The American Medical Association’s Bureau of Investigation received so many letters from outraged physicians that it drafted a form letter to send in response. “We plan to get around to this institution after a while,” it promised. The first such letter in the Tyrrell Hygienic Institute file at the AMA archives is dated 1894, and the last, 1931, suggesting that a little more vim and snap might have been applied.
One member rose on his own to the task. In 1922, physician and autointoxication doubter Arthur Donaldson artificially and incontrovertibly constipated three dogs by temporarily sewing shut their anus. After four days, all the while eating regular meals of meat, milk, and bread, the dogs showed no physical symptoms beyond a mild loss of appetite—nothing to suggest a poisoning from within. All three, impressively, “seemed to be in fair spirits.”
Donaldson didn’t rest his case there. He withdrew small amounts of blood from his surgically constipated charges, once at the end of fifty-five hours, again at seventy-two hours, and finally at ninety-six hours. This he injected into the bloodstream of two normal, unconstipated dogs,* to see whether symptoms suggestive of “fecal poisoning” would develop. They did not.
Donaldson contended that the symptoms people and doctors were so quick to blame on autointoxication were in fact caused by the simple mechanics of constipation: rectal distention and irritation. To test the theory, he packed four men with turd-sized wads of cotton. After three hours, the men began to exhibit the sorts of symptoms commonly blamed on autointoxication. The moment the wads were removed, relief ensued. If fecal blood poisoning had been the culprit, relief would have taken far longer. It takes several hours for the liver and kidneys to clear chemicals from the system. The reek of asparagus pee, Walter Alvarez pointed out, though not in those exact words, doesn’t abate the moment you set down your fork. It lingers through the following morning. The very swiftness with which the enema brings relief itself refutes the premise of autointoxication.
In the incomparable phrasings of gastroenterologist Mike Jones, “Everybody who’s bound up feels a whole lot better after a big dump. From where I sit, you don’t need to invoke anything else.”
THE ALTERNATIVE APPROACH to ridding the body of “faeculent poisons” was to eat so much fiber that digesta sped through the colon too quickly to generate them. Insoluble dietary fiber, or roughage, is the indigestible, nonfermentable parts of plants—internal yard trimmings that the gut cannot break down. This fiber sponges up water, contributing dramatically to fecal “bulk.” The bulkier the trash, the sooner you need to empty the bin.
John Harvey Kellogg was the archbishop of roughage. The healthy colon, he maintained, empties itself three or four times a day. This was “Nature’s Plan.” As evidence, he cited the estimable bowel frequency of “wild animals, wild men, . . . infants and idiots.” Kellogg’s sources included the staff at “well-managed idiot asylums” and ape keepers at the London Zoo. Kellogg paid several visits to the latter “for the express purpose” of discussing the toilet habits of their charges. The chimpanzees, noted Kellogg, “move their bowels four to six times daily.” All the more to throw at zoo visitors. Kellogg effected a habit of dressing in immaculate white suits, but probably not on the second and third visits.
Kellogg didn’t gather data on the regularity of “wild men,” but someone else sure did. In the early 1970s, epidemiologist A. R. P. Walker held a post at the South African Institute for Medical Research, affording easy access to Bantu people and others “pursuing a primitive manner of life.” In his travels through South African villages, Walker noted that “unformed stools are frequently encountered among rural Bantu.” One man’s ruined footwear is another’s eureka moment. The Bantu, Walker knew, were almost never diagnosed with Western digestive diseases. Was it because they ate so much fiber? Did their woody digesta exit the colon too quickly to inflict harm?
Walker got busy clocking stool: British versus Bantu. Subjects swallowed radio-opaque pellets and then “voided” into plastic bags that they labeled with the date and time. The bags were X-rayed* so researchers could see exactly how long it took the pellets to complete their journey. As with foot races, so with digestion: the slowest third of the Bantu were quicker than the fastest third of the Caucasians. This was because, Walker assumed, the Bantu ate a shitload of insoluble fiber in the form of millet and corn porridge.
