Clinical lectures on the diseases of women / delivered in Saint Bartholomew's Hospital by J. Matthews Duncan.

  • James Matthews Duncan
Date:
1889
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Licence: Public Domain Mark

Credit: Clinical lectures on the diseases of women / delivered in Saint Bartholomew's Hospital by J. Matthews Duncan. Source: Wellcome Collection.

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    extremely rare for anything to occur like a bursting of bowel, vagina, or bladder into an abscess-cavity. The passage of liquids and solids into abscess-cavities (or ovarian cysts) from these viscera I have elsewhere discussed (see my work On Perimetritis and Parametritis, p. 167), and I shall here only repeat the utter inapplicability of the valvular theory ascribed to ]3upuytren, and extensively adopted, a theory implying such an opening as permits in most cases only of liquids leaving the abscess, not of anything entering it. This theory cannot be entertained by any one who has seen the actual openings. The existence of communication between replete cavities with- out any active interchange of contents from one to the other, or vice versd, is illustrated in the fcetal heart, in abscesses communi- cating with arteries, and in other cases. I may here mention a remarkable case of ffecal abscess. It occurred in a recently married young woman, who was, imfortu- nately, operated on for sterility while she was actually pregnant. Early abortion took place, and then a journey by railway, and then a common perimetritis. A lump, of the size of an orange, was indistinctly felt behind the horizontal ramus of the right pubic bone; and in this lump I remarked gurgling, produced by hand, and felt on one occasion. The woman got so well that my attendance, which was in consultation, was given up. A few days afterwards, fa?C3s and air were copiously passed per vaginam, and the opening of transmission was easily felt behind the cervix. It soon healed up. After a few days the discharge of forces and air recommenced, and it was again arrested in a few days. The woman had no fever or suffering during these fiecal discharges, and is now quite well. In Martha lately we had a patient with large ovarian cystoma. Extensive inflammatory induration, especially behind tlae cervix uteri, made us delay ovariotomy, which, however, was successfully performed soon after the healing of the f;ecal abscess. This suddenly evacuated itself, and the discharge of pus and ffeces was very large. An aperture behind the cervix easily admitted the f nger. It was soon healed. It is interesting to remark that during ovariotomy and subsequently, careful investiga- tion detected nothing unusual, no trace of the course of this abscess ! Lastly, in an other chapter we mention a f;ecal fistula in con- nection with parametric abscess aud cancer.