should be given for a day or two after the attack, although there is usually no pain of any kind when the intense agony is over.

NEURALGIA OF THE STOMACH.-This is more common in pale women, who worry constantly about household matters, although occasionally it is seen in apparently healthy men. It is also caused by various diseases of the stomach when there have existed, previous to the severe attack, some symptoms of dyspepsia after eating. Neuralgia of the stomach also occurs in nervous diseases, as in locomotor ataxia, in which disease there are pains in the limbs, unsteady gait, difficulty in passing urine, etc.

When not caused by any other existing disease, the attack comes on without regard to the taking of any special food, and the patient is well between the attacks. The attack begins with intense pain, feeling of weight, and often burning sensation in the pit of the stomach, just below the breastbone. There is often nausea (but not usually vomiting), headache, faintness, and dizziness at the onset. The pain sometimes extends to the shoulder blades, back, and all over the belly. The pain is accompanied by an appearance of great anxiety and anguish, and cold sweat breaks out on the forehead. Light pressure on the belly may be painful, but greater pressure gives relief, to obtain which the patient often presses a pillow on the stomach. He usually lies with his legs drawn up to relax the abdominal muscles. The stomach is not

generally distended, but rather sunken in appearance. The attack may last from fifteen minutes to several hours, and stops as suddenly as it began, and is frequently followed by a keen desire for food.

Neuralgia of the stomach may be distinguished from intestinal colic by the fact that the intense pain is felt in the pit of the stomach and that it is not relieved by the escape of wind from the bowels, as often happens in colic, and does not follow constipation, which is not rarely the case in colic. The treatment is the same as described above for colics, generally, but if not very severe, hot drinks, hot applications externally, and twenty drops of chloroform on a teaspoonful of sugar, may arrest the pain. Otherwise, one of the preparations of opium, advised previously, must be given. If symptoms of dyspepsia are present when the severe pain has passed, it may be that the patient has some serious disorder of the stomach, and this can only be determined by examination of the stomach contents by a competent physician.

PERITONITIS (Inflammation of the Bowels).— Peritonitis is an inflammation of the membrane which covers the inside of the cavity of the belly, and also the stomach, intestines, and other organs within it. The old and unscientific term "inflammation of the bowels" probably covered peritonitis, appendicitis, and colitis, besides other disorders.

Very rarely peritonitis starts as such, from blows on the belly or exposure to cold, but it almost in

variably is secondary to inflammation of one of the organs situated within the belly, which extends to the covering of these organs, and then to the whole of the membrane (peritoneum) lining the belly cavity.

A large proportion of cases of peritonitis follow surgical operations upon the belly, but, excluding these, the disease in a male is more frequently due to appendicitis, and in the female to inflammation of some of the maternal organs, following infection after childbirth or miscarriage. Ulcers of the bowels (as from dysentery and typhoid fever), ulcer of the stomach and first part of the bowel, and inflammation of the gall bladder may lead to perforation of these organs and to escape of germs into the cavity of the belly, where they cause general inflammation of its whole inner surface, or peritonitis.

Symptoms.-Peritonitis begins with intense pain in the belly in most cases. The site of the pain in the beginning depends upon the location of the organ in which the trouble originates.

If in the appendix-that little wormlike projection from the cæcum-there is pain in the lower right quarter of the belly, as described elsewhere (p. 528); if in the sexual organs of woman, the pain is low down in the belly, in the middle, or to the right or left. The pain soon becomes general all over the belly and continuous, instead of in paroxysms, as in colic of the bowels. The pain may lessen as the disease progresses, but the belly becomes very tender to pressure, dis

tended, and drumlike. The pain is made worse by movements, and the patient lies on the back, with his knees drawn up toward the belly, to relax the muscles. Vomiting is constant and produces much pain. At first whatever happens to be in the stomach is expelled, later a greenish or yellowish fluid, and finally a brownish-black material is brought up. The bowels are constipated, although they may be loose at first. The pulse is rapid (110 to 150), and the temperature may be increased, ranging from 100° to 103° F. The face is expressive of much suffering and anxiety, the eyes are sunken, the features pinched, the nose sharper in appearance. The breathing is weak and the skin cold. General peritonitis is one of the most fatal diseases, death occurring in from two to six days.

Peritonitis cannot easily be mistaken for intestinal, renal, or gallstone colic, as the pain is steady and continuous for days and is general over the belly. Also, in peritonitis, there is gradually increasing tenderness to pressure and distention of the abdomen, which are not seen in colic. Continuous fever is present in peritonitis, and this serves to distinguish it from colic with distention, in which there is pain but no fever; and if, during colic, oil of turpentine is given by the mouth on sugar in five-drop doses, hourly, and injections of warm soapsuds containing a tablespoonful of turpentine are introduced into the bowels at two-hour intervals, the gas will be expelled and the patient will

soon recover, which could not possibly happen so rapidly in peritonitis. Pain and tenderness in the lower right side of the belly, and other symptoms described under appendicitis, will serve to distinguish this disease from peritonitis; but, as has been said, appendicitis often terminates in peritonitis. Obstruction of the bowels, more difficult to diagnose from peritonitis than the other disorders, is accompanied by severe pain in the belly, and often ends in peritonitis. In either case a surgeon should be summoned at the earliest possible moment, since surgery offers most hope in both conditions.

Treatment. The treatment comprises absolute rest and, when medical advice is not obtainable, the use of opium. The same treatment should be followed as regards medicines and nourishment that is recommended under appendicitis. Opium may be used more freely and in sufficient quantity to keep the patient fairly comfortable. No cathartics should be given. To relieve the distention of the belly, a quart of warm water containing a tablespoonful of oil of turpentine may be injected at frequent intervals into the bowel. Cloths dipped in turpentine and wrung out of hot water, or cloths dipped in ice water, should be applied to the abdomen with frequent changes throughout the disorder. Sometimes one, sometimes the other, gives relief.

As the disease may last a long time, if the patient recovers, it is permissible to begin to feed him by