572 AFFECTIONS OF THE INTESTINAL CANAL. 



owe their reputation as universal remedies to the great frequency of 

 this affection. 



Occasionally, however, chronic intestinal catarrh is accompanied by 

 increased secretion from the mucous membrane and accelerated peri- 

 staltic movement of the bowels, and then runs its course as chronic 

 diarrhoea. But in adults these cases are very rare ; hence, diarrhoea, 

 lasting a week or a month, must always excite the suspicion that there 

 are more severe lesions of the intestines, and we should not consider 

 simple catarrh as the cause of such cases till we have excluded other 

 lesions. In such cases the dejections consist of quantities of glairy or 

 puriform mucus, mixed sometimes with softened faeces, or sometimes 

 with undigested food, if the catarrh be very extensive (diarrhoea lien- 

 terica). If colorless masses of mucus or puriform fluids be passed at 

 some times, while at others hard scybola are evacuated, we may decide 

 that the lower part of the large intestine is the seat of the disease, 

 and that there is danger of the catarrh passing into follicular ulcera- 

 tion. Occasionally the diarrhoea ceases for a few days, giving place to 

 obstruction, and then begins again more severely. Sometimes patients 

 die of exhaustion from the chronic diarrhoea ; but then we usually find 

 some further disease or change in the intestines. 



The case is quite different in the chronic intestinal catarrh of chil- 

 dren. This almost always runs its course as an obstinate and exhaust- 

 ing diarrhoea, and we must be careful not too hastily to diagnosticate 

 tuberculosis of the intestines, or mesentery, or a catarrhal ulcer, from 

 this symptom. In the intestines of most children who die of chronic 

 diarrhoea, usually with the imperfect diagnosis of "marasmus," on 

 post-mortem examination, we find only the traces of a chronic catarrh, 

 which may readily escape notice. This disease most frequently occurs 

 toward the end of the first year, shortly after weaning (diarrhoea ab- 

 lactatorum). At first the evacuations are more mucous and less copious 

 than natural, have an acid reaction, and either immediately after being 

 passed, or after being exposed to the air for. a while, they have a 

 greenish color. This depends on the admixture of unchanged bile, 

 and on higher oxidation of the still retained coloring matter of the 

 bile. Subsequently the dejections are very copious, watery, occasion 

 ally clay-colored, fetid, and mixed with undigested food. The previ- 

 ously healthy, well-nourished child is at first but little affected by this 

 diarrhoea, but some fatal judgment often asserts it to be a safety-valve 

 that protects the child from convulsions during teething, and that 

 must not be stopped. Hence it often happens that the doctor is not 

 sailed till the child has become flabby and relaxed, and then it is fre- 

 quently difficult to master the disease ; the diarrhoea continues, the 

 child emaciates more and more ; and a large number of children die 



