INFLAMMATION OF THE PERITONAEUM, PERITONITIS. 641 



the fluid, also disappear after they have undergone a fatty metamor- 

 phosis, become fluid, and ready for absorption ; but partial thickenings 

 and adhesions of the peritonaeum always remain. In less favorable 

 cases the absorption of the fluid part of the exudation is incomplete. 

 The pus-corpuscles, which were at first rare in the exudation, now in- 

 crease so as to give it a purulent appearance, and the fibrinous deposits 

 also become yellower and softer. At some places the intestines ad- 

 here quite firmly and enclose the fluid, thus limiting its motions. If 

 the patient survive this stage also, which is usually found in persons 

 who have died in the fourth to sixth week of peritonitis, the capsulated 

 fluid may be absorbed or thickened, and changed to a yellow cheesy 

 or even chalky mass, which, enclosed in tough connective tissue, re- 

 mains in the abdominal cavity. In other cases the extensive cell-for- 

 mation occurring in the free surface of the peritonaeum attacks the tis- 

 sue itself, causing ulceration and perforation of the peritonaeum ; accord- 

 ing to the location of this perforation, the capsulated fluid reaches the 

 intestines or bladder, breaks through the abdominal walls, or descends 

 into the cellular tissue of the pelvis, and escapes outwardly at some 

 deeper point. 



In acute partial peritonitis, the changes that we have described 

 are limited to the serous coating of the liver, of the spleen, of a portion 

 of intestine, or of several loops lying near together, and to the immedi- 

 ate vicinity of these parts. If the exudation be scanty and fibrinous, 

 the process usually terminates with the adhesion of the inflamed parts. 

 If the exudation be more copious and sero-fibrinous, portions may be 

 capsulated between the inflamed parts, as in the diffuse form, and these 

 capsulations run the course above described. 



By chronic peritonitis is usually meant, first those cases which, 

 beginning acutely, run a protracted course, and lead to the formation 

 of the collections of pus above described. Secondly, those cases occur- 

 ring, particularly in children, in connection with tuberculosis of the 

 intestine and mesenteric glands, which are chronic from the start, and 

 spread over the whole or the greater part of the peritonaeum. This 

 form is characterized by the excessive proliferation of connective tis- 

 sue, as a result of which there are gelatinous or indurated thickenings 

 of the peritonaeum. The intestines usually adhere in shapeless masses, 

 and between the various convolutions there are cavities filled with 

 serous, purulent, or bloody fluid. The admixture of blood depends on 

 the rupture of vessels, which usually occurs where a chronic inflamma- 

 tion is repeatedly lighted up, for not only the original tissue, but that 

 which has recently formed on it, and is rich in large and thin-walled 

 capillaries, becomes the seat of the new inflammation. Tubercles are 

 often found in the thickened peritonaeum, in this form of peritonitis ; this 

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