212 STOMACH DIGESTION. 



Schlatter's Case. On September 6, 1897, Carl Schlatter of 

 the University of Zurich, performed on a woman, aged fifty-six 

 years, the operation of esophago-enterostomy ; the patient being 

 the subject of diffuse carcinoma of the entire stomach. In this 

 operation the entire stomach was removed and the esophagus 

 attached to the jejunum, it having been found impossible to 

 approximate the esophagus and duodenum. We are indebted to 

 the New York Medical Record of December 25, 1897, and March 

 18, 1899, for the history of this case. This article contains intro- 

 ductory remarks by Dr. E. C. Wendt, of New York, and a descrip- 

 tion of the operation and subsequent history of the case by Dr. 

 Schlatter. 



So completely was the stomach removed, that at the cardiac 

 end of the extirpated organ esophageal tissue was demonstrated 

 to be present, as was also the pylorus at the other extremity. 

 The patient lived fourteen months after the operation, during 

 twelve of which she was free from suffering and gained in weight. 

 Her death was due to general cancerous infection proceeding from 

 a carcinoma of the mesenteric lymph-glands. It is the opinion 

 of those familiar with the case that it was not attributable in any 

 degree to the operation nor to absence of the stomach. 



Shortly after the operation an enema containing brandy and 

 two eggs was given. The first day after the operation two 

 enemata were administered containing milk, eggs, and brandy, 

 and later in the day a small quantity of tea and milk by the 

 mouth, which was retained. On the second day the enemata were 

 not retained, and claret wine was given by the mouth. On the 

 third day, small quantities of milk, eggs, bouillon, and wine were 

 given by the mouth, and pepsin and hydrochloric acid. On the 

 seventh day a little scraped meat was given, and the following 

 day the bowels moved for the first time. Occasionally there was 

 some regurgitation of milk, but no actual vomiting until the tenth 

 day ; on that day, and subsequently, the patient took the following 

 food: 7 A.M., a cup uf milk with one egg ; 9.30 A.M., same; 

 dinner (time not stated), very soft scraped meat or cup of thin 

 gruel with an egg ; 4 P.M., cup of milk with egg ; 7.30 P.M., cup 

 of milk or gruel. Besides these, she took tea and Malaga wine, 

 amounting in the course of the day to from 140 c.c. to 200 c.c. 



On the tenth day the patient vomited for the first time since 

 the operation. The vomiting was preceded by nausea, and w r as 

 apparently superinduced by the patient having witnessed a change 

 of dressing in a neighboring surgical case. There was a good deal 

 of retching, and about 200 c.c. of bilious and slightly acrid fluid 

 were ejected. On the twentieth day she ate half a chicken, and 

 later milk and an egg. About three hours after eating the chicken, 

 and one hour after the milk and egg, she vomited about 280 c.c. 

 of milk and meat-fibers. This was accompanied by retching and 

 marked contraction of the abdominal muscles. On subsequent 



