Observations on the DIAGNOSIS AND TREATMENT OF CATARRHAL AND ULCERATIVE COLITIS
Authors: H. L. Tidy
Journal: BMJ (1930)

THE medical treattment of catarrhal colitis needs the niost careful attention to detail.A bald stiatement of general principles is insufficielnt guilde.Indeed, as ustually enuinci- ated, these consist mainlv of starvation and opium and medicated enemnata-measures which wouild induce colitis in miiany healthv individuals.For success, it is necessary to attelad to many details which might appear to be minutiae.The chroniic forimi will be dealt w-itlh first and special points in the treatment of the acute type will be giv-eni subsequently.Chron-ie catarrhal colitis is a condition ill which clinically ther e is persisteiit diarrhoea over a long period.Cliarac- teristically gastric symptoms are absent thiat is to say, there is no nauisea, -omiting, heartburn, waterbrash, or flatulent eructations.If present, they are slight and do not form a lproiniinent feature.Tile appetite is not sharp, but is usually sufficient for the patient to take a consider- able amount of nourishment.Gastric symptoms are, how- ever, easily L)roduced by an uinsuitable diet.It is obvious that a sev-ere or extensive catarrhal gastro-entero-colitis is hardly consistent with a cheonic course.Exclutiding effects of treatment, the diarrhoea does not tend to vary greatly froim day to day.Nor does the tharacter of 'the stools alter markedly from one mzotion to aniotlher.Days of constipation or tile passage of solid faeces are not interspersed in the course.Blood and mllucus may be present in varying quantities and mixed in v-arying degrees of intimacy, buit blood is not always present.Chroniic colitis milav commence suddenlv with an acute or subacute colitis; this partly siubsides, but persists as chroniic colitis.On the other hiand, chronic colitis may drift in gradually.The patient notices that the daily motioi hiaS become consistently soft and half-formed.Tlhei in coturse of time two stools a day are passed.Gradually the frequency increases in spite of ordiniary measures for dealing w-ith casuial diarrhoea.No distinction is made here between catarrhal anid ulcera- fiv e colitis.The conditions are essenitially the samie andl the treatment is identical.Before describing the treat- ment, the diagnosis must be referred to-first, because certain diseases have somie resemblance to catarrhal colitis, but call for different treatm-ent, and secondly, because certaii mnetliods of diagnosis affect the treatmlent. DIAGNOSIS.The patient m11ust be under observation in bed aild the stools examined, at least withi the n-aked eye, before a diagnosis of catarrhal colitis is mnade.Apparent colitis may sometimes prove to be due to aperients takems from un- grounided fears of cancer or of constipation, and the stools may become solid in a few days withouit treatment; in other instanlces the history lhas ev-idently been ilaccurate, especiall w hen there is a factor of neurosis.In se-ere cases very little observation is sufficient, and no time need be lost before treatment is comiimenced.Difficulties in dia.gnosis mi-nore commnonly arise in cases of less sev-erity, and a few days may be necessar-y for diagnosis; this time can safely be afforded for observation in suclh instanlces.Bac- teriological and microscopical exanainatioii of the stools should be carried out in every case, but it is not necessary for commencemenit of treatmnient to wait until these are complete.The special condition-s fromi wlhich time diagnosis of catarrlial colitis mnust be illadle are:1. Muco-nimbrllanouls csolitis.2. Dysenter.-