ELVIS PRESLEY’S MEGACOLON, AND OTHER RUMINATIONS ON DEATH BY CONSTIPATION

L ENIN’S TOMB IS unusual among public memorials in that it displays the man’s actual remains. As such, it attracts not only those who wish to pay respect, but others, like me, who are simply curious. Either way, death demands a respectful silence, and one cannot easily distinguish mourner from gawker. I was reminded of Lenin’s tomb when I visited the Mütter Museum, in Philadelphia, to view the remains of a man identified as J.W. There was the glass case and the careful curatorial lighting, the transfixed but largely unreadable faces of the visitors, the general hush and horror of it.

The J.W. vitrine doesn’t exhibit a corpse–just a colon. That this glass case is not much larger than the one that holds Lenin tells you two things: Vladimir Ilyich Lenin was a small man, and the colon of J.W. was enormous: twenty‑eight inches around at its most distended point. I remember standing there thinking, It wears the same size jeans as me . A normal colon, perhaps three inches around, has been laid alongside for scale.

What happened here? Hirschsprung’s disease. As J.W.’s embryonic self was laying down nerves along the length of the colon, the process petered out. The final stretch was left without. As a result, peristalsis–the wave of contraction and dilation that moves things through the gut–stops right there. Digesta pile up until the pressure builds to a point where it shoves things through. The shove might happen every few days, or it might take weeks. Just behind the dead zone, the colon becomes overstretched and damaged–a floppy, passive, swollen thing. The megacolon may eventually take up so much room that it begins to bully other organs. Taking a deep breath is a struggle. J.W.’s heart and lungs were thrust upward and outward to the point where they pushed the ribs aside and began jutting horizontally from the torso.

Without surgery, a megacolon like J.W.’s will prevail. If the specimen is spectacular enough, it finds its way to a museum, earning a toehold in medical history while the man himself fades to obscurity. This was the case, too, with the megacolon of a Mr. K., written up in the Journal of the American Medical Association in 1902. In a photograph that accompanies the article, the organ lies on what appears to be a hospital bed, as though it grew so big that it eventually eclipsed Mr. K. entirely and the doctors and nurses took to caring for it in his place, changing the sheets, bringing meals on trays, putting bendy straws in its ginger ale. All we know about poor Mr. K. is that he lived in Groton, South Dakota. Everything else has been subsumed by the details of the autopsy and a frightful chronology of doctor‑assisted evacuations. From a medical aside, we glean that Mr. K. had a family and that they seemed to care about him: “June 22, the report was received that he had passed an ordinary pailful of feces…. There was much rejoicing in the family.”

Anna Dhody, the Mütter Museum curator, led me down to the basement[112]to see what we could learn about J.W. the man. The file holds a reprint of a paper presented at the College of Physicians of Philadelphia on April 6, 1892, by Henry Formad, Demonstrator of Morbid Anatomy. On top of overseeing the “rather voluminous autopsy,” Formad had interviewed J.W.’s mother. The woman recalled that “disturbances in defecation” and abdominal swelling had been evident by age two, suggesting Hirschsprung’s. J.W. began working at sixteen, first in a foundry and later a refinery. All the while, his belly continued to swell. In a photograph taken shortly before he died, he stands in a doctor’s wood‑floor examining room, naked except for hospital slippers, baggy white socks, and a few days’ growth of beard. He looks directly at the camera with a demeanor of calm defiance. Imagine the biggest potbelly, the longest overdue triplets, on a meager frame of knobby limbs. The bastard offspring of Humpty Dumpty and Olive Oyl. To better capture the great torso on film, the photographer had instructed J.W. to raise one hand to his head. The cheesecake pose invites you to stare, but everything else says, Look away.

By the age of twenty, J.W.’s physique had grown so peculiar that he was hired by a freak show in Philadelphia’s old Ninth and Arch Museum. The museum’s first floor housed carnival‑style tests of strength and fun‑house mirrors, and I imagined J.W. hanging around those mirrors on his breaks, positioning his girth just so and taking in the bittersweet sight of himself as a normally proportioned man. J.W. was exhibited under the carnival name Balloon Man, along with the Minnesota Woolly Baby[113]and an assortment of other human and animal oddities.

Formad made no reference to J.W.’s emotional state other than to note that he was unmarried and, justifiably, given to drink.

