Mr. B-, aged sixty-two years. Symptoms for a year. Epigastric tumour noticed a month. No free HCl in vomit. Exploratory operation November 15th, 1900. Ring of cancer found, forming hourglass-shaped stomach. Patient too ill for gastrectomy. Posterior gastro - enterostomy performed. Good recovery. December 20th, a month later, partial gastrectomy performed, the ring of growth being removed and the proximal and distal ends of the stomach being fixed together over a large bone bobbin. Good recovery; returned home within the month. Quite well a year later. Letter from Dr. G-, November, 1902, to say that Mr. B- had put on flesh, gained colour, and been able to take food well for over a year, but bad succumbed to exhaustion from secondary growths in the omentum March 30th, 1902, about eighteen months after operation.
Miss B-, aged twenty-four years. Five years' history of stomach symptoms with great loss of flesh and recently coffee-ground vomit with tumour at epigastrium. Exploratory operation April 17th, 1902. Large tumour found involving the pylorus and anterior wall of the stomach. Enlarged glands rendered gastrectomy inadvisable. Posterior gastroenterostomy performed. Oood recovery and returned home on the nineteenth day. Seven months later Dr. W- wrote to say that the patient, who weighed 4 st. 5 lb. at the time of operation, on September 1st weighed 8 st. lh lb., thus nearly doubling her weight in five months, but that she had recently developed jaundice, possibly due to extension of the growth to the common bile-duct.
Mr. B-, aged thirty-six years, seen with a manifest tumour of the stomach October 26th, 1901, and with a history of stomach trouble extending over several years, with vomiting of blood and passage of melama on two occasions within the preceding four months. At the operation a large tumour involving the duodenum and pyloric end of the stomach, too adherent for removal, was found and gastroenterostomy performed. After the operation he went abroad and for six months he rapidly gained weight and felt very well. Fie then began to get thinner and lose strength, and without any pain he gradually lost strength and succumbed in September, 1902, eleven months after operation.
The patient was a married woman, aged thirty-seven years, who was seen with Dr. D-. Cancer of the body of the stomach and pylorus with dilatation was diagnosed. Gastroenterostomy was performed on December 21st, 1899. She made a good recovery and was so well that gastrectomy was advised, but cancer of the uterus supervened and prevented further operation. She lived for nine months and was able to take ordinary food.
The patient, a man,aged sixty-three years, had had symptoms for five years, at first those of chronic ulcer, later those of malignant ulcer with tumour associated with haematemesis. Gastroenterostomy was performed on March 22nd, 1901. He made a good recovery. He returned home at the end of the month and gained 4 lb. in weierht during the fourth week. He ultimately gained about 2 st. and lived for a time in great comfort, but the growth progressed and he succumbed to exhaustion about a year later, having been able to enjoy life for some months.
Mr. W-, aged sixty-eight years, operated on July 18th, 1902, for pyloric tumour with dilatation of the stomach, the patient being extremely feeble and suffering great pain. The disease appeared to be cancer, and the glands were extensively involved so that gastroenterostomy only could be performed. A letter from Dr. S- says : " Patient gained 10 lb. up to November, and is now 14 lb. heavier than before he fell ill last June. He is able to take regular exercise, and had never felt any pain after taking any meal whatever since the operation." He was well over three years later.
Other cases could be given, but these will suffice to show the beneficial effects of gastroenterostomy even in advanced cases of cancer of the stomach, for, as will be seen immediately, it is only in the cases too advanced for removal that the short-circuiting operation should be performed.
The operation can be done with little risk, as including all my cases of posterior gastroenterostomy for cancer performed during the past ten years the mortality is only 3.4 per cent.-a great contrast to the death rate of these cases a few years ago.
The remaining class of cases is of great interest, and includes those where the disease is limited to the stomach, and where the lymphatic glands and adjoining organs have not been seriously invaded, the patient being in a sufficiently good condition to permit of the radical operation of gastrectomy being done. The folloAving are examples :
Mrs. J-, aged fifty years. Symptoms five months: tumour noticed three weeks. Operation January 31st, 1901. Tumour found involving the whole circumference of the pyloric end of the stomach a sliort distance from the pylorus. After the growth had been widely excised the distal and proximal ends of the stomach were brought together over a large bone bobbin. Glands were excised from the lesser and also from the greater omentum. Smooth recovery. On January 4th, 1903, two years later. Dr. F- was kind enough to write and tell me that the patient was remarkably well. She remained well until 1905, when there were signs of recurrence.
Mrs. S-, aged fifty-four years. Loss of flesh and pain with failing health for eight months; slight jaundice and tumour in epigastrium, also right hypochon-drium for a shorter period. Operation August 9th, 1900. The gall-bladder, containing gall-stones, and the site of the tumour was removed. As the adjoining portion of the liver was involved, a wedge-shaped partial hepatectomy was performed, and as the pylorus was also the site of growth a partial gastrectomy including the pylorus was done, the cut section of stomach being united to the duodenum by two continuous sutures over a bone bobbin. The removed tumour examined microscopically after operation proved to be cancer. That part of the abdominal wall to which the tumour had been adherent was also excised. She was reported well in 1906.