Licence: Public Domain Mark
Credit: The physiognomy of diseases / [George Corfe]. Source: Wellcome Collection.
![disease, either of the coecum or of the rectum, and where the latter passes over the brim of the pelvis, becomes inflamed, diarrhoea supervenes, the tongue exhibits a glazed, raw, and dry surface, the skin is hot, and intestinal fever is established. In such cases, powdered opium * in four oz. of starch, as an enema, together with small doses of our compound grey powder t with opium, twice or three times a day, have proved of great value. When, however, the sac has continued to fill, in spite of all our remedial agents, and ovarian dropsy has become fully established, there are no reasons why we should not be able, for the most part, to decide between the existence of this disease and that of ascites. By attending to a few principles, the difference can be ordinarily made out. For instance, if the percussion over the tumour is dull, but is clear at the flanks; if, also, the dulness in front increases towards one of the iliac regions; and if the patient is made to turn on her side, and the flank on which she now lies emits a duller, in lieu of a clearer sound, while the percussion over the exposed flank is yet clearer; if, also, the fluctuation is more perceptible in front of the abdomen, and gradually becomes less marked towards the spine,—then we may assert with confidence that the swelling is from ovarian dropsy; for the very reverse of all these phenomena occur in ascites. The explanation of these facts will readily present itself to an observing mind. It may, however, be remarked, that the thickness of the walls of an ovarian sac; its floating over and upon the intestines; its free motion from side to side; and the enlarged body of the ovarium itself; are so many pathological reasons why the above principles afford such assistance in the formation of a just diagnosis. I once knew an instance where the surgeon plunged a trocar into the linea alba, under the false notion that he was tapping for ascites, when nothing flowed; he withdrew the instrument, and again thrust it into the linea semilunaris on the left side, and emptied an ovarian sac of several quarts of fluid. If the above precautions had been attended to prior to the operation, the sad blunder would certainly have been prevented. OVARIAN DROPSY.—EXTENSIVE ULCERATION OF THE STOMACH. Louisa Ann Alder, aged fifty-five, unmarried. The subject of ovarian dropsy; has for the last ten years been an occasional patient at the hospital, for the purpose of being tapped. During this period it has been performed twenty-nine times, at intervals, first, of twelve months, but latterly of six weeks only, the quantity of fluid being generally three gallons. Admitted for the last time on Nov. 28; was tapped on Dec. 10, but only half of the usual quantity was drawn off, the canula becoming obstructed by shreds of lymph; the fluid was darker in colour and more turbid than before. After a month the operation was repeated, when a considerable quantity of lymph in flakes, obstructed the escape of the fluid. After a day or two, renewed symptoms of inflammation of the cyst came on, great depression of the vital powers, tenderness of the abdomen, with pain, vomiting, heat of skin, a quick, irritable pulse, thirst, and slight constipation. Leeches were applied to the abdomen, and a blister; some mild purgatives were given. After a few days the inflammatory symptoms subsided, and she seemed to rally, but never regained her vigour, and, gradually sinking, she died on the 20th of February, about four weeks after the last tapping. On examination, seventeen hours after death, a large globular cyst was found distending the cavity of the abdomen, adherent to the peritoneum on the right side, and at its upper portion, the posterior part of the stomach was also adherent to it. It seemed to have its origin in the left ovary, the healthy structure of which was entirely lost; the uterus and the right ovary were natural. It contained a considerable quantity of air, and more than a gallon of whey-like, purulent fluid; it was lined by a thick and ragged layer of lymph, evidently recent, and beneath which were several other layers much firmer; these were thickest at the anterior part of the cyst. The interior of the stomach presented numerous ulcerations, two of the extent of half-a-crown, with four or five smaller ones; irregular in form, their edges rounded, smooth, and quite pale; their bases, which were also pale and smooth, were in the * The powder is far better than laudanum in such cases, as well as in retention of urine, diseased prostate, inflamed bladder, or stricture, &c. in the male ; for it is usual to find the rectum so irritable in these instances that the bowel cannot retain the fluid upwards of five minutes, and it is expelled, before the laudanum has exerted any influence ; whereas, when the opium in powder is suspended in the starch, although the latter may be passed away, yet the former will lodge in the folds of the bowel, and continue to exert its soothing effect for many hours afterwards. Hence it is that we have retained our form of Enema Pulv. Opii in preference to the Enema Trse. Opii of the London Pharmacopceia. + This valuable combination is thus made :—]£,. Hydrarg. c creta ij. gr.; sodse sesq.-carb.; pulv. cretse comp, aa gr. iv. ft. pulv.](https://iiif.wellcomecollection.org/image/b22011833_0134.jp2/full/800%2C/0/default.jpg)
