Acute Peritonitis generally sets in with well-marked symptoms, smart rigors and high fever, with a hard and sharp pulse, which very soon becomes frequent, and often becomes feeble, and is sometimes small from the very first. After the disease has continued for a certain time, it is attended with tension and swelling of the belly. The tension and swelling are tympanitic in the earlier stages.

When the disease is advancing towards a fatal termination, the abdomen often becomes greatly distended; the pulse is exceedingly frequent and feeble; the countenance (which in all the stages of the disorder is expressive of anxiety) becomes pinched and ghastly: cold sweats ensue; and the patient dies at length by exhaustion. The mind is often clear to the very last. In addition to the symptoms mentioned above, there are sometimes sickness and vomiting, and occasionally suppression of urine.

Acute Peritonitis, in its simple form, is always a dangerous, yet frequently a manageable disease; when it is complicated with other and earlier organic mischief, and especially when it has been excited by the entrance of foreign irritating matters into the cavity of the belly, it is all but hopeless under any kind of treatment.

Treatment

As early as possible after the inflammation has set in, apply leeches to the belly. As many as thirty or forty may be applied at once; and a smaller number next day, if the tenderness has not abated. If the pulse becomes fuller and stronger after the bleeding, it is good evidence that the bleeding has been beneficial. After the leeches are removed, the belly may be covered by a large, but light, warm poultice, which must be repeated as often as it becomes cool; or the belly may be constantly fomented with flannels wrung out in warm water. This must be kept up day and night.

Purgatives should not be given. If the bowels are confined; injections of warm water or of warm linseed oil may be given. And the Bromide of Potash in ten grain doses, or the Hydrate of Chloral in ten grain doses, may be given every two or three hours.

The strength must be supported with gruel, milk, and, if thought necessary, injections of Beef Tea may be given.

Chronic inflammation of the peritoneum is sometimes only the remains of the acute. Where, however, it arises of itself, it often begins and steals on in a very insidious manner. The patient complains of pains in the abdomen; sometimes slight, amounting to scarcely more than uneasiness, but abiding; sometimes occasional only. Usually there is a sensation of fulness and tension of the belly, although its bulk may not be sensibly altered. Sometimes there is a sense of pricking felt. Dr. Pemberton remarks, that you may detect a sort of deep-seated tension; that the skin and muscles lie loosely on the peritoneum, which gives to the hand a sensation as of a tight bandage underneath, over which the integuments appear to slide. The uneasiness or pain is increased by pressure, and sometimes is only felt when pressure is made. Sometimes there is loss of appetite, with nausea and vomiting; an irregular state of the bowels, and unhealthy evacuations. Sometimes on the contrary, the digestive organs perform their office in a tolerably healthy manner. Sooner or later, in most cases, the belly enlarges, becomes tight and tympanitic; and fluctuation is felt. All along there is some fever, more or less distinctly marked; with progressive emaciation and debility. The face is pale and sallow.

Treatment

Leeches, in small numbers must be applied, and frequently be repeated, and followed by soft warm poultices. After the tenderness has been diminished in this way, blisters may be applied. The state of the bowels must be regulated by mild laxafives, and not by strong purgatives. The following mixture would be useful:

Castor Oil....................................Two Ounces.

The Yolks of two Eggs......Mix completely and then add:

Syrup..........................................One Ounce.

Compound Tincture of Cardamoms....One Ounce. Water, sufficient to make Half a Pint. Two tablespoonfuls to be taken every two hours till it operates.

If the patient is feverish he may take the following:

Solution of Acetate of Ammonia..........One Ounce.

Sweet Spirit of Nitre.........................Six Drams.

Tincture of Henbane........................Two Drams.

Syrup...........................................Half an Ounce.

Water, sufficient to make Half a Pint. Two tablespoonfuls three times a day.

Frictions of the belly with Ointment containing Iodine is said to have done good in these cases. The following may therefore be tried, after the leeches, and after the blisters have healed. It must not be applied to a sore surface.

Iodine........................................Forty Grains.

Iodide of Potash (in line powder)....Eight Grains.

Water........................................Fifteen Drops.

Mix the Iodine and Iodide of Potash with the water, and then add Lard.........................................Two Ounces.

One-fourth of this may be rubbed on the belly night and morning. If it seems to be beneficial, and does not irritate the skin, it may be continued for some time.

The diet must be nourishing, but unstimulating: Milk, Sago, Rice, Arrowroot, Corn starch, Corrageen jelly, and things of that description.