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of Hamilton's in which there was so extraordinary a number as thirteen wounds of the intestines, besides wounds of the omentum and the mesentery, and yet both of these patients made uninterrupted recoveries! In a recent table by Morton of 19 cases of stab wounds (all, of course, by dirty knives, and one even by a ragged splinter of dirty wood) with hæmorrhage and protrusion of the bowels, 12 recovered and but 7 died, and even of 110 gunshot wounds of the intestines in which the abdomen was opened, 36 lives were saved.
If this be the admirable showing in wounds attended by infection from dirty knives, from the dirt on the clothing, and from the ground on which wounded persons would fall, it is no wonder that, with clean hands and instruments, surgeons have dared not only to open the abdominal cavity to verify a probable diagnosis, or to perform an operation, but to go still farther and to open the abdomen to make a diagnosis. It is often impossible to make an absolute diagnosis from external examination alone, not only on account of the inherent difficulty from the close grouping of so many organs within the abdominal cavity, but even in cases apparently not obscure we may be in error. At the present day it is not only considered justifiable and not unreasonably dangerous to open the abdomen for the removal of tumors that are clearly fit for operation, but in a very large number of doubtful cases it is the duty of the surgeon to make a small opening directly into the abdominal cavity, and to insert two fingers in order to determine by touch what the nature of the tumor or other disorder is, and, having determined its nature, to proceed to its removal, if the facts warrant it; if not, the abdominal wound is closed, and the patient almost always recovers from the incision. So slight is the danger from such "exploratory operations," as they are rightly called, that it is not to be weighed for a moment against the advantages derived from positive knowledge.
The most remarkable statistics recently published are those of Mr. Tait, and a mere statement of his percentages will go far to convince the non-medical public of the correctness of the above statements, startling as they appear to one unfamiliar with modern surgical progress. Mr. Tait has completed a second series of 1000 cases in which he opened the abdomen for the removal of tumors, for abscesses, for exploration, etc. In his first 1000 cases only 92 patients died (9.2 per cent.), and in the second 1000 only 53 died (5.3 per cent.). In ovariotomy alone the percentage fell from 8.1 in the first 1000 to 3.3 in the second. Only a quarter of a century ago the mortality of ovariotomy was but little, if at all, under 50 per cent. I have heard the first obstetrician of his day, when I was a student, say that any man who dared to open the abdomen to remove an ovarian tumor should be indicted for murder! Sir Spencer Wells, even with the far larger mortality of his earlier days, added 20,000 years to human life as the net result of 1000 ovariotomies! He has lived to see even his great success far surpassed by the best surgeons; and all over the civilized world, even the average surgeon is followed by benedictions for recovery. in ninety out of every hundred of such operations.
Surgeons have even successfully removed tumors that after removal weighed more than all the rest of the patient's body. But we go further than the mere removal of abdominal tumors. In a considerable number of cases of cancer of the stomach the diseased part of the stomach itself has been removed, and the patient has made a good recovery. Of course, however, the disease often returns, and is eventually fatal. In cases of cancer and obstruction of the bowels, or of extensive wounds, even three or four feet of the bowel have been completely removed, the ends sewed together, and the patients have recovered. In other cases, instead of removing the diseased parts, openings have been made in the bowel, one above and one below
the disease, the two openings being then placed opposite each other and united by their margins, and the continuity of the bowel has been thus successfully re-established, the intestinal contents following the "short-cut" thus provided. This very new operation has only been done in man in a very small number of cases, but the mortality in dogs is only 7.69 per cent., and as our procedure will improve by experience, it will probably be even less in the human subject.
When the spleen is enlarged, it also has been successfully removed in 90 cases, followed by 51 recoveries. Occasionally the spleen, instead of being fixed in its place, is loose or "floating" in the abdominal cavity. In 10 cases these have been removed, with 8 recoveries.
