The Investigation of Persistent Diarrhoea

Diarrhoea is the passage of loose stools so frequently as to cause annoyance. To some patients, four bowel actions a day is an intolerable nuisance, some are much more stoical, while others complain freely when the inconvenience is less. The severity of Pain, urgency and tenesmus accompanying the diarrhoea often determines whether 1 patient seeks medical help or not. By persistent diarrhoea is meant the occurrence frequent loose stools, continually or intermittently for a period of over three weeks. It is true that many patients with chronic diarrhoea begin their illness abruptly, but 'he problem of acute flux itself is beyond the scope of this paper. Whereas in acute cases the emphasis is on the search for and treatment of an infective agent, together with the Palliation of symptoms and treatment of dehydration, in the case of persistent diarrhoea the search for a cause has spread far beyond the confines of infection. Indeed, in temperate climates an infective cause is the exception rather than the rule, ^et the almost automatic action on the part of many doctors faced with a case of Persistent diarrhoea is to obtain a specimen of faeces and send it many miles to a Public health laboratory with "? organisms" on the request card. The patient's difficulties with the ice cream carton provided are matched by those of the bacteriologist the other end, who naturally finding plenty of organisms has to report in such terms as "No significant departure from the normal bowel flora". In circumstances like lhese it is well to ask what precisely we are looking for, and I suppose the answer ^'Ould be "typhoid and paratyphoid, and things like that". It is true that in infants and children, cases of paratyphoid fever may occur with persistent diarrhoea as a Main symptom, but in the adult, diarrhoea if it occurs at all is completely overshadowed by the feverish and constitutional symptoms. It is true also that in the very old or debilitated, chronic Sonne Dysentery or other salmonella infections may cause persistent diarrhoea. In these cases, especially if the illness is accompanied by fever, the bacteriological search for non-lactose fermenting organisms by culture is worthwhile. Where the patient has been abroad and chronic amoebic dysentery or lambliasis are ^spected the examination of old stale specimens of faeces is completely useless. If lhese diseases are suspected the faeces should be taken straight from the rectum …