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Elimination - The Enema
By William Howard Hay, M.D.

The habitual use of the enema is freely condemned by the rank and file of the medical profession, under the assumption that to use it regularly is to take away from the colon all initiative, and thus insure a deepened tendency to sluggishness, or constipation.

A physician who makes such a statement has either had little experience with the daily use of the enema over long periods of time, or has not used a proper enema.

A full three quart enema of hot water will deplete and enervate the colon, and tend to its increasing sluggishness. When used occasionally it may appear to slow down colonic activity, by superseding the normal function.

Such use of the enema is wrong, and will never tend to cure any case of constipation.

An enema used properly does empty the colon much more thoroughly than will any laxative or even a drastic purge. But cure of the sluggishness in colonic action is a matter of general bodily rejuvenescence, a return to more vital condition of all the tissues of the body.

The colon is merely a part of the body, and as such partakes of the state of the entire body, and when we are constipated, we also prove that the entire body tone has fallen below the normal.

The colon has a visible function, and we recognize the delay here, but since we do not see the internal functions of the body, we do not realize that they too have declined in efficiency.

If the colon is not delivering today all the residues from the food taken yesterday, it is constipated, contrary to the assumption that the average one-a-day affair is adequate.

About twenty-five years ago I analyzed nearly a hundred cases of once daily habit. None considered that they were suffering from constipation.

With no change in feeding habit these cases were fed a different color at each noon meal with their regular food, using carbon black, cochineal, or berries of dark color, as blackberries or blueberries, the red color interpolated between the two dark colors.

The passages were checked daily for appearance of the color, and the result was that twenty-four hours after the meal was taken the first color appeared; forty-eight hours showed the peak of passage, and seventy-two hours showed the last traces of the color.

This meant that from the time the food was eaten until it was all voided from the body, three full days had elapsed, which is far too long.

Food eaten today should all be fully voided tomorrow, no later, and anything slower than this rate constitutes constipation.

Some time ago Friedlander and Alvarez pursued similar studies, also selecting those of a once-a-day habit, using colored beads enclosed in a gelatin capsule, a different color to each capsule.

They went to great trouble to check the result, collecting and sieving and washing the stools and counting the beads, and their results were exactly the same, twenty-four hours for the first appearance of color, forty-eight for the peak of passage, and seventy-two for the last appearance of the color.

They made the fatal mistake, however, of assuming that because this rate of passage of food residues was average, that therefore it was normal.

Averages and normals bear very little relation to each other, for the average man is far from the ideal normal.

The entrance of food into the stomach is the natural stimulus to evacuation of the lower third of the colon, and Nature seems in this way to make room for the oncoming materials just ingested.

The colon empties normally in thirds, and one-third should follow each meal, the entire colon being emptied after these three meals are taken.

Thus all the food eaten today should be voided entirely tomorrow, not the second day after tomorrow, as is usual in those boasting of one movement per day.

If foods leave behind a recognizable residue, and if the bowel habit is once a day, you should recognize the foods eaten today by tomorrow morning, most of them the next day, and the balance the third day after they are eaten, as this color test proved. But this is constipation.

Even on the second day after foods are eaten there should be no trace of the foods at that time, all having been passed within twenty-four hours after their ingestion. Anything that falls behind this schedule is constipation to that extent.

With such delay the food residues are subject to too much fermentation and putrefaction, the toxins thus developed being absorbed in too great amount, while the twenty-four hour rate permits of little fermentation and less putrefaction. So the greater the delay the higher the degrees of fermentation and putrefaction, and the greater the percentage of absorption.

If the bowels are not on a twenty-four hour schedule this is a sure indication for the use of the daily enema, until the bowels again achieve the twenty-four hour rate, which will always be very definitely recognized by the return of voluntary stools before the time for the enema.

Then you will know that this represents a twenty four hour schedule, as the colon was presumably well emptied by the enema of the night before, and today's materials must have entered the colon since that time. When this time arrives it is well to quit the enema and see if the twenty-four hour rate is really established, that is, see if the bowels move after each meal, and if not, then return to the daily enema for a time.

Now as to the nature of a proper enema, let us say that no enema is proper unless its temperature is below that of the body.

Eighty degrees Fahrenheit or less is as warm as the enema should ever be used, and it is not necessary, generally not advisable, to add anything whatever to the water, as it is intended for the mechanical removal of the debris from the colon.

