350 SURGERY 



year with a mortality of about 10% to 15%. Thus 50,000 to 75,000 

 patients perish annually from this disease. Osier states that a third 

 of the deaths in typhoid occur as a result of perforation and "Taylor 

 thus estimates that 25,000 deaths occur yearly from this accident. 

 On a basis of a possible 30 % recovery by operative interference he 

 further concludes that 7500 persons perish in the United States 

 each year who might be saved." The mortality of perforation in 

 typhoid is estimated by Murchison at 90 % to 95 %, and Osier says 

 that "he could not recall a single patient in his experience that had 

 recovered after perforation had occurred." Harte has shown that the 

 mortality has steadily decreased as earlier operations were per- 

 formed and technic improved; thus in 277 cases in successive inter- 

 vals the mortality was as follows : 



1884 to 1889, 10 cases; mortality 90.0 % 



1890 to 1893, 16 " " 87.5 % 



1894 to 1898, 110 " 74.5% 



1899 to 1902, 141 " 66.6% 



Duodenal idcer has been operated upon with great success and is 

 a signal illustration of what modern surgery has accomplished. Mayo 

 operated upon 56 patients, in which 6 of the operations were for the 

 relief of acute condition, with 3 deaths, or a mortality of 50 % ; and 50 

 operations for the relief of chronic condition, with 1 death, or a 

 mortality of 2 %. This operation marks an important epoch in the 

 history of surgery. When the nature of the lesion is considered, the 

 record is a most brilliant one. The difficulties of the diagnosis can 

 only be appreciated when it is considered how similar are the symp- 

 toms of duodenal ulcer with pyloric ulcer, gastric ulcer, gall-stones, 

 and other neighboring lesions. A few years ago there was no surgeon 

 who was bold enough to attempt this life-saving operation. The 

 uncertainty of the diagnosis and the frightful mortality that would 

 have ensued made this operation for the relief of duodenal ulcer 

 impossible. 



Penetrating wounds of the abdomen are treated at the present time 

 by an exploratory laparotomy, the value of which operation is 

 evident by statistics reported by Postemski in 1891, in which he 

 demonstrated that 60 % to 70 % of 645 cases of penetrating wounds 

 of the abdomen terminated fatally, while the mortality was 100 % 

 when the abdominal viscera were injured. In a later series of pene- 

 trating abdominal wounds there were 36 uncomplicated cases, in 

 which the patients were treated by exploratory laparotomies; all 

 recovered, and 22 cases of penetrating wounds of the abdomen 

 associated with intra-abdominal injury, in which 12 patients re- 

 covered. 



Rupture of the intestine affords another striking illustration of the 

 progress of surgery. Siegel has collected 532 cases in patients treated 

 without operation and the mortality was 55.2%. In 376 cases in 



