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"The point of rupture formed adhesions, the natural drainage of the peritoneal ichorous focus ceased, perhaps a new influx of inflammatory material from the perforated appendix also took; place. There was a fresh relapse of the local peritonitis which extended beyond the boundaries of the limiting adhesions, and permitted the invasion by bacteria of the free abdominal cavity.
He says that in this case the woman, while pregnant, received a blow on the lower part of her body, in consequence of which a small tumor appeared shortly after the accident. It so happened in this case that the peritoneum was extremely dilatable, and the uterus, with the child inside, made its way into the peritoneal sac. In his presence an incision was made and the fetus taken out alive.
Old opinions with respect to what parts of the human economy are really vital have been abolished; and a new concept of the relation of life to organism has prevailed. Until recently it was supposed that the peritoneal cavity and the organs contained therein, such as the stomach, the liver, the bowels, etc., could not be entered by the surgeon without the certain result of death.
Tait describes a case of rupture of the spleen in a woman who, in attempting to avoid her husband's kick, fell on the edge of the table. There were no signs of external violence, but she died the third day afterward. The abdomen was found full of blood, and the spleen and peritoneal covering was ruptured for three inches.
With the rupture of the abscess, the entrance of poisons into the free peritoneal cavity, and their resorption by the extensive peritoneal surfaces, as well as the vomiting and the intestinal paralysis, ceased. The taking of nourishment again be came possible.
There were none of the tumors, or pestilential buboes, that, in an earlier or later period of the malady, usually accompanied and characterized murrain; but upon inspection of the dead bodies, considerable peritoneal inflammation was found; the first and second stomachs were filled with food, but the third stomach was the palpable seat of the disease; its leaves were black and gangrened.
In like manner the other defects above enumerated may gradually be rendered less serious. A most important point remains; the peritoneal ligaments of the uterus fully subserve suspensory functions. The anterior, posterior, and lateral ligaments are mainly concerned in preventing the gravid uterus, in quadrupeds, from pitching too far forward toward the diaphragm.
It spreads to the uterus, Fallopian tubes and ovaries and may even affect peritoneal tissues, first of the pelvis, then of the abdomen may even finally affect the heart and joints. Of course, these are rather the extreme limit, but they are not at all rare cases.
If the pulse of either the merchant or the farmer had been due to peritonitis death would have ended either one before his abscess had broken. In fact diffuse peritonitis comes from perforation with discharge of the abscess contents into the peritoneal cavity, and it always spells death.
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.
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