CHRONIC DIARRHCEA usually depends upon a catarrhal condition of the bowel, and is often the sequel of the irritative or septic type when not depending on tuberculous ulceration. In infants and young children it may be due to feeble circulatory powers with successive attacks of chill, in which case warm clothing, the avoidance of cold bathing, and the substitution of predigested thick foods for cow's milk will usually restore the digestive power and tone of the intestinal tract.
In older subjects the relaxed mucosa will require the stimulus of astringents; popular preparations, consisting of Dino, Rhatany, Catechu, Tannin, Logwood, &c., are usually prescribed with Opiates and Chalk Mixture for this condition, but since the greater part of their astringent principles are absorbed in the stomach they frequently upset gastric digestion without influencing the flux from the bowel, and the same remark applies to the salts of Lead, Copper and Silver.
The best routine remedy for checking the watery motions is a com pound of tannin, which will pass unabsorbed through the stomach and exercise its local astringent action upon the intestines. Tannalbin Tannigen, Tannoform, Tannol, Tannvl and Tanocol act in this manner. The writer prefers the first mentioned.
Tannalbin gr. xv.
Bismuthi Carb. gr. x.
Pulv. Cretce Ar. c. 0 pio gr. x. Misce. Mille tales xij. (in cachet. serv.) i. ter die.
Nitrate of Silver, Lead Acetate, Copper Sulphate, and Extract of Log,•ood may be given in pills coated with Keratin, and Opium can be administered along with them to restrict the exalted peristalsis always present. Tincture of Coto bark is a favourite remedy with some physi cians.
The diarrhoea caused by tuberculous ulceration should be treated on similar lines, and in all chronic cases Rhubarb, Dec. Aloes Co., Castor Oil, or Calomel should be occasionally administered from time to time, the latter drug always being selected when the motions are foul. Salol,
Naphthol, or Aspirin may be combined with tannalbin, and carminatives like Cinnamon, Clove and Peppermint Oils may be given for griping.
Diarrhoea due to catarrhal or other states of the colon is to be treated locally and constitutionally as Colitis (p. 16.0.
Chronic Nervous Diarrhea is of the same type as the lienteric, and should be treated upon the same principles by Bromides and small doses of Arsenic.
Malarial Diarrhea yields to Arsenic and Quinine, and diarrhoea occur ring in the tropics, when riot of the ordinary irritative type, is likely to be dysenteric in origin, and should be treated by Ipecacuanha. A routine for chronic tropical diarrhoea will be found in a strong decoction of Cinna mon bark administered in conjunction with a diet of well-boiled arrowroot.
Dietary in chronic diarrhoea should be such as is indicated in typhoid fever, the object being to give all foodstuffs in either the liquid form or in preparations of thicker consistency containing impalpable farina ceous materials which cannot mechanically stimulate the bowel membrane and increase peristalsis. Peptonisation of the food is necessary in all severe cases to aid its absorption, since owing to the increased peristalsis the food is only a short time in the intestinal canal.
After-treatment when the flux has been checked should consist of tonics to strengthen the relaxed tone of the intestinal tract. Iron is always valuable when the tongue is uncoated, and minute doses of Strychnine may be advantageously combined with it. A favourite tonic is Aromatic Sulphuric Acid with small doses of Quinine. Should constipation follow the cessation of the flux irritating cathartics are contra-indicated, Castor Oil or enemata being clearly the safest methods of opening the bowels.