This section is from the book "Diseases Of The Intestines", by Max Einhorn. Also available from Amazon: Diseases Of The Intestines A Text-Book For Practitioners And Students Of Medicine.
Enteritis acuta; Catarrhus intestinalis acu-tus; Acute diarrhoea; Cholera nostras.
An inflammatory affection of the intestines characterized by a sudden development of pains and more or less loose movements.
Acute intestinal catarrh is one of the most frequent diseases. While it occurs more often in infants and children it is found in persons of all ages.
The affection may attack the entire intestinal tract or may be limited to a part of it. Thus we may have a duodenitis, jejunitis, ileitis, typhlitis, colitis, and proctitis (inflammation of the rectum). With regard to frequency the colon is most often affected. According to Woodward,1 an inflammation of the small intestine alone hardly ever exists, a portion of the large bowel always being affected. Intestinal catarrh is either primary (idiopathic) or secondary when occurring as a sequel of other diseases. Acute enteritis may be due to a number of causes:
1. It may result from the ingestion of heavy indigestible food, ice-cold drinks, and tainted meat or fish, unripe fruit, stale or sour beer, bad water.
2. Good food and drink taken in unusually large quantities may also produce this condition.
1 Woodward: "The Medical and Surgical History of the War of the Rebellion," vol. i , part 2.
3. A host of organic and inorganic substances may chemically irritate the intestinal mucosa and cause inflammation. All the drastic remedies, like croton oil, colocynth, jalap, etc., belong to these organic irritating substances; of the inorganic may be mentioned tartar emetic, arsenic, lead, sulphate of copper, all the mercurial preparations, concentrated acids, and strong, caustic alkalies.
4. Enteritis may be caused by mechanical irritants. Thus hardened scybala, biliary calculi, enteroliths, or foreign bodies which have been swallowed, like large kernels of fruit or coins, may evoke inflammation. The catarrh accompanying intestinal worms may also be placed in this group.
5. Intestinal catarrh is very often due to variations in temperature or to catching cold. It seems that the disposition to this agent varies in different individuals. Thus some people get an attack of diarrhoea if they sleep uncovered during the summer and a drop in temperature occurs, the colder atmosphere affecting the abdomen. Others, again, are attacked with diarrhoea whenever they get their feet wet. How the influence of cold acts in causing the enteritis is difficult to say. Some writers believe that the sudden change in the circulation of the blood caused by the cold is the principal factor; others again explain it on the ground of a more favorable development of microorganisms during the change of temperature.
6. Auto-intoxication. Poisonous substances may develop in the intestinal tract and cause diarrhoea. The enteritis following large burns of the skin belongs to this group. Here the poisonous substance is probably formed at the site of the burned skin and carried by the blood current into the intestinal tract.
Secondary catarrh of the intestine occurs in almost all acute infectious diseases in the same way as gastric catarrh. It is further found accompanying heart, kidney, and liver diseases, tuberculosis, diabetes, etc. Most organic diseases of the bowels are associated with intestinal catarrh, as cancer of the intestines, volvulus, invagination, peritonitis, thrombosis. In this class of cases, however, the intestinal, catarrh is of little importance compared with the primary affection.
The anatomical changes found in autopsies are not always very well marked, and there is certainly no exact relation between the intensity of the clinical symptoms and the severity of the pathological processes discovered. The mucous membrane of the affected part of the intestine appears reddened either over its entire extent or only in spots. This red color is more pronounced around the follicles and patches, at the apex of the folds and of the villi. If the process is intense, extravasations of blood may be found. The mucous membrane appears swollen, sometimes cedematous, often it is covered with tenacious mucus. The villi and the solitary follicles are succulent and appear as whitish, small prominences surrounded by a red stratum (enteritis follicularis seu nodularis). If the process continues, these gray areas may rupture, and thus give rise to ulcerative lesions (follicular ulcers). Catarrhal ulcers also exist, however, caused by the loss in some places of the protective epithelial covering of the mucosa. Through extension of the inflammation in width and depth irregular losses of substance with undermined edges are produced.
Inflammatory irritation in the neighborhood of these defects may give rise to polypoid growths, especially when the process has run a protracted course.
Microscopically the vessels of the mucosa and submucosa appear in a more or less congested state. Small extravasations often exist between the glands of Lieber-kuehn. The spaces between the glands are frequently widened and filled with an abundant accumulation of round cells. The epithelium of the mucosa has mostly disappeared, especially in the large bowel. But according to Nothnagel this may be a post-mortem phenomenon and not always the result of inflammation. Desquamative processes in the epithelial layer, however, occur during life caused by the catarrhal affection, for the changed eroded epithelial cells are found in the mucus voided with the stool. The glands often appear altered with regard to their contour, being wider at their fundus and much narrower at their mouth, frequently presenting a flask shape. The submucous tissue is usually somewhat hyperplastic, otherwise not much changed. The muscular and serous coats are not affected.
Intestinal catarrh usually manifests itself through a feeling of fulness in the lower part of the abdomen, colicky pains appearing from time to time, and diarrhoea. As a rule, no fever is present except in cases of a severe type. The number of the stools and their quality vary a great deal. In mild cases there may be only two or three movements in twenty-four hours; in severer cases fifteen to twenty diarrhoeal evacuations. The first passage as a rule still contains normal fecal matter in its first portion, while the second part is of a mushy character. The next movements are semi-fluid, and at last entirely liquid dejecta may appear. The first stool still has a brown color and the characteristic fecal odor, while the following evacuations present a slightly yellowish color or even a grayish appearance, occasionally resembling rice-water. The latter are sometimes devoid of fecal odor, have an acid reaction, and show a foamy surface. Mucus is almost always present. The fecal matter in its yellow parts contains, as a rule, unchanged biliary substances which give a characteristic Gmelin reaction. Microscopically undigested food particles may be discovered in larger than normal amounts; thus meat fibres and well-preserved granules of starch may be observed.
A host of micro-organisms, epithelial cells, sometimes in contiguous groups, and mucus are found. Very seldom and only in severer cases small amounts of pus and red blood corpuscles may be discovered. Chemically peptones and sugar may be found in the dejecta.