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

  • Bantock, George Granville, 1837-1913.
Date:
1879
Catalogue details

Licence: Public Domain Mark

Credit: First 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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    Until the introduction by Professor Lister of the antiseptic method I had always used a fine hempen ligature, of which I had obtained a beautiful sample, many years ago, from Coxeter. I was induced to adhere to this from a consideration of the fact that a hempen cord shortens on becoming wet, and that thus the tightness of the loop might be ensured. Now that the ligatures are previously steeped in carbolised water, this argument ceases to hold. I had always been under the impression that whipcord was too stout, and that by its use a willing horse was being overburdened. May not this be held as, in part, an explanation of the untoward results sometimes witnessed in former days? In thinking over the ligature, I had worked out mentally a mode of application, viz., the chain link, when a single loop was insufficient, owing to the thickness of the pedicle. In this I found myself at one with the late Dr. Peaslee, to whose work I refer for an illustration.* In my eighth case, I encountered a very broad and short pedicle, which I had to divide into three portions. The process was in this manner. I first passed a needle armed with two threads through the pedicle, at the point between its outer (broad ligament) and middle thirds. Then I re-threaded the needle with one of these, and a third ligature which I carried through the pedicle at such a distance as to divide the whole into three nearly portions. Each thread was now tied in turn, and care was taken to complete the chain. The object of this linking of the loops was to prevent the pulling open of the holes made by the needle; for it will at once be seen that, if the needle should happen to pierce a vessel in passing through the pedicle (a very difficult thing to avoid when the pedicle is very thick), immediate and trouble- some bleeding, or slow oozing, more serious in its after-effects, might ensue. This patient, aged 61, made a most excellent recovery, and is in admirable health to this day. Although the parietal adhesions were very extensive, and so intimate that a considerable extent of peritoneum was separated from its subperitoneal tissue, and otherwise injured on both sides, in the endeavour to find the cyst-wall proper, and there were extensive adhesions at the brim of the pelvis on one side, and the other ovary had to be removed, the patient’s temperature never exceeded 100.4 deg., and she was quite convalescent by the fifth day. There is one modification in the application of the ligature which I have not seen anywhere mentioned,-and which I was, I believe, the first to introduce. It is that of first securing the outer or broad ligament edge of the pedicle by a fine ligature (No. I or 2 Chinese silk) separately. Painful experience in my nineteenth case, in which haemorrhage occurred from retraction of this portion of the pedicle, taught me that it was necessary, in the case of very short pedicles, to use some special means for preventing this accident; I accordingly hit upon the plan of first of all passing a very fine ligature through the pedicle, about a quarter or three-eighths of an inch from its outer edge, where the strain was greatest. This I tied independently. The stronger ligature occu- * Ovarian Tumours, p. 466.