Colitis

“ Proctologists who have written on the subject of mucous colitis have noted the many symptoms very accurately, but have missed the usual location of a most aggravating disease from which mankind suffers early and late in life. Authors of books on stomach and intestinal troubles are also groping very much in the dark and are unable to diagnose the cause of a very common functional disturbance of the whole digestive apparatus, caused by proctitis and sigmoiditis, bringing numerous and severe primary and secondary symptoms to which other diseases may be traced. ”

“ The colon is subject to three main forms of inflammation. In simple colitis the mucous membrane of the colon is intensely injected, bright red in colour, and secreting a thick mucus, but there is no accompanying ulceration. It is often found in association with some constitutional disease, as Bright’s disease, and also with cancer of the bowel. But when it has no association with other trouble it is probably bacterial in origin, the Bacillus enteritidis spirogenes having been isolated in many cases. The motions always contain large quantities of mucus and more or less blood. ”

“ The colitis in these cases may come on suddenly with vomiting and high fever, or it begins slowly, with no vomiting and with little fever. Their appetite is poor, their digestion is feeble, their prostration is pronounced. They lose flesh rapidly and may be emaciated to a remarkable degree. Very few of these cases recover completely. Serious and sometimes fatal relapses may take place. The feeding of these children is a difficult task and the greatest care must be constantly taken; a very little mistake may cost the life of the child. ”

“ A continuous stream of carbonic acid or of hydrogen directed against muscular tissue will cause paralysis of the part.
Physicians admit that in certain portions of the alimentary canal extensive dilatation may occur, independent of any permanent obstruction, in the lumen, or bore, of the gut. As a rule, however, victims of proctitis and colitis suffer from more or less occlusion of the lumen in the region invaded by the ulcerative inflammatory process. ”

“ Paratyphoid infections may give the clinical picture of a colitis and such cases at times show a large amount of blood in the dysenteric stools. Usually the symptoms are rather those of an entero-colitis or a gastro-enteritis.
3. In Japan, dysentery-like epidemics of a very fatal disease, termed ekiri, occur among young children. The organism is very motile, producing gas and acid in glucose, but not in lactose media. It is reported at times to show indol production. ”

“ Diseases of the colon itself, including chronic constipation, colitis, diverteculitis, hemorrhoids, irritable bowel syndrome, and mucous colitis, are often cured solely by an intensive series of several dozen colonics given close together. Contrary to popular belief, many people think that if they have dysentery or other forms of loose stools that a colonic is the last thing they need. ”

“ Treatment.—All diseases of the intestine in childhood should be promptly and efficiently treated. If any form of diarrhea is neglected, it may result in the development of ileo-colitis with all its risks and uncertainty. When a child is seized with sudden bowel trouble, no matter what variety it is, it should be treated with the greatest care because "sudden" bowel trouble usually means plenty of trouble if it is neglected. ”

“ The tenth objection to using an enema is in being obliged to use it from the fact of having such a disease as chronic inflammation of the rectum and colon. Every victim hates to be compelled to do a thing; and the victim of proctitis and colitis is no exception to the rule. In fact, he is beginning to realize that unless he uses it his system will be poisoned by the absorption of the sewage waste. Let the victim object to the disease that necessitates the use of the enema, and all will shortly be well. ”

“ Enemata.—It will be recollected, from our remarks on the anatomical characters, that inflammatory lesions are commonly present in the entire length of the colon, and that at the sigmoid flexure, where acid and irritating fecal matter is probably longest delayed in its passage downward, the colitis is usually most severe. Aware of this fact, I was [p. 761] led to prescribe at my first visit a large clyster of warm water, given with the fountain or Davidson's rubber syringe, especially in cases in which the stools showed mucus or mucus tinged with blood. ”

“ The insidious manner in which proctitis, colitis, con­sti­pa­tion, and self-poisoning progress from mild through medium to severe stages does not, generally, alarm the victim of intestinal neurasthenia until many years have elapsed, and one or more of the vital organs have become diseased, and the whole system is thoroughly under its toxic effects. ”

