fact that the disease occurs principally during the rains. Chill after exposure to the high temperature of the plains has possibly an important share. Manifestly there is a suspension of the functions of the liver and, considering the dyspepsia and looseness, most probably of those of the pancreas and of the other glandular structures subserving digestion. Hill diarrhœa is certainly something more than an intestinal catarrh. As Crombie pointed out, it is more in the nature of dyspepsia. There are no adequate grounds for connecting it with either the water or the food supply. The question of micro-organisms has, apparently, not been studied.
Symptoms.— Without very obvious cause the patient, who in other respects may be in good health, soon after arrival at a hill sanitarium becomes subject to a daily recurring diarrhœa, the looseness coming on regularly every morning some time between 3 and 5 o'clock. The calls to stool are apt to be sudden and imperative. The motions passed are remarkably copious; very watery in some instances, pasty in others. They are pale, frothy, and like recently stirred whitewash, so devoid are they of biliary colouring matter. Their passage is attended with little or no pain, often with a sense of relief. From one to half a dozen, or more, such stools may be voided before 11 a.m. After that hour, at all events in ordinary cases, the diarrhœa is in abeyance for the rest of the day, and the patient may then go about his duties or pleasures without fear of inconvenience.
The distinctive features of this form of diarrhœa are, therefore, the regularity of its recurrence every morning and its cessation after a certain hour in the forenoon; the absence of colour in the stools; and the attendant flatulence. The abdomen is sometimes blown out like a drum, the patient being conscious of unpleasant borborygmi associated with a feeling as of some boiling or chemical operation proceeding in his inside. Occasionally cases are met with in which the stools are very pale although there is no diarrhœa.
Under treatment, or spontaneously, or, according to Crombie, on acclimatization occurring, after some
