I. Ovarian abscess and pyosalpinx. II. Pelvic abscess / by Francis Imlach.

  • Imlach, Francis Brodie, 1819-1891.
Date:
1886
Catalogue details

Licence: Public Domain Mark

Credit: I. Ovarian abscess and pyosalpinx. II. Pelvic abscess / by Francis Imlach. 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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    genera they are packed awa}- in Douglas's space, where they become strongly adherent. Menstrual discharge is not found in healthy tubes, for ovarian hiemorrhage is always pathological, and probably soon sets up tubal disease. In htematosalpinx there is always distension, and the coats of the tube may be so thin and translucent that the blood is plainly seen through them. Sometimes while the fimbriated extremity is glued up the uterine outlet is free, and the tubes are then like half-filled sacs, and it is quite possible that such a simple case of occluded tubes, under careful manage- ment, may become practically well without surgical treatment; but there are no means of estimating how many go on to the state of pelvic haematocele, in which the tubes are still more distended, their walls immensely thickened, and the abdominal cavity perhaps half-filled with thick dark clotted blood, which never becomes wholly absorbed. When this stage is reached the pain and finally the septic fever make women anxious for any chance of relief, and the removal of the diseased organs, followed by sponging out of the peritoneum, results in a per- manent cure. I know it is alleged that pelvic haematocele is curable by methods intended to promote absorption, but as I have removed large quantities of dense clot during abdominal section from a patient who had been constantly under medical treat- ment by various gynaecologists for a period of twelve years, such absorption mvist at any rate be a slow process. In hydrosalpinx, which occurs chiefly between the ages of 30 and 45, the tubes are closed at both ends, and are dis- tended with from one to five ounces of thin limpid sero- albuminous fluid which rarely coagulates on standing. The tubal wall is generally thin and quite transparent, the mucous membrane and muscular coat being almost entirely obliterated ; but the peritoneal covering is so strong that, unless there are tough adhesions, the tubes can be drawn out of the pelvis with- out rupture. When, however, there is moderate hypertrophy of the muscular coat of the tube, and the wall is tough and opaque, It IS safer to aspirate before removal, as it is impossible to foro- ca.st the nature of the fluid contents. The pain of tension is