed. I am not in favor of indiscriminate operating, but operations often save lives. I remember one case in which I very strongly urged the lady to have an operation performed. It was a case of ascites, caused, as I was sure, by a tumor of the ovary. The lady, as almost all people do,--and I do not blame them for it,--dreaded even the thought of an operation, but she was finally compelled to have an operation or die. She filled so full that it was almost impossible for her to breathe. She went away from home in terrible shape, almost out of breath, and returned home a well woman and has remained so. Such cases formerly died. But not all cases of ascites can be cured by an operation, it depends upon the cause. In many cases all one can do is to doctor the cause, if that cannot be removed, make the patient's remaining days as comfortable as possible.

DISEASES OF THE RECTUM AND ANUS.--The lower part of the alimentary canal is called the rectum, originally meaning straight. It is not straight in the human animal. It is six to eight inches long. The anus is the lower opening of the rectum. In health it is closed by the external Sphincter (closing muscle). Disease may wear this muscle out and then the anus remains open, causing the contents of the bowel to move involuntary.

CONSTIPATION. Causes.--1. Mechanical obstruction.

2. Defective motion of the bowels.

3. Deficient bowel secretions.

4. Other causes. Mechanical obstruction.--Anything that will hinder the free and easy passage of the feces (bowel contents). Too tight external sphincter (rectum) muscle, stricture, tumors, etc. Bending of the womb on the bowel.

Defective Worm-like Bowel Movement.--Irregular habits of living head the list causing this defective action. Everyone should promptly attend to Nature's call. Some people wait until the desire for stool has all gone, and in that way the "habit" of the bowels is gradually lost. Everyone should go to stool at a certain regular time each day, and at any other time when Nature calls. If a person heeds this call of Nature, the call will come regularly at the proper time, say every morning after breakfast. If these sensations (Nature's calls) are ignored day after day, the mucous membrane soon loses its sensitiveness and the muscular coat its tonicity, and as a result, large quantities of fecal matter may accumulate in the sigmoid (part of the bowel) or in the rectum without exciting the least desire to empty the bowels. Again, irregular time for eating and improper diet are liable to diminish this action also. Foods that contain very little liquid and those that do not leave much residue are liable to accumulate in the bowel and at the same time press upon the rectum hard enough to produce a partial paralysis.

Deficiency of the Secretions.--Many of the causes that hinder worm-like motion are also likely to lessen the normal secretions of the bowel. Some kinds of liver diseases tend to lessen the secretions of the bowel, because the amount of bile emptied into the bowel is lessened. Sometimes the glands of the intestine are rendered less active by disease and other causes.

Sundry Causes.--Diabetes, melancholy, insanity, old age, paralysis, lead poisoning and some troubles of local origin, like fissure of the rectum, ulceration, stricture and polypus.

[DIGESTIVE ORGANS 137]

Symptoms.--Headache, inattention to business, loss of memory, melancholy, sallow complexion, indigestion, loss of appetite, nervous symptoms. Spasmodic muscular contraction of the external sphincter. The bowel contents press upon it; spasm of this sphincter muscle is frequently brought on by the presence of a crack in the mucous membrane, caused by injury inflicted during expulsion of hardened feces. Instead of aiding a bowel movement, the muscles now present an obstruction beyond control of the will and aggravate the condition. The most frequent cause of disease of the rectum is constipation and anyone of the following local diseases of the rectum and anus may be a symptom of constipation. (1) Fissure or crack of the anus. (2) Ulceration. (3) Hemorrhoids (piles). (4) Prolapse (falling). (5) Neuralgia. (6) Proctitis and periproctitis.

Fissure of the anus is a common local symptom of constipation. The feces accumulate when the bowels do not move for a few days, the watery portion is absorbed; they become dry, hard, lumpy, and very difficult to expel, frequently making a rent (tear) in the mucous membrane and resulting eventually in an irritable fissure. Ulceration of the rectum and the sigmoid (part of the bowel) is a symptom of persistent constipation, because the pressure exerted upon the nourishing blood vessels by the fecal mass causes local death of the tissues.

