Gastrostomy in malignant disease of the oesophagus / by T. Whitehead Reid.

  • Reid, T. Whitehead.
Date:
[1884]
Catalogue details

Licence: Public Domain Mark

Credit: Gastrostomy in malignant disease of the oesophagus / by T. Whitehead Reid. 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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    siuce Mr. Howse so strongly advocated and successfully practised its division into two stages, and since Mr. Bryant insisted on a mere puncture with a tenotomy kuife for opening the previously attached stomach. From the time (1849) of Sedil lot’s first gastrostomy for cancer of the oesophagus till Mr. Cooper Forster performed the opera- tion in England, the attempts to establish a permanent gastric fistula were peculiarly unfortunate; for beyond a certain amount of relief afforded for the remaining few days or hours of life, but little real good was done. Gradually the operation has been performed earlier, better methods have been employed, and antiseptic precautions taken, while progressively encouraging results have been obtained. Those who have watched to the bitter end cases of complete obstruction of the gullet from disease, who have seen the pangs of insatiable thirst, and viewed the horrors of slow dying from starvation, cannot but rejoice that such need no longer be the inevitable termination of such cases. It is surely just as impe- rative ou the surgeon to avert such a painful climax by a timely gastrostomy, as to perform tracheotomy for admission of air to a starved lung, or to do a colotomy for a bowel obstructed by disease. The report by my friend Mr. C. B. Gabb (in the Lancet for April 14, 1877) of the gastrostomy performed by Callender on a case of cancer of the oesophagus shows well the after troubles and dangers of the old method of operating, as also the compli- cations likely to arise from endeavours to pass bougies, especially in advanced cases and within too near a period of operating. Such attempts must, prior to the gastrostomy, court disaster, aod after the operation, in malignant disease are unwarrant- able. Though the power of swallowing frequently improves after the operation, the gastric fistula having once been established, feeding by the gullet should be discountenanced. As now executed, the operation itself is neither so difficult nor so dangerous as was formerly supposed, and every consideration {joints to the advisability of a more frequent resort to it at a far earlier period; not as a last resource, nor as a mere matter of euthanasia, but as an undertaking full of encouragemeut for the prolongation of life and staying of the progress of disease by establishing a state of physiological rest for the part morbidly affected. My friend Dr. Wilks of Ashford tells me he operated last autumn on a female patient, ait. 64 years, who had been rapidly emaciating. When he first saw her, she was only able to swallow a few drops of liquid at a time with great difficulty, and she also