As the name implies, we have here an inflammatory condition, often with extensive ulceration of the colon, and of the distal portion of the small intestine.

The Shiga bacillus is the most common or even the specific cause. The characteristic symptom is a diarrhea with ten to thirty bowel movements a day, that are composed largely of mucus and blood, often with considerable pus, have a peculiar mawkish odor, and are so irritating that their passage is accompanied by extreme tenesmus and eversion of the rectum. There is a high, continuous temperature, 102° to 105° F. for a week or longer, that is uninfluenced by withdrawal of food. There is often complete anorexia, great restlessness or apathy, prostration, etc., but not the rapid breathing and nervous depression of an intoxication, unless this is a complicating factor. The clear eyes of the one (even though the temperature may be 105° F.) make a striking contrast with the heavy, half-closed, languid eyes and stuporous state of even a mild intoxication, when they are seen side by side.

Treatment

The intestinal tract is emptied of its food contents by a twenty-four-hour water, or tea, or barley-water diet. The temperature, frequency of bowel movements, etc., are but little influenced by this as compared with those of an intoxication. Our aim is now to give water freely, and to give a food that will be as little irritating as possible to the inflamed mucous membrane, will be nourishing, and yet will not superinduce an intoxication upon so favorable a foundation. The food that naturally commends itself, from all that has been said, is a boiled fat-free milk and a cereal-water diluent, and this can be given after the first day of starvation and continued throughout. There is an essential difference in composition and in its effect on the baby of separated (centrifugal) fat-free milk and skimmed milk. The latter contains a considerable amount of fat that can act as an irritant and favor the production of an intoxication. If separated milk cannot be obtained, one must proceed more cautiously with skimmed, or preferably siphoned milk. One must never wait in these cases for even approximately normal bowel movements, nor for the characteristic hunger-diet bowel movement before beginning to feed them. Albumen water and in older babies broths are useful additions, but contain little nourishment. Only after the temperature and bowels are normal or nearly so, is it wise to add more starches and dextrinized flours; in older babies, sugar, and lastly and cautiously whole milk. In strong, vigorous, fat babies one can often be content if they take water alone, freely for days, if they refuse food. In others it is commonly best to resort to gavage, especially if the water taken is likewise deficient. Often only a few such feedings have a marked effect. Rectal feeding is not feasible.

Drugs that check excessive peristalsis and pain, that soothe inflamed mucous membranes, and possibly intestinal antiseptics, are all useful. Flushing the colon with cleansing non-irritating fluids, such as normal salt solution, or with mild antiseptic solutions, would seem peculiarly indicated because the lesions are largely accessible. Their effect in relieving, if only temporarily, the distressing tenesmus is not the least benefit derived from their use.