Twenty-six cases in which an abdominal section has been performed a second time / by John D. Malcolm.

  • Malcolm, John David.
Date:
[1897]
Catalogue details

Licence: Public Domain Mark

Credit: Twenty-six cases in which an abdominal section has been performed a second time / by John D. Malcolm. 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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    convalescence, although, she was in a position of extreme danger for weeks on account of her debility and the state of her lungs. The cervix came completely away as a slough during the fourth week of convalescence, and for a time there was a free opening between the vagina and the anterior wound. Convalescence was slow but complete. I saw the patient on October 5th, 1896, when her wound was quite healed, she was free from pain and had put on much flesh. Microscopically the tumour was a round- celled sarcoma. In it there was a cavity containing about half a pint of fluid. Probably the canal of the uterus had closed on account of the application of caustics, and a considerable retention cyst had foi-med. (In the spring of 1897 this patient was successfully operated on by another surgeon for acute obstruction of the intestine.) Group III.—In the remaining cases the second opei'ation was performed on account of some complication resulting from the first opei’ation, or arising dui’ing convalescence. In this group I did both operations in six cases. In the other seven I did the second operations only, Pive of the patients died. The first three cases in this group indicate three forms of bowel difficulty which may arise after an abdominal section. Case No. 14.* In this case the patient, when I first saw her, was 46 years of age, and had been under treatment for uterine tumours in America for 11 years. Amongst other methods Apostoli’s had been applied twice a week for 12 months, and the patient asserted that this had made her worse rather than better. She had constant and increasing pain, which was more severe at her monthly pei’iods. I was at first inclined to take the view which had pi’obably been taken by others, namely, that an opera- tion for the removal of the gi’owths was unjustifiable when the patient might shortly hope for relief by passing through the change of life. After keeping her under observation for about six months, however, I came to the conclusion that she really did suffer sufficiently to justify immediate sui’gical interference, and, on opening the abdomen, I found that there was in each iliac region a very hard oval tumour about the size of an orange attached to the top of the uterus by a pedicle about an inch and a half long and as thick as an ordinary cedar pencil. These growths were almost devoid of blood supply, and had undergone
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