Surgery has, as is well known, made great progress in recent years.
Apropos of this subject, we shall describe to our readers an operation
that was recently performed by one of our most skillful surgeons, Dr.
Terrillon, under peculiar circumstances, in which success is quite
rare. The subject was a man whose oesophagus was obstructed, and who
could no longer swallow any food, or drink the least quantity of
liquid, and to whom death was imminent. Dr. Terrillon made an incision
in the patient's stomach, and, through a tube, enabled him to take
nourishment and regain his strength. We borrow a few details
concerning the operation from a note presented by the doctor at one of
the last meetings of the Academy of Medicine.
[Illustration: FIG. 1.--FEEDING A PATIENT THROUGH A STOMACHAL TUBE.]
[Illustration: FIG. 2.--DETAILS OF THE TUBE. C, rubber tube for
leading food to the stomach, E; B B', rubber balls, which, inflated
with air by means of the tube, T, and rubber ball, P, effect a
hermetic closing; A, stopper for the tube, C; R, cock of the air
tube.]
Mr. X., fifty-three years of age, is a strong man of arthritic
temperament. He has suffered for several years with violent gastralgia
and obstinate dyspepsia, for which he has long used morphine. The
oesophagal symptoms appear to date back to the month of September,
1887, when he had a painful regurgitation of a certain quantity of
meat that he had swallowed somewhat rapidly.
Since that epoch, the passage of solid food has been either painful or
difficult, and often followed by regurgitation. The food seemed to
stop at the level of the pit of the stomach. So he gave up solid food,
and confined himself to liquids or semi-liquids, which readily passed
up to December 20, 1887. At this epoch, he remarked that liquids were
swallowed with difficulty, especially at certain moments, they
remaining behind the sternum and afterward slowly descending or being
regurgitated. This state of things was more marked especially in the
first part of January. He was successfully sounded several times, but
soon the sound was not able to pass. Doctors Affre and Bazenet got him
to come to Paris, where he arrived February 5, 1888.
For ten days, the patient had not been able to swallow anything but
about a quart of milk or bouillon in small doses. As soon as he had
swallowed the liquid, he experienced distress over the pit of the
stomach, followed by painful regurgitations. For three days, every
attempt made by Dr. Terrillon to remove the obstacle that evidently
existed at the level of the cardia entirely failed. Several times
after such attempts a little blood was brought out, but there was
never any hemorrhage.
The patient suffered, grew lean and impatient, and was unable to
introduce into his stomach anything but a few spoonfuls of water from
time to time. As he was not cachectic and no apparent ganglion was
found, and as his thoracic respiration was perfect, it seemed to be
indicated that an incision should be made in his stomach. The patient
at once consented.
The operation was performed February 9, at 11 o'clock, with the aid of
Dr. Routier, the patient being under the influence of chloroform. A
small aperture was made in the wall of the stomach and a red rubber
sound was at once introduced in the direction of the cardia and great
tuberosity. This gave exit to some yellowish gastric liquid. The tube
was fixed in the abdominal wall with a silver wire. The operation took
three quarters of an hour. The patient was not unduly weakened, and
awoke a short time afterward. He had no nausea, but merely a burning
thirst. The operation was followed by no peritoneal reaction or fever.
Three hours afterward, bouillon and milk were injected and easily
digested.
Passing in silence the technical details, which would not interest the
majority of our readers, we shall be content to say that Mr. X.,
thanks to this alimentation, has regained his strength, and is daily
taking his food as shown in Fig. 1. The aperture made in the stomach
permits of the introduction of the rubber apparatus shown in Fig. 2,
the object of which is to prevent the egress of the liquids of the
stomach and at the same time to introduce food. A funnel is fitted to
the tube, and the liquid or semi-liquid food is directly poured into
the stomach. Digestion proceeds with perfect regularity, and Mr. X.,
who has presented himself, of his own accord, before the Academy, and
whom we have recently seen, has resumed his health and good
spirits.--_La Nature._
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