PATHOLOGY. 
255 
els become more and more irregular in their aCtion ; 
the tendernefs and fwelling increafe; the appetite fails; 
the pulfe acquires greater velocity; the features look 
fharp and contracted; the countenance becomes pale or 
fallow; the lips parched and ikinny; the tongue, fome- 
times of a bright colour, refembling what is feen in dia¬ 
betes, at other times it is covered with a thick whitilh 
mucus. The flefli and ftrength decay rapidly ; and great 
emaciation takes place. The {kin, except towards the 
Jail ttage, is for the mod part dry and fcaly; the urine 
fmall in quantity, occafionally clear, more frequently 
otherwife. If a cough has not exifted from the begin¬ 
ning, it is very apt to occur about this time ; but this is 
by no means to be confidered as a diagnoftic fymptom ; its 
evidence depending upon the fpreading of the difeafe to 
the pleura, and the thoracic vifcera. The feet foinetimes 
1'well towards the conclufion of the difeafe, but the fwel¬ 
ling is often confined to one leg and thigh. At this pe¬ 
riod, if the examination of the abdomen be made with 
due care, it will he found to communicate to the touch 
the feeling occafioned by a folid tumour ; the integu¬ 
ments and mufcles not rolling upon the contained parts 
as in the fird dage. Butin fome cafes, where ed’ufion is 
conjoined with the original and more important difeafe, 
a fenfe of fluctuation may be difcovered. Very frequent¬ 
ly the patients complain of a didreding feel of what they 
call a “ broiling heat” at the domach, the difcharge of a 
tough ropy phlegm from the mouth, condant naufea, 
with violent retching and vomiting; and, in two cafes, 
the matter brought up during feveral days before death 
was dercoraceous. 
In the courfe of the complaint, the appetite is for the 
mod part very bad ; but the defire for liquids is infatiable, 
even though a confcioufnefs exids that a large quantity 
cannot be Iwallowed without occafioning very great dif- 
trefs. When a feeling of finking and emptinefs prevails, 
the patient eagerly thinks of many articles that might 
allay his uneafinefs; but the fight of them feldom fails 
to excite loathing and dilgud. Should any fudenance be 
taken, it is either fpeedily rejected by vomiting, or it 
caufes indefcribable uneafinefs. The patient rolls about 
in all directions, in vain feeking for fome point where 
he may repofe. Every aCtion of the domach or intef- 
tines comes to be performed with great pain. The paf- 
fage of flatus upwards or downwards, the movements 
which take place before the evacuation of the bowels, 
all give rife to fufFering. At times the pain is (harp and 
tranfient; at others heavy and obtufe. But a fenfe of 
weight is feldom abfent; and it is more felt after vomit¬ 
ing or purging than before. One patient, (an infant,) 
in allufion to this fymptom, ufed to put its hand on the 
abdomen, and exclaim piteoufly, “ Oh ! fo heavy.” Ano¬ 
ther faid, that his bowels felt as if they were “ tied up 
in a napkin.” At another time he faid, “ they feemed 
to be in a mafs :” and at a third, he declared, that if he 
bad “a (hot attached to every convolution of his intef- 
tines, he could not differ more than he did.” 
The above defcription, which is chiefly taken from 
Drs. Pemberton and Baron, is not applicable to all cafes. 
Chronic peritonitis fometimes comes on fo infidioufly, 
that not the flighted fufpicion could be entertained of its 
exidence. We fliould therefore be careful, fince this dif¬ 
eafe is often the fequel of acute peritonitis, not to remit 
too foon in our endeavours for the cure of the latter 
difeafe. 
Exceptions to the fymptom of condipation are more 
frequent in chronic than in acute peritonitis. In fome 
cafes, too, the appetite is preferved, and the digedion but 
little deranged ; in which cafes we may conclude, that 
the peritoneum reflected over the domach is not very 
deeply involved in the difeafe. At other times, however, 
there is vomiting; hut this is not to be confidered a pa¬ 
thognomonic fymptom of chronic peritonitis. Brouffais 
mentions a fenfation, as though a ball were rolling about 
in the abdomen, and fometimes approaching the throat; 
Vol. XIX. No. 1301. 
this he attributes to the agglutination of the infedines, 
which form, with the gorged mefenteric glands, around 
and mobile mafs in the belly, often without any effufed 
fluid. 
