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WITH REGRETS.
1419 twice observed syncope in operations on patients under One case was that of operation for cancer of the rectum and the other disarticulation of the I am, Sir, yours faithfully, femur. The cardiac weakness lasted for 24 hours. By experiM. R. C. S. May 5th, 1909. ments on animals he had found that by the compression of the aorta the blood pressure increased rapidly for 25 seconds after WITH REGRETS. the constriction was applied and decreased when the bandage To the Editor of THE LANCET. was removed. He therefore issued a warning against the SIR,—Having published for advertising purposes a letter method, especially in cases of weak heart. Dr. PAGENSTECHER of Wiesbaden said that he had used we received from Dr. F. W. Forbes Ross, on Dec. 18th, 1908, which he has informed us was not intended for publication, Dr. Momburg’s method in operations on the pelvis with good results and without any haemorrhage. After the operation, we beg to state that we have taken the necessary steps to withdraw that letter as an advertisement, and much regrethowever, a paresis of the bladder and of the rectum appeared if any inconvenience has been caused to Dr. Forbes Ross which was possibly the sequel to a nerve lesion caused by the Iconstriction. through a misapprehension on our part. in my opinion unwise, and animosity and resentment.
is certain to
rouse a
spirit
of
Momburg’s constriction.
v nn..." f"it.hf" 11",
JOHN
KNIGHT, LIMITED.
THE GERMAN SURGICAL CONGRESS.1 (FROM OUR BERLIN CORRESPONDENT.) (Continued from
p.
1350.)
Operation for Enabolism of the Pulmonary A?’tery. Professor RIEDEL of Jena reported the ease of a woman in whom an operation for femoral hernia was followed by One morning while the thrombosis of the femoral vein. dressing was being changed she suddenly became very bad and complained of prsecordial pain and dyspnoea. The pulse totally disappeared. It was obvious that embolism of the pulmonary artery had occurred and the assistant surgeon at Under slight narcosis a resection once decided to operate. of the second and third left ribs was performed and the left pleura and the pericardium were opened. The pulmonary artery was found to be rather firmer than normal and an incision was accordingly made into it without any haemorrhage resulting. An embolus of 10 centimetres in length was extracted from the artery, but even then only a slight bleeding occurred. Another embolus of 10 centimetres in length was then removed, which was followed by profuse haemorrhage from the artery. This was stopped by artery forceps and then the incisions and the thoracic wound were closed by sutures. The cardiac action ceased several times during the operation, but reappeared after massage of the heart. The patient after the operation felt much relieved. The operation was performed during Professor Riedel’s absence on the first day of the Congress by his assistant, and on the fourth day Professor Riedel was able to tell the Congress that he had received telephonic information that the patient’s state continued to be satisfactory. Dr. MULLER of Rostock said that he was in the habit of performing a ligature of the saphena vein to prevent embolism of the pulmonary artery. He reported a case where the thrombosis had reached the external iliac vein at its junction with the hypogastric vein. He ligatured the vein at this point and removed the whole external iliac and common femoral veins as low down as the union with the saphena. Dr. Muller recomThe cedema of the limb disappeared. mended this method of dealing with an ascending thrombosis. J!Jsmaroh’s Method of Constriction applied to the Abdominal Aorta. Dr. MOMBURG of Spandau reported that he had applied Esmarch’s method of constriction to the abdominal aorta. He put an indiarubber bandage round the waist between the ribs and the crista ilii so tightly that the pulse in the femoral artery disappeared. He then put another bandage round - each femur in order that the circulation in the legs might afterwards be restored by degrees when the abdominal bandage was loosened. Dr. Momburg claimed that this method was valuable for operations on the abdominal organs, especially on the female genital organs. The re-establishment of the circulation after the removal of the bandage produced contractions of the uterus: Professor TRENDELENBURG of Leipsic said that he had 1 Our correspondent received valuable assistance in the preparation of this report from the editor of the Deutsche Medicinische Wochenschrift, whose courtesy we wish to acknowledge.