Walker was the man behind bran. Papers published by him and, more recently, his research partner Denis Burkitt, fueled a decade-long fiber craze. Americans were forcing down unprecedented amounts of bran muffins, oatmeal, and high-fiber breakfast cereals. Whorton cited a 1984 survey that found a third of Americans eating more fiber to stay healthy.
You don’t hear so much about fiber these days. Curious, I ran a PubMed search on cancer and dietary fiber. The most recent study, published in the American Journal of Epidemiology in 2010, followed three thousand Dutch men for thirteen years. Get a load: “Frequent bowel movements were associated with an increased risk of rectal cancer in men, and constipation was associated with a decreased risk.” Mike Jones wasn’t surprised. The medical community was never completely on board Burkitt’s fiber train. “He was comparing the Bantu to, like, British naval recruits, guys who ate practically no fiber and they all smoked.” Many other factors also set the British apart from rural black Africans—how do you control for them all? “It was correlation, not causality, and you really couldn’t take it any further.”
So why did we hear so much about fiber back then? Because, Jones said, there was money to be made: “things to go out and buy and eat more of.” Walker and Burkitt wrote the tune, but it was the cereal companies that kept on playing it. Jones said that when he sat down and looked at the studies on dietary factors and colon cancer, the thing that stood out as a determinant of risk wasn’t how much fiber you ate, but how many calories. The fewer calories, the lower the risk. No easy profits there.
AND GET THIS. The newest research suggests that slower transit time—that is, longer exposure to your nasty stuff, may in fact be of benefit. Hydrogen sulfide appears to prevent inflammation and its sometime consequences, ulcerative colitis and cancer. In rodent studies, anyway, the gas has a significant anti-inflammatory effect on the walls of the digestive tract: the opposite of what aspirin does in there. Aspirin and ibuprofen combat inflammation everywhere but the stomach and bowel; there they create inflammation. Used in tandem with hydrogen sulfide, says Ken Olson, a professor of physiology at Indiana University School of Medicine and author of multiple papers on the topic, aspirin or ibuprofen may be thousands of times as potent at preventing tumor growth—at least, in mice and in laboratory-grown tumor cells. Human trials have not yet begun.
Hydrogen sulfide is not the devil. Beneath the danger and stench is a molecule as basic and indispensable as sodium chloride. The gas is produced in all of the body’s tissues, all the time, regardless of what was for dinner. (Some recent thinking disagrees.) “It’s a gasotransmitter, a signaling molecule, it has tremendous therapeutic potential,” says Olson. “This is the hottest area in biomedicine right now.”
The moral of the story is this: It takes an ill-advised mix of ignorance, arrogance, and profit motive to dismiss the wisdom of the human body in favor of some random notion you’ve hatched or heard and branded as true. By wisdom I mean the collective improvements of millions of years of evolution. The mind objects strongly to shit, but the body has no idea what we’re on about.
HERE’S THE OTHER hitch with autointoxication. Absorbing things is primarily the business of the small intestine, not the colon. That’s what the smaller tube, with its millions of villi, is for: delivering nutrients to the blood. The autointoxication zealots would counter that, as John Harvey Kellogg put it, “the foul fecal matters in the colon pass back into the small intestine.” But, in fact, they don’t. The ileocecal valve, the anatomical portal between the small intestine and the colon, opens in one direction only.
It is possible to force open the ileocecal valve from the wr
ong direction, but it does not happen naturally, in the course of day-to-day living. It has tended to happen unnaturally, while dead, on a slab in a nineteenth-century anatomy amphitheater with one end of a flexible tube disappearing up the rectum and the other attached to a pump. No less than five experimenters, representing Britain, France, Germany, and the United States, from 1878 to 1885, tested the competence of the ileocecal valve. “Heschl made a number of experiments on the cadaver and satisfied himself that the ileocecal valve serves as a safe and perfect barrier against the entrance of fluids from below,” wrote the author of one review. W. W. Dawson of the Medical College of Ohio put the ileocecal through its paces on thirteen cadavers; in twelve, the valve held strong. The transcript of the thirteenth cadaver demonstration is printed in an 1885 issue of the Cincinnati Lancet and Clinic. (“From your seats, . . . you see the colon expanding as the fluid enters.”) This one, he concludes, was an anomaly. “The valve was doubtless imperfect.” But the showmanship flawless.
