DEVELOPMENT IN NINETEENTH CENTURY 371 



Rupture of the bladder has been successfully treated by modern 

 surgery. Formerly these patients nearly all died; thus Ullman's 

 statistics show only 22 recoveries in 237 cases, and in 143 intraperi- 

 toneal ruptures only two patients recovered. If the patients are oper- 

 ated upon early and with aseptic precaution, the prognosis is as 

 brilliant as it was formerly forlorn. 



Tumors of the bladder have been removed in recent years, and this 

 operation marks an important epoch in this department of surgery. 

 In benign tumors the mortality is about 10%, while in malignant 

 tumors the mortality is 25 %. These statistics are certain to improve 

 in the future. Intravesical cauterization with the operating cysto- 

 scope for small tumors of the bladder has met brilliant results; thus 

 Nitze had 119 cases without a death. 



In surgery of the kidney great progress has been made. The floating 

 kidney is successfully anchored, gunshot wounds of the kidney 

 cured, renal calculi removed, suppuration in the pelvis of the kid- 

 ney arrested, removal of the kidney itself undertaken for tuberculous 

 and other diseases, and tumors of the organ excised. These are 

 among the achievements of modern surgery, to relieve conditions 

 which were uniformly fatal in pre-anesthetic and pre-antiseptic days. 



Nephrotomy for the extraction of calculi has been performed and in 

 aseptic cases has a mortality of only 2.9%. If infection is present 

 the mortality reaches 23 %. If nephrectomies for the past ten years 

 are taken, irrespective of the disease for which the operation is per- 

 formed, surgery has obtained a great victory, since in 365 cases of 

 lumbar nephrectomies there was a mortality of 17 %, and in 165 cases 

 of abdominal nephrectomies there was a mortality of 19%. These 

 figures indicate what surgery has accomplished in cases heretofore 

 fatal. 



Nephrectomy for the relief of tuberculous kidney marks a great 

 advance in surgery of recent years. Statistics show that in 22 

 nephrectomies, 16 patients recovered, or about 70%. In another 

 group the recoveries were from 12% to 33%. 



Aneurism of the renal artery has been operated upon by Albert, 

 Harm, and Keen, and all of their patients recovered. 



Wounds of the ureters have been successfully sutured, a triumph 

 of modern surgery, and the ureter itself catheterized for diagnostic 

 purposes. 



Malignant tumors have been treated with brilliant success in recent 

 years. In fact, so much so in certain varieties that the term seems 

 almost a misnomer. In the management of malignant tumors, 

 American surgeons have displayed great ability. The early work of 

 Warren, of Boston, was among the first attempts systematically to 

 collect and study neoplasms from a clinical point of view. The writ- 

 ings of Gross upon tumors demand more than a passing notice, 



