DEVELOPMENT IN NINETEENTH CENTURY 367 



a later series collected by Murphy the mortality of the operation 

 was reduced to 16 %. The recurrence of pain after the operation is ob- 

 served in about 10 % of the cases. This operation is one of the most 

 beneficent ones in surgery, as it has afforded relief from the most 

 excruciating pain and suffering. 



In 1863 Gross removed the inferior maxillary branch of the same 

 nerve. In 1871 Sands excised a piece of the brachial plexus for the 

 relief of persistent neuralgia of a traumatic origin. Gross for the first 

 time excised nearly two inches of the spinal accessory nerve. The 

 sutures of nerves, even three days after division, have been united 

 with restoration of the function of the nerve. Operation for the re- 

 lief of facial paralysis marks a new epoch in surgery of the nerves. 

 There have been 12 cases of facial paralysis reported by Faure. In 

 these cases the paralyzed facial nerve was exposed by dissection and 

 then united to the hypoglossal or the eleventh nerve, and through 

 this inosculation, motor stimulus was given to the facial, which had 

 lost its function. The results have been most satisfactory, even 

 though the face had been paralyzed from five months to three years. 



Amputation shows a steady improvement in its results during the 

 past century. In this department of surgery American surgeons have 

 not only taken the initiative in the more important amputations, 

 but they have perfected methods devised by eminent surgeons in 

 other countries throughout the entire world. The first successful 

 primary amputation at the hip-joint was performed by a Kentucky 

 surgeon named Brashear, in 1806. The amputation was repeated 

 with success by Mott, in 1824. Nathan Smith was among the first, 

 if not the first, to successfully and systematically amputate at the 

 knee-joint, in 1824, and the technic of this operation has been per- 

 fected by Markoe and Stephen Smith. The first successful ampu- 

 tation of the ankle-joint in any country was performed in 1842, by 

 Syme, in Scotland. Triple simultaneous amputations have been 

 performed successfully, also quadruple amputation. These are 

 among the curiosities of surgery, and illustrate the preservation of 

 human life in the face of the greatest danger. 



In the invention of prothetic apparatus the ingenuity of the American 

 mind has discovered a most wonderful field of operation, since in no 

 country can be found the mechanism that is displayed in the manu- 

 facture of aluminium artificial limbs. I have at present patients who 

 can walk and even run with two artificial limbs, and one who has 

 artificial hands who is employed as a pharmacist. 



Staphylorrhaphy was performed by Warren, in 1820, the same 

 year, it is just to state, that the operation was performed in France 

 by Roux, but Warren had no knowledge of Roux's method. 



Excision of the tonsil was an operation placed upon a permanent 

 and safe basis by Dr. Cox, of New York. This surgeon invented, in 



