Inflammation of the peritoneum presents the symptoms common to inflammation of serous membranes. It may occur as an idiopathic affection, or in consequence of traumatic lesions of the abdomen, of pressure from incarceration, or from contact with the atmosphere, with the contents of the stomach or intestines, with bile, urine, vaginal secretions, blood, or pus. It may be presented to us in the form of spontaneous or rheumatic peritonitis; it may occur as the result of a propagation of disease from the organs contained in the peritoneal sac. The most frequent form is the one attributed to metastasis, in which the peritoneum, from the large serous surface which it offers (and in this respect it presents an analogy with the vast tract of the intestinal mucous membrane), and, owing to its proximity in many cases to the primary seat of disease, is converted into a focus of extensive exudative process. To this class we refer more particularly the inflammatory and exudative processes of puerperal fever, of which we shall have occasion to speak more fully at a future period.

The affection is either general or partial. In the former case, it involves the peritoneum of the abdominal parietes, of the parenchymatous viscera, and of the colon (enteritis peritonealis), though generally with a predominance in one or the other. In both it may appear in the acute or chronic form.

A^ute general peritonitis very often terminates fatally, with symptoms of intestinal paralysis, and with imminent or existing ileus; or death is caused by exhaustion, which gives rise to the formation of large fibrinous, puriform and purulent exudations. We then find, in addition to the symptoms of serous inflammation, an enlargement of the intestine; it is expanded by gases (tympanitis), by thin watery and feculent matters; the coats of the intestine, and chiefly the interstitial cellular tissue and the mucous membrane, are tumefied, the muscular layer is pale, and they are all fragile and friable.

The tumefaction of the intestinal coats is commonly owing to an infiltration of the tissues by a watery fluid, and increases in proportion to the degree in which the mucous membrane participates in the exudative process. It occurs in the most exquisite degree in the so-called metastatic form, in that inflammation of the peritoneum which is the local expression of a general disorganization of the blood, i. e. in the puerperal type. In this case the mucous membrane presents a relation similar to that exhibited by the peritoneum in exudative processes of the mucous membrane, in Asiatic cholera, in colliquative diarrhoeas generally, or in dysentery in the shape of a mucous secretion, or of a delicate indication of plastic exudation, evidenced by mere loss of brilliancy and smoothness.

The ileus,1 which occurs in general peritonitis, is, like the dilatation of the intestine, the consequence of paralysis of the muscular coat; a relation observed to exist wherever muscular fibres are subjacent to serous membranes. The exudation of plastic lymph, especially in the case of various abnormal contortions, is also likely to contribute to its occurrence by binding down the intestine. We may easily infer which will be the terminal point of the antiperistaltic movement, or of ileus, in cases of enteritis peritonealis. As the inflammation of the peritoneum is accompanied by paralysis of the entire intestine, it can be no other portion of the intestine than the duodenum, at the lower end of which the peritoneum, and consequently the inflammation and paralysis, terminate, and which by itself is, under no circumstances, capable of controlling, by its peristaltic action, the accumulated contents of the small intestines which are being thrown into it. Yet cases which, like puerperal peritonitis, are generally accompanied by diarrhoea, form exceptions to this rule.

1 Vide Oestr. Jahrb. xviii. 1.

The exudations seen on the peritoneum, exhibit, in reference to quantity and minute structure and to their metamorphoses generally, all those variations which we have cited in the general remarks on inflammation of serous membranes. The general remarks there made with regard to the acute and chronic forms of the process, are equally applicable here. Nevertheless, we observe numerous peculiarities in peritonitis, to which we must here advert. We very frequently find extensive ca-coplastic, disorganized, discolored, septic exudations, accompanied by an almost imperceptible increase of redness and vascularity; they are more especially associated with puerperal, septic processes in the uterus. Plastic exudations become organized intpj cellular or cellulo-serous tissue. This remains attached to the peritoneum in the shape of a pale, grayish-white, or bluish-red and vascular, or slate-colored accumulation; or it forms a new movable cellulo-serous investment to all organs enveloped by the peritoneum, or it assumes the shape of flakes or strings, which pass from one to the other in different directions. In the two latter cases, various tense or loose adhesions between the abdominal viscera, among themselves, or with the parietes of the abdomen, will result; of these the following are the chief: