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.

    426/468 (page 362)
    1865. Death in that case was caused by slipping of the ligature securing the left broad ligament, and consequent hsemorrhage. From the great success which has attended my practice of division of the pedicle of ovarian tumours by actual cautery, I am led to hope that this frequent cause of death* in the operations we are now considering will be very considerably diminished, and in any future case I shall certainly divide the uterine attachments by this method. Of the differential diagnosis of those tumours, for which we should advise this operation from ovarian tumours, I have treated very fully in my work on Ovarian Dropsy. The steps of the operation, with the exception of the actual cautery, are related in the case now given. Case.—Complete extirpation of the uterus and ovaries, with large fibrous tumours.—A. B,., set. 49, single, was admitted into the London Surgical Home on October 18th, 1864. She was sent to me by Dr. White, of Londonderry, who kindly favoured me with the following history :— Miss B. has a large tumour of nine years' standing. It commenced on the left side, and when first observed was about the size of a goose's egg. For three or four years it made slow progress, and appeared to be kept in check by treatment. When I first examined it, three and a half years since, it ex- tended across the abdomen, and from ribs to pubes, measuring twelve inches in length by ten in breadth, was movable, generally hard, but in some parts soft, yielding, and tabulated. Catamenia regular. For a considerable time it remained stationary, but during the last twelve months has increased much more rapidly. When Dr. White placed the patient under my care, the whole abdomen was filled with a large tumour, regular in its outline, very movable, elastic to the touch, and in parts giving somewhat the feeling of obscure fluctuation. It appeared that the growth during the last few months had been very rapid, Last March she fell down from sudden pain caused by the rolling of the tumour, and since then has been seldom free from suffering. She has had two attacks of peritonitis within a short period, each apparently excited by the rolling of the tumour. Latterly also the catamenia have been profuse, and a discharge of blood from the vagina is now excited by very slight causes, even by mental emotion. The general health has within the last couple of months suffered severely, and she is much wasted, especially about the neck and shoulders. The expression of the face is very anxious and worn. Upon examining the abdomen I found a large tumour, which was very movable ; and deeper down another mass, filling the pelvis, and much more tabulated to the touch than the movable mass. Movements of the one portion did not appear to affect the other. The os uteri was drawn high up in the vagina, and was somewhat difficult to reach, from its situation behind * Of the eighteen unsuccessful cases recorded by Dr. Storer, five died from haemorrhage.