Intestinal obstructions : diagnosis and treatment / by Frederick Holme Wiggin.

  • Wiggin, Frederick Holme, 1853-
Date:
1892
Catalogue details

Licence: Public Domain Mark

Credit: Intestinal obstructions : diagnosis and treatment / by Frederick Holme Wiggin. 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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    to Utilize for statistical purposes the cases of so-called spontaneous or idiopathic peritonitis recorded in litera- ture. Nevertheless, it must be admitted that cases of acute peritonitis occur, in which the most careful exam- ination dmring life and after death fail to reveal any dis- ease outside of the peritoneum which can be supposed to bear any relation to the peritonitis. I have the notes of an autopsy of this character on a young woman with acute purulent peritonitis. If the epithet idiopathic be applied to all cases of acute peritonitis in which the peri- toneal inflammation is the sole manifestation of an in- fectious process, then it cannot be said that idiopathic peritonitis is extremely infrequent. Any pathological anatomist of experience must have met with cases of acute peritonitis developing in connection with cirrhosis of the liver, or with chronic Bright’s disease, without any infec- tious lesion in the body save the peritonitis. Here we may fairly assume that the presence of ascites, or chronic thickening of the peritoneal membrane, or perhaps of waxy degeneration, acts as a predisposing cause, permit- ting the growth of pyogenic bacteria which would not have multiplied in a healthy peritoneal sac. If we ex- pand still further the limits, as some writers have done, and designate as idiopathic cases of peritonitis occurring with acute articular rheumatism, with distinct local in- fections, as for instance tonsillar abscess (I have seen such a case of acute peritonitis), then, of course, the category of cases is still further increased. I should prefer to limit the term idiopathic peritonitis to the first class of cases. It may be said that there is no priori reason why an acute spontaneous peritonitis of an infectious origin may not occur as well as an acute spontaneous osteomyelitis, for example; but, as a matter of fact, the healthy peri- toneum, instead of being, as was once believed, one of the least resistant, is one of the most resistant parts of the body against the lodgement and the multiplication of pyogenic bacteria, as has been abundantly demonstrated by experimental work.”