INFLAMMATION OF THE PERITONAEUM, PERITONITIS. 



grave injuries or severe blood-disease, or occurs in persons previously 

 ill, and having little power of resistance. If peritonitis be induced by 

 the same causes on which most cases of pleuritis depend, the prognosis 

 is unmistakably better than it is in the latter disease. Thus we fre- 

 quently see the rheumatic peritonitis, which exceptionally occurs in 

 otherwise healthy persons, particularly in menstruating women, as well 

 as that which accompanies retention of faeces, typhlitis, or even strangu- 

 lated hernia, terminate in cure, provided the exciting causes can be 

 removed soon enough. Still less dangerous is the circumscribed chronic 

 peritonitis, which complicates chronic inflammations and degenerations 

 of the abdominal organs. We might regard the final object of this 

 inflammation as an attempt of Nature to guard against future injury. 1 

 Among the symptoms on which the prognosis depends in each 

 case are, in the commencement of the disease, tympanites, and the 

 dyspnoea that it causes ; the more oppressive the latter, the greater the 

 danger. Subsequently, particularly in protracted cases, the fever and 

 the strength and nutrition of the patient affect the prognosis more 

 than most of the other symptoms. 



TREATMENT. Where retention of fasces, and consequent ulceration 

 of the intestines, particularly typhlitis stercoracea, or where strangu- 

 lated hernia has caused peritonitis, the caudal indication may be an- 

 swered by the treatment for the original disease and by operation, 

 respectively. In all other cases we cannot fulfil it. This, however, is 

 the proper place to speak of the treatment of perforation by large and 

 repeated doses of opium ; by arresting, as much as possible, the move- 

 ments of the intestines, this prevents, to some extent, the contact of 

 the escaped substances with large portions of peritonaeum ; and, more 

 particularly when these foreign substances are shut off from the rest of 

 the peritoneal cavity by adhesions, it prevents their breaking through. 

 Statistics show favorable results for this treatment, and, in cases where, 

 instead of opium, purely symptomatic treatment was used, and the 

 constipation was treated by enemata and purgatives immediately after 

 the use of these remedies, I have often seen a peritonitis, which was 

 previously circumscribed, and might have remained so, spread over the 

 entire peritonaeum. At first we give gr. ss j of the opium every hour, 

 and later do not give it so often.* 



Concerning the indications from the disease, views have changed 

 greatly of late. Formerly every patient treated lege artis was bled 

 a pound or two ; then the abdomen was covered with leeches, and one 

 to two grains of calomel given every two hours, and at the same time 

 i quantity of mercurial ointment was rubbed into the skin of the 

 thighs and abdomen. " That was the proper treatment ; the patients 

 died, and no one thought of asking who recovered." It is true, we 



