The Cause of Death in Experimental Acute Diffuse Peritonitis. ∗

Abstract

There are several current conceptions regarding the cause of death in acute diffuse peritonitis. Askanazy 1 considers the intestinal paralysis with dilatation of lymphatics and pressure upon the ganglion cells responsible for death. Lennander 2 agrees with the intestinal paralysis view but holds that the passage of toxins and bacteria through the paralyzed intestinal wall is the causative factor in fatal terminations. Whatever factor the intestinal obstruction plays in the fatal outcome (Orr and Haden 3 do not believe that sufficient evidence has been presented to justify the belief that intestinal obstruction is alone the cause of death) it is of secondary importance. The intestinal paralysis constitutes one of the several complications incident to an acute diffuse peritonitis. Steinberg and Ecker 4 presented evidence in experimental colon bacillus peritonitis that the soluble toxic substance of the bacillus produces death and possibly the coincident complications. Additional evidence that the bacterial toxin is the primary death producing factor has been furnished by Williams, 5 who demonstrated that B. welchii toxin is responsible for death in acute diffuse peritonitis from obstruction of the small intestine.

The experiments here reported have been undertaken to obtain further facts of the rôle of the bacterial toxin in acute peritonitis. Diphtheria bacillus was used because it is a definite toxin producer and the antitoxin is readily available. Diffuse peritonitis was produced by the intraperitoneal introduction into dogs of diphtheria bacilli suspended in a 2 1/2% suspension of gum tragacanth in saline. It has been demonstrated 6 that bacteria suspended in gum tragacanth invariably produce a fatal peritonitis.