It thus happens that people, under the impression that a good daily stool has produced a clean bowel, still have a residue, and this can instantly be seen by removing the same by purging drugs. We, therefore, recommend the weekly use of a reliable purgative, such as bitter water, thus cleaning the bowels of all residue, which frequently remains in deep haustra of the intestines, as in Barlow’s disease. The stagnation of fæces around the cæcum may also facilitate the development of appendicitis, this being frequently due to neglect of the hygiene of the intestines. It is also one of the commonest diseases, as we will show in the succeeding chapter. ------------------------------------------------------------------------ CHAPTER XX. HYGIENE OF THE INTESTINES—A FEW REMARKS ON THE CAUSE AND PREVENTION OF APPENDICITIS. APPENDICITIS, in these days, is one of the most frequent causes of an unexpected death. As this work is designed to set forth the means by which we may prolong life, it is desirable not to miss the opportunity of offering a few remarks, in connection with the chapters on the preservation of the intestinal functions, upon the cause and prevention of an intestinal disease by which particularly young and promising lives are frequently cut off. In the previous chapters we saw that the cæcum was one of the places of selection for the stagnation of the fæcal contents in the intestinal canal. As the pressure of such fæcal matter in the cæcum and colon is greatest toward the appendix the contents may go more easily into than away from the appendix, and particularly so when, from a long rest in the cæcum, they are thickened. The return of fæcal matter from the appendix is often hindered by a spindle-shaped thickening at the junction of the appendix with the cæcum, which presents the appearance of a narrow bridge. This thickening of the mouth of the appendix is the consequence of the very close contact of the psoas muscle, upon which, in many people, the appendix lies, so to speak resting upon it. This has been shown by Offerhaus[219] (a surgeon in the Hague Hospital) to be the case in 62 per cent. of normal men. Footnote 219: Offerhaus: Proefschrift, “Eine mechanische oorzaak voorhet ontstaan van Appendicitis,” Leiden, 1901. In certain movements, such as running or cycling, the psoas is continually pressing against the appendix, and it is natural that such continuous pressure against this organ will in time leave a permanent mark, which is, indeed, seen in many cases of appendicitis. After a certain time a circumscribed segmentation will be visible on the parts of the appendix which are in contact with the psoas, and later this becomes so marked that a circular kinking results, establishing the narrow bridge to which we have already referred.