Gastroenteritis

“ The diagnosis is rather difficult, for the condition is very apt to be confused with primary dyspepsia, or with inflammation of the gastric compartments. It might also be mistaken for acute enteritis of the first part of the small intestine; but as gastritis is very often complicated with duodenitis, such a mistake is without serious consequences.
Prognosis. The prognosis is grave, not because death is a frequent termination, but because the disease very often leads to chronic incurable lesions. ”

“ Normally the intestine contains an extremely large number of different microbes, which may prove of service so long as circulation, secretion, and peristalsis continue normal; but as soon as any perturbation occurs, either in the blood supply or in the movement of the bowel, normal secretion is impeded; abnormal organic fermentation commences, producing irritant principles or toxins which at once set up local irritation, or, being absorbed, produce that complex of symptoms which we recognise as enteritis, intoxication of intestinal origin, or even infection. ”

“ As the disease very often implicates the stomach (gastro-enteritis) , the usual lesions of gastritis will be seen. Most commonly the lesions are best marked in the small intestine, and again in other cases in the colon, but usually there is more or less change in all parts of the intestinal canal. The small intestine is almost devoid of aliments and the mucosa deeply congested in patches or striæ, with at points thickening, softening so that it crushes under the finger, hemorrhagic discoloration, and even ulceration, and necrotic changes. ”

“ The treatment in chronic gastritis is very like that in the more acute form; that is, it must be combated by removing the cause. Lack of fresh air and exercise have much to do with the development of chronic gastritis, but even they combined with a judicious amount of rest would be wasted without a proper adjustment of the diet to cover the main points of the disturbance. As has already been mentioned, the cause may be a lack of gastric juice or it may be an excess of it; it may be intensified by an atonic condition of the organ or from the food passing too quickly into the duodenum. ”

“ In the present state of our knowledge dysentery would be known by marked tenesmus, by the grave general symptoms, the reddish fluid stools with flocculi, and by its occurrence in epidemic form.
Enteralgia presents the following features which distinguish it from intestinal catarrh: The tongue in enteralgia is clean or coated white, but with no red tip and edges; the appetite is capricious, but not lost; the bowels are constipated; the pain bears no relation to the ingestion of food or drink, as in enteritis. Fever is accidental, and there are other nervous phenomena. ”

“ As has been pointed out, inflammation, septic poisoning, intestinal foulness, or retained feces, act as irritants on the mucous membranes, thereby drawing the blood to the colon where it is excreted and exhaustion follows. The great danger in diarrhea, therefore, is the rapid depletion of the vital force. But when the small intestines are affected the consequences may be still more deplorable. Then the unassimilated food is hurried along too quickly for absorption and the body receives but little nourishment to restore its powers. ”

“ In the preceding chapters we have mentioned some of the most common cases of retention of excreta in the rectum, sigmoid cavity, colon, cecum, duodenum and stomach, and how the consequent foul conditions often resulted in diarrhea. Auto-infection impairs the functions of every organ in the body, by clogging the pores with poisons and filth. By the transfer of disease germs from one infected, that is, tainted, contaminated part of the body to parts that were free from infection, the kidneys, mucous membrane and skin receive these unnatural products, and their functions are disturbed thereby. ”

“ In chronic gastritis it will be found that all the local symptoms are exasperated by the usual treatment of functional dyspepsia.
5. Stimulants and stimulating food are not well borne. Alcohol, especially on an empty stomach, produces gastric distress. There is also frequently slight febrile disturbance.
Chronic gastritis, with nausea, vomiting, hæmatemesis, general pallor, and loss of flesh, may be mistaken for cancer of the stomach. But in cancer vomiting is about as apt to take place when the stomach is empty as during the ingestion of food ”

“ The third group, including typhoid and paratyphoid fevers, cholera, and dysentery, all of which are intestinal diseases, is largely conveyed from the sick to the well indirectly through contaminated water and food. To develop one of these diseases means that the excreta of somebody who has the disease or who has had it, has been taken into the mouth and swallowed, and the germs finding a favorable medium in the intestines have multiplied and produced the typical symptoms. One of the chief ways in which this type of infection occurs is through drinking sewage-contaminated water or milk ”

“ In this way some of the germs are rubbed off and adhere to the food and are swallowed with it by human beings. The diseases most commonly disseminated in this manner are those of the alimentary canal known as enteric diseases, such as typhoid fever, cholera and dysentery, the germs of which are voided in fecal matter, which if left exposed is certain to be visited by hundreds of flies, and some of the causative bacterial germs of these diseases are thus transferred to food, and infection is thus made possible. ”

“ Infliction, misery, are everywhere. The taint of auto-generated intestinal morbific products, carried and communicated to the remotest parts, manifests itself now here now there as if it were a local trouble, and it is difficult therefore, nay, impossible, to classify scientifically the symptoms of auto-infection. A classification, though necessarily imperfect, will aid in the diagnosis and treatment of the various abnormal conditions of the stomach and intestines, that is, of mal-digestion. ”

“ Inflammation of the stomach, gastritis. Notwithstanding the incessant irritation and distinction of this sensible organ, by innumerable varieties of food and drink, yet its inflammation is a rare event. The symptoms, acute fever; fixed burning pain and heat in the region of the stomach, aggravated by pressure; frequent nausea and vomiting after taking any nourishment; anxiety, restlessness; weak, hard, intermittent pulse; frequently delirium; universal debility. It may prove fatal in the space of a few days, or even of a few hours: there are{153} different gradations of severity and danger. ”

