One goal above all must be attained - i. e., the action of the bowels must be rendered normal not only for the time of the "cure" but for all time. By "normal" bowel action we understand regulation of the bowels as in a normal subject by the ingesta alone. If laxatives of any kind, massage or clysters, etc., are necessary to promote the evacuation of the bowel contents, the action of the bowels is not "normal" - even if the color, the consistency, the form and the chemical composition of the feces do not differ in any way from normal dejecta in healthy subjects. As soon as the sluggishness of the bowels is removed, and as soon as the action of the bowels is "normal" in the sense that we have outlined, the disease, colica mucosa, may also be considered cured and it will never return.

While we agree with Boas, Westphalen and others, that the chief indication for treatment lies in the removal of the constipation, we nevertheless recognize that there are as large a number of good and successful methods of treatment of colica mucosa as there are methods of treating spastic constipation in general. Without wishing to deny, therefore, that other methods of treatment are valuable and important, we nevertheless feel justified in stating that our particular method of procedure in the particular conditions that we are dealing with in this disease - i. e., in the combination of spastic constipation with colica mucosa - is not surpassed in regard to safety, rapidity and permanency of results by any other method.

The dietetic regulations are rarely exhausted with the arrangement of a dietary suited to remove the condition of chronic constipation and the accumulation of mucus. As a rule the patients are generally reduced and under-nourished or they are subjects who have never reached what is for them the height of nutrition. Directly or indirectly dependent on this poor state of nutrition is the impairment of the nervous powers; and the patients belong to that group of hysteric and neurasthenic subjects in whom a successful rest cure with overfeeding may be the starting point for renewed physical and mental vigor. In all such cases of colica mucosa I consider the improvement of the general nutrition to be the fundamental preliminary condition that must be fulfilled if we wish to attain a permanent cure; we agree in this respect with the majority of writers on this subject. The choice of foods and the amount of food allowed must be selected and regulated to fit this purpose, and we have invariably found that patients who were treated on this plan gained considerably in weight. The average duration of a systematic cure was four weeks; the minimum three weeks, the maximum six weeks. The gain in weight amounted to 6 kilo as a minimum, 16 kilo as a maximum, 10 kilo on an average, during the period of time that we have mentioned. This good result was chiefly attained by enormously increasing the fats. If we add all the fat that these patients received in the form of milk, cream, butter, bacon, we find that an average of from 200 to 250 grams of pure fat was given a day. The fact that we were able to administer such large quantities of food, and in particular such large quantities of fat without producing any appreciable disturbance, - a few cases excepted - demonstrates better than any theoretical arguments that colica mucosa has nothing whatever to do with a truly anatomic, inflammatory disease of the intestine.

It has become a literary habit for an author who prescribes a certain dietary not only to lay down the general rules and principles that should govern the therapeutist in the selection of the diet but also to append to his work specialized bills of fare. We do not like to follow this custom, and only do so unwillingly, for we have learned from experience that success can only be expected if we individualize carefully; we have learned to appreciate that any form of dietetic therapy is apt to be abortive and unsuccessful if we adhere too closely to any one scheme. We give a dietary that has been found serviceable in many cases.