[The author plays so fast and loose with the words, “diffuse peritonitis,” that I am reminded of a remark made to me several years ago by a society lady who posed as a pace-setter in all matters pertaining to the intricacies of what one should and should not do.  The subject was one that I did not know much about at that time, and upon which I am not much better informed at present.  It was on diamonds.  I complimented her on a very beautiful sunburst.  She took the compliment modestly, of course.  The center diamond was large and, I thought, of uncommon brilliancy, and I remarked, “That center stone properly mounted would make a very fine solitaire.”  She then informed me that she once owned a cluster of solitares.

The author tells us that at first the diffuse peritonitis probably did not extend beyond the local focus; this of course is exactly what I am contending for from first to last and I insist that there was not peritonitis proper until the occurrence of the fatal relapse.

It is somewhat surprising that this article should be selected to represent the last word on this subject, when the author builds his treatment upon diffuse peritonitis; then enters into a lengthy analysis and explanation of symptoms to fit the diagnosis and treatment and before he is through with the subject he declares that the diffusion is confined to the focus of infection.

If I did not know something of the worth of words I am not sure but such an excellent explanation might persuade me!!  If I did not know from experience that all this is theory, beautiful theory, it might be very hard to resist!]

“After the symptoms of local and general inflammation with their secondary signs in the stomach and intestine had lasted for six days, suddenly a complete change took place:  The nervous, anxious, extremely distressed patient became feeble and scarcely complained at all; his formerly congested face was pale and elongated, the nose pointed and cool; the skin lost its turgescence and warmth and was covered with a cold sweat; the bodily temperature also fell, the pulse became small and frequent but remained quite regular, the abdomen became softer and to a great extent lost its sensitiveness; the vomiting decreased to a few painless attacks,”

[Wholly due to the opium and morphine given]

“and singultus disappeared:  A picture which, to a certain extent, is a combination of collapse and narcosis although not to the degree of profound loss of consciousness, being the picture of an intoxication in sharp contrast to the preceding febrile state.”

[That is exactly what I stated above—­a case of narcotism.  How is it possible that the author, recognizing the narcotism, feels it incumbent to give other explanations?]

“Just as the affection had suddenly developed to its full height at the onset of the disease, and much more swiftly than, for example, is the case in phlegmon of the external walls, so with extraordinary rapidity did the clinical picture assume a new type.  In this respect we must consider the very great area of the peritoneal folds, their numerous lymphstomata, and their intimate relation to the circulation, and we are impressed with the fact that fluids and solubles, as well as formed products, are rapidly absorbed by the peritoneum.