Y OU DON’T NEED a megacolon to fall victim to “defecation‑associated sudden death,” but it helps. At the age of twenty‑nine, J.W. was found dead on the floor of the bathroom at the club where he regularly took his dinners. The autopsy report described the death as instantaneous, but there was no evidence of a heart attack or a stroke. Likewise, our Mr. K. died at 2 A.M. while straining, as they say, at stool.

“That’s what killed Elvis,” said Adrianne Noe. Noe is the director of the National Museum of Health and Medicine, which has its own megacolon, from an unknown party. As we were about to get off the phone, Elvis Presley dropped into the conversation. Noe related that she’d been standing by the megacolon exhibit one day and a visitor told her that Elvis had had one too. The man added that Presley had struggled with constipation his whole life and that as a child his mother Gladys had had to “manually disimpact” him. “He said that’s why Elvis was so close to his mother.”

A quiet moment followed. “Really.”

“That’s what he said.”

I had heard that Presley died on the toilet, but I’d assumed the location was happenstance, as it was with Judy Garland and Lenny Bruce: an embarrassing setting for a standard celebrity overdose. But the straining‑at‑stool theory made some sense. With all three autopsies–that of J.W., Mr. K., and E., as Presley’s intimates called him–the collapse was abrupt and the autopsy revealed no obvious cause of death. (Though Presley had traces of several prescription drugs in his blood, none was present at a lethal level.) What Elvis’s autopsy did unambiguously reveal was a colon two to three times normal size.

At the time it happened, no one pinned Presley’s death on his colon or efforts to empty it. It wasn’t until years later that Dan Warlick, the coroner on the case, came forward with the megacolon/straining‑at‑stool theory. Presley’s longtime doctor, George “Nick” Nichopoulos, was an eager adopter of Warlick’s theory. Nichopoulos had been vilified for overprescribing prescription drugs, and many fans blamed him for Presley’s death. He wrote a memoir and made himself available to talk to the press. Few seemed inclined to listen. The reference I came across was on a website hawking herbal constipation remedies. A short piece headlined “Elvis Died of Constipation” had run as the site’s lead story (and its middle and last story) under the category Constipation News.

Why didn’t the colonic inertia theory come up earlier? Nichopoulos says that at the time, he had never heard of it. Nor had the gastroenterologist who treated Presley in the 1970s. “Nobody knew about it back then,” Nichopoulos says.

I recall reading in one of Charles Tyrrell’s books that advances in medical knowledge about the colon had, historically, been hobbled by the organ’s repulsiveness. Eighteenth‑ and nineteenth‑century dissectors and anatomy instructors would, he claimed, promptly cut the lower bowel out of the cadaver and throw it away, “on account of its scent‑bag propensities and nastiness.” Michael Sappol, a historian with the National Library of Medicine who has written extensively on the history of anatomy, said he’d heard this too. Leading me to wonder: Does distaste slow progress in treating diseases of the bowel? Does the excretion taboo discourage research, discussion, media attention?

I recall riding a bus in San Francisco, years ago, and seeing a public service ad about anal cancer, “the cancer no one talks about.” I had never heard of it, and in the decade and a half since then, I haven’t come upon another reference. Until I looked it up, while writing this paragraph, I didn’t realize Farrah Fawcett had died of anal cancer. There were references to her ailment as cancer “below the colon.” It was like my mother, when I was a kid, calling the vagina “your bottom in front.” Up through 2010, anal cancer had no nonprofit society, no one to organize fund‑raisers and outreach, no colored awareness ribbon. (Even appendix cancer has a ribbon.)[114]Like cervical cancer, anal cancer is caused by the human papillomavirus; people get it via sex with an infected person, and that seems like something they ought to know when making decisions about using a condom.

Colonic inertia has an even lower profile than anal cancer. And I doubt you’ll be seeing bus posters about defecation‑associated sudden death any time soon. I imagine the stigma discourages open talk among doctors and patients and people at risk. As Nichopoulos wrote in The King and Dr. Nick , “Nothing could have been more embarrassing than having people whispering about his bowel difficulties.”

But I have questions. At what point does constipation cross over from unpleasant to life‑threatening? How hard would you have to be pushing? How exactly does it kill you? Should certain people be taking stool softeners the way others take baby aspirin?

I know one person who doesn’t mind talking about it.

G EORGE NICHOPOULOS LIVES in a leafy Memphis neighborhood of widely spaced homes, on a bend in the road where once or twice a year a drunk fails to notice the curve and crashes his car in the yard of the house across the street. Elvis Presley had the house designed and built as a present for Nichopoulos and his family in the 1970s. You can see that in its day it was modish and luxe: the peaked ceiling with exposed rafters, the massive stone fireplace that divides the open floor plan of the downstairs, the backyard swimming pool.

