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

  • Charles Clay
Date:
1842
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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.

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    it had been for the last two days. I gave her a draught with three-fouiths of a grain of mur: morphine, with one ounce of camphor water, and left her very composed, if not really cheer- ful. Before I proceed with the details of the case, I will briefly describe the tumour itself, as some very important circumstances are con- nected with it. DESCRIPTION OF THE TUMOUR. It will be recollected that paracentesis abdo- minis had been performed in this case, previ- ously, and the amount of twenty-five pounds and-a-half of fluid of the true ascitic character had been drawn off, and it became of import- ance to know of a certainty if this fluid was really ascitic or had been contained in the ovarian sac. The form of the tumour was an oblate spheroid, and when perfectly emptied of its contents the solid part weighed very nearly five pounds ; it was composed of a white tough membranous bag, capable of holding about four pints, and a flattened round solid mass, the cells of which contained various matters from the consistence of pus to that of cerate, and of considerable variety in colour. The interstices of the cells were of a hard cartilaginous structure. Inside the large membranous bag, hung from its under surface a pendulous mass, with a narrow neck, about the size of a hen’s egg, or rather larger, and of an irregular shape, very similar to a portion of brain enclosed in a thin transparent mem- brane, which must have floated loosely in the fluid of the sac. The tumour with the mem- branous bag had very much the appearance of a large placenta with its membranes nearly entire, and its form and arrangement exactly similar. On examining the membranous pouch very carefully, I could find no puncture but the one by which the sac had been emptied at the pedicle ; and as its capacity was not more than for fouror five pints of fluid, this toge- ther with the apparently thick unyielding cha- racter of the walls of the sac, convinced me that it had never held more than from four to five pints; consequently, the twenty-five pounds and-a-half of fluid previously dis- charged were decidedly that of ascites, in no way connected with the cyst, but produced by its pressure. '1 he connection of the tumour anteriorly with the parietes was to a considera- ble extent, and remarkably firm, completely surrounding the umbilicus, including the re- mains of the umbilical chord; in cutting through it, the part was hard, as a piece of cartilage, and not easily divided ; the fibrous bands connecting the tumour with the omen- tum, intestines, &c., were in many places two inches in length, and very strong, (no doubt of long standing); they were arranged in groups of three or four together, most of them about the thickness of thread, but one or two were broad and flat like narrow tapes. The solid portion (as well as the membranous cyst of the tumour) was beautifully injected with blood vessels, both internally and externally As the contents of the sac were discharged at the conclusion of the operation, I had not an opportunity of ascertaining its peculiarities. The gross amount of matter removed was : ascitic fluid, 25.) lbs.—contents of cyst, 4 lbs. —cyst and solid substance, 5 lbs.—total,34| lbs. SUMMARY OF THE FIRST FIFTY-TWO HOURS AFTER OPERATION. Before this, my second operation, I had concluded it scarcely possible that any case o< such importance and peculiar liabilities could have progressed more favourably than in the case of Mrs. Wheeler ; but, certainly, the present as far exceeded the first case, in the rapid progress of its recovery, as it did in having worse prospects to contend with in the beginning. The patient was older by many years, the system equally worn down, nume- rous adhesions of a very firm nature to over- come, together with an extensive ascitic deposit.—and yet it is impossible to look at the above tabulated 52 hours without surprise, when all these circumstances are considered. A The Temperature was kept nearly the same throughout, as in the first case, but in accom- plishing this, fires had to be occasionally made as the weather was colder. Pulse.