The indications for surgical treatment in the diseases of the stomach / by J. Crawford Renton.

  • Renton, J. Crawford (James Crawford)
Date:
[1898]
Catalogue details

Licence: Public Domain Mark

Credit: The indications for surgical treatment in the diseases of the stomach / by J. Crawford Renton. Source: Wellcome Collection.

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

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    THE INDICATIONS FOR SURGICAL TREATMENT A lady brought to me by Dr. Campbell after six years of persistent dyspepsia, having the pain worst at one fixed point an inch below the lower end of the sternum, was completely relieved by an exploratory incision and the removal of an unobliterated umbilical vein attached by adhesions to the stomach. A third case sent by Dr. Orr M'Niven, a man, aged 35, had recurrent attacks of obstruction, due apparently to a tumour in the region of the stomach. On exploration the tumour could not be removed, but has since disappeared, and the patient is well. In addition to doing a great deal of good in inflammatory and tuber- culous cases, it is sometimes useful in staying the progress of malignant growths. No one has yet explained why simple incision does so much good, but there is no doubt that a change of government takes place some- where. 3. Cases in which the physician has no doubt as to what is wrong, but is anxious to delay surgical interference. The simplest of these are cases of dilatation of the stomach from fermentative dyspepsia. If washing out the stomach with antiseptic fluids and using massage is not sufficient, then gastro-enterostomy ought to be performed, or the operation of Professor Porter, of Boston, by which he puts a tuck in the stomach. When the dilatation is due to simple tumour of the pylorus, it may be either removed or gastro-enterostomy performed ; if caused by cicatricial contrac- tion at the pylorus, then splitting the pylorus vertically and uniting it transversely is followed by great success. Patients on whom I have operated continue well after five and seven years, which is long enough to test the value of operations. I would strongly urge the need of not delaying until patients are too weak to enjoy the benefits of operation. I was glad to hear Dr. Lauder Brunton strongly recommending gastro-enterostomy in cases of dilated stomach. . 4. Possibly in no other disease have such strides been made medically and surgically as in gastric ulcer. Some have been cut out previous to rupture, and soon, I hope, we may be able to diagnose them absolutely when the gastroscope is improved. When a gastric ulcer ruptures, the sooner it is operated on the better for the patient. The symptoms are so distinct that no delay should take place in the physician and surgeon being associated so that operation may be performed, and already a large number of cases have been operated on with gradually increasing success. The extravasation of much fluid into the abdomen so pinches the patient's vitality that, even with operation, until some modification takes place the mortality must be high. 5. In malignant disease at the cardiac end of the stomach with narrow- ing of the entrance we can often give great relief by using Simon's tubes or by a gastrostomy ; and this should not be too long delayed, for it rests the