The desirability of operative interference in suspected perforation of chronic ulcer of the stomach

Alfred R. Parsons
1892 Dublin Journal of Medical Science  
PAaSONS, M.B. (Univ. Dubl.); late House Surgeon in Sir P. Dun's Hospital. PATHOLOGICAL observation and experimental investigation, particularly the latter, have done much to aid clinical diagnosis, and to render feasible operations which seemed little short of impious to our forefathers. The physician can often, from the clinical history and symptoms, now localise a cerebral abscess with suMcient certainty to justify a surgeonin applying his trephine and attempting to drain it. A clearer
more » ... ge of the origin and functions of the spinal nerves has enabled the neurologist to point accurately to a certain level as the seat of spinal pressure, and the surgeon's knife has confirmed the accuracy of the diagnosis, and by the removal of the tumour made life a pleasure where it had been full of pain. Certain symptoms and signs referable to one hypochondriac region, and the presence in the urine of a small quantity of caseous pus, containing tubercle bacilli, justify, with certain restrictions, a recommendation of surgical interference, and the excision of a kidney with a localised tubercular focus has saved an otherwise forfeited life. Opening the peritoneal cavity demanded at one time no less an atonement than the life of its possessor; but to-day the surgeon, strong in his antiseptic precautions, does an exploratory laparotomy with greater coolness and confidence than he can find in the administration of chloroform to a child. But though much has been done in the past, and many lives have been saved by the combined action of physician and surgeon, much still remains to be done, and I trust that the day is not far distant when the man who dallies with acute perforative peritonitis will be equally guilty with the practitioner who follows the hounds knowing a patient of his is suffering from a strangulated hernia, and then calls in some one else to share the responsibility with him. To one of the causes of acute perforative peritonitis--namely, chronic ulcer of the stomach--I desire in this paper to refer; and I would wish, from my very limited experience, to attempt to deduce the phenomena which indicate the occurrence of perforation, and then suggest what seems to be the only line of treatment offering any hope of
doi:10.1007/bf02957871 fatcat:4phrxz6tsfg7xdopddfbz66sma