2. Dyspeptic Diarrhoea

Under dyspeptic diarrhoea may be comprised (a) the diarrhoea which appears after certain articles of food; (b) diarrhoea accompanying abnormal conditions of the gastric contents.

(a) Certain foods may cause mushy or watery evacuations, as, for instance, fresh fruit, cucumbers, cabbage, and beets. The liability to diarrhoea from these foods, however, greatly varies in different persons. In some people milk produces diarrhoea, while in others it is rather constipating.

(6) Pronounced conditions of subacidity of the gastric contents and still oftener achylia gastrica are associated with diarrhoea. Here probably the chyme on account of its not having undergone any considerable changes in the stomach exerts mechanically too great a stimulus on the intestinal wall and thus causes the increased peristalsis. Hyperchlorhydria, although rarely, is also found associated with diarrhoea. Here the chyme containing too much acid most probably produces the increased peristalsis.

3. Stercoral Diarrhoea

Stercoral diarrhoea means a diarrhoea arising in consequence of too great a stimulus from fecal matter.

Etiology And Symptomatology

If healthy persons for some cause or other become constipated for a certain period of time, the constipation may be followed by diarrhoea. The latter is generally produced by the formation of certain gases which chemically or mechanically exert a stronger stimulus upon the intestinal peristalsis. Occasionally hard scybala, as such, irritate the mucous membrane of the bowel too much and cause increased secretion and peristalsis. In stercoral diarrhoea the evacuations are as a rule at first formed and solid, later mushy and watery. Off and on these watery passages contain several small scybala as hard as a stone. Shortly before the appearance of diarrhoea the abdomen is often quite bloated and borbo-rygmi are heard in the intestines. The patients very frequently complain of intense headaches. The passage of bad smelling flatus affords only temporary relief, while a good movement removes almost all the symptoms. Slight gastric symptoms may accompany this condition. A rational diet effectually arrests the diarrhoea, but after another period of constipation it may reappear, and if this happens very frequently, intestinal catarrh may be the result.

Diagnosis

The diagnosis of nervous diarrhoea can be made, if anatomical lesions of the intestines can be excluded and if the passages do not contain a considerable amount of mucus. The special type of the diarrhoea may be determined either by the symptoms (nervous diarrhoea proper, stercoral diarrhoea) or by an examination of the gastric contents (dyspeptic diarrhoea).

Prognosis

Most cases of nervous diarrhoea give a favorable prognosis. In some instances the diarrhoea, originally of a nervous origin, assumes a chronic course and ultimately produces an enteritis.

Treatment

The treatment will vary according to the type of the diarrhoea. In nervous diarrhoea proper the general condition of the patient must be strengthened and the remedies will have to be directed toward this end. Arsenic and iron will often prove efficient. In some cases the administration of bromides for a few weeks will be of great benefit.

In nervous diarrhoea dependent on a reflex action emanating from some other diseased organ, the treatment must be directed toward the primary affection.

In all cases of nervous diarrhoea, persistent training of the intestines in the normal direction must be urged by the physician. The patient should be instructed after having had his first movement in the morning to refrain from any other evacuations of the bowels during this day, answering nature's call only when absolutely necessary. In quite a number of instances the patient at first continues to have 19 the desire for an evacuation quite often, but succeeds in controlling it. Later on the desire for defecation appears less often and at last a normal state is reached.

In dyspeptic diarrhoea the treatment should be directed toward the improvement of the abnormal condition of the stomach. Thus diarrhoea due to hyperchlorhydria can be successfully checked by bicarbonate of sodium taken in half-teaspoonful or teaspoonful doses two hours after meals. The diarrhoea resulting from achylia gastrica can be remedied by a diet rich in vegetable foods, prepared in such a manner that they are easily broken up into minute particles. Stomachics, intragastric faradization, and generally the treatment of achylia gastrica will also control the diarrhoea.

In stercoral diarrhoea an efficient cathartic is the best means of checking the diarrhoea. Diarrhoea having its cause in a faulty composition of the blood should be remedied by improving the constitutional condition. If this is impossible the treatment must be symptomatic.

In this connection it may be advisable to describe the means we have at our command symptomatically to treat diarrhoea, no matter of what nature it may be. The first place must be given to opium, a remedy which has stood the test of ages and is still the most reliable. It efficiently decreases the abnormal peristalsis and probably also diminishes the intestinal secretion. Morphine and the other derivatives of opium act in a similar manner, but opium as such seems to be preferable in diarrhoeal conditions. Besides opium there is hardly another remedy efficiently to check increased intestinal peristalsis, although there are several others which may arrest the diarrhoea. Among these may be mentioned nitrate of silver, subnitrate and salicylate of bismuth, and all the remedies containing tannic acid. Another important means in treating diarrhoeal conditions is heat. A hot-water bag or warm linseed poultice applied over the abdomen and warm drinks have a favorable influence upon the diarrhoea.