On surgical diseases of women / by I. Baker Brown.

  • Isaac Baker Brown
Date:
1866
Catalogue details

Licence: Public Domain Mark

Credit: On surgical diseases of women / by I. Baker Brown. Source: Wellcome Collection.

    319/468 (page 263)
    chloroform, and in the lithotomy position, I seized the os with a pair of vul- sellum forceps, and the vagina being held open with retractors, I brought the polypus into view, and carefully dissected it away from the os and cervix uteri. It wras irregular in shape, and about the size of a twTo-shilling piece. Lint soaked in a strong solution of alum was applied to the os, and the patient placed in bed. One grain of opium to be taken every four hours. 28th. No bleeding, little pain in the abdomen ; the urine is drawn off by catheter. This case progressed favourably without any untoward symptom, and now, after the lapse of some considerable time, no recurrence of the polypus, nor, indeed, of any inconvenience about the uterus, has troubled the patient. This was a case where the base of the polypus was so broad, and the polypus itself so short, that it could not very easily be tied. But many surgeons would have thought the base too broad for excision. Case II.—Polypus, from the fundus uteri, adherent to os and cervix: Re- moval : Subsequent death from disease in the chest.—E. S., set. 45, married ; has had five children. She enjoyed good health until two years ago, when she was admitted into the Middlesex Hospital for some affection of the uterus. Fourteen months ago she applied at St. Mary's for retention of urine, which she had frequently suffered from, and became an out-patient under my care. She had also chronic bronchitis, which added very much to her distress. On making a vaginal examination, I found an enlarged uterus, with the os and cervix very patulous, through which the finger could be easily passed, and discovered a polypus, the size of a small apple, occupying the whole cavity of the uterus. It was, moreover, evident that the pressure of the enlarged uterus on the bladder had pro- duced the suppression of urine. This poor woman had suffered from re- peated attacks of haemorrhage, and her general health was much impaired. A few months after this examination, the polypus gradually protruded out of the uterus, tightly encircled by the os and cervix, giving great pain and suf- fering to the patient. A portion of the polypus, about an inch and a-half in length, was seen projecting from the vulva, of a yellowish colour, surrounded by a margin of fleshy substance, which, on careful examination, was found to be the os uteri extremely dilated, and inseparably adherent around the poly- pus ; and when the patient was placed on her back for examination, it pre- sented exactly the appearance of a distended glans penis projecting from the vagina, and completely filling up the orifice of that cavity. It could, however, be pushed back out of sight, but did not remain so. She was now admitted into Boynton ward December 12th, 1852, the chest was examined, and no disease found except chronic bronchitis. December 29th. She was placed under chloroform, in the lithotomy posi- tion ; the end of the polypus was seized by a pair of vulsellum forceps, and held by an assistant. I proceeded first to make a circular incision around the tumour at the point of juncture with the os uteri,'dividing some of its fibres ; then carefully dissected back the os and cervix, separating their very firm adhesions to the tumour, which extended upwards two inches. Above this the bands of the adhesion were fewer, and easily broken down by the finger. The polypus could now be distinctly felt growing from the fundus of the uterus. Having forcibly pulled out about three inches of the polypus, I passed a needle with a double ligature through its body as high up as possible, and tied a ligature on either side, so as completely to strangle it. I then cut off with a scalpel the portion anterior to the ligature. The operation occupied rather more than an hour. The patient was then removed to bed, had a rigor immediately afterwards, and vomited freely. Some brandy and water was given her, which having subdued the sickness, one grain of opium was taken, and ordered to be repeated every 10111- hours. In the course of the evening