Pneumococcus peritonitis : paper read in the Section of Pathology, at the Annual Meeting of the British Medical Association, Cheltenham, July-August, 1901 / by J.H. Bryant.

  • Bryant, John Henry.
Date:
[1901]
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Licence: In copyright

Credit: Pneumococcus peritonitis : paper read in the Section of Pathology, at the Annual Meeting of the British Medical Association, Cheltenham, July-August, 1901 / by J.H. Bryant. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    Remabks. Pneumococcus peritonitis may be classified in tvro ways : 1. Primary, wlien the peritoneum is the first structure to be involved. 2. Secondary, when the peritoneum is infected as a com- plication of some other pneumococcus lesion. .Or according to the distribution: («) Local or encysted; (b) general or diffuse. Morbid Changes. In the general or diffuse form the abdomen is distended, partly from the presence of fluid in the peritoneal cavity and partly from tympanitic distension of the intestines. On opening the peritoneal cavity a fair amount of turbid, light greyish-yellow fluid may be found. If this is collected and allowed to stand, the upper portion becomes much clearer, and a thin pale, greyish-yellow deposit of pus cells and flakes of lymph falls to the bottom of the glass. Coverglass pre- parations of the pus stained with Maconochie’s stain show the presence of capsulated diplococci. The intestines are, as a rule, distended with gas. The peritoneum, both visceral and parietal, is covered with pale yellow flakes of lymph and coils of intestine may be adhering to each other and to adjacent viscera. The lymph peels off with ease, leaving a slightly dull surface, and the peritoneal blood vessels are found to be congested, dilated, and distended with blood. In virulent infections there may be actual extravasations of blood. In the local or encysted variety a similar condition of a portion only of the peritoneal cavity may be seen, and the parts most likely to be involved are the upper surface of the liver, the upper surface of the spleen, the pelvic cavity, and occasionally the right iliac fossa. In some cases the lymph is very thick and there is little fluid. The fluid is quite different to what is found in a strepto- coccus peritonitis. In the latter condition it is thick yellow or green pus; on standing in a glass it remains thick and opaque throughout, whereas in the former it resembles diluted pus and separates into two layers, an upper, slightly opaque liquid and a thick, greyish-yellow, opaque deposit. When the peritonitis is localised to the pelvis, an abscess containing this thin pus may form, become walled off from the rest of the peritoneal cavity, and open spontaneously into the vagina, bladder, rectum, or even at the umbilicus. As a rule, there is no obvious primary focus to be discovered in the abdomen to acoount for the peritonitis. In each of my cases pleurisy was found at the necropsy ; it varied in degree and extent; in some cases it appeared to be secondary to the peri- tonitis, whereas in others it looked as if it was a part of a general infection, and had the appearance of having been affected at the same time as the peritoneum. In none of my cases was the pericardium affected, and in none of them was there any sign or evidence of pneumonia or broncho-pneumonia. Pei'icarditis, endocarditis, meningitis, pneumonia, broncho- pneumonia may in some cases be associated with the peri- tonitis. Pneumococcus peritonitis rarely occurs in adults. One of my cases was a man aged 45. Ilieuhifoy found only 2 cases in adults out of 17. Mdndtrier and Legroux report 2 cases, one a man aged 22, and the other a man aged 35. Tdmine, in Ins thesis published in 1898, reports ouly 3 cases occurring in the adult.