Operative surgery of the gall tracts : with original report of twenty successful cholecystenterostomies by means of the anastomosis button / by John B. Murphy.

  • John Benjamin Murphy
Date:
1894
Catalogue details

Licence: Public Domain Mark

Credit: Operative surgery of the gall tracts : with original report of twenty successful cholecystenterostomies by means of the anastomosis button / by John B. Murphy. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    4-1- entire body, while the average amount of feces in the same time is five ounces. Fifth. The fragment of a sentence quoted by Senn, from Keen’s article, is such an inadequate representation of the scien- tific and fair manner in which this recognized authority treats the subject, that I venture to quote more extensively from it as follows, pages 6C0, 661: “The speed and certainty with which an anastomosis can be made once the bowel is prepared for it, are certainly advantages which the button possesses over all other means of anastomosis, whether by simple suturing or by bone plates, catgut or other rings.” “ It is certainly a most happy mechanical invention, especially the method of fastening it by what is practically a secure screw, and yet instead of being rotated in order to fasten it, it simply needs to be pushed home. The two projecting teeth which answer the purpose of the male screw, make it one of the most ingenious devices I have ever seen.” From Keen’s postscript I will quote the following, as showing the perfection of the union; “From the outside, one would almost think that it was the normal termination of the ileum in the colon; no more perfect union could be imagined.” In regard to the contraction found by Keen in the post-mortem which he reports, we are compelled to admit the force of the suggestion made to me by Dr. W. J. Mayo, that a vital point in the report of that post-mortem is omitted, namely, a comparison of the diameter of the ileum before operation and at the post-mortem. Before operation there was undoubtedly, with a chronic obstruction, dis- tention of the ileum. Did the opening contract more in propor- tion than the ileum itself, and was not the contraction of the open- ing due to the contraction of the ileum from its expanded, ob- structed, preoperative condition, to its normal, contracted, empty con- dition produced by a free escape at the anastomosis as found in the post-mortem ? An analagous contraction to this is shown in cases in which a cholecystenterostomy is performed experimental!}’; the opening which was originally the size of the button used is re- duced not by the contraction of the cicatrix, but by the contraction of the gall bladder, which after a number of weeks is reduced to the size of a cystic duct. Dr. C. E. Ruth, of Keokuk, in The Omaha September, 1893, sa}’s: “I wish to call especial attention to the specimen in which an approximation was made between the duodenum and the gall bladder. You see that what was a gall bladder has ceased to exist as such, and nothing remains of it but a duct. Its contraction has narrowed the opening which delivered
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