The special form of inflammation of the bladder and ascending affections of the urinary pas.sages, occurring frequently in girls suffering from this form of infectious colitis, are to be looked upon as a continua tion of the processes from the anus into the vagina and urethra.
The treatment of this severe form of acute inflammation of the large intestine, which shows a tendeney to produce toxic and infectious complications in various parts, should be commenced as early as pos sible, and should aim at the complete emptying of the alimentary tract and absolute rest of the intestine. This is best accomplished by means of a diet of water, moderate purgation and intestinal irrigation. If severe vomiting is present the stomach should also be lavaged. These procedures should be continued until the odorless character of the evacu ations indicates that the result desired has been accomplished. In addition, moist applications can be used to the abdomen, or, when there is great pain, opium, a few drops in mucilage, for example, for a three year old child 20 to 23 drops in 100 c.c. .3 oz.) of mucilage: of this a teaspoonful every two hours; antipyrin which Hutinel quite strongly recommends (2 to 2.5 per cent. solution), or pyramidon (.5 per cent.) which is very effective in such cases can be given. When there is high fever, and symptoms of irritation on the part of the nervous system are present, warn) baths are of great service: or in such cases chloral can be given (either a teaspoonful of 1 to 1 per cent. solution eN-ery two hours or the .25 Gm. (4 gr.) given at once). If cholera-like symp toms dominate the scene, salt infusions are indicated in addition to the application of artificial heat.
The initial return to food demands the greatest care. It is best to commence with a thin flour soup without the addition of milk or of broths, to which milk can be slowly added. After the evaeuations have been normal for some time, the previous diet ean be slowly resumed, in which meat particularly is deferred until later, and then in a form most easily assimilated. A tendency to constipation, which may easily result from a diet of this kind, must be met in the manner above de scribed; where on the other hand diarrhma is present, tannin or bis muth preparations are indicated, the latter usually combined with opium. An improvement in the diminished appetite may be brought about, a.s has previously been mentioned, by small (loses of Carlsbad -water; orexin tannate is of considerable use in such cases. (This is given most conveniently in the form of commercial orexiti chocolates, two tablets of which can be taken an hour before meals.) The arnemia and weakness require climatic therapy assisted by the use of iron.
In addition to these acute affections of the large intestine, in older children, there are also chronic diseases of this portion of the alimentary tract, which occur in the form of mucous or inacomembranous colitis (Gif-Tard, Combes and others). Children who are anaimic and who suffer
from habitual constipation are, as a rule, affected, especially those who are overfed on a diet particularly rich in meat. In these children, in consequence of the fecal stasis and of the chronic irritation of the mu cous membrane of the colon, an inflammatory condition is eventually set up, and this is manifested clinically by an increased production of mucus which envelops or accompanies the solid fecal masses, or, under certain conditions, by the formation of material resembling membrane. The abdomen is sunken. It is never markedly distended with gas but is sensitive along the course of the large intestine, particularly in the region of the sigmoid flexure. In sufficiently thin abdominal w-alls one can feel, on deep palpation, a cord-like mass resembling India rubber in consistency, which corresponds to the moderately contracted and thick-walled colon; the palpation of this mass produces considerable pain. The subjective disturbances are for the most part of a trifling nature.
The diagnosis is frequently only to be made after examination of the stools which consist of the products above mentioned, and which, under the microscope, are found to contain cylindrical cells, leucocytes, red blood cells, crystals of cholesterin, oxalic acid, uric acid, as well as numerous bacteria. They give the typical reaction for mucus, and the membranous type of the disease shows also shreds of fibrin.
The treatment of this condition consists, in the first place, in a change of diet from which meat is, as far as possible, cut out, and which should be made up for the most part of milk and cereals. [Comlies has given thorough directions as to diet, which can be consulted in his book.) In addition one attempts, through ntild purgation, to empty the intes tine, by means of irrigations with warni water given at regular intervals. and to remove the masses of mucus and membrane resting, upon the mucosa of the colon. Non-irritant fluids, such as phy.siological salt solution and irrigations with oil and similar materials are also useful; in addition, general treatment of a climatic nature, warm baths, massage, etc., are of service.
There are still those cases to be considered in which an acute at tack of vomiting and diarrhuia or catarrh of the small intestine results in colitis. The latter condition is indicated by the appearance of mucus. pus and blood in the movements, and of tenesnaus during defecation. The treatment of this condition. likewise, follows the rules above described.