II. The ordinary, in which food too abundant in quantity or unsuitable in quality occasions diarrhoea has already been explained under the head of Ingestion. In many of its forms at least, diarrhoea itself is little other than a symptom or consequence of intestinal indigestion. And of course those external accidents of food of profuse in quantity, or disagreeable in quality, but serve to aggravate the pre-existing disposition to diarrhoea, arising from the before-mentioned internal or constitutional conditions.
III. As to the third as class of diarrhoea, that dependent upon climatic or atmospheric conditions, it will be sufficient to recall the immense proportion of cases of this disorder which occur in particular seasons, in order to realize how largely even young infants are subject to such influences. Thus, on a comparison of the results of eight years’ observation at the Children’s Infirmary, in London, Dr. West found that in the six winter months, from November to April, inclusive, diarrhoea, formed seventeen and three-tenths per cent. of all the cases of diseases; while in the six summer months, from May to October, inclusive, diarrhoea formed thirty-eight and three-tenths per cent. of the cases of disease. ( West on Diseases of Children, Phila, 1866, p. 508.) Exposure to the night air will often occasion an attack of diarrhoea in young infants. And the dysentery, or actual inflammation of the bowels, so notably depends upon certain conditions of the weather, either magnetic or atmospheric, that when they recur, especially in the autumn, this disorder prevails as an epidemic throughout the whole district.
Symptoms. The different appearance of the stools, in diarrhoea, deserve careful attention, since in many instance they greatly aid in the selection of the appropriate remedy. Thus at the onset of the disorder the discharge are at first purely fecal; presently they may assume a bright-yellow color, like that of the yolk of an egg; often they are intermixed with slime; and in other cases they present a frothy appearance. Under exposure to the air, the bright-yellow color of the evacuations often though by no means always changes to green. In other cases the green and yellow colors appear intermingled in the evacuations; while the present of the small white specks, the caseine of the undigested milk, shows that the function of the stomach is disturbed by the same cause that produces the over action of the bowels. From the admixture of the white and yellow, in these cases the stools have the appearance of chopped up eggs. As the disorder r advances, the stools become more frequent and they are attended with much more distress, each motion being evidently preceded or accompanied by griping or other pains. The symptoms of simple diarrhoea are, however, very variable in their character as well as in their intensity. Sometimes there is much suffering; sometimes very little, even in severe cases. In many instances the child does not seem, for a while at least, to be much weakened by the disorder; in others it very rapidly runs down. But these latter are rather cases of the severe or inflammatory form of diarrhoea, in to which the simple variety is very often apt to run if continued more than a few days.
In the inflammatory diarrhoea, so called, we find all the symptoms of true inflammation of the bowels and sometimes also of the stomach, in different degrees of violence; there are fever, thirst, tenesmus, colic; abdominal tenderness and heat; frequent, painful, slimy, bloody or even offensive discharges; great and rapidly increasing exhaustion; and evident tendency to hydrocephaloid, coma, or convulsions. Either the severity of the pain and fever, the putridity of the stools, or the occurrence of tympanitis, will indicate very great danger. When the attack comes on suddenly, it often commences with vomiting, and sometimes the irritability of the stomach becomes and continues so extreme that the least drop of fluid is immediately rejected; and frequent and distressing efforts to vomit occur when the stomach is entirely empty. Almost simultaneously with the vomiting occurs the relaxation of the bowels; and the child may have twenty or thirty, or even more evacuations in the course of twenty-four hours. These may be slimy and streaked with blood, or greenish and watery; or serous; or they may consist of intestinal mucus intermixed with feces and more or less streaked with blood. Where the stools are scanty there is usually much tenesmus followed by the discharge of a little or a few drops of blood. With all these severe local symptoms the constitutional disorder is no less distressing; the pulse is quick, the skin hot and dry; and the child is either fretful and irritable when disturbed, or lies sleeping, apparently, with half-open eyes. The tongue at first is moist, coated slightly with mucous fur; its papillae are often of a bright red, as are also its tips and edges, while if the disease continues the redness becomes more general, and the tongue grows dry, though it is not often much coated. The thirst is generally intense, the child craving for cold water and crying out for more the moment the cup is taken from its lips, and the thirst is quite as urgent even in those case where the stomach is so irritable that it immediately rejects whatever is swallowed. West.
Aconite. The skin is hot and dry; restlessness and much excitability; stools watery and often of a dark color. After the fever has subsided, we have but to wait and the diarrhoea will also disappear without the use of another remedy.
Antimonium c. White-coated tongue, some nausea, and watery evacuations; sometimes hard lumps of feces with the water.
Argentum nit. Much loud flatus passing with the water.
Arsenicum. Much exhaustion and rapid emaciation, stools undigested; offensive and painful stools immediately after taking nourishment. Stool and vomiting at the same time.
Belladonna. The child is very drowsy, half sleeping, and half waking; much moaning.
Bryonia. Diarrhoea from hot weather; or it is aggravated by the return of every hot spell of weather.
Calcarea c. In children who have large head and open fontanelles. The head perspires much, so as to wet the pillow far around. Muscles soft and flabby. The child awakens at three A.M.
Carbo veget. If Bryonia does not cure under these circumstances.
Chamomilla. Stools watery or greenish; or like eggs beaten up. The child must be carried; it is very feverish and cross. The stool has the odor of rotten eggs.
China. Painless and undigested, putrid stool; very copious stool, worse every other day.
Colocynth. The passages are small and frequent, with very much pain, causing the child to writhe and twist, as if in great distress, and to draw itself double.
Croton. t. Colic and diarrhoea immediately after nursing. The stool escapes suddenly, as if with an expulsive spasm.
Dulcamara. Every cool change of the weather excites the diarrhoea; it is excited also by exposure in cold, damp places.
Ferrum. Undigested stools, with easy vomiting of ingesta, often with a very red face.
Graphites. Very frequent and small stools, with eruptions on the skin, from which oozes a gelatinous fluid. The stool is often sour and excoriates the external anus.
Hepar. Fetid stool, the child itself smelling sour.
Ipecacuanha. Much nausea or vomiting; almost constant nausea. Fermented stools, particularly indicated at the period of weaning when food disagrees.
Lachesis. Excessively offensive stools; the child always awakens in distress.
Magnesia c. Stools resembling the scum of frog-pond. Stools green and slimy, or watery and sour.
Mercurius sol. Much pain before the stool; great relief immediately after. Stools frothy, slimy, bloody, or dark-green, with much straining. The child’s thighs and legs are cold and clammy, particularly at night.
Nux v. Alternate constipation and diarrhoea. Indigestible food has been the cause of the diarrhoea; the passages are small and frequent and painful; much fretfulness. Worse at four A.M.
Opium. Diarrhoea from fright.
Phosphoric acid. The diarrhoea does not seem to debilitate much, although of long continuance, and the mother wonders that the child remains so strong with it all.
Podophyllum p. Morning diarrhoea, green or watery; or the stools may be quite natural, only too frequent. Prolapsus ani and diarrhoea.
Pulsatilla. The stools are very changeable, no two alike; much worse at night.
Rheum. Very sour-smelling stools, attended with much pain. Very sour smell of the child, which cannot be removed by any amount of washing and care in keeping it clean.
Rhus t. Worse particularly after twelve at night; very restless after that hour.
Sepia. There is an almost constant oozing from the bowels.
Sulphur. Particularly in children of delicate parents. Much redness around the anus; or excoriation between the thighs, and upon the parts adjacent. Eruption of pimples upon the skin; or if the child after getting better under other remedies, always gets worse again.
