656 DISEASES OF THE PERITONAEUM. 



ADDITIONS TO THE REVISED EDITION OF 1880. 



SECTION VI. DISEASES OF THE PERITONAEUM. 



l._p. 647. 



Puerperal peritonitis is least unfavorable when it is an extension 

 of primary inflammation of the uterus and adnexa, and runs its 

 course as pelvic peritonitis. When occurring in childbed it is ac- 

 companied by blood-poisoning ; then its course is somewhat peculiar. 

 There may be little or no inflammatory pain ; exudation is copious 

 and of bad quality ; there is excessive meteorism and often diar- 

 rhoea. The worst forms may come from escape of fluids into the 

 abdomen from rupture of the uterus, or possibly through the Fal- 

 lopian tubes. 



If peritonitis becomes chronic, the sensitiveness to pressure on 

 the abdomen lessens, pulse and temperature fall ; but the patient 

 remains weak, thin, and pale, with dry skin and irregular bowels ; 

 as the meteorism decreases, incapsulated exudations may be felt. 

 Tubercles may develop in the peritonitic exudation and cause hec- 

 tic, consumption, and death. 



2. P. 647. 



The opium-treatment is not to be limited to cases due to per- 

 foration ; it should be given in doses sufficient to arrest pain and 

 peristole. Opinions are not unanimous as to the benefit of mercu- 

 rial inunctions. Some cases certainly seem to profit by the daily 

 application to the abdomen of oleate of mercury with morphine, 

 and others by the regular inunction-treatment. 



In severe peritonitis, when every thing taken into the stomach 

 is vomited, absolute abstinence should be enjoined until nausea 

 ceases ; then give milk by the spoonful. If meat-broths, milk, 

 e gg s > wine, etc., cannot be taken by the stomach, nutrient enemata, 

 elsewhere spoken of, may be employed. 



