Possible errors in the diagnosis of abdominal cancer : a plea for exploratory laparotomy illustrative cases / by William Seaman Bainbridge.

  • Bainbridge, William Seaman, 1870-1947.
Date:
[1913?]
Catalogue details

Licence: In copyright

Credit: Possible errors in the diagnosis of abdominal cancer : a plea for exploratory laparotomy illustrative cases / by William Seaman Bainbridge. Source: Wellcome Collection.

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    POSSIBLE ERRORS IN THE DIAGNOSIS OF ABDOMINAL CANCER—A PLEA FOR EXPLORATORY LAPAROTOMY -ILLUSTRATIVE CASES.* By WM. SEAMAN BAINBRIDGE, Sc.D., M. D. New York. Professor of Surgery, New York Polyclinic Medical School and Hospital; Surgeon, New Y ork Skin and Cancer Hospital; Consulting Surgeon, Manhattan State Hospital; Tarry town Hospital, etc. NOT so many years have elapsed since the abdominal cavity was a veri¬ table terra incognita. In many respects, and to some physicians and surgeons, it is still a world of mystery. It has furnished a convenient hiding place for many of the budgets of diagnostic error which have made so large a part of the history of medicine and surgery. And yet, within its hidden recesses have been performed some of the most brilliaut and daring feats of surgery. With the general progress in medicine and surgery wrhich has marked the last quarter-century, modern methods of diagnosis, chemical, bacterio¬ logical, physical, and electrical, have brought us into more intimate ac¬ quaintance with the abdominal cavity and the diseases to which its contents are subject, enabling us, with a fair degree of accuracy, to predict what will be revealed by operation. In many cases, however, it is impossible, by any external diagnostic methods, to ascertain the exact conditions to be dealt with, and consequently we aie unable to apply effectual remedial agencies. In such cases exploratory laparotomy comes into requisition. The purpose of this brief paper is to emphasize, not by statistics, but by illustrative cases, the importance of exploratoiy laparotomy, not as a last resort, but as an early means of making an absolutely correct diagnosis, not only as to the presence and extent, but as to the site of cancer. The most telling arguments in favor of opening the abdomen and seeing and feeling the actual state of affairs, are cases in which patients have been allowed to go untreated, or to be incorrectly treated, until it is too late for curative surgical intervention, and cases in which, through inexperience, perhaps, the surgeon is unable to make the correct diagnosis even when the abdomen is opened. More frequent resort to exploratory laparotomy, and the de¬ velopment of skill in differential diagnosis when this is done, would be the means of saving many lives, and of prolonging the span of many more, where otherwise mistakes in diagnosis must inevitably lead to disastrous results, as some of the appended histories show. The following cases, the number of which might be multiplied many times, from the experience of the abdominal surgeon, are selected to illus¬ trate the six most common sources of error in the diagnosis of abdominal cancer. Type I. Cases diagnosed as Cancer, with no Cancer Present.—This is not an uncommon class of cases, for the reason that there are so many conditions which, without exploratory laparotomy, may be so easily mistaken for cancer of some portion of the abdominal contents. The real condition may be easily amenable to surgical intervention and cure, yet the patient may be considered incurable and operation of too little avail to warrant the supposed contingent risks. The following are the conditions which are most commonly mistaken for abdominal cancer ; i. Appendicitis with abscess formation (Case i, Type I). 2. Tuberculosis of kidney, liver, spleen, etc. (Case 2, Type I). 3. “Stomach trouble”—healed ulcer, with pyloric stenosis (Case 3, Type I). 4. Stone in kidney, with cachexia, etc. (Case 4, Type I). 5. Gallstones. ♦Read at the annual meeting of the Medical Society of tbe State of New York, at Rochester April 29, 1913. (0