PERFORATING DUODENAL ULCER. 



583 



save employment. By far the most certain and useful remedy is opium, 

 little as we positively know of its manner of action. If a diarrhoea 

 Beem dangerous, and we wish to check it quickly and certainly, we 

 may use laudanum (3j 3 ss to vj of mucilage, or weak infusion, 

 of ipecac. Give a tablespoonful every hour). Opium given by enema 

 is not less serviceable than when given by the mouth,. 



Intestinal disease is only one symptom, and is not even a constant 

 symptom, in typhus fever [Professor N. divides typhus fever into exan- 

 thematous or typhus, and abdominal or typhoid fever. This explains 

 why he does not consider the bowel affection as by any means a con- 

 stant symptom] ; hence it is impossible to fully describe the typhous 

 disease of the intestine without depicting typhus fever. Moreover, 

 typhous bowel affections are the result of the specific infection, 

 which we are compelled to admit in typhus. On this account, when 

 considering the infectious diseases, we shall speak both of typhus 

 and the accompanying intestinal affection. 



The case is somewhat different with the intestinal affections in Asi- 

 atic cholera and dysentery, induced by miasma ; for, in these affections, 

 disease of the intestines is very rarely absent, and all the symptoms of 

 cholera and dysentery may be deduced from the bowel lesions. Hence, 

 we have spoken of cholera morbus and catarrhal dysentery in the 

 present section, and will treat of epidemic cholera and epidemic dys- 

 entery in a future one, because we believe that, from a proper inter- 

 pretation cf the etiological causes, the latter must be regarded as 

 infectious diseases. 



CHAPTER II. 



PERFORATING DUODENAL ULCER. 



THE cases of perforating ulcer of the duodenum, scattered through 

 the journals, hand-books of practice, and monographs, on the diseases 

 of the duodenum, or of the intestine, were first collected by the indus- 

 trious and meritorious labor of IZrauss, and were so carefully analyzed 

 that it is now possible to state something positive about this disease 

 which is probably not very rare. 



ETIOLOGY. From the great resemblance, as well of the anatom- 

 ical appearances as of the symptoms, course, and results, it is more than 

 probable that perforating duodenal ulcer is due to the same processes 

 that cause perforating ulcer of the stomach ; hence, that it is not a 

 proper ulceration, but a necrosis, and a solution of the necrosed part of 

 intestine by the gastric juice. 



It is difficult to give any thing definite concerning the frequency 

 of duodenal ulcer, for doubtless some cases that have not led to perfo- 



