DIARRHCEA.
The treatment of this symptom can only be rationally carried out after its cause has been discovered. Unfortunately the general acceptance of the theory which has bracketed diarrhoea and enteritis as synonymous terms has plunged the subject into hopeless confusion. In the great majority of cases of diarrhoea the frequent loose motions are the result of some purgative substance introduced into the intestinal tract from with out, or produced in the bowel through the action of ferments or microbes. It is therefore as irrational to regard the catharsis as a disease as it would be to call the pharmacological action of castor oil or senna by the same name.
A catarrhal enteritis may supervene when the action of the cathartic agent has been of long standing, and it may even remain after this has been expelled from the body, hut such instances are rare except in the case of infants.
The purgative substance is often the product of fermentative or microbic, action which has already been induced in some article of food as contamin ated milk, or it may be a ptomaine poison originating in fish or meat, or the irritant itself may be harmless from a chemical point of view, but still be capable by its mechanical action of exciting greatly increased but in effectual peristalsis, as is seen in indigestible masses of casein or accu mulations of faeces in the colon.
The term irritative diarrhoea, therefore, may be applied to most of the examples of looseness of the bowel met with by the physician, and they follow for the most part some indiscretion in diet, and, especially in adults, may he safely regarded as if the patient had taken a cathartic which was irritating the small intestine, causing sometimes intense griping and smart purging. Such cases will require little treatment, and certainly should not be checked at first. The diarrhoea is nature's method of getting rid of a poison introduced from without in the food, or generated within the bowel, and if the physician must interfere, it may be best to assist nature, and give a mild dose (r dr.) of Castor Oil,
or a teaspoonful of Gregory's Powder. The severe pain is best combated by a large dose of Whiskey or Brandy, or 5 mins. of Oil of Peppermint or other essential oil. Salines may increase the pain, and, by rendering the motions quite fluid, may sweep past and not remove the source of irritation.
Diarrhoea common in infants fed upon cow's milk is clearly of this nature. It can be recognised at once by an examination of the child's napkins. The motions consist of masses of undigested curd, closely resembling glazier's putty in appearance and consistence; these masses can be easily shaken off or detached from the napkin, which they scarcely soil. They•are often green in colour and are passed solid, with a little acrid watery discharge often mistaken by the nurse for urine. Here the employment of vegetable astringents or opiates means delay, and too often death.
The preliminary colic and diarrhoea may be rapidly followed by vomiting, and if the cause be not promptly removed, a low and fatal form of enteritis sets in which is beyond the reach of drugs. The cow's milk should be instantly stopped, and a healthy wet nurse obtained. When this cannot be accomplished without delay, which is often the case, two courses are open. Raw Meat, grated or pounded to a pulp, may be given or made into strong beef tea; or a peptonised food or predigested milk should he tried. Directions must be given that cow's milk should not be administered till long after the attack is passed, and then only in very small amount, and but once a day at first, watching its effects. It is upon the whole better never to return to it if the attack has been a serious one. As soon as the child takes to the new food, a smart dose (one teaspoonful) of Castor Oil should be given to clear any indigestible curds out of the bowel. No further drugs are needed in the majority of cases.