DISEASES ATTENEDED WITH ALTERED SECRETION - It might very fairly be argued that many cases of which con stipation is a prominent symptom, and all of those attended with diarrhcea, should be classed under this division. Our object, how ever, is not pathological accuracy, but simplicity of arrangement, and we have now to do with cases in which either diarrhcea is continually alternating with oonstipation, or the evacuations ex hibit special characters which show that some form of' secretion is wanting or perverted.
§ 1. Disordered Bowe18.—This first subdivision must include by far the larger number of cases; we are yet far too ignorant of the special actions going on to attempt to classify them more accu rately, and the only reason for their enumeration is, that the ques tion of classification leads to investigating symptoms more closely, and thinking more clearly of the morbid actions and therefore tends to a more judicious selection of remedies.
a. In childhood we often find a condition of malnutrition and anaemia, with a ravenous appetite and unhealthy secretions, when the rectum is very generally loaded with ascarides : in such cases it used to be imagined that the worms were the cause of all the symptoms; it seems more probable that the true explanation is to be found in the faulty secretion of the canal affording a nisus for the development of the parasite. Whether the condition of the bowels be primary or secondary, it is of no importance to inquire, because it is invariably accompanied by symptoms of more general disorder, and these demand our attention and care quite as much as the local ailment. It is also quite a matter of accident whether there be diarrhoea or constipation at the time of examination, because, as a general rule, we shall find that neither -condition is persistent, but that the child has been subject to one or other for some time. The chief difficulty presented is the close analogy of such cases to those of mesenteric disease : so little is known of the scrofulous element that we can scarcely form any correct diagnosis until the dry shrivelled skin and prominent belly leave us in no doubt : and our prognosis must be always guarded when any symptoms of scrofula have been marked in the child's history.
b. In other cases the evacuations present appearances more or less definitely indicating the secretion that is at fault. Thus we have the "chopped spinach" appearance of the stools in infancy, their excessively dark color, or the opposite in adult life, each pointing out that the biliary secretion is that to which attention should be paid : in other instances, undigested aliment, mixed with feculent matter, shows that the gastrin juice is defective in quality, or insufficient in quantity : the lodgment of dark, offensive feces, again, which are got rid of by nature or art, from time to time, rather leads to the belief that the secretion in the bowels them selves is defective.
We must not forget in this enumeration, the frothy, yeast-like motions which are occasionally passed, and seem to show that fermentation has taken the place of intestinal digestion, just as we found the same circumstance, when occurring in the stomach, indicated by vomiting of a similar character. Nor must we omit that rare condition which has been, with some reason, attributed to disease of the pancreas—viz., the passage of fatty matter in a liquid state along with the feces, which floats on the surface of water, and consolidates with cold.
Much may undoubtedly be learned from an inspection of the stools; and no careful practitioner will omit it when treating_a case in which there is a pos sibility of disease of the abdominal viscera. In almost any of the cases just mentioned, the first complaint is very likely to be of a transient diarrhea, in consequence of the irritation which these matters excite ; or, passing by the repeated alternations of constipation, the patient may only speak of being subject to diarrheas, and, until the excreta be seen, we may be ignorant of his real state. It seems pretty certain that, when we find irregular action lasting for a considerable period, we may regard it as due to a fault in some of those secretions which serve to prepare the alimentary substances for the uses of the economy, and our chief object must be to detect and correct that fauli: in the majority of instances this can only be done by ascertaining the charac ter of the stools.