Hemorrhoids (Piles) may be produced by constipation in several ways; first by obstruction to the return of the venous (dark) blood. Second, by venous engorgement (filling up) of the hemorrhoidal veins during violent and prolonged straining at stool. Third, as a result of the general looseness of the tissues in those suffering from constipation.

Prolapse (Falling of the Bowel).--This falling of the rectum may be partial or complete, and may be caused by straining or by the downward pressure exerted by the fecal mass during the emptying movement of the bowel. It may also be the result of a partial paralysis of the bowel caused by pressure of the feces upon the nerves.

Proctitis and Peri-Proctitis.--Inflammation of the rectum and surrounding tissue that may or may not terminate in an abscess and fistula, sometimes follows injury to the very sensitive mucous membrane by the hardened feces.

Neuralgia of the Rectum.--This may sometimes result from the pressure of the fecal mass upon the nearby nerves causing pain in the sacrum coccyx (bones).

MOTHERS' REMEDIES.--1. Constipation, a Good Substitute for Pills and Drugs.--"Two ounces each of figs, dates, raisins, and prunes (without pits) one-half ounce senna leaves. Grind through meat chopper, and mix thoroughly by kneading. Break off pieces (about a level teaspoonful) and form into tablets. Wrap each in a wax paper and keep in covered glass jars, in a cool place. Dose.--One at night to keep the bowels regular. Very pleasant to take."

[138 MOTHERS' REMEDIES]

2. Constipation, Substitute for Castor Oil.--"Take good clean figs, and stew them very slowly in olive oil until plump and tender, then add a little honey and a little lemon juice, and allow the syrup to boil thick. Remarks.--Keep this in a covered glass jar and when a dose of castor oil seems necessary, a single fig will answer every purpose. Not unpleasant to take."

3. Constipation, Hot Water for.--"A cup of hot water, as hot as one can drink it, a half an hour before breakfast." The hot water thoroughly rinses the stomach and helps the bowels to carry off all the impurities.

4. Constipation. Excellent Nourishment for Old People.--"A tablespoonful of olive oil three times a day internally for weak or very old people: it can be injected,--used as an enema." Olive oil will be found very beneficial for young people as well as old. It acts as a food for the whole system and is very nourishing.

5. Constipation, Salt and Water for.--"A pinch of salt in a glass of water taken before breakfast every morning. I have found it a very good remedy." This is a remedy easily obtained in any home and will be found very helpful. Few people seem to realize how valuable salt is as a medicine. It acts as a stimulant and loosens the bowels.

6. Constipation, Water Cure for.--"Drink a quantity of water on retiring and during the day." This simple home remedy has been known to cure stubborn cases of constipation if kept up faithfully.

7. Constipation, Tonic and Standard Remedy for.--"Calomel one ounce, wild cherry bark one ounce, Peruvian bark one ounce, Turkish rhubarb ground one ounce, make this into one quart with water, then put in sufficient alcohol to keep it." Dose:--Take a small teaspoonful each morning when the bowels need regulating, or you need a stimulating tonic.

8. Constipation, Glycerin and Witch-Hazel Remedy Where Castor Oil Failed-- "Equal parts of glycerin and witch-hazel." Dose :--One teaspoonful every night at bedtime. In severe cases where you have been unable to get a movement of the bowels by the use of other cathartics, take a teaspoonful every two hours until the bowels move freely. This remedy has been known to cure when castor oil and other remedies have failed.

9. Constipation, Well-known Remedy for.--

"Fluid Extract Cascara Sagrada 1 ounce Syrup Rhubarb 1 ounce Simple Syrup 2 ounces

Mix."

One teaspoonful at night or fifteen drops four times a day for an adult.

[DIGESTIVE ORGANS 139]

10. Constipation, Effective Remedy, in the most Stubborn Cases of.--

"Fluid Extract Cascara Sagrada 1 ounce Fluid Extract Wahoo 1 ounce Neutralizing Cordial 2 ounces

Mix."

Adults may take a teaspoonful of this mixture before retiring, this will be found very effective in the most stubborn cases of constipation.

11. Constipation, Remedy from a Mother at Lee, Massachusetts.--

"Senna Leaves 1/2 pound English Currants 1/2 pound Figs 1/4 pound Brown Sugar 1 large cup

Chop all together fine. Dose:--One-fourth to one-half teaspoonful every night. Do not cook. The best remedy I know."