Operations for Hypospadias and Cryptorchism. Dr. BECKER of Rostock said that in hypospadias he im planted a piece of the saphena vein into a tunnel made in the penis. No catheterisation became necessary, and the implanted piece healed without difficulty. He had performed the same operation in a case of hermaphroditism. It was still a debateable point whether the implanted tissue would be durable or whether shrivelling, and consequent strictures, might afterwards develop. Dr. SCHMIEDEN of Berlin reported that he had once implanted a piece of ureter obtained from another patient operated on for hydronephrosis. Dr. AuscHUTZ of Kiel said that in cases of cryptorchism he had exposed the spermatic cord and the vessels, and after bringing the testicle into a normal position had united it with the other testicle by silk sutures. Operations on the Stomach. Professor RIEDEL spoke on the Resection of the Middle Portion of the Stomach. The operation was indicated when a gastric ulcer had perforated and adhesions existed between the stomach and the liver, or the abdominal wall, or the omentum, also in cases of hour-glass stomach. The results were, according to his experience, fairly good. He had operated in 25 cases with seven deaths, none of which was due to peritonitis. The cause of death was either pneumonia or inanition. In one case the whole stomach was filled with masses of growth. When the growth was removed it was found to have been connected by a pedicle with the posterior wall of the stomach. The middle part of the stomach was then resected. The growth proved to be malig-
nant adenoma.
Professor PAYR of Greifswald was of opinion that in ulcers of the lesser curvature of the stomach the operation of gastro-enterostomy was not sufficient. He had therefore in an excision or resection of the stomach. 17 cases To ascertain the local conditions he brought the stomach fully into view through the abdominal wound so that he could see whether adhesions existed between the posterior surface of the stomach and the pancreas. An exploratory incision was then made into the stomach in the neighbourhood at the supposed ulcer. If the ulcer had perforated into the pancreas the adherent part only was resected. Dr. BREUER of Linz said that relapses of ulcers happened even after resections and that he had therefore abandoned It was essential for the resection for gastro-enterostomy. success of gastro-enterostomy to make the anastomosis in the
performed
right place. After-treatment of Laparotomies. KOTHENBERG of Hamburg reported that in the Eppendorf Hospital the patients were allowed to leave their oeds in from three to four days after laparotomy. 629 ases, the majority of which were cases of operation for appendicitis, were treated in this way. The mortality from embolism of the pulmonary artery, which formerly was LO per cent. of the total mortality, had now decreased to L 8 per cent. The frequency of pneumonia seemed uniltered. The wounds were, as a rule, closed by several rows )f sutures (etagennaht), but even patients whose wounds The vere simply plugged were allowed to leave their beds. bction of the bowels is made easier and convalescence is onsiderably shorter. Of 71 cases examined a year after he operation two showed post-operative hernia; in both hese the wound had not been sutured but plugged. Dr.
Operations on the Pancreas. Professor MARTENS of Berlin said that in
cysts of the
is certain to
rouse a
spirit
of
Momburg’s constriction.
v nn..." f"it.hf" 11",
JOHN
KNIGHT, LIMITED.
THE GERMAN SURGICAL CONGRESS.1 (FROM OUR BERLIN CORRESPONDENT.) (Continued from
p.
1350.)
