Cases of ovariotomy / by Thomas Keith.

  • Keith, Thomas, 1827-1895.
Date:
1866
Catalogue details

Licence: Public Domain Mark

Credit: Cases of ovariotomy / by Thomas Keith. Source: Wellcome Collection.

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    and she had lost nearly all her teeth. She measured forty and a-half inches at the umbilicus, and nineteen inches from the ensi- form cartilage to the pubes. The tumour was very prominent at the epigastrium ; above the umbilicus there was a broad contraction in it running across the abdomen ; here adhesion was evident. Below the umbilicus there was coarse crepitus over a large extent. The left side of the vagina was depressed, and felt hard. The uterus was movable, and its fundus lay to the left, pushed down¬ wards by the tumour. Ovariotomy was performed on the 21st of November. Dr Matthews Duncan, Dr Gamgee, and other friends, were, present. The incision extended from two inches above the umbilicus, to seven inches below it. The adhesions were extensive and firm, the omentum came in between the tumour and wall, and was partly adherent to both. As it was a good deal torn, and bled freely, I cut away a piece the size of the hand. The tumour was veiy vascular, and there was more blood lost than usual. The pedicle was about an inch and a-half in length ; it arose from the right side of the uterus, and was secured by a clamp. Several vessels in the omentum and wall were ligatured, the ends being cut short. The pelvis was sponged from all blood, and the wound closed, by eight deep silk sutures. There was nowhere any pelvic adhesion, and no evidence m what way the fluid had escaped the year before. The left ovary felt normal in size, but it was adherent, and could not be brought into view. The cyst walls and contents weighed thirty-three pounds. The operation lasted an hour. She looked very pale on being put to bed; the pulse was 120. By evening she was in a profuse perspiration ; she had no pain, but cough was troublesome, and the pulse had risen to 130. She passed a very restless night from cough and vomiting. Next morning the pulse was 140; the respirations 36. The skin was hot at some places, perspiring at others; the mouth was parched, and there was a troublesome suffocative cough, with some tracheal rale. The heart was oppressed, and its action tumultuous. No respiratory murmur could be heard, only an occasional sibilant r&le. This state of matters continued all day, and sometimes she looked extremely ill. I thought of taking a little blood from the arm, but was deterred by the extreme feebleness of the pulse. A little brandy and soup were thrown up the bowel occasionally. Nothing was retained on the stomach, and as she always seemed relieved after vomiting, this was encouraged by drinks of tepid water. Every now and then the ribs were forcibly compressed by the hands, and she was made to cough up the phlegm which collected in the trachea. Towards evening she became more comfortable, and by midnight the heart and lungs were acting well, as also were the kidneys and skin. After the second day she went on well. There was profuse expec¬ toration, and severe cough for some days. The silk sutures were removed five days after the operation, and neither then nor subse-