Twenty-six cases in which an abdominal section has been performed a second time / by John D. Malcolm.

  • Malcolm, John David.
Date:
[1897]
Catalogue details

Licence: Public Domain Mark

Credit: Twenty-six cases in which an abdominal section has been performed a second time / by John D. Malcolm. 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.

    21/30 (page 19)
    I have seen a considerable number of cases of rupture of the abdomiual wound due to a sudden strain, as from retching, or coughing, after the sutures had been removed, but I have never seen any other than this in which there was no attempt at union of the exposed viscera to the edges of the incision, or any in which a fatal issue has resulted from the accident. In Case Ho. 22* the patient was 40 years old. She had had one miscarriage soon after marriage, nine years before she came under my care. There had been an uterine discharge for about six years, which constantly increased and had been very offensive for about two years. The uterus had been curetted by one of my colleagues in February, 1896, but a microscopic examination of the scrapings had not indicated that the disease was malignant. After a time, however, a clinical diagnosis of malignancy was made, and I was asked to remove the uterus. When I saw the patient her womb was slightly enlarged, and was discharging great quantities of extremely offensive matter, and as a conse- quence the patient was extremely anaemic. Removal of the uterus seemed possible, and the patient, although made fully aware of the sei’ious nature of operative treatment, was most anxious to take the risk. My colleagues, with whom I consulted, thought an operation was justified as affording the only chance of relief. I therefore agreed to open the abdomen and to perform hysterectomy if the disease seemed confined to the womb. I found an enlarged uterus, retroflected, but quite free from adhesions, and apparently limiting the disease within its walls. I removed the uterus, but in separating it from the bladder my finger slipped through the tissues of the cervix into the cervical canal, and when I divided the peritoneum behind the cervix, the body of the uterus came away in my hand. Cancer had almost destroyed the whole circumference of the uterine wall at the level of the inner os. I removed the remains of the cervix piecemeal, but, I thought, completely, securing all bleeding points, and cleaning the parts carefully. The patient, at the end of a long operation, was in a very weak state, the temperature being 97'6° and the pulse 136. The pulse soon came down to 96, the temperature gradually rose, and in the evening, although she was very feeble, the patient’s condition, both physically and mentally, was satis- factory. Next day she appeared to be doing well in many ways. She had passed 10 ounces of urine in the night without the aid