INOCULATION INTO THE PERITONEUM. 209 

 INOCULATION INTO THE GEEAT SEROUS CAVITIES. 



Inoculation into the peritoneum presents no difficulties 

 if fluids are to be introduced. In this case one makes, 

 with a pair of hot scissors, a small nick through the 

 skin down to the underlying fascia, and, taking up a 

 fold of the abdominal wall between the fingers, plunges 

 the hypodermic needle through the opening just made 

 directly into the peritoneal cavity. There is no fear 

 of penetrating the intestines or other internal viscera if 

 the puncture be made along the median line at about 

 midway between the end of the sternum and the sym- 

 physis pubis. Though this may seem a rude method, it 

 is, nevertheless, the rarest of accidents to find that the 

 intestines have been penetrated. The object of the 

 primary incision is to lessen the chances of contaminat- 

 ing the inoculation by bacteria located in the skin, 

 some of which would adhere to the needle if it were 

 plunged directly through the skin, and might complicate 

 the results. 



If solid substances, bits of tissue, etc., are to be intro- 

 duced into the peritoneum it becomes necessary to con- 

 duct the operation upon the lines of a laparotomy. The 

 hair should be shaved from a small area over the median 

 line, after which the skin is to be thoroughly washed. 

 A short longitudinal incision (about 2 cm. long) is then 

 to be made in the median line through the skin, and 

 down to the fasciae. Two subcutaneous sutures, as 

 employed by Halsted, are then to be introduced trans- 

 verse to the line of incision at about 1 cm, apart, and 

 their ends left loose. This particular sort of suture 

 does not pass through the skin, but instead, the needle is 

 introduced into the subcutaneous tissues along the edge 



