Cases of tuberculous disease of the uterine appendages and peritoneum / by Alban Doran.

  • Doran, Alban H. G. (Alban Henry Griffiths), 1849-1927.
Date:
1893
Catalogue details

Licence: Public Domain Mark

Credit: Cases of tuberculous disease of the uterine appendages and peritoneum / by Alban Doran. 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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    CASES OF TUBERCULOUS DISEASE OF THE UTERINE APPENDAGES AND PERITONEUM.1 By ALBAN DORAN, F.R.C.S., Surgeon to the Samaritan Free Hospital, London. Primary tuberculous disease of the peritoneum is a disorder more or less hypothetical, in the eyes of the pathologist. This implies that the primary disease, of necessity tuber- culous, lies somewhere else, a matter of great importance to the physician and surgeon. We all know the insidious character of tuberculous peri- tonitis ; diagnosis is often difficult. In this communication I shall assume that the disease is correctly diagnosed, or at least strongly suspected, as arising in the genital tract, and I limit my observations to female patients. How far the treatment should be expectant and how far operative I cannot precisely determine. That is why I have chosen the subject of tuberculous disease of the female internal organs. I seek other opinions. Purely expectant treatment is not always satisfactory. Tubercle of the appendages may, in its later stages, involve the worst complications so familiar in tabes mesenterica, with the additional torments of listulous tracks in the groins and vaginal fornices. The presence of tubercle in the ovaries and tubes certainly endangers organs and parts where tubercle may kill or cripple. Again, experience shows that operative measures do good, even though it is not certain how that good is done. On the other hand, we must be slow in urging opera- tions lest we become operators rather than surgeons. In many parts of the Continent most unjustifiable measures are taken in cases of chronic affections of the appendages, tubercle not excluded. The uterus, tubes, and ovaries are taken out or the uterus alone extirpated through the vagina, the operator proudly boasting that he is thus enabled to empty cavities full of pus. Plainly this is operating, not sur- gery. I read of a typical case of the kind in a foreign medical paper recently. A surgeon operated on a woman who had a large swelling on each side of her uterus—clearly disease of the appendages, but whether tuberculous, gonorrhoeal, or the result of puerperal mischief remains uncertain. The question seems to have been overlooked as though unimportant. He removed the uterus and the right tube and ovary, but the left appendages were so firmly adherent to the pelvic wall and other parts that they were left behind. A few days after 1 Head at the East Anglian Branch (British Medical Association) Jubilee Meeting.