“ We are enabled thus to treat by double medication as it were, a chronic disease of the intestines and its symptoms—that is, intestines that have been long neglected or maltreated through lack of proper diagnosis, or by all sorts of chemical compounds from above, through mouth and stomach.
The author and inventor naturally enjoys not a little satisfaction in being able to present to sufferers as nearly perfect an instrument as can be devised; one that, in conjunction with other aids, meets all requirements involved in the proper treatment of proctitis and colitis. ”

“ The distended colon projects and the abdominal swelling is not so uniform. If the attack is subacute or mild, the stools contain normal feces mixed with a great deal of mucus; when the inflammation is in the sigmoid flexure, pure mucus is passed. Blood mixed with mucus and tenesmus accompany inflammation low down. Blood may, however, come from intense inflammation of the ascending and transverse colon without disease of the lower bowel.35
35 In a case seen by the writer of colitis terminating fatally from perforation of the transverse colon this point was illustrated. ”

“ We should remember that ulcerative proctitis and colitis have made the use of the enema a necessity; that, accordingly, the diseased, constricted gut or canal must be treated very gently and not irritated in any avoidable way. The least irritation will result in still greater muscular contraction. It stands to reason that the effort to reach the healthy portion of the bowel with a slightly flexible colon tube frustrates its own purpose, and that it is besides a source of serious and unnecessary irritation. ”

“ Enteritis, entero-colitis and dysentery are different forms of bowel troubles that cause much uneasiness, for it is such a common matter to call everything appendicitis, and if the patient is credulous and gullible he may be operated upon even if his disease is a proctitis or a case of gas in the bowels. ”

“ How can any mode of physical culture meet the requirements for effecting a cure of ulcerative proctitis and colitis, to say nothing about keeping the bowels sweet and clean? Chronic, subacute, and acute inflammation, accompanied with ulceration, located in any part of the body, requires rest to overcome the fever and congestion. Muscular exercise irritates and inflames the diseased parts. ”

“ ENTERITIS. Enteritis consists in inflammation of the intestine, or, more precisely, in inflammation of the intestinal mucous membrane. All the constituent portions of the intestinal tube may be affected (duodenum, jejeunum, ileum, colon, cæcum) ; but clinical distinctions and localisation of inflammation in the various parts are very difficult in the domesticated animals, and at present it is impossible to describe with any accuracy the differences between duodenitis, enteritis of the jejeunum and ileum, colitis or typhlitis. ”

“ All persons suffering from proctitis and colitis and their symptoms, as described in the previous chapters of this work and in Intestinal Ills, will require, now and then, if not under treatment, special irrigation of the stomach to remove fermentative matter, particles of undigested food, and tenacious, ropy mucus before the next meal is taken. Otherwise the condition will be made doubly bad, for the fresh material is piled on top of the unduly retained contents of the stomach. As evidence of our civilization, we clean pots and kettles before the next meal. ”

“ Muco-membranous colitis occurs mainly in nervous individuals, and is much more frequent in women than in men, but it is not limited to women. Some of the severest cases have occurred in men, and Woodward, in the second volume of "The Medical and Surgical Reports of the Civil War," has an exhaustive description of the disease as it occurred among soldiers. It is particularly those who are worried and run down from overwork and excitement who are likely to suffer from it, but it occurs typically in people who, faute de mieux, worry about themselves. ”

“ Of course the secretory and excretory glands of the colon also suffer, and we then have costiveness resulting from lack of absorption and excretion.
Abnormal irritability of the bowels is necessarily involved in the inflammatory process known as proctitis and colitis. Increase this irritability to a certain point and diarrhea takes the place of constipation—a much more alarming symptom. Diarrhea is more alarming because the intensified local activity of the excretory glands of the bowels brings on, as has been said, a general exhaustion of the vital powers. ”

