254 
PATHOLOCY. 
the body is heated, and whatever fuddenly interrupts 
certain functions of the fyftem, as the fuppreffion of per- 
fpiration, the iochia, and the menftrual difcharge. 
Over the caufes which produce epidemic difpenfations 
of this difeafe, the fame veil of myftery hangs, that con¬ 
ceals from our view the etiology of other epidemics. 
M. Broulfais faw the difeafe epidemic, and apparently 
contagious, among the Prench armies, in various 
psrts of the continent; in Germany, Holland, and 
Italy. We have all feen puerperal peritonitis epidemic 
in our own country. The tranflation of rheumatic, ar¬ 
thritic, or eryfipelatous, inflammations, from the joints 
or furface of the body to the interior tiffues, is not to 
be overlooked. 
Bayle, Broulfais, and others, have noted the following 
morbid appearances after acute peritonitis, i. Rednefs, 
thickenings,, and even efchars, which penetrated to the 
mucous membrane of the peritoneum. 2. Solid exuda¬ 
tions, in form of falfe membranes, lining the ferous fur- 
face of the peritoneum, but without organization. 3. A 
liquid exudation, fometimes turbid, fometimes limpid 
or reddifh : more or lefs of ferous and purulent fluid was 
always found in the abdominal cavity, bathing the fur- 
face of the inteftines. 4. M. Brouffais alfo found red 
clots, fometimes thin, fometimes thick, fpread over, 
in form of membrane, the peritoneum, which was red¬ 
dened and thickened underneath. Blood itfelf has been 
found effufed from the peritoneal lining of the abdomen, 
without any apparent breach of velfel or fubltance. 
Sphacelations were fometimes found. 
In molt cafes where acute peritonitis has been cured, 
and the patient foon afterwards died of other difeafes, 
adhefior.s were found, fimilar to tliofe occafioned by 
pleurify. 
The nature of the difeafe being once afcertained, the 
method of cure will be obvious. As in all other acute 
inflammations, blood-letling from the fyftem at large is 
the remedy to be principally depended upon, and fhould 
be referred to at as early a period as poflible. And this 
evacuation fhould be large, frequent, and early ; for, if 
the inflammation be not mitigated in the fpace of twen¬ 
ty-four hours of adtive treatment, the event wdll gene¬ 
rally be fatal. The chief guide in directing this opera¬ 
tion mult be the degree of pain expreffed by the patient, 
particularly under the adtion of preffure : and even if 
this be much diminiflied, it may ftill be right to apply 
from ten to fifty leeches to the abdomen ; and, as i’oon 
as thefe have done their office, its whole furface fhould 
be covered with a blifter. It is to be diftindtly under¬ 
stood, however, that neither leeches nor bliftering ffiould 
be trufted to, until fome diminution of pain has ac¬ 
tually been produced by the general bleeding. And far¬ 
ther, if it fhould happen that the pain is not dimfnifhed 
after the Second bleeding, this operation muff be re¬ 
peated even to the fourth or fifth time, after intervals of 
three or four hours each. If it fhould be unequivocally 
manifeft at any one of thefe bleedings, that the ftrength 
of the patient is inadequate to the lofs of Sixteen ounces, 
a Smaller quantity may be taken away, and we may re- 
Sort, at the Same time, to the topical application of leeches 
and biifters. It Seems, however, preferable to delay the 
application of a blifter till the constitutional eff'edts oc- 
calioned by the local inflammation are partly removed 
by the general bleeding, and till the diforder is thus re¬ 
duced to a State more nearly approaching to a Simple to¬ 
pical affedtion. For, by proceeding thus, the double ad¬ 
vantage will be obtained, of applying the topical reme¬ 
dies at a period when their influence will be exerted 
with the greateft effedt, and the pradtitioner moreover 
wiil r.ot be deprived of the only means of ascertaining 
the variations of the diforder; namely, by preffure on 
the abdomen. The firft Symptom on which we may pro¬ 
nounce the recovery of the patient, is the ability of re¬ 
maining in a Sitting pofture, after he had previoufly been 
confined to the back: this pofition of the body proves 
that the inflamed peritoneum is now able to bear the 
weight of the bowels, which perhaps never takes place 
where the patient does not recover. 
