Licence: In copyright
Credit: Surgery of the stomach / by Walter G. Spencer. 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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![extent, into the lands in the gastrocolic omentum along the greater curvature. Hut the chief importance from the surgeon’s point of view attaches to the involvement of the lymphatic glands about the head ol the pancreas. The Early Diagnosis of Cancer.—The interest of the surgeon is confined to the early diagnosis of cancer. The chief point is the existence of a tumour, generally in the position of the pylorus, occa- sionally in some other part of the stomach. It is not, however, by any means infrequent that no tumour is to be felt until the cancer is beyond removal, whether because the abdominal walls are fat or rigid, or the tumour is so soft, or because the pylorus is displaced, as is often the case. Because a pyloric tumour can be felt, it does not follow that it is malignant ; inflammatory thickening and adhesions may be felt ; also there are the rarer benign tumours of the stomach, cysts, polypi, papillomas and sarcomas. / As to the early symptoms, they are those of dyspepsia, or pyloric stenosis. Persistent small haemorrhages producing the coffee-ground vomit are very suspicious indications. Great attention has been paid to the question of the diminution of hydrochloric acid since Golding Bird, in 1842, found it so in a case of cancer. As an early sign the diminution of hydrochloric acid with the presence of lactic acid is a suspicious sign ; at any rate, hydrochloric acid is not increased in amount, but the acid may be much diminished or nearly absent in severe gastritis and atrophy of the mucous membrane. Therefore, the presence of a pyloric tumour with loss of flesh and gastric disturbance is an indication for exploration as well as the previously mentioned symptoms, where there is no ]ialpable tumour, viz., persistent “gastric stasis” and loss of flesh. To wait until the signs of cancer become liiore positive is to allow the opportunity for removal to pass away. (.5,) Gastrectomy.—The operation for removal of a cancer of the stomach can be traced in its evolution from earlier experiments and operations. Raindohr, of Wblfenbiittel, in 1727, resected two feet of gangrenous intestine in a case of inguinal hernia, and united the two ends by invaginating the upper into the lower bowel. The man died of pleurisy one year later, and a good union of the intestine was found. Astley Cooper made use of a double row of sutures in his experiments for gangrenous hernia, but seems to have rendered success impossible by allowing the ends of the sutures to hang out of the wound. Merrem, in 1810, experimented on dogs by removing the pylorus and joining the stomach to the duodenum ; but all his animals died. Lembert published Ins method of suture in 1826, and](https://iiif.wellcomecollection.org/image/b22369090_0037.jp2/full/800%2C/0/default.jpg)
