IV. Natural Recovery

Diarrhoea is a striking instance of the first method of natural recovery-by removal of the cause. By this means not only is the bowel purged of irritant matters, but constipation may be naturally relieved by a spontaneous diarrhoea produced by the irritant effect of the retained faeces. Both diarrhoea and constipation, if left entirely to themselves, may spontaneously cease, and the normal action of the bowels return. Therapeutical assistance is, however, constantly valuable, and frequently essential. Thus the diarrhoea of infants may quickly end in fatal exhaustion, and atony of the gut may be the result of neglected constipation.

V. Therapeutics

1. Excessive Intestinal Activity; Treatment Of Diarrhoea

Excessive Intestinal Activity; Treatment Of Diarrhoea. The treatment of diarrhoea should begin, if possible, with the removal of its cause. If this is being accomplished by the bowel itself, we must encourage intestinal activity for a time by such purgatives as Castor Oil, Rhubarb, Calomel, Magnesia, and Senna. The first two drugs are specially valuable, as they also possess an astringent action, which comes into force after the purgation. On the same principle, diarrhoea from hepatic or renal disorder or disease, is rationally treated by noninterference or even by a judicious increase of elimination by the bowel, hepatic and renal stimulants being also combined; that is, by the use of a purgative which is partly cholagogue, followed by a diuretic-a mercurial pill supplemented by a Seidlitz powder. Again, diarrhoea due to acidity in the duodenum is rationally treated by an alkali or alkaline earth, such as Lime-water, Chalk, and Bicarbonate of Soda-a highly successful method in the intestinal dyspepsia of infants. If the cause cannot he removed, its effects may he physically prevented by coating the surface of the bowel with Bismuth.

To counteract the irritant influence, astringent measures must be employed; and the two kinds of astringents in general use for this purpose are the constringents and the nervo-muscular intestinal sedatives. Of the former, Tannic Acid is less often used than its allies, between which there is little to choose, such as Catechu, Kino, and Krameria. With the constringent there is usually combined some preparation of opium as a nervo-muscular sedative, in the form of Dover's Powder, Kino, and Opium, or Compound Opium Powder, which relieve pain, diminish the peristaltic movements, check the secretions, and arrest tha cramps or tormina. It will be found desirable in almost every case of diarrhoea demanding immediate arrest, to combine a certain amount of opium, however small, with the other drugs. We are now in a position to understand the use of the intestinal vascular astringents: Lead, Silver, and Diluted Sulphuric Acid. These are specially indicated in inflammatory conditions of the bowel, such as accompany ulceration in typhoid fever, dysentery, and tuberculosis. Diluted Sulphuric Acid is given when the effect is intended to be speedy and brief. A small quantity of Opium or Morphia is again a powerful adjuvant; for instance, as the Lead and Opium Pill, Diluted Sulphuric Acid and Laudanum, and Dilute Acetic Acid, Acetate of Lead, and Acetate of Morphia combined. In certain cases these remedies may be administered in an enema, the Enema Opii being particularly valuable. Coto Bark is successful in some cases of persistent tubercular diarrhoea. Nervous diarrhoea may be relieved by Bromide of Potassium. Some forms of chronic diarrhoea, and the flux of uraemia (when it can be safely checked), are best treated with Persalts of Iron.

The food is to be ordered in diarrhoea with a view to prevent irritation, and thus contribute to the cure; and dieting must be regarded as of equal importance with the medicinal treatment. The food must be entirely fluid, as a rule, and will consist chiefly of broths and milk. The former must be carefully prepared, without fat or seasoning, and given cold. The milk must be in a form which will not yield a large indigestible curd-itself a source of intestinal derangement, but given with effervescing alkaline waters, or lime-water, or boiled and mixed with some kind of starch, such as arrowroot or rice. Eggs must be used with caution. Ice is the best means of relieving 2C-8 thirst, or sips of toast-water; draughts of all kinds must he avoided. Stimulants may he required by the aged, by infants, and in all cases of protracted diarrhoea, brandy and port wine being the most suitable forms.

2. Deficient Intestinal Action: The Use of Purgatives.-The treatment of constipation consists chiefly in careful regulation of the diet, which should include fruits, green vegetables, meats, and "whole" brown bread, whilst milk and strong tea are to be avoided. As a rule, however, its chronic "habitual" form calls for active interference.

In the treatment of constipation, the cause must first be removed if it can be discovered. The diet, digestion, and liver must be regulated, and sufficient muscular exercise, mental relaxation, and other hygienic provisions ensured.

Habitual constipation being generally referable to torpidity of the muscular coat, will be rationally treated by the administration of nervo-muscular stimulants. But these must be preceded by a free evacuation, since the tone of the intestinal wall cannot be restored until over-distension has been removed. For this purpose a more powerful purgative must be given at first, such as Colocynth and Blue Pill, followed by a saline, to thoroughly empty the gut; and this practice will be repeated with advantage every few weeks for a time. A regular course of aperient medicine may then be commenced. There is considerable choice of drugs which increase peristalsis, the best for habitual use being Aloes, Senna, Rhamnus Prangula, and Cascara Sagrada. Nux vomica (strychnia) is often added, in cases where the muscular tone has been lost by protracted overdistension; and Belladonna is a valuable adjuvant of Aloes in particular cases. Rhubarb, which is a popular aperient, is apt to produce further constipation.