Presented at Bobs Roberts 1 lospitah for tIme mlm(eting of tIme Anmericaim Aca(hemumv of Pediatrics, October 0, 1955.
663
Pediatrics
VOLUME 18 OCTOBER 1956 NutBF;mm 4
AMERICAN
ACADEMY
OF
PEDIATRICS
PROCEEDINGS
CLINICAL
CONFERENCE
Ulcerative
Colitis
By F. Howell Wright, M.D., and John F. Kenwood, M.D.
Department of Pediatrics, University of Chicago
l)mi. \\muculT: I simahl describe a boy with
ulcerative colitis wimom we have been followimmg for time last 15 ears. His fatlmer is of Swedish extractiomm, Amnericami bormm. He is a very phacid, iommg-sumfferimig gemmtleman who eumters ‘er’ little iumto the picture whmiclm follows. His cciucatiomm extemiched shighmtiv hievomid time high school level itS Ime vemmt to college for 2 ears at a tech-ricoh scimool.
Time boy’s iimotbmer, h’ comitrast, w’as hormi in Italy. Her fammmilv migrated to this coummmtry wimeiu shme ommhv 9 mmmommthsold. They settled in Ciii-cag() and set tip closely kmmit famimilv unit wimicim 51)Oke Italiamm roost of time time. His mmmother grew LII) ummcler circumstauuces wimicim macic her feel ecmnsiclerably imiferior to persons aroummmcl her. Sime Imad a \‘ouumiger sister of wimom she was very jealous durimug time early pirt of her life. She 1l5() had nmanv feelings of resentment toward lmer mother fronm wimom she appareumtlv received little or mmo affectiomm. During imer earl child-hood sue had dluml)bed feet whmichm were cor-rected liv her unotimer 1)i the application of amm (ml)i)(mr(ttus vhmicim was 1)ailtftml amid which caused Imer to cry a gOOd (heal without reccivimmg mmmumcim solace fronm hmer mmmotimer. Her eduication
cx-tended onlv tlmrouugh grammar schmool, with the d(l(hitioum (If 2 ears of secretarial traimming. After this, sime mmever held a job for any length of time. Sime workeci sporadically as a waitress.
Shme lived at home with her fanmilv aumd i)eeanme closely attached to timemmm. 1mm spite of imer feel-immg toward hmer mother, slme was quite
de-pemmdent upoim her. SIme married whemm sue was
about 23 years old. She seenmed to be erv iia)p\ ill time marriage h)ut almost at ommce be-came pregmmaimt, aim evemmt for whicim she was psvclmologicahiv, at least, umot well prepared.
She was fearfumi that sue would not make amm
adle(Iumate mmmothier, aimd that she woumld not be able to nmeasure up to the standards thmat )eople aroummd imer had set for her. She worried about every criticism leveled at lien.
Time birth of time patient was umormumal. He was a full-term baby weighing 3.83 kg. His mother apparemmtlv experienced little (lifficultv
witim him during time first 2 mouths of hmis
664 WRIGHT - ULCERATIVE COLITIS
lime Iirst sign ol tli)llh)h( aI)1)(ar(’(1 \VhlVl) lie ,i(s ahiont 2 v(’ars of ag( v1memm his :Lp)etite hc gun to slacken. At that time lie was taken to a Phmysicilmm Vim() said the child had a mild anemia arch 1)ktce(i imimumoim sommme sort of iromm mnedication. At tbme age (if 27 nm(ilmthis lie begamm to imave a mmmilcl chiarrimea. Time iron medication vas
stop)e(l, hut time (hiarrhea commtinued. B 29
uim(Inths (If age, his (iiarrhmca lm:mdbed’Ome l)lO(id\’, Lmm(lafter a month of this he was a(imittcd t(I time imospitai here for time first time.