It seems fair to say that it takes an unnatural volume of liquid, under unnatural pressure, to breach the heroic ileocecal valve and enter the small intestine from the rear. It takes, perhaps, a Joy-Beauty-Life colonic irrigator. In their fervor to rid the body of fecal residues, devotees of internal bathing were flushing the dread residues higher up into the gut, away from the colon—a region of the anatomy that does relatively little absorbing—and right on into the one that evolved specifically for the job, the small intestine.
You may be wondering why the minds of medicine so assiduously concerned themselves with the matter. Were they drawn to it simply as lecture hall spectacle? Not entirely. The experiments aimed to resolve a lingering medical debate over the value of “feeding per rectum.”
* * *
* It could be worse. In a study of malodorous dog flatulence carried out at the Waltham Centre for Pet Nutrition in Leicestershire, England, the far end point of the scale was “unbearable odor.”
* The exception being the Saturday Evening Post. The Post has a robust tolerance for graphic medical copy, as evidenced by the November 2011 article “Lumps and Bumps on Your Pet: What Could They Be?”
* These nurses deserve a special award that is difficult to picture.
† Back in the 1980s when everyone looked a bit off, my friend Tim and his brothers had some publicity shots taken of their band. Eventually the photographer sold the rights to a stock photo agency. Years later, one of the images turned up on a greeting card. The inside said, “Greetings from the Dork Club.”
* Before you try to tell me that the proper verb for degassing Tupperware is burp not fart, let me pass along the words of a Tupperware spokeswoman I interviewed in 1998: “We don’t say burp anymore. Now we talk about making the seal ‘whisper.’” I don’t think whisper is a good substitute for burp, but it makes a lovely, poetic euphemism for the silent rectal passage. Forsooth, Horatio, even her whispers beguile me.
* Though some more than others, depending on your flora. Some people have more of the sulfur-producing bacteria. The sulfur-spewers, by the way, prefer to colonize the descending colon, the part nearest the rectum. This is why noxious flatus tends to have heat. The composting happens right near the exit, so the flatus is, as gastroenterologist Mike Jones put it, “hot off the press.”
† Inventors of the world’s first purgative superhero, EneMan: an enema bottle with arms and legs and a pointy nozzle head, dressed in a green cape. (Plush-toy EneMen occasionally turn up on eBay, not that I was looking.)
* So strongly does stink depend on diet that the gases emanating from a rehydrated 6,400-year-old turd have been used to reconstruct the diet of an ancient “defecator.” Or so claimed J. G. Moore and colleagues in the 1984 article “Fecal Odorgrams.” The title refers to a method of analyzing waste fumes via a gas chromatograph and a “sniffing port.” Nowadays diet can be determined by sequencing the DNA of the food in fossilized turds, so no one need ever create (or send) a Fecal Odorgram.
† Decomposing protein stinks: “aged” cheese, rotten eggs, corpses, dead skin on the bottoms of your feet. “Morning breath” is hydrogen sulfide released by bacteria consuming shed tongue cells while you mouth-breathe for eight hours; saliva normally washes the debris away. The stench is a warning: this item contains a lot of bacteria and could (depending on which bacteria they are) make you sick. The scariest, stinkiest cuisines are in countries where both food and refrigeration are scarce. Rural Sudanese eat fermented (that is, decomposing) caterpillar, frog, and, less proteinaceously, heifer urine. Yet one more reason tourism has been slow to catch on in the Sudan.
* One of the physicians was a Dr. Crapo, who would, you’d think, have long ago ceased to find that sort of thing amusing.
* Heartlessly, Jubol failed to provide its imaginary workers with tiny face masks. Or shoes! They’re barefoot in there! In reality, it’s people inside French sewers who deserve our concern, not people inside sewers inside French people. France’s Department of Occupational Epidemiology found elevated rates of liver cancer among Parisian sewer workers, though most of them also drink to excess, and who can blame them.
* Most of them dead, bought, or similarly corrupt—like the purveyor of Medicine for the Prevention of Motherhood and (perhaps the fallback nostrum) Remedies for Children.
