SECTION VI. 

 DISEASES OF THE PERITONEUM. 



CHAPTER I. 



INFLAMMATION OF THE PERITONAEUM, PERITONITIS. 



ETIOLOGY. For the pathogeny of peritonitis we may refer to 

 what was said of the pathogeny of pleuritis and pericarditis. The 

 same course that we have described as occurring in the pleura and 

 pericardium during those diseases is repeated in the peritonaeum during 

 peritonitis ; while there is a new formation of young connective tissue, 

 a proliferation in the peritonaeum, its surface is covered by a fibrinous 

 exudation, containing a variable number of young cells pus-cor- 

 puscles. In some cases of chronic peritonitis, however, the inflamma- 

 tion seems to remain limited to the proliferation of the peritoneal con- 

 nective tissue, and there is no free exudation. It is most probable 

 that the thickenings and adhesions of the peritonaeum, which exactly 

 resemble those of the pleura, and, like these, are formed without symp- 

 toms, occur in this manner. 



The predisposition for peritonitis, at least for the acute and diffuse 

 form, is not great in strong, healthy persons. Slight causes, such as 

 frequently induce inflammations of other serous and of mucous mem- 

 branes, scarcely ever cause peritonitis. Hence, when a previously 

 healthy person is attacked with peritonitis, we should suspect that it 

 is due to one of the serious difficulties below mentioned, and should not 

 consider it as a case of so-called rheumatic peritonitis till these other 

 causes have been excluded, which is sometimes a difficult task. The 

 tendency to peritonitis is much greater in persons affected with tuber- 

 culosis, morbus Brightii, and other exhausting diseases, as well as 

 in women at the menstrual periods, than in healthy persons. Among 

 the former, slight causes not unfrequently suffice to induce peritonitis. 

 We have frequently given our reasons for not considering these 

 cases of peritonitis as secondary symptoms, just as we have done the 



