Book Review Eye, Ear, Nose and Throat . A Manual for Students and Practitioners. By Howard Charles Ballenger, M.D., and A. G. Whippern, M.D. New second edition, thoroughly revised. Illustrated with 180 engravings and 8 colored plates. Philadelphia and New York: Lea and Febiger. 1917
Boston Medical and Surgical Journal
stance I think of in modern medicine was the recommendation of Dr. Reginald H. Fitz, who recommended that all eases of acute appendicitis be subjected to immediate surgical interference. It is conceivable that splenectomy may take, in the future a larger rôle than it seems to me to occupy at the present time. It is also possible, if every case of pernicious anemia was studied early enough to make a very early diagnosis, that our control over the disease might be greater. We are talking, of
... e, not of cures but of remissions, and it may be possible that in the small number that are ultimately going to be benefited, a remission may be effected frequently enough to create practically what might be called a cure. As to the operation itself, I cannot quite accept as general, Dr. Vincent's extraordinarily good figures as applied to mortality in splenectomies. In the Mayo Clinic, where the operation has been done for one thing or another some one hundred and fifty times, the mortality at present approximates ten per cent., and that includes Banti's Complex and other conditions in which the general bodily state of the patient is more favorable than it is in pernicious anemia. I cannot believe that the mortality through the country, as the operation is done by the average surgeon, is much below fifteen per cent. I should think an eventual mortality of five per cent., which is a low mortality for major surgery under conditions of anemia of any sort, would not be reached for some little time. As to the suggestion made and prominently pushed by one surgeon that not only should the patient have the spleen removed, but also the gallbladder and appendix, I cannot believe that there is any indication for such a proceeding. The operation for splenectomy is serious enough in itself, and only to be recommended after very careful and continued study by the laboratory expert and the clinician, and the surgeon. Finally, the question as to the rôle of splenectomy in pernicious anemia is not to be settled by the experience of a single surgeon, or of many surgeons for a single year, but by the results of many surgeons, in many carefully studied cases, over a period of many years. Perhaps ten years from today, we shall know whether splenectomy can cure any case of pernicious anemia, or whether it will help all cases, or whether it is only one method whieh may help a little to prolong life, but not to preserve it indefinitely. Dr. George R. Minot: I have noticed this morning in the last issue of the Journal of the, American Medical Association that Sydenstricker and others at the Johns Hopkins Hospital have reported more striking instances than ours of transfusion reactions that may be due to the development of immune bodies to the donor's blood. I think that the statistics for the operative mortality of splenectomy in general are higher than those for the operative mortality for splenectomy in pernicious anemia. This may be because in the latter condition the spleens are more easily removed.