It might be well to say, in advance of the consideration of the simple catarrh and specific inflammations of the colon and rectum, that those enumerated under this heading are accepted from the text of other authors as the simplest classification. The nomenclature used by pathologists and internists varies greatly, either as to names or classifications, and it is often very confusing to the student. So the reader must of necessity endeavor to understand these diseases when described by other writers under somewhat different titles.

Again it seems that surgeons who premeditate operations for the relief of the severe colonic affections should make themselves familiar with these different pathological conditions so that they may be able to make a diagnosis similar to the internist, then to decide as to which is the better way to treat a particular case. Often these cases have passed beyond relief from surgical treatment and die from shock when operated, as the result of their great debility. They are sometimes treated more successfully without operation for a certain period until a better physiological balance is attained.

To facilitate the formation of a mental picture of the simple catarrh and specific diseases of the colon, sigmoid and rectum, the following diagrammatic scheme is submitted:

Ulceration colitis

Secondary membranous colitis

Follicular colitis

The catarrh diseases of the large intestine classified as colitis, those described as sigmoid, and lastly those attacking the lower five or six inches of the alimentary canal, known as proctorial, are pathologically the same diseases only situated at different portions of the large bowel.

The first step to a practical understanding as to the etiology, diagnosis, and treatment must be the ability to reason the cause and effect of either of these forms of disease at any level of this tract. The cause may be the same in either a colitis, sigmoid, or a proctorial in many instances, but just why a particular area is selected cannot be explained, unless there is a known physiological or anatomical weakness. We may have all the alimentary canal affected by the same inflammatory process at one time. Experience with the simple catarrh inflammations show a tendency to extend downward while an extension upward seldom or never occurs.

When the disease has been a general inflammation of the entire colon and resolves itself into a chronic catarrh condition of either of these three portions of the bowel, it is hardly possible to decide as to the exact area affected in the original or primary inflammation.

The catarrh inflammations of the rectum find their analogues in those of the pharynx, and the comparison makes them easily recognized by the general practitioner with average experience.

Many of the pathological conditions which affect the adult intestinal canal are to be found in those of the child. If we could conceive of a general working scheme or classification based upon our more intelligent knowledge of local conditions in the adult, perhaps more could be accomplished with the treatment of these diseases when they occur in children and infants.