The tongue is coated, the abdomen distended, there is a general depression and the extremes of heat of summer, or cold of winter are felt acutely. There are evidences of auto-intoxication. These subjects suffer frequently with fur uncle Thick masses of mucus may be discharged before or after fecal defecation, and at times nothing but mucous discharges, irritating and annoying the patient. Casts of thickened mucus from some portion of the intestine may be passed and give the gravest apprehension to the patient.

Treatment. The treatment of this disease is also one to be studied with the greatest care, as often the simplest appearing case will cause the greatest difficulty or uncertainty in locating the cause. Very often it seems to be linked with some other disorder, and due to that disorder through some nervous disturbance. Therefore, we have many different opinions as to its treatment. Constipation, appendicitis, floating kidney, disease of the reproductive organs or the compositional of them in women, adhesion, enterprising, or imagination of the intestine produce a certain amount of nervous reflexes. Such a neurosis is the cause of a number of cases of hypertrophy catarrh colitis, and must be treated accordingly. The removal of an appendix, the loosening up of adhesion by the kaleidoscope and the Wales bogie, or a tracheotomy, are often followed by excellent results.

Those cases most commonly brought to our attention, and which give most gratifying results to patient as well as physician, are due to digestive errors and constipation. The digestive trouble may be dependent upon many well-known causes - habits of eating, drinking, environment, temperament, and constipation caused by obstruction, pain from fissure in anew, hemorrhoids .

The Diet should be nutritious in order to sustain the patient during a long period of treatment, but restricted to foods that are easily digested and not productive media for the bacteria which inhabit the intestinal tract. Foods containing starch and sugar are therefore contraindicated, because their rapid fermentation increases and favors bacterial growth. Coffee and tea are harmful to some patients and are best limited to the smallest amount. Milk as a single diet forms hard, insoluble stools, which irritate the mucous membrane and often causes bleeding.

Stimulating drinks in the form of alcohol and the irritating condiments ordinarily used on foods are harmful and should be interdicted. A cup of hot water before breakfast or before each meal is most beneficial in flushing out the stomach and moving the bowels. The bowels should be regulated if necessary with cascara. The resin-bearing cathartics should not be used because of their irritation to the mucous membrane of the rectum. To relieve the hyper secretions of the intestinal mucous glands, an alkaline laxative should be administered once each week in the constipated cases, and in some instances to those suffering from a diarrhea with a profuse mucous discharge.

The administration of quinine in three to five-grain doses to these cases has been of benefit. Just why the quinine proved of value I am unable to say. when no plasmid have been found in the feces. Again the administration of five grains of powdered ipecac two to three times a day have also been of service in other instances when no amoebae have been present in the intestinal discharges. Creosote carbonate is considered by some internists as an excellent remedy for its bactericide effect.

Bismuth, zinc polycarbonate salon, naphthalene and ichthyology are all indicated for their selective action in arresting fermentation. Castor oil in five to ten drop doses repeated every two or three hours for a period of a few weeks often controls the diarrhea. Sulphide of calcium in one-fourth grain doses, given three or four times a day in some cases acts specifically, and is worthy of a fair trial.

Locally, the irrigation of the entire colon is easily accomplished in some patients if the preliminary cleansing enema is given to ensure an empty bowel. The irrigation is best given in the knee-chest position but may be effective with the patient in the Sims's position. One to three quarts of any of the following drugs in solution may be used each day for a period of two weeks, afterward varying the irrigation to three times a week or oftener as indicated. Fifty per cent. peroxide hydrogen solution, ten to twenty per cent. fluid extract hydras, 1-5000 solution of nitrate silver, five to ten per cent. ichthyology solution or a five to ten per cent. solution of aqueous fluid extract of Kramer The Kramer in all cases excepting the very severe form, has proved the most beneficial for its pain relieving and astringent properties and is best prepared according to the formula of Dr. Miller as given by Cuttle, which is as follows:

Macerate one pound of bark of Kramer in a long percolating tube for twenty-four hours. After this a mixture of twenty per cent. glycerin and eighty per cent. water is allowed to percolate through it. The percolate should be constantly stirred and re filtrated through the bark the second time. The filtrate is then evaporated down to one pound, thus obtaining an aqueous fluid extract containing grain for grain, all the therapeutic properties of the bark. The preparation should be kept in a dark place and not exposed to the air.

When ulceration exists the direct application of nitrate of silver in two per cent. solution through the kaleidoscope is best suited to these cases, which may be done on alternating days of treatment with any of the other irrigation solutions recommended.