In case the patient survives, the effusion and neoplasm are slowly absorbed, but the false membranes only imperfectly, and they may be found later as organized bands attaching the intestines or other organs to adjacent parts, and limiting their motions or constricting and strangling them. Hence there is left a predisposition to relapse or to other disease of the abdomen. Röll has noticed degeneration and softening of the false membranes, which extended to the wall of the bowel beneath and led to perforation.
Prevention. In solipeds especially this affection is so fatal that every precaution should be adopted to prevent its occurrence. In this class of animal the tendency to suppuration in wounds and inflammations of all kinds greatly exceeds what we see in other animals. A wound that in man will heal kindly by first intention will almost certainly suppurate in the horse, and an abdominal wound which in man, ruminant, or pachyderm might be viewed with confidence, must be treated as a very serious matter in the horse. But though thus differing in degree, all abdominal wounds must be considered as serious lesions. The peritoneal sac is, like other serous sacs, a dependency of the great lymphatic system of vessels, and the liquid present in it in health is, like the lymph, the most favorable culture medium of the body for microbian life, the greater the amount of such peritoneal fluid (as in inflammatory or other exudate) the more favorable it becomes to its growth and diffusion, and finally the enclosed intestine is teeming with micro-organisms, which, though held in check by the healthy mucosa, are ready when any congestion, inflammation or other morbid process gives occasion, to traverse these thin walls and start their deadly career in the peritoneum.
In every animal, therefore, but in solipeds above all, every precaution should be taken against the infliction of accidental wounds of the abdominal walls, and to remedy any serious derangement of the digestive organs. Above all, operations that involve the peritoneal cavity should be made only under careful surgical precautions. The introduction of pyogenic, septic or potentially septic material from hands, head, beard, floating dust, unboiled water, or surgical appliance of any kind, is a direct bid for a fatal peritonitis. Next to this the greatest care must be exercised to prevent unnecessary injury to the peritoneum or any abdominal organ, which would in any way impair its vital properties and resisting power. Again, to leave blood or exudate of any kind in the wounded peritoneum is a direct bid for the propagation of micro-organisms. These should be removed by means of aseptic agents. Finally, in case of enteric disease and abdominal wounds the patient should be guarded against chill, which would lower the vital and resisting powers and lay the system open to microbian invasion.
Treatment. The therapeutics of peritonitis furnishes a striking example of the transforming influence of bacteriological discovery. Systematic medical and veterinary works enjoin the time-honored method of treatment by opium to check intestinal peristalsis and the painful friction of inflamed surfaces on each other, and to keep the organs quiescent until nature shall have time to subdue the inflammation. The still older treatment by calomel and opium has essentially the same foundation. To the bacteriologist the latter has the recommendation of being to some extent antiseptic and of tending to secure depletion from the intestinal mucosa. Another cardinal principle of the old practitioner was to hail the liquid exudate as tending to separate the inflamed and painful surfaces, and as allowing them to move past each other without aggravating the suffering and inflammation. In short, the practitioner of the past had an especial dread of mechanical injury, and treated all other measures as secondary to this though by no means unessential.
Bacteriological considerations direct attention rather to the vital properties of the causative bacteria and seek to check the disease by checking this its most effective cause.
In simple local peritonitis, as in the infection following castration, the washing out of the infected wound with boiled water and application of an antiseptic (iodoform, iodoform or carbolic acid guaze), and the free use of carbolic acid solution (1:50) to the skin is of great value. If the sheath or inguinal region is swollen to any extent, puncturing it at intervals with a lancet to the depth of half an inch so as to drain it speedily and thus reduce the swelling and culture fluid, and to restore the vitality of the parts, and the frequent bathing with the carbolic acid lotion, will usually succeed in bringing about a healthy action.
The question of medical treatment comes forward mainly in cases that have invaded the abdominal peritoneum, and which are not already completely generalized, nor the result of extensive escape of gastric nor intestinal contents. In such forms and above all in the early stages of surgical cases sulphate of soda given to the extent of causing free purgation has been found to be incomparably more effective than the opium treatment. The explanation of its action may rest in part (1) on the expulsion from the bowel of a large proportion of the dangerous microbes which are simply waiting for that opportunity to pass into the peritoneum, which will be furnished by the inflammation of the intestinal walls; (2). On the elimination from the blood and system of much of the deleterious ptomaines and toxins which have already been absorbed from the inflamed surface and the presence of which robs the tissues of their vitality and resisting power; (3). On the active depletion from the intestinal mucosa and (through the common capillary plexus) from the congested peritoneal coat, counteracting alike the effusion into the peritoneum which forms the culture fluid for the invading bacteria, and the infiltration of the serous and subserous tissues which beside tearing apart the tissue-elements, and robbing their leucocytes of their power of phagocytosis, furnishes within the invaded tissue itself the most favorable of culture media; and (4) on preserving a better tone of the nervous system and, locally, of the tissues the cells of which, can struggle more successfully against the small body of invading bacteria advancing slowly along the surface of the peritoneum, than with the countless myriads produced in and washed everywhere by the abundant liquid exudate.
Along with the soda sulphate may be given antiseptics, like sodium salicylate, or chloral hydrate. The latter serves to mitigate the pain without checking the secretion or peristalsis.
When the suffering is very acute, opium may still be resorted to, but preferably subcutem, in the form of morphia sulphate so as to lock up the poisons as little as possible.
Enemata are in order to facilitate the operation of the bowels, and may be made laxative and antiseptic. The danger of tympanitis speaks forcibly for a judicious use of antiferments, both by the mouth and anus.