482 PERITONITIS. 



but more rarely, in certain chronic diseases, such as chronic dysentery 

 and lymphadenitis. 



Lesions. The lesions consist of local thickenings of the peritoneal 

 layers, and numerous papilliform vegetations scattered very irregularly 

 over the parietal peritoneum, mesentery, epiploon, etc. 



If the disease has existed for a long time, fibrous bands or solid 

 adhesions may be discovered, connecting various parts of the digestive 

 apparatus with one another, or with the abdominal walls. 



Sometimes the intestinal contents seem almost entirely adherent to 

 the abdominal walls. 



The primary lesions of the liver, spleen, Iddneys, or genital organs, 

 from which the disease originated, are also found. 



The quantity of exuded liquid varies greatly ; sometimes there is a 

 great quantity of a transparent or lemon-coloured liquid, resembling that 

 of ascites. In other cases the liquid is scanty, and may be confined 

 between layers of bowel, w^hich are connected by an inflamed layer of 

 epiploon. 



These old-standing lesions cause atrophy of the abdominal organs, 

 contraction of the intestine, and sometimes true obstruction. 



In chronic tuberculous peritonitis the adhesions between the intes- 

 tine and the abdominal w-alls may be enormous. The peritoneum is 

 generally covered with great masses of tuberculous new growth, while 

 the mesenteric and sublumbar lymphatic glands are attacked. 



Symptoms. The disease develops without marked fever or grave 

 interference with the chief functions, and the first approach of the 

 disease may, therefore, easily be overlooked. Chronic peritonitis, 

 moreover, may remain strictly localised. 



When the disease assumes the ascitic form the dominant sign is 

 readily detected. Where new membranes form the principal lesions the 

 symptoms are much less definite, and the existence of disease is chiefly 

 indicated by digestive disturbance, such as diminished peristalsis, the 

 occurrence of colic, diarrhoea, etc. 



It is well to remember, however, that these troubles often follow an 

 ascitic stage, which may gradually disappear owing to the fluid becoming 

 absorbed. Even in the fibrous form, where the intestines appear com- 

 pletely glued together by adhesions, the volume of the abdomen is 

 increased and the belly is deformed, as in ascites. 



In time patients suffering from primary lesions of an important 

 internal organ are aft'ected in their digestion, lose flesh and become 

 anaemic, and finally cachectic. 



Diagnosis. The diagnosis is by no means easy, particularly in the 

 fibrous forms, owing to the great difficulty of -discovering the primary 

 lesion. 