12. Constipation, Fruit and Hot Water Cure for.--"Drink a pint of hot water in the morning before eating. Eat fruit, plenty of apples, eat apples in the evening, and they will loosen the bowels. Chew them fine, mix with saliva."

13. Constipation, Herb Tea for.--"One ounce senna leaves steeped in one-half pint of hot water, with a teaspoonful of ginger powdered; strain. This is a most certain and effective purge, and mild in its action upon the bowels. Dose:--A cupful at bedtime. This is far superior to salts."

14. Constipation, Purshiana Bark Tea Without an Equal for.--"An infusion of one ounce of purshiana bark to one pint of boiling water; infuse for one hour and strain. It stands without an equal in the treatment of constipation in all its varied forms. Dose:--One teaspoonful, morning and evening according to symptoms or until the bowels are thoroughly regulated." This is fine for constipation, especially if of long standing. It may be used in connection with cascara. This will give relief when other remedies fail.

PHYSICIANS' TREATMENT for Constipation.--Too much reliance has been placed upon medicine in the treatment of this disease and too little attention given to diet, and the establishment of regular habits in eating, exercising, sleeping and attending to the calls of Nature. Also, local disease of the rectum has been overlooked until of late years. Remedies of a laxative and cathartic nature soon lose their power and the dose must be repeated or a new remedy must be given. This method of treatment is well recommended and is very good.

1--Stretching of the sphincter.

2--Frequent rectal and abdominal massage.

3--Copious injection of warm water (in the beginning only).

4--Application of electricity over the abdomen and in the rectum.

[140 MOTHERS' REMEDIES]

In addition to this treatment which must be carried out by a physician the patient must observe the following rules: Go to stool daily, and as near the same time as is convenient, correct errors of diet. Drink an abundance of water and eat sufficient fruit. Take plenty of outdoor exercise; take a cold bath every morning followed by a thorough rubbing. Dress warmly in winter and cool in summer. Change of temperature or climate if the case demands it. Be temperate in all things affecting the general health. Stretching the sphincter must be done carefully, but in a thorough manner. It can only be done properly by an experienced person. Stretching of the sphincter closes the opening so that the feces are not passed at all times. It is circular in shape. Sometimes this grows larger, stiffer, or it acts spasmodically. The opening is often so tight in some people that it is difficult to introduce even a finger, and it frequently produces a spasm of pain in the bowels, stomach and head to do so. This kind will produce constipation or make it worse. In such cases it should be stretched thoroughly but carefully so that the muscle will be able to close the opening and the bowel contents will not pass at any time unhindered. There are two methods of stretching the muscle--forcible or gradual. The forcible method is generally done by inserting the two thumbs into the anus and stretching the muscle thoroughly in every direction until there is no resistance. (Dilators are made for this purpose, but unless they are very carefully used they will tear the muscle). The forcible method should be done under an anesthetic. Gradual stretching is done when an anesthetic cannot be used. It is better to do too little than to do too much at the first sitting. The muscle is very stubborn sometimes, and it requires careful handling or the irritability will be increased. An instrument in the hands of a careful man is all right. They can be stretched by the fingers or the Wales' bougie, thus: Patients should come to the office two or three times a week, the instrument (bougies) are introduced and allowed to remain within the bowel until the muscle resistance is overcome, and many times their withdrawal will soon be followed by a copious stool. Forcible stretching is seldom required more than once, if a large sized instrument is used from time to time afterward, just as in gradual stretching; when thorough dilatation has been accomplished, the muscle instead of acting as an impassable barrier to the discharge of the feces, now offers only passive resistance, but sufficiently strong, however, to prevent any unpleasant accidents, yet not strong enough to resist the power of the expulsory muscles when the latter are brought into full play during stool. Large quantities of feces do not now accumulate; consequently the pressure upon the mucous membrane and neighboring nerves is eliminated, and the bowel regains its normal sensibility and strength. There are now sold dilators in sets for self use in almost every drug store. These when used continuously do good and successful work.

