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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    only a general lowering of the resistance of the body but also a local l owering of resistance in the stomach and intestine and also an altered condition of the gastro-intestinal secretions. Such a series of changes might well predispose to the growth and development of the pneumococcus in the gastric and intestinal mucosa, and might also allow of the passage of the organisms by means of the blood vessels and lymphatics to the peritoneum itself, and in this way a peritonitis might be brought about. That the pneumococcus does actually attack the mucosa is proved by the case of pneumococcus enteritis published by Boulay. The question may be asked why the pleura is so much more frequently affected than the peritoneum ? The answer to this, I take it, is that by far the most frequent manifestation of a pneumococcus infection is pneumonia, and the close relation of the pleura to the lung is the explanation of it so fre- quently being involved. 2. The Uterine Organs. The very large proportion of girls to boys (Qudhant, 27 girls to 6 boys ; Brun 11 girls, 3 boys ; Uagenbach Burckhardt, 2 gii-ls : Bryant, 2 girls ; Fisher, 1 girl) affected by this form of peritonitis is very suggestive that the uterus and Fallopian tubes are the channels by means of which the pneumococcus gains a«cess to the peritoneal cavity. It is not easy to explain, however, why it is that when adults are attacked they are nearly always men. Boulay has noted the presence of the diplococcus pneu- moniae in the cavity, and in the walls of the uterus, an im- portant observation which indicates that the micro-organism may easily reach the peritoneum through the Fallopian tubes or the lymphatics or blood vessels of the uterus. Another point which favours the view that this is often the source and channel of infection is the fact that the pelvic peri- toneum is much more extensively involved than the rest of the peritoneum, even when the peritonitis is diffuse and that when the peritonitis happens to be local or encysted the pelvic peritoneum is frequently the part which is affected. It has been well established that peritonitis may result from gonococcus infections of the uterus and Fallopian tubes and in cases of tuberculous peritonitis, even in young children it is not unusual to find advanced tuberculous disease of the uterus and Fallopian tubes, and from their appearance it would seem that they were the first parts to be affected, and were the primary focus of the disease. Peritonitis also frequently follows septic conditions of the uterus, the result of parturi- tion or abortion. These examples of primary disease of the uterine organs illustrate their importance as sources and channels of infection. There were no obvious changes in the uterus and Fallopian tubes in my two cases, and, unfortunately, no bacteriological examinations were made, so that there is no conclusive evidence to show what part these organs played in the produc- tion of the peritonitis. 3. The Blood Vessels. There is no doubt that many cases die as a result of a general pneumococcus septicaemia, and then the question naturally arises in such cases whether there was a general blood infection from the first, with a primary peritoneal manifestation and subsequent morbid changes in the pleura, pericardium, and