Recovery, Prognosis, etc.—­The action of the heart becomes weak and irregular, respiration is shallow, the temperature taken in the rectum is high, the skin is cold, pale and livid, death occurs sometimes suddenly, usually in three to five days; less often thirty-six to forty-eight hours; or even after ten days.  The results depend mainly upon the cause of the inflammation, and the nature of the infection, infectious disease that produces it, being usually very bad after puerperal sepsis (after confinement), induced abortion, perforation of the bowel or stomach, or rupture of an abscess.

Local peritonitis.—­This may come from local injury, but it is usually secondary to empyema, tuberculosis, or cancer, abscess, perforation of the stomach or bowel, ulcer, etc.

Symptoms.—­Onset is usually sudden.  There is sudden local pain, increased by any movements; tenderness, and vomiting; then chills, irregular fever, sweating, difficult breathing, emaciation.

Treatment of the acute peritonitis.—­There must be absolute rest, morphine by hypodermic method, one-fourth to one-half grain to relieve the pain.  Ice cold and hot fomentations with some herb remedy like hops, smartweed, etc.; or cloths wrung out of hot water with five to ten drops of turpentine sprinkled on them.  This is very good when there is much bloating from gas.

The turpentine should be stopped when the skin shows red from it.  The cloths should not be heavy or they will cause pain by their weight.  Ice water can be used when cold cloths are needed.

For vomiting.—­Stop all food and drink for the time and give cracked ice.

Diet.—­Should be hot or cold milk with lime water or peptonized milk if necessary.  If the feeding causes vomiting, you must give food by the rectum.  For the severe bloating enemas containing turpentine should be given, one to two to six ounces of water used with ten to thirty drops of turpentine in it; sometimes it is necessary to resort to surgery.

Tubercular peritonitis.—­This may occur as a primary trouble or secondary to tuberculosis of the bowels, lungs, and Fallopian tube.  It is most frequent in males between twenty and forty.

[ Digestive organs 135]

Symptoms.—­These are variable.  It may occur like acute peritonitis with sudden onset of high fever, pain, tenderness, bloating, vomiting and constipation; these symptoms passing into those of chronic peritonitis.  Often there are gradual loss of strength and flesh, low and irregular fever; frequently the temperature goes below normal with a little ascites tympanites, constipation, diarrhea and masses in the abdomen which consist of the omentum (apron covering the bowels) rolled up and matted into a sausage-shaped tumor in the upper part of the abdomen, or of thickened or adherent coils of the bowel, enlarged mesentric lymph nodes, etc.  Spontaneous recovery may occur, or the course of the disease may resemble that of a malignant tumor.