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JAMA 100 Years Ago
February 11, 1998


Author Affiliations

Edited by Brian P. Pace, MA, Assistant Editor.

JAMA. 1998;279(6):428S. doi:10.1001/jama.279.6.428

Dr. Frederick Holme Wiggin, in a paper read before the Hartford Medical Society and the New York Medico-Surgical Society, January, 1898, considered the management of patients before and after laparotomy as follows: In the early days of the decade now drawing to a close, it was generally believed that abdominal operations could not be safely performed outside of hospitals especially constructed for such work; but it is now known that although personal effort and responsibility are increased, it is perfectly safe to do such operations in ordinary houses. It is, therefore, not improbable that in the near future many of these patients will prefer to be operated on at home, and this means that the general practitioner will have a more important part to play in the management of these cases than has been customary in the past. Where circumstances will permit, one week should be devoted to preparing the patient for the operation. This time can be profitably spent in accustoming the patient to the new environment, in examining the heart and lungs, and the conditions of the secretory and excretory organs and in thoroughly evacuating the bowel. Early in the week several small doses of calomel and soda should be given daily, for three days, and followed each morning by a saline. On each of the three succeeding mornings a large enema should be administered, consisting of three or four quarts of saline solution. . . . The diet during this week should be light and easily digestible, and the patient should be encouraged to drink freely of liquids and to rest as much as possible. . . . The nervous system may be quieted by administering, on alternate nights, a mild hypnotic, such as a combination of sulfonal and chloralamid, and arranging its administration so that a dose is given on the last night before the operation. . . . The patient's body and limbs should be properly protected with clothing during the operation. The furniture of the room should be removed and the windows left open for two or three hours. Then, the woodwork should be wiped off with bichlorid solution, 1 to 1000, and the floor liberally sprinkled with the same solution. The operating table should be about 20 inches wide and thirty high. The following should be provided, and, after cleansing and washing with bichlorid solution, should be placed in the room: Several small tables or stands, a few wooden-bottomed chairs, several pitchers and meat platters, four or five basins and a fish-kettle for the instruments. In addition, there should be several gallons of both hot and cold water, sterilized by boiling, and at least a dozen towels sterilized by steaming. For emergency cases it is safer to cover the floor with a sheet wet with bichlorid solution than to stir up the dust of the room by more elaborate preparations.

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