DISEASES OF THE PERITONEUM. 



Subsequently this redness disappears, apparently because the capil- 

 laries are compressed by the occurrence of oedema in the tissue of the 

 peritonaeum. The surface soon becomes cloudy from loss of its epithe- 

 lium, and has the velvety appearance which, as we have fully described 

 in pleuritis, depends on a proliferation of the connective tissue compos- 

 ing the peritonaeum. 



Far more noticeable than these structural changes of the perito- 

 naeum, are the exudations which never fail even after a short duration 

 of the peritonitis. Then* shape and amount vary greatly. Occasion- 

 ally a thin transparent layer of coagulated fibrin, which may be peeled 

 off like a delicate membrane, coats over the inflamed peritonaeum, and 

 unites the loops of intestine loosely together ; fluid exudation is no- 

 where to be found. In other cases the deposit is thicker, less trans- 

 parent, yellow, like croup membrane, and, in the dependent parts of 

 the abdomen, there is a moderate amount of cloudy flocculent serum. 

 In other cases there is a great quantity of exudation ; when the abdo- 

 men is opened, an immense amount of turbid, flocculent fluid escapes, 

 while a still greater quantity remains among the intestines, in the pel- 

 vis, and along the spine. Then, besides the membranous deposits cov- 

 ering the peritonaeum, we find numerous yellow clumps of coagulated 

 fibrin which partly swim in the fluid, partly sink, and collect in the 

 dependent parts of the abdomen. 



The scanty, very fibrinous exudation is chiefly found in peritonitis 

 due to injuries or to propagation of inflammation from neighboring 

 organs. On the contrary, the abundant sero-fibrinous exudations are 

 more frequent in peritonitis from perforations, or dependent on infec- 

 tion, particularly puerperal, and lastly in the so-called rheumatic 

 peritonitis. 



All the coats of the intestines are the seat of collateral oedema, 

 particularly in those cases accompanied by profuse exudation. Con- 

 sequently the intestinal wall appears thicker ; the oedema of the mu- 

 cous membrane has caused serous transudation into the intestine, and 

 the oedema and paralysis of the muscular coat have often led to enor- 

 mous collections of gas in the intestine. The superficial layers of 

 the liver, spleen, and abdominal walls, are often infiltrated and discol- 

 ored. Finally, we must mention (more particularly as this partly 

 explains the early death), that the exudation, and still more the dis- 

 tention of the intestines, may press the diaphragm up to the third or 

 second rib, and compress a great part of both lungs. 



If the patient does not die at the height of the inflammation, the 

 appearances change. In the most favorable cases the fluid part of 

 the exudation is rapidly absorbed. Subsequently the coagula and pus 

 corpuscles, which are partly enclosed in them and partly suspended ii? 



