Gastric ulcers : their surgical treatment : two papers republished from The Lancet of June 8, 1901, March 29 and April 5, 1902 with an introduction and with brief notes of a case of operation for perforation of an ulcer of the duodenum and of a case of perforation of a cancerous stomach / by C.B. Keetley.

Keetley, Charles Bell, 1848-1909.

Date:: 1903

Credit: Gastric ulcers : their surgical treatment : two papers republished from The Lancet of June 8, 1901, March 29 and April 5, 1902 with an introduction and with brief notes of a case of operation for perforation of an ulcer of the duodenum and of a case of perforation of a cancerous stomach / by C.B. Keetley. 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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$thin. The orifice of the umbilical sinus was exceedingly small. There was an area of dulness to the left of and below it. The temperature was normal. The patient was now seen by Dr. Leonard Dobson, who im- mediately recommended operation and placed her under me. Operation. -0\\ October 27 I proceeded to operate. A sinus or cavity w<as traced, extending from two and a half inches to the left of and below the umbilicus, underneath the rectus, up to the lower surface of the diaphragm as far as the fingers would reach beneath the edge of the ribs. It contained granulations and much foul-smelling pus. The left rectus was divided, and after its anterior wall had beer freely slit up, the cavity was scraped, swabbed, and douched. Finally, a low counter-opening was made and three rubber drains were inserted, two between the stomach and the diaphragm and one from the umbilicus to the counter-opening. With regard to the after-history of the case, there was no pain, the wounds gradually completely healed, and the patient put on weight. She was discharged well on February 3, 1897. (The notes are by Mr. Ellacombe.) C.VSE 12. History suggestive of old perforation of the stomach ; more or less i*ecoveredfrom without operation; but the patient 7iot really well several years afterwards.—I may mention that 1 have had in the period covered by these hospital cases a private case with Mr. H. Scott Elliott and Mr F. W. Way of Southsea, in which the history and symptoms pointed to a perforation of a gastric ulcer fourteen months before with localised peritonitis and left pleurisjc The patient cannot be said to be really well yet, although there is nothing now which would quite justify oiDeration. She sufifers a great deal from a recurrent skin rash, and has o-'''asionally pain and discomfort in the gastric region. It is now four years since the first onset of gastric symptoms. Ca.se 13. Gunshot {revolver) perforation of the liver and stomach in a?t itifant suffering from rickets and whooping-cough ; a sloughing burn on the heel; laparotomy; death on the eighth day.—The patient, an infant, aged fourteen months, was admitted into the hospital at 9.45 a.m. on May 5, 1901. At 8.30 A.M. his mother, playing with him, accidentally shot him through the abdomen with a revolver, placed close to him. The bullet was found in the bed by Mr. Herbert W. Chambers, who cleaned and dressed the wounds and sent the child into the hospital at once The child was admitted crying and slightly collapsed. The pulse was 168, the temperature was 96-2° F'., and the respirations were 40. He was markedly rachitic and had whooping-cough. The collapse increased, and was combated by various usual means, including oxygen inhalation. There were two abdominal wounds, one in the middle line below the apex$

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