DEVELOPMENT IN NINETEENTH CENTURY 339 



small mortality, eliminates the possibility of cancer of the stomach 

 arising from these two important and frequent causes. 



Partial gastrectomy was twice performed by Langenbuch and 

 published by him in 1894. In both cases seven eighths of the stomach 

 was removed. In 1898 Kronlein records all his own cases of partial 

 excision of the stomach and Schlatter's case of complete excision. 

 There were in all 24 cases, with 5 deaths, or a mortality of about 

 20%. Maydl, in 1899, reports 25 cases of cancer of the stomach, 

 in which a partial gastrectomy was performed, with a mortality 

 of 16%. Of the patients who recovered from the operation, 7 had 

 recurrence very soon afterward, and the average duration of life 

 was 11.7 months. In 1898 Kocher has reported 57 cases of resec- 

 tion of the pylorus, with 5 deaths, or a mortality of 8%. In the 

 list there were 8 patients cured. Rydygier, in 1901, reported 25 

 partial gastrectomies, in which 8 patients recovered and 17 died, 

 or a mortality of 68%. Czerny, in 1899, reports 29 partial gas- 

 trectomies, with 11 deaths, or a mortality of about 40%, and the 

 average duration of life was 22 months. Morison reports 16 cases 

 of partial gastrectomy, with 7 deaths, or a mortality of about 43 %. 

 Two of Morison's patients are still living. In one 6 years have elapsed, 

 and in the other about 4 years. Mayo reports 48 cases of partial 

 gastrectomy for pyloric cancer, with a mortality of 12.5 %, and 

 in the last 19 cases there was only 1 death. 



Complete gastrectomy was first performed by Conner, of Cincin- 

 nati, in 1883. The patient died upon the operating table. Com- 

 plete gastrectomy was performed by Schlatter in 1897. The patient 

 lived 13 1 months. Complete gastrectomy was next performed by 

 Brigham in 1898. The patient recovered from the operation. Com- 

 plete gastrectomy has been performed 12 times, as reported by 

 Robson and Moynihan. Four died as result of the operation, or 

 a mortality of 33 %. These cases are too recent for a pronounced 

 opinion as to the permanency of the cure. 



Surgery of the liver forms a unique chapter in the development 

 of the science. Operations upon the gall-bladder and biliary ducts 

 afford the most striking illustration of what modern surgery has 

 achieved. Within the past 37 years this new operation has been 

 performed with most gratifying results. It is a source of great 

 national pride that this operation, destined to relieve so much in- 

 tense suffering and to save life itself, was discovered in this coun- 

 try. To Bobbs of Indianapolis is due the great honor of the dis- 

 covery of an operation which has accomplished these two bene- 

 ficent results. In 1867, 37 years ago, Bobbs performed successfully 

 the new operation of cholecystotomy and removed 50 gall-stones 

 by an incision into the gall-bladder. This event marks an epoch in 

 abdominal surgery that places this renowned Western surgeon 



