Cases of ovariotomy / by Thomas Keith.

  • Thomas Keith
Date:
1863
Catalogue details

Licence: Public Domain Mark

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

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    against the third rib. Relatively to the size of the patient, who was a little spare woman, it was the largest ovarian tumour I had ever seen. She told me that after the tapping, from which she had been led to expect great things, she measured herself with a string, and was disappointed to find that her girth was exactly the same as before. The amount of fluid removed was little more than a gallon; and, though her breathing was at once relieved by the tapping, in three days she was as uncomfortable as before. But after this she first noticed a thickened state of the parts round the opening. This slowly increased till the whole abdominal wall became cedematous, and took on a hard brawny feeling, as if affected with erysipelas. Under these circumstances, favourable now no longer, I was asked to remove the tumour; and, at first sight of her, I must say, that, from the large size which the tumour had attained, from her extreme emaciation, from the unfavourable state of the abdominal wall, and especially from the great displacement of the heart, my impression was, that the time for interference was past, and that the disease should be allowed to run its natural course. But, however anxious I might be at the time not to operate in desperate cases, I found I could not refuse ; for the patient was young, with the prospect of a long life before her, free of suffering, in the event of a favourable issue. She had quite made up her mind, and though she was made fully aware that the chances were against her, she was sanguine and hopeful as to the result. She was again examined by Professor Simpson and other friends, and the important question as to the amount of adhesion was care¬ fully considered. From my previous examinations of the case, I believed that more or less adhesion existed along the upper edge of the tumour about a year before. But now there was distinct evidence of a layer of ascitic fluid, which did not exist even when Professor Simpson first saw her about ten days previously. The wave thrill was most distinct over every part of the abdomen, and this seemed to indicate that the adhesions could not be very extensive. The fact, too, that her girth had remained unaffected by the tapping, appeared to show that the upper part of the tumour had at that time considerably subsided. It was therefore hoped that no diffi¬ culty would be met with in removing the tumour. After remaining quietly in bed for a few days, for the circum¬ stances of the case forbade any farther delay, the operation was performed on the 6th of February. The distance between the umbilicus and pubis being sixteen inches, the tumour was exposed by an incision of nearly that length. The tissues were hard and brawny, and, considering their great distention by the tumour, of great thickness, especially near the pubis. The amount of ascitic fluid was much smaller than previous examination had led one to expect. The hand was at once passed to the left under the ribs, where a large mass of solid matter was known to exist. There,
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