DISEASES OF THE PERITONAEUM. 



cannot claim any brilliant results from the treatment now in vogue- 

 but that above given was just as irrational as it was injurious. On 

 examining the bodies of persons who had died of peritonitis with 

 abundant effusion, even when no blood had been taken, the tissues 

 were found uncommonly bloodless, as a result of the excessive 

 exudations. But, on examining the bodies of persons dying from 

 a peritonitis treated lege artis, we find so very little blood in the 

 heart and arteries, that we are tempted to ascribe death to the 

 treatment rather than to the disease. If to this we add the fact 

 that experience shows that a great loss of blood during labor 

 proves to be no protection against an epidemic puerperal fever, and 

 that all injurious influences which generally act as causes of peri- 

 tonitis are just as active in debilitated, bloodless persons as in the 

 strong and well-nourished, we silently pass over other reasons for 

 avoiding venesection. (Nevertheless, we shall hereafter see that the 

 symptomatic indications occasionally demand bleeding.') Of late 

 scarcely any one believes in the antiphlogistic and antiplastic action 

 of mercury, and we do not hesitate to say that we consider calomel 

 and mercurial ointment as at least superfluous in the treatment of 

 peritonitis, and that in purgative doses we regard calomel as directly 

 injurious. It is far different with local blood-letting, which is much 

 less dangerous than venesection, and of whose beneficial effect on the 

 pain, at least, there is no doubt ; this effect does not fail even hi those 

 cases where the peritonitis is caused by perforating ulcer of the 

 stomach. The employment of cold acts in the same way, and perhaps 

 it has even more effect on the inflammation itself. If the patient can 

 bear it which, unfortunately, is not always the case we may cover the 

 entire abdomen with cold compresses, and renew them every ten minutes. 

 From this treatment, which is recommended by Abercrombie, Kiwlsch^ 

 and others, I have seen the best results in cases that were amenable 

 to any treatment ; but I cannot deny that warm cataplasms were bet- 

 ter borne than cold compresses by many patients. Recently the re- 

 sults of the opium-treatment in peritonitis, caused by perforation, and 

 the belief that the inflamed parts needed rest more than anything else, 

 have rendered opium popular in the treatment of all forms of peri- 

 tonitis. We agree fully with those who consider the application of 

 leeches to the abdomen, the use of cold, and the internal administra 

 tion of opium as the most effective treatment. Opium is invaluable 

 in all forms of peritonitis. By the peristaltic motion of the gut the 

 exudation an intense irritant is constantly brought in fresh contact 

 with uninflamed parts of the peritonaeum. Hence, by checking this 

 motion with opium, we remove a main cause of spreading of the dis- 

 ease. In protracted cases, any incapsulated collections of pus which 



