fiicting opinions
of different
high authorities,
but that the
best and safest rules may, if possible, be definitely laid clown for the guidance of those young Surgeons who, coining from
England,
find themselves at once face to face with
number of cases of diseased liver and 1.
Given the in
abscess,
case
of
favorable
a
a
site,
hepatic patient suffering with
no
so
large
a
abscess. from
hepatic
serious intestinal disease,
and with health not broken down
so far as to preclude a fair hope of ultimate recovery. Query.?In gucli a case is the weight of medical opinion in this country decidedly in favor of operative interference? 2. If the weight of opinion is decidedly in favor of operating under these circumstances, is it grounded on the conviction that under the circumstances it is likely only to prolong life and alleviate suffering, or on the belief that it not only does this, but that it likewise affords the patient a better chance of ultimate and complete recovery ? 3. Has the danger of operative interference, if properly carried out, been exaggerated or not ? What do Indian statistics prove ? Is there extremely little cause to fear any actual harm being thus done ? Are the results positively beneficial ?
4. THE TREATMENT OF HEPATIC ABSCESS. We have been asked to invite free discussion in
our
columns.
"We
gladly
do
so.
on
In these
this
days
subject
it cannot
but be that every intelligent physician is deeply interested in a topic of such vital moment to humanity. Here in India, as
compared with England, weha ve by far the largest experiences We ought therefore to have superior know011 the subject. ledge regarding it. It must be well known to all our readers that there exists, at present, a sort of faction in the profession 011 the merits of this questio vexata. Some would oppose all operative interference as hurtful and useless, whilst others, adopting directly opposite views, maintain that very many patients die simply because they are not operated on. In the opinion of the latter class of Surgeons, the operation is quite as
justifiable
and proper
as
that of Paracentesis Thoracis in
an
yet a third school whose .doctrine is that active interference is likely to prolong life, but not to save it. Its disciples are always chary of handling the trocar, the lancet, or the knife, yet they are ready to do so in very hopeful cases. What then, we are constrained to ask, are the exact merits of all the arguments that can be brought to bear on this grave matter ? In what direction docs the weight of professional opinion lean in India ? What can reliable statistics prove ? What, are exactly the conditions that may safely be laid down as justifying or negativing operative interference P The result of all the experience acquired, in the past, by good and careful practitioners must be of great value. We would fain have it not only recorded, but freely discussed in our columns. Wo shall not ask who agree with Cameron, with Martin, or urgent
with
case
of
Empyema.
Murray?who
There is
with Maclean
and
Budd?or who with
Aitken and others that regard the propriety of opening hepatic But we shall tabulate a few abscess as still an open question. we fancy embrace all the more which imporgeneral enquiries tant considerations of the
attention, believing time for such
an
as we
subject,
and towards these
investigation,
not
we
present is a most only that we may
do that the
Is
not the chance of complete ultimate recovery, after
performance of the operation, less although, in ordinary instances, greater the
invite
suitable be able
to decide for ourselves regarding the true value of the
con-
than many suppose ; than in cases
which
have been left to nature ? is it not true that, under all circumstances, when regularly formed in the liver, the majority of prove fatal, whether operated on or not ? operation is considered justifiable, what instrument
Is it
5.
or
abscess has
an
the
cases
G.
If
should be used ? 7.
What
which
must
are
regards the patient's health specially contra-indicating all
the conditions
be
regarded thought of interference. Lastly and more generally?
as
as
a case of liver abscess, peripheral, centrical, or 'of position ; or again given the same disease finding exit on the surface, along the intestine or by the lung,?What are the standard rules of treatment to be laid down and accepted
Given
doubtful
under each and all of these conditions ? We throw these for
our
questions
friends to crack.
out
as
a
handful
of hard nuts
of different
high authorities,
but that the
best and safest rules may, if possible, be definitely laid clown for the guidance of those young Surgeons who, coining from
England,
find themselves at once face to face with
number of cases of diseased liver and 1.
Given the in
abscess,
case
of
favorable
a
a
site,
hepatic patient suffering with
no
so
large
a
abscess. from
hepatic
serious intestinal disease,
and with health not broken down
so far as to preclude a fair hope of ultimate recovery. Query.?In gucli a case is the weight of medical opinion in this country decidedly in favor of operative interference? 2. If the weight of opinion is decidedly in favor of operating under these circumstances, is it grounded on the conviction that under the circumstances it is likely only to prolong life and alleviate suffering, or on the belief that it not only does this, but that it likewise affords the patient a better chance of ultimate and complete recovery ? 3. Has the danger of operative interference, if properly carried out, been exaggerated or not ? What do Indian statistics prove ? Is there extremely little cause to fear any actual harm being thus done ? Are the results positively beneficial ?
4. THE TREATMENT OF HEPATIC ABSCESS. We have been asked to invite free discussion in
our
columns.
"We
gladly
do
so.
on
In these
this
days
subject
it cannot
but be that every intelligent physician is deeply interested in a topic of such vital moment to humanity. Here in India, as
compared with England, weha ve by far the largest experiences We ought therefore to have superior know011 the subject. ledge regarding it. It must be well known to all our readers that there exists, at present, a sort of faction in the profession 011 the merits of this questio vexata. Some would oppose all operative interference as hurtful and useless, whilst others, adopting directly opposite views, maintain that very many patients die simply because they are not operated on. In the opinion of the latter class of Surgeons, the operation is quite as
justifiable
and proper
as
that of Paracentesis Thoracis in
an
yet a third school whose .doctrine is that active interference is likely to prolong life, but not to save it. Its disciples are always chary of handling the trocar, the lancet, or the knife, yet they are ready to do so in very hopeful cases. What then, we are constrained to ask, are the exact merits of all the arguments that can be brought to bear on this grave matter ? In what direction docs the weight of professional opinion lean in India ? What can reliable statistics prove ? What, are exactly the conditions that may safely be laid down as justifying or negativing operative interference P The result of all the experience acquired, in the past, by good and careful practitioners must be of great value. We would fain have it not only recorded, but freely discussed in our columns. Wo shall not ask who agree with Cameron, with Martin, or urgent
with
case
of
Empyema.
Murray?who
There is
with Maclean
and
Budd?or who with
Aitken and others that regard the propriety of opening hepatic But we shall tabulate a few abscess as still an open question. we fancy embrace all the more which imporgeneral enquiries tant considerations of the
attention, believing time for such
an
as we
subject,
and towards these
investigation,
not
we
present is a most only that we may
do that the
Is
not the chance of complete ultimate recovery, after
performance of the operation, less although, in ordinary instances, greater the
invite
suitable be able
to decide for ourselves regarding the true value of the
con-
than many suppose ; than in cases
which
have been left to nature ? is it not true that, under all circumstances, when regularly formed in the liver, the majority of prove fatal, whether operated on or not ? operation is considered justifiable, what instrument
Is it
5.
or
abscess has
an
the
cases
G.
If
should be used ? 7.
What
which
must
are
regards the patient's health specially contra-indicating all
the conditions
be
regarded thought of interference. Lastly and more generally?
as
as
a case of liver abscess, peripheral, centrical, or 'of position ; or again given the same disease finding exit on the surface, along the intestine or by the lung,?What are the standard rules of treatment to be laid down and accepted
Given
doubtful
under each and all of these conditions ? We throw these for
our
questions
friends to crack.
out
as
a
handful
of hard nuts
