SURGERY. 



751 



the seat of the incision for the formation of an 

 artificial anus. The latter is the simpler pro- 

 cedure, and the lower segment of the bowel, 

 being closed with a ligature, is dropped back 

 into the abdomen and left to nature. 



A bullet-wound of the intestines has always 

 been considered one of the most fatal of in- 

 juries. The following account illustrates the 

 difference between the surgery of to-day and 

 that of a few years ago, when to interfere ac- 

 tively in any way with such a case would have 

 been considered hardly less than criminal. A 

 man is shot in the abdomen between tbe navel 

 and the pubes. He is not seen by the surgeon 

 until nine hours have passed, when the abdo- 

 men is found distended and painful, and a 

 wound of the intestine is distinctly made out. 

 Opening of the abdomen gives the only chance 

 of saving the patient's life, and this is done 

 with all the modern antiseptic precautions. 

 The intestines are examined, and five perfora- 

 tions of the smaller bowel and two of the mes- 

 entery are discovered. The edges of all the 

 wounds are vivified with the scissors and all 

 are sewed up with silk, rendered antiseptic by 

 soaking in a solution of phenol. The abdomi- 

 nal cavity is then thoroughly cleansed of blood 

 and fecal matter, and a drainage-tube inserted 

 into the lower end of the wound. The patient 

 died three days after. At the autopsy it was 

 found that all the wounds which b^ad been 

 sewed up were healing nicely, but one had 

 escaped observation and had caused death. 



Hernia. The operation for the radical cure 

 of hernia, or rupture, has attained considerable 

 prominence. In many cases, by a compara- 

 tively trivial operation, which consists in the 

 injection of a small quantity of an irritating 

 fluid, like the tincture of white-oak bark, into 

 the tissue over the canal through which the 

 hernia descends, an amount of irritation is ex- 

 cited just sufficient to cause an adhesive in- 

 flammation in the canal, and thus close it. In 

 this way a disease which a few years ago was 

 only curable by a severe and dangerous surgi- 

 cal operation, and which on this account was 

 simply treated with a truss, without any ex- 

 pectation of a cure, is now often radically 

 cured. For this discovery, surgery is indebt- 

 ed to Dr. Heaton, ot Boston, who practiced 

 it successfully but secretly during his lifetime. 



Haemorrhoids. The exceedingly common and 

 troublesome disease known as hsemorrhoids, or 

 piles, was formerly curable only by operations 

 which removed the tumors, such as cutting 

 them off with a knife, tying them off with a 

 ligature, or destroying them with powerful 

 caustics. This treatment also has been radi- 

 cally changed, and an equally efficient method 

 of cure by injections has been discovered, 

 which is almost painless, is devoid of danger, 

 and free from the objections generally consid- 

 ered inseparable from a surgical operation. 



Not only has the alimentary canal for its 

 entire length thus been brought within the 

 range of successful operative measures for the 



relief of incurable disease, but all the other 

 organs contained within the abdominal cavity 

 have each in their turn been reached by the 

 hand of the surgeon. 



Operations upon the LlYer. Abscess of the 

 liver was formerly very fatal, owing to the 

 unapproachable position of the pus, which, 

 though beyond the reach of the surgeon, might 

 at any moment be discharged into the abdomi- 

 nal cavity and cause death. A few years since 

 it was found that a very fine hollow needle, 

 might be plunged into the liver with compara- 

 tive safety ; that to this an air-pump might be 

 attached, and the abscess emptied of its con- 

 tents by suction. This was in itself a great 

 advance; but now, when an abscess is sus- 

 pected, the needle is boldly plunged into the 

 organ as a means of exploration. If pus is 

 found, the region over the liver is cleansed 

 with a disinfecting . solution, the needle is al- 

 lowed to remain as a guide, and an incision is 

 made through the abdominal wall into the 

 liver till the pus is reached. The cavity of the 

 abscess is next washed out with a disinfectant, 

 a large drainage-tube is inserted, and the 

 wound is covered with an antiseptic dressing. 

 This dressing is changed daily. Each time the 

 tube is cleansed and replaced, and the abscess 

 is forced in this way to close, as an abscess in 

 any other part of the body would, by a gradual 

 healing from the bottom. 



Spleneetomy. This is another of the great 

 operations of surgery which have become more 

 prominent within the past few years. Though 

 at first invariably fatal, it now numbers several 

 successful cases. The operation is seldom un- 

 dertaken except for the cure of a fatal disease 

 known as leucocythsemia, which is marked by 

 a great enlargement of the spleen, and by a 

 great increase in the number of white corpus- 

 cles found in the blood. The change in the 

 blood is supposed to depend upon the change 

 in the spleen, and it is thought that if the 

 spleen could be removed from the body the 

 patient's life might possibly be saved. The 

 operation is performed by opening the abdo- 

 men from near the end of the breast-bone to 

 the pubes. drawing out the enlarged organ, 

 which sometimes fills nearly the entire abdo- 

 men, placing a ligature around the vessels that 

 supply it with blood, and cutting it loose. Al- 

 though never but once successful in a case of 

 leucocythsBmia, it has often been done in cases 

 of other disease with a favorable result. 



Nephrotomy and tfephreetomy. The number of 

 cases in which surgeons have cut into the kid- 

 ney, or have taken out the kidney, is now very 

 considerable, while a few years ago the opera- 

 tion was a rarity. The kidney is subject to 

 many incurable diseases, and especially to the 

 formation of stone in its substance. Such a 

 stone can be reached in no way except by the 

 knife. An incision is made through the loin 

 down to the diseased organ, and it is laid open. 

 If the disease be calculus, this may be removed 

 and the kidney left in its place ; or, if the kid- 



