PERITONITIS Notes on Treatment


In the treatment of peritonitis, local symptoms must be carefully compared with the general condition, especially with the state of the circulation, the bodily temperature and what is of equal importance, the mental state….


IN no disease is it more important to observe strictly every Homoeopathic rule of prescribing; for the vital forces are quickly and profoundly depressed, and a mistake in the choice of the remedy may precipitate a fatal termination. Local symptoms must be carefully compared with the general condition, especially with the state of the circulation, the bodily temperature and what is of equal importance, the mental state.

Mucilaginous drinks acidulated with tamarinds of or lemon juice are are often grateful and soothing to the irritated stomach. If the lemonade be made hot and then allowed to cool it is less likely to cause intestinal griping. Effervescing drinks may increase the tympany, and should usually be avoided. During the early stages, when the fever runs high, farinaceous foods may he given; but if the liver is so diseased as to interfere with biliary secretion, starch and oily foods will not be readily digested, and must be mainly substituted by mutton, beef or chicken broth. In such a contingency the broth should be allowed to cool first, that all the fat may be skimmed off. In large cities poultry is brought to market so poorly and improperly, fed, that great care is needed in its purchase.

Alcoholic drinks should be interdicted except in advance cases, in which vitality is very low, or where blood-poisoning demands them.

ACONITE.- Burning-cutting pains, worse from the slightest motion and from lying on the right side; hard, frequent pulse; skin hot and dry. Abdomen hot and sensitive to touch. Face anxious; restlessness; fear of death. Caused by checked sweat, exposure to dry, cold winds, drinking ice-water while fatigued and hot. Puerperal cases especially in full-blooded women, when violent, emotions seem to have caused a checking of the lochia. Hahnemann’s advice here is imperative, not to give Aconite simply because there is fever or because there is synochal fever, but to be guided by the infallible accompaniments of restlessness and mental agony.

VERATRUM VIRIDE. has come into fashion as a rival of Aconite. It is selected in the beginning of inflammations by the pulse, which is said to express great arterial excitement. But the two remedies are really not at all similar. The Veratrum rather pictures asthenic fever of a low type. Congestions and inflammations are accompanied by delirium, great prostration, and, what is very characteristic, a red streak down the centre of the tongue. It has no action on serous membranes, like Aconite.

BELLADONNA.- Abdomen distended, hot, and exquisitely sensitive to touch or to the least jar of the bed; pains in sudden attacks, which come and go suddenly; or less frequently, gradually increase and gradually decrease (see Allen, Vol.II P.102). Sometimes Enteritis co-exists, with clutching as from nails at the navel; bloody, slimy diarrhoea. Bodily temperature very high. On raising the bed-clothes a hot steam rises. Head very hot and dry; or hot and yet bathed in sweat. Feet cold, head hot. This is not the coldness indicative of collapse, but of upward congestion. Urine scanty and sometimes golden- yellow. Delirium, varying from simple starts in sleep to furor, with red, congested face and throbbing carotids. The face instead of being red, may appear pale, hot, and expressive of deep-seated distress. There are drowsiness, and stupor, but is easily aroused.

Belladonna especially attacks the uterus and ileo-caecal region, and should be studied in Metritis with Peritonitis, and also in Typhlitis. In the former case the lochia will be checked or hot, and occasionally in offensively-smelling clots. There is also backache; she feels, as if her back was broken.

CANTHARIS.- That portion of the peritoneum which covers the bladder is particularly affected; frequent and painful urination; the urine passes in drops and may be bloody; tenesmus vesiae and burning, cutting continue after micturition. Cutting, griping, burning, and wandering pains, worse in the lower abdomen. Face indicates extreme suffering; eyes sunken. Also indicated when effusion has taken place. and still more when collapse results from internal suppuration; surface cool; he lies unconscious with outstretched arms, which occasionally jerk; convulsions; suppressed urine.

Bryonia, Cantharis, MercuriusCor., Apis and Sulphur are useful especially when exudation has taken place. It would be an egregious mistake to select one of these, or of any other group, merely because they have been known to produce seroplastic effusions. The individual symptoms must always determine the choice.

BRYONIA acts well, especially in rheumatic patients and when the diaphragm is attacked as shown by stitches with each breath or motion of the body. Tongue dry, possibly white down the center. There is none of the restlessness and agony of Aconite. He desires to lie perfectly still and be quiet. Still, his face is a perfect picture of anguish; he breathes in quick, short inspirations, which oppress him, and in some instances he is impelled by his distress to move, but desists, for the pains become thereby aggravated. The fever runs higher than with Cantharis, and the urine is scanty, dark, red and clear.

MERC. COR. has produced in toxic doses peritoneal effusion. The exudate is purulent, and is accompanied with creeping chills, sweat without relief, and cutting, stabbing griping pains. There is less of the well-defined stitch which characterizes Bryonia. Both MercuriusCor. and Cantharis have strangury with intense burning and if Enteritis complicates, both may have slimy, bloody stools. The latter, however, is relieved by perspiration.

