LET us look at the case of a man who has accidentally wounded his finger. The instrument which inflicted the wound i soiled with septic matter, and introduces the same into the tissues. An intense and painful inflammation follows, and suppuration is in due course established. The disease (so called) is distressing enough, but the manifestations are no mere outcome of a malign purpose.
They are well intended and have for their object the protection of the body from further parasitic invasion on the one hand, and the elimination of such septic matter as is already introduced on the other. But for the inflammation and suppuration, every neglected septic prick would be fatal. The ancient surgeon who endeavoured to exorcise inflammation, as if it were the evilest of evil spirits, was directing his wrath against the most benevolent of angles who was ever entertained unawares.
This matter may be followed out a little more in detail in connection with the symptoms of the disease familiar by the uncouth name of appendicitis. In this malady a trouble occurs in the appendix. The wall of the little tube becomes perforated, and an acrid poison finds it way into the sensitive cavity of the abdomen. This, at least, is the essential calamity in many instances. The perforation is sudden, is accidental, and may be preceded by no warning sign of any kind. Here again the disease proper may be without a single symptoms. The manifestations which follow the perforation are termed the symptoms of peritonitis.
They are distressing and urgent, but they are all benevolent in intent, and are the outcome of Natures vigorous effort to minimise the calamity and save the patients life. The intense pain and collapse impose upon the victim absolute rest and, more than that enforce rest in the most advantageous posture, that, namely, of recumbency. He is rendered helpless at a moment when any movement may be attended by disaster.
The sickness and utter nausea which attend it secure some emptying of the alimentary canal, and forbid the introduction of any fresh material into an intestine which is best placed for recovery when it is least occupied. The skin of the abdomen becomes acutely sensitive, and so protects the damaged parts from disturbance and pressure, and this most necessary end is further secured by another symptom-the remarkable rigidity of the abdominal wall. Even should the affected area be accidentally pressed upon, the firmly contracted muscles which cover it will shield it like a protecting cuirass.
Thus is brought about that state of absolute rest which is essential as the very first step towards the repair of the injury, and let it be noted that this life saving end is secured by what are termed the deplorable symptoms of disease. At the same time, the condition of the circulation is so modified as to render absorption of septic matter from the affected district as little ready as possible.
Within the abdomen the manifestations of peritonitis are appearing. Peritonitis has commonly been spoken of as one of the most deadly and most malignant of calamities. Never was a condition more unjustly abused. The phenomena of peritonitis should he hailed with thankfulness. Peritonitis is concerned only in effecting good. It is in every instance a beneficent process.
It is Natures method of bringing about a cure,and is successful in millions of instance. But for peritonitis, every intraabdominal wound and a multitude of intro-abdominal lesions would be inevitably fatal. So far as the abdomen is concerned peritonitis is the great life saving process, and should its possibility be denied to mankind, the human would be threatened with extinction. There is, indeed, no terror in peritonitis, although a world of alarm may well attend the calamity that calls it forth.
Its mode of action is admirable in its simplicity. It induces an immediate paralysis of the ever-moving intestine. With the4 cessation of these now most dangerous movements the essential state of rest is secured. More than that, it pours out a plastic lymph which glues adjacent coils of bowel together and, in an incredibly short time, isolates and encloses the damaged area.
It forms a barrier around the seat of the mischief, and upon that barrier the life of the patient depends. An abscess form but, thanks to an active peritonitis, the matter contained therein is shut off, is rendered for the time innocuous, and is placed in a favourable condition to be discharged from the body.
It has been the custom of many surgeons in the past to speak of peritonitis as it if were the very hand of fate, an impending horror which spreads only disaster and death. In actual truth, peritonitis is the operating surgeons best friend. He who condemns it is like the man whose house is in flames and who execrates the torrent of water which is poured upon the burning fabric.
Many of the symptoms of disease, instead of being pounded out of the body by violent as wholly pernicious, should rather be regarded as means for guiding the physician in the treatment he should adopt. Treatment has to be, for the most part, imitative of natural processes, and the imitation is founded upon the much- abused symptoms of the swallows concerned.
The man who swallows a poison is sick, and the treatment which suffices best in such a case is the fullest development of that symptom-namely, the washing out of the stomach.
The abscess tries to find a way of escape, and the surgeons knife but carries out the suggestion forced upon him by the evident intention of the pus. The cough which is so marked which must needs be got rid of and the physician, acting upon the hint, promotes such elimination. In older days effort was made to stay the cough, because it was a symptom of disease and therefore must needs cease.
The difference between the old creed and the new in this particular of treatment is well illustrated by the treatment of aneurysm. As soon as an aneurysm has reached certain proportions, a clot is found to be forming in it, layer by layer. The surgeon who first approached the operative treatment of this condition advised the cutting out of the clot. He regarded the clot as a malignant product, because he considered all the phenomena of disease to be malign.
Indeed, he went so far as to consider the laminated clot to be the cause of the whole trouble, and therefore he advised that it should be excised at all coast. A later pathology taught that the clot formation represented Natures method of cure, and that in it lay the saving of the patients life. The modern surgeon, therefore, not only does not disturb this product, but he adopts every measure to ensure its formation.
The most successful treatment of aneurysm, indeed, professes nothing more than an encouragement of a natural process, and is based upon the imitation of a prominent symptom of disease.