ACUTE PERITONITIS The source of infection may be the gastrodntestinal canal, the liver and the gall bladder, the kidney and the bladder, and also the female geni talia. Inflammatory processes in the peritoneum may proceed from the retroperitoneal lymph-nodes and the lymph-nodes of the mesentery.
In infancy, acute peritonitis is most frequently the result of inflam mation of the appendix. Exceptionally, intestinal ulcers are the cause; while perforation of typhoid ulcers occurs much less often than in adult life. Since round ulcers of the stomach and malignant new growths are extremely- rare, we seldom, if ever, encounter peritonitis dependent upon perforation of the stomach. The liver and gall bladder rarely give rise to peritonitis, since gall-stones, as well as abscesses of the liver, are uncommon in childhood. Echinococcus cysts are even more rare, and are only exceptionally encountered in our section of the country. The urinary tract scarcely requires consideration; on the other hand, the female genital organs may be a portal of entry. We do not meet the septic inflammations that are so common in adult life.
The rnost important micro-organisms in the causation of the disease are the bacterium coli commune, the streptococcus, the pneuniococcus, the staphylococcus aureus, and the gonococcus. Single or multiple infection may occur; when the disease is due to perforation of the gastro-intestinal tract, many varieties of aerobic and anaerobic intestinal bacteria invade the peritoneal cavity.
In considering this subject, we shall endeavor to set forth those features that are peculiar to infancy and are most often encountered at this time of life. Perforation-peritonitis runs its course as in adults, and need not be considered; also inflammation after intestinal occlusion and with incarcerated hernia. Traumatic peritonitis requires no special mention. Septic inflammations are considered with peritonitis in 2.51 infants, and the newborn. Inflammatory processes originating in disease of the appendix are considered in a special section of this work.
On the other hand, some forms of peritonitis are peeuliar to child hood. It is the common experience that pneuinococcus and strepto coccus infections are more easily acquired in childhood. Examples may be cited; such as pnemnoroccus and streptococcus osteomyelitis. pneumococeus otitis, and pneuniococcus empyema, which occur so seldom in later life. Both pneumocoecus and streptococcus peritonitis form well-defined pictures in early life, They will, therefore, receive special consideration and serve as the type of acute peritonitis. In flammations of the peritoneum resulting from vulvovaginitis are of special interest to the pediatrist; and they, as well as peritonitis in the newborn and in infants, will receive mention.