Pathology and clinical significance of stomach ulcer : from a study of the material from 216 partial gastrectomies for ulcer, ulcer and carcinoma, and carcinoma / by Wm. Carpenter MacCarty.

  • MacCarty, William Carpenter.
Date:
1910
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Licence: In copyright

Credit: Pathology and clinical significance of stomach ulcer : from a study of the material from 216 partial gastrectomies for ulcer, ulcer and carcinoma, and carcinoma / by Wm. Carpenter MacCarty. 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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    Reprint from SURGERY, GYNECOLOGY AND OBSTETRICS May, iqio, pages 44Q--/62 o10 PATHOLOGY AND CLINICAL CE OF STOMACH ULCER From a Study of the Material from 216 Partial Gastrectomies for Ulcer, Ulcer and Carcinoma, and Carcinoma By YVM. CARPENTER MacCARTY, M. D., Rochester, Minnesota Associate Pathologist to St. Mary’s Hospital IN the history of the study of ulcer another period may be recorded, and that is, the observation of ulcer in the living indi- vidual as seen at operation and imme- diately after removal. With the improvement of legal right and individual submission to more scientific examination, trained obser- vation, and surgical dexterity, our knowledge has increased in a systematic and orderly manner until to-day we are in a better position to confirm and add to the remarkable observa- tions and records of Baillie, Abercrombie, Cru- veilhier, Morgagni, Rokitansky, Muller, Heit- ler, Waldeyer, Hauser, Welch, and others in passing successively from purely autopsy find- ings, and autopsy and clinical findings, to the immediate examination of early ulcers during and after resection. The cases herewith presented are a part of the material examined freshly within two minutes after removal from two hundred and sixteen resections of the stomach for ulcer, ulcer and carcinoma, or carcinoma, in the clinics of Drs. W. J. and C. H. Mayo. The material divides itself grossly and mi- croscopically into three groups. These groups comprise two hundred and sixteen cases, fifty- eight of which are ulcers, one hundred and twenty-five ulcer and carcinoma, and thirty- three carcinoma without any good evidence of ulcer. The last two groups will be con- sidered in this paper. Group one comprises cases which, at operation, were ulcers which were resected for ulcer with possibly car- cinomatous borders. Upon examination, grossly and microscopically, no evidence of carcinoma was found. Group two is con- sidered here because the specimens present all the characteristics of ulcer grossly and mi- croscopically, with the additional feature that the borders contain definite areas of carcinoma microscopically. Specimens in this group show the base of the ulcer free from carcinoma and consisting only of granulation and scar tissue. In order to show that up to the present time we cannot say absolutely that all gastric carcinomata develop on ulcer and that some ulcers do show carcinomatous remnants in the base, and may be ulcerated primary carcinomata, it may be well to show some ad- vanced cases of ulcer and carcinoma. From the pathological standpoint during the ob- servations the following questions arose: What is the life history of gastric ulcers, e. g., how do they begin, progress, and ter- minate? What are the gross and microscop- ical characteristics, and how do they differ from the so-called ulcerated, gastric carcinomata? From a clinical diagnostic standpoint: Can one be sure that one is dealing with the simple ulcer, and what are the chances for its not being a simple ulcer? From a therapeutic