98 SUPPURATION. 



fluid is no indication of the presence of bacteria, as these may be 

 absent even in fluid having a fecal odor. In cases in which the 

 bowel becomes gangrenous, bacteria pass through its walls and 

 death is caused by septic peritonitis. 



Frankel (" Ueber puerperale Peritonitis," Deutsche med. Wochen- 

 sckrift, 1884, p. 212) has found the streptococcus pyogenes in a 

 great variety of puerperal diseases ; especially in cases in which 

 the local affection implicated the lymphatic vessels. In such cases, 

 the microbes found entrance into the pelvic tissues from abrasions 

 or ulcers in the vagina, and by extension of the inflammatory pro- 

 cess the broad ligaments and the peritoneum are successively 

 reached ; after the peritoneum has once been reached, rapid diffu- 

 sion takes place, and finally the diaphragm and pleura are impli- 

 cated in the same process, and the microbes reach the blood and 

 cause sepsis and pyaBmia. 



Weischelbaurn ( Centralblatt f. Chirurgie, August 17, 1889) has 

 shown that peritonitis is not always caused by pus-microbes as has 

 been heretofore believed ; he has found the diplococcus of pneu- 

 monia unaccompanied by any other microorganism in three cases 

 of peritonitis. In one case peritonitis and acute pneumonia existed 

 at the same time ; in the other, double pleuritis followed the peri- 

 tonitis; but in the last case the peritonitis was undoubtedly pri- 

 mary and in the absence of any other microbes in the products of 

 the inflammation must have been caused by the diplococcus of 

 Friedlander. 



Orth (British Medical Journal, March 1, 1890) has shown that 

 the pathogenic properties of pus-microbes are strongly modified by 

 certain preexisting pathological conditions, although large doses of 

 pure cultures of the staphylococcus and streptococcus injected into 

 the peritoneal cavity of rats failed to cause any lesion of the perito- 

 neum, the same microbes in the same doses caused fatal results 

 when mixed with material which could only be absorbed slowly. 

 Preexisting disease of the peritoneum favored the action of the 

 microbes , in ascitic animals a very small quantity of a culture of 

 staphylococcus caused septic peritonitis. The same result followed 

 when any intra-abdominal structure was wounded. These experi- 

 ments show the great danger which may follow infection of the 

 peritoneum after laparotomy, especially if fluids or solid particles 

 are allowed to remain after the operation. 



Fraukel (Berl klin. Wochenschrift, May 14, 1888) made a bac- 

 teriological study of twelve cases of empyema. In three cases in 

 which no special cause could be traced the pus contained exclusively 

 the streptococcus pyogenes. In three cases the pus contained 

 only pueumococci. Other authors have found, in such cases, also 

 other pus-microbes. Frankel thinks that when this is the case, 



