British American Journal of Medical and Physical Science

notwithstanding the influence adverted to, and that when it does occur, it assumes, in most instances, a form which is very readily under the control of treatment. Again,

It is unnecessary that I should offer any definition of in the absence of this influence, the act of teething, conthe term "Diarrhea," a disease which I suppose to sidered simply in itself, is not so frequently productive of be coeval with the history of our first parents; nor do I the disease under consideration, a proof of which is expropose to dwell at any length on its numerous varieties, hibited in the cessation of the symptoms on the approach which are distinctly described in all the standard authori- of cold weather, although the process of dentition conties in medicine of the present day. The feculent, the tinues to go forward with undimished activity. These bilious, the mucous, the serous, the chylous, and other circumstances have led me to the obvious and irresistible species of Diarrhoea, are respectively attributed to dif- conclusion, that a primary cause, as well as one arising ferent agencies, and each of them seems to demand a from sympathy, generally concurs to establish (at least different mode of treatment. I shall confine myself, on in our Canadian climate) the obstinate Diarrhea with the present occasion, to that general form arising princi- which this feeble class of patients have so often to conpally from the irritation produced by dentition, and into tend.

which one or other of the varieties I have just mentioned It must have been observed that, under ordinary is found most commonly to enter. For the sake of per-circumstances, it makes its approach with insidious steps: spicuity I shall notice it:

1st. In its history, general and pathological. 2nd. In the treatment which, so far as my observation has extended, it is desirable to pursue.

the dejections are rather more frequent than they ought to be, but as they present a natural appearance, it excites but little attention, and it is permitted, perhaps, to coninue for some days, and gradually to increase before The amount of deaths, from this and from other die medical aid is solicited. Even now that aid would not eases, occurring at the period of dentition, is greater than be sought were it not for the more prominent co-existing I feel warranted in stating in precise terms. Dr. Ar- circumstances of irritability of the stomach, and constant buthnot estimated it to be one in every ten, and other retfulness of temper. The absence of pain on presauthors one in every six. Whether these computations sure, of pyrexia, and of morbid redness of the tongue, have been founded on correct data or otherwise, I do not give satisfactory evidence, that in this stage of the disease venture to say, but admitting that they have exceeded the it cannot be regarded as of a truly inflammatory characreality, we cannot close our eyes to the truth, which ter. There is merely a degree of irritability in the stands out in bold relief, that the mortality, at this critical period, is exceedingly great.

mucous membrane, occasioned by an increased secretion of bile, evidenced by the bright green evacuations. But this irritability, from the continued operation of the same causes, in process of time, produces alteration in the pathological condition of the lining membrane, and some degree of inflammatory action ensues.

I am disposed to consider this malady as being possessed of a two-fold nature, although in giving expression to this opinion I may be exposed, perhaps, in some degree, to the charge of admitting a paradox. But if I should say it is Idiopathic, it would involve a conclusion It is very difficult, in the early stages of Diarrhea, to manifestly erroneous,-if it is pronounced Symptomu- ascertain the precise nature of the morbid appearances. tic, it would not comprehend all the circumstances con- I must own that I have never had the opportunity of beverging to its production. I deem it, therefore, to being present at such an examination, and I believe that constituted of both, and believe it to arise idiopathically the opportunities must be rare. Dr. Crampton observes, from the action of a hot sun on the hepatic system, and that "the membrane, in recent cases, has been observed symptomatically from the irritation of dentition. I am more or less red and congested, or extremely pale and supported in this opinion by the fact, that infunts under anemic; the redness being disposed in patches or in conthe age of six months are much less subject to Diarrhea, tinuous stripes, leaving the intervening portions very

