[On the history of surgical treatments of peritonitis]

The surgical treatment of peritonitis started with the first laparotomy for an infected ovarian cyst by McDowell in the beginning of the 19(th) century. Thereafter the surgical approach developed parallel to the advances in abdominal surgery. In the last decade of the 19(th) century Mikulicz felt that laparotomy was indicated in all patients with purulent peritonitis. In the beginning of the 20(th) century Körte and Kirschner defined the principles of surgery for peritonitis that are valid up to this day: early surgical intervention, elimination of the source of infection, and peritoneal toilet. Since that time surgeons have discussed the utility of draining and irrigating the peritoneal cavity. Postoperative lavage was already advocated in the beginning of the last century, but generally regarded ineffective. Thirty years ago postoperative lavage was again strongly advocated, but evidence for its benefit is still missing. The history of the treatment of peritonitis examplifies that basic concepts which have been discovered in the past often remain valid and can serve as guidance for a long time. Such discoveries deserve recognition and should give reason for a critical appraisal of current practice. Thus, the statement of Trendelenburg made one hundred years ago remains true: "...in medicine, too, the today is based on the yesterday, and to follow a gradual development is of immense interest. In daily practice, especially in surgery and obstetrics, many things are much older than an ignorant can imagine."