[Reprinted from the American Gynecological and Obstetrical Journal 
for March, 1895.] 
HOW TO DO ABDOMINAL SECTION WITHOUT FUSS, 
FEATHERS, AND FOOLISHNESS, WITH 
IMMUNITY FROM SEPSIS.* 
Joseph Price, M. D., Philadelphia. 
The profession was very slow to acknowledge the correctness of 
the pathology of pelvic diseases in women, as demonstrated by Ber- 
nutz and Goupil. Their almost mathematical presentation of the 
subject was received with ill-expressed disregard, and characteristic 
criticism, both harsh and unprofessional. Mr. Tait did much to open 
the way for the ultimate reception of their views, and his work must 
always stand a monument to the period of the most remarkable 
progress in modern surgery. Cavilers may carp, and envy strive to 
belittle, but to the minds of the generous and just, there is no question 
as to his merit. From 1872 to 1888 there was a remarkable regularity 
in the advancement of both the theory and practice of pelvic surgery, 
but since this latter period there is much to discourage the practical 
and progressive mind, which is never satisfied to abandon progress, 
or to go forward, looking backward, or to be satisfied with obsolete 
or obsolescent methods. If we take the trouble to look up the papers 
of this latter period, we shall find them already quivering with doubt, 
and quavering from disaster. Many men who without training or 
drill, or previous education in any branch of medicine, rushed into 
the abdominal field as the road to ready fame, have begun to redress 
their steps, doubt the correctness of their absolutely ignorant, but no 
less positive statements and to hedge behind their so-called conserva- 
tive opinions, for which their crude work had built the foundation. 
This had been well, had it only reacted upon themselves, but the 
effect was of wider extent, and the reading profession were misled 
into considering their cry for quarter, as an honest surrender. This 
*Read before the Medical Society of the District of Columbia, November 28, 
1894. 
Copyright, 1895, by J. D. Emmet and A. H. Buckmaster. Joseph Price. M. P. 
defection indeed has got beyond the line of current literature, and 
invaded the presumably standard books of the day. Men who are 
supposed to be an authority on what they write, because they are 
backed by medical colleges and standard publishers, are deluding 
the profession, by a counterfeit presentation of experience, and pres- 
ent that as general which is only the shady result of their own lim- 
ited knowledge, which presumes to teach, while it has yet all to 
learn. The pathology of these pseudo-instructors, is at fault and 
their conclusions surgically considered, are not to be considered or 
trusted. Of pathology, there must be a working knowledge, not, 
necessarily a microscopic one, but such information as will enable 
the operator to understand what he is likely to meet, why it is thus 
and so, and the results of certain complications, and the necessity of 
dealing with each one specifically as it arises. To start out in any 
line of work, with a fair show of success, there must be a preparation 
both subjective and objective. The objective preparation in pelvic 
work is applied to the patient. She is to be duly purged, and her in- 
testinal tract thereby freed from debris which may interfere with 
post-operative comfort. An empty bowel has better tone than a dis- 
tended one. For the purpose of catharsis, calomel and salines should 
be used, according to the peculiarities of the patient. Light, simple, 
liquid nourishment is to be preferred, while in feeble cases the ante- 
cedent administration of strychnine is of value.- The patient is to be 
thoroughly cleansed, and kept clean while' all the rules of personal 
cleanliness are to be applied both to the nurse and the surroundings 
of the patient. It often is questioned whether successful operation 
can be done in and under conditions which do not permit of rigid 
cleanliness, so far as the room itself is concerned. My answer from 
an extensive personal experience, is that the best results have been 
obtained, under the most adverse conditions, but these have only 
been reached, by extra care and painstaking avoidance, of accidental 
introduction into the immediate field of operation, the filth of the 
surroundings. This last assertion is to be taken literally. Cleanli- 
ness by soap and water is all that is required. 1 do not use nor 
advocate the use of any chemicals whatever, and consider that the 
operator who has need of corrosive poisons to render him fit for the 
operating table, had better take a month’s vacation to prepare himself 
for the safety of the patient. Chemical solutions bring into the field 
of operation an additional danger of irritation. This is great enough 
owing to the nature and character of the interference. 
