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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    the open peritoneal end, which caused adhesive peritonitis, an effort of nature to prevent more general contamination of the peritoneum, and hence cystic dilatation of the closed tube. Then with regard to cirrhosis of the ovary being the result of pressure from adhesions, he doubted the conclusions; they knew that cirrhosis did result from inflammatory changes in the course of some or all of the acute exanthemata, and they also knew that such cirrhotic ovaries, performing their functions badly or not at all, were a cause of great suffering, and yet were often found entirely free from adhesion to neighbouring parts. Such ovaries may of course he surrounded by adhesions, but in the great majority of the cases of what may be called adhesion tumours, the ovaries are found large and cedematous, their tunic markedly thickened, their stroma also thickened, and full of abnormal cell growth with much fluid, and their follicles un- ruptured and tending to become cystic. It is of course possible that such ovaries may, as the result of long pressure from surrounding adhesions, eventually waste and resemble the true cirrhotic ovary ; but he thought the two conditions should be carefully distinguished, and that careful inquiry into the history of the patient would leave little doubt in most cases that she had cirrhosis of her ovaries, before she had the pelvic peritonitis. Such patients were especially liable to find their way into the hands of those too active gymecologists to whom Professor Sinclair had referred, and as a result of treatment, have added to their miseries in- flammation and matting of parts around their already diseased ovaries. So, again, he thought the majority of the cases which Dr. Duncan described as congenitally ill-developed ovaries were really not congenital, but the result of acute disease during childhood, especially about the time of the onset of menstruation, in the case which he gave as an illus- tration, he mentioned, as if of no consequence, the ordinary diseases of childhood ; and he (the President) thought these were often of the first consequence, and were too often overlooked in considering abnormalities in the future menstrual history. In such cases he should carefully avoid the free dilatation of the cervical canal, which Dr. Duncan recommended, because it was just this sort of interference which was likely to lead to inflammatory mischief and adhesions. Then Dr. Duncan said the symptoms of diseased appendages were essentially two—pain and menor- rhagia; in his (the President’s) experience they were essentially three, for amenorrluea was even a more important symptom than menorrhagia ; many of the cases which suffer from pain and menorrhagia will cure without surgery. None of the cases, so far as his experience went, which suffer from pain and amenorrluea, will so cure, and still worse, it was very doubtful if they will cure with complete removal of the .appendages. He, at any rate, had found them not always, but very often, most unsatis- factory as to their condition after operation. Then Dr. Duncan said the pain was referred to the side most affected, and left the statement without qualification; now one of the earliest observations he (the President) made after commencing to operate upon these cases was that the side in which the pain was chiefly complained of was the one in which, so far as one could judge on opening the abdomen, there was least disease, and this he had repeatedly pointed out to those present at his operations. Then again, his cases did not bear out Dr. Duncan’s statement with regard to increase of flow being most marked when there was merely salpingitis or ovaritis present, and that when the tubes were distended with fluid this symptom was not marked. He (the President) found that in most of the cases that had had palpable tumour, there had been very marked increase