BONE AND JOINT SURGERY xxxi
bloody and tragic picture of tracheotomy in diphtheria into a simple, pain- less and bloodless bit of technical jugglery by his perfected method of intubation, has practically closed for all time one of the most conspicuous chapters in the history of surgery." ("Analysis of Fifty Cases of Croup Treated by Intubation of the Larynx," J. O 'Dwyer, " New York Medical Journal," 1888, vol. xlvii.) Aside from its value as a substitute for tracheotomy, Fell (a Buffalo physiologist) first saw that it might have other important uses. During the modern advances in thoracic surgery, much study has been devoted to some method which will obviate the disadvantages resulting from collapse of the lung when the pleura is opened. The Fell-O'Dwyer apparatus was probably the first means ever used for inflating the lung. (See paper by Northrup, "Transactions, Association American Physicians," June, 1895.) Many other forms of apparatus accomplishing the same result in a somewhat different way have been devised by other workers, but the principle is the same, and there is a growing belief that this simpler form of apparatus is quite as satisfactory as the costly and cumbersome Sauerbruch's chamber.
Suture of heart wounds belongs to the most daring of the modern operations made possible by antisepsis and anesthesia. The successful operation for an incised wound of the heart reported by Marks (" Medical Fortnightly," 1893, vol. vi), is probably the first operation ever reported for suture of a heart wound. G. T. Vaughn gives priority to Farina, of Rome (1S9G) ("Journal American Medical Association," 1909, vol. Hi). The fact that stabbing affrays are less frequent in this country than in some other parts of the world gives less frequent opportunity for this operation. However, a number of successful heart sutures have been reported by American surgeons. Vaughn's table showed up to 1901, 150 operations.
Abdominal Surgery. — In the pre-anesthetic days abdominal surgery had its origin in America with Ephraim McDowell's first ovariotomy per- formed in 1809. He afterwards operated in thirteen cases with eight recoveries. This is one of the few operations first performed by American surgeons for which credit it generally given.
Nathan Smith performed a successful ovariotomy in 1821, without knowledge of McDowell's operation, tying the stump with leather liga- tures said to have been cut from a buckskin glove.
After the introduction of anesthesia the progress in abdominal surgery was far more rapid. The claims of Wolcott, of Milwaukee, for the first nephrectomy and of Bobbs, of Indianapolis, for the first cholecys- totomy ("John Hopkins Hospital Bulletin," 1901, xii) will bear careful investigation. In addition to these operations nearly all of the mechan- ical methods of intestinal anastomosis which have greatly hastened and promoted the growth of stomach and intestinal surgery were introduced
