Books. .41, 95, 149, 196, 243, 297, 347, 408, 460, 507, 557, 616 Briefs on the Surgery of the Genito-Urinary Organs.. 65 .527 Cerovisine in the Treatment of Gonorrheal Ophthalmia.. .602 .480 Editorial Department...21, 81, 143, 189, 235, 287, 339, 399, 449, 497, 551, 605 .579 Gasoline, Effects of Poisoning from, with Report of Two Cases. .184, 484, 549 .336 Insanity, Some Observations on the Home Treatment of. ..267 Middle Ear, Suppuration of the. Moleen, George A. Monoplegia-Disturbances of Sensibility in Contical Paralysis. Morphinism ..... Movable Right Kidney as a Cause of Pancreatic Diabetes.. 5. .423 .445 .371 391 ..527 60 ..542 Osteomyelitis, Operation for Chronic, in a Patient With a Constitu- .441 Strabismus, The Cure of. Stuver, E...... Syphilis, A Case of Delayed Eruption Following Abortion and Resem- .283 69 .445. .129 .280 225, 489 .583. .1, 441 урод BOSTON MEDICAL FEB11 1904 VOLUME XXII. JULY, 1902. NUMBER 1. REPORT OF A CASE OF REMOVAL OF STOMACH By CHAS. S. WRIGHT, M.D., Salt Lake City, Utah. Operations for removal of the stomach are still sufficiently rare to justify reporting cases when they do occur, even though they may terminate unfavorably. It may impress some of you as a peculiar proceeding to report a case like the one I have selected, as my patient died. This is a remote reason for reporting the case. It is not so fascinating to report unsuccessful cases, though this, after all, is only a relative term, as I consider it better to take a chance on life in an effort to be benefited rather than suffer without cessation. It takes some courage to report in detail our fatal cases, although I believe if the rule prevailed to so report them, many times more real information would be the result than we obtain at present. In fact I would like to be a member of a very secret society composed only of persons who would honestly report their mistakes and badly terminating cases. Literature pertaining to cancer of the stomach and its removal for the same is as yet somewhat meager. The somewhat noted case of the German physician who recently removed the stomach successfully is still fresh in our minds and has doubtless stirred some surgeons to emulate his example. This is not exactly my case, but like the boy who took hold of a live wire, I could not let go from an innocent procedure when I most desired. The case in brief is as follows: Mr. B., aged 57, a farmer with no particular family history bearing upon this subject, came to me June 1 for a stomach disorder for which he had been treated with confidence by a number of physicians for dyspepsia. The patient said that for four years past he had been afflicted with digestive disturbances and for the last year more especially he had been a sufferer with pain in the region of his stomach. His general appearance was dishearten *Read before the Rocky Mountain Inter-State Medical Association, Denver, Colorado, September 3 and 4, 1901. ing, being emaciated to rather an extreme degree. He could not retain his food no matter how carefully it was prepared at home. A feature which troubled him greatly was the tendency of all food to ferment or sour and cause him unusual distress until relieved by vomiting. A physical examination of the region of the abdomen occupied by the stomach showed a somewhat distended condition, and upon palpation a hard mass was located about the pyloric end of the stomach, suggesting that I had a cancerous condition with which to deal. At my request, the lady with whom the patient came also easily felt this hardened mass. My advice to send him to the hospital was accepted, with a view to more closely watch the case, also with the intention of making an incision to determine more definitely what hope might be given in an effort to remove the diseased tissuee, believing at that time it was pyloric alone. He reached the hospital in about a week, and strange to say, with the most careful efforts, no lump or swelling could be outlined, leaving the impression with some physicians who saw the case at this time that there was not sufficient evidence to justify an exploratory incision. The other symptoms, vomiting and pain, continued, though the latter was nearly relieved on a carefully prepared diet at the hospital. The vomited matter consisted principally of fermented food products, and at no time contained any trace of blood or broken down tissue. I experienced no difficulty in washing his stomach out, though no particular benefit seemed to follow this treatment. test breakfast was given about ten days after the patient had been in the hospital, consisting of a pint of weak tea and a slice of toast, after which the stomach was washed out and an examination made of its contents, showing a very large quantity of lactic acid which required 10 c.c. deci-normal solution of sodium hydroxide to neutralize 10 c.c. of the filtered stomach contents. A A report which was confirmed in this case and referred to in the Medical Review of Reviews by Dr. Ehret of Strasburg may be of interest. In speaking of the fermentation in these cases, he says: "There is one bacillus of special interest in connection with gastric fermentation. All observers who have studied the contents of the cancerous stomach have doubtless seen a long, thin, filiform bacillus which may be present in great abundance. Accompanying the bacillus we usually see the yeast plant (sarcina) and various bacteria, both bacilli and cocci." Boas, who first described this filiform bacillus about four years ago, noted that it was usually present in the cancerous stomach. Among many other findings it was learned that this bacillus was capable of producing lactic acid in large quantities. The author firmly believes that cancer of the stomach may be diagnosticated by the presence of this bacillus in large quantities, when the general health is as yet unimpaired. Out of twenty-nine cases in which this germ occurred in abundance in the stomach, twentyfive were examples of cancer of the stomach. In the remaining cases cancer could not be diagnosticated. After observing this case for a period of about ten days, I concluded we were justified in making an exploratory incision to determine the actual condition of things. Accordingly an incision was made in a median line, and we found the lesser omentum involved in an extensive inflammation and was adherent to the surrounding intestines, full of nodules, and necessitated great care in freeing it from adhesions. After it had been freed, we were able to explore the stomach a little better, though not easily, as the left lobe of the liver had become involved on its under surface to the stomach generally, but particularly the cardiac end of the stomach. In gently freeing these adhesions, the stomach was entered, and much of its contents gushed out through the incision, although carefully washed out before operating. We were now a little further than desired, and owing to the nature of the stomach being in a soft, cheesy, degenerated and sloughy condition, we could not close it up, as no sutures would hold and the whole lesser curvature, including an inch and a half of the esophagus, was involved. So to complete as much as possible the work, we were compelled to remove the entire stomach, and hoped to be able to unite with a button the duodenum with the esophagus. This task was too difficult to do owing to the friable nature of the esophagus and inability to bring it out far enough to unite them. After several unsuccessful efforts, we abandoned this idea, and to make as finished a piece of work as possible, tied off the lower end of the esophagus and brought the pylorus into the wound and stitched it there, leaving an artificial opening. The patient stood the rather lengthy operation exceedingly well under chloroform and ether anesthesia. and rallied to consciousness promptly. He lived about twentyfour hours afterwards, dying from what appeared to be shock produced by the operation. Since writing the above, I noticed a recent article in American Medicine by MacDonald of San Francisco, bearing |