DEVELOPMENT IN NINETEENTH CENTURY 351 



which operation was done, the mortality was 51 %. This does not 

 seem so great a triumph for surgery as might be expected, yet if 

 these statistics are carefully gone over it becomes evident that the 

 mortality is due to a cause which in the future can be obviated. 

 Aggressive surgery can do much in these serious cases if operation 

 is not postponed too late, as shown by Senn, and as for example: 



Cases operated first 4 hours, mortality 15.2 % 



" " 5 to 8 hours, mortality 44.4 % 



9 to 12 " " 63.6% 



later 70.7% 



Rupture of the stomach has been cured by laparotomy; thus 

 Petry found 44.5 % of recoveries in 18 patients operated upon within 

 24 hours after the injury, and 25% of recoveries in 24 patients 

 operated upon more than 24 hours after rupture. 



Gangrene of the intestine forms an indication for resection of a seg- 

 ment of the intestine and offers a prospect of recovery in a class of 

 cases otherwise fatal. Thus Roswell Park resected 8 ft. 9 in. of bowel 

 for the relief of a gangrenous condition and the patient recovered. 

 The same surgeon assembled from surgical literature 16 additional 

 cases in which over 200 cm. of bowel" were resected with 14 recoveries, 

 or 80 % of cures, or a mortality of 17 %. A singular fact recorded 

 by Park is that when from 100 cm. to 200 cm. was removed, the 

 mortality was 30 %. 



Subphrenic abscess is another serious condition which terminates, 

 as a rule, fatally; but in which surgical intervention has been fol- 

 lowed in a certain percentage of cases, thus Maydl records 74 opera- 

 tions with 39 recoveries, and 35 deaths, or a mortality of 47.2 %. 



Ovariotomy forms a new milestone in the march of surgery. In all 

 probability the most important surgical event that has ever hap- 

 pened in this country and the world, was the conception, birth, and 

 development of ovariotomy. To Dr. Ephraim McDowell of Dan- 

 ville, Ky., belongs this great honor. In 1809 he was the first one to 

 perform this unique and original operation which has made his name 

 immortal. The far-reaching influences that have proceeded from 

 this step are incalculable. Dr. McDowell is to-day recognized as the 

 originator of not only one of the greatest operations in surgery, but 

 also as the author of an operation, the influence of which has made it 

 possible to develop the present wide field of abdominal surgery. 

 McDowell's work will live in the memory of thousands in this land, 

 and will be honored the world over as long as time endures. In 1821 

 Dr. Nathan Smith performed ovariotomy in Connecticut, and with- 

 out the knowledge that it had been performed by McDowell; Smith 

 dropped the pedicle into the abdominal cavity and thus made a great 

 advance in McDowell's operation. In 1823 Allan G. Smith also 

 performed an ovariotomy in Kentucky, and David L. Rodgers in 

 New York in 1829. All these cases of ovariotomy were successful. 



