Important facts in water drinking are overlooked in the foregoing somewhat contradictory observations.
Thus Starling says there is relatively nearly as much moisture at the lower end of the long small intestine as there is at the upper. Hawk says that soon after copious water drinking the water can be demonstrated far down in the small intestine. Starling further observes that no water is absorbed from the stomach and that water drinking does not produce fluid motions although about 2½ quarts of water pass the ileocecal valve into the colon in 24 hours. Howell states that as the food residue advances through the colon its moisture decreases and confirms Starling in the’ statement that it gains little moisture by secretion. Hurst observes that dryness of the colon is a condition of practically all forms of intestinal stasis and that women who suffer from the condition are notoriously poor water drinkers. Kellogg has observed that water on the empty stomach is much more effective and acts differently than when taken with food; that fluidity of the colon contents is produced by milk drinking (87 per cent water) and that milk soured by digestive ferments when drunk copiously is freely present in the colon. Finally Hawk says he has demonstrated that when a large amount of water is drunk at meals the colon moisture decreases, thus showing a stimulation of the power of absorption.
Despite his high reputation as a physiologist the observation of Starling that the drinking of water does not bring about the fluidity of the colon contents is believed not to be based on the facts. By his own statement the amount of moisture on the two sides of the ileo-cecal valve (at the end of the small intestine) is practically the same. If there is serious stasis (delay) in the colon his observation will apply. But where there is a rapid movement through the colon, sometimes, ac-cording to Hurst, in as short a time as two hours, it is quite evident that an observation on the dryness of the contents that will apply to one condition will not apply to the other. Thus it has been observed by competent investigators that in people who still retain their strength, particularly if they are under 40, and have no organic impediments, the drinking of three glasses of water, either all at one time or within half an hour, the last an hour or an hour and a quarter before breakfast, when the water has a free right of way through the small intestine, the moisture in the colon will become pronounced and effective almost without exception. If there is a serious impaction of the lower bowel this must first be relieved by enema, thus supplying moisture where most needed. In all cases where a prompt movement through the colon can be secured (that is where there is no organic obstruction) it seems a safe deduction that there is such a thing as semi-fluidity of the contents from water drinking. The reason seems not far to seek. There is not enough time allowed for the absorption of the moisture as is the case where there is stasis. Kellogg supports this conclusion by his observations of the full presence of milk in the colon after it has been copiously imbibed, it being 87 per cent water, and Webster in “Diagnostic Methods” says many factors may influence the amount of water present in the colon output, one of which is the large intake of water. Goiffon, a competent French observer, also states that the decrease of moisture and bacteria corresponds to the time occupied by their pas-sage through the colon).
The mechanics of the problem are simple and it is easily `within the power of each patient to prove or disprove the soundness of the theory.
The difference of effect in drinking hot water or cold before breakfast lies in the fact that water at body temperature leaves the stomach more rapidly than cold water. Many people can bear three glasses of either warm or cold water an hour or more before breakfast without the slightest discomfort. This volume makes a prompt impression on the colon at a time when the small intestine is empty and peristalsis is renewed with the eating of breakfast. Or two glasses of cold water can preferably be taken, to be followed in five minutes by a glass of warm water. This method secures the stimulation of the cold water before the warm is taken. Such an early morning washout of the stomach not only relieves that organ of any overnight fluid residue, possibly aciduous, referred to by Hawk as a frequent condition, but relieves the kidneys by diluting the blood.
In considering the great value of three glasses an hour or more before breakfast, the time depending upon the activity of the stomach and kidneys of each individual, allowance must be made for the percentage of absorption as the water progresses through the nearly 23 feet of supposedly empty small intestine, not more than half of it possibly, especially in warm weather, or when there is perspiration from exercise, reaching the colon. When it does, its effect must be distributed through an organ nearly five feet long. In practically all cases it must be supplemented by bran and abdominal exercises.
After a few months the patient can tell by the sensation in the stomach when it has disposed of the before-breakfast water ration. The addition of the juice of one or two oranges is an agreeable and palatable addition to the water aside from the vitamin value of the fruit.