Triumphs and Wonders of the 19th Century: The True Mirror of a Phenomenal Era / A volume of original, entertaining and instructive historic and descriptive writings, showing the many and marvellous achievements which distinguish an hundred years of material, intellectual, social and moral progress

by James P. Boyd

What has been said of gunshot wounds applies also to stab wounds of the chest and abdomen.

The Alimentary Canal.—Probably the surgery of no portion of the body, unless it be the brain, has been so much improved during the past fifteen years as that of the alimentary canal. The esophagus or gullet is now opened with impunity for both disease and injury. This organ is not only approachable through the neck but also through the back part of the chest, by resection of the ribs; and the latter operation is frequently made necessary by the lodgment of foreign bodies,—buttons, false teeth, etc.—so low down in the esophagus that they cannot be reached through the mouth or through an opening made in the neck.

The Stomach.—This organ, which was formerly a forbidden field to the surgeon, is now subjected to the most varied surgical operations, from simple opening for the purpose of removing a foreign body or establishing a fistulous tract to the resection of a portion of it or to its complete resection, as has been successfully accomplished several times within the past year or two for malignant disease. The removal of the smaller end of the stomach for cancer is now a frequent operation. During the war of the rebellion there were sixty-four cases of wounds of the stomach, and only one recovered. In over six hundred and fifty cases of wounds of the intestines there were recorded only five cases of recovery from wounds of the small and fifty-nine from wounds of the large intestine.

The Intestinal Tract.—What has been said of the stomach applies also to this portion of the alimentary canal. No surgeon can nowadays call himself such if he is incapable of removing a diseased portion of intestine, it may be only a few inches or several feet, and bringing the dividing ends of remaining intestine into such apposition that healing takes place and the function is restored. Until recently, when the means of anastomosing the intestinal canal were perfected, it was the custom of the surgeon to bring the severed ends of the intestines into the abdominal incision and suture them there, establishing in this way an artificial anus with all its accompanying discomforts. This was certainly better than allowing the patient to perish from his disease, but how infinitely preferable is the present method of bringing the healthy cut ends of the intestine into apposition and reëstablishing the calibre. It is this operation which has so much reduced the mortality of intra-abdominal injuries, gunshot wounds, stabs, etc., and has made hundreds of sufferers from intestinal cancer either well again or comfortable for years. The perfection of the operation of joining one part of the alimentary canal to another has been due largely to the ingenuity and perseverance of American surgeons, who have devoted years to experimentation and practice upon the cadaver and upon animals.

The Kidneys.—The kidney has not been behind the other organs of the body in reaping the benefits of modern surgery. The first case of removal of the kidney was done in 1869 by Simon, and was successful. It was done only after a number of dogs were operated on successfully to demonstrate that life and health are compatible with only one kidney. Since this time the removal of a kidney for disease or injury, when its fellow of the opposite side is healthy and performing its function, has been looked upon as an entirely justifiable operation. The surgery of this organ has lately so far advanced, however, that many kidneys are now treated by more curative operations. In 1880 the first operation was done for the removal of a stone from the kidney, an operation which now nearly every surgeon of much experience has performed. The operation for the fixation of a floating kidney, which is now so common, was first done in 1881. Now, since Simon’s bold experiment the lives of between two thousand and three thousand persons have been thus saved who had otherwise certainly died.

The Bladder.—For generations the bladder has been considered a legitimate field for surgery, but modern methods and technique have greatly extended the domain. One of the greatest advances in bladder surgery has been the crushing of stone and its immediate removal. Until 1825 the treatment of all stones in the bladder was their removal through an incision made in the organ. At that time Civiale first performed the operation of passing a bladed instrument into the bladder and crushing the stone, then allowing the patient to pass it subsequently at urination. The operation became quite popular with certain surgeons as early as the middle of the century. The cutting operation has, however, never been entirely put aside, and even to-day it is, in many cases, the best and only procedure. In 1878 Bigelow, of Boston, devised the method which is now universally used, of crushing the stone and washing it out at once through a silver tube. This was a great stride ahead of the old method.

One of the great difficulties in deciding upon the removal of a kidney has been the trouble of finding out whether the other kidney is doing its work, and this Kelly, of Johns Hopkins University, has done much to overcome in devising his method of examining by looking at the openings of the tubes of the kidneys where they empty into the bladder. If the kidney is performing its function the urine will be seen flowing from its tube into the bladder.

Hernia or Rupture.—Probably the treatment of no condition has received more consideration from the surgeon of the nineteenth century than that of rupture, and it was not until 1891 that an operation was devised, simultaneously by an Italian and an American surgeon, which has proved for itself all that its originators claimed. Hundreds of operative methods have been brought forward for the cure of this troublesome and dangerous condition; but, until the operations of Halstead and Bossini were brought forward, little prospect of an absolute cure could be promised a patient, and the conservative surgeon would only undertake to operate upon very troublesome cases such as could not be controlled by a truss. Now nearly every case of hernia may be looked upon as curable by an operation.

Operative Gynæcology.—The operative treatment of the disease of the female generative organs has been revolutionized in our century, and its revolution has been largely due to American surgeons. The first ovariotomy ever performed was done in Kentucky, by Dr. Ephraim McDowell, in 1809. In the fifties, Marion Sims won great renown for himself and his country by his wonderful ingenuity and boldness in this line of work. The greatest advance here, as in all departments of surgery, has been made since the introduction of antiseptic and aseptic principles. To-day there is no disease or condition which, if seen early enough, cannot be cured, or essentially relieved at the hands of an expert abdominal surgeon. Thousands of women are now saved every year by these means who formerly would have certainly died or remained hopeless invalids.

Appendicitis.—This condition must seem to the ordinary reader to be either a new disease or one much more prevalent than in days gone by, but it is not the case. The cause of this appearance is the fact that in former times the condition was not recognized in its incipiency, and the exact cause of the trouble was unknown. The condition then advanced until it was called typhlitis, peritonitis, and obstruction of the bowels, etc., all of which would to-day occur if the conditions were not recognized early and treatment immediately instituted before the inflammation and infection extended from the appendix to neighboring tissues.