In health the small amount of mucin secreted by the lining membrane of the colon has a lubricating effect, which is of some value in promoting normal peristalsis, and so preventing constipation. In disease there may be marked hypersecretion of mucin, as in the condition under consideration. Mucous colitis is characterised by the occasional passage by the bowel of a large amount of mucinoid material, which is often present in the form of large tubular casts. The stools are usually frequent and very foetid, and in some cases contain a little blood. In other cases the bowels are notably constipated, and they are usually so in the intervals between the attacks. The attacks are accompanied by a varying degree of abdominal pain - enterospasm. This may be slight, as in the form of slight tenesmus, or may be very severe, simulating the pain present in acute appendicitis. The condition is a serious one, and very troublesome to treat. It is serious, because it is so often associated with a marked degree of hypochondriasis from which the patient can with difficulty be aroused; it is troublesome, because in many cases it is complicated by gastric neurasthenia and general inanition, from which the recovery is at the best slow. The etiology of the disease is unknown. It is by some regarded as of nervous origin, a secretion neurosis; by others as a distinct catarrh, probably of bacterial origin. The latter is, in all probability, the correct explanation; it is a form of catarrh to which people of a nervous temperament are more than usually susceptible.

Dietetic Treatment

The first point which the practitioner should recognise and seek to impress on the patient is the fact that in the great majority of instances the patient's condition is not nearly so serious as he imagines. The attention of the patient should be directed away from the continual daily personal examination of the dejecta; and it should be explained to him that some excess of mucin in the stool is frequently present in health, and may be of no pathological consequence whatever. Attention should be more particularly directed to correcting the form and odour of the faeces, which are usually ill-formed, pultaceous, and foetid. The diet must be framed to diminish the abnormal fermentative and putrefactive changes which are responsible for this condition. To this end two distinct types of dietary have been recommended: one, a coarse cellulose dietary which leaves a large residue in the intestines; the other, a bland diet which leaves little residue. The former may be beneficial in cases where constipation is a marked feature; its favourable action is, however, probably due to the diminished protein putrefaction associated with its use: the favourable effect of the bland diet, which leaves little residue, is in all probability due to the reduction in the fermentation of carbohydrates, and to the lessened strain on the digestion in general. At the outset of treatment complete rest in bed is for a time advisable.

Meat foods, and more especially red meat, should be restricted or in some cases avoided; fats should be taken as freely as the state of digestive power will allow; fruits are valuable, but little or no sugar should be added to them. The diet should be essentially simple, free of spices and condiments, and all extras carefully avoided. Alcohol in all its forms is, as a rule, inadvisable. Extract of malt preparations are of great value in some cases where there is deficient power of digesting carbohydrates, and much benefit is often derived from the use of various intestinal antiseptics, especially the lactic acid bacilli group. Lavage is also of value in many cases, but in others its use is distinctly disadvantageous. Two illustrative dietaries are here given; the first is arranged on the system of the coarse cellulose diet recommended by Von Noorden, the second illustrates the bland nutritious diet which leaves little residue. The author's practical experience has led him to conclude that, if the points referred to in the text are duly regarded, and if a course of treatment for acute colitis (p. 358) is first carried out for eight or ten days, a judicious compromise gives the most satisfactory results.

Cellulose Diet For Mucous Colitis

7 A.M. - Hot water, 1/2 pint; with apples, oranges, bananas, figs, grapes, strawberries, gooseberries, etc., in their season.

8.30 A.M. - Tea, coffee, or cocoa, made with milk, one cup.

Fat bacon, fish, or eggs.

Brown wholemeal bread (toast), 2 slices.

Butter, honey, raspberry, strawberry, or black-currant jam.

Lunch

Egg savoury; vegetable dish, e.g., baked tomatoes, beans and tomatoes, artichokes, salads, green, or with beetroot and celery.

Small allowance of water; brown bread. 4.30 p.m. - Tea, with brown bread and butter.

Vegetable soup - celery, turnip, onion, carrot; broth; bean soup.

Fish (fried or steamed), with bread or toast.

Vegetable dish, as at Lunch.

Fruit (stewed), made into fritters or souffle, with cream.

Water to drink.

9 P.M. - Glass of hot water; rusk, or wholemeal biscuit.

Bland Diet For Mucous Colitis

7 A.M. - Hot water, 1/2 pint.

8 a.m. - Milk, diluted with hot water or weak tea.

White bread - pan loaf, and not new. Butter, honey, jam, or jelly. Egg or fat bacon.

11 A.M. - Hot milk, 1/2 pint.

I P.M. - Vegetable stock, thickened with cream and milk, 1/2 pint; toast.

Milk pudding, made with egg and breadcrumbs, sago, tapioca, macaroni; or Custard or blancmange, flavoured with fresh fruit juice, 4.30 P.M. - Milk, flavoured with tea or cocoa, 1 cup.

Bread and butter, toast and butter, or sponge cake - a small supply.

7 P.M. - Vegetable stock soup, e.g., lentil, pea, milk (also p. 206).

Fish or egg or oysters.

Vegetable - potato puree, or balls, or fritters; spinach, or cauliflower or vegetable souffle, with beans or peas, celery, cream. Milk pudding or blancmange, with cream and fruit juice. Bread or toast.

10 P.M. - Warm milk alone, or with Horlick's malted milk.

In some cases it is beneficial to commence the treatment with a diet of skimmed milk (2 pints), buttermilk (1 pint), with the whites of two eggs in the twenty-four hours, continuing this regime for six or eight days. In cases where the rich cellulose diet gives at the outset good results, too frequently this diet must be modified on account of the flatulence to which it may give rise. The patient must be told that immediate results are not to be expected, as the rate of recovery is usually slow. At the same time every effort must be made to counteract the hypochondriacal condition frequently present in these patients. Undue attention must not be paid to the patient's own ideas as to what is good or bad for him, as his ideas are often merely fanciful. If the colitis be associated with gastric neurasthenia, and pain in the stomach follows the ingestion of any solid food, an exclusive milk regimen should be given for some days. Gain in weight is the most important criterion of success in treatment.