EEVIEW — TBOPICAL MEDICINE, ETC. 65 



2. The colour of the stool and its consistence. Faeces — 



3. The presence or absence of evidence of gaseous fermentation. continued 



4. The odour. 



5. The reaction, determined as soon as possible after the stool is passed. 



6. The bulk of the stools. 



7. Any visible signs of animal parasites, such as the worms themselves or the proglottides or segments of 

 tape-worms. 



8. Mucus alone, or streaked or mixed with the blood, usually indicates inflammatory action in the lower 

 bowel, not necessarily dysenteric. It may be caused by anything that sets up such inflammation, such as bilharzia, 

 ulcerated haemorrhoids, or chronic ulcerations of various kinds of the rectum. These latter include malignant 

 growths, granulomatous growths, and the ulceration left as a sequela of dysentery. Rarely, mucus derived from 

 the small intestines is passed with the faeces. Such mucus is recognised easily as it is stained with bile. 



Clear mucus, whether streaked with bright blood or not, without any admixture of faecal matter, is met with 

 in early or acute dysenteric attacks. Turbid or purulent mucus, sometimes in large quantities and passed either 

 without any stool or with solid-formed motions, is more indicative of a chronic ulceration of the rectum, from 

 whatever cause. 



Sometimes the mucus is passed in large masses and condensed, and may include much debris and numerous 

 epithelial cells. In the condition known as membranous colitis, complete casts, several inches in length, of the 

 rectum may be passed. These are usually twisted up when passed, and may be mistaken for worms. They can 

 sometimes be floated out in water, and in any case the microscopic structure should render any mistake impossible. 



With ulceration limited to the rectum, stools are often coated with mucus. The more intimately the mucus 

 and blood are mixed with the faeces the higher up are the lesions from which the mucus or blood is derived. In 

 some lesions the mucus is so intimately mixed with the fluid faeces that it is difficult to discern, but tilting the 

 vessel from side to side will often indicate its presence by the manner in which the stool flows. In some cases it 

 is better shown by adding water to the faeces, when the flakes or masses of mucus can be more readily seen, 

 especially if the diluted faeces are poured from one vessel to another. Amoebae are killed or have their motility 

 destroyed by this addition of water, and therefore this method should only be adopted when the masses cannot 

 be seen on inspection. 



Blood may be passed, bright red or in clots, in large quantities. This is no proof that it is passed from the 

 rectum, as if in sufficient quantity and not mixed with the faecal contents of the intestine it need undergo very 

 little change in passing thi-ough the large intestine. Such blood is occasionally passed in ankylostomiasis. If 

 intimately mixed with the faeces it may have lost completely the red colour and appear black and tarry — melaena. 



The consistence of the stool is of great importance, and it will be found that " looseness " of stools is of more 

 importance in tropical practice than in England. In ulceration of the caecum and upper part of the colon, even 

 when this is acute and extensive, there need be neither visible mucus nor blood, nor even tenesmus. " Tropical 

 diarrhoea, " is fi-eqnently shown at post-mortem examinations to be dysenteric. It is very fatal. On the other 

 hand, mucus and blood may be passed with formed or even hard stools when there are a few chronic ulcers high up 

 in the large intestine. 



In some forms of tropical diarrhoea, particularly that form known in the East as sprue, the stools passed are 

 full of air bubbles and are undergoing active gaseous fermentation. 



The odour varies so greatly with the diet that it is of minor importance. In the races subsisting mainly on a 

 scanty vegetable diet the odour is singularly slight. The smell is mainly due to indol and skatol. In cases of 

 dysentery associated with formation of sloughs the ordinary fscal odour is replaced by the peculiar penetrating 

 smell associated with that condition. Excessive decomposition of the stools may cause an increase in the intensity 

 of the normal smell, or if the diet is mainly of carbohj'drate food-stuff, no increase, but even a diminution. 



Variations in the odour indicate changes in the decomposition of the contents of the intestine, often from 

 variations in the food, but sometimes from variations in the "flora" of the intestinal contents, rarely from 

 structural lesions of the intestinal wall. 



The result of the administration of intestinal antiseptics is more often a diminution in the putrefactive 

 changes in the contents of the bowel than any real improvement in the diseased condition of the intestinal wall. 



The normal reaction of the faeces as determined by litmus is nearly neutral ; when fasting it is acid, with a 

 milk diet faintly alkaline. It is usually acid to phenolphthalein. In many cases of diarrhcea and dysentery this 

 is replaced by a decidedly alkaline reaction. To determine the reaction the faeces must be examined as soon as 

 they are passed, as a change rapidly occurs in most faeces, particularly when fluid, rendering them alkaline. Solid 

 motions must be rubbed up with water in a mortar. 



Indeed, the whole of this section is worth careful perusal. As regards parasites, the 

 method of straining through muslin or fine wire gauze is described, while a point of practical 

 importance in examining for ova in a watery stool is to remember that the eggs are heavier 

 than the fluid and sink to the bottom of the vessel, from which they can be obtained by a 

 pipette. 



Sandwith,> under "Ankylostomiasis" (page d) , notes that free moving larvae in fresh 

 faeces are never ankylostoma but are probably Strongylus stercoralis. 



1 Sandwith, P. M., " The Medical Diseases of Egypt," Part I., 1905. 



