A clinical lecture on seven cases of perforated gastric ulcer treated by operation, with three recoveries : delivered at University College Hospital on Oct. 20th, 1896 / by Arthur E. Barker.

  • Barker, Arthur E. J. (Arthur Edward James), 1850-1916.
Date:
[1896]
Catalogue details

Licence: Public Domain Mark

Credit: A clinical lecture on seven cases of perforated gastric ulcer treated by operation, with three recoveries : delivered at University College Hospital on Oct. 20th, 1896 / by Arthur E. Barker. 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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    energetic in her work. She had suffered from epigastric pain after food for some years. There had been no vomiting or hasmatemesis before this attack. At 2 p.m. on the 9th she had been attacked with severe epigastric pain, which gradually spread over all the abdomen. There was repeated vomiting, but no hasmatemesis. On admission on the 10th, at 5 P M., she was found to be pale, ill, and collapsed. The pulse was 160, small, and thready ; the respiration was 60, and chiefly thoracic. The abdomen was extremely distended and rigid and resonant everywhere, even over the liver and as high as the fourth space. There was slight dulness in the right side. The operation took place at 6.15 p.m., twenty- eight hours after the rupture. A median incision was made from the ensiform to the umbilicus, followed by a great escape of gas and yellow turbid fluid containing fragments of the last abundant meal, with return of the liver dulness and improvement of pulse. The stomach was strongly adherent by recent lymph to the parts around, and a firm, old, fibrous band, an inch long and as thick as a goose-quill, united it with the abdo- minal wall. This had to be divided in order to bring the perforation into view. This lay about the middle of the anterior wall of the stomach just below the edge' of the left lobe of the liver. It was surrounded by much old half- organised and recent lymph and the wall of the stomach around washtrdand gristly. The organ was now emptied by gentle pressure, green fluid escaping by the perforation. This manipulation had a very bad effect upon the pulse and respirations The lymph having been wiped away thoroughly from around the perforation the latter was closed as in the other cases with a double row of silk sutures. Then the same elaborate mopping with sponges introduced everywhere by hand was done and a drain opening was made in the left flank for a tube passing between the liver and the diaphragm. The closure of the wound over iodoform gauze strips was effected in the same way as in the other cases. The opera- tion lasted sixty-five minutes, during which time the patient’s condition was very critical. She only lived four hours, never having properly rallied. Case 6 —This patient, a housemaid aged seventeen years, was admitted to University College Hospital on Feb. 29th, 1896. Her history showed indigestion for six months, with pain a quarter of an hour after meals, which had become much worse during the last week. There was constipation,