748 



SURGERY. 



In conclusion, it may be said that this method 

 will probably never be generally adopted, nor 

 is there any reason why it should not be re- 

 garded as one of the curiosities of medicine. 



Transfusion. Under this name, we formerly 

 understood the introduction of fresh blood 

 (obtained either directly or indirectly from 

 the veins of another) into the system of a pa- 

 tient that had been reduced to a desperate con- 

 dition by excessive haemorrhage. Its meaning 

 has now been extended so as to include the 

 intra-venous injection of other fluids, especial- 

 ly of fresh milk. Of late the same favorable 

 results have been claimed for weak solutions 

 of salt, the idea being that in this way the 

 lost fluid is restored to the vessels and the 

 heart's action is sustained. A small quantity 

 of the solution (having a strength of 1 to 150) 

 is injected slowly into the principal vein of 

 the forearm, through a glass tube; from five 

 to fifteen hundred centigrammes are sufficient. 

 Many cases have been reported in which life 

 has been saved by this simple process. 



Bladder, Operations on. The old operation of 

 supra-pubic lithotomy, or removal of stone by 

 an incision made through the abdomen into 

 the bladder, has been highly recommended by 

 French surgeons, and bids fair to be generally 

 resorted to in certain cases to which lithotrity 

 and the ordinary lithotomy operation are in- 

 applicable, as in aged patients and young girls, 

 and where the bladder is very sensitive; also 

 where the stone is very large, or is encysted 

 so inclosed in the mucous membrane that it 

 can not be extracted through a small opening. 



Sir Henry Thompson has called attention to 

 certain cases in which it is justifiable to open 

 the bladder and explore its interior, in order 

 to discover, and remove if possible, the cause 

 of distressing symptoms. Hemorrhage from 

 the organ, without a clear cause, is the prin- 

 cipal indication for the operation. In simple 

 cases the mere opening of the bladder, and the 

 establishing of free drainage, are sufficient to 

 effect a cure. If a tumor is present (unless it 

 be an extensive cancer), it is removed. 



Laryngotomy. Formerly removal of the en- 

 tire larynx was regarded as an impossible 

 operation. It has now been accomplished up- 

 ward of sixty times, generally for cancer, with 

 a mortality of 60 per cent. Although the oper- 

 ation is condemned by American surgeons, who 

 prefer the palliative measure, tracheotomy, or 

 opening of the windpipe, laryngotomy is con- 

 sidered as justifiable where the patient is not 

 above fifty years of age and enjoys good gen- 

 eral health, and where the disease is limited to 

 the organ removed. 



Thyroidectomy. Removal of goitre, or swell- 

 ing of the thyroid gland, has been performed 

 about four hundred times, and frequently with 

 success. It is mostly practiced by German sur- 

 geons. The chief indication for the operation 

 is extreme dyspnoea, due to pressure of the tu- 

 mor on the windpipe. So experienced a sur- 

 geon as Bardeleben says that, out of many 



hundred examples of this affection, he has only 

 seen a score that seemed to call for this radi- 

 cal measure. The difficulties encountered in 

 removing a growth so richly supplied with 

 blood-vessels, and in so close proximity to im- 

 portant structures in the neck, make the opera- 

 tion one of the most serious in surgery. 



Extirpation of the Spleen. The past year has 

 witnessed several operations of this nature. 

 Crede has recently collected all of the record- 

 ed cases, to the number of thirty, of which 

 nine were successful. It is noticeable that only 

 one leucffimic patient has ever recovered from 

 this operation a formidable argument against 

 resort to such an extreme measure for the cure 

 of leucocythsemia. The same writer calls at- 

 tention to the interesting fact that, after re- 

 moval of the spleen, the white corpuscles of 

 the blood become at first greatly increased in 

 number, but afterward return to their normal 

 condition; and he infers from this that the 

 spleen, doubtless, transforms the white corpus- 

 cles into red. He suggests that the thyroid 

 gland probably discharges the duties of the 

 spleen after the ablation of the latter organ. 

 It should not be forgotten that in severe in- 

 juries to the abdomen where the normal spleen 

 protrudes from the wound, its removal is at- 

 tended with far less risk than when the organ 

 is extirpated for disease. 



Resection of the Lung. This bold procedure 

 was actually carried out successfully by an 

 Italian surgeon. The patient was an old wom- 

 an, with a large phthisical cavity in the right 

 lung. The entire upper lobe was taken away 

 through an opening made in the anterior wall 

 of the chest, two ribs being removed in order 

 to give sufficient room. There was no trouble 

 with the breathing during and after the opera- 

 tion, and the patient lived for several days. 

 This account is introduced more for the pur- 

 pose of giving the reader some idea of the 

 boldness of modern surgery, than with the 

 view of applauding a desperate measure. 



Resection of the Pylorus. This operation was 

 referred to in a former volume. About forty 

 cases are now on record in which a portion of 

 the stomach has been removed for cancer, and 

 as many more in which the abdomen was 

 opened ; but it was necessary to abandon the 

 attempt, on account of unlooked-for complica- 

 tions. The appalling mortality of over 90 per 

 cent, has deterred American surgeons from 

 undertaking the operation. Billroth, who has 

 been particularly identified with the measure, 

 does not regard it with as much favor as for- 

 merly. So difficult is it to determine before- 

 hand just what cases are suitable for operation, 

 that he finds only one out of sixty patients 

 suffering with cancer of the stomach in whom 

 he ventures to perform it. 



Digital Divulsion of the Pylorns. This is an in- 

 genious measure, recently introduced by Prof. 

 Loreta, of Bologna, for the cure of cases in 

 which an ulcer at the outlet of the stomach 

 has so contracted the orifice that the food can 