Do not use more than two quarts of water to each enema; but if the results are not wholly satisfactory do not hesitate to use a second or even a third enema immediately, the object being to empty the colon by any harmless means such as this.

Hang the enema bag or bucket not more than three feet above the hips, to prevent the too rapid inflow of water, which might cause much resistance on the part of the colon.

If gas is present and cramps are distressing, allow the water to flow out and fill the bag afresh and begin again. One enema after another does no harm, if the water is cool enough and the bag hung not too high, and after a few attempts it will be easy to retain the entire two quarts.

If the pressure is no greater than from a three-foot fall; if the water is not introduced at a temperature higher than eighty degrees Fahrenheit, thus slightly stimulating the peristalsis; if nothing but plain water is used, then the enema is certain to be harmless in results, and will offer opportunity for a very delinquent colon to catch up with its work.

If while using the enema daily the intake of food is so managed as to prevent the usual fermentations resulting from the incompatible combinations of starch or sugar with either acids or protein, then there will be a general revival of vitality, and the colon will partake of this change and gradually act more promptly.

You have heard it said that to begin the use of the enema is to take away all chance for recovery from constipation, and have even heard such fanciful objections as that the enema washes out mucous from the colon that is necessary in its function, or that it injures the delicate mucous membrane of the colon. No one who has had a long experience with this simple means of emptying the sewer would ever make such a statement, but lest you hear and fear such statements let us look at them.

Is it better to help the colon to get rid of its waste or to allow it to continue its struggles unaided? It is true that one seldom sees mucous in the stool except when the enema is used, or in mucous colitis, though it is always present in some degree.

As to the danger of injury to the mucous membrane of the colon by use of daily enemas, stop and think of the nature of the materials with which this delicate mucous lining is in continual contact in the absence of the enema. Decaying, fermenting, putrefying filth is the usual load carried by the average colon, isn't it?

Is it better to allow this material to continue to putrefy and decay and spread its toxins to the body than to empty it harmlessly by a simple enema of plain water?

If the skin of your face does not deteriorate through daily application of water, why should your colon?

If the delicate mucous membrane of the colon has successfully resisted this contact with filth for these many years without breaking down into ulcers, then it is surely fair to suppose that it will not be seriously damaged by a few minutes contact with water.

Any way we look at it, there does not seem to be much cause for alarm in the daily use of the enema of plain water, for in my own experience it is estimated that well over fifty thousand cases have been instructed to use this simple daily means of keeping the colon up to date, and in not a single instance has harm appeared to result from this procedure. Besides, these persons acquire in time the normal three-timesa-day habit of evacuation, it they are patient and persistent, and if at the same time they are so managing their food as to increase their vitality and state of well-being. This they can do, and quite universally.

Help the colon out harmlessly until it can again do all its own work without the daily assistance of the enema.

Sir William Arbuthnot Lane states that there is but one cause for disease, deficient drainage.

This means that in his opinion there would never be any disease if we were able to get out of the body every day all the waste matter created.

This does not apply to the colon alone, for it is by four channels of elimination that we depurate the body daily. Through the lungs, skin, kidneys and bowels we eliminate daily the wastes of every character, and these are of importance to this task in just the order in which they have been enumerated.

Without the action of the lungs we would live but five minutes, dying of accumulation of carbonic acid.

Without the action of the skin we would live but a few hours, five hours being the estimated time required to complete a fatal poisoning with the chemical debris that finds its way out through the skin.

Without the action of the kidneys we would live not over five days. Some have lived this long, dying of uremia, or a saturation chiefly with the end products of protein.

Without the action of the bowels of these four avenues of elimination plainly indicated as five minutes, five hours, five days and five weeks, and without the action of any one of these emunctories we could not live at all.

We must breathe and keep on breathing, and we must have air containing about the usual percentage of oxygen and carrying out about the usual amount of carbonic acid if we are to keep our system clear of carbon accumulation.

The skin must have the ability to excrete from the body those chemical wastes that can find their way out by no other means, chiefly common salt, or sodium chloride, and failing to secure this excretion we have but a few hours to live.

We must have kidneys of at least average capacity if we are able to eliminate the protein wastes that can pass out of the body by no other channels than by the kidneys, and failing this, we are subject to rapid poisoning with this very irritating class of body debris.

