The Etiology of Hill Diarrhœa

Sir,?In the January issue of the Indian Medical Gazette, you have a note on hill diarrhoea as it occurs at Darjeeling and Poona and suggest a record of the experience of Civil Surgeons at other hill stations. From an experience of three years at Ootacamund, the "Queen of Hill Stations," the period including four "seasons," and from information gathered from my predecessors as Civil Surgeon, or contemporaries in some other appointment there, there can, I think, no be reasonable doubt that the classical picture of "hill diarrhoea" is not seen at Ootacamund. Bowel disturbances are very common and sometimes troublesome to cure, and the early morning diarrhoea of colon catarrh is a fairly frequent phenomenon. The sequence is common, and one has seen it time after time, of the arrival in the hills, the checked perspiration, the extra eliminatory work thrown on the liver and kidneys, the objections of the liver to the extra work; and the saving bilious diarrhoea which supervenes. Liver congestion in all forms up to actual abscess, common : disturbances of the bowels of all degrees up to actual dysentery, common : but classical hill diarrhoea, still more sprue, never. I should say true dysentery is uncommon : catarrh of the bowels, especially the larger one, common. I have no records by me to give actual figures, and in any case doubt if the hospital records of Ootacamund would be of much value as one is writing at present of Europeans, and the vast majority of them, of course, were private patients or at least treated at home, and of them I have no exact records. But during three winters and four summers, there it was a very rare event, indeed, to have to send a patient down to the plains because of intractable diarrhoea; indeed, I can only recall one case of my own at present, and he afterwards died of liver abscess in England. Nor can I recollect, at the moment, any death of a European of the ordinary social standing of an Anglo-Indian officer from diarrhoea, and I am practically sure none such occurred though there were several deaths from liver abscess. In this connection it is interesting to note what Surgeon Major Whitton, M.B., B.A., then Civil Surgeon, wrote in 18S0 in the Manual of the Nilgiri District, the official publication dealing with that district: " There are no diseases peculiar to the hills. Diarrhoea and dysentery, said to be endemic in some of the Himalayan sanitaria, are not met with in this form 011 these hills.''