Abdominal section for purulent peritonitis resulting from ectopic gestation / by James F.W. Ross.

  • Ross, James Frederick William, 1856-1911.
Date:
[1892]
Catalogue details

Licence: Public Domain Mark

Credit: Abdominal section for purulent peritonitis resulting from ectopic gestation / by James F.W. Ross. 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.

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    treatment of obscure intra-peritoneal disease is as yet in its infancy. \ye are prepared to make a few mistakes for the sake of the benefit that must accrue to mankind from the vast amount of actual accurate in- formation that we will obtain. To operate on a patient with an enorm- ously distended abdomen, cold hands, rapid, thready pulse, and in a profoundly septic condition is unwise. If the patient dies—as they always do—people at once ask themselves the very reasonable question: “ Why did the doctor operate?” Well, why did he operate? Because everything else had been tried and failed; he operated as a last resource. This should not be. Operation should be instituted in all cases of peritonitis that do not show signs of improvement, and in which the origin of the disease is veiled in obscurity, for purposes of diagnosis, before all chance of relief from the operation is removed. Opening into a peritoneum, already the seat of a violent inflammation, cannot add to the inflammation already present. For every attack of peritonitis I believe there is a cause, and we will find the cause if we look for it in the proper way. Guessing at the cause from without the abdominal walls will not help us. If any of you have carried out experimental work on the abdomen of the dog, you must frequently have been amazed at the intra-peritoneal condition found after pistol shot wounds of this cavity. The abdomen is full of faeces, blood, and even worms, after a very few minutes. Intestines are smashed to pieces in many places. We are convinced that such an abdomen, in a dog, after such an injury, should be opened at once. If this is true of the abdomen of a dog, it is equally true of the abdomen of a man. Our methods of dealing with such in- juries after the abdomen is opened are not yet as perfect as they will be ten years hence, but they are better than the “no method ” treatment of calling to see the patient three or four times a day, with or without con- sultants, of giving him opiates to relieve his pain, and buoying ourselves up with the hope that the bullet, or the knife, or the kick, or other violent injury did no serious damage. And then when the patient is handed over to the undertaker we console ourselves, and endeavor to console the friends of the deceased, by saying that all was done that could be done. I can point out to you three surgeons who have lost three sons from appendicitis. Surgeon No. 1 lost his eldest son before the opera- tion was instituted for the relief of this condition. Surgeon No. 2 lost his only son—himself a physician—after the operation had been per- formed. Surgeon No. 3 lost a lad, scarcely four years of age, after oper- ation for perforation of the appendix and purulent peritonitis had been performed—but too late. Each surgeon learned a life-long lesson that has been of practical value to him since, and has enabled each of them to save lives that would otherwise have been sacrificed. Many a young practitioner, when brought face to face with a case of acute peritonitis or a case of abdominal injury, strong with the faith that is within him, is forced by the overpowering weight of circum-