Causes

Diarrhea is a symptom of several intestinal affections. Frequent, thin, stools, which characterize it, are due either to increased peristalsis, to excess of fluids in the intestines, or to both. Peristalsis is stimulated by irritating and undigested foods, such as spoiled or unripe fruits, and by chemical irritants, such as saline purgative waters, and toxic substances produced by putrefaction of food. Diarrhea is frequently caused by drinking too much water, fermented liquor, or other fluids, as is often the case with persons working in extreme heat. More commonly the excess of fluid is chiefly due to excess of secretion.

As a rule, irritating foods are rapidly expelled from the alimentary tract by diarrhea or by both diarrhea and vomiting. When this is not the case, it is best to provoke their prompt removal by laxatives, or irrigation, or both. If living ferments are the cause of chemical irritants, little or nothing is accomplished by any purgative except calomel, which possesses not only purgative, but also antiseptic, properties.

One must be careful to abstain from drinking water or other fluids too freely, especially in hot weather, or when work is done in a hot place. But during the first twenty-four or thirty-six hours of a diarrhea it is often best to give water and nothing else, and in small amounts, at short intervals, so that toxins generated in the stomach and intestinal canal and absorbed into the blood will be diluted. Water will help also to eliminate them faster by the kidneys. The administration of water only, while the intestines are being rapidly emptied of their contents, furnishes a very imperfect culture-medium for the micro-organisms that may have generated the toxins provocative of diarrhea.

Treatment

In acute attacks of considerable severity it is best to forbid all food for twenty-four or forty-eight hours, as it will undergo fermentation and thereby produce chemical irritants, or remain undigested and irritate stomach and bowels. During this period water only should be given, or a little barley-water, tapioca gruel, or egg-water.

The indications for dietetic treatment are to give such foods as will produce as little residue as possible, and to diminish fermentation in stomach and bowels. To accomplish this, after twenty-four or forty-eight hours of abstinence, broths may be given either with or without soft-boiled rice, tapioca, sago, or cracker-crumbs. It is of importance that only small portions be taken at a time, because the intestinal residue will thus be limited and because the organs have a diminished power of digesting and absorbing. At first, a few teaspoonfuls should be given each hour, then a half cup, and later, at longer intervals, a cup.

An exclusive milk diet is the best to start with, except in infancy or when it was the exclusive diet at the time of the onset of the trouble. Under the last condition, abstinence at first, and later a diet of egg-water and broth is best. When milk is not well borne, which happens sometimes with adults, broths must be substituted for it. If milk alone is used, it should be continued until all looseness of the bowels ceases. In some cases of diarrhea a change to a mixed and more generous diet must be made slowly. When it is safe to discontinue the milk diet, the following foods may gradually be substituted for it: Scraped meat, oysters, boiled rice with meat-juice, squab, breast of chicken, partridge, or quail, eggs, puree of peas, potatoes or beans, milk toast, macaroni, Zwieback, stale bread, weak tea, or cocoa.

So long as there is danger of relapse, foods that contain much cellulose, such as the green vegetables, should be forbidden, likewise preserves, fruit, game that is 'high,' cheese, fat meats, rich sauces and gravies, or very sweet foods.

In mild cases the dietetic restrictions need not be long maintained, and changes may be made more rapidly. When frequent vomiting accompanies the diarrhea, the case must at first be treated as one of acute gastritis, and foods must be selected as for that disease.