This section is from the book "Materia Medica And Therapeutics Inorganic Substances", by Charles D. F. Phillips. Also available from Amazon: Materia medica and therapeutics.
Charcoal acts well in the diarrhoea of scrofulous children when the stools are small, slimy, and light-colored, with intermediate troublesome discharge of flatus and itching of the anus; also when the attacks have depended upon irritation of the mucous membrane from undigested food, etc. It may be well given with milk (cf. Medical Record, March, 1881). Rhubarb is often usefully combined with it in the cases described.
Charcoal is also serviceable in the atonic irritative diarrhoea of old people, but I have more than once known intestinal hemorrhage occur after its use. If large quantities be given, some may be retained and act as a mechanical irritant, so that the remedy is not so innocent as commonly thought.
The abdominal pain of acute diarrhoea is soothed by compresses, poultices, or warm bathing. In children some care is required as to the bath, for convulsions have occurred on placing a child suffering from diarrhoea in a bath at 98° F. This was most likely from an increase in body-temperature under the influence of external heat (Dr. Haddon: Practitioner, vol. viii.). The child ultimately recovered, but in such a case the cold sheet would probably answer better.
Cold applications are often more suitable than hot ones in choleraic diarrhoea (McKenna: Lancet, ii., 1876), and I agree with Messemer in the experience that cold water enemata act excellently as tonics and astringents in chronic cases. If slowly injected, they distend and keep apart the coats of the bowel, and thus save irritation (Medical Record, 1878). I have followed this practice for many years. Wenzel, an experienced naval surgeon, recommends injections of ice-cold water in dysentery, and has found recent acute cases subside quickly under this without other treatment. Fleury gives some remarkable illustrations of chronic dysentery and diarrhoea cured by the systematic use of the cold douche, one patient, aged forty, having previously used many medicinal remedies under able physicians. It is certainly a remedy to be remembered in obstinate cases.
Even in cholera the application of water, warm or cold, may be made highly serviceable. Trousseau wrote strongly in its favor when prejudice against it was greater than it is at present. The stage of collapse may be controlled by a hot mustard blanket-pack; but, as a rule, more permanent good will be obtained from cold applications. Niemeyer is an authority for recommending the pack with iced sheets in cholera (Lancet, ii., 1876, p. 346), and Dr. Chapman has offered evidence in favor of ice-bags to the spine.
In this complaint, hydrochloric is often preferred to other acids, not because it has a more energetic effect than, e.g., sulphuric acid, but because it is better borne by the stomach. It is most reliable in cases that are due to abnormal fermentation in the bowels, with formation of lactic acid, as in what is called summer diarrhoea and gastric catarrh of infants; there are, however, many other remedies for this condition which must be considered better than the acid.
1 Manassein showed that in dogs made anaemic by blood-letting, the normal proportion of acid and pepsine was altered, and in such animals an addition of artificial acid to the gastric juice is, ceteris paribus, more effective than in the healthy (Virchow's Archiv, lv., p. 451).
When the dejections are frequent, serous or "watery" in character, especially if markedly alkaline, and if there be no evidence of acute inflammation and not much pain, then nitric acid acts well, and in cases of profuse purging from summer heat, and in the diarrhoea of phthisis, it has a deserved repute: if necessary, it may be combined with a small quantity of opium. In dysenteric diarrhoea with tenesmus, blood, and profuse discharge of mucus, nitric acid acts well. Dr. Hope had reason to prefer the dilute nitrous to the nitric acid; he gave 15-min. doses, with laudanum and camphor water, in most forms of diarrhoea and chronic dysentery, with much success. Dr. H. C. Wood found it succeed in some cases where nitric acid had failed: it is, however, unstable, and requires to be recently prepared.
Phosphoric acid is suitable for cases of diarrhoea when an acid is indicated. Sedgwick strongly recommends it for choleraic cases, and argues for its use in true cholera (Lancet, ii., 1871, p. 280).
Dilute sulphuric acid has a well-deserved reputation in various forms of intestinal flux, and especially in summer diarrhoea of choleraic character: it often answers well, but when given alone I have sometimes found it aggravate the disorder, whether by irritation or by increasing the acidity of secretions: the aromatic sulphuric acid should then be preferred in combination with some preparation of opium.
In diarrhoea, with coated tongue and evidence of biliary disorder, the acid has acted admirably with small doses of magnes. sulph., tinct. rhei., and aqua chloroformi: it is a good remedy for children.
I have found alum very useful in infantile diarrhoea when arising from errors in diet, and attended with vomiting, acidity, and green stools: from 1 to 5 gr. may be given with syrup. Diarrhoea dependent upon relaxed conditions of mucous membrane is also cured by alum. Fouquier and others have praised it in enteric fever (Bulletin de Thera-peutique, ix., p. 301), but it is not easily taken, and it is liable to irritate, so that other remedies are usually to be preferred. Alumina, or argilla pura, is placed in the Austrian Pharmacopoeia as an antacid remedy for diarrhoea, especially in children, and is used like bismuth salts. Barthez recommends the single sulphate as preferable.
In irritative diarrhoea, with red tongue, nausea, heartburn, griping pain, worse after meals, and frequent ill-formed stools, I have found bismuth invaluable. In some persons, mostly women, such a condition becomes habitual, and even ordinary articles of diet may cause severe aggravation of symptoms; the constant use of this remedy, however, gives them the greatest relief, and enables them to take food with comparative comfort; much flatulence is often present, and sometimes the diarrhoea depends on irritation from the development of sulphuretted hydrogen (Chambers). Bismuth is then also very suitable, for it combines readily with that gas and absorbs it (Practitioner, 1869); sometimes charcoal, or aromatic chalk powder, or rhubarb, may be added with much advantage.
In simple cases, occurring in weakly children, and continuing after preventable causes have been removed, the vinum ferri is a mild but very useful astringent tonic, which is often sufficient both to stay the discharge, and to prevent its recurrence. In more serious cases of chronic mucous diarrhoea with slimy, bloody, offensive stools, and tenesmus, whether met with in adults or in children, the best preparation is the liquor ferri pernitratis, in doses of from 1 to 5 drops, as originally recommended by Neligan, and I have seen also much benefit from its use in the colliquative diarrhoea of phthisis. Dr. Graves specially advised it in the "nervous diarrhoea" which is liable to occur from emotional causes, and is more frequent in women: in cases with nausea and impaired appetite, calumba may be well added to the iron (British Medical Journal, ii., 1870; Dr. Cooke).
In intestinal irritation and diarrhoea dependent upon unwholesome food, and especially stone-fruit, sulphate of magnesia is a good evacuant, because it produces so little irritation. In cases of severe dysenteric diarrhoea from this cause I have often given drachm doses at intervals of six hours, for three or four doses, with the best results.
The chlorate of potash has been recommended in dysentery, and even in inflammatory diarrhoea (Amisy: Lancet, ii., 1872, p. 300). Marotti considers the acetate valuable in gastro-intestinal disorder connected with chronic catarrhal conditions and increased secretion of mucus in the alimentary canal, and marked by coated tongue and anorexia (Practitioner, vol. ii.), but I think we have more dependable remedies. I should rather avoid it in acute conditions of this kind, but in the form connected with advanced stages of chronic nerve-disorder and cachexia, or "vaso-paralytic" diarrhoea, its use is more indicated. The chlorate is an ingredient in the "saline treatment" of cholera.