Wounds of the abdomen, especially gunshot wounds, are among the most fatal injuries known to surgery. A small, innocent-looking, external pistol wound may cover multiple and almost inevitably fatal perforations of the abdominal viscera. The recoveries from 3717 such wounds during the late Civil War only numbered 444, and of those with escape of the intestinal contents the recoveries, says Otis, may be counted on one's fingers. The prevailing treatment as laid down in our text-books has been purely conservative, treating symptoms as they arise. The brilliant results achieved in other abdominal operations have led a few bold spirits, such as our own Sims, Gross, Otis, McGuire, and others, to advocate the opening of the abdomen and the repair of the injuries found.

In May of last year, Parkes, of Chicago, reported to the American Medical Association* a serious of systematic experiments on thirty-seven dogs, that were etherized, then shot, the abdomen opened, and the wounds of the intestines, arteries, mesentery, etc., treated by appropriate surgical methods. The results confirmed the belief awakened by earlier experiments and observations that surgery could grapple successfully with multiple and formidable wounds, by sewing them up in various ways, or even by removing a piece of the bowel and uniting the cut ends. Hard upon the heels of this important paper, and largely as its result, comes a striking improvement in practice. And remember that this is only the first fruit of a rich harvest for all future time, in all countries, in peace and in war.

November 2d, of last year, a man was brought to the Chambers Street Hospital, in New York, with a pistol-shot wound in the abdomen. Under careful antiseptic precautions, and following the indications of Parkes, the abdomen was opened

*Medical News, May 17, 1884. I shall refer readers frequently to this journal, as it is often more accessible than foreign journals, and it will refer them to the original papers.

by Dr. Bull, coil after coil of the intestines was drawn out, the bullet was found and removed, and seven wounds of the intestines were successively discovered and properly treated, and the patient made an uninterrupted recovery. A recovery, after so many wounds, any one of which would necessarily have been fatal under the old methods of treatment, shows that we have now entered upon a proper and success

ful method of treatment for such frightful accidents.†

This is but one of the remarkable achievements of late years in abdominal surgery. The spleen has been removed, part of the stomach has been cut out for cancer,‡ part of the bladder § has been dissected away, the entire gall-bladder has been removed, and several inches of the intestine have been cut out, || all with the most remarkable success. To all of these, experiments upon animals have either led the way or have taught us better methods. To recite each in detail would occupy too much time, but one illustration I must not omit, for the improvement, produced by it and other experiments, affects every abdominal operation. When I was a student, the peritoneum was avoided by knife and needle wherever possible. After the death of his fourth case of ovariotomy, Mr. (now Sir Spencer) Wells,¶ in making the post-mortem, was led to believe that the then received treatment of the peritoneum was incorrect, and that he ought to bring its surfaces in contact in order to obtain secure union.

*Medical News, Feb. 14, 1885.

Since 1885 hundreds of such wounds have been successfully treated and recovery has followed after as many as nineteen wounds of the bowels. —(W. W. K., 1905.)

Since 1885 the entire stomach has been repeatedly removed.—(W. W. K., 1905.)

§ Since then the entire bladder has been repeatedly removed.—(W. W. K., 1905.)

Much larger portions have been removed since then, even as much as eight feet eight inches, with success.-(W. W. K., 1905.)

¶ Wells, Ovarian and Uterine Tumors, 1882, p. 197.

Accordingly, instead of testing his ideas upon women, he experimented upon a few dogs, and found that his suspicions. were correct. Since then it has been accepted as a cardinal point in all abdominal operations. Following this came improvements in the ligatures used, in the method of treating the pedicle, in the use of antiseptics, etc., all more or less the result of experiments upon animals, and what are the results? Taking successive hundreds of cases, Sir Spencer Wells's percentage of mortality has decreased steadily from thirty-four per cent. to eleven per cent.

Since then, others have reduced the percentage of deaths after ovariotomy to three in the hundred; and Martin, of Berlin, has lost but 1 patient from blood-poisoning in his last 130 cases.

It can not be claimed, of course, as to all this wonderful history of abdominal surgery-and remember that in 1862, when I was a medical student, I heard ovariotomists denounced from a professor's chair as murderers!—that experiments upon animals have done the whole work. No one man, no one series of experiments has sufficed, and experiment alone would not have done it. But had such experiments not been made on animals, as to the peritoneum, the pedicle, the sutures, the ligatures, etc., we should be far behind where we now are, and still be ignorantly sacrificing human life and causing human suffering.

