COLITIS.
The catarrhal form of the disease manifesting itself mainly by the pres ence of diarrhoea is to be treated as any ordinary form of irritative diarrhcea by rest in bed, a diet of milk and lime water, with egg albumin, arrowroot, cornflour or other smooth farinaceous food given in small quantities. Abdominal pain is best relieved by the application of the hot-water bag, and tenesmus by a small enema of starch containing 15 mins. Laudanum. Unless the symptoms be very acute it is a good plan to administer 2 to 4 drs. Castor Oil at the start in order to expel any irritant in the intestines, and when this cannot he borne the colon should be once a day washed out with a copious enema of warm water. The routine method of administer ing vegetable astringents like catechu and tannin is irrational, as these upset the stomach and may never reach the colon. The best practice is to give a mixture containing 3o grs. Carbonate of Bismuth suspended in freshly prepared mucilage and chloroform water with 5 mir s. Liquor orphia: every two or three hours. When the diarrhoea persists and the motions keep profuse and watery, astringent treatment must be tried. The best remedy is Tannalbin—a drug which passes unchanged through the stomach; it may be given in doses of 20 grs. with the same amount of Bismuth in a cachet. The alternating attacks of constipaticin are best avoided by large doses of Liquid Paraffin or Olive Oil.
'1.Incons or membranous colitis occurring in neurotic subjects is a most intractable affection. The treatment must be varied from time to time, since the frequent painful membranous discharges usually alternate with periods of obstinate constipation. During the attack of pain and diarrhoea the patient must remain in bed and a hot-water bag or poultice is to be applied to the abdomen; the colon should be flushed out with a weak warm Boric Acid solution or a large enema of warmed Olive Oil should be given and retained if possible. The writer's routine practice is to inject into the colon warm strained Linseed decoction as much as the patient can tolerate so as to thoroughly sluice out the bowel.
Narcotics are to be avoided; owing to the neurotic condition the opium habit is very liable to be induced. The best routine drug treatment is large doses (3o to Go grs.) of Carbonate of llismuth every four or six hours; it should be given in freshly prepared mucilage. Purgatives as a routine are contra-indicated; the spells of constipation are best cut short by enemata, but occasionally a mild cathartic must be administered, and Castor Oil is preferable to all others, but there is great difficulty in gauging the dosage; a teaspoonful al one time purges freely, whilst at other times i oz. has no effect, and this is even more noticeable with salines. Intes tinal antiseptics are as a rule useless, but gr. Calomel twice daily may be given in courses of about a week with advantage. hale White recom mends Cyllin, which may be udministcred in 3 min. keratin capsules. Large doses, 1-3 oz., Liquid Paraffin may be administered daily for lung periods.
Two Opposite systems of dietetic treatment are vaunted. Thus Langenhagen insists upon a dietary affording the least possible indiges tible residue, all fat, green vegetables and fibrous constituents being strictly forbidden, and in severe cases he gives milk only with eggs, beef tea and pounded raw meat.
Von Noorden's dietary, on the other hand, aims at leaving the largest amount of cellulose residue to pass through the intestines. Fat is to be freely given—viz., pound of butter and pint cream daily—coarse green boiled vegetables mashed with butter and brown bread of the coarsest kind of wholemeal flour containing the largest possible percentage of bran or husk. Thick vegetable soup containing all the insoluble envelopes of the dried peas and lentils employed in its manufacture ; baked fruits and potatoes are also freely administered and Kissingen water allowed in small amount, massage being daily performed. both local for the abdominal wall and general for its sedative influence.