342 SURGERY 



former treatment no cure can be effected, while in the latter the 

 percentage is very large. 



Choledochotomy is an operation which consists of opening one of the 

 biliary ducts and is a more formidable operation than opening the 

 gall-bladder. Ferrier, in 1893, reported 20 cases, with a mortality 

 of 25 %. Kehr, in 1896, reported 84 cases, with 31 deaths, or a mor- 

 tality of 37.8 %. In a later series his mortality was reduced to 12.5 %. 

 Mayo states that in 130 cases of benign series he had a mortality of 

 7.75%. Mayo Robson reported, in 1901, 37 cases, with 4 deaths, or 

 a mortality of 10%, and since 1901 51 cases, with 1 death, or 1.9%, 

 and later a consecutive series of 52 choledochotomies with no deaths. 

 Choledochotomy is one of the most difficult operations in surgery, 

 and the advance which surgery has made is shown by a reference to 

 the great mortality of these cases for which this operation is per- 

 formed, since under medical treatment suffering was not relieved 

 and death often supervened, whereas under surgical treatment the 

 mortality has been reduced even to 1.9%. 



Cholecystenterotomy is a modern operation on the biliary passages, 

 and consists in establishing a new communication between the 

 gall-bladder and the intestine. Murphy reported 23 cases by use of 

 sutures, with 8 deaths, or a mortality of 34 %; 21 cases by Murphy's 

 button, with no mortality, and 2 cases for malignant disease, with 

 2 deaths, or a mortality of 100 %. 



Cholecystduodenotomy has been performed by Murphy's button in 

 67 non-malignant cases with only 3 deaths, or a mortality of about 

 4%, and in 12 malignant cases by Murphy, 10 died, or a mortality 

 of 83.3 %. Mayo performed Cholecystduodenotomy on 5 patients 

 for chronic pancreatitis with no death, and 4 times for cancer with 

 1 death, or a mortality of 25 %. 



Pancreatic disease affords a field for the display of what modern 

 surgery has achieved that astonishes the scientific world. Korte has 

 computed the mortality of the operation for the cure of pancreatic 

 cysts, and shows that Gussenbaur was the first to operate for the 

 relief of this fatal disease. Previous to Gussenbaur's operation, 

 the mortality under medical treatment was 100 %. In the 84 cases 

 collected by Korte, five patients died as the immediate result of the 

 operation, thus giving the low mortality of not quite 0.6 %. This 

 statement seems incredible and affords the most startlingly unpre- 

 cedented illustration which has no parallel in any other science. 

 This operation has attracted great attention in the scientific world 

 and its brilliant and unique record has been heralded throughout 

 Christendom. Still more striking is another report of 15 cases of 

 complete excision of the cyst of the pancreas with 13 recoveries, or 

 a mortality of about 13 %, and in 7 additional cases the extirpation 

 has been only partial, since some of the cyst-wall was so adherent 



