PERITONITIS. 83 



DISEASES OP THE PERITONEUM. 

 Inflammation of the Peritoneum — Peritonitis. 



Etiology. Peritonitis is generally seen as a secondary disease due 

 originally to some irritation or injury of some of the other organs of 

 the abdomen : From toxic gastro-enteritis, ulceration of the stomach 

 or intestines, accumulations of fecal matter in the intestines; from 

 metritis or parametritis after labor ; from inflammation or abscess 

 of the liver ; from purulent inflammation of the kidneys or from 

 purulent pleuritis; from rupture of the intestines and the escape 

 of food or feces into the abdominal cavity. It may also occur 

 from a general inflammation of all the serous membranes of the 

 body, as is sometimes observed in infectious diseases ; to pyaemia 

 or metastatic peritonitis ; from the breaking down of tubercular 

 masses that have collected on the peritoneum, or from cancer. 

 Primary peritonitis is always caused by some injury to the abdom- 

 inal wall — shocks, blows, or by penetration of the abdominal 

 walls, or after some operations. It is a question whether cold will 

 cause the disease ; the author doubts it very much. 



Pathological Anatomy. According to the extent of the 

 disease we call it either partial (circumscribed) or general perito- 

 nitis (diffused); according to its course acute or chronic ; and accord- 

 ing to its character we call the exudate serous, fibrinous, purulent, 

 putrid, or hemorrhagic. The purulent form of the disease is the 

 most common, and on account of the extensive irritation that any 

 inflammation causes in the peritoneum it is apt to take the diffuse 

 form of the disease; and when it starts originally as circumscribed 

 the disease generally becomes diffused in a short time. The peri- 

 toneum is first injected and eccbymoscd, becoming dull-red and 

 velvety, due to the removal of the endothelium and partially to the 

 exudate, which contains more or less fibrinous substances. This 

 collects as a thick layer over the peritoneum; the exudate unites 

 the intestines to each other, to the different organs in the abdom- 

 inal cavity, or to the sides of the abdominal walls. In recent cases 

 these adhesions are easily pulled apart, but later on they become 

 firmly united and very hard to separate (adhesive peritonitis). 

 There is also a quantity of a fibrous exudate thrown out, accom- 

 panied by more or less liquid. This varies from a small quantity 



