752 



SURGERY. 



this legislation, especially in modern times, 

 viz., that the more carefully men have studied 

 the history of such legislation and its philoso- 

 phy, the less eager have they been in its sup- 

 port ; if, indeed, they have not wholly dis- 

 carded it. The discussions of the past few 

 years, and in some instances the decisions of 

 courts, have sought a new basis for Sunday 

 legislation in the needs of society and of indi- 

 viduals, apart from religious considerations. 

 Many now deny the right of the civil law to 

 touch Sunday in any way as a religious insti- 

 tution, and admit only the right to consider it 

 as a legal holiday, on hygienic and economic 

 grounds. See Irmischer's " State and Church 

 Ordinances concerning the Christian Observ- 

 ances of Sunday " (Erlangen, 1839), and Lewis's 

 "Critical Historv of Sunday Legislation from 

 321 to 1888" (New York, 1888). 



SURGERY. While the advance in the science 

 of surgery during the past three years has been 

 great, it has not been due to the addition of 

 many new ideas, but rather to the development 

 of some already suggested and partly tested. 



Bacteriology. The study of bacteria, or the 

 germs of disease, has been pursued vigorously. 

 Many troubles belonging to the domain of sur- 

 gery are directly caused by these organisms, 

 and by their exclusion or destruction preven- 

 tion or cure is accomplished. The following 

 surgical diseases are proved to be due to mi- 

 crobes, and their peculiar forms of bacteria are 

 so well known that the diagnosis can be made 

 from them alone : The various forms of tuber- 

 culosis or scrofula, septicaemia or pyaemia, an- 

 tlirax or malignant pustule, suppurative in- 

 flammation (abscess), gonori-hoea, glanders, and 

 hydrophobia. Many other diseases are pre- 

 sumed to have the same origin, but we must 

 wait for proof positive. Cancer and syphilis 

 are among these latter. While there can be 

 little doubt that their peculiar bacteria have 

 been discovered, that fact has not yet been 

 placed beyond a question. The antiseptic 

 method is founded on the germ theory, and 

 neglect of it on the one hand, or strict observ- 

 ance on the other, will furnish ample proof of 

 the correctness of the theory. 



Anaesthetics. Many new substances have been 

 tested, but a good anaesthetic has not been added 

 to the list. Cocaine has been extensively ex- 

 perimented with, and has proved very valua- 

 ble. It has aided greatly in the study and 

 treatment of diseases of the eye and the throat. 

 It is extremely useful in small surgical opera- 

 tions and in dressings. For instance, abscesses, 

 felons, small tumors, etc., may be operated 

 upon painlessly by its aid, and irritable wounds 

 may be dressed without discomfort. When it 

 can be employed it possesses a great advantage, 

 as its effect is local and transient, and we can 

 have the intelligent co-operation of the patient. 



Antiseptics. In general, our methods of se- 

 curing an aseptic condition have not changed. 

 By aseptic is understood freedom from germs 

 of disease that cause inflammation, blood- 



poisoning, and similar conditions. It is chemi- 

 cal and microscopic cleanliness. The weak 

 solution of corrosive sublimate (^gVo) carbolic 

 acid, and heat (for the instruments and dress- 

 ings), are the chief agents employed. A new 

 substance called creoline is being tested, and 

 has shown excellent results. It is a coal-tar 

 product. The advance in this connection has 

 been a more general knowledge of its impor- 

 tance and a more universal adoption of its use. 



Abdomen. In surgery of the abdomen the 

 greatest advance in medical science has been 

 made. By the careful use of antiseptic meas- 

 ures the operation known as laparotomy, or 

 opening the abdominal cavity, is so free from 

 danger that the patient is put to scarcely any . 

 risk, and we are therefore able to treat suc- 

 cessfully and safely many diseases and acci- 

 dents that formerly would have been hopeless. 

 The past three years have added little that is 

 entirely new in this connection, but there has 

 been great improvement in operative tech- 

 nique, and consequently much better statistics 

 as to results. 



The most important operations are : 1. Gas- 

 trotomy, or opening the stomach for the re- 

 moval of foreign bodies. 2. Gastrorrhaphy, 

 or sewing wounds of the stomach- wall. 3. 

 Digital dilatation of the intestinal end of the 

 stomach, done by forcing the finger through 

 the opening to the intestine without cutting 

 (except the laparotomy). The intestine is in- 

 verted over the end of the finger, and the con- 

 striction is dilated. This is done in cases of 

 stricture due to cancer or to scar following 

 ulceration. 4. Gastro-enterostomy, or joining 

 the intestine to the side of the stomach and 

 making a communication between them, so 

 that the food shall pass through the new open- 

 ing. This is done for cancer at the lower end 

 of the stomach or at the upper end of the 

 bowel. 5. Removing intestinal obstruction, 

 which may be due to any one of several causes, 

 such as twisting or knotting of the bowel, 

 telescoping of a portion of the intestine within 

 itself, constriction due to matting together of 

 the bowels by inflammation, impaction of for- 

 eign bodies, often gall-stones, etc. 6. Resec- 

 tion or removal of a diseased portion of the 

 intestine in cases of cancer, gangrene, exten- 

 sive wound, typhoidal ulceration causing peri- 

 tonitis, etc. 7. Enterorrhaphy, or sewing of 

 wounds of intestine. 8. Entero-enterostomy, 

 or making a direct communication between 

 two portions of the intestine, so that their 

 contents shall pass through the new opening 

 and avoid the intervening diseased part of the 

 bowel. This is done in case of cancer. 9. 

 Abscesses or cystic tumors of the liver may be 

 opened and cured. The laparotomy is done, 

 and the wall of the abscess or cyst is sewed 

 to the abdominal wall, and not opened till the 

 third day. By that time firm union takes 

 place, and there can be no leakage into the 

 abdominal cavity. 10. The gall-bladder may 

 be opened (cholecystotoiny), and accumulated 



