Acute Catarrhal Enteritis.

Synonyms.—Acute Intestinal Catarrh; Acute Diarrhea; Enterocolitis.

Definition.—An acute catarrhal inflammation of all, or a part of the intestinal tract, and characterized by frequent mucous diarrheal stools.

Etiology.—There are certain predisposing causes that should be taken into consideration; viz., age, season, previous attacks, and individual susceptibility.

Age.—While no age is exempt, children under two years of age suffer from catarrhal enteritis more than those in any other period of life.

Season.—The hot season, or the months of July, August, and September, will witness the most cases.

Previous Attacks.—Previous attacks render the patient far more liable to the disease.

Individual Susceptibility.—Some individuals, who are otherwise perfectly healthy, suffer from frequent attacks of diarrhea.

Other conditions, such as an enfeebled vitality, insufficient clothing, confinement within doors without proper exercise, may be considered as predisposing to this disease.

The Exciting Cause may be divided into primary and secondary.

Primary.—Irritation is the primary cause of an attack, and may arise from food, changed secretions, acid or alkaline, drugs, or from infection. The most common, especially in children, is improper food, unripe fruit being peculiarly irritating. Green food stuffs not properly prepared, or insufficiently cooked, are very common causes during the hot summer months.

Over-eating, even though the food be of good quality and properly prepared, may also give rise to diarrhea. Pure water, or water to which the patient is not accustomed, may also be the causal factor. Toxic substances in the form of ptomains, produced in cheese, milk, canned goods, or from the ingestion of certain drug's, such as arsenic, mercury, antimony, and the mineral acids and alkalies, may give rise to diarrhea. Even harsh cathartics may act in the same way.

Sudden atmospheric changes, especially from hot to cold, when the individual has insufficient clothing, may produce the disease, while a change in the intestinal secretions, either an excessive or perverted secretion, will give rise to diarrhea. Mental excitation, such as a great shock, or severe fright, will also act as the excitant.

Secondary.—Infectious diseases, such as typhoid fever, tuberculosis, dysentery, cholera, measles, pneumonia, septicemia, and pyemia are preceded or attended by diarrhea. The extension of the inflammatory process from adjacent parts, such as gastritis, peritonitis, hepatitis, intestinal ulcer, hernia, invagination; certain cachectic diseases, as cancer, Bright's disease, anemia, syphilis, etc.; circulatory disturbance, especially congestion of the portal circulation.

Pathology.—The pathological changes are similar to those of all mucous surfaces, viz.: Engorgement by an excessive exudation of mucus. The membrane is red and swollen, though when the inflammatory process is long continued, the redness subsides and the mucous membrane becomes soft and pale. The solitary and agminate glands become enlarged and stand out prominently; the centers of the follicles undergo necrosis, giving rise to follicular ulcers. The mesenteric glands are usually swollen and hyperemic.

Symptoms.—The symptoms depend somewhat upon the seat of the inflammation, whether a part or the whole of the intestine be involved. Diarrhea is the most characteristic symptom and is very early attended with pain, usually of a griping character. If the colon be much involved there will be a more constant desire to go to stool, and there will be tenesmus, similar to dysentery.

The stools vary from two or three to twenty or thirty in twenty-four hours. They may be small, and mostly mucus, or large, watery, and feculent, the color depending largely upon the amount of bile present. Mucus with specks of blood is often seen in the stool, and sometimes undigested food.

There is usually more or less rumbling of the bowels, especially where the small intestine is the seat of the disease, and is due to increased peristalsis. The tongue is generally elongated and red at tip and edges, there is marked thirst, the skin is dry and hot, and the temperature slightly elevated. In children there may be nausea and vomiting, and in nervous children, a convulsion is not uncommon. In delicate children and old people, there is danger of collapse, the skin becoming relaxed, cold, and clammy.

Diagnosis.—There is usually but little difficulty in recognizing this disease. Sometimes it may resemble typhoid fever, but the peculiar temperature curve, the enlarged spleen, and the characteristic eruption of the latter, will enable one to note the difference between the two. It is distinguished from dysentery by the severe tenesmus of the latter, together with a mucous or muco-bloody stool.

Prognosis.—Unless severe complications arise, the prognosis should be favorable.

Treatment.—The management and care of the patient is of great importance, and must be rigidly followed to get the best results from medication; in fact, the best treatment may be rendered void by neglect in this line. The patient should be placed in bed and required to remain quiet, not allowing him to get out of bed to stool, as the exertion brings on increased peristalsis; for this reason a bed-pan should be used. The patient should be encouraged to resist the call to stool just as long as possible.

The diet should consist of milk taken in small quantities, or whey or junket may replace the milk, which usually is received kindly. Malted milk is also borne well, and strained chicken or lamb broth may be given after the acute stage is passed.

During convalescence, scraped beef, well-cooked rice, and fresh, ripe fruit may be cautiously given, withdrawing at once any article that causes irritation. During the acute stage the patient is very thirsty, and calls almost constantly for water; the gratification of his thirst, however, increases the irritation and aggravates the disease. Small bits of cracked ice or albumen water, in small quantities, may be allowed, or, what is better still, a teaspoonful of white liquid physic in a fourth of a glass of water; this acts kindly to the inflamed bowel, and at the same time checks the thirst.

In the use of remedies, do not give castor-oil or salines, unless you are thoroughly convinced that there are accumulations of fecal matter that are a source of irritation. Where the tongue is elongated and red at tip and edges, give,—

Many of the old Eclectics are still wedded to the old neutralizing cordial, which is certainly a grand prescription.

Where the tongue is red and moist, the following prescription will give good results:

Where there is nausea, bismuth and mint-water will be indicated.

When there is griping pain and much flatus, colocynth is one of our best remedies.

When the tongue is broad, skin relaxed, and pain points to the umbilical region, use,—

Where the stools are watery, and green in color, give arsenite of copper 2x, half as much as will lie on a dime, every one or two hours.

Where there is nervous irritation, with nausea, the prescription will be,—

This is one of our best agents.

If the tongue be full and coated, Podophyllin 2x, 2 grains, every two or three hours, will give good results.

Dioscorea.—Where there is marked tenderness on pressure, or the patient complains of constant soreness, use,—

Local Measures.—Where the stools are frequent and acrid, flushing out the bowel is of great benefit. We may use simple sterilized water, or a weak saline solution; allow the stream to flow till the water returns perfectly clean. Should the pain be intense, a tablespoonful of starch-water, to which has been added from five to twenty-five drops of laudanum, should be thrown into the rectum. A liniment of camphor, turpentine, 1 ounce each; alcohol, 2 ounces, may be used to gently rub over the abdomen every three or four hours.

The Eclectic Practice of Medicine, 1907, was written by Rolla L. Thomas, M. S., M. D.