The writer has tried both methods of dieting, and believes that the routine employment of either is bad practice. In cases where obstinate constipation with the passage of hard scybalous masses is a frequent complication Von Noorden's plan is a good one, and in those where frequent loose mucous discharges associated with great pain and griping are constantly wearing down the patient's health the soluble diet of Langenhagen is more suitable. The best procedure on the whole is in the acute diarrhceal paroxysms to keep the 'patient upon a diet of Koumiss (p. 19) and gradually to introduce a free and mixed dietary containing abundance of fats and cellulose.
The Plombieres treatment carried out at the spa in Vosges consists in free intestinal lavage with a copious use of the soft thermal water by the mouth, for bathing purposes and for douching. The underlying neurotic condition is, moreover, generally markedly improved by the thermal water and spa regimen.
Hypodermic injections of fresh sea-water Plasma, as carried out by Robert-Simon, sometimes afford excellent results. He recommends an injection of 5o to 75 c.c. behind the trochanter every second or third day as described under Eczema. Larat, assuming that this type of colitis is due to nervous and arthritic causes, has recommended as of primary importance active exercise in games, walking, gymnastics, rowing and mountain climbing.
The greatest practical difficulty next to the management of the bowels in mucous colitis is the treatment of the insomnia which is often a prominent feature, and morphine must be seldom employed ; the newer hypnotics only should be used. Where in spite of dietetic and other measures the case continues intractable, good results have been achieved by colotomy and by establishing an opening in the appendix through which the colon can be daily flushed out with weak antiseptic or saline solutions.
Ulcerative colitis is often of dysenteric origin, though Ipecacuanha in every form is generally useless in its treatment. The best routine is free lavage of the colon with weak antiseptic solutions—Boric Acid being the best, or r gr. to each pint of Silver Nitrate. These should be followed by the introduction of a r per cent. Argyrol solution injected in the knee elbow position. Nitrate of Silver (3 to 5 grs. to 4 oz.), Methylene Blue (4 grs. to 4 oz.), Creolin and other antiseptic solutions are also in use. By the mouth small doses of Calomel gr.) twice or thrice daily or a full dose followed by Castor Oil once a day gives the best results.
Serum treatment should always be employed; the Lister Institute Serum, prepared by immunising the horse with Shiga's and other types of bacilli and their toxins, is both antitoxic and bactericidal; it may be injected in 4o c.c. doses and upwards, and Antidysenteric Serum has been successfully employed in cases of non-amcebic variety.
('olotomv affords the only hope of saving life in most chronic cases, and there can always be the hope held out that the artificial anus may ulti mately be closed as the colon heals by rest; but a meal anus should he always provided. After colotomy constant flushing of the bowel with antiseptics will be required daily. The establishment of an opening in the appendix with the view of irrigating the colon by antiseptics has proved efficacious, hut in severe cases colotomy is preferable.
The diet should be such as leaves the minimum of residue to pass through the colon; strong clear soups, milk, Koumiss and scraped raw meat may be freely administered.