[DIGESTIVE ORGANS 141]

Abdominal Massage. (Kneading, Rubbing, etc.).--This is an essential feature in the treatment. It was practiced by Hippocrates hundreds of years ago. Place the patient in the recumbent position upon a table which can be so manipulated that the head may be raised or lowered, the body rolled from side to side. Gentle but firm pressure is then made with the palm of the hand and the ball of the thumb over the large intestine beginning in the lower right groin region. Then go up to the ribs on the right side, then over the body to the same place on the left side and down to the left lower side and center, accompanying the pressure by kneading the parts thoroughly with the fingers. Repeat this several times for about ten to twelve minutes. At first this should be practised every day; later twice a week. Special treatment should be given the small intestines and liver when the bile and intestinal secretion are lessened. In children gentle rubbing of the abdomen with circular movements from right to left with a little oil for ten minutes daily will help to increase the action of the bowels and often bring on a normal movement.

Copious Warm Water Injections.--This is good at the beginning of the treatment when the feces become packed. They soften the mass and aid its discharge. The water must go above the rectum into the colon. To do this a colon tube from eighteen to twenty-four inches long, a good syringe (the Davidson bulb) hard rubber piston or a fountain syringe, the nozzle of which can be inserted into the tube, are required. The patient is placed in the lying down position on the left side with knees drawn up, with the hips elevated. Oil the tube and pass it gently and slowly up the bowel for a few inches until it meets with a slight obstruction. A few ounces of water are then forced through the tube and at the same time pressure is made upward with the tube; by these means the obstruction will be lifted out of the way each time the tube meets with resistance; the procedure must be repeated until the tube is well within the colon. Attach the syringe to the tube and allow the water to run until the colon is distended. A quart to a gallon of warm water can be used depending upon the age and amount of feces present. The water should be retained as long as possible.

The injections should be continued daily until all the feces has been removed. They should not be used for weeks as has been recommended. If soap suds are used in the enema, green or soft soap should be used, not the hard soap.

Electricity.--One pole may be placed over the spinal column and the other moved about over the course of the colon, or one over the spine and the other over the rectum.

Again constipation is caused by the womb lying upon the rectum. Change this condition. (See diseases of women).

[142 MOTHERS' REMEDIES]

Rules.--Patients should go to stool daily at the same hour, usually after the morning meal. You can educate the bowel to act daily at the same hour or after breakfast; or on the other hand not more than once in two or three days in those who are careless in their habits. Some patients need to have two or three movements daily in order to feel well. It may take time to educate the bowels to do this, but it can be done in many cases and many persons become constipated because they put off attending to the educated bowel's call, and often produce constipation by carelessness. It is surprising how many educated people put off this duty; Nature neglected, soon ceases to call. If constipated persons will persevere in going to the closet at or near the same time every day and devote their entire time while there to the expulsion of the fecal contents, and not make it a reading room, they will bring about the desired result. Patients are apt to become discouraged at first; they should be informed that the final result of the treatment is not influenced by the failure of the bowel to act regularly during the first few days. Do not strain to expel the stool.

Corrections of Errors in Diet.--This is one of the necessary features in the treatment. All kinds of foods known to disagree should be discarded. The foods should be easily digested. In children the diet should be rich in fats, albuminoids and sugar, but poor in starches. A reasonable amount of fruits such as apples, oranges, and figs should be allowed. Meals should be at regular hours. Foods that can be used:

May Take--

Soups.--Meat broths, oyster soup.

Fish.--Boiled fish of all kinds, raw oysters.

Meats.--Almost any fresh tender meat, poultry, game, not fried.

Farinaceous.--Oatmeal, wheaten grits, mush, hominy, whole wheat bread, corn bread, graham bread, rye bread.

Vegetables.--Boiled onions, brussels sprouts, spinach, cauliflower, potatoes, asparagus, green corn, green peas, string beans, salads with oil.

Desserts.--Stewed prunes, figs, baked apples with cream, ripe peaches, pears, oranges, apples, melons, grapes, cherries, raisins, honey, plain puddings, fig puddings, apple charlotte.

Drinks.--Plenty of pure water, cold or hot, new cider, buttermilk, orange juice, unfermented grape juice.

Must Not Take--

Salt, smoked, potted or preserved fish or meats, pork, liver, eggs, new bread, puddings of rice or sago, pastry, milk, sweets, tea, nuts, cheese, pineapple, spirituous liquors.

