which it is most needed to prevent toxic substances from entering
the system.

A _fourth_ objection is that after taking the first enema the constipation
is worse.

With many persons a certain amount of undue accumulation of feces will
excite a sufficient muscular effort of the gut to force the dried mass
through the proctitis- and colitis-strictured bowels. This unnatural
effort may occur once a day or once in two or three days, and has
doubtless been a habit of many years' duration.

To introduce a new order of conduct on the part of the bowels requires
time. If the bowels have been in the habit of expelling feces in the
morning, and an enema were taken the night before, there might be no
desire to stool the next morning because of the fact that the bulk or
accumulated mass of excrement was no longer there to create a vigorous
call or impulse for defecation.

But we have found the extent of local damage and reflex to the organs,
and more especially the constant absorption of poisons into the system,
due to the presence of feces. It is for this reason that the
elimination of feces twice or thrice in twenty-four hours is advised.
The condition for which an enema is used is one of disturbance and
poison to the system. It is, therefore, a most unnatural condition.
What is more rational, consequently, than to employ an "unnatural" yet
not harmful means to bring about a more normal condition, one free from
poisoning and irritating consequences?

A _fifth_ objection is made by those who have as a symptom of proctitis
a large development of pile tumors or hemorrhoids (distended mucous
membrane). The objection is that at times these tumors or sacs prolapse
very freely during the act of expelling the injected water. But this
prolapse occurs in many cases whether water is used or not.

A certain amount of anal irritation caused by the passage of feces
occurs, causing contraction of the circular muscular tissue that forms
the anal and rectal canal, also of the longitudinal muscular bands and
the levator muscles of the organs. The enema lessens or entirely
diminishes the irritation of passing feces, and the natural result is
that the serum-filled sacs, called piles, and the tissue loosened by
the inflammatory product will more readily prolapse during the act of
defecating. It is simply a choice between irritation of the stool
keeping the tissue up and no irritation permitting a prolapse.

Of course, if there be no expulsio