Outlines of the diseases of women / by John Phillips.

  • Phillips, John.
Date:
1897
Catalogue details

Licence: Public Domain Mark

Credit: Outlines of the diseases of women / by John Phillips. Source: Wellcome Collection.

    202/332 (page 182)
    sponge is removed, and the whole uterus comes away easily: the ovaries are better left. The stumps of the broad ligaments shrink towards the sides of the pelvis. Some operators sew up the opening in the peritoneum; this is, however, found to be practically closed in twenty-four hours without this proceeding, and the author cannot recommend it from his own experience. The ligatures should be left long, and allowed to he in the vagina. Antiseptic douching should be systematically carried out at intervals during the operation, it is unnecessary afterwards. A piece of antiseptic gauze is laid in the vagina, to act as a drain. In four cases operated upon by tbe author, convalescence occurred without any fever or complication; but death from recurrent haemorrhage, peritonitis, or shock is not uncommon. Subsequent Course of the Case.— i. After either operation keep the patient under observation for at least two years. 2. See her every month, and examine the condition of the cicatrix : any bleeding after examination should be regarded as suspicious of recurrence. 3 Her weight should be taken every month : continued, though slight increase, is of very favourable import. 4. On the slightest suspicion of return of the growth examine the patient under an anaesthetic, and if accessible touch the diseased part freely with a Paquelin's cautery. Recurrence in the broad ligaments is indicated by the formation of an irregular hardish mass at the side of, or in, the vaginal roof : in a case of the author's where return occurred six months after operation, the tissue broke down, and a copious flow of watery ascitic fluid took place through the site of the old cicatrix. Physiological Changes following Total Extirpation.—(a) If the ovaries are left and the patient has not yet reached the meno- pause, although periodic hsemorrhagic discharge ceases, the process of ovulation goes on. (b) At the time the catamenia should appear there are reflex symptoms present, such as headache, pain, vomiting, and neuralgia. (c) Should the climacteric have been passed, no changes are produced by the operation. (B) Those cases in which the advance of the disease renders any radical operation impossible—i.e., incurable. In this group no hope of cure is entertained, but much relief may be given by— 1. Partial operative measures; 2. Palliative treatment.