Great judgement is necessary in the selection of
cases suitable for operation. First, one would not
'think of operating', in moribund cases. Second, again in
malignant cases as a rule one does not operate unless
an early diagnosis is made, when the disease is dis¬
tinctly localized, not having had time' to infiltrate
the surrounding tissues,'' asi' for example, early malig¬
nant disease of the bowel where one can excise the
mass thoroughly, or in another class of cases where,'
not with a view of eradicating the disease, but rather
relieving the' symptoms operation is frequently justifi¬
able as for example,- Gastro Jejunostomy in Pyloric
Cancer or Inguinal C'olotomy for Rectal Cancer. The
existence of Septicaemia negatives operation,' unless
by operation you can remove the cause; also does Grave
Cardiac,: or Pulmonary or Renal disease. So also does'
extreme age of the patient.
The co-existence of pregnancy with other abnormal
Abdominal conditions frequently confronts the Surgeon,
who has to decide whether operation is justifiable or
not. If the condition is one that can wait a few months
without running any grave risk to the. Mother, such as a
small fibroid or small Ovarian Tumour, it may be well
to wait and watch the symptoms. Should the ovarian give
rise to disturbing symptoms which may probably lead to
abortion, operation should at once be undertaken.
Frequently urgent cases are met with where a pregnancy
is complicated with an ovarian Tumour, with a twisted
pedicle or a ruptured Cyst with suppuration of its
contents, or inflammation of Vermiform Appendix followed by abscess. In these cases operation is imperative .