PERITONITIS. 421 



Effusion of serous fluid or plastic lymph, or probably both, 

 will be sure to ensue, should gangrene at once be produced. 

 Added to the vascularity of the membrane, it will be here 

 and there coated with lymph, and the surface of the bowels 

 partaking of this, and in places perhaps glued together by it. 

 Sometimes the effusion mostly consists in serous fluid within 

 the cavity, in whch are floating flocculi of lymph ; though this 

 is a termination more to be looked for after chronic perito- 

 nitis. Sometimes, after a continuation of disease, the mem- 

 brane is found thickened, with adhesions between its visceral 

 and parietal surfaces. 



Gangrene ; a change made known by sudden cessation 

 of pain and irritation, and other remarkable alterations in 

 the symptoms, of a kind such as have already been detailed 

 in the account of enteritis -^ is a disease with which, in its 

 idiopathic form, peritonitis is often associated. 



Treatment. — When once the disease has become recog- 

 nised, no time ought to be lost in bleeding the patient until 

 the pulse at the jaw responds ; and, in a violent case, in four or 

 six hours afterwards, providing the pain and fever appear un- 

 diminished, the bloodletting may be repeated to an amount 

 to make the same impression : for, unless this effect upon the 

 circulatory system be produced, we do little comparative 

 good. After two or three such evacuations as these, we must 

 be guided entirely by circumstances — such as direct us in 

 bloodletting in enteritis and pleurisy, and other acute inflam- 

 mations; though, in truth, the further use of the phleme is not 

 often to be recommended. French veterinarians recommend 

 the use of leeches and cupping-glasses to the belly, as means 

 of topical bloodletting : since, however, we are in the habit 

 of carrying the general abstraction of blood much farther than 

 the French, I apprehend that neither of these remedies would 

 meet our views of sufficiency ; independently of the one, viz. 

 leeches, in addition to their inefficaciousness, being very ex- 

 pensive ; and of the other being, I should imagine, exceed- 

 ingly troublesome — nay, difficult, if not impossible — to apply 



' For an account of which turn to page 327. 



