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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    tion was placed in the small ward she was to occupy afterwards, with the same nurse to attend her; her urine was drawn off at regular intervals; she was fed entirely by the rectum with pep- tonised meat suppositories (50 grains in each), alternated (to avoid the thirst induced by the suppositories given alone) with peptonised beef-tea or milk ; her temperature was taken regu- larly, and all her surroundings were similar to those which were to obtain after the operation and between its two stages. The result was, that though her temperature was 99.7° two days before the operation, it never went above 99.4° afterwards ; and during the five days between the two stages she was quiet and com- posed, being well accustomed to her position, and apprehensive of no ill; the edges of the stomach consequently united to the wound by first intention, and the one dressing first applied remained on till this was accomplished. On the fifth day the wall of the stomach was held up and punctured by a tenotomy knife; a No. 12 catheter was intro- duced into the viscus, and 5 oz. of peptonised beef-tea given to make sure all was right; but the rectal alimentation was con- tinued as previously, and only very gradually withdrawn, the stomach being allowed by almost imperceptible steps to supple- ment the rectum; and even then for days all food was digested before it was injected into the viscus by means of a funnel tube and catheter. The patient weighed 5 stones 6| lbs. before the operation, having lost 1 11). during the eight days she was waiting. On the ninth day from the opening of the stomach she weighed 5 stones 8^- lbs., and was well enough to be shown to the mem- bers of the East Kent district of the South-Eastern branch of the British Medical Association. She enjoyed 14 oz. of peptonised beef-tea in their presence, but told them that peptonised milk- gruel was more agreeable to her stomach. With regard to the operation itself, the patient was anaesthe- tised by bichloride of methylene from a Junker’s apparatus, and no sickness occurred at the time, nor afterwards. Antiseptic precautions were taken ; a warmed weak carbolic spray, 1 in 60, being employed, and balls of absorbent cotton-wool wrung out of carbolic acid solution, 1 in 60, used instead of sponges. The abdominal wound, nearly three inches in length, was made one finger’s breadth from, and parallel to, the cartilages of the eighth and ninth ribs, and extended towards the. tip of the tenth rib cartilage (a point always to be felt distinctly as a projection movable on the ninth cartilage, to which it is attached by a broad ligament). Three small vessels only required ligature, and fine chromic