Medical reprints with original essays : home, foreign, and colonial, illustrated.

Date:
1897
Catalogue details

Licence: Public Domain Mark

Credit: Medical reprints with original essays : home, foreign, and colonial, illustrated. 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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    EDIO ©lit^ @rigin:r( <£ssags: |mirc, Jfortign, ;urb c4.ud: Jlhlfcffc^ OL. VIII.] London: October 15th, 1837; 11 23 • v^ [No. 93. CONTENTS of this number. if6 0varian humour, with Special Reference to the Diagnosis of Abdominal Swellings. By Arthur J. Sharp, M.D. London, F.R.C.S. Eng., &c. (Original Contribution) ... . ilignant Adenoma of the Uterus. By William S. Stone M.D., &c. (With Five Illustrations) ... ... ..’ ictopeptine in the Treatment of Malarial Enteritis By W- Forbes-Leslie, M.B. & C.M. Aberdeen. (Original Contribution) ... ... istract of a Paper on the Use and Abuse of Er<mt iii Obstetrics. By Thomas More Madden, M.D., F.R.C.S. Eng., &c. (By Permission) ladache in Epilepsy. By L. Pierce Clark, M.d!, &c. .” me cases in which I have found Antikamnia of Use By J. P. Maguire, M.B., B.Ch., B.A.O. (Original Contribution) Xvs and Notes ierapeutic Notes 129 130 133 134 135 135 137 138 CASE OF OVARIAN TUMOUR, WITH SPECIAL REFERENCE TO THE DIAGNOSIS OF ABDOMINAL o\\ JELLINGS. Arthur J. Sharp, M.D. Lond., F.R.C.S. En<u, etc Whitby, Yorks. n Original Article, specially written for Medical Reprints.] f.» thirty-two, married fourteen years, was taken ill on April bwith sickness, swelling of the abdomen and constipation. lenses very regular except during pregnancies, when they e stopped at once. The last two years periods have n more frequent, with much more pain preceding the 1, v liich has been scantier. The blood has been darker, no shreds of membrane, debris or cysts have been ced. The periods continued till May 25th. Pregnancies, six : all the children now living. Last con- ment seven years ago, nothing noteworthy. Lactation.— Nursed all the children herself for nine nths or so. Micturition.—At the beginning of April could not empty bladder completely : this difficulty disappeared. Oefacation.—Bowels always costive : usually goes nine to rteen days without any action. A motion I saw was anctly flattened. General health, good. Four or five years ago was laid up Bpr three weeks with severe abdominal pain and sickness, issitating morphia. Present Illness.—When first seen on April 5th she was ’ condition of obstruction and seriously ill. The abdomen jjnmforinly distended, dull all over and particularly tender Ei the caecum and above the umbilicus. The symptoms Ei ?adualIy re^eved by frequent and copious enemata, ed by massage and starvation. They were attributed to jrceration of scybala with probably distension ulcers it the caecum. The abdomen, however, continued dull bt loin hypochondria, epigastrium, and upper part of Some firm masses could be made out above the umbilicus, tthe following possibilities were seriously considered :— Ovarian tumour. Ectopic pregnancy. Faecal accumulations. Intestinal or omental growth. Ascites, etc. The distension was still uniform and the umbilicus at cs slightly bulged. 3 uterus could not be recognized bimanually, but was itely movable. The sound passed 24 inches with the ’ty forwards. Ament with croasotc, capsicum, salol, and cinnamon dispersed a quantity of wind, and made the motions much less offensive, 'h*3hte'\\?as able to get up and attend to her duties. XMO , By April 30th it was clear that the abdomen was full of ascitic fluid, and her friends pressed for her to be tapped. The legs also were dropsical. In the absence of cardiac, renal or hepatic disease, she was given diuretics. In this way the fluid present in the abdomen diminished so much that it was not difficult to recognize a median, partly cystic tumour reaching from the pelvis above the navel. The umbilicus was an inch nearer the symphysis pubis than the ensiform cartilage (in a simple ovarian tumour it should be nearer the sternum). The girth at the umbilicus was 38£ inches. The measurements from the navel to each iliac spine were practically identical. The tumour could be seen to influence the shape of the abdominal wall, when looked at from the side. The possible conditions considered were the following:— 1. Distended Bladder.—At once settled by the catheter, which did not affect the tumour at all. [I well remember in 1893 a patient sent up to a great London hospital for “ovarian tumour.” Ever since her confinement six months previously she had had dribbling of urine, and a tumour had gradually developed in the lower abdomen. The first thing that struck one was the urinous odour about the case, the second was the foul nature of the specimen of the patient’s urine, and the third was passing a catheter and drawing off some pints of water, by which time the tumour had vanished. Curiously enough the ward sister was most unwilling to have a catheter used, and with that fragmentary knowledge which is so dangerous, thought it was only boyish meddlesomeness that suggested such an unnecessary proceeding. No one ought ever to forget the aphorism of Sir Henry Thompson— Incontinence means Retention]. 2. Phantom tumour, pseudocyesis, etc.—Repeated careful examinations were sufficient to eliminate this without recourse to amesthesia. The tumour could be definitely separated from the parietes. 3. Pregnancy.—This, the diagnosis of her first medical attendant, was made unlikely by the absence of amenorrhoea, sickness, quickening: no single positive sign of pregnancy could be found in the breasts, cervix, vagina, or vulva. No contrac- tions, foetal movements, souffle or foetal heart have ever been elicited in the tumour. Sound passed 2§ to 3 inches only. The uterus was fairly movable with the sound, and had not the bulky inertia one would expect in a pregnancy of six months or more. An attempt was made to retrovert the uterus with the sound, and recognize its position from the rectum, but it was too tender and not sufficiently movable. There was a case some years ago of a lady whose chastity was impugned, and who vindicated her reputation by dying of an ovarian cyst, so that the diagnosis is by no means always easy. 4. Pregnancy with excess of liquor amnii.—This condition has more than once been mistaken for an ovarian cyst and tapped. In this case, the lower part of the womb was not expanded as in a four to six months’ pregnancy. The cervix was not softened, shortened, nor drawn up. 5. Ectopic Pregnancy.—No single positive sign of preg- nancy. No feetus can be felt with certainty, though the upper part of the tumour struck one as partly solid. The tumour was so large that it would be in an advanced stage, but such a pregnancy may continue for as long as ten months. 6. Missed Abortion.— ) As No. 3. No uterine pains. 7. Missed Miscarriage.—J Ergot was given for a short time without any ecbolic effect being produced. 8. Hydatidiform Mole.—) As No. 3. No evidence of cysts, 9. Cameous Mole.— | etc., in the discharges. Flow not constant; no pains nor amenorrhoea. Tumour not hard enough for No. 9. 10. Pregnancy with placenta preevia.—As No. 3. Os not readily dilatable. 11. —TJtarine Fibromyoma (hard or soft).—A tumour this sizo would almost certainly have caused very much more