154 CLINICAL BACTERIOLOGY. 



PERITYPHLITIS. 



Perityphlitis, like other inflammations arising from the 

 intestine, is due to the activity of the bacterium coli com- 

 mune. Thus far only perityphlitic abscesses and their 

 complications have been submitted to examination, coli- 

 bacilli being predominantly found. Actinomycotic and 

 tuberculous perityphlitis are associated with the presence 

 of their special exciting agents. 



CHOLECYSTITIS AND CHOLANGITIS. 



Normally the bile is sterile, the bacterium coli and cocci 

 being found only in the lowest portion of the choledoch 

 duct. Every obstruction, however, that interferes with the 

 free discharge of bile (gall-stones, etc.) renders possible in- 

 fection of the biliary passages. The bacteria present in 

 the bowel, particularly the bacterium coli commune, less 

 commonly staphylococci, streptococci, and pneumococci, 

 gain entrance into the gall-bladder and the biliary passages, 

 where they induce inflammation and suppuration. 



Normal bile possesses no bactericidal activity ; when ob- 

 tained in a sterile condition, it constitutes a fairly good 

 nutrient medium for coli-bacilli and staphylococci. 



Infection of the unobstructed biliary passages takes place 

 in human beings in individual cases of typhoid fever, 

 cholera, and croupous pneumonia. It may be assumed 

 that in these cases also the infection takes place through 

 the choledoch duct. Typhoid-bacilli and cholera-bacilli 

 are systematically present in a virulent state in the intestinal 

 canal throughout the course of the respective diseases to 

 which they give rise. The pneumococcus occurs but 

 seldom in the intestinal tract, although it has been found 

 there with certainty in individual cases of pneumonia. As 

 a result of the constitutional disease, the function of the 

 liver is more or less impaired, the excretion of bile is not 

 normal, and, in consequence, infection from the intestine is 

 possible. 



Infection through the blood is probably of rare occur- 

 rence in human pathology. In experiments on animals 

 this may be attained by introducing the bacteria in large 

 number, or by previous injury of the biliary passages as, 

 for instance, by the establishment of a biliary fistula. 



