A Study of Influenza; and the Laws of England Concerning Infectious Diseases

R. Sisley
1892 BMJ (Clinical Research Edition)  
INFLUENZA AND THE LAW AS TO INFECTIOUS DISEASES. [M VIWA,L JOtRIRAL , J into the peritoneal cavity, the ease with which deep-seated abscess may be treated, the avoidance of frequent disturbance of the patient to change dressings at the most critical time, the saving of time to the surgeon. Through knowing that he has such an operation to fall back on, the young and inexperienced or timid practitioner will be encouraged to attempt the early diagnosis of abscess of the liver with the aspirator,
more » ... d to operate with confidence should he find pus. This is an important matter which practitioners in large centres may have a difficulty in understanding. Many lives are lost through delay in operating on hepatic abscess. The disease occurs most frequently in lonely out-stations in India, China, Africa or the West Indies, where there is probably only one medical man and no experienced consultant and surgeon to fall back on. Very possibly this man has never seen abscess of the liver before; probably never seen it treated surgically or himself had much surgical practice. It is very trying to such a one to have to act promptly and boldly on his own responsibility, and he is tempted to delay active interference till, perhaps, it is too late. I am sure in such circumstances the operation I describe, which is almost as easily performed as tapping a hydrocele, will be welcome. The merits I claim for it have, I am aware, one or two drawbacks. Chief of these is the necessity for a special apparatus, not very elaborate or expensive, it is true, but, nevertheless, apparatus not to be found in the ordinary armamentarium of the surgeon. Against this I may urge that with a little ingenuity a serviceable substitute may be extemporised from the resources of most places, no matter how far from civilisation. A second drawback lies in the number of details the operator has to bear in mind, and which during the flurry of operation may not present themselves to his mind in their proper sequence. Against this I may say that if the various details have been provided for, and the steps of the operation carefullythought out and rehearsed before he proceeds with it, there is not much likelihood of confusion on the surgeon's part when the instruments are taken in hand in earnest. Difficulty of execution is an objection to an operation, and an excuse for failure; but the necessity for careful preparation is no serious objection to any operation, and the neglect of careful preparation is no valid excuse for failure.
doi:10.1136/bmj.1.1621.167 fatcat:lmi47jlowbcjpm2e5mbtjtkph4