1403. Diseases Of The Abdominal Viscera

In Acute Peritonitis, Calomel, combined with Opium, is the sheet-anchor, after local or general depletion. It should be given early, and repeatedly, till the system become affected. Dr. M'Adam* notices a fact which has been observed by other physicians, that, when the gums become sore, the symptoms improve and the patient almost invariably recovers. The bowels should be kept open by mild enemas, and antiphlogistic measures enforced. A similar treatment is most effectual in Enteritis. Purgatives of a strong or irritating nature should be avoided.

1404. In Gastro-Enteritis complicated with lesions of the Lungs (by no means an uncommon complication), Dr. Stokes considers that a combination of Mercury with Opium, so as to induce ptyalism, is the remedy the most entitled to confidence, after bleeding and the use of blisters. Care should be taken that it does not purge, as such an effect is decidedly injurious in this form of disease.

1405. In Acute Hepatitis, occurring in otherwise healthy persons, a full blood-letting, followed by a full dose of Calomel (gr. x.) and Opium (gr. j.), and subsequently by a purgative (Pulv. Jalapaj Co. 3j. often mitigates or subdues the urgency of the symptoms. If they, however, persist, the induction of a mild degree of ptyalism is advisable. Here Calomel and Opium may be given in small and repeated doses, and they may in all cases be advantageously conjoined with Tartar Emetic, as pointed out by Dr. Cutlilfe.* Leeches to the verge of the anus, to relieve the portal circulation, are often most serviceable. Hot fomentations to the abdomen are also useful. Perfect rest and a strict antiphlogistic regimen should be enforced. In neglected cases, and when the disease occurs in asthenic individuals, the above treatment requires modification. When the violence of the symptoms is subdued, Nitro-hydrochloric Acid may be had recourse to with advantage (see that article). It is only in the earlier stages of Hepatitis that Mercury can be of any service: when the inflammation has progressed and passed into a state of suppuration, no advantage can be expected from Mercury; it cannot cause the absorption of pus, and by debilitating the patient it may tend to increase the general disturbance of the system. The extreme difficulty of inducing salivation after abscess has formed in the liver is well known. The Mineral Acids, the Iodides, counter-irritation, setons, &c, promise, under such circumstances, more advantage than mercurials.

* Cyc. Pract. Med., vol. iii. p. 307.

Ibid., vol. ii. p. 337.

calomelas.

1406. In Chronic Hepatitis, alterative doses of Mercury, so as to correct a vitiated state of the biliary secretion, are often of great benefit. Dr. J. Johnson advises the following formulae: -

1403 Diseases Of The Abdominal Viscera 114 Ext. Coloc. Co. 3iss., Calomel, gr. xv., Ant. Pot. Tart, gr. iij., Ol. Carui gutt. viij., M. ft. pil. xxx.; or, Ext. Aloes j., Pulv. Antimonialis gr. x., Pil. Hydrarg. j., Ol. Carui gutt. vj M. ft. pil. xv. Two of these pills are to be taken at bedtime. These, with a seton over the region of the liver, and the use of the nitro-muriatic bath, are spoken of as being highly efficacious. The salts of Iodine may sometimes be advantageously substituted.