A system of practical medicine. By American authors. Vol. 1 : $b Pathology and general diseases
History
A system of practical medicine. By American authors. Vol. 1 : $b Pathology and general diseases
Medicine -- Practice
If, with frequent disposition to pass something, only small quantities
of bloody mucus escape, with pain and bearing down, we recognize
dysentery. When, instead, a large quantity of colorless fluid, with or
without floating flakes (rice-water), comes from the bowels at short
intervals, with vomiting of the same sort of material, we suspect
epidemic cholera, and must inquire for corroborative or corrective
indications in {164} reference to that suspicion. Very bad cases of
cholera morbus also may, at a late stage, present this symptom. So may
exceptional cases of pernicious malarial fever. The diarrhoea of
typhoid fever exhibits usually liquid stools of a brownish color
(gutter-water passages). Occasionally, hemorrhage from the bowels adds
to the danger of this fever, as well as to that of malarial remittent
fever. In phthisis pulmonalis, at a late stage, colliquative
diarrhoea, like colliquative perspirations, shows the breaking up of
the system by excessive waste. Very foul, offensive discharges from
the bowels may always be understood as showing that in the alimentary
canal, whether originating there or in the blood, morbid changes have
been going on. The indication is to promote the elimination of such
material as soon and as thoroughly as possible.
Clayey stools show absence or deficiency of bile in the intestines,
whether from its non-secretion by the liver or from obstruction to its
entrance by a gall-stone in the common gall-duct. Green stools are not
uncommon in sick children. The cause of the color has been much
disputed. Probably it depends chiefly on a modification of the
bile-pigment, with some admixture of altered blood. When mercurials
have been taken sulphide of mercury may give a green color to the
discharges.
Blood, nearly or quite unmixed, coming from the bowels, may have its
origin in internal hemorrhoids, intestinal ulceration, cancer of the
rectum, intussusception, rupture of an aneurism, typhoid or yellow
fever, or vicarious menstruation.
Pus is discharged per anum in cases of dysenteric or other ulceration
of the bowel; also when an abscess occurring in any part of the
abdomen (most frequently hepatic) opens into the intestine.
Pseudo-membranous discharges, shreds or other fragments of fibrinous
material, appear sometimes in what may be called diphtheritic
dysentery. Tubular casts are occasionally seen (diarrhoea tubularis),
which, however, are most likely to consist of thickened and
accumulated mucus. Fatty discharges from the bowels are rare. Authors
report observation of them in cases of disease of the liver or
pancreas, as well as in phthisis, typhoid fever, diabetes mellitus,
cholera, and tubercular enteritis of children.
Lientery is the term applied when imperfectly changed food appears in
the stools. It shows, of course, great deficiency in the process of
digestion.
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