When peritonitis arises from exposure to cold, and only then, is **Aconite the remedy. The indications are a rapid increase of the fever, with violent peritoneal pains. Here it will relieve the pains and reduce the raging febrile storm, and after this is accomplished the remedy should be discontinued. It may perchance be the remedy in traumatic peritonitis, but as soon as the disease has localized itself **Aconite is of no more use than it is in peritonitis from perforation, obstruction of the bowels or in the infectious forms. For the sharp febrile attacks the lower dilutions in repeated doses are to be preferred.
**Ferrum phosphoricum is also a valuable remedy for peritonitis arising from cold.
The second stage of peritonitis, especially of the serous variety, corresponds well to **Bryonia; as a rule, however, it should not be given if copious diarrhoea be present. Thus we see that this remedy comes in at the most important stage of the disease, and it may be given until the effusion becomes free or purulent, when the symptoms will no longer correspond. It is indicated when the fever is violent with a burning heat all over; the patient is in an impatient irascible mood and the excitability of the nervous system is marked. There is violent thirst, the patient drinking much and probably vomiting it soon afterwards. The patient is alternately chilly and hot, and the great characteristic of the remedy is present, namely, sharp stitching pains in the abdomen worse from pressure and motion. The abdomen is also swollen, hot and sensitive; there is constipation and the patient has a yellowish gray complexion.
**Sulphur follows **Bryonia, but if ulcerative symptoms be present do not give it, as it would be a loss of time.
It comes in after **Aconite in peritonitis from cold.
The characteristic of **Belladonna are the swollen abdomen, which is tense like a drum, very sensitive to touch, so sensitive that the patient wants the bedclothes removed. The least jar greatly aggravates. There is a pungent heat of the body it seems to steam out on raising bed clothes, the abdomen is intensely hot. There is much cerebral irritation; perhaps delirium and the discharge is scanty or suppressed. The slightest noise, loud talking and light aggravates. The patient is uneasy; must constantly change her position, but is made worse thereby. There is a sensation as if the bowels were grasped or clawed and a violent pressure towards the genital organs; the latter symptom is almost a deciding one. There is also a continued distressful retching, and vomiting even of bile. This vomiting is especially met with **Belladonna. Dr. Kafka recommends, in case **Belladonna fails, **Atropine sulphate 6X, especially is this remedy useful in secondary peritonitis in sensitive individuals, at the commencement of perforation.
When suppuration has commenced, and the abdomen is tympanitic, showing evidences of effusion which is partly serous and partly purulent, and the patient has rigors and sweats, **Mercurius is the remedy. It follows **Belladonna well and often. There is the nocturnal aggravation, the desire for cold water, the borborygmus and the diarrhoeic stools. Frequent exacerbating fever with creeping chills and copious perspiration, with no relief, is a group of valuable symptoms for **Mercurius.
**Mercurius corrosivus is also useful, especially in the purulent form, with burning and cutting pains. Hughes prefers it to **Bryonia, in most cases, but it is likely to be better indicated in the purulent cases than in the serous cases. Peritonitis with effusion. The inflammatory action of this drug is intensely acute and tends rapidly to septic and gangrenous disorganization. It is especially useful in violent cases.
Rhus toxicodendron. [Rhus-t]
When there is a typhoid tendency **Rhus is the remedy in most cases. The fever is high, the tongue is dry, the tip is red, the skin is also dry and there is great adynamia and weakness. It comes in late in a case, after **Bryonia, where there is swelling of the abdomen and diarrhoea which has been preceded by constipation. Its application to septic stages and its well-known power to prevent absorption of poisonous materials renders renders it a most valuable medicine.
**Terebinth. When renal complications arise and there are violent drawing pains in the region of the kidneys, scanty, bloody or suppressed urine, excessive abdominal distension, weakness and prostration this remedy will not disappoint.
Another remedy for the low forms is **Lachesis. Here the fever is worse at night. The slightest touch to the surface of the body is unbearable. It follows **Belladonna well. There is tenderness at one spot and typhoid symptoms are present. In inflammations associated with a gangrenous tendency, such as is found in appendicitis, it may be well indicated.
**Apis may be useful in the chronic form, with tendency to dropsies.
**Colocynth is also recommended, but it hardly corresponds to inflammatory conditions of any kind. It belongs to the neurotic remedies.
**Arsenic iodide corresponds especially to the tubercular variety and **Arsenicum album is of great value in septic cases of an asthenic type.