Septic general peritonitis in children : practical points in its surgery and successful after-treatment / by F.W. Forbes Ross.

  • Ross, Frederick William Forbes, 1867-1913.
Date:
[1912]
Catalogue details

Licence: In copyright

Credit: Septic general peritonitis in children : practical points in its surgery and successful after-treatment / by F.W. Forbes 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.

    14/22 page 12
    pushing away, as it were, and interposing healthy normal opsonic serum and phagocytes between the surface and the pathological fluids and detritus. This copious “ serous weeping ” tends to create a current towards the most dependent point, and if this is also the point of outlet by reason of the posture of the patient, then the entire peritoneal cavity rapidly renders itself almost aseptic, this satisfactory condition usually supervening within twelve hours of operation. The importance of the post-operative attitude in bed of the patient is now quite apparent. The above also explains the rationale of the advice that no toilet manipulations of the peritoneum should be attempted, not for the common fear that they serve to further “ distribute infectious matter,” but solely for the reason that they damage the surfaces and remove valuable aids to neutralizing, and then auto- matically floating away harmful materials, besides increasing shock and diminishing the chances of recovery in children. The surgeon who scrapes lymph off the intestines is com- mitting a grave error. One feels convinced that many more young children would survive laparotomy for this intensely septic condition if full reliance were placed on this “ natural automatic lavage ” of the peritoneum, and all toilet manipulations whatsoever abandoned except where faeces or actual foreign matter were present. If the utmost use must be made of the natural biological lavage of the peritoneum and full benefits accrue, then the importance of the oft-repeated rectal saline injection during the first twenty-four hours after operation is overwhelmingly obvious. Free drainage, after gentle manipulation at operation, with an oft-repeated rectal saline, will drag many a hopeless case amongst children out of the grave. DRAINAGE. Another point of surgical interest is the desirability of using drainage tubes of sufficient, but not too large diameter, as experience shows that too large a drainage tube—too much foreign body—tends to keep up the nervous abdominal symptoms in children, and the prompt recognition and removal
    digitised image 1
    digitised image 2
    digitised image 3