These diseases of the colon, sigmoid, and rectum, represent different catarrh inflammations, the result of a specific organism introduced into the body in various ways. The avenues of entrance are in some instances fairly well understood, but in others our knowledge is meager and dependent upon the researches of the pathologists for further enlightenment.

The diseases classified as specific catarrh inflammations are the tubercular, dysentery, gonorrheal, syphilitic, erysipelas In addition to these, the intestine is liable to infection from nearly all the specific inflammations in general that affect the human body, dependent upon environment and hereditary influences.

Tubercular.

Tubercular ulceration of the rectum, sigmoid or colon may be either primary or secondary. Many persons of tubercular tendency are sufferers from local tubercular inflammation of the rectum, which seems to be the most commonly affected. The disease may present itself in an ulceration, papillary, military, or lupine form. It may develop in the skin, much-cutaneous, mucous or cellular tissue, due in all instances to infection from the tubercle bacillus.

Diagnosis. The diagnosis is made positive by finding the bacillus in the scrapings under the microscope.

Treatment. The treatment should be directed to the general constitutional condition of the patient and should include tonics and abundance of fresh air. The local treatment con-sits in keeping the ulcers clean and in gently stimulating the surface with solutions of either nitrate of silver, argyle, or pure ichthyology or by dusting over the surface powdered borax. chloroform, or Bristol

If possible, the knife should not be used in the treatment of these cases, as nature's barrier against infection in the form of granulation tissue surrounding these ulcerations should not be broken down or destroyed. When destruction of the mass seems necessary it should be accomplished with the actual cattery, thus killing the germs and sealing up the lymphatics and blood vessels to prevent absorption.

Dysentery Dysentery ulceration i>. as a rule, an acute specific inflammation of the bowel. The disease begins generally in the large colon and travels downward. This form of dysentery is now generally recognized as due to an infection from a specific micro-organism, representing three forms of the disease, classified as the Amebic, Bacillary and Mixed Infection. The Mixed Infection type may be due to ordinary germs found in the intestinal canal and represents a milder and more common disease.

Amebic Dysentery is due to infection by the Amoebae dysentery, which infiltrates through the mucous and sub mucous tissue. The disease may appear suddenly as an acute diarrhea, with blood and mucus, accompanied by irritation of

Abscess of the liver, extreme anemia and localized peritonitis are its chief complications, often resulting in death without pronounced diarrhea.

The Diagnosis is proven by the microscopic findings, with a history of protracted or irregular diarrhea, with loss of strength and anemia. The appearance of the mucous membrane, when the infection has progressed to the rectum or sigmoid, is somewhat characteristic of the disease, in that the ulcers are usually upon the summit of the mucous membrane folds and the valves of Houston. The ulcer is irregular in outline varying from one-fourth to one inch in diameter, surrounded by a dark red or purplish zone. Usually, in the chronic form they appear gutter-like, with clean-cut overhanging edges which sometimes cross one another.

Treatment. The amoeba bacillus grows very slowly in low temperature, losing its motility at 70° F. For diagnostic information the microscopic examination should be made while the feces or scrapings from the ulcer are at the body temperature and before the amoebae lose their motility.

Fig. 17. Amebic dysentery. Typical ulcers - (left) on mucous membrane and (right] on the Houston valves the rectum, or it may be more insidious in its onset, presenting a simple looseness of the bowels with a gradual increase in frequency. During the acute irritation in the rectum, a frequent desire to defecate, elevation of temperature and loss of appetite are fairly constant symptoms. In these cases severe constitutional weaknesses and pain are absent. Patients may have from three to forty movements in a day, seldom associated with much pain or tenements They will often have one or two movements in a day, which are normal in character and during the same day have a number of blood and mucus discharges. The chief features of the disease are its variable periods of existence, which may extend sover years of quiescence and recurrences, and its irregular course of relapses and exacerbation

Irrigation should be made possible from the cecum by means of an appendicitis, or a colostomy after the method of Gibson. The solutions recommended for irrigating the bowel are quinine from one to three hundred, or as low as one to one thousand, or a solution of formalin - one part to one thousand of water. A solution of nitrate of silver one-half to one per cent., used every second day for a number of weeks is very efficacious. The nitrate of silver may be neutralized with normal saline solutions. Peroxide of hydrogen is also of value.

Turtle has found that simple cold water at a temperature of 65° or colder is as effectual as any of the above solutions, not only to wash out the bowel but destroy the amoebae Patients may be placed in the knee-chest position and the fluid allowed to run slowly into the bowel. The quantity of cold water should be from two to three quarts and this treatment should be continued every day for a period of several weeks, according to the ability of the patients to retain the fluid, and the presence of the germ. In acute cases this treatment is sometimes very efficacious. Quinine is best administered once a week during the course of treatment.