No obvious preci1)itatilmg episode for the hil(I0(i (liarrimea \V15 (iiscovered. At the time of imis first aclmissiomm, lie was a well-mmourishecl and well-developed iumfaimt. The most strikimmg feature was his (mppc’(mr(tmmee. His mother had emmcoumrage(l bug, shmoulder-iemigth, i)hack curls to grow. He was aim immacumlately kept little h)O\ Who was (1umitc inhibited, very good imm his (Iumtwardi behavior, Umm(i ‘Who 5(iOi hiecame a Pet (If time ward. He had mild alidomimmal distemmtiomm aimci passed stools which were loose amid bioociy.
The immitial stuudv at that time iimclumded
umu-mnerous stool cumltuumes aum(i examimmatioums for anmoebae amid parasites, all (If wimich were nega-tive. In adchitiomm, a pr(ictscp\ performne(i rcvcahimmg a granumiar, friable, red muicosa vimichm \vas described liv Dr. Kirsimer as heimmg
char-acteristic of cimrommic Im(Immspecific umlcerative
C(Ilitis. A i)ariumm emmema showed mumcosal chmammges iii time lower i)o\vel, sumpportumg time diagmiosis.
1mmthe b(I51)ital time child was at first givemm a low-resicluue, imoim-laxative, high-caloric, high-vitamin diet. 0mm this regimemm imis stools slowly
improved so that b the time ime had been iii
the hospital :3 m(imuths it was thmouught per-missible to discharge him. I imave attempted to graph his coumrse l)y givimmg a record of time prog-ress of his height and weight at different ages iii Figumre 1;the top portiomm indicates the course that imis weight followed, vhicim is pretty closely related t(I the exacerbations and remissioums of his disease.
His mother said that as soon as lie retumrumed hm(Imne from the hospital there was a chamuge ium time child’s behavior. He was mmo lommger qumiet
audi veli behaved. He became much more
active, mmaughtv, amid aggressive. Iii addition, he
began to have emmuresis regularly llmdi to soil. His diarrhea also returned and, after a brief
peric1 at hmomc, he was broumghmt back to the
hospital.
At that time time first referral to psychiatry
\,iLs mmud(hc101 tht( purpose of evaluating time lammmilv sitnatr)11. Nothing much ctmmic of this becaumse in the process of taking time history it was determiumed by the psychiatrist that time patiemut’s mother vas unable or ummwihhimmg to
accept aumv help.
Toward the sprimmg of timis timird year, the
boy contracted measles which was folioved 1w
a period of 3 mumoumthms (If remission iii his
diarrhea. Iii the fall when lie became :3 ears old, hue had amm exacerbatioum of Imis diarrhea. His behavior oimce more i)ecame very good. He had to be admitted t(i the hospital ammd \vas given a tramisfusion of bloodi. His diarrhea improved, hue was semmt home, amud his “bad,” provocative behavior returned.
Duirimug the following winter at our immsistcmmce
he was putt into umursery school. He attemmcied more or less regumlariv. We fimmailv persuaded his mother to cumt off his bug cumrls to make him look more like a boy. Dumrimmg the winter he did fairly well. He had immternmitteumt bouts of diarrhea which were umot well couutr(Ihlcd liv
diet, sulfonamides, or other mncasumres
cm-)lOyed. By the eum(i of time spring lme h)ecanmc
worse.
You will note as a recurrent feature that ime became worse duniumg the summer mumonths. At this time he was admitted to the hospital with
rather severe diarrhea which lasted for a
period1 of 3 mouths. Exteumsive attempts were
made to discover some allergic imsis for
his disease. The possibility of immfection was also reviewed. Although uuothiumg was discovered which suuggested clefimmite aiicrgeuus, im’ was
placed on a diet free of cow’s milk amid egg
which was contimmumed for several mouths with
cloubtfuml improvemeuut. He was also given
suilfathiazole amud transfusiomms. During the
course of this exacerbatioum his motimer became
mumch uipset amud agreed to proceed witim some
psychiatric help. On this occasiomm she vent a little fumrther than before but really dud1 mint make muich progress.
Duriumg the umext 3 to 4 years, tIme boy
was muot serioumslv incapacitated liv his diarrhea.
