Review of previously reported cases of Clostridium difficile enteritis showed a high mortality rate. We attribute this to delayed diagnosis secondary to rarity of this illness. Some patients were diagnosed only after pseudomembranes in small-bowel segments were found at autopsy. This rare disease entity is firmly established among the differential diagnosis to clinicians treating patients with total proctocolectomy.
2.Shock.-This is remarkably little. It is prevented by speed in operating, and by continuous subcutaneous administration of saline. It is naturally lessened by operating in two stages.3. Hemorrhuge.-There should be none; but in advanced cases thc vessels are of preternatural size, and require careful ligaturing with silk. It is important to leave forceps on all vessels distal to their point of section until the whole bowel is removed. A considerable quantity of blood may be lost unobserved, from a vessel in a detached part of the bowel several feet away from the still attached part. RESULTS.Of seveii cases-all examples of thc disease in its most extreme formtwo died as the result of the operation-one from shock, and one from the effects of a severe accidental haeinorrhage a t the operation. Of the five remaining 'cases, I was enabled to show four before the American surgeons in July last. Three of these cases are perfectly healthy normal children without any distention or constipation. One has still some slight distention ; but this is attributed to tubqculosis of the mesenteric glands, which has been a complication throughout. A letter from the parents of the fifth informs me that he is in perfect health. The most recent of these operations was ten months ago, and it is therefore reasonable to hope that their cure is permanent. The cases comprise tuberculous disease of most of the large joints, inultiple arthritis of the infective or rheumatoid type, and three of Still's disease in children. In the majority, short-circuiting only (ileocolostomy) was performed. A circular letter was sent to dl patients asking them to fill in answers to the following questions if unable to attend for inspection :- AN ANALYSIS OF A CONSECUTIVE SERIES OF CASES OF VARIOUS FORMS OF ABTERITIS
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