UNITED STATES OF AMERICA
WASHINGTON,  D. C.
GPO  16—67244-1 
 
 
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 Case <y Enteritis, accompamearvim:atreter-nAtu-
   ral  formation o/* ?Ae Ileum.   Communicated to the
   Editors of the American Médical and  Philosophical
   Register, by John W. Francis, of New-Tork.

   The writer of the foUowing paper was an eye-witness to
 most of the facts which he relates.   They are taken from
 memoranda made at the  request of his preceptor,  Dr.
 David  Hosack,  in  whose practice  the  case occurred.
 Should the Editors of the Register consider it deserving
 a place in their journal, they are at liberty to insert it.
   On the morning of December the 22d, 1809, Dr. Ho-
 sack was requested to visit a Captain D----, aged about
 thirty-five ; of a slender habit of body ; who was repre-
 sented tobe in an alarming condition.  At the first vievv
 of the patient it was  perceived that he was afflicted with
 ail  the symptoms characteristic of enteritis, accompanied
 with those of iléus ; viz. an acute and constant pain in the
 whole abdominal région, particularly about the umbilicus :
 the abdomen greatly  distended, hard, and extremely sen-
 sible to the slightest touch, or whenever he attempted to
 move : vomiting  of stercoraceous  matter,  and consti-
 pated state of the bowels : puises small,. tense, and fré-
 quent ;  respiration hurried and  anxious ; countenance
 livid ; heat of the body increased somewhat beyond its
 natural température ; and  excessive thirst.   Thèse symp-
 toms were  attended  with  a great prostration of strength,
 and an extrême degree of restlessness.
   Upon inquiring into the history of his complaint, it ap-
 peared  that he had been first attacked  while at the
 théâtre,  on Wednesday  evening,  the  20th.  On  the
 morning of the day foUowing he was visited by an eminent
 physician,  who directed an antispasmodic  mixture, the
symptoms  of his disease  being, at that time, but slight.
Deriving no relief from  the medicine prescribed,  Dr. 
2
Gase of Enteritis.
 Hosack was called upon on Friday  morning, the 22d,
 between the hours of eight and nine, when he found him
 labouring under ail the symptoms above described.
   From the best information that could be obtained, it
 was rendered highly probable, that the  exciting cause of
 his complaint was  cold.  He had repeatedly been sub-
jected to attacks of this kind, though less violent than the
 présent, for several years past ;  at which  times he was
 relieved by the ordinary method of treatment.
   Immédiate recourse was now had to the  lancet, and he
 Iost blood to the amount of eighteen ounces.  A cathar-
 tic, composedof the pulv. jalap. andsub-muriate of quick-
 silver, each ten grains,  was directed to  be given,  which
 was rejected in about an hour after he had  taken it ; and
 a  similar one  repeated  with  the  same resuit.  Blisters
 were applied near the umbilicus ;  fomentations of vine-
 gar and water over the whole abdomen ; and enemata of
 the oleum ricini and tinct. assafœtid. were  administered.
 Thèse were  partly discharged bv vomiting ;  which afford-
 ed abundant proof,  that an inverted  action of the  whole
 intestinal canal had already taken place. In  the afternoon,
 the several applications to his surface were repeated ; and
 during the remainderof the day he  took, in divided doses,
 no less than two scruples of the sub-muriateof quicksilver,
 combined  with  opium and camphor ;  which, however,
 were rejected by vomiting shortly  after they were taken.
 The enemata, rendered more active, were again given,
but with no advantage,   At this time Dr. Miller visited
the patient, in conjunction with Dr.  Post and Dr. Hosack.
They united in recommending a  continuance of the same
mode of treatment that had been pursued.   In this con-
dition he passed thenight ; the constipation  of the bowels
obstinateîy resisting every means used to obtain  an éva-
cuation.
   On the  morning of the 23d, the sub-muriate of quick-
 silver, combined with opium, v/as again directed, in doses
 of fifteen grains every two  hours.   The warm bath was 
Case of Enteritis.
o
 at the same time employed. It produced a temporary mi-
 tigation of his symptoms ; but leithim still more enfeebled.
 His fate, which for some time  had been probable, now be-
 came almost certain.   The vomiting,  which, within the
 first thirty hours from the commencement of his disease,
 had become stercoraceous, and which had continued, with
 but  little intermission, to the présent time,  was  now re-
 newed.  Attempts were made to aliay it by the free use
 of the tincture of opium and other remédies usually indi-
 cated under similar circumstances.   The effect was  an
 aggravation  of ail the symptom .   At  10 o'clock, p. m.
 his  dissolution  was  momentarily expected.  Kis  puises
 were scarcely perceptible, and his extremities cold.
   He expired on Sunday morning, the 24th, at 6 o'clock,
 the vomiting having  been incessant  until about twenty
 minutes before his death.

        morbid appearances on dissection.
   At 2 o'clock in the  afternoon, the body was examined
 in the présence of  the  attending physicians, and several
 other professional characters.   The abdomen was  tense
 and greatly distended : upon making  a longitudinal inci-
 sion into it, a considérable quantity of serous fluid issued
 out.  Having completed the division, the intestines were
 found in a highly inflamed state,  and of a dark red co-
 lour : the peritoneum lining the abdomen was also  much
 inflamed,  and  covered with coagulable  lymph.  A re-
 markable  déviation from the ordinary structure of the
 parts was now discovered to exist : a portion of intestine,
 attaching itself to the umbilicus, formed a union  between
 it and a part of the intestinal canal.   Upon further exa-
 mination this appendix was observed to be a dïverticulum
from the ileum.  At the place of its union with the  ileum
it was enlarged and inflamed,  in cominon with the upper
 portion of the small intestines ; the remaining part was of
 a natural colour, and so intimately connected by its blind
 extremitv at the umbilicus as  to leave little doubt  of its 
4
Case of Enteritis.
  being an original mal-formation.  The ileum,  above this
  appendix,  was  very  much inflated, extremely vascular,
  and in size, equal to the transverse colon ;  while the lower
  portion  was greatly contracted, and twisted round the di-
  verticulum ; and in this  manner  had been the means at
  least of aggravating, if not of inducing the inflammation
  and its conséquences in this particular part of the intesti-
  nal canal.  This portion of the ileum was of a dark, livid
  appearance, and had lost its  natural tenacity.  The great
 intestines were found completely  emptied  of their  con-
 tents, and preter-naturally contracted in their diameters
 throughout their course.
   The omentum, transverse colon, and stomach,  were, at
 first, altogether  concealed by the  distended  state of the
 small intestines ; and found in close contact with the dia-
 phragm.  The omentum was irregularly drawn togethen
 No  unnatural appearance  of the transverse colon  was re-
 marked.   The stomach lay in  a circumscribed situation,
 was not more than two inches in width, and contracted in
 the same proportion throughout its whole extent.  It was
 entirely empty ;   upon a minute inspection,  no discoloura-
 tion or affection  of its coats was seen.
   From  the annexed draught,  by  the ingenious Mr. In-
 derwick, a student of medicine of this city, the  peculiar
 structure of the parts affected will be more accurately un-
 derstood.
 A. The manner  in which the diverticulum was connected
     to the umbilicus.
 B. The diverticulum.
 C. The manner of its union with the ileum.
D. The upper portion  of the ileum,  enlarged and ex-
     tremely vascular.
E. The lower portion, contracted and in a state  of ap-
     proaching sphacelus.
                          JOHN  W. FRANCIS.
  Nevj-York, June 4-th, 1810. 


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