One of the most extraordinary operations in the annals of surgery has been performed recently in the extreme West, and deserves to be recorded on account of its boldness, successful result, and for the judicious method of procedure adopted by the surgeon. A man named Bates, on Christmas day, in Wapello, Iowa, performing some tricks with a bar of lead, accidentally swallowed it.
They know how to enjoy themselves in Wapello, Iowa. A bar of lead is not an obviously promising prop for conjuring tricks, it must be said.
He went at once to Dr. Bell of that place, but being tipsy his story was not believed, and for four days he continued at his work, until the violent vomiting, abdominal soreness and loss of strength, compelled him to desist. The physician, finding that it was, indeed, true that he had swallowed the bar of metal, determined upon the operation of Gastrotomy.
Gastrotomy is the creation of an artificial opening to the stomach. It’s most often employed today to enable artificial feeding, although veterinary medicine also does a roaring trade in gastrotomies to remove foreign objects from the stomachs of naughty dogs.
Operation.—Wednesday, Jan. 3d The patient seemed much as on the previous evening. He had great prostration and faintness on attempting to rise. The patient having been properly placed and secured, chloroform was administered. It produced, at first, some nausea, and he threw up a quantity of black, foetid, watery fluid. As soon as insensibility ensued, I made an incision from the point of the second false rib to the umbilicus, dividing the skin and cellular membrane; thence through the abdominal muscles to the peritoneum, which I laid bare the whole length of the incision. I then made a minute opening at the lower end of the section, through the peritoneum, passed in the director, and with a probe-pointed bistoury divided it through the entire length of the incision. The division of the peritoneum produced a spasmodic contraction of the muscles of the abdomen, and a large quantity of the omentum and bowels was ejected from the orifice.
Increasing the chloroform controlled the spasm, and I replaced the bowels as speedily as possible, and passed my hand inward and upward through the incision, grasped the stomach, and immediately discovered the bar of lead and its position. It lay in a direction from right to left, the upper end resting against the walls of the stomach to the right of the cardiac orifice; the lower end in the greater curvature of the stomach, to the left of and below the pylorus. As it was impracticable to reach the upper end, I seized the bar between my thumb and middle finger, and with the forefinger on the lower end of it, I retraced it upward and backward, for the purpose of making the incision in the stomach as high up as possible. I then passed a scalpel in, along the side of the forefinger as a director, and divided the coats of the stomach immediately at the end of the bar, making the incision parallel with the muscular fibres, and not larger than to admit of the removal of the lead. I then introduced a pair of long forceps, seized and drew out the lead, and placed the stomach in its natural position. The external orifice was closed with the ordinary interrupted suture and adhesive straps, a compress applied, and a roller around the body.
The time occupied in operating was twenty minutes. Considerable delay was occasioned by the protrusion of the contents of the abdomen, which had to be replaced before the operation could proceed. As soon as the effects of the chloroform passed off, a quarter of a grain of sulphate of morphia was administered, and the patient left in charge of a judicious medical attendant. The after treatment of this case was simple, the patient was kept quiet—permitted to eat but little, and the operator had the pleasure of seeing him walking about on the 14th day convalescent.
This blog takes great delight in laughing at the occasional foibles of early medicine, so let me make clear that Dr Bell deserved all the plaudits he received for this operation. He was working in a rural backwater, with the most basic of equipment, and to have succeeded in a major abdominal procedure at such an early date is hugely impressive. No less impressive was the size of the object his patient had somehow managed to swallow:
The length of the bar was 10¾ inches and its weight 9½ ounces.