Climate and Health in Hot Countries and the Outlines of Tropical Climatology / A Popular Treatise on Personal Hygiene in the Hotter Parts of the World, and on the Climates That Will Be Met Within Them.

by George Michael James Giles

Practically speaking, to restart the action of the liver is to cure dysentery in all recent cases, and hence it is of the greatest importance not to give opium, or that dangerous abomination “chlorodyne,” both of which are most efficient in diminishing the flow of bile. They are doubly dangerous, because they quiet not only the action of the gall bladder, but also that of the intestines, and this, it must be remembered, without really curing the disease. The flux from the bowel is not really the disease, but merely an outward symptom of mischief going on within, and is further the useful and salutary effort of Nature to get rid of the irritating matter that is causing the mischief; and hence to stop the movements of the bowel, before the peccant matters have been got rid of, is a most dangerous step to take; so that no drug of the above description should on any account be given during the earlier stages of an attack of this sort. Next to this the matter of greatest importance is to give the irritated intestine rest by at once stopping the ordinary diet of solid food and substituting some mucilaginous preparation, such as milk thickened with a little arrowroot and taken cold. Where the attack is sharp, a few hours’ fast is by no means unadvisable, but must not, of course, be continued too long. Wherever possible, it is best for the patient to rest in bed, and if there be much abdominal pain a hot-water bottle placed against the pit of the stomach will afford great relief. In a large proportion of cases no other treatment than rest and avoidance of opiates is required. Avoid also alcohol in all forms, at any rate unless extremely diluted. If, however, the symptoms fail to moderate under this treatment, it is well to secure the removal of any irritating or poisonous matter that may remain in the bowel by the administration of a dose of castor oil, a full ounce for a grown-up person down to a teaspoonful for small infants. The great advantage of this drug is that besides acting as a safe and certain laxative, the oil itself forms a most soothing application to the irritated bowel, just in the same way as it does to the skin when that structure is scorched or otherwise inflamed. To treat an intestinal flux by the administration of a laxative may appear strange to the lay mind, but you need never fear to employ castor oil, however violent the flux may be, and in children especially, it is a good routine commencement of treatment for any looseness of the bowels. A good plan for getting down this remedy, which, it must be admitted, is usually most obnoxious to adults, is as follows. Select a wide, shallow drinking vessel, such as a champagne glass, and moisten its interior thoroughly with a teaspoonful of some strongly-flavoured spirit, such as gin, turning the glass about until all parts are wetted, then add a couple of tablespoonsful of water, and into the middle of this pour the oil, avoiding the sides, so that it floats separately, like the yolk of an egg surrounded by the white. If now the contents of the glass be swallowed as nearly as possible at a single gulp, the oil passes through the mouth and throat so completely surrounded by the spirit and water that its presence cannot be noticed. A tabloid containing ¹⁄₄₀ grain of perchloride of mercury should be taken shortly after, and after a lapse of three or four hours the disinfection of the contents of the intestine may be completed by taking a 10-grains tabloid of resorcin every four hours.

As a rule, under this treatment the yellow colour soon reappears in the motions and all symptoms disappear; but should the liver refuse to act, as is indicated by the continued absence of the natural yellow colour in the motions, it will be necessary to give a large dose of ipecacuanha—to get this drug down without setting up vomiting, requires a certain amount of preparation—as in smaller doses, it is one of the safest and most certain of emetics. It is best to give the dose the last thing at night, when the patient is naturally likely to be sleepy, and half an hour before it is given, a preparatory dose of a grain of opium should be administered. The patient should lie as quietly as possible, and after the dose (30 grains, or half a dozen 5-grain tabloids of ipecacuanha) all liquids should be withheld. It is also important to use as little water as possible to wash down the tabloids, as success in keeping down the drug depends mainly on the absence of any notable amount of fluid from the stomach; and this abstinence from fluids, as well as from food, should be continued until the next morning, when in all probability a copious bile-stained motion will show that the drug has taken its desired effect. As a rule, after this, two or three tabloids, containing ¹⁄₄₀ of a grain of perchloride of mercury per diem, for a few days, will suffice to maintain the action of the liver and to disinfect the bowel, but occasionally the medication with ipecacuanha may have to be repeated. Remember, however, that no drugs will be of much service in this disease without the greatest care in diet.

