Duration

The duration of acute enteritis varies considerably. Mild cases improve in about two to five days, while those of a severer type may last about two weeks. After recovery from acute enteritis the intestinal tract remains quite sensitive for a long time. If no attention is paid to this condition and gross errors of diet are committed, relapses are liable to occur. Several relapses may also follow each other and ultimately cause a chronic enteritis.

1 A. Mayor: Revue med. de la Suisse Romande, 1893, No. 4. 2 J. Boas: "Krankheiten des Darms, " ii., p. 513. 3 Mathews: " Disease in the Sigmoid Flexure." The American Medical Quarterly, June, 1899.

Diagnosis

As a rule the recognition of acute enteritis is very easy. The characteristic diarrhoea, the admixture of mucus in the dejecta, the fact that a dietetic error has been committed, or that the abdomen (or other parts of the body) has been exposed to cold, will all indicate the nature of the affection. The localization of the process, whether affecting more or less the entire intestinal tract or only certain parts, is more difficult, and the important points of differentiation have already been given above. Frequent vomiting and very pronounced general symptoms (especially collapse) point to cholera nostras, which is the most severe form of acute enteritis. If the diarrhoea is accompanied by high fever, urinary casts, and pains in the muscles and joints, then the assumption of an acute enteritis of an infectious type is justified.

Prognosis

The prognosis of acute enteritis is, as a rule, good, the disease tending to recovery in a very short time. In children, however, and very old and weakened persons, the course of the disease is sometimes not so favorable and may lead to collapse and even to death.

Treatment

In mild cases of acute enteritis no medicinal treatment will be necessary. Abstinence from food for one or two days, allowing the patient to take only weak tea, a small quantity of bouillon, and some boiled water may suffice to check the attack. Sometimes, however, especially if the attack of enteritis has been caused by dietetic errors, and fulness of the abdomen and frequent colicky pains indicating that irritating substances are lodged within the intestines are present, a good old-fashioned drastic is in place. Thus castor oil - about one ounce - may be given or calomel 0.6 (gr. x.), the latter being preferable in cases of a probably infectious nature. If there is no fever and the symptoms are mild, then the patients may be up and about, although it is always advisable for them to keep quiet more or less. In cases of a severer type, and especially those with fever, the patients should stay in bed until the symptoms are entirely subdued. If the diarrhoea shows no signs of abating after a day or two, or if the symptoms occur so frequently as to be debilitating, then an opiate is in place. Tincture of opium, seven drops every three hours, or codeine, 0.02 or 0.03 (gr. 1/3-1/2) also every three hours, may be given.

Frequently the combination of an opiate with subnitrate of bismuth and chalk or with tannigen may be useful. Thus I often prescribe the following powders:

Treatment 29

Bism. subnitr..............

6.0

(3 iss.)

Cret. pulv................

3.0

(gr. xlv.)

Cod. phosph..................

0.1

(gr. iss.)

Elaeosacch. menth. pip............

5.0

(gr. lxxv.)

Misce f. pulv. Div. in p. aeq. No. x. S. One powder three or four times a day.

Or-

Treatment 30

Morph. muriat............

0.1

(gr. iss.)

Tannigen,

Elaeosacch. menth. pip...........

aa 5.0

(gr. lxxv.)

Misce f. p. Div. in p. seq. No. x. S. One powder three times daily.

Calumba, cascarilla, catechu, kino, may also be employed, twenty to thirty drops of the tinctures being given about three times daily. Another useful remedy is dermatol, which may be administered in doses of 0.5 gm. (gr. viii.) three times daily. In cases in which the entire colon or its lower part is affected, irrigation of the bowels with astringent solutions is of great benefit. This may be done with a solution containing nitrate of silver, 0.3 (gr. v.) to 1,000 (one quart) water, or tannic acid, 2 to 5 gm. (30 to 80 grains) to 1,000 water, or liquor ferri sesqui-chlor. 2: 1,000. It is best to inject these solutions after a previous washing out of the. bowel with plain water or soon after a movement. The astringent solution should be allowed to remain for about five to ten minutes, but in case the patient is not able to retain it for even so short a time, fifteen to twenty drops of tincture of opium may be added to the injection. This, as a rule, lessens the irritation of the rectum and the patient is thus able to hold the enema longer. The temperature of the water should be tepid. All the above-mentioned astringent remedies have also slight antiseptic qualities.

In cases, however, in which the fermentative processes within the bowels are especially pronounced, the following stronger antifermen-tative substances may be used for irrigation: salicylic acid, 2: 1,000 water, or salicylate of sodium, 10.0 (3 iiss.): 1,000; boracic acid, 5.0: 1,000; creolin, 1.0 (gr. xv.): 1,000/

If pains are present a warm poultice or a hot-water bag over the abdomen is very beneficial.

Cold drinks should be forbidden. Warm teas, fennel or camomile, are useful; on the second or third day the patient can be nourished with soups or gruels (barley, rice, oatmeal soup cooked with or without milk); water soup (stale bread softened in hot water with the addition of a little butter and salt) and hot spiced claret are then in place. A little later toasted bread, crackers, soft-boiled eggs may be added to the diet; still later, scraped meat, lamb chops, tenderloin steak, bread and butter. As soon as the diarrhoea has entirely stopped we may allow mashed or baked potatoes in addition to the other articles. For quite a while after an attack of enteritis the patient has to be careful with vegetables and especially fruits. The first he may begin to take in small portions soon after an attack, while the latter should be avoided for a somewhat longer time.

In secondary enteritis the principal primary affection must be considered first. Thus enteritis accompanying malaria will be best remedied by quinine. Enteritis accompanying affections of the lung, heart, or liver must be treated after due attention has been given to the primary affection.