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Wallace reports a case of spontaneous rupture of the abdominal wall, following a fit of coughing. The skin was torn and a large coil of ileum protruded, uncovered by peritoneum. After protracted exposure of the bowel it was replaced, the rent was closed, and the patient recovered.
Like the stomach, the small intestine has four coats, the serous, muscular, sub-mucous, and mucous. The serous is the peritoneum. The muscular consists of an outer layer of longitudinal, and an inner layer of circular fibers, by contraction of which the food is forced along the bowel. The sub-mucous coat is made up of a loose layer of tissue in which the blood-vessels and nerves are distributed.
"There could be no doubt that the perityph abscess had ruptured into the intestine, and that in consequence of this the diffuse peritonitis had at once been relieved." The peritoneal cavity, or the peritoneum as an organ, was not involved in this disease; hence it is an error to say that there was diffuse peritonitis which was at once relieved by the rupturing of the abscess into the intestine.
It was generally believed to be due to the presence of foreign substances, such as grape seeds, etc., in the vermiform appendix, but this idea is exploded. It is an inflamed condition of the appendix, but the inflammation may have extended from the colon or from the peritoneum. With a clean colon appendicitis is practically an impossibility.
The reason why it gives rise to so much trouble is that it is so small scarcely larger than will admit a knitting-needle and so twisted upon itself that germs or other poisonous substances swallowed with the food may get into it, start a swelling or inflammation, get trapped in there by the closing of the narrow mouth of the tube, and form an abscess, which leaks through, or bursts into, the cavity of the body, called the peritoneum.
The lowermost are called round ligaments, taking their origin from the side of the womb near the horn, from whence they pass the groin, together with the production of the peritoneum, which accompanies them through the rings of the oblique and transverse muscles of the belly, by which they divide themselves into many little branches resembling the foot of a goose, of which some are inserted into the os pubis, the rest are lost and confounded with the membranes which women and children feel in their thighs.
Do they lie in front of or back of the peritoneum? Do they lie exactly opposite each other? Find a slender tube, the ureter, running from each kidney to the bladder. Do the ureters connect with the top or with the base of the bladder? Show by a sketch the connection of the kidneys with the large blood vessels and the bladder.
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