In chronic peritonitis, the peritoneum acquires a great¬ 
er degree of morbid thickening, and the inflammation 
appears to have penetrated to the different ItruCtures of 
the fubjacent organs. The efl’ufion is ferous, limpicj, or 
greenifli, or reddilh, with white purulent-looking fila¬ 
ments floating about. Occafionally we find fpread over 
the whole extent of the peritoneum, or over fome of the 
envelopes which it lends to various organs, a crop of gra¬ 
nulations, pifiform, white, and not unlike certain mili¬ 
ary eruptions of the {kin. Bayle, who examined thefe 
granulations very minutely, obferves that,in a fubjeCt who 
prefented them to a great extent, he could fcrape them 
off very eafily with the fcalpel in many places, and that 
there the peritoneum underneath appeared perfectly found. 
In other parts, however, they could not be railed from 
the membrane without tearing it. Brouflais has alfo re¬ 
lated numerous cafes where the peritoneum was larded, 
and immenfely thickened, with crops of tubercles. “ I 
have alfo (fays the fame author) feen afpecies of veficles, 
fimilarto hydatids, formed of the mod limpid ferutn, un¬ 
der a tranfparent flieet of membrane which had been ele¬ 
vated thereby.” 
Brouflais obferved, that thin men, of a lymphatic tem¬ 
perament, and who had been weakened by any difeafe, 
particularly by protracted intermittents, were the molt 
iubjeCr to thefe tuberculated diforganizations of the pe¬ 
ritoneum. ThefubjeCts opened by M. Laennec prefent¬ 
ed the following morbid appearances in the abdomen. 
On perforating the peritoneum, a quantity of gas rufhed 
out, which had the odour of fulphurated hydrogen. The 
inteftinal canal was found Angularly conglomerated, and 
agglutinated into one mafs, and partly covered by thick¬ 
ened and adherent epiploon. In fome cafes the intef- 
tines were entangled and twilled upon each other, and 
glued together by falfe membranes. The peritoneum it- 
felf was thickened, diforganized, and tuberculated, in 
the maimer already delcribed, with effufions of va¬ 
rious kinds in the cavity of the abdomen. It is evident 
that thefe chronic diforganizations of the peritoneum 
cannot long exilt without affeCting the ftruCture, and con- 
fequently the functions, of the various abdominal Vifcera. 
Hence the digeltion, chylification, biliary fecretion, See. 
all become deranged, and prefent a complication of dif- 
trefllng phenomena. But not only is the difeafe propa¬ 
gated to the organs over which the peritoneum is fpread ; 
it is not feldom extended to the ferous tillues of other 
cavities than that of the abdomen. 
Before we proceed further, it will be right to inform 
our readers, that in following the common notion, that 
all the above-mentioned morbid products are therefult 
of inflammation, we are oppofed by fome very refpeCta- 
ble pathologifts. Dr. Baron, in his clever work on the 
“Tuberculated Accretions of Serous Membranes,” pro¬ 
mulgates the idea, that morbid productions on the peri¬ 
toneum are not always the confequence, but rather the 
caufe, of inflammation of that membrane. He fuppofes 
that tubercles are formed from hydatids, (a notion enter¬ 
tained by Morgagni;) and that thefe fubltances owe their 
production to a difeafed {fate of the abforbent rather 
than the vafcular fyltem. He details many faCts drawn 
from the obfervance of the fcrophulous diathefis of the 
patients of chronic peritonitis, from the abfence of 
fymptoms of inflammation, till in all probability the 
morbid products were formed. He traces up the forma¬ 
tion of large tumours and general agglutination of the 
inteftines, from the fmallelt millet-fized hydatid; and he 
{hows that the fymptoms of derangement of the vafcu¬ 
lar fyftem, when they exilt, may eafily be referred to the 
local llimulation of the tubercle or other morbid pro¬ 
duct. We are not able to decide the queflion, whether 
morbid accretions of the peritoneum never arife but from 
3 U inflammation 5 
