584 DISEASES OF THE PERITONEUM. 



of a watery character, but tliat more or less of a varying-con- 

 ditioned fibrinous material is associated with it. 



The variations in the general character and plasticity of this 

 fibrinous exudate are distinctly seen in the different ways in 

 which it comports itself : at one time it will be found forming 

 a loose coating over the parts diseased, or causing adhesions 

 between the coils of the intestines, or between these and dif- 

 ferent parts of the abdominal walls ; at others, particularly 

 when fluid is in great amount, instead of adhering to the walls 

 of the cavity, it is found in loose portions floating in the 

 fluid, with which are mingled varied forms of cell-growth, epi- 

 thelial and pustular, as also colouring matter of the blood. 

 These latter adventitious materials are rarely absent in the 

 effusion we encounter in the peritonitis of the puerperal state. 



The condition of thickening and increase in bulk which the 

 effusion and cell-proliferation give to the membrane, parietal 

 and visceral, tend much to alter its physical character of co- 

 hesion, it being more easily lacerated of itself as well as more 

 readily torn from the structures which it covers. 



Symptoms. — These vary much, both as to their character and 

 severity; nor may we with certainty, from suspecting the cause 

 of the disease — i.e., whether traumatic or proceeding from 

 agencies more hidden — predict the course or the character 

 which they will develop. When occurring as an independent 

 affection it more frequently assumes the subacute or chronic 

 form, with a rather slow and insidious development of symp- 

 toms. The patient is restless, lying down, resting uneasily, 

 repeatedly turning his nose to his flank, and although not 

 showing so much pain by violence of movement as m many 

 less serious bowel disturbances, has yet an anxious and wearied 

 expression of face. 



When following injuries and wounds inflicted in surgical 

 operations, or in cases following abdominal perforation and 

 rupture, there is usually more demonstration of internal pain, 

 pawing with the fore-feet and restless moving of the hind ones, 

 even when there is no lying down and rolling, which latter 

 symptom occurs less frequently than with severe and serious 

 bowel affections. 



The appetite is much disturbed, the respirations quick and 

 catching, with a frequent, small, and rather hard pulse, and 



