The treatment of chronic disease of the uterine appendages / by Alban Doran.

  • Doran, Alban H. G. (Alban Henry Griffiths), 1849-1927.
Date:
[1891]
Catalogue details

Licence: Public Domain Mark

Credit: The treatment of chronic disease of the uterine 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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    broken down, the cause of suffering is removed. By appropriate treatment, for a few weeks after the operation, a recurrence of the inflammation may be avoided. Two considerations must be taken into account in respect to this proceeding, namely, the experience of others and the difficulty of the operation itself. We hear much about consecutive cases of removal of the appendages, but little about this simple breaking down of adhesions. Men do not like to record what may be set down as a “ partial operation.” They have an idea that it may be set down by their rivals as a failure. The most honest operator in these cases usually sets to work with a fixed notion that the tube and ovary is at the time the sole or chief cause of trouble. The cutting away of a tube and ovary is definite— even if difficult. Then, in the amputated structure there is something to show for one’s trouble, and for the risks to which the patient has been exposed. In so many operations it is right to take something away, that surgeons very naturally tend to believe that it is wrong to take nothing away. Lastly, the patient’s prejudices may give us great trouble, since, though she usually dislikes the prospect of any kind of amputation or mutilation, she, on the other hand, having undergone an operation, is often dissatisfied if she learns that nothing has been removed. Hence the surgeon should clearly explain beforehand, in all cases where he intends to operate, that the abdominal section is intended to set right what is wrong and is not necessarily undertaken in order to remove anything. The operation itself, however, the breaking down of adhesions alone, is not, as a rule, easy. It is indefinite. No set of rules can be laid down to guide future operators. It is only when operating that the surgeon can determine if the tube and ovary be not suffi- ciently diseased to require removal, whilst certain adhesions should be deliberately broken down. Most assuredly, in any case, there are adhesions that had much better be left alone ; whilst to dis- turb others would be criminal. Expei’ience can alone guide in these cases, and the surgeon who has not done many abdominal sections must not look upon this proceeding as a mild affair. He must not hold it as an intended preliminary to removal of the ovary, which, if the ovai’y be found, in his opinion, to be irre- movable, will signify little or nothing—a little benefit and no risk. On the contrary, such an operator should remember that carelessly breaking down adhesions is far more dangerous than cutting away an ovary, and, as in the kind of case we are considering, lie is