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PERITONITIS

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Originally appearing in Volume V21, Page 172 of the 1911 Encyclopedia Britannica.

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PERITONITIS , inflammation of the peritoneum—the serous membrane which lines the abdominal and pelvic cavities and gives a covering to their viscera. It may exist in an acute or a chronic See also:

FORM (Lat. forma)

form, and may be either localized or diffused. Acute peritonitis may be brought on, like other inflammations, by exposure to wet or See also:

COLD (in O. Eng. cald and ceald, a word coming ultimately from a root cognate with the Lat. gelu, gelidus, and common in the Teutonic languages, which usually have two distinct forms for the substantive and the adjective, cf. Ger. Kolte, kalt, Dutch koude

cold, or in connexion with injury to, or disease of, some abdominal See also:

ORGAN

organ, or with See also:

general feebleness of See also:

HEALTH

health. It is an occasional result of See also:

HERNIA (Lat. hernia, perhaps from Gr. Epvos, a sprout)

hernia and of obstructionof the bowels, of wounds penetrating the See also:

ABDOMEN (a Latin word, either from abdere, to hide, or from a form adipomen, from adeps, fat)

abdomen, of the perforation of viscera, as in See also:

ULCER

ulcer of the See also:

STOMACH (Gr. vrbsaxos from arbga, a mouth)

stomach, and of the See also:

INTESTINE (Lat. intestinus, internal, usually in neuter plural intestina. from intus, within)

intestine in typhoid See also:

FEVER (Lat. febris, connected with fervere, to burn)

fever, of the bursting of abscesses or cysts into the abdominal cavity, and also of the extensions of inflammatory See also:

ACTION

action from some abdominal or pelvic organ, such as the appendix, the uterus, or See also:

BLADDER (from A.S. blaeddre, connected with bl¢wan, to blow, cf. Ger. blase)

bladder. At first localized, it may afterwards become general. The changes effected in the peritoneum are similar to those undergone by other serous membranes when inflamed. Thus, there are congestion; exudation of See also:

LYMPH

lymph in greater or less abundance, at first greyish and soft, thereafter yellow, becoming tough and causing the folds of the intestine to adhere together; effusion of fluid, either clear, turbid, bloody or purulent. The tough, plastic lymph connecting adjacent folds of intestine is sometimes See also:

DRAWN

drawn out like spun-See also:

glass by the movements of the intestines, forming bands and loops through or beneath which a piece of bowel may become fatally snared. The symptoms of acute peritonitis usually begin by a shivering See also:

fit or rigor, together with vomiting, and with See also:

pain in the abdomen of a peculiarly severe and sickening See also:

CHARACTER (Gr. xapareri7p, from xap&crew, to scratch)

character, accompanied with extreme tenderness, so that pressure, even of the See also:

bed-clothes, causes See also:

AGGRAVATION (from Lat. ad, increasing, and gravis, heavy)

aggravation of suffering. The patient lies on the back with the knees drawn up so as to relax the abdominal muscles; the breathing becomes rapid and shallow, and is performed by movements of the See also:

CHEST (Gr. Kiarl, Lat. cista, O. Eng. cist, test, &c.)

chest only, the abdominal muscles remaining quiescent—unlike what takes See also:

PLACE (through Fr. from Lat. platea, street; Gr. IrAar6s, wide)

place in healthy respiration. The abdomen becomes swollen by flatulent distension of the intestines, which increases the See also:

DISTRESS

distress. There is usually See also:

CONSTIPATION (from Lat. constipare, to press closely together, whence also the adjective " costive ")

constipation.

The skin is hot, although there may be See also:

PERSPIRATION (Lat. per, through, and spirare, to breathe)

perspiration; the See also:

PULSE

pulse is small, hard and wiry; the urine is scanty and high coloured, and is passed with pain. The See also:

FACE (from Lat. fades, derived either from facere, to make, or from a root fa-, meaning " appear "; cf. Gr. cbatvstv)

face is pinched and anxious. These symptoms may pass off in a See also:

day or two; if they do not the See also:

case is See also:

apt to go on to a fatal termination. In such event the abdomen becomes more distended; hiccough, and the vomiting of See also:

brown or See also:

BLOOD

blood-coloured See also:

MATTER

matter occur; the temperature falls, the face becomes cold and clammy; the pulse is exceedingly rapid and feeble, and See also:

DEATH

death takes place from collapse, the See also:

MENTAL

mental faculties remaining clear till the See also:

close. When the peritonitis is due to perforation—as may happen in the case of gastric ulcer or of ulcers of typhoid fever, or in the giving way of a See also:

LOOP

loop of strangulated bowel—the above-mentioned symptoms and the fatal collapse may all take place in from twelve to twenty-four See also:

