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BRADFORD ROYAL INFIRMARY.
1605 volume. The
patient presented no bad symptoms, excepting walls of the stomach. The coronary arteries were ligatured flatulent pain, until the ninth day, when the tempera- on either side of the growth and the gastro-colic omentum It then fluctuated between 100° and ’ was ligatured off below it. Clamps having been placed on ture rose to 102° F. until the seventeenth 1010 day. Examination then revealed either side of it, the stomach was divided vertically clear of The patient was the growth and the open end was closed with two layers of a swelling bulging in Douglas’s pouch. aneasthetised and this swelling was cut into from the vagina continuous sutures. The first layer passed through all thewith scissors. Some sanious pus was let out. The tempera- coats and the two ends were left long and were finally tied tare at once fell and the patient’s recovery after this was together so as to pucker the wound. The growth was cut uninterrupted. She left the hospital well on Jan. 3rd, 1901. away and the duodenal end was treated in the same way. The child was born alive, but died suddenly five hours after Two or three glands were removed from the omentum close birth. It weighed less than flve pounds. The tumour was to the lesser curvature. An anterior gastro-enterostomy was next done by means of a Murphy’s button. The wound was an ordinary fibroid without any sign of degeneration. Remarka by Dr. HERMAN.-In THE LANCET of May 2nd, closed with through-and-through silkworm gut sutures. The 1891 (p. 986), Dec. 16th (p. 1508) and 23rd, 1893 (p. 1565), whole operation took 70 minutes. A gauze drain was left in and July 14th, 1894 (p. 77), I published all the cases of which was removed on the second day. The patient made Caesarean section that I had till then performed in the an uneventful recovery. The button was passed on the London Hospital. I now add to them two more performed twentieth day and he left the infirmary in apparently good since, which make the record complete up to the present health and with unimpaired appetite on April 20th. Seven The growth was a scirrhous carcinoma involving the whole time. These cases bring the number up to 13. patients recovered and six died. In the six fatal cases circumference of the wall of the stomach for over five the necessity for the operation was revealed by the inches of its length and stopping just short of the pyloric failure of the natural powers to effect delivery, and the ring which was normal. The mucous membrane was not operation was in consequence not performed until the patient ulcerated anywhere and there was no obvious musculature had been long in labour. All the cases recovered in which left. the diagnosis of the conditions affecting delivery had been Remarks by Mr. PHILLIPS.-A noteworthy feature in this made during pregnancy, and the operation was in con- case was the very slight nature of the symptoms, the sequence performed before the patient was exhausted by pro- abdominal tumour alone indicating the serious nature of the tracted labour. This ought always to be the case; for if the case. The importance of making an abdominal examination necessity for the operation is ascertained before term is in patients who complain of even slight dyspeptic symptoms reached it is the simplest of all abdominal operations, for is emphasised by two other cases of cancer of the stomach the operator has to deal only with healthy tissues, and the which have lately been in the Bradford Royal Infirmary details of the operation are the same in every case. For the where before the abdomen was examined and the tumour notes of Case 1 I am indebted to Dr. A. Gordon Wilson, was found secondary deposits had formed and operation was resident accoucheur, and Mr. W. F. Ellis, clinical clerk ; and useless. With regard to the operation, the closing in of the for those of Case 2 to Mr. J. Sherren, resident accoucheur, stomach and duodenum was found to be facilitated by and Mr. C. Bramhall and Mr. A. M. Simpson, clinical clerks. leaving the ends of the through-and-through continuous suture long and then tying them together, so puckering the line of suture and rendering fewer covering Lembert’s some
sutures necessary.
BRADFORD ROYAL INFIRMARY. A CASE OF CARCINOMA OF THE WALLS OF THE PARTIAL GASTRECTOMY; RECOVERY.
(Under the
STOMACH ;
Medical Societies.
of Mr. W. H.
HORROCKS.) THE statistics of partial gastrectomy, including pylorectomy, are on the whole fairly satisfactory. Mr. Mayo Robson in his lectures at the Royal College of Surgeons of care
England in 19001 has collected 572 cases, recovered ; this is equal to a mortality of
and of these 398 30 per cent., but if suitable cases are chosen the death-rate is much less. For instance, Maydl had only four deaths in his 25 cases, and Kocher had only five deaths in 57 cases. Statistics collected by Haberkant2 show clearly the higher mortality which occurs when extensive adhesions are present, for under those circumstances the death-rate was 7L per cent., but when there were no adhesions only 27 per cent. of the cases died. The improvement of the results in the future will depend chiefly on an earlier calling in of the aid of the surgeon in any case in which the possibility of the existence of malignant disease of the stomach is suspected. For the notes of the case we are indebted to Mr. James Phillips, senior house surgeon. A man, aged 46 years, was admitted into the Bradford Royal Infirmary in March last complaining of pain after food of six or seven weeks’ duration with occasional vomiting and pyrosis at night. He had lost one and a half stones in weight in 11 months. He had never been ill in his life before. He was a strong, well-built, healthy-looking man. The tongue was indented and furred. The abdomen was flat. In the epigastrium a hard lump was felt, apparently about two inches deep by one and a quarter inches wide, which moved up and down with respiration immediately under the abdcminal wall and could be pushed laterally up under the left ribs. On distending the stomach with air the tumour was found to be to the right of a resonant area not greater than the normal stomach resonance. Cancer of the pylorus was diagnosed and on March 22nd an operation was undertaken for its removal. The stomach was pulled out through a five-inch incision and the growth was found to extend from the pylorus five inches along the ’
BRADFORD MEDICO-CHIRURGICAL
SOCIETY.
