The treatment of diarrhoea should not pro ceed on any rule of thumb, but the person should try to make out whether the probable cause is connected with the diet or catarrh (cold), or the presence of an irritant, or excessive action of the intestinal coat, or nervous, and treat ac cordingly.
In the case connected with diet, altering the food, and exercising watchfulness in the matter of eating and drinking, is probably all that will be necessary.
If the attack be dependent on a chill, let the patient rest, and restrict the diet to milk as directed on p. 227. If medicine be necessary, a saline purgative should first be taken early iu the morning, a dose of seidlitz-powder or rochelle-salts. If, after the action of the salts, diarrhoea does not abate, then let the sub nitrate of bismuth be taken in combination with prepared chalk, 20 grains of each, several times a day. If these fail, 5 grains of the corn pound ipecacuan powder should be added to the dose.
If irritation of the intestinal canal is sus pected to exist, purgative medicine should in variably be given first, ounce of epsom or glauber salts, or a dose of castor-oil. After the irritant may be supposed to be expelled, the bismuth and compound powder of iptcacuan should be used.
For nervous diarrhoea, and the type called lientery, some preparation of opium is proper. It must be given in small doses, drop doses, 1 to 5 drop doses of laudanum taken before food (but only to adults). In the nervous form, 10 to 15 drops of ether may be added to the laudanum. For summer diarrhea, which conies on usually with great rapidity and severity, the treatment consists in keeping the person quite quiet in bed, and iu the administration of such soothing drinks as may be expected to some extent to calm the irritated mucous membrane. Chicken broth seems to answer this purpose well, also iced water, rice-water, barley-water, flour and water. To the same end hot applications, a mustard poultice, a hot flannel sprinkled with turpentine, Sze., may be laid over the belly. Ipecacttan powder, and in large doses, 20 grains repeated every two or three hours, is strongly recommended. Stimulants are also required— the ether-and-ammonia stimulant being most useful. (See PRESCRIPTIONS — STIMULANTS.; One is strongly tempted to use opium. If ern ployed it must be with great care. The best way would be to add 5 drops of laudanum tc each dose of the ether mixture, and to watch how it acted. It could be repeated every twc hours if the patient bore it well, and the dose of laudanum even slightly increased if experi ence showed it proper in the individual or the chalk, catechu, and opium mixture may be given carefully. (See PRESCRIPTIONS—DIA• RHEA MIXT., p. 617, Vol. II.) The difficulties attending the treatment of summer diarrhoea are, however, so great, and the disease is so rapidly exhausting, that nc delay should be permitted in the summoning of a qualified physician. In all cases of chronic diarrhoea also the difficulties of obtaining a remedy are so great that medical advice should be sought so that the details of the particular case may be duly examined into.
It must be noted that nothing is here said about summer diarrhoea of infants, which it treated of under DISEASES OF CHILDREN. Ii is also necessary to note here that nothing it more dangerous than the administration of laudanum or opium in any form to children, A single drop of laudanum will often throw a child into a stupor for forty-eight hours.
Constipation, or costiveness, is that condi tion in which the ordinary passage of matters from the bowels is less frequent than is usual, or the quantities passed less in amount than usual. The common rule is that a person should go to stool once a day ; but this rule must not be indiscriminately applied. There
are plenty of exceptional cases, cases where persons regularly have only one passage in two or three days, with whom a greater frequence indicates something wrong, and who, with the less frequent passage, are in perfect health. With a few people, indeed, once a week is the rule, and there are even cases on record of per sons who for years had an interval of several weeks without going to stool, and that without any manifest impairment of the usual state of health. It would, consequently, be wrong to insist that everyone, without exception, should have a daily passage, to be effected by the use of medicine if it did not occur naturally. The question should always be asked : What is cus tomary? If a two or three days' interval has been the rule in the person's life, do not inter fere; if the two or three days' interval is a de parture from the usual, even though it be a departure which has lasted for some time, efforts should be made to restore what has been cus tomary. There may be various causes for costiveness. It has been seen (p. 239) that the various materials contained in the bowel are propelled along it by contractions of the mus cular walls. The contractions are of a remark able kind, not occurring in the whole tube at once, but passing along it in waves, one region contracting after another. The movement is called peristaltic, because it occurs in steps or stages. Now if this movement be very vigor ous tho food will be hurried along, will quickly reach the rectum, which may in turn as quickly expel it, so that looseness of the bowels is occa sioned. On the other hand, if the muscular walls have lost their tone the peristalsis will be feeble and the movement correspondingly slow. Further, as the materials move along, the nour ishing and watery parts are removed, and there fore the more slow the movement the more firm and compact will become what is left. In the large intestine the pouches in the wall (p. 199) will offer great difficulties to the advance of the faeces, and so extreme constipation results. It is also clear that, though the muscular contrac tion of the bowel be efficient enough, if there has been a scanty quantity of secretion from the liver, pancreas, and walls of the intestine, the alimentary materials may be too dry, and their advance will be delayed. Taus deficient secretion into the bowel, especially of bile, or want of tone in the muscular walls, in fact, sluggishness of the intestinal tract, may be the cause of costiveness. Now it is of the utmost consequence to observe that this sluggishness may be determined and developed directly by persons themselves. The feeling of a necessity to go to stool is an indication of peristaltic action occurring in the rectum in the endeavour to expel the material lodged there. If the in clination is resisted, the action, being ineffectual, becomes exhausted; and if this resistance is a daily occurrence the healthy tone of the bowel is lost, both because of the opposition it con tinually meets, and also because the matters, allowed to accumulate in the rectum and parts above it, distend unduly these parts, and over stretched structures always lose tone. Sluggish action of the bowels is also induced by want of exercise. Many articles of diet are constipating. Every man ought to know for himself what substances act thus on him; but an exclusively animal diet tends to costiveness, while a vege table diet is the reverse. Very dry feeding is also binding. There are also mechanical causes of constipation, such as are noted under OB STRUCTION OF THE BOWELS (p. 253).