A dictionary of practical medicine: comprising general pathology, the nature and treatment of diseases, morbid structures, and the disorders especially incidental to climates, to the sex, and to the different forms of life : with numerous prescriptions for the medicines recommended, a classification of diseases according to pathological principles, a copious bibliography, with references, and an appendix of approved formulae : the whole forming a library of pathology and practical medicine and a digest of medical literature (Volume 6).

James Copland

Date:: 1834-59

Credit: A dictionary of practical medicine: comprising general pathology, the nature and treatment of diseases, morbid structures, and the disorders especially incidental to climates, to the sex, and to the different forms of life : with numerous prescriptions for the medicines recommended, a classification of diseases according to pathological principles, a copious bibliography, with references, and an appendix of approved formulae : the whole forming a library of pathology and practical medicine and a digest of medical literature (Volume 6). Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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cles to be the chief seat of the rheumatic affec- tion in those cases which I have seen. A care- ful examination of the abdomen, the state of the countenance, and the absence of retchings, and of the chief symptoms characteristic of per- itonitis, will readily indicate the nature of the disease. It should, however, be kept in recol- lection that acute rheumatism of these muscles may be followed by peritoneal inflammation. Such instances are rare, but I have met with two or three. The pains and girding sensa- tion, or feeling of tension around the abdomen, often attending irritation and inflammatory ac- tion in the spinal chord or its membranes, can hardly be mistaken for peritonitis, if the least attention be paid to the history and symptoms of the case. 129. VIII. Prognosis.—A. At an early pe- riod of acute sthenic peritonitis, much confidence may be entertained in a favourable result, al- though considerable danger should be appre- hended until the good effects of active and prompt treatment become apparent. If, how- ever, those effects are not manifested soon af- ter the measures have been resorted to that I am about to advise at an early stage of the malady; if the disease have advanced far be- fore suitable treatment was adopted ; if indica- tions of any of the unfavourable terminations mentioned above ($ 32, et seq.) have appeared; and if the case presents the asthenic form, or a complicated state, an unfavourable prognosis should be given ; but hopes of recovery should not be entirely relinquished. The prognosis of peritonitis occurring in the puerperal state de- pends upon various circumstances peculiar to this state, and must be considered in connexion with Puerperal Diseases. 130. The most favourable indications are fur- nished by the symptoms already enumerated of resolution of the inflammatory action ($ 31) by a subsidence of all the painful and urgent symptoms. On the other hand, if the symptoms increase in severity, especially after judicious means have been administered ; if the heat of the abdomen augment, or is more harsh ; if the vomiting become more urgent; the pulse more frequent, smaller, irregular, or intermittent; the countenance more anxious and collapsed, or the extremities cold or clammy ; if the breath- ing be very short, interrupted, painful, and at- tended by distress and restlessness ; if singul- tus supervene with or without meteorismus, or apumping-up of the contents of the stomach, or eructations of fluid matters, and if constipation be obstinate, no hopes of the recovery of the patient should be entertained. 131. The causes of the disease, and the vari- ous circumstances and complications attending and characterizing particular cases, should be duly estimated before we form or give an opin- ion as to the result. Thus, peritonitis caused by perforation of the stomach or intestines, or that appearing in the advanced course of con- tinued and exanthematous fevers, or following abscess in, or the rupture of, any viscus, rarely or never admits of complete recovery. Peri- tonitis, also, following surgical operations in- volving the peritoneum, and that caused by or consequent upon, or connected with, erysipelas, is attended by very great danger, particularly in the crowded wards of an hospital, or in an impure atmosphere. Various other circum- stances of only casual occurrence will also weigh with the intelligent physician when he forms his prognosis in any case. 132. B. The chronic forms of peritonitis very rarely admit of recovery in any case which is distinctly characterized. The slighter or even partial states, following the acute, may, how- ever, be removed more or less completely by careful treatment and regimen, especially when affecting persons not far advanced in life, and of an otherwise good constitution ; but the more general form of primary chronic peritoni- tis, and still more particularly the tubercular complication of it, should be considered as en- tirely hopeless, although life may be prolonged for some months. 133. IX. Causes.—The causes of peritonitis are many of those which most frequently oc- casion inflammation of other internal viscera and external parts (see Inflammation, y 91- 121); but there are some causes which de- termine more especially the development of this disease, and which may be more particu- larly adverted to.—a. Many of these act directly upon the seat of inflammation; as wounds, operations,* bruises, lacerations, ruptures, dis- placements, strangulations of parts, &c, impli- cating the peritoneum more or less ; great or unusual stretching or distention of this mem- brane; the passage into its cavity of matters foreign to it, as blood, chyle, bile, faces, pus, tubercular matter or other morbid secretions, &c. ; invaginations of portions of the bowels, or stricture or undue pressure of parts of them, or of the omentum by tumours, bands of old adhesion ; inordinate and continued pressure by or on surrounding or adjoining parts, and prolonged and unusual exertion of the abdom- inal muscles, &c. 134. b. Other causes act from contiguity, as pre-existent disease of some viscus covered by the peritoneum, especially dysentery, diarrhcea, and ulceration of the stomach or bowels; en- largements or tumours of subjacent parts ; in- flammation of any of the viscera or structures enveloped by this membrane, particularly of the intestines, urinary bladder, uterus, ovaria, liver, and spleen ; and malignant or other structural lesions of adjoining parts. This class of causes generally occasion partial or limited peritonitis. [Peritonitis from perforation of the serous membrane is not an unfrequent affection, and may generally be distinguished by the sudden- ness of the attack, and the rapidity with which the disease runs on to a fatal termination, in spite of all medical treatment. The causes of this accident are, 1st, external injuries, eithei of the solid or hollow viscera of the abdomen, or of the parietal peritoneum merely ; 2dly, rup- ture of the bladder from distention, and of the uterus during parturition ; 3dly, rupture of some portion of the digestive tube, from softening of its coats ; 4thly, ulcerative perforation of the serous membrane, arising either from disease in any part of the subdiaphragmatic portion of [* Most cases of the Cesarean section terminate fatally, from consequent peritoneal inflammation. Operations for tying the iliac arteries often cause death in the same way, as in a recent case, where the internal iliac was tied by Mr. Liston, of London, for a wound of a superficial artery of the thigh, received in a duel. Owing to the great danger of this result, operations for removing ovarian tumours are, in our judgment, altogether unjustifiable, and should be abandoned.]

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