Vol. 60, 1909 - University of North Carolina at Chapel Hill

188 THE CHARLOTTE MEDICAL JOURNAL.
profound faith in these preparations. In end, the csecostomy or appendicostomy
small quantities.they do no harm. Similarly,
a hot, clean fluid, such as beef-tea, is pleasopening
is easily closed. In chronic ulcerative
colitis the urgency of the symptoms
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ant to the
digestion.
febrile tongue and disordered is not so great and milder medical measures
As ordinary articles of an in- may be given a prolonged trial. But when
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fant's dietary, these foods must be con- the diarrhcea still continues with the pass- ;
densed. age of blood and mucus, and despite treatment
the patient is progressively losing
The Surgical Treatment ol Colitis.— weight and passing, as they frequently do,
Heaton, according to the Edinburgh Medi- into a neurasthenic condition, an appendi-
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cal Journal, says that of the causes of acute costomy with prolonged daily irrigation of
ulcerative colitis we know but little. Some the colon will in many cases effect a cure. ;
authorities, notably RoUeston. include all Many such successful cases have been re-
such cases under the term dysentery, and ported.
maintain that bacteriological examination „ ^ „ .. . ,,. . ^.^ .^
shows them to be identical. But Osier, «^"» Degeneranon ol Uterme Fibroids i
Allchin, and others hold that they are sep- Complicating Pregnancy.- Bland-Sutton ;
arate and distinct disease. Bright's disease in the Edinburgh Medical Journal discusses <
would certainly seem to be a predisposing the influence which pregnancy exerts on j
factor and the disease seems equally com- fibroids. When the walls of the uterus are i
mon in men and women. There is pro- occupied with fibroids and pregnancy en-
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found diarrhcEa, and blood is almost always sues, the fibroids are often influenced by
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present in the motions, mixed with a most the altered conditions. They often become j
offensive mucus and pus. There are usu- red or flesh-colored and this has been sup- 1
ally marked abdominal tenderness, rapid posed to be due to an increase in muscular ;
and progressive emaciation and weakness, fiber. Another important change is the !
the patient in some cases lapsing into a onset of pain and tenderness. In early !
typhoid condition. The temperature is stages the reddish change comes in streaks,
irregular, and there may be profuse pers- but as pregnancy advances the whole fibroid \
pirations. Distinct diagnosis has to be mass becomes so affected and the whole
made from abdominal tuberculosis, typhoid fibroid may even soften and become difiiufever,
and malignant ulceration of the lower ent. In these degenerating fibroids no orbowel
with spurious diarrhcEa, and is in ganisms are usually found, but the tissue
some cases a matter of extreme difficulty, is necrotic and refuses to stain. The char- |
A sigmoidoscopic examination should be acteristic redness is found to be due to the
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made whenever practicable in these cases, diffusion of blood pigment through the
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and will often materially help in arriving necrosed tissues, so that the hardest fibroid
at a right conclusion. The prognosis seems may become of the consistency of soft soap,
'from the reported cases to be a very bad From a large subserous fibroid staphyloone;
intestinal perforation is frequently a coccus pyogenes aureus has been isolated, ,
cause of death. Murrell reported five cases but no organisms have been found in the
treated on purely medical lines with one re- interstitial variety. It is now believed that
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covery and four deaths. Active surgical when a uterus becomes pregnant the fibroids i
treatment is urgently called for in such do not enlarge in consonance with the physicases.
The large bowel must be kept empty ological increase of the normal muscular
and at rest, and yet to starve such patients tissue of the uterus. Some fibroids do en-
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is to kill them, while rectal feeding is out large beyond doubt, but this results froir i
of the question. An artificial opening is interference in circulation in these tumors, ,(
made in the caecum, or the appendix is producing edema and color change due to
fixed to the abdominal wall and opened, hemolysis of blood, not to rapid increase in 'i
The operation can be done in a very few muscular tissue, as has generally been sup-
minutes and with but little or no shock,
Intestinal contents are in this way diverted
posed. The sudden pain and tenderness
produced by the red change may suggest
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from the ulcerated colon, which is at the rupture of a pregnant tube. If the patient
same time put at rest and under the best is kept in bed the pain and tenderness due
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conditions for repair. Through the open- to the red change will generally subside.
ing thus made the inflamed and ulcerated Occasionally surgical intervention is neces- ',>
bowel can be daily irrigated. H. C. Curl sary. During the last nine years twenty ';
has reported eleven such cases, with eight cases have come under the author's personal ;i
recoveries and three deaths. One of the care. Of these ihe symptoms came on in li
deaths occurred in a patient who was al- the first month once, in the second four 1;
ready moribund when operated upon, times, in the third four times, in the fourth :i
Later, when the patient is convalescent and six times, in the fifth, sixth, and seventh )i
the ulcerative processes have come to an once each, and in the puerperium twice. \i
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