157 
PATHOLOGY. 
The feveral exciting caufes of diarrhoea may be referred 
to two different clafl'es. The firfl: comprifes diforders of 
certain parts of the body, which, either from a fympathy 
of the inteftines with thefe parts, or from their connec¬ 
tion with the fyftem at large, occafion an increafed attion 
of the inteftines, without the transference of any ftimu- 
lant matter from the primary difeafed part to them. 
Thus, the general fympathy of the inteftines is often ma- 
nifefted in perfons under the influence of certain paffions 
of the mind, as anger, fear, and fome others, which oc- 
cafionally excite a diarrhoea. And among the difeafes of 
other parts of the body, which aftett the inteftines, the ir¬ 
ritation of dentition, in infants, may be mentioned as a fa¬ 
miliar illuftration, as it is feldom difficult and painful 
without occafioning diarrhoea. The fympathy between 
the (kin and the bowels is particularly great in many in¬ 
dividuals, fo that a chill, or the application of cold and 
moifture, efpecially to the feet, will generally excite a 
diarrhoea : and the fame fympathy is (ltown in others by 
the occurrence of diarrhoea from the fuppreffion of cuta¬ 
neous eruptions, or the flopping of profufe or habitual 
difcharges from fores, &c. 
The fecond clafs of occafional caufes of the increafed 
a&ion of the inteftines, confifts of the ftimuli which are 
applied dire&ly to the inteftines themfelves : and thefe are 
of various kinds. They may be fubftances introduced 
by the mouth, as indigeftible aliment, purges, &c. or 
poured into the inteftines by the feveral excretories open¬ 
ing into them, as the fecretions of the liver, &c. 
Diarrhoea, when it occurs in fevers, is often a very un¬ 
manageable and dangerous fymptom. After the meafles 
it is often falutary ; but in many inftances it has proved 
more fatal than the difeafe itfelf, as is faid to have been 
the cafe in the fatal epidemic meafles in the ifland of St. 
Helena in the year 1807. Diarrhoea is one of the moil 
common diforders attendant on difficult dentition in 
children : in fatt, almoft every irritation which excites 
feverilhnefs in young children, is apt to occafion it. It 
is likewife a fymptom of the prefence of worms in the in¬ 
teftines. In the laft ltage of pulmonary conl'umption, a 
colliquative diarrhoea, which is liable to alternate with 
the colliquative fweats, is an almoft univerfal occur¬ 
rence. 
The leading indications of the cure of diarrhoea will 
turn upon one or other of the following circutnftances. 
Whether it appear to a rife from, 1. a morbid irritability 
of the inteftines ; a. a preternatural ftimulus applied to 
them ; or, 3. a combination of thefe two. The firfl: in¬ 
dication will require the irritability to be allayed ; the fe¬ 
cond, that the offending matter be expelled, or its acri¬ 
mony corrected ; and the third will demand a mixed plan, 
confiding of the other two, either jointly or alternately, 
together with an attention to the ftate of other func¬ 
tions and organs, which may affeft that of the prima via. 
The means adapted to fulfil the JirJl indication, or to 
allay the morbid irritability of the inteftines, will confift 
in the adminiftration of opiates. In moft of the forms 
of diarrhoea, fmall dofes of rhubarb are a good altrin- 
gent. In the cafes of D. mucofa or D. lienteria, efpecially 
when it has arifen from acrid purgation, conftituting a 
hypercatharfis, and in all inftances of colliquative diar¬ 
rhoea, the adminiftration of opiates is particularly requifite. 
The vicarious difeharge muft be folicited to the (kin by 
warm bathing and fudorifics; and, if difofganization is 
threatened, the ufe of calomel, as in dyfentery, muft be 
reforted to. 
The means adapted to fulfil the fecond indication, of 
removing a preternatural ftimulus from the inteftines, 
confift in the adminiftration of evacuants, or correctors 
of acrimony. Hence the ufe of emetics, of purgatives, 
of clylters, with the one view; and of mucilaginous di¬ 
luents, alkalies, and abforbents, with the other. 
