DEVELOPMENT IN NINETEENTH CENTURY 343 



to important structures that its removal was impossible and 4 of the 

 patients died, thus giving a mortality of 57 %, which in contrast to 

 100% mortality under medical treatment is a great advance, though 

 it is admitted that it is not what is expected, since as technic im- 

 proves, the operation will be brought perhaps nearly as low as simple 

 ovariotomy in the future. In evacuation and drainage of the pan- 

 creatic cyst there have been collected by Takaysan 17 cases with 1 

 death, a mortality of not quite 6 %. Mayo had 5 consecutive cases 

 of chronic pancreatitis with recovery in each case, and 4 cases of 

 cancer of the pancreas with 1 death, or a mortality of 25 %. Opera- 

 tions upon the pancreas afford another brilliant example of the 

 achievements of surgery within the past few years. Mayo Robson 

 and Moynihan, in 1902, reported 24 operations for the relief of chronic 

 pancreatitis with 2 deaths and complete and perfect recovery in the 

 22 remaining cases. There is no more striking example of the pro- 

 gress which surgery has made than is afforded by this record. In 

 cancer of the pancreas, which is always fatal, the operation has been 

 attended by about 50 % mortality, and in the other 50 % the patients 

 have survived a comparatively short period. This is an operation 

 in which surgery in the future will have a better showing just as soon 

 as the methods of diagnosis are improved so as to operate in the early 

 stages of the disease. Mayo has had 37 cases of pancreatic disease 

 with 2 deaths, or a mortality of about 5 %. 



Surgery of the spleen offers an illustration of the progress which 

 surgery has made during the past century. The cases of major opera- 

 tions upon the spleen are too few to make any extensive and reliable 

 statistics. The prognosis which is most marked, and which interests 

 us in connection with the subject of this address, shows improve- 

 ment each year. Thus Murphy shows that in 1890, in the operated 

 cases, the mortality was 70%. In 1897 the mortality was 37%. In 

 1899 the mortality was 26 %. These figures are unsatisfactory, except 

 to point out that in this new department of surgery great advance is 

 made each year. Fevrier grouped under four heads the surgical con- 

 ditions in the spleen that call for operative interference. They are 

 traumatism, abscess, tumors, and displacements. As these condi- 

 tions were nearly all fatal without surgical intervention, it is inter- 

 esting to inquire what surgery has accomplished in this new field. 

 Fevrier collected 56 cases of rupture of the spleen, in which splen- 

 ectomy was performed 46 times, with 23 recoveries, thus giving a 

 mortality of 50 %. There were 8 cases of stab and gunshot wounds, 

 with 3 deaths, or a mortality of 30 %. Abscesses and hydatid cysts 

 have called for operative interference, but there are no reliable 

 statistics on the results. Malarial splenomegaly was operated upon 

 117 times, with 31 deaths, or a mortality of 26%. Displacements 

 of the spleen have been operated upon by spenectomy and by splen- 



