A clinical history of the medical and surgical diseases of women / by Robert Barnes.

  • Barnes, Robert, 1817-1907.
Date:
1874
Catalogue details

Licence: Public Domain Mark

Credit: A clinical history of the medical and surgical diseases of women / by Robert Barnes. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

    359/842 (page 349)
    election to avoid other dangers. The result was successful, in all three giving birth to living children at term. When pregnancy supervenes on ovarian dropsy, there are three, perhaps four, courses out of which to select. 1. We may leave things alone, simply watching, prepared to act, if urgency from rupture of the cyst, axial twisting, or hemorrhage or ex- cessive pressure arise. In a considerable proportion of cases pregnancy goes on to term, and the labor is completed happily. Is it wise then to stand by and trust to the chance of this issue ? If we determine to anticipate danger, we may 2. Tap the cyst. This will, of course, at once lessen the inconveni- ence of pressure, and the danger of bursting. 3. Or we may act upon the uterus. We may lessen the distension and risk of rupture by drawing off the liquor amnii; that is, by induc- ing labor, postponing the question of dealing with the tumor, until the case is reduced to its simplest expression, by eliminating the pregnancy. I have discussed this question in my work on Obstetric Operations, and have there given the reasons which appear to me to weigh in favor of this course. The opposite view, that of acting on the ovarian tumor by tapping or extirpation, is well argued by Mr. Goddard (Obstr. Trans., 1871). No doubt in certain cases, either proceeding may be preferable to the other. But, as a general rule, I believe experience wTill show that it is better to act first upon the pregnant uterus. Mr. Wells refers to five patients whom he has tapped during preg- nancy, one of them three times, once twice, and three once. In all these women great relief was afforded by the tapping, no ill effect of any kind was observed to follow it, and in all the children were born alive, after labors of moderate duration. There is a peculiar state of nervous and vascular tension produced by pregnancy which should be taken into account. Pregnancy induces great irritability of the nervous centres, spinal and cerebral. This irritability accounts for the greater risk of abortion, of vomiting, if in- terference be resorted to. It also is a source of danger if accident or complication arise, as rupture of cyst, inflammation, &c. And as this complication may be more serious than the operation, the operation may become justifiable as the lesser danger. Believing, as I do, that a woman in whom pregnancy is complicated with an ovarian cyst, is in a position of imminent peril; that her life is threatened at any moment by some catastrophe which may strike so suddenly and so violently as to leave no time for action, my opinion is decidedly in favor of eliminating the pregnancy. I have acted on this principle on several occasions with a successful result, not counterbal- anced by a single unsuccessful one. 4. If the cyst actually burst, or give rise to hemorrhage or periton- itis, there should, I think, be no hesitation in attempting removal of the tumor, which is the cause of immediate danger.