Report upon the treatment of chronic colitis / by D'Arcy Power.

  • Power, D'Arcy, 1855-1941.
Date:
1911
Catalogue details

Licence: In copyright

Credit: Report upon the treatment of chronic colitis / by D'Arcy Power. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    which relieved her for about a year. She was then seized with diarrhoea and passed blood for three months. She has pain at her menstrual periods and she is an epileptic. On examination her abdomen was found to be soft and flaccid. There was no swelling to be felt in any part, but there was marked tenderness in the right and left iliac regions. She passed evil-smelling faecal material several times a day, but she had control over her bowels and her temperature was normal. Sigmoido- scopic examination showed that the rectum and lower part of the sigmoid flexure was deeply congested, the mucous membrane being of a purple colour and secreting an abundance of mucus stained with faecal material. I performed an appendicostomy on February 23rd and inserted a number S soft rubber catheter. The case is still under observation and on March 25th has undergone very marked improvement. Conclusions. This series of cases is not a very long one, but I venture to think that it may prove interesting as a record of the work of a single surgeon in the treatment of a serious and intractable form of disease. It seems to me that ulcerative colitis does not begin suddenly. Enquiry shows that the mucous membrane of the large intestine has exhibited signs of weakness for a long time before the symptoms of ulceration have appeared. Fissures, ulcers or piles have given evidence of this weakness, and it is noteworthy, I think, that some of the cases began shortly after parturition either at full term or as a miscarriage. This weakness of the rectal mucous membrane has been followed by chronic irritation which led to an increased secretion of mucus from the crypts of Lieberkiihn and by a desire to go to stool repeatedly. The irritation passed on slowly to ulceration marked by the appearance of blood, pus and offensive stools. Absorption of the inflammatory products from the ulcerated bowel has led to a condition of profound toxaemia from which the patient is unable te recover. The first step in the treatment of colitis is to endeavour to find a cause and, if possible, to remove it. Such gross causes as cancer, polypi and appendicitis can usually be excluded without much difficulty by a com- petent surgeon using the later instruments of surgical precision. Typhoid, tuberculous ulceration, inflammation due to the pneumo- coccus, the ray-fungus of actinomycosis, the spirochaete of syphilis and the b. mallei of glanders ought not to be overlooked, and the urine