Nichopoulos escorts me to the sofa. He and his wife, Edna, sit in armchairs to my left and right. The furniture is positioned far enough apart that I hand the doctor my tape recorder, for fear it won’t otherwise pick up his words. The coffee table is just out of reach, so that each time I pick up or set down my cup, I have to rise partway from my seat. It’s as though the family had been at a loss to fill the expanses of a home designed by someone with far more extravagant taste.

Nichopoulos is recovering from hip surgery. Although he’s in his eighties and using a mobility scooter to get around, he doesn’t appear much diminished. He’s tan and spiffed up, having just arrived home from an appearance at an Elvis Week memorial event. His hair is white, but it is not the sparse, scalp‑clinging strands of the nursing‑home frail. His stands firm and frames his head like an aura.

I open a folder and pass around the pictures I have of J.W. and of K.’s megacolon resting on its bed. No documents were released from Presley’s autopsy, but Nichopoulos has a photo of a similarly proportioned megacolon. He opens his laptop and turns it to face me. I get up to set down my coffee and cross the divide. In the photograph, a surgeon in blue scrubs holds a limp, bloody colon above his head in the triumphant, two‑handed pose of an athlete with a trophy cup. Nichopoulos says he thought about including the photo in his book, so people would have a sense of what Presley had been dealing with. “But we knew that Priscilla was not going to allow us to put this in there.”

“She goes and puts her nose in everything.” A dispatch from the distant island nation of Edna.

I ask Nichopoulos to talk about precisely, medically, what caused Presley’s death.

“The night he died he was bigger than usual,” he begins. Depending on how long it had been since Presley had managed to empty himself, his girth fluctuated between big and stupendous. He sometimes appeared to be gaining or losing twenty pounds from one performance to the next. “He wanted to get rid of his gut that night. He was pushing and pushing. Holding his breath.” As the constipated do. The technical term is the Valsalva maneuver. Let’s have Antonio Valsalva, writing in 1704, describe it: “If the glottis be closed after a deep inspiration and a strenuous and prolonged expiratory effort be made, such pressure can be extended upon the heart and intrathoracic vessels that the movement and flow of the blood are temporarily arrested.” After a momentary spike, the heart rate and blood pressure plunge as the pressure squeezes off the flow of blood. This is followed by what one paper termed the “after‑fling”–the body taking emergency measures to get things back up to speed.

The body’s response to this wild, Valsalvic seesawing of the vital signs can throw off the electrical rhythm of the heart. The resulting arrhythmia can be fatal. This is especially likely to happen in someone, like Elvis, with a compromised heart. Fatal arrhythmia is the cause of death listed on Presley’s autopsy report. “Probably every physician practicing emergency medicine has encountered tragic cases of sudden death in the lavatory,” writes B. A. Sikirov in “Cardio‑vascular Events at Defecation: Are They Unavoidable?”

In 1950, a group of University of Cincinnati physicians documented the phenomenon–rather recklessly, I thought–by monitoring the heart rate of fifty subjects, half of them with heart disease, and asking them to “take a deep breath, hold it, and strain down vigorously as if endeavoring to have a bowel movement.” No one died, but they could have. It happens often enough that stool softeners are administered as a matter of course on coronary‑care wards.

Making matters riskier: bed pans! “The notorious frequency of sudden and unexpected deaths of patients while using bed pans in hospitals has been commented upon for many years,” wrote the Cincinnati doctors. Notorious enough for a term to be coined: “bed pan death.” Lying flat is as counterproductive a posture as squatting is productive. Squatting passively increases the pressure on the rectum. It does the pushing for you. It also, Sikirov discovered in his study “Straining Forces at Bowel Elimination,” makes the task easier by straightening out the recto‑anal angle, which I read as “angel.” The overall result, purrs Sikirov, is “smooth bowel elimination with only minimal straining.”

The other mode of defecation‑associated sudden death is pulmonary embolism. The surge of blood when the person relaxes can dislodge a clot in a large blood vessel. When the clot reaches the lungs it can get stuck, causing a fatal blockage, or embolism. A 1991 study found that over a three‑year period, 25 percent of the deaths from pulmonary embolism at one Colorado hospital were “defecation‑associated.” This study’s authors took issue with Sikirov over squatting, claiming that descending and rising from a squat raises the risk of dislodging clots in the deep veins of the thighs.

