Medical versus surgical means of diagnosis and treatment of gastrointestinal diseases : the burning question in medicine / by Anthony Bassler.

  • Bassler, Anthony, 1874-
Date:
1912
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Licence: In copyright

Credit: Medical versus surgical means of diagnosis and treatment of gastrointestinal diseases : the burning question in medicine / by Anthony Bassler. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    of these mistakes been due to ? During the last years gastroen- terostomy has become a common operation, and still the only conditions in which it is helpful are stenoses to the onward flow of chyme in the stomach and chronic duodenal ulcer, and these comprise but few of all cases that are seen. Even though it is true that the duodenal ulcers are prone to chronicity from the start, why is it that at autopsies ten ulcers of the stomach are found to one of the duodenum, and that at operation more duodenal are met with than gastric ? Is it only because they are not diagnosed, or do the majority of them heal at some time? I think that both are true, and wish to state that if more of them were diagnosed and treated by three weeks bed and diet and six months dieting afterward, that about one-fourth of all would heal which are today meeting with surgery therefor. Since four-fifths of all gastric ulcers are in the lesser curvature in the posterior wall of the stomach—a surgical inaccessible place—and since gastroen- terstomy in a curative way is helpful in only a small proportion of them and partial gastrectomy is such a serious matter, should every chronic gastric ulcer be operated upon? This is a moot question, for most should be and others should not. The strongest argument in favor of generous surgery is in the prevention and saving of life from malignant disease. Ac- cording to some surgeons, old ulcers are the basis of this in the majority of instances. Careful autopsies on those who have died of malignant disease of the stomach do not prove this to be true. If carcinoma can develop in a gall-bladder which has no stones, the head of the pancreas which is well protected from trauma, in a uterus which is freely suspended and only the erosion of the cervix of which can be taken as a probable pre- disposing factor, in the distensile and simple mucous membrane of the rectum, and in the breast of virgins who have not even had a definite trauma, then we have a right to believe that it may develop in the stomach too without an ulcer having first been there. The usual step in the process of degeneration of epithelial tissue is hyperplastic before it becomes atrophic, and degeneration may take place from general as well as simple local causes. Such hyperplasia means small nound cell infiltration, and if it were not for collection into carcinoma nests you could not tell the difference between the tissue of simple inflammation and malignant disease, for the cells of both look just alike. May not then, such local inflammation in susceptible individuals, which can come from causes other than ulcer, continue in the cell proliferation with the development of malignant disease? I think so, for cancer does not kill by the disease alone, it kills because of pressures, hemor- rhages, perforations, and deadening interference with the func- tions of important organs. In Mayo’s review of 266 partial gastrectomies for cancer of the stomach, the condition of 191 of which was known three years