Acute Peritonitis from a Medical
Standpoint.

By W. H. Vincent, M. D., Orwell.

I will review with you today my experience with one of the most serious diseases we have to treat.

It is not necessary for me to go over the symptoms of peritonitis-you all know them.

I can now recall 23 cases of this disease and it has been my good fortune to see 21 recover without surgical interference.

These cases were of the most severe form, where life was despaired of for a time.

Peritonitis may be considered as either acute, infectious or chronic. All my cases have been of an acute form, caused either by the irritation of undigested food, traumatism or irritation and disease of the reproductive organs of the female.

In a threatening case of acute peritonitis the first thing to do is to remove the irritating cause.

If from undigested food, and I am called early, I empty the stomach, if it has not already been done.

I then give salts or castor oil by the mouth and an enema of one ounce of Epsom salts and glycerine to onehalf pint of water.

I control the pain with opiates-codeine by the mouth or hypodemically as preferred, repeated as needed.

After removing all undigested food and irritation from the intestinal tract as far as possible and the stomach remains sensitive as it usually does, I try first hot water as hot as it can be swallowed, repeating every time there is an effort to vomit.

This washes the stomach out, acts as a sedative to the mucous membrane, prevents retching and stimulates the circulation.

I have seen the worst cases of vomiting relieved by hot water alone.

I also give a tenth grain calomel triturate every hour, and counter irritate over the stomach with mustard, horse radish leaves or spice poultices, stop all food but egg albumen, and if I then fail, I apply a fly blister over the pit of the stomach and give champagne in cracked ice which rarely fails to give relief.

If cathartics work easily your case will be of short duration as a rule, but usually you fail to have them retained. If you fail in the commencement of the disease you must wait.

At the first indication of inflammation and distention I depend on my hypodermics for the pain and turpentine stupes for the distention and inflammation.

I prepare my stupes in the following manner :

Oil meal enough to fill two cheese-muslin bags, onefourth inch thick, large enough to completely cover the abdomen.

I order these to be heated in a steamer over hot water and when hot, cover the surface that comes next the body with fresh lard and when ready to apply sprinkle on a tea

spoonful of turpentine, changing the poultices every 30 or 60 minutes as required to keep hot.

The lard prevents the turpentine from blistering.

I give these directions fully, for unless you have an experienced nurse they will do more harm with these applications than good.

To remove the gas below the obstruction I use the following enema, repeating as required.

30 drops spts. turpentine.

1⁄2 teaspoonful sodium chloride.

An ounce each of sulphate magnesia and glycerine dissolved in one pint of warm water,

and I will guarantee you will empty the intestines of gas below the obstruction within five minutes.

Gas cannot live with this injection any more than pus can with peroxide of hydrogen.

I sometimes remove the gas by inserting a rectal tube and sometimes get benefit from high injections through the rectal tube.

As soon as the stomach will retain anything I give sweet oil in ounce doses every 3 hours until the bowels move, and if retained you will be surprised at the soothing effect it has. It is a non-irritant, soothing and nourishing cathartic.

If you fail with the above treatment you may be sure you have a case for surgical interference.

I have reported 23 cases of peritonitis with 21 recoveries treated as above.

The first case that died was diagnosed as obstruction of the bowels-a boy 7 years old-who was delicatehad always had indigestion-was taken with severe pains.

in the stomach and bowels, and vomiting-after riding a horse-rake-started as a severe attack of indigestion.

For one week his condition improved under treatment; at the beginning of the second week inflammation developed with distention and there was evidence of complete obstruction accompanied with general peritonitis.

An operation was asked for and refused. The symptoms continued and the patient died from prostration at the beginning of the fourth week.

The autopsy revealed the small intestine tied in a complete knot, causing a strangulation and obstruction.

Medication was handicapped in this case by mechanical obstruction and only a surgical operation could have saved the boy.

The peculiarity of this case was the length of time the child lived in this condition. The intestine must have been strangulated over two weeks.

The second case was a lady thirty-five years of age, strong and healthy to all appearances up to time of sickness. Saw the case first on Jan. 10, 1896; was taken with vomiting, and severe pain in the bowels, which gradually developed into peritonitis. Patient claimed her husband

struck her in the bowels.

Tenderness, mostly in right side, over McBurney's

point.

Said she had been kicked in the bowels four years before, which caused considerable inflammation, but had not given her much trouble of late.

The case continued about the same until Jan. 25th, or for fifteen days, with all the symptoms of peritonitis. Retained but little food except by rectal enemas.

About this time a tumor was distinctly felt at McBurney's point, and appendicitis was suspected. A surgeon was called and my diagnosis confirmed.

We operated on Jan. 27th. The cœcum was found firmly bound down in region of appendix by old inflammatory adhesions, and very much thickened. The glands in this region were very much enlarged. The appendix showed the same inflammatory condition as the cœcum, but did not seem to be the primary cause of inflammation.

Six inches of the intestine was removed. It was a long, tedious operation owing to the strong adhesions, and the patient never fully recovered from the operation.

This brings us to a very important part of the subject. There is no disease a physician comes in contact with that so taxes the skill and judgment to decide whether to depend upon medication or an operation.

The attending physician is the one to decide this question and it often comes to a point where immediate decision means life or death to your patient.

Appendicitis is given as one of the most common causes of peritonitis.

Not long ago I heard a physician say he believed every case of acute peritonitis caused by indigestion was appendicitis in a mild or severe form.

I did not agree with him.

There has been so much written upon appendicitis in newspapers and medical literature for the past few years that not only those with real appendicitis were operated on, but many in our large cities were worked up to a point of having the appendix removed for fear they might have it.