124 PRACTICE OF MEDICINE. 



Symptoms, — Fain in the abdomen, generally worst at some par- 

 ticular spot, whence it radiates. It is of a severe burning character, 

 unlike colic. It is aggravated by pressure. The patient lies on his 

 back, with the knees drawn up, so as to relax the abdominal parietes, 

 and breathes with the thorax. Coughing and deep breathing are 

 painful. The pulse is small and wiry, there is often vomiting, ob- 

 stinate constipation, and much distress of countenance. 



If the case assumes an unfavourable character, death ensues from 

 failure of the heart's action. The pulse becomes very rapid and 

 feeble ; the features sunk ; and there is great restlessness or hiccup. 

 But perhaps the patient loses all pain, so that he and his friends 

 flatter themselves with hopes of amendment, when death is at the 

 very threshold. 



Causes. — Wounds or other injuries; hernia and ileus; or cold 

 and wet, when the bowels are loaded or in an otherwise unhealthy 

 state. 



Treatment nearly the same as of peritonitis. Bleeding according 

 to the state of strength (and the pulse often rises under it) ; leeches 

 to the abdomen ; opium after bleeding ; and regular doses of calomel 

 and opium to affect the mouth ; warm fomentations and poultices to 

 the abdomen, are the chief measures. 



But the bowels are obstinately costive, and what is to be done for 

 that? Why, " the costiveness arises from their being inflamed and 

 unable to propel their contents ; and the proper remedies for it are 

 such as will relieve the inflammation." — (Druitt's Surgery, p. 417.) 

 Purgatives given during the acute stage only add to the sickness. 

 But when the pain and tenderness are relieved, castor oil, or small 

 doses of colocynth and henbane may be tried ; and throughout the 

 disease, the bowels may be solicited by enemata. Blisters will be of 

 service in the later stages. 



If there is any great tendency to faintness or collapse after bleed- 

 ing, wine must be administered. 



CHRONIC PERITONITIS, AND TABES MESENTERICA. 



Chronic peritonitis is sometimes a sequel of the acute disease, 

 sometimes, on the contrary, it begins in a very obscure and insidious 

 manner, and is attended in scrofulous subjects by a deposit of gra- 

 nules or tubercles external to the membrane. 



8ymj)toms. — Slight occasional abdominal pains, often scarcely 

 noticeable, increased by pressure; fulness and tension of the belly, 

 particularly a deep-seated tightness, as if the integument and muscles 

 glided over the tight and thickened peritoneum ; feverishness and 

 emaciation. 



This disease is often attended by enlargement of the mesenteric 

 glands, with which it is usually identical in symptoms. 



Morbid o2)2^eara7iccs. — The peritoneum thickened ; the bowels 



