ACUTE GENERALIZED PERITONITIS.— In this condition the chief distinctive features are an early rise of temperature, the history, and the general tympany and abdominal tenderness. There is a history of appendicitis, ulcer, trauma tism, or some condition capable of lead ing to peritonitis, attended by an early and marked rise of temperature. The pain is not localized and the abdominal wall is so tender that the weight of the sheets even causes severe suffering. The abdomen is greatly and generally dis tended, and peristaltic action cannot therefore be discerned. The later stages of the cases also differ: collapse comes on later, while fmcal vomiting is never observed.
Importance of a very careful diag-,nosis emphasized, a,s intestinal obstruction has been frequently confounded with hys teria, hepatic colic, crises in locomotor ataxia, and certain forms of poisoning. L. Revilliod (Revue Mk'. de la Suisse Rom., Sept. 20, '92).
Etiology and Pathology. — Though the term "obstruction" is usually- in eluded in the list of diseases, it is ob viously- not an affection, but a mere gen eral appellation indicating the general etiological factor. The causes, nature, and the lesions attending the various forms of obstruction are, therefore, to be reviewed under this head.
STRANGULATION.—Of all the varieties of obstruction, this is the most frequent, representing, as it does, fully one-third of the cases classified. Strangulation
occurs as the result of adhesions in over 60 per cent. of cas.es, the bands being due, in the majority, to previous attacks of peritonitis, to various causes, or to any other local inflammatory process en tangling, compressing, or surrounding the loop of intestine involved.
Strangulation may also be the result of an anomalous union between the end of Meckel's diverticulum and the ab dominal wall or the mesentery, a loop being thus formed into which a portion of intestine may become engaged and strangulated. The tip of the vermiform appendix may also, in the same manner, become the source of strangulation. Slits in the omentum or mesentery, or peritoneal openings or diverticula, ad ventitious or normal, the foramen of Winslow, the duodeno-jejunal fossa, openings in the diaphragm, etc., repre sent as many traps into which a loop of intestine may become caught and strangulated.
The small intestine is involved in 90 per cent. of the cases; and the obstruc tion occurs, according to Osler, in the right iliac fossa in 67 per cent. of the cases and in the lower abdomen in 33 per cent. Seventy per cent. of the cases occur in males, and 40 per cent. of all cases occur between the ages of 15 and 30 years.