Presley was given laxatives and enemas on an almost daily basis. “I carried around three or four boxes of Fleets,” Nichopoulos says, referring to the enema brand and recalling his days on tour with Presley. Getting the timing right was, he says, “a difficult balancing act.” Presley sometimes did two shows a day, and Nichopoulos had to schedule the administration such that the treatments didn’t kick in while the singer was on stage. This was the low point of Presley’s career: the bulky jumpsuit and isosceles sideburns era. His colon had expanded so dramatically that it crowded his diaphragm and had begun to compromise his breathing and singing. Beneath the polyester and girth, it was hard to see the man who had performed on the stage of the Ed Sullivan Theater, his moves so loose and frankly sexual that the producers had ordered him filmed from the waist up. Now there was a different reason to do so. “Sometimes right in the middle of the performance, he’d think, ‘I’m passing a little gas,’ and it wouldn’t be gas,” Nichopoulos says quietly. “And he’d have to get off stage and change clothes.”

People who saw the Graceland master bathroom would remark on its extravagance–a TV set! Telephones! A cushioned seat!–but the décor was in equal part a reflection of how much time was spent there. “He would be thirty minutes, an hour, in there at a time,” Nichopoulos says. “He had a lot of books in there.” Constipation ran Presley’s life. Even his famous motto TCB–“Taking Care of Business”–sounds like a reference to bathroom matters. (The TCB oath touched on self‑respect, respect for fellow men, body conditioning, mental conditioning, meditation, and, according to a group tell‑all by Elvis’s entourage, “freedom from constipation.”)

When Nichopoulos’s book came out, a colorectal surgeon named Chris Lahr contacted him. Lahr’s specialty is the paralytic colon.[115]He has excised, in part or in whole, more than two hundred of them, and he surmised that Presley had had one too. When I spoke to Lahr by phone he told me Johnny Cash, Kurt Cobain, and Tammy Wynette had also struggled with obstinate constipation, and he was convinced that they too had stretches of paralyzed colon. But these were also people who struggled with obstinate drug addictions. Opiates, whether they’re in the form of heroin or prescription painkillers, drastically slow colon motility (as do, by varying degrees, antidepressants and other psychiatric drugs).

To know which is right–whether it was drugs or genetics behind the King’s condition–you’d need some information about his childhood. Most people with Hirschsprung’s–the main cause of megacolon–are diagnosed as infants or young children. As Mike Jones put it, “They come out of the box that way.” If there were truth to the story Adrianne Noe had heard, about Presley’s mother having to use her finger on him, that would suggest a hereditary condition like Hirschsprung’s. I ask Nichopoulos whether he’d heard the business about manual disimpaction. Edna volunteers that she’d read that in one of the many Elvis biographies.

Nichopoulos says he looked into it himself. “We were trying to figure out if it was there from birth or whether it was something that came on later. But his mother was gone.” Gladys Presley died when Elvis was twenty‑two. Presley’s father wasn’t around the house much when Elvis was a child.

“I wanted to talk to Priscilla about it,” he says. Presumably Elvis would have discussed his medical issues with his wife. Nichopoulos shifts his weight. The hip still causes him pain. “She didn’t want to discuss it.”

It surprises me that Presley’s condition didn’t dampen his enthusiasm for food. He so appreciated Edna Nichopoulos’s Greek hamburgers that he gave her a ring he’d commissioned, with each of the recipe’s ingredients represented by a different‑color diamond. “Green for parsley,” says Nichopoulos when I ask about it, “white for the onion, brown is the hamburger, and yella…” Some words are born for the Memphis accent. Yellow is one.

“Yella is the onion,” says Edna.

Nichopoulos considers this. “Wasn’t that the white?”

“No, white’s the bread.”

“Elaine!” Nichopoulos shouts toward the upstairs. “Can you get the hamburger ring!” Elaine Nichopoulos has been living with her parents, helping out since her father broke his hip.

A few minutes pass before Elaine appears on the stairs. She crosses the living room with a crooked gait, the combined aftermath of a car crash and a fall from a ladder. “Sorry, I was in the bathroom,” she says. “I’m sure y’all can understand”–y’all meaning the freaks down in the living room talking about bowel health.

Elaine sits down on her dad’s mobility scooter. She shows me where the pins stuck out of her ankle as it healed. Then she pulls down the shoulder of her shirt. I expect more medical hardware, but it’s a tattoo. “Do you like monkeys?” I almost say, but then I get it: There’s a monkey on her back. Oxycontin, fentanyl, drugs for chronic pain. On top of everything else, she has fibromyalgia.