HOURS, CANONICAL

hours. The puerperal form of this disease, which comes on within a day or two after childbirth, is often rapidly fatal. The actual cause of death is the absorption of the poisonous inflammatory products which have been poured out into the peritoneal cavity, as well as of the toxic fluids which have remained stagnant in the paralysed bowel. Perhaps the commonest cause of septic peritonitis is the See also:

ESCAPE (in mid. Eng. eschape or escape, from the O. Fr. eschapper, modern echapper, and escaper, low Lat. escapium, from ex, out of, and cappa, cape, cloak; cf. for the sense development the Gr. iichueoOat, literally to put off one's clothes, hence to sli

escape of , micro-organisms (bacillus coli) from the ulcerated, mortified or inflamed appendix (see See also:

APPENDICITIS

APPENDICITIS). A See also:

GENERATION (from Lat. generare, to beget, procreate; genus, stock, race)

generation or so ago deaths from this cause were generally placed under the single heading of " peritonitis," but at the See also:

PRESENT

present See also:

time the See also:

PRIMARY

primary disease is shown upon the certificate which too often runs thus: appendicitis five days, acute peritonitis two days. Chronic peritonitis may occur as a result of the acute attack, or as a tuberculous disease. In the former case, the gravest symptoms having subsided, some abdominal pain continues, and there is considerable swelling of the abdomen, corresponding to a thickening of the peritoneum, and to the presence of fluid in the peritoneal cavity. This See also:

KIND (O. E. ge-cynde, from the same root as is seen in " kin," supra)

kind of peritonitis may also develop slowly without there having been any preceding acute attack.

There is a See also:

GRADUAL (Med. Lat. gradualis, of or belonging to steps or degrees; gradus, step)

gradual loss of strength and flesh. The disease is essentially a chronic one; it is not usually fatal. Tuberculous peritonitis occurs either alone or in association with tuberculous disease of a See also:

JOINT (through Fr. from Lat. junctum, jungere, to join)

joint or of the lungs. The See also:

CHIEF (from Fr. chef, head, Lat. caput)

chief symptoms are abdominal discomfort, or pain, and distension of the bowels. The patient may suffer from either constipation or See also:

DIARRHOEA (from Gr. &Q, through, pfw, flow)

diarrhoea, or each alternately. Along with these See also:

LOCAL

local manifestations there may exist the usual phenomena of tuberculous disease, viz. high fever, with rapid emaciation and loss of strength. But some cases of tuberculous peritonitis present symptoms which are not only obscure, but actually misleading. There may be no abdominal distension, and no pain or tenderness. The patient may See also:

lie quietly in bed, See also:

FLAT (a modification of O. Eng. flet, an obsolete word of Teutonic origin, meaning the ground beneath the feet)

flat on his back, with the legs down straight, and he may have no marked See also:

ELEVATION

elevation of temperature. There may be no vomiting and no constipation or diarrhoea. In some cases, the neighbouring coils of intestine having been glued together, a collection of serous fluid takes its place in the midst of the See also:

mass, and, being walled in by the adhesions, forms a rounded See also:

TUMOUR (Lat. tumor, a swelling)

tumour, dull on percussion, but not See also:

TENDER

tender or painful. Such cases, especially when occurring in See also:

WOMEN

women, are apt to be mistaken for cystic disease of the ovary.

As regards the treatment of acute peritonitis, the first thing that the surgeon has to do is to assure himself that the disease is not due to some cause which itself should be dealt with, to a septic disease of appendix or Fallopian See also:

TUBE (Lat. tuba)

tube, for instance, or to a toxic See also:

CONDITION (Lat. condicio, from condicere, to agree upon, arrange; not connected with conditio, from condere, conditum, to put together)

condition of the uterus, the result, perhaps, of a criminal or See also:

innocent See also:

ABORTION (from Lat. aboriri, to fail to be born, or perish)

abortion, or to a perforated ulcer of stomach or intestine. In many obscure cases the safest treatment is likely to be afforded by an exploratory abdominal See also:

section. If the medical attendant has made up his mind that the question of exploration is not to be entertained—a decision which should be arrived at only after most deliberate consultation—the best thing will be to apply fomentations to the abdomen, and to administer small and repeated doses of morphia by the skin—8 or a See also:

GRAIN (derived through the French from Lat. granum, seed, from an Aryan root meaning " to wear down," which also appears in the common Teutonic word " corn ")

grain—repeated every See also:

HOUR

hour or so until the physiological effect is produced. As regards other drugs, it may be a question as to whether See also:

CALOMEL

calomel or See also:

EPSOM

Epsom salts should be given. As regards See also:

food, the only thing that can be safely recommended is a little hot See also:

WATER

water taken in sips. A bed-See also:

CRADLE (of uncertain etymology, possibly connected with " crate " and " creel," i.e. basket; the derivation from a Celtic word, with a sense of rocking, is scouted by the New English Dictionary)

cradle should be placed over the patient in See also:

order to keep the See also:

WEIGHT

weight of the bed-clothes from the abdomen. (E.

End of Article: PERITONITIS

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