Sealing of operative wounds about the abdomen v. treatment by dressing / by E. Stanmore Bishop.

  • Bishop, E. Stanmore (Edward Stanmore), 1848-1912.
Date:
1899
Catalogue details

Licence: Public Domain Mark

Credit: Sealing of operative wounds about the abdomen v. treatment by dressing / by E. Stanmore Bishop. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

    9/30 (page 7)
    flushing. Robb, Peaslee and others all agreed in this. The results of bacteriological examination of such pus is curiously opposed to such a view : thus out of 42 cases examined for this purpose by Miller, no bacteria at all were found in 34 cases ; in 144 cases examined by Schauta, streptococci and staphylococei were found only 4 times; Menge found the staphylococeus once in 26 cases, and Morae once m 33. It appears therefore, that we may consider pus found in chronic pus sacs as practically free from active organisms, and as merely representing the debris left behind after the authors of it have perished. With regard to other fluids, Waterhouse’s observations show the necessity for careful haemostasis, before the closure of the peritoneum, so as to avoid the possibility of including blood-clots of any size; the only other fluid likely to be present in the majority of cases then will be the serous oozing from any large adhesion which has necessarily been separated during the operation. As far as possible such raw surfaces should be covered by adjacent peritoneum, which is attached so loosely that in most instances it can be drawn over them, and this fluid may safely then be left to be dealt with by that membrane. It is, of course, evident that progress in this direction is absolutely dependant on the exclusion of germs, the maintenance of absolute asepsis. There remain a very few exceptional cases, in which great damage has been done to intestine, and in which it is impossible to feel certain that the bowel wall may not give way. As to these, opinions are still greatly divided, and it seems at present impossible to lay down any definite rule—but these cases are rare. The whole practice was, as we have said, one-sided. If assumed that the fluids exuded were themselves dangerous and must be got rid of: and this assumption is now being questioned, and the results are notable. The belief which is daily gaining ground, and which promises to drive the drainage tube out of, possibly, the whole surgical field and certainly out of abdominal work, is that these fluids are not only harmless but extremely useful, if uncontaminated, and that our efforts must be directed