In man Fränkel found the bacillus coli communis 9 times, streptococcus pyogenes 7 times, bacillus lactis aerogenes 2 times, micrococcus pneumoniæ crouposæ 1 time, staphylococcus pyogenes aureus 1 time. Flexner found the proteus vulgaris.
ACUTE PERITONITIS IN SOLIPEDS.
Susceptibility to pyogenic bacteria, infection simple or complex. Traumatic injuries: accidental, omphalitis, operations, strangulation, wounds in rectum or vagina, coition, hernia, castration of mare, or horse, infected from 2d to 6th day, later granulation protects, ruptured stomach, perforating ulcer, perforation of parturient womb, ruptured abscess, microbes in circulation, debility. Symptoms: trauma with spreading swelling, œdema, tenderness, stiffness, arched back, tucked up abdomen, fever, prostration, colics, careful decubitus and rising, tense tender belly, ridge along flank, breathing short, inspirations catching, straddles, steps short, costive or later diarrhœa, enuresis, abdomen fluctuates, death in 1 to 8 days. With ruptured stomach or intestine prostration extreme, collapse, vomiting. Resolution. Ascites. Diagnosis: trauma, gastric or intestinal lesion, followed by specific symptoms. Lesions: trauma, rupture and escape of ingesta, congestion, ecchymoses, false membranes, adhesions, liquid effusion, bloody, pink, or straw colored, albuminous, fibrinous, granules, cells, salts, bacteria, pus, fœtor, bowels tympanitic, later fibrous bands, strangulations, degenerations. Prevention: fatal in solipeds, avoid abdominal congestions, inflammations, traumas, infections, accumulation of serum, blood, etc., also debility, ill health, chill. Treatment: old methods, by anodynes and checking peristalsis. Modern method: antisepsis, iodoform, carbolic acid, mercuric chloride, irrigation with boiled water, drainage; internally, saline laxatives, eliminates from bowels, blood, peritoneum, favoring phagocytosis, and innervation, antiseptics, sodium salicylate, chloral hydrate, morphia, enemata, hot fomentations, or ice, in suppuration drainage and washing with normal salt solution at body temperature, derivatives, laparotomy, puncture in tympany.
Causes. Solipeds are especially subject to peritonitis in its acute and dangerous forms largely because this class of animals is preëminently obnoxious to the attacks of pyogenic bacteria. The disease may however be dependent on a great variety of different organisms, and these may cause different forms through invasion by one specific microbe or by a complex invasion. It is convenient to note the different channels of invasion.
a. Traumatic injuries. Wounds are not uncommon from pricks with forks, pickets, broken rails, prongs of stump fences, poles or shafts of wagons, nails, barbed wire, horns of cattle, tusks of boar, and other sharp or pointed objects, which carry infecting germs, or in any case make an entrance for those found in the dust of the stable, on the horses skin, comb, brush, rubber or clothing. Inflammation of the umbilicus and resulting abscess may prove an entrance way for the germs either by rupture into the peritoneum or by causing adhesions between two loops of intestines from which the microbes escape through the weakened tissues. Wounds made in operations on hernias may have a similar ending and as Dieckerhoff has pointed out the onset of the peritonitis may be delayed for one or two weeks while the abscess is maturing or the walls of the bowels are being traversed by the microbes. Strangulated hernias and those in which the intestine is congested are especially subject to such peritonitis, as the germs may enter by the external wound and through the intestinal wall as well. The author has seen artificial anus formed through inclusion in the clamps of an adherent loop of small intestine, and at such a point peritonitis is liable to start.
Wounds of the rectum or vagina are sometimes the starting point of the inflammation. The penis of a stallion entering and lacerating the rectum of a mare, or the large penis of an ardent male rupturing the roof of the vagina are occasional causes. The latter may occur without fatal consequences, yet the author has seen a generalized and rapidly fatal attack follow such an injury when the mare had at once thereafter made a journey of nine miles in a cold rainstorm. The horse was a Percheron with very large penis and the mare would weigh about 900 lbs. The castration of mares, even through the vagina may be followed by peritonitis from sepsis of the instruments, hands or arms.
The castration of the horse is more liable to be followed by this infection. Too often no attempt at asepsis is made, implicit trust being placed in the defensive power of the tissues. In other cases even a very careful local antisepsis fails, the germ being already present in the circulation and the extensive wound and resulting local congestion and debility are seized upon as an opportunity for colonization and growth. This infection usually takes place from the second to the sixth day while the inguinal canal and vaginal sheath are still open to the cavity of the abdomen. Later when these have closed by adhesion, and when protective granulation has formed the implication of the peritoneum is rare.
b. Rupture of the Stomach or Intestine. This comes as already shown from gaseous distension, overloading, sudden shock or concussion, obstruction by dried ingesta, calculi, foreign bodies, parasites, etc., and by abuse of too powerful purgatives in cases of obstruction. The resulting infection is very abundant and varied, and the microbes accustomed to an anærobic existence in the intestines, multiply with extreme rapidity in the peritoneum and prove rapidly fatal. Beside the bacillus coli commune, there are usually staphylococcus and streptococcus pyogenes and not unfrequently the bacillus of malignant œdema.
c. Perforating ulcer. Though having a separate point of origin the effect of this is precisely the same as in rupture, the same bacteria escaping and the nature of the infection being identical. Inasmuch, however, as the perforation is usually small at first and the escape of contents very limited the symptoms advance more slowly and reach their acme later.
d. Perforation of the Parturient Womb. This usually depends on a case of dystokia in which the organ is torn by a foot of the fœtus or by some ill-directed instrument. The infection has usually been carried in on the hands or instruments, or introduced as dust by an aspiratory movement in the intervals of labor pains. The healthy womb is usually sterile as regards microbes, yet Lignieres claims that he has found staphylococcus pyogenes albus and aureus and in contagious abortion the specific bacillus of this affection can always be found. In woman peritonitis following rupture of the womb usually shows streptococcus pyogenes.