HILL DIARRHCEA 351 



It may affect the whole body. 



Fever to 102° F. is usually present at some time during the attack. 

 Aching of muscles, bones and joints comes on early as a rule. 



Anaesthesia is not consistent and muscular paresis is rare. 



An eruption, erythema of the face and rubeola of the trunk and 

 limbs was seen in Mauritius but less so in Calcutta. It comes seven 

 days after the oedema appears and goes in ten to fourteen days. 



Cardiac dilatation with the concomitant symptoms was common in 

 Calcutta. Pleural and pericardiac effusions, oedema of the lungs with 

 their corresponding signs and symptoms were common in all but mild 

 cases. Anaemia, wasting and prostration was marked. 



DIAGNOSIS. 



See " Differences " in Beriberi, p. 349. 



TREATMENT. 



This is symptomatic. 



Diuretics, diaphoretics and saline purges to remove the fluid. 



Tapping may be necessary to relieve the lungs or the heart. 



For cardiac weakness, digitahs or strophanthus. 



For attacks of orthopncea, nitrites and trini trini. 



Iron and arsenic during convalescence. 



HILL DIARRHCEA. 

 DEFINITION. 



A gastro-intestinal catarrh occurring in high altitudes in the tropic s, 

 with liquid, pale, frothy morning stools. 



It is somewhat epidemic in the Indian Hill Stations. 



AETIOLOGY. 



Causation unknown. 



Perhaps it is an infection, because good sanitation and good water 

 diminishes its frequency. 



THEORIES. A diminished atmospheric pressure (Crombie). 

 Irritation by mica in the water (Duncan). 

 Fcccal contamination of water. 

 Exposure to cold. 



Functional digestive disturbance in the low temper- 

 atures of high altitudes (Bahr). 



PATHOLOGY. 



The mucous membrane of the stomach and bowels is congesttJ, 

 there is also a proliferation of lymphoid and fibrous tissue. 

 There is a thick layer of mucus but no ulceration. 

 The tongue is seldom affected. 



