Colitis.
Definition:—Acute colitis is an inflammatory condition of the colon, principally of the lower part, characterized by severe abdominal pain and frequent small movements of the bowels.
Etiology:—Exposure to cold determines the attack very commonly. The inflammatory process extends to the rectum, usually accounting for the tenesmus.
Symptomatology:—The symptoms are diarrhea, which, after the contents of the bowel are expelled, eventuates in the passage of but a little mucus with each movement. There is marked abdominal pain of a colicky nature and severe tenesmus as a proctitis is developed. There is tenderness over the sigmoid flexure.
Diagnosis:—The nature of the stools and the usual brief course of the disease will serve to differentiate it from other colonic affections.
Prognosis:—The prognosis is good, as the course is usually brief. Occasionally the attack may be so severe as to cause suppuration and follicular ulceration.
Treatment:—The treatment of these cases is almost entirely symptomatic. After the lower intestinal tract is irrigated, it is well to introduce a small quantity of an efficient antiseptic solution. Colic may be treated with dioscorea in hot infusion, colocynth, or small doses of chloroform in emulsion. Tenesmus, if present, will be relieved with gelsemium, or with the introduction of starch water, from two to four ounces, which contains from ten to fifteen drops of the tincture of opium. If a tenderness upon pressure is a conspicuous symptom and is inclined to persist, it should be met with bryonia, from one half to one drop every hour, for perhaps one day. Other indications which may occur from causes incident to the case in hand should be treated with the indicated remedy. These patients should be put to bed and should be kept very quiet for one or two days. The diet should be selected carefully, as the condition of the digestive apparatus seems to indicate.
Mucous Colitis.
Synonyms:—Mucous colic; tubular diarrhea; membranous enteritis.
Definition:—Mucous colitis is an affection of the colon, characterized by the production of considerable amounts of tenacious mucus, sometimes in the form of casts of the bowel.
Etiology:—It is most commonly found in adults, though occasionally seen in children. Eighty per cent of the cases are found in women. It occurs in the overworked of both sexes. The majority of cases are in persons suffering from neurasthenia or hysteria. Indeed, it is a true secretion neurosis. Another group of cases is due to local irritation and to uterine, tubal and ovarian diseases.
Symptomatology:—The disease is characterized by the passage of a tenacious mucus, which varies from a small, slimy mass to long strings, and tubular casts of the bowel. There are attacks of severe colicky pain. There are frequently areas of great tenderness over the colon, especially near the splenic flexure. The cutaneous sensibility is frequently increased.
The diarrhea is not so extreme as in other forms, and sometimes constipation is marked. At times undigested particles of food are passed, because the bowels are in a state of hyperperistalsis, though the digestive function itself may not be impaired. There is no fever, but there is a tendency to hypochondriasis and melancholia. Individual attacks last from one to ten or fourteen days.
Diagnosis:—The diagnosis is not difficult if the age and nervous condition of the patient are considered, together with the periodical nature of the attacks and the character of the passages.
Prognosis:—The prognosis as to life is good, but the disease is of a chronic nature and may last for years. The health of the patient may become very much impaired.
Treatment:—The treatment of this condition involves a consideration of the constitution of the patient, of the condition of the nervous system, as well also as of each condition separately which may seem to exercise a causative influence. Complete rest is demanded in nearly every case. Freedom from care, anxiety and from any sudden influence which will be likely to produce shock of any kind, is essential. In nearly every case tonic treatment will be necessary, and especially measures calculated to restore tone to the nervous system. Any causes of reflex irritation, such as ovarian or uterine disorders, must have careful attention. The digestive apparatus must be relieved for a time from as much of its usual work as possible, and every cause of irritability there must be removed. Mild stomach tonics should be given and faults of the digestive fluids must be remedied. Attention must be paid to the quantity of hydrochloric acid secreted, and a deficiency or an excess must be corrected. The food should be selected with the utmost care, and it is advisable to assist the digestion for the time being with artificial digestives.
Starchy foods may be given if there is no fermentation—foods prepared from flour, rice, sago, tapioca, and later of macaroni, may be allowed. Oatmeal, graham and cornmeal foods are apt to be irritating in the early stages, but corn starch is capable of acceptable preparation in various ways. Meat diet should be avoided during the more active stage of the disease. Fatty foods and cured meats are to be entirely excluded, as well as the coarser vegetables, and usually uncooked fruits.
Systematic flushing of the colon, with properly medicated solutions, will do much toward promoting a cure. Antiseptic solutions, especially the peroxid of hydrogen or the normal salt solution, to which a few drops of carbolic acid is added, may be used. If there is an excessive quantity of mucus passed, with colicky pains, or especially if there be a steady, dull pain across the lower abdomen, the most directly indicated remedy is turpentine. This should be applied externally and should be administered in doses of from three to five drops with one or two drops of the oil of wintergreen, in an emulsion, every three or four hours. This agent must be studied with reference to its influence upon excessive mucus discharges. It is very reliable when indicated.
The administration of small doses of ipecac, either alone or in conjunction with one or two grains of the chlorid of ammonium in solution, will remove the local irritation where the condition has persisted for some time. I at one time succeeded in curing a case which had resisted other treatment by the use of chlorid of ammonium one grain with one-sixteenth of a grain of morphin, every two or thres hours.
Counter irritation or external applications are of signal service in nearly all cases. Mustard poultices may be used, or turpentine may be applied, or antiphlogistine, the latter if there is persistent tenderness. It is seldom that astringents will be needed, but there are times when small doses of epilobium or geranium maculatum, combined with a little tincture of capsicum, will do a great deal of good.
I would repeat the statement previously made, in order to emphasize the fact, that rest in bed with mental quietude throughout the entire course of treatment are absolutely essential, and that each condition demanding tonic treatment should have such treatment most carefully adjusted in accordance with its indications.
