334 SURGERY 



been shown that of 28 operations attempted upon the stomach, 

 there were 28 deaths, or a mortality of 100 %. From 1875 to 1884, 

 improvement took place in that 163 operations were performed with 

 133 deaths, or nearly 82 % mortality. 



The reduction of the mortality of 100 % to 82 % was a gain in the 

 right direction; but it left much to be desired. The rapid strides 

 which scientific surgery has made in the operations upon the stomach 

 forcibly illustrate what can be expected in the future in this depart- 

 ment of surgery. There are at present about 12 recognized opera- 

 tions upon the stomach, and in 7 of these there is practically no 

 mortality, while in the remaining 5 it has been reduced to about 25 %. 

 Keen predicts as technic improves the mortality in the most diffi- 

 cult operations ought not to be higher than 10 %. 



I should predict, from an examination of late statistics, that even 

 less than 10 % has already been accomplished, and in the future the 

 mortality will be still lower. Mayo has shown that in an investiga- 

 tion of over 900 operations upon the organs contained in the upper 

 abdominal zone there existed a relationship between gall-bladder 

 and ducts, the duodenum, the pancreas, and stomach. In other 

 words, that the continuity of tissue like the mucous membrane 

 makes the disease of one organ a menace to the others. Mayo also 

 believes that the duodenum, on account of its situation, acts as a 

 buffer, and is involved secondarily in about an equal proportion of 

 cases from gall-bladder disease and gastric ulcer, in the same way 

 Mayo pointed out that diseases of the pancreas were secondary to 

 gall-stone diseases. 



Cardiospasm, in which there is difficulty in deglutition from a 

 spasm of the muscles of the cardiac end of the stomach, forms a new 

 indication for operation. It is comparable to pyloric obstruction, 

 and the operation for the relief of cardiospasm is similar to that of 

 pyloric stenosis. Mikulicz and others have performed this opera- 

 tion with brilliant results and effected a cure that could be obtained 

 only by surgery. 



Pyloric stenosis is another and new indication for operative inter- 

 ference to relieve the distressing symptoms so often disguised under 

 the term of dyspepsia. In 1901 Roswell Park collected upward of 40 

 cases in which the patients were cured by surgery. 



Gastroptosis is a prolapse of the stomach due to relaxation of the 

 ligaments which support the organ. This condition gives rise to 

 ordinary signs of dyspepsia accompained by acute pain and later 

 emaciation. Modern surgery in its evolution has devised an opera- 

 tion for the relief of this distressing and painful condition. The 

 stomach is elevated and held in its anatomic position by shortening 

 of the gastrohepatic and phrenic ligaments of the stomach. Thus the 

 normal ligaments are shortened and the stomach held in its proper 



