CHAPTER XXV.

CHRONIC MUCOUS PROCTITIS AND SIGMOIDITIS--USUALLY DIAGNOSED AS CHRONIC MUCOUS COLITIS.

Chronic mucous colitis ought to mean inflammation of the ascending, transverse, or descending colon. The length of the rectum varies from five to eight inches, and the average length of the sigmoid flexure is about nineteen inches; the length of the two organs is thirty or more inches. Chronic follicular, ulcerative proctitis and sigmoiditis, extending half, or even the whole length of the sigmoid flexure, causes great suffering, and the symptoms are similar to those attributed to chronic mucous colitis. For about thirty years I have positively known that many of my patients suffered not only from chronic mucous proctitis, but from sigmoiditis as well, since I was able to make positive diagnosis of the diseased condition for at least ten to fifteen inches up the lower bowels.

If the anal canal is inflamed from any cause and not cured, the chronic inflammation will gradually extend up the whole length of the rectum and into the tissues of the sigmoid flexure, invading the organ to a greater part of its length, if not all of it. The sigmoid flexure is the normal receptacle for feces, and gases, and physiologically and hygienically ought to be emptied three times in twenty-four hours to keep it clean for those who are in the habit of eating food three times a day. The hygienic condition of the sigmoid receptacle is entirely dependent upon a healthy condition of the rectum and a sensible tenant of the body; but when chronic proctitis has taken possession of the rectum and neighboring tissues, it serves no longer as a normal passageway for emptying the sigmoid flexure of accumulated feces, gases, and liquids.

At first inflammation causes spasmodic muscular contraction of the anus and rectum, which in time becomes more and more permanent stricture as the progress of disease advances, lessening the bore of the organs until it becomes very difficult for anything to pass into and through the rectal and anal canals. Inflammation extending from the rectum into the sigmoid flexure for perhaps its whole length, interrupts its functions likewise, thus creating another cause for undue accumulation of feces and gases in the organ; this accumulation of the waste material of the body becomes very foul, generating toxic gases, putrid substances, and poisonous germs which in turn irritate and excite the diseased organ from their constant contact with the follicular ulcerated mucous membrane of the sigmoid receptacle. Why should we not find in these cases all the symptoms attributed by authors to chronic mucous colitis? Especially so when we have, in addition to the enumerated symptoms of colitis, those caused by periproctitis and perisigmoiditis, which are always present and quite severe.

As a rule, the symptoms which have been diagnosed as those of chronic mucous colitis, membranous colitis, or ulcerative colitis are nothing more than symptoms of chronic mucous proctitis and sigmoiditis, accompanied by periproctitis and perisigmoiditis. Proctologists who have written on the subject of mucous colitis have noted the many symptoms very accurately, but have missed the usual location of a most aggravating disease from which mankind suffers early and late in life. Authors of books on stomach and intestinal troubles are also groping very much in the dark and are unable to diagnose the cause of a very common functional disturbance of the whole digestive apparatus, caused by proctitis and sigmoiditis, bringing numerous and severe primary and secondary symptoms to which other diseases may be traced.

Chronic proctitis and sigmoiditis and their local symptoms convert the sigmoid receptacle into an Augean stable, from which foul poisonous gases and germs are forced up and along the bowels, distending the descending and transverse colon and finally reaching the ascending colon and the cæcum, causing undue retention of their contents; hence so much attention to the cæcum and the vermiform appendix. The ends of a long rubber tube distended with gas will exhibit more strain and disturbance than the intermediate parts, and the same is true of the colon, owing to the intermediate sections of the organ possessing greater mobility. The great volume of gases confined in the colon prevents its normal peristaltic action, causing undue retention of contents, with resulting inflammation of the cæcum, as well as dislocation of the stomach, colon, etc., and suggesting radiographic and fluoroscopic examination and surgical operations to discover the cause of all the trouble, which should have been learned through use of the speculum before so many complications occurred.

In all cases of chronic mucous proctitis and sigmoiditis where there is a great amount of secretion of mucus, membranous cords, shreds, and casts (called mucous colitis), I have found the marked acute symptoms more or less periodic and accompanied by increased inflammation in all the tissues involved in the disease, which convinced me that the colitis we read about had become dislocated and was where I could see its results without the use of a speculum.

Through often witnessing the phenomena, I have learned what a “mucous colitis” storm means from a pathological exhibit, a personal demonstration, and a verbal description of what the sufferer is enduring. It requires the stuff heroes are made of to endure chronic mucous proctitis and sigmoiditis for ten, thirty, or forty years without the disease being accurately diagnosed, and to be told that all treatment is useless and that the trouble is in the head of the sufferer, that he is a hypochondriac, and a neurasthenic, terms often used by doctors who are unable to make a proper diagnosis of a case.

The common symptoms of mucous colitis have been accepted by writers on the subject, but as to the real cause of them there has been thus far only mere conjecture, just as the writers have been doing as to the cause of pruritus ani, scroti, and vulvæ. Dr. George M. Niles, of Atlanta, Ga., says: “In looking up the literature, one is amazed at the divergent views as to the etiology and management held by diligent students and competent observers. It is fairly well agreed that most cases occur in nervous, neurasthenic, hypochondriac, or hysteric individuals.” Others blame the liver, hysteria, constipation, fermentative processes in the intestines. How foolish to name symptoms of the disease as a probable cause of it! It is not necessary for me to again enumerate the many primary and secondary symptoms of proctitis and sigmoiditis, but I will mention briefly a few nervous symptoms which I think are due to the absorption of mucus into the system. There is that intense, exasperating, sore, and restless feeling, with inability to concentrate the mind, with the nerves and muscles of the body pinched and contracted. Such feelings are at their height during an acute mucus storm, which is an indication of increased inflammation in all the inflamed tissues, causing secretion of a great quantity of mucus or membranous casts. No doubt much of the inflammatory exudate from the mucous membrane, from the muscular structure of the organs, and the connective tissue surrounding and supporting the organs, passes into the sigmoidal and rectal canals, while a portion is absorbed into the system. In a similar manner, the inflammatory exudate from a subtegumentary mucus channel and cavity passes through the skin, causing moisture of the skin, pruritus ani, scroti, and vulvæ. I know of no non-malignant disease, where the symptoms may truly be said to be a thousand times worse than the disease that caused them, except in chronic proctitis and sigmoiditis.

Treatment of such cases has been very successful in my practice, requiring four principal aids: (1) Local treatment; (2) medicated enemata; (3) local medication; (4) the recurrent application of medicated hot water at a temperature of 125 to 135 or more degrees. A further valuable aid is the determination of the sufferer to get well by faithfully carrying out the home treatment. The more a patient studies my diagnosis and treatment of his case, the more he is encouraged that eventually a cure will be effected. Dr. James Moran of this city has been a student and assistant at my office for more than three years, and will bear testimony to the success of my treatment in all cases observed by him.