Here as in all other operations the less the paraphernalia and Abdominal Section without Fuss, Feathers, and Foolishness. 
3 
complexity, the less the danger of annoying delays and impediments 
to speedy and careful, uninterrupted work. 
The incision should bs as short as is consistent with the removal 
of the diseased part. This is of importance also at the close of the 
operation. The smaller the incision the less we have to deal with in 
closing. If the tumor is irreducible, the incision must be longer than 
otherwise. Adhesions are to be dealt with as they are found, and not 
passed by. Ligation of bleeding points must be carefully attended 
to. All points of bleeding do not necessarily require a ligature. The 
haemostatic forceps very readily controls many of these, especially in 
the incision. Too numerous ligatures introduce an irritating element 
into the surgery of the pelvis and abdomen whose evil is far reaching, 
and should be avoided. All pathological conditions should be re- 
moved as they are discovered. Adhesions, freed, debris consequent 
upon these removed, and the really diseased organs carefully separated 
and tied off. Leaking vessels must be controlled, and must be pri- 
marily handled so as to excite as little hsemorrhage as possible. 
This is accomplished by breaking the adhesions down with the 
cushioned end of the finger, using the nail practically not at all, and 
the scissors or knife never, unless where it is absolutely necessary to 
tie. After adhesions are loosened and ligatures placed, the toilet is 
to be looked to. Drainage is the most essential feature, and this is 
begun by flooding the abdomen. The abdominal douche is as neces- 
sary for successful surgery in the peritoneal cavity as is soap for com- 
mon cleanliness. The sneerers at drainage all with common consent 
acknowledge the efficiency of flooding out the abdomen to clear it of 
debris, pus clots and the like. Not only does it do this but it is a 
powerful stimulant in shock, and enables many a successful recovery 
to be made, where otherwise we would lose our patient. Now drain- 
age, I mean glass drainage, not a gauze masquerade, simply continues 
the good work initiated by abdominal flooding. It permits the escape 
of lymph, the smaller clots, the serum from the irritated surfaces, and 
conduces to bringing the peritonaeum into a more natural condition. 
Gauze simply abstracts fluid as such, and does not permit of the 
elimination of anything else whatever. It is interesting to note in 
this connection that those operators who so bitterly opposed drainage 
some little time ago, now commonly pack the pelvis full of their so- 
called gauze drain from vagina to and through abdominal incision, and 
with the same consistency yet violently oppose supravaginal extraperi- 
toneal hysterectomy which when perfectly done does away with all 
intraperitoneal tinkering, and closes without even leaving a sinus. All 4 
Joseph Price, M. D. 
gauze packing opposes prompt healing, except that by adhesions, and 
therefore the less of it we use the better we are off, except in those cases 
in which it is desired to wall off a cavity, such as the seat of a suppu- 
rating appendix which it is impossible or rash to remove at a primary 
operation. The closure of all abdominal wounds should be made 
with silkworm gut. This makes a perfect splint for the abdominal 
walls, is nonirritating, and safe. For other needs of abdominal work, 
I find fine silk the desideratum, it has many advantages over catgut, 
but above all is safer and cleaner. Again it is much stronger in the 
finer threads, and therefore permits the use of a less bulky thread. 
After the essentials of the operation comes the after-treatment. Here 
I find no reason to diverge from the lines I have so often laid down, 
to wit : that rest, position, and simple diet without anodynes are the 
essentials. I do not allow my patients to be shifted for the first 
twenty-four to thirty-six hours, for the reason that in abdominal 
wounds and tying, absolute quiet, I hold, is just as essential as in other 
surgery, such as that of bones, or plastic work, and after all much of 
abdominal and pelvic surgery is only plastic work on a large scale. 
Milk should be avoided as a diet in most cases. Anodynes are not 
indicated save in those cases in which the opium habit has been pre- 
vigusly contracted, and the operation urgent. 
The vast majority of patients are better without it, in every way, 
physically, morally and mentally. 
So much for the real necessary common sense of abdominal sec- 
tion. 
