§ 224. Enteritis, colica inflammatoria, inflammation of the boucels.

Such an inflammation generally commences in the mucous coat, whence it spreads to the other tissues. We distinguish an erythematous, (mucous,) phlegmonous, viscous, follicular, serous inflammation of the bowels. It is principally the follicular inflammation which occasions ulcers in the intestines, such as we observe in abdominal typhus.

The most frequent kind of enteritis is ileocolitis, which occurs both as a mucous and phlegmonous inflammation. The latter is characterized by excessively violent, piercing, burning, and tearing pains, which are frequently most intense at a circumscribed spot in the umbilical region or the right iliac fossa; here the pains are seated, constant, aggravated by the least contact, efforts to vomit, breathing, cough, etc.; the patient is lying on his back, without stirring, with his lower limbs drawn up, moaning, not daring to move lest the pain should get worse. The pain comes on in paroxysms, like colic. The abdomen feels hot, distended, hard, frequently tympanitic; obstinate constipation, which continues during the whole period of the inflammation; troublesome, painful flatulence, passing upwards; vomiting, first of mucus, bile, and food, afterwards of green masses, resembling faeces, and even vomiting of faecal matter.

An inflammation of the bowels, like all other violent inflammations, sets in with a violent chill, or else fever and inflammation develop themselves at the same time. The pulse is very frequent, (100 to 120,) small, spasmodically contracted, hard, and intermittent. There is internal heat, and unquenchable thirst, although the extremities are cool; the features express pain and anguish; the respiration is anxious, hurried, and is generally performed by means of the intercostal muscles. The tongue is generally dry, red, or coated white; skin dry; urine scanty and red. Sometimes nervous paroxysms, singultus, speechlessness, fainting spells, and delirium, are present.

A mucous inflammation is distinguished from the other one by being less violent; the pain is more remittent, as in colic, even intermittent, dull, tensive, cutting, with feeling of fulness in the umbilical region and in the right iliac fossa. There is no vomiting, unless the inflammation should reach the stomach. This form of inflammation is more frequently attended with diarrhoea than constipation, generally occurring at night, characterized by discharge of flocks. The fever is erethic, sometimes even inclining to torpor; the pulse is soft and frequent. Evening exacerbations, and remissions in the morning.

§ 225. A very acute enteritis runs a course of from 24 to 48 hours, or at most from 3 to 6 days; a mucous enteritis runs from 4 to 14 or even 30 days, in which case the inflammation becomes chronic. Recovery from the phlegmonous inflammation takes place by alvine evacuations, and from the mucous enteritis by critical fevers and abatement of the symptoms. Death ensues by gangrene and paralysis of the abdomen; in the second form, by the passage of the disease into en-terophthisis.

The disease may be caused by irritating, bad, decayed food, unripe fruit, melons, cucumbers; overloading the bowels; abuse of spirituous drinks; irritating drugs; acrid bile; mechanical irritants; suppression of cutaneous secretions, in consequence of cold; suppression of habitual discharges of blood, of sweat on the feet; or the disease may set in as a sequel of gastritis, hepatitis, peritonitis, or may be occasioned by dys-crasia.

The prognosis depends upon the nature of the course of the disease, upon the extent and intensity of the inflammation, and upon the general character of the symptoms.

§ 226. The treatment should commence with Aconite, which is to be continued at longer or shorter intervals, according as the inflammation is more or less violent; for the symptoms which remain, after the inflammation has been subdued, Nux. v., Bryon., Cha-mom., Bellad., Rhus t., Puls., or Merc, Arsen., or Can-thar., are appropriate remedies. In some cases these remedies are indicated from the commencement.

If some other adjoining organ should be inflamed at the same time as the bowels, the specific remedy should be administered in alternation with Aconite.

For sub-inflammatory symptoms, when the inflammation is not distinctly developed, Belladonna and Hyosryamus are excellent remedies.

The so-called stagnationes sanguinis, (physconia sanguinis,) in the abdomen, have frequently the appearance of an inflammation of the bowels, particularly when they are accompanied with fever and pain. The symptoms are less intense, with remission and even perfectly free intervals. The pain is less seated, more changeable, goes and comes; sometimes there is only a disagreeable sensation of pressure, tension; burning, or beating, accompanied with other various symptoms according as one or the other portion of the abdomen is the seat of the affection. This condition frequently arises from irregular piles or catamenia. and occurs in hypochondriac or hysteric persons, or in those who are fond of spirituous drinks. Indigestible, stimulating food aggravates the disease. The patient complains of troublesome thirst, dryness of the lips and mouth, flatulence, borborygmi. The stool is lumpy, dry, and dark, or slimy, thin, fetid. Diarrhoea sometimes alternates with constipation. At first, there is no fever, afterwards only in the evening, with morning remissions and slight sweat. Emaciation, prostration of strength, cachectic appearance, cough, night-sweats, dropsical symptoms.

The cure is generally effected by Nux v., Bryon., Puls., Bellad., Digit., Phosphor., Calc. acet., Sep., Ve-ratr., Sulphur, and other remedies.*