The first condition to success

But to return to America. ful treatment is an accurate knowledge of what any disease is-its cause and its course; then we may guide it, and in due time, it may be, cure it.

Before Dr. H. C. Wood's* accurate experiments on the effects of heat on animals the nature and effects of sunstroke were almost matters of mere conjecture. Every one had his own theory, and the treatment was equally varied. Even the heat-effects of fever itself-the commonest of all symp

* Wood, Thermic Fever or Sunstroke, Philadelphia, 1872.

toms of disease were ill understood. Wood exposed animals to temperatures of 120° to 130° F. and studied the effects. These experiments have often been alluded to as "baking animals alive." You will note that the heat was no greater than that to which laborers are frequently exposed in our hot summer-days, when working in the sun or in many industrial works. His experiments showed that the effects of sunstroke—or, as he happily termed it, thermic or heat fever, a scientific name now widely adopted-were solely due to the heat, death following from coagulation of the muscular structure of the heart, or by its effects on the brain. They explained also many of the phenomena of ordinary fever as the result of heat alone. They have established the rational and now generally adopted treatment of sunstroke by reduction of the body-temperature; and the same method is now beginning to be appreciated and employed in ordinary fever.*

The same observer, with Dr. Formad, has made important experiments on the nature of diphtheria, and when we learn, as we probably soon shall, how to deal with the microscopical forms of life which seem to be its cause, it will not be too much to hope that we may be able to cope far more successfully with a disease now desolating so many homes.†

In India alone twenty thousand human beings die annually from snake-bite,‡ and as yet no antidote has been discovered. How can we search intelligently for an antidote until we know

* Eighteen out of Wood's experiments were on the general effects of heat, as above alluded to. In six others the local effects of heat (135° to 190° F.) on the brain, and in four others the local effects (up to 140° F.) on the nerves were studied and gave most valuable results, entirely and evidently unattainable on man.

†The remarkable results in lessening the mortality from diphtheria by the use of the antitoxine discovered since this address was published are now universally known. Thousands of human lives, especially of children, are saved annually in this country alone.-(W. W. K., 1905.)

Fayrer, Thanatophidia of India, p. 32.

accurately the effects of the poison? This can not be studied. on man; we must resort to animals, or else let the holocaust go on. Accordingly, Dr. T. Lauder Brunton began such a series of experiments in London, but was stopped by the stringent antivivisection laws there in force. But Drs. Weir Mitchell and Reichert,* in this city, have recently undertaken experiments on cobra and rattlesnake venom, the cobrapoison being furnished, be it observed, by the British Government, whose own laws have prevented investigations for the benefit of its own subjects! The results are as yet only partly made known, but they have been brilliantly successful in showing that there are two poisons in such venom, each of which has been isolated and its effects studied. The first step has been taken-the poison is known. Who will raise a finger to stop progress toward the second-the antidote? † Can the sacrifice of a few scores of animals each year in such research weigh for a moment against the continuous annual sacrifice of twenty thousand human beings? ‡

The modern history of anæsthetics is also of interest. To say nothing of ether and chloroform, whose safer use Bert has investigated in France, nor of cocaïne, to which I have already alluded, let us see what experiments on animals have

* Medical News, April 28, 1883.

Since then Calmette and Noguchi have both discovered an antivenene or antidote to the venom of snakes.-(W. W. K., 1905.)

I am permitted by Rev. R. M. Luther, of this city, to state the following fact in illustration of the practical value of vivisection in snake-bite: When a missionary in Burmah, he and his brother-in-law, Rev. Mr. Vinton (two missionary vivisectionists!), made a number of experiments to discover an antidote to the poison of the "brown viper"—a snake but little less venomous than the cobra. They found a substance which is an antidote in about sixty per cent. of the cases if applied at once Thah Mway, one of their native preachers, when bitten by the brown viper, had some of this antidote with him, and by its use his life was saved when on the verge of death. This one life saved, it is estimated, has been the means of leading two thousand Karens to embrace Christianity. Was not this one life worth all the dogs used in the experiments—to make no mention of the many other lives that will be saved in all the future?