[Reprinted from The Medical News, August 9, 1890.] 
EARLY OPERATIONS IN PURULENT 
PERITONITIS} 
JOSEPH PRICE, M.D., 
OF PHILADELPHIA. 
In operations for purulent peritonitis, the results 
have been almost uniformly unsatisfactory. Dr. Ban- 
tock, in a late discussion, said that in opening the 
abdomen for these cases, he has been very much 
disappointed with the results. Possibly, he says, 
he operated too late, but always with unsatisfactory 
results—drainage did not seem to make any differ- 
ence for all the patients died. Such an experience 
from such an operator, is a most telling argument 
for the early interference which he has advocated in 
other abdominal troubles. 
No case of general puerperal peritonitis will re- 
cover without Where there are simple 
inflammatory signs without localized mischief, which 
is the focus of the general trouble, recovery will 
follow general treatment. If there is pus in these 
cases, the necessity for early operation is as much 
to be recognized as in any other case or set of cases 
in abdominal surgery. There is but one treatment 
for suppurative peritonitis—section, irrigation, and 
1 Read before* - lire rAI IlgTUiilfV of 
Surfferv.Mav.iBoo. 9 I t*< Ar£ \ 2 
PRICE, 
drainage. Postponement is more dangerous than 
the operation, and at the worst only hastens a result 
which is certain to follow without operation. 
In the Medical Mirror, May, 1890, is reported a 
case of general peritonitis, from appendicitis, in 
which the patient died on the thirty-first day. The 
results of delay are here too evident, when we 
take into consideration the numerous cases of ap- 
pendical trouble, now relieved by prompt operation. 
The late Lexington disaster, in which Colonel 
Goodloo lost his life, by a delay in operating of 
twenty-four hours, followed by another case in the 
same city, in which prompt intervention saved the 
patient, who is now active and well, is also a lesson 
in cases of this kind. 
Further, to illustrate the subject, I introduce the 
following cases of my own. Other recent illustra- 
tions could easily be cited, but these are sufficient: 
Case I.—Mrs. 8., aged twenty-eight years. Seen 
five weeks after labor. High temperature; rapid 
pulse; rapid progressive emaciation; profound sepsis. 
Abdominal section revealed, thickened omenteum 
adherent over entire pelvis; right pyosalpinx and 
abscess the size of an orange in the ovary ; universal 
adhesions; six inches of ileum cheesy and disorgan- 
ized to the mucous coat along the line of adhesion 
on the right side. A knuckle of bowel was opened 
in enucleating the appendages ; it was trimmed and 
stitched ; there was purulent peritonitis, and one pint 
of pus free in pelvis, from leakage; appendages re- 
moved ; cavity irrigated and drained ; recovery. 
Case II.—Mrs. M., aged twenty-four years, seen 
twenty one days after labor. Abdominal section 
showed acute puerperal pyosalpinx on the left side, PURULENT PERITONITIS. 
3 
and general purulent peritonitis; bowel, omentum, 
and pelvic organs matted together by friable adhe- 
sions; left tube gangrenous; right tube congested, 
but showed no evidence of pus; only the left tube 
removed ; irrigation and drainage; recovery. 
Case lll.—Mrs. W., aged thirty-six; seen twelve 
days after labor ; most profoundly septic. At the 
section universal friable adhesions were found; both 
appendages absolutely gangrenous ; uterus large and 
soft, with cheesy walls; removal of both appendages; 
irrigation and drainage; recovery. 
Case IV.—Mrs. F., aged twenty-three; seen four 
weeks after labor ; removal of both appendages for 
left pyosalpinx and ovarian cyst; right tube occluded, 
adherent, and acutely inflamed; adhesions universal; 
general peritonitis; irrigation and drainage; re- 
covery. 
Case V.—Mrs. S., seen two years after labor. She 
had puerperal fever and was in bed nine months; 
since then has been a hopeless invalid, with loss of 
locomotion, constant agonizing pain, great emacia- 
tion, constant nausea and recurring attacks of peri- 
tonitis. I removed a left psyosalpinx and ovarian 
abscess; dense bowel adhesions; omen ten m, bladder, 
and uterus glued together; irrigation and drainage; 
recovery from the operation and cure. 
It should be noted that: 
ist. All were cases of true puerperal “ fever. ” 
2d. All were saved by section, after wTell-directed 
medical treatment. 
3d. The operations undertaken to save life, 
not to demonstrate ideal surgical procedures.