Forty cases of ovariotomy / by Thomas Keith.

  • Keith, Thomas, 1827-1895.
Date:
1866
Catalogue details

Licence: Public Domain Mark

Credit: Forty cases of ovariotomy / by Thomas Keith. Source: Wellcome Collection.

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    powerful woman, though now exceedingly emaciated. The tumour was large ; her greatest girth was 47-^- in., and the distance between the ensiform cartilage and pubes was 32 in. The heart and liver were pushed upwards by the tumour, which also hung down over the pubes upon the thighs. The uterus was low in the pelvis; it felt heavy, but was central and movable. She had been a good deal shaken by a long coach journey, and passed a restless night, complaining of general uneasiness in the tumour and pain in the back. In the hope of relieving her, and of giving her some good nights before operation, I tapped her on the 2d of December—a practice I have now frequently followed a few days before the removal of very large tumours with the best results. The tumour was nearly unilocular, and upwards of 49 lbs. of bland albuminous fluid were removed from the largest cyst. Next day she looked and felt quite well, but the pulse was upwards of 100; and on the evening of the second day after the tapping, slight pain on moving was complained of in the left iliac region. She had little inclination for food, suffered greatly from flatulence, was excitable, and did not sleep. On the 6th she had passed a very restless night, and had wandered a good deal. The conjunctive were yellow, and she had a strange wild look • the pulse was 120; the tongue loaded and dry; and there was a dark dis¬ charge from the uterus. The bowels had been freely acted on by medicine, but the urine was scanty and offensive. Still there was no tenderness except over one small spot in the left iliac region; the intestines, however, had become much distended, and the transverse colon felt very large, running along, and apparently attached to the upper margin of the cyst. These symptoms—all too indicative of low cyst inflammation— continued with varying intensity till the morning of the 9th, when it seemed to me, most unpromising though the circumstances were, that the proper practice was to give the patient a chance of life by the removal of the tumour ere the blood should be fatally poisoned. I confess, however, that, on uncovering the abdomen after she was under chloroform, I almost hesitated to proceed, for the intestines were now very much distended. The cyst was exposed midway between the umbilicus and pubes, and as far as the finger reached was unattached. About half a gallon of fluid, which had accumu¬ lated in the cyst since the tapping, was withdrawn, and its gangrenous odour was at once perceived by all who were present. The. aperture made in the cyst was then carefully closed, the incision was enlarged upwards and downwards, and very extensive intestinal adhesion came at once into view. There was no parietal adhesion except over a space the size of the hand, close to the false rib on the left side. This was very firm, and the bleeding from it very troublesome. The adhesions between the different folds of small intestine and to the tumour were of greater extent than I had ever met with before, and embraced the whole of the posterior