Acute Inflammation of the Peritoneum. Peritonitis.
This disease affects the extensive membrane which lines the whole inside of the belly, an extension of which forms the omentum or apron. It is an inflammation to which women are much exposed after confinement, and is known, in such cases, as childbed or puerpral fever. It is common among men also, and is a grave disease.
The accepted notions of no disease have undergone so much of a revolution of late years as those relating to peritonitis. It was formerly considered to be generally of spontaneous or idiopathic origin, whereas now we know it to be the outcome of some one of several diseases, but lately understood, as for instance, appendicitis, septicemia or blood poisoning, inflammation of the fallopian tubes and ovaries, tuberculosis, abscess of gall bladder, strangulated hernia, etc.
Symptoms. Like other forms of fever and inflammation, it is preceded by chills, with increased heat of surface, thirst, full~ strong, and frequent pulse, flushed face, and red eyes, dry tongue with red edges, dry skin, restlessness, short, quick breathing, nausea and vomiting.
The pain is increased by the patient sitting or standing up, the bowels being thus pressed against the inflamed membrane. Lying upon either side is painful for the same reason. To lie flat upon the back, with the feet drawn up, is the only endurable position. The patient lies still, for all movements give pain.
The pain in this disease is generally sharp, cutting, and pricking, but is not always equally intense. It is aggravated by the passage of wind along the bowel, by which the inflamed membrane is slightly stretched.
When the disease is advancing towards a fatal termination, the belly becomes greatly swollen and tense, having to the hand a peculiarly tight, drumhead feeling; the pulse is rapid and feeble; the countenance is full of anxiety, and is pinched and ghastly; and a cold sweat breaks out.
Treatment. No time should be lost in calling a competent surgeon to see a case with symptoms of peritonitis, for as before pointed out there are comparatively few cases but what depend upon some disease which will require operating upon the abdomen. It is of the utmost importance to distinguish local inflammation within the belly wall so that no time will be lost when it is so important that an early operation should be performed if needed.
The two main indications in the treatment of peritonitis after having discovered and treated the causes, are the thorough draining of the bowels of their watery secretions by some gentle saline which will not stir them up; and secondly to maintain them in a state of quiet and rest. The first is met by magnesia in the form of the solution of the citrate, say one half bottle every four hours till copious watery movements occur. This drains the glands and causes a flow of the poisonous effete material into the bowels and rids the system of so much poison. The second indication is met by opium in some of its many forms. It is often, however, a serious problem for even the physician to decide, and should only be undertaken with his advice.
The drinks should be lemonade, soda water, tamarind water, currant jelly dissolved in water, and preparations (298) and (299).
Indian meal gruel, toast water, barley gruel, and the like, are the only allowable diet.
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