The food required by patients suffering from catarrh of the large intestine, mucous or membranous colitis, etc., should be that already given in detail for the treatment of catarrh of the small intestines. There is no necessity to repeat the directions. It is the dietary which must be given at the beginning of the treatment of every case of disease of the colon until we have got a thorough insight into the patient's symptoms and condition. That diet will not cure every case of catarrh of the colon. But there are many cases where any other kind of diet will irritate the mucous membrane and aggravate the disease.

A. The diet for chronic intestinal catarrh should be given continuously when the symptoms of colon disease are complicated by the following conditions: -

(a) In all cases attended by diarrhea; (b) in all cases of constipation due to inflammatory or ulcerative processes; (c) in organic diseases - cancer, tubercle, syphilis, etc.; (d) spasmodic affections of the colon due to a hypersensitive condition of the mucous membrane; (e) diseases of the pelvic organs - bladder, uterus, fallopian tubes, ovaries, or painful affections of the rectum and anus.

B. Cases in which the diet should be different from that for intestinal catarrh: -

(a) When diseases of the pelvic organs are absent; (b) when inflammatory and ulcerative conditions are absent; (c) when the catarrh is chiefly confined to the appendix and colon; (d) when the condition is distinctly neurotic - e.g., myxoneurosis or secretion neurosis.

The theory of the neurotic origin of mucous and membranous colitis which is largely accepted is founded on the fact that the disease affects neurotic persons, and an attack of mucous colic can be brought on in persons subject to it by severe mental emotion, worry, or anxiety. In inflammatory diseases of the colon the discharge of mucus is not so profuse as in mucous colitis, and differs in character from that of the membranous form. The symptoms of the disease occur in a vicious circle; intestinal dyspepsia is probably the first act, the absorption of toxins from the bowels causes the second act, or debility of the nervous system, whence arises atony of the bowels and constipation ; as the result of constipation there is a greater absorption of albu-moses and toxins from the bowels, which still further poisons the nervous system, and the neurasthenia is believed to give rise to the perverted secretion of mucus. The theory of local irritation of the mucous glands by the absorption of toxins, and their effects on the cells in the mucous crypts, producing first a profuse but normal mucus, and later on the change in the character of the discharge which results in the formation of "skins," membranes, or flakes of mucus, is also held by many authorities. The disease is seldom fatal, but it drags through a long period with intermissions. The affection is curable, but very many patients go on for years before the disorder is recognized or properly treated; the prospect of complete recovery is thereby diminished. About 50 per cent of cases are cured. Men do better than women. If this disease is neglected the patients go from bad to worse, get thinner, paler, more anaemic, and feebler; they ultimately lie in bed a good deal of their time, being too ill to move. When they are somewhat better they move from place to place in search of health and comfort. Truly their condition is miserable. Few diseases have a wider ramification and produce more serious ill-health than membranous colitis.

These are the cases which are improved by a dietary of a very different character from that of chronic intestinal catarrh. They require a bulky diet, one which contains a good deal of fibre (cellulose), which probably acts upon the mucous membrane by stimulating it, provoking muscular action, and by tending towards a daily action of the bowels, removing the poisons which irritate the mucous glands or poison the nerves which control them. The first difficulty which faces us is the small appetite of the patient. It is useless to expect these people to take a dinner like a navvy's or like a healthy woman. Cabbage, savoy, cauliflower, turnips, swedes, carrots, and other fibrous vegetables are exceedingly useful in this complaint. But the patient cannot take a sufficient bulk of food to be able to nourish her body with these in nutritious foods; besides she has no taste for them and does not appreciate them. They will take fruit and fill their small stomachs with it to the exclusion of everything else. Fruits are useful, but insufficient as a sole diet. They will also eat nuts, and these are a valuable source of protein if the patients can digest them; at any rate, they should be allowed to try them. But it is absolutely necessary that the body should get a sufficient supply of proteins as well as carbohydrates and fat. The following is the dietary I am in the habit of prescribing; it has proved very successful in my hands. It consists of two pints of milk, two or three eggs, half a pound of brown bread, two ounces of butter, and as much vegetables, fruit, and nuts as the patient can eat. With regard to fruit and nuts, some kinds go together better than others. The following combinations appear to me to be the most useful: Apples, walnuts, and figs; pears, hazel nuts, and dates; grapes, Brazil nuts, and figs; bananas, hazel nuts, and figs; blackberries, roasted peanuts, and pears; strawberries, walnuts, and dates; currants or gooseberries, bananas, and Brazil nuts. Dried peas and beans may be taken at the same meal as cabbage, cauliflower, spinach, seakale, boiled lettuce, skirret, or turnips and carrots. Meat will not do the patients any harm, but as a rule they take nuts and fruit better. The kernels of nuts have about the same protein value as meat. They can be ground in a mill and made into an omelette with the eggs. A glassful of milk, two ounces of shelled nuts and plenty of fruit will make a meal large enough for most young ladies. But the food must be varied day by day. Moreover, it is necessary to see these patients eat their food. It is wonderful what tricks neurotics play their nurses and how they dispose of their food without consuming it. An extended trial of this dietary should be made; it must be carried out carefully and religiously ; half measures are worse than useless, for instead of improving the tone of the body and correcting constipation, they would lead to an aggravation of the neurotic condition.