An Indian medical officer has generally a variety of institutions under his charge, and usually amongst them a prison, of which he is not only the medical officer, but also the military governor—a sensible combination of offices which might well be imitated elsewhere. Now, although dysentery is a disease which gives much trouble in Indian prisons, the writer did not lose a single one of his jail-birds from that cause for several years; and he imputes his success to the practice he made of at once relegating each case of dysentery to a solitary cell, where it was utterly impossible for the patient to obtain any other food than that ordered for him. When left in the general wards they could not be kept from obtaining more or less of the bread and vegetable curry that formed the ordinary diet of those not seriously ill.

Soups are rarely well borne in dysentery, and hence the diet must be restricted to milk foods, the milk being always rendered mucilaginous by the addition of a little arrowroot or gelatin, cornflour, &c. When there is much dyspepsia the milk may be given semidigested by combining it with one of the numerous pancreatised proprietary articles, such as Benger’s food. Afterwards a raw egg may be given beaten up with the milk or Benger’s food, and subsequently rice pudding and fish; but great caution is always required in resuming the ordinary diet, as the bowel always remains easily irritated for some time after the attack has subsided. Everything should be given cold (preferably moderately iced), and in small quantities at a time.

Diarrhœa.

Diarrhœa in tropical climates arises from much the same causes as dysentery, and like it, is very apt to be set up by chills to the abdomen; in fact, these diseases may be regarded, for the practical purposes of prevention and treatment, as different degrees of the same condition; the more serious disease being further complicated by concomitant affection of the liver. Heavy dosing with ipecacuanha will not, of course, be required in the milder disease, but otherwise its prevention and treatment may be regarded as the same, especially as in tropical climates, the mildest access of diarrhœa should always be respectfully dealt with, as it may easily develop into dysentery if neglected.

Hill diarrhœa is a peculiar form of chronic looseness of the bowels that is not uncommon in the Himalayas, and, I believe, in other elevated regions. Certain people appear specially liable to it, much in the same way as some are subject to hay fever, while others are never affected; and the proclivity is so marked in some persons that it is impossible for them to reside in such localities, and they are hence debarred from taking refuge from the fierce heat of the plains. We are not very clear as to its causation, though the disease is traceable in some places to the presence of finely divided mineral matter (mica) in the drinking water, and so may be guarded against by careful filtration of all water used for drinking or cooking. The climate of the hills, again, though pleasant enough, is during the rains even more treacherous than that of the plains—damp cold, alternating with warmth; but withal, as has already been remarked, the disease is mainly one of personal proclivity, and where the tendency is very marked the only course is to avoid residing in places where it is apt to occur. Should you, when travelling in the hills, be attacked with this malady, careful filtration of water and care in diet should be attended to, and a pill or tabloid containing one grain each of euonymin, blue pill and ipecacuanha may be taken at night; but should the trouble persist, no time should be lost in returning, if possible, to within range of competent medical assistance, as if neglected, the disease is apt to develop into a most troublesome condition known as sprue.

Infantile Diarrhœa

is terribly common in hot countries, and hence the least disturbance of this sort should never be neglected in young children. The rapid rise in the infantile death-rate that coincides with any approach to a tropical temperature in Europe, shows well how full of risk is a child’s tenure of life in latitudes where such temperatures are not the exception, but the rule. The liquid food, which alone is suitable to the infantile digestion, is perilously liable to decomposition when the temperature of the air rises much over 70° F., and, under such conditions, food which, to the nose and eye, shows no appreciable change, may yet be virulent with a poison as lethal in its effects as arsenic, and far more deadly, weight for weight. As a matter of fact, the poisons which may be generated in food subjected to high atmospheric temperatures, differ only from the most active of mineral poisons in their greater virulence, and to commence treatment in such cases with any agent that checks the action of the bowels ensures an unfortunate result with even greater certainty than if we were dealing with antimony or vitriol.

The first desideratum is to get rid of the supply of poison which has already been generated within the bowels, and the second to stop the fermentation which alone can generate the poison. To meet the first indication an unirritating laxative should be at once administered. When the symptoms are severe, one or two teaspoonfuls, according to the age of the child, of castor oil is probably the safest remedy, but in less violent disturbances a drachm of our old friend, Gregory’s powder, will be more appropriate. The laxative should be promptly followed by the administration of one of the intestinal antiseptics, amongst which I have a personal preference for 5-grain doses of resorcin; but β naphthol grs. ii., salicylate of bismuth grs. v., or perchloride of mercury gr. ¹⁄₆₄, if more readily to hand are equally valuable, and are, I know, preferred, one or the other, by practitioners according to their individual favourable experiences; but opiates of all sorts are always to be avoided as long as active mischief continues, though fifteen or twenty drops of paregoric or some other preparation of the poppy may possibly accelerate the cessation of obvious symptoms when the “causing cause” of the disease has been disposed of.