“ The bilious fever often appears in the same person in the form of colic, dysentery, inflammation of the liver, lungs, and brain, in the course of five or six days. The hypochondriasis and the hysteria seldom fail to exchange their symptoms twice in the four and twenty hours. Again: the oak tree has not united with any of the trees of the forest, nor has the lion imparted his specific qualities to any other animal. But who can apply similar remarks to any one disease? Phrenitis, gastritis, enteritis, nephritis, and rheumatism all appear at the same time in the gout and yellow fever. ”

“ How it attains the human intestine is not known, but as it is a common parasite of the pig and apes, in which it occasions a fatal form of dysentery, it is likely that one or other of these animals is a usual source of infection. As attempts to infect animals experimentally have failed, it is reasonable to conclude that the infusorian, on occasion, assumes some resistant form which enables it to withstand the gastric and intestinal juices on the way to its habitat, the end of the ileum and the large intestine. ”

“ It occurs in greatest abundance in dysenteric lesions and especially in the solitary lymphatic follicles of the large intestine, and in the mucus in the stools during the most acute stage of " epidemic " dysentery. It is pathogenic to many animals, but it does not produce in them, or only exceptionally, dysenteric lesions, although the toxins of the bacillus, pounded and killed cultures, when injected intravenously into rabbits and other animals, produce necrosis of the large intestine into which they are excreted by some selective action. ”

“ In gastritis the nausea is from the first a pronounced feature of the disease. Vomiting in affections of the brain is often unattended by nausea. In gastritis the tongue is more frequently coated or red and glazed. Diarrhoea is also more frequently present, especially in early life. In affections of the brain the tongue may be clean and the bowels are usually obstinately confined. When there is much fever, gastritis may be confounded with remittent or typhoid fever. In periods of childhood this mistake is specially liable to occur, for there are many symptoms in common. ”

“ There is a legion of secondary symptoms of proctitis, all of which medical empiricism considers and denominates causes. As constipation is such an every-day complaint of almost everybody one meets, it will not tax our imagination unduly to conceive how it may be a frequent cause of diarrhea, which is only Nature's effort to get rid of its useless and excessive burden of retained feces and gases. Constipation, semi-constipation, and irregular action of the bowels, excessive fermentation, putrefaction, self-generated or auto-infection, are the factors to be considered. ”

“ They are difficult to be seen upon a dark skin.
The possibility of enteric fever should always be remembered in cases where there is constant fever, unaccompanied by any definite symptoms, such as the recurrent shiverings of malaria, or the spitting of blood in pneumonia.
Prophylaxis.—As for dysentery (see p. 186) . Preventive inoculation is very important and confers immunity for a considerable period (see “Inoculation,” p. 168) .
Treatment.—Absolute quiet in bed. If constipated, bowels should be kept open by soap and water enema only. ”

“ It may be going too far to affirm, as did Broussais, that gastritis sustains a causative relation to all forms of fever, but that gastro-duodenitis is an important secondary condition in all forms of malarious fever, complicating and perpetuating the febrile state, there can be no doubt; and it is equally clear that it constitutes one of the most dangerous complications. Excessive alimentation, with the injudicious use of tonics and stimulants, so often resorted to in the treatment of these fevers in their early stages, only serves to intensify the local inflammation. ”

“ Obstruction has also been described as accompanied by loss of appetite, constipation, the passage of black, coated, fœtid and sometimes blood-streaked fæces, symptoms of chronic tympanites with fœtid eructations and sometimes vomiting. These sometimes accompany hydrochloric acid dyspepsia, a form of chronic gastritis, and, from our standpoint, the stagnation of food in the omasum is only secondary. We therefore interpret the facts in quite a different manner, and believe that only by a rational and physiological interpretation of the symptoms observed can one diagnose the condition. ”

“ Sooner or later, then, gastritis and stomach indigestion develop, with consequent intestinal indigestion. If lie takes strong alcohol, like whisky, oil an empty stomach, he may sooner or later cause serious disease of the mucous membrane of the stomach, first chronic gastritis, and later atrophy of the glands of the stomach. ”

“ Now, first of all, it must be remembered that mesenteric disease, due to consumption, plays but a very small part in the production of the symptoms just described, but that the covering and the lining of the bowels are chiefly involved. Next, enlargement of the mesenteric glands and disorder of their functions take place from many causes other than consumption. They are always more or less enlarged in typhoid fever; they become enlarged when irritated by unwholesome food in infancy, or they may swell in the course of chronic indigestion. ”

“ TREATMENT.—Prophylaxis has great importance, since the causes of the malady are to a considerable extent, at least, preventable. Errors of diet in respect to the use of condiments, fats, meat, pastry, etc. must be corrected. When there is pronounced gastro-duodenal catarrh and acid fermentation in the duodenum, the saccharine, fatty, and starchy elements of the food must rather be excluded and lean meats allowed. Abundant exercise, bathing, and an open-air life in general should be directed. Whenever a malarial infection is causative a change of climate becomes imperative. ”

“ The secretion of the bowels is then increased, and by the excitement or over-work a diseased condition of the intestinal surface may be established. In this way the diarrhœa and ulceration of the glands in Typhoid fever may be accounted for. The air of a dissecting-room, or [Pg 295] the neighbourhood of a noxious sewer, is apt to bring on diarrhœa by exciting a putrefaction of the blood. Severe bodily exercise, as a long walk, may cause it, by increasing the waste of tissue. We find that constipation is commonest in youth, when nutrition is most active ”

“ Paratyphoid infections may give the clinical picture of a colitis and such cases at times show a large amount of blood in the dysenteric stools. Usually the symptoms are rather those of an entero-colitis or a gastro-enteritis.
3. In Japan, dysentery-like epidemics of a very fatal disease, termed ekiri, occur among young children. The organism is very motile, producing gas and acid in glucose, but not in lactose media. It is reported at times to show indol production. ”