PERITONI'TIS, or INFLAMMATION OF TIIE PERITONEUM, may be either an acute or a chronic disease.
Acute peritonitis presents well-marked symptoms. It sometimes commences with a chill, but severe pain in the abdomen is usually the first symptom. The pain is at first sometimes confined to particular spots (usually in the lower part of the abdomen), but it soon extends over the whole abdominal region. It is increased, on pressure, to such an extent that the patient cannot even bear the weight of the bedclothes; and to avoid, as far as possible, internal pressure upon the peritoneum, he lies perfectly still, on Lis back, with the legs drawn up, and breathes by means of the ribs, in consequence of the pain occasioned by the descent of the diaphragm in inspiration. The breathing is naturally shallow in these cases, and, less air being admitted at each movement of respi ration, the number of those movements is increased. There are perhaps 40 or even GO respirations executed in a minute, instead of 18 or 20. The pulse is usually very fre quent, often 120 or more in the minute, and small and tense, though occasionally strong and full at the commencement of the attack. After the disease has continued for a cer tain time, the belly becomes tense and swollen, the enlargement being caused at first by flatus, and afterward also by the effusion of fluid, as may be ascertained by percus sion and auscultation.
The progress of the disease is in general rapid. In fatal cases, death usually takes place within a week, and often sooner. The symptoms indicating that the disease is advancing towards a fatal termination are great distention of the abdomen, a very frequent and feeble pulse, a pinched and extremely anxious appearance of the face, and cold sweats Peritonitis may arise' from any of the ordinary causes of inflammation, such as sud den change of temperature (especially the combined effects of cold and wet on the su• face of the body), excessive use of stimulating fluids, the suppression of long-standing discharges, translation of gout and rheumatism, etc. It is frequently the result of local
violence, and of wounds penetrating the peritoneal sac, including various surgical oper ations. Besides the above causes, there are two which give rise to special varieties of peritonitis, viz., contagion or infection, which often crevails epidemically, and produces great mortality amongst women after childbirth, giving rise to puerperal peritonitis, one of the most perilous accompaniments of the awful disorder known as puerperal fever (q.v.); and perforation of the stomach, bowels, gall bladder, urinary bladder, etc, by which their contents are allowed to escape into the peritoneal cavity, where they excite the most violent inflammation Peritonitis from perforation is characterized by the sud denness of the attack, intense pain, incapable of mitigation by medicine, all at once arising in some part of the abdomen, the whole of which soon becomes tender in every part. This form of the disease is generally fatal, death usually ensuing within two days, and sometimes within a few hours. Perforation of the small intestine, in conse que;:ce of ulceration of the glands, is of not uncommon occurrence in continued (typhoid) fever, and sometimes occurs in phthisis.• That apparently useless structure, the vermiform appendage of the mount, is a comparatively frequent seat of perforation. Sometimes it is the stomach which is perforated, and in these cases the patients are usu silly unmarried women (especially domestic Servants), who had previously appeared in good health, or at most had complained of slight dyspepsia.
The only disease with which peritonitis is likely to be confounded by the well-edu cated practitioner is a peculiar form of hysteria; but the age and sex of the patient, the presence of hysteria in other forms, and the general history of the patient and of her symptoms, will almost always lead to a correct diagnosis of the disease.