(e) Gonococcic infection. In the peri toneal cavity the gonococcus produces a plastic peritonitis, and sometimes local ized suppuration. Salpingo - peritonitis and the more diffuse pelvic peritonitis is most frequently caused by gonococcic infection.
(f) Tubercular infection. The rapid diffusion of the tubercle bacillus in the peritoneal cavity occasionally gives rise to a form of acute peritonitis character ized as such in a modified way by the clinical manifestations which accompany it. According to the intensity of the infection or the degree of susceptibility of the patient to the action of the tubercle bacillus, the disease assumes one of the following pathological forms: (1) tubercular ascites; (2) fibrinoplastic peritonitis; (3) adhesive peritonitis.
Suppuration takes place only when the tubercular product becomes the seat of a secondary mixed infection with pus microbes. N. Senn (Med. News, May 8, '97).
Personal cases bring for the first time convincing evidence of the existence of a diffuse, general inflammation of the abdominal cavity caused by the gono coccus. It has been recognized that ex tension of the gonorrheal infection from the genital organs to the peritoneum may occur in the puerperal state; a similar sequel is shown to be possible during menstruation. Such ascending forms of gonorrhea doubtless under ordi nary circumstances remain localized in the pelvis, and rarely demand surgical investigation in the acute stage.
A general involvement of the peri tonenm must either be rare or unrecog nized, and may depend upon some espe cially-receptive condition of the serosa or virulence of the organism. The peri toneum is not more immune than are the Pericardium and endocardium to gono coccic infection, and, being more ex posed, suffers more commonly in females, although the relatively benign course of the disease makes it a rare condition to come to the attention of the surgeon in the acute stages. Cushing (Johns Hop kins Hosp. Bull., May, '99).
Avenues for the entrance of bacteria into the peritoneum: Any injury or dis ease of the alimentary canal sufficiently intense to cause a perforation, notably appendicitis, and less frequently ulcers; any obstruction—such as invagination, intussusception, or strangulated hernia —which causes a necrosis of the gut; septic conditions of the abdominal or pelvic organs—such as abscess of the liver or kidneys, and especially disease of the Fallopian tubes—giving rise to pelvic peritonitis; septic conditions of the postpartum uterus giving rise to puerperal metritis, this latter often be ing classified under a distinct heading; traumatism from within or without the lumen of the bowel, or traumatism to the abdominal wall. C. D. Hill (Med.
News, Aug. 17, 1901).
The most frequent source of infection is from the intestine, caused by the migration of the bacilli coli communis through inflamed intestinal walls or directly through a rupture caused by traumatism or perforating ulcer.
Peritonitis is frequently caused by ex tension of inflammation from the various abdominal organs and by perforation in some part of the intestinal tract, as in gastric, typhoid, tubercular ulcers or perforative appendicitis, or perforating diseases of the gall-bladder. It may low inflammation or disease of the pelvic viscera, as shown in many cases of sal pingitis, extra-uterine pregnancy, and septic metritis. The primary inflamma tion in the various organs or viscera is always caused by a micro-organism, and the peritonitis which follows, to exten sion of the infection. The bursting of abscesses into the abdominal cavity from the liver, the spleen, or the kidneys is another cause of peritonitis. Gonorrhoea may cause peritonitis by extension of the infection through the uterus and Fal lopian tubes.
Diseases in which acute general peri tonitis may arise are as follow (they do not include the traumatic and gyneco logical cases) : 1. In the alimentary canal: (a) peptic ulcer, gastric and duodenal; (b) enteric fever; (c) ap pendicitis. 2. Other hollow viscera, the contents of which may be infected: (a) the gall-bladder; (b) the pelvis of the kidney; (c) the urinary bladder. 3. Rupture of abscesses: (a) purulent pleurisy ; (b) subphrenic abscess; (c) hepatic abscess; (d) abscess of the pan creas; (e) appendicular abscess, and (f) other pus collections in regions in rela tion with the peritoneum. 4. Necrotic processes involving abdominal viscera: (a) internal strangulation; (b) intus susception; (c) vol•ulus; (d) embo lism and thrombosis of the mesenteric vessels; (e) gangrene of the pancreas or of the spleen; (f) displaced kidney or spleen with twisted pedicle; (g) acute hmtnorrhagic pancreatitis; (It) fat-ne crosis. J. C. 'Wilson (Jour. Amer. Med. Assoc., July 9, '98).