Microscopical De,7?2 onstration.-Exhibit ion of Patients
removed from the Common Duct ; (3) Sarcoma of the Sheath of the Rectus Abdominis ; and (4) Rickets in a Chicken. Dr. C. F. M. ALTHORP showed : (1) A case of Excision of the Tongue and Cervical Glands (operation 15 months previously) ; and (2) a case of Excision of the Breast for Scirrhus (operation two and a half years previously). Both
patients were in good health. Dr. H. ANGUS showed a Spleen from
1 THE LANCET, March 24th, 1900, p. 838. Archiv fur Klinische Chirurgie, 1896, vol. ii., p. 484.
a case
of
Hodgkin’s
Disease. Mr. R. MERCER showed a photograph ofa Foot showing great Hypertrophy of One Toe. Dr. R. H. CROWLEY showed the following specimens(1) Cystic Kidney (7) Congenital ; (2) Calcareous Pericardium ; (3) Thrombosis ofthe Right Pulmonary Artery and its Branches ; and (4) Excessive Dilatation of the Auricles. Dr. A. BRONNER showed the patients in the following cases : (1) Recent cases of Mastoid Disease treated by Transplantation of the Skin ; and (2) Extraction of Cataract in a,
aged 84 years. Dr. EURICH showed :
woman,
(1) A Brain illustrating Contrecoup ; (2) Intussuscepted Bowel; and (3) Dysenteric Ulcers of the Colon, with Perforation. Dr. JAMES KERR showed a boy, aged five years, originally for eye symptoms, who about two years ago awoke with the mouth drawn to the left and with paralysis of the right half of the face. This had completely passed off as regards seen
2
and’
8pecimens.-Caeliotomy.-Pe’J’forated Gastric Ulcer.-The S’uppl,y of Pure Milk. A MEETING of the above society was held on May 2lst, Mr. F. FARROW, the President, being in the chair. Dr. F. W. EURICH gave a microscopical demonstration illustrating some Tumours of the Kidney. Mr. J. B. HALL showed : (1) A Stomach on which Gastroenterostomy had been recently performed ; (2) Gall-stones
patient presented no bad symptoms, excepting walls of the stomach. The coronary arteries were ligatured flatulent pain, until the ninth day, when the tempera- on either side of the growth and the gastro-colic omentum It then fluctuated between 100° and ’ was ligatured off below it. Clamps having been placed on ture rose to 102° F. until the seventeenth 1010 day. Examination then revealed either side of it, the stomach was divided vertically clear of The patient was the growth and the open end was closed with two layers of a swelling bulging in Douglas’s pouch. aneasthetised and this swelling was cut into from the vagina continuous sutures. The first layer passed through all thewith scissors. Some sanious pus was let out. The tempera- coats and the two ends were left long and were finally tied tare at once fell and the patient’s recovery after this was together so as to pucker the wound. The growth was cut uninterrupted. She left the hospital well on Jan. 3rd, 1901. away and the duodenal end was treated in the same way. The child was born alive, but died suddenly five hours after Two or three glands were removed from the omentum close birth. It weighed less than flve pounds. The tumour was to the lesser curvature. An anterior gastro-enterostomy was next done by means of a Murphy’s button. The wound was an ordinary fibroid without any sign of degeneration. Remarka by Dr. HERMAN.-In THE LANCET of May 2nd, closed with through-and-through silkworm gut sutures. The 1891 (p. 986), Dec. 16th (p. 1508) and 23rd, 1893 (p. 1565), whole operation took 70 minutes. A gauze drain was left in and July 14th, 1894 (p. 77), I published all the cases of which was removed on the second day. The patient made Caesarean section that I had till then performed in the an uneventful recovery. The button was passed on the London Hospital. I now add to them two more performed twentieth day and he left the infirmary in apparently good since, which make the record complete up to the present health and with unimpaired appetite on April 20th. Seven The growth was a scirrhous carcinoma involving the whole time. These cases bring the number up to 13. patients recovered and six died. In the six fatal cases circumference of the wall of the stomach for over five the necessity for the operation was revealed by the inches of its length and stopping just short of the pyloric failure of the natural powers to effect delivery, and the ring which was normal. The mucous membrane was not operation was in consequence not performed until the patient ulcerated anywhere and there was no obvious musculature had been long in labour. All the cases recovered in which left. the diagnosis of the conditions affecting delivery had been Remarks by Mr. PHILLIPS.-A noteworthy feature in this made during pregnancy, and the operation was in con- case was the very slight nature of the symptoms, the sequence performed before the patient was exhausted by pro- abdominal tumour alone indicating the serious nature of the tracted labour. This ought always to be the case; for if the case. The importance of making an abdominal examination necessity for the operation is ascertained before term is in patients who complain of even slight dyspeptic symptoms reached it is the simplest of all abdominal operations, for is emphasised by two other cases of cancer of the stomach the operator has to deal only with healthy tissues, and the which have lately been in the Bradford Royal Infirmary details of the operation are the same in every case. For the where before the abdomen was examined and the tumour notes of Case 1 I am indebted to Dr. A. Gordon Wilson, was found secondary deposits had formed and operation was resident accoucheur, and Mr. W. F. Ellis, clinical clerk ; and useless. With regard to the operation, the closing in of the for those of Case 2 to Mr. J. Sherren, resident accoucheur, stomach and duodenum was found to be facilitated by and Mr. C. Bramhall and Mr. A. M. Simpson, clinical clerks. leaving the ends of the through-and-through continuous suture long and then tying them together, so puckering the line of suture and rendering fewer covering Lembert’s some
sutures necessary.
