The successful treatment of colitis requires, first of all, a change of the intestinal flora; that is, the infectious bacteria to which the disease is due must be gotten rid of. Since the first cause of colitis is constipation, it is evident that frequent bowel movement is also essential; in other words, the colon must be kept clean. The diarrhea which is sometimes present in colitis is the result of Nature's effort to clear the intestine from offending materials. The mucus which is often discharged in large quantities is a protective material which Nature pours out upon the surface of the intestine to protect the tissues against the attacks of bacteria and parasites which flourish in the colons of persons suffering from this disease.
Various species of bacteria are capable of giving rise to colitis, according to Tissier. In general, it may be said that colitis is the result of the presence in the colon of excessive numbers of putrefactive bacteria.
In recent years, attention has been called to the fact that acute infections of the colon are sometimes due to animal parasites. Certain amoebae, flagellates, spirochetes and other forms of protozoa are also found in great numbers in the colon in cases of chronic constipation and colitis, as well as in cases of amoebic dysentery. These organisms have been regarded by most authorities as pseudo parasites, with the exception of those of amoebic dysentery. Dr. Ronald Ross has recently pointed out the fact that all these organisms are parasitic and dangerous. If they do not set up acute inflammation characteristic of amoebic dysentery, they bore into the mucous membrane and thus prepare hiding places for pernicious bacteria, which develop chronic infections and intestinal toxemia. Observations made a few years ago by Miss York show that these animal parasites are rarely found in the stools of persons who subsist upon a non-flesh dietary. They abound in feces which are in part made up of undigested residues of flesh foods.
As already stated, it is necessary in the treatment of colitis first of all to adopt thoroughgoing measures to secure a change of the intestinal flora. The writer has found that this may be accomplished in a short time by placing the patient on a special diet, which for convenience is termed a fruit regimen. For a description of this regimen see page 191. After a few days of this regimen (three days to a week) the character of the stools will be found to be wholly changed. The stools become soft, almost odorless and frequent, the tongue clears, the appetite is keen and is satisfied with simple foods. Cereals and a moderate amount of fats can now be added to the bill of fare, but the fruits, bran or agar-agar, and paraffin must be continued.
The diet must be made so bulky and laxative that the bowels move three or four times a day. Four movements a day are better than three. The stools should be odorless or they may have a slight sour odor. An ammoniacal or putrid odor is evidence that the flora has not yet been changed, and the fruit regimen must be continued or repeated after a few days. Sometimes several repetitions of the regimen at intervals of a week or two are required for complete success. Animal products of all sorts must be avoided. Even milk must be excluded, as well as eggs and meat. As pointed out by Tissier some years ago, the bacteria which produce colitis thrive best upon animal protein.
Another point of importance is to supply the colon with carbohydrates. Sugar administered by the mouth never reaches the colon, for the reason that it is so readily absorbed that it is all taken up by the small intestine. Cooked starch is digested so quickly that it is also absorbed from the small intestine, only a mere trace reaching the colon. The way to get carbohydrate into the colon is either to introduce it by enema, or to administer it in an uncooked, or partially cooked, state, so that it may have an opportunity to reach the colon before digestion is complete. It is well known that saliva does not act upon cooked starch.
Raw starch may be digested by the pancreatic juice, but the process is very slow, and so when starch is taken raw a considerable proportion, ten to twenty per cent according to the writer's observations, may reach the colon. In the colon there are always present bacteria capable of digesting raw starch and converting it into sugar. When sugar is present, not only the ordinary lactic acid forming bacillus but the various putrefactive bacteria seize upon the sugar with great avidity and convert it into lactic acid. It appears that even putrefactive germs are putrefactive, or carnivorous, only when compelled to be so through the absence of carbohydrate in available form. When sugar is present, putrefaction does not take place. This important fact was pointed out by Kendall some years ago, and demonstrates that it is possible to reform the bacteria of the colon, and this is much more easily accomplished than to drive out the various species of bacteria which, in most cases, have been thoroughly established in the intestine for years, and occupy every nook and corner of the colon; they cling so tenaciously to the territory which they have invaded, that it is practically impossible to drive them out so completely that a sufficient number will not be left behind to quickly re-establish themselves when favorable conditions develop.
Raw starch may be introduced in various ways. A convenient method is by the use of "brose" (see page 237). Another excellent plan is the following: Pour into a bowl six ounces of boiling water. Rapidly stir in a heaping tablespoonful of fine oatmeal, or rolled oats, which has been passed through a vegetable grinder. Let it stand one side for five minutes and add a little salt and eat as porridge. The preparation is not unpalatable. If desired, it may be taken as a beverage with the addition of a little water or fruit juice.
In addition to the above, there are several other highly effective measures which may be advantageously employed in the treatment of colitis. Notwithstanding the free use of bran or agar-agar and paraffin, the colon may be so crippled that it does not completely empty itself and a sufficient amount of material is constantly left behind to encourage putrefaction, and to prevent the healing of the diseased surfaces. Examination with the X-ray shows in these cases a spastic, or contracted, condition of the descending or pelvic colon, and in many cases a prolapsed condition of the pelvic colon, which may be adherent. In these cases, the colon must be daily washed out by means of an enema consisting of two or three pints of salt water. The temperature of the water should be 105° to 108°. The enema should be repeated several times, or until the water returns clear. The effectiveness of the enema is greatly increased by thorough massage of the colon, especially of the pelvic colon, with the patient in the knee-chest position. When the pelvic colon is distended by the enema it may be manipulated more effectively.
After the colon has been thoroughly emptied, an injection is made consisting of a culture of Bacillus Bulgaricus in whey, to which has been added a small portion of well boiled starch and also a small quantity of malt sugar. By this means the colon is inoculated with germs; in other words, a new flora is planted and supplied with the material to promote its growth and development, and to help reform the wild bacteria of the colon to which colitis is due.
It is well to use short tonic baths, the moist abdominal bandage, fomentations and other applications of heat to this region. Light baths, and meas-uses of all sorts which build up the general health, must supplement the local measures above suggested. This method of dealing with cases of colitis has long ago passed the experimental stage. By thorough application of these simple means many hundreds of chronic sufferers from colitis have been not only relieved, but cured. It must be remembered, however, that the measures found necessary to effect a cure of this distressing ailment must be adhered to more or less strictly after the cure, as the only certain means of preventing recurrence.