APIS MEL. is recognized by a distressing aching soreness of the abdomen, which will tolerate no pressure; burning stinging pains, or sudden knife-life thrusts through the abdomen. Urine scanty, dark and often albuminous. Absence of thirst, or drinks little and often. Oedematous puffiness of the face. In bad cases, with Enteritis combined, he passes thin yellow stools with every motion of the body, as though the anus and rectum were paralyzed. Infants and those predisposed to Tuberculosis scream out in their sleep, – a sudden shrill cry from cerebral irritation. Face looks distressed, the feels, as if he would die; but he is not so full of fear as to indicate Aconite. Sleepy but cannot sleep. This differs from Belladonna; the Apis patient can’t sleep because he feels so nervous and fidgety.

When typhoid symptoms develop, Rhus Tox, Lachesis, Lycopodium, Arsenic and Baptisia stand foremost.

RHUS TOX. is most frequently indicated. Tongue red, dry; red at the tip; tympany; restless change of place; change of position relieves his pains, though it increases his weakness and compels his to desist. Muttering, not violent delirium. His dreams are full of laborious effort; he thinks he is swimming, climbing hills, etc. If Enteritis is present the stools are bloody, and each movement is accompanied with tearing down the thighs.

BAPTISIA deserves the preference when he is confused as to his personal unity,- thinks himself double, scattered in pieces, etc. Tongue is brown, especially down the centre. Stools dark, bloody, painless. Fever and temperature show decided evening exacerbation.

LACHESIS inflames the caecum. Even if unconscious, he will resist the slightest touch to the abdomen; parts most distant from the heart are cool; pulse rapid, feeble, or intermittent; arouses from sleep smothering. This smothering may also suggest Baptisia, but the conditions are different. The tongue trembles and catches behind the lower teeth.

LYCOPODIUM.- Rumbling in the splenic flexure. Diaphragmitis, with feeling of a cord making the costal attachments of the diaphragm; tympany. Especially useful when the brain shows signs of giving out; he becomes more and more drowsy; eyes half- open, expressionless, and covered with a film; the lower jaw tends to drop; one foot cold and the other warm; no urine in the bladder, or it passes involuntarily and stains the sheets with a red sand.

ARSENIC is invaluable when the patient is pale and hot, eyes half-open, with absence of winking; “gum” on the eyes; restlessness or great anguish after 12 P.M. These symptoms are not uncommon in infants.

HYOSCYAMUS must be remembered when there are spasmodic jerking delirium; she suddenly sits up, looks around and lies down again; uncovers herself; lascivious talk; or, stupor; stool and urine involuntary; the urine leaves a streaks of red sand on the clothing.

TEREBINTHINA.- Burning in the uterus; tympany; tongue dry and smooth; urine scanty, dark, smoky, with strangury.

KALI CARB. – Stitching pains all over the abdomen; tympany; urine scanty, dark; nervous; easily startled if touched, especially if the feet are touched; unconsciousness in puerperal Peritonitis; or, stupid, cares for nothing; when questioned is at a loss what to reply; pulse rapid, weak, or intermittent.

In Peritonitis of infants, generally tuberculous, compare with the above. Sul., Silicea, CalcareaOstr., CalcareaPhosphorus, Phosphorus Iodine, Arsenicum Iod., Baryta C., Psorin, etc.

CALC. OSTR.- General symptoms agreeing, it must be remembered when, in child or adult, the abdominal pains are relieved by cold applications. This exceptional symptom of Lime is recorded in Raue’s Pathology, and may be inferred from the provings. In Allen, Vol., II P. 365, we read; “Frequent attacks of colic after the disappearance of a severe coryza that had lasted two days, with great weariness and sickly look of the face, lasting several days, and then suddenly and completely relieved by bathing in cold water.”

For Typhlitis, which frequently leads to Peritonitis; Belladonna, Lachesis, Mercurius, Mercurius Cor., Rhus Tox., Nux Vom., Ginseng. Hepar, Opium, Plumbum, Rhamn. Frangula, etc.

The tympany which so annoys the patient is a very dangerous symptom when occurring late in the disease. For this compare: Opium, Lycopodium, Kali.C., Terebintha, Rhus Tox., Colchicum, Carbo Veg., Phosphorus, Cinchona, Veratrum Alb. and Cocculus.

RAPHANUS produces distended abdomen; no emission of flatus either upwards or downwards. Dr. Bell’s case confirming this symptom is suggestive and should lead us to a careful study of the drug.

E. A. Farrington
E. A. Farrington (1847-1885) was born in Williamsburg, NY, on January 1, 1847. He began his study of medicine under the preceptorship of his brother, Harvey W. Farrington, MD. In 1866 he graduated from the Homoeopathic Medical College of Pennsylvania. In 1867 he entered the Hahnemann Medical College, graduating in 1868. He entered practice immediately after his graduation, establishing himself on Mount Vernon Street. Books by Ernest Farrington: Clinical Materia Medica, Comparative Materia Medica, Lesser Writings With Therapeutic Hints.