The X-Ray Treatment of Acute Peritonitis

Abstract

The treatment of acute peritonitis at the bedside with x-ray was begun by us in 1934, and our early experience was reported before the section on Radiology of the American Medical Association in June 1938. In the last three years we have added several cases to the series presented at that time, and this new report, though leaving many questions unanswered, will give the reasons why we still believe in the procedure and think it worthy of more general adoption. Since 1928 there has been no doubt in our minds that x-rays should be used with other conservative measures in the treatment of gas gangrene. That others agree with this conclusion is evidenced by the fact that over twenty favorable reports, covering more than 100 cases, now appear in the literature, showing that the mortality and morbidity in this disease have been definitely reduced when x-ray therapy has been used as an aid in its treatment. While adverse criticisms of the use of x-rays in gas gangrene have appeared since the advent of the sulfonamides, no series of cases adequately treated by irradiation has been introduced into the literature, with detailed data on specific cases, showing any high percentage of failures. For the honest practitioner who is a physician first and a specialist last, we believe that the status of the x-ray as an aid in the prevention and treatment of gas gangrene is settled. Other measures now undergoing trial may prove successful in the future, but what the x-ray can do is established. Reference to the use of x-rays in the treatment of gas gangrene in association with a discussion on the treatment of acute peritonitis is not irrelevant. Few physicians are aware of the half century of controversy waged in the literature, and participated in by research workers and clinicians, concerning the exact rôle of Cl. welchii in the etiology of the most common form of acute peritonitis, namely, that following appendicitis, intestinal obstruction, and other lesions in which the peritoneal cavity becomes contaminated with intestinal contents or their numerous bacteria. In this report only brief reference can be made to the possible etiologic relationship between gas gangrene and acute spreading peritonitis of intestinal origin. If they have the same causative organisms, our excellent results with x-ray therapy in the few cases here reported are explained.