PERITONITIS is an inflammation of the peritoneum. It may exist either as an acute or as a chronic disease. The chief symptoms of the acute form are pain, swelling, and tenderness of the abdomen, accompanied with fever and a frequent, small, and hard pulse. The pain in peritonitis is usually much more severe than that of any other inflammatory disease of the intestines or other abdothinal organs. It is acute and cutting, and sometimes occurs in paroxysms ; it is generally diffused, but occasionally it is almost confined to a single part of the abdomen ; but its most distinguishing character is that it is greatly increased by pressure, so that in a severe caso the patient cannot support so much as the weight of the bed-clothes, but lies on his back with his knees drawn up, and breathes quickly and lightly, moving the diaphragm as little as possible, so as to avoid the pain which its pressure would excite in the inflamed parts. The bowels in cases of peritonitis are usually, but by no means constantly, constipated ; commonly also there are present nausea, vomiting, and hiccup, and almost alwsys excessive thirst and prostration of strength. If not checked in its course, acute peritonitis usually terminates fatally in from five to ten days ; the patient becoming more and more depressed, and all the symptoms regularly increasing till within a short time of death, when the pain commonly ceases, and a deceptive improvement in many of the other signs of the disease takes place.
The usual morbid effects of peritonitis ere the effusion of serum with lymph or pus into the cavity of the abdomen, and adhesions of the opposite surfaces of the several organs within it. After death from acute peritenitis, the walls of the abdomen and the surfaces of the organs chiefly or alone affected, are found thickened, swollen, and vascular, covered with blotches of dilated blood-vessels, and more or leas firmly adhering together by the lymph which is effused between them, and which, if the patient survives for • certain length of time, becomes vascular, and is converted into the usual tissue of adhesions Or false membranes. [INFLAMMATION.] The causes of peritonitis are various. Like other acute inflamma. tions, it may occur after exposure to cold, or the other common excitants of disease ; but it is more certainly produced by injuries of the peritoneum, as by tumoura developed within the abdomen, by the obstructions which occur in strangulated hernia, and intusauseeption, of which it is a constant consequence, by the spreading of disease from the adjacent viscera, by heavy blows and falls on the abdomen, by penetrating wounds inflicted, in operations for hernia or in other circumstances, by the passage of foreign bodies into the cavity of the abdomen, and especially by the ulcerative perforation or accidental rupture of any of the organs contained within It, and the escape of their contents, circumstances which are productive of the most cer tainly and rapidly fatal form of the disease.
From these causes acute peritonitis may occur at all periods of life, but it more frequently affects persona of the middle age than any others. Women in child-bed are peculiarly liable to it. They may be
attacked either with common peritonitis, presenting no remarkably peculiar symptoms or effects; or they may have that which is especially called puerperal peritonitis. In cases of tho latter disease, however, the peritonitis is not always the most important symptom, but must rather be regarded merely as one of the mincidents of the peculiar fever by which the patient is affected, and which often assumes the character of an epidemic.
The treatment of peritonitis may commence with local bleeding by the application of leeches to the abdomen. General bleeding may be had recourse to where the symptoms are severe and the patient's strength will bear it. Hot fomentatibns should be assiduously applied to the abdomen. Of internal medicines the most effectual is calomel, of which three or four doses of five grains or more, with one or two grains of opium, should be given at intervals of about four hours, and afterwards smaller doses till a slight salivation is produced. During all the time of the treatment, the lowest diet only should be allowed, unless the patient is evidently sinking. In that case, and generally in the later stages of the disease, a more nutritious diet may be given, but there is perhaps no affection in which relapses are so liable to occur in consequence of the early or injudicious use of stimulating food.
Acute peritonitis sometimes, after fifteen or twenty days' con. tinuance, assumes a chronic form. Sometimes peritonitis from its commencement is of slow progress ; the pain being but slight or dis coverable only by considerable pressure, and the swelling or tension of the abdomen occurring only at a late period of the disease. Its more important symptoms are the low fever, the constant thirst, the hectic flushings of the taco, the emaciation, languor, and regularly increasing debility by which it is accompanied. It rarely proves fatal till after many months have elapsed; and its effects are found after death to be thickening and increased density of all the peritoneal coverings, in creased vascularity or blackness of their surfaces, which in many cases are beset with vast numbers of minute grayish-white tubercles, and effusions of serum with lymph or pus wherever the adjacent organs are not connected together by the adhesions. The chronic form of disease is always the result of a scrofulous state of the body and is seldom cured. The treatment of chronic peritonitis is usually unsatisfactory and of doubtful benefit. Local bleedings should be employed, and blisters or other counterirritants should be applied over the abdomen. The diet should be light and nutritious, and, as often as they seem necessary, mild purgatives may be administered. Frictions of oint• menta containing mercury or iodine are also useful, and iodine should be administered internally when the patient is of a scrofulous con stitution.