340 SURGERY 



upon a pedestal that commands homage and respect from the civil- 

 ized world. Bobbs's first cholecystotomy was soon followed, in 1868, 

 by a second operation by another American surgeon, J. Marion 

 Sims, who removed 60 gall-stones from the gall-bladder. To Tait, 

 however, who was at the time of his death the greatest authority 

 on hepatic surgery, belongs the great credit of perfecting the technic 

 of this operation. Excision of biliary calculi by incision into the 

 umbilical vein was performed by Dr. John C. Warren of Boston 

 within the century. Such in brief is the history of the operation, 

 the development of which from its crude to its almost perfect technic, 

 forms a remarkable chapter in surgery. 



Gall-stones with intestinal obstruction are attended under med- 

 ical treatment, with a mortality of nearly 100%, while surgery 

 has brought relief in a certain proportion of cases and with every 

 encouraging prospect of a very great improvement. Courvoisier 

 reports 125 cases, with a mortality of 44%; Schiiller had 82 cases, 

 with a mortality of 56%; Eve 28 cases, with a mortality of 40%; 

 and Bannard 8 cases, with a mortality of 57 %. 



Cholecystotomy is an operation which consists in opening the 

 gall-bladder for the relief of various conditions. Cholecystitis or 

 inflammation of the gall-bladder is a disease that was formerly 

 treated by medical means, with little or no prospect of cure if septic 

 infection was present. In those cases in which gangrene or pus or 

 rupture has occurred, medical treatment is attended by death; 

 but surgical treatment may effect a cure in a large percentage of 

 cases. Cholecystotomy is one of the most gratifying operations 

 in surgery, because it relieves suffering, effects a permanent cure, 

 and is attended by the exceedingly low mortality of less than 3 %. 

 The statistics of the operation of cholecystotomy varies greatly, 

 owing to the special conditions for which the operation is performed. 

 Mayo Robson states that when the operation is performed for sim- 

 ple disease, as gall-stones, when malignant disease and jaundice 

 with infective cholangitis are absent, the mortality in 281 cases 

 was only 1.06 %. If now the complicated cases are included, such 

 as phlegmonous cholecystitis, gangrene of gall-bladder, infective 

 cholangitis with or without gall-stones, the mortaliy is only 2.7 %. 

 If further the malignant cases be collected, in which cholecysto- 

 tomy has been resorted to in the presence of cancer of the pan- 

 creas or bile-ducts, the mortality of the operation itself in 22 cases 

 was only 5.8%. As regards the recurrences, the statistics will be 

 mentioned latter. Mayo reports, in 1902, 227 cases of cholecysto- 

 tomy for various simple conditions, chiefly for gall-stones, with 6 

 deaths, or a mortality of 2.6%. The same operator reported, in 

 1903, 352 cholecystotomies for simple conditions, with 8 deaths, 

 or a mortality of 2.27 %. For malignant disease the same surgeon 



