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Related post: those of ulcerative colitis, for obstinate constipa- tion, as a Lidocaine Jelly 2 rule, both precedes and accompanies membranous colitis, while diarrhea as unifomily accompanies ulcerative colitis. There are several forms of secondary mem- branous colitis, on the other hand, which have nothing in common, excepting the formation of membranous patches, with the disease which we are considering, either in their etiological or in their clinical characters. Thus, in some cases of chronic Bright's disease, the patients lie coma- tose for Purchase Lidocaine days and pass loose movements in bed. After death the colon, as well as parts of the small intestine, are found lined with thick, diph- theritic-looking patches, while, because such membranous exudations never appeared in the dejecta, their existence was demonstrated 2 Lidocaine Jelly only on the post-mortem table. On the other hand, the presence of both albuminuria and of hematuria is not uncommon, as temporary symptoms in true membranous colitis. In two patients of mine I have noticed these signs of direct irritation of the kidney repeatedly, but Lidocaine Iv I do not place much store upon them, for other signs of progressive renal disease have remained absent, although these pa- tients have been under my continuous observation for several years, 1 ascribed these renal sj-mp- toms to the entrance of the bacillus coli into the blood through the diseased intestinal wall, A case of true membranous cohtis, such as we have been considering, has no real resemblance to a catarrhal colitis or to a catarrhal inflamma- tion of any kind. What leads to a confusion be- tween this especial affection and others, the seat of which is in the large intestine, is the presence, more or less common to them all, of colonic Lidocaine Anesthesia symptoms. Just as any form of arthritis, whether traumatic, rheumatic, gouty, gonorrheal, pyemic, etc., will cause very similar symptoms of pain on movement of the joints, with redness, swell- ing, etc., so that the most diverse varieties of arthritis can be confounded in diagnosis and even in nomenclature — witness that impossible hybrid, rheumatic gout— so every serious process in the colon will occasion abdominal distress, tenesmus, or "bearing down," or pain before and during defecation, etc., and it is only when we have set these colonic symptoms aside and direct our attention to the conditions which they present, as separately characteristic of each form, that it becomes plain that in true membranous colitis we have a specific affection of the large intestine, the patholc^y of which is undoubtedly distinct from all other colonic disorders, with, in all probability. as specific an etiology. From Lidocaine Purchase the clinical side some of the etiological factors appear to be direct mechanical 4 Lidocaine irritation of the rectum, as by horseback or bicycle-riding, as already mentioned in two of my cases. Sim- ilar to these are cases traceable to pressure on the rectum by uterine fibroids, and it is well to examine carefully in women for the presence of such possible causes. In my opinion, however, by far the commonest cause is the prolonged re- tention of hardened scj-bala. A history of pre- June 3, 1900] THOMSON : TREATMENT OF MEMBRANOUS COLITIS. 8Si ceding habitual constipation of Lidocaine 4 years' standing is the rule in these patients, Lidocaine Cost and, hence, the greater frequency of the complaint in women. It is striking to find, Iv Lidocaine Lidocaine Oral when we carefully investigate the antecedents of most of these female patients, how evidently Cost Of Lidocaine they have been subject to fecal reten- tion for months at Buying Lidocaine a time, and there is nothing which favors the formation of stationary hard lumps of feces in the weakened and distensible colon Lidocaine Anesthetic as the habitual use of certain laxatives and cathartics. One of the largest masses of the kind which I have ever had to deal with proved on examination to consist mainly of hg-seeds. Once that this irritation awakens the morbid process in the colon, it seems to change the nu- trition of the intestinal wall in its own special way, with a Lidocaine Mg definite tendency for this initial local change to spread in the wall either upward or downward, according to its first seat and, finally, to induce a permanent perverted Anesthetic Lidocaine secretion, which becomes very difficult to alter or to cure. As to treatment, the first indications are to relieve the colonic symptoms proper, as they may be termed, that is, symptoms which are more or less common to all diseases of the colon, as pain and stiffness of the joints on movement are common to all varieties of arthritis. Thus, noth- ing is so soothing to the tenesmus, the 10 Lidocaine cutting and bearing-down pains, Lidocaine Gel 2 and the general abdomi- nal distress, as free irrigation of the colon with normal saline solution, to which may be added oil of peppermint, five drops to the pint. Lidocaine Price Three to five gallons, at a temperature of 100° F., may be employed once Oral Lidocaine in twelve hours, and given by Lidocaine 10 Kemp's rectal irrigator, according to the printed directions which are furnished with this simple and serviceable instrument. The relief which this hot douche affords is often described by the patients as very great, and as enabling them to sleep at 'flight better than any Lidocaine Ointment 5 other measure. Care must be taken, however, that all the fluid is returned, lest any quantity retained may after- ward provoke a return of pain, thus causing it to act as an enema. By a little practice, how- ever, this may be avoided. Great quantities of mucus are thus dislodged and washed away, but
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