The colon must be evacuated every day, for very little improvement of the general condition will be made until the constipation is improved. As a general rule aperient medicines and pills are useless. But a large dose of castor oil, one ounce or even an ounce and a half, every morning for months together will sometimes do a vast amount of good by removing the irritating cause - viz., the faeces. If this is objected to, the next best thing is lavage of the colon by a large enema every morning. Many patients are sent to Plombieres, where this treatment is carried out with the natural mineral water of the place. Water made in imitation of it can be used at home. Boracic lotion and other mild antiseptics may also be used. Hot baths, compresses over the abdomen, massage of the whole body and of the abdomen in particular will materially help in the cure. Various forms of electrical treatment are also useful

Occupation of the mind and body is essential. The patients should be encouraged to find something congenial to do. They are always worse when they do nothing. Out-of-door exercise is good for them; if they have strength to play tennis, Badminton, croquet, bowls, or golf they should occupy themselves daily in one or other of these games. If they cannot do so, they must be encouraged to walk as far as their strength will allow. It is useless, however, to push these exercises too far; patients soon tire of anything which exhausts them; and if they feel worse after any game, it may be a week or two before they will try it again. Change of place and scenery is good for them; but they must go to a bracing place, such as the Malvern Hills, the mountains of Wales or Switzerland.

When other means fail of curing these diseases of the colon, various operative measures may be resorted to. I have seen cases improved by the formation of an artificial channel through the appendix. This allows of daily irrigation of the entire colon with water or lotion. Finally, there is the operation for removing the colon, which has proved very successful of recent years.

The foregoing dietary is of great value in persons who suffer from tenderness in the region of the appendix but who have never had appendicitis, or from whom the removal of the appendix is unnecessary. The value of the appendix to human beings is unknown. It is an organ of great importance in many of the lower animals. The future may disclose some function of importance to mankind which the appendix performs. At present we can only liken it to an oil-can which pours, drop by drop, a lubricating fluid into the intestinal canal and smooths the passage of the contents of the bowel. This function may be disturbed in various ways. Catarrh of the caecum may extend to the appendix ; swelling of the mucous membrane may obstruct the passage of the secretion from the appendix; microorganisms, always present in the intestine, may at any moment, and in the presence of irritating secretions, transform a mild catarrh of the appendix into an acute inflammation, which may terminate in suppuration, perforation, or mortification of the appendix.

While an attack of appendicitis is in progress absolute rest is necessary, the patient will require no food except milk and barley-water in equal parts, and some ice to suck. The question of removal of the appendix will have to be considered. But it is not advisable to operate during an attack of acute inflammation; nor is an operation necessary for all cases of appendicitis. The cases which require an operation are those where suppuration has occurred, where there is a suspicion of peritonitis caused by it, and when the patient has had several attacks of appendicitis. In many cases, under the influence of a simple diet, complete rest, and the application of poultices or compresses to the abdomen, the pain and swelling will gradually subside and disappear in fourteen to twenty-one days.

The subsequent treatment of the appendix is the same as for catarrh of the bowels. If intestinal fermentation and putrefaction be prevented, and a free daily evacuation of the bowel ensured by dietary suited to intestinal dyspepsia and constipation, it is probable that further attacks of appendicitis will be prevented. When the bowel is healthy the free use of vegetables and fruit, even those which contain seeds, is one of the best means of preventing a recurrence of the disease. When intestinal catarrh is in evidence the seeds and skins of fruit must be removed, according to the rule of Brunton; but an abundance of cooked apples, rhubarb, plums, peaches, prunes (and other fruits after removal of the seeds) may be taken. By preventing intestinal stasis, and especially a collection of faeces in the caecum and ascending colon, the initial symptom of appendicitis will be warded off, and any tendency to inflammation of the appendix may be removed.