pale." With due deference to so high an authority, I writings I have so far become familiar. I refer to the may affirm, that in almost numberless instances, I have influence which the very great disproportion of the cerewitnessed these very appearances in the alimentary tube, bral mass to the rest of the body in infants must exercise when it was deemed, by more competent judges than in giving origin to gastro-intestinal affections. myself, to be perfectly healthy. I am willing, however, I now come to speak, in the second place, of the to allow, that an acrid secretion of bile, continuing to treatment which this formidable affection seems to reflow over a tender membrane, exhibiting the disposition quire. If I am correct in my views as to its causes, to put on inflammatory action, may lead to more well- and its pathological history, the indications to be fulfilled marked changes in its normal structure; and when these will be sufficiently apparent. I need not point out the take place, the evacuations alter their character, being separate treatment which a mucous, a bilious, or a chyserous with slimy or ropy matter, occasionally containing lous tendency in its early stage would clearly indicate, coagulable lymph, tinged with blood, and generally speak-but I would briefly dwell upon that course which, in its ing of a highly fœtid description. established form, it appears advisable to pursue. In The mesenteric glands now become, in many instances, those instances, where a change of climate is practicable, inflamed, enlarged, and indurated, from the absorption such a change cannot but be regarded as promising much of the acrid alimentary matter, very analogous to that that is valuable in this disease. In addition to the irriwhich occurs in inguinal bubo. Fever takes place, with tation of teething, the continued heat of the summer in thirst, restlessness, and interrupted sleep. Rapid emacia- the western portion of this Province operates in a detion follows, and the scene is frequently closed with re-gree that can scarcely be too highly appreciated, in the peated convulsive attacks. production, in the first place, and in the subsequent aug

We may probably agree in thinking, that in the middle mentation of the Diarrhoea of infants. Where, then, and latter stages, the term Diarrhea is no longer applica- there is no combination of obstacles to a removal, the ble to this disease, for all the different features of dysen- climate of Quebec offers a decided advantage, simply tery are essentially assumed, and the appearances ob- because its temperature is modified by those frequently served on dissection are precisely those presented in recurring easterly breezes which are sent up the St. cases of dysentery. If it be inquired what these ap- Lawrence as through a huge funnel; and from my obpearances are, a more satisfactory reply can be given şervation during a long residence in that city, I can than that which refers to an earlier period of the disease; bear, without fear of controversy, this favorable testialthough it must be admitted that they differ in most mony to its character. The climate of Kamouraska, cases, sometimes being limited to the intestines them- situated farther down, and having a near proximity to selves, and at others, involving, with these, the omentum, the sea coast, would, perhaps, hold out still higher adthe mesentery, and its glandular appendages. I believe vantages to the infant invalid, although, on this point, I I am correct in stating that the chief traces of disease do not speak from personal knowledge. But of this I are to be found in the intestines themselves, which are am quite persuaded, that the cases of recovery would exsometimes agglutinated together-at other times con-hibit a much larger proportion, could my professional tracted in their calibre, and not unfrequently intussus- brethren be induced to urge an exchange of the now ceptions are met with. The mucous coat is much thick- favorite locality of Niagara for the more distant points to ened, inflamed, and even ulcerated; the ulcers varying which I have just adverted.

in shape and size, and occupying sometimes the large and sometimes the small intestines. It is also occasionally edematous, and flakes of coagulable lymph are found adherent here and there to inflamed or congested portions of its surface. Whatever may be the nature of other concomitant structural changes, it is evident, as I before observed, that the primary and chief seat of the disease is found in one part or other of the mucous membrane of the intestines, and this fact must be deemed satisfactory, in the position it holds, with regard to a definite plan of treatment.

I have but one more circumstance to notice as occurring in connection with this disease, and of which no mention is made by any of those authors with whose

In many instances the inflammation or morbid action of the mucous membrane extends, or perhaps is transferred to the serous coat, giving rise at one time to ascites, and at another to general anasarca. The plan of treatment which I have found of most service is best shown in the detail of an interesting case of this nature which occurred to me during the past summer.

Mrs. B's infant had suffered for many weeks from Diarrhea. The parents stated that they had lost a child a year or two previously under precisely the same circumstances, and so persuaded were they that all means would now prove unavailing-that they fully expressed this belief on confiding the infant to my charge.

Several teeth were forcing their way through the

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British American Journal of Medical and Physical Science, Volumen1