With refpedt to internal medicine, it is of Secondary 
importance. Nevertheless it is neceffary that the bowels 
fhould be kept open, and this fhould be effedted with as 
little irritation as poflible. For this pu.rpofe, caftor-oil, 
or Small doSes of the Sulphate of magnefia, may be admi- 
niftered with advantage ; and emollient ciyfters may be 
injected, which, at the Same time that they procure 
ftools, will adt as internal fomentations. Fomentations 
may be alfo applied externally to the abdomen, when 
the tendernefs is Sufficiently removed to admit of the 
preffure. It is Scarcely neceffary to add, that the ftridteft 
antiphlogiftic fyftem muft be adopted, both in refpedt to 
diet and medicine. 
It may be right to mention an irregularity in the com¬ 
plaint, which is apt to miflead the pradtitioner, and to 
deter him from reforting to thofe vigorous meafures fo 
effential to counteract the magnitude of the danger. 
There is now and then, at the very firft attack, fo great 
a degree of proftration of ftrength, accompanied likewife 
by a pulfe Scarcely perceptible at the wrift, as might in¬ 
duce us to confider the patient at the point of death, and 
unequal to undergo the treatment above recommended. 
There is alfo a fpafmodic attack of pain, which remits. 
Thefe appearances, however, feem to arife wholly from 
the inflammation extending to the peritoneal coat of the 
ftomach and inteftines. Here, as in different circumftan- 
ces, the pain on preffure muft be the criterion to deter¬ 
mine our pradtice; and, if the pain fhould be found ex- 
quifite, no accidental Symptom fhould lead us from truft- 
ing for relief chiefly to the lancet. Such a decifion will 
foon be juftified by a freedom in the adtionof the arterial 
fyftem, the pulfe becoming fuller and ftronger, by an 
abatement of the languor and proftration of ftrength, and 
by a diminution of pain. 
Among other powerful but uneftabliffied meafures we 
have to mention the injedtion of tobacco per ano, cold 
lotions to the belly, and the exhibition of oil of turpen¬ 
tine. Whether any further good can be attributed to 
the laft medicine than what refults from its purgative 
operation is not yet known. 
The attack of the chronic inflammation of the perito¬ 
neum is very different from that of the acute Species. It 
advances by degrees, manifefting itfelf only by occasional 
Superficial pricking pains over the abdomen, without 
producing any inclination to go to ftool : the pulfe is 
Somewhat accelerated, and the tongue (particularly in 
the morning) is Slightly covered with white fur. There 
is alfo considerable thirft; yet there is no exacerbation 
of fever in the evening, nor any hedtic fluflies on the 
cheeks : on the contrary, the countenance is full of lan¬ 
guor, and the face is pale and doughy. 
In the early ftages of the difeafe, the patient is capable 
of performing his ordinary avocations, and only com¬ 
plains, after fatigue, of a certain degree of tightnefs and 
pricking forenefs acrofs the abdomen, from one os ilium 
to the other. This ftate will continue, with little varia¬ 
tion, for many months, during w'hich the operations of 
the bowels will fometimes proceed naturally, though 
more commonly the patient is coftive. There is no ten¬ 
sion of the fkin of the abdomen, as in the acute Species ; 
on the contrary, the fkin and abdominal mufcles are 
fometimes obferved to fit loofely upon the peritonaeum, 
which gives a fenfation to the touch, as of a tight band¬ 
age underneath, over which the fkin and mufcles may be 
Said (as it were) to play. The patient always complains 
more of the tightnejs than of th epain-, and, as this tight¬ 
nefs is much increased by any congeftion in the inteftines, 
the relief which he experiences from evacuating their 
contents, leads hifn to attribute his fenfations to an ha¬ 
bitual coftivenefs, for the removal ol which evil all his 
endeavours are uiually diredted. 
The progrefs of the aftection is as follows: The bow¬ 
els 
