SOME VARIETIES OF BOWEL DISORDER AS INDICATED BY THE NATURE OF THE CHIEF SYMPTOM.
We have already seen that as regards the bowel itself its chief disturbances, so far as digestion is concerned, centre round the amount and character of the fluid secreted by its walls, and the peculiar movement by which it propels its contents along in the proper direction. The most obvious disturbance of the former is when, by irritation, it becomes excessive and mucous in character, giving rise to loose, fluid or semi fluid motions, and of the latter when it becomes sluggish, so that evacuation of the bowel is de layed or arrested. A third symptom is pain of a peculiar character, cramp-like pain, due to the peristaltic movement becoming excessive and spasmodic in limited parts of the tube. Thus we have the three chief affections asso ciated with indigestion in the bowel: EllarrhCea.—This term is derived from a Greek word diarreo, meaning to flow through, and is applied to the condition in which the stools are frequent and watery.
Its causes are various. Some food that has been taken may not agree, may irritate the mucous lining of the stomach and bowels, and cause an excessive secretion of the intestinal juices, or may stimulate the bowels to too ener getic contraction. The presence of worms will act as an irritant. Similar results may be brought about by the catarrhal condition al ready described (p. 214) as producing the copi ous discharge from the nostrils, throat, &c. Thus the condition so well known as "cold-in the-head " may have its likeness in a catarrh of the bowels. Emotions of various kinds may produce diarrhoea, the "diarrhoea a timore", looseness from fear, for example. In many women of a hysterical tendency the least excite ment will provoke the flux. A kind of nervous diarrhoea is common in women about the time of the "change of life," and is accompanied by flushings and sweatings. It should not be for gotten also that an irritation applied only to the anus or lower part of the rectum may deter mine a flux from the large intestine above and even from the small intestine. This is un doubtedly because of the nervous communica tions distributing, so to speak, over the whole bowel the effect of an irritation experienced at one part of it. This explains how piles pro duce griping and diarrhoea. Further, it is necessary to remember that articles of food, ordinarily quite easily digested, will produce indigestion, griping, and looseness of bowels in some. Thus Trousseau says : "I knew a man who suffered from diarrhoea for years, notwith standing the trial of every sort of treatment, and whose general health was seriously im paired by the affection. The symptoms dis
appeared, as if by enchantment, upon the patient, of his own accord, discontinuing tea for break fast, which for twelve years he had been in the habit of taking. I attended the family of a ship-builder at Havre whose children were unable to tolerate milk for the first seven years of life. A few mouthfuls of any kind of milk at once caused diarrhoea and vomiting." It must also be noted that diarrhoea is a common symptom in various diseases, in chronic inflam mation of the bowel, in diseases of the liver and spleen, in typhoid fever, in tubercular dis ease of the bowel. (See CONSUMPTION OF THE BOWELS, p. 254, &c.) purging, sickness and vomiting occur, and there are loss of appetite, furred tongue, and thirst. In most cases also griping is a feature, flatulence, and belching. Where the pain is severe, the person may be much prostrated; his skin may be cold and pulse feeble. In what is called summer diar rhoea, or English cholera, the attack is often occasioned by errors in diet, by eating tainted meat, unripe fruits, herrings, &c., and begins suddenly with vomiting, which is frequent, and speedily accompanied by purging. Pain across the belly is severe. The irritating nature of the discharge causes a constant feeling of need to go to stool, which the patient would fain not do because of the painful straining that ensues. What passes is very watery, and contains often bile-colouring matter. The vomit is generally, after a little, also coloured with bile, because the retching has forced bile into the stomach from the small intestine. The patient speedily becomes seriously weak, cold, and complains of cramps in the limbs, and the features are pinched and sunken. A similar form attacks children, and is called infantile diarrhoea. It is spoken of under DISEASES OF CHILDREN. Lientery is the term applied when the stools that are passed consist largely of un digested food. It indicates excessive action of the intestinal wall, and that the food has been hurried through the bowels. This shows how the character of the motions may afford valu able indications of the nature of the attack. Thus if the early motions are covered with mucus, as with a coat of gluey-looking material, this indicates excessive secretion and intestinal irritation.