New-York tribune., 1901-03-30
STOMACH AT LAST RENOVED.
WICHMAN LIVES AFTER THE OPERA
TION PERFORMED IN BROOKLYN.

The extraordinary operation Of total gastract-
omy, the entire removal of a patients stomach.
was successfully performed yesterday morning
at the German Hospital, St Nicholas-ave. and
StockhOlm-st. Brooklyn
Jacob Wichman. nearly sixty years old, came
to the hospital a charity patient. and was
first placed in the medical service of the hospital
for treatment for stomach disorder. In a short
time it was seen that the case had passed be-
yond purely medicinal measures, and that If
anything to be done for his relief it must be
through surgical interference. He was trans
ferred from the medical to the surgical service.
The patient readily acceded to the proposal that
an exploratory laparotomy be performed, with
the view of determining the extent of the can
cerous disease. and that further surgical inter
ference might be carried out then and there if
the conditions present indicated justified such
a
The patients friends. saying he was too weak
and feeble minded 10 judge for himself, served
a written request upon the authorities of the
hospital that the operation be not performed.
a few days ago. however, the patients son
visited the hospital. and left a signed paper, in
which he made the request that the surgeons
do whatever they thought best in the way of
surgical Intervention.
This. doubt. hastened by the recep-
ton by the patient Of a letter in which the
writer. a resident of Portland, Me, said that
his father man of seventy. had been similarly
operated upon, and living and in as good
health as a man OF seventy could be expected
TO be.
Yesterday at o'clock the patient was placed
upon the operating table. and the operation was
performed by the surgeon-in-chief of the hos
pital and his assistants. The anasthetic admin
istered was a combination of choroform and
oxygen. which has recently come into use and
been very satisfactory, particularly in the case
Of old and feeble individuals.
1t was found that both the point of entrance
and the exit Of the stomach were diseased. This
accounted for some of the complex symptoms
of the case. there being difficulty in the food
entering the stomach and when a portion had
gained entrance thereto exit from the stomach
obstructed. The small quantity of food
which found its way into the stomach accounted
for the absence Of dilation which Is quite fre-
quently present in obstructive disease at the
point Of exit. The condition. however, de-
manded total extIrpaton of the organ. and this
reSOrted 10.
The blood vessels supplying the stomach,
which also are largely concerned in its anchor
age. We're first tied and then divided. thus free
ing the stomach, except at the points Where II
joins the duOdenum. or second stomach, below.
and the gullet above. These points were Sc.
cured, particularly the former, so thdt none OF
the contents of the intestine could escape when
the stomach finally severed and removed
Following the removal Of the stomach the IN
! testine and gullet Joined together and Sc
cured by stitches. after which the external
wound was closed.
The operation lasted two hours, and the pa
/ tient left the operating table in apparently as
! good condition as when he was placed upon IL:
! Up late hour last evening he was reported
| by the hospital authorities as doing extremely
! well. The surgeons state that it will he neces-
sary for the first few days. or until the point OF
jonture is sufficiently healed. that no leakage
can occur, TO feed the patient preternatural.
When proper adhesions have been formed and
| sufficient -pretsotion assured at the point OF
| joining of the intestine and gullet he VIII be
/ fed by the mouth with predgested food Later
/ on he will be permitted TO partake OF certain
| food without predigestion. II is said 10 be as
| tonishing TO what extent food can be taken up
| which is not predigested. An explanation Is
| that two of the most important digestive fluids,
namely, the bile and the pancreatic juice, enter
| the digestive tract below thestomach, so that
| food taken is acted upon by them in the alb
/ sence Of the stomach. and that really the only
| foods which could be intellectually interdicted
would be those requiring pepsn for their di-
gestion. for instance, meats. Experience shows
| however, that even these in the shape Of meat
| hroths are al least we'll borne by the patient
| in some recorded instances Such, for example
| was the case first operated upon by surgeon
| in Switzerland.
| The difficulties I'm the way Of forming early
/ estimate of the conditions present in cases of
| suspected cancer Of the stomach have within the
| last wear suggested that the operation OF eX
| pioratory gastrotomy be performed. This con-
| ssts in making an inCision over the stomach
! and examining II with the finger. and If this be
insufficient, to enlarge the lnclSlOn, bring
| the stomach down within reach. open it. and
| both by inspection and the sense of touch obtain
a definite knowledge as TO its exact condition. 1t
/ is hoped by this means that many cases OF can
| Ger of the organ may be discovered sufficiently
/ early in the disease materially to lessen the
| mortality which now obtains in operations for
/ removal of the stomach. The risks attending
/ the operation of exploratory gastrotony are
sufficiently slight to warrant its frequent en-
! rllO