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Diseases of the Abdominal Cavity and Walls

belly, pain, result, inflammation, blood, chronic, patient and fever

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Peritonitis.---There has been mentioned on p. 189 the delicate membrane which lines the wall of the belly within, and clothes the intes tines. It is called the peritoneum, and it is subject to inflammation, which is called peri tonitis.

It is caused by injury. A severe blow on the belly is liable to produce it, and it is often set up by a wound piercing the belly. Cold seems also to produce it. Often it is the result of ulcerations of the stomach and bowels (see p. 253), which eat their way through the intes tinal walls, and permit the escape of material into the cavity of the belly, which irritates the membrane and excites the inflammation. It results often from various diseases of liver, kid neys, &c. A grave form occurs in women after child-birth, due, apparently, to the absorption of poisonous discharges from the womb. [Refer to DISEASES OF WOMEN-PUERPERAL FEVER] Matter may form in the course of the disease, and an abscess be formed within the belly.

The symptoms are chiefly pain and fever. The pain is severe, cutting, or burning, and at first usually limited to one place, but it ex tends. It is increased by pressure, and is thus distinguished from the pain of colic. So severe is the pain that the patient lies on his back, the muscles of his belly on guard to prevent anything coming in contact with it, his knees drawn up to relax the parts. Even the weight of the bed-clothes can hardly be borne. The fever is considerable, pulse frequent and sharp, skin hot and dry, tongue coated, and there is usually costiveness. If the urine cannot be passed, it indicates the inflammation is low down. The disease is often fatal; and the case is very serious if the belly becomes swollen up, if the extremities become cold, the face pale, pinched, and anxious, and the pulse thready and weak. If the inflammation is the result of perforation of the bowel, the pain is sudden and severe, there are cold sweats, faintness, and vomiting, followed by the signs of fever and inflammation, if death do not speedily result. In milder cases there is fever, pain in the belly at one place, increased on pressure, cos tiveness, furred tongue, &c.

The disease should not be prolonged beyond a week unless it becomes chronic. In chronic eases the symptoms are vague, and include pain in the belly, not very marked and often colicky, tenderness of belly and swelling, weak ness and paleness. The swelling is often due to accumulations of fluid—the result of the chronic inflammation.

Treatment.—The patient should be kept )erfectly quiet in bed, and hot cloths should le kept constantly applied to the painful -egion of the belly. The pain must be kept

lows by opium, of which (to an adult) 1 grain may be given at a time, or 30 drops of lau lanum may be given instead. It is to be re peated as seems desirable, the purpose being to keep the pain down, but not to throw the patient into stupor. Vomiting gives rise to great pain, and must be avoided by giving the patient small pieces of ice to suck, and by warm applications over the stomach. Fluid food is to be given—beef-tea, thin soup, milk, &c. The question of relieving the bowels is often a difficult one, because it would greatly increase the risk of perforation, if such were present. It is a question for a medical man to decide, and in any case a warm-water injection is safest. Often the urine must be drawn off by a catheter. (See APPLIANCES FOR THY. SICK ROOM.) If the patient become weak and collapsed, stimulants are needed.

An abscess that has formed may open into the bowels, and the matter may conic away with the faeces. It would be much more desir able that a doctor should discover the presence of the abscess and draw off the matter.

For chronic cases nourishing diet is required, sea-air, friction of the belly with cod-liver oil, iodine liniment, &c.

Dropsy Of' the Belly (Ascite8) is an affection that may occur as a complication in various diseases. It may be due, as we have seen, to the accumulation of fluid poured out from the blood-vessels as a result of chronic inflamma tion (peritonitis). In many cases it is the direct result of too full blood-vessels of the abdomen. Anything which impedes the due return of blood from the veins of the abdo minal organs through the liver to the heart is apt to produce it, because, the veins and small vessels being gorged with blood, watery por tions of the blood filter through the delicate walls of the vessels to relieve the pressure, and thus the fluid accumulates. Its amount will thus depend, among other things, on the ful ness of the vessels and the length of time the obstacle to the free circulation has occurred, and may vary from a few pints to some gallons. Now this obstacle may exist in the liver, may be due to simple congestion of the liver, but more commonly to that thickening of the liver called cirrhosis (see p. 272), which is a fre quent result of constant drinking. Of course it might be caused by some tumour pressing on the great veins, and thus blocking the return of blood. Disease of the heart or of the lungs, by impeding the due circulation of the blood, may occasion it, because the blood is penned up in the veins, not being able to get along quickly enough.

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