LOCAL CIRCUMSCRIBED PERITONITIS may give rise to the symptoms of a gen eral peritonitis. The disease becomes localized by reason of a rapid adhesive inflammation shutting off the general peritoneum. This often follows ulcera tion of the stomach and other abdom inal viscera. The most frequent seat of local or circumscribed peritonitis is in the right iliac fossa, due to perforation of the appendix vermiformis subsequent to catarrhal ulceration of the same. Dis ease of the Fallopian tubes is frequently the cause of localized peritonitis. A general acute peritonitis may follow any of these forms of localized peritonitis, with abscess-formation, by reason of a gradual extension and burrowing of pus in various directions and so infecting the general peritoneal cavity. (See sec and colored plate in the article on AP PENDICITIS, volume i.) Signs of most value in recognizing typhoid perforation are sudden, acute abdominal pain, collapse, and abrupt and decided fall of temperature. Vomiting is often present. The obliteration of liver-dullness, the gurgling sound on res piration, hiccough, etc., are valuable signs when present. As a rule, perfora tion is quickly followed by symptoms of peritonitis. The streptococcus pyogenes is usually found in numbers in the exu date of perforative peritonitis. J. N. T. Finney (Annals of Surg., Mar., '97).
Of the general peritoneal infections dependent upon appendicitis, those in which the colon bacillus predominates are attended by a comparatively low temperature; those caused by the strep tococcus pyogenes by a high one; a mixed infection may show a high or a low temperature, according to the pre dominance of one or the other of these germs; the progress of a streptococcic infection is rapidly fatal, of a staphylo coccic comparatively slow, of a colon bacillus sometimes rapid and fatal and sometimes mild and favorable. As a rule, however, the milder the germ, the milder and more favorable the ease.
Personal case in which erysipelas was the cause of infection. M. H. Richard son (Boston Med. and Surg. Jour., Sept.
8, '9S).
Etiology and Pathology.—The surface of the peritoneum, we are told, is as large as that of the integument of the body; in its reduplications and folds it partially surrounds all the abdominal organs and viscera. It is, therefore, ex posed to infection on all sides. The in fection is always one or several forms of micro-organism which gain access to the peritoneal cavity. The pathogenic germs which most commonly give rise to peri tonitis are the bacillus coli communis, the staphylococci aureus and albus, bacil lus pyocyaneus, the streptococcus pyog enes, the gonococcus, and the tubercle bacillus. The infection is not always a pure culture, but is usually mixed; eral forms of pathogenic micro-organisms being present.
Bacteriological classification of peri tonitis: (a) Streptococcic infection. The streptococcus pyogenes is the microbe which is most frequently found in the tissues in cases of septic peritonitis. The infection spreads so rapidly over the peritoneal surface and through the sub serous lymphatics that death, as a rule, occurs from septic intoxication before a sufficient length of time has elapsed for any gross pathological lesions to form. Absence of fibrinous exudate and effu sion are the most striking negative find ings at operations and necropsies.
(b) Staphylococcic infection. In peri tonitis caused by staphylococcic infection the intrinsic tendency to localization of the disease is more marked. As a rule, the inflammation terminates in the for mation of thick, cream-colored pus.
(e) Pneumococcic infection. The dip lococcus occasionally is found as the bacteriological cause of acute suppura tive peritonitis.
(d) Bacillus - coli - commune infection. The bacillus coli commune is, in a fair percentage of cases, the bacteriological cause of acute peritonitis. This microbe possesses pyogenic properties, and in in testinal paresis and perforations escapes into the peritoneal cavity, and usually produces a pathologically mixed form of peritonitis; that is, suppurative and fibrinoplastic peritonitis.