DEVELOPMENT IN NINETEENTH CENTURY 333 



19 died; 8 cases of actinomycosis, in which the patients recovered; 

 96 . operations for pulmonary abscess, with 80% of recoveries; 122 

 cases of pulmonary gangrene, with 66% of recoveries; 57 operations 

 on bronchiectasis, with 60 % of recoveries, but only half permanently 

 cured; 79 cases of hydatid cysts of the lung, with about 90% of 

 recoveries. In some 400 cases of pneumotomy collected from various 

 sources by Murphy there have been about 300 recoveries, or about 

 75 %. This is a most remarkable result in a department of surgery 

 that has developed within a few years, and includes a class of cases 

 that were formerly practically hopeless. Much credit is due to 

 Murphy for his work as a pioneer in thoracic surgery. Perhaps one 

 of the most interesting operations in connection with pulmonary 

 surgery refers to tuberculosis of the lungs. In reference to excision 

 of tuberculous foci, Whitacre has shown that in nearly 98% the 

 operation is "impossible and irrational." In only 2% of the cases 

 can surgery afford relief, and in these cases the foci are located in the 

 apices of the lung. It is thus evident that there is little to be expected 

 in the future as regards pulmonary surgery as it refers to tubercu- 

 losis, since careful investigation has demonstrated the fact that, as 

 a rule, the tuberculous foci are not accessible to the surgeon. Before 

 dismissing this subject the nitrogen compression method intro- 

 duced by Murphy deserves recognition. The object of this method is 

 to compress the diseased lung by gas, thereby restraining its move- 

 ment to cause a mechanical obliteration of the cavity and the limita- 

 tion of the already existing focus, to favor fibrosis, thereby closing 

 in the avenues of dissemination to afford rest to the affected part in 

 the same manner as a splint to a fractured bone. In certain judi- 

 ciously selected cases this method is applicable. 



In October, 1842, Sayre made a free incision in the chest in a case 

 of empyema, and the patient made a good recovery. Forty-eight 

 years ago Sayre raised the inquiry, "In the empyema of a tubercu- 

 lous patient from the rupture of an abscess into the pleura, should 

 we not be justified in tapping as soon as discovered?" In 1850, Dr. 

 Henry Bowditch suggested and practiced paracentesis thoracis. 

 Wyman, unaware of Bowditch 's operation, performed the same 

 operation. For a long time in this country, as well as in Europe, 

 paracentesis thoracis was condemned; but at last the operation has 

 advanced to the stage of full acceptance by all surgeons. It is almost 

 impossible to estimate the number of lives saved by this operation, 

 but the number is very great, and this operation forms an enduring 

 monument to the fame of American surgery. 



Surgery of the stomach has claimed attention only for the past 

 quarter of a century, for previous to that time it was practically 

 unknown. The unsatisfactory state of the surgery of the stomach 

 previous to 1875 is best illustrated by a reference to statistics. It has 



