Chronic Strophic Sigmoid manifests itself by an atrophy of the mucous membrane and glandular elements. This atrophy extends throughout the mucous membrane and glandular elements, without involving the tissue between. Its chief symptoms are those of strophic colitis with which it is very often associated, and generally gives a history of a prolonged constipation. Local symptoms are referred to the rectum and anus in the form of hemorrhoids, fissures, and prurient an

Treatment. This disease is the most intractable of the catarrh conditions of the rectum, sigmoid or colon, and in some instances is best treated as an inherited or tertiary syphilis. Co-existing diseases such as fissure, hemorrhoids and prurient an, can be greatly alleviated or cured by irrigating the bowel with Kramer, ichthyology or nitrate silver, as recommended for this condition in the colon.

Acute Periodontists is the term used to describe an inflammation on the outer surface of the sigmoid, and presents a picture of the collection of pus. A true periodontists may be suspected in the female when pelvic inflammations are excluded and the history of an enter-colitis is elicited. The disease may be secondary to diverticulitis or infection of the exterior of the bowel through the blood or the lymphatics as the result of an inflammation existing on the inside of the gut.

Symptoms - There are no pathogenic symptoms of periodontists further than the presence of pus in the form of an abscess. There is an elevation of temperature, accompanied by pain and possibly a chill, coated tongue and peritoneal irritation. The abscess, as a rule, is in the form of a diffuse tumor, irregular in outline, without modulation, and may be situated as cited by Maurice Patel, in any of the following positions: "I. Inferiority; anterior from the

A peristalsis abscess, as a rule, perforates some portion of the bowel and peritonitis from this source is generally fatal.

As a secondary infection a left-sided phlebitis may be present or a left-sided inflammation of the broad ligaments may be associated with this condition.

Treatment. A periodontists of the suppuration type requires surgical treatment which should be over the site of the inflammation and before an extension to the peritoneum or rupture of the abscess occurs. A drain should be inserted and left in for five or six days, the same as the after-treatment for appendicitis of a similar nature.

Fig. 21. Periodontists Abscess on outer surface of sigmoid Schematicilia spine along Forepart’s ligament, peritoneal 2. Anterior superior; to the left and slightly below the umbilicus, peritoneal 3. Intramuscular; lying between two layers of the ilia Mesolithic, sub peritoneal. 4. Sacroiliac; lying between that part of the sigmoid which is covered on its front side with peritoneum and the post abdominal wall in the loose tissue. 5. Lumbar abscess; in this variety the pus escapes through Pest’s canal and invades the lumbar region.

Fig. 21. Periodontists Abscess on outer surface of sigmoid Schematicilia spine along Forepart’s ligament, peritoneal 2. Anterior superior; to the left and slightly below the umbilicus, peritoneal 3. Intramuscular; lying between two layers of the ilia Mesolithic, sub-peritoneal. 4. Sacroiliac; lying between that part of the sigmoid which is covered on its front side with peritoneum and the post-abdominal wall in the loose tissue. 5. Lumbar abscess; in this variety the pus escapes through Pest’s canal and invades the lumbar region."

Chronic Periodontists is due in most instances to a primary inflammation outside of the intestine or to an ulceration which has penetrated the bowel and in which still lingers sufficient irritability to produce an occasional exacerbation. The disease, ordinarily, is not limited to the sigmoid alone and may involve the surrounding tissue.

Symptoms. The localized pain and the evidence of a mass over the sigmoid may help in the diagnosis. Obstruction due to adhesion to the adjacent organs or to a narrowing of the sigmoid from an exudation process in its outer structure, is the cause of subjective symptoms.

Treatment. Indications for treatment will depend upon the condition revealed through the kaleidoscope, or the origin of the trouble in a neighboring organ. The treatment may be directed locally through the kaleidoscope, by means of irrigation, or surgically, when dependent upon a primary source of infection.