STREPTOCOCCUS PERITONITIS Streptocoeci may apparently cause primary inflammation of the peritoneum. Such eases occur less often than pneumococcus peritonitis, but are more dangerous. They have this in common with pneurno coccus peritonitis; that they set in very acutely and apparently without cause, and are usually accompanied by very violent (liar:in-ea. Vomit ing, fever, and pain are likewise present; but the tendency of the disease noticed in the former group of cases to become circum scribed rarely. observed, and most of the numerous eases reported end fatally in a few (lays. The purulent exudate is generally thin and reddish yellow.
The case that follows illustrates the course of this disease: A six year-old girl was taken sick subsequently to a light attack of jaundice, with high fever arid violent abdominal pain, accompanied by vomit ing, and distention; and, soon after this, with loose, offensive stools. On the fifth day after admission to the ho,spital, almost three-fourths of a quart of pus was evacuated at the operation, giving a pure culture of streptococci. Three days after this, death occurred. Besides the lesions of the peritoneum the autopsy revealed merely- a hyper:multi of thc mucous membrane of the stomach and of the ileum, with small hasmorrhagic areas. The appendix was intact. Figure 62 portrays an encapsulated peritoneal abscess in the left hypochonclrium, in a five-year old girl, which began with the same violent symptoms, some weeks before her entrance into the clinic, where she recovered after operation. The
bacteriological findings were streptococci and colon bacilli. In this case, the process had become circumscribed—ft rare occurrence, possibly due to the presence of colon bacilli.
In this category belong those cases of peritonitis that excep tionally follow in the wake of the infective fevers; such as scarlet fever, diphtheria, measles, erysip elas, and acute tonsillitis. Henoch has frequently seen postscarla final peritonitis, especially when nephritis was present; and Heub ner designates as a peculiarity of streptococcus sepsis in scarlet fever, the tendency to suppura tive inflammation of the serous membranes.
The treatment of diffuse streptococcus peritonitis i s most unsatisfactory. Considering the fact that the chances of recovery are slight, surgical intervention should be made at the earliest possible moment. In any event, the mortality in these eases is very high. Polyvalent strepto coccus serum, as prepared by Tavel, Van de Velde, and Aronson, should be injected as early as possible. Intravenous collargol injec tions may also he given.