354 INFECTIVE PROCESSES IN THE PERITONEUM 



According to them, there is a deposition of masses of fibrin on 

 the omentum, and in and upon these masses there are numerous 

 polynuclear leucocytes. 



The formation of fibrin, it need hardly be pointed out, is 

 universally regarded as being due to the liberation of fibrin 

 ferment by the leucocytes. It is not yet settled beyond controversy 

 whether this is to be regarded as a process of secretion, a vital 

 phenomenon, or a process occurring only during the solution 

 phagolysis of the leucocytes. The point is of no importance : 

 the remarkable feature is that, according to the opinions we have 

 considered as most probably correct, complement is set free at the 

 same time as fibrin ferment. The deposition of fibrin on the 

 surface of the omentum may be taken as sufficient proof of the 

 liberation of this substance, so that the rapid destruction of the 

 bacteria which occurs in the peritoneum in some cases cannot be 

 regarded as constituting definite proof that it occurs preformed in 

 that situation. 



In some cases, therefore, bacteria injected into the peritoneum 

 are killed rapidly, almost instantaneously, by a process resembling 

 bacteriolysis, and doubtless due to amboceptor existing in the 

 peritoneal fluid as such at the time of the injection, together with 

 complement which is probably set free from the leucocytes as a 

 result of the presence of the foreign body, but which may possibly 

 also be present in the normal state. As an example of this process, 

 Buxton and Torrey quote the case of a rabbit which received an 

 intraperitoneal injection of about 4,000,000,000 typhoid bacilli, and 

 was then immediately killed, the peritoneum washed out with 

 normal saline solution and plated out. The fluid contained only 

 about 1,000 bacilli, and there were none in the blood or internal 

 organs. In a case which was allowed to survive for two hours no 

 bacilli were found in any part of the body. It is most remarkable 

 that, with all this sudden, almost explosive, solution of bacilli there 

 were no symptoms indicative of the liberation of endotoxins, the 

 temperature remaining constant. The culture was one of very 

 moderate virulence. 



In other cases the whole process differs, and the defence of the 

 body appears to be entrusted to the phagocytes rather than to the 

 bacteriolytic substances, and in these a most interesting train of 

 phenomena occurs. Some destruction of the bacilli may occur in 

 the peritoneum, showing that the bacteriolytic properties do not 

 fail entirely, but comparatively few organisms are destroyed by 



