Boston Society for Medical Improvement
Boston Medical and Surgical Journal
the President, in the chair. ORAL COMMUNICATIONS. Dr. F. S. Watson : As one of the dissatisfactions of surgical practice is the losing sight of the ultimate results of cases after surgical operation, so a corresponding satisfaction occurs when we are able to follow them for long periods. I do not think, therefore, that I need offer any excuse for asking the attention of the Society once more to a case I reported last year and which is now thirteen months from the date of operation. And more
... ation. And more especially as it is the only operation of the kind done in this country and was theu the third that had been performed anywhere. The case was fully reported in the Boston Medical and Surgical Journal, April 2, 1896. The patient is a woman who a year ago last September came to the City Hospital in a dying condition. She had had for a year very frequent vomiting; she was greatly emaciated, having lost forty pounds in weight within the past year. The stomach could retain no food and she suffered a great deal from pain in the stomach. There was a history of gaBtric ulcer seven years before. Upon examiuing her, I found a slight seusation of resistance in the epigastrium on the left side and slight rigidity of all the abdominal muscles, but no distinct tumor could be felt. I told her I might give her relief by an operation, having in mind rapid anastomosis between the stomach and intestine in case of finding cancer, but I could not promise anything iu regard to saving life aud I told her she might die on the table. On the following day I operated and she got the reward of her courage. I found an hour-glass constriction of the stomach due to contraction of tho cicatrices of former ulcers which antedated the operation several years and of which there was a pretty clear typical history. It occurred to me on the Bpur of the moment, aud without having any precedent to authorize me iu so doing to turn the pyloric half of the stomach upon the cardiac portion using the constriction as a hingeto sew the two together and make a communicating hole between so that the gastric contents might pass through both halves of the stomach without going through the constriction. I did this as rapidly as possible. It also occurred to me first to sew the two portions all around before making the communication between them, and to do the latter through an incision made iu the roof in the presenting part of the stomach. A single row of silk sutures was used to unite the two portions; one long suture was left at each corner of this ellipse in order that I might know where my knife was going and might not go beyond the borders of the ellipse made by the sutures. I then incised the presenting portion of the stomach and made the communicating cuts, then button-hole sutured rapidly the edges of the two coats so that they might not unite, and finally sewed up the wound in the presenting portion, and put the stomach back in the abdominal cavity. The next morning to my surprise she was alive. The wound healed perfectly by first intention. She had no hernia. I fed her for seveu days by rectal enemata, after that by mouth with milk and champagne mixed and champagne and egg mixed. The first time she took food by the mouth I was interested to known what her sensations were, and she said it passed through without pain aud without trouble. She has had no trouble practically speaking from that day to this and has continued to gain. She is now in perfect health aud weighs more than at any time iu her life. Patient : I have no trouble from the operation at all. For three years before the operation I lived iu agony all the time. I am now perfectly free from pain. When I take food I am not conscious of any thing but a perfectly natural feeling in my digestion. Dr. Watson preseuted a second patient, and Baid : This patieut is an example of the recently popularized operation of castration for the relief of prostatic hypertrophy. He came to the City Hospital, and after trying for two months the most thorough treatment to relieve his condition of chronic retention of urine from obstructive prostatic disease, cystitis, and a slowly increasing loss of vitality, 1 removed both testicles. He had no trouble following the operation, and has been absolutely and entirely comfortable ever since. The prostate has disappeared and is now below its normal size. Before the operation it was about as big as an average russet apple. Catheterizatiou was very difficult. He bled profusely when it was first done. Patient : 1 think it was a very successful operation. It has been some six or seven weeks since the operation, and 1 don't think I was ever better iu my life. Dr. Watson : The patient has shown no evidence of the accident which sometimes follows the operation, namely, meutal derangement, which has been noticed in a certain number of caseB. The statistics published recently by Dr. Cabot which seem to show that the mortality of this operation is nearly as high if not higher than from the operation of prostatectomy, were a great surprise to us; in spite of them it'is hard to feel convinced that the operation of castration is as dangerous as the other. In the most successful case of castration performed by mo for this purpose the patient has remained absolutely well. It is now eighteen months since operation. In answer to a question, Dr. Watson said the first patient had not been on a restricted diet since six weeks after the operation. Dr. C. B. Porter showed a patient and related the following history : This man, seventeen years ago, was standing iu a Btooping position when liíb revolver of calibre 45 went off, the bullet passing along the ribs and lodging under the bhoulder-blade. He has been operated upon three different times where it was supposed the bullet was lodged. He was troubled, because any motions of the arm brought friction of this bullet upon the ribs and upon the under surface of the scapula. He had these photographs taken in New York, which located the bullet on the second rib and in the subscapular space. I made an incision here four days ago, through the trapezius and came upon the interval between the levator anguli scapulas aud rhomboids and entered the finger under the shoulderblade.