EDITOR'S TABLE. 



411 



I demonstrated the possibility of cutting out 

 sections of the oesophagus in large dogs, and 

 that the wound healed, leaving the oesopha- 

 gus slightly contracted but easily to be dilated. 

 Czerny was the first to caiTy out this opera- 

 tion successfully upon a human being. His 

 experiments to extirpate the larynx led to my 

 successfully removing a human larynx ob- 

 structed by a cancerous growth. In 1877 I 

 succeeded in performing the operation of gas- 

 teroraphy, which proved that no anxiety need 

 be entertained as to the gastric juices of the 

 stomach interfering with the scar-tissue so as 

 to bring about its solution. 



I have stated this for the benefit of those 

 who are of the opinion that my operation is a 

 reckless experiment on a human life. Such 

 an opinion can not be entertained for one 

 moment. The operation of cutting out parts 

 of the human stomach has, like any other 

 new operation, been prepared anatomic-phys- 

 iologically and technically by myself and 

 my assistants. Eveiy surgeon, having any 

 ex'perience in experiments on animals, and 

 similar operations upon the human body, ar- 

 rives at the conclusion that this operation 

 must and will succeed. Pean, the Paris sur- 

 geon, was of the same opinion. He attempted 

 the removal of a cancerous pylorus, about six 

 centimetres in diameter, in the case of a pa- 

 tient veiy much reduced by suffering, and 

 who died four days after the operation. His 

 method of operating, and especially his choice 

 of catgut as sewing material, did not seem to 

 me a good one. He has not attempted to re- 

 peat the operation, so far as I know, and no 

 other surgeon has ventured to undertake this 

 by no means easy task. 



CUTTING A CAJXCER FROM THE STOiMACH. 



The few cases which came under my no- 

 tice in the course of the past year did not 

 seem to me to be proper ones for a first op- 

 eration of this kind.. It was only recently 

 that the case of a woman was presented to 

 me where the diagnosis of a cancerous pylorus 

 was certain. After a few days of observation, 

 the patient assenting, I made up my mind to 

 undertake the operation. The woman, about 

 forty-three years of age, and mother of eight 

 children, was taken sick very suddenly, it 

 would seem in October, 1880, with vomit- 

 ing. The symptoms of cancer of the stomach 

 with stenosis of the pylorus soon shovred 

 themselves. The only thing she was able to 

 retain for any length of time was sour milk. 

 The preparations for the operation consisted 

 in accustoming the patient to peptonized in- 

 jections, and the cleansing of the stomach 

 by the well-known method of injection and 



pumping. The room, specially prepared for 

 the occasion, was heated to 24 Reaumur, and 

 the narcotic administered by one of my assist- 

 ants, every one of whom seemed to be con- 

 scious of the importance of the undertaking. 

 No interruption and not a minute of unneces- 

 sary delay occurred. The movable tumor, 

 lying a little to the right, seemed to be of the 

 size of an ordinary apple. A diagonal in- 

 cision about eight centimetres long was made 

 over the tumor, which proved to be a knotty 

 and infiltrated cancer of the pylorus, occupy- 

 ing more than a third of the lower portion of 

 the stomach. Separation of the adhesion to 

 the omentum and the transverse colon fol- 

 lowed ; then the division of the large and 

 small omentum. Every vessel was tied be- 

 fore being cut, the loss of blood being very 

 small. The tumor was turned out over the 

 abdominal walls, and a cut was then made 

 through the stomach, one centimetre beyond 

 the Infiltrated part, at first only backward, 

 then in the same manner through the duode- 

 num. The attempt to put together the edges 

 of the cut parts showed the possibihty of join- 

 ing them. Six stitches were taken through 

 the edges, but the threads were not yet tied, 

 and only used to retain the edges in position. 

 A further cutting through the stomach was 

 then made diagonally from the upper and 

 inner to the lower and outer side, but always 

 at a distance of one centimetre from the in- 

 filtrated portion of the coating of the stom- 

 ach. The next thing done was to join the 

 diagonal cut upward, until the opening was 

 small enough to fit the duodenum to it. A 

 complete separation of the tumor from the 

 duodenum was effected next by an Incision 

 one centimetre on the other side of the in- 

 filtrated portion, and parallel to the cut 

 through the stomach. Then the duodenum 

 was Introduced into the opening left in the 

 stomach. About fifty stitches were taken 

 with Czerny's carbolized silk. The whole 

 was cleansed with a two per cent, carbolized 

 solution. The stitches were then examined, 

 and a few more added where there seemed to 

 be weak spots. The whole was replaced in 

 the abdominal cavity, the outer wound closed, 

 and the bandages applied. 



The operation lasted about one hour and 

 a half. No weakness, no vomiting, and no 

 pain seemed to be apparent after the opera- 

 tion. The patient was given ice only In the 

 first twenty-four hours, then peptonized in- 

 jections with wine ; on the following day, at 

 first every hour only, then eveiy half-hour, a 

 tablespoonful of sour milk. The woman slept 

 the greater part of the night, with the aid of 

 a small injection of morphine. The only food 



