Diarrhœa, or looseness of the bowels, is one of the most common and one of the most serious ailments of the tropics, and should never be neglected. In many cases it is a sign of enteric fever, dysentery, cholera, or sprue, the symptoms of which are given below. Ordinary attacks are usually due to the presence of some irritant in the bowels, such as irritating sand, bad food, unripe fruit, or other poisonous material. Amongst African and other natives diarrhœa is often due to a faulty or ill-cooked dietary. The importance of flies in fouling food should not be overlooked.
Treatment.—Begin the treatment by administering castor oil, fruit salt, cascara, or other mild aperient, to clear out the cause of the diarrhœa. If castor oil is used the following note as to its administration is likely to be of service. Place an ounce of brandy in a glass or cup. Carefully pour the oil into the centre of the brandy and then add one ounce of water. The mass of oil will then resemble the yolk of an egg enclosed in the white. Lime juice may be used instead of brandy. Failing these, black coffee helps to cover the taste and “feel” of the oil. Sometimes three grains of calomel with fifteen grains of sodium bicarbonate act better than castor oil. A warm-water enema of about a pint is useful.
If the diarrhœa continues, give chlorodyne (20 minims) and tincture of ginger (10 minims) in an ounce of water two or three times a day.
This treatment should not be persisted in for more than two days.
If the diarrhœa is persistent, an astringent is needed: five grains of tannin, or two or three grains of sulphate of iron may be given three times a day. Ten grains of quinine should be given each day.
All food should be semi-solid and tepid; milk diet, as recommended below for enteric fever, is the safest food, but soup thickened with rice or arrowroot is good. The patient should keep in bed and wear a flannel band round the belly. Sometimes in the tropics, as the result of excessive purgation, diarrhœa is very acute and may be alarming. In such cases a hot bath, stimulants and the administration of astringents are indicated.
If the trouble continues for more than a few days it is probably due to dysentery, or typhoid.
Diphtheria.
Diphtheria is an acute infectious disease, the essential feature of which is a peculiar inflammation of the lining membrane of the mouth, nose, throat, and windpipe, characterised by the formation of a membrane upon the inflamed surface. Diphtheria occurs in the tropics but happily does not spread much in hot countries.