He was gemuerailv on a blauud diet. Sumifagumaumid-imue amid sulfasumxidimme were givemu periodicaiiv,
together with transfumsioums for ammemia. Most
(if the time he was able to attemmci
school-numrsery school, kindergarten, ammdi themm first grade. At the begimmmmimmg of his school
expeni-ence, he did not soil himself immschool bumt did
AGE I 2 3 4 5 6
I I I I I I
A\IEHICAN ACADENIY OF PEDiATRICS - PROCEEDINGS 665
1I(;. I. lhmmcttm(Ltiomms 1mm tIme 1)nti(nts height ammdweighmt cltmring the first 6 years of life, plotted omi State of Iowa growth chart. Nuimuhers ifl(hi(ate adinissiomis t(I the’ hospital.
(:i 01. 7 ‘ears (11(1,hic’ was soiling hmimmmsehf at
selmool as \\‘(ih as at imonme. As once again his
mumotimer \vas foummd t(I hi(’ mimakimmg umo progress,
l)SvChmidtliC trettmuicumt vas t’ruumimmateci for time
timir(l tiumm(’. :\iici again, tim(.’ 1)atiemmts cliarrhct was vors (hiring time suimmnmer thaum at thm’
lie-giummuimugof timeear.
If vc jt55 along uuumtih time timmme vhemm hue vas S ‘ears 01(1, vc comime to a ear in which his
troul)hes l)(gaml to ulmOulOt (Fig. 2). Durimug time
fail of that year he was admmmitte(l t(i this hospi-tal omi two Occasiolls hweaumse (If severe lil(i(Idi\
chiamrimea. For time first timume, ervtimemmma mu(I(i(Isummm tPI)etre(i (iii his sums. A suspiciomm of clubbimig
(if iuis fingers was also mioted for the first time. Proctoscopic cxamimmatiomm was repeated amid the same mucosal chamuges were observed. H’ ‘as trammsfumseci dli(l vas able to lie in 5(11(101 for a few months of that ‘ear.
1mmApril amud May, the ammemmuia becamime worse and the erytimema noclosumm retuirnecl with aim exacerbatiomm of diarrhea. At this point it was diecided to 1(lmit imim to time hospital for what
666 \VRIGIIT - ULCERATIVE COLITIS
AGE 5 6 7 8 9
10
II
2
3
4
I I I I I I I I I I
15 16 17
I I I
Fmc. 2. Fhtmctuatiomms in time patient’s height and weight during the period from 6 to 15 years of age.
This coumsisteci of paremmteral feedings, except for water amid a small amotmmmt of skimmed milk.
He was treated immtravenouisly with Amigen#{174}, j)iasma, gluicose, ammci blood. Suulfommamicie prepa-matiomms were given liv mouth, and streptomvcimm immtramumsculanly, imm the hope of reducing the bacterial flora in time h)owel. This procedure vas comitimmueci for a little over 2 weeks and resulted imm aIm excelleumt remission. Dumrimmg the
sumbsequment summer he vas quite well. He
joimmed the Y.M.C.A., began to play baseball,
and became physically active. This remission lasted for about 10 mouths.
In April of the year he was 9 years old, his
symptoms returned, presumably following
in-creased bickering at home between the boy
and his mother, and perhaps because he
cur-tailed some of his physical activity and at-tendammce at the Y.M.C.A.
AMERICAN ACADEMY OF PEDIATRICS - PROCEEDINGS 667
his problemuus, he was readmitted to the hospital for amiother “medical colostomy.” This time, hmowevcr, time 1)rocedure resulted iim relief of
his symptoms ommlv during the time he was iii
time hospital, recurring when he went home. Fohlowimug these episodes he got aiommg fairly
well for about 2 years. He went back to
school at the age of 10 ears on a somewhat restricted diet. 1mm the spring of that year he agaimm had erythema nodosum. This was found to be associated with an infected rectal fistula and abscess. When these were adequately treated, time ervthema nodosum cleared.
