Cases of ovariotomy / by Thomas Keith.

  • Keith, Thomas, 1827-1895.
Date:
1863
Catalogue details

Licence: Public Domain Mark

Credit: Cases of ovariotomy / by Thomas Keith. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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    otomy, but culpably negligent if we do not do so. For her liealth was rapidly giving way ; she was able no longer to procure her livelihood; a feverish state of the system was being set up ; her stomach was irritable; she suffered greatly from distention; her nights were wearisome and restless; she walked with difficulty; and her breathing was becoming more and more impeded. Having made up her mind to have the tumour removed, she was brought to town in the end of December. Meanwhile, in the course of three weeks, her girth had increased from 39f inches to 43^ inches, the distance between the ensiforra cartilage and pubis being 23 inches. For several days preceding the operation she was so uneasy that she could neither sit nor lie in any position for more than a few minutes at a time. The tumour was removed on the 7tli of January last. There were present Ur Thomson of Dalkeith, Dr Thomson of Inveresk, Dr Graham Weir, Dr Keiller, and Dr Keith. The day was cold, and the temperature of the room could not be raised above 65°, and owing to a dense fog there was so little light that it was a question whether the operation should be gone on with or not; but as the patient had spent the preceding nights in gTeat distress, leaning over the edge of the bed, it was thought advisable not to delay. The tumour was accordingly exposed by an incision about ten inches in length, and some slight adhesions along the line of incision were broken down. The hand passed freely to the left of the incision, but adhesions were encountered over the whole extent of the right side. In the iliac region these gave way readily to the hand, up to a line leading from the spine of the ilium to the umbilicus; but over the whole space above this the adhesions were very startling, and of the most firm description. Before attempting to separate these, the tumour was reduced as much as possible by tapping and breaking down the various cysts, all of which Avere of small size, and all filled with a thick dar'k.grumous fluid. The openings into these were then tied, in the hope of preventing the escape of any of their contents into the cavity of the abdomen; but the cyst walls were so very thin that on the least pressure they burst in all direc- tions, and some at least of this grumous fluid must have found its way over the intestines. The incision was then extended slightly above the umbilicus, the line of demarcation of the cystic and parietal layers of peritoneum brought into view, and the separation of the adhesions proceeded with. This was a long and tedious business, for there was at least a square foot and a half of densely organized adhesion, against which the hand made no impression. The dissection was accomplished chiefly with the point of the scissors, sometimes using the edge freely to divide any bands firmer than the rest. As the separation reached the edges of tlie ribs a large piece of bowel, strongly adlierent, was separated from the upper part of the tumour. Tlie adhesions then became less firm; some of the delicate texture of the mesentery and omentum