Peritonitis. 389 



peritonitis would be practically abolished, portions of aseptic 

 powdered glass, sponge or gauze can be left in the abdominal 

 cavity with comparative impunity, the tendency being, as shown 

 in the dog, to coat themselves with a fibrinous exudate, and to 

 make their way into the intestines through which they escape 

 (Sternberg, Jalaguier and Manclaire). Hence it is that periton- 

 itis is to a very large extent the result of a traumatism (castra- 

 tion, penetrating wound of the abdomen, contused wound of the 

 abdomen), or of a rupture or ulceration of the stomach or intes- 

 tine, through which the microbes make their way into the 

 peritoneal cavity. In enteritis, congestions, strangulations, in- 

 tussusceptions and obstructions of the bowels, the cause is the 

 same, the microbes making their way with greater ease through 

 the coats of the bowels in which the circulation and nutrition are 

 impaired and the power of resistance diminished. Finally the 

 occurrence of the disease as a consequence of exposure to cold or 

 wet, of exposure in a cold rain or snow storm, of standing in a 

 draught when perspiring, or plunging into cold water when 

 heated and fatigued, or drinking ice cold water when in a similar 

 condition, may in most cases be explained on the same grounds. 

 The germs in this case had already gained access to the blood, 

 but were helpless to accomplish much harm, until by chilling, the 

 resisting power of the system was lowered and an occasion 

 furnished for their successfully colonizing the peritoneum. 

 Parallel cases are found in the frog which is immune from anthrax 

 until it is heated, and in the chicken which is immune from 

 anthrax until chilled. Reduce the vitality of the system and the 

 germ which was already present, and up till now harmless, takes, 

 occasion to colonize more or less destructively. 



This view also furnishes an explanation of the tendency of 

 local peritonitis to become generalized. In the scanty liquid 

 which bedews the surface of the abdominal organs, the microbes 

 grow, multiply and spread ; by the constant peristaltic movements 

 of the bowels and their rolling upon each other this extension is 

 largely favored ; and the tendency to generalization will be in 

 ratio with the potency of the invading germ, and the general or 

 local weakening of the invaded tissues. With a limited infection 

 wound in an otherwise healthy peritoneum and system, and in- 

 vasion by a pus coccus only, the infection may not succeed in 



