Traumatic peritonitis occurs as the result of cold or injury by wounds or blows and occasionally as the result of caustic poisons.
The intestines are distended, con a t ested, and more or less matted to gether, while the peritoneum is opaque and lustreless. As in inflammation of other serous membranes, so in inflamma tion of the peritoneum may be found the fibrinous, sero-fibrinous, purulent, putrid, and hTmorrhagic forms of exudation.
treatment of acute peritonitis is both medical and surgical. The old form of medical treatment by opium narcosis, small doses of calomel, and applications to the abdomen has been abandoned. Our present knowl edge of the etiology and pathology does not admit of it. In fact, opium should seldom be used in peritonitis except oc casionally for the relief of great pain and in some cases of peritonitis due to sudden rupture of gastric or intestinal ulcer when the object is to put the stomach and intestines at rest and so prevent peristaltic action and the further leakage of intestinal contents into the general peritoneal cavity. Operation should follow as soon afterward as pos sible. The later form of medical treat ment in peritonitis not due to perfora tion is by saline catharsis and the appli cation of cold to the abdomen. The saline is given in concentrated solution in doses of 1 to 2 drachms every two or ' three hours until several copious dis charges occur daily.
In cases of threatening acute septic peritonitis administration of saline ca thartics (magnesium sulphate, 30 to GO grains) advised. Opium ought not to be given in these cases. Opium should be administered in all cases of peritonitis which are due to perforation. Stimu lants should be freely given by the mouth or the rectum, and, if they are not readily retained, they should be ad ministered by injection. Early opera tion advocated in all cases of acute septic peritonitis. Senn (Brit. Med. Jour., Sept. 4, '97).
Many cases of threatened peritonitis aborted after abdominal section abated by the timely administration of saline eittharties. Tait's plan was to give SO or 40 grains (2 or 2 grammes) of sul phate of magnesia, repeated every hour or second hour until the bowels moved freely. Sometimes when the stomach is
intolerant it will be found expedient to resort to small doses of calomel. re peated each hour for a number of times. Coincidently saline rectal injections can be employed with benefit. Senn (Yew England Med. Jour., July, 1902).
Even in aseptic cases, to a limited ex tent there will be found the cardinal symptoms of inflammation localized about the field of operation. This reac tion is always present and is apparently due solely to traumatism. Some of the cases may be septic, and the inflamma tion may spread to the peritoneum. Post-operative peritonitis may often be prevented or controlled by the proper use of ice, when localized and consequent upon inflammatory affections of the pelvic organs. In several hundred of these eases personal mortality has hardly exceeded 1 per cent. Ice-bags are placed on the abdomen of patients in whom it is feared that peritonitis might develop. Simpson (Amer. Joni. of Obstet.. Nov.. 1002).
In connection with this treatment, the employment of decinormal salt solutions by intravenous injections or by dermoclysis has been highly recom mended and undoubtedly gives most excellent results. This latter measure is particularly useful in puerperal peri tonitis, when it should be used in con junction with frequent intrauterine irri gations.
Continuous irrigation with warn) nor mal salt solution may prove valuable in the treatment of heretofore fatal peri tonitis. The peritoneal cavity stands, with perfect safety, a continuous irriga tion with normal salt solution at a tem perature of 100° F. during 74 hours. The infection may entirely cease, together with pain, vomiting, and distension. The irrigation was comfortable, and no com plaints were made. The copious irrigation should dissolve and carry off the toxins as they are formed and, reaching the more dependent portions of the peritoneal cav ity, remove infectious material; effectual drainage would ensue. It acts as a tonic to the heart, some being doubtless ab sorbed into the system. The irrigation was carried out through an incision in the abdominal wall and with success in an apparently hopeless case. Ernest La place (Phila. :lied. Jour., Oct. 14, '99).