The details of ovariotomy and disputed points in after-treatment / by Alban Doran.

  • Doran, Alban H. G. (Alban Henry Griffiths), 1849-1927
Date:
1897
Catalogue details

Licence: Public Domain Mark

Credit: The details of ovariotomy and disputed points in after-treatment / 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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    wise died in relative peace ; the few reported recoveries of which I have heard seem to mean removal of obstruction caused by adhesions. , With great relief I come to a very practical subject—flatulence. Free passage of flatus from the rectum almost invariably signifies that the patient is not in any danger from any complication. Obstruction is not necessarily the cause of sepsis, as I have seen it absent in the case of diabetes already mentioned. But it makes septic, ursemic, and inflammatory symptoms worse, and when air can be made to pass these symptoms nearly always fall in severity or disappear altogether. Tympanitic distension during the third week or later, with no other unfavorable symptoms, is usually due to accumulation of scybala. Having reviewed the more troublesome complications at some length, I may speak now of their treatment. The ice-cap is always advisable when the temperature keeps at 103° or rises higher; even hopeless septic cases are more comfortable when thus treated. Flatus passes easier when the cooling process brings comfort. In the neuroses—if they be neuroses—in association with metrorrhagia, the ice-cap is beneficial. Of all treatment, however, I say once more that ensuring the passage of flatus is the most imperative. It leads on to a special question — the opening of the bowels. Firstly, nutrient enemata must be continued when flatus fails to pass, as food by the mouth aggravates the symptom, and so does starvation, whilst the enema promotes the passage of flatus and keeps the patient from exhaustion. When these means fail, an injection of over a pint of gruel with 2 drachms of oil of turpentine should be slowly and carefully injected. If scybala come away, so much the better. Twenty minims of Tine. Belladonna may be given in beef-tea enemata every six or eight hours if the flatulence continues. We prefer this method, at the Samaritan Hospital, to Lawson Tait’s saline purgative practice, which we admit is of some value. Coming to the question of opening the bowels, I always find that the simple enema, a few hours after an injection of 4 ounces of oil, is the best agent, and it need not be given till the evening of the sixth day. When, however, the tongue is foul, and distinct evidence of irritation of the gastro-intestinal mucous membrane exists, I find that it is better to give a compound colocynth pill, or 2J grains of the com- pound extract every six hours, till the bowels act. The patient will then be better able to eat. I find that colocynth pills and extract answer better in this respect than castor-oil (which patients dislike), liquorice powder, or saline purgatives. The dressing of the wound at the end of the operation has been described. As a rule it may be left alone for a week. Do not sacrifice, however, the patient’s comfort to that evil principle, 11 Let me boast that I never touch my dressings for a week.” Sweat rashes in some patients give great discomfort, relieved by change of dressings, even on the third or fourth day. A few sutures should be removed on the ninth day; indeed, if there be any that are clearly cutting, they may be taken away on the eighth, as they hinder healing. It is not good, however, to remove all the sutures till the tenth day, or even later, as the cicatrix is very liable to stretch when only a week old. I much prefer to continue the application of strapping for some time after the removal of the sutures, and firm bandaging is needed.
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