Prognosis.—Simple typhlitis almost always ends favourably ; but if perforation occur, and extravasation take place into the peritoneum, re covery rarely follows. If a retro-peritoneal abscess result from the per foration, the prognosis is less unfavourable ; but here, too, the patient often dies from exhaustion, or from extension of the inflammation to the serous membrane. The most favourable course is that in which the abscess discharges itself again into the bowel. Of the cases where it opens ex ternally, a large proportion die. Perforation of the ctecal appendix is usually fatal.
every case of typhlitis our chief care should be to quiet peristaltic action, and.prevent any movement of the bowels, by the free use of opium. Whether the inflammation has had its origin in a collection of ka cal matter in the .cteCum, or has been induced by other causes, the same necessity exists for keeping the bowels at rest until the inflammation has subsided. Therefore an aperient in any sliape is not to be thought of for a moment. Even enemata would be injurious while the acute symptoms continue.
The child should lie in bed, with a small pillow under his right knee; and hot linseed-meal poultices should be applied to the right side of the belly, and be frequently changed. Opium should be given by the mouth. A child of eight years of age will take three drops of laudanum every four hours. If this be vomited, Morphia (one-sixteenth to one-twelfth of a grain) can be injected subcutaneously in its stead. The vomiting is, however, usually checked by the opiate, and the second attempt to administer it in a draught is often successful. A good combination in these cases is that of the tinctures of opium and belladonna. The latter drug is not only of great service in most forms of arrested function of the bowels, but also by its antagonistic action tends to modify the narcotic influence of the laud anum without interfering with its power as a sedative. If this combination be used, five drops of tincture of opium may be given with twenty of the belladonna tincture three times a day to a child eight years of age.
If the child be very strong, and the tenderness severe, three or four leeches should be applied to the painful spot.
The diet must consist of milk and broth, given in small quantities at a time. The milk should be diluted with an equal quantity of barley-water, to separate the particles of curd and prevent their coagulating in a lump. It should be also alkalinised by fifteen or twenty drops of the saccharated solution of lime to the teacupful.
When the acute symptoms subside the bowels will generally act spon taneously. If they do not, an injection can be administered. Purgatives of any kind should be avoided for some time after convalescence is estab lished. We can never be sure that some slight ulcerative process is not going on, and the only hope of the child in such a case would be the establishment of sufficient adhesions to prevent rupture and extravasation. Such adhesions, if formed, an aperient would probably destroy.
In cases where we have reason to suspect the presence of a retro-ctecal abscess, the same, reason for the avoidance of purgatives exists. The child should be kept in bed, and hot applications should be applied to the pain ful part. He should be fed with nourishing food in small quantities at a time ; and a suitable proportion of stimulant should enter into his diet. Minced mutton and chicken, strong beef-essence, yolk of egg, milk and toast should form the staple of his food. If the bowels are obstinately con fined, or faecal vomiting occur, an enema may be administered, but purga tives should be avoided. For medicine, quinine and a mineral acid, with small doses of may be given, and as the child grows weaker, am monia and bark. Directly signs of pointing are noticed the pus should be let out at once.
If peritonitis occur, the treatment must be conducted as directed in the chapter treating of that subject.