SURGERY. 



753 



gall-stones removed. Peritonitis is treated 

 surgically. Laparotomy is performed, and the 

 cause removed. A frequent cause of perito- 

 nitis, and one that is often cured, is perfora- 

 tion of the vermiform appendix, due to ulcera- 

 tion or gangrene. The diseased appendix is 

 removed, then the abdominal cavity is disin- 

 fected by washing, carefully dried, and closed. 

 This is also done in peritonitis from other 

 causes. Ha?morrhage from an abdominal or- 

 gan, following disease or accident, may be 

 arrested. Laparotomy is performed, and the 

 bleeding vessel ligated. Tumors of many of 

 the organs may be removed, especially those 

 of the uterus and ovaries. The uterus and 

 ovaries may be removed when diseased. All 

 the above-named operations are done fre- 

 quently and with good results. An important 

 innovation in this connection is the device 

 known as Semi's absorbable plates, used for 

 the various sewing operations on the intes- 

 tines. They consist of flat rings of bone, from 

 which the mineral elements have been removed 

 by acid and are used as follows: To each 

 circular plate four threads are attached and 

 passed through needles. One plate is then 

 placed in each end of the intestine that is to 

 be united, and the needles passed through the 

 intestine from the interior about a quarter of 

 an inch from the margin. The corresponding 

 threads are then tied tightly together, bringing 

 the outer layer of the intestines firmly in con- 

 tact, pressed together between the two rings 

 of bone. Nature causes adhesion to take place 

 in a few hours, which gradually becomes a 

 complete union. The bone plates are softened, 

 and, after a few days, are discharged through 

 the bowels. This is a complete and rapid 

 method of connecting the parts. The old 

 method of sewing the ends together required 

 from one to two and a half hours, while this 

 process can be completed in abont half an hour. 



Hernia is cured by operation, with little or 

 no risk. The proportion of permanent cures 

 has greatly improved, owing to better methods 

 and to the increased experience of individual 

 surgeons. 



But little has been added to our possibili- 

 ties in surgery of the kidneys and bladder. 

 An ingenious instrument has been perfected, 

 known as the cystoscope, which enables us to 

 explore the interior of the bladder visually 

 and renders our means of diagnosis much 

 more perfect and extended. It consists of a 

 tube, at the end of which is a small but pow- 

 erful electric lamp which illuminates the blad- 

 der. The tube is passed into the bladder, as a 

 catheter would be, and the current turned on, 

 the bladder having first been filled with wa- 

 ter. The entire interior of the bladder is 

 seen, part at a time, in a small mirror at the 

 end of the tube. A telescope in the tube 

 magnifies the image to about the actual size. 

 Tumors, ulcerations, encysted stones, etc., can 

 be seen, which could not be detected other- 

 wise without opening the bladder. By watch- 

 YOL. xxvni. i8 A 



ing the urine enter the bladder, we can tell 

 which kidney is the source of haemorrhage or 

 of pus. 



Enlargement of the prostate gland, obstruct- 

 ing the flow of urine from the bladder, has 

 of late been successfully treated by operation. 

 Operations on the kidney are not new, but the 

 results are much better than formerly. The 

 removal of a stone from the kidney has be- 

 come a comparatively common operation, and 

 is quite free from danger. Floating or movable 

 kidneys are replaced and retained by sutures ; 

 and in case of destruction of a kidney by dis- 

 ease, as diffuse abscess or cystic degeneration or 

 tubercular disease, the unhealthy organ may be 

 removed, the other kidney carrying on the work. 



The Brain and the Nervous System. The brain 

 has become much more a field for operative 

 surgery, and mortality from its diseases and 

 injuries has been diminished considerably, 

 many cases being saved by an operation which 

 formerly would have been lost. A most im- 

 portant advance in this direction is our enlarged 

 and improved knowledge of what is known as 

 cerebral localization, i. e., determining, by 

 paralysis and other nervous phenomena in a 

 given part of the body, exactly what part of 

 the brain or spinal cord is affected, and to 

 about what extent. So exact has our knowl- 

 edge become that abscesses, tumors, inflamma- 

 tory changes, bullets, haemorrhage, old fract- 

 ures causing pressure on the brain, etc., can be 

 successfully located and operated upon. Many 

 parts of the brain may be cut into quite freely 

 without producing ill effects. This has been 

 shown by experiments on animals and by 

 some remarkable cases of head-injury. By 

 removing diseased conditions, many cases of 

 epilepsy, constant headache, neuralgia, and 

 paralysis have been cured. The interior of 

 the skull is reached by removing a button- 

 shaped piece of bone with a trephine. Tumors 

 have been removed from the spinal cord, and 

 some cases have been successfully treated 

 where the bone has been pressed upon the 

 nerve substance by fracture of the spinal col- 

 umn. It has been known for a long time 

 that a nerve accidentally divided may be sewed 

 together and regain its full power. This prac- 

 tice was at first confined to recent cases, but 

 lately cases of local paralysis of long standing 

 are cured by this operation. 



Respiratory Organs. The most important ad- 

 dition to the treatment of diseases of the larynx 

 is known as intubation of the larynx (O'Dwyer). 

 It is especially useful in cases of obstruction of 

 the larynx due to diphtheria and membranous 

 croup. It is now universally employed, and 

 has greatly reduced the death-rate. It is a 

 substitute for the operation of tracheotomy, 

 consisting in placing a very perfectly shaped 

 and sized tube in the larynx, through the natu- 

 ral opening. This forms a metallic lining to 

 the larynx, through which the patient breathes. 

 The tube can be retained several days, and is 

 not removed until the disease has subsided. 



