Cases of peritoneal section, for the extirpation of diseased ovaria, by the large incision from sternum to pubes. Successfully treated / [Charles Clay].

  • Clay, Charles, 1801-1893
Date:
1842
Catalogue details

Licence: Public Domain Mark

Credit: Cases of peritoneal section, for the extirpation of diseased ovaria, by the large incision from sternum to pubes. Successfully treated / [Charles Clay]. Source: Wellcome Collection.

    15/28 (page 11)
    copious passing of urine. She again passed her urine freely, immediately before the operation. On the afternoon of the 7th, I com- menced the operation in the presence of Dr. Radford, Mr. W. C. Vaudrey, Messrs J. J. & G. Southam, surgeons, and Mr. Iligginbottom, nephew to Dr. Radford.—Pulse, before the operation, 70. OPERATION. As paracentesis abdominis had been previ- ously performed, and the tumour was of smaller dimensions than Mrs. Wheeler’s, the first incision extended from about two inches above the umbilicus to the pubes, or nearly ten inches in length. The parietes of the abdomen were so flaccid that more difficulty occurred in making the first incision, and in dissecting through the peritoneum, than in the first case, where tl e same were distended. No sooner was the tumur exposed than adhesions pre- sented themsilves in every direction. In the diagnosis which Dr Radford and myselt had formed of the case, I fully expected an exten- sive and long standing adhesion to the anterior of the tumour, immediately in the vicinity of the umbilicus ; but from the mobility of the tumour in every direction, (save the exception mentioned,) we thought it pretty free else- where. In this we were deceived : adhesions were found in almost every part remarkably strong, and only to be separated with the scalpel. There was also a decided difference in the character of the adhesions: those at- tached to the parietes were broad and firm in their attachments, whilst the connection with the viscera was by numerous long fibrous bands; it was evidently their length and adhesion to the moveable parts that gave the tumour the mobile character it had. The pedicle, too, being long (as I had anticipated) facilitated the movements of the tumour ; the pedicle was broader and thicker than in Wheeler’s case, and when cut through, one of the cysts discharged about four pints of fluid. In this instance 1 passed a strong double liga- ture through the central expansion of the pe- dicle, and tied it both ways ; thus securing it by two ligatures, which appeared to be quite sufficient to secure the vessels of the pedicle from pouring out blood, as they did in Wheeler’s case,where they had to be separately tied. The adhesions were overcome by the scalpel, and their number was more than expected. I he whole blood lost in the opera- tion was trifling,—certainly not more than two ounces. The uterus (with the rest of the viscera) was perfectly healthy; the intestines not in the least distended, with either flatus or foecal matter, and in no way impeded the operation—a circumstance which I again at- tributed to the effects of the inspissated ox gall, which she had taken the night before. The parietes were secured by seven interrupted sutures, with straps of adhesive plaister be- tween, side straps, with pads of linen, and bandages over the whole. My patient was quite equal to the task she had undertaken : scarcely a word fell from her lips indicative of pain,—on the contrary, she replied to any question with great composure, and drew comparisons between the sufferings of parturi- ent efforts and the operation, — concluding that she had had worse labours, as to suffering pain, than the present operation. After the 'opera- tion she complained of pain in the left iliac region. and the loins, evidently owing to the stretching of the adhesions, but more parti- cularly the pedicle. 1 he whole time consumed in the operation was about ten minutes, and in about twenty-five minutes from the com- mencement she was placed comfortably in bed; and, what was most extraordinary, the pulse had scarcely varied a single stroke from what - RECORD OF FIFTY-TWO HOURS AFTER OPERATION ON ELIZABETH BESWICK. Operation. 4 o’Clock p.m. Oct. 7th, 1842. Friday. 8 o’Clock p.m. 11 o’ctock p.m.—7hours after operation. 5 o’clock a.m. Oct. 8tli, 13 hours after. 11 o’clock A.M. 19 hours after. 4 o’clock p.m. 24 hours after. 10 o'clock p.m. 1 30 hours after. 5 o’clock a.m.—Oct. 9 th 37 hours after. 10 o’clock, A.M. 42 hours after. i 8 o’clock p.m. 52 hours after. Temperature. 68 70 70 68 70 70 70 70 70 Pulse 76 80 Soft. 80 Soft. 8 Soft. 80 Soft. 80 Soft. 86 Soft. 86 Soft. 90 Soft. Tongue Clean and moist. Clean and moist. Clean and moist. Clean and moist. Clean and moist. Clean and moist. Clean and moist. Clean and moist. Little furred. General Sur- face Moist and warm Moist and warm Moist and warm. Moist and warm. Moist and warm.- Moist and warm. Moist and warm. Moist and warm. Moist and warm. Pain None. None. None. None. None. None. None. None. None. Lightbeaded- ness None. None. None. None. None. None. None. None. None. Cough None. None. None. None. None. None. None. None. None. Shivering None. None. None. None. None. None. None. None. None. Urine None. None. Twice, naturally ^xiv. Twice, naturally i;xvi. Once, naturally §x. Twice, naturally ^xx. 3 Times, naturally ^xxii. Twice, naturally. ^xii. Twice, naturally. ^xii. Motions .... None. None. None. None. None. None. None. None. None. Thirst None. None. None. None. None. None. None. None. Little. Flatus None. None. None. None. None. Little. None. None. Little. Respiration.. Free. Fi ee. Free. Free. Free. Free. Free. Free. Free. Sleep 20 min. 45 min. hours. 11 hour. n hour. 2 hours. 3 h hours. 2 hours. 2 hours. Cold None. No e. None. None. None. None. None. None. None. © § © ^3 © © © «o C/3 *•* M P5 « ◄ © W © pcj £ >-5 < CO 05 <3 9 •« £ © M O O £ R 8 © © ,«o J © S r . .77 Ul u. 11 ine slightest coldness, or shivering—The pain had left the oins and mac regions.—Had slept soundly 20 minutes, and smoked a pipe of obacco—Pulse had risen. Had had three sleeps, amounting to 45 minutes—Pulse soft and compressible.— u elt as though she could pass her water naturally. Her sleeps had been very sound—Passed her water with great ease—Pulse tobaccj S°ft Ioo c the Panada and gr«el well, and had smoked another pipe of Pulse very soft and compressible—Has taken her diet freely—Enjoyed her pipe, and felt perfectly free from pain—Simple diet continued. Expressed herself very comfortable—Felt as though she would have a motion, and complained of being hungry—No alteration in the diet. For the first time felt a sensation of wind in the bowels—In every other respect well Diet continued Gave her 10 grains of Inspissated Gall at bed-time. continued & comfortaMe n!&ht—Flatus not been felt since last night—Diet Continues well—Diet continued. LatJs6 ‘ofvpVpTfiv6 firS- tim,e’Ta lktIe fujTed’ accompanied with a little thirst and iflatus—Gave her five grams of Inspissated Gall.