Protection of the peritoneum against infection has been attempted by many investigators since Issayeff1 in 1894 found that intraperitoneal injections of sterile irritants, such as blood serum, broth and sodium chloride solution, increased peritoneal resistance to bacteria. However, such substances and the usual bacterial vaccines were at best only moderately effective in protecting patients from peritonitis; these materials at the same time produced local and systemic reactions that were always unpleasant and often severe. Issayeff's method nevertheless constituted a valuable lead toward future experimentation. More than thirty years later, the peritoneal "struggle mechanism" was clarified by Steinberg and his associates.2 They demonstrated that satisfactory peritoneal protection is determined by three factors: 1. A sufficiently large number of phagocytic cells (polymorphonuclears) must be mobilized to phagocytose invading bacteria and to prevent bacterial multiplication and elaboration of soluble toxic substances. 2. Such a mobilization requires retention of the leukocyte evoking antigen within the peritoneal cavity
PERITONEAL PROTECTION. JAMA. 1937;109(18):1457–1458. doi:10.1001/jama.1937.02780440047018
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