“…and bipolar,” her dad chimes in.

She makes a face at him. “No, you are.”

I ask permission to try on the hamburger ring. “Go ahead,” Nichopoulos says. “We’ve got finger cutters.” It’s a fabulous object. I love the mix of diamonds and hamburger, glamour and trash. I feel like Elizabeth Taylor and Larry Fortensky at the same time.

E LVIS PRESLEY’S COLON is not on display in a glass case, but you can get a good sense of what it looked like by reading the autopsy section of The Death of Elvis . “As Florendo cut, he found that this megacolon was jam‑packed from the base of the descending colon all the way up and halfway across the transverse colon…. The impaction had the consistency of clay and seemed to defy Florendo’s efforts with the scissors to cut it out.”

Nichopoulos was at the autopsy and remembers the moment. The clayey material, he says, was barium, administered to prep Presley for a set of X‑rays–taken four months earlier. “That barium was…” He gestures toward the fireplace. “Just like a rock.” He says the impaction obstructed at least 50 to 60 percent of the diameter of Presley’s colon.

In the 1600s, the venerable English physician Thomas Sydenham advocated horseback riding as a remedy for an impacted bowel. I mention this to Nichopoulos, noting that Presley had liked riding well enough to have had a stable built at Graceland.

“That’s interesting,” he says. “It would certainly loosen it up.” Elaine turns the scooter and drives away.

Thomas Sydenham was an uncommonly gentle practitioner. Another of his treatments for intestinal obstruction featured mint water and lemon juice, as if all that were needed to make a man right was a refreshing summertime beverage. “I order, too,” he continued, “that meanwhile a live kitten be kept continually lying on the naked belly.” The kitten was to remain in place for two to three days, whereupon a dram of something unrecognizable but presumably stronger was prescribed. “The kitten is not to be taken off before the patient begins with the pills.”

Sydenham did not explain himself. I was left wondering whether this was an early form of animal‑assisted therapy and the kitten’s role was simply to help the patient relax while nature took its course. Impactions often resolve on their own. Sydenham once treated an overburdened London businessman by sending him to Edinburgh to visit a specialist who didn’t exist. The patient returned from his weeklong rail journey vexed but rested and cured.

It’s also possible, though unlikely, that the kneading of the kitten’s paws was viewed as a kind of therapeutic massage. Around the turn of the last century, massage–or medical gymnastics, as it was also then called–was not uncommonly applied to the obstructed bowel. Here is Anders Gustaf Wide, in the Hand‑Book of Medical and Orthopedic Gymnastics , discussing the technique of “colon‑stroking”: “One can at least feel the lower part of the larger intestine and often the hard feces in it and even feel, how, in stroking, these are carried forward in the direction they should go.”

Or not. In a 1992 University of Munich study, nine sessions of “colonic massage” failed to speed colon transit time in constipated subjects and nonconstipated controls. The subjects’ sense of well‑being was monitored throughout the three weeks of treatment, and this too failed to improve. It might have gone differently had the masseuses incorporated some techniques from Anders Gustaf Wide–“anal massage,” for instance, wherein “small circular strokings are made to each side alternately with tremble‑shaking round the anus.”

Surgeons, too, advocated the use of the hands to dislodge an impaction, though here it was less of a laying‑on than a reaching‑in. “I propose this evening to demonstrate upon the cadaver some phases of bowel exploration,” began our friend W. W. Dawson, the professor of surgery from the Medical College of Ohio, whom we met in a previous chapter. The year was 1885. Dawson introduced his assistant, Dr. Coffman, to the gathered crowd and then turned to face the examining table. “The subject, you see, is a female.” We’re going to skip ahead to item 2 on the agenda: “How far can the hand be introduced?” The “patient” was rolled on her back with the thighs raised and the knees bent. The position is known as the lithotomy position, or the missionary position, depending on whether you are taking things out or putting them in. In this case, it was a bit of both. “Dr. Coffman now introduces his hand through the anus and presses gently onward and upward.” Here Dawson invited the spectators to watch closely, because it was possible to see the bulge of Coffman’s hand moving below the body’s surface, like a cartoon mole tunneling under the lawn. “Dr. Coffman is able to move his hand with great freedom. You will recognize at once how it would be possible to dislodge… impacted feces.”[116]

For the most part, the historical treatment of obstructed bowels took its cues from the world of plumbing. There were, as there are with bathroom pipes, two main strategies: blast it free with water or air (plunge it), or break it up with something metal (snake it). The June 1874 Atlanta Medical and Surgical Journal describes Dr. Robert Battey’s “safe and ready” method of dissolving “accumulations of hardened feces” by injecting water, as much as three gallons, up the rectum. “So great was the abdominal tension that the water spouted from the anus when pressure was removed,” writes Battey of one memorable case, “in a bold stream” two feet high. Battey’s lecture was accompanied by a demonstration. A haphazard perusal of the medical journals of the day seemed to indicate, among surgery and anatomy professors, a keen spirit of one‑upsmanship that drove lecture hall demonstrations ever farther in the direction of spectacle.

