OCCURRENCE OF CAUSATIVE AGENTS. 153 



carried out in the study of peritonitis have thus far not 

 yielded practically available results. In some of the cases 

 there existed multiple infection that is, infection with a 

 number of varieties of bacteria. Coli-bacteria, as well as 

 staphylococci and streptococci, have been mostly found in 

 the effusion. In addition, pneumococci have been ob- 

 served, as well as a large number of other bacteria, of which 

 the gonococcus, the proteus vulgaris, the. bacillus pyocya- 

 neus, as well as a number of nonpathogenic varieties 

 described by Tavel and Lanz, a bacillus resembling that of 

 diphtheria, one resembling the tetanus-bacillus, and one the 

 actinomyces-fungus, may be mentioned. The bacterium 

 coli commune, which is the most common attendant upon 

 peritonitis, is not a bacteriologic entity, but so variable in 

 form and properties that the designation, bacterium coli, 

 must be employed only as the collective name for a large 

 group of related bacteria. When infection takes place 

 through the blood-stream, only one exciting agent is 

 found, and principally the streptococcus or the pneumo- 

 coccus. In cases of operative peritonitis, usually strepto- 

 cocci have been found ; and in cases of puerperal peritonitis, 

 in addition also the other exciting agents of inflammation. 

 Tuberculous peritonitis is caused by the tubercle-bacillus. 



From all that has been said it may be seen that peri- 

 'tonitis is not due to a single specific exciting agent, as the 

 organ from which it arises (bladder, intestine) generally 

 contains various bacteria. The infections that originate from 

 the female genital organs are associated especially with 

 cocci ; those originating from the intestine, especially with 

 coli-bacteria. Further, the peritonitis arising from the 

 small intestine is believed to be attended with the presence 

 of fewer bacteria, while that arising from the large intestine 

 is attended with the presence of more, as the contents of 

 the large intestine exhibit a larger number of microorgan- 

 isms than those of the small intestine. Both points of dis- 

 tinction are, however, not conclusive, and the results' of 

 bacteriologic examination of the peritonitic exudate can 

 not be employed without reservation as a certain guide for 

 diagnostic purposes, nor have these results yet acquired 

 noteworthy significance from a prognostic or a therapeutic 

 point of view. 



