The prognosis of this form of colitis, arising acutely, and accom panied by moderate fever of short duration, which does not alter markedly the condition of the patient, is favorable. The condition is seen most often in children between two and four years of age, that is at the transitional time when the child leaves its early form of nourish ment and gradually takes that of adults. The disease consists of a super fieial catarrh of the mucous membrane of the colon, which, in its bacteriological etiology, is not perfectly clear, but which is probably produced by the dysentery bacillus. The lesion, in most cases, involves the rectum and leads to increased secretion of its glands, hypermmia, and cellular infiltration without extensive loss of substance.
Its treatment is relatively simple. An endeavor should be made to bring about a mechanieal emptying of the mass of mucus collected in the large intestine, and to have in the evacuation the intestinal content of the higher portions of the alimentary tract. A form of nour ishment is prescribed which limits the processes of decomposition in the intestine. Consequently, therefore, treatment should be commenced with a mild, non-irritative laxative, for example, castor oil, or powdered rhubarb, or compound liquorice powder; of the first, one tablespoonful, and of the last, as much as can be heaped upon the point of a knife. The appearance of fecal stools is usually followed by improve ment and exerts a particularly- favorable influence on the tenesmus. Irrigation of the large intestine, with a long soft rectal tube introduced high up in the bowel and slowly drawn out along the colon, is a useful local therapeutic measure. As an irrigating fluid I use, first boiled water of body temperature; when the stools contain considerable blood, I to 2 per cent. solution of alum, or one tenth per cent. solution of nitrate of silver (solutions of stronger concentration produce great pain), or one half per cent. solution of tannic acid (a higher content of tannin has, in some cases, been followed by- symptoms of faintness suggesting collapse), or, finally-, the solution of liquor alumini acetatis (P. G.) diluted one-half. Irrigations once or twice daily, according to the number of stools and the amount of mucus in the movements,are indicated, allowing to I quart of fluid to run in under moderate pres sure. The procedure is discontinued when the tenesmus, the degree of intensity of which one can measure readily on the introduction of the rectal tube, 9.8 well as the discharge of mucus, has ceased, since by persistence of the irrigations recurrences of the affection can be easily brought about. The diet should be free from large quantities of milk, particularly in those patients who were made ill after the use of milk. Milk can be given with cocoa, cereal coffee, tapioca, or flour soup. The most suitable form of bread is zwieback; the dinner should consist of a cereal decoction, gruel (rice, barley, oatmeal, potato, grits, etc.), and a strained vegetable suitably prepared; for supper, soup made from roasted flour in which are cooked balls of dough or noodles, or to which pieces of toast are added.
Since the disease is caused by overfeeding, and since in any event a relative abstinence is of value in these mostly overfed children, one can persist in the three somewhat restricted meals. As a rule, it is pos
sible after three or four days to introduce some variation, and to increase the amount of nourishment through eggs (omelette, souffle, yolk of egg stirred in the soup) and by pieces of buttered zwieback: soon afterward return to normal diet by means of finely divided and thor oughly cooked meat, preserves and pastry. Thc meals, however, should be preferably limited to three. Constipation remaining after this condition, and in part in consequence of the curative diet, should be overcome by moderate laxatives, cold applications to the abdomen (one applied in the evening and allowed to remain until morning), as well as by the use of vegetables; as a rule, however, this constipation lasts but a short time.
Acute colitis, occurring in later childhood, does not always run its course in the benign and local manner above outlined; there are cases in which the passage of typical dysenteric stools, arising in the large intestine, last for a long time. Such children suffer from persistent constipation, pass a few hard scybala, the surface of which is often cov ered with mucus; their nutrition is gradually lowered, they look ill, an unpleasant odor comes from the mouth and the tongue is coated; when, suddenly, with high fever, following a very slight indis cretion in diet, and often without any recognized cause, the acute dis turbance may set in with vorniting, headache, prostration and pain in the abdomen. Soon afterwards a foul smelling diarrhoea ensues which, in a short time, takes on the characteristic appearance. Hutincl, who has observed a large number of these cases, considers the condition an acute exacerbation of chronic intestinal infection localized at first in the large bowel. The affection stands in close relation to dysentery, with which idea the newer bacteriological findings mentioned elsewhere correspond. At this stage, it is still possible to accomplish much by intelligent treatment and to maintain the local character of the illness by quickly modifying the symptoms. If this opportunity is missed a number of sequelre set in, brought about, in part, by intense intoxi cation; in part, by the involvement of other organs from the spread of infection from the large intestine. Among these belong cholera-like symptoms, associated with a great reduction in bodily temperature, severe nervous manifestations in the form of somnolence, slight convul sive seizures and conditions of increased irritability (certainly of purely functional nature since autopsy shows only hypertemia of the meninges, and the spinal fluid is sterile on lumbar puncture); and, further, as an evident sign of severe intoXication there is diffuse erythema, at times resembling measles, or scarlet fever, or, again, like urticaria in appear ance, with alburninuria and similar manifestations. Bronchopneu monia, various inflammatory conditions of the mucous membrane of the mouth and throat, multiple abscesses, vesicular eruptions, etc., should be mentioned as secondary infections. These may occur either from the entrance of micro-organisms, through the intestine primarily diseased into the lymph and blood-streams, or as a metastasis, in a body much injured in its power of resistance from other situations, skin, mouth, etc., which can often only be determined by careful post-mortem examination.