THE DIGESTIVE SYSTEM. 



571 



Chronic Peritonitis may follow the acute exudative form or may occur 

 independently. The lesions vary. In one group of cases the peritoneum 

 is beset with minute translucent nodules, sometimes visible, sometimes 

 invisible to the naked eye. These are apparently formed by a local pro- 

 liferation of the mesothelial and connective-tissue cells. Associated with 

 this there may be a general irregular proliferation of the peritoneal meso- 

 thelium. This has been called chronic cellular peritonitis. 



In other cases there are local or general fibrous adhesions, sometimes 

 firm, sometimes loose, between the intestinal coils or between the intes- 

 tine and the abdominal wall. In this way sacculated collections of sero- 

 fibrinous or purulent exudate may form in the abdominal cavity. Finally 

 chronic peritonitis may result in a dense fibrous thickening of the peri- 

 toneum, either local or widespread. 



In some cases the parietal peritoneum is principally involved; in 

 others the peritoneum of the stomach, intestines, liver, and spleen. The 

 thickening of the capsule of the liver may be attended with a diminution 

 in the size of that viscus. There may or may not be adhesions ; serous 

 or other exudate may be present. Great distortion of the omentum, 

 mesentery, and other abdominal viscera may occur. 



FIG. 347. MILIARY TUBERCLES OF THE OMENTUM. 



Tuberculous Peritonitis may occur in acute general miliary tuberculosis 

 or it may be secondary to tuberculous inflammation elsewhere, as in the 



Silber schmidt, ibid., Heft 5, p. 432; Flexner, Philadelphia Med. Jour., November 12th. 

 1898; Cullen, Johns Hopkins Hospital Reports, vol. iv., p. 411, 1895; Abramow, Ziegler's 

 Beitr., Bd. xxiii., p. 1. 1898; Biittner, ibid., Bd. xxv., p. 453, 1899. 



For special studies on the entrance of micro-organisms into the body from the 

 gastro-intestinal canal see Opitz, Zeits. f. Hygiene, Bd. xxix., p. 505, 1898; Eircli- 

 JlirscJtfeld, Ziegler's Beitr., Bd. xxiv., p. 304, 1898; Buchbinder, Deutsche Zeits. f. Chir., 

 Bd. Iv., H. 6 and 7, 1900; Marcus, Zeits. f. Heilkunde, Bd. xx., p. 427, 1899; also 

 Wiener kliu. Wochenschrift, January 3d, 1901; Ravend, Jour. Med. Kes., vol. x., 1903, 

 p. 460. 