Wimemm he was from 12 to 13 years old, hue reached a climax in his disease. As you can see from his growth curve, he began to
in-crease rapidhv in height, presumably due to a
l)rePuberal growth spurt. This was soon
con-firmed b’ the appearance of secondary sex characteristics. In the fall of the year just after
his twelfth birthday, he was in excellent phvsi-cal conditiomu. He had acquired a paper route amid was making some mommey omm Imis own. He was cocky, sumre of himself amid, as a
conse-(ltlemmce, paid little attention to his school home-work. Duiring the middle of the ‘ear, because
of his poor school work, he was dropped back a half year. At first this did not seem to affect imim very mumch, although he was considerably puit oumt hiy it. B April, however, he had a suddemm, severe exacerbatioum of diarrhea.
1mmadditiomm he lost his appetite, began to have
(1iZZV spells, and erythema nodosum
reap-peared. With this, for the first time, he had diffuse arthritis in the hamuds and feet. Abscesses imu the skin and a staphylococcic puria were also present. The precipitation of this severe exacerbation was thought to be due to the fohlowimmg circumstances : Although his mother imad muot heen able to accept psvchotherap, the boy himself had been seen over the pre-cedliuig 4 or 5 years at regular intervals
by a psychiatric social worker. In the coumrse
(if treatment, the worker had tried to present
herself as a sympathizing, permissive mother-figure whose emutire role was to give him
affec-tion ammci coimsole him at all times. 0mm one
Occasiomu, after his school failtmre, she dropped time hmimmt that perima)5 of the difflcuit lay with time patient himself amid that if he
tried to work a little harder at school he might muot fail. Actually this conversation took place jumst a few ciavs hx’forc time suuddcn return of severe diarrhea.
At this point ime was again admitted to time
hospital and was successfumhly brought through this exacerbatiomm. He weumt t(i summer school
with the hope of making up lost ground amid
rejoining his class. However, he resemmted
summ-mer school so much that he not only did not
succeed in making up his work but iii additiomm
had an exacerbation of diarrhea. During the
latter pant of this summer he dechimmed to time
lowest point in the course of his ihimmess. As can
be seemm from the marked dip iii the weight
curve, hue lost weight just before time age of
13 years. Pyumria developed agaimm. He imad edema of the feet, severe abdomimmal paimm and severe biood’ diarrhea.
He was again admitted to the Imospital irm
what appeared to be a seniouis coum(iitiomm. The
first night in the hospital he thought thimmgs
over and walked out. He stayed home for
about a week in a senioumslv ill comudition before
hue finally ielded to his parents’ demands that
he return to the hospital. A proctoscopic
exami-nation disclosed a draimmimmg rectal abscess. He
was treated with antibiotics and traumsfumsions.
His fever remitted amid the infectiomm cleared,
bumt the arthritis, which had returned together
with edema of the feet, commtinued. At this time it was decided to umse ACTH. After one dose had been administered lie agaium left the hospital iii a huiff. Within 3 weeks after he walked ouit, he had improved to the point
where he was able to go back to school.
From this time on, physical improvememit
was progressive and maintained. As can be
seen from the curve, his weight went up, reach-ing the top hue, and stayed there. He
suubse-quenthv went to high school where lie was
much interested in sports and actively played
football, basketball and baseball, making the
high school teams in both h)asebahh amid
basket-ball. His school work was mediocre amid hue
finished the course with difficumltv. Dumriumg this time euuumresis contimuumed amid! occasiomual soilimug occurred. The exact extemut of diarrhea is muot
known because he would imot reveal it to
amuy-omme. We can only guess that some diarrhea
was presemut becaumse his mother reported pen-odic episodes of soiiimmg and ciiarnhmcal stools.
He continumed to see time psvcimotherapist
pen-odicahly, hint umot at regular immtervahs. At home his behavior became aiarmimiumg to his 1)arents.
He was very demandimmg. He stole mommey from
his parents, took the family car withmout per-missi(imu, amid refused to comtfornm to any of the rules or regulatiomms laid down for imimumat home.
