DISEASES ATTENDED WITH RELAXATION - now come to those conditions of the in testinal canal which are marked by excessive action of the bowels: they are chiefly dependent on the state of the mucous membrane, including in that term the whole secreting apparatus. The dis orders of this class may be formed into several distinct groups, from a consideration of their history attendant phenomena.
a. With no heat of skin or quickness of pulse, we have (1) a history of previous constipation, when slight watery discharges are place, in consequence of the irritation of the mucous membrane by the accumulation : (2), the ingestion of some un healthy aliment, or of a larger quantity of food than the stomach can digest, which passes into the intestine in a crude condition. In both of these cases there is usually pain and a foul tongue; the action is a preservative one, by which nature seeks to expel the offending material, and, if opposed, dangerous inflammation and obstruction may result. (8) This reaction may have served to remove the cause of disturbance, and yet the diarrhoea may persist merely as an excessive secretion set up by the irritation and congestion of the membrane. (4) It may result from expo sure to changes of temperature, producing changes analogous to the more common effects of cold on the bronchial membrane. Of this kind seems to be that form of diarrhoea which is often pre valent in summer when the tongue is coated, the stools dark, and there are griping pains in the abdomen. (5) The genuine summer cholera, on the other hand, is marked by copious, pale, watery evacuations, with a clean tongue, a cold. skin, and no abdominal pain ; it is exactly like the choleraic diarrhoea, which attends the spread of epidemic cholera. (6) There is also a very well-marked form dependent on disorder of the liver and excessive secretion of bile, to which the name of bilious diarrhoea is not inappropri ate ; it is most commonly, however, associated with excesses in eating and drinking, and is consequently allied with the class of cases caused by indige,stion.
b. When general symptoms are present they belong, in a large number of cases, to some other disease, of which diarrhcea is also only symptomatic.
To determine this point we must refer to the modes of investi gation and sources of information enumerated in treating of these diseases themselves ; as the most common we may mention con tinued fever with bowel-symptoms, tubercular diseases, and albu minuria. In the two first it is always accompanied by ulceration, in the latter the secretion seems to be often vicarious of that of the kidney.
c. Diarrhoea, with febrile symptoms which are not referable to any other disease, is more frequently seen in this country in child hood than in adult life. Inflammation of the mucous membrane, with a tendency to ulceration, is the pathological condition which, in its fullest development, is only met with in dysentery. The tongue is coated, the pulse quick, the skin hot, with much thirst ; the bowels continue for some days to act very many times, and the stools soon become slimy and mixed with blood: among chil dren there is very often prolapsus ani ; then follow the appear ances of putrid flesh and fetid puriform matter, corresponding to the analogous appe,arances in true dysentery. But the symptoms may stop short of this extreme condition, and then it is often hard to distinguish them from those of dental irritation; there is nothing, indeed, to show that the latter may not pass into inflam mation, and in infantile life it is a very frequent source of febrile diarrhoea.
Again, we more frequently see the condition of membrane which is characterized by aphthce of the mouth and faucet; in childhood, than we do in adult life, and among them the occa sional presence of a similar condition at the anus, affords still farther proof that the malady is not a local one.
d. Chronic diarrhoea is very often dependent on ulceration ; but we have abundant proof that it also sometimes persists for lcmg periods without any indication of such a condition from the character of the stools. Many persons are subject to it from the most trivial causes. In childhood the complaint is often very obstinate, and yet ultimately complete recovery proves that no structural change has occurred : in other instances it depends on disease of the mesenteric glands, and is only one form of its asso ciation with tubercles in early life.