The general picture presented by peritonitis is usually one which may well cause anxiety. There is continued high fever, accelerated pulse, and nausea and vomiting ; the abdomen is distended and tense as a drum, and sensitive to the slightest touch. The patient usually lies curled up in order to reduce the tension on the abdomen. The cardiac weakness brought about by the action of the toxins from the purulent process usually causes the disease to terminate fatally within two or three days.
When the inflammation of the peritoneum is not general, hut limited to some definite portion, the outlook is more favourable. This may result in encapsulated collections of serous or purulent fluids, which often become shut off from the rest of the cavity by enclosing walls of thick connective tissue. These purulent foci can usually be emptied by an operative incision, and a complete cure obtained. This is fortunately often the case in the treatment of an abscess resulting from an inflammation of the vermi form appendix. See APPENDICITIS. If operative interference is delayed too long, however, the focus of pus is liable to rupture and to produce a general peritonitis, which rapidly proves fatal.
The treatment of peritonitis consists of complete rest in bed, the appli cation to the abdomen of an ice-bag, which may be suspended from a frame as shown in Fig. 333. and keeping the intestines quiet by means of drugs. This method of treatment is often efficient when the inflammation is circumscribed, and particularly if no pus be present.
Chronic peritonitis pursues a course unaccompanied by the stormy symptoms characteristic of the acute attack. This type is usually due to
tuberculosis of the peritoneum, and is mainly marked by AscrrEs, a con dition in which the abdomen is distended by a watery fluid. A physician alone can diagnose this disease, which is especially frequent in children. It may be present as a complication of general tuberculosis of the intestines or of the lungs, or as a premonitory sign of this disease. A spontaneous cure is rare in these cases. The internal administration of creosote and cod-liver oil may aid in conjunction with proper nourishment, principally milk and eggs. Abdominal inunctions with various remedies arc to be undertaken only on the advice of the attending physician. The most certain means of obtaining a cure is by means of laparotomy, an operation consisting in opening the abdomen by incision in the loin.
Finally, there is another form of chronic peritonitis, wilich is not accompanied by the accumulation of fluid in the abdominal cavity, but in which there are formed more or less dense bands of connective tissue. bring ing about adhesions between the various organs in the cavity. This type, which may involve some or all of the abdominal organs, may run its course with few or no definite symptoms. In other cases, however, the patients suffer more or less constant abdominal pain and digestive disturbances, or there may be attacks of severe pain recurring at long intervals. The con dition may at times be cured by opening the abdomen and breaking up these adhesions.