254 DISEASES OF THE PERITONEUM 



terminate in recovery, or chronic peritonitis, which runs a 

 long chronic course. 



Diagnosis.— In typical cases the sudden onset, the sensi- 

 tiveness over the abdominal region, the fever, the wiry pulse, 

 the development of effusion, the collapse and the vomiting, 

 present a rather characteristic picture. In some cases of 

 rapid development the diagnosis is very difficult and is 

 hard to differentiate from septicemia or toxemia. 



In the latter stages of the disease, where deep coma is 

 present, an accurate diagnosis is impossible. Often circum- 

 scribed, acute peritonitis is overlooked. A careful examina- 

 tion, therefore, is necessary to determine the exact condition. 



Prognosis. — The prognosis in acute, diffuse peritonitis is 

 unfavorable, especially if it follow rupture of the stomach, 

 bowel or abdominal abscesses. Such cases invariably 

 terminate in death. In circumscribed fibrinous or sero- 

 fibrinous peritonitis the majority of cases make a complete 

 recovery. Circumscribed peritonitis, however, due to local 

 infection should be looked upon as dangerous, as the abscess 

 may rupture into the abdominal cavity eventually terminat- 

 ing in death from diffuse peritonitis. 



Treatment.— Medical.— In the early stages, diarrhea is 

 present and the peristalsis active. In order to prevent 

 friction between the peritoneal surfaces, which tends to 

 spread the inflammation, small doses of opium (dog, 0.1-0.3; 

 cat, 0.05-0.1), or morphin sulphate (dog, 0.016-0.12) subcu- 

 taneously are indicated. 



Cold applications, if applied early to the walls of the 

 abdomen, are indicated (cold water compress or ice pack) to 

 relieve the intense congestion of the serous membrane. Later 

 counterirritants may be used in the form of oil of mustard 

 mixed with olive oil (1-10). Apply by rubbing well into the 

 skin of the abdomen. Hot water applications may also be 

 used. Should constipation be marked laxatives should be 

 given, such as castor oil (dog, 15.0-30.0; cat, 5.0-8.0) or mag- 

 nesium sulphate (dog, 10.0-14.0; cat, 2.0-5.0). Warm water 

 infusions into the rectum will be useful to remove feces and 

 also to produce a soothing action on the membranes. 

 General stimulants (strychnin sulphate, dog 0.001; cat, § 



