In enterocolitis the ileum and colon are chiefly affected, especially
the lymphatic glands or lymph follicles.
=Osteopathic Etiology= and =Pathology=.—Warm weather, the artificial
feeding of children, dentition and bad hygiene are predisposing causes.
The disease usually occurs between the ages of six and eighteen months,
but it is not infrequent in the third or fourth year. This disease
is not confined to the warm weather, but may set in at any season of
the year. Previous light attacks of diarrhea are often a predisposing
factor. Lesions in the spine occur from the eleventh dorsal to the
fourth lumbar.
The mucous membrane is congested and swollen, and the solitary
follicles and Peyer’s patches are swollen and often ulcerated. The
changes may end here or the ulcers enlarge and extend into the muscular
coat with the separation of a slough. There may be infiltration and
thicking into the submucous and muscular coats, followed by induration
of the tissue, producing abnormal rigidity.
=Symptoms.=—The disease may be a sequel of dyspeptic diarrhea or
cholera infantum. The temperature increases and the stools change in
character, being at first yellow, and later green. They contain traces
of blood and mucus. Vomiting may be present, but is not a constant
symptom. The abdomen is distended and tender along the course of
the colon. The disease may abate here, recovery from the condition
being slow; or the symptoms may increase in severity with persistent,
small, painful stools, mainly of blood and mucus, tenesmus, and with
scanty urine. The child grows pale and emaciated, and assumes a senile
appearance. These cases last five or six weeks, death being preceded by
coma and convulsions; though a few recover. Relapses are not uncommon
and should be guarded against. =Ulcerative and membranous= forms may
occur. Pneumonia and nephritis are possible complications.
=Diagnosis.=—=Enterocolitis= is distinguished from dyspeptic diarrhea
by the greater severity, more fever, greater prostration, the stools
containing more mucus and even blood, and by the greater pain and
suffering. =Cholera infantum= may be recognized by the abrupt onset,
very high fever, constant vomiting, and early collapse. If typhoid
fever seems a possibility, the Widal test should be used.
=Prognosis.=—Grave; recovery follows prompt treatment with favorable
surroundings.
=Treatment.=—Attention should be given to the condition of the spine
from the eleventh dorsal to the fifth lumbar. An inhibitory relaxing
treatment over the sacral foramina will lessen the tenesmus. When
the ileum and colon are involved, disorder is usually present at the
third and fourth lumbar vertebræ, although the lesion may be higher.
Relaxation of all muscles in this region and correction of the
vertebral lesions are essential.
Irrigation of the bowels once a day with a pint of cold water is very
beneficial and even pieces of ice may be introduced into the rectum.
Fresh, pure air, rest and cleanliness, with a restricted diet and daily
warm baths are important. In a word, hygienic and dietetic treatment
similar to that for acute diarrhea should be employed.
In all forms of diarrheal diseases in children much depends upon
previous =osteopathic= attention, =diet=, =hygiene=, and =environment=.