PATHOLOGY. 
complaint. Chronic erythemata, or inflammation of the 
ftomach, is no uncommon difeafe in this country, where 
the common pradlice of purging dyfpeptic patients is 
frequently adopted in it, and tends materially to increafe 
its violence. 
ii. Emprefma enteritis, inflammation of the bowels : 
griping pain in the belly, with tenfion, tendernefs, and 
vomiting ; fever a fynochus. This alfo has two varieties 
diftinguifhed thus ; that one afteils all the coats of the 
bowels, and the other only its mucous membrane. 
a. E. adhsefiva. Pain very acute ; vomiting frequent; 
obftinate coftivenefs; fever violent. 
When this difeafe attacks the fmall inteftines, it is at¬ 
tended with many of the fymptoms of inflammation of 
the ftomach. There is acute pain fituated in different 
parts of the abdomen, but generally about the umbilical 
region ; it is conftant, but liable to exacerbations from 
time to time, generally defcribed as of a twilling kind. 
There is, in a marked degree, a painful expreffion of 
countenance and manner, and difficulty of refpiration. 
The general furface is at firfl fomewhat hot, but at length 
the countenance and extremities become fhrunk, cold, 
and perhaps affedled with cold perfpiration, and lividity. 
The pulfe is frequent and fmall. The tongue is moift, 
but not always free from load. The ftomach ufually 
rejedts every article of food or of medicine. The bowels 
are moved with great difficulty, but generally with 
much relief. The abdomen in general becomes tumid 
and tenfe, and exceedingly tender under prefl'ure. 
An inflammation attacking the large inteftines isdif- 
tinguifhed by pain ufually fituated in the hypogaftric and 
iliac regions, or on one or other fide of the abdomen, 
and gradually becoming more general: this pain is at 
firft, perhaps, of a violent or fpafmodic charadler ; after¬ 
wards it is fixed, conftant, increafed under prefl'ure, re- 
llrains the movements of the body, and, in fome degree, 
cf refpiration ; and induces a ftate of continued and pain¬ 
ful contraction of the features. 4 Tlie patient becomes 
reftlefs, and throws the arms about. The furface is af¬ 
fedled as in inflammation of the fmall inteftines. The 
pulfe is fometimes little accelerated, until the affedlion is 
advanced. The tongue is moift, and whitifh or loaded. 
There is often little or no vomiting. The operation of 
purgative medicine is effective, but attended by an ex¬ 
cruciating pain, charadleriftic of this difeafe. Sometimes 
the bladder feems to participate in this affedlion; and there 
is a conftant defire, with ineffedlual efforts, to void urine. 
Enteritis is much difpofed to terminate in gangrene, 
an occurrence indicated by a fudden remiflion of the 
pain, while, at the fame time, the ftrength fails, the 
pulfe finks, the voice grows feeble, the countenance 
fhrinks, and aflumes even a cadaverous afpeCt; yet the 
difler.tion of the belly is not diminifhed, but often in¬ 
creafed. This tendency to terminate fpeedily in morti¬ 
fication conllitutes the great danger of inflammation of 
the inteftines. Sometimes the difeafe terminates in fup- 
puration, which, though lefs rapidly fatal, mod common¬ 
ly wears out the patient’s ftrength and life in a lingering 
manner; but fometimes this condition ends in recovery. 
The formation of pus is indicated in this difeafe, as in 
other internal inflammations, by the remiflion, but not 
total ceflation, of the pain, and by the occurrence of 
frequent fits of rigor, and fometimes by a purulent dif- 
charge by ftool. But the difeafe, efpecially when the aid 
of medicine is early and adlively obtained, frequently 
terminates favourably, by refolution, as it is called ; i. e. 
by a gradual diminution and ceflation of the fymptoms. 
If the pains abate gradually, and the tendernefs and dif- 
tention of the abdomen leflen, while the pulfe becomes 
fofter and fuller, natural evacuations of fasculent matters 
are pafled, and a free general perfpiration breaks out, 
this favourable termination may be anticipated. Where¬ 
as, the continuance of the conftipation and of the fixed 
pain, the increafe of the ficknefs and vomiting, the oc¬ 
currence of the fymptoms juft defcribed as indicative of 
Vol. XIX. No. 1301. 
