DEVELOPMENT IN NINETEENTH CENTURY 337 



given rise to fatal hemorrhage. Mayo reports five cases of acute 

 perforation and hemorrhage with three deaths. 



Cancer of the stomach was a uniformly fatal disease. Under med- 

 ical treatment no patient ever recovered. Surgery has entered 

 this domain, and already the beneficent results are beginning to 

 be felt. It must be remembered that this invariably fatal disease 

 reaches, according to Haberlin, 40 % of all the cases of cancer that 

 invade the human body. Here is the most important and serious 

 problem with which surgery has been confronted. Mayo assigns 

 three reasons why surgery has never until recently interested it- 

 self in this fatal disease: (1) a belief that cure cannot be accom- 

 plished; (2) that the mortality of radical operations is almost pro- 

 hibitory; (3) that the diagnosis cannot be made until the case is 

 hopeless. In regard to the first reason, Mayo cites the fact that 

 McDonald found 43 cases of cancer of the stomach, in which a per- 

 manent cure was effected by operation. Murphy collected 189 

 cases, in which the operation was performed by several operators, 

 with 5 % permanent cures in cases of over three years' standing. 

 In some of these cures the patients were operated upon more than 

 two years, and hence would, by law of average, survive to bring 

 the percentage up to 8 %. Beside these recoveries, Kronlein has 

 proved by his statistics that human life is prolonged 14 months 

 over the unoperated cases. These facts are in striking contrast to 

 the uniformly 100 % mortality under medical treatment. The second 

 reason why surgery has never generally entered the operative field 

 for the relief of gastric cancer was due to the high mortality of 

 60 % which Billroth published. This mortality has been happily re- 

 duced to 10 % by improvement in technic and by early operation. 

 If the operation is performed before adhesions have formed, and 

 by men thoroughly trained in this field of operative work, the mor- 

 tality will soon be even less than 10 %. Mayo has had 41 cases of 

 excision of the stomach, with a mortality of 17 %. Out of the total 

 number, 13 were performed by an improved method, with only 1 

 death, or 6 %, while in the last 11 cases of excision of the stomach 

 there was not a death, or the mortality zero. The mortality has 

 been reduced in Mayo's last series of 11 cases to zero, from 60 %, 

 as reported by Billroth. No other statistics can be adduced to show 

 so emphatically what surgery has achieved within a period of time 

 that has elapsed since the erection of this magnificent building in 

 this wonderful exposition. This one fact alone is the grandest and 

 most striking proof of the miraculous work which surgery has 

 accomplished, and to Mayo is due the credit of leading the world 

 in this new department of surgery, which may be said to be the 

 highest, the final, the most triumphant monument of the contri- 

 bution of surgery to the human race. Here, again, is another strik- 



