Winifred C., age 21. Admitted in November, 1911, for joint trouble and constipation. She had been constipated for many years, and was reduced to rectal enemata. In September, 1911, she had acute abdominal pain in the right iliac fossa. There had recently been more attacks. Had had " rheumatoid arthritis of both knees " for two years-wasting of right quadriceps. On admission, the right rectus is kept rigid on abdominal examination. Bismuth a-ray examination.-Transverse colon apparently much distorted-great delay. After 9 hours, all bismuth in mcum and ascending colon. After 33 hours, nearly all in first half of transverse colon.
After 81 hours, in descending colon and rectum. There was much gas in large bowel. December 8.-Ileocolostomy.
Very long pelvic colon. Well-marked ileal kink. Appendix also kinked. Discharged January 30, 1912.
M' e saw her in August, 1914, and noted " No evidence in report of condition of joints before operation. Now grating in both knees. Movements perfect and painless except occasionally. Right knee is no better and no worse since operation, but the left is quite well now. Right hip hurts when she lies on it. There is not and never has been limitation of this joint. She is still constipated, but can get regular motions with aloin and paraffin. There is no change in her general condition." July 2.-Colectomy.
After 57 hours, scattered portions in transverse colon.