The sigmoid flexible is probably more vulnerable to simple catarrh diseases than any other portion of the large intestine, because of its peculiar anatomical construction and its physiological functions.

Experiments with the X-ray made by Hertz demonstrated that in the average adult the fecal mass reaches the transverse colon within about ten to twelve hours after taking food and then takes from sixteen to twenty-four hours longer to reach the sigmoid flexible Further, he demonstrates that the sigmoid flexible is the reservoir in which the fecal mass rests prior to its descent into the rectum and that the expulsion act really begins with the descent of the mass from the sigmoid to the rectum.

Diseases of the sigmoid flexible are divided into simple and specific inflammations, just as we recognize the many inflammatory processes in any of the portions of the intestinal canal. 1 Diseases found in this portion of the alimentary canal are very frequently associated with similar pathological conditions affecting the entire large bowel. It is surprising, however, how great a number of supposed intestinal diseases yield to the treatment of the rectum and sigmoid when all symptoms attribute the disease to the entire large bowel.

The sigmoid may be the seat of, or there may be extending above or below a simple catarrh inflammation, namely, acute atropine or hypertrophy colitis or a proctorial Or there may be specific diseases, such as gonorrhea, erysipelas, dysentery, tuberculosis or syphilis. In addition, we may have the consideration of follicular colitis, secondary colitis or ulcersrive colitis. The sigmoid flexible is also liable to secondary affections very often not recognized until their relation to the other organs and tissues is understood.

Affections of the sigmoid flexible are rarely seen before the twentieth year and are more frequent in the female than male. Affections of the sigmoid are termed sigmoid or periodontists, just as we speak of syphilitics or per - typhlitis Simple catarrh sigmoid occurs in two forms, acute and chronic inflammations which are non-suppuration Periodontists is either suppuration, an acute type, or non-suppuration which is chronic. One form may, however, merge imperceptibly into the other.

Acute Catarrh Sigmoid, non-suppuration, attacks young adults most frequently. Intestinal parasites, foreign bodies such as arsenic or corrosive sublimate, impacted feces, diverticulitis, insusceptible, voluminous and severe purging are mentioned as causes responsible for this disease. It resembles in character acute catarrh proctorial There is severe pain in the left ilia Fosse, sometimes accompanied by a chill, rise in temperature, a coated tongue, possibly peritoneal irritation, no bowel movements and a slight amount of flatus will be expelled.

The acute symptoms may run the ordinary course of catarrh inflammations and subside on the seventh or eighth day, or may become chronic. The attack may be an exacerbation in the sigmoid or a per-existing colitis. After the acute symptoms subside, a painful, non-fluctuating, sausage-shaped mass may be felt, with its convexity to the right. This mass may persist for a month or two after the attack, should the disease become chronic. The severity of the onset will vary the clinical picture and the disease may terminate in ulceration. The history and clinical manifestations will differentiate this affection of the sigmoid from an appendicitis of the left side or a tubal disease.

Treatment. Acute catarrh sigmoid must be treated the same as a proctorial of a like nature by relieving the cause and using remedies to soothe the inflamed mucous membrane.

When the inflammation is due to intestinal inflammation or putrefaction the bowel should be cleaned out by the administration of a saline cathartic or lavage, the patient should be put to bed and absolute rest insisted upon. The rectum and sigmoid should be irrigated with cold or warm water or by means of the double current rectal irrigation, for from ten to fifteen minutes. The temperature of the water should be that most agreeable to the patient. Instead of the water a solution of either of the following may be found more useful: Nitrate silver. 1-2000; hydras, 1-2 per cent.; or aqueous fluid extract Kramer, 5 to 10 per cent. Kramer and witch-hazel have given me the best results. The irrigating fluid should return as fast as it enters and is therefore not dangerous. After the irrigation, the rectum should be drained out with the irrigation, and a sedative suppository of chloroform with opium inserted.

The Diet should be restricted to thin gruel and broths of beef, mutton or chicken, or prepared foods such as peptides or Merlin’s, which are preferable to a milk diet in order to avoid constipation and irritation of the sensitive mucous membrane. Intestinal medication with bismuth, salon, beta-naphtha, sulphide - carbolate of zinc and copper sulphate, with opium, are all useful in these cases.

Chronic Hypertrophy Sigmoid may follow acute catarrh sigmoid, with a hypertrophy of the mucous membrane, sub-mucosa, and the glandular elements. Proctorial of a similar nature is very likely to be associated. The "ilia roll." "sausage-shaped roll." or "sigmoid sausage," all meaning the characteristic inaugurated sigmoid, is revealed on examination. This inaugurated sigmoid is well defined by its peculiar sensitiveness on pressure.

The Symptoms of hypertrophy catarrh colitis (membranous colitis, mucous colitis, chronic colitis, meaning one disease by several names), may be present in the form of mucous crises, constipation with alternating diarrhea and nervous disturbances. Brenton and Boas claim that an early morning diarrhea is a characteristic symptom of hypertrophy catarrh sigmoid and in my experience it has proven almost a positive indication of this affection.

Treatment. The treatment of this disease is almost identical with the treatment indicated for chronic hypertrophy colitis. The sigmoid should be irrigated through a colonic tube or the double current rectal irrigation, two or three times a week with the following solution: Five per cent. ichthyology, one to two thousand solution of nitrate silver in a quantity not less than two quarts. The irrigation fluid should be discharged at once. In addition, to relieve congestion, a weekly saline laxative should be given and the bowels kept regulated with cascara or rhubarb.