Intestinal Ulcers.

Probably no part of the body is more subject to the ulcerative process than the intestinal canal, and it may arise from various causes. The symptoms may be so slight as not to suggest the nature of the lesion, and the disease go undiscovered until revealed by an autopsy.

Various forms of ulceration are noted, the principal ones being stercoral and the simple ulcers attending catarrhal disease of the intestine, or the result of the infectious fevers.

Etiology.—The same causes that give rise to gastric ulcer may produce duodenal ulcer, and extensive burns are not infrequently followed by intestinal ulceration. Septicemia may be responsible for this condition, probably the result of embolism.

Amyloid degeneration of the intestinal blood-vessels are also cited as a possible cause.

Follicular and catarrhal ulcers develop in catarrhal enteritis of both children and adults. Long-continued constipation, attended by impaction of hardened fecal masses, may give rise to stercoral ulcers. Ulceration frequently attends the infectious fevers; especially is it found in typhoid fever, dysentery, diphtheria, small-pox, pyemia, and erysipelas. Of the chronic diseases, tuberculosis attended by ulceration and syphilis are the most notable.

Pathology.—The pathological changes are the same as take place in gastric ulcer, or that of any other mucous surface. The ulcer may be superficial, involving the mucosa, or extend to the deeper structures, even to perforation.

Symptoms.—The most constant symptom of intestinal ulceration, unless located very high up in the bowel or of a very superficial character, is diarrhea. Hemorrhage is also quite frequent, and unless retained in the bowel for some time, is bright red in color; otherwise it is tarry in character.

Pain occurs three or four hours after eating. The general symptoms depend upon the causes giving rise to it, and whether masked by the primary lesions. The stools contain pus, blood, shreds of mucus, fecal matter, and various bacteria.

Treatment.—The diet should be bland and nourishing, and though at first liquid in character, should be changed to a dry diet as soon as possible. Beginning with pepsin or sherry whey, malted milk, Mellin's food, imperial granum, Eskay's food, etc., we change to scraped beef, stewed sweetbreads, broiled steak, lamb-chops, toasted bread, baked potatoes, etc., but enjoin the use of tea, coffee, milk, or water while taking food.

In the way of medication, hydrastin phosphate, ten grains to four ounces of water, a teaspoonful every three or four hours, will give good results. Where the action of an astringent is desired, bismuth subgallate, in five or ten grain doses, is to be recommended.

Dioscorea will be used where there is soreness of the bowels, or colocynth if colicky pains are experienced. Epilobium and ipecac are not to be forgotten. Where the ulcers are in the sigmoid flexure or rectum, tampons of wool smeared with balsam of Peru, and passed with dressing forceps to the seat of the ulcers, will prove of great benefit. They should be used two or three times per week.

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