DIARRHCEA, a symptom of a disordered condition of the intestines, accompanied by too frequent movements of the bowels, due to their increased peristaltic (or wave-like) motion. Like dyspepsia, it is only a symptom of some pathological condition. Diarrhoea is usually the result of some indiscretion in diet, such as the eating of unripe or overripe fruit, improper or indigestible foodstuffs; or of poorly cooked, de composed or tainted meats and fish, these in ducing a kind of diarrhcea due to toxic sub stances, and frequently alluded to as ptomaine poisoning. While relatively more prevalent in the city than in country districts, and oftener found among the poor than the well-to-do, it cannot be said that diarrhcea is particularly a disease of the city or of the poor, since severe and even fatal attacks of it frequently occur among the rich inhabiting the seaside or moun tains.
The conditions that produce diarrhcea are varied and numerous. Exposure and sudden chilling of an overheated body, particularly of the abdomen, are potent causes; and travelers who make frequent changes of drinking water are very susceptible to it. In these cases per sonal idiosyncrasy plays an important role. The drinking of impure water and living in poor hygienic surroundings cause diarrhcea. Whether sewer gas or pollution of the atmosphere has direct influence is a disputed point, but it is certain that direct drainage of polluted sewage from districts infected with epidemic diarrhcea into a water supply is a potent cause.
Daily variations of temperature, such as are experienced in the hot season from May to September, are familiar predisposing factors. Environment such as is found in densely pop. ulated districts where people live in damp base ments, etc., with vitiated atmosphere and want of care, is in the same category of causes.
Diarrhoea is often caused by the irritating action of mineral poisons, such as mercury, arsenic and antimony, by overdoses of croton oil, etc., or by various cathartic nostrums. Worms of various species are likewise causative factors. Of late much attention has been given to these parasitic causes, notably that of proto zoon Ameba coli, so frequently found in the stool of diarrhceics, principally in tropical cases. Secondary diarrhcea is a phenomenon found during an attack of some antedating disease, as ulcer of the bowel, cancerous growths of the intestines and the inflamed and ulcerative stage of typhoid fever. In diabetes and Bright's dis ease it is mostly a form of eliminative diar rhcea. In neurotic subjects psychogenic diar rhceas are frequent and are often very trouble some. Nearly 25 per cent of the chronic diar rhceas are of psychogenic origin. They repre sent unconscious wishes. These psychogenic diarrhoms are characterized by the frequency of partly formed movements although this is not absolute.
The symptoms of diarrhcea naturally vary with the causes, though certain symptoms are common to all forms. One of these is the fre quency and character of the stools, which may vary from 5 to 20 or more in a day. At first soft, and mixed with particles of undigested food, they gradually grow more liquid until almost watery, and are attended by griping colic like pains about the navel. Flatulence and vom
iting are also prominent features, and thirst is often great, owing to loss of liquids from the body through repeated evacuations. The pulse is usually quickened, though the fever is sel dom high, and is of no serious consequence. If the diarrhoea become chronic or long continued, prostration ensues, though this contingency is infrequent. Secondary diarrhoea, due to chronic congestion or pathological changes in the intes tines, is much more intractable.
The treatment of diarrhoea must necessarily vary with the inciting cause, though many cases recover spontaneously or need treatment for only a few days. Absolute rest and low diet are indicated in the toxic forms. If the attack is due to exposure or cold, the application of hot turpentine stupes to the abdomen, with the administration of small and frequent doses of opium and bismuth, may be all that is required; when, however, it is due to offending food in the intestines, or to ptomaines, the prompt removal of these elements must be effected. Broken doses (one-tenth grain) of calomel every half hour, or a teaspoonful dose of Epsom salts in Vichy water, until the stools assume a more natural consistency, are prompt and efficient remedies. By far the most popular is a pre pared dose of castor oil containing 10 to 15 drops of laudanum. This should be followed by astringent antiseptics, combined with opium and a digestive; for instance, sulphocarbolate of zinc or soda, opium in either powdered or extract form, with blue-mass. Should the pain be excessive, chlorodyne, or hyoscyamine, or in extreme cases small doses of morphia may be given until the patient is relieved. For the vom iting, small doses of hot water or plain lime water will be effective, and the application of the old-time spice-plaster or hot poultice will be found soothing. Some prefer the ice-bag. Should there be any oppression, aromatic spirits of ammonia, or stimulants like brandy or whis ky, well diluted, will restore the strength, though this is seldom necessary.
The undue haste to stop diarrhoea suddenly, and the eagerness which patients exhibit to take large doses of paregoric or laudanum, or nos trums called cholera drops or diarrhoea mixtures, in all cases are mentioned only to be condemned. A more rational course is to remove the cause, thereby assisting nature to regain her normal tone and reassert her disturbed functions.
In children and infants the same general rules should be followed, with modifications to suit each individual. In place of milk, substitute a milder form of nourishment such as egg, barley or rice water. (See CHOLERA INFANTUM). Another and more direct form of treatment than giving remedies by the mouth is the use of enemas, or both can be employed in conjunction. High rectal enemas are used of astringent anti septics held in suspension in thin starch solu tions, or with turpentine added.
The constipation which usually occurs after recovery from diarrhoea had better be disre garded for a day or two, when mild cathartics or laxative remedies can be used. Very effect ive remedies are glycerine suppositories and enemas of cold water.