Acute: Chronic; general; local; idiopathic; traumatic; surgical;
accidental; perforation; strangulation; cachexia; microbian almost
always; aseptic foreign bodies escape into bowel: Castration; gastric
or intestinal rupture or ulcer, enteritis, obstructions, cold storms,
draughts, chills, all lower resisting power of tissue; generalization
through peritoneal serum. Non-infective peritonitis from chemical
irritants. Paves the way for microbes of ingesta. Rheumatic
peritonitis, tuberculous, actinomycotic, microbes differ.
All inflammations of the peritoneum go under this general name. At the
same time clinical and pathological distinctions have been made with the
view of distinguishing more precisely different classes of cases. Thus
it is described as _acute_ and _chronic_, _general_ and _local_,
_idiopathic_ and _traumatic_, _surgical_, _accidental_, or by
_perforation_, _by strangulation_ and _by cachexiæ_.
The advance of bacteriology has greatly simplified our views of the
disease, as microbes are found to be at work in practically all cases.
If we could exclude microbes from this membrane, peritonitis would be
practically abolished, portions of aseptic powdered glass, sponge or
gauze can be left in the abdominal cavity with comparative impunity, the
tendency being, as shown in the dog, to coat themselves with a fibrinous
exudate, and to make their way into the intestines through which they
escape (Sternberg, Jalaguier and Manclaire). Hence it is that
peritonitis is to a very large extent the result of a traumatism
(castration, penetrating wound of the abdomen, contused wound of the
abdomen), or of a rupture or ulceration of the stomach or intestine,
through which the microbes make their way into the peritoneal cavity. In
enteritis, congestions, strangulations, intussusceptions and
obstructions of the bowels, the cause is the same, the microbes making
their way with greater ease through the coats of the bowels in which the
circulation and nutrition are impaired and the power of resistance
diminished. Finally the occurrence of the disease as a consequence of
exposure to cold or wet, of exposure in a cold rain or snow storm, of
standing in a draught when perspiring, or plunging into cold water when
heated and fatigued, or drinking ice cold water when in a similar
condition, may in most cases be explained on the same grounds. The germs
in this case had already gained access to the blood, but were helpless
to accomplish much harm, until by chilling, the resisting power of the
system was lowered and an occasion furnished for their successfully
colonizing the peritoneum. Parallel cases are found in the frog which is
immune from anthrax until it is heated, and in the chicken which is
immune from anthrax until chilled. Reduce the vitality of the system and
the germ which was already present, and up till now harmless, takes
occasion to colonize more or less destructively.
This view also furnishes an explanation of the tendency of local
peritonitis to become generalized. In the scanty liquid which bedews the
surface of the abdominal organs, the microbes grow, multiply and spread;
by the constant peristaltic movements of the bowels and their rolling
upon each other this extension is largely favored; and the tendency to
generalization will be in ratio with the potency of the invading germ,
and the general or local weakening of the invaded tissues. With a
limited infection wound in an otherwise healthy peritoneum and system,
and invasion by a pus coccus only, the infection may not succeed in
extending from its primary centre, but with a debilitated system, an
extended enteritis, or when the invasion is made by septic germs it is
likely to become speedily and fatally generalized.
Pernice has shown, however, that peritonitis may occur independently of
infection. The injection into the cavity of concentrated mineral acids,
acetic acid, phenol, nitrate of silver and other powerful antiseptics
determine inflammation by their purely irritant action. By weakening the
tissues of the bowels these in their turn pave the way for the escape of
the microbes from the contents, and to the occurrence of a secondary
infective inflammation.
Cases occur as a manifestation of rheumatism, tuberculosis,
actinomycosis and other affections which will be treated at greater
length under these respective heads.
The microbes would seem to vary greatly. Soula attributes infection of
castration wounds mainly to the bacillus of malignant œdema which is 3
to 3.5 μ long and 1 to 1.1 μ broad often bearing a refrangent spore at
one end (is sporeless in the peritoneal cultures), and growing out into
chains in artificial cultures. They are anærobic, liquefying, motile,
easily stained by aniline colors, but bleached by iodine.
In other forms of peritonitis the bacillus coli commune is found and
probably comes from the intestinal contents where it is present in all
our domestic animals.
In man Fränkel found the bacillus coli communis 9 times, streptococcus
pyogenes 7 times, bacillus lactis aerogenes 2 times, micrococcus
pneumoniæ crouposæ 1 time, staphylococcus pyogenes aureus 1 time.
Flexner found the proteus vulgaris.