BRADFORD ROYAL INFIRMARY. A CASE OF CARCINOMA OF THE WALLS OF THE PARTIAL GASTRECTOMY; RECOVERY.
(Under the
STOMACH ;
Medical Societies.
of Mr. W. H.
HORROCKS.) THE statistics of partial gastrectomy, including pylorectomy, are on the whole fairly satisfactory. Mr. Mayo Robson in his lectures at the Royal College of Surgeons of care
England in 19001 has collected 572 cases, recovered ; this is equal to a mortality of
and of these 398 30 per cent., but if suitable cases are chosen the death-rate is much less. For instance, Maydl had only four deaths in his 25 cases, and Kocher had only five deaths in 57 cases. Statistics collected by Haberkant2 show clearly the higher mortality which occurs when extensive adhesions are present, for under those circumstances the death-rate was 7L per cent., but when there were no adhesions only 27 per cent. of the cases died. The improvement of the results in the future will depend chiefly on an earlier calling in of the aid of the surgeon in any case in which the possibility of the existence of malignant disease of the stomach is suspected. For the notes of the case we are indebted to Mr. James Phillips, senior house surgeon. A man, aged 46 years, was admitted into the Bradford Royal Infirmary in March last complaining of pain after food of six or seven weeks’ duration with occasional vomiting and pyrosis at night. He had lost one and a half stones in weight in 11 months. He had never been ill in his life before. He was a strong, well-built, healthy-looking man. The tongue was indented and furred. The abdomen was flat. In the epigastrium a hard lump was felt, apparently about two inches deep by one and a quarter inches wide, which moved up and down with respiration immediately under the abdcminal wall and could be pushed laterally up under the left ribs. On distending the stomach with air the tumour was found to be to the right of a resonant area not greater than the normal stomach resonance. Cancer of the pylorus was diagnosed and on March 22nd an operation was undertaken for its removal. The stomach was pulled out through a five-inch incision and the growth was found to extend from the pylorus five inches along the ’
BRADFORD MEDICO-CHIRURGICAL
SOCIETY.
Microscopical De,7?2 onstration.-Exhibit ion of Patients
removed from the Common Duct ; (3) Sarcoma of the Sheath of the Rectus Abdominis ; and (4) Rickets in a Chicken. Dr. C. F. M. ALTHORP showed : (1) A case of Excision of the Tongue and Cervical Glands (operation 15 months previously) ; and (2) a case of Excision of the Breast for Scirrhus (operation two and a half years previously). Both
patients were in good health. Dr. H. ANGUS showed a Spleen from
1 THE LANCET, March 24th, 1900, p. 838. Archiv fur Klinische Chirurgie, 1896, vol. ii., p. 484.
a case
of
Hodgkin’s
Disease. Mr. R. MERCER showed a photograph ofa Foot showing great Hypertrophy of One Toe. Dr. R. H. CROWLEY showed the following specimens(1) Cystic Kidney (7) Congenital ; (2) Calcareous Pericardium ; (3) Thrombosis ofthe Right Pulmonary Artery and its Branches ; and (4) Excessive Dilatation of the Auricles. Dr. A. BRONNER showed the patients in the following cases : (1) Recent cases of Mastoid Disease treated by Transplantation of the Skin ; and (2) Extraction of Cataract in a,
aged 84 years. Dr. EURICH showed :
woman,
(1) A Brain illustrating Contrecoup ; (2) Intussuscepted Bowel; and (3) Dysenteric Ulcers of the Colon, with Perforation. Dr. JAMES KERR showed a boy, aged five years, originally for eye symptoms, who about two years ago awoke with the mouth drawn to the left and with paralysis of the right half of the face. This had completely passed off as regards seen
2
and’
8pecimens.-Caeliotomy.-Pe’J’forated Gastric Ulcer.-The S’uppl,y of Pure Milk. A MEETING of the above society was held on May 2lst, Mr. F. FARROW, the President, being in the chair. Dr. F. W. EURICH gave a microscopical demonstration illustrating some Tumours of the Kidney. Mr. J. B. HALL showed : (1) A Stomach on which Gastroenterostomy had been recently performed ; (2) Gall-stones