THE PRINCIPLES OF SURGERY xxxiii
tion, did as much as any one to bring about the views now generally accepted. R. J. Hall ("New York Medical Journal, " 1886, vol. xliii) was probably first to remove the appendix by laparotomy followed by recovery, but the operation was undertaken with a mistaken diagnosis of strangulated hernia. Thomas G. Morton reported at the thirty- ninth meeting of the American Medical Association a case of appendicitis operated upon April 27, 1887, which was probably the first deliberately planned successful appendectomy on record, but the diagonsis was alter- native, "either intussusception or perityphlitic abscess." Henry B. Sands ("New York Medical Journal," 1888, vol. xlvii) first opened the abdomen with a positive diagnosis and removed the appendix with a successful result. These are only a few of the many American names deserving honorable mention in this connection. In Germany, England and France many of the best known surgeons still have not advanced further than had Willard Parker over forty years ago, and only a few of the most progressive surgeons of European countries have come to adopt the treatment which has been proved by the experience of the thirty years in America to save most lives. At the present time there are unquestionably a number of American surgeons who in originality, resourcefulness, skill and wide experience in abdominal surgery have no superiors and few equals. Their special methods and a record of their successes are of course out of place in an historical paper.
The Principles of Surgery.
Besides the definite operative measures which have been mentioned, American surgeons have introduced many new and important general principles of procedure. They were among the first to advocate the necessity of excision wide of the disease in the treatment of malignant growths. As an example of this, Crosby's complete removal of the upper extremity, interscapulo-thoracic amputation has already been mentioned; also Gross's advocacy of the importance of wide excision for breast cancer and of removing the nearest group of lymphatic glands. In discussing bone surgery, manipulation in the reduction of dislocations has been mentioned with the important part taken in this advance by Physick, Nathan Smith, Reid and Bigelow; also extension in the treatment of fractures suggested by Swift and Guidon Buck. The introduction of the use of absorbable ligatures by Physick, the experimental work of Jameson showing its value, and the introduction of kangaroo tendon as suture, have also been mentioned.
The importance of rest in the treatment of surgical tuberculosis has recently been strongly emphasized. As I have also mentioned pre- viously in this article, Physick advocated this important principle in hip-
