Harveian lectures on the mode of death from acute intestinal strangulation and chronic intestinal obstruction : delivered before the Harveian Society of London, 1884 / by Thomas Bryant.

Date:
1885
Catalogue details

Licence: Public Domain Mark

Credit: Harveian lectures on the mode of death from acute intestinal strangulation and chronic intestinal obstruction : delivered before the Harveian Society of London, 1884 / by Thomas Bryant. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    3-8 ANALYSIS OF THE WHOLE NUMBER OF EIOHTY-TWO CASES OF COLOTOMV. 60 were performed for cancerous stricture. If ,, ,, stricture and ulceration of the rectum not cancerous. 1 was ]ierfnrmed for volvulus of the sigmoid flexure of the colon. 2 for obstruction due to pelvic tumours. Side operated vpon :•— Left lunibar colotomy was performed in 77, and right lumbar colotomy in 5 of these cases, all of the & being cancerous. Right lumbar colotomy was called for in 1 out of 12 cases of cancerous stricture requiring operation. Duration ojlife after the operation:— 2(5, or 43 per cent., of the cancerous, and 6, or 31.5 per cent., of the non- cancerous cases, with one of the cases operated upon for obstruction, or 40 per cent, of the whole number of 82 cases operated uoon, died within the month. 34, or 56 percent., of thg cancerous, and 13, or 68.5 per cent, of the non- cancerous cases, with the case of volvulus and one of the cases of obstruction, or 60 per cent, of the whole number of cases operated upon, received, more or less fully, the benefit of the operation. OJ the 49 successful cases:— 16 cases, 9 cancerous and 7 non-cancerous, died within 6 months. 8 ,, 7 ,, 1 ■ ,, lived from 6 to 12 months. 12 1, 9 II 3 ,, lived from 1 to 5i years. 6 ,, 1 ,, 4 ,, were alive from IJ to 14 years after operation. 8 „ 8 ,, had left the hospital convalescent. 49 34 16 •Sex:— Of the 60 cancerous cases: 40 were in males, 20 in females. ,, 19 non-cancerous: 10 ,, 9 ,, 1 case of volvulus : 1 was in male. 2 cases of obstruction : 1 ,, 1 in female. Of the 82 cases: 62 were in males, 30 in females. Cancerous stricture is more frequent in males. Non-cancerous stricture is found equally in both sexes. Age :— The average age of the cancerous cases. When fatal was 53 : in male subjects 54, in female 51. ,, successful 44 ,, 46 ,, 41. The average age of the successful being about 10 years less than that of the fatal cases. No abnormality as to the position of the colon was met with in any of the 82 cases. [Continued from page 29.'] anus was very narrow. Two and a half years after the operation the man was well. He passed all his motions through his lumbar wound. The rectum was cicatricially almost closed. The third case was that of a man who, when 38 years of age, was dying from obstruction of six weeks' standing, the cause of which was not clear. He was a patient of Dr. Wilks. To save life, I opened the colon in his left loin, and with success. Four years later, he was alive and well. All his motions passed through the lumbar wound. No fresh light has been thrown upon his disease. I was, and am [disposed to think it was due to a twist of the sigmoid flexure. The fourth case was a patient of Dr. Habershoii, a man, aged 49, who had a recto-vesical fistula of three years' standing. The disease in his case was supposed to have been cancerous. I operated upon him to give relief to his bladder as much as to his intestinal symptoms, with no idea of helping towards a cure. He rapidly convalesced after the operation, and all his motions passed through his loin. Fourteen years after the operation. May 20th, 1884, he wrote to me as follows. I am glad to iaform you that the operation has been quite successful, as it has added nearly fourteen years to my life. I am quite free from pain, and I feel as strong as if nothing was the matter with me. Tlic contents of the bowel all pass through the opening in the back.