346 SURGERY 



while in 226 cases of the same operation with rubber gloves upon 

 the surgeons' hands there were 4 cases of suppuration, or a fraction 

 over 1 %. 



In umbilical hernia Mayo has devised an operation that offers 

 relief to those patients who heretofore followed a life of constant 

 suffering and danger. Mayo first performed his overlapping operation 

 in 1895, and in a series of 50 cases there was no mortality and no 

 relapses except in which the relapse was only a partial stretching. 



The operation for the relief of acute appendicitis is clearly traced 

 to the work of American surgeons. In 1843, Willard Parker, and 

 later Gurdon Buck, did much to explain the nature of these iliac 

 inflammations, and Sands cleared the way for the perfected operation 

 of McBurney, which aims to prevent these dangerous peritoneal 

 inflammations, and to prepare the wound for aseptic healing. Sands 

 also first operated with success after perforation had taken place 

 and general peritonitis w r as present. To McBurney is due great 

 credit for the perfection of this operation, which is now recognized 

 throughout the world as the best, safest, and most scientific way of 

 managing these varieties of suppuration hitherto so fatal. The 

 operation of removing the appendix vermiformis during the quiescent 

 period between relapsing attacks was suggested by Sir Frederick 

 Treves, of London, although the appendix was successfully removed 

 in this country by Dennis in 1887. In this case the appendix was 

 diseased, owing to adhesions to an ovarian tumor. 



The surgery of the appendix is most interesting with a view to a 

 study of what surgery of the past century has accomplished. There 

 is probably no surgical disease about which so much has been written 

 as appendicitis. The subject is trite and threadbare in many respects. 

 There is little to be learned in regard to the etiology, symptomatology, 

 and diagnosis of the disease. The operative technic can be but little 

 improved upon in its present state of perfection. The mortality 

 under proper antiseptic and aseptic conditions is so low that in the 

 nature of the disease it will never in all probability be brought much 

 lower. The percentage in these days of aseptic surgery in this ab- 

 dominal operation is less than the percentage in the simple amputa- 

 tion of the ringer in the preantiseptic days. It would seem that 

 surgery had reached its climax in regard to mortality in operation 

 for the relief of appendicitis, yet the time will never come when 

 there will be no death-rate. Complications are certain to arise that are 

 beyond the control of the surgeon. Crural thrombosis, intestinal 

 obstruction, acetonemia, embolism, shock of operation, intercurrent 

 affections, all afford examples to show that some mortality must 

 always exist. If a fraction of a per cent can be gained in the reduction 

 of the mortality, it is an advance in the right direction. The ex- 

 perience of surgeons during the past few years has demonstrated new 



