INFLAMMATION OF THE PERITONAEUM, PERITONITIS. 645 



at some circumscribed spot,, the abdominal walls become infiltrated, 

 reddened, and finally the pus breaks through, or abscesses form and 

 point at the most varied places, or in fortunate cases, the abscesses 

 perforate into the intestine, and the pus is passed at stooL In these 

 cases, also, the patients usually die of exhaustion, and but few recover 

 after tedious convalescence. 



Acute partial peritonitis is usually preceded by premonitory symp- 

 toms, due to the disease of the organs, from which the inflammation 

 extends to the peritonaeum. Thus acute partial peritonitis, beginning 

 in the right iliac fossa, is usually preceded by the symptoms of typh- 

 litis ; that commencing in the hypogastric, epigastric, or right hypo- 

 chondriac regions, by the symptoms of ulcer of the intestines or 

 stomach, or of abscess of the liver. The commencement of the disease 

 itself is characterized by pain extending over the entire abdomen, but 

 the great sensitiveness of the abdomen to pressure, which is almost 

 characteristic of peritonitis, is limited to a circumscribed portion. Tym- 

 panites is wanting, or is, at least, partial, and the fever is more moder- 

 ate than in the diffuse form. If the exudation be not extensive, these 

 symptoms usually disappear rapidly, and the disease ends in perfect 

 cure, unless adhesions form to disturb the movements of the intes- 

 tines, or the original disease cause some other termination. When 

 the exudation is more extensive, acute partial peritonitis runs a dif- 

 ferent course. In the vicinity of the peritonitis the percussion gradu- 

 ally becomes duller, the resistance of the abdominal walls more de- 

 cided, till finally, in this case also, palpation shows a tumor in the ab- 

 domen. Such masses occur rarely after perforation of ulcer of the 

 stomach ; more frequently in the slow perforation of tuberculous in- 

 testinal ulcers, and in ulcerations of the ccecum, and the vermiform 

 process. Its subsequent course is the same as that of capsulated ab- 

 scesses, after protracted diffuse peritonitis. 



In his clinic of abdominal diseases, Senoch gives a very true de- 

 scription of the chronic peritonitis which occurs, particularly in child- 

 hood, along with tuberculosis of the intestines and mesentery. He 

 pictures the children as weak, scrofulous individuals, in whom the occa- 

 sional colicky pains, the diarrhoea, alternating with constipation, and 

 the increasing emaciation, often excite the suspicion of worms, or of 

 tabes mesenterica. On careful examination of the abdomen, during 

 which we must guard against mistaking the signs of displeasure foi 

 those of pain, we find it more sensitive at certain points. Sometimes 

 even the pressure of the abdominal muscles causes pain, so that the 

 child cries when going to stool While the emaciation progresses rap- 

 idly, and becomes very great in a few months, while fever, toward even- 

 ing, occurs regularly the belly of the child becomes more protuberant. 



