298 CLINICAL BACTERIOLOGY AND H^EMATOLOGY 



PERITONEAL EXUDATES. 



These are very equivocal, and often difficult or impossible 

 to interpret The ultimate conditions leading to the produc- 

 tion of the cells are doubtless the same in the peritoneum 

 as in the pleura, but here the fluid is in close proximity to the 

 intestine, and liable to constant mild infective processes. 

 These call forth a polynuclear leucocytosis, which is very com- 

 mon in ascitic fluid, and devoid of the significance which it 

 has in the pleura. 



TUBERCULOUS PERITONITIS may be accompanied by a pure 

 lymphocytosis, the cells becoming extraordinarily abundant, 

 so that the fluid may be turbid, or there may be polynuclears 

 in a practically pure state. I do not think the condition can 

 be diagnosed unless tubercle bacilli are found. 



SEPTIC PERITONITIS. The cells are all polynuclears except 

 in the early stages, in which a few endothelial cells and red 

 corpuscles may be found. The diagnosis is to be made by 

 the discovery of the organism, which is usually easy. 



MECHANICAL ASCITES (i.e., that due to cirrhosis of the liver, 

 renal disease, cardiac disease, etc.). Here endothelial cells, 

 often in masses, are almost always present, and sometimes 

 practically unmixed with other cells. But chronic inflamma- 

 tion of the peritoneum, with or without mild sepsis, is 

 often present, and polynuclears and lymphocytes frequently 

 occur. 



MALIGNANT DISEASE. Here the large vacuolated endothelial 

 cells shown on Plate X., Fig. 3, may occur, and are extremely 

 suggestive, though they cannot be taken as definite proof. 

 Rarely you may find definite malignant masses, which, of 

 course, settles the diagnosis. In other cases there may be 

 numerous polynuclear cells, and in yet others mostly lympho- 

 cytes. The presence of an abundance of red cells is sugges- 

 tive, provided you can be sure it does not come from the 

 puncture, in which case it will be most abundant at the begin- 

 ning of the flow. It will be apparent that the diagnosis of 

 malignancy cannot be made in the majority of cases by the 

 cytology of the ascitic fluid. 



