DEVELOPMENT IN NINETEENTH CENTURY 335 



position without disturbing its mobility or function. In eight cases 

 reported, including four by Bier, seven patients were cured and one 

 improved. This is a new operation of modern surgery calculated to 

 relieve a distressing condition for which medical treatment was of 

 no avail. 



Dilation of the stomach has been operated upon with a view of relief 

 of distressing symptoms to which it gives rise. The operation is 

 called gastroplication and consists in reducing the capacity of the 

 dilated stomach by tucking in folds of the stomach wall. It is a most 

 satisfactory operation, provided there is no pyloric obstruction 

 present. The operation is safe and effects a permanent cure. 



Exploration of the stomach has been resorted to successfully by 

 Dennis to relieve hysteric vomiting. Hysteria, as is well known, 

 gives rise to persistent and uncontrollable vomiting, and in one case 

 in which no relief could be obtained by medical means, a laparo- 

 tomy was performed, the stomach drawn put and then returned into 

 the peritoneal cavity. The psychic effect or the mechanical stretch- 

 ing of the stomach itself resulted in cure. 



Gastrotomy for the removal of foreign bodies in the stomach has 

 been resorted to successfully during the past 25 years. The foreign 

 bodies enter the stomach as a result of accident or are purposely 

 swallowed as a livelihood, or on account of insanity. In preantiseptic 

 days, Murphy reports 19 cases of gastrotomy, with 15 recoveries and 

 4 deaths, or a mortality of 21 %. In antiseptic days, 71 patients were 

 operated upon, with a mortality of 9 %. This includes early and late 

 cases and at the present time if the cases are seen early the mortality 

 is very low. Thus, modern surgery has developed to such a state of 

 perfection that the stomach can be opened and foreign bodies re- 

 moved with almost a certainty of success. 



Gastrostomy is an operation employed for the relief of stricture of 

 the esophagus, either benign or malignant, or for certain lesions 

 connected with the stomach itself. It has for its prime object the 

 prevention of death by starvation. 



In 1883 Le Fort compiled some statistics in 105 cases of gastro- 

 stomy, in which he showed that the mortality from 100% was re- 

 duced to 74.2%. In 1885 Zisas collected 162 cases of gastrostomy, 

 with 113, or 69.7 % of mortality. In 1886 Knis had 169 cases of gas- 

 trostomy, with a mortality of 66.6 %. In 1887 Heydenreich collected 

 33 new cases of gastrostomies, with 19 deaths, or 57 % mortality. 

 Since 1887 Guerin has collected 121 cases of gastrostomy, with 43 

 deaths, or 35.5 % mortality. Mayo has performed gastrostomy with a 

 much smaller death-rate than any mentioned. There can be no more 

 beautiful illustration of the development of surgery than is demon- 

 strated in this one operation, since formerly it was attended by a 

 mortality of 100%, while to-day, after about a quarter of a century 



