Surgery of the appendix gives a very ex tensive history regarding what has been written in the past, and, now, regarding diagnosis and treatment, becoming very concise. The general practitioner of to-day is more alert than ever in the recognition of early symptoms and prompt surgical procedure. When these methods are yet more thoroughly considered and carried out, the appendix, from the medical and surgical standpoint, will present a mor tality much less than exists at present, though this is exceedingly small.
The history of operations done upon the bladder, for various pathological conditions, is a very impressive one. Decided advances have been made in this direction, and the same can be said of the prostate gland, while surgery of the kidney has reached a point of great pre cision, the same also to be said regarding the ureters.
In all that pertains to the surgery of the "abdominal cavity, much has been accomplished through the study of the Trendelenberg and other positions for the patient during the time of operations, especially upon the kidney or gall-bladder and in pelvic work. Much of this also applies to the treatment of the patient after an operation, particularly in suppurative, septic appendicitis, as has so well been brought out by the writings of the late Dr. Fowler.
In the advances made within the abdominal cavity the searching out of every pathological condition, no organ or tissue being overlooked, is one of the most impressive to be noted in the history of general surgery.
Gall-stones have a way of giving a great variety of symptoms, the same applying to cases of appendicitis, and which, perhaps, has brought out many valuable conclusions.
In operating upon either of these organs and not finding a pathological condition that will accord with the symptoms, it is admitted by most surgeons that a more thorough ex amination is called for, and in some other un suspected organbe found the source of the symptoms, being afforded only by doing the operation called for in that direction.
Since the last edition of the Encyclopedia Americana much has occurred in the history of general surgery, regarding surgical procedure, to make clearer new fields of observation, and which applies especially to the abdomen and its contents.
The abdomen has claimed much of the at tention of the general surgeon. It has not been possible for the specialist to control this line of work. With our increased knowledge of pathological changes within this cavity, and with the aid afforded the operator through the advances made by the assistance of the ex perienced radiographer, who is able to inter pret radiograms correctly, the success has been so great that patients, or their friends, have little hesitation in entering a hospital, or going to the operating table, when the necessity is made apparent to them. Hence in the building of the many smaller hospitals the past few years, local surgeons have developed an ex perience that permits of doing many opera tions deemed impossible for them to perform a few years ago.
In the past two decades much progress has been made in surgery of the bones; in the conservation of limbs and joints; in the better understanding of conditions and especially does this apply to cases of malig nant and tubercular troubles.
Surgical lesions of the circulatory system have received much attention, and surgeons have had occasion to discuss the subject of idiopathic aneurisms. Operative surgery in the near past has not met with so many of these cases, and the condition is believed to be due to the more successful treatment of syphilis, this being one of the chief factors in develop ment of this lesion.
The subject of inflammation of the veins — phlebitis — has commanded careful investiga tion in our laboratories, it so often being the factor in connection with sudden death follow ing an important operation. To relieve the blood clot that forms in the vessel, then sud denly separates, enters the circulation, plug ging the heart valves and causing sudden death, calls for surgical intervention, when it can be recognized as being present in the large veins of the extremities.
It is also to be observed that a less num ber of cases of stone in the bladder are pre sented, due to the better understanding of calculi originating in the kidney, and this con dition corrected by the study of diet, the drink ing of properly selected mineral waters or the careful use of plain sterile waters. Here diet has much to do in lessening the development of many surgical lesions.
The medico-legal side of the responsibility of the surgeon has been pretty covered the past few years in the history of malpractice suits for foreign bodies left in the abdominal cavity, with the result that the operator, the hospital or nurse share somewhat alike the responsibility, and must give evidence of having exercised every precaution possible to avoid such occurrences. Especially is it the duty of the surgeon to have it well understood with the one nearest in relationship to the patient regarding the extent of an operation. If, in the midst of it, it is found necessary to do more than was explained, the operator must communicate with the responsible person re garding the condition present that requires more serious, additional procedure. This is one reason why every cautions surgeon desires some person near at hand to inform them, should complications unexpectedly arise. Our British surgeons have had some unpleasant ex periences In this direction.
Regarding the anzsthetic in use by the general surgeon, it may be said that sulphuric ether is undoubtedly employed to a greater ex tent than either one of the other anxsthetics. Chloroform is believed to be advisable in the short operations, and in those upon children, while for those only requiring a few moments the nitnous oxide or ethyl chloride are of great service.