Case in which colitis was treated by valvular colostomy and irrigation as proposed by Keith in 1SS5, to spare the mucous membrane of the colon from contact with the fecal matter, and facil itate local treatment. The first step in the treatment consisted in performing a cecal colostomy, a incision being carried through the abdominal wall parallel with the right Poupart ligament and an inch internal to its outer part. The cncum, which pre sented, was then opened sufficient to admit a fair-sized soft-rubber catheter, and three tiers of sutures were placed above and below the orifice to inclose the meal wall. The ends of those last introduced were left long and carried through the margin of the abdominal incision to insure close contact of the CO2C11111 with the abdominal wall. Irri gation of the colon was begun at once, and several quarts of 0.01-per-cent. so lution of silver nitrate were injected through the catheter. This was fol lowed by a 0.5-per-cent. salt solution. For the first three days this washing was done twice a day, for the next eleven days once a day, and the strength of the silver solution increased to 0.02 per cent. for the remaining time every other day. Complete recovery followed, and the artificial anus finally closed. A small ventral hernia has appeared at the site of the operation, however, and the intermuscular incision of the ab dominal wall will therefore be resorted to in future operations. P. R. Bolton (Med. IZecord, Mar. 16, 1901).
Colitis, Mucous.
Synonyms. — Membranous enteritis; mucous colic; tubular diarrhoea.
occurs occasion ally in hysterical women and neuras thenic and hypochondriacal men a con dition characterized by the discharge from the bowel, from time to time, of membranous or tube-like material, in conjunction with abdominal pain that may reach a high grade of intensity. Apart from the paroxysms, the bowels are often constipated; sometimes they are loose; they are rarely regular. The stools usually contain mucus. The matters expelled from the bowels consist prin cipally of mucus, although at times fibrinous and cellular elements have been found. They sometimes resemble and may readily be mistaken for sheets or casts of the bowel. It is believed that they are derived from the large intes tine. Sometimes they appear in strings or shreds. They are believed to be the product of an abnormal secretion of the mucous glands of the bowel.
Abdominal pains regarded as the most prominent symptom in membranous co litis. These pains, which often precede the evacuations by some hours, are fre quently localized in the left side of the abdomen and follow the course of the descending colon and of the sigmoid flexure. The pains may become general ized or may be most decided near the transverse colon, or, at other times, near the crecum, generally ceasing after the evacuations, though the abdomen re mains very sensitive. Besides these
spontaneous pains there is pain upon abdominal palpation in different portions of the large intestine and particularly the region of the sigmoid flexure. In such eases the pain is at its height in the entire left iliac fossa. Touvenaint (Revue Inter. de Med. et de Chir., July 25, '95).
Membranous enteritis is not inflam mation, either acute or chronic. It is a secretory neurosis affecting generally the mucous follicles of the colon and their regulating nerves, but sometimes involving the corresponding elements of the small intestine, bladder, uterus, and vagina. There are correlated sensory, vasomotor, and motor disturbances. It constitutes a comparatively rare local manifestation of a general neurosis, usually hysteria or neurasthenia. Glent worth R. Butler (N. Y. Med. Jour., Dec. '95).
Case of intestinal calculi in a young woman of 31 years, arthritic and neu rotic, who had suffered for six years from digestive disorders in the form of flat ulent dyspepsia, with dilatation of the stomach. The symptoms of muco-mem branous enteritis intervened, with sharp abdominal pain, tenderness along the course of the colon, and obstinate con stipation. After passing a large amount of muco-membranous material over a period of six or seven months the patient began to notice small stones in the pas sages. Most of these stones were about the size of orange-seeds, the largest as big as a nut, and their discharge lasted two or three weeks. The concretions were of a yellowish-white color, and very friable, some of them presenting conical elevations on their surfaces, others smooth. They were homogeneous on section, and did not contain any central nucleus. Chemical examination showed the stones to be composed principally of carbonate of lime and phosphates of magnesia, with a small amount of or ganic matter, iron, and water. Mongour (Comptes-Rendus de la Soc. de Biol., Feb. 28, '96).
Intestinal gravel is always associated with membranous colitis. Dieulafoy (Acad. de Med., Mar. 9, '97).
Diagnosis between mucous colic and membranous catarrh of the colon can only be made by a careful study of the discharges. In mucous colic the secretion of mucus is periodical, and the stools in the intervals are normal and free from mucus. If the stools contain mucus in the intervals, then it is membranous colitis. R. Schultz (Mtinchener med. Woch., Apr. 24, 1900).
attacks are induced, as a rule, by emotional disturbances and errors in diet, and they recur with vary ing frequency, lasting from a day or two to a couple of weeks.