It is purely arbitrary to diagnose an intestinal derangement as duodenitis, jejunitis, typhlitis, ileitis, colitis, or proctitis; for diarrhea--or, rather, its cause or causes--will not be confined to one particular section of the intestinal tract. Indeed, when there is a serious derangement of this organ, the entire tract is more or less involved. The derangement oftenest met with in civilized life is colitis. Yet this derangement is not absolutely confined to the colon; for, as a rule, the rectum is more or less involved, and, either directly or sympathetically, the small intestine plays its part. In established derangements of the large bowel there is almost invariably sympathetic derangement of the stomach; hence, to my mind, it is exceedingly foolish to separate the intestinal tract into special locations for the development of the derangement known as catarrhal diarrhea.

Etiology

First, last, and all the time, the most important cause of all diarrheacal derangements of the intestine is improper feeding or improper eating. Foods vary in their influence on the stomach and bowels. A persistent use of the laxative foods--such as prunes, figs, spinach, onions, mutton, lamb, and others which I might mention--will keep the bowels of those in normal health quite regular, while in those who have a sensitive state of the mucous membrane it develops a diarrheacal condition. Strange to say, there are more people who are inclined to constipation than to diarrhea, and foods that prove laxative to some will appear to produce constipation in others. Young children will be forced into a diarrheacal state by being overfed on milk. At first they are severely constipated, but the constipation eventually creates inflammation of the mucous membrane, and from this time on diarrhea supplants constipation, This is very largely true with grown people. Those who eat excessively will be troubled with constipation and bloating of the bowels. Constipation grows more confirmed from year to year, until a catarrhal state is set up in the large intestine. This we call colitis; when it extends to the rectum it is called proctitis. As the disease advances, the patient becomes more and more toxin-poisoned, and the catarrh becomes more intense. Local inflammations start up, on the order of appendicitis or typhlitis, with periodic diarrhea and constipation.

If the patient is not carried off by a typhlitic abscess or an appendiceal abscess, it will be because the abscess opens into the bowel. The real cause of this diarrhea is toxin poisoning and the irritation produced by the hardened fecal accumulations from constipation. The influence of polyuria in causing constipation must not be overlooked.

The exanthematous skin diseases, when there is a retrocession of the rash from the surface to the mucous membrane, may set up a diarrhea that is very intractable.

Such diseases as dysentery, cholera, typhoid fever, pyemia, septicemia, tuberculosis, etc., are often accompanied or followed by a state of catarrh of the intestine--colitis. This is according to the leading authorities. I should like, however, to put in a few words of explanation. When those diseases leave in their wake a catarrhal diarrhea, it is more often due to the treatment than to the natural evolution of the disease. In the first place, dysentery cannot end in anything but health, unless it is maltreated. This is true of all the other diseases named above; hence all the causes that are listed as inclined to produce catarrhal diarrhea will fall short of any such effect if they are treated in the most simple, but the most effective manner-namely, by removing their causes.

Treatment

When a diarrhea begins, what is the probable cause? Indigestion. What causes indigestion? Improper combinations of food, on the one hand; on the other hand, nerve exhaustion. Those who eat when tired--when pronouncedly enervated--do not have the power to take care of food; but if they eat heartily under such circumstances, fermentation is set up instead of digestion. In other words, the system, on account of being enervated, does not furnish enough digestive fluid to finish physiological fermentation; hence, as germs are always present, pathological fermentation is set up, resulting in diarrhea.

If the condition is understood and properly treated, the attack will end as soon as the gastro-intestinal canal is emptied of its contents. The diarrhea washes the offending material out of the bowels. If no food is taken, and the efforts of nature are seconded by copious enemas of hot water within twenty-four to forty-eight hours the intestinal canal will be cleaned out; and if proper rest--bodily rest and rest from food--is given, after all symptoms have passed away--say twenty-four hours with no nourishment except hot water--the disease will end, never to return unless some imprudence in eating is practiced. If, however, this disease is met with opiates to relieve pain, locking up the decomposition in the intestine, producing a sluggish state of the liver, locking up secretions and excretions, and the patient is fed for the purpose of keeping up. his strength, instead of the case being entirely free of disease within seventy-two hours, those hours will be spent in laying the foundation for chronic diarrhea; for be it known that, if eating is continued before there has been a reestablishment of normal secretions and excretions, digestion will be imperfect and diarrhea will continue.