XVIII. Diseases of the Intestines.

Diarrhea.

Diarrhea is not a disease per se; it is but a symptom of disease. Its etiology is varied. It may arise from organic diseases, especially those of the heart, lungs and kidneys; it may occur during the course of infectious diseases, such as tuberculosis, syphilis, typhoid and typhus fever and influenza; from infections peculiar to the bowels, such as cholera and dysentery, or from ptomaine poisoning; or it may be secondary to infections of the mouth and stomach. It occurs from mechanical causes, as from gall-stones and enteroliths, or from intestinal parasites, such as tenia and ascarides. It also occurs from neoplasms and from diabetes. This condition is a manifestation of hysteria, occurring from sudden anger or great grief, or other conditions which induce sudden shock. It occurs during intense nervous strain, as with students before examination, or with physicians confronted with severe aspects of disease, or soldiers just before battle. There is a class of cases in which constipation is a cause of diarrhea.

Serous Diarrhea.

Definition:—Serous diarrhea is a condition in which the intestinal mucosa is hyperemic, and the serum of the blood is poured into the bowel, causing frequent watery evacuations.

Etiology:—Indiscretions in diet are the most frequent causes of serous diarrhea. Exposure to cold or wet will also cause it. Severe nervous strain in some persons invariably brings on an attack. Persons with chronic renal disease are seized from time to time with frequent watery evacuations, doubtless a vicarious function to relieve the insufficient kidneys.

Symptomatology:—The symptoms are almost entirely those of the large watery discharges. There is little or no febrile reaction, flatus or pain. If the condition persists, there is dizziness, anorexia, indisposition and weakness.

Diagnosis:—The diagnosis is made from the character of the discharges and the lack of evidences of an appreciable degree of enteritis.

Treatment:—There are certain conditions present in all diarrheas which will demand much the same treatment, whatever the cause. If deprived of food for a short time, varying from six to twenty-four hours, these patients will respond the more promptly to treatment. The bowels should be washed out with a large, hot colonic flush. In severe cases this should follow each bowel movement, until it has been repeated perhaps three times. The abdomen may be covered with a hot wet compress if any pain be present, and this should be kept hot. Occasionally the application of equal parts of turpentine and lard before the compress is applied will exercise a beneficial revulsive influence; in other cases a spice poultice is of service.

If undigested material is thought to be present in the bowels, especially in sthenic cases, with adults it is sometimes advisable to give a full dose of castor oil; in young infants the same result is obtained from the use of sweet oil, or in children the two oils may be combined. This will assist in the removal of the irritating substances, and the castor oil will exercise a mild, after-astringent influence which is beneficial.

The specific indications in nearly all of these cases point directly to the use of arsenite of copper. If the movements are large and watery, and are passed freely without tenesmus, or if, as is often the case in childhood, these free movements contain greenish particles and are passed with little, sharp, colicky pains, this agent is demanded. It can be depended upon if it is properly administered. A tablet containing the one-hundredth or the one-fiftieth of a grain should be dissolved in half a teacupful of hot water, and of this the patient should take a teaspoonful every ten minutes for from three to five hours, excluding everything else from the stomach during that period, unless perhaps a little water, or small pieces of ice. Afterwards a teaspoonful may be given, every hour or two for twenty-four hours longer. Where, in the subsequent treatment, there is debility with some intestinal irritation, an entire tablet of the one-hundredth of a grain may be given three or four times a day.

If the appearance of the tongue and mucosa of the mouth point to extreme acidity of the stomach, it is a good plan to begin the treatment with a large dose—from two to four drams, of the syrup of rhubarb and potassium compound. The comprehensive influence of this old-time preparation is sometimes more satisfactory than that of any other method. This dose may be given either in cold or hot water and sweetened to suit the taste.

In mild cases, where there is gastric acidity, the following prescription will sometimes be all that is needed: ℞ Fluid extract of geranium, five drams; tincture of capsicum, half of a dram; syrup of rhubarb and potassium compound, sufficient to make four ounces. Of this a teaspoonful may be given every hour or two. If pain be present or abdominal tenderness, two or three drams of the deodorized tincture of opium may be added to the above mixture. This course, while of service in most of the simple cases, cannot be called specific treatment, and yet it need not be discarded because of that fact.

Patients suffering from diarrhea in any form will obtain great benefit by a careful course of dieting for two or three days following the acute development of the attack. Dry toast, a dry cereal and hot milk, if the acidity of the stomach does not persist, will be the safest diet for this period. This can be carefully increased as the appetite returns.

The Eclectic Practice of Medicine with especial reference to the Treatment of Disease, 1910, was written by Finley Ellingwood, M.D.