All forms of colitis are the result of bacterial or parasitic influences. In most cases of acute intestinal catarrh resulting from toxic articles of food, there is an associated inflammatory state of the colon; in these cases a mild degree of colitis is present. This catarrh of the colon readily subsides under the treatment laid down for the correction of the diseased state of the small intestine (p. 356). There is a large group of affections, however, in which the catarrh involves the colon primarily, and here all grades of severity of the disease are met with. Four clinical types are recognised: -
1. Simple colitis, acute and chronic.
2. Ulcerative, acute and chronic.
3. Dysentery, acute and chronic.
4. Mucous colitis, or muco-membranous colitis (see p. 360).
It is probable that ulcerative colitis and dysentery are really one and the same condition.
The treatment of the different forms of colitis is difficult, and sometimes unsatisfactory. The patient requires to exercise considerable patience in regard to treatment.
Complete rest in bed is essential. Care must be taken that the bowel has been thoroughly emptied by a cathartic or by enema. At the outset the diet should be restricted to fluid foods, and especially milk. Plain milk is not at this stage suitable, but may be given diluted with water or lime-water in proportions of three to one. Where the diluted milk is found unsuitable,skimmed milk, whey,or koumiss may be well borne. Thirst is best relieved by sipping tea-spoonfuls of hot water or by sucking ice. As soon as the more acute symptoms have passed off, milk diluted with lime-water, curds, or milk blancmange, Plasmon, yolk of egg, various invalid foods such as Allenbury, Savory & Moore's, and Benger's, and arrowroot, sago, and other simple farinaceous foods, may be added to the diet. Soured milk is also advantageous in some cases. Proteins in the form of fish, chicken, sweetbread, and tripe are then added to the diet. Fatty foods, green vegetables, raw fruits, and any of the less digestible foodstuffs should be avoided for a long time after the disappearance of the acute symptoms. The following dietaries are given as being appropriate to the onset of the disease, and at the end of tin first week of an acute colitis of average severity: -
At onset of diseases. pints of milk in twenty-four hours should be given, slightly warmed, as follows: -
Every two hours about 5 ounces of sweet milk, either in the form of milk diluted with water or lime-water, or an equal amount of whey, koumiss, skimmed or soured milk.
The milk may sometimes be fortified by the addition of albumin water (white of 2 eggs), or Plasmon, 1 to 2 drams daily.
At end of first week.
6 a.m. - Milk, 5 to 10ounces, diluted with lime-water.
8 a.m. - Milk, 5 to 10 ounces, with yolk of egg. 11 a.m. - Soured milk, 5 to 10 ounces. 1 p.m. - Rice soup (strained), with yolk of egg. Milk blancmange, made with isinglass; or Arrowroot, well boiled, with milk. 3 P.M. - Milk, 5 ounces, with Plasmon. 5 p.m. - Whey, 5 ounces, with yolk of egg.
7 P.M. - Benger's food, 10 ounces, with Plasmon; or Mutton broth, boiled barley (strained), and yolk of egg.
9 P.M. - Milk, 5 to 10 ounces.
Great care is necessary in selecting the diet for these cases. The condition has usually been of loner standing, and the patient's attention may be unduly concentrated on the state of his digestion, with the result that he has cut off one article of food after another, and may be living on a semi-starvation dietary. The keynote to the successful treatment is simplicity. It is not, as a rule, necessary to cut off either the proteins, fats, or carbohydrates. It is, however, essential to cut off all the extras in an ordinary dietary, and for each meal to be made up of one or at most two dishes, which must be simply prepared. Lavage on the Plombiere system, is frequently of great value. In certain patients with hypochondriacal tendencies it is better avoided. In most cases it is best to give during the first week of treatment the diet for acute colitis (supra). The following points will be found of value in prescribing the different meals for these cases after this preliminary course of treatment is over: -
7 A.M. - Small glass of milk (warmed).
Lightly boiled egg, toast and butter, weak tea with milk (small cup); or Tender streaky bacon, toast (no butter), weak tea with milk (small cup); or Steamed fish, bread and butter, weak tea with milk (small cup); or Slice of tongue or lean ham, weak tea with milk (small cup).
(Avoid sugar unless in very small amount, jam, marmalade, hot scones, and oatcake).
11 A.M. - Small cup of clear soup, with strips of toast.
Fish (fried or steamed, one of the white varieties); potato; or Chicken (roasted or boiled), with bread sauce; or Tripe or sweetbread; or Broiled chop or steak, or slice of roast beef or mutton, and one plain vegetable.
4.30 p.m. - Cup of freshly made tea, rice biscuit, rusk, or sponge cake.
Not more than two courses.
any simple good soup (not broth, unless strained); hare, kidney, oxtail, and mulligatawny should be avoided. Meat, fish, or chicken as above, with one vegetable. Pudding - a milk pudding made with egg, a souffle, custard, cream, or jelly. No suet puddings or pastry. No extras such as dessert, fruits, sweets, nuts, or pickles.
9.30 P.M. - Cup of Benger's food if desired.