DEVELOPMENT IN NINETEENTH CENTURY 341 



reported, in 1902, 4 cholecystotomies, with 2 deaths, or 50% mor- 

 tality, and in 1903, 5 additional cases, with 3 deaths, or 60 % 

 mortality. It is thus evident that cholecystotomy is attended by 

 a high mortality when the operation is performed for cancer. It 

 must be remembered, however, that the mortality is 100% under 

 medical treatment. The mortality of 100% under medical treat- 

 ment will never be improved, while the 50% or 60% mortality 

 under surgical treatment will be reduced as diagnosis and technic 

 improve, and early operation is performed. Kehr, in 1896, reported 

 209 cholecystotomies upon 174 patients. In the simple chole- 

 cystotomies, the mortality was only 1 %. In the complicated cases 

 the mortality was 58.8 %. In a later series Kehr reported 202 cho- 

 lecystotomies Math 32 deaths, or a mortality of 16 %. The higher 

 mortality in this series is accounted for by the greater severity of 

 the cases which earlier did not submit to operation. In conserva- 

 tive cholocystotomies Kehr had 68 operations with three deaths, 

 or a mortality of 4.4%. In 1902 Kehr again reported his statis- 

 tics, which consisted of 720 operations for gall-stones, with a mor- 

 tality of 15 %. In the simple cases of cholecystotomy the mortal- 

 ity was 2.1%, and in the complicated cases, including cancer, the 

 mortality was 97%. Greig Smith reported 11 simple cholecysto- 

 tomies with no mortality, and one complicated case with death, 

 or 12 cases in total, with a mortality of 8.33 %. Lawson Tait re- 

 ported 55 cases of cholecystotomy with three deaths, or a mor- 

 tality of 5.4 %. 



Thus in cholecystotomy alone is an operation that has shown a 

 steady improvement in its statistics. In no other operation is a greater 

 contrast between the medical and surgical treatment of a disease 

 at the present day. 



Cholecysiectomy is an operation which consists in excising the gall- 

 bladder in a manner somewhat similar to the removal of the appen- 

 dix. Ferrier reported, in 1901, 16 cases with 4 deaths, or a mortality 

 of 25 %. Courvoisier reported 47 cases with 12 deaths, or a mortality 

 of 25 %. Martig, in 1894, collected 87 cases of removal of the gall- 

 stones with 15 deaths, or a mortality of 17.2%. Mayo Robson re- 

 ports 28 cases with 4 deaths, or a mortality of 14.2 %. Mayo, in 1902, 

 had 31 cases with 3 deaths, or a mortality of 9.6 %, and in 1903 had 

 70 cases with 3 deaths, or a mortality of 4.3 %, and up to the present 

 time he states that he has had 204 cases with a mortality of 4%. 

 Kehr reported 21 cases with 1 death, and a mortality of 5 %, and 

 later another list with the mortality of 3 %. Thus in cholecystectomy 

 is another operation that has shown steady improvement in its 

 statistics. This operation affords another illustration of the marked 

 contrast between the medical and the surgical treatment, for in the 



