ENTERITIS. 123 



objection, however, to its performance is, the obscurity and uncer- 

 tainty of the symptoms. When the case seems hopeless, the 

 patient's sufferings should be soothed with opiates, and his strength 

 kept up by nourishing enemata. 



PERITOrflTIS. 



Causes, — Inflammation may exist at any point of the peritoneal 

 sac, but the term peritonitis more properly belongs to inflammation 

 of that portion which does not invest any of the viscera. The 

 causes of peritonitis are the same as those of inflammation in gene- 

 ral ; besides which are, external violence, metastasis, disease of the 

 mesenteric glands, obstruction of the bowels, the irritation produced 

 by disease of neighbouring viscera, and the effusion either of the 

 contents of the alimentary canal or of the urinary bladder, &c. 



Symptoms. — Acute pain, commencing at a particular part of the 

 abdomen, and gradually extending over the rest of the surface ; heat 

 of skin ; frequency and smallness of the pulse ; in many cases, 

 nausea and vomiting ; constipation ; anxious countenance ; tongue 

 dry, but not foul ; respiration accelerated and costal ; urine scanty. 

 The patient lies on his back, with the thighs flexed, and cannot bear 

 the slightest pressure on the abdomen, which becomes tumid or tym- 

 panitic. In addition to these general symptoms, others will present 

 themselves, according to the vicinity of the part inflamed to any of 

 the principal abdominal viscera. Peritonitis from intestinal perfora- 

 tion is characterized by the suddenness and the rapid progress of the 

 symptoms, and the great accompanying prostration. 



Morbid appearances. — Injection, by patches, of the sub-serous 

 tunic ; effusion of lymph, or a sero-purulent fluid, into the cavity of 

 the abdomen ; adhesions, by means of soft, whitish false membranes, 

 between the folds of the intestines. 



Treatment. — Bloodletting, to be repeated according to the patient's 

 strength, &c. ; leeches over the painful parts, and warm fomenta- 

 tions, are the chief means on which reliance is to be placed at the 

 onset of the disease ," small doses of calomel may also be given, 

 until the mouth becomes sore ; and the bowels must be kept open 

 with gentle laxatives or enemata. If the tympanitis be troublesome, 

 enemata containing turpentine or assafcetida may be administered for 

 the sake of obtaining temporary relief. In peritonitis from perfora- 

 tion of the intestinal canal, the only hope of saving the patient lies 

 in the instant administration of opium in doses sufficient to arrest the 

 peristaltic motion of the bowels. This gives us some time for the 

 employment of other means, with a faint chance of success. 



ENTERITIS. 



This term signifies inflammation of the serous and muscular tunics 

 of some portion of the intestines; the point most frequently attacked 

 being the termination of the ileum. 



