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


longed. The mortality of such an opera
tion Is very small.
BY a freak OF nature or disease the
stomach sometimes is narrowed in the
middle. forming what Is called an hour
glass stomach" In such a case we open
the abdomen, make an opening into the
two parts of the stomach and unite the
two so that We re-establish the single cav
fty OF the stomach. The mortality of the
operation is very slight, s per cent. Again.
sometimes the stomach becomes unduIy
dilated, thus interfering seriously with its
function. A number OF surgeons in such
cases have simply folded over the wall of
the stomach upon itself and have sewed II
together, taking plat or tuck" in the
stomach wall and have restored 1t to its
normal capacity and function.
One of the most important advances has
been made in the treatment OF gan stones
The bile in the gall bladder is in a state OF
quiescence, which Is favorable to a de-
posit of crystals from the bile. These
crystals become agglutinated together into
larger or smaller solid masses called gall
stones. Sometimes the number of these
sometimes they accumulate in enormous
numbers. several hundreds having been
reported In number of instances Where
they are small they can escape through
the duct OF the gall bladder into the bow
el and create no disturbance. but where
they are large so that they cannot make
their escape they not uncommonly are
causes not only OF serious discomfort and
prolonged Ill health, but often of death.
Nowadays one of the safest operations of
surgery. is to open the abdomen and the
gall bladder and remove this menace to
life. and the great majority of such pa
tents recover without any untoward
symptoms Even large assesses Of the
liver, and, what is still more extraordi-
nary. large tumors of the liver, are nov
removed successfully. A year ago all 'of
the reported cases we're collected which
had been operated from 1888 to 1898. rs in
number. The termination in two cases
was unknown. but of the other "A. So re-
covered and IL died, mortality of only
1i.9 per cent.
The surgery of the intestines by itself
Is subject which could well occupy the
entire space allowed to this article I can
only in very superficial way outline what
has been done. Hernia or rupture is a
condition In which through an opening in
the abdominal wall a loop of the bowel
escapes. II 1t can be replaced and kept
within the abdomen by suitable truss
this was the best we could do till within
the last ten or fifteen years. The safety
and the painlessness of modern surgery
which have resulted from the introduction
Of anaesthesia and antisepsis are such
that now no person suffering from such a
hernia, unless for some special personal
reason. should be allowed to rely upon
truss, which is always a more or less
treacherous means of retaining the hernia
We operate on all such cases now with
impunity. Coley has recently reported a
series ofa639 cases. all OF which recovered
with the exception of one patient. Even
in children if a truss worn for a reason
able time, year or so, does not cure the
rupture. operation affords an admirable
prospect of cure.
Every now and then a band forms inside
the abdomen, stretching like a string from
one place to another. If loop of bowel
slips under such a band 1t can be easily
understood that total arrest of the intesti-
nal contents ensues, condition incompat-
ible with life. There are other causes for
such intestinal obstruction" which are
too technical to be described in detail. bu.
this may be taken as a type of all. 1t is
impossible. of course, TO tell before OPEN
ing the abdomen precisely the cause of the
obstruction. but the fact is readily deter
mined in most cases. If we open the alb
domen promptly, we can cut such a band
or remove the other causes of obstruction
in the majority of cases, and if the opera
ton has not been too long delayed. the
prospect of entire recovery Is good The
mortality which has followed such opera
lions has been considerable. and by that
I mean, say, over 90 per cent; but very
large number of the fatal cases have been
lost because the operation has been de-
layed. In fact, it may be stated very pos
itively that the mere opening of the abdo-
men to find out precisely the nature of
any disease or injury is attended with but
little danger. If further surgical interfer-
ence is required. the danger will be in
creased proportionately to the extent and
gravity of such interference. But lex
ploratory operations as we call them, are
now undertaken constantly with almost
uniform success.
Even in cancer of the bowel. we can pro-
long life if We cannot save 1t. Cancer of
the bowel sooner or later produces 'ob-
struction" and so destroys life, but in such