MULTIPLE ACUTE GASTRIC ULCERS AFTER USING PERCY'S "COLD IRON" FOR INOPERABLE CARCINOMA
Journal of the American Medical Association
BALTIMORE In this case, rigid application of Percy's "cold iron" was ineffectual in eradicating the carcinoma, and was followed by death after four days with lesions similar to those of extensive cutaneous burns. History.\p=m-\Woman,aged 52 (two children) had had no bleeding since the menopause at 42 until November, 1915. Then she had profuse vaginal bleeding for five days which recurred once. Further symptoms were loss of weight, slight pain, constipation and painful defecation. The general
... sical examination was negative. Hemoglobin was 56 per cent. Pelvic examination showed the cervix entirely destroyed by a rough, firm growth extending far out into each broad ligament, fixing the uterus firmly in the pelvis. The clinical diagnosis was inoperable carcinoma of the cervix. Operation.\p=m-\The technic most recently advocated by Percy1 was rigidly followed in every detail. A midline incision showed the uterus firmly fixed to the pelvis and a hard mass 3 by 6 cm. in each broad ligament. There were hydrosalpinx, left, and hydro-ureter, right, diameter 15 mm. The internal iliac arteries and infundibulopelvic ligaments were ligated with silk. The left tube was removed. The vagina was dilated to admit the whole hand, and tissue was removed for section. A Percy cautery (Point "A") was introduced into the uterine cavity, and heating was continued one hour at a temperature low enough to avoid all charring, and never heating the tissues to a point at which the assistant's gloved (medium weight rubber) hand in the abdomen could not retain hold on the uterus with comfort. A Percy cautery (Point "E") was then introduced into the middle of the right broad ligament mass, and heating was continued one-half hour under the same conditions. The left broad ligament was treated in exactly the same way for onehalf hour. The structures became movable. On the second, third and fourth days after the operation there was acute gastric dilatation. On the third day there was a urinary fistula, and on the fourth day a paralytic ileus. During preparation for enterostomy, the patient died suddenly. Abstract of Protocol.-The peritoneal cavity contained 100 c.c. of serosanguineous fluid with a little fibrinous exúdate at the operative site. The intestines were distended. No obstruction could be demonstrated. The pleural cavities each contained 500 c.c. of bloody fluid. There were a few subserous ecchymoses. Extensive pul¬ monary edema was present. The stomach was distended with gas. Its mucosa was perforated by about twenty-four clean, round ulcers which measured from 1 to 7 mm. in diameter. Microscopically the loss of substance extended to the submucosa and was unassociated with any cellular change. The other viscera showed extreme cloudy swelling, together with renal epithelial necrosis. The operative site was extensively softened, and much had sloughed away.