The times. [volume] (Washington [D.C.]) 1897-1901, 1901-02-03

too, the limits of surgery have by no
means been reached.
Cg) SURGERY OF THE ABDOMEN
OF the abdomen and the pelvis very DIFF
ferent story can be told. These cavities
might almost be called the playground Of
the surgeon, and the remarkable results
which have been obtained warrant us in
believing that even greater results are in
store for us in the future.
In the earlier part of this article l spoke
OF the advantages of the study of the
pathological anatomy or the diseased con-
dition Of individual organs. Perhaps no
better illustration of the value of this can
be given than In the study of appendicitis.
This operation has been one of the contri-
buttons to the surgery of the world In
which America has been foremost. While
there were one or two earlier papers, Will
lard Parker. of New York. In 1867 first
made the profession listen to him when he
urged that assesses appearing above the
right groin should be operated on and the
patients life saved. But 1t was not until
Fftz. of Boston, In 1888 published his pa
per. in which he pointed out. as a result of
study OF series of post-mortem exam
nations OF persons dying from such an
abscess above the right groin. that the APP
pendix was the seat of the trouble that
this so frequent disease was rightly I'M
derstood and rightly treated
AS a result of the facts gathered in this
paper, the treatment was perfectly clear,
not only that we ought to operate in cases
of abscess but that in the case of patients
suffering from two or more attacks and
often from even one attack of appendicitis
that the appendix should be removed to
prevent such abscess.
The mortality in cases in which such an
abscess has formed is. perhaps, quite 20
per cent or 2 per cent. whereas. il pa
tents are operated on "in the interval"
that Is to say, when the abdominal cavity
is free from pus, the mortality is scarcely
more than per cent or 3 per cent, and
may be even less than that.
Surgeons are often asked whether appen-
dicitis is not fad and whether our grand
fathers ever had appendicitis, etc. As
matter of fact. in my early professional
days. appendicitis was well known. But
1t was called localized peritonitis,' or To-
calized '.abscess;" but While the disease
was very frequent. its relation to the ap-
pendix was not recognized until from his
study of its pathology an American point
ed it out. Even now European surgeons.
with a few exceptions. are not alive to the
need for operation in such cases.
There is little doubt that the great prev
alence of grippe during the last few years
has increased the number of cases Of ap-
pendicitis. both of them being catarrhal
conditions of the lining membrane of the
same continuous tract of the lungs the
mouth. the stomach and the intestines.
One of the most fatal accidents that can
befall patient is to have an ulcer of the
stomach perforate so that the contents of
the stomach escape into the general alb
dominal cavity. Until 1855 no one ventured
to operate in such a case. In an inaugural
dissertation by Tinker. of Philadelphia
zS2 cases of such perforating ulcers of the
stomach were reported, of which 1913 re-
covered. a mortality of 1881 per cent. In
not a few of them, if prompt instead of
late surgical help had been invoked, even
a still better result would have been re-
ported. II no operation had been done the
mortality would have been 100 per
cent.
In cancer of the stomach itself we are
able, as rule, to make a positive dag
nosis only when perceptible tumor is
found. By that time so many adhesions
have formed and the Infection has in
volved the neighboring glands to such an
extent that it is impossible to remove the
tumor. but the statistics even here are not
without encOura cement, at least for COM
fort If not for life. In many cases the tu-
NOR has been removed and the stomach
and intestine Joined together by various
devices. and the mortality, which is neces-
sarily great. has been reduced by Czerny
Even the entire stomach has been re-
moved in several cases and recovery has
followed in about one-half. Most of these
patients, however, have died from a return
of the disease.
When. as a result of swallowing caustic
I've or other similar substances, the gullet
(the oesophagus) becomes contracted to
such an extent that no food can be swai-
lowed we now establish an opening into
the stomach through which a tube is in.
serted at meal time and the patient has his
breakfast. dinner. and supper poured into
his stomach through the tube. If the
structure of the oesophagus is from ma
lignant disease. of course this only pro-
longs life by preventing u horrible death
by starvation. but in cases in which It is
nOn-malignant life is indefinitely pro-
a. yros N nutraua tn accant ou,, Iorror ,ha