The colon must be emptied at least occasionally if we would escape those depressing re-absorptions of debris created in this sewer of the body though we can build up a tolerance for these that will allow us to carry on for a long time before we become fatally poisoned.

It is not that carbon is more poisonous than the debris from the skin, kidneys or bowels, but that we create such vast amounts of this continually, our energies all resulting in the creation of carbonic acid and water. Thus life is terminated more rapidly through retention of the carbon debris, which accumulates so fast that in five minutes it will have stopped all function.

We can do nothing to speed up the elimination of this class of waste through the lungs except to take sufficient exercise and breathe plenty of good fresh air.

We can assist the action of the skin very little except through exercise to the point of perspiration, and the use of water and sunlight on the surface of the body.

We can do nothing at all to speed up the action of the kidneys, but we can lower the eliminative task by means of properly regulated intake of food.

So we cannot wholly manage elimination from these three emunctories, and can assist only through prevention of excessive tasks and the use of exercise, sunlight, and proper use of water.

But the least important of these avenues of elimination, the colon, is completely under our full control, through proper use of the daily enema.

To assist the body in keeping up with its tasks in elimination we should regulate the intake with this in mind; we should be reasonably active; we should take plenty of exercise in the open air, and use the sun bath when it is possible or convenient; and we should use the daily enema regularly unless there is a normal rate of rejection of debris from the colon, which means a movement of the bowels after each meal. How many are able to report such a condition? Most people would consider themselves the victims of too great activity of the bowels if blessed with this normal rate of movement.

I have found it inadvisable to prescribe any set form or any fixed amount of exercise, for I believe firmly that when the other requisites of correct living are well established exercise will take care of itself very nicely.

With the daily enema and correct eating habits one will crave and take enough exercise to keep the lungs and skin sufficiently active, and the kidneys will always take care of themselves under such circumstances.

This conception greatly simplifies the task of keeping well, or of regaining health once it is lost or greatly impaired. Forget all about specific disease states, and remember only that all disease is the same thing with many different expressions.

In any recital of cures from the so-called impossibly low states in disease, I am not taking to myself the least atom of credit for a single one of these recoveries. For it is my belief that there is absolutely nothing that can be done for disease except what the patient himself does.

In other words, when we have removed from the case all visible handicaps to recovery we have done all that mortal man can do. Recovery is distinctly a matter for the body itself to determine; whether it has vitality enough to readjust itself to the normal when the handicaps are removed.

In deeply toxic states' of the body so much of the chemical state depends on whether or not the colonic debris has been removed and is being removed, that it seems logical to empty the colon by means of a harmless cool enema, instead of waiting until a delayed or problematic recovery allows of spontaneous emptying of this sewer by the body's own efforts.

Why wait for this to occur, when every minute is adding to the toxicity of the body's fluids, when it can be done for the body without harm?

This removes much of the cause of the toxic state and so gives the body released vitality to attack the other eliminative tasks.

The cases I noted indicate that this simple procedure was sufficient to tip the scales in favor of recovery.

All the apparatus necessary for a proper application of the enema is the simple two quart enema bag or bucket. In case there is tenderness of the rectum that makes the pressure of water there intolerable, then slip over the tip a large size colon tube, about a twenty-six French or about the size of the little finger. Lubricate this well with an edible oil and insert slowly until it stops against what seems like a wall. Then turn on the water and at the same time press gently and twist the tube. You will feel this suddenly slip upward, which means it has passed through the sigmoid valve and the upper end is now in the sigmoid. The pressure on the rectum is thus relieved, and the water tends to pass up slowly without pain, unless the colon is inflamed or gas is present.

Better take the knee-chest position on the bath rug, or if this is uncomfortable, then lie on the back.

If the enema is painful, get up and pass the water already injected, and with this much gas will be evacuated, leaving more room in the colon.

Again fill the bag or bucket full and try once more, and even a third time, or until the entire two quarts can be retained at one time, thus mildly distending the entire colon. If possible or at all comfortable, retain this two or three minutes, while lying on the back with the knees drawn up, and while massaging the abdomen deeply and thoroughly. When the water is discharged there will then be much more fecal matter present than if the enema is used and at once passed off.

It is necessary to keep the colon up to date, as well as to correct the intake of food in such a way as to prevent the usual amount of fermentation and putrefaction.

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