332 SURGERY 



the heart would normally be, that organ was freely grasped through 

 intervening diaphragm. There was an entire absence of heart action. 

 Placing the right hand over the precordial region, externally, he now 

 plainly palpated the heart as it lay between his hands, and began 

 rhythmic compression, using both hands at a rate of about sixty a 

 minute. After about thirty seconds a slight beat was felt by the left 

 hand. The heart now began to beat slowly, gradually increasing in 

 strength and rapidity until at the end of a minute the beats regis- 

 tered about eighty, and respiration began to be partially reestab- 

 lished. About two minutes after this, respiration was normal, pulse 

 80, and shock being apparently recovered from, the anesthetic was 

 changed to ether, and the operation finished in about thirty minutes, 

 with recovery of patient." 



For the relief of pericardial adhesions, a new operation has been 

 devised by Peterson and Simon. This operation is analogous to 

 Estlander's operation for pleuritic adhesions. The operation consisted 

 in a resection of a portion of several ribs, and in some cases a part of 

 the sternum. Murphy cites the fact that of 38 cases of stab-wound 

 of the heart, 90 % were penetrating, and only 19 % were immediately 

 fatal, thus leaving 81 % of the cases amenable to surgical treatment. 

 This new operation, the outgrowth of modern surgery, will afford a 

 new field for this science to save human life in a class of cases here- 

 tofore fatal. 



In addition to the surgery of the heart, there are many other opera- 

 tions of the chest that deserve mention as indicating the pro- 

 gress which surgery has made within the past century. In surgery of 

 the chest the wounds of the pleura and lung have been successfully 

 treated since the introduction of antiseptic surgery. Abscesses of the 

 mediastinum, caries, and necrosis of the ribs and sternum, tumors 

 of the chest-wall, actinomycosis, and other infective processes, re- 

 moval of fluid from the pleural and pericardial cavities, are among 

 the recognized operations of the day. 



Wounds of the heart during the past century, and especially during 

 the past 10 years, have been treated surgically with remarkable 

 success. Stewart reports that Roberts, in 1881, suggested the pro- 

 priety of suturing these wounds. Tillmann believed in the hopelessness 

 of this procedure, yet in 1897, Rehn published the first successful 

 case of cardiorrhaphy in man. Stewart likewise has operated with 

 success, and he has collected 60 cases with the brilliant result of 

 38.3 % of recoveries. 



In the surgery of the Im^g advance has been made within the last 

 quarter of a century. The diseases of the lung which have become 

 amenable to surgical treatment are tumors, tuberculosis, abscess, 

 gangrene, hydatid cysts, actinomycosis, and bronchiectasis. Murphy 

 has collected 47 cases of tuberculosis; 26 patients were improved and 



