An address on the treatment of bleeding and other uterine fibroids by removal of the appendages / by Alban Doran.

  • Doran, Alban H. G. (Alban Henry Griffiths), 1849-1927.
Date:
[1894]
Catalogue details

Licence: Public Domain Mark

Credit: An address on the treatment of bleeding and other uterine fibroids by removal of the appendages / by Alban Doran. 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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    the eldest of the six. The tumour was steadily increasing, and menorrhagia was severe. Directly after the operation the period was reduced to a few spots of “show” at long intervals, whilst the tumour steadily diminished in size. The result could not be due to the coincidence of a natural menopause, and the same may be said of the five other cases, all younger. One interesting result of successful removal of the append- ages is the advent of marked stoutness. This was seen in Cases i, n, and v. In all the corpulence was marked and clearly represented more than mere restoration to health. The well-marked neurotic symptoms which not rarely fol- low removal of the ovaries are well known and should always be recorded by the operator in a report of his cases. They differ entirely from the symptoms of hsematocele or pelvic inflammation, septic or otherwise, setting in late after opera- tion. They are often most marked when the checking of the period is most complete from the first, as in Case i. The severe nerve disturbance of an artificial menopause is a strong contraindication to removal of the ovaries for a purely functional neurosis aggravated at the menstrual period. For if a woman, aged 25, suffer mentally at her period she is likely to suffer worse from its premature suppression. In cases of bleeding fibroid neuroses are seldom present ex- cepting as effects of anaemia. In all the six cases here recorded neuroses were observed after operation. In Cases n, in, iv, and v flushings of the face, a well known sign of the menopause, occurred, and in Case n as early as the eighth day. This symptom appeared on the twenty-first day in a patient on whom I operated in February, 1894. In Case i there was a feeling of extreme weakness and discomfort when a slight show appeared during the third week. The miliary eruption soon after operation must not be ranked as a neurosis of the same class, if it be a neurosis at all. InCase vi there were free perspirations and numb- ness of the upper extremities. In Case in there was severe lumbar pain three months after operation, but the suffering was in great part due to a chill. None of these neuroses involve any danger. The surgeon must always endeavour to remove every trace of ovarian tissue. This is easy and safe when, as in Case iv, the ovarian ligament is elongated. The task, however, not rarely proves to be impossible. The ovarian ligament, often j very long when its ovary has become a large cystic tumour, is, in the normal condition, frequently too short to allow of a safe pedicle if all the ovary be cut away. In cases of large myoma this ligament frequently remains unstretched and not hypertrophied. Moreover, just as small myo- mata sometimes develop on the ligament close against the ovary, so, on the other hand, semi-detached pieces of ovarian tissue may lie on the ligament close against the uterus. The operator must tie the ligature as close to the uterus as possible; then, if any trace of ovarian tissue re- main on the stump, it will be on the distal side of the liga- ture, where it will almost certainly undergo atrophy. When the surgeon finds that the ligature, as he pulls it tight, cuts into the pedicle, that means that it is cutting into ovarian tissue. The silk should be loosened and tied closer to the uterus. The ovarian ligament is very tough, and is not readily cut by the ligature silk. In Case i, though there was