An Address ON THE NATURAL HISTORY OF ULCERATIVE COLITIS AND ITS BEARING ON TREATMENT
Authors: H. P. Hawkins
Journal: BMJ (1909)

HE-proved value of serum treatment in tropical bacillary -dysentery makes it important that the active bacterial agents .inulcerative colitis should be known.It is the -very:type of disease which should yield to serum or vacaine treatment.The site of infection is localized, 'here is no general infection, and the symptoms are mainly tocal and exhaustive, though partly toxaemic.If it is not -cured in an early stage, nothing remains as a rule but .,uchcrude measures as colostomy and ileo-sigmoidostomy.The necessity for bacterial treatment holds good, whether ,the primary organism concerned should ultimately prove 'o belong to the dysenteric, paratyphoid, coli or pyogenic ~group.Nothing can be done until the natural history of the disease is understood.The pedigree of the disease can be traced back for nearly .300years.It was then called dysentery, or bloody flux.-In the seventeenth century epidemics were common in this country.There were sometimes 4,000 deaths a year from "bloody flux."These epidemics usually occurred in *,he fly season, but sporadic cases were met with also in ,the spring and winter.In the eighteenth century, probably through a safer disposal of excreta, epidemics became less common.In the nineteenth century they mnearly disappeared in the open, except in Ireland, but -they persisted in certain institutions, Millbank Peni- 'tentiary and various asylums being the chief offenders.At the present time small outbreaks still occur in -asylums.They still occur also on a small scale in the ,open, and the evidence is almost conclusive that-both in rthese small epidemics and in asylum outbreaks the disease is spread by direct transference of infected material from -person to person.Thus a small epidemic (Carver) arose sn and around the Great Northern Central Hospital, in which children and aduits were equally infected.In 1900 -a small outbreak (Cautley) occurred in a London barracks.'On one staircase lived 13 women and 30 children.Of the -adults, 3 were infected and recovered; of the children, 6 were infected and 4 died.Both these outbreaks occurred in the fly season.In August and September of 1901 an -epidemic occurred at Aldershot, and of the civilian popula- tion between 170 and 180 persons were attacked, of whom 38 died.All ages were affected, but of the 38 deaths 28 occurred uinder the age of 5, and 3 over the age of 65.This mortality-rate of about 27 per cent. is identical with -that of Japanese dysentery before serum treatment was adopted.The reporting medical officer of health states that flies were very numerous at this time.This same decline of the epidemic and persistence of the sporadic disease are to be noted all over Europe, except in 'the south-eastern fringe, where epidemics still occur.The -sporadic case is still with us, just as Sydenham described -it, and it has-never altered its form.His description of -the disease in 1669 may be applied word for word to the -condition as we now see it.One sentence may be quoted, because I believe that a non-necrotic "dysenteric diar- rhoea," such as he alludes to, is still to be recognized: aWMh these slimy motions appear streaks of blood, though S jIways; sometimes, indeed, there is no passage of blood ver from first to last.Notwithstanding, provided the motions be frequent, slimy, and attended with gg, the disease is a true bloody flux or dysentery."ha few cases of dysentery are specified in the ar-General's report, this separate heading has only red in the last few years, and the bulk of our cases obably buried with the 20,000 annual deaths from o oea.en the epidemic disease became insignificant, the case ceased to attract much attention, and it ally acqnired the new name of " ulcerative colitis."j-{he moment I think this is a better name than "dysentery," and there should be no reversion to the original name, unless and until it has been shown bacterio- logically that this disease belongs to the dysenteric group.THE CLINICAL EVIDENCE.This disease comes before us in varying guise, as a short severe illness, and as a long illness continuous or inter- mittent.To these three forms I think must be added a