668 WRIGHT - ULCERATIVE COLITIS
imito any tuOUh)le with the civil aumtimorities umor ‘as there ami report of serious troumble at school.
Fimmahly, timis past summmmmner Ime reached aim age which permitted him to joium the arms’ which ime l)mmPtl\ dud. Now he is off immcamp wait-iuig for the arm to (liscover that he has uulcera-tive colitis.
So much for time prtntcteci hmist(irv. I visii imow to make a few brief comummemmts about some of the featuires of this patieumts history.
As yotm will have imoted imm Figure 1, this hios growth was really mmot iimterfered with iii
a permaument fashiouu. The height followed the middle curve ummmtil lie reached puberty ummcl then imucreased abrumptl to the tipper himme. The weight vacillated aroummici the midlimme and finally, witim 1)ubentv, ascemmded to the himme indicatimug 1)ltms Olie stamidiardi deviation . His
clevehopmemmt, immteilectumallv ammd physically, has
been umormal throughoumt. His inteliigemmce
(luotiemmt has i)een ummeasumred at 1 18. Physically,
as I related, lie imas beeum ahle to participate
in very active 51)oIts.
The course of the anemia is rouighmly related
t(i the exacerbations amid remissioums (if the
clis-ease bumt ui(it exactly so. There have beemu times
wheum he was immoderately anemic taut withouut symptoms, auii there have I)een times wheim lie had severe symptoms vithoumt ammemia. Jim the couirse of time last few years lie has had mmo sigmuificamit ammenmia.
Several roentgeumogramums of time coloum showed, at first, mucosal changes iii the lower
rectosig-moid, later on, changes immtime descencliuug colon
amud portioums of time transverse coioum, buit not mumclm aclvaumce in the severity or extemmt of time lesiomm over time years.
A few wordls should be said ab(iumt the
effec-tiveimess of the treatmemmt. Dumnimmg most of the 15 ears ve have beemm trvimmg to correlate timerapeutic measures with chaumges iii time dis-ease. By ammd large, ve have l)eemm fruistrated in this attem1)t. Certainly, traumsfumsions made him feel better whemm hue was ammenmic, amid meas-tunes used to decrease the diarrhea were umsuahly effective. On the whole, however, neither diet, vitamnimus, iromm therapy, mmor sulfommamides pro-dumced aumy rehiahile, iastimmg chaumge iii the state of his colon. At times he actumahly seemed to improve when he refumsed to accept the treat-meumt of the doctors. For instamice, whemi omm restricted diet at omie poimmt hue was havimug immoderate diarrhea, l)ut vimemm lie mefuseci to follow the diet, imis mmmother yielded and gave
him a gemmeral diet, amid he immediately im-proved. Similarly, in the last hospitalization (hescnibedi, he was iii severe straits, bumt ne-belied, walked out of the hospital, amid stir-prisiimglv became progressively better.
We have failed to demonstrate aim specific infection to lie the etiology of the disease. Theme has beeim mmo suspicioum of vitamin
defi-cieumcy, amid attempts to demomistrate allergy were mmot fruitfuil.
The significance of the erytheimma nodosumm amid arthritis is open to commjecture. 0mm at least
three of the four occasions whemm he had
enythema mmodosum, there was an associated pyogeumic immfection present either in the urinary tract or iii the wall of the bowel.
Some of the characteristics of this boy’s per-sonalitv amid of the family situatiomm are
inter-esting. Dr. VamudenVeer who followed him
dun-ing most of the illness thoumght that oume of the
major mechanisms was immternalization of hostile amid aggressive feeiimmgs. Whemm he was uumable
to discharge emotiommai tension liv the usumal
routes, diarrhea developed. Some suipport for
this thesis camm be observed immthe course of the disease. When his behavior was good,
diar-rhea was severe, and conversely whemu diarrhea was umider commtrol his behavior teumcled to be
bad.
