Diphtheria Colitis only occurs as a complication of the pharyngeal affection.

Ulceration Colitis, Sigmoid and Proctorial, occur as the result of other diseases as maraschino, hepatic, kidney and central nervous diseases. Some diseases are probably the predisposing rather than the direct cause of the disease and make it probable that the ulceration is due in many instances to the invasion of a specific bacillus.

It also follows as the result of a protracted catarrh inflammation and if extending over a period of years is very likely to be associated with skin eruptions, as Memphis and severe eczema These ulcers may be found anywhere in the large bowel, from the anal margin to the tip of the appendix. The ulcer varies in extent from one-fourth to one inch, and in some instances involves the entire circumference of the colon. The depth of the ulcer sometimes extends to the muscle wall or is so superficial as not to extend deeper than the sub mucous tissue. In very severe cases, the ulcer may resemble that of the duodenum or stomach, and penetrate the muscular wall to the peritoneum. There is a tendency for the ulceration to extend in a circular outline around the intestine and the number of ulcers may be as many as one hundred when superficial. The follicles of Lieberman may be the seat of ulceration. The disease is said to begin in various ways either from the rectum and travel upward, or that it may begin at any point in the large intestine.

Symptoms, In some cases the disease seems sudden in its onset, with sharp fascinating pains over the colon attended with griping and a tendency to frequent movements of the bowel.

Patients in whom the disease is progressive in spite of treatment, or who have received no treatment, present a mental condition almost characteristic of the toxic effect of the disease upon the nervous system. I have found that men of more than average intelligence presented a mental deterioration resembling imbecility. The suggestion of surgical interference is sufficient to cause them to cry like a child and beg to be left without such treatment. Their judgment as to any practical conception of their condition seems to be lost.

These symptoms disappear for a short while and the patient will feel apparently well for a few weeks, when they will recur again. The attacks last from one to several days. The stools at first do not contain any mucus, blood or pus. When the pain is persistent and the attacks frequent, blood and pus will be added to the movements and indicate ulceration. When the ulceration is high up, the pus and blood will be mixed with the stool and the feces contain dark, decomposed blood. When the ulceration is in the lower part of the sigmoid or rectum fresh blood will precede the stool. The amount of pain does not vary with the extent of ulceration nor with the ingestion of food. Pain is probably due to the irritation of the ulcerated surface by the intestinal contents which brings on irregular peristalsis, and is not due to the existence of the ulceration itself at any particular portion of the bowel. Patients may have as many as from five to twenty stools each day, which may alternate with short periods of constipation.

In dysentery and acute catarrh inflammation of the rectum and colon, there is ordinarily a constant tenements and a desire to empty the bowel, while in ulceration there is an inclination at periods to empty the bowel which is imperative at the time. During the intervals the patient does not suffer from either pain, tenements, or the desire to empty the bowel, but when the demand recurs it is imperative. The tongue, as a rule, presents a polished red color, with more or less brown in the middle, resembling the typhoid tongue. The frequency of movements causes great thirst. There is progressive loss of flesh accompanied by great depression and anemia. There may be a very irregular temperature varying from subnormal to 100° F. The course of the disease may be from a few days, as the result of a perforation and subsequent peritonitis, to a long period of suffering due to an amylase degeneration. The prognosis is always grave.

Diagnosis. This disease is likely to be mistaken for a dysentery, typhoid fever, or malignant disease. In malignancy, the history of the case shows the onset to be very much slower, the pain and the griping is seldom a source of complaint and constipation is marked. Furthermore, after the bowels have moved the patients are comfortable excepting in the later stages of malignant disease when mucus and blood are indicative of the disease. Malignant disease also has its peculiar pathogenic odor which is characteristic. There is seldom any discharge of glare mucus in ulceration of the colon, but the blood and pus are very abundant.

Treatment. When the disease is to be considered from the point of a secondary affection the chief indication is to find out the cause or the original trouble. Local treatment should be directed to the ulceration of the colon or rectum by means of either a colostomy appendicitis, or the use of the kaleidoscope in the lower gut. The patient should be kept on an nonirritating diet. The irrigation of the rectum or sigmoid should be with either the fluid extract of Kramer or witch-hazel.

The patient should be in the knee-chest position and the temperature of the irrigating fluid from 110° to 115o F. The Kramer solution should be from five to twenty per cent. in strength and the Hammerings not stronger than ten per cent. Either of these solutions will do much to control hemorrhage, the discharge of mucus or lessen the irritation of the bowel. A combination of ergot, cinnamon, and hydras is recommended internally when the hemorrhage is excessive. The patient should be given tonics in the l≪&Raquel;rm of iron and strychnine or alcohol, as would be indicated in cases suffering from septic poisoning.