The above title refers to a recently acquired antique medical document by a nineteenth century physician called Dr. Clovis Stanton-Marwood. He was a pioneer in the field of holistic medicine, advocating stool analysis as a method of assessing the overall health of an organism. This particular publication dates from 1880, while I do not intend to publish the whole thing verbatim I have decided to print the first chapter for the education and amusement of the reader:
Chapter 1: The Composition Of Excrement
" A sound stool is the outcome of an agreeable diet. Light, nourishing and well balanced. Too many times have I seen patients writhing in agony, sore afflicted with excessive bowel gas, owing to the costive effects of rich, stodgy foods. Suet pudding is the enemy of a healthy bowel! One patient in particular, a wealthy industrialist from the north, called Mr.H- consumed such an excess of bowel clogging foods, he required surgical intervention. Mr.H- aged 54, plump leonine countenance, Sanguine-Choleric temperament. Height: 5 feet 7 inches, Weight: 16 stones. Apart from carrying excess weight the patient enjoyed better health than one with such a dysfunctional bowel could reasonably expect.
He came to visit me at my rooms in Harley Street complaining of a terrible "gripping" sensation, as if "a red-hot hand had caught hold of my innards and twisted them about". He was taken ill at his club and had to be brought in as an emergency. After conducting a very brief, preliminary assessment of his general condition, I asked him a series of questions about his diet. Beginning with what he had consumed at his club that day. There followed a litany of sins against the bowel. Scrambled eggs topped with cheese, followed by a steak and kidney pudding and quantity of fried potatoes. He concluded his ghastly repast with jam roly-poly and custard. When I asked him how many fresh vegetables he consumed in a week, he told me never, insisting that he was loath to "feast upon the devil's t----s". As I was about to admonish Mr.H- for despising the humility and medicinal efficacy of plants, he brought forth a great roar and fell to the ground. He was in the grip of a full paroxysm of the bowel. Time, was now of the essence. I called for assistance from his friends who had brought him in. They burst through the door of my consulting rooms and took hold of him, all the while he struggled, as we lifted him onto the bed in my adjoining surgery. Mr.H- screamed as he was straightened out and had to be secured, to the bed on all fours, by wrist and ankle straps. I then cut off his breeches with a pair of scissors. He begged for chloroform, but I refused, assuring him that the inherent risks did not justify its employment. Besides which, I was experienced in these matters and the situation would very quickly be resolved. This inspired confidence in the patient and he relaxed sufficiently for me to examine the area. There was no need to utilise a speculum as the matter had already begun to present itself. A hard impacted mass of faecal matter known medically as a 'spigot'.The etymology of the word is rather interesting, it derives from the Latin Spica meaning ear of grain. Its spiral shape comes from faeces having to slowly tunnel through a tight intestine creating a 'corkscrew' effect. Also from the magma spigot of a volcano, as extraction often precipitates the expulsion of a stream of burning, liquid excrement. There are two types. Firstly the simple or 'crowning' variety where the end protrudes from the anus. The second complex or 'occult' variety is situated further up the large intestine and is far more difficult to treat. fortunately, this was a typical presentation of the former occurrence. There was only one course of action; to perform an extraction. One of the more alarming consequences of a crowning spigot is the immense build up of gas pushing it forward. In order to alleviate the pressure and lubricate the surrounding tissues, I was first going to drill into the spigot, by means of a narrow brace and bit and through said hole introduce Castor oil via a syringe. This on occasion, coupled with anal massage can be enough to free the blockage, however, this was one of the most extreme instances I have ever treated in my 35 years of practice. I knew it required more a more radical solution. I prepared myself for surgery, washing my hands in a solution of carbolic acid and donning my protective goggles. The goggles are an essential when performing this type of operation, I know of a terribly sad incident involving a talented young surgeon, whose career was ended when he was blinded by a high velocity spigot. I made but one concession to my patient, I gave him an inhaler, a modified version of Clover's invention, which allowed him to inhale nitrous oxide throughout. Many physicians favour a combination of compounds such as nitrous oxide, sulphuric ether and chloroform. I however, harbour grave doubts as to the safety of chloroform and so prefer a combination ether and nitrous oxide during minor operations. My methods have not met with universal approval in the medical community, some still question the orthodoxy of my approach. My adoption of stool analysis, coupled with my preference for nitrous oxide has lead to me being referred to colloquially as: "Dr. S---s and giggles". As he began to inhale the gas, the patient relaxed, and chuckled pleasantly to himself. I first drilled the spigot, the deepest, most tightly impacted I have ever encountered. I calculated from the residue on the brace and bit it must be at least 5inches deep. Then inserted my longest needle through the hole I had just made and injected a syringe full of Castor oil through the opening, directly into the bowel. This proved unsuccessful. Not even the most rigorous massage, or the now rapid contractions of the rectum, {precipitated by the patient's now almost convulsive laughter} were enough to dislodge the spigot. I then had recourse to a device of my own invention. The laqueoscope, patent pending. From the Latin laquem meaning 'trap'. it consisted of a narrow steel tube divided in to two segments. Inside the uppermost chamber were two hooked prongs. both made of strong metal wire, though covered with rubber to protect the delicate tissues of the bowel. One must first insert the tube through the hole in the spigot, then twist the uppermost chamber in a clockwise direction away from the bottom one which releases the hooks. These should then grip into the mass. In the base of the bottom chamber one will find a small protruding button. Pressing this inward releases the telescopic handle which extends the exposed gripping area from 6 to 18 inches, thus affording the physician a better purchase. I inserted the device, before extending both the hooks and handle. Once in position, I began to gingerly pull the spigot towards me. It refused to budge, even a fraction of inch and so I was forced to exert greater pressure. Once it had proved itself resistant to all the force I could personally muster, I was forced to call Mr.H-'s friends back in. As in the children's fable, The Enormous Turnip, as I held onto the instrument, so they held onto me. At the count of three we all heaved in unison and flew backwards as the spigot came free. When we three healthy specimens of manhood had gathered ourselves from the floor we turned our attention to the patient. Mr.H- let out a scream through the incessant laughter when the spigot was released. This was followed by the usual stream of acrid diarrhoea. While the spigot was safely impaled on the laqueoscope the liquid ordure had squirted out and befouled a picture of Sir Joseph Lister on my far wall. Upon examination his bowel proved sound, no lasting damage had been sustained. When questioned further regarding his dietary habits it transpired that the spigot crisis was precipitated by his actions of the previous day, specifically his gluttonous consumption of an entire jar of his wife's plum conserve. The liberating effects of fruit combined with the already brewing crisis in his bowel caused the situation to come to a head. The plum conserve was the cause of the gas and diarrhoea, hence the magma flow following the extraction of the spigot. Mr.H- was extremely fortunate to be brought to such an experienced physician. I have known of many instances in which such a crisis has proved fatal. To conclude: Dietary imbalances are frequently the cause of acute dysfunction of the bowel. Such dysfunction may be avoided by careful, infrequent consumption of such foods as are considered costive. A plant based diet is therefore to be recommended, however, excessive consumption of fruit is to be avoided as this may cause the opposite problem {too fast a digestive transit}. Although I am unaware of anyone perishing from such excesses. I will delineate further on what I consider to be the ideal diet in Chapter 2: The Perils Of Fruit: loose stools in infants, the elderly and invalids. After adopting my dietary principles, Mr.H- now enjoys excellent bowel health, having lost 3 stones and has experienced no recurrence of any of his previous symptoms.
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