Fourth series of twenty-five cases of completed ovariotomy / by G. Granville Bantock.

  • Bantock, George Granville, 1837-1913.
Date:
1881
Catalogue details

Licence: Public Domain Mark

Credit: Fourth 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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    usual symptoms. An advocate of the clamp would naturally cite this case to clinch all he has to say about the ligature; but it helps him very little, for here the clamp could never have been put on; the breaking of the ligature will happen, but can be remedied, and no valid objection can be made of the punctured vessel against the ligature, since, with all its liabilities, it was the only substitute for the impossible clamp. I have now the satisfaction of seeing the clamp almost abandoned, and its place taken by the ligature. The reason assigned for this is the adoption of the “antiseptic system”, which is thought to be incom- patible with the clamp, and to render the ligature safer. Here it is worthy of notice that, while one party is putting forward the antiseptic system as the explanation of their greater success, we find, on the other hand, Mr. Lawson Tait reversing the proposition, and urging that this supposed antiseptic success is due to the coincident use of the ligature. As for myself, I am not prepared to assent to the doctrine that the antiseptic system does enable me to carry out the intraperitoneal method (ligature) with greater safety. The fact of the disuse of the clamp alone concerns me, and not the reasons given for it, regarding which there is room for difference of opinion. The only method that is truly in rivalry with the ligature is the actual cautery. Remembering the excellent results obtained with it by Baker Brown and Keith, and that Wells’s cases, so far as they go, are in favour of it, and although desirous of completing a hundred cases with the ligature, I have several times made arrangements to try it; but, as often as I have done so, I have encountered a very short pedicle, with no room for the clamp between the tumour and the uterine cornu. Thus it has happened that my third case remains the solitary example of the use of the cautery in my prac- tice. As I have already stated, no true comparison between the clamp and ligature has ever been made, nor are the data for such a comparison even now forthcoming. It is manifestly unfair to compare the results of the two methods in the hands of one who always treated the long pedicles with the clamp, and the short (and otherwise bad) cases with the ligature, as a dernier ressort. I began to practise the antiseptic method in my thirty-first case, at the time when thymol was brought to our notice with a great German reputation as a germicide. My first five cases did very well with it; one was a case of acutely inflamed tumour with recent vascular adhe- sions, and required a drainage-tube; another was a case of sessile tumour—operation tedious, with nine ligatures; the other three were either simple, or only moderately complicated. The sixth was a case of colloid tumour in a bad subject, and ended in death on the fifth day.. The post mortem examination revealed a slight amount of peritonitis, the presence of a small quantity of thin colloid and ascitic fluid in the peritoneum, and advanced fatty degeneration of the heart and liver. “Cheyne-Stokes’ respiration” was well marked before death, and it was noticeable that the ice-cap, instead of reducing the temperature, actually caused it to rise. I have since regretted not using a drainage-tube, for it was just one of those cases in which the extra elimination provided for by it would probably have averted the fatal termination. Although I could not attribute this death to the failure of the antiseptic, but rather to the degeneration of important organs, and although the other cases yielded results which could scarcely be improved upon, I changed the thymol for carbolic acid. At first, I was by no means satisfied; for the second case (aged 51) died of acute pulmonary congestion, and