The treatment, in an ordinarycase of peritonitis (not arising from mechanical injury, or perforation from disease, or occurring in connection with puerperal fever), consists, if patient is moderately robust, in bleeding from the arm, till a decided impression has been made on the circulation; after which the abdomen should be covered with 20 or 30 leeches, and the bleeding from their bites should he encouraged by fomenting the loslly with flahnels wrung out of hot water, or, if the patient can bear its weight, by the application of a light poultice. The system must, at the same time, be got as speedily as possible under the influence of mercury, by the menus described in the treatment of pericarditis (q.v.). Opium may be given freely, not merely to guard against the purga tive action of the calomel, but with the view of securing sleep to the patient, and quiet to the inflamed membrane. The patient must be kept on low diet, unless Indications of sinking appear. In peritonitis from perforation the only remedy is opium, which nmst be given in large and repeated doses, so as to keep the bowels perfectly at rest, in order to promote the formation Of adhesion, by which alone the patient can be possibly saved. For the same reason, perfect rest must also be insisted on, and even drinks forbidden, thirst being allayed by the application of ice to the tongue.
Chronic peritonitis occurs in two forms, which differ in their origin and degree of fatality, but are very similar in their symptoms. lu the first the inflammation is of the ordinary character, and, although the disease sometimes originates spontaneously, it is more frequently the sequel of an imperfectly cured acute attack, in the second, it depends upon granules (supposed by Louis and most writers to be tubercles) lying in countless numbers in the scrolls membrane, and serving as a constant source of irrita tion. The second form is confined almost, if not entirely, to persons of a scrofulous
constitution.
The symptoms of chronic peritonitis are more obscure than those of the acute form. There is abdominal pain, often slight, and not always constant, which is increased by pressure, or sometimes is felt only whets pressure is made. The patient complains of a sensation of fullness and tension of the belly, although its size is not visibly increased, of a loss of appetite; and of nausea and vomiting; and the bowels are usually more or less out of order After a time, the abdomen enlarges, and becomes tympanitic, or more or less filled with fluid; and death gradually ensues from debility and emaciation, unless the fatal issue is accelerated by an acute inflammatory attack.
It is not always easy to determine, during life, whether the disease belongs to the first or second form. When its origin cannot be traced to a preceding acute attack, to iaeal abdominal injury, or to chronic affections of the abdominal viscera, there is strong reason to believe it to be of the granular, or, as it is commonly called, the tubercular form, especially if the general constitution and the hereditary tendencies of the patient point in the same direction.
Little can be done in the way of treatment, especially in the tubercular form, fur ther than mitigating the most distressing symptoms, and • possibly retarding the final issue. The frequent application of a few leeches to the abdomen, followed by warms, poultices, occasional blisters, attention to the how els, which, if costive, should be acted upon by gentle laxatives, and a mild, nourishing, but unstimulating diet, are more likely to be of service than remedies of a snore energetic nature. •