Reports of Societies

1893 BMJ (Clinical Research Edition)  
President, in the Chair. Friday, October 27,th, 1893. GASTRO-JEJUNOSTOMY. Mn. BIDWELL read notes of this case. The patient was a .gentleman, 69 years of age, who was suffering trom cancer of the pylorus. The operation was undertaken to relieve the pain and vomiting. An incision was made in the left linea semilunaris, and the jejunum united to the anterior surface sof the stomach by Ilaisted's method for lateral intestinal -anastomosis, twenty sutures only being inserted. The patient made a
more » ... patient made a rapid recovel-y, not vomiting once after the operation, but died five weeks later from exhaustion and extension of the disease. Special attention was drawn to Haisted's method of suture, which was compared with the use of Senn's plates. 'I-eference was also made to the methods of Mlr. Paul and Mr. MXlayo Robson. Appended was a table of fifteen published cases, in which pastro-enterostomy had been performed in England since Mr. Jessett's paper before this 'Society last year; eleven of these cases recovered from the oreration, the xemaining four dying fiom shock or exhaustion. Counting the seventeen cases collected by MIr. Jessett, a total of thirty-two cases was obtained with nine deaths, which was equal to a death-rate of 28+ per cent. The PRESIDENT remarked that the patient lhad evidently *died with symptoms of his malady mitigated by the operation, and not in consequence of the operation. Ile was not in favour of bone plates, bobbins, etc. He believed they favoured reflux of the intestinal fluids into the stomach for --the first few days after the operation; and much mischief was referable to this cause. Mr. BALLANCE would lhave liked to know thleresults of the post-mortem examination of MTr. Bidwell's case. He said that six cases submitted to an operation of this nature improved .nuch for about six weeks, when the opening between stomach and intestine closed, and the old symptoms arose again. lie and lMr. Edmunds had performed miiany experiments on animals, ,and lhad found MrI. Paul's method of uniting stomach and intestine the best. W\'hen the jejunum was fixed to the posterior surface of the stomach the opening did not close, because a portion of the stomachl wall was taken away at the operation or sloughed afterwards in a manner not obtained by any other method of operation. Paul's operation, too, ,was easy of performance. As to Senn's and Halsted's anethods, he believed the former ought to be entirely super-.seded by the latter. Mr. SYMONDS had done the operation thlree times, twice for cancer, both cases being relieved, though they afterwards -died. In the othercase therewas stricture of the pylorus, due to ;ulceration. The patient was greatly relieved for some six weeks, when a second operation was performed, and the opening made at the first operation could not be found in the stomachl wall. He then removed a portion of the wall of the .stomach, and the man did well for a time, wlhen the opening -closed again. A third operation was then done, of a much more complicated nature. The man was now doing well. He had given up Senn's method. Mr. MANSELL MOULLIN lhad done the operation on two occasions. The first was enected with Senn's plates. The patient died six weeks afterwards, when the gastric opening -was found to be so reduced in size that only the tip of the little finger would pass into it. although at the time of the -operation it had admitted two fingers freely. If that patient had lived for six months lhe believed the openinglwould lhave *quite closed. The second patient lhad died in a week, from exhaustion. In both cases the bone plates and bobbins Seemed to favour regurgitation into the stomach until the bobbin or plate was absorbed. Mr. BATTLE WaS pleased with Senn's method. An operation of the kind done by him at the Royal Free Hospital he had found to be easily performed in lialf an hour. There had 'been complete relief of the symptoms for four months; no regurgitation; and death then occurred from extension of .the disease. Alr. WAR4INGTON HANWARD said tllat as tlle patients were often not operated upon until their exhaustion was great, it was highly desirable that the operationi should be done easily and quickly, and that was possible when Senn's plates were used. As to the regurgitation, it was probably due to the position in which the opening was made. The contraction was probably due to the way in which the opening was effected, the manner of applying tlle sutures, etc. Ile thought the evidence tendered against the use of Senn's plates was not very convincing. Mlr. PEARCE GOULD said he ha(l done one case for carcinoma of the pylorus, with distension of the stomach. The jejunum was united to the stomaclh near the pylorus. Hle united the cut edges of the stomach and jejunum by a continuous suture, adding a few Lembert's sutures to make the union more secure. The patient died on the sixtll day subsequently. He had been, however, greatly relieved for four days, and had taken food. As to wlhere the place of union should be made, lie thought the nearer the opening was to the natural position at the pylorus, surely the better it was. Senn's method was easy, thouglh closure of the opening sometimes soon occurred. He lhad found the jejunum close in front of the notch of the left kidney. Mr. BIDWELL, in reply, tllouglht Paul's operation must be a long one. He lhad wanted to operate quickly, as hlis patient was very ill. As to experimental operations on animals, he considered that there was less clhance of the opening becoming closed wlhen, as in these operations upon diseased humani beings, there was an obstruction at the pylorus. He lhad fixed the intestinie to the cardiac end of tlle stomachl, on account of the great extent of the pyloric growtll. LIVING SPECIMENS. 1)r. FREDERICiK TAYLOR slhowed a case of Cancrum Oris after Typlhoid Fever. The patient was a girl, aaed 11. Suppuration took place at the root of a temporary molar, from which apparently the mischief started. It was treated by applications of carbolic acid (10 per cent. solution) every half hour, and then by nitric acid applied under an anmsthetic, wlichl stopped the sloughiing process. The patient recovered, but with contractions of the moutlh.-Mr. STANLEY BOYD showed a case of Resection of the Symplhysis Menti, and insertion of a spanner of stout silver wire. The patient was a woman, aged 61, and the operation was done for extensive epithelioma. The mucous membrane readily united over the spanner. He lhad previously in anotlher case used a piece of knitting needle for the same purpose.-Mr. C. SYMONDS showed a case of Successful Operation for Ectopia Vesiee. lIe first dissected the erttire bladder from the abdominal wall, folded it over, and united it in the middle line from top to bottom. Next, bringing up the scrotum witlh the skin of the penis, he fixed it over the bladder, and made a buttonhole in the perineum tlhrough wllich lhe fixed the glans penis. Unfortunately tlle mucous membrane was becoming extruded througlh this small orifice.-Mir. BALMANNO SQUIRE slhowed a mlaan suffering from Mor-hcea of the Fifth Nerve. The disease lhad somewlhat improved under treatment by strong coun-ter-irritation.-Mr. PEA:RCE GOULD exhibited a man, aged 26, wlho, after sprain of the wrist, developed a Compound Palmar (ianglion. The swelling, which extended in the sheatlh of the flexor sublimis digitorum above tlhe wrist and into the palm, was completely exposed throughout by an incision extending tlhrough the annular ligament. All the serous membrane was excised, and recovery with good movement followed. The disease returned in the sheath of the flexor longus pollicis, which was opened and plugged with iodoform gauze. Good movement again followed, and the patient lhad now a very useful hand.-Dr. IIALE WHITE slhowed a chlild suffering from, probably, Congenital Syphilitic Disease of the Liver. Its mother had been in hospital with nodes. The child was 6 years old. It had tlhree gummata of the liver, which. under large doses of mercury, were becoming lessened. It lhad keratitis, whicih was also improving. It lhad also extra prominence of the parietal prominences. Dr. Ilale AWrhite also exlhibited specimens of Dark Urine from two cases of Pernicious AnTmia. One patient, a man, lhad at first improved unader arsenic, but then died. His liver contained a large excess of free iron, as shown by the Prussian blue reaction. The dark colour of the
doi:10.1136/bmj.2.1714.994 fatcat:qoex3lyxnfad3osfwty2xztre4