Aretaeus, De causis et signis acutorum morborum (lib. 1)
Francis Adams LL.D., Ed.

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CHAPTER VI. ON ILEUS

AN inflammation takes place in the intestines, creating a deadly pain, for many die of intense tormina; but there is also formed a cold dull flatus (pneuma), which cannot readily pass either upwards or downwards, but remains, for the most part rolled up in the small convolutions of the upper intestines, and hence the disease has got the appellation of Ileus (or Volvulus). But if in addition to the tormina, there be compression and softening of the intestines, and the abdomen protrude greatly, it is called Chordapsus, from the Greek word ἕψησις, which signifies softening, and χορδὴ, which is a name for the intestines; and hence the Mesentery, which contains all the nerves, vessels, and membranes that support the intestines, was called ἐπιχορδὶς by the ancients.¹

The cause of Ileus is a continued corruption of much multifarious and unaccustomed food, and repeated acts of indigestion, especially of articles which are apt to excite Ileus, as the ink of the cuttle-fish. And the same effects may be expected from a blow, or cold, or the drinking of cold water largely and greedily in a state of sweating; and in those cases, in which the gut has descended into the scrotum with fæces, and has not been replaced into the belly, or has been restored to its place with violence, in such cases it is customary for the

lower intestines to get inflamed.² This affection is customary with children, who are subject to indigestion, and they more readily escape from the mischief, owing to their habits and the humidity of their intestines, for they are loose. Old persons do not readily suffer from the complaint, but rarely recover. The season of summer engenders the disease rather than that of spring; autumn, than winter; but the summer more than both.

Many therefore die speedily of these tormina. But in other cases pus is formed; and then again, the intestine having become black and putrified, has separated, and thus the patients have died. In these cases, provided the Ileus is mild, there is a twisting pain, copious humours in the stomach, loss of tone, languor, vacant eructations bringing no relief, borborygmi in the bowels, the flatus passing down to the anus, but not making its escape.

But if the attack of Ileus acquire intensity, there is a determination upwards of everything, flatus, phlegm, and bile; for they vomit all these; they are pale, cold over the whole body; much pain; respiration bad, they are affected with thirst.

If they are about to die, there is cold sweat, dysuria, anus constricted, so that you could not pass a slender metal plate by it;³ vomiting of fæces; the patients are speechless; pulse, at last

rare and small, but before death very small, very dense, and failing. These symptoms attend the disease in the small intestines.

But the same affections occur also in the colon, and the symptoms are similar, as also the issue; some of these escape if pus form in the colon, the reason of which is the fleshy thickness of this intestine. The pain is slender and sharp in the small intestines, but broad and heavy in the colon; the pain also sometimes darts up to the ribs, when the disease puts on the appearance of pleurisy; and these, moreover, are affected with fever; but sometimes it extends to the false ribs, on this side or on that, so that the pain appears to be seated in the liver and spleen; again it affects the loins, for the colon has many convolutions in all directions; but in other cases it fixes on the sacrum, the thighs, and the cremasters of the testicles. But in colic affections, they have rather retchings; and what is vomited is then bilious and oily. And the danger therefrom is so much the less, as the colon is more fleshy, and thicker than the small intestines, and consequently more tolerant of injury.