The Hidden Story of Innovation: Charity Hospital, Angola Prison, and the Challenging of Surgical Dogma

Abstract

The late 1960s was a period of significant upheaval of social, cultural, and scientific norms. The generally accepted notion of mandatory laparotomy for all penetrating abdominal injuries was among those norms being called into question across the country and many advocated expectant management of selected patients presenting with this type of injury. Leaders of the surgical community published opinions on either side of the argument. The house staff at Charity Hospital during this period was among the busiest in the nation in treating these injuries, many of them inmates of the Louisiana State Penitentiary who used self-inflicted stab wounds to the abdomen as a means of temporary respite from the inhumane conditions in the prison. Inspired, in part, by the overabundance of negative laparotomies among this group, F. Carter Nance went on to systematically challenge the standard of care. This effort constitutes one of the major forces for change of the surgical dogma of mandatory laparotomy for all abdominal stab wounds. It is the first major study to show conclusively that delayed laparotomy for perforated viscous was not significantly detrimental and posed less of a risk than unnecessary laparotomy. The circumstances surrounding this initiative constitute a powerful and heretofore unknown chapter in the history of surgical innovation.

Prevalence of war vıctıms ın Madına Hospıtal Mogadıshu Somalıa

“…Trauma constitutes a challenge for the surgeons, and the outcomes depend on multiple factors including initial care, characteristics of the wounds, and surgical management. [1][2][3] A gunshot wound (GSW) targetting a solid organ such as heart, lung, liver, etc or a component of nervous system may cause devastating effects on human body which mostly end up withserious clinical results. [4][5][6] Socioeconomic characteristics and differences have great influence on the management of trauma.…”