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USE OF FOWLER'S POSITION IN SURGERY

JAMA. 1946;131(10):827. doi:10.1001/jama.1946.02870270027013.
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The use of Fowler's position was based, as is well known, on the fact that fluids run downhill. Opinions as to the value of Fowler's position in the prevention of subphrenic abscess vary from the statement of Hamilton Bailey that "Fowler's position marks the greatest advance in the practice of acute abdominal surgery since Lister's day," to the statement of Wangensteen that "Fowler's position has been superseded by frequent postoperative change of posture." Spalding1 noted that the suprahepatic spaces differ from the main cavity in respect to the special function of the diaphragmatic lymphatics in the absorption of particulate matter from the peritoneal cavity and in the pressure changes within the spaces during respiration. The diaphragmatic peritoneum is the main route for the removal of particulate matter from the peritoneal cavity. Normally a steady upward flow of intraperitoneal fluid toward and into the subphrenic spaces occurs. This upward flow

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