Pylorectomy for carcinoma / by Carl Beck.

  • Beck, Carl, 1864-1952.
Date:
[1897?]
Catalogue details

Licence: Public Domain Mark

Credit: Pylorectomy for carcinoma / by Carl Beck. Source: Wellcome Collection.

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    Reprinted from the Clinical Recorder, July, 1897. PYLORECTOMY FOR CARCINOMA. By CARL BECK, M D. The early and extensive removal of carcinoma of the breast has rewarded the surgeon with successes of which, but a few years ago, he did not dream of. On the other hand, extirpation of the carcinoma pylori is still considered an extremely unpromising pro¬ cedure; and the reasons for this unfortunate state of affairs are obvious. A carcinomatous nodule in the breast, no matter how small it may be; can be seen as well as palpated, while a small nodule on the pylorus does not cause any perceptible symptoms at all, and will, therefore not be diagnosticated. It is only after the pain following each meal, the frequent vomiting, the cachexia, and the presence of a tumor in the pyloric region have originated the suspicion of a malignant growth, that operative steps will be considered. But when the peritoneal coat of the stomach, the adjacent serous surfaces, and the glands in the gas- tro-hepatic omentum have become involved, pylorectomy will, of course, be as unpromising an undertaking as amputatio mamma when the car¬ cinoma extends down to the intercostal space. As alluded to the presence of a small cancerous nodule in the py¬ lorus cannot be diagnosticated. But in the greater number of cases there is a period when the carcinoma, while it extends over a considerable portion of the pylorus or over its entirety, is still confined to the pylorus alone. In these cases a diagnosis can always be made; and pylorec¬ tomy, if done under proper precautions, yields a favorable prognosis. In these cases the salient point of success, as in many other surgi¬ cal diseases, is in the early diagnosis. First of all, it is to be considered that the carcinoma of the pylorus occurs only in patients of from forty to sixty years, the average age being about fifty-four. (Among a very large number of cases I have seen carcinoma pylori but once below forty. It concerned a lady of 35 years, which I regard most unusual. Pylorectomy being performed by me, I could easily verify the diag¬ nosis by the microscope.) The symptoms of the disease are vague at first, only slight disturbances of digestion, decrease of appetite, etc. being noted. Such symptoms are generally attributed to the assumed presence of a chronic gastritis; but if they occur in an individual of the age alluded to, and particularly if he has had an excellent digestion all through his life time, and could stand all kinds of food without noticing any disturbance, carcinoma should be suspected. As soon as the carcinomatous infiltration begins to narrow the lumen of the pylorus, the symptoms become typical. Pain, nausea, and vomiting set in, stagnation of the meals producing permanent indiges¬ tion. Anacidity as well as the presence of the lactic acid in the juice of the stomach will also be noted. In far the greater majority of cases