On ovariotomy / by J. Marion Sims.

  • J. Marion Sims
Date:
1873
Catalogue details

Licence: Public Domain Mark

Credit: On ovariotomy / by J. Marion Sims. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

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    hanging out of the vagina and the other passing out of the abdomen at the lower angle of the abdominal incision, and then falling over the pubes. On the fifth day I concluded that the tube was obstructed by a contraction of the punctured opening through which it passed into the vagina, and so determined to enlarge the open- ing. I was greatly surprised to find, when the opening was enlarged by incision bilaterally, that the finger could not pass into the peritoneal cavity, but entered into a dense, inelastic tube of well-organized fibrinous structure which had sur- rounded the drainage-tube for at least two inches. IIow much more it was impossible to determine. This fact, and the experience of the first case, determined me to make the puncture thereafter, not in the lowest part of the cul-de-sac, but as near the cervix uteri as it could be made, and with what result has already been detailed in the history of Dr. Walker's case, in which he so kindly allowed me to make the puncture. This case proves, beyond question, that the proper place to make the puncture is at the lowest point of the Douglas cul- de-sac, just where the rectum and vagina diverge from each other. While I am satisfied on this point, and while I am convinced more than ever that drainage should be made through the cuZ-de-sac, I am not satisfied with the tube d drainage of Chassaignac for the purpose. In Dr. Walker's case I attempted to introduce a self-retaining silver tube through the puncture in the cul-de-sac, but failed on account of the unfitness of the mechanical contrivances at hand at the time. If I had succeeded, I think our patient might have stood some chance of recovery, because the little tube would ' not in the least have disturbed the easy and natural relations of the boundaries of the cul-de-sac / whereas, with the Chas- saignac tube, as already explained, the uterus was elevated and lifted up toward the abdominal incision, thus alio wing- four and a half or five ounces of reddish serum to settle down into the pouch below the level of outlet by the drainage-tube. With the silver tube unattached by any contrivance above, the uterus would naturally have gravitated to the level of the lowest point of the cul-de-sac, and then the drainage might have been complete.