On the surgical treatment of diseases of the stomach from a physician's point of view / by John Lindsay Steven.

  • Steven, John Lindsay, 1859-1909.
Date:
[1904]
Catalogue details

Licence: In copyright

Credit: On the surgical treatment of diseases of the stomach from a physician's point of view / by John Lindsay Steven. 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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    admission but for four months she had sufiEered from an uneasy “ rumbling ” in the stomach. She was transferred to the surgical ward on Oct. 1st for gastro-enterostomy but pylorectomy was performed as conditions seemed favourable when the abdomen was opened. The patient died the same day. Case 11.—The patient, a married woman, aged 67 years, was admitted on April 11th, 1902, and was transferred to the surgical ward on the 23rd. Pylorectomy was performed a few days later and death occurred on the same day. The following is a clinical summary of the case. “Tumour of the pylorus with considerable dilatation of the stomach. Palpable mobile tumour and visible gastric peristalsis. Duration of at least a year since a sudden attack of faint- ness and melsena in May, 1901; condition much worse the last four months, during which she had frequent vomit- ing attacks. Vomitus like that of gastric dilatation, with a minute trace of free hydrochloric acid but no free lactic acid. Bowels constipated but respond to aperients. Liver apparently free, though right extremity of the tumour may be adherent to its under surface. Very free mobility of the tumour as a whole.” On April 15th I concluded a long clinical note in the ward journal with the following sentence: “Pyloric obstruction, though great, is not complete, and emaciation, though considerable, is not extremely advanced. Pylorectomy does not seem from the medical aspect to be indicated but gastro-enterostomy certainly promises con- siderable relief.” On opening the abdomen the conditions for a radical operation seemed so favourable that pylorectomy was performed. Case 12.—The patient, a married woman, aged 42 years, was admitted to Ward 8 on Nov. 4th, 1902, on account of vomiting, constipation, emaciation, and a “lump” in the epigastrium associated with visible peristalsis. No haemat- emesis was present. The stomach symptoms had been troublesome for 15 years and were greatly aggravated since the previous January. In August she was seen in consulta- tion and gastro enterostomy was advised. On Nov. 7th no free hydrochloric acid was discovered in the gastric contents. Gastro-enterostomy was successfully performed on the 15th. The patient died at home on Dec. 29th. Case 13 —The patient, a married woman, aged 44 years, was admitted to Ward 8 on Nov. 17th, 1902. on account of stomach symptoms which were observed for the first time in June, 1902. She had been in residence in the preceding May for acute rheumatism and systolic murmur at the apex, when certainly no stomach symptoms were complained of. Since then she had been liable to vomiting every three or four days and emaciation had begun. On admission a large, palpable, freely moveable nodule was presented in the
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