Hydrotherpeutic Measures

In cases of diarrhoea warm mineral baths or baths with the addition of pine needle extract and mud and bran baths are favorable. Cold baths should be avoided. A cold sponge bath, however, or a cold shower on the back may be serviceable in chronic enteritis with nervous symptoms. A Priessnitz (wet pack) over the abdomen may be advantageously used over night. Cold sitz baths and cold showers over the abdomen are also often beneficial.

Mineral Waters

According to Nothnagel chronic enteritis is sometimes greatly improved, and even perfectly cured, by a methodical course of drinking certain mineral waters. Such a cure can best be carried out at the mineral springs themselves. For here the patients not only take the waters in the right way, but also observe the necessary rules of diet and are besides kept free from their business cares. Carlsbad is to be regarded as the best place in cases of chronic enteritis in which the diarrhoea is a prominent feature; Vichy comes next. For cases of chronic enteritis with constipation Marienbad seems to be very useful; the same applies to Saratoga (Hawthorn and Congress Springs). For cases in which neither constipation nor diarrhoea plays a prominent part Kissingen or Homburg may be recommended. Chronic enteritis accompanied by anaemia may be benefited at the watering-places of Fran-zensbad and Elster. The Carlsbad water should be taken in small quantities, about a wineglassful twice daily; in some cases even smaller amounts (25 to 50 gm.) three to five times daily. In cases which have been benefited by a drinking cure in Carlsbad, Nothnagel suggests having these patients use at home the Carlsbad waters in a similar manner as at this resort, four times a year for an entire month.

Nothnagel says: "The chronic condition requires a chronic treatment."

Medicaments

Strong cathartics should be avoided in the treatment of the constipation. Here some articles of diet which moderately increase the intestinal peristalsis may be first tried - buttermilk, a glass of cold water, stewed fruits, and the like. If these fail, small amounts of rhubarb, fluid extract of cascara sagrada, podophyllin may be used. Of greater value, however, are rectal injections either of plain water or with the addition of some soap or salt (a teaspoonful to a quart) or Carlsbad water. Enemas of olive oil, as first recommended by Habershon and later by Kussmaul and Fleiner, may also be advantageously used. The oil enemas should, however, be given in small quantities (half a pint to a pint) and be retained over night in the bowels. The frequent use of calomel, castor oil, and jalap should be forbidden.

The diarrhoea is best treated either by large doses of subnitrate of bismuth or salicylate of bismuth (1 to 2 gm., gr. xv.-xxx.) three times daily, or some of the drugs containing tannic acid as their principal ingredient (calumba, cascarilla, rhattania, catechu, kino, lig. campechianum, fructus myrtili). Weber 1 recommends the following prescription :

Medicaments 31

Extr. monesiae,

Extr. calumbae....................

aa 15.0

(Medicaments 32 ss.)

Extr. gent, et pulv. liq...............

.. q.8.

Ut f. pil. cxx. S. Three times daily two to four pills.

I very frequently give fluid extract of condurango and fluid extract of calumba of each twenty drops three times daily. Dermatol (subgallate of bismuth) seems to be quite beneficial in cases in which the formation of gas is a predominant feature. It may be given in doses of half a gram (gr. viii.) three times daily. For the same condition salicylate of bismuth, benzonaphthol, and creosote in small doses may be given. Tannigen and tanalbin may be used in doses of 0.5 to 1 gm. (gr. viii.-xvi.) three times daily, the first being preferable. Both substances seem to lessen fermentation, and by their astringent qualities exert a beneficial influence upon the healing-process. They may therefore be given continuously for a long period of time.

1 L. Weber : New-Yorker medicinische Monatsschrift, 1892.

Cases accompanied by pains will require an opiate (morphine, or still better codeine), with or without the addition of belladonna extract. In chronic proctitis suppositories of opium and belladonna extract with cacao butter are indicated. Small enemas of starch solution with an opiate are also useful here. It is of course to be understood that the administration of opiates will have to be limited to a short period of time.