Operation for Enabolism of the Pulmonary A?’tery. Professor RIEDEL of Jena reported the ease of a woman in whom an operation for femoral hernia was followed by One morning while the thrombosis of the femoral vein. dressing was being changed she suddenly became very bad and complained of prsecordial pain and dyspnoea. The pulse totally disappeared. It was obvious that embolism of the pulmonary artery had occurred and the assistant surgeon at Under slight narcosis a resection once decided to operate. of the second and third left ribs was performed and the left pleura and the pericardium were opened. The pulmonary artery was found to be rather firmer than normal and an incision was accordingly made into it without any haemorrhage resulting. An embolus of 10 centimetres in length was extracted from the artery, but even then only a slight bleeding occurred. Another embolus of 10 centimetres in length was then removed, which was followed by profuse haemorrhage from the artery. This was stopped by artery forceps and then the incisions and the thoracic wound were closed by sutures. The cardiac action ceased several times during the operation, but reappeared after massage of the heart. The patient after the operation felt much relieved. The operation was performed during Professor Riedel’s absence on the first day of the Congress by his assistant, and on the fourth day Professor Riedel was able to tell the Congress that he had received telephonic information that the patient’s state continued to be satisfactory. Dr. MULLER of Rostock said that he was in the habit of performing a ligature of the saphena vein to prevent embolism of the pulmonary artery. He reported a case where the thrombosis had reached the external iliac vein at its junction with the hypogastric vein. He ligatured the vein at this point and removed the whole external iliac and common femoral veins as low down as the union with the saphena. Dr. Muller recomThe cedema of the limb disappeared. mended this method of dealing with an ascending thrombosis. J!Jsmaroh’s Method of Constriction applied to the Abdominal Aorta. Dr. MOMBURG of Spandau reported that he had applied Esmarch’s method of constriction to the abdominal aorta. He put an indiarubber bandage round the waist between the ribs and the crista ilii so tightly that the pulse in the femoral artery disappeared. He then put another bandage round - each femur in order that the circulation in the legs might afterwards be restored by degrees when the abdominal bandage was loosened. Dr. Momburg claimed that this method was valuable for operations on the abdominal organs, especially on the female genital organs. The re-establishment of the circulation after the removal of the bandage produced contractions of the uterus: Professor TRENDELENBURG of Leipsic said that he had 1 Our correspondent received valuable assistance in the preparation of this report from the editor of the Deutsche Medicinische Wochenschrift, whose courtesy we wish to acknowledge.
Operations for Hypospadias and Cryptorchism. Dr. BECKER of Rostock said that in hypospadias he im planted a piece of the saphena vein into a tunnel made in the penis. No catheterisation became necessary, and the implanted piece healed without difficulty. He had performed the same operation in a case of hermaphroditism. It was still a debateable point whether the implanted tissue would be durable or whether shrivelling, and consequent strictures, might afterwards develop. Dr. SCHMIEDEN of Berlin reported that he had once implanted a piece of ureter obtained from another patient operated on for hydronephrosis. Dr. AuscHUTZ of Kiel said that in cases of cryptorchism he had exposed the spermatic cord and the vessels, and after bringing the testicle into a normal position had united it with the other testicle by silk sutures. Operations on the Stomach. Professor RIEDEL spoke on the Resection of the Middle Portion of the Stomach. The operation was indicated when a gastric ulcer had perforated and adhesions existed between the stomach and the liver, or the abdominal wall, or the omentum, also in cases of hour-glass stomach. The results were, according to his experience, fairly good. He had operated in 25 cases with seven deaths, none of which was due to peritonitis. The cause of death was either pneumonia or inanition. In one case the whole stomach was filled with masses of growth. When the growth was removed it was found to have been connected by a pedicle with the posterior wall of the stomach. The middle part of the stomach was then resected. The growth proved to be malig-
nant adenoma.
Professor PAYR of Greifswald was of opinion that in ulcers of the lesser curvature of the stomach the operation of gastro-enterostomy was not sufficient. He had therefore in an excision or resection of the stomach. 17 cases To ascertain the local conditions he brought the stomach fully into view through the abdominal wound so that he could see whether adhesions existed between the posterior surface of the stomach and the pancreas. An exploratory incision was then made into the stomach in the neighbourhood at the supposed ulcer. If the ulcer had perforated into the pancreas the adherent part only was resected. Dr. BREUER of Linz said that relapses of ulcers happened even after resections and that he had therefore abandoned It was essential for the resection for gastro-enterostomy. success of gastro-enterostomy to make the anastomosis in the
performed
right place. After-treatment of Laparotomies. KOTHENBERG of Hamburg reported that in the Eppendorf Hospital the patients were allowed to leave their oeds in from three to four days after laparotomy. 629 ases, the majority of which were cases of operation for appendicitis, were treated in this way. The mortality from embolism of the pulmonary artery, which formerly was LO per cent. of the total mortality, had now decreased to L 8 per cent. The frequency of pneumonia seemed uniltered. The wounds were, as a rule, closed by several rows )f sutures (etagennaht), but even patients whose wounds The vere simply plugged were allowed to leave their beds. bction of the bowels is made easier and convalescence is onsiderably shorter. Of 71 cases examined a year after he operation two showed post-operative hernia; in both hese the wound had not been sutured but plugged. Dr.
Operations on the Pancreas. Professor MARTENS of Berlin said that in
cysts of the