Complete gastrectomy in a patient 56 years of age. At the time of the report fully nine months have elapsed since the operation was performed.
The patient has gained pounds in weight, is engaged all day long at work of various kinds in the wards of the hos pital, and suffers no discomfort, except ing a sensation of pressure or tension in the epigastrium after the ingestion of an unreasonable quantity of food. Palpa tion through the relaxed abdominal walls fails to reveal anything suggestive of re currence. Carl Schlatter (Lancet, Nov. 19, '98).
Instance of successful removal for epi thelioma of the pylorus together with adjacent portions of othentum which contained two glands in a state of ad vanced cancerous degeneration. This case shows the fallacy of view that can cer of the stomach is a localized disease, and has but slight tendency to invade the lymphatic system. The pathological investigations of Cuneo in a great num ber of cases of cancer of the stomach have never failed to show glandular de generation. It is necessary, therefore, in removing the pylorus for malignant dis ease, to also take away the adjacent portions of omentum and the included lymphatics. Poirier (Bull. et Mimi. de la Soc. de Chin, Jan. 2, 1900).
So operation requires more careful se lection of cases and more careful prepa ration for the strain and shock of opera tion. The patient must be neither very old, thin, nor cachectic. The heart espe cially must be in good condition. Pa tients who have used alcohol even to slight excess, and those who have been subjected to constant nervous strain are not suitable. Renal or hepatic disease contra-indicates the operation. The stomach should be made as nearly asep tic as possible. The operating-room should not be cooler than 80° F.; the pa tient should be swathed in cotton and placed on hot-water bags to prevent loss of heat. The causes of failure have been: Poor general condition, the patient dying either on the table or soon after opera tion; the heart has galloped to exhaus tion in spite of treatment and leakage and peritonitis from imperfect coaptation of oesophagus and duodenum. G. C. MacDonald (Phila. Med. Jour., Feb. 3.
1900).
Another successful case of gastrectomy added to the four previously reported by Schlatter, of Zurich: Brigham, of San Francisco; MacDonald, of San Francisco; and Richardson, of Boston. In less than six weeks she left the hospital appar ently perfectly restored, after taking a dinner consisting of roast beef, mashed potatoes, ice-cream, milk. and coffee. On admission to the hospital her weight was 79 pounds; three months later it was 100 pounds. On returning to her home she immediately assumed the re sponsibility of her household work. liarvie (Annals of Surgery, Mar., 1900).
Surgery of the Intestines.
Preliminary and General Measures.— For a few days before operation careful attention should be given to the tient's general condition; especially as regards the diet, which, in some cases, should be restricted to fluids. The use of intestinal antiseptics is of some value; the intestinal tract should be thoroughly emptied, if possible, by the administra tion of purgatives and by the use of ene mata. Washing out the stomach a short time before the operation also assists in preventing vomiting and retching.
Inasmuch as the shock following some of the severe intestinal operations is great, it is important to make use of such prophylactic measures as are likely to lessen it as much as possible. The ad ministration of some form of alcoholic stimulant by the rectum before the oper ation and the hypodermic injection of strychnine, grain, insures their ab sorption, while, if we wait until after severe shock is present, we often fail to get the full effect of the drugs. The administration of an intravenous infu sion of salt solution during the operation is of great value. It is, of course, of first importance to provide such efficient protection and to make use of such other measures as will keep up the body-heat.
The anmsthetic should be adminis tered with special care, not only because of the immediate danger, but to avoid after-vomiting and retching. In severe operations a considerable quantity of warm salt solution, left within the ab dominal cavity, is an aid in combating shock.