It seems to me as I have watched him oven these years that he maintains a very brittle sort of adjustment. He is better off when he caum emmgage in vigorous activities which
presum-ably give vent to some of his emotiomms. Yet this brittle adjustment leads to periodic troumble with his eumvironment and sets off aim exacerba-tiomu.
Omue final commeumt should be made about
the similarity between the childhoods of the
boy amid his mother, amid the similarity of their
persommahities. The mother, whom I have
iii-adequatei described, is a very temmse,
cmi-trolleci sort of individual most of time time, very dependemmt, and fnequuentlv having coumsiderable concealed hostility and anxiety. The boy him-self has a similar disposition. Neither of them, appaneumtlv, had aim appropriate quota of
affec-tioum from their respective mothers.
At this poiumt I voumld like to tumnum the ciis-cuission over to the psychiatrist, Dr. Keumwood,
who has had extensive experience with
chil-ciren stiffening from umlcerative colitis.
Dii. KENVOOD: Actually, I have not had a
large series of patiemmts. Four have beemm stumdied
A\IEIIICAN ACADE\IY OF PEDIATRICS - PIIOCEEI)INGS 669
(hlih(hmiIm ‘erc v(ry mmuumchu inuprov((l, t\V() ol
theni I think (0111(1 l)C class(’(l LS cured. One
camumiot say as vet that thie’ vihl n(It have
cx-accri)atioums, bumt as of this p:irticumlar momemut,
tW(I (‘iiih(hremi have had mmo retuirmm of their svmp-torus for time past 9 nmonths.
It is (if interest that as timese cimildremm improve sommmaticahiv, emumotuiumal prol)lems ma lie han-(lied! ium a mucurotic vay. For instance, one \Vt5
iii recently in aim actmte auuxictv state, limit at least time h)ovel (.(Imfl})ltimit hid(l not hicgumum again. Ouue (xl)ert in this particular field bias said that
thU way (II1C treats this sort of timimmg is to tr’t’
to ummake time 1)itient umeurotic, giving a psvcimic
rather timaim a somatic ouutiet, amid themm treat the
mleuurosis hater oum. Neither aim acute aumxietv at-tack uior uk’erative colitis is pleasauut, hint at l(’dst anxiety is muot goiumg to kill the patiemmt ammch C(Ihitis mmmight.
\\Tc have foumnd a remarkable similarity tiiiouig time pirents (if these chiidremm. Wheuu I
first hiegan t(I mike obsenvatiomus iii this p1r-ticular field, I was t(Ildi that these paremmts wene ahi’ohumtelv hi(iITIeicss, that we umuight as well not c(Imisi(ier thmemim hiumt plaum to treat time children
imitemmsively timd then place them imm a foster
hmomne. I have commue to completely disregard thuis 1)hiii50phm\. \Vhat I imave fotmmmcl, immgeneral, is that thmesc’ parcmmts, at the tinme of time dhildls h:rthm, were un(ler a 1)artidular stroumg extermmah
stress, so great that they felt their own lives
‘c’rc iii danger. Basically they were fairly souuui(l I)eopl’ hiuit the external stress interfered vithm relatiommslmip vithm timis particni:mr cimild. This is imlcttci liv time fact thmat (II1C sees the
other cimilcireum in time same family d(Iimmg quuitc
nicely amid imavimig no sigmm of timis kind of trouble. \Ve hmay.’ foummd that we camm work with thmese 1):Lreumts. In those cases where we (1(i con-red’t time situmatioums at hommme, we have a mucim hettcr chmammc’ of suiccess. 0mm time vhuole, I have foummd time paremmts (1uiite co-operative.
You mimav imave hmear(l specuhatiomm that umicena-tive colitis is prohial)iv related t(I toilet traimmimmg.
1 think it safe to say timat it is related to the
toilet traimiimmg period because this is the clisci-phmmarv 1)eriod iii a cimild’s life, but it is not related to time t(Iihet trainimug per se. In almost ever case we have found that toilet traimming ‘as not heguim t(iO eanh, muir vas it carried On 1)umliitiyelt. Bumt some external evemmt will be
fonuud to have disturh)edl the relationships iii the faummilv; for immstammce, iii omme case the voummgster ‘as turmmecl over to a maid for toilet traimming time very week that time mother left honme. So
it is O)i11( (iI(’IImmiSt.LiI(C Othi(’I than time toilet training its(’l1 tlmat is sigmiifmcant. \Vc have foumid in every case timat there were feedimmg difficulties, often severe, night from imufancv.
