Volume 1

Abdominal surgery / by J. Greig Smith.

  • Smith, J. Greig (James Greig), 1834-1897.
Date:
1897
Catalogue details

Licence: Public Domain Mark

Credit: Abdominal surgery / by J. Greig Smith. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

    560/614 (page 538)
    Groups of cases have been reported in support of special methods of operating. Thus Magill,* in support of the method by decalcified bone plates, records 47 successful operations, being a percentage of recoveries of 77.05. Bowreman Jessetti records 5 operations so performed with 2 deaths. With the Murphy]; button the operation has been performed 27 times, with 9 deaths. In four of the successful cases the button dropped into the stomach ; but in none, it is said, did it give rise to any unpleasant symptom. On the other hand, using no special apparatus, Hahn§ records 14 gastro-enterostomies without a death. And Doyen|| has a record even more brilliant, with 21 operations and no death. The general mortality, at its best not under 30 per cent., seems almost too high for an operation intended not to save life, but only to prolong it, and that only for a few months. The cases of survival over a year or more are very rare : the average duration in cases of undoubted cancer cannot often be longer than six months. The operation having a purpose analogous to that of colostomy for cancer of the rectum, is inferior to it in respect of prolonging life and relieving pain, while it has a higher mortality. If after ten years’ experience we are likely to lose a third of our cases of gastro-enterostomy for cancer, it is doubtful whether the operation should be retained amongst justifiable surgical operations. The gratifying success of certain operators, such as Hahn and Doyen, promise to place the operation on a more favourable footing; and we may hopefully wait to see whether their good results will be extended. In cases not cancerous the operation will doubtless continue to have a legitimate application under the conditions specified. THE OPERATION. Preparatory.—The stomach should, if possible, be empty. But no special means, such as the stomach tube, causing worry and * Annals of Snrg., Sept., 1894. + Brit. Med. Journ., 1892, vol. i., p. 119. 4 Lancet, April 27th, 1895. § Dent. mcd. Woch., Oct. 25th, 1894. || Traitement Chirurgical des Affections de Vestomac et du duodenum, 1895.