As to the opposite of this, in all that pertains to abdominal work 
of every sort, there has been so much written, and so much said, sug- 
gested, and attempted, that just at the present time, we are in a tre- 
mendous muddle. Men who do not know how to drain, cry out 
“ There is no need of drainage in abdominal work. The man who is 
in favor of it is a dirty operator.” These same men would not argue 
drainage away from other branches of surgery, and yet in the abdo- 
men, where in many cases the dirt and debris are boundless, they 
waive this important step in the technique of abdominal section aside, 
forgetting that assertion is not argument. 
These same men are ever ready to adopt anything new, or original, 
be it suggested by a nightmare or hypnotic ecstasy, only so it attract 
by its air of novelty, be it by a patent abdominal sewing machine, or 
a new German Salvation, vacuum, wherein both patient and operator 
are made to breathe sterilized ethereal ozone, and perspire some never- 
failing never-ending antiseptic. Abdominal Section without Fuss, Feathers, and Foolishness. 
5 
Boiling water to these oglers of foreign fads, has become so cool, 
that it will no longer scald or cleanse (at least, so it is believed in 
Germany, where they ought to know), and in its stead is imported, a 
real German bake oven, which can be heated hotter than the scrip- 
tural fiery furnace, and the little sinning microbes, unlike Shadrach 
and the other two, can not stand the strain. All this is a combination 
of fuss and feathers. Let us see. Instruments baked, assistants 
oxalated, permanganated, bichlorided, floor tiled, with the chance of 
three out of five of the nurses menstruating, or ending it up with a 
discharging irritating leucorrhoea, with the water supply and drain 
communicating directly with a sewer, and the operation attended, 
perhaps, by fifteen or a dozen men, all of whom have come from filthy 
street-cars or dirty carriages, or perchance even from stables, if perhaps 
they have an oversight of their own conveyances. This is fuss, 
feathers, and foolishness. The trouble is that too many err in imag- 
ining that cleanliness comes from antiseptics. This is not so. The 
man who can not be clean without bichloride, can not be clean with it. 
Being clean by spasm is like trying to become a society man by 
buying a dress suit. It is all right for theory, but it won’t work. If 
looks were all, and nothing back of them required, the goal would be 
reached ; but not so. Put it down, that the men who dwell the most 
on the ultra-refinements of Listerian surgery, do so only in the hope of 
succeeding in some way to overcome failures, in themselves, which 
they are loath to acknowledge. 
This is not fuss or feathers or foolishness alone. It is false pre- 
tense. He parades to the learner and to the outside world, that all 
surgery is reduced to the hoo-doo of chemicals, or the Trendelenburg 
position, and that these make surgeons and surgery easy. We are 
waiting for the book, Every Man his own Surgeon: A Crying Need to 
protect us from Quackery. 
Fuss in surgery is of two kinds, as are most other sensations, sub- 
jective and objective. Objective sensational fuss is of the sort I have 
briefly and generously and gently referred to, withal, seriously. Sub- 
jective fuss is due to the natural tendency, drilling and disposition of 
the operator. I have known an operator to leave his patient before 
closing the incision to discuss a specimen removed. Only a patho- 
logical devotion completely overshadowing the surgical instinct, can 
explain a freak like this. In my work I hate stupidity, whether in 
assistants, nurses, or onlookers. I hate it worse in myself. When I 
quarrel with myself in my work, I know I am a ringleader in a con- 
spiracy against the life of my patient. If I learn that an operator 6 
Joseph Price, M. D. 
curses his sponges, nurses, damns the eyes of his needles, and sends 
his knife to a place hotter than his Dutch bake oven, I look for many 
of his patients in another direction. 
One thing an operator has to learn. He is the head, judicial legis- 
lative, and operative in all that concerns his patient. He is bound to 
see that all is in working order, before he begins work. He is to know 
that all around him are trustworthy and efficient. If he is in doubt 
about this he has no right to begin work. 
If he begins work without skilled assistance, he must know himself 
capable of going through it without assistance. In the event of fail- 
ure, he has no right to bulldoze those around him or lament their 
inefficiency. Subjective fuss combined with objective feathers, re- 
duces surgery to a farce, and the operation often to a tragedy.