Also, while there have apparently been a few excellent results, yet Edebohl's suggestive treatment of nephritis, by decapsulation of the kidney, does not seem to have sustained the endorsement of the pathologist or the operating surgeon.
In the changes and successes in diagnosis and treatment, during the past decade or two, great progress is to be observed in comparing one period with another — one method with another. That of which so much was expected too often proves valueless, while that which seemed of lesser importance proving of great value, on trial.
In civil life the advances made in surgery of the head, face, neck and thorax, the medi astinal space, the heart, of the lungs and pleura, indicate the calm, steady progress that is now to be observed in all larger hospitals.
Especially does this apply to stab wounds of the heart, to the drainage of abscesses within the pericardium, also in operations upon the lungs and treatment of the pleura for various surgical conditions.
The recent acquisition of the pathology of the thyroid and parathyroids has resulted in the understanding of goitre, far ahead of any thing that has ever taken place in the past. The function of these glands, the classifica tion of symptoms and of the pathological con dition, has enabled the surgeon to do his work in a more scientific manner and the results much more favorable. The better understand ing of the term exophthalmic goitre is exceed ingly pleasing in every respect.
In abdominal surgery it is no longer neces sary to make use of theories, for practical facts arc such that, for instance, in surgery of the liver, gall-bladder, pancreas, gall ducts, the pancreatic ducts, there is now a fixed line of treatment, and not to be deviated from very much. This is becoming more and more posi tive, and also applies equally well to the ap pendix.
The surgical treatment of gastric and duodenal ulcer is one of the finest demonstra tions of surgery being made more of as an exact science than internal medicine has yet attained.
Injuries and diseases of the pancreas and spleen illustrate much of the advance made hi the field of diagnosis and treatment.
The abdominal cavity has come under such thorough observation that the right side can no longer hold its exclusive position regarding operative intervention.
There is no part of this one classification of the human body, and in which Galen was so correct, that is entirely free from possible invasion.
In the past two decades much has been added to our knowledge of intestinal surgery and methods of treatment have reached a more conclusive line of operative procedure.
In civil life no more brilliant results can be shown in any of the various departments of surgery than the treatment of multiple gun shot wounds and ruptures of the intestines and other organs within the abdominal cavity.
This applies particularly to hernia — rupture —and especially for relief of gangrene of the intestine. To the surgeon of many years prac tice, it is particularly striking to note how few cases we now come in contact with of delayed strangulated hernia, in which we have the complication of gangrene of the bowel. The prompt recognition for early operation in such cases has largely eliminated this catastrophe. Our pathological knowledge is much more clear, also the willingness of the patients to have an early operation, and not trust to mechanical supports. These cases, treated, as they often are, comfortably and palliatively by the applica tion of trusses, still continue to present an ex cellent history in the good results of operative intervention. We see a gradually increased willingness, in fact patients often seek an operation, the result being so thoroughly satis factory. All of this applies as well to children as adults.
In the treatment of conditions within the abdominal cavity a greater concensus and uni formity of opinion has been reached than in some other surgical channels.
Perhaps we may say there is yet a lack of uniformity in doing the operation of intestinal anastomosis.
Excision of the large intestines seems to have reached the peak of operative interven tion, and present results are being studied with great care, regarding curative results in this class of surgery.