DEVELOPMENT IN NINETEENTH CENTURY 349 



the intussusception was found, and it was drawn out and released, 

 and the patient made a complete recovery. 



In 1809 Physick was the first to ligate the e"peron, when an arti- 

 ficial opening had been made in the intestine on account of patho- 

 logic changes. In 1847 Gross urged the excision of a section of the 

 intestine, with suturing of the divided ends, with a view to establish 

 the continuity of the canal, but the patient refused, and in 1863 

 Kinloch, of South Carolina, accomplished this result. In 1834 

 Luzenberg laid open a strangulated hernia, found it gangrenous, 

 excised the mortified section of the intestine, stitched the serous 

 surfaces, and the patient fully recovered. This same surgeon sug- 

 gested, in 1832, exclusion of light to prevent pitting of small-pox. 

 The operation of laparotomy for the treatment of penetrating gun- 

 shot and stab wounds of the peritoneal cavity was the work of 

 American surgery. Gross, in 1843, and Sims, just before his death, 

 both suggested this method, but these surgeons never practiced this 

 method of treatment. It remained for Bull, of New York, to make 

 the practical application of the method, and to him is due the credit 

 of this great advance in surgery. It is a source of national pride that 

 laparotomy in penetrating wounds, and visceral injuries of the 

 abdomen, was conceived, developed, and perfected in America. The 

 widespreading influence of this operation is felt in abdominal surgery, 

 and much of the present advance is the result of Bull's surgery. 



Cancer of the rectum is a disease which was formerly uniformly 

 fatal. Modern surgery has, hoVever, rescued many of these unfor- 

 tunate victims from a most distressing and painful death due to 

 inanition, hemorrhage, and exhaustion. Taking the three-year limit 

 as a point when it can be fairly stated that a return is rare after an 

 operation, Kronlein collected 640 cases with a cure of 14% of over 

 three years' lapse of time from the operation. Czerny, Bergmann, 

 Kraske, and other surgeons report from 20% to 30% of permanent 

 cures, and Kocher has had as high as 50 % of permanent cures. The 

 statistics of Kocher will be even improved upon as technic is per- 

 fected and early operation performed. 



The first and only successful case of laparotomy for the relief of 

 perforation of the intestine during the progress of typhoid fever was 

 performed in this country, and to Dr. Weller Van Hook of Chicago 

 is due the credit of having first established an operation for the relief 

 of these cases, which hitherto were fatal. 



Perforation in typhoid fever has given rise to an operation for the 

 relief of fatal suppurative peritonitis. This operation is one of the 

 most signal triumphs in modern surgery. In 1884 Ley den suggested 

 and Mikulicz performed the operation. Haggard collected 295 cases 

 in which operation was done up to May 1, 1903. Haggard states that 

 500,000 cases of typhoid fever occur in this country alone every 



