Among patients complaining of constipation, a group can be defined in which there is slow whole gut transit shown by retention of radiopaque markers but a rectum and colon of normal width judged by measurements of barium enema radiographs compared with control observations. It is not known whether their symptoms are due to an abnormality of colonic motility or to a failure of the defecatory mechanism. Defecation was simulated experimentally in a group of these patients by asking them to expel a water-filled rectal balloon. The constipated patients were not able to expel the balloon, whereas normal subjects could do so. Electromyography of the striated pelvic floor muscles during attempts at expulsion of the balloon in the constipated patients showed failure of the normal inhibition of resting activity. Failure of external and sphincter relaxation on attempted defecation may contribute to the symptoms of some patients who complain of constipation.

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SUMMARY Strains of E. coli from the faeces of patients with active ulcerative colitis and with colitis in remission were examined for haemolysin and necrotoxin production. Cultures from 63 patients with active colitis grew haemolytic E. coli in 23 (37 %) as compared with 24 (21 %) from 1 15 patients whose disease was in remission (P < 0.05). The corresponding proportions for necrotoxin-producing strains were 22% and 12 %. Of 35 patients investigated both in relapse and remission of the colitis, 14 changed their carriage of haemolytic E. coli. Thirteen of these carried haemolytic organisms in relapse but not in remission, and one carried haemolytic organisms in remission but not in relapse (P < 0.01).Strains of E. coli were also examined from specimens of faeces obtained at weekly intervals for 28 weeks from 19 patients. The acquisition of haemolytic or necrotoxic E. coli strains tended to follow rather than precede the onset of the attack in the four patients who developed a relapse of the disease during this period. Among these 19 patients haemolytic and necrotoxic strains were found most commonly when blood was regularly present in the faeces. These facts suggest that conditions in the bowel during a relapse of colitis tend to favour the presence of haemolysin-and necrotoxinproducing organisms, rather than that these organisms cause the relapse.Of 50 strains of E. coli from patients treated with sulphasalazine tested for sensitivity to sulphapyridine 49 were resistant. There was no clear relation between the activity of the colitis and the presence of any of the 27 serotypes of E. coli examined.It has previously been shown in a small series of patients that the strains of Escherichia coli in the faeces of patients with ulcerative colitis differ from those of normal persons (Cooke, 1968). Two studies have been undertaken to extend this observation. In the first, the faecal coliform flora of patients with active colitis has been compared with that of patients whose disease was in remission; in the second, the time relations between a change in faecal flora and the activity of the disease were studied by examining the faeces of 19 patients at weekly intervals for six months. The opportunity has also been taken to assess the sensitivity to sulphapyridine of strains of E. coli from patients with colitis treated with sulphasalazine. 'Present address:

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