Appendicitis : its pathology and surgery . Fig. 44.—Streptococcic peritonitis. Streptococci in depths of the 900. serous membrane is covered with lymph, crowded with intes-tinal bacilli. But these bacilli do not penetrate the substances 1 Figs. 41, 42, and 43 arefrom Hunterian Lectures on Trctumatic Infection,Lockwood (Figs. 4, 5, and 6). 2 Loc. cit. p. 14, Fig. 3. APPENDICITIS of the peritoneum, or only to a very small extent, perhapsfor a hundredth of an inch. The surface fibrin and lymphmay be very thick, and the bacilli do not seem to be par-ticularly virulent. The prognosis i
Appendicitis : its pathology and surgery . Fig. 44.—Streptococcic peritonitis. Streptococci in depths of the 900. serous membrane is covered with lymph, crowded with intes-tinal bacilli. But these bacilli do not penetrate the substances 1 Figs. 41, 42, and 43 arefrom Hunterian Lectures on Trctumatic Infection,Lockwood (Figs. 4, 5, and 6). 2 Loc. cit. p. 14, Fig. 3. APPENDICITIS of the peritoneum, or only to a very small extent, perhapsfor a hundredth of an inch. The surface fibrin and lymphmay be very thick, and the bacilli do not seem to be par-ticularly virulent. The prognosis is, therefore, extremelygrave in acute peritonitis accompanied with odourless can, however, be done by freely and abundantly washingand disinfecting the peritoneal cavity. I have also occasion-ally seen such striking results in streptococcic synovitis andcellulitis from the use of anti- streptococcic serum, that Iam only waiting for an opportunity of using it in a case. Fig. 45.—Diffuse septic peritonitis. Bacteria in the lymph upon the surface of theperitoneum and just within its substance. x 900. of streptococcic peritonitis. When the suppuration is cir-cumscribed by firm fibrinous adhesions, we may infer thatthe infection is not virulent, that the peritoneum is resistant,and that these favourable conditions will persist after theoperation. The introduction of fresh infection by the opera-tion may be left out of the question. The results of opera-tions, in which localised collections of pus are found, bearout those inferences, because the patients so seldom die ofperitonitis. In truth, this chronic form of suppuration isnot greatly to be feared as a complication of operations forremoval of the appendix. The abscess is drained with a rubbertube, and the wound not infrecpuently heals by first intention. xni CHRONIC APPENDICULAR ABSCESS 171 The diagnosis of chronic appendicular abscess is usuallyvery difficult or, perhaps, impossible. Owing to the s
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