On ovarian dropsy : with cases of ovariotomy / by Thomas Keith.

Date:
1863
Catalogue details

Licence: Public Domain Mark

Credit: On ovarian dropsy : with cases of ovariotomy / by Thomas Keith. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    moment that some of the iliac veins had been injured. This was seen, however, to have been caused by the return blood from tlie tumour, the ligature having slipped. I next cut into the mass of the tumour, passed my arm into it, and broke down the numerous small cysts of which it was composed. The relaxed state of the abdominal wall was now so great, that the adhering cyst-walls were easily cut away, without its being necessary to enlarge the incision above the umbilicus. It was thought better to leave a piece about the size of a handsbreadth, close to the ensiform cartilage. This could not have been conveniently dissected off witliout enlarging the incision at least eighteen inches, and this I was most unwilling to do. The omentum, which was puckered at its base, by old adhesions, had given a good deal of trouble during this latter part of the operation, and as it had been necessarily a good deal handled, and felt cold, a fine silk ligature was passed round its base, and the whole cut away, the ends of the ligatures being cut off short and left behind. We then waited till the bleeding ceased. Some clots lying upon the upper surface of the stomach were removed, and the abdomen and pelvis cleansed from clots, ovarian fluid, and debris of cysts. This was done carefully, but most thoroughly. The clamp, which had been allowed to drop into the pelvis to be out of the way, was brought outside ; but, notwithstanding the laxity of the abdominal walls, there was a considerable drag upon the uterus. The wound was now closed amidst the most serious appre- hensions for the immediate safety of the patient; for my brother, who was giving chloroform, had reminded me occasionally during the last half-hour, that the pulse had fi-om time to time been imperceptible at the wrist. The operation lasted an hour and a half. The shock was most severe, and for an hour or two she looked as if she would die. Keaction was not encouraged however, and she was not stimulated, for I was afr'aid of bleeding fr-om the gi-eat extent of adhesion that had been separated, and she had a peculiar hsemorrhagic look, which was most alarming. Towards evening, vomiting came on, and her appearance improved after this. She passed a better night than could have been expected, and by morning the fear of death from shock or hsemon-hage was over. She remained under the charge of Dir Carruthers of Cramond, and I take this opportunity of acknowledging the intelligent care Avith which the after-treatment of this case was conducted by him. The wound healed by the first intention, and the clamp fell off on the twelfth day. That afternoon she complained of some irritation of the rectum, and began to pass small quantities of bloody jelly- like mucus. Next day, there was a feeling of some fluctuation above the pubis, and there was also some fulness of the recto- vaginal fossa, with great swelling and tenderness of the vagina. Soon after our visit in the morning, she was seized with intense abdominal pain, severe vomiting, followed by coldness of the