Persistent pain after abdominal section / by James B. Hunter.

  • Hunter, James B. (James Bradbridge), 1837-1889.
Date:
1886
Catalogue details

Licence: Public Domain Mark

Credit: Persistent pain after abdominal section / by James B. Hunter. 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 patient suffers, not from the old dysmenorrhea, but from a pain more or less constant. She is encouraged to wait pa- tiently ; but in some cases, which have probably occurred to all of us, time brings no relief, and pains of some kind per- sist, varying perhaps in degree at different times, but never entirely absent. There are a few cases in which the suffer- ing after operation is even greater than it was before. It may be stated in a general way that if, after an operation of the kind in question, there is not marked relief from pain at the expiration of eighteen months or two years, the patient having taken proper care of herself and been favorably situ- ated, the operation may be pronounced a failure, as far as the patient is concerned. It is certainly interesting, and it may be instructive, to inquire into the causes of such fail- ures. The pain may be due, we shall find— I. To the former peritonitis. II. To peritonitis following the operation. III. To some defect in the abdominal wound. I, If, as we have seen to be more than probable, local- ized attacks of pelvic peritonitis are due to the existence of pyo-salpinx, the removal of the diseased tubes must prevent the attacks which recur with each menstrual epoch; but it does not necessarily remove the consequences of past inflam- mation, or restore the normal relations of the injured and displaced viscera. For this reason pain is often not relieved by operation. I believe that, if the subsequent history could be obtained of all the patients who are simply “ discharged cured ” after Tait’s operation, it would be found that many of them, though radically cured of a disease that might en- danger life, still suffer pain long after they have passed out of sight. I have made a point for some years past of fol- lowing up all cases in which I had a right or could obtaiu permission to do so, in order to satisfy myself of the com- pleteness or permanency of the cure, or the reverse. In con- nection with the presence of a certain amount of peritonitis, the question arises, whether the disease of the tubes may not sometimes be secondary to the local peritoneal inflammation.