Chronic intestinal catarrh usually develops from an acute attack \ViliCh has been neglected. The transition from one form to the other is often unobserved, for, although the abdominal pains diminish, the diarrhoea con tinues, although it becomes less severe. The faces become somewhat more solid, and in some cases constipation may be present for a few days, only to be succeeded by an increased diarrhoea. The longer the duration of the catarrh, the more the intestinal glands lose their power to absorb the nutrient materials of the food, and a large portion of the latter is excreted unchanged. The patient's nutrition becomes affected to such an extent that he presents an alarming picture of emaciation. The skin becomes dry and hard, the complexion pale, the urine scant, and the strength diminished. An organism weakened in this manner soon loses its power of resistance, and the individual readily succumbs to any intercurrent disease. Chronic intestinal catarrh may be combined with other diseases, especially ‘vith chronic catarrhal gastritis, in which affection the inflammation simply extends from the stomach down into the intestine. Cardiac and pulmonary complication may likewise set in, and in this way the prognosis is rendered still more unfavourable.
In treating the acute form of intestinal catarrh, rest in bed and a re stricted diet are among the most essential requirements. Complete abstinence from food is the best course to follow on the first day, or the patient may be given warm fluids, such as grttels, tea, or milk, and soft-boiled eggs. After the severe symptoms have subsided, zwieback, white bread, toast, rice, farina, etc., may be administered. Hot, and preferably dry, abdominal applications afford the patient a great deal of comfort ; they alleviate the pain and favour the process of healing, which usually occupies from three to fourteen days. In order to prevent recurrences, the patient must exercise care in eating, even for some time after his recovery. If the trouble is known to have been brought on by some dietary indiscretion, it is advisable thoroughly to clear out the intestinal tract by the administration of a brisk cathartic, which, if necessary, may be followed by some astringent remedy.
The treatment of the chronic form demands strict adherence to a carefully prescribed diet. Even a neglected case may be greatly improved by following such a course for from four to six weeks. \Then the intestinal glands have become completely atrophied, a complete cure can no longer be expected. When obstinate cases of diarrhoea occur in apparently healthy persons, notwithstanding a selected diet, it is more frequently due to the presence of a malignant tumour in the intestine than to a mere chronic catarrh. The main rules for dieting these cases may be summarised as follows : Vegetables, fruits, cake, spices, sugar, sour and sweet dishes or drinks, beer, wine, brandy, rye-bread, fatty meat, cheese, lobsters, and a number of other articles, are to be forbidden. It is permitted to take milk
(if no unfavourable effects are observed), soup, gruel, rice, sago, tapioca, farina, white bread, toast, zwieback, crackers, eggs, lean meat or fish, tea, cocoa, chocolate, claret, and seltzer which has ceased effervescing. The abdomen should always be kept warm by means of a ‘voollen bandage. Warm applications, sitz-haths, and complete body-baths are also of value. The necessary drugs must be prescribed by the physician. In obstinate cases irrigations of the colon may be tried.
Intestinal Catarrh in Children.—In addition to the very acute and severe form of catarrh of the gastro-intestinal tract, known as CHOLERA infants may be subject also to a more chronic type, Nvhich lasts for a con siderable time and resists most forms of treatment. It may develop from the acute variety, or it may assume a chronic form from the very beginning. The most frequent cause of these•chronic catarrhs is errors in diet, either \vial regard to its quantity, its character, or its composition.
In a nursing infant it is almost invariably the quantity of the food which produces the trouble ; and the composition of the mother's milk is rarely at fault. Very often the child is given the breast too frequently, on the mistaken supposition that a child must needs be hungry every time it cries. This causes over-filling of the stomach, and likewise of the remainder of the alimentary canal, and gives rise to attacks of spasmodic colic. When the colicky pains cause the child to cry, an inexperienced mother simply offers her breast to the infant again, thus bringing about further stuffing. This increases the trouble and favours the development of a chronic intestinal catarrh. The quantity of the milk is affected by suppurative inflammation of the breast, or if the mother allows her milk to become contaminated on account of lack of cleanliness. The composition of the milk may be changed by conditions of nervous excitement or by febrile diseases.
In artificially nourished infants, an excessive quantity of food is likewise an important factor in causing acute as yell as chronic catarrhs. The disease may be caused also by giving the child milk is either too thin or not sufficiently diluted during the early months ; or it may arise from feeding it with farinaceous gruels before its stomach is able to digest such mod. The presence in the food of an excessive amount of fat may assert itself in a fatty diarrhoea. An attack of cold is also a frequent source of this trouble. Another cause which is often under-valued, but nevertheless important, is lack of cleanliness on the part of the nurses, either Nvith regard to their own persons or Nrith the child. It must not be forgotten that intestinal catarrhs may occur also as accompaniments or complications of other diseases, especially of rickets.