COLIC.-ENTERALGIA.

When a muscle is thrown into a state of unnatural, or spasmodic contraction, pain constituting cramp is the result. The muscular fibres of the intestine are not exempt from liability to be thrown into this irregular mode of action, or spasm; and what is called colic, bellyache, or the gripes, forms the complaint resulting therefrom. A variety of causes constitute excitants of this condition, and upon the nature of the cause will depend the degree of import belonging to the affection, which may range from one of a trivial and passing nature to one of the utmost gravity and danger. It should be always borne in mind that colic, if not overcome, may, by the deranged action arising from the obstruction produced, pass into enteritis, or acute inflammation of the bowel. Through irregularity of muscular action, also, one portion of bowel may become accidentally inserted into another, forming what is known as intussusception-a condition more particularly encountered in infancy and childhood.

The causes of colic, or the conditions giving rise to spasmodic contractions of the intestinal muscular coat, may be grouped into: sources of irritation existing within the canal; abnormal states in respect of structure and position of the intestinal tube; contamination of the system with lead; and certain general and

remote affections implicating in a secondary manner the muscular fibres of the intestine.

The sources of irritation within the canal that may produce colic comprise such as flatus, worms, irritating ingesta of any kind-whether of the nature of food or otherwise, morbid secretions, intestinal concretions, and unduly retained excrementitious matter. Idiosyncrasies exist, and an article that is food for one man may be poison to another-setting up violent derangement accompanied with colic.

As regards colic attributable to the condition of the intestine itself, anything which causes an occlusion of the canal or impedes the passage of its contents will lead to irregular action of its muscular fibres above the seat of obstruction, and thus occasion colic. Morbid structural conditions leading to constriction, hernia, and internal strangulation from whatever cause arising, act in this way. An inflamed, ulcerated, or any diseased state, which renders the mucous surface morbidly irritable, may be the source of colic, through the increased readiness with which undue muscular contraction is excited.

With respect to colic arising from general and remote causes, contamination of the system with lead is a well-known source of one of the most severe forms of the affection that is met with. As occasional exciting causes falling under this head must also be enumerated strong passions and emotions in persons of a nervous or irritable temperament, exposure to cold, dentition, and uterine derangement. The hysterical and gouty dispositions form habits of body which predispose to the occurrence of colic.

The treatment of colic must be regulated by what

Friction

is found or believed to be its exciting cause; but purgatives, anodynes, narcotics, and antispasmodics, administered by the mouth or used as enemata, are the medicinal agents that will have to be selected from, according to the circumstances of the case. with stimulating liniments, hot fomentations-medicated and simple, and the mustard poultice or turpentine stupe, applied to the abdomen, often assist materially the other measures adopted. The warm bath has also a powerful effect in overcoming spasm, and should, therefore, in obstinate cases, not be left untried. When a free action of the bowels can be obtained relief is generally afforded.

The particular treatment required for colic arising from structural disease, mechanical displacement, and obstruction of the intestine, and also from lead poisoning, would be beyond the purport of this work to refer to.

It is probable that, as with the stomach, a morbid sensitiveness of the mucous membrane of the intestine may sometimes exist and constitute, instead of colic, the cause of pain referable to this portion of the alimentary canal. Enteralgia and enterodynia are names given to this condition, about which but little of a definite nature can be said. Abercrombie speaks of four forms of gastralgia, and refers one of them to a painful condition of the first part of the small intestine. Pain, for example, beginning from two to four hours after a meal, and continuing for some hours-a form of complaint that is not unfrequently encountered-Dr. Abercrombie thinks, is probably seated in the duodenum and connected with inflammatory action or morbid sensibility of its mucous membrane. This form of affection, continues Abercrombie, is often accompanied with pain and ten

derness on pressure in the right hypochondrium, and on that account is apt to be mistaken for disease of the liver.

As regards treatment, what has been said under the head of gastrodynia may be taken as applying also to enteralgia.

INTESTINAL FLATULENCE. TYMPANITES.

The inordinate accumulation of gas in the stomach has already been treated of. As the result of deranged intestinal action, gas is also apt to accumulate to an unnatural extent in the intestine. It may arise from exhalation from the mucous surface (at least there are good grounds for believing so); or, form a product derived from the occurrence of changes of decomposition amongst the contents of the canal.

The presence of flatus in the intestine may give rise to irregular contraction of the muscular coat accompanied with pain constituting colic. The movement of the flatus is often accompanied with rumbling noises in the abdomen, which are termed "borborygmi." In some cases the fibres of the colon contract around an accumulation of gas and make it appear that a circumscribed tumour exists. This can be moved about like an ordinary tumour, and in other respects may feel so like one as to render it difficult to convince the patient that no actual morbid growth exists. The patient will admit that sometimes it can be felt, at other times not; and not unfrequently, that it is sometimes to be found on one side and sometimes on the other side of the abdoIts phantom nature is shown by the sudden disappearance that may be generally induced by a little manipulation. Percussion clearly discloses in reality when it is a flatulent accumulation that has to be dealt with.

men.