DEVELOPMENT IN NINETEENTH CENTURY 345 



Van de Warker presented this case at a meeting of the New York 

 State Medical Association in 1883. From this time on, the operation 

 of laparotomy for the cure of tuberculosis of the peritoneum has 

 been practiced. The operation has, however, been modified from year 

 to year; but most surgeons still adhere to the simple operation at 

 first devised by our American surgeon. As regards the result of 

 laparotomy for the cure of tuberculous peritonitis, surgeons differ 

 largely in their statistics. Parker Syms shows that some claim 80 % 

 of cures, while others 24%. Marked improvement follows in 80% 

 of the cases, and the mortality of the operation is only about 3 %. 

 Syms concludes that it is safe to estimate that 30 % of the cases of 

 tuberculous peritonitis are permanently cured by laparotomy. 



In suppurative peritonitis surgery has opened up a new field 

 within the past few years. The operation of incision into the peri- 

 toneal cavity has effected cures in a class of cases that heretofore 

 were uniformly fatal. Murphy reports 7 recoveries out of 9 cases, or 

 77 % of recoveries in diffuse suppurative peritonitis following ap- 

 pendicitis, while Dennis has had 11 cases of diffuse suppurative 

 peritonitis without a death. 



The radical cure of hernia presents one of the most forcible illustra- 

 tions of the onward march of surgery. Coley reports 1003 operations 

 with a mortality of less than a fifth of 1 %, and with relapses of less 

 than a tenth of 1 %. When it is considered that nearly one person 

 in every 20, and even by some statisticians one to every eight, persons 

 is born with a rupture, and these patients must wear trusses, the 

 bane of human existence, and which are as necessary to the comfort 

 and safety of the patient as a splint is to a fractured leg, the untold 

 blessings of this one contribution of surgery to the human race be- 

 come strikingly apparent. In other words, surgery offers to the 

 thousands affected in this way a sure, perfect, and safe cure, and with 

 the complete elimination of the uncomfortable, inconvenient, often 

 painful, and sometimes dangerous instrument of barbaric times, the 

 truss. What aseptic surgery has accomplished for the human family 

 in the relief of this one distressing and common condition, no one can 

 appreciate except he who has been the recipient of this blessing 

 offered to him by the science of surgery. Until recently great ex- 

 pense was incurred and time consumed in fitting trusses. Many of these 

 patients died as a result of strangulated hernia, which formerly had 

 a mortality of over 50 %. Now the possibility of strangulated hernia 

 is eliminated and a radical cure effected with less than 1 % mortality 

 and 1 % relapse. Perhaps one of the most forcible arguments to 

 show the effect of certain improvements in the technic of surgical 

 operations is demonstrated by the use of rubber gloves. In 116 cases 

 of hernia operated upon at the Johns Hopkins Hospital prior to 

 1896, there were 28 cases of suppuration in the wounds, or 24 %, 



