DEVELOPMENT IN NINETEENTH CENTURY 329 



of each prominent operation, and then to show what result has been 

 accomplished since its introduction. In this way an idea can be 

 obtained of the value of each great operation, and the advance which 

 each has made toward saving life. A review of this kind naturally 

 is devoid of popular interest, but at the same time these important 

 factors are worthy of record and study. In this way only can the 

 true progress of surgery be measured, since the operations performed 

 prior to the past century are insignificant and unimportant. It is 

 only by a study of the operations of the past century that the mag- 

 nitude and usefulness of modern surgery become impressive and 

 apparent. If what has been accomplished during the nineteenth 

 century be taken from the sum total of knowledge of surgery, 

 nothing will be left to entitle surgery to a recognition among the 

 sciences. The work accomplished with the century, however, as a 

 study entitles surgery to a prominent place among the sciences. 



The important operations will be considered in the following order: 

 Those belonging to the cranial, thoracic, and abdominal cavities, 

 and finally those of a miscellaneous nature. 



External to the cranial cavity, the operation for the cure of race- 

 mose arterial angioma, aneurisms of the scalp, sinus pericranii, 

 dermoid cysts, sarcoma, and carcinoma, are among the recent opera- 

 tions that indicate the extension of surgery in this department. The 

 improvement in the technic of the operation for compound fractures 

 of the skull, fractures of the base, encephalocele, and within the 

 cranial cavity, the operations for the relief of hydrocephalus, com- 

 pression of the brain, ligation of the middle meningeal artery, are 

 worthy of mention, as denoting the progress which surgery has made 

 within recent years. Abscess of the brain has been recently treated 

 with success. Delvoie cites 21 cases of trephining for acute cortical 

 abscess, with 15 recoveries, and 33 operations for chronic deep-seated 

 abscess, with 19 recoveries. In cerebral abscesses secondary to 

 otitis media, Ropke reports 142 cases, 59 of which recovered, and 

 40% were permanently cured. Frontal abscesses of nasal origin 

 have been operated upon with brilliant success. This life-saving 

 operation which has resulted in cure, until recently hopeless, indi- 

 cates the progress of surgery. In thrombosis of the intracranial 

 sinuses with operation, results have been obtained. Thus Macewen 

 had only 8 fatal cases in 28 cases. For the cure of infective throm- 

 bosis, all of which die without surgical intervention, this is a remark- 

 able showing for this new operation. 



Intracranial tension has very recently become a new indication 

 for operative interference. This operation affords relief in a class of 

 cases that heretofore were fatal. This operation is a contribution of 

 modern surgery, and is another milestone which marks the progress 

 of the science of surgery. The recent advances in clinical medicine 