The majority (If these chmiidreum, in various
ways, are mmot at a loss to express hostility, as
all of the nurses, doctors amid others who deal
with them are well aware. What I thiuuk is
im-portamit is that tlme hmavc difficuultv expressimug
hostility against the very person who, perhaps, is the most importamit to them. What we are trvimmg t(i (10 15 to correlate their dispha of emnotiomu imm curremut situuatiomms with the labora-tory (lata. Oume of the chiidremm showed mmo im-i)rovemeuut until omme day wheum she “blew uup” at a nurse oven taking her bath. Actually, as we traced it hack, this was the first time that she had showmm any hostility toward a womami at all. She centaiuuhv had been hostile witim nme, amid1 she had been hostile with other mcii iii time
eumviroumment, i)tmt not wth womemi. But the’
notew(inthy aspect (if this incident was a rise in hemoglobin which begaum very shortly there-after. All of these voumumgstens have beemu down
to 5 t(i 5.5 glum. of hcmogiobium amid, as aim aver-age, 5 mouths after the start of
psycimo-therapy, the hemoglobumm begaum to rise. Thus
ma be the very first eviclemuce seen of aim’s improvememut in time disease.
The last symptom to disappear is the bowel symptom, wimicim I consider a very imiterestimmg
aspect. I certaimmly do mmot ummderstammd it, buut this disease is not coumfiumedl merely to time bowel. Mammy (if the amuemias are of a iuemolvtic type ammcl are not related (hirectly to time loss of iilood, for grossly time’ 1(155 of i)h(iod commtimmumes at the same nate amid vet time imemoghoi)imi ‘svill rise.
Omme other cimaracteristic of these childnemi is
that they are exceedimmglv (lemamm(limmg. The’ will
drive otm stark, raving mac! if youm tr’ t(i
satisfy all of their whims. They have a bottom-less pit as far as needs are concenmmed. I do umot believe iii i)eimug excessively permissive with these ‘oummgsters, but I think initially omme has to allow a certain amoumumt of aggnessiomm amid greediness. Shortly thereafter, one has to bring them iumto a normal, socially acceptal)le pat-tern. This is very chifficumit aimcl takes time and Iiatiemice. At the same time, orue mtmst lie very “giving” to these chmiiciremm, liv whicim I meamu
that omme must become aim ideal paremut to the
best (if one’s ability. I have takemu these children
670 WRIGHT - ULCERATIVE COLITIS
‘svithmiimtime l)(IIlim(lsof a m(’asolmahile social
stitic-ture.
I thimmk ammother very important component
imu timese votmngsters is sexumal conflict. I suspect,
although certaimmiy camm’t prove it at this momemmt, that there is a sexual trigger which sets off this disease.
In ciosimmg, Dr. Wright mumemmtioned that this hov temided to recover when he was placed on a free, general diet. The youngsters that we had in a more or less coumtrohled environment were placed omm just this kind of diet. They were mmot restricted in any way so that for weeks and months they practically lived on wieners and hamburgers, with tremendous amounts of mumstand, catsup, etc. Furthermore, almost ever,’
single itemit of forbiddemm food was time very one they wanted over a period of tinme. Gradually, they retunmmed to a good diet, even though in some cases it took a year or more, and I am
firmly convinced, without harm to them or
the bowels. Tnyiimg to emmforce a rigid diet omi
these youngsters caused more damage to their
emotional state, increasing the feeling that the
whole world was against them and that they
were being deprived. The free diet at first
caused doubts and shudders in the staff, but in
the long nun, I believe the results were very
good.
My whole attitude about this particular
dis-ease is, that while work with it is very
