Pathological Physiology

Diarrhoea is commonly the result of excessive peristalsis. It may also be occasioned by the presence of a large volume of fluid in the intestine, caused either by lack of absorption of an excess of liquid ingested, or oftener by hypersecretion or failure to absorb the fluid of the chyme.

The exaggerated peristalsis is occasioned -

1. By increased irritation of the nerves or muscles of the intestine, due to mechanical stimulation of irritant or undigested particles of food (e. g., the seeds of berries or husk of corn grains).

2. By chemical products which are contained in the food.

3. By abnormal fermentation, the products of which excite muscular contractions. There are many dietetic causes of diarrhoea. It may be produced by fermented or putrefactive food, by improper food mixtures, by food which is too coarse, bulky, and irritating, or by monotony of diet. The excessive use of meat extracts or " peptones" is liable to cause it. In the tropics, as shown among the troops employed in Cuba and Porto Rico in the Spanish-American war, it may originate from a salt-pork ration, the consumption of too much meat, canned dried beans ("baked beans "). In the tropics and in hot weather, generally, catarrhal enteritis is easily excited, and animal food soon spoils if exposed to the heat and air.

Diarrhoea may be (a) acute, due to temporary errors in diet, "taking cold," causing acute intestinal catarrh, the ingestion of poisons, overdoses of aperients, etc., or (b) chronic, complicating some intestinal or other malady.

Acute diarrhoea often subsides of itself if food be withheld until the irritant matter has passed off from the intestine.

Chronic diarrhoea of long standing requires great care and patience in treatment.

Abundant greenish fluid stools showing much bile pigment indicate that the stools have been hurried out of the small intestine before digestion was complete.

Of the many forms of diarrhœal diseases, the treatment of those only which are most influenced by diet will be discussed in the succeeding pages. There are a few propositions which have general application to the different varieties, which will be mentioned here.

Dietetic Treatment

It is a general rule to moderate the quantity of food and avoid all food likely to undergo abnormal fermentation (such as sugars), or having a considerable residue. Unirritating or bland substances only should be taken. Fruits and vegetables must be wholly interdicted.

At the commencement of an acute attack food may be withheld for ten or twelve hours, and a little barley water or arrowroot gruel flavoured with a mere taste of lemon or spice should then be ordered with one or two tablespoonfuls of brandy in soda water. Mutton or chicken broth may next be given, and, if desirable, it may be thickened with boiled rice, tapioca, sago, or cracker crumbs. Patients who are not at the same time "bilious" or vomiting may take milk diluted with one third lime water.

The return to ordinary diet should be in all cases gradual, and such articles as milk toast, oysters, well-cooked macaroni, boiled rice with beefsteak gravy, the breast of boiled chicken, or a little partridge in season, with baked and mashed potatoes, may be first allowed.

Loose stools sometimes occur immediately after meals, the impulse for the bowels to move coming so suddenly that the patient scarcely has time to leave the table for the closet. In such cases "some one article of diet is at fault" (Osier). The patient should be put upon a diet restricted mainly to meat and stale bread or toast for a few days, and made to lie down and rest immediately after meals. Taking food into the stomach excites a reflex intestinal peristalsis, and the intestinal contents are hurried onward before they can be digested.

For the form of diarrhoea which occurs in hysterical women, if a milk diet is not well borne, Osier recommends feeding the patient upon egg albumin exclusively while medicinal antispasmodics are given to diminish peristalsis.

In diarrhoeas demulcent and mucilaginous drinks are useful, and they are believed to coat the alimentary canal and protect it from local irritation. It is doubtful, however, whether any such action occurs beyond the stomach.