This disease like gastritis is exceedingly painful and rapid in its progress. In its idiopathic form or setting in from the commencement as an inflammation of the bowels, it is by no means of frequent occurrence, yet as a symptomatic affection, setting in during the progress, or the sequele of some other disease, such as the various forms of fever, it is of very frequent occurrence. We are apt to find the symptomatic form existing to a greater or less degree in almost every variety of acute inflammation.

Diagnosis

Where the peritoneal coat is the principal seat of the disease, it is called "Peritonitis," and is accompanied in a greater degree, in addition to the usual symptoms of enteritis, with high fever, violent pain and an extreme sensitiveness of the abdomen to the touch. One variety of this disease we shall refer to under puerperal fever. In the acute form of enteritis, involving the sub-mucous tissue and peritoneal coat, as well as the mucous membrane, we have violent burning, cutting pain, generally in one spot, especially in the region of the navel, and gradually extending over the abdomen, increased by the slightest pressure with tightness, heat and distension of the abdomen. The patient lies on the back, with the knees drawn up, and using only the muscles of the chest in breathing, avoiding, on account of the intense pain, every motion of the body. There is obstinate constipation ; nausea and vomiting, so violent that not only every thing taken into the stomach is thrown up, but even faeces; constant desire for cold water, which, however, produces aggravation of pain. The pulse, as in all acute abdominal inflammations is small and wiry, or weak and like a thread. As the disease advances, there is hiccough, the pulse heats irregularly, the extremities grow cold, the features are sharpened and ghastly, and cold sweat breaks out. Delirium may occur toward the last, but generally the intellect remains clear. When the disease ends in death, similar symptoms to those mentioned in gastritis occur, terminating in gangrene. The pain ceases, the pulse becomes weak and scarcely perceptible, the extremities cold, and the impress of death is seen stamped in visible characters on the face, in the sharpening features, the glazing eye and the cold breath. The less acute form of this disease, or that developed by other diseases, is not characterized by the same violent symptoms, but may end in obstinate constipation, perforation of the intestines and gangrene. In this variety, the pain is more diffuse, and diarrhoea of a slimy or bloody character may also be present.

* For a description of the intestines, see plate 4, and Anatomy.

Causes

It may arise from mechanical injuries, errors in diet, abuse of ardent spirits, the pernicious practice of eating chalk, magnesia, etc.; from cold, suppressed eruption, drastic cathartics, worms, parturition, and in connection with other diseases such as the malignant fevers.

Treatment

The utmost quiet is of course essential, and in those cases where the patient can not bear the lightest pressure on the abdomen, it may be protected from the weight of the bed-clothes by a light framework not allowing the clothes to touch the skin. A warm bath, if the patient is able to bear it, or sponging the abdomen with hop-water, will be found advantageous. The obstinate constipation being occasioned by inflammation, will not be relieved by the most violent cathartics, and when that inflammation subsides, the constipation ceases or is readily controlled.

Aconite should commence the treatment as directed in gastritis, and be continued so long as the fever is intense, the skin hot and parched.

Arsenicum is a prominent remedy in the severe forms of this disease; there is prostration of strength, intense burning pain. It may be given either alone or in alternation with Veratrum. For particular indications, see Gastrits. It is also a prominent remedy in the less acute forms of the disease, where there is burning heat. thirst, increase of pain after cold drink, nausea, fetid diarrhoea, and extreme debility.

Belladonna

Red and smooth tongue, or coated in the centre with red tip and margin; dry and hot skin, thirst, delirium, particularly at night; sensation of soreness in the abdomen, with tenderness on pressure. Belladonna is a prominent remedy in the severe forms of this disease, and is very often indicated in alternation with Mercurius.

Dose

Two drops, or twelve globules, of the above remedies in a tumbler of water, a tablespoonful at a dose; or six globules dry on the tongue. Give every one or two hours.

Mercurius

The tongue is foul, coated white or brown; dry or covered with thick mucus; great thirst, abdomen tender to the touch, hard and distended; watery, bilious, and offensive stools; urging to stool, followed by severe straining and the passage of blood. There may be prostration of strength, chilliness, and disposition to perspire during the night.

Dose

A powder, or six globules, every two or three hours.

Nitric acid is serviceable where Mercury has proved insufficient, particularly in chronic cases, where there is tenderness and tenesmus, especially where the disease occurs in those persons who have taken large quantities of calomel.

Dose - Two drops of the first dilution, in a tumbler of water, a tablespoonful once in six or twelve hours.

Opium and Plumbum are the prominent remedies where there is vomiting of feces, spasmodic pain about the stomach or abdomen.

Dose

Of the former one drop, or twelve globules, in a tumbler of water: of the latter a powder, or three globules dry on the tongue. Give every three or four hours.

Nux-V

There is soreness with burning heat in the abdomen, loss of appetite, vomiting of food, pain on drinking, constipation, flatulence, or watery or bloody stools with straining. Sulphur is frequently indicated in alternation.

Dose

A powder, or six globules, every four, six or twelve hours.

Catharides

In severe cases where there is a discharge of pure blood and an inability to pass urine, also in the advanced state of this disease.* See also Dysentery.

Dose

One drop, or six globules, in a tablespoonful of water, every three hours, until the severity of the symptoms have subsided.

Veratrum - may follow Arsenicum, especially when there is coldness of the extremities; great prostration, severe burning about the navel, nausea and vomiting.

Dose

Two drops, or twelve globules, in a glass half full of water, a teaspoonful every hour, unless in alternation with Arsenicum and then every two hours.

Besides the remedies already enumerated, Bryonia, Colocynth, Chamomilla, Pulsatilla, China, Rhus, Phosphorus may also be consulted. As the more common forms of inflammation of the bowels occur in connection with other diseases, the particular indications of many of the remedies will be given when speaking of those diseases. Consult Worms, Gastritis, Hepatitis, Diarrhoea, Dysentery, Colic.

Diet

Same as in Gastritis.