The digestive tract is an intricate, flexuous pipe not easily snaked. Patients had to more or less swallow the snake. For more than a hundred years, swallowing lead shot or metallic mercury, as much as seven pounds, was thought to be a good way to break up an obstruction. The patient was then rolled or shaken, in hopes that the heavy stuff would work its way through the clog. The problem was that the stomach releases its contents gradually, no matter how swiftly they’re swallowed. Rather than pushing through the gut in a cohesive front, the metal shot would journey forth in dribs and drabs, appearing on X‑rays like an ingested strand of pearls. Just as well. A physician named Pillore, writing in 1776, describes an autopsy he performed on a patient whose small intestine was so weighed down by the two pounds of mercury that had collected in a lump, that a loop of the organ had stretched and sunk down into the pelvis. The man died a month later. Between the mercury, the unresolved obstruction, and the taffy‑pulled gut, it’s anyone’s guess what ultimately did him in.

For a brief span of years, the plumbers stepped aside and the electricians got to work. Like radioactivity in its day, electricity was new and exciting and presumed to cure whatever ailed a person. Galvanic therapy for obstinate constipation–or “obstipation”–entailed passing a mild electrical current through the abdomen. “Efficacious?” an 1871 British Medical Journal contributor is quoted in reply to a dubious colleague. “I could hardly get out of the way in time.”

The crudest approach to breaking the dam was simply to toss the patient over a hospital attendant’s shoulder.[117]The intestines do not take a fixed position in the human interior, and simple inversion can, in some cases, bring a measure of relief. A Dr. William Lewitt, of Rush Medical College, in 1864 related the case of a man with a tumor in his abdomen the size of “a child’s head at term,” which was putting the squeeze on his digestive works. “On visiting the patient, we found him suffering intense agony from pain in the abdomen, with frequent desire to expel flatus from the rectum, which could only be accomplished by standing upon his head and hands, in a perpendicular position.” Dr. Lewitt gave his title as Demonstrator of Anatomy, and I imagine it took all the restraint he had not to pack the man up and bring him down to the lecture hall for a demonstration.

The treatment of last resort was surgery. If a blockage could not be shaken, stroked, hosed, or zapped into submission, it was likely to be excised. Surgery in the pre‑handwashing, pre‑glove‑donning era bore a sobering risk of infection. Surgery on the bacteria‑laden colon, all the more so. Horrifyingly, colectomy was being performed not just for life‑threatening impactions, but as a treatment for constipation and its spurious consequence: autointoxication. What better way to speed digesta through the body than by shortening the chute? Scottish surgeon Sir Arbuthnot Lane, the operation’s inventor and vociferous champion, began with “short circuits,” removing a span of a couple feet. Soon he moved on to total colectomy, removing basically healthy colons and stitching the end of the small intestine directly to the rectum. If diarrhea can be considered a cure for constipation, he may have done his job, but in the process he put his patients at risk of nutritional deficiencies. As we learned from the coprophagic rodents of chapter 15, the colon–via the metabolic labors of its bacteria–produces not just feculant putridity, but valuable fatty acids and vitamins.

Lane was a raging coprophobe. The normal variances of skin color that you or I would attribute to race or time spent in the sun, Lane perceived as staining from fecally poisoned blood. One patient’s “yellowish‑brown complexion” disappeared, he noted with pride, a month after her surgery. “She has lost almost all her brown colour,” he wrote of another woman. Lane went so far as to deem the colon a useless structure and a “serious defect in our anatomy.”

It takes a sizable sum of arrogance and ignorance to second‑guess human anatomy and the evolutionary fine‑tuning that produced it. The colon that Lane would so cavalierly lop from his patients’ interiors is more than a simple waste‑storage facility. The bacteria feared and despised by the likes of Lane and Tyrrell and Kellogg–the germs that live and thrive and ply their trade within our waste–are not only harmless, they are critical to good health.

17. The Ick Factor