— Before the operation the pulse stood at 70. After the operation it was counted by Dr. Radford, and found to be the same ; a cir- cumstance very remarkable, and only to be accounted for by the small quantity of blood lost during the operation, and the imperturbable coolness of my patient, who neither moved a muscle, nor expressed herself in the least as suffering from pain. During the fifty two hours it will be observed it advanced to 90, but always remained soft, and easily compressible, bleeding therefore was not resorted to, which, in consequence of her age, I was not sorry for. Tongue.—During the time was clean and moist, except at the last visit on the table, when it showed itself slightly furred, probably owing to the bowels not being yet moved. General Surface.—Was never otherwise than warm and moist, with gentle perspiration. Pain. - For about half an hour the pain in the left iliac region continued, and also in the loins, but on giving three-fourths of a grain of mur. morphine it disappeared, and didnot occur again. Light Headedness.—Never occurred. Cough.—There was not any. <S hivering.—None. Urine.—It was surprising how easily she passed urine by her own efforts, so early after the operation, and continued to do so through- out, amounting nearly to seven pounds' in 52 hours ; the catheter was, therefore, uncalled for. Motions.—As yet none, but as flatus had troubled her a little towards the conclusion of the above table, a motion was expected. Flatus.—Throughout was too trifling to dwell upon. Respiration.—Never in the least disturbed. Ciild.—This sensation was never experienced even in the least degree. Shep.—The pain in the loins and left’iliac region, rendered it necessary immediately after the operation to give three fourths of a grain of the mur. morphine. The pain soon left and a sound sleep followed. The number of sepa- rate sleeps, tlieirlength, and soundness, amount- ing to upwards of seventeen hours in the fifty- two, no doubt facilitated much her rapid and satisfactory recovery. In the next table I shall dispense with those items of the last table which did not occur again, as pain, light-headedness, cough, shiver- ing, flatus, respiration, cold. All my medical friends who visited the case, were surprised at the progress of recovery, and the perfect absence of dangerous symptoms. The next table traces the case up to the first dressing of the wound on the fourth day. SUMMARY From the conclusion of the first fifty-two hours to the end of the fourth day, when the wound was first dressed. Temperature.— Kept about the same. Pulse.—Increased in frequency, but kept soft and very compressible. Tongue.—Kept very clean and moist. General Surface.—Moist and Warm. Urine.—Continued very free by natural efforts, nearly five pounds in the last forty-five horns. Motions.—2 immediately after the clysters. Thirst and Flatus. — Entirely absent. Sleep—The time passed in sleep was con- GENERAL REMARKS. Flatus . . . . Sleep Thirst . . . . Motions . . . Urine 1 General Sur- face . . . . Tongue.... Pulse Temperature. From the Con- clusion OF THE 1st 52 HOURS, TO THE END OF THE 4th day and 1st DRESSING. Felt a little smarting and itching in the line of the wound—felt very hungry— diet continued. None. o hours. None. [ None. 3 times ?xviij- |l •3 SP Little furred. 90 Very soft cs o 5 o’clock, a.m., Oct. 10th — 61 hours after operation. Continued remarkablywell —ordered a clyster of gruel, with olei ricini. olei tere- binth, a ii 3SS, to be repeated if necessary. None 30 minutes, None. None. X <. 3: c • o Moist and warm. Little furred. 90 Very soft. os QC 12 a.m.—68 hours after. Two copious motions fol- lowed the clysters—felt very hungry — no alteration in diet. None. 1) hours j None. 2 after clyster. ON01 X 2. S.S ® o' © LFN b. Moist & warm. Clean & moist. 90 Very soft as 00 10 p.m.—78 hours after. I Moist and warm. j Clean and moist. j 100 soft. 1 os 00 9 a.m., Oct. 11th— 89 hours after. Had passed a very com- fortable night — ordered a little weak mutton broth for dinner—diet, in other re- spects, as before. None. G hours. None. None. Dressed the wound, re- moved every other suture— wound healed in its whole length except where the li- gatures came out. None. None. None. None. o* © OTI i Moist and warm. Clean and moist. 105 soft os 00 12 a.m.—92 hours after. The pulse, though high, was very soft, no pain or un- easiness—former diet conti- nued without the broth. None. None. None. None. o 3 o CO ow Moist & warm. Clean & moist. no i Very sofij as 00 5 p.m.— 97 hours after.
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