Second and third series of twenty-five cases of completed ovariotomy / by G. Granville Bantock.

  • Bantock, George Granville, 1837-1913.
Date:
1880
Catalogue details

Licence: Public Domain Mark

Credit: Second and third series of twenty-five cases of completed ovariotomy / by G. Granville Bantock. 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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    end of the loop could be distinctly felt, but it finally disappeared. In not one of these cases has the suture been heard of again. Several times, when taking them out at the end of a fortnight, the deeper por- tions of the loops have presented the appearance of becoming blended with the tissues, and they have required an unusual amount of force for their extraction. I am glad to find that silkworm-gut is making its way in professional estimation. I have taken every opportunity of urging its adoption, and it is satisfactory to me to find other workers in the field, such as Mr. Bryant, Dr. Heywood Smith, and Mr. Walters of Reading. A short time ago, I removed five of these sutures from the vagina of a patient whose perinaeum I had restored three weeks previously; not one of them had cut its way out, and there was absolutely no irritation about any of them. They might have been left in indefinitely, but for the chance of being a source of inconvenience in the case of a married woman. I repeat that I know of no substance which yields such satisfactory results in the closing of wounds. I think that, after gastrotomy, there is an undoubted advantage in including the peritoneum in the suture. But it is not sufficient merely to take this up with just the thickness of the skin; such a practice tempts the formation of a hernia. In a sufficient number of post mortem examinations of patients, dying at various periods beyond three days after operation, in which the parietes have been reflected so as to show the peritoneal aspect of the wound, not once have I seen any of the sutures exposed. They have been invariably covered in by lymph. Koeberle distinctly objects to the inclusion of the peritoneum. He says: “Spencer Wells believes it to be of the highest importance to include the peritoneum in the suture. Evidently this importance is exaggerated, since I have never done it, and the general results of my operations, as well as the results obtained during the later years, are in nowise inferior to those of my eminent confrire. On the contrary, one can reproach this suture with interposing the peritoneum between the fibrous tissues, whose juxtaposition becomes impossible, and with dis- posing to abdominal hernia” (Maladies dcs Ovaires et de rOvaiiotomie, par E. Kceberle, 1878). This is a valid objection where the imperfect practice above referred to is observed; yet I cannot conceive anyone preferring the complicated method of Kceberle to that of including the whole of the tissues in the simple suture. Koeberle’s method consists in leaving the peritoneum, and in applying sutures to the muscular aponeurosis alone, bringing the ends out in pairs between the lips of the wound, and then closing the skin by hair-lip pins. It is impossible to get union by first intention in this way, for these sutures come away by sloughing. Is it not better to adopt a method by which primary union is not only possible, but almost certain ? It is curious to notice the strong conservatism which reigns amongst French surgeons, with reference to the management of the ligature