RECENT PROGRESS IN SURGERY.

New Zealand Times, Volume LI, Issue 8877, 2 January 1890, Page 7

RECENT PROGRESS IN SURGERY.

{Da. W. W. Keen, in Harper’s Magazine.) One of the practical results of a scientific study of bacteriology is seen in the recent immense improvement of our treatment of compound fractures. The statistics of com. pound fractures from a half dozen of the best hospitals of America and Europe for varying periods from twelve to twenty years before the introduction of antiseptic methods gave a mortality varying from 26 to 68 per cent., the majority of deaths being from serious complications due to blood poisoning. The 'introduction of antiseptics caused a falling off of the death rate of Billroth’s cases in Vienna to one-tenth of what it formerly was, and in the other hospitals in similar though varying proportions. Still more remarkable are the results recently reported by Dennis of New York, Of 446 compound fractures ■of all grades, from the most severe down, of which 385 belonged to the class of severe fractures, only two died, the mortality being less than one-half of one per cent. Less than two in 400 in contrast to the rate previous to the introduction of modern surgical methods of from 104 up to 272 in 400 ! At present bis list of cases extends to about 900 without a single death from blood-poisoning. Nothing can add force to such a statement. The two regions of the body in which the most marvellous advance has been made are the abdomen and the bead. Twenty-five years ago, to open the cavity of the abdomen and explore the peritoneum (a thin membrance which lines the entire cavity and co vers all it’s contents) was a step from which every prudent surgeon shrank. If it were opened by accident, there was nothing left for us but to do the best we could, and usually the best meant, in the absence of antiseptic methods, to look on until the patient died, helpless to do aught except administer a few anodynes until death came to his relief. Daring the war of the rebellion there were sixty-four cases of wounds of the stomach, and only one recovered, Otis estimated the mortality at 99 per cent. In over 650 cases of wounds of the intestines there are recorded in the literature of the war only five cases of recovery from wounds of the small ictestine, and fifty-nine from wounds of the large Intestine. A gun-shot wound in the abdomen was looked upon as almost necessarily fatal. Surgeons did not dare to open the abdomen, either to search for the ball, to close a fatal perforation of the bowels, or to check hemorrhage. America can rightly boast of playing the chief role in effecting-the change that has taken place. The elder Gross long since led the way by his experiments on dogs, but we owe onr present boldness and success chiefly to the experiments of Parkes, Bull, and Senn, all Americans, who have first shown in animals that it was safe and right, with antiseptic methods, to interfere actively for the health and hearing of bur patients. While it is true that a small rear-guard in tbe surgical army would fold their hands and give opium until the patient died, there is scarcely a man abreast with modern ideas who In such a case would not open tbe abdomen, tie bleeding vessels, sew up a rupture or wound of the stomach or bowels, remove a lacerated kidney, and in general repair any damage done. Of course, large numbers •of such patients, either from immediate hemorrhage or from the severity of the wound inflicted, must always die. The possibilities -of modern surgery are well shown in a case reported by Senn, in which eleven perforations of the bowel were sewed up, and another ease of Hamilton’s in which there was so -extraordinary a number as thirteen wounds of the intestines, besides wounds of the omentum and the mesentery, and yet both of these patients made uninterrupted recoveries ! In a recent table by Morton of nineteen cases of etab wounds {all, of course, by dirty knives, and one even by a ragged splinter of •dirty wood) with hemorrhage and protrusion of the bowels, twelve recovered and but seven died, and even of 110 gunshot wounds -of the intestines ita which the abdomen was -opened, thirty-six lives were saved. If this be the. admirable showing in wounds attended by infection from dirty knives) from tbe dirt on the clothing, and from the ground on which wounded persona would fall, it is no wonder that, with clean hands and instruments, surgeons have dared not only to open the abdominal cavity to verify a probable diagnosis, or to perform an operation, but go still further and to open the abdomen to make a.diagnosis,