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 xxxii INTRODUCTION

by Americans; also the importance of taking in the submucosa in the suture method of intestinal anastomosis first suggested by Gross. But the Murphy button, Senn's bone plates, Laplace's and O'Hara's anas- tomosis forceps, Abbe's catgut rings, the Halsted, Cushing and Connell stitches, though now mainly a matter of history, are of such recent introduction that they are well known to every one.

Several years ago sensational newspaper reports as well as much professional interest was called forth by the report of a complete excision of the stomach by Schlatter, of Zurich (" Correspondenzblatt fur Schweize Aertze," December 1, 1897, and " Medical Record," 1897, vol. Hi). A little investigation showed, however, that a complete excision of the stomach had been done by Phineas S. Conner, of Cincinnati, about twelve years before Schlatter's operation. Dr. Conner reported this operation at the Cincinnati Academy, and it was noticed in the " Centralblatt fur Chirurgie " for 1885. After the great stir about Schlatter's operation, he again brought his report before the profession in an article published in the "Journal of the American Medical Association," 1898. The interest in the subject about this time also brought to light the fact that two other operations in this country were performed between Dr. Conner's opera- tion and that of Schlatter, one by Dr. A. C. Bernays, of St. Louis, Missouri ("Journal of the American Medical Association," 1898), and a second by Dr. J. M. Bayley ("Journal of the American Medical Association, 1898). The fact that all three of the patients operated upon by American surgeons died within a short time prevented the report of the procedure from attracting much attention. There is no question but that all these American surgeons were well fitted by skill and experience to perform the operation, and the success of Schlatter's operation justified their attempt. The magnitude of the procedure illustrates the fearlessness and ingenuity of American surgeons. The daring of such men has made possible the ever widening field of surgical intervention. With experience in stomach surgery, that which was at first a desperate chance becomes a fairly good risk.

American surgeons have done more to show the importance of opera- tive treatment of appendicitis than the rest of the world put together and in this way have been instrumental in saving thousands of lives. In 1867 Willard Parker ("Medical Record," 1867, vol. ii), of New York, showed as the result of his experience that early operation would save 75 per cent, of all cases as compared with nearly 50 per cent, mortality without operation. He advocated operation from the fifth to the twelfth day, and after his operation had been in use fifteen years, the mortality was still further reduced to 15 per cent. Fitz (" American Journal of the Medical Sciences," 1886, n. s., vol. xcii), of Boston, though not a surgeon, by his exhaustive study of this subject and his advocacy of early opera-