Case of successful double ovariotomy done antiseptically / by James Murphy.

  • James Murphy
Date:
1879
Catalogue details

Licence: Public Domain Mark

Credit: Case of successful double ovariotomy done antiseptically / by James Murphy. 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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    As the case seemed suitable for ovariotomy, I informed the patient and her husband fully of the necessity of the operation, also of its attendant risks, but strongly recommended her to submit to it. To this she readily assented, and I commenced the preparatory treatment at once by ordering her to remain in bed the greater portion of the day, thus to accustom her to the enforced rest which would be necessary after the operation. The pain, which after a little became more decided, was relieved by bromide of ammonium, in half-drachm doses—a medicine that I have often found useful in the treatment of ovarian disease. The vomiting was troublesome and difficult to subdue, but the bromide of ammonium relieved this symptom also to a considerable extent; and a week before the operation, as her urine became scanty, she was put on half-drachm doses of tincture of perchloride of iron and spirit of nitrous ether, which rendered the urine clearer and much more copious. As I failed to convince a medical friend, whose opinion I value highly, that fluctuation existed in the larger tumour, I tapped one of the largest c)’sts in it, and removed a large bowl of clear brown fluid by means of the aspirator. Though the needle I used was no bigger than a duck- quill, and the abdominal wound healed at once, the opening in the cyst failed to do so, and the result was a copious discharge of fluid into the peritoneum, which it so irritated that a considerable amount of ascites was present at the time of operation. The operation was performed on August 15th. The patient was put under the influence of chloroform, which, when properly given, I believe to be less liable to cause sickness than ether; the latter also being very apt to give rise to a troublesome cough, which lasts some days, if not more, and is very distressing and dangerous to a patient after ovari- otomy. I left bichloride of methylene out of the question, as I have no personal experience of it; but from the strong recommendation of Mr. Spencer Wells, I purpose soon to try it. And here I may say that, though I have given chloroform close upon a thousand times, I have very rarely met with sickness where circumstances permitted it to be administered four hours after a light repast; and the more I see of its administration, the more firmly am I convinced that it should be given slowly and gradually, notwithstanding the high authority against this method of administration. The abdomen was opened from the umbilicus to within an inch of the pubes, and a large quantity of ascitic fluid came away over the waterproof sheeting; the latter was that used by Profes- sor Lister for his dressings, which, from its thinness, fits closely and firmly to the abdomen. The peritoneum was then found very red and velvety in parts, caused by the irritation from the fluid which escaped from the cyst. The tumours were removed in the usual manner; the larger had a long pedicle, which was secured by Mr. Wells’s calliper- clamp ; the smaller one, as is usual, was almost sessile, and its pedicle was transfixed and secured by a thin carbolised silk ligature, the ends of which were cut short and returned with the pedicle into the abdo- men. The toilet of the peritoneum was then carefully completed, the
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