† Judging by the number of testimonials from priests, prelates, sisters, and superiors, religious celibates were avid embracers of rectal irrigation. Inside the J.B.L. Cascade files in the Historical Health Fraud collection of the American Medical Association archives, I found a “Dear Reverend Father” come-on—a special offer “being made to the Catholic Clergy only.” Though Presbyterians found their way to it too; a satisfied Reverend J. H. M. wrote to say that he had “worn out” three bags over the years.
Balancing out testimonials from the gentle and the frocked was one by the trainer of the New York Giants from 1930 to 1932, Leonard Knowles. Knowles hinted but did not outright state that the players’ regimen had included sessions with the Joy-Beauty-Life Cascade. In an unusual display of restraint, Charles Tyrrell did not take credit for the Giants’ second- and third-place finishes in the National League during the time Knowles was with the team.
* As autointoxication experiments go, this one presents a comparatively minor affront to animal welfare. Less mildly, here is Frenchman Charles Bouchard, in 1893, referring to his laboratory rabbits: “I have practiced intravenous injection with the extracts of fecal matter. It produces depression and diarrhea.” Which begs the question: If you are a caged lab animal under the care of a man who is liable, on any given day, to inject you with human excretions, is it possible to be any more depressed? Ask the animals over in Christian Herter’s lab. Over the course of several months in 1907, Dr. Herter injected rabbits and guinea pigs with fecal extract from lions, tigers, wolves, elephants, camels, goats, buffalo, and horses. Herter wanted to see whether the shit he got from carnivores was more pernicious than the shit he got from herbivores. The rodents died either way, leading one to wonder about the shit he got from the humane society.
* As an aside, Walker noted that “stools can be sieved to retrieve the pellets, thus avoiding the need for X-rays.” Who would sieve when they could X-ray? Someone who long ago wore out his welcome in the radiology department. Based on the following, I’m guessing Walker may also have been pushing his luck with Bantu villagers. “Eighty to 98 percent of rural Bantu children,” he marveled, can “produce a stool on request.”
15
Eating Backward
IS THE DIGESTIVE TRACT A TWO-WAY STREET?
AS FAR BACK as ancient Egypt and as recently as 1926, patients unable to keep their food down would be given their food up. The “nutrient enema” was a last resort for people who, the thinking went, would otherwise starve. As unlikely as it may sound, the practice was broadly accepted in the medical community, so much so that ready-made preparations were available for purchase. You would see them advertised in the pages of journals, complete with the occas
ional customer testimonial (as from the satisfied 1859 patient for whom rectal coffee* and cream “relieved the sense of ‘famishing thirst’ better than any other injection”).
President James Garfield was the poster boy of rectal feeding. In 1881, Garflield’s liver was pierced by an assassin’s bullet and shortly thereafter inoculated with a dose of bacteria from the unwashed fingers and instruments of Dr. D.* W. Bliss. From August 14 to the time of Garfield’s death on September 19, the dwindling, retching head of state, on Bliss’s orders, was fed nothing but nutrient enemas prepared in the dispensary of the United States surgeon general.
Here is the recipe for Assistant U.S. Surgeon General C. H. Crane’s Rectal Beef Extract: “Infuse a third of a pound of fresh beef, finely minced, in 14 ounces of cold soft water, to which a few drops of muriatic acid and a little salt . . . have been added. After digesting for an hour to an hour and a quarter, strain it through a sieve.” The yolk of an egg was then added, along with 2 drams of Beef Peptonoids and 5 drams of whiskey.
The nice thing about cooking for someone who can’t taste the food is that the same dish can be served over and over without complaint. Or without the usual complaint. A downside to eating rectally is that body heat quickly leads to rot and reek. President Garfield and his nurses endured five days of sulfurous flatus so “annoying and offensive” that egg yolks were stricken from the recipe. Beef blood was likewise to be avoided; one physician lamented that the odor produced by decomposing blood was “so offensive as to pervade the whole house.” Bouillon, another common rectal menu item, also created optimal conditions for bacteria. (Before agar was widely used for laboratory cultures, a medium of choice was beef broth.) The enema-fed rectum was a highly efficient incubator, an in-house petri dish.