REMOVAL OF THE HUMAN STOMACH. 



217 



to arrest putrefactive changes in the intestinal tract. Its antiseptic 

 and bactericide potency has been overestimated." 



Brigham's Case. Dr. Charles B. Brigham, of San Francisco, 

 California, on February 24, 1898, completely removed the stom- 

 ach from a woman, sixty-six years of age, affected with adeno- 

 carcinoma of the stomach, involving one-half the organ, and sub- 

 sequently connected the esophagus with the duodenum, thus 

 performing the operation of esophago-duodenostomy. This case 

 is described by Dr. Brigham in the Boston Medical and Surgical 

 Journal of May 5, 1898, and to this journal we are indebted for 

 the details. 



In this case the operator was able to bring the duodenum 

 up to the esophagus, which was not possible in Schlatter's 

 case, and the two were approximated by 

 means of a Murphy button (Fig. 114) 

 instead of by sutures. Fig. 113 shows 

 anterior view of the diseased organ after 

 removal. 



After the operation the patient was nour- 

 ished at first by enemata of brandy and water, 

 eggs, milk, and broths. During the evening 

 of the day of the operation the patient vom- 

 ited some bloody mucus. On the following 

 day hot water was given by the mouth, 

 which relieved the intense thirst. On the 

 second day claret and water, hot black 

 coffee or chicken-broth was given, but 

 after two teaspoonfuls there was no desire 

 for more. On the third day double this 

 quantity was taken each time, and on this 

 day the bowels were moved for the first 

 time. The nutrient enemata were given 

 every four hours up to the fourth day, 

 when they were discontinued. On the 

 sixth day she was taking about 22 c.c. at each feeding, but could 

 take no more. This quantity, however, was gradually increased. 

 About three weeks after the operation she took for breakfast a 

 cup of coffee with milk, a soft-boiled egg, and a third of a baked 

 apple ; at noon, a cup of green-pea soup, a dozen small oysters, 

 and an olmce of milk ; in the afternoon, some orange-jelly, one 

 raw egg, half a cup of pea soup, and a dozen oysters ; in the even- 

 ing, half a cup of asparagus soup, with 14 c.c. of whiskey and 42 

 c.c. of wine. During convalescence the patient vomited food once, 

 and on another occasion some mucus. About a month after the 

 operation she complained of hunger, and ate a squab. About ten 

 days later she ate in one day the following : At 6.30 A.M., cup of 

 coffee and a raw egg ; at 10 A.M., two dozen small oysters and a 



FIG. 114. Murphy but- 

 ton (enlarged) : A, open ; 

 B, closed, 



