=Cathartics and Enemas.= He who makes a practice of flushing out his intestinal tract with high enemas and internal baths is like a person who eats a good dinner and then proceeds to wash out his stomach.  In the mistaken idea that he is making himself clean, he is washing what was never intended to be washed and robbing the body of the nutrition which it needs.  And the man who persists in the pill habit is making a worse mistake, adding insult to injury and forcing the mucous membrane to toughen itself against such malicious attacks.

=Cathartics and Operations.= Even in emergencies, the use of purgatives as a routine measure is happily decreasing year by year.  For many years I have deplored the use of purgatives before and after operations.  That other practitioners are coming to the same conclusion is witnessed by a number of papers recently read in medical societies condemning purgation at the time of operation.

Among the most favorably received papers of the California Medical Societies have been one by Emmet L. Rixford, surgeon of the Stanford University Medical College, read before the Southern California Medical Society at Los Angeles December 8, 1916, and one by W.D.  Alvarez at the California Medical Society, Del Monte, 1918,—­both condemning the use of purgatives as a routine measure before operations.  An article entitled the “Use and Abuse of Cathartics” in the “Journal of the American Medical Association” admirably summarizes the disadvantages of purgation at such a time.[53]

[Footnote 53:  “1 Danger of dissemination of infection throughout the peritoneal cavity, in case localized infection exists.

“2 Increased absorption of toxins and greater bacterial activity by reason of the fact that undigested food has been carried down into the colon to serve as pabulum for bacteria, and that liquid feces form a better culture medium than solid feces.

“3 Increased distention of the intestine with gas and fluid, when it should be empty....

“4 Psychic and physical weakness produced by dehydration of the body, disturbance in the salt balance of the system, and the loss of sleep occasioned by the frequent purging during the night preceding the operation.  As Oliver Wendell Holmes says:  ’If it were known that a prize fighter were to have a drastic purgative administered two or three days before a contest, no one will question that it would affect the betting on his side unfavorably.  If this be true for a powerful man in perfect health, how much more true must it be of the sick man battling for life.’

“5 Increase in postoperative distress and danger:  thirst, gas pains, and even ileus....”—­Journal of American Medical Association, Vol. 73, No. 17, p. 1285, Oct. 25. 1919.]

Four years ago I was called to a near-by city to see a former patient who two days before had had a minor operation,—­removal of a cyst of the breast.  She was dazed, almost in a state of surgical shock and very near collapse.  I found that she had been put through the usual course of purgation before operation and starvation afterward, and I diagnosed her condition as a state bordering on acidosis, or lowering of the alkaline salts of the body.  I ordered food at once.  She rallied and recovered.