Peritonitis Preventives

Of all the nightmares that haunt an able surgeon, none is worse than his fear of infection after an abdominal operation. When he goes after an appendix, a ruptured spleen, a gall bladder, a twisted or telescoped bowel or a cancered stomach, he never knows at what moment the sewage system of the human body may, for all his skill, spring a leak, with disastrous results.

To reach any of these organs the surgeon must cut through the peritoneum, a closed sack within the hollow of the abdomen. The outside coat of the peritoneum resists germs, but its slippery, serous inner wall offers streptococci an ideal breeding place. The peritonitis which results is exceedingly hard to cure. A high percentage of peritonitis cases die, and many of the remainder suffer lifelong pain and debility from adhesions. Because of the difficulty of coping with this form of infection all surgeons cock hopeful ears toward any serious colleague who promises them a preventive of peritonitis.

Last week when 3,000 fellows of the American College of Surgeons surged into Boston for their 24th convention, they crowded instructive lectures about stomach wrinkles, minced glands and many another subject (see p. 35). But none of these topics provided the assembled surgeons with the practical interest that Dr. Herbert Lester Charles Johnson packed into his lecture on the use of concentrated amniotic fluid as a preventive of peritonitis.

Amniotic fluid is a liquid which a mother secretes in her womb while she is bearing her baby.

The baby floats in that liquid until it is born. Just before birth, the "bag of water" bursts, and the fluid cascades forth.

That amniotic fluid might have another use gradually dawned on surgeons, when they realized that women who underwent caesarean sections seldom developed peritonitis. That was because amniotic fluid is a potent germicide. When an obstetrician opens the belly to lift out the child, the protective waters flood all the neighborhood of the womb.

Dr. Johnson well knew that going around to maternity hospitals to collect the waste waters of childbirth was a silly and tedious procedure. Because the amniotic fluids of all higher animals are alike in their antiseptic potency he went instead to dairy farms, and stood by while cows dropped their calves.

Again and again Dr. Johnson flushed the abdominal cavities of his surgical patients with fresh bovine fluid. In an astonishing number of cases peritonitis was prevented and mortality records were brought down to an enviable degree.

Dr. Johnson's Boston colleague and good friend, Dr. Edward Lorraine Young Jr., then suggested that Dr. Johnson give him some concentrated amniotic fluid to try as a prophylactic. In risky bowel operations where the mortality rate is usually about 30% Dr. Young had the satisfaction of reducing it to about 2%. These Johnson-Young experiments went successfully forward to the point where the two doctors last week felt warranted in making this significant announcement to their fellow surgeons: Three ounces of the concentrate injected into the peritoneum four to six hours before an operation will, in a vast majority of abdominal cases, prevent peritonitis.

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