348 SURGERY 



because it was offering the only possible chance of life, forlorn as the 

 prospect was, the mortality of the disease was zero. The mortality of 

 the operation both for acute and chronic appendicitis was also zero. 

 Such cases as the two in which death occurred will always happen, and 

 will always prevent the absence of mortality in the disease. In other 

 words, if the two fatal cases are eliminated on the ground that 

 surgery is powerless to save when complications such as empyema 

 and abscess of the lung exist, the mortality in the medical and oper- 

 ative treatment of this disease in 117 consecutive cases was zero. 

 The two deaths which make the mortality of the operation in all cases 

 about 2 %, which in itself is insignificant when the nature of the 

 disease is considered, deserve special consideration. 



Richardson, of Boston, reports 574 appendectomies in the interval, 

 with no deaths. Mayo has had 1668 cases in the interval, with two 

 deaths, one from pneumonia secondary to an intercurrent attack 

 of grip, and the other to surgical kidney following the use of catheter 

 in an enlarged prostate. 



Acute intestinal obstruction is a condition in former years almost 

 universally fatal, while to-day surgery has afforded relief in this dis- 

 ease. Thus Wiggins gives a mortality of 67.2 % for laparotomy. Ex- 

 cluding cases in which either the operation was abandoned, the bowel 

 incised, and an artificial opening made, resection attempted, or an 

 anastomosis effected, there are 45 cases, in which 24 resulted fatally, 

 or a mortality of 53.4 %. Counting only the operations that have been 

 performed since 1889, and throwing out those cases in which the 

 operation was not completed, we have a total of 18 cases, of which 

 14 were successful, and 4 unsuccessful, giving a mortality of only 

 32.2 %. This Wiggin believes to be a fair estimate of the risk to-day 

 of laparotomy performed in a young infant for the relief of this con- 

 dition, if performed within the first 48 hours of the onset. This gives 

 a chance of success represented by 78%, which, according to this 

 author, would speedily rise to 90 %, as the patients come more fre- 

 quently to operation during the first 24 hours. 



Cancer of the bowel is a uniformly fatal disease. The recent advances 

 in surgery have been the means of saving some of these patients. 

 Mikulicz and Korte have each reported 12 cases of operations in 

 which 9 of these cases had no return after four years, which is equal 

 to 37 % of permanent cures. Dennis operated upon a patient with 

 cancer of the cecum, resecting six or seven inches of the bowel, and 

 subsequently making an anastomosis with Murphy's button. The 

 patient is now perfectly well after a lapse of many years since the 

 operation. 



Laparotomy was performed by Dr. Wilson, in 1831, for the relief 

 of intussusception. The patient was a negro slave, and had suffered 

 from intestinal obstruction for 17 days. The abdomen was opened, 



