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Diseases of the Intestinal Canal

inflammation, enteritis, peritoneum and action

DISEASES OF THE INTESTINAL CANAL - diseases of the Intestinal canal have one feature in com mon, that they are accompanied either by constipation or relax ation, or by an alternation of these two states. This is detailed as part of the necessary history of the case ; and it again comes before us in the inquiry which we have supposed it necessary to make into the evidences of the general state of the patient before commencing the investigation of individual organs : it will there fore, perhaps, best serve our present purpose to adopt this common feature as the basis of classification, and so follow out the symp toms which are available in discriminating the various cpnditions which these circumstances serve primarily to indicate.

It is necessary, before proceeding further, to make a few remarks on the subject of inflammation, to point out more clearly its relations to the action of the bowels. Idiopathic gastritis is almost unknown : peritonitis, as we shall see, is more common : inflammation of the stomach is sometimes conjoined with that of the peritoneum ; inflammation of the bowels is so more frequently, in consequence of their greater extent of surface.

Enteritis, as a primary affection, holds a position in regard to frequency between gastritis and peritonitis; but even when the inflammation seems to have began in the bowel, it is almost always found to have affected the peri toneum ; so that in general it is not easy to say which disease has been first in the order of succession. The cases of enteritis without peritoneal inflam

mation are among the curiosities of medical literature; and possibly the highly susceptible membrane of the peritoneum is the first to take on inflammatory action, whether the irritation have been conveyed to it from within or from without. The disease known as enteritis consists of inflammation involving all the structures and especially the muscular coat of the canal ; and by com mon consent, inflammation of the mucous membrane alone is not meant., when the name enteritis is employed. A knowledge of these relations is of great importance in symptomatology ; because, first, the inflammation involving the peritoneum produces great tenderness on pressure; secondly, the inflammation of muscle produces paralysis, with interruption of peristaltic action and con stipation ; and thirdly, the inflammation of other mucous membranes teaches us that the primary effect may be suppressed secretion, but that this is soon replaced by increased and altered secretion, perhaps by effusion of bloodó active hemorrhage.