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

Treatment ol Severe Cases ol Chronic
Colitis.
P. L. Mummary says that cases Qf chronic
colitis naturally divide themselves into two
classes: First, those which, if carefully
treated by a suitable dietary, proper regulation
of the bowels, and perhaps one or
more visits to some suitable spa where
proper lavage of the bowels can be carried
out, get well and stay so; and, second,
those in which, in spite of prolonged care-
ful medical and spa treatment, but little if
any improvement follows, and in which relapses
quickly occur. The latter forms one
of the worst classes of chronic invalids and
chase after all forms of quackery. The first
task of the physician should be to find out
the real cause of the symptoms. The term
"chronic colitis" should be reserved for
those cases in which there is a chronic inflammatory
condition of the colon mucosa.
They should be made out easily with the
sigmoidoscope, as the sigmoid flexure is
practically always involved. Such cases
do well on lavage and the Plombieres
douche. In some of the cases with this
class of symptoms there is, instead of lesion
of the mucosa, some chronic obstructive
lesion, such as adhesions from a previous
peritonitis or perimetritis. Cancer of the
colon may cause symptoms of chronic
colitis. In another group of cases we find
a chronically inflamed appendix. In still
another group there is no inflammation of
the mucosa, but the whole colon is lax and
atonic and there is a marked tendency for
the upper portions to prolapse into the lat-
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ter, and there is generally well-marked
ptosis of the stomach and the transverse
colon. Here lavage would be harmful.
Those cases which medical measures fail to
relieve may call for appendicostomy. The
most difficult cases to treat are those in
which there is a general atony of the bowel
combined with ptosis of the colon. Stitching
up the colon is quite useless, as it is unreasonable
to expect stitches to hold up the
stomach and transverse colon permanently
when the natural supports have not been
able to do so. In such instances very satisfactory
results follow appendicostomy and
the fitting of a belt to support the abdomen.
The object of operation in such cases is to
prevent the stagnation of the fecal contents
of the colon and at the same time by the
introduction of peristaltic stimulants to improve
and restore the muscular tone of the
bowel wall.—British Medical Journal.
THE CHARLOTTE MEDICAL JOURNAL.
quired during systole to keep up the circulation
is as low as possible. A mixture
containing bromides and iodides may be ;
given to these cases. Iodide of sodium has j
no practicable superiority over iodide of j
potassium; either will do, but the addition j
of bromide of potassium is advantageous, I
possibly partly because it quiets the nerv- 1
ous system, and we know that the blood
pressure is largely influenced by the emo-
tions. The various vasodilators, such as I
amyl nitrite, trinitrin, erythrol tetranitrate, I
are also useful, but should not be given as •',
a matter of routine Belladonna combined 1
with bromide and iodide is often beneficial, i
Wiere there is sleeplessness, as is not in- '
frequently the case, a hypodermic injection ;
of morphine is often of the greatest service, i
Digitalis should not be given in this class
of cases. Strophanthus causes less peripheral
constriction than digitalis, and so is :
safer, but even this drug is better avoided :
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if the mitral valve is competent. The heart
muscle may be sustained and stimulated, if
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desirable, by strichnine, but strychnine is
incompatible with iodide of potassium, as it
forms an insoluble iodide.
There is, however, another class of cases I
where aortic regurgitation has gone on for i
some time, producing the conditions in the
ventricle already described, without any i
sudden rise of pressure, causing sudden )
death, but where, as the result of the grad- i
ual dilatation of the left ventricle, the mitral
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valve becomes incompetent. When this i
occurs the danger of sudden and dramatic I
death is to a certain extent lessened, but a ;
new series of symptoms arises. Before, the '
diflaculty which the left auricle had to face
was that of pouring, during its systole, the i
blood it contained into a possibly partly I
filled ventricle, but now, added to this, it
has a stream of blood underpressure forced '
into it during its diastole by the contraction >
of the ventricle; consequently the auricular 1
dilatation increases and the pulmonary',
blood pressure rises, so greatly increased :
work is thrown upon the right ventricle and
changes occur in the right side of the heart. I
For a time the increased pulmonary press-;!
ure may be compensated by hypertrophy of
the right ventricle, but in a heart already, i
seriously altered from aortic regurgitation'
this compensation is not, as a rule, long I
maintained; the right ventricle dilates, tri- :
cuspid regurgitation takes place, and we I
get engorgement of the systemic venous
system, with the usual symptoms of enlarg- i
ed liver, oedema of the legs, and possibly i
ascites; in fact, the case which was pri- ;
marily aortic regurgitation now puts on the,
The Treatment of Aortic Valve Disease.
In cases of pure aortic regurgitation, our symptoms of mitral disease and terminates'
efforts should be directed to lowering this as mitral cases do. |
resistance, so that the amount of force re-
This is the class of aortic cases in which i
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