154 DISEASES OF THE PERITONEUM 



enteritis are very probable, especially if the pulse becomes 

 frequent and irregular early. However, the character cf the 

 pulse in peritonitis is harder and in gastro-enteritis diarrhea 

 with loud peristalsis is present. In ordinary "colics" due to 

 fecal stasis, etc. there is no fever present and the pulse is 

 softer in quality. 



Chronic or circumscribed peritonites can rarely be diag- 

 nosed. 



Course. — In acute diffuse peritonitis, especially when a 

 sequela to gastric or intestinal rupture or the bursting of a 

 mesenteric abscess (strangles), the course is obviously rapid 

 and fatal, causing death within twenty-four hours. In less 

 violent cases the disease may last several days (four to four- 

 teen) and lead to death; or more rarely become chronic, 

 lasting for months, leading to adhesions (adhesive peritonitis) 

 and ascites, causing the patient to suffer from periodical 

 attacks of colic. There is usually edema of the ventral part 

 of the abdomen. 



Prognosis. — Acute diffuse peritonitis is a very fatal disease 

 usually leading to death in a few hours. In mild infections 

 not associated with the perforation of the stomach or bowel 

 or the escape of pus in the abdominal cavity death may not 

 ensue for several days. Circumscribed peritonitis rarely leads 

 to death. Chronic peritonitis may persist for months or 

 even years and cause adhesions which may in some cases 

 affect digestion. Peritonitis due to penetrating abdominal 

 wounds if treated according to surgical principles before in- 

 fection has become extensive may be kept under control, its 

 spread prevented and healing produced. 



Treatment. — The treatment of acute diffuse peritonitis con- 

 sists in the use of hot applications or of sharp counterirri- 

 tants, such as turpentine or the oil of mustard in alcohol 

 (1 to 12). To prevent the spread of the inflammation by the 

 movements of the intestines, opium (5j-ij) should be given. 

 Later mild purgatives such as calomel (5 j) may be employed. 

 Attempts, however, should be made to allay constipation by 

 using lukewarm clysters rather than through the use of drugs. 

 Later to assist in the absorption of ascitic fluids diaphoretics 

 and diuretics may be tried. Tapping may be employed and 



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