“ A fourth objection is that after taking the first enema the constipation is worse.
With many persons a certain amount of undue accumulation of feces will excite a sufficient muscular effort of the gut to force the dried mass through the proctitis- and colitis-strictured bowels. This unnatural effort may occur once a day or once in two or three days, and has doubtless been a habit of many years' duration. ”

“ The occasional occurrence of Balantidium coli in the fæces, particularly in association with dysenteric diarrhœa, has been recognized for the last fifty years. It is only lately, and more particularly since Strong and Musgrave called attention to the subject, that B. coli has come to be regarded as the germ cause of a particular type of colitis resembling in many respects amœbic dysentery. ”

“ A physician who prescribes for a case of chronic constipation or diarrhea without first examining the sufferer for proctitis and colitis, is either ignorant or does wilful harm to his patient and injury to his practice. ”

“ Diarrhea is a symptom of an acute illness, or it may be associated with a chronic condition such as chronic intestinal indigestion, tuberculosis of the bowel, or may occur alternately with constipation in colitis. ”

“ Pure blood is rarely passed; and an extensive hæmorrhage, unless there be concurrent colitis, is still more rare, although, post mortem, considerable quantities of blood may be found in the small intestine. Fever of an irregular, intermitting, or even of a subcontinued type is common. On the other hand, the temperature may be constantly subnormal. Or these conditions may alternate. After a longer or shorter time, symptoms of profound anæmia gradually disclose themselves. The mucous surfaces and the skin become pallid, the face is puffy, and the feet and ankles are swollen. ”

“ Constipated people, semi-constipated people, irregular people and twenty-four-hour people, are not healthy. They are constantly being poisoned by the abnormal products of indigestion and putrefaction resulting from fecal stagnation, which products enter the blood and circulate through every tissue of the body.
All cases of proctitis are more or less accompanied by constipation and diarrhea. In all cases of chronic constipation I have found proctitis, and often colitis, and am forced to believe it is the most common and proximate cause of chronic constipation of the bowels. ”

“ An overloaded condition of the large intestine may cause inflammation of the liver or dropsy of the abdomen. When the colon is distended, it becomes a mechanical impediment to the free circulation of the blood in other organs, and causes congestion of the portal system, predisposing to chronic inflammation or cirrhosis of the liver. This latter is a structural affection, and may, in turn, give rise to abdominal dropsy. In a word, the accumulation of feces in the colon irritates both the large and small intestines, thus causing congestion of the bowels, liver, or stomach. ”

“ As has been pointed out, inflammation, septic poisoning, intestinal foulness, or retained feces, act as irritants on the mucous membranes, thereby drawing the blood to the colon where it is excreted and exhaustion follows. The great danger in diarrhea, therefore, is the rapid depletion of the vital force. But when the small intestines are affected the consequences may be still more deplorable. Then the unassimilated food is hurried along too quickly for absorption and the body receives but little nourishment to restore its powers. ”

“ Colick is generally a temporary disease; and with which some, much more than others, are afflicted at intervals. Inflammation of the intestines ileus, volvulus, enteritis; generally sudden assault of excruciating, fixed, and increasing pain, in some degree affecting the whole abdomen, but more pungent about the navel; with nausea, frequent vomiting of food and drink, and sometimes of intestinal feculence; obstinate costiveness, severe gripes, eructation, flatulence: the fever sometimes succeeding, sometimes preceding, the local pain ”

“ At other times it is attended with strong and full pulse like other inflammations of internal membranes. Can the seat of the disease being higher or lower in the intestinal canal, that is, above or below the valve of the colon, produce this difference of pulse by the greater sympathy of one part of the bowels with the stomach than another? In enteritis with strong pulse the pain is great about the navel, with vomiting, and the greatest difficulty in procuring a stool. In the other, the pain and fever is less, without vomiting, and with diarrhœa. ”