The Indianapolis journal. [volume] (Indianapolis [Ind.]) 1867-1904, 1897-12-26
THAT STOMACH REMOVAL
DIR. sCHLATTER A CLAssMATE OF
DIR. RURCKHART, or THIS CITY.
Remarkable Case Technically De-
scribed-EquaIIy Great Operation In
This City, Says DIR. Brayton.

iOiiS account OF the operation recently per-
formed in Zurich, Switzerland by DR.. Carl
Schlatter. in which he removed woman's
stomach. From the fact that this is the
first case on record where a human being
has lived without a stomach, the case is
considered a most remarkable one. 1t has
already attracted the attention of surgeons
and physicians throughout the civilized
world and is being discussed in the medical
journals everywhere. While it was pub
lished only yesterday in the daily papers OF
the United States. a number of medical
journals have already published accounts
of it.
DR.. Louis Burckhardt, of this city, is a
native Swiss, was in school with Schlatter
and knows him intimately. Further than
this, DR.. Burckhardt is a member of the
Central Medical Society of Switzerland, of
which DR.. Schlatter is also a member.
Oct. 80 DR.. Schlatter read paper describ-
ing in detail the operation of removing the
stomach of Anna Lands. 1t was at the
fftyfourth annual meeting of the Central
Medical Society held at Zurich. The PAPER
was published in full with illustrations Dec.
in the Correspondent Zeitung, the official
organ of the society. DR.. Burckhardt has a
copy of that paper containing DR.. Schlat-
ter's paper. 1t is a long article and was
written fer medical men.
THE TECHNICAL DESCRIPTION.
The part describing the actual work of
taking out the stomach and connecting the
oesophagus directly to the intestines, trans
lated freely, is as follows:
II first freed the stomach from all it's at
tachments at the greater and lesser curva-
ture, having previously shut off the general
cavity of the peritoneum by sterilized COM
presses The omentum was incised between
Pean'S forcepS. Silk sutureS were used
The stomach was then forcibly dragged
downward as to enable me to reach the
oesophagus. The left lobe of the liver had
to be constantly held upward by an assist
ant in order to permit me to freely manlpu-
late within the field of operation. In this
way / finally succeeded in securing the
CeSophaguS, rather high up, by means OF q
Wolher clamp.
"A Stille forceps was next fastened close
iy to the cardiac end of the tuEor. Then the
stomach was severed directly beneath the
oesophageal extremity. AS the oesophageal
incision appeared somewhat oblique, / pro-
ceeded to place small occluding suture at
the gastric wound The same steps We're
now repeated at the pyloric end of the
stomach.
II next modified the duodenum as far
as possible towards the head of the PAN
creas. Then, having applied duodenal
compressor and likewise a tumor clamp, l
removed the entire stomach, between the
two points of compression. | also disSected
out the Emphatic nodes. The patent lumen
of the duodenum was treated like the oeso-
phageal opening, with iodoform gauze me
broad bridge joining together different divi-
sionS of the alimentary canal had now
been entirely removed.
JOINING THE PARTS.
"T next tried to pull the duodenal opening
upward toward the oesophageal cleft. 1t
was only with considerable difficulty that
the two could be made to touch. 1t was
manifestly impossible to join them by direct
suture. L therefore invaginated the duo
denial rim, and closed the opening by a
double suture. I then searched for a suit
able coil of small intestine. Beginning at
the duodenal-jejuna fold [ followed down
the intestine for about fifteen inches. The
present knuckle of intestine / grasped, and,
pulling it over the transverse colon, placed
it against the oesophageal slit
"a piece of this intestine, about five
inches in length, was secured between two
Wolfier clamps. BY means of sutures not
going deeper than the serous coat the in
testine was then attached to the oesoph-
ageal stump A longitudinal slit, about one
inch in length, was then made into the
bowel. Then the mucous membrane of the
oesophageal end was firmly united with the
intestinal mucous membrane by a continu-
Gus circular suture. The material en-
ployed was silk Above this, a second
suture, extending through the muscular and
suture finally completed the stitching, which
now seemed to hold
The oesophageal and duodenal clamps
were then removed, the former having re-
manned in position for over two hours On
dropping back the organs into the abdom
inal cavity the sutured portions showed
marked retraction upward, toward the
oesophageal part of the diaphragm. The
abdominal wound was closed in the ordinary
way by silk ligatureS.
Less than eight ounces of ether had been
employed during the necrosis. which had
fortunately been very quiet one.
The patients pulse after the operation
was ninety-six a minute, steady and of
fair volume
There had been only very slight loss
OF blood during the course of the operation
which, however, lasted nearly two hours
and half
SUCCESSFUL OPERATIONS BEFORE.
In the beginning of his paper DR.. Schlat-
ter very modestly states that the operation
of removing the stomach had been per-
formed before, and mentions the names of
Kroeein, Maydl Hacker Langenbuch and
Schuchardt as physicians who had made
successful operations in that line. Dr.
Burckhardt says that this does not do DR..
Schlatter full justice, for in no case record
ed has the full stomach ever been removed.
Seven-eighths of it has been removed but
there has always been left, in other cases,
the connections between the oesophagus
and the stomach and the stomach and the
intestnes. In some cases the surgeon has
recognized the fact that the stomach was
valueless as an organ and has practically
removed it, but the connections have al
ways been left. Dd. Schlatter's was a holder
case. 1t was necessary to remove the entire
stomach. He had to cut the oseophagus off
close to the stomach and sever the stomach
entirely from its connection with the intes-
tines. The problem was to unite the intes-
tines and the oesophagus The end of the
intestine which had been attS aed TO the
stomach could not be made to reach the end
of the oesophagus. Attached close to this
end were the connections with the liver and
pancreas, and it was necessary that the
means of these organs diScharging them
selves be not disturbed. DR.. Schlatter
caught the intestine up about fifteen inches
from the upper end and made an opening in
1T into which the end of the oesophagus was
fastened. He then sewed up the end of the
intestine where it had connected with the
stomach. This placed the opening from the
liver and pancreaS above the opening from
the oescphagus, but this was probably for
tunate, inasmuch as the discharges from
these organs were now to be called upon to
perform the work formerly done by the
juices of the stomach
The operation was performed Sept. g. and
two months later the woman was up and
at work in the hospital. She left her bed
Oct. Is. Her food is not greatly different
from that used by people who have good
stomachs Apparently there are but two
differences which she must observe in eat
ing. She must masticate the food well. for
the motion of the stomach is n