To may mind the key to most troubles found in everyday practice is what has been crowded and unmercifully thrown into the alimentary canal. How and when has it been done ? What has become of it ? What has in all likelihood been its pathological result ?

IT is a notorious fact, and almost a scandal about doctors among the laity, that the simplest disorders they are called to treat are mistaken in the ONE fundamental cause found in the pouch under McBurneys point known as the Caecum. What I call the mechanics of the internal organs does not seem to enter the minds of many who practice medicine.

To may mind the key to most troubles found in everyday practice is what has been crowded and unmercifully thrown into the alimentary canal. How and when has it been done ? What has become of it ? What has in all likelihood been its pathological result ? The whole eating question and the nature of the tube it has to go through is at the nature of the tube it has to go through is at the bottom of more than half of the troubles we meet.

But we let functional symptoms of the various organs affected by this abuse of the alimentary canal get the best of our reasoning. If the heart flutters and makes a cursory set of irregular beats, we at once jump to the conclusion that there is some organic trouble present. It is too far for our thinker to reach down and see mentally the gas from much delayed fecal matter in the pockets of the colon, and especially in the caecum, the transverse portion the splenic flexure and perhaps also at the sigmoid.

If the patient says : “I have a choky sensation and a shortness of breath,” we are mislead again into thinking that we have some sort of pneumonic trouble. In fact, I was called into consultation with two old “standpat” allopaths, “very wise” who both disagreed with me in the case and that the young woman “had pneumonia”. Her pulse was rapid, her breathing hard and fast, her fever high, with flushed face.

The signs were there that misled them, but they did not hear a single rale for there ware none. They did not feel the abdomen at all. Therefore they passed judgment without finding the awful soreness over nearly the whole of the whole of the bowel tract. I had examined the patient before they were called, and I found that she was suffering from an impacted bowel and not a thing else.

All her symptoms were the result of that autotoxaemia from the food of poison escaping into the tissues from the decomposing fecal matter that had remained impacted there for days. I told them that by emptying the bowels she could be saved. They smiled a negative. The next morning she was dead.

If we find gall-stones, or at least a soreness in the region of the gall-bladder and duodenum, an appendicitis, an enlarged liver or spleen, soreness over the kidneys, a heart that palpitates at times, soreness to the left of the uterus, etc., we too often come to the conclusion to treat what are in most cases but EFFECTS of what was caused by impaction of the colon. What makes gall-stones ?

The reasoning that certain chemical acids are there in too large an amount does not satisfy my reasoning. Stagnate, impacted gall in the gall bladder, owing to pressure of fecal matter in the ascending colon, is far more reasonable and far more true. Experience proves it. What makes appendicitis ? An impacted caecum ; nothing, it follow that any appendage of it would receive the inflammation.

I fully believe that those cases that die, either upon the operating table or soon afterward, are those whose colons were impacted and not emptied thoroughly before the operation. They are toxic and low in resistance.

Two-thirds of alleged ovarian trouble are not due to the ovary at all, but to an impacted sigmoid and possibly the rectum. Hence they complain of soreness in the pelvis. More livers become engorged and enlarged and sore from the duodenal flexure of the colon than from any other cause.

Why not ? A big mass, nearly as large as ones fist lying just behind the duodenum and pressing against the common duct, must cause the engorgement of the live and with it vomiting, I think of the colon, and the first part of the colon- the caecum. Nearly all impaction has its origin in the caecum for the reason that it is mechanically situated for trouble. The moment it becomes filled to distension, it becomes atonic and will not force it s contents upward. The mass lies undisturbed in the bottom of the caecum while other fecal matter comes in through the ilio-caecum valve soft and pushed upward, but as a rule too slow.

Finally it impacts above and on and on until the whole colon may be involved. But usually nature attempts to rid itself of this caecal mass by causing the mucous glands to throw off an extra amount of liquid. This is the start of a diarrhoea. I maintain that a diarrhoea is the sign that somewhere in the colonic tract there is an impaction which should be removed by high flushings before the diarrhoea can be stopped.

The excellent findings of Dr. Case with the X-ray show that the caecum may be markedly distended when there is an atonic condition of the ascending colon and that “in some case there is a marked caecal stagnation even if the bowels move four of five times a day.” This agrees with observations I have made for the last fifteen years. The bowels need not be empty because they have moved four or five times a day.

If you feel over the tract of the colon beginning over the caecum and following up deep with the fingers, somewhere you will find a sore spot or mass that makes soreness and if you move that mass along with the fingers in the direction the fecal matter should move, you doubtless will remove the soreness after about six or seven deep upward movements. The patient will feel relieved at once.

Now, with another fact in mind, we will see that the caecum is the first thing one should think of in examining a patient that has any internal trouble, be it heart, lung, kidney, liver, spleen or intestine. Knowing that, when the colon above the caecum becomes spastic it sets up an antiperistaltic movement, thus forcing the fecal matter downward instead of upward on the right side and packs the caecum till it often becomes three of four centimetres greater in diameter, we have a greater reason why we should keep this much abused pouch in mind in entering the sick room.

If practitioners will make it a rule to thrust their fingers gently but deep over the caecum in every case that has some internal trouble, they will be surprised how many of them will be sore spots. Every one of them has old fecal matter hidden there and must be moved on by any process you can invent. I use the fingers invariably, moving deep in the direction of the rectum.

Six to ten deep movements will be followed by a loss of the soreness and your patient is relieved at once. It will be a quick victory that most doctors fail to win. These deep fingerings also will aid in breaking up any beginning adhesions that may be forming if the impaction and consequential inflammation have been there for some time. Would you increase your success, always examine the caecum. It is mechanically, morphologically, and by nature made for trouble.

Thomas L. Brunk