Foods classed as laxatives are honey, cider, molasses, and acid fruits, such as apples, pears, peaches, cherries, and oranges. Berries are effective laxatives on account of the acids and seeds they contain. (Huckleberries are constipating). Prunes, dates and figs are good and effective, also fruit juices.

[DIGESTIVE ORGANS 143]

Drinks.--There are few laxatives better than a glass of cold water or preferably hot water, taken upon an empty stomach before breakfast; water prevents the feces from becoming dry and massed, and stimulates the intestinal movements. A pinch of salt added to the water increases its effectiveness.

Out-door Exercise.--This should be taken regularly and freely.

Bathing.--The best time is before breakfast, and in as cold water as possible. The bath should be followed by a thorough rubbing of the skin with a Turkish towel.

Clothing.--Warm clothing in winter; cool clothing in summer. Cold weather induces constipation, and warm weather diarrhea. Moderate manner of living is everything.

PHYSICIANS' TREATMENT for Constipation. 1. One year to three years.--For infants one teaspoonful or less of black molasses or store syrup, or of olive oil; and Mellin's food eaten dry, is good for babies a year and older.

2. Small Children.--Increase cream in the milk, give oatmeal or barley water. Castile soap suppository, enema, massage, castor oil, or citrate of magnesia if drugs are needed.

3. Older Children.--In older children, fruit, oatmeal, etc. Black molasses is good for children, one to two teaspoonfuls.

4. Fluid Extract of Cascara Sagrada.--Dose: ten to sixty drops at night. This is good for a great many cases and sometimes it cures the trouble, but on the other hand it seems to injure some people.

5. The Aromatic Cascara is also good; doses are larger and pleasant to take. This is more agreeable for children.

6. The Compound Licorice Powder is a mild, simple laxative and effective. It is composed of senna eighteen parts, licorice root powder sixteen parts, fennel eight parts, washed sulphur eight parts, sugar fifty parts. Dose:--One to two teaspoonfuls.

7. For one dose, or one capsule, the proportions would be:

ONE AMOUNT FOR CAPSULE ONE DOZEN Aloin 1/4 grain 3 grains Extract of Belladonna 1/8 grain 10 grains Extract Nux Vomica 1/4 grain 3 grains Powdered Gentian 3 grains 36 grains

Mix and put up in twelve capsules and take one at night.

There are many tablets and pills made that can be bought at any drug store. No doubt some of them are first class, though perhaps not attaining to that high degree of virtue claimed in their advertising columns.

[144 MOTHERS' REMEDIES]

ITCHING OF THE ANUS. (Itching Piles) (Pruritus ani).Causes.--An inherited or an acquired nervous constitution. Disease of the colon, rectum or anus. Improper diet. Skin affections in that region. Operations about the rectum and anus with resulting discharge sometimes. Diseases in the neighboring organs. Disease of the general system. Diarrhea, discharge of mucus and pus, fissure, etc. Irregular habits and dissipation. Over-seasoned foods such as lobster, salmon, shell-fish and foods containing much grease or starch are especially conducive to it; the same is true of tea, coffee, cocoa, strong alcoholic drinks. Skin diseases, lice, pin worms often cause it.

After Operations.--Some part has not healed, and there is left an irritating discharge.

Symptoms.--There is intense itching at the anus, increased by warmth, and contact of the buttocks. The itching grows worse after the patient becomes warm in bed. It may spread and extend to the scrotum, down the limbs and sometimes over the lower back.

PHYSICIANS' TREATMENT FOR ITCHING OF ANUS. Preventive and Palliative.

DIET.--May Take.--Strong drink must be prohibited; tea, coffee, cocoa, if used at all should be sparingly used. A light diet such as bread, milk, eggs, nourishing soups, kumiss and a little fresh fish, broiled steak, etc., may be used.

May Not Take--Hot cakes, pastry, parsnips, cheese, pickles, beans, cucumbers, cabbage, oatmeal, pork, shell-fish, salmon, lobster, salt fish, confectionery and starchy or highly seasoned foods are to be prohibited. Regular meals, no lunches between meals, and the patient must not over-eat at any time. Long course dinners and over-indulgence in highly seasoned foods and wines aggravate it.