om childhood
to old age, the orifice of the intestinal sewer otherwise than
chronically inflamed, the invasion extending, moreover, the whole
length of the rectum for some distance into the sigmoid colon.

It is no trifling matter to have the function of some thirty feet of
the gastro-intestinal tract disturbed, especially of the large
intestine--some five feet in length, two and a half inches in diameter
in not a few sections.

Almost without exception, we find the lower portion of the intestinal
sewer the seat of chronic inflammation that extends into the sigmoid
colon; and, as an inevitable result of the inflammation, contraction
more or less permanent has taken place in the circular and longitudinal
muscular bands that form its structure. The constriction is especially
severe at the junction of the rectum with the sigmoid colon, where it
flexes upon itself in the region where the bore of the rectum is less.
The comparative shutting up of the caliber of the upper end of the
rectum and lower portion of the sigmoid colon occasions undue retention
of the feces and gases which accumulate, and in accumulating dislocate
various portions of the large intestine, thus forming pouches, sacks,
reservoirs, prolapse, etc., which hold the products of putrefaction as
well as the irritating, poisonous mucus thrown out from the inflamed
tissue.

I regard the occlusion of the upper portion of the rectum, and
especially of the region involved in the flexure of the bowel, as the
most usual seat and source of constipation. Not so very long ago it was
the custom to stretch the sphincter muscles for the "cure" of
constipation; at the present time the "cure" is found in the valves of
the middle lower portion of the rectum. The folly of these "cures"
becomes apparent when we understand that the parts treated were neither
the seat nor the source of constipation. I have always regarded great
retention of feces in the rectum as _impaction_ in a delivery canal,
due to contraction of the anal muscles, not as constipation, which can
only take place in the temporary storage-place--the sigmoid flexure.
The lower two-thirds of the rectum plays no part in constipation of the
bowels.

Form a manikin, made out of very thin, soft rubber tubing, to represent
the stomach and small and large intestine, holding the various parts in
place with elastic bands, and cotton to represent fat. When all
portions are properly and anatomically placed close the low