The Abdomen 145 



whereby ligatures become loosened, and because the stumps tend 

 to give rise to trouble through mortification. 



PERITONITIS. 



It will be remembered that the peritoneum is a large lymph 

 sac normally possessed of a remarkable absorptive capacity. Pro- 

 vided this property remains unimpaired it is rendered but moder- 

 ately susceptible to the action of pathogenic microorganisms. The 

 experiments of Wegner and Grawitz hare shown that considerable 

 numbers of the ordinary forms of pyogenic microbes may be in- 

 troduced into the peritoneal cavity without any particular effect on 

 the animal, provided the absorptive power of the peritoneum is not 

 impaired. Reichel found that peritonitis developed, only when the 

 quantity of putrescible material exceeded that amount which could 

 be eliminated within a limited time. Waterhouse injected 6 cc. 

 of cultures of staphylococcus aureus, streptococcus, and intestinal 

 bacteria, respectively, and found the animals survived. He then 

 tried to produce the same conditions which sometimes exist after 

 operations by introducing 8 cc. of urine and small quantities of blood 

 with the cultures, and still the animals lived. But the presence of 

 considerable quantities of putrescible material, such as blood clots 

 3 cc. in size when the cultures were introduced, was followed by 

 death in twenty-four hours. Cats suffering from ascites quickly 

 died from peritonitis, owing to diminished absorptive activity of the 

 peritoneum and the presence of a favorable culture medium. Hal- 

 sted introduced pieces of sterile potato, and found they became en- 

 capsulated without producing any disturbance, but when infected 

 with pyogenic organisms invariably caused peritonitis. Welch 

 made similar observations, and found further that an infected 

 wound readily and uniformly suppurated when it contained masses 

 of tissue strangulated by ligature. He made a large number of ex- 

 periments by ligating portions of omentum and then injecting cul- 

 tures of staphylococcus aureus into the peritoneal cavity, In most 

 cases general peritonitis developed, in some cases localized peritoni- 

 tis and in others no peritonitis followed the inoculation. 



The conditions which impair the refractory power of the peri- 

 toneum are: General systemic conditions producing a lowering of 

 vitality, and presence of putrescible material in quantity in excess 



II 



