336 SURGERY 



the operation has by evolution achieved a record that is most re- 

 markable, since the latest figures show the mortality to be less than 



30%. 



Mikulicz recently performed 10 gastrostomies for the relief of 

 non-malignant strictures of the esophagus, with only 7 deaths, or a 

 mortality of about 20 %. 



Dennis operated upon a case of impermeable stricture of the 

 esophagus, caused by ulceration and cicatricial contraction by ty- 

 phoid ulcers. This case is one of the two in which typhoid ulcers 

 have been found. The patient is now living, seven years after the 

 gastrostomy. His weight previous to the operation was less than 

 100 pounds, and to-day it is 184 pounds. He had not taken a mouth- 

 ful of food except through the fistulous opening for several years, 

 and is perfectly well nourished. 



Gastric ulcer has become a recent indication for operation. It 

 has been performed 184 times as collected by Mayo Robson up to 

 1900. These 184 cases do not include those for perforation or hem- 

 orrhage; 157 patients recovered, and 31 died, thus giving a mor- 

 tality of 16.4 %. In 1901 statistics show that in 25 % of cases of 

 gastric ulcer the patients died under medical treatment, and only 

 5 % under surgical treatment, according to the latest statistics. 

 Gastric ulcer is a pathologic condition which formerly was con- 

 sidered exclusively from a medical point of view. To-day this dis- 

 ease in the stage of complication has been relegated to the domain 

 of surgery. It has been during the past quarter of a century that 

 progress has been made in the management of the serious compli- 

 cations, such as hemorrhage and perforation, of this intractable 

 disease. Under medical treatment, the mortality of gastric ulcer 

 in hemorrhage or perforation was nearly 100 %, while under sur- 

 gical treatment this frightful mortality has been reduced by the 

 Mayos to 5 % in the benign ulcers and 18 % in the malignant ulcers. 

 The advance that surgery has made in this disease has been in the 

 study of the mechanics of the stomach, rather than the chemis- 

 try. Medical treatment based on chemistry was of little avail. 

 Gastric ulcer of the stomach affords a striking illustration of the 

 progress of surgery within the past decade. In addition to the re- 

 duction of the mortality from nearly 100 % by medical treatment 

 to about 5 % by surgical treatment in the acute cases of hemor- 

 rhage and perforation, to 23 % in the chronic cases with malignancy, 

 there has been eliminated the danger of cancer engrafted upon an 

 ulcer which at the beginning was benign. 



Gastric hemorrhage is a condition which has been relieved through 

 the mediation of modern surgery. These hemorrhages from the 

 stomach are peculiar in that the smallest ulcers, which can scarcely 

 be recognized by the naked eye on post-mortem appearances, have 