259 
gangrene, efpecially if accompanied with hiccup and 
cold fweats, are among the unfavourable prognoftics. 
The principal fource of miftake into which the pradli- 
tioner is likely to fall in treating this difeafe, is in con¬ 
founding it with colic ; a fpafmodic diforder, which re¬ 
quires a treatment efl'entially different, but which never- 
thelefs occafionally terminates in enteritis. The diag- 
noftic fymptoms of the two complaints have been already 
Hated at length. See Coliea, p. 14.9. 
The exciting caufes of enteritis are obftruCtions in the 
bowels, which neceflarily retain the fasces, until thefe, 
by their quantity or quality, become extremely irritat¬ 
ing, and excite inflammation ; or irritating fubllances 
conveyed into the inteftine, which, by their bulk, fhape, 
or indigeftibility, or by their chemical or fpecific acri¬ 
mony, produce excitement there. Thus, the fwallowing 
of hard kernels, feeds, or ftones of fruit, of pieces of 
metal, &c. has often induced the difeafe ; and the pre¬ 
fence of fcybala, or hardened faeces, and of calculous con¬ 
cretions, operates partly, by the immediate irritation 
which they occafion. Thus alfo, llrong concentrated 
acids or alkalis, fpirituous liquors, high-feafoned food in 
large quantities, draftic purgatives, worms, &c. in the in- 
teftinal canal, have excited inflammation in it in different 
inftances. Hence the difeafe has fometimes been the im¬ 
mediate efteCl of repletion, or of a fit of intoxication -. 
and even a mild cathartic, when the bowels were loaded 
with much hardened faeces, which the medicine was in¬ 
capable of removing, has, in fome rare cafes, produced 
inverted motion and intus-fufception , terminating in ente¬ 
ritis. A very common caufe of inflammation in the 
bowels is the application of cold to the legs and feet, or 
to the abdomen itfelf, efpecially if fudden or long con¬ 
tinued. Gout, rheumatifm, eryfipelas, or chronic erup¬ 
tions, are fometimes followed by inteftinal inflammation. 
It is alfo a fymptom in hernia. 
In the cure of enteritis, as in all other acute inflamma¬ 
tory difeafes, the leading objeCt is to remove the inflam¬ 
mation, from which all the other fymptoms of the dif¬ 
eafe originate. This, though apparently an identical 
propofition, cannot be too llrongly inculcated, in the 
treatment of enteritis; becaufe the exceflive conftipation 
of the bowela, which, ifo common with the reft of the 
fymptoms, is in general merely an efteCl of the inflam¬ 
matory condition of the bowels in fome part, is often at¬ 
tacked by the inattentive practitioner with aCtive purga¬ 
tive medicines, as if it were the primary objeCl, and the 
fource of all the mifchief. The inflammation is to be 
fubdued by blood-letting, from a large orifice, to an ex¬ 
tent which mull be various according to the conftitution 
of the patient, and the violence of the fymptoms. This 
depletion may be aided in its efteCts by tiie application 
of leeches, and afterwards of a blifter, to the abdomen ; 
and by the ftriCteft abftinence from all ftimularing ali¬ 
ment. The blood-letting mull be repeated in a ftiort 
time, if the fymptoms do not abate, and the ftrength 
of the patient is fufficient to fupport the evacuation; 
which can only be determined by the obfervation and 
experience of the practitioner. If the pulfe fliou'ld be¬ 
come fuller and lefs wiry after the operation, it will af¬ 
ford a ftrong reafon for the repetition of it, fiiould the 
continuance of other fymptoms appear to require it. The 
warm bath may be reforted to with advantage. 
It mull be obvious, that before the inflammation of 
the inteftines is leflened or removed by thefe meafures, 
any additional irritation to the membranes, already in an 
acute ftate of fenfibility, whether by the immediate fti- 
mulus of a cathartic medicine, or by the contents of the 
bowels being forced forwards to the inflamed part, muft 
tend to aggravate the diforder, rather than to relieve it. 
In faCt it is ufually found, that purgatives, given by the 
mouth, are not fuccefsful, where this previous diminu¬ 
tion of the inflammation has not been effected. And, 
when this has been accompiiflied, fome of the milder pur¬ 
gatives, as the neutral falts, fhould firft be admiuiftered, 
3 X the 
