Diarrhea is a common symptom of many rectal and intestinal diseases. It almost always accompanies stricture, carcinoma, ulceration, adenoidal, prolapse, insusceptible and the acute and chronic hypertrophy catarrh inflammations of the colon, sigmoid and rectum. The specific inflammations of the intestine, dysentery, erysipelas, diphtheria, ulceration colitis, follicular colitis and secondary membranous colitis are manifested by this symptom.

A diarrhea may be represented by a single liquid movement each day or, in the presence of an ulceration colitis, by an AL-most constant evacuation. The disease may be regularly periodic, dependent upon a constant pathological condition with exacerbation.

Pain may accompany diarrhea due either to a lesion in the intestine irritated by the secretions or excited by rapid peristalsis.

Rectal tenements is most frequently caused by diarrhea -the result of the frequent irritating discharges, noticeably more Severe immediately after the bowels have been evacuated. Diarrhea with temperature may indicate typhoid fever, malaria or the specific diseases of the colon. Nervous diarrhea may have its cause outside of the intestine, as the result of shock or a sudden chilling of the body. In others, it is brought about by some definite condition which produces nervousness. This type of diarrhea is often a symptom of neurasthenia or hysteria. There is probably an over-secretion from the intestinal mucosa, due to a hypersensitive nervous system. This diarrhea is characterized by several water movements which occur suddenly under excitement or fatigue, and as quickly stops after the removal of the cause.

Elimination Diarrhea is the term given to a type of diarrhea which cannot be classified with the intestinal diseases nor with those due to nervous influences. Its exact etiology is not clearly understood, but it is recognized as distinctive when accompanying uremia and some of the acute infectious diseases. It seems to be due to the toxins produced in the system as a result of the primary disease. The diagnosis must be made by considering the complicating disease, particularly its severity, and then arriving at a possible solution by elimination of other causes.

Fat Diarrhea is simply a form, or evidence, of weak, fat-digesting powers. It is indicated by the presence of large amounts of undigested fat in the stools.

Vomiting with Obstinate Constipation, when occurring within the first forty-eight hours, would indicate the presence of an intestinal obstruction due to a malformation of the rectum, anus or colon. Congenital deformities may' occur at any point in the intestinal canal, but are most common in the rectum. Vomiting at this early period of life may also be due to a specific duodenal ulcer.

Rectal Pain may vary from a slight discomfort to the most intense suffering, and may be constant or periodic. It may be described as covering a large portion of the rectal region, either externally or internally, suggesting the involvement of some adjacent organ. The pain from fissure and abscess, in almost every instance, excites the spasmodic contraction of the sphincter muscles and originates a train of symptoms greatly out of proportion to the gravity of the disease.

The fascinating, dull, throbbing, or heavy pain accompanying an acute catarrh proctorial is so characteristic of that affection that a diagnosis is easily suggested.

The pain of fecal impaction, due to an obstruction, is usually referred to the sacral region higher up than the ordinary affections and is nearly always of a dull, aching character, constant whether the patient is walking about or lying down.

Pain is much more severe at the much-cutaneous junction, and progressively becomes less pronounced in affections higher up in the rectum. The patient will complain more from the presence of a fissure at the anal orifice than from the ravage and destruction of a malignant growth higher up in the rectum. The excruciating pain causing tenements points to some affection of the anal ring, while the dull, constant boring, aching, pain indicates the involvement of the rectum. Pain coming on immediately after stool is almost a positive sign of the presence of a fissure from the stretching or bruising of the ulcerated surface by the fecal mass. When due to an extensive ulceration, blood and pus are often present in the discharge, and the patient is likely to have fever and looseness of the bowels.

Pain in the back portion of the abdomen and pain affecting the sciatic nerve of the left side is always suggestive of an infiltration from a long-standing rectal growth into the adjacent tissue.

Hemorrhage. Bleeding from the rectum is a very frequent symptom of rectal diseases. It may be slight, coming directly from a protruding hemorrhoid or the ulcerated surface of a fissure, while in other instances it will be profuse and dangerous to the life of the patient. Profuse hemorrhage seldom occurs with diseased conditions, and when post-operative is almost exclusively the accompaniment of the surgical treatment.

Blood-streaked mucus or fecal matter indicates a catarrh condition, malignant growth, polyp or adenoidal, higher up in the alimentary canal while the sudden spurt or steady stream of blood after coughing, sneezing or straining usually indicates an abrasion or rupture of the arterial or venous plexus in or above the anal canal. Typhoid fever, yellow fever and malaria, anemia, purport, scorbutic and heart diseases may be accompanied with loss of blood from the rectum. Blood from the stomach or small intestine is incorporated with the digestive residue, while blood from the lower portion of the alimentary canal is often expelled, independent of the fecal mass, in the form of slight or severe hemorrhage. Bleeding in the majority of cases may be associated with internal hemorrhoids, and is probably next frequent with fissure in anew.

Protrusion ordinarily indicates the presence of hemorrhoids, but it may be caused by a polyps, malignant growth, prolapse or a foreign body. Ordinarily protrusion does not take place in any of these diseased conditions without straining, or a prolapse of the adjacent organs, and may be regarded as a symptom of little value which only affords the visual aspect and a convenience in making a digital examination.

Inflammation with or without the formation of pus may be a symptom of infection, or injury to the rectal mucous membrane or the per-rectal tissue. It may be secondary to some irritant swallowed with food, as a fish bone, which might later lodge in the rectum. The passage of hard feces, the ingestion of irritating purgatives or the use of frequent enema ta may inflame the mucous membrane and cause acute catarrh proctorial. Kicks, blows, ulcerations and surgical operations in this region may result in infection and abscess formation.

Auto-Intoxication is an almost constant symptom of all the chronic intestinal diseases and constipation. Bacteria or their toxins are either absorbed through the diseased mucous membrane or they enter through the blood vessels. Their mode of entrance and the effect upon the nervous system is not well understood.

Discharge of Blood, pus or mucus from the rectum should always suggest an examination. The finger or the proctorial may be used. Blood may be due to fissure, hemorrhoids, polyp, cancer or ulceration. Pus suggests broken down tissue from ulceration, due to malignant or non-malignant growths, colitis, abscess, fistula, or fissure. The odor of bloodstained malignant disease discharges is characteristic of the disease. Mucus may indicate chronic strophic or hypertrophy colitis, sigmoid or proctorial.

Altered Stools. When the normal form and color is changed there may be stricture, from many causes, producing the hard, narrow, tape-like stool, with symptoms of fecal mi-caption. Fluid stools indicate irritation and quickened peristalsis from a number of colonic affections.

Frequent and Painful Urination is often due to fissure in anew, particularly when located in the anterior median commissary. Fissure in anew is commonly overlooked in children as a cause of these symptoms. Rectal disease located low down usually cause reflex irritation of the bladder.