Another remarkable achievement of abdominal surgery is in operations on the gall-bladder. Occasionally a number of gall-stones* are formed in the gall-bladder or its duct and produce dangerous and often fatal disease. In 78 cases now recorded the gall-bladder has been opened, the gallstones removed, and 64 of the patients have recovered. Not satisfied even with this, in 22 cases the entire gall-bladder itself has been removed to prevent any recurrence of the disease, and 19 of the patients have demonstrated the fact that they could get along quite as well without such an apparently useless appendage as with it; in fact, in their cases at least, a good deal better. In 100 operations, therefore, on the gall-bladder the mortality has only been 17 per cent. Mr. Tait himself has performed 54 such operations, and has lost but 2 patients, a mortality of less than 4 per cent. Considerable portions of the liver have also been removed with success, one of the operations being necessitated as a direct result of the use of corsets, in the opinion of the operator.
*These stones arise from the bile, and are often as large as marbles. Sometimes only one exists, but sometimes there are even hundreds of them.
Operations on the kidney are among the most remarkable triumphs of abdominal surgery. In 1869 Simon, of Heidelberg, had a patient suffering from various troubles with the duct of the kidney. After many experiments on dogs to determine whether it was possible for them to live with one kidney, after the sudden removal of its fellow, he ventured to remove this otherwise healthy organ, and the patient lived for eight years in perfect health. Since then very many such operations have been done, and the latest results are as follows: In 375 cases of entire removal of one kidney in consequence of its being hopelessly diseased, 197 lives were saved. In 95 cases of abscesses and other diseases, in which the kidney was cut down upon in the loin or abdomen, and the kidney opened and drained, 76 lives were saved. In 102 cases in which stones were removed from the kidney, 76 lives were saved, and in 25 cases in which the kidney (as in the case of the spleen above referred to) was "floating" around loose in the abdomen, and a source of discomfort and pain, it had been cut down upon, sewed fast in its proper place, and all but one got well, and even this one death was from injudicious surgery. A total of 597 operations on the kidney shows, therefore, recovery and in general complete restoration to health in 373. Had the patients been let alone (as they would have been prior to Simon's experiments in 1869), almost every one would have died, and that too after weeks, or years it might be, of horrible pain and loathsome. disease.
But the most extraordinary achievement of modern surgery remains to be told. In the "Lancet" for December 20, 1884, Dr. Bennett and Mr. Godlee published an article which startled the surgical world. Dr. Bennett had diagnosticated not only the existence, but the exact locality of a tumor in the brain, of which not the least visible evidence existed on the exterior of the skull, and asked Mr. Godlee to attempt its removal. The head was opened and the brain exposed.
No tumor was seen, but so certain were they of the diagnosis that Mr. Godlee boldly cut open the healthy brain and discovered a tumor the size of a walnut and removed it. After doing well for three weeks, inflammation set in, and the patient died on the twenty-sixth day. But, like the failure of the first Atlantic cable, it pointed the way to success, and now there have been 20 tumors removed from the brain, of which 17 have been removed from the cerebrum with 13 recoveries, and 3 from the more dangerous region of the cerebellum, all of which proved fatal. Until this recent innovation every case of tumor of the brain was absolutely hopeless. The size of the tumors successfully removed has added to the astonishment with which surgeons view the fact of their ability to remove them at all. Tumors measuring as much as three and four inches in diameter and weighing from a quarter to over a third of a pound have been removed and the patients have recovered.
Another disease formerly almost invariably fatal is abscess of the brain. In the majority of cases this comes as a result of long-standing disease of the ear, which after a while, involves the bone and finally the brain. So long ago as 1879 Dr. Macewen, of Glasgow, diagnosticated an abscess in the brain, and wished to operate upon it. The parents declined the operation, and the patient died. After death Macewen operated precisely as he would have done during life, found the abscess and evacuated the pus, thus showing how he could probably have saved the child's life. Since then the cases treated in such a manner amount to scores, and more than half of them have recovered without a bad symptom.
In injuries of the skull involving the brain, the larger arteries are sometimes wounded, and the blood that is poured out between the skull and the brain produces such pressure as to be speedily fatal. In some cases, even without any wound, the larger arteries are ruptured by a blow or fall, and