Nine cases of diffuse septic peritonitis treated by elevated posture of the head and trunk and drainage after operation. Recovery in all. In an equal number of cases of diffuse septic peritonitis subject to the same measures of treatment, but without the elevated head and trunk posture, four recovered and five died. This is due to the fact that the pelvic peritoneum absorbs less readily than the upper peritoneal structures. G. R. Fow ler (Med. Record, Apr. 14, 1900).
The majority of cases follow perfora tion of an ulcer in the small intestine. A diffuse, purulent peritonitis follows, which causes death in 95 per cent. in three to six days. Of 90 cases of perfo ration surgically treated, collected from literature, 16 recovered: i.e., 21.6 per cent. Perforation generally occurs in the second, third, or fourth week, and cases operated within twenty-four hours after perforation has occurred usually recover. E. Loison (Revue de Chir., Feb., 1901).
The main point in perforative perito nitis in typhoid is the difficulty of diag nosis. He notes a case in which there had been sudden abdominal pain, great and other evidences of perfo ration which had subsided within a short period, and he believes there had not been a perforation. He observed, in one instance, pain referred to the end of the penis. James Tyson (Jour. Amer. Med. Assoc., Feb. 1G, 1901).
There may be difficulty in finding a perforation during an operation for perforative peritonitis. In one instance personally operated on a patient with typhoid fever under the impression that there was a perforation, but none could be found. In this instance the patient made an uneventful recovery and stood the operation well. Simple Hustling out of the abdominal cavity seems to do good. G. G. Davis (Jour. Amer. Med. Assoc., Feb. 16, 1901).
Operation gives no prospect of re covery except when the general sepsis is not far advanced. As in the treatment of abscesses in general it is important to remove the pus and to prevent its ae mutilation again, so in general peri tonitis. The best method of doing this is drainage from the lowest point—the pelvis. This part, however, only remains the lowest point so long a, the patient is kept in the most upright position. The Douglas pouch is drained through the vagina, and in men through the perineum. The patients are supported by hands, and are kept upright day and night and washed out through the drain age tubes every two hours. Hr. Langan
buch (Medical Press, April 3. Irmo.
An important feature of all operative measures instituted is that all manipula tions of the intestine should be attended with the greatest possible gentleness, in order to avoid local complications lead ing to intestinal obstruction (q. r.). This should not, however, prevent the thor ough removal of all exudates: a feature of the operation upon which its success depends.
Peritonitis in Infants.
Symptoms.—The symptoms of acute peritonitis in the newly born are often obscure and may not be recognized dur ing life. The onset is sudden, with vom iting and high temperature: 103° to 105° F. The abdomen, at first normal, soon becomes swollen and tympanitic. Upon the occurrence of this symptom the diagnosis is established. The pulse is small and rapid, respirations hurried, and there is great prostration. There may or may not be diarrhoea. Retention of urine is common, yet there may be fre quent micturition. The infant is rapidly overwhelmed by the toxins of strepto coccic infection.
Etiology.—According to Holt, peri tonitis is quite frequent in the newly born. It is a streptococcic infection, oc curring as the result of sepsis in the mother, and is often the cause of death. The avenue of infection to the infant is the umbilical cord. The disease may be either local or general. When local it is usually in the neighborhood of the um bilicus or the liver. As in the adult, it results in adhesions or else in peritoneal abscess-formations. Should the infant survive, the resulting adhesions may cause an arrest or an alteration in the development of some part of the intes tinal tract. Peritonitis is not uncom mon in fcetal life. It is probably the cause of those cases of congenital mal formations and atresias of the intestines which are sometimes met with. Cases of imperforate anus and stricture in various parts of the intestinal tract are accounted for in this manner.
The records of the Moscow Lying-in Asylum show that in 75,000 autopsies on infants there were 36 cases of con genital atresia of the digestive tract: 21 in boys and 15 in girls. In 11 the occlusion was situated in the ileum, in S in the rectum, in 7 in the duodenum,