I demonstrated the possibility of cutting out sections of the oesophagus in large dogs, and that the wound healed, leaving the œsophagus slightly contracted but easily to be dilated. Czerny was the first to carry out this operation successfully upon a human being. His experiments to extirpate the larynx led to my successfully removing a human larynx obstructed by a cancerous growth. In 1877 I succeeded in performing the operation of gasteroraphy, which proved that no anxiety need be entertained as to the gastric juices of the stomach interfering with the scar-tissue so as to bring about its solution.
I have stated this for the benefit of those who are of the opinion that my operation is a reckless experiment on a human life. Such an opinion can not be entertained for one moment. The operation of cutting out parts of the human stomach has, like any other new operation, been prepared anatomic-physiologically and technically by myself and my assistants. Every surgeon, having any experience in experiments on animals, and similar operations upon the human body, arrives at the conclusion that this operation must and will succeed. Pean, the Paris surgeon, was of the same opinion. He attempted the removal of a cancerous pylorus, about six centimetres in diameter, in the case of a patient very much reduced by suffering, and who died four days after the operation. His method of operating, and especially his choice of catgut as sewing material, did not seem to me a good one. He has not attempted to repeat the operation, so far as I know, and no other surgeon has ventured to undertake this by no means easy task.
cutting a cancer from the stomach.
The few cases which came under my notice in the course of the past year did not seem to me to be proper ones for a first operation of this kind. It was only recently that the case of a woman was presented to me where the diagnosis of a cancerous pylorus was certain. After a few days of observation, the patient assenting, I made up my mind to undertake the operation. The woman, about forty-three years of age, and mother of eight children, was taken sick—very suddenly, it would seem—in October, 1880, with vomiting. The symptoms of cancer of the stomach with stenosis of the pylorus soon showed themselves. The only thing she was able to retain for any length of time was sour milk. The preparations for the operation consisted in accustoming the patient to peptonized injections, and the cleansing of the stomach by the well-known method of injection and pumping. The room, specially prepared for the occasion, was heated to 24° Réaumur, and the narcotic administered by one of my assistants, every one of whom seemed to be conscious of the importance of the undertaking. No interruption and not a minute of unnecessary delay occurred. The movable tumor, lying a little to the right, seemed to be of the size of an ordinary apple. A diagonal incision about eight centimetres long was made over the tumor, which proved to be a knotty and infiltrated cancer of the pylorus, occupying more than a third of the lower portion of the stomach. Separation of the adhesion to the omentum and the transverse colon followed; then the division of the large and small omentum. Every vessel was tied before being cut, the loss of blood being very small. The tumor was turned out over the abdominal walls, and a cut was then made through the stomach, one centimetre beyond the Infiltrated part, at first only backward, then in the same manner through the duodenum. The attempt to put together the edges of the cut parts showed the possibility of joining them. Six stitches were taken through the edges, but the threads were not yet tied, and only used to retain the edges in position. A further cutting through the stomach was then made diagonally from the upper and inner to the lower and outer side, but always at a distance of one centimetre from the infiltrated portion of the coating of the stomach. The next thing done was to join the diagonal cut upward, until the opening was small enough to fit the duodenum to it. A complete separation of the tumor from the duodenum was effected next by an Incision one centimetre on the other side of the infiltrated portion, and parallel to the cut through the stomach. Then the duodenum was Introduced into the opening left in the stomach. About fifty stitches were taken with Czerny's carbolized silk. The whole was cleansed with a two per cent, carbolized solution. The stitches were then examined, and a few more added where there seemed to be weak spots. The whole was replaced in the abdominal cavity, the outer wound closed, and the bandages applied.
The operation lasted about one hour and a half. No weakness, no vomiting, and no pain seemed to be apparent after the operation. The patient was given ice only In the first twenty-four hours, then peptonized injections with wine; on the following day, at first every hour only, then every half-hour, a tablespoonful of sour milk. The woman slept the greater part of the night, with the aid of a small injection of morphine. The only food
