Cases of ovariotomy / by Thomas Keith.

  • Thomas Keith
Date:
1866
Catalogue details

Licence: Public Domain Mark

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

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    loin was clear, the left dull; besides, the history was so clearly that of an ovarian tumour that no doubt as to the nature of the case was then entertained. A number of friends were present, and there and then a day was fixed for operation. More careful examination in a day or two distinctly showed that the fluid was free in the peritoneal cavity. Up to four inches above the umbilicus the sound on percussion was always dull, and what at first appeared a hernial protrusion was only fluid forced under the skin on coughing through some weak point in the wall. The uterus was movable, and the roof of the vagina felt high and tense. Still the patient’s statement was so circumstantial as to the presence of a lump, the size of her two hands, in the abdomen at the beginning of her illness, that though no solid tumour could be felt it seemed most likely that one did exist concealed by the ascitic fluid. Dr Matthews Duncan, and Dr Haldane, who now saw her, concurred in this opinion, and the diagnosis written down was, u Case of ascites, with probably an ovarian tumour.” The doubt now entertained was ex¬ plained to the patient, and it was agreed, with her consent, to make a small incision, tap, and remove any tumour if present. On the 6th of March I made an incision an inch and a-half in length, and exposed the peritoneum, which was of a deep leaden colour. Three and a-half gallons of clear yellow serum were with¬ drawn, and the edge of the peritoneum was seen to be studded with small granular transparent bodies. As I was about to introduce a stitch to close the puncture, an irregular looking mass, near the ribs, on the left side, caught my eye, and thinking that, after all, I had to do with a thin-walled adherent cyst, I separated the peritoneum for several inches round, enlarging the wound to about three inches ; then finding I was separating the peritoneum, and not a cyst wall, I enlarged the puncture made by the trocar, and saw that the whole peritoneum was studded with transparent, hard, glassy-looking bodies from the size of a pin head to that of a pea. The mesen¬ tery and intestines were in some places bound together ; the uterus arid ovaries quite healthy, except that their peritoneal covering par¬ took of the general peritoneal disease. After sponging up as much fluid as possible, the wound was closed by three silk sutures, and ten days afterwards the patient left her lodgings, not the slightest bad symptom having followed this little operation. I have unfor¬ tunately lost sight of her, and do not know her address, but I have given her name in case she should at any future time come under the care of any of my Glasgow friends. Case XLIII.—Multilocular Ovarian Tumour. Four times Tapped. Ovariotomy. Death two days after. ^ C. R., aged twenty-five, was sent to me in March 1866 by Dr banders. The tumour had been detected three years ago, and within the last nine months she had been tapped four times. Her girth was forty-two and a-half inches, and the length from the ensi-