570 THE DIGESTIVE SYSTEM. 



Acute exudative peritonitis may terminate in recovery with absorp- 

 tion of the exudate, permanent connective-tissue adhesions and thickeu- 

 nings of the peritoneum often remaining. Chronic peritonitis may follow 

 the acute phase. 



Bacteria are the usual excitants of acute exudative peritonitis. In 





FIG. 346.-ACCTE CELLULAR PERITONITIS HUMAN OMENTFM. 



There are swelling and proliferation of the mesothelial cells as well as of the cells of the flbrillar tissue form- 

 ing the omental trabeculae. 



primary forms of peritonitis the Streptococcus and Staphylococcus pyo- 

 geues are the bacteria most frequently present. 



In secondary exudative peritonitis the pyogenic cocci and the colon 

 bacillus have been most frequently found. Of the other bacteria which 

 have been found in the exudate we may name the pneumococcus, the 

 gonococcus, 1 B. pyocyaueus, B. proteus, B. aerogenes capsulatus, B. 

 typhosus. 



There is abundant evidence that bacteria can pass from the intes- 

 tinal cavity through its wall into the peritoneum without perforation, 

 especially in regions where the integrity of the tissues is impaired by 

 disturbances in circulation and nutrition or in necrosis, as in strangula- 

 tion of the gut." 



1 See Gushing on Gonococcus peritonitis, Johns Hopkins Hospital Bulletin, vol. x., 

 p. 75, 1899. 



2 Consult for studies and bibliography of various phases of peritonitis Tavel and 

 Lam, "Peritonitis," Mitth. a. kl. u. med. Inst. d. Schweiz, 1 Reihe, Heft 1, p. 1, 1898; 