The acrimony, which excites diarrhoea, efpecially in 
children, is moft commonly of an acid nature, and is ge¬ 
nerated in the ftomach during the impferfed digeftion of 
the food. Alkaline andabforbent medicines tend to neu¬ 
tralize it, and therefore to remove the irritation of this 
acrimonious caufe of diarrhoea. Cordials and ftimu- 
lants alfo are ufeful auxiliaries in removing fuch a di¬ 
arrhoea. 
When the third indication occurs ; when there is, at 
the fame time, a morbid irritability of the inteftines, and 
an unufual ftimulus applied to them, the latter muft be 
removed or corrected, where that is practicable, by eva¬ 
cuants or other means, and the irritability moderated. 
Abforbents, fuch as preparations of chalk, teftaceous 
powders, lime-water taken with milk, See. will tend to 
correCt any acid acrimony that may be formed in the ca¬ 
nal ; while gentle laxatives may be combined with them, 
fuch as rhubarb. Thefe are principally indicated in cafes of 
chronic diarrhoea, and in debilitated habits. A determina¬ 
tion of the fluids to the (kin, by diaphoretics, by warm¬ 
bathing, by reftoring fupprefled difcharges, or fubftitut- 
ing fuch as may be equivalent, by warm clothing, friction, 
and the exercifeof geftation, will aid in fulfilling this in¬ 
dication ; efpecially in cafes where the occurrence of di¬ 
arrhoea is obvioufly connected with the application of 
cold, the fuppreflion of cutaneous excretions, or with a 
generally debilitated habit. This purpofe is alfo more 
effectually accompliftied, when a courfe of fuitable diet 
is purfued at the fame time ; efpecially the ufe of milk, 
rice, the amylaceous parts of vegetables, fuch as arrow- 
root, tapioca, fago, &c. with animal broths and jellies. 
Dr. Heberden recommends the combination of fpices 
with the vegetable mucilages, as the nutmeg, cinnamon. 
See. or the combination of cretaceous medicines with 
fpices and opiates. He alfo advifes the ufe of a fpoonful 
of mutton fuet, difl'olved in four ounces of warm milk, 
twice a-day, both as medicine and nutriment to a patient 
under chronic diarrhoea. 
Dr. Good mentions a cafe of D. ferofa, which occurred 
to himfelf in 1806. The patient <Was a young woman, 
aged twenty-four; the diforder had continued for ten 
years, and had never produced fewer than nine or ten' 
watery ftools a-day, fometimes tinged with blood. She 
was often in great fpafmodic pain in the ftomach or intef¬ 
tines ; and had tried a long lift of aftringents, anodynes, 
and other medicines, to little purpofe. She was much 
reduced; and it appeared to be a cafe of great local ir¬ 
ritation from local debility. Gentle ftimulants were here 
of eflential fervice ; and the difeafe gradually yielded to 
camphor mixture and pills of the refinous gums. 
Diarrhoea is a common complaint among infants. The 
natural appearance of the ftools is altered from the bright 
orange colour, pulpy and curdled confidence, and inoften- 
five fmell; and they become green, (limy, and at the fame 
time emit a four fmell, which arifes from the prevalence 
of acidity in the firfl: paflages. The complaint is not 
often dangerous ; it generally yields to a laxative com- 
pofed of a little magnefia and rhubarb. But the nurfe’s 
food (hould be regulated; and the infant ought to have 
no other food, in addition to the milk, than arrow-root. 
This complaint generally arifes from expofure to cold, 
or from fome irritation or accumulation in the bowels. 
The linen and ftools are ftreaked with blood ; and there 
is violent pain, or fymptoms of fever. Where (limy 
ftools are of the colour of clay, and emit a putrid fmell, 
the infant foon becomes emaciated ; and the difeafe of¬ 
ten terminates fatally, though its progrefs be flow. 
As the diforder proceeds, very unfavourable fymptoms 
occur, fuch as emaciation and drynefs of the (kin, fwel- 
ling or fhrinking of the belly, with an altered appear¬ 
ance of the countenance ; and there is a conftant fretting* 
or peevilhnefs of temper. Swellings of the glands of 
the groin, and a little uneafinefs of breathing, as if there 
were a flight tendency to cough, are alfo very unfavour¬ 
able fymptoms. In many of thefe cafes the purging is 
the effeCl of a difeafed ftate of fome of the digeftive or¬ 
gans, or of the mefenteric glands; but in